Coronary Heart #6 US

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May / June 2007Issue 6

DES: Are You Concerned?

St Joseph, PA, USASouthampton, UK

••

LATEST NEWS,EDUCATION

+ more...

EMP

LO

YMENT

MMPP

LLOOMM

PPLLO

Carol Mascioli - Baptist Hospital, FL

Special Feature

“The World’s Fastest

Growing Cardiac

Magazine!!”

Management Interview

USACanadaEdition

Site Visits

Pacemaker Anatomy - Step-by-stepEducation

September 5-8, 2007 New Orleans

FIRST IN THE FALL

A MultidiSciplinARy confeRence

Cardiovascular & Endovascular Professionals, Interventionalists, RNs,

Cath Lab Techs and Venous Specialists

for

New Orleans New Orleans

Julio Palmaz, MD ~ Edward Diethrich, MD ~ Thomas Fogarty, MD ~ Mark Wholey, MD ~ Jay Yadav, MDJohn Simpson, MD ~ Zvonimir Krajcer, MD ~ Lynne Jones, RN, RCIS ~ Thomas Malony, MS, RIC

Kenneth Gorski, RN, RCIS ~ Chris Nelson, RN, RCIS, FSICP ~ David Katz, MDMarsha Holton, RN, RCIS ~ Chris J. Hebert RT(R), RCIS ~ Gary Chaisson, RT(R), R-CVT

(tentative NCVH faculty)

David E. Allie, MD & Craig M. Walker, MDConference Co-Chairmen

pReviouS AwARd RecipientS:2006 ~ Michael E. DeBakey, MD2005 ~ John B. Simpson, MD, PhD2004 ~ Thomas J. Fogarty, MD2003 ~ Martin B. Leon, MD2002 ~ Edward B. Diethrich, MD2001 ~ Julio C. Palmaz, MD

2007New Cardiovascular HorizonsAchievement Award Recipient

Earl E. Bakken

SICP & ACVP’s Review Courses~ SICP’s Review Courses for RCIS Exam

Wednesday, September 5- Friday September 7, 1-5:30 pm

~ ACVP’s Basic Cardiovascular Science ExamWednesday, September 5, 1-4 pm

~ ACVP’s CCT Exam ReviewThursday, September 6, 1-4 pm

~ 3rd International Multidisciplinary CLI Summit~ Multiple Live Cases From CIS~ SCCT Sponsored PV-CTA Symposium~ 2nd Global Endovenous DVT Symposium~ Horizons Cath Lab Professionals Symposium~ SICP & ACVP Members Receive $50 Discount* (*Discount includes full conference registration & review course)

Live Cases

Call For

AbstractsLive Cases

Call For

Abstracts

ConFEREnCE HIGHLIGHTS

Breakthrough PeriPheral interventional, CritiCal limB isChemia,endovasCular and CardiovasCular toPiCs

Presented By 125+ emininent FaCulty inCluding:

Register Today! www.newcvhorizons.com or (337) 261-0944

September 5-8, 2007 New Orleans

FIRST IN THE FALL

A MultidiSciplinARy confeRence

Cardiovascular & Endovascular Professionals, Interventionalists, RNs,

Cath Lab Techs and Venous Specialists

for

Julio Palmaz, MD ~ Edward Diethrich, MD ~ Thomas Fogarty, MD ~ Mark Wholey, MD ~ Jay Yadav, MDJohn Simpson, MD ~ Zvonimir Krajcer, MD ~ Lynne Jones, RN, RCIS ~ Thomas Malony, MS, RIC

Kenneth Gorski, RN, RCIS ~ Chris Nelson, RN, RCIS, FSICP ~ David Katz, MDMarsha Holton, RN, RCIS ~ Chris J. Hebert RT(R), RCIS ~ Gary Chaisson, RT(R), R-CVT

(tentative NCVH faculty)

David E. Allie, MD & Craig M. Walker, MDConference Co-Chairmen

pReviouS AwARd RecipientS:2006 ~ Michael E. DeBakey, MD2005 ~ John B. Simpson, MD, PhD2004 ~ Thomas J. Fogarty, MD2003 ~ Martin B. Leon, MD2002 ~ Edward B. Diethrich, MD2001 ~ Julio C. Palmaz, MD

2007New Cardiovascular HorizonsAchievement Award Recipient

Earl E. Bakken

SICP & ACVP’s Review Courses~ SICP’s Review Courses for RCIS Exam

Wednesday, September 5- Friday September 7, 1-5:30 pm

~ ACVP’s Basic Cardiovascular Science ExamWednesday, September 5, 1-4 pm

~ ACVP’s CCT Exam ReviewThursday, September 6, 1-4 pm

~ 3rd International Multidisciplinary CLI Summit~ Multiple Live Cases From CIS~ SCCT Sponsored PV-CTA Symposium~ 2nd Global Endovenous DVT Symposium~ Horizons Cath Lab Professionals Symposium~ SICP & ACVP Members Receive $50 Discount* (*Discount includes full conference registration & review course)

Live Cases

Call For

Abstracts

ConFEREnCE HIGHLIGHTS

Breakthrough PeriPheral interventional, CritiCal limB isChemia,endovasCular and CardiovasCular toPiCs

Presented By 125+ emininent FaCulty inCluding:

Register Today! www.newcvhorizons.com or (337) 261-0944

CONTENTSMay / June 2007

ContentsCORONARYHEART

CORONARY HEART ™ 3

04 Welcome Editorial

05 Latest News

08 Future

10 Product Focus‘TOSHIBA - Leading Innovation in Australia’

12 Special Feature‘DES - Should Hospitals be Concerned’

15 Product Focus‘BIOTRONIK - Telemedicine’

16 Management‘Customer Satisfaction’

18 Interview‘Carol Mascioli - Baptist Heart & Vascular Institute’

22 Competition 1‘Win a Site Visit’

23 Site Visit (USA)‘St Joseph Medical Center, Reading, PA

28 Site Visit (UK)‘Southampton General Hospital, UK’

31 CRM Education‘Pacemaker Implant Anatomy - Step-by-Step’

37 Competition 2‘Win 12-Lead ECG Course’

38 Case Study‘Extra-Adrenal Paraganglioma’

39 SICP Update‘CARE Bill’

40 Cath Lab Hot Tips

41 Problem Solving Answer‘From Page 11’

04 Welcome Editorial

THIS EDITION

42 Conferences & Meetings

43 Conference Review‘ACVP Leadership’

44 ACVP Overview

46 Employment

Managers Nurses Radiologic Technologists Cardiovascular Technologists RCIS Echo

Page: 18

Interview: Carol Mascioli

Page: 23

Site Visit: St Joseph Medical Center

Welcome EditorialEDITORIAL

It was over a month ago, but visiting New Orleans for the ACC conference almost seems like yesterday. It is diffi cult to know

what to expect when you fl y in down there after hearing all the news reports of violence and looting. I must admit, although I have travelled extensively internationally, I was a little apprehensive.

With the loss of a signifi cant portion of their population, the city is defi nitely quiet, and like all cities there are places you shouldn’t go alone, especially after dark. However wander down Bourbon Street and you realise that life is returning to normal. Th e legendary street party is still alive, although slightly less crowded, making it easier to play the “Spot the Cardiologist” game. Th e famous southern hospitality also remains with everybody from hotel staff through to the waiters in the crowded restaurants all so helpful and grateful for your support. Safety is not a problem. Transport is great. And the seafood is to die for.

Th e damage still exists in some suburban areas (see page 43) however it is inspiring to see students and visitors from around the world chipping in to help rebuild a severely damaged city. In Australia we call this mateship, demonstrating friendship, loyalty, and equality to all people for the mutual benefi t of society. By attending conferences and supporting the New Orleans community the entire world can be apart of this redevelopment. For this reason we will be heading back to New Orleans in September for the New Cardiovascular Horizons conference, and I certainly hope you can make it. You will sure to have a good time!!

Disclaimer:Coronary Heart should never be regarded as an authoritative peer reviewed medical journal. Coronary Heart has been designed as a guide only, to inform readers who work in the cardiology environment about latest news stories and the diff erent techniques used by others around the world. Whilst all care is taken in reviewing articles obtained from various companies and contributors, it is not possible to confi rm the accuracy of all statements. Th erefore it is the reader’s responsibility that any advice provided in this publication should be carefully checked themselves, by either contacting the companies involved or speaking to those with skills in the specifi c area. Readers should always re check claims made in this publication before employing them in their own work environment. Opinions expressed by contributors are their own and not necessarily those of their institution, Coronary Heart Publishing Ltd or the editorial staff .

Coronary Heart Publishing Ltd145 - 157 St John Street

London, EC1V 4PYUnited Kingdom

Phone: +44 (0) 207 788 7967Fax: +44 (0) 207 160 9334

Visit us online at www.coronaryheart.com

Director / Chief EditorTim Larner

Clinical EditorDr Rodney Foale

Consulting EditorsDr Richard Edwards

Ms Voncile Hilson-MorrowMr Ian WrightMr Stuart Allen

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CIRCULATION

USA / Canada Edition7857 Cardiac Professionals

Copyright 2006 by Coronary Heart Publishing Ltd. All rights reserved.

Material may only be reproduced by prior arrangement and with due acknowledgment of

Coronary Heart Publishing.Th e publication of an advertisement or product

review does not imply that a product is recommended by Coronary Heart Publishing Ltd.

Subscribe Online to get your own

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Tim LarnerDirector

TimClinical Editor

Dr Rodney Foale, FRCP. FACC. FESC. FCSANZ.Clinical Director, Surgery, Cardiovascular Sciences and Critical Care. SMHT.

COVER PHOTO: Preparing for an LV injection in one of their new cath labs at Southampton General Hospital, United Kingdom.

4 CORONARY HEART ™

LATEST NEWS

Latest NewsGE wins CT Award at ACC

At the recent 56th Annual Scientifi c Session of the American College of Cardiology

(ACC) meeting in New Orleans, global growth consulting company, Frost & Sullivan, presented GE Healthcare with the 2006 North American Market Leadership Award in CT for its continuing leadership in CT in North America.

“GE Healthcare has set the pace in CT technology with a performance unmatched by its competitors,” said Frost & Sullivan industry research analyst Nadim Daher.

Launched four years ago, the Lightspeed VCT has recently gained a sister scanner called the Lightspeed VCT XT. We spoke with Erin Lange, the General Manager of GE Healthcare’s Americas Cardiology

Marketing division at ACC discussing the main advantages of the XT version which helped it win the award.

SnapShot Pulse™ Technology

Th is is a new technology that ensures that the X-ray is only on for portions of a scan, automatically responding to the patients heart rate. Th is process, called prospective triggered gating, signifi cantly reduces a patient’s X-ray exposure time.Benefi t: Up to 70% dose reduction.

Gantry Rotation

Th is technology allows the Lightspeed VCT XT to track a patient’s heart rate real-

time moving the table when needed.Benefi t: High quality images & low dose.

Volume Shuttle™

Th is technology addresses the need for wide coverage for both dynamic angiography and perfusion in a single scan to enable whole organ anatomical and physiological assessment. Benefi t: Doubles the coverage width of the anatomy without increasing dose relative to a single axial acquisition with a single contrast injection.

Visit www.gehealthcare.com for more information.

Philips Brilliance Cardiac CT Reduces Dose

Philips proudly displayed a new technological innovation at

ACC for their Brilliance 64-slice CT. Called Step & Shoot Cardiac, it is claimed to reduce patient dose with better clarity in a shorter breath hold, aiding in patient comfort. Th e Wisconsin Heart Hospital found that the Step & Shoot Cardiac feature delivered an 80-percent dose reduction versus retrospective helical CT angiography techniques.

Visit www.medical.philips.com for more information

CARDIAC CT

VCT XT to track a patient’s heart rate real-


Image Courtesy GE Healthcare

Latest NewsLATEST NEWS

PCI + Therapy Fails to Reduce Deaths

Probably the most important and controversial study to come out of the ACC which hit the

headlines internationally were results from Th e Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial.

Th e results showed that percutaneous coronary interventions (PCI) combined with Optimal Medical Th erapy (OMT) was no more eff ective than OMT alone in preventing heart attacks and other cardiac events among patients with coronary artery disease. It has been conventional wisdom internationally that PCI used together with OMT is superior to using OMT alone, however this study has proved otherwise.

Th e trial enrolled 2,287 patients at 50 hospitals in the United States and Canada, randomizing them to one of two study arms: PCI and OMT together or OMT alone. Enrolled

patients suff ered from chronic chest pain (angina pectoris) and had at least a 70 percent blockage of one or more coronary arteries.

Both groups of patients received OMT, which includes guideline-driven intensive treatment with medicines such as aspirin, statins, anti-platelets, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers, as well as lifestyle programs such as smoking cessation, exercise and weight control and nutrition counselling.

Th e majority of the patients in the study were men (85%) and had experienced chest pain for about two years. Th ey also had several risk factors for heart disease.

Patients in the study group underwent PCI to clear the aff ected artery or arteries, with investigators following patients for two-and-a-half to seven years, with a primary endpoint of a death or a non-fatal heart attack.

Results of the study showed a similar rate of death, heart attack or stroke. Th ere were 211 primary events in

the PCI group and 202 events in the medical therapy group. Th e 4.6-year cumulative primary rates of death or non-fatal heart attack were 19.0 percent and 18.5 percent in the PCI and medical therapy groups, respectively.

Hospitalization rates for acute coronary syndrome were similar for both groups as well, at 12.4 percent and 11.8 percent, respectively. Th ere was no statistically signifi cant diff erence between the rates of heart attack: 13.2 percent in PCI plus OMT patients and 12.3 percent among OMT alone.

Th ese fi ndings, along with data from recent studies of more than 5,000 patients combined, show that PCI has no impact on reducing major cardiovascular events.”

So does this study mean that physicians should stop using PCI to treat Coronary Heart disease? Not really. Although having a PCI may not make you live longer or reduce your chance of a heart attack, the major benefi t for the PCI group was less angina, therefore improving symptoms and quality of life.

WinMed Steerable Guidewire

We found this new product at ACC released by WinMed Inc.

and thought it was great. Th e VariSoft is a user controllable, steerable wire, with a tapered tip. With a diameter of .014” and a tapered tip of 0.010” it is being marketed as “the only guide wire your laboratory will require for coronary interventional procedures”.

It works by the physician retracting a restraining core wire which is attached to the smooth ball welded tip of

VariSoft which extends down the central axis of VariSoft to the proximal handle, all achieved with one hand operation. It is likened to pulling on a guy wire.

Th e VariSoft has exchange wire capability, and because it utilises a central core attached to a small tip it is useful for crossing tight lesions. Need to access a side branch once through? Simply pull back on the wire to create the curve and your done. Th e wire also conforms to its original shape. So no more trashed wires.

Visit their website for a more detailed description and videos at www.winmed-inc.com

CATH LAB

CAUTION: Some products within this magazine may be restricted to specific regional usage, and may not

be available in your region. Always check with the manufacturer to determine availability.

VariSoft Wire Straight

VariSoft Wire Retracted


Latest NewsLATEST NEWS

Boston’s 2-Year Report from TAXUS V ISR Trial

Boston Scientifi c Corporation recently announced at the ACC meeting in New Orleans

the two-year results from the TAXUS V In-Stent Restenosis (ISR) trial. Th ey demonstrated that the TAXUS® Express2™ paclitaxel-eluting coronary stent system met its primary endpoint in the treatment of in-stent restenosis, compared to vascular brachytherapy.

What is Vascular Brachytherapy?

Th e placement of small radioactive pellets inside the vessel to treat in-stent restensosis. It is the only currently approved treatment.

Bare-metal stent restenosis occurs in roughly 25 percent of patients and is a diffi cult condition to treat and can

result in adverse events.

Th e study showed that compared with brachytherapy, the TAXUS Stent signifi cantly reduced the overall rate of TVR at two years from 27.5 percent to 18.1 percent and the overall target lesion revascularization (TLR) rate from 21.6 percent to 10.1 percent.

Th e study also demonstrated a 19.7 percent rate of Major Adverse Cardiac Events (MACE) for the TAXUS Stent group, compared to 29.5 percent for the control group. Rates of cardiac death or myocardial infarction (MI) were lower in the TAXUS Stent group at 4.7 percent, compared to the brachtherapy group at 7.5 percent. Rates of target vessel thrombosis were also lower in the TAXUS Stent group at 2.7 percent, compared to the brachtherapy group at 3.8 percent.

Please note that the TAXUS® Express2™ paclitaxel-eluting stent system is not approved for marketing in the United States for use in treating in-stent restenosis and for this indication is limited by Federal Law to investigational use only.

Visit www.bostonscientifi c.com for more information.

Medtronic Endeavor III Two-Year Results

Whilst still not approved for use in the USA, over here in the

UK we have been lucky enough to have been using the Endeavor stent for a while now, and with the two year results from the Endeavor III Trial released at ACC the fi ndings are promising for an eventual release across the Atlantic.

Th e two year results comprise of a

follow-up of 1300 patients with the Next-Generation Endeavor Drug-Eluting Stent. It showed no reported cases of late stent thrombosis using the independent, pre-specifi ed clinical trial protocol defi nitions for thrombosis.

Scott Ward, senior vice president at Medtronic and president of the Vascular business, added: “Patients have been 99.7% free from overall stent thrombosis and we’ve seen no late stent thrombosis in our pooled clinical trials. In addition, Endeavor has demonstrated a sustained reduction in repeat procedures of 61% compared to the Medtronic Driver® bare metal stent

and Endeavor’s death/MI rates have been trending lower than bare metal stents.”

Th e Endeavor stent is made of a cobalt alloy and has a unique modular architecture designed to enhance deliverability over standard bare metal stents. In addition to the proprietary drug compound Zotarolimus, the Endeavor stent is coated with phosphorylcholine (PC), a polymer designed to simulate the outside surface of a red blood cell and mimic the structure of the natural cell membrane.

Visit www.medtronic.com for more information.

CATH LAB

TAXUS Express2™ Drug Eluting StentImage Courtesy Boston Scientifi c Corporation


FUTURE

Cardiology Advances


Toshiba’s Next Revolution: 256-slice CT

Only the second shipped outside of Japan, John Hopkins Medicine located

in Maryland, has recently installed for testing and clinical evaluation, the fi rst 256-slice CT in the USA. Th e Aquilion beta 256 made by Toshiba

weighs in at a hefty 2 metric tons and is expected to be available for general clinical use by the end of the year.

Th e key technological advantage

of the 256-CT is that it can cover in a single scan four times the area of a 64-slice CT, which is currently the technology for cardiac CT internationally. Th erefore a single rotation of the device’s X-ray-emitting gantry can image a diameter of 12.8 cm (or 5 inches), compared with 3.2cm from a conventional 64-CT. So the overall time required for testing the heart will decline to 1 or 2 seconds with the 256-CT, from eight to 10 seconds with the 64-CT.

Th e advantages are clear. It will be possible to scan patients with arrhythmias, as a full image can be taken within one heart beat. Also patients will be exposed to far less radiation, as little as one-eighth to one-third of the dose required in testing with the 64-slice scanner.

Gantry cooling systems to deal with the friction and heat caused by multiple rotations of the gantry will also no longer be necessary, however will

remain for the computer hardware. Each scan produces 5 to 10 GB of data compared with 1 to 2.5GB with 64-CT.

One of the main hurdles Toshiba overcame with designing this system was from cone beam artifact due to the increased cone angle. Th e mathematical brains modifi ed a conventional algorithm to produce a high quality reconstruction algorithm that eff ectively eliminates this artifact.

Th is technology is a major breakthrough in cardiac imaging, allowing us to visualise anatomy in more detail than ever seen before. Toshiba has seen a meteoric rise in the United States CT market being awarded the 2006 Frost & Sullivan Market Penetration Leadership Award in February 2007, capturing 19% of market revenues in 2005.

Visit www.medical.toshiba.com for more information

256-slice CTImage Courtesy JHM


Detect Heart Attacks in the Making

Scientists at New York’s Mount Sinai Medical Center and the

New York University School of Medicine have developed a contrast agent that improves cholesterol detection by 79 percent. Th e newly developed synthetic molecule delivers an imaging enhancer to cholesterol-fi lled cells embedded in the arterial walls. Th is enhancer makes the plaque appear bright when viewed under MRI.

Th erefore physicians are now able to assess cholesterol build-up from the amount of infl ammation in the

arterial wall. Th is technique will also be useful for determining the eff ect of cholesterol lowering drugs post therapy.

At present the studies have only been carried out on animals so more studies need to occur with humans before it is used in a clinical setting. Th e signs are promising though for this new agent.

Source: American Chemical Society

Credit: Courtesy of David Cormode

New Plastics to Assist PCI

A new group of plastics have been developed that release Nitric Oxide (NO). Th e molecule has

been found to infl uence body functions such as dilating blood vessels for long periods.

So far the experiments have only been undertaken on lab rats, however after balloon angioplasty the NO releasing agent reduced formation of scar tissue in the artery. Th e possible applications for this technology extend to new generations of stents and new techniques for bypass surgery.

Th is article was included in the April 4 issue of the Journal of the American Chemical Society.

FUTURE

Cardiology Advances (cont...)


Abbott’s Bioabsorbable DES Latest Results

Abbott recently announced at the 56th Annual American College of Cardiology Scientifi c Session

in New Orleans, the six month results from ABSORB, a trial evaluating the overall safety and performance of a fully bioabsorbable drug-eluting stent platform for the treatment of coronary artery disease.

Although only 30 patients have participated in the trial so far, the results are promising, demonstrating

no stent thrombosis and a low (3.3 percent) hierarchical rate of ischemia-driven Major Adverse Cardiac Events (MACE), such as heart attack or repeat intervention.

“Early results at one and six months indicate that the BVS stent is safe, eff ective and easy to deploy,” said Patrick Serruys, M.D., of the Erasmus Medical Center and lead author of the study. “We will continue to follow these patients to determine the long-term safety and performance of the stent, and if it eliminates any of the issues associated with metal stents.”

Abbott’s everolimus-eluting bioabsorbable stent is made of polylactic acid, a proven biocompatible material that is commonly used in

medical implants such as dissolvable sutures. As with a metallic stent, the bioabsorbable stent is designed to restore blood fl ow by propping the vessel open, providing support until the blood vessel heals. Unlike a metallic stent, a bioabsorbable stent is designed to be slowly metabolized by the body and completely absorbed over time.

Robotics is advancing along rapidly. You only have to look at Honda’s ASIMO to

see just how far we have advanced in creating a humanoid. However across the Atlantic the French have designed a robotic ultrasound system that will change the way we perform examinations forever.

Th e Robosoft Estele is described as a tele-operated robotic system allowing any expert clinician to perform remotely echographic diagnosis as if he were “on-site”. All you need to do is have any medical assistant hold the system on the patient, whilst the physician or ultrasonographer remotely controls the probe.

Th e probe holder robot can be moved in a 4 degree axis and contains a contact pressure control. Th ere is also a bidirectional visio-conferencingsystem allowing the operator, assistant, and patient to see and communicate for

holding the breath and for moving.

Th e Estele weighs in at less than 3kg and is completely noiseless. It is also compatible with most probe brands and sizes, and is connected by a simple attachment.

So what kind of circumstances would you use this technology for? Th e most obvious application is with patients who live in remote regions away from expert clinicians. Th is would be perfect in African countries whereby it would be possible for a echocardiographer in the USA to perform an examination on a patient in Ethiopia.

Th e system is actually already installed in 4 sites including Tours Hospital (Central France) and in surrounding healthcare centers. And according to the manufacturers it is available around the world.

Visit www.robosoft.fr for more information

Robotic Echocardiography Coming Soon

Abbott’s

So what kind of circumstances would you use this technology for?


Image Courtesy Abbott

Image Courtesy Robosoft

PRODUCT FOCUS


Toshiba Infi nix CFi System Installed with Monash Heart

Toshiba has installed its latest Infi nix CFi Single Plane Angiographic System at

Monash Medical Centre in Melbourne.

Monash Medical Centre Clayton is one of the State’s major teaching and referral hospitals, and is the largest within Southern Health providing specialist care to the State’s south-east. With cardiovascular disease still the biggest killer of Australians, the success of Cardiology is vital for the community that Southern Health services.

Th e Cardiology Department at Monash, now known as ‘Monash Heart,’ includes two cardiac catheterization laboratories for which the new Infi nix CFi provides the very latest technology for all the forms of diagnostic and interventional work performed. Nurse Unit Manager Mr John Koutsoubos said that “since

starting with the new Toshiba system we have realized improvements in work effi ciency and patient comfort”.

Th e Infi nix CFi incorporates Toshiba’s latest generation of fl oor mounted C-Arm which has a very unique 5-Axis pivoting arm providing extraordinary patient coverage and C-Arm parking capability. What this means is that patient’s can be quickly positioned and

the C-Arm takes over manoeuvring to the most demanding and tight angulations. No table movement is necessary to obtain head-to-toe and fi ngertip-to-fi ngertip coverage. Better patient access for physicians and nurses improves patient care and comfort.

Table-side control of the Infi nix further adds to examination effi ciency and reduces radiation exposure time and image review. Cardiologists Dr Yuvi Malaiapan, Dr Paul Antonis and Professor Ian Meredith routinely utilize the programmable ‘Hyperhandle’ to access C-Arm auto positioning, select frame rates, optimize dose control and review patient runs together with previous cases or images from other modalities.

Th e Flat Panel Detector provides 20 x 20cm fi eld of view and the detector always maintains ‘heads up display’. Th e smaller than usual detector housing also allows closer proximity to the patient with steeper angles helping to improve radiographic technique and patient comfort.

ADVERTISEMENT

The Monash Medical Centre Cath Lab Staff

From Australia / New Zealand Edition

PRODUCT FOCUS


A key benefi t to the department has been the Toshiba advanced Image processing system which provides a full multi-tasking interface standard on Toshiba’s range of Infi nix Systems. Jackie Yu, Senior Radiographer in the Catheterization Laboratory says ”I can access patient data from various sources for display, manage cases for recording on CD or DVD and utilize measurement packages all at the same

time the Cardiologist is acquiring runs! Th ere is no wait time and this has made a tremendous diff erence to the workfl ow in our lab.”

One of the remarkable achievements at the time the Infi nix was installed was the speed with which the Laboratory was built, from scratch, for the 2006 TCT meeting and had to be ready in

time for Professor Meredith to use for live transmission to the workshops being held at TCT in Washington. Th e Laboratory was installed just in time, and after literally a hand full of patients examined, a successful transmission with live images, data and audio was carried out.

A key consideration for Monash was the fl exibility of Fluoroscopy for Intervention or EP. Toshiba’s Infi nix has standard 1 to 30 pulses/sec fl uoroscopy

with recording direct to hard disc for up to 90 seconds storage per run with full 1024² ready to use for with a validated measurement package. Pulse rates can be tailored to each Doctor protocol and can to be changed on the fl y.

Special Th anks to John Koutsoubos, Nurse Unit Manager and Jackie Yu, Senior Radiographer for their assistance with this article.

Professor Meredith

Drug Eluting Stents; Should Hospitals be Concerned?

SPECIAL FEATURE


(1) “Drug Eluting Stents may carry a greater risk of thrombosis than their bare metal counterparts, according to research presented at the 2006 World Congress of Cardiology (WCC)”! (2). “Recent studies increase concern among researchers about potential for dangerous blood clots in individuals with drug eluting stents, what does this mean for patients? (ptca.org)” (3). “Serious clinical implications that might be unreported”, (Th eheart.org, Heartwire). (4). “New information suggests long term problems, (About: Heart Disease, January 2007)”.

Do these headlines sound familiar? Th ey should, they have been saturated all over

the internet, local and national news and newspapers. Th e general public hears words like, “death”, ‘increased concern”, “problems”, “dangerous”, myocardial infarction”, and “late-stent thrombosis”. Th ey are then given small specifi c pieces of information that require them to interpret, dependant on their knowledge or lack thereof in regards to cardiovascular diseases and their treatments. Can they decipher the complicated clinical aspects of the cardiovascular system and its intricacies? It’s diffi cult enough, at times, for those of us who are trained medical professionals and intimately involved in the science and studies of this fi eld. A little information can sometimes go a long ways, was the public given enough?

What is/are the concern(s)?

In this case, it’s “late stent thrombosis”. In March of 2006, during the American College of Cardiology (ACC) conference held in Chicago, Illinois, the results of the “BASKET-LATE” trial were released. Th e published fi ndings found that, “patients who receive drug eluting stents (DES) are two to three times more likely to have late-stent thrombosis than patients who have bare metal stents (BMS). While the diff erences between the two groups’ rates of stent thrombosis (0.8% v. 1.4% for BMS and DES, respectively) and thrombosis-related events (1.3% v. 2.6%) were not signifi cant, researchers contend that there is nevertheless “cause for concern” because the events occurred up to one year after antiplatlet

therapy was discontinued and because “the consequences (of thrombosis) are dire.”

What do we know about stent thrombosis? It is evident that stent thrombosis can be fatal. It is implicated as a life threatening condition. Stent thrombosis usually occurs within the fi rst twenty four hours. A condition or complication known as “subacute thrombosis (SAT)” occurs between 24 hours and 30 days. SAT’s are usually fi brogenic in nature. SAT’s should not be confused with in-stent restenosis. Late-stent thrombosis, by debated defi nition, can be at one year and beyond. “Cardiovascular Watch” explains Late-Stent Th rombosis (LST) as occurring “during an average follow-up of 1.5 years”. Th is time

The Drug Eluting Stent Controversy - Are you concerned?

FLASH! HEADLINES! BREAKING NEWS!

Written by: Dennis Holloway, MBA, BA, CVT Director Diagnostic CV Services, Sarasota Memorial Hospital, Sarasota, Florida

SPECIAL FEATURE

Drug Eluting Stents (cont...)


period is reasonable since drug eluting stents were fi rst FDA approved in April of 2003. Although post FDA approval has been over 3 years, the initial market volume was far less than expected with cath lab usage rates generally around 40% to 50% of total stent implants for the fi rst year.

What are the factors for Stent Th rombosis?

Single vessel multiple stentsLength of stentsGrade of blood fl owVessel sizeLVEFApposition of stentMedication compliancyBifurcation lesionsDiabetesRenal failurePremature antiplatelet discontinuationEndothealization

Less than 1% of patients who receive a drug eluting stent develop late-stent thrombosis during the fi rst 1.5 years, stopping aspirin is an “absolute contraindication”.

Other factors that inhibit late-stent thrombosis are:

Patient non-compliance of prescribed medications (i.e. Aspirin, Plavix or other antiplatelet medication)Patients that are Aspirin resistant.Platelet build up after discontinuation of Aspirin or Plavix or the combination thereof.Antiplatelet therapy not long enough (this is an on-going debated topic)Off label use of drug eluting stents. (According to the “U.S. Food and Drug Administration (FDA), September 14, 2006”,

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Th e CYPHER Sirolimus-eluting Coronary Stent is indicated for improving coronary luminal diameter in patents with symptomatic ischemic disease due to discrete de novo lesions of length ≤ 30 mm in native coronary arteries with reference vessel diameter of ≥ 2.5 mm to ≤ 3.5 mm. Th e TAXUS Express Paclitaxel-Eluting Coronary Stent System is indicated for improving luminal diameter for treatment of de novo lesions ≤ 28 mm in length in native coronary arteries ≥ 2.5 to ≤ 3.75 mm in diameter.”)

Is Stent Th rombosis a concern for hospitals?

When the headlines fi rst came out from the “Th e Advisory Board, Daily Briefi ng”, “Cardiovascular Watch”, questions arose from administrations all over. What does this mean? Do we stop using drug stents and go back to bare metal? Understandably the initial concern is liability, patient safety, possible need for a policy or procedural change, do we discontinue the use of drug eluting stents? As a result of all the publicity, physicians, nurses, Tech’s and other medical professionals who work with these devices everyday are now having to be more in tune with studies and research. Th ey become the clinical consultants for the hospital, patients and patient’s families in answering the questions that may arise. I recall when the advisory was published; I received an E mail from administration wanting to know if we will be going back to bare metal stents. My response was a White Paper presented to them, explaining this phenomena and what its potential could mean to our facility. We must remember, when presenting clinical data in this type of forum, not all present will poses clinical backgrounds or experience, therefore, the information needs to be

somewhat basic in nature, and at the same time, explicit enough to satisfy all questions or concerns. What would your response be? How would you answer these valid concerns? As with everything, customize yourself to the situation. I decided to present my fi ndings to all of administration (i.e. CEO, CFO, COO, CNO, VP’s, etc). Th is aff orded me the opportunity to inform everyone at one time.

Th e initial question posed was, “do we quit using drug stents? My answer, no, absolutely not. Why? Drug Eluting stents are safe and eff ective (this is also the response from the FDA in their article written on September 14, 2006) and are superior to bare metal stents (in my opinion). Th e average rate for in-stent restenosis in a BMS was about 30%. Th is rate would increase dependant upon how many stents were placed (i.e. full metal jacket), size of the lumen, TIMI grade fl ow, bifurcations, and diabetics. Th ese are the major causes, there may well be other clinical factors presented that would aff ect this rate change as well. Drug eluting stents, arguably, have restenosis rates varying from 3%, 10% or even higher. Irregardless, this is a signifi cant decrease. In combination with Statins, a decrease in restenosis rates, repeat interventions, and coronary artery bypass graphs (CABG) have been globally experienced.

CONCLUSION

Drug eluting stents do in fact have proven potential for late stent thrombosis. Early discontinuance of combination antiplatelet therapy seems to be a leading cause for late-stent thrombosis. Drug eluting stents are superior to bare metal stents in the prevention of coronary artery disease and in-stent restenosis. Th ere is a substantial need for further antiplatelet

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Drug Eluting Stents (cont...)

SPECIAL FEATURE


therapy studies to determine the length of time a patient should take these medications. In meeting with many cardiologists, I have asked this question. Th e answers are varied to include anywhere from 9 months to life. As we all know, patient compliancy is a conjunctional problem especially with indigent care facilities. Th e need for generic medications is evident in order to help curb the costs of antiplatelet drugs, thus decreasing the potential of those individuals who are without insurance and/or can not aff ord the high monthly costs.

What’s in the future? Porcine studies of the “bioabsorbable” drug eluting stents seem to be showing signifi cant promise. It has been discussed that stent use is not necessary after several months. If this holds true, bioabsorbable stents should in all actuality eliminate late stent thrombosis, thus too, eliminating the need for combination antiplatelet therapy. Th e patient could continue with their maintenance dose of

Aspirin or other cardiac medications, which would be determined by their physician. It seems predictable that this new technology, by itself, will not be the fi nal step. Pharmacologic uses play a major role in the fi ght for heart disease. Th e combination of stents and medication go hand-in-hand, one aspect being the use of “immunosuppressant” drugs. Time will tell, we will be watching, learning, and waiting for the next step in cardiovascular disease science.

Resources

“Th e Advisory Board”, “Cardiovascular Watch, Daily Briefi ng”.“Angioplasty.org”, “Recent Studies Increase Concern Among Reseachers About Potential for Dangerous Blood Clots in Individuals with Drug-Eluting Stents”, “What Does this Mean for Patients?”“U.S. Food and Drug

1.

2.

3.

Administration”, “FDA Statement on Coronary Drug-Eluting Stents (September 14, 2006)”“Heartwire”, “Late stent thrombosis reported with drug-eluting stents”“Platelets.org”“TCTMD”“Th e BAsel Stent Kosten Eff ektivitats Trial – Late Th rombotic Events”, “BASKET-LATE TRIAL”

4.

5.6.7.

Author: Mr Dennis Holloway, Director Diagnostic CV Services,

Sarasota, FL

ECG Problem Solving

CLUE: ECG of a patient who has an implanted device for treatment of heart failure.

By Mr Stuart Allen, Cardiac Rhythm Group Manager - Southampton University Hospitals NHS Trust, UK

ANSWER: See Page 41


PRODUCT FOCUS

Telemedicine in Cardiology Easing the Burden


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BIOTRONIK Home Monitoring® Global Benefi ts

How can telemedicine really facilitate CRM device follow-up? Th is is a topic that is on

many Cardiologists minds. Th e steadily increasing number of implants causes an overload at ICD follow-up clinics; a situation that Professor Dr. Nicolas Sadoul from the Nancy University Hospital, France, pointed out, saying: “ICD implantation is no longer the problem. Th e problem is the ICD follow-up!”

Many cardiologists agree that telecardiology may introduce the aspects of fl exibility and individual patient treatment to ICD follow-up, and, hence, present a promising solution. Th e most advanced Telecardiology solution available today is Biotronik Home Monitoring®. Th is revolutionary technology is available in its most recent addition to it’s CRM portfolio, the new Lumax ICD.

Lower Costs Th anks to More Effi cient Th erapies

Th e new Lumax ICD not only sets new security and functionality standards, but also contributes to reducing the costs of the health-care systems. Th anks to individual and event-oriented patient care – patients only consult their physicians when it is really necessary – enabling clinics and hospitals to manage their resources more effi ciently. Every consultation costs time and money, and is a burden for the patients as it reduces their working or leisure time.

Environmental Benefi t

More and more society is not just evaluating fi nancial costs in the provision of modern healthcare. A topic at the forefront of many minds today is the reduction of Carbon footprints. Many healthcare providers, and users, are taking into account the implication their choices have on the environment. In a recent publication Prof. Pedro Brugada highlighted how Biotronik Home Monitoring® can reduce in hospital ICD follow-ups by 47%. Th e implications of this reduction are not restricted to enhanced patient management and effi cient use of resources, but also to its positive eff ects on Carbon emissions. In 2006, 3986 new ICD devices were implanted in the UK. If the in hospital follow up burden was reduced by 47% we could cut carbon emissions by 1,254 tonnes; or the equivalent of 1000 return fl ights from Heathrow Airport to New York’s JFK airport.

Enhanced Diagnostic Possibilities

Furthermore, Biotronik Home Monitoring® technology facilitates patient follow up, as remote diagnosis enables physicians to be continuously informed on their patients’ health status. In case of any rhythm disorder in either the atrium or the ventricle, the integrated GPRS technology automatically sends ECGs of both chambers to the physician. Th is detailed intracardiac ECG refl ects both the onset

and termination of the event, thus considerably improving the physician’s diagnostic scope. Moreover, the cardiologist may analyze the ICD’s programming at any time using the Internet.

BIOTRONIK is the worldwide leader in telecardiology development with its Internet-based Home Monitoring system. Th e company, which is a a pioneer in implementing telecardiology in clinical practice, not only aims to increase the level of patient comfort, but also supports clinics and practices in developing effi cient therapy management. Th e physician obtains highly useful data in outstanding quality and can thus develop intelligent data management.

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enables physicians to be continuously informed on their patients’ health status. In case of any rhythm disorder in either the atrium or the ventricle, the integrated GPRS


enables physicians to be continuously informed on their patients’ health status. In case of any rhythm disorder in either the atrium or the ventricle, the integrated GPRS

BIOTRONIK Home Monitoring® Helps

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Customer Satisfaction - Do Some of the Easy Work

MANAGEMENT New Regular Contributor

Customer Satisfaction - Do Some of the Easy WorkDo Some of the Easy Work

New Regular Contributor

Customer Satisfaction - Customer Satisfaction - New Regular Contributor


As technology, training, experience, industry pressures and advanced consumerism

continue to drive improvements in cardiovascular care and outcomes, more hospitals are increasing their focus on customer satisfaction initiatives to fi nd competitive advantages. It has been estimated that a patient may have as many as 30 contacts with friends and families about their hospital encounter. Th e math is simple - for a program that performs a thousand cath lab procedures, there may be as many as 30,000 discussions about your service alone. It is worth the eff ort.

To address this issue, hospitals have engaged external survey companies as well as developed internal surveys to bring focus on areas with the greatest potential for improving the patient/customer experience. Th is survey information has been used to change processes, invest in technology, educate employees and change behaviors related

to patient and visitor encounters. Signifi cant eff orts have improved performance in areas such as patient wait times, response to concerns or complaints, room cleanliness, noise levels, skill of the nurses, as well as many others. Sometimes we are met with disappointment when the improvement in survey scores don’t seem to rise at a pace to correspond with the amount of eff ort invested. Th e good news is that if we have done the hard work, we can now do some of the easy work that should improve scores even more. Lets look fi rst at what we are actually measuring.

A customer satisfaction score is really the measurement of the relationship between a CUSTOMER’S EXPECTATION (CE) and the CUSTOMER’S PERCEPTION (CP) OF THEIR EXPERIENCE which may have little to do with our performance. Many times we do have the ability to control or infl uence both of these variables.

Next, as we look at some specifi c examples, we need to examine what infl uences a CE. Many of our patients are here on their fi rst hospital admission, so their expectations are created by factors outside our service – television, newspaper, experiences with other industries, other people’s experiences, or, we may be creating expectations that could be impossible to exceed.

Noise Levels

What does a patient expect noise levels to be, especially if this is their fi rst hospital admission? As quiet as their bedroom at home? If you have made the eff ort to reduce noise levels around the patient, tell them: “Although

hospitals are very busy places, we have worked very hard to reduce the noise levels here for your comfort. Would you also like me to keep your door closed for better privacy?”

Cleanliness of the Room

If the patient room is clean, taking the opportunity when the housekeeper is in the room to recognize her with the patient “Jane does a great job of keeping our rooms spotless” not only creates the perception of the patient on room cleanliness, but exposes a positive warm element of the corporate culture.

Wait times

How fast is fast? Like a fast food restaurant? Like an outpatient area that has little disruption or variation to regular scheduled appointments? We experience unpredictable variations in procedure length, disruptions from emergencies and patient needs. Make this part of the patient’s expectation: “sometimes we have changes to our schedule based on patient care needs. Your procedure may be delayed so our team can focus all their attention on your care without distraction.” Or, “We may take a little longer with your procedure because we take extra steps to ensure your safety and quality results.” I doubt most patients would prefer speed over quality. Th is is most often neglected in fast track emergency rooms.

Make the Patient Feel Important

Focus specifi c attention on the individual patient – know their Primary Care Physician (PCP,) know what town or area they are from: “How was your drive from Yourville yesterday?

Gary M. Maras

Senior Vice President, Hamot Medical CenterDirector Hamot Heart Institute

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MANAGEMENT

Customer Satisfaction (cont...)

MANAGEMENTMANAGEMENT

Mayo Clinic FAST TRACK

Saint Mary’s Hospital at Th e Mayo Clinic campus in Rochester, renowned

internationally as one of the worlds leading cardiac institutions and recently designed a new system to dramatically decrease the door to balloon time for patients suff ering from an ST-elevation myocardial infarction -- STEMI for short.

Previous studies have shown that a maximum door-to-balloon time of 90 minutes is recommended for STEMI patients to give them the best chance of preventing any long term heart muscle damage. Th e shorter the time, the better chance of survival.

Key elements in the FAST TRACK Protocol:

Single-call instant alert to the care team from the ER Physicians via a single phone number which activates a pager alert to all members of the cath lab team, without review of the case or approval by a cardiologist.

ECG (EKG) within fi ve minutes of arrival to the ER. Patients with symptoms suggestive of heart attack who arrive at the hospital or one of the 28 regional hospital emergency departments in Minnesota, Iowa and Wisconsin receive within fi ve minutes an electrocardiogram, a test that quickly identifi es a STEMI.

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Direct line of communication to all care team principals, from the regional hospital staff to the on-call cardiologist, via one single phone number.

Rapid loading by air ambulance. Th e air ambulance transport team developed an innovative “hot load” procedure where the helicopter engine is left on and the time to pick up a patient from landing to take-off is less than 10 minutes.

24/7 readiness. Th e Mayo system was designed to achieve the best door-to-balloon time during regular hours, as well as during off -hours on weekdays, weekends and holidays.

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We have cared for many patients from your area.”. “We are pleased in the confi dence he has in our team to take care of his patients.”

Quality Staff

If you have good staff , tell the patient. How else might they know about their expertise, experience or their skills? As the nurse on the fl oor is preparing the patient to be sent to the cath lab, EP lab or noninvasive lab, add to the conversation “we have a great staff in the lab” or our staff in the lab are very experienced”. Likewise, the staff in the lab can tell the patient that the fl oor that they came from has some of the best nurses in the hospital. Few patients understand anything about the quality of medical treatment our physicians provide. We can help them: “Dr. Jones has performed thousands of these procedures and I would be very comfortable having him as my physician.

Adding this simple step can be applied to almost any issue that you wish to improve, not just the scores, but the patients belief that they had an experience that exceeded

their expectations. Remember, as a healthcare worker, you are already perceived as a qualifi ed expert to the patient. What you say can have equal and sometimes greater impact on a patient’s perception than what you do. If these actions are duplicated throughout the hospital with all the patient’s encounters the summary eff ect will be far greater than a single encounter.

If you have to use a patient survey, every staff member should know the questions asked and discuss what they can say to a patient, as well as what they can do for a patient to improve the relationship between expectations and perceptions of the patient experience. When your patient does receive a survey, they will remember those things that you helped them remember and you are more likely to receive the scores that you have earned and deserve. If you have done the hard work, do some of the easy work and get the credit.

INTERVIEW

Carol Mascioli

Carol Mascioli’s 26 years of progressive experience are pivotal to the success of the Baptist Cardiac & Vascular Institutes organizational success. Her leadership style conveys a strong sense of advocacy, and provides staff with an overall positive sense of support. She is a knowledgeable leader and a strong risk-taker who follows a meaningful philosophy that is made explicit in day-to-day operations of her departments. It was a great pleasure conducting this interview with her.

Carol, please gives us an overview of your program and your areas of responsibility.

Th e responsibilities that I have at Baptist Cardiac & Vascular Institutes (BCVI) are to assess, plan, develop, organize, implement and evaluate services and activities for Th e Baptist Cardiac & Vascular Institute and Baptist Diabetes Center. Th ere are fi fteen direct management reports

and 315 full-time employees. Th e 51 impatient units will soon be 99 beds…adding a new bed tower to the Institute. Th e programs included in the institute are:

BCVI Management Company (LLC)Cardiac Cath Lab- 3 suitesInterventional Radiology- 3 suitesNeuro Interventional Radiology- 1 suiteElectrophysiology lab- 1 suiteCardiac and Vascular MRI- 1 suiteCardiac and Vascular CT- 2 suitesProcedure Care Unit- 13 bedsEchocardiographyPeripheral Vascular LabStress TestingEKGResearch and OutcomesCardiac Rehab/Wellness and PreventionDiabetes Care Center (inpatient and outpatient)Records and TranscriptionClinical Practice (Interventional Radiologists) Inpatient Patient Care Unit- 51 beds

What is it like to be an AVP (Assistant Vice President) at the Baptist Cardiac & Vascular Institutes? Identify your strengths, weakness, opportunities you see for yourself and the threats that keep you from making the most of those opportunities.

I have the best job in the country as far as I’m concerned. I’ve been here for 20 years and have driven an hour or more each way to work every day for the last 12 years. So in order to do that, and to like that, I have to have the best job in the world. As far as I’m concerned, I have great staff that I work with here. Th e management team is outstanding.

Did you select the management team?

Mostly yes over the last 20 years; the management team has been selected by

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me. I have a peer interviewing process where the managers interview each other as it relates to open positions and then we make the determination as a group. Th e physicians also interview all management candidates and provide input. I’m a people person so I love the patients; I still get out there with the patients. I’m out there with the staff ; I’m out there with the physicians. I think that this is the best job. Especially after hearing some of the issues leaders have at other organizations.

I am an operations person and I think that contributes to one of my weaknesses – not delegating enough. In order for me to grow as a leader, I’m going to have to start stepping back and allow other people to take on some of those operational areas if I want to grow in my own fi eld and within our organization.

I not only have the responsibility for the hospital from an operations standpoint. But I also have the responsibility of running a company with the management company. It’s a lot on my plate at certain times but I wouldn’t change it for the world.

What type of leader are you and what makes you a good leader?

I’m a participatory leader. My philosophy has always been, I do for people what I would want done for myself. Th at’s how I look at management. Th ere’s a diff erence between being a leader and a boss. I don’t ever want to be a boss. A boss is often times just interested in the bottom line. A leader helps people grow, and I’m always interested in people growing and doing diff erent things that are important to them. It’s important to me that my staff and my management team are able to grow and that the physicians respect everyone and that they are respected in return. I also have a very much hands on

Carol MascioliAssistant Vice President

Baptist Cardiac & Vascular InstituteBaptist HospitalMiami, Florida

Interviewed by Ms Voncile Hilson-Morrow(Previous Director of Invasive Cardiology at

Washington Heart at the Washington Hospital Center)


INTERVIEW

Carol Mascioliapproach to leadership. An open door policy which sometimes is not always that great when it comes to time management, but I know every staff members name within my organization -- even the nurses on the night shift. I make sure that everyone feels very comfortable in an environment where they can provide suggestions to make things better. It’s not a dictatorship, it’s defi nitely a democracy. We try to create an environment where collaboration is the only answer; and I believe that is refl ected not only in the hospital administration here but in the physician leadership here also.I tell my staff all the time the most important person to me is Mrs. Clementine who comes to clean my offi ce every night. She is the most important person to me, not a physician; and everyone should be treated that way.

Has there been any one particular person that you can say that helped you in your growth in this profession?

I would not be where I am if it were not for the support, mentoring and guidance from Dr. Barry Katzen, he is the Medical Director at Baptist Cardiac and Vascular Institute, I’ve worked with him for 28 years.

Dr. Kayzen is the epitome of a visionary. He has unbelievable leadership skills as it relates to physicians, not necessarily good business skills which is why he has a wonderful wife who handles that part of their life. Th is is a man who really has no ego, and it’s refreshing. You don’t get that opportunity to work with a physician for that long and still look forward to coming to work each day to continue to work with him. He is so humble. He is probably the biggest reason that I’m still here.

So what motivates you in this position?

All it takes is a letter from a patient thanking us for doing what we’re supposed to do every single day. What motivates me is an employee who says thank you for the smallest thing like asking how their family is doing. Having physicians who really care about quality that’s what motivates me.

Why do you think you’re qualified for this position?

Nobody else wants it. No I’m just kidding.

You know, you and I are very similar. We worked our way up through the ranks. I think what qualifi es me here are a couple of reasons. Th e clinical experience that I have combined with the business aspect; I think my people skills and the ability to work with people is something that has helped me to remain qualifi ed for this position. I have a drive that’s still moving forward; and I’m not going to be retiring any time soon -- not that I know of.

Are there any things out there or that you’ve done or a meeting that you’ve attended that have prepared you in any way for the challenges that you’ve encountered?

You know there’s not just one thing or one meeting or one experience that has prepared me. I think it’s the combination

of really being out there and getting exposed to all aspects of this business. Networking with other individuals -- I can’t tell you how important that is. Having the network to be able to validate something you’re trying or to validate why something didn’t work. We can’t live in a silo. Th at is extremely important; not only within our fi eld but also within our organization. We have to be able to work well with everybody and be able to infl uence individuals to provide assistance when you need it. But there’s not just one thing that I can say that I went out there and learned. Even when I did my masters, there weren’t a lot of things that I hadn’t already experienced. So it’s just a lifetime of experience and exposure that has helped prepare me and helped keep me in this role.

So you would definitely agree that attending the ACVP, ACCA, ACC and other leadership meetings are valuable in gaining a knowledge base from other people like yourself that have similar problems or new

problems that you may not have encountered; but may

be coming down the pipe so that when it does come, you can say, oh wow, I heard

that being talked about a couple of months ago.

Exactly, but you know

you have to go to those

meetings with an open mind. You can’t go into those meetings

and think that everything you’re doing is perfect. I mean I know that I’ve gone and I’ve explained what we’re doing here and of course some say, “Ok Carol you

live in utopia”; but there are

and I’m not going to be retiring any time soon -- not that I

out there or that you’ve done or a meeting that you’ve attended

way for the

encountered?

You know there’s not just one thing or one meeting or one experience that has prepared me. I think it’s the combination

problems that you may not have encountered; but may

be coming down the pipe so that when it does come, you can say, oh wow, I heard

that being talked about a couple of months ago.

you have to go to those

meetings with an open mind. You can’t go into those meetings

and think that everything you’re doing is perfect. I mean I know that I’ve gone and I’ve explained what we’re doing here and of course some say, “Ok Carol you

live in utopia”; but there are >>CORONARY HEART ™ 19

Carol Mascioli

INTERVIEW


things that I’m struggling with that other places have perfected. Th at’s what’s important is to be able to go to those meetings with an open mind in order to see what other people are doing better than you are. And no one is perfect.

Where does your staffing base coming from?

Beg, borrow and steal. From a nursing standpoint, the hospital and our health system has been very active in growing our own nurses from scholarship programs that we have developed here. From the technologist standpoint, we don’t train our own. We haven’t had to resort to that yet. With our reputation, we have the ability to attract technologists from other hospitals or from outside the area. It’s gotten more diffi cult over the last year to get anyone from outside of the area because no one wants to move to south Florida; Too expensive and too many hurricanes have been the stated reasons. I would say in the next few years we’re going to need to be looking at what we are going to have to do to grow our own. Th e health system has scholarship programs related to Radiologic Technologists (RT). With that in mind, we have been able to get some RT’s and train them in the cath labs and in interventional radiology suites but from ultrasound and everything else we haven’t had a huge issue; it’s mostly nursing.

Are the staff cross trained? Do they cross between IR, EP, and CATH or do they stay in their own specialty?

Th ere is some cross between Cath Lab and EP, but there really is no cross between Interventional Radiology and cardiology. Initially that was our goal, but we don’t have the luxury of having over staff in order to cross train at this time. Consequently, we are trying to maintain the staffi ng in the particular

specialties as they are now.

You have a cardiac department, a vascular department, and an interventional radiology department; not cardiac doing vascular?

Yes, we really would like people to understand that vascular is a standalone area and that it is not necessarily incorporated or blended into cardiovascular.

We have a product line management; and the institute incorporates cardiac and vascular surgery which results in me having CV surgery from a product line standpoint; however, I am not responsible for the surgical end of it with regards to day to day operations that area reports to the Director of Surgery.

We also have a diff erent model here. We have an overall management company which can be called a joint venture. It can be called a Limited Liability Corporation; it is half owned by the hospital and half owned by physician share holders.

How does your product line management work?

Anything related to cardiac and vascular would fall under the institute’s responsibility. Sometimes that’s good and sometimes that’s bad. Even if our physician aren’t necessarily completely responsible for that particular product line; I’ll give you an example: congestive heart failure. Our cardiologists do not admit patients for congestive heart failure. Th ose patients are admitted under a hospital list; but the cardiologists are consultants. Th erefore, since the congestive heart failure falls under medical cardiology it falls under our area, we are responsible for handling that area and making it work better.

So, what’s the incentive for the physicians to be in a partnership?

Th e incentives for the physicians, as far as the management company; is their perception is that they were getting increased control. Our perception is that we’re getting increased collaboration. It’s really been a blend of both. It’s been unique. We are almost fi nished with our second year on it, and we are going to continue with it. Th e physicians have become much more involved and more aware and accountable for the quality and operational issues within the institute.

Would you say that this setup is very important in differentiating your program in this field?Yes, everyone knows that the institute is not the management company. Th e institute is everything as a whole; but I think what diff erentiates us in the fi eld is that we have had the ability over the last 20 years to have physicians from multiple specialties collaborate and work together to provide quality care that’s best for the patient. Not necessarily what’s in each specialty’s interest from a fi nancial standpoint

So they all play together?

Yes, they all play together. It’s not all good days. Th ere are good days and bad days, but as a whole I can tell you from hearing what’s going on with other places across the country that we’re probably the only place that’s been able to pull it off and have all the specialties work together under one roof in a collaborative environment.

What threats do you think are in the mix that may challenge your being able to maintain this environment?

Other hospitals within our area have defi nitely stepped up to the plate and seen where we’ve been successful,

Assistant Vice PresidentBaptist Cardiac & Vascular Institute

Carol Mascioli

INTERVIEW


and are trying to mirror it with their organizations. What’s going to be important in maintaining this position is patient, physician and empoloyee satisfaction in order to keep the revenue coming in. If there are going to be choices, then you have to fi gure out what diff erentiates yourself from other organizations.

Do you have anything in particular you’ve done well that is going to influence that?

I think we’ve done well from a quality standpoint. I think we’ve done a fantastic job of communicating our quality to the public. Our health system has an excellent reputation when it comes to quality. I think the biggest thing that we need to concentrate on is the basics and patient satisfaction.

Now Carol, you’ve said that quality is the most important. As we know, quality sometimes gets pushed to the side in the face of revenue.

Yes, I agree with you but that’s one thing that’s quite diff erent here --especially with the management company. We are looking at quality for each physician; and if physicians aren’t maintaining those quality standards, whether they bring in a huge volume or not, it will hurt us in the long run. Th e Baptist Health Systems as a whole base their whole foundation on quality, not just the institute. If we don’t have that, then we won’t be successful. Bringing all the revenue in and not having that quality is not something we care to be involved in here. I can tell you if a physician was having quality issues here, we wouldn’t think twice about getting rid of him.

What past successes, methods of leadership and ideals to this point, have shaped the organization?

I think what’s worked well within our organization is a team leadership approach -- Not only from the hospital administration, but from the medical staff . I have the luxury of having an outstanding physician leader in Dr. Katzen and he has the ability to be able to see past his specialty and to look at what is going to be best for everyone, rather than centering in on one specialty. Getting physicians to play well in the sandbox is a challenge; and for the physicians in each specialty, it’s important for them to feel that I am not playing specials with one specialty over the other. Th us having that collaborative environment and the ability to see everything as a whole and not as a snapshot in time is extremely important.

What opportunities do you see that’s different from what you are doing?

I think a lot of organizations, and we’re one of them, has spent a lot of time in the last few years focusing on new strategic ways to do things and innovations and technology, etc. etc. and I think we’ve sort of lost focus of

the basics; the basics of bedside care, the basics of good customer service, and the basics of looking at our costs and those issues associated with those costs. Where we’re refocusing this year is really taking a look at our basics and honing in on those and fi ne tuning them again. You can have all the wonderful technology in the world at your organization, but if you don’t have good basic customer service, patient satisfaction, employee satisfaction, physician satisfaction, it doesn’t matter what technology you have.

As a result, we’re just looking at how to get back into honing in on those basic areas especially the bedside care. Nurses have been inundated with doing paperwork and using technology and all other types of issues that we’ve lost focus of what’s really important to the patients.

What do you see as threats that will stand in the way and keep you from being able to develop some of these opportunities?

Some of the threats are from a cost standpoint. Th e obstacles that we

Baptist Cardiac & Vascular InstituteMiami, Florida

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INTERVIEW

Carol Mascioli


can’t move related to cost. We can’t necessarily get the bottom dollar pricing that we think we should get on certain items in order to reduce cost.

Th e other issue is trying to get all physicians on board and moving in the same direction that may not be within the cardiovascular environment. We have a huge number of hospices here who control the inpatients and who control those costs. We’re really working with them and having them collaborate with us to look at opportunities, and make suggestions and then carry out suggestions.

We tend to be very good with coming up with what’s wrong, coming up with the fi x, and then not necessarily always keeping it fi xed. At times, we go back and review it and everything we setup has disappeared I think a lot of organizations have that problem: A few months later it’s like when did we stop doing this?

What would be some of your biggest challenges you have now?

Th e biggest challenges now are going to be staffi ng, reimbursement and, cost

issues -- those are our major challenges. Th ere will be ongoing physician relationship challenges which will probably heat up and then cool down, but that’s just everyday life; however, the challenges related to staffi ng, reimbursement, and costs are going to be a huge challenge for all of us going forward.

How do you know you’ve been successful?

I’ve been successful when my patients are happy, my employees are happy, my physicians are happy and we’re bringing a nice return to the hospital. Th at’s how I know I’m successful in my job. Th e other way that I know I’m successful is if when I go home at the end of the day, I’m looking forward to coming back tomorrow – because if I’m not, then I’m not successful.

What do you want the readers to get from this interview?

I think what I would like the readers to get how important it is for everyone to collaborate and to really look at ways for hospitals to be successful as a whole and not necessarily as a silo. Hospitals

can have great cardiovascular programs that are extremely successful; but unless they work together with everyone else within their organization in order to be successful they aren’t going to maintain that for very long.You can no longer stand on your laurels by saying “well you know we make the most money for the hospital so therefore I should get this and I should have that and I should have these luxuries”. It’s extremely important to realize that the hospital can’t stand alone on its cardiovascular program it requires collaboration in a whole not just a unit. Do you think the Baptist Cardiac and Vascular Institute is on the fast track? Do you think they have their hands on the pulse of what’s going on in the field?

I think we defi nitely have our hands on the pulse of what’s going on in the fi eld. We’ve had 20 years of success and we’ve been able to achieve things that many hospitals are still struggling with. Now our challenge is going to be to maintain that.

Grab a copy of our magazine. Grab a camera. Convince your work collegues to be in a photo. Th e most innovative photo wins, but our magazine must be in the photo somewhere. Email hi-res photo to [email protected]

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Th e demand for site visit articles within this publication has been extremely strong, so we have decided to make Edition 9 (Nov/Dec) up for grabs.

Friday August 17th, 2007 at 5pm GMT

All entries will be displayed either online or within the editions leading up Edition 9. Goodluck!!

Assistant Vice PresidentBaptist Cardiac & Vascular Institute

Win a Site Visit Article!!

How to win?

Entries Close:

Th e demand for site visit articles within this publication has been extremely strong, so we have decided to make Edition 9 (Nov/Dec) up for grabs.

Win a Site Visit Article!!

How to win?

PhotoCompetition

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UNITED STATES OF AMERICA

ADDRESS

MAP

Cardiovascular Diagnostic and Interventional Suite St. Joseph Medical Center Bern Campus 2500 Bernville Road Reading, PA19605United States of America

FAST FACTS

Completed entire hospital shift in one day.

Merger of Interventional Radiology Department & Cardiac Cath Lab.

4 Labs

Cardiac, Vascular Surgery, Peripheral, & EP cases.

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St Joseph Medical Center, PA

Ambulances line-up at St Joseph Medical Center to transfer patients(Incorrect Date on Photo)

CARDIAC SITE VISIT


The St. Joseph Medical Center Cardiac Catherization Laboratory in Reading,

PA underwent a dramatic change during the past six months. Th e hospital Administration and Catholic Health Initiatives determined that the institution, which was originally built in 1912, needed to be enlarged, reorganized and moved from its center city location to a rural area on the outskirts of the city that was more accessible to the referral areas.

One of our radiology colleagues Bill Arentz wrote the following article.

More than fi ve years of planning, fund raising and construction culminated in a historic move that was carried out fl awlessly.

Th e whole move was orchestrated like a grand symphony. Each step was planned and rehearsed to carry out this once-in-a-lifetime event with the least amount of disruption to the patients.

Did you know there are actually companies whose whole existence is to plan and carry out such a move? Each step diagrammed and rehearsed, down to driving the exact route beforehand in order to make an accurate estimate of the time needed to complete the move. When moving day fi nally arrived after many months of planning even the weather cooperated. Th e patient move began at 9 a.m. sharp, with every ambulance in the area participating (see photo above). Th e last patient to be moved was from maternity; Momma

and baby arrived safe and sound at the new facility by 11:30 a.m.

Th e old Cardiac Catheterization laboratory was comprised of two labs and was used by one group of nine Cardiologists. Th e fi rst change that was made to prepare for the dramatic change to occur on November 5, 2006 was to start the merger of the Interventional Radiology Department with the Cardiac Catheterization Laboratory. Th e Interventional Radiology Lab Philips V5000 System needed to be disassembled and reassembled at the new site. During this time, the Interventional Radiology staff used one of the existing catheterization laboratories in the morning and the Interventional Radiology and Catheterization Laboratory staff started to assist each other and become familiar with diff erent procedures and equipment.

Th e second change was to install one of the new McKesson Hemodynamic Monitoring systems in the old >>

CARDIAC SITE VISIT

St Joseph Medical Center



catheterization laboratory. This allowed the staff to start to become proficient using the McKesson system before the move to the ultra modern facility.The third change was to bring new employees onboard to start the orientation process. The goal was to have these individuals competent in basic procedures with intensive training to be completed at the new facility.

On November 5, 2006, the biggest change was the entire combined staff had to get acclimated to all the changes that accompanied the move; not just to the new facility but to the new department as well. Each technologist/RN was assigned a mentor to work with during the transition. Educational and clinical competencies were also incorporated. Radiology technologist/RN needed to learn cardiac procedures while cardiovascular technologists/RN needed to learn radiology/vascular procedures. Vertebroplasties were far different and fascinating to the cardiovascular colleagues.

You would think the hardest part would be mixing people with different licenses to perform the same work. But what was amazing in making this transition is the camaraderie that has developed so quickly. The department became, metaphorically speaking, a family. The staff are radiologic technologists, nurses and cardiovascular technologists all performing some of the same functions. Monitoring, scrubbing and patient care are performed by each specialty.

The catheterization laboratory staff and interventional radiology staff both old and new were involved with at least some of the design and many individuals spent days in the new facility before the actual move.

Four staff members attended Super User Training for the Phillips X-ray system before the move.

1. Size of the Department

At St. Joseph Medical Center Bern Campus, the Heart Institute

Cardiovascular Diagnostic and Interventional Suite have combined the personnel, equipment resources of the Cardiac Catheterization Laboratory and Interventional Radiology Suite into one department.

The Heart Institute, the Cardiovascular Diagnostic and Interventional Suites are located on the second floor, adjacent to the Operating Rooms and the Outpatient Interventional Surgical Unit. This allows us to have easier access to the OR Suites. This central location also facilitates the processing of outpatients. The Critical Care Unit (CCU) and the Progressive Cardiac Unit (2N) is also located on the second floor. The Emergency Room is located directly under the Cardiovascular Suites with direct elevator access providing rapid transporting of those clients needing emergency interventional procedures.

The Cardiovascular Diagnostic and Interventional Suite consist of four multipurpose suites built with future expansion planned.

Lab #1 has a Philips V5000 and has OR compatibility with extra medical gas lines to allow the Vascular Surgeons greater flexibility. A patient whose procedure cannot be accomplished percutaneously but need surgical intervention does not need to be transferred to the OR. Anesthesia and OR staff will come to the patient in Lab #1.

Lab #2 has a Philips Allura XPer FD 20 allowing for treatment of both coronary and peripheral cases.

Lab #3 has a Philips Allura XPer FD 10 for coronary cases.

Lab #4 has a Philips V5000 for electrophysiology or coronary cases.

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CARDIAC SITE VISIT




All four of these labs have the McKesson hemodynamic monitoring and cardiovascular information system.

The Cardiac, Vascular and Neurodiagnostic Services Department are located on the first floor. This department consists of 12 procedural rooms.

2. Procedures

Cardiovascular Diagnostic and Interventional Suite:

Provides a full range of cath lab and electrophysiology services to both inpatients and outpatients including 24-hour emergency cardiovascular care.

Cardiac, Vascular and Neurodiagnostic Services Department:

In the Cardiac section, studies range from electrocardiograms and holter monitors, to full service echocardiography, and everything in between.

3. Staffing Roles

We have never used the traditional cardiac catheterization laboratory set up. We would like to think that this helps retain staff by providing diversity in types of procedures and the role each staff member performs. While nurses are responsible for all aspects of patient care and assessment, they rotate all positions on the interventional procedural team. Cardiovascular

invasive technologists and the cardiovascular radiology technologists also rotate to all positions on the interventional procedural team with the exception medication administration.

4. Procedures/volumes per year

The Cardiovascular and Interventional Suite perform approximately 3,500 procedures per year.

Cardiac Catheterizations 1,600PTCA 650Peripheral 450Carotid 80Pacemakers 200Defibrillators/BiV 200Electrophysiology/NIEPS 525

Cardiac Catheterization Suite staff at St Joseph Medical Center

>>

CARDIAC SITE VISIT




The Cardiac, Vascular and Neurodiagnostic Department perform approximately 11,500 tests per year.

Cardiac Ultrasounds 4,000Cardiac Stress Tests 1,500Vascular Tests 6,000

5. Cross Training

All members of the Cardiovascular and Interventional Suite are cross-trained for all procedures and positions with the exception that only the RN can administer medication and that there must always be an RN in each procedure to supervise patient assessment.

6. Day Case Procedures

Coronary diagnostic and peripheral interventions, electrophysiology studies, device generator replacement, non-invasive studies and cardioversion may be done as a same day procedure. Approximately 40 to 45% of all our cases are performed as same day or extended stay procedures.

7. Surgical Back-up

The OR and the Interventional Suites

are located on the same floor adjacent to each other. In rare instances a coronary intervention case requires an open-heart procedure; the patient can be transported directly across the hall. One of our Suites is called the Philips V5000 room, which is primarily used by the Vascular Surgeons and can become an OR Suite when needed.

8. New Procedures Implemented

We purchased the 3DRA option on the Philips FD20. This allows for prop and spin images on our peripheral cases which then converts to a 3D reconstructed image.

We have installed the McKesson hemodynamic monitoring system as well as the entire McKesson information system including CPAC’s. The system has been interfaced with Meditech to allow for a seamless workflow beginning with entering an order for a cardiovascular procedure and ending with a report viewable on Meditech.

While Electrophysiology procedures and implantation of devices are routinely performed, radiofrequency

ablations are a new and challenging addition. A new physician specializing in ablations has been recruited to develop our Radiofrequency Ablation program.

9. Inventory Management

We are going to be the final department to have PAR Excellence installed in our hospital. This inventory management system will allow for restocking as well as automated tracking of our inventory. Prior to this we had an entirely manual process.

10. Hemostasis Management

A majority of all cases are performed using femoral access. 63% of all procedures have hemostasis obtained using Perclose or Angioseal. This allows quicker sheath removal in anticoagulated patients, for quick ambulation and when discharging diagnostic patients. Manual compression and Quic Klamp are used to obtain hemostasis for the rest of the cases. Femostops are available if required to manage difficult cases requiring prolonged pressure. Within the last few weeks a lot of interest has been placed on the Syvek NT Patch. Limited use has shown excellent results in hemostasis management using this patch. This Syvek NT Patch provides patient satisfaction with early ambulation in 2 hours and is cost saving.

11. Training and continuing Education

All new employees undergo institutional orientation and then a comprehensive three month clinical orientation and training. All new staff members are assigned a preceptor to be their resource during this transition. All Cardiovascular Diagnostic and Interventional staff members must obtain BCLS certification. All RN


CARDIAC SITE VISITUNITED STATES OF AMERICA


and technologists must obtain ACLS certifi cation. Each Cardiovascular Diagnostic and Interventional Suite staff member has skill lists for orientation and a skill list for yearly demonstration of competency. All RN’s and technologists are expected to achieve National Certifi cation in their area of specialty by their second year of employment.

Continuing education is strongly encouraged for all staff members. Company representatives periodically provide educational sessions for staff both in the institution and as outside dinner presentations. Professional development awards are presented annually for those RN’s who exceed requirements for continuing education, staff development projects and community service. National Certifi cation reimbursement is awarded annually for those who have met the requirements to maintain their specialty certifi cation.

12. Methods Implemented to Reduce Costs

Decreasing reimbursement for patient procedures and increasing costs have necessitated cost reduction in all phases of our operation.

Th e Catholic Health Initiative Management Group networks monthly to determine how best to use corporate buying power to lower high dollar items (drug-eluting stents and cardiac resynchronization management devices) for all 60 member hospitals.

On the local level we use bulk purchases especially pacers and defi brillators to lower the cost of each device between 5-15%.

13. Th e Main Challenges Faced in 2006

While the design and selection of

equipment for our completely new facility was challenging, the merging of the Cardiac and Vascular units both invasive and non-invasive to form the Heart Institute was by far more challenging.

In 2007, meeting the National standard for Percutaneous Coronary Intervention (PCI) of 90 minutes time from the Emergency Room door to the fi rst treatment of the lesion is proving to be our primary challenge.

14. Best Part of Working at your Facility

When the entire staff ranging from our aide to the physicians were asked this question, the same answers were repeated many times.

Institutional pervasive sense of caring for the patient and family.

Camaraderie of staff not just in our department but throughout the institution.

Flexibility in work scheduling to allow for a good work-life balance.

Entire staff – RN, technologist and physicians have a high level of expertise in their fi eld allowing for work on the cutting edge of medical technology. We have been performing peripheral procedures for 14 years and percutaneous carotid interventions for 5 years.

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In 1743, Richard and Thomas Penn (sons of William Penn, for whom Pennsylvania is named) planned the town of Reading. Taking its name from Reading, England, it was established in 1748. Upon the creation of Berks County in 1752 the town became the county seat.

Interesting Facts about Reading:

Reading is the fi fth largest city in Pennsylvania with a population of over 80,000.

Th e city’s cultural institutions include a symphony orchestra, and museum, Goggle Works art gallery.

One of the fi rst localities where outlet shopping became a tourist industry.

Reading hosts the annual Berks Jazz Fest which is the largest jazz fest on the east coast.

Close to Lancaster County famous for the Amish Community.

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WHY READING?

CARDIAC SITE VISIT UNITED KINGDOM

ADDRESS

MAP

Southampton General HospitalTremona RoadSouthamptonHampshire SO16 6YDUnited Kingdom

FAST FACTS

1200 Bed Acute Hospital.

Serves population of 2.8 million.

Undergone a major £60 million redevelopment

Four Cath Labs currently

Full range of procedures including paediatrics.

New Cardiac MRI

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SouthamptonGeneral Hospital

WTE = Whole Time Equivalent


Southampton General Hospital, part of the Southampton University Hospitals NHS

Trust, is located on the south coast of England, only two hours train journey from London. Th e hospital itself is recognised internationally as one of the UK’s most successful healthcare

organisations, with the cardiology department recently undergoing a major expansion, becoming one of the largest cardiac departments in Europe. Th e population served by the unit is a staggering 2.8 million people coming from southern England, the channel islands, and occasionally mainland Europe itself.

1) Cath lab facilities?

Southampton General is a 1200 bed acute site, including the regional centre for cardiology. Th e cardiac services are now provided in a brand new £60 million new build including 5 catheter labs, 2 labs have biplane x-ray and these are used as a dedicated paediatric lab, the other lab is dedicated for EP. Th e 5th lab is being commissioned to include advanced navigation equipment for PCI/EP. Included in the new build is a dedicated cardiac MRI scanner, plane x-ray fi lm room and a 16 bed cardio-thoracic Intensive Th erapy Unit (ITU).

2) Staff Numbers?

13 (WTE) radiographers, the extended roles include IVUS.12 (WTE) nurses extended roles include sedation and contrast injections for angiograms. 4 Healthcare AssistantsTh e cardiac physiologists rotate between invasive and non–invasive and extended roles include pressure wires and non industry supported ICD/CRT implants.

3) Procedures?

Full range of diagnostic and interventional procedures in paediatrics including trans-catheter valve replacement, EP (including Ensite/NavX and Carto), routine and complex PCI (including rescue and 24/7 primary PCI). Southampton is also involved in international PCI, EP, and implantable device clinical trials.

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The brand new EP Lab with the Siemens Axiom Artis bi-plane

CARDIAC SITE VISITUNITED KINGDOM

Southampton General Hosp.


4) Equipment?

4 Siemens axiom artis. MRI avanto 1.5 T.GE mac labsBard EP lab systemJ & J Carto advanced mappingSt Jude Ensite advanced mappingIVUS, pressure wireMedcon archive

5) Procedures performed in a year?

4500 procedures a year, including paediatric diagnostic and interventional, adult diagnostic and interventional agiography, adult and paediatric EP and pacemaker, ICD and CRT implants

6) Day Cases?

Yes. At the moment only routine angiograms and pacemaker generator replacements are performed as day cases. Routine EP day cases are to start soon.

7) Surgical back-up?

Yes. We have 24/7 internal surgical

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cover for both paediatric and adult patients.

8) New procedures recently implemented?

Primary PCI.Percutaneous valve replacement.New cutting edge techniques for PCI.

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9) Haemostasis?

Almost exclusively arterial closure devices are used. Digital pressure for venous haemostasis performed by nurses.

10) Private cases? Any special considerations?

Occasionally private cases are performed at SGH which in the past we have had an arrangement for waiting list initiative cases.

11) Inventory Management?

We have barcode computerised stock control system and a full time stores person dedicated to cath labs.

12) Alliances with other hospitals for the treatment of patients?

We have a hub and spoke approach for rescue and primary PCI and complex EP cases.

From Left: Rebecca Gough (Chief Cardiac Physiologist), Holly Cottrell (Senior Cardiac Physiologist), Stuart Allen (Technical Head CRM), Karen Bradshaw (Sister Cath Lab), Andy White (Superintendent Radiographer), Ceri Partridge (Senior Radiographer), Peter Hopper

(Senior Radiographer), Karen Wilson (Cath Lab Nurse), Claire Eldridge (Cath Lab Nurse)

>>

UNITED KINGDOMCARDIAC SITE VISIT

Southampton General Hosp.


13) Measures implemented to cut costs?

Procurement of consumables.Shared contracts for radiology with other departments.Negotiation of new equipment.Regular cath lab user group meeting s to improve effi ciency.

14) Cross Training? Within the lab there is high degree of fl exibility and co-working between the professions, but no formal generic training programme is in place. Th e cath lab coordinators role is also rotated on a daily basis between the senior nurses, cardiac physiologists, and radiographers to ensure an effi cient throughput of patients.

15) Training for new employees?

Full trust induction. Also the nurses, cardiac physiologists and radiographers have their own departmental signing off of competencies.

16) Continuing education programs for staff ?

All staff are encouraged and funded to attend national conferences and study days.

Trustwide manadatory study half days once a month. In the cath lab we use this time for individual study, ALS training, mandatory training, ECG training and cross discipline training in new techniques.

Frequent study days as part of a cardiology education programme with a 1 million ‘heart beat education centre’ with all labs, theatres, TOE room linked with audio and camera’s.

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Several live case study days have been performed since the September opening including live link ups to us for TCT in Washington DC, and to Minneapolis for teaching and ‘fi rst’ implants of new medical devices.

17) Some of the challenges setting up the department?

It is a similar story throughout the United Kingdom that we have sometimes struggled to fi nd the experienced roles often needed for a regional cardiac centre.Th ree years of design work and negotiation with architects, planners, builders, and equipment manufacturers to implement the 60 million new build. Th is was a co-ordinated by a commissioning team set up by the senior members of each discipline who use the lab, led by the lead superintendent radiographer.Dealing with cardiologists, anaesthetists and surgeons!!

18) What is the best part of working at your facility?

A signifi cant amount of our staff have worked within the cath labs for a number of years creating a ‘family’ environment. Th e cath lab is known locally as the rest home for radiographers!! We’re not all that old!!

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Southampton, located on England’s south coast is famous for its harbour which has been in use since Roman times. In 1620 the Pilgrim Fathers set out from here in the Mayflower, bound for America, and in 1912 the Titanic sailed on her maiden voyage from here. The harbour also features a double tide, first from the west, then from the east.

Th ings to see and do:

City Walls walk:Parts of the original city walls remain which walkers can see by following the “Walk the Walls” signs. You will see restored towers, city gates, and ancient churches.

Maritme Museum:Discover Southampton’s maritime heritage spanning back to the vikings, through to the modern port today which is home to the famous cruise ships of the QE2, Oriana, Aurora, and Arcadia.

WHY SOUTHAMPTON?

CRM EDUCATION

PACEMAKER IMPLANT ANATOMY Step-by-Step


PACEMAKER IMPLANT PACEMAKER IMPLANT

By: Mr Stuart Allen, Technical Head CRM, Southampton General Hospital, UK

Pacemaker implantation can be performed either from the right side or from the left side (refer to image on left).

Th ere is no diff erence in principle. It may depend on the patient’s preference. Th e right sided approach demands a double curve.Th e left sided approach allows for a unidirectional curve.

It depends on the preference of the implanting physician whether the cephalic cut down is used as the mode of entry, or the subclavian puncture technique. Subclavian puncture as addressed here. In anatomic drawings the course of the subclavian is fairly straight (above right).In real life, in the elderly patient the subclavian vein may fl ow in conjunction with a tortuous artery (right).

The Left Side and Right Side Approach

Subclavian Vein in Elderly Patient

Anatomical Drawing of Subclavian Vein

Once the choice for subclavian puncture has been made, the direction of puncture is important and should be made parallel to the clavicle (green line).

When a more medial introduction is selected, there is a risk of subclavian crush (red line). Always allow for ample space between the clavicle and fi rst rib in lead introduction. >>

CRM EDUCATION

Cephalic Vein Approach

Pacemaker Anatomy (cont...)


Th e Incisura Jugularis and Acromion are reference points (see above). On two thirds of the distance from the Acromion towards the Incisura Jugularis, the punture should be made.

Always allow for ample space between the clavicle and fi rst rib in lead introduction. Th e direction and puncture under the clavicle is important to allow pacemaker leads suffi cient freedom of movement.

When the puncture needle is directed too far upwards, the mandrin will slide into the internal jugular vein.

Fluoroscopy (see above) is helpful to fi nd the proper direction for the mandrin. First have a look at the proper position of the mandrin before sliding the introducer and sheath over it.

After the puncture a small incision is made just to allow the introducer access, thus avoiding opening a larger part of the skin for a prolonged time. In this way we can avoid infection to a certain extend. In another technique a larger incision is made prior to the subclavian puncture After the lead is introduced, the mandrin is re-introduced to serve as guiding for the second lead introduction. Th e mandrin is fi xed during manipulation with of the fi rst lead.

The smaller Cephalic Vein can be seen entering the larger Subclavian Vein

Anatomical diagram of the Cephalic Vein



CRM EDUCATION

Atrial Appendage - The Atrial Lead


Some prefer the cephalic vein in entry in pacemaker implantation as this technique eliminates the risk of pneumothorax. Although at fi rst this technique was thought to be only suitable for one lead

systems but now with smaller French leads the cephalic vein does allow for the introduction of two leads. Only for three lead systems this approach is not suitable as a single introduction site.Th e cephalic vein is the extension of the most lateral vein in the ‘fossa cubitalis’.

Anatomical cut-away diagram of the Cephalic Vein approach

The Cephalic Vein approach

The illustration above shows placement in the atrial appendage. Th is is the classic position of the atrial

lead and often a non-traumatic (passive) J-shaped lead is used for this purpose.

All manufacturers make a passive atrial lead with a preformed J to aid positioning into the atrial appendage, however if an active lead is needed not all manufacturers make a lead with a preformed J. When a straight lead is used a curved stylet is used to aid manipulation to attain a proper position with the atrium.

Non-Traumatic (passive) Fixation

>>CORONARY HEART ™ 33

Entanglement in the pectinate muscles

CRM EDUCATION



In the picture left active fi xation is used. One can clearly see the screw protruding from the tip of the lead. After fi xation is established, the stylet can be withdrawn. Th ereafter the lead will show its fi nal curve. Note that diff erent brands of lead have a typical appearance on fl uoroscopy. Even diff erent models from the same manufacturer can have diff erent radiological appearances.

Th e pathology specimen (above) of the non-traumatic lead clearly shows how well the tines of the lead lodge the tip in the right atrial appendage. Tines provide ample pressure to establish close contact between the tip and endocardium of the atrial appendage.

Active Fixation (see screw)

When introducing a J-shaped pre formed lead on fl uoroscopy.Th e entrance of the appendage is somewhat lower than one would expect. When the “windscreen wiper” movement is observed, the lead is in the proper position.About a 5 o’clock position will allow the lead to enter the right atrial appendix.

The cast of the right atrium (left) gives a good impression

of what happens on fl uoroscopy. Th e atrial lead enters the atrium and comes to a halt almost halfway. When pushed further, it curves upwards (right).

Th e position and typical movement (windscreen wiper) tells the implanting physician that the tines have become entangled in the anterior extension of the atrial appendage, not in the tricuspid valve.

Atrial lead at 5 o’clock position

Cast of Right Atrium Atrial Lead curving upwards>>

CRM EDUCATION



Atrial lead entangled in the pectinate muscles

Atrial lead entangled in the pectinate muscles

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Valvular Entanglement

Ventricular Lead

CRM EDUCATION



When a tined lead is turned

around its own axis, the tines can easily get entangled in the chordae. Extensive and delicate manipulation is needed in such cases to liberate the tined lead from the subvalvular chordae. A gentle pull and a second attempt to pass the valve will usually do the trick.

One of many ways to enter the ventricle is to make bend of about

90 degree bend in the stylet. Position the sharply curved lead in the direction of the tricuspid ostium. Advancement of the lead in this position will usually cross the tricuspid valve.

Some extra support from the stylet, by advancing lead and stylet at the same time, can be helpful. In many cases this simple manipulation is enough to attain a proper apical ventricular position.

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The chordae easily causes entanglement

The Missing Curve Over The Tricuspid Valve

CRM EDUCATION



When a ventricular lead is introduced the lead will show a nice curve over the tricusped valve ring. On fl uoroscopy

the lead will follow valve movement

In this x-ray (left) the typical gentle curve over the tricuspid annulus is absent. Th e bending of the lead by the valve is absent as well. Th is lead has been introduced via the coronary sinus into a inter ventricular vein.

Th e two typical lead positions are depicted here (right). Above is the typical tricuspid valve curve of the ventricular lead. Th e coronary sinus is fi lled with contrast and the drawn line shows a position in the interventricular vein.

© Stuart Allen & Coronary Heart Publishing Ltd, 2007

CASE STUDY


This 32 yr old male was admitted to hospital with acute SOB and bleeding from the nose. Th e

patient also noted the veins in his neck were more prominent and he had a feeling of “head congestion”. No weight loss, night sweats or lymphadenopathy.

Initial echocardiogram (Figure 1) demonstrated a large pericardial eff usion with some suggestion of tamponade. A large mixed echogenic “mass” (red arrows) measuring 8cm x 4.7 cm was shown within/compressing the left atrium. A percutaneous drain was inserted and 1700 ml of blood stained fl uid was extracted from the eff usion.

A CT scan of the chest and abdomen established the large mediastinal

mass (Figure 2) to be quite vascular in the subcarinal region and not invading the left atrium or surrounding structures. A CT of the heart using a coronary angiogram protocol was also performed but found the coronary arteries unremarkable. An MRI with T1 and T2 weighted scans demonstrated multiple vessels around the mass due to collateral formation.

As part of his assessment this man underwent a cardiac catheter investigation. An injection into the descending aorta demonstrated a large bronchial vessel supplying part of the tumour. Selectively catheterised with a Left 4 Judkins it outlined the left bronchial wall and typical of a bronchial artery but supply to the right side was large and this also supplied a sizable upper part of the tumour (Figure 3).

Th e right coronary artery had a very large vessel at the level of the right ventricaular branch, which ran posterior and superior to supply a large vascularity to the tumour (Figures 4).

Th e circumfl ex supplied two large vessels into the tumour arising from a branch at the level of the obtuse

marginal and running posteriorly over the atrium (Figure 5).

Th e patient was screened for urinary catecholamines and vanillylmandelic acid as part of the investigation and this came back positive. A MIBG scan was then undertaken and demonstrated

Compiled by Mr Mark Bowers, Superintendent Radiographer, Harefi eld Hospital, UK

Figure 1

Figure 2

Figure 3

Figure 4 (a)

Extra-adrenal Paraganglioma

CASE STUDY (cont...)


an area of increased uptake in the region of the mediastinal mass, showing features consistent with that of an extra-adrenal paraganglioma/phaeochromocytoma.

Following selective catheterisation and embolisation of

the collateral branches, a follow-up CT of the chest was performed with contrast that demonstrated a reduction in vascularity.

Th e patient is currently awaiting surgery.

Figure 4 (b) Figure 5

CARE Bill Update

The 2007 Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Th erapy bill, or CARE bill, was introduced in the

U.S. Senate by Sen. Michael Enzi, R-Wyo., and Sen. Ted Kennedy, D-Mass., on March 30. Th e bill is supported by the Society of Invasive Cardiovascular Professionals (SICP), which is a member of the Alliance for Quality Medical Imaging and Radiation Th erapy (CARE Bill Alliance) representing more than 122,000 medical imaging and radiation therapy professionals. CARE Alliance founding member ASRT (American Society of Radiologic Technologists) Director of Government Relations Christine Lung said she’s very encouraged by the introduction of the bill this early in the session.

Th e CARE bill would require those who perform medical imaging and radiation therapy procedures to meet minimum federal education and credentialing standards in order to participate in federal health programs administered by the Department of Health and Human Services. Th ese programs include Medicare and Medicaid.

Under current law, basic training standards are voluntary in some states, allowing individuals to perform radiologic procedures without any formal education. Poor quality images can lead to misdiagnosis, additional testing, delays in treatment and anxiety in patients, costing the U.S. health care system millions of dollars each year.

Th e Senate passed a version of this bill, the RadCARE bill, in December 2006, but the congressional session ended before the House version of the bill could be brought up for a vote.

“CARE Bill Alliance members have worked diligently to educate their senators and congressmen on the need for education and credentialing standards in medical imaging and radiation therapy,” Ms. Lung said. “It will be exciting to see the long-term eff orts of so many dedicated imaging technologists come to realization when the CARE legislation is enacted.”

Th e SICP & Coronary Heart will continue to keep you updated as the CARE Bill moves forward through the legislative process.

Extra-adrenal Paraganglioma

HOT TIPS

We have all seen it. Somebody standing only meters from the X-ray

equipment in the Cath Lab believing they are safe because they are in the next room, even though there is no lead screen protecting them. Two hospitals in London, UK have approached this problem with a novel solution.

St Thomas’ Hospital:

Each of their new cath labs has a red line on the fl oor exiting the lab to the control room and diff erent fl oor colour indicating where a person can stand safely without getting irradiated. So in the photos, stand to the left of the line and get zapped, or stand to the right and you are safe (x-rays don’t go around corners). Th ey have also installed a retractable barrier, like what you see in the airports in case people still don’t get the message.

The Wellington Hospital:

When some cardiologists believe they can stand close to the x-ray equipment safely with no protection because

they are not scrubbed in it is time to get serious. Th e Wellington Hospital have taken it one step further than St Th omas’. Where the fl oor is red you are getting irradiated, even if it is around the corner. Pretty simple.

Send us your interesting cases, lab studies, hot tips, and funnies to:[email protected] or visit our website for more details at:www.coronaryheart.com

The following Cardio-Th oracic Surgeon case report was for a

patient taken to the cath lab for a graft study. It was sent into us from a reader in Australia. For obvious reasons we can’t disclose who it was or their location.

Operation Title:

Saphenous Vein Bypass Grafts.

Pre-Operative Notes:

Th is obese young man was admitted to hospital two days ago in XXXX.

He had only stopped smoking two weeks ago and it was only

because he has waited a long time

and comes from a long way away

that I kept him in

hospital. I was sorely tempted to send him out of the hospital without an operation because he had

only stopped smoking two weeks ago. In typical fashion he denied that any doctor had ever told him that he should stop smoking!

they are not scrubbed in it is time to

Above: Red line on floor directly in line with x-ray tube (St Thomas’ Hospital)

Above: Retractable barrier preventing access (St Thomas’

Hospital)

Above: The red floor indicates where you are likely to get exposed

to radiation if you stand without lead protection (Wellington Hospital).

TRUECASE

REPORTS

Cath Lab Hot Tips



and comes from a long way away

that I kept him in





and comes from

that I kept him in




PROBLEM SOLVING

Answer: (from Page 14)

CLUE:ECG of a patient who has an implanted device for treatment of heart failure.

Answer:

The ecg shows bursts of multiple of impulses from a device called a cardiomyostimulator which is a specialised pacemaker manufactured by

Medtronic used in a procedure called a ‘cardiomyoplasty’(description below) for the treatment of heart failure. the timing of the bursts can be altered but generally stimulus is provided every other cardiac cycle.

Th is procedure was pioneered before the advent of cardiac resynchronisation therapy and there are patients worldwide who after 10 years since their original procedure continue to lead normal lives.

What is cardiomyoplasty?

Cardiomyoplasty is a surgical procedure designed to expand the diseased or injured heart’s capacity to pump blood. Th ere are actually two operations

involved in cardiomyoplasty, which is also called the muscle-fl ap procedure. In the fi rst, physicians detach the latissimus dorsi, the large skeletal muscle in the back. Th e muscle is then allowed to “rest” for a week to 10 days to improve its blood supply. Th e patient will be hospitalized for several days, then discharged until the second surgery.

During the second surgery, the muscle is wrapped around the heart like a blanket. Th en, a special pacemaker is implanted into the abdominal area and connected to the heart and back muscle. Th is pacemaker “trains” the skeletal muscle to beat like the heart.

Who is a candidate for cardiomyoplasty?

Candidates for this operation include those who suff er from

severe end stage heart failure. Th e patient cannot have undergone previous heart surgery.

Th ere are two types of muscle fi bers: fast, or type II, and slow, or type I. Type I fi bers, like those in the heart, allow sustained action without muscular fatigue. Th e type II fi bers found in the skeletal muscle allow it to perform faster activities of limited duration.

When the pacemaker is implanted during cardio-myoplasty, one of its leads is anchored to the outside of the heart; it senses the heart’s natural electrical activity and carries this information to the pacemaker. Th e lead transmits this information to a muscle-pacing channel, which directs these impulses to a second lead, a system of insulated wires. Woven into the skeletal muscle, these wires conduct impulses to it, forcing it to contract and “squeeze” the heart.

For approximately six weeks, physicians stimulate the skeletal muscle by increasing the impulse voltage for longer periods of time. Th is continues until the muscle fi bers complete the chemical transformation necessary to regularly beat like the heart without tiring.

How is the pacemaker different from those used in conventional treatment?

Conventional pacemakers deliver a single pulse to trigger contraction of heart-muscle cells. Th e sophisticated pacemaker used in cardiomyoplasty, called

a cardiomyostimulator, sends multiple, precisely timed and controlled bursts of impulses to stimulate contraction of the muscle fi bers. It creates a beat more like that of the heart.

By Mr Stuart Allen, Cardiac Rhythm Group Manager - Southampton

University Hospitals NHS Trust, UK


CONFERENCES

Meetings & Events 2007


Date Name Location Website / Contact

May 9-12 Heart Rhythm 2007 Denver, CO, USA www.heartrhythm2007.org

May 9-12 SCAI 30th Annual Scientific Sessions

Orlando, FL, USA www.scai.org

May 22-25 EuroPCR Congress Barcelona, Spain www.europcr.com

June 4-7 British Cardiac Society Annual Scientific Conference

Glasgow, Scotland, UK www.bcs.com

June 7-10 The 2007 Port Douglas Heart Meeting and Expo

Port Douglas, QLD, Australia

[email protected]

June 9-12 Heart Failure 2007 Hamburg, Germany www.escardio.org

June 11-15 Advanced Cardiovascular Interventions - 16th Annual Symposium

Hilton Head Island, SC, USA

www.cvintervene.org

June 14-16 16th Interventional Cardiology Symposium

Montreal, Canada www.mhi.interv.org

June 18-21 American Society of Echocardiography - 18th Annual Scientific Sessions

Seattle, WA, USA www.asecho.org

June 24-27 EuroPace Lisbon, Portugal www.escardio.org

June 28 - July 1 1st World Congress on Controversies in Cardiovascular Diseases

Berlin, Germany www.comtecmed.com/ccare

July 23-25 Endovascular Summit Colorado Springs, CO, USA

www.endovascularsummit.com

August 9-12 55th ASM of the Cardiac Society of Australia and New Zealand

Christchurch, New Zealand

www.csanz.edu.au

September 1-5 European Society of Cardiology Congress (ESC)

Vienna, Austria www.escardio.org

September 5-8 8th Annual New Cardiovascular Horizons

New Orleans, LA, USA www.newcvhorizons.com

October 6-10 ACE: Advances in Cardiac & Endovascular Therapies

New York, NY, USA www.ny-ace.com

October 20-24 Canadian Cardiovascular Congress 2007

Quebec City, Canada www.css.ca

October 20-25 TCT 2007: Transcatheter Cardiovascular Therapeutics

Washington DC, USA www.tct2007.com

October 29-31 Heart Rhythm UK Congress Birmingham, UK www.ukheartrhythm.org.uk

November 4-7 AHA Scientific Sessions Orlando, FL, USA scientificsessions.americanheart.org

November 25-30 RSNA Chicago, IL, USA www.rsna.org

Website / Contact

www.heartrhythm2007.org

www.comtecmed.com/ccare


www.newcvhorizons.com

Website / Contact

www.heartrhythm2007.org

www.comtecmed.com/ccare


Conference ReviewCONFERENCES


ACVP Leaders Conference is a Hit!

Escaping the cold winter weather of London for a conference trip to New

Orleans was not the hardest decision to make. Th ree conferences, ACC, ACVP and ACCA, all designed for cardiac professionals. Th is report though will look at the ACVP conference and why we think you should attend next year in

Chicago.

Th e ACVP Cardiovascular Leadership Conference was held at the beautiful Chateau Sonesta in New Orleans between March 22-23 as a lead up to the main ACC conference. Th e faculty was made up of a who’s who of the cath lab management world,

with the attendees responsible for 40% of all the cardiac product purchases in the USA. So if you want to hear from and network with the best, this is the place to be.

Th e conference started on Th ursday with keynote speaker Dr. Christopher White (Director, Ochsner Heart & Vascular Institute) giving an amazing account of Hurricane Katrina, and how the team at Ochsner Hospital coped under extraordinary pressures as the only major hospital open in the city at the time.

Th is was followed over the two days by various panel discussions from

hospital and industry leaders designed to assist managers in the operations within their department. Topics such as managing EP, departmental communication, and growth initiatives were all popular with good follow-up questions and discussions.

Our editior Voncile Hilson-Morrow from Healthworks also led a panel discussing current staffi ng challenges and solutions.

David Katz, the Head of the Cardiology Round Table spoke about STEMI results around the USA, and Liesel Cooper from Cordis spoke about the challenge faced by all departments with regards to reimbursments.

However the most popular discussion was left until late on the fi nal day when a panel formed to discuss “Leadership for the Future & Hot Topics in Current Management. Th e speakers included Joel Sandler (Florida Hospital), Teresa Waters (University Hospital), Carol Mascioli (Baptist Cardiac & Vascular Institute), Victor Hall (Cleveland Clinic), and Suzanne Riva (Lenox Hill).Each speaker came from high profi le departments however each had diff erent challenges to overcome. Th is proved to be a very valuable session for the audience whom openly put forward their own department challenges to the panel for their views.

Th is is not your typical conference as it is a more relaxed and comfortable environment. In the breaks, department managers mingle with the various industry experts without the stress of high pressure sales. For new managers just starting out or for those already experienced but wish to learn new ideas from others in a casual environment, the ACVP Leadership Conference is where you should go.

Meet Us in New Orleans.....

After such a great time in New Orleans in March, Coronary Heart magazine will be back again in September for the 8th Annual New

Cardiovascular Horizons Conference. Th is time though we will have a dedicated stand allowing us to meet all of our readers, answer any questions, as well as introduce the publication to those who have unfortunately been missing out. Refer to page 2 for details of the event.

So pack your bags and come on down y’all!! It is sure to be a great time!!


EOrleans was not the hardest decision to make. Th ree conferences, ACC, ACVP and

Chicago.




Th is was followed over the two days by various panel discussions from


EOrleans was not the hardest decision to make. Th ree

Chicago.




Th is was followed over the two days

Leadership PanelFrom left: Victor Hall (CCHSWEST), Teresa Waters (University Hospital), Carol Mascioli (Baptist Hospital), Suzanne Riva (Lenox Hill),

and Joel Sandler (Florida Hospital)

The watermark on an abandoned house in New Orleans.

The city is slowly rebuilding and still needs our support by attending

events such as these.

A boat still lying on the road near where the levy breached.

Photos and report by Tim Larner, Director

CARDIAC SOCIETIES

ACVP Overview


The Alliance of Cardiovascular Professionals is thrilled at the opportunity to support and

contribute to the new international magazine Coronary Heart. ACVP, as the oldest, most comprehensive cardiovascular professionals’ organization in the world celebrates all occasions to share information, exchange ideas and learn from experts and each other. ACVP members have long recognized their professional society to be “one of the best kept secrets for professional development”. We are excited about the chance to share this dynamic organization with others committed to improving healthcare for cardiovascular patients everywhere!

A Globally Respected Reputation

When you join the Alliance of Cardiovascular Professoinals (ACVP), you’re joining an organization respected throughout the world as an authority on Cardiovascular Management and Practice. We have almost 50 years of continuous service representing cardiovascular professionals across the country. Our membership consists of over 3000 individuals specializing in all areas of cardiovascular practice: echocardiography, invasive, noninvasive, cardiopulmonary and management. We also represent all levels of practice: administrators, managers, supervisors, nurses, technologists and technicians.

Strength from Diversity

ACVP’s strength lies in the fact that we have combined all the cardiovascular specialties and disciplines. Th is diversity provides a rich source of networking possibilities for you, as well as a strong voice in the fi eld.Th ere are distinct advantages to belonging to an organization that includes professionals from many

diff erent fi elds. ACVP has become a unique catalyst for multi-skilling and cross training. Information and learning also takes a leap forward.

Professional recognition…credentialing and accreditation…reimbursement and revenue changes...mergers and acquisitions...the changing healthcare environment...the global economy…

More than ever, ACVP can help you meet challenges, fi nd opportunities, survive and succeed in a dynamic, turbulent fi eld. And today is the best time for you to join, as ACVP off ers powerful new member services, expands its most popular programs and boosts its profi le as a key player in healthcare. Once you join ACVP, you’ll discover that membership is just the start!

Network to Increase Your Bottom Line

You will profi t from others’ experience as you make valuable career connections with people who understand your desire for personal, as well as professional fulfi llment. Th rough local events, national conferences, and chapters, you’ll meet friends, allies and insiders from hospitals, clinics, physician offi ces, supplier corporations, research institutions, educational programs, and consulting groups. Whether you’re looking for peers support or market data...job leads or promising talent...insight on new technologies or state regulations, you can count on ACVP.

Take Charge of Change with ACVP’s Annual Conferences

Job security. Healthcare management. Managing Stress. Managed care. Networking. Th ese are some of the

pressing issues explored in ACVP’s Annual Management Conference held each year immediately preceding ACC. ACVP also hosts webinars throughout the year as well as partners with other organizations in providing meetings and seminars all year long. Th e result is over 200+ CEUs for members.

Benefi t from New, ImprovedPublications

Our members cite publications as being a leading benefi t. It is no wonder why — with over 26 periodicals provided to our members annually, ACVP is a rich source for information, cutting edge technologies and provocative approaches. CP Digest — Our bi-monthly newsletter takes a fresh approach to presenting member news and views, trends and issues as they pertain to professionals in our fi eld.Cardiovascular Standards & Competencies — Th is multi-organization endorsed publication provides you with a guideline for practice and a commitment to excellence. Advance — a radiology management publication off ered by our partner, Merion Publications.Cath Lab Digest — an invasive publication to which ACVP contributes monthly. All members may receive this complimentary of HMP Communications.Monographs & Study Guides — Th is material off ers you an opportunity to review information, learn new concepts, prepare for exams and maintain handy reference materials.Specialty Publications — Th ese technical publications provide detailed and indepth information and trends in the ACVP member specialty areas including: Th e Beat Goes On for noninvasive/echo professionals; Heart to Heart for invasive professionals; Strategies for management professionals and CV Educator for educators.

ACVP OverviewCARDIAC SOCIETIES


And of course, now CORONARY HEART!

Capitalize on Your Leadership Potential and Gain Valuable Insight into All Areas of Practice

To help members gain leadership experience, ACVP off ers several options. You can participate in ACVP governance through committee work. ACVP committees are charged with the responsibility of developing projects and programs geared towards the benefi t of the entire membership and ultimately, the profession.You can participate in the leadership through Specialty Councils. Th e Councils are responsible for developing tools and products geared towards the specialists represented in that council. Members can also participate in the House of Delegates. Th is body is composed of representatives from the chapters within ACVP. Th e House provides recommendations for activities, policies and projects to the Board of Directors. You can get involved at the highest levels through board participation. With Vice Presidents representing various functional areas including: Membership, Advocacy, Marketing and Education.

Increase Your Market Value: Training & CEUs

With ACVP’s exclusive programs, you’ll fi nd great opportunities to improve your presentation skills, management abilities and overall self-confi dence. You will have the chance to exchange ideas, hear the latest information and discuss current practices. ACVP sponsors more CEUs per year with reviews, teleconferences, workshops and webcasts. ACVP’s unique transcript service also provides members with a complete annual print-out of sessions attended

and CEUs earned throughout the year. Th is transcript is recognized by licensing board and credentialing organizations.

An Alliance of Cardiovascular Professionals

If you are...managing all or portions of a cardiovascular program...a cardiovascular practitioner...involved in cardiovascular educational or training programs...researching in the area of cardiovascular medicine...consulting in the cardiovascular arena...promoting equipment or technology for cardiovascular services...a member of another cardiovascular organization...you are invited to become a member of an integrated professional organization that provides educational programs, as well as resources for information related to cardiovascular healthcare.Membership activities include research projects, developing guidelines and standards, providing information in all areas of specialty, representation

of YOU, and providing members with tools and opportunities for development and advancement.

TOGETHER WE CAN MAKE A DIFFERENCE IN CARDIOVASCULAR SERVICES DELIVERY TODAY!

Categories of Membership

Regular membership—managers/administrators/supervisors of cardiovascular programs and/or consulting based groups; credentialed professional or licensed healthcare practitioner; practicing in the fi eld of cardiovascular medicine and/or management.Associate membership — associated with cardiovascular medicineStudent membership — enrolled in a recognized healthcare program.Visit us online at www.acp-online.org for more information about programs and benefi ts.

When you thrive in an intensely challenging but rewarding work environment,you follow the high road no matter where it takes you. For the nurses andAllied healthcare professionals who work at DEBORAH Heart and LungCenter, “The High Road” took them to Browns Mills, New Jersey, just aheartbeat away from Philadelphia, the Jersey Shore and Trenton.

DEBORAH is a leader in tertiary care services and is the only specialtyhospital in the region focused exclusively on cardiac, pulmonary, andvascular diseases. Our staff works in an environment typically found in auniversity-based setting, but with a positive employee culture more like atraditional community hospital.

A full service Cardiac Catheterization Lab, Electrophysiology Lab, Non-InvasiveCardiac Lab, Interventional Radiology and CT Scan and various clinics,including Pacemaker, Heart Failure and Endovascular are just some of theareas where our experienced staff demonstrates their expertise.

Deborah is known for its state-of-the-art equipment, cutting-edge clinical services, environment of clinical education and support,and outstanding patient and staff satisfaction. Our clinical outcomes,patient and staff satisfaction consistently rank among the best in the country.

Looking to take “The High Road” in your career? Please go to www.deborahcareers.org/CH

to view our current openings.

EOE

LOOKING TO TAKETHE HIGH ROAD

EMPLOYMENT ADVERTISING


United States of America May / June 2007

RecruitmentAdvertisingRates

RecruitmentRecruitment

Online only:

Magazine + Free Online:

$150 for 30 days + hypertext link

1 Column (2.4”)= $50 per inch1/4 Page = $4001/2 Page = $600Full Page = $1000

COLOR no extra cost

[email protected]:

Why Pay More?

Prices are Net and do not include agency commission


EMPLOYMENT ADVERTISING United States of America May / June 2007

Valley View Hospitalis looking for a few good

CATH LAB RNFull-time position available in our Cath Lab. Required: ACLS and RN, with 5 years of experience. Preferred: Cardiac and peripheral experience.

We offer an excellent compensation package that includes health/dental coverage, a pension plan, 22 paid days off per year, daycare availability, discounted ski passes, and more.

Apply online using our new application system!If you have not checked us out lately, be sure to go to

www.vvh.org.EOE

Valley View Hospital1906 Blake Avenue • Glenwood Springs, Colorado • 970.945.6535

heartsPLANETREE

Dedicated professionals who arecaring and compassionate people.

t Valley View Hospital, an 80-bed, full service community hospital, all of our patients are lucky enough to benefi t from our Planetree philosophy of patient-centered care. A holistic approach

to healing, it combines conventional medical therapies with alternative therapies and therapeutic massage to maximize healthcare outcomes.Our community hospital is located halfway between Vail and Aspen and a three-hour drive west of Denver in scenic Glenwood Springs, Colorado. Our community is nestled in the Rocky Mountains where life is exhilarating and recreation is plentiful. Here, you can explore the Glenwood caverns, camp, hike, bike, ski, raft, kayak and fi sh. If you’d like to be part of our progressive and exciting healing environment, join us for a rewarding future.

A meaningful mission, an exceptional workplace

Lancaster General Hospital, a 590-bed healthcare provider ofchoice in Lancaster, PA, is surrounded by rich culture; excellentschools and universities; endless outlet shopping; sports teams;and family-friendly recreational attractions sure to delight everyage group. We are only 1-3 hours away from NewYork City,Philadelphia, Baltimore andWashington, DC. With close to ahalf million people living in our community, Lancaster Countyoffers a remarkable lifestyle for employees and families.

EP PROGRAM COORDINATORWill work collaboratively with the EP Physician, EP staff, EP Director, andCardiac Surgeon to develop cardiology programs for A-fib and cardiac re-synchronization therapy that address the complex needs of the electrophys-iology patient. The qualified candidate will have certification or licensure as acardiovascular invasive specialist, registered radiology technologist or be aregistered nurse with current licensure. HRS preferred and CPR/ACLS

certification required with 2+ years of prior Lead EPTechnician experiencein a high volume EP program. Must have excellent skills in communication,

project management, data collection and outcomes analysis.Contact Sue Martin at (717) 544-4475.Email: [email protected].

EP TECHNOLOGISTExciting, fast paced opportunity for an experienced EP, interventionalcardiovascular, radiology tech or RN with a critical care background.We will provide a 22-week internship of clinical and didactic educationin the field of electrophysiology and cardiac devices. FT dayshift position.

Contact Sue Martin at (717) 544-4475.Email: [email protected].

CARDIOVASCULAR INVASIVEPROGRAM COORDINATOR/INSTRUCTOR

A vital member of our College of Nursing & Health Sciences, you will coordi-nate the cardiovascular invasive program and provide supervision and instruc-tion to our students. The qualified candidate will have a Bachelor’s degree orequivalent experience in invasive cardiology, and certification in the specialty.

Two years of clinical/work experience in invasive cardiology required.Contact Sharon Graver at (717) 544-4104.Email: [email protected].

We offer competitive compensation, and generous benefits includingmedical/dental and a fully funded pension plan. EOE

excellenceI S J U ST THE BEG INN ING .

CONSIDER BEING PART OF OUR TEAMWHICH PERFORMS OVER 3,600 PROCEDURESA YEAR IN FOUR STATE-OF-THE-ART EP LABS.

See more careers in Cardiology

www.LancasterGenera l .org

Details at:

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- J. Brandt, Department Manager, Medina Hospital, Ohio

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