The George Mason University-Inova Health SystemTranslational Research

Centers, a unique partnership betweentwo respected Northern Virginia institutions, is poised to pave the wayfor accelerated, cutting edge ‘bench tobedside’ research. Internationallyrenowned scientists who embraceinnovative technologies and engage incollaborative efforts with clinicalinvestigators will ensure that medicalcare keeps pace with advances inbiomedicine.

The initiative comprises theresearch efforts of the Center forApplied Proteomics and MolecularMedicine, the Center for BiomedicalGenomics and the Center for theStudy of Genomics in Liver Diseases.The centers will coordinate multipleprograms to apply the advances arising from novel and exciting proteomics, nanotechnology, andgenomics technologies to the develop-ment of improved diagnostics, prognostics and therapies for cancer,metabolic syndrome, and cardiopul-monary, liver and neurodegenerativediseases. “We are excited that George

Mason University and Inova HealthSystem are working together to devel-op technologies to enhance treatmentfor people with cancer, diabetes, liverdisease, and other conditions that areincreasingly prevalent in our society,”says J. Knox Singleton, president andchief executive officer, Inova HealthSystem. “We’re honored that the newfrontier in translational medicine isright here in Northern Virginia.”

These translational research pro-jects address the genomic, proteomicand clinical aspects of a single diseaseand represent the future of medicine.

Until recently, researchers seeking a treatment for a disease may havetested hundreds of drugs individuallyover years. Now targeted therapy canbe tested simultaneously on thousandsof genes and dozens of protein net-works in days, greatly accelerating the elimination of drugs with obvioustoxicity while identifying those withpotential efficacy.

The GMU-Inova partnershiptraces its roots to the Center for theStudy of Genomics in Liver Diseases.

GMU-Inova Translational Research Centers to Advance ‘Bench to Bedside’ Research

GMU-Inova Research, continued on page 10

SUMMER 2005

Vol. 33 No. 3

A Newsletter for Physicians of Inova Fairfax Hospital and Inova Fairfax Hospital for Children

Zobair M. Younossi, MD, MPH, (far right) co-director of GMU-Inova Health SystemTranslational Research Centers, speaks with Lance Liotta, MD, PhD, co-director,Center for Applied Proteomics and Molecular Medicine; Emanuel F. Petricoin,PhD, co-director, Center for Applied Proteomics and Molecular Medicine; and Vikas Chandhoke PhD, associate dean of Research, College of Art and Sciences,GMU, and co-director, GMU-Inova Health System Translational Research Centers.

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Commonwealth University School of Medicine. This campus wasapproved, as well, by the LiaisonCommittee on Medical Education,which included representatives fromthe AAMC and the AMA.

In my view, this is a very impor-tant milestone in the development of our hospital from what began as arelatively small community hospital in the 1960s to our becoming a signif-icant academic medical center.Needless to say, there will be benefitsfor all of the parties in this relation-ship. The VCU School of Medicinewill have students who will enjoy aclinical experience with a focus bothon primary and tertiary care in a community setting that the main campus in Richmond could not byitself adequately provide. Anotherbenefit is a larger and broader patientbase. The students themselves willbenefit from this affiliation as well.The AAMC reports that student surveys from other regional medicalcenter campuses in the nation consis-tently show that the students rate theeducational experiences provided atthese campuses as good as, if not better than, the educational experi-ences at their primary medical schoolteaching hospitals. Inova FairfaxHospital and Inova Fairfax Hospitalfor Children will benefit from anaffiliation that will surely enhance our stature as a medical center. Thisshould also lead to better recruitmentof residents and eventually of fellowsin our teaching programs.

Currently, we have 60-70 medicalstudents from a number of medicalschools performing a small number oftheir clinical rotations at our hospitalat any one time. In addition, we have 167 residents in many different

specialities with us as well. Our current teaching program is strongand it will be significantly strength-ened by this new affiliation with theVCU School of Medicine. In thisstrengthened academic environment, I believe that we physicians will enjoya more gratifying academic milieuwhich should give us the opportunityto further enhance our own continuingmedical education. We expect to see a strengthening of the patient careenvironment as well. This will begood for us all.

In the last issue of Medifax thelead article focused on the newClaude Moore Health EducationCenter. One of the several purposes of the new center will be to housefacilities for the VCU School ofMedicine, including the administra-tive offices, classroom space, and a simulation center for the students.Prior to the opening of the ClaudeMoore Center, the students will bebased in the renovated ground floor ofthe ECC building. As you may know,Russell Seneca, MD, is the associatedean and Craig Cheifetz, MD, is theassistant dean of the Inova branch ofthe VCU School of Medicine.

The advent of our regional campus status, in my view, codifieswhat we already believe about ourselves, that, while we came fromhumble beginnings which many of uswere part of, we have now matured to become a significant teaching hospital.

Welcome VCU School of MedicineClass of 2007

In August, we will see new faceson the patient care units andthroughout Inova Fairfax Hospital

and Inova Fairfax Hospital forChildren. Twenty-four third year students from the Virginia Common-wealth University (VCU) School ofMedicine in Richmond will be start-ing their clinical clerkships at ourhospital. By the fall of 2006, the fullcomplement of 48 medical studentsfrom the VCU School of Medicinewill be located on our campus.

These third and fourth year medical students will be serving all oftheir clinical rotations with us. Thethird year students will have rotationson Surgery, Medicine, Pediatrics,Family Practice, Obstetrics andGynecology, and Neurology. Thefourth year for the students will bemostly a year of electives. In Augustwe will officially become a “regional”or “branch” campus of the VCUSchool of Medicine. When this happens, 27 of the 126 U.S. medicalschools will have one or more branchcampuses. The number of regionalcampuses will probably continue toincrease across the nation. These campuses, such as ours, will “ineffect, be mini-medical schools lack-ing only basic science instruction”according to the Association ofAmerican Medical Colleges (AAMC).

The process of our becoming aregional campus began in 1999 whenrepresentatives of the VCU School ofMedicine and Inova Fairfax Hospitaland Inova Fairfax Hospital forChildren began working in earnest toestablish this branch campus at ourinstitution. In the spring of 2002, thestate legislature of Virginia and thegovernor authorized the creation ofthe Inova campus of the Virginia

F. Joseph Hallal, MD Medical Staff President

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M E D I FA X S U M M E R 2 0 0 5 3

Dr. Binder Honoredat Gala 2005

Richard Binder, MD,accepts the 2005 Caring forand About People Award.

As part of this year's Inova HealthSystem Gala 2005 to support InovaCancer Services, three outstandingchampions of Inova's not-for-profithealth care mission were honored onMay 7.

Richard Binder, MD, was therecipient of the 2005 Caring For andAbout People Award. Dr. Binder hasbeen an integral part of Inova HealthSystem Cancer Services for 30 years.He was instrumental in developingand supporting community partner-ships, including work with the AvonFoundation and the Colon CancerGreen Team. Dr. Binder also helped to develop the genetic counseling program at Inova Fairfax Hospital,helping people with a personal orfamily history of cancer obtain information about genetic testing andcancer risk-reducing options.

This year's Community Responsibility award was given toPricewaterhouseCoopers, LLP, and theInnovation Award was given to theAvon Foundation.

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All Inova Facilities Earn FullJCAHO AccreditationFrom: Gregory BurfittTo: Inova_AllDate: 6/30/2005 3:13:38 PMSubject: Announcement of JCAHO's Decision

Iam pleased to announce that we received official word today thatall Inova facilities have earned full accreditation and the Gold Sealof Approval™ from the Joint Commission on Accreditation of

Healthcare Organizations (JCAHO). A team of JCAHO physicians,nurses and other clinical experts independently reviewed each ofInova’s hospitals and long-term care facilities in April and May. As you know, we participate in the JCAHO accreditation survey processbecause it reinforces our commitment to continuously improve and be a learning organization.

I want to take this opportunity to thank you and your staffs foryour hard work during these surveys. Literally, thousands of Inovaemployees and physicians spent many, many hours preparing for, par-ticipating in and supporting this effort. And, this was the first time weexperienced the tracer methodology, so that added more anxiety thanusual. We will continue to be diligent in our preparation as we moveforward, as all JCAHO visits will be unannounced in the future.Additionally, I am confident that our learnings from the review processwill be hard-wired, enabling Inova to improve upon its already strongfoundation and patterns of practice.

Throughout the survey, we heard many positive comments from the surveyors about our staff, patient care and how well they (the surveyors) felt they were treated. The surveyors were particularlyimpressed with the knowledge of front-line clinical staff and comment-ed frequently that the tracers had gone so well because of the greatinterviews with nurses, techs, therapists, and other caregivers. Ourbuildings and environment of care services were also given specialrecognition. The Engineering and Administrator surveyors were veryimpressed by the knowledge, skills, and initiatives of our engineeringstaffs across the system. Two Inova forms - the restraint monitoringform and the long term care resident safety assessment form - werecited by the surveyors as best practice and may be included in JCAHOreference materials for accredited organizations. These were just a fewof the many compliments we received.

So, hats off to all of you—our employees, physicians and volunteers—for helping bring world-class health care to our community! We can all be proud of the results of our efforts.

Gregory BurfittExecutive Vice President and Chief Operating OfficerInova Health System

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In May, Inova Fairfax Hospital,Inova Fairfax Hospital forChildren and the Inova Heart and

Vascular Institute participated in thetriennial JCAHO survey. We hosted11 surveyors during the five-dayreview, which represented our firstexperience with the tracer methodolo-gy (following patients through thecare process).

I acknowledge the many hoursphysicians, staff and Inova employeesspent preparing for and participatingin this effort. Senior leadership and Ithank you for your support.

During the survey, it wasextremely gratifying to hear manypositive comments. It is my pleasureto share some of this feedback withyou:

• the knowledge of front-line clinicalstaff is impressive

• the tracers went well because of thegreat interviews with nurses, techs,therapists, physicians and othercaregivers

• two Inova forms—‘restraint moni-toring’ and ‘resident safety assess-ment’—were cited as best practiceand may become part of JCAHOreference material for accreditedorganizations

• we deal exceptionally well withchallenges presented by culturaldiversity, ‘hospitals within hospi-tals,’ wide-range of services, patientflow and ED overcrowding as wellas staff retention

• building and environment of careservices deserve special recognition

I am proud to say that on severaloccasions, and in a variety of care set-tings, the surveyors mentioned theywould feel comfortable seeking carefor themselves or a loved one at our

facilities. I am sure you will agreethat this is the highest compliment wecould hope to receive. Again, I thankand congratulate all of you for yourhard work and dedication.

Every survey presents opportuni-ties for improvement as JCAHO andothers continue to “raise the bar”.Public scrutiny also is on the rise, and the public’s expectations of us aresignificant. By increasing our efforts,we will maintain our proud traditionof providing the highest quality careand become the very best.

JCAHO’s requirements forimprovement (RFI) reflect some areaswe were already working on and identify others that are new. The RFIsthat impact medical staff includeissues with the following:

• complete and correct medicationorders

• completeness of boarding passes• procedure pause in moderate

sedation cases• timely operative report dictation

It is apparent that failure touphold the standards of care theseRFIs address will have serious impli-cations. These RFIs must beaddressed promptly and uncondition-ally for us to maintain full accredita-tion.

The Medical ExecutiveCommittee, in their June meeting,decided that the medical staff mustcommit to 100 percent compliance tomeet the above requirements. Thecommittee asks that physicians takethe following actions:

• Dictate operative/procedure reportsimmediately after the procedure(i.e., before the patient goes to thenext level of care).

• Ensure that all medication ordersare legible and include dose, fre-quency, date, time, signature, InovaID number. Never include “do notuse” abbreviations or range ordersfor the frequency of administration.Review orders for completeness andaccuracy with the RN, when possi-ble. If clarification or correction isneeded, nursing will contact thepractitioner.

• Fully complete the ‘boarding pass’prior to any surgery or invasive procedure.

• Conduct a procedure pause prior tothe administration of moderatesedation.

The fact that the Inova hospitalson the Fairfax campus are staffed by ateam of smart, dedicated and caringphysicians and other providers wasone of the main reasons I accepted theposition of administrator. Now I haveevery confidence we will seize theopportunity to learn from our recentJCAHO survey and emerge providinga higher level of quality care.

Thank you again for all of yourefforts in conjunction with theJCAHO survey. Senior leadership andI look forward to working closelywith you. Together we will achieveour mutual goals.

Please call me at 703-776-3332with your suggestions and/or concerns.

JCAHO Results Positive

Doug Cropper Administrator, Inova Fairfax Hospital,Inova Hospital for Children and Inova Heartand Vascular Institute

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Altieri AwardDeborah Archer, MD, far left,third year resident, was given thefirst Michael Altieri, MD, annualaward on June 16. Dr. Archer ispictured with Rose Altieri, ImoIbia, MD, and David Ascher,MD, chair, Department ofPediatrics. Dr. Altieri is a formerchairman of Pediatrics who diedin 2004.

of life and function. Palliative carealso increases hospital efficiency. Bysupporting the work of intensivists,palliative care specialists help movepatients along the continuum of care,reducing ICU and overall length ofstay, thus making beds available sophysicians may continue admittingpatients.

“Palliative care increases patient,family and physician satisfactions,”Dr. Muir says. “Programs also help hospitals meet accreditation standards.”

Dr. Muir is president of CapitalPalliative Care Consultants, the onlyoffice-based palliative care practicethat serves patients in hospitals, nursing homes, assisted living orlong-term care facilities and at homethroughout Northern Virginia,Washington, DC, and suburbanMaryland. The practice has extensivefellowship training in palliative medicine and is an arm of CapitalHospice, which has served the areasince 1977.

Physicians may request a pallia-tive care consultation, or patients and their family can self-refer. “Weconsider it a privilege to be ‘invited to

Palliative Care Offers Treatment Options forProgressive Chronic Illness

People with progressive chronicillness who may one day needthe full spectrum of hospice

care often require pain and symptommanagement. And family memberswho must navigate the medical system while suffering the emotionaldistress of watching a loved onedecline also may need specializedcare. Physicians managing this popu-lation face the challenge of meetingthe difficult and time consumingphysical and psychosocial needs ofpatients and families.

Physicians specializing in pallia-tive care can bring a substantial measure of relief to chronically illpatients, their families and theirphysicians. “There exists a tremen-dous unmet need in our communitylong before the ‘six months or less’prognosis,” says J. Cameron Muir,MD, a physician board-certified ininternal medicine, medical oncologyand palliative medicine, who consultsat Inova Fairfax Hospital. “Improvingaccess to palliative care has a positiveimpact that extends beyond patientsand their caregivers.”

It has been documented that early palliative care improves quality

the dance,”’ Dr. Muir says. “Howeverwe never consult on a patient withoutan order from the primary physician.”

Palliative care often providesexpertise and support in conjunctionwith curative care. Round-the-clockcoverage facilitates access to servicesand relieves referring physicians of time-consuming patient/familycommunication.

“We are eager to emphasize thatour services are a consultation, not a takeover,” Dr. Muir explains. “Andthey never compromise revenue forreferring physicians.”

At a minimum, consultationsinclude the patient, the patient’s primary medical decision maker, thepalliative care consultant and the palliative care nurse practitioner.Ideally, the referring physician alsoparticipates. In some instances, onlyan initial consultation is needed. Themajority of cases require a number offollow up visits.

For more information aboutappropriate palliative care options,speak to a nurse case manager or call Inova’s physician referral number—703-204-3366—to requesta consultation.

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Leigh Hume, RN, MN

Respiratory Program Manager

HealthSource

Whether your practice caters to adults or children,choosing the correct

delivery device can play a critical rolein effectively treating asthma. Thethree mainstays for delivering asthmamedications are:

• nebulizers• pressurized Metered Dose Inhalers

(pMDI)• dry powder inhalers (DPI).

The amount of medicine delivered to the lung using any one of these devices can vary from one to40 percent, depending on a multitudeof factors. Narrowing this variance byoptimizing drug delivery allows thephysician a clearer picture of howwell a patient is responding to a prescribed regimen. Understandingthe factors that cause these varianceswill assist the physician in both pre-scribing the right delivery device andeducating the patient on the impor-tance of proper inhalation techniques.

Nebulizers require minimal coor-dination to administer medicationproperly. Poor coordination, however,is not the only factor related to poordrug delivery. Output from a nebuliz-er can be reduced 50 percent if notwashed properly. For optimum deliv-ery, nebulizers should be washed insoapy water, rinsed and dried betweeneach use and cleaned daily with onepart vinegar and four parts water. Inthe pediatric population, commonpractices that can result in less thanone percent of medication reachingthe lungs is the “blow by” techniqueand administering a nebulized treat-ment while a child is crying. Cryingis a prolonged exhalation, followed

by a rapid, shallow inspiration, thusallowing no medication into the respiratory tract.

A more time efficient alternativeto the nebulizer is the metered doseinhaler. Once activated, medicinefrom a CFC pMDI travels between60-90 mph. As a result, as little asfive percent of medicine can bedeposited in the lung and as much as80 percent to the oropharynx, thusincreasing systemic absorption. ApMDI with a valved holding chamber(Aerochamber™) “slows down” thedelivery process and can increaselung deposition to 15-30 percent andreduce oropharyngeal deposition to 15percent. If patients wash their holdingchamber before its first use, reducingthe electrostatic charge, the half lifeof respirable particles in the holdingchamber can extend beyond 10 seconds, allowing for optimal inhala-tion. Thus, the purpose of a holdingchamber extends beyond assistingyoung children with limited coordina-tion skills, and should be prescribedwith any age population.

Because of environmental concern, CFC pMDIs will soon bephased out and replaced with HFAinhalers and dry powder inhalers(DPI). Patients tend to prefer DPIsbecause they are less complicated touse than a pMDI and require fewer“puffs” than the MDI. DPIs weredesigned to deliver more medicine tothe lung than pMDI, but this can onlyoccur if the patient has a sufficientinspiratory flow rate. The most mod-ern DPI’s require a fairly low inspira-tory flow rate to be effective. Mostadults and healthy children over fivecan use the Turbuhaler (AstraZeneca)since it requires an inspiratory flowrate of ≥ 60 L/min. The Diskus(GlaxoSmithKline) requires an inspiratory flow rate of ≥ 30 L/min. A potential problem with DPIs is

Correctly Delivering Asthma Medicine Critical to Effective Treatment

exhaling into the device prior toinhalation, which can result in anempty dose. Humidity is also a potential problem since it candecrease output.

An added benefit of the DPI isthe dose counter, which lets thepatient know how many doses are leftat any given time. Most patients usingan MDI are under the misconceptionthat if they are able to hear airflownoise or “feel” medication when shak-ing the canister, there is medicationstill available. In reality, patients whouse an inhaler until it no longer makesa sound when actuated, have inhaledmore then 40 puffs with little to nomedication. In addition, “floating” thecanister to determine whether aninhaler still contains medicine has nomerit. Researchers found that eachbrand of inhaler has its own distinc-tive floating pattern regardless of content. The only way to determine if a CFC pMDI has medication is tocount puffs. The AmericanRespiratory Alliance has developed a“Scratch-A-Dose” card that sticks onthe inhaler. The card provides patientsan easy way of tracking doses.

The margin for error when usinginhaled medications far exceeds thatof oral medications. Educatingpatients on some of the concepts mentioned above could significantlyimpact their response to medicationsand ultimately improve control.

For further information on educating the asthma patient, callInova HealthSource at 703-208-5606.The HealthSource CARE(Community Asthma Resource and Education) program provides education services to both physicianoffice staff and the community.

NICU check presentationRobert Beck, MD, Kathleen Schaffer, RN, and Jerrod Ullah, RN,thank Lee Brown for his $5,000 donation in honor of his fifth birthday inJune. His parents Leonard and Diane Brown are on the right.

M E D I FA X S U M M E R 2 0 0 5 7

brain,” Dr. Leiphart says. “Patientsoften can resume activities abandonedfor years and enjoy a greatlyimproved quality of life.”

Parkinson’s patients who maybenefit from DBS are those withtremor uncontrolled by medicationand those with symptoms that respondto medications yet who experiencesevere motor fluctuations, includingwearing off and dyskinesia.

Beneficial effects of DBS havebeen shown to last for several years.Most patients can drastically reducetheir levodopa dosage. Patients withdyskinesia due to their medications,experience over 80 percent reductionin their involuntary movements.Patients who initially responded wellto medications, but over time devel-oped side effects, may experience 60-80 percent improvement in tremor andslowness of movement. Patients onaverage report a 50 percent improve-ment in walking and balance. For

Deep Brain Stimulation for Parkinson’s Patients

Deep brain stimulation (DBS),which uses high frequency,pulsatile, electrical stimula-

tion to mimic the effects of ablativesurgery without destroying tissue,offers an exciting treatment option forcertain Parkinson’s patients.

“Deep brain stimulation is thebiggest breakthrough we’ve seen fortreating Parkinson’s disease indecades,” says James Leiphart, MD,PhD, a neurosurgeon practicing atInova Fairfax Hospital. “And if evenmore advanced therapies becomeavailable, the DBS procedure can beeasily reversed.”

The DBS system consists of astopwatch-sized neurostimulator, alead and an insulated wire that ispassed under the skin of the head,neck, and shoulder to connect thetwo. The lead is implanted in the tar-get area of the brain through a smallopening in the skull. The neurostimu-lator is implanted under the skin nearthe collarbone.

Prior to the procedure, MRI orCT scanning locates the precise target- thalamus, subthalamic nucleus orglobus pallidus - where abnormalelectrical nerve signals underlie theParkinson’s symptoms. The patient isawake during the procedure.Microelectrode recording monitorsthe activity of nerve cells to confirmoptimal lead placement and togetherwith macrostimulation provides physi-ological verification of the target.

The stimulator is implanted undergeneral anesthesia either at the timeof electrode implantation or later.Within a few weeks, neurologists pro-gram the neurostimulator and makeadjustments, as needed, to optimizesymptom control.

The system is generally very welltolerated with no significant changein brain tissue around the electrodes.

“DBS allows us to interfere withthe signals that cause debilitatingsymptoms without damaging the

some, neurostimulation alone cansuppress dyskinesia.

Risks associated with DBSinclude a two to three percent chanceof brain hemorrhage that may beinsignificant or may cause paralysis,stroke and speech impairment and a15 percent chance of a minor or tem-porary problem. Infection, whichoccurs rarely, may require removal ofthe electrode, but does not cause last-ing damage.

Disadvantages associated withDBS therapy include equipment fail-ures, such as fractures or erosion, andadditional surgery required for batteryreplacement.

DBS requires time and effort onthe part of the patient and the medicalteam for programming and medica-tion adjustments to achieve optimalsymptom control.

For more information about deepbrain stimulation, Dr. Leiphart can bereached at 202-741-2750.

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Online Medical Abbreviation Resource Available

Medical abbreviations are adouble-edged sword – theycan save time, but they can

also be misinterpreted. The InovaFairfax Hospital Health SciencesLibrary introduces the online compan-ion to an Inova Fairfax Hospital stan-dard, Medical Abbreviations: 26,000Conveniences at the Expense ofCommunication and Safety, by NeilDavis. This resource can assist physi-cians and staff in recognizing com-monly used medical abbreviations andincludes Inova Health System’s “Do

Not Use” list – abbreviations thatmust be avoided to help ensure patientsafety.

You can access MedicalAbbreviations from any computerworkstation within the hospital. Fromthe InovaNet home page, click on“Manuals/References” on the leftside, then click on “Safe MedicalAbbreviations [Neil Davis]” under the “Clinical” heading. This will takeyou to the Medical Abbreviations Web site. Features on this site includeInova’s dangerous abbreviations and

dosage designations not to use (listedunder “Your Facility’s Do Not UseList”), other common dangerousabbreviations and dosage designa-tions, and an alphabetical abbreviationsearch. For more information on thisresource or other Library services callthe Inova Fairfax Hospital HealthSciences Library reference staff at703-776-3357.

Organ Donation Committee Recognized by HHS

enhanced through transplantation in2004. The award was given at the FirstAnnual Organ Donation NationalLearning Congress in Pittsburgh onMay 19, 2005.

Anyone interested in learningmore about the organ donation pro-cess at Inova Fairfax Hospital and

Members of the Inova Fairfax Hospital and Inova Fairfax Hospital for Children Organ DonationCommittee, left to right, are: Jamie Dubbs, RN, NSICU; Tori Scott, RN, TICU-Trauma ICU;Kimberly Stahl and Kenny Boyd, Washington Regional Transplant Consortium (WRTC);Elizabeth Duke, MD, administrator, Health Resources and Services Administration;Christopher Michetti, MD, Trauma Services; Marjorie Avery, RN, patient care director,TICU; Lori Brigham, CEO, WRTC; and Susan Hartmus, RN, NSICU.

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Members of the OrganDonation Committee, onbehalf of Inova Fairfax

Hospital and Inova Fairfax Hospitalfor Children, were recently awardedthe Department of Health and HumanServices (HHS) Medal of Honor forexcellence in organ donation rates.This honor was given to hospitalsacross the country that achieved theHHS goal of at least a 75 percent conversion rate in organ donation overa year. (Conversion rate is the numberof actual organ donors out of the totalnumber of eligible donors.)

Through its participation in thenational Organ DonationBreakthrough Collaborative over thepast year, the Organ DonationCommittee is dedicated to sustainingthis success by spreading the bestknown practices in organ donationthroughout the hospital. Only a thirdof the nation's largest hospitals metthe 75 percent goal, but the award willnow be given annually to those thatdo. Prior to the Collaborative, thenational average conversion rate was46 percent. But as a result of thisnational effort, a record breakingadditional 1,400 lives were saved or

Inova Fairfax Hospital for Children isencouraged to contact Tori Scott, RN,Trauma ICU; Margorie Avery, RN,PCD of Trauma ICU; Susie Hartmus,RN, Neuroscience ICU; orChristopher Michetti, MD, TraumaServices.

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There’s HELP for Older Patients Elder Life Program Aims to Improve Hospital Experience

With almost half of hospitalpatients being age 65 orolder, health care providers

at Inova Fairfax Hospital are takingmeasures to ensure excellent care forolder patients.

Being in the hospital can upsetnormal routines and activities. As a result, 25 to 60 percent of olderpatients will experience delirium or confusion, which can lead to func-tional and cognitive changes that canpersist for months and slow recovery.The Hospital Elder Life Program, orHELP, is being developed to improvetheir hospital experience by helpingthem to maintain their mental alert-ness and functional abilities.

A team of professionals andtrained volunteers will carry out interventions specially designed tomeet the needs of hospitalized olderpatients. Patients and families willalso have access to Joanne Crantz,MD, FACP, a geriatric specialist, and Deirdre Carolan, PhD, CRN, a geriatric clinical nurse specialist.During daily visits, volunteers offerassistance during mealtimes, walkwith patients, and engage in socialand mental stimulation activities.

In addition to benefiting olderpatients, The HELP program is alsovery beneficial for their family andfriends. A waiting room on the 10thfloor of Inova Fairfax Hospital isbeing set up as a geriatric communityresource room. Materials on caregiversupport, end-of-life issues, the latesttechnol-ogy and a directory of geriatric services offered in the community will be available for families.

Anyone 70 years and older whohas some risk factors for delirium orfunctional/cognitive decline can beevaluated for admission to this pro-gram. There is no charge for theseservices, and Inova encourages callsfor information or referrals.

HELP Goals

The primary goals of the HospitalElder Life Program (HELP) are:

• maintain cognitive and physicalfunctioning of high-risk older adultsduring hospitalization

• prevent delirium• maximize independence at

discharge• decrease LOS• prevent unplanned hospital

readmissions• increase patient and family

satisfactionFor more information about the

HELP program or to make a referral,call 703-776-6824 or e-mailsusan.heisey@inova.com.

HELP ServicesHELP volunteers provide these services to hospitalizedolder patients:

• communication/comfort—keeps patients aware, alert andoriented to their surroundingsusing hearing and vision equipment and orientationboards

• relaxation—promotes bettersleep by easing anxiety symptoms through breathingtechniques, music and massage

• therapeutic—offers stimulating activities for themind and body through exercise and help with walkingsocialization, card playing,puzzles and reading material

• meals—encourages healthyeating and drinking and offers companionship duringmealtimes

Medication OrderWriting for JCAHOCompliancePhysicians please note the following:

• The date and time must be on allorders.

• Your signature, Inova ID #, andprinted name must be on all orders.

• Write indication for PRN medications, i.e., prn pain, prnheadache, prn insomnia, and prnanxiety.

• Do not use abbreviations such asQD, QID, QOD, U, IU, AU, AS, AD,MS, MS04, MgS04, AZT, Nitrodrip.

• Do not use range orders for frequency of administration (use: q 4 H, do not use: q 4-6 H)

• Sign all verbal orders within 72hours.

• Post procedures and transfers. Donot write “Resume previous meds”.

• Rewrite all medications. Use theIDX/CARECAST ActiveMedication List order sheet.

Try to be as clear as possible withyour orders - This is mandatory forJCAHO compliance!

Thank you from the hospital administration and pharmacy.

Save the Date:Annual Medical StaffMeeting• Tuesday, Nov 8, 2005• Fairview Park Marriott,

Falls Church• Registration, 5:30 p.m.;

meeting, 6 p.m.

Election of officers and members-at-large. Nominationsmust be submitted to medicalstaff president by earlySeptember. More info to come.

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Established in 2000, the centergrew out of a research effort betweenthe Center for Liver Diseases at InovaFairfax Hospital and the GeorgeMason University genomics team tostudy the genetic epidemiology ofobesity-related nonalcoholic steato-hepatitis (NASH). Zobair Younossi,MD, MPH, a leader in clinicalresearch of liver diseases, includingNASH and hepatitis C (HCV), servesas medical director of the Center forLiver Diseases, which has conductedpioneering research in genomics ofobesity-related fatty liver, liver fibro-sis, obesity and metabolic syndromeand made more than a dozen presenta-tions. Based on the academic successof this type of research, it was time togo to the next level, Dr. Younossi says.

“The ability to conduct transla-tional research requires a basic science partner,” he adds. “It makesgood sense to partner with a universi-ty with an excellent basic scienceinfrastructure.”

The partnership with GMU putsInova ahead of the curve. “Patientcare, research and education are Inovapriorities, and academic and mediaexposure will enhance the image ofour health system as a leader in translational research,” Dr. Younossisays. “This integrated approach will certainly help our patients, our colleagues and our students.”

Dr. Younossi and VikasChandhoke, PhD, associate dean ofresearch for the GMU College of Artsand Sciences, co-direct the GeorgeMason University-Inova HealthSystem Translational ResearchCenters. Since its inception, they havealso co-directed the Center for theStudy of Genomics in Liver Diseases.

Dr. Chandhoke serves as directorof the Center for BiomedicalGenomics, which is dedicated toapplied genomic research inbiomedicine using microarray tech-nology, and the Shared Research

Instrumentation Facility at GMU. Healso leads the development of medicaland scientific research programs withmolecular bioscience and informaticsscientists who use synergistic junc-tures of cutting-edge applied research.Current studies include cancergenomics, genomics of liver diseases,cartilage studies, and development of large scale relational database inte-grating clinical and gene expressiondata.

"This partnership offers an integrated approach to translationalresearch where scientists and clini-cians work as a team to accelerate the latest research findings and tech-nologies directly to patient care," Dr.Chandhoke says.

George Mason University hasappointed Lance A. Liotta, MD, PhD,formerly of the National CancerInstitute, and Emanuel F. (Chip)Petricoin III, PhD, formerly of theFood and Drug Administration, to itsfaculty. The two pioneers in pro-teomics and molecular medicine willco-direct the Center for AppliedProteomics and Molecular Medicine.Research will focus on proteinbiomarker discovery for early diseasedetection and risk stratification aswell as molecular network analysis oftissue to create targeted treatment.

Much of George MasonUniversity’s success has resulted froma commitment to draw upon and contribute to our region.

“Our expanding partnership withInova Health System is one of thehighlights of several new innovativeinitiatives and is the basis for futurekey activities,” says Alan Merten,president of George MasonUniversity. “Our ability to attract

and support Dr. Liotta and Dr.Petricoin is possible only because ofthis partnership.”

Dr. Liotta and Dr. Petricoin willalso hold research appointments atInova Fairfax Hospital. “Translatingthe results of bench research directlyinto patient care through clinicalresearch and trials holds the promiseof a shift to personalized medicaltreatment,” says Douglas Cropper,administrator, Inova Fairfax Hospital.“The positive impact on healthcare ofthe George Mason University andInova Health System collaborationmay be far beyond what we currentlyenvision.”

Dr. Liotta and Dr. Petricoin havedeveloped technologies that can map

the hyperactive protein circuits in cancer cells from a biopsy specimen.Circuit mapping enables tailoringdrug therapy that targets individualaberrant circuitry. “Our new proteo-mic technology will be employed toeventually help the clinician knowexactly how the patient’s diseasedcells have changed, and then use thisinformation to tailor the treatment forthat specific individual,” Petricoinsays. “We are excited to work withInova Health System to bring thesetechnologies to the bedside as rapidlyas possible.”

Recently, Dr. Liotta and Dr.Petricoin discovered that a richarchive of protein biomarkers isbound to common blood proteins,such as albumin. These abundant proteins act as molecular ‘mops,’which by harvesting and amplifyingthebiomarkers, enable protein sequen-cing, a facile approach that can

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GMU-Inova Research, continued on next page

"This partnership offers an integrated approach to translationalresearch where scientists and clinicians work as a team to accelerate the latest research findings and technologies directly to patient care,"

— Vikas Chandhoke, PhD

M E D I FA X S U M M E R 2 0 0 5 11

uncover and identify thousands ofcandidate biomarkers that fluctuatewith disease stages. Simultaneousmeasurement of panels of multiplebiomarkers results in higher sensitivi-ty and specificity than does individualbiomarker measurement.

“We have uncovered a hugeuntapped repository of potentialbiomarkers that we never before knewexisted and in the future we can envision measuring multiplexed panels of these biomarkers,” Liottasays. “The goal is to improve diagnos-tic accuracy so we can detect diseaseearlier and provide better guidance forpatient management.”

Dr. Liotta and Dr. Petricoin have intersected this discovery withnanotechnology, using engineerednanoparticles as molecular harvestingagents to directly capture the disease-associated biomarkers. Once the disease is diagnosed and a tissue biopsy is obtained, the scientists’

GMU-Inova Research, continued from page 10

protein microarray technology canmap the protein circuitry. The pro-teomic ‘barcode’ of the circuitry ofthe diseased cells can then predict apatient’s response to conventionaltherapy. The technology also providesa roadmap for new drug combinationsthat may improve outcomes forpatients unresponsive to traditionalapproaches.

“The relationship between InovaHealth System and George MasonUniversity is a true paradigm shift,”Liotta says. “When our colleagueshear about the relationship and ourplans, they are very excited. We reallydo have an opportunity to do some-thing that no one else in the world hasbeen able to do.” Petricoin adds, “Alot of people and entities talk aboutpersonalized medicine, but this rela-tionship throws a gauntlet down thatsays, ’Hey we understand this is notan easy path, but we are really goingto do this.’”

The Center for AppliedProteomics and Molecular Medicinewill facilitate the translation of thisresearch into clinical trials conductedunder Inova Health System.

The creation of the GeorgeMason University-Inova HealthSystem Translational ResearchCenters is one of the most excitingrecent developments in the long-term collaboration between the twoinstitutions.

“The laboratory facilities andacademic environment of GMU, coupled with the outstanding clinicalset up at Inova has been key in attract-ing to our region some of the greatestscientists in the entire world,” saysDaniele Struppa, PhD, dean of theCollege of Arts and Sciences at GMU.“The work we will be doing with Drs.Liotta and Petricoin and their group ischanging the paradigm through whichwe understand cancer and othermolecular diseases. I would not besurprised if this was the beginning of an operation that within a decadedramatically changes the way inwhich we think about these diseases.”

Funding for the George MasonUniversity-Inova Health SystemTranslational Research Centers willcome from grants and contracts,strategic alliances with the biotechnol-ogy and pharmaceutical industries,technology agreements and royalties,as well as philanthropic donations.Laboratories and support facilitieswill be maintained at George Mason’sPrince William Campus in Manassasand at Inova Fairfax Hospital in FallsChurch. Additional scientists areexpected to join the centers withinfour years.

For more information on theTranslational Research Centers, contact Dr. Younossi at 703-208-6650.

PICU TourCraig Futterman, MD, Senator Jeannemarie Devolites Davis and David Sas, DO, tour-ing the Pediatric Intensive Care Unit at Inova Fairfax Hospital for Children on May 4.

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Inova Health System is a not-for-profithealth care system based in NorthernVirginia that consists of hospitals andother health services including emergency and urgent care centers, homecare, nursing homes, mental health andblood donor services, and wellness classes. Governed by a voluntary boardof community members, Inova’s missionis to improve the health of the diversecommunity we serve through excellencein patient care, education and research.

In This Issue:

• GMU-Inova Translated Research Centers

• Welcome VCU Class of 2007

• JCAHO Results Positive

• HELP for Older Patients

SUMMER 2005

Vol. 33 No. 3

A Newsletter for Physicians ofInova Fairfax Hospital and InovaFairfax Hospital for Children

Medical Staff PresidentF. Joseph Hallal, MD

AdministratorDouglas Cropper

EditorDenise Tatu

PhotographyAnne Ford DoyleDebra Troell

If you have questions or comments, call 703-321-2912. For more informationabout Inova Health System, visit our Website, www.inova.org.