F a l l 2 0 0 8

MD360ºContents:• AreYouReadyforaThree-Sixty?,2

• NewVPFostersCultureofQuality,2

• Growth,QualityandService Excellence,3

• TakePrideinYourPractice,4

• WorkingonHospitalPractice ManagementIssues,4

• VillaMarieClairetoSetStandard forHospiceCare,5

• MedicalStaffGuidetotheNew EmergencyCareCenter,6

• EmpoweringNurses,MagnetRecognition andBuildingRelationships,8

• TheMedicalSocietyofNJ,8

• BreastSurgeonErikaBrinkmann,9

• Korean-FriendlyMedicalProgram,9

• Women’sHealthPartners,10

• HNH’sDiabetesCenter,10

• DeepVeinThrombosis,11

• ClassicGolfTourney,12

• BookNews,13

• Urology—ThenandNow,13

• AboutNJPhysicians,14

• HandWashingandthePrimordial Soup,15

• Miscellaneous,16

MD360º is published quarterly by Holy Name Hospital’s Department of Marketing/Public Relations and is intended for use by the medical staff of Holy Name Hospital.

editorial staff: Jane F. Ellis, Vice President Marketing and Public Relations Jacqueline Brunetti, M.D. President of the Medical Staff Barbara Franzese Cron Communications Coordinator Marketing and Public Relations

Please e-mail all comments and contributions to: editorMD360@holyname.orgOr call Jane Ellis: 201/833-3129

premier

issue!

Medical Staff Guide to New Emergency Care Centerpage6

News for Holy Name Hospital’s Medical Staff

A “360º” goes all the way ‘round, taking in every perspective. And so it is with MD360º. This is the newsletter of Holy Name Hospital’s medical staff. It’s a mechanism for communication—doctor to doctor, hospital to doctor, doctor to hospital. If it impacts the way you practice medicine, we would like to feature it here: State and federal issues, new poli-cies and procedures, recommendations for efficiency and safety, office manage-ment issues, cutting-edge technology, new partners, fresh ideas. We’d also like to include material that’s on the lighter

side, such as movie, restaurant and show reviews; travel tips, getaway suggestions and book recommendations. Not to worry if you don’t like writ-ing—just pen it the way you’d say it. MD360º’s editorial staff will help pol-ish your article—but only if you make a request for this service. The newsletter will be available in print and electronic editions, and you can give us your feedback or make a contribution anytime by e-mailing editorMD360@holyname.org. So read on, and we hope to hear from you soon.

PaGE 2

Jacqueline Brunetti, M.D. is President of the Medical Staff and Medical Director, Department of Radiology at Holy Name Hospital.

> New Vp Fosters Culture of Qualityarol Dinsmore has joined Holy Name as the hospital’s Vice President for

Quality. She is responsible for the develop-ment, implementation and evaluation of quality programs and initiatives to support the delivery of high quality patient care. “In this day and age, to be successful, a hospital has to optimize patient safety and deliver the highest quality of care for its patients and physicians,” says Paul Mendelowitz, M.D., Senior VP and Chief Medical Officer. “In order to recognize this priority, Mike Maron has created a position that will function at the level of senior management to ensure that quality and patient safety is an absolute unequiv-ocal priority of this organization.” The intention, Dr. Mendelowitz notes, “is to create a culture of quality at Holy Name, and to weave quality and perfor-mance improvement into the fabric of how we do our work here every day.”

Unifying the quality function While the medical staff, nursing division and ancillary departments have always had effective quality improve-ment programs, now, all performance improvement projects, patient safety programs and quality initiatives will flow

from one central source and be served by a unified set of policies and resources, increasing their effectiveness. “We’re going to examine our current performance improvement processes and help staff and management to redefine those processes in order to attain our quality goals,” says Ms. Dinsmore. “I’m looking forward to working with each and every member of the medical staff and will need physician input on the issues that effect performance improvement.”

A rich background in hospital and performance improvement Ms. Dinsmore’s career in the health-care industry spans 34 years. She is a registered nurse, a certified profes-sional in health quality (CPHQ) and a certified case manager (CCM). For the last 11 years, she was Vice President of Administration-Operations/Acting C.O.O. in the Saint Barnabas Health-care System at Union Hospital. Prior to that, she was Assistant Vice President of Clinical Services at Union Hospital. Ms. Dinsmore began her career at Union as a staff nurse and, over a period of 21 years, advanced to positions of increas-ing responsibility until she became Union’s Director of Specialty Services and, subsequently, the Director of Quality Improvement. She is an adjunct professor at Kean University’s College of Public Adminis-tration, and a member of the American College of Healthcare Executives, the National Association for Healthcare Quality, and the Healthcare Quality Pro-fessionals of New Jersey. Ms. Dinsmore can be reached at ext. 7251.

froM the presiDent of the MeDicAl stAff

> Are You Ready for a Three-Sixty?

Giveusyourfeedbackormakeacontributionanytimebye-mailing

editorMD360@holyname.org

C

PaGE 3

This is MD360º, an opportunity for progress. As a vehicle for communica-tion between administration and the medical staff, and between physician colleagues, MD360º will feature news and issues that matter to you. Sharing important information that can impact your patients’ satisfaction with your practice, as well as your own satisfaction with Holy Name Hospital, is what this publication is all about. Your participa-tion—through contributions of story ideas, finished articles and general feed-back—will increase its relevance. In this inaugural issue, the hospital’s much-anticipated Emergency Care Center makes its introduction with some key points to help you navigate that new landscape (p. 6). I hope you’ve taken the opportunity to visit this amazing facility, which is one of the most progressive in the entire tri-state region. There’s definitely a “wow-fac-tor” here, and I have no doubt that your patients’ responses to the Center will be enthusiastic. Not only is the Center more than twice the size of our former ED, but it employs the kinds of best practices in design, staffing models and care delivery strategies that are going to facilitate faster, better service. Our goal is to minimize your patients’ wait times without compromising quality of care in any way. We continue to see our inpatient and Emergency Department volumes increase. In fact, we are on course to treat 47,000 ER patients through 2008, and with added support from our com-munity, physicians and first responders, we project that we’ll be treating up to 70,000 patients annually, beyond 2011. Converting this growth into profits is essential, and we remain focused on maintaining our long-term financial stability in an increasingly capricious industry. Other important renovation projects on the horizon include the creation of a separate radiology suite adjacent to the

Emergency Care Center for maximum efficiency, as well as the modernization of the Hemodialysis, Physical Reha-bilitation, and Cardiac Rehabilitation departments. And riding on the suc-cess of HNH Fitness in Oradell, which has nearly 2,500 members after only 20 months in operation, we’re exploring the opening of an on-campus medi-cally-based fitness facility. Earlier this month, a Vice President for Quality, Carol Dinsmore, joined our executive staff. This is an exciting new position that underscores my focus on the importance of maintaining the

highest standards of medical practice at Holy Name. Carol has 34 years in hospi-tals, and brings an intimate knowledge of the issues needed to distinguish Holy Name in this arena. More about Carol appears on pg 2. Achieving and sustaining outstand-ing clinical performance is essential to our future viability, as more emphasis is being placed on hospital quality measures by third-party entities. But “providing service excellence” can’t be

just a perfunctory buzz phrase in this highly competitive and customer-fo-cused market. At Holy Name, we try to live the mission, as evidenced by the recognition the hospital has consistently achieved over the last several years. For those of you who may not already know, I’m happy to report that Holy Name is among only eight hospi-tals in New Jersey and 269 nationwide to receive the Distinguished Hospital Award for Clinical Excellence from HealthGrades. This honor places us among the top five percent of hospi-tals in the nation—and we’ve received this citation for four consecutive years. We’ve also garnered the 2008 Health-Grades Specialty Excellence Award for stroke, pulmonary and gastrointestinal care, ranking us in the top 10 percent of hospitals nationally for those services. In addition, four J.D. Power and As-sociates Distinguished Hospital awards have come our way, the most recent for maternity care. To top it all off, we’ve been named among the top 10 “Best Places to Work in New Jersey” by NJ Biz, and one of Modern Healthcare’s 100 “Best Places to Work in Healthcare.” Providing a level of care that is worthy of acknowledgement by these highly regarded organizations can’t be achieved without the talent and dedica-tion of our medical staff, and I value what each of you does for Holy Name. We try continuously to implement initiatives that will elevate everyone’s experience at the hospital, and I encour-age you to share any suggestions you may have for improving physician rela-tions here at Holy Name.

Michael Maron is President/CEO of Holy Name Hospital.

“Achieving and sustaining outstanding clinical performance

is essential to our future viability, as more emphasis is

being placed on hospital quality measures by third-party entities...

At Holy Name, we try to live the mission, as evidenced by

the recognition the hospital has consistently achieved over

the last several years.” —Mike Maron

heADs Up froM the presiDent/ceo

> Growth, Quality and Service Excellence

As the Senior Vice President for Medical Affairs, I have a unique 360-degree vantage point from which to view the care that is provided at Holy Name Hospital. My daily work constantly brings me into contact with patients and cases that require review for one reason or another. I am constantly impressed by the commit-ment, depth of knowledge, clinical acumen, and perhaps most impor-tantly, the compassion and humanity that our medical staff manifests on a daily basis. You do yeoman’s work and you do it every day. You do it on-call at any hour. You do it often, for insuf-ficient or no compensation at all. You do it with little or no recognition. And you do it so very well. Our profession seems to be under

siege from 360-degrees around. The regulators make incessant demands on us. The managed care and insurance companies battle with us daily. The malpractice insurers present us with mammoth premiums, the plaintiff ’s lawyers name us frivolously in cases, and the politicians and legislators turn deaf ears to our difficulties. Yet we continue to serve our patients with dedication and quality. In today’s difficult environment, where do you find fulfillment and gratification in your work? What keeps you going day after day? What makes it worthwhile for you? I’ve heard Medi-cine described as a “grand profession.” I’m not so sure many of us still believe this. Can we recapture it? What do we need to do?

I hope that we can use MD360 as a vehicle to answer some of these ques-tions and to share our ideas, experienc-es and hope. The Hospital is kicking off the premier edition of this newsletter, but I invite the medical staff to make it your own, to serve your needs.

Paul Mendelowitz, M.D. is the Senior Vice President of Medical Affairs/Chief Medical Officer at Holy Name Hospital.

In “Medical Management Notes” we plan to share key information about the physician component of hospital practice management at Holy Name Hospital. As you know, the world of hospital practice management is quite complex, with ever-increasing regula-tory demands and financial challenges. It is our pleasure to work with you on these challenges, as we provide the highest level of quality and satisfaction to you and your patients.

improved Discharge planning statsHoly Name has made consistent strides over the past few years in discharge planning, with your assistance. As a result, we’ve seen overall decreases in insurance company denials and length-of-stay. The trend continues to be quite good: Our commercial denial rate is un-der 5%, year-to-date; several years ago,

it was triple today’s rate. Our Medicare average length-of-stay (ALOS) in 2008 is 6.5 days, which is down nearly 10% from 2007 levels. While our Medicare ALOS is improving, it still lags behind nearly all other hospitals in Bergen County, so there’s plenty of room for improvement.

‘observation status’ in placeWith your help, we’ve been able to suc-cessfully implement “observation status” at Holy Name. “Observation status” is taking on increasing significance as CMS, the Centers for Medicare and Medicaid Services, has contracted with Recovery Audit Contractors (RACs) in all 50 states to retrospectively review inpatient admissions. RACs can reclaim any monies paid for admissions that are considered “not medically necessary.” Fortunately, we have a solid process in place to monitor all inpatient admis-

sions, and work with Holy Name physi-cians to ensure the right patient status. We sincerely thank you for your commitment to Holy Name Hospital and appreciate your cooperation in practice management initiatives. I can be reached at 201-541-5947 for further discussion, or feel free to stop by the Medical Affairs office anytime.

Craig Hersh, M.D. is Assistant Vice President of Medical Affairs at Holy Name Hospital.

PaGE 4

progress notes

> Take Pride in Your Practice

MeDicAl MAnAgeMent notes

> Working on Hospital Practice Management Issues

> Villa marie Claire to set standard for Hospice Careoly Name Hospital plans to begin renovations on the Villa Marie

Claire Hospice this fall, with the hope of admitting patients within the next year. Set on 26 pastoral acres in Saddle River, the Villa will set the standard for compassionate end-of-life care, under the direction of Charles Vialotti, M.D. This 20-bed inpatient facility will provide residents of northern New Jersey with a much-needed resource that is unique to our area. Providing day-to-day care to patients and families touched by irreversible illness, the Villa’s palliative medicine program will focus on symptom control, quality of life, and patient and family communication, with a wide range of physical, social, psycho-logical and spiritual services. Dr. Vialotti’s vision for the Villa combines the provision of specialized hospice care with tenderness, respect and loving kindness for patients and their families. He shares some thoughts on end-of-life care below:

on healing as opposed to curing: “When we can’t be cured, we can still find healing in an environment that enables us to be calmed, soothed and loved — and gives us the opportunity to experience what joys remain for us.”

on living well: “Patients will find joy in the beautiful, pastoral view from each room, the pres-ence of family members and a concept that focuses on quality of life and living well during whatever time is left. We

will create a stimulating environment in which every moment of the resident’s life will be as rich and meaningful as before his or her illness progressed.”

on giving back dignity:“At present, much end-of-life care is weighted toward technological inter-ventions that can be painful, unneces-sary and alienating. Hospice restores dignity, self respect and control over the patient’s life. Through its support-ive setting, patients can find a certain level of independence, allowing them to focus on communicating with their loved ones in a comfortable and family-centered environment. It gives families the opportunity to have their final memories of their loved one framed by positive experiences.”

on those who donate:“Those who donate to this project should un-derstand the long-term impact of their philanthropy. Their gift will have a multi-generational influence on the many lives that will be improved and enriched as a result of their efforts. What they are giving will not have a fleeting benefit, but will be deeply felt

in the personal experience of the indi-viduals and families who stay at the Villa Marie Claire Hospice. Not only will their gift help us set the standard in hospice care today, it will touch the lives of gen-erations of families in the future.”

Charles Vialotti, M.D. is Director of Radiation Oncology at Holy Name Hospital and Medical Director of the Villa Marie Claire Hospice.

PaGE 5

H

medical staff Guide to the New emergency Care Center

oly Name’s new Emergency Care Center is a whole new

world, not only for patients, but for doctors and staff, as well. Many of our physicians have toured the new facility; if you aren’t among them, I hope you’ll stop by soon to experi-ence the beauty and functionality of this 21,000 square foot center. In the meantime, this primer will lend some insight into navigating our depart-ment, where we’ll make our greatest effort to accommodate you and your patients the very best we can.

layout The new ED is arranged as a central “core” with four surrounding “pods.” The department will expand and contract through the 24-hour daily cycle, as our volume expands and con-tracts. Pod 1 and Core are open 24/7, Pod 2 from 9 a.m. to 1 a.m. and Pod 4 from 11 a.m. to 11 p.m. (Pod 3 will not be opening immediately.) These opening and closing times are based on historical peak volume statistics. The department has 41 beds, contained in 28 rooms (i.e. there are five multi-bedded rooms, containing from 2-4 beds; the remaining rooms are private). Rooms are numbered sequentially from Room 1 in Pod 1 go-ing up through Room 25 in Pod 4, and then into Core, where beds 26, 27 and 28 are located. Multi-bedded rooms are subdivided by lettered beds (A, B, C and D). Therefore in Core, a patient may be in 26A or 28D (for example).

pod functionality Every bed in the department is equipped to handle any type of patient, from critical to minor. However, the various pods will have specialized func-tionalities through the 24-hour cycle. Pod 1 (immediately adjacent to the walk-in entrance and waiting area) will be our Fast Track throughout

most of the day. Patients requiring the least resources (tests and nursing services) will be seen quickly in Pod 1, our goal being a “throughput time” (arrival to discharge) of less than one hour. During the wee hours of the night, sicker patients requiring private rooms (Pod 1 has six of them) will be cared for in Pod 1. The Core is our largest “pod” in terms of beds. It contains a large work station, a big-screen patient tracking board on the wall and the Unit Secre-tary’s work station. The patient care rooms in Core are multi-bedded (four beds each). Core also has a private “ob-servation” room for patients requiring specialized observation (e.g. potentially suicidal or violent psychiatric patients). Core beds are extremely flexible as far as patient acuity and complaints go. However, as abdominal pain is our most common presenting complaint, we will be maintaining a specialized abdominal pain room in Core. Pod 2 is the critical care pod. The sickest patients will be in this area. Pod 2 also contains several specialty rooms, such as our two negative pressure rooms and two GYN rooms (these four rooms each have a private bathroom). The orthopedic supply closet is also in Pod 2. Pod 4 (all private rooms) is for our pediatric patients requiring care be-yond what can be delivered quickly in the Fast Track. Adult patients requir-ing additional resources may also be assigned to this pod.

CoVer story: emerGeNCy Care CeNter

“Every bed in the department is equipped to handle any type of patient, from critical to minor. However, the various pods will have specialized functionalities

through the 24-hour cycle.” —richard Schwab, M.d.

PaGE 6

H

Richard Schwab, M.D. is Medical Director, Emergency Services at Holy Name Hospital.

PaGE 7

some tips for the private Attending Where is my patient? YoucanfindyourpatientbyhisorherinitialsonthetrackingboardinCore,orjustaskanyofourstaff.

Where is the chart? Asyouallknow,wehaveanelectronicmedicalrecordandthereisnopaperchart(unlessyou’dlikeone).Thereisachartrackateachnursingstation,whichhasaslotforeachbed.Iftherearepaperrecords(e.g.,thepatienthasanursinghometransferpacketorambulancecorpssheets)theywillbefoundinthelabeledslotcorrespondingtothepatient’sbednumber. Ifyou’dlikeapaperchart,signintoHMEDasUser:000000andPassword:Doc123.Thenhigh-lightyourpatient’sname,click“ChartReview”andthenselectthe“charttype”you’dliketoview.Forclinicalinformation,chooseeitherPMDAdmitChartorClinicalChart.Fordemographics,selectFaceSheet.YoucanprinteitherbyjustclickingthePrintbutton.Thereisaprinterateverypod.

Where is the nurse? Eachpodwillhaveitsownnursingpersonnelassignedtothatpod.

How do I write orders, get a consult sheet or write initial progress notes? TheseformshavetobeprintedfromRUMBA.IfyouarefacilewithRUMBA,youcandothisyourself.Otherwise,youcanaskthenursecaringforyourpatientortheunitsecretarytoprinttheseformsforyou.Orderscanbeplacedinabinlabeled“PMDOrders”ateachpod,orcanbehandeddirectlytothenurseorunitsecretary.

How do we communicate with each other in such a large facility? Wehaveanewinternalcommunicationsystem.EveryoneinthedepartmentcarriestheirownpersonalASCOMphone.IfyouwerepagedbyanERphysician,youcanreturnthecalldirectlytothatphysician’sphone(carriedonourbelt;youwouldcall833-3000andthenenterourexten-sion,e.g.,I’m2100).Wewilltrytoanswereachsuchcallourselves;however,ifwearebusyinaprocedureorwithapatient,thecallwillbeautomaticallyforwardedtotheunitsecretary.

The skill and enthusiasm with which our nurses practice their profession is a major factor in the degree to which your patients feel satisfied with their hospital experience. We know from the literature, that nursing excellence and satisfaction at the bedside is embodied by the nurse who feels she/he has control over the care that is being rendered. At Holy Name Hospital, we have made a concerted effort to allow nurses to govern the care given patients. The nursing culture here provides knowl-edge, state-of-the-art technology, and compassion to our patients, while nurturing a practice environment that engenders empowerment and deci-sion-making. Through participation in activities such as the Nurse Practice Councils, unit-based quality improvement activities, and the Evidence-Based Practice Council, Holy Name’s nursing staff has been very successful in deci-sion-making from a multidisciplinary perspective.

seeking Magnet recognition Our Nursing Department is in the midst of pursuing the journey toward Magnet recognition, the most coveted honor bestowed upon a nursing organi-zation by the American Nurses Cre-dentialing Center. It is a process that is transformational and highly significant. Through this most sophisticated road to excellence, we will demonstrate that nursing at Holy Name Hospital consis-tently strives to improve patient care and enhance professional growth. Magnet documentation will be submitted on February 2, 2009. We are confident that we can demonstrate the outstanding patient care provided by every member of the multidisciplinary healthcare team on a daily basis. In-deed, achievement of Magnet status is a reflection not only upon nursing, but our entire organization.

numbers confirm What We Know Building relationships and bridges among caregivers is the key to compre-hensive patient care, and Holy Name

does it well. We enjoy a long tradition of collegiality between nurses and physi-cians. In our recent nursing satisfaction survey, nurse-physician interaction scored in the 64th percentile—above the national average. The American Nurses Credentialing Center character-izes any score above the 60th percentile as “high satisfaction.” I look forward to continuing that constructive dynamic, in which we support one another in our mutual efforts to give the very best care to our patients. I have a keen interest in work-ing closely with our physicians, and my door is always open—for problem-solving, as well as for any dialogue that would help us, together, to improve patient care at Holy Name.

Sheryl Slonim, R.N.,C., M.Ed., CNE-A,BC is Senior Vice President, Patient Care Services & Chief Nursing Officer at Holy Name Hospital.

> the medical society of New Jerseyor 242 years, the Medical Society of New Jersey (MSNJ) has worked for physicians and their patients. It speaks

as the unified voice of the Garden State’s physicians in all specialties. MSNJ has built strong working relationships with government, the specialty societies, and the hospitals, so that working together, the medical community can prevail. The public, the media, and the government consider MSNJ to be a legitimate contributor in the formation of public policy. MSNJ’s ability to protect the best interests of patients and the healthcare community can clearly be seen in the sun-setting of the out-of-network fee proposal, which would have been costly to both physicians and patients. MSNJ has done so much more for medicine in New Jersey. For more informa-tion, visit their web site at www.msnj.org. Beyond MSNJ’s invaluable advocacy work and practi-cal seminars for practice managers, it offers its members

financial benefits: discounts with Verizon Wireless, Liberty Mutual, Brooks Brothers, Geico, STS Tire, and more. It also offers its members a prepaid two-tiered legal representation package, at discounted rates, from the WolfBlock law firm. MSNJ encourages all physicians to take advantage of the amenities that a membership in the largest physician- advocacy organization in the state has to offer. Learn more by contacting Lisa Hibbs at 609.896.1766, ext. 245 or lhibbs@msnj.org.

Robert S. Rigolosi, M.D.Treasurer and Past-President, MSNJ

John W. Poole, M.D.Member, MSNJ Board of TrusteesChair, MSNJ Political Action Committee

PaGE 8

nUrsing perspective froM the cno

> Empowering Nurses, Magnet Recognition and Building Relationships

F

PaGE 9

> introducing Breast surgeon erika Brinkmann, m.D.

rika M. Brinkmann, M.D., a board-certified general surgeon with

advanced training and expertise in breast surgery, has joined Holy Name as the hospital’s Director of Breast Sur-gery. Dr. Brinkmann was most recently Director of the Highland Park Hospital Breast Program in Highland Park, IL and an assistant professor of surgical oncology at the Feinberg School of Medicine at Northwestern University. “The focus of my practice,” explains Dr. Brinkmann, “is the diagnosis and treatment of breast cancer.” She will work closely with the breast imaging team at Holy Name’s Breast Center, medical oncologists, radiation oncolo-gists, and genetic counselers. De-pending on patients’ needs, she “will formulate a plan for surveillance for women at high-risk for breast cancer, determine the etiology of an abnor-mality and whether it’s cancer, or give strategies for breast cancer prevention.” Dr. Brinkmann advocates for im-

mediate breast reconstruction after mastectomy, working with plastic and reconstructive surgeons who will accompany her in the OR during treat-ment surgery. “I prefer my patients go to sleep with a breast and wake up with a breast,” she notes. Dr. Brinkmann studied at Kwansei Gakuin University in Nishinomiya, Japan as a President’s Scholar before earning a bachelor’s of science degree in electrical engineering and biomedi-cal engineering from Southern Meth-odist University in Dallas. She obtained her medical doctorate from Yale Uni-versity School of Medicine, completed her postgraduate training in general surgery at Saint Vincent’s Hospital and Medical Center in New York, NY, and was a surgical breast oncology fellow at the Lynn Sage Breast Center, North-western University Medical School in Chicago. Dr. Brinkmann can be reached at 201-833-3357.

he mission of Holy Name Hospi-tal’s Korean Medical Program is to

serve the Korean-American commu-nity with culturally and linguistically sensitive medical services. Our goal is to become the most “Korean-friendly” hospital in the metropolitan area and in the state. The program consists of three components: • Two off-campus physician offices— one in Closter, a multi- specialty practice for patients of all ages; the other in Englewood Cliffs, which is dedicated to women’s health. • In-hospital customer services, such as language interpretation,

patient visits, special menu offerings, and patient shuttle services. • Community outreach programs, including a hotline for community members seeking answers to medical questions, health education and screenings, and promotion of acculturation among first-generation immigrants.

There are over 70 Korean-American physicians who are working together under the umbrella of the Korean Medical Program. Their specialties are internal medicine, ob/gyn, pediatrics, orthopedics, general surgery, plastic

surgery, interventional cardiology, pulmonology, urology, otolaryngology, endocrinology and podiatry.

> a Korean-Friendly medical program

Kyung Hee Choi is Director of the Korean Medical Program.She may be reached at 201-833-3399 or atk-choi@holyname.org.

“I prefer my patients go to sleep with a breast and wake up

with a breast. ” —erika brinkMann, M.d.

T

E

PaGE 10

> Women’s Health partners Join HNHoly Name Hospital announces the association of Women’s Health

Partners, a new obstetrics/gynecology practice with Lev D. Kandinov, M.D., F.A.C.O.G. and Devorah Catherine Daley, M.D. They have two office locations: one in Teaneck, the other in Cliffside Park. Dr. Lev D. Kandinov is a board-certi-fied obstetrician/gynecologist with a spe-cial interest in laparoscopic/hysteroscopic and minimally invasive surgery, as well as menopause counseling and education, and training in the management of high-risk pregnancies and gynecologic sonog-raphy. He earned his medical doctorate from Albert Einstein College of Medicine and completed his training in obstetrics and gynecology at Albert Einstein College of Medicine/Montefiore Medical Cen-ter. During his residency, Dr. Kandinov was inducted into the college’s Leo M. Davidoff Society for outstanding achieve-ment in the teaching of medical students. He has been a contributing author to WebMD’s “Ask the Experts” column. Dr. Kandinov is fluent in Russian and conver-sational in Hebrew. Dr. Devorah Catherine Daley is a board-eligible obstetrician/gynecologist with an interest in minimally-invasive procedures, the medical and surgical treatment of uterine fibroid tumors, and adolescent medicine. After graduating

with honors from Rutgers University with a bachelor’s of arts degree in biology, Dr. Daley earned her doctorate of medicine from Weill Medical College of Cornell University. She completed her residency training in obstetrics and gynecology at Yale-New Haven Hospital, and was a Gal-loway Fellow in gynecologic oncology at Memorial Sloan-Kettering Cancer Center. Drs. Kandinov and Daley provide general health maintenance to women of all ages, and state-of-the-art diagnosis and surgical treatments for gynecology and obstetrics. The Women’s Health Partner’s philosophy is one of evidence-based medicine, and the physicians take a

personalized approach to the care of each individual. Both raised in Bergen County, the doc-tors have chosen to practice locally after completing rigorous academic and clinical training at prestigious institutions. Their own ethnicity and personal experience affords them a profound understanding of the cultural and religious values inherent to the surrounding community. Women’s Health Partners can be reached at 201-836-4025 (222 Cedar Lane, Teaneck) or 201-943-4884 (434 Palisade Ave., Cliffside Park). Their web-site, www.womenshealthpartnerspc.com, is under construction.

iabetes is a disease that truly requires self-management. Diabetics make

multiple daily decisions that affect their glucose control, now and over the long-term. Living with diabetes can be com-plicated and is best managed by a team approach, which might include a diabetes nurse, dietitian, primary care physician and/or endocrinologist.

refer Your patients We understand that the amount of time a physician can spend on any one office visit is limited; for this reason, the Diabetes

Educator plays a critical role in improving clinical outcomes through education. The healthcare professionals at Holy Name’s Diabetes Center can devote the time that’s necessary to teach your patients basic self-management skills, which can enhance clients’ quality of life and reduce the risk of long-term compli-cations. The Diabetes Center promotes and counsels patients on positive behavior changes, such as healthy eating habits and daily physical activity. Educational top-ics include diabetes as a chronic disease process, blood glucose monitoring, use of

oral medications and insulin instruction. Certified by the American Diabetes As-sociation, the Center offers a comprehen-sive course for diabetes self-management, as well as private classes and consultations. As diabetes educators, we encourage committed involvement by all mem-bers of the healthcare team, as we work together to provide the most comprehen-sive care possible.

> HNH’s Diabetes Center – Here For your patient

Maria Soper, M.S.N., R.N. and Debra Davidson, M.S., R.D., C.D.E. are diabetes educators at Holy Name Hospital. They can be reached at 201-833-3298 or 201-833-7093.

H

D

PaGE 11

eep vein thrombosis (DVT) is the formation of a blood clot, known

as a thrombus, in the deep leg vein. In the United States alone, 2,000,000 new cases are diagnosed each year. DVT is a very serious condition that can result in a life threatening pulmonary embolus, cause early pain and swelling, and produce long-term permanent damage to the leg, known as post-thrombotic syndrome. The treatment goals for patients with DVT are threefold: (1) Prevent pulmonary embolism, the most devastating complica-tion of acute DVT; (2) Prevent recurrent DVT, since inadequate initial treatment results in 20-50% risk of clinically signifi-cant recurrent thromboembolism1, and; (3) minimize the risk of the post-thrombotic syndrome (PTS), with associated pain, edema, hyperpigmentation, ulceration, and substantial socioeconomic morbidity. Prospective studies have shown the fre-quency of PTS after symptomatic DVT to range from 30 to 75% within 2 years after the initial episode2. Up to one-quarter of patients with PTS will have severe symp-toms, with 4-6% developing a venous ulcer. The severity of symptoms is determined by the presence and magnitude of valvular reflux, the anatomic distribution of the DVT, and the degree of persistent venous obstruction. The treatment of DVT consists of acute anticoagulation with unfractionated or low molecular weight heparin, early clot re-moval or thrombolysis in selected patients, and long-term low intensity anticoagula-tion. Ridker et al found the incidence of recurrent venous thromboembolism (VTE), hemorrhage or death at four years following DVT to be 5.5% in patients treated with long-term coumadin, versus 15% in a placebo group3. Anticoagulation should be targeted to an INR of 2.0-3.0 to minimize recurrent DVT and related mor-tality. Idiopathic DVT should be treated for 6-12 months, whereas patients with recurrent DVT or long-term risk should be considered for permanent anticoagulation. To prevent PTS, current guidelines also recommend the use of an elastic compres-sion stocking (30-40 mmHg) during the two years after an episode of DVT (grade 1A recommendation), with a relative risk reduction of approximately 50 percent4.

Anticoagulants help prevent further clotting but do nothing to remove the current clot. Since persistent and proximal thrombus is a strong predictor of recur-rent VTE and PTS, strategies to remove the inciting thrombus in patients with iliofemoral thrombosis are appealing. All patients with transient DVT risk or under the age of 70 years old who have DVT extending to the common femoral or iliac veins should be considered for venous thrombolysis or mechanical thrombec-tomy. In recent years, advances in throm-bolytic and thrombectomy catheters and drug delivery methods by interventional radiologists have shortened the duration of these treatments to brief overnight procedures, and on occasion, can result in complete thrombus removal in a single treatment session without the need for overnight thrombolytic infusions. In the national venous registry, there was a clear association between early clot removal and sustained venous patency at one year5. In addition, early success directly corre-lated with venous valvular function at six months. Both observational data and small prospective trials have shown thrombolysis to be associated with a high rate of clot resolution, infrequent bleeding complica-tions, and dramatically improved rates of six-month venous patency and venous reflux when compared to anticoagulation therapy alone6,7. In particular, iliofemoral DVT should be aggressively treated using thrombolysis and thrombectomy tech-niques to prevent long-term PTS sequelae. In summary, DVT is a highly prevalent

and morbid condition. Established guide-lines support the use of long-term stan-dard intensity anticoagulation and graded compression stockings in all patients. DVT involving the common femoral or iliac veins should be aggressively treated with catheter-based techniques includ-ing interventional radiology thrombolysis and thrombectomy; with newly available devices and techniques, this can result in rapid clot removal, early symptom relief and a dramatic reduction in long-term complications. The Interventional Insti-tute at Holy Name Hospital has extensive experience and a wide range of minimally invasive catheter-based techniques to help in the care of these patients.

1. Raskob G. Calf-vein thrombosis. Venous Thromboem-bolism, An Evidence-Based Atlas. Armonk, NY: Futura Publishing Co; 1996;233:233-238.2. Kahn, S. and Ginsberg. Arch Internal Medicine. Volume 164, January 12, 20043. Ridker PM, et al. NEJM 2003; 348:154. Buller H, et al. Chest 2004;126:401S5. Mewissen et al. Radiology 1999;211:39–49.6. Elsharawy M, Elzayat E. Eur J Vasc Endovasc Surg 2002: 24: 2097. Siegal J, et al. Ann Int Med 2007: 146: 211

John Rundback, M.D. isDirector of the Interven-tional Institute at Holy Name Hospital.

> Deep Vein thrombosis D

PaGE 12

> Holy Name Classic Golf tourney players swing for Villa marie Claire Hospice

agpipes heralded guests at The Holy Name Health Care Foundation’s 14th

Annual Holy Name Classic Golf Tourna-ment, which was held at two courses on June 16: Hackensack Golf Club in Oradell and Arcola Country Club in Paramus. With over 220 players and a roster of fully-subscribed sponsors, the event fea-tured pleasant weather, challenging fair-ways, good food and prizes, all in support of the hospital’s Villa Marie Claire Hospice in Saddle River. Highlights and bloopers from the golf courses were captured in a hilarious video shown during the ceremo-ny later that day.

Many thanks go out to all the volun-teers and the Holy Name Hospital EMS team for helping to make the event run so smoothly, as well as the tournament’s principal sponsors, including: J. Fletcher Creamer & Son, Inc., MD-X Solutions, Inc., and Melli, Guerin & Wall, PC. The Wm. Blanchard Co., who played the Hackensack course, placed first as lowest gross team and secured the Charles R. Melli, Jr. Memorial Award. Aspen Medical Group won 2nd place, and Electronics Expo came in 3rd place at Hackensack. At Arcola, Sea Pearl, Inc. took 1st place, while MD-X Solu-tions, Inc. took 2nd and 3rd places.

B

CyrilCoffey,Dr.GerardEichman,Dr.YogeshSagarandMikeCoffey

Dr.JayMeyerowitz,Dr.JeffreySalizzoni,Dr.JosephRizzoandCarlRizzo

Dr.MatthewNalbandian,TomDevine,Dr.JamesHaleandBrianCosgrove

TimConlonandMichaelMaron

hen I started practicing urology in 1975, a cystoscopy required

a two- to three-day admission to the hospital. The patient would be admitted the day prior to the procedure and would be discharged the day after the proce-dure—quite a contrast to what happens now, as most cystoscopies are performed in an office setting. I can still remember Sister Michael, head of the OR, peering out from behind the desk in her office and gazing across the hall into the cysto room watching everything that was taking place. Woe to you if you raised your voice or made a remark Sister Michael deemed inap-propriate, for you would hear Sister say something to the effect, “Doctor please act in a more professional manner for the patient’s sake.” Once I tried to get her to cut me some slack when I told her that I attended Catholic schools and was taught by the nuns, but she would have none of it. The cysto room was the bailiwick of Michele, an OR tech, who still works in our OR but unfortunately deserted urology for orthopedics many years ago and is now the senior person in the OR since the recent retirement of the unflappable Carter Moore. Today most urological procedures are performed on a same-day basis, and even those that require overnight stays such as nephrectomies and radical prostatecto-mies typically have patients being dis-charged after only two or three days. I can still recall my old mentor, Don Kissinger, showing me a case of a large kidney tumor measuring 17 to 18 cm, which I removed

through an extensive thoracoabdominal incision after expending three to four units of blood. Large renal tumors are rarely seen anymore since CT scans most often diagnose these tumors as incidental small lesions. And speaking of CT scans, I can remember when scans weren’t readily available and patients were transported to centers to have a scan performed. Thanks to minimally invasive techniques, urinary tract calculi rarely, if ever, require open surgery. Patients are admitted for a laser lithotripsy or ESWL (extracoporeal shock wave lithotripsy) and after a brief proce-dure typically lasting less than an hour, are discharged as soon as they recover from anesthesia. Some contrast to the good old days of open surgery, when my old partner Eddie Beaugard and I would spend hours bisecting a kidney searching for stones. Afterwards the patient would be in the hospital for at least a week recov-ering and another four to five weeks at home before returning to work. In 33 years, I have witnessed revo-lutionary changes in the practice of urology, and I am sure that the next generation of urologists will continue to see advancements that will make present day practices seem primitive. The new generation of urologist, like my associate Richard Lee, is proficient in advanced laparoscopic techniques which enable him to perform highly technical, demanding procedures like laparoscopic partial nephrectomy, lapa-roscopic pyeloplasty, and radical robotic prostatectomy. —Philip Affuso, M.D.

> urology — then and Now

> Gene makeover The 21st Century Anti-Aging Breakthrough

BooK neWs

authors:VincentC.Giampapa,M.D.,F.A.C.S.,FrederickF.Buechel,M.D.,F.A.A.O.S.,F.A.C.S.andOhan Karatoprak, M.D., F.a.a.F.P., specialistinfamilypractice-geriatrics,inwhichheisboard-certified.Heisananti-agingphysician,aswellasclinicalassociateprofessorattheUniversityofMedicineandDentistryofNewJersey.Dr.KaratoprakistheformerdirectoroftheobesityclinicandformerdirectorofthefamilymedicinedepartmentatHolyNameHospital.

In2000theHuman

GenomeProject

wascompleted

andsignificantsci-

entificknowledge

concerninggenes

wasrevealed.The

Gene Makeover,a

collaborativeeffort

betweenDr.VincentGiampapa,Dr.FrederickF.

Buechelandmyself,aimedtodiscussthelatest

developmentsinthestudyofgenetics.Wenow

knowthatgenes,environmentandlifestyle

determineourlongevity,andtheprocessofaging

canbepositivelyornegativelyaffectedwithdiet,

exercise,stressmanagement,andneutraceuti-

cals.Furthermore,thisprocesscanbetailoredto

eachindividual’sneedswithgenetictesting.Our

bookisacomprehensiveguideforanyoneinter-

estedinoptimizingandimprovingtheirlifestyle

andagingprocess.

Fromthisexcitingprojectstemmedmyown

endeavortoprepareacompleteguidetoobesity

treatment.Nowourpatientscanbeeducated

aboutobesityandhaveatailoredtreatment

fortheirweightproblems.Obesityisacomplex

medicalproblemailingapproximately100million

Americansandnoteveryoneisobeseinthesame

wayorforthesamemedicalreasons.Pleasevisit

www.drkhealthnetwork.comformoreinformation.

—OhanKaratoprak,M.D.

PaGE 13

W

PaGE 14

J Physicians was launched Sept. 12, 2007 as a new advocacy group for

New Jersey’s doctors. I am often asked, Why do we need another advocacy group and isn’t this divisive? The answer is we need a group that will advocate ef-ficiently, wisely, with political savvy and will unify the already divided NJ medi-cal community. We need an organiza-tion that will identify battles that can be won and mobilize resources quickly and effectively to win those battles. The key to successful advocacy is credibility and access. Credibility comes with membership. We need an organi-zation that will represent a significant majority of New Jersey’s physicians. Access comes with having the right people in position to build upon prior relationships and developing a long-range strategic plan to foster important relationships in the future. These ideas aren’t new or revolution-ary, they just haven’t been implemented so far. Why not? Below are the top five excuses for not getting involved and why NJ Physicians gives us a fighting chance for overcoming these objections.

1) i’m too busy. I agree. We are all too busy. We are too busy with the overwhelming adminis-trative burden that being a physician in New Jersey entails. We are too busy working to meet our ever-expanding overhead. We don’t have enough time for our families and outside interests. THE SOLUTION: Go to NJPhysi-cians.com and enroll. It will take three minutes. From that point forward, you can choose to be as involved or not, as suits your wants. Meetings, if you choose to attend, will be virtual and conducted on-line. CME will be avail-able on-line – for free. We will assist in selecting and implementing EMR systems, for those who are interested.

2) it’s too expensive. I agree. Why should we need to spend thousands of dollars to belong to mul-tiple advocacy organizations?

THE SOLUTION: NJ Physicians dues are only $295 per year. With our buying alliances, practices will be able to save significant amounts of money on medical and office supplies. You will save money if you join and take advan-tage of these opportunties.

3) organized medicine is not effective. I disagree, but only to a point. It is clear that we have not been as effective as possible to date, but that’s not a reason to give up. Those battles that have been won have been won because a small number of hard-working colleagues have given their time, effort and money to the fight. THE SOLUTION: More involve-ment, continued hard work, and a cooperative rather than confrontational model to achieve our goals along with other organizations that share our goals, whether they are physicians’ organiza-tions or other stakeholders in New Jersey’s healthcare system. Witness what has been accomplished recently. Horizon has rescinded its new rule requiring pre-certification of echocar-diograms and Aetna has withdrawn its proposal not to pay for anesthesia dur-ing colonoscopies.

4) too much of our money is spent on administrative functions. I agree. While an organization needs professionals to function, any money spent on salaries, benefits, mortgages, utilities, transportation and meals, is money that can’t be spent for advocacy. THE SOLUTION: NJ Physicians is a virtual organization. There is one full-time employee and two part-time employees. There are no bricks and mortar. Overhead is minimal and will be kept that way. Your dollars will be spent advocating for you.

5) the war is over. We have lost. I disagree. We have been in retreat and have ceded our rightful position in too many arenas. But we have not lost. We need to hold our ground, not let man-aged care, government regulation or the tort system further erode our position. Once we’ve held our ground and fought off initiatives that are detrimental to our interests, we can advance an agenda that will bring incremental, positive changes. THE SOLUTION: NJ Physicians. We have open lines of communication with the major insurers in New Jersey. We have experienced lobbyists with access to all levels of government. We have empaneled a group of the most experienced medical malpractice de-fense lawyers in New Jersey, along with several medical malpractice defense in-surance companies to develop a Medi-cal Malpractice Defense Bar for the first time in New Jersey.

go to the website...NJPhysicians.com. More information is available there. Call me directly. I appreciate the opportunity to be heard and in the future will focus more on the specific issues we face and our expected victories. Join now – it couldn’t hurt.

Ron White, M.D., J.D. is a colon and rectal surgeon on staff at Holy Name Hospital and President of NJ Physicians. He may be reached at 201-567-7615.

> about NJ physicians...

“... we need a group that will advocate efficiently, wisely,

with political savvy and will unify the already divided NJ

medical community. We need an organization that will identify battles that can be won and

mobilize resources quickly and effectively to win those battles. ”

—ron white, M.d., J.d.

N

PaGE 15

henever I think about hand washing, I think about the

evolution of early life forms in the “primordial soup” of warm nutrient-rich ponds and puddles. For hundreds of millions of years, bacteria, fungi and protozoa evolved in constant competi-tion. When our lower species ancestors left the soup, they brought it along internally. Today, we are 70% water by weight, our blood is salty and our internal environment is carefully main-tained to optimal temperature, elec-trolytes, nutrients and oxygen tension. We have more than 50 trillion human cells but have brought along even more than 50 trillion microorganisms in and on our bodies. Each of us is an ambula-tory (hopefully) ecosystem in a state of constant exchange with our intimate and not-so-intimate associates. Our usual self-concept is that of pristine individuality but the recent outbreak of Norovirus is a dramatic reminder that since birth, we are not the “boy in the bubble” of 1970s technology. We are swimming in the primordial soup. For these facts of existence, the Centers for Disease Control have developed the concept of Zone of Contact. An imaginary zone extend-ing three feet surrounds each patient. Whenever we enter that zone, there is a high likelihood of acquiring or inoculating organisms by touching the patient, secretions, handrails, linens or other fomites. In Britain, physicians have discarded ties, watches and rings. They wear short sleeves, gloves and aprons and disinfect the stethoscope between patients. When we wash hands for 15 sec-onds with soap, we reduce bacterial colony counts from approximately 100,000 to 100 organisms per square centimeter and dramatically reduce the transmission of resistant pathogens. When I leave a patient, I feel that my hands are radioactive and can’t touch

anything until they get a once-over with Purell or soap and water. We have: MRSA, VRE, RPSA, KPC, Norovirus, C. Diff and now an Aci-netobacter resistant to all known anti-biotics in our house. Please keep your

soup to yourself. Make a personal, pro-fessional habit to: isolate when needed, glove, wash, gown where appropriate and never take the charts, pagers or other fomites into the zone of contact. All of these items and phones, comput-ers, counters, door handles, handrails and the “non-hand” parts of our bodies are outside of the zone of contact ac-cessible only through washing hands. Please forgive preaching these ideas, but we are seeing the end of the anti-biotic era with this Acinetobacter and the organisms that will undoubtedly follow. Only our intellect, self-disci-pline and hopefully some innovation, stand between us and infections that will take away much of our other medical technology.

> Hand Washing and the primordial soup

Thomas Birch, M.D. isChief, Division of Infectious Diseases at Holy Name Hospital.

“When we wash hands for 15 seconds with soap, we reduce

bacterial colony counts from approximately 100,000 to 100

organisms per square centimeter and dramatically reduce

the transmission of resistant pathogens. When I leave a

patient, I feel that my hands are radioactive and can’t

touch anything until they get a once-over with Purell or

soap and water.” —thoMaS birch, M.d.

W

oUr fAvorites

ThisphotographoftheGeorgeWashingtonBridgeatnightwastakenbyEvaHorn,M.D.,Radiologist.

> your Favorites...

WAnteD

Share your favorites with us. Write a brief critique of a restaurant, movie, show, CD, book or vacation spot. Send your reviews and images (high resolution) to: editorMD360@holyname.org.

Imagine the Possibilities718 Teaneck Road • Teaneck, NJ 07666

Call 201/833-3000 or visit www.holyname.org

the Best MeDicine

SubmittedbyRobertRigolosi,M.D.

> physician seeks Broad spectrum antibioticFifty-something physician at peak of career seeks long-term committed re-lationship with a broad spectrum antibiotic. The ideal candidate shall possess cell wall activity, potential synergy with aminoglycosides, extended spectrum beta lactamase resistance and be tolerated by penicillin allergic patients. Physician offers the brightest levels of respect, discretion and parsimony in the intended relationship.

Dear Physician,I am the antibiotic that you desire. At age 30, I have demonstrated an outstanding record of aerobic gram negative activity, am well tolerated by patients with penicil-lin allergy, and widely distributed into body tissues and fluids including the cerebral spinal fluid. I act synergistically with aminoglycosides through my cell wall active mechanism. I am resistant to some beta lactamases but should not be used alone when gram positive or anaerobic organisms may contribute to infection. Because of my popularity I have been overused in situations where a lesser antibiotic would suffice. As a result, my potency is slipping. Any relationship with me will require the physician to employ my services in only that special niche requiring a cell wall active agent for pseudomonas in the Type I PCN allergic patient. I should never be used with quinolones, as this combination is a particularly potent inducer of extended spectrum beta lactamase. If you are a physician of honor and discretion, I look forward to a joyful relationship for many years to come. Yours truly, Azactam