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January 27, 2016
“Winter is coming.”
–Ned Stark, Game of Thrones
“Hard work is its own reward.”
–Author unknown
The Scope appreciates the enthusiastic response of readers contributing quotes. These
quotes were submitted by Pediatric Nurse Practitioner Toni Eimicke. Though the author is
unknown who first stated, “Hard work is its own reward” – she says her husband is fond of
saying it if she complains about something. Please submit a favorite you’d like to share with
others by emailing to: [email protected]
Dear Members of the Maine Medical Center Medical Staff,
Spring is just around the corner! Please mark your calendar for April 6 when we will hold
the first MMC Medical Staff Dinner of the year.
In this issue, Drs. David Butzel and Scott Buchanan, M.D. share that since 2012 when the
TAVR (trans catheter aortic valve replacement) procedure became commercially available
the number of procedures performed at MMC has grown to a total of more than 200 cases.
Also, Drs. David B. Seder and Samip Vasaiwala introduce a pilot randomized clinical trial to
improve patient outcomes for those with early coronary angiography for post-cardiac
arrest.
And Dr. Joseph deKay shares an article on relationship-based care we hope you will find
insightful.
Joel Botler, M.D.
Chief Medical Officer
Cindy Boyack, M.D.
Medical Staff President
In This Issue
Save the Date: April 6 Medical Staff Dinner
Advanced Valve Program: 200-plus TAVRs
Pearl Study to Improve Patient Outcomes
Relationship-Based Care: Food for Thought
Publications
Calendar
Save the Date: April 6 Medical Staff Dinner
You are invited to attend the first of two dinners planned for this year for the MMC Medical
Staff. We hope you will add this date to your calendar as an opportunity to enjoy a nice
dinner and connect with colleagues: Wednesday, April 6 from 5:30 p.m. – 7:30 p.m. at the
Dana Center Lobby/Auditorium.
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Advanced Valve Program: 200-plus TAVRs
By David Butzel, M.D.
MMP-MaineHealth Cardiology
Scott Buchanan, M.D.
MMP-Cardiothoracic Surgery
Co-Directors, Advanced Valve Program
Severe, symptomatic aortic valve stenosis is a common diagnosis. Unfortunately, patients
are often poor candidates for traditional surgical aortic valve replacement due to advanced
age, frailty, and co-morbidities. A less invasive procedure known as TAVR gives these
patients new hope.
Since 2012 when the TAVR (trans catheter aortic valve replacement) procedure became
commercially available, there has been rapid adoption across the U.S. and around the
world. Here at MMC, our program has grown each year since our first TAVR in 2012. In
2015 alone, we performed 87 TAVR procedures, bringing our total procedure volume to
more than 200 cases.
Our results include a dramatic decrease in the complication rate of patients undergoing
traditional surgical aortic valve replacement as more of them undergo the less invasive
TAVR procedure. Also, patients report marked improvement in their quality of life. “I’m
starting to enjoy life again,” is how one patient, Jim Farrington, put it when he shared his
story in a patient video.
The TAVR team consists of dedicated mid-level providers, radiologists, anesthesiologists,
cardiothoracic surgeons, and cardiologists, supported by experienced OR and cath lab
staffs. The TAVR systems we employ are improving rapidly, and we now use the third
generation. Smaller delivery sheaths, more accurate valve positioning technology, and
improved valve sizing are all resulting in increased procedure success, decreased hospital
length of stay, and enhanced patient satisfaction.
We anticipate continued growth of this program as indications for the procedure are
rapidly expanding to include patients at medium risk for surgery (not just patients at high or
extreme risk). In fact, studies are currently being conducted on low surgical risk patients as
well.
Over the next year, we will be developing a Rapid Discharge Track for a carefully selected
subset of TAVR patients which may include conscious sedation as an option and will target
discharge on post-op day one or two.
For more information, contact Dr. Butzel at [email protected] and Dr. Buchanan at
[email protected].
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Pearl Study to Improve Patient Outcomes
By David B. Seder, M.D.
Division Director, Neurocritical Care
Samip Vasaiwala, M.D.
Interventional Cardiologist
Cardiac arrest outcomes have improved in recent years, but overall remain poor. With your
help, we will advance a clinical trial that might improve these numbers.
The PEARL Study (A Pilot randomized clinical trial of Early coronary Angiography versus no
early coronary angiography for post cardiac aRrest patients without ECG ST-segment
eLevation) is a pilot randomized clinical trial of early coronary angiography for post-cardiac
arrest patients with a presumed cardiac cause of the arrest but without ECG ST-segment
elevation. The question that the study will answer is whether cardiac arrest patients
brought to the emergency department, regardless of ECG findings, should be taken to the
cardiac cath lab to evaluate their coronary arteries and provide hemodynamic support.
Patients will be randomized to receive standard treatment plus an emergency heart
catheterization, with PCI and hemodynamic support if appropriate, or to standard
treatment alone, which typically means heart catheterization on a delayed basis after
demonstration of neurological recovery. We believe the trial results may lead to new
treatment algorithms and improved patient outcomes.
How can you help? Since patients won’t be able to give informed consent and may not
have a family member present to speak on their behalf, this study falls under special FDA
guidelines for exception from informed consent for emergency research. Before the study
begins, however, researchers are required to notify the public. We are inviting people to
complete a brief survey (online or hardcopy), which includes information on how people
can choose not to participate in the study.
Please talk with your patients age 18 and older, especially those with risk factors for cardiac
arrest, about the PEARL Study, between now and March 1st. Encourage them to complete
the survey, which can be seen here: www.mmc.org/PEARL. To obtain a hard copy, send
email to [email protected], or call (207) 662-2066.
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Relationship-Based Care: Food for Thought
Submitted by Joseph deKay, D.O.
Read this article that appeared in Hospitalist News on December 9, 2015 and was written
by A. Maria Hester, M.D., a hospitalist at Baltimore-Washington Medical Center in Glen
Burnie, Maryland.
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Publications
Soslow JH, Damon SM, Crum K, Lawson MA, Slaughter JC, Xu M, Arai AE, Sawyer DB, Parra
DA, Damon BM, Markham LW. Increased myocardial native T1 and extracellular volume in
patients with Duchenne muscular dystrophy. J Cardiovasc Magn Reson. 2016 Jan
21;18(1):5.
Yamamoto Y, Wang X, Bertrand D, Kern F, Zhang T, Duleba M, Srivastava S, Khor CC, Hu Y,
Wilson LH, Blaszyk H, Rolshud D, Teh M, Liu J, Howitt BE, Vincent M, Crum CP, Nagarajan N,
Ho KY, McKeon F, Xian W. Mutational spectrum of Barrett's stem cells suggests paths to
initiation of a precancerous lesion. Nat Commun. 2016 Jan 19;7:10380.
Xi G, Shen X, Rosen CJ, Clemmons DR. IRS-1 Functions as a Molecular Scaffold to Coordinate
IGF-I/IGFBP-2 Signaling During Osteoblast Differentiation. J Bone Miner Res. 2016 Jan 16.
Bascom K, Riker RR, Seder DB. Heart Rate and the Post Cardiac Arrest Syndrome: Another
Clue to Individualizing Care? Crit Care Med. 2016 Feb;44(2):448-449.
Schönenberger S, Niesen WD, Fuhrer H, Bauza C, Klose C, Kieser M, Suarez JI, Seder DB,
Bösel J; SETPOINT2-study group and the IGNITE-study group. Early tracheostomy in
ventilated stroke patients: Study protocol of the international multicentre randomized trial
SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in
Neurocritical care Trial 2). Int J Stroke. 2016 Jan 5.
Cohen MC. Combined supine and prone imaging acquisition in cardiac SPECT: A turn for the
better. J Nucl Cardiol. 2016 Jan 7.
Krebs LT, Norton CR, Gridley T. Notch signal reception is required in vascular smooth
muscle cells for ductus arteriosus closure. Genesis. 2016 Jan 6.
Fried HI, Nathan BR, Rowe AS, Zabramski JM, Andaluz N, Bhimraj A, Guanci MM, Seder DB,
Singh JM. The Insertion and Management of External Ventricular Drains: An Evidence-Based
Consensus Statement : A Statement for Healthcare Professionals from the Neurocritical
Care Society. Neurocrit Care. 2016 Jan 6.
Chang J, McGrory BJ, Rana A, Becker MW, Babikian GM, Guay P, Smith KA. Current
Orthopaedic Surgeon Practices for Nonarthroplasty Treatment of Osteoarthritis of Adult
Hip and Knee. J Surg Orthop Adv. 2015 Winter;24(4):213-20.
Trojian TH, Concoff AL, Joy SM, Hatzenbuehler JR, Saulsberry WJ, Coleman CI. AMSSM
scientific statement concerning viscosupplementation injections for knee osteoarthritis:
importance for individual patient outcomes. Br J Sports Med. 2016 Jan;50(2):84-92.
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Calendar
MMC Medical Executive Committee Meeting Schedule for 2016
All meetings are held from 12-2 p.m. in the Dana Center Boardroom, and lunch will be
served:
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February 19
March 18
April 15
May 20
June 17
July 15
August 19
September 16
October 21
November 18
December 16
2016 Medical Staff Dinner
Please mark your calendar for the 2016 Medical Staff Dinners to be held from 5:30 p.m. –
7:30 p.m.
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April 6: Dana Center Lobby/Auditorium
September 28: East Tower Patio
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Story Ideas?
Your participation is essential to making The Scope a dynamic and sustainable publication.
Please submit articles of 250-300 words to [email protected]. Include practitioner’s
byline with title and appropriate contact for further information. We publish two times
each month.
To view past issues, visit www.mmc.org/TheScope.
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Medical Staff Value, Mission, and Vision Statements
Value Statement
The Medical Staff of Maine Medical Center values both individuality and collaboration. We
will continually pursue higher value health care. We embrace a culture of curiosity and lifelong learning. We are partners with Maine Medical Center, and we mirror its values of
compassion, service, integrity, respect, and stewardship.
Mission Statement
The Mission of the Medical Staff of Maine Medical Center is to provide affordable, highquality health care to our community. We teach future health care providers and develop
innovative ways to improve the health of our community. In partnership with the Medical
Center, we proudly accept our responsibility as one of Maine’s leaders in patient care,
education, and research.
Vision Statement
The Medical Staff of Maine Medical Center will be the driving force within Maine Medical
Center leading the way to making Maine the healthiest state in the nation.
A Compact Between Maine Medical Center and Its Medical Staff
Peer Support
for the MMC Medical Staff
[email protected]
Physician leader: Christine Irish, MD
Confidential * One-on-One * Peer Support
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www.mmc.org
22 Bramhall Street, Portland, ME 04102 | (207) 662-0111
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