spring 2017 Recognizing the Signs of Peripheral Artery Disease P. 6 Plus: DIABETIC EDUCATION CENTER OPENS P. 3 SOUTH NASSAU AWARDED NATIONAL RECOGNITION FOR OUTSTANDING ELDER CARE P. 10 Spring 2017 PHYSICIANS’ FORUM is published three times a year by the External Affairs Department for the medical communities of South Nassau Communities Hospital, One Healthy Way, Oceanside, NY 11572 Department of External Affairs 2277 Grand Avenue, Second Floor Baldwin, NY 11510 PHONE: (516) 377‑5370 FAX: (516) 377‑5385 www.southnassau.org Please email your comments or suggestions to [email protected]. Physicians’ Forum is online! Log onto www.southnassau.org and click on the “Medical Staff” link. CHAIRMAN OF THE BOARD Joseph J. Fennessy PRESIDENT AND CEO Richard J. Murphy SENIOR VICE PRESIDENT OF CORPORATE COMMUNICATIONS & DEVELOPMENT Joe Calderone VICE PRESIDENT OF EXTERNAL AFFAIRS Mark Head MANAGING EDITOR Donna Kutt Nahas EDITORIAL ASSISTANT Sharon Lebowitz GRAPHIC DESIGN James Castle Knowledge is Power I t is an old adage that has withstood the test of time because it is fundamentally true: Knowledge is power. For our patients, knowledge is one of the keys to better health. Knowledge leads to better informed conversations with clinicians, increased screening rates, more widespread adoption of preventive measures, and improved compliance with therapeutic recommendations. While our investments in technology and recruitment of highly skilled clinical staff yield important results, we must simultaneously commit to enhancing our patients’ and community members’ knowledge of health and wellness. In this issue of Physicians’ Forum, our cover story provides insight into the full range of options we offer for patients who experience peripheral artery disease. As you will read on page 3, our newly opened Diabetes Education Center, staffed by certified diabetes educators, provides patients with the tools they need to monitor and maintain their health. Diabetes is the seventh leading cause of death in the U.S., according to the American Diabetes Association. It affects more than nine percent of Americans, but most are undiagnosed. Of those who are, education is critical to living a long and healthy life. Whether young or elderly, healthy or managing a chronic illness, caring for oneself or for family members, knowledge is critical to helping all members of our community make the choices that will help them lead healthier lives. This is the underlying message of our newly launched advertising campaign. Dubbed “Truth in Medicine,” the campaign features its own website (truthinmedicine.org) and a series of videos featuring South Nassau physicians answering common health and wellness-related questions. Please visit the site and share the videos as well as your thoughts about the campaign. The months ahead promise to bring political uncertainty, dramatic regulatory and reimbursement changes and an overhaul of our entire health care system. Keeping ourselves informed and maintaining our commitment to educating our patients so that they can make the most appropriate decisions about their health are the most important steps we can take to ensure the best possible outcomes for our patients and our profession. Thank you for your continued support and partnership. Sincerely, 2016 Distiction in Writing Richard J. Murphy PRESIDENT AND CEO 2 | Physicians’ Forum • Spring 2017 Stephen Onesti, MD PRESIDENT, MEDICAL STAFF Helping Diabetes Patients Achieve Better Outcomes F or the nearly 20 years that Patricia F. has had diabetes, her blood sugar has fluctuated like a roller coaster. “I was not well-controlled,” the Valley Stream mother of two admits, “it was my own fault.” Even though she wore a continuous glucose monitor that tracked her blood sugar day and night, she continued to experience blood sugar swings because “every time I had a snack, I didn’t check my [insulin] pump.” But thanks to South Nassau’s newly opened Diabetes Education Center, Patricia’s blood sugar is back on track and she’s even shedding weight. The center, recognized by the American Association of Diabetes Educators, provides adults diagnosed with Type 1 and Type 2 diabetes the skills, tools and knowledge to manage their disease and avoid complications. Located at 519 Merrick Rd., Rockville Centre, the center is staffed by certified diabetes educators and can refer patients to a professional panel of physicians specializing in all areas of diabetes, including endocrinologists, podiatrists, cardiologists and vascular surgeons. “The center is dedicated to helping individuals overcome their challenges with diabetes,” said Lucille Hughes, a certified diabetes educator and director of the center. “Managing diabetes is key to a healthy lifestyle.” For Patricia, reining in her dietary choices was key to stabilizing her blood sugar. Hughes explained how Patricia’s lunchtime routine of consuming chicken salad or ham on white bread caused her blood sugar to fluctuate. Even after Patricia substituted wheat bread for white bread, her blood sugar still rose. “When we advised her to change her meal plan and substitute it with better choices, such as roasted chicken and a salad, her blood sugar finally normalized,” Hughes said. And at the center’s suggestion, Patricia has headed back to the gym and works out five days a week. “You feel like you’re working with a partner,” said Patricia of the center. “I know what the triggers are and the foods I should be eating. I feel more in control and that I can do this.” n ABOUT THE DIABETES EDUCATION CENTER The Diabetes Education Center was launched in July 2016 under the leadership of Lucille Hughes, RN, director of diabetes education. The center was established to meet the needs of the growing number of people diagnosed with pre-diabetes, clinical diabetes and gestational diabetes. Lucille Hughes can be reached at 516-497-7421 or [email protected]. Physicians’ Forum • Spring 2017 | 3 Capsules a regular column on medication matters MEDICATION USE IN THE ELDERLY By Carl Zipperlen, RPh M edication prescribing in older adults. To physicians and allied health personnel, that means being mindful of dosing adjustment requirements; lessening troublesome side effects; determining the actual need for various medications; and avoiding polypharmacy when possible. Older adults are twice as likely as others to come to the emergency department for adverse drug events and are seven times more likely to be hospitalized after an emergency visit, according to the Centers for Disease Control. the health care provider make dose adjustments to lessen side effects or determine possible alternatives that will best meet the patient’s needs and contribute to the overall therapy goals. Did You Know? Older adults are twice as likely as others to come to the emergency department for adverse drug events. Source: Centers for Disease Control The American Geriatrics Society maintains an exhaustive list of potentially inappropriate medications for older adults. This evidence-based clinical tool called the Beers Criteria list (www.americangeriatrics.org) serves as a guide to identify medications that may impose risks that outweigh any benefit in the geriatric population. If the patient is currently taking a medication on the Beers Criteria list, the unit-based pharmacist can help Long-term use of a medication on the Beers Criteria list may pose a problem for older patients, since the body’s ability to metabolize the medication changes over time. If you are considering discontinuing the drug, a dose adjustment or slow taper is advised. If you have older patients currently taking a medication on the Beers Criteria list, consult with your unit-based and clinical pharmacists for a chart review. They can help you manage your older adult’s medication regimen and avoid potential adverse drug events. Questions? Contact Carl Zipperlen, clinical pharmacist, at 516-632-4568 or [email protected] South Nassau Ethics Committee T he South Nassau Ethics Committee, co-chaired by Lori Raffaniello, RN, director of Nursing, and Jonathan Altus, MD, is available for clinical consultation and offers assistance to health care team members, patients and their families coping with ethical questions or dilemmas related to patient care. 4 | Physicians’ Forum • Spring 2017 The Ethics Committee can be reached 24/7 by calling the Nursing Office at 516-632-3910. In addition, providers can place an order in the EMR for an ethics consultation. n Helping Health Care Consumers Decipher Fact from Fiction D oes dyeing your hair increase your risk of cancer? Does a heart attack feel like an elephant is sitting on your chest? Do older adults need less sleep? The answers to these questions and more are posed in a new, multi-faceted South Nassau Communities Hospital advertising campaign called “Truth in Medicine.” The new “Truth in Medicine” ad campaign includes a full complement of strategically placed cable television and print ads in Newsday, the Herald community newspapers and other local newspapers; ads were also placed on social media and South Nassau’s website, aimed at educating the public on critical health issues. The unconventional ads feature provocative full page photos – such as a woman who has dyed her hair green – and poses a question relevant to the photo. Consumers are then urged to go to the hospital’s ‘truthinmedicine.org’ webpage, which provides health consumers with guidance from South Nassau experts (and more than a dozen health education videos) about where to turn for information and medical care. n These unconventional ads are featured in the hospital’s new “Truth in Medicine” ad campaign. Physicians’ Forum • Spring 2017 | 5 COVER STORY: Recognizing the Signs of Peripheral Artery Disease When the redness and swelling in her toes didn’t resolve, the great-grandmother of 13, who has diabetes and high blood pressure, consulted a podiatrist back on Long Island who took an X-ray, removed an ingrown toenail and prescribed a topical medication. But after about a week, the swelling and redness worsened and now a sore, where the ingrown toenail was, had formed. Another podiatrist also prescribed a topical cream, but when the sore didn’t heal, she consulted yet another podiatrist who immediately referred her to South Nassau Vascular and Endovascular Surgery. “There were wounds that encompassed all of her second and third toes on her right foot,” vascular surgeon Charles Sticco, DO, recalled. “The wounds were very advanced and so painful that she could only put weight on her heel.” He explained that inadequate blood flow to her lower extremities, due to atherosclerosis complicated by diabetes, was interfering with her body’s ability to heal itself. “ The wounds were very advanced and so painful that she could only put weight on her heel. “ S tella P., 84, will never forget her 2015 Caribbean vacation, not because of the pink, sandy beaches, pristine waters or lush mountain landscapes, but because she stubbed her toes on a table leg. After performing a series of tests to evaluate the blood flow to her lower limbs, Dr. Sticco diagnosed Stella with peripheral artery disease, which affects more than 10 million Americans, including up to 20 percent of those older than 60. Untreated, peripheral arterial disease can cause blockages that lead to gangrene and amputation of a limb, heart attack and stroke. “Unfortunately, the condition may go undetected for years, because people assume the pain will go away or they think it’s due to arthritis and aging, so they downplay their symptoms,” Dr. Sticco said. “But ignoring it, could have dire consequences down the road.” To improve blood flow to Stella’s foot, he recommended she undergo minimally invasive angioplasty and stenting. On the day of her procedure, she returned home with a prescription to help maintain adequate blood flow to her leg. 6 | Physicians’ Forum • Spring 2017 In some cases, bypass grafting surgery is recommended if blood flow to the limbs is severely blocked. For this procedure, a graft is made by using a blood vessel from another part of the body or a synthetic tube,” explains vascular surgeon Harmandeep Singh, MD. “Circulation is restored by rerouting the blood around the blockage.” Stella is back on her feet now, though two of her middle toes could not be saved due to the severe nature of her wounds. Following a course of physical therapy, Stella says she can walk without a walker or cane. ”Everything is healed now and perfect.” n ABOUT THE DOCTORS Vascular surgeons Harmandeep Singh, MD, and Charles Sticco, DO, are board-certified in general and vascular surgery. Director of Vascular and Endovascular Surgery, Dr. Singh specializes in cardiovascular and venous diseases, including carotid disease, thoracic aneurysm and aortic dissection, abdominal aortic iliac/iliac aneurysm and aortoiliac occlusive disease, peripheral artery disease, hemodialysis access, varicose and spider veins and lower extremity wound care. After earning a medical degree from Baba Farid University of Health Sciences in Faridkot, Punjab, in India, he completed an internship in internal medicine and a residency in general surgery at Brookdale University Hospital Medical Center, where he also served as chief resident. He was fellowship-trained in vascular and endovascular surgery at University Hospital at Buffalo. Director of South Nassau’s Wound Care Center, Dr. Sticco has a special interest in endovascular treatment of aortic aneurysms, peripheral vascular disease, hemodialysis access and venous disorders. Dr. Sticco graduated from SUNY at Buffalo with a Bachelor of Science in pharmacy and earned a medical degree from Chicago College of Osteopathic Medicine of Midwestern University in Downers Grove, Illinois. He completed an internship and residency in general surgery at Nassau University Medical Center, where he served as chief intern and resident. He was fellowship-trained in vascular and endovascular surgery at Staten Island University Hospital/Northwell Health. Prior to joining the South Nassau staff, Dr. Sticco served as an assistant professor of endovascular surgery at the Albert Einstein College of Medicine/Montefiore Medical Center. What Your Patients’ Legs and Feet Could Be Telling Them About Their Health Only half of the people with peripheral vascular disease experience symptoms. Here are some of the warning signs of peripheral vascular disease: • • • • • • Toe or foot wounds that heal slowly or don’t heal Calf or thigh cramping or pain with physical activity Cramping that does not go away after exercising Legs and feet feel cold or change color Loss of hair on the legs Shiny skin on the legs and feet Prevent Peripheral Artery Disease in Your Patients Reduce their risk of peripheral artery disease by advising them to follow these steps: • Stop smoking • Control blood pressure, blood sugar and cholesterol • Exercise regularly • Keep weight at a healthy level • Follow a low-fat, low-cholesterol diet To discuss a patient with Dr. Singh, email [email protected]. Dr. Sticco can be reached at [email protected]. Physicians’ Forum • Spring 2017 | 7 Enhancing Safety for High-Risk Patients I n hospital-speak, patient falls are a “never event”—serious medical errors or adverse events that should never happen to a patient. To help prevent harm to “safety-watch” patients who are considered high risk for falling, South Nassau has several tools in its arsenal: color-coded patient wrist bands; chair and bed alarms; door signs alerting providers of the fall risk; staff safety rounds every 15 minutes; and patient “sitters.” The hospital’s latest tool is a robot-like device that can remotely keep an eye on as many as a dozen or more patients simultaneously. Meet TeleSitter®, a remote video monitoring system that reduces reliance on nursing staff to watch patients at risk of falling due to impaired mobility, confusion and delirium, among other conditions. An estimated 700,000 to 1 million patients fall in U.S. hospitals each year, resulting in fractures, lacerations or internal bleeding, according to the Agency for Healthcare Research and Quality. The system’s fixed and mobile wireless monitors enable trained technicians to see and talk The TeleSitter technology enhances safety for with patients over video and patients who need constant supervison. audio feed in real time, explains Dawn Keiley, RN, director of Nursing. If a patient engages in a potentially self-injurious behavior, such as getting out of bed without assistance or pulling out IV tubes, the observer immediately notifies unit staff. The technology, which helps reduce patient falls,enhances patient safety and decreases costs related to sitter use, also frees up staff to assist other patients. 8 | Physicians’ Forum • Spring 2017 The TeleSitter video monitoring system allows trained technicians to see and talk with patients over video and audio feed in real time. The system is intended to help reduce patient falls and increase safety. Keiley points out that TeleSitter cannot record video or audio and allows the caregiver and patient to request privacy. Health care providers can request ‘privacy mode’ by dialing the phone number on the mobile monitor, she explains, but asks that they “communicate the amount of time they will need.” So far, 14 portable, wireless monitors have been deployed throughout the hospital. South Nassau is currently installing fixed cameras in some patient rooms on D 1-East, G-2, D 2-East and D 2-West, which logged the highest need for sitters at South Nassau in 2015. “The feedback has been extremely positive,” said Robert Davis, RN, nurse manager of D-2 East, of TeleSitter. “Since implementation, we have seen an increase of staff on the floor versus sitting in a room with a patient.” n KUDOS Nephrologist is South Nassau’s First Physician of the Quarter S outh Nassau has recognized Louis Swartz, MD, with the Physician of the Quarter award for his commitment to patient care and the hospital’s mission and values. The award was presented at the March 7 quarterly staff meeting. The co-chief of nephrology first joined the medical staff in 1995 and is currently serving a two-year term as the treasurer of the Medical Board. The award was established by South Nassau’s 13-member Physician Engagement Committee, part of the Service Excellence Steering Committee, which aims to enhance patient-centered performance initiatives. Once a quarter the program recognizes an upstanding physician member of the medical staff who excels in the following six areas: 1. Community service: Instrumental in the development and support of community wellness and health care initiatives and/or participated in supporting political and legislative health care initiatives. 2. Clinical collaboration and teamwork: Role model for teamwork in health care delivery and of respect and caring in interpersonal interactions. He/she may have facilitated cooperation between specialties and disciplines and promoted the concept of interdisciplinary cooperation and coordination. Louis Swartz, MD, Physician of the First Quarter for 2017, is center. Posing with him, from left, are Adhi Sharma, MD, chief medical officer; Stephen Onesti, MD, president of the medical staff; Rajiv Datta, MD, chairman of the Department of Surgery and medical director of South Nassau’s Gertrude & Louis Feil Cancer Center; Frank Coletta, MD, co-director of Critical Care; Raul Mendoza, MD, associate chairman of the Department of Medicine; and Aaron Glatt, MD, chairman of the Department of Medicine and hospital epidemiologist. 3. Clinical quality: Promotes improvement in clinical quality and systems. He/she may have championed patient safety initiatives or facilitated establishment of “best practices” and or supported Performance Improvement. This physician should have demonstrated consistently favorable patient outcomes. 4. Leadership: Provides leadership for new initiatives and demonstrates a visionary approach to problem solving. He/she may have provided leadership to the Medical Staff or the broader medical community. He/she builds consensus among groups of physicians and other health care providers and may have participated in legislative and other political activities in support of health care. 5. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores: Must demonstrate a record of providing high-quality patient experiences. 6. Charting: Must complete charting in a timely manner. n Long Island Business News Recognizes Trauma Center Physician, Nurse Long Island Business News honored Narinder P. Grewal, DO, associate trauma medical director and medical director of Trauma/ Surgical Critical Care, and Margaret Puya, RN, Trauma Center manager, with the Achievement in Health Care award for their contributions to advancing the quality of health care on Long Island. Dr. Grewal was recognized in the physician category, and Ms. Puya in the nurse category. The pair was lauded at an awards dinner on November 1, at the Crest Hollow Country Club in Woodbury. Physicians’ Forum • Spring 2017 | 9 NEW MEDICAL STAFF John D. Bedell, DO Family Practice Alan M. Brickman, MD Endocrinology Lisa Ann Buckley, PA Emergency Medicine Kelly A. Cash, NP Cardiology Farhad M. Gazi, MD Emergency Medicine South Nassau Awarded National Recognition for Outstanding Elder Care S outh Nassau Communities Hospital has been awarded designation as a NICHE hospital for its commitment and dedication to meeting the complex health care needs of elder patients. South Nassau is just the second Long Island-based hospital to earn the designation. NICHE (Nurses Improving Care for Healthsystem Elders) is an international program designed to help improve the care of adults 65 and older. Based at NYU College of Nursing in Manhattan, NICHE’s network has more than 680 hospitals and healthcare organizations from the U.S., Canada, Bermuda and Singapore. “This award underscores South Nassau’s commitment to our older patients who often have special needs that our staff members are trained to recognize and address,” said Richard J. Murphy, South Nassau’s president and CEO. As a NICHE-designated hospital, South Nassau will serve as an 10 | Physicians’ Forum • Spring 2017 incubator of evidence-based, interdisciplinary advancements in the care of elder patients. It has also adopted a new model of practice known as ACE (Acute Care for Elders) that aims to prevent functional decline of elders over the age of 70 while they recover in the hospital. The goal of ACE is to maintain the physical and psychosocial needs of elder patients and to help prevent complications associated with immobility and delirium. The nationally recognized model of care significantly enhances clinical outcomes by improving the elderly patient’s ability to function upon discharge and reducing the need for transfers to nursing homes or rehabilitation hospitals. South Nassau’s palliative care program, a component of ACE and NICHE, focuses on maintaining and optimizing the overall quality of life of hospitalized elder patients by meeting their medical, physical, emotional, social and spiritual care needs. n Alexandra Gutman, NP Anesthesia Maureen Kallman, NP Gastroenterology Jesse Katz, PA Emergency Medicine Sooji Kim, DPM Podiatry Valerie Kremer, MD Hematology/Oncology Brett A. Lenart, MD Orthopedic Surgery Moiz Manaqibwala, MD Orthopedic Surgery Rita Mizrahi, DDS Oral and Maxillofacial Surgery Richard S. Obedian, MD Orthopedic Surgery Mark C. Pillitteri, DO Obstetrics/Gynecology Kiran Reddy, MD Cardiovascular Disease Joyce Folashade Robert, MD Family Practice Cheriyan Thomas, MD Internal Medicine David Vivas, MD Colorectal Surgery Tara Gibney, PA Surgery News Notes: On Dec. 6, Podiatry residents attended a workshop on ortho-digital devices led by Bernardino Basas, a practicing podologist, a nonphysician specialist in gait analysis and foot disorders from Salamanca, Spain. Basas introduced the residents to the use of Back row, from left, first-year new silicone devices that podiatry residents Amanda Riley and Weijei Liao; and Michael Lam, can reduce plantar senior podiatry resident. Front row, pressure and horizontal Bernardino Basas; Juan C. Goez, DPM, FACFAS, director of Podiatry, Division shear stress of the foot, of Orthopedics; and Areeba Ahmed, which plays a role in the second-year podiatry resident. development of ulcers in patients with diabetes. The workshop was coordinated by Juan C. Goez, DPM, FACFAS, director of Podiatry in the Division of the Department of Orthopedics. n Department of Surgery Recognizes Surgeon, Professor Rajiv Datta, MD, chairman of South Nassau’s Department of Surgery and medical director of the Gertrude & Louis Feil Cancer Center, recognizes guest speaker Corrado P. Marini, MD, FACS, professor of surgery, New York Medical College. Dr. Marini presented “The Intensive Care Unit Model: The Impact on Overall Performance” to more than 50 physicians, surgical residents and allied health professionals at the hospital’s annual Noto Memorial Lecture. The Noto Memorial Lecture bears the name of the late Salvatore Noto, MD, South Nassau’s first pediatric surgeon who served on the medical staff from 1951 until his death in 1992. n CHIARI AND SYRINGOMYELIA CONFERENCE The Chiari and Syringomyelia four-day conference, from July 19 to July 24 at the Long Island Marriott in Uniondale, will feature more than 70 speakers from four continents who are tops in the field. Admission for South Nassau resIdents and nurses is free. For more information or to register, email [email protected] or [email protected] by June 30. appointments South Nassau has named Harmandeep Singh, MD, director of the Division of Vascular Surgery in the Department of Surgery. Board-certified in general surgery and endovascular surgery, Dr. Singh joined the South Nassau staff in 2012 after practicing medicine in Massachusetts. He was fellowship-trained in vascular and endovascular surgery at the University of Buffalo and completed a general surgery residency at Brookdale University Hospital Medical Center in Brooklyn. He earned a medical degree from Baba Farid University of Health Sciences in Faridkot, India. Charles Sticco, DO, has been named medical director of the Wound Care Center. Prior to joining South Nassau’s staff in 2015, he served as an associate professor of endovascular surgery at the Albert Einstein College of Medicine/Montefiore Medical Center. Fellowship-trained in vascular and endovascular surgery at Staten Island University Hospital/Northwell Health, Dr. Sticco is board-certified in general and vascular surgery. He earned a medical degree from Chicago College of Osteopathic Medicine of Midwestern University in Downers Grove, Illinois. Physicians’ Forum • Spring 2017 | 11 One Healthy Way, Oceanside, NY 11572 save the dates: Second Annual Women’s Center Gala Thursday, April 20, 6:30 p.m. - 10:30 p.m. Sand Castle, Franklin Square Benefits the establishment of a women’s center for specialty care at South Nassau Honoree: Mrs. Stamatiki Valiotis Buy tickets or sponsorships at womenscenter.eventbrite.com or call 516-377-5360. Annual SIBSPlace Auction Saturday, May 6, at 6 p.m. The Seawane Club, Hewlett Harbor Honorees: Rachel and Randy Gwirtzman Buy tickets or sponsorships at benefitoffice.org/sibs or call 516-377-5360. physicians’ events calendar 2017 Quarterly Staff Meetings When? June 7 at 6 p.m. sharp (Years of Service Awards) October 3 Annual Golf Tournament Monday, June 12 The Seawane Club, Hewlett Harbor and The Woodmere Club, Woodmere Benefits the ED Expansion Campaign To buy tickets or sponsorships, call 516-377-5360. December 5 (Cocktails start at 5:30 p.m., this meeting only) Where? Conference Center Providing Language Assistance to Limited English-Proficient Patients Office-based Medicaid providers can now be reimbursed for language interpretation services to limited English proficient patients in their offices. This includes language services provided over the phone through companies such as CyraCom, which offers interpretation services in more than 170 languages, 24 hours a day, seven days a week. For more information, refer to the “New York State Medicaid Update,” October 2012, V. 28, No. 11. Read Physicians’ Forum online! go to www.southnassau.org and click on the “Medical Staff” link.
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