The Power of Many CAMC cancer center · Employees raised $11,000 by purchasing Power of Many T-shirts, bringing the total employee contribution to more than $571,000. They celebrated

Employees raised $11,000 by purchasing Power of Many T-shirts, bringing the total employee contribution to more than $571,000. They celebrated the employee contribution to the cancer center by wearing their Power of Many shirts.

CAMC Today is a publication of CAMC Health System

Inside this issue

Jan. 15, 2013 CAMC: Quality leader, economic engineWhile most people think of CAMC as a leader in quality care, technology and as a referral center for many specialties, many may not think of CAMC as a powerful force in the region’s economy. Yet it is.

According to a recent study by the National Center for Rural Health, “the role hospitals and hospital systems play as major contributors to the economy is often overlooked… the economic contributions result in a significant number of jobs and wages, salaries, and benefits created in other businesses and industries.”

According to a National Center for Rural Health study conducted and presented by Dr. Gerald A. Doeksen, regents professor and director at Oklahoma State University, jobs and payroll in the health care industry in West Virginia continue to grow and now account for roughly 20 percent of employment and payroll in the state.

The study looked specifically at Kanawha, Putnam, Boone, Clay and Lincoln counties. In 2011, CAMC Health System accounted for about 11,000 jobs in our area.

“CAMC had 6,126 full- and part-time employees in fiscal year 2011. The area hospital employment multiplier was 1.75; this means that for every job in the hospital sector, another 0.75 jobs are created in other businesses in the economy of the five-county medical service area,” according to the study.

In dollars and cents, this means “the total income impact of Charleston Area Medical Center from operating activities was $520.9 million on the economy of the five-county medical service area.”

When you consider construction-related activities at CAMC, that number jumps to $536.3 million.

The fact that Charleston Area Medical Center is a tax-exempt entity does not mean that CAMC does not generate significant tax dollars through its employees and the secondary employment.

The study estimated CAMC employees

paid $41.4 million in federal taxes in 2011 (adding construction and secondary employees the total was $64.8 million); total state income taxes (CAMC, construction and secondary employees) was $23.4 million; total sales taxes (CAMC, construction and secondary employees) was $12 million and the total local residential property taxes (CAMC, construction and secondary employees) was $4.7 million.

“Only by continually re-investing in the broader forms of wealth will we be able to increase the quality of life for present generations and sustain the livelihoods for all of us,” said Becky Ceperley, president and CEO, The Greater Kanawha Valley Foundation.

“CAMC not only provides health services to the residents of our community but also contributes to many aspects of that broader wealth. The Greater Kanawha Valley Foundation looks forward to continuing to work with CAMC to improve the quality of life in our region.”

During this same time (FY 2011), CAMC wrote off more than $39 million in charity care at cost, wrote off more than $21.5 million as bad debt at cost and experienced more than $140.2 million in losses on patients with government insurance (i.e. Medicaid, Medicare, PEIA), which reimburses health care providers below the cost of care.

As the state’s largest safety net hospital, CAMC provides care to a disproportionately large Medicaid and uninsured population, offers services that the community needs

and serves as a regional tertiary care center that many rural hospitals refer patients to for specialized treatment.

“CAMC provides the community with many services, at a financial loss, that no one else offers,” said David Ramsey, CAMC CEO. “And as a not-for-profit, any money remaining at the end of the year gets invested right back in to equipment, facilities and services.”

Volunteerism is another vital part of creating and maintaining a thriving community, and each year employees give their time to local nonprofits, churches and other organizations in hopes of making a difference in the area.

CAMC recently conducted a volunteerism survey to see where employees and physicians are helping their communities. The 232 employees and six physicians who responded spend an average of 11 hours a month volunteering. The organizations range from national groups to local schools, churches and fire departments.

“We encourage our employees to be involved in their community, in whatever form they choose,” Ramsey said. “One of the reasons our area has such a wonderful quality of life is that West Virginians have a strong sense of community.”

CAMC also is one of four major teaching hospitals in West Virginia that trains medical students, resident physicians and students in a variety of other health-related disciplines.

There are currently 176 residents, fellows and interns at CAMC in various specialties. CAMC also serves as a clinical training site for about 800 students per year through educational affiliations with regional colleges and universities. In addition to teaching future clinicians, CAMC also provides several educational opportunities to the public.

For more information about the companies of the CAMC Health System, and job opportunities or services offered, visit camc.org.

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The Power of ManyCAMC cancer center

The CAMC Play Patch at the Charleston Town Center is now open near JCPenney. Kids can play and learn about healthy eating and living.

CAMC focuses on preparing residents for quality and safety initiatives…Page 2

The CAMC Weight Loss Center has individualized programs to help kids and adults achieve their goals…Page 3

Vaccines are more important than ever to protect the health of our population…Page 3

THE CUTTING EDGESurgeons are using a new tool for earlier detection and better treatment of bladder cancers…Page 4

CAMC’s newest MRI scanner provides faster scan times and better patient comfort…Page 4

A new treatment is available for life-threatening aneurysms…Page 4

CAMC’s impact11,000 jobs

$536.3 million income impact$104.9 million taxes (federal, state, income, sales, property)

Community benefit: $121 million

Ciaccia sees patients of all ages with varying injuries and conditions.

“We see everything from simple sprains and strains to profound injuries related to motor vehicle accidents, power tools and heavy machinery use,” Ciaccia said. “We also see overuse syndromes with musicians and athletes, as well as degenerative conditions like arthritis.”

Ciaccia’s expertise includes the latest, minimally-invasive surgical procedures for many common surgical ailments to result in a faster, less painful recovery period. Procedures range from mini-open carpal tunnel release to percutaneous fracture fixation to arthroscopic rotator cuff repair.

CAMC’s Physical Therapy Center moved to a new location in December, just down the street from the old building. The new center is located directly beside the CAMC Weight Loss Center (600 Tracy Way, Northgate Business Park).

The center provides a full range of physical therapy services, including hand therapy, lymphedema treatment, industrial rehabilitation and athletic training.

The center recently added an additional service to its practice: massage therapy. Patients will not need a referral for massage appointments.

For a physical therapy appointment, the Center accepts referrals from primary care physicians, orthopedic surgeons, plastic surgeons, rheumatologists, chiropractors, podiatrists and other medical specialists. For more information about the physical therapy center, visit camc.org/pt or call (304) 388-4900.

Think about how much you use your hands. From grasping, throwing and lifting to writing, texting, cooking and driving, our hands are constantly in motion, which makes them susceptible to injury as well as everyday wear and tear.

“When your hands hurt, every part of your life is affected,” said Scott Ciaccia, DO, CAMC’s only orthopedic hand and upper extremity specialist. “Although non-surgical methods are often the first line of treatment, surgery may be necessary to improve a person’s function and overall quality of life.”

Common problems of the hand and upper extremity include pain, stiffness, numbness, tingling and loss of dexterity. This can lead to loss of function and the inability to perform duties at work, the loss of enjoyment that comes from hobbies, and even the inability to perform basic activities of daily living. Common causes include carpal tunnel syndrome, cubital tunnel syndrome, painful cysts, trigger fingers, inflammation of the tendons, and a host of arthritic conditions. Sometimes, however, these problems are caused by more serious and complex conditions.

“The anatomy from the wrist to the fingertips is quite complex, which is what makes hand surgery very intricate – it’s like working on a watch,” Ciaccia said. “Certain surgeries are so delicate a surgical microscope is needed to repair tiny blood vessels and nerves.”

The endoscopy department at CAMC Memorial Hospital provides diagnostic and therapeutic procedures for patients with conditions or diseases of the gastrointestinal and respiratory systems. The department relocated to the second floor earlier this month.

The new space has seven functioning procedure rooms. One room has a dedicated

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2013

under Tarantino’s leadership, has worked to engage residents in interprofessional teams and forums, which can also involve residents in quality improvement.

Second year internal medicine resident Moniba Nazeef, MD, is grateful to have the experience.

“As young physicians, these projects have helped us learn a lot about systems-based practices and to look for problems that potentially lead to inconsistencies and inefficiencies,” she said. “We get an insight into the importance of time and cost effectiveness as well as overall patient satisfaction, which are things we do not learn a lot in medical school. Understanding these issues leads to brainstorming and discussions of identifying where these problems lie and how they can be approached to come up with practices for improvement and follow-ups to maintain consistency.”

The main goals in all the quality improvement projects are to improve patient care, better prepare residents to enter a regular practice, as well as improve communication among all health care providers.

Internal medicineThe internal medicine department worked on several different projects, including improving outcomes for cardiac and pneumonia patients, as well as overall patient satisfaction.

The QIPS committee educated residents and implemented new discharge instructions for heart failure patients hospital wide, bringing the process compliance to 100 percent.

In the outpatient care center, Tarantino and her residents changed the call back process, and the department decreased the time it took to call patients back by 60 percent.

This year, internal medicine won a CAMC quality award for best innovation for their work.

SurgeryResidents in the surgery department found that the transfer of information from the surgical/trauma intensive care unit (STICU) to a step-down unit or different floor was not unified, causing a lot more work for the

unit receiving the new patient. The nature of the resident program limits the number of hours a resident can work, meaning several different residents will be working with each patient. Resident Adam Ubert, MD, created a form that standardized the process, providing the unit receiving the patient with a summary of the injuries or procedures, required follow-up care and any other pertinent information.

The initiative was overseen by Richard K. Umstot Jr., MD, attending physician in the STICU. The surgical care improvement project (SCIP) is a national initiative that outlines specific protocol for every surgical procedure, such as giving certain antibiotics, taking steps to prevent deep vein thrombosis (a blood clot in the vein), and other preventative measures after a patient has been under anesthesia. The team was invited to speak at a national teleconference about the hand-off improvement and improvement in patient outcomes.

PediatricsJamie Jeffrey, MD, oversees the resident quality improvement projects at CAMC Women and Children’s Hospital. The residents are working on several projects,

including improving asthma patient care and bronchiolitis treatment.

Pediatrics is working on a way to improve outcomes for asthma patients. If a child with asthma is admitted to the hospital, he or she is given a specific treatment plan to treat the symptoms. The residents found a need for more education at discharge for a home management plan, which would include a daily treatment recommendation, a reminder to get a flu shot and getting information to school nurses so they will be able to take an active role in the child’s treatment.

Bronchiolitis is the number one admitting diagnosis for infants. There is a national guideline for the care and treatment of a patient afflicted, and the residents have worked on developing a specific order set for these patients, including working closely with respiratory to expedite healing.

“The institution is very engaged in involving these residents, and the residents have been great,” said Joan Phillips, MD, clinical director of pediatrics at CAMC Women and Children’s Hospital.

Thirty-eight students from the University of Charleston’s School of Pharmacy and 40 third-year medical students from the West Virginia School of Osteopathic Medicine participated in an Interprofessional Collaboration Education Day in November at CAMC’s Simulation Center at General Hospital.

Students rotated through different simulations like diagnosing patients (actors provided with a list of symptoms

Medical educationand medical history) and life-threatening situations on simulation dummies.

Students also had the chance to work in teams to come up with treatment plans for simulated patients. The collaboration between the pharmacy and medical students helped them gain a better idea of how they will interact in a hospital setting, each providing their own expertise to ensure the best patient outcomes possible.

As a teaching institution, CAMC strives to provide many educational experiences for its students. Each year, CAMC welcomes more than 175 medical residents, interns and fellows to its campuses.

Heather Tarantino, MD, FACP, clerkship director and assistant professor for WVU School of Medicine-Charleston Division, is dedicated to making sure these residents get the best training possible during their time at CAMC, and said it’s about more than just basic patient care.

“We want to teach them when they walk in the door,” Tarantino said. “New doctors are held to the same standards as a doctor that’s been in practice for 30 years.”

There are a number of quality improvement initiatives in place at CAMC to ensure health care providers are working as efficiently and safely as possible. While these initiatives are a regular part of the day-to-day for many, educators are working to specifically include residents.

In 2010, Tarantino initiated a pilot project to introduce internal medicine residents to quality improvement programs.

Working with educators and quality improvement and patient safety professionals, Tarantino formed the internal medicine Quality Improvement and Patient Safety committee (QIPS) to develop a learning curriculum and to integrate CAMC’s existing performance improvement structure into the resident training process.

Seeing the need for more integration with all residents, CAMC has taken steps to develop a QIPS committee in all residency specialties. A QIPS Advisory Council of educators and team leaders, chaired by Tarantino, is promoting learning and involvement in quality and patient safety initiatives in all residency programs, and is working to develop curriculum at the institutional level that provides these opportunities.

Quality improvement projects focus on integrating quality and patient safety issues into the daily experience and language of the residency training experience as residents are engaged in identifying areas for improvement, evaluating outcomes data and looking at ways to improve patient care and efficiency. The QIPS Council,

CAMC residents benefit from participating in quality and patient safety projects

CAMC hand surgeon offers relief for problems of the hands, wrists and arms

bronchoscopy suite with radiology capabilities for allowing physicians to look inside of patients’ lungs, one is a stationary radiology room and the additional five are standard procedure rooms for things such as upper gastrointestional and colonoscopy procedures. Anesthesia services are available in the department for procedures requiring deep sedation. An eight-bed recovery bay is an increase from six in the former space.

The department is committed to providing the highest quality care based on national standards.

For more information about endoscopy at CAMC Memorial Hospital, visit camc.org/endoscopy.

CAMC Memorial Hospital endoscopy moves to provide more efficient patient care

CAMC’s Physical Therapy Center

Ciaccia received his undergraduate degree from The Ohio State University. He attended medical school at Ohio University College of Osteopathic Medicine. After completing a five-year residency in general orthopedics, he pursued additional training in hand and upper extremity care. His fellowship training was undertaken at the Christine M. Kleinert Institute for Hand and Microsurgery in Louisville, KY. After completing his fellowship in August 2012, he joined the CAMC Physicians Group Orthopedics practice at CAMC General Hospital.

“I chose to come here because I like the energy of the young orthopedic surgeons working at CAMC and the cutting-edge treatments available here,” Ciaccia said. “Having the opportunity to relieve pain and restore function is why I chose this career and why I love what I do.”

Ciaccia’s primary focus is treating conditions of the hand and upper extremity. He also focuses on injuries and chronic conditions of the shoulder and elbow. When appropriate, he uses arthroscopic and other minimally-invasive techniques in these regions to speed recovery. Ciaccia also does general orthopedic care, including the treatment of various lower extremity injuries and chronic conditions.

Dr. Ciaccia is accepting new patients. For more information call the CAMC Physicians Group Orthopedics practice at (304) 388-7700.

Dr. Scott Ciaccia

camc.org 3

CAMC residents benefit from participating in quality and patient safety projectsWeight loss is big business, and it gets bigger every year as the population continues to become more obese. In fact, Americans spend more than $30 billion each year on weight loss programs, products and pills, but the painful truth is the only thing many people lose in their quest to shed pounds is money, not weight.

The CAMC Weight Loss Center offers real solutions for people who are ready to make a commitment to changing their size and their lives.

“Obesity is an epidemic that is far more dangerous than many people realize because it increases the risk of developing type 2 diabetes, high blood pressure, cardiovascular disease, arthritis and other cancers,” said Robert Shin, MD, medical director of the Weight Loss Center.

Over half of Americans are overweight, and more than one-third are obese. The CAMC Weight Loss Center offers customized medical and surgical weight loss solutions to help anyone struggling with weight issues, no matter how big or small.

“This is not just a diet and exercise facility, this is a place where we explore all aspects of weight gain, weight loss and weight maintenance to help people have long-term success for better health,” Shin said.

Medical weight loss is open to anyone. Care is monitored by a registered dietitian, exercise physiologist and nurse practitioner. Meal planning and exercise routines are tailored to meet each person’s individual preferences and abilities. With a focus on improving overall health, educational classes are offered on a routine basis along

“There’s a lack of awareness about how bad obesity is,” said Robert Shin, MD, medical director of the CAMC Weight Loss Center. “It’s the #1 killer in society, but it’s still treated more like a shameful problem than a medical issue. We need to break the barriers of obesity and understand that it is one of the most serious health problems facing this generation and future generations.”

The health of future generations is what concerns pediatrician Jamie Jeffrey the most.

“When I started seeing the complications of obesity in my pediatric patients around 10 years ago, I had to re-learn about ‘adult’ diseases like type II diabetes, hypertension and sleep apnea,” said Jamie Jeffrey, MD, medical director of the Children’s Medicine Center at CAMC. “Type 2 diabetes wasn’t something I learned about in my pediatrics residency because at that time children didn’t get it – only adults did. Likewise, hypertension was rare in kids, but now is very common because of the obesity epidemic.”

The American Heart Association reports that one in three American children and teens is overweight or obese, nearly triple the rate in 1963, which is causing a broad range of health problems in children that previously weren’t seen until adulthood such as high blood pressure and high cholesterol. Plus, there are the psychological effects: obese children are more prone to low self-esteem, negative body image and depression.

“Obesity is the biggest public health threat facing today’s children,” Jeffrey said. “If you make their health better, you make their lives better.”

maintain it, exercise and eat right. If you go back to bad habits, you will gain weight.”

Weight loss surgery is performed at CAMC General Hospital. Its dedicated bariatric unit offers a patient-friendly environment that includes private rooms to comfortably accommodate patients and their guests, as well as oversized chairs and beds for patient comfort.

“Everyone on this unit, from the floor nurses to the transport staff, shares the Weight Loss Center’s dedication to providing the highest-quality care,” said Mary Colley, practice administrator.

After surgery, the Weight Loss Center staff helps patients develop a healthy and fit lifestyle in order to achieve and maintain their weight loss goals.

“Weight maintenance requires a lot more work than the surgery,” Shin said. “It’s extremely difficult to change people. That’s why diets aren’t successful. Our team approach to weight loss includes a nutritionist to help with changing eating behaviors, an exercise physiologist to help incorporate activity into daily life, and a psychologist to help manage stress, because overeating is often stress related.”

Support also continues long after surgery. Patients attend monthly support group meetings to stay on track with their goals, share challenges with others, and to help maintain a healthy diet.

“Bariatric surgery is such a life-changing event,” Rossi said. “You see people not only lose weight, but get off medications for other health problems as a result of losing weight.

children attend monthly sessions for the remainder of the year,” Jeffrey said.

Jeffrey uses intrinsic motivation techniques to encourage participants. Rather than telling children what to do, she helps them stay focused on their goals and what motivates them.

“During the screening process we ask the kids, ‘What’s in it for you? How will you be better if you lose weight?’ For girls, it’s clothes and bathing suits. For boys, it’s sports activities and keeping up with friends that are more active. So we help them stay focused on what’s important to them.”

Participants have an individual responsibility to set their own goals and work toward them. They fill out nutritional food logs, physical activity logs, look at food labels, and participate in exercise programs designed specifically for them.

“We meet at the CAMC Weight Loss Center where there’s a gym with kid-size equipment, like an elliptical machine, and we make exercise fun,” Jeffrey said.

Family support is also key, because it often takes changing a family’s habits to help children be successful.

“We have to teach children to be healthy at home, which means making better food choices at the grocery store, planning ahead

with individual counseling appointments. Participants also gain support from other members in the program.

“Whether you want to lose 10, 20 or 30 pounds, we can create a comprehensive weight loss management plan for anyone who doesn’t want or need surgery but is looking for long-term success,” Shin said.

Surgical weight loss options are available for people who need to lose 80 pounds or more, or who have other medical conditions such as diabetes and high blood pressure. Laparoscopic gastric bypass, adjustable gastric binding (Lap Band®), and laparoscopic sleeve gastrectomy are surgical weight loss options available at the CAMC Weight Loss Center. (Visit camc.org/weightloss for a chart comparing these surgeries.)

“Bariatric [weight loss] surgery has greatly advanced over the past 15 years,” Shin said. “Incisions are smaller, recovery times are faster, complication rates are lower, and outcomes are better. For many people it’s the only option for a healthier, more enjoyable life when diet and exercise have failed.”

There’s much planning and preparation for weight loss surgery long before a patient reaches the operating room. From physical and psychological exams to support groups to checking on insurance coverage, preparing for a life-changing surgery takes time, physical and mental readiness, and most of all, personal commitment.

“Surgery is not a magic bullet or a quick fix,” said Samuel Rossi, MD, bariatric surgeon at the CAMC Weight Loss Center. “Losing weight is a lifelong journey that takes a lot of patient responsibility. You still have to

So Jeffrey created the Healthy Kids Pediatric Weight Management Program at CAMC, which is a family-based, medically-supervised program that encourages a healthy diet and active lifestyle for children and teens 5 to 18 years old.

“We encourage making healthy changes by setting small goals each week. It’s all about taking baby steps to make change easy and permanent,” Jeffrey said. “Children go through a complete medical evaluation to identify complications of being overweight, and they are guided through every step of the program by a doctor, dietitian and nurse educator.”

The program consists of three tracks that vary in length and intensity.

“We do a thorough screening before enrolling a child and family into the group session,” Jeffrey said. “We talk with parents about their concerns, we talk with the children about what motivates and concerns them, and we find out if it’s the right time for the family to make this commitment.”

After the initial consultation, the doctor and family choose which track best suits their needs: a consult track that involves just a few visits; a monthly track that includes meeting with a doctor, dietitian, and nurse educator in addition to weekly weigh-ins; or an intensive one-year multidisciplinary track.

“The one-year program includes weekly visits for the first eight weeks, individual sessions with team members, group nutrition and exercise sessions, and weekly weigh-ins. After the first eight weeks,

You see their personalities change. You see them get more active. You see them get their lives back. Patients tell us all the time their biggest regret after surgery is they wish they would have done it earlier because they had tried everything else. It’s so gratifying to watch the positive changes this can make in a person’s life.”

The CAMC Weight Loss Center is Charleston’s only Bariatric Surgery Center of Excellence designated by the American Society for Metabolic and Bariatric Surgery (ASMBS). This designation recognizes surgical programs with a demonstrated track record of favorable outcomes in bariatric surgery.

To earn the ASMBS Bariatric Surgery Center of Excellence recognition, programs must adhere to rigorous standards established by Surgical Review Corporation (SRC), an organization dedicated to pursuing surgical excellence.

“Being a Center of Excellence assures patients that CAMC surgeons and staff adhere to the highest standards of care and that the program has a proven track record of providing quality weight loss services to patients,” said Mike Williams, administrator of CAMC General Hospital.

To learn if medical or surgical weight loss might be an option for you, call (304) 388-4965 to register for an upcoming free weight loss seminar or to schedule a private consultation. You can also visit us online for more information at camc.org/weightloss.

for meals, learning about portion control, sending healthier snacks to school, and making healthier food choices when eating out,” Jeffrey said. “After kids get to a certain age if all they’ve eaten are fries, pizza and milkshakes, all of a sudden parents think they have picky eaters. But if that’s what kids are used to eating, that’s all they’ll want.”

As a busy working mom of four children herself, Jeffrey practices what she teaches.

“I used to drive through fast food on our way to the pool, dance or soccer, and I noticed my kids gaining weight. So we stopped ordering french fries and sides, which made a difference. We also keep veggie trays in the house to snack on, and we plan our meals ahead instead of choosing fast food all the

time. You have to do what works for your schedule, but making small changes can have big results.”

Healthy Kids is also seeing results. Of the last 100 children who

went through the multi-disciplinary program, 93 percent of patients lost

weight. Their average BMI range also dropped from 34.5 to 32.3 in the first eight weeks.

“We, adults, have demanded a life and environment of convenience and it’s killing our children,” Jeffrey said. “We have to be advocates for them and change it.”

For more information about the Healthy Kids program at CAMC,

call (304) 388-2938.

CAMC Weight Loss Center focuses on the journey, not just the destination

Vaccines protect health of populationMany of us cannot recall the devastating effects caused by diseases like smallpox and polio. Successful vaccination programs worldwide have either eradicated these diseases or significantly limited their impact to only a few cases each year.

“Immunizations have made the largest impact on the health of our population,” said Raheel Khan, MD, FAAP, a specialist in pediatric infectious diseases. “Vaccine-preventable diseases are no longer a major cause of death in children, and vaccines have played a major role in increasing the life expectancy by 30 years.”

People may think that since many of these diseases haven’t appeared in years, that they do not need to have their children vaccinated. “I think the public perception about vaccination has changed, in part, because people don’t see these diseases anymore and don’t think that they are a health risk. However, these diseases still exist and if we stop immunizing our population for these vaccine-preventable diseases, they have a potential to come back and spread like a wildfire if we have an un-immunized or under immunized population. The world has become a much

smaller place with modern-day travel, and the next disease load can only be a flight away. We have an obligation as health care providers to keep our guard up and protect our population,” Khan said.

Safety of vaccinesAnother issue that has changed perception about vaccines is the publication of a study in the late 1990s that proposed a link between the MMR vaccine (measles, mumps and rubella) and autism spectrum disorders.

“I think the scare that happened because of this study has definitely hurt our effort to increase vaccination rates. Vaccination rates dropped, and there have been outbreaks because of that,” Khan said. “The study was eventually retracted and the lead author of the original study lost his medical license because it was found that he manipulated evidence.”

Several large, well-controlled and designed studies have been conducted since then, and none found any link between the MMR vaccine and autism.

Khan said that receiving vaccines on

schedule is the best way to be protected from diseases like measles, mumps, rubella, pertussis and others.

“Parents sometimes choose to withhold or delay vaccinations. This can cause outbreaks and puts everyone at risk. No one is claiming that vaccines are absolutely safe, but there is nothing in life that is 100 percent safe. Vaccines, like many other medicines, can have minor side effects, but the benefits of vaccines hugely outweigh the risks,” he said.

Vaccines are tested in very large, comprehensive clinical trials before marketing or public use. “The current rotavirus vaccine trial had more than 70,000 subjects; the HPV vaccine was tested in 30,000 women and the pneumococcal vaccine was tested in 30,000 children,” Khan said. “We are constantly improving vaccines. The current vaccines are not the ones that our parents would have received.”

There is also a system in place to report adverse events that occur after one receives a vaccine. The system is maintained by the Centers for Disease Control and the Food and Drug Administration.

Herd immunityOne of the ways in which vaccines protect against diseases is through herd immunity. “Herd immunity means that there must be a very large percentage of the population immunized in order to protect those who are not immunized,” Khan said.

However, the concept is not absolute. “There are always people within a given population who have a medical reason for not being vaccinated and then there are people who do not develop immunity, even after receiving the vaccine. When people who are able to receive vaccines choose not to, the vaccination level drops below the critical percentage and puts everyone at risk,” he said.

Protecting those most vulnerableIt is very important that pregnant women receive a flu vaccine to protect themselves and their unborn child. “Flu vaccines are not given to babies under six months. If a mother is vaccinated, she will transfer the immunity across the placenta to the baby,” Khan said. Pregnant women should also get the Tdap vaccine to protect against tetanus, diphtheria and pertussis during the third trimester or immediately postpartum.

Healthy Kids program combats an epidemic: The impact of obesity on children

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New telemedicine program provides diabetic eye screenings to rural West Virginia

JOB surfing? Apply online camc.org

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CAMC is one of a select number of medical centers nationwide offering a newly approved technology for the detection of papillary cancer of the bladder in patients with known or suspected bladder cancer.

Cysview® is used to detect bladder cancer in individuals suspected or known to have lesion(s) in the bladder, based on a prior cystoscopy (examination of the bladder and urethra using a cystoscope, which is a thin, tube-like instrument with a light and a lens for viewing). It also helps to better treat early bladder cancer by improving the ability to remove early tumors that are not yet visible with traditional white light cystoscopy.

It is used with the photodynamic diagnostic system, which includes a white light setting to illuminate the bladder during a routine cystoscopy, and a blue light setting to induce and view fluorescence (i.e., Cysview®), thereby enabling physicians to detect lesions in the bladder.

Cancer of the bladder is among the most common cancers in men diagnosed at CAMC. Nationally, bladder cancer is the fourth most common type of cancer in men, and the eighth most common in women. Smoking is the most common cause of bladder cancer. The most common initial sign of the disease is red-colored urine, which calls for urine cytology (tests performed on cells in urine to detect disease), imaging of the kidneys and cystoscopy.

Arteries are blood vessels that carry oxygen-rich blood to your body. They have thick walls to withstand normal blood pressure. However, certain medical problems, genetic conditions and trauma can damage or injure artery walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm or a balloon-like bulge. As the aneurysm grows there is a greater risk of rupture, which can lead to severe hemorrhage, and other complications, including sudden death.

Aortic aneurysms occur most commonly in individuals above 50 years old and are more common among men and smokers. They tend to cause no symptoms, although occasionally they cause pain in the abdomen, chest and back (due to pressure

on surrounding tissues or rupture) or in the legs (due to reduced blood flow).

Shadi Abu-Halimah, MD, a vascular surgeon at the CAMC Vascular Center of Excellence, is using a newly developed special endovascular graft to treat complex aneurysms occurring in the chest area and/or stomach areas of the aorta.

Traditionally to treat aneurysms in these areas an open surgery is required with more pain and longer hospital stay. Dr. Abu-Halimah is using a fenestrated/branched graft that is deployed using minimally-invasive transcatheters. This graft is like a stent with holes that align with the arteries branching off from the aorta.

The stent or graft is inserted inside the affected area of the aorta. This shields the dangerously weak section from the high-

pressured flow of blood.

“This is a huge breakthrough for patients,” said Dr. Abu-Halimah. “Until recently, major chest and abdominal surgery was necessary to treat certain thoracic and abdominal aortic aneurysms.

“Patients used to have to go out of state to have this procedure or have an open surgical procedure. Some are high risk for surgery and this is a safer option.”

Dr. Abu-Halimah is participating in a national study on the effectiveness of the new grafts.

The minimally-invasive, endovascular procedure can be carried out with just two small cuts in the groin to access the arteries; patients can leave the hospital within a day or two afterward.

For more information on this and other vascular procedures call the CAMC Vascular Center of Excellence at (304) 388-8199.

Surgeons use new imaging tool to detect and treat early bladder cancers

New graft used to treat life-threatening condition

“Bladder cancer is difficult to visualize and to treat effectively,” said Samuel Deem, DO, who specializes in urologic oncology. “A missed diagnosis or less than optimal resection can result in delayed or incomplete treatment, which may lead to serious complications and a lower chance of survival for patients with potentially aggressive tumors.”

“Cysview® has been shown in multiple clinical trials to significantly improve tumor free recurrence rates when compared to white light cystoscopy and we are proud to offer this latest technology to the people of southern West Virginia,” Deem said.

Advances in diagnostic technology enable a more accurate diagnosis of bladder tumors and more complete resection of those tumors at time of surgery.

The standard diagnostic procedure for bladder cancer combines testing urine and possibly visually inspecting the inside of the bladder with white light cystoscopy to localize the tumors. The physician performs Transurethral resection, a form of cystoscopy-guided biopsy, of suspicious areas of the bladder, and then test the tissue samples to determine if they are malignant.

Cysview technology will allow more complete resection of all tumors at the time of surgery to decrease the chance of recurrence and improve outcomes.

When a patient is about to undergo an MRI scan, his or her primary concerns are accuracy and comfort. CAMC’s newest MRI scanner, the Philips Ingenia 3T, allows for shorter scan times and has a wider opening for a more comfortable scanning experience. It is also the first digital broadband MRI, which contributes to an improvement in image quality.

“The 3T MRI is extremely efficient,” said Christine Oskin, corporate director of medical imaging. “It has shorter scan times, so it maximizes the patient’s comfort without compromising the quality of the image. The reliability of high-field MRI allows our board-certified radiologists to differentiate between benign and potentially dangerous medical conditions with confidence.”

The scanner, located at General Hospital, can accommodate patients of varying size, age and physical condition. Many scans can be performed with the patient’s head entirely out of the opening, which alleviates the feeling of claustrophobia that many people associate with getting an MRI scan.

Routine scans of the brain, spine, knee, ankle and liver can be performed in less than eight minutes with 3T MRI. More complex scans may take 20 to 40 minutes,

New MRI scanner maximizes comfort, improves accuracy

but excellent image quality is maintained in all scans because of the digital broadband capability. The scanner digitizes the signal directly in the coil, substantially improving the signal-to-noise ratio. A higher signal-to-noise ratio results in a clearer image. The Ingenia 3T also features patient-adaptive scanning, which improves image contrast, uniformity, consistency and speed.

“The new MRI brings with it important tools to help physicians improve the accuracy of diagnoses and treatments of broad categories of diseases, including stroke, brain tumors, epilepsy, musculoskeletal and heart disease,” Oskin said.

The Ingenia was also recently rated number one in an annual MRI report by the health care research firm KLAS.

For more information about medical imaging at CAMC, visit camc.org/imaging.

Living with diabetes involves more than just proper nutrition and exercise—the disease puts those who have it at risk for several other serious medical conditions, such as blindness. That’s why it’s so important for people living with diabetes to have annual eye screenings to check for any changes in the retina or optic nerve.

Unfortunately, many West Virginians living with diabetes don’t have access to these screenings, but the CAMC Institute Center for Telemedicine is changing that with help from WV Eye Consultants. The CAMC Institute received a grant in 2010 from Frontier Communications, which, combined with CAMC Institute monies, allowed them to fund the portable digital retinal cameras and other necessary equipment to rural communities currently without the resources to screen for diabetic retinopathy.

In West Virginia, diabetic retinopathy (damage to the eye’s retina caused by Type 1 or Type 2 diabetes) is the leading cause of blindness, and there are few warning signs for early detection. Research has shown that a retinal photograph, even without a dilated eye, can show the early stages or diabetic retinopathy.

“We can find disease that would otherwise go unnoticed,” said Christopher Stansbury, OD.

Rural health centers with existing telemedicine equipment can apply for mini-grants through the CAMC Institute to receive

the retinal screening equipment. The clinics participating in the program conduct the screenings in the office, and the films are sent electronically to WV Eye Consultants in Charleston for ophthalmologist Joseph Jefferds Sinclair, MD, and Stansbury, an optometrist, to review.

Currently, the program has one satellite office operating at Community Care WV in Clay (opened in early June), but Barbara McKee, RN, an outreach coordinator for the Center for Telemedicine, hopes to get equipment to more rural areas soon.

“Our goal is to equip a total of six rural locations with the retinal cameras, which will hopefully increase the number of diabetic patients receiving the screenings,” McKee said.

When patients come to Community Care WV for a regular check-up or other appointment, Sarah Chouinard, MD, medical director, offers the eye screening as a regular part of the visit. Chouinard said patients often don’t see the value of diabetic retinopathy screening because in most cases it’s asymptomatic.

“Traveling to a doctor’s office for something they don’t see value in is something that’s hard to push. What’s so great about this is with the setup right in the office, we make it quick and convenient for them,” Chouinard said. “It’s been a game-changer for us. The patients don’t have an excuse not to get screened.”

Once Chouinard’s office staff takes the images, Sinclair and Stansbury can essentially video chat with the patients and discuss the results of the scans and any subsequent treatment plans.

“It’s a huge opportunity to provide a level of care that isn’t currently available,” Sinclair said.

Chouinard is thrilled to be able to offer the service to her patients, and is grateful to the CAMC Institute and WV Eye Consultants for making it happen.

“So many projects are routed in a financial gain…this is all about patient care,” Chouinard said.

If a patient has signs of diabetic retinopathy, the doctors recommend he or she get a more thorough, dilated eye exam, and offer to see the patient themselves if he or she isn’t already established with an eye doctor. For more severe cases, the patient might be referred to a retina specialist. Treatment could include injections or laser surgery, and in extreme cases, more invasive surgery.

“We have the potential to prevent a whole lot of diabetic eye disease by creating value for patients by catering to them. I’m excited about it because it’s a service we should offer, and we’ve never been able to until now,” Chouinard said.

A large part of preventing diabetic retinopathy is keeping blood sugar levels under control, so patient education plays a major role in the telemedicine program. The eye is one of the first places that diabetes is visible.

“Sometimes we diagnose diabetes,” Sinclair said of his practice.

So far, Sinclair and Stansbury have seen 20 patients through the telemedicine program, and are eager to get the other clinics up and running.

At last year’s CAMC HealthFest, 42 people were screened using the portable retina cameras.

CAMC Institute is currently going through applications for the mini-grants and is hoping to have all six sites up within the next year. The diabetic retinopathy program is the third telemedicine program for CAMC. The Center for Telemedicine also manages programs in perinatal health and psychiatry.

Dr. Joseph Sinclair and Dr. Christopher Stansbury.

Also, anyone who lives with or cares for young children should receive flu and Tdap vaccines. “Babies are so vulnerable. We need to make an effort to immunize anyone who is around the baby. It’s not worth taking any risks, because babies often get sicker than older children or adults and end up being hospitalized if they are infected,” Khan said. “It is so important to prevent these diseases from occurring.”

For more information about vaccines, visit camc.org/peds.

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