Download Crittenton Hospital Medical Center joins Ascension Health

FALL 2015
REPORTS AND BEST PRACTICES FROM ST. JOHN PROVIDENCE
INSIDE PAGES
2Research aims to extend joint
replacement life
Crittenton Hospital Medical Center
joins Ascension Health
GWEN MACKENZIE
Senior Vice President, Ascension Health/Michigan Market Leader
St. John Providence Corporate Services
Warren, MI 48092
(586) 753-0718
[email protected]
3First Baby-Friendly Hospital designated
in Macomb County
4New unit specializes in care of the elderly
6Decompression surgery offers solution
for Chiari malformation symptoms
7Study assesses treatment options for
rare brain tumor in children
8Study evaluates King–Devick test
for concussion in high school football
players
9Patients with flu-like symptoms sought
for international study
10SJP a research site for uncontrolled
hypertension study
IT’S OFFICIAL - AS OF OCT.1, 2015, CRITTENTON HOSPITAL MEDICAL
CENTER is part of Ascension Michigan. The 290-bed acute care
healthcare facility joins St. John Providence, Borgess, Genesys,
St. Mary’s of Michigan and St. Joseph Health System as part of the
statewide footprint of Ascension. Crittenton has been serving Oakland,
Macomb and Lapeer Counties as an independent hospital since it
opened in Rochester in 1967.
The addition of Crittenton strengthens Ascension’s presence in
Northern Oakland County, and will position it to participate with
other members of Ascension in clinically integrated systems of care to
manage the health of populations in partnership with insurers and
other care providers.
We have formed an integration team of Crittenton and Ascension
Michigan leaders to oversee program and operational alignment.
Together with other market leaders, we held town hall sessions with
associates, physicians and volunteers on Oct. 1 and 2.
12Surgery to calf muscle may resolve
plantar fasciitis
14POEM offers incisionless treatment for
swallowing disorder
15Miniature device signals the future of
pacemaker technology
Copyright © 2015 St. John Providence
The growth strategy for Crittenton includes immediate capital
investments, aligning hospital service lines with Ascension Centers of
Excellence, engaging primary care physicians, and making operational
improvements and revenue enhancements. Program “cooperation” in
such areas as occupational health, home health and retail pharmacy are
being explored.
continued on page 13
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
UPDATES & INNOVATIONS / FALL 2015
1
Jean Meyer, MSN, RN
President & CEO
St. John Providence
Editorial Board
Michael C. Wiemann, MD
President, Providence-Providence Park
Hospital, Southfield
Sr. Vice President
St. John Providence
Robert Hoban
Interim President, St. John Hospital &
Medical Center
Senior Vice President
Strategy & Business Development and
Centers of Excellence
H. Lee Bacheldor, DO
Chief Medical Officer
St. John River District Hospital
Gary Berg, DO
Chief Medical Officer
St. John Macomb-Oakland Hospital, Warren
Kevin Grady, MD, FCCP
Chief Medical Officer
St. John Hospital & Medical Center
Scott Eathorne, MD
President and CEO
Together Health Network
Gina Buccalo, MD
Chief Medical Officer
Partners in Care
Medical Editor
David Svinarich, PhD
Vice President, Research
St. John Providence
[email protected]
Publication Editor
Theresa Vigiano
Lead, Physician Marketing
St. John Providence
[email protected]
2
UPDATES & INNOVATIONS / FALL 2015
Research aims to extend
joint replacement life
DAVID MARKEL, MD
Chief, Orthopedic Surgery and Market President,
The CORE Institute
Providence-Providence Park Hospital
Southfield and Novi, Michigan
(248) 349-7015
[email protected]
ONE MILLION HIP AND KNEE REPLACEMENTS ARE PERFORMED
IN THE US EVERY YEAR. Despite improvements in implant
technology, patients are living longer and having initial implant
surgery at younger ages. Thus, approximately 10 percent of
patients outlive the usefulness of their implants and require
implant revision surgery.
Another reason patients might require revision surgery is due
to an overaggressive immune system. Over time, friction between
the mechanical parts of joint replacement implants produces tiny
particles of wear debris. For some patients, the body’s reaction
is an immune response, dispatching macrophage cells to destroy
the particles. The macrophage cells also destroy some of the bone
around the joint replacement, resulting in bone erosion. The
response is not unlike that seen in normal bone turnover or severe
osteoporosis, but in this case it is aggravated by the wear debris.
The resorption of the bone ultimately causes joint replacements to
become loose, and historically after 15 to 20 years, patients often
need implant revision surgery.
A possible solution comes from a familiar source: the antibiotic
erythromycin. Over the past 10 years, researchers have confirmed
that erythromycin is also
effective in inhibiting
particle-induced
chronic inflammation
in orthopedic settings.
This is the same kind
of wear that occurs in
joint replacements, but
it was unknown whether
the inflammationfighting properties of
erythromycin would
affect bones.
In the lab, our team
discovered that when
pre-osteoblastic cells
(immature cells that
can become boneproducing cells) were
grown in the presence of
continued on page 7
First Baby-Friendly Hospital designated in
Macomb County
PAULA SCHRECK, MD, IBCLC
Breastfeeding coordinator,
St. John Hospital & Medical Center
Medical Director, St. John Breastfeeding Support Services
and the Outpatient Breastfeeding Clinic
Detroit, Michigan
(313) 343-3146
[email protected]
ST. JOHN MACOMB-OAKLAND HOSPITAL, WARREN, IS THE
FIRST HOSPITAL IN MACOMB COUNTY TO ACHIEVE BABYFRIENDLY DESIGNATION.
More than 1,100 deliveries take place annually in the
Birthing Center at St. John Macomb-Oakland Hospital,
Warren. The community’s diverse population includes a
large Chaldean and Arab-American refugee population
and a large Bangladeshi population. Our challenges are
language barriers, poverty and stress. The recent refugee
families are vulnerable, unsettled, and were persecuted
before they arrived in the U.S.
Despite these unique obstacles, St. John Macomb-Oakland
Hospital, Warren joined 286 U.S. hospitals in achieving
the high standards required for Baby-Friendly designation,
a challenging quality-improvement designation. Prior to
receiving Baby-Friendly designation, the hospital had the
KIMBERLY RONNISCH, RN, BSN, HNB-BC, MHA
Director, Patient Care Services and director,
Women’s Services, East Region
St. John Hospital & Medical Center, Detroit, Michigan
St. John Macomb-Oakland Hospital, Warren, Michigan
(313) 343-7176
[email protected]
lowest breastfeeding initiation rate in metropolitan Detroit.
Today, the initiation rate is 75 percent.
St. John Providence has invested significant time and
resources in achieving the designation, including three
hours of training for pediatricians and OB/GYN physicians
and 20 hours of training for department nurses.
Baby-Friendly designation is an important step in working
toward culture change that views breastfeeding as normal
and even “cool.” We encourage breastfeeding as a choice
every mother can consider. When women learn the
benefits and talk about breastfeeding with their health care
team, many more are willing to try it.
To achieve Baby-Friendly designation, St. John
Macomb-Oakland Hospital, Warren established and
adhered to the Ten Steps to Successful Breastfeeding.
Developed by a team of global experts, these evidencebased practices increase breastfeeding initiation and
duration:
1. Have a written breastfeeding policy that is routinely
communicated to all health care staff.
2.Train all health care staff in the skills necessary to
implement this policy.
3.Inform all pregnant women about the benefits and
management of breastfeeding.
4.Help mothers initiate breastfeeding within one hour
of birth.
5.Show mothers how to breastfeed and how to
maintain lactation, even if they are separated from
their infants.
6.Give infants no food or drink other than breast milk,
unless medically indicated.
7.Practice rooming in – allow mothers and infants to
remain together 24 hours a day.
8.Encourage breastfeeding on demand.
9.Give no pacifiers or artificial nipples to breastfeeding
infants.
10.Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge.
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
continued on page 5
UPDATES & INNOVATIONS / FALL 2015
3
St. John Macomb-Oakland Hospital, Warren Campus
New unit specializes in care of the elderly
MARILYN CITO, RN, BSN, MA ED
Director of Nursing at St. John
Macomb-Oakland Hospital,
Director of Nursing and
Patient Education,
East Region, St. John Providence
Warren, Michigan
(586) 573-5030
[email protected]
GEMMALYNN DIXON, RN, BSN,
MBA
Nurse Manager, Acute Care
of the Elderly (ACE) Nursing Unit
St. John Macomb-Oakland Hospital
Warren, Michigan
(586) 573-5522
[email protected]
AFTER A HOSPITAL STAY, MANY OLDER ADULTS EXPERIENCE
A DECREASE IN MOBILITY AND STRENGTH. The Acute Care
of the Elderly (ACE) Unit at St. John Macomb-Oakland
Hospital, Warren Campus, opened in July 2015 and is
designed to prevent deterioration during a hospital stay and
incorporate strength-building and socialization into every
patient stay.
Senior patients who were walking and completing
activities of daily living prior to hospitalization often
remain in bed for most of the time during a hospital stay.
To address this concern on the ACE unit, physical therapy
mobility techs visit patients who need minimal to moderate
assistance, and get them up and walk them on the unit
daily. Mobility techs are ideal for patients who don’t require
physical therapy, but benefit from encouragement and
minimal assistance. During multidisciplinary rounds in the
morning, nurses identify patients who will benefit from
this service and notify the tech responsible for walking
the patient. The nursing unit has identified markers in the
hallways so patients and staff can measure the distance the
patient has walked.
Vintage, nostalgic art of Detroit and surrounding cities
line the unit hallways. These images, such as Olympia
stadium, the Hudson’s building, the Boblo Boat and
Mackinaw Bridge are familiar landmarks for many of our
senior patients, who linger as they look at the images and
reminisce with associates and family members. We find these
simple additions to the unit increase the duration of time
patients stay up, moving and socializing.
In addition to nursing associates, the unit has a dedicated
social worker and discharge planner who sees every patient
during their stay to prepare for a successful transition from
hospital to home or assisted living facility. Almost 90 percent
of the unit nurses are Geriatric Resource Nurses (GRN)
with additional training in care of the elderly.
Our goals are to prevent setbacks and manage daily
patient needs before physicians arrive. A dedicated nurse
practitioner leads multidisciplinary rounds with the
manager, nurses, social worker, and discharge planner on
4
UPDATES & INNOVATIONS / FALL 2015
CYNTHIA SHIELDS, MSN, NP-C
Nurse practitioner, Acute Care
of the Elderly (ACE) Nursing Unit
St. John Macomb-Oakland Hospital
Warren, Michigan
(586) 576-4364
[email protected]
ACE Unit Inclusion Criteria
• Age 65 or older with an acute condition requiring
medical/surgical care. Will accommodate patients 60
and above if census permits.
• Admitted from home or assisted living facility (extended
care facility patients may be considered).
• Bedridden or hospice patients are not eligible.
• Admitting diagnoses include:
• TIA/seizures
• Acute mental status changes/Alzheimer’s Disease/
dementia
• Syncope
• Degenerative nervous system disorders
• Uncontrolled hypertension
• Pneumonia/COPD/asthma/respiratory infections or
failure
• Pulmonary embolism
• Gastrointestinal bleeding (GIB)/ulcers
• Abdominal pain/gastroenteritis/small
bowel obstruction
• Urinary tract infection
• Renal failure (non-dialysis)
• Sepsis
• Uncontrolled diabetes
• Cellulitis
• Deep vein thrombosis
• Dehydration
• Ataxia/weakness/balance problems/failure to thrive
• Pressure ulcers
• Minor surgical procedures
(Patients with primary diagnoses of stroke, orthopedic or cardiac
conditions are better matched for the units with nursing staff
specifically trained to care for those conditions.)
the floor daily. Rounds include reviewing labs, vital signs,
replacing electrolytes, requesting medications, and if a
patient is not active, contacting the mobility tech or physical
therapy to increase mobility. Pharmacy also attends some
multidisciplinary rounds and confers with physicians to
detect opportunities to lower dosages or discontinue a
medication. Our nursing staff rounds every two hours
to ensure the patients’ needs are being met; we “bundle”
continued on next page
New unit specializes in care of the elderly
continued from page 4
nursing care at night to avoid waking patients.
Mealtime is another opportunity for patients to get
up, and we ensure they leave bed to eat twice a day, when
possible. A common Day Room is outfitted with chairs
and tables for dining, playing cards and board games, and
watching TV. Wii games, classic movies and music also
interest patients and lead to socialization and active time
out of their rooms.
Special events take place regularly. Twice a week,
patients are invited for short health and wellness talks.
Manicures and movie night also generate high attendance.
Aromatherapy, music therapy and pet therapy occur several
times weekly.
Family members benefit from the unit’s Community
Resource Center, stocked with relevant and current
information on home care options, home medical resources,
and caring for their elderly loved one. A hard of hearing
telephone is showcased in this area and can be ordered for
patients after discharge, if a prescription is signed by the
physician or nurse practitioner. Sleeper chairs in patient
rooms enable family members to spend the night.
Most patients are admitted through the St. John
Macomb-Oakland Hospital, Warren, Emergency
Department, while others are transferred from another
unit, such as ICU or step-down. Stable patients can be
directly admitted to the unit. Telemetry monitoring is
available.
We are collecting outcomes data on falls, pressure
ulcers, and discharge destinations. Since opening, just two
falls have occurred and the unit has remained restraint free.
Nursing leaders have completed the Hartford Institute
for Geriatric Nursing program, Nurses Improving Care
for Healthsystem Elders (NICHE) program. As the unit
continues to evolve, we are developing and investigating
additional strategies and techniques to ensure the best
possible outcomes and highest levels of patient satisfaction.
The 24-bed unit has private and semi-private rooms. It
is located on the fourth floor of St. John Macomb-Oakland
Hospital, Warren, and accessible via the central tower
elevator. Physicians are welcome to visit and tour the unit
at any time.
For more information or to admit a patient, call Gemmalynn
Dixon, RN, BSN, MBA, nurse manager, (586) 573-5522
or Cynthia Shields, MSN, NP-C, nurse practitioner,
(586) 576-4364. After business hours/weekends, contact
the unit charge nurse, (586) 573-4364.
First Baby-Friendly Hospital designated in Macomb County
continued from page 3
The Ten Steps to Successful Breastfeeding are beneficial to
all mothers and infants, not only those who are breastfed.
Universal benefits include:
• Adequate prenatal education ensures mothers come
to the hospital to deliver with balanced, accurate
information about infant feeding and can make
informed choice.
• Rooming-in after birth means babies are not taken
from the room for routine tests, such as hearing
tests, blood draws and weight assessments. Infants
experience less stress, and mothers gain a deeper
understanding of infant health care and their babies’
unique communication. Since babies are often active
at night, mothers learn to rest during the day and get
better quality sleep.
• All mothers are offered the option to engage in
skin-to-skin contact after birth. Research shows
skin-to-skin contact decreases infant stress, increases
breastfeeding success, decreases health concerns
for mothers and babies, and decreases the mother’s
perception of pain.
• Staff encourages feeding on demand; babies are fed
according to need and assuring a minimum of eight
feedings in 24 hours.
We have engaged several community organizations,
such as the Chaldean American Ladies of Charity,
Macomb County WIC and the Infant Mortality Project at
St. John Providence, to support the Baby-Friendly initiative
and provide resources for women as they continue to
breastfeed at home. We started an outpatient breastfeeding
clinic, and have a Chaldean Arabic-speaking lactation
consultant to provide follow-up care in. An Arabiclanguage support group for mothers meets at a Chaldean
facility in nearby Troy, and the Ronald McDonald
foundation provided support to purchase breast pumps.
In addition, a grant from the Michigan Department
of Community Health allowed us to translate most
educational materials into Arabic.
St. John Hospital & Medical Center was the first in the
system to receive Baby-Friendly designation. Expanding
the designation supports a coordinated approach to patient
care and sharing of best practices. Providence-Providence
Park Hospital, Southfield and Novi are currently working
to achieve Baby-Friendly designation.
Baby-Friendly Hospital Initiative (BFHI) is a global
program launched in 1991 by the World Health
Organization (WHO) and the United Nations Children’s
Fund (UNICEF). To learn more, log on to https://www.
babyfriendlyusa.org.
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
UPDATES & INNOVATIONS / FALL 2015
5
Decompression surgery offers solution for Chiari
malformation symptoms
HOLLY GILMER, MD
Neurological Surgery and Pediatric Neurological Surgery
St. John Hospital & Medical Center
Providence-Providence Park Hospital
Detroit and Southfield, Michigan
(877) 784-3667
[email protected]
CHIARI MALFORMATIONS ARE STRUCTURAL DEFECTS THAT
OCCUR IN THE CEREBELLUM, the part of the brain that
controls coordination and muscle movement. Previous
estimates were that malformations occur in about one in
every 1,000 births, but increased use of diagnostic imaging
indicates that the disorder may be more common.
Normally the cerebellum and parts of the brain stem sit
in the posterior fossa of the skull, above the foramen
magnum, or the opening to the spinal canal. In individuals
with Chiari malformations, the posterior fossa is abnormally small and misshapen. It presses on the brain, forcing
it downward and causing the cerebellar tonsils to protrude
into the spinal canal. This blocks the flow of cerebrospinal
fluid to the brain, which can lead to hydrocephalus and/or
increased intracranial pressure. It also causes direct
pressure on the brain stem and upper spinal cord.
Chiari malformation is diagnosed by MRI. When
deciding if surgery is an option, the extent of the herniation of the brain into the spine is not as important as the
symptoms the patient experiences. For some adults,
symptoms are not severe and they do not require surgery.
Chiari malformation is also sometimes an incidental
finding on MRI, and the person is asymptomatic.
Chiari malformations are classified as types I-IV, as
described by the Austrian pathologist Hans Chiari based
on their anatomic features. The most common type is
Chiari I. It is often associated with scoliosis and syringomyelia, and may not cause problems during childhood.
Chiari II is associated with myelomeningocele, or spina
bifida. It is most commonly diagnosed in infants or on
prenatal ultrasound, and is associated with hydrocephalus.
Infants with Chiari may have symptoms which include
difficulty swallowing, irritability when being fed, excessive
drooling, a weak cry, frequent gagging or vomiting, arm
weakness, breathing problems, developmental delays, and
poor weight gain.
Older children experience headaches, dizziness, ringing
in the ears, and problems with vision. One of the most
frequent presentations is scoliosis with none of these
symptoms except infrequent headaches. Some children
6
UPDATES & INNOVATIONS / FALL 2015
In patients with Chiari malformation, the posteria fossa is
abnormally small and misshapen, forcing the cerebellar tonsils
down into the spinal canal, as noted in this patient MRI.
may not have noticeable symptoms until adolescence or
adulthood. In teen and adult years, problems can include
persistent headaches, neck pain, and weakness and/or
numbness and tingling in the arms and legs.
Adult symptoms include neck pain, balance problems,
muscle weakness, numbness or other abnormal feelings in
the arms or legs, dizziness, vision problems, difficulty
swallowing, ringing or buzzing in the ears, hearing loss,
vomiting, insomnia, or headache made worse by coughing,
laughing, or straining. Hand-eye coordination and fine
motor skills may be affected. Symptoms can change over
time depending on the build-up of cerebrospinal fluid and
pressure on the brain, spinal cord, and nerves.
The surgical treatment to correct the compression
involves removing a portion of the skull and usually part of
the C1 vertebra. The cerebellar tonsils are usually partially
removed. We always open the covering of the brain (dura)
and use an expansion graft to make the dura larger and
give the brain more room to expand.
Decompression surgery returns the normal flow of
spinal fluid and relieves some or all of the symptoms by
relieving pressure from the brain stem. The surgery also
helps decompress the venous circulation, which in turn
improves resorption of spinal fluid. This procedure usually
keeps symptoms, particularly headaches in adults, from
getting worse and frequently results in complete resolution
of some symptoms. In approximately 500 cases since 2000,
patients have had greater than 90 percent improvement
or resolution of symptoms following surgery.
We perform decompression surgery at St. John
Hospital & Medical Center. For more information, visit
http://bit.ly/1G0lWmF.
To refer a patient for diagnosis of Chiari malformation or
evaluation for decompression surgery, call (877) 784-3667.
Study assesses treatment options for rare brain tumor
in children
PAUL CHUBA, MD, PHD, FACR
Chief of Radiation Oncology
St. John Macomb-Oakland Hospital
Warren, Michigan
(586) 573-5186
[email protected]
PRIMARY GERM CELL TUMORS (GCTS) ARE RELATIVELY
UNCOMMON MALIGNANCIES in the central nervous
system, making up less than four percent of brain tumors
in children in Western countries, with nearly 90 percent
occurring before age 20. A subgroup of these malignancies,
nongerminomatous germ cell tumors (NGGCTs) are quite
rare; NGGCTS are less sensitive to radiation therapy. In
the past, five-year survival rates for this disease had been in
the range of 30 to 40 percent.
We participated in a national study conducted by the
Children’s Oncology Group, designed to evaluate how
treatment that included adjuvant chemotherapy would
affect tumor response and survival outcomes in children
with newly diagnosed NGGCTs. The study began in
2001 with follow-up over several years. The course
of chemotherapy, administered prior to craniospinal
irradiation, was intended to reduce measurable disease in
order to increase the effectiveness of the radiotherapy.
The choice of drugs for the adjuvant chemotherapy was
informed by success observed in the treatment of similar
germ cell tumors occurring more commonly in areas other
than the central nervous system, particularly in the ovaries
and testes. The schedule for administering the therapy was
also unique to this study. Patients received six courses of
intravenous chemotherapy on alternating 21-day cycles.
Cycles one, three, and five consisted of carboplatin (day
one) plus etoposide (days one through three). Cycles two,
four, and six consisted of ifosfamide and etoposide (both
on days one through five). Granulocyte colony-stimulating
factor was given after each cycle.
Evaluating the effects of adjuvant chemotherapy
Determining the level of response to this chemotherapy
approach was the study’s primary objective. The secondary
objective was to establish both event-free and overall
survival rates for the patients in the trial. Response was
measured by three-dimensional MRI images of the tumor
sites, and characterized as complete, partial, no response
(stable disease), or negative response (progressive disease),
based on changes in the size of tumors.
Depending on a patient’s response to this step, studyindicated treatment could also include second-look
continued on page 11
Research aims to extend joint replacement life
continued from page 2
erythromycin, the erythromycin promoted bone cell growth.
Additional studies showed that when we simulated a joint
replacement by placing a titanium pin into an animal bone
and exposed the pin/bone to small plastic “wear” particles,
the oral erythromycin made the bone become more stable
and prevented osteolysis, or bone resorption.
Our team has most recently examined the effect of oral
erythromycin on implant stability for patients undergoing
hip or knee joint replacement revision surgery. After giving
patients erythromycin before the revision surgery, we
examined changes in their tissues at the time of surgery for
evidence of a positive biologic response via markers in the
blood and tissues. The erythromycin had a positive effect.
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
A long-term goal is to develop a delivery system
that brings the erythromycin directly to bone by using
nanofibers attached to the implant. Our work focuses
on infusing these very thin fibers with erythromycin
and potentially spinning them around the metallic joint
replacement implant. Once in place, the “coated” parts
could deliver erythromycin slowly, strengthening bone over
time, encouraging greater attachment between the bone
and implant, and delaying or even eliminating bone loss.
We are in the very early stages of what could be an
important development in joint replacement technology.
Our goal is to make joint replacements a permanent
solution for joint pain.
UPDATES & INNOVATIONS / FALL 2015
7
Study evaluates King–Devick test for concussion in
high school football players
MICHAEL SHAW, PHD
Director, Research and Clinical Trials-Osteopathic Division
St. John Macomb-Oakland Hospital
Warren, Michigan
(248) 967-7791
[email protected]
IN HIGH SCHOOL FOOTBALL, PLAYERS RISK CONCUSSION
AND OFTEN PRESSURE THEMSELVES to continue to play
despite injury. It is critical to remove a concussed athlete
from play in order to prevent
further damage and keep the
athlete from returning to play
until they have made a full
recovery. Many on-field tests
for concussion are subjective,
relying on the assessment of a
trained professional to diagnose
concussion and remove the
player from competition.
Repetitive brain injury can lead
to consequences later in life,
including anxiety, depressive
disorders and chronic traumatic
encephalopathy (CTE). Athletes
who have had one concussion are
more susceptible to another. This
fact makes it even more crucial
to detect concussion, remove
athletes from play immediately,
and seek medical attention.
DANIEL SEIDMAN, DO
Chief Resident, Family Medicine
St. John Macomb-Oakland Hospital
Warren, Michigan
(586) 582-7550
[email protected]
Our study was the first to evaluate the King-Devick
test as a concussion screening tool for high school football
players, and was recently published in the Journal of the
Neurological Sciences (J Neurol
Sci. (2015), http://dx.doi.
org/10.1016/j.jn).
The King-Devick test is a
reliable tool that that relies on
an objective measure: number
reading. An oculomotor test
originally designed for reading
evaluation, it consists of three
cards with a series of numbers
printed on them. The test screens
for saccades (eye movements),
attention, concentration, speech/
language, and other correlates
of sub-optimal brain function.
The test administrator times
the players as they read the
numbers. Each card is more
difficult to read.
The King-Devick test
was previously examined as
continued on next page
Individual players with concussion
Baseline cumulative
read time(s)
8
Sideline cumulative
read time(s)
Sideline percent
baseline (%)
Repeat (end of season)
read time(s)
End of season
percent baseline
Player 1
42.4
65.7
155.0
42.1
99.3%
Player 2
44.5
51.0
114.6
43.7
92.8%
Player 3
58.3
89.9
154.2
61.8
106.0%
Player 4
35.0
73.6
210.3
60.6
173.1%
Player 5
47.5
92.1
193.9
60.8
128%
Player 6
59.1
90.2
152.6
58.4
98.8%
Player 7
43.3
56.4
130.3
42.9
99.2%
Player 8
47.1
54.1
114.9
NA
—
Player 9
54.7
66.2
121.0
NA
—
UPDATES & INNOVATIONS / FALL 2015
NA = lost to follow-up (quit football)
Patients with flu-like symptoms sought for
international study
RODGER MACARTHUR, MD
Infectious Disease and Internal Medicine specialist
Providence-Providence Park Hospital
Southfield, Michigan
(248) 552-0620
[email protected]
EVERY YEAR, BETWEEN FIVE AND 20 PERCENT OF THE US
POPULATION CONTRACTS INFLUENZA. During the upcoming
flu season, St. John Providence will again participate in
FLU PLUS 002, a worldwide study funded by a division
of the National Institutes of Health (NIH) to find out
more about influenza.
This observational study allows participants to use any
treatment they wish for their symptoms. With these data,
we’ll learn about various strains of the influenza virus that
circulate in different parts of the world and correlate the
information with individual health histories. We’ll also find
out about the virulence of certain strains, discover which
strains are geographically limited, and identify specific
MARTI FARROUGH, BSN, RN
Project Director
Providence-Providence Park Hospital
Southfield, Michigan
(248) 552-0620, ext. 2874
[email protected]
strains of the virus
that are associated
with poor clinical
outcomes.
The study began
in November 2014
and continued
through mid-March
2015. It will start
again in November
2015 and continue through mid-March 2016. After this
year, the NIH expects to continue the study for one to two
continued on page 11
Study evaluates King–Devick test for concussion in high school football players
continued from page 8
a removal-from-play device in college football, mixed
martial arts and rugby, but had not been evaluated for use
in younger, adolescent athletes who are more prone to
concussion.
We studied football players at four area high schools
where St. John Providence employs athletic trainers:
Grosse Pointe South, Chippewa Valley, L’Anse Creuse and
L’Anse Creuse North. Prior to the beginning of the season,
we recorded a baseline time for the King-Devick test with
each player. Our team followed more than 350 players
throughout the season, attending every game and practice.
When a player suffered a suspected concussion,
a member of our team administered the test on the
sidelines in a matter of minutes. Players who had suffered
a concussion performed poorly on the second testing,
adding significant time to their baseline score. (See table on
facing page.) In 100 percent of cases where the time was
significantly longer, subsequent medical testing confirmed
the presence of a concussion.
Standard protocol among trainers and coaches is the
ImPACT (Immediate Post-Concussion Assessment and
Cognitive Testing) test. It is the most-widely used and most
scientifically validated computerized concussion evaluation
system. A disadvantage is that it cannot be administered on
the sidelines. Players are out for the remainder of the game.
In contrast, the King-Devick test can be administered by
a trained layperson such as a coach, teacher, parent or
volunteer. It takes only minutes to perform and is portable,
so it can be administered on the sidelines.
This study was only possible due to our team of 20
dedicated co-investigators that included residents, medical
students and trainers from the physical rehabilitation
department at St. John Providence.
In the 2016 football season, we plan to study the
King-Devick test with younger football players – those in
“pee-wee” leagues – to evaluate its effectiveness in this age
group. There is little research on concussion incidence in
younger athletes, because there are typically no trained
professionals on the field to evaluate them.
The King-Devick test is inexpensive and commercially
available for purchase. Individuals can be trained to
administer it in just 15 minutes. It is a valuable tool for any
contact sport where players are at risk for concussion.
Contact Michael Shaw, PhD, at (248) 967-7791 or michael.
[email protected] for information on how to purchase the test.
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
UPDATES & INNOVATIONS / FALL 2015
9
SJP a research site for uncontrolled hypertension study
SHUKRI DAVID, MD
Physician Chair, Heart & Vascular Center of Excellence,
St. John Providence
Southfield and Novi, Michigan
(248) 552-9858
[email protected]
PROVIDENCE-PROVIDENCE PARK HOSPITAL, SOUTHFIELD,
HAS BEEN SELECTED AS A RESEARCH SITE FOR THE
MEDTRONIC SPYRAL HTN GLOBAL CLINICAL TRIAL
PROGRAM, a unique, phased clinical trial studying renal
denervation in patients with uncontrolled hypertension.
The SPYRAL HTN trial investigates the impact of multielectrode renal denervation with and without the addition
of antihypertensive medications. There are two arms of the
study, ON MED and OFF MED. Each group will include
approximately 100 patients internationally with moderateto high-risk hypertension. Patients enrolled in either arm of
the study may be randomized to receive renal denervation or
be in a control group, which does not receive the therapy.
Providence-Providence Park Hospital, Southfield, is
one of approximately 20 centers in the USA and globally
to conduct the study. The SYMPLICITY HTN-3 trial,
conducted from 2012 to 2014, was a precursor of the
SPYRAL HTN trial. Providence-Providence Park Hospital,
Southfield was a site for that study as well. The focus of the
earlier study was treatment for a resistant population, while
the current study is designed to isolate the effect of renal
denervation on blood pressure reduction and address the
confounding factors encountered in the previous clinical
trial, including medication, adherence, patient population
and procedural variability.
The two arms of the study are:
• SPYRAL HTN-OFF MED, which will examine the
effect of renal denervation alone on hypertensive
patients without the effect of anti-hypertensive
pharmaceutical agents.
• SPYRAL HTN-ON MED, which is designed to
examine the effect of renal denervation on hypertensive
patients with a prescribed set of anti-hypertensive
medications.
Renal denervation is intended to lower blood pressure
by targeting renal nerves. The Symplicity system consists
of a flexible catheter and proprietary generator. In an
endovascular procedure, we insert the catheter into the
femoral artery in the upper thigh and thread it into both
renal arteries. Once the catheter tip is in place within the
SUSAN STEIGERWALT, MD
Director, Resistant Hypertension Clinic
Providence Heart institute
Nephrology and Internal Medicine Specialist
Providence-Providence Park Hospital
Southfield and Novi, Michigan
(313) 549-9523
[email protected]
renal artery, we activate the Symplicity generator to deliver
controlled, low-power radio-frequency energy to deactivate
surrounding renal nerves. This is intended to reduce
hyper-activation of the sympathetic nervous system for
an extended duration (months to years), which is an
established contributor to chronic hypertension. The
procedure requires an overnight stay.
Eligibility Criteria
The primary eligibility criteria for the SPYRAL HTN-OFF
MED study include:
• Seated office systolic blood pressure of ≥ 150 mm Hg
and < 180 mmHg and a diastolic blood pressure ≥ 90
mmHg in the absence of anti-hypertensive medications
• An eGFR of greater than 45 mL/min/1.73m2
• 24-hour ambulatory systolic blood pressure
measurement of ≥140mmHg and <170 mmHg
• No hemodynamically significant (<50 percent) renal
artery stenosis
If a patient is currently being treated for high blood
pressure, we will temporarily discontinue antihypertensive
drugs to allow study of the impact of renal denervation in
the absence of antihypertensive medications. There is close
medical follow up and if at any time a patient blood pressure
elevates above a safety threshold, they will be restarted
on medications. Medications will be started to keep blood
pressure below 140/90 after three months regardless of
whether the patient received the denervation therapy or not.
The primary eligibility criteria for the SPYRAL HTNON MED study include:
• Seated office systolic blood pressure of ≥ 150 mmHg
and < 180 mmHg and a diastolic blood pressure ≥
90 mm Hg while adhering to three anti-hypertensive
medications of specified classes (dihydropyridine, ACEinhibitor/ARB, thiazide diuretic)
• An eGFR of greater than 45 mL/min/1.73m2
• 24-hour ambulatory systolic blood pressure
measurement of ≥140mmHg and <170 mmHg
• No hemodynamically significant renal artery stenosis
continued on page 13
10
UPDATES & INNOVATIONS / FALL 2015
Patients with flu-like symptoms sought for international study
continued from page 9
more flu seasons.
The St. John Providence research team finds
interested participants primarily through local emergency
departments and urgent care clinics. The only criteria to
participate are a temperature of 100.4 or higher or feeling
feverish, and a cough and/or sore throat. Individuals do not
need to have confirmed flu.
Participants may include patients,
staff, visitors, or others. They first
meet with a researcher and provide
a history of their symptoms, other
health problems and medications, and
give a blood sample, which will be
used for influenza testing. Researchers
also take throat and nasal swabs to
verify flu and identify the strain.
Over the next 14 days,
participants keep a “flu diary,” checking off the symptoms
they experience. At their second visit, participants bring
their flu diaries with them. Researchers collect a blood
sample and information about any hospitalizations,
complications or new health problems that arose because
of their flu symptoms.
Flu Genomics study
We are also conducting the Flu Genomics study, a substudy to FLU PLUS 002. Participants give an extra blood
sample for genetic testing. We will examine patient
DNA and correlate it with patient
health information and flu strain.
The intent is to learn more
about whether certain genetic
factors make people more or less
susceptible to flu and secondary
health problems caused by the virus.
Results of the genomic data will be
used to identify genetic markers for
influenza and potentially make flu
prevention and treatment far more specific.
To refer a patient with flu-like symptoms for study participation,
contact Project Director Marti Farrough at (248) 552-0620,
ext. 2874, or email [email protected].
Study assesses treatment options for rare brain tumor in children
continued from page 7
surgery, high-dose chemotherapy, and peripheral blood
stem cell rescue prior to craniospinal irradiation. Patients
whose tumors showed complete or partial response, with
or without second-look surgery, proceeded directly to
craniospinal irradiation.
Overall, adjuvant induction chemotherapy produced a
69 percent objective response rate (complete or partial) in
the evaluable patients. Of those evaluated by the Quality
Assurance Review Center, a positive response rate of 87
percent was reported. A chemotherapy treatment that was
expected to reduce tumors preparatory to radiotherapy
demonstrated that it was sufficient in some cases to
eliminate NGGCTs and other germ cell tumor elements,
with examination showing residuals that included
teratomas, fibrosis, or no evidence of tumor. Furthermore,
for the 102 eligible patients in the study, the five-year
event-free and overall survival rates were 84 percent and
93 percent, respectively.
Evaluating the data gathered in the trial
In many ways, this study is now the gold standard for
treatment of nongerminomatous germ cell pediatric brain
tumors. The report recently appeared in the Journal of
Clinical Oncology (JCO Aug 1, 2015: 2464-2471).
More than 100 children and young adults were enrolled
in the group, making it the largest controlled trial for this
type of tumor. The survival rates are the highest achieved
in any cooperative group trial that has been done in this
disease. In addition, particular attention was paid to quality
assurance review of the trial’s findings. For the first time, all
the MRI images of patients with the same rare brain tumor
are in one place. Our team has all their surgical findings,
pathology reports, and the details of radiotherapy, and we
know all their outcomes.
The data set produced by the study should serve as the
backbone of follow-up research and as a guide for treatment
in the future. Already, analysis is underway to correlate the
MRI images with the effects of treatment on these cases.
The steps taken in quality assurance will allow future trials
to draw on these results in confidence, and more study will
lead to adjustments in both the volume and the dose of
radiotherapy to get the best outcomes with the least side
effects.
To refer a patient, call Radiation Oncology Specialists, PC, at
(586) 573-5186.
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
UPDATES & INNOVATIONS / FALL 2015
11
Surgery to calf muscle may resolve plantar fasciitis
NEAL MOZEN, DPM, FACFAS
Podiatrist and podiatric surgeon
Providence-Providence Park Hospitals
Southfield and Novi, Michigan
(248) 258-0001
[email protected]
PLANTAR FASCIITIS RELEASE IS TRADITIONAL SURGICAL
TREATMENT FOR PLANTAR FASCIITIS, but it may not offer
patients relief from severe heel pain. For many patients, it
is not the plantar fascia, but tight calf muscles and a
condition called equinus that causes their heel pain.
Gastroc recession surgery releases tension on the calf
muscles and Achilles
tendon, and in most cases,
offers patients relief when
conservative treatments
have failed.
In a retrospective study,
researchers compared 30
patients with chronic plantar
This cadaveric view demonstrates
fasciitis who underwent
the continuity of the Achilles tendon
plantar fasciitis release with
and the plantar fascia.
30 patients who underwent
gastroc recession to treat
chronic plantar fasciitis. Both
groups were matched in
terms of previous treatments
and time from onset of
Intra-operative views of endoscopic symptoms to surgery. Just
gastroc recession, before (left)
60 percent of patients in the
and after.
plantar fasciotomy group
had satisfactory results
compared with 95 percent
of the patients in the gastroc
recession group. Gastroc
recession patients resumed
work and sports an average
of seven weeks faster than
the plantar fascia release
group, and functional and
pain scores were considerably
better for gastroc recession
with fewer complications.
Demonstration of the silfverskiold
test, a basic test for the source of
(Int Orthop. 2013 Sep; 37(9):
equinus. When upward bending
1845–1850. 10.1007/s00264motion of the ankle joint is limited
013-2022-2)
to less than 10 to 15 degrees,
equinus is usually present.
12
UPDATES & INNOVATIONS / FALL 2015
THOMAS BELKEN, DPM, AACFAS
Podiatrist
Providence-Providence Park Hospitals
Southfield and Novi, Michigan
(248) 258-0001
[email protected]
There is more than a 20-fold increased chance for
developing plantar fasciitis when equinus is present, and a
direct correlation between increased tension on the Achilles
tendon and increased tension on the plantar fascia. Because
the Achilles tendon is continuous with the plantar fascia, it
is crucial to also screen for equinus when treating patients
for plantar fasciitis. (Podiatry Today, 2015 May; 28(5). http://
www.podiatrytoday.com/closer-look-gastroc-recessionplantar-fasciitis)
Plantar fasciitis affects one in 10 people during their
lifetime. The tough, fibrous plantar fascia ligament runs
between the heel bone and the base of the toes, where it fans
out. It becomes inflamed in patients with plantar fasciitis and
typically worsens without treatment. Patients can develop
foot, knee, hip and back problems due to gait changes. Foot
pain causes a drop in activity, which has a negative impact
on quality of life and overall health and contributes to many
chronic health conditions.
In our practice, we first treat patients with plantar fasciitis
conservatively, with posterior stretching exercises, night
splints, injection therapy with needling, orthotic therapy,
platelet rich plasma (PRP) and shockwave treatment. We
encourage patients to shorten their stride length to allow
the knee to absorb more shock than the heel, and advise
on proper footwear for both inside and outside the house.
Working with primary care physicians, we help patients
avoid strong corticosteroids when possible, as they cause
atrophy of the essential fat pad in the heel. We also advise
patients to maintain a healthy weight. For most individuals
presenting with plantar fasciitis, a combination of these
strategies will resolve their symptoms.
However, when patients do not improve with
conservative treatment, and the upward bending motion
of the ankle joint is limited to less than 10 to 15 degrees,
equinus is usually present. These patients lack the flexibility
to bring the top of the foot toward the front of the leg.
Even wearing orthotics can be intolerable when the foot
can’t function normally or be held at the proper angle.
The gastrocnemius and the soleus are two muscles that
make up the calf. The gastroc is the larger of the two, and
continued on next page
Surgery to calf muscle may resolve plantar fasciitis
continued from page 12
the gastroc tendon combines with the soleus tendon to form
the Achilles tendon. In gastroc recession surgery, we lengthen
the aponeurosis, which is the fibrous band just below the
gastrocnemius muscle belly. Distally the gastroc aponeurosis
merges with fibers from the soleus muscle to form the
Achilles tendon. Because the gastrocnemius aponeurosis
sits on top of the well-vascularized soleal muscle, the
aponeurosis usually heals in its lengthened position relatively
quickly. Using local anesthesia and IV sedation, we make
a small incision at the back-inside of the mid-calf, locate
the gastroc aponeurosis, and lengthen it with endoscopic
instrumentation. The cut aponeurosis heals in an elongated
position helping relieve contracture to the Achilles tendon
and reducing mechanical stress to the heel and plantar fascia.
Following surgery, patients stay off their foot for three
days, then walk in a supportive boot for three weeks. At six
weeks, we typically see a dramatic improvement in pain. Full
activity may require up to three months.
Releasing tension on the gastroc relieves mechanical
stress on the foot. By combining gastroc recession with
other supportive measures, such as orthotic therapy, activity
modifications and supportive shoes, we can create the proper
environment to allow heel pain symptoms to further resolve.
While plantar fascial release remains a common
treatment, and for some patients may be indicated, in
other patients with equinus contracture, it targets the
wrong anatomy and in all patients, weakens the arch of
the foot. The arch acts as a spring mechanism and absorbs
shock. Cutting the plantar fascial ligament can cause an
unstable foot structure, foot fatigue, and limitations on
patient activity. Some patients develop other conditions as
a result, such as bunions and hammer toe, due to increased
mechanical stress on the foot. We generally do not see foot
instability as a result of gastroc recession.
We have been performing endoscopic gastroc recession
for almost 15 years and are one of the pioneering practices
for the procedure in this area.
Crittenton Hospital Medical Center joins
Ascension Health
Medtronic SPYRAL HTN studies renal
denervation in uncontrolled hypertension
continued from cover
continued from page 10
Crittenton will continue to have its own medical
staff and by-laws, as do other hospitals within St. John
Providence and Ascension Michigan. Crittenton Hospital
Medical Center will not become a Catholic hospital.
However,
as a member
of Ascension,
Crittenton
will follow
and adhere to
the Ethical
and Religious Directives (ERDs) for Catholic Health
Care Services (http://www.usccb.org/about/doctrine/
ethical-and-religious-directives/) as issued and revised
from time to time by the United States Conference of
Catholic Bishops. Like the other Ascension Michigan
hospitals and health systems, Crittenton will retain its
current name.
Crittenton is a distinct Ascension Michigan ministry,
not part of either St. John Providence or Genesys.
To Refer a Patient
Recruitment for this study is ongoing. For more information or to refer patients, contact Jean Kelly, RN, (248)
849-3369, or [email protected].
Refer patients with foot and heel pain that has not resolved with
rest or conservative treatment by calling (248) 258-0001.
To learn more about the clinical trial, visit http://www.
spyralhtntrials.com.
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
Submit your story ideas
for Updates & Innovations
If you are conducting research, performing new or
advanced medical procedures or services, using the
latest technology or providing a service not typically
offered in southeast Michigan, please contact Theresa
Vigiano, the editor of Updates & Innovations, at
(248) 331-4794, or [email protected].
We are constantly seeking story ideas
from St. John Providence medical staff to
highlight your innovations and share
them with referring physicians.
UPDATES & INNOVATIONS / FALL 2015
13
POEM offers incisionless treatment for swallowing
disorder
MOHAMMED BARAWI, MD
Medical director, Endoscopy Unit, and division head,
Department of Gastroenterology
St. John Hospital & Medical Center
Detroit, Michigan
(313) 343-7020
[email protected]
PATIENTS UNABLE TO SWALLOW DUE TO ACHALASIA OR
SPASTIC ESOPHAGEAL DISORDERS not responding to
medical therapies may be candidates for Peroral Endoscopic
Myotomy (POEM). POEM is a highly specialized procedure
and offered at only a few locations in the United States.
St. John Hospital & Medical Center is the only location in
southeast Michigan offering POEM.
Approximately 2,000 people in the US are diagnosed
with achalasia each year. Achalasia is caused by a tight
sphincter muscle, which doesn’t relax enough to allow
food to pass from the esophagus into the stomach. The
condition compromises peristalsis of the esophagus,
resulting in motility issues and making it difficult for food
to move into the stomach. The condition occurs most often
in middle-age and older adults, whose symptoms include
trouble swallowing, regurgitation, heartburn, chest pain,
cough and weight loss.
Before POEM
After POEM
To perform the procedure, we introduce the endoscope
through the mouth into the esophagus, where we make an
incision in the mucosa of the esophagus. Using a knife on
the tip of the endoscope, we tunnel through the esophagus
wall to access to the muscle layers below. Next, we perform
the myotomy by cutting and partially removing the
inner circular of muscle layer from the lower esophageal
14
UPDATES & INNOVATIONS / FALL 2015
sphincter and the upper part of the stomach. The myotomy
relieves the tightness of the sphincter so food can pass
normally through the esophagus.
Patients stay overnight and after a barium swallow test
the next morning, are discharged on a liquid diet for three
days. After that, they can begin to eat normally.
Patients typically experience a dramatic improvement
in quality of life, and are usually able to eat and drink
normally just days after the procedure. Following the
procedure, one of our patients, who had been unable to
swallow for 20 years, was brought to tears when he could
drink a cup of water. Another patient told us the procedure
changed his life because he can now sleep lying flat.
Prior to POEM, surgeons performed the myotomy
through a large open incision in the chest or abdomen.
More recently, we performed laparoscopic esophageal
myotomy through several small incisions.
However, POEM involves no abdominal incision, no
chest incision, and a minimal stay in the hospital. Because
the surgery is incisionless, patients experience no blood
loss. The cost to perform POEM is lower than open or
laparoscopic surgical approaches.
Other non-surgical treatment options include nitrates
or calcium channel blockers, but these typically offer only
short-term relief. Botox injections are another option, but
they must be repeated every six to nine months and should
be used with caution, as they can cause fibrosis and make
surgery more difficult in the future.
Patients are seen in the newly renovated and expanded
Elaine E. Blatt Endoscopy at St. John Hospital & Medical
Center. The unit is twice as large as the previous area
and includes additional procedure rooms and technology.
It provides patients superior privacy and comfort, and
was essential to accommodate high patient volumes and
advanced procedures, such as POEM, that physicians at
St. John Hospital & Medical Center are offering.
To refer a patient, call the Elaine E. Blatt Endoscopy Department
at St. John Hospital & Medical Center, (313) 343-7020.
Miniature device signals the future of pacemaker
technology
SOHAIL HASSAN, MD
Director of Electrophysiology
St. John Hospital & Medical Center
Detroit, Michigan
(586) 777-7772
[email protected]
THE ELECTROPHYSIOLOGY TEAM AT ST. JOHN HOSPITAL &
MEDICAL CENTER WAS THE FIRST IN SOUTHEAST MICHIGAN
TO IMPLANT THE NANOSTIM, a wireless, non-surgical cardiac
pacemaker placed directly into the right ventricle of the
heart. St. Jude Medical’s Nanostim is one of the most
exciting advances yet in pacing technology, and has the
potential to transform how heart rhythm patients are
treated.
Within seven months of the first Nanostim implant
in the US, we brought it to patients locally. We have
implanted 14 leadless pacemakers so far, with no
complications or dislodgements, with some patients
followed up for more than a year. Patient experience has
been excellent and their sharing of experiences has helped
more patients feel comfortable with the technology.
Patients report that lack of a surgical scar on the chest and
lack of hardware under the skin below the collar bone
are major benefits. In addition, Nanostim does not restrict
mobility of the arm.
Currently, Nanostim is only available in the US through
the LEADLESS II trial, an international clinical study to
evaluate the safety and effectiveness of the pacemaker.
St. John Providence is one of 55 participating centers
worldwide. The study is expected to enroll approximately
670 patients total as St. Jude Medical works toward FDA
approval.
Every year in the US, surgeons implant more than
700,000 pacemakers to regulate the heart’s rhythm. With
traditional pacemakers, all patients have a chest incision
and a lump in the chest. In addition to a pulse generator
that houses a battery and small computer, traditional
pacemakers have one to three leads. Surgeons implant the
device through an incision in the upper chest and insert
the leads through one or more of the veins in the heart.
Although the incidence of pacemaker complications is
relatively low (about four percent), when complications
occur, they typically happen in the pocket where the
pacemaker is implanted or with the leads. In about one
percent of patients, the pocket becomes infected and in
about three percent of patients, the leads move out of
place causing complications.
Research shows that six out
of 10 patients experience
reduced mobility in the
shoulder region where the
pacemaker is implanted.
In contrast, Nanostim
has no leads, doesn’t require
surgery and leaves no scar
or lump in the chest. It
works much like a traditional pacemaker, but is smaller
than a AAA battery and less than 10 percent the size of a
conventional pacemaker.
To implant Nanostim, the surgical team passes a
catheter that contains the leadless pacemaker through a
small puncture in the groin and then into the femoral vein.
Using X-ray images as a guide, we advance the catheter to
the right atrium of the heart, through the tricuspid valve,
and into the right ventricle. We place the pacemaker and
secure it to the wall at the bottom of the right ventricle.
After our team tests the pacemaker to ensure it is placed
and programmed correctly, we remove the catheter and
the pacemaker stays within the right ventricle.
We typically implant Nanostim in less than an hour.
The risk of infection of the chest incision and dislodged
leads are eliminated. If necessary, the pacemaker can
be repositioned or removed at a later time. When the
pacemaker needs to be replaced, typically after ten years
or longer, the procedure is similar to the original implant
procedure.
Nanostim is the least invasive pacing technology
available today. We find patients are more comfortable
following Nanostim implantation, and many of the
restrictions that were necessary to prevent the leads from
moving out of place or becoming damaged are no longer
necessary.
To refer a patient, contact Linda Mannino, NP, Arrhythmia
Center of Excellence, St. John Hospital & Medical Center,
(313) 343-3904 or [email protected].
ST. JOHN PROVIDENCE stjohnprovidence.org/updatesandinnovations
UPDATES & INNOVATIONS / FALL 2015
15
St. John Providence
28000 Dequindre
Warren, MI 48092
stjohnprovidence.org
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Organization
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