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News Article | February 21, 2017
Site: www.prweb.com

A new digital breast tomosynthesis technique has the potential to reduce the rate at which women are called back for additional examinations without sacrificing cancer detection, according to a new study published online in the journal Radiology. In 2011, the U.S. Food and Drug Administration approved digital breast tomosynthesis (DBT) for use with full-field digital mammography (FFDM) in breast imaging. DBT uses a scanner that rotates partially around the breast, providing individual images of thin layers of tissue. When used with FFDM, DBT has been shown to improve cancer detection and reduce callbacks for additional examinations. However, the combination of the two methods requires a second radiation exposure to the breast, while also slightly increasing the time a patient spends in breast compression. Researchers at Christiana Care Health System’s Helen F. Graham Cancer Center & Research Institute in Newark, Del., have been exploring a relatively new approach in which the DBT images are used to create a synthesized 2-D (s2D) compilation image. The method has the potential to render FFDM unnecessary. “The adoption of s2D mammography combined with DBT into screening programs would limit radiation exposure to the patient, and, on the basis of our results, may improve clinical performance,” said Jacqueline S. Holt, M.D., FACR, director of Breast Imaging at Christiana Care Health System’s Helen F. Graham Cancer Center & Research Institute. Dr. Holt and colleagues set out to compare the clinical performance of DBT-s2D with that of DBT-FFDM and FFDM alone. As part of a community oncology program dedicated to breast imaging, the researchers were able to study 78,810 screening mammograms performed from 2011 to 2016. In the study group, 32,076 women were screened with FFDM, 30,561 women were screened using DBT-FFDM and 16,173 women were screened using DBT-s2D. Performance was assessed by looking at recall rate, the cancer detection rate, and positive predictive value (PPV), or the ability to predict if an image-detected abnormality is cancer. The results were eye-opening. DBT-s2D’s recall rate was only 4.3 percent, compared with 5.8 percent for DBT-FFDM. Overall cancer detection rates were similar, but DBT-s2D detected 76.5 percent of invasive cancers, compared with 61.3 percent for DBT-FFDM. At 3.6 percent, the false positive rate for DBT-s2D was significantly lower than the 5.2 percent rate for DBT-FFDM. And the positive predictive value of biopsy for DBT-s2D was 40.8 percent, compared to 28.5 percent for DBT-FFDM. Dr. Holt described the findings as both encouraging and surprising, especially given the fact that, with DBT-s2D, the positive predictive value went up. “If synthesized 2-D imaging is performed, you’ll get equal or better patient outcomes and go to a lower radiation dose,” she said. “These findings could be a practice-changer globally.” The results of the study also suggest that adoption of s2D mammography combined with DBT into screening programs would reduce the number of false-positive findings—an important consideration in the age of value-based medicine. “The downstream cost reduction when women don’t need to be called back for additional imaging amounts to millions of healthcare dollars saved,” Dr. Holt said. Dr. Holt understands that radiologists may be wary of relying on the s2D image. Her advice for clinics is to gradually adopt the technology and track how they’re doing through an initial trial period during which the DBT-s2D approach is used side-by-side with the DBT-FFDM technique. “A lot of the controversy surrounding screening mammography is about false-positive findings,” Dr. Holt said. “With this method, we are addressing this issue, optimizing patient care and adding value.” “Clinical Performance of Synthesized Two-dimensional Mammography Combined with Tomosynthesis in a Large Screening Population.” Collaborating with Dr. Holt were Mireille P. Aujero, M.D., Sara C. Gavenonis, M.D., Ron Benjamin, D.O., and Zugui Zhang, Ph.D. Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://pubs.rsna.org/journal/radiology) RSNA is an association of 54,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)


News Article | February 21, 2017
Site: www.eurekalert.org

OAK BROOK, Ill. - A new digital breast tomosynthesis technique has the potential to reduce the rate at which women are called back for additional examinations without sacrificing cancer detection, according to a new study published online in the journal Radiology. In 2011, the U.S. Food and Drug Administration approved digital breast tomosynthesis (DBT) for use with full-field digital mammography (FFDM) in breast imaging. DBT uses a scanner that rotates partially around the breast, providing individual images of thin layers of tissue. When used with FFDM, DBT has been shown to improve cancer detection and reduce callbacks for additional examinations. However, the combination of the two methods requires a second radiation exposure to the breast, while also slightly increasing the time a patient spends in breast compression. Researchers at Christiana Care Health System's Helen F. Graham Cancer Center & Research Institute in Newark, Del., have been exploring a relatively new approach in which the DBT images are used to create a synthesized 2-D (s2D) compilation image. The method has the potential to render FFDM unnecessary. "The adoption of s2D mammography combined with DBT into screening programs would limit radiation exposure to the patient, and, on the basis of our results, may improve clinical performance," said Jacqueline S. Holt, M.D., FACR, director of Breast Imaging at Christiana Care Health System's Helen F. Graham Cancer Center & Research Institute. Dr. Holt and colleagues set out to compare the clinical performance of DBT-s2D with that of DBT-FFDM and FFDM alone. As part of a community oncology program dedicated to breast imaging, the researchers were able to study 78,810 screening mammograms performed from 2011 to 2016. In the study group, 32,076 women were screened with FFDM, 30,561 women were screened using DBT-FFDM and 16,173 women were screened using DBT-s2D. Performance was assessed by looking at recall rate, the cancer detection rate, and positive predictive value (PPV), or the ability to predict if an image-detected abnormality is cancer. The results were eye-opening. DBT-s2D's recall rate was only 4.3 percent, compared with 5.8 percent for DBT-FFDM. Overall cancer detection rates were similar, but DBT-s2D detected 76.5 percent of invasive cancers, compared with 61.3 percent for DBT-FFDM. At 3.6 percent, the false positive rate for DBT-s2D was significantly lower than the 5.2 percent rate for DBT-FFDM. And the positive predictive value of biopsy for DBT-s2D was 40.8 percent, compared to 28.5 percent for DBT-FFDM. Dr. Holt described the findings as both encouraging and surprising, especially given the fact that, with DBT-s2D, the positive predictive value went up. "If synthesized 2-D imaging is performed, you'll get equal or better patient outcomes and go to a lower radiation dose," she said. "These findings could be a practice-changer globally." The results of the study also suggest that adoption of s2D mammography combined with DBT into screening programs would reduce the number of false-positive findings -- an important consideration in the age of value-based medicine. "The downstream cost reduction when women don't need to be called back for additional imaging amounts to millions of healthcare dollars saved," Dr. Holt said. Dr. Holt understands that radiologists may be wary of relying on the s2D image. Her advice for clinics is to gradually adopt the technology and track how they're doing through an initial trial period during which the DBT-s2D approach is used side-by-side with the DBT-FFDM technique. "A lot of the controversy surrounding screening mammography is about false-positive findings," Dr. Holt said. "With this method, we are addressing this issue, optimizing patient care and adding value." "Clinical Performance of Synthesized Two-dimensional Mammography Combined with Tomosynthesis in a Large Screening Population." Collaborating with Dr. Holt were Mireille P. Aujero, M.D., Sara C. Gavenonis, M.D., Ron Benjamin, D.O., and Zugui Zhang, Ph.D. Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology. ) RSNA is an association of 54,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)


News Article | February 15, 2017
Site: www.prweb.com

The American Board of Quality Assurance & Utilization Review Physicians is pleased to announce the selection of Tabassum Salam, MD, FACP, CHCQM as the recipient of the 2017 CHCQM Diplomate Achievement Award. Congratulations to Dr. Salam who demonstrated an outstanding example of an IT-enabled care coordination system: the Care Link team. Beginning with the development of clinical pathways to standardize the treatment of surgical patients, robust inter-professional care coordination and discharge planning, and the proactive interaction with the Delaware and Maryland Health Information Networks, this Population Health Management project led to positive outcomes in an impressive population of post-surgical patients. Integrating data exchange into clinical workflow is an impressive task; leveraging this data with predictive modeling into a reduction in length of stay, enabling more patients to return directly home after surgery, and reduced readmissions is outstanding. Dr. Salam proudly states that, “The development of the IT innovations for Population Health Management positioned our clinical and care coordination teams to make meaningful and timely contributions to the success of patients who underwent knee and hip replacement surgery in this project. The IT innovations as well as the relationships developed by the clinical and care coordination teams broke down significant communication barriers between the many providers, health systems and post-acute agencies that contribute to the patients' care. The use of a shared population health management electronic health record allow a geographically dispersed team to collaborate on the care of the patients and avoid redundancy of efforts. In addition, the novel real-time admission, discharge and laboratory results feeds from the state health information exchanges arm the whole team with tremendously valuable, actionable alerts that had never been available before.” Patient care innovations under Dr. Salam’s leadership make the impressive work at Christiana Care a benchmark for the rest of the nation. The project clearly embodies the health care quality and management and patient safety principles ABQAURP was looking for in the award selection process. Aligned with our mission, the Care Link team found, “In addition to the technological advances, we did not forget to emphasize the building of relationships with patients, their families and their circle of care. Our team has a much more rounded view of our patients' clinical progress and social and personal needs, and this in turn allows us to guide them to recovery in a far more streamlined manner, while minimizing unnecessary, wasteful clinical activity. We have been able to seamlessly expand this model to the care of other progressively larger and geographically distributed populations in our state.” ABQAURP’s CHCQM Award Selection Panel and association Board Members felt that Dr. Salam’s project, “incorporated all of the elements of a model quality project” and successfully “integrated health IT into clinical outcomes and set a stage for addressing the needs for Population Health and for implementing MACRA.” ABQAURP would like to extend our sincere Thank You to Dr. Salam and all who submitted their outstanding achievements in quality and patient safety that have led to improvement, positive outcomes, and the advancement of Health Care Quality Management and Patient Safety. In accepting the award, Dr. Salam graciously says, “It is wonderful to receive this award on behalf of the team at Care Link, a truly interprofessional group of Population Health clinicians and Information Technology specialists. It is through their persistent hard work that we are able to bring targeted resources to patients and their families at essential healthcare-related moments in their lives. And the best part about the Care Link team is the innovation, development, and expansion continues every day; we are able to grow the network of people benefiting from our Population Health interventions.” Join us at the 40th Annual Health Care Quality & Patient Safety Conference to congratulate Dr. Salam and celebrate all of our Diplomate’s achievements. For more event information, please visit: http://www.abqaurp.org/AnnualConference. Dr. Tabassum Salam is a board-certified Internal Medicine physician. She has been at Christiana Care Health System for over fifteen years. She spent many years as a clinician-educator and Associate Director of the Internal Medicine residency program. In this role, she practiced in both inpatient and outpatient clinical settings and educated resident physicians and medical students. Currently, Dr. Salam is a Senior Physician Advisor for Population Health at Christiana Care Health System. In this role, she leads and orchestrates population health management projects for the health system. She serves as the Medical Director of Care Link Services, leading a care coordination team of nurses, pharmacists and social workers who care for large populations throughout the state of Delaware. The Care Link team focuses on improving health outcomes and optimizing utilization of health care services in the populations it cares for. Dr. Salam also serves as the Governor of the Delaware Chapter of the American College of Physicians. About ABQAURP Celebrating our 40th year of excellence in Health Care Quality Management and Patient Safety, ABQAURP is a premier professional association providing Health Care Quality and Management (HCQM) certification, ACCME-accredited continuing medical education, and membership to health care professionals worldwide. The HCQM Certification is the only interdisciplinary health care quality and management examination administered through the National Board of Medical Examiners® (NBME®). Learn more at: http://www.abqaurp.org. “National Board of Medical Examiners®” and “NBME®” are registered trademarks of the National Board of Medical Examiners.


Saltzberg M.T.,Christiana Care Health System | Szymkiewicz S.,ZOLL Cardiac Management Solutions | Bianco N.R.,ZOLL Cardiac Management Solutions
Journal of Cardiac Failure | Year: 2012

Background: Peripartum cardiomyopathy (PPCM) mortality rates vary between 2% and 56%, with half occurring ≤12 weeks'; postpartum. Although risk factors for PPCM have been identified, predicting sudden cardiac death among PPCM patients remains difficult. This study describes the characteristics and outcomes of PPCM patients and controls referred for a wearable cardioverter defibrillator (WCD). Methods and Results: Deidentified WCD medical orders between 2003 and 2009 and death index searches were used to characterize women (ages 17-43) with PPCM (n = 107) or matched nonpregnant women with nonischemic dilated cardiomyopathy (NIDCM; n = 159). Demographics were similar. WCD use averaged 124 ± 123 days and 96 ± 83 days among PPCM and NIDCM patients, respectively. No PPCM patients received an appropriate shock for ventricular tachycardia/ventricular fibrillation; 1 NIDCM patient received 2 successful shocks. No PPCM patient died during WCD use versus 11 concurrent NIDCM deaths. After WCD use, 3 PPCM and 13 NIDCM patients died, respectively. Conclusions: The mortality rate of 2.8% (over 3.0 ± 1.2 years) in PPCM patients is low compared to published data. The role of WCD therapy among PPCM patients deserves further study. © 2012 Elsevier Inc. All rights reserved.


News Article | November 23, 2016
Site: globenewswire.com

NEW YORK, Nov. 23, 2016 (GLOBE NEWSWIRE) -- Barry Dahllof, Jr., Corporate Director of Managed Care Contracting at Christiana Care Health System, has been selected to join the Industry Board at the American Health Council. He will be sharing his knowledge and expertise in Finance and Accounting. A photo accompanying this announcement is available at http://www.globenewswire.com/NewsRoom/AttachmentNg/88dfebe4-c947-4b77-9765-e4b3a7a748d5 With more than twenty-five years in the finance industry, Mr. Dahllof offers valuable insight on contractual agreements and accounting. His knack for numbers and reading led him to a career in Finance and Contracting, while injuries he sustained playing sports during high school inspired him to become more knowledgeable about healthcare, something he would be able to pass on to his children and to others. As the Corporate Director of Managed Care Contracting at Christiana Care Health System, Mr. Dahllof’s day-to-day responsibilities consist of negotiating and constructing contracts with a wide variety of commercial and management organizations, while also directing various departments. Moreover, he serves as the liaison for the healthcare system and the management care organization. In 1990, Barry Dahllof received his Bachelor’s Degree from Liberty University in Accounting. He is affiliated with the Healthcare Financial Management Association (HFMA) and the Institute of Managed Accounting (IMA). In addition, Mr. Dahllof is a member of the Travel Baseball Team, the University Flames Club, and the Love of Christ Church. He has been recognized for his outstanding contributions and achievements by Strathmore’s Who’s Who. Among his many accomplishments, he is proudest of his ability to collaborate with creative individuals in bringing about an improved delivery of healthcare. Barry Dahllof attributes his success to listening, learning, and collaborating with the right people at the right time. Mr. Dahllof’s long term goals include living one day at a time and to continue growing in his career. During his free time, Barry Dahllof, Jr. enjoys supporting his children’s sports, which include baseball, soccer, field hockey, and gymnastics.


News Article | November 28, 2016
Site: www.prweb.com

The Workgroup for Electronic Data Interchange (WEDI), the nation’s leading nonprofit authority on the use of health IT to create efficiencies in healthcare information exchange, announced today the election of four new board members to its Board of Directors, as well as the re-election of eight previous board members to serve two-year terms. The WEDI Board of Directors represents a diverse cross-section of the industry including payers, providers, government regulators and industry vendors. This group of executives will lead the organization forward in its efforts to promote the use of health IT in improving healthcare information exchange – enhancing quality of care, improving efficiency and reducing costs. New board members include: 1. Pam Grosze, PNC Bank (Vendor) 2. David Haugen, Minnesota Department of Health (Government) 3. Teresa Rivera, Utah Health Information Network (Not-for-Profit/Affiliate) 4. Michael Wilson, HealthCare Information Management, Inc. (Vendor) Standing and appointed board members include: 13. Stacey Barber, ASC/X12N (Standards/Operating Rules) 14. Laura Darst, Mayo Clinic (Provider) 15. Durwin Day, Health Care Service Corporation (Health Plan) 16. Lorraine Doo, Centers for Medicare and Medicaid Services (Government) 17. Jay Eisenstock, Aetna (Health Plan) 18. Wendy Fuller, BCBS Arizona (Health Plan) 19. Chuck Jaffe, HL7 (Standards/Operating Rules) 20. John Kelly, Edifecs (Vendor) 21. Gwen Lohse, CAQH CORE (Standards/Operating Rules) 22. Peggy Lynahan, Christiana Care Health System (Provider) 23. Deborah Meisner, Change Healthcare (Vendor) 24. Jean Narcisi, American Dental Association (At-Large Position) 25. Ryan Reddick, Anthem (Health Plan) 26. Samuel Rubenstein, Montefiore Medical Center (Provider) 27. Srinu Sonti, Federation of American Hospitals (Provider) 28. Lee Ann Stember, NCPDP (Standards/Operating Rules) 29. Debra Strickland, Xerox (Vendor) 30. Robert Tennant, Medical Group Management Association (Provider) “WEDI prides itself on representing the full spectrum of perspectives in healthcare information exchange,” said Charles W. Stellar, president and CEO of WEDI. “Our Board of Directors elections and appointees represent just that. As leaders in their fields, we look to rely on them to guide our organization forward united in the goal of improving the efficiency of healthcare through the use of information technology. Congratulations to the new and re-elected board members.” For more information on the WEDI Board of Directors, visit the WEDI website. About WEDI The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services (HHS) and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit http://www.wedi.org.


Weiss S.,Christiana Care Health System | Weintraub W.,Christiana Care Health System
Progress in Cardiovascular Diseases | Year: 2015

The keynote COURAGE and BARI-2D trials changed the way the interventional community selects patients for revascularization. What we now consider appropriate, especially for percutaneous coronary intervention, has narrowed significantly in scope compared to previous practice a decade ago. Medical therapy has been shown to be both safe and effective as a primary treatment modality for patients with stable ischemic heart disease on the whole. However, it appears that patients with a heavy ischemic burden may benefit from revascularization, although investigation of this is ongoing. Evidence preliminarily supports this practice with coronary artery bypass grafting, and possibly in specific populations undergoing multivessel intervention with functional assessment of lesion severity during PCI. © 2015.


Derman R.J.,Christiana Care Health System
Osteoporosis International | Year: 2010

Pharmacologic osteoporosis therapy, particularly anti-resorptives, is recommended in postmenopausal women with clinical risk factors for fracture. Treatment decisions should be made based on the relative benefit-risk profile in different patient populations. Emerging options [e.g., selective estrogen receptor modulators (SERMs) and denosumab] may hold promise for providing protection from bone loss and for fracture risk reduction. Osteoporosis, the most common clinical disorder of bone metabolism, is characterized by low bone mineral density, deterioration of microarchitecture, and a consequent increase in bone fragility and risk of fracture. Pharmacologic therapy is recommended in postmenopausal women with clinical risk factors for fracture and includes anti-resorptive agents such as bisphosphonates, hormone therapy, SERMs, and calcitonin. The anabolic agent teriparatide (parathyroid hormone) is usually reserved for high-risk patients or those with glucocorticoid-induced osteoporosis. Strontium ranelate, available outside the USA, has both anti-resorptive and anabolic properties. Supplementation with calcium and vitamin D is recommended for all women aged 50 years and older. Bisphosphonates are often considered first-line therapy for osteoporosis and have the largest base of clinical trial data showing efficacy for global fracture risk reduction. Low-dose hormone therapy is appropriate for younger women who are experiencing other menopausal symptoms. In women for whom bisphosphonates are not appropriate or not tolerated or in younger postmenopausal women who have a low risk for hip fracture, SERMs are a suitable treatment option. Calcitonin is designated for patients who are unable or unwilling to tolerate other osteoporosis agents. Emerging options, including newer SERMs (e.g., bazedoxifene and lasofoxifene) and the monoclonal antibody denosumab, may hold promise for providing protection from bone loss and for fracture risk reduction. Because no single agent is appropriate for all patients, treatment decisions should be made on an individual basis, taking into account the relative benefits and risks in different patient populations. © 2010 International Osteoporosis Foundation and National Osteoporosis Foundation.


Gakhal M.S.,Christiana Care Health System
Delaware medical journal | Year: 2013

To analyze the age distribution, underlying etiology, and side of involvement in patients diagnosed with ovarian vein thrombosis (OVT). A retrospective study was conducted at Christiana Care Health System to identify all patients with an imaging diagnosis of OVT from January 2003 to September 2010. The data collected on this patient population included patient age, etiology, imaging modality used for diagnosis, side of involvement, as well as renal vein and inferior vena cava involvement. A total of 26 patients were diagnosed with OVT. The age distribution in patients with ovarian vein thrombosis ranged from 21 to 91. Ovarian vein thrombosis was diagnosed by computed tomography (CT) in 85 percent (22/26) of patients and magnetic resonance imaging (MRI) in 15 percent (4/26) of patients. The most common etiologies were underlying malignancy (27 percent, 7/26) and non-pregnancy related pelvic surgery (23 percent, 6/26). The postpartum state accounted for only 12 percent (3/26) of the cases. Thrombosis occurred in left ovarian vein in 50 percent (13/26), in the right ovarian vein in 42 percent (11/26), and bilaterally in 8 percent (2/26) of patients. Associated thrombus in the left renal vein was observed in 12 percent (3/26), and in the inferior vena cava in 15 percent (4/26) of patients. In our clinical practice, ovarian vein thrombosis is primarily diagnosed with computed tomography (CT) and less frequently via magnetic resonance imaging (MRI). In contrast to most of the published data, which emphasizes occurrence of OVT in women of child bearing age and postpartum state, in our series we found it occurred over a broad age distribution. There were a wide range of underlying etiologies. Half of the cases of ovarian vein thrombosis unilaterally involved the left ovarian vein, unlike the overwhelming right sided predominance reported by most other studies.


Coletti C.,Christiana Care Health System
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2010

Remote intensive care unit (ICU) monitoring (tele-ICU) may provide a means to address the shortage of intensive care physicians. However, the consequences of implementing a tele-ICU system for house staff education and clinical experience are unknown. The purpose of this study was to determine resident perceptions of the impact of a tele-ICU implementation on patient care, education, and the overall work environment. Materials and Cross-sectional survey of residents who rotated through the medical ICU within the first year after the implementation of a tele-ICU in a large, academically affiliated, community hospital. Each question was graded on a 5-point Likert scale. Thirty-five of 60 residents completed the survey (58% response rate). Sixty-three percent of residents reported that tele-ICU was associated with an improved ability to focus on urgent patient issues, and 46% thought that the tele-ICU helped them to feel less overwhelmed. Although most residents were neutral (51%), 37% agreed that the tele-ICU was a valuable educational experience. Seventy-seven percent reported that the tele-ICU integration was associated with improved patient safety, but many were concerned about the impact on continuity and communication. There was no perceived association with patient or family satisfaction. Our study suggests that a tele-ICU implementation in a medical ICU does not seem to have a negative impact on the educational experience of residents and is associated with perceived improvements in patient safety and quality. Future studies should objectively measure the educational impact of implementing a tele-ICU system.

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