Wheeling, WV, United States
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News Article | April 17, 2017
Site: www.prweb.com

Hospital M&A activity slowed in the first quarter of 2017, according to new acquisition data from HealthCareMandA.com. The number of hospital acquisitions decreased to 19 in the first quarter, down 17% from the 23 publicly announced acquisitions in the fourth quarter of 2016, and a 30% decrease from the 27 announced deals in the year-ago first quarter. All but four of the transactions did not disclose a purchase price. The largest acquisition price announced was for $25 million, as the Health Care Authority of the City of Anniston (AL) acquired Stringfellow Memorial Hospital in that city. The largest group of acquirers were not-for-profit hospitals and health systems, with 11 acquisitions announced by nine buyers. Wheeling Hospital in West Virginia and Fairview Health Service in Minnesota each announced two acquisitions. Two real estate investment trusts (REITs) closed one acquisition apiece for standalone hospitals. “The hospital sector has been greatly affected by the uncertainty surrounding the ‘repeal and replace’ efforts by the Congressional Republicans,” stated Lisa Phillips, editor of the Health Care M&A Report, which publishes the data. “Until the legislative issues are settled, mergers and acquisitions in this sector will stay soft.” Among the sellers, two financially troubled publicly traded hospital companies divested 15 hospitals through five announced deals. Community Health Systems sold 13 hospitals, and its spinoff, Quorum Health, sold two. “Strategic acquisitions between large health systems are still possible, but the majority of hospital deals in the next quarter will be driven by finances,” commented Phillips. All quarterly results are published in The Health Care M&A Report for all 13 sectors of health care, which is part of the HealthCareMandA.com investment research source. For more information, or to order the report, call 800-248-1668. Irving Levin Associates, Inc. was established in 1948 and has headquarters in Norwalk, Connecticut. The company publishes research reports and newsletters, and maintains databases on the health care and senior housing M&A markets.

Bittner N.,Tacoma Valley Radiation Oncology Centers | Merrick G.S.,Wheeling Hospital | Butler W.M.,Wheeling Jesuit University | Bennett A.,Wheeling Jesuit University | Galbreath R.W.,Wheeling Jesuit University
Journal of Urology | Year: 2013

Purpose: We determined the incidence of cancer detection by transperineal template guided mapping biopsy of the prostate in patients with at least 1 previously negative transrectal ultrasound guided biopsy. Materials and Methods: From January 2005 to January 2012 at least 1 negative transrectal ultrasound guided biopsy was done in 485 patients in our clinical database before proceeding with transperineal template guided mapping biopsy. No study patient had a previous prostate cancer diagnosis. The incidence of patients with 1, 2, or 3 or greater previous transrectal ultrasound guided biopsies was 55.3%, 25.9% and 18.8%, respectively. Transperineal template guided mapping biopsy was done in 74.8% of patients for increasing or occasionally persistently increased prostate specific antigen, in 19.4% for atypical small acinar proliferation and in 5.8% for high grade prostatic intraepithelial neoplasia. Results: For the entire study population a median of 59 cores was submitted at transperineal template guided mapping biopsy. Cancer was ultimately detected in 226 patients (46.6%) using the transperineal template guided method, including 196 (86.7%) with clinically significant disease according to the Epstein criteria. The most common cancer detection site on transperineal template guided mapping biopsy was the anterior apex. Conclusions: Transperineal template guided mapping biopsy detected clinically significant prostate cancer in a substantial proportion of patients with negative transrectal ultrasound guided biopsy. This technique should be strongly considered in the context of increasing prostate specific antigen with failed confirmation of the tissue diagnosis. © 2013 American Urological Association Education and Research, Inc.

Bittner N.,Tacoma Valley Radiation Oncology Centers | Merrick G.S.,Wheeling Jesuit University | Wallner K.E.,Puget Sound Health Care System | Butler W.M.,Wheeling Jesuit University | And 2 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: To compare biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) rates among high-risk prostate cancer patients treated with brachytherapy and supplemental external beam radiation (EBRT) using either a mini-pelvis (MP) or a whole-pelvis (WP) field. Methods and Materials: From May 1995 to October 2005, 186 high-risk prostate cancer patients were treated with brachytherapy and EBRT with or without androgen-deprivation therapy (ADT). High-risk prostate cancer was defined as a Gleason score of ≥8 and/or a prostate-specific antigen (PSA) concentration of ≥20 ng/ml. Results: With a median follow-up of 6.7 years, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 91.7% vs. 84.4% (p = 0.126), 95.5% vs. 92.6% (p = 0.515), and 79.5% vs. 67.1% (p = 0.721), respectively. Among those patients who received ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 93.6% vs. 90.1% (p = 0.413), 94.2% vs. 96.0% (p = 0.927), and 73.7% vs. 70.2% (p = 0.030), respectively. Among those patients who did not receive ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 82.4% vs. 75.0% (p = 0.639), 100% vs. 88% (p = 0.198), and 87.5% vs. 58.8% (p = 0.030), respectively. Based on multivariate analysis, none of the evaluated parameters predicted for CSS, while bPFS was best predicted by ADT and percent positive biopsy results. OS was best predicted by age and percent positive biopsy results. Conclusions: For high-risk prostate cancer patients receiving brachytherapy, there is a nonsignificant trend toward improved bPFS, CSS, and OS rates when brachytherapy is given with WPRT. This trend is most apparent among ADT-naïve patients, for whom a significant improvement in OS was observed. © 2010 Elsevier Inc. All rights reserved.

Taira A.V.,University of Washington | Merrick G.S.,Wheeling Jesuit University | Butler W.M.,Wheeling Jesuit University | Galbreath R.W.,Wheeling Jesuit University | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: To present the largest series of prostate cancer brachytherapy patients treated with modern brachytherapy techniques and postimplant day 0 dosimetric evaluation. Methods and Materials: Between April 1995 and July 2006, 1,656 consecutive patients were treated with permanent interstitial brachytherapy. Risk group stratification was carried out according to the Mt. Sinai guidelines. Median follow-up was 7.0 years. The median day 0 minimum dose covering at least 90% of the target volume was 118.8% of the prescription dose. Cause of death was determined for each deceased patient. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on the evaluated survival parameters. Results: At 12 years, biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) for the entire cohort was 95.6%, 98.2%, and 72.6%, respectively. For low-, intermediate-, and high-risk patients, bPFS was 98.6%, 96.5%, and 90.5%; CSS was 99.8%, 99.3%, and 95.2%; and OS was 77.5%, 71.1%, and 69.2%, respectively. For biochemically controlled patients, the median posttreatment prostate-specific antigen (PSA) concentration was 0.02 ng/ml. bPFS was most closely related to percent positive biopsy specimens and risk group, while Gleason score was the strongest predictor of CSS. OS was best predicted by patient age, hypertension, diabetes, and tobacco use. At 12 years, biochemical failure and cause-specific mortality were 1.8% and 0.2%, 5.1% and 2.1%, and 10.4% and 7.1% for Gleason scores 5 to 6 and 7 and ≥8, respectively. Conclusions: Excellent long-term outcomes are achievable with high-quality brachytherapy for low-, intermediate-, and high-risk patients. These results compare favorably to alternative treatment modalities including radical prostatectomy. © 2011 Elsevier Inc.

Merrick G.S.,Wheeling Jesuit University | Butler W.M.,Wheeling Jesuit University | Galbreath R.W.,Wheeling Jesuit University | Lief J.,Wheeling Jesuit University | And 3 more authors.
BJU International | Year: 2011

OBJECTIVE To evaluate cause-specific survival (CSS), biochemical progression-free survival (bPFS) and overall survival (OS) in high-risk prostate cancer brachytherapy patients. PATIENTS AND METHODS From April 1995 to June 2005, 284 patients with high-risk prostate cancer (Gleason score ≥8 or prostate-specific antigen >20 ng/mL or clinical stage ≥ T2c) underwent brachytherapy. Supplemental external beam radiation therapy was given to 257 (90.5%) patients and 179 (63.0%) received androgen deprivation therapy (ADT). Median follow up was 7.8 years. The median post-implant day 0 D90 was 118.9% of prescription dose. Patients with metastatic prostate cancer or castrate-resistant disease without obvious metastases who died of any cause were classified as dead from prostate cancer. Multiple parameters were evaluated for impact on survival. RESULTS Twelve-year CSS, bPFS and OS were 94.2%, 89.0% and 69.7%. On multivariate analysis, bPFS was best predicted by percent positive biopsies and ADT. The analysis failed to identify any predictors for CSS, while OS was highly correlated with patient age, percent positive biopsies and diabetes. Fourteen percent of patients died from diseases of the heart, while 8%, 8% and 6% of patients died from non-prostate cancer, other causes and prostate cancer, respectively. When OS was stratified by patients with 0-3 vs ≥4 comorbidities, the 12-year OS was 73.0% and 52.7% (P= 0.036). CONCLUSIONS High-quality brachytherapy results in favourable bPFS and CSS for high-risk patients. Death from diseases of the heart is more than twice as likely as death from prostate cancer. Strategies to improve cardiovascular health may positively impact OS. © 2010 BJU INTERNATIONAL.

Butler W.M.,Wheeling Hospital | Butler W.M.,Wheeling Jesuit University | Morris M.N.,Wheeling Hospital | Merrick G.S.,Wheeling Hospital | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To evaluate, using real-time monitoring of implanted radiofrequency transponders, the intrafraction prostate displacement of patients as a function of body mass index (BMI). Methods and Materials: The motions of Beacon radiofrequency transponders (Calypso Medical Technologies, Seattle, WA) implanted in the prostate glands of 66 men were monitored throughout the course of intensity modulated radiation therapy. Data were acquired at 10 Hz from setup to the end of treatment, but only the 1.7 million data points with a "beam on" tag were used in the analysis. There were 21 obese patients, with BMI ≥30 and 45 nonobese patients in the study. Results: Mean displacements were least in the left-right lateral direction (0.56 ± 0.24 mm) and approximately twice that magnitude in the superior-inferior and anterior-posterior directions. The net vector displacement was larger still, 1.95 ± 0.47 mm. Stratified by BMI cohort, the mean displacements per patient in the 3 Cartesian axes as well as the net vector for patients with BMI ≥30 were slightly less (<0.2 mm) but not significantly different than the corresponding values for patients with lower BMIs. As a surrogate for the magnitude of oscillatory noise, the standard deviation for displacements in all measured planes showed no significant differences in the prostate positional variability between the lower and higher BMI groups. Histograms of prostate displacements showed a lower frequency of large displacements in obese patients, and there were no significant differences in short-term and long-term velocity distributions. Conclusions: After patients were positioned accurately using implanted radiofrequency transponders, the intrafractional displacements in the lateral, superior-inferior, and anterior-posterior directions as well as the net vector displacements were smaller, but not significantly so, for obese men than for those with lower BMI. © 2012 Elsevier Inc.

Merrick G.S.,Wheeling Jesuit University | Wallner K.E.,University of Washington | Butler W.M.,Wheeling Jesuit University | Galbreath R.W.,Wheeling Jesuit University | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: The necessity of external beam radiotherapy (EBRT) as a supplement to prostate brachytherapy remains unknown. We report brachytherapy outcomes for patients with higher risk features randomized to substantially different supplemental EBRT regimens. Methods and Materials: Between December 1999 and June 2004, 247 patients were randomized to 20 Gy vs. 44 Gy EBRT followed by a palladium-103 boost (115 Gy vs. 90 Gy). The eligibility criteria included clinically organ-confined disease with Gleason score 7-10 and/or pretreatment prostate-specific antigen (PSA) level 10-20 ng/mL. The median follow-up period was 9.0 years. Biochemical progression-free survival (bPFS) was defined as a PSA level of ≤0.40 ng/mL after nadir. The median day 0 prescribed dose covering 90% of the target volume was 125.7%; 80 men received androgen deprivation therapy (median, 4 months). Multiple parameters were evaluated for their effect on bPFS. Results: For the entire cohort, the cause-specific survival, bPFS, and overall survival rates were 97.7%, 93.2%, and 80.8% at 8 years and 96.9%, 93.2%, and 75.4% at 10 years, respectively. The bPFS rate was 93.1% and 93.4% for the 20-Gy and 44-Gy arms, respectively (p =.994). However, no statistically significant differences were found in cause-specific survival or overall survival were identified. When stratified by PSA level of ≤10 ng/mL vs. >10 ng/mL, Gleason score, or androgen deprivation therapy, no statistically significant differences in bPFS were discerned between the two EBRT regimens. On multivariate analysis, bPFS was most closely related to the preimplant PSA and clinical stage. For patients with biochemically controlled disease, the median PSA level was <0.02 ng/mL. Conclusion: The results of the present trial strongly suggest that two markedly different supplemental EBRT regimens result in equivalent cause-specific survival, bPFS, and overall survival. It is probable that the lack of benefit for a higher supplemental EBRT dose is the result of the high-quality brachytherapy dose distributions. © 2012 Elsevier Inc.

See-Sebastian E.H.,Wheeling Hospital
The West Virginia medical journal | Year: 2013

Spinal Cord Intramedullary Cavernoma is a rare disease. It is a vascular disorder composed of capillary-liked vessels without intervening neurons within a spinal lesion. It may only be discovered incidentally or may be diagnosed after a neurologic deficit. Patients may present with weakness which could mimic other neurologic pathology. A case of a 65 year old with history of hypertension and diabetes mellitus. He had previous microdissectomy of the lumbar L4-L5 disc. He presented with progressive lower leg paresis, urinary retention and obstipation. An MRI revealed a cavernous angioma at the T5 level. A multitude of neurologic deficits could lead to a patient presenting with a Spinal Cord Cavernoma. Prompt imaging is warranted in cases presenting with the symptoms to allow appropriate diagnoses and treatment. The clinician must be aware of this rare, but debilitating disease complex.

Anesthesia providers serve a vital role in preventing the transmission of disease by following safe injection practices, yet violations of these standards have occurred. The goal of this study was to determine the extent of unsafe injection practices that exist among student anesthesia providers. An online survey containing 8 yes-no questions that assessed injection practices as outlined by the American Association of Nurse Anesthetists was sent to student registered nurse anesthetists with at least 3 months' clinical experience. Three hundred twenty-five students completed the survey. Results showed that 14 (approximately 4%) have administered medications from the same syringe to multiple patients, 59 (18%) have reused a needle on the same patient, 266 (82%) have refilled used syringes, and 2 (0.6%) have reused infusion sets for more than 1 patient. Furthermore, 71 (22%) have reused a syringe or needle to withdraw medication from a multidose vial, and 160 (49%) have reentered a single-use medication vial to prepare doses for multiple patients. Students also were asked to report their experiences with nurse anesthetists who engaged in these practices. The results demonstrate that additional education on injection safety must take place to improve practice, increase patient safety, and reduce healthcare costs.

Butler W.M.,Wheeling Hospital | Stewart R.R.,Wheeling Hospital | Merrick G.S.,Wheeling Hospital
Brachytherapy | Year: 2011

To re-evaluate prostate implant dosimetry using American Association of Physicists in Medicine Task Group 43 parameters and the radiobiologic approach of American Association of Physicists in Medicine Task Group 137. Methods and Materials: Among 1473 consecutive patients implanted with iodine-125 or palladium-103 sources before March 2006, there have been 55 biochemical failures. The dosimetric quality parameter, D90, was updated according to the radionuclide and dosimetric era of the implant. For each patient, biologically equivalent dose (BED) and tumor control probability (TCP) were calculated from the updated implant D90 plus any external beam dose using recommended indices and equations. Results: There was no significant difference in BED between biochemical failures and nonfailures, 148 ± 27. Gy and 145 ± 24. Gy, respectively (p= 0.352). TCP was 0.90 ± 0.26 for biochemical failures and 0.93 ± 0.21 for nonfailures (p= 0.414). Cox regression analysis found that neither BED nor TCP predicted for biochemical control either for the entire population or within each radionuclide-dependent dosimetric era. The only overall predictors of biochemical control were dosimetric era, Gleason score, and percent positive biopsies. Improvements in dosimetric quality over the first 300 patients were evident, but dosimetric era remained a better predictor of biochemical outcome than implant sequence number. Conclusion: In a large prostate implant population, dosimetric and derived radiobiologic parameters did not predict for failure. Apparently, too few patients had total BEDs below the level necessary for optimum biochemical control. A learning curve extended over hundreds of patients before plateauing but changes in seed characterization parameters also had a pronounced effect. © 2011 American Brachytherapy Society.

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