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Archive for the ‘Cardiovascular and Vascular Systems’ Category


Regulatory MicroRNAs in Aberrant Cholesterol Transport and Metabolism

Curator: Marzan Khan, B.Sc

Aberrant levels of lipids and cholesterol accumulation in the body lead to cardiometabolic disorders such as atherosclerosis, one of the leading causes of death in the Western World(1). The physical manifestation of this condition is the build-up of plaque along the arterial endothelium causing the arteries to constrict and resist a smooth blood flow(2). This obstructive deposition of plaque is merely the initiation of atherosclerosis and is enriched in LDL cholesterol (LDL-C) as well foam cells which are macrophages carrying an overload of toxic, oxidized LDL(2). As the condition progresses, the plaque further obstructs blood flow and creates blood clots, ultimately leading to myocardial infarction, stroke and other cardiovascular diseases(2). Therefore, LDL is referred to as “the bad cholesterol”(2).

Until now, statins are most widely prescribed as lipid-lowering drugs that inhibit the enzyme 3-hydroxy-3methylgutaryl-CoA reductase (HMGCR), the rate-limiting step in de-novo cholesterol biogenesis (1). But some people cannot continue with the medication due to it’s harmful side-effects(1). With the need to develop newer therapeutics to combat cardiovascular diseases, Harvard University researchers at Massachusetts General Hospital discovered 4 microRNAs that control cholesterol, triglyceride, and glucose homeostasis(3)

MicroRNAs are non-coding, regulatory elements approximately 22 nucleotides long, with the ability to control post-transcriptional expression of genes(3). The liver is the center for carbohydrate and lipid metabolism. Stringent regulation of endogenous LDL-receptor (LDL-R) pathway in the liver is crucial to maintain a minimal concentration of LDL particles in blood(3). A mechanism whereby peripheral tissues and macrophages can get rid of their excess LDL is mediated by ATP-binding cassette, subfamily A, member 1 (ABCA1)(3). ABCA1 consumes nascent HDL particles- dubbed as the “good cholesterol” which travel back to the liver for its contents of triglycerides and cholesterol to be excreted(3).

Genome-wide association studies (GWASs) meta-analysis carried out by the researchers disclosed 4 microRNAs –(miR-128-1, miR-148a, miR-130b, and miR-301b) to lie close to single-nucleotide polymorphisms (SNPs) associated with abnormal metabolism and transport of lipids and cholesterol(3) Experimental analyses carried out on relevant cell types such as the liver and macrophages have proven that these microRNAs bind to the 3’ UTRs of both LDL-R and ABCA1 transporters, and silence their activity. Overexpression of miR-128-1 and miR148a in mice models caused circulating HDL-C to drop. Corroborating the theory under investigation further, their inhibition led to an increased clearance of LDL from the blood and a greater accumulation in the liver(3).

That the antisense inhibition of miRNA-128-1 increased insulin signaling in mice, propels us to hypothesize that abnormal expression of miR-128-1 might cause insulin resistance in metabolic syndrome, and defective insulin signaling in hepatic steatosis and dyslipidemia(3)

Further examination of miR-148 established that Liver-X-Receptor (LXR) activation of the Sterol regulatory element-binding protein 1c (SREBP1c), the transcription factor responsible for controlling  fatty acid production and glucose metabolism, also mediates the expression of miR-148a(4,5) That the promoter region of miR-148 contained binding sites for SREBP1c was shown by chromatin immunoprecipitation combined with massively parallel sequencing (ChIP-seq)(4). More specifically, SREBP1c attaches to the E-box2, E-box3 and E-box4 elements on miR-148-1a promoter sites to control its expression(4).

Earlier, the same researchers- Andres Naars and his team had found another microRNA called miR-33 to block HDL generation, and this blockage to reverse upon antisense targeting of miR-33(6).

These experimental data substantiate the theory of miRNAs being important regulators of lipoprotein receptors and transporter proteins as well as underscore the importance of employing antisense technologies to reverse their gene-silencing effects on LDL-R and ABCA1(4). Such a therapeutic approach, that will consequently lower LDL-C and promote HDL-C seems to be a promising strategy to treat atherosclerosis and other cardiovascular diseases(4).

References:

1.Goedeke L1,Wagschal A2,Fernández-Hernando C3, Näär AM4. miRNA regulation of LDL-cholesterol metabolism. Biochim Biophys Acta. 2016 Dec;1861(12 Pt B):. Biochim Biophys Acta. 2016 Dec;1861(12 Pt B):2047-2052

https://www.ncbi.nlm.nih.gov/pubmed/26968099

2.MedicalNewsToday. Joseph Nordgvist. Atherosclerosis:Causes, Symptoms and Treatments. 13.08.2015

http://www.medicalnewstoday.com/articles/247837.php

3.Wagschal A1,2, Najafi-Shoushtari SH1,2, Wang L1,2, Goedeke L3, Sinha S4, deLemos AS5, Black JC1,6, Ramírez CM3, Li Y7, Tewhey R8,9, Hatoum I10, Shah N11, Lu Y11, Kristo F1, Psychogios N4, Vrbanac V12, Lu YC13, Hla T13, de Cabo R14, Tsang JS11, Schadt E15, Sabeti PC8,9, Kathiresan S4,6,8,16, Cohen DE7, Whetstine J1,6, Chung RT5,6, Fernández-Hernando C3, Kaplan LM6,10, Bernards A1,6,16, Gerszten RE4,6, Näär AM1,2. Genome-wide identification of microRNAs regulating cholesterol and triglyceride homeostasis. . Nat Med.2015 Nov;21(11):1290

https://www.ncbi.nlm.nih.gov/pubmed/26501192

4.Goedeke L1,2,3,4, Rotllan N1,2, Canfrán-Duque A1,2, Aranda JF1,2,3, Ramírez CM1,2, Araldi E1,2,3,4, Lin CS3,4, Anderson NN5,6, Wagschal A7,8, de Cabo R9, Horton JD5,6, Lasunción MA10,11, Näär AM7,8, Suárez Y1,2,3,4, Fernández-Hernando C1,2,3,4. MicroRNA-148a regulates LDL receptor and ABCA1 expression to control circulating lipoprotein levels. Nat Med. 2015 Nov;21(11):1280-9.

https://www.ncbi.nlm.nih.gov/pubmed/26437365

5.Eberlé D1, Hegarty B, Bossard P, Ferré P, Foufelle F. SREBP transcription factors: master regulators of lipid homeostasis. Biochimie. 2004 Nov;86(11):839-48.

https://www.ncbi.nlm.nih.gov/pubmed/15589694

6.Harvard Medical School. News. MicoRNAs and Metabolism.

https://hms.harvard.edu/news/micrornas-and-metabolism

7. MGH – Four microRNAs identified as playing key roles in cholesterol, lipid metabolism

http://www.massgeneral.org/about/pressrelease.aspx?id=1862

 

Other related articles published in this Open Access Online Scientific Journal include the following:

 

  • Cardiovascular Diseases, Volume Three: Etiologies of Cardiovascular Diseases: Epigenetics, Genetics and Genomics,

on Amazon since 11/29/2015

http://www.amazon.com/dp/B018PNHJ84

 

HDL oxidation in type 2 diabetic patients

Larry H. Bernstein, MD, FCAP, Curator

https://pharmaceuticalintelligence.com/2015/11/27/hdl-oxidation-in-type-2-diabetic-patients/

 

HDL-C: Target of Therapy – Steven E. Nissen, MD, MACC, Cleveland Clinic vs Peter Libby, MD, BWH

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2014/11/07/hdl-c-target-of-therapy-steven-e-nissen-md-macc-cleveland-clinic-vs-peter-libby-md-bwh/

 

High-Density Lipoprotein (HDL): An Independent Predictor of Endothelial Function & Atherosclerosis, A Modulator, An Agonist, A Biomarker for Cardiovascular Risk

Curator: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/03/31/high-density-lipoprotein-hdl-an-independent-predictor-of-endothelial-function-artherosclerosis-a-modulator-an-agonist-a-biomarker-for-cardiovascular-risk/

 

Risk of Major Cardiovascular Events by LDL-Cholesterol Level (mg/dL): Among those treated with high-dose statin therapy, more than 40% of patients failed to achieve an LDL-cholesterol target of less than 70 mg/dL.

Reporter: Aviva Lev-Ari, PhD., RN

https://pharmaceuticalintelligence.com/2014/07/29/risk-of-major-cardiovascular-events-by-ldl-cholesterol-level-mgdl-among-those-treated-with-high-dose-statin-therapy-more-than-40-of-patients-failed-to-achieve-an-ldl-cholesterol-target-of-less-th/

 

LDL, HDL, TG, ApoA1 and ApoB: Genetic Loci Associated With Plasma Concentration of these Biomarkers – A Genome-Wide Analysis With Replication

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/12/18/ldl-hdl-tg-apoa1-and-apob-genetic-loci-associated-with-plasma-concentration-of-these-biomarkers-a-genome-wide-analysis-with-replication/

 

Two Mutations, in the PCSK9 Gene: Eliminates a Protein involved in Controlling LDL Cholesterol

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2013/04/15/two-mutations-in-a-pcsk9-gene-eliminates-a-protein-involve-in-controlling-ldl-cholesterol/

Artherogenesis: Predictor of CVD – the Smaller and Denser LDL Particles

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2012/11/15/artherogenesis-predictor-of-cvd-the-smaller-and-denser-ldl-particles/

 

A Concise Review of Cardiovascular Biomarkers of Hypertension

Curator: Larry H. Bernstein, MD, FCAP

https://pharmaceuticalintelligence.com/2016/04/25/a-concise-review-of-cardiovascular-biomarkers-of-hypertension/

 

Triglycerides: Is it a Risk Factor or a Risk Marker for Atherosclerosis and Cardiovascular Disease ? The Impact of Genetic Mutations on (ANGPTL4) Gene, encoder of (angiopoietin-like 4) Protein, inhibitor of Lipoprotein Lipase

Reporters, Curators and Authors: Aviva Lev-Ari, PhD, RN and Larry H. Bernstein, MD, FCAP

https://pharmaceuticalintelligence.com/2016/03/13/triglycerides-is-it-a-risk-factor-or-a-risk-marker-for-atherosclerosis-and-cardiovascular-disease-the-impact-of-genetic-mutations-on-angptl4-gene-encoder-of-angiopoietin-like-4-protein-that-in/

 

Excess Eating, Overweight, and Diabetic

Larry H Bernstein, MD, FCAP, Curator

https://pharmaceuticalintelligence.com/2015/11/15/excess-eating-overweight-and-diabetic/

 

Obesity Issues

Larry H. Bernstein, MD, FCAP, Curator

https://pharmaceuticalintelligence.com/2015/11/12/obesity-issues/

 

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3D Printing for Surgical Planning: The Clinical and Economic Promise using Quantitative Clinical Evidence

Reporter: Aviva Lev-Ari, PhD, RN

The Clinical and Economic Promise of 3D Printing for Surgical Planning

M A K I N G  T H E  C A S E  T H R O U G H  Q U A N T I TAT I V E CLINICAL EVIDENCE

Stratasys engaged Quorum Consulting, experts in health economics and outcomes research, to conduct a comprehensive analysis of the clinical and economic evidence on 3D printing for surgical planning. This white paper, authored by Quorum Consulting, summarizes the result of that analysis.

Wade Aubry1,2, Raj Stewart1 , Chance Scott1 , Jeffrey Chu1

The modern emphasis on evidence-based medicine centers on three core tenets: • Best available research findings • Clinical expertise • Patient value Incorporating cutting-edge technology alongside these principles – often delicately balancing material innovation against scientific rigor, state-of-the-art professional training and experience, and attempts to provide the best care while respecting patient perspectives – is a challenge. 3D printing, however, aligns with the first two tenets, and when appropriately employed, may inform and indirectly influence the third.1

1 Quorum Consulting, Inc., San Francisco, CA, USA

2 University of California, San Francisco; San Francisco, CA, USA

 

3D printing was used in surgical planning applications in a wide range of specialties including cardiothoracic, orthopedic, neurological, reconstructive and transplant surgeries, as well as gastroenterology and surgical oncology. When examining these use cases, five general benefits emerge in association with 3D printing for surgical planning:

  • Patient communication
  • Anatomic familiarity
  • Procedure practice
  • Procedure selection
  • Patient selection / rule-out

 

INDICATION-SPECIFIC UTILIZATION AND EVIDENCEBASED EFFECTIVENESS DATA / RESULTS

  • Cardiothoracic surgery
  • Neurosurgery
  • Reconstructive surgeries

 

CONCLUSION

In a healthcare environment continuing to shift towards value- and outcome-contingent systems that penalize providers for inefficiencies and suboptimal outcomes in rendered care, 3D printed models for surgical planning – with their ability to facilitate procedural efficiency, improve treatment outcomes, and reduce downstream re-intervention costs – offer high potential value. Patients, clinicians and hospitals all have a vested interest in quality, affordable patient care and service, and surgical planning with 3D models appeals to each of these stakeholders.

Accordingly, results and trends from published literature and healthcare data support the effectiveness of 3D printing for surgical planning. As shown for several surgical procedures, clinicians with access to 3D printed models are able to provide better, more efficient care likely to improve patient outcomes and reduce the need for additional surgical interventions. Procedures that would most justify the financial and resource cost in creating 3D printed patient models are those with long operating times, high Relative Value Units (RVUs), greater risk and uncertainty, and risk of complications. Concurrently, this quality care is also potentially less costly and more profitable to providers. Amidst the growing commercial market for 3D printers and related technologies, there are some key differentiators when evaluating utility for surgical planning. As reflected in clinician surveys, the most effective 3D models should capably depict complex, fine anatomy with high fidelity to actual patient physiologies. This degree of fidelity crosses several characteristics:

  • Accurate depiction of a variety of colors
  • Simulation of multiple textures
  • Manipulability,

including the ability to be dissected or probed with surgical instruments.22 Given these real-world requirements, next generation multi-material and multi-color 3D printers likely represent the best option for facilities and clinicians. Viewed objectively, additional data addressing the quantitative impact of 3D printed models is needed. Preferably, this data will be generated from well-designed, patient outcome-oriented studies. However, in the interim, the tide of evidence favors 3D printed models for surgical planning, particularly for leading-edge clinicians and healthcare administrators who are able to recognize its value.

A Brief RVU Primer:

Relative Value Units (RVUs) are used by Medicare to determine reimbursement rates for a given service:

• For each service, Medicare determines the cost value of three primary components – physician’s work, practice expenses and malpractice insurance.

• These three components are then adjusted based on differences in living and business costs nationwide, using a factor called the Geographic Practice Cost Index (GPCI).

• The adjusted values are multiplied by an annual conversion factor, established by the U.S. Congress, and totaled to calculate final reimbursement rates.

SOURCE

http://s3.amazonaws.com/engineering.whitepapers/Stratasys/SurgicalPlanningPromise_Quorum_WP.pdf

From: Medical Design & Outsourcing <newsletters@e.medicaldesignandoutsourcing.com>

Reply-To: <newsletters@e.medicaldesignandoutsourcing.com>

Date: Wednesday, February 15, 2017 at 2:00 PM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: The Clinical and Economic Promise of Surgical Planning Using 3D Printing

Other related articles published in this Open Access Online Scientific Journal including the following:

Curator: Aviva Lev-Ari, PhD, RN

 

Technologies for Patient-centered Medicine: From R&D in Biologics to New Medical Devices

 

Read Full Post »


A Rich Tradition of Patient-Focused Care — Richmond University Medical Center, New York’s Leader in Health Care and Medical Education 

Author: Gail S. Thornton, M.A.

Co-Editor: The VOICES of Patients, Hospital CEOs, HealthCare Providers, Caregivers and Families: Personal Experience with Critical Care and Invasive Medical Procedures

 

Richmond University Medical Center (www.RUMSCI.org), an affiliate of The Mount Sinai Hospital and the Icahn School of Medicine, is a 470+ bed health care facility and teaching institution in Staten Island, New York. The hospital is a leader in the areas of acute, medical and surgical care, including emergency care, surgery, minimally invasive laparoscopic and robotic surgery, gastroenterology, cardiology, pediatrics, podiatry, endocrinology, urology, oncology, orthopedics, neonatal intensive care and maternal health. RUMC earned The Joint Commission’s Gold Seal of Approval® for quality and patient safety.

RUMC is a designated Level 1 Trauma Center, a Level 2 Pediatric Trauma Center, a Level 3 Neonatal Intensive Care Unit (NICU), which is the highest level attainable, and a designated Stroke Center, receiving top national recognition from the American Heart Association/American Stroke Association.  Their state-of-the-art Cardiac Catheterization Lab has Percutaneous Coronary Intervention (PCI) capabilities, for elective and emergent procedures in coronary angioplasty that treats obstructive coronary artery disease, including unstable angina, acute myocardial infarction (MI), and multi-vessel coronary artery disease (CAD).

RUMC maintains a Wound Care/Hyperbaric Center and a Sleep Disorder Center on-site at its main campus.  The facility also offers behavioral health services, encompassing both inpatient and outpatient services for children, adolescents and adults, including emergent inpatient and mobile outreach units.  RUMC is the only facility that offers inpatient psychiatric services for adolescents in the community.

In April 2016, RUMC announced its intent to merge with Staten Island Mental Health Society in order to expand its footprint in Staten Island and integrate behavioral health services alongside primary care. As part of New York’s Medicaid reforms, funding is available to incentivize providers to integrate treatment for addiction, mental health issues and developmental disabilities with medical services.

With over 2,500 employees, RUMC is one of the largest employers on Staten Island, New York.

rumcexteriorrumcexterior2rumcinterior

Image SOURCE: Photographs courtesy of Richmond University Medical Center, Staten Island, New York. Interior and exterior photographs of the hospital.

 

Below is my interview with President and Chief Executive Officer Daniel J. Messina, Ph.D., FACHE, LNHA, which occurred in September, 2016.

What has been your greatest achievement?

Dr. Messina: Professionally, my greatest achievement is my current responsibility – to be President and Chief Executive Officer of one of the greatest hospitals with a strong, solid foundation and rich history. I was born in this hospital and raised on Staten Island, so to me, there is no greater gift than to be part of a transformative organization and have the ability to advance the quality of health care on Staten Island.

My parents taught me the value of responsibility and motivation and instilled in me the drive and tenacity to be the best person I could be – for my employees and for my family. I am a highly competitive person, who is goal-oriented, hands-on and inspired by teamwork. I rarely sit behind my desk as I believe my place is alongside my team in making things happen.

As a personal goal, I recently climbed the 20,000-foot Mount Kilimanjaro in Tanzania. It was the experience of a lifetime. I could not have completed this challenge without the support of the guides and porters who helped me and my group along the way. For me, it was a challenge in proving to myself that I could be out of my comfort zone. My group and I hiked hours and hours each day, dodging rocks and scrambling along rock walls with the goal of reaching the summit. In many ways, it takes a village to climb the mountain, relying on each other in the group to get you to the next level.

In many ways, that is how I see my professional day at the hospital, working with a strong team of dedicated medical staff and employees who are focused on one goal, which is to continue our hard work, continue to improve care and continue to move forward to advance life and health care.

The mission of Richmond University Medical Center, an affiliate of The Mount Sinai Hospital and Mount Sinai School of Medicine, serves the ethnically diverse community of Staten Island, New York, by providing patients with a range of services.

How has your collaboration with the Mount Sinai network helped to expand health care delivery and services for patients of Staten Island, New York?

Dr. Messina: Being able to serve our patients year after year continues to be a top priority, so we are constantly improving upon our rich history of 100 years of exceptional patient-focused care given by our medical and surgical health care professionals as well as innovative technologies and programs created by our award-winning hospital team. We have committed medical specialists, passionate employee staff, exceptional Board of Trustees, supportive elected government officials – all who in their own way contributes to providing the highest level of patient care to the more than 500,000 residents of Staten Island, New York.

As a member of the Mount Sinai Health network, we have found ways to work collaboratively with our academic partner to ensure that our patients’ health care needs not only are fully met but also exceeded. This alliance will facilitate the development of a new, Comprehensive Breast and Women’s Healthcare Center. We have leveraged our Breast and Women’s Health Center with our RUMC general surgeons in conjunction with breast imaging, fellowship-trained physicians from Mount Sinai’s Icahn School of Medicine. The physicians who are granted this renowned fellowship interact with our patients and become an active participant in multidisciplinary breast conferences and resident and medical student education. For patients, this means that they have access to the best minds and latest research, therapies and treatment regimens throughout our network.

What makes Richmond University Medical Center and its specialty areas stand out from other hospitals?

Dr. Messina: We bring the highest level of advanced medicine to our patients. For more than 100 years, we have built a rich history of delivering patient-focused care that is unique. Our organization is recognized as a family organization with strong community spirit and family values. We are proud to be a high-technology/high-touch organization of caring professionals that go above and beyond the standard of health care. Our strengths lie in the areas of acute, medical and surgical care, including emergency care, surgery, minimally invasive laparoscopic and robotic surgery, gastroenterology, cardiology, pediatrics, podiatry, endocrinology, urology, oncology, orthopedics, neonatal intensive care and maternal health.

Each year, we embark upon a comprehensive, robust strategic planning process that involves our senior leadership team, clinical chairs, Board of Trustees as well as our medical and surgical staff and hospital employees that looks out three to five years in the future to determine what is best for the patient. We are each committed in our own way to quality patient care and building an even stronger organization.

Some of our achievements are noteworthy:

  • As a New York City Department of Emergency Services designated Level 1 Trauma Center and Level 2 Pediatric Trauma Center, the only Trauma Center dually verified in New York City, we rely on sophisticated equipment so our medical and surgical specialists are prepared to treat severe conditions within minutes.
  • Our Neonatal Intensive Care Unit (NICU) is a designated Level 3 facility, the highest level attainable. The unit delivers 3,000 babies annually and it was recognized as having the lowest mortality rate in the metropolitan area and a survival rate of 99 percent, that exceeds national benchmarks. Our specialists in our pediatric ambulatory services department treat over 10,000 patients annually and our children’s urgent care area records over 23,000 visits annually.
  • Our state-of-the-art, 38,000-square-foot Emergency Department (ED), which will be replaced by an expanded facility and projected to open in 2018, will provide for more focused care, operational efficiency and flexibility for our staff and patient. We also will be better integrated and connected to the entire hospital campus.

Originally designed to serve 22,000 patients each year, the ED is expected to accommodate an increased volume of patients, which is estimated at 70,000 and give our medical specialists the tools they need to provide the best in care for this volume of patients. In a new patient and family-centered space with 49 treatment positions, the new ED will be connected to the existing hospital, close to surgical services, the radiology department and lab services.

Equally as important, the hospital has been strong in the face of natural disasters, especially Hurricane Sandy which occurred a few years ago, and the new ED is being designed with storm resilient and redundant design to minimize impact from severe weather conditions.

In fact, the New York City Council and the Staten Island Borough President have set aside a combined $13.5 million for this $60+ million project and believe in the transformative impact that it will have on emergency care on Staten Island. These local officials believe that Staten Island residents deserve quality, readily accessible health care.

  • Heroin addiction is an epidemic on Staten Island, so we have a number of programs in place at RUMC’s Silberstein Center to provide outpatient treatment, rehabilitation and clinics, along with group therapy sessions, Alcoholics Anonymous meetings and individual therapy sessions.
  • Our new primary care/walk-in facility in the heart of Staten Island borough is operational and there are no appointments required. Patients can visit with one of three physicians or a nurse practitioner. This off-site facility is not located in the hospital complex and is an expansion of our services outside of the hospital walls.
  • We also maintain a Wound Care Center, Pain Management Center and a Sleep Disorder Center at our facility. In fact, we are the only local facility that offers inpatient psychiatric services for adolescents and we are expanding our capacity to meet the needs of the community.

 

RUMC has been awarded a top designation jointly by the American Heart Association and the American Stroke Association. What does that mean to the hospital?

Dr. Messina: This designation makes us proud as the recipient of the American Heart Association/American Stroke Association’s Quality Achievement Award for six consecutive years and its first Elite Plus recognition. This means that we have achieved 85 percent or higher adherence in indicators for two or more consecutive 12-month periods to improve quality of patient care and outcomes for stroke patients.

Our cardiac catheterization lab with Percutaneous Coronary Intervention (PCI) capabilities – the newest facility of its kind on Staten Island — now treats semi-urgent and elective coronary procedures.

For patients, this means that we have a commitment to ensure that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence. With a stroke, when time is lost, brain is lost, and this award demonstrates our commitment to ensuring patients receive care based on evidenced-based guidelines. We are dedicated to continually improving the quality of stroke care and this recognition helps us achieve that goal.

Studies have shown that hospitals that consistently follow these quality improvement measures can reduce length of stay and 30-day readmission rates and reduce disparities in care. To qualify for the Elite Plus recognition, we met quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. We earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

The values of Richmond University Medical Center are summarized in the acronym, WE CARE (Welcoming Energized Compassion Advocacy Respect Excellence). How is this part of your day-to-day life?

Dr. Messina: For more than 100 years, Richmond University Medical Center has

been building a rich history of exceptional patient-focused care for the residents of Staten Island. Each year, we carry that tradition forward by our medically innovative and patient-focused care and services we offer. It is the passion, creativity and caring of everyone who is part of our ‘hospital team’ that moves the organization to new heights.

The chart below summarizes our credo, the values that guide us every day and help us focus on the care and well-being of the people who come through our doors.

We are welcoming and gracious toward each other, and toward all who come to receive our services.

Personnel are energized for quality, creativity, commitment and teamwork.

Compassion is the way we share deep concern and care toward each person.

Advocacy is our activity that promotes the rights and responsibilities of patients, families and staff, in the hospital setting and in the community.

We show respect by recognizing the basic dignity of every person in all our interactions and in the formulation of policies and procedures.

Excellence is our way of demonstrating that we can always be more and always be better.

 

The Richmond University Medical Center Board is comprised of distinguished leaders of the Staten Island community who are committed to the success of the hospital and to the health of Staten Islanders.

How is this local approach revolutionizing health care for the Staten Island community?

Dr. Messina: The members of our distinguished Board of Trustees, who represent a cross-section of business professionals and community leaders, continue our goal of meeting the needs of our patients and our hospital.

Our Board remains committed to providing solutions for our patients to challenging healthcare issues they face every day and to making a difference in the lives of patients by providing the latest thinking and technology solutions. Our Board Chairperson Kathryn K. Rooney, Esq., and Vice Chairperson Ronald A. Purpora, as well as the other Board members, and even our elected government officials, have a strong connection to Staten Island and we believe it truly ‘takes a village’ to make this organization flourish.

Each year, our Board of Trustees is presented with new opportunities and possibilities for growth and development. That is why their top priority for this past year was approving the construction of a state-of-the-art Emergency Department (ED) as this undertaking will serve both the patients and staff equally. In order to serve the residents of Staten Island properly, the new ED will accommodate an increased number of patients and our medical staff will receive the tools and technology to provide the best in care for our patients.

This past year, we were provided with a $1.5 million gift from the Staten Island Foundation that will go toward the hospital’s capital campaign to construct the new $60 million Emergency Department. We decided to name the RUMC’s Allan Weissglass Pavilion Center for Ambulatory Care, in honor of our long-time community and business leader, who is a founding Board member and Board of Trustees member. Allan Weissglass devoted his time, energy and talent to the success of this hospital over many years.

We are positioning our organization for the future and we continuously build on our strengths, being responsive to the needs of the community. In the past, we saw the patient was the only ‘customer’ of the hospital. Today, that perception is evolving and our ‘customers’ are many.  With the help and support of donors, local foundations, volunteers, staff, and the community, local government officials, we are building a bright future for Richmond University Medical Center.

What is RUMC’s commitment to graduate medical education?

Dr. Messina: Our six Graduate Medical Education (GME) programs in Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Diagnostic Radiology and Podiatry, signify our commitment to teaching as a cornerstone of our philosophy. Our medical staff are seen as role models for our medical residents and provide quality training, medical education and research capabilities. Our existing medical staff functions as supervising physicians and gives medical residents exposure to specific responsibilities and patient care, as well as scholarly opportunities. One interesting fact is that the doctors we train come back to help treat our patients by using their knowledge and experience to work in our community.

You mentioned that ‘outreach in the community’ as a key factor in the success of the hospital’s mission to enhance the quality of life for residents of Staten Island. What types of activities are under way?

Dr. Messina: Our lifesaving work takes many forms. We are constantly finding new and different ways to engage with our community – to raise awareness and educate on a number of diseases and conditions, and, hopefully move toward better health care. We believe that our patients need to see us outside of a clinical environment, which strengthens our relationship.

For example, over the past year:

  • We sponsored an annual health and wellness expo with the Staten Island Economic Development Corporation that was attended by over 2,000 people to equip the community with knowledge about their health and the local health services available to them.
  • We pioneered an organ donor enrollment day by welcoming 59 visitors and guests who can potentially donate their organs to save lives.
  • We partnered with the New York City Department of Transportation and our own Trauma team to demonstrate and educate the community on car seat safety.
  • Our Dermatologist team took part in the Borough President’s “Back to the Beach” festival by performing skin screenings and distributing sunscreen and information on skin cancer.
  • Our Obstetrics and Gynecology team hosted a baby expo to talk with new mothers and mothers-to-be about services available at the hospital.
  • Our Diabetologist team partnered with the YMCA on a 16-week partnership to curb the diabetes epidemic on Staten Island through information talks and health screenings.
  • We were even present at last year’s Staten Island Yankees home opening baseball game to throw out the first pitch and conduct a blood drive while distributing wellness information.

 

Since roughly one third of the residents on Staten Island are enrolled in Medicaid or Medicare, what steps are you taking to improve the delivery of treatment for them?

Dr. Messina: We started several initiatives last year that were funded by the federal and state governments to look at the way care is delivered to patients who are enrolled in Medicare and Medicaid. So far, we’ve reduced costs by $3.75 million and realized $1.8 million in shared savings that are re-invested in key hospital programs.

As you know, Medicare and Medicaid are two different government-run programs that were created in 1965 in response to the inability of older and low-income Americans to buy private health insurance. They were part of our government’s social commitment to meeting individual health care needs. Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income, while Medicaid is a state and federal program that provides health coverage if you have a very low income.

We’ve set up our own Richmond Quality Accountable Care Organization (ACO), that comprises 30 providers serving 7,500 Medicare patients. This innovative program is accountable for the quality, cost and overall care provided to people on Medicare and who are enrolled in the traditional fee-for-service program.  One program that is ongoing is one that we’ve partnered with the Visiting Nurse Service of Staten Island to prevent hospital readmissions and to identify hospitalized patients who would benefit from a higher level of care and home care services.

Another program that is under way for our Medicaid patients is teaching our staff to prevent hospital readmissions by creating an accurate list of medications that a patient takes and comparing that list against physician’s admission, transfer and discharge orders to ensure that the correct medication plan is in place.

We believe that we are transforming the underlying systems with a focus on delivering quality care and hopefully better outcomes for patients.

RUMC recently announced a merger with Staten Island Mental Health Society (SIMHS) to integrate SIMHS’ broad range of behavioral health programs into the hospital’s existing medical and behavioral program throughout Staten Island. What does this merger bring to the community?

Dr. Messina: We believe that the proposed merger between RUMC and the Staten Island Mental Health Society (SIMHS) will provide a strengthened, comprehensive network of behavioral health services across Staten Island.

This partnership will bring together two Staten Island institutions, with a combined 230 years of service to the borough, and create one strong and vibrant organization dedicated to meeting the health needs of the diverse community.

Merging the range of community-based behavioral health services provided by SIMHS with the solid foundation of primary care services provided by RUMC will create a seamless range of behavioral and medical services for our residents. We are in the unique position to transform and enhance the services of these two vital health care providers. The SIMHS will keep its name and become a division of the hospital. The merger is expected to close during calendar year 2017.

 rumcdanmessina

Image SOURCE: Photograph of President and Chief Executive Officer Daniel J. Messina, Ph.D., FACHE, LNHA, courtesy of Richmond University Medical Center, Staten Island, New York.

Daniel J. Messina, Ph.D., FACHE, LNHA
President & Chief Executive Officer

Daniel Messina, Ph.D., FACHE, LNHA, became President and Chief Executive Officer of Richmond University Medical Center (RUMC) – an affiliate of The Mount Sinai Hospital and Mount Sinai School of Medicine – in April 2014.

Dr. Messina, a life-long resident of Staten Island, is a seasoned executive with nearly 30 years of healthcare leadership expertise. For the previous 13 years, he served as the System Chief Operating Officer of CentraState Healthcare System in Freehold, New Jersey, where his responsibilities included all System Operations for the Medical Center, Assisted Living Facility, Skilled Nursing and Rehabilitation Center and Continuing Care Retirement Community. While in this role, Dr. Messina developed additional growth strategies that include a new Cancer Center, a Proton Therapy Center, Radio-Surgery, a new Infusion Center and programs in Robotics, Minimally Invasive Surgery, Bariatric and Neurosurgery. Other accomplishments include a new state-of-the-art 26-bed Critical Care Unit, a 49-bed Emergency Department, and the development of an 180,000 sq. ft. Ambulatory Campus and Wellness Center anchored by a 35,000 sq. ft. Medical Fitness Center. Additionally, Dr. Messina developed the Linda E. Cardinale MS Center – one of the largest and most comprehensive MS Centers in the tristate area – leading to a fundraising event that has generated over $2 million.

Dr. Messina received his B.S. in Health Science/Respiratory Therapy from Long Island University Brooklyn, and earned his M.P.A. in Healthcare Administration from LIU Post. He obtained his Ph.D. in Health Sciences and Leadership at Seton Hall University where he currently serves as an adjunct professor in the School of Health and Allied Sciences. He is active in the American College of Health Care Executives, is board certified in healthcare management as an ACHE Fellow, and recently completed a three-year term as Regent for New Jersey.

Dr. Messina serves as trustee on the National Multiple Sclerosis Society, the New Jersey Metro Chapter, and the Alumni Board of Trustees at Seton Hall University. He is a Board member of the VNA Health Group of New Jersey and a member of the Policy Development Committee of the New Jersey Hospital Association. Dr. Messina has been honored by various organizations for his service to the community, including Seton Hall University with the “Many Are One” award, the American College of Healthcare Executives with Senior, Early and Distinguished Service Awards, New Jersey Women Against MS, CentraState Auxiliary, and the Staten Island CYO.

Editor’s note:

We would like to thank William Smith, director of Public Relations, Richmond University Medical Center, for the help and support he provided during this interview.

 

REFERENCE/SOURCE

 

Richmond University Medical Center (http://rumcsi.org/Main/Home.aspx)

Other related articles:

Retrieved from http://rumcsi.org/main/annualreport.aspx

Retrieved from https://en.wikipedia.org/wiki/Richmond_University_Medical_Center

Retrieved from http://rumcsi.org/main/rumcinthenews/si-live-5202016-170.aspx

Retrieved from http://rumcsi.org/main/rumcinthenews/merger-agreement-4132016-159.aspx

Retrieved from http://blog.silive.com/gracelyns_chronicles/2016/06/rumc_receives_presitigious_bab.html

Retrieved from https://www.statnews.com/2016/10/17/vivan-lee-hospitals-utah/

Other related articles were published in this Open Access Online Scientific Journal include the following: 

2016

Risk Factor for Health Systems: High Turnover of Hospital CEOs and Visionary’s Role of Hospitals In 10 Years

https://pharmaceuticalintelligence.com/2013/08/08/risk-factor-for-health-systems-high-turnover-of-hospital-ceos-and-visionarys-role-of-hospitals-in-10-years/

Healthcare conglomeration to access Big Data and lower costs

https://pharmaceuticalintelligence.com/2016/01/13/healthcare-conglomeration-to-access-big-data-and-lower-costs/

A New Standard in Health Care – Farrer Park Hospital, Singapore’s First Fully Integrated Healthcare/Hospitality Complex

https://pharmaceuticalintelligence.com/2016/06/22/a-new-standard-in-health-care-farrer-park-hospital-singapores-first-fully-integrated-healthcarehospitality-complex/

2013

Helping Physicians identify Gene-Drug Interactions for Treatment Decisions: New ‘CLIPMERGE’ program – Personalized Medicine @ The Mount Sinai Medical Center

https://pharmaceuticalintelligence.com/2013/04/15/helping-physicians-identify-gene-drug-interactions-for-treatment-decisions-new-clipmerge-program-personalized-medicine-the-mount-sinai-medical-center/

Nation’s Biobanks: Academic institutions, Research institutes and Hospitals – vary by Collections Size, Types of Specimens and Applications: Regulations are Needed

https://pharmaceuticalintelligence.com/2013/01/26/nations-biobanks-academic-institutions-research-institutes-and-hospitals-vary-by-collections-size-types-of-specimens-and-applications-regulations-are-needed/

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Ralph’s Story: An Entertainer at Heart

Patient was diagnosed with heart disease and pulmonary hypertension in January 2016 and had a triple-bypass operation at age 69. Interview was conducted six months post-surgery.

Author: Gail S. Thornton, M.A.

Co-Editor: The VOICES of Patients, HealthCare Providers, Caregivers and Families: Personal Experience with Critical Care and Invasive Medical Procedures

 

Evergreen, Colorado, an idyllic, peaceful community with an elevation of 8,000 feet west of Denver, offers its residents and visitors a beautiful place for arts and culture, summer and winter sporting activities, and scenic beauty. In fact, Ralph Nichols has lived in the town for more than 20 years.

“This past September [2015] was, particularly, challenging for me, where winter begins quite early for us. It became increasingly painful and difficult to breathe in the freezing temperatures. It seemed that my lungs were inflamed and I couldn’t even stand the cold weather. I thought it might be the beginning of a bad cold, and I wasn’t overly concerned that there was anything terribly wrong.”

At that time, Ralph went to his family physician who performed the usual routine examination with no significant results.

“Many years ago, I developed a mild case of scleroderma, a chronic connective tissue disease. I thought that perhaps my symptoms were the result of some type of inflammation in my body that could be managed with prescription medications.”

Scleroderma is known as an autoimmune disease, which adds an inappropriate amount of collagen to various parts of the body, such as the joints, skin, and later stages, various organs, such as the lungs, in Ralph’s case. Scleroderma can cause the organs to shut down and, eventually, cause death.

“I never let this condition stop me from doing anything as it is life-long condition. It was always something I had to tolerate and work through.”

http://www.scleroderma.org/site/PageNavigator/patients_whatis.html#.V5Zrm84luKo

 

Image SOURCE: Photographs courtesy of Ralph Nichols and Gabriela Contreras.  Top left: Ralph today. Top right: Ralph recovering one month after surgery. Bottom left and center: Ralph with his medical team. Bottom right: Ralph in rehabilitation center.

Over the brutal Colorado winter, Ralph’s symptoms were getting worse. He had no idea that his life would dramatically change over the next few months. He went to see his family physician again. During this physical examination, Ralph was referred to pulmonary and cardiovascular specialists for a routine electrocardiogram, echocardiogram and stress test in order to further diagnose his symptoms. He had always been relatively healthy and fit and never been seriously ill or hospitalized.

“On the outside, Ralph was the picture of good health,” said his wife, Gabriela. “On the inside, his body was telling him that something was wrong.”

Three months later in December 2015, Ralph met with Dr. Alexandra Smart, a pulmonologist, who ordered a chest x-ray and other diagnostic tests, including a right heart catheterization. At that point, Ralph’s medical team grew. It was then determined that Ralph needed to see other cardiovascular specialists and undergo more tests. In January 2016, he met with Dr. Sameer Mehta, cardiologist at Cardiac & Thoracic Surgery Associates, in Lakewood, Colorado, who reviewed his tests to date, listened to Ralph’s symptoms, and told him he needed both a right and left heart cardiac catheterization.

 “They gave me sedation for the catheterization procedure and went through my neck with a camera to see what was going on with my lungs and heart. We were all singing together on the way to the operating room. During the procedure, my cardiologist found more than he had anticipated.”

The result was not good. Ralph had major blockages in two main arteries that supply blood to his heart muscle compounded by the fact that his lungs were affected by scleroderma.

“The catheterization was alarming. It showed that my arteries were in bad shape. They were both clogged with atherosclerotic plaque; one of them was 99 percent blocked and the other was 85 percent blocked.”

His cardiologist believed that the blockages would not respond to medications quickly or a stent.

“Even though my father had major heart disease and died two years later of cancer at the age of 56, I thought that I would be immune to this particular experience. After all, I was in good health, exercised regularly, lived a reasonable lifestyle and had a great diet.”

 Preparing for Life-Saving and Life-Changing Surgery

Unfortunately, surgery was the next step. Ralph was referred to Dr. Mehta’s colleague, Dr. Patrick D. Rudersdorf, cardiothoracic surgeon at Cardiac & Thoracic Surgery Associates.

“I didn’t leave the hospital that day as expected. Instead, I got a visit from Dr. Rudersdorf and couldn’t believe what he was telling me. My only chance to live was having triple bypass surgery which needed to be done immediately. The doctor met with me that same day to explain the procedure, answer my questions and talk through the details of the rehabilitation period after the surgery.”

Dr. Rudersdorf reassured Ralph that he was doing the right thing and calmed my fears.

“He said that I needed this life-saving surgery because I was at high risk for having a major heart attack. I was shocked, at first, at the thought of the intensity of surgery on my body. It’s a situation that no one likes to be in, but I had to make a decision about alleviating the ongoing pain and pressure in my chest along with shortness of breath due to diseased heart arteries. Coronary bypass surgery was my answer to feeling better — and it essentially gave me my life back.”

Dr. Rudersdorf moved his previously planned morning surgery to another day to accommodate me first thing in the morning. Ralph underwent triple bypass surgery at St. Anthony Hospital in Lakewood, Colorado. The procedure was complex and took eight hours. He was in the hospital for a total of 31 days.

“It was an ordeal that I thought I’d never have to experience. I had no time to call anyone, or time to even contemplate life and death…or even being scared.  My wife Gabriela spent the entire time in the hospital, supported by our dearest friends, Norma Delaney and Garret Annofsky, in addition to keeping family and friends in other parts of the United States and Mexico updated as well. Once the surgery was over, the medical team woke me up and said the procedure was successful, but I was far from being out of the woods.”

Ralph had some complications because of a condition called pulmonary hypertension, a type of high blood pressure that affects the arteries in the lungs and the right side of the heart. According to the Mayo Clinic’s web site, in one form of pulmonary hypertension, tiny arteries in the lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through the lungs, and raises pressure within the lungs’ arteries. As the pressure builds, the heart’s lower right chamber (right ventricle) must work harder to pump blood through the lungs, eventually causing the heart muscle to weaken and fail. http://www.mayoclinic.org/diseases-conditions/pulmonary-hypertension/home/ovc-20197480

“The pulmonary hypertension limited some of the medications that the doctors would have used during my recovery. It was a tough few days for me in intensive care, hooked up to about 18 monitors. The medical team had to stop and re-start my heart four different times because of atrial fibrillation — finally getting both parts of the heart to dance together in the same rhythm.”

Ralph’s heart was beating abnormally fast and irregular and not functioning the way it should. The doctors restore regular rhythm to the heart by sending an electrical shock to the heart, which is called electrical cardioversion or chemically using antiarrhythmia medications, which is called pharmacologic or chemical cardioversion.

“The doctors shocked my heart first chemically with medications when I was awake. This procedure was the scariest. I was sitting up in bed and felt my heart stop, then the medical team flushed the medication out with saline in order to restart my heart. That procedure was not successful, so that is why the doctors had to shock my heart three more times electrically.

“The reason the doctors stopped my heart was to correct the atrial fibrillation and to get my heart into regular sinus rhythm, which is a wave mode of the heart where everything is synchronized. The doctors did not want me to continue to experience atrial fibrillation because if continued, I would not be able to regain my strength.”

Ralph was finally moved from intensive care to intermediate care after five days and the medical team kept him in intermediate care another 12 days until his heart and lungs got stronger.

“From there, I didn’t go home but instead went to Evergreen Life Center for rehabilitation for two weeks to learn how to walk, climb stairs so that I could access my home on my own, and develop my strength again. The rehab team would let me leave only after making sure I had oxygen in my home.”

After that, Ralph started another phase of his rehabilitation at St. Anthony Cardiac Rehabilitation and Wellness Center. For the next three months, he took part in cardiac rehabilitation three days a week. He passed that with flying colors. Now, he is in another phase of rehabilitation, building his lung capacity two days a week.

Ralph didn’t have the means or even the will to communicate with friends during this tumultuous time, except Gabriela and several close friends who were always at the hospital and rehabilitation center who gave him the strength to continue.

“I finally returned home after many weeks with an enormous feeling of gratitude for each and every one of my friends, as well as the St. Anthony’s hospital team of doctors, nurses, and therapists, who supported me and Gabriela during this exceptional adventure that has certainly changed my life.”

Surely, this experience has been a life-changing experience for Ralph.

 Coronary Artery Bypass Facts

 Coronary artery bypass grafting (CABG, often pronounced “cabbage”) is a surgical treatment for blocked coronary arteries. Coronary arteries supply blood to the heart muscle and when blockages in these arteries form, chest pain, shortness of breath and heart attacks can occur. Catheter procedures performed by interventional cardiologists address the blockages themselves with stents. Coronary bypass surgery performed by cardiac surgeons reroutes the blood around the blockages to supply better blood supply to the heart muscle and is a better treatment option, although more invasive, for certain patients and more durable for most patients.

http://ctsurgery.com/conditions-procedures/heart-aorta/cardiac-surgery/coronary-artery-bypass-grafting-cabg/

Life for Ralph Today

Today, Ralph is regaining his strength both in mind and body. He visits the cardiovascular and pulmonary rehabilitation center three times a week for the past few months and walks on their treadmill, lifts weights and pedals the bicycle for one hour, supervised by the therapists. He also sees his medical team for regular check-ups every month, eats healthier with no fat and no salt, and takes a cocktail of medicines daily for his heart and lungs, including amiodarone, furosemide, pitavastatin, and aspirin.

“Almost six months after my surgery, although I am not in the best shape of my life, however, I am in the best spiritual place than ever before. This is a huge milestone for me. I continue to improve my strength, which will make my heart more resilient. There is nothing that I can’t do now, and I am doing everything I can to experience a normal life as far as work and regaining my strength. I find it necessary to move to a warmer climate and lower altitude in order to continue to improve.”

Ralph also is the former lead singer of The Letterman and The Sandpipers, two American easy-listening bands during the 1960-70-80s. He is an entertainer at heart with over 3,000 professional appearances to his credit. He has been performing and recording for over 50 years, traveled the world extensively and performed before members of the Vatican with Pope Pius XII and Royalty with Prince Rainier and Princess Grace Kelly, as well as notables such as Frank and Nancy Sinatra, Tony Bennett, Ronald Reagan, Merv Griffin, Danny Thomas, Shirley Bassey, Rosalind Russell and Bob Hope.

Ralph and his vocal group were dubbed by Billboard Magazine as “the greatest romantic vocal group of all time.” He is also a member of the Vocal Group Hall of Fame, a prestigious honor. He is a true legend as his group has sold more than 20 million recordings, performed live thousands of times, and whose recording of the song “Love” was left by NASA astronauts in a time capsule on the moon.

“I enjoy each and every day and appreciate all that life has to offer.”

Ralph’s next step is to get back to singing and his solo entertainment business, which he holds dear to his heart. That should be a task that he can easily accomplish.

 

Editor’s note:

We would like to thank Gabriela Contreras, a global communications consultant and patient advocate, for the tremendous help and support that she provided in scheduling time to talk with Ralph Nichols.

Ralph Nichols provided his permission to publish this interview on July 30, 2016.

 

REFERENCES/SOURCES

http://www.scleroderma.org/site/PageNavigator/patients_whatis.html#.V5Zrm84luKo

http://www.mayoclinic.org/diseases-conditions/pulmonary-hypertension/home/ovc-20197480

http://ctsurgery.com/conditions-procedures/heart-aorta/cardiac-surgery/coronary-artery-bypass-grafting-cabg/

 

Other related articles:

Retrieved from http://www.sunset.com/travel/rockies/evergreen-colorado-day-trip-travel-planner

Retrieved from http://www.secondscount.org/heart-condition-centers/info-detail-2/benefits-risks-of-coronary-bypass-surgery-2#.V5dkK_krKUk

Other related articles were published in this Open Access Online Scientific Journal include the following: 

2016

People with blood type O have been reported to be protected from coronary heart disease, cancer, and have lower cholesterol levels.

https://pharmaceuticalintelligence.com/2016/01/11/people-with-blood-type-o-have-been-reported-to-be-protected-from-coronary-heart-disease-cancer-and-have-lower-cholesterol-levels/

2015

A Patient’s Perspective: On Open Heart Surgery from Diagnosis and Intervention to Recovery

https://pharmaceuticalintelligence.com/2015/05/10/a-patients-perspective-on-open-heart-surgery-from-diagnosis-and-intervention-to-recovery/

No evidence to change current transfusion practices for adults undergoing complex cardiac surgery: RECESS evaluated 1,098 cardiac surgery patients received red blood cell units stored for short or long periods

https://pharmaceuticalintelligence.com/2015/04/08/no-evidence-to-change-current-transfusion-practices-for-adults-undergoing-complex-cardiac-surgery-recess-evaluated-1098-cardiac-surgery-patients-received-red-blood-cell-units-stored-for-short-or-lon/

2013

ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery

https://pharmaceuticalintelligence.com/2013/11/05/accaha-guidelines-for-coronary-artery-bypass-graft-surgery/

On Devices and On Algorithms: Arrhythmia after Cardiac SurgeryPrediction and ECG Prediction of Paroxysmal Atrial Fibrillation Onset

https://pharmaceuticalintelligence.com/2013/05/07/on-devices-and-on-algorithms-arrhythmia-after-cardiac-surgery-prediction-and-ecg-prediction-of-paroxysmal-atrial-fibrillation-onset/

 

Editor’s note:

I wish to encourage the e-Reader of this Interview to consider reading and comparing the experiences of other Open Heart Surgery Patients, voicing their private-life episodes in the ER that are included in this volume.

I also wish to encourage the e-Reader to consider, if interested, reviewing additional e-Books on Cardiovascular Diseases from the same Publisher, Leaders in Pharmaceutical Business Intelligence (LPBI) Group, on Amazon.com.

  •  Perspectives on Nitric Oxide in Disease Mechanisms, on Amazon since 6/2/12013

http://www.amazon.com/dp/B00DINFFYC

  • Cardiovascular, Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation, on Amazon since 11/30/2015

http://www.amazon.com/dp/B018Q5MCN8

  • Cardiovascular Diseases, Volume Three: Etiologies of Cardiovascular Diseases: Epigenetics, Genetics and Genomics, on Amazon since 11/29/2015

http://www.amazon.com/dp/B018PNHJ84

  • Cardiovascular Diseases, Volume Four: Regenerative and Translational Medicine: The Therapeutics Promise for Cardiovascular Diseases, on Amazon since 12/26/2015

http://www.amazon.com/dp/B019UM909A

onepagecvdseriesaflyervol1-4

 

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What could replace animal testing – ‘Human-on-a-chip’ from Lawrence Livermore National Laboratory

The iCHIP research, Moya said, could have implications for creating new drugs to fight cancer, vaccines or evaluating the efficacy of countermeasures against biowarfare agents.

Lab scientist Heather Enright is leading research into the peripheral nervous system (PNS), which connects the brain to the limbs and organs. The PNS device has arrays of microelectrodes embedded on glass, where primary human dorsal root ganglion (DRG) neurons are seeded. Chemical stimuli such as capsaicin (to study pain response) then flow through a microfluidic cap to stimulate the cells on the platform.

The microelectrodes record electrical signals from the cells, allowing researchers to determine how the cells are responding to the stimuli non-invasively. Microscopic images can be acquired at the same time to monitor changes in intracellular ion concentrations, such as calcium. This platform is the first to demonstrate that long-term culture and chemical interrogation of primary human DRG neurons on microelectrode arrays is possible, presenting researchers with an advantage over current techniques.

Read full article at the SOURCE

 

http://universityofcalifornia.edu/news/human-chip-could-replace-animal-testing

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Medical MEMS, BioMEMS and Sensor Applications

Curator and Reporter: Aviva Lev-Ari, PhD, RN

 

Contents for Chapter 11

Medical MEMS, BioMEMS and Sensors Applications

Curators: Justin D. Pearlman, MD, PhD, FACC, LPBI Group, Danut Dragoi, PhD, LPBI Group and William H. Zurn, Alpha IP

FOR

Series E: Patient-centered Medicine

Volume 4:  Medical 3D BioPrinting – The Revolution in Medicine

Editors: Larry H Bernstein, MD FCAP and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/biomed-e-books/series-e-titles-in-the-strategic-plan-for-2014-1015/volume-four-medical-3d-bioprinting-the-revolution-in-medicine/

Work-in-Progress

ContactLens

Image Source

http://www.memsjournal.com/2010/05/medical-applications-herald-third-wave-of-mems.html

Image is courtesy of Google Images

 

WirelessPressure

Image Source

Stanford Engineering Team Invents Pressure Sensor That Uses Radio Waves | CytoFluidix

Image is courtesy of Google Images

 

Introduction by Dr. Pearlman

 

Chapter 1: Blood Glucose Sensors

1.1       MINIATURIZED GLUCOSE SENSOR – Google

  • Tiny wireless chip and miniaturized glucose sensor
  • Embedded between two layers of soft contact lens material
  • Accurate glucose monitoring for diabetics
  • Using bodily fluids, i.e. tears
  • Prototypes can generate one reading per second
  • Experimenting with LEDs
  • Early warning for the wearer

 

Chapter 2: Blood Chemistry Tests – up to 100 Samples

2.1       NON-INVASIVE BLOOD MONITOR- UCSD

  • Digital tattoo monitors blood below the skin
  • Tattoos are needle-less
    • Sensor-laden transdermal patch
  • Painless for the user Tiny sensors “ink”
  • Can read blood levels of:
    • Sodium, glucose, kidney function
  • Prototypes contain probes
  • Wireless, battery-powered chip
  • Continually test up to a hundred different samples

 

2.3       CELLPHONE-BASED RAPID-DIAGNOSTIC-TEST (RDT) READER – UCLA

  • Lateral flow immuno-chromatographic assays
  • Sense the presence of a target analyte in a sample
  • Device connects to the camera on a cell phone
  • Weighs only 65 grams

 

2.4       IMPLANTABLE BLOOD ANALYZER CHIP – EPFL

  • Implantable device for instantaneous blood analysis
  • Wireless data transmission to a doctor
  • Applications include monitoring general health
  • Tailor drug delivery to a patient’s unique needs
  • Includes five sensors and a radio transmitter
  • Powered via inductive coupling from a battery patch
  • Worn outside the body

 

Chapter 3: Motion Sensors for Head-Impact

3.1       HEAD-IMPACT MONITORING PATCH – STMicro & X2Biosystems

  • Wearable electronic contains MEMS motion sensors
  • Microcontroller, low-power radio transmitter, and power management circuitry
  • Cloud-based system combines athlete concussion history
  • Pre-season neurocognitive function, balance, and coordinate-performance data
  • Creates a baseline for comparison after a suspected injury event

 

Chapter 4: Drug Delivery & Drug Compliance Monitoring Systems

4.1       Smart Pill delivers Therapeutic Agent Load to target – ELECTRONIC PILL – Phillips

  • Electronic pill to treat gastrointestinal cancer
  • An ingestible pill is swallowed by the patient, finds its way to the tumor, dispenses the drugs and passes harmlessly from the body
  • Smart pill contains reservoir for drug supply, fluid pump for drug delivery, pH sensor (for navigation), thermometer, microprocessor, communication

 

4.2       Drug Compliance Monitoring Systems

4.2.1    INGESTIBLE BIOMEDICAL SENSOR – Proteus Digital Health

  • Biomedical sensor that monitors medication adherence
  • Embedded into a pill, the sensor is activated by stomach fluid
  • Transmits a signal through the body to a skin patch
  • Indicates whether a patient has ingested material

 

4.2.2    MICROPUMP DEVICES – Purdue University

  • Device based on skin contact actuation for drug delivery
  • Actuation mechanism only requires body heat
  • Induced actuation can result to a gradient of 100 Pa/oC
  • Sufficient to drive liquid drug through micro-needle arrays
  • Prototypes exhibit low fabrication costs, employment of biocompatible materials and battery-less operation Suitable for single- or multiple-use transdermal drug dispensers

 

4.2.3    IMPLANTABLE MEMS DRUG DELIVERY SYSTEM – MIT

  • Device can deliver a vasoconstrictor agent
  • On demand to injured soldiers to prevent hemorrhagic shock
  • Other applications include medical implants
  • For cancer detection and monitoring
  • Implant can provide physicians and patients
  • Real-time information on the efficacy of treatment

 

Chapter 5: Remove Monitoring of Food-related Diseases

5.1       LASER-DRIVEN, HANDHELD SPECTROMETER

  • For analyzing food scanned
  • Information to a cloud-based application
  • Examines the results Data is accumulated from many users
  • Used to develop warning algorithms
  • For Allergies, Bacteria

 

Chapter 6: Skin Protection and Photo-Sensitivity Management

6.1       WEARABLE-UVEXPOSURESENSOR – Gizmag

  • Wristband for monitoring UV exposure
  • Allows user to maximize vitamin D production
  • Reducing the risk of sun
  • Over-exposure and skin cancer
  • LED indicators light up as UV exposure accumulates
  • Flashes once the safe UV limit has been reached

 

6.2       WEARABLE SKIN SENSOR KTH – Chemistry 2011

  • Bio-patch for measuring and collecting vital information through the skin
  • Inexpensive, versatile and comfortable to wear
  • User Data being gathered depends on where it is placed on the body

 

Chapter 7: Ophthalmic Applications

7.1       INTRAOCULAR PRESSURE SENSOR – Sensimed & ST Microelectronics

  • Smart contact lens called Triggerfish
  • Contact lens can measure, monitor, and control
  • Intra-ocular pressure levels for patients
  • Catch early cases of glaucoma
  • MEMS strain gage pressure sensor
  • Mounted on a flexible substrate MEMS

 

7.2       MICRO-MIRRORS ENABLING HANDHELD OPHTHALMIC – OCT News

  • Swept source OCT model for retinal 3D imaging
  • Replaces bulky galvanometer scanners in a handheld OCT probe for primary care physicians
  • Ultrahigh-speed two-axis optical beam steering gimbal-less MEMS mirrors
  • MEMS Actuator with a 2.4 mm bonded mirror and an angular reach of +6°
  • Low power consumption of <100mW including the MEMS actuator driver Retinal 3D Imaging

 

Chapter 8: Hearing Assist Technologies

8.1       MEMS TECHNOLOGY FOR HEARING RESTORATION – University of Utah

  • Eliminates electronics outside the ear
  • Associated with reliability issues and social stigma
  • Accelerometer-based microphone
  • Successfully tested in cadaver ear canals
  • Prototype measures 2.5 x 6.2mm, weighs 25mg

 

Chapter 9: Lab-on-a-Chip

9.1       ORGAN-ON-A-CHIP – Johns Hopkins University

  • Silicon substrate for living human cells
  • Controlled environment
  • Emulate how cells function inside a living human body
  • Replace controversial and costly animal testing
  • Lab-on-a-chip: a cost effective end to animal testing

 

Chapter 10: Intra-Cranial Studies: Pressure Measurement, Monitoring and Adaptation

10.1:   CEREBRAL PRESSURE SENSOR – Fraunhofer Institute

  • Sensor to monitor cerebral pressure that can lead to dementia
  • Pressure changes in the brain can be measured and transmitted
  • Reading device outside the patient’s body
  • Operating at very low power, the sensor module
  • Powered wirelessly by the reading device

 

10.2    WIRELESS, IMPLANTABLE BRAIN SENSOR – National Institute of Biomedical Imaging and Bioengineering

  • Fully implantable within the brain
  • Allow natural studies of brain activity
  • Cord-free control of advanced prosthetics

Wireless charging Prototypes transmitted brain activity data

 

Chapter 11: Cardiac and Cardiovascular Monitoring System

11.1    IMPLANTABLE MICRO DEVICE FOR MONITORING AND TREATING ANEURISMS – Electronic Design

  • RF-addressed wireless pressure sensor are powered by inductive coupling
  • Do not need batteries MEMS pressure sensor
  • Wireless antenna are inserted near the heart
  • With a catheter, Blood-pressure readings
  • Are sent to a wireless scanner for monitoring Pressure changes
  • Deflect the transducer’s diaphragm
  • Change the LC circuit’s resonant

 

11.2    CUSTOM- FITTED, IMPLANTABLE DEVICE FOR TREATMENT AND PREDICTION OF CARDIAC DISORDERS – Washington University

  • Working prototypes were developed on inexpensive 3D printers
  • The 3D elastic membrane is made of a soft, flexible, silicon material
  • Precisely shaped to match the outer layer of the heart

 

Chapter 12: microfluidic chips

12.1    MICROFLUIDIC MEMS FOR DIABETES TREATMENT – Micronews

  • Watertight pump mounted on a disposable skin patch
  • Provides continuous insulin infusion
  • Controlled by a dedicated smart phone device
  • Incorporating a BGM (blood- glucose meter)

 

12.2    ACOUSTIC RECEIVER ANTENNA/SENSOR PDMS MEMBRANE – Purdue

POLY-DI-METHYL-SILOXANE (PDMS)

Polydimethylsiloxane called PDMS or dimethicone is a polymer widely used for the fabrication and prototyping of microfluidic chips.

It is a mineral-organic polymer (a structure containing carbon and silicon) of the siloxane family (word derived from silicon, oxygen and alkane). Apart from microfluidics, it is used as a food additive (E900), in shampoos, and as an anti-foaming agent in beverages or in lubricating oils.

For the fabrication of microfluidic devices, PDMS (liquid) mixed with a cross-linking agent is poured into a microstructured mold and heated to obtain a elastomeric replica of the mold (PDMS cross-linked).

 

Why Use PDMS for Microfluidic Device Fabrication?

 

PDMS was chosen to fabricate microfluidic chips primarily for those reasons:

Human alveolar epithelial and pulmonary microvascular endothelial cells cultured in a PDMS chip to mimick lung functions

  • It is transparent at optical frequencies (240 nM – 1100 nM), which facilitates the observation of contents in micro-channels visually or through a microscope.
  • It has a low autofluorescence [2]
  • It is considered as bio-compatible (with some restrictions).

The PDMS bonds tightly to glass or another PDMS layer with asimple plasma treatment. This allows the production of multilayers PDMS devices and enables to take advantage of technological possibilities offered by glass substrates, such as the use of metal deposition, oxide deposition or surface functionalisation.

PDMS, during cross-linking, can be coated with a controlled thickness on a substrate using a simple spincoat. This allows the fabrication of multilayer devices and the integration of micro valves.

It is deformable, which allows the integration of microfluidic valves using the deformation of PDMS micro-channels, the easy connection of leak-proof fluidic connections and its use to detect very low forces like biomechanics interactions from cells.

SOURCE

http://www.elveflow.com/microfluidic-tutorials/microfluidic-reviews-and-tutorials/the-poly-di-methyl-siloxane-pdms-and-microfluidics/

 

  • Ferrite RF radiation Acoustic wave Rectifier
  • Buried in PDMS Implantable miniature pressure sensor
  • Powered by an acoustically actuated cantilever
  • No battery required
  • Acoustic waves in the 200-500 hertz range
  • Cause cantilever to vibrate
  • Scavenging energy to power pressure sensor

 

Chapter 13: Peropheral Neuropathy Management

13.1    WIRELESS SHOE INSERT – Mobile Health News

  • WIRELESS SHOE INSERT – Mobile Health News
  • Help diabetics manage peripheral nerve damage
  • Insole collects data of where wearers
  • Putting pressure on their feet
  • Transmits wirelessly to a wristwatch-type display
  • Prevent amputations that often stem from diabetic foot ulcers

 

Chapter 14: Endoscopic Diagnostics Tools

14.1    ENDOSCOPE USING MEMS SCANNING MIRROR

  • For gastrointestinal and urological imaging
  • Alternative to biopsies in cancer detection
  • A laser beam pointed at the mirror is precisely deflected
  • Steered by the scanning mirror to reach a target

 

Chapter 15: MEMS guided Surgical Tools

15.1    MICROMACHINED SURGICAL TOOLS; SILICON MEMS TWEEZERS – ElectrolQ Used for minimally invasive surgical (MIS)

  • Procedures where diagnosis, monitoring, or treatment of diseases are performed
  • Performing with very small incisions MEMS
  • Based microsurgical tools is a key enabling technology for angioplasty, catheterization, endoscopy, laparoscopy, and neurosurgery

 

Summary by Dr. Pearlman

  • Multiple projects by Academia & Industry
  • Multiple MEMS devices for measuring body activities.
  • Many patch type devices attached to the skin
  • Devices attached to the eye
  • Smaller is better, lower footprint, lower power

 

 

 

 

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Third Annual BioPrinting and 3D Printing in the Life Sciences, 21-22 July 2016 at Academia, Singapore General Hospital Campus

Reporter: Aviva Lev-Ari, PhD, RN

 

Overview

Select Biosciences South East Asia are pleased to present Bioprinting and 3D Printing in the Life Sciences, taking place on the 21-22 July 2016 at Academia, the state-of-the-art conference facilities housed within the Singapore General Hospital Campus.

Building on the success of the 2013 and 2014 meetings The International Bioprinting Congress, we have decided to increase the scope of the event for 2016 to include the latest advances within 3D Printing for the Life Science arena.

We are honoured to again be working in partnership with our Conference Chairman, Professor Chua Chee Kai, Executive Director, Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.

We welcome Professor Martin Birchall, from University College London and Assistant Professor Wai Yee Yeong, from Nanyang Technological University as our Keynote Speakers for 2016.

The meeting will include scientific presentations from the leading international experts covering the latest advances developments and techniques within these allied fields, two highly topical panel discussions which will also highlight the views of the international regulatory authorities plus a tour of the facilities at the Centre for 3D Printing, hosted by Professor Chua.

We will provide you with a balanced overview of the industry from the varied perspectives of the leading researchers, solution providers and legislative authorities.

Attending this meeting will give you an excellent opportunity for networking and help you to build long term collaborations within this rapidly developing field.

We hope you can join us.

 

AGENDA

https://selectbiosciences.com/conferences/index.aspx?conf=BIO3D

@NTUsg

@SelectBio

Join the Third Annual Bioprinting and 3D Printing in the Life Sciences, taking place on the 21-22 July 2016 at Academia, Singapore General Hospital Campus.

Working in partnership with our Conference Chairman, Professor Chua Chee Kai, Executive Director, Singapore Centre for 3D Printing (SC3DP), Nanyang Technological University, Singapore.

We welcome Professor Martin Birchall, from University College London, Assistant Professor Wai Yee Yeong, Programme Director, SC3DP, Nanyang Technological University and Associate Professor Roger Narayan, University of North Carolina at Chapel Hill, as our Keynote Speakers for 2016.

The meeting will include scientific presentations from the following international experts who have already confirmed their participation.

Paulo Jorge Bártolo,

Chair of Advanced Manufacturing Processes & Director of the Manchester Biomanufacturing Centre, University of Manchester

Goh Bee Tin,

Senior Consultant, Department of Oral and Maxillofacial Surgery (OMS), Research Director and Deputy Director, Research and Education , National Dental Centre Singapore

Jerry Fuh,

Professor, National University of Singapore

Michael Golway,

President & CEO, Advanced Solutions, Inc.

Nazia Mehrban,

Post-Doctoral Researcher, University College London

L.P. Tan,

Associate Professor, School of Materials Science and Engineering, Nanyang Technological University

William G Whitford,

Senior Manager, GE Healthcare

Shoufeng Yang,

Associate Professor, University of Southampton

We are still accepting abstract submissions, if you would like to be considered for an oral presentation at this meeting, Submit an abstract for review now!

Oral Presentation Submission Deadline: 31 March 2016

We will address the following subject areas;

3D-Printing Applications in the Life Sciences

4D Bioprinting

Additive Manufacturing Technologies and Substrates

Bio-Ink and Bioprintable Hydrogels

Biofabrication and 3D-Bioprinting Technologies and Tools

Blueprints (Digital Models of Organs in STL Files)

Emerging Trends in Bioprinting

Intellectual Property and Patent Landscape in the Bioprinting Field

Laser Printing

Medical and Non-Medical Applications of Bioprinted Products

New Bioprinters

Organ Printing

Scaffolds and Biomaterials for Tissue Engineering

Technology Platforms for 3D-Printing

The application of Additive Manufacturing and Medical Devices

We hope you can join us for this exciting event, for further details please do not hesitate to contact me.

Best Regards

Linda

Linda Eriksson

Conference Manager

Select Biosciences South East Asia Pte. Ltd.

16 Raffles Quay, #33-03 Hong Leong Building,

Singapore 048581

l.eriksson@selectbio.com

www.SelectBio.com

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