UNC Cardiology News

The greatest gift

Born with a congenital heart defect, Samiya was diagnosed with congestive heart failure at just 4 months old. Her only hope of survival: a heart transplant. But would it come in time?

A weary LaCria Hicks stood on the sidewalk just beyond the entrance of N.C. Children’s Hospital that unforgettable September night. Her daughter, Samiya, just two days past her first birthday, occupied a room in the pediatric intensive care unit (PICU) just a couple of floors up. Troubled by the baby’s worsening condition, LaCria had been unable to tear herself away from her daughter's bedside and missed the final shuttle to the Ronald McDonald House.

As guest services personnel secured alternative transport for her, the beleaguered mother reflected on an earlier conversation with one of the critical care physicians amidst the evening’s chaos.

“Be straight with me,” she had implored him just past midnight. They had been waiting for more than six months. Was there hope they would find a heart in time?

In a moment she will never forget, the doctor had taken her hand in his and, eyes locked on hers, said, “She is going to be a stubborn teenager.” And with that, she found renewed faith.

“The doctors haven’t lost hope, so I haven’t lost hope,” she thought to herself as she waited for transport. And then her mobile phone rang.

A heart defect

LaCria’s pregnancy had been considered high risk from the start given a previous history of gestational diabetes. She and husband, Chris, felt reassured by the extra monitoring until LaCria’s four-month ultrasound revealed some anomalies.

Samiya spent her first birthday in the PICU.
The couple was referred to the UNC Children’s Heart Center, where Blair Robinson, MD, did a fetal echocardiogram. He confirmed a narrowing of the baby’s aortic arch along with a hole in her heart.
 

“Dr. Robinson was great,” says LaCria. “He explained Samiya’s heart defects and the course of treatment. He said she would need three surgeries, the first at 5 days old and the next would be around 6 months, and then another when she was like 5 or 6.”

LaCria’s pregnancy became difficult. She developed gestational diabetes again and then pre-eclampsia, a complication of pregnancy whose hallmarks are high blood pressure and protein in the urine. The dangerous condition can compromise organ function and threaten both the mother and unborn baby’s health, delivery of the baby being the only cure. As such, Samiya was born a couple weeks shy of full term.  

“She spent a day in the NICU and then was transferred to the PICU in anticipation of her heart surgery, which went as anticipated,” recounts LaCria. “We stayed about three weeks post-op. She went home with a feeding tube, so we had some complex care issues, but things were going about how we expected.”

But by the time Samiya was 4 months old, LaCria became concerned by some frightening symptoms. Samiya was vomiting frequently, and she had bouts when her face would turn blue. Dr. Robinson did an echocardiogram, which revealed a terrifying development. Samiya was suffering from congestive heart failure.

“It horrifying. I went into panic mode. I didn’t really understand what it all meant,” says LaCria.

Samiya was admitted to the PICU. When surgical interventions didn’t improve her condition, her care team presented another option: a heart transplant.

“That was very hard and painful decision for us,” recalls LaCria. “I am a Christian woman. How can you pray for a heart? How can you pray for another person’s child to die? I had a hard time reconciling that, but there were no other options. Even on the transplant list, there weren’t any guarantees. Would she be strong enough? I finally surrendered. God, if it is your will, your will done.”

The ensuing months were difficult on the family. The family, LaCria, Chris, and Samiya’s two older siblings, Briana and Brandon, spent the summer at the Ronald McDonald House. When school started back up again, Chris spent his days in Chapel Hill at the hospital with Samiya, while LaCria went to work and ran back and forth with the older kids. She visited Samiya every day.

“It’s a complete waiting game,” LaCria remembers of those months waiting for a heart transplant. “We didn’t know when it was going to come, if it was going to come. At the beginning, it didn’t occur to me that she wasn’t going to make it that far. But then her condition began to deteriorate. Her oxygen levels were dropping for no reason. She had been through so much, so much suffering.”

The phone call

“The doctors haven’t lost hope, so I haven’t lost hope,” was the last thought to cross LaCria’s mind before her mobile phone rang that September night, just two days past Samiya’s first birthday.

Radiothon
A year after her transplant, Samiya returned to participate in the Radiothon.
“Mrs. Hicks?” said the man who identified himself as a member of the transplant team. “I just want you to know, we found a heart for Samiya.”
 

“I just busted out screaming,” recalls LaCria. “Tears and yelling and jumping around. He’s still talking, telling more, and I’m not hearing him.”

The transplant surgery took 10 hours. Michael Mill, MD, was Samiya’s transplant surgeon.

“Dr. Mill, I swear that man is heaven sent,” says LaCria. “I never felt so confident. He just told me this is the perfect time, this is meant to me—lots of positive affirmation that everything was going to be okay.”

“When we saw him again after the operation, you could tell everyone was tired, that they had given it their all,” remembers LaCria. “And Dr. Mill, he stayed afterwards and prayed with my mom.”

Samiya spent three months in the hospital following the transplant surgery and was discharged week before Christmas.

“It was beautiful, our own Christmas miracle,” says LaCria.

Now 4 years old, Samiya is a happy child, a natural comedienne who loves to play and dance, says her mom.

“She goes to playground and comes back with five friends,” beams LaCria. “She never met a stranger.”

“Maybe it has to do with all the time she spent in the hospital,” continues LaCria, “all the people who became part of our extended family. They mean the world to us—Dr. Robinson, Dr. Mill, Dr. [Cheri] Hanson and Dr. [Benny] Joyner in the PICU. And the nurses, I call them the ‘unspoken champions.’ Too many to count, they are our heroes. They’ve given us the greatest gift.”

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Healthy hearts reunite with caregivers

September’s Heart Reunion provided patients and their families an opportunity to reconnect with one another and members of their care team.
Healthy hearts reunite with caregivers click to enlarge The Williams family.

By: Morgan Noelle Smith, student of the UNC School of Media and Journalism

The UNC Children’s Heart Center hosted an event on Sept. 12 that tugged on the heartstrings of all those in attendance; literally. Almost 200 families of children receiving specialized heart surgery gathered at the Heart Reunion to reunite with other heart families and their caregivers.

One of those parents in attendance was Lauren Williams, the mother of 2-year-old Benji, who has already undergone two open heart surgeries and is on schedule to have his third open heart surgery next summer.

Williams’ son was born with multiple critical heart defects that prevented his right ventricle from developing due to his pulmonary valve never opening. The medical plan to address his defects and give him a chance at life will make him a single ventricle baby—basically he will have half a heart.

“Tomorrow is never guaranteed for anyone, but heart families are reminded of that every moment of every single day,” Williams says, reflecting on the past two years of her son's journey. "Benji reminds many that the next breath—or next beat—may not ever come, but he continues to march on, the only way heart warriors know how."

When Benji was born, there was little chance for his survival given one of the diagnosed heart defects. Williams says the care from UNC Children's has given her two years with a boy who never should have lived.

About 200 children receive surgery to correct congenital heart defects at N.C. Children’s Hospital each year. The Heart Reunion was created to enable patients and their families to interact and share stories with one another.

The event was filled with games, crafts, and an array of heart-themed treats. Parents of patients watched their children run, play, and be active, while patients were able to interact with other children facing similar health challenges. 

Benji's Heart Doctors
Benji with his favorite heart doctors, Drs. Michael Mill, Jennifer Nelson, and John Cotton. (Click to enlarge.)
“I know [the surgeons] carry such heavy burdens on their shoulders every day.  They do not always get to deliver good news,” says Williams. “It is so important and vital for their spirit and their mental health to see these kids running around, just being kids and seemingly so healthy.”
 

The UNC Children's Heart Center team has hosted the Heart Reunion annually for 17 years but took a hiatus last year due to a lack of funding. A generous donor—the father of a former patient, now a college sophomore—sponsored this year's event.

Williams says the reunion had a nice turnout but fewer attendees than she had anticipated. She states that more families should consider coming to events such as these, because they gives families hope, foster relationships between families who share similar stories, and can help develop friendships between peers who understand.

“Seeing older kids there with similar conditions as my son gives me hope that I will not outlive my child,” she says. “There were faces of health, strength, tenacity and fortitude—the same qualities I see in my son every day. It strengthened my resolve fight just as hard against congenital heart defects as these incredible heart warriors.”

The UNC Center for Heart & Vascular Care receives national recognition for providing quality cardiovascular and stroke care

This voluntary program is designed to recognize clinicians who have met standards demonstrating delivery of high-quality care to patients with cardiovascular disease and/or stroke. UNC Heart & Vascular was also recognized by the NCQA Heart/Stroke Program from 2011-2014.

FOR IMMEDIATE RELEASE

Media Contact: Laura Melega, (919) 843-8217, laura_melega@med.unc.edu

CHAPEL HILL, NC – The National Committee for Quality Assurance (NCQA) and the American Heart Association/American Stroke Association (AHA/ASA) have announced that the UNC Center for Heart & Vascular Care has received Recognition from the Heart/Stroke Recognition Program.

This voluntary program is designed to recognize clinicians who have met standards demonstrating delivery of high-quality care to patients with cardiovascular disease and/or stroke.  UNC Heart & Vascular was also recognized by the NCQA Heart/Stroke Program from 2011-2014.

To receive recognition, which is valid for three years, the UNC Center for Heart & Vascular Care submitted data that demonstrates performance that meets the Program’s key cardiovascular and stroke measures.  These measures include blood pressure and cholesterol control, among others.  When people with cardiovascular disease or who have had a stroke receive quality care as outlined by these measures, they are less likely to suffer additional complications, such as a second heart attack or stroke.

“Quality patient care translates into lives saved,” said Sidney Smith, MD, Professor of Medicine, University of North Carolina at Chapel Hill and Past President and Past Chief Science Officer of the American Heart Association. “This is why the American Heart Association/American Stroke Association is supporting a recognition program for clinicians providing quality care.  This program closes the gap by putting into practice AHA/ASA guidelines and statements to fight heart disease and stroke.”

More than 60 million Americans have one or more types of cardiovascular disease.  Cardiovascular disease is the leading cause of death in the United States, responsible for approximately 950,000 deaths each year.  Approximately 700,000 Americans suffer a stroke each year; stroke is the third-leading cause of death and a leading cause of severe, long-term disability.  Despite evidence that reducing cholesterol levels and controlling high blood pressure prevent further health complications, many cardiac and stroke patients are not treated effectively for these symptoms.

“Controlling blood pressure and quitting smoking are common-sense treatments for cardiovascular disease.  But the number of clinicians who don’t urge their patients who smoke to quit would surprise you,” said NCQA President Margaret E. O’Kane. “The Heart/Stroke Recognition Program identifies clinicians who follow these evidence-based guidelines.  The UNC Center for Heart & Vascular Care is to be commended for their achievement in earning Recognition.”

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations.  It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers.

Sudden Unexpected Death in NC is being studied at the University of North Carolina

The SUDDEN study will collect medical information from North Carolinians who died from sudden unexpected death in an effort to define contributing disease processes and improve prevention.

The University of North Carolina at Chapel Hill School of Medicine is involved in a multi-year research study to understand the epidemiological and pathophysiological causes of sudden unexpected death in North Carolina.

Sudden unexpected death (SUD) is a malfunction of the heart that results in a rapid loss of blood flow through the body, leading to death.  It is a very rapid process and may have few or no known warning signs.  Upwards of 450,000 people in the United States die from SUD each year.  Despite notable improvements in the past two decades in treatment of coronary artery disease, efficiency of first responder systems, and advancements in resuscitation science, the overall survival rate for out-of-hospital arrest remains only 5-10%.

The Sudden Unexplained Death Registry in North Carolina (SUDDEN) is an ongoing research venture, initiated and managed by the Electrophysiology division of the UNC Center for Heart and Vascular Care.  The SUDDEN study will develop a database of all sudden expected deaths in North Carolina.  The researchers hope to determine SUD incidence rates for various populations, as well as more clearly define cardiac abnormalities and diseases that contribute to SUD in order to improve prevention in North Carolina.

While previous studies of SUD focused on small populations in the Northwestern United States, SUDDEN at UNC is studying a racially and socioeconomically diverse cohort of SUD victims in North Carolina.

Eugene H. Chung, MD, MSc, FACC, FHRS, Associate Professor, division of cardiology, is the principal investigator of the SUDDEN study.  Dr. Chung says that a broad community-based study is needed to determine the cause of SUD.

“North Carolina has a racially and socioeconomically diverse population that will allow us to better estimate the true incidence of sudden unexpected death in various populations,” explains Dr. Chung.  “Our focus will be statewide as we develop the database.

The impact of sudden unexpected death on society is incalculable. With an average of 32 SUD-related deaths each day in North Carolina, the survivors are often emotionally overwhelmed, and family economics may be immediately disrupted.  Families can be threatened by the unanticipated loss of livelihood, sometimes during the most productive years of an individual’s life. 

Paul Mounsey, MD, PhD, MRCP, FACC, Director, UNC Electrophysiology, is the chairman of the steering committee that directs day-to-day operations of the study.  "It is only by identifying people who suffer SUD that we will be able to monitor the changing patterns of SUD in our society.” says Dr. Mounsey.  “This is the number one killer in the United States. It deserves our attention.”

SUDDEN is being conducted with the assistance and support of the NC Office of the Chief Medical Examiner.  Experts from the University of North Carolina in epidemiology, emergency medicine, radiology, genetics and pathology are contributing to the ongoing management of the project.

The SUDDEN study is funded by individual donations from Cecil Sewell, Scott Custer, and Joe and Ann Lamb. Additional support is provided by the Heart and Vascular division of the University of North Carolina at Chapel Hill.

Learn more about SUD (also sometimes known as Sudden Cardiac Arrest) at the following links:

National Heart, Lung, and Blood Institute

American Heart Association

SUDDEN at UNC

UNC Hospitals honored with Mission: Lifeline quality achievement award for heart attack care

UNC Hospitals has received the Mission: Lifeline® Gold Receiving Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks.
UNC Hospitals honored with Mission: Lifeline quality achievement award for heart attack care click to enlarge AHA Mission: Lifeline® Gold Receiving Quality Achievement Award

Each year in the United States, approximately 250,000 people have a STEMI, or ST-segment elevation myocardial infarction, caused by a complete blockage of blood flow to the heart that requires timely treatment. To prevent death, it’s critical to immediately restore blood flow, either by surgically opening the blocked vessel or by giving clot-busting medication.    

UNC Hospitals earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients to open the blocked artery. Before patients are discharged, they are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers, and they receive smoking cessation counseling if needed. Eligible hospitals must adhere to these measures at a set level for a designated period to receive the awards.

The American Heart Association’s Mission: Lifeline program helps hospitals, emergency medical services and communities improve response times so people who suffer from a STEMI receive prompt, appropriate treatment. The program’s goal is to streamline systems of care to quickly get heart attack patients from the first 9-1-1 call to hospital treatment.    

“UNC Hospitals is dedicated to improving the quality of care for our patients who suffer a heart attack, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that goal through internationally respected clinical guidelines,” said George “Rick” Stouffer, MD, interim chief, division of UNC cardiology.  “We are pleased to be recognized for our dedication and achievements in cardiac care, and I am very proud of our team.”    

“We commend UNC Hospitals for this achievement award, which reflects a significant institutional commitment to improve the quality of care for their heart attack patients,” said A. Gray Ellrodt, MD, Chair of the Mission: Lifeline committee and Chief of Medicine at the Berkshire Medical Center in Pittsfield, Mass. “All too many heart attack patients in the United States still fail to receive appropriate treatment for their life-threatening condition within the recommended timeframes. We must all continue this important work to streamline and coordinate regional systems of care to save lives and prevent complications.”  

The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology Foundation clinical treatment guidelines.  For more information, visit heart.org/missionlifeline and heart.org/quality.

Frequent in-person home visits can reduce both readmission and death for patients with heart failure

Home-visiting programs and multidisciplinary heart failure clinic interventions can reduce hospital readmission and improve survival for patients with heart failure, according to research from RTI International and the University of North Carolina at Chapel Hill.

Monday, May 26, 2014

Home-visiting programs and multidisciplinary heart failure clinic interventions can reduce hospital readmission and improve survival for patients with heart failure, according to research from RTI International and the University of North Carolina at Chapel Hill.

The work, based on a report funded by the Agency for Healthcare Research and Quality (AHRQ), was published today in the Annals of Internal Medicine.

Heart failure is a leading cause of hospitalization and health care expenditures in the United States. Nearly 25 percent of patients hospitalized with heart failure are readmitted to the hospital within 30 days of discharge, according to data from AHRQ’s Healthcare Cost and Utilization Project. Hospital readmission can lead to additional health complications and unnecessary costs for patients, insurers and hospitals.

The Centers for Medicare & Medicaid Services began reducing reimbursements to hospitals with high readmission rates in 2012. All these factors have led hospitals, insurers, and other healthcare providers to create transitional care programs, which provide services, resources and education to reduce readmission. Heart failure is associated with the highest rate of hospital readmissions among Medicare patients, therefore many programs focus on this condition. 

“Hospitals and other healthcare systems are under increasing pressure to reduce unnecessary readmissions,” said Cynthia Feltner, professor in the department of internal medicine and researcher at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, and lead author of the article. “At the same time, what types of programs are most effective remains uncertain.”

Feltner led a team from the RTI-UNC Evidence-based Practice Center to examine the efficacy, comparative effectiveness and harms of transitional care programs for heart failure patients. Researchers conducted a systematic evidence review of 47 randomized controlled trials of programs that included home-visits, outpatient clinic visits, telemonitoring (monitoring physiological data remotely), telephone support, and educational programs.

Programs providing a series of home visits soon after hospital discharge can reduce 30-day readmission rates by 66%. Both home-visiting programs and multidisciplinary heart failure clinics visits can improve mortality and reduce all-cause readmission in the six months after hospitalization. Telephone support interventions do not appear to reduce all-cause readmission, but they can improve survival and reduce readmission related to heart failure. Programs focused on telemonitoring or providing only education did not appear to reduce readmission or improve survival.

The number and frequency of visits varied by program, but Feltner said face-to-face contact was a common theme among the most effective programs. The multidisciplinary heart failure clinic interventions included contact with physicians as well as dieticians, pharmacists and nurses.

“Hospitals and providers should consider focusing efforts on interventions that provide frequent in-person monitoring after discharge—specifically, home-visiting programs and multidisciplinary heart failure clinic interventions. This may be a challenge because these programs require more resources; however, they have the best evidence for reducing unnecessary readmissions and improve survival for patients with heart failure,” Feltner said.

The journal article is based on a report developed by the RTI-UNC Evidence-Based Practice Center, a collaboration between RTI International and the University of North Carolina at Chapel Hill. Daniel E. Jonas at UNC co-directs the RTI-UNC Evidence-based Practice Center with Meera Viswanathan at RTI.

Sheps Center contact: Sonya Sutton, ssutton@unc.edu, (919) 966-4118

UNC News Services contact: Thania Benios, thania_benios@unc.edu, (919) 962-8596

AHRQ Contact: Rachel Wagner, rachel.wagner@ahrq.hhs.gov, (301) 427-1258

 

Web-based and live counseling programs can reduce patients’ risk for heart disease

The work, by UNC researchers, adds to a growing body of evidence suggesting that nontraditional approaches to health care are becoming ever more important in managing health and disease.

Monday, May 26, 2014

Web-based and live counseling programs can effectively reduce the risk of heart disease for patients at high risk for the disease, and web-based programs are particularly cost effective, according to research from the University of North Carolina at Chapel Hill.

The work, published Monday in JAMA Internal Medicine, adds to a growing body of evidence suggesting that nontraditional approaches to health care are becoming ever more important in managing health and disease. 

“Following a healthy lifestyle and taking prescribed medications can reduce the risk for heart disease,” said Thomas Keyserling, MD, MPH, lead author of the study. “However, most providers do not have the skills and resources to help their patients achieve these goals. Delivering programs in nontraditional and cost-effective ways gives providers more options to keep patients healthy.”

Keyserling and Stacey Sheridan, MD, MPH, led a team from the UNC Center for Health Promotion and Disease Prevention for the study. Both Keyserling and Sheridan are faculty members in the division of general medicine and clinical epidemiology in UNC’s School of Medicine.

"These programs offer doctors two great resources to serve their patients,” said Sheridan. “The web program can be used to reach patients beyond the office and allows flexibility in the timing of counseling. The counselor intervention, on the other hand, offers the human interaction and can be personalized for those who need it."

They recruited project participants from five primary care practices in central North Carolina for a comparative effectiveness study. A total of 385 participants who did not have heart disease but who were at moderate to high risk for developing it were randomized into either the counselor-delivered or web-based formats of the same intervention.

The main outcome for the study was change in a calculated score, called the Framingham Risk Score, that predicts the chances of future heart disease events. This score was reduced substantially in both groups at four and 12 months follow-up. Also of note, several risk factors improved, including blood pressure, blood cholesterol levels, self-reported dietary intake, physical activity and medication adherence.

In addition to examining health outcomes, the researchers compared the costs of each approach. The in-person counseling session cost $207 per patient and the web-based program cost $110 per person.  Both interventions were cost effective by commonly accepted standards, especially the web-based format. Both intervention approaches were also very well received by participants, with 75 percent saying they would strongly recommend this program to others.

“We were pleased that the intervention appeared to be effective in both formats, highly acceptable to participants, and cost-effective,” said Keyserling. “This study provides support for the importance of combining lifestyle and medication interventions to reduce heart disease risk and for the cost-effectiveness of the web-based format.”

 

HPDP Contact: Sonya Sutton, ssutton@unc.edu, (919)966-4118

UNC News Services contact: Thania Benios, thania_benios@unc.edu, (919) 962-8596

 

 

 

UNC Hospitals Achieves New Status as Accredited Chest Pain Center

Hospitals that have received Society of Cardiovascular Patient Care (SCPC) accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack, emphasizing the importance of treatment programs that provide more efficient and effective evaluation as well as rapid treatment of patients with chest pain and other heart attack symptoms.
UNC Hospitals Achieves New Status as Accredited Chest Pain Center click to enlarge Prashant Kaul, MD, Medical Director, UNC Chest Pain Center

Media Contact: Laura Melega, laura_melega@med.unc.edu, 919-843-8217 (919) 843-8

March 25, 2014

CHAPEL HILL, N.C. --  UNC Hospitals announces that it has received Chest Pain Center with Percutaneous Coronary Intervention (PCI) Accreditation from the Society of Cardiovascular Patient Care (SCPC), an international not-for-profit organization that focuses on transforming cardiovascular care by assisting facilities in their effort to create communities of excellence that bring together quality, cost and patient satisfaction.

Hospitals that have received SCPC accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack. They emphasize the importance of standardized diagnostic and treatment programs that provide more efficient and effective evaluation as well as more appropriate and rapid treatment of patients with chest pain and other heart attack symptoms. They also serve as a point of entry into the healthcare system to evaluate and treat other medical problems, and they help to promote a healthier lifestyle in an attempt to reduce the risk factors for heart attack.

“Receiving this accreditation for UNC Hospitals is a testament to the hard work of people from many different areas, including, but certainly not limited to, our local EMS crews, Chatham Hospital, Emergency Services and Emergency Medicine, Cardiology, Cardiac Cath lab and Cardiac Services, UNC Heart & Vascular Nursing, Cardiac Rehab, and Laboratory Services,” says Prashant Kaul, MD, FACC, FSCAI, UNC Chest Pain Center Medical Director.

“This accreditation underlines our commitment to the highest standards of personalized cardiovascular care.  We look forward to effectively treating and educating patients to achieve the best possible outcomes.”

To become an Accredited Chest Pain Center with PCI, UNC Hospitals engaged in rigorous evaluation by SCPC for its ability to assess, diagnose, and treat patients who may be experiencing a heart attack. To the community served by UNC, this means that processes are in place that meet strict criteria aimed at:

  • Reducing the time from onset of symptoms to diagnosis and treatment
  • Treating patients more quickly during the critical window of time when the integrity of the heart muscle can be preserved
  • Monitoring patients when it is not certain that they are having a heart attack to ensure that they are not sent home too quickly or needlessly admitted to the hospital

“People tend to wait when they think they might be having a heart attack, and that’s a mistake,” states Tracey Blevins, RN, BSN, MBA, UNC Chest Pain Center Coordinator. “The average patient arrives in the emergency department more than two hours after the onset of symptoms, but what they don’t realize is that the sooner a heart attack is treated, the less damage to the heart and the better the outcome for the patient.”

The state-of-the-art UNC Chest Pain Center at UNC Hospitals encompasses the entire continuum of care for the heart patient and includes such focal points as dispatch, Emergency Medical System, emergency department, cath lab, UNC’s quality assurance plan, and community outreach program. By becoming an Accredited Chest Pain Center, the hospital has enhanced the quality of care for the cardiac patient and has demonstrated its commitment to higher standards.

About the Society of Cardiovascular Patient Care

The Society of Cardiovascular Patient Care (SCPC) is an international not-for-profit organization whose mission is to transform cardiovascular care by assisting facilities in their effort to create communities of excellence that bring together quality, cost and patient satisfaction. As the only cross-specialty Society, SCPC provides the support needed for hospital systems to effectively bridge existing gaps in treatment by providing the tools, education and support necessary to successfully navigate the changing face of healthcare.   For more information on SCPC, accreditation and certification opportunities, visit www.scpcp.org, or call toll free at 1-877-271-4176. 1-877-271-4

Simple Diagnosis - Complicated Solution

The UNC Center for Heart and Vascular Care collaborates with specialists in the Raleigh area to provide care for the most complex heart cases. (This feature was originally published in UNC Health Care's Well Magazine, Winter 2014 issue)

By Stephanie Soucheray-Grell

Written for UNC Health Care

Wednesday, February 26, 2014

Craig Wilkins was feeling tired, breathless and in need of a vacation. Although he attributed his tiredness to too many long and hectic hours at the office, the 56­-year­-old decided to see his family doctor in Cary, N.C., before leaving for a family trip.

Craig was otherwise healthy and had no history of heart disease, but his doctor discovered he had atrial fibrillation, a condition that can cause the heart to race, sometimes beating hundreds of times in one minute. These episodes, called tachycardias, were making Craig feel fatigued.

He said my heart was beating a mile a minute, that’s why I was so tired. My heart was wearing me  out.

An estimated 12 million people will have atrial fibril­lation by 2050, according to the Centers for Disease Control and Prevention. Atrial fibrillation is a type of arrhythmia that causes the heart to beat irregularly. It can be genetic or caused by scar tissue on the heart, diabe­tes, high blood pressure or  stress. An  aging  population, an increased survival rate following heart attacks and ris­ing rates of heart disease mean more Americans will be entering their 60s and 70s with arrhythmias, which are a leading cause of stroke and cardiac events, and can dra­matically alter a person’s quality of life.

For some, atrial fibrillation is annoying but not life threatening. For Craig, the condition had gone undetected for so long that he had developed congestive heart failure. “I was shocked when the doctor told me how serious it was,” says Craig.

Initially, Craig was given a course of blood thinners to prevent clots that could be lethal, followed by a cardio­version, an electrical shock to the heart, to reset the heart­ beat back to normal. Though this worked initially, his heart eventually returned to the abnormal heartbeat. After several attempts at cardioversion, Craig’s doctor tried anti­ arrhythmia  medication.

“They put me in the hospital and used a powerful anti­ arrhythmia drug,” says Craig, who stayed in the hospital for three days as doctors watched his heart.Two days after he was released, he returned to work and passed out at his desk.

Craig Wilkins“Two days out of the hospital and my heart not only went out of rhythm but went into a life­ threatening rhythm, and I passed out cold at my desk. I came around as my co­workers were reading the instructions on the defibrillator paddles.”

Because his heart kept falling out of rhythm despite several  attempts  to  regulate  it  with  electric  shock  and medications,Craig’s cardiologist referred him to Paul Mounsey, MD, FACC, director of electrophysiology at UNC Hospitals.

Working Together to Provide Top-Notch Care

UNC Health Care is on the cutting edge of treating complex arrhythmias. Now, specialists from Wake Heart & Vascular Associates, Rex Heart & Vascular Specialists, and the UNC Center for Heart and Vascular Care are joining to create the UNC Heart & Vascular Network.

“We are going to establish a network in Raleigh that enables patients and physicians to work together in Wake County for patients who have difficult-to-treat arrhythmias,”says Andy Kiser, MD, chief of the Division of Cardiothoracic Surgery. “This is a collaborative effort between the best doctors in the region. Our idea is to bring the service closer to the people so patients don’t have to travel so far to find collaborative care.”

Dr. Mounsey says opening the UNC Heart & Vascular Network will help many patients remove the barriers that block their access to the best care for their conditions.

“Half of our patients come from Wake County,” says Dr. Mounsey, “and many patients—both new and referrals—have to make a 60-mile round-trip drive to see us in Chapel Hill. What we’re looking for in the new network is to offer our services of highly complex procedures. Arrhythmias are a public health issue, and we’re seeing more patients in need of these services every year.”

Complex Solutions for Complex Arrhythmias

Treatment for arrhythmias typically includes medication called beta blockers, which help slow the heart down, or pacemakers, which are small implanted devices that keep the heart’s rhythm regulated with small electric shocks to the heart. For patients like Craig whose arrhythmia was not corrected with initial treatment options, surgery may be necessary to reset the heart’s rhythm. 

Kiser and Mounsey
Andy Kiser, MD (left), with Paul Mounsey, MD Courtesy Donn Young

Dr. Mounsey performed a cardiac ablation on Craig’s heart. In an ablation, doctors thread catheters through the arteries to the heart and use radiofrequency to destroy the damaged heart tissue causing the atrial fibrillation. Ablations are often successful, but in Craig’s case, a flutter continued even after the procedure. A second ablation was performed, but the location of where the flutter was originating meant ablation could not correct it.

Dr. Mounsey then collaborated with Dr. Kiser to perform the Convergent Procedure.

Traditionally, surgeons, like Dr. Kiser, have created scar pat- terns to disrupt the circuitry that causes atrial fibrillation arrhythmia, while electrophysiologists, like Dr. Mounsey, have performed ablations. With the Convergent Procedure, Drs. Mounsey and Kiser work side by side using miniature cameras, small catheters and electrodes to map out an individualized pattern that will work to reestablish normal rhythms in each patient.

Drs. Mounsey and Kiser have been performing the procedure since 2011, and they recently completed their 100th surgery. They have an 80 percent success rate, which is extremely high for complex arrhythmias.

Five years after Craig’s initial atrial fibrillation diagnosis and a year and a half after having the Convergent Procedure, he says his health is excellent. “I can’t believe how bad I used to feel,” says Craig. “I have energy and a desire to do things now.”

Craig felt so good, he left his IT job behind and made a career change, opening The Meat House, a neighborhood butcher and grocery franchise in Raleigh and Cary.Warning Signs

 A Coordinated Effort

Shah from Rex
Sidharth Shah, MD Courtesy Bryan Regan
Craig’s  case  is  a  good  example  of  the  patients  who  will benefit most from the UNC Heart & Vascular Network. Patients who live in the Raleigh area and their primary care physicians will have access to a group of cardiologists and services in their local communities, and for the most complex  cases, they  will  have  access to the leading research, technology and specialty care available at UNC Health Care.

With the creation of this new network, Drs. Kiser and Mounsey will work alongside Sidharth Shah, MD, a cardiac electrophysiologist in Raleigh. Dr. Shah performs cardiac ablations and works with cardiac devices, such as pacemakers and cardio defibrillators, and his work is closely associated with research opportunities and clinical trials.

“In the past we had to send our patients who were in the UNC or Rex system to other centers,” says Dr. Shah. “Now, we can keep them close to home.”

 


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Aortic Aneurysms: The Silent Killer

Ultrasound screening for aortic aneurysms is vital for patients at high risk

aneurysm diagram
An infrarenal abdominal aortic aneurysm.
celebritiesWhat do Albert Einstein, Lucille Ball, George C. Scott, and John Ritter have in common? They all died from aortic disease.  

Einstein and Scott suffered from abdominal aortic aneurysms while Ritter and Ball experienced aortic dissections, or a tear in the inner wall of their aortas.  More than 15,000 people a year die from ruptured aneurysms, with the incidence of aortic aneurysms tripling in the United States in the past 30 years, attributed to an aging population.  Abdominal aortic aneurysms are the third leading cause of sudden death in men over age 60.  

Aneurysms are often called a “silent killer,” because patients often have no symptoms until the aneurysm bursts.  Nearly 75 percent of all patients with a ruptured aneurysm die from the condition, which makes screening crucial for people at greatest risk.

What are aneurysms?Aortic Disease Risk Factors
Aneurysms are a ballooning and weakening of the arterial wall and occur in almost any artery in the body.  If an aneurysm grows large enough it may lead to rupture, internal bleeding, shock and even death.

Common types of aneurysms

Aortic aneurysms occur in the aorta, which delivers blood throughout the body from the heart to organs.  Thoracic aneurysms occur in the section of the aorta located in the chest, while abdominal aneurysms can occur in any section of the abdomen, including the intestines and kidneys.

Aortic Dissection

An aortic dissection begins when a tear forms in the innermost lining of the aortic wall. When the tear occurs, blood leaks into the aortic wall, causing separation of its layers. This leads to intense pressure in the aortic wall and a high risk of rupture. Aortic dissections may also limit the flow to several important organs including the heart, brain, liver, kidneys, intestines, spinal cord and legs.  Aortic dissection is a life-threatening emergency and is frequently fatal.

Aortic Screening
Early detection of aortic disease is proven to save lives.  Preventative screening in high-risk patient populations and treatment of individuals with aneurysms have saved thousands of lives each year.  

Each year approximately 200,000 people in the U.S. are diagnosed with abdominal aortic aneurysms. Because many do not experience symptoms, it’s estimated that more than one million people are living with an undiagnosed abdominal aortic aneurysm.  Fortunately, at least 95 percent of these aneurysms can be successfully treated if detected prior to rupture.

Finding and treating an aortic aneurysm before the aneurysm ruptures is vital for patient survival. 

Source: AAAneurysm Outreach


Get screened
Contact UNC Aortic Disease Management at 919-843-2867, or online at uncheartandvascular.org to find out about aortic disease screenings.

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Hope for Elijah

3-year-old boy Elijah Smith had 13 surgeries in his first 2 years of life to correct lymphatic malformations. If left untreated these malformations would have caused him serious problems in breathing, eating and speaking.


twoheartsWhen Elijah Smith of Wade, N.C., was born in December 2010 at Cape Fear Valley Hospital in Fayetteville, excess fluid had overrun his lymphatic vessels, engorging and distorting his neck and upper chest cavity.  Diagnosed at birth, Elijah suffered from lymphatic malformations (LMs), and he represented the most common type of patient with this condition -- a congenital case requiring an immediate, multidisciplinary course of treatment.   

Thought to be caused by errors in fetal development of lymphatic channels, the LMs afflicting Elijah had begun in the womb and gone undetected in multiple ultrasounds.  Marked by mass swelling distorting Elijah’s upper thoracic cavity, the malformed vessels could not efficiently transport tissue fluids back into the bloodstream via his lymph nodes.  If left untreated, the accumulated lymphatic fluid would have increasingly obstructed his airways.  Non-intervention would also have risked lifelong maxillofacial complications such as thickening of the tongue (macroglossia) and speech/eating challenges, as well as recurrent cellulitis, enlarged soft tissues and bones, and bleeds from the LMs themselves.

Elijah was referred to UNC Health Care shortly after birth in early 2011 for corrective treatment.  Over a two-year span, his team included clinical faculty from the Departments of Pediatrics, Pediatric Surgery, Otolaryngology/Head and Neck Surgery and Radiology.  UNC Professor of Pediatrics Dr. Timothy Weiner’s confirmation of Elijah’s diagnosis at birth was so brief that his case referral to UNC’s Department of Otolaryngology entailed escorting the Smith family directly over to Associate Professor and Pediatric Otolaryngology Chief Dr. Carlton Zdanski’s clinic.  

As Zdanski examined the fluid-filled cysts throughout the boy’s throat, he found dilated cysts in the back of the throat and deep in the chest that could cause breathing problems.  He knew immediately that UNC Health Care would be able to treat Elijah.

Dr. Zdanski explained to Elijah’s parents that the boy’s care would take multiple treatments over the next few years and eventual surgery to correct the skin and tissue below the cysts. Also, close surveillance was necessary in the event the cysts suddenly enlarged and compressed his throat or became infected.

Due to the invasive treatment Elijah’s case required for correcting the malformed lymph vessels, Zdanski referred him to UNC’s Vascular-Interventional Radiology (VIR) division for assistance and treatment.  Since Elijah’s first corrective treatment in early 2011, Vascular-Interventional Radiology Professor Dr. Joe Stavas has worked closely with the Smith family over the course of 13 outpatient procedures, conducting the most recent one in September 2013. Drs. Zdanski and Stavas collaboratively mapped out a long-term treatment plan with Elijah’s parents that included MRI scans, drainage and ablating the cysts to cause shrinkage.  These early steps would provide a basis for future surgery to remove extra skin and malformation tissue.  

Elijah has progressed through his first two years of life with relative ease, yet the challenges related to his throat and chest distortions range from limited swallowing to the emotional toll on his family due to stares and even cruel comments in public from others.  Fortunately, with each surgery, Elijah’s throat and airway obstructions have cleared, and the distortions in his lower neck have diminished.  His only setback during the course of treatment occurred at five and 10 months, when he underwent inpatient stays for infected and inflamed lesions. Two hours after Dr. Stavas conducted his last procedure on Elijah in September, the toddler was back at home in Wade.   

Elijah’s parents April and Tim are very involved in his care, and the entire UNCH team that cares for him have become very close to them.  Tim often brings reading materials for the doctors and April sends pictures of Elijah “just being a toddler” around the house. “We’ve seen him grow and be happy boy since this all began,” remarked Dr. Stavas.

With each of Elijah’s surgeries, April Smith observed how her son’s throat and chest area restored itself to more natural form, giving her greater peace for how he will progress as a healthy, growing child.

“We were lucky from the beginning, because Elijah didn’t have the severe lesions I’ve seen from photos of other children with this condition. Don’t get me wrong, it took us a good bit of strength to get through 13 surgeries in two years of my child’s life, but we’re really blessed as a family because of it all. He’s such a happy, playful 3-year-old now!”  

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Human Interactions, Robotic Solutions

The university's culture of collaboration is leading to new possibilities for diagnosing and attacking cancers – by using robots.

                               In medicine, the eureka moment rarely happens. Sometimes medical advances gain momentum from a simple gesture like an introductory email or a serendipitous meeting. Just ask Ron Alterovitz, PhD, assistant professor of computer science and head of the Computational Robotics Research Group in the Department of Computer Science at UNC.

Since arriving in Chapel Hill in 2009, Alterovitz’s group has been investigating new algorithms that can enable robotic tentacles to achieve depth and precision inside the human body. One of his devices – steerable needles he co-created as a graduate student at UC-Berkeley – is being developed to treat liver and prostate cancers.

Now Alterovitz is focused on a new surgical device – a snake-like, robotic set of concentric nested tubes made of nickel titanium. The device can be deployed from the tip of a bronchoscope, allowing physicians to reach farther than ever into the lungs to diagnose abnormal growths called nodules. It can also be deployed via the nose to surgically access tumors in the brain or nearby structures in the head. The robotic device has the potential to move through the body so precisely that it can avoid anatomical obstacles and reach its target within a millimeter.

These interdisciplinary, NIH-funded projects have been of interest to School of Medicine faculty members Richard Feins, MD, professor of surgery in the division of cardiothoracic surgery, and Brent Senior, MD, Nathaniel and Sheila Harris Distinguished Professor of Otolaryngology.

After receiving an email from Alterovitz upon his arrival at UNC, Dr. Feins, an early user of the superDimension lung navigation system, was immediately interested in hearing what Alterovitz had to say.  “As surgeons, most of what we do in terms of treatment involves getting where we need to go, so when Ron came to me with the concept of a steerable catheter that could get anywhere he preprogrammed it to go, it was exciting,” says Dr. Feins.

As surgeons, most of what we do in terms of treatment involves getting where we need to go, so when Ron came to me with the concept of a steerable catheter that could get anywhere he preprogrammed it to go, it was exciting.

Dr. Senior’s work with Alterovitz didn’t involve an email; it began at church. Dr. Senior was mentoring a student of Alterovitz’s at church when the two got to talking about their work at UNC. It soon became clear to Dr. Senior that he should meet Professor Alterovitz.

“I was excited to hear what he was doing because it really is exactly what we need to be thinking about for the future of what we do in skull-base surgery,” says Dr. Senior.

Two Lungs graphic for Robotic Research by Ron AlterovitzBranching out

“Think about the airway as a tree,” says Dr. Feins. “The limbs get smaller and smaller as you fan out. You’d like to climb out to grab an apple off one of the branches, but you can only go so far before you have to stop because the limbs are too small and will break. That’s sort of what we’re talking about with reaching peripheral lung lesions.”

Diagnosing peripheral-zone lung cancer is difficult. The nodules can be reached with a CT scan and biopsied, but doing so runs the risk of collapsing the lung. Furthermore, even when the lesion is reached, the amount of tissue that can be gathered may be limited, and therefore the sample is potentially inaccurate.

Snake-like robotic needles, attached to and deployed by the bronchoscope, may provide more accurate diagnoses. As curvilinear devices that can be programmed, the needles can snake their way through the parenchyma of the lung to access nodules in the peripheral zone, striking their target with precision.

“If the nodule identified in the CT scan is on the peripheral zone, and the bronchial tubes are so small that you can’t use existing devices like the superDimension, then that’s where these robots can work,” says Alterovitz.

Early-stage diagnosis through biopsies of peripheral nodules has the potential to save lives. And in the immediate term, that’s the focus of Alterovitz and Dr. Feins. The long-term goal, however, is to actually treat the tumors. Dr. Feins uses the analogy of the early days of cardiology.

“Cardiology was primarily a diagnostic specialty,” says Dr. Feins. “They did angiograms and saw what was wrong with the patient, and then they’d have to send the patient to the surgeon. Eventually they found therapeutic options. They could dilate the arteries or put stents in the arteries. Those therapies changed the whole dynamic. I think it’s possible that if we can get the technology to precisely where we need it to go, not only can we make a diagnosis, but we can add therapeutics like localized radiation, localized chemotherapy, or even localized freezing or radio-frequency ablation.”

Skull Graphic for Robotic Research by Ron AlterovitzHigh-priced real estate 

The pituitary gland sits squarely in the middle of the skull. Flanking it on either side are the carotid arteries, which control blood flow to the brain. The cranial nerves surrounding the pituitary control vision, movement of the eyeballs, sensation to the face and jaw, and other functions critical to everyday life.

“I tell my residents that we’re dealing in high-priced real estate,” says Dr. Senior. “You have to be very exact. Critical nerves are a millimeter or two from the target area we’re trying to reach.”

According to cadaver studies, tumors in this region are common. Although rarely cause for concern, some abnormalities require operations. A century ago, surgeries in the pituitary were highly invasive, requiring the face to be fileted open. The procedures resulted in high mortality and complication rates. Today, after a series of advances, endoscopic procedures, which include dissection inside the nasal cavity, are relatively safe. UNC Hospitals performs roughly 100 such procedures per year.

Although utilizing the surgeon’s fine finger motion has proved effective thus far, there’s room for further improvement, according to Dr. Senior. Robotic technology coming from the Computational Research Group is poised to allow surgeons performing this procedure to reduce dissections and increase precision within the target area.

“The beauty of Ron’s work is that we may be able to go through natural openings and do minimal expansion of them, and then pinpoint directly into where the tumor is located by using a roadmap system,” says Dr. Senior. “Because the robot has such fine ability to position and move instruments, theoretically it would be safer as well.”

The beauty of Ron’s work is that we may be able to go through natural openings and do minimal expansion of them, and then pinpoint directly into where the tumor is located by using a roadmap system. Because the robot has such fine ability to position and move instruments, theoretically it would be safer as well.

The device can be outfitted with a variety of applications at its tip, including a camera, gripper, suctioner, and irrigator. Up to four devices with different tips could be deployed simultaneously during a procedure, with the idea that the devices could be used together by the surgeon as part of a treatment of the tumor.

Dr. Senior is optimistic about the possible advances. “Our goal with these surgeries is 0 percent mortality, 0 percent morbidity,” he says. “We don’t want any complications. Of course, we’ll never reach that, but I think that the robot will help to move us in the right direction, and it will be a stepping stone into other areas of the skull base as well. We have seen amazing advances in these surgeries in the last 20 years, and I believe that the robot will keep chipping away at those numbers and continue to improve the quality of life of our patients after the procedures.”

Learning new languages

As the collaborators continue to trade technical expertise to advance their work, Alterovitz and his lab scour medical journals for the relevant research that will aid them in the medical applications of their robots.

“Building up your vocabulary takes time, but it’s required to get up to speed,” he says.

Alterovitz talks at length with the physicians to learn about the specific procedures. Despite the challenges of learning another discipline, the give-and-take provides all parties with a better understanding of each other’s work.

“I’m in awe of what Ron does,” says Dr. Feins. “For Ron, the world of computer science is very easy. But the medicine part of what we’re doing – a lobectomy, for example – can be difficult for him to understand. I’m exactly the opposite.”

Dr. Feins and Alterovitz maintain an open dialogue. They sometimes speak for hours, hashing out the complications and challenges of their project. For them to be successful, it’s essential, Dr. Feins says, for Alterovitz to feel comfortable asking questions.

“I don’t want him to have any fear about asking, ‘What do you mean by this?,’” says Dr. Feins. “I might have to tell him you can’t put a hose that big down the airway because the patient won’t be able to breathe. And he may have to tell me that we can’t make a right-angle turn. It’s a good back and forth.”

Alterovitz enjoys the process.

“That’s the fun part about this line of work – learning about these procedures, how the physicians do them, what’s important to them as they do them, and how we can translate what they want to do into technology,” says Alterovitz.

Alterovitz isn’t a complete newcomer to medicine. After finishing his PhD at Berkeley, he received an NIH award that gave him the opportunity to work in a medical research group at UCSF Medical Center, where he was embedded with medical physicists and radiation oncologists. Dr. Senior has watched Alterovitz learn medical concepts and admires his commitment to building his medical knowledge base.

“I have to say, I was honestly impressed that he has taken it as far as he has already,” Dr. Senior says. “He has a lot more insight into the anatomy and our procedures than I would expect a computer scientist to have. He’s really done quite well in terms of getting a good, established knowledge base.”

At the start of their collaboration, Dr. Senior invited Alterovitz’s students into the cadaver lab to perform dissections. He showed them the current endoscopic instrumentation so that they could get a sense of the distances, the tightness of the space, and the current complexities of the surgeries they do.

“I think that was a very valuable thing for them,” continues Dr. Senior. “Their knowledge of the anatomy is sort of like a black box with some obstacles in it. So we were able to give them a view of the anatomy in a very true and biologic and physiologic way.”

Alterovitz acknowledges that building his medical knowledge is a work in progress.

“I’ve been learning as I go,” he says. “I almost wish I had a little more formal training. But it’s been helpful that I have great collaborators.”

Lung Graphic for Robotic Research by Ron AlterovitzCulture of collaboration

Prior to arriving at UNC, Alterovitz’s collaborative work with a UC-San Francisco Medical Center team and Johns Hopkins University mechanical engineers led to the development of steerable needles for improving the precision of prostate brachytherapy. When needles are inserted – and located accurately – in the prostate gland, radioactive seeds are deployed. The seeds distribute high doses of radiation to the tumor and only low doses to the surrounding healthy issues – so low that side effects are minimal.

Although UCSF Medical Center was located just across San Francisco Bay, Alterovitz recalls the challenges presented by the distance between Berkeley, where he lived and worked, and his collaborators near Haight-Ashbury. He had to take both a train and a bus any time he traveled to meetings with them, and it was difficult to set up gatherings spontaneously.

Such logistical impediments, Alterovitz admits, can slow research down. He has found the opposite situation at UNC, which he considers the perfect location for his work.

“A big reason this research can go forward is that here the School of Medicine and the College of Arts & Sciences are located on the same campus,” says Alterovitz. “It’s a simple thing, but it’s a huge benefit for this line of research because I can simply walk to the hospital to meet with my clinical collaborators, and we can even meet somewhat spontaneously.”

Dr. Feins feels fortunate to have such a close connection to other areas of the university.

“Proximity is critical,” says Dr. Feins. “Traditionally, in highly creative places, you have a critical mass of people that are in proximity to each other. Look back at the enclaves of painters in France, for example.”

Being geographically close has allowed Dr. Senior’s lab meetings with Alterovitz and his students to occur often.

“We’re literally right down the road from each other – and my lab is halfway between us,” says Dr. Senior. “So we’ve been able to meet very easily. It’s been absolutely great.”

Proximity alone doesn’t foster a collaborative atmosphere – silos often stand side-by-side and never meet. Rather, a shared spirit of creativity found across the campus helps to break down those silos and bring different sets of expertise together.

 “UNC has a tremendous culture of collaboration,” says Dr. Feins. “We’re able to collaborate very easily and readily, and without a lot of the things that other centers worry about, such as what’s patentable. It’s vitally important to have that proximity and culture and even, some would say, architecture – places where you can get together and talk – to foster that. That’s what allows for a creative environment, which is the reason we’re all here.”

Dr. Senior echoes those sentiments.

“I’ve worked at a lot of places,” says Dr. Senior, “and the collaborative spirit that I get from the people here is fantastic. Ron is an expert in robotics and the computer science required to make these advances possible. I’m an expert at the disease and getting us into the area where the tumors are located. My neurosurgeon colleague upstairs is the expert at the actual tumor. It’s all of us bringing our expertise together that makes advances in medicine possible.”

by Zach Read
zread@unch.unc.edu

Prashant Kaul, MD, honored by the American College of Cardiology as an "Up & Coming" physician

Dr. Kaul was honored by the ACC in the December 2013 issue of CardioSource World News

Prashant Kaul, MD, FACC, FSCAI, was honored by the American College of Cardiology as an "Up & Coming" physician in their December 2013 issue of CardioSource World News.

Dr. Kaul is an Assistant Professor of Medicine in the Division of Cardiology and Medical Director of the UNC Chest Pain Center.  Nominated for the honor by Rick Stouffer, MD, interim chief, Division of Cardiology, the article talks about Dr. Kaul's medical specialties, training, awards, his family, and his hobbies, including his involvement in the UNC Cricket Club.

To review the full issue of CardioSource World News, click here. (select page 16 for Dr. Kaul's article)

Congratulations Dr. Kaul!

Seven UNC Heart & Vascular doctors listed in The Best Doctors in America® 2014

These doctors are also listed in the December 2013 issue of Business North Carolina Magazine, as part of its annual compilation of the best doctors in North Carolina.

Seven doctors affiliated with the UNC Center for Heart and Vascular Care are included in the latest compilation of The Best Doctors in America® database. Only five percent of doctors in America earn this prestigious honor, decided by impartial peer review.

The UNC Heart & Vascular physicians included in 2014 are:

Kirkwood Adams, MD

Mark Farber, MD

Anil Gehi, MD

Larry Klein, MD

Paul Mounsey, MD, PhD

Brian Rayala, MD

Sidney Smith, MD

These seven physicians are also listed in the December 2013 issue of Business North Carolina Magazine, as part of its annual compilation of the best doctors in North Carolina.

To learn more about The Best Doctors in America® 2014 database, as well as the complete listing of all UNC physicians included, click here.

To learn more about the Business North Carolina Magazine compilation of best doctors in NC, click here.

UNC researcher earns American Heart Association award

Wolfgang Bergmeier, PhD, will use the $400,000 award to study the role of blood platelets in inflammation and injury.
UNC researcher earns American Heart Association award click to enlarge Wolfgang Bergmeier

Media contact: Mark Derewicz, 919.923.0959, mark.derewicz@unch.unc.edu

January 22, 2014

Wolfgang Bergmeier, PhD, associate professor of biochemistry and biophysics, won an Established Investigator Award from the American Heart Association to continue researching hemostasis and the role that blood platelets play in the health of blood vessels during inflammation and at sites of injury.

Hemostasis is a process by which blood stays within damaged blood vessels. In 2013, Bergmeier’s lab characterized the critical role that platelets play in that process. His team found that platelets respond to inflammation differently than they do during injury. That is, there are distinct cellular signaling pathways involved in each condition. The finding has implications for the development of antithrombotic agents, such as bloodthinners.

Dr. Bergmeier, who is a member of the UNC Lineberger Comprehensive Cancer Center and the McAllister Heart Institute at UNC, was also honored with a Contributions to Hemostasis Investigator Recognition Award from the International Society on Thrombosis and Haemostasis.

The American Heart Association established investigator award supports mid-career investigators who show unusual promise, have an established record of accomplishments, and have demonstrated a commitment to cardiovascular or cerebrovascular science through publications and scientific accomplishments.

The award carries an amount of $80,000 for each of the next five years. Bergmeier will use the money to supplement the salary of a research fellow in his lab, as well as for supplies necessary to conduct research.

UNC Cardiac Catheterization Lab reduces average radiation dose to physicians and staff by 25 percent

When technologist Mike Wolter, RT, moved from Vascular Interventional Radiology (VIR) to the Cardiac Catheterization Lab in the fall of 2012, he was reviewing radiation doses in the lab and wondered if a small reduction in the frame rate would make a difference in the long-term total radiation dose to which the cath lab employees were exposed. Here's what he found.

There are many medical reasons for needing an x-ray: broken bones, trauma to an internal organ, cancer diagnosis and treatment. The list goes on and on. During each of these x-rays, the patient is exposed to radiation.

Treatment in the cardiac catheterization lab is no different. During a typical procedure, a patient is brought into the procedure room and assisted onto a procedure table, x-ray scanning is performed to guide the physician and technologists during the procedure, and then the patient is transferred from the procedure table and taken to a room to recover.

However, the physicians and technologists do not leave the lab after one patient. They are in the lab all day, all week, all month, for many, many years. They are exposed to more radiation than any single patient will probably receive in their lifetime.

How do we keep these dedicated health care workers safe from radiation exposure?

The UNC Cardiac Catheterization Lab and Electrophysiology Lab have always been highly aware of radiation safety for its workers, and have maintained excellent radiation levels throughout the years, always much lower than the regulatory dose limit in the United States. 

Over the past year, small changes have been made in the Cardiac Catheterization lab, which is on track to reduce the average dose of radiation to physicians and staff by 25 percent in 2013, as compared to the previous four years.

When technologist Mike Wolter, RT (pictured on right), moved from Vascular Interventional Radiology (VIR) to the Cardiac Catheterization Lab Mike Wolterin the fall of 2012, he was reviewing radiation doses in the lab and wondered if a small reduction in the frame rate would make a difference in the long-term total radiation dose to which the cath lab employees were exposed. Also, would it make a difference in the image quality that the physicians needed to treat the patients? Could he lower the frame rate AND achieve a useable image?

Having worked in VIR for many years, and having learned a great deal about radiation safety from VIR physician Robert Dixon, MD, Wolter decided to make some small changes in the cath lab. 

The frame rate is the number of x-ray frames per second needed to view images of a moving object in real time. For example, when x-rays are performed to assess a broken bone, the bone is completely still with no movement involved. In the cath lab, the x-rays are assessing moving organs: the heart, kidneys, blood vessels, etc. Thus, an x-ray in the cath lab must take multiple frames per second to accurately show the moving organ/vessel.

Fluoroscopy is the medical term for the type of imaging that shows a continuous x-ray image on a monitor, which is what is used in the UNC cath lab. During a fluoroscopy procedure, an x-ray beam is passed through the body. The image is transmitted to a monitor so the movement of a body part, medical instrument or contrast agent in the body, like x-ray dye, can be seen in detail.

Wolter says, “Everybody focuses on fluoro-time (the actual length of time in which the patient is exposed to an x-ray beam).  However, it isn’t a direct representation of how much x-ray is being used. Of course, we want to cut down on fluoro-time, but I was taught to look at total patient dose during a procedure.”

Wolter started by suggesting a few things here and there and putting in his own settings for the patient frame rate, checking constantly to confirm that the physicians were able to use the images provided by the reduced frame rate. By reducing the number of frames per second, less radiation is produced.

Bradford Taylor, Associate Radiation Safety Officer for UNC Environment, Health & Safety, stresses that the goal with radiation is to use “the lowest amount to give an acceptable, diagnostic image.”

Taylor’s job is to make sure that employees at UNC are exposed to as little radiation as possible, making sure that they meet federal guidelines for radiation exposure as well as the guidelines mandated by the UNC School of Medicine and UNC Health Care.

The U.S. regulatory dose limit for radiation is 5,000 millirem/year (50 mSv/year). The average background radiation received by Americans each year is about 600 millirem (6 mSv), coming from a variety of natural sources (radon and thoron) and man-made sources such as consumer products, nuclear medicine procedures, and, of course, medical x-ray systems. 

From 2009-2012, the physicians in the UNC cath lab received an average annual radiation dose of 579 millirem. The technologists and staff in the cath lab received an average annual dose 172 millirem. Physicians, technologists and staff wear dosimeter badges that measure the radiation they are exposed to each day, and the badges are collected monthly.

Taylor has some helpful tips to remember when discussing radiation exposure.

Physicians will (most likely) always have higher doses.

Taylor explains, “Physicians get the highest dose. End of story. The procedures require them to be located closest to the patient where the doses are highest.” 

The farther a person is from a radiation source, the less they absorb. Technologists have more flexibility than the physician to step back from the radiation source during a procedure, and the distance does not need to be large to make a difference. Doubling the distance between a person and a radiation source reduces the radiation by a factor of four. If a technologist is 12 inches from the radiation source, and steps back an extra 12 inches, their dose will be four times less.

Always find out what dose calculation is being used.

Taylor says, “There are two standard measurements in dose reading: DDE and EDE. DDE is the deep dose reading of radiation. This is the exact reading from the dosimeter badges, which do not take into account any protection offered by the lead apron. EDE is the effective dose reading of radiation. This number is closer to the actual amount of absorbed radiation as it takes into account lead shielding.”

The UNC cath lab average annual dose of 579 millirem and 172 millirem from 2009-2012 is the DDE dose reading. By applying the EDE equation, which takes into account lead shielding, the average annual dose for UNC physicians and technologists/staff in the cath lab drops to 174 millirem and 52 millirem, respectively.

Don’t jump to conclusions when learning about increases or decreases in radiation exposure

Taylor recommends caution when reading about radiation exposure in the media or other sources. He says, “There are many factors that must be considered when evaluating radiation exposure. You need to find out the dose calculation being used (DDE vs. EDE). You also need to know the number of cases per year that are being performed. If volume is increasing in a particular lab, then that could be one reason why radiation is increasing."

He adds, “The opposite could also be true. If a decrease in the average dose of radiation is discovered, it could be simply that fewer procedures are being performed.”

Of the procedural cost centers reviewed in the UNC cath lab from 2009-2012:

  • 47% of procedures had an increase in total volume
  • 25% of procedures had a decrease in total volume
  • 28% of procedures had the same total volume

If this growth trend continues while the total radiation dose is being decreased, it is quite an accomplishment for the UNC Cath lab.

Best Practices in the UNC Cardiac Catheterization Lab

Since Wolter began reducing the patient x-ray frame rate in the Cath lab, the physicians and other technologists have agreed that it was a good decision, with everyone taking an active role to continually improve radiation safety.

Wolter explains, “Sometimes, the frame rate is increased to where it was previously, and the physicians will say, ‘That’s just too fast.’ They’ve adjusted to the lower frame rate very well with excellent patient results.”

Every physician and technologist wears a lead apron, which is very effective in protecting workers from up to 90% of the radiation to which they are exposed. Many also wear lead around their neck to protect their thyroid and other sensitive areas in the neck.

Wolter also decided to add some extra lead shielding in the procedure rooms. He added a second lead drape to protect the chest, in addition to lead shielding below the patient table to protect the legs and feet of the physicians and technologists.

no lead for legsyes lead for legsno abdomen shieldyes abdomen shield

Pictured from left: Cath Lab procedure table without the second lead drape protecting the legs; Cath Lab procedure table with the additional lead drape in place (notice the large gap is now sealed off); Cath Lab table without the lead chest shield; Cath Lab table with the additional lead chest shield in place, which adds 12-15 more inches of vertical protection.

In the first three months that Wolter implemented these changes (4thquarter 2012), the average radiation dose dropped by 35%. The fourth quarter 2013 radiation dose levels are still being processed, but if these trends continue, the Cath lab will have ended 2013 with a 25 percent yearly reduction in the average dose of radiation for physicians, technologists and staff.

Wolter says, “If we want to have successful, lifetime careers treating patients in a cardiac catheterization lab setting, we need to be vigilant about making it safe for everyone.”

UNC Cardiovascular Disease Fellowship Program has successful matching for 2014-2015

The National Resident Matching Program announced the five matching physicians for the UNC Cardiovascular Disease Fellowship Program for 2014-2015.

The UNC Cardiovascular Disease Fellowship Program has received their five matching physicians for 2014-2015 from the National Resident Matching Program (NRMP or The MATCH), successfully matching for all of the available positions in the program.

For the second consecutive year, the fellowship program matched with candidates selected in their top ten, showing the continued strength and growth of the program.  The new class of fellows will begin their training at UNC in July 2014.

The new 2014-2015 Cardiovascular Disease fellows are:

AKINNIRAN ABISOGUNAbisogun

RESIDENCY:  Brown University

MEDICAL SCHOOL:  Rutgers, Robert Wood Johnson Medical School

UNDERGRADUATE:  The College of William and Mary

 

SARAH CICCOTTO

Ciccotto

 RESIDENCY:  University of Maryland Medical Center

 MEDICAL SCHOOL:  University of Maryland Medical Center

 UNDERGRADUATE:  Bucknell University

 

KAMAL HENDERSON

Henderson

RESIDENCY:  Washington University School of Medicine

MEDICAL SCHOOL:  University of Alabama School of Medicine

UNDERGRADUATE:  Alabama Agricultural and Mechanical University

 

EVELEEN RANDALL

Randall

RESIDENCY:  Beth Israel Deaconess Medical Center – Harvard Medical School

MEDICAL SCHOOL:  University of North Carolina at Chapel Hill

UNDERGRADUATE:  University of North Carolina at Chapel Hill

 

SZYMON WIERNEK

Wiernek

RESIDENCY:  Norwalk Hospital – Yale University Program

GRADUATE SCHOOL:  Medical University of Silesia, School of Medicine, Katowice, Poland

MEDICAL SCHOOL:  Medical University of Silesia, School of Medicine, Katowice, Poland

You are all ‘Heart Heroes’: American Heart Month - February 2014

February is American Heart Month. All month long, the UNC Center for Heart and Vascular Care will be celebrating your hard work and dedication to treating patients with cardiovascular disease.

Heart Heroes

The UNC Heart and Vascular theme for American Heart Month 2014 is Heart Heroes.

You are all heroes to your patients, providing them with compassionate care and life-saving procedures.  You are continually researching to find new and better ways to treat cardiovascular disease.

We want to share your Heart Hero stories with the UNC community and the general public.  We need your help.  I am looking for feedback from anyone: faculty, fellows, residents, technologists, managers, administrative assistants...if you are part of UNC Heart and Vascular, I'd love to hear about your Heart Hero story.

  • Send us patient success stories. 
  • Tell us about your innovative research or procedure.
  • Let us know about a colleague who you think is a true Heart Hero.
  • Involved in collaborative work across Heart and Vascular?  Let us know about it.
  • Have great cardiovascular lifestyle or diet tips? Share them with us.

Each week in February, the UNC School of Medicine Vital Signs newsletter and UNC Health Care Employee News will be sharing our Heart Hero stories, and we need your story ideas because you are the ones making the difference in the lives of our patients.

Contact Laura Melega, Communications Specialist, with any Heart Hero story idea at , (919) 843-8217, or stop by her cubicle on the 6th floor of Burnett-Womack (6038-E). 

Schedule of Events

We have many events planned for February, and we hope you’ll show your support for American Heart Month.  More events to come as we get closer to February! 

Monday, February  3 - UNC Center for Heart and Vascular Healthy Heart Initiative – 11:00am-1:00pm – NC Children’s Hospital Lobby

Stop by for free information on how to improve your cardiovascular health.  Information will include heart healthy diets, symptoms of heart disease, and where to find treatment that is right for you. And don’t forget to pick up your free American Heart Month pin and learn about our GO RED FOR WOMEN Photo Booth!

Friday, February 7 – GO RED FOR WOMEN Photo Booth – 11:00am-1:00pm - NC Children’s Hospital Lobby Stage

February 7 is National WEAR RED DAY. Show your support for women’s heart health by stopping by the GO RED FOR WOMEN Photo Booth!  Bring your co-workers to get your photo taken for a UNC Health Care slide show highlighting our support for women’s heart health.  Can’t wear Red to work?  No problem!  Bring a red sweater, jacket, hat, scarf to slip on, or simply wear your American Heart Month pin (which is RED and will be available at the booth!).  Show your support for women’s heart health and stop by the Photo Booth.

Friday, February 14 – Atrial Fibrillation: Live Facebook chat with Heart and Vascular experts from UNC Center for Heart and Vascular Care and Rex Healthcare - Time TBD (Date subject to change)

Faculty physicians from the new UNC Heart Rhythm Specialists at Rex will be available during this live Facebook chat to talk about atrial fibrillation and the multiple treatment options for A-Fib that are available at UNC and Rex.  If you or a loved one is at risk for cardiovascular disease or is currently struggling with atrial fibrillation, join us during the live chat.

February 18-21 - Heart Month Employee Appreciation 

Be on the lookout for some heart-healthy goodies that will be delivered to your unit this week!  Please know that you are all appreciated for your hard work and dedication.  Thank you!

Tuesday, February 25 - UNC Employee Health Fair – 10:00am-3:00pm - NC Women's Hospital Lobby

Get screened for cardiovascular disease!  It is one of the most important things you can do to maintain your cardiovascular health. Exams include cholesterol and blood pressure screenings, weight and waist measurements with BMI (Body Mass Index), as well as medical counseling and educational information, including risk factors and lifestyle modifications. No appointment is necessary, and all appointments are free of charge to UNC Health Care and UNC School of Medicine employees. Stop by the Employee Health Fair and get screened!

Wednesday, February 26 - 8:30am-9:00am - UNC Mallwalkers 'Heels in Motion' Program -  The Streets at Southpoint

Ross Simpson, MD, Director of the Lipid Prevention Clinic at UNC, will be talking about the importance of cholesterol management.  UNC Mallwalkers at The Streets at Southpoint has been helping local residents live healthier lifestyles since 2002. The program has provided community members with the opportunity to stretch their legs and exercise in safe and comfortable environments. Since its inception, the mallwalking program at Southpoint has grown to more than 1,200 members who have logged more than 250,000 miles.  Know a friend or family member who might want to sign-up?  Click here for more information.

New guidelines for management of high blood pressure released

Dr. Sidney Smith of UNC is a member of the expert panel that wrote the new guidelines.
New guidelines for management of high blood pressure released click to enlarge Dr. Sidney Smith

Media contact:  Tom Hughes, 919-966-6047,

Wednesday, December 18, 2013

A new guideline for the management of high blood pressure, developed by an expert panel and containing nine recommendations and a treatment algorithm (flow chart) to help doctors treat patients with hypertension, was published online by JAMA.

"These new guidelines provide reliable, evidence-based recommendations that can reduce the burden of stroke and heart disease in our country," said Dr. Sidney Smith, a member of the expert panel that wrote the new guidelines and professor of cardiology at the University of North Carolina School of Medicine.

"The challenge now is to see that these new guidelines are implemented by physicians and patients. Doing so will reduce the burden of stroke and heart disease facing the more than 75 million patients in our country with high blood pressure," Smith said.

Hypertension is the most common condition seen in primary care and leads to heart attack, stroke, kidney failure, and death if not detected early and treated appropriately. “Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults,” according to information in the article.

The report, the “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults,” is from panel members appointed to the Eighth Joint National Committee.

The guideline addresses three questions related to high BP management:

1) At what BP should medication be started in patients with hypertension?
 
2) What BP goal should patients achieve to know they are enjoying proven health benefits from their medication?
 
3) What are the best choices for medications to begin treatment for high blood pressure?
 
The nine recommendations in the guideline answer those three questions. In summary, “There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years.”

“There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.”

The authors emphasize important differences from the past versions of the guideline. For development of these recommendations, “evidence was drawn from randomized controlled trials (RCTs), which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important health outcomes,” the authors write. These guidelines also sought to establish “similar treatment goals for all hypertensive populations except when evidence … supports different goals for a particular subpopulation.”

Also, rather than defining hypertension, the panel addressed threshold blood pressure for starting treatment. The report recommends beginning treatment for people aged 60 and older at a blood pressure of 150/90, and treating to below that level based on trial evidence, but the authors emphasize that “this evidence-based guideline has not redefined high BP and the panel believes that the 140/90 mm Hg definition from Joint National Committee 7 remains reasonable.” Lifestyle interventions should be used for everyone with blood pressures in this range.

They add that with each strategy, clinicians should regularly assess BP, encourage evidence-based lifestyle and adherence interventions, and adjust treatment until goal BP is attained and maintained. “For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs.”

“The recommendations from this evidence-based guideline from panel members appointed to the Eighth Joint National Committee offer clinicians an analysis of what is known and not known about BP treatment thresholds, goals, and drug treatment strategies to achieve those goals based on evidence from RCTs. However, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient. We hope that the algorithm will facilitate implementation and be useful to busy clinicians. The strong evidence base of this report should inform quality measures for the treatment of patients with hypertension,” the authors conclude.

   

The Top Ten Heart and Vascular News Stories of 2013

As we near the end of 2013, find out which Heart and Vascular news stories were most popular with our online readers.

Let's count down the Top Ten Heart and Vascular News Stories of 2013...

#11 - The UNC Comprehensive Vein Clinic expands, adding interventional radiologists to treat varicose veins and other venous diseases - June 2013 - **ADDED BONUS STORY - With a mere 26 readers less than #10, it deserved inclusion on this list.**

Physicians and nurse practitioners from the Vascular Interventional Radiology division of the UNC School of Medicine have joined the UNC vascular surgeons in offering comprehensive vein treatment services at the UNC Comprehensive Vein Clinic, conveniently located in Chapel Hill at Meadowmont Village’s UNC Center for Heart and Vascular Care.

#10 - New Faculty and Staff Join UNC Center for Heart and Vascular Care - August 2013

Introduction of new faculty and staff from all four divisions of UNC Heart and Vascular: Cardiothoracic Surgery, Cardiology, Vascular Interventional Radiology, and Vascular Surgery.

#9 - UNC Hospitals offers free screenings for persons at risk of life-threatening arterial disease and aortic aneurysms - August and September 2013

Physicians and nurses from the UNC Center for Heart and Vascular Care will provide free screenings for peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) on Saturday, September 21, from 9:00am to 1:00pm in the Procedural Recovery Unit (PRU) on the second floor of N.C. Memorial Hospital.

#8 - Mending A Broken Heart - May 2013

The cardiovascular research of award-winning Li Qian, PhD, of the UNC McAllister Heart Institute, included at #2 on the American Heart Association “Top Ten Advances in Heart Disease and Stroke Research” during 2012

#7 - UNC is Treating Prostate Enlargement Without Surgery - October 2013

Vascular interventional radiologists in the UNC Center for Heart and Vascular Care are some of the first in the nation to use a catheter-based procedure to treat men with an enlarged prostate.  Called prostatic artery embolization (PAE), the new technique is minimally-invasive for patients. It requires no open surgery, meaning less pain, no hospital admission, and for many patients, an almost immediate improvement in their symptoms.

#6 - CICU and CTICU implement new staffing models to improve patient care and efficiency- October 2013

In July 2013, the Cardiac Intensive Care Unit (CICU) and the Cardiothoracic Surgical Intensive Care Unit (CTICU) implemented new staffing models to improve patient care and efficiency.  Jason Katz, MD, MHS, Medical Director of the CICU and CTICU & Critical Care Service, spearheaded the effort to make these changes.

#5 - Meet the 2013-2014 Fellows and Integrated Residents in the UNC Center for Heart and Vascular Care - July 2013

Introduction of fellows and integrated residents in all four divisions of UNC Heart and Vascular: Cardiothoracic Surgery, Cardiology, Vascular Interventional Radiology, and Vascular Surgery.

#4 - Trial begins on “off-the-shelf” stent graft for pararenal aortic aneurysm - January 2013

Mark Farber, MD, Director of UNC Aortic Disease Management in the UNC Center for Heart and Vascular Care, investigates stent graft that may be an improvement over other stent grafts used for aortic aneurysms in that it does not need to be customized for the patient, thus earning the nickname as an “off-the-shelf” graft.

#3 - Cardiac Catheterization Lab and Electrophysiology Lab Construction and Renovation - November 2012 **This is a great example of the power of the Internet.  While this story was originally posted in November 2012, it was viewed so often in 2013 that it landed at #3 on the list!**

For the past two years, the Cardiac Catheterization labs and Electrophysiology labs have been undergoing a dramatic transformation.  And now, much of the work has been completed.  And the results are amazing.

#2 - The DASH Diet Named Best Diet Overall by U.S. News & World Report - February 2013

Alan Hinderliter, MD, of the UNC Center for Heart and Vascular Care was an investigator in the Duke University ENCORE trial, which evaluated the effectiveness of the DASH diet on cardiovascular health.

And the Number One Heart and Vascular News Story of 2013 is....

#1 - Unique multidisciplinary treatment for vascular malformations at UNC Health Care - December 2012 - **The UNC Malformations Clinic received a confirmed new patient from this story, after the patient "googled" their condition from their home and found this story.**

Vascular interventional radiologist Joseph Stavas, MD, professor of radiology in the UNC School of Medicine, and clinician in the UNC Center for Heart and Vascular Care, works with UNC physicians from 14 different departments to provide comprehensive care for vascular malformations.


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UNC Heart and Vascular Interventional Radiologists offer help and support to the community

For the second year in a row, the Vascular Interventional Radiology division combined teamwork building, outreach and service, all into one at Urban Ministries (UM) in Durham (http://www.umdurham.org/) in November 2013. UM is a community support facility in downtown Durham that offers food, shelter, and counseling for those in need.

Members of the VIR division brought their kindness, humor, and dedication to serving others to UM and fed dinner to 275 members of the greater Durham-Chapel Hill community.  

Ari Isaacson, MD, Assistant Professor in the VIR division, participated last year while he was a VIR Fellow.   He was very happy to be able to participate again this year.

Members of the division that participated in the outreach are faculty Hyeon Yu, Ari Isaacson, Robert Dixon, and Joe Stavas and fellow Eric McCloney.  Abdominal Imaging faculty member Lauren Burke also volunteered.

 VIR homeless docsisaacson stirringDixon and Burke on lineYu stirring

Pictured from left to right: VIR faculty Robert Dixon, Joseph Stavas, Ari Isaacson, and Hyeon Yu; Dr. Isaacson working in the kitchen; Robert Dixon and Lauren Burke serving food; Dr. Yu working in the kitchen

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Media Coverage - November 2013

Carolina Week News - Trans Fats - featuring Ross Simpson, MD (from 11:28-13:50)

(for more information on trans fats, click here)

 

'Arts for Hearts' raises money for UNC Cardiology

Daily Tar Heel

Pharmaceutical Devices


Pat Robertson donates to UNC after successful heart surgery - featuring UNC Cardiothoracic Surgery

Raleigh News & Observer

Twitter: @univgazette - reaching 737 followers

 

UNC Kenan-Flagler presents alumni awards - featuring Cam Patterson, MD

Kenan-Flagler online news

Kenan-Flagler Blog

San Francisco Chronicle

PR Web

Insurance News Net

Twitter - retweeted 4 times reaching 39,584 followers

@uncheartvasculr

@KenanFlagler

 

Shift In Cholesterol Advice Could Double Statin Use - featuring Sidney Smith, MD

See full article on media coverage here

Twitter: @nprnews - retweeted four times reaching 2,127,761 followers

National Public Radio (NPR) 

NPR Blog

All Things Considered, National Public Radio **AUDIO**

The People's Pharmacy, National Public Radio **AUDIO from 27:59-34:32**

Delmarva Public Radio, WSDL/WSCL, Delaware/Maryland

WYPR, Maryland, NPR

New Hampshire Public Radio

 

Risk calculator for cholesterol appears flawed - featuring Sidney Smith, MD

The New York Times

The Boston Globe

Time Magazine

Columbus (OH) Dispatch

NBC News


How Good Is the New ACC/AHA Risk Calculator? - featuring Sidney Smith, MD

 Medscape

 

Experts defend new heart attack prevention advice - featuring Sidney Smith, MD

Newsday

 

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Presentations and Publications - November 2013

Presentations

"Collegiate Athlete with an Abnormal QT Interval on ECG"

Eugene Chung, MD, ACC Sports Cardiology Summit, October 2013

 

"Cases in PH, Dilemmas, from WHO Group 2"

Lisa Rose-Jones, MD, 5th Annual North Carolina Research Triangle Pulmonary Hypertension Symposium, November 8, 2013, Durham, NC

 

"Porsche By Design exhibition at NC Art Museum - American Cars and Hot Rods Meetup"

Jenni Hughes, MSN, RN,CCRN-CSC, Program Manager, Aortic Disease Management, November 9, 2013, Raleigh, NC

 

"Left Atrial Appendage Closure for Stroke Prophylaxis in Patients with Atrial Fibrillation"

Eugene Chung, MD, Cardiovascular Grand Rounds, November 11, 2013, Chapel Hill, NC

 

"Acute Heart Failure: A New Era or Same Old Problems?"

 Kirkwood Adams, MD (Moderator), AHA Scientific Sessions, November 17, 2013, Dallas, TX

 

"New Guideline Recommendations for Prevention and Control of Cardiovascular Risk Factors: From Diabetes to LDL Cholesterol Control"

Sidney Smith, MD, AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"Joint AHA/Brazilian Society of Cardiology Session: New Trends for Prevention and Diagnosis of Cardiovascular Disease"

Sidney Smith, MD, (Moderator), AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"Ventricular Tachycardia Events Are Associated with Admissions for Infection or Heart Failure in Patients with Left Ventricular Assist devices and Implantable Cardio-Defibrillators"

TJ O'Neill, MD (Fellow, Cardiology), AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"A Novel Implantable Cardio-Defibrillator Programming Strategy for Patients with Left Ventricular Assist Devices Reduces Shocks"

TJ O'Neill, MD (Fellow, Cardiology), AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"Guidelines: Is Contextualization Necessary?"

Sidney Smith, MD, AHA Scientific Sessions, November 19, 2013, Dallas, TX


"Medicare Part D Medication Use in a Community Cohort with Hypertension: The Atherosclerosis Risk in Communities (ARIC) Study"

Carla Sueta, MD, PhDAHA Scientific Sessions, November 19, 2013, Dallas, TX

 

"Current Role of AHA and ACC in Guidelines Development"

Sidney Smith, MDAHA Scientific Sessions, November 20, 2013, Dallas, TX

 

"Clinical Practice Guidelines for Prevention: Next Steps"

Sidney Smith, MD,  (Panelist), AHA Scientific Sessions, November 20, 2013, Dallas, TX

 

"VAD-Related Infections"

Jason Katz, MD, MHSAHA Scientific Sessions, November 20, 2013, Dallas, TX

 

Publications

Living in a medically underserved county is an independent risk factor for major limb amputation.

McGinigle KL, Kalbaugh CA, Marston WA.

J Vasc Surg. 2013 Nov 16. doi:pii: S0741-5214(13)01741-2. 10.1016/j.jvs.2013.09.037. [Epub ahead of print]

 

Biomarker Guided Therapy for Heart Failure: Focus on Natriuretic Peptides.

Pruett AE, Lee AK, Patterson JH, Schwartz TA, Glotzer JM, Adams KF.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Adams et al. Respond to "Body Mass Index and Mortality"

Adams KF, Leitzmann MF, Ballard-Barbash R, Albanes D, Harris TB, Hollenbeck A.

Am J Epidemiol. 2013 Nov 11. [Epub ahead of print] No abstract available.

 

Soluble ST2 in Ambulatory Patients With Heart Failure: Association With Functional Capacity and Long-Term Outcomes.

Felker GM, Fiuzat M, Thompson V, Shaw LK, Neely ML, Adams KF, Whellan DJ, Donahue MP, Ahmad T, Kitzman DW, Piña IL, Zannad F, Kraus WE, O'Connor CM.

Circ Heart Fail. 2013 Nov 1;6(6):1172-1179. Epub 2013 Oct 8.

 

Advanced Therapies for End-Stage Heart Failure.

Katz JN, Waters SB, Hollis IB, Chang PP.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Left atrial thrombus after appendage ligation with LARIAT.

Baker MS, Paul Mounsey J, Gehi AK, Chung EH.

Heart Rhythm. 2013 Nov 7. doi:pii: S1547-5271(13)01163-6. 10.1016/j.hrthm.2013.10.024. [Epub ahead of print] No abstract available.

 

The Effect of Anxiety and Depression on Symptoms Attributed to Atrial Fibrillation.

Thompson TS, Barksdale DJ, Sears SF, Mounsey JP, Pursell I, Gehi AK.

Pacing Clin Electrophysiol. 2013 Nov 11. doi: 10.1111/pace.12292. [Epub ahead of print]

 

Genetics and Heart Failure: A Concise Guide for the Clinician.

Skrzynia C, Berg JS, Willis MS, Jensen BC.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Heart factory or fiction?: cardiac progenitor cells and regeneration.

Jensen BC, Patterson C.

Circulation. 2013 Nov 12;128(20):2181-2. doi: 10.1161/CIRCULATIONAHA.113.006262. Epub 2013 Oct 18. No abstract available.

 

Survival After Shock Therapy in Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy-Defibrillator Recipients According to Rhythm Shocked: The ALTITUDE Survival by Rhythm Study.

Powell BD, Saxon LA, Boehmer JP, Day JD, Gilliam FR 3rd, Heidenreich PA, Jones PW, Rousseau MJ, Hayes DL.

J Am Coll Cardiol. 2013 Oct 29;62(18):1674-9. doi: 10.1016/j.jacc.2013.04.083. Epub 2013 Jun 27.

 

Pulmonary Hypertension: Types and Treatments.

Rose-Jones LJ, McLaughlin V.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

RE-LYing on Dabigatran for Periprocedural Anticoagulation: Is It Safe?

Bamimore A, Mounsey JP.

Pacing Clin Electrophysiol. 2013 Nov;36(11):1325-7. doi: 10.1111/pace.12217. Epub 2013 Jul 22. No abstract available.

 

Platelet-targeted gene therapy with human factor VIII establishes haemostasis in dogs with haemophilia A.

Du LM, Nurden P, Nurden AT, Nichols TC, Bellinger DA, Jensen ES, Haberichter SL, Merricks E, Raymer RA, Fang J, Koukouritaki SB, Jacobi PM, Hawkins TB, Cornetta K, Shi Q, Wilcox DA.

Nat Commun. 2013 Nov 19;4:2773. doi: 10.1038/ncomms3773.

 

The Ubiquitin Ligase CHIP Prevents SirT6 Degradation through Noncanonical Ubiquitination.

Ronnebaum SM, Wu Y, McDonough H, Patterson C.

Mol Cell Biol. 2013 Nov;33(22):4461-72. doi: 10.1128/MCB.00480-13. Epub 2013 Sep 16.

 

Orthostatic change in blood pressure and incidence of atrial fibrillation: results from a bi-ethnic population based study.

Agarwal SK, Alonso A, Whelton SP, Soliman EZ, Rose KM, Chamberlain AM, Simpson RJ Jr, Coresh J, Heiss G.

PLoS One. 2013 Nov 11;8(11):e79030. doi: 10.1371/journal.pone.0079030.

 

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson J, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW.

Circulation. 2013 Nov 12. [Epub ahead of print] No abstract available.

 

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Stone NJ, Robinson J, Lichtenstein AH, Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW.

Circulation. 2013 Nov 12. [Epub ahead of print] No abstract available.

 

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Eckel RH, Jakicic JM, Ard JD, Hubbard VS, de Jesus JM, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Miller NH, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TW, Yanovski SZ.

Circulation. 2013 Nov 12. [Epub ahead of print] No abstract available.

 

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, McBride P, Eckel RH, Schwartz JS, Goldberg AC, Shero ST, Gordon D, Smith SC Jr, Levy D, Watson K, Wilson PW.

J Am Coll Cardiol. 2013 Nov 7. doi:pii: S0735-1097(13)06028-2. 10.1016/j.jacc.2013.11.002. [Epub ahead of print] No abstract available.

 

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Eckel RH, Jakicic JM, Ard JD, Miller NH, Hubbard VS, Nonas CA, de Jesus JM, Sacks FM, Lee IM, Smith SC Jr, Lichtenstein AH, Svetkey LP, Loria CM, Wadden TW, Millen BE, Yanovski SZ.

J Am Coll Cardiol. 2013 Nov 7. doi:pii: S0735-1097(13)06029-4. 10.1016/j.jacc.2013.11.003. [Epub ahead of print] No abstract available.

 

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Goff DC Jr, Lloyd-Jones DM, Bennett G, O'Donnell CJ, Coady S, Robinson J, D'Agostino RB Sr, Schwartz JS, Gibbons R, Shero ST, Greenland P, Smith SC Jr, Lackland DT, Sorlie P, Levy D, Stone NJ, Wilson PW.

J Am Coll Cardiol. 2013 Nov 7. doi:pii: S0735-1097(13)06031-2. 10.1016/j.jacc.2013.11.005. [Epub ahead of print] No abstract available.

 

Stage B: What is the Evidence for Treatment of Asymptomatic Left Ventricular Dysfunction?

Reed BN, Sueta CA.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Stage A: Can Heart Failure Be Prevented?

Danelich IM, Reed BN, Sueta CA.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

A Practical Guide to the Treatment of Symptomatic Heart Failure with Reduced Ejection Fraction (HFrEF).

Reed BN, Sueta CA.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Long-term clinical outcomes with the use of a modified provisional Jailed-Balloon stenting technique for the treatment of nonleft main coronary bifurcation lesions.

Depta JP, Patel Y, Patel JS, Novak E, Yeung M, Zajarias A, Kurz HI, Lasala JM, Bach RG, Singh J.

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UNC Center for Heart and Vascular Care is "a recognizable presence" at American Heart Association Scientific Sessions 2013

The American Heart Association Scientific Sessions 2013 were held in Dallas, TX from Nov. 16-20, 2013.

The UNC Center for Heart and Vascular Care had multiple presenting authors at the American Heart Association (AHA) Scientific Sessions 2013, held in Dallas, TX from November 16-20.

AHA Scientific Sessions is the leading cardiovascular meeting for basic, translational, clinical and population science in the United States, with more 18,000 cardiovascular experts from more than 105 countries, in addition to more than 1.5 million virtual professional attendees.

Programming is designed to improve patient care by communicating the most timely and significant advances in prevention, diagnosis and treatment of cardiovascular disease from many different perspectives. Sessions includes five days of comprehensive, unparalleled education, all from the world’s leaders in cardiovascular disease.

Jennifer Schwartz, MD, says, "I would like to applaud everyone involved in AHA. We are clearly moving towards being a recognizable presence at national meetings. I hope we can highlight this and continue this momentum. It's exciting to see fellows presenting and it could not be done without faculty mentorship and participation."

Presenting Authors from the UNC Center for Heart and Vascular Care included: (in alphabetical order)

  • Kirkwood Adams, MD - Moderator, Acute Heart Failure: A New Era or Same Old Problems?
  • Jason Katz, MD, MHS - VAD-Related Infections

Brian Jensen, MD, added, "Fantastic.  Let’s recognize [Dr. Katz's] central role in leading the resurgence of our investigator-initiated clinical research enterprise."

  • TJ O'Neill, MD (Fellow, Cardiology) - Ventricular Tachycardia Events Are Associated with Admissions for Infection or Heart Failure in Patients with Left Ventricular Assist devices and Implantable Cardio-Defibrillators

A Novel Implantable Cardio-Defibrillator Programming Strategy for Patients with Left Ventricular Assist Devices Reduces Shocks

Dr. Katz added, "We had several great VAD presentations here at the AHA. [Dr. O'Neill] presented both of his posters on the novel ICD programming protocol...and there was a ton of buzz about them. Very well-received and lots of interest in moving forward with a multicenter, collaborative prospective study."

  • Sidney Smith, MD - Current Role of AHA and ACC in Guidelines Development

Guidelines: Is Contextualization Necessary?

New Guideline Recommendations for Prevention and Control of Cardiovascular Risk Factors: From Diabetes to LDL Cholesterol Control

Panelist, Clinical Practice Guidelines for Prevention: Next Steps

Moderator, Joint AHA/Brazilian Society of Cardiology Session: New Trends for Prevention and Diagnosis of Cardiovascular Disease

  • Carla Sueta, MD, PhD - Medicare Part D Medication Use in a Community Cohort with Hypertension: The Atherosclerosis Risk in Communities (ARIC) Study
  •  Ramsey Wehbe, MD (former UNC Medical School student) - Obesity is Associated with Increased Mortality and Hospitalization in Patients Supported with a Continuous-Flow Left Ventricular Assist Device

Dr. Katz added, "[Dr. Wehbe] presented our work on obesity and VADs in an oral abstract presentation. He did an incredible job and brilliantly fielded questions from the moderators, as well as David Farrar (Head of Research at Thoratec)."

Study Authors also include: Sarah Waters, Amanda Bowen, Kimberly Guise, Eugene Chung, Anil Gehi, Brian Jensen, Patricia Chang, Paul Mounsey, Jennifer Schwartz, Jerome Federspiel, Anna Kucharska-Newton, Jo Rodgers, Sally Stearns, Aparna Veeramachaneni, and Brett Sheridan.

 

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FDA Says Trans Fats Aren't Safe in Food

Ross Simpson, MD, of the UNC Center for Heart and Vascular Care spoke to the media about trans fats
FDA Says Trans Fats Aren't Safe in Food click to enlarge Ross Simpson, MD, PhD

In November 2013, the Food and Drug Administration (FDA) made a preliminary determination that "partially hydrogenated oils (PHOs), the primary dietary source of artificial trans fat in processed foods, are not “generally recognized as safe” (GRAS) for use in food."

Ross Simpson, MD, PhD, of the UNC Center for Heart and Vascular Care and Director of the UNC Lipid Prevention Clinic, spoke to Carolina Week News about the use trans fats in foods and the cardiovascular health implications of trans fats.

Carolina Week News - (video from minute 11:28-13:50)

The FDA has opened a 60-day Comment Period on Measure to Further Reduce Trans Fat in Processed Foods.

To read more about the proposed FDA ban on trans fats, click here.

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New cholesterol guidelines published by the American College of Cardiology and the American Heart Association

Sidney Smith, MD, of the UNC Center for Heart and Vascular Care served as one of the guideline writers
New cholesterol guidelines published by the American College of Cardiology and the American Heart Association click to enlarge Sidney Smith, MD

In November 2013, the American College of Cardiology and the American Heart Association, by request of the National Heart, Lung and Blood Institute, published revised guidelines for treatment of high cholesterol levels.  Sidney Smith, MD, of the UNC Center for Heart and Vascular Care served as one of the guideline writers and spoke extensively to the media about the guidelines.

National Public Radio - Shift In Cholesterol Advice Could Double Statin Use

Broadcast Summary: "The new study throws out the notion that a specific blood cholesterol level should automatically trigger treatment with cholesterol-lowering drugs. Also out the window is any notion of treating patients with drugs until their so-called bad cholesterol hits a specific target – one that for most people is all but impossible to achieve by diet alone. Instead, the new guidelines groups adults into four categories most likely to benefit from cholesterol-lowering drugs. They include people with heart disease and diabetes, as well as people with high levels of LDL cholesterol, the bad kind. The guidelines also explicitly tell doctors not to bother with drugs other than statins, saying they're the only ones proven to reduce the risk of heart attacks and strokes."

This story was broadcast on NPR stations across the country, including: Delmarva Public Radio, WSDL/WSCL, Delaware/Maryland, and WYPR, Maryland

All Things Considered, NPR - November 13, 2013 (Audio)

The People's Pharmacy, NPR - November 16, 2013 (Audio, from minute 27:59-34:32)

When the risk calculator for the revised cholesterol guidelines appeared to be flawed, Dr. Smith again spoke extensively with the media about the calculator.

The New York Times - Risk calculator for cholesterol appears flawed

This story was published across the country, including: The Boston Globe, Time Magazine, the Columbus (OH) Dispatch, and NBC News.

Medscape included an article entitled, "How Good Is the New ACC/AHA Risk Calculator?" in which Dr. Smith commented about the risk calculator, saying that they "intend to move forward with the implantation of these guidelines," but if there is something that can make them better, they will do it. "If we think there are some minor changes or some alterations in therapeutic strategies, we'll do it," said Smith."

In a Newsday article, Dr. Smith explained the process the committee used to create the Risk Calculator.

Story summary:  Dr. Sidney C. Smith Jr., a former Heart Association president from the University of North Carolina at Chapel Hill, said dozens of heart experts spent nearly five years carefully reviewing top-quality studies to develop the guidelines and the formula and let other major medical groups review it before adopting it.  "We think that we've come up with a good risk instrument" and intend to move forward to implement the guidelines, he said. The formula doesn't prescribe or mandate that someone take a drug, just flag people whose heart risks are high enough that they should consider it.  "You should have that conversation with your physician. This is not computer medicine," Smith said.


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Recent UNC Nursing News and Accomplishments

  • UNC Health Care was the #1 academic health care center IN THE COUNTRY for HCAHPS scores in 2011 and 2012.  This was announced at the 2013 University Health Care System Consortium (UHC) meeting in October 2013. 

The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals have collected information on patient satisfaction, prior to HCAHPS there was no national standard for collecting or publicly reporting patients' perspectives of care information that would enable valid comparisons to be made across all hospitals.

Mary Tonges, RN, PhD, FAAN, Senior VP and Chief Nursing Officer, UNC Health Care System, said in an email, "IT DOESN”T GET BETTER THAN THIS!!  Please be sure to let your staff know and extend our sincere thanks.  Wow, what you do for our patients."

  • The Cardiothoracic ICU (CTICU) has gone 400+ days (and counting) without a VAP (ventilator-associated pneumonia).

They join the Cardiac Intensive Care Unit in reaching an outstanding milestone in reducing VAP in patients.

  • The 2013 Fiscal Year Nursing Annual Report has been released, and you can view the entire report here.

Make sure to check out pages 20-21 to recognize Heart and Vascular nurse Ellenita Kornegay, named as a Nurse of the Year and pages 22-23 to recognize Heart and Vascular health unit coordinator Vanessa Moore as an Assistive Personnel of the Year.


 

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Year In Review - UNC Medical Foundation

Each year, supporters of UNC Cardiovascular Medicine receive an update about our various activities, awards, grants, conferences, and new faculty. Here is a sampling of what our donors and supporters are hearing about this year.

UNC and the American Heart Association celebrate a 40-year Partnership

On December 11, 2012, a select group of friends and supporters of UNC Cardiovascular Medicine and the American Heart Association gathered at the Medical Biomolecular Research Building (MBRB) on UNC’s campus to celebrate the 40-year partnership between the American Heart Association (AHA) and the University of North Carolina School of Medicine.  Guests at this intimate event were treated to an Liu in labinsider’s research tour, led by Mauricio Rojas, MD, and Jiandong Liu, PhD, of the Mouse and Zebra Fish Core research facilities - both of which are integral to the cutting edge cardiovascular research at Carolina.

Jiandong Liu, PhD, holds up a specimen in the Zebra Fish Core Research Facility during the UNC-AHA research tour Rojas

Mauricio Rojas, MD, discusses his cardiovascular research in the Mouse Core Research Facility

 


Cody DeenCody Deen, MD, will serve as Chief of Staff of Chatham Hospital beginning in January 2014

Cody Deen, MD, of the UNC Center for Heart and Vascular Care was nominated for and has accepted the role of Chief of Staff of Chatham Hospital for a two-year term starting in January 2014.  Dr. Deen is the medical director of Cardiac Rehab at Chatham Hospital, and he sees patients at Chatham Primary Care.  Nominated by Dr. James Davis, MD, of Chatham Primary Care, Dr. Deen's "personality, community presence, leadership, and ability to work with multiple parties to resolve problems and move innovation forward" were cited as reasons for his nomination.

 Awards 

Sid SmithSidney C. Smith, Jr. MD, receives the 2013 Joseph Stokes, III, MD Award from the American Society for Preventive Cardiology.  This prestigious award honors those who have made significant contributions in the field of preventive cardiology through research, teaching, clinical activity and leadership.  Dr. Smith is a past president of the American Heart Association (AHA) and the World Heart Federation (WHF).

 

schwartz 1Jennifer Schwartz, MD, was honored as a Fellow of the Heart Rhythm Society.  The Fellow of the Heart Rhythm Society (FHRS) credential exemplifies advanced training, certification, and commitment to the field of electrophysiology. 

 

Charles Burke, MD, Division Chief, Vascular Interventional Radiology, has Burkebeen inducted as a Fellow in the Society of Interventional Radiology (SIR). This honor, achieved by fewer than 10 percent of SIR members, goes to members who have been recognized by the society as a leading contributor in educational, investigational, organizational or professional aspects of interventional radiology. 

 

Mounsey 1J. Paul Mounsey, MD, PhD, MRCP, FACC, has been awarded the Sewell Family/McAllister Distinguished Professorship in electrophysiology.  The professorship is designed to recognize an outstanding clinician, teacher, and scholar for the Division of Cardiology and the UNC McAllister Heart Institute within the School of Medicine who is a recognized leader in the field of electrophysiology.


The Rita and Eric Bigham Cardiology Special Project Fund brings young Afghan girl to UNC for life-saving cardiac care

MaryamIn Summer 2013, Rita and Eric Bigham of Chapel Hill partnered with UNC Cardiovascular Medicine and the Medical Foundation of North Carolina to provide medical treatment for Maryam, a little girl from Afghanistan, who suffers from a heart defect.

Maryam underwent heart surgery at UNC Hospitals on Tuesday, July 9, and came through it well, said her surgeon, Michael R. Mill, MD, Division of Cardiothoracic Surgery. Dr. Mill corrected a narrowing of Maryam's aorta (a surgical procedure called resection of coarctation of the aorta) and closed a fetal blood vessel, the ductus arteriosus, that had not closed normally when Maryam was a newborn (that surgery is called division of a patent ductus arteriosus (PDA).

BighamsRita Bigham, a retired school teacher, has an enduring passion for work with children, medical volunteerism, and philanthropic investment. Eric Bigham was a dedicated scientist during his impressive tenure at GlaxoWellcome. Rita and Eric are active volunteers at UNC Hospitals in areas ranging from the Cardiac Intensive Care Unit, the N.C. Children’s Hospital, Adult Rehab, and the Lineberger Comprehensive Cancer Center.  At the Bigham household, service is a family affair – even her dog Pippin has contributed more than 1,000 service hours at UNC as a therapy dog.

The cost of Maryam’s cardiac care was covered by the Rita and Eric Bigham Cardiology Special Project Fund, established through the Medical Foundation of North Carolina.  Remaining funds and new contributions will be used to support additional children in the future, as well as other cardiology-related causes at UNC. 

UNC is First in N.C. to Use New Minimally-Invasive Procedure to Reduce the Risk for Stroke

In June 2013, the UNC Center for Heart and Vascular Care became the first in North Carolina to successfully close a left atrial appendage, which is a part of the heart where blood clots and strokes come from, using the Lariat® procedure.  

The new Lariat® procedure is a minimally-invasive alternative to reduce stroke risk in people with atrial fibrillation who cannot tolerate blood thinners. For these AF patients – who account for 25 percent of all AF patients - it can essentially eliminate their risk for stroke, which is five times more likely in AF patients.

Not only did UNC perform the first Lariat® procedure in North Carolina, they also performed the second Lariat procedure in North Carolina on the same day.  No other hospital in North Carolina offers this technology.

New Faculty and Staff Join UNC Center for Heart and Vascular Care

The UNC Center for Heart and Vascular Care is pleased to welcome these new faculty and staff members.

Adult Cardiac Surgery

James Morris, MD, is joining the division of cardiothoracic surgery in August as a Clinical Associate Professor of Surgery.  Dr. Morris will practice at High Point Regional, the largest component of the High Point Regional Health System.  Dr. Morris is coming to UNC from the Christine Lynn Heart and Vascular Institute in Boca Raton, FL, where he served as the Medical Director.  Previous appointments also include the Roper Saint Francis Health System in Charleston and the Mayo Clinic.

Cardiology

Xuming Dai, MD, PhD, has joined Interventional Cardiology as an Assistant Professor of Medicine. Dr. Dai finished his interventional cardiology fellowship in June at the University of North Carolina.  He completed his residency at the Long Island Jewish Medical Center and received his medical degree from the Second Military Medical University in China.

(F. Roosevelt) Rosey Gilliam, MD, FACP, FACC, has joined UNC Electrophysiology as a Professor of Medicine.  With more than 30 years of experience in EP and implantable cardiac devices, Dr. Gilliam brings a wealth of knowledge and expertise to UNC.  Dr. Gilliam served as the Director of the Electrophysiology Section of the Cardiology Division at Duke University for many years, and comes to UNC from Cardiology Associates of Northeast Arkansas.

Lisa Rose-Jones, MD, is continuing in UNC cardiology in a subspecialty fellowship position in heart failure and as part-time faculty as a Clinical Instructor in the division of cardiology.  Dr. Rose-Jones completed her cardiology residency in June at the University of North Carolina and graduated with her doctorate from the University of Virginia Medical School.

Vascular Interventional Radiology

Ari Isaacson, MD, has joined Heart and Vascular as an Assistant Professor of Radiology.  Dr. Isaacson finished his VIR fellowship in June at the University of North Carolina and will continue to make an excellent addition to the UNC Center for Heart and Vascular as a VIR faculty member.  Dr. Isaacson received his medical degree from the USC School of Medicine and spent four years in the Navy after medical school, including a deployment in Iraq.  He completed his residency at the University of North Carolina.

Cardiology and Heart Surgery ranked as 'High Performing' specialty area by U.S. News & World Report

In 2013, the U.S. News & World Report “Best Hospitals” issue recognized Cardiology & Heart Surgery as a “high performing” specialty area.  This is the second year in a row that Cardiology & Heart Surgery were ranked on the ‘Best Hospitals’ list.

This year, there were only 180 hospitals in the country in named as “high-performing” in the “Cardiology & Heart Surgery” specialty, so the inclusion of our Cardiology & Heart Surgery programs for two consecutive years is an impressive accomplishment.

2013 North Carolina Cardiovascular Update held Sept. 6-7, 2013 at the Friday Center

The 2013 North Carolina Cardiovascular Update as held at the Friday Center in Chapel Hill on Sept. 6-7.  The event featured the 12th Annual Ernest and Hazel Craige Lecture, given this year by guest faculty Spencer B. King, III, MD, President, Saint Joseph's Heart and Vascular Institute and Professor of Medicine, Emeritus, Division of Cardiology, Emory University School of Medicine.  Dr. King's lecture was entitled, "Stable Ischemic Heart Disease: Is the Role For Revascularization Changing?" 

Guest faculty lecturer Joel Schneider, MD, Wake Heart and Vascular Specialists also presented. Faculty lecturers from the UNC Center for Heart and Vascular Care and UNC School of Medicine include Patricia Chang, Xuming Dai, Cody Deen, Anil Gehi, Roosevelt "Rosey" Gilliam, Prashant Kaul, Andy Kiser, Paul Mounsey, Marschall Runge, Brett Sheridan, George "Rick" Stouffer, and Michael Yeung.

Heart Failure Management 2013: Personalized Medicine to Optimize Care, July 18-21, 2013, Amelia Island, FL

UNC faculty contributing to this event include Kirkwood Adams, MD (co-director of the event): Patricia Chang, MD, MHS, Eugene Chung, MD, Anil Gehi, MD, Jana M. Glotzer, MSN, ACNPBrian Jensen, MD, Jason Katz, MD, MHS, Paul Mounsey, MD, PhD, William Stansfield, MD, Carla Sueta, MD, PhD, and Sarah Waters, ANP-BC.

UNC Heart Rhythm Specialists at Rex scheduled to open in November 2013

A new outpatient electrophysiology (EP) clinic serving the complex arrhythmia needs of Wake and the surrounding counties is scheduled to open in November 2013 on the main Raleigh campus of Rex Healthcare.  UNC Heart Rhythm Specialists at Rex will be full-service, capable of handling new and returning patients needing care and management related to atrial fibrillation.  A full complement of diagnostic services will be available through the clinic and Rex Healthcare labs and diagnostic suites.   The clinic will utilize the combined services of physicians from North Carolina Heart and Vascular and UNC faculty physicians from the UNC Center for Heart and Vascular Care.  For procedures, the clinic will refer patients to both UNC and Rex, with the location based on a variety of factors, including the complexity of treatment needed, patient acuity, capacity, and patient preference.

Sid Shah, MD, of North Carolina Heart and Vascular (formerly Wake Heart and Vascular) will soon be accepting new patients at UNC Heart Rhythm Specialists at Rex.  UNC Center for Heart and Vascular Care faculty physicians Paul Mounsey, MD, director, UNC Heart Rhythm Services, Eugene Chung, MD, Anil Gehi, MD, and Jennifer Schwartz, MD, will also be accepting new patients at the clinic.   New UNC faculty member Jim Hummel, MD, will join the clinic in January 2014, allowing further expansion and integration of EP services.

ShahHummelMounsey 1Chung 1Gehi 1schwartz 1

 Physicians at UNC Heart Rhythm Specialists at Rex (from left): Sid Shah, MD, Jim Hummel, MD, Paul Mounsey, MD, Eugene Chung, MD, Anil Gehi, MD, and Jennifer Schwartz, MD


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Media Highlights - 2013

Read about all of the UNC Heart and Vascular physicians and nurses in the media this year
Media Highlights - 2013 click to enlarge UNC Center for Heart and Vascular Care IN THE NEWS

January

Hillary Clinton hospitalized with blood clot - featuring Dr. Cam Patterson: The Global Post (Canada) and "The Two Way" National Public Radio

FDA Clears nContact’s Cardiac Ablation Device, EPi-Sense® With Embedded Sensors - featuring Dr. Paul Mounsey: Reuters, Diagnostic and Interventional Cardiology, and Cardiac Rhythm News

Setting the stage for a new paradigm in treatment of heart failure - featuring Dr. Cam Patterson: New England Journal of Medicine, Science Daily, and UNC General Alumni Association

"Open Road,  Open Heart." - featuring Dr. Hemant Solomon, who practices at UNCPN’s Sanford Specialty Clinic and Dr. Andy Kiser: "Central Carolina Health” magazine, Winter 2013 - click for full article

February

"Healing the Stubborn Wounds" - featuring UNC Wound Healing Center: Well Magazine, Winter 2013

"Love Your Heart" - featuring Dr. Paul Mounsey: WRAL-TV, February 18, 2013

Image Guide Ablation Therapy – featuring Dr. Matthew Mauro: The Oncologist Journal, Society for Translational Oncology

Mall-walking program marks 10th anniversary – featuring Dr. Paula Miller: The Herald-Sun (Durham),

Message to NCGA: Focus on Chronic Disease Prevention! - featuring Dr. Ross Simpson: NC Spin – Statewide News Show

Cardio Notes: Links Between Heart-Brain Diseases – featuring Dr. Cam Patterson: MedPage Today

March

Mummies show signs of heart disease – featuring Dr. Cam Patterson: USA Today

Spraying Away Chronic Wounds - featuring Dr. William Marston: Ivanhoe Broadcast News reaching 80 million U.S. households

New drug improves on standard blood thinner Plavix – featuring Dr. Cam Patterson: USA Today

Cardiac Rhythm Management - featuring Drs. Paul Mounsey, Andy Kiser, Anil Gehi, Eugene Chung, and Jennifer Schwartz: The Triangle Physician (cover story)

April

Patients who have STEMI heart attacks while hospitalized more likely to die - featuring Dr. Rick Stouffer: Science Daily, Triangle Business Journal and The Journal of the American Heart Association

Father/daughter physician runners offer aid after Boston Marathon Bombing - featuring Dr. Joseph Stavas: Boston GlobeNew York Daily News, BBC Radio and Los Angeles Times

AHA Lists Year's Big Advances in CV Research - featuring Dr. Sidney Smith and the research of Dr. Li Qian: MedPage Today

Collaborative Convergent Epicardial and Endocardial Atrial Fibrillation Ablation - featuring Dr. Paul Mounsey and Dr. Andy Kiser: EP Lab Digest

May

UNC Health Care staff forms peer mentoring program for amputees - featuring the UNC Center for Heart and Vascular Care Nursing Staff on 5 Anderson Vascular Acute Care Unit: News 14 Carolina

Drug May Treat Resistant HTN in ESRD Patients - featuring Dr. Alan Hinderliter: Renal and Urology News

Boston Marathon Bombing Aftermath and Recovery - featuring Dr. Joseph Stavas: Triangle Business Journal, Your Health Radio, WNCT-TV, Greenville, NC

June

Afghan girl to receive treatment for heart condition at NC Children's Hospital - featuring UNC Cardiovascular Medicine donors, Rita and Eric Bigham: Health Canal and UNC Health Care News, Daily Tar Heel, Sandhills Tribune, Pinehurst, NC and Follow-up article featuring UNC Cardiovascular Medicine, The Pilot Newspaper, Moore County, NC

July

Statins Have Few Side Effects, But Should More People Be Taking Them? - featuring Dr. Sidney Smith: Time Magazine

Randy Travis Gets an LVAD, Future Uncertain - featuring Dr. Cam Patterson: MedPage Today

UNC is First in N.C. to Use New Minimally-Invasive Procedure to Reduce the Risk for Stroke - featuring Drs. Paul Mounsey, Eugene Chung, Andy Kiser, and Alan Hinderliter: WPTF News Radio - 680/850AM and WCHL News Radio - 97.9FM

UNC Hospitals applies for radiology equipment - featuring Vascular Interventional Radiology: Triangle Business Journal and Durham Herald-Sun

ACA Delays Decisions in Cardiology - featuring Dr. Cam Patterson: MedPage Today

The Hybrid Ablation for Atrial Fibrillation Combines Surgery and Catheter Ablation — Featuring Video Interview with Dr. Andy Kiser: Stop Afib.org

Heart and Vascular's Burke inducted as Fellow in the Society of Interventional Radiology - featuring Dr. Charles Burke: University Gazette

Lamberth and Shirley Mitchell: Losing Teeth, but Keeping Spirit and Faith - featuring UNC Wound Care: UNC Health Care: Family House Diaries

Heart and Vascular's Schwartz and Weres inducted as Fellows of the Heart Rhythm Society - featuring Dr. Jennifer Schwartz and Melanie Weres, NP: University Gazette

Durham health care angel fund hauls in $5.1M - featuring Dr. Cam Patterson: Triangle Business Journal and Durham Herald-Sun

August

Recognizing a Heart Attack - featuring Dr. Prashant Kaul: UNC Well Magazine

Black patients undergo aortic valve replacement significantly less frequently than white patients - featuring Dr. Michael Yeung: Cardiovascular News International

UNC Physician Elected President of the Association of Professors of Cardiology - featuring Dr. Cam Patterson: UNC Well Magazine

Convergent Care - featuring Dr. Andy Kiser: UNC Endeavors

Chatham Hospital Q&A - featuring Dr. Cody Deen: Chatham Economic Development Corporation

September

UNC Hospitals hosts Legs for Life Free Screening - featuring Vascular Interventional Radiology and Aortic Disease Management: University Gazette, WRAL-TV Online, WNCN-TV Online, and The Times-News (Burlington, NC)

Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation - featuring Dr. Li Qian, McAllister Heart Institute: Durham Herald-Sun, University Gazette (page 5), UNC Voices, blog of the Health Sciences Library, Science and Technology Health (Portuguese)

Stopping the Heart Failure Patient Bounce-Back - Kirkwood Adams, MD (mentioned as expert): Medscape Online (VIDEO)

Collaborative Experience Using the LARIAT System for Left Atrial Appendage Closure - featuring Matthew Baker, MD (Fellow), J. Paul Mounsey, BM BCh, PhD, MRCP, FACC, Andy C. Kiser, MD, Eugene H. Chung, MD, FACC:  EP Lab Digest, Cath Lab Live, and Cardiovascular Live

October

NHLBI hands off hypertension guidelines to ACC, AHA – featuring Sidney Smith, MD: Family Practice News, Clinical Endocrinology News, Clinical Neurology News, Journal of Family Practice, and E-Cardiology News

Tarheels leaving their footprint in Malawi – featuring Joseph Fulton, MD: World Camp for Kids

Platelet imaging can enable detection of blood clots in vivo – featuring Timothy Nichols, MD:  Medical Physics Web and Academia Online

European hypertension guidelines help fill U.S. void – featuring Sidney Smith, MD:  Clinical Endocrinology News

November

Carolina Week News - Trans Fats - featuring Ross Simpson, MD: Carolina Week (from 11:28-13:50)

'Arts for Hearts' raises money for UNC Cardiology: Daily Tar Heel and Pharmaceutical Devices

Pat Robertson donates to UNC after successful heart surgery - featuring UNC Cardiothoracic Surgery: Raleigh News & Observer

UNC Kenan-Flagler presents alumni awards - featuring Cam Patterson, MD: Kenan-Flagler Blog, San Francisco Chronicle, and Twitter - retweeted 4 times reaching 39,584 followers - @uncheartvasculr and @KenanFlagler

Shift In Cholesterol Advice Could Double Statin Use - featuring Sidney Smith, MD: National Public Radio (NPR), NPR Blog, All Things Considered, National Public Radio **AUDIO**, The People's Pharmacy, National Public Radio **AUDIO from 27:59-34:32**, and Twitter: @nprnews - retweeted four times reaching 2,127,761 followers

Risk calculator for cholesterol appears flawed - featuring Sidney Smith, MD: The New York Times, The Boston Globe,Time Magazine, Columbus (OH) Dispatch, and NBC News

How Good Is the New ACC/AHA Risk Calculator? - featuring Sidney Smith, MD: Medscape

Experts defend new heart attack prevention advice - featuring Sidney Smith, MD: Newsday

 

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Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation

Qian’s lab plans to investigate the fundamental events underlying the progression of various cardiovascular diseases as well as to discover the basic mechanisms of cell reprogramming.
Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation click to enlarge Li Qian, PhD
Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation click to enlarge Dr. Li Qian at work in her laboratory in the McAllister Heart Institute.

Media contact: Laura Melega, 919-843-8217, laura_melega@med.unc.edu

Wednesday, Sept. 11, 2013

Li Qian, PhD, an assistant professor in the University of North Carolina School of Medicine, has received a 2013 New Scholar in Aging Award from the Ellison Medical Foundation.

Qian’s research focuses on developing innovative approaches to regenerate or repair an injured heart. The goal of her lab is to understand the molecular specification and maturation of heart muscle cells to improve efficiency and clinical applicability of cellular reprogramming in heart disease.

Qian’s lab plans to investigate the fundamental events underlying the progression of various cardiovascular diseases as well as to discover the basic mechanisms of cell reprogramming. Qian uses in vivo modeling of cardiac disease in the mouse, including myocardial infarction (MI), cardiac hypertrophy, chronic heart failure and congenital heart disease (CHD), taking advantage of traditional mouse genetics and newly developed reprogramming technologies.  

The award provides funding of $100,000 per year for a four-year period.

Qian joined the Department of Pathology and Laboratory Medicine and the McAllister Heart Institute in 2012.

The foundation’s New Scholar awards provide support for newly independent investigators in the first three years after their postdoctoral training, when they are establishing their laboratories. These awards support bright young scientists during their early years, enabling them to staff their labs, collect preliminary data and organize research programs of sufficient momentum to obtain ongoing support from other sources.

The Ellison Medical Foundation is a non-profit organization that supports basic biomedical research on aging relevant to understanding lifespan development processes and age-related diseases and disabilities. The foundation aims particularly to stimulate new, creative research that might not be funded by traditional sources or that is often underfunded in the U.S.

More information about the foundation’s New Scholar award program and other funding activities is available at http://www.ellisonfoundation.org/index.jsp.