Sinai Hospital Offers Driver Education

Remember that feeling of finally getting your drivers' license? That feeling of freedom and independence is also connected to reaching many of our day-to-day activities. Yet a disability, illness or aging can affect our ability to be a safe driver by impairing our decision-making skills and our ability to control a vehicle. Being a child of an elderly parent also may mean it's time to talk about driving.

The facts: the danger of driving increases with age. According to the Centers for Disease Control and Prevention, there was a 19 percent increase in older drivers between 1997 and 2007. Motor vehicle crash deaths per capita among males and females begin to increase markedly starting at ages 70-74. Fatal crash rates increase starting at age 75 and increase notably after age 80.

That's why Sinai Hospital is pleased to offer a driver evaluation and training program that can help you maintain your or your loved one's independence while ensuring your safety on the road. The evaluation at Sinai is a two-part process consisting of a pre-driving screening and a behind-the-wheel evaluation.

A recent column in the Bowie Blade-News offered some advice and guidance on discussing this sensitive topic with a parent. By letting a driver education program review and then make a recommendation, the decision becomes more objective.

For more information or to schedule an appointment with the Sinai program, call 410-601-5830.

Checking in on New Year's Resolutions

By Jamie Strauss, R.D., L.D.N.
Clinical Dietitian, Food and Nutrition Services
Sinai Hospital

It’s the last week of January - how well have you done with your New Year's resolutions? Many of us made it a goal to lose weight, exercise more or just generally be healthier. Even if you feel discouraged a month in, you can still take steps toward being healthier. Lifestyle changes do not have to be overwhelming!

Start by making smaller changes. These may have a bigger impact than larger ones. By taking the stairs more often, parking farther away from an entrance, or stretching at your desk, you can burn extra calories. You can also ask your coworkers if they'd like to take a walk during your lunch hour.

Another tip is to use recipe modifications such as substituting margarine for butter, which will result in a lower-fat dish. You can also switch to whole grain products, which add more fiber in your diet. Finally, sit down with your family and develop a weekly list of meals. By planning ahead, you can save time and money all week.

As you adapt and make these smaller lifestyle changes, you progress toward bigger changes. So remember - start small and you will be able to keep your resolutions this year without a problem!

Free H1N1 Shots Saturday in Baltimore Country

Even if you've stayed healthy so far this winter season, you are not out of the woods for acquiring the H1N1 virus.

Luckily, there are free H1N1 Shots being offered from 10 a.m. to 4 p.m. Saturday, at a variety of locations in Baltimore County. These locations are Baltimore Highlands Lansdowne Health Center, Banneker Community Center, Cockeysville Volunteer Fire Department, Dundalk Health Center, Eastern Family Resource Center, Essex Health Center, Edgemere Senior Center, Fleming Community Center, Hannah Moore Health Center, Hereford Middle School, Liberty Family Resource Center, Middle River Middle School, Pikesville Library, Drumcastle Government Center, Towson Health Center, and Woodlawn Health Center. The vaccines will be given on a first-come, first-serve basis.

Peter Andrews, PA-C, director of Occupational Health at Sinai Hospital, says will be “peaks and valleys” in the number of H1N1 cases over the next few months.

“Whenever there are family gatherings around the holidays, we tend to see big spikes in the number of flu cases,” Peter say. Additionally, he warns that late January/early February is when the seasonal flu historically strikes hard.

LifeBridge Health employees are encouraged to get their H1N1 vaccination by visiting Employee/Occupational Health at Sinai Hospital or Northwest Hospital.

Stories from the Front Lines

In honor of LifeBridge Health being named one of Fortune Magazine's "100 Best Companies to Work For," we asked some of our employees what they think about working here. We'll be posting their stories regularly. If you work at LifeBridge Health, we'd love to hear from you!

“My first impression of Sinai was the friendliness of the Human Resources department, and how well the hiring process worked. Then, it came time for me to go to New Employee Orientation. Who is the first person to greet me? Neil Meltzer! No ivory towers here!”

-Rona Karol, Practice Manager for General Surgery Specialists, Sinai Hospital

“I’ve been employed a Sinai Hospital in the Radiology Department for 11 years. I’m so proud to work here I continue to wear my badge when I run errands after work. In the mall and at cash registers I receive positive comments, such as “My mom had her surgery at Sinai” or “Sinai is great, my daughter was delivered in your Labor and Delivery unit.” I stand tall, shoulders arched, and smile from ear to ear.”

-Darlene Rogers, Radiology Coordinator, Radiology Department, Sinai Hospital

“What do I love about my workplace and coworkers? There is A LOT that I love! We are a BIG family (residents and staff) at Courtland Gardens! We create a diverse culture for our staff and residents. We motivate, recognize and we still have fun, while we all continue to work very hard. Trying to make a difference is what makes coming to work a positive and rewarding experience for me.

-Joy Curbean, HR Business Partner, Courtland Gardens Nursing and Rehabilitation Center

“A year ago, my director, Nelson Figueroa, developed a new program that would assure quality of care to our Emergency Room patients. I was asked to place follow up calls to a variety of patients who are discharged from our department. The calls involve finding out how the patient is doing once they leave the ED, and to make sure that they understand the discharge instructions that we give to them. I have found that not only are they receptive to my call, but that they are very appreciative of the caring that is conveyed. Telling someone that we care is easy to do because we at LifeBridge do just that! I know that LifeBridge cares and that is why the staff and our patients are satisfied.”

-Roslyn Klein, RN II, ER-7, Northwest

RIAO Doctor Treating Injured Haitians

A team from Sinai Hospital’s Rubin Institute for Advanced Orthopedics recently arrived in the Dominican Republic to treat Haitians injured in the earthquake. Team members include Shawn Standard, M.D., a pediatric orthopedic surgeon, Marie Gdalevitch, M.D., an orthopedic fellow and James Pepple, M.D., an anesthesiologist. This team is treating severely injured Haitians who have been transported out of field hospitals in Haiti to the more sophisticated CURE International Hospital in Santo Domingo, Dominican Republic.

The Sinai team has already operated on a 22-year-old woman who has pelvic and foot fractures and is battling infection in her amputated fingers.

“Bernadine is the lone survivor of a school that had 85 students,” said Standard. “After the building collapsed, she was able to crawl out through a window.” The team will also operate on a Haitian orphan who underwent a leg amputation and now has an infection.

Several doctors from the CURE International hospital have been in Port-au-Prince since the early days of the disaster, which has forced surgery to be delayed for Dominican children with dislocated hips and other complicated orthopedic problems.

“The ward is full of children who were scheduled to have surgery and are now waiting for treatment,” said Standard. The Sinai team is filling in for the CURE Dominican team by providing care to these children as well as the Haitians who are transported to Santo Domingo for treatment.

Several months from now, the region will still need orthopedic surgeons who can treat bone infections, broken bones that failed to heal, and broken bones that healed incorrectly. Dr. Standard plans to return in March to help Haitians with these orthopedic problems.
This mission trip is funded in part by the Save-A-Limb Fund, a program of Sinai Hospital. The Save-A-Limb Fund fights to save limbs from amputation and provide hip and knee replacements to patients in need both domestically and abroad.

For more information on the Save-A-Limb Fund, click here.

Physician and Author Discusses Cultural Challenges

by Holly Hosler

During grand rounds at Sinai Hospital yesterday, scores of LifeBridge Health doctors and residents heard physician and writer Danielle Ofri, M.D., speak about the cultural challenges presented when meeting with patients.

Dr. Ofri’s talk, titled “Journeys with our patients: multiculturalism in a two-person canoe,” opened with a passage from her book Incidental Findings: Lessons from My Patients in the Art of Medicine. She read about her patient, Mrs. Uddin, a 35-year-old Bangladeshi and observant Muslim, who always complained of pain. “Why so much pain? Why, doctor, why?” the patient would moan in broken English.

Mrs. Uddin’s test results showed she was physically healthy; rather, her pain was a psychosomatic result of depression. Unfortunately, Mrs. Uddin continually resisted Dr. Ofri’s advice to see a psychiatrist and take medication that would alleviate her depression. Yet Mrs. Uddin frequented the doctor’s office month after month for eight years, and Dr. Ofri grew to despise her and everything about her – religious veil included – simply because there was nothing she could do to help or get through to her patient.

Dr. Ofri also documented this saga in a piece in the New England Journal of Medicine called “Torment.” She says she published it to “face up to the parts of me that I’m not proud of” and to expose areas in which doctors need to learn to be more sensitive to their patients’ cultural differences. Later in the lecture, Dr. Ofri revealed that when she openly asked Mrs. Uddin and her daughter about their Muslim veils – why they wore them and why they were of different styles – her patients warmed to her in ways previously unimaginable. Instead of being offended by her questions about their cultural practices, they were eager to discuss these parts of their lives. For the first time in her presence, says Dr. Ofri, Mrs. Uddin became “delighted” and “buoyant.”

“All the multicultural education we receive … seems so limited,” says Dr. Ofri.

Generalizations about different cultural groups – e.g., Hispanics are religious and value family and camaraderie – feel so “awkward” and “pitiable,” she says. On the other hand, when doctors practice cultural neutrality, patients perceive it as coldness and indifference. As a solution, Dr. Ofri suggests that doctors take “journeys” with their patients and coworkers from different cultural backgrounds by asking questions and gaining insights into their different perspectives. And she also warned us to be careful not to stereotype against ourselves, which she learned after failing to notice a key symptom in one of her patients whom she perceived to be like her – “white, female and neurotic.”

“Being a good doctor is so much harder than knowing all your medicine,” Dr. Ofri observed. By getting to know one’s patients, doctors will often find that their initial assumptions about their patients and the patients’ realities will be vastly different.

To see if Dr. Ofri is speaking in your city, click here.

LifeBridge Health Makes Fortune Magazine's "100 Best Companies to Work For"

LifeBridge Health announced today that it was ranked 96 on Fortune Magazine’s 2010 list of “100 Best Companies to Work For.” The full list and related stories appear in the February 8 issue of Fortune, available on newsstands on Monday, January 25.

LifeBridge Health is one of four Maryland-based companies and the only Maryland-based health care system to make the list.

“It’s a tremendous honor to be recognized by Fortune,” said Warren Green, president and CEO, LifeBridge Health. “Our position on this list demonstrates how well our employees work together, the camaraderie felt throughout the system and our continued focus on providing excellent quality of care for our patients. It’s a combination of our corporate culture and benefits that led us to being honored. Throughout our system, each employee is a valued participant doing his or her role providing excellent health care for our patients.”

Fortune Deputy Managing Editor Hank Gilman said, “The most important considerations for this year’s list were hiring and the ways in which companies are helping their employees weather the recession. All 100 companies on our list are currently hiring, many of the aggressively, leading to more than 96,000 open job positions expected in the next year.”

“We are on the continuous journey of becoming and remaining a great place to work -- where everyone can do their best work and feel his or her unique contributions are recognized and appreciated,” said Taylor Foss, vice president of Human Resources at LifeBridge Health.

LifeBridge Health helps its employees alleviate some of the financial and personal stress caused during the recession by offering various benefits and services such as negotiating lower tuition discounts at several colleges and universities; providing onsite training to prepare employees for college and higher paying jobs; providing free access to Carebridge Work-Life Services for practical advice regarding child and eldercare, financial challenges and legal issues; scholarships for employees' children who will be college sophomores, and reduced membership fees for the system-owned fitness facility.

Some of the unusual benefits and services offered to employees include adoption assistance, phased-in retirement, a telecommuting program, BridgeList, an online forum where employees with similar interests can meet, share skills, start carpools and swap free items, and the LB rewards program. Employees earn points in the LB rewards program for anything from above-and-beyond patient service to helping LifeBridge Health maintain a strong accreditation score. Employees can redeem their points at any time for various gifts, large or small, depending on the number of points they have.

LifeBridge Health is hiring in most areas of patient care, allied health and administrative positions. Currently, over 250 positions are available to qualified candidates.

“We have various entry level and professional positions in high demand right now including physician assistants, physical therapists, occupational therapists, administrative associates, central sterile technicians, drivers, geriatric nursing assistants, nurses in various specialty areas including neuroscience, and various other technician and management types of positions,” said Foss. “We are hiring daily, and will continue to hire to fill positions to maintain the most effective and efficient care for our patients.”

To pick the 100 Best Companies, Fortune partners with the Great Place to Work Institute to conduct the most extensive employee survey in corporate America. Two-thirds of a company's score is based on the results of the Institute's Trust Index survey, which is sent to a random sample of employees from each company. The survey asks questions related to their attitudes about the management's credibility, job satisfaction, and camaraderie. The other third of the scoring is based on the company's responses to the Institute's Culture Audit, which includes detailed questions about pay and benefit programs and a series of open-ended questions about hiring, communication, and diversity.

Kevin Crutchfield, M.D., Named to NFL Committee

Kevin Crutchfield, M.D., director of the Comprehensive Sports Concussion Program at the Sandra and Malcolm Berman Brain & Spine Institute of LifeBridge Health, has been appointed to the National Football League Players Association Concussion and Traumatic Brain Injury (TBI) Committee. The committee will meet on January 26 in Palm Beach, Florida, to discuss issues regarding the handling of concussions by the NFL.

The 15-member panel is composed of experts from differing backgrounds, including players and medical professionals. Members of prominence include post-concussion syndrome advocate and former WWE wrestler Chris Nowinski, and Mark Lovell, M.D., director of the University of Pittsburgh Medical Center Sports Medicine Concussion Program.

The panel will look at how NFL research funds should be used to improve concussion and traumatic brain injury research. This committee will give the NFL Players Association a direct role in changing perceptions about the serious nature and long-term effects of concussions and mild brain injury.

Dr. Crutchfield has dedicated much of his professional career to the study and treatment of mild brain injury. Many types of mild brain injury, such as concussions, occur from a significant blow to the head, such as a helmet-to-helmet collision in football. Dr. Crutchfield has been a leader in the study of blood flow to the brain and the changes that occur after a concussion occurs.

“Dr. Crutchfield’s expertise and commitment to providing cutting-edge treatment to patients who suffer from concussions make him an ideal choice for this committee,” says Michael A. Williams, M.D., medical director of the Brain & Spine Institute. “As an industry leader, he will offer insights that could lead to lasting changes in the NFL’s policies dealing with concussions.”

Gear Up for 2010 at LifeBridge Health & Fitness

Many of us have 2010 goals focused around our health - quit smoking, eat healthier, lose weight and start exercising.

After all, the statistics are frightening - in 2008, there was only one state in the United States, Colorado, had a prevalence of obesity less than 20 percent, according to the Centers for Disease Control and Prevention. Maryland was at 26 percent.

A recent article in the Urbanite explored gyms around Baltimore, and key factors to success. At LifeBridge Health & Fitness, there are several crucial components to success, one of which is the Face2Face program. Face2Face is a program that is included within your membership, and allows members to meet with a personal trainer five times for 30 minutes to help create fitness goals.

Last year, the gym spent $600,000 on upgrades, and now provides members with the some of the most advanced exercise equipment in the area.

Make 2010 the year to embrace fitness. For more information, call 410-484-6800 or visit www.lifebridgehealthandfitness.com .

Medical Records A Key Factor in Patient Safety

Whether it's a nursing home resident needing a procedure, or tracking medications for a hospital inpatient, medical records are a crucial component to successful treatment.

Right now, LifeBridge Health has hybrid medical records systems, which include both paper and electronic records. Eventually, all records will be computerized.

The Cerner Power Chart system is state-of-the-art and is used at both Northwest and Sinai hospitals. Courtland Gardens and Levindale work with a compatible counterpart.

“The main reason for employing electronic medical records is patient safety,” says Angela Niparko, director of Health Information Management at Sinai. “One example of this is a mechanism in Cerner to alert doctors about potentially dangerous drug interactions.”

Plus, an electronic medical record allows multiple clinicians to access the same information at the same time.

Patients may also request copies of their records for any number of reasons. A fee is usually charged for the service. The procedure for requesting medical records at LifeBridge Health centers is as easy as turning on your computer. Request forms and hospital addresses, along with privacy policies, can be found here. The forms must be printed, filled in and sent to health information management at the appropriate hospital. Requests are usually processed in about a week or so from the day the record is located.

Many people at Levindale and Courtland Gardens prefer to make requests in person. Since patients and residents are often in long-term care for years, medical records can be between 45 and several thousand pages long.

“It's best to meet with me to identify what information you want," says Carol Carder, manager of Health Information Management for Courtland Gardens and Levindale. “To keep the fee associated with this service down, I try to copy only the pages needed.”

LifeBridge Health also offers the opportunity to create a personal health record. The LifeBridge Health MySELF Personal Health Record is a safe and secure way to stay on top of all your medical information.

Golf Challenge Raises Money for Cancer Patients

Thanks to one skilled New Jersey golfer, there is even more help available for LifeBridge Health cancer patients.

In November, the annual LifeBridge Health Golf Challenge was held at Chestnut Ridge Country Club, raising more than $93,000 for the Patient Assistance Fund at the Alvin & Lois Lapidus Cancer Institute of LifeBridge Health. The fund assists those undergoing cancer treatment at Sinai and Northwest hospitals with prescription drugs, transportation to and from treatments, and other expenses not covered by insurance. The money raised at the challenge exceeded the 2009 goal by $8,000.

But the excitement wasn't over. This LifeBridge Health golf challenge included an auction where one of the items was a trip to Pebble Beach for the Lexus Champions for Charity golf tournament. This trip was generously donated by Len Stoler Lexus. New Jersey resident Rich Mulvey was the winning bidder of the auction package, and he tied for ninth place in the Champions tournament. As a result, LifeBridge Health received a check for the patient assistence fund for $1,000 from Lexus.

The 2010 LifeBridge Health Golf Challenge will be in late August - stay tuned for additional details.

Health Care Field Continues To Grow

It's a new year, but one thing hasn't changed - the health care field continues to be the largest industry in the United States, according to the Bureau of Labor Statistics.

It is anticipated that 20 percent of new jobs created between now and 2014 will be in health care, with many of those jobs in the category of Allied Health. This cluster of health professions encompass jobs like diagnostic testing, physical/occupational/speech therapy and coders. Our Allied Health professionals ensure everything from making sure a patient has received the right reimbursement to sending someone home with a nutrition plan.

“As a recruiter and business partner at Northwest Hospital, one of my roles is to go out to the community. This means going everywhere from middle schools to colleges with the Allied curriculum, all to promote and influence students on the opportunities and the education available," said Joan Montgomery, human resources business partner at Northwest. “Education is of the utmost important to obtaining a career in the allied health arena. Health care is a viable existence and there is a demand for those to provide the care.”

Among the "hot jobs" in Allied Health available Northwest include medical lab technician (Blood Bank), diagnostic coder (CCS), respiratory care practitioner (RRT), cardiac sonographer, physical therapist, and physical therapy assistant. All these jobs require four years or less of college. Additional available jobs at LifeBridge Health include physician assistants, occupational therapists, biomedical technicians, critical care and emergency department nurses, geriatric nursing assistants, medical secretaries, and central sterile technicians.

To see a complete listing of the opportunities available at at LifeBridge Health, visit www.lifejobs.org.

X-rays Stand the Test of Time

by Ryan Nawrocki

Have you ever thought about some of those medical technologies that just don’t seem to go away? Many were created years ago but have stood the test of time. X-rays are exactly that type of invention – they have only gotten better with age.

I talked with Jeanette A.F. Linder, M.D., the new chief of the Weinman Family Department of Radiation Oncology in the Alvin & Lois Lapidus Cancer Institute about the history of X-rays and their current usage.

Wilhelm Rontgen first discovered X-rays in 1895 when he took a photo of his wife’s hand, says Linder.

“It was clear at this point in history that X-rays could have a significant medical use," she says.

X-rays work by using a type of electromagnetic energy. During an imaging procedure, the ray passes through the body and then the image is captured on a photographic plate. Dense body parts, like bones, absorb more of the X-ray beam; and less dense parts, like muscle, allow more to pass through to the photographic film and turn it dark. That’s why bones appear white and soft tissues appear grey.

“In addition to providing images of our bodies, X-rays are also used to fight cancer,” says Linder. “The CyberKnife® at Sinai Hospital is one example of how X-ray use has improved over the years. When X-rays were first used to treat cancer, patients were only exposed to these weakly penetrating beams until burns would appear on the skin. This meant that X-rays were not able to treat cancers deeper in the body effectively.”

Today, radiation is a regular course of treatment in fighting cancer. The rays of radiation kill cancer cells, while sparing most healthy cells near the tumor site. Most patients don’t typically experience skin burns that were common in radiation treatments of the past.

X-rays now are capable of being so focused because they use linear accelerators, which dramatically increase the strength of the beam. New machines such as the CyberKnife don’t just treat cancer with one beam. During a CyberKnife treatment, a tumor is targeted by hundreds of beams from multiple angles.

So what does the future hold for X-rays? X-ray technology will only continue to improve. With the advancements of computers and other digital technology, medical professionals are able to get better images and treat cancer with a tighter and tighter focus. This means that X-rays will continue to be one of the old standbys in modern medicine.

To learn more about the Sinai Department of Radiation Oncology, call 410-601-WELL (9355).

How to Shop for Healthy Food - On a Budget

As part of the Know Your Health program, LifeBridge Health is pleased to offer regular healthy shopping tours. These tours, held in a variety of grocery stores, are led by community health educator Kristen Diaz, M.S. Kristen leads participants around the store, providing information on how to make heart healthy food choices, how to understand food labels, and what you need to know about organic food. She will also provide information on shopping for healthy food while on a budget. Here she is pictured leading a tour last year at Whole Foods.

The next healthy shopping tour will be at Trader Joe's at the Woodholme Shopping Center in Pikesville from 1:30 to 3 p.m. Wednesday, January 27. Click here for more information. Registration is required.

Berman Brain & Spine Neurosurgeon Receives Honor

Richard North, M.D., a neurosurgeon at the Sandra and Malcolm Berman Brain & Spine Institute of LifeBridge Health, has received the North American Neuromodulation Society’s Lifetime Achievement Award. The society’s highest honor, this award is given only on an as-merited basis to individuals who have demonstrated exemplary achievement in the field of neuromodulation.

Neuromodulation is a therapy that relies on an implanted electrical stimulator or implanted drug-delivery system to treat pain and movement disorders. Neuromodulation is reversible and adjustable, and its therapeutic effect can be tested with a temporary electrode or catheter before a specialist decides to implant a device for chronic use. The most common form of neuromodulation is spinal cord stimulation to control chronic pain.

Dr. North has dedicated most of his professional career of nearly four decades to the study, innovation and clinical use of spinal cord stimulation. In addition to publishing extensively and speaking internationally on the topic, he conducts research in the field and holds numerous patents for neurostimulation devices.

“Dr. North’s commitment to excellence in the field of neuromodulation makes him an ideal recipient for the Lifetime Achievement Award,” said Neil Meltzer, president of Sinai. “He is a distinguished educator, administrator, researcher and clinician. As a national leader in neuromodulation for three decades, Dr. North has proven his expertise in the field.”

Dr. North became the director of Neuromodulation, Surgical Pain Management, and the Surgical Spine Pain Program at the Sandra and Malcolm Berman Brain & Spine Institute in 2007, following 25 years in the Department of Neurosurgery at the Johns Hopkins University School of Medicine.

Michael A. Williams, M.D., medical director of the Brain & Spine Institute noted, “I am very proud that Dr. North has received this well-deserved award and that he continues to provide his expert care to patients from around the world at the Berman Brain & Spine Institute.”

For more information about the Berman Brain & Spine Institute, call 410-601-WELL (9355).

Breast Cancer Treatments Discussed in Teleconference

by Holly Hosler

To learn about the latest research on treatments for breast cancer, a group of 25 LifeBridge Health doctors, nurses and technicians joined over 675 others around the country for the Living Beyond Breast Cancer’s San Antonio Breast Cancer Symposium Update teleconference yesterday.

Eric Winer, M.D., of the Dana-Farber Cancer Institute in Boston and faculty member of the Harvard Medical School, summarized the findings of about a dozen presentations from the 32nd annual symposium held December 9-13, 2009. The San Antonio Symposium is the largest annual international gathering of breast cancer researchers, and the LifeBridge Health clinicians were excited to participate in this informational and Q&A session on the most cutting-edge research in their field. The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.

Dr. Winer said that although the past year didn’t provide a striking number of breakthroughs for cancer treatment, the information shared at the symposium is expected to inform research and clinical trials for the next few years. For example, one example of results presented at the conference was a recent Duke University study of 300 patients. It showed that women with advanced breast cancer who receive a combination of Herceptin and Tykerb lived close to five months longer than those only given Tykerb. The combination of the two drugs focus on a protein called HER-2 that appears in large quantities in about a fourth of all breast cancers. Cases with the HER-2 protein tend to be more aggressive, but Herceptin and Tykerb work in tandem, with Tykerb going after HER2 and the receptor and Herceptin taking on the ER2 protein.

Dr. Winer said that the future of breast cancer treatment lies in the development of targeted biologic therapies, drugs that are used alongside chemotherapy and are delivered directly to cancer cells. Because these drugs can zero in on cancer cells, they are less toxic to patients.

However, each patient’s biological makeup is different. Therefore, research is constantly being performed to determine which breast cancer treatments work, in what situations they work, and in what combination they work best to shrink tumors and produce minimal side effects.

Dr. Winer concluded that it’s “inevitable that therapy will become personalized,” which is good news for future patients. Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer, with around 40,000 women dying annually from breast cancer. However, when breast cancer is detected early at stage 0 or stage 1, survival rates are at 98 percent.

Visitor Restrictions Lifted at Sinai and Northwest

We have good news if you are visiting Northwest or Sinai hospitals. Due to the current low level of H1N1 Flu in Maryland, the Maryland Department of Health and Mental Hygiene is recommending that hospitals return to their normal visitation policies. As a result, there are no longer restrictions on visiting loved ones in the hospital.

That said, please use our hand sanitizers located throughout our hospitals, and remember to wash your hands frequently. Individual units may have restrictions on visitors, as it is important for our patients to receive enough rest. If you have not received your seasonal flu or H1N1 vaccination, you can go to Google's Flu Shot Finder, type in your ZIP code, and a list of convenient locations and what they offer will pop up.

Alzheimer Disease by Any Other Name

by Majid Fotuhi, M.D., Ph.D
Director, Center for Memory and Brain Health
Sandra and Malcolm Berman Brain & Spine Institute

Most recent studies show that elderly people over the age of 80 often have mixed pathologies in their brains that account for their memory loss and confusion. Very few senior citizens have “pure Alzheimer disease,” and therefore, this diagnostic terminology should be used with caution. It now appears that vascular problems such as high blood pressure and diabetes can shrink the parts of the brain that control memory and can significantly affect at what age elderly people become demented. Those with better health (good diet, optimal fitness, low stress) may be able to postpone the cognitive decline that occurs late in life.

In a recent publication in Nature Review Neurology, my colleagues and I discuss our formulation of a new framework, called the dynamic polygon hypothesis, by which to think about memory loss and dementia with aging. They believe that a balance of positive and negative factors affect the brain throughout early life and midlife to determine the degree of cognitive agility and impairment in late life. These factors increase or decrease cerebral blood flow, inflammation, insulin-signaling components, size and frequency of strokes, and concentrations of growth factors, cortisol, and other hormones.

The realization that the size of our brains can be modulated throughout adult life brings hope to millions of baby boomers concerned about losing their memories with aging.

A full discussion of this topic was published in the December 2009 issue of Nature Reviews Neurology article, Changing perspectives regarding late-life dementia.

Click here for more information on the Center for Memory and Brain Health.

H1N1 influenza: too close for hindsight

Many end-of-year medical commentaries for 2009 have naturally taken a look back at the 2009 H1N1 influenza virus, as I did, in part, last week. Unfortunately, some are losing sight of the fact that while we are currently in a lull in influenza activity, the "flu season" isn't over yet, and so drawing conclusions about the impact of the 2009 H1N1 virus is quite premature.

The US has currently seen two peaks of H1N1 activity, the first being shortly after its discovery, and the second ending just a few weeks ago. From the CDC's site, the current trends in positive influenza tests being reported tell the tale:



In addition to this, the CDC has reported a mid-range estimate of 47 million people infected with the novel H1N1 virus, and 9,820 H1N1-related deaths from April 14 through November 14. When compared to traditionally cited estimates that seasonal influenza typically infects 5-20% of the US population and is responsible for ~36,000 deaths annually, this seems to paint a picture that the 2009 virus is panning out to be overall less lethal than the typical seasonal varieties. It has even been suggested that perhaps we should stop vaccinating against the new virus, to allow it somehow to "overtake and replace" the traditional viruses in circulation for this reason.

These latter conclusions are just plain bad, let alone unscientific, for a number of reasons:

• we're only halfway through the traditional influenza season - "Flu season" is tracked from October through May, so any numbers at this point are useful for tracking the disease progress, but too incomplete to make any conclusive statements from. Furthermore, seasonal influenza over the last couple of years hasn't peaked until February or March, so it's entirely possible that there's more activity in store for us ahead.

• comparing pandemic influenza statistics to seasonal flu stats during a pandemic is akin to comparing apples to oranges - As the WHO rightly points out, the numbers for people who are infected by, or die from, season influenza are based on statistical models that look back on the affected population and influenza season as a whole. In contrast, during this new H1N1 pandemic, the primary data reported on are the number of positive tests, not estimates based on complete data. While the CDC has been reporting the number of people affected as estimates, their margin of error in the April to November numbers quoted above is huge due to the fact that the season is still unfolding (between 34 and 67 million cases, and 7 to 14,000 deaths). Accurate numbers to estimate from won't be available until we are well out of this flu season.

• the novel H1N1 virus may return again, possibly in a more lethal form - Previous pandemics have taught us that there can be at least three "waves" of spread of a new influenza virus through a population, and that mutations the circulating viruses can pick up can make it cause more serious illness. While a post-holiday spike in cases that some predicted (due to increased travel, and increased clustering of people together) hasn't shown itself yet, this pandemic is spreading in a strikingly similar way to that of 1957, which had another peak in January.

• it is impossible to predict how this will impact seasonal influenza viruses - The usual seasonal varieties of influenza have yet to show themselves, although as mentioned before, it is earlier in the season than they are usually seen. It is impossible to say at this point if or when they may surface, and eventually if the 2009 H1N1 will join or supplant them over the coming years, or simply fade away. The answer to this lies in numerous complex factors that we can't accurately model for right now, including viral genetics, population immunity from infections and vaccinations, and environmental components.

We may be in the eye of the 2009 H1N1 pandemic storm (or it may, in fact, have already passed us by), but it is still too soon to meaningfully analyze how "bad" it is on its own, or compare it to recent seasonal influenza. That said, this is an excellent time to look back at some of the human factors involved in the pandemic to date, and some lessons learned... which I will be doing shortly.

All in Favor, Say Eye

Several initiatives allowed residents in Baltimore County and the city of Baltimore to have their eyes screened in 2009.

The Eyes Have It program, created by the Polakoff Foundation, offers monthly free glaucoma screenings at hospitals through the city, and hundreds of residents were screened in 2009. The Krieger Eye Institute, a partner in this effort, screened 45 people in 2009, and roughly 1/4 of those patients received follow-up services. Many patients with financial hardship who needed additional care were helped through the generosity of the institute and Sinai Hospital.

Through the LifeBridge Health Know Your Health program, 65 residents received care at two diabetic eye screenings, which are for those who have diabetes or are recently diagnosed with diabetes. At the cataract eye screening in October, 31 people were screened.

The next diabetic eye screening is 9 a.m. to 1 p.m. on Saturday, January 23 at Clinical Associates, 515 Fairmount Avenue, Suite 407, Towson. The next glaucoma screening is 4:30 to 7:30 p.m. on Tuesday, February 16 at Krieger Eye Institute at Quarry Lake, 2700 Quarry Lake Drive, Suite 180. Both of the screenings are free.

For more information on the Know Your Health program, click here. For information on the Eyes Have it, call 410-601-7295 or visit the Web site.