Synergism Key to Success inMcLaren’s Heart and Vascular Program

Senior Leadership members, Don Kooy, MRMC President and CEO; Cheryl Ellegood, Vice President of Business Development and Clinical Services; Ed Gullekson, Vice President Medical Affairs; and Joan Maten, Vice President of Nursing; also participate in the leadership sessions.

2008 AccomplishmentsAs a result of this team structure several key initiatives were achieved in the last 12 months. These include:• AMI Core Measures Met• Neuro Intervention• Expanded Medical Staff• Diagnostic Advancements• Atrial Fib Ablation• MRMC Door-to-Balloon Initiative• Lapeer Regional Door-to Balloon Initiative• Cardiology Lecture Series

P u l s eMcLaren Regional Medical Center

In this issue

Synergism Key to Cardiac

Success(Pages 1-7)

OB/GYN Offers Care for

Chronic Pain(Page 8)

Grants Benefit Local Cancer

Patients(Page 8)

Medical Staff Announcements

(Page 9)

Medical Records

Documentation – Physicians Are

Key to Success(Page 10)

Effectiveness of Continuous

Renal Replacement

Therapy (CRRT) Studied

(Page 12)

March 2009Issue 1

Newsletter for the Medical Staff of

McLaren Regional Medical Center

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Many credit Aristotle for saying “The whole is greater than the sum of its parts.” This statement

exemplifies the synergy taking place within the heart and vascular program at McLaren Regional Medical Center (MRMC). Obtaining recertification as a Blue Cross/Blue Shield Center of Excellence is just one of several recent accomplishments in the Heart and Vascular program. These achievements are credited to the dynamic team in place composed of physicians, administrators, nurses and support staff. Long regarded as a regional leader in cardiac care, the medical center now offers patients with acute heart and vascular conditions faster and more comprehensive services than ever before.

“We have all the right people in all the right places,” said James Chambers, D.O., Chief of Cardiology at MRMC. “Our success in accomplishing the goals we set forth can be attributed to the physicians and administration working diligently together for a common purpose. Every member of the team is committed to the success of our program.”

In 2008, a leadership team was assembled to expand and enhance the heart and vascular program. Each month, four cardiology specialists and key administrators meet to discuss clinical issues and facilitate implementation of new processes.

Continued on page 2

Interventional Cardiologists Cyrus Farrehi, M.D., and Peter Farrehi, M.D., perform a procedure in the newest Catheterization Lab.

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Synergism Key to Success inMcLaren’s Heart and Vascular Program

Continued from page 1

What to expect in the Coming YearCurrently, the leadership team is looking forward to new challenges. Expanding treatment options for neurocerebral aneurisms, fostering 12-lead EKG reception from ambulances, and advancing the Chest Pain Clinic model are all initiatives underway.

“I am very encouraged by the progress

we have made by working together with a common goal to provide the best care at McLaren,” stated Dr. Chambers. “I am confident that we will be able to put these ideas into action where they will make a profound difference in the health of our patients. When something is good for our patients, it is good for the entire community.” n

Achievement of all AMI Core MeasuresThe Core Measures set forth by the Centers for Medicare

and Medicaid Services (CMS) are specific practices for treating patients suffering an acute myocardial infarction

(AMI) by which medical centers are evaluated.

The Core Measures are:• Patient receives aspirin upon arrival in Emergency

Department• Patient is prescribed aspirin at discharge• Patient receives beta blocker upon arrival• Patient is prescribed beta blocker at discharge• ACE or ARB for LVSD – AMI patients with left ventricular

systolic dysfunction (LVSD) and without both angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications are prescribed an ACEI or ARB at hospital discharge.

• Patient Receives Percutaneous Coronary Intervention (PCI) in 90 minutes or less

Through a concerted effort, McLaren has achieved 100% on nearly all AMI Core Measures. The dashboard indicators on this page illustrate the most recent statistics. n

SynergismS y N E R g I S M

0 100

10

20

3040 50 60

70

80

90

Actual: 100%Target: 100%

AMI-1: Aspirin Within24 Hours of Arrival

0 100

10

20

3040 50 60

70

80

90

Actual: 100%Target: 100%

AMI-3: ACEI or ARBfor LVSD at Discharge

0 100

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80

90

Actual: 96%Target: 100%

AMI-2: Aspirin Prescribedat Discharge

0 100

10

20

3040 50 60

70

80

90

Actual: 100%Target: 100%

AMI-5: Beta Blocker Prescribed at Discharge

0 100

10

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3040 50 60

70

80

90

Actual: 100%Target: 100%

AMI-6: Beta BlockerWithin 24 Hours of Admission

0 100

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3040 50 60

70

80

90

Actual: 100%Target: 100%

AMI-8a: PCI Within90 Minutes of Arrival

0 90

10

2030

40 5060

70

80

Actual: 67 minutesTarget: 90 minutes or less

AMI-8: Median Timeto Primary PCI

Core Measure Outcomes – AMI

Based on December 2008 Data

LEGEND

Met/Exceeded Target

Missed Target

For Every Heart. For Every Condition.Recognized as a certified Blue Cross Blue Shield Center of Excellence, McLaren not only meets the U.S. national rate of survival for heart attack but is only one of two hospitals in Michigan to exceed the national rate of survival for heart failure. What’s more, McLaren has achieved successful outcomes in all core measures for heart attack as established by the Centers for Medicare and Medicaid Services. n

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Neuro InterventionThe damage sustained by those who suffer a stroke can depend on the speed and degree to which medical staff can break up the clot. Rapid administration of clot busting medications is an effective therapy and the most commonly performed emergency treatment to minimize the damage caused by a stroke. With the addition of James Mick, M.D., a board certified neuroradiologist, McLaren now has the expertise to perform cerebral angioplasty as an advanced intervention for patients suffering a stroke.

Expanded Medical Staff During 2008 the cardiovascular medical staff increased by two electro physiologists, one cardiologist, and one neurointerventionalist. These physician specialists broaden the scope of services offered at MRMC and provide access to advanced heart and vascular care to area residents.

Diagnostic AdvancementsRecent testing and imaging enhancements at McLaren now allow for greater detail and information concerning a patient’s condition. Three-dimensional echocardiography, and the Cardiac CT provide high resolution images of the heart to assist McLaren physicians in determining the best course of treatment. The testing equipment is all located within the Medical Center so patients can enjoy the efficiency of “one-stop” lab work. n

MRMC BroadensServices and Diagnostics

James Mick, M.D., a board certified neuroradiologist, who specializes in interventional neuroradiology, has joined the medical staff at McLaren Regional Medical Center. Dr. Mick cares for patients at his office located at 44555 Woodward Avenue, in Pontiac.

Dr. Mick has completed two fellowships, one in interventional neuroradiology at the University of

California in San Francisco, and the other in neuroradiology at William Beaumont Hospital in Royal Oak. He also completed his residency at William Beaumont Hospital. Dr. Mick received his medical degree from Ohio State University in Columbus, Ohio. n

James Mick, M.D.

SynergismS y N E R g I S M

Heart & Vascular Leadership Team

James Chambers, D.O.Chief of Cardiology

Jeffrey Harris, D.O.Medical Director

of Cath Lab

Richard Hennig, D.O.Medical Director of CCU and 12 Tower

George Predeteanu, M.D.Medical Director of

Non-invasive and CTA

Cheryl EllegoodVice President

of Business Development and Clinical Services

Administrative Leadership

Cheryl WieberAdministrative

Director of Cardiovascular

Services

Medical Leadership

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Patients suffering from an abnormal, fast heartbeat, known as supraventricular tachycardia (SVT) may be candidates for radiofrequency ablation to correct the condition, available

only at McLaren.

SVT is an abnormal, fast heartbeat that occurs suddenly, triggered in the atria, the upper chambers of the heart.

Abdul Alawwa, M.D., F.A.C.C., is a clinical cardiology electrophysiologist, specializing in the treatment of irregular heartbeats. Dr. Alawwa began performing radio frequency ablation using three-dimensional mapping technology in 2008. McLaren is the only facility in the region where this procedure is performed.

The procedure involves inserting catheters into veins on both sides of the groin through “paper cut” size incisions that are fed up into the heart. On one side are the diagnostic catheters used to locate the tissue causing the irregular heartbeat. On the other side are ablation catheters used to destroy the bad tissue. Using the NAVX system, 3-D mapping shows precisely the places in the heart where the abnormal tissue needs to be cauterized. This is done using radio-frequency energy delivered through the ablation catheter. The small area of heart tissue is heated by the energy creating a tiny scar. As a result, this tissue is no longer capable of conducting or sustaining the irregular heartbeat.

“I was a little apprehensive about having the procedure, but nothing else was going to make my condition go away and I did not want to take medication for the rest of my life,” states Caitlin Vanderkarr, a 21 year-old college student. Vanderkarr chose radiofrequency ablation for her SVT after taking medications for almost 10 years for the condition.

Just three days after her ablation this summer, she was back to exercising. The procedure has a 99% success rate.

The clinical expertise and technology available at McLaren are giving young people like Caitlin the opportunity to get off medications, cure their condition and enjoy life. n

3D Atrial Fib Ablation

New Technology at McLarento Treat Irregular Heartbeat

Caitlin Vanderkarr hopes her mother Kathryn Daly, who is a nurse at McLaren, will worry less about her health now that she has had a

procedure to cure her irregular heart beat.

SynergismS y N E R g I S M

Abdul Alawwa, M.D., F.A.C.C.

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Adoor-to-balloon time process put in place between McLaren Regional Medical Center and Lapeer Regional

Medical Center is already saving lives of heart attack victims. Julie Ann Klein, 54, of Columbiaville, can attest to it. She is alive today because of her own awareness and the rapid response she got from clinicians.

MRMC clinicians accepted Blue Cross Blue Shield’s (BCBS) door-to-balloon time challenge to Michigan hospitals in fall 2007. The BCBS challenge is to reduce the time it takes to deliver care to patients having ST elevated myocardial infarctions (STEMIs), the most common type of heart attack. The benchmark is to treat these patients in 90 minutes or less. The clock starts when they arrive in the Emergency Department and stops when the doctors inflate a tiny balloon to re-open the blocked arteries that cause heart attacks. McLaren’s door-to-balloon times now average between 60 and 70 minutes, well below the 90-minute mark.

With the hard work of MRMC and LRMC administrators, physicians, and clinicians, a door-to-balloon process was created for Lapeer area patients as well. When patients arrive at LRMC’s Emergency Department experiencing an AMI, they are brought to McLaren’s Cath Labs where their blocked arteries can be opened back up. Julie Ann was the first patient to go through the new process. From the time she arrived at Lapeer’s Emergency Department to the insertion of the balloon into her arteries at McLaren it took just 64 minutes. An incredible feat as the BCBS initiative is designed for a single location not for transferring of a patient from one location to another. The entire process is triggered by an EKG.

“On the EKG we are looking for stemi(ST)-segment elevation which shows up in people having a certain kind of heart attack,

called a myocardial infarction,” states Jodi Ralston, M.D., McLaren Emergency Department. “This means the heart is not getting enough blood flow, and heart muscle will die if the flow is not restored quickly. When Emergency Department physicians see the elevation, our department alerts the Cath Lab staff and a cardiologist to prepare for a patient.”

Julie Ann had 100% blockage in one artery, and had to have three stents put in, with a fourth to come later. Remarkably, she also had no muscle damage.

Julie Ann and her husband, Benjamin, are grateful to the paramedics and clinical staff at both hospitals for her care and for the door-to-balloon process that is now in place. They know it saved her life.

“The patient’s well being is the reason for this effort,” states James Chambers, D.O., McLaren cardiologist and Chairman of the Division of Cardiology at MRMC. “By having this process in place, studies have shown patients will have a shorter hospital stay, they will live longer, and have a better quality of life in regards to their heart health.”

As a result of these measures, MRMC was recertified as a Center of Excellence by Blue Cross and Blue Shield and a Blue Care Center of Distinction. The most recent data ending in December 2008 shows the average door-to-balloon time for patients presenting at MRMC is 67 minutes, representing a decrease of nearly 50% from December 2007. n

Rapid Response EffortsSaves Heart Attack VictimMcLaren door-to-balloon times exceed BCBS Challenge

Julie Ann Klein was visited in the hospital by her grandson Tyler, age 5, who came from

Alabama with his parents to be with her.

SynergismS y N E R g I S M

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Cardiology Lecture Series

Leadership HostsCardiac Lecture SeriesSynergismS y N E R g I S M

Wilfredo Rivera, M.D., and Majed A. Nounou, M.D., interventional cardiologists on staff at

MRMC, participated in the current media campaign promoting McLaren’s cardiac services.

The cardiology leadership team at McLaren Regional Medical Center, led by Richard Hennig, D.O., is

offering a series of lectures to provide the most current practice guidelines and evidence-based medicine for specific cardiac conditions.

The lectures will take place at McLaren’s Ballenger Auditorium and are planned for the following Wednesday evenings at 6 p.m.: March 18, April 9 and May 5, 2009.

Those attending the one-hour lecture receive a Category one CME credit. Topics of the presentation include:• Cardiomyopathy/CHF• Peripheral Vascular Disease• C a t he t e r / Dev ice Tr ea t men t o f

Arrhythmias• CABG/AVR/MVR/Percutaneous AVR

Online registration is available through www.mclarenregional.org. Click on Classes & Events. Select the desired program and follow the instructions. Space is limited to the first 150 registrants. Registration

brochures are available by calling McLaren’s Medical Education Coordinator at (810) 342-4620.

The objective of the grand rounds is to focus on the current concepts in patient treatment, resolve common difficulties in diagnostic treatment, update the practicing physician on new drugs on the market, and discuss cost effective methods of treatment.

McLaren Regional Medical Center is accredited by the Michigan State Medical Society Committee on CME Accreditation to provide continuing medical education for physicians. McLaren Regional Medical Center designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. n

A series of lectures to

provide the most current

practice guidelines and

evidence-based medicine

for specific cardiac

conditions

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Cardiac Services Available at McLaren

McLaren Regional Medical Center provides superior heart and vascular care utilizing specially-trained medical experts and sophisticated equipment and

technology. Advanced diagnostic tests, catheterization and surgical procedures are all performed efficiently at an award-winning hospital recognized for excellent patient safety and care.

Diagnostic Capabilities• EKG (electrocardiogram)• Holter Monitor / Event Monitoring• Echocardiogram• Treadmill Stress Test• Treadmill Stress Echocardiogram • MUGA Scan• Nuclear Cardiac Stress Test.• Pharmacalogical Stress Test• Transesophageal Echocardiogram (TEE)

Cardiac Catheterization Procedures• Coronary Angioplasty• Coronary Stenting (including Drug Eluting Stents)• Coronary Atherectomy• Coronary Angiography

Electrophysiology Procedures• Cardiac Rhythm Management• Electrophysiology Studies (EPS)• Cardiac Ablations

Cardiac Surgical ProceduresTreating Coronary Heart Disease:• Coronary Artery Bypass Graft Surgery (CABG)• Minimally Invasive Direct Coronary Artery Bypass

(MIDCAB) • Robotic Assisted Coronary Artery Bypass• Off Pump Coronary Artery Bypass• Videoscopic Saphenous Vein Harvesting• Endovascular Stent Grafting

Treating Heart Valves and Repairing Arteries:• Aortic Valve Replacement• Minimally Invasive Aortic Valve Replacement• Mitral Valve Replacement• Aortic Aneurysm Repair• Atrial Septal Defect Repair

Treating the Conduction System:• MAZE procedure, a surgical option to treat atrial

fibrillation.• Insertion of Automatic Implantable Cardioverter Defibrillator

(AICD) • AICD Power Pack Change• Pacemaker Wire Insertion/Removal

Treating the Pericardium:• Pericardectomy• Pericardial Window

McLaren offers services to patients to ensure their optimal recovery and health maintenance following heart trauma and cardiac procedures.

Pacemaker Services• Device Clinic: A test to perform interrogations of pacemakers

and defibrillators for appropriate function and battery life.• Remote Pacemaker Analysis: This test checks and defines the

functioning of existing pacemaker over the phone.

Rehabilitation• Cardiac Rehabilitation: A program to assist patients in

regaining the greatest level of activity and health possible through teaching and exercise following a cardiac illness or procedure. n

SynergismS y N E R g I S M

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Theodore Fellenbaum, M.D. OB/GYN, FACOG, has provided care for women in the Greater Flint area for 25 years. Last spring, Dr. Fellenbaum opened the Mid-Michigan Vulvar

Care and Colposcopy Center. In addition to traditional obstetrics and gynecology, the clinic is the first in the area to specialize in

the treatment and care of vulvodynia, a condition of persistent and/or chronic pain and/or itching in the vulvar area, as well as patients with irregular colposcopy (pap smear) results. Located at 1289 S. Linden Road, Flint, the clinic is only the second such facility in the state.

Dr. Fellenbaum accepts patients through physician referral. He offers his services as a resource to primary care physicians whose patients do not respond to initial treatment. The primary care physician is kept informed

about their patient’s progress throughout the treatment process. Any outside concerns which may arise are referred back to the primary physician.

Vulvodynia, a chronic vulvar pain without an identifiable cause, can affect women of all ages. Millions of American women experience

OB/gyN Offers Specialized Care for Women Suffering From Chronic Pain

Theodore Fellenbaum, M.D.

chronic vulvar pain at some point in their lives.

Although no single treatment is appropriate for every patient, Dr. Fellenbaum will work with each patient to find the right treatment or combination of treatments to minimize the discomfort of vulvodynia. Dr. Fellenbaum utilizes the following options to treat patients: topical anesthetic and steroid ointments, oral medications, physical therapy, surgery, a n d r e d u c i n g irritation through modifications to personal care and lifestyle.

Dr. Fellenbaum is involved in the development of the North American Chapter of the International Society for the Study of Vulvovaginal Diseases (ISSVD) and is a certified ASCCP mentor for teaching colposcopy. For more information call The Mid-Michigan Vulvar Care and Colposcopy Center (810) 733-8200. n

Millions of American women

experience chronic vulvar

pain at some point in their

lives.

Providing cancer patients with information to actively participate in their healing may become an easier task with a new patient education initiative at the Great

Lakes Cancer Institute. Grants from the American Cancer Society, the McLaren Foundation and other charitable foundations in the McLaren system totaling more than $120,000 will fund the creation of individual patient DVDs and websites. The project is coordinated by the Great Lakes Cancer Institute

The DVDs were first introduced two years ago at GLCI’s Ingham Regional campus in Lansing. The materials include:• a personal introduction and biography by the patient’s

doctor

grants From McLaren Foundationand ACS Benefit Local Cancer Patients

• specific information about the stage and form of their cancer

• what to expect as a standard of care

• t ypes o f therapies available

• strategies the caregiver team expects to use to treat the cancer

The DVD is updated as needed each time the patient comes in for treatment. n

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Ratnaja Katneni, M.D., a nephrologist and hypertension specialist cares for patients at her Flint office located at 1170 Charter Drive, Suite A. Dr. Katneni completed a fellowship in nephrology at the University of Texas Southwestern in Dallas, Texas. She completed her internal medicine residency at McLaren Regional Medical Center in Flint. Dr. Katneni received her medical degree from Kasturba Medical College in Manipal, India.

Welcome to the Medical Staff

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Ratnaja Katneni, M.D. Kavitha Reddy, M.D.

Kavitha Reddy, M.D., a board certified physical medicine and rehabilitation specialist cares for patients at the Great Lakes Spine Center, located at G-3239 Beecher Rd., Flint. Dr. Reddy completed her residency at Barnes-Jewish Hospital in St. Louis, Missouri. She received her medical degree from the University of Health Sciences Kurnool Medical College in India.

Abdul M . A . Hasnie , M .D., F.A.C.C., F.S.C.A.I., has successfully completed the requirements of the American Board of Internal Medicine for Maintenance of Certification in Internal Medicine and has passed the Maintenance of Certification Board in Internal Medicine. Dr. Hasnie is also board certified in Cardiovascular Disease, Interventional Cardiology, Nuclear Cardiology, Vascular Medicine and Endovascular Medicine.

Announcements

Abdul M.A. Hasnie, M.D.

Ahmad Abdel-Halim, M.D., is the author of two recently published books for medical students preparing for the United States Medical License Exam. The guides entitled, “Passing the USMLE: Clinical Knowledge" and "Passing the USMLE: Basic Science" are published by Springer and areavailable at most book retailers, including online at Amazon, Target and Overstock.com. Dr. Abdel-Halim was inspired to author the

guides while preparing for the exams as a medical student.

“It seemed like a lot of the study guides I found focused on only a portion of the exam, or were written as a quick review to look at just before the exam.” said Dr. Abdel-Halim. “I wanted a comprehensive source of information which I could use as a long-term study aide.”

Dr. Abdel-Halim is a member of the McLaren Academic Hospitalist Group and completed his internal medicine residency at McLaren Regional Medical Center in 2007.

Applause

Ahmad Abdel-Halim, M.D.

CorrectionDr Jeffrey Harris’ group practice name was incorrectly stated in the Announcements section of the October 2008 issue. Dr. Harris is a member of Cardiology Consultants of East Michigan.

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Physicians’ assistance is needed to increase Medical Record documentation compliance within

your patients’ records at MRMC. Both the Centers for Medicare and Medicaid (CMS) regulations and The Joint Commission (TJC) standards require very specific compliance in the following areas:

Verbal & Telephone Orders (VO/TO): • CMS regulations and TJC standards

require that VO/TO be used minimally or in emergent situations.

• When used, the ordering practitioner must authenticate (sign, date & time) within 48 hours of the order being given. (Including Date & Time is the only way to monitor our compliance with these rules.)

Medical Records Documentation – Physicians Are Key to Success

• Currently, MRMC has only 15% compliance with this standard. Only you can help achieve timely authentication of VO/TO

• Units have been instructed to “flag” the orders, as well as stamp them with a reminder to “DATE, TIME & SIGN” your VO/TO.

• If you are not seeing the flags and/or stamps, please alert the appropriate department/unit Manager.

Discharge Summaries & Patient Medications:• Case Summaries do not require that a

listing of the patients’ medications be included.

• In many situations, the medications referred to in the Discharge Summary do not match (reconcile) with the list of medications provided to the patient at discharge. Such discrepancies create the illusion of lack of communication, and possible adverse drug events for your patients when patient data is abstracted and submitted to CMS and other required external reporting agencies.

• There is no requirement to state all medications in Discharge Summaries. Instead, we recommend that you refer to either: A) Patient Discharge Instructions, or B) the Transfer/Discharge Medication Order (TMO) form.

Immediate Post-Operative Notes:CMS and TJC require that an immediate post-op note be entered into the patient’s record for all invasive procedures that occur in Surgical Services, Endo, Heart & Vascular, Interventional Radiology, and at the bedside. This note is important documentation to ensure the safety of your patients as they move between levels of care.• This immediate note need not be lengthy,

unless you so choose, but at a minimum, must contain the following elements:

First-year resident Enson Tseng, M.D., and faculty member Kenny Luong, M.D. of the

McLaren Family Practice Residency Group.

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1. Name(s) of primary surgeon(s) and assistant(s),

2. Procedure(s) per formed and a description of each procedure finding,

3. Estimate blood loss (must indicate “None” if no blood loss),

4. Specimens removed (must indicate “None” if nothing removed), and

5. Post-operative diagnosis.

“Blanket” Orders:• Both CMS and TJC strongly discourage the

use of “blanket” orders, such as “Resume Home Meds” or “Resume Pre-Op Meds” due to the propensity of medication errors that occur from such broad orders.

• MRMC Nursing personnel have been educated to contact the ordering practitioner for more specific orders when blanket orders are written.

• Please discontinue the use of such “blanket” orders, and support Nursing staff requesting clarification to best serve the medication needs of your patients.

Physicians, and any Allied Health Professionals that assist in the care of your patients, hold the key to our success for these documentation requirements. Your dedication to patient care, and

the documentation of the care that you provide is greatly appreciated. If you have any questions about the above

initiatives to ensure your patients’ safety, and adequate sharing of information throughout their care, please contact Health Information Management at (810) 342-2229 or Compliance at (810) 342-2248. n

your dedication to

patient care, and the

documentation of the care

that you provide is greatly

appreciated.

Davison Sports Medicine Clinic Has Moved

The McLaren Sports Medicine Clinic, currently located at G-2140 Fairway Drive in Davison, moved on February 27, 2009. The clinic has merged with the McLaren

Physical Therapy clinic at St. John Family Center, 505 North Dayton, Davison. The phone number for McLaren Sports Medicine will remain (810) 653-3962. The new fax number is (810) 658-7732. Staff began seeing patients at the new location on Monday, March 2. The clinic is now called McLaren Physical Therapy and Sports Medicine-Davison. If you have any questions contact Sally Wagner, Manager, Therapy Services at (810) 653-3962. n

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MissionMcLaren Health Care, through its

subsidiaries, will be Michigan’s best value in healthcare as defined by quality

outcomes and cost.

VisionMcLaren Regional Medical Center will be the recognized leader and preferred

provider of primary and specialty healthcare services to the communities of

mid-Michigan.

Editorial DirectionEdwin H. Gullekson, M.D., FAAFPChief Medical Officer, McLaren Regional Medical Center

Donald Kooy, President and CEO, McLaren Regional Medical Center

Managing EditorLaurie Prochazka, Director of Marketing Communications,McLaren Health Care Corporation

Visit our website and view Pulse online: www.mclarenregional.org

Newsletter for the Medical Staff of McLaren Regional Medical Center

EditorEllen Peter

Contributing AuthorsSherry Stewart, Ellen Peter, Laurie Prochazka

PhotographyTed Klopf

DesignBrian J. Bohnett

PrintingMcLaren Graphics Department

We welcome comments, suggestions and ideas: ellenp@mclaren.org or call (810) 342-4478.

Shady Megala, M.D., a third-year and chief internal medicine resident at MRMC, co-authored a retrospective study of patients with compromised kidney function who received

CRRT to cleanse their blood of the dye used in catheterization procedures. MRMC is one of the few facilities in the area equipped to perform this continuous 24 hour per day therapy.

Kidney disease patients undergoing cardiac catheterization have the additional concern of ridding their body of the dye used in the catheterization process. Reduced kidney function impairs their body’s ability to cleanse the blood of the dye. Nicknamed “slow go” therapy, Continuous Renal Replacement Therapy (CRRT), is a safer form of dialysis for the less stable cardiac patient population because it performs necessary blood cleansing at a slower, gentler, pace without causing unsafe drops in blood pressure. Although CRRT has been an accepted form of treatment for some time, evidence to support the treatment was minimal. With the information generated through research, MRMC physicians are expanding the realm of evidence-based medicine regarding life-saving therapies.

The research of Dr. Megala et.al., entitled “The Additional Role of Continuous Renal Replacement Therapy in the Prevention of Radio-Contrast Induced Nephropathy in Patients with Chronic Kidney Disease Undergoing Coronary Angiography” received recognition when presented at the Michigan’s Associates Day of the American College of Physicians in Troy, Michigan in 2008. Subsequently,

Effectiveness of Continuous Renal

Replacement Therapy (CRRT) Studied

it received international attention by being shown at the 41st Annual Meeting & Scientific Exposition of the American Society of Nephrology in Philadelphia, Pennsylvania.

The success of the initial study has prompted the development of a larger, prospective study of patients at MRMC with chronic kidney disease that are scheduled to undergo coronary angiography. Dr. Megala anticipates the study will begin in late winter or spring of 2009. n

Nabil Zaki, M.D. and Shady Megala, M.D. at the 41st Annual Meeting & Scientific Exposition of the American Society of Nephrology in

Philadelphia.

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