Charlotte's Presbyterian hospital now treatment choice for trauma

Since Aug. 1, Carolinas Medical Center is no longer Mecklenburg County’s only trauma center.

Paramedics can now transport victims of gunshot wounds and other serious accidents to Novant Health Presbyterian Medical Center.

The Hawthorne Lane hospital received approval in June as a “practicing Level II trauma center” from the North Carolina Office of Emergency Medical Services. To qualify for the full designation, Presbyterian must care for 1,200 trauma patients in the next year. During that time, the state agency will evaluate Presbyterian’s physician response times and patient outcomes.

Carolinas Medical Center remains the county’s only Level I, or highest level, trauma center where Medic, the county’s emergency medical service, takes the most serious trauma victims. CMC has had that designation since 1990.

Three other area hospitals – CMC-NorthEast in Concord, Cleveland Regional Medical Center in Shelby, and CaroMont Regional Medical Center in Gastonia – are Level III trauma centers, which can treat less seriously injured patients.

Before 2013, Presbyterian had been treating some trauma patients transported by Medic, said Phil Angelo, Novant’s regional trauma program manager. But a change in state regulations that year prohibited Medic from taking trauma patients to any hospital without an official trauma center designation.

Now, when Medic staff ask patients where they want to be transported, patients can choose between CMC and Presbyterian. If the patient makes no choice, Medic will transport patients to the nearest center.

“We’ve shown that we can take care of those patients,” Angelo said. “This (designation) allows our patients who want to come to our facility to come here.”


Medic will continue to transport some patients to CMC automatically because of the seriousness of their injuries. They include patients with head injuries, extreme burns or amputations. CMC will also receive any pediatric trauma patients.

Teens ban on tanning goes nowhere

In the same week the U.S. Surgeon General called for immediate action to reduce the rate of skin cancer, the North Carolina General Assembly failed to act on a bill that would have banned the use of tanning beds by teens.

The Youth Skin Cancer Protection was OK'd by the North Carolina House of Representative last year by a vote of 94-22, and dermatologists across the state had hoped the Senate would follow suit.

"It's a sad irony that we received the news about North Carolina tanning bed bill the same week as the U.S. Surgeon General issued a national call to action on skin cancer," said Dr. Brent Mizelle, president of the North Carolina Dermatology Association. "We are disappointed that North Carolina teens will not be among those who enjoy this protection."

Eleven states have prohibited minors from using tanning beds.

Similar legislation has been opposed by the American Suntanning Association, a group of tanning salon owners whose website says they are "dedicated to taking immediate action to correct misconceptions about sunbed salons in the press, the medical community and in state and federal government bodies." 

Earlier this week, acting Surgeon General Dr. Boris Lushniak said no previous surgeon general has ever said "UV radiation is bad for you; protect your skin."

"We have to change the social norms about tanning," he said. "Tanned skin is damaged skin, and we need to shatter the myth that tanned skin is a sign of health."

The report was released just two months after the Food and Drug Administration said it would require manufacturers to put warnings on tanning beds, cautioning against their use by anyone under the age of 18. 

Skin cancer is on the rise, according to the American Cancer Society, with more cases diagnosed annually than breast, prostate, lung and colon cancer cases combined.

Nearly 5 million people are diagnosed and treated for skin cancer each year. From 1973 to 2011, the rate of melanoma, the deadliest form of skin cancer, increased more than 200 percent, according to the Department of Health and Human Services.

Will fist bumps replace handshakes in the hospital?

In June, the well-respected Journal of the American Medical Association published an article that proposed "Banning the Handshake From the Health Care Setting."

Given the problem with hand hygiene and transmission of infections in hospitals, this isn't as far-fetched as it sounds.

But I bet the authors of the JAMA article didn't realize that another study, to be published in August in the American Journal of Infection Control, would take their proposal to the next level.

The newer piece concludes that “fist bumping” -- the gesture made popular by President Barack Obama and First Lady Michelle Obama during the 2012 election campaign -- transmits significantly fewer bacteria than a handshake or a high-five.

Researchers from the Institute of Biological, Environmental, and Rural Sciences at Aberystwyth University in Wales found nearly twice as many bacteria were transferred during a handshake compared to a high-five, and significantly fewer bacteria were transferred during a fist bump than a high-five.

“Adoption of the fist bump as a greeting could substantially reduce the transmission of infectious diseases between individuals,” said author David Whitworth. “It is unlikely that a no-contact greeting could supplant the handshake; however, for the sake of improving public health we encourage further adoption of the fist bump as a simple, free, and more hygienic alternative to the handshake.”

I won't hold my breath until this change of habit takes place. But any reminder that we should be more careful about transmitting germs in the hospital is welcome.

The hands of health-care providers frequently spread potentially harmful germs to patients, leading to "health-care associated infections," among the leading causes of preventable harm and death in the United States. 

Charlotte doctor offers alternative to PediaSure

Charlotte pediatrician Sheila Kilbane has a keen interest in good nutrition and helping children who have developed allergies or aversions to particular foods.

Kilbane

As an integrative medicine practitioner, trained by Dr. Andrew Weil at the Univesity of Arizona, Kilbane was asked by "100 Days of Real Food" to write a recipe for a natural alternative to PediaSure, advertised as a "nutritional drink for children."

Her report, including a recipe for Dr. Kilbane's Liquid Vitality, starts by describing her own experience with Pediasure. On a road trip years ago, she stopped at a gas station and bought a bottle of PediaSure instead of indulging in chips or candy bars. She began drinking as she finished pumping my gas, and she described what happened next as a "scene from a Jim Carrey movie."

She gagged and nearly spit the contents all over her car. THEN she read the ingredient list. After water and sugar, the list was rife with items such as short-chain fructooligosaccharides, carrageenan, calcium pantothenate, phylloquinone and cyanocobalamin.

She realized she should have followed the advice she has given parents for years: “If you can’t pronounce the product ingredients, put it back on the shelf.”

Chikungunya virus strikes North Carolina resident

North Carolina’s first case of chikungunya, a viral infection that can be transmitted to humans by infected mosquitos, was confirmed in a resident who recently traveled to the Caribbean.

The virus has been spreading rapidly through the Caribbean, but for now, no cases of the disease are known to have been acquired in North Carolina or in the continental United States.

Still, state health officials say the Asian Tiger mosquito that is commonly found in North Carolina could effectively transmit this virus.

Prior to its introduction in the Caribbean, chikungunya was established in East Africa, India, the Indian Ocean and the Western Pacific regions. It was introduced in the Caribbean in 2013 through travelers returning from affected areas. As of June 6, chikungunya has caused illness in over 130,000 persons in the Caribbean, state health officials said.

Symptoms of chikungunya usually begin three to seven days after being bitten by an infected mosquito. They typically include sudden onset of fever and severe, often disabling, joint pains in the hands and feet. Many patients feel better within a week, but joint pain may persist for months in some people. Newborns exposed during delivery, adults over 65 years and people with chronic medical conditions have a greater risk for a severe form of the disease.

State health officials advise people traveling to countries where chikungunya transmission is occurring to take precautions to prevent mosquito bites and immediately consult a doctor if they develop fever in the two weeks after their return.

“With North Carolina residents traveling to and from the Caribbean and other affected areas, we have been monitoring for possible imported cases,” said Dr. Megan Davies, state epidemiologist for the Department of Health and Human Services. “Travelers who visit countries where chikungunya is widespread should take extra precaution against mosquito bites.”

Precautions include wearing light-colored long pants and long-sleeved shirts, reducing time outdoors during early morning and early evening hours when mosquitoes are most active, and applying mosquito repellents such as DEET, picardin, oil of lemon eucalyptus or IR3535 to exposed skin areas.

Also, residents should take steps to decrease possible breeding grounds for the Asian Tiger mosquito. That means removing containers that hold water, changing water in bird baths and pet bowls, keeping gutters in good repair, using screens for doors and windows.

See how Charlotte hospitals rated in safety survey

Charlotte's two major hospitals did not make the "A" list Tuesday when the nonprofit Leapfrog Group issued its annual safety scores.

The scores are developed from a survey based on 28 safety measures such as hand hygiene, antibiotic selection and catheter removal.

Carolinas Medical Center got a B, and Novant Health Presbyterian Medical Center got a C.

Charlotte-area hospitals that received "A" grades were: Carolinas Medical Center-University and CMC-Mercy in Charlotte, CMC-Pineville, CMC-Union in Monroe, Cleveland Regional Medical Center in Shelby, Kings Mountain Hospital, Stanly Regional Medical Center in Albemarle. Both Piedmont Medical Center in Rock Hill, and Springs Memorial Hospital in Lancaster also got A grades.

Other "B" grades went to: CMC-NorthEast in Concord, CaroMont Regional Medical Center in Gastonia, Iredell Memorial Hospital in Statesville, Novant Health Huntersville Medical Center, Novant Health Matthews Medical Center, Novant Health Rowan Medical Center in Salisbury.

Other "C" grades went to: CMC-Lincoln in Lincolnton, and Lake Norman Regional Medical Center in Mooresville.

The Leapfrog group's survey is intended to address the more than 180,000 deaths and accidents from hospital errors and injuries that occur each year. Scores are based on federal data from the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services as well as an annual survey by the American Hospital Association.

Nationwide, 32 percent of hospitals got A grades, 26 percent got B’s and 35 percent got C’s. Six percent got Ds and less than 1 percent got an F.

Tom Zweng takes over as Novant Health's chief medical officer

Dr. Tom Zweng, a longtime Charlotte surgeon, has assumed the role of chief medical officer for Novant Health, replacing Dr. Stephen Wallenhaupt, who moved to a part-time role after seven years as chief medical officer and more than 20 years with Novant.

Zweng

Wallenhaupt

Zweng, 58, served as senior vice president of medical affairs for Novant Health’s Greater Charlotte market for the past seven years. A graduate of the University of California at Davis and UCLA medical school, did his surgery residency at the University of Michigan.

From 1990 to 1995, he was assistant professor of surgery at University of Kentucky Medical School where he developed the laparoscopic program for general surgery. He then moved to Charlotte, where he practiced with Surgical Specialists of Charlotte for 11 years and also served as chief of general surgery for Novant Health Presbyterian Medical Center.

Wallenhaupt, 62, will focus his efforts on roll-out of electronic medical records across the hospital system.

Winston-Salem-based Novant operates four hospitals in Mecklenburg County -- Presbyterian Medical Center, Charlotte Orthopaedic Hospital,  Huntersville Medical Center and Matthews Medical Center.

After patient notices expired drink, Charlotte hospital changes protocol

Carolinas HealthCare System has instituted a new tracking system at its doctors’ offices after a Waxhaw patient recently noticed the liquid she had been asked to drink as part of a glucose tolerance test had an expiration date from October.

“We’re grateful for the patient’s having observed this situation,” said spokesman Scott White. “Because it was past the expiration date, the glucose drink should have been rotated out and it was not. That was an error.”

The pregnant patient from Waxhaw will be retested. Her husband, Abhishek Sinha, told the Observer she was given an oral glucose tolerance test at Carolinas Medical Center-Waxhaw to see if she has gestational diabetes.

He said his wife had consumed about 80 percent of the sugary drink used for the oral glucose tolerance test before she noticed the label and its expiration date. When she pointed it out, the test was stopped, and Sinha said the doctor told him to watch his wife for 24-48 hours to make sure she didn’t have a bad reaction.

“I’m so surprised because this is happening in America. We are not in a Third-World county,” said Sinha, who moved to the United States from India seven years ago. “This is negligence.”

Sinha said his main concern was to make sure other patients who may have had a similar test at that center know they could have received an outdated product. Sinha said he tried to contact a laboratory supervisor with Carolinas HealthCare System, but she did not return his calls.

White said there were six bottles in the expired lot of glucose drinks. He said two were left in the laboratory refrigerator and were disposed of. The other three had been used but cannot be traced because the lot number was not recorded in the patients’ records.

“Our laboratory personnel have been inspecting other centers where glucose tolerance testing is done and have found no additional outdated stock,” White said. “We have changed the protocol for such testing and will now require that the lot number and expiration date be listed on the order before providing it to a patient.”

High turnover not unusual in individual health insurance market

Last October, as enrollment for the Affordable Care Act got underway, I wrote about some Charlotte-area consumers who were surprised to learn their individual health insurance policies were being cancelled because they did not meet the minimum requirements under the new federal law.

A political firestorm erupted as others across the country experienced similar problems and complained that President Barack Obama lied when he had promised Americans could keep their insurance policies if they liked them.

A new study in the journal Health Affairs reviewed that phenomenon and provides more context about patterns in the individual insurance market.

First, the study found this market has been characterized by high turnover before the Affordable Care Act took effect in January 2014. It found that only 42 percent of Americans who have non-group coverage retain that coverage after a year.

Another finding: 80 percent of those who leave non-group coverage end up with different health insurance within 12 months, most commonly through employer-provided coverage. 

The author concluded: "Given estimates from 2012 that 10.8 million people were covered in this market, these results suggest that 6.2 million people leave non-group coverage annually. This suggests that the non-group market was characterized by frequent disruptions in coverage before the ACA and that the effects of the recent cancellations are not necessarily out of the norm."

Who decides what procedures are unnecessary?

Americans love lists. But we should pay attention to who's making the list.

As Kaiser Health News reported, when America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly affected their incomes.

The American Academy of Orthopaedic Surgeons discouraged patients with joint pain from taking two types of dietary supplements, wearing custom shoe inserts or overusing wrist splints after carpal tunnel surgery. The surgeons also condemned an infrequently performed procedure where doctors wash a pained knee joint with saline. 

Kaiser Health News reported: "They could have chosen many surgical procedures that are commonly done, where evidence has shown over the years that they don't work or where they're being done with no evidence," said Dr. James Rickert, an assistant professor of orthopedic surgery at Indiana University. "They chose stuff of no material consequence that nobody really does."

Read the entire story here.

Charlotte-area doctors named to medical board

Dr. Timothy Lietz, a Charlotte emergency medicine specialist, and Dr. Debra Bolick, a Hickory psychiatrist, have been named to the North Carolina Medical Board, the state agency that licenses doctors and regulates the practice of medicine.

Lietz

Lietz works at Mid-Atlantic Emergency Medical Associates in Charlotte and is chairman of the Department of Emergency Medicine for Novant Health Matthews Medical Center. He earned his medical degree from Ohio State University and completed internship and residency at Eastern Virginia Medical School.

Bolick

Bolick is acting section chief of outpatient mental health for the Hickory and Winston-Salem Community-Based Outpatient Clinics and is on the medical staff of the Veterans Affairs Medical Center in Salisbury. She earned her medical degree with the University of Colorado Health Sciences Center in Denver, and completed internship and residency training in psychiatry at UNC-Chapel Hill.

Two other new board members are Dr. Barbara Walker, a retired family physician from Kure Beach, and Wayne Holloman of Greenville, who owns Holloman Properties and Investments and formerly owned Holloman Apparel. He is one of three non-physician and non-nurse board members.

Each member serves a three-year term.

The other Charlotte-area physician on the 12-member board is President-Elect Dr. Cheryl Walker-McGill of Gastonia. Here's a link to read more.

Charlotte cancer patients can get free and reduced-cost lodging

Charlotte and Durham are among the U.S. cities where cancer patients can now benefit from a partnership between the American Cancer Society and Extended Stay America hotel chain.

Patients can get free or low-cost lodging while they're receiving cancer treatment away from home.

The American Cancer Society launched the program in Atlanta, Boston and Houston last October, and it has now expanded to 10 more, including Charlotte and Durham. The program will soon go nationwide.

Since October, the society has booked nearly 2,900 rooms serving 567 patients. Over two years, Extended Stay America has promised to provide 40,000 hotel stays to cancer patients, including 20,000 free rooms and 20,000 stays for $12 a night.

To request a room, call the American Cancer Society, 800-227-2345.

Open house planned for Wingate University's new physical therapy program

Last month, Wingate University launched a new three-year doctoral degree program in physical therapy with 42 students enrolled. 

The program is having an open house Friday, Feb. 21, from 1 to 3 p.m. on the Wingate campus. 

Applications are now open through May 2014 for the class entering in Jan. 2015. 

Physical therapist ranks number eight in U.S. News and World Report’s list of 100 Best Jobs. Wingate also offers doctorates in pharmacy, physical therapy and education. For more information: http://dpt.wingate.edu/visit.

Researchers on Gulf War illness seek veterans

Researchers at East Carolina University will spend another year studying the causes of Gulf War illness and medicines that might be able to treat it.

Forty veterans from North Carolina, South Carolina and Virginia who developed Gulf War illness have participated in the East Carolina study so far. But study leader, Dr. William Meggs, a medical toxicologist and professor of emergency medicine at the Brody School of Medicine at East Carolina University, hopes to recruit another 20. 

Gulf War illness is the name given to the chronic fatigue, chronic pain and difficulty with mental tasks suffered by some who served in the 1991 Gulf War and its aftermath. It affects almost one-third, or about 250,000, of the veterans who served, according to the National Institute of Medicine.

The $1.1 million study, funded by the Department of Defense, is researching the effectiveness of generic drugs that control inflammation in the brain that may have been triggered by neurotoxin exposures. 

Immediately after the war, Gulf War illness was attributed to post traumatic stress disorder. Others claimed that it was a psychological illness. The Department of Veterans Affairs founded a research advisory committee, including Meggs, to direct research efforts in the disease.

Research has shown that exposure to neurotoxic chemicals is most strongly associated with development of Gulf War illness. Those serving in the Gulf War had exposures to sarin nerve gas from Scud missiles and demolition of ammunition dumps containing sarin. Neurotoxic insecticides related to sarin were used to spray tents to control sand fleas. Troops also received a drug to prevent sarin from binding irreversibly at nerve junctions but that has similar toxicities. Soldiers were also exposed to smoke from oil well fires in Kuwait, depleted uranium, multiple vaccinations and oil sprayed on the sand in camps to reduce sand dust.

Gulf War veterans interested in knowing more about the study may contact Allison Mainhart at 252-744-5568.

Young, unvaccinated adults account for severest flu cases in North Carolina, Duke study shows

A review of the first 55 patients treated for flu at Duke University Hospital in Durham from November through Jan. 8 shows that only two of the 22 patients who required intensive care had been vaccinated prior to getting sick. The  findings were published online in the American Journal of Respiratory  and Critical Care Medicine. “Our  observations are important because they reinforce a growing body of evidence that the influenza vaccine provides protection from severe illness requiring  hospitalizations,” said the lead author, Dr. Cameron Wolfe, assistant professor of  medicine at Duke. “The public health implications are important, because not only could a potentially deadly infection be avoided with a $30 shot, but costly hospitalizations could also be reduced.” Wolfe  said this year’s flu season was marked by hospitalizations of previously healthy young people with a median age of 28.5 years. Of the 55 patients hospitalized at Duke, 48 were infected with the H1N1 virus, the so-called swine flu virus that caused the 2009 pandemic. That outbreak also hit young adults particularly  hard. Of  33 patients admitted to regular wards rather than the ICU, only 11 had been vaccinated. Most of those were chronically ill or had weakened immune systems for other reasons, or were taking medicines that weakened the  vaccine’s protection. The study also highlighted problems with the rapid test for influenza. Wolfe said 22 of the patients treated at Duke had been given a rapid influenza test that came up negative even though other tests showed they did have the flu. As a result, the patients had not received anti-viral medicines that might have eased flu symptoms if taken shortly after the onset of symptoms. “...Our observations support previous findings that vaccination reduces the severity of disease and should be encouraged as recommended by the U.S. Centers for Disease Control and  Prevention,” Wolfe said. To  read the article in full, http://www.atsjournals.org/doi/abs/10.1164/rccm.201401-0066LE#.Uvj_H7JMgXk.

Young women know dangers of tanning beds, and don't care

 
New research shows that young women who use tanning beds are generally aware of -- but choose to ignore -- the health risks.

Two UNC Chapel Hill researchers surveyed sorority women to find out what motivates young people to use tanning beds and how to develop messages that could discourage their uses.

The study, published in JAMA Dermatology, was co-authored by Seth Noar, of the UNC School of Journalism and Mass Communication, and Dr. Nancy Thomas, of the UNC School of Medicine.

They found that most women start using tanning beds in their teens, often accompanied by a parent or friend.

As a next step, the researchers plan to work with UNC graduate students to develop messages about the dangers of tanning beds that target young audiences. 

Changing behavior will require "very strategic" messages that don't focus solely on the health risks, Noar said. The messages might suggest alternatives, such as self-tanning products that do not rely on UV rays, he said.

Of the women surveyed, 45 percent said they had used tanning beds, 30 percent in the past year. Nationally, more than 28 million people use tanning beds each year, and the population most at risk from developing skin cancer as a result are users younger than 35.

Since the introduction of tanning beds in the late 1970s, indoor tanning has grown to a $2.6 billion a year industry. The number of tanning parlors in most U.S. cities is greater than the number of Starbucks or McDonalds.

The growing awareness of the dangers has led to major efforts to curtail tanning bed use, especially among teens. Five states ban the use of tanning beds for minors under 18, and 33 states and the District of Columbia have passed regulations limiting minors’ access to indoor tanning. 

In North Carolina, a tanning bed bill targeting minors was introduced in 2012 but did not reach a final vote. 

First tobacco warning came 50 years ago

Saturday marks the 50th anniversary of the first Surgeon General’s report on smoking and health. 

On Jan. 11, 1964, Surgeon General Luther Terry identified smoking as a cause of lung cancer in men, a likely cause of lung cancer in women and a likely cause of emphysema and chronic bronchitis - now known as chronic obstructive pulmonary disease.  

This was a clarion call in the fight against tobacco use, which is the leading cause of preventable death and illness today in the United States. 

Harold Wimmer, president and CEO of the American Lung Association, has called for a "recommitment by the nation to end tobacco use, and free us from the terrible toll it takes on our health and future. We can’t afford another 50 years.”

In 1964, the American Lung Association was known as the National Tuberculosis Association. And just as the TV series "Mad Men" reminds us, smoking cigarettes in the office, in restaurants, almost everywhere, was not only not shunned, it was condoned and almost encouraged. 

I remember in my own childhood home, where no one smoked, we had ash trays on every end table and coffee table. And when I started working as a newspaper reporter in the early 1970s, nearly all of my colleagues smoked. Newsrooms smelled like bars, and no one said a thing.

Today, with smoking bans in most buildings and restaurants, the stalwart few are banished to outdoor smoking areas from the heat of summer to the cold of winter.

In the meantime, the American Lung Association reminds us that tobacco use remains the nation’s number one cause of preventable death, killing 443,000 Americans and costing the nation $193 billion in health care expenditures and lost productivity each year. 

More than 8 million premature deaths have been avoided and life expectancy has been extended for men by more than two years and for women by more than 1.5 years over the past 50 years due in large part to tobacco control efforts such as increased tobacco taxes, smoke-free air laws, marketing and sales restrictions and cessation treatment programs, according to a study in the Journal of the American Medical Association.

“We have made significant progress against tobacco use over the past half century, but there are still nearly 44 million smokers nationwide, more than 3,000 kids pick up their first cigarette every day, and more than 443,000 people in America will die from smoking-related diseases this year," said John Seffrin, CEO of the American Cancer Society.

"The main reason: The unscrupulous tobacco industry continues to oppose tobacco control efforts, challenge proven tobacco control policies in court, manipulate products to get around existing regulations, produce and promote new tobacco products and spend billions of dollars on marketing to deceive the public and to addict more kids."