SUMMER 2005

Vol. 33 No. 3

A Newsletter for Physicians of Inova Fairfax Hospital and Inova Fairfax Hospital for Children

GMU-Inova Translational Research Centers to Advance ‘Bench to Bedside’ Research

he - TTranslational Research Centers, a unique partnership between two respected Northern institutions, is poised to pave the way for accelerated, cutting edge ‘bench to bedside’ research. Internationally renowned scientists who embrace innovative technologies and engage in collaborative efforts with clinical investigators will ensure that medical care keeps pace with advances in Zobair M. Younossi, MD, MPH, (far right) co-director of GMU-Inova Health System biomedicine. Translational Research Centers, speaks with Lance Liotta, MD, PhD, co-director, The initiative comprises the Center for Applied Proteomics and Molecular Medicine; Emanuel F. Petricoin, PhD, co-director, Center for Applied Proteomics and Molecular Medicine; and research efforts of the Center for Vikas Chandhoke PhD, associate dean of Research, College of Art and Sciences, Applied Proteomics and Molecular GMU, and co-director, GMU-Inova Health System Translational Research Centers. Medicine, the Center for Biomedical Genomics and the Center for the Mason University and Inova Health Until recently, researchers seeking Study of Genomics in Liver Diseases. System are working together to devel- a treatment for a disease may have The centers will coordinate multiple op technologies to enhance treatment tested hundreds of drugs individually programs to apply the advances for people with cancer, diabetes, liver over years. Now targeted therapy can arising from novel and exciting disease, and other conditions that are be tested simultaneously on thousands proteomics, nanotechnology, and increasingly prevalent in our society,” of genes and dozens of protein net- genomics technologies to the develop- says J. Knox Singleton, president and works in days, greatly accelerating ment of improved diagnostics, chief executive officer, Inova Health the elimination of drugs with obvious prognostics and therapies for cancer, System. “We’re honored that the new toxicity while identifying those with metabolic syndrome, and cardiopul- frontier in translational medicine is potential efficacy. monary, liver and neurodegenerative right here in .” The GMU-Inova partnership diseases. “We are excited that George These translational research pro- traces its roots to the Center for the jects address the genomic, proteomic Study of Genomics in Liver Diseases. and clinical aspects of a single disease and represent the future of medicine. GMU-Inova Research, continued on page 10 PRESIDENT’S COLUMN Welcome VCU School of Medicine Class of 2007

n August, we will see new faces Commonwealth University School HI-RES ON DISK on the patient care units and of Medicine. This campus was Ithroughout Inova Fairfax Hospital approved, as well, by the Liaison F. Joseph Hallal, MD and Inova Fairfax Hospital for Committee on Medical Education, Medical Staff President Children. Twenty-four third year which included representatives from students from the Virginia Common- the AAMC and the AMA. wealth University (VCU) School of In my view, this is a very impor- specialities with us as well. Our Medicine in Richmond will be start- tant milestone in the development current teaching program is strong ing their clinical clerkships at our of our hospital from what began as a and it will be significantly strength- hospital. By the fall of 2006, the full relatively small community hospital ened by this new affiliation with the complement of 48 medical students in the 1960s to our becoming a signif- VCU School of Medicine. In this from the VCU School of Medicine icant academic medical center. strengthened academic environment, will be located on our campus. Needless to say, there will be benefits I believe that we physicians will enjoy These third and fourth year for all of the parties in this relation- a more gratifying academic milieu medical students will be serving all of ship. The VCU School of Medicine which should give us the opportunity their clinical rotations with us. The will have students who will enjoy a to further enhance our own continuing third year students will have rotations clinical experience with a focus both medical education. We expect to on Surgery, Medicine, , on primary and tertiary care in a see a strengthening of the patient care Family Practice, and community setting that the main environment as well. This will be Gynecology, and Neurology. The campus in Richmond could not by good for us all. fourth year for the students will be itself adequately provide. Another In the last issue of Medifax the mostly a year of electives. In August benefit is a larger and broader patient lead article focused on the new we will officially become a “regional” base. The students themselves will Claude Moore Health Education or “branch” campus of the VCU benefit from this affiliation as well. Center. One of the several purposes School of Medicine. When this The AAMC reports that student of the new center will be to house happens, 27 of the 126 U.S. medical surveys from other regional medical facilities for the VCU School of schools will have one or more branch center campuses in the nation consis- Medicine, including the administra- campuses. The number of regional tently show that the students rate the tive offices, classroom space, and campuses will probably continue to educational experiences provided at a simulation center for the students. increase across the nation. These these campuses as good as, if not Prior to the opening of the Claude campuses, such as ours, will “in better than, the educational experi- Moore Center, the students will be effect, be mini-medical schools lack- ences at their primary medical school based in the renovated ground floor of ing only basic science instruction” teaching hospitals. Inova Fairfax the ECC building. As you may know, according to the Association of Hospital and Inova Fairfax Hospital Russell Seneca, MD, is the associate American Medical Colleges (AAMC). for Children will benefit from an dean and Craig Cheifetz, MD, is the The process of our becoming a affiliation that will surely enhance assistant dean of the Inova branch of regional campus began in 1999 when our stature as a medical center. This the VCU School of Medicine. representatives of the VCU School of should also lead to better recruitment The advent of our regional Medicine and Inova Fairfax Hospital of residents and eventually of fellows campus status, in my view, codifies and Inova Fairfax Hospital for in our teaching programs. what we already believe about Children began working in earnest to Currently, we have 60-70 medical ourselves, that, while we came from establish this branch campus at our students from a number of medical humble beginnings which many of us institution. In the spring of 2002, the schools performing a small number of were part of, we have now matured state legislature of Virginia and the their clinical rotations at our hospital to become a significant teaching governor authorized the creation of at any one time. In addition, we hospital. the Inova campus of the Virginia have 167 residents in many different

2 MEDIFAX SUMMER 2005 All Inova Facilities Earn Full JCAHO Accreditation From: Gregory Burfitt To: Inova_All Date: 6/30/2005 3:13:38 PM Subject: Announcement of JCAHO's Decision HI-RES ON DISK

am pleased to announce that we received official word today that all Inova facilities have earned full accreditation and the Gold Seal Iof Approval™ from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). A team of JCAHO physicians, nurses and other clinical experts independently reviewed each of Inova’s hospitals and long-term care facilities in April and May. As Richard Binder, MD, you know, we participate in the JCAHO accreditation survey process accepts the 2005 Caring for because it reinforces our commitment to continuously improve and be and About People Award. a learning organization. I want to take this opportunity to thank you and your staffs for your hard work during these surveys. Literally, thousands of Inova employees and physicians spent many, many hours preparing for, par- Dr. Binder Honored ticipating in and supporting this effort. And, this was the first time we at Gala 2005 experienced the tracer methodology, so that added more anxiety than usual. We will continue to be diligent in our preparation as we move As part of this year's Inova Health forward, as all JCAHO visits will be unannounced in the future. System Gala 2005 to support Inova Additionally, I am confident that our learnings from the review process Cancer Services, three outstanding will be hard-wired, enabling Inova to improve upon its already strong champions of Inova's not-for-profit foundation and patterns of practice. health care mission were honored on Throughout the survey, we heard many positive comments May 7. from the surveyors about our staff, patient care and how well they Richard Binder, MD, was the (the surveyors) felt they were treated. The surveyors were particularly recipient of the 2005 Caring For and impressed with the knowledge of front-line clinical staff and comment- About People Award. Dr. Binder has ed frequently that the tracers had gone so well because of the great been an integral part of Inova Health interviews with nurses, techs, therapists, and other caregivers. Our System Cancer Services for 30 years. buildings and environment of care services were also given special He was instrumental in developing recognition. The Engineering and Administrator surveyors were very and supporting community partner- impressed by the knowledge, skills, and initiatives of our engineering ships, including work with the Avon staffs across the system. Two Inova forms - the restraint monitoring Foundation and the Colon Cancer form and the long term care resident safety assessment form - were Green Team. Dr. Binder also helped cited by the surveyors as best practice and may be included in JCAHO to develop the genetic counseling reference materials for accredited organizations. These were just a few program at Inova Fairfax Hospital, of the many compliments we received. helping people with a personal or So, hats off to all of you—our employees, physicians and family history of cancer obtain volunteers—for helping bring world-class health care to our information about genetic testing and community! We can all be proud of the results of our efforts. cancer risk-reducing options. This year's Community Gregory Burfitt Responsibility award was given to Executive Vice President and Chief Operating Officer PricewaterhouseCoopers, LLP, and the Inova Health System Innovation Award was given to the Avon Foundation.

MEDIFAX SUMMER 2005 3 ADMINISTRATOR’S COLUMN

JCAHO Results Positive

n May, Inova Fairfax Hospital, facilities. I am sure you will agree Inova Fairfax Hospital for that this is the highest compliment we HI-RES ON DISK IChildren and the Inova Heart and could hope to receive. Again, I thank Vascular Institute participated in the and congratulate all of you for your Doug Cropper triennial JCAHO survey. We hosted hard work and dedication. Administrator, Inova Fairfax Hospital, 11 surveyors during the five-day Every survey presents opportuni- Inova Hospital for Children and Inova Heart review, which represented our first ties for improvement as JCAHO and and Vascular Institute experience with the tracer methodolo- others continue to “raise the bar”. gy (following patients through the Public scrutiny also is on the rise, • Ensure that all medication orders care process). and the public’s expectations of us are are legible and include dose, fre- I acknowledge the many hours significant. By increasing our efforts, quency, date, time, signature, Inova physicians, staff and Inova employees we will maintain our proud tradition ID number. Never include “do not spent preparing for and participating of providing the highest quality care use” abbreviations or range orders in this effort. Senior leadership and I and become the very best. for the frequency of administration. thank you for your support. JCAHO’s requirements for Review orders for completeness and During the survey, it was improvement (RFI) reflect some areas accuracy with the RN, when possi- extremely gratifying to hear many we were already working on and ble. If clarification or correction is positive comments. It is my pleasure identify others that are new. The RFIs needed, nursing will contact the to share some of this feedback with that impact medical staff include practitioner. you: issues with the following: • Fully complete the ‘boarding pass’ prior to any surgery or invasive • the knowledge of front-line clinical • complete and correct medication procedure. staff is impressive orders • Conduct a procedure pause prior to • the tracers went well because of the • completeness of boarding passes the administration of moderate great interviews with nurses, techs, • procedure pause in moderate sedation. therapists, physicians and other sedation cases caregivers • timely operative report dictation The fact that the Inova hospitals • two Inova forms—‘restraint moni- on the Fairfax campus are staffed by a toring’ and ‘resident safety assess- It is apparent that failure to team of smart, dedicated and caring ment’—were cited as best practice uphold the standards of care these physicians and other providers was and may become part of JCAHO RFIs address will have serious impli- one of the main reasons I accepted the reference material for accredited cations. These RFIs must be position of administrator. Now I have organizations addressed promptly and uncondition- every confidence we will seize the • we deal exceptionally well with ally for us to maintain full accredita- opportunity to learn from our recent challenges presented by cultural tion. JCAHO survey and emerge providing diversity, ‘hospitals within hospi- The Medical Executive a higher level of quality care. tals,’ wide-range of services, patient Committee, in their June meeting, Thank you again for all of your flow and ED overcrowding as well decided that the medical staff must efforts in conjunction with the as staff retention commit to 100 percent compliance to JCAHO survey. Senior leadership and • building and environment of care meet the above requirements. The I look forward to working closely services deserve special recognition committee asks that physicians take with you. Together we will achieve the following actions: our mutual goals. I am proud to say that on several Please call me at 703-776-3332 occasions, and in a variety of care set- • Dictate operative/procedure reports with your suggestions and/or tings, the surveyors mentioned they immediately after the procedure concerns. would feel comfortable seeking care (i.e., before the patient goes to the for themselves or a loved one at our next level of care).

4 MEDIFAX SUMMER 2005 Altieri Award Deborah Archer, MD, far left, third year resident, was given the first Michael Altieri, MD, annual award on June 16. Dr. Archer is pictured with Rose Altieri, Imo Ibia, MD, and David Ascher, MD, chair, Department of Pediatrics. Dr. Altieri is a former chairman of Pediatrics who died in 2004.

HI-RES ON DISK

Palliative Care Offers Treatment Options for Progressive Chronic Illness

eople with progressive chronic of life and function. Palliative care the dance,”’ Dr. Muir says. “However illness who may one day need also increases hospital efficiency. By we never consult on a patient without Pthe full spectrum of hospice supporting the work of intensivists, an order from the primary physician.” care often require pain and symptom palliative care specialists help move Palliative care often provides management. And family members patients along the continuum of care, expertise and support in conjunction who must navigate the medical reducing ICU and overall length of with curative care. Round-the-clock system while suffering the emotional stay, thus making beds available so coverage facilitates access to services distress of watching a loved one physicians may continue admitting and relieves referring physicians decline also may need specialized patients. of time-consuming patient/family care. Physicians managing this popu- “Palliative care increases patient, communication. lation face the challenge of meeting family and physician satisfactions,” “We are eager to emphasize that the difficult and time consuming Dr. Muir says. “Programs also our services are a consultation, not physical and psychosocial needs of help hospitals meet accreditation a takeover,” Dr. Muir explains. “And patients and families. standards.” they never compromise revenue for Physicians specializing in pallia- Dr. Muir is president of Capital referring physicians.” tive care can bring a substantial Palliative Care Consultants, the only At a minimum, consultations measure of relief to chronically ill office-based palliative care practice include the patient, the patient’s patients, their families and their that serves patients in hospitals, primary medical decision maker, the physicians. “There exists a tremen- nursing homes, assisted living or palliative care consultant and the dous unmet need in our community long-term care facilities and at home palliative care nurse practitioner. long before the ‘six months or less’ throughout Northern Virginia, Ideally, the referring physician also prognosis,” says J. Cameron Muir, Washington, DC, and suburban participates. In some instances, only MD, a physician board-certified in Maryland. The practice has extensive an initial consultation is needed. The internal medicine, medical fellowship training in palliative majority of cases require a number of and palliative medicine, who consults medicine and is an arm of Capital follow up visits. at Inova Fairfax Hospital. “Improving Hospice, which has served the area For more information about access to palliative care has a positive since 1977. appropriate palliative care options, impact that extends beyond patients Physicians may request a pallia- speak to a nurse case manager or and their caregivers.” tive care consultation, or patients call Inova’s physician referral It has been documented that and their family can self-refer. “We number—703-204-3366—to request early palliative care improves quality consider it a privilege to be ‘invited to a consultation.

MEDIFAX SUMMER 2005 5 Correctly Delivering Asthma Medicine Critical to Effective Treatment

Leigh Hume, RN, MN by a rapid, shallow inspiration, thus exhaling into the device prior to Respiratory Program Manager allowing no medication into the inhalation, which can result in an HealthSource respiratory tract. empty dose. Humidity is also a A more time efficient alternative potential problem since it can hether your practice to the nebulizer is the metered dose decrease output. caters to adults or children, inhaler. Once activated, medicine An added benefit of the DPI is Wchoosing the correct from a CFC pMDI travels between the dose counter, which lets the delivery device can play a critical role 60-90 mph. As a result, as little as patient know how many doses are left in effectively treating asthma. The five percent of medicine can be at any given time. Most patients using three mainstays for delivering asthma deposited in the lung and as much as an MDI are under the misconception medications are: 80 percent to the oropharynx, thus that if they are able to hear airflow increasing systemic absorption. A noise or “feel” medication when shak- • nebulizers pMDI with a valved holding chamber ing the canister, there is medication • pressurized Metered Dose Inhalers (Aerochamber™) “slows down” the still available. In reality, patients who (pMDI) delivery process and can increase use an inhaler until it no longer makes • dry powder inhalers (DPI). lung deposition to 15-30 percent and a sound when actuated, have inhaled reduce oropharyngeal deposition to 15 more then 40 puffs with little to no The amount of medicine percent. If patients wash their holding medication. In addition, “floating” the delivered to the lung using any one chamber before its first use, reducing canister to determine whether an of these devices can vary from one to the electrostatic charge, the half life inhaler still contains medicine has no 40 percent, depending on a multitude of respirable particles in the holding merit. Researchers found that each of factors. Narrowing this variance by chamber can extend beyond 10 brand of inhaler has its own distinc- optimizing drug delivery allows the seconds, allowing for optimal inhala- tive floating pattern regardless of physician a clearer picture of how tion. Thus, the purpose of a holding content. The only way to determine well a patient is responding to a chamber extends beyond assisting if a CFC pMDI has medication is to prescribed regimen. Understanding young children with limited coordina- count puffs. The American the factors that cause these variances tion skills, and should be prescribed Respiratory Alliance has developed a will assist the physician in both pre- with any age population. “Scratch-A-Dose” card that sticks on scribing the right delivery device and Because of environmental the inhaler. The card provides patients educating the patient on the impor- concern, CFC pMDIs will soon be an easy way of tracking doses. tance of proper inhalation techniques. phased out and replaced with HFA The margin for error when using Nebulizers require minimal coor- inhalers and dry powder inhalers inhaled medications far exceeds that dination to administer medication (DPI). Patients tend to prefer DPIs of oral medications. Educating properly. Poor coordination, however, because they are less complicated to patients on some of the concepts is not the only factor related to poor use than a pMDI and require fewer mentioned above could significantly drug delivery. Output from a nebuliz- “puffs” than the MDI. DPIs were impact their response to medications er can be reduced 50 percent if not designed to deliver more medicine to and ultimately improve control. washed properly. For optimum deliv- the lung than pMDI, but this can only For further information on ery, nebulizers should be washed in occur if the patient has a sufficient educating the asthma patient, call soapy water, rinsed and dried between inspiratory flow rate. The most mod- Inova HealthSource at 703-208-5606. each use and cleaned daily with one ern DPI’s require a fairly low inspira- The HealthSource CARE part vinegar and four parts water. In tory flow rate to be effective. Most (Community Asthma Resource the pediatric population, common adults and healthy children over five and Education) program provides practices that can result in less than can use the Turbuhaler (AstraZeneca) education services to both physician one percent of medication reaching since it requires an inspiratory flow office staff and the community. the lungs is the “blow by” technique rate of ≥ 60 L/min. The Diskus and administering a nebulized treat- (GlaxoSmithKline) requires an ment while a child is crying. Crying inspiratory flow rate of ≥ 30 L/min. is a prolonged exhalation, followed A potential problem with DPIs is

6 MEDIFAX SUMMER 2005 Deep Brain Stimulation for Parkinson’s Patients

eep brain stimulation (DBS), brain,” Dr. Leiphart says. “Patients some, neurostimulation alone can which uses high frequency, often can resume activities abandoned suppress dyskinesia. Dpulsatile, electrical stimula- for years and enjoy a greatly Risks associated with DBS tion to mimic the effects of ablative improved quality of life.” include a two to three percent chance surgery without destroying tissue, Parkinson’s patients who may of brain hemorrhage that may be offers an exciting treatment option for benefit from DBS are those with insignificant or may cause paralysis, certain Parkinson’s patients. tremor uncontrolled by medication stroke and speech impairment and a “Deep brain stimulation is the and those with symptoms that respond 15 percent chance of a minor or tem- biggest breakthrough we’ve seen for to medications yet who experience porary problem. Infection, which treating Parkinson’s disease in severe motor fluctuations, including occurs rarely, may require removal of decades,” says James Leiphart, MD, wearing off and dyskinesia. the electrode, but does not cause last- PhD, a neurosurgeon practicing at Beneficial effects of DBS have ing damage. Inova Fairfax Hospital. “And if even been shown to last for several years. Disadvantages associated with more advanced therapies become Most patients can drastically reduce DBS therapy include equipment fail- available, the DBS procedure can be their levodopa dosage. Patients with ures, such as fractures or erosion, and easily reversed.” dyskinesia due to their medications, additional surgery required for battery The DBS system consists of a experience over 80 percent reduction replacement. stopwatch-sized neurostimulator, a in their involuntary movements. DBS requires time and effort on lead and an insulated wire that is Patients who initially responded well the part of the patient and the medical passed under the skin of the head, to medications, but over time devel- team for programming and medica- neck, and shoulder to connect the oped side effects, may experience 60- tion adjustments to achieve optimal two. The lead is implanted in the tar- 80 percent improvement in tremor and symptom control. get area of the brain through a small slowness of movement. Patients on For more information about deep opening in the skull. The neurostimu- average report a 50 percent improve- brain stimulation, Dr. Leiphart can be lator is implanted under the skin near ment in walking and balance. For reached at 202-741-2750. the collarbone. Prior to the procedure, MRI or CT scanning locates the precise target - thalamus, subthalamic nucleus or globus pallidus - where abnormal electrical nerve signals underlie the Parkinson’s symptoms. The patient is awake during the procedure. Microelectrode recording monitors the activity of nerve cells to confirm optimal lead placement and together with macrostimulation provides physi- ological verification of the target. The stimulator is implanted under general anesthesia either at the time of electrode implantation or later. Within a few weeks, neurologists pro- HI-RES ON DISK gram the neurostimulator and make adjustments, as needed, to optimize symptom control. The system is generally very well NICU check presentation tolerated with no significant change Robert Beck, MD, Kathleen Schaffer, RN, and Jerrod Ullah, RN, in brain tissue around the electrodes. thank Lee Brown for his $5,000 donation in honor of his fifth birthday in “DBS allows us to interfere with June. His parents Leonard and Diane Brown are on the right. the signals that cause debilitating symptoms without damaging the

MEDIFAX SUMMER 2005 7 Organ Donation Committee Recognized by HHS

embers of the Organ Donation Committee, on Mbehalf of Inova Fairfax Hospital and Inova Fairfax Hospital for Children, were recently awarded the Department of Health and Human Services (HHS) Medal of Honor for excellence in organ donation rates. This honor was given to hospitals across the country that achieved the Hi-Res on Disk HHS goal of at least a 75 percent conversion rate in organ donation over a year. (Conversion rate is the number of actual organ donors out of the total number of eligible donors.) Through its participation in the Members of the Inova Fairfax Hospital and Inova Fairfax Hospital for Children Organ Donation national Organ Donation Committee, left to right, are: Jamie Dubbs, RN, NSICU; Tori Scott, RN, TICU-Trauma ICU; Breakthrough Collaborative over the Kimberly Stahl and Kenny Boyd, Washington Regional Transplant Consortium (WRTC); past year, the Organ Donation Elizabeth Duke, MD, administrator, Health Resources and Services Administration; Committee is dedicated to sustaining Christopher Michetti, MD, Trauma Services; Marjorie Avery, RN, patient care director, TICU; Lori Brigham, CEO, WRTC; and Susan Hartmus, RN, NSICU. this success by spreading the best known practices in organ donation throughout the hospital. Only a third enhanced through transplantation in Inova Fairfax Hospital for Children is of the nation's largest hospitals met 2004. The award was given at the First encouraged to contact Tori Scott, RN, the 75 percent goal, but the award will Annual Organ Donation National Trauma ICU; Margorie Avery, RN, now be given annually to those that Learning Congress in Pittsburgh on PCD of Trauma ICU; Susie Hartmus, do. Prior to the Collaborative, the May 19, 2005. RN, Neuroscience ICU; or national average conversion rate was Anyone interested in learning Christopher Michetti, MD, Trauma 46 percent. But as a result of this more about the organ donation pro- Services. national effort, a record breaking cess at Inova Fairfax Hospital and additional 1,400 lives were saved or

Online Medical Abbreviation Resource Available

edical abbreviations are a Not Use” list – abbreviations that dosage designations not to use (listed double-edged sword – they must be avoided to help ensure patient under “Your Facility’s Do Not Use Mcan save time, but they can safety. List”), other common dangerous also be misinterpreted. The Inova You can access Medical abbreviations and dosage designa- Fairfax Hospital Health Sciences Abbreviations from any computer tions, and an alphabetical abbreviation Library introduces the online compan- workstation within the hospital. From search. For more information on this ion to an Inova Fairfax Hospital stan- the InovaNet home page, click on resource or other Library services call dard, Medical Abbreviations: 26,000 “Manuals/References” on the left the Inova Fairfax Hospital Health Conveniences at the Expense of side, then click on “Safe Medical Sciences Library reference staff at Communication and Safety, by Neil Abbreviations [Neil Davis]” under 703-776-3357. Davis. This resource can assist physi- the “Clinical” heading. This will take cians and staff in recognizing com- you to the Medical Abbreviations monly used medical abbreviations and Web site. Features on this site include includes Inova Health System’s “Do Inova’s dangerous abbreviations and

8 MEDIFAX SUMMER 2005 There’s HELP for Older Patients Save the Date: Elder Life Program Aims to Improve Hospital Experience Annual Medical Staff Meeting ith almost half of hospital • Tuesday, Nov 8, 2005 patients being age 65 or • Fairview Park Marriott, older, health care providers HELP Services W HELP volunteers provide Falls Church at Inova Fairfax Hospital are taking these services to hospitalized • Registration, 5:30 p.m.; measures to ensure excellent care for older patients: meeting, 6 p.m. older patients. Being in the hospital can upset • communication/comfort— Election of officers and normal routines and activities. As keeps patients aware, alert and members-at-large. Nominations a result, 25 to 60 percent of older oriented to their surroundings must be submitted to medical patients will experience delirium using hearing and vision staff president by early or confusion, which can lead to func- equipment and orientation September. More info to come. tional and cognitive changes that can boards persist for months and slow recovery. • relaxation—promotes better The Hospital Elder Life Program, or sleep by easing anxiety HELP, is being developed to improve symptoms through breathing Medication Order their hospital experience by helping techniques, music and massage Writing for JCAHO them to maintain their mental alert- • therapeutic—offers ness and functional abilities. stimulating activities for the Compliance A team of professionals and mind and body through Physicians please note the following: trained volunteers will carry out exercise and help with walking interventions specially designed to socialization, card playing, • The date and time must be on all meet the needs of hospitalized older puzzles and reading material orders. patients. Patients and families will • meals—encourages healthy • Your signature, Inova ID #, and also have access to Joanne Crantz, eating and drinking and printed name must be on all orders. MD, FACP, a geriatric specialist, offers companionship during • Write indication for PRN and Deirdre Carolan, PhD, CRN, mealtimes medications, i.e., prn pain, prn a geriatric clinical nurse specialist. headache, prn insomnia, and prn During daily visits, volunteers offer anxiety. assistance during mealtimes, walk HELP Goals • Do not use abbreviations such as with patients, and engage in social QD, QID, QOD, U, IU, AU, AS, AD, and mental stimulation activities. The primary goals of the Hospital MS, MS04, MgS04, AZT, Nitro In addition to benefiting older Elder Life Program (HELP) are: drip. patients, The HELP program is also • Do not use range orders for very beneficial for their family and • maintain cognitive and physical frequency of administration (use: friends. A waiting room on the 10th functioning of high-risk older adults q 4 H, do not use: q 4-6 H) floor of Inova Fairfax Hospital is during hospitalization • Sign all verbal orders within 72 being set up as a geriatric community • prevent delirium hours. resource room. Materials on caregiver • maximize independence at • Post procedures and transfers. Do support, end-of-life issues, the latest discharge not write “Resume previous meds”. technol-ogy and a directory of • decrease LOS • Rewrite all medications. Use the geriatric services offered in the • prevent unplanned hospital IDX/CARECAST Active community will be available for readmissions Medication List order sheet. families. • increase patient and family Anyone 70 years and older who satisfaction Try to be as clear as possible with has some risk factors for delirium or For more information about the your orders - This is mandatory for functional/cognitive decline can be HELP program or to make a referral, JCAHO compliance! evaluated for admission to this pro- call 703-776-6824 or e-mail gram. There is no charge for these [email protected]. Thank you from the hospital services, and Inova encourages calls administration and pharmacy. for information or referrals.

MEDIFAX SUMMER 2005 9 GMU-Inova Research, continued from page 1 Instrumentation Facility at GMU. He and support Dr. Liotta and Dr. also leads the development of medical Petricoin is possible only because of Established in 2000, the center and scientific research programs with this partnership.” grew out of a research effort between molecular bioscience and informatics Dr. Liotta and Dr. Petricoin will the Center for Liver Diseases at Inova scientists who use synergistic junc- also hold research appointments at Fairfax Hospital and the George tures of cutting-edge applied research. Inova Fairfax Hospital. “Translating Mason University genomics team to Current studies include cancer the results of bench research directly study the genetic epidemiology of genomics, genomics of liver diseases, into patient care through clinical obesity-related nonalcoholic steato- cartilage studies, and development research and trials holds the promise hepatitis (NASH). Zobair Younossi, of large scale relational database inte- of a shift to personalized medical MD, MPH, a leader in clinical grating clinical and gene expression treatment,” says Douglas Cropper, research of liver diseases, including data. administrator, Inova Fairfax Hospital. NASH and hepatitis C (HCV), serves "This partnership offers an “The positive impact on healthcare of as medical director of the Center for integrated approach to translational the George Mason University and Liver Diseases, which has conducted research where scientists and clini- Inova Health System collaboration pioneering research in genomics of cians work as a team to accelerate may be far beyond what we currently obesity-related fatty liver, liver fibro- the latest research findings and tech- envision.” sis, obesity and metabolic syndrome nologies directly to patient care," Dr. Dr. Liotta and Dr. Petricoin have and made more than a dozen presenta- Chandhoke says. developed technologies that can map tions. Based on the academic success of this type of research, it was time to "This partnership offers an integrated approach to translational go to the next level, Dr. Younossi says. research where scientists and clinicians work as a team to “The ability to conduct transla- accelerate the latest research findings and technologies directly tional research requires a basic science partner,” he adds. “It makes to patient care," good sense to partner with a universi- — Vikas Chandhoke, PhD ty with an excellent basic science infrastructure.” George Mason University has the hyperactive protein circuits in The partnership with GMU puts appointed Lance A. Liotta, MD, PhD, cancer cells from a biopsy specimen. Inova ahead of the curve. “Patient formerly of the National Cancer Circuit mapping enables tailoring care, research and education are Inova Institute, and Emanuel F. (Chip) drug therapy that targets individual priorities, and academic and media Petricoin III, PhD, formerly of the aberrant circuitry. “Our new proteo- exposure will enhance the image of Food and Drug Administration, to its mic technology will be employed to our health system as a leader in faculty. The two pioneers in pro- eventually help the clinician know translational research,” Dr. Younossi teomics and molecular medicine will exactly how the patient’s diseased says. “This integrated approach co-direct the Center for Applied cells have changed, and then use this will certainly help our patients, our Proteomics and Molecular Medicine. information to tailor the treatment for colleagues and our students.” Research will focus on protein that specific individual,” Petricoin Dr. Younossi and Vikas biomarker discovery for early disease says. “We are excited to work with Chandhoke, PhD, associate dean of detection and risk stratification as Inova Health System to bring these research for the GMU College of Arts well as molecular network analysis of technologies to the bedside as rapidly and Sciences, co-direct the George tissue to create targeted treatment. as possible.” Mason University-Inova Health Much of George Mason Recently, Dr. Liotta and Dr. System Translational Research University’s success has resulted from Petricoin discovered that a rich Centers. Since its inception, they have a commitment to draw upon and archive of protein biomarkers is also co-directed the Center for the contribute to our region. bound to common blood proteins, Study of Genomics in Liver Diseases. “Our expanding partnership with such as albumin. These abundant Dr. Chandhoke serves as director Inova Health System is one of the proteins act as molecular ‘mops,’ of the Center for Biomedical highlights of several new innovative which by harvesting and amplifying Genomics, which is dedicated to initiatives and is the basis for future thebiomarkers, enable protein sequen- applied genomic research in key activities,” says Alan Merten, cing, a facile approach that can biomedicine using microarray tech- president of George Mason nology, and the Shared Research University. “Our ability to attract GMU-Inova Research, continued on next page

10 MEDIFAX SUMMER 2005 The Center for Applied Proteomics and Molecular Medicine HI-RES ON DISK will facilitate the translation of this research into clinical trials conducted under Inova Health System. The creation of the George Mason University-Inova Health System Translational Research Centers is one of the most exciting recent developments in the long- term collaboration between the two institutions. “The laboratory facilities and academic environment of GMU, coupled with the outstanding clinical set up at Inova has been key in attract- ing to our region some of the greatest scientists in the entire world,” says Daniele Struppa, PhD, dean of the College of Arts and Sciences at GMU. “The work we will be doing with Drs. PICU Tour Liotta and Petricoin and their group is changing the paradigm through which Craig Futterman, MD, Senator Jeannemarie Devolites Davis and David Sas, DO, tour- ing the Pediatric Intensive Care Unit at Inova Fairfax Hospital for Children on May 4. we understand cancer and other molecular diseases. I would not be surprised if this was the beginning GMU-Inova Research, continued from page 10 of an operation that within a decade dramatically changes the way in uncover and identify thousands of protein microarray technology can which we think about these diseases.” candidate biomarkers that fluctuate map the protein circuitry. The pro- Funding for the George Mason with disease stages. Simultaneous teomic ‘barcode’ of the circuitry of University-Inova Health System measurement of panels of multiple the diseased cells can then predict a Translational Research Centers will biomarkers results in higher sensitivi- patient’s response to conventional come from grants and contracts, ty and specificity than does individual therapy. The technology also provides strategic alliances with the biotechnol- biomarker measurement. a roadmap for new drug combinations ogy and pharmaceutical industries, “We have uncovered a huge that may improve outcomes for technology agreements and royalties, untapped repository of potential patients unresponsive to traditional as well as philanthropic donations. biomarkers that we never before knew approaches. Laboratories and support facilities existed and in the future we can “The relationship between Inova will be maintained at George Mason’s envision measuring multiplexed Health System and George Mason Prince William Campus in Manassas panels of these biomarkers,” Liotta University is a true paradigm shift,” and at Inova Fairfax Hospital in Falls says. “The goal is to improve diagnos- Liotta says. “When our colleagues Church. Additional scientists are tic accuracy so we can detect disease hear about the relationship and our expected to join the centers within earlier and provide better guidance for plans, they are very excited. We really four years. patient management.” do have an opportunity to do some- For more information on the Dr. Liotta and Dr. Petricoin thing that no one else in the world has Translational Research Centers, have intersected this discovery with been able to do.” Petricoin adds, “A contact Dr. Younossi at 703-208-6650. nanotechnology, using engineered lot of people and entities talk about nanoparticles as molecular harvesting personalized medicine, but this rela- agents to directly capture the disease- tionship throws a gauntlet down that associated biomarkers. Once the says, ’Hey we understand this is not disease is diagnosed and a tissue an easy path, but we are really going biopsy is obtained, the scientists’ to do this.’”

MEDIFAX SUMMER 2005 11 Nonprofit Org. U.S. POSTAGE

3300 Gallows Road PAID Falls Church, VA 22042-3300 Falls Church, VA Permit No. 118

Inova Health System is a not-for-profit health care system based in Northern Virginia that consists of hospitals and other health services including emergency and urgent care centers, home care, nursing homes, mental health and blood donor services, and wellness classes. Governed by a voluntary board of community members, Inova’s mission is to improve the health of the diverse community we serve through excellence in patient care, education and research.

SUMMER 2005

Vol. 33 No. 3

A Newsletter for Physicians of Inova Fairfax Hospital and Inova Fairfax Hospital for Children

Medical Staff President F. Joseph Hallal, MD Administrator Douglas Cropper Editor In This Issue: Denise Tatu Photography • GMU-Inova Translated Research Centers Anne Ford Doyle Debra Troell • Welcome VCU Class of 2007 If you have questions or comments, call • JCAHO Results Positive 703-321-2912. For more information about Inova Health System, visit our Web • HELP for Older Patients site, www.inova.org.