PUBLISHED2 017 OUTCOMES OUTCOMES Neuroscience Institute OCHSNER Ochsner’s longstanding tradition of bringing physicians together to improve health outcomes continues today. Our goals are to work together with our referring providers to serve the needs of patients and to provide coordinated treatment through partnerships that put patients first. We have automated physician-to-physician patient care summaries for hospital encounters and enhanced the patient experience by giving patients the ability to schedule appointments online.
Close coordination and collaboration begin with transparency and access to the data you need to make informed decisions when advising your patients about care options. OchsnerOutcomes, a compilation of clinical data, represents only part of our efforts to better define the quality of Ochsner’s care and to share that information with you.
Trusted, independent organizations give the highest marks to Ochsner’s quality. Ochsner Medical Center was the only healthcare institution in Louisiana, Mississippi and Arkansas to receive national rankings in four adult specialties from U.S. News & World Report for 2017–2018. Ochsner Hospital for Children has been ranked among the top 50 children’s hospitals in the country for Cardiology Warner L. Thomas and Heart Surgery in the 2017–2018 U.S. News & World Report Best Children’s Hospitals rankings, President & making it the only nationally ranked children’s hospital in Louisiana. Chief Executive Officer ® Ochsner Health System Additionally, CareChex named Ochsner Medical Center, Ochsner Baptist and Ochsner Medical Center – West Bank Campus among the top 10% in the nation in Medical Excellence for 16 different specialties. Ochsner was also named #1 in the nation in Medical Excellence for Organ Transplants and, for the fifth year in a row, #1 in the nation in Medical Excellence and Patient Safety for Liver Transplant.
Ochsner is expanding its already robust research program with two new partnerships. The first, with TGen, brings early-phase cancer clinical trials to the region. The second, with TriNetX, an international data research network, will allow Ochsner clinicians to have the opportunity to provide new therapies to their patients sooner, as well as provide our researchers access to new tools with which to analyze data on our own patients and refine treatments.
Ochsner Multi-Organ Transplant Institute is one of 19 transplant hospitals in the United States to participate in the initial pilot phase of the Collaborative Innovation and Improvement Network Patient referrals, transfers and consults are critically important, Robert I. Hart, MD (COIIN) project, a three-year study by the United Network for Organ Sharing (UNOS) intended Executive Vice President & to increase transplantation, with a particular focus on utilization of deceased donor kidneys. and we want to make it easy for referring providers and their Chief Medical Officer staff. To refer your patient for a clinic appointment, call our Ochsner Health System Ochsner consistently earns the respect of independent evaluators. We do not rest on these achievements, but use them as a benchmark to continuously improve. We will continue to Clinic Concierge at 855.312.4190. share the data you need to care for your patients, provide services you may not have in your community and develop the collaborative relationships essential to ensuring the best outcomes for every patient, every time. Table of Contents
Letter from the Chairmen ...... 6 Ochsner Neuroscience Institute ...... 7 Neurological Health Issues on the Rise ...... 8 Locations ...... 10 Neuroscience Accolades ...... 12 Comprehensive Services Offered ...... 13 Stroke Care ...... 20 Neurosurgical Care ...... 42 Neuro-oncology Care ...... 49 Radiosurgery Program ...... 50 Pituitary Disorders ...... 51 Epilepsy Program ...... 52 Neurocritical Care Unit ...... 55 Physical Medicine and Rehabilitation ...... 56 Concussion ...... 59 The Back and Spine Center ...... 63 Movement Disorders ...... 74 Pediatric Neurosurgery Program ...... 76 Headache Disorders Program ...... 78 Multiple Sclerosis Program ...... 80 Memory Disorders Program ...... 83 Research ...... 85 Publications ...... 91 Contact Information and Locations ...... 93 Providers ...... 94 About Ochsner Health System ...... 96 Letter from the Chairmen Ochsner Neuroscience Institute
The Ochsner Neuroscience Institute earns national and regional recognition as a leader in providing referring physicians and patients with quality neuroscience services. Our multidisciplinary team offers the latest diagnostic and therapeutic Back & Spine Emergency options for adults and children in a variety of care settings and locations. Center Medicine Pediatric Hospital Neuro/NS/ Neurological diseases are on the rise. In order to care for this complex population, Medicine PM&R we have created a comprehensive Neuroscience Institute. Ochsner integrates expert providers from a variety of specialties through centers and programs collaborating Neuro- Concussion/ to provide patients with comprehensive, coordinated services throughout the ophthal- TBI continuum of care. We provide inpatient and outpatient neurological care in locations mology Wale Sulaiman, MD, PhD throughout greater New Orleans, the North Shore and Baton Rouge and in a broad System Chairman, In 2016, Ochsner range of subspecialties. Our multidisciplinary approach results in more effective Department of Neurosurgery transitioned from ICD and efficient care, leading to better patient outcomes. General Neuro- 9 to 10 (International Neuro- radiology Statistical Classification The quality of the Ochsner Neuroscience Institute has been independently verified surgery of Diseases and Related as being among the nation’s best. In 2017, U.S. News & World Report ranked Ochsner Health Problems). The 10th #24 in the Nation for Neurology and Neurosurgery. Healthgrades honors us as one Neurosurgery edition allows for greater of America’s 100 Best Hospitals for Stroke Care. It also recognizes us with its Excellence accuracy with the addition Awards for Neurosciences and Stroke Care. We also earned its Five-Star Awards for Stroke Neurology MS Center of more than 14,000 new Treatment of Stroke. Finally, CareChex® ranks Ochsner as #4 in the Nation for Medical Center PM&R diagnostic codes and Excellence in Neurological Surgery. Neurocritical Care sub-classifications. While this tool permits greater We are finding new and innovative ways to bring this level of care to physicians specificity, the additional and patients. Our fleet of medically equipped helicopters, fixed-wing aircraft and Memory &
classifications have resulted OCHSNER NEUROSCIENCE INSTITUTE ground vehicles is available for emergency and critical care needs. It offers a flight Movement Psychiatry in outcomes metrics that team of physicians, critical care nurses and other specially trained neurosciences staff Disorders may appear inconsistent on call 24/7. Our unique telestroke program uses telemedicine to deliver nationally from 2015 to 2016. ranked care to patients in 42 hospitals across Louisiana and Mississippi and has cared Richard Zweifler, MD for more than 7,500 telestroke patients. System Chairman, Neuro- NEUROSCIENCE INSTITUTE NEUROSCIENCE Neurotology
| Department of Neurology muscular Ochsner is committed to excellence in patient care and service to our referring providers. We look forward to working with you and hope you will find the results of our efforts herein useful. Headache Epilepsy Disorders Center Neuro- General oncology Neurology OCHSNER OUTCOMES
6 7 Neurological Health Issues on the Rise
Head injury is the leading 1 IN 6 Stroke is the cause of death people will leading cause in young adults have a stroke of adult disability
people in the U.S. of the population who have 2.2M suffer from epilepsy 10% epilepsy will have a seizure
Louisiana ranked 8 IN 10 Hospital & ER visits people will have a spine 130M resulting from back pain #50 disease at some time in brain health OCHSNER NEUROSCIENCE INSTITUTE
increase in deaths from Alzheimer’s th leading cause of death in NEUROSCIENCE INSTITUTE NEUROSCIENCE
| 64% is expected in the next 5 years 6 the U.S. is from Alzheimer’s OCHSNER OUTCOMES
8 9 1 Baker
1 Mississippi River 110 4 Walker 55 Picayune 190 190 Robert Baton 3 Livingston 41 Rouge 1212 12 12 1212 10 42 Ponchatoula 22 10 12 11 3 Westminster 51 10 1 Gulfport 59 1 Pearl River 43 3 Mandeville 59 10 OHS Hospitals 42 Pass 1010 Christian Lacombe 22 90 Prairieville Slidell 1010 4 Lake Maurepas Gonzales 11 Geismar 1 1
22 51 1010 1010 Locations 5 90
Lake Pontchartrain 11 1010 Donaldsonville Reserve 9 Laplace 1010 OHS Hospitals Lutcher 44 Mississippi River Lake Borgne Convent OHS Clinics Vacherie 1010 1 610 Pierre Part 44 New Orleans Chalmette
90 Avondale OCHSNER NEUROSCIENCE INSTITUTE 0 20 90 Violet
St Bernard Belle Chasse 4
23 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| Thibodaux
Schriever 20 Raceland Lake Salvador
90 Morgan City 39 90
Lockport
OCHSNER OUTCOMES Bayou Cane 1
10 11 Neuroscience Accolades Comprehensive Services Offered
• Comprehensive stroke center • Traumatic brain injury #4 for Medical • Level 4 epilepsy center • Concussion Excellence in Neurological Surgery #24 for Neurology • Complex spine surgery • Telemedicine & Neurosurgery • Neuro-oncology/radiosurgery • Second opinions • Neurocritical care • Clinical trials • Neurotology • International fellows 100 Best Hospitals • Neuro-ophthalomology • General PM&R for Stroke Care • Pediatric neurosurgery • Psychiatry Excellence Awards: • Multiple sclerosis • Back and spine care Neurosciences Stroke Care • Neuromuscular • Primary stroke centers • Movement disorders • General neurology 5 Star Awards: Neurosurgery • Adult inpatient rehab • General neurosurgery Treatment of Stroke • Neurological rehabilitation • Headache disorders OCHSNER NEUROSCIENCE INSTITUTE
Level 4 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| Epilepsy Center OUTCOMES OCHSNER
12 13 We apply the latest technology and focus on patient-centered care. Our multidisciplinary team of nationally recognized experts from neurology, neurosurgery, neurocritical care, neuroradiology, physical medicine and rehabilitation, as well as our team of excellent neuroscience nurses, provides state-of-the-art care to patients in a coordinated and efficient fashion. These experts are in one location for the convenience of patients and their families. Our team is your team – working to get patients better and back to doing what they love to do.
Neuroscience Institute Provider Growth Ochsner Health System, 2016–2019 Estimated
160%
134
121 OCHSNER NEUROSCIENCE INSTITUTE
97
79 80% NEUROSCIENCE INSTITUTE NEUROSCIENCE
| OUTCOMES
OCHSNER 0% 2016 2017 Estimated 2018 Estimated 2019 Estimated
14 15 In addition to the subspecialties you will The Memory Disorders Program is an interdisciplinary team Ochsner Rehabilitation specializes in neurological and First in Patient-Centered Quality Care approach under the direction of a cognitive and behavioral musculoskeletal rehabilitation in both inpatient and outpatient Ochsner Neuroscience Institute has developed several read about, we also have expertise in the neurologist, with clinical care provided by a geriatric nurse settings. The Ochsner inpatient program is certified by multidisciplinary patient-centered programs that cater to practitioner, geriatric psychologist and a neuropsychiatrist. the Commission on Accreditation of Rehabilitation Facilities following areas: the needs of patients with neurological disorders. Our unique Neurology and psychiatry residents, postdoctoral fellows in (CARF) in general rehabilitation and has a specialty CARF approach to patient care has resulted in some of the best behavioral neurology, geriatric psychiatry and geriatric medicine certification in the area of stroke recovery. The Ochsner Adult Neurology department has patient outcomes in the region and has been recognized and medical students are an integral part of the clinic team. a comprehensive team of neurologists, neuropsychologists, nationally and internationally. advanced practice providers, nurses and technicians Areas of Expertise: Areas of Expertise: who evaluate and manage a wide variety of neurological • Gait disorders conditions in both inpatient and outpatient settings. • Memory loss First in Technology We work in close collaboration with specialists in internal • Spasticity management • Age-related cognitive changes The Ochsner Neuroscience Institute offers the latest diagnostic medicine, emergency medicine, radiology, psychiatry, • Str oke, spinal cord injury, neurological disease and head injury and therapeutic technologies for our patients with diseases physical medicine and neurosurgery. • Mild cognitive impairment of the brain, spinal cord, peripheral nerves or muscles, such Special Programs and Services: Areas of Expertise: • Alzheimer’s disease as the following: • Acute and chronic stroke management • Weakness • Vascular cognitive impairment and vascular dementia • Stereotactic Radiosurgery – A noninvasive, outpatient • OASIS (Ochsner Acute Stroke Intervention Service) treatment for brain tumors that uses targeted high-powered • Frontotemporal dementias, including behavioral • Pain in the extremities X-ray techniques subtypes, primary progressive aphasia, Pick’s disease • Regional telemedicine program for acute stroke care • Numbness and semantic dementia • Positron Emission Tomography-Computed Tomography • Stroke research (PET/CT) – A premier imaging technology used to identify • Seizure disorders • Cortical-subcortical dementias, including Lewy body • Cerebrovascular imaging cancer, dementia and brain disorders disease and corticobasal degeneration • Endovascular therapies for acute ischemic stroke • Telestroke Network – A network of more than 40 facilities • Metabolic and genetic types of dementias of adult onset Ochsner’s Neuromuscular Program addresses both the using the latest remote monitoring technology, bringing • Received $3.87M Centers for Medicare and Medicaid diagnostic and therapeutic aspects of nerve and muscle • Mixed types of dementia and complex cognitive cases first-class care to stroke patients within the states of Services (CMS) Innovation Grant for stroke care disorders. Services are delivered by a collaborative team Louisiana and Mississippi of physicians and other healthcare providers with expertise Special Programs and Services: • Stroke rehabilitation in neuromuscular disease. • Comprehensive Epilepsy Monitoring Unit – Accredited • Expert care in the area of aging • Stroke risk management by the National Association of Epilepsy Centers (NAEC) OCHSNER NEUROSCIENCE INSTITUTE and dementia as a Level IV Epilepsy Center Areas of Expertise: • Spasticity and baclofen pump management • Early diagnosis and treatment • Fetal Surgery – The first in the region to have • Peripheral neuropathy • Wheelchair clinic a multidisciplinary team dedicated to fetal surgery. • Follow-up during disease progression • Muscular dystrophies • Driving education We provide in utero treatment options for treatment NEUROSCIENCE INSTITUTE NEUROSCIENCE
| • Training program for physicians of certain congenital spinal diseases • Amyotrophic lateral sclerosis (ALS) • Stroke recovery clinic • Research program in aging, dementia and stroke • Myasthenia gravis • Multiple sclerosis clinic • ALS clinic • Adult spina bifida clinic OCHSNER OUTCOMES
16 17 Ochsner’s Neuroscience Institute is a destination center for patients throughout the region. Transfers into Ochsner Medical Center have more than doubled over the past five years.
Neuroscience Institute Transfer Volume Ochsner Medical Center, 2012–2016
2,344 2300%
1,952 OCHSNER NEUROSCIENCE INSTITUTE
1,263 1150%
NEUROSCIENCE INSTITUTE NEUROSCIENCE 979 953 |
0% OCHSNER OUTCOMES 2012 2013 2014 2015 2016
18 19 Stroke Care To provide physicians with access to Ochsner’s Certified Comprehensive Stroke Center teams up neurologists, neurointensivists, Ochsner specialists, neurosurgeons, interventional neuroradiologists and vascular surgeons to provide the highest we implemented level of care in managing a variety of ischemic and hemorrhagic stroke disorders in the acute, the CareConnect post-acute and rehabilitation settings. Our innovative Telestroke Network brings world-class 360 Stroke Program, care to stroke patients within the states of Louisiana and Mississippi, using the latest technology. which enables Through our telestroke program, we treat more than 1,700 patients annually. remote consultation through innovative Areas of Expertise: video technology. • Ruptured and unruptured cerebral aneurysms • Spontaneous intracerebral hemorrhage This program is • Ischemic stroke • Chronic cerebral ischemia especially beneficial • Transient ischemic attacks (TIAs) • Stroke rehabilitation to communities • Cerebral vascular malformations • Atherosclerosis without 24-hour • Subarachnoid hemorrhage • Stroke risk management and prevention access to stroke neurologists.
CareConnect 360 treats more than 1,700 patients throughout our network NEUROSCIENCE INSTITUTE NEUROSCIENCE
| of facilities and provides 48 services to more than 42 facilities throughout Louisiana
and Mississippi and continues to grow. STROKE CARE OUTCOMES OCHSNER
20 21 Program Growth and Development Awards and Recognitions Educational and Research Development
2009–2011 2009–2010 2010–2011
• Primary Stroke Center Certification • Primary Stroke Center Certification • Neurointerventional Fellowship • Ochsner Telestroke begins: 4 sites (2009), 12 sites (2011) • American Stroke Association (ASA); Gold Award • CDC Grant • Neurocritical Care Unit opens with 6 beds (2011) • Healthgrades® Excellence Award • U.S. Department of Agriculture (USDA) Grant • Louisiana Emergency Response Network (LERN) Commission for Stroke
2012–2013 2011–2012 2012–2013
• Comprehensive Stroke Center Certification (May 10, 2013) • Ochsner Innovation Award • CMS Innovations Grant • Telestroke Coordinator, Data Manager, Stroke Data Analyst • Healthgrades ® 5 Star • DIAS 4 and Penumbra 3D Separator Trials • Telestroke at 19 sites • ASA Gold Plus Target Stroke • Neurocritical care and Neurointerventional Fellowships • NCCU expands to 20 beds; Stroke Service and Unit • #1 Stroke Program in LA • U.S. News & World Report Top 50 Neuroscience Programs
2014–2015 2013–2015 2014–2016
• Dedicated Neuroscience floor – Neuroscience Institute • Comprehensive Stroke Center Certification • ACGME-approved neurology residency program • NCCU expands again to 34 beds • Healthgrades ® 5 Star • Multiple clinical trials including ATTACH II (completed enrollment), IcTUS, SOCRATES, MaRISS, DALF-PS, • Telestroke at 42 sites and growing • ASA Gold Plus Target Stroke NAVIGATE-ESUS and RESPECT-ESUS • #1 Stroke Program in LA • Received ACGME approval for vascular neurology fellowship • U.S. News & World Report Top 25 Neuroscience Programs • Multiple peer-reviewed manuscript presentations NEUROSCIENCE INSTITUTE NEUROSCIENCE
| at national meetings STROKE CARE OUTCOMES OCHSNER
22 23 Stroke Central encompasses the inpatient Comprehensive Stroke Care Program. The program provides a real-time, proactive Nearly half of Ochsner’s approach to ensure the patient receives the best care with the stroke patients are best opportunity for recovery. All patients who present to Ochsner discharged home to their Medical Center New Orleans are eligible for this program. Stroke families, allowing them Mobile continues the program into the home. This portion of the to enjoy life in their most program focuses on education, behavior and lifestyle modification comfortable environment. to reduce the likelihood of another stroke. Patients who reside in Jefferson or St. Tammany Parish are eligible for this program.
Stroke Disposition at Discharge Ochsner Medical Center, 2016
1%
4% 4%
9%
Home Rehab Nursing Home/SNF 49% NEUROSCIENCE INSTITUTE NEUROSCIENCE
14% Expired | LTAC Hospice/LOPA On average, every Other STROKE CARE 40 seconds someone in the United States 19% has a stroke. OCHSNER OUTCOMES
24 25 Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. Hemorrhagic stroke accounts for about 13 percent of stroke cases. It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. The two types of hemorrhagic strokes are intracerebral (within the brain) hemorrhage or subarachnoid hemorrhage. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).
Ischemic Stroke Case Volume Ochsner Medical Center, 2014–2016
900% 849 807
640
450% NEUROSCIENCE INSTITUTE NEUROSCIENCE
| STROKE CARE Ischemic stroke accounts OUTCOMES for 87 percent of all stroke cases. 0% OCHSNER 2014 2015 2016 26 27 Ischemic Stroke Expected Complication Rate Index (ECRI) ECRI Ochsner Medical Center, 2014–2016 National Average
1.09
0.60 0.48 Methodology and Source: IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only 2014 2015 2016
Ischemic Stroke Risk-Adjusted Mortality Index (RAMI) RAMI Ischemic Stroke Average Length of Stay (in Days) Ochsner Average Ochsner Medical Center, 2014–2016 National Average Ochsner Medical Center, 2014–2016 National Average
6.5 6.2 6.3 6.4 5.7 5.6 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| STROKE CARE 0.62 0.57 0.49 Methodology and Source: Methodology and Source: IBM Watson Health / Truven Care Discovery IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only Adult Hospital Inpatients Only OCHSNER OUTCOMES 2014 2015 2016 2014 2015 2016 28 29 Hemorrhagic Stroke Case Volume Ochsner Medical Center, 2014–2016 Hemorrhagic stroke accounts for 280 about 13 percent of stroke cases.
230 208
2014 2015 2016
Hemorrhagic Stroke Risk-Adjusted Mortality Index (RAMI) RAMI Ochsner Medical Center, 2014–2016 National Average NEUROSCIENCE INSTITUTE NEUROSCIENCE
|
0.79 0.72 0.69 STROKE CARE
OUTCOMES Methodology and Source: IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only OCHSNER 2014 2015 2016
30 31 Hemorrhagic Stroke Expected Complication Rate Index (ECRI) ECRI Ochsner Medical Center, 2014–2016 National Average
0.67 0.50 Methodology and Source: 0.36 IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only 2014 2015 2016
Hemorrhagic Stroke Average Length of Stay (in Days) Ochsner Average Ochsner Medical Center, 2014–2016 National Average
11.6 11.6 11.5 10.4 9.8 9.5 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| STROKE CARE
OUTCOMES Methodology and Source: IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only OCHSNER 2014 2015 2016 32 33 CST K-05a Intracranial Hemorrhagic Complication IV tPA Ochsner Medical Center, 2016
7.0% 6.4%
3.6% 3.5% NEUROSCIENCE INSTITUTE NEUROSCIENCE
|
Ochsner’s tPA administration rate has STROKE CARE averaged 13.4 percent from 2009 to 2015. OUTCOMES This rate far exceeds the national average of 3.4 to 5.2 percent, reported in 2011.
OCHSNER 0.0% Ochsner 2016 National Institute of Neurological Disorders and Stroke (NINDS) Trial 34 35 Mechanical thrombectomy for acute ischemic stroke is a minimally invasive procedure in which the clot responsible for the stroke is removed from the arteries of the brain. This procedure is performed by highly specialized physicians and can be safely performed only on patients who meet certain criteria. A thrombectomy allows for reestablishment of blood flow to brain tissue in order to minimize the damage of the stroke.
Thrombectomy Volume Ochsner Medical Center, 2014–2016
100% 94
72
50% 48 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| STROKE CARE OUTCOMES
OCHSNER 0% 2014 2015 2016 36 37 The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of High blood pressure is the leading cause of stroke and the most important controllable risk factor disability or dependence in the daily activities of people who have suffered a stroke or other for stroke. Approximately 77 percent of people who have a stroke have a blood pressure greater causes of neurological disability. It has become the most widely used clinical outcome measure than 140/90 mmHg (Heart Disease and Stroke Statistics, 2014). The American Heart Association for stroke clinical trials. The scale runs from 0 to 6, with 0 representing no symptoms and recommends a blood pressure of less than 140 mmHg systolic and less than 90 mmHg diastolic 6 representing death. (Guidelines for the Prevention of Stroke in Patients with Stroke and TIA).
Modified Rankin Scale 2016* Percentage of Achievement of Blood Pressure at Control* Ochsner Medical Center, 2016 *Measured at 90 days post-stroke. Ochsner Medical Center, 2016 *Measured at 12 months post-stroke.
30% 100%
26% 88%
21% 20% 67%
15% 50% 44% NEUROSCIENCE INSTITUTE NEUROSCIENCE
| 12% 11% STROKE CARE 5% 5% OUTCOMES
0% OCHSNER 0% 0 1 2 3 4 5 6 Oschner 2016 National Health and Nutrition Reasons for Geographic and Racial Examination Survey (NHANES) Differences in Stroke (REGARDS) Study 38 39 The national average of tPA utilization for acute ischemic stroke is approximately 12% (Genentech, Inc.). The original National Institute of Neurological Disorders and Stroke (NINDS) tPA study reported that patients who received tPA within 3 hours after onset of symptoms were at least 30 percent more likely to have minimal or no disability at 3 months than those who received placebo. The ECASS III study, which looked at tPA use in the 3- to 4.5-hour window, showed a favorable outcome of 28 percent of patients returning to an independent lifestyle with tPA versus with placebo (Thrombolysis with Alteplase 3 to 4.5 hours after Acute Ischemic Stroke). Recombinant tissue-type plasminogen activator (rtPA) is the only approved therapy for acute ischemic stroke (AIS). Ochsner’s stroke treatment team has seen positive outcomes, with only one tPA-related complication out of 40 cases in 2015. The utilization of tPA continues to increase annually.
Telestroke Total Volume vs. tPA Administered Total Volume Telestroke Diagnoses Volume Patients who receive tPA Ochsner Medical Center, 2009–2016 tPA Given CareConnect 360, 2016 within 3 hours of onset of stroke symptoms are 1, 811 1, 730 889 more likely to have a favorable outcome.
NEUROSCIENCE INSTITUTE NEUROSCIENCE 1, 267
| 520 956 843
648 STROKE CARE 234 OUTCOMES Source: Adeoye O, Hornung R, Khatri P, Kleindorfer 283 257 D. Recombinant tissue-type plasminogen activator 190 217 use for ischemic stroke in the United States: 119 163 58 33 28 67 a doubling of treatment rates over the course 29 4 of 5 years. Stroke. 2011;42:1952–1955. OCHSNER 2009 2010 2011 2012 2013 2014 2015 2016 Ischemic Stroke Mimic Other TIA ICH/SAH 40 41 Neurosurgical Care
Ochsner’s Neurosurgery department has grown to 10 surgeons. Our care team, made up of nurses, residents, physician assistants and surgeons, has provided quality surgical outcomes in cranial and spinal cases.
Neuroscience Surgical Volume by Year All Ages, Outpatient and Inpatient Outpatient Ochsner Medical Center, 2013–2016 Inpatient
1,112
934 839 866 NEUROSCIENCE INSTITUTE NEUROSCIENCE NEUROSURGICAL CARE
|
368 360 345
201
OCHSNER OUTCOMES 2013 2014 2015 2016 42 43 Neurosurgery Adult (Age 22 or Older) Neurosurgery Adult (Age 22 or Older) Cranial Subgroup Case Volume Cranial Subgroup Expected Complication Rate Index (ECRI) ECRI Ochsner Medical Center, 2014–2016 Ochsner Medical Center, 2014–2016 National Average
425 404 390
1.24
0.57 0.38 Methodology and Source: IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only 2014 2015 2016 2014 2015 2016
Neurosurgery Adult (Age 22 or Older) Neurosurgery Adult (Age 22 or Older) Cranial Subgroup Risk-Adjusted Mortality Index (RAMI) RAMI Cranial Subgroup Average Length of Stay (in Days) Ochsner Average Ochsner Medical Center, 2014–2016 National Average Ochsner Medical Center, 2014–2016 National Average
11.4 10.7 9.8 NEUROSCIENCE INSTITUTE NEUROSCIENCE NEUROSURGICAL CARE
8.0 | 7.5 7.4
0.73 0.51 0.52
OUTCOMES Methodology and Source: Methodology and Source: IBM Watson Health / Truven Care Discovery IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only Adult Hospital Inpatients Only OCHSNER 2014 2015 2016 2014 2015 2016 44 45 Neurosurgery Adult (Age 22 or Older) Neurosurgery Adult (Age 22 or Older) Spinal Subgroup Case Volume Spinal Subgroup Expected Complication Rate Index (ECRI) ECRI Ochsner Medical Center, 2014–2016 Ochsner Medical Center, 2014–2016 National Average
549 531 476
0.86 0.69 0.54 Methodology and Source: IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only 2014 2015 2016 2014 2015 2016
Neurosurgery Adult (Age 22 or Older) Neurosurgery Adult (Age 22 or Older) Spinal Subgroup Risk-Adjusted Mortality Index (RAMI) RAMI Spinal Subgroup Average Length of Stay (in Days) Ochsner Average Ochsner Medical Center, 2014–2016 National Average Ochsner Medical Center, 2014–2016 National Average NEUROSCIENCE INSTITUTE NEUROSCIENCE NEUROSURGICAL CARE
| 1.03 0.95 0.94 5.6 5.4 5.7 4.5 4.0 3.9 Methodology and Source: Methodology and Source: IBM Watson Health / Truven Care Discovery IBM Watson Health / Truven Care Discovery
Compare Group: Avg of All Hospitals Nationwide Compare Group: Avg of All Hospitals Nationwide
Adult Hospital Inpatients Only Adult Hospital Inpatients Only OCHSNER OUTCOMES 2014 2015 2016 2014 2015 2016 46 47 Neuro-oncology Care
Brain and Spinal Tumors Program Radiosurgery The Brain and Spinal Tumors Program Our neurosurgeons eradicate tumors at Ochsner provides patients with using radiosurgery, a sophisticated comprehensive, multidisciplinary care noninvasive treatment modality. Our and the convenience of fast-track surgeons are among the Gulf South appointments. Our surgeons are trained region’s most experienced in treating in the surgical and nonsurgical treatment tumors using this technology. They of brain and spinal tumors. are also experienced in using Gamma Knife as well as linear accelerator-based Treatment Modalities/Surgical technologies. Intervention Medical Management Our comprehensive team of board-certified, fellowship-trained neurosurgeons, plastic Treatment planning and adjuvant surgeons and otolaryngologists are care for brain tumors are managed Ochsner’s neuro-oncology experts in skull base tumor resection and by a multidisciplinary team consisting group is a multidisciplinary the treatment of skull base tumors. We of a neurosurgeon, oncologist, use the most advanced technologies, such neuroendocrinologist and radiation NEURO-ONCOLOGY CARE NEUROSCIENCE INSTITUTE NEUROSCIENCE
team of award-winning
| as intraoperative navigation systems and oncologist (in many cases). This physicians, all experts brain mapping, to aid in the safe, maximal approach gives patients access to the resection of tumors, while reducing most up-to-date, comprehensive care. in their field. They come postoperative deficits. We apply minimally together to create unique invasive surgical techniques to treat plans of care to best serve patients with spinal tumors and cancer. each individual patient. OCHSNER OUTCOMES
48 49 Radiosurgery Program Pituitary Disorders
Stereotactic radiosurgery, also known as stereotactic radiotherapy, is a noninvasive procedure that The Ochsner Center for Pituitary Disorders is a multidisciplinary center designed to provide includes the precise delivery of high-dose radiation to a small field of treatment but with a very comprehensive care to all patients with newly diagnosed and preexisting pituitary disorders. small-dose delivery to surrounding areas. Our program is built upon a strong foundation of recognized Almost all pituitary tumors are benign (noncancerous) glandular excellence in neurosurgical and neuroendocrine care and tumors called pituitary adenomas. These tumors are considered This noninvasive treatment often allows patients to go home growing sector of tumors in patients with tumors. Patients research. We have assembled a team of dynamic physicians, benign because they do not spread to other parts of the body, the same day as the procedure. Radiosurgery can be used to are living longer with primary diseases and are therefore all recognized experts and current leaders in their respective like cancers can do. Still, even benign pituitary tumors can treat conditions such as benign and malignant brain tumors, experiencing more metastases. Radiosurgery is an ideal fields, who have considerable experience in the evaluation cause significant health problems because of their location near arteriovenous malformations of the brain and trigeminal treatment option for many of these patients. and management of patients with diseases of the pituitary the brain and because many of them secrete excess hormones. neuralgia or tic douloureux. Brain metastasis is the fastest gland and hypothalamus. Pituitary cancers (called pituitary carcinomas) are very rare.
Our program is built upon a strong foundation Gamma Knife Distribution of Radiosurgery Cases Meningioma Ochsner Medical Center, 2016 Metastatic of recognized excellence in neurosurgical and Trigeminal Neuralgia neuroendocrine care and research. 1% Pituitary Tumor Arteriovenous Malformation (AVM) / 2% Essential Tremor 3% Acoustic Neuroma 3% Primary Brain Tumor Glioblastoma Multiforme (GBM) 4% 20% Sarcoma NEUROSCIENCE INSTITUTE NEUROSCIENCE
PITUITARY DISORDERS |
8% OUTCOMES
9% OCHSNER 11%
50 51 Epilepsy Program
Ochsner’s Epilepsy Program hosts an outstanding group of experienced epileptologists and Long-term monitoring is neurosurgeons who provide the most modern and innovative medical and surgical care for the continuous, combined EEG evaluation and treatment of patients with epilepsy and seizure disorders. Ochsner is the only facility and video recording of in the state with a comprehensive epilepsy monitoring unit (EMU) where patients with complex patients for hours to days. seizure disorders can be diagnosed and managed.
Epilepsy Growth in Long-Term Monitoring Ochsner Medical Center, 2013–2016
850% 795
580 551
425%
NEUROSCIENCE INSTITUTE NEUROSCIENCE 364
| EPILEPSY PROGRAM EPILEPSY OUTCOMES
OCHSNER 0% 2013 2014 2015 2016 52 53 Neurocritical Care Unit Epilepsy Surgical Volume Ochsner Medical Center, 2014–2016 Patients with acute neurological and neurosurgical injury who require critical care are treated by our specially trained and board-certified multidisciplinary team. Our neurocritical care unit offers the only high volume tertiary referral center in the state for patients with neurocritical care needs. 31 Complex patients may be covered through the regional referral center to include neurosurgical
25 and neurological cases. With outcomes recognized nationally as the best in the region, Ochsner’s neurocritical care unit is ready 24 hours a day to care for patients. This unit is currently equipped with 34 beds and has more than 1,800 admissions per year.
7 National Securities Clearing Catheter-Associated Urinary Tract YTD 2016 1.80 Corporation (NSCC) – Overall Infection (CAUTI) Rate
2014 2015 2016 Hand Hygiene 85% National Healthcare Safety Network 25th (NHSN) CAUTI Percentile Isolation Compliance 80% NHSN Foley Utilization Percentile 25th
Epilepsy Growth in Monitoring Unit Admissions CAUTI Bundle Compliance 36% Ochsner Medical Center, 2013–2016
Central Line-Associated Bloodstream Infection 0.59 Ventilator-Associated Pneumonia (VAP) Rate 0.00 (CLABSI) Rate 395
NHSN CLABSI Percentile 25th NHSN VAP Percentile 10th NEUROCRITICAL CARE UNIT
NEUROSCIENCE INSTITUTE NEUROSCIENCE NHSN CL Utilization Percentile 50th Vent Utilization 0.99
| 289 CLABSI Bundle Compliance 42% NHSN Vent Utilization Percentile 90th 210 Blood Culture Contamination Rates 5.07% VAP Bundle Compliance 98% 122 OUTCOMES
OCHSNER 2013 2014 2015 2016 54 55 Plans are in place to open a 60-bed acute rehabilitation unit on Jefferson Highway in 2018. Physical Medicine and Rehabilitation This facility will offer a regional referral center, along with specialized rehab programs for the treatment of stroke, traumatic brain injury, spinal cord injury, amputations and cardiac and Ochsner’s Physical Medicine and Dedicated Specialty Clinics orthopedic conditions. As a Center of Excellence for Stroke, Brain and Spinal Cord Injury, this Rehabilitation Program is seeing continued • Spasticity Clinic unit will be able to care for higher acuity patients and will bring a whole new level of inpatient annual growth, serving patients from • Stroke Recovery Clinic rehabilitation care to New Orleans and the surrounding Southeast Louisiana region. all over Louisiana and Mississippi. • Wheelchair Clinic • Multiple Sclerosis Clinic (Multidisciplinary with Neurology) 28-Bed Inpatient Facility • ALS Clinic (Multidisciplinary with Neurology) • Commission on Accreditation of Rehabilitation Facilities certified • Amputee Clinic (Prosthetic & Orthotics) • CARF Stroke Specialty Accreditation • Adult Spina Bifida Clinic (Multidisciplinary with Urology and Neurosurgery)
Pediatric Rehabilitation Volume 2015 Intrathecal Baclofen Pump Patient Totals* A baclofen pump delivers the drug Ochsner Medical Center, 2015–2016 2016 Ochsner Medical Center, 2014–2016 Lioresal® Intrathecal (baclofen injection) PHYSICAL MEDICINE AND REHABILITATION for ITB TherapySM, a treatment for 746 severe spasticity. People who suffer from severe spasticity resulting from 679 36 36 cerebral palsy, multiple sclerosis, stroke, brain injury or spinal cord 29 injury may be candidates for ITB NEUROSCIENCE INSTITUTE NEUROSCIENCE
Therapy. Patients may be considered | for ITB Therapy if oral baclofen has not controlled their spasticity or has 250 resulted in serious side effects. 219 OUTCOMES
*13 pump trial patients in 2015
OCHSNER New Patients Follow-Up Patients 2014 2015 2016 56 57 Concussion
A concussion is a traumatic injury to the brain that affects how the brain functions. Early diagnosis and correct treatment are important to recovery and return to play.
Children and adolescents are particularly sensitive to Children, adolescents and adults are all at risk for concussion, the effects of concussion, which, if not managed properly, with common causes including sports, recreational activities, can lead to prolonged time away from sports and school – falls and motor vehicle collisions. Emergency department visits or even long-term problems. for concussions in children and adolescents ages 8 to 13 years old has doubled, and concussions have risen 200 percent Ochsner Health System is dedicated to enhancing among teens ages 14 to 19 in the last decade, according athletes’ health on and off the field by helping to educate to the American Academy of Pediatrics. athletes, families and coaches about concussion and concussion management.
Football is the most common sport with CONCUSSION RISK FOR MALES. 50% chance that girls who play 50% soccer will have a concussion.* 75% chance that boys who While loss of consciousness is associated with 75% play football will 75% FEWER THAN 20% OF CONCUSSIONS, a loss
NEUROSCIENCE INSTITUTE NEUROSCIENCE *
have a concussion. | of consciousness or loss of memory after a head Approximate injury implies that a concussion has occurred. percentage of Youths who have already had HEAD INJURIES a concussion are at higher risk for Soccer is the most common sport with that are CONCUSSION subsequent ones. CONCUSSION RISK FOR FEMALES. concussions. OUTCOMES
*Sources: The Sports Concussion Institute, Institute of Medicine and National Research Council, Centers for Disease Control and Prevention. OCHSNER
58 59 About the Ochsner Concussion Management Program Concussion Patient Volume 2015 Ochsner Medical Center, 2015–2016 2016 The Ochsner Concussion Management Program partners with This program is the first and largest of its kind in the more than 40 high schools, colleges and recreational sports Gulf South and features: leagues across the state, working with over 5,000 student- • Patient assessment by board-certified physicians, each with 1,135 athletes to provide baseline ImPACT testing and continued care. specialized training in the field of concussion management The program focuses on fast diagnosis and the most effective treatment to get athletes back on the playing field as quickly • Multifaceted evaluation, including neurological, 850 and safely as possible. Individualized treatment is designed to: neurocognitive and balance examinations 779 • Lessen recovery time • Focused evaluation of memory, processing speed and other related functions 535 • Lower the risk of persistent, long-term neurocognitive deficits • Prompt development of an individualized medical • Prevent potential catastrophic events such as second treatment plan impact syndrome • Support services, including serial assessment, concussion • Reduce the risk of repeat concussion education, counseling, return-to-play surveillance and • Recognize and treat persisting concussion symptoms cognitive therapy New Patients Follow-Up Patients requiring more than just rest to resolve • Referrals, when necessary, to our extensive network of pediatric and adult specialists and ancillary medical professionals
• Physicians that have all completed fellowship training in Baseline ImPACT Test Volume Sports Medicine, Sports Neurology or Traumatic Brain Injury Ochsner Medical Center, 2015–2016
4,261 3,806
Concussion Symptoms: NEUROSCIENCE INSTITUTE NEUROSCIENCE
| • Physical: headache, dizziness, nausea/vomiting • Emotional: irritability, sadness, nervousness • Cognitive: confusion, mental fogginess, poor memory • Sleep: insomnia, fatigue, drowsiness CONCUSSION OUTCOMES
OCHSNER 2015 2016 60 61 The Back and Spine Center
The Ochsner Back and Spine Center provides the most comprehensive and specialized care and relief to patients suffering from any type of spine or back pain or discomfort. At the center, we are able to care for patients ranging from pediatric to elderly.
Each patient receives a customized patient-reported measurements of pain Our minimally invasive treatment approach designed to address and quality of life/disability ratings. their specific condition. Patients have access A lower score (for VAS, ODI & NDI) surgical techniques get to medical experts from different disciplines, represents better quality of life or an patients back to doing including neurosurgery, orthopedic, improvement when compared to previous interventional pain management, physical quality of life. A higher score for AQoL what they love. medicine and rehabilitation and psychiatry. represents an improvement. We offer the most sophisticated minimally invasive spine surgery techniques to treat Back and Spine: Healthy Back Clinic a whole spectrum of spine diseases. These techniques offer the best treatment • Comprehensive multidisciplinary benefits for patients with shorter hospital spine clinic stays, less blood loss and less postoperative • Physical therapy for chronic neck pain. The Back and Spine Center also and low back pain with active offers patients the convenience of same- resistance exercise, health coaching day appointments. and progression to wellness program
The Ochsner Healthy Back Rehabilitation • Encourages collaboration between
Program is a patient-focused, nonsurgical pain management, PMR, neurosurgery THE BACK AND SPINE CENTER rehab program to treat patients with and orthopedic spine surgery back pain. These treatments improve NEUROSCIENCE INSTITUTE NEUROSCIENCE • Subjective and objective outcomes
| patient outcomes, as demonstrated in the collected following pages. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Neck Disability Index (NDI) and Australian Quality of Life (AQoL) assessments are OUTCOMES OCHSNER
62 63 Spine Center: Pure Healthy Back Results at 3 Months Postoperatively Preoperative Mean Score Ochsner Medical Center, 2016 3 Months Postoperative Mean Score
62.1 Cervical spine
27.2 22.6 The incidence and prevalence of back and 15.0 13.2 Thoracic spine All these patient measures show improvement 7.7 spine problems are 4.5 5.3 at the 3-month mark. Pain level, ODI and NDI 0.4 0.7 all go down, while Patient-Centered Outcomes increasing in the population, and AQoL-4D go up. Pain Level Patient-Centered Oswestry Neck Disability AQoL-4D with 80 percent prone Outcome Disability Index Index to have back pain during their lifetime. When surgery is needed, we specialize Spine Center: Pure Healthy Back Results at 6 Months Postoperatively Preoperative Mean Score Lumbar spine Ochsner Medical Center, 2016 6 Months Postoperative in innovative, effective Mean Score and minimally invasive surgical techniques. 61.8 THE BACK AND SPINE CENTER Sacrum & coccyx NEUROSCIENCE INSTITUTE NEUROSCIENCE
|
23.2 23.7 16.8 OUTCOMES 11.6 All these patient measures show improvement 7.7 at the 3-month mark. Pain level, ODI and NDI 3.8 5.0 0.4 0.8 all go down, while Patient-Centered Outcomes and AQoL-4D go up. OCHSNER Pain Level Patient-Centered Oswestry Neck Disability AQoL-4D Outcome Disability Index Index 64 65 Average Visual Analog Scale (VAS) Average Visual Analog Ochsner Medical Center, 2016 Scale Open Average Visual Analog Scale Mini-Open
6.5 6.0 5.5
4.6 4.1 3.8 3.6 3.6
Preoperative 6 Weeks 6 Months 1 Year + Thoracolumbar Spine Surgeries: Open vs. Mini Open Corpectomy
Average Oswestry Disability Index (ODI) Average Oswestry Disability We use minimally invasive Ochsner Medical Center, 2016 Index Open surgical techniques even Average Oswestry Disability Index Mini-Open in patients with complex spine problems such as
spine fracture, infection THE BACK AND SPINE CENTER and tumor, and our 64.0 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| technique significantly 51.4 48.2 44.3 improves pain and quality 37.3 38.6 30.8 of life when compared 27.9 26.30% to conventional open 18.41% surgical techniques.
OCHSNER OUTCOMES Preoperative 6 Weeks 6 Months 1 Year + 66 67 Surgery for Degenerative Spondylolisthesis Average Visual Analog Scale (VAS) Spinal Stenosis Average Visual Analog Scale (VAS) Ochsner Medical Center, 2016 Ochsner Medical Center, 2016 Spine Diseases: Lumbar Spinal Stenosis, Disc Herniation and Spondylosis 7.0
6.0
4.4 3.7 3.8 3.6 3.4 3.0
Preoperative 6 Weeks 6 Months 1 Year + Preoperative 6 Weeks 6 Months 1 Year +
Spondylolisthesis Average Oswestry Disability Index (ODI) Spinal Stenosis Average Oswestry Disability Index (ODI) Ochsner Medical Center, 2016 Ochsner Medical Center, 2016 Lumbar spine
56.6 THE BACK AND SPINE CENTER
47.5 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| 38.6 34.2 33.9 30.6 31.0 26.9 OUTCOMES
OCHSNER Preoperative 6 Weeks 6 Months 1 Year + Preoperative 6 Weeks 6 Months 1 Year + 68 69 Microdiscectomy Average Visual Analog Scale (VAS) Anterior Cervical Discectomy and Fusion Average Visual Analog Scale (VAS) Surgery for Degenerative Ochsner Medical Center, 2016 Ochsner Medical Center, 2016 Spine Diseases: Cervical
6.3
5.4
4.1 4.1 4.2
3.1 2.4 1.6 Cervical spine
Preoperative 6 Weeks 6 Months 1 Year + Preoperative 6 Weeks 6 Months 1 Year +
Microdiscectomy Average Oswestry Disability Index (ODI) Anterior Cervical Discectomy and Fusion Average Neck Disability Index (NDI) Ochsner Medical Center, 2016 Ochsner Medical Center, 2016
62.8 THE BACK AND SPINE CENTER
44.9 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| 39.0 33.4 30.5 28.8 24.0 21.3
OCHSNER OUTCOMES Preoperative 6 Weeks 6 Months 1 Year + Preoperative 6 Weeks 6 Months 1 Year + 70 71 Surgery for Degenerative Posterior Cervical Fusions Average Visual Analog Scale (VAS) Average Visual Analog Scale (VAS) Ochsner Medical Center, 2016 Ochsner Medical Center, 2016 Spine Diseases: High Cervical C1-C2 Fusions
6.2
4.8 4.7 4.4 4.5
3.1 2.7 2.2 C1-C2 Our patients experience an improvement in their Preoperative 6 Weeks 6 Months 1 Year + Preoperative 6 Weeks 6 Months 1 Year + pain levels and quality of life even after undergoing very intricate and complex spine surgery, such as C1-C2 Posterior Cervical Fusions Average Neck Disability Index (NDI) Average Neck Disability Index (NDI) Ochsner Medical Center, 2016 Ochsner Medical Center, 2016 fusions, at the 1+ year postoperative point. THE BACK AND SPINE CENTER
45.5 45.9 47.6 NEUROSCIENCE INSTITUTE NEUROSCIENCE
| 38.3 37.5 37.0
27.2 OUTCOMES 9.5
OCHSNER Preoperative 6 Weeks 6 Months 1 Year + Preoperative 6 Weeks 6 Months 1 Year + 72 73 Movement Disorders This man with Parkinson’s The neurological subspecialty of movement disorders addresses abnormalities in normal human disease is being treated with the latest Duopa™ therapy. movement. Symptoms of a movement disorder can be walking difficulties, tremor, jerking, The pump shown can deliver “dance-like” movements or slowing of normal movement. While some movement disorders continuous dopamine through a tube to the patient. The are identified by diagnostic tests, many are diagnosed by physical exam alone. Our team of Ochsner Neuroscience Institute’s neurologists and neurosurgeons applies state-of-the-art treatment modalities including deep Movement Disorders Program is brain stimulation (DBS) surgeries to help improve patients’ symptoms and quality of life. the leading program in the Gulf South to provide Duopa therapy for advanced Parkinson’s disease. Specific Diseases and Syndromes Treated in this Clinic: Special Programs and Services: Led by Dr. David Houghton and • Parkinson’s disease (PD) and secondary Parkinsonism – • Botulinum toxin therapy for spasticity, dystonia Dr. Georgia Lea, this therapy can degenerative disorder and blepharospasm dramatically control trembling, frozen movements and balance • Normal pressure hydrocephalus – too much fluid in the brain • Deep brain stimulation for Parkinson disease, impairment associated with essential tremor and dystonia • Essential tremor (ET) – involuntary shaking of an arm, this chronic condition affecting chin or leg either in motion or at rest • Lumbar puncture and gait evaluations for suspected almost a million Americans. normal pressure hydrocephalus • Torticollis – abnormal, asymmetrical head or neck position • Information and referral center for the American • Tourette syndrome – repetitive, involuntary movements Parkinson Disease Association and vocalizations • Duopa therapy • Huntington’ s disease – neurodegenerative genetic disorder • Gait disturbance or imbalance problems • Friedr eich’s ataxia – difficulty walking or maintaining balance • Spasticity – stiffness and involuntary muscle spasms • Dystonia – a sudden jerk-like movement of a muscle MOVEMENT DISORDERS NEUROSCIENCE INSTITUTE NEUROSCIENCE
or muscle group | OUTCOMES OCHSNER
74 75 Pediatric Neurosurgery Program Our team includes: Our program offers multidisciplinary and comprehensive neurosurgical care for children of all ages, as well as adults with congenital processes. We treat hydrocephalus, brain tumors, congenital • Pediatric Neurosurgery malformations, cerebral palsy and all forms of pediatric brain and spinal disorders. • Maternal Fetal Our top pediatric neurosurgeons provide: • Spinal disease treatment for tumors, cervical instability due Medicine/ OB-GYN to Down syndrome, spinal dysraphism, myelomeningocele, • Expertise in performing cranial endoscopy, minimally lipomeningocele, fatty filum terminale, tethered cord, • Plastic Surgery invasive cranial procedures, complex shunts, oncology cerebral palsy spasticity and sports-related spinal injuries and Chiari malformation evaluation • Pediatric Cardiology • Cranial disease treatment for hydrocephalus, tumors, We offer the only multidisciplinary fetal surgery team in the craniofacial defects/craniosynostosis, Chiari malformations, Gulf South. In 2011, Ochsner’s pediatric neurosurgeon assisted • OB Anesthesia seizure disorders, cranial cysts and congenital cranial the Maternal Fetal Medicine division with our first in utero or brain defects fetal myelomeningocele correction. • NICU • Expertise in diagnosing spinal occipital/cervical pathologies, tumors and congenital defects
Annual Pediatric Neurosurgical Volume We offer several pediatric multidisciplinary clinics, such as the At Ochsner, we have assembled a fetal surgery team with Ochsner Medical Center, 2014–2016 spina bifida clinic and the craniofacial clinic. These specialized the active participation of pediatric neurosurgery, maternal care teams provide improved outcomes for children with fetal medicine, pediatric surgery, obstetric anesthesia, PEDIATRIC NEUROSURGERY PROGRAM NEUROSURGERY PEDIATRIC complex congenital diseases. pediatric cardiology and pediatrics. After more than a year 118 117 112 of preparation, the first fetal surgery in the southeast region Myelomeningocele (spina bifida) is the most common form was performed on December 3, 2012. We have completed of congenital central nervous system defect that is compatible 14 surgeries to date with positive outcomes and without with life. Most spina bifida patients have significant problems intraoperative complications. NEUROSCIENCE INSTITUTE NEUROSCIENCE
with walking and bowel and bladder function. They require | permanent cerebrospinal fluid diversion with shunting and have a significant chance of complications from hindbrain herniation (Chiari II malformation). The advent of intrauterine surgery has provided new opportunities to better address
OUTCOMES this lifelong debilitating disease.
OCHSNER 2014 2015 2016 76 77 Headache Disorders Program Robert Jones | Migraine Patient At the Comprehensive Headache Center, we recognize that headaches, along with several other Robert Jones sought treatment for migraine headaches that had become continuous associated symptoms like nausea, dizziness and fatigue, can be extremely disabling. In fact, migraine rather than episodic. By the time he began is the seventh most common cause of disability globally. Thirty-six million Americans, about 12 percent treatment with Dr. Fawad Khan, his disability of the population, suffer from migraine headaches. To fulfill this need, the Comprehensive Headache level was well over 50 percent and for many activities approached 100 percent. Dr. Khan Center, which comprises nationally recognized experts, was launched in 2014. We diagnose and treat was creative in applying techniques from primary and secondary causes of complex head and neck pains. other neurological issues to diagnose and treat Mr. Jones. If it were not for Dr. Khan, Mr. Jones’ papillary thyroid cancer would Advanced and Innovative Therapies Offered at the Comprehensive Headache Center: have gone undetected and perhaps have • Botox® (Botulinum toxin A) • Cryoanelgesia become a more serious issue. In addition, Mr. Jones would not be aware of the severe • Peripheral nerve block and trigger point injections • DHE (dihydroergotamine) infusion arthritis in his neck and the complications • Sphenopalatine ganglion block • Transcutaneous electrical stimulation it was causing. Today, Mr. Jones’ disability levels are well below 50 percent and most • Trigeminal nerve block • Intracranial pressure monitoring and treatment trials days he “feels pretty normal.” • Intranasal lidocaine therapy • Vitamin replacement therapy
Outcomes of Fast Track Program Pre-Infusion Ochsner Medical Center, 2016 Post-Infusion
7.4 HEADACHE DISORDERS PROGRAM The headache Fast Track Program is an exclusive program that allows patients to receive rapid
5.1 intravenous therapies for an acute headache without the need of an emergency department. NEUROSCIENCE INSTITUTE NEUROSCIENCE
| This reduces emergency department wait time, cost and inconvenience. Most importantly, this program is driven by personalized medicine, allowing maximum effectiveness specific 2.8 to each individual patient. OUTCOMES
0.9
OCHSNER Severity of Pain (0–10) Severity of Nausea/Vomiting (0–10) 78 79 Multiple Sclerosis Program
The Ochsner Multiple Sclerosis (MS) Program combines state-of-the-art therapeutics, including the latest infusion therapies, for individuals with MS. It consists of coordinated and comprehensive care for patients and their families, including the management of all symptoms associated with MS. The program focuses on patient wellness, such as routine counseling on vitamin supplementation, diet, exercise and stress reduction. We participate in translating leading-edge research into better treatments for patients with MS.
Areas of Expertise: Other Highlights: • Multiple sclerosis • Comprehensive model of care • Neuromyelitis optica • All advanced immunotherapies and treatment of all symptoms associated with MS • Optic neuritis • Focus on wellness • Neuroimmunological disorders • Mental health services provided within our own clinic • Spasticity • MS yoga class at Elmwood Fitness Center Special Programs and Services: • More than 1,100 patients cared for by the MS clinic in 2016 • MS wellness and education • Patients travel to Ochsner from all over the Gulf South • Advanced MS management (northern and western LA and AL) • Intracthecal baclofen therapy for spasticity Certification: • Botulinum toxin therapy for spasticity MULTIPLE SCLEROSIS PROGRAM • Information and referral center for Multiple Sclerosis Certified by the National Multiple Education and Resource Center Sclerosis Society as a Partner in MS Care, NEUROSCIENCE INSTITUTE NEUROSCIENCE
| Comprehensive Care Center Research: • Participating in four industry-sponsored clinical trials and one investigator-initiated clinical trial in collaboration with the University of Queensland OCHSNER OUTCOMES
80 81 Memory Disorders Program
The Memory Disorders Program is an interdisciplinary team approach under the direction of a cognitive and behavioral neurologist, with clinical care provided by a geriatric nurse practitioner, geriatric psychologist and a neuropsychiatrist. Neurology and psychiatry residents, postdoctoral fellows in behavioral neurology, geriatric psychiatry and geriatric medicine and medical students are an integral part of the clinic team.
Areas of Expertise: Special Programs and Services: • Memory loss • Expert care in the areas of aging and dementia • Age-related cognitive changes • Early diagnosis and treatment • Mild cognitive impairment • Follow-up during disease progression • Alzheimer’s disease • Training program for physicians • Vascular cognitive impairment and vascular dementia • Research program in aging, dementia and stroke • Frontotemporal dementias, including behavioral subtypes, primary progressive aphasia, Pick’s disease and semantic dementia • Cortical-subcortical dementias, including Lewy body disease and corticobasal degeneration • Metabolic and genetic types of dementias of adult onset • Mixed types of dementia and complex cognitive cases MEMORY DISORDERS PROGRAM NEUROSCIENCE INSTITUTE NEUROSCIENCE
| OCHSNER OUTCOMES
82 83 Research
Active Studies 2016
Principal Investigator/ IRB# Study Title Co-Investigator 2012.028.B Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) Sulaiman for spondylolisthesis: Technical feasibility and clinical outcome.
2012.163.A Midline Minimally Invasive Placement of Spinal Cord Stimulators: Sulaiman A Technical Note.
2013.085.A Increased intracranial pressure in children with cerebral palsy; Bui implications for baclofen pump placement and associated complications
2013.110.C A Pilot Study of Microparticles and Gene Expression in Patients with Iwuchukwu Cerebrovascular Diseases
2013.157.A Association between MTHFR mutation and Leukoencephalopathy Bagert on Brain MRI
2013.188.A Minimally Invasive DLIF: outcome studies Sulaiman
2013.196.B Intraoperative neurophysiological monitoring for minimally invasive one Sulaiman and two level transforaminal lumbar interbody fusion: A retrospective review of its need and outcomes at a single institution
2013.201.A Efficacy of radiosurgery as part of a multimodal treatment protocol for Ware central nervous system pathologies.
2013.225.A Minimally Invasive DLIF versus TLIF: Outcome studies Sulaiman NEUROSCIENCE INSTITUTE NEUROSCIENCE
| 2013.283.A Outcomes of lumbar spinal surgery in patients over 65 years old Sulaiman
2014.001.A Central Nervous System (CNS) Molecular Characterization and Ware Chemotherapeutic Susceptibility RESEARCH
OUTCOMES 2014.016.A Functional outcome and cost-utility analysis of minimally invasive Sulaiman thoracolumbar corpectomy versus conventional open corpectomy. OCHSNER
84 85 2014.019.A Long-term outcomes after minimally invasive lumbar laminectomy for Sulaiman 2015.071.B A Single-Blinded, Randomized, Controlled Study to Evaluate the Safety Ware spinal stenosis- Ochsner experience and Effectiveness of EVICEL®
2014.067.C A Multicenter, Global, Observational Study to Collect Information on Bagert Fibrin Sealant (Human) Compared to a Hydrogel Sealant as an Adjunct to Safety and to Document the Drug Utilization of Tecfidera™ (Dimethyl Sutured Dural Repair Fumarate) When Used in Routine Medical Practice in the Treatment of 2015.080.A Randomized, double-blind evaluation in secondary stroke prevention Zweifler Multiple Sclerosis (ESTEEM) comparing the efficacy and safety of the thrombin inhibitor dabigatran 2014.078.C A placebo-controlled randomized withdrawal evaluation of the efficacy Bagert etexilate 110 or 150 mg (twice daily) versus acetylsalicylic acid (100 mg and safety of baclofen er capsules (grs) in subjects with spasticity due to once daily) in patients with embolic stroke of undetermined source (RE- multiple sclerosis SPECT ESUS)
2014.091.A A Chart Review on the Incidence and Management of Status Epilepticus Sabharwal 2015.119.B Effectiveness of stereotactic radiosurgery as a primary or adjunct therapy Ware in the Neurocritical Care Unit for central nervous system pathologies
2014.102.B Exploring the Role of Antibodies against Myelin in the Development of Bagert 2015.136.C A Clinical Evaluation Of The Safety Of Baclofen ER Capsules (GRS) When Bagert Multiple Sclerosis Administered Once Daily To Subjects With Spasticity Due To Multiple Sclerosis (MS): An Open Label, Long Term, Safety Trial 2014.168.A Predicting hemorrhagic conversion in ischemic stroke using CT Iwuchukwu permeability studies 2015.137.A A pilot study of microrna expression in patients with intracerebral Iwuchukwu hemorrhage and status epilepticus 2014.189.A Humanitarian Device Exemption: Deep Brain Stimulation for Dystonia Houghton 2015.148.B Study title: Multicenter, randomized, double-blind, double-dummy, Zweifler 2014.210.A A Chart Review on the Demographic, Clinical Characteristics and Sabharwal active-comparator, event-driven, superiority phase III study of secondary Outcomes of Ischemic and Hemorrhagic Stroke in the Neurocritical Care prevention of stroke and prevention of systemic embolism in patients and Stroke Units with a recent Embolic Stroke of Undetermined Source (ESUS), comparing rivaroxaban 15 mg once daily with aspirin 100 mg (NAVIGATE ESUS) 2014.260.C Mild and Rapidly Improving Stroke Study (MaRISS) Vidal 2015.174.A Comparison of Unilateral versus Bilateral Pedical Screws in Spine Fusion Sulaiman 2014.291.B Surgical Treatment of Chiari I Malformations: Advantage of Linear Bui Surgery: Clinical Outcomes and Cost Effectiveness Analysis Autologous Duraplasty 2015.175.A Prospective Randomized Clinical Study to Evaluate the Clinical Impact of Sulaiman 2014.303.C Prenatal Intrauterine Surgery for Myelomeningocele: Performance in a Bui Pharmacogenetics-Guided Treatment for Patients Undergoing Elective Low Volume Hospital Setting Spinal Surgical Procedures
2015.041.C Outcomes in movement disorder patients managed with Deep Brain Smith 2015.210.A A randomized, double-blind, placebo-controlled study to evaluate the Ramsay Stimulation (DBS): an Ochsner Experience NEUROSCIENCE INSTITUTE NEUROSCIENCE efficacy and safety of sage-547 injection in the treatment of subjects
| 2015.046.C Sphenopalatine ganglion block for Episodic and Chronic Headaches Khan with super-refractory status epilepticus
2015.067.C Novel Approach to Decrease Venous Plexus Bleeding in C1-2 Sulaiman 2015.223.A Plegridy™ (peginterferon β 1a) Real World Effectiveness and Safety Bagert Instrumentation: A Technical Note Observational Program
POP RESEARCH OUTCOMES Biogen Idec Protocol Number: 105MS401 OCHSNER
86 87 2015.232.A Quality Improvement and Practice Based Research in Neurology Larriviere 2016.148.A Comparison of the Pupil Light Reflex measured using Automated Khan Using the EMR Pupillometer in patients with Progressive Supranuclear Palsy, Parkinson’s disease, and controls 2015.237.B A double-blind, randomized, placebo-controlled, parallel-group, Ramsay multicenter study to evaluate the efficacy and safety of lacosamide as 2016.183.C A randomized, double-blind, placebo-controlled trial of urate-elevating Houghton adjunctive therapy for uncontrolled primary generalized tonic-clonic inosine treatment to slow clinical decline in early Parkinson’s disease seizures in subjects with idiopathic generalized epilepsy 2016.200.B Vigilant ObservatIon of GlIadeL WAfer ImplaNT (VIGILANT) Registry: A Ware 2015.249.C An Open-Label, Randomized, Crossover Pharmacokinetic Study to Ramsay Multicenter, Observational Registry to Collect Information on the Safety Determine Relative Bioavailability, Safety and Tolerability of Single Doses and Effectiveness of Gliadel® Wafer(Carmustine Implant) Used in Usual of Diazepam Nasal Spray Versus Medical Practice ® Diazepam Rectal Gel (Diastat ) in Patients with Refractory Epilepsy 2016.242.C The Upper Motor Neuron Disease (UMND) Registry Larriviere
2015.253.C An open-label, multicenter extension study to evaluate the long-term Ramsay 2016.244.C An Open-label, Randomized 12 Week Study Comparing Efficacy Houghton safety and efficacy of lacosamide as adjunctive therapy for uncontrolled of Levodopa-Carbidopa Intestinal Gel/Carbidopa-Levodopa Enteral primary generalized tonic-clonic seizures in subjects with idiopathic Suspension and Optimized Medical Treatment on Dyskinesia in Subjects generalized epilepsy with Advanced Parkinson’s Disease DYSCOVER (DYSkinesia COmparative 2015.258.A Admission leucocyte count as a predictor of outcomes in patients with Iwuchukwu interventional trial on Duodopa VERsus oral medication) intracerebral hemorrhage 2016.248.C Stroke Recovery Navigation Jennings
2015.295.B An extension study to evaluate the long-termsafety,tolerability and Zweifler 2016.261.B Identifying characteristics of synovial cysts that predispose them Sulaiman efficacy of dalfampridine extended-release tablets for the treatment of to become symptomatic and in need of surgical intervention or chronic post-ischemic stroke walking deficits in subjects who participated neurointerventional drainage in the dalf-ps-1016 study (milestonesm) 2016.293.A Management of Acute Stroke Patients on Treatment with New Oral Jennings 2016.025.A Activation procedures in the Epilepsy Monitoring Unit (EMU) Khan Anticoagulants: Addressing Real-world Anticoagulant Management 2016.086.B Functional outcome of intracranial hemorrhage in patients on Warfarin Iwuchukwu Issues in Stroke (ARAMIS) Registry versus novel oral anticoagulants 2016.304.C Diagnostic accuracy and clinical outcomes of a Louisiana-based Zweifler 2016.088.A The Upper Motor Neuron Disease (UMND) Registry Larriviere telestroke network
2016.090.C An exploration of the incidence of lymphopenia associated with dimethyl Bagert 2016.329.C Comparing clinical variables between Conversion Disorder and Ischemic Zweifler fumarate use in MS patients Stroke in a Louisiana-based telestroke network to determine predictors for Conversion Disorder NEUROSCIENCE INSTITUTE NEUROSCIENCE
2016.109.C aminocaproic acid for tPA reversal study Iwuchukwu | 2016.349.A A pilot study of microrna expression in patients with cerebral microbleeds Adil 2016.113.B An open-label study to evaluate the effectiveness and safety of Bagert ocrelizumab in patients with relapsing remitting multiple sclerosis who 2016.351.A An Open-Label, Multicenter Study with an Extension Phase to Evaluate Ramsay have had a suboptimal response to an adequate course of disease- the Safety, Tolerability, and Exposure-Efficacy Relationship of Perampanel
modifying treatment Oral Suspension when Administered as an Adjunctive Therapy in Pediatric RESEARCH OUTCOMES Subjects (Age 4 to less than 12 years) with Inadequately Controlled Partial-Onset Seizures or Primary Generalized Tonic-Clonic Seizures OCHSNER
88 89 2016.366.A A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial With Ramsay an Open-Label Extension Phase of Perampanel as Adjunctive Treatment Publications in Subjects at Least 2 years of Age With Inadequately Controlled Seizures Associated With Lennox-Gastaut Syndrome
2016.376.B The relationship between the bispectral index (bis) and the (gcs) scores Sabharwal Publications 2016 AK, Webb TA, Weiss MD, Windebank AJ, Wolfe GI. Editorial by in pre- and post- rrt patients admitted to neuro critical care unit: a concerned physicians: unintended effect of the orphan drug act prospective observational study on the potential cost of 3, 4-diaminopyridine. Muscle Nerve. Adil MM, Saeed F, Chaudhary SA, Malik A, Qureshi AI. 2016 Feb; 53(2): 165–168. Epub 2015 Dec 21. 2016.455.C METIS: Pivotal, open-label, randomized study of radiosurgery with or Ware Comparative outcomes of carotid artery stent placement without Tumor Treating Fields (TTFields) for 1-10 brain metastases from and carotid endarterectomy in patients with chronic kidney Commiskey P, Afshinnik A, Cothren E, Gropen T, Iwuchukwu non-small cell lung cancer (NSCLC). disease and end-stage renal disease. J Stroke Cerebrovasc Dis. I, Jennings B, McGrade HC, Mora-Guillot J, Sabharwal V, Vidal 2016 Jul; 25(7): 1721–1727. Epub 2016 Apr 13. 2016.475.B Retrospective chart review on patients evaluated in the Epilepsy Khan GA, Zweifler RM, Gaines K. Description of a novel telemedicine- Monitoring Unit and patients on video Electroencephalography (VEEG) enabled comprehensive system of care: drip and ship plus drip Adil MM, Vidal G, Beslow LA. Weekend effect in children monitoring in the hospital and keep within a system of stroke care delivery. J Telemed with stroke in the nationwide inpatient sample. Stroke. Telecare. 2017 Apr; 23(3): 428–436. Epub 2016 Mar 16. 2016 Jun; 47(6): 1436–1443. Epub 2016 Apr 26. Iwuchukwu I, Nguyen D, Sulaiman W. MicroRNA profile in Adil MM, Vidal GA, Beslow LA. Clinical outcomes among cerebrospinal fluid and plasma of patients with spontaneous transferred children with ischemic and hemorrhagic strokes intracerebral hemorrhage. CNS Neurosci Ther. 2016 Dec; in the nationwide inpatient sample. J Stroke Cerebrovasc Dis. 22(12): 1015–1018. Epub 2016 Nov 7. 2016 Nov; 25(11): 2594–2602. Epub 2016 Jul 21. Mathkour M, Garces J, Scullen T, Hanna J, Valle-Giler E, Kahn Burns TM, Smith GA, Allen JA, Amato AA, Arnold WD, Barohn L, Arrington T, Houghton D, Lea G, Biro E, Bui CJ, Sulaiman R, Benatar M, Bird SJ, Bromberg M, Chahin N, Ciafaloni E, OA, Smith RD. Short and long-term outcomes of deep brain Cohen JA, Corse A, Crum BA, David WS, Dimberg E, Sousa stimulation in Parkinson’s Disease patients 70-years and older. EA, Donofrio PD, Dyck PJ, Engel AG, Ensrud ER, Ferrante M, World Neurosurg. 2017 Jan; 97: 247–252. Epub 2016 Jun 11. Freimer M, Gable KL, Gibson S, Gilchrist JM, Goldstein JM, Gooch CL, Goodman BP, Gorelov D, Gospe SM Jr, Goyal NA, Rice KL, Bennett MJ, Berger L, Jennings B, Eckhardt L, Fabré- Guidon AC, Guptill JT, Gutmann L, Gutmann L, Gwathmey K, LaCoste N, Houghton D, Vidal G, Gropen T, Diggs E, Barry E, Harati Y, Harper CM Jr, Hehir MK, Hobson-Webb LD, Howard St John J, Mathew S, Egger A, Ryan S, Egger R, Galarneau D, JF Jr, Jackson CE, Johnson N, Jones SM, Juel VC, Kaminski HJ, Gaines K, Ely EW. A pilot randomized controlled trial of the Karam C, Kennelly KD, Khella S, Khoury J, Kincaid JC, Kissel JT, feasibility of a multicomponent delirium prevention intervention NEUROSCIENCE INSTITUTE NEUROSCIENCE
Kolb N, Lacomis D, Ladha S, Larriviere D, Lewis RA, Li Y, Litchy | versus usual care in acute stroke. J Cardiovasc Nurs. 2017 Jan/ WJ, Logigian E, Lou JS, MacGowen DJ, Maselli R, Massey JM, Feb; 32(1): E1–E10. Mauermann ML, Mathews KD, Meriggioli MN, Miller RG, Moon
JS, Mozaffar T, Nations SP, Nowak RJ, Ostrow LW, Pascuzzi RM, PUBLICATIONS Saeed F, Adil MM, Kaleem UM, Zafar TT, Khan AS, Holley Peltier A, Ruzhansky K, Richman DP, Ross MA, Rubin DI, Russell JL, Nally JV Jr. Outcomes of in-hospital cardiopulmonary
OUTCOMES JA, Sachs GM, Salajegheh MK, Saperstein DS, Scelsa S, Selcen resuscitation in patients with CKD. Clin J Am Soc Nephrol. D, Shaibani A, Shieh PB, Silvestri NJ, Singleton JR, Smith BE, 2016 Oct 7; 11(10): 1744–1751. Epub 2016 Jul 21. So YT, Solorzano G, Sorenson EJ, Srinivasen J, Tavee J, Tawil R, Thaisetthawatkul P, Thornton C, Trivedi J, Vernino S, Wang OCHSNER
90 91 Sumrall WD, Mahanna E, Sabharwal V, Marshall T. Do not Sulaiman OAR, Garces J, Mathkour M, Scullen T, Jones RB, resuscitate, anesthesia, and perioperative care: a not so clear Arrington T, Bui CJ. Mini-open thoracolumbar corpectomy: order. Ochsner J. 2016 Summer; 16(2): 176–179. perioperative outcomes and hospital cost analysis compared to Contact Information and Locations open corpectomy. World Neurosurg. 2017 Mar; 99: 295–301. Vidal GA, Milburn JM. The Penumbra 5MAX ACE catheter Epub 2016 Nov 25. is safe, efficient, and cost saving as a primary mechanical Ochsner Medical Center Ochsner Health Center – Metairie thrombectomy device for large vessel occlusions in acute Sulaiman W, Nguyen DH. Transforming growth factor beta 1, 1514 Jefferson Hwy. 2005 Veterans Memorial Blvd. ischemic stroke. Ochsner J. 2016 Winter; 16(4): 486–491. a cytokine with regenerative functions. Neural Regen Res. New Orleans, LA 70121 Metairie, LA 70002 2016 Oct; 11(10): 1549–1552. 504.842.4033 | 504.842.3980 504.836.9820 Wang J, Guo R, Yang Y, Jacobs B, Chen S, Iwuchukwu I, Gaines KJ, Chen Y, Simman R, Lv G, Wu K, Bihl JC. The novel methods Sulaiman WA. Transforming growth factor – promotes axonal Ochsner Baptist Medical Center Ochsner Health Center – Central for analysis of exosomes released from endothelial cells regeneration after chronic nerve injury. Spine (Phila Pa 1976). 2700 Napoleon Ave. Central Park Professional Plaza and endothelial progenitor cells. Stem Cells Int. 2016; 2016: 2016 Apr; 41 Suppl 7: S29. New Orleans, LA 70115 11424-2 Sullivan Rd. 2639728. Epub 2016 Mar 28. 504.842.2000 Central, LA 70818 Ferre CL, Brandão M, Surana B, Dew AP, Moreau NG, Gordon 225.261.9790 Wang J, Zhong Y, Ma X, Xiao X, Cheng C, Chen Y, Iwuchukwu AM. Caregiver-directed home-based intensive bimanual Ochsner Medical Center – Kenner I, Gaines KJ, Bin Zhao, Liu S, Travers JB, Bihl JC, Chen Y. training in young children with unilateral spastic cerebral palsy: 200 West Esplanade Ave. Ochsner Health Center – Summa (Bluebonnet Blvd.) Analyses of endothelial cells and endothelial progenitor cells a randomized trial. Dev Med Child Neurol. 2017 May; 59(5): Kenner, LA 70065 9001 Summa Ave. released microvesicles by using microbead and q-dot based 497–504. Epub 2016 Nov 19. 504.464.8588 Baton Rouge, LA 70809 nanoparticle tracking analysis. Sci Rep. 2016 Apr 20; 6: 24679. 225.761.5200 Ochsner Medical Center – West Bank Campus Denis DR, Hirt D, Shah S, Lu DC, Holly LT. Minimally invasive 2500 Belle Chasse Hwy. Ochsner Health Center – O’Neal surgery for lumbar synovial cysts with coexisting degenerative Gretna, LA 70056 16777 Medical Center Dr. spondylolisthesis. Int J Spine Surg. 2016 Oct 24; 10: 37. 504.842.3980 Baton Rouge, LA 70816 eCollection 2016. 225.754.3278
Ochsner Health Center – Covington CONTACT INFORMATION AND LOCATIONS Garces J, Mathkour M, Beard B, Sulaiman OA, Ware ML. Insular 1000 Ochsner Blvd. Ochsner Specialty Health Center – Raceland and sylvian fissure dermoid cyst with giant cell reactivity: a case Covington, LA 70433 141 Twin Oaks report and review of the literature. World Neurosurg. 2016 Sep; 985.875.2828 Raceland, LA 70394 93: 491. e1–491. e5. Epub 2016 May 27. 985.537.2666 St. Charles Parish Hospital Mathkour M, Garces J, Beard B, Bartholomew A, Sulaiman OA, 1057 Paul Maillard Rd. Ware M. Primary high-grade osteosarcoma of the clivus: a case Luling, LA 70070 NEUROSCIENCE INSTITUTE NEUROSCIENCE
report and literature review. World Neurosurg. 2016 May; 89: | 985.785.6242 730. e9–730. e13. Epub 2016 Feb 1.
Strong MJ, Blanchard E 4th, Lin Z, Morris CA, Baddoo M, Taylor CM, Ware ML, Flemington EK. A comprehensive next
OUTCOMES generation sequencing-based virome assessment in brain tissue suggests no major virus - tumor association. Acta Neuropathol Commun. 2016 Jul 11; 4(1): 71. OCHSNER
92 93 Neurology Care Team Jose Posas, MD Dionne Rachal, NP Richard Zweifler, MD Headache, General, TBI, Sports Brooke Richard, PA-C Providers System Chair, Neurology Eugene Ramsay, MD Epilepsy Vascular Neurology EMU Director Stephanie Ryan, PA-C Neurosurgery Care Team AMD, Medical Services Director, Comprehensive Epilepsy Program Wale A.R. Sulaiman, MD, PhD Bridget Bagert, MD Epileptologist Neurocritical Care Team System Chair, Department of Neurosurgery Director, Comprehensive MS Center Cornel Rogers, MD Vivek Sabharwal, MD Medical Director, Back and Spine Center Neil Billeaud, MD Korak Sarkar, MD Chair, Neurocritical Care Erin E. Biro, MD Jacqueline Carter, MD Concussion Ifeanyi Obi Iwuchukwu, MD General & Functional Neurosurgery Daniel Chehebar, MD R. John Sawyer, PsyD Harold McGrade, MD Cuong J. Bui, MD Terence D’Souza, MD Joseph Tarsia, MD Augusto Parra, MD Adult & Pediatric Neurosurgery Robin Davis, MD Colin Van Hook, MD Murad Talahma, MD Ilias Caralopoulos, MD Ezra Elkayam, MD Gabriel Vidal, MD Alan Velander, MD Daniel Denis, MD Epileptologist Director, Comprehensive Stroke Center Leslie Bridges, NP General Neurosurgery & Spine Kenneth Gaddis, MD Vascular & Interventional Neurology Nadia Bull, NP James Kalyvas, MD Kenneth Gaines, MD, MBA, FAHA Michael Wilensky, MD Varsha Castro-Gusman, PA-C Complex Spine Chairman Emeritus, Neurology General Neurology & MS Genny Culotta, PA-C Sebastian Koga, MD PI – CMS Innovation Grant Maria Wilson, MD Amanda Farrell, PA-C Cranial & General Neurosurgery Thomas Gann, Jr, MD Headache Brittany Gowland, PA-C Carl E. Lowder, MD General Neurology, Epilepsy Sadie Chotto, PA-C Megan Irland, PA-C General Neurosurgery & Spine Leslie Hightower, MD Neuromuscular Jason Sheard, C-NP Roger D. Smith, MD General Neurology Amanda Daigle, PA-C Helen Taylor, NP Vascular Neurosurgery and Neuro-oncology David Houghton, MD Amanda Downey, PA-C Edison Valle-Giler, MD Vice Chairman, Neurology Movement Disorders and Vascular Physical Medicine & Rehabilitation Care Team Marcus L. Ware, MD, PhD Director, Cognitive Disorders Lynn Eckhardt, RN, MSN, GNP-BC Aaron M. Karlin, MD Medical Director, Neurosurgical Oncology, Director, Memory Disorders Geriatric & Stroke Nurse Practitioner System Chair, PM&R Neuro-oncology Medical Director, Telemedicine Program Movement/DBS/Memory Clinics Mirjana Bukara, MD Caitlin Baker, PA-C, MMS Jamie Huddleston, MD Melissa Hammerli, PA-C Nicholas Goyeneche, MD Emily Burke, PA-C, MMS Neurology Sidney Jackler, PA-C Natalia Jolliff, MD Alicia Harpole, PA-C, MMS Abdul Khan, MD Headache, Stroke, and General Neurology Christine Keating, MD Tiffany Hartman, PA-C, MMS Fawad Khan, MD Bethany Jennings, MN, APRN, FNP-C Site Director, Back & Spine Center Stacy Luna, PA-C Epileptologist System Stroke Program Coordinator, Vascular Neurology Sindhu Pandit, MD Terry Nguyen, PA-C, MMS Director, Comprehensive Headache Program Molly Joubert, PA-C Mahmoud Sarmini, MD NEUROSCIENCE INSTITUTE NEUROSCIENCE
Emily Montz, PA-C Dan Larriviere, MD Colleen Knoop, NP Michael Saucier, MD | Melanie Oldendorf, PA-C, MMS Vice Chairman, Neurology Movement Disorders Medical Director, Inpatient Rehabilitation Randi Rasberry, PA-C, MMS Director, Residency Program Kelly Kropog, PA-C Taylor Bailey, NP Stephen W. Yancovich, Jr., PA-C, MMS Georgia Lea, MD Barbara Liscum, NP Movement Disorders Specialist Megan McKown, PA-C PROVIDERS
OUTCOMES Uma Menon, MD Amber Peskin, CNS For patient referral and transfer information, Brian Mizuki, PsyD Camille Quinn, LCSW Neuropsychology Clinical Social Worker please see page 96. OCHSNER
94 95 About Ochsner Health System
Ochsner Health System is Louisiana’s largest non-profit, academic healthcare system. Driven by a mission to Serve, Heal, Lead, Educate and Innovate, coordinated clinical and hospital patient care is provided across the region by Ochsner’s 29 owned, managed and affiliated hospitals and more than 80 health centers and urgent care centers. Ochsner is the only Louisiana hospital recognized by U.S. News & World Report as a “Best Hospital” across four specialty categories caring for patients from all 50 states and more than 80 countries worldwide each year. Ochsner employs more than 18,000 employees and over 1,100 physicians in over 90 medical specialties and subspecialties, and conducts more than 600 clinical research studies. Ochsner Health System is proud to be a tobacco-free environment. For more information, please visit ochsner.org and follow us on Twitter and Facebook.
Patient referrals, transfers and consults are critically important. We make it easy Visit us online at ochsner.org for referring providers and their staff. To refer your patient for a clinic appointment, call our Clinic Concierge at 855.312.4190. To initiate a transfer to any Ochsner hospital, call our Regional Referral Center, staffed 24/7 by clinicians, at 855.OHS.LINK (647.5465).
For patients needing to schedule their own appointments, please call 866.OCHSNER (624.7637). NEUROSCIENCE INSTITUTE NEUROSCIENCE
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