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Clinical care updateFour new pediatric specialists join Maynard Children’s Hospital teamStrengthening an already-impressive depth and breadth of clinical expertise, Maynard Children’s Hospital continues to recruit high-caliberpediatric subspecialists to practice in the recently completed, two-story addition that houses state-of-the-art facilities and programs.The following physicians recently joined the Maynard Children’s Hospital team and stand ready to serve referring physicians and their patients.Please feel free to contact them directly at the numbers provided.NINA VERDINO, MD252-744-4911MARZENA KRAWIEC, MD252-744-8285Pediatric Critical Care/PICUPediatric PulmonologyDr. Nina Verdino has joined the staff ofMaynard Children’s Hospital’s pediatricintensive care unit. The 12-bed pediatricintensive care unit is staffed by pediatriccritical care physicians who provide24/7 care to manage critically ill infants,children and adolescents. They aresupported by a multidisciplinary teamthat includes advanced practice nurses,pharmacists, respiratory therapists,physical therapists, Child Life specialists,and fellows and residents.A weekly asthma clinic provides accessto pulmonary function testing andexhaled nitric oxide measurements.Allergy skin testing has begun and, in2013, Maynard Children’s Hospital willexpand its pediatric sleep services,become a cystic fibrosis satellite clinicand develop an aero-digestive clinic toevaluate chronic respiratory disease.Dr. Verdino received her medical degree from the AmericanUniversity of the Caribbean. She completed a pediatric residencyat Vidant Medical Center and a fellowship in pediatric critical careat the University of North Carolina-Chapel Hill. Dr. Verdino is boardcertified in pediatrics, and her research interests include pediatriccardiac output measurements.JASON HIGGINSON, MD252-744-4911NeonatologyDr. Jason Higginson has joined our staffof neonatologists who are available fortelephone consultation 24/7 to stabilizeand manage ill newborns. VidantMedical Transport’s robust transportsystem expedites transfer of childrenvia air or ground.Dr. Higginson received his medicaldegree from the University of CaliforniaLos Angeles. He completed a pediatricresidency at Children’s Hospital-Oaklandand a fellowship in neonatal-perinatalmedicine at the National Capital Consortium in Bethesda, Maryland.He is board certified in pediatrics and neonatal-perinatal medicine.4 VIDANT HEALTH MEDICAL REPORTMarzena Krawiec has joined MaynardChildren’s Hospital as a pediatricpulmonologist. She received hermedical degree from the University of Colorado Health SciencesCenter, where she also completed a pediatric residency anda fellowship in pediatric pulmonology. She then completed afellowship in pediatric pulmonology at the National Jewish Medicaland Research Center in Denver.SUDIPTA MISRA, MD252-744-4963Pediatric GastroenterologyMaynard Children’s Hospital welcomedDr. Sudipta Misra as it plans to doublethe pediatric gastroenterology,hepatology and nutrition faculty. Thisexpansion in faculty will allow for theaddition of leading-edge capabilitiessuch as multiple impedance studiesfor reflux, ano-rectal manometryand biofeedback for constipation.Dedicated clinics for inflammatorybowel disease, short gut diseases,constipation and aero-digestivediseases also are being established.Vidant Medical Group is improvingaccess to careVidant Medical Group, which operates ambulatory physician practicesand outpatient services, and provides hospitalists, emergencymedicine services and comprehensive medical practice managementto several regional hospital partners, is experiencing major growth.In fiscal year 2013, Vidant Medical Group expects to employ anestimated 335 providers, an increase of 53 percent over FY12, andtotal encounters are projected to reach 750,000.While the numbers are impressive, it’s what they represent that ismost important. Bottom line, the reason Vidant Medical Group is onsuch a growth trajectory is that the need for high-quality, accessiblehealth care in eastern North Carolina is so great. Filling this need is anintegral part of Vidant Health’s mission – and what is fueling growth.“We have made a significant investment in recruitment andretention of providers to eastern North Carolina,” says TravisDouglass, Vidant Medical Group’s executive vice president anddirector, noting that the group is now present in more than a dozencommunities.Notably, Vidant Medical Group has expanded its panel of specialists,with an emphasis on cardiology, oncology, general surgery,orthopedics and women’s care – no small feat given the nationalphysician shortage in many specialties. The recruitment goal isnot only to strengthen geographic coverage, but also to increasecapacity so that expanded clinical hours and on-site diagnosticimaging and lab services can be offered efficiently – therebymaking health care more convenient and accessible.Equally important, Vidant Medical Group is transitioning all itsprimary care practices to the patient-centered medical home(PCMH) model. This model takes a 360-degree view of health –with the patient at the center – and engages the patient and familyas equal partners with an entire care team. During the past year, fiveprimary care medical practices prepared for PCMH recognition, andfive more are preparing this year.“The PCMH replaces episodic care with coordinated care and along-term relationship between the provider team, the patient andfamily,” says Clyde Brooks, MD, vice president for medical affairs,Vidant Medical Group.To enhance patient engagement and communication withproviders, Vidant MyChart – the patient portal of the Vidant HealthElectronic Health Record (EHR) through which patients can reviewand update their record, and request prescription refills andappointments – is being piloted in the PCMH practices.Vidant Medical Group manages a nurse triage telephone servicethat ensures patients receive the appropriate level of care as quicklyas possible. Later this year, the service will provide health coachingto monitor recently discharged patients.Vidant Medical Group also manages the system’s telehealthprograms, where health care professionals actively monitor morethan 600 patients.To optimize chronic disease management, Vidant Medical Grouphas certified diabetes educators and heart failure specialistsavailable in the region.In addition to the diabetes educators, heart failure specialists, andhealth coaches, Vidant Medical Group also has care coordinators tohelp those with chronic diseases, working with physicians betweenvisits to the office.“Our overarching philosophy is that the most effective health carebegins close to home,” says Douglass. “Vidant Medical Group iscommitted to being there.”For more information about Vidant Medical Group – includingbecoming part of our team – please call 252-847-6607.Vidant Cardiology was an exciting component of the rapid growth of Vidant Medical Group in the past year. From left are: Brad Jones, MD, Jerry Simpson, MD, Anthony Christiano, MD,Reza Ershadi, MD, Michael Smith, MD, Rony Shammas, MD, Adam Clark, MD, Gary Fontana, MD. Not pictured: Hassan Alhosaini, MD, and John Brooks, MD.Dr. Misra received medical degrees from the Medical College-Calcuttaand the Post Graduate Institute of Medical Education and Research inChandigarh, India. He completed a pediatric residency at MaimonidesMedical Center and a fellowship in pediatric gastroenterology atUCLA Medical Center. Dr. Misra is board certified in pediatrics, as wellas pediatric gastroenterology, hepatology and nutrition.VIDANT HEALTH MEDICAL REPORT 5

Vidant Medical Center acquires Leksell Perfexion Gamma Knife technologyStuart Lee, MD, director of the GammaKnife Center at Vidant Medical CenterWith the recent installation of its newPerfexion stereotactic radiosurgerysystem, the Gamma Knife Center atVidant Medical Center becomes theonly facility in eastern North Carolina,and one of just two in the entirestate, offering this gold standardfor non-invasive treatment of braindisorders, such as metastatic braintumors, meningiomas, acousticschwannomas, trigeminal neuralgiaand vascular malformations.This new technology – which replaces previous-generationequipment – offers significant advantages.“It gives us virtually unlimited reach to any place in the brain downto the mid-cervical spine,” says Stuart Lee, MD, director of theGamma Knife Center, noting that even tumors that are lateral or lowin the brain now can be targeted. “And its conformality is greater,ensuring that we treat the targeted lesion with the greatest possibleaccuracy while sparing nearby normal tissue.”The new system also delivers greater patient comfort and safety.“The previous system often required the patient’s head to be flexedduring treatment, a particularly difficult position for older patients,”Dr. Lee explains. “With Perfexion, the patient’s head remains in aneutral position.”Plus, he notes, Perfexion delivers a peripheral dosage of radiationthat’s up to 100 times less than other technologies, enhancingpatient safety. And, because so many set-up tasks are automated,patient flow-through is much faster.“Of any type of stereotactic radiosurgery, nothing is more accurateand precise than the Gamma Knife,” Dr. Lee adds. “The newPerfexion system is supported by an impressive scientific trackrecord with more than 2,000 peer-reviewed articles on treatmentefficacy, improved quality of life and cost efficiency. We are pleasedto offer this advanced level of care.”For more information on Gamma Knife radiosurgery, or to discussa particular patient, please call 252-847-2611.Indications forGamma Knife therapyEndovascular neurosurgery advances available at Vidant HealthDr. Robert James, medical director of endovascular neurosurgeryat Vidant Medical Center, is now performing the minimally invasiveflow diversion procedure for cranial aneurysms using the Pipeline Embolization Device stent. Flow diversion is an innovative alternative tothe traditional aneurysm clip.In the procedure, the Pipeline device is placed across the neck of alarge or complex aneurysm to divert blood flow through the parentblood vessel and away from the aneurysm. The reduced blood flowleads to eventual closing of the aneurysm. The minimally invasivetechnique reduces the risk of rupture by eliminating the need to enterthe aneurysm during surgery. Dr. James is assisted by Dr. Hilal Kanaan inperforming the procedure at Vidant Medical Center.Dr. James is also leading East Carolina University’s participation inthe multicenter Hydrogen Endovascular Aneurysm Trial (HEAT). HEATwill test the effectiveness of polymer-coated, bio-active coils to fillaneurysms. The new coils would potentially allow for increased densityin the packing of aneurysms. They could replace current bare-metalcoils when long-term filling of the aneurysm is necessary.For more information on neurosurgical procedures, or to discusspatient eligibility, please call 800-816-7264.Colleague cornerIn each issue, this column will highlight a Vidant Health professional and the services they provide.PAUL WALKER, MDDirector of Thoracic OncologyDiagnoses that indicate Gamma Kniferadiosurgery include: Meningiomas, acoustic neuromas, pituitaryadenomas, craniopharyngiomas and otherbenign tumorsIn most Gamma Knife cases, patients experience little pain and are back on their feet withinhours. Most patients are discharged home the day of the procedure and many resumetheir normal routines within 24 hours. Trigeminal neuralgiaOn recent advancesThere’s been a radical change in our understanding of tumorbiology, enabling us to individualize chemotherapy based on tumorpharmacogenomics. We’ve also gained more understanding of theimportance of continuing to treat the primary tumor in metastaticlung cancer.On how outcomes have changed in the past decadeStatistically, they haven’t changed much. Part of that is a nihilisticattitude toward treatment, particularly among those who don’t seemany patients. We see six to eight new cases a week – you haveto take care of lots of patients to do it well – and we’re seeing thatmaintenance chemotherapy can double or triple survival times.We’re seeing curative outcomes in stage III lung cancer doublingand tripling when proper, full-dose chemotherapy and radiationtherapy are used. Primary or recurrent malignant brain tumorsincluding astrocytomas and oligodedrogliomas Brain metastases Intracranial tumors such as nasopharyngealcarcinomas and ocular melanomasThe new Perfexion technology is in the hands of our skilled, multidisciplinary team ofneurosurgeons, radiation oncologists, medical physicists and nurses.6 VIDANT HEALTH MEDICAL REPORTThe Pipeline device reconstructs the parent artery by providing a flexible yet supportivescaffolding across the aneurysm neck.Integrate aggressive treatment, and you see more individualsliving longer – we have one patient who’s lived 45 months withmetastatic lung cancer. Statistics always lag behind and there’s nodata that really reflects what’s going on with the individual.On Vidant Health’s thoraciconcology resourcesWe have an interdisciplinaryteam of three thoracicsurgeons, two thoracic medicaloncologists, two thoracicradiation oncologists, aninterventional pulmonologist,a Pharm.D. for symptommanagement, a nurse navigator,a social worker and othersupport staff. We hold a twohour case conference everyweek. We have tremendoustechnological expertise, including a surgeon who does more roboticlobectomies than all other surgeons in North Carolina combined.And we have an aggressive screening program, which has beenshown to reduce lung cancer mortality by 20 percent.For more information on the Thoracic Oncology Program,please call 252-744-1789.VIDANT HEALTHMEDICALREPORTVIDANTMEDICALREPORT7 7

PRESORTEDFIRST-CLASS MAILU.S. POSTAGEPAIDPERMIT NO. 374PO Box 6028Greenville, NC 27835-6028Vidant Medical Center opens region’s first hybrid operating room—amongthe largest in the nationEast Carolina Heart Institute at Vidant Medical Center is home tothe first hybrid operating room in eastern North Carolina. With itsintegration of angiographic imaging capabilities, it’s like having acardiac catherization lab and radiology suite in the OR – a versatile,state-of-the-art environment that enables cardiac and vascular surgeonsand interventionalists to perform both open and complex minimallyinvasive procedures in the same room – often working side by side.Among the advanced procedures for which the hybrid ORis particularly advantageous are trans-catheter aortic valvereplacement (TAVR), stent grafting for aortic aneurysm repair, andaortic dissection repair.A signature aspect of the hybrid OR is the floor-mounted roboticC-arm which can be positioned virtually anywhere around thepatient to produce real-time clinical imaging, including 3Drepresentation with a live fluoroscopy overlay. It enables diagnostic,intraoperative and postoperative imaging to be performed rightin the OR, which is not only more convenient and efficient butpotentially lifesaving as emergent patients can bypass radiologyand go directly to the hybrid OR – saving precious time.The versatility of the hybrid OR also eliminates the need to transfera patient to another OR if it is deemed necessary during aninterventional procedure. For instance, if an acute problem is foundduring a percutaneous catheter intervention, surgeons can convertimmediately to an open procedure on the same table.At 1,200 square feet, the hybrid OR is among the largest of suchfacilities in the nation. Beyond size, however, this new OR –designed by the physicians and nurses who use it – delivers thehighest degree of flexibility for the full range of vascular and cardiacprocedures, and the best-possible patient care.For more information on the East Carolina Heart Institute, pleasecall 866-910-6900.The hybrid operating room at Vidant Medical Center is among the largest in thenation. Dr. Randolph Chitwood Jr. (front row right) leads the team of 38 highly skilledphysicians, surgeons, nurses and surgery technologists.VidantHealth.com

July 23, 2012, Vidant Medical Center joined an elite group of only 11 percent of the nation's hospitals with a dedicated pediatric emergency facility. The new child- and family-friendly facility - open 24/7 - is strategically located on the western side of Vidant