James W. Campbell, MD, MS - AkronCantonMDNews

Greater Cleveland Edition | February-March 2008 VOL. 11, NO. 2 

UH Heart & 

Vascular Institute 

An Update 

St. John West Shore’s 

Emergency Chest 

Pain Center 

Special Section 

Cardiovascular 

Disease 

James W. 

Campbell, MD, MS 

Realizing a Dream—MetroHealth’s Senior 

Health & Wellness Center

Why go 

anywhere 

else 

The New Orthopedic Joint 

and Spine Skilled Unit 

Southwest General Health Center is proud to announce 

the further development of its orthopedic and spine 

surgery program with the opening of a new skilled 

unit. This unit is dedicated exclusively to the care of 

joint and spine surgery patients, so you get the exact 

care needed to get back on your feet again. 

Nationally recognized by HealthGrades* for its 

award-winning clinical services*, Southwest 

General Health Center is: 

In the Top 10% in the nation for overall 

orthopedic services and spine surgery 

Best in Northeast Ohio for spine surgery 

In the Top 10 in Ohio for joint replacement 

One of America’s 50 Best Hospitals 

Why go anywhere else 

To learn more about the Orthopedic Joint and Spine 

Skilled Unit, call 440-816-4075. 

440-816-5050 / www.swgeneral.com / 1-71 to Bagley Road (west) / Middleburg Heights

from the managing editor 

Congratulations to the Cleveland Medical Consortium on its $64 million NIH Clinical and 

Translational Science Award (CTSA). Formed in 2006, the Consortium includes Case Western 

Reserve University, Cleveland Clinic, University Hospitals, and MetroHealth. Funds will be 

utilized to improve the health of patients in Northeast Ohio through patient-based research. 

With this award, the Cleveland Medical Consortium is now part of a national consortium 

designed to transform how clinical and translational research is conducted, ultimately enabling 

researchers to provide new treatments more efficiently and quickly to patients. 

Cleveland Clinic, University Hospitals and MetroHealth Medical Center provide 90 percent 

of the medical care delivered in the seven-county Northeast Ohio region and offer a wealth of 

clinical research opportunities. The CTSA will enable new community partnership resources, 

a new coordinated bioinformatics infrastructure, a new MD/Ph.D program in clinical research, 

and coordinated resources in bioethics and regulatory support. An academic home for 

clinical research, the Center for Clinical Investigation will also provide career development 

support for clinical investigators. For more information, see page 24 of this issue of Greater 

Cleveland M.D. News. 

The CTSA initiative grew out of the NIH commitment to re-engineer the clinical research 

enterprise, one of the key objectives of the NIH Roadmap for Medical Research. When fully 

implemented in 2012, the initiative is expected to provide more than $570 million over five 

years to 60 academic health centers. 

So, once again, congratulations to the Cleveland Medical Consortium! 

Here’s to your health! 

Jan Raabe, Managing Editor 

Greater Cleveland M.D. News 

jraabe@mdnews.com 

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05-738

contents VOL. 

11, NO. 2 

FEBRUARY/MARCH 2008 

4 COVER STORY 

JAMES W. CAMPBELL, 

MD, MS 

MetroHealth’s new Senior Health 

& Wellness Center is a $32 million 

225,000-square-foot project which offers 

comprehensive care in a one-stop shop. To 

geriatrician Dr. James Campbell, it’s his 

dream come true. 

7 

St. Vincent Charity Hospital 

Receives National Awards 

8 

Changes in Anti-Markup Rules 

16 SPECIAL SECTION 

CARDIOVASCULAR DISEASE 

24 

NIH Awards $64 Million to 

Cleveland Medical Consortium 

25 

Ireland Cancer Center 

Researchers Advance 

Stem Cell Gene Therapy 

28 

Local Docs in National News 

DEPARTMENTS 

ON THE COVER 

James W. Campbell, MD, MS 

PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON 

9 

RateMDs.com: Physicians 

Beware 

18 hospital spotlight 

26 the sommelier 

27 hospital rounds 

11 SPECIAL FEATURE 

UH HEART & VASCULAR 

INSTITUTE 

It’s been 18 months since leading Harvard 

cardiologist Daniel I. Simon, MD, joined 

University Hospitals (UH) as chief of the 

Division of Cardiovascular Medicine. Since 

then, he’s made considerable progress 

toward his goal of establishing a national 

cardiovascular center of excellence. 

11 

4 

2 | GREATER CLEVELAND M.D. NEWS FEBRUARY-MARCH 2008

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James W. Campbell, MD, MS 

Realizing a Dream—MetroHealth’s Senior Health & Wellness Center 

By Alex Strauss 

cover 

story 

Years before Cleveland native James W. Campbell, MD, MS, became 

a geriatrician and the director of Senior Health at MetroHealth 

Medical Center, he was a student of history who did his undergraduate 

thesis on the founding of geriatric medicine. When he did decide to 

go to medical school, it was not hard to choose a specialty. 

“If you like history then, by definition, you have to love old people,” 

said Dr. Campbell, who is also a professor of Family Medicine at Case 

Western Reserve University. “If you’re a historian, they have the 

best stories of anybody. I have always enjoyed interacting with that 

age group and have always believed that we should honor, respect 

and care for them. So it was only natural to go on to do training in 

geriatrics.” 

After medical school at the University of Cincinnati and a residency 

in Family Medicine at University Hospitals (UH) of Cleveland, Dr. 

Campbell completed his fellowship in Geriatric Medicine at UH. 

He had worked as an intern in Cleveland’s very first geriatric clinic 

alongside some of what he considered to be family medicine’s greatest 

minds at that time, and he knew that the care of Ohio’s elderly would 

be his life’s mission. 

“The thing that people don’t get is that we’re now spending a third 

of our life as old people. And yet so much of the world says they don’t 

matter. People don’t understand that old people are as diverse as any 

population. They talk about ‘the needs of the elderly,’ forgetting that 

these patients have had 75 years to individuate. Their needs are very 

diverse because they are all so unique,” said Dr. Campbell. “Not valuing 

old people is a societal problem.” 

James Campbell, MD, MS, chairs the Department of Family Medicine and directs Senior Health at MetroHealth, where he has undertaken a number 

of projects to improve the medical care of seniors. Two of which he is most proud are Concordia Care and the new Senior Health & Wellness Center, 

a $32 million 225,000-square-foot facility in Old Brooklyn. Dr. Campbell is pictured here in a multi-purpose room of the Center. 



Now, as a board-certified geriatric 

specialist, who is also boarded in Family 

Medicine and Addiction Medicine, Dr. 

Campbell is working diligently to develop 

solutions to that problem in the Cleveland 

area. At MetroHealth, where he chairs 

the Department of Family Medicine, Dr. 

Campbell helped rejuvenate the Geriatric 

Fellowship program and supervised the 

planning and building of the Prentiss 

Center skilled nursing facility adjacent to 

the Hospital. This facility, which replaced 

the outdated county nursing home, has 

been at-capacity since the day it opened. 

In his 15-year tenure at MetroHealth, Dr. 

Campbell has also assembled a team of 20 

certified geriatricians, helped open a busy 

senior outpatient clinic which realizes over 

10,000 visits per year, and overseen the medical 

management of 15 nursing facilities. 

In addition, he was instrumental in the 

development of Concordia Care, a joint 

project of the Benjamin Rose Institute and 

MetroHealth which opened in 1997 to 

provide service to frail elders who want to 

stay independent in the community, and MetroHealth’s new Senior 

Health & Wellness Center—a one-of-a-kind in the nation for 

seniors’ health and medical needs. Of all of Dr. Campbell’s accomplishments, 

these two are sources of particular pride for him. 

CONCORDIA CARE 

Concordia Care is a unique aggressive health management program 

aimed at the frailest and poorest elderly patients. One of only 

two such programs in Ohio and 42 nationally, it has served over 

700 Cleveland-area people in the past 10 years. 

“Concordia Care provides all-inclusive, wraparound care for 

people who would otherwise have to be in a nursing home,” explained 

Dr. Campbell. “This program allows them to stay in their 

homes by providing transportation to a medically supervised adult 

day care, all medications, home care, and even durable medical 

equipment. We have to aggressively manage their care. If a person 

in that program doesn’t request to have their medicines refilled, 

for instance, that triggers a question as to why.” 

Statistics show the program works, not only to keep patients 

healthier longer, but to save money for both Medicare and 

Medicaid. 

“Without this kind of program, these types of patients would 

have an average of 17 hospital days per year. In 2006, we found that 

the patients in this program had an average of just 1.6 hospital days 

per year,” Dr. Campbell said. “In addition, we are keeping them 

out of nursing homes. That is a significant savings.” 

The Senior Health & Wellness Center is home to 20 geriatricians, including Joseph Baker, DO, 

shown here with Dr. Campbell. It also offers access to MetroHealth specialists in a variety of 

clinical areas including cardiology, dentistry, dermatology, neurology, podiatry, pulmonology, 

radiology, rheumatology, ophthalmology, otolaryngology, urogynecology, and mental health. 

THE SENIOR HEALTH & WELLNESS CENTER 

Soon, the Concordia Program will be expanding, along with a 

whole host of other programs for seniors at all health levels, thanks to 

Dr. Campbell’s biggest undertaking yet — the first-of-its-kind Senior 

Health & Wellness Center. Located on the fully renovated site of the 

former Deaconess Hospital in the Old Brooklyn neighborhood of 

Cleveland, the 225,000-square-foot Senior Health & Wellness Center 

is the result of a $32 million commitment and offers the region’s largest 

team of geriatricians providing a unique model of seamless care 

for seniors. 

“This one really is a dream come true. It’s the culmination of all the 

things we’ve been doing here for the last 15 years,” said Dr. Campbell. 

“We believe that seniors deserve the best care available. We’ve created 

a place that is truly going to be a one-stop shop for all of their health 

and medical needs.” 

The Senior Health & Wellness Center is home to 20 geriatricians 

and offers access to MetroHealth specialists in a variety of clinical 

areas including cardiology, dentistry, dermatology, neurology, 

podiatry, pulmonology, radiology, rheumatology, ophthalmology, 

otolaryngology, urogynecology, and mental health. There is also an 

on-site pharmacy and laboratory services. 

“The ability to see your primary care doctor and go right down the 

hall to see your dentist or your cardiologist is a huge benefit to senior 

patients,” asserted Dr. Campbell. “Not only is it easier, meaning they 

are more likely to get the care they need, but from the standpoint of 

the practitioners, we are able to easily communicate with one another 


GREATER CLEVELAND M.D. NEWS FEBRUARY-MARCH 2008 | 5

PHOTO COURTESY OF METROHEALTH MEDICAL CENTER 

and coordinate care better. Everyone is aware of what everyone else 

is doing. We are even working to interface all of the electronic medical 

records.” 

But the Senior Health & Wellness Center is more than a place to 

see a doctor. As of this spring, it will house a 144-bed skilled nursing 

facility; an adult day care program; home- and community-based 

nursing and personal care services; offices for various senior citizen 

agencies and organizations, such as the Western Reserve Area Agency 

on Aging; and a 14-bed hospice unit. 

Dr. Campbell believes the facility will not only save time for patients 

and help keep them healthier longer, but will also save millions of 

dollars while providing higher quality care. 

“Right now, if you have a nursing home patient who needs to go 

see a cardiologist, that visit might cost $1,000 dollars by the time 

you add up the cost of an ambulance to take them there, a nurse’s 

aid to accompany them and the cardiologist himself,” he said. “In the 

Senior Health & Wellness Center, that patient can be brought down 

from long-term care in the elevator, see a cardiologist on campus, and 

go right back upstairs. It’s simpler and less stressful for the patient, 

The Senior Health & Wellness Center will house a 144-bed skilled nursing facility; an adult day 

care program; home- and community-based nursing and personal care services; offices for 

various senior citizen agencies and organizations, such as the Western Reserve Area Agency on 

Aging; and a 14-bed hospice unit. 

and there is so much potential for improving healthcare quality at a 

fraction of the cost.” 

Dr. Campbell explained that the collection of multiple geriatric 

specialties in one place also opens up the possibilities for shared 

services such as on-site nutrition counseling (right in the cafeteria!), 

recreational or music therapy, spiritual support in the form of a fulltime 

chaplain, and more. The building’s interior hallways are even 

being mapped to provide a safe, temperature-controlled exercise 

walkway for seniors who might otherwise walk at the mall. 

“There is no end to the possibilities,” said Dr. Campbell. “We even 

have a beautiful garden on the grounds that the residents of the nearby 

high-rise apartments tend to. We expect that the Senior Health & 

Wellness Center will become the local hub for geriatric activity in 

the area. This is the biggest program designed specifically for seniors 

between New York, Los Angeles, and Little Rock.” 

THE FUTURE OF ELDER CARE 

Dr. Campbell believes the one stop-shop concept of the Senior 

Health & Wellness Center will be the wave of the future in elder care 

because it saves money, improves access, and 

has the potential to keep more seniors out of 

hospitals and nursing homes longer. But he 

cautions that America needs to change the 

way it thinks about senior care in order to 

truly move ahead. 

“America loves to pay for something technical 

but, unfortunately, we don’t have the 

‘geriscope’ yet,” he mused. 

He points out that, although geriatrics is 

the specialty with the highest job satisfaction 

rate, it is also one of the lowest paid specialties. 

Improved geriatric care—and innovative 

concepts like the Senior Health & Wellness 

Center—is going to require a greater commitment 

to supporting “the best and the 

brightest physicians” as they pursue careers 

in the field. 

“We need to make sure that we can 

recruit people who are truly interested 

in caring for the elderly. This is still very 

much a care-based specialty where you are 

not just taking care of an individual but 

that person’s family and the broader community. 

In order to help them, you really 

do have to address those around them, too,” 

he said. “And, above all, you have to have a 

deep level of care.” 

For more information about Concordia Care or 

the Senior Health & Wellness Center, call 216-957- 

2000 or visit www.metrohealth.org. ■ 


St. Vincent Charity Hospital 

Receives National Awards 

St. Vincent Charity Hospital recently received 

the Select Practice National Quality 

Award. The award, issued by Premier 

Healthcare Alliance, recognizes the top 

1 percent of more than 4,700 acute-care 

inpatient facilities in the United States for 

superior outcomes. 

Select Practice National Quality Award 

recipients did not apply for the award. 

They were selected based on reported data 

in areas such as mortality, morbidity and 

length of stay. To identify top performers, 

Premier evaluated quality and efficiency data 

reported by all acute care facilities in the 

MEDPAR 2005 database, regardless of bed 

size or teaching status. The data included 

16 different clinically relevant indicators 

of risk. The quality index was calculated 

by combining the outcome deviations for 

mortality, morbidity and complications 

into a single quality measure for each facility. 

The combined quality and efficiency 

ratings were then used to determine the 

award recipients. 

Premier Healthcare Alliance is the largest 

healthcare alliance in the United States. 

Its mission is to improve patient outcomes, 

while safely reducing the cost of care through 

network purchasing. 

St. Vincent Charity Hospital also recently 

received the following awards for 2008 from 

Healthgrades, an independent healthcare 

ratings company: 

• O r t hop e d ic Su rger y C l i n ic a l 

Excellence Award for superior outcomes 

in Orthopedic Surgery. 

• Pulmonary Care Excellence Award, 

acknowledging a low inpatient, 1-month 

and 6-month post-discharge mortality 

rate for COPD and Pneumonia care over a 

three-year period (2003-2005). 

• Spine Surgery Excellence Award, 

recognizing low complication rates in Back 

and Neck Surgery over a three-year period 

(2003-2005). 

• Stroke Care Excellence Award, recognizing 

excellence in Stroke Care based 

on inpatient, 1-month and 6-month postdischarge 

stroke mortality data over a 

three-year period (2003-2005). 

St. Vincent Charity Hospital is a 480- 

bed, full-service inpatient and outpatient 

healthcare center which has served the 

Greater Cleveland community for more 

than 142 years. It is jointly owned by 

the Sisters of Charity Health System and 

University Hospital. ■ 

THE HOSPICE OF CHOICE 

Hospice & Palliative Care Partners of Ohio, an agency 

of the Visiting Nurse Association, makes every day 

count for patients and their families. 

We are raising the bar on providing end of life 

care through expanded medical technology, and 

innovative programs. In the home, hospital or extended 

care facility, Hospice & Palliative Care Partners, your 

hospice of CHOICE for over 25 years. 

800-862-5253 

www.hospiceohio.org 


Changes in Anti-Markup Rules 

By Joy Kosiewicz and Mary T. Link 

In the 2008 Medicare physician fee 

schedule, CMS substantially expanded 

the scope of the anti-markup provisions. 

The revised anti-markup provisions apply 

if a physician, physician organization 

or other supplier bills for the technical 

component (TC) or the professional 

component (PC) of a diagnostic test, 

the test was ordered by the billing physician 

or other supplier or a party related 

by common ownership or control, and 

the test is either: (1) purchased from an 

outside supplier, or (2) performed at a 

site other than the office of the billing 

physician or other supplier. 

EFFECTIVE DATE AND 

APPLICABILITY DATE 

The rule changes are effective as of 

January 1, 2008. However, as of January 

1, 2008, the revised anti-markup provisions 

only apply to: (1) the TC of 

any purchased diagnostic test, and (2) 

anatomic pathology diagnostic testing 

services furnished in space that is utilized 

by a physician group practice as a “centralized 

building” for purposes of complying 

with the self-referral rules; and does not 

qualify as a “same building.” 

The revised anti-markup provisions 

will not apply to the PC of a diagnostic 

test until January 1, 2009. The reason 

for the delay is to clarify what constitutes 

an “office of the billing physician 

or other supplier.” CMS intends to issue 

guidance, propose additional rulemaking 

or both. 

KEY CHANGES TO RULES 

Site of Service. The rules will now 

apply to tests ordered and billed by a physician 

in a group practice, but performed 

at a location other than the “office” of the 

billing practice. However, CMS received 

comments which raised concerns that 

“office of the billing physician or other 

supplier” may not be entirely clear and 

could have unintended consequences. 

Specifically, some commenters indicated 

the definition is unclear with respect to 

whether certain space arrangements are 

included. Others were concerned that 

if office space which satisfies the “same 

building” test or otherwise complies with 

the physician self-referral rules is now 

subject to the anti-markup provisions, 

physician groups will not be able to render 

services cost-effectively and patient access 

will be disrupted. Thus, CMS has decided 

to study these issues further. 

Until CMS issues further guidance 

or additional rules, the following new 

definitions are applicable to TCs and 

anatomic pathology diagnostic testing 

services: 

• “Office of the billing physician or 

other supplier” means “space where the 

physician or other supplier regularly 

furnishes patient care.” 

• The “office” of a group practice means 

space in which the organization furnishes 

“substantially the full range of 

patient care services” that the practice 

provides generally. This new “office” 

test differs from the “same building” 

test used in the Stark in-office ancillary 

services exception. In order to meet 

the “office” location standard, the PC 

or TC must be furnished in the same 

office suite where physician services 

are furnished. 

Purchased from Outside Supplier. 

The anti-markup provisions continue to 

apply to services furnished by “outside 

suppliers,” but this term now means 

anyone who is not a full or part-time 

employee of the billing practice and who 

does not furnish the PC or TC to the billing 

practice under a reassignment. 

Expansion to TC. The anti-markup 

provisions will now apply to both the PC 

(except the rule changes will not apply 

until January 1, 2009) and the TC (the 

rule changes apply as of January 1, 2008) 

of diagnostic tests (other than diagnostic 

clinical laboratory tests). 

Focus on Ordering. There will be a 

new focus on who ordered the test. When 

a test is ordered by a physician outside 

the billing physician practice, the test 

will not be subject to the anti-markup 

provisions. However, the “related party” 

rules must be considered when determining 

whether an ordering physician 

is outside the billing practice. 

Net Charge. A supplier’s “net charge” 

now must be determined without regard 

to the cost of equipment or space leased 

to the performing supplier by or through 

the billing physician. Furthermore, the 

billing physician may not include billing 

or other overhead costs when calculating 

the net charge. 

Other Suppliers. The rules will 

apply not only to physicians, but also 

physician organizations and other suppliers, 

such as IDTFs. 

Joy Kosiewicz and Mary Link are attorneys 

in the Health Care Group at Brouse 

McDowell. Ms. Kosiewicz practices in the 

areas of Health Care and Real Estate 

Law, representing health systems, physician 

groups and health plans in a variety of 

regulatory, real estate and corporate matters. 

Ms. Link counsels hospitals, physicians, home 

health agencies, hospices, dialysis facilities 

and other providers on the full spectrum of 

health care issues. ■ 


MetroHealth Receives ASA’s Get 

With The Guidelines Gold Award 

MetroHealth Medical Center recently 

received the American Stroke 

Association’s Get With The Guidelines– 

Stroke (GWTG–Stroke) Gold Performance 

Achievement Award. The award recognizes 

MetroHealth’s commitment and success in 

implementing a higher standard of stroke 

care by ensuring that stroke patients receive 

treatment for at least 24 months according 

to nationally accepted standards and 

recommendations. 

MetroHealth has developed a comprehensive 

system for rapid diagnosis and treatment 

of stroke patients admitted to the emergency 

department. This includes always being 

equipped to provide brain imaging scans, 

having neurologists available to conduct 

patient evaluations and using clot-busting 

medications when appropriate. 

To receive the GWTG—Stroke Gold 

Performance Achievement Award, 

MetroHealth demonstrated 85% adherence 

in the GWTG–Stroke key measures for 24 

or more consecutive months. These include 

aggressive use of medications like tPA, antithrombotics, 

anticoagulation therapy, DVT 

prophylaxis, cholesterol-reducing drugs, and 

smoking cessation. 

“The American Stroke Association commends 

MetroHealth for its success in 

implementing standards of care and protocols,” 

said Lee H. Schwamm, MD, 

national Get With The Guidelines Steering 

Committee member and director of the acute 

stroke services at Massachusetts General 

Hospital in Boston. “The full implementation 

of acute care and secondary prevention recommendations 

and guidelines is a critical step 

in saving the lives and improving outcomes 

of stroke patients.” 

According to the American Stroke 

Association, each year approximately 

700,000 people suffer a stroke—500,000 

are first attacks and 200,000 are recurrent. 

Of stroke survivors, 21 percent of men and 

24 percent of women die within a year, and 

for those aged 65 and older, the percentage 

is even higher. 

For more information on Get With The 

Guidelines, visit www.americanheart.org/getwiththeguidelines. 

■ 

RateMDs.com: 

Physicians Beware 

By Corbin Moore 

The Internet is a valuable tool for 

physicians both for research and communication. 

However, recently it has 

become dangerous ground. This is because 

the trend of anonymous consumer 

ratings has finally spread to healthcare. 

The reputations of all physicians are now 

vulnerable to damage by anonymous 

postings on internet sites. 

One of the most popular of these 

sites is www. RateMDs.com. RateMDs 

encourage patients to anonymously 

evaluate their doctors and post whatever 

they choose about their experience. The 

lack of checks or any kind of authenticity 

requirements mean that essentially, 

anyone can write anything about 

any physician. 

Angry patients, competitors, and 

others who would seek to harm your 

reputation now have a free and easy 

global platform in which to do so. A 

company out of North Carolina founded 

to protect physicians from frivolous 

lawsuits has been conducting research 

on RateMDs.com and other sites and 

what they have discovered is unsettling 

to say the least. 

Until now, there has been little that physicians 

could do about libel on the internet. 

However, there is at least one organization 

which is gearing up to combat web defamation 

(see www.medicaljustice.com). They 

have crafted a proactive, innovative solution 

that can help you prevent unwanted 

comments and take action if and when you 

find them. 

We encourage all physicians to look 

themselves up on www.RateMDs.com, 

www.healthgrades.com, and other sites. 

It is also a good idea to “Google” yourself 

and your practice regularly to see what’s 

out there on websites and blogs. 

Corbin Moore is president of Sirak-Moore 

Insurance Agency in Canton and Akron. ■ 


1 0 | GREATER CLEVELAND M.D. NEWS FEBRUARY-MARCH 2008

UH Heart & Vascular Institute: 

An Update 

By Robert Jansen 

special feature 

In July 2006, when leading Harvard cardiologist Daniel I. Simon, 

MD, joined University Hospitals (UH) as chief of the Division of 

Cardiovascular Medicine, his goal was to expand UH’s entire cardiovascular 

service line and to establish a heart and vascular institute that 

would rise to the rank of a national center of excellence—not only in 

regard to patient care, but also in regard to cardiovascular research 

and physician education. 

A triple threat in his own right, Dr. Simon was formerly an associate 

professor of Medicine and associate director of Interventional 

Cardiology at Harvard and the Brigham and Women’s Hospital in 

Boston, where he completed his medical residency, cardiovascular 

fellowship, research and advanced interventional cardiology training. 

Board certified in Internal Medicine, Cardiovascular Disease 

and Interventional Cardiology, Dr. Simon’s clinical activities focus 

on interventional cardiology while his research work, funded by the 

National Institutes of Health (NIH) for the past 16 years, has involved 

developing new approaches to prevent heart attack and restenosis of 

arteries after angioplasty and stenting. 

Today, as the director of University Hospitals Heart & Vascular 

Institute, Dr. Simon is proud of the milestones he and his colleagues 

have already achieved during the past 18 months. These include new 

facilities, physician and physician-scientist recruits, research grants 

and awards, expanded clinical services, and new cardiovascular subspecialty 

fellowships. 

“What we’re trying to build is a premier academic cardiovascular 

program . . . a balanced and well-rounded program that encompasses 

research, fellow education, and cutting-edge clinical care,” said Dr. 

Simon. 

Daniel I. Simon, MD, (left) is the Herman Hellerstein chair and University Hospitals’ chief of the Division of Cardiovascular Medicine and director 

of the Heart & Vascular Institute. Mukesh K. Jain, MD, is the Ellery Sedgwick Professor of Medicine, chief research officer at University Hospitals 

Heart & Vascular Institute and director of the Case Cardiovascular Research Institute. Both receive research funding from the National Institutes 

of Health and are elected members of the prestigious American Society of Clinical Investigation. 


1 1 | GREATER CLEVELAND M.D. NEWS FEBRUARY-MARCH 2008 



James Fang, MD, (right) is chief medical officer at University 

Hospitals Heart & Vascular Institute and medical director of Heart 

Failure, Transplantation, and Circulatory Assistance. Ivan Cakulev, 

MD, is a senior instructor at Case Western Reserve University and an 

electrophysiologist at University Hospitals. 

To help in this regard, Dr. Simon initially recruited five cardiovascular 

colleagues from Harvard and Brigham, including James C. Fang, 

MD, and Mukesh K. Jain, MD. Dr. Fang serves as chief medical officer 

at University Hospitals Heart & Vascular Institute and medical director 

of Heart Failure, Transplantation, and Circulatory Assistance. Dr. Jain 

is the Ellery Sedgwick Professor of Medicine, chief research officer 

at University Hospitals Heart & Vascular Institute and director of the 

Case Cardiovascular Research Institute. Drs. Anne Hamik, Brandon 

Atkins, and Saptarsi Haldar, all highly accomplished clinician-scientists 

from Harvard Medical School, were recruited as well. Since then, 

more than 13 clinicians and researchers have joined them. 

RESEARCH AND EDUCATION 

Dr. Simon believes that research—from clinical research to population 

research to basic science research—is fundamental to all top-flight 

cardiovascular divisions, and he encourages all faculty members to be 

engaged in some aspect of research to advance patient care. To help in 

this endeavor, Case Western Reserve University School of Medicine 

founded the Case Cardiovascular Research Institute. The results have 

been quite impressive. 

“We’ve experienced enormous growth on the research front,” said 

Dr. Simon. “Before we joined the Cardiovascular Medicine Division, 

there were 22 people conducting cardiovascular research. Now, there 

are 59.” 

The most recent include Aaron Proweller, MD, PhD, and Diana 

Ramirez-Bergeron, PhD, from the University of Pennsylvania. 

Their research interests include heart and blood vessel development 

and genetics. Marco Costa, MD, PhD, was recruited to direct the 

Research & Innovation Center and Invasive Services at UH’s Heart 

& Vascular Institute. Richard Josephson, MD, joined UH to direct 

Cardiovascular-Pulmonary Rehabilitation. 

According to Dr. Simon, Dr. Costa is a world-renowned interventional 

cardiologist who trained with two of the most prominent 

interventionalists in the world—Patrick Serruys, MD, from the 

Thorax Center in Rotterdam, The Netherlands, and Eduardo Sosa, 

MD, from Brazil. 

“Dr. Costa was trained on two continents and brings us key industrial 

and new device technology that’s way ahead, about three to five 

years ahead, of what we currently have in the United States. So he 

provides us access to innovative technology and discovery,” Dr. Simon 

explained. “His specialty is in imaging, and he has a core imaging 

laboratory that uses OCT (optical coherent tomography), intravascular 

ultrasound, and MRI for high-resolution imaging of blood vessels.” 

Richard Josephson, MD, trained at Johns Hopkins and at the 

NIH and is known for developing one of the premier cardiovascular 

pulmonary rehabilitation programs in the nation while in Akron, 

according to Dr. Simon. A member of the National Cardiovascular 

and Pulmonary Rehabilitation Board of Directors and an NIH-funded 

researcher, Dr. Josephson uses state-of-the-art neuro-imaging modalities 

to study the effects of exercise on cognitive function in patients 

with heart failure. 

While the ability to continue to recruit such outstanding individuals 

is a measure of success for the cardiovascular division, so, too, is 

the explosive growth in total grant support over the past 18 months. 

When Dr. Simon and his colleagues arrived at UH, R01 grants (the 

most prestigious of research awards) totaled seven; now that total is 

15. Previously, there were no career development grants; now there 

are eight K08 and SDG awards from the NIH and American Heart 

Association. Total committed grant support (direct and indirect costs) 

from the NIH now exceeds $21 million. 

In 2007, Dr. Simon personally received a prestigious MERIT 

award—one of only four to seven annually given by the NIH to 

investigators across the country. This will likely bring in up to $3.9 

million. 

“We’ve garnered prestigious awards, and these are signs that the 

institution is doing well,” said Dr. Simon. 

Perhaps one of the best success stories is in the area of cardiovascular 

stem cell and regenerative medicine research, which has been 

a win not just for UH but for the state of Ohio, as well. University 

Hospitals Case Medical Center and Case Western Reserve University 

School of Medicine, with its FDA-approved cell production facility 

led by Stanton Gerson, MD, is a nationally recognized site for adult, 

non-embryonic stem cell research. Not coincidentally, it is also the 

site of the Ohio Cell-Based Therapy Consortium for Cardiovascular 




(Far left) Alan Markowitz, MD, chief surgical officer of University Hospitals Heart & Vascular 

Institute, directs University Hospitals’ new Valvular Heart Center. He is shown here (left 

to right) with Jerry Goldstone, MD, chief of the Division of Vascular Surgery, and Adnan 

Cobanoglu, MD, chief of the Division of Cardiac Surgery and co-director of University Hospitals 

Heart & Vascular Institute. 

Disease, a multi-institutional effort directed by Dr. Simon which includes 

investigators from University of Toledo, Ohio State University, 

Christ Hospital in Cincinnati, and University of Cincinnati. Current 

trials are underway to examine cell-based therapy for ischemic heart 

and peripheral vascular disease. 

Dr. Simon is also a member of the Commercialization Advisory 

Board of the Global Cardiovascular Innovation Center (GCIC). 

GCIC’s goal is to build cross-industry partnerships to facilitate the 

development and adoption of new cardiovascular technologies geared 

towards improving patient care. 

“This has been a great windfall for UH, because we received about 

$1.8 million in state funding to build innovative cardiovascular programs 

that lead to discovery and also jobs for the state of Ohio,” he said. 

As pleased as Dr. Simon is with the progress of the research arm of the 

Heart & Vascular Institute’s cardiovascular program, he’s equally pleased 

with the ongoing evolution of the physician education arm. Currently, 

there are 18 physicians in fellowship training programs at UH. 

“Our success on the research side is now leading to recognition of 

Case’s cardiovascular fellowship training program as really being a 

top program,” said Dr. Simon. “We’re now getting applicants from 

Johns Hopkins, Duke and the University of Texas Southwestern for 

the first time.” 

He reported that his division will be introducing two new fellowship 

programs—one in vascular medicine and the other in cardiovascular 

imaging. Teresa Carman, MD, who headed the Cleveland Clinic 

vascular medicine fellowship program, was 

recruited to initiate a similar program at UH. 

The new cardiovascular imaging fellowship 

program will be directed by three UHCMC 

physicians: Brian Hoit, MD, director of 

Echocardiography; Robert Gilkeson, MD, 

director of Cardiovascular Imaging Center; 

and James O’Donnell, MD, director of 

Nuclear Medicine. 

“We’ll have pretty strong coverage now in 

electrophysiology, interventional cardiology, 

general cardiology, vascular medicine and 

cardiovascular imaging,” said Dr. Simon. 

His commitment to education extends 

to the medical community, as well. Only 

three months after joining UH, he and 

three of his colleagues initiated an annual 

continuing medical education course entitled 

Update in Cardiovascular Medicine. The 

first year, 150 physicians attended. Last 

year, there were 300 attendees. The purpose 

was to increase cardiovascular disease 

awareness especially among UH internists 

and family practice physicians. 

CLINICAL CARE 

Regarding patient care, Dr. Simon is 

pleased to report the development of a ventricular assist device program 

and reactivation of UH’s heart transplantation program. 

“Drs. Jim Fang, Arie Blitz (surgical director of Heart Transplantation) 

and Adnan Cobanoglu (chief of the Division of Cardiac Surgery and 

co-director of the Heart & Vascular Institute) are committed to offering 

all components of advanced heart failure therapies, whether it’s 

devices, improved medical therapy or transplantation. There’s strong 

commitment from UH in these areas, and I think the lung and heart 

transplants in 2007 showed that,” said Dr. Simon. 

In the Division of Electrophysiology (EP), which is directed by 

Judith Mackall, MD, he’s excited about the “great growth” in the number 

of electrophysiologists. There are now six, and one more is being 

recruited. The most recent addition is Mauricio Arruda, MD. 

“Dr. Arruda just joined us from the Cleveland Clinic. He is 

quite renowned for AF ablation and will direct our AF Center and 

Electrophysiology Laboratories in the Heart & Vascular Institute,” 

said Dr. Simon. 

Community outreach efforts included the expansion of EP services 

to UH medical centers in Bedford, Richmond, and Geauga, as well 

as ambulatory facilities in Westlake, Twinsburg, Chardon, Euclid, 

Mentor and Chagrin Highlands. 

Perhaps even more exciting are the new and innovative prevention 

programs at UH developed by Carl Orringer, MD, director of Lipid 

and Prevention. “Carl has developed one of the most innovative screening 

programs for asymptomatic patients. It’s based on what’s called 



the SHAPE protocol, which uses coronary 

calcium scoring to screen at-risk individuals. 

And we’ve been able to develop a protocol to 

offer $99 calcium screening tests to identify 

these individuals,” Dr. Simon explained. 

“It’s really a paradigm shift to identify 

patients that have a 10-year risk of disease 

that could be as high as 25 percent versus 

3 percent for a low-risk individual, and to 

embark upon therapies and evaluation that 

you normally wouldn’t. And it’s already 

garnered a lot of interest from other institutions 

which want to know how we were 

able to do this and how we organized it 

and set it up.” 

Dr. Orringer, who is a board-certified 

lipidologist and serves on the National 

Lipid Board, is also developing an LDL 

Apharesis Center for treatment of very 

high-risk patients at UH. Once implemented, 

it will be the only LDL apharesis 

center in the entire Northeast Ohio/ 

Western Pennsylvania region. 

“Again, we’re trying to offer the full spectrum 

of prevention and lipid coverage from 

the simple to the most complex patients that 

are at very high risk but refractory to management,” said Dr. Simon. 

Another new development is the creation of a Valvular Heart Center 

made possible by a substantial donation to UH by John Haugh, a grateful 

patient. Directed by Alan Markowitz, MD, chief surgical officer of 

the Heart & Vascular Center, and James Fang, MD, the new Center 

will offer comprehensive evaluation and minimally invasive treatments 

for patients with valvular heart disease. 

“Alan Markowitz is a real gem of a surgeon and has a very large 

following for complex valvular heart disease,” said Dr. Simon. “This 

has really been a success story over the past year, as well.” 

Another success story is the cardiovascular division’s collaboration 

with University Hospitals’ MacDonald Women’s Hospital to provide 

women’s heart care. The plan is to provide access to cardiovascular 

expertise for women in neighborhood communities as well as in 

downtown Cleveland. 

“We’re the primary sponsor for the American Heart Association’s 

Go Red for Women campaign. We did that last year, and we’re excited 

to be doing that again this year,” said Dr. Simon. “Heart disease 

is the number one health threat to women. Go Red for Women is 

designed to educate women about the signs and symptoms of heart 

disease. Women are the most important drivers of health decisions 

in their families, but we need to remind them that they need to 

take charge of their own health, too. We are excited to be a part of 

MacDonald Women’s Hospital programs focusing on bone, breast 

and heart health.” 

In terms of other issues regarding clinical care, Dr. Simon is very 

Judith Mackall, MD, is medical director, Division of Electrophysiology, University Hospitals 

Case Medical Center. University Hospitals Heart & Vascular Institute recently announced a 

collaboration with MacDonald Women’s Hospital to provide women’s heart and vascular care 

in neighborhood communities as well as in downtown Cleveland. 

pleased that construction is completed on UHCMC’s new cardiovascular 

ambulatory/outpatient center which now houses cardiac medicine, 

vascular medicine, cardiac surgery and imaging all in one location. 

An additional 15,000 square feet of laboratory space exclusively for 

cardiovascular research was also recently completed in the Wolstein 

Research Building, owned Case School of Medicine. 

To further facilitate patient access, new catheterization labs have 

been opened in a number of UH’s community medical centers, including 

University Hospitals Bedford Medical Center and University 

Hospitals Richmond Heights Medical Center. Heart and vascular 

services also play a fundamental role in the new University Hospitals 

Twinsburg Health Center which opened in October 2007, and Dr. 

Simon is looking forward to the opening of the University Hospitals 

Concord Health Center in 2009 and the Ahuja Medical Center in 

Beachwood in 2010. All of these new facilities are expected to improve 

not only patient access, but also patient care. 

“All in all, I think the state of the Heart & Vascular Institute mirrors 

the overall state of the institution—it’s aggressively expanding,” said 

Dr. Simon. “Achilles Demetriou (UH president), Tom Zenty (UH 

CEO), and Fred Rothstein (UHCMC president) have provided strong 

leadership and supplied us with sufficient resources to grow the heart 

and vascular enterprise. And we’re just wildly excited about it.” 

To schedule a patient, call 216-844-3800 or UH4-CARE. For more information 

about UHCMC’s Heart & Vascular Institute, call 216-844-8448 

or visit www.uhhospitals.org/heart. ■ 

PHOTO COURTESY OF UNIVERSITY HOSPITALS CASE MEDICAL CENTER 

1 4 | GREATER CLEVELAND M.D. NEWS FEBRUARY-MARCH 2008 GREATER CLEVELAND M.D. NEWS FEBRUARY-MARCH 2008 | 14

R E G E N C Y H O S P I T A L C O M P A N Y 

Giving People Their Lives Back 

Regency Hospital Cleveland East and Regency Hospital Cleveland West are 

intensive critical care hospitals serving the needs of medically complex patients 

that require acute level care for a longer period of time than traditional hospitals 

are set up to provide. We are a national network of hospitals with a different way 

of thinking, a different way of caring, and a different way of treating, and it shows 

in everything we do. 

R E G E N C Y PRO G R A M S A N D S E RV I C E S 

Pulmonary/ventilator program 

Medically complex/multi-system failure program 

Wound care program (stage III and IV decubitus) 

Low-tolerance rehabilitation services 

Regency Hospital Cleveland East 

4200 Interchange Corporate Center Rd. • Warrensville Heights, Ohio 44128 

Main: 216.910.3800 • Referral: 216.910.3900 

Regency Hospital of Akron 

155 Fifth Street NE • Barberton, Ohio 44203 

Main: 330.615.3792 • Referral: 330.615.3800 

Other locations in the Northeastern Ohio area: 

Regency Hospital Cleveland West 

6990 Engle Road • Middleburg Heights, Ohio 44130 

Main: 440.202.4200 • Referral: 440.202.4300 

Regency Hospital of Ravenna 

6847 North Chestnut Street • Ravenna, Ohio 44266 

Main: 330.296.2350 • Referral: 330.615.3800

special section: cardiovascular disease 

Percutaneous Repair of 

Atrial Septal Abnormalities 

By Jaikirshan J. Khatri, MD 

Catheter-based techniques provide a 

safe, efficacious method to treat many 

patients with an atrial septal defect (ASD) 

or patent foramen ovale (PFO). These 

minimally invasive procedures can be 

performed on an outpatient basis and 

avoid much of the potential morbidity 

associated with surgical repair. Several 

devices are available for the percutaneous 

repair of ASDs and PFOs. In this review, 

I will discuss the embryological origin of 

these defects, their clinical manifestations, 

and indications for treatment. 

ORIGIN OF PFO AND 

ASD DEFECTS 

The interatrial septum is composed 

of the septum primum and septum 

secundum. These septa interact in a 

complex sequence through development 

to accommodate fetal circulation. The 

septum primum arises from the superior 

portion of the common fetal atrium 

and grows caudally to the endocardial 

cushions located between the atria and 

ventricles to close the orifice (ostium 

primum) between the atria. A second 

orifice (ostium secundum) develops in the 

septum primum. This orifice is covered 

by the septum secundum, which arises 

on the right atrial side of the septum 

primum. The septum secundum grows 

caudally and covers the ostium secundum. 

However, the septum secundum 

does not completely divide the atria, but 

leaves an oval orifice called the foramen 

ovale, which is covered but not sealed on 

the left side by the septum primum. In 

approximately 70 percent of individuals, 

the primum and secundum septa fuse 

after birth, creating an intact interatrial 

septum. However, in a significant portion 

of the population, the septa do not 

fuse. If the foramen ovale is completely 

covered but not sealed, it is designated 

a PFO, indicating that the foramen can 

be opened by a reversal of the interatrial 

pressure gradient or by an intracardiac 

catheter. Less commonly, poor growth 

of the secundum septum, or excessive 

absorption of the primum septum, results 

in an open communication classified as a 

secundum-type ASD. Secundum ASDs 

account for 70 percent of all ASDs and 

are the only type that can be repaired 

percutaneously. 

CLINICAL MANIFESTATIONS 

ASDs are often asymptomatic until 

adulthood. Continuous flow of oxygenated 

blood from the left to the right 

atrium across the defect occurs because 

left atrial pressure is slightly higher 

than right atrial pressure. Although the 

natural history is variable, this rightsided 

volume overload is usually well 

tolerated for years. Easy fatigability and 

declining exercise tolerance are common 

presenting symptoms. Potential 

complications of an untreated ASD with 

significant right-sided volume overload 

include right ventricular failure, atrial 

arrhythmias, paradoxical embolization, 

and pulmonary hypertension that can 

become irreversible and lead to right-toleft 

shunting (Eisenmenger’s syndrome). 

The goal of surgical or percutaneous 

repair is to treat the symptoms as well as 

avoid the long-term sequelae in patients 

who may be asymptomatic. There is no 

effective medical treatment for a hemodynamically 

significant ASD. 

See Page 22 



Healthy Lifestyle: Preventing 

Heart Disease in Women 

By Karen Kutoloski, DO, FACC 

Heart disease is America’s No. 1 killer. 

After decades of decline, deaths due to 

heart disease appear to have leveled off 

among older Americans and young men. 

However, according to a recent study 

published in the November 27 issue of the 

Journal of the American College of Cardiology 

(JACC), deaths due to heart disease may be 

trending upward in young women. 

Dr. Earl S. Ford, from the Centers for 

Disease Control and Prevention (CDC), 

Atlanta, and Dr. Simon Capewell, of the 

University of Liverpool, U.K., analyzed 

U.S. vital statistics data between 1980 

and 2002 for people aged 35 and older. 

The study found that the death rate from 

heart disease fell by 52 percent in men and 

49 percent in women. 

Among men, the death rate from heart 

disease declined by 2.9 percent per year 

during the 1980s, 2.6 percent per year 

during the 1990s, and 4.4 percent per year 

from 2000 to 2002. Among women, the 

death rate fell by 2.6 percent, 2.4 percent, 

and 4.4 percent, respectively. The average 

annual rate of death from heart disease in 

men aged 35 to 54 fell by 6.2 percent in 

the 1980s, by 2.3 percent in the 1990s, 

and leveled off with an annual decline of 

just 0.5 percent between 2000 and 2002. 

However, among women aged 35 to 54, 

the average annual rate of death from heart 

disease fell by 5.4 percent in the 1980s and 

by 1.2 percent in the 1990s — and then 

increased by 1.5 percent between 2000 

and 2002. In even younger women, aged 

35 to 44, the rate of death from heart 

disease has been increasing by an average 

of 1.3 percent annually between 1997 

and 2002. 

This is likely due to poor health habits 

and the growing number of young 

Americans who are overweight or obese, 

which increases their risk of developing 

other cardiovascular risk factors. Heart 

disease has not gone away and could become 

a greater problem if Americans fail 

to pay attention to known cardiovascular 

risk factors. It is especially important that 

young women learn to develop appropriate 

behaviors that minimize their risk for heart 

disease later in life. 

Preventing heart disease in a woman 

requires assessing her lifetime risk. The 

lifetime risk of dying from cardiovascular 

disease is one in 2.6 for U.S. females, 

which highlights the need for women 

and their healthcare providers to adopt a 

healthy lifestyle and treat any risk factors 

that may be present. 

Lifestyle recommendations include 

urging women to seek a healthy weight, 

increase their physical activity, drink 

alcohol in moderation, eat less salt 

and sodium-containing products, and 

include fresh fruits, vegetables and 

low-fat dairy products in their diets. 

Women should stop smoking and seek 

counseling, or nicotine replacement to 

achieve that goal. Women who need to 

lose weight or to maintain a weight loss 

should exercise an hour to 90 minutes 

a day. Saturated fats should make up no 

more than 7 percent of calories each 

day. They recommend eating oily fish 

such as salmon twice a week. Women 

with heart disease or high triglycerides 

should consider taking a supplement of 

EPA (eicosapentaenoic acid) and DHA 

(docosahexanoic acid). Drug therapies 

include recommendations of various 

antihypertensive and lipid lowering 

medications, diabetes management, and 

use of aspirin. 

The guidelines recommend against 

taking hormone replacement therapy or 

selective estrogen receptor modulators 

to prevent heart disease. Antioxidants 

such as vitamin E, C and beta-carotene 

have not been shown to prevent heart 

disease and should not be used as preventive 

agents. 

Low-dose aspirin could be useful in 

women 65 years or older for prevention 

of stroke in situations where the benefits 

outweigh the risks. Women at high risk 

for heart disease can take as much as 325 

mg per day, rather than the 162 mg/day 

previously recommended. However, 

women less than 65 years of age and 

who are healthy should not use aspirin 

to prevent a heart attack. Women at high 

risk who have heart disease should try 

to reduce their low-density lipoprotein 

cholesterol levels below 70 mg/dL. 

After decades of hard won progress in 

reducing cardiovascular deaths, it is worrisome 

that the rate of death from heart 

disease has been increasing in younger 

women. The risk is real, and women of 

any age should seek ways to reduce the 

risk that they will develop cardiovascular 

disease during their lives. As healthcare 

providers, we should be aware to suspect 

heart disease in even young women and 

take the necessary steps to prevent the 

disease by helping our patients adopt a 

healthy lifestyle and treat any risk factors 

that may be present. 

Dr. Karen Kutoloski is director of Cardiac 

Rehabilitation at MetroHealth Medical 

Center’s Heart and Vascular Center. She also 

pioneered and now serves as director of the 

Women’s Heart Center which was established 

in 2004. She is an assistant professor at Case 

Western Reserve University. ■ 


hospital spotlight 

St. John West Shore Hospital Chest Pain Center 

Saving Time, Saving Lives 

Acute Myocardial Infarction (AMI) is the single leading cause 

of death in America, accounting for one in five deaths in 2003, according 

to statistics from the American Heart Association. Ongoing 

advancements in the treatment of AMI result in reduced mortality 

and morbidity, but successful treatments are time dependent and 

necessitate rapid initiation. For good outcome, the patient must 

quickly recognize the signs and symptoms of an AMI and seek 

medical care, and the physician must quickly diagnose the AMI and 

initiate treatment. 

In 2004, St. John West Shore Hospital introduced to Cuyahoga 

County the concept of a chest pain center as a strategy to significantly 

reduce heart attack deaths through the rapid treatment of 

patients with AMI. Two years later, in June 2006, The Society 

of Chest Pain Centers accredited St. John West Shore Hospital’s 

With the information obtained by real-time 12-lead EKGs and 

transmitted to the Hospital ahead of the patient’s arrival, the Hospital 

has reduced its average door-to-balloon time to less than 72 minutes. 

In one instance, the D2B time was only 13 minutes! 

Chest Pain Center. 

“When it comes to AMI, anyone 

in the medical profession will tell 

you that time is muscle,” said Atul 

Hulyalkar, MD, medical director of 

Non-Invasive Cardiology at St. John 

West Shore Hospital. “Even five 

minutes can make a difference as to 

how well a patient may recover.” 

The Society promotes protocolbased 

medicine to address rapid 

diagnosis and treatment of acute 

coronary syndromes and heart 

failure, and to promote the adoption 

of process improvement science by 

healthcare providers. St. John West 

Atul Hulyalkar, MD, medical 

director of Non-Invasive 

Cardiology at St. John West 

Shore Hospital 

Shore Hospital’s Chest Pain Center is one of only 400 hospitals 

nationwide to be accredited by the Society. 

To earn accreditation status, the Hospital underwent an on-site 

evaluation by a Society review team. Their findings showed the 

Hospital demonstrated expertise in the following eight areas: 

EmergencyDepartmentIntegrationwiththeEmergency 

Medical System. A formal relationship between the ED and the 

local EMS links the care processes for patients with symptoms of 

possible Acute Coronary Syndrome (ACS). 

Emergency Assessment of Patients with Symptoms of 

ACS / Timely Diagnosis and Treatment of ACS. An ED program 

minimizes delays in institution of therapy for an ACS (nitrates, 

heparin, aspirin, percutaneous intervention, thrombolytics, etc.). 

Patients with Low Risk for ACS and No Assignable Cause 

for their Symptoms. An ED or hospital observation program 

monitors and evaluates low-risk patients to avoid the inadvertent 

release home of patients with ACS or unstable angina. 

Functional Facility Design. The ED CPU has a functional 

design for chest pain evaluation to accomplish optimal patient care. 

It includes appropriate cardiovascular monitoring equipment. 

Personnel, Competencies, and Training. Physicians and 

nursing staff in contact with patients with symptoms of ACS have 

certain core competencies and training. Leadership and management 

may require additional core competencies and training. 

Process Improvement Orientation. CPU management 

structure is based on continuous quality improvement program 

principles to ensure quality patient care and proper utilization of 

ED resources. 

Organizational Structure and Commitment.The facility’s 

administration, medical staff, and multidisciplinary committee must 

make a commitment to the establishment and support of a Chest 

Pain Center. 


Community Outreach Program. An ED- or hospital-based 

community outreach program educates the public to promptly seek 

medical care if they have symptoms of an AMI and risk factors for 

coronary artery disease, particularly smoking. 

Most heart attacks present identifiable symptoms, such as chest 

pain or discomfort, shortness of breath, diaphoresis, and syncope. 

However, patients often do not feel that their symptoms are significant 

enough to seek professional help. By waiting, they unfortunately put 

themselves at much greater risk of injury or death. 

“The American College of Cardiology and The American Heart 

Association guidelines suggest best standard for restoring blood to 

the heart is 90 minutes door-to-therapy or door-to-balloon (D2B),” 

said Dr. Hulyalkar. “So, it’s really important that someone with 

symptoms of AMI sees a physician right away.” 

To further help in this regard, St. John West Shore Hospital spearheaded 

the purchase and installation of 12-lead EKG technology in 

local Emergency Medical Services vehicles serving communities on 

the west side of Cleveland and eastern Lorain County. This equipment 

enables the transmission of real-time data from the field to a receiving 

station in the Hospital’s Emergency Department to expedite diagnosis 

and treatment of cardiac emergencies. In fact, with the information 

obtained by real-time 12-lead EKG’s and transmitted to the Hospital 

ahead of the patient’s arrival, the Hospital has reduced its average 

door-to-balloon time to less than 72 minutes. In one instance, the 

D2B time was only 13 minutes! 

“A North Ridgeville man was experiencing chest pain and called 

9-1-1. The paramedics responding to the call, transmitted real-time 

12-lead EKG data from the ambulance to the St. John West Shore 

Hospital’s Emergency Department where AMI was diagnosed,” said 

Dr. Hulyalkar. “Before the patient arrived, the Chest Pain Center 

team was activated and the cath lab was prepared for the patient. As a 

result, we were able to successfully treat him for a 100 percent blockage 

of the Left Anterior Descending Artery within 13 minutes of his 

arrival. This helped saved his life and his quality of life, as well.” 

In an effort to do the same for patients experiencing stroke symptoms, 

St. John West Shore Hospital obtained accreditation from 

The Joint Commission as a Primary Stroke Center in 2007. The 

accreditation verifies that the Hospital follows national standards 

established by the American Stroke Association and has achieved 

superior patient outcomes in the area of stroke treatment. 

“As with AMI, time is critical in the case of a stroke, and the entire 

emergency staff is specially trained to diagnose and react quickly to 

both,” said Dr. Hulyalkar. “We’re continually measuring our care 

processes and making plans to improve them and lower our doorto-treatment 

times.” 

For more information about St. John West Shore Hospital’s 

Chest Pain Center, call Linda Owen, RN, clinical 

manager, CCU, at 440-827-5503. 

St. John West Shore Hospital spearheaded the purchase and installation of 12-lead EKG technology in local Emergency Medical Services vehicles 

serving communities on the west side of Cleveland and eastern Lorain County. This equipment enables the transmission of real-time data from the 

field to a receiving station in the Hospital’s Emergency Department to expedite diagnosis and treatment of cardiac emergencies. 



Doctors Report Rare Heart 

Attacks in Adolescents 

By John Lane, MD, and Giora Ben-Shachar, MD 

Chest pain in otherwise healthy children 

and adolescents is a frequent cause 

for emergency room visits. In the vast 

majority of these patients, the cause of 

this pain is non-cardiac in origin – often 

a result of muscle strains or stress. 

However, based on our study of nine 

pediatric patients over an 11-year period, 

it seems wise to take these complaints 

seriously. While it is uncommon, myocardial 

infarction can occur in adolescents 

with normal coronary arterial anatomy. 

Emergency medicine physicians assessing 

children and adolescents with acute chest 

pain should not assume the pain is noncardiac 

in nature just because they are, 

in fact, pediatric patients. Such patients 

need a protocol work-up and, even hospital 

admission, if myocardial enzymes are 

abnormal. Further work-up, dysrhythmia 

monitoring, possible coronary angiography 

and treatment would then also 

be warranted. 

We examined the clinical history, 

electrocardiographic (ECG) tracing, 

echocardiography, and cardiac enzymes of 

nine patients presenting in the emergency 

department of Akron Children’s Hospital 

or Rainbow Babies and Children’s Hospital 

in Cleveland between June 1995 and May 

2006. The patients reported acute chest 

pain, especially a crushing-type pain that 

radiates to the arm or jaw or neck, similar 

to the symptoms of adults experiencing 

heart attacks. 

Patients in whom findings were suggestive 

of acute myocardial infarction, 

in addition, underwent drug screening, 

serum lipid profile, and hypercoagulability 

work-up. Where myocardial infarction 

was definitely diagnosed, the patients 

underwent heart catheterization with 

coronary angiography. All of these 

patients lacked common risk factors for 

heart problems, such as high blood pressure, 

unhealthy cholesterol levels, and 

drug abuse. 

All nine patients (eight of them male), 

between the ages of 12 and 20 years 

(mean age of 15.5 years), met established 

criteria for myocardial infarction. 

Eight had abnormal ECG findings. 

All nine patients had abnormal cardiac 

enzymes. Three presented with 

echocardiographic abnormalities. 

Four patients had cardiac dysrhythmias, 

three with nonsustained ventricular 

tachycardia. Drug abuse, lipid profiles 

and hypercoagulability (done on the last 

seven patients) studies were negative 

in all. Five patients had left ventricular 

focal hypokinesia, as seen by echo 

or angiography. None had abnormal 

coronary anatomy. 

Cardiac function normalized in eight 

patients. One patient had a persistent focal 

inferior hypokinetic wall segment. 

Acute treatment for all patients included 

Nitroglycerin and aspirin or intravenous 

Heparin. Thrombolytic therapy was not 

administered in any patient. Diltiazem 

was started post infarction and continued 

post-discharge. 

Cardiac catheterization with coronary 

angiography was performed in all patients 

to assess for congenital heart disease, myocardial 

wall motion abnormality, and to 

define coronary arterial anatomy. Patients 

were assessed post-hospitalization by 

clinical history, ECG, echocardiography 

and exercise stress testing. 

Calcium channel blocker therapy was 

initiated in all patients with no recurrence 

of anginal chest pain on follow-up. One 

patient complained of chest pain distinct 

from anginal pain on follow-up. 

The patients in the study did not have 

any permanent, long-term injury in 

heart function. The necessary duration 

of therapy with calcium channel blockers 

is unknown. 

The etiology of infarction in the patients 

in the study is presumed due to coronary 

spasm given the lack of fixed anatomic 

stenosis or occlusion. The spasm was apparently 

of sufficient duration to result 

in myocardial necrosis and enzyme leak. 

The vasoactive nature of their ischemia 

was also suggested by effective response 

to Nitroglycerin. 

Ruling out myocard ial i n farction 

cannot solely depend on the 

absence of typical electrocardiographic 

changes. Obtaining cardiac 

enzymes is critical to exclude myocardial 

infarction when chest pain suggests 

myocardial ischemia. 

No precipitating event could be identified 

as a cause for coronary spasm and it 

is unclear, at this time, which adolescents 

are at risk. One patient in the study had 

been treated with Ritalin, but it was not 

deemed to have played a causative role. 

The implication of acute myocardial 

infarction in otherwise healthy adolescents 

for future cardiac events, activities 

and lifestyle, as well as for long-term 

management, is, as of yet, unknown. It, 

therefore, makes it important to identify 

and establish long-term follow-up into 

the adult years. 

Drs. John Lane and Giora Ben-Shachar are 

pediatric cardiologists in Akron Children’s 

Hospital’s Heart Center. In addition, Dr. 

Lane is director of Akron Children’s Adult 

Congenital Heart Service. Their study, entitled, 

“Myocardial Infarction in Healthy 

Adolescents” was published in the October 2007 

issue of Pediatrics. ■ 



Failure of HDL-Raising Drug Reported 

Cleveland Clinic researchers reported 

in November that the drug torcetrapib 

produced regression of coronary atherosclerosis 

in patients who achieved the greatest 

increases in high-density lipoprotein (HDL) 

or “good” cholesterol. These findings suggest 

that the HDL particles are fully functional 

during treatment with torcetrapib, and the 

lack of efficacy likely reflects a compoundspecific 

toxicity, which is also responsible for 

the increase in blood pressure. 

The ILLUSTRATE study provided strong 

evidence that raising HDL predicts the 

drug’s benefit and indicates that additional 

clinical study of other experimental drugs 

in this class is necessary. The development 

of drugs to raise HDL has been a key research 

priority because, despite lowering 

LDL (low-density lipoprotein, or “bad” 

cholesterol) with statin drugs, many patients 

continue to experience heart attacks, stroke 

or sudden cardiac death. 

A total of 1,188 coronary artery disease 

patients were enrolled in the ILLUSTRATE 

trial, which initially determined that torcetrapib 

markedly increased good cholesterol 

levels, but also substantially raised blood 

pressure and failed to significantly slow the 

buildup of plaque. The initial trial manuscript 

was published in the New England Journal of 

Medicine in March. 

ILLUSTRATE used the intravascular ultrasound 

(IVUS) technology to determine 

the findings. IVUS is a technique in which 

a tiny ultrasound probe is inserted into the 

coronary arteries, providing a precise and 

reproducible method for determining the 

change in plaque, or atheroma, burden during 

treatment. 

POSTOPERATIVE STATIN 

TREATMENT LOWERS STROKE 

INCIDENCE 

Cleveland Clinic researchers have 

discovered that patients undergoing coronary 

artery bypass grafting (CABG) can 

reduce their risk of postoperative stroke 

by taking statin therapy to reduce their 

levels of LDL (low-density lipoprotein) 

or “bad” cholesterol. 

Postoperative stroke remains a catastrophic 

and costly complication of 

CABG. Prior research has demonstrated 

a significant reduction in the rate of stroke 

associated with statin use in the non-operative 

setting. 

The Cleveland Clinic cardio-thoracic 

surgery database was used to identify 

5,205 consecutive patients who underwent 

first time, isolated CABG from 1993 to 

2005. Patients with a prior history of atrial 

fibrillation, known clotting disorders, or requirement 

for anticoagulation were excluded 

from the analysis. Discharge medications, including 

statins, were prospectively collected. 

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Patients were divided into groups based upon 

serum LDL-C. 

The overall incidence of postoperative 

stroke at one year was 3.3% (181 events). 

Patients discharged on statin therapy 

were more likely to have a lower LDL-C 

and were significantly less likely to suffer 

a post operative stroke at one year. 

Multivariate logistic regression identified 

age (HR 1.05 [1.024, 1.075]; p

Continued from Page 16 

INDICATIONS FOR 

TREATMENT 

The clinical importance of a PFO lies in 

its association with paradoxical embolism 

and cryptogenic stroke. Approximately 

30 to 40 percent of ischemic strokes have 

no clear etiology and are termed cryptogenic. 

Paradoxical embolization occurs 

when an embolus arising in the systemic 

venous system or the right atrium crosses 

the PFO during right-to-left shunting and 

enters the systemic arterial circulation. 

There is a much higher prevalence of PFO 

in patients with cryptogenic stroke, particularly 

those under age 55. It has been 

estimated that approximately 40 percent 

of ischemic strokes in this age group are 

cryptogenic. Although controversial, there 

is also evidence to suggest that migraine 

and vascular headache may be associated 

with PFO and right-to-left cardiac shunting. 

Therapeutic options for secondary 


Catheter-based techniques provide a safe, efficacious 

method to treat many patients with an atrial septal 

defect (ASD) or patent foramen ovale (PFO). These 

minimally invasive procedures can be performed on 

an outpatient basis and avoid much of the potential 

morbidity associated with surgical repair. 

prevention of stroke in patients with an 

atrial septal abnormality, including patent 

foramen ovale (PFO), atrial septal defect 

(ASD), and atrial septal aneurysm (ASA), 

are medical therapy with anti-platelet 

agents or anticoagulation, and surgical or 

percutaneous closure of the defect. 

The decision to repair an ASD or PFO 

requires careful consideration of many 

clinical parameters. The availability of 

several percutaneous devices for the repair 

of these congenital abnormalities has 

greatly expanded the therapeutic options 

available to clinicians. In general, these 

devices can be deployed on an outpatient 

basis via several transvenous insertion sites. 

Anti-platelet therapy and bacterial endocarditis 

prophylaxis is recommended for six 

months post-implantation. Success rates are 

comparable to surgical repair without the 

associated morbidity. 

Dr. Jaikirshan J. Khatri is a member of the 

medical staff of Southwest General Health 

Center. He is board certified in Internal Medicine 

and Cardiology and performs percutaneous repair 

of atrial septal abnormalities in the cardiac catheterization 

lab at Southwest General. ■ 


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NIH Awards $64 Million to 

Cleveland Medical Consortium 

The National Institutes of Health 

(NIH) announced in September the 

awarding of $ 6 4 million to Case 

Western Reserve University, in partnership 

with the Cleveland Clinic, 

University Hospitals and MetroHealth 

Medical Center, to become part of 

a national consortium designed to 

transform how clinical and translational 

research is conducted, ultimately 

enabling researchers to provide new 

treatments more efficiently and quickly 

to patients. 

The consortium, funded through 

NIH’s Clinical and Translational Science 

Awards (CTSA), was formed in 2006 

with an initial 12 academic health centers 

located nationwide. 

The ultimate goal of the CTSA in 

Cleveland is to provide full service and 

integrated clinical translational research 

capability within the Cleveland community 

that will improve the health of 

patients in Northeast Ohio through patient-based 

research. 

The CTSA will be awarded to Case 

Western Reserve University and three 

of its hospital affiliates, the Cleveland 

Clinic, MetroHealth Medical Center, 

and University Hospitals Case Medical 

Center, including three existing GCRC 

facilities, a successful multidisciplinary 

institutional K12 program, substantial 

technological and statistical core facilities 

that currently exist in silos, and the institutions’ 

famous practice-based research 

networks. 

In addition, the partners will create 

new resources, including community 

partnership resources, a new coordinated 

bioinformatics infrastructure, a new 

MD/Ph.D program in clinical research, 

and coordinated resources in bioethics 

and regulatory support. An academic 

home for clinical research, the Center 

for Clinical Investigation, will provide 

career development support for clinical 

investigators. 

Cleveland Clinic, University Hospitals 

and MetroHealth Medical Center provide 

90 percent of the medical care 

delivered in the seven-county area of 

Northeast Ohio, offering a wealth of 

clinical research opportunities. In addition, 

excellent programs based within the 

Frances Payne Bolton School of Nursing, 

School of Dental Medicine and the Case 

School of Engineering, as well as those 

in the School of Medicine and its hospital 

partners reach into the community at 

many sites, some of which will become 

study sites in the CTSA. 

The CTSA initiative grew out of the 

NIH commitment to re-engineer the 

clinical research enterprise, one of the 

key objectives of the NIH Roadmap 

for Medical Research. Funding for the 

CTSA comes from redirecting existing 

clinical and translational programs, 

including Roadmap funds. When fully 

implemented in 2012, the initiative is 

expected to provide more than $570 

million over five years to 60 academic 

health centers. ■ 


Ireland Cancer Center Researchers 

Advance Stem Cell Gene Therapy 

Ireland Cancer Center of University 

Hospitals Case Medical Center researchers 

have recently made great strides in 

stem cell gene therapy research by transferring 

a new gene to cancer patients, via 

their own stem cells, with the ultimate 

goal of being able to use stronger chemotherapy 

treatment with less severe side 

effects. Under this protocol, MGMT, 

a drug-resistance gene, is added into 

purified hematopoietic stem cells to 

protect these cells from the damage of 

chemotherapy regimens. 

In one of 24 presentations by Ireland 

Cancer Center researchers at the annual 

American Society of Hematology 

meeting, Stanton Gerson, MD, and 

colleagues presented that eight patients 

were enrolled on the trial and six were 

infused with their own stem cells 

which were engineered to carry the 

MGMT gene. In three patients, stem 

cells carrying the gene were identified 

in their blood or bone marrow. In one 

patient, stem cells carrying the gene 

were detected up to 28 weeks after their 

administration. This significant finding 

has never been reported before with this 

gene and drug combination. 

“This study is the first to show the success 

of treatment with evidence that stem 

cells now carry the new gene,” said Dr. 

Gerson, director of the Ireland Cancer 

Center and Case Comprehensive Cancer 

Center, who spearheaded the Phase I 

study along with a team of researchers. 

“These patients show the success of 

treatment with evidence that their stem 

cells now carry the new genes. This is a 

breakthrough—the first time selection 

with MGMT has been shown to occur 

in patients.” 

Preclinical animal research, conducted 

by Dr. Gerson and his colleagues, has 

shown that the gene G156A-MGMT can 

provide stem cells with very high levels 

of drug resistance, compared to normal 

stem cells not carrying the gene. In the 

Phase I trial for patients with advanced 

malignancies, researchers collected peripheral 

blood stem cells from patients 

and exposed them to a retrovirus containing 

the G156A-MGMT gene. 

In addition to this promising research, 

Ireland Cancer Center scientists presented 

24 oral and poster presentations 

at ASH. These included 

• Dr. Hillard Lazarus and colleagues 

presented significant findings that 

treatment with Rituximab before 

transplantation results in cure rate and 

overall survival in patients undergoing 

autologous stem cell transplantation 

for Diffuse Large B-Cell lymphoma. 

Dr. Lazarus and colleagues of the 

Eastern Cooperative Oncology Group 

(ECOG) presented data that show 

that Imatninib (Gleevec) does not 

change outcomes on patients with 

Philadelphia Chromosome Positive 

Acute Lymphoblastic Leukemia. Dr. 

Lazarus presented an assessment of 

data over 30 years regarding acute 

leukemia and its management. He 

found that all avenues lead to stem cell 

transplantations. His team provided 

this assessment of a whole host of entities 

that provide leukemia care. 

• Dr. Jonathan Kenyon and colleagues 

found that normal individuals 

over age 50 begin to show evidence 

that genetic mutations are accumulating 

in marrow stem cells. This finding 

might be the key underlying the 

increased risk of anemias, myelodysplastic 

syndrome and acute leukemia 

in older individuals. 

• Dr. Kevin Bunting’s laboratory gave 

two important presentations on how 

intracellular STAT5 (an intracellular 

signaling protein) influences normal 

pathologic hematopoiesis (blood cell 

formation) and stem cell engraftment. 

• Dr. Shigemi Matsuyama and colleagues 

presented a novel way of 

treating chemotherapy-induced thrombocytopenia 

(decrease in number 

of platelets in the blood) using Bax 

Inhibiting Peptides to rescue the damaged 

cells. 

• Dr. Keith McCrae and colleagues 

presented that ß2 glycoprotein is a 

cofactor in the process that dissolves 

blood clots through the use of the 

medical agent tPA. ■ 


the sommelier 

Some Like It Hot 

By Natalie MacLean 

I enjoy skiing, sledding and skating best 

from my kitchen window. From here, 

warm and dry, I can watch my more active 

friends and family participating in those 

chilly activities. When they come in to 

sit by the fire, I offer them hot toddies, 

mulled wine and hot buttered rum cider. 

These winter warmers are what make my 

cheeks rosy and they also infuse the whole 

house with the heady aromas of steaming 

spices. They make me embrace the great 

indoors as I pour the top-ups into a thermos 

for the hardiest souls to take outside 

with them again. 

HOT TODDY 

The word “toddy,” from the Hindu 

tári tádi, originally meant a drink of fermented 

sap or coconut milk. The British 

picked up the idea in the 19th century, 

though their toddies, usually made from 

scotch, were more often consumed for 

medicinal purposes. Today we usually use 

dark spirits as a base, such as rum, scotch, 

Irish or Canadian whiskey or bourbon, as 

the base for this classic and simplest hot 

cocktail. For a modern twist, use hard 

cider or apple brandy for a lovely baked 

apple pie flavor. 

In a heat-proof bowl, mix 4 tablespoons 

of sugar with a few dashes of cloves and 

cinnamon in 16 ounces of boiling water. 

Then add 8 ounces of your preferred dark 

spirit. Pour into four coffee mugs and add 

a splash of lemon juice if desired. Stir 

with a cinnamon stick, which you can 

leave in for decoration and flavor. Grate 

fresh nutmeg over the top if you like. 

For an extra kick, use spicy tea instead 

of hot water. In fact, if you’re looking 

for some inventive updates on the traditional 

toddy, check out DiscCookery 

These winter warmers are what make my cheeks rosy 

and they also infuse the whole house with the heady 

aromas of steaming spices. 

(Whitecap, $18), by CBC radio host 

Jurgen Goethe. 

MULLED WINE 

This Dickensian classic was created 

before vintners learned how to preserve 

wine with corks and sulfites. Back in 

Victorian times, wine was kept in oak barrels 

until consumed, and it often spoiled. 

So wine merchants created “mulled 

wine,” masking the bad odors with spices 

and liqueurs. Mulled means heated, not 

boiled, which is important to keep in 

mind as you make this cocktail. 

To make mulled wine for four, choose 

a full-bodied red wine, such as an 

Australian shiraz or a Chilean cabernet. 

The wine needn’t be expensive, but don’t 

use anything you wouldn’t drink by itself 

as cooking it concentrates flavors for good 

or bad. Heat the contents of a 750-ml 

bottle in a large, nonreactive saucepan. 

Keep in mind that “mulled” means just 

warmed, not boiled. Simmer gently, stirring 

occasionally, for about 10 minutes. 

Then add 3 to 4 ounces of either port or 

orange liqueur, two whole cloves, a tablespoon 

of sugar and a dash of cinnamon. 

Simmer for another five minutes. Pour 

through a sieve to strain the solids from 

the liquid. Pour into heat-proof mugs or 

glasses. Stir with a stick of cinnamon and 

garnish with orange slices. 

HOT BUTTER RUM CIDER 

This ought to be the Canadian national 

drink given all the rum we ran to the 

United States during Prohibition, as well 

as our heritage in making first-class cider. 

To make hot buttered rum cider for four, 

heat four cups of cider in a small saucepan 

over low heat, along with two cinnamon 

sticks, 2 tablespoons of honey and 1 

tablespoon of lemon juice. Simmer uncovered, 

stirring occasionally, for about 

10 minutes. Strain the mixture to remove 

the solids. Next, combine 4 teaspoons of 

butter with 4 tablespoons of brown sugar 

and add it the cider and hot water. This 

prevents the butter from floating on top of 

the liquid like an oil slick. Pour the cider 

mixture into four heat-resistant mugs and 

then top up with a quarter cup of rum. For 

extra decadence, add a dollop of whipped 

cream on top. Not only is this festive, but 

it is symbolically hopeful: Beneath the 

snowcaps of winter lies the promise of 

summer warmth. 

All these hot drinks warm the parts of 

us that other drinks just don’t reach. As 

we sit by the fire with our feet up, our 

hands wrapped around the toasty mug, 

letting the steam brush our cheeks and 

the spices tickle our noses, we feel that 

we’ve been warmed from the inside out. 

Natalie MacLean is the author of Red, 

White and Drunk All Over: A Wine- 

Soaked Journey from Grape to Glass. 

She was named the World’s Best Drink 

Writer for the articles and wine picks 

in her free wine newsletter available at 

www.nataliemaclean.com. ■ 


What’s New at Area Hospitals 

hospital rounds 

Cleveland Clinic Children’s Hospital 

unveiled its new Ronald McDonald Family 

Room on the third floor of the Hospital. 

Cleveland Clinic funded the remodeling and 

refurnishing of the room to support the families 

of patients who are receiving treatment at 

the Children’s Hospital. The room includes a 

kitchen, two computers with Internet access, 

a television area, a play area for the siblings 

of patients, showers and a laundry facility. It 

is operated by the Ronald McDonald House 

and staffed by volunteers from 9 a.m. to 9 

p.m. seven days a week. 

The mission of the Ronald McDonald 

House of Cleveland is to support families 

whose children are receiving treatment at 

area medical centers by providing a homelike 

environment and essential resources 

and services. The Ronald McDonald Family 

Room program was developed to provide 

these services within the hospital. 

MetroHealth is the first hospital in the 

world to have a 264-slice CT scanner on 

site. The Philips Brilliance iCT scanner has 

four-times the resolution of the current “top 

of the line” scanners, which are 64-slice. 

Installation of the new scanner began at 

MetroHealth on October 8; it was first used 

with patients on November 5. 

The resolution of the 264-slice CT scanner 

is higher, allowing anatomy and blood vessels 

to be seen much more clearly, so danger areas 

and disease can be detected both faster and 

earlier in the disease process. The scanner’s 

detector is also larger—twice the size of those 

in 64-slice scanners. This means larger areas 

can be scanned in less time. For example, the 

entire heart can be imaged in two heartbeats, 

and the entire brain and its blood flow can be 

imaged in one to two rotations. 

The Home Health Care Department of 

Parma Community General Hospital 

has been named to the HomeCare Elite, 

a select list of the top-performing home 

health agencies in the United States. Included 

are the Medicare-certified agencies which 

ranked among the top 25% of providers 

nationwide in quality, improvement and 

financial performance. The top 25% covers 

approximately 1,800 agencies nationwide. 

Parma Hospital’s Home Health Care placed 

among the Top 500 providers. 

Publicly available data from thousands of 

home care agencies nationwide was reviewed 

to select the HomeCare Elite. The list is prepared 

by OCS, Inc., the leading provider of 

healthcare informatics and DecisionHealth, 

publisher of the independent newsletter 

Home Health Line. 

Rainbow Babies & Children’s 

Hospital’s Division of Pediatric Orthopaedics 

is studying a groundbreaking blood conservation 

program that uses epsilon aminocaproic 

acid (Amicar) to reduce the amount of blood 

loss during spine surgery. Amicar is an 

antifibrinolytic agent that has been successfully 

utilized in pediatric cardiac surgery. 

It decreases clots from dissolving, thereby 

decreasing bleeding during surgery. This 

translates into substantial reductions in autologous 

blood donations and blood transfusions, 

as well as lower costs and complications. 

Conserving blood also helps maintain hemodynamic 

equilibrium and contributes to an 

unobstructed view of the surgical field. 

With the exception of those who are 

hypersensitive or at risk for thrombosis, all 

pediatric orthopaedic spine fusion patients 

at Rainbow receive Amicar pre- and perioperatively. 

As a result, only one in three 

patients requires any donated blood at the 

time of surgery. 

St. John West Shore Hospital has become 

the area’s newest Primary Stroke Center 

in Northeast Ohio, having received official 

certification from The Joint Commission. 

The accreditation came after a recent on-site 

review by Joint Commission representatives 

confirmed that St. John West Shore Hospital 

follows the national standards set by the 

American Stroke Association and has achieved 

superior patient outcomes in the area of stroke 

treatment. The Joint Commission launched 

the national accreditation program in 2003 

as a means of designating those hospitals that 

follow national standards and guidelines that 

can significantly improve the outcomes for 

stroke patients. 

In addition to having a certified Stroke 

Center, St. John West Shore Hospital also has 

an accredited Chest Pain Center and is in the 

process of pursuing Level III accreditation for 

its Trauma Center. 

St. Vincent Charity Hospital’s Center 

for Vascular Health is looking for participants 

for a six-month clinical research study. Inhale, 

a liquid-inhaled insulin, is in its third phase 

of study for FDA approval for the treatment 

of type 2 diabetes. The product was created 

by Novo Nordisk, the world’s largest supplier 

of diabetes care products. 

Participants for this voluntary study must 

have a diagnosis of type 2 diabetes, be at least 

18 years of age and currently taking two or 

more oral medications for two months or 

more for the treatment of type 2 diabetes. 

They must not currently be taking or never 

have taken insulin and have been a non-smoker 

for at least six months. Participants in 

this study will receive all study-related care, 

medications, supplies, strips and laboratory 

work provided to them at no cost. 

Southwest General Health Center 

ranked among the best Northeast Ohio hospitals 

in seven of 11 health conditions listed in 

the recent Employers Health Coalition of Ohio 

(EHC) in its Consumer Guide to Ohio Hospital 

Quality Version 4.0. The seven of 11 “above average” 

conditions for Southwest General were: 

carotid (neck) surgery, congestive heart failure 

(CHF), coronary artery bypass graft (CABG), 

hip replacement, knee replacement, pneumonia 

and colon surgery. Southwest General 

did not have any conditions considered in the 

“below average” category. 

EHC is an independent, non-profit employer-based 

organization committed to 

creating an environment for continuous 


hospital rounds 

improvement of quality in health care. By 

region, EHC analyzes 11 conditions using an 

“above average,” “average” and “below average” 

ranking system. The conditions EHC 

ranks are listed under the general headings of 

cardiac care, orthopedic surgery, pulmonary 

disease and general surgery. Mortality rates 

and major complications are used as indicators 

of performance. The data for Version 4.0 

was based on 2006 billing data sent to the 

Center for Medicare and Medicaid Services 

(CMS). For more information, visit www. 

ohiohospitalquality.com. 

Researchers at University Hospitals 

Case Medical Center’s Ireland Cancer 

Center are the first in the region to have 

joined a nationwide clinical trial to evaluate 

the effectiveness of a gene therapy in patients 

with advanced melanoma which is aimed to 

help a patient’s own immune system fight 

their cancer. The gene therapy is termed 

Allovectin-7, and is injected directly into the 

cancer while it is still in the body in order to 

make it appear foreign to the immune system. 

Previous studies using the gene therapy have 

shown that injection of a single site of cancer 

can train the immune system to fight other 

areas of the disease in the body which have 

not been injected with the gene. 

The current Allovectin-7 study is focused 

upon patients who have melanoma. 

Melanoma is among the fastest-growing 

cancer diagnoses. Although early detection 

results in many patients being cured by surgical 

removal of the melanoma, in a percentage 

of patients the disease will spread to other 

areas of skin or organs. The American Cancer 

Society estimated that in 2007 about 60,000 

new cases of melanoma were diagnosed in the 

United States and more than 8,000 patients 

died from melanoma, suggesting that new 

treatments such as gene therapies and vaccines 

are needed. 

Special thanks to the hospital public relations 

administrators who submitted information for this 

column. To include your hospital news in the next 

issue of Greater Cleveland M.D. News, add us 

to your press release list or e-mail information to 

jraabe@mdnews.com. The editorial deadline for 

the April-May issue is March 2nd. ■ 

Local Docs in National News 

DR. JEFFREY COHEN 

INDUCTED INTO NATIONAL MS 

SOCIETY’S HALL OF FAME 

Jeffrey Cohen, 

M D , w a s i n - 

ducted into the 

National Multiple 

Sclerosis Society’s 

Volunteer Hall of 

Fame for Health 

Professionals. He 

was recently honored 

at the Society’s National Conference at 

the Hyatt Regency Dallas in Dallas, Texas. 

Dr. Cohen was selected for his outstanding 

volunteer support of the National MS 

Society and for making a difference in the 

community. For nearly 20 years, Dr. Cohen 

has provided high quality care for people living 

with multiple sclerosis and has devoted 

considerable time to educating people with 

MS and their families so they will understand 

the impact of living with a chronic 

illness. He has also volunteered to speak at 

numerous National MS Society programs, 

newly diagnosed sessions and self-help group 

meetings. 

Dr. Cohen serves on the Ohio Buckeye 

Chapter’s Board of Trustees and Clinical 

Advisory Committee. Dr. Cohen has 

participated in the chapter’s “Pedal to the 

Point” Bike Ride for about 10 years. He 

cycles approximately 150 miles from Berea 

to Sandusky and back to help raise funds for 

local programs and research. 

Dr. Cohen is a staff physician at Cleveland 

Clinic’s Mellen Center for Multiple 

Sclerosis Treatment and Research, where 

he serves as the Director of the Clinical 

Neuroimmunology Fellowship. 

AHA NAMES DR. DAVID 

KAELBER’S STUDY A ‘TOP 

TEN’ FOR 2007 

David Kaelber, MD, PhD, has received a 

special recognition from the American Heart 

Association (AHA) for his study on hypertension 

in children, which was published in the 

August 22, 2007 

issue of the Journal 

of the American 

Medical Association 

( J A M A ) . D r. 

Kaelber’s study 

was named by the 

AHA as a Top Ten 

Study of 2007. 

In his study, Dr. Kaelber and his residents 

used MetroHealth’s electronic medical record 

system to examine the charts of 14,000 

children. They discovered high blood pressure 

was undiagnosed in three-quarters of 

the pediatric patients. Dr. Kaelber warned 

in his study that his findings suggest as many 

as 1.5 million children nationwide have 

hypertension and are going undiagnosed. 

Diagnosing hypertension in children is more 

difficult than the simple blood pressure check 

required in adults, because abnormal blood 

pressures in children vary with age, sex, 

and height. 

Since 1996, the AHA has compiled an annual 

list of the top 10 major advances in heart 

disease and stroke research and continues to 

highlight influential research annually. 

Dr. Kaelber is an internist and pediatrician 

at MetroHealth and a senior instructor 

at Case Western Reserve University. He 

is currently a medical informatics fellow 

at the Center for Information Technology 

Leadership at Harvard University and a 

staff physician at Brigham and Women’s 

Hospital, Children’s Hospital Boston, and 

Massachusetts General Hospital. ■ 


The new and expanded Center for Orthopedics and Sports Medicine 

offers a personalized, all-in-one approach to care for: 

+ Orthopedic evaluation and surgical and nonsurgical treatment 

+ Sports Medicine evaluation and treatment 

+ Fully-equipped, sports-oriented rehabilitation and therapy services 

+ Diagnostic testing, including fast, high-resolution, digital X-ray 

+ Orthotic and prosthetic services 

+ Research and education 

We also offer timely appointments and quick results. 

Refer a patient at 330-543-3500. 

*Based on a recent survey of Northeast Ohio parents 

www.akronchildrens.org 

Considine Professional Building | 7th Floor

How did doctors 

make a lasting 

impression on a 

man who owns 

a printing press 

Rob Durham, President of HKM Direct Market Communications 

At age 62, Rob Durham’s father, George, was becoming forgetful, something the 

family initially attributed to stress at work. But as time passed, George’s forgetfulness 

worsened; he even lost the ability to communicate effectively. And he was becoming 

weaker. When the family sought help at MetroHealth, they found doctors and nurses 

who offered treatment options for his Alzheimer’s and, most importantly, helped George 

feel safe and the family feel strengthened. For Rob, it was reassuring to know that 

George had received tremendous medical care—the same quality of care MetroHealth 

provides each day to patients from across the region. Today, as a valued donor, Rob 

continues to help MetroHealth remain the region’s leader in senior care. 

“MetroHealth made an 

overwhelming situation 

for my family much more 

manageable.” 

To learn how you, like Rob, can support MetroHealth, call 216-778-5004.

James W. Campbell, MD, MS - AkronCantonMDNews

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