VitalSigns Summer 2014

Leading the way

n AdvAnced technologyn MiniMAlly invAsive procedures

suMMer 2014For Baptist HealtH’s medical staFF

2 VitalSigns | Summer 2014

a message from the chief medical officer 3

Mazor robotics

robotic spine surgery enhances accuracy 4

technology provides real-time images 7

Baptist Jacksonville uses mazor robotics system 8 for bilateral deep brain stimulation

Da Vinci® surgical systeM

Urologists break ground in robotic surgeries 10

robotic lung surgery easier for patients 12

robotic heart surgeries on the horizon 14

da Vinci® expands general surgery capabilities 15

robotic-assisted surgery becoming more 16 common in gynecological procedures

Baptist south expands use of da Vinci® 17

Makoplasty®

maKoplasty® shows positive results 18

new technology

Baptist Jacksonville uses world’s 20 smallest heart pump

laser technology available at Baptist Nassau 21

Baptist’s new stroke & cerebrovascular center 22

Neurologists use videoconferencing 24

Baptist Beaches becomes primary stroke center 25

Gastric pacemaker provides relief 26

Baptist Health uniforms improve safety 28

Bar code medication administration 29 enhances safety

New tools help Wolfson children’s Hospital 30

Gps system helps in inspecting lungs 32

catheterization labs continue to grow 34

computer-aided detection system 35 assists radiologists

other news

Baptist Health expands palliative access 36

Baptist Nassau and community Hospice 37 help patients

lylerly celebrates 80 years 38

physicians named to Baptist boards 39

patient centered caring communication 39

brieFs

radiation oncologist participates in 40 national program

cardiologist honored as “Hero Next door” 40

Baptist center for Bariatric surgery accredited 41

pediatric physicians recognized 41

Wolfson children’s Hospital gains 42 international attention

Honoring Baptist Jacksonville and 42 Baptist Nassau

Baptist Jacksonville recognized as nurse-friendly 43

Baptist clay campus continues to grow 43

New Baptist Health medical Back cover staff members

Pictured on the cover is Neurosurgeon Bradley Wallace, MD, PhD, with the Mazor robot.

VitalSigns is published for Baptist Health’s medical staff.

to submit items, call the Baptist medical center medical staff office

at 904.202.1117; Wolfson children’s Hospital medical staff office at

904.202.8799; Baptist Beaches medical staff office at 904.627.2902;

Baptist Nassau medical staff office at 904.321.3501; or Baptist south

medical staff office at 904.271.6056.

president and chief executive officer, baptist health

a. Hugh Greene, FacHe

chief operating officer, baptist health

John Wilbanks, FacHe

Managing editor, VitalSigns Keith l. stein, md, Fccm, Fccp

chief medical officer, Baptist Health

senior Vice president for medical affairs and clinical effectiveness

editor/writer deborah circelli, phone 904.202.4916, fax 904.202.4920

contributing writers Beth stambaugh

Vikki a. mioduszewski, apr

Table of ConTenTs

a Message froM The Chief MediCal offiCer

3Summer 2014 | VitalSigns

New technologies enhance Baptist Health’s safety commitment

keith l. stein, MDChief Medical Officer,

Baptist Health

as physicians, we know our patients want effective treatment that is the least invasive with the quickest recovery time so they can return to their normal lives.

to that end, this issue of VitalSigns highlights a host of advanced technologies and minimally invasive procedures in a variety of specialties for the benefit of adult and pediatric patients. as medical staff, we are devoted to “changing Health care for Good” by incorporating the latest evidence-based therapeutic approaches to common and complex conditions, recommending the solution that is best for each patient.

Baptist Health is committed to putting the patient first, whether through our investment in new antimicrobial Vestex® scrubs and garments to heighten safety for staff and patients, or through the development of revolutionary programs such as our new stroke & cerebrovascular center to advance brain health in our region. this new center features fully dedicated neurointerventional staff and operating suites and an expanded neuro icU. the addition of the center and of renowned neurovascular surgeons, ricardo Hanel, md, phd, and eric sauvageau, md, means that patients don’t have to leave our region to get the best possible neurological care.

other examples of our devotion to optimal patient care include:

n setting the bar as a leader in robotic surgeries, including procedures to treat conditions of the brain, spine and the genitourinary tract in children and adults

n enhancing our systemwide electronic medical records for meaningful Use and ensuring physicians have the most up-to-date information at their fingertips

n introducing the new Bar code medication administration program to help ensure patients get the right dose of medication at the right time

n speeding collaboration via teleneurology videoconferencing technology that connects physicians to Baptist-affiliated neurologists who provide a live consultation in minutes

i invite you to learn more in this issue and stay tuned to further enhancements, as together we continue to change health care for good.

Robotic spine surgery helps provide more precision

robots in the or are redefining the standard of care in spinal surgery. Baptist medical center Jacksonville leads the way with two spinal robotics systems. the renaissance™ Guidance system, developed by mazor robotics, allows Baptist Health to treat patients with more complex spinal deformities, such as those with severe scoliosis and other conditions.

Mazor robotics

Baptist Health is the region’s leader in offering robotic-assisted surgery and in providing minimally invasive procedures and surgeries. Physicians are using a variety of robots to improve recovery times and outcomes for patients as part of Changing Health Care for Good.

Specially trained spine surgeons use Renaissance’s advanced 3-D planning software before entering the operating room to create the ideal procedure for each patient’s condition. In the OR, the surgeon is guided by a unique surgical blueprint to place the implants safely and accurately, using minimally invasive techniques whenever possible.

Conditions treated with Mazor include:

n Scoliosis

n Degenerative and herniated disc

n Spinal stenosis

n Spinal and traumatic fractures

n Reconstructive spine surgery

n Parkinson’s disease and essential tremor

Mazor roboTiCs


Baptist Jacksonville has the only mazor robotics technology in North Florida and was the first hospital between atlanta and orlando to obtain the system in 2013.

“the robot allows us to be that much more minimally invasive and that much more accurate,” said andrew F. cannestra, md, phd, director of robot spine surgery at Baptist Jacksonville and a neurosurgeon with lyerly Neurosurgery at Baptist

aboVE: A scoliosis patient’s scans show the spine before surgery in top photo. The scan in the bottom photo is after surgery with the Mazor robot.

LEFt: Andrew F. Cannestra, MD, PhD, performs a spine surgery using the Mazor Renaissance™ Guidance System, which is the size of a soda can next to his left hand.


Jacksonville. “the robot also allows us to place larger screws so we can apply more force on the spine more accurately and obtain a better correction of the spine.”

Before surgery, dr. cannestra sits at a computer console to plan out the surgery, which is then fed into the robot’s software.

a preoperative blueprint of a surgery is created with the software using ct-based 3-d images of the patient’s spine to help guide the surgeon to the location where intervention is needed. during the procedure, two fluoroscopic images are taken and automatically synchronized with the ct-based surgical blueprint so that tools are guided to the precise area of concern.

during the surgery, a frame attaches to the bed or the patient.

“the robot can basically walk along that frame and uses very fine movements to obtain the right trajectory relative to the frame and the patient. the surgeon can then either put a drill or an instrument accurately down to the spine to a precise location or specific trajectory,” dr. cannestra said.

“By correlating or really creating a map between the patient lying on the table and the patient’s scans before surgery, the robot can position the trajectory within

a tenth of a millimeter and get us where we need to be so that we can keep the incisions as small as possible,” dr. cannestra added. “We can really have an incredibly minimally invasive surgery and correct spinal conditions that are very complex.”

the mazor robotic technology is used to help neurosurgeons correct various spine conditions such as deformities, short/long fusions, fractures and degenerative and herniated discs.

Mazor roboTiCs


the success of the robot is based on the expertise of the surgeon using it.

advantages of minimally invasive spine surgery include increased safety and precision, smaller incisions and scars, less blood loss, shorter hospital stays, less postoperative pain and less need for pain medicine, plus faster return to work and daily activities.

“robotic surgery is going to take over. it’s going to become the standard of care with respect to placing screws and hardware into the spine,” said dr. cannestra, who also performed the first surgery at Baptist with the first mazor robot last year.

the use of robots has become commonplace at lyerly Neurosurgery, he added.

the new technology also has been employed in bilateral deep brain stimulation for parkinson’s disease. Future uses may also include tumor biopsies and resections of the brain, as well as additional spinal applications.

the robot allows surgery to be performed with only one-third the amount of radiation exposure than traditional surgery.

“traditionally, we would have to bring in X-ray machines to visualize the position and rotation of the spine. We would then interpret those images in

our minds to place our instruments into the right position. We would get a lot of radiation exposure ourselves as neurosurgeons, but there was also exposure for the patient,” dr. cannestra said.

When discussing a scoliosis case, dr. cannestra said the robot can “move to positions in an incredibly accurate fashion.”

“it’s very difficult to get the screws that we need into the bone because there’s just not that much real estate to get that screw in there,” dr. cannestra said. “the robot allows us to put the largest screw possible into the smallest space safely so that we can then do an aggressive correction to try to get (the patient) standing as straight as possible following surgery.”

physicians currently using the mazor renaissance robot include lyerly neurosurgeons Javier Garcia-Bengochea, md; paulo monteiro, md; michael J. petr, md, phd; and Bradley a. Wallace, md, phd; and Jacksonville orthopaedic institute surgeons Gregory Keller, md, and Brandon Kambach, md. Bh

“The system has been used on the lumbar and thoracic region, but

the technology will continue to expand with new applications for the cervical spine.”

andrew F. cannestra, MD, phD Director of Robot Spine Surgery, Baptist Medical Center Jacksonville

For more information about mazor robotics, call 904.388.6518.


Technology provides real-time images for brain and spine surgeriesBaptist Health is the first health system in North america to have adult and pediatric neurosurgical suites equipped with Buzztm digital or software that acts like a Gps to help neurosurgeons more accurately locate brain and spine tumors during surgery.

the three surgical suites in the J. Wayne and delores Barr Weaver tower use the Buzz technology, which puts 3-d images of a patient’s brain and spine at a doctor’s fingertips during neurosurgery by way of a 42-inch, high-definition touchscreen.

By integrating all of the technology in the room, Buzz enables neurosurgeons to see the brain more precisely and helps them determine whether or not they have removed the entire tumor. if neurosurgeons see any remaining tumor, they can continue the procedure until they have removed as much of the tumor as possible, reducing the likelihood of a second surgical procedure.

conditions may change during surgery – for instance, the brain may swell – so it’s important to have updated information, notes neurosurgeon michael petr, md, phd, of lyerly Neurosurgery who specializes in neuro-oncology for the brain and spine.

“the Buzz creates a more accurate resection of the tumor. You get more of the tumor out without interfering with more of the functional tissue and you get better patient outcomes,” dr. petr said.

images from the intraoperative mri and ct can be taken in real time and projected on the screen to help surgeons map out precisely where the tumor is located.

surgeons can scroll through and enlarge medical images either taken that day or downloaded from a patient’s file.

dr. petr uses small endoscopes in the Buzz or for frontal and middle skull base surgery to remove tumors in the pituitary or behind the eyes, for example.

“this new intraoperative technology offers advances in neurosurgery on two fronts,” said philipp aldana, md, chief of pediatric Neurosurgery for Wolfson children’s Hospital. “First, it’s a very powerful tool that enables us to integrate a variety of types of patient data, including more precise mri and ct scan data, into our surgical navigation plan. second, the touch screen, which has functions similar to a tablet, makes the process very easy for the surgeon to use in the operating room.” pediatric neurosurgeons Nathan ranalli, md, and alexandra Beier, do, also use the Buzz or.

in addition to that technology, dr. petr plans to use the mazor robotics renaissance™ Guidance system to more precisely guide his instruments during surgery. the robot, similar to that used for spine surgeries, attaches to a mount in front of the face, but does not touch the patient. Bh

Michael Petr, MD, PhD, performs brain surgeries with Buzz™ Digital OR software.

Philipp aldana, MDChief of Pediatric Neurosurgery, Wolfson Children’s Hospital

Mazor roboTiCs


a lyerly neurosurgeon is the first in the world to perform bilateral deep brain stimulation using the mazor robotics renaissancetm Guidance system, according to mazor

officials. the procedure is done to treat both sides of the brain in one operation.

Bradley Wallace, md, phd, is also the first to use renaissance for frameless deep brain stimulation so patients do not have to be fixated to a large stereotactic or halo frame around their head. Baptist Jacksonville is just one of three hospitals in the world using the mazor robotics renaissance system for deep brain stimulation.

Neurosurgeons are currently using the procedure for people with movement disorders such as parkinson’s disease and for essential tremor, which is a condition characterized by uncontrollable shaking or tremors in different parts of the body. For parkinson’s patients, the surgery also helps with stiffness and slow movement.

“it essentially is a pacemaker for the brain,” dr. Wallace said. “Without the surgery, we’ve

World’s first use of Mazor Robotics system for bilateral deep brain stimulation

Baptist Medical Center Jacksonville is an international leader in using robotic-assisted surgery to help patients with Parkinson’s and other similar conditions.

seen a number of folks with significant weight loss, even 30 to 40 pounds, because they lose the ability to feed themselves. they can’t keep food on their utensils and get the food to their mouth. they can’t drink a cup a water without spilling it.”

For parkinson’s patients, deep brain stimulation has proven to be better than the best management with medicines alone, he said.

“For essential tremor patients, there really is not a good medical management approach. the drugs invariably offer little benefit in the end,” dr. Wallace said.

bradley Wallace, MDNeurosurgeon

Bradley Wallace, MD, PhD, (left) looks over a patient’s images prior to surgery. The scans are synchronized with the robot.


deep brain stimulation is an ongoing therapy. the neurologist programs and can adjust the pacemaker device.

dr. Wallace notes that this therapy is Fda-approved and is proven to be safe to help correct abnormal circuits in the brain. But what is unique at Baptist is the use of the robot, an alternative to traditional surgery that would require a rigid frame attached to a patient’s head. the robot helps the surgeon precisely locate the target for deep brain stimulation.

With the mazor system, dr. Wallace said, “the patient is not required to go into the frame and be fixated. the patient is awake for a portion of the surgery. Not being fixed to the bed and being able to move a little bit is an advantage and more comfortable to the patient.”

the traditional method is also more time consuming, dr. Wallace said, because the surgeon has to dial in coordinates for each side of the brain for a bilateral procedure and also for any modifications during the procedure.

the new surgery is conducted in two parts. the first is a three-hour procedure during which electrodes are implanted into the brain and the patient is awake for part of the surgery.

“We pick a very specific point within the brain, and we are able to deliver it very accurately within millimeters of where we intend to put it,” dr. Wallace said.

With the frameless surgery, the robot temporarily connects to the patient’s skull using only three

screws and a small mounting platform the size of a silver dollar. the robot helps guide the physician in implanting leads or electrodes, which deliver electrical stimulation to targeted areas of the brain that control movement. a 3-d image from both an mri and ct scan is synchronized with the robotic system, enabling physicians to map out, even before the surgery begins, where they will place the electrodes in the brain.

the patient is brought back one to two weeks later to implant a neurostimulator or pacemaker-type device in a 45-minute outpatient surgery. the electrodes are connected to one or more neurostimulators implanted near the collarbone to block abnormal brain signals that cause the symptoms of

parkinson’s and essential tremor. the neurostimulator contains a small battery and computer chip programmed to send electrical pulses to control symptoms. the clinician can program and noninvasively adjust stimulation to help maximize symptom control and minimize side effects.

during the procedure, dr. Wallace said he is able to easily relocate the robot when he is done with one side of the brain as opposed to previously taking the stereotactic frame off and dialing in coordinates for the second side and putting the frame back on.

“there is a seamless flow,” dr. Wallace said. “it’s simply a matter of pushing a button and redirecting the robot to the new trajectory.” Bh

Bradley Wallace, MD, PhD, performs bilateral deep brain stimulation surgery with the Mazor robot.

da VinCi® surgiCal sysTeM


Urologists break ground in robotic surgeries

When it comes to robotic-assisted surgery with the da Vinci® Surgical System, urologists were the first to break into the field about eight years ago.“Urology was the first adapter of the robot nationwide,” said urologist apoorva Vashi, md, of mciver clinic and chief of Urology for Baptist medical center Jacksonville, adding that gynecology and general surgery followed. “it revolutionized the field of urology.”

surgery on the prostate, including removal of the prostate to treat cancer, was the first major application of the robot, which provides fewer incisions and scarring, and improved

Da Vinci® surgicaL systEM

Since purchasing its first da Vinci robotic-assisted surgical system in 2005, Baptist Health now has six robot systems — four at Baptist Medical Center Jacksonville, one at Baptist Medical Center South and one at Baptist Medical Center Beaches. The da Vinci combines superior 3-D high-definition vision with patented EndoWrist® instruments allowing for enhanced dexterity, precision and control.

Using a robotic system is advantageous because it can eliminate even the slightest tremor of the surgeon’s hand, and it also provides a better view than the 2-D image obtained during traditional laparoscopy. Additionally, the robotic tools can move in ways that the surgeon’s hands cannot and in smaller anatomy, allowing for greater dexterity.

A near-infrared fluorescence imaging guided system provides an enhanced field of view for the surgeon, allowing greater precision.

Access is accomplished through tiny incisions for faster patient recovery. apoorva Vashi, MD

Chief of Urology, Baptist Jacksonville


postoperative urinary control and sexual function. patient recovery is also quicker.

For the experienced surgeon, the robot is more precise and provides a greater view and magnification.

Now the da Vinci is used to facilitate partial kidney removal, so patients can sometimes keep part of their kidney as opposed to removing the whole organ.

“if you can remove part of the kidney, you are saving the rest, and that is a much better operation for the patient than taking out the whole kidney,” dr. Vashi said.

other robotic procedures include removing kidney blockages; bladder cancer surgeries (including removing tumors); and treating congenital and ureteropelvic obstructions. the most common procedure remains prostate removal due to cancer.

While there was some resistance at first, robotic surgery has become the standard of care for a lot of these operations, dr. Vashi said.

“about 85 percent of cases are done with the da Vinci, and 15 percent are open,” dr. Vashi said. “people are now looking at quality metrics, and patients are looking for surgeons who have done a lot of robotic procedures and therefore have better outcomes.”

mciver urologist c. shawn West, md, who practices at Baptist medical center south, uses the da Vinci to remove cancerous growths on the kidney (partial nephrectomy)

and for pyeloplasty (reconstruction of the ureter to correct blockage).

“We’ve been using the robot for most of our complex renal surgeries for the last four years,” dr. West said.

often, there is a congenital or acquired obstruction at the renal pelvis that prevents the kidneys from draining, which leads to pain for the patient. the robot allows dr. West to make four small incisions and take out the diseased segment of the ureter. the patient is usually discharged the next day rather than staying a minimum of four days after an open surgery.

removing cancerous growths robotically eliminates the need for a very large incision below the patient’s rib cage, dr. West said. Now, there are several small incisions and the post-operative length of stay is cut in half, he added.

michael J. erhard, md, chief of pediatric Urology at Wolfson children’s Hospital, began to perform minimally invasive urologic surgeries with the da Vinci system in 2005, recognizing the benefits of being able to do complex procedures that required accessing the small anatomical structures of infants and children. Bh

c. shawn West, MDUrologist, Baptist South

Michael J. Erhard, MDChief of Pediatric Urology, Wolfson Children’s Hospital



Robotic lung surgery easier for patients

today, Baptist surgeons are using the da Vinci® surgical system for some thoracic surgeries, which replaces a foot-long incision with just three to four half-inch-long incisions.

“With the da Vinci, there is much less trauma to the chest wall because the incisions are much smaller,” said Jack pirris, md, who performs robotic thoracic surgery at Baptist medical center Beaches.

“thoracotomies are considered one of the most difficult surgeries for patients,” dr. pirris said. sometimes the pain can prevent the patient from breathing effectively, which can lead to pneumonia.

recovery from a thoracotomy takes six to eight weeks. With the da Vinci, patients can return to normal activities in as little as one week. “patients who need to have part of their lung removed due to cancer can leave the hospital the next day,” dr. pirris said.

lung cancer is by far the leading cause of cancer death among men and women, according to the american cancer society, so there are many patients who may benefit from robotic thoracic surgery.

patients who are elderly, or have cancer and are too weak to withstand open surgery, are especially good candidates for robotic thoracic surgery. lung cancer usually occurs in older people; about two out of three people with lung cancer are older than 65.

“i am amazed at how quickly these patients recover,” dr. pirris said. “they have minimal pain and do well post-operatively.”

cardiothoracic surgeon robert still, md, at Baptist medical center Jacksonville, said that robotic thoracic surgery provides hope for some of the more debilitated lung cancer patients. “patients with impaired lung function have a new option now for a cure rather

robert still, MDCardiothoracic Surgeon

Don cousar, MDChief of Thoracic and Cardiovascular Surgery

Thoracic surgery is evolving to become much easier on patients. In the past, patients who needed heart or lung surgery had to undergo a thoracotomy, a complex surgery involving a large chest incision and a prolonged recovery.


than being treated in a palliative way,” dr. still said.

some patients are better suited for traditional open surgery. “the patient’s anatomy plays a role,” said don cousar, md, chief of staff-elect and chief of thoracic and cardiovascular surgery for Baptist Jacksonville. “patients with incomplete fissures between the lobes of the lung are sometimes better candidates for open surgery.”

dr. cousar has been performing open-surgery thoracotomies for 26 years and performed his first robotic case in march. “i admit i can be skeptical when it comes to new technology, but i like using the robot. it’s a good technique with favorable outcomes for patients.”

dr. still added, “a significant benefit is that you don’t have to cut muscle or bone, which significantly reduces the patient’s pain and also allows for a much quicker recovery.“

as a cardiothoracic surgeon, dr. still is looking forward to applying the robot for other cardiac procedures in the near future.

Jack Pirris, MDCardiothoracic Surgeon

“patients are inquiring about having surgeries performed robotically,” he said. “consumers are becoming more savvy, and they want their surgery performed in the most minimally invasive way possible.” Bh



Robotic heart surgeries on the horizonlong incisions in the chest wall for heart surgeries may no longer be the standard as doctors turn to the assistance of robots.

robert still, md, cardiothoracic surgeon, said many patients travel out of state to get cardiac robotic surgery because options locally have been limited to the south Florida area.

Heart procedures with the da Vinci® surgical system will start by November at Baptist medical center Jacksonville.

procedures could include mitral valve repair/replacement; aortic valve replacement; tricuspid valve repair/replacement; atrial septal defect repair; left atrial appendage ligation; pericardial window surgery; internal mammary artery harvesting in bypass surgery, and a maze procedure for atrial fibrillation.

“there is a tremendously large group of patients who are going elsewhere to have robotic mitral valve surgery,” dr. still said.

performing the procedures at Baptist Jacksonville, he said, will allow patients to be treated closer to home, which is much easier on their families and helps recovery.

“it will mean patients won’t have to have a major incision on their chest. the recovery times will be much shorter and the amount of pain will be markedly reduced. they can go back to their lives and work very quickly.”

recovery times in the hospital also will be reduced. even now with other minimally invasive procedures, patients may have an incision of four to five inches on the right side of the chest, but with the robot there are only small half-inch incisions.

dr. still said the demand for robotic heart surgery is “very much patient and doctor driven.”

“the physicians who have trained in places where they have the da Vinci want their patients to have the opportunity to be repaired that way rather than having a traditional sternotomy,” dr. still said. “patients are savvy these days. they get online and read about these things and they go and check out their options.”

“What you are doing is just a different approach to the same problem. it’s just a different way to get there. as long as you are able to see what you need to see and put the sutures where they need to go and do a good operation, it doesn’t really matter to me how you get there,” dr. still added. “With the robot, the patient is going to have no major incision, a signficant decrease in the amount of pain and time in the hospital, and a quicker return to work. those are the advantages i see.”

Using the da Vinci involves the surgeon sitting at a console after making a few small incisions between the ribs. the da Vinci system features a magnified 3-d high-definition vision system and special wristed instruments that bend and rotate more than the human wrist. these features enable the surgeon to operate with enhanced vision, precision, dexterity and control.

“it gives you a 3-d view and then you have hand controllers that mimic your movements,” dr. still said. “You have different instruments you can utilize in there to cut, sew, dissect, pull and push, and do whatever you need to do and get where you want to go.”

some other advantages include reduced blood loss and need for transfusions; less time in icU; a lower rate of atrial fibrillation; and a lower rate of pleural effusions after surgery.

But dr. still also points out that not all patients are candidates for robotic surgery. in some cases, other techniques are being used for minimally invasive procedures featuring new retraction devices and equipment that allow the surgeon to see the valve through a small incision on the right side of the chest.

“the view of the valve we get is a better view than we did with the open technique because we are looking directly at it,” dr. still said. “our techniques continue to evolve. We have new retractors available that we didn’t have before. We have the support devices we need to enhance our surgical approach,” he added. Bh


Da Vinci® expands general surgery capabilitiesphysicians have been using the robotic-assisted surgical system for several years for urology and gynecology cases. But recently, more general surgery procedures are being performed robotically, from colon resections to complex hernia repairs.

steven Hodgett, md, vice chair of the department of surgery at Baptist medical center Jacksonville, is using the da Vinci for component separation for incisional hernia repair. only a handful of doctors nationally have performed the procedure. performed at Baptist Jacksonville, it minimizes the incision size and wound complications, and lowers recurrence rates.

traditionally, component separation procedures have required large, midline incisions to repair the hernia and bring the primary tissues back together. those procedures have higher wound complication rates than their laparoscopic counterparts, according to dr. Hodgett, of North Florida surgeons.

“laparoscopic ventral hernia repair has very low wound complication rates, but we have been unable to bring the primary tissue together, leaving the patient with a less functional abdominal wall,” he said.

the da Vinci system allows surgeons to “combine the best of both worlds – open surgery and laparoscopic surgery,” dr. Hodgett said. “We are able to use the robot to make relaxing incisions in the lateral muscle layers of the anterior abdominal wall and then to bring the primary tissue back together.”

He added that the use of the da Vinci system has exploded in the field of general surgery: “every day we are finding something easier or new to do with it.”

specially trained surgeons sit at the console and view an enhanced 3-d image while controlling instruments that allow for superior dexterity. Baptist Health’s da Vinci surgical system combines superior 3-d high-definition vision and patented endoWrist®

instruments. Baptist Health is among a small group of U.s. hospitals to employ a new near-infrared fluorescence imaging guided system with da Vinci for an even more enhanced field of view, allowing finer assessment and operations.

dr. Hodgett was the first at Baptist Jacksonville to use the da Vinci robot to perform a low anterior colon resection more than a year ago. the technology has distinct advantages. depending on the location of the tumor, the robotic-assisted surgery is his treatment of choice to assist in removing part of the colon for people with colon cancer.

“less than a decade ago, without a robot, we were requiring patients to have not only their rectum, but also their anus removed,” dr. Hodgett said. “Without the robot, there were positions where you could not get around the mass far enough, and the patient would end up with a permanent colostomy.”

He added, “thanks to the advent of robotic surgery, we are able to go lower and often preserve their sphincters and intestinal continuity and enable them to have a more normal life.”

similar to laparoscopic surgery, dr. Hodgett said the robot “allows us to get lower in the pelvis and make these operations safer for people.”

“the robot allows you to see and safely dissect areas you couldn’t see before,” dr. Hodgett said. “it also allows you to preserve the necessary vascular supply of the colon and it can thus improve a patient’s overall outcome.” Bh

steven Hodgett, MDVice Chair, Department ofSurgery, Baptist Jacksonville

Gynecological surgeons are finding progressively more applications for the da Vinci® surgical system.

“the da Vinci is revolutionizing gynecological surgery,” said gynecologic oncologist stephen l. Buckley, md, with southeast Gynecological associates, which affiliated with Baptist Health last November. “robotics allow

us to transform a procedure that traditionally requires a large incision and a long hospital stay to one requiring very small incisions, allowing the patient to go home the same day or the day after many types of surgeries. Not only is the recovery quicker, but the risks of complications are lower,” he said.

Baptist gynecological surgeons are using the da Vinci for a wide range of procedures, including fibroid removal, hysterectomies, tubal reversals and prolapse surgeries, to mention a few.

Gynecologist mary ellen Wechter, md, who provides evaluation and treatment for fibroids and other gynecological conditions at Baptist medical center Jacksonville, finds that the da Vinci is best for more complex surgeries with higher levels of dissection and suturing, such as myomectomies, in which large fibroid tumors are removed from the uterus. “the robot is very useful when the surgery is not straightforward,” said dr. Wechter, of North Florida oB/GYN associates.

she said the da Vinci’s advanced optics make complex surgical cases easier to perform. “With traditional laparoscopic surgery, the surgeon can only see two dimensionally, while the da Vinci allows you to see

three dimensionally,” dr. Wechter said, adding that the enhanced view makes it easier to perform critical dissections (separation of tissues from each other).

dr. Wechter’s fellowship included both laparoscopic and robotic training, but she finds that she is using the robot more than laparoscopic techniques. “With traditional laparoscopic surgery, you have to rely on the fulcrum effect—meaning you have to rotate the instrument around the abdominal wall. You also must coordinate each movement with another surgeon. the robot makes surgery smoother, more elegant, and more independent for the primary surgeon,” she explained.

Gynecologist and obstetrician leandro rodriguez, md, medical staff secretary for Baptist medical center Beaches, finds that



Robotic-assisted surgery becoming more common in gynecological procedures

“The robot is very useful when the surgery is not straightforward,” said Mary Ellen Wechter, MD, gynecologist.

stephen L. buckley, MDGynecologic Oncologist, Southeast Gynecological Associates

Baptist South expands use of da Vinci®

Baptist medical center south is providing single-site incision gallbladder surgeries with the da Vinci robot. single-site surgery is in popular demand because one incision means minimal scarring as opposed to several small incisions typically made with robotic-assisted procedures.

Benjamin piperno, md, of North Florida surgeons, who is board-certified in general surgery and colon and rectal surgery, is performing single-site surgeries. He has been using the da Vinci for more than a year for gallbladder and colon surgeries at Baptist south.

the single-site technique will initially be used for gallbladder surgeries until regulatory approval is granted for colon cases.

dr. piperno said one incision will be better for patients, who will have less pain and a quicker recovery. the robot provides better visualization and arm control.“it will improve the surgery for the patient and make a difference,” he said.

steven Hodgett, md, of North Florida surgeons and vice chair for the department of surgery at Baptist medical center Jacksonville, has been performing single-site surgeries with the da Vinci robot for one-and-a-half years, mainly for gallbladder surgeries.

Janet troff, rN, msN, director of surgery for Baptist south, believes there will be opportunities for single-site surgeries in other specialties, such as gynecology, in the near future.

since acquisition of the da Vinci surgical system in 2011, the Baptist south program has grown in the number of surgeons and staff trained in robotic surgery. procedures include partial removal of kidneys, gallbladder removals, hysterectomies, myomectomies and lobectomies.

at the end of march, Gynecologist Kristin Fernandez, do, performed the hospital’s 500th robotic surgery with the da Vinci – a laparoscopic-assisted supracervical hysterectomy.

the Baptist south robotic team is excited about the future growth of the program and benefits to our patients. Bh


the da Vinci is well-suited for patients with complicated hysterectomies, such as those with previous surgeries, endometriosis or scar tissue. “We are seeing a significant decline in the number of open hysterectomies we are performing,” said dr. rodriguez, of North Florida oB/GYN. “patients are often able to go home the day following surgery and can return to most of their normal activities within a week.” With an open hysterectomy, a patient’s recovery usually takes six weeks.

there are also many benefits to the surgeon in using the da Vinci. “ergonomically, the robot is much easier on the surgeon because you are sitting rather than standing. operating with the robot is like having four hands,” said dr. Wechter, referring to the fact that the surgeon controls three instruments, as well as the camera, simultaneously.

“this allows surgeons to see and manipulate tissue planes more easily, even better than we can with open surgery, which, in my opinion, makes the surgery safer for the patient.” dr. Wechter said. Bh

Kristin Fernandez, DO, (second left) and her medical team celebrate the hospital’s 500th da Vinci robotic surgery.

benjamin Piperno, MDColon and Rectal Surgeon, General Surgeon

MakoplasTy


MAKOplasty® partial knee resurfacing showing positive results

maKoplasty partial knee resurfacing is increasingly becoming a viable alternative to total knee replacement for many patients. since the beginning of 2012, Baptist Health and Jacksonville orthopaedic institute have completed more than 150 maKoplasty procedures, more than any other provider in Northeast Florida.

“maKoplasty is an excellent option for patients who are relatively young and don’t need a total knee replacement,” explained orthopaedic surgeon stephen lucie, md. “the best candidates are those who have an early form of osteoarthritis confined to either one or two of the three compartments of the knee.” most frequently, the patient has damage to the medial compartment, which is the interior part of the knee.

With maKoplasty, the surgeon uses a 3-d system to size the implant so that it is a perfect fit for the patient’s knee. then, using a robotic arm system, only the damaged areas of the knee are removed and the implant is precisely positioned.

“maKoplasty prompts the surgeon on exactly how much bone to resurface for optimal results,” said orthopaedic surgeon carlos tandron, md.

the process begins with a preoperative ct scan of the patient’s knee, allowing the physician to perform the surgery virtually before the actual procedure. “the results are very consistent from case to case because of the preoperative planning,” dr. tandron said. “maKoplasty eliminates the guesswork.”

patients can expect excellent long-term results. “data shows that partial knee replacements that are well-positioned can last 10 to 15 years,” dr. lucie said. “Because maKoplasty is computer-navigated and robot-controlled, the implant is placed perfectly every time. the element of human error is removed.” this precise placement, along with advances in implant material, can extend the implant’s lifespan.

PHysicians PErForMing MaKoPLasty, incLuDE:

n Steven M. Crenshaw, MD San Marco

n Philip R. Hardy, MD San Marco

n R. Stephen Lucie, MD San Marco

n William G. Pujadas, MD San Marco

n Carlos R. Tandron, MD San Marco

n Dale A. Whitaker, MD Baptist Beaches

To schedule a consultation, call 904.202.KnEE (5633).


“compared to total knee replacement, it provides a more natural feel and a longer lifespan for the implant,” added orthopaedic surgeon steven m. crenshaw, md, chair of the department of orthopaedic surgery at Baptist medical center Jacksonville.

one of the major benefits of maKoplasty is that all of the knee ligaments are maintained, so activities such as kneeling, squatting or going up stairs feel more natural. With total knee replacement, some of the ligaments are sacrificed. Because maKoplasty is minimally invasive, patients also benefit from smaller incisions, fewer complications, less discomfort and a quicker recovery.

“the surgery can give patients a new lease on life,” said orthopaedic surgeon William pujadas, md.

patients can usually leave the hospital one to two days after maKoplasty. “eventually, with improvements in pain control, we may be able to perform maKoplasty partial knee resurfacing on an outpatient basis,” dr. lucie said.

maKoplasty benefits include:

n preserving healthy parts of the knee

n smaller incision

n shorter hospital stay

n rapid recovery

n pain relief

n natural function and feel

2012/2013 Post-surgery results for Joi/baptist Health

Robot-Assisted Partial Knee Resurfacing

Versus Total Knee

Replacement

Average Length of Hospital Stay 2.3 days 2.6 days

Flexion 96.7° 91.3°

Extension 1.21° 1.81°

Ambulation 916 feet 810 feet

Results based on 112 surgeries performed by six JOI surgeons at Baptist Medical Center Jacksonville in 2012 and 2013 (as compared to 608 total knee replacements for the same period).

Patient satisfaction with robotic-assisted Partial Knee resurfacing

80%

60%

40%

20%

0% Very Satisfied Neutral Dissatisfied Very Satisfied Dissatisfied

64%

25%

5% 4% 2%

89% of patients were very satisfied or satisfied.

new TeChnology


Beverly Huneau, nurse manager for the Cardiovascular OR and Surgical Services at Baptist Jacksonville, holds the Impella device.

Baptist Medical Center Jacksonville uses world’s smallest heart pumpBaptist medical center Jacksonville has new technology in place for helping patients who undergo certain heart procedures.

the impella® ventricular assist device is a catheter-based heart pump that pulls blood from the left ventricle through an inlet area near the tip and expels it into the ascending aorta.

the device provides temporary circulatory support and reduces the workload of the heart muscle through a minimally invasive, catheter-based pump.

the pump can be inserted in a standard catheterization procedure through the femoral artery, into the ascending aorta, across the valve and into the left ventricle.

the impella 2.5, billed as the world’s smallest heart pump (smaller than the width of a pencil), is inserted percutaneously through a small hole in the leg in the cardiac catheterization laboratory. once positioned in the left ventricle, the impella 2.5 delivers peak blood flow of 2.5 liters per minute. it can be used to ensure blood flow during cardiac procedures, or it may be used in patients who require circulatory support.

according to abiomed inc., the self-contained motor drives the “impeller” at 50,000 revolutions per minute, which in turn drives blood flow to support the heart and the rest of the body.

a similar device, the impella 5.0, can be inserted into the left ventricle via femoral cutdown or through the axillary artery, and provides up to five liters of flow per minute.

“it allows blood to be pumped from the heart to the body so the heart can rest,” said marc litt, md, Baptist Heart specialists’cardiologist and director of the Baptist Jacksonville catheterization lab. “this helps support patients through coronary procedures and interventions and makes them a lot more stable, so we can work on them and do more complex procedures.”

Getting the device in place, dr. litt said, is a collaborative effort with cardiologists, heart and vascular surgeons, including cardiothoracic surgeon robert still, md; cardiothoracic surgeon don cousar, md, chief of thoracic and cardiovascular surgery for Baptist Jacksonville, and chief of staff-elect; vascular surgeon erin moore, md, and cardiologist Bernardo Utset, md.

the impella is then able to take blood from the bottom of the chamber and push it out the top portion of the device, sending it to the body.

“it is close to what a normal heart will pump with every beat,” dr. litt said. “an intra-aortic balloon pump, on the other hand, pushes blood down coronary arteries, but doesn’t pump blood to the whole body.”

the impella can be used to help rest the heart during certain procedures or for a longer period of time while the patient recovers.

Marc Litt, MDCardiologist, and Director, Catheterization Lab, Baptist Jacksonville


if a patient has a large amount of cardiac blood vessel territory to work on, for example, the pump will allow the body to maintain its normal flow, or close to it, while the cardiologist is working on the arteries, dr. litt said.

during a complex angioplasty or stent procedure, it may take longer if the patient has a lot of heart muscle at risk. “the impella will allow the heart to relax or rest during the procedure so there will be less risk,” dr. litt said.

if a patient is in shock after a massive heart attack, the pump can help avoid the need for iV drugs. the pump will provide blood flow to the body while the heart is recovering from damage.

“We are thrilled to be able to offer this service,” dr. litt said. Bh

Laser technology for cataracts available at Baptist Medical Center Nassaupatients at Baptist medical center Nassau who need cataract surgery now have access to the latest laser technology.

ophthalmologist William dillon, do, is performing surgery with a laser similar to that used for lasiK procedures.

“this is a new technology for cataract surgery that makes more precise and safer incisions than a surgeon using hand instruments,” dr. dillon said. “it cuts down on the time and energy we need to use instruments in the eye for cataract surgery, which provides for a safer operation for patients.”

the moFe™ mobile Femtosecond laser by sightpath medical provides image-guided computer precision as an alternative to traditional

surgery with a physical blade to create several small incisions. the refractive laser assisted cataract surgery allows the doctor to plan and perform cataract surgery to a patient’s individual specifications.

“the laser can make the incisions with much more precision and makes them exactly the right size, shape and length,” dr. dillon said.

the surgery is performed according to the surgeon’s preferences using focused laser pulses to create incisions in the lens capsule, crystalline lens and cornea. treatments are tailored to surgeon specifications and can deliver remarkable accuracy.

laser surgery also can correct astigmatism.

patients still may have traditional surgery or laser surgery, if they prefer. the laser surgery is not yet covered by most insurance plans. Bh

William Dillon, DO, demonstrates the MoFe™ Mobile Femtosecond laser.

new TeChnology


A race against timeBaptist’s new Stroke & Cerebrovascular Center speeds access to lifesaving treatments

as the No. 4 cause of death and the leading cause of adult disability in the U.s., stroke is a formidable foe. to fight its devastating effects on patients and their families in our region, Baptist created the new stroke & cerebrovascular center at Baptist medical center Jacksonville.

leading the center are internationally renowned neurovascular surgeons ricardo a. Hanel, md, phd, and eric sauvageau, md. Both doctors have endovascular fellowships from the state University of New York at Buffalo, and skull base and cerebrovascular training from the Barrow Neurological institute in phoenix, ariz.

With the addition of drs. Hanel and sauvageau, who specialize in advanced groundbreaking neurovascular treatments, Baptist now has the most advanced stroke treatment center in the region. they joined the prestigious team of lyerly Neurosurgery, the region’s premier neurosurgical practice founded in 1934.

ricardo a. Hanel, MD, PhD, left, and Eric sauvageau, MD, Directors, Baptist Stroke & Cerebrovascular Center

“referring physicians and residents of Florida, Georgia and beyond can now take comfort that there is one place to call for any condition of the brain, spine or nervous system, at any level of complexity,” said Javier Garcia-Bengochea, md, chair of the board for lyerly Neurosurgery.

the level of expertise and access at the center is unprecedented in our region. “We are available 24/7 with high-level coverage to take care of the community,” dr. Hanel said. “there is no single neurological, cerebrovascular, neuro-oncological or spinal disease that cannot be treated by our team.”

Both doctors specialize in groundbreaking minimally invasive procedures for treating strokes, cerebral aneurysms, brain tumors and brain arteriovenous malformations. they are known for their advanced treatment of aneurysms, including flow diverter technology, stenting and coiling, as well as more traditional methods, such as clipping and bypasses.

every year in the United states, more than 759,000 people suffer strokes. it is predicted that by 2018, that figure will grow to about 1 million. a stroke occurs about every 53 seconds in our country.

“as physicians, we all know that when it comes to stroke, time is of the essence,” dr. Hanel said. “We have a tremendous task to educate the public so they know the signs and seek help immediately.”

the average patient loses 1.9 million neurons for each minute that a stroke goes untreated, according to the National stroke association. the new stroke & cerebrovascular center works in concert with Baptist’s


six emergency rooms to make sure patients get the right treatment at the right time.

a highly integrated system with identical protocols in all of Baptist’s emergency rooms ensures that patients needing advanced care are treated as quickly as possible. “every second counts,” dr. Hanel said. “in many situations, if treated soon enough, these patients can be helped.”

in emergent situations, referring physicians should call 202.BraiN (2724) to be connected to the neurovascular surgeon on call and an intervention team will be ready as soon as the patient arrives. Future alliances with other area hospitals are under way to serve as many patients as possible.

“the communities Baptist serves are going to benefit greatly from this high level of care,” said Nicole thomas, mBa, FacHe, vice president of operations and specialty services for Baptist Jacksonville.

stroke and cerebrovascular treatments have advanced tremendously over the years. Before 1990, neurosurgeons’ only alternative was to perform craniotomies to clip the aneurysms. today, the preferred method is to use minimally invasive interventional procedures to treat the aneurysm.

“With the current range of treatments and technology available today, an aneurysm patient’s chances of living a normal life have increased greatly,” dr. sauvageau said.

Baptist is one of the few sites in the country to have all Fda-approved and trial flow diverter technology, in which drs. Hanel and sauvageau have extensive experience. together, they have treated more than 300 patients with flow diverters, making the two doctors the most experienced in the region.

the stroke & cerebrovascular center has dedicated neurointerventional suites equipped with biplane angiography imaging, lowering radiation to the patient and enhancing visualization. “advances in imaging have changed the landscape of stroke treatment,” dr. sauvageau said. “it helps us make more accurate diagnoses, and helps us understand what areas of the brain can be saved.”

in emergent situations, referring physicians should call 202.brain (2724) to be connected to the neurovascular surgeon on call and an intervention team will be ready as soon as the patient arrives.

continual improvement through research is part of the vision for the center. Nine studies have already been approved since march to evaluate improved tools for treating brain aneurysms, such as new materials for coiling. a study is also underway to extend the time period to use tpa (tissue plasminogen activator) from 4.5 hours after onset of stroke symptoms to 12 hours.

the stroke & cerebrovascular center spans four floors of the Weaver tower and includes a 12-bed Neurointensive care Unit, which is being expanded to 24 beds. pediatric neurovascular surgery is an important part of the center. even before joining Baptist, dr. Hanel performed pediatric neurosurgery in collaboration with philipp aldana, md, chief of pediatric Neurosurgery for Wolfson children’s Hospital, as well as pediatric neurosurgeons Nathan ranalli, md, and alexandra Beier, do. this collaboration will continue and likely will grow.

“We are the only center in the region to provide pediatric and adult stroke care under the same roof,” dr. Hanel said. “regardless of the patient’s age, we have our community covered.” Bh

Teleneurology


Neurologists get quicker consult with patient through videoconferencing

Because every minute counts when it comes to treatment of strokes or other life-threatening neurological conditions, Baptist Health’s emergency rooms are now equipped with technology to connect a neurologist quickly with the patient.

teleneurology is a subset of telemedicine. to speed access to expert care, videoconference technology allows a Baptist-affiliated neurologist to provide a live neurological consultation in minutes.

“teleneurology is a great way to gain access to the patient without being physically present,” said Nicole thomas, mBa, FacHe, vice president of operations and specialty services for Baptist Health. “When there is a stroke, we need a neurologist to help us determine if a patient is eligible for thrombolytic or interventional therapy.”

a pilot program started last summer at the Baptist clay medical campus utilizing a vendor to provide teleneurology services. Now Baptist neurologists have

the tools to perform this service and improve Baptist Health’s ability to support the new endovascular Neurosurgery program.

each of Baptist’s five adult emergency departments have telemedicine carts, allowing the neurologist to see and hear the patient, who can also see and hear the doctor.

if neurologists are not at the hospital, they can use their ipad or laptop, programmed to the hospital network, to communicate with the patient via a secure connection.

“it’s an excellent tool for the neurologist,” thomas said. “the neurologist can evaluate the patient by talking to them and their family, and performing a neurological exam with the help of the nurse to determine the next step of care for the patient. the goal is for our neurologists to decrease the amount of time between being notified of a code stroke in the emergency center and responding to the patient.”

the technology helps save connection time. For example, a neurologist who is 30 minutes away when a code stroke is called can quickly get on an ipad or computer and see the patient before traveling to the hospital.

casey carrigan, md, neurohospitalist at Baptist medical center Beaches and medical director of the primary stroke center at Baptist Beaches, was one of the first to test the new equipment.

“teleneurology is a great addition to our toolbox for providing timely and efficient care to patients experiencing acute neurological emergencies,”

nicole thomas, Mba, FacHE, Vice President, Operations and Specialty Services, Baptist Health

casey carrigan, MDNeurohospitalist


Neurologists get quicker consult with patient through videoconferencing

Baptist Medical Center Beaches becomes Primary Stroke Center

dr. carrigan said. “it’s very good equipment, gives very clear detail and the audio is good as well. it’s a wonderful and better-than-adequate substitute for actually being there.”

if someone comes in with neurological symptoms, the er doctor calls for a consultant. dr. carrigan then has a nurse roll the teleneurology work station to the patient.

if it’s a stroke patient who is a candidate for intervention, dr. carrigan can do the initial evaluation via teleneurology. “the work station can even be wheeled into the ct scanner room so not a single minute is wasted,” he said.

through the technology and with the nurse’s assistance, dr. carrigan is able to perform all aspects of a thorough neurological history and exam.

“if someone has a headache, sudden weakness, seizure or any neurology symptom, you can push the teleneurology equipment in the room and interview the patient while telling the nurse what maneuvers you want performed,” dr. carrigan said. Bh

Baptist medical center Beaches has been designated as a primary stroke center by the agency for Health care administration (aHca).

as a primary stroke center, Baptist Beaches follows national standards and guidelines that can significantly improve outcomes for stroke patients. Baptist Beaches has a dedicated stroke-focused program with neurologists available 24/7 to care for stroke patients.

Within minutes of arrival, a neurologist will be interacting at the patient’s bedside, making decisions along with an emergency physician. Baptist Beaches has advanced imaging capabilities to diagnose stroke and an emergency room medical team with the proper training to administer tissue plasminogen activator (tpa), a clot-busting drug for patients who suffer an ischemic stroke (caused by a blockage of blood flow to the brain).

“the primary stroke center designation at Baptist Beaches is an example of our ongoing commitment to continually evaluate the medical needs of the Beaches community and implement new programs and services that best meet the needs of our patients,” said Joe mitrick, FacHe, president of Baptist medical center Beaches.

“We are glad to be recognized for having the skills and technology in place to give stroke patients the immediate care they need,” mitrick said. “seconds can make a difference in preventing severe brain damage or death.”

casey carrigan, md, medical director of Baptist Beaches stroke center, added, “our Beaches stroke team is fully trained and ready to receive, diagnose and treat patients presenting with acute stroke. We have the expertise and technology for rapid stroke diagnosis and the ability to administer life-saving tpa to people in our community, which can prevent devastating disability.” Bh

new TeChnology


John M. Petersen, DO, a board-certified gastroenterologist with Borland-Groover Clinic, who is a member of the medical staff at Baptist Jacksonville, holds the Medtronic Enterra gastric pacemaker. This device is placed surgically and is designed to help patients with severe gastroparesis.

Gastric pacemaker provides relief for stomach condition

Gastric electrical stimulation, which is being used for patients ages 18 to 80, may reduce symptoms of gastroparesis, a chronic, debilitating condition in which the stomach does not process and properly empty food, causing nausea and vomiting.

often called a gastric pacemaker, the electrical stimulator not only can reduce nausea and vomiting in patients with severe gastroparesis, but may also help improve stomach functioning.

“We have something now we can offer people who are completely refractory to medical care,” said John m. petersen, do, a board-certified gastroenterologist with Borland-Groover clinic and member of the medical staff at Baptist Jacksonville.

He has a special interest in biliary and pancreatic diseases, Barrett’s esophagus and inflammatory bowel disease, as well as all motility-related disorders.

the procedure was approved by Baptist Health’s institutional review Board. dr. petersen is the principal investigator in these research activities.

He said the majority of pacemaker recipients improve quickly in their overall well-being and dependence on medications.

“i’ve read a lot of literature that shows encouraging results,” dr. petersen said.

Patients suffering from a debilitating stomach condition have renewed hope through a new procedure at Baptist Medical Center Jacksonville where a device similar to a heart pacemaker can help their stomach function better.


“the numbers are better than a 50-50 chance for marked health improvement.”

Gastroparesis occurs most often in people with diabetes who have neuropathy or damage to the nervous system. Healthy patients can be affected after a viral infection impacts the nerves controlling stomach motility or after a gastric surgery interrupts the vagus nerve. symptoms include feeling full after eating only a small amount of food, loss of appetite, nausea with vomiting, abdominal pain, bloating, abdominal distention and weight loss.

steven Hodgett, md, vice chair of Baptist Jacksonville’s department of surgery, who specializes in laparoscopic surgery and bariatric surgery, has been performing the implantation procedures.

“the gastric pacemaker signals the stomach to contract to try to improve patients’ gastroparesis,” dr. Hodgett said. “this is a patient population that overall is miserable. results show a significant amount of improvement in their lives.”

dr. Hodgett is also using the da Vinci® robotic surgical system in some cases. He said using the robot provides “better visualization, less pain for the patient, faster recovery, and more precision in placement of the leads.”

Gastroparesis can affect patients of all ages, but is slightly more prevalent in females and is usually treated with diet and medication.

“the patients can have significant weight loss to the point where they can’t function. they can’t work, they can’t eat,” dr. petersen said. “if they are diabetic, their diabetes is out of control.”

“Up until now, there have been only a couple of medications you could use to treat it. those

medications are fraught with a lot of side effects and are really not that effective.”

the enterra® gastric neurostimulator, developed by medtronic, comprises two insulated wires or electrodes attached laparoscopically to the lower body/antrum of the stomach. the neurostimulator is placed in a subcutaneous pouch on the abdominal wall.

petersen said the neurostimulator can be programmed easily to enhance the frequency of gastric contractions. the mild electrical stimulation of the antrum portion of the stomach muscle wall helps to reduce chronic intractable nausea and vomiting.

dr. petersen and colleagues Vikram Gopal, md, Kyle etzkorn, md, chief of Gastroenterology at Baptist Jacksonville, and dr. Hodgett are involved in evaluating patients, proceeding with gastric stimulation and providing follow-up care. Bh

For more information, call Baptist Jacksonville center for endoscopy at 904.202.1182.

Close-up of the Medtronic Enterra gastric pacemaker.

VesTex™ TeChnology for apparel


Baptist Health continues safety commitment with new uniforms and patient apparel

Baptist Health is the first health system in the world to widely adopt innovative Vestex™ textile technology for staff and patient apparel to minimize the risk of transmission of organisms. soft surfaces such as fabrics are known to be vectors for the spread of infectious organisms in acute care settings.

Baptist is partnering with Vestagen technical textiles to create custom-designed uniforms, lab coats, scrub jackets and patient apparel made with Vestex™ fabric. this innovative fabric incorporates a highly repellent fluid barrier and an embedded antimicrobial which has been shown to be effective against a broad spectrum of organisms1.

Baptist Health is not making the change because of a problem with infection, but to be proactive in our use of this new technology to enhance our environment.

“there is nothing more important than the safety of our patients,” Baptist Health president and ceo Hugh Greene, FacHe, told staff at a leadership conference.

“these garments are just part of an organization-wide emphasis on quality and safety to create the safest possible environment for our patients.”

diane raines, dNp, rN, Nea-Bc, Baptist Health’s senior vice president and chief nursing officer, said newly designed patient garments made from Vestex fabric are designed to provide more coverage and “provide our patients with dignity as well as protection.”

“We believe this is not just an investment in new attire, but in an innovative technology that will make our environment safer,” said John Wilbanks, Baptist Health’s chief operating officer. “these uniforms are a symbol of our commitment to protect our patients, staff – and their families.”

But Wilbanks emphasized this technology alone is not enough. Baptist Health continues to focus on all aspects of infection prevention and safety.

1 Bearman Gm, rosato a, elam K, et al. a crossover trial of antimicrobial scrubs to reduce methicillin-resistant

Staphylococcus aureus burden on healthcare worker apparel. Infection Control Hospital Epidemiology, 2012;33:268–

275. Bearman, Gm, et al. Healthcare personnel attire in Non-operating room settings. Infection Control and Hospital

Epidemiology, 2014, 35: 107-121.

Unni Thomas, MD, vice chair of the Department of Medicine at Baptist Medical Center Jacksonville, tries on a Vestex lab coat with the assistance of Vestagen CEO Uncas “Ben” B. Favret III.


another way Baptist Health is enhancing safety is through a Bar code medication administration (Bcma) program. this program will make medication administration safer in all Baptist Health hospitals, with phased implementation that began in may.

Bcma involves the use of mobile computers, handheld scanners and updated emr features and functionality to ensure the right medication is getting to the right patient, at the right dose, through the right route and at the right time.

scanning the bar codes on the new armbands and medication packages will take place before medications are opened or administered to patients. Nurses will spend more time charting at the point of care; therefore, physicians will be able to see updated information in patients’ charts much more quickly.

“physicians will be able to be confident in making clinical decisions based on current information in the chart,” said debbie aguilar, pmp, senior clinical project manager for Baptist Health. “With the addition of mobile stations, nurses will have better tools for real-time documentation.”

For physicians, the new Bcma changes will help to close a gap in automating all of the processes, said louis penrod, md, Baptist Health’s chief medical information officer. “the bar code medication is the piece that has been missing to finally close that loop,” he said.

the program includes changes to both adult and pediatric patient armbands. single white-colored armbands with 2-d barcodes have replaced blue ed armbands. these 2-d labels are present on the patient’s armband and not on any additional labels, in order to ensure proper bedside identification.

“Based on what has happened at other facilities when Bcma was implemented, there is usually a clear, demonstrable improvement in medication administration as you automate each step along the way,” dr. penrod said. Bh

Bar Code Medication Administration enhances safety systemwide

“the number-one way to prevent infection in our hospital environments is effective hand hygiene,” said mobeen rathore, md, cpe, Faap, Fpids, Fidsa, Facpe, FsHea, chief of pediatric infectious disease for Wolfson children’s Hospital. “the addition of this uniform technology is one more way we can enhance our environment of safety.”

effective July 2014, about 5,000 Baptist Health hospital staff who have frequent patient contact will receive these new Vestex uniforms, including nursing, imaging, respiratory therapy and environmental services members.

“in the last five to 10 years, there have been a number of articles published showing that many objects in our environment become a vector for infection, including a doctor’s necktie, stethoscope and computer keyboards,” said ted Glasser, md, medical director of the Hospitalist program for Baptist Health and chief of staff for Baptist Jacksonville. “What’s exciting about the new material is that it increases our ability to break that chain of transmission.”

physicians are currently able to order lab coats and scrubs.

The new staff uniforms will be color-coded by function so that patients can more easily recognize who is caring for them.

new TeChnology


New tools help Wolfson Children’s Hospital neurosurgeons stream, store and share digital footage of complex surgical cases

Wolfson children’s Hospital recently installed connectsuite and studio3 technology in the dedicated pediatric neurosurgical suite and pediatric cardiovascular surgical suite. Wolfson children’s is one of the few children’s hospitals in the nation to have this advanced technology, thanks to a generous gift from the Beaubouef Family Foundation. members of the foundation were impressed by the potential educational opportunities presented by this technology for training by our pediatric neurosurgeons of other pediatric physicians around the world.

a hybrid or that recently opened in the Weaver tower at Baptist medical center Jacksonville for neurovascular surgeons ricardo Hanel, md, phd, and eric sauvageau, md, includes connectsuite and studio3 technology.

already being used by pediatric neurosurgeons philipp aldana, md; Nathan ranalli, md; and alexandra Beier, do, the neurosurgical suite has a wall camera and an in-light camera. during all video calls using connectsuite, not only can the neurosurgical team stream actual video from the surgical suite, but also anything that can be viewed on a monitor in the or, including patient vitals, navigation mapping, patient X-rays, images from the microscope, and more.

dr. aldana noted, “With this new technology, we have a powerful tool to capture, disseminate and archive digital information generated in the operating room. this greatly facilitates our missions in education, research and enhancing patient care. For example, we are able to capture high-resolution video of complex brain and skull-base surgeries second by second, and stream it live to physician residents and colleagues for teaching purposes. it doesn’t require the person who is watching to have anything other than a regular pc and monitor with a webcam and audio. and with bidirectional audio capabilities, we can answer questions from residents, pediatric specialty physicians, and other clinical professionals whom we grant access to via a secure network.”

dr. ranalli commented, “With studio3’s media management system, we can share our surgical

Technology also will be used in the near future for pediatric cardiovascular and adult neurovascular surgeries.

Pediatric neurosurgeon Nathan J. Ranalli, MD, (right, pictured with Paul Hofrichter, ARNP) performs a craniotomy in Neuro OR 10, which is being securely livestreamed into a conference room via ConnectSuite technology.


approaches for a range of advanced neurosurgical and craniofacial conditions, including endoscopic procedures for craniosynostosis, with referring physicians, as well as physicians and healthcare professionals in other children’s hospitals and academic institutions. We also can use it to show select footage to parents of patients on an ipad to help us explain complex procedures.”

While connectsuite allows real-time viewing of surgical procedures via the internet, studio3 technology allows Wolfson children’s Hospital and neurosurgeons to archive and share the content while protecting patient privacy and eliminating

the need for external hardware such as dVds and UsB drives.

michael d. aubin, FacHe, Wolfson children’s Hospital president, said, “We are implementing connectsuite and studio 3 in three phases. in this first phase, we will be able to stream video only within the Baptist Health network. in the near future, adult and pediatric neurosurgeons, neurovascular surgeons, and cardiothoracic surgeons with Wolfson children’s Hospital and Baptist Jacksonville will be able to share this surgical content with colleagues around the world for educational and other external purposes, while also being Hipaa-compliant.” Bh

University of Florida College of Medicine – Jacksonville pediatric residents and medical students gather to watch Dr. Ranalli perform a decompression surgery to relieve the pressure on a young boy’s brain as a result of Chiari malformation.

new TeChnology


GPS system helps in inspecting lungs

a superdimension® bronchoscopy uses electromagnetic technology to localize and guide endoscopic tools through the airways of the lung.

the technology overlays a patient’s ct scan on the body to guide the physician to the area of concern by providing a three-dimensional image rather than a one-dimensional image. the superdimension® bronchoscopy is used on hard- to-find tumors, small tumors, tumors that are deep in the lung toward the periphery and places where other structures may be limiting the doctor’s view.

“it’s effectively like a Gps in the lung,” said Jennifer Fulton, md, pulmonologist and secretary of the medical staff for Baptist medical center Jacksonville. “it gives us a pathway to get to the tumor. the technology has increased our rate of positive diagnostic studies by about 50 percent.”

“Before, it was like trying to find a rural route without a map. Now we have this technology that gives us a Google map for the lungs,” added dr. Fulton, who is also chief of critical care medicine for Baptist Jacksonville. “Now with this mapping technology, we see it live as we are doing the procedure.”

dr. Fulton noted that in the past, with a conventional bronchoscopy, it could be difficult to get to certain tumors and determine which airway to follow.

“You would get down there and then say, ‘No, i’m in the wrong airway,’ and back up and try again,” dr. Fulton said. “the machine now draws us a pathway and aligns the ct image with the patient lying on the table.”

the 3-d system enables physicians to diagnose benign and malignant lung lesions, enhancing

treatment decisions and minimizing the need for higher-risk procedures.

if there is a larger tumor that is centrally located and seen on the ct scan, a conventional bronchoscopy would still be the standard method to use.

But if the tumor is on the periphery of the lung or blocked by other structures, she said, this is a more effective procedure.

“it’s astounding to see how quickly technology has changed medicine,” dr. Fulton said.

“instead of dealing with developments over decades in terms of more accurate and less invasive diagnoses and improved therapies, we are now dealing in years and sometimes months,” dr. Fulton said. “innovation moves at both the macro level with robots and computer technology and the micro level with genetic-specific therapies now being delivered in diseases such as cancer and inherited disorders.”

“Not only do we now use computers to give us 3-d reconstruction to better assist us in understanding anatomy within individual patients, but we use it for therapy as well,” she added.

superdimension technology can be used to place fiducial markers to aid with radiation therapy, for example, and recently physicians used 3-d printing technology to reconstruct an airway (elsewhere in the nation) for an infant with an underdeveloped trachea.

“on a nearly daily basis, i am asked to evaluate new icU technology for monitoring patients or new technology for biopsies, from things as big and innovative as super-d to new forceps to obtain better biopsies with less crush artifact,” she said. “the

New advances in technology give pulmonologists the ability to better inspect lungs for certain tumors or airway abnormalities.


design that now creates medical technology has moved into the forefront of leading-edge engineering and computer design.”

However, dr. Fulton pointed out that as quickly as innovation occurs, physicians need to evaluate each development and see if it will truly move medicine in a better direction, or just in a sexier, more expensive one.

Pulmonologist Jennifer Fulton, MD, (left) looks for cancer on a patient’s lung using new GPS-type technology. Respiratory therapist Jeffrey Mathews assists.

“this can be a daunting task. as being a doctor becomes as much about the technology as it is the practice of medicine, we must remember to keep the patient at the center of all decisions,” dr. Fulton said. “Just as we have gene-specific therapy, we must also now have patient-specific clinical decision-making. Bh

new TeChnology


Catheterization labs continue to growBaptist medical center Beaches’ state-of-the-art hybrid lab for diagnostic cardiac catheterizations and interventional radiology procedures is surpassing its original goals.

For its first year ending april 15, the lab performed 382 heart catherizations, which was higher than the goal of 315.

“We hit more than 300, which was an important milestone. We will continue to do between 300 to 350 cases a year or more, which is good,” said ruple Galani, md, a cardiologist with Baptist Heart specialists at Baptist Beaches.

dr. Galani is also performing transradial catheterizations, in which doctors access the heart through the wrist rather than the femoral artery in the leg.

“it’s safer and more comfortable and has better outcome rates and fewer complications, but it does take more work and training,” dr. Galani said. “it’s better for the patient because there is less discomfort and there are fewer bleeding complications and less time lying flat. You can sit right up after the procedure. it allows people to become more mobile faster.”

the $3.3 million rackley center for cardiac and interventional radiology brought two new capabilities to Baptist Beaches:

n the lab has allowed Beaches residents to have diagnostic cardiac catheterizations performed at their local hospital.

n several interventional radiology procedures that had never been offered in the area are now available. these include declotting procedures to improve blood flow for dialysis patients, intra-arterial chemotherapy for tumors and tumor ablation.

“the new dual-procedure lab provides a more complete range of both cardiac and vascular care right here in the Beaches community, which means less need for patients to leave our community,” said Joe mitrick, FacHe, president of Baptist Beaches.

cardiac catheterizations are being offered at Baptist Beaches by cardiologists from Baptist Heart specialists, the same experienced physicians who perform these procedures at Baptist medical center Jacksonville and Baptist medical center south.

“the lab is doing well as a whole. the patients are happy, the physicians are happy, and the team is well-trained,” said Valory peeples, director of cardiopulmonary services for Baptist Beaches.

steve shirley, md, interventional radiologist at Baptist Beaches, said the new lab is larger and has more up-to-date equipment than most other local interventional radiology labs.

“We are able to offer a new array of services for cancer patients while continuing to provide the highest level of care,” dr. shirley said. “the expansion of the technical and nursing staff allows us to respond more rapidly to the needs of inpatients and er patients without inconveniencing our outpatients. this results in more efficient, timely treatment of patients, moving them more rapidly along the road to recovery.”

Bernardo Utset, md, who is board-certified in cardiology, interventional cardiology and internal medicine, is medical director of the Beaches catheterization lab.

“cardiovascular disease continues to be a leading cause of death among american men and women and claims more lives than all cancers combined,” dr. Utset said. “cardiac catheterization is the definitive anatomic assessment of the presence and severity of coronary heart disease, so we are pleased to add this to the other diagnostic tests already available at Baptist Beaches.”

Baptist south, whose cardiac catherization lab opened in 2011, does an average of 70 cases a month. many heart attack patients have been treated since may 2013, instead of needing to be flown to Baptist Jacksonville.

“it’s going well. We are expediting their care. they are getting intervention quicker so we are saving heart muscle,” said ron roberts, director of cardiopulmonary services at Baptist south. Bh

ruple galani, MDCardiologist


Computer-aided detection system assists radiologists

Baptist Health is using a new advanced computer-aided detection system to assist radiologists in helping to identify breast cancer earlier in women.

the system, developed by Vucomp, is called m-Vu® cad and works by analyzing mammographic images and marking suspicious areas using sophisticated mathematical algorithms.

in tandem with m-Vu cad, Baptist Health is also using another tool called m-Vu Breast density to evaluate the appearance of structures and textures in the breast to differentiate between fatty and dense regions.

While a few other hospitals in Florida use Vucomp’s advanced computer-aided detection tool, Baptist Health is the first in Northeast Florida to apply the technology and the first in the state to use Vucomp’s automated breast density product, according to the company.

the new technology is being used at all of Baptist Health’s mammography sites at: the Hill Breast center at Baptist medical center Jacksonville, Baptist medical center south, Baptist medical center Beaches, Baptist medical center Nassau and the Baptist clay medical campus.

christine Granfield, md, medical director of Breast imaging for Baptist Health, said Vucomp’s new system is more accurate at highlighting abnormalities, calcifications or masses.

“Vucomp uses the most advanced aerospace digital informatics in their technology,” dr. Granfield said. “Vucomp, compared to other computer-aided detection (cad) companies utilized, offers a far superior product with more accurate marks and far fewer erroneous marks than we have seen in other products.”

she added, “the technology is like having another set of eyes to look at the images. We are excited to be the only health system/center in Northeast Florida utilizing this advanced technology.”

the added technology also helps to more accurately assess a patient’s level of breast density, dr. Granfield said, which can be important information for the referring physician regarding managing patient care.

“the future of early detection lies in the hands of radiologists equipped with advanced imaging and analysis tools,” dr. Granfield said. “With these advanced tools, we will further help extend lives, shorten treatment times and reduce costs.” Bh

christine granfield, MDMedical Director, Breast Imaging, Baptist Health

oTher news


Baptist Health expands palliative access with new staff, longtime partner

palliative medicine, a new medical specialty focused on pain relief and care planning for the chronically ill, has exploded in U.s. hospitals in the past decade.

the center to advance palliative care reports more than two-thirds of facilities with at least 50 beds now have a dedicated palliative program. that’s up from less than a quarter in 2000.

Numerous studies document palliative care’s ability to improve health care quality and lower costs through relief of suffering and improved care coordination.

realizing the value palliative care brings to patients, Baptist Health is adding new staff to better serve a growing adult population that needs symptom relief and assistance with establishing health care goals, two pillars of this care.

pediatric patients have had access to palliative services since 2000 when community pedscare, a collaborative program with community Hospice, Wolfson children’s Hospital, Nemours children’s clinic and UF Health Jacksonville, began serving pediatric patients at Wolfson children’s Hospital.

today, representatives from a variety of clinical disciplines participate in Baptist’s palliative care committee. What began as and remains largely a grassroots effort to address the needs of patients with advanced illness and their families has led to the hiring of two full-time staff to support patient care.

social worker darleen cervasio, msW, and chaplain david morrell, mdiv, work alongside Baptist Health palliative care program coordinator tasha m. schoppee, rN, BsN, cHpN, with the support of Kristin Vondrak, dNp, arNp-Bc, Ne, cpHQ, Baptist Health vice president and chief quality officer.

these palliative team members work directly with providers from community palliative consultants, a physician consult service and program of community Hospice, which began serving Baptist medical center Jacksonville patients in august 2011.

chief medical director of community palliative consultants andrew daigle, md, joins newly hired associate medical director elizabeth mccullough, md, and the dedicated Baptist staff to form the core clinical team. the team leads intensive conversations with patients and families to help them relieve pain, understand treatment options and set realistic goals for their care.

“as palliative physicians, we are both impressed and encouraged by the acceptance and support Baptist has provided for our services,” dr. daigle said.

the clinical team sees patients admitted at Baptist Jacksonville and is beginning to work with ageWell institute. the goal is to expand the consult service, in collaboration with schoppee, Vondrak and the full palliative care committee, for systemwide patient access.

palliative care seeks to relieve the symptoms of serious and chronic illnesses, including pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. it helps patients find the strength to carry on with daily life, improves their ability to tolerate medical treatments, and gives them a sense of greater control over their care by helping them better understand their treatment options.

palliative care is appropriate at any age and at any stage of a serious illness. it also can be provided along with curative treatment. Bh

andrew Daigle, MDChief Medical Director, Community Palliative Consultants

Elizabeth Mccullough, MDAssociate Medical Director,Community Palliative Consultants


Baptist Medical Center Nassau and Community Hospice to help patients with hospice needs

community Hospice of Northeast Florida is leasing space in a new medical office building to open this summer at Baptist medical center Nassau in Fernandina Beach.

the eight-room unit is designed to meet hospice patients’ acute end-of-life care needs.

“We are continually looking for ways to bring more health care services to the families of Nassau county, and this collaboration with community Hospice will be another great resource for the community,” Baptist Nassau president stephen lee, FacHe, said.

“community Hospice has a reputation for providing excellent, compassionate, end-of-life care, and we are pleased they will be on the Baptist Nassau campus.”

lee said that, today, patients at that stage in their lives either stay in a hospital bed, go home to receive hospice treatment or go to a facility in Jacksonville, which makes it challenging for their friends and family to come visit.

“this will be very convenient. We will take them from a hospital room to a hospice room, and they will never have to leave the building,” lee said. “Family and friends can visit them in a first-class hospice facility that has hospice physicians and nurses taking care of them. it will make it convenient for their own doctors as well, because it will be right here on campus.”

community Hospice currently operates six other centers for caring, totaling 108 inpatient beds for short-term acute hospice care needs in Northeast Florida.

“community Hospice focuses on enhancing the range of services we provide to residents of Fernandina Beach, amelia island and throughout Nassau county,” said susan ponder-stansel, president and ceo of community Hospice. “We have a longstanding relationship with Baptist Health and look forward to collaborating further with their physicians and

staff to help bring comfort to those dealing with advanced illness.”

discussions are ongoing with other physicians’ offices to move into the three-story building, part of an $8 million expansion to the Baptist Nassau campus that includes a new parking lot, entryway and courtyard for patients and their families. other confirmed tenants include Baptist Heart specialists; Borland-Groover clinic; a new sleep lab; urologist Kenneth son, md, and pulmonologist John muir, md.

community Hospice serves nearly 80 hospice patients each day in Nassau county in private residences and at nursing homes and assisted-living facilities.

the new inpatient hospice unit is designed to provide short-term support for patients who require more intensive care than can be provided adequately at home. the goal is to stabilize patients, ensure their comfort and return them to their place of residence. Bh

Lyerly neurosurgeons from left are Ricardo Hanel, MD, PhD; Paulo Monteiro, MD; Andrew F. Cannestra, MD, PhD; Michael J. Petr, MD, PhD; Javier Garcia-Bengochea, MD, chair of the Lyerly board; Eric Sauvageau, MD and Bradley A. Wallace, MD, PhD.

oTher news


Celebrating 80 years of comprehensive neurosurgical care

lyerly Neurosurgery has provided neurosurgical care in Northeast Florida since 1934 when James G. lyerly, sr., md, opened a practice that today offers a full range of advanced neurological services for the brain, spine and nervous system.

through the years, lyerly has grown into a well-known practice in local, regional and national medical communities. lyerly’s strength lies in its ability to provide outstanding patient care, as well as its continuous improvement in innovative technology, including:

n providing 80 years of comprehensive care, innovative services and compassionate delivery

n providing patients with treatments to relieve chronic pain and shorten recovery time

n treating spine disorders, brain tumors, cerebrovascular disease, peripheral nerve disorders, skull base lesions and movement disorders

n Having professionals who are experts in minimally invasive techniques (brain and spine), neuroendoscopy, radiosurgery and endovascular neurosurgery

oldest neurosurgery practice in the region

dr. lyerly opened his practice as the first sole neurosurgical practice in Florida, and for the next five years, he was the only practicing neurosurgeon in the state, traveling from hospital to hospital performing surgeries. dr. lyerly, a graduate of the University of Virginia, practiced for 13 years before his arrival in Jacksonville. He sponsored the formation of the Florida Neurosurgical society. His son, James lyerly, Jr., md, joined the practice in 1956. meanwhile, the nearest cities where neurosurgeons practiced were orlando, New orleans and atlanta. patients from as far as 200 miles away would travel to Jacksonville for treatment.

affiliation with baptist health

in 2006, lyerly Neurosurgery partnered with Baptist Health to expand neurological care and provide a convenient option to patients in the surrounding areas of Northeast Florida. the group moved to the top floor of the newly constructed Weaver tower at Baptist medical center Jacksonville, a soaring 11 stories that includes facilities for both adults and children. the building contains neurosurgery operating suites and a Neurointensive care Unit with innovative, state-of-the-art features that produce fast results and cater to patients needs. Bh

James g. Lyerly, sr., MD


Patient Centered Caring Communication program

Physicians named to Baptist boards

effective communication leads to better health outcomes, according to the Joint commission. Baptist Health offers a patient caring centered communication course that focuses on key elements of effective communication with patients.

ten members of Baptist’s medical staff have completed the faculty training and serve as faculty to teach the four-hour course. since december 2012 when the course was introduced at Baptist Health, 178 Baptist physicians have attended. the free course earns physicians four continuing medical education credits.

evidence shows that better communication skills can help increase patient safety and satisfaction scores, increase compliance with treatment plans, enhance patient outcomes and decrease malpractice claims.

the patient centered caring communication course developed by the american academy

of communication includes classroom instruction, breakout groups and skills training. to register, go to the physician portal or call the medical staff office at 904.202.2080. the four-hour course is held from 3:45 – 8 pm to minimize disruption of physician practice.

sessions for 2014 are scheduled for aug. 14, sept. 11 and oct. 16 at Baptist medical center Jacksonville.

current Baptist faculty members include Jerry Bridgham, md, chief medical officer for Wolfson children’s Hospital; drew daigle, md; adam dimitrov, md; Nick dodaro, md; Graciela diez-Hoeck, md; mark puglisi, md; Hardik shah, md, vice chair of the department of internal medicine, Baptist Beaches, and michelle Zenko, md.

past faculty members include Justin Federico, do, Jantzen Fowler, md, and donald mars, md.

reserve your spot by registering today. Bh

Baptist Health recently announced that michael J. erhard, md, and timothy Groover, md, have joined Baptist Health’s Board of directors.

dr. erhard, a pediatric urologist, is medical director of Nemours children’s clinic, Jacksonville. He is also the chief of pediatric Urology for Wolfson children’s Hospital and Nemours, Jacksonville.

timothy Groover, md, is a board-certified anesthesiologist with Florida anesthesia associates in Jacksonville. He also serves as former chief of staff for Baptist medical

center Jacksonville and serves as co-chair of the hospital’s credentials committee. dr. Groover is the chairman of the Board of managers for Baptist physician partners.

Baptist medical center Beaches announced that cameron Greene, md, board-certified in obstetrics and gynecology, joined its Board of directors. dr. Greene is a founding partner of North Florida oB/GYN associates. He serves as president of North Florida oB/GYN, and is on the staff at Baptist medical center Beaches, where he has served as an officer of the medical staff. Bh

Michael J. Erhard, MDPediatric Urologist

timothy groover, MDAnesthesiologist

cameron greene, MDObstetrician and Gynecologist

briefs


cynthia anderson, md, radiation oncologist in the department of radiation oncology at Baptist medical center Jacksonville, has been selected to participate in the american society of clinical oncology’s (asco)leadership development program. asco is the largest organization devoted to

oncology in the country and has traditionally focused on the field of medical oncology.

she is one of 10 nationally who will participate in the program, which helps physicians network and receive mentorship, gain exposure to U.s. government research agencies, enhance leadership skills through interactive sessions, and receive first-hand advocacy experience on capitol Hill.

the program lasts a year and involves dr. anderson traveling every other month to Washington, d.c. she will meet with members of congress to discuss oncology issues and will be assigned a project and present findings at next year’s annual meeting.

as a radiation oncologist, she said she will benefit from networking with doctors in the medical oncology field.

she also will learn what issues they may be facing in oncology with changes in health care “as patients are trying to decide whether they can afford insurance, get screened for cancers, and afford treatments if they are diagnosed.”

“many times, several doctors are taking care of patients together,” dr. anderson said. “i think it’s good to understand the practice of oncology from other perspectives. i will be reaching out across my discipline to another discipline to help build some bridges of communication and think about cancer together.”

dr. anderson said the program could also give Baptist Health opportunities for collaboration with other institutions across the country.

“it’s also a good opportunity for those in the program to share some of their successes, as well as challenges, and how they are dealing with them,” she said.

dr. anderson looks forward to sharing her experiences and gaining insight from others about the future of oncology.

anderson also is chairing the annual speaking of Women’s Health conference on saturday, aug. 23. the day-long conference, which is devoted to women’s health issues, is an annual partnership between Baptist Health and WJct-tV. Bh

Radiation oncologist to participate in national oncology program

cynthia anderson, MDRadiation Oncologist

tom Hilton, md, a cardiologist and chief of cardiology at Baptist medical center Beaches, was recently honored by First coast News as a “Hero Next door.” once a month, dr. Hilton volunteers and renders free services to the uninsured and underinsured at Beaches community Health care clinic.

“the health care system in the United states is fractured. it is broken. in the meantime, we need a solution, and volunteerism has got be a part of that solution,” dr. Hilton told the television station.

dr. Hilton said there is an epidemic of cardiovascular disease across the U.s., and it claims more lives than all the cancers combined.

“i can either sit around and complain about the health care system or i can be a small part of the solution,” dr. Hilton said.

dr. Hilton has been helping the underserved for the last two years. He said the most rewarding part about volunteering is knowing he’s part of the solution. Bh

Cardiologist honored as “Hero Next Door”

tom Hilton, MDCardiologist


the Baptist center for Bariatric surgery received its accreditation last year by the metabolic and Bariatric surgery accreditation and Quality improvement program.

only centers meeting strict standards with a focus on the overall health of the patient receive the accreditation, which is a joint program of the american college of surgeons and the american society for metabolic and Bariatric surgery. requirements include performing at least 125 surgeries in a calendar year, having a dedicated medical director, offering support groups and providing long-term follow-up to ensure patients are staying on the right track to a healthy lifestyle.

Baptist Center for Bariatric Surgery accredited

2014 lifetime achievement award maryanne l. dokler, md pediatric surgeon Nemours children’s clinic, Jacksonville

pioneer of innovation award ricardo a. Hanel, md Neurovascular surgeon Wolfson children’s Hospital and Baptist Health

pediatrician of the year thomas p. stanley, md pediatrician Jacksonville pediatrics

hospitalist of the year Kuo “Jimmy” chen, md pediatric Hospitalist University of Florida college of medicine – Jacksonville

2014 Medical specialist of the year randall m. Bryant, md pediatric electrophysiologist UF college of medicine – Jacksonville

2014 surgical specialist of the year dawn m. duss, md pediatric ophthalmologist Nemours children’s clinic, Jacksonville

2014 resident of the year Kaitlin porcaro Vellore, md UF pediatric residency program – Jacksonville

2014 special recognition award Nicholas d. poulos, md pediatric surgeon Nemours children’s clinic, Jacksonville

Pediatric physicians recognizedat their June meeting, the Northeast Florida pediatric society presented awards to local pediatricians and pediatric subspecialists in our area in recognition of their efforts to improve the health and well-being of children in our community.

“We’re treating the weight, but most importantly we’re treating the medical problems people have or will have if they don’t address their obesity,” said craig morgenthal, md, Facs, medical director of the Baptist center for Bariatric surgery and chief of General surgery at Baptist medical center Jacksonville.

most patients who have bariatric surgery at Baptist are able to stop taking medications for high-blood pressure, cholesterol and diabetes once their weight is in check, dr. morgenthal said.

When a person is considering bariatric surgery at Baptist Health, the patient has a one-on-one meeting with a counselor to discuss weight and other health issues. in some cases, healthy eating and

exercise can alleviate the need for surgery. other patients, with input from Baptist Health surgeons and counselors, opt for surgery. Before patients can be scheduled for surgery, they are required to attend a support group for people who have undergone a bariatric procedure.

“Baptist center for Bariatric surgery continues to excel and grow as a major institution for the surgical treatment of obesity, which is imperative as more than 35 percent of the population in Northeast Florida are candidates based on current criteria,” said steven Hodgett, md, of North Florida surgeons and vice chair for the department of surgery at Baptist Jacksonville. Bh

briefs


Wolfson children’s Hospital gained international attention for pediatric development at a forum in Beijing last fall. three local physicians attended the 1st Beijing international Forum of pediatric development.

attended by 1,500 physicians, the forum was sponsored in part by Wolfson children’s Hospital and the University of Florida college of medicine – Jacksonville, as well as Beijing children’s Hospital and capital medical University in Beijing.

mark Hudak, md, chair of the department of pediatrics for the UF college of medicine – Jacksonville and chief of Neonatology for Wolfson children’s Hospital; thomas t. chiu, md, medical director for external affairs for the UF department of pediatrics in Jacksonville and former UF

pediatric department chair; and david Wood, md, medical director for UF’s center for Health equity and Quality research and program director for the college of medicine’s international medical education programs, attended the event.

dr. Hudak, who was vice chair of the organizational committee, presented at the conference on necrotizing enterocolitis and also on the effects of maternal drugs on newborns.

drs. chiu and Hudak noted that the Beijing forum gave Wolfson children’s Hospital international recognition and will lead to future educational and research

opportunities. three physicians from Beijing children’s Hospital, for example, came to the Jacksonville area in February for a month of observation. other leaders from the sichuan University in china also recently toured Wolfson children’s Hospital. Bh

Wolfson Children’s Hospital gains international attention

Dr. Chiu and Dr. Hudak with Kunling Shen, MD, vice president of the Beijing Children’s Hospital and president of the Chinese Pediatric Society.

Baptist medical center Jacksonville and Baptist medical center Nassau have been recognized by two international groups for excellence in lactation care.

the hospitals have received the iBclc care award in recognition for staffing professionals who hold the prestigious international Board certified lactation consultant® certification and provide a lactation program that is available five to seven days a week for breastfeeding families.

the award was given by the international Board of lactation consultant examiners and the international lactation consultant association.

catherine mcintyre, md, obstetrician and gynecologist with North Florida oB/GYN associates, said the awards demonstrate Baptist Jacksonville and Baptist Nassau’s

commitment to promoting breastfeeding for new mothers.

“it is valuable to have certified lactation consultants onsite to support and educate our patients about the importance and benefits of breastfeeding,” dr. mcintyre said. the lactation consultants will even help moms after they go home on an outpatient basis and are available by phone, dr. mcintyre added.

the facilities also demonstrated that they have provided recent breastfeeding training for medical staff who care for new families, and have recently completed activities that help protect, promote and support breastfeeding.

Baptist medical center south was recognized with the award last year. Bh

Baptist hospitals honored for lactation care


the Baptist clay medical campus celebrated its one-year anniversary in may.

the campus on Fleming island, which is providing clay county residents services closer to home, sees an average of 60 patients a day in the emergency center, about 40 percent of them children.

more than 21,000 patients, including more than 8,000 children, have been treated for emergencies throughout the year.

“We have far exceeded our expectations,” said darin roark, administrator of the Baptist clay medical campus and emergency service line at Baptist Health.

emergency physicians and staff from Baptist Health and Wolfson children’s Hospital provide care in the Baptist/Wolfson children’s emergency center, open 24/7. the emergency center has 16 treatment rooms, a separate waiting room for children, child-specific medical equipment and imaging capabilities, a lifeFlight helipad and an on-site ambulance.

staffed 24/7 by a board-certified emergency medicine physician, the 26,000-square-foot emergency center, which serves adults and children, is the centerpiece of 32-acre Baptist clay medical campus, located on U.s. Highway 17 and Village square parkway.

pediatric emergency medicine physicians affiliated with Wolfson children’s Hospital are also available during peak hours from 10 am to 10 pm.

“We have served children of all ages from clay county for decades, and now we are making it easier than ever for these families to access Wolfson children’s Hospital’s emergency, rehabilitation and specialty care

closer to home,” said Wolfson children’s Hospital president michael d. aubin.

diagnostic and imaging services available include ct, mri, X-ray, ultrasound, mammography, bone density and laboratory tests. imaging exams for children are offered by radiologic technologists specially trained to provide the smallest radiation dose possible for accuracy and safety. images are read by pediatric radiologists from Wolfson children’s Hospital.

a three-story medical office building on the campus includes a Wolfson children’s specialty center, Wolfson children’s rehabilitation, Nemours children’s clinic, University of Florida college of medicine – Jacksonville, Baptist primary care, Baptist Heart specialists, Baptist medical center cardiac testing, Borland-Groover clinic and orange park pediatrics.

Nicholas dodaro, md, emergency medical physician with emergency resources Group and emergency medicine director for the clay emergency center, said the chance to integrate pediatric and adult medical specialties in clay county “has been exciting and beneficial.”

“the physicians who are here have really enjoyed the chance to work with the clay county physician community,” dr. dodaro said. “it’s been great also to work with clay county Fire rescue and emergency services who bring a high level of professionalism and medical capability. the cultivation of relationships has really been rewarding for staff.” Bh

Serving children and families in Clay County

a nursing website listed Baptist medical center Jacksonville as No. 4 in an original list of 30 most nurse-friendly hospitals nationally.

the website, toprNtoBsN.com, evaluated hospitals that value their nursing staff, provide employees with a host of benefits and have

support teams and outstanding work environments. the list noted that many of the hospitals have received awards for the quality of their nursing staff and practices and also offer educational, training and career advancement programs.

in highlighting Baptist Jacksonville, the website pointed to the system’s comprehensive benefits package, as well as “adjustable schedules, training remuneration and assistance to the tune of $5,000 for first-time homebuyers.” Bh

Baptist Medical Center Jacksonville recognized as nurse-friendly

thomas Moon, MDPediatric Cardiologist

New Baptist Health Medical Staff membersApril 1, 2013 to March 31, 2014

baptist Medical center Jacksonvillemark K. ackrell, md, emergency medicine (B, s)

indrani e. acosta, md, teleneurology

Waqas ahmed, md, internal medicine Hospitalist (s)

Jon c. allmon, md, Vascular surgery (B, s)

aisha amin, md, internal medicine Hospitalist (s)

Heidi H. ashbaugh, md, emergency medicine (s)

Zeeshan s. aziz, md, otolaryngology (s)

Kim m. Barbel-Johnson, do, Family medicine

Frederick c. Beck, md, Family medicine

Bhavna Bhasin, md, internal medicine Hospitalist

ryan B. Brenes, do, emergency medicine (Fasttrack) (s)

mark W. Brodeur, md, emergency medicine (s)

William m. Brown, iii, md, emergency medicine (s, N)

michael l. Burleson, md, emergency medicine (Fasttrack) (B, s)

mujtaba i. Butt, md, Gastroenterology (s)

James e. callan, md, emergency medicine (s)

Joseph a. cartwright, md, pain medicine (s)

robert J. catalla, md, infectious diseases (s)

donald s. covington, md, Hyperbaric medicine

larry V. crisco, md, cardiology (s)

marcelo c. darabos, do, emergency medicine (s)

melinda davis-malesevich, md, otolaryngology

Justin G. deaton, md, emergency medicine (B, s)

andrea e. deNeen, md, cardiology (s)

James W. dennis, md, Vascular surgery (B, s)

Zachary deutch, md, anesthesiology (W)

oscar d. espetia, md, emergency medicine (B, s)

Nura Festic, md, Family medicine

Gigi Geiger, do, pain medicine (s)

Joe e. Gerges el Khoury, md, Gastroenterology

peter F. Gloersen, md, pediatric anesthesiology

Bharat K. Gummadi, md, cardiology (s)

Joseph H. Habib, md, Vascular surgery (B, s)

ricardo a. Hanel, md, endovascular Neurosurgery (W)

christopher c. Henderson, md, emergency medicine (s)

michael e. Herman, do, Gastroenterology (s)

Zhigao Huang, md, Neurology

silke N. Hunter, md, Family medicine

tanya e. Hunter, md, emergency medicine (Fasttrack) (B, s)

Vatsal inamdar, md, cardiology (s)

Franklin l. irwin, Jr, md, pain medicine (B)

syed H. Jafri, md, internal medicine Hospitalist (s)

alexis a. Jimenez, md, pain medicine (s)

Benjamin r. Jivcu, do, emergency medicine (s)

steven B. Kailes, md, emergency medicine (s)

Nikolaos Karamitsos, md, internal medicine Hospitalist (s)

Heidi N. Kenney, md, emergency medicine (s)

elizabeth c. Kent, md, Hematology/oncology (s)

Jason l. Kent, do, emergency medicine (s)

Jaime l. Kibler, do, Family medicine (s)

James r. Kimberly, md, Gastroenterology (s)

chelsea s. Kolshak, md, emergency medicine (s)

semaan G. Kosseifi, md, pulmonary diseases (B)

Kristin V. Kowalchik, md, radiation oncology (B, s, W)

Jeffrey W. Krenzer, md, Family medicine

amy r. Kulak, md, ophthalmology

louis V. la Vopa, md, emergency medicine (s)

lin li, md, pathology (B, s, N, W)

Xiaoyu li, md, Gastroenterology (s)

Jenny t. lim, md, emergency medicine (Fasttrack) (s)

Breno d. lima, md, ophthalmology

stephen J. macdade, md, emergency medicine (s)

dinesh madhok, md, Gastroenterology (s)

rajesh mali, md, internal medicine Hospitalist (s)

christopher J. mann, md, emergency medicine (s)

lawrence J. mason, md, internal medicine Hospitalist (B, s)

tiffany t. massey, md, Family medicine Hospitalist

Jennifer l. mauzy, md, emergency medicine (B, s)

Gerald s. maxwell, do, emergency medicine (Fasttrack) (s)

christina a. mcadams, md, emergency medicine (Fasttrack) (s)

elizabeth H. mccullough, md, palliative medicine

Jason r. molinaro, md, psychiatry (B)

Brian B. moon, md, radiology (B, s, W)

Walter morales, md, maternal and Fetal medicine (s)

shahriar a. Nabizadeh, md, physical medicine and rehab (s)

simone Nader, md, cardiology

eli Neiman, do, teleneurology (s)

omeni N. osian, md, cardio thoracic surgery (B)

ravi U. pande, md, Neurology

Joseph W. parks, md, plastic surgery (B, s)

rutuja d. patel, do, internal medicine Hospitalist (s)

david J. powell, md, emergency medicine (s)

ariel d. prager, md, radiology (B, s, N)

Jayapriya raj, md, internal medicine Hospitalist (s)

sofija a. rak, md, Family medicine (s)

edgard ramos-santos, md, maternal and Fetal medicine (s)

Jaime m. ranieri, md, plastic surgery (B)

michael ravelo, md, emergency medicine (Fasttrack) (B, s)

malleswari s. ravi, md, internal medicine Hospitalist (B, s)

shariq refai, md, psychiatry (B, s)

sharon l. reinertsen, md, Family medicine

emily G. rostholder, md, Gastroenterology

tatjana a. rotko, md, internal medicine Hospitalist

abhijit roychowdhury, md, Gastroenterology (s)

muhammad a. salahuddin, md, Nephrology

eric sauvageau, md, endovascular Neurosurgery (W)

deepak scindia, md, internal medicine Hospitalist (B, s)

swati shah, md, rheumatology

marwan e. shaikh, md, internal medicine Hospitalist

manisha shakya-siddhi, md, internal medicine Hospitalist

lenka soltes champion, md, ophthalmology

Jason a. soriano, md, teleneurology

Jonathan a. staman, md, ophthalmology (W)

Kristen m. stewart, md, dermatology (s, W)

christine e. swenton, md, emergency medicine (B, s)

cynthia s. tainsh, md, teleneurology (s)

staci tanouye, md, obstetrics and Gynecology

Kimberly N. thivierge, md, emergency medicine (s)

Karen a. toppi, md, Gynecology (s)

philip V. tran, md, internal medicine Hospitalist (B, s)

ali tutar, md, cardiology

ameeth Vedre, md, cardiology (s)

ramesh Vedula, md, radiation oncology (B, s, W)

Hermes Velasquez, md, pulmonary diseases (B, s,)

aaditya m. Vora, md, cardiology (s)

alison e. Vukich, md, Family medicine

timothy m. Ward, md, emergency medicine (s)

adrienne Warrick, md, anesthesiology (W)

louise K. Webb, md, pediatric emergency medicine (B, s, W)

dilendra H. Weerasinghe, md, General surgery (s)

Jenny Whitworth, md, Gynecologic oncology (B, s)

tommy c. Yu, md, physical medicine and rehab (s)

sikander Zulqarnain, md, pulmonary diseases (s)

baptist Medical center beachesmichelle e. aquino, do, internal medicine Hospitalist

igor Berengolts, md, internal medicine Hospitalist

Warren ”casey” V. carrigan, iii, md, Neurology

anhtung t. chau, md, Gastroenterology

Harry J. d’agostino, Jr., md, cardio thoracic surgery

John t. daniels, do, pulmonary diseases

amie G. deutch, md, Gastroenterology

christina Gindele, md, emergency medicine

Babak H. Golbaba, md, anesthesiology

John d. Grigas, md, pulmonary diseases (N)

stephanie l. Henley, md, oral & maxillofacial surgery (W)

samuel p. Jacks, md, cardiothoracic surgery

saundra a. Jackson, md, emergency medicine

david m. Johnson, md, Family medicine

Fawad Khawaja, md, cardio thoracic surgery

prasanth Krish, md, Nephrology

Jason d. meier, md, otolaryngology (W)

peter a. Nassar, md, pulmonary diseases

Kristen l. Neuharth, md, internal medicine Hospitalist

eric d. pinnar, md, General surgery (s)

prabodh ranjan, md, Nephrology

richard reid, md, pulmonary diseases (N)

Joseph B. salenga, md, internal medicine Hospitalist

danny H. Vo, md, Vascular surgery

Hamilton Warren-sutton, md, psychiatry

baptist Medical center nassaudavid a. Holloman, md, pathology

eduardo oyola torres, md, radiology

ronald J. ross, md, emergency medicine (Fasttrack)

Kenneth a. son, md, Urology

Bijoy p. telivala, md, Hematology/oncology

Unni c. thomas, md, Hematology/oncology

maria J. Valente, md, Hematology/oncology

robert J. Wilson, md, internal medicine Hospitalist

George r. Woodward, do, emergency medicine

baptist Medical center southKakarla V. chalam, md, ophthalmology

doreen m. dargon, md, emergency medicine

donald m. downer, md, ophthalmology

Kenneth J. eaddy, md, internal medicine Hospitalist

ali moghani lankarani, md, Gastroenterology

saswata roy, md, pediatric otolaryngology (B)

wolfson children’s hospitalVibhuti agarwal, md, General pediatrics

Geoffrey a. agrons, md, pediatric teleradiology

rana alissa, md, pediatric emergency medicine (Fasttrack)

steven m. andreoli, md, pediatric otolaryngology

mark d. Bedard, do, General pediatrics

aleksander Bernshteyn, md, pediatric surgery

mark a. Bittles, md, pediatric teleradiology

angela p. Black, md, pediatric otolaryngology

april d. Brenes, md, General pediatrics (s)

arabinda K. choudhary, md, pediatric teleradiology (s)

ameneh a. ebadi, do, pediatric emergency medicine (Fasttrack)

tirbod t. Fattahi, md, oral & maxillofacial surgery

mary K. Greene, md, pediatric teleradiology

sara Guzman, md, General pediatrics

laura J. Hanahan, md, pediatric teleradiology

renee m. Heng, md, pediatric anesthesiology

clara c. Howell dudley, md, General pediatrics (s)

shareen ismail, md, pediatric emergency medicine

lincoln Jimenez, md, pediatric Neurosurgery

Vinay V. Kandula, md, pediatric teleradiology (s)

Grace Kunjukunju, md, General pediatrics

matthew r. locklair, md, pediatric emergency medicine

sandra machado, md, pediatric teleradiology

carol a. mannings, md, pediatric emergency medicine

thomas d. miller, iii, md, pediatric emergency medicine

ronny l. rotondo, md, radiation oncology

staci m. suggs, dds, pediatric dentistry

lournaris torres-santiago, md, pediatric endocrinology

erick N. Viorritto, md, pediatric Neurology

chantel p. Walker, md, General pediatrics

key

(B) also on the Baptist medical center Beaches medical staff

(N) also on the Baptist medical center Nassau medical staff

(s) also on the Baptist medical center south medical staff

(W) also on the Wolfson children’s Hospital medical staff

800 prudential driveJacksonville, Fl 32207

NoNproFit orG.

U.s. postaGe

PAIDJacKsoNVille, Fl

permit No. 3693

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VitalSigns Summer 2014