Category: 2024

Upstate Golisano Children’s Hospital: Celebrating 15 Years of Excellence in Pediatrics

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By: Elizabeth Landry

Since the Upstate Golisano Children’s Hospital first opened its doors in 2009, the hospital has grown and evolved significantly while remaining true to its founding mission of providing safe, effective, innovative and family centered care for children across the Central New York region. Now celebrating its 15-year anniversary, the children’s hospital has become a 71-bed pediatric healthcare hub serving children in 22 counties that span North to the Canadian border and South to the Pennsylvania border. Under the leadership of Gregory Conners, MD, MPH, MBA, Professor and Chair of Pediatrics and Executive Director of Upstate Golisano Children’s Hospital, who joined the hospital in 2019, the organization is a pillar of Central New York healthcare and has had a strong positive effect on the community.

“It’s the people in the community who really helped us get started,” said Conners. “I frequently meet people whose kids or grandkids, nephews or nieces have been treated here over the past 15 years. I really think people don’t take us for granted because many can remember a time when there wasn’t a children’s hospital here and they notice we have a better community because of the excellent care we provide for the children.”

The children’s hospital has produced significant research that has made an impact on strategies for treating pediatric patients, including research on Covid prevention and vaccination and the prevention of RSV infection. Both research and community improvement are keystones of the robust pediatric residency program, during which the intern year also includes skills in advocacy and global health.

Conners expressed how proud the team is of the program, saying, “We work hard to give our trainees great experiences. We all put a lot of time and energy to make the program the very best it can be.”

Well-Rounded Pediatric Care Through Extensive Subspecialties
To provide children with comprehensive healthcare, the Upstate Golisano Children’s Hospital offers services from a long list of subspecialties. These include experts in pediatric hospital medicine, pediatric cardiology, children’s infectious diseases, rheumatologic conditions, pediatric nephrology, pediatric urology, gastroenterology and nutrition, and many more. Importantly, healthcare providers from the different pediatric subspecialties often function as one holistic pediatric team rather than separate departments.

“Many children need two or three different medical providers at once. We often have multiple physicians from different specialties collaboratively caring for the same child. It’s the whole team of specialty physicians, nurses and other health professionals who work together that makes the children’s hospital so special,” emphasized Conners.

An important distinction the children’s hospital holds is serving as the region’s only ACS verified Level 1 Pediatric Trauma and Burn Center, which is, in fact, one of only eight such trauma centers in the state. The Trauma Center provides around the-clock care for children critically injured by such mechanisms as falls, motor vehicle accidents, bicycle crashes and physical abuse. The summer of 2024 saw a record number of pediatric trauma activations.

Kim Wallenstein, MD, PhD, Pediatric Trauma Medical Director, emphasized the importance of the care her team provides and highlighted the impact of preventing injuries before they happen. “We have a top-notch trauma team in place to provide care whenever it is needed. Additionally, we strive to raise awareness of injury prevention strategies, so children avoid traumatic injuries in the first place,” she said.

The Upstate Trauma Center is staffed by fellowship-trained pediatric surgeons, who also see a wide variety of surgical patients at the hospital’s Center for Children’s Surgery.

“All types of surgery for children should be done by someone with a focus on pediatrics,” noted Tamer Ahmed, MD, Division Chief of Pediatric Surgery.

“Our entire infrastructure as part of a children’s hospital is set up to care for pediatric patients from birth into their teens, and the unique needs of each age. This includes working with pediatric subspecialists, pediatric nursing, child life and others. From evaluation to treatment to follow up care our entire children’s hospital is focused on caring for children and their families, whether they are one day old or 17 years old.”

Inpatient and Outpatient Pediatric Services

In addition to the hundreds of children treated on the inpatient floor of the children’s hospital, Upstate University Hospital also has an extensive network of pediatric outpatient services. Upstate is the only institution in 

Central New York to offer comprehensive pediatric services for children diagnosed with cancer or blood disorders including leukemia, brain tumors, solid tumors, benign blood disorders (anemia and thalassemia, among others), sickle cell anemia and hemophilia. Children needing these services are cared for at the hospital’s Waters Center for Children’s Cancer and Blood Disorders, and patients have immediate access to inpatient services at the Golisano Children’s Hospital as needed. The team at the Waters Center also focuses on research trials and studies aimed at advancing how childhood cancer is cured. Melanie Comito, MD, Director of Children’s Cancer and Division Chief of the Waters Center, explained the importance of devoting time to research studies.

“As members of the International Children’s Oncology Group, a wide-ranging network of pediatric oncology providers, we’re able to actively participate in the advancement of childhood cancer treatment. Each pediatric cancer center doesn’t see many patients of the same type of cancer, so we work together across the country to study new drugs and treatment strategies. Childhood cancer and hematology treatment keeps advancing, and there have been many improvements over the years,” Comito said.

Comito also highlighted the importance of survivorship at the Waters Center, which includes the Survivor Wellness Program to help children prepare for life as adults, assisting them with their health care needs and how to handle their complicated medical histories.

“My passion is watching the children grow up and getting back to their lives again,” stated Comito. “Survivorship is important because we’re monitoring any delayed effects of drugs and treatments and we’re also trying to teach them good habits like nutrition and exercise, taking care of their mental health, and helping them understand that it’s OK to feel different from their peers. We hope that by the time they are late adolescents or young adults they know how to advocate for their adult healthcare. We’ll always remain a resource for them.”

Comprehensive Support Through Child Life

Another major service supporting pediatric patients is the Child Life department led by Regina Lozito, Director of Child Life. The department grew from a team of three to a team of 18, who help children and their families cope with medical experiences. Child Life Specialists offer support in the inpatient setting of the children’s hospital and in many Upstate clinical areas.

“We work very closely with the medical staff to make sure children can tolerate what we’re asking them to do” said Lozito. “For example, if a child needs an MRI or a CT scan, we help assess if they can undergo the procedure without anesthesia, which helps lower their risk, and we use age-appropriate strategies to help them understand what will happen so they can get through the experience as easily as possible.”

Much of the Child Life Department’s work involves helping children use coping strategies such as play, art and music therapy, as well as gaming and tech, but another side of the work involves legacy building when end of life care is needed, whether for a child or for a child’s caregiver. Jewelry made using fingerprints or handprints after a loved one passes away, and heartbeat recordings placed into stuffed animals are some of the ways the Child Life department provides support in difficult situations.

No matter the specific application, the Child Life department makes an impact on children that lasts into adulthood. “We’re teaching them coping skills they can use in any situation, such as at school and eventually as adults,” said Lozito. “They can teach other kids strategies like deep breathing, counting and squeezing a stress ball–generally learning how to deal with really difficult situations in a positive manner.”

The department also will soon have a facility dog, who will be highly trained to be an extension of the Child Life staff. “We’re really excited about this new program because research shows animals help bring down blood pressure and make people less anxious,” Lozito explained.

Community Connections and Continued Expansion
As the Upstate Golisano Children’s Hospital grows and expands, one aim is to continue cultivating meaningful connections in the community. Kali Kearns, MHA, Administrator for the Upstate Golisano Children’s Hospital, recently joined the hospital’s leadership team to focus on strategic planning, growth and expansion, and community relationships and partnerships.

The children’s hospital partners with the Upstate New York Safe Kids Coalition, which uses advocacy, education and preventative strategies to reduce the incidence of injuries in children in the community. Kearns emphasized plans for developing further ties in the community as well as ways the hospital aims to increase service offerings.

“We are excited to develop new partnerships so we can continue to provide important preventative services in the community,” said Kearns. “With Micron coming to the area, we need to think about the potential influx of pediatric patients and make sure we can continue to meet patient needs in both the inpatient and outpatient setting. We really put the patient and their family at the center of everything we do, and our aim is to continue to provide the best experience possible.”

Conners also echoed the sentiment that patients and their families are at the heart of the hospital’s strategies for continued expansion into the next 15 years and beyond.


“When I first came to the hospital, I immediately liked the culture, the collaborative nature of the team and the mission that we have of caring for the children in our community,” explained Conners. “I’m looking forward to continuing our growth and being able to care for more and more children and families over time. We’re not growing the organization and increasing our connection to the community because we want to be the biggest, but because we truly want to serve as many kids as we can.”

Serving on a Board

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By: Kathryn Ruscitto, Advisor

Throughout my career I have served on a variety of Not for Profit Boards. It’s a way to serve the community, open doors, connect people and causes, and to learn Boards can help you to build new skills, connect with new parts of the community, begin to plan for things you want to do in your free time or in retirement. Good Board members want to learn and aren’t afraid to ask questions. Recently I was at the View Arts Center in Old Forge and met a new surgeon who had moved to Syracuse. She had taken the time to explore not for profit arts organizations in the region and was visiting them to get to know the region.

Boards function differently, and expectations of Board members can vary. It really is important to think through why you are joining a Board and what your expectations are for that service.

Some simple guidelines should always be part of a Board members thinking: What is expected of me: time, donations, terms of service.

What do I expect from the organization: following state and federal guidelines, communications on meetings and important issues.

How do you go about deciding on a Board or getting to know what organizations might be a good fit? Talk to colleagues, look at their current Board list, call and talk to the Executive Director. Many of you attend community fundraisers, also a good place to ask about Board service.

The Boards I have enjoyed the most, pushed what I knew, and connected me to best practice ideas. The Boards I found frustrating provided information but didn’t use my skills or ask for help. 

Not for profits are local, regional and national. Some belong to larger associations or organizations that have Boards at multiple levels. Board service in a not for profit is as a volunteer and is uncompensated. Organizations carry Board and officer insurance coverage to protect Board members.

There are also For Profit Boards of start ups and businesses that seek certain disciplines for their Boards and do provide compensation and other benefits. These Boards choose members primarily through other Board members. The services that promise to get you a Board seat in exchange for a fee are unproven.

Some mix of Board service across for profits and not for profits during a career is desirable.

Resources:
www.councilofnonprofits.o g/running-nonprofit/ governance leadership/board-roles and-responsibilities

www.boardeffect.com/blog pros-cons-nonprofit-board-membership/

www.boardsource.org/fundamental-topics-of-nonprofit-boardservice/roles-responsibilities/

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com

Grieving Families Act 3.0: What’s Changed?

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By: Jenn Negley, Vice President, Risk Strategies Company

Most in healthcare and medical malpractice have been keeping an eye on the GFA legislation for several years now knowing the negative effect it would have on an already stressed sector. While all involved are assumed to have good intentions, it appears they have a blind spot when it comes to the GFA’s impact on the State’s medical malpractice insurance market and in turn healthcare. This failure to address the concerns continues with GFA 3.0 despite being clearly indicated in past vetoes.

While GFA 3.0 did eliminate “disorders” as a category of damages it maintained “grief or anguish.” The GFA 3.0 also still looks to broaden the current statute of limitations from two years to three years. GFA 3.0 originally scaled back the “eligible” family members that could recover damages to the current law’s definition only to propose assembly bill AB 9232B/S8485B that would result in the expansion of eligible family members once again. What is most troubling to industry experts is the current GFA calls for an immediate implementation effective for all wrongful death that occurs on or after January 1, 2021.

As I mentioned last year when discussing the GFA 2.0, malpractice carriers are already struggling with upticks in claim frequency and a dramatic rise in payout amounts. A recent study released in April 2024 by the New York Civil Justice Institute titled Consumers in Crisis How New York’s Hostile Liability Environment Inflates Insurance Cost and Fleeces Empire State Families (www.nycji.org/research) details the issues already contributing to a difficult insurance market. If signed as is, it will add to the pressures already in play. With no caps in place, more time to file, and the broadening of who can file the deck will be stacked against malpractice carriers. In addition, adding the change retroactively eliminates a carrier’s ability to make the necessary financial adjustments potentially forcing some out of the market. To maintain solvency, carriers as well as the insurance department will keep a close eye on these trends which might indicate the need for increased rates. Milliman, an independent actuary determined with the new inclusion of grief and aguish only, rates would need to be increased by 40%. As this has dragged out for several years, I have had the opportunity to speak to many of New York’s carriers’ upper management and everyone agrees such an increase would be a disaster for New York’s healthcare market, but all also note their fear that the New York State Department of Financial Services will see it as a necessity for admitted carriers to remains solvent.

To be clear, none of the admitted carriers are looking to take these steps but cannot ignore the independent statistical analysis of the GFA’s impact on their ability to defend New York’s healthcare providers and facilities. With little change, the “New” GFA the Governor’s veto message from last year still rings true. “Legitimate concerns have been raised that the bill would likely lead to increased insurance premiums for the vast majority of consumers, as well as risk the financial well-being of our healthcare facilities – most notably, for public hospitals that serve disadvantaged communities.” For the health safety of all New Yorkers GFA 3.0 in its current form needs to be vetoed once again.

Reach out to Governor Hochul now.
Facebook: @Governor Kathy Hochul

Twitter: @govkathyhochul

Instagram: @govkathyhochul

For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@Risk Strategies.com.

The views expressed in this article on pending legislation are solely those of the author and do not necessarily reflect the official stance, policies, or opinions of Risk Strategies. This article is intended for informational purposes only and should not be construed as professional advice.

CPR Gave Patient CriticalTime to Get to Crouse

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FOR LIFESAVING CARDIAC CARE

Steve Gorczynski, 55, remembers very little of what happened on the morning of Aug. 30, 2023, but his wife, Julie, will never forget it.

She woke up when she heard a “thud” and found her husband unresponsive on the floor. Julie immediately called 911. She hadn’t taken CPR since their children were small, but with the help of the 911 operator, she was able to administer it to her husband until a police officer arrived within minutes and took over. EMTs quickly showed up, continuing CPR and using a defibrillator on Gorczynski twice. Julie asked the first responders to transport her husband specifically to Crouse Hospital, acknowledging that the well-known tagline: “Take Me to Crouse,” was echoing in her head.

These quick actions were critical to Gorczynski’s survival and successful recovery, according to his cardiologist Anil George, MD, FACC, a member of Crouse Medical Practice. “Time is heart muscle,” says George. “Steve’s heart took a big hit, and had he not received CPR almost immediately, he may have had a very different outcome.”

Ready at Crouse
George and the team at Crouse were ready when Gorczynski arrived at the hospital. “Once we got his EKG, we rushed him to the cardiac cath lab on arrival and quickly inserted a stent into his blocked artery,” says George. “Crouse’s average ‘door to balloon time’ is 63 minutes — in comparison to the national guidelines recommendation of 90 minutes or less — and we work hard to maintain that critical window. We’ve developed a smooth transition to minimize delays and get patients into the cardiac cath lab as quickly as possible.”

Gorczynski had a lethal arrhythmia of the left anterior descending (LAD) artery. Commonly known as the “widow maker,” only 12% of those who experience this condition outside of a healthcare facility survive, according to the American Heart Association (AHA). If CPR is not given within five minutes or less, the heart and brain are deprived of oxygen, causing irreparable damage to the heart muscle and cognitive issues, and, in many cases, death.

After the cardiac team inserted a stent to open the blockage, Gorczynski was put into a medically induced coma. The Crouse team was there every step of the way to ensure his full recovery. He doesn’t remember much until Day 5. On Day 8, he was able to go home to continue his healing.

Road to Recovery
“My doctor and nurses were very surprised that I had such an accelerated recovery,” explains Gorczynski. “It’s kind of miraculous. I did have some cognitive issues due to the medication I was on, and I needed some occupational therapy, but my post checkup showed no scar tissue from the heart attack, and I felt almost normal after a couple of weeks.”

Before his heart attack, Gorczynski never had indications of cardiac issues, and he was physically fit. In fact, a check-up shortly before this event had given him a clean bill of health. Today, as he marks the one year anniversary of his heart attack, he is back to his full exercise routine, and while he never had high cholesterol or weight issues, he has improved his diet.

Bank Employees Learn the
Importance of CPR

Gorczynski is the Central New York regional president of M&T Bank, and after his experience he thought it was important to offer basic CPR and AED (automatic external defibrillator) training to bank employees and their families with the help of Crouse and the local chapter of AHA. More than 80 employees learned CPR, including Gorczynski himself. The group was joined by seven nurses from Crouse, led by Lynne Shopiro, RN, chief nursing officer and cardiac nurse, who is also president of the Central New York Chapter of the AHA’s advisory board.

“You don’t have to be a medical professional to learn hands-on CPR,” Shopiro says, noting that the current method involves hands-only chest compressions with no mouth-to-mouth resuscitation. “Learning basic CPR takes five minutes and gives you the confidence as a bystander to help someone in need. I think it’s important for people to remember that CPR can double or triple the chance of someone surviving a cardiac event.”

The CPR training at M&T was a success, and Gorczynski hopes to offer it again in the future. In addition, he and Julie helped coordinate CPR training in their Manlius neighborhood this past year.

“I’m a big proponent of learning CPR, and I’ll continue to spread that message,” Gorczynski says. “The experience is still very surreal. I’m not sure I realized how serious it could have been at the time, and I’m sure I was a bit of a challenge as a patient, but I’m very thankful for my wife, the 911 operator, the local police, EMTs and everyone at Crouse who helped save my life with the excellent level of cardiac care and compassion that the hospital offers. There were a lot of people rooting for me and a lot of people who made sure that I’m here today — healthy and grateful.”

 

Women In Healthcare- Setting No Limits: Recognize Your Dreams and Make Them Your Reality

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By Erin L.W. Zacholl

Swans move across water with such dignity and (what appears to be) effortless ability that it’s easy to admire what they achieve as they glide to their destination. Unless we really ponder what’s being done beneath the surface, we rarely see the hard work that’s propelling them. There are people among us with this same amazing trait. Dr. Tanya Paul is a shining example of someone with a calm and dignified quality that’s perfectly blended with a tenacious spirit that drives her to achieve her goals and then, set new ones.

Dr. Paul is a physician specializing in Obstetrics & Gynecology at Auburn Community Hospital. “Anything is possible if you want to work for it,” she says from a lifetime of experience. “Even as a young child, I have worked toward the direction of accomplishing my dreams.” Originally from Queens, New York, Dr. Paul graduated from the University of Virginia School of Medicine and completed her internship and residency at SUNY Upstate Medical University in Syracuse. “I knew from a very young age that medicine would be a large part of my future,” Dr. Paul reflects on the dreams of a school-aged child, “Although the type of medicine I’ve built my career on is different from my childhood goals, I knew I would become a doctor.”

“My medical ambitions began when I lost two grandparents in one year to cancer,” Dr. Paul remembers that this impacted her so profoundly, that she wanted to cure cancer. “I was so young, but this childhood tragedy opened my mind to practicing medicine. I was determined.” As a young girl, her medical direction would change, “When I was in 5th grade, a friend of mine endured a serious eye injury,” she details, “after seeing her appearance as she had been treated and was recovering, I wanted to be an eye doctor.” It was this dream that Dr. Paul clung close to through the rest of her adolescence and even through her medical school interview.

In medical school, Dr. Paul entertained her various rotations as a young student. “I kept an open mind to possibilities beyond my long-time dream, but was still focused on ophthalmology.” On her first night during her rotation in obstetrics, however, everything changed. “On that very first night, I was able to assist in the delivery of a baby,” she remembers with joy, “and that was it! Being a part of delivering that new life and interacting with the mother sparked a fire in me.” Dr. Paul recounts that everything about obstetrics and women’s medicine was interesting to her from that first night, “I followed through with my other rotations, including satisfying my life-dream of ophthalmology, but I knew being an OB/GYN was where my heart was leading me. Helping women through all the changes in their lives is where I belong.”

As a general obstetrician and gynecologist, Dr. Paul has more than 20 years of experience specializing in comprehensive health care in women of all ages. She is certified by the American Board of Obstetrics and Gynecology and prides her work on providing quality and compassionate care. “As important as my work is in serving medical care to my patients,” Dr. Paul says, “empowering women to take an active role in their healthcare is equally important. It’s so important for women to be healthy and to be heard. If I can help empower women to speak up for themselves, then I’ve been successful.” She says, “there is no distinct blueprint as an OB/GYN and every patient / woman deserves to be heard.”

Her confident and kind demeanor radiates in her voice. Dr. Paul’s ambitions have always been from a place of deep compassion. “I was the first person in my family to graduate college,” she says, “helping other women care for themselves is just part of my goal. Women, who come from a humble place, don’t always see their value and potential. If I can help boost them to realize not just their potential, but help them find the direction to their goals, then I’ve done my job.”

Identifying her own ambitions and reaching past them has always been the motor driving Dr. Paul. Throughout her entire career, she has taken on leadership roles including being the president of the medical staff at Auburn for two years. “I’ve been able to attain my goals and often strive beyond them, because of my support system,” Dr. Paul credits the strength of community. “It is important to have your community around you, to help you fill the gaps. Even if it’s a community of one, a strong support system is essential for all of us to boost ourselves toward our dreams.”

She also believes that what individuals need changes at different points in life and that it’s important to recognize change. “Throughout my career, when I take a job, I make sure that it fits into my life at that time,” Dr. Paul says, “Every person needs to figure out what works best for them where they are in their lives.”

As a physician, Dr. Paul loves the patient interactions the most. “When patients open up to me and I can humanize medicine to them, it’s very rewarding,” she says. “I try to give everyone a voice. Everyone wants to be, and should be, heard.” Dr. Paul believes that a person’s mental health is important in all aspects of medicine, “All doctors should encourage mental health as one of the standard check ups, like visiting the dentist or going for an annual physical.” She believes that all patients would be able to advocate best for themselves if mental health checkups were more universally practiced.

With so much already accomplished in her career, Dr. Paul continues to look forward, “There are always new goals in my scope,” she says, “I ask myself; how can I have the best impact on my community?” Right now, the answer to that self inquiry is her desire to help lower the Maternal Morbidity and Mortality Rate in our CNY Community. “This is such a large problem, and I want to be able to help our most vulnerable mothers.” Another career goal she has in her sight is truly assisting women transition through menopause and perimenopause with a healthy mindset and with accurate information. “This is an aspect of women’s medicine that is so unique to each patient that it’s difficult to generalize and yet, that’s what happens all too often.”

For Dr. Paul, the circumstances may change a bit, but she says, “What has allowed me to be who I am, at all stages of my life and career, is my strong faith and my amazing support system which includes my husband, three sons and extended family as well as the community that I live in. Raising my sons and seeing them grow into strong, compassionate young men is a tremendous inspiration. I feel blessed to have such a source of strength in my life. Everyone needs support to move ahead in life and I only hope that I can help those that need it the most, find it.”

Comprehensive Care Alliance: Enhancing Back Pain Management through a Full Spectrum Partnership

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Primary care physicians are familiar with diagnosing back pain. But when it comes to discerning the source of the pain and how to treat it, a referral to the physicians at Syracuse Orthopedic Specialists (SOS) and New York Spine & Wellness Center (NYS&WC) is often the next step. The medical groups are in partnership to provide a continuum of care, creating the most complete musculoskeletal group in Central New York and helping patients navigate through their back pain.

Chronic back pain, defined as lasting at least three months, accounts for the most common pain complaint among American adults, according to a 2019 study by the Centers for Disease Control and Prevention, afflicting 39 percent of patients. In 2023, the World Health Organization outlined these key points about low back pain:

  • It is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation.
  • It can be experienced at any age, and most people experience it at least once in their life.
  • Prevalence increases with age up to 80 years, while the highest number of low back pain cases occurs at ages 50 to 55, and more prevalently with women.
  • Non-specific low back pain is its most common presentation (about 90 percent of cases).

Providers at both SOS and NYS&WC offer initial consultations to patients experiencing back pain. “It’s really important having a trusted partner because there are many sides to pain management,” said Jessica Albanese, MD, a spine surgeon with the SOS Neck and Back Team. “Between our two practices, we offer the full spectrum of interventions. Patients can begin care at either practice and providers will diagnose and navigate patients to the most appropriate specialist to support their treatment and recovery.”

“The best first step for a patient with back pain is to seek treatment and guidance from their primary care provider” shared Dr. Brendan McGinn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC. “By having an initial consultation with their PCP, patients can most effectively take first steps to help manage their pain by trialing a nonsteroidal anti-inflammatory drug (NSAID) or an oral steroid, physical

 therapy, and then if it’s indicated, a referral to SOS or NYS&WC”.

Patients are also welcome to contact SOS and NYS&WC directly to request appointments. Both practices accept nearly all insurance types and do not require referrals unless the patient’s insurance company requires it.

Dr. Ryan McConn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC shares, “The benefit of the close partnership between our two organizations is that patients have seamless access to both groups and the services they provide once within our doors. Each practice will consult patients and ensure care is given by the most appropriate provider.”

Upon initial consultation at either organization, patients may meet with a physician assistant, nurse practitioner, or physician. Each clinical team is highly trained, working in tandem to deliver specialized medical care to every patient.

Together, from initial consultation through treatment, clinicians focus on patient education. “A lot of time is spent with our patients, in both practices, educating them and having a discussion about what is going on, the options they have, and the risks and benefits of each option,” Dr. McConn continued. “I refer to it as ‘getting organized’ because when they first come in, they’re in distress, they don’t know exactly why and they’re not sure how this ends for them and they’re nervous.”

After an initial consultation, conservative treatment options are discussed at both practices. Because of the partnership and symbiosis of SOS and NYS&WC, providers can discuss all options from the musculoskeletal perspective to make people feel better. Between the two practices, services include: physical therapy, behavioral therapy, diagnostic and prescriptive services, electrodiagnostic lab, X-ray and MRI Imaging, and ultimately surgery if all conservative measures fail.

Conservative Approach to Spine Care

When pain is reported, figuring out where it hurts is the first step. “We are able to identify the source of the pain using technologies such as X-rays, MRIs and electrodiagnostics to narrow down the diagnosis,” said Dr. Albanese. New York Spine and Wellness Center has the only accredited electrodiagnostic lab in Central New York.

A conservative approach works best, especially with any spinal issue. “We always maximize non-surgical care first,” Dr. Warren Wulff, a spine surgeon with the SOS Neck and Back Team, said. “Only the smallest percentage of patients where that doesn’t work do we consider for surgery. In our toolbox of surgical procedures, we always select the least invasive way that works. We match the procedure to the problem, giving the best chance for a good outcome.”

Still, the first order of business is reducing the pain, and there’s the expertise of Dr. McConn and Dr. McGinn. “Surgery is never the first line treatment for pain unless the patient has neurological deficits.” Dr. McGinn said. “When pain is the issue, there are many interventions along the continuum of care before reaching the surgery option.” 

Some patients ask for a cortisone shot, thinking that will solve the problem. “But that injection is intended to be more of a bridge toward a faster recovery as the body heals and gets stronger with exercise,” Dr. McGinn added. “It’s supposed to allow for improved functionality and to get patients moving again above all. An injection is part of a multi-modal approach to recovery that can also include chiropractic care, acupuncture, physical therapy, and surgical intervention.”

Importance and Impact of Physical Therapy

Physical therapy is one of the most common treatment choices. “Motion is what makes people feel better, and we typically start treatment with PT,” Dr. Albanese said, “and having patients relearn how to move. They may have some mechanical dysfunction, so they work with the therapy team on strength and mobility.”

Physical therapy includes therapist-guided strengthening, stabilization, and stretching, re-training functional movements, hands-on joint and tissue mobilization, and patient education. At SOS, the therapists pride themselves on individualized, personalized care. SOS offers Orthopedic & Sports Therapy at 5 locations surrounding Central New York, as well as offering remote physical therapy (RTM). RTM is offered to patients living outside the area, to those with limited access to transportation, as well as to patients who prefer online care.

One of the greatest benefits of the Orthopedic & Sports Therapy department within SOS is the close relationship built with the physicians. This direct connection enhances communication amongst the entire care team to expedite patient recovery.

On average, SOS patients achieve superior outcomes with fewer visits and shorter treatment durations compared to national averages. This is consistently shown through the outcomes and patient satisfaction data measured by FOTO Inc. (Focus on Therapeutic Outcomes, Inc.). FOTO has 26 million patients, which is the largest database of outpatient orthopedic therapy patients to compare and the greatest participation by therapy providers.

Non-Operative Interventions 

If pain persists, other interventions remain, which is a huge benefit to starting with conservative treatments. “That’s where New York Spine & Wellness Comes in. They can prescribe medications that may be appropriate and perform minimally invasive procedures – options that are still non-surgical,” Dr. Albanese said.

“While we specialize in spine pain and back disorders, we treat all types of acute and chronic pain” said Dr. McGinn. “Some of our interventions can help patients avoid surgery by working through injuries and healing while others can be used as maintenance therapy for chronic arthritic or disc-based pain in the spine for which there is no real surgical option. Other procedures can involve temporary or permanent implants that can treat debilitating nerve pain that may be severely affecting quality of life. We also perform minimally invasive surgeries in patients with spinal stenosis who may be poor candidates for more invasive surgery due to their age or medical comorbidities.”

Surgical Innovation

“Given enough time and attention, many painful spinal conditions will resolve with non-surgical measures only.” shared Dr. Warren Wulff. In instances when surgical intervention is recommended, we use the latest technology and newest techniques such as neuromodulation and minimally invasive surgery at our orthopedic focused surgery center”.

Neuromodulation, through the use of a spinal cord stimulator, is a recent trend in pain management, and Wulff is expert in the procedure. The International Neuromodulation Society defines it as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.” The goal is to re-establish normal function of the nervous system.

Neuromodulation itself is nothing new. Cardiologists have been using the technology for more than 90 years. “People whose hearts don’t beat regularly, most often get a pacemaker, which is a neuromodulator,” said Wulff. “Similar systems are being investigated to treat tremors, epilepsy, limb ischemia, obesity and eating disorders, and even depression—stimulating the brain with painless magnetic pulses.”

Again, that approach begins conservatively. “We can attach an external version of the neurostimulator for a week,” Wulff said. “If the patient has a good reaction, a permanent device is implanted. This is a 1-2 hour procedure that requires an overnight stay. The benefits can be lifelong.”

“These patients may have been highly medicated for years, taking higher doses of opioids with all the negative consequences,” Wulff continued. “Once you get patients off opioids, they feel better and think clearer. It also leads to reduced need for spinal procedures, and medications, which results in long term savings to the healthcare system.”

Reducing a patient’s pain is the ultimate goal, and both practices advocate for attempting the least invasive, most conservative treatments first. “With everybody being unique,” said Dr. McConn, “there is no one modality that is going to relieve symptoms long-term. It’s actually a combination of all these modalities. I tell patients I don’t know what’s going to work for you but we have the access to all options and we’re going to find a combination that’s going to make the pain more manageable and enhance your quality of life.”



The Importance of Culture in Health Care

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By: Kathy Ruscitto

A few months ago I had the opportunity to hear two physicians talk about their careers as they received recognition. Dr. Kara Kort, a surgeon, and Dr. James Tucker, a family physician.

Both are esteemed by their patients and colleagues. They are passionate about the profession they chose and the work they do as physicians and leaders in their disciplines.

As they spoke, the words, tone, and tears they shared all spoke to service to others. They chose medicine to help people.

In his remarks Dr. Tucker thanked to his patients for letting him be part of their villages, lives and families.

Dr. Kort talked about how being vulnerable in her own life experiences , enabled her to help patients at critical points in their lives.

Health professionals often choose their career to contribute to improving  the  health of others. Clinicians  value their  professional expertise, training, the ability to give their patients high quality care , and collegiality across a health care system.

The reality is they are facing complex systems that require automation, long hours to balance their complex demands, and frustrated patients with payer barriers. We knew we were going to face a large segment of retirements across physicians and nurses, COVID accelerated those trends. The current system feels broken to many clinicians and patients.

In an article in Medscape, Drs. Toprol, Verghese and Pearl discuss Physicians’ roles in accelerating  system changes to improve patient care. They all suggest some of the challenge is clinician resistance to letting go of old culture, and adopting new more efficient options like telemedicine. Changes that allow patient access and follow up during workforce shortages is better than delayed, or no care at all.

Other experts feel the most important investment we can  make is a shift away from fee for service care to value based care, aligning incentives around patient outcomes. 

While these examples may be part of structural system redesign, shared culture is equally important.

Medicine is a team sport. It requires collaboration across a spectrum of disciplines, workforces, and payers. We must listen and value the input of the health professionals if we are to rebuild our health systems culture and workforce to continue to provide high quality patient centered care. System redesign alone, in the absence of shared culture will not resolve our issues.

Right care, right time, right place, right cost is often included in marketing and headlines these days. The underlying assumption being we have a shared culture of achieving this care. 

As you plan retreats , strategy and future goal sessions, spend time discussing culture and clinician input into our future in health care. It is the most important thing we need to do to meet our challenges.

Resources:

Healing the Professional Culture of Medicine – Mayo Clinic Proceedings

To End Burnout, Doctors Must Change the Culture of Medicine

https://hbr.org/2022/09/5-steps-to-restore-trust-in-u-s-health-care

Understanding Fatty Liver Disease

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Nathan Hamm, DC, FNP-C.

In 2023 a group of over 200 physicians, public health experts, and industry leaders from around the globe voted to rename non-alcoholic fatty liver disease or NAFLD to metabolic dysfunction-associated steatotic liver disease or MASLD.  The goal was to update outdated nomenclature and better reflect the metabolic nature of the disease.  Experts hope that the rebrand will spark more conversation – and research interest – around these conditions that still lack treatment options.

Non-alcoholic steatohepatitis or NASH was coined in the 1980s and was meant to differentiate from fatty liver that was traditionally caused by excessive alcohol consumption. NAFLD and NASH are used interchangeably and over the past few decades several attempts were made to update the terminology unsuccessfully. But all that changed last year and NASH is now MASH, metabolic dysfunction associated steatohepatitis.

What is MASH?

MASLD or MASH is a form of liver disease caused by metabolic risk factors where excess fat accumulates in the liver and creates inflammation. When not diagnosed or left untreated it can lead to scarring and permanent liver damage. Common risk factors for MASH include: Obesity, type 2 diabetes, insulin resistance, high cholesterol or triglycerides, and high blood pressure.

Although only around 4.5 million adults in the U.S. have been diagnosed with some form of liver disease it’s estimated that up to 25% of the U.S. adult population could have MASH or some other type of liver condition and not even know it.  MASH affects nearly 12% of the global population and is most commonly seen in patients with obesity and type 2 diabetes. Survey data suggests that MASH is an underdiagnosed condition. Hopefully, the recent name change will help to increase public awareness.

In general, symptoms of liver disease are often vague or non-existent. Some symptoms of a fatty liver may include, excess weight around the midsection, right upper abdominal pain discomfort or fullness, gastrointestinal upset including nausea and/or bloating, and fatigue or weakness. Most people don’t have any symptoms and a diagnosis of MASH is often made due to abnormal liver function tests.

Velocity Clinical Research is proud to help develop innovative therapies that are designed to assist in the diagnosis, treatment and prevention of liver disease. Velocity uses FibroScan Technology to help detect and stage fatty liver disease for their patients. Excessive inflammation from MASH can cause fibrosis and scarring of the liver and these changes are measured on a scale of 0-4. The FibroScan is a non-invasive type of elastography that uses ultrasound technology to measure the stiffness(hardness) and fatty changes to the liver to help assist in the diagnosis of MASH.

Regarding treatment, weight loss and healthy lifestyle choices remain the cornerstone for the management of MASH. But earlier this year Madrigal Pharmaceuticals received FDA approval for Rezdiffra (resmetirom) as the first ever therapy for adults with MASH. Jeff McIntyre, vice president of Liver Health Programs at non-profit Global Liver Institute, said in a statement. “This approval gives patients and healthcare providers a long-awaited tool to change the trajectory of their chronic liver disease.”   

Velocity Clinical Research was part of the research that went into that approval. We worked with that study for about 2 years, screened over 65 patients and enrolled almost half of them. Currently we have other liver studies that are enrolling. Many people find joining a clinical trial to be a rewarding experience, especially when you see the therapy you help develop actually come to market. Velocity aims to be a resource in the community for medical decision making.

If you are interested in hearing more about clinical trials or what we have to offer please contact our office at 315-760-5905.

Healthcare Organizations Very Vulnerable to Cyberattacks

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By: William Ecenbarger

Like most other organizations, healthcare facilities have moved toward total digitization. The major benefit of this change is that it has provided an efficient way of sharing patient records among healthcare professionals. Compared to paper-based records, electronic health records require less workforce, time, and physical storage.

However, this shift has created a new and growing risk: cyber-attacks that are compromising patient information, delaying patient procedures and tests, and rerouting ambulances to alternative emergency rooms.

“The health care sector is experiencing a significant rise in cyberattacks, putting patient safety at risk,” warns Andrea Palm, deputy secretary of the U.S. Departent of Health and Human Services. “These attacks expose vulnerabilities in our health care system, degrade patient trust, and ultimately endanger patient safety.”

The HHS Office for Civil Rights said the medical information of some 88 million Americans was exposed in the first 10 months of 2023. HHS also reported a 93 percent increase in large, healthcare-related cyber breaches between 2018 and 2022.

Much of the official concern is focused on breaches of patient privacy.

Healthcare institutions are a gold mine for cyber attackers. They hold huge amounts of information on patients–not just medical records, but also financial information, Social Security numbers, names and addresses. Moreover, unlike most businesses, they are open all the time–meaning, as the Seattle Times pointed out in a recent article, “they might be more likely to prioritize avoiding disruptions and, therefore, more likely to pay a hacker’s ransom.”

Geetha Thamilarasu, an associate professor of computing and software systems at the University of Washington and a specialist in health care security, said patients’ health information is valuable to cyber-attackers, who can use stolen medical records to buy bogus prescriptions, sell identity information online and file fraudulent insurance claims.

“There is a huge underground market on the dark web,” Thamilarasu told the Seattle Times. “Research shows that if a compromised credit card sells for about $1 to $5 each, a compromised medical record can sell anywhere from $400 to $500 — sometimes even $1,000.”

Moreover, anyone concerned about stolen Social Security numbers can enroll in a credit-monitoring agency, but patients have little recourse if their personal health information is stolen.

There are often hundreds of Internet-connected devices in a hospital, each of which may require a different type of security. “While an X-ray machine itself might not carry any patient data, it can act as an entry point for attackers trying to break into an organization’s broader network,” Thamilarasu said.

The American Hospital Association recently warned: “Health care organizations are particularly vulnerable and targeted by cyberattacks because they possess so much information of high monetary and intelligence value to cyber thieves. The targeted data includes patients’ protected health information (PHI), financial information like credit card and bank account numbers, personally identifying information (PII) such as Social Security numbers, and intellectual property related to medical research and innovation.”

John Riggi, the AHA’s Senior Advisor for Cybersecurity and Risk, said hospitals and other healthcare organizations constantly face attacks that can put patient safety at risk. “That’s why I advise hospital senior leaders not to view cybersecurity as a purely technical issue falling solely under the domain of their IT departments. Rather, it’s critical to view cybersecurity as a patient safety, enterprise risk and strategic priority and instill it into the hospital’s existing enterprise, risk-management, governance and business-continuity framework.”

Riggi, a former FBI cybersecurity specialist, urges hospitals to adopt “a culture of cybersecurity” that would result in staff members seeing themselves as “proactive defenders of patients and their data.”

“The cyber bad guys spend every waking moment thinking about how to compromise your cybersecurity procedures and controls. The best defense begins with elevating the issue of cyber risk as an enterprise and strategic risk-management issue. If possible, you should also dedicate at least one person full time to lead the information security program, and prioritize that role so that he or she has sufficient authority, status and independence to be effective. Furthermore, you and your team should receive regular updates on your organization’s strategic cyber risk profile and whether adequate measures are dynamically being taken to mitigate the constantly evolving cyber risk.”  

According to the healthcare news publication HealthcareDive, cyber-attacks exposed 385 million patient records from 2010 to 2022. though individual patient records could be counted multiple times. The HIPAA Journal says the number of healthcare data breaches has been increasing over the past 14 years. In 2023, 5,887 data breaches of 500 or more records were reported to the federal officials. In 2023, more than 540 organizations reported healthcare data breaches to HHS, affecting more than 112 million people.

Riggi said hospitals have been working to put in place better safeguards and more backup systems to prevent such attacks and respond to them when they occur. But he said it is almost impossible to make them completely safe, especially because the systems need to rely on Internet and network-connected technologies to share patient information among clinicians involved in a patient’s care. “Overall, that’s a good thing,” he said. “But it also expands our digital attack surface.”

The HHS recently released a cybersecurity strategy for the healthcare sector that includes these actions:

 –Publish voluntary healthcare sector cybersecurity performance goals to “help healthcare institutions plan and prioritize implementation of high-impact cybersecurity practices.”

 –Provide resources to “incentivize and implement cybersecurity practices.” HHS said it would work with Congress to obtain new authority and funding to administer financial support and incentives for domestic hospitals to implement high-impact cybersecurity practices.

–Implement an HHS-wide strategy to support greater enforcement and accountability. HHS will propose new enforceable cybersecurity standards.

–Expand and mature the one-stop shop within HHS for healthcare sector cybersecurity. This will “deepen HHS and the Federal government’s partnership with industry, improve access and uptake of government support and services, and increase HHS’s incident response capabilities.”

The AHA’s Riggi offered his expertise. “I am available to assist your organization in uncovering strategic cyber risk and vulnerabilities by conducting an in-depth cyber-risk profile, and by providing other cybersecurity advisory services such as risk mitigation strategies; incident response planning; vendor risk management review; and customized education, training and cyber incident exercises for executives and boards. Please contact me for more information at 202-626-2272 or jriggi@aha.org.

New TB Vaccine A Strong Possibility

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by William Ecenbarger

Tuberculosis is the 13th leading cause of death in the world and its second worst infectious killer. Only COVID 19 claimed more lives, and there were fewer deaths from HIV and AIDS. According to the World Health Organization (WHO), 10.6 million people fell ill with TB in 2021, and 1.6 million of them died. The WHO estimates that one in every four people in the world has latent TB, meaning they are infected with bacterium that causes TB. Up to 10 percent of them will develop TB.

Despite these numbers, the only TB vaccine in use today was developed in 1921 and is only moderately effective.

But a new TB vaccine, called M72, is now on the horizon. A trial is being backed by the Gates Foundation ($400 million) and the United Kingdom’s Wellcome Trust ($150 million). The trial, at sites in Africa and Asia, will take between four and six years.

The M72 vaccine was initially developed some 20 years ago by the British firm GSK (formerly GlaxoSmithKline), but GSK abandoned it in 20l9 because the company believed it lacked economic return.

But in the GSK trials, the shot showed a 54 percent efficacy in reducing pulmonary TB. Maziar Divangahi, associate director of the McGill International TB Centre, said this was “really a big deal.” He went on to note that the WHO concludes that over 25 years, a vaccine with at least 50 percent efficacy could prevent up to 76 million new TB cases and 8.5 million deaths, avert the need for 42 million courses of antibiotic treatment, and prevent US$41.5 billion in TB related catastrophic household costs, especially for the world’s poorest and most vulnerable people.

Julia Gillard, chair of the Board of Governors at Wellcome, concurred. “The development of an affordable, accessible vaccine for adults and adolescents would be game-changing in turning the tide against TB. Philanthropy can be a catalyst to drive progress, as shown by this funding of the M72 vaccine as a potential new tool in preventing escalating infectious diseases to protect those most affected. Sustainable progress against TB and wider disease threats will depend on global collaboration, financial backing, and political will. By working with communities and researchers in countries with a high burden of the disease, we can get one step closer to eliminating TB as a public health threat.”

WHO Director-General Dr. Tedros Adhanom Ghebreyesus said the support by the Gates Foundation and Wellcome to develop a new TB vaccine shows the world can turn the tide on the TB crisis through sustained political and financial action.

Although TB occurs in every part of the world, the WHO says over 80 percent of TB cases and deaths are in low- and middle-income countries. Indeed, more than two thirds of the global total occurs in eight nations–Bangladesh, China, the Democratic Republic of the Congo, India, Indonesia, Nigeria, Pakistan, and the Philippines.