Podcasts about Christiana Care Health System

Send us a textIn today's episode we have the pleasure of speaking to Dr. Anna Levy, D.O.   Dr. Levy is an oncologist who works in the very specialized area of liver related cancers.  Dr. Levy is Medical Director of Hepatobiliary Malignancies and the Hepatic Artery Pump Infusion Program, based at the R.J. Zuckerberg Cancer Center.   Dr Levy is  is Board certified in Internal Medicine, Hematology, and Medical Oncology.  She is  Assistant Professor of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health Medical School.  Dr. Levy earned her medical degree at the Lake Erie College of Osteopathic Medicine followed by an Internal Medicine Residency at the Christiana Care Health System and ultimately completed her fellowship in Medical Oncology and Hematology at the Long Island Jewish Medical Center.Dr. Levy will delve into the life of an oncologist and the difficulties treating very sick patients.  She will discuss the difficulties of work life balance and how her family and home life allow her to “keep her cup full."  Dr. Levy will discuss the problem of suicide, among physicians specifically among high stress professions such as Hematology/ Oncology.  Dr. Levy will share her journey which started as an emigre from the Ukraine.  She will tell us about her discovery of Osteopathic Medicine and how she developed a  love for oncology, a difficult and complex specialty.  Please join us in our discussion with this  remarkable physician. . . a discussion you won't want to miss!

Dr. Eric Kmiec is Director of the Gene Editing Institute of the Helen F. Graham Cancer and Research Institute at Christiana Care Health System. He also holds faculty appointments at the University of Delaware and the Wistar Institute. Eric and his colleagues are working to develop new ways to treat cancer by destroying the genes that cause cancer cells to be resistant to typical therapies like chemotherapy, radiation, or immunotherapy. Throughout his life, Eric has enjoyed sports. He particularly likes playing baseball and hockey, and he still plays baseball competitively in a league in Philadelphia. Eric also spends much of his time doing landscaping and yard work. He Received his B.A. in Microbiology from Rutgers University, his M.S. in Cell Biology and Biochemistry from Southern Illinois University, and his Ph.D. in Molecular Biology and Biochemistry from the University of Florida School of Medicine. He conducted postdoctoral research at the University of Rochester before joining the faculty at the University of California, Davis in 1987. Since then, he has served on the faculty of Thomas Jefferson University, the University of Delaware, and Delaware State University. In addition, Eric founded, consulted for, and served as Vice President of Kimeragen, Inc., he was Chief Scientific Advisor for the Genomics Division of Tapestry Pharmaceuticals, was an Eminent Scholar and Director of the Marshall University Institute for Interdisciplinary Research, and also served as Co-Founder, Chief Scientific Officer, and a Board Member of OrphageniX. Eric has received numerous awards and honors over the course of his career, including receipt of the 2012 Proudford Foundation Unsung Hero Award in Sickle Cell Disease, designation as an Honorary Commander of the 436th Air Wing at Dover Air Force Base in 2013 and 2014, and also induction into the Southern Illinois University, Edwardsville Alumni Hall of Fame in 2012. Further, Eric and the team at the Gene Editing Institute were recently awarded the inaugural Life Sciences and Bio Innovation Award from the Philadelphia-Israeli Chamber of Commerce. In our interview, Eric shared his experiences in life and science.

In the current health care landscape, joint ventures between for-profit and tax-exempt entities may trigger tax or other reporting consequences that should be considered and addressed at the outset. Jennifer Noel, Corporate Director of Tax, Christiana Care Health System, Robert Friz, Partner, PricewaterhouseCoopers, and Gerald Griffith, Partner, Jones Day, discuss why it's important for a nonprofit to consider IRS guidance and the various tax implications before entering into a joint venture, the types of issues a nonprofit might encounter, and the types of transactions currently taking place. Jennifer, Robert, and Gerald are speaking at AHLA's upcoming 2023 Tax Issues for Health Care Organizations program in Washington, DC.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Tim Gibbs and Dr. Omar Khan of the Delaware Academy of Medicine/Delaware Public Health Association (https://delamed.org/) speak about connections among health, housing, and place with Julia O'Hanlon and Sean O'Neill, Policy Scientists at the University of Delaware's Institute for Public Administration. Topics covered in this August 22, 2022 conversation include the function of housing and place as social determinants of health, the importance of collaboration among housing, medical, and planning professionals, and the focus and value of resources provided through the Delaware Journal of Public Health (https://delamed.org/initiatives/delaware-journal-of-public-health/). Mr. Gibbs is the executive director of the Delaware Academy of Medicine / Delaware Public Health Association and publisher of the Delaware Journal of Public Health. A native Delawarean, he attended Wilmington Friends School, then Earlham College. He later became certified in nonprofit management from the University of Delaware and earned a Master's degree in Public Health from Arcadia University. Dr. Khan is co-chair of the Delaware Public Health Association Advisory Council and serves as President & CEO of the Delaware Health Sciences Alliance (DHSA), a consortium of Christiana Care Health System, Thomas Jefferson University, Nemours, and the University of Delaware. He is also a practicing physician interested in general primary care, medical education, outcomes research infrastructure, and global health. The Institute for Public Administration is a research and public service center in the Joseph R. Biden, Jr. School of Public Policy & Administration at the University of Delaware. For more information, visit https://www.bidenschool.udel.edu/ipa. Opening and closing music: "I Dunno" by Grapes, used under Creative Commons 3.0 License.

I've known Robert for over 13 years and I am proud to share this podcast with you.Robert, like many immigrants, had humble beginnings when he first moved to Philadelphia, PA.  However, he's stayed focused and relentless.  This guy is now the Chief Privacy Officer at Christiana Care Health System.  In this podcast, Robert shares his story, lessons learned along the way and also some advise for immigrants.  As we proceeded through the podcast, Robert also shared about the importance of giving back to our communities back home.  He talks about the non for profit he started and what he has been able to do just to support his hometown in Ghana.  This is a great opportunity to be inspired and be reminded about the importance of resilience, focus but also serving humanity. Thanks Robert for being a great inspiration.  Medaase! The Immigrant View is brought to you by Immigrantnetworks.com. Visit immigrantnetworks.com

When I first spoke with Bob Mina to prepare for this interview, he said to me about his unexpected career journey, “You don't necessarily end up where you're aiming, so just be present where you are”. Bob earned 2 degrees in Psychology, and he's now a Senior Information Center Analyst at Christiana Care Health System. In Part 1 of this interview, we talk about his professional journey, including how he reacted to getting laid off at 41. We also address imposter syndrome, and how it may actually help us.Part 2 will include Bob's responses to the standard WYGU Podcast interview questions. Check it out on January 15th, 2022.A few references you may be interested in reading more about:Philadelphia Flying Phoenix dragonboat team, Against the Wind: https://www.philadelphiaflyingphoenix.org/about-us/first-slideshow/Lunarbaboon comics: http://www.lunarbaboon.com/comics/?currentPage=2 Follow along:whenyougrowup.orgwww.instagram.com/whenyougrowup_podcast/If you'd like to connect on LinkedIn, send me a message to say hello and let me know if you liked this episode: www.linkedin.com/in/kaitlynluboff-pmp.#wygupodcast #podcast #career #personalgrowth #professionalgrowth #mentor #rolemodel #professionaldevelopment #dragonboat #careerchange #IT #Y2K #impostersyndrome

In our final Workforce Re-entry companion podcast, HIMSSCast welcomes Anahi Santiago, CISO of ChristianaCare to discuss the cybersecurity risks and challenges created by telehealth and other teleconferencing accomplishments in healthcare.This podcast is brought to you by Zoom.Talking points:ChristianaCare's preparation for the pandemicSteps to take to secure virtual communicationsResponding to Zoom-bombing and similar threatsProtecting against threats and bad actors in healthcareWhy telecommunications platforms are important, even beyond telehealthKeeping data secure in multiple locationsAdvice for securing communicationsImportance of multi-factor authenticationKeeping in mind clinician workflow and patient experienceMoving toward hospital at home — the benefits and challengesProvider and patient security educationSecurity is a patient safety issueMore about this episode:This episode's companion video on HIMSS TVTelehealth is biggest threat to healthcare cybersecurity, says reportTelehealth poses big cybersecurity dangers, Harvard researchers warnAnahi Santiago, Christiana Care Health System: 'Security a safety issue'Cybersecurity in a pandemic year: One CISO's perspectiveCIO Spotlight: ChristianaCare's Randy GaboriaultCEO's perspective: Cybersecurity is a strategic imperative

For the month of October as part of the Black History Month celebrations, Diary of a Kidney Warrior Podcast will running a series focusing on the topics around Kidney Health & the Black Community.   In this first episode in the series, America's first African American Female Transplant Surgeon, Dr Velma Scantlebury, joins Dee Moore to share the story of her journey to becoming a Transplant Surgeon, health inequalities and more.   For updates & more, follow Dee Moore on:   Instagram: @diaryofakidneywarrior Facebook: www.facebook.com/diaryofakidneywarrior Twitter: @diaryofakidneyw Youtube: https://www.youtube.com/channel/UChGUfib7lu9eKENlLJ6lafw TikTok: @diaryofakidneywarrior   Follow Dr Scantlebury:   Instagram: @scantleburyv Website: www.vpscantleburymd.com   Dr. Velma Scantlebury-White is a Barbadian-born American transplant surgeon. She was the first African American woman transplant surgeon of the United States. She has received many honours in her career, having been named to both the "Best Doctors in America" and "Top Doctors in America" lists multiple times. Dr. Scantlebury has been awarded the Woman of Spirit Award for inspiring others and the "Gift of Life Award" from the National Kidney Foundation. In addition to recognition by the Caribbean American Medical and Scientific Association, she received the Order of Barbados Gold Crown of Merit, for her efforts to educate minorities about organ transplant. She has performed over 2,000 transplants and published many peer-reviewed papers and the recent author of “Beyond Every Wall – Becoming the First Black Female Transplant Surgeon.” She completed her fellowship in multi-organ transplantation at the University of Pittsburgh Medical Centre. After 15 years, she moved to  the University of South Alabama (USA) as Professor of Surgery and  Director of the USA's Gulf Coast Regional Transplant Centre . She relocated to Delaware in 2008 to join the Christiana Care Health System, as Associate Director of the Kidney Transplant Program and Director of Outpatient Services. In 2020, Dr. Scantlebury retired from ChristiansCare to pursue an academic career and is currently a Professor of Surgery at Texas Christian University and University of North Texas Health Science Centre. She also serves as the Medical Director, Black Doctors Consortium in Philadelphia, PA. Dr. Scantlebury has been passionate about educating minority communities regarding the need for more organ donors and the rising number of patients in need of transplantation. As a board member of National MOTTEP (Minority Organ and Tissue Transplant Educational Program), she continues to promote education regarding the higher incidence of renal failure and the need for dialysis within the African American community. She has also served on the Board of Donate Life America, the Medical Advisory Board of the Gift of Life, in Philadelphia PA., and current serves on the NKF Health Equity Task Force, as well as the ASTS Boldly Against Racism Task Force. Dr. Scantlebury continues to mentor young students and is actively involved in her community through her volunteer work with the Wilmington Chapter of the Links, Inc, as well as an Honorary Member of Delta Sigma Theta Sorority, Incorporated.

Rep. David Bentz joins leaders from Christiana Care Health System to discuss expanding telehealth services for Delawareans through House Bill 160. According to those who support the proposed piece of legislation, all Delawareans deserve high-quality, affordable health care. Find out if health care professionals will still be able to meet the needs of patients who don't have access to internet, and how the demand for telehealth services exploded during the pandemic. 

Today we get a chance to get into the entrepreneurial mind of Dr Garrick Baskerville! Like many of us see in our businesses, Dr Baskerville saw many opportunities to increase the level of care in his healthcare practice. Unfortunately, he is in an industry that measures success based upon the number of patients seen in a day, no the care that is delivered. What would you do in that situation? Dr Baskerville took it upon himself to re-imagine what a medial practice looks and feels like. He launched METSI Care in Austin, TX and is in the process of expanding around the country. His practice provides care with an innovative subscription model that allows patients to enjoy a high level of care and attention without the need for complicated insurance plans. Dr. Garrick Baskerville is a board-certified Family Medicine physician and the Founder of METSI Care. He received a B.S. degree in Biology from the Pennsylvania State University. He then received his Medical Degree (M.D.) from the Pennsylvania State Hershey College of Medicine and completed his residency at Christiana Care Health System in Wilmington, DE. He has practiced in Primary Care, Urgent Care, Sports Medicine, and Occupational Health (Worker's Compensation) for the past 14 years. ​ Dr. Garrick is passionate about providing high quality care that addresses all aspects of what makes us human beings, including mind, body, and spirit. He believes that care should be affordable for everyone and that quality care takes time. That said, he believes a patient should have time to address their issues and not feel rushed during a visit. At METSI, the visits are 30 - 60 minutes, if needed. When he practiced in traditional, insurance, based models of care, he was scolded by administrators when he wanted to spend more than 15 minutes with his patients. That didn't sit right with Dr. Garrick and he told himself back in 2012 that he would eventually start his own practice where he could provide the kind of care he would give to his own family. With that, he founded METSI Care. METSI launched in November of 2019. Dr. Garrick is also a photographer who enjoys capturing human expressions of joy and excitement. He also enjoys taking both action and slow motion, low light shots. He has photographed artists including Aaliyah, 98 degrees, Mos Def, Colbie Caillat, and Taylor Swift. Dr. Garrick started photography using his dad's professional Minolta camera after losing his father to bone cancer in 1997. He used the camera as a way of healing and connecting with his father which he still does today. In his free time, he enjoys creating and cooking healthy recipes as a freestyle cook, and attending live music events, comedy shows, art shows, and performance art/theatre events. He was an extra in Season 3 of House of Cards. He has been taking bass lessons and plans to start voice lessons soon, as he wants to perform in his favorite cities including Austin, Philly, LA, and Nashville! ​ Dr. Garrick was a speaker at the SXSW Conference 2019 and for the American Academy of Family Practice Direct Primary Care Summit in 2020, as well as other various speaking events in 2020. If you would like to schedule a time to speak with Dr. Garrick, you can email him at info@metsicare.com Thanks again for being part of the Sell Them With Kindness community! We would really appreciate your honest rating of our podcast. Click here to rate & review: http://getpodcast.reviews/id/1556313256 If you'd like to be interviewed on the pod or want your business featured in our "Kind Business" directory, please head over to www.sellthemwithkindness.com today!

Dr. Kirk Garratt, Medical Director of the Center for Heart & Vascular Health at the Christiana Care Health System, provides a coronavirus and vaccine update. Bloomberg Businessweek Editor Joel Weber and Bloomberg Businessweek Features Editor Max Chafkin talk about the story “Elon Musk Loves China, and China Loves Him Back — for Now.” May Habib, CEO of Writer, discuss the dangers of “toxic communication” on Twitter. Hosts: Carol Massar and Tim Stenovec. Producer: Doni Holloway.

Dr. Kirk Garratt, Medical Director of the Center for Heart & Vascular Health at the Christiana Care Health System, provides a coronavirus and vaccine update. Bloomberg Businessweek Editor Joel Weber and Bloomberg Businessweek Features Editor Max Chafkin talk about the story “Elon Musk Loves China, and China Loves Him Back — for Now.” May Habib, CEO of Writer, discuss the dangers of “toxic communication” on Twitter. Hosts: Carol Massar and Tim Stenovec. Producer: Doni Holloway. Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

In this episode of Fireside Chat, we welcome four CEO's who have been previous guests on the show to talk about what they have learned during the COVID crisis and look ahead to priorities in 2021. We're pleased to welcome Dr. Craig Samitt, President and CEO, Blue Cross Blue Shield of Minnesota; Dennis Murphy, President and CEO, Indiana University Health; Ken Paulus, President and CEO, Prime Therapeutics; and Dr. Janice Nevin, President and CEO, Christiana Care Health System

Christine Bryson, DO, is an Associate Professor of Medicine, the Medical Director of Teaching Services in the Division of Hospital Medicine, and an Associate Program Director for the Internal Medicine Residency program at the University of Massachusetts Medical School at Baystate Health. Dr. Bryson completed her medical school from Nova Southeastern University College of Osteopathic Medicine, and her residency from Christiana Care Health System. She has been training and mentoring students and residents for almost two decades. Be prepared for the unexpected. Today, Dr. Christine Bryson reminds us that it's okay for our priorities to evolve as time goes on—and to look at everything with an open mind. Although some people seem to have it all figured out from day one, it's okay for us to go with the flow, figure out what we want as we gain more experience and knowledge. The most important thing for us to keep in mind, though, is the search for finding our passion: We need to ask ourselves what makes us excited to get up in the morning and go to work each day. Pearls of Wisdom: 1. Leading a team involves humility on the part of the leader, and transparency with the team. Not everyone will agree with every decision that is made, but keeping the process transparent helps keep the team together. 2. Give space for the patient to tell you what is important to them, and leave your own preconceived notions at the door.  The best patient care comes with listening. 3. Be confident in your training, but know that this is a lifelong learning process. It's okay to know everything—because we are here to learn. Ask questions, admit what we don't know, and take on any opportunity for growth with an open mind. 4. Do not bring your life outside the hospital inside the patient's room. Pause to reflect on what is affecting us in our day to day lives, and know it's okay to take a day off, and talk to our peers about our experience. In order to give quality care to patients, we have to take care of ourselves.

Special guest Anahi Santiago, CISO of Christiana Care Health System discusses her experience using recruitment agencies for hiring security employees. Tim does not agree with using them.

ONS member Darcy Burbage, DNP, RN, AOCN®, CBCN®, ONS director-at-large, quality and safety education specialist for Christiana Care Health System in Newark, DE, and member of the Delaware Diamond ONS Chapter, joins Chris Pirschel, ONS staff writer/producer, to discuss evidence-based practice processes and models, why they're crucial to nursing practice, and ways nurses lead the charge for evidence-based practice at their institutions. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons: By Attribution 3.0 Episode Notes: Check out these resources from today's episode: Complete this evaluation for free nursing continuing professional development. Adopt an Evidence-Based Practice Model to Facilitate Practice Change Overcome Barriers to Applying an Evidence-Based Process for Practice Change The Difference Between Quality Improvement, Evidence-Based Practice, and Research Evidence-based practice articles from the Clinical Journal of Oncology Nursing ONS Communities ONS Evidence-Based Symptom Interventions

In this episode Scott talks to Dr. Heather Farley, the Chief Wellness Office at Christiana Care Health System. Here she discusses fighting burnout, core initiatives in her position, creating a positive work environment and her leadership philosophy.

Studies by the U.S. Centers for Disease Control and Prevention and others demonstrate that well-being — a combination of physical, mental, and spiritual health — is of primary importance in the workplace. Establishing a culture of health and well-being continues to garner the commitment and attention of organizations and we are exploring it further in this Trending Health episode. To help us dive into this topic Dr. Heather Farley, Chief Wellness Officer at Christiana Care Health System, is joining us to discuss why healthy culture and well-being matters.  

Week 7 of 10; Dr. David Chen, a dual board certified hospitalist in Pediatrics and Internal Medicine at Christiana Care Health System, graduated from Princeton University with a degree in Electrical Engineering and a certificate in Engineering Biology, as well as completed a dual MD/MPH at Rutgers – Robert Wood Johnson Medical School in Health Systems & Policy, explores what it means to be a Christian in every aspect of life, including vocation.

Randy Gaboriault, SVP, Innovation and Strategic Development and CIO at Christiana Care Health System, and host Maryfran Johnson sit down to discuss digitizing healthcare supply chains, VR in healthcare and more.

Read more > Listen to the podcast (duration: 12:44) > Janice E. Nevin, MD, MPH, President and CEO, Christiana Care Health System, shares her perspective on embracing challenges and disruptions in healthcare, improving patients' experience, and preparing for the future, with David Nuzum, Senior Partner, McKinsey & Company in a June 2018 conversation.See www.mckinsey.com/privacy-policy for privacy information

Janice E. Nevin, MD, MPH, President and CEO, Christiana Care Health System, shares her perspective on embracing challenges and disruptions in healthcare, improving patients’ experience, and preparing for the future, with David Nuzum, Senior Partner, McKinsey & Company in a June 2018 conversation. Read more > Listen to the podcast (duration: 12:44) >

Janice E. Nevin, MD, MPH, President and CEO, Christiana Care Health System, shares her perspective on embracing challenges and disruptions in healthcare, improving patients’ experience, and preparing for the future, with David Nuzum, Senior Partner, McKinsey & Company in a June 2018 conversation. Read more > Listen to the podcast (duration: 12:44) >

Janice E. Nevin, MD, MPH, President and CEO, Christiana Care Health System, shares her perspective on embracing challenges and disruptions in healthcare, improving patients’ experience, and preparing for the future, with David Nuzum, Senior Partner, McKinsey & Company in a June 2018 conversation. Read more > Listen to the podcast (duration: 12:44) >

Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart, and some would say the art of medicine. The panel is joined by Vynamic colleague & guest, Deepa Mischler, to discuss the "how" around improving provider/patient interactions, and friend of Vynamic, Mike Puchtler, VP Patient Experience at Christiana Care Health System.  Mike's focus is in driving excellence in patient experience at Christiana and we can't think of a better guest to join us in this conversation.   Resources http://www.medxm1.com/3-studies-show-patient-physician-interaction-affects-health-outcomes/   Mike discussed the development of an augmented reality headset by Apple and the variety of applications in the healthcare industry. https://apple.news/AE95GZR0uSrCgO2xPuKkyFw   Mindy mentioned a recent report released by Medscape regarding physician burnout and some key attributes that were cited in the study as major causes to a problem that is plaguing the healthcare industry. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056   Ryan discussed a recent University of Penn study around the significant increase in broken bones in the elderly, due in large part to dog walking! https://www.sciencedaily.com/releases/2019/03/190306110620.htm    

Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart, and some would say the art of medicine. The panel is joined by Vynamic colleague & guest, Deepa Mischler, to discuss the "how" around improving provider/patient interactions, and friend of Vynamic, Mike Puchtler, VP Patient Experience at Christiana Care Health System.  Mike’s focus is in driving excellence in patient experience at Christiana and we can’t think of a better guest to join us in this conversation.   Resources http://www.medxm1.com/3-studies-show-patient-physician-interaction-affects-health-outcomes/   Mike discussed the development of an augmented reality headset by Apple and the variety of applications in the healthcare industry. https://apple.news/AE95GZR0uSrCgO2xPuKkyFw   Mindy mentioned a recent report released by Medscape regarding physician burnout and some key attributes that were cited in the study as major causes to a problem that is plaguing the healthcare industry. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056   Ryan discussed a recent University of Penn study around the significant increase in broken bones in the elderly, due in large part to dog walking! https://www.sciencedaily.com/releases/2019/03/190306110620.htm    

What is the microbiome, how might it be connected to IBD and other conditions, and how can it affect health when it's pushed out of balance? Dr Sarina Pasricha of the Christiana Care Health System gives me the scoop on how the microbiome is created when we are young and how it changes with our activities and diet, as well as why we should not try fecal transplants at home, and how a little bit of dirt is good for our kids.   Concepts and ideas discussed in this episode: Christiana Care Health System 2nd Annual GI Symposium: https://events.christianacare.org/event/gi-symposium-2018/ The American Gut Project: http://americangut.org/ Fecal Bacteriotherapy (FB): https://www.verywellhealth.com/fecal-bacteriotherapy-fb-1942426 DINE-CD research study: http://dinecd.web.unc.edu/   Find Sarina Pasricha, MD, MSCR at: Facebook: https://www.facebook.com/DocSarina/ Instagram: https://www.instagram.com/docsarina/   Find Amber J Tresca at: Verywell: https://www.verywell.com/ibd-crohns-colitis-4014703 Blog: http://aboutibd.com/ Facebook: https://www.facebook.com/aboutibd Twitter: https://twitter.com/aboutIBD Pinterest: https://www.pinterest.com/aboutibd/ Instagram: https://www.instagram.com/about_IBD/   "About IBD with Amber Tresca" © Cooney Studio http://cooneystudio.com/   After completing her undergraduate training in biological anthropology and nutrition from Harvard University, Dr. Pasricha attended Northwestern Feinberg School of Medicine for medical school. She subsequently completed her residency and fellowship at the University of North Carolina where she also received a Masters of Science in Clinical Research. She has published extensively in the most respected gastroenterology journals and has given more than 30 national presentations. In addition to receiving numerous teaching awards, she has received prestigious awards from the Howard Hughes Medical Institute and the National Institutes of Health. Dr. Pasricha’s research background will allow her to best use evidence-based medicine to individually treat her patients.   Dr. Pasricha’s clinical interests include, but are not limited to, prevention of colon cancer, evaluation and treatment of gastroesophageal reflux disease and esophageal cancer, and women’s wellness and health with a focus on integrative gastroenterology. She has completed additional subspecialty training in motility disorders with a focus on esophageal motility, constipation, fecal incontinence, and prevention and non-surgical treatment of hemorrhoids.   Dr. Pasricha is a native of Delaware and is an alumnus of Sanford School. She resides in Delaware with her husband and two daughters.

Dr. Eric Kmiec is Director of the Gene Editing Institute of the Helen F. Graham Cancer and Research Institute at Christiana Care Health System. He also holds faculty appointments at the University of Delaware and the Wistar Institute. Eric and his colleagues are working to develop new ways to treat cancer by destroying the genes that cause cancer cells to be resistant to typical therapies like chemotherapy, radiation, or immunotherapy. Throughout his life, Eric has enjoyed sports. He particularly likes playing baseball and hockey, and he still plays baseball competitively in a league in Philadelphia. Eric also spends much of his time doing landscaping and yardwork. He Received his B.A. in Microbiology from Rutgers University, his M.S. in Cell Biology and Biochemistry from Southern Illinois University, and his Ph.D. in Molecular Biology and Biochemistry from the University of Florida School of Medicine. He conducted postdoctoral research at the University of Rochester before joining the faculty at the University of California, Davis in 1987. Since then, he has served on the faculty of Thomas Jefferson University, the University of Delaware, and Delaware State University. In addition, Eric founded, consulted for, and served as Vice President of Kimeragen, Inc., he was Chief Scientific Advisor for the Genomics Division of Tapestry Pharmaceuticals, was an Eminent Scholar and Director of the Marshall University Institute for Interdisciplinary Research, and also served as Co-Founder, Chief Scientific Officer, and a Board Member of OrphageniX. Eric has received numerous awards and honors over the course of his career, including receipt of the 2012 Proudford Foundation Unsung Hero Award in Sickle Cell Disease, designation as an Honorary Commander of the 436th Air Wing at Dover Air Force Base in 2013 and 2014, and also induction into the Southern Illinois University, Edwardsville Alumni Hall of Fame in 2012. Further, Eric and the team at the Gene Editing Institute were recently awarded the inaugural Life Sciences and Bio Innovation Award from the Philadelphia-Israeli Chamber of Commerce. In our interview, Eric shared his experiences in life and science.

This week on DisrupTV, we interviewed John Nosta, President & Founder at NOSTALAB, Anahi Santiago, Chief Information Security Officer at Christiana Care Health System, and Ravi Ramamurti, Author of "Reverse Innovation in Health Care." DisrupTV is a weekly Web series with hosts R “Ray” Wang and Vala Afshar. The show airs live at 11:00 a.m. PT/ 2:00 p.m. ET every Friday. Brought to you by Constellation Executive Network: constellationr.com/CEN.

Christopher L. Hunter, PhD, ABPP, graduated from the University of Memphis with his PhD in clinical psychology with a specialization in behavioral medicine. He is board certified in clinical health psychology and works for the Defense Health Agency as the Department of Defense (DoD) Program Manager for Behavioral Health in Primary Care. As the DoD lead for the last nine years, he has worked to develop policy, secure funding, and oversee the rollout of primary care behavioral health services for Military Health System enrollees. He has extensive experience developing integrated primary care behavioral health services as well as training individuals to work in primary care settings treating common mental health conditions (e.g., depression), health behavior problems (e.g. tobacco use, obesity) and chronic medical conditions (e.g., diabetes, chronic pain). He is also a coauthor on the 2016 book, Integrating Behavioral Health Into the Medical Home: A Rapid Implementation Guide and a coeditor on the 2014 Handbook of Clinical Psychology in Medical Settings: Evidence-Based Assessment and Intervention. Jeffrey L. Goodie, PhD, ABPP, is a board certified clinical health psychologist and an associate professor in the department of Medical and Clinical Psychology and the department of Family Medicine at the Uniformed Services University (USU) in Bethesda, MD. He serves as the Director of Clinical Training of the Clinical Psychology program at USU. Dr. Goodie earned his PhD from West Virginia University and completed his residency and a post-doctoral fellowship in clinical health psychology at Wilford Hall Medical Center at Lackland Air Force Base. Dr. Goodie has served as an internal behavioral health consultant in family medicine, internal medicine, and OB/GYN clinics. He has trained psychology and social work residents and providers how to provide behavioral health interventions in integrated primary care settings. He is a Fellow of APA and the Society of Behavioral Medicine. Rosemary Szczechowski, PsyD, is a licensed psychologist and behavioral health consultant for Christiana Care Health System in Newark, DE. She earned her PsyD in Clinical Psychology from Immaculata University in 1999. Dr. Szczechowski has worked with children, adolescents and adults in a variety of settings, including schools, residential treatment programs, outpatient clinics, skilled nursing and rehabilitation centers, and hospitals. Dr. Szczechowski works with clients experiencing a variety of issues including anxiety, depression, trauma exposure, and school/academic problems. She also works with clients struggling with health issues, including diabetes, hypertension, and obesity.

Dr. Carolyn Lam:               Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore.                                                 This week's journal is really special. It is the 2017 cardiovascular surgery-themed issue of "Circulation." To summarize this issue, I am so privileged to have the editors, Dr. Marc Ruel from University of Ottawa Heart Institute, as well as Dr. Timothy Gardner from Christiana Care Health System. Welcome gentleman. Dr. Timothy Gardner:     Hello. Dr. Marc Ruel:                   Hi, Carolyn. Glad to be here. Dr. Carolyn Lam:               Thank you for another beautiful themed issue, Marc. I see that there are four general themes within this theme, if I may. The first of which are a collection of papers on coronary disease and coronary surgery. Could you maybe start by giving us an overview of that? Dr. Marc Ruel:                   One of the main topics that have been looked at in the surgical-themed issue this year is coronary surgery. We all know well that 2016, 2017, the academic year was quite fertile in providing new information around coronary surgery, especially with the release of the ART trial had actually scientific sessions of the American Heart Association the last November with simultaneous publication.                                                 Interestingly, the cardiovascular surgical-themed issue has several coronary papers and one that deals with essentially with graft failure, if you will. There's an in-depth review written by Mario Gaudino, who is well known and does fantastic work at Cornell, who essentially put a team together looking at several aspects of coronary graft failure. I guess we can say that these are looked in quite great depth, and they deal with several aspects of what would lead to a coronary bypass graft to fail.                                                 First and foremost, Mario and the team look at the blood components. Then the artery and the native bed itself. Then they focus a lot on the conduit, not only the nature of the conduit being a venous versus arterial conduit, but also the way of storing the conduit prior to performing the bypass. Also, the technique that's used around the use of that conduit.                                                 Finally, I'd say that the review culminates with the patient bioreactor, for lack of a better term, aspect. Endothelial dysfunction in the patient with diabetes, age, gender, hypertension, dyslipidemia, etc., all these things that do act as a significant substrate for the fate of the conduit vessel.                                                 A very unique, I think, first-time, in-depth review that, certainly, the "Circulation" editorial team and reviewers were very excited about. I think this will be quite impactful and provide very, very detailed information for future research and future improvement and fate of the coronary graft conduits. Dr. Carolyn Lam:               And, Dude, I agree. It's the new look at perhaps a classic, old, central surgery, the cardiovascular surgery. Very nice, indeed. Dr. Marc Ruel:                   Precisely, thank you. We also have a couple of important, seminal original papers within the realm of coronary surgery. In fact, these also deal, to some extent, with the fate of conduits and certainly how they work in the patient population in long ago bypass surgery.                                                 One is a randomized control trial, a single center randomized control trial that was performed in South Manchester. It's called the VICO trial, a study comparing vein integrity and clinical outcomes. Essentially, the study looked at open vein harvesting versus two types of endoscopic vein harvesting for coronary artery bypass grafting.                                                 The study was performed at a single center in England with three sound methods, having three groups of 100 patients who were compared with regards to the vein harvest technique. The primary outcome was with regards to actual vein integrity, looking at muscular damage and endothelial function and integrity on microscopy.                                                 Surprisingly and actually quite reassuredly that there were very few differences between endoscopic vein harvest and open vein harvest. Certainly the investigators also looked, as one of their secondary outcomes, at quality of life. It was quality of life that was gained in patients who had endoscopic vein harvest versus those who had open vein harvest.                                                 Overall, there was no difference in major adverse cardiac events. Therefore, showing at least in an internally valid fashion that these investigators at their center could do endoscopic vein harvesting as well as open vein harvesting. Dr. Carolyn Lam:               I know that there are other original research papers, perhaps. Would you like to highlight any of them? Dr. Marc Ruel:                   Yes, for sure. Carolyn, there's also one more coronary surgery paper, which I wanted to highlight and that is the paper entitled, "Does Use of Bilateral Internal Mammary Artery Grafting Reduce Long-Term Risk of Repeat Coronary Revascularization?"                                                 This is a multi-center analysis with first author is Iribarne from Northern New England. Essentially, seven medical centers got together and took about 20 years of consecutive CABGs with a total number of 50,000 operations, or just shy of 50,000 operations.                                                 The median duration of follow-up was 13 years, and these patients were well matched together using a propensity matching scheme. I think this paper and this research is unique and of high impact. Even though it does have shortcomings of not being a randomized control trial, it is very welcome information, especially in light of the recent ART trial, which, as you know, did not show any difference at five years analysis between single and bilateral internal thoracic artery use.                                                 The particularity of the Iribarne paper is that it is a very large data set up with close to 50,000 patients. It is multi-centered, therefore, it is real life. It is a consecutive series. The patients are extremely well matched, and it is remarkable to hear that the patients, in fact, had no difference in mortality until about five years after the operation.                                                 As opposed to many previous series where single versus bilateral internal mammary grafting shows a mortality difference very early on, which always raises the suspicion of poor matching or confounding by indication, if you will, this paper did not have that.                                                 Finally, the follow-up was quite long and at about six years, there was really a mechanistic signal with regards to repeat revascularization events, which seemed to match the difference in late mortality. There was no difference in early and five-year mortality, but afterwards as repeat revascularization events started to occur more frequently in the single mammary group, this was matched by a difference in mortality, as well.                                                 I think a very useful, large, long follow-up mechanistically-based information that I think adds very significantly to the current information we have about bilateral versus single mammary use. Dr. Carolyn Lam:               Thank you, Marc. Two original papers, highlighted, dealing with really very important modern controversies in this area. Open vein versus endoscopic vein harvesting, single versus bilateral mammary artery bypass. Excellent.                                                 Let's move on now to the next sub-theme, if you will. And that is the collection of papers on "Adult Congenital Heart Conditions," really, really an increasingly important and growing population that we're seeing. Tim, would you like to summarize maybe some of the highlights of the papers there? Dr. Timothy Gardner:     The first paper, as you point out, is focused on adult patients with repaired tetralogy of Fallot. This series came from the UK and it examines the course of almost 60 patients, at a mean age of 35 years following a repair of tetralogy as infants or young children, developed right heart failure and required pulmonary valve replacement.                                                 This is a common scenario that we're seeing, successfully repaired children who appear to do well but as they get into their late 20s and 30s, their pulmonary valve function, which is often inadequate or not even present valve, require an intervention.                                                 The important learning here is that pulmonary valve replacement, either surgically or by catheter technique, was shown to be highly effective in salvaging right ventricular function. That is based on imaging studies as well as hemodynamic studies of right ventricular function. There was an almost, in this group of patients, almost an immediate reverse remodeling of the right ventricle after placement of the valve, that continued to improve over time.                                                 This was, I think, quite reassuring. There, historically, was a bit of a reluctance to operate on these patients as their right heart was failing, despite the fact that without some intervention to take the volume load off of the RV, the patients didn't do well. This is good news for an important group of patients who we are all seeing, who oftentimes present to the adult cardiologist because of this right ventricular failure problem. A nice, reassuring study.                                                 Actually, the other two congenital papers are, again, focused on the infant. They both deal with the infant with hypoplastic left heart syndrome or single ventricle pathology. The first paper seems sort of specialized in terms of its focus, "The Optimal Timing of Stage-2-Palliation for Hypoplastic Left Heart Syndrome." This was a report from the NIH Pediatric Heart Network. They had a single ventricle reconstruction trial.                                                 This network is comprised of about 10 North American centers, both in the U.S. and Canada and has provided excellent data about the management of pediatric heart disease but, in particular, the single ventricle trial has been excellent.                                                 In this particular paper, they look at the optimal timing for stage-2 repair. Just to remind ourselves, the first part of the three-stage treatment for hypoplastic left heart syndrome is the Norwood procedure, which has to be done shortly after birth, as the patent ductus arteriosus closes and converts, essentially, the single right ventricle into the systemic ventricle.                                                 The stage-2 comes along, usually done with a Glenn-type of shunt, increases pulmonary blood flow and stabilizes these infants until they can reach the age for, and the heart function for definitive repair. This has been a particularly difficult problem for the congenital heart surgeons. What is the optimal timing?                                                 This study, which involved over 400 patients, identified optimal timing for the second stage between three and six months after the Norwood. I think this was very reassuring, is reassuring or supportive for the congenital heart community in terms of both patients and also good evidence base that a delay of three to six months does, in fact, produce the best transplant-free survival.                                                 In fact, the other aspect of this observation was that infants who developed the need for another second stage operation sooner than that did not do well, and the reasons for the required earlier surgery could be failure of the initial operation or additional anatomic risk factors. But this, I think, was an important, large series, multi-center study that will prove to be very helpful in sorting out this complex timing of a three-stage repair.                                                 Just to comment, again, for readers who don't deal with infant congenital heart treatments very often, there's been a remarkable amount of success over the last two decades in salvaging and saving these very difficult infants with the hypoplastic left heart syndrome. In fact, an additional paper in this surgery-themed issue, comes from the UK and is, in fact, a report on the findings from the UK-wide audit of the treatment of infants with hypoplastic left heart syndrome.                                                 In fact, their findings, in this sort of real world, not in the Pediatric Heart Network trial group, is very similar. They found that infants who got to the second stage without additional refinement of the initial Norwood procedure and were able to be successfully treated with a Glenn shunt somewhere in the four-to-six-month age range, did well. They actually made the point that the anatomy was more of a determinant than anything else.                                                 I think that this particular review will reinforce what the congenital heart surgeons have learned about optimal timing for this three-stage treatment of what previously were unreconstructable children. Dr. Carolyn Lam:               Thank you so much, Tim. Isn't it wonderful the way papers come in and they're actually complementary and consistent with one another. We're just so lucky to be publishing all of these great, high-quality, impactful papers in "Circulation."                                                 Moving on, the next paper actually reminds us why this is a cardiovascular surgery-themed issue and not just a cardiac surgery-themed issue. Didn't we just say that earlier, Marc? This one is on abdominal aortic aneurysm treatment. A population-based landscape of this. Could you tell us a little bit more about that one? Dr. Marc Ruel:                   Absolutely. Carolyn, you're entirely right. We must remember that "Circulation" is also about peripheral vascular disease, saying this earlier, or cardiovascular surgery and anesthesia consult also when it encompasses vascular surgery. Precisely to that effect, one of the papers in our cardiovascular surgical-themed issue is a landscape population based analysis from Finland that looks at the incidence of abdominal aortic aneurysm between the years of 2000 and 2014.                                                 Finland has a population of about 5.5 million and remarkably has a very circumscribed healthcare system. They do not have an organized system of AAA care as some other countries have shown to have and potentially benefit from, but rather they have a treatment of this condition at several institutions, many of which may not be high volume.                                                 I think the paper is remarkable is that it is very well nested in terms of a population. It provides a comprehensive landscape of where this condition has evolved to over the last few years. Obviously, we see in the results from the authors that the mortality has decreased quite a bit, but also the incidence, probably as a result of better control of risk factors. And also the incidence of rupture outside the hospital.                                                 One thing that came out of this paper, as well, is a potential cohort of the benefits gained from developing an organized system of AAA care, from the reason that the mortality of AAA rupture in Finland was still quite high, despite this being a modern series. In fact, when you include ruptures, before arrival to hospital and at arrival to hospital, the overall mortality was almost 80% for ruptured AAA.                                                 Perhaps one message that comes out of this is that there may be a benefit in having specialized centers dealing with these conditions, especially as they are in the process of rupturing. One last observation was, obviously, the increasingly prevailing role of endoscopic vascular repair in the treatment of this condition, which, in fact, has now surpassed open repair as the dominant method of elective repair.                                                 I think, overall, a very comprehensive, well-nested, country-wide with good follow-up landscape of the AAA condition in a country that has essentially a similar socioeconomic status to much of the western world. Therefore, with external generalized ability to some extent. Dr. Carolyn Lam:               Exactly, and contemporary data. I really enjoyed that you paired those with an excellent editorial, as well. Finally, before we wrap this up, I have to ask Tim to comment on this next paper, and it's on ventricular assist device malfunctions, I love the title, "It's More Than Just The Pump." Of course, as a heart failure physician, this one's very close to my heart. Forgive the pun. But, Tim, could you tell us about that? Dr. Timothy Gardner:     This paper comes from the University of Pittsburgh and their artificial heart program. Robert Kormos is the first author and he's been one of the stalwart leaders in the use of LVADs and other pump devices. He reports on their experience with over 200 both HeartMate and HeartWare ventricular assist devices.                                                 It was interesting when we reviewed this paper by the editors, there was some thought that maybe this was a little too engineering focused and so on, but I think the point of the paper is that, as they say in the very first line in their report, reports of LVAD malfunction had focused on pump thrombosis.                                                 But they point out very appropriately that, in fact, controller failure, battery failure, cable failure and other causes of device failure, which can be critical and life threatening and so on, are engineering issues. It reminds us that when we're managing this difficult group of patients, and we're seeing many more patients today with getting LVADs than 10 or 20 years ago, we need to have the bioengineering abilities and resources available.                                                 Even the surgeon and the critical care physician who is dealing with these patients either has to acquire this kind of knowledge or capacity himself or herself, or needs to have a good bioengineer nearby.                                                 What's interesting, I think, that all of us define that these mechanical failures were more common in this pretty big experience than what we've more clinically worried about, which was thrombosis of the pump. Dr. Carolyn Lam:               Exactly. That's so wonderful. And you know it just leads me to really thank you both, Marc and Tim, for this extraordinarily excellent selection of original research, state-of-the-art and perspective articles and editorials on congenital, coronary, vascular and heart failure surgery. This really appeals not just to the cardiovascular surgeons but really to the vast readership of "Circulation."                                                 Thank you for a wonderful themed issue and thank you for this great podcast. Dr. Timothy Gardner:     Well, thank you. Dr. Marc Ruel:                   Thank you very much, Carolyn. Dr. Carolyn Lam:               Listeners, don't forget to tune in again next week.

  Carolyn: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. We have such a special podcast for you today. The entire podcast is going to be a conversation with two very special guests, Dr. Marc Ruel from The University of Ottawa Heart Institute, the guest editor of the surgery themed issue this week. Hi Marc.   Marc: Hello Carolyn. How are you?   Carolyn: Very good. Especially because we also have Dr. Timothy Gardner, Surgeon, Associate Editor from Christiana Care Health System. Welcome back again, Tim.   Timothy: Thank you, Carolyn. Glad to be here.   Carolyn: Marc, could you first give us an overview of the surgery themed issue from your perspective.   Marc: This year as we have had on previous years, we are having a surgery themed issue which comprises what I would argue which is some of the very best cardiac surgical science can offer to the wide readership in the cardiovascular community that served by circulation. This year, we will have a total of ten articles that would be published in circulation, as a section of one of our regular issues and out of those ten, there are five original papers. There's one research letter which is an original research article but in a shorter format and we'll also have one invited perspective paper namely about coronary artery bypass grafting and its future with respect to multi-arterial grafts and the themed issue will be completed by three state of the art papers that deal in a very in depth comprehensive way with some important problems that the cardiovascular community faces from a clinical point of view.   Carolyn: Thanks Marc. That was a beautiful summary of the issue. I couldn't help but notice that there was a theme of coronary artery bypass surgery covering at least four of the papers and I really like your thoughts on that. You covered everything from medical therapy, CABG versus PCI, on versus off-pump, emergency surgery in the setting of shock. Could you go through each of these four papers a little and tell us what was your take home message from each?   Marc: As you said, there are three original research articles and one invited perspective that relate to coronary artery bypass grafting surgery and these encompass the number of clinical problems that are still controversial and certainly I believe they contribute a very, very significant [inaudible 00:02:31] with the wealth of knowledge that the cardiovascular community is looking for at this point. If I may go one by one, just with a very high level overview, if you will. The first one is a paper from the Leipzig Heart Center with first author, [Pieroz Adewalla 00:02:45], which looked at surgery for acute myocardial infarction but accompanied with cardiogenic shock. As you know, many patients undergo surgery in an acute MI context, but surgery for cardiogenic shock is often a very gruesome difficult decision.     Leipzig Heart Center looked at over 3,000 patients who had an acute MI prior to cardiac surgery for bypass surgery and of these, there were 508 patients who actually had cardiogenic shock due to [valve 00:03:15] failure with myocardial dysfunction and to give you an idea, these patients were quite sick. There's about 40% of the patients who were ventilated prior to surgery or very close to 40%. The timing was quite urgent, those patients were on inotrophes and on vasopressors to support their blood pressure prior to operation. Essentially, what they found is that first the outcomes got better over the last number of years, this is a series that dates back to about the 2000's, so the early 2000's.     They also favor an approach where they tried to avoid a cardioplegic arrest of the heart. Their favored overall approach is to do what we call on-pump beating heart type of surgery which would be a surgery where the cardioplegia would not be administered to stop the heart but the hemodynamics would be supported for the cardio coronary bypass. They also have over the years since the beginning of this year, is in 2000 ranging up to 2014 of increasing the use of the off-pump bypass surgery and certainly the outcomes have been better and the mortality although high has decreased significantly. It was as high as 40% in the early parts of the cohort if you will and in the latest third of the experience, therefore from 2010 to 2014, the mortality has been down to about 25%.     Again, these are patients who present with cardiogenic shock. What's also interesting to note is that patients who survive out of hospital still have a significant mortality burden and about 50% of them survive long term. What was interesting is the  Leipzig group is looking at some predictors of bad outcomes in those patients and they found that the serum lactate over four minimal per liter was actually a very robust and multi-variative predictor of a poor outcome after surgery.   Carolyn: That was a great summary of that first paper. You mentioned beating heart surgery and so on. Would you like to comment on next paper that I think was the largest single institution European study comparing on versus off-pump bypass surgery?   Marc: You're absolutely right. This is a paper from England, [inaudible 00:05:25] from Liverpool, where the patients were gathered from and with some contribution from Oxford as well from a statistical and methodological point of view and it's a retrospective cohort study of all isolated CABG patients in Liverpool between 2001 and 2015. These are bypass surgery patients and in total, there were over 13,000 patients who had CABG. About 6,000 patients had off CAB which is off-pump bypass surgery and more than 7,000 had bypass with cardiopulmonary bypass. The median follow up was 6.2 years. What's interesting in this paper is that they essentially found equivalent long term outcomes. As you know, there has been some debate regarding the completions of myocardial revascularization and the long term graft patency with off-pump surgery versus on-pump surgery. Also named conventional CABG.     What's interesting here is that the benefits of off-pump CABG appear to be seen early on with regards to antiemetic release as stroke rates, etc. Which does correspond to some of what has seen in the randomized controlled studies. However, the long term data is interesting. There's a a nice editorial about this paper written from a group from the Cleveland Clinic with Dr. Joe Sabik as the senior author and essentially it raised a number of good points, although this is an important series, it also shows that the surgeons who are very good at off-pump bypass surgery may overall be slightly technically more skilled at doing bypass surgery in itself and for instance, use more often arterial grafts and have more advanced techniques in their completion of bypass surgeries for their patients.   Carolyn: Right. I'm so glad you mentioned the editorial. I was about to bring that up as well. Switching gears to you very kindly included a paper that talked about medications and the impact of here is the medical therapy on the comparative outcomes between CABG and PCI. Would you like to discuss that paper?   Marc: This is a paper from the Care Registry which has generated some interesting publications in the past. The lead author is Dr. Paul Polinski and there's co-authors, Dr. Herbert Prince and Michael Mack from Dallas as well. This was presented at the science sessions in Orlando last November and it's an interesting paper. Essentially they have looked at large databases, again the Care Registry which comprises eight community hospitals and they look at six month period of performance of CABG and those eight community hospitals. They ended up with over 2,700 patients who were then systematically followed on a regular basis up to 2009 at which time the database was locked.     They look at various outcomes but also medication use in great detail over that period of time and the interesting perspective that this paper brings is that first, most patients at least in that period were not on optimal medical therapy. The authors used their own predefined definitions of what constitutes optimal medical therapy and this is with regards to adherence to aspirin use, lipid lowering agents, beta blockers and indicates of PCI, dual anti-platelet therapy. As expected but nicely documented in this paper, the outcomes of patients who were not on optimal medical therapy were much worse than those who were and CABG proved to be more robust in patients who were not on optimal medical therapy compared to PCI.     The differences between CABG and PCI in patients who were on optimal medical therapy tended to vanish. However, a number of caveats here is that only 25% of patients in fact in this cohort were on optimal medical therapy. The vast majority of patients were not considered to be on optimal medical therapy. Therefore, there are considerations of definitions that one has to be aware of and also considerations of statistical power because the group that was on optimal medical therapy was much smaller than the other group. Therefore, the effects, the superiority of CABG over PCI could only be firmly demonstrated in the group was not on optimal therapy, again comprising 75% of patients in this cohort.   Carolyn: I love your summaries and they really show that these are true significant original contributions to that knowledge gaps in coronary artery bypass surgery. To round it all up, you also invited a perspective on novel concepts. Would you like to comment on that paper?   Marc: This is an invited perspective in the view classifications that circulation has which is entitled, "The evolution of coronary bypass surgery will determine relevance as a standard of care for the treatment of multi-vessel CABG." It is authored by three leaders in the field, Dr. Gener, Dr. Gudino, and Dr. Grouw. Dr. Gener has been leading several of what I would call the advanced multi-vessel coronary re-vascularization trials looking for instance at multi-arterial grafts doing numerous anastomosis with two ventral mammary arteries in a wide fashion. He's been a leader of this movement certainly. Dr. Gudino recently published [inaudible 00:10:43] the 20 years of outcome of the radial artery graft and certainly has been one of the pioneers which use of this arterial graft for coronary artery bypass surgery. What the authors provide here is a very nice summary of what the trials have shown so far and they also report as many know that their rate of multi-arterial grafts use in SYNTAX, FREEDOM and I think we will soon see in EXCEL and NOBLE that will be presented this fall, has not been as high as it should have been.     In the US, it is estimated right now that the rate of use of more than one mammary artery is less than 10% across the nation, and other countries have not performed better than this either. This perspective is a call to improving the quality of multi-vessel coronary artery bypass mainly through the use of multiple arterial re-vascularization. There is also considerations around the hybrid coronary re-vascularization and as well as the use of off-pump versus on-pump surgery.   Carolyn: I am really proud and privileged to have helped to manage one of the papers as associate editors in this issue as well and that is the paper from the group with corresponding author, Dr. Veselik, from Boston Children's Hospital and it centers around patients with congenitally corrected transposition of the great arteries but a management problem that is really increasingly encountered and really needs to be reviewed properly and that is the management of systemic right ventricular failure in these patients. Tim, you were so helpful in looking at this paper as well. Could you share some of your thoughts?   Timothy: Well, this is a somewhat unique situation where a patient with this condition, congenitally corrected transposition of the great arteries may go through early life, in fact may end up as a young adult before this particular condition is identified because if there is no shunting or no cause for cyanosis and heart murmurs and so on early on, the circulations seem to work pretty well until the poorly prepared right ventricle which is the systemic ventricle, starts to fail after years of work carrying the systemic circulation and that is really the focus of the paper. There's been a lot of work and publications and attention to transposition syndromes but this particular one is a condition that may be first encountered by adult heart failure cardiologist who have not had this kind of exposure to congenital heart disease. It's a particularly apt paper to bring this condition to our attention and to demonstrate that really it's the adult heart failure cardiologist who may be managing these patients in their late 20's or 30's, when that systemic right ventricle fails because of a lack of formation to manage the systemic circulation.   Carolyn: Exactly. Written by a group that has one of the most robust experiences in this field, so that also brings to mind another state of the art article in the issue that refers to the hypoplastic left heart syndrome and though it's entitled that and people may think it's rare, I think it's increasingly being seen in the adult cardiology world as well. You want to comment on that one?   Timothy: That actually is one of the main points of this paper that this very, very difficult condition of hypoplastic left heart syndrome that requires staged operations beginning in the neonatal period has now reached the state of surgical accomplishment in medical management where many of these young children are surviving into young adulthood. Albeit, with having had two, or three, or four operations. In a community like ours here in Delaware, where pediatric patients transition to adult services and adult cardiologist sometime around their 20's, it's really important for the entire cardiology community to be aware of what has happened in terms of the successful staged treatment of children with hypoplastic left heart syndrome and that is brought out very nicely by the three authors who look at various accomplishments and different techniques for managing these staged repairs. It is very amazing to someone who has been observing this field for sometime as I have, that many of these children are in fact surviving into young adulthood and will require comprehensive cardiovascular treatment, not just by neonatal specialist but by specialist in adult congenital heart disease.   Carolyn: Exactly, which is why such a timely state of the art articles both of them for this issue. There is another state of the art article that you were handling, Tim, "The Surgical Management of Infective Endocarditis Complicated by Embolic Stroke", now that's an important topic.   Timothy: Absolutely, as we know up to a half or more of patients with infective endocarditis primarily on their left sided heart valves will have cerebral embolic problems and it has really been a dilemma for many of us in terms of optimal timing for the cardiac surgery with respect to the existence of cerebral injury from the embolism, from hemorrhage that may occur, from hemorrhage that may be exacerbated by placing the patient on the heart-lung machine, etc, and this paper really takes an extremely comprehensive, careful and judicious look at all of the evidence that has emerged and it has been a confusing field of evidence as to how to best optimally manage these patients with cerebral involvement from infective endocarditis.     I think this paper is going to have a big impact. It appears that there are a couple of messages that I took away from this paper. Number one, we really need to use the full panoply of diagnostic opportunities or diagnostic test for characterizing the nature and the extent of the cerebral involvement in these patients and then perhaps even more important, we need to convene what the authors called the infective endocarditis team and that has to include not just the surgeon, the cardiologist and the infectious disease specialist but also the neurologist, the neuro-interventional specialist, the neurosurgeon and so on because all of these specialist need to contribute to the assessment and choosing the optimal timing for these patients.     That is the central message of the paper. The authors also suggest that we may be getting to the point where we need to update and make sure that the guidelines that we're using are in fact current. Current in the sense that the experience now with advance imaging and with more aggressive management of the neurological or cerebral issues really need to be factored into how best to handle these patients, but I think this paper is going to have a big impact, it's very well written and very thorough.   Carolyn: I agree. In fact all the content we just discussed is just so rich. Congratulations on such a beautiful issue. Marc, do you have any last highlights you'd like our audience to hear about?   Marc: I'd like to also mention two other original research papers that will be featured in the surgery themed issue. One, in keeping with the congenital theme that we had talked about is about the modified [Straun's 00:19:08] procedure for palliation of severe Ebstein's anomaly and this is a series actually from Professor [Straun 00:19:16] himself mostly originating from Children's Hospital Los Angeles and essentially, the series here is that of 27 patients about equal in gender distribution who were operated at seven days of life, between 1989 and 2015.     It's very interesting that patients did well, the survival at ten years is 76% and most of them have undergone successful Fontan completion. I think this is a very important paper not only because it is an extremely vexing and difficult problem to deal with Esbtein's anomaly but it comes from the innovator of the operation himself with his team and it provides much needed data regarding the long term outcomes of these children with this very difficult solution. I think this will be of great interest and also as we commented before veering into the world of adult cardiology as well, because fortunately most of these patients survive into adulthood.     The other paper I wanted to touch upon which is also an original research paper that will be in this themed issue, is a paper from the CTSN Group looking at the impact of left ventricular to mitral valve are being mismatched on recurrent ischemic MR after ring annuloplasty and this paper used the free innovative and interesting methods. As some of you may know, there were two large files recently that were conducted by the CTSN looking at either moderate MR at the time of coronary artery bypass grafting or at severe ischemic mitral regurgitation. The randomizations were different when the moderate MR was CABG lone versus CABG post mitral valve repair and the severe MR was mitral valve repair versus mitral valve replacement.     These studies have led to interesting conclusions that several will know about but what's been interesting in the current study is that they have gathered all patients who underwent mitral valve repair from both studies, original randomized trials and they ended up with about 214 patients who underwent mitral valve repair. The others had moderate or severe MR and basically the point of this study is to look at predictors of failure of mitral valve repair and this is an extremely relevant problem, not only for the cardiac surgical community I would venture, but also for heart failure community and for JV General cardiology community. What the others found is that the most important predictor of recurrent mitral regurgitation after mitral valve repair was something called the left ventricular and systolic diameter to ring size ratio and they provide an algorithm which will have to be tested clinically with regards to whether it is applicable and indeed changes outcome, but this is a very important discovery in the field of ischemic MR and enabling us to hopefully better understand and improve outcomes for patients with this very difficult problem.   Carolyn: I agree. Thank you so much, Marc and Tim for this most insightful discussion. Thank you very much and to the listeners out there, don't forget you've been listening to Circulation on the Run. Join us next next week for more highlights and features.    

  Speaker 1: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Joining me in just a moment are Dr. James Gammie and Dr. Timothy Gardner to discuss our feature paper this week describing the first-in-human clinical experience with a novel transapical beating heart mitral valve repair.     First, here are the highlights of this week's journal. The first paper is from co-primary authors doctors Yoon, [Tsue 00:00:49], and [Cha 00:00:50] as well as corresponding authors Dr. [Che 00:00:55]  and Dr. Kim from the Seoul National University College of Medicine. These authors examine mechanisms underlying diabetes-induced microvasculopathy, testing the hypothesis that Notch signaling in endothelial cells may play an important role in this condition.     The authors tested this hypothesis by inducing diabetes in eight-week-old adult mice using intravenous streptozotocin. They then modulated endothelial Notch signaling using chemical inhibitors in both wild type and transgenic mice. Results showed that the Notch ligand called Jagged-1 was markedly increased in endothelial cells of diabetic mice. Using endothelial specific Jagged-1 knocked down mice, they found that blocking Jagged-1 prevented diabetic microvaculopathy. Furthermore, using the induceable endothelium-specific Jagged-1 knocked down mice, blocking Jagged-1 even at four weeks after the establishment of diabetic microvaculopathy could reverse the condition.     In summary, these findings show that diabetes induces Jagged-1 over expression and suppresses Notch signalling in endothelial cells leading to diabetic microvaculopathy in adult mice. The clinical implications are that dysregulated intercellular Notch signalling may therefore represent a novel molecular target in the treatment of diabetic retinopathy.     The next study by Dr. Smith and colleagues at the Leiden University Medical Center in the Netherlands evaluated the association between LDL cholesterol variability and four cognitive domains at 30 months in the 4428 participants of the prosper study.     Results showed that a higher LDL cholesterol variability was associated with lower cognitive test performance for intermediate and delayed memory-related tasks, selective attention, and processing speed. Higher LDL cholesterol variability was also associated with lower cerebral blood flow and greater white matter hyperintensity load in an MRI substudy of 535 patients.     In addition to being independent of the mean LDL cholesterol levels and of clinically overt cardiovascular diseases, these associations were present both in the placebo and pravastatin treatment [inaudible 00:03:43] of the prosper trial suggesting that the findings did not mearly reflect pleiotropic effects of statins or of nonadherence.     The study importantly provides the first observational evidence that lipid variability, not just absolute or mean values, but the variability, maybe of importance to neurocognitive function and thus contributes while understanding potential pathways of neurocogniticve decline.     The next study is by first author, Dr. [Huh 00:04:19], and corresponding author, Dr. Ralph, from the Menzies School of Health Research Charles Darwin University in Australia. These authors aimed to investigate the long term outcomes from acute rheumatic fever and rheumatic heart disease.     They achieved this aim by using linked data between the rheumatic heart disease register, hospital data, and death register for residents of the northern territory of Australia, and examined 1248 patients with rheumatic heart disease as well as 572 patients with acute rheumatic fever in the period 1997 to 2013.     The main findings were that in the first year after an acute rheumatic fever episode, the incidents of progression to rheumatic heart disease was 10 times higher than acute rheumatic fever recurrence; 10% of rheumatic heart disease patients had severe disease at diagnosis. The presence of comorbidities was associated with higher incidence of rheumatic heart disease complications and mortality. In particular, comorbid renal failure and hazardous alcohol use accounted for 28% of the access indigenous mortality.     These findings have global relevance for settings with high acute rheumatic fever, rheumatic heart disease rates and really emphasized the need for integrated chronic disease management strategies for these patients.     The final paper is by first author Dr Bettencourt, corresponding author Dr. Blankstein, and colleagues from Brigman and Women's Hospital in Boston, Massachusetts. These authors sought to answer the question what is the most appropriate score for evaluating the pretest probability of obstructive coronary artery disease?     To answer the question, the authors compared the Diamond-Forrester score with the two CAD consortium scores recently recommended by the European Society of Cardiology, and they did this in 2274 consecutive patients without prior CAD referred for coronary CT angiography. CT angiography findings were used to determine the presence or absence of obstructive CAD defined as 50% or more stenosis.     Here's a refresher of the different probability scores. The Diamond-Forrester score is calculated based on chest pain type such as non-anginal, atypical or typical angina, gender, and age. The first CAD consortium model score called CAD consortium basic is also based on these factors, but was developed using more advanced statistical modeling strategies which were not available when the Diamond-Forrester model was derived. Additionally, the population had a lower prevalence of disease than the original Diamond-Forrester derivation cohort.     The second CAD consortium score called CAD consortium clinical included the same characteristics as CAD basic, but also included the following clinical risk factors; diabetes, smoking status, hypertension, and dyslipidemia. Moreover, the presence of typical chest pain was weighted less in diabetics compared to nondiabetics in the CAD clinical score.  Results showed that among symptomatic individuals referred for coronary CT angiography, the CAD consortium clinical pretest probability score demonstrated improved calibration and discrimination for the prediction of obstructive CAD compared to the Diamond-Forrester classification.     Driving home the clinical implications of this, the authors applied these observed differences in pretest probability of obstructive CAD to guidelines-based patient management algorithms and projected that the use of the newest score could decrease the proportion of individuals in whom testing would be recommended and increase the yield of diagnosing obstructive CAD.     Those were the highlights of these weeks issue. Now, for our feature paper. Our feature paper today is about the first-in-human clinical experience with the transapical beating heart mitral valve repair using a expanded polytetrafluoroethylene chordal insertion device. We're really lucky today to have the first and corresponding author, Dr. James Gammie from the University of Maryland Medical Center as well as Dr. Timothy Gardner, associate editor from Christiana Care Health System to discuss this exciting paper. Welcome, both of you.   Tim: Thank you.   James: Thank you.   Speaker 1: James, may I start with you? What an exciting title, a first-in-human experience, and this is really sounding very reminiscent of our experience with TAVR and aortic stenosis valves. Could I ask you, with so many exciting things, what is it about the results that excited you most?   James: This is an exciting project in that we believe it affords a new treatment option for patients with degenerative mitral regurgitation. We believe that this is a less invasive way of achieving surgical grade reduction of mitral regurgitation. This is a project which has involved a great number of people on our team both within the university and then within Harpoon Medical, as well as our colleagues in Europe to bring this device from an idea which was asked more than a decade ago into a clinical experience.     It really rose out of our recognition in particularly my own practice that virtually, every patient with degenerative mitral regurgitation could be fixed with ePTFE or Gore-Tex neo-chords, and the question became how can we place neo chords on a prolapsed mitral leaflets without doing open heart surgery?     We begin working on that in the laboratory a number of years ago and went through a variety of prototypes, and ultimately, came up with this idea where we could use a 3 millimeter shafted instrument with a specially designed wrap of Gore-Tex on a 21-gauge needle such that we could land on the underside of the mitral leaflet, deploy device, and create a specially designed knot on the atrial surface of the leaflet, and that would anchor the ePTFE on the leaflet. We could repeat that a few times transapically and then adjust the length of those chords in real time using transesophageal echo guidance.     We got this to work in the laboratory and we had hoped that we would have some modest success in humans, but we've been quite pleasantly surprised that it has just worked and we've outlines this initial clinical experience in the manuscript.   Speaker 1: First of all, I'd just like to pick up on the point that this is degenerative mitral regurgitation, so this is limited to the primary mitral regurgitation, not secondary?   James: That's correct and we know that right now, at least in North America, that two-thirds of mitral valve operations are done for degenerative disease. That's correct.   Speaker 1: I think a lot of the audience out there is going to be wondering how this new technique compares to the MitraClip. Could you tell us a little bit more about that?   James: I do MitraClip as well, so I think I'm well positioned to comment on the differences. The Harpoon device right now is still in operation. It does require a small one or two-inch incision. We anticipate it's going to be a thoracoscopic approach in the very near future and then, beyond that, we would hope to extend it to a transcatheter approach. That's one difference.     The MitraClip now is certainly across the world. It's used predominantly for functional mitral regurgitation. In our own experience, it seems to work best for functional mitral regurgitation and as you know, there are anatomic limitations for MitraClip in degenerative disease. The MiraClip replicates the LCRA surgical approach and I think what we've learned from all the less invasive approaches to treat mitral valve disease is that we have to respect what we've learned from our surgical experience, and we know that the LCRA approach works best when it's combined with an annuplasty ring, and certainly, the MitraClip, again, is mostly this perfunctional MR.     Another point I'd bring up is that the experience with MitraClip has been that when you place a MitraClip, you get a fairly strong fibrous reaction and in most of the series, it's not been possible to then go back and surgical repair the valve, but you have to do a replacement because you've compromised the leaflets. Our own approach were simply putting Gore-Tex sutures in the leaflets and we believe that one advantage is that we're not burning any bridges, and that you can go back and do an open repair of you had to.     In our experience, you asked about our results, we had great results in 10 out of 11 of our patients. One patient did require a reoperation. Actually, one of the chords had come untied on the surface in that patient. We were able to go ahead and do a repair and we saw as we had anticipated it based on our animal experience, there was not much compromised to the leaflets.     One of the advantages of our approach is that we can titrate the length to the Gore-Tex chords to optimize the amount of coaptation and maximize the quality of the repair, and that's something that we can't do an open cardiac surgery, and one of the challenges of mitral valve repair is that you have to figure out how long to make those chords while the heart is arrested and placid, and that's one of the challenges in why mitral valve repair is certainly some degree of an art to doing that.     What we've found is that the imager is incredibly important, and so we've teamed up with our echocardiography colleagues, and they really provide essential input into the procedure, and it's done not looking directly at the valve, but looking up at the screens. I think as surgeons, with this procedure, we're moving more into almost becoming interventionalists.   Speaker 1: Thank you, James. That was so exciting. Tim, I have to bring you into this now. Now that James has said they're becoming like the interventionalist. Back to my original comment of TAVR and aortic stenosis, are we witnessing history in the making now? You invited an editorial by Dr. Michael Mack and his title was very provocative, Transcatheter Treatment of Mitral Valve Disease. Is it deja vu all over again? What are your thoughts?   Tim: I think this is an exciting report and I think that this is the wave of the future. I agree completely with Michael Mack that we are beginning to see interventions for mitral valve disease that are effective, less invasive, in some instances catheter based, but this is just the beginning. In fact, mitral valve disease is somewhat more complex even than aortic stenosis, but this type of experience and the ingenuity and the technical prowess, and the ability to do this minimally, invasively, and so on really portend a whole new era.     I agree with Jim. This is sort of the common ground between the interventional structural cardiologist and the surgeon, and we're becoming even more entwined, more collaborative, and more mutually supportive. We are in a new era and I think over those next decade or so, we're going to see this and similar, and even different procedures tried and proven to be useful for the variety of mitral valve disorders that we encounter. Perhaps the era of the full sternotomy for fairly straightforward, single, focused operations will become something of a thing of the past.   Speaker 1: That's beautifully put. James, with that comment, what are the next steps?   James: As we said in the manuscript, this isn't barely experience and we're continuing to learn as we move [inaudible 00:17:07] to the clinical arena. We are currently in the midst of a CE Mark trial in Europe. We rolled it out to eight separate centers. As we approve clinical experience, we will learn more about precisely which patients work best with this approach and we will accrue longer term data. We now have a number of patient out to a year with stable results and so, as the numbers go up, we'll do that, and then we anticipate a randomized trial in the United States in the early to mid portion of 2017 where we'll compare this approach to conventional open cardiac surgery.   Speaker 1: That's fantastic. Thank you so much to both of you, gentlemen, for joining me on our podcast today.   Tim: Thank you.   James: Thank you.   Speaker 1: You've been listening to Circulation on the Run. Thank you for joining us this week and don't forget to tune in next week.  

Can amalgam be bonded? Can amalgam last longer? Is composite reson nontoxic?     Michael Wahl practices general dentistry in Wilmington, Delaware and received his undergraduate and dental degrees from Case Western Reserve University. He has published over 60 articles in many dental and medical journals and lectured at many major national and international meetings on dental treatment of medically compromised patients, amalgam and composite, and practice management, among other topics. He is a part time assistant attending dentist at Christiana Care Health System.     WahlFamilyDentistry.com DrMike@WahlFamilyDentistry.com

Guest: William S. Weintraub, MD, MACC, FAHA, FESC Host: Matthew J. Sorrentino, MD, FACC, FASH The COURAGE trial suggested that optimal medical therapy and angioplasty are equivalent in reducing major cardiovascular events for patients with coronary artery disease. Dr. William Weintraub, the John H. Ammon Chair of Cardiology and director of the Center for Outcomes Research at the Christiana Care Health System in Newark, Delaware, will describe his research on the impact of angioplasty on the quality of life for participants in the COURAGE trial and show that the patients with severe angina received the greatest benefit from angioplasty. Hosted by Dr. Matthew Sorrentino