Intra Operative Radiation Therapy (IORT)

Posted on Oct 1, 2020 in Announcements | 0 comments

October is Breast Cancer Awareness Month.  This is a scary time to be a breast cancer patient due to the ongoing COVID-19 pandemic.  Many women have the option to keep their breast when they have breast cancer.  The cure rate for early stage breast cancer is the same whether the woman keeps her breast or has a mastectomy.  Most women rather keep their breast but then they usually have to undergo weeks of daily radiation.  Some women are forgoing this important part of their breast cancer treatment or choosing a mastectomy instead since they do not want to risk coming to a medical clinic every day for weeks.

Since 2011, ABSMC has been offering Intra Operative Radiation Therapy (IORT) for early stage breast cancer.  We have treated more than 350 patients with excellent results and published our data.  

We are very excited to share with you newly published long term results of the TARGIT-A trial in the British Medical Journal, 8/19/2020.  Once again the trial demonstrates that risk adapted IMMEDIATE single dose TARGIT-IORT radiation during lumpectomy is non-inferior to whole breast external beam radiation therapy (EBRT).  TARGIT-IORT has comparable long term efficacy for cancer control and lower non-breast cancer mortality.  At five year complete follow-up, the number of local recurrences was only 2.11% for TARGIT-IORT.

Women with early breast cancer were eligible if they were:
1)  aged 45 years or older, 
2)  had a diagnosis of a unifocal invasive ductal carcinoma, and 
3)  suitable for wide local excision with a cancer that was ≤3.5 cm in size on imaging. 

With long term follow-up (median 8.6 years, maximum 18.9 years), no statistically significant difference was found between immediate TARGIT-IORT and EBRT for the following outcomes: 

local recurrence-free survival (P=0.28), 
invasive local recurrence-free survival (P=0.70), 
mastectomy-free survival (P=0.74), 
distant disease free survival (P=0.30), 
overall survival (P=0.13), and 
breast cancer mortality (P=0.54). 

Mortality from other causes was significantly lower (P=0.005) in the TARGIT-IORT arm.

Benefits of TARGIT-IORT during lumpectomy for early stage invasive ductal breast cancer:

less travel, thus less cost,
less pain, 
better quality of life, 
cosmetically superior
fewer non-breast cancer deaths
less risky during the CV pandemic since most patients do not need to come in every day for weeks for external radiation
and IORT bridges the health care disparity gap for women of color.

TARGIT-IORT should be offered when planning breast cancer surgery, especially in these CV-19 pandemic times.  The patient gets all her radiation during her lumpectomy with less risk.

Respectfully,

Valery Uhl, MD
Radiation Oncology, IORT Specialist at ABSMC
President, TARGIT Collaborative Group (TCG)

Operative Report / Immediate Post Op Note Reminder

Posted on Oct 1, 2020 in Health Information Management | 0 comments

Operative Report  / Immediate Post Op Note Reminder

JC Standard RC 02.01.03 EP 5,7: Operative and High Risk Procedure Reports – Timeframe of Dictation or Written In what timeframe must an operative or other high-risk procedure report be dictated and placed in the medical record? The report must be written or dictated immediately after an operative or other high risk procedure.  If the operative or procedural report is not placed in the medical record immediately following the procedure, then a progress note must be immediately entered after the procedure to provide pertinent information to the next provider of care. ‘Immediately after surgery or procedure’ is defined as “upon completion of procedure, before the patient is transferred to the next level of care”. This is to ensure that pertinent information is available to the next caregiver. If the practitioner performing the operation or high-risk procedure accompanies the patient from the operating room to the next unit or area of care, the report can be written or dictated in the new unit or area of care. If the progress note option is used (see RC.02.01.03 EP 7), it must contain, at a minimum, comparable operative/procedural report information. The minimum required elements include; the name of the primary surgeon and assistants procedures performed and description of each procedure findings any estimated blood loss, any specimens removed, and the post-operative diagnosis.

  • ABSMC compliance is measured based on the Joint Commission standard above.
  • Please ensure you are documenting all content requirements in both Operative and IPON.   This also applies if you dictate your operative report.
  • On audit we consistently note several dictated operative reports missing specimens removed and or EBL.  

Alisa Stinn, RHIT
Health Information Manager   
Sutter Health
Alta Bates Summit Medical Center
Summit-Ashby-CCC Herrick
510-869-8741 | Direct
510-869-8856 | Fax
510-381-5181 | Mobile
stinnal@sutterhealth.org

VERBAL ORDER COMPLIANCE REMINDERS

Posted on Oct 1, 2020 in Health Information Management | 0 comments

Let’s end the year strong.   Our goal is to reach 90% with a stretch goal of 95%,   Please ensure you do everything you can to help us reach this goal.   As a reminder, surveyors may be arriving, please ensure your orders are signed within 48 hours.

VERBAL ORDER COMPLIANCE REMINDERS

  1. Please remember to sign your Verbal/Telephone Orders. Our Medical Staff Rules and Regulations state that Verbal and Telephone Orders must be signed within 48 hours.
  2. Hardwire signing your Verbal/Telephone Orders. Make signing deficiencies the first and last thing you do daily.
  3. Sign ALL Verbal/Telephone orders including Discontinued and Canceled orders.
  4. Work with your group to sign orders for each other. Inform your team when going off service and ask that your orders be signed.  Patty Fitzgibbons at Summit or Shala Thomas at Ashby will work with you and your group to make it easy to sign each other’s verbal orders.
  5. Set up a daily email reminder to your preferred email.

Thank you in advance for working on this very important compliance measure.

Alisa Stinn, RHIT
Health Information Manager   
Sutter Health
Alta Bates Summit Medical Center
Summit-Ashby-CCC Herrick
510-869-8741 | Direct
510-869-8856 | Fax
510-381-5181 | Mobile
stinnal@sutterhealth.org

Sutter Community Connect

Posted on Oct 1, 2020 in Announcements | 0 comments

New Physicians Memo

Posted on Oct 1, 2020 in New Physicians | 0 comments

S U M M I T   M E D I C A L   S T A F F   O F F I C E M E M O R A N D U M

The following new physicians have been granted privileges. To review privilege list please go to the Intranet: Department/Medical Staff/ Summit/ Physician Privileges. Please contact the Medical Staff office if you have any question.

Ryan J. Anderson, MD
East Bay Regional Critical Care and Pulmonary Medicine
411 30th St., Ste 314 Oakland, CA 94609-3312
(510) 841-0689 (510) 841-8119
Pulmonary/Critical Care Medicine

Erica K. Benson, DPM
Sun Healthcare and Surgery Group Inc.
1815 Arnold Dr. Martinez, CA 94553-4219
(925) 753-1986 (866) 735-9266
Podiatry

Stephanie P. Kekulawela, MD
Sutter East Bay Medical Foundation
3901 Lone Tree Way, Ste 211 Antioch, CA 94509
(925) 756-1192 (925) 779-7220
General Surgery

Erwin L. Kong, MD
Berkeley Emergency Medical Group Inc
2450 Ashby Ave. Berkeley, CA 94705-2067
(510) 204-4723 (510) 204-4816
Emergency Medicine

Sheng C. Lin, DMD
Bayside Oral and Maxillofacial Surgery
2345 Webster St., Ste 200 Berkeley, CA 94705
(510) 548-9114 (510) 548-8046
Oral and Maxillofacial Surgery

Daphne P. Ly, MD
Cancer Center Stanford Healthcare Emeryville
5800 Hollis St. Emeryville, CA 94608-2016
(510) 901-3552 (510) 806-2557
General Surgery

Austin A. Pitcher, MD
Webster Orthopedics
3315 Broadway, Fl 1 Oakland, CA 94611-5717
(510) 238-1200 (510) 486-2333
Orthopedics

Robert M. Roth, MD
Berkeley Emergency Medical Group
PO Box 1258 San Ramon, CA 94583
(925) 962-1800 (925) 962-1801
Emergency Medicine

Rubina I. Sharief, MD
Virtual Medical Staff, LLC
2655 Northwinds Pkwy. Alpharetta, GA 30009-2280
(877) 732-7089 (404) 751-5297
Psychiatry

Anshu Shukla, MD
Bay Imaging Consultants
2125 Oak Grove Rd. Ste. 200 Walnut Creek, CA 94598-2520
(855) 424-2723 (925) 296-7171
Radiology, Diagnostic

Ken M. Stern, MD
East Bay Regional Critical Care
411 30th St., Ste. 314 Oakland, CA 94609
(510) 841-0689 (510) 841-8119
Pulmonary/Critical Care Medicine

Michael L. Sung, MD
Epic Care
365 Hawthorne Ave., Ste 101 Oakland, CA 94609-3115
(510) 465-5523 (510) 832-6061
General Surgery

Nicholas T. Trapp, MD
2655 Northwinds Parkway Alpharetta, GA 30009
(877) 732-7089 (404) 751-5397
Psychiatry

Giao L. Vu, DDS
Bayside Oral & Maxillofacial Surgery
2345 Webster St., #200 Berkeley, CA 94705
(510) 548-9114 (510) 548-8046
Oral and Maxillofacial Surgery

President’s Message

Posted on Sep 1, 2020 in Uncategorized | 0 comments

California is burning.

Just two years ago, the Camp Fire destroyed the town of Paradise and burned nearly 150,000 acres, leading to billions of dollars in damage and claiming 85 lives. This year, the wildfire season began earlier than expected due to dry lightning strikes and dry vegetation, causing multiple discrete fires throughout the bay area, of which at the time of writing, are still not fully contained.

The scope of the devastation is not nearly as large in terms of human lives lost, largely in part to the efforts of emergency officials to evacuate civilians, and the fact that the fires are mostly concentrated in less inhabited areas. However, the air is choked with smoke, and the air quality index in the bay area (AQI) has been mostly unhealthy, at times dangerously so. As expected, this causes an increase in visits for respiratory illness, particularly for those with underlying conditions such as Asthma/COPD, but also with heart disease, and the young.

The map below is from Cal Fire, the agency that manages fire services for the state. They have pulled in out of state resources to fight the fires, which at this point have burned 1.42 MILLION acres of land. The areas in red indicate the active fire zones.

This picture, taken from NASA, shows the charred earth and smoke from space.

Many of us live in the fire affected zones, and some of us have had to evacuate. Thankfully, some of the evacuation alerts have been lifted, but the predicted ongoing dry weather poses additional risks.

What can we do ourselves to mitigate risk? These websites have some useful resources and fire update information, as well as up to date air quality information.

https://www.readyforwildfire.org/
https://www.fire.ca.gov/
https://www.kqed.org/science/1930023/map-heres-your-daily-air-quality-report-for-the-bay-area
https://www.baaqmd.gov/about-air-quality/current-air-quality/air-monitoring-data/#/aqi?id=316&date=2020-08-31&view=hourly

Thanks and best wishes to the firefighters at the front lines right now battling the blazes to keep us safe.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

Balancing Authenticity with Positivity: Using “Right Speech” to cope with 2020

Posted on Sep 1, 2020 in Uncategorized | 0 comments

Balancing Authenticity with Positivity: Using “Right Speech” to cope with 2020

 It seems the provocations to what we thought was normal life just keep coming; they are piling up upon each other faster than we can resolve them.  We are still grieving and trying to cope with one thing when another happens. Now the state is burning, and the air is toxic.  Our beautiful bay area has air quality as bad as anywhere in world.  Anyone not feeling overwhelmed at times must be great at denial.

There are great reasons to keep it positive even if we are not feeling great.  Our brains are in fact wired bidirectionally so that a forced smile can lead to mood change.  We all know that mood is contagious and some positivity at the workplace can bring everyone up. We have much to lift us up as we go through our day if we look for it: the beauty in our patient’s struggles, the love the nurses bring to their care, our teamwork and sense of meaning that caring for those in need brings.

Yet we are human and need to be so at work. Expressing our vulnerabilities can be healing and liberating as we break stereotypes about physicians’ emotional lives.  More generally, nothing predicts workplace satisfaction more than the feeling at we can be our authentic selves.

Getting the balance right between being cheerful and “real” is not easy.  We don’t want to dump all or frustrations and anxieties on our co-workers, and at the same time, we don’t want to try to be someone we are not. Getting the balance right takes some mindfulness.  We need moments of calm to actually understand how we are feeling. This starts with stopping our never-ending mental narratives and sense what is happening in our body, our mind and surroundings. At this point we can communicate in ways that are authentic and productive to our culture.

The Buddhist have this notion of “Right Speech” I call upon to communicate in the “right” way.

First, we need to listen to our selves. What are we feeling and why are we feeling that way?  We need to carefully listen to those around us to see how they are feeling.

Then, when we speak, we want to make sure our comments are wholly truthful; don’t let your grief or fear take you to unhelpful hyperbole.  We want our comments to be expressed with kindness and be helpful.  Perhaps most importantly, we want our words to be spoken at the right time.  Unloading on others about your problems at the wrong time can certainly make the work environment more toxic – such as during a meeting or during direct patient care.

Yesterday during a meeting, I felt I wanted to explode; this initiative we have been working on was going nowhere and my patience these days is short – understandably right? Well, I kept it together and after the meeting, I framed my concerns as best I could without the hyperbole and expletives it might have earlier had.  I also let people know I was struggling.  My comments were met with kindness and concern and a constructive conversation then ensued.  The Skype called then ended with me feeling better about myself, my awesome teammates and the initiative we were working on.  Being my authentic self, expressing my vulnerability and then using “right speech” led to a win-win.

In these crazy times we need to take care of ourselves and we need to invest in our culture. Using right speech to express our vulnerabilities can help us with both of these. Sharing our struggles offers our teammates an opportunity for them to act on their compassion and we get the gift of receiving it.

So, be positive, keep your eyes open to the beauty of our work, open your heart to your colleagues.  That means sharing our struggles with your colleagues when the time is right and picking them up when they need some love.  With this mindset we can build individual relationships and our culture and create a healing environment for our patients as well as all of us who are lucky enough to work at ABSMC.

Lief Hass, MD – Wellness Chair- Summit

Empiric Treatment of Enterococcus Infections

Posted on Sep 1, 2020 in Announcements | 0 comments

Alta Bates Summit Introduces New Mobile Mammography Van

Posted on Sep 1, 2020 in Announcements | 0 comments

“88 Thank Yous” to Our Alta Bates Summit Team Members

Posted on Sep 1, 2020 in Announcements | 0 comments