Ask the Doctor: Dr. Rachelle Leong

Rachelle Y. Leong, MD, is a breast surgeon at Englewood Health, where she focuses on breast cancer surgery, benign breast disease, and breast cancer in minorities and young women.“I always knew I wanted to work in cancer treatment,” says Dr. Leong. “My mother is a lung cancer survivor and has been out of treatment for over 13 years. This personal experience helps me understand both the patient and the family, and I use my family’s stories to convey to my patients that there is survivorship at the end of cancer treatment.”

How often do women need mammograms, and at what age should they start getting them?

Dr. Leong: There are conflicting recommendations, but we recommend that women with an average risk should begin having mammograms at age 40 and continue to have one every year. This helps us detect cancers as early as possible, when they are most treatable.

After some women have their annual mammogram, they are called back for an ultrasound. Why is that?

Dr. Leong: Mammograms and ultrasounds look at different things. Mammograms are great at looking at asymmetries, calcifications, and distortions while ultrasound are great at looking for cysts and solid tumors. For women with heterogeneously dense breasts, an ultrasound is recommended for further testing as a denser mammogram is harder to read.

Why do some women need a follow-up appointment after their mammogram?

Dr. Leong: We bring patients back in for a follow-up to see if anything like shape, size or appearance has changed. Such changes can be cause for concern, so sometimes we call patients back every six months to make sure everything has stayed the same.

What are the most common questions and concerns you hear from patients?

Dr. Leong: Many patients complain of breast pain and are fearful that it is a symptom of breast cancer. Breast pain is common in women, both before and after menopause. Pain can change over time with fluctuations in hormones and is not typically a cause for concern.I also see patients concerned about their family history. Because family history can increase risk, if a relative was diagnosed with breast cancer at a young age, say 45, we suggest you start yearly mammograms at age 35 rather than 40. For patients at high risk, we have genetic counselors who will help you decide whether to be tested for any abnormal gene such as BRCA and discuss the results with you if you are tested.

What are some misconceptions patients have about their breast health?

Dr. Leong: One misconception is the belief that if you have surgery for cancer , the cancer will grow when it is exposed to the open air. Exposure to air does not cause cancer to grow.
Another misconception I run across is that if you need a biopsy, it will definitely turn out to be cancer. It is human nature to believe the worst-case scenario, but often cancer is not the outcome of a biopsy. The final misconception I’ll mention occurs at the time of diagnosis. When a woman who is diagnosed with breast cancer missed her mammograms the previous year or two, she often blames herself and feels the cancer is her fault. Missing a mammogram does not cause cancer. Yes, we may have caught it earlier, but you are not to blame for the cancer.

Posted July 2019

Englewood Health Honored with Resuscitation Recognition Award

Englewood Health has received the Get With The Guidelines®-Resuscitation Silver Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer cardiac arrests in the hospital.

More than 200,000 adults and children have an in-hospital cardiac arrest each year, according to the American Heart Association. The Get With The Guidelines-Resuscitation program was developed with the goal to save lives of those who experience in-hospital cardiac arrests through consistently following the most up-to-date research-based guidelines for treatment. Guidelines include following protocols for patient safety, medical emergency team response, effective and timely resuscitation (CPR), and post-resuscitation care.

Englewood Health received the award for meeting specific measures in treating adult patients who suffer in-hospital cardiac arrests in the hospital. To receive this award a hospital must comply with the quality measures for one year.

“Receiving this award from the American Heart Association represents Englewood Health’s commitment to using the latest research-based standards for resuscitation care as well as our broader commitment to evidence-based practice,” said Hillary Cohen, MD, MPH, chief of emergency medicine and vice president of medical affairs at Englewood Health.

“We are pleased to recognize Englewood Health for their commitment in following these guidelines,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Shortening the time to effective resuscitation and maximizing post-resuscitation care is critical to patient survival.”

Get With The Guidelines-Resuscitation builds on the work of the American Heart Association’s National Registry of Cardiopulmonary Resuscitation, originally launched in 1999, and has collected in-hospital cardiac arrest data from more than 500 hospitals. Data from the registry and the quality program give participating hospitals feedback on their resuscitation practice and patient outcomes. The data also help improve research-based guidelines for in-hospital resuscitation.

About Get With The Guidelines

Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 6 million patients since 2001. For more information, visit heart.org.

Posted June 20, 2019

What You Need to Know About the Powassan Virus and Ticks This Summer

In the wake of the recent death of an 80-year-old, Hunterdon County man from a rare but sometimes deadly virus spread by ticks, New Jersey has been forced to, once again, confront our growing tick problem.

The virus in question is called Powassan, a neuroinvasive disease, first discovered in 1958 in Powassan, Ontario—its eventual namesake.

“The Powassan virus is typically found in the northern parts of the country: Minnesota, Wisconsin and eastern Canada. It can cause encephalitis, or inflammation of the brain, and in its worst form can cause a brain infection,” Dr. Ashwin Jathavedam, Chief of Infectious Disease at Englewood Health said.

While many who contract the virus will display no symptoms at all, those who do will experience flu-like indicators, including fever, headache, confusion and even seizures. According to Dr. Jathavedam, by the time a patient seeks medical attention for the Powassan virus, they are typically quite ill.

There is no known cure for the Powassan virus and, apart from medical assistance like respiratory support and intravenous fluids, it’s up to the immune system of the individual to fight it off. For this reason, contracting the virus can be deadly for vulnerable populations including the very young, the very old and the already immunocompromised.

There are several types of ticks that have been known to carry the Powassan virus, some of which are more inclined to infect animals like rodents or groundhogs rather than humans. One tick in particular, the deer tick, which is also known for carrying Lyme disease, can be a vector for human contraction of the virus.

In the case of the 80-year-old man who recently died after contracting the Powassan virus, it is unknown what kind of tick he came into contact with and ultimately contracted the virus from.

“The overall risk for contracting this virus is quite low. In the 10 years from 2005-2015 there were only 50-60 detected cases, so it is still pretty rare,” Dr. Jathavedam said.

In total, there have been nine known cases of Powassan virus in NJ, six of which were found in Sussex County. Dr. Jathavedam explained that there is a direct correlation between how rural and forested a region is and the risk of tick-related illnesses.

“The rates of Powassan are on the incline due to an overall increase in the tick population. Climate change also contributes to this, as it affects the animal and tick populations’ natural habitats. The third factor here is that, as humans continue to encroach upon previously wooded areas, we are brought in closer proximity to these ticks,” Dr. Jathavedam said.

Powassan does not spread human-to-human; so, prevention of the virus relies on implementing tick safety measures, especially during the coming summer months, such as wearing bug spray, putting long hair in tight braids, avoiding walking in tall grass and being mindful when interacting with livestock.

“I know it’s hard during the summer, but one of the best things you can do is wear long sleeves and long pants, especially if you’re hiking or otherwise in a forested or rural area. After being in such an area, doing a full-body check on yourself and especially on children is important,” Dr. Jathavedam said.

Health officials in NJ have advised the public that an infected tick must be attached to an individual for several hours before it can transmit the virus. So, if you do find a tick on you or your child, your next step should be removing it swiftly with tweezers.

If you choose to dispose of the tick, do so in a sealed plastic bag and monitor yourself for any abnormal symptoms over the next several weeks. If you’re more inclined to worry about these things, you can choose to bring the tick (in its sealed plastic bag) to a doctor, who can send it to a lab for testing.

Dr. Jathavedam explained that, despite the rising presence of ticks, the chances of contracting Powassan are still very low and we should not allow the fear of ticks to prevent us from going on hikes and engaging in outdoor activities.

“There are bigger things to worry about. Ticks are simply something we should be aware of this summer,” Dr. Jathavedam said.

Posted June 2019

Englewood Health Vascular Surgery Fellowship Returns in July

June 14, 2019 — For over four decades, Englewood has had a long and respected tradition of vascular training and excellence. The ACGME has now approved a two year vascular fellowship. Dr. Tom Bernik, Chief of Vascular Surgery since 2016, will serve as the program director.

The Englewood Vascular Surgical Service was created in 1976 after the hospital saw extraordinary growth in the number of limb salvage cases. This growth was the direct result of the introduction and FDA approval of the umbilical vein graft, which was invented by Englewood’s own Dr. Herbert Dardik. Prior to the development of this approach, amputation was often the only option for patients who required vascular reconstruction but lacked suitable veins, or in whom a prosthetic graft would likely fail.

Since that time, Englewood has maintained a regional, national, and international reputation in the vascular community and is well known as a respected training ground for vascular surgeons. The first Vascular Fellowship program at Englewood began on July 1, 1978 and continued for over 3 decades graduating 37 fellows under the Englewood program, and 10 fellows under the combined Englewood/Mt. Sinai program. Some of those fellowship graduates continue to be part of Englewood and have provided skilled and compassionate care to our community for years including:

In addition to these well respected clinicians, the fellowship program has also achieved academic prominence through awards, published manuscripts, and presentations based on clinical and laboratory research.   The successful Vascular Research Laboratory is a unique model of basic science and translational research in a community setting.  It has trained countless residents, pre-medical students, and high school students.

As the paradigm related to vascular surgery has dramatically changed over the years, Englewood has continued to evolve its clinical care models.  We have seen the development of the Aortic Center, Wound Care Center, and Vein Center and remained on the cutting edge of endovascular care delivery.   The recruitment of Dr. Bernik to his position as chief in 2016 has continued to drive that momentum.

The fellowship will launch next month.  It is thrilling that this fellowship will continue enhancing care for our community and contribute to the next generation of great vascular surgeons.

Englewood Hospital Achieves Healthgrades 2019 Patient Safety Excellence Award

May 29, 2019 — Englewood Hospital has received the 2019 Patient Safety Excellence Award™ from Healthgrades, placing it among the top 10% of hospitals in the nation for patient safety.

“Receiving the Patient Safety Excellence Award from Healthgrades speaks to the unwavering commitment of our entire staff to ensure that our patients receive the safest and most patient-centered medical care,” says Kathleen Kaminsky, MS, RN, NE-BC, senior vice president of patient care services and chief nursing officer at Englewood Health. “Englewood Health is committed to being a leader in providing high-quality patient care with great outcomes. We focus on ensuring safety in the care we provide to continuously drive our quality improvement efforts.”

During the study period (2015 to 2017), Healthgrades 2019 Patient Safety Excellence Award recipient hospitals demonstrated excellent performance in safety provided for patients in the Medicare population, as measured by objective outcomes (risk-adjusted patient safety indicator rates) for 14 patient safety indicators defined by the Agency for Healthcare Research and Quality (AHRQ).

Healthgrades found that patients treated in hospitals receiving the Patient Safety Excellence Award were, as compared to patients at non-recipient hospitals, on average*:

  • 9% less likely to experience an accidental cut, puncture, perforation, or hemorrhage during medical care.
  • 9% less likely to experience a collapsed lung due to a procedure or surgery in or around the chest.
  • 4% less likely to experience pressure sores or bed sores acquired in the hospital.
  • 57% less likely to experience catheter-related bloodstream infections acquired at the hospital.

In addition, if all hospitals in the country performed at the level of award recipients for each of the 14 Patient Safety Indicators, 127,667 patient safety events could have been avoided.*

“Our staff are dedicated to ensuring that patients throughout our community experience exceptional care at any Englewood Health location, and we are delighted to receive this award,” adds Warren Geller, president and CEO of Englewood Health.

“We are proud to recognize the recipients of the 2019 Healthgrades Patient Safety Excellence Award, which shines a spotlight on the hospitals that are preventing the occurrence of serious, potentially avoidable complications for patients during their hospital stay,” said Brad Bowman, MD, Chief Medical Officer, Healthgrades. “We applaud these hospitals and their commitment to providing the best possible care for every patient.”

View Healthgrades hospital quality methodologies.


* Statistics are calculated from Healthgrades Patient Safety Ratings and Excellence Award methodology which is based primarily on AHRQ technical specifications (Version 5e and 2018) to MedPAR data for years 2015 through 2017 and represent 3-year estimates for Medicare patients only.

Cancer Talk: Roundtable Discussions with Dr. Max Gomez

Colon Cancer Talk

In this roundtable discussion, health reporter Dr. Max Gomez joins four of Englewood Health’s experts to learn the latest information on colon cancer prevention, screening, and treatment. Featured experts:

Steven Brower, MDSteven Brower, MD
Medical Director, The Lefcourt Family Cancer Treatment and Wellness Center
Full profile

 

Minaxi P. Jhawer, MDMinaxi Jhawer, MD
Chief of Hematology/Oncology
Full profile

 

Walter Klein, MDWalter Klein, MD
Gastroenterologist
Full profile

 

Anna Serur, MDAnna Serur, MD
Chief of Colon and Rectal Surgery
Full profile

Warren Geller Named to NJBIZ Health Care Power 50

In the May 13, 2019, issue of NJBIZ, Warren Geller, president and CEO of Englewood Health, was named as among the state’s Health Care Power 50, highlighting the men and women responsible for maintaining the fitness of an industry vital to the state’s economy.

Geller was recognized for his role helping to transform Englewood Health from a community hospital into a leading tertiary health system at the forefront of high-quality care. Since Geller joined Englewood Health in 2009, patient volume and acuity, financial performance, and quality and safety outcomes have all improved. Geller has fostered positive community relations; modernized the hospital’s campus, facilities and technology infrastructure; strengthened key clinical programs; expanded outpatient services; and developed an integrated physician network. Over his career, he has been recognized for building sophisticated clinical services with leading-edge technology, achieving financial stability, and providing community outreach to improve the quality of life for residents of the communities he has served.

Englewood Health Launches Nurse Residency Program

May 7, 2019 — Englewood Health has launched a new nurse residency program, a training initiative designed to ensure that nurses with a year or less of experience transition into practice with skill and confidence. Englewood Health’s acute care hospital is the first healthcare organization in Bergen County and the second in New Jersey to implement the Vizient/American Association of Colleges of Nursing (AACN) Nurse Residency Program. Englewood’s initial group of nurse residents began their one-year training program in April. Additional groups of up to 10 newly hired nurses will enter the program every three months.

Kathy Kaminsky
Kathy Kaminsky

“At Englewood Health, we are dedicated to high-quality patient care, nursing excellence and innovations in nursing practice,” says Kathleen Kaminsky, MS, RN, NE-BC, senior vice president of patient care services and chief nursing officer. “We foster a culture of leadership throughout our patient care services, and especially in nursing, to provide outstanding patient safety and evidence-based care. We want our new nurses to succeed and excel in this environment.”

She added, “By supporting nurses in their transition from the academic setting to clinical care, we are fostering a highly qualified staff and better preparing our new nurses for clinical encounters, communicating with other medical professionals, as well as with patients and families, and encouraging them to become future leaders.”

More than 500 healthcare organization across the United States participate in the Vizient/AACN nurse residency program, which not only supports new nurses but also more experienced nurses who are transitioning into new roles. The program teaches skills such as effective decision making and clinical nursing leadership, incorporating research-based evidence into practice, and strengthens their professional commitment to nursing.

Maria Natal-Gopin
Maria Natal-Gopin

“Our ultimate goal is to provide safe, high-quality care by nurses who are skilled and highly competent,” says Maria Natal-Gopin, PhD, RN, MSN, CPHQ, director of the Center for Clinical Practice at Englewood Health. “The nurse residency program will help us support new nurses as they transition into their practice.”

The curriculum focuses on five major areas of development including critical thinking and clinical reasoning, patient safety and leadership, interprofessional leadership, evidence-based practice, and professional progression. Englewood is initially focusing its efforts on new graduate nurses who are hired throughout the hospital.

Nurse residents are required to participate in a 12-month program, which centers on monthly seminars led by subject matter experts. The curriculum provides case studies, simulation activities and lectures to accommodate a variety of learning styles. Residents attend the program as a group and then meet with a facilitator in smaller groups to debrief and reflect, allowing the new nurses to bond and form longer-term support networks.

As part of the program, each nurse has an individual development plan and concludes the residency with an evidence-based practice project to be used in a clinical setting. This project helps them apply concepts learned throughout the program and teaches the resident that they, personally, can contribute to the delivery of safe, high-quality patient care.

Guiding the nurse residency program is an advisory board that includes—in addition to Kaminsky and Natal-Gopin—James McGinty, MD, chief of surgery and surgical services; Felician University’s dean of the School of Nursing, Professor Christine Clouthier Mihal, EdD, RN; and Professor Patricia Munno, MSN, CPN, RN, from the Senior Student Clinical Immersion Program; Elizabeth Galetz, PhD, RN, associate professor at William Paterson University; as well as a number of Englewood Hospital nursing team members.

Like many community hospitals nationwide, Englewood traditionally provided newly graduated nurses with a mentor as they began their clinical careers. During the mentorship, medical/surgical care was emphasized at the expense of specialty units or ambulatory care. Over time, experience revealed that new nurses were so focused on learning the day-to-day tasks of the job that they did not fully benefit from the one-on-one mentoring experience.

With the Vizient/AACN Nurse Residency Program the curriculum can be customized for each nurse resident group, enabling the team to be responsive to the needs of the individual. The nurse residents are given time away from their patient care responsibilities to focus on their professional development.

Englewood Health’s Center for Clinical Practice monitors the progress of both the group and the individual nurses with a survey component provided through the program. By measuring at baseline, three-, six- and 12-month intervals, the team is able to assess the new nurses’ skill development, comfort levels, and confidence, and work to improve any gaps.

“At Englewood Health, we are committed to investing in nursing across all levels, and especially for new graduates so that they can transition successfully and provide the best care” notes Kaminsky.