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FOCUS For heart surgery and rehabilitation, Philly sportswriter chose Christiana Care

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ohn Smallwood, 44, a respected sportswriter, has written about winning teams from the Super Bowl to the Olympic Games. So, when he learned he needed to have the mitral and aortic valves in his heart replaced, he looked for a winning team off the field. “I decided to go to Christiana Care,” says the Philadelphia Daily News columnist. “It turned out to be a lifesaving choice.” Quality care close to home

His primary care physician, Stephen Ogden, D.O., suggested Smallwood consider Christiana Care in researching his options for repairing the damage to his heart caused by radiation therapy he had more than 20 years before. Smallwood found Michael Banbury, M.D., the W. Samuel Carpenter III Distinguished Chair of Cardiovascular Surgery at Christiana Care’s Center for Heart & Vascular Health. Personal care

For years, Smallwood, a survivor of Hodgkin’s lymphoma, had gone to Philadelphia for routine care. When Christiana Care’s Smyrna Health & Wellness Center opened in 2007, he made a switch because it enabled him to get quality care only a few miles from home.

“I did my homework and so did my wife, Yvette,” he recalls. “We quickly realized that at Christiana Care we would get the very best doctors. Plus, I would be treated like a person, not a number.” The valve replacements were success-

Clinical News American Heart Association Scientific Meetings

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Making MRIs safer and more efficient

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General News Senior Vice President Ben Shaw retires

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Achieving Competency Today graduation

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Employee Engagement

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Caring for Yourself

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Philadelphia Daily News sportswriter John Smallwood had valve replacement surgery at Christiana Care’s Center for Heart & Vascular Health, where his doctors say superb nursing care and the most advanced technology saved his life.

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To register visit http://www.delamed.org/estore.shtm. Responses are required by Friday, February 19, 2010. Call 302-452-3452, prompt 1 for more information. Our featured speakers, panel discussions and workshops will explore Cost Benefit in Cardiology. Guest Speakers Thomas Dayspring, M.D. Steve Ellwing, Ph.D. Franz H. Messerli, M.D. Michael Miller, M.D.

Sponsored by:

MEDICAL SOCIETY OF DELAWARE 10HRTC14

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Local Speakers Zohra Ali-Khan Catts, M.S., C.G.C. Bruce M. Boman, M.D., Ph.D. Philip C. Chapman, Jr., M.H.A., M.A. Andrew J. Doorey, M.D. Mandip S. Gakhal, M.D. Timothy J. Gardner, M.D. In joint sponsorship with:

$40

REGIST RATION FEE

Michael Kostal, M.D. Ronald L. Lewis, D.O. Lawrence R. Narun, M.D. Edward R. Sobel, D.O. Henry L. Weiner, M.D. William Weintraub, M.D. Further sponsored by: DELAWARE ACADEMYof M E D I C I NE


Center for Rehabilitation serves patient’s care continuum COVER

S T O R Y, C O N T I N U E D

ful. But soon after the surgery, Smallwood suffered major pulmonary complications. His lungs filled with fluid, making it impossible for him to breathe. His blood pressure plummeted and his heart stopped beating. Doctors quickly revived Smallwood and gave him the oxygen he needed through ECMO—extracorporeal membrane oxygenation—a mechanical bypass pump that circulates blood through an artificial lung outside the body. Superb nursing care “In most hospitals, he would have died that night,” Dr. Banbury says. “But we had the equipment to keep him alive—and a team that knows how to use it.” For two weeks, Smallwood was heavily sedated while his body healed. “Throughout those long days, we fell in love with John and his family,” recalls Kim Proctor, RN, part of the team of nurses who cared for Smallwood in the cardiac intensive care unit. “The moment he awoke was a thrill beyond words.” Dr. Banbury says superb nursing played a significant role in the sportswriter’s amazing recovery. “They could not have cared for him more tenderly if he was their own child,” he says. Getting patients home faster On Nov. 1, 37 days after his heart surgery, Smallwood began the arduous process of recovery at the Center for

recalls. “But most of all, I wanted to Rehabilitation at Wilmington Hospital. write about the nurses and all the When he arrived he was too weak to people who had taken such good care get out of bed and had to be transof me.” ferred into a wheelchair with a mechanical lift. “I'm in the Christiana Care system, and The team the people here literally saved my life.” worked diligently to —John Smallwood help him regain function and independence. ‘With me every step of the way’ “In rehab, we take the life that has been given back to us and give it new purpose,” says Rebecca Whitney, director of Patient Care. When it comes to helping patients attain independence, the Center for Rehabilitation excels, with higher outcome measurement scores than regional and national averages. Patients are also far more likely to gohome directly from the center than to a nursing home. “We get patients home faster—and they also are able to function better,” says Kelly Eschbach, M.D., the center’s medical director. Using his forum to offer thanks Smallwood soon began writing again, painstakingly typing a column for the Daily News. “I'm in the Christiana Care system, and the people here literally saved my life,” he wrote. “I wanted to let my readers know where I was, that I hadn’t changed jobs or gone away,” Smallwood

Less than two weeks later, he would face yet another challenge. The medication that helped to push blood to his brain and organs works by robbing blood from the extremities. An unfortunate side effect is tissue damage to the digits, and Smallwood lost all 10 toes. Benjamin Cooper, M.D., a plastic and reconstructive surgeon, performed the amputations on Nov. 20. A few days later, Smallwood resumed rehab. “They pushed me hard, and I needed that,” he says. “They knew how determined I was to get home, and they were with me every step of the way.” On Dec. 4, he rejoined his wife and 5year-old daughter Ryan at home in Smyrna. Daily News readers are enjoying his columns once more. “The people at Christiana Care were able to work a miracle,” he says. “That’s why I’m here.”


Christiana Care authors present at AHA Scientific Meetings

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he November American Heart Association (AHA) Scientific Meetings highlighted four studies by by Christiana Care investigators on outcomes and quality of care. Christiana Care cardiology fellows presented two poster abstracts.

Zeshan Rana, M.D., presented a study in a specialized group of atrisk patients who undergo surgery to remove blockages in both their carotid and coronary arteries. The study added to a limited body of knowledge showing that serious complications, Zeshan Rana, M.D. including stroke or death, can occur during or following either procedure when a carotid endarterectomy precedes coronary artery bypass grafting. Medicine chief resident and incoming cardiology fellow Kevin Copeland, M.D., worked with a team in Cardiology to look at outcomes using polytetrafluoroethylene-covered stents to repair coronary artery perforation during angioplasty/stenting procedures. The Christiana Care team observed that proceeding to surgery is not always required for these patients, and longterm outcomes are reasonably good. Kevin Copeland, M.D. 4

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Investigative research presented at international meetings such as the AHA are tremendous learning opportunities for new investigators, according to Ehsanur Ehsanur Rahman, M.D. Rahman, M.D., associate chief of Cardiology and senior author on both papers. “We are teaching our residents and fellows not only how to conduct their own research, but also how to more critically analyze what they read in the literature,” he says. “Their work is also an illustration of the valuable research resource we have here at Christiana Care in our large, well-documented collection of patient data.” The following Christiana Center for Outcomes Research (CCOR) investigators also presented at the meeting. n Ed Ewen, M.D., co-director of Ambulatory Research for the Department of Medicine and director of Informatics for CCOR, led a team showing that in community-based settings, effective use of warfarin led to a 37.5-percent reduction in stroke risk. T Ed Ewen, M.D.

The study found that in actual practice, however, anticoagulation therapy is attempted only 50 percent of the time and that the best therapeutic range is achieved only 25 percent of the time. Xiaozhang Jiang, Ph.D. n CCOR biostatistician Xiaozhang Jiang, Ph.D., presented results showing physical limitations can predict outcomes for cardiovascular events in people with stable coronary artery disease. n CCOR Director William S. Weintraub, M.D., John H. Ammon Chair of Cardiology, presented data from the worldwide Record Atrial Fibrillation (AF) Registry suggesting that rhythm control, more than rate control, would improve theraputic success in patients with recurrent or persistent AF. Dr. Weintraub is a member of the Registry’s Scientific Committee. “Christiana Care investigators are publishing in some of the top journals and increasingly bringing in grant money to support our growing research programs,” he says. “Their work is well-recognized around the country.”

William S. Weintraub, M.D.


Revised procedures increase patient safety, cut MRI wait time

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ew Magnetic Resonance Imaging procedures and a new MRI unit reduced inpatient wait times at Christiana Hospital from 13 hours to eight—a 40 percent improvement that also reduces length of stay. Piloted at Christiana, the procedures have been so successful that Wilmington Hospital is now implementing them. A team from nursing units, the Radiology Department and Operational Excellence modified procedures and protocols in three key areas: patient interviews, communication between the units and Radiology, and orders for pre-MRI X-rays. “Working together, we’ve transformed the whole MRI process, eliminating backlogs and improving patient satisfaction and safety,” says Kert Anzilotti, M.D., chair of Radiology. Improved communication Instead of handwritten, faxed orders and safety checklists that could be misinterpreted, mislaid or missed at shift change, the process is now electronic—and 80 percent of the time is completed within two hours. Physician MRI orders and a revised, clearer safety checklist are transmitted through PowerChart. To ensure appropriate handoffs, a MRI nurse calls the unit nurse for a brief report. Nurses also use the two-part Round-Trip Ticket. The unit nurse fills out the top part, answering questions such as, “Can the patient ambulate and transfer independently?” The MRI nurse fills out the bottom part, indicating any important events or changes while the patient was away from the unit and the name and phone number of a contact person in case the unit nurse has any questions.

According to Adrienne Briggs, RN, staff nurse on 5C, “The whole process is much faster and smoother now. Instead of being two completely separate departments, we are working as a team. We’re happier, and it’s safer for the patients.” More effective orders If patients need a pre-MRI X-ray—if they have been shot, for example, or have worked with sheet metal—the MRI unit now has a standing order for the X-rays. Before the redesign, the unit had to notify the physician, who then had to write the order. Because the X-rays are high priority, they are usually completed and read in an hour. Safer and more efficient Under the earlier system, unit staff nurses interviewed patients or their families, when patients could not communicate and then relayed the information to the MRI unit staff. Unit staff

nurses continue to do the initial safety clearance for alert and oriented patients. But for patients who are not, MRI staff now get safety information from family members. They also do the final clearance once the patient arrives in the MRI department. Transferring safety screening from nursing to the MRI department has decreased the possibility of misinterpretation and saves time spent trying to clarify information. “Completing the interviews in the MRI unit and being able to order pre-MRI screening X-rays have made such a difference,” says Nicole Harris, AS, RT (CT) (MR), MRI inpatient supervisor. “Patient safety and satisfaction have definitely improved as a result of process automation.”

Center for Women’s Health now open in Greenville

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he Christiana Care Center for Women’s Health now open in Greenville has specialists who focus on the toughest gynecologic issues, including those conditions that get more complicated for women as they age, such as perimenopause /menopause, urogynecology, pelvic disorders and sexual dysfunction. The new group practices at 3706 Kennett Pike in Greenville offers special consultation and advanced treatments including reconstructive and minimally invasive surgery, all

from one convenient location. OB/GYN specialists now seeing patients at the new Center for Women’s Health include: n Richard Derman, M.D. n William A. Hohman, M.D. n Howard B. Goldstein, D.O., MPH n Babak Vakili, M.D. n Gretchen Makai, M.D. For more details on these specialists, visit the Center for Women’s Health at www.christianacare.org. For appointments and more information call 302-623-6320 .


Center for Comprehensive Behavioral Health has new home

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he newly renamed Center for Comprehensive Behavioral Health’s new home enhances outpatient psychiatry services by consolidating care in a single setting. Formerly on several floors in Wilmington Hospital, the center now combines outpatient services in a 10,000-square-foot space at 201 W. 14th St., in a building near Hercules Plaza previously occupied by Blue Cross Blue Shield of Delaware. Draws clinicians closer together “This allows our clinicians to work together more closely, improves communication and allows patients to shift levels of care without the need to move to a new location or work with a new group of staff,” says Harold Rosen, M.D., chair, Department of Psychiatry. “We believe this will improve continuity of care and decrease the risks associated with the transfer of care between clinicians.” Consolidation also will help the center track outcomes, with the goal of reducing the cost of care across an episode of illness. The move includes adult services as well as the Herman Rosenblum Child & Adolescent Center, which serves young people ages 13-18. “With the new center, we believe the Department of Psychiatry is best positioned to offer adult psychiatric and behavioral health care across the continuum, from emergency services through inpatient, outpatient and advanced procedural interventions,” Dr. Rosen says. Tranquil, private setting The new center is in a tranquil, private setting with views of the Brandywine Creek. “It’s within walking distance to the

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Wilmington campus, and the site is beautiful,” says Stephen Smith, MA, administrative director and program manager, Department of Psychiatry. Psychiatry Department offices will close at Wilmington Hospital on Friday, Jan. 15 and reopen at the new center on Tuesday, Jan. 19, ensuring a seamless transition. Hours of operation are 7 a.m.-5:30 p.m., Monday

through Friday. Outpatient care will continue to be available at Christiana Hospital. The Wilmington campus is undergoing a $205-million transformation that will add 337,000 square feet and create a 1 million-square-foot state-of-the-art medical center, slated for completion in 2012. From left, Director of Psychology Alan Schwartz, Ph.D., Chair of Psychiatry Harold Rosen, M.D., and Michael N. Marcus, M.D., medical director of the Center for Comprehensive Behavioral Health, expect improved communications and closer working relationships among staff and clinicians in Outpatient Psychiatry at the new site.

Clinical Pearls Day: A Medicine tradition

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he 7th Annual Clinical Pearls Day at Medical Grand Rounds is Thursday, March 4, at 8 a.m. in the John H. Ammon Medical Education Center auditorium, with video transmission to Room 8119, Wilmington Hospital. Clinical Pearls Day is an opportunity for selected attending physicians to present their favorite case studies in 10 minutes to the Medical Grand Rounds audience. The Department of Medicine Staff selects Clinical

Pearls speakers as a way of recognizing their contributions to residency education. Guest speakers this year include: n n

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Philip Blatt, M.D., Hematology. Matt Burday, D.O., Internal Medicine. David M. Cohen, M.D., Infectious Diseases. Ehsanur Rahman, M.D., Cardiology. Badrish Patel, M.D., Pulmonology. Anand Panwalker, M.D., Infectious Diseases.


ORLive Webcast listed among Best of 2009

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hristiana Care’s first live surgery Webcast, “Dramatic Advance in Parathyroidectomy,” was selected as one of the year’s best in ORLive’s Best of 2009 awards list. Congratulations to Raafat AbdelMisih, M.D., Michael Rhodes, M.D., and the producer, Web Services Project Manager Shane Hoffman and his External Affairs colleagues. Subscribers are still voting to determine the winner. To cast your vote, visit www.orlive.com/channels/bestof-orlive-2009.

Formulary Update


Open House highlights region’s only facility dedicated to breast care

Dr. Penman heads American College of Surgeons chapter

Katherine Esdale, RT (left), demonstrates the Ethicon Mammotome Biopsy Device using X-ray guidance on the stereotactic table for medical oncologist David D. Biggs, M.D., and Jennifer Pugh, MSN, NPC, at the Breast Center’s open house in December.

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Above, Obstetrics & Gynecology Chairman Richard Derman, M.D. (right), views Delaware’s first designated breast MRI imaging machine at the Breast Center open house.

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mily J. Penman, M.D., is serving as 2010-2011 president of the Delaware Chapter of the American College of Surgeons. Dr. Penman is associate vice chair of Christiana Care’s Department of Surgery and medical director of the Breast Center at the Helen F. Graham Cancer Center. She is an associate professor of sugery at Jefferson Medical College in Philadelphia and a member of the American Society of Breast Surgeons. Dr. Penman chairs Christiana Care’s Breast Care Team and serves on the Technology Management Committee and other committees at Christiana Care.


Ben Shaw, senior VP, Human Resources, retires

Christiana Care hosts Medicare enrollment event

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pproaching age 65, Denair Paproth felt bewildered by her many Medicare eligibility options, including 45 drug plans. She found answers to many of her questions at a Medicare information and enrollment event Nov. 30 at Christiana Care’s John H. Ammon Medical Education Center, where she was able to meet one-on-one with Debbie Feierman from the Centers for Medicare and Medicaid Services (CMS). Trained counselors from CMS and ELDERinfo met with 47 people that day, a 17.5 percent increase from last year’s event at Wilmington Hospital Health Center. The event was one of nine held throughout Delaware by ELDERinfo and Delaware Medicare Partners Coalition during Medicare’s open enrollment period Nov. 15 through Dec. 31. Understanding Medicare Part D

Senior Vice President of Human Resources Ben Shaw

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enior Vice President of Human Resources Ben Shaw retired Jan. 1. “With more than a quarter of a century of service, Ben led a host of projects that have truly transformed Christiana Care,” says President and CEO Robert J. Laskowski, M.D., MBA. “During his tenure, the number of employees grew from 4,000 to 10,000. Ben and his team pioneered our ‘Great Place to Work’ culture with a host of new initiatives, including the development of on-site day care, on-site fitness centers, a new and innovative flexible benefits model, a progressive peer review process, a robust nursing scholarship program and pay for performance,” Dr. Laskowski says. “He developed the strategy for doubling the number of 24/7 nurses, putting Christiana Care in the enviable position of being close to fully staffed. “Ben’s latest effort—Transformation Rewards—is a ground-breaking gain-sharing program. His institutional memory, wisdom and focus on excellence have been extraordinarily helpful to me and to Christiana Care.”

“Beneficiaries should do a checkup each year on how their health plan is working for them,” Feierman says. “We provide access to counselors all year long, but it is particularly important during the open enrollment period.” The counselors focus primarily on Medicare Part D, the drug coverage option, because it is so complex. “Most people are comfortable with the health piece of Medicare, but the drug piece concerns them,” Feierman says. “There is much more information to process and the consequences are significant.” Different Medicare Part D plans cover different drugs and at different costs, so what is right for one person might be wrong for another. Moreover, the plan that saves a person the most money can change from year to year. Where to get help The Medicare Web site at www.Medicare.gov allows recipients and their caregivers to research and compare original Medicare and Medicare HMO and PPO plans. With the site’s Medicare Prescription Drug Plan Finder, people can enter their specific medication list and find the plans that suit them best. Delawareans on Medicare or their caregivers can also call ELDERinfo at 800-336-9500 for free health insurance counseling.


Team 1 (Door to 24), from left, standing: Barbara Roberts-Baker, MBA, Lisa Mack, RN, Melani Murphy, RRT, MBA. Seated: Keala TeKolste, M.D., James Larson, M.D., Cynthia Stuller, RN, BSN.

Team 2 (It’s OK to ask), from left, standing: Matthew Rubino, M.D., James Perkins, M.D. Seated: Bonnie Osgood, MSN, RN-BC, NE-BC, Jennifer Cooke, D.O., Melinda Rizzo, RN, BSN.

Team 3 ( Vital signs as a predictor of early deterioration), from left, standing: Tim Gibbs, NFMC, Lionel J. Malebranche, M.D., Nancy Homan, RN, MSN, MBA, APRN-BC. Seated: Deborah Devuono, RN II, BSN, PCCN, Lynda Goldberg, D.O., Kathleen L. Kozak, RN, BS, CSHA.

Team 4 (Is there a doctor in the house?), from left, standing: Jamie Rapacciuolo, D.O., Metty S. Mesick, MDiv, MAPC, BCC, Bobby Gulab, M.D., JoEllen Workman, RN, MSN/HSA. Seated: Robin Thomas, RN, Josephine E. Steffe, RN, CCRN, Lori Killian, MBS, RRTNPS, RPFT, AE-C.

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Latest ACT class projects aim to improve system-wide processes

OB/GYN nutrition booklet available

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he seventh class of Achieving Competency Today (ACT): Issues in Health Care Cost, Quality, Systems and Safety joined a growing list of course graduates determined to create ways to improve system processes at Christiana Care. The latest class, comprising 24 nurses, residents and allied health professionals divided into four groups, each with a facilitator, graduated on Dec. 9. Brian Little, M.D., Ph.D., vice president of Academic Affairs and Research, and Sharon Anderson, RN, BSN, MS, FACHE, senior vice president of Quality and Patient Safety, awarded certificates of completion to the graduates. Two new course facilitators, Carmen Pal, RN, BSN and Matthew Judd, D.O., received certificates of completion, as well. Here’s a look at the project titles and what the teams accomplished: Door to 24

One team aimed to reduce by 25 percent the time it takes for certain behavioral health patients to be evaluated in the Wilmington Emergency Department. By piloting a process that uses a mental health-specific triage tool, the team exceeded its goal. The facilitator was Carol K. Moore, RN, MS, APN-BC and co-facilitator Carmen Pal, RN, BSN, PCCN. It’s OK to ask This team hung posters at Wilmington Hospital encouraging patients to ask health care providers if they’ve washed or used gel on their hands. Follow-up studies showed that

patients reported feeling more comfortable asking the question and that overall hand hygiene improved. The facilitator was Teri Foy, MEd, RT. Vital signs as a predictor of early deterioration A third team’s aim was to foster early recognition of deteriorating vital signs in Emergency Department patients. The goal was to reduce by 15 percent the need for Rapid Response Team calls within the first four hours. The team identified opportunities for improvement in the ED and on arrival at the nursing unit. The facilitator was Thea Eckman, RN, BSN, CCRN. Is there a doctor in the house? The fourth team’s goal was to improve patients’ ability to identify the doctor in charge of their care by 25 percent. Physicians wrote their names on patients’ white boards and circled their photos on the resident roster. The facilitator was Loretta ConsiglioWard, RN, MSN and co-facilitator Matthew Judd, D.O. Anderson and Dr. Little applauded the teams’ work and the growth of ACT. The graduate-level, interdisciplinary 12-week course covers performance improvement, change theory, patient safety, interdisciplinary team concepts, measurement and outcomes analysis, the U.S. health care system, and budgets and approval processes. The next course offering is in September 2010. Those interested in enrolling may contact Theresa Fields at 302-623-4487 or tfields@christianacare.org.

regnant and nursing women are bombarded with information about what and how much to eat. Often, the advice they receive is contradictory and comes from a variety of sources. To help our OB patients make healthy choices, dietitians from the Preventive Medicine & Rehabilitation Institute have compiled a booklet that includes up-to-date nutrition recommendations, weight guidelines, recipes, and menus. Nutrition Tips for Two, Healthy Eating During Pregnancy and Breastfeeding is available in Christiana Care OB/GYN offices.

Expo to give student nurses a closer look

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ore than 250 nursing students are expected to attend Christiana Care’s annual Student Nurse Expo on Friday, Jan. 29 at the John H. Ammon Medical Education Center from 10 a.m.-2 p.m. The Student Nurse Expo is a key component in Christiana Care’s recruitment plan. Nursing preceptors, staff development specialists and nurse recruiters will be available to greet students, give guided tours of nursing units and provide information about nursing orientation, internship programs and scholarship programs. Register for the event online at www.christianacare.org/careers.


‘Having Proper Materials’ and ‘Doing What I Do Best’

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s we strive to make Christiana Care a Great Place to Work, consider how you would respond to the following employee engagement statements from our survey: “I have the materials and equipment I need to do my work right.”

We value the work of our employees. Christiana Care supports your efforts to “do your work right” by providing the materials and equipment each employee needs. We can all work more effectively when we have the right resources. Ask for what you need. Your manager will help determine if your request can help achieve the results your team desires. What can you do?

formance impacts service and affects the rest of your team. Managers and employees should work together to discover each staff member’s strengths so they can be put to use serving our patients and internal customers. Even if you can’t use all your strengths in your current role, find ways to contribute on teams or special projects. What can you do? n Identify the aspects of your job that give you the most satisfaction. n Figure out what kinds of activities you are drawn to and ask yourself what it is you like about them. n Think about what your primary strengths are in terms of skills, knowledge and talents. Write them down and share with your manager.

n Communicate what you need and why, even if you think your manager already knows. You know best what you need to do your job successfully.

n Identify opportunities to volunteer for committees, projects, assignments or tasks that provide you with the most job satisfaction.

n Always follow up with your manager regarding your requests. Understand that budgetary or other constraints can delay requests.

n Explore Christiana Care’s Career Development program.

“At work, I have the opportunity to do what I do best every day.” Doing “what you do best every day” refers to your job fit. Making the most of the unique skills, knowledge and personal talents you bring to your position enriches your work life. Ask your manager for feedback on your performance. Ask how your per-

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n Take advantage of internal and external educational opportunities through continuing education or tuition assistance. n Explore new and different opportunities through the internal job posting system.

When we work together using materials we need and performing the tasks we do best, we contribute to making Christiana Care a Great Place to Work.

GET HELP WITH TOBACCO CESSATION


Advice to help you kick the nicotine habit

To beat stress, listen to your body

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eople who quit smoking often say it is the hardest thing they have ever done. Blame it on nicotine, an addictive substance that hooks people on tobacco by physically altering the cells in their brains. After awhile, smokers and people who chew tobacco depend on nicotine to help them concentrate, relax or control hunger. Brain must learn new pattern

When people stop smoking, they crave nicotine until their brains learn new patterns. That’s why so many folks who are in the process of quitting are anxious, grouchy and irritable. Smoking a cigarette will make you feel better for a short time—but it will derail your goal of living smokefree because you will soon yearn for more tobacco. The first few days are the worst. Some people crave cigarettes for weeks or even months. Still, people can and do kick the habit every day. You can increase your odds of quitting for good if you arm yourself with a few tried-and-true coping techniques. Here are ways you can set yourself up for success: n When you get the urge to light up, distract yourself with physical activity. Walk around the block. Mop the kitchen floor. Play catch with the kids. (Exercise also reduces stress and can counteract weight gain.) n Breathing exercises help, too. Take several breaths, as deep as you can. Hold that last breath, then breathe out as slowly as you can. Relax the muscles in your body. n Make meditation part of your routine. Options include yoga, listening to relaxing music, self-hypnosis and tai chi and qi gong, two Chinese relaxation disciplines. Find the fit that is best for you. n Fill the fridge with fruits, veggies and whole grains. Toss foods that are high in sugar and fat. But don’t even think about going on a diet. You already are giving up cigarettes, and this is no time to deprive yourself of food, too. n Take a warm bath before bed. To ensure a good night’s sleep, don’t drink alcohol late in the evening or caffeine in the eight hours before bedtime. Avoid naps. If you still can’t sleep, ask your doctor for medication that helps you rest while you are going through withdrawal. n Consider nicotine replacement drugs that will reduce your physical craving for nicotine. The medicine will help you feel better and cool the urge to light up.

ou can’t sleep—or you are having a hard time staying awake. You couldn’t eat a thing—or you want to nosh morning, noon and night. You’re constipated—or you have diarrhea. You’re sad, anxious, depressed and have developed a bad attitude. Listen to your body Odds are, your body is telling you: I’m stressed! Stress is our bodies’ response to changes in our environment. The death of a loved one, divorce or job loss are bigtime generators of stress that can manifest in such physical ways as backaches, headaches, chest pains, muscle spasms and shortness of breath. Even happy events, such as getting married, starting a job or buying a house can be stressful until we learn to adjust to these major changes in our lives. A little stress is normal It’s helpful to internalize that a little stress is a normal part of life, like eating and sleeping. The key is to balance stress with periods of relaxation that keep stress from overcoming our day-to-day lives. Think of a blissful honeymoon after the stress of planning a wedding. Without regular breaks, stress can erode concentration, making it difficult to focus. People who are stressed out might cry for no reason or feel out of control—or simply go numb, feeling little or nothing at all. Try exercising If you are having difficulty keeping a handle on your mood, you will find that regular exercise is highly effective in taming your inner beast. Walk or jog or do other aerobic exercises to decompress and allow the anger and sadness to evaporate harmlessly from your body. Meditation and relaxation techniques also can help. Simply taking a few deep breaths—inhale and exhale slowly—can take the edge off when you feel your stress level rise. If you have multiple symptoms of stress, worries you can’t seem to shake, contact your doctor for help. You can learn ways to treat and manage stress before it causes long-term harm to your body.


Christiana Care promotes global approach to research ethics

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hristiana Care’s Institutional Review Board Corporate Director Jerry Castellano, Pharm.D., CIP, traveled to India in November to share expertise on ethics in clinical and biomedical research. Dr. Castellano presented “Conducting Clinical Trials in India—a U.S. Perspective,” at an international workshop hosted by Sri Ramachandra University in Chennai Province. The workshop was in collaboration with the University of Miami as part of the Collaborative Institution Training Initiative (CITI). “India is one of the fastest-growing

areas for both drug development and therapeutic research,” explains Dr. Castellano, a member of the CITI Executive Committee and the CITI Developer’s Group since 2001. Plans are to add India to the more than 1,300 CITI sites in 39 countries around the world participating in Web-based, peerreviewed research ethics training. Low trial costs, increasing government incentives and a well-trained medical community of English speakers with qualified patients, make India a desirable research field location to bring new drugs and new therapies more quickly to market here at home. U.S. Food and Drug Administration and Department of Health and Human Services regulations

As part of a U.S. delegation, Christina Care Institutional Review Board Corporate Director Jerry Castellano, Pharm.D., CIP, lectured on ethics in clinical and biomedical research at a workshop in Sri Ramachandra University in Chennai Province, India.

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and approvals still apply. Richard Derman, M.D., MPH, chair of Obstetrics and Gynecology, is a principal investigator for the National Institutes of Health Global Research Network for Women and Children. His studies in collaboration with Jawaharlal Nehru Medical College in Belgaum, India, are building opportunities for international research and cross-cultural exchanges here and abroad. “Christiana Care is the largest recruiter among seven sites worldwide for the Global Network,” says Dr. Derman. His work, featured in The Lancet and upcoming in The New England Journal of Medicine, is focused on reducing major risks to maternal, neonatal and infant health. “The primary health issues affecting mothers and babies in India are the same ones that contribute to maternal and infant mortality in America as well as other parts of the world,” he adds. Ongoing investigations include new drugs to reduce post-partum hemorrhaging, pathways to educate and promote labor and delivery best practices among rural midwifes, and the effects of secondhand smoke on women of child-bearing age. The Christiana Care IRB serves as the U.S. institutional review board of record for these federally funded research studies in India. Dr. Derman is the principal investigator.


Gifts from Junior Board Medicine Ball total $100,400

Representatives from the Junior Board’s 2009 Medicine Ball committee presented a check for $100,400 to Christiana Care for nursing and allied health professional scholarships. In its 10-year-plus history, the Medicine Ball has raised more than $1 million to benefit numerous Christiana Care services and programs. This year, the Medicine Ball will be on April 23— mark your calendar for a festive evening of food, fun and dancing. Watch Focus for more details soon.


Helen F. Graham Cancer Center expansion wins 2009 design and construction award

T

With the expansion, the Helen F. Graham Cancer Center has more than tripled in size, centralizing the entire continuum of cancer care resources.

he expansion of the Helen F. Graham Cancer Center at Christiana Care won a 2009 design and construction award from MidAtlantic Construction magazine. The expansion was named Project of the Year in the health care category. The magazine honored 40 projects in 16 categories, representing the finest examples of design and construction in Virginia, Maryland, Delaware, Pennsylvania and the District of Columbia.

Focus: Jan. 14, 2010  

Focus is a publication for physicians and employees of Christiana Care Health System.

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