As Northern Virginia’s population and healthcare needs continue to expand, many of the region’s hospitals and medical professionals are searching for ways to meet current demands while improving how they provide care to the community.
By Lexi Gray Steacy / Photography by Erick Gibson
Continued dedication and service from our region’s health care professionals is leading to medical innovations with a far-ranging impact.
Cardiac patients are alerted of a possible heart attack before it occurs. Robotic technology allows a surgeon to perform a procedure that was otherwise prohibited by the patient’s religious beliefs. Predictions about the likelihood of premature birth and congenital diseases will be available to those considering parenthood. Artial fibrillation patients are being provided procedures that are minimally invasive, with less post-procedural pain and better outcomes. Surgeries that once required almost a weeklong stay in the hospital now have drastically reduced recovery times. Lives are being saved and changed as a result of the region’s focus on medical innovations and research being performed by area doctors.
For instance, a number of clinical trials and new surgical procedures are offered by Northern Virginia-based facilities each year. These trials allow local patients to have access to the most up-to-date technology, which would be otherwise unavailable due to federal and state laws governing the medical field. In addition to clinical trials, Northern Virginia residents have many options for healthcare—whether they receive treatment in a local clinic, a community hospital or in a facility that is part of a larger hospital chain.
Researchers and staff members behind these local facilities agree that Northern Virginia is a growing force, not only in the region but the nation, with an increasing focus on providing new treatments and disease interventions that will benefit a multitude of patients.
Improving Healthcare through Research
Two of the region’s most seasoned researchers are John Niederhuber, M.D. and Joe Vockley, Ph.D, of the Inova Translational Medicine Institute (ITMI). With a career that includes time as a former director of the National Cancer Institute, Dr. Niederhuber is both a surgeon and a researcher. Dr. Vockley’s career is also expansive, with a focus on cancer, genetics and genomics—with a special interest in bioinformatics.
In a March 2012 editorial letter published in the journal “Annals of Surgery”, Dr. Niederhuber expressed his dedication to advancing medicine through research, and proposed that improvements in cancer outcomes are not solely the result of surgical-based research. He noted that much can be learned from a more basic focus of the patient—for instance, examining the effect of social factors such as vaccination, clean water and proper nourishment for the patient.
Dr. Niederhuber holds respect for research based in everyday life, yet his work conducted at ITMI is highly technical—with a mission that proposes the creation of genetic models based on large patient populations, in hopes of predicting and managing disease risk.
ITMI is currently working on two research studies—the first, examining the underlying causes of pre-term birth; with the second project building upon the initial research in order to identify an association between pre-term birth and family genetics. The goal of the second project includes gathering enough information for medical professionals to have an ability to predict the occurrence of premature birth and other childhood diseases. The study currently includes 2,500 families, with hopes to expand that number to 10,000.
Expressing his excitement about the future of ITMI, Dr. Niederhuber says, “Clearly the pre-term birth study will shed considerable light on causes that lead our pre-term birth babies to require years of costly medical care.”
Research Drives Medical Innovations
When it comes to medical innovations like those taking place at ITMI, data and research is an important driving force, according to Robert L. Hong, M.D., medical director of radiation oncology at Virginia Hospital Center in Arlington.
With regard to complex surgeries and medical procedures, Dr. Hong says it is important for physicians to have the data available about the efficacy and benefits of what each prodecure does, and how it affects the overall well-being of their patient.
“Patients should have access to the information available regarding their conditions and procedures,” Dr. Hong adds. “Unless they have all the necessary data, people might not realize that they need a second opinion about what’s going on with their health.”
With regard to using data and research in his own practice, Dr. Hong is dedicated to drawing attention to research on breast brachytherapy—or implantable radiation—using the Strut-Adjusted Volume Implant (SAVI).
For breast cancer patients who may only need partial irradiation treatment, SAVI is a way to avoid overexposure association with “whole breast” radiation treatments. SAVI treats only the tumor bed and a small surrounding area—instead of the whole breast—and implanting this device is an outpatient procedure, which Dr. Hong says adds to the appeal for patients.
The heart of the issue, Dr. Hong says—and why he pushes for increased focus on presenting this data—is because the result is often that patients feel more informed and have more options for care. He adds that well promoted research may inform patients about procedures and treatments not known by their own doctors.
Radiation Oncologist Susan Boylan, M.D., of Sentara Northern Virginia Medical Center in Woodbridge, agrees that research is an essential part of her profession. “I make it a point to stay abreast of the abundance of recently published clinical research outcome studies and new treatment technologies available to practicing radiation oncologists. I also participate in clinical trials at my institution.”
Dr. Boylan says that when she began practicing as a radiation oncologist 30 years ago, patients received treatments with broad beams and no varying intensities; it was not precise to the tumor locations, like today’s technology. “A much more sophisticated and precise approach called 3-dimensional Conformal Radiation Therapy (3DCRT) was then developed, and allows [doctors] to contour the shape of the radiation beam to conform to the irregular shape and size of the tumor.”
“We can deliver more dosage to the tumor while at the same time decreasing the dose to surrounding normal tissues,” Dr. Boylan explains. “The result is better tumor control with fewer side effects for the patient.”
While the 3DCRT therapy is impressive in its own right, improvements to this technology increasingly improve outcomes for oncology patients. Intensity-Modulated Radiation Therapy (IMRT), for example, is a technology that destroys tumors without the invasiveness of a scalpel, says Dr. Boylan. “The end result of all these advances is better protection of normal tissue and higher doses of radiation to the tumor.”
Preventing Life-Threatening Events
In patients who have heart and vascular diseases, early detection often means the difference between life and death. This high mortality rate is further magnified when considering just how many people are affected by heart disease and stroke—the first and third leading causes of death for men and women in the U.S., repectively, according to the Centers for Disease Control and Prevention (CDC). Total costs related to cardiovascular disease in the U.S. are estimated at approximately $444 billion, which equals $1 of every $6 spent on medical care. As a result, research and innovations related to cardiovascular disease commonly focus on early detection and prevention.
One way that local physicians are addressing these alarming statistics is by providing their patients with access to clinical trials. Hamid Taheri, M.D., an interventional cardiologist and director of research at Virginia Cardiovascular Associates (VCA), shares a vision similar to Dr. Niederhuber’s. Dr. Taheri says a focus on nanotechnology—which has implications for improvements to implantable devices—will open the door for less invasive treatments
Currently, VCA, with offices in Manassas, Annandale, Warrenton and Haymarket, is helping to facilitate a trial involving a device designed to alert cardiac patients of a possible impending heart attack. Patients are able to seek emergency care before the heart attack takes place, potentially saving their lives.
This trial, called “the ALERTS study”, is targeted to patients with existing cardiovascular conditions who undergo implantation of a device that recognizes certain changes in the body that tend to precede a heart attack. When these signs are identified, the device employs an audio, vibratory and visual alert system notifying the individual that they must seek immediate medical care.
Marcia Makoviecki, director of clinical enrollment and communications at AngelMed, which manufactures the implantable alert device, says “The goal of the ALERTS study is to determine the safety of the device, and whether it effectively gets the patient ‘o the ER door’ ore quickly.” The trial is approved by the FDA for the enrollment of 1,020 patients—and the final participant group will be added to the program in 2013. Following the enrollment period, AngelMed will focus on pulling together data and research on the trial in order to gain final FDA approval for the device. After this, the device will be available to the public.
While the AngelMed/VCA-facilitated trial focuses on patients at risk of heart attack, patients suffering from another common cardiovascular irregularity—atrial fibrillation—are benefiting from an innovative procedure offered by the medical team at Virginia Hospital Center (VHC).
Atrial fibrillation (AF), the most common arrhythmia, has varying effects on those who are diagnosed with it—it may have no apparent symptoms, or it may deeply affect a person’s quality of life. Some AF patients are unable to walk up a flight of stairs or engage in even minimal activity without experiencing shortness of breath or a racing heartbeat, according to Dr. John R. Garrett, Virginia Hospital Center’s chief of cardiac surgery, chief of non-cardiac thoracic and vascular surgery and chairman of the board of directors. In severe cases, AF leads to stroke—and AF patients are up to seven times more likely to experience a stroke than those with normal heart function.
Several years ago, in recognition of the potentially severe impact of AF, Dr. Garrett and his team began searching for ways to provide better, more effective options for the region’s patients. Traditional treatments for AF, Dr. Garrett says, were often invasive and did not guarantee a successful outcome. It is not uncommon for AF patients to take medications and receive several surgical procedures, only to find that their arrhythmia was not corrected, he says. Patients with AF are seeking an improved quality of their daily life, in addition to decreased stroke risks.
As a result of Dr. Garrett’s quest for improved AF treatments, VHC recently began offering a minimally invasive procedure called convergent maze. Dr. Garrett describes convergent maze as a co-disciplinary approach that combines techniques of both cardiac surgery and electrophysiology. “Using the convergent procedure, we don’t have large incisions, blood loss is minimized, and patients report very little pain,” Garrett says. “The patient is expected to remain in the hospital one day instead of five or six, which is common with some other procedures for AF.”
Dr. Garrett’s decision to begin offering convergent maze is backed by recent data and research outcomes. An article published in “Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery” concluded this is an improved approach over previously established methods for treating AF. The article examined a study of 65 patients who received the convergent procedure from 2009-2010, and found that 82 percent of participants had a normal heart rhythm after one year. Another study presented during the American College of Cardiology’s 2012 annual meeting showed 85 percent of its participants were free of AF one year after receiving the convergent procedure.
Speaking to results from his personal experiences with convergent maze, Dr. Garrett says the successful outcomes are encouraging and inspiring. The hospital’s plans for the future include setting up a program to train physicians from other facilities on how to perform convergent maze. “We’re truly excited to be able to offer this procedure,” Dr. Garrett says. “When considering those patients who have experienced repeated treatment failure, there is a sense of anticipation that I don’t see with other cardiac surgeries.”
Improved Practices, Research and Products
Minimally invasive procedures such as convergent maze are increasingly becoming the norm in surgical settings, and are a vast improvement over the invasive and limiting procedures of the past, which often required longer hospital stays and intense recovery periods. Reston Hospital Center is among the local facilities focused on responding to the increasing demand for a wider range of high quality, minimally invasive procedures. Providing Northern Virginia with high quality care and innovative technologies is a top goal for Reston Hospital Center, according to its Interim CEO Jane Raymond. An example of the hospital’s ability to meet its goals for innovation is the Institute for Robotic and Advanced Minimally Invasive Surgery’s operative guidance system called Renaissance, which is used for spine procedures.
Renaissance employs a 3-D simulation of the patient’s spine that surgeons use to navigate spinal procedures, ensuring an accuracy of 1 millimeter of pre-planned locations for surgery. Thomas Schuler, M.D., a spine surgeon and CEO of the Virginia Spine Institute, says that in addition to the precision assured via Renaissance, it also equates to less pain, shorter hospitalizations and a shortened recovery period for the patient when compared to the normal freehand surgeries.
The equipment also opens up a wider patient base, offering more options to patients who previously had few options to relieve spine-related conditions. For instance, the robot opened up the option of spinal surgery for a patient whose religion prohibits blood transfusions. Renaissance requires only small incisions, and so the risk of blood loss is drastically decreased—meaning increased safety and peace of mind for the patient who is unable to receive blood transfusions.
The Renaissance equipment is just one of several innovative tools doctors have available helping to improve surgical options and outcomes for patients. Prince William Health System recently began offering treatment with the MAKOplasty robot, used for partial knee resurfacing procedure. The MAKOplasty tool has the ability to selectively target and treat areas of the knee damaged by osteoarthritis.
W. Bartley Hosick, M.D., an orthopedic surgeon with Prince William Health System and Northern Virginia Orthopedic Specialists in Manassas, says a benefit of MAKOplasty is that it provides partial knee procedures allow ing increased preservation of the patient’s natural bone. He adds, “MAKOplasty allows us to precisely plan surgeries at a higher level than we’ve been able to before.”
Dr. Hosick says the tool provides an expanded range of options for patients with osteoarthritis (OA)—especially those who were previously deemed difficult to treat. MAKOplasty also expands the demographics of eligible recipients to the region’s younger patients with OA.
Dr. Hosick says, “We have a patient in his mid-30s who is undergoing the procedure, and we probably wouldn’t have been able to provide him treatment before MAKOplasty. Before, you’d have to tell those younger patients that they should attempt to just manage the pain of osteoarthritis. So in that respect, MAKOplasty is certainly able to provide an improved quality of life for our patients in the community.”
Orthopedic conditions, much like those affecting the cardiovascular system, involve quality of life issues centered on discomfort and pain. Deeni Bassam, M.D. is an anesthesiologist and pain management specialist with the Spine Care Center in Manassas, a facility focused on interventional pain management and minimally invasive orthopedic spine surgeries. Dr. Bassam emphasizes the importance of providing innovative approaches for the pain associated with conditions such as spinal stenosis, which leads to narrowed spacing between vertebrae that causes pinched nerves, pain and numbness.
Spinal stenosis has similar quality of life issues as those seen with OA, Dr. Bassam says. “Spinal stenosis is a very common problem that many people have to live with. In the past, the only option was to have an open operation.” Open spinal surgeries carry risks including infection, tears to the spinal cord, blood clots and a potentially long and intense recovery period. Dr. Bassam says, “Now we can offer an outpatient procedure for spinal stenosis, and it does not even require general anesthesia. Patients walk out of the hospital the same day, and are able to get back on their feet while experiencing relief from their long-term pain. There are no bandages, no stitches and no recovery period.”
Dr. Bassam says an important part of his practice involves measuring patient outcomes related to pain management procedures. His patients average a 50-percent improvement in pain, with a 30-percent improvement in function and mobility. “I hear compelling stories from patients about how this hour-long procedure has made a significant impact on their everyday life,” Dr. Bassam adds.
Yet Dr. Bassam says he wonders if innovative approaches to care are advancing as rapidly as they could. With regard to Northern Virginia’s medical landscape, Dr. Bassam says advancements in pain management and spinal procedures are somewhat stifled locally. “It is challenging for new providers to bring innovations to the region, unless they have an affiliation with a local hospital group. Exclusive agreements between hospitals and physicians may exclude patients from learning about innovations going on elsewhere.”
Dr. Bassam notes that the exclusivity between hospitals and surgeons may discourage physicians from setting up practices in Northern Virginia. “These [agreements] may block providers who wish to pursue new techniques but don’t have the support necessary to do so.”
Promotion of a Holistic Care Model
Facilities with smaller patient populations and budgets are making their mark on the region via those communications outside the operating rooms, by focusing on increases in holistic care. Within the region’s smaller hospital facilities, the mission is often to connect with the needs of the surrounding community, while exceeding expectations for care. Just as within the larger hospitals, these community healthcare facilities are searching for programs and initiatives that will set them apart from the competition.
Among the top concerns of female patients in primary and community settings is the risk for breast cancer. Sarah Mezban, M.D., is a radiologist with Northern Virginia Radiology Consultants at Virginia Hospital Center in Arlington whose practice recently began providing 3-D mammography to the local community. This advanced mammogram allows the examination of each layer of breast tissue—Dr. Mezban related it visually to paging through a book.
“This approach makes it easier to detect breast cancer. My patients appreciate the comprehensive nature of this technology because it gives them added peace of mind,” Dr. Mezban says. “Patients in the Northern Virginia region are very well educated overall, and tend to be very savvy with their health. They want to be involved in decisions about their healthcare. We had many inquiries about 3-D mammography when patients began to hear about it in the news, and we thought it was important to meet this need for the community.”
On the other end of the region, the Fauquier Health organization is promoting nurse-led initiatives to provide holistic care and to go beyond what is expected from a community hospital, according to Amy Powers, R.N. In late 2011, Fauquier Hospital’s Family Birthing Center implemented a critical congenital heart disease (CCHD) screening program for newborns, in order to identify this condition and provide immediate action. The decision to implement the CCHD screening program was based entirely on research.
“We found the research to be strong, promising and overwhelmingly positive, and knew it was something we should implement as standard of care at our facility,” Powers says. “We felt that this important initiative should and would be implemented throughout the country and we wanted to participate in that process.” CCHD screening takes approximately 30 seconds, and is performed in conjunction with newborn hearing screens between 24 and 48 hours after birth. The Birthing Center has screened almost 750 infants since the program was implemented.
In June, Powers gave a presentation to the Virginia Department of Health (VDH) in support of a newly convened task force that will result in statewide implementation of CCHD screenings. Powers says, “We are an example to other community hospitals that this life-saving screening is quick, painless, non-invasive and can be easily implemented in a facility that promotes and supports nursing leadership and care excellence.”
Looking to the Future
The procedures and innovative research pursued by medical professionals in Northern Virginia may one day make the region as notable for its healthcare as it already is for industries such as technology and government. For now, the local community can rest assured that there is little reason they would need to travel outside Northern Virginia for care.
As Virginia Hospital Center’s Dr. Garrett states: “For medical care, Northern Virginia is just as good—or better—than most places in the world.”
Speaking of her own specialty—radiation oncology—Dr. Boylan says the Northern Virginia region is home to highly qualified professionals who are equipped to provide treatment for cancer. “Many of the oncologic physicians and medical institutions in Northern Virginia participate in or have access to protocols and investigational drugs. Such access offers our patients the opportunity to receive the most advanced treatment services close to home without having to leave their own medical community.”
Of her own fondness for the Northern Virginia region, Dr. Boylan adds that she “fell in love” with the area during her years as a medical student at Georgetown University. “I have had the privilege of caring for thousands of patients. In some cases, I am providing care to a second generation of family members. I have enjoyed working with every one of our patients and consider myself lucky to work in Northern Virginia and at Sentara Northern Virginia Medical Center.”
How the Region’s Hospitals stack up
U.S. News & World Report’s “Best Regional Hospitals” rankings examined the region’s hospitals, noting where each facility was strongest in high-performing specialties.
Inova Fair Oaks
Inova Mount Vernon
Mary Washington Hospital
Reston Hospital Center
Sentara Northern Virginia Medical Center
gynecology and urology
Virginia Hospital Center
*Inova Fairfax is also nationally ranked for the following specialties: gynecology, heart/heart surgery
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