TODAY news - April 29, 2004

Study shows heart failure patients live longer with cardioverter defibrillator

A study recently completed shows that people with heart failure live longer when they receive an implantable cardioverter defibrillator (ICD), a device offered by the Loma Linda International Heart Institute. The results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) were released on March 8. It included data from 2,521 patients enrolled in the largest ICD trial ever. The study showed that ICDs reduced death by 23 percent in people with moderate heart failure compared to those who did not receive defibrillators.

"This is a very important study because we now know that implanted defibrillators can save patients who have heart failure without coronary artery disease," says J. Thomas Heywood, MD, director of the heart failure program at Loma Linda University Medical Center. Implantable cardioverter defibrillators administer electrical shocks to stop ventricular fibrillation (VF)--a lethal condition in which the heart quivers chaotically and pumps little or no blood. They also stop ventricular tachycardia (VT), and less problematic arrhythmias. The shock from an ICD briefly shocks the heart and allows it to quickly resume a normal rhythm.

They also collect information for the physician to use in programming the device to the exact needs of the patient. These devices are proven to be 98 percent effective in treating ventricular arrhythmias that can lead to sudden cardiac arrest.

Sudden cardiac arrest is the number one killer of Americans, taking the lives of nearly 450,000 people in the United States each year. An ICD can benefit those who have intermittent ventricular tachycardia, in which the heartbeat suddenly and without warning speeds up to dangerous levels, people who have survived a sudden cardiac arrest, and people who have survived a myocardial infarction (heart attack) and have impaired function in the lower chambers.

SCD-HeFT was a placebocontrolled, three-arm trial examining the use of ICD therapy and anti-arrhythmic drug therapy in patients who have moderate heart failure (New York Heart Association class II or III), plus impaired pumping function of the left ventricle, the heart's main pumping chamber. One-third of patients enrolled in the study received an ICD provided by Medtronic; onethird received amiodarone, a medication used to manage fast heart rhythms, and one-third received a placebo.

All patients received optimal conventional heart failure medications when appropriated and tolerated, such as ACE inhibitors, beta-blockers, diuretics, statins, and aspirin. Sponsored by the National Heart Lung and Blood Institute of the NIH, with funding from Medtronic and Wyeth Pharmaceuticals, patient enrollment began in 1997 and continued through 2001.

Two Loma Linda University Medical Center and Children's Hospital volunteers were named to the San Bernardino Sun's 2004 academic team.

Benjamin Koo, a senior at Loma Linda Academy; Harvey Xiao, a senior at Etiwanda High School; and Christine Wong, a senior at Redlands High School, were among 14 students named by The Sun to be on the 2004 All- County Academic Team.

Members of the All-County Academic Team were featured in a two-page spread in the Sunday, April 4, 2004, edition of The Sun. Mr. Koo is second in his class of 160 at Loma Linda Academy. A National Merit Finalist, he scored 1,580 on his Scholastic Aptitude Test.

An accomplished pianist, the 18 year old placed first in the Inland Empire Piano Festival, winning twice in the solo division and once in the duet division.

In addition to volunteering at Loma Linda, Mr. Koo is involved with student government serving as treasurer. He has also served as band chair and plays trombone in the Loma Linda Academy Symphonic Band.

With all his studies and extracurricular activities, Mr. Koo credits his family with keeping him focused on his goals. "A lot of times I feel overwhelmed," he says, "but home is what keeps me grounded."

Eighteen-year-old Harvey Xiao is ranked first in his class of 873 students at Etiwanda High School.

Mr. Xiao recently received first place for his division in the San Bernardino County Academic Decathlon, being the high scorer for his team. He is president of the national honor society.

So far, Mr. Xiao has volunteered more than 350 hours at Loma Linda University Children's Hospital and has also worked more than 100 hours at Pomona Valley Chinese School.

After completing college, Mr. Xiao plans to take medicine. "I've known I was interested in medicine and wanted to go into that field, and I still plan to," he says.

Ms. Wong ranks first in her class of 631 and is valedictorian for the class of 2004. This past summer, Ms. Wong spent 80 hours as a research assistant in the department of microbiology and molecular genetics at Loma Linda University School of Medicine.

In addition, Ms. Wong spreads cheer to the patients at Loma Linda University Medical Center through song with the Sunshine Band. Following college, Ms. Wong plans to attend medical school and upon completion, she plans to specialize in ophthalmology.

Ms. Wong is the editor of her school newspaper. She recently won the Gallup award for a news article she wrote about religious diversity.

Hearing coordination center helps give parents a leg up on hearing difficulties

The staff at the South Eastern California Hearing Coordination Center are (from left to right): Magdalena Junca, RN, screening coordinator; Ursula Flores, administrative secretary; Linda Neimeyer, parent coordinator; David McGann, MS, CCC-A, consulting audiologist; Katharine West, MPH, MSN, RN, CNS, director; and Karyn Howe, data coordinator.

Hearing loss happens in nearly two to four out of every 1,000 infants. If unnoticed, this hearing loss can be detrimental to the critical first months and years as a child develops communication skills. The earlier the hearing loss can be identified, the sooner intervention can help the child and family adjust.

The California Newborn Hearing Screening Program (NHSP) is aimed at doing just that. Using a comprehensive coordinated system of early identification and provision of appropriate intervention, the NHSP screens newborns for hearing loss by one month of age, confirms that loss by three months, and links babies identified with hearing loss to early intervention services no later than six months of age. It is expected to screen 400,000 babies for hearing loss every year and find 1,200 with hearing loss annually.

Four geographically based hearing coordination centers have been set up throughout California to complete this task. They act as a critical component, implementing the system efficiently, assuring the screening and services are of high quality, and most importantly, making sure babies failing the hearing screening test are not lost to follow-up.

At the South Eastern California Hearing Coordination Center (SEC HCC), based in the Mountain View suites of Loma Linda University Medical Center, a staff of six track the hearing of newborns from 27 hospitals across six counties (San Diego, Imperial, Mono, Inyo, San Bernardino, and Riverside).

The California department of health services funds the SEC HCC through a grant for $1,064,000, which began in November, 2002, and continues through June 30, 2005.

The nationwide rate of newborns not being followed-up with is from 30 to 50 percent. In California, that is cut to five percent.

The program is available to all children born in California at California Children's Services approved hospitals. Any child born in a non-approved hospital is eligible to enter the program through an outpatient screening provider, usually an outpatient audiologist or hospital credited for both.

"I like this work, says Katharine West, MPH, MSN, RN, CNS, program director. "I started with the program in February of 2000 and have followed it here to Loma Linda."

With the help of Magdalena Junca, RN, screening coordinator; Ursula Flores, administrative secretary; Linda Neimeyer, parent coordinator; David McGann, MS, CCC-A, consulting audiologist; and Karyn Howe, data coordinator, Ms. West's office does everything from helping hospitals develop screening programs in compliance with the department of health services standards, certify hospitals to participate as screening sites, and monitor existing programs.

In addition, the office helps by tracking infants to assure those with abnormal hearing receive proper follow-up such as rescreening, diagnostic evaluation, and treatment, as well as educate families and providers so they can effectively advocate with commercial health plans to access the appropriate treatments for their child.

Because Loma Linda University Medical Center is situated between the San Andreas and San Jacinto faults, the hopsital is about to embark on its largest construction project since the Children's Hospital was built 1993.

The entire Medical Center staff and patient population will benefit from four years of designing, planning, research, and extensive development led by Ken Breyer, administrative director for the department of construction and architectural services; Brad Johnson, project superintendent and LLUMC representative to the contractors; and Paul Denney, technical manager for Edison Welding Institute (EWI).

The construction project, dubbed the seismic retrofit, is all but ready to get underway to meet California's senate bill 1953, a 1994 law requiring hospital buildings to meet more stringent seismic and structural requirements.

The ultimate goal of the project is to limit the Medical Center building's movement to the standards outlined in SB1953 by thickening the walls. The Medical Center, even prior to the requirements of SB1953, had set out to assure patient safety and to do so with an innovative laser technology that will virtually eliminate the typical noise, vibration, dust, and contamination problems associated with current concrete removal methods. The laser will be used to drill holes in the existing concrete, place Lshaped rebar inside, epoxy it into place, tie more rebar on, and pour another layer of concrete to thicken the walls, creating a matrix strong enough to keep the building together as a single piece during an earthquake.

Since many hospital structures consist of reinforced concrete, a major problem associated with structural strengthening of these facilities has been the noise, vibration, and dust created by the use of conventional jackhammers and cutting tools. The disruption caused by these processes may even make it impossible to continue patient care activities in buildings being retrofitted. The laser process for drilling into concrete will reduce much of the disruption, but the office of Statewide Health Planning and Development (OSHPD) has watched closely over the project to ensure all safety codes, especially those pertaining to accessibility issues, are met. The LLUMC retrofit is a national model program to produce a virtually non-disruptive retrofit so that this hospital, and others, may continue to provide quality health care during the retrofit process itself. LLUMC has made the use of the laser technology available to all non-profit hospitals without fee for the use of the technology.

"We all have the same goal in mind, and that's protecting the building occupants," says Mr. Johnson, project manager. The project is split into two parts. The original clover leaf design of the 1967 construction makes up one part needing seismic retrofitting, and the research wing constitutes the second part. Retrofitting of the clover-leaf portion will most likely start mid-fourth quarter in November. OSHPD and LLUMC construction recently agreed upon issues regarding hallway and restroom accessibility during the retrofitting process. The next step will incorporate the concepts into design drawings for OSHPD's approval, which is expected to be completed by November. Loma Linda University Medical Center has been in the lead in California to obtain retrofit design approvals, a new process for OSHPD to deal with and one that is determining the pace of the retrofit itself.

The research wing portion of the project actually began on January 6 with the relocation of all the occupants of the B-level. The general contractor for the project, Turner Construction, established control measures to protect the rest of the research wing from dust contamination by making changes to airflow, constructing physical barriers, and placing sticky mats at entrances to collect dust. Workers then began removing materials in order to install new concrete grade beams when they discovered various hazardous materials such as asbestos and lead-based paint needing removal. The removal process is underway and the grade beams were completed the middle of last month.

The laser drilling is planned to go into effect in June to begin drilling the estimated 50,000 holes for the research wing. A demonstration of the final laser device was held in late April.

"Getting started is exciting," says Mr. Johnson. "This has been the longest design process I've ever been involved in. Knowing the building will be safer when we're done leaves me with a good feeling. It's just hard because when we're finished there won't be any sign of what's happened--just concrete walls that have been painted."

During the design process the engineering firm ABS Engineers utilized a software program, SAP 2000, to simulate the Medical Center's structural integrity during an earthquake. Developed by Computers and Structures, Inc., this is the most comprehensive computer software for modeling concrete buildings. At the start of the project, it took 14 days to run one model through a simulation. With the computer advances since then it now takes three days. The software helped show the need for 40-foot friction columns that will be placed in the emergency department to effectively nail down the south side of the building during an earthquake.

The laser-drilling portion of the retrofit process has been developed in conjunction with EWI, of Columbus, Ohio. EWI is a world leader in thermal processes, and its laser processing team conducts research and development for a diverse group of industrial applications. EWI is particularly experienced in delivering industrial-hardened equipment for both private industry and government agencies, primarily the Department of Defense.

The Federal Emergency Management Agency and the California Governor's Office of Emergency Services have facilitated the government support for this model non-disruptive retrofit, including the break through support for the successful research and development needed for the laser-drilling technology.

Orthopaedic professor invited to speak at Ninth International Ceramic Symposium

Ian Clarke, PhD, professor of orthopaedic surgery, School of Medicine, was an invited speaker at the Ninth International Ceramic Symposium on Total Joint Replacements held in Paris , France, this spring.

The sponsor of the symposium was CeramTec, Inc., a ceramic company based in Plochingen, Germany. The newly created LLUMC orthopaedic research laboratory on the East Campus has been comparing the wear performance of the latest ceramic hip designs (Delta) to the conventional ceramic (Forte). The wear machines at LLUMC have been simulating micro-separation of the hip joint during gait.

Dr. Clarke presented his research to the international gathering of ceramic surgeons. While at the meeting, he was asked to give a presentation honoring the achievements of a famous ceramic professor and educator, Gerd Willmann, PhD.

For mor than 16 years, Dr. Willmann has been the technical ceramic "guru" for CeramTec, Inc. After the Paris meeting, Dr. Clarke took advantage of the Chunnel train to go from Paris to London to take part in an editorial board meeting for the journal Engineering in Medicine.

His comment was that "traveling under the English Channel was now so much more comfortable and efficient than flying over the channel."

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