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May 2005 This edition: Letter from the Chair Feature Story: Children's Heart Program Message from the Medical Director Update from the Administrator Children's Research Institute News Brief Mental Health News Brief Letter from the Chair L. Lyndon Key, MD Professor and Chairman Department of Pediatrics Our pediatric cardiology division and pediatric cardiothoracic surgery division are shining stars at the Children's Hospital. As we listened to this year's commencement speaker recount his accomplishments, it made me think of how much has been accomplished by our own group. Our heart specialists current to strive to offer the best training programs, a growing body of research, a superb clinical program and a statewide network. The electrophysiological miracles performed even with a patient on ECMO, keeping a patient alive for more than a month while waiting on a transplant, and the special care, providing life-sustaining procedures to foreign children and local children in need is all-inspiring. Much of the success results from collaboration of cardiologists with the PICU staff and the PCICU unit. However, the most impressive accomplishment is that the entire state has been knitted together to provide the best cardiologic care anywhere in the country. This allows cardiologist around the state to communicate and consult with one another sharing their clinical, to advance therapeutics, and to create research teams that address the problems of South Carolina's children. Dr. Phil Saul has been at the helm and has provided the remarkable leadership that has built and shaped this team. Dr. Bradley has provided the skill and compassion of one of the best cardiothoracic surgeons, following in the footsteps of Drs. Crawford and Sade. Working together, their success in treating patients has been outstanding. In addition, this program provides the training for most of the pediatric cardiologists now practicing in South Carolina. I compliment this group for their hard work, their careful attention to detail and innovation, and their dedication to training. I am proud that our children's hospital is the home to this wonderful program and thank each participant for their role. Sincerely, L. Lyndon Key, MD Chair, Department of Pediatrics Feature Story: The Children's Heart Program of South Carolina By: Christy Farrell Trio Solutions Inc. Dr. Phil J. Saul, MD Imagine the possibility, in the not-too-distant future, of doctors using your own stem cells to build a new heart for your body, thereby eliminating your need for a heart transplant. Sounds futuristic, but the work being done in the MUSC Cardiac Developmental Biology Center is paving the way for this kind of development, potentially within the next decade. Under the direction of J. Philip Saul, MD, professor and chief of pediatric cardiology at MUSC, the Children's Heart Program has grown by leaps and bounds over the last seven years. When Dr. Saul came to MUSC from Harvard Medical School in late 1997, he broadened the focus of the department from an emphasis on electrophysiology to include all subspecialties, echocardiography, cardiac intervention, ICU specialists and general cardiologists. With the addition of new faculty sub-specialists, MUSC facilities were also upgraded. A new clinic has been built in renovated space, as well as a new echocardiography lab, a second catheterization lab and a six-bed same day surgery unit for recovery from special procedures. As if that's not enough, a 12-bed pediatric cardiac ICU (PCICU) - the only one in the state - is in the process of being built on the fourth floor of the Medical University Hospital adjacent to the operating rooms and the Children's Hospital. According to Dr. Saul, the combination of new faculty and new facilities has allowed the department to provide the highest level of excellence so that outcomes are equal to, if not better than, the best level of cardiac care available anywhere. Through the Children's Heart Program of South Carolina, created and now directed by Dr. Saul, MUSC specialists work with pediatric cardiologists across the state so that their young patients and their families can be seen regularly close to home, and still receive MUSC expertise and consultation. Clinical research plays a huge role for the division, as evidenced by the award of one of seven National Institute of Health (NIH) grants, allowing MUSC to participate in the Pediatric Heart Network (PHN), a multi-center program for performing prospective clinical trials on surgical techniques, drug therapy, and device therapy in children with heart disease. It's no wonder with all of these new developments, the Pediatric Cardiology unit's overall volumes have increased steadily by five to 10 percent each year. "Providing the subspecialties, such as intensive care, has had a big effect on the management of patients," says Dr. Saul. "You need a dedicated team of cardiologists, surgeons, anesthesiologists, nurses and other therapists. With that, we've seen the time our patients spend on the ventilator reduced by 70 to 80 percent." Dr. Saul says with current technology about 97 percent of kids can get out of the hospital after surgery. The most complex cases are newborns, whose problems need to be repaired early in life. "Forty years ago, any child with a severe form of heart disease would have died before the age of two," says Dr. Saul. "Now they can not only live, but we can provide the vast majority with a normal lifestyle, which is ultimately our goal." This commitment to the children's quality of life has been an important factor leading to the cardiac research being carried out in the Children's Research institute, trying to determine the real causes of congenital heart disease. With MUSC's Cardiac Developmental Biology Center and Dr. Roger Markwald, the pediatric cardiology division is forming a cardiac molecular genetics program. "We are recruiting junior and senior faculty members who will attempt to understand why the heart forms normally, or abnormally, and then change how it works by using molecular genetic tools in combination with regenerative medicine," explains Dr. Saul. It's this genetic research that will lead to the future capability to manipulate the heart and to use a patient's own stem cells to correct a heart problem or build a new one, says Dr. Saul. For the present, his focus is on providing the "the best experience possible" to every patient and family who comes to the hospital and he feels confident that MUSC's dedicated staff, with their new facilities, is doing just that Message from the Medical Director J. Philip Saul, MD Medical Director Director, Pediatric Cardiology As the Children's Hospital's medical director and the chief of pediatric cardiology, I am particularly pleased that this issue of the newsletter focuses on the research activities of the Children's Heart Program. First and foremost, our primary clinical job is to provide the best possible services to our patients. However, in the subspecialty fields of pediatrics, like pediatric cardiology, we can only do that over the long run by keeping our eyes on the future, and the future is built through research. Those of us in the Children's Heart Program are proud of both our extensive participation in clinical research projects designed to directly improve our care in the near future, and the laboratory efforts highlighted in the newsletter, which hold the promise of a patient specific replacement heart down the road. With the Children's Research Institute up and running, it won't be long before we see the clinical and scientific worlds merging together to improve patient care. Update from the Administrator John Sanders, MHA Administrator MUSC Children's Hospital MUSC Children's Hospital Nurses Make a Connection We spend a lot of time talking about new technologies available for children and new procedures that are being used to treat various diseases. We continue to enhance our programs with cutting-edge technology and improved techniques, but another aspect of our care that separates us from others is our nursing staff. No one in the hospital spends more time with the children in the hospital than our nurses and it is that relationship that makes our patients and their families feel safe and well cared for during a very difficult time. It takes a special kind of nurse to want to work in a children's hospital. Not just anyone can do it because in our minds it is really not logical for children to have some of the diseases that we see. There has to be a passion to care for children and that is what is exhibited at the MUSC Children's Hospital. I recently had a conversation with a journalist who had talked to a parent who had a child that passed away. She was amazed at the positive emotion that the family had for the Children's Hospital after such a life changing event. I explained to the journalist that it was the staff that made a connection with the family. Our nurses create a special bond with our families everyday. I continue to be amazed at well our nurse connect with the children. They will see a children that they cared for years ago and remember names and know what is going on in their lives. In many cases, our staff become a special member of their family. This month we celebrate nurse's week. What a wonderful time to truly recognize the care that our nurses provide to our patients and their families. The MUSC Children's Hospital nurses are constantly working to improve their practice and they work to make sure that the children get the very best care. We are truly blessed to have such a wonderful group of professionals that put their hearts and souls into their day to day work. They are the Children's Hospital. Children's Research Institute News Brief Bernard L. Maria, MD, MBA Executive Director Children's Research Institute Inderjit Singh, PhD Scientific Director Children's Research Institute Through university and federal grants, the Children's Research Institute will work with Dr. Donald Miller, director of MUSC's summer health professionals program, to employ medical students again this summer to work on a number of research projects important to children's health. Each summer, this opportunity is available to medical students entering their second year because this is the only summer they will have free during their four-year education. It provides valuable hands-on experience with several research projects that will study the nervous system and brain activity. The projects include: A study of Joubert syndrome, an inherited balance and coordination disorder; An evaluation of medical treatment protocols for common conditions that affect children's nervous systems; A study to identify ways to stop a brain tumor from spreading to other parts of the nervous system; A study of dysgraphia, a disorder that affects children's handwriting and their ability to learn and communicate. For the dysgraphia study, MUSC students will work with students from Trident Academy, where approximately 12 to 25 percent of the school's 165 students struggle with handwriting problems in addition to learning disabilities. By mapping brain activity in these children through MRI, the students will try to find a key to discovering solutions and a better means of diagnosing dysgraphia. The mutual benefit of the research projects is that it gives medical students a chance to develop their bedside manner and experience medicine outside of the classroom, dealing with patients and families. In turn, their research may ultimately affect even stroke patients and others afflicted with nervous system disorders, tumors and communication problems. Click here to view the Post and Courier article on summer research. Mental Health Resource News Brief Mental health Issues in Primary Care Primary care visits for mental health issues in children are quite common. It has been documented that 16-20% of all children will have a developmental or behavioral problem in childhood. A problematic issue in primary care pediatrics is poor reimbursement of these time-consuming issues. For billing, time becomes a key factor when the counseling, coordination of care, or both account for more than 50% of the face-to-face time with the patient. Therefore, if time determines the code level, an established patient visit that takes 40 minutes can be coded as 99215. In addition, the pediatrician can report an E/M service, using time as the key factor, when the parent comes in to discuss a child's problem without the child being present. Time must clearly be documented in the patient's chart. Documentation example: F/U visit-evaluation for ADHD PE normal. No allergies. Occasional eye blinking tics. History, teacher and parent checklists indicate criteria met for ADHD. Dx discussed with parents and child; stimulant effects and side effects also discussed. Need for accommodations in classroom discussed. Total visit 50 minutes; counseling 35 minutes. Our Promoting Happy and Healthy Youth discussion group of health care professionals meets on the third Tuesday of each month in room 377 - Rutledge Tower at 8 a .m. This Collaborative Office Rounds group provides an ideal way to disseminate mental health and behavioral information of interest to primary care providers in an informal setting that can be customized to the needs/questions of participants. Moderators are Drs. Eve Spratt and Michelle Macias, and co-moderators Drs. Angela LaRosa and Roxane Scott. All health care providers are welcome to attend. Breakfast is provided. For more information, please call Dr. Spratt or Cristol Duke at (843) 876-0504 or e-mail spratte@musc.edu. A special thanks to the following individuals for their efforts in putting together Kids Connection each month. Managing Editor: Bernard L. Maria, MD, MBA Publisher: Jessica Munday (Trio Solutions Inc.) Web design: Jennifer Cherock (Trio Solutions Inc.) and Brian Dadin (Trio Solutions Inc.) Contributing Writers: Lyndon Key, MD; Bernard Maria, MD; John Sanders, Inderjit Singh, PhD, Phillip Saul, MD, Michelle Macias, MD, Eve Spratt, MD and Christy Farrell (Trio Solutions Inc.)

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