Sutter Medical Center of Santa Rosa

“Tell me your life story, I’m listening, I see you.”

Posted on Sep 3, 2020 in California Pacific Medical Center, Community Benefit, Expanding Access, Health Equity, Innovation, Mental Health, People, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento

Faculty and residents in Sutter’s Family Medicine Residency Program

We are a mosaic of our experiences, lifestyle, social and family connections, education, successes and struggles. Apply those factors to our health, and a complex formula arises that clinicians commonly call the patient experience.

Learning the skills to assess these factors and deliver compassionate care to patients is what Sutter’s family medicine resident physicians aim to enhance. The newly enhanced Human Behavior & Mental Health curriculum is helping lead the way.

“We encourage faculty and residents to think about context, systems and dynamics within population health to address social determinants of health,” says Samantha Kettle, Psy.D., a faculty member in Sutter’s Family Medicine Residency Program.

She and colleague, Andy Brothers, M.D., a family medicine physician in Sacramento and faculty member in the residency program, are bringing health equity to the patient experience and training family medicine residents in Sacramento and Davis.

Family medicine faculty and residents at Sutter Medical Center, Sacramento

Seven residents each year learn to screen patients for social determinants of health (such as financial challenges, environmental and physical conditions, transportation needs, access to care and social factors) that may impact patients’ risk of depression and anxiety, substance use disorder and suicide.

This year’s residents may train in addiction medicine, psychotherapy, chronic pain, spirituality in medicine, well-being and the field of medicine that supports those who are incarcerated.

And in a community as diverse as the Sacramento Valley Area, statistics suggest these factors may significantly impact the health of its residents:
• 15.9% of California adults have a mental health challenge(1)
• Nearly 2 million Californians live with a serious mental challenge
• Substance misuse impacts 8.8% of Californians
• The prevalence of mental health challenges varies by economic status and by race/ethnicity: adults living 200% below the federal poverty level are 150% more likely to experience mental health challenges; 20% of Native Americans and Latinos are likely to have mental health struggles, followed by Blacks (19%), Whites (14%) and Asians (10%).

“Taking care of our local population’s health is a moral imperative,” says Dr. Kettle. “Many residents have entered our program to continue their quest in helping people in underserved communities.”

For instance, third-year Sutter family medicine resident Mehwish Farooqi, M.D., is studying ways to screen for post-partum depression using an approach developed through the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program.

“Women are most vulnerable to mental health concerns during the post-partum period: as many as one in seven women experience PPD. ROSE is a group educational intervention to help prevent the diagnosis, delivered during pregnancy. It has been found to reduce PPD in community prenatal settings serving low-income pregnant women,” says Dr. Farooqi.

“Sutter has clearly demonstrated a commitment to health equity and social justice that has propelled our residency program toward a future vision of health care in which all patients are cared for as individuals with unique life stories, struggles and successes,” says Dr. Brothers.

Advancing Social Determinants of Health through Graduate Medical Education at Sutter:
Other family medicine programs across Sutter’s integrated network incorporate health equity into ambulatory training for residents. The family medicine faculty at California Pacific Medical Center include a social worker who teaches residents to address concerns like financial and food insecurity, as well as social isolation. Residents learn how to care for people with depression and anxiety, and lecture series are offered on topics like addiction medicine and chronic pain/narcotic management.

Sutter Santa Rosa Regional Hospital’s Family Medicine Residency Program incorporates social justice through a Community Engagement and a Diversity Action Work Group—a committee comprised of faculty and residents who help tackle issues around inequity and structural racism.

“We are committed to strengthening a relationship between the residency program and the diverse communities we serve, guided with cultural mindfulness and compassion in our pursuit of overall wellness for all,” says Tara Scott, M.D., Program Director of the Family Medicine Residency Program in Santa Rosa.

Learn more about Sutter’s Family Medicine Residency Program.
• Find out how Sutter is advancing health equity.

Reference:

  1. California Department of Health Care Services.

Could an Experimental Drug Studied for Ebola Work Against COVID-19?

Posted on Apr 8, 2020 in Affiliates, California Pacific Medical Center, Community Benefit, Expanding Access, Innovation, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Santa Rosa Regional Hospital

Not-for-profit Sutter Health Launches Clinical Trials with Gilead Sciences

clinical trials for Covid-19

Sutter Health, together with health systems across Northern California has teamed up with Foster City-based Gilead Sciences on clinical trials for a promising treatment for COVID-19. The COVID-19 vaccine is at least a year away and now scientists across the globe are investigating existing medicines that might work as treatments.

In April 2020, Sutter began participating in two of Gilead Sciences’ Phase 3, randomized clinical trials to evaluate the use of the company’s drug, remdesivir, in adults diagnosed with COVID-19, the disease caused by the novel coronavirus.

The studies test the clinical efficacy and safety of remdesivir in patients with moderate or severe COVID-19, compared with standard-of-care treatment. The U.S. Food and Drug Administration (FDA) reviews results from Phase 3 trials when considering a drug approval.

Promising Treatment
Remdesivir is an antiviral, intravenous drug made by Gilead Sciences. It’s been available as an experimental compound for years, but has not been approved by the FDA for use in clinical treatment.

Jamey Schmidt, Director of Clinical Research at Sutter’s California Pacific Medical Center (CPMC), quickly saw the potential benefit to patients in partnering drug manufacturers (in this case, Gilead Sciences) with Sutter researchers and physicians skilled in clinical trial start-up and ready to help tackle the infectious disease outbreak.

“Sutter research is committed to bring this investigational treatment to Sutter physicians caring for patients infected with the novel coronavirus,” says Schmidt, who collaborated with Greg Tranah, Ph.D., CPMC’s Scientific Director, and Jennifer Ling, M.D., infectious disease specialist at CPMC and principal investigator of the remdesivir clinical trials at CPMC.

CPMC, Sutter Santa Rosa Regional Hospital, Sutter Roseville Medical Center and Sutter Medical Center Sacramento are participating in the clinical trials of remdesivir, and other Sutter sites may enroll to the studies later this month.

“In response to this global health crisis, we’re proud that Sutter is helping lead efforts across Northern California and seeking new tools to combat this novel infection and lessen the virus’s impact,” says Dr. Ling. “Through research at Sutter, new discoveries will help determine the potential of remdesivir to help individual patients with COVID-19.”

Some patients who have been infected by the novel coronavirus and are severely ill may not meet the study criteria for enrollment in the clinical trials of remdesivir. Instead, they may qualify for treatment via Gilead Sciences’ expanded access program (EAP) for remdesivir. The EAP provides alternative access to the investigational drug for severely ill patients with COVID-19 who do not meet the clinical trials study criteria.

First developed in 2009 and used during the Ebola outbreak in 2014, remdesivir is being studied in multiple clinical trials worldwide to see if it is safe and effective against the coronavirus in humans. The drug was previously tested in animals infected by other coronaviruses like SARS and MERS, and is now being tested in humans to determine if it can reduce the intensity and duration of COVID-19.

“Research at Sutter is helping deliver safe, high-quality care to our patients during this unprecedented pandemic,” says Leon Clark, Vice President, Chief Research and Health Equity Officer, Sutter Health. “By bringing innovation to the forefront of how we can best care for Sutter patients who acquire COVID-19, Sutter’s talented researchers are stepping up to the challenge presented by this global health crisis.”

April 29 Update:
Results from a clinical trial of remdesivir, an antiviral manufactured by Gilead Sciences, led by the U.S. National Institutes of Health (NIH) were reported April 29, 2020. The findings suggest that hospitalized patients with advanced COVID-19 and lung involvement who received remdesivir recovered faster than patients who received placebo, according to a preliminary data analysis from a randomized, controlled trial involving 1063 patients. The trial (known as the Adaptive COVID-19 Treatment Trial, or ACTT), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, was the first clinical trial launched in the United States to evaluate remdesivir as an experimental treatment for COVID-19.

Additionally, Gilead Sciences also shared preliminary results today from the company’s open-label, Phase 3 SIMPLE trial evaluating five- and 10-day dosing durations of remdesivir in hospitalized patients with severe COVID-19. The study results demonstrated that patients receiving a 10-day treatment course of remdesivir achieved similar improvement in clinical status compared with those patients who were administered a five-day treatment course of the drug.

Sutter is not participating in the ACTT treatment trial nor the SIMPLE clinical trial. However, as described in the above article posted on April 8, Sutter is participating in the two Phase 3, randomized, controlled clinical trials that are testing remdesivir. Gilead Sciences has not yet disclosed when results of these clinical trials will be published. Clinical trials at Sutter testing investigational use of remdesivir will close to enrollment May 29, 2020.

May 4 Update:
On May 1, 2020, remdesivir received FDA Emergency Use Authorization for the treatment of COVID-19. The authorization enables the potential use of remdesivir to treat hospitalized patients suffering from severe COVID-19 disease in the U.S., outside of the context of an established clinical trial of the drug. Based on patients’ severity of disease, the authorization allows for five- and 10-day treatment durations.

Learn more about Sutter research and clinical trials.



Helping Mind the Gap on Cardiovascular Diseases

Posted on Feb 7, 2020 in Alta Bates Summit Medical Center, California Pacific Medical Center, Cardiac, Expanding Access, Innovation, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Sutter Medical Foundation, Sutter Roseville Medical Center

Heart valve imaging
Heart valve imaging

Lifesavers appear in big sizes and small. For patient Adam Livingstone, rescue was a dime-sized clip that restored his heart’s normal rhythm and size. For months, Livingstone had been experiencing shortness of breath, chest pain and fatigue. Diagnosed with mitral valve regurgitation, a minimally invasive procedure to repair the valve was performed at Sutter Medical Center, Sacramento—one of Sutter’s sites where researchers evaluate new devices for treating damaged or diseased heart valves.

The Heart’s Finely Orchestrated Blood Flow

Heart valves
Heart valves

Like a musical conductor, the heart oversees rhythm and flow, circulating blood to each of its chambers in a coordinated, unidirectional symphony.

THE MITRAL VALVE

Mitral regurgitation, the most common type of heart valve disorder, occurs when blood leaks backward through the mitral valve when the left ventricle closes.

Some patients undergo non-surgical heart valve repair with transcatheter mitral valve repair (TMVR) with MitraClip®.2 During the procedure, doctors thread a catheter into a large leg vein reaching the heart. Then a dime-sized clip clamps the improperly working valve, allowing it to close more tightly with less backward blood flow.

“Some research participants recover faster and resume normal activities within a week of the procedure, and may not require lifelong anticoagulant medications, repeat surgeries, or re-hospitalization,” says David Roberts, M.D., FACC, FSCAI, medical director of cardiovascular services at Sutter in the Valley Area.

A new clinical trial at Sutter called PASCAL CLASP IID/IIF will test the safety and effectiveness of TMVR with the PASCAL Transcatheter Valve Repair System® compared with MitraClip® in patients with mitral regurgitation.3

For patients with severe mitral regurgitation, Sutter’s CPMC seeks to enroll patients in a clinical trial called SM3, which assesses the safety and efficacy of the SAPIEN M3 System™.4

“In this study, we are evaluating a new type of mitral valve that may provide a minimally invasive alternative to surgery for high-risk patients with severe mitral valve disease,” says David Daniels, M.D., co-director of Sutter’s Structural Heart Program in the Bay Area, and principal investigator of the SM3 clinical trial at Sutter.

Some patients develop mitral valve disease when calcium deposits accumulate on the fibrous ring attached to the mitral valve leaflets. For these patients with mitral annular calcification (MAC), Sutter will begin offering enrollment in the Summit clinical trial, which will test the safety and effectiveness of the Tendyne™ transcatheter mitral valve.5

“Previous approaches to treat patients with MAC have mainly involved the off-label use of transcatheter aortic valves,” says Dr. Roberts. “But this strategy may lead to residual mitral regurgitation and the need for open-heart surgery. Sutter’s participation in Summit may lead to novel ways to care for this hard-to-treat subset of patients.”

THE TRICUSPID AND AORTIC VALVES

Although a skilled conductor, sometimes the heart needs help to maintain proper blood flow for musical perfection. To the rescue: Sutter researchers test interventional devices designed to treat patients with diseased or damaged tricuspid and aortic valves.

In one new clinical trial, Sutter researchers will collect information about treatment for severe aortic regurgitation, a condition typically treated with aortic valve replacement surgery.

This study will examine the use of TAVR (Transcatheter Aortic Valve Replacement), a minimally invasive procedure designed to replace the aortic valve inside the heart. In this study, TAVR will be performed using the JenaValve™ Pericardial TAVR System, designed to help treat patients with severe aortic regurgitation or severe aortic stenosis.6

“Until now, all commercially available TAVR valves have focused on aortic stenosis, or a restricted valve,” says Dr. Daniels, co-principal investigator of the TAVR with JenaValve™ clinical trial at Sutter. “The JenaValve™ may allow researchers to treat patients with a leaky valve in the absence of any calcium. Currently these patients are only candidates for open-heart surgery.”

Additionally, Sutter researchers at CPMC and Sutter Medical Center are seeking to enroll patients who have tricuspid regurgitation in a clinical trial called TRILUMINATE.

The TRILUMINATE study will evaluate the safety and effectiveness of the Tricuspid Valve Repair System™ (TVRS) for treating moderate or severe tricuspid regurgitation in patients currently on medical management and who are deemed appropriate for percutaneous transcatheter intervention.7

  • Learn more about Sutter cardiovascular diseases research and clinical trials.
  • If you are suffering from mitral or tricuspid valve regurgitation, aortic valve stenosis or other heart valve disorder, talk to your cardiologist to see if research participation and/or valve replacement or repair is right for you.

References:

  1. American Heart Association.
  2. MitraClip™ is manufactured by Abbott Medical Devices.
  3. The PASCAL clinical trial is sponsored by Edwards Life Sciences, makers of the Transcatheter Valve Repair System®.
  4. The S3 clinical trial is sponsored by Edwards Life Sciences, makers of the SAPIEN M3 System™.
  5. The Summit clinical trial is sponsored by Abbott Medical Devices, makers of the Tendyne System™.
  6. The JenaValve™ clinical trial is sponsored by JenaValve Technology, Inc., makers of the Pericardial Transcatheter Aortic Valve Replacement (TAVR) System.
  7. The TRILUMINATE clinical trial is sponsored by Abbott Medical Devices, makers of the Tricuspid Valve Repair System™.

Novato Community Hospital Hip and Knee Replacement Program Honored for Excellence

Posted on Dec 12, 2019 in Affiliates, Quality, Scroll Images, Sutter Medical Center of Santa Rosa

Joint Commission Awards Highest Certification for Second Time

NOVATO, Calif. — The Total Hip and Total Knee Replacement Program at Novato Community Hospital (NCH), a member of the Sutter Health not-for-profit integrated network of care, recently earned the Joint Commission’s Advanced re-certification for Total Hip and Total Knee Replacement. This is the second time the program has achieved Advanced certification—the highest level offered by the nationally recognized accrediting body—since the program was established.

“This Advanced certification showcases our team’s commitment to excellent patient care and confirms the lengths we go to ensure the best in quality and service for patients every day,” said Shannon Thomas, Novato Community Hospital administrator.

In 2015, NCH spearheaded a community-wide effort to ensure that everyone involved in these surgeries follows a rigorous set of standards. The hospital convened anesthesiologists, surgeons, nurses, physical therapists and others to reach consensus on how best to manage post-surgery pain, get patients mobile after surgery and support patients at home. The group’s efforts paid off in 2018, when 97 percent of joint replacement patients were discharged from NCH directly to their home (instead of a skilled nursing facility), representing a 35 percent improvement over 2013.

“Our patients come from far and wide, so we had to work hard to ensure that regardless of where they come from, or go home to, they get consistent, high-quality care,” said Jennifer Lehr, director of Orthopedic Services at NCH. “We know that patients often recover faster in their own homes, as opposed to a facility, so we are very proud of this achievement.”

“We want every knee and hip replacement to be a success,” said orthopedic surgeon and program medical director Peter Callander, M.D. “We are always learning and applying what we learn in order to make that happen.”

In addition to improving the quality of care that patients receive, the group also working to make care more efficient. “We’ve developed systems to share information at all points of care, so patients don’t have to answer the same questions multiple times,” said Lehr.

This level of coordination is available even after the surgery and the patient is home thanks to NCH’s dedicated outpatient nurse case manager who helps patients through the entire rehabilitation process.

“The Joint Commission is one of the premier health care quality improvement bodies in the nation,” said Thomas. “This certification is a recognition of the work done by our entire provider community when we focused on improving pain management, quality of life, function, mobility, experience and safety for orthopedic surgery patients – and achieved amazing results. We are committed to sustaining these gains and will do so with the continued leadership of our area orthopedic surgeons.”

There’s Room at This Inn: Firefighters Battling Kincade Fire Find Respite in Rebuilt Home for Families of Hospitalized Babies

Posted on Nov 7, 2019 in NICU, People, Scroll Images, Sutter Medical Center of Santa Rosa

Newly-reopened facility was destroyed in 2017 Tubbs Fire

SANTA ROSA, Calif. –Sutter Health’s mission is to care for the health and well-being of its neighbors, especially in an emergency. So when Sutter Santa Rosa Regional Hospital was ordered to evacuate patients on Oct. 26 for the second time in two years, the Elizabeth and Bill Shea House, normally used by families of hospitalized babies, was offered to firefighters as a place to rest.

The Elizabeth and Bill Shea House

About 100 firefighters representing Cal Fire, Pacifica, Napa, Clearlake, Pomona, Mill Valley, Walnut Creek and Santa Rosa, who were using the hospital’s parking lot as a staging area, accepted the offer to relax, catch up on much-needed sleep, rehydrate and have a snack at Shea House before returning to the frontlines of the fire.

“We were so pleased to be able to offer the first responders a comfortable place to take a break from fighting the Kincade Fire,” said Mike Purvis, CEO of Sutter Santa Rosa. “Sutter Santa Rosa has been a part of this community for many years and we were glad to support their efforts to save it.”

Ironically, finishing touches had just been completed on the newly-rebuilt Shea House –which was destroyed in the 2017 Tubbs Fire.

Now that the Kincade Fire is contained and Sutter Santa Rosa has reopened for patients, Shea House is again providing free lodging for low-income families of hospitalized babies who need a nearby place to stay while their newborns are cared for in the neonatal intensive care unit (NICU).

About the Elizabeth and Bill Shea House

Nothing is more stressful for a parent and family than having a hospitalized child. The feeling of helplessness can be overwhelming, especially when home is far from the hospital. Studies have long shown that parent presence at the bedside of a sick child is critical to bonding and long-term recovery. For low-income families that don’t live near the hospital, staying in the area can be a significant hardship.

Since it opened in 2004, more than 560 families from across Northern California, including far-flung communities like Ukiah, Gualala, Potter Valley, Sea Ranch, Middletown, Talmage and Willits, have benefited from the comfort of Shea House’s home-like environment. Families stay in one of four private suites anywhere from one to 60 days, with an average stay of about nine days. Shea House also offers guests a fully-equipped kitchen, laundry facilities and comfortable indoor and outdoor areas in which to relax. With the average cost of a nearby hotel room running $225 per night, it’s easy to see how a lengthy hospital stay could be a hardship on any family, let alone one with limited financial resources. To date, Shea House has provided more than $831,000 worth of accommodation to these families.

The Elizabeth and Bill Shea House was rebuilt through the generosity of community donors and its namesakes, Elizabeth and Bill Shea. Shea House’s operational costs are entirely supported by the Sutter Santa Rosa Regional Hospital Foundation.

About Sutter Santa Rosa’s Care for Sonoma County’s NICU Patients and Their Families

For nearly 50 years, Sutter Santa Rosa’s NICU has provided the highest level of intensive care for newborns in the community. An average of 300 newborns are admitted to its NICU each year. These babies and their families would otherwise have to travel to San Francisco to receive life-saving treatment. With 12 NICU beds, three full-time neonatologists and 39 specially trained nurses, the NICU offers pediatric subspecialties including neurology and leading-edge technology to ensure the best possible outcomes for its tiny patients and provides their families with support services to address the many challenges they face in caring for their newborns.

Quelling the Storms of Seizures in People with Epilepsy

Posted on Nov 1, 2019 in Affiliates, California Pacific Medical Center, Innovation, Neuroscience, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Transformation, Uncategorized

SAN FRANCISCO, Calif. – An electrical “storm” in the brain causes seizures in people with epilepsy, producing symptoms that may include lapses in consciousness, twitching or jerking movements, weakened or limp muscles, spasms, blurred vision, experiencing unusual smells or tastes, and changes in sensation or emotions.

Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide.1 Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures.2

Epileptic seizures are generally categorized into three main groups: generalized (affecting both sides of the brain), focal (seizures that start in one area of the brain), and those that could start anywhere.

The stormy weather of seizures can clear with medications called anti-epileptic drugs (AEDs). AEDs can to stop seizures from occurring, but they do not always lead to a remission or cure epilepsy. With the right AEDs, up to 70% of people with the illness may remain seizure-free, and sometimes may “outgrow” seizures or go into remission. For other people whose seizures are uncontrolled with conventional AEDs, other treatments including surgery may be an option. Surgery may involve removing part of the brain that causes the seizures.

Michael Chez, MD

“Knowing where seizures start in the brain provides us clues into what occurs during a seizure, what other conditions or symptoms may be seen, how they may affect someone and, most importantly, what treatment may be best for that seizure type,” says Michael Chez, M.D., a pediatric neurologist and epileptologist, and Sacramento regional director of pediatric epilepsy and research at the Sutter Neuroscience Institute.

“Life without seizures and improved quality of life is what specialists aim to provide epilepsy patients, through a treatment plan personalized to their particular type of epilepsy and seizures,” says Dr. Chez.

Two Sutter hospitals, California Pacific Medical Center and Sutter Medical Center, Sacramento are renowned for providing patients specialized epilepsy care guided by leading-edge research. Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.

Sutter examining new ways to ‘map’ and monitor brain activity

Epilepsy is usually diagnosed with magnetic resonance imaging (MRI) and electroencephalogram (EEG) testing. Those techniques are also used to regularly monitor brain activity in people with the illness. Sutter researchers are studying the use of novel neuroimaging techniques to visualize and track the brain’s electrical activity in people with epilepsy.

For patients with refractory epilepsy (in whom medications are not adequately controlling seizures), a new “high-density” EEG machine is being tested to locate precisely where a patient’s seizures originate in the brain.

“Use of these high-density or high-array EEG machines can help dramatically accelerate research and patient care by identifying the focal point of a seizure,” says Kenneth Laxer, M.D. a researcher in the Sutter Pacific Epilepsy Program at Sutter’s California Pacific Medical Center (CPMC).

With more than 40 years’ experience in epilepsy research, Dr. Laxer is renowned for studying neuroimaging techniques including magnetic resonance spectroscopy for the evaluation and management of the illness. With high-density EEGs, the patient wears a net over their head, and the brain’s electrical activity is recorded from 250-plus electrodes. The recordings are combined with the patient’s own high-resolution MRI scan to help localize the seizure focus. Surgeons use these precise images to remove the section of the brain that’s causing the seizures.

“If we pinpoint that abnormal area, we can remove a smaller portion of the abnormal brain tissue and therefore decrease the risk of serious complications from the surgery,” says Dr. Laxer. He notes that 50-70% of patients who undergo a focal resection may become seizure free. “Most of these patients remain on seizure medications, frequently at reduced dosages; however, the goal of surgery is to bring the epilepsy under control—not to stop epilepsy medication use. Patients who undergo such surgeries typically experience improved quality of life.” Stay tuned later this month for Part 2 of this series on Sutter epilepsy research, which will include information on neuromodulation and anti-epileptic medications.

Stay tuned later this month for Part 2 of this series describing epilepsy research at Sutter.

References: 1. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/fast-facts.htm 2. Epilepsy Foundation. https://www.epilepsy.com/learn/types-seizures/refractory-seizures SAN .