Clinician's Roundtable

Host: Mark Nolan Hill, MD Guest: Beverly Green, MD, MPH By the year 2025, it is predicted that more than 1.5 billion people around the world will have hypertension, accounting for nearly half of heart disease risk and three-quarters of stroke risk. With new Web-based technologies emerging as potential treatment options, how will we change our approach to care? How might these programs impact the treatment of hypertension on a global scale? Dr. Beverly Green, an affiliate investigator at the Group Health Center for Health Studies in Seattle, and the lead author of research published in JAMA on innovative Web-based interventions for patients with uncontrolled hypertension, peers into the future of hypertension care during this discussion with host Dr. Mark Nolan Hill.

Host: Mark Nolan Hill, MD Guest: Beverly Green, MD, MPH The Internet plays such an integral role in so many of our lives, it's only natural to consider expanding its position in medicine. This process is underway, and moving rapidly in some areas, with the first large-scale, randomized clinical trial probing web-based hypertension interventions. How can we, as clinicians, adapt to new digital mechanisms for providing care? Does this particular hypertension concept mesh with the idea of a fee-for-service payment plan? Dr. Beverly Green, an affiliate investigator at the Group Health Center for Health Studies in Seattle, and the lead author of research published in JAMA on innovative web-based interventions for patients with uncontrolled hypertension, explains more about this collaborative approach to care with host Dr. Mark Nolan Hill.

Host: Mark Nolan Hill, MD Guest: Beverly Green, MD, MPH For each 10 millimeter drop toward normal systolic blood pressure, research tells us that heart disease mortality risk drops by an average of 30 percent. New internet-based hypertension interventions are proving they could produce this steep, impressive decline. How can these web initiatives help our patients take a more active role in their care? If patients are based at home, how can we ensure that they are following proper protocol for taking blood pressure measurements? Host Dr. Mark Nolan Hill takes a closer look at these issues and more with Dr. Beverly Green, an affiliate investigator at the Group Health Center for Health Studies in Seattle, and the lead author of research published in JAMA on innovative web-based interventions for patients with uncontrolled hypertension.

Host: Maurice Pickard, MD Guest: Kristine A. Rapp Kristine Rapp, vice president of global ethics & compliance at Hospira, Inc., discusses with host Dr. Maurice Pickard the new PhRMA Code and the significant limitations on gifts to healthcare professionals. The hope is that marketing practices will be held to a higher ethical level.

Host: Michael Greenberg, MD Guest: Rosalie Greenberg, MD There is hope for children with bipolar disorder, says Dr. Rosalie Greenberg, assistant professor of clinical psychiatry at Columbia University School of Physicians and Surgeons, and author of the book, Bipolar Kids: Helping Your Child Find Calm in the Mood Storm. Dr. Greenberg joins host Dr. Michael Greenberg to discuss diagnosis, misdiagnosis, and genetics of the disorder, along with treatment options and potential outcomes.

Host: Michael Greenberg, MD Guest: Rosalie Greenberg, MD Pediatric bipolar disorder may be more common than our diagnoses indicate. What constitutes a proper diagnosis? Host Dr. Michael Greenberg is joined by Dr. Rosalie Greenberg, assistant professor of clinical psychiatry at Columbia University School of Physicians and Surgeons, and author of the book, Bipolar Kids: Helping Your Child Find Calm in the Mood Storm. Dr. Rosalie Greenberg discusses the nuances and easily overlooked symptoms in children eventually diagnosed with the disorder, and shares her perspective on the challenges of bipolar disorder for children and their families.

Host: Matthew J. Sorrentino, MD, FACC, FASH Guest: Michael P. Siegenthaler, MD Dr. Michael Siegenthaler, associate professor of surgery and associate director of the Artificial Heart Program at the University of Pittsburg, will discuss the current state of the art of ventricular assist devices and the artificial heart as an alternative therapy for end stage heart failure patients.

Host: Matthew J. Sorrentino, MD, FACC, FASH Guest: Michael P. Siegenthaler, MD Dr. Michael Siegenthaler, associate professor of surgery at the University of Pittsburgh School of Medicine, describes the Impella 2.5 system: a percutaneously-placed ventricular-assist device, now approved for high risk coronary interventions, that has earned the moniker, 'world's smallest heart pump.' Dr. Matthew Sorrentino hosts.

Host: Bill Rutenberg, MD Guest: Sarah de Ferranti, MD, MPH The American Academy of Pediatrics Report on Lipid Screening and Cardiovascular Health in Childhood, published in July 2008, triggered extensive discussion and debate among pediatricians. Dr. Sarah de Ferranti, director of the Preventive Cardiology Clinic at the Children's Hospital in Boston, shares her interpretation of the report and its recommendations with host Dr. Bill Rutenberg. How concerned should we be about the scarcity of long-term data on statin use among pediatric patients? What do we know about statins and puberty? Will the future bring non-invasive ways to assess the cardiovascular status of a child? Join us to learn more.

Host: Maurice Pickard, MD Guest: Stefan J. Friedrichsdorf, MD, PhD Dr. Stefan Friedrichsdorf, medical director of the Pain and Palliative Care Program at Children's Hospitals and Clinics of Minnesota, discusses a range of topics within the field of pediatric palliative care. In contrast to the expected standard of care for adults, many children with life-limiting and terminal diseases receive inferior treatment in this area. Given that a child's condition may last well into adulthood, effective programs embrace physical, emotional, social and spiritual elements, with a focus on enhancing the child's quality of life and providing support for their family. Dr. Maurice Pickard hosts.

Host: Bill Rutenberg, MD Guest: Heidi Feldman, MD, PhD "White matter of the brain is particularly more susceptible to injury after a premature delivery," explains Dr. Heidi Feldman, professor of developmental and behavioral medicine at Stanford University School of Medicine. Dr. Feldman and host Dr. Bill Rutenberg discuss neurodevelopmental recovery in preemies, as well as children with other brain damage. Can we capitalize on other healthy areas of the brain to make up for deficiencies from underdeveloped or injured areas of the brain?

Host: Bill Rutenberg, MD Guest: Heidi Feldman, MD, PhD Much is invested to bring premature infants to the point of hospital discharge. However, there is an extreme drop-off in services after the infant is released from the hospital. This is a very important area for preventative healthcares and should be conceptualized as a chronic condition says our guest, Dr. Heidi Feldman, professor of developmental and behavioral medicine at Stanford University School of Medicine Lucile Packard Children's Hospital. She and host Dr. Bill Rutenberg discuss interventions often required to help a pre-mature infant to reach its developmental age. How much intervention is necessary? Do socioeconomics play a role in which children are most likely to catch up sooner? Why do kids who get the most services often have the greatest delay? Join us to learn more.

Host: Jennifer Shu, MD, FAAP Guest: Jatinder Bhatia, MD Although breast milk is the ideal source of nutrition for children under 12 months, most babies receive infant formula at some point during the first year. With dozens of formulas on the market, making a choice can be confusing for parents and for physicians as well. Dr. Jatinder Bhatia, professor and chair of neonatology at the Medical College of Georgia, and a member of the American Academy of Pediatrics Committee on Nutrition, lends his expert insight on choosing an infant formula. What are the latest recommendations regarding infant formulas? How should physicians decide what formula is best for a patient? Dr. Jennifer Shu hosts.

Host: Jennifer Shu, MD, FAAP Guest: Jatinder Bhatia, MD Guest: Darshak Sanghavi, MD It's the leading cause of death and morbidity in American adults, but the cardiovascular disease process may begin in childhood. A new clinical report from the American Academy of Pediatrics (AAP) recommends some children as young as age 8 should receive pharmacologic treatment for dyslipidemia. The recommendations have stirred considerable debate among pediatricians and others in the medical community. Given the absence of long-term data to support the safety of prescribing statins, how was the decision made to go forward with these recommendations? What potential adverse effects from the medications should we be most concerned about? What are the most prudent alternatives to medicating children at risk for cardiovascular disease? Host Dr. Jennifer Shu welcomes Dr. Jatinder Bhatia, professor and chair of neonatology at the Medical College of Georgia, and a member of the AAP Committee on Nutrition, and Dr. Da

Host: Bruce Japsen Guest: William Jessee, MD Should doctors also be running their own practices? Dr. William Jessee, president and chief executive officer of the Medical Group Management Association, tells Bruce Japsen about how a team approach between doctor and administrator may be in order to improve the patients' experience, boost doctor revenue and help foster more consumer-friendly medicine.

Host: Bruce Japsen Guest: William Jessee, MD The squeeze of reimbursement from private payers and Medicare cuts to doctors are conspiring to take a substantial toll on physician incomes, which in many cases, are not keeping up with inflation. Dr. William Jessee, president and chief executive officer of the Medical Group Management Association (MGMA), details trends in physician practice incomes, as documented in a survey conducted by the MGMA. Bruce Japsen hosts.

Host: Bruce Japsen Guest: William Jessee, MD Administrative burdens and an overload of paperwork have a cumulative effect on a medical group practice. How is a doctor supposed to deal with this so it does not effect patient care? Dr. William Jessee, president and chief executive officer of the Medical Group Management Association, tells Bruce Japsen about new and innovative ways MGMA advises doctors to deal with the ever-changing rigors of practicing in a group setting.

Host: Mark Nolan Hill, MD Guest: Alan Hemming, MD As we extend the bounds of surgical resection for hepatic malignancies, we overcome previously held limitations of our efforts against liver disease. How do our techniques and theories on hepatic resection also relate back to hepatic transplantation? Are we developing more effective strategies to protect the liver during surgery? Dr. Alan Hemming, professor of surgery and chief of transplantation and hepatobiliary surgery at the University of Florida College of Medicine, also peers into the future to examine the potential role of laparoscopy or endoscopy in hepatic surgery. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: Alan Hemming, MD In recent years, extensive debate has centered around the possibility of further extending the scope of hepatic resection. With research now demonstrating the potential value of extended resection, will more patients be offered this as a treatment option? Are there common complications to consider when evaluating a candidate for this surgery? Dr. Alan Hemming, professor of surgery and chief of transplantation and hepatobiliary surgery at the University of Florida College of Medicine, explains the next steps toward entrenching extended resection in our arsenal of treatment for hepatic disease. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: Alan Hemming, MD For patients with severe hepatic malignancy, attempts to cure their illness are rarely, if ever, successful. We're learning, however, that a more aggressive surgical approach may extend survival rates well beyond those of our previous techniques. Dr. Alan Hemming, professor of surgery and chief of transplantation and hepatobiliary surgery at the University of Florida College of Medicine, details his pursuit of novel measures to surgically address severe hepatic malignancies with host Dr. Mark Nolan Hill.