Volume 2, Issue 4, July 2000
IEPR Coordinator Spotlight
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Danielle Glancey, RN
Cardiology Associates
West Paterson, NJ
Site 80
I've only been a nurse for two years and already I have seen great strides in healthcare and the changing roles of the nurse. I had been working on a telemetry unit since graduating from school in May of 1998. In nursing school, the focus is on bedside nursing; however, once you're working on the unit you must delegate several tasks to other healthcare personnel so that you have time to chart and complete the required paperwork. This time away form the patient changed my view of nursing and made me question the quality of my care.
I was offered the opportunity to begin the EECP Clinic in January 2000 at a private practice. My decision to leave the hospital environment weighed heavily on my mind. But the chance to work closely with the patients under my care and learn a groundbreaking new treatment intrigued me. Although I was eager to learn this amazing new therapy, I was skeptical when I first saw the machine in action. I was thinking, "How could this help anyone? It looks so uncomfortable!" After a few weeks however, people were starting to improve. Patients who were taking nitroglycerin three to four times a day were down to once a week, it at all. This made a believer out of me and provided me with the confidence to tell new patients that this treatment would help them. I now have proof that it does work. I had never heard of EECP prior to working in this practice, but it has helped to rebuild the nurse/patient relationship that makes this profession so rewarding.
I love my new roles as an EECP therapist. I am now able to guide my patients personally in their progression towards healthfulness. Before starting therapy, they experience angina after mild activity. After a few short weeks, I find myself warning them not to overexert themselves, because they describe increased energy and attempt to do more as they begin to feel better. This is the main reason I wanted to become a nurse- to help people! EECP has truly helped dozens of patients that I've treated. It gives them a better quality of life, enables them to do the things that they used to take for granted such as climbing the stairs, walking to the store, and picking up their grandchild. The greatest gift I've received as a nurse is hearing that a treatment I administer with care, has given my patients their freedom back. This is evident when they tell me, "Thank you, I haven't felt this good in years!"
To date, we have successfully treated 24 patients, 19 of which are currently enrolled in the IEPR. I am presently using two EECP tables and my list of prospective patients continues to grow. Through my experience with EECP therapy, nursing has taken on a new meaning for me as I realize that I'm not only giving my patients a treatment, I'm giving them hope!
Danielle lives in Harrison, NJ, enjoys reading and working out at the gym and will be married to her fiancé, David, on October 20, 2000. Heartiest congratulations!
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Dan Shanahan, RN, EMT-P
I graduated form Oklahoma State University with my RN degree in 1984, and received my license as a nationally registered EMT-Paramedic in 1990. I worked in the emergency room for Children's / University Hospitals for 7+ years and 10+ years as a flight nurse / paramedic for Medi Flight Oklahoma (an emergency helicopter transport service out of Oklahoma City). Yes, I did have an active part in the treatment of the survivors of the Murrah Federal Building bombing. By far, one the worst days to experience an emergency nurse, being not a stranger to tragedy. I live in Edmond, Oklahoma (15 mile north of Oklahoma City) in the middle of tornado alley.
My wife, Celia, of almost 18 years and my daughters (Alish-13 years and Mallory-almost 4 years) are the center of my world. I spend my leisure time primarily with my girls. I enjoy landscaping. Ou Japanese Koi/Gold fish pond and basically anything outside.
I made the switch to the position of a Clinical Applications Specialist for Vasomedical May 1, 2000. I have enjoyed the opportunity to meet outstanding, hospitable, quality clinicians across the country. This Okie has seen many beautiful states for the first time since beginning my new traveling career. I also had the pleasure of working to establish the first EECP center in Oklahoma, here in Oklahoma City. The travel away from my family has been the toughest adjustment. However, the goal is to accumulate frequent flyer miles to be used for family vacations, at least this is Alisha's goal for us.
By far, the most exciting part of this job is talking with progressive coronary disease patients with often a less than optimal prognosis for the future. Most are no longer acceptable risks for surgical interventions. EECP offers these patients a non-surgical option that can potentially improve their quality of life. For many, the results are very dramatic and inspirational. When not in their shoes, it is hard to imagine living with significant restrictions on exercise tolerance, chest pain, shortness of breath and the inability to perform even basic activities of daily living. I have talked with many patients across the country in just the past 9 weeks whose lives have been very positively improved. This has had wonderful impacts on their lives, spouses and families.
The physiologic principles of EECP therapy are sound and proven. But, moreover is the way a course of treatment has transformed the lives of several of these patients holding on to EECP as a "last resort". It has been very inspiring and motivating for me as a clinician. The doctors and therapists that deliver this therapy are the key to the success of EECP. They are professionals that are supportive and motivating. They develop long term, very therapeutic relationships with their patients and patient's families. I believe that the centers that work to address the holistic needs of the patients and incorporate EECP into a cardiac rehabilitation program, managing the complexities of these patients with multiple / progressed diseases achieve optimal patient outcomes. The centers with therapists specifically dedicated to EECP and strong physician support are shining examples of success in EECP therapy.
My hat goes off to all of the wonderful dedicated people at Vasomedical, as well as, the doctors and therapists that have propelled EECP to the point it is now. Few patients or therapists in training can point out a more unusual appearing therapy at first introduction. But, these professionals have pushed EECP to the forefront of traditional cardiology medicine as a mainline, legitimate, viable therapy. I feel very fortunate to have joined the Vasomedical team, along with the many that have been with EECP from the very beginning of the company. I do not encounter the skepticism that they have overcome.
I look forward to the opportunity to meet the many fantastic therapists and physicians that make EECP such a success for their patients at upcoming AHA and ACC conferences. I also look ahead to training new centers and visiting the existing successful centers as the years progress. I am excited to be a component of Vasomedical's dedication to making each and every EECP center a tremendous success.
Mike Matthew, RNFA, CNOR
Before working for Vasomedical my career was as a Registered Nurse, working in the ICU for one year and as an operating room staff nurse for four years before attending the Registered Nurse First Assistant (RNFA) program in St. Louis, Missouri. When I graduated from this program my nursing career focused on being an RFNA in open-heart surgery assisting the surgeons with a variety of cardiac procedures and independently harvesting the greater saphenous vein and the internal mammary artery for coronary artery bypass graft surgery.
Currently I am licensed and live in Colorado, enjoying the great outdoors in Colorado Springs. I have been married to a wonderful woman named Donnell for fourteen years who shares my love for hiking, biking and white water rafting. Time permitting, golf is a personal passion. The weather here is just perfect for all outdoor activities and we take full advantage of it at every opportunity.
I began my position as a Vasomedical Clinical Applications Specialist (CAS) on May 1, 2000, and am thoroughly enjoying this new personal and professional adventure. My primary responsibility as a CAS is preparing medical personnel to become proficient in the practice of EECP. I travel throughout the continental United States training in a variety of settings. Most of the EECP centers are located in cardiology offices, with others in hospitals and free-standing clinics.
I have only been training new EECP therapists a short time and have found it to be both rewarding and challenging. The majority of the people I train have a basic understanding of EECP. They vary in position and background, including medical assistants, licensed practical nurses, exercise physiologists, EMT's, registered nurses and even some physicians. They bring with them various preconceptions about EECP, and occasionally some skepticism about the treatment. However, once they treat patients and see the positive outcomes their patients achieve they become advocates for the therapy. I thoroughly enjoy interacting with the therapists and the medical directors. Each center presents a new set of challenges for me to address in helping establish its presence in the growing community of EECP providers.
I must admit, when I first came into contact with EECP I was somewhat skeptical myself. I was a firm believer in interventional cardiology and thought the claims of EECP seemed a bit far-fetched. I have since spoken with many patients who have expressed how beneficial the treatment has been for them. They talk about how their quality of life has improved and their need for medication has decreased. I truly believe in EECP and look forward to a long career with Vasomedical and the continuing, fulfilling challenge of training therapists in the practice of EECP.
Amy Schmidt, RN, BSN
Change is good. I recently joined Vasomedical's Clinical Application Specialist team in May of 2000. I have been a Registered Nurse since graduating from Ohio State University in 1994, beginning my career at St. Vincent Charity Hospital in Cleveland, Ohio. Following my brief oncology experience, I was delighted to discover my niche and developed my talents in cardiac nursing. I have lived in Boulder, Colorado since 1996 enjoying skiing, hiking and sailing in my free time. I worked at Boulder Community Hospital in the cardiac unit, pre and post-cardiac catheterization recovery room, and on the case management team. I have also worked for Baxter Healthcare as a nursing consultant where I gained valuable experience in traveling and teaching medical personnel about new products in different hospitals throughout the US. This experience was particularly advantageous in preparing me for my exciting new venture with Vasomedical.
My responsibilities as a Clinical Application Specialist with Vasomedical include establishing new EECP centers as well as providing existing EECP providers with additional training, on-going clinical support, and physician education. I recently attended the AACN (American Association of Critical Care Nurses) in Orlando, Florida. Being at the Vasomedical booth was very inspiring, not only because I felt very much a part of the Vasomedical team, but also because I was experiencing the keen interest of the nurses who visited the booth with questions and curiosity.
I find it's exciting traveling all over the United States, but mostly find it enlightening hearing patient stories about the improvements in the quality of their lives.
Speaking with patients and hearing the many examples of how they are able to do things in every day life that they haven't done in a long time is very exciting. I like developing friendly relationships with the EECP centers I visit, and enjoy calling back to see how the patients I met are doing. Time after time I hear how the severity of their angina has decreased, their energy and exercise level increased, and their cardiac medications have been tapered down. This is thrilling to hear for the therapists and for Vasomedical staff. I feel proud to say I work for a company that makes a product that improves the lives of so many people.
When I first started with Vasomedical I was impressed by the kindness of the staff. Everyone I met gave me their phone numbers and encouraged me to call anytime, for any reason. This was especially important for someone living across the country. I feel just as much a part of The Team living in Boulder, Colorado as if I lived near the home office in Westbury, New York. I try hard to carry this welcome over to the sites I visit. I encourage the customers to call me anytime they need support. I want them to feel as much a part of our important team as EECP providers as we as a company feel they are. Early in my nursing career I felt the same level of fulfillment providing the best direct patient care as I now do teaching health care providers to administer proper EECP treatment to their patients.
My experience has shown me that anyone that is dedicated, educated, positive, and enthusiastic makes a successful EECP therapist. EECP is a therapy that is given to patients suffering from angina, usually over a seven-week period. A good EECP therapist develops important relationships with his/her patients that often last well beyond those seven weeks. A positive attitude, professionalism, and proper delivery of treatment are essential to successful patient outcomes. Given these skills many medical personnel can become wonderful EECP therapists. This is an exciting time for Vasomedical. The company is growing quickly with more than 120 centers in the United States. EECP patients are Vasomedical's best promoters. Thank you to all the patients and therapists that have shared their happy stories with me.
Center 71 - Central Cardiovascular Associates, Pittsburgh, PA
Louanne Tempich, LPN
Center 73 - HeartGen Centers, Indianapolis, IN
Georgiann Linnemeier, MD
Michele Cox
August 2000
Abstracts Accepted
Six Month Outcome of Patients with Left Ventricular Dysfunction Treated with Enhanced External Counterpulsation for Chronic Angina
O Soran, E Kennard, R Holubkov, J Strobeck, A Feldman
Does Optimal Diastolic Augmentation Predict Clinical Benefit from Enhanced External Counterpulsation (EECP)?: Data from the International Enhanced Counterpulsation Patient Registry
A Michaels, E Kennard, S Kelsey, R Holubkov, S Spence, T Chou
September 2000
Abstracts Accepted
Benefit and Safety of Enhanced External Counterpulsation in the Treatment of Ischemic Heart Disease with History of Congestive Heart Failure
W Lawson, J Hui, E Kennard, R Holubkov, S Kelsey, J Strobeck, A Feldman
Six Month Outcome of Patients with Left Ventricular Dysfunction Treated with Enhanced External Counterpulsation (EECP)
O Soran, E Kennard, R Holubkov, J Strobeck, A Feldman
Clinical Tips
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FROM:
Louanne Tempich, LPN, RCVT, EECP Center of Pittsburgh, Pittsburgh, PA:
Patients with colostomy and ileostomy stomas can receive EECP treatments safely and comfortably. Louanne creates a "protective ring" around the stoma using two layers of egg crate material. A hole is cut out of the center of each piece in keeping with the shape of the stoma. One layer of egg crate is positioned with the "bumps" against the patient's skin, the other layer with the "bumps" facing up. A towel is placed over the egg crate (to protect the cuffs) and the patient is wrapped as usual. Louanne tells us, "This technique has worked very well; we have never had a problem. The egg crate seems to equalize the pressure around the stoma better than the "donuts" typically used in this situation."
Angelica Patten, RN, Columbia-JFK Medical Center, Atlantis, FL:
A wound care specialist at JFK suggested the use of Duoderm to help heal skin that has blisters. Angelica places the Duoderm over the irritated area and either pads the spot or treats the patient without the calf cuff on the affected leg. After approximately one week the Duoderm is removed revealing pink, healthy, new tissue. This protective covering promotes healing from "the inside out".
Joanne Giordano, LPN, Cardiology and Medicine Associates, Inc., Vero Beach, FL:
Joanne tells us that she has had remarkable success preventing skin irritation by having all her patients apply lotion to their legs before each treatment and by making the wearing of pantyhose under the treatment tights mandatory. Admittedly this is met with some resistance from the male patients, but Joanne is insistent and has had only two incidents of minor skin problems since the beginning of this year. Having the guys purchase Queen size pantyhose seems to make it easier for them to put them on, and assures a more comfortable fit. Joanne adds that once the initial shock wears off and their wives stop teasing them, they get lots of good laughs from the experience and wind up with a course of EECP treatment free of skin complications.
Joanne also said that Dr. Nancy Cho, the Medical Director at this center sometimes gives Nitroglycerin before and during EECP treatment to improve augmentation.
The Vasomedical Clinical Applications Specialists suggest the following for a stable ECG and a smooth treatment experience for the patients:
1) Use stress test quality electrodes with soft gel in the center. Body temperature further softens the gel providing good skin contact. Several brands of electrodes (with ordering information) are included on the, "Treatment Room List" found in the EECP Clinical Training Resource Manual.
2) Gently cleanse the skin and allow the area to dry, before applying the ECG electrodes, to assure good skin contact.
3) The lead wires are best positioned under the clothing, exiting from the shirt or blouse at the right side of the patient's neck. Encouraging the patient to wear a shirt or blouse with buttons, rather than a tee shirt or turtle neck, makes this a little easier.
4) Do not allow the ECG and finger plethysmogram cables to tangle. Movement of the patient's hand will produce motion artifact, the system will hesitate and the patient will experience extra pressure when treatment is resumed.
5) Artifact may also be caused by electrical wires (headphones) touching the ECG cable.
6) Looping and taping the lead wires to the patient's chest and securing the ECG cable harness to the pillow also help to prevent artifact.
7) A fractured lead wire or a damaged ECG cable could be the culprit when no other source of difficulty can be identified.
Got a great idea you'd like to share with your EECP Therapist colleagues? Contact any of the Vasomedical Clinical Applications Specialists or Gudrun Lang (1-800-376-3321, ext. 116) and they will forward your suggestion(s) to the Newsletter.
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The IEPR Working Group was formed of IEPR Investigators who will be responsible for initiating analyses and setting publication priorities. The Working Group is also charged with advising the Registry regarding initiation of ancillary studies such as the collection of data from Thallium testing.
The IEPR Working Group first met briefly in Anaheim, CA at the ACC Scientific Sessions, in March 2000. It was at this meeting that Dr. Sheryl Kelsey, Director of IEPR, discussed the focus of the working group which includes: setting priorities for analyses and manuscripts, recommending changes in data collection forms, and proposing ancillary studies.
The first extended assembly of the IEPR Working Group was in Pittsburgh at the IEPR Coordinating Center at the University of Pittsburgh in May 2000. The exciting meeting was full of discussion for changes in data collection, research proposals, as well as current publication matters.
At this meeting, ideas were presented and discussed concerning future analyses and manuscripts. Many of the investigators are now currently working on these manuscripts, and we hope to report on any new developments as they occur.
The possibility of ancillary studies was also presented. Many ideas were debated, including studies concerning optimal treatment duration; measurement of endpoints other than angina class, specifically stress testing using radionuclide or EKG endpoints, stress echo testing, and brachial vasoreactivity; and a collaboration with the extensive Kaiser Permanente database.
The next convening of the IEPR Working Group will occur briefly at the AHA Scientific Sessions in New Orleans, November 2000.
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Chairman of Steering Committee
Jonathan R. Jaffe, MD, FACC
Editorial Staff
Nichole Dwyer, BA
Elizabeth Kennard, PhD
Design and Production
Nichole Dwyer, BA
Sponsor Office: Vasomedical, Inc.
Anthony Peacock, Vice President of Clinical Affairs
Gudrun Lang, RN, BSN, Director of Clinical Research
IEPR Coordinating Center
University of Pittsburgh
Graduate School of Public Health
Epidemiology Data Center
Sheryl F. Kelsey, PhD, Principal Investigator, Registry Director
Richard Holubkov, PhD, Biostatistician
Elizabeth Kennard, PhD, Registry Coordinator
Nichole Dwyer, BA, Data Manager