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Deena Brecher is a clinical nurse specialist in the emergency department at Alfred I. duPont Hospital for Children. Photograph by Jared CastaldiIf there’s one thing Deena Brecher knows from her 12 years as a pediatric emergency room nurse, it’s that kids can’t be treated as little adults.

Indeed, getting better care for the tiniest patients is a goal Brecher intends to pursue when she joins the board of directors of the Emergency Nurses Association in January. “The vast majority of children are cared for in community hospital emergency departments,” says the 36-year-old Brecher, clinical nurse specialist in the emergency department at Alfred I. duPont Hospital for Children in Rockland. “A lot of them don’t have the correct equipment or medications to take care of children.”

She’d also like to see nursing schools better train students in the interpersonal skills necessary to interact with children and their families. “Children have different needs than adults,” she says. “They come in with their families all the time. You can’t treat them in isolation.”

Brecher will also work to raise awareness about the growing problem of violence in the nation’s emergency departments—a goal she shares with the association. A recent ENA study finds that more than half of emergency room nurses report experiencing physical violence on the job. Brecher acknowledges she once had a knife pulled on her at a hospital in Connecticut. Yet hospital administrations and law enforcement often downplay the problem, blaming it on stress. “Even the nurses think it’s just part of the job,” she says. Brecher admits she was surprised when she arrived at A.I. five years ago and some parents actually said “thank you.”

As the only member of the panel with a pediatric specialty, Brecher feels she can provide a unique perspective during her three-year tenure. She is thrilled to have been elected and says that the staff at A.I. has been totally supportive. “They want me to succeed,” she says. “I’m going to learn a lot.” —Christine Facciolo
 

Page 2: Lab on Wheels | Can’t get to a testing site? Let it come to you.

 

The Mobile Intraoperative Consultation Service van leaves Eden Hill Medical Center in Dover.Lab on Wheels

Can’t get to a testing site? Let it come to you.

The first licensed mobile pathology department in the country might soon be hitting the road well outside of the Mid-Atlantic region.

In July Dover-based Doctors Pathology Services was awarded a patent for its Mobile Intraoperative Consultation Service, or MICS, and calls have been coming in from around the globe.

From the outside, one of the company’s four units might look like a simple van, yet the inside is anything but basic. “We have copied what is done in a laboratory exactly the same as you would get from a hospital,” says DPS director Ray Sukumar. “We just cut the cost, make it more convenient and speed up the service.”

Usually, a patient would have to block out hours to make a trip to a hospital and have their tissue tested, Sukumar says. The MICS makes it possible for difficult tests to be performed anywhere.

“Patients with muscle weakness need muscle biopsy, and to do so, you need to freeze the muscle 72 below zero right away, so it’s restricted to hospitals,” he says. “A test like that typically costs $1,500 at a hospital, but we can do it for around $400 because of our lack of overhead.”

A successful debut of the vehicle at a medical conference last year has piqued interest from large states such as Texas and California.

“For a lot of people, taking a day off is an economic problem,” Sukumar says. “We have made it convenient for people to have these tests done.”    —Bob Thurlow
 

Page 3: Walk Hard | A local provider of prostheses helps people find solid footing.

 

NESS L300. Photograph courtesy of Bioness Inc.Walk Hard

A local provider of prostheses helps people find solid footing. 

More than 10 years after his diagnosis, Rodney Sampson of Wilmington had come to terms with having multiple sclerosis, but what he could not accept was the slow atrophying of his calf muscle as a result of wearing an ankle-foot orthosis.

Muscle weakness and foot drop had also led Sampson to “do the helicopter” when he walked, swinging his leg from the hip. Then he learned about two new devices that would allow him to walk more normally while stopping the atrophy.

One month after he began walking with the NESS L300, Sampson says, “I am more than pleased. It’s like a miracle.”

The NESS L300 and its competitor, WalkAide, are functional electrical stimulation devices designed to improve the gait of a person afflicted by foot drop as a result of illness or injury. A person with foot drop is unable to raise his or her foot at the ankle, leading to dragging of the foot or a high-stepping walk.

The new technology is not only less cumbersome than an AFO, but over time can also lead to an improved ability to walk because the device stimulates muscle, says John Horne, president of Independence Prosthetics-Orthotics in Newark, which carries both systems.

The NESS L300 and WalkAide work best for foot drop caused by stroke, multiple sclerosis, cerebral palsy, traumatic brain injury or incomplete spinal cord injury, according to Horne. A doctor’s prescription is required, and coverage of the devices varies by insurance company.

The NESS L300 cuffs below the knee and costs $6,200. The WalkAide, which straps to the calf, costs $4,900. —Theresa Gawlas Medoff
 

 Page 4: Better Than Ever | The expanding Graham Center continues to innovate in cancer care and treatment.

 

The expanded center houses the Center for Translational Cancer Research that allows doctors and scientists to collaborate more quickly. Better Than Ever

The expanding Graham Center continues to innovate in cancer care and treatment.

Before the Helen F. Graham Cancer Center opened in 2003, Delaware ranked among the top five states for cancer incidence and mortality. But in a report released in July, those numbers dropped to 11 and 12, respectively. And the downward trend continues.

Oncologists at Christiana Care attribute the improvement to services offered at the Graham Center. Now an expansion has tripled its size, allowing it to combine more services and patient-centered care under one roof.

“When you get all those services and all those physicians and support staff seeing the patient on one visit, it really is better cancer care,” says Dr. Nicholas J. Petrelli, medical director of the Graham Center.

One of the most exciting aspects of the 124,000-square-foot expansion is that it makes room for the Center for Translational Cancer Research, a joint effort between Christiana Care, the University of Delaware and the Nemours Research Institute. For patients, it means that doctors and scientists can collaborate more quickly.

Recent expansion of the Helen F. Graham Cancer Center tripled its size. “It’s going to bring new treatments and, even more importantly, new preventive agents to Delaware,” says Petrelli.

The expansion also brings the Christiana Care Breast Center and Delaware’s first dedicated breast MRI scanner to the new facility. Other features of the expansion include the Community Health Outreach and Education Program, the Oncology Data Center, and the Center for Rehabilitation Oncology.

New chemotherapy infusion suites open out to a rooftop garden that overlooks ponds and fountains. A chapel and meditation room provide respite for patients and their families.

“The Graham Center at Christiana Care can treat any cancer that’s diagnosed with any individual in the state of Delaware,” says Petrelli. “Delawareans don’t have to leave the state for their cancer care.”   —Christine Facciolo
 

 Page 5: Thinking Outside the Box | A new walk-in clinic has a radical new idea about healthcare: Some of it needs to happen quickly.

 

Doc In A Box locations in Dover and Camden each include a special pediatric room.Thinking Outside the Box

A new walk-in clinic has a radical new idea about healthcare: Some of it needs to happen quickly.

When Dover-based doctor Monty Spangler began as an urgent care physician more than a decade ago, he saw his share of patients that required immediate assistance, but it was the other patients in the emergency rooms that have been in the back of his mind all these years.

“I noticed a lot of people would use the emergency room for non-life-threatening conditions—fractures, cuts, tough colds, sore backs,” says Spangler. So he founded Doc In A Box walk-in medical clinics. “Walk-in care centers are able to provide an efficient alternative to emergency rooms, especially in a medically underserviced area like Kent County.”

Doc In A Box’s two locations in Kent, Dover and Camden, have taken root in shopping centers and, despite moving into pre-fabricated spaces, feature an open reception area, private patient rooms and an on-site lab for testing. They even have a special pediatric room equipped with a race-car exam table.

“We are already up to about 30 patients at each site a day,” Spangler says, adding that he has only been open since July. “We could handle up to three times that number.”

The idea is that people will use Doc In A Box for any non-emergency problem that arises, from sinusitis and allergies to sprained ankles and tennis elbow, but without having to wait to be squeezed into a general practitioner’s schedule, Spangler says.

“The more streamlined plan we use is one of the ways that health care will change in the future,” he says. “I am happy about my great staff and the overwhelming community response. It’s well above what we expected by this point.”   —Bob Thurlow
 

 Page 6: Starrlight, Starr Bright | A special fund lights the way for women with ovarian cancer.

 

Starrlight, Starr Bright

A special fund lights the way for women with ovarian cancer.

Battling ovarian cancer is an emotionally and physically draining experience for any woman. But for those in Kent and Sussex counties, the challenges can be overwhelming.

Tammy Brittingham and husband Mike Pelrine became painfully aware of the plight when she began treatment for stage III C ovarian cancer at Christiana Care’s Helen F. Graham Cancer Center three years ago. Sitting in the chemo room with his wife, Pelrine heard stories about financial hardship that were heartbreaking: women who were uninsured or underinsured and couldn’t afford their medications or important diagnostic tests, women who couldn’t afford to pay utility bills or buy groceries, or, worse yet, women who didn’t have the human or financial resources to get to and from life-saving treatments.

“The problem is there are only four gynecological oncologists in Delaware, and they’re all upstate,” says Pelrine. “If you want proper cancer care for a gynecological cancer, you have to travel to the Graham Center or elsewhere. No one hears those stories.”

Pelrine, a Lewes restaurateur and Brittingham, a newspaper publisher, wanted to help. Last year, on Pelrine’s 50th birthday, they established the Starrlight Fund with the Delaware Community Foundation to provide financial assistance to women in crisis. (Starr is Brittingham’s maiden name.)

One year later, the fund started making disbursements to non-profit cancer organizations and hospitals. A permanent source of funding is the sale of Shooting Starrs Gourmet Cupcakes at Béseme, their family-owned restaurant.

Ovarian cancer is the sixth leading cause of death for women, but it hasn’t received as much publicity as breast or prostate cancer. “Hey, now it’s our turn,” says Pelrine.  —Christine Facciolo
 

Page 7: Bloody Good Show | Better technology helps the Blood Bank serve patients better.

 

A UD student gives blood using automated double red cell technology.Bloody Good Show 

Better technology helps the Blood Bank serve patients better.

After winning the national Spring Match-up Challenge two years in a row, the Blood Bank of Delmarva’s Christiana Center has earned bragging rights, but the competition really isn’t about winning and losing. It’s about spreading awareness of advanced technology that allows donors to give twice the number of red blood cells.

Red blood cells are the component of whole blood most in demand—and most subject to critical shortage. Red blood cells are the most commonly transfused component of blood. They’re used for trauma victims, surgery patients, premature infants and mothers who lose too much blood giving birth, among others.

When a person donates a pint of whole blood, he donates a unit of red blood cells. With the specialized ALYX equipment acquired three years ago, however, the Blood Bank can collect twice as many red blood cells from the same amount of donated fluid.

Blood Bank spokeswoman Carrie Aiken estimates that, during the past year, some 3,000 donors have given blood using the new technology.

It takes 20 to 25 minutes to donate a unit of double red blood cells, compared to five to eight minutes for a unit of whole blood. Still, the process can be a timesaver for regular donors, because the donation schedule is every 112 days instead of every 56 days.

The Blood Bank of Delmarva has four of the double red blood cell machines: two in Christiana and two in Salisbury, Maryland. The machines are portable, so they can be taken to the Blood Bank’s established mobile sites, as well.  —Theresa Gawlas Medoff

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