Health News & Information for Healthy Living

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shaping up after shoulder

surgery Page 6

Don’t let fruits & veggies make you sickPage 2

You can save your own life — like she didPage 5

‘It hurt so bad I couldn’t even cry’

Advanced surgical technology arrives

just in time to help accident victim Page 3

P r o g r a m P l a n n e r : P u l l o u t c a l e n d a r i n s i d e

Healthy LivingAltoona Regional’s

Healthy Living

Magazine is published

four times a year by

the Marketing and

Communications

department.

President/CEOJerry murray

Chief Operating Officerronald J. mcConnell

Director, Marketing and CommunicationsDave Cuzzolina

Staff WritersPatt KeithAnne stoltz

DesignerChip mockmock Creations LLC

For more information, please contact:

Altoona regional Health systemmarketing and Communications620 Howard Ave.Altoona, PA 16601-4899889.2271info@altoonaregional.org

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If you are not receiving Healthy Living Magazine in the mail and would like to,

you need to join the Healthy Living Club.

It’s free, and the magazine is just one of

the many benefits!

Join online at www.altoonaregional.org

or call 889.2630 or 1.888.313.4665.

Don’t let good food make you sick

“Viruses, bacteria and parasites can survive on fruits and vegetables.”

Fruits and veggies are healthful but demand proper care, handling

Everyone needs to be aware of the importance of proper food handling to avoid food-borne illnesses. This is especially true of produce.

Fruits and vegetables can be a bit trickier than other food groups since they come in multiple shapes and various surface textures, and can be eaten raw. That makes proper handling even more crucial, according to Monica Richers-Kelly, an Altoona Regional registered dietitian. And, she said, safety begins well before the produce reaches your table.

“When buying, make sure there are no blemishes or soft spots,” she said. “At home, discard fruits and vegetables that have been stored beyond their shelf life or are shriveled or slimy. And keep your refrigerator’s produce bin clean.”

Monica emphasized that all fresh produce should be washed before eating.

“Viruses, bacteria and parasites can survive on fruits and vegetables,” she said, “but they’re easy to remove by following a few recommendations.”

Wash produce with cool running tap water. Don’t use soaps or bleach solutions. And produce-cleaning solutions on the market have not been proven more effective than water.

“Water that is a little warmer than the produce will help prevent absorption of surface pathogens into the produce, especially at the stem end,” she explained. “New research shows that for certain vegetables, such as tomatoes, bacteria can be pulled into openings if the wash water temperature is colder than that of the produce item.”

It is enough to rinse soft-skinned produce like apples and grapes, while hard-surfaced produce like melons, potatoes, carrots and citrus fruits should be scrubbed with a clean brush under the cool running water.

“Make sure the outside of hard-skinned produce is clean or you could transfer bacteria into the fruit when you cut through it or peel it,” she cautioned.

Monica recommends that you remove outer layers from leafy greens, then pull lettuce and spinach apart completely and rinse each leaf under running water.

An important rule to follow is never to wash produce until you are ready to use it.

“If you wash those strawberries then store them in the fridge, they’ll get moldy,” she said. “It’s because of the added moisture. You want to keep down the moisture.”

Discard any fresh produce left at room temperature for longer than two hours after peeling or cutting, Monica said.

She cautioned that all of your produce handling could be sabotaged if you don’t follow these recommendations before beginning preparation:

• Wash your hands with hot, soapy water for 20 seconds.

• Clean and sanitize cutting boards and utensils with hot soapy water or, better yet, in a dishwasher.

• Don’t let fruits and vegetables come in contact with surfaces exposed to raw meat, poultry or fish.

“The rate of illness from contaminated produce is relatively low when you consider how much of it is eaten in the United States,” Monica said. “But as with any food, the possibility exists, and proper handling is essential to make it as safe as possible.”

3

New technology helps surgeon repair woman’s severe spinal injuries

Altoona regional is only the seventh hospital in the state to offerthe O-arm®

Just in tiME

Dr. Maserati

Image of Karen Smith’s repaired spine.

KarenSmith

contact:matthew B. maserati, m.d.allegheny Brain and spine surgery501 Howard ave., Bldg. e-1 Altoona • 946.9150

Karen Smith has a deeper appreciation for a healthy back. She is grateful for the skill of her neurosurgeon, Matthew Maserati, M.D.

And she remains amazed at her good fortune to be just the third patient to benefit from surgical technology so advanced that Altoona Regional is only the seventh hospital in the state to have it.

The O-arm® Multi-Dimensional Surgical Imaging System debuted eight days before Karen’s car accident, which severely damaged her spine and required four hours of complex surgery.

The revolutionary system allows surgeons to see inside the patient and fix problems without harming healthy parts of the body only a hair’s width away from surgical instruments.

O-arm® imaging provides up-to-date, 3D images of the patient instantaneously on oversized, visually pristine flat-screen monitors easily seen by the surgeon and the surgical staff assisting him or her.

‘Powerful tool’

“The O-arm® is an extremely powerful tool,” Dr. Maserati said. “I know at all times where the instruments are in relation to the bones, blood vessels and nerves. This reduces the risk of injury to those structures and makes it more likely that screws will be correctly placed, resulting in a more stable final result and fewer complications.”

O-arm® technology is helpful in surgeries to correct spinal deformities, such as curvature of the spine (scoliosis); to fix bone-splintering spinal fractures like those Karen suffered, and to perform minimally invasive procedures where screws are guided to their target using only X-rays.

“The roads were snowy and icy, and I lost control,” said Karen, who lives in Woodbury. “The car became airborne, went over an embankment and landed wheels-down with such force it jolted my spine upward. I immediately felt excruciating pain; it hurt so bad I couldn’t even cry.”

risk of paralysis

When she got out of the car to get help, she crumpled to the ground.

Dr. Maserati said Karen was at great risk for a spinal cord injury that, without surgery, could cause paralysis to her legs, and bowel or bladder dysfunction.

“She had extensive injuries up the spinal column to the mid-back,” he said. “And unpredictable disc movements increased the likelihood that bone fragments could also move and further endanger her spinal cord.”

To remove those risks and restore spine strength and stability, Dr. Maserati performed a spinal fusion with a supporting scaffold of rods and screws.

Like others, Karen’s spinal anatomy presented significant challenges because of where screws were needed.

o-arm® ‘critical’

“In Karen’s case, the O-arm® was critical because the target is very small where the screws are placed,” Dr. Maserati said. “Such screw placement is challenging, risky and sometimes impossible — when 3D image guidance provided by the O-arm® is not available.”

Karen is obviously glad the tech-nology was available in Altoona.

“It’s easier on everyone being close to home for surgery,” she said. “My recovery is going very well. I can tell my back is healing and I am regaining strength. I am very happy to stand and do even little things without pain.”

Program alert! Peripheral Artery Disease (PAD) screeningSee calendar insert for details, date and time

About the Non-Invasive Vascular Laboratory• Thelabprovidesstate-of-the-artcirculationassessments

(ultrasound testing) of the heart, head, neck, abdomen, arms and legs for blockages in arteries and veins.

•Thelabwasfoundedin1979byneurosurgeonCarrollP.Osgood Jr., m.D., who continues as medical director today. Founding sonographer was John madey, a registered vasculartechnologist(RVT),whonowservesastechnicaldirector.

•In1990,thelabwasaccreditedbythenewaccreditingagency — the Intersocietal Commission for the Accreditation of Vascular Laboratories. It was the first in Pennsylvania and one of the first 200 vascular labs accredited in the country. Accreditation has been continuous.

•In1992,itwasoneofthefirsttoobtainandusedigitalultrasound.

•In2010and2011respectively,Dr.Osgoodandvascularsurgeon Arthur Demarsico, D.O., received certification as registered physicians in vascular interpretation — the highest attainable standard in vascular sonography interpretation.

“When the late Dr. Ira Kron (former Altoona nephrologist) and I started, we didn’t know how accurate the technology would

become or how widely used it would be by so many specialties,” Dr. Osgood said. “All of our physicians

who interpret studies — myself, Art Demarsico, subhashis maitra, mark Lipitz, Larry Primack,

Ciceron Opida — and our techs — John madey, Jeff Leamer, Dave Fay, Dan solomon, meagan ricciotti and morgan shoop — are proud of our service to the community and will continue to provide high quality service as we keep abreast of changes in the field.

“ultrasound technology has a bright future in medicine because of its safety and relatively low cost.”

Grateful patients make staff’s day at Non-Invasive Vascular Lab

“The first visit is often the start

of a long-term, lifesaving

relationship.”

Andrew “Drew” Campbell, 49, thought the increased swelling and pain around his six-day-old artificial knee reflected his over-zealous start to rehabilitation.

Two days later, his wife Lisa’s skills as a registered nurse led her to suspect something more serious as his condition rapidly deteriorated. Her instincts proved correct.

A registered vascular technologist at Altoona Regional’s Non-Invasive Vascular Laboratory detected four blood clots in an artery behind the artificial joint. The clots blocked the blood flow into his lower right leg, causing it to swell to five times its normal size.

“My leg felt like wood,” Drew said. “It was so swollen, so tight and hard that when you pushed on it, there was no give to it. I was at my breaking point with the pain.”

testing is pain-free

For any patient visiting the Non-Invasive Vascular Laboratory already in pain, John Madey, a registered vascular technologist and technical director of the lab, offers reassurance that the tests performed are as pain-free as its name suggests.

No preparation, needles or intravenous dyes are necessary to capture the images and detect any obstructions within the circulatory system. The studies are painless, safe and radiation-free. A warm, blue gel applied to the scan area allows a hand-held probe to glide painlessly over the skin surface. The six-member Non-Invasive Vascular Laboratory staff performs more than 14,000 studies annually.

A high patient volume combined with 95 years of combined hands-on experience ensures the quality of the scans, according to vascular surgeon Arthur DeMarsico, D.O., medical director of the Vascular Institute and Drew’s consulting physician.

Has doppler study

“We rely on non-invasive studies not only for initial diagnosis but also for monitoring patients for disease progression and follow-up care in post-operative cases,” Dr. DeMarsico said. Studies are performed in the department to assess circulation of the heart, arms, legs, neck, head and abdomen.

Drew needed a vascular ultrasound, also known as a Doppler study, the most commonly ordered test, which examines the arteries, veins and smaller blood vessels that circulate blood from the heart to the organs.

“It was a very quick process,” Drew, of Clearfield County, said. “I was in a tremendous amount of pain and I had no idea what was causing it. However, within a very short time, I knew I had blood clots behind the knee, and I was being admitted. Blood clots are serious, but compared to other scenarios I’d thought about, I was very relieved. It was fixable.”

Drew, who received pain and clot-dissolving medications, became one of the estimated 2 million Americans diagnosed annually with deep veinthrombosis (DVT).

‘life-threatening condition’

“DVT is a life-threatening condition where blood clots form in a vein,” John said. “If a clot breaks free, it may travel to the heart and lung, producing what is termed a ‘pulmonary embolus.’ So we diagnose quickly and help get these patients to immediate treatment.”

Blood clots can be fatal and continued to be a problem for Drew, delaying physical therapy on his knee. Dr. DeMarsico implanted a filter that prevents blood clots from traveling to the lungs.

Drew resumed physical therapy a week after the filter implant. He remains on anticoagulant therapy and needs periodic monitoring through Non-Invasive — which is not unusual.

“The first visit is often the start of a long-term, lifesaving relationship,” John said. “Many, many times over the years I have had patients return to say, ‘Thank you for helping to save my life.’ That’s the best feeling.”

‘thank you for saving

my life’

Information provided by Dr. Osgood

Wise Move

Dr. Deur. “The earlier the stage, the greater the survival rate.”

As for Janice, she saw a surgeon from Altoona Regional affiliate Allegheny Regional Surgical Associates.

“I learned that the standard treatment for DCIS is a lumpectomy, followed by radiation therapy,” she said, “so that’s what I did.”

Janice had to heal from surgery before beginning 6½ weeks of radiation under the direction of Jack D. Schocker, M.D., at Altoona Regional’s Center for Cancer Care. And now, more than a year since her initial diagnosis, Janice says she feels great and is preparing to retire as a teacher from Northern Cambria School District.

‘one step at a time’

“I always tell people not to worry until you have something to worry about, and even then, just take it one step at a time,” she said. “The best thing you can do for yourself is get regular mammo-grams. You really have the opportunity to save your own life. Catching the cancer as early as I did would never have happened had I not gotten my mammogram.”

Dr. Deur agrees, citing numerous trials that have shown mammography reduces the risk of dying from breast cancer.

“Despite its limitations, mammography is still our most effective method of early detection,” she said. “Mammography can identify cancer several years before the point at which physical symptoms develop, and that’s important to remember.”

“The best thing you can do for yourself

is get regular mammograms.”

5

Since age 40, Janice Kosto has “never missed” her annual mammogram.

On Feb. 15, 2012, Janice, 58, of Carrolltown, reported to Altoona Regional at Station Medical Center for her routine screening mammogram. A few days later, she received a call she never expected.

“I can’t say that I was alarmed when they asked me to come back for a second mammogram. Just surprised,” she recalled. “I had an ultrasound once before on my breast and everything turned out to be fine.

“Still, I knew how important it was to follow up, and I’m so happy I did.”

On Feb. 29, Janice met with radiologist David Rose, M.D., of Altoona Regional affiliate Lexington Radiology. He analyzed her second mammogram, which was diagnostic.

Biopsy performed

“He showed me what are called ‘microcalcifications’ on my scan,’” she said. “I remember seeing the largest one, which was like the size of a piece of popcorn, and he told me I needed a stereotactic breast biopsy.”

The biopsy was performed at Station Medical Center by radiologist

Peter L. James, M.D., medical director of Lexington Radiology.

Soon after, Janice, who still couldn’t feel the lump, received word that she had an early form of breast cancer known as DCIS, or ductal carcinoma in situ.

“DCIS is the earliest form of breast cancer, stage 0,” explained Lauren Deur, M.D., a radiologist with Lexington Radiology who is fellowship-trained in mammography. “It most commonly presents on a mammogram as microcalcifications, which look like tiny white specks.

cancer had not spread

“The term ‘in situ’ essentially means the cancer is confined within the milk ducts. This is different than invasive or infiltrative ductal carcinoma, which has broken through the duct wall to invade surrounding tissue.”

About 60,000 cases of DCIS are diagnosed each year in the U.S. Dr. Deur said the incidence has increased in the past decade because of improved screening.

“More patients used to present with symptoms,” she said. “Now, DCIS is mostly asymptomatic because it is detected by mammography. And microcalcifications, the most common findings in DCIS, are seen even better with digital mammography.”

Altoona Regional installed digital mammography in

March 2011 at Station Medical Center.

earlier the better

“We really are helping women receive the screening they need to help identify breast cancer at the earliest stage possible,”said

‘You really have

the opportunity

to save your

own life’

Talk to your doctor

and schedule your digital mammogram

today by calling 889.4222.

Janice and her husband, Jim, have been married for

more than 35 years. They have three grown children

and two grandchildren.

Janice Kosto

According to the American Academy of Orthopaedic Surgeons, rotator cuff pain (also known as “shoulder impingement syndrome”) is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction or painting, are also susceptible.

Sha

ping

up

After shoulder surgery, Army vet is able to train for an endurance challenge

Joe can now do several exercises involving his shoulder with no pain, including pushups with added weight from his son.

If you have pain, weakness or loss of movement in a

shoulder and want to get started on the road to recovery, call

814.889.3600 for an appointment today.

Joe Patterson, 45, of Gallitzin, had shoulder issues “for awhile.”

He spent 24 years in the U.S. Army, teaching soldiers various ground-fighting techniques. He says he was required to be “100 percent in shape” and was constantly engaged in intense physical activity.

“I wasn’t exactly taking it easy on my shoulders by doing pushups over and over and over again,” Joe said.After he retired from the Army, Joe did some research on what he might be able to do to alleviate his shoulder pain. He wasn’t used to feeling “not at 100 percent” and soon found himself in the office of Jack Rocco, M.D., of Southern Alleghenies Elite Orthopedics.

needed to regain strength

“I sat down with Dr. Rocco and had a straightforward conversation,” he said. “I wanted — actually, I needed — to regain my strength. I didn’t want to lose the fitness level I had while in the Army.”

Dr. Rocco says he sees many patients with shoulder pain.

“They tend to come in two broad categories — the younger, athletic shoulder and the older, wearing-out shoulder,” he said. “Symptoms of both may include pain, weakness and/or loss of movement.”

For Joe, it was constant pain and increasing weakness, leading to a diagnosis of impingement syndrome and tendinitis. Bone spurs, or tiny, pointed outgrowths of bone from his collar bone were rubbing on his rotator cuff. Left untreated, Dr. Rocco said, Joe eventually could have suffered a tear in his rotator cuff.

tried therapy, cortisone

“The shoulder has a greater range of motion than any other joint in the body,” Dr. Rocco explained. “The ball-and-socket joint is held together by a group of muscles and tendons called the ‘rotator cuff.’ A healthy rotator cuff keeps the ball in the socket and aids in movement in many directions, but overuse or injury can disrupt normal stability of the shoulder, causing symptoms.”

Joe and Dr. Rocco attempted to alleviate the symptoms with physical therapy and cortisone injections but had no success.

“We usually try to avoid surgery, but current surgical treatment, if necessary, is much less invasive than traditional open surgery,” said Dr. Rocco. “Fortunately, new and exciting advances allowed me to treat Joe with arthroscopic surgery.”

Arthroscopic surgery uses a few small incisions to insert an arthroscope (camera) and the instruments needed for diagnosis and repair.

Better results, fewer risks

“With arthroscopic surgery, I can see better, do more, and get better results than with open procedures,” Dr. Rocco said. “You really do get more advantages and significantly fewer risks.”

Since undergoing shoulder surgery in July 2012, Joe has traded in his aches and pains for a bachelor’s degree from St. Francis University and several hours in the gym daily. He said he considers himself “back to 100 percent.”

“My quality of life is so much better — so much so, that I’m back to working out regularly with my son, Joe Jr.,” he said. “I’m even training to compete in the popular endurance challenge Tough Mudder this August!”

HOW to giveTomakeagiftinlove,tributeorremembrance,contacttheFoundation for Life at 889.6406, or send a check with a note providing background on the reason for your gift. You can also make your gift at www.altoonaregional.org/gift giving.

TheFoundationwillnotifythepersonofyourtributegiftwithan appropriate card, and you will receive a receipt and letter thanking you for your generosity and thoughtfulness.

HOW

n e w s f r o m t H e f o u n d a t i o n f o r l i f e

7

Employees raise funds for FoundationThe Employer of Choice Committee at Altoona Regional held a wreath contest holiday fundraiser and raised $558 to help the Foundation for Life fulfill its mission “to help financially support exceptional health care for the well-being of all Central Pennsylvania residents.”

At the presentation of the cash donation are (from left): Shirley Hoyne, acting coordinator of the Foundation for Life, and Rosemarie Gibson, chairwoman of the committee. Representing Altoona Family Physicians, Williamsburg Family Practice and Women’s Health and Wellness employees who created the wreath that earned the most votes in the contest are Susan Chew, practice manager; Christina Zumer Quinn, PA-C, and Marcia Shirk, certified medical assistant

At the first quilt presentation by the Bonnie Hunter Club of Bedford are (from left): Todd Azeles and Anita Grimes of Altoona regional, Theresa Leppert of the Bonnie Hunter Club, Shirley Hoyne of Altoona regional’s foundation for Life, Doris Caldwell of the Bonnie Hunter Club and Angie Claar of Altoona regional.

Group donates quilts for chemo patientsThe Bonnie Hunter Club of Bedford has donated 12 lap quilts to Altoona Regional’s Foundation for Life for patients receiving chemotherapy and plans to provide many more.

Todd Azeles, nurse manager of the Medical/Oncology Unit and the Hospice/Palliative Care Unit, thanked Bonnie Hunter Club members for the donation.

“The staff will enjoy the opportunity to offer them to their patients and share in the appreciation and comfort they will bring,” he said. “Dealing with a cancer diagnosis and the treatment that at times can be life-altering is a challenging task for our patients and families.

“These quilts, and the caring involved in their creation, will provide our patients with warmth and a sense of the comforts of home during this difficult time.”

The group meets monthly to make quilts. In the quilting community, Bonnie Hunter is well-known as an author and quilt teacher. She shows others how to make quilts from scrap material left over from other projects.

Members of the club include Doris Caldwell, Fae Kurtz, Jane Jakovac, Eunice Pile, Deb Clark, Heather Sipes, Bonnie Doran and Theresa Leppert, mother of Altoona Regional Infection, Prevention & Control employee Angie Claar, who served as liaison for the donation.

“We appreciate this thoughtful gift and the efforts of Angie, who advocated on behalf of our cancer patients,” said Shirley Hoyne, acting coordinator of the Foundation for Life. “It is an example of how groups and individuals can assist in fulfilling patient needs or providing a caring touch by using their unique and diverse special talents.”

Wrapped in Love Foundation Inc. of Pittsburgh supplied canvas carry totes for each quilt.

Team aids breast cancer detection, treatmentThe Penn State Altoona women’s basketball team donated $2,142 to Altoona Regional’s Foundation for Life. The donation was money from the team’s annual Pink Zone game. The donation will be used to benefit improved breast cancer detection and treatment at Altoona Regional. At the check presentation are (from left): Casey Shoup, assistant coach; Donna Kling, head coach; Gayle Conner, development associate, Foundation for Life, accepting the check from team captains Alidia Strouse and Allyson Hoffman; and Pat Nagle, assistant coach.

What impact has technology made on patient safety?

We have achieved significant milestones through the support of our nurses, physicians and ancillary staff, and we’re aided by the many advances in technology. For example, our computerized medication administration check system uses bar-coding to digitally verify that our patients are receiving the right drug, the right dose, through the right route at the right time.

We have purchased IV pumps called “smart pumps” that screen dosages for accuracy. We have also implemented the PIK system, which uses bar-coding for lab samples. We have had no mislabeled lab specimens with the use of the PIK system.

Hospital-acquired infection is a national issue and of great concern to patients. What is Altoona regional doing to reduce or prevent hospital-acquired infections?

Non-ProfitOrganizationU.S. Postage

PaidAltoona Regional Health System

Altoona Hospital Campus620 Howard AvenueAltoona, PA 16601-4899

A nonprofit community health care system Change Service Requested

How do you approach your role as the person in charge of quality and patient safety at Altoona regional?

When I took this position, I had only a glimpse of the “behind the scenes” quality monitoring and process improvement that goes on in a facility of this size. For me, quality and patient safety are the most important things in health care.

I try to look at every situation as if it was my mom receiving the care or service. My concern is about each individual patient. The most important thing we can do is make sure our patients feel safe when they come to us with health problems.

When errors happen, how do you ensure they don’t happen again?

My goal is error-free care, but if a mistake occurs, I feel that transparency is of the utmost importance. Reviewing the process and

p r o f i l e

Dr. Batzel received her medical degree from Jefferson Medical College in Philadelphia and completed her residency in emergency medicine at Geisinger Medical Center in Danville. She also has a master’s degree in business administration from Penn State University’s Smeal College of Business.

events that led to a mistake is the only way to prevent it from happening again.

We have a process in place — supported by The Joint Commission and the state Department of Health — which encourages reporting of anything that may affect patient safety. Most of these reports are not done because of a mistake or harm but because one of our many engaged staff sees that potential and wants to avoid it.

For example, we have made a big improvement in hospital-acquired pressure ulcers (HAPU) through collection of large amounts of data and analysis. Now we are better at assessing risk, early reporting of reddened skin, early wound care consults and the use of specially purchased mattresses for high-risk patients. Our rates of serious HAPU have steadily declined from nine in 2007 to none in 2012 and none year-to-date for 2013.

Altoona Regional had 1.14infections per 1,000 patient days. The average in Penn-sylvania hospitals is 2.22.

We are significantly lower in both catheter-associated urinary tract infections and central line-associated blood infections. For hip and knee replacements, we are well below the state averages for infection.

We continue to make efforts to improve because even one infection, especially if it is you or someone you know,is too many.

We have a comprehensive infection prevention process. As bacteria are becoming more resistant and more difficult to treat, we have to focus on prevention.

We have isolation protocols for different types of current and past infection, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), etc. We also routinely screen patients who may be at risk and patients who had previous infections. We use disposable or dedicated items in rooms with infections. For example, isolation patients have disposable trays and utensils from Nutrition Services.

In addition, we have a very aggressive hand-washing policy to protect patients and staff.

Because of these strict precautions, we have very low hospital- acquired infection rates. For 2011,

a s K t H e s P e c i a l i s tLinnane r. Batzel, m.D., m.B.A., is the chief medical officer and senior vice president of quality and medical affairs at Altoona regional.