1. A loved one who is suffer-
ing from a serious complication of
diabetes is admitted to the hospital.
Incomplete information is relayed
from one of the patient’s specialists
to the hospital care team. As a result,
a key medication needed to treat a
preexisting condition is not included
in his medical record. The patient
gets sicker. He requires more tests and
treatments, and a longer hospitaliza-
tion, before he is able to recover and
can be discharged.
This type of scenario happens
all too frequently in the day-to-day
interactions between patients and our
health care system. It also illustrates
the direct relationship between the
quality of the care we receive and the
costs of that care. It’s estimated that
about 30 percent of the $2.5 trillion
spent on health care every year in the
U.S. is used ineffectively due to issues
such as hospital errors, readmissions,
and unnecessary and/or inappropriate
tests and procedures.
For more than 30 years, researchers
at The Dartmouth Institute for Health
Policy and Clinical Practice (formerly
the Center for Evaluative Clinical Sci-
ences) have been the recognized leaders
in diagnosing what ails our nation’s
health care system. For example, their
Dartmouth Atlas of Health Care has
shown glaring variations in how medi-
cal resources are used across the coun-
try, demonstrating that more care and
more expensive care don’t guarantee
high-quality care.
Applying Science
Tackling the twin challenges of
improving care and lowering costs
in a health care system as large and
complex as ours requires an innova-
tive approach that applies the right
resources and diversity of discipline.
In May, Dartmouth College Presi-
dent Jim Yong Kim announced the
creation of a new science—in the for-
mation of the Dartmouth Center for
Health Care Delivery Science—which
will build on the foundational work
of The Dartmouth Institute. “We’ve
made huge progress in the last century
in the basic, clinical, and evaluative sci-
ences,” says Dartmouth-Hitchcock Co-
President James N. Weinstein, DO,
MS, who will head up the new Center
with Kim, and also serves as the Direc-
tor of The Dartmouth Institute.
“What we need is a new field that
brings the best minds—from manage-
ment, systems thinking, anthropology,
sociology, the medical humanities,
environmental science, economics,
health services research and medi-
cine—to focus on
BLOCKS
for a Better Health
Care Delivery System
(Continued on pg. 2)
(Continued on pg. 2)
Janet Kulig had received
a call like this before.
She’d had a routine mammogram
on January 18, 2010, and now a
day later her doctor’s office was
calling to tell her there were some
unusual findings. “They asked me
to go back in for a repeat mam-
mogram,” she recalls. “When it
had happened before, everything
turned out fine, so I wasn’t overly
concerned.”
But further tests, which led to
a biopsy, confirmed the presence
of cancer. “It was pretty shocking to
hear,” says Kulig. “And then when my
husband Ray and I went for the follow
up appointment and the doctor him-
self came out to the waiting room to
greet us and escort us back to a room,
we thought, ‘Oh boy; this probably
isn’t going to be great news.’”
Though Kulig would undergo a
lumpectomy in February and would
also require radiation and hormone
therapy treatments, she had several
factors working in her favor. Her dis-
ease had been caught early, she had a
strong family and social support net-
work, and she was being cared for at
Dartmouth-Hitchcock’s Norris Cotton
Cancer Center (NCCC)—one of the
most advanced cancer treatment and
research centers in the country. Within
NCCC’s Comprehensive Breast Can-
cer Program, Kulig was impressed to
find specialists and care teams focused
on providing coordinated, compas-
sionate, and family-centered care.
This would turn out to be especially
true in Radiation Oncology. “When I
first met with the nurse, I said to her,
‘You look really familiar to me,’ and
she felt the same way,” says Kulig. “We
talked about it,
Making a Difference…
Building
Nancy Kennedy, RN, has been there for Janet Kulig,
through the birth of her daughters in the ‘80s, and
again recently through breast cancer treatments.
Thenand Now
Volume Nine, Number Three Summer 2010
1
Breast Cancer
Conquerors band
together to live, love,
and laugh.
Page 3
Expanding
Patient Access:
Dartmouth-Hitchcock
is working from the
ground up.
Page 4
Breathing
easier through a
less-invasive sinus
procedure
Page 4
CREST: The
landmark nine-
year trial in Stroke
Prevention.
Page 7

2. Then and Now (from page 1)
Dartmouth Center for Health Care Delivery Science (from page 1)
Left to right, radiation oncology nurse Nancy
Kennedy, RN, Janet Kulig, Rachel Kulig,
radiation oncologist Lesley Jarvis, MD.
Remarkably, Kennedy, who spent most of her
career in obstetrics and women’s and children’s
health before switching specialties about a year
and a half ago, was the delivery nurse for the
births of Rachel in 1989 and her older sister
Sarah in 1986. “I thought, ‘Oh my goodness;
talk about personal care,’” says Kulig, who
completed radiation treatments for breast
cancer in May. “It made the appointments very
comforting and reassuring. I felt like I had an
old friend with me on this journey.”
and that prompted me to look back
at some pictures I had at home. I
thought, ‘Gee; could it have been her?’
When I brought the pictures in, she
confirmed it.”
Remarkably, Nancy Kennedy, RN,
who spent most of her career in obstet-
rics and women’s and children’s health
before switching specialties about a year
and a half ago, had been the delivery
nurse for the births of both of Kulig’s
daughters—Sarah in 1986 and Rachel
in 1989. “I thought, ‘Oh my goodness;
talk about personal care,’” says Kulig.
“It made the appointments very com-
forting and reassuring. I felt like I had
an old friend with me on this journey.”
“I was very touched that Janet took
the time to go back
through her baby
books and bring
photos in,” says Ken-
nedy. “Looking back,
I remembered think-
ing what a nice young
couple she and her
husband were. I’d had
my children around
the same time and
those experiences were
still fresh in my life, so
I think it only intensified my desire to
see everything go well for them with
their new family.”
At one of Kulig’s appointments,
21-year-old Rachel accompanied her
mom to provide support and to meet
Kennedy. “It was wonderful to see her;
she’s grown into a lovely young woman,”
says Kennedy. “I told her, ‘I probably
gave you your first bath and your first
shot,’ which made her smile. I actually
did a little teaching with her around
bone health and breast health, as well.”
Kulig finished a course of 33 radia-
tion treatments in May. “Radiation
therapy is the ‘insurance
policy’ after surgery to
eliminate the possibility
of any cancer cells
being left behind,”
explains radiation
oncologist Lesley
Jarvis, MD, who
supervised her
treatments. “Janet
experienced a slight sunburn reac-
tion to her skin and also some fatigue,
which are both common side effects
of radiation treatments, but overall
she did quite well. She has a very good
prognosis.”
“Towards the end of treatment, I
noticed that I was getting a bit tired
and a little less patient by mid-week, so
I took a couple of Wednesdays off from
school which helped,” says Kulig, who
is a kindergarten teacher. “Everyone
at my school was so supportive and
so encouraging.” To thank them, she
donated a dollar on behalf of each staff
person to help sponsor Sarah who rode
in The 29th Annual Prouty, held in
July, which raises funds for NCCC.
“I was very lucky—if my situa-
tion motivates anyone to get a mam-
mogram, then that’s wonderful,” says
Kulig, who began her final phase of
treatment, a 5-year course of hormone
therapy, in June. “And I can’t say
enough about the prompt, personal
care I’ve received from everyone at
Dartmouth-Hitchcock through this
whole experience.”
“It’s been a privilege to help Janet
and her family through another pivotal
point in their lives,” says Kennedy. “To
me, making that human connection is
what medicine is all about.”
To me, making that human
connection is what medicine is all
about.” Nancy Kennedy, RN
delivery,” says Kim.
With a track record of creating innovative models
of clinical care such as the Spine Center, the first-in-
the-nation Center for Shared Decision-Making, and
the Comprehensive Breast Program, Dartmouth-
Hitchcock is already a leader in reforming health
care delivery. “This is a fantastic opportunity to
build new partnerships across the Dartmouth com-
munity, and take advantage of President Kim’s
experience in tackling the challenge of health care
delivery in some of the most difficult settings in the
world,” says Weinstein.
The new Center will focus on five areas: research,
education, collaboration, implementation and out-
reach, drawing on the expertise of faculty from the
Tuck School of Business, Thayer School of Engi-
neering, and the Arts and Sciences. The Dartmouth
Institute and Dartmouth-Hitchcock will be central
partners in the work of the Center, as will Dartmouth
Medical School, both in research and in the education
of medical students.
“We’ll have a new, expanded medical curriculum
that will take students in our M.D. program beyond
traditional medical school training and give them
grounding in this exciting new science,” says William
R. Green, PhD, Dean of Dartmouth Medical School.
“This will give them a unique understanding of what
it takes to provide quality, value-based care, and an
opportunity to be change agents in the care settings in
which they work—whether that’s here at Dartmouth
or at other leading institutions across the country.”
Unique Partnership
This is the first time that a college and academic
health system have come together in this way to
address health care delivery. “We feel so lucky to be
partnering with Dartmouth-Hitchcock,” says Kim,
a Harvard-trained physician and co-founder of Part-
ners in Health, a nonprofit organization that pro-
vides health care to underserved areas of the world.
“It’s not often that a president of a hospital or clinic,
in the case of Dr. Weinstein, is also one of the leading
practitioners in the field of health care delivery sci-
ence. That gives us a unique opportunity.”
“But at the end of the day, we have to prove
that we can take our ideas and actually implement
them,” he adds. “And it starts right here at home. So
Dartmouth-Hitchcock is going to be the place where
we can demonstrate to others that what we’re turn-
ing into practice actually leads to greater access, lower
costs, and higher quality.”
The launching of the new Center is especially
timely, given passage of health care reform legislation
that will expand health coverage to 32 million Ameri-
cans by 2014. “To handle this increased demand and
critical need for services, the care we provide must
become more efficient, with consistent quality and
safety, based on evidence, best practices, patient pref-
erences, and value,” Weinstein says.
New Curriculum
As its first order of business, the Center will establish
a new Masters program in Health Care Delivery Sci-
ence—an 18-month course of study for health care
managers, administrators, and providers with high
potential to become change agents—to be offered
jointly by The Dartmouth Institute and the Tuck
School of Business. Executive education and distance
learning will be incorporated into the new degree
program, which will enroll its first students (about
50) in July, 2011.
Other plans for the Center include: an expanded
research agenda, new undergraduate offerings,
national and global outreach, and collaboration
across universities and leading health care institu-
tions to innovate and implement improvements in
care delivery.
For more information about the Dartmouth Cen-
ter for Health Care Delivery Science, visit http://tdc.
dartmouth.edu. To learn more about The Dartmouth
Institute, go to: http://tdi.dartmouth.edu.
JOSEPHMEHLINGCOURTESYDARTMOUTHCOLLEGE
James N. Weinstein (left), DO, MS, Co-President of
Dartmouth-Hitchcock, and Dartmouth College President Jim
Yong Kim, will head up the Dartmouth Center for Health
Care Delivery Science, which will build new partnerships
to improve care and lower costs. Kim launched the Center
in May, thanks to a $35 million commitment from an
anonymous donor.
www.dhmc.org Skylight2

3. Happy hour at Molly’s Restaurant in
Hanover. Most of the nine women gathered at the
long, rectangular table order margaritas, only two
dollars a drink.
“You can’t beat the price,” one of them laughs.
In fact, there is a lot of laughter among this group
of friends, teachers, moms, writers, grandmas, busi-
nesswomen, and sisters in life experience. They have
dubbed themselves TGIF—thank goodness for Fri-
days, and Mondays, and every day of life after cancer.
TGIF is a group of breast cancer “conquerors”
who meet at Molly’s the first Friday of every month
for good cheer and camaraderie, explains PJ Hamel,
co-founder of the group with Debra Grabill. Note the
preference for the term conqueror rather than survi-
vor. “Survivor sounds like you’re just making it,” says
Hamel, a writer at King Arthur Flour, “but we’re win-
ning. We’re flourishing.”
The seeds of TGIF were planted six years ago—just
two women diagnosed with breast cancer connecting
over coffee. Today, this self described “support group
without the social worker” has an e-mail list of forty-
six names and counting, most of them referred by the
staff at Dartmouth-Hitchcock’s Norris Cotton Cancer
Center. TGIF is open to women of any age, any stage
of breast cancer.
Member Pam Gile, a medical secretary at DHMC,
readily admits that she’s not the support group type,
but this one, she explains, is different. She likes that
the meetings are outside the hospital walls in a social
setting. “We don’t feel pressured to adhere to any
guidelines. We have fun.”
Hamel elaborates, “We can talk about cancer with-
out feeling guilty, like we’re hurting or worrying our
families. We’ve all been through it so we don’t have to
be serious. We can joke and whine and needle each
other about chemo hair, botched surgeries, and out-
of-shape bodies because, underneath, there’s always
love, understanding, and support.”
This afternoon the women’s conversation shifts
across topics in typical fashion.
“I have to say something about hot flashes here
and now,” announces Caroline Schneider of Killing-
ton. Schneider’s brown hair is just starting to grow
back, and she is experiencing early menopause thanks
to chemo. This is her second happy hour with the
group. “For once, I’m not cold all the time,” she jokes.
Another TGIF member, Amy Dressler, a special
educator at Grantham Village School, recalls when her
tumor markers went up two years ago (a false scare,
thankfully). As Dressler talks about how TGIF members
rallied around her, the mood around the table turns seri-
ous. Everyone here has had her fair share of scares and
tears. But then the subject segues to shoes—pink patent
leather shoes, to be exact—and the laughter is back.
Cancer conqueror Janet Daniels of Hanover
(dubbed the group’s “costume queen”) wore those
particular shoes in a dance video TGIF recently made
to help raise money for the Prouty Bike Ride and
Challenge Walk in July. For five years, Team TGIF has
participated in this annual event to support research
and patient services at the cancer center. This year,
inspired by the wildly popular “Pink Glove” dance
video made by hospital staff at Providence St. Vin-
cent Medical Center in Portland, Oregon, the group
decided to follow suit. Only instead of pink gloves,
the twelve TGIF dancers sported feather boas, beads,
and sunglasses.
TGIF credits two outside volunteers for helping
them make the video (which runs almost seven min-
utes) a reality. Filmmaker Jeff Morris of Woodstock
worked the camera, at one point strapping it to a
wheelchair to achieve a weaving effect. And chore-
ographer Denise Frawley of Lyme managed to keep
everybody in line (mostly) during the upbeat dance
segment, shot on the lawn outside DHMC’s cafeteria.
Hamel talks about some of the challenges of the
nearly three-hour shoot to create the dance portion
of the video. For starters, some of the women claim a
total lack of rhythm, which meant a lot of counting
aloud, some confusion about “stage right,” and a few
pink pompoms in the face. And then there were other
issues: chemo-brain; old bones; a bout of heat exhaus-
tion. Oh, and the fact that one of the women was
scheduled for major surgery the next day.
Given all the challenges, why bother making the
video?
“We wanted to show other women with breast can-
cer how we’re doing,” Hamel explains. “We’re thriv-
ing. We’re enjoying ourselves.”
“When you have the chance to do something,”
adds Janet Daniels, owner of the coveted pink shoes,
“you say, Yes!”
“We’re happy to be alive,” Pam Gile states. This
is evident as the video’s final credits roll: “With
pure gratitude to the caring folks at Dartmouth-
Hitchcock Medical Center and Norris Cotton
Cancer Center. You saved Our Lives.”
To view the TGIF dance video, visit Dartmouth’s You-
Tube channel http://bit.ly/teamtgif. For more informa-
tion about TGIF, e-mail hamel.pj@gmail.com.
Breast Cancer“Conquerors”Enjoy Serious Fun
“We can talk about
cancer without feeling
guilty, like we’re
hurting or worrying
our families … We can
joke and whine and
needle each other
about chemo hair … and
out-of-shape bodies
because, underneath,
there’s always love,
understanding, and
support.”
3

4. Three projects moving
from concept to concrete
From the
Ground Up
For more than 10 years, Eric Smith dealt
with the nagging symptoms of chronic sinusitis—a
condition that causes the sinuses to become inflamed
and swollen, interfering with the drainage of mucus
into the nose. Chronic sinusitis is very common,
affecting about 14 percent of the U.S. population or
37 million Americans.
“Every year, I’d get several sinus infections,” Smith
recalls. “They became so predictable I could almost
mark them on the calendar. The winter months were
the worst because of the dry air and being inside
heated buildings. My job required me to do a fair
amount of traveling internationally throughout the
year, so those long flights also made me more suscep-
tible. I always seemed to get sinus infections at the
worst times, like when I had to do presentations to
customers.”
He took antibiotics to subdue the infections, and
did frequent sinus rinses as a preventive measure. “I
also tried some of the prescription nasal steroid sprays,
but that was like trading one problem for another,” he
says. “I went from having sinus infections to a chronic
post-nasal drip and sore throat.”
Smith had talked with his doctor several years
ago about sinus surgery, but had decided against it.
“I didn’t want to get involved with anything that
was that invasive and required that much recovery
time,” he says. “Then around 2004 while doing some
research online, I read about a less-invasive procedure.
I thought the concept made sense, but as I remember
it was still in trials and only available in a couple of
locations.”
Meanwhile, his symptoms gradually grew worse.
“The infections and sinus headaches became more
frequent and my breathing became a bit labored—my
wife noticed that I was mouth-breathing all of the
time,” says Smith. “I was also snoring much more
at night which affected my sleep. I finally got to the
point where I thought, ‘I don’t care what it takes; I’ve
got to do something.’”
To Smith’s surprise and relief, the procedure he had
discovered online, called balloon sinuplasty, was now
being offered at Dartmouth-Hitchcock. “Instead of
surgically removing bone and tissue, as is done with
more traditional functional endoscopic sinus surgery,
we use a small, flexible balloon catheter to open the
Dartmouth-Hitchcock Nashua
Ambulatory Care Center
On May 26, Dartmouth-Hitchcock
Nashua held a Groundbreaking Cer-
emony to celebrate construction of the
new state-of-the art ambulatory care cen-
ter slated to open in January 2012. The
Honorable Donnalee Lozeau, Mayor of
the City of Nashua, spoke to the more
than 100 attendees about the positive
impact the new facility would have on
the Nashua community by expanding
access to quality care, and how the new
facility will be home to additional high-
quality sustainable jobs during a time of
heightened economic uncertainty.
Attendees heard from Dartmouth-
Hitchcock patient Rebecca McCarthy,
whose diagnosis of Crohn’s disease
has taken her on a journey through
Dartmouth-Hitchcock’s system of care
including Keene, Manchester, and Leba-
non. Rebecca’s journey emphasized the
impact of clinical services integration,
and superior communication between
providers throughout the Dartmouth-
Hitchcock system. Her story also dem-
onstrated the need and positive impact
the new facility will address by bringing
specialty care services close to home.
According to Dr. Thomas Colacchio,
President of Dartmouth-Hitchcock
Health, the ceremony marks a major
milestone in moving us closer to our
vision of achieving the healthiest popula-
tion possible by carefully and effectively
integrating research, education, com-
munity partnerships and the delivery of
health care, so that we can provide each
person in the region the best care, in the
right place, at the right time, every time,
while delivering the highest value.
Dartmouth-Hitchcock Nashua
serves more than 60,000 patients in
the Greater Southern New Hampshire
Region, with more than 215,000 outpa-
tient visits last year. The new, five story
140,000 square feet facility will allow
consolidation of services that exist at
Dartmouth-Hitchcock Nashua practices
including the East, West and Squires
Centers and will expand patient choice
and increase access to quality, convenient
healthcare and specialty care services.
A rendering of the new facility allows a peek into the not-too-distant future. According to
Dr. Sanders Burstein, Medical Director for Dartmouth-Hitchcock Nashua, “This new site will
consolidate the services of the three buildings … , allowing us to provide the most effective
and efficient healthcare delivery possible in an outpatient setting.”
The future home of the new Dartmouth-Hitchcock Nashua Ambulatory Care Center slated to
open in January 2012. The five-story building will allow for the expansion of specialty services
and future growth in the Nashua community, in line with Dartmouth-Hitchcock’s vision of
improving the health of people in the region.
After balloon sinuplasty, Eric Smith is breathing easier, he
has more energy, and he’s sleeping better. “I’m very happy
with the outcome,” he says. “It just goes to show you that
new technologies are constantly becoming available, so you
don’t always have to accept living with issues that affect
your quality of life.”
Easier
BreathingWith Balloon
Sinuplasty
www.dhmc.org Skylight4

5. DHMC’s Outpatient Surgery Center
(OSC) Welcomes Patients and Families
On June 22, the Outpatient Surgery
Center (OSC) officially opened its doors
for the first time to patients and families.
Following months of construction, the
40,000-square-foot facility located on
LaHaye Drive, provides much-needed
operating room (OR) capacity by wel-
coming same-day procedures, while
allowing the main OR to accommodate
more urgent cases.
“Right now we are at capacity in our
main operating room,” says Doug Mer-
rill, MD, Medical Director. “The Out-
patient Surgery Center will allow us to
create more capacity and to separate out-
patient surgical procedures and patients
from more complex procedures done for
inpatients.”
Merrill expects the easily accessible
facility will divert 4,500 cases from the
OR department in the first 12 months,
with a total of 25 to 30 operations on
a daily basis. Merrill said. “The OSC
will initially provide care for patients
undergoing orthopaedics, sports medi-
cine, pediatric and adult ear, nose and
throat, pediatric and adult urology,
eye, hand and plastic surgeries. As we
go forward, we will plan to include
patients who are having surgery per-
formed by gynecological, general and
other surgeons.”
It is important that a friend or fam-
ily member be on site in the OSC at
all times during the surgery. Therefore
the reception area offers floor to ceil-
ing windows meant to provide a light
and warm area for patients to wait. “We
recognize this can be difficult for some
people, families in particular, because
day care can be incredibly expensive, so
the OSC is very family-friendly,” Mer-
rill says. There is even a CHaD-inspired
children’s section where patient’s siblings
can watch television, play with toys or
read books.
“No one is ‘just’ a nurse or a doctor,”
notes Merrill. “We will all work together
to make sure things run smoothly and
efficiently. Our primary concern is to
accommodate the needs of our patients
and their families.”
The New Transfer Center at
Dartmouth-Hitchcock Medical Center
“We knew we needed to improve patient
flow, access and care management,” says
Nancy Bagley, MD, Medical Director of
the new Transfer Center at Dartmouth-
Hitchcock Medical Center. That was
three years ago. On May 3, the new
Transfer Center at DHMC was in full
activation, providing a single point of
contact for urgent/emergent transfers.
The Transfer Center is staffed 24/7 by
Access Nurse Coordinators (ANC).
With the exception of Trauma, Neo-
natology and Psychiatry, all calls for
transfers into the hospital are now going
through this central system. Each call is
recorded and reviewed in order to have
a complete clinical picture for future
reference for each and every patient, says
Nettie Warren, MSN, RN, Director of
Patient Placement Services.
“Our goal,” Bagley adds, “is to be
able to say yes to every appropriate
urgent/emergent patient transfer. We
don’t want lack of beds or staff to be
an issue.” An important mission of the
Transfer Center is the accurate collection
of data. “With a central system we have
the capacity for the first time to collect
accurate data on referrals and bed avail-
ability,” says Bagley. A flex-unit, staffed
with a team of nurses, is now available
for patients until beds are ready.
“The core reasons for the creation of
the Transfer Center,” says Warren, “were
to improve access and customer service
and to address the issue of multiple calls
for a single patient.” Bagley explains, “In
the past individual clinical services were
called by outside physicians when an
emergent transfer was required. There
are over 20 clinical services, so it was
confusing for some practitioners.”
The staff of the Transfer Center
is dynamic and eager to facilitate
patient access. “We want to provide
exemplary customer service to our
patients,” Warren says. “We welcome
any and all who would like to visit our
Transfer Center.”
The internal number to the Transfer
Center is 650-5152. The external num-
ber is (877) 999-9870.
nasal passages,” says otolaryngologist Giridhar Ven-
katraman, MD, the only specialist who is currently
performing the procedure in the region.
The technique is very similar to that used by car-
diac specialists when opening partially clogged arter-
ies, says Venkatraman. “The general principle is the
same, but rather than using X-ray imaging we use a special
fiber-optic-lighted guidewire that illuminates the sinus cavi-
ties,” he explains. “We thread the guidewire through the
nostrils and into the sinus. Once we’re sure the guidewire is
in the right spot, we feed the catheter and balloon over the
guidewire, and pull the guidewire out.”
The balloon is then inflated with saline to apply local-
ized, high-intensity pressure. “Most of the tissue of the
sinus openings is made up of a combination of soft tissue
and very soft bone,” says Venkatraman. “Applying that kind
of pressure allows us to push against the bone and crack it
a little bit. This prevents the bone from re-growing into the
same position, and keeps the sinus passage open.”
The procedure offers a number of significant benefits
over conventional sinus surgery, including less bleeding, less
pain and discomfort, and faster recovery time for patients.
Smith had the same-day procedure done last October and
saw immediate results. “There was a dramatic difference
between going in and coming out,” he recalls. “Then when
I got home and removed the little bit of packing they gave
me, I was amazed at how well I could breathe. I probably
had some noticeable discharge for about 4 hours, but that
was no big deal.”
Since having the procedure, Smith has had more energy
and has become more active, which has helped him to lose
a few pounds. And he’s sleeping much better. “I still snore,
but nothing like I used to,” he says. “I still have to do sinus
rinses when it’s dry. And I have a little bit of drainage trou-
ble, due to some scar tissue I developed on the right side.
I’m going to go in before winter and see Dr. Venkatraman
to take care of that.”
“But I’m very happy with the outcome—it just goes to
show you that new technologies are constantly becoming
available, so you don’t always have to accept living with
issues that affect your quality of life,” Smith adds. “Dr. Ven-
katraman and everyone at Dartmouth-Hitchcock have been
responsive, knowledgeable, and professional. They really
work at making the quality of the whole care experience the
best it can be.”
Al Keiller, Trustee (Treasurer) Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital,
Nancy A. Formella, MSN, RN, President, Mary Hitchcock Memorial Hospital, Co-President, and
Dartmouth-Hitchcock’s Outpatient Surgery Center Medical Director Douglas Merrill prepare to
cut the ribbon celebrating the Center’s grand opening.
The new Transfer Center will improve patient flow, access and care management. Brandy
Hollis, Patient Placement Coordinator, and Karla Wilson, RN, Access Nurse Coordinator, Patient
Placement Services, are on the ready to provide a single point of contact for transfer access
and customer service.
By using a fiber-optic-lighted guidewire and small,
flexible balloon catheter, balloon sinuplasty offers a
less invasive method of opening sinus airways blocked
from chronic sinusitis, says Otolaryngologist Giridhar
Venkatraman, MD, the only specialist currently performing
the procedure in the region.
The procedure offers a
number of significant
benefits over conventional
sinus surgery, including
less bleeding, less pain
and discomfort, and faster
recovery time …”
Giridhar Venkatraman, MD
5

6. PHOTOSBYJONGILBERTFOX
Neither Madame Bovary nor
Anna Karenina, so far as we know,
had colon cancer, and yet each was
partially responsible for launching the
career of Stefan Balan, MD, recently
appointed the first Clinical Director of
Hematology/Oncology at Norris Cot-
ton Cancer Center in Manchester.
Balan, who speaks five languages,
intended to pursue a career in gastroen-
terology in his homeland of Romania.
Economics and politics, however, made
him look elsewhere for his residency,
first to France, and then to the United
States. During an interview at New York
University, Professor Harold Ballard
asked him to make a parallel between
Madame Bovary and Anna Karenina.
“My jaw dropped,” reports Balan.
“I told myself, if NYU is anything like
this, I want to be here.” Balan, who has
published one book of poetry, entitled
The Night, and co-authored an award-
winning book of film criticism on the
Danish filmmaker, Lars von Trier, does
not recall precisely how he responded
to that question, but does remember
that he wasn’t satisfied with his answer.
Happily, Ballard (later Balan’s mentor)
was—and Balan began a fellowship in
Ballard’s sub-specialty of hematology/
oncology.
Initially, after switching to English
from his native Romanian, Balan pub-
lished only “a couple of essays on haiku
and a few poems.” Language might
not be the only barrier; one needs time
to write. Balan holds daily clinics in
Manchester, constantly recruits patients
for clinical trials, and is on-call every
fourth day. He spends one day a week
in Lebanon, usually driving up the
night before, but occasionally rising at
4:00 a.m. to make the trip. A typical
day there begins with a Gastrointestinal
tumor board at 6:45 a.m., followed by
a Thoracic Oncology tumor board and
meetings with the Chief of Hematology
and Oncology, other regional directors,
and fellow researchers. He likes to carve
out several hours during the afternoon
to stay current with his research and to
prepare lectures. Balan has a passion
for teaching, and has received several
awards for excellence. Dr. Murray Korc,
the Chief of Medicine at Dartmouth,
described Balan’s last Grand Rounds as
“one of the best of the decade.” Balan’s
twelve-hour day ends with a Neuro-
Oncology tumor board.
Balan likes hematology/oncology
because it’s constantly changing. “We
are living in a revolutionary period of
oncology. A colon cancer patient with
metastatic disease fifteen years ago was
living four to six months. Now we’re
pushing towards three years. It’s a big
intellectual challenge.” He also likes the
human contact and describes the fine
line a physician must walk between
“being objective and practicing evi-
dence-based medicine, and being emo-
tionally penetrable and accessible. At the
end of the day, all these issues that are
your patients’ become yours. It becomes
personal.”
For Balan the personal is the payoff.
He recently received the American Can-
cer Society’s Lane Adam Quality of Life
Award, bestowed annually to individuals
who “innovatively and consistently pro-
vide excellent and compassionate skilled
care, counsel, and/or service to persons
with cancer and their families.” Balan
was cited for his “caring, down-to-earth
approach” and for giving patients and
families “an increased sense of strength,
perseverance, and hope for the future.”
Balan, who used to edit an interna-
tional cultural e-magazine of poetry,
prose, and literary and film criticism,
“Clouds,” understands the importance
of stories. He tells of a former colon
cancer patient, “Charlie.” Balan learned
that when Charlie was a child, he’d been
in a terrible automobile accident that
left him partially disabled and so trau-
matized he was unable to speak without
a severe stutter. His parents, maybe out
of guilt, lost their patience to the point
of becoming abusive. Charlie, seek-
ing some solace
Friends of Dartmouth medicine who attended a black-tie
Gala fundraiser on June 5th weren’t just there to have a good time. The
500 guests were also doing their part to save lives and advance medicine
by raising funds to support patient care, teaching, and research at Dart-
mouth-Hitchcock and Dartmouth Medical School.
The community’s enthusiastic participation—through sponsorships,
ticket sales, and donations of auction items—demonstrated the breadth
of support and depth of commitment that Dartmouth-Hitchcock and
Dartmouth Medical School enjoy throughout the region. The successful
event surpassed its fundraising goal of $500,000, bringing in $600,000
in critically important unrestricted funds for D-H and DMS.
Stefan Balan, MD, was recently appointed the first Clinical Director of Hematology/Oncology
at Norris Cotton Cancer Center in Manchester. Balan’s vision for the Manchester clinic includes
bringing in sub-specialty services: a breast cancer surgeon, a genetic oncologist, a neuro-
oncologist, and a pediatric oncologist, “ so parents don’t need to travel too far. Bringing sub-
specialty services is very important to me,” he states. “I try to bring Dartmouth-Hitchcock to
each patient’s home … At the end of the day, all these issues that are your patients’ become
yours. It becomes personal.”
A Passion
for Stories
(Continued on pg. 8)
Community Support Shines at Gala
Dartmouth’s Leverone Field House in
Hanover was creatively transformed to
provide a beautiful setting for the event.
Top: Guests bid generously during
the live auction, led by auctioneer
John Terrio. Above: Before dinner,
DMS Dean Bill Green chatted with
Dr. Julia Nordgren, DMS ’99 and
her husband, Robert.
Al Griggs, chair of the DHMC Board of Trustees, and his
wife, Sally, were among those dancing to the music of
the band “Skin Tight.”
Gala attendees included (left to right): Lisa and Phil
Ferneau, Tuck School Professor Sydney Finkelstein, and
his wife Gloria.
Three generations of the Williamson family
gathered at the event, including Susan
Williamson (left), her daughter-in-law Leslie,
and granddaughter Katie (right).
www.dhmc.org Skylight6

7. The National Institutes of
Health (NIH) landmark clinical
trial in stroke prevention—the Carotid
Revascularization Endarterectomy vs.
Stenting Trial (CREST)—has recently
released its results. Dartmouth-Hitch-
cock (D-H) was part of the nine-year
potentially paradigm shifting study
that compared the safety and efficacy of
carotid endarterectomy (CEA), a surgi-
cal procedure to clear blocked blood
flow, and carotid artery stenting (CAS).
The results have shown that both stroke
prevention procedures are equally safe
and effective.
Surgery was considered the gold
standard at preventing future strokes,
although some smaller studies showed
stenting was better. Richard Powell,
MD, Professor of Surgery, Section of
Vascular Surgery and Principal Inves-
tigator for the study at Dartmouth-
Hitchcock Medical Center says,
“CREST really was the tie-breaker, and
though it showed that in certain subsets
of the population surgery is more effec-
tive and in certain subsets stenting is
better, this study showed that both are
equally safe and effective.” The results,
Powell says, are great news for patients.
“Here at D-H where vascular surgery
has a proven track record of doing both
CEA and CAS, we can really individual-
ize treatment for the best outcome for
each patient.”
James Schumann of Keene received
a stent as part of CREST. “Suddenly
I had this line across my eye and I
couldn’t see of out of one eye,” says
Schumann recalling what
brought him to the Emergency
Department five years ago.
“Turns out a vessel had been
shut off. Dr. Lukovits talked
to me about the program. I
wanted the stent, but I knew
that it was a 50-50 chance I’d
get the surgery.” It turned out
that Schumann got what he
wanted, and he couldn’t be
happier. “Getting the stent
wasn’t a hard procedure. I felt
great when I went home and
I’ve felt great since then. You
feel comfortable when you
learn that everything is fine.”
Schumann also said that every follow-
up visit was reassuring and thorough.
“Dr. Powell and Dr. Lukovits are just
excellent. They stay right on top of
everything. I’d do it again the same way.”
Hugh Sycamore of Hebron, NH dis-
covered he had a blockage in his carotid
artery at a routine check-up with his
primary care physician in Plymouth,
who sent him to DHMC. “The block-
age was in the 60-70% range and getting
worse. I didn’t really have a preference at
the time for which procedure I received,
but I was very glad to have conventional
surgery.” Sycamore says he had no com-
plications from the surgery in 2006 and
has felt very good ever since. Addition-
ally, Sycamore, a former hospital admin-
istrator, felt privileged to be part of such
a well run trial. “I was kept extremely
well-informed about the trial and the
results. I have the utmost respect for Dr.
Powell and Dr. Lukovits.”
Powell explains that while deemed
equally safe and effective, important dif-
ferences in the procedures were teased
out in the study: “For example, the
study found that patients under the age
of 68 generally do better with stenting,
while patients greater than 68 generally
do better with surgery.”
Timothy Lukovits, MD, Medical
Director of the Cerebrovascular Disease
and Stroke Program at DHMC and the
study neurologist adds, “This study also
found that there was a slightly higher
risk of heart attack following surgery
and a slightly higher risk of stroke in
the stent group in the periprocedural
period. These outcomes were counted
equally in the results but may differ
greatly in their impact on a patient’s
quality of life. This aspect of the results
has not been fully released yet and war-
rants further discussion.”
The study, with joint NIH and
industry funding, was conducted at 117
sites around the country. Sites selected
had to prove a high degree of profi-
ciency and safety with both procedures
to be considered. “We had to have
done 50 stents with good outcomes,
which we had,” Powell says. “We had a
good track record with both procedures.
And D-H has a unique perspective, in
many sites stenting is done by cardiol-
ogy or interventional radiology; here,
vascular surgery does both procedures.
We don’t have a bias.”
CREST enrolled 2,502 patients in
the randomized trial—some with previ-
ous stroke history and some who were
at risk but asymptomatic. Patients were
followed for 30 days for immediate
complications of stroke, heart attack
and death, and for four years for future
stroke events. The trial was one of the
largest stroke prevention trials ever and
being one of the sites participating in
this landmark trial was important for
D-H in many ways. “This was an excel-
lent, tightly run trial and it was impor-
tant for us regionally to be part of this.
It was stimulating for the physicians and
non-physicians and important training
for fellows,” Lukovits says. “It was also
an excellent collaboration between neu-
rology and vascular surgery.”
Since both treatment options are
available at D-H, Powell is excited
about the ability to better tailor treat-
ment to each individual. “While the
results of CREST showed that the two
procedures were equally safe and effec-
tive, we now better understand the
strengths and weaknesses of both, which
benefits each patient tremendously.”
in Stroke Prevention:
CREST
Trial Shows
Stenting
and Surgery
Equally Safe
& Effective
The results of a nine-year
landmark study are great
news for patients
Top; James Schumann and his wife, Wanda, of Keene, NH. James received a stent for a
vessel that had been shut off. “Getting the stent wasn’t a hard procedure … I’ve felt great
since then. Above; Hugh Sycamore of Hebron, NH used conventional surgery to remove
the blockage in his carotid Artery. “I didn’t really have a preference at the time for which
procedure I received, but I was very glad to have conventional surgery.” Both James
Shumann and Hugh Sycamore took part in the CREST trials.
Timothy Lukovits, MD, Medical Director of
the Cerebrovascular Disease and Stroke
Program at Dartmouth-Hitchcock Medical
Center and the study neurologist.
Richard Powell, MD, Professor of Surgery,
Section of Vascular Surgery and Principal
Investigator for the study at Dartmouth-
Hitchcock Medical Center.
7

8. Profile: Stefan Balan, MD (from page 6)
and comfort, taught himself to play
the piano (and, later on, several other
instruments). One day, toward the end
of Charlie’s life, Balan asked him to
bring in his keyboard. “He didn’t know
how to read music,” Balan recalls, his
gaze turning inward. “He was using
letters instead of the usual scores. He
played and the patients danced with the
nurses. It was a very different side that I
hadn’t seen before.” Charlie’s story didn’t
end there. Soon after Charlie died, a
chaplain at the VA approached Balan
with a “theoretical request.” Was it pos-
sible for a patient to have some of their
ashes buried in the flowerbeds around
the hospital? Charlie always loved the
VA, and one of his last wishes was to
be close to the place he loved so much.
Balan informed the chaplain that unfor-
tunately, it was not possible. Still, Balan
can’t help wondering, when he passes
one of the lush gardens on the hospital
grounds, whatever became of Charlie’s
remains.
Balan’s vision for the Manchester
clinic includes bringing in sub-specialty
services: a breast cancer surgeon, a
genetic oncologist, a neuro-oncologist,
and a pediatric oncologist, “…so parents
don’t need to travel too far. Bringing
sub-specialty services is very impor-
tant to me,” he states. “I try to bring
Dartmouth-Hitchcock to each patient’s
home.”
Balan does extensive clinical
research and is currently running tri-
als in lung cancer, colon cancer, breast
cancer, palliative care, neurophathy,
and plans to begin even more. He
was part of the palliative care study
at DHMC, ENABLE II (Educate,
Nurture, Advise, Before Life Ends),
co-authoring the paper that was the
lead article in JAMA (The Journal of
the American Medical Association) in
August 2009. He is currently working
on ENABLE III. “It’s a project dear to
my heart,” Balan says.
Both Emma Bovary and Anna Kare-
nina followed their hearts and, for each,
a chance meeting took her in a direction
she hadn’t foreseen. The same might be
said for Stefan Balan. If not for a chance
encounter with Dr. Ballard at NYU,
Balan might well be practicing gastro-
enterology in France. However, while
neither of our noted protagonists had
a happy ending, Dr. Balan is delighted
with his new role as Clinical Director.
“It’s a challenging job and has many
layers. And it’s the most exciting thing
for me that I learn something every day.
It’s a wonderful team and it carries the
Dartmouth-Hitchcock spirit, which is
deeply gratifying for me.”
ACCOLADES
Dartmouth-Hitchcock Medical
Center wins top environmental
leadership award
Dartmouth-Hitchcock Medical Center
has been awarded the highest environ-
mental achievement award presented
by Practice Greenhealth, a national
membership organization for health care
facilities committed to environmentally
responsible operations. The facility was
named a member of the Environmen-
tal Leadership Circle, Practice Green-
health’s most prestigious award.
Dartmouth-Hitchcock Physicians
Cited As ‘Top Doctors’ in New
Hampshire
Forty-two physicians with Dartmouth-
Hitchcock ties, in 30 different special-
ties, were recently named to New
Hampshire Magazine’s list of the Top
Doctors in New Hampshire, in the maga-
zine’s April edition, on newsstands now.
In January 2009, New Hampshire
Magazine distributed more than 3,800
surveys to physicians throughout the
state, asking them to nominate medical
specialists in different categories who
they would recommend to friends and
family for treatment. The surveys were
then compiled and the top vote getters
named as the top doctors and leading
physicians in their respective specialties.
A complete listing of New Hamp-
shire’s Top Doctors and excerpts from
the articles can be found online at
www.nhmagazine.com.
CHaD Diabetes Education Program
Awarded Recognition
The Children’s Hospital at Dartmouth
(CHaD) has received recognition from
the American Diabetes Association
(ADA) for their Pediatric Diabetes
Education Program at their locations
in Manchester and Lebanon. CHaD’s
Manchester based program originally
received this distinction in 2007. CHaD’s
Pediatric Diabetes Education Program
offers diabetes self-management educa-
tion to families of children with diabetes.
Programs that achieve recognition
status maintain a staff of knowledge-
able health professionals who can pro-
vide state-of-the art information about
diabetes management. The American
Diabetes Association Recognition cer-
tificate assures that the CHaD Pediatric
Diabetes Education Program meets the
National Standards for Diabetes Self-
Management Education Programs.
For more information you can contact
the Pediatric Diabetes Education offices
at (603) 695-2790 for Manchester, or
Lebanon at (603) 653-9877.
DHMC Designated Level
4 Epilepsy Center by
National Organization
Dartmouth-Hitchcock Medi-
cal Center (DHMC) has been
designated as a Level 4 epi-
lepsy center by the National
Association of Epilepsy Cen-
ters (NEAC).
The Level 4 designa-
tion is applied to hospitals
and medical centers that
provide the more complex
forms of intensive neuro-
diagnostics monitoring, as
well as extensive medical,
neuropsychological, and
psychosocial treatment,
according to the NEAC.
Fourth-level centers also
offer a complete evaluation
for epilepsy surgery, includ-
ing intracranial electrodes,
and provide a broad range
of surgical procedures for
epilepsy.
DHMC’s Epilepsy Pro-
gram, the only Level 4 cen-
ter in northern New England, meets all
of those criteria, says Program Director
Barbara Jobst, MD.
For more information on the pro-
gram, visit dhmc.org/goto/epilepsy.
NEWS&EVENTS
Our vision
Achieve the healthiest population
possible, leading the transformation
of health care in our region and
setting the standard for our nation.
The best care, in the right place, at
the right time, every time.
dhmc mission:
We advance health
through research,
education, clinical practice
and community partnerships,
providing each person the best
care, in the right place, at the
right time, every time.
about dhmc:
Dartmouth-Hitchcock Medical Center in-
cludes Mary Hitchcock Memorial Hospital,
a member of the New England Alliance
for Health; Dartmouth Medical School,
the state’s only medical school; Dart-
mouth-Hitchcock Clinic, a multi-specialty
academic group practice; and Veterans
Affairs Medical Center in Vermont, which
provides a rich educational environment
for doctors in training.
Skylight is published quarterly by the
Office of Public Affairs and Marketing.
Phone: (603) 653-1910
Please address comments to:
“Skylight Editor” via e-mail at:
CreativeServices@blitz.hitchcock.org
or by mail to:
Dartmouth-Hitchcock Medical Center
One Medical Center Dr., Lebanon, NH 03756
Editor: E. Senteio
Contributing Editor: Sandra Adams
Contributors: Joni B. Cole, Tim Dean,
Vicky Fish, Katharine Fisher Britton,
Kate Villars
Photographer: Mark Washburn unless
otherwise noted.
Design and Illustration: David Jenne
CLASSDAYGraduates gathered with their families, friends and officials
to celebrate Dartmouth Medical School (DMS) Class Day
and Dartmouth Commencement on June 12 and 13. DMS
awarded 192 degrees: 86 MDs, 41 PhDs, 42 MPHs, and 23
MS degrees. Student speakers at DMS Class Day were PhD
candidate Yolanda Nesbeth, who spoke of her experience in the
“Dartmouth environment [as] a very collaborative one, … with
talented individuals who provide great intellectual stimulation
…”; and MD candidate Rajesh Ramanathan, who summed up
the excitement and promise for the future saying, “… it is
my honor to join you all as we step forth boldly into a future
committed to the welfare of our patients and our communities.”
For Class Day information, speeches, or to view additional photos
visit: http://now.dartmouth.edu/2010/06/commencement-2010/.
JohnDouglas/FlyingSquirrelGraphics
www.dhmc.org Skylight8
One of America’s Best Hospitals
U.S.News & World Report has again ranked Dartmouth-Hitchcock Medical Center among the nation’s top hospitals in its most recent
“America’s Best Hospitals” issue. Dartmouth-Hitchcock earned a Top 50 ranking for its care in Gynecology; the 2010-11 edition
marks the fourth consecutive year and the eighth time since 1995 that Dartmouth-Hitchcock’s Gynecology program has been ranked.
One of the best for cardiovascular care
DHMC is among 100 U.S. hospitals that produce the best clinical outcomes for cardiovascular care, treating heart patients in less time
and at a lower cost. Also, in 2010, Thomson Reuters cited Dartmouth-Hitchcock in its 100 Top Hospitals Health System Benchmarks Study.
Dartmouth-Hitchcock was ranked among the 51 top-performing health systems nationwide, cited for “higher quality patient outcomes across
the facilities in their system.” Thomson Reuters analyzed 255 health systems nationwide for its health system benchmarks study.
Nationally designated Comprehensive Cancer Center
Dartmouth-Hitchcock Norris Cotton Cancer Center is one of only 40 centers in the nation designated as a Comprehensive Cancer
Center by the National Cancer Institute (NCI) for excellence in research; new approaches to cancer prevention, diagnosis and treatment;
and education and outreach to its communities. Norris Cotton Cancer Center has held the prestigious NCI designation since 1978.
One of a select group of Magnet hospitals
Magnet institutions demonstrate excellence in nursing services and patient care, a professional environment, and growth
and development opportunities for nursing staff.
Top doctors in New Hampshire
Each year, dozens of Dartmouth-Hitchcock physicians are named among the state’s leading physicians in New Hampshire
Magazine’s annual “Top Doctors” issue.
One of the top medical schools
Dartmouth Medical School has been repeatedly recognized by U.S.News as among the nation’s finest medical schools.
Medal of Honor recipient for organ donation
DHMC received the national Medal of Honor for achieving and sustaining an organ donation rate of 75 percent or more of eligible donors.
Among the environmental leaders in health care
Hospitals for a Healthy Environment recognized DHMC for continuous and sustainable efforts, and a commitment to environmental health.
One of the best large companies to work for
Business NH Magazine named DHMC to its select Hall of Fame for repeated top five designations in its “Best Companies to Work
For” recognition program.
Learn more at Dartmouth-Hitchcock.org
Among theNation’s Best
201007-191a