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Fall 2009 - Vol.4, No.3 SHHH. . . . It's Going to be Quiet (Will anyone notice?) Lawrence I. Bonchek, M.D., F.A.C.S., F.A.C.C. Editor-in-Chief

Even regular readers of the Journal have often surprised me by pleading ignorance when I ask if they enjoy the audio CDs that have accompanied the Journal. When the Journal started in April 2006, it seemed to me that an audio CD would add a differentiating and appealing feature to the print content. Based on my experience as an interviewer for the audio journal of the American College of Cardiology, I conducted interviews for JLGH with members of our medical staff and hospital administration about hot medical topics or special aspects of Lancaster General Health. With her usual technical expertise, Gina simplified the task of recording and producing the CDs.

We soon learned that the idea wasn't as obvious as we thought it would be, and a distressingly large number of readers thought the CDs contained a digital copy of the print journal. (For all we know, some still do.) We set out to make it clear that these were audio CDs, and the reality seems to have gradually sunk in. Indeed, we have received occasional positive comments, especially as we accumulated several interviews with some of the senior members of our medical staff and administration who recalled the history of Lancaster General.

The fact remains, however, that though we are now in our fourth year of publication, those messages have been rare. We do not depend on flattery, of course, but the paucity of feedback (positive or negative) indicates that the CDs do not reach a wide enough audience to justify the considerable time, energy, and expense involved in conceiving, recording, editing, and producing them. We temporized in the last issue of the Journal by compiling a CD that contained a group of previous interviews about the history of Lancaster General. With the current issue, however, I have decided (this is emphatically my decision alone) that it is time to pull the plug on the audio journal.

We have enjoyed providing the CDs. To those of you who have been kind enough to express your compliments, Gina and I express our sincere thanks for your courtesy and thoughtfulness. I, in turn, want to publicly thank Gina for being indispensable in not only managing all the technology needed to produce the CDs, but for being personally committed to making them such an excellent product. Most of all, I want to thank all those who so generously gave of their time and insights to be interviewed. None of those interviews have been lost; they can all be listened to or downloaded as MP3 files from our website.

Henceforth we will redouble our efforts to keep you interested in the print Journal.

As for this issue, it is chock-full of interesting and unique material. I'm delighted to have an article from Alan S. Caniglia, PhD, who is Sr. Associate Dean of the Faculty, Vice Provost for Planning and Institutional Research, and Professor of Economics at Franklin and Marshall College. Dr. Caniglia has a particular interest in the demographics of F&M students both before and after matriculation, and after graduation as well. College students who apply for medical school these days are more likely that in the past to be non-science majors. I asked Dr. Caniglia to see how often these non-science majors were able to enter careers in the sciences, particularly the medical sciences. He did so with the perspective of an econometrician and the lucidity of a Professor. You will find his analysis fascinating, particularly if you are a parent who is wondering how your child (or grandchild) will end up.

Everyone knows that outcomes analysis is becoming increasingly common, and is being mandated in certain disciplines. Several states require public reporting of the results of cardiac surgery, and Pay for Performance is always in the news. The American College of Cardiology began a National Cardiovascular Data Registry in 1997, but they were already almost a decade behind the Society of Thoracic Surgeons which began its National Database in 1989. And they were both beaten off the mark by the cardiac surgery service at LGH, which has maintained a registry for all cardiac surgery since 1983. Whether or not you are personally participating in a database, it will be important to understand what databases are, and how they develop. Phyllis Wimer, RN, who has been the Database Coordinator at LGH since 1990, explains the origins and development of the National Database for Cardiac Surgery as a paradigm of how Databases develop.

In other featured articles, Dr. Jeffrey Eshleman describes the new process of tomographic radiotherapy and the equipment that has just become available at LGH; Dr. Attila Devenyi explains the dangers that threaten children who ingest small magnets, and he describes an illustrative case; and Dr. Matthew Beelan discusses the importance of cognitive reserve as a prognostic factor in Alzheimer's Disease.

In the section we devote to Perspective from the Administration, Michele Campbell, MSN, Vice President for Nursing at Women and Babies Hospital, describes the new model for nursing care called Relationship Based Care. For older physicians it will sound like a throwback to simpler times when nurses attended personally to patients. Younger physicians may find it new, but all will see it as sensible, and they will wonder why we ever deviated from this classical model of nursing care.

In briefer reports, Dr. Richard Thompson describes the new technique of radiotracer guided thoracoscopic biopsy of lung nodules; Paul Visneski advocates a common sense approach to evaluation of infertility; and – as always – Alan Peterson contributes a lucid and practical article. Since we have been making it a common practice to have an article that updates a clinical article that appeared previously, Alan has provided an update of several of his prior "Top Tips."

As we "serve" you these fine articles, I can only say what servers always say – Enjoy!