Gifford Hospitalist, Lab Manager
Published in National Journal

Skim the index of contributors to the February 4 edition of the prestigious American Journal of Cardiology and listed among some of the largest teaching institutes in the country is the 25-bed Gifford Medical Center in Randolph.

Putting Gifford and Randolph on the map of medical expertise are Gifford hospitalist Dr. Martin Johns and laboratory manager Carol Stephenson, who were published in the journal used by cardiovascular disease specialists and internists throughout the world. The pair researched and wrote about amino-terminal pro-B-type natriuretic peptide (NT-proBNP) testing in neonatal and pediatric patients.

More simply put, Dr. Johns and Stephenson followed up on a 2004 consensus statement on an active hormone in the body known as BNP. BNP balances fluid in the body and, through a blood test, can be a measurement of one’s "cardiac status," Dr. Johns explains. More recently, however, hospitals, including Gifford have been using NT-proBNP, a byproduct of BNP and a more reliable measurement, to diagnose or exclude heart failure in patients. Gifford alone did 862 of these blood tests last year.

Dr. Johns and Stephenson specifically looked at this lab test for pediatric patients, summarized all the information in the literature on pediatric NT-proBNP, and from that research provided guidelines that health-care providers should use in evaluating pediatric patients’ heart conditions.

"It’s difficult to measure pediatric patients," says Dr. Johns, noting, for example, a child’s shortness of breath could be a problem with the lungs or the heart, "so this test gives you an objective measure of a pediatric patient’s cardiac condition."

Dr. Markus Meyer, a Fletcher Allen Health Care cardiologist who also works at Gifford, called Dr. Johns and Stephenson’s work an "excellent review of this clinically important topic," and adds, "This article will be an important reference for clinicians around the world."

Dr. Johns was approached last August by Dr. James Januzzi Jr., an associate professor at Harvard and director of the cardiac intensive care unit at Massachusetts General Hospital, to write the piece. Dr. Johns was sought out for his expertise in neonatal heart hormones. Prior to joining Gifford in 2006 as the medical center’s first hospitalist, he was a resident at the large Geisinger Medical Center in Pennsylvania, where he did research and went on to lecture on neonatal heart hormones, which when present in high levels indicate abnormal stress on the heart. Dr. Januzzi had heard Dr. Johns speak, and singled him out for this project.

With only several weeks to complete their piece, however, Dr. Johns and Stephenson had a lot of work before them and spent their vacations researching and writing to meet a late September deadline. They summarized 68 articles on the topic and ended with a multi-page piece complete with tables and graphs.

"This is now a national guideline that assists providers in using natriuretic peptides, specifically the newest measurable peptide called NT-proBNP, in diagnosing and managing patients with cardiologic disorders," Dr. Johns concluded.

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