January 2020 Health Matters

The latest news on the health and wellness issues that matter most • January 2020 HealthMatters

Is Your HEART Skipping a Beat?

“The procedure can take from one to four hours and has a low complication rate

of less than two percent, even in older patients.” -DR. DINESH SHARMA

NCH Heart Institute Offers a Procedure to Fix That

Y ou may be stressed out, upset, have an existing heart condition or simply be resting comfortably in a chair. Suddenly, you feel lightheaded, your heart starts pounding, or you suddenly become aware of your own heartbeat, and its rhythm seems to be off. These are some of the signs and symptoms of premature ventricular contractions or PVCs. Although medication has traditionally been prescribed to control PVCs, it isn’t always a successful course of treatment for all patients. The good news for these and other PVC patients is that the NCH Heart Institute now offers a minimally invasive procedure called PVC ablation that boats a 90 percent success rate in restoring normal heart rhythms in all patients – even in elderly. According to NCH Electrophysiologist Dinesh Sharma, MD, PVCs occur when the heart’s lower chamber emits an extra beat or current, which is

out of sync with the beats or currents of the pace- setting upper chambers. “While many of us have some extra beats, they are usually of no concern,” explains Dr. Sharma. “But when a patient is symptomatic with PVCs, it is abnormal, and there is usually irritable tissue in either the right or left lower heart chamber.” “In some situations, the extra beats can cause passing out, heart failure or rarely cardiac arrest,” says Dr. Sharma, “but most commonly, it leads to symptoms like lightheadedness, fainting, shortness of breath, palpitations and skipped heartbeats.” These symptoms are most likely to worsen when these patients ingest caffeine or alcohol, or are under psychological stress, or become dehydrated. In some cases, there is no clear trigger for the occurrence of PVCs. To remedy this condition, Dr. Sharma, who was

specially trained in New York, performs a minimally invasive PVC ablation procedure, which destroys the tissue in the heart muscle that is causing the irregular contractions. Using ultrasound and mapping technology, a catheter is inserted into a vein in the groin and guided to the heart, where the cause of the PVCs is isolated and destroyed using radiofrequency energy. “We can cauterize or freeze the tissue, depending on the location, to cure the PVCs with low risk of damage to critical structures and tissue,” explains Dr. Sharma. “The procedure can take from one to four hours and has a low complication rate of less than two percent, even in older patients. PVC ablation therapy requires an overnight hospital stay, but patients may then resume normal activities. However, exercise is discouraged for one week, to allow the groin incision to heal properly.

PVC Triggers

• Fluttering • Dizziness, lightheadedness, fainting • Pounding or jumping feeling • Known heart problems like heart failure, heart disease • Skipped or missed beats • Increased awareness of your heartbeat PVC Symptoms

• Stress, anxiety • Medications such as

decongestants, antihistamines • Increased adrenaline caused by caffeine, tobacco • Alcohol use • Use of Illegal drugs

Risk Factors

• Caffeine, tobacco, alcohol, illicit drugs • Stress and anxiety

• Heart disease including congenital heart disease, coronary heart disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)

For more information, contact the NCH Heart Institute at (239) 624-4200 .

NCH Doctor Offers Relief from Tennis Elbow

All you did was lift the milk jug from the refrigerator. Suddenly, pain shoots from your elbow down your forearm to the wrist. And it happens regularly, like when you drink your morning coffee or type on a keyboard for long stretches of time. While you may not play tennis, NCH Physician Group internal medicine and sports medicine specialist Dr. Gregory Rubin knows what it takes to alleviate the pain of lateral epicondylitis, which is more

a year,” Dr. Rubin says. For those few patients who don’t find relief in non-surgical treatments, Dr. Rubin offers platelet-rich plasma (PRP) injections. Platelet-rich plasma therapy is a form of regenerative medicine that can amplify the natural growth factors the body uses to heal tissue. “The growth factor brings all of these good cells so the tendon can heal,” Dr. Rubin explains.

Symptoms of “tennis elbow”

The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to: • Shake hands or grip an object • Turn a doorknob • Hold a coffee cup Risk Factors • AGE. While tennis elbow affects people of all ages, it's most common in adults between the ages of 30 and 50. • OCCUPATION. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop

Dr. Gregory Rubin

commonly known as “tennis elbow.” “Despite its name, athletes aren't the only people who develop tennis elbow,” says Dr. Rubin. The pain of tennis elbow occurs primarily where the tendons of the forearmmuscles attach to a bony bump on the outside of your elbow. Pain can also spread into the forearm and wrist. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers. To begin with, Dr. Rubin recommends conservative treatments and suggests rest, ice, compression and elevation in the short term. When pain is not alleviated by these at-home treatment methods, physical therapy is often prescribed as the first non-surgical treatment option. A therapist can teach you exercises to gradually stretch and strengthen yourmuscles, especially themuscles of your forearm. Eccentric exercises, which involve lowering your wrist very slowly after raising it, are particularly helpful. A forearm strap or brace may reduce stress on the injured tissue. Topical steroids and corticosteroid injections are other non-surgical options. “Ninety percent of patients get better with conservativemeasures within

tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks. • CERTAIN SPORTS. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.

Dr Gregory Rubin performs these procedures in his office located at 1285 Creekside Blvd, Suite 102, Naples . Call the office at (239) 624-0310 to make an appointment.

Graston Technique - An Instrument-Based Type of Massage Therapy For Pain Relief and Improved Function

The Graston Technique is effective in treating the following: Ankle Pain / Achilles Tendinosis/itis Wrist Pain / Carpal Tunnel Syndrome Tennis elbow Golfer’s elbow

N CH physical therapists have a new technique – utilizing new tools – at their disposal when diagnosing and treating patients with overuse or post-operative conditions. The Graston Technique (GT) utilizes stainless-steel instruments to help patients recover faster and more completely, with shorter treatment times. The Graston Technique is an instrument-assisted soft tissue massage (IASTM) treatment technique that is producing excellent results, says Diane Carroll, MPT, OCS, one of five NCH physical therapists who have been trained in application of the technique. Healing often begins after the first treatment, she says. “We use different instruments to locate abnormal restrictions or muscle knots,” explains Carroll. “We then determine which instrument and which technique is best for each individual patient and body part. It is very tolerable and patients typically leave feeling better than they came in.” Matt Bleau, PT, DPT, ATC, explains that the Graston Technique is a form of manual therapy that uses 6 stainless steel instruments in combination with a specialized form of massage. The instruments have beveled edges and are used to scan and detect injured tissues as well as to provide treatment. Using deep tissue massage, scar tissue is broken down and connective tissue is realigned. The therapy produces micro-trauma to body tissues and this process causes temporary inflammation which is the body’s method of healing. GT benefits the injury by increasing the rate and amount of blood flow, initiating the healing process of the affected tissues. “By using the GT treatment, we are able to reduce patient pain, increase flexibility and improve muscle function,” adds Bleau. “After an initial assessment, an individualized treatment plan is formulated that is continually re-assessed,” explains Bleau. “Depending on the tissue and area treated, the depth of pressuremay change.” Most commonly treated are tendon or muscle restrictions. GT is effective for chronic or acute pain, post-operative or overuse conditions. Patients must be referred by their physician to NCH Outpatient rehabilitation locations. Four years ago, Dr. Richard de Asla, NCH physician leader for NCH’s Orthopedic Division, was the first to make a presentation about the benefits of GT to NCH therapists. “I saw great results for pain relief of Achilles tendinosis with GT at Massachusetts General Hospital,” says Dr. de Asla. “I am now collaborating on a physical therapy study about the results of GT on relieving pain, as compared to more traditional modalities.”

Rotator cuff tendinosis/itis Hip pain / tendinosis/itis Knee pain/patellofemoral dysfunction Heel pain / Plantar fasciitis Post-surgical scar tissue

Benefits of Graston Technique treatments: Alleviates pain Speeds rehabilitation recovery time Increases range of motion Improves muscle function and strength Decreases inflammation Reduces need for anti-inflammatory and pain medication

For more information, contact NCH Outpatient Rehabilitation Creekside at (239) 624-0380 .

NCH North Naples Hospital Expands Interventional Radiology Services

Patient benefiting from the latest state-of-the-art Siemens Artis Q technology.

N CH is proud to announce the expansion of its interventional radiology (IR) services to NCH North Naples Hospital campus, allowing better access to these important and cutting-edge diagnostic services to the North Naples, Bonita Springs and Estero communities. With this new equipment, outpatients can undergo every IR procedure, with the exception of stroke diagnoses and treatments, without having to travel to the NCH Downtown Baker Hospital. IR is a field of radiology that requires extensive specialized training. Interventional radiologists use imaging guidance to diagnose and treat conditions affecting just about every system in the human body – with minimal negative impacts on surrounding structures and tissues, leading to more precise treatments, less recovery time, and less risk of the complications that are inherent to open surgeries. Affected areas are generally accessed through veins and arteries located in the groin, wrist or upper arm. Using imaging technologies such as CT, ultrasound and fluoroscopy, interventional radiologists are able to view structures inside the body to treat complex medical conditions. “Patients of all ages benefit by shorter hospital stays and less recovery time with lowered complications,” explains Scott Peterson, MD, who serves as NCH Radiology Chairman. “Usually, procedures are performed through a minimal needle stick, which is afterwards covered with an adhesive bandage. Patients receive moderate sedation for their procedure, are recovered and discharged when stable – all on an outpatient basis.” The IR expansion effort brings the interventional radiologists (IRs) team to four and is supported by six interventional technologists and specially trained nursing staff. Interventional staff are available to work at either hospital campus and provide around-the-clock service to the community. Included in the expansion is the addition of a reading room and remodeled waiting and holding areas. One of the highlights of the renovation is the acquisition of the new, state-of-the-art Siemens Artis Q, which is a visionary breakthrough in X-ray generation and detection that

Dr. Scott Peterson reviews a Transjugular Intrahepatic Portosystemic Shunt or TIPS image along with Dee Myli, NCH Director of Radiology.

takes performance and precision to the next level. In addition, it provides low-dose fluoroscopy, which is beneficial for children and pregnant women. Because of the precision of this latest technology, NCH interventional radiology can now offer these procedures among many others at the NCH North Naples hospital: ■ Prostate arterial embolization, which helps to improve urinary tract symptoms for men with enlargement of the prostate gland. ■ New interventional oncology (IO) services which assist in the delivery of radiation and chemotherapy to cancer patients allowing for more targeted treatments without harming healthy tissues. ■ Treatment of tumors occurring in the lungs, liver, kidneys or bones, utilizing thermal ablation to heat or freeze cancerous cells, effectively killing the tumor and lessening the need for surgery, chemotherapy, or radiation.

To make an appointment with NCH Imaging contact Centralized Scheduling at (239) 624-4443 .

NCH enters the Neurosciences Field with the arrival of Dr. Edison Valle

Committed to patient care, excellent outcomes and the utilization of cutting-edge technology, NCH welcomes Edison Valle, MD, NCH Physician Group’s first staff neurosurgeon, who will allow NCH to offer a wider variety of neuroscience services. Before Dr. Valle’s arrival, Southwest Florida patients had to travel to Sarasota or the east coast for the treatment of certain disorders of the spine and brain. Now, they can be treated at NCH with minimally invasive procedures. Dr. Valle completed his neurosurgery residency at Tulane University, focusing on minimally invasive treatment of open and complex spinal disorders. His endovascular and open vascular fellowship was at

surgeries for recurrent strokes. “We use veins

taken from the arm or leg, or arteries from the scalp to connect a vessel outside of the head to the inside vasculature, increasing blood supply to the brain, and preventing the recurrence of strokes.” Minimally invasive endovascular procedures are accomplished through small incisions in the groin or wrist, which leaves little or no scarring. “Whereas previously we needed open surgery, with endovascular we can get access through arteries in the wrist or groin to treat brain disorders like aneurysms, vascular malformations, strokes and

" When deciding on the best care option, my philosophy is to put patients first,” says Dr. Valle, “treating them as if they were my own family always leads me to do what is right for my patients. "

headaches,” explains Dr. Valle. Dr. Valle is one of few Florida neurosurgeons that is certified to use new technology like the Woven Endobridge device (WEB) to treat brain aneurysms as an outpatient procedure. “The WEB has revolutionized the way we treat brain aneurysms, now we are doing less open brain surgery and treating very complex brain aneurysm patients as outpatients, it is just unbelievable!” explains Dr. Valle. See video at https://www.microvention. com/product/web-family

Thomas Jefferson University Hospital for Neurosciences. He then accepted a faculty position at the Ochsner Health Center in New Orleans, where he remained for three years before moving to Florida. Dr. Valle champions minimally invasive surgery because it is associated with less recovery time, less blood loss, a return to normal activities within a week and same-day discharge. “Patients get the benefits of open surgery without the complications,” explains Dr. Valle. Among the conditions Dr. Valle can treat with minimally invasive surgery are cervical spine, thoracic spine and lumbar spine disorders for patients with herniated discs, sciatica, spine tumors, spinal stenosis, neurogenic claudication and neurologic deficits from the spine. Dr. Valle also treats brain disorders including brain tumors, pituitary tumors or hormonal releasing tumors, aneurysms, vascular malformations, intracranial hemorrhage, hydrocephalus, chronic face pain, headaches and he is one of the few cerebrovascular surgeons that can perform cerebral bypass

Woven Endobridge Device (WEB) to treat brain aneurysms

Benefits of minimally invasive endovascular procedures: Small incisions (with either no or minimal scarring) Less blood loss Less recovery time Same day or next day discharge (outpatient) Minimizes risk of neurological injury and long hospital/ICU stay

Minimally invasive spine procedures used for: Herniated discs Sciatica Spine tumors Spinal stenosis Neurologic deficits from the spine Intractable back pain

For more information, contact the NCH Neuroscience Institute at 239-624-4670 .

LESS WAIT TIMES, COMPARABLE CARE found at NCH Freestanding Emergency Departments

A mile matters when it’s an emergency, but that’s less of a worry in our community. In addition to the emergency departments at both NCH Baker Downtown and North Naples hospitals, NCH operates two freestanding emergency departments (FSED), which are emergency centers not attached to a hospital. And just like hospital emergency departments, they are staffed with the same board-certified emergency physicians and specially trained emergency nurses who rotate between the main hospitals emergency departments and the FSEDs 24 hours a day, seven days a week. They can achieve hospital-level quality of care, even for the most serious, time-critical conditions, such as heart attack and stroke and are fully stocked with the latest in emergency service equipment. “We have the full gamut of resources. Each is equipped with a CT, MRI, ultrasound, all the resuscitation equipment and medications to treat any presentingemergency,” saysDr. ShawnPatterson, chair ofNCHEmergency Medicine. “We also have on-site laboratories, which allow the FSED locations to boast shorter wait times than other emergency departments. NCH Healthcare System Freestanding Emergency Departments are Open 24-Hours a Day, 7-Days aWeek and are located at: NCH Healthcare Northeast 15420 Collier Boulevard Naples, FL 34120 Tel: (239) 624-8700 NCH Healthcare Bonita

Our results come back more quickly because we are not competing with the rest of the hospital,” explains Dr. Patterson.

Patients remain within the FSED for less than 24 hours, at which point they are either discharged or transferred to a hospital via medical transport.

NCH offers two FSEDs, NCH Healthcare Northeast at the intersection of Immokalee Rd. and Collier Blvd and NCH Healthcare Bonita located two blocks South of Coconut Point on the west side of US-41. Both sites provide emergent care to those who live further away from the main hospitals, “we brought all of the emergency services you can get at the hospital emergency departments closer to the Bonita/Estero and Golden Gate/ Eastern Collier County,” says Dr. Patterson. Dr Patterson adds, “Remember, always call 911 in an emergency that may threaten life or limb. But, for most other circumstances, the freestanding EDs are standing by to help.”

24040 S. Tamiami Trail Bonita Springs, FL 34134 Tel: (239) 624-6900

From left, Betsy Novakovich, NCH Administrator of Emergency Services; Caitlin George, NCH Nurse Manager Northeast FSED; and Dr. Shawn Patterson.

Quinoa and Sweet Potato Chili


• 29-ounce can black beans, rinsed and drained • 32-ounce reduced sodium vegetable stock • 1 sweet potato, peeled and cut into bite-size chunks • 1 cup dry quinoa • salt and pepper to taste • avocado, cilantro for garnish (optional)

• 1 Tablespoon olive oil • 1 onion, chopped • 5 cloves garlic, minced • 1 Tablespoon chili powder • 1 Tablespoon cumin • 1 teaspoon oregano • 6-ounce can tomato paste

From the kitchen of: Blue Zones Project ®


Heat oil in a large, heavy soup pot over medium-low heat. Add onions, and cook them until they are soft and start to turn brown (about 10 minutes). Add the garlic and cook for about 2 minutes. Add the tomato paste, chili powder, cumin, and oregano and cook for about 2 minutes, stirring constantly. Add the beans, stock, and potatoes. Then, season with salt and pepper. Cook for about 5 minutes. Next, add the quinoa. Cooking for 15 - 30 minutes, stirring frequently, until quinoa and potatoes are cooked and the chili has thickened. Add a bit of water if it becomes too thick for your liking. Top with avocado and chopped cilantro.

Yields: Source: http://www.milkfreemom.com/vegan-quinoa-sweet-potato-chili/ Serves 6

Per Serving: 355 calories, 5 g fat, 695 mg sodium, 12 g fiber, 17 g protein

Copyright © 2013 Blue Zones, LLC and Healthways, Inc. All rights reserved.

NCH and the NCH Physician Group

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Academic Internal Medicine Clinic Charles Graeber, MD 

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Bryan Murphey, MD Robert Sadaty, MD Mark Speake, MD  Tracy Walsh, MD  David C. White, MD

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Allergy and Immunology Florina Neagu, MD 

Nephrology Shariq Ahmad, MD Neurosurgery Edison Valle, MD

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Cardiology David Axline, MD Michael S. Flynn, MD Adam J. Frank, MD Bruce A. Gelinas, MD

Orthopedic Surgery Christopher Adams, MD

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Herbert M. Bertram, MD Jon S. Dounchis, MD Howard J. Kapp, MD Gregory Rubin, DO Scott Thompson, MD Raisa Genao, APRN  Pain Medicine Magid Al-Kimawi, MD Palliative Care Elizabeth Brawner, MD Ryan Perdzock, MD Pediatrics Paul Shuster, MD Danielle Silva, MD Whitney Vedella, MD Tali Wojnowich, MD 2 Haroon Andar, DO

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Tracey Roth, MD

Gastroenterology & Hepatology Mazen Albeldawi, MD

Carlo Santos-Ocampo, MD Dinesh Sharma, MD David A. Stone, MD Hillary Tassin, MD Silvio C. Travalia, MD Shona Velamakanni, MD Caroline Shaw, PA-C Cardiovascular Surgeons Stephen D’Orazio, MD  Center for Breast Health Tran Ho, DO  Sharla Gayle Patterson, MD  Concierge Medicine Ruben Contreras, MD  Mark Goldstein, MD  Robert E. Hanson, MD  Robert Pascotto, MD  Brian Solomon, MD 

Maged Bakr, MD

Anna Juncadella, MD Rajeev Prabakaran, MD Kunal Suryawala, MD

Heather Paris, PA

Aubrey Fulton, APRN

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General Surgery Robert Bailey, MD 

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Wesley Dailey, MD

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David Lamon, MD Luigi Querusio, MD Infectious Disease Sergey Akimov, MD Gary A. Bergen, MD Vato Bochorishvili, MD  Mark A. Brown, MD Miguel Madariaga, MD Rebecca Witherell, MD  Internal Medicine Susan Best, DO Elisabeth Broderick, MD Louis Dusseault, MD Giuseppe Guaitoli, MD

Pulmonary, Critical Care & Sleep Medicine Brenda Juan, MD

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Douglas Harrington, DO

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Vinay Patel, MD Vishal Patel, DO Carl Ruthman, MD Gary Sporn, MD

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Endocrinology Victor Luna, MD Valeriu Neagu, MD

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Rheumatology Su Yien Zhaz Leon, MD Urology Marc Colton, MD Stacey Gazan, APRN

Janice King, APRN  Michelle Nowak, APRN  Family Medicine Andrew M. Bernstein, DO Christian O. Beskow, MD

Kim Hamilton, MD

Jeffrey Howland, MD 

Larry Kohn, MD David Linz, MD Pedro Martin, MD

Jerry G. Best, MD

Rasai Ernst, MD 

For an appointment with a physician, please call (239) 624-8106 Consult with a healthcare provider 24/7 from anywhere in Florida for only $45, visit NCHmd.org/VirtualCare to start your treatment.

NCH Baker Hospital Downtown NCH Downtown Naples Hospital: 624-5000 Academic Internal Medicine Clinic: 624-0940 Business/Occupational Health: 624-4630 Community Blood Center: 624-4120 Dr. John N. Briggs Wellness Center: 624-2750 Emergency Department: 624-2700 NCH Heart Institute: 624-4200 NCH Imaging: 624-4443 Outpatient Cardiac Rehabilitation: 624-1680 Outpatient Infusion Services: 624-4370 Outpatient Oncology Navigator: 624-4988 Outpatient Rehabilitation Center: 624-1600 Palliative Care Clinic: 624-8490 vonArx Diabetes & Nutrition Health Center: 624-3450 NCH North Naples Hospital Campus NCH North Naples Hospital: 624-5000 Emergency Department: 624-9199 Center For Breast Health: 624-8120 NCH Imaging: 624-4443 NCHWound Healing Center: 624-0630 Outpatient Pulmonary Rehabilitation: 624-6800 Pediatric Emergency Department: 624-5000 The BirthPlace: 642-6110 The Brookdale Center: 624-5722 NCH Marco Island Campus Marco Urgent Care Center: 624-8540 Outpatient Cardiac Rehabilitation: 624-8590 Outpatient Pulmonary Rehabilitation: 624-8595 Outpatient Rehabilitation Center: 624-8580 NCH Healthcare Bonita Emergency Department: 624-6900 NCH Imaging: 624-4443 NCH Healthcare Northeast Emergency Department: 624-8700 Outpatient Rehabilitation Center: 624-8790 NCH Imaging: 624-4443 NCH Healthcare Southeast NCH Immediate Care: 624-8220 NCH Sleep Center: 624-8220 Outpatient Rehabilitation Center: 624-1900 NCH Imaging: 624-4443 NCH Imaging: 624-4443 NCHWound Healing Center: 624-0650 NCH Central Campus: 513-7144 White Elephant Thrift Store: 624-6690 Outpatient Rehabilitation Center: 624-6820 WhitakerWellness Center: 624-6870




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Outpatient Rehabilitation Center: 624-0970

NCHWound Healing Center: 642-0900 Bonita Community Health Center

NCH Immediate Care: 624-8220

NCH I magin g: 624-4443

Marco Island

NCHWound Healing Center: 642-0630 Outpatient Rehabilitation Center: 624-0380 NCHHeart Institute: 624-1000 Outpatient Cardiac Rehabilitation: 624-1080 NCH Immediate Care: 624-1050


For information on any of the NCH Healthcare System services, please call 624-1999 or visit us online at www.NCHmd.org The NCH Health Matters is a bi-monthly publication of the NCH Healthcare System. Every effort is made to ensure information published is accurate and current. NCH cannot be held responsible for any consequences resulting from omissions or errors. NCH Healthcare System, 350 7th Street North, Naples, FL 34102, Telephone: (239) 624-5000, www.nchmd.org

Quality. Defined.

But don’t just take our word for it...


4 Star Rated for Safety & Quality

NCHhas always beenand continues tobea leader in Floridaand in thenation for quality healthcare. Three of the largest independent healthcare quality reporting agencies and the U.S. government all agree. For accurate and complete information on the quality services of the NCH Downtown Baker Hospital & NCH North Naples Hospital, please visit the agencies shown above at: • QualityCheck.org • Health.USnews.com/best-hospitals • Healthgrades.com/find-a-hospital • Medicare.gov/hospitalcompare


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