Arkansas Heart Hospital as Chief Operating Officer (COO) ... foundation for the vision of CARTI becom- ...... and spine,
+($/7+&$5(-2851$/ JULY / AUGUST 2018 I healthcarejournallr.com I $8
of
Little Rock
Carti: Vision Casting A closer Look at Medicare Part B Q&A with Bo Ryall CEO, Arkansas Hospital Association
Delivering!
it’s our speciality
+ /5
July / August 2018
Our Mission
Healthcare Journal of Little Rock analyzes healthcare for the purpose of optimizing the health of our citizens. Chief Editor
Smith W. Hartley
[email protected] Contributing Editors
Karen Tatum
[email protected]
Laura Fereday
[email protected] Web editor
Betty Backstrom
[email protected] contributors
Charles Ornstein Ryann Grochowski Jones correspondents
Martin Eisele, LAc William Golden, MD David Lukas Nathaniel Smith, MD, MPH Mark R. Story, MD Joseph W. Thompson, MD, MPH Wendy Thompson sponsorship director
Dianne Hartley
[email protected] ART DIRECTOR
Cheri Bowling
[email protected] photogr apher
HJLR
Zoie Clift
eNews
Subscribe today.
[email protected]
Copyright© 2018 Healthcare Journal of Little Rock The information contained within has been obtained by Healthcare Journal of Little Rock from sources believed to be reliable. However, because of the possibility of human or mechanical error, Healthcare Journal of Little Rock does not guarantee the accuracy or completeness of any information and is not responsible for any errors or omissions or for the results obtained from use of such information. The editor reserves the right to censor, revise, edit, reject or cancel any materials not meeting the standards of Healthcare Journal of Little Rock.
visit us online Read the Journal / Get eNews Updates Subscribe / Learn about sponsorship Healthcare Journal of Little Rock Sponsors Arkansas UROLOGY www.ArkansasUrology.com CARTI www.CARTI.com Evergreen Acupuncture www.EvergreenHealth.net lammico www.lammico.com Orthoarkansas www.OrthoArkansas.com David lukas Financial www.DavidLukasFinancial.com state volunteer mutual insurance www.svmic.com The BridgeWay www.TheBridgeWay.com The Doctors Company www.TheDoctors.com
ON the Cover: Pictured, L-R: Dr. Xiang Gao, Radiation Oncology; Dr. Balan Nair, Medical Director and Medical Oncology; Dr. Diane Wilder, Medical Oncology; and Dr. Mariann Harrington, Medical Oncology; and Dr. Theodore Hronas, Diagnostic Radiology
Smart, In-depth, Award-winning Healthcare News at your fingertips. Each issue of Healthcare Journal of Little Rock provides important articles, features, and
Subscribe To subscribe to the Little Rock Healthcare Journal and receive weekly eNews, please email us at
[email protected].
Advertising
[email protected]
Feedback
[email protected] We would love to hear from you.
information for healthcare professionals. Access current and past issues online at:
HealthcareJournalLR.com
Contents + /5
July / August 2018 I Vol. 5, No. 5
fe atures CARTI: Vision Casting...... 10 A Closer Look at Medicare Part B ................14 Q&A with Bo Ryall, MD...................................... 18 CEO, Arkansas Hospital Association
18
10
Depart m ent s Editor’s Desk.............................................................8 Healthcare Briefs............................................... 25 Hospital Rounds................................................. 55 Book Review......................................................... 65 Ad Index................................................................... 66
Co rr es po nd ent s Policy.......................................................................... 40 Director’s Desk.................................................... 42 Mental Health....................................................... 44
14
Medicaid................................................................... 46 Acupuncture.......................................................... 48 Wealth Management....................................... 50 Oncology................................................................. 52
Editor’s Desk
Slow down everyone. You’re moving too fast. Frames can’t catch you when you’re moving like that. -Jack Johnson, Inaudible Melodies
Sometimes moving too fast is fun. It’s a rush. People enjoy it. It can be like riding way too fast on a motorcycle on the open road—a Being aware of your body’s rate of movement will go a long way to improve your grace and health. There is a speed to life. It’s cultural. High speed offers many attractions— more accomplishments, avoidance of the quiet, strategic confusion, strategic focus. Speed of life, like wind and fire, offers gifts or trouble, depending on the use. The subtle movements of the body perform in conjunction with the fluctuations of the mind. There is a speed of health. Ever play a musical instrument? One of the worst things you can do is try to play too fast—before you’re ready. Few people are actual musical geniuses. All the time we see people moving fast, driving fast, talking fast. Some are ready for it. Some move at that pace. But most people are moving too fast. You can see it all around. Faster is slower and messier, if moving outside the natural rhythm. The world is often like a slick salesman. It delivers news, information, and self-righteous ideas so fast that we don’t take a moment to realize the ridiculousness of it all. It often delivers a message of pressure to move from a life of wellness to battle an unnecessary cause, and to feel unnecessary pain. The motives, while delivered righteously, are questionable. Anything to take your attention from a point of wellness must be considered carefully. Despite the world culture, and messages of more and faster, we can train ourselves to control our pace. Watch people
somewhat controlled exhilaration with inherent risks. Testing the boundaries of life is often a pleasure. When it’s a conscious decision, the rush is a healthy choice. For some it’s an opportunity to feel success, and to feel alive. What is success, if it’s not peace of mind? Tai Chi is an example of a practice which helps with the control of movements and fluctuations of the mind. Play with bringing the physical movements down a few octaves to observe and find a more ideal, or alternative pace for the mind through the movements of the body. It’s another form of calming the mind by first calming the body. Of course, it’s all connected. It’s certainly worthy of consideration. There’s so much to do, and so much see. The experiences of life are meant to be enjoyed. The experiences are meant to be lighthearted, and appreciated for their uniqueness, and appreciated for the pleasures of being ordinary. As we ride through it all, doing what we should do, at the speed of health, sharing life with the like-hearted, we support our own well-being. That’s the best we can do. When speaking with patients, we have an opportunity to notice their speed of life. We notice their pace and their relationship to their own pace. It may be an opportunity to recommend a practice of meditation, or play, which encourages a speed of well-being. It’s not just about going slower. For some, it may be about going faster. It’s about finding the speed that feels right. Only the individual will know the best speed of life. But, mindfulness of speed of life is usually an unconsidered concept in the flow. Just presenting the idea of speed of health may be sufficient for improving health. It’s best to be a living example.
rushing around. Watch people moving too fast. Watch people pretending to get more done than they really are. Know that many may have a burden in their mind, as evidenced by the body. It’s interesting to see. We hope it’s temporary. We’ve all struggled with an overly ambitious schedule, with selfimposed rankings of high priorities. I often wonder what we’re accomplishing, or hiding from, or selling, and wonder about the sanity of it all.
8 JUL / AUG 2018 I Healthcare Journal of Little rock
Smith Hartley Chief Editor
[email protected]
Q&A with
Adam Head
CEO, CARTI Cancer Center Adam Head grew up in North Little Rock, Arkansas. Upon graduation from the University of Arkansas with a degree in Business Administration, he was commissioned as an officer in the United States Army’s Medical Service
Balan Nair, MD
CMD, CARTI Cancer Center
Corps through the University’s ROTC program. After serving in various leadership capacities in the U.S. and overseas, he left the Army as a Captain and moved back home to become Assistant Administrator of Arkansas Heart Hospital. In early 2011, Adam received his Master’s degree in Business Administration from Capella University and left Arkansas Heart Hospital to become Chief Operating Officer (COO) and site Administrator of HealthSouth Lake-
Balan Nair, MD has been practicing as a medical oncol-
shore Rehabilitation Hospital in Birmingham, Alabama.
ogist in Arkansas for 20 years. He joined CARTI, Arkansas’s
After serving in that role for two years, he returned to
largest private, not-for-profit full service cancer center in
Arkansas Heart Hospital as Chief Operating Officer (COO)
2011 and was named Chief Medical Director in 2017.
and served in that role until August 2017. In September,
Nair sees patients in Little Rock and in clinics in El Dorado
he began in his current capacity as President and CEO of
and Heber Springs. He is a graduate of Grant Medical
CARTI. He is a fellow of the American College of Health-
College, University of Bombay, where he also was in resi-
care Executives (ACHE) and in 2015 received the ACHE
dency training in Pathology. Nair did his fellowship train-
Arkansas Chapter Young Administrator of the Year award.
ing at Yale University in New Haven, Connecticut, and
Adam is a student of leadership theory, team develop-
at the H. Lee Moffitt Cancer Center in Tampa, Florida.
ment and organizational system improvement.
Healthcare Journal of little rock I JUL / AUG 2018 11
dialogue
Chief Editor Smith W. Hartley How does
CARTI uniquely approach cancer care in Arkansas? CARTI CARTI delivers the highest quality
comprehensive cancer care, offering cutting edge radiation therapy, medical and surgical oncology, interventional oncology, and diagnostic radiology, along with many other services. The reach, delivery, and quality of this cancer care are unparalleled, and we bring that care to 11 cities throughout the state. Editor Can you shed some light on the
financial challenges CARTI has been facing? What can be done to improve the reimbursement/revenue side? How important is the foundation to CARTI’s financial success and overall mission? CARTI For the first 35 years of CARTI’s
proud 42-year history, financial performance was narrowly focused in the cancer sub specialty of radiation oncology. In 2011 and 2012, CARTI made the strategic decision to pull more components of the cancer care experience—and therefore more physician practices—under one umbrella. This led to the construction of the CARTI Cancer Center, which opened in late 2015. In the midst of this period of massive upscaling, many financial challenges became apparent due to the complex nature of a multi-faceted consolidation, and especially in light of a
occurrence and mortality, there is an incred-
unleashing of the patient’s immune system
$50 million bond issuance to support the
ible opportunity to use state-of-the-art
to attack the tumor with immunotherapeu-
construction of the Cancer Center.
technology, research in the latest drug ther-
tic agents, and the development of newer
Over the last nine months, CARTI has
apies, new screening techniques, and yes,
non-chemotherapy biologic agents that act
undergone a process of cultural refor-
preventative educational tools to change
by novel mechanisms of action. There have
mation, financial stabilization, and vision
this trend. Our entire team is focused on
also been impressive advances in imaging
casting. Revenue is up, new patients are
aggressively meeting this challenge, while
of tumors and in radiation and proton beam
up, and bottom-line performance has radi-
compassionately treating the patients we
therapy.
cally changed. This has all provided a strong
serve.
foundation for the vision of CARTI becoming the cancer treatment destination.
Editor Is cancer a curable disease? Editor What is new and interesting in the
field of cancer care? prevention of cancer?
CARTI It is already curable in certain tumor
types and certain stages, but for the major-
Editor Is CARTI doing anything towards the CARTI A number of fascinating trends in
ity of patients with advanced cancer, newer
oncology are beginning to revolutionize
developments hold the promise of convert-
CARTI In a state that consistently ranks
cancer care—the use of genomics of the
ing cancer care to a chronic disease model
in the top five in the nation for cancer
tumor to inform treatment decisions, the
in the future.
12 JUL / AUG 2018 I Healthcare Journal of Little Rock
Editor What are some expansions or merg-
ers CARTI is working on? CARTI As mentioned, CARTI’s vision is to
be the cancer treatment destination. To be that destination, we are absolutely focused on scaling our services and offerings up in pursuit of that vision. More to come. Editor How does CARTI take a holistic
approach to each patient’s care? CARTI At CARTI, we understand a diagnosis
of cancer presents a challenge to the physical, mental, emotional, and financial wellbeing of an individual. Our outstanding physicians, nurses, technologists, counselors, social workers, nutritionists, and research personnel are well equipped to help our patients meet these challenges. Editor How specifically does CARTI handle
and measure quality as an organization? CARTI Continuous quality improvement
is a huge focus at CARTI, and this is measured in medical oncology, surgical oncology, imaging, and radiation therapy. We are a part of a number of initiatives that seek to measure and deliver higher quality care so that we can be the best value proposition Pictured, L-R: Dr. Mariann Harrington, Medical Oncology; Dr. Balan Nair, Medical Director and Medical Oncology; Dr. Diane Wilder, Medical Oncology; Dr. Theodore Hronas, Diagnostic Radiology; and Dr. Xiang Gao, Radiation Oncology
for our patients and our payers. Editor What are some other things CARTI
is currently working on?
“We are working on a number of outreach initiatives, delivery of novel therapeutics, and therapies that have never been delivered in Arkansas before.”
CARTI We are working on a number of
outreach initiatives, delivery of novel therapeutics, and therapies that have never been delivered in Arkansas before. Editor What does the future of cancer care
look like in the state of Arkansas? CARTI The future of cancer care in Arkan-
sas is bright and promising. New scientific advances, the local delivery of comprehensive cancer care, and Arkansans never-giveup attitude promises increasing success in the fight against cancer. n
Healthcare Journal of little rock I JUL / AUG 2018 13
Examining Medicare
Some Doctors Still Billing Medicare for the Most Complicated, Expensive Office Visits A Closer Look at Medicare Part B By Charles Ornstein and Ryann Grochowski Jones Propublica
T
housands of times a year, Medicare patients file into Dr. Mark Roberts’ family practice clinic in rural Evergreen, Alabama, for standard office visits. And almost every time they did in 2015, Roberts billed Medicare for the most complex, and most expensive, type of office visit — one that typically takes 40 minutes and for which Medicare reimbursed him an average of $94. He billed for 4,765 such high-level visits that year, according to federal data, more than any other doctor in the country. And for that, he collected nearly $450,000 from Medicare.
14 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK
Examining Medicare
and inspections for the U.S. Department of Health and Human Services in Atlanta. Grant’s team produced reports in 2012 and 2014 that said Medicare needed to do more to address improper billing. “We continue to believe that focusing on these high-coding physicians is going to improve oversight, reduce overpayments and really serve as a deterrent effect,” he said. Among the 1,825 physicians who billed most often for complex office visits was Dr. Jose Prieto, an internist in Hialeah, Florida. He billed for 721 office visits in 2015, all of them at the highest level, Medicare data show. Medicare revoked Prieto’s ability to participate in the program in December 2016 for falsified information, according to data provided under the Freedom of Information Act. Prieto did not respond to a phone call and email seeking comment. A woman who Roberts’ billing pattern was highly
billed Medicare for the most expensive
returned a call placed to his office said Pri-
unusual compared to his peers. All told,
type of office visits for established patients
eto is an infectious disease doctor who treats
family medicine doctors in Alabama billed
at least 90 percent of the time in 2015. That
patients with HIV and routinely spends 45
for such visits only 5 percent of the time.
was almost the same as the 1,807 that we
minutes with each patient. The woman dis-
Roberts did so 95 percent of the time. Even
found based on 2012 data. Some physicians
puted that Prieto exclusively bills for the
some doctors who had sicker patients billed
that were billing Medicare this way in 2012
highest level office visits, as Medicare data
for top-level visits less often, Medicare data
still were in 2015, we found.
shows. “He bills for the time he spends with
show. Several messages left at Roberts’ office were not returned.
Office visits are a staple of medicine.
his patients,” she said.
In 2016, Medicare paid for more than 227
Another is Dr. James Beale, an orthopedic
For years, internal government watch-
million of them at a cost of $13.2 billion
surgeon in Warren, Michigan. All 1,150 of his
dogs have been warning the federal Medi-
(including Medicare outlays and patient
Medicare office visits were billed at the high-
care program that some doctors were over-
copayments). They are far from the most
est level in 2015. Beale has been disciplined
charging for office visits. And for years,
expensive services that Medicare provides,
three times by Michigan’s medical board,
federal health officials have been promis-
but they are ubiquitous.
most recently in May 2016 when he was sus-
While it’s possible that some physicians
pended for failing to respond to a 2015 board
But a new ProPublica analysis shows very
only treat the sickest patients who require
complaint that he prescribed controlled sub-
little has changed since we first wrote about
the highest level office visits, “I don’t think
stances for patients without adequate justi-
the issue in 2014. ProPublica found that 1,825
it’s very probable,” said Dwayne Grant,
fication. Beale also extensively billed Medi-
health professionals, including Roberts,
regional inspector general for evaluation
care for psychotherapy services in 2015. He
ing to focus on the problem.
90%
16 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK
“ProPublica found that 1,825 health professionals billed Medicare for the most expensive type of office visits for established patients at least 90 percent of the time in 2015.”
could not be reached for comment. Also, on the list is Dr. Rand Ritchie, a Pismo Beach, California psychiatrist. He
The coding system developed by the Ameri-
meaning to bill at a higher level than justi-
can Medical Association gives doctors five
fied, Weston said. If doctors copy and paste
options.
phrases about a patient’s condition and
billed 1,475 visits at the highest level, or 97
An uncomplicated visit, typically of short
their electronic medical record automati-
percent of his Medicare office visits, in 2015.
duration and which may not require a physi-
cally decides how to bill for the visit, “that
The California medical board has disciplined
cian, is coded a 1; a visit that involves more
is worrisome.”
Ritchie twice for alcohol abuse and multiple
intense examination and often consumes
convictions for driving under the influence
more time is coded a 5. The most common
of alcohol. He completed probation most
codes for visits are in the middle, 3 and 4.
recently in 2014 and currently has an unrestricted license.
How We Did This Analysis
For this story, ProPublica analyzed pro-
Most health professionals had a tiny per-
vider billing patterns for standard office
centage, if any, visits billed at level 5, but
visits in Medicare. We focused on those for
Ritchie’s office manager, Darryl Schum-
more than 1,250 billed only at the highest
established patients who had been seen at
acher, who handles billing for the practice,
level in 2015, ProPublica found. Another 570
least one time by the provider previously.
said Ritchie had started accepting Medicare
billed that way more than 90 percent of the
These are among the most common services
around 2015 because no other psychiatrists
time. That was very similar to what we found
performed in the program.
in private practice in the area did so. “He was
three years earlier.
We used data released by the Centers
taking on many new patients and the com-
Cyndee Weston, executive director of
for Medicare and Medicaid Services show-
plexity of some of these patients, because
the American Medical Billing Association,
ing the services provided by and payments
they had either gone without treatment for
an industry trade group, said such num-
made to providers in Medicare’s Part B pro-
many years or had gone without a psychi-
bers raise red flags. “It’s not likely that every
gram in 2015. Medicare redacted data on ser-
atrist, was pretty difficult at the beginning,”
patient that comes to a doctor’s office is a
vices when a provider billed for a service for
Schumacher said.
level 5,” she said.
fewer than 11 patients.
Schumacher also said that no one from
The doctors who billed at the top level in
More than 490,000 providers billed the
Medicare had contacted the practice to ask
2015 were not all the same as those who did
program for standard office visits for at least
about Ritchie’s numbers and that questions
so in 2012. Of the 1,825, 650 were on the list
11 patients in 2015.
from ProPublica were the first indication
in both years. Another 536 billed for a lesser
Office visits are coded using the Current
that his billing pattern was unlike that of
share of visits at the highest level in 2012.
Procedural Terminology system devised
his peers. As for his discipline, Schumacher
And the remaining health providers did not
by the American Medical Association and
said Ritchie fulfilled the requirements of his
bill Medicare in 2012 for office visits involv-
used by Medicare. The severity of each visit
probation and is once again board certified
ing at least 11 patients.
depends on three criteria: the thoroughness
in psychiatry.
For some doctors, the shift was jarring.
of the review of a patient’s medical history,
Asked for comment, a spokeswoman for
In 2012, Roberts, the Evergreen, Alabama,
the comprehensiveness of the physical exam
the Centers for Medicare and Medicaid Ser-
family doctor, never billed for high-level
and the complexity of medical decision-
vices said the agency is exploring how to
office visits. He billed Medicare 4,681 times
making involved.
make changes to its billing rules for office
for level 3 visits, for which Medicare paid
An uncomplicated visit, typically of short
visits to reduce the burden on doctors and
him an average of $43.57, less than half as
duration, should be coded a 99211; a visit
better reflect the way medicine is practiced
much as he received per visit in 2015.
that involves more intense examination and
and care is coordinated.
In Oak Harbor, Washington, doctors Rob-
often consumes more time should be coded
In a notice in the Federal Register in
ert Lycksell and Zayan Kanjo also didn’t bill
a 99215. The most common codes for visits
November, CMS said the guidelines govern-
for level 5 visits in 2012. Lycksell billed for
are in the middle, a 99213 or 99214.
ing how health professionals bill for office
1,948 level 5 visits in 2015 and Kanjo 1,297 in
To protect against variation hidden
visits, more formally called Evaluation and
2015. The doctors did not return phone calls
by redactions, we focused on the nearly
Management visits, date to 1995 and 1997.
seeking comment.
364,000 providers who billed for at least
CMS said the process for updating them
Weston said it’s disappointing that the
100 standard visits in 2015.
same problems identified years ago appear
We identified more than 1,250 providers
As it stands now, doctors and their staffs
to remain today. Some of what’s happen-
who billed for every office visit using the
decide how to bill for a patient visit based on
ing, she said, is related to electronic medi-
99215 code. We found another 570 provid-
a host of factors, including how thoroughly
cal record systems that assign billing codes
ers who billed level 5 visits at least 90 per-
they review a patient’s medical history, the
based on the computer boxes doctors click
cent of the time. n
intensity of the physical exam and how com-
during office visits.
could take several years.
plicated the medical decision-making was.
“Those programs tend to upcode,” Healthcare Journal of LITTLE ROCK I JUL / AUG 2018 17
dialogue
18 JUL / AUG 2018 I Healthcare Journal of Little Rock
A Q&A with
Bo Ryall
CEO, Arkansas Hospital Association
Bo Ryall is president and CEO of the Arkansas Hospital Association. He has been with the Association since 2005, and was named president in 2010. He holds a bachelor’s degree from the University of Arkansas at Fayetteville, and a master’s degree in public administration from the University of Arkansas at Little Rock. Bo also served as the chief lobbyist on the state level for Arkansas hospitals, and was previously executive director of the HomeCare Association of Arkansas. He currently serves as the chairman of the Health Care Providers Forum, is a member of the Health Care Industry Council of the Federal Reserve Bank of St. Louis, is an Arkansas Regional Organ Recovery Agency board member, and is a past-president of the Arkansas Society of Association Executives.
dialogue
Chief Editor Smith W. Hartley What is the
opinion of current payment models for hospitals? What would the Arkansas Hospital Association like to see differently in payment models? Bo Ryall The Arkansas Hospital Association
certainly recognizes that change is occurring, and it is occurring rapidly. Hospitals are attempting to survive in the current payment models, while preparing their systems for the new payment models. It proves the old saying, “one foot in the canoe and one on the dock”. We all talk about how feefor-service is an outdated system of payment, and that health care should be reimbursed on a value-based payment system. We believe this payment methodology shift is occurring, but all payers are testing it in a number of different forms. Medicare is testing Accountable Care Organization (ACO) models, and we have found that those throughout the nation require a significant capital investment, all the while knowing that any positive returns on those investments will take at least five years. This experiment may be attempted by a large health care system with the financial capabilities to absorb initial losses, but our state has many small rural hospitals that cannot afford the investment. Worse, if those small rural hospitals convert to a new payment system that reduces reimbursement significantly, it puts them in real jeopardy of no longer remaining viable. Medicaid is testing its Provider-led Arkansas Shared Savings Entity (PASSE) for developmentally disabled and behavioral health populations. This model is untested,
“Hospitals are attempting to survive in the current payment models, while preparing their systems for the new payment models. ”
and there are a lot of unknowns about the payments and the management of care that will ultimately be provided by four new
insurance through Arkansas Works and
that cause them to lose coverage in another
insurance company partnerships.
the subsidized plans on the health insurance
month.
Commercial insurance companies have
marketplace, which is extremely important
All of this is to say that while hospitals
experimented with episodes of care, and
to and appreciated by hospitals. Even with
are ready to be a part of changing reim-
are now outlining plans for their version
the improvements of reduced uncompen-
bursement methodologies, the entire health
of value-based payments, which has the
sated care because of Arkansas Works,
care system would benefit more if entities
potential to reduce reimbursement for
hospitals must still prepare for individuals
who reimburse hospitals and other health
all types of providers—not just hospitals.
who have insurance in a particular month,
care providers for patient care would get
Commercial insurance companies have
but do not keep up with the administrative
together on the most efficient and respon-
also assisted with the uninsured gaining
reporting requirements or other mandates
sible payment model, and have consistent
20 JUL / AUG 2018 I Healthcare Journal of Little Rock
rules. The complexity of multiple payers, and a multitude of rules that predicate which hoops hospitals must jump through for adequate reimbursement, actually drives up the costs of care to hospitals and, ultimately, our patients.
“The entire health care system must do a better job of sharing patient information across computer systems, while maintaining appropriate patient privacy.”
Editor What are some ways hospitals can
leverage technology for better performance and coordination? Ryall Health care entities began buying
computer software to get away from the large amount of paper files and become more efficient. Some of those information technology systems worked adequately, and some did not work at all. All of them were expensive. They also came with an expectation that if hospitals were able to gather
Editor With so much effort towards cost
patients. The more uninsured and underin-
and maintain electronic health records, that
controls, how can hospitals continue to
sured people we have accessing emergency
those perceived data warehouses could
improve quality and patient safety?
care, the more pressure is placed on the
share information with anyone at any time.
other payers and the hospital to cover the
The reality is, of course, that all of these
Ryall Hospitals continue to invest in quality
costs of the uninsured. Because hospitals
computer systems are different, and they
and patient safety because, ultimately, that
are federally required to provide services to
do not easily communicate with one other.
is what drives better care for the patient,
all individuals, regardless of their ability to
We often hear the frustration of patients
produces efficiencies in care, and gives
pay, hospitals have a business model that is
who must complete multiple new forms at
the patient the best opportunity for better
not sustainable if large numbers of patients
every health care provider visit. The ques-
health outcomes. In addition, the cost of
have no source of payment.
tion is always, “Why can’t the doctors, the
any type of medical error to an organiza-
The ACA made health care as political as it
hospitals, the pharmacists, and the insurers
tion often outweighs the cost of implement-
has ever been. We hope to get away from the
all share patient information so I don’t have
ing a safe system. An easy example of this is
politicization of health care, and move into
to tell each one my entire medical history
the investment in lift equipment designed to
true problem-solving mode. Hospitals are
at every visit?” The entire health care sys-
prevent patient falls and employee injuries.
the backbone of the health care system, but
tem must do a better job of sharing patient
Averting the costs of the injury justifies the
we cannot improve health outcomes alone.
information across computer systems, while
purchase of the equipment.
It takes all health care providers and pay-
maintaining appropriate patient privacy.
ors working together; it takes appropriate
For hospitals, you can’t mention gains
Editor What would the Arkansas Hospital
patient engagement and involvement. Part
in technology without the excitement sur-
Association like to see regarding the unin-
of that has to be keeping people insured,
rounding the continued development of
sured and underinsured populations?
and assuring that insurance products for
telehealth as a tool to care for patient needs.
our most vulnerable Arkansans are afford-
We have seen major advancements in recent
Ryall With the passage of the Patient Pro-
able, and appropriately reimbursing health
years, and we need to continue improving
tection and Affordable Care Act (PPACA),
care providers.
the use of telehealth capabilities, and to pay
and the implementation of Arkansas Works,
fairly for those services. In rural states like
Arkansas saw one of the largest reductions
Editor Can you describe specific workforce
Arkansas, many people live in areas with
in uninsured people in the nation over a
issues facing hospitals?
limited access to hospital care. Hopefully,
one-year period. Since then, our state has
greater access increases efficiency, and over
seen the uninsured numbers creep up, all
Ryall Hospitals are competing for doctors,
time, creates better health outcomes for
while more insurance products offer high
nurses, and all types of therapists. There
patients, which can add to reduced health
deductible plans ($5,000 deductible or
are just not enough in the market to fill all
care costs.
more), which translates to underinsured
of the open positions throughout the state.
Healthcare Journal of Little Rock I JUL / AUG 2018 21
Google Maps/Google Earth
dialogue
“There will always be a need for hospitals, but hospitals have long since realized the shift from inpatient care to delivering services in an outpatient setting.”
Specifically, there are many opportunities
their communities tomorrow. AHA not only
Ryall Arkansas hospitals, which are primar-
for nurses in the health care field. We are
contributes to our mission with advocacy
ily small, rural, and independent, are very
not only competing with other hospitals, but
efforts, we also offer broad support with
similar to their sister facilities in other small
also clinics, insurers, and others. Arkansas
educational programming provided to hos-
rural states. If there is something that makes
has a great opportunity to recruit and retain
pital executives, trustees, managers, clinical
them unique, it is the improved chance of
graduates from the two new osteopathic
professionals, and rank-and-file employ-
long-term survival offered through the
schools in our state. Data show that health
ees. The quality improvement programs we
state’s commitment to insurance expan-
care providers—especially doctors—tend to
offer, and the information and communi-
sion through Arkansas Works.
locate close to areas where they trained. We
cations we distribute, keep members up to
hope to retain a number of those doctors
date on major issues.
in the state to help with our primary care shortage.
There will be other issues we need to
Editor What do you see as the future for
Arkansas’ hospitals?
address in Washington and Little Rock, but for now, our main objective will continue
Ryall There will always be a need for hos-
Editor What are some other issues Arkan-
to be the reauthorization of the Arkansas
pitals, but hospitals have long since real-
sas Hospital Association is working on, or
Works program. This program insures
ized the shift from inpatient care to deliv-
lobbying for?
275,000 individuals across our state. The
ering services in an outpatient setting. You
¾ legislative vote requirement for the pas-
will continue to see the growth of hospital
Ryall The AHA has been around since 1929.
sage of the appropriation for the Arkansas
clinics throughout the community, which
During that entire time, its primary purpose,
Works program will always create a chal-
make the services more accessible and
which is our mission statement today, has
lenge, but this program is important to the
convenient for patients. We will continue
been to safeguard hospitals’ operational
health of Arkansans and the sustainability
to serve the sickest and most vulnerable
effectiveness in advancing the health and
of hospitals.
patients through inpatient care, but we fully
well being of their communities. In one
recognize that in a world rapidly creating
way or another, that help is geared toward
Editor Are Arkansas hospitals unique to
new expectations for convenience and effi-
helping hospitals remain financially viable
other US hospitals in any way?
ciency, hospitals will do more to place qual-
today, so that they can continue serving
ity, efficient outpatient services closer to our patients. n
22 JUL / AUG 2018 I Healthcare Journal of Little Rock
We’re a little bit different . . and we’re okay wit h that. Mailed directly to local healthcare leadership including physicians, administrators, insurers and ancillary providers. The most comprehensive and costeffective way possible to reach your local healthcare industry. Request a media kit at
[email protected]
+($/7+&$5( healthcarejournallr.com
-2851$/ of Little Rock
N e w s / p e o p l e / i n f o r m at i o n
Healthcare Briefs
Ribbon cutting for Philander Smith College Nursing Nook.
Philander Smith College Provides Space for Nursing Mothers Story next page
Healthcare Journal of little rock I JUL / AUG 2018 25
Healthcare Briefs Philander Smith College Nursing Nook Opens
breastfeeding in the workplace and institutional settings, making it the norm.
Despite major improvements in safety measures over the past few decades, motor vehicle
Brittany Taylor became a mother in 2016. It
Healthy Active Arkansas is a 10-year framework
crashes continue to be the leading cause of death
wasn’t until she chose to breastfeed her child
to increase the number of Arkansans at a healthy
for young children, and parents still frequently
that Taylor, a student of Philander Smith College
weight. There are nine priority areas, including
choose the wrong type of car seat or seat restraint
(PSC), realized that there was no place for parents
breastfeeding, that impact the health of the state.
for their children. The National Highway Traffic
Sisters United is a community-based initiative
Safety Administration has estimated, for exam-
“I am glad to say, in 2018, I helped establish
designed to increase public awareness and pro-
ple, that only about 46 percent of children aged
the first Nursing Nook on the Philander Smith
mote healthy behaviors aimed at reducing infant
ages four to seven years are placed in the proper
College campus geared toward offering a space
mortality among African-Americans. The initia-
booster car seats, and that 24 percent use a seat
to students and employees who are nursing,”
tive is a partnership among chapter members of
belt prematurely.
said Taylor, who is the 2017–2018 Miss Philan-
Alpha Kappa Alpha, Delta Sigma Theta, Zeta Phi
der Smith College and a Healthy Active Arkan-
Beta, and Sigma Gamma Rho.
to breastfeed on campus.
sas ambassador. PSC collaborated with the Arkansas Department of Health, Healthy Active Arkansas, and Sisters United to officially open the Nursing Nook in its Health and Wellness Center located in the M.L. Harris Building. Taylor spoke along with PSC President Roderick L. Smothers, Sr.; ADH Office
The Safety in Seconds v2.0 app works on iPhones and Android phones. It asks each partic-
To learn more about Healthy Active Arkansas,
ipant a series of questions about his or her prac-
visit www.healthyactive.org. To learn more about
tices and beliefs concerning child car seats, and
Sisters United, visit https://bit.ly/2jjoILG.
then, based on that information, delivers appro-
Arkansas Children’s: Smartphone App Successfully Promotes Child Car-Seat Safety
priate safety tips in a personalized way, using the names of the participant’s children and referring to relevant child car seat laws in the participant’s state. The app provides a link to an online par-
of Minority Health and Health Disparities Direc-
A smartphone app designed to promote proper
ent portal with additional safety education, and
tor Michelle R. Smith, PhD; HAA Worksite Well-
child car seat use among parents proved effec-
can send reminder messages about child car seat
ness manager Kenya Eddings; and ADH Family
tive in a study led by researchers at Arkansas Chil-
safety as the child grows.
Health Medical Director Dr. William Greenfield.
dren’s Hospital Research Institute and Johns Hop-
The Nursing Nook is the first free-standing
kins Bloomberg School of Public Health.
The researchers recruited a total of 742 parents of four to seven-year-olds to the study in
room solely dedicated to nursing among histori-
The researchers and their colleagues devel-
the emergency rooms of the Johns Hopkins Chil-
cally black colleges and universities in the state.
oped the interactive app, Safety in Seconds
dren’s Center and Arkansas Children’s Hospital.
When it comes to providing babies with the
v2.0, and tested it in a randomized, controlled
Each participant was randomly assigned to an
best nutrition, breastfeeding is not only econom-
trial involving more than 700 participants, half of
intervention group, which received the Safety in
ical, it has positive health effects for both baby
whom were seen in the emergency department
Seconds app, or a control group, which received
and mom. Despite the benefits, Smith said there
at Arkansas Children’s.
a similarly structured app about fire safety.
is a disparity in the breastfeeding rates between
Participants reported significant improvements
In the study, the team examined four behaviors
African-Americans and whites, according to
in several child car seat practices, such as having
reported by participants at enrollment, and after
Pregnancy Risk Assessment Monitoring System
the correct car seat or restraint for the child’s age
three and six months—having the correct car seat
(PRAMS) survey data.
and weight, and having the car seat inspected
or restraint for the child’s age and weight; always
“For example, in Arkansas, the 2015 PRAMS
by a child passenger safety technician. These
having the child ride in the back seat; buckling
survey found that 83 percent of white mothers
results held up at three and six months after the
up the child all the time; and having the car seat
reported that they breastfed compared to only
program.
inspected by a certified child passenger safety
57 percent of African-American mothers,” Smith
“We wanted to see how this form of commu-
said. “This translates to fewer African-American
nication with messages tailored to each family
technician, often accessible via a local fire depart-
babies receiving the nutrients needed for healthy
would help them improve compliance,” said Mary
At three months, the group receiving the Safety
brain development and biological milestones.”
Aitken, MD, MPH, medical director of the Injury
in Seconds app reported large and statistically
ment or children’s hospital.
Not only does breast milk offer a nutritionally
Prevention Center at Arkansas Children’s Hospital
significant increases in the rates of three of these
balanced meal, it also reduces the risk for cer-
and a professor of pediatrics in the University of
four behaviors—the exception was having the
tain allergies, asthma, and obesity in babies as
Arkansas for Medical Sciences College of Medi-
child’s seat belt buckled, for which the rates were
well as Type 2 diabetes in moms. The lower rate
cine. “We’re excited to see families will embrace
very high at the start and thus had little room to
of breastfeeding also contributes to a higher rate
an app like this and keep their kids safer by fol-
rise. For each of the three behaviors with signifi-
of infant mortality within the African-American
lowing its instructions.”
cant reported increases, the increase was roughly
community. One way to reduce this disparity is to promote
The study is published this month in the American Journal of Preventive Medicine.
26 JUL / AUG 2018 I Healthcare Journal of little rock
double than that seen in the control group. At six months, there remained significant
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
improvements in the intervention group rela-
“We are very fortunate to have identified Dr.
tive to the control group for two of the behav-
Patterson and his strong skill set that will help
iors—having the correct car seat and having it
lead UAMS into a very crucial period in its con-
inspected.
tinued tradition of innovation and excellence,”
“These results are encouraging. The trial design
said Donald. R. Bobbitt, PhD, president of the
with a well-matched control group gives us con-
University of Arkansas System. “His experience in
fidence that this is a real, positive finding that we
leading a very complex clinical enterprise and his
can attribute to the content of the app,” says co-
varied background in clinical care, research, and
author David Bishai, MD, PhD, pediatrician and
administrative leadership will complement and
professor at the Bloomberg School, and who led
elevate the momentum already being generated
the team’s analytic approach. “Reaching parents
there. I am thrilled to bring him into the UA Sys-
with messages focused on their child’s specific
tem, and I welcome him and his family to Arkan-
needs can help them sort through the confusing
sas. I am also extremely grateful to Dr. Gardner for
array of products and information currently in the
her leadership and willingness to take on incred-
the position to UAMS’ governing board, the
consumer market place.”
ible challenges in her time as interim chancel-
University of Arkansas Board of Trustees, which approved the appointment January 3.
The team is now following up with a larger-
lor. She has proven herself to be an exceptional
scale, foundation-sponsored trial of the app in
leader and an invaluable member of the UAMS
four states. They are also exploring ways to dis-
leadership team.”
Cam Patterson, MD, MBA
The search was conducted by Bobbitt and a campus advisory search committee, along with
tribute the app to parents, possibly via pedia-
Patterson previously held numerous academic
tricians’ offices or even Apple’s App Store or
and clinical appointments at the University of
Google’s Play Store.
North Carolina, including physician-in-chief at
The search committee was chaired by Jean-
“Results of an RCT in Two Pediatric Emer-
the UNC Center for Heart and Vascular Care and
nette Shorey, MD, associate provost for faculty
gency Departments to Evaluate the Efficacy
executive director of the UNC McAllister Heart
and professor of internal medicine. It included
of an m-Health Educational App on Car Seat
Institute.
representatives from campus faculty, administra-
the help of Isaacson Miller, a contracted national search firm.
Use” was written by Mary E. Aitken, Andrea C.
Over the course of his career, Patterson, as prin-
tion and staff, supporters from across the state,
Gielen, David M. Bishai, Elise Omaki, Wendy C.
cipal investigator or co-investigator, has received
and a member of the University of the Arkansas
Shields, Eileen M. McDonald, Nicholas C. Riz-
more than $60 million in grants from the National
Board of Trustees.
zutti, James Case, and Molly W. Stevens. Fund-
Institutes of Health, the American Heart Associ-
ing was provided by the National Institutes of
ation, and the Centers for Disease Control and
Health (HD069221).
Prevention. His work has been published in 323
UAMS Welcomes New Chancellor Cam Patterson, MD, MBA
peer-reviewed scientific publications.
Registered Dietitian Nutritionists Celebrate Healthful Eating and Lifestyle at the Capitol
He earned his Bachelor of Arts in psychology
Registered dietitian nutritionists from around
from Vanderbilt University, his medical degree
the state gathered at the Capitol recently to cele-
Cam Patterson, MD, MBA, a renowned cardi-
from Emory University School of Medicine, and
brate National Nutrition Month® and Registered
ologist and healthcare administrator, is the new
his Master of Business Administration from the
Dietitian Nutritionist Day. They handed out man-
chancellor of the University of Arkansas for Med-
University of North Carolina Kenan-Flagler School
darin oranges (also known as Cuties) to remind
ical Sciences (UAMS), the state’s only health sci-
of Business.
people about healthy food choices, and to edu-
ences university.
His residency, including a year as chief resident,
cate them on what exactly a registered dietitian
Patterson comes to UAMS from Weill-Cornell
was conducted at Emory University Affiliated Hos-
nutritionist can do for them. Approximately 100
Medical Center and Komansky Children’s Hospi-
pitals. He was a research fellow at the Cardiovas-
dietitians then met with Gov. Asa Hutchinson as
tal/New York Presbyterian Hospital in New York,
cular Biology Laboratory in the Harvard School
he declared March 14 as Registered Dietitian
where he was senior vice president and chief
of Public Health in Boston and a clinical fellow
Day, and the month of March as National Nutri-
operating officer since 2014.
in cardiology at The University of Texas Medical
tion Month®.
He replaces Dan Rahn, MD, who retired as chancellor July 31, 2017. Stephanie F. Gardner,
Branch at Galveston, Texas, where he joined the institution’s faculty in 1998.
National Nutrition Month ® is celebrated annually in March and encourages everyone to make
PharmD, EdD, who had been serving as interim
His wife, Kristine Patterson, MD, is an infec-
healthful food choices and develop realistic and
chancellor since that time, will continue as senior
tious disease specialist who is an expert in treat-
wholesome eating habits. National Nutrition
vice chancellor for academic affairs and pro-
ing menopausal women with HIV. They have three
Month ® also promotes the Academy of Nutri-
vost at UAMS, as she had before and during the
children Celia, Anna, and Graham.
tion and Dietetics and Registered Dietitians Nutri-
transition.
Patterson was recommended by Bobbitt for
tionists (RDN) as the most valuable and credible
Healthcare Journal of little rock I JUL / AUG 2018 27
Healthcare Briefs source of scientifically sound food and nutri-
state hospitals had higher readmission ratios for
APhA annual meeting on March 19 in Nashville,
tion information. The Academy of Nutrition and
pneumonia, heart failure, and heart attacks. But
Tennessee. About 300 students of the UAMS
Dietetics is the world’s largest organization of
when they controlled for hospital and commu-
College of Pharmacy are members of the APhA-
food and nutrition professionals, with more than
nity factors, the significant difference in readmis-
Academy of Student Pharmacists chapter that
100,000 credentialed members.
sion ratios for pneumonia and heart attack disap-
earned the awards. They were given in recogni-
Registered dietitian nutritionists have fulfilled
peared, and the difference for heart failure was
tion of its achievements in patient care and edu-
specific requirements to earn the RDN credential,
much less pronounced between hospitals in the
cation for diabetes and cardiovascular health,
which includes earning a bachelor’s degree, com-
Delta region and those in the rest of the nation.
along with the Division AA Chapter Achieve-
pleting a supervised practice program, and pass-
Factors linked to higher readmission ratios
ing a registration examination. To maintain the
for pneumonia and heart failure were whether
“These three national awards prove my belief
credential, continuing education requirements
a patient was treated in a major teaching hospi-
that these students are the best in the country,”
are required.
tal, which tend to take the sickest patients, and
said Eddie Dunn, PharmD, the chapter’s faculty
the percentage of the community that is African
advisor. “That a national association of profes-
American.
sional pharmacists shares that high opinion is val-
Community Factors Drive Hospital Readmissions in the Delta
ment Award.
Oddly, high poverty was associated with lower
idating. The entire college is proud of them and
readmissions for heart attacks, but the research-
the very hard work and effort they put in to be
Researchers at the University of Arkansas for
ers noted that mortality rates for this condition
so honored.”
Medical Sciences (UAMS) call for revision to the
are very high if patients cannot access treatment
Hospital Readmissions Reduction Program to
in a timely manner.
Dunn is an associate professor in the College of Pharmacy’s Department of Pharmacy Practice.
reduce unintended consequences that could
Chen and coauthors conclude that these find-
Operation Heart is a national, public educa-
threaten the healthcare delivery system in the
ings show that changes to the program are nec-
tion project of APhA-ASP, and Operation Diabe-
Mississippi Delta region in a new study published
essary and urgent to ensure that resources are
tes seeks to identify individuals with previously
in The American Journal of Managed Care.
not removed from the communities that need
undiagnosed diabetes while increasing overall
them most.
awareness of the disease. The Chapter Achieve-
The program provides financial incentives for hospitals to deliver higher quality care and higher
Her co-authors are Adrienne Nevola,
ment Award recognizes the overall activities of a
value care by reducing Medicare reimbursements
MPH.; Mack Bird, PhD; Saleema Karim,
chapter from patient care to policy activities and
to hospitals with higher than average readmission
PhD; Michael Morris, PhD; and J. Mick Tilford,
guest lecture programs.
rates for selected conditions.
PhD, from the Department of Health Policy
To win all three awards the students, through-
“In the Mississippi Delta, one of the coun-
and Management, and Fei Wan, PhD, from the
out the 2016–2017 academic year, participated
try’s poorest areas, community factors matter,”
Department of Biostatistics, both in the UAMS
in dozens of public outreach events, as well as
said Hsueh-Fen Chen, PhD, associate professor
College of Public Health.
organized many of their own, and visited public schools, Dunn said.
in the UAMS Fay W. Boozman College of Pub-
To read the full study, go to http://www.ajmc.
lic Health and lead author on the study. “They
com/journals/issue/2018/2018-vol24-n5/under-
Notably, he said the chapter in 2016–2017 initi-
matter so much that, once accounted for, read-
standing-factors-associated-with-readmission-
ated a new screening program at a commercial
missions were not much different from those
disparities-among-delta-region-delta-state-and-
gym to detect diabetes and high blood pressure
in the rest of the country for heart failure, and
other-hospitals.
in individuals who otherwise are athletic, fit, and
were about the same for pneumonia and heart attacks.” The study examined data from 2013–2016 for counties that fall under the Mississippi Delta
UAMS Student Pharmacists Win Three-Award Sweep in National Competition
may not think they need testing. The chapter also began an education campaign with flyers and a YouTube video to make people aware of the link between untreated psoriasis and an increased
Regional Authority in parts of eight states.
Students of the UAMS College of Pharmacy
Those states include Alabama, Arkansas, Illinois,
recently took home three American Pharmacists
The student chapter also placed as first runner-
Kentucky, Louisiana, Mississippi, Missouri, and
Association (APhA) national awards for patient
up in the national competition for awards for OTC
Tennessee.
care and education. Several of the college’s fac-
Medicine Safety and Operation Immunization as
ulty and alumni also were elected to leadership
well as second runner-up for Generation Rx.
Chen and her colleagues compared 30-day readmission ratios for hospitals in the Delta region, the remaining counties of the eight Delta
positions in the association.
risk of stroke.
Operation Immunization is an immunization
Nicki Hilliard, PharmD, a professor in the col-
education campaign that works to raise the num-
lege, became the first Arkansan to serve as APhA
ber of adults receiving immunizations. OTC Med-
When not controlling for hospital and com-
president. She will serve for the 2018–2019 term.
icine Safety is a campaign of APhA-ASP Chap-
munity factors, they found the Delta region and
The students garnered their wins during the
ters to educate fifth and sixth-graders in reading
states, and the rest of the nation.
28 JUL / AUG 2018 I Healthcare Journal of little rock
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
medicine directions, following those directions,
continue exclusively breastfeeding for the rec-
and substance abuse diagnoses receiving ther-
proper measuring of medicine, safe storage and
ommended six month timeframe.
apy and regular doctor checkups were less likely
disposal of medicine, and consulting with par-
Individuals or organizations interested in learn-
to die, but only if they were not prescribed opi-
ents or guardians before taking medications.
ing how they can support breastfeeding can
oids or benzodiazepines. Another study showed
Generation Rx is another APhA-ASP national
learn more by visiting the Arkansas Breastfeed-
that veterans from Iraq and Afghanistan were
educational program. Its goal is to increase pub-
ing Coalition at www.arbfc.org. The Expressly for
prescribed opioids at rates similar to the rest of
lic awareness of prescription medication abuse
You breastfeeding helpline (501) 202-7378 is also
the U.S. population, indicating that overprescrib-
and to enhance cooperation between healthcare
available 24 hours, seven days a week to mothers
ing is a nationwide issue not specific to veterans.
providers, teens, parents, and communities to
who have questions or need advice. The Arkansas
Three related studies are looking at methods to
prevent such abuse.
Breastfeeding Helpline (1-844-344-0408) is also
decrease opioid use and improve pain manage-
Elected to APhA leadership positions are Lanita
available 24/7. Additional information, includ-
ment among veterans with chronic pain.
White, PharmD, faculty – APhA-APPM Precep-
ing lactation room design plans and community
Peter Crooks, PhD, is working to develop safer
tor SIG Coordinator; Rachel Stafford, PharmD,
breastfeeding resources, can be found at healthy-
opioid molecules that work better for pain than
faculty – APhA-APPM Medication Management
active.org.
existing drugs, with fewer side effects and less
SIG Coordinator; and Denise Clayton, BSPharm, alumnus – APhA-APPM Executive Committee Member-at-Large.
potential for addiction. Within the Women’s Men-
UAMS Fights Opioid Epidemic on All Fronts
tal Health Program, Jessica L. Coker, MD, is studying opioid addiction in pregnant women. Lisa
Nominated for leadership positions are Brandi
The University of Arkansas for Medical Sci-
Brents, PhD, is developing new therapies for opi-
Hamilton, PharmD, alumnus – candidate for
ences (UAMS) is attacking the nationwide opi-
oid addiction during pregnancy that reduce fetal
APhA trustee; and Stephanie White, PharmD,
oid epidemic on multiple fronts that have pro-
exposure to opioids. William Fantegrossi, PhD, is
pharmacy resident – candidate for APhA-APPM
duced new research and treatment options for
studying new types of opioids and whether they
new practitioner officer.
patients and healthcare providers across Arkan-
are more addictive than older types or require
sas and beyond.
more aggressive treatments for dependence and
Healthy Active Arkansas, RiverFest Partner to Support Breastfeeding Moms
There were 116 deaths per day from opioid-
overdose. Benjamin Teeter, PhD, is studying ways
related drug overdoses in the United States in
to more effectively distribute naloxone, which is
2016, according to the U.S Department of Health
used to treat opioid overdoses in emergency sit-
Healthy Active Arkansas (HAA) and the organiz-
and Human Services. Arkansas ranks second in
uations, in the community. Bradley Martin is also
ers of RiverFest partnered to offer a breastfeed-
the nation for its opioid prescribing rate with an
about to initiate a study to see if physical ther-
ing nook for breastfeeding moms as part of 2018
average of 114.6 prescriptions per 100 people,
apy can interrupt long-term opioid use among
RiverFest. They provided a comfortable, private
according to U.S. Centers for Disease Control and
patients with low back pain.
space for mothers who needed to breastfeed
Prevention data from 2014–2016.
The Psychiatric Research Institute’s Center for
their children or pump while visiting the event.
Research to improve understanding of opioid
Addiction Research has many ongoing studies
This is the first time a designated breastfeeding
addiction and its treatment is ongoing in depart-
related to improving opioid detoxification treat-
space has been offered as part of RiverFest.
ments across campus, and some of it is having
ments by testing different methods and drugs, or
national impact.
combinations of the two.
Staff from the University of Arkansas for Medical Sciences and the Arkansas Department of Health
For example, the Centers for Disease Con-
In addition to performing the kind of research
were at the breastfeeding nook, and available to
trol Prevention Morbidity and Mortality Weekly
that could change physician behavior nationwide,
answer questions about breastfeeding. The nook
Report published a study in 2017 led by UAMS
UAMS clinicians are turning a critical eye to their
was housed within a tent provided by the Arkan-
pharmacy professor Bradley Martin, PharmD,
own behavior in the name of improvement.
sas Coalition for Obesity Prevention—a partner
PhD, that showed that by prescribing patients
UAMS is the state’s largest public employer,
of HAA—in the Ford Family Fun Zone.
opioid supplies of three days or less, providers
with a hospital, five colleges, seven institutes,
can reduce the likelihood of the patient using opi-
a Northwest Arkansas campus, a network of
oids chronically one to three years later.
regional centers statewide and physician place-
Breastfeeding has been linked to fewer incidences of ear and upper respiratory infections in infants, sudden infant death syndrome, and obe-
The UAMS Psychiatric Research Institute’s
ment partnerships with Arkansas Children’s Hos-
sity over the lifespan. In addition, breastfeeding
Division of Health Services Research, directed
pital, the VA Medical Center, and Baptist Health.
benefits mothers by reducing their risk of breast,
by Teresa Hudson, PharmD, PhD, is conducting
With such a wide reach, changes to the institu-
uterine, and ovarian cancer, and aids in losing
a variety of studies related to opioid addiction,
tion’s internal processes can have a huge impact.
weight gained during pregnancy. Mothers who
including opioid addiction among people with
receive support to breastfeed through their fam-
mental health diagnoses and among veterans.
ily, employer, or community are more likely to
One study found that people with mental health
For example, colorectal surgeons in the UAMS College of Medicine Department of Surgery set out to change the way its physicians
Healthcare Journal of little rock I JUL / AUG 2018 29
Healthcare Briefs helped their patients manage pain, limiting opi-
doctor-patient discussions about pain manage-
discussing the opioid crisis, educating on phar-
oid use as part of a comprehensive Enhanced
ment and expectations before and after surgery.
macists’ role with administering naloxone and
Recovery Protocol. The process began with a year
There has been interest from outside groups to
of internal education about the new approach
adopt the protocols developed by the Orthopae-
In the College of Medicine, James Graham,
and the evidence to back it up, followed by an
dics Department and the accompanying patient
MD, associate dean for undergraduate medical
official kickoff in 2015.
information materials.
education, tracks the overall curriculum to ensure
emphasizing non-opioid pain management.
The latest data show that over a two-year
The emergency department, with the help of
that medical students learn about all of the neces-
period, narcotic use decreased 40 percent.
the Pharmacy & Therapeutics Service Line, con-
sary topics, including opioids. In response to the
Patients who are not prescribed narcotics are
ducted a similar review of the amount of opi-
crisis, the college’s leaders have made changes to
well enough for discharge an average of 1.5 days
oids being prescribed to patients when they are
how the information about opioids is presented
sooner. Complications resulting in readmission
discharged from the emergency department. It
to emphasize the dangers of its abuse and poten-
are also down among those patients.
found the averages were within an appropriate
tial for overdose.
“When we looked at the data, we saved about
range, but recommended improvements in the
“One of the issues that led to the opioid crisis
$2 million over two years just in length of stay
electronic prescribing processs, and better writ-
was a lack of education among doctors about the
alone, and if we accounted for other factors, like
ten guidelines for opioid prescribing.
dangers of opioids and the nature of addiction in
the reduction in complications and readmissions,
They revised prescribing protocols and updated
general,” Graham said. “We’re making sure that
we’re probably saving more,” said Jonathan A.
the automatic defaults of opioid orders within
the next generation of doctors doesn’t have those
Laryea, MD, colorectal surgeon and associate
the electronic health record. In addition, they
same gaps in their knowledge.”
professor of surgery. “More importantly, what’s
are seeking ways to make it easier for prescrib-
Direct clinical care related to opioid abuse is
behind those numbers is that our patients are
ers to see potential alternatives to opioids, such
another vital part of the effort. The Emergency
doing better and getting better sooner. We’ve
as nonsteroidal anti-inflammatory medications,
Department and UAMS Medical Center treat opi-
known for some time in the literature that nar-
acetaminophen, hot/cold treatments, and phys-
oid overdose patients. The Psychiatric Research
cotics impede recovery and increase complica-
ical therapy.
Institute’s Center for Addiction Services and Treat-
Moving beyond the walls of UAMS, educa-
ment treats opioid addiction through medication
tion and outreach are elements of achieving the
and group therapy. It has one program specifi-
Meanwhile, the Department of Orthopaedic
institution’s mission of improving the health of
cally for female patients. The institute’s Women’s
Surgery conducted a similar internal review and
all Arkansans. Professionals from across the state
Mental Health Program treats opioid addiction in
developed its own opioid prescription guide-
had access to the latest information at the Arkan-
pregnant and postpartum women
lines. Simon Mears, MD, orthopaedic surgeon
sas Pain Management Symposium at UAMS in
and professor of orthopaedic surgery, helped
April.
tions, but now we have our own institutional data to show that’s true.”
lead that effort. In a little more than a year, their
Educating the next generation of caregivers is
narcotic prescriptions have decreased by a third.
critical. UAMS has 2,834 students, 822 medical
Both Laryea and Mears said it’s common for
residents, and six dental residents.
UAMS Program to Expand in Five Arkansas Counties to Improve Doctor-Patient Communication Organizations in five Arkansas counties are
patients to come to them for surgery already
In the College of Pharmacy, faculty members
invited to participate in programs offered free of
on high doses of opioids prescribed to them by
are bringing their direct clinical experience with
charge by the University of Arkansas for Medical
other doctors.
the crisis to bear as they educate future pharma-
Sciences (UAMS) designed to improve doctor-
“So we are working on it from both ends,”
cists. Victoria Seaton, PharmD, works in veteran
patient communication.
Mears said. “In orthopaedics, it’s been incredibly
mental health at an inpatient psychiatric unit in
The How to Talk to Your Child’s Doctor program
common in the past for people to be prescribed
Fayetteville, where she also brings students for
will be provided to clinics, hospitals, schools, and
narcotics for things like osteoarthritis, when in fact
firsthand experience. The most common diag-
other interested community organizations in Cle-
they don’t help. There has also been evidence
nosis is addiction combined with chronic pain.
burne, Conway, Faulkner, White, and Van Buren
to show that if people are on narcotics before
In the classroom, the College of Pharmacy’s cur-
counties, thanks to a donation of $60,122 from
surgery, they actually do worse with something
riculum has included a section on chemical addic-
BHP, an Australia-based global resources com-
like a knee replacement. So, communicating with
tion for more than 30 years.
pany with shale operations in Arkansas.
patients about that has become a big part of our effort.”
“This is not a typical course required by other
Offered by the UAMS Center for Health Liter-
colleges, but our leadership recognized the
acy, the How to Talk to Your Child’s Doctor pro-
With that issue in mind, the orthopaedics
importance of educating future pharmacists on
gram was developed to help parents better pre-
team enlisted the help of UAMS’ Center for
the problems arising from addictive diseases,
pare for visits with their children’s primary care
Health Literacy, which produced clear and easy
including alcohol and drug abuse,” Seaton said.
doctors. A companion program for adult patients,
to read materials about opioids to help with
This year, they dedicated extra hours on
How to Talk to Your Doctor, is being implemented
30 JUL / AUG 2018 I Healthcare Journal of little rock
Healthcare Briefs
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
in these communities now, and resources remain
during the coming summer months, the Arkan-
Arkansans should protect themselves from these
available at no charge, thanks to the BHP dona-
sas Department of Health (ADH) is stressing the
diseases by preventing tick and mosquito bites.
tion. This content can be delivered by UAMS or
importance of taking precautions against ticks
Tick and mosquito bites can be prevented in sim-
by lay persons at organizations such as churches,
and mosquitoes and the diseases they can carry.
ilar ways:
schools, hospitals, and clinics. Organizations
Arkansas has some of the highest rates in the
interested in participating in either program
nation for tick-borne diseases, such as Rocky
may contact Alison Caballero at (501) 686-5463
Mountain Spotted Fever (RMSF), Ehrlichiosis, and
• Use permethrin on clothing, as directed.
or
[email protected].
• Use an EPA-approved insect repellant as directed.
Tularemia. Anaplasmosis, Lyme disease, Heart-
• Wear long sleeves and pants. Light-colored
After engaging in the original How to Talk
land virus, and other diseases may also be car-
clothing makes it easier to spot ticks. Tuck pants
to Your Doctor program, patients reported
ried by ticks. Mosquitoes in Arkansas can carry
improved confidence in communicating with their
West Nile Virus and other less common diseases.
• Check for ticks on yourself, your children, and
doctor and understanding their doctor’s instruc-
Arkansans traveling within or outside of the coun-
your pets regularly. Remove ticks quickly and
tions. Benefits also may include increased patient
try should educate themselves on the specific
satisfaction and engagement, such as improved
concerns ticks or mosquitoes may pose on their
adherence to preventive care, follow-up visits,
trip. Mosquito-borne diseases, such as Zika, Den-
and immunization schedules.
gue, malaria, and yellow fever, are more common
ADH: Take Precautions During Tick, Mosquito Season As Arkansans plan to enjoy the outdoors
outside of the United States.
into socks or boots.
correctly if they are found. • To avoid ticks, walk in the middle of a hiking trail or path; avoid tall grass and leaf litter. • To reduce mosquitoes around the home, get rid of any standing water on the property. Mosqui-
Some of these diseases can be fatal; some
toes can breed in as little as a bottle cap full of
of them can also be difficult to diagnose and
water.
treat. Whether in their own backyard or on a trip,
If found, it is important to remove ticks correctly.
Healthcare Journal of little rock I JUL / AUG 2018 31
Healthcare Briefs
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
Remove ticks with tweezers. Position the twee-
of cancer research will enable us to expand
Wilkerson of Little Rock were newly elected to
zers as close to the skin as possible and lift up
our efforts at understanding the causes of and
the AFMC’s Board of Directors at its May annual
on the tick firmly. Do not twist or jerk the tick or
improving the treatments for women with triple
membership meeting. Both physicians will serve
use home remedies such as petroleum jelly, heat,
negative breast cancer and will move us closer
a two-year term.
or waiting for the tick to fall off. These methods
to achieving National Cancer Institute (NCI) des-
Sneed, a board-certified pediatrician with The
can increase the chance that a tick may transmit
ignation,” said Cancer Institute Director Peter
Children’s Clinic in Jonesboro, earned her medi-
a disease.
Emanuel, MD. Emanuel also serves as a profes-
cal degree in 1989 from the University of Tennes-
sor in the UAMS College of Medicine Division of
see Center for the Health Sciences in Memphis.
Hematology.
She completed her pediatric residency at Lebon-
If you or your child does get a tick bite, be on the lookout for symptoms such as fever, chills, rash, fatigue, and aches and pains within the next
NCI-designated cancer centers are recognized
few weeks following the bite. If symptoms occur,
for their scientific leadership, resources, and
it is important to see a medical provider quickly.
research in basic, clinic, and population science.
Sneed has also served as chief of staff at St.
Learn more about insect-related diseases
There are 69 designated cancer centers in the
Bernard’s Regional Medical Center in Jonesboro
United States, and the UAMS Winthrop P. Rock-
from 2015-17 and has been practicing pediatrics
efeller Cancer Institute is in the process of pursu-
full time since 1994.
at www.healthy.arkansas.gov.
$1 Million Estate Gift to Benefit Breast Cancer Research at UAMS Cancer Institute
ing this nationally recognized status.
heur Children’s Hospital in Memphis in 1992 and was chief resident from 1992-93 at Lebonheur.
A “champion of the patient-centered medi-
In triple negative breast cancer, the cancer cells
cal home (PCMH) model,” Sneed said, “I under-
do not contain the hormones estrogen and pro-
stand that the present cost of medical care is not
A $1 million gift from the estate of Linda Gar-
gesterone or the protein HER2. Therefore, the
sustainable at its current rate of growth. I totally
ner Riggs to the Winthrop P. Rockefeller Cancer
most common hormonal therapies for breast can-
acknowledge the need to practice evidence-
Institute at the University of Arkansas for Medical
cer are not effective for women with this form of
based medicine to get the best outcome in the
Sciences (UAMS) will be used to advance research
the disease, which is often aggressive and likely to
most cost-effective manner.”
of triple negative breast cancer. Riggs, who died
spread or return after the initial diagnosis.
Sneed has served the community on sev-
in November 2017, was a former Arkansas insur-
Triple negative breast cancer is diagnosed in up
eral boards of directors including the Arkansas
ance commissioner and managing director at Ste-
to 20 percent of cases, and is more likely to occur
Board of Health, Court Appointed Special Advo-
phens Inc.
in younger people, African-Americans, Hispanics,
cates, and the State Volunteer Mutual Insurance
and those with the BRCA1 gene mutation.
Company.
“This gift will have long-lasting effects on UAMS’ ability to help women living with breast
In appreciation of her gift, Riggs will be honored
Wilkerson is a board-certified anesthesiologist
cancer. We are grateful to Mrs. Riggs for this
as a member of the 1879 Society of UAMS, which
and has practiced for more than 30 years in both
transforming gift, which provides vital funds for
recognizes all individuals who have made estate
private practice and university teaching. He has
our ongoing initiative for cancer research,” said
gifts to the university.
been a professor in the Department of Obstetrics
UAMS Interim Chancellor Stephanie Gardner, PharmD, EdD. A native of Fordyce, Riggs worked about 10
New Officers Elected to AFMC’s Board of Directors
and Gynecology and the Department of Anesthesiology at UAMS since 2012. From 2003 until 2014, he served as medical director for OB anes-
years in state government, serving as director of
The Arkansas Foundation for Medical Care’s
the research and committee staff of the Arkansas
(AFMC) Board of Directors recently elected new
thesiology at UAMS. He earned his medical degree in 1983 from
Legislature; legislative and budgetary director for
officers to lead the board for the next year, as well
UAMS and completed his anesthesiology resi-
Gov. Frank White; and insurance commissioner.
as two new board members. AFMC is a health
dency there in 1986. He relocated to Rogers and
She later joined Stephens Inc., where she worked
improvement organization that has served Arkan-
practiced anesthesiology for 14 years at St. Mary’s
for 25 years in corporate finance, and as manag-
sas physicians and the healthcare community for
Rogers Memorial Hospital.
ing director of investment banking.
more than 45 years.
In 2000, he returned to UAMS. He is currently a
“Linda lived an exemplary life, and I was so priv-
Stacy C. Zimmerman, MD, a practicing physi-
professor in the Department of Anesthesiology
ileged to know her and be her partner in it. She
cian in Searcy, will lead the 15-member board as
and holds a secondary appointment in the UAMS
was a wonderful example and role model to any-
its new chair. Other newly elected members of
Department of Obstetrics and Gynecology. He
one who wanted to become a better person,”
the AFMC Board’s Executive Committee include
has served as medical director of the Division of
said her husband, Lamar Riggs of Little Rock.
Vice Chair Harvey Potts, MD, MPH, of Fort Smith;
Obstetric Anesthesiology, working with high-risk
“We are honored and humbled that Mrs. Riggs
Treasurer Jennifer Styron of Little Rock; Secretary
cases. Wilkerson also served on the anesthesiol-
designated the UAMS Cancer Institute as a recip-
Alan Wilson, MD, of Crossett; and Member-at-
ogist staff of the John L. McClellan VA Hospital
ient for this generous gift from her estate. Her
Large LaDell Douglas, MD, of Hope.
in Little Rock.
foresight and dedication to the importance
Dr. Jane Sneed of Jonesboro and Dr. Danny
32 JUL / AUG 2018 I Healthcare Journal of little rock
Wilkerson said he wants to “provide quality
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
healthcare for fewer dollars spent through cost
to the families served by Roller Funeral Homes
Treatment (AR-IMPACT) was announced at a news
sharing, such as electronic medical records and
and UAMS.
conference at the state Capitol with Gov. Asa
Health Information Management systems.”
“It has always been our calling to serve fami-
Hutchinson, Arkansas Blue Cross and Blue Shield,
He has served the medical community as a
lies with all our respect during one of the sad-
Arkansas Drug Director Kirk Lane, and partnering
member and president of the boards of both the
dest days of their lives,” said Byler. “Our wonder-
agencies. Those agencies include the Arkansas
Arkansas Medical Society and the Arkansas Soci-
ful friends at UAMS often serve these very same
Medical Society, the Arkansas Academy of Fam-
ety of Anesthesiologists; board president of both
families. That is why this partnership is so spe-
ily Physicians, the Arkansas State Medical Board,
the Benton and Pulaski County Medical Societ-
cial. Two separate work families coming together
the Arkansas Department of Human Services, and
ies; and Arkansas Director of the American Soci-
with the same heart to give back. We hope that
the Arkansas Department of Health.
ety of Anesthesiologists Board. He was named
this memorial will serve as a place of peace and
Funding for UAMS AR-IMPACT’s first year has
one of the Best Doctors in America every year
remembrance for our most precious little ones
been provided by $104,125 from Arkansas Blue
from 2009-2015.
and their families.”
Cross and Blue Shield and $49,000 from the office
Wilkerson has also volunteered on medical
The bereavement program provides person-
mission trips to Honduras, has participated in an
alized care through family-centered support for
“We are thankful to Arkansas Blue Cross and
emergency assistance course for the Red Cross,
those who have experienced pregnancy or infant
Blue Shield for their partnership as we work to
and has served on the Anesthesia Tech Advisory
loss. It provides the families with everlasting keep-
improve pain management in Arkansas,” said
Board of Pulaski Technical College.
sakes as a remembrance of their baby, as well
UAMS Interim Chancellor Stephanie Gardner,
as education and ongoing support to help each
PharmD, EdD. “As the state’s only health sci-
family member as they journey through the griev-
ences university, UAMS is uniquely positioned to
ing process.
address this issue head on for the betterment of
UAMS, Roller Funeral Homes Dedicate Memorial to Pregnancy and Infant Loss In memory of pregnancy and infant loss, the University of Arkansas for Medical Sciences
of the state drug director.
all Arkansans.”
Science Café Focuses on CSI & Evidence Collection
“Arkansas Blue Cross recognizes that the opioid epidemic threatens the health of the peo-
(UAMS) Love Lives Program and Roller Funeral
Science Café Little Rock, co-sponsored by
ple of Arkansas in many ways,” said Curtis Bar-
Homes dedicated the Love Lives Memorial
the University of Arkansas for Medical Sciences
nett, Arkansas Blue Cross president and CEO.
at Riverwood Memorial Gardens Cemetery in
(UAMS), held a public forum entitled CSI & Evi-
“For those in chronic pain and for those treating
Maumelle.
dence Collection. Panelists discussed crime
them, it’s not an easy resolution. We already have
Love Lives, the UAMS perinatal bereavement
scene best practices, types of evidence, col-
been working with healthcare providers to help
program, worked with Roller Funeral Homes to
lection methods, and how society defines and
get a better understanding of opioid prescribing
establish the memorial garden as a final resting
responds to crime.
patterns in Arkansas and we believe the new AR-
place for some. For others, it may be a conse-
The panel included Bob Lytle, PhD, assistant
IMPACT education program with UAMS will help
crated place of quiet reflection where families and
professor, department of criminal justice, Uni-
doctors learn about resources and alternatives
loved ones may come to feel close to their pre-
versity of Arkansas at Little Rock; Payton Tucker,
to managing pain. It will take everyone working
cious little ones whom they will always remember.
agent, Federal Bureau of Investigation, Little
together to truly impact this crisis.”
Neonatologist Sara Peeples, MD, an assistant
Rock; and Meagan Buchert, Crime Scene Search
professor in the department of pediatrics in the
Unit, Little Rock Police Department.
Arkansas ranks second in the nation for its opioid prescribing rate with an average of 114.6
UAMS College of Medicine, said establishing the
Dorothy Graves, associate director for adminis-
prescriptions per 100 people, according to U.S.
memorial garden recognizes that these losses
tration of the UAMS Winthrop P. Rockefeller Can-
Centers for Disease Control and Prevention data
have a profound and lasting impact on families.
cer Institute, moderated the event.
from 2014–2016.There were 116 deaths per day
“We would like to thank Roller and all of our community partners for supporting these families affected by perinatal loss,” said Peeples. “It is our hope that this becomes a place of comfort and healing for those who have been touched by
from opioid-related drug overdoses in the United
UAMS Launches Free Video Conference Service About Opioids for Arkansas HealthCare Providers
States in 2016, according to the U.S Department of Health and Human Services. UAMS AR-IMPACT is a live streaming online video conferencing service staffed by a multidis-
unspeakable and immeasurable loss. Together we
The University of Arkansas for Medical Sciences
ciplinary team from UAMS, including a pain physi-
can inspire hope as we bring awareness to the
(UAMS) has launched a free weekly education and
cian, an addiction psychiatrist, a psychologist, two
issues surrounding perinatal loss and the need
consultation service for Arkansas healthcare pro-
pharmacists, and a physical therapist. For more
for ongoing community support.”
viders to better manage chronic pain patients and
information, go to arimpact.uams.edu.
Ranata Jenkins Byler, third-generation owner of Roller Funeral Homes, said the memorial is a gift
those who need their opioid dosage reduced. Arkansas Improving Multidisciplinary Pain Care
“Prescribers are experiencing greater scrutiny than ever before,” said G. Richard Smith, MD, a
Healthcare Journal of little rock I JUL / AUG 2018 33
Healthcare Briefs professor in the department of psychiatry in the
state epidemiologist. “There are numerous Hep
UAMS College of Medicine who is spearhead-
A outbreaks occurring across the country. We
The new Arkansas numbers are based on infor-
ing the project. “However, they won’t be able to
are encouraging everyone in the county and sur-
mation collected from health and special edu-
reduce their patients’ dependency overnight. In
rounding areas to be aware of the risk factors for
cation records of almost 40,000 eight year old
fact, stopping cold is dangerous. What these doc-
getting Hep A.”
children living in Arkansas in 2014. They are the
Arkansas for Medical Sciences (UAMS).
tors need is access to the whole toolkit of what
Hep A is usually spread when a person ingests
first numbers statewide since a 2010 count and
is available so they can best serve their patients.
tiny amounts of fecal matter from contact with
are part of national data released by the Cen-
We hope to help with that.”
objects, food, or drinks contaminated by the
ters for Disease Control and Prevention that was
Each weekly conference will include a 20-min-
feces, or stool, of an infected person. Hep A can
gathered from the national ADDM network. The
ute presentation on an opioid-related topic and
also be spread through unprotected sex or the
2010 count estimated that one in 65 Arkansas chil-
a question-and-answer session. Participants are
sharing of injection drugs.
dren were identified with autism. The current esti-
encouraged to present patient cases for individ-
Typical symptoms of Hep A include fever,
mate still could be as high as 1 in 64 (1.6 percent),
ualized feedback about approaches to treatment.
fatigue, loss of appetite, nausea, vomiting,
accounting for records that were not located for
Physicians, physician assistants, nurse practitio-
abdominal pain, dark urine, clay-colored bowel
review.
ners, pharmacists, and other healthcare providers
movements, joint pain, or jaundice (yellowing of
The Arkansas monitoring program includes
are welcome to use the service and will be able to
the skin or eyes). Hep A can range in severity from
investigators with UAMS and operates in collab-
earn continuing medical education credits.
a mild illness lasting a few weeks to a severe ill-
oration with the Arkansas Department of Health
Topics will include how to taper off opioids,
ness lasting several months. A person can trans-
and the Arkansas Department of Education to
alternatives to opioids for pain management,
mit the virus to others up to two weeks before
track the number and characteristics of eight-
when physical therapy is appropriate, when to
and one week after symptoms appear.
year-olds with ASD and/or intellectual disability.
recommend a nerve block or an epidural, and
The virus can cause illness anytime from two
The AR ADDM data found that boys are 3.8
more. Smith said participant interest will guide
to seven weeks after exposure. If infected, most
times more likely to be identified with autism
future topic choices.
people will develop symptoms three to four
than girls. Also, white children are significantly
weeks after exposure. Many people, especially
more likely to be identified with ASD than black
children, may have no symptoms. The older a per-
or Hispanic children. In Arkansas, autism was 30
son is when they get Hep A, typically the more
percent more likely to be identified in white chil-
severe their symptoms are. Up to one in three
dren than in black children and 70 percent more
adults are typically hospitalized. Almost all peo-
likely to be identified in white children than in
The Arkansas Department of Health (ADH)
ple who get Hep A recover completely and do
Hispanic children. Of children identified as ASD
warned of a possible Hepatitis A (Hep A) expo-
not have any lasting liver damage, although they
cases based on record review, about 92 percent
sure after an employee of the Doublebee’s gas
may feel sick for months.
had developmental concerns by age three, but
Health Department Warns of Possible Hepatitis A Exposure to Customers of Walnut Ridge, Arkansas Doublebee’s
station in Walnut Ridge, Arkansas, located at 1003
Hepatitis A is preventable through vaccination.
Hwy 63, tested positive for the virus. Hep A is a
A Hepatitis A vaccine has been recommended for
contagious liver disease.
school children for many years, and one dose of
“As in the overall ADDM Network, Arkansas has
Anyone who ate at this facility between April
Hep A vaccine is required for entry into kinder-
a lag between first concern about a child’s devel-
7 and April 18, 2018 should seek care immedi-
garten and first grade as of 2014. Most adults are
opment and an autism diagnosis,” said Maya
ately if they have never been vaccinated against
likely not vaccinated, but may have been if they
Lopez, MD, associate professor in the UAMS Col-
Hep A, or are unsure of their vaccination status.
received vaccinations prior to traveling interna-
lege of Medicine’s Department of Pediatrics. “We
There are no specific treatments once a person
tionally. Contact the LHU in your county for more
should use this information to promote develop-
gets Hep A; however, illness can be prevented
information about vaccination. A listing of LHUs
mental screening in health and educational pro-
even after exposure by getting the vaccine or a
can be found at www.healthy.arkansas.gov.
viders statewide and to connect these children
medicine called immune globulin. This medicine contains antibodies to Hep A and works best if given within two weeks of exposure to the virus. So far this year, 13 cases of Hep A have been
CDC, UAMS Report: One in 77 Arkansas Children Has Autism Spectrum Disorder
only 31 percent had received a comprehensive developmental evaluation by age three.
with appropriate services.” UAMS’ Dennis Developmental Center and Schmieding Developmental Center, both in the College of Medicine Department of Pediatrics,
reported in this outbreak. Five of the cases have
An estimated one in 77 Arkansas children are
offer diagnostic multidisciplinary team evalua-
involved food service workers. All 13 of the cur-
identified as having Autism Spectrum Disorder
tions for children with developmental and behav-
rent cases have been in adults.
(ASD), according to a new report by the Arkan-
ioral concerns from birth to 21 years of age.
“The number of cases in this Hep A outbreak
sas Autism and Developmental Disabilities Mon-
The Arkansas monitoring program’s findings
are continuing to rise,” said Dr. Dirk Haselow,
itoring (AR ADDM) Program of the University of
also can be used to inform educational outreach
34 JUL / AUG 2018 I Healthcare Journal of little rock
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
initiatives, specifically those targeting minority
will receive health education and screenings for
and underserved populations to promote early
untreated chronic conditions including obesity,
“At St. Bernards, we began the Internal Medi-
identification, plan for services and training, guide
diabetes, and anxiety/depression, as well as refer-
cine residency program to meet a very important
future ASD research, and inform policies promot-
rals to regional physicians for follow-up care.
need in this area—to equip clinically trained phy-
ing improved health outcomes for individuals with
Program.
“The Delta Care-a-van program will allow us to
sicians to provide care to the patients who need it
remove several of the obstacles to health care
the most,” said Chris Barber, president and CEO
AR ADDM provides individualized presenta-
that have prevented local residents from receiving
of St. Bernards Healthcare. “We are happy to
tions on the number and characteristics of chil-
the health services and education they deserve
partner with NYIT College of Osteopathic Medi-
dren with ASD to state and community agen-
and need,” said Shane Speights, DO, native
cine, Arkansas State University, and UAMS on this
cies. The Arkansas monitoring program also
Arkansan and site dean, NYITCOM at A-State.
Delta Care-a-van program so our internal medi-
co-sponsors educational events for families and
“At the same time, this service will provide valu-
cine residents can continue the St. Bernards mis-
educators, such as the Team Up state conference
able clinical training to an army of future physi-
sion of providing Christ-like healing.”
on autism, and collaborates on developmental
cians and health care professionals, and will also
The mobile clinic is expected to begin visiting
disabilities awareness events such as Arkansas
expose them to the joys, opportunities, and chal-
the Arkansas cities of Harrisburg, Leachville, Lep-
Walk Now for Autism Speaks.
lenges of rural practice.”
anto, Manila, Piggott, Walnut Ridge, and Marked
the disorder.
“Our college is excited to be involved in this
Tree in late summer 2018, with plans to expand
interprofessional education and service delivery
services to other areas of the Delta region. The
project that will impact many of the smaller towns
Delta Care-a-van will see patients in the seven
in our region. The health of our communities is so
communities, conducting an expected 78 mobile
New York Institute of Technology College of
important to our economic future,” said Dr. Susan
clinic encounters over the course of approxi-
Osteopathic Medicine at Arkansas State Univer-
Hanrahan, PhD, dean, Arkansas State University
mately 18 months, and will offer evening hour
sity (NYITCOM at A-State) has received a total
College of Nursing and Health Professions. “I
services.
award of $828,748 from the United States Depart-
think we can make a difference.”
NYITCOM at A-State Secures USDA Funding for Mobile Medical Clinic
From these visits, NYITCOM at A-State will col-
ment of Agriculture (USDA) for a mobile medical
Equipped with two examination rooms and
lect data regarding diabetes, obesity, immuniza-
clinic aimed at delivering healthcare to under-
state-of-the-art telemedicine technology (tele-
tion and vaccination, prenatal care, mental health,
served and rural populations in Arkansas and the
communication and information technology that
and other health topics to measure performance
Delta region.
enables clinical healthcare from a distance), the
levels and determine strategies for improving
Healthcare outcomes in the Mississippi
mobile clinic will offer a training program for
patient outcomes.
Delta region are among the worst in the nation,
medical students from NYITCOM at A-State,
creating a high demand for clinically trained rural
resident physicians from UAMS and St. Ber-
physicians and health professionals. In an effort to
nards Medical Center, and Arkansas State Uni-
break down barriers to health care, NYITCOM at
versity nursing and social work students. Under
A-State, in collaboration with Arkansas State Uni-
the guidance of NYITCOM at A-State faculty
versity (A-State) College of Nursing and Health
and trained medical experts, these students
Professions, University of Arkansas for Medical
will conduct screenings and wellness examina-
A University of Arkansas for Medical Sciences
Sciences (UAMS) Northeast Family Medicine Res-
tions to monitor blood pressure, blood glucose,
(UAMS) professor of neurobiology recently co-
idency Program, and St. Bernards Medical Cen-
and signs of mental health conditions. Patients
authored a Kentucky Law Review article that
ter Internal Medicine Residency Program, will
requiring additional treatment will be connected
offers insights into the nature of criminal intent,
develop a mobile medical clinic, known as the
to local providers or receive telemedicine con-
and urges the court system to admit more expert
Delta Care-a-van.
sultation while on board the mobile clinic, build-
testimony into trials regarding the subject.
For more information about NYITCOM at A-State, visit https://www.nyit.edu/arkansas.
UAMS Professor Offers Insights into Criminal Intent, CoAuthors Law Review Article
This mobile clinic will initially travel to the
ing upon NYITCOM at A-State’s legacy of being
In “Actus Reus, Mens Rea, and Brain Science:
heart of seven northeast Arkansas rural commu-
among the first United States medical schools to
What Do Volition and Intent Really Mean?,” Edgar
nities to deliver preventative care services and
train first-year medical students to deliver care
Garcia-Rill, PhD, and the late Erica Beecher-
health education without cost or need for an
via telemedicine.
Monas, JD, give the example of someone walk-
appointment. Funded by the USDA Delta Health-
“UAMS Northeast Family Medicine Residency
ing along a sidewalk while in conversation, yet
care Service Grant—with $828,748 awarded
is very excited to be a part of this innovative proj-
being preconscious of traffic and other pedestri-
in federal shares and $228,604 provided in
ect that will help bring vital preventative care ser-
ans, allowing for safe navigation.
kind—this service will expand care to
vices to Arkansans who live in the Delta,” said
The co-authors conclude that, “we are con-
patients who might otherwise be unable to see
Scott Dickson, MD, assistant professor and direc-
scious while performing the movement, and that
a physician. Patients visiting the mobile clinic
tor, UAMS Northeast Family Medicine Residency
the activity preceding the intent is a manifestation
Healthcare Journal of little rock I JUL / AUG 2018 35
Healthcare Briefs of our preconscious awareness. That is, we are
recently held two Hepatitis A (Hep A) vaccina-
weeks after exposure. Many people, especially
preconscious to the performance of our move-
tion clinics.
children, may have no symptoms. Up to one in
These clinics are for anyone at higher risk of
three adults are typically hospitalized. Almost all
getting Hep A. Risk factors include: close contact
people who get Hep A recover completely and
Studies by the late researcher Benjamin Libet
with someone who has Hep A; restaurant work-
do not have any lasting liver damage, although
in the early 1980s suggested that one’s voluntary
ers; people with infections or chronic diseases
they may feel sick for months.
movements begin unconsciously, because brain
like Hep B or C, HIV/AIDS, or diabetes; drug use;
Hepatitis A is preventable through vaccination.
waves are manifested in advance of the subjec-
homelessness; or incarceration. If you do not fall
Hepatitis A vaccine has been recommended for
tive will to move. This led to the suggestion that
into a group with a high risk of getting Hep A, but
school children for many years, and one dose of
there is no free will. Libet surmised that individu-
are still concerned about Hep A, see your doctor
Hep A vaccine is required for entry into kinder-
als still have the ability to stop actions or move-
or healthcare provider.
garten and first grade as of 2014. Most adults are
ments, and therefore responsible for all of our actions. And yes, free will is alive and well.”
ments of which they are not fully conscious. This became known as free won’t. However, Garcia-Rill has been working on the
At these clinics, the shot is provided at no cost
likely not vaccinated, unless they received vacci-
to the patient. ADH bills the patient’s insurance,
nations prior to traveling internationally. Patients
if the patient has it.
can contact the closest county health unit for
brain regions that further preconscious aware-
Since February of 2018, 31 cases of Hep A have
more information about vaccination. A listing of
ness, and such activity is present in a person’s
been reported as part of an outbreak in northeast
county health units can be found at www.healthy.
brain while conscious (not when one is uncon-
Arkansas, with a majority of the cases in Clay and
arkansas.gov.
scious) but the person is just not paying atten-
Greene counties. Cases have also been found in
tion to it, thus the term preconscious awareness.
Lawrence, Randolph, and Craighead counties. All
Garcia-Rill is director of the UAMS Center
of the cases have been in adults.
for Translational Neuroscience, funded by the
“The number of cases in this Hep A outbreak is
National Institute for General Medical Sciences’
continuing to rise,” said Dr. Dirk Haselow, state
IDeA Program.
UAMS, DHS Launch Free Consultation Service for Healthcare Providers Treating Opioid-Addicted Patients
epidemiologist. “There are numerous Hep A
The University of Arkansas for Medical Sciences
Beecher-Monas was a professor of law at Wayne
outbreaks occurring across the country. We are
(UAMS) and the Arkansas Department of Human
State University until her death in the summer of
encouraging everyone in these areas to be aware
Services (DHS) launched a free one-on-one con-
2017.
of the risk factors for getting Hep A and to get
sultation service for healthcare providers treating
vaccinated if needed.”
patients diagnosed with opioid addiction.
Garcia-Rill and Beecher-Monas argue that the legal concepts of criminal act and criminal intent are outmoded.
Handwashing can also prevent the spread of
These providers can call the Medication-
Hep A. If soap and water are not available, clean
Assisted Treatment Recovery Initiative for Arkan-
“The legal meaning of choice, intent, and voli-
hands with hand sanitizer containing at least 80
sas Rural Communities (MATRIARC) hotline for
tion originated not from empirical studies about
percent alcohol. Hep A is a contagious liver dis-
advice on a range of topics—anything from deter-
human brains and behavior, but from ungrounded
ease that results from infection with the Hepa-
mining dosages of addiction treatment medica-
beliefs about human nature,” the authors stated.
titis A virus. It is usually spread when a person
tions like buprenorphine/naloxone (Suboxone),
“The law still operates on outdated, 19th century
ingests tiny amounts of fecal matter from contact
to connecting patients with support services to
assumptions about how human beings function.”
with objects, food, or drinks contaminated by the
handling billing. The providers can also receive a
Refusing to admit expert testimony about men-
feces, or stool, of an infected person. Hep A can
telemedicine consult for advice or a second opin-
tal illness is contributing to the complex prob-
also be spread through unprotected sex or the
ion from a UAMS addiction expert.
lem of mental illness among prison inmates, and
sharing of injection drugs.
To connect with the hotline service, call (833)
failing to protect society when the convicted are
Typical symptoms of Hep A include fever,
released, Garcia-Rill and Beecher-Monas argued.
fatigue, loss of appetite, nausea, vomiting,
“There are few people in the state who are pro-
“Judges should instead admit expert testimony
abdominal pain, dark urine, clay-colored bowel
viding medication-assisted treatment, so many of
so the jury can perform its interpretive and evalu-
movements, joint pain, or jaundice (yellowing of
our patients drive hours for treatment and others
ative functions,” they concluded.
the skin or eyes). It can range in severity from a
never seek treatment because of these barriers
The article and the edition of Kentucky Law
mild illness lasting a few weeks to a severe illness
to care,” said Michael Mancino, MD, a psychia-
Review in which it was published were dedicated
lasting several months. A person can transmit the
trist, director of the Center for Addiction Services
to the family of Beecher-Monas.
virus to others up to two weeks before and one
in the UAMS Psychiatric Research Institute, and
week after symptoms appear.
leader behind MATRIARC.
ADH Holds Hep A Vaccination Clinics in Northeast Arkansas The Arkansas Department of Health (ADH)
872-7404 or (501) 526-8459.
The virus can cause illness anytime from two
“We think helping community providers gain
to seven weeks after exposure. If infected, most
the knowledge and confidence to treat these
people will develop symptoms three to four
patients close to home will be an important step
36 JUL / AUG 2018 I Healthcare Journal of little rock
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
Helicopter Delivers Ball for First Pitch at Arkansas Travelers for Strike Out Stroke Night A helicopter landed with University of Arkansas for Medical Sciences (UAMS) neurologist and AR SAVES medical director Sanjeeva Reddy Onteddu, MD, to deliver the ball for the first pitch of the Arkansas Travelers’ game against the Springfield Cardinals. During the event, volunteers answered questions about stroke, distributed stroke education materials, and threw brain-shaped stress toys into the stands. Stroke survivors were also honored. The event, held at Dickey-Stephens Park, was sponsored by the UAMS-led AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support) program and hosted by the Arkansas Travelers.
in addressing the deadly opioid epidemic in
opioid addiction, also called opioid use disorder,
Arkansas.”
with medications like buprenorphine. Treatment
of Family Physicians. Physicians and APRNs also attended a separate
The service was announced at a symposium at
through the UAMS Center for Addiction Services
hands-on session to practice joint injection of the
UAMS about the opioid epidemic’s national and
involves a combination of medication and group
knee and shoulder taught by orthopaedic special-
state impact. The symposium speakers included
and individual therapy.
ists John Bracey, MD, and Michael Cassat, MD.
Mancino; Pedro Delgado, MD, director of the
In Arkansas, there are about 85 doctors certi-
Other topics were migraines, cold turkey smok-
UAMS Psychiatric Research Institute; Cindy Gil-
fied to prescribe buprenorphine, much less than
ing cessation, opioid use in Arkansas, breast can-
lespie, director of the Arkansas Department of
many other states. For example, in Tennessee,
cer screening, and genetic testing for gynecologi-
Human Services; Kirk Lane, state drug director;
there are more than 800.
cal cancer. It featured an Arkansas clinic’s success
John Kirtley, PharmD, executive director of the
“Most of those doctors are centered in large
Arkansas Pharmacy Board; and Laura Monteverdi,
cities; they’re not located in small communities
anchor on THV11’s Morning Show.
where people can drive down the street and go
MATRIARC is made up of two parts—the hot-
see their doctor,” Mancino said. “Our goal is for
line service that is open now and a group video
there to be doctors in every part of the state who
conference service that launches in August.
can offer help to these patients.”
The group conference program will also be free and open to healthcare providers who are treating or who are interested in treating patients addicted to opioids. The group will meet via a
story in team-based care, project management, electronic medical records, and billing.
Public Invited Attend UAMS Community Scientist Academy Arkansans interested in having a voice in
Family Medicine Conference Gives Practical Topics for Practitioners
research programs at the University of Arkansas for Medical Sciences (UAMS), or simply learning how research is done, were invited to participate in UAMS’ Summer 2018 Community Sci-
live online video connection and be able to learn
Family physicians, nurses, pharmacists, and
about treating opioid addiction and present spe-
physical therapists learned updates on marijuana
entist Academy. Sponsored by the UAMS Translational Research
cific cases for advice and consultation.
and medicine, fibromyalgia, sleep apnea, and
Institute, the Community Scientist Academy was
Arkansas ranks second in the nation for its opi-
common orthopedic issues at the 40th Annual
held on Tuesdays each week, May 22 through
oid prescribing rate with an average of 114.6
Family Medicine Intensive Review Course held
June 26, from 5:30–7:30 p.m. on the UAMS cam-
prescriptions per 100 people, according to U.S.
recently at the University of Arkansas for Medical
pus in Little Rock.
Centers for Disease Control and Prevention data
Sciences (UAMS).
The training was offered at no cost to
from 2014–2016.There were 116 deaths per day
With more than 23 hours of content, including
from opioid-related drug overdoses in the United
a full day of orthopaedic topics, the conference
Participants in the Community Scientist Acad-
States in 2016, according to the U.S Department
featured updates on the Medicare Access and
emy interacted with UAMS researchers and com-
of Health and Human Services.
CHIP Reauthorization Act of 2015 by Amy Mullins,
munity members involved in research in small
MD, medical director for the American Academy
roundtable discussions and other interactive
It takes specific training to be able to treat
participants.
Healthcare Journal of little rock I JUL / AUG 2018 37
Healthcare Briefs sessions. They learned:
an important population health issue, with the
* How researchers decide what health issues to
goal of improving public health outcomes.
study
The team consists of Keneshia Bryant-Moore,
* The research process
PhD, RN, associate professor; and Tiffany Haynes,
* The benefits of individual and community orga-
PhD, assistant professor. Both are with the UAMS
nizations’ involvement in research
Fay W. Boozman College of Public Health. The
Graduates of the Community Scientist Acad-
other members are Joy Rockenbach, faith-
emy became more knowledgeable volunteers
based coordinator at the Arkansas Department
with additional opportunities to help influence
of Health, and Rev. William Givens, minister of
UAMS research decisions on behalf of their communities. Examples include serving on:
Amanda George, CPA, MHSA
* Standing community advisory boards
Bryant-Moore is the team lead for Arkansas FAITH Network.
* One-time community boards created to advise
“This is a great opportunity for academia, pub-
researchers on specific studies * Panels that decide what research grants get
Christian education for St. John Baptist Church.
lic health, and faith/community leaders to not UAMS Medical Center. “Her experience in the
only have training and support from the national
funded
College of Medicine and at the service line level,
program and the CDC, but to really dig deep
For graduates who are leading community
as well as her work at other institutions, provides
and address population health with those most
organizations, there may also be opportunities to
insight into the budgeting process required to
affected by illness due to health disparities,” Bry-
partner with UAMS on community-based research
achieve our financial goals and support a bal-
ant-Moore said.
projects.
anced budget for the institution.”
Arkansas ranks 48th in the nation in overall
“The Community Scientist Academy will pro-
George previously served as service line admin-
health status and in the ability to access health-
vide the basic knowledge to strengthen the pub-
istrator for the Medical Specialties service line
care. Individuals in Arkansas are more likely to
lic’s voice on research steering committees, men-
and as administrator for the Department of Inter-
report engaging in behaviors such as smoking
toring committees, review committees, research
nal Medicine. Before joining UAMS, she served
and lack of physical activity that place them at risk
projects, and in other leadership capacities,” said
as controller for ambulatory services for the East/
for developing chronic health conditions.
Kate Stewart, MD, MPH, who leads the Transla-
Southeast division of Catholic Health Initiatives
The team will address three health issues due
tional Research Institute’s Community Engage-
in Little Rock and assistant controller for St. Vin-
to disparities experienced in racial/ethnic minority
ment program. “We want our fellow Arkansans
cent Health System hospitals in North Little Rock
communities and vulnerable populations includ-
to understand what we do because their input
and Morrilton.
ing mental health, obesity, and diabetes over the
makes a big difference in our efforts to improve health.” UAMS researchers conduct clinical studies and community-based studies. Its clinical studies are conducted in UAMS’ hospital and clinics across the state, including at its main campus in Little Rock, its eight regional campuses, Arkansas Children’s Research Institute, and the Central Arkansas Veterans Healthcare System.
Amanda George Named CFO for UAMS Clinical Programs Amanda George, CPA, MHSA, has been named associate vice chancellor for clinical finance and
She is a certified public accountant and has a bachelor’s degree in accounting and finance from the University of Central Arkansas and a master’s in health services administration from UAMS.
Arkansas FAITH Network Selected for National Public Health Leadership Program The Arkansas Faith-Academic Initiatives for
next several years. Initial projects will focus on mental health. “This program will impart population health teams with the skills to lead across sectors and collaboratively solve complex population health problems in innovative ways,” said Carmen Rita Nevarez, MD, MPH, vice president for external relations and director of the Center for Health Leadership and Practice.
Transforming Health (FAITH) Network has been
The National Leadership Academy for the Pub-
selected to participate in the National Leadership
lic’s Health will provide training and support to
Academy for Public’s Health program, funded by
assist the team in successfully addressing men-
the Centers for Disease Control and Prevention
tal health in Arkansas. Training and support will
(CDC).
focus on two tracks. The first track is the develop-
chief financial officer for the Integrated Clinical
The Arkansas FAITH Network is a collaboration
ment of leadership skills, including personal and
Enterprise at the University of Arkansas for Med-
of the University of Arkansas for Medical Sciences
collaborative leadership in a multi-sector environ-
ical Sciences (UAMS). George has been at UAMS
(UAMS) and faith-based organizations. They work
ment. The second track emphasizes growth from
since 2013.
to deliver health programs and health education
team-based collaborative work to policy and sys-
to faith communities across the state.
tems change.
“Amanda is uniquely qualified to serve in this role,” said Richard H. Turnage, MD, senior vice
The Arkansas FAITH Network team will work on
The National Leadership Academy for the
chancellor for clinical programs and CEO for
an applied health leadership project that tackles
Public’s Health is a national program focused
38 JUL / AUG 2018 I Healthcare Journal of little rock
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
on improving population health by working with multi-sector leadership teams and training the teams through an applied, team-based collaborative leadership development model. The program is implemented by the Center for Health Leadership and Practice, a center of the Public Health Institute, and will provide training and support for one year.
UAMS Researchers Unlock More Clues to Alzheimer’s University of Arkansas for Medical Sciences (UAMS) researchers led by Sue Griffin, PhD, have found a way to illustrate how a protein known to be a risk factor for Alzheimer’s disease interacts with DNA. Sue Griffin, PhD, is an internationally known Alzheimer’s disease researcher at UAMS. The findings were published in February in Alzheimer’s and Dementia, the Journal of the Alzheimer’s Association.
University of Arkansas for Medical Sciences (UAMS) researchers Sue Griffin, PhD, right, Meenakshisundaram Balasubramaniam, PhD, and Paul Parcon, MD, PhD candidate.
Apolipoprotein E, more commonly known as ApoE, is a protein in the body responsible for carrying cholesterol and other fats through the
autophagy, the process by which cells get rid of
simulate what was happening at the molecular
bloodstream, and is the main protein for supply-
proteins that are no longer needed.
level by using advanced computational tools run-
ing lipids to brain cells. Everyone has two copies
“In Alzheimer’s, it’s pretty clear that autoph-
of the gene for ApoE, one inherited from each
agy has failed,” Griffin said. “Because there’s
“This research is a perfect example of interdis-
parent.
more buildup of tangles inside and plaques out-
ciplinary work,” Balasubramaniam said. “Biol-
side the nerve cells. The waste is just not being
ogy, computational modeling followed by exper-
eliminated.”
imental validation came together to understand
Most people have two copies of ApoE3, considered to be associated with average risk for devel-
ning on high-performance super computers.
molecular mechanism of ApoE4”
opment of Alzheimer’s. But 10–15 percent of the
Parcon and Griffin began looking at what could
population has at least one copy of the gene for
be causing that failure. Griffin said that three
Balasubramaniam says they not only predicted
ApoE4. That population is three times as likely
proteins are necessary for autophagy; all three
the ApoE4 interaction in the simulation, they
to develop Alzheimer’s, and will tend to develop
of these proteins are made from an interaction
proved it using the experimental approach in
symptoms at an earlier age. The risk increases to
between a transcription factor and a specific DNA
the research paper.
12 times for those who have two copies of ApoE4.
sequence, and Parcon proposed that this interac-
Abnormal clusters of plaques and tangles are
tion could be affected by ApoE4.
The researchers hope this finding will be the first step in developing a drug that would treat
the characteristic finding in Alzheimer’s. Griffin’s
“We proposed that ApoE4 competes with the
those with Alzheimer’s disease. “Now that we
group noticed that patient carriers of ApoE4 had
transcription factor—the final piece needed for
know it is the ApoE4 protein that is interacting
significantly more of these plaques and tangles
autophagy—to block the process,” Griffin said.
with the DNA, we may be able to model a mole-
built up between and within nerve cells, along
“This explained why those who have two copies
cule to block that interaction so that the cells may
with fewer nerve cells. She said the discovery of
of ApoE4 have more plaques and tangles, and
then function normally,” Parcon said.
more plaques and tangles in people with two
why they were more likely to develop Alzheim-
copies of ApoE4 gets scientists closer to answer-
er’s disease at an earlier age.”
ing the question, “Why are people with the
Caption: University of Arkansas for Medical Sciences (UAMS) researchers led by Sue Griffin,
Meenakshisundaram Balasubramaniam, PhD, a
PhD, have found a way to illustrate how a pro-
computational biologist and postdoctoral fellow
tein known to be a risk factor for Alzheimer’s dis-
Griffin and graduate student Paul Parcon were
at the lab of Robert J. Shmookler-Reis, DPhil, in
ease interacts with DNA. Pictured with Griffin,
discussing their ideas over lunch one day when
the College of Medicine’s Department of Geriat-
right, are co-author Meenakshisundaram Bala-
Parcon, an MD PhD candidate, suggested the
rics, is a co-author with Griffin, Reis, Parcon, and
subramaniam, PhD, and Paul Parcon, MD, PhD
problem might be caused by a disruption of
Ayyadeva. Balasubramaniam told them he could
candidate n
ApoE4 gene at a higher risk?”
Healthcare Journal of little rock I JUL / AUG 2018 39
column policy
The national dialogue on gun violence has intensified in response to mass shootings in Las Vegas, Parkland, Florida, and Santa Fe, Texas. The frequency of these events, and the protests and advocacy efforts they have inspired, have moved the issue of gun violence to the forefront of public consciousness. However, the frequency is also numbing because of the expectation, even voiced by school students across the nation, of the next shooting. A consensus on how to address the problem has not yet emerged, but it is time to initiate frank discussion on what we know.
a firm stance, stating, “The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.” Earlier this year, Health and Human Services Secretary Alex Azar, expressed support for expanding federal gun violence research within the CDC. The CDC collects data on firearm deaths and injuries, but research has been limited since passage of the Dick-
Gun Violence: A Public Health Perspective
ey Amendment, a 1996 provision in federal legislation that prohibits the agency from spending money on advocacy or promotion of gun control. The amendment’s sponsor was Republican Rep. Jay Dickey of Arkansas, who died last year. In his later years, Dickey expressed regret about the amendment and favored new research on gun violence. In 2016, more than 100 medical organizations signed a letter calling on Congress to lift the Dickey Amendment. Azar has said he believes the amendment only bars the CDC from tak-
According to the Centers for Dis-
The rate of gun-related homicides in the
ing an advocacy position, not from doing
U.S. was 3.61 per 100,000. That was over
research. Language in Congress’ omnibus
Each year, 38,000 people in the U.S. die as
seven times higher than the rate in Canada,
spending bill earlier this year restated this
a result of gun violence, and almost 85,000
which had the second-highest rate at 0.5 gun
interpretation.
more suffer non-fatal gun injuries.
homicides per 100,000 people, and was 25
There is a financial—as well as a human—
times higher than the rate for the rest of the
cost to gun violence. A 1999 study published
wealthy nations as a group.
in The Journal of the American Medical Asso-
ease Control and Prevention:
Nationally, the rate of firearm-related deaths increased from 10.3 per 100,000 people in 2014 to 11.8 per 100,000 people
One concept that is gaining support is
ciation found that the 134,445 gunshot in-
in 2016. The rate is even higher in Arkansas,
that gun violence should be viewed and
juries reported in the U.S. in 1994 produced
which went from 16.6 deaths per 100,000
studied as a public health issue. The Amer-
$2.3 billion in medical costs, of which an
people in 2014 to 17.8 deaths per 100,000
ican Public Health Association cites gun
estimated $1.1 billion, or 49 percent, was
people in 2016.
violence as a major public health problem
paid by taxpayers. Lost productivity and dis-
and a leading cause of premature death. The
ability costs of survivors are immeasurable.
A 2016 study published in The American
Journal of Medicine reviewed 2010 World
American Medical Association has called
Also, studies have shown that violent
Health Organization data and found that:
gun violence a public health crisis requiring
crime and a perceived lack of safety have
Among the 23 nations with per capita
a comprehensive public health response and
an indirect impact on public health by cre-
gross national incomes greater than $12,736,
solution. Because children are frequently
ating barriers to outdoor physical activity.
the U.S. accounted for 46 percent of the pop-
injured at home or while visiting others, the
Physically active people have a lower risk
ulation, but 82 percent of gun deaths.
American Academy of Pediatrics has taken
for health problems such as heart disease,
40 JUL / AUG 2018 I Healthcare Journal of little rock
Joseph W. Thompson, MD, MPH Director, Arkansas Center for Health Improvement
high blood pressure, and type 2 diabetes. As a pediatrician, I am acutely aware of and concerned about the impact of violence
unwilling to play outside, and fear of gangs
locks, gun safes, and storage strategies to
or crime was one of the top three responses
separate ammunition from firearms. Bal-
from both boys and girls.
ancing gun owners’ rights with their respon-
on children. Adverse Childhood Experiences,
Mass shootings typically are followed by
sibilities while finding ways to identify at-
or ACEs, is a term researchers use for stress-
calls for greater restrictions on gun access
risk individuals and engage in appropriate
ful or traumatic events such as abuse, ne-
by people with mental health problems.
interventions are discussions that need to
glect, or the witnessing of violence. ACEs are
The issue is complicated, however. Of the
happen.
associated with the development of risky
millions of Americans with mental health
Some may question why gun violence
health behaviors, chronic health conditions,
issues, the vast majority are not violent. Cer-
should be viewed through a health lens,
low life potential, and early death. The 2016
tainly, this is an area where more research
arguing that it has no medical cure. But
National Survey of Children’s Health found
would be beneficial.
healthcare professionals seek not just to
that 5 percent of Arkansas children have
The presence of youth-on-youth violence
cure ailments but also to promote health.
been a victim of, or a witness to, neighbor-
at schools is not new—Jonesboro experi-
It is becoming clear that gun violence is an
hood violence, compared to 3.9 percent
enced a school shooting two decades ago.
epidemic that threatens the ability of Ameri-
nationally.
However, the frequency and lethality of
cans to lead healthy lives, beginning as early
In one study, children ages 6-14 in New
these events is increasing. There are clear
as childhood. Arkansas is, unfortunately, no
Jersey were asked what would make them
strategies to safely maintain guns—trigger
exception. n
Healthcare Journal of little rock I JUL / AUG 2018 41
dialogue
column
Director’s Desk
Expanded Options for Adoption Records in Arkansas One of the important functions performed by the Arkansas Department of Health is to provide vital records for Arkansans. Vital records are documents of important life events, such as births, deaths, marriages, and divorces. There are procedures that instruct the public on how to access records. This month, there are changes pertaining to adoption records.
On average, there are about 400 adop-
Department of Health for birth parents to
new form that medical professionals, such
tions recorded in Arkansas each year. In the
complete. The first form is a contact prefer-
as obstetricians, should tell their patients
past, the law governing access to adoption
ence form that allows a birth parent to indi-
about if they are considering placing their
records meant that access to files was lim-
cate his or her preference for contact with
child up for adoption. This information will
ited, and Arkansas was considered a closed
the individual requesting the adoption file.
allow adoptees the opportunity to identify
adoption state. Act 519 of 2017 changed the
The second form is a family history form that
hereditary health issues. Not all adoption
law regarding who may access adoption
allows birth parents to add updated social,
files will include this updated medical his-
records. Now, adoptees are able to request
cultural, and medical history information to
tory; however, the new policy does allow
their adoption file from the Arkansas De-
what is already in an adoption file, including
for the medical history of an adoptee’s bio-
partment of Health after they turn 21 years
any known medical conditions of the birth
logical family to be updated, which has not
old. This law also brings significant changes
parents or their relatives. Birth parents can
always been the case.
for an adoptee’s birth parents, and parents
also indicate any drug or alcohol use during
considering adoption. Some changes for birth parents to be
the pregnancy, the mother’s reproductive life (age of first menses, age at menopause, mis-
aware of include the ability to provide im-
carriages or fertility issues), and if there were
portant contact and medical information for
special circumstances surrounding concep-
the adoptee, as well as the ability to redact
tion, pregnancy, or delivery. A special cir-
their names from the file, and their prefer-
cumstance could include the mother-to-be
ence for contact with the adoptee. Three
being put on bed rest or not carrying to term.
forms are available through the Arkansas
The medical history information form is a
42 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK
Nathaniel Smith, MD, MPH Director and State Health Officer, Arkansas Department of Health
Finally, birth parents that would like to
Beginning August 1, 2018, written requests
must be notarized and include proof of
request the redaction of their names from
for adoption files will be accepted from
their identity. There is a $100 fee to process
the original birth file may do so by filling
adoptees or, upon their death, by a surviv-
an application for adoption files. Adoptees
out a redaction request. In order to submit
ing spouse, child, or guardian of a child of
must provide identification such as a driv-
a redaction request, the birth parent must
a deceased adoptee. Adoptees should note
er’s license, passport, or temporary resident
show proof of his or her identity and submit
that the information in an adoption file
card, while their surviving spouse, child, or
a notarized form. A form cannot be submit-
might vary widely from file to file. Each file
guardian of a child of a deceased adoptee
ted by one birth parent for another. While
usually includes an original birth certificate
must show documentation establishing their
the birth parent’s name will be redacted,
and adoption decree. Beyond this basic in-
relationship to the adoptee. Upon receiv-
the birth certificate may still include some
formation, some files may not contain much
ing a request, the Arkansas Department of
identifying information, such as race and
detail, while others include court documents,
Health staff will diligently search through
occupation, as well as the hospital and town
such as affidavits from grandparents, peti-
files for an adoption record that matches the
where the birth occurred. As adoption file
tions from the biological father if he is not
request. Timeframes for accessing files may
requests are made, Arkansas Department
named in the original birth record, or infor-
vary depending on how much information is available, age of the file, and other factors.
of Health Vital Records staff will look at all
mation from attorneys and others involved.
requests for redaction forms first, before
Before this year, an adoption file could only
The forms needed by adoptees, as well as
filling the requests. The redaction forms may
be accessed by a court order. A person had to
those forms for birth parents, may be picked
be filled out or updated at any time.
have a judge rule that he or she had a com-
up at any Arkansas Department of Health Local Health Unit in the state. Forms must
Birth parents who wish to redact their
pelling reason to access his or her adoption
names from adoption files or update their
record. The Arkansas Department of Health
be returned via mail to the Arkansas Depart-
contact or medical information are encour-
did not regularly receive court orders for
ment of Health Vital Records Department,
aged to fill out the forms found online at
adoption files.
www.healthy.arkansas.gov.
State Registrar, 4815 West Markham St., Slot
All written requests for adoptees’ files
44, Little Rock AR 72205. More information is available by contacting
[email protected] or 1-800-462-0599, and asking to speak with someone about the forms and processes used by birth parents and adoptees. n
“Beginning August 1, 2018, written requests for adoption files will be accepted from adoptees or, upon their death, by a surviving spouse, child, or guardian of a child of a deceased adoptee.”
Healthcare Journal of LITTLE ROCK I JUL / AUG 2018 43
column Mental Health
Be the Voice
To Stop Suicide
Suicide is the 10th leading cause of death overall in Arkansas. On average, one person dies by suicide every 16 hours in the state, and more than twice as many people die by suicide in Arkansas annually than from homicide. Suicide knows no age, race, gender, or socio-economic boundaries, and no one expects it to happen to them or someone they love.
S
uicide did not cross my mind until it happened to my family. After losing my father, Larry, to suicide when I
was 13 years old, I was left trying to understand why.
How could this have happened? How could my intelligent, loving father, who loved his children, take his own life? He
was a wonderful father who, like many fathers, took us to our extracurricular activities, sporting events, and wonderful
What leads to suicide? There’s no single cause. Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Most people who actively manage their mental health conditions lead fulfilling lives. Conditions like depression, anxiety and substance use problems, especially when unaddressed, increase risk for suicide.
vacations. One of his favorite things to do with us was take us camping and spend lots of time outdoors. What could I or anyone else have done? The question that weighs most heavily on my mind 37 years after losing my father is why are we still not treating mental health issues the same as other physical health issues? When are we going to start treating the brain like any other organ in our bodies, and when are we going to demand change? We cannot continue to lose our family and friends to an illness that is preventable. Suicide is a public health issue, and we all have a role to play in preventing suicide. It is time to take action. In 2008, I decided my role was to become a volunteer with the American Foundation for Suicide Prevention. AFSP is dedicated to saving lives and bringing hope to those affected by
44 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK
Wendy Thompson Area Director American Foundation for Suicide Prevention
Prevention. This fundraising walk supports
Suicide Warning Signs
the American Foundation for Suicide Prevention’s local and national education and ad-
Talk If a person talks about: • • • • • •
Killing themselves Feeling hopeless Having no reason to live Being a burden to others Feeling trapped Unbearable pain
Behavior Behaviors that may signal risk, especially if related to a painful event, loss, or change: • Increased use of alcohol or drugs • Looking for a way to end their lives, such as searching online for materials or means
Withdrawing from activities Isolating from family and friends Sleeping too little or too much Visiting or calling people to say goodbye • Giving away prized possessions
vocacy programs and its bold goal to reduce
Mood
affected by suicide. Arkansas now has six
People who are considering suicide often display one or more of the following moods:
Texarkana, Malvern, and Jonesboro, and all
• • • •
• • • • • • •
the annual rate of suicide 20 percent by 2025. We walk to raise awareness about this important health issue. Suicide touches one in five American families. We hope that by walking, we save lives and bring hope to those community walks throughout the state in North Little Rock, Bentonville, Fort Smith, of them will take place this fall. More than 375 Out of the Darkness Community Walks are
Depression Anxiety Loss of interest Irritability Humiliation Agitation Rage
held nationwide. The walks are expected to unite more than 250,000 walkers and raise millions for suicide prevention efforts. These walks are about turning hope into action. Suicide is a serious problem, but it is a problem we can solve. The research has shown us how to fight suicide, and if we keep up the fight, the science is only going to get better, our culture will get smarter about mental health, and we’ll be able to save more people from dying from depression and other mental health conditions. It is time for ev-
suicide. AFSP creates a culture that is smart
Bereavement Clinician Training (SBCT) to
about mental health through education and
the state in August. SBCT is a one-day work- stop suicide.
community programs, develops suicide pre- shop that provides a focused overview of the vention through research and advocacy, and
Please join us at one of the walks at www.
impact of suicide on survivors, and the clini- afsp.org/walks or register to attend one of
provides support to those affected by sui- cal and support responses that are needed. cide. In 2008, the first Out of the Darkness
eryone to get involved and be the voice to
our upcoming trainings at www.afsp.org/
Developed jointly by the American Associa- arkansas. n
Walk for suicide prevention was held in Little
tion of Suicidology, the American Foundation
Rock, and in 2009, the Arkansas Chapter of
for Suicide Prevention, and John R. Jordan,
Wendy Thompson started the first Out of the Darkness Community Walk in Arkansas, and co-founded the is intended for clinical professionals seeking AFSP Arkansas Chapter in 2009. During her time as a volunteer, she served as the board chairman, secretary, to bolster their knowledge and understandtreasurer, Survivor Outreach Program coordinator, and ing of—and empathetic regard for—people walk chair before becoming the AFSP Area Director for Arkansas and Oklahoma in September 2016. Prior bereaved by suicide. As a non-profit, AFSP is able to further our to joining AFSP, Ms. Thompson served as Assistant Director at the UAMS Center for Health Literacy, and mission because of generous contributions Director of Operations at the March of Dimes. Wendy from individuals, corporations, and foun- is a suicide loss survivor after losing her father to suidations. Our signature fundraising event is cide in 1981. She is married to Executive Chef Len the Out of the Darkness Walk for Suicide Thompson, and they have two sons, Dylan and Tristan.
the American Foundation for Suicide Pre- Ph.D., a leading expert in this area, the SBCT vention was formed. Since 2008, we have had countless volunteers working across the state to further our mission. We have a variety of education programs, including Talk Saves Lives™, a communitybased program that teaches the risk and warning signs of suicide, research on prevention, and what people can do to fight suicide. In addition, AFSP will bring a Suicide
Healthcare Journal of LITTLE ROCK I JUL / AUG 2018 45
dialogue
column medicaid
Medicaid’s Response to Opioid
Prescribing
Overuse of prescription narcotics has led to a widely publicized epidemic of addiction and overdose deaths. Arkansas Medicaid had interventions in place to reduce some problematic prescribing earlier this decade, and has increased its interventions to reduce risks in our communities.
A summary of key changes follows:
shopping and patients collecting multiple prescriptions of narcotics paid for by the
Fentanyl lollipops
program.
Believe it or not, this potent drug was widely marketed 10 years ago. Designed for
Mandatory Provider Enrollment
like many other state programs, has gradu-
quick onset for short, painful procedures like
Pharmacy managers noticed patterns
ally reduced the maximum daily MME to be
the changing of dressings in burn patients,
likely representing “pill mill” prescribing in
paid for with program funds. As of this fall,
or for patients with head and neck cancer
out-of-state facilities. Rules were changed to
the program will pay for only the equivalent
who had limited oral intake, the drug be-
require prescribers and pharmacies to enroll
of 90 mg of morphine a day for chronic pain
came used in some primary care practices
as Arkansas Medicaid providers, which would
management.
for headaches and even back pain. Arkan-
require them to adhere to program oversight
sas Medicaid learned of abuses elsewhere
and potential removal for abusive activity
in the country and limited prescribing only
patterns. Several of the suspicious actors did
A core response to the opioid crisis is to
to cancer/burn patients with specific indica-
not enroll and thus could no longer supply
reduce the number of new patients depen-
tions several years ago, and tamped down the
narcotics paid for by program funds.
dent on prescription medication. In keeping
potential for widespread abuse and diversion.
New Start Limitations
with CDC guidelines, Arkansas Medicaid now Daily Morphine Equivalent (MME) Limits
limits new starts of opioid medications to
As health professionals re-evaluated ap-
7 days and 50 MME per day. Conversion to
Several years ago, the program did not
propriate dosing of chronic opioids, it be-
higher doses or longer duration prescriptions
limit the daily dosing of opioids, but did
came apparent that administration of these
would require review for appropriateness.
limit beneficiaries to a 30-day supply that
agents beyond the equivalent of 100 mg a
could not be refilled until the next month.
day of morphine did not improve non-cancer
This administrative rule, managed by point-
pain control, but did increase likelihood of
Eighty-five percent of eligible Medicaid
of-sale computer monitoring, reduced doctor
dependence or diversion. Arkansas Medicaid,
beneficiaries are now part of a voluntary
30-Day Supply Limits
46 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK
Opioid Report Card
William Golden, MD Arkansas Medicaid Medical Director
“Arkansas Medicaid now provides each PCMH with an opioid report card that displays the percent of its patients receiving chronic opioids, chronic benzodiazepines, and chronic sleeping pills alone or in combination, and how that PCMH compares to statewide peer groups.”
Patient Centered Medical Home (PCMH).
nasal spray to patients with symptoms of an
Arkansas State Medical Board and its more
This popular program involves nearly 1,000
overdose. Repeat use of this agent or visits
aggressive oversight of physician prescrib-
primary care physicians in 200 practices. Ar-
to an emergency room for overdose events
ing and management of narcotic prescribing.
kansas Medicaid now provides each PCMH
are flags for future fatal events. Neverthe-
Nevertheless, street drugs, cash purchases,
with an opioid report card that displays the
less, many patients continue to receive pre-
and other behaviors by dependent patients
percent of its patients receiving chronic opi-
scriptions for those drugs that put them at
remain a challenge. Awareness has increased,
oids, chronic benzodiazepines, and chronic
risk. Arkansas Medicaid now has computer
and provider behavior has changed, but the
sleeping pills alone or in combination, and
alerts for patients that have refilled naloxone
opioid crisis will remain a substantial chal-
how that PCMH compares to statewide peer
or have been treated for an overdose. This
lenge in the near-term years ahead. n
groups. It is well known that opioids and
alert rejects new claims for narcotics or ben-
benzodiazepines prescribed in combina-
zodiazepines, and pharmacy professionals
tion increases the risk of serious overdose
contact the prescribing provider to discuss
events. The report card is used to sensitize
the problem. Most conversations reveal that
primary care doctors about their patterns of
the prescribing health care professional was
care that might need reevaluation. A similar
unaware of the overdose events, and quite
report card has been developed for dental
responsive to adjust management of these
providers to be used by the Medicaid dental
high-risk patients.
managed care program. As noted above, Medicaid has done a lot Naloxone and Overdose Alerts
in concert with other state partners such as
Recently, the program liberalized access
the Department of Health and its Prescription
to naloxone, an acute drug administered by
Drug Monitoring Program database, and the
Bill Golden, MD, Professor of Medicine at UAMS, holds a secondary appointment in the COPH Department of Health Policy and Management and has been appointed to serve as a member of the guiding committee for the national Health Care Payment Learning and Action Network. The network, which is under the federal Centers for Medicare & Medicaid Services (CMS), was convened to identify payment models and reforms that will lead to better care at lower costs – primarily by tying health care payments not to services but to value and quality of patient outcomes. Dr. Golden, who has been a leader in state and national efforts to move towards payment models that emphasize value over volume, also serves as Medicaid Medical Director for the Arkansas Department of Human Services.
Healthcare Journal of LITTLE ROCK I JUL / AUG 2018 47
column Acupuncture
Integrating the Whole: Personal care for your Patients’ Benefit Regardless of whether you are a doctor, nurse, acupuncturist, chiropractor, physical therapist, massage therapist, mental heath practitioner, or other medical therapist, you are in the business of listening to patients’ problems all day long. As medical practitioners, we have accepted the job of taking on other people’s burdens. Most of us entered our professions completely aware of this, but I think few of us imagined how significantly it would affect our minds and bodies. Moreover, I am sure that most practitioners are unaware, or won’t acknowledge, the effect it has on our daily health and lives. 48 JUL / AUG 2018 I Healthcare Journal of little rock
Martin Eisele, LAc Evergreen Acupuncture
Everything in the universe has energy in some form. Animals, and especially humans, are unique in how we take on the energy of others. Don’t believe me? Next time you pass someone, see how you feel. Are they smiling? Doesn’t that make you smile or feel relaxed? Are they frowning, or mad? It probably makes you uncomfortable, or go into protection mode. Are they describing something bad, telling a joke, or on the phone ignoring you? Even spaces can affect how we feel. Is there trash on the floor or flowers on the desk; is it dark and
“In acupuncture school, we were taught that because we are dealing with people’s energies, we need to have some sort of grounding practice to bring us back to a calm, centered space.”
dingy or bright and airy? How does that make you feel? In acupuncture school, we were taught that because we are dealing with people’s energies, we need to have some sort of grounding practice to bring us back to a calm, centered space. Asian medicine has always emphasized these types of health practices called nei gong, meaning internal work. Tai chi, chi gong (energy breathing), yoga, and prayer (if you are spiritual or religious) are all meditative practices that help you turn your thoughts inward to find your center. Asians also focus on feng shui (lit. wind water), the energy of living and working spaces. In Chinese medicine, practices are split into three levels relating to heaven, humans, and Earth. Earth practices are for body strength and stamina, and are what we think of as exercising our body and muscles (running, weights, biking, etc.). Human level practices represent our emotions, breath, and concentration/focus energy, that keep us going each day—coordinating mind and body, plus our daily care of diet and sleep. These practices involve tai chi, chi gong, yoga, body scan relaxation, or something similar. Heaven level represents our spiritual lives, be it prayer or spiritual based meditation—practices
of opening the heart and connecting to
a simple connection, whether it’s an intel-
something bigger than us.
lectual conversation, or primal lust. Some-
Many of my patients tell me they relax
times there is total connection between
by running or exercising. This is good, but
spouses or lovers; their minds, hearts, and
I tell them that it is something like starting
bodies are in sync. However, this is more
your car and letting in run in the driveway.
likely to happen if each individual in that
It gets their mind off of things, but is only
relationship practices each of the three
part of the picture. I try to emphasize the
levels as individuals.
addition of meditation to let both the mind
We have a relationship with our patients. Practicing health on the three levels at
and body rest together. The Chinese idea is practicing all three
least a few minutes a day, or longer, several
levels because they are interwoven strings
times a week, keeps us from taking on the
of the same yarn; yarn is much stronger
heaviness of the emotions and sicknesses
than the individual strings. Without body
of our patients. It is essential that we take
strength, your energy level is not support-
care of our health first, so we can take care
ed. Body strength without body awareness,
of our patients (and families). We must be
internal focus, and daily care leaves our
present when we meet with patients. We
health depleted. Either, without spiritual
must practice how to listen and observe,
practice, leaves us, and our connections
and give them the time they deserve, even
with others incomplete. Relationships
if we only spend a few minutes with them.
work in the same way. Sometimes there’s
We must practice health to give health. n
Healthcare Journal of little rock I JUL / AUG 2018 49
column Wealth
David Walker. Does that name ring a bell? David Walker served as the comptroller general of the federal government. What does that mean? It means he was the head of the government accountability office. He was the equivalent of the CPA of the United States. He did it for ten years under Bush and Clinton. David Walker took one look at the books and said, “Hey, we have promised way more than we can afford to deliver.” He said if you think social security is terrible, Medicare is five times more expensive.
ey grows, you get to pay a tax. At the end of the year, the financial institution sends you a love letter called Form 1099. It says, “Your money grew this much, and you must give a portion of that money back to the IRS in the form of taxes.” The growth on the money in this bucket is 100 percent taxable. 2. The Tax-Deferred Bucket The second type is what we call the tax-deferred bucket, meaning you don’t
The Four-Letter Word That Will Derail Your Retirement, and How to Fix It
pay taxes on any of those dollars saved until you withdraw the money. The most common tax-deferred account is the 401(k). Other popular accounts in this category include 403(b) and IRAs. 3. The Tax-Free Bucket The third type has all sorts of different names. Some people call it tax-advantaged, tax-preferred, or tax exempt. I call it tax-free. There are other investments out there that masquerade as tax-free, but in my opinion, to be truly tax-free, it must qualify in two different ways.
In 2008 Walker said to be able to deliv-
diagnosed the problem. He appeared on
er on these two promises alone, taxes
NPR to talk about his book and told the
First, it’s got to really be tax-free. By tax-
would have to double immediately. He
radio show hosts that tax rates have to
free, I’m talking free from three different
went on to say that you don’t have to
double or we’re going to go broke. Walker
types of taxes: free from federal tax, free
increase taxes right away, but for every
said, “I can give you one four-letter word
from state tax, and free from capital gains
year that you postpone, the national debt
to explain why tax rates have to double.”
tax.
will grow by about 2 trillion dollars per
The interviewer couldn’t figure out what
Second, a true tax-free investment has
year, every year, until we hit the moment
it was, so they opened the phone lines. No
no social security taxation. In other words,
in our country when we have 53 trillion
one could figure out what the one four-let-
when you take distributions from a true
dollars of debt. So, here is my question
ter word was to explain why tax rates must
tax-free investment, it should not count
for you. What’s wrong with a country that
double. The word is MATH.
as provisional income. Provisional income
What do MATH and taxes have to do
is the calculation the government uses to
At 53 trillion dollars of debt, all the rev-
with your retirement, and how do you fix
determine if up to 85% of your Social Secu-
enue flowing into the U.S. Treasury under
this freight train bearing down on your re-
rity benefit will be subject to taxes. For an
today’s tax rates would only be enough
tirement savings? Keep reading...
investment to be truly tax-free, it should
has 53 trillion dollars of debt?
to pay the interest payments, let alone
There are literally millions of different
not count against the threshold which
any principal or a single dollar for social
investment types out there, but no matter
causes social security taxation. When you
security, Medicare, Medicaid, or anything
where you save your money, all of those
take interest off of your municipal bonds,
else. David Walker was so concerned
investments basically fit into only three
does that count as provisional income? It
about this that in 2008 he resigned and
types of accounts. How’s that for easy? 1. The Taxable Bucket
sure does. An investment that we’ve been
started to crisscross the country raising the warning cry to whoever would listen.
The first type is what we call the taxable
In 2010, he wrote a book where he
bucket, meaning every year as your mon-
50 JUL / AUG 2018 I Healthcare Journal of little rock
told for years is tax-free doesn’t even meet our two most basic tests. What if tax rates went up to 50 percent
David Lukas David Lukas Financial
as David Walker portends? How much money would you have to take out of your IRA to be able to pay the 50 percent tax to the IRS, and then be left with $5,000, with which you can then plug the hole in your social security? What is the double of $5,000? $10,000. I’ve done the math 100 times, in 100 different ways, and concluded that when your social security is taxed, you run out of money five to seven years faster than people who do not have their social security taxed. Why? Because the act of compensating for social security taxation forces you to spend down all your other assets that much faster. A disproportionate number of people I meet with have most of their savings waiting to be taxed by the government. They have no plan to be in the zero percent tax bracket in retirement. The truth is, with proactive tax-planning, it is possible to get into the zero percent tax bracket in retirement and live comfortably. The cost of getting to the zero percent tax bracket is that you must be willing to pay a tax. In my opinion, given the choice between paying taxes today at historically low tax rates, or postponing the payment of those taxes until some point much fur-
ther down the road, you’re probably better
someone who knows the rules, or you could get burned.
off paying them today. To get into the zero percent tax bracket
• Back Door Roth Conversions allow
in retirement, you’ve got to think beyond
higher income earners to contribute to
working with a CPA. Working with an ad-
ROTH accounts through a back door.
visor who understands tax-free accumula-
I wrote about this in detail in the 2017
tion and distribution strategies is a must.
September-October issue of Healthcare
The combination of the following five strategies can help you achieve a zero per-
Journal of Little Rock.
• LIRP or Life insurance Retirement Plans
cent tax-bracket in retirement.
are one of the most misunderstood op-
• Contribute no more to your tax-deferred
tions among the general population. At
accounts than what will be offset by
the same time, these specially designed
your standard deductions. This truly is
life insurance retirement plans are ex-
a winning strategy because not only do
tremely popular among the wealthy and
you get to take a tax deduction on the
large corporations for tax-free accumu-
front end, but you get to spend it tax-
lation and distribution strategies. Banks
free as well.
purchased 40 billion dollars of this as-
• If your employer offers a ROTH op-
set class alone in 2008. Industry-wide,
tion, contribute the maximum amount
these types of tax-free savings vehicles
allowed. Even higher income earners
dwarf real estate holdings among cor-
who cannot contribute to a traditional
porations and the wealthy. As of 2015,
ROTH can contribute between $18,000
Bank of America owned 20 billion in
to $24,000, depending on age. If this op-
Life Insurance Retirement Plans and
tion isn’t currently available to you, ask
just nine billion in real estate. The truth is, with a forward-thinking tax
for it. • Roth Conversions remain a viable op-
plan, one can achieve the goal of being in
tion, although this option has become
a zero percent tax bracket in retirement.
trickier with the recent tax reform
If tax rates double, two times zero is still
signed into law. Be sure to work with
zero. n
Healthcare Journal of little rock I JUL / AUG 2018 51
column ONCOLOGY
with imaging equipment so we can confirm exactly where the tumor is in the body
CARTI North Little Rock Debuts New Technology for Precise Cancer Treatment
before and during treatments. IMRT and IGRT are used at CARTI most often to treat prostate cancer, head and neck cancer, lung, and breast cancer. Part of the reason for this is that these tumors tend to be located close to critical organs and tissues in the body. The radiation treatment process follows a fairly standard pattern. Patients generally have surgery, followed by chemotherapy for some, followed by radiation, which
In June, CARTI North Little Rock began treating cancer patients with Vision RT—a new technology that makes sure radiation is delivered every treatment to the precise spot cancer has been detected. Although it is initially geared toward breast cancer patients to ensure the lowest possible dose to the heart, the applications go well beyond that diagnosis. It is one more example of how CARTI continues to be a leader in providing cutting edge technology to care for cancer patients of Arkansas. Radiation Therapy
IMRT and IGRT
generally begins one month from surgery or chemotherapy. For breast cancer, radiation patients have three to six and a half weeks of treatment, Monday through Friday, for about 10 minutes a day. The number of weeks depends on their age, type of cancer, and whether lymph nodes were involved with the cancer. Breast cancer treatment and risk of heart disease Earlier this year, the American Heart
I have served as president of Radia-
In 2001, the year I joined CARTI, I helped
Association issued a statement on the in-
tion Oncology Associates (ROAPA) since
to initiate and develop the IMRT program
tersection of cardiovascular disease and
2007, and have operated a single-physi-
for our physician practice, ROAPA, across
breast cancer. Although many people as-
cian facility at CARTI North Little Rock
CARTI facilities.
sume breast cancer is the number one
since 2001. CARTI’s mission is to promote
Intensity modulated radiation thera-
threat to women’s health, in reality, cardio-
the finest quality cancer treatment and
py, or IMRT, is a type of cancer treatment
vascular disease remains the leading cause
compassionate care, and to improve our
that uses advanced computer programs to
of death among women.
knowledge through education and re-
calculate and deliver radiation directly to
They referenced a study that compared
search.
cancer cells from different angles. It allows
women who had left-side breast cancer
In our practice, we see a lot of women
people with cancer to receive more even
to those who had right-side breast can-
with breast cancer. Typically, the women
doses of radiation, while limiting damage
cer. Both groups had radiation. The study
have had surgery, and radiation is then
to the healthy tissues and organs around
found that women who had left-side
used as a preventative treatment. I use the
it. In other words, you treat the areas you
breast cancer had a small but significant
analogy of a broken glass. After you clean
want to treat, and you don’t treat the areas
increased risk of heart disease 30 plus
up the pieces you see, you sweep and
you don’t want to treat. This increases your
years after their treatment.
mop to make sure you’ve gotten every-
chance for a cure and lessens the likeli-
thing, including the pieces you can’t see.
hood of side effects.
When treating cancer with radiation therapy, our goal is to deliver radiation to
That’s what radiation does. It increases the
Image guided radiation therapy (IGRT)
the breast area while protecting surround-
rate of survival because it decreases the
takes IMRT one step further. The machines
ing healthy tissue from exposure and po-
chance of cancer coming back.
used to deliver the radiation are equipped
tential damage. If a patient has left-breast
52 JUL / AUG 2018 I Healthcare Journal of little rock
Mark R. Storey, MD President Radiation Oncology Associates PA
the same way as before. When their breast surface is at the right position, the display lights turn green and AlignRT turns the radiation beam on. Using three cameras to monitor thousands of points on the skin, AlignRT can detect any motion as the patient holds her breath, with submillimeter accuracy. If the patient moves out of position, the radiation beam is turned off. A recent study showed that AlignRT, when combined with DIBH, effectively prevented radiation-induced abnormalities in blood flow to the heart. Of the breast cancer patients treated, zero percent showed these abnormalities after six months. This compares to a previous study without AlignRT or DIBH, where 27 percent of patients showed new abnormalities in blood flow to the heart six months after radiation therapy.
New Vision RT Technology.
My clinical philosophy is to provide high-quality guideline-based care, while cancer, we take extra precautions to make
about heart disease down the road as a
caring for my patients as if they were my
sure their heart receives minimal radiation
result of radiation treatment.
family. I am excited to incorporate another
exposure during treatment. If the cancer
In conjunction with Vision RT software,
tool to help fight cancer aggressively, even
is in the center part of the chest, we have
we have incorporated deep inspiration
as I continue to protect my patients both in
to develop different plans to get the heart
breath hold (DIBH) for left-breast cancer
the short term and in the years to come. n
dose to safe levels. After that study, and
patients. DIBH is a radiation therapy tech-
with new emerging technology available in
nique where patients take a deep breath
the market, I started looking at ways to do
during treatment and hold this breath
things better.
while the radiation is delivered.
Vision RT
anterior descending (LAD) artery is an
In left-breast cancer patients, the left I have a biomedical engineering degree,
important part of the heart that lies very
and I remain very interested in technology.
close to the radiation field. By taking a
About two years ago, I started looking at
deep breath in, the patient’s lungs fill with
Vision RT, as I had patients I thought would
air and their heart will move away from
benefit.
their chest, providing more room to treat
Technology called AlignRT by Vision RT
and sparing those critical structures.
gives us a mapping of the patient’s surface
During treatment planning, patients lie
to help us make sure the radiation is de-
on their back for 3-D images to be taken of
livered to the right spot every treatment.
their body. They are asked to take and hold
Heart radiation damage is a widely ac-
a deep breath, usually for 15 to 25 seconds,
knowledged issue, and the goal with this
so that the breast area is as far from their
software is to make sure patients treat-
heart as it can be. Then, during treatment,
ed for breast cancer don’t have to worry
they will take and hold a deep breath in
Mark Storey has been in the NLR CARTI facility since 2001. He was born in Hot Springs, AR and graduated from Vanderbilt University with honors with a BE in Biomedical Engineering. He returned to Arkansas for medical school and then performed his residency training at MD Anderson Cancer Center in Houston from 1997-2001. After completing his training, he returned to his home state and has been in the NLR facility since graduation. He has been President of the Radiation Oncology Associates PA since 2007 and has served on the CARTI Board on two occasions. The NLR CARTI clinic has consistently performed in the top 1-3 percent nationally with respect to patient satisfaction based on third party Press Ganey survey data during his 15-year leadership. He started the CARTI IMRT program in 2001. He initiated forward planning for breast cases in NLR in 2003. Under his leadership, the NLR center was the first CARTI center to move to a fully electronic medical chart in 2009. The center began the hypo fractionated breast treatments (~3 weeks versus ~6 weeks) in 2009 to reduce patient time and expense.
Healthcare Journal of little rock I JUL / AUG 2018 53
H o s p i ta l n e w s a n d i n f o r m at i o n
Hospital Rounds
CHI St. Vincent Infirmary, Arkansas’s first hospital to achieve magnet status, celebrates having earned its first re-designation as a magnet hospital for its continued commitment to nursing excellence and patient care.
CHI St. Vincent Infirmary Receives Magnet Re-designation Story next page Healthcare Journal of Little rock I JUL / AUG 2018 55
Hospital Rounds CHI St. Vincent Infirmary Receives Magnet Re-designation
healthcare providers around the state to promote vaccine uptake is one of most gratifying aspects of what I do.”
CHI St. Vincent Infirmary, Arkansas’s first hospital to achieve magnet status, has earned its first
A frequent consultant for the Arkansas Depart-
re-designation as a magnet hospital for its con-
ment of Health (ADH) on vaccine issues, Romero
tinued commitment to nursing excellence and
also takes daily calls from physicians around the
patient care.
state regarding indications, side effects, and pol-
The magnet designation is the highest honor an
icy. In nominating him for the award, Hilda Dupwe,
organization can receive for professional nursing
ADH immunization program manager, wrote,
practice. It recognizes excellence in nursing leadership, clinical practice, innovations, and positive
José Romero, MD
outcomes. CHI St. Vincent Infirmary is one of just
“Most impressive is his ability to rally forces to execute ideas once he formulates a clear need for the community.”
over 400 magnet hospitals nationwide, and one
“Dr. Romero sets the standard for his peers
of just two in Arkansas. As a magnet institution,
hospitals generally have higher registered nurse
by documenting immunization records on every
it employs the highest standards of quality and
retention rates, fewer RN vacancies, and less nurse
patient who is seen in the Infectious Disease clinic
ensures that patient care and safety are the top
burnout than other hospitals.
on every appointment, to make sure they are up
priority. Studies show that magnet hospitals have better overall patient outcomes than non-magnet hospitals. “The magnet designation is an independent verification of the excellence demonstrated every day by our nurses at CHI St. Vincent Infirmary,”
CHI St. Vincent Infirmary’s magnet designation continues until 2022.
Dr. José Romero Recognized for Contributions to Childhood Immunization
to date on their immunizations,” Dupwe said. “Because he sees patients with immune compromising conditions, he promotes additional indicated immunizations in high risk groups and educates medical students and residents, thereby establishing himself as the primary instructor and resource for the state.”
said Polly Davenport, president of CHI St. Vin-
Dr. José Romero with Arkansas Children’s has
cent Infirmary. “Our journey to this designation
been named Arkansas’s CDC Childhood Immu-
It was a lecture on the poliovirus during medical
made us a better hospital, as we identified ways
nization Champion for his outstanding efforts to
school that led Romero to becoming a passionate
to strengthen our nursing program. Over the past
promote childhood immunization. Romero is
champion for childhood immunization. He said,
four years, we’ve made additional improvements
recognized for his critical analysis of vaccine data
“To see what a scourge it was and the impact the
in patient safety and quality, and we’re honored to
that has helped lead Arkansas through a num-
vaccine had on the lives of children made me real-
be re-designated as a magnet hospital.”
ber of influenza, pertussis, mumps, and measles
ize the importance of polio vaccine in maintaining
outbreaks.
the health of children.”
The American Nurses Credentialing Center (ANCC) Magnet Recognition Program follows a
Romero is director of the Pediatric Infectious
“One of the reasons I decided to pursue a
rigorous recertification process that included site
Diseases Section at Arkansas Children’s. He is a
career in pediatrics is because pediatricians make
visits, nurse and patient interviews, and public
professor of pediatrics in the University of Arkan-
such an impact on the longevity and quality of
comments. Magnet hospitals are recertified every
sas for Medical Sciences (UAMS) College of Med-
life of their patients,” Romero said. “Vaccines are
four years. CHI St. Vincent Infirmary first earned
icine, and holds the Horace C. Cabe Endowed
key to that. They prevent early death and lifelong
magnet status in 2013.
Chair in Infectious Diseases at Arkansas Children’s.
sequelae. As I tell the trainees, no other medical
He also serves as director of clinical trials research
intervention has such a profound and long-lasting
at Arkansas Children’s Research Institute.
effect as vaccination.”
“I am blessed and privileged to lead nurses who are dedicated to the profession and to providing excellent and compassionate patient care,” said
“I am extremely honored for being nomi-
“We are extremely pleased that Dr. Romero
Nancy Brown, chief nursing officer at CHI St. Vin-
nated for and having received the CDC Child-
has received the Childhood Immunization Cham-
cent Infirmary. “Nurses are fundamental to any
hood Immunization Champion Award out of all
pion award for Arkansas, said Jennifer Dillaha,
hospital’s success and critical to patient outcomes.
the extremely worthy candidates in our state,”
MD, ADH medical director for immunizations.
I’m grateful for the partnership and teamwork
Romero said.
“He is passionate about the health of our chil-
among everyone involved in helping to retain
Since medical school, Romero said, “I have
dren, and he has worked tirelessly to make sure
believed that vaccination for the prevention of
that vaccines are safe and effective and available
Multiple research studies indicate that mag-
infectious diseases is the single most important
to every child in our state.”
net hospitals have higher patient satisfac-
medical intervention that has led to improved
Each year, the CDC Foundation uses National
tion, decreased mortality rates, fewer falls, and
quality of life and longevity. The opportunity
Infant Immunization Week as an opportunity to
improved overall patient safety and quality com-
to work closely with the Arkansas Department
honor health professionals and community leaders
pared to other hospitals. In addition, magnet
of Health, vaccine advocacy organizations, and
from around the country with the CDC Childhood
magnet status.”
56 JUL / AUG 2018 I Healthcare Journal of little rock
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
CHI St. Vincent marked a milestone in the expansion of its Arkansas Neuroscience Institute with a formal groundbreaking for a $17 million education and research center at CHI St. Vincent North in Sherwood. The new education and research building at CHI St. Vincent North near Little Rock will be part of a destination neurosciences institute that provides advanced neurosurgery care to patients in Arkansas, in the United States, and internationally.
Immunization Champion awards. These awards
submitted nominees to the CDC. One winner was
in Sherwood by the end of this year. The edu-
acknowledge their outstanding efforts to ensure
selected in each of the participating states and the
cation and research center will open its doors in
that children in their communities are fully immu-
District of Columbia.
early 2019.
CHI St. Vincent Breaks Ground on Arkansas Neuroscience Institute Project
for its internationally-recognized neurosurgeons
nized against 14 preventable diseases before the age of two. “The tremendous success of CDC’s immunization programs to protect the nation’s children
“The Arkansas Neuroscience Institute is known who perform more than 1,000 complex surgeries a year and serve as mentors to clinicians seeking
from vaccine-preventable diseases is a direct
CHI St. Vincent marked a milestone in the
to learn the most advanced, sophisticated tech-
result of the efforts of childhood immunization
expansion of its Arkansas Neuroscience Institute
niques for treating neurological disorders,” said
champions,” said Dr. Nancy Messonnier, direc-
with a formal groundbreaking for a $17 million
CHI St. Vincent CEO Chad Aduddell. “This world-
tor of the National Center for Immunization and
education and research center at CHI St. Vincent
class institute will give CHI St. Vincent additional
Respiratory Diseases at the Centers for Disease
North in Sherwood.
capacity to treat patients and improve upon the
Control and Prevention. “We cannot overstate
The new education and research building at CHI
excellent and compassionate care we strive to
the value of the dedication our champions have
St. Vincent North near Little Rock will be part of a
offer in the community and beyond. It’s an excit-
shown, which ultimately protects our children,
destination neurosciences institute that provides
ing day to launch the construction phase of our
schools, and communities from serious diseases.”
advanced neurosurgery care to patients in Arkan-
project, and reflect on efforts of the CHI St. Vin-
sas, in the United States, and internationally.
cent coworkers and benefactors that make this
CDC Childhood Immunization Champions were selected from a pool of health professionals, coali-
The Arkansas Neuroscience Institute, currently
tion members, community advocates, and other
located a few miles away at CHI St. Vincent Infir-
state-of-the-art institute a reality.” The education and research center will be adja-
immunization leaders. State immunization pro-
mary in Little Rock, will relocate its surgical and
cent to the hospital on the CHI St. Vincent North
grams coordinated the nomination process and
clinical operations to the newly expanded center
campus. It will feature an expanded laboratory
Healthcare Journal of little rock I JUL / AUG 2018 57
Hospital Rounds and classrooms, an auditorium, the Arkansas Neuroscience Institute clinic, and office space for the institute and other physicians. The laboratory will be the only one of its kind in the world, featuring a patented teaching model developed by Dr. Emad Aboud, director of the lab. Denver-based NexCore Group is the developer for the project and will oversee construction. Work is already underway to renovate part of CHI St. Vincent North to house the institute. Among those renovations are the addition of 10
David Hays, MD
Amy Jo Jenkins, MS, CCRP
intensive care unit rooms, updated operating rooms, an angiography suite, a new pharmacy, and advanced imaging technology, including a
service to ACR; evidenced significant accomplish-
Center, CARTI Little Rock, CARTI North Little
128-slice CT scanner and 3T MRI equipment.
ments in scientific or clinical research in the field
Rock, CARTI Conway, CARTI Mountain Home,
The Arkansas Neuroscience Institute is led by
of radiology; made significant contributions to
and CARTI Searcy. CARTI radiation oncology pro-
Dr. Ali Krisht, a renowned neurosurgeon who
literature; and/or provided outstanding work as
grams account for six of the seven ACR-accredited
specializes in vascular microsurgery involving the
a teacher of radiology. Only 10 percent of ACR’s
programs in Arkansas.
treatment of aneurysms, arterio-venous malfor-
members have been awarded this honor.
mations, cavernous sinus tumors, and acute treat-
Fellowship is awarded to diagnostic radiolo-
ment of stroke. Krisht is the chief editor of the jour-
gists, radiation oncologists, interventional radiol-
nal, Contemporary Neurosurgery.
UAMS’ Amy Jo Jenkins Named President-Elect of SOCRA
ogists, medical physicists, and nuclear medicine
Amy Jo Jenkins, MS, CCRP, executive director
“Our ability to serve the people of Arkansas
physicians at the convocation held during the
of the University of Arkansas for Medical Sciences
and truly, the world, has been limited only by
ACR annual meeting. Radiation oncology (radi-
(UAMS) Translational Research Institute, has been
the amount of space available to us,” Krisht said.
ation therapy) is the careful use of high-energy
named president-elect of the Society of Clinical
“This is an amazing opportunity to grow the Insti-
radiation to treat cancer. A radiation oncologist
Research Associates (SOCRA) Board of Directors.
tute, bring additional qualified neurosurgeons
may use radiation to cure cancer or to relieve a
to Arkansas, and conduct research that will
cancer patient’s pain.
change the lives of people living with neurological disorders.”
“CARTI is proud to add another ACR Fellow designation to our ranks,” said Jeremy Land,
SOCRA, a nonprofit, charitable and educational membership organization, provides an internationally recognized certification program for clinical research professionals (CCRP®).
Patients from 38 states and from all 75 coun-
senior vice president of radiation oncology and
Jenkins founded the Arkansas SOCRA chap-
ties in Arkansas have been treated at the Arkan-
imaging at CARTI. “Dr. Hays adds so much to our
ter in 2011. It has been recognized for a record
sas Neuroscience Institute. The institute is a com-
program, and we are proud to have his level of
six consecutive years by the international associ-
prehensive program that incorporates all aspects
expertise to offer our patients.”
ation for providing the most continuing education
of neurosurgery and a full spectrum of neurolog-
"This is a richly deserved honor for Dr. Hays. He
hours of any of its 63 chapters. She was elected
is an exemplary interventional radiologist, and
to the SOCRA Board of Directors in 2016 and will
For more information about the groundbreak-
we are fortunate to have him as a member of our
become president in 2019.
ing, including an animation of the planned
CARTI team,” said Dr. Christopher Pope, an ACR
center, visit http://www.nexcoregroup.com/
Fellow also at CARTI.
ical disorders.
anigroundbreak.
CARTI’s David Hays, MD, Awarded Fellowship in Radiation Oncology Dr. David Hays of CARTI has been named an American College of Radiology (ACR) Fellow.
“I believe education empowers people to be outstanding in both their personal lives and pro-
Hays, who has been an ACR member since 1999,
fessional careers,” said Jenkins, also an instructor
is also a member of the Society of Interventional
in the UAMS colleges of public health and phar-
Radiology, Arkansas Radiological Society, Pulaski
macy. “As president, I will work with the board of
County Medical Society, and Mid-America Inter-
directors to further establish SOCRA as the global
ventional Radiological Society. He and his wife,
leader in clinical research education and profes-
Cindy, have five children.
sional certification. It will be a privilege to serve
He is the medical director of imaging and inter-
In addition, CARTI has been awarded a three-
ventional oncology, who practices interventional
year term of accreditation in radiation oncol-
radiology and serves as a diagnostic radiologist.
ogy as the result of a recent survey by the ACR.
Clinical research professionals certified by
ACR Fellowship is awarded to members of the
This accreditation covers all of CARTI’s radia-
SOCRA work with volunteer participants in studies
ACR in good standing who have demonstrated
tion oncology sites, which include CARTI Cancer
at UAMS’ main campus in Little Rock and clinics
58 JUL / AUG 2018 I Healthcare Journal of little rock
the diverse and robust clinical research workforce that makes up SOCRA’s membership.”
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
Rohit Dhall, MD
affects movement, thinking, and mental state.
were previously provided at two separate loca-
As the disease progresses, people with Hunting-
tions. The current medical oncology facility has
ton’s need help with all aspects of their daily lives,
12 chairs for infusion therapy, through which che-
and become bedridden in the final stages of the
motherapy is delivered. The renovated facility will
disease.
provide a new chemotherapy infusion center with
To make an appointment, call (501) 526-5443.
15 heated chairs, extra room for family members,
Huntington’s is a rare condition affecting about
and the space to grow at a later date. Public areas
30,000 people in the United States and 150-200
in the renovated clinic will include a lobby with
in Arkansas.
areas to sit, converse, or rest; an atrium; a coffee
While there are no treatments that stop the disease’s progression, there are supportive care
and refreshment bar; Wi-Fi; digital patient education; and a resource library.
resources and medications to help patients man-
Drs. Jamie Burton, Ryan Hall, and Lawrence
age symptoms. There have been advancements
Mendelsohn will provide medical oncology, while
across the state, including its eight regional cam-
in care, with newer medications developed in the
Dr. Christopher Pope will continue providing radi-
puses, Arkansas Children’s Research Institute, and
past five years.
ation oncology services.
the Central Arkansas Veterans Healthcare System.
Dhall also hopes to connect patients with Hun-
CARTI offers technologically advanced, com-
“The continuing education we provide ulti-
tington’s research. He has experience in clinical
prehensive diagnostic radiology, and is accredited
mately improves the quality of research in our
trials for Huntington’s disease, and worked on tri-
by the American College of Radiology. All areas
state,” said Jenkins. “This will be evident for any-
als for two medications aimed at helping patients
of diagnostic radiology services may be obtained
one who volunteers as a research participant.”
maintain motor skills.
by outside referrals for non-malignant diagnostic
UAMS Adds Huntington’s Clinic to Movement Disorders Care
The clinic can also connect patients with genetic
exams at CARTI Conway, including lung screen-
testing and counseling, which is an important part
ings, diagnostic CT, nuclear medicine, PET-CT
of Huntington’s care. Each child of a parent with
scans, ultrasound, and interventional radiology.
The Movement Disorders Clinic at the University
Huntington’s has a 50 percent chance of inherit-
“We are excited to expand our cancer care ser-
of Arkansas for Medical Sciences (UAMS) is offer-
ing the disease. Working with a genetic counselor
vices to the Conway community at one convenient
ing a monthly clinic for Huntington’s disease, fea-
is helpful for people considering being tested for
location,” said Adam Head, president and CEO
turing a multidisciplinary approach to care that
Huntington’s or people with Huntington’s who are
of the statewide network of cancer care provid-
aims to be a one-stop shop for patients.
considering having children.
ers. “From minimizing the steps a patient has to
The clinic’s multidisciplinary team includes
Tuhin Virmani, MD, PhD, is director of the Move-
take between registration and end-of-treatment,
movement disorder neurologists, nurses and
ment Disorders Clinic at UAMS and said the Hun-
to state-of-the-art equipment for optimal patient
nurse practitioners with expertise in Huntington
tington’s clinic adds to its overall mission of serv-
comfort, the delivery of care will make a huge dif-
disease, social workers, nutritionists, and speech
ing patients with movement disorders, which
ference to patients who receive their treatment
and physical therapists. The clinic partners with
includes Parkinson’s disease and essential tremor.
in Conway.”
neuropsychologists, psychiatrists, and genetic
“Too often, people with Huntington’s slip
When CARTI opened its radiation oncology
through the cracks in healthcare,” Virmani said.
clinic in Conway in 1996, it was the network’s
counselors for quick referrals. “Huntington’s disease can be incredibly chal-
“Our intent is to not only connect these families
fourth such clinic. Medical oncology services in
lenging for the individual and their family, and spe-
with our clinical expertise and access to research,
Conway have been provided since 2015. The
cialized care can be difficult to find. Most patients
but to build a structure of support.”
general contractor for the $1 million renovation
travel out of state for care, or do the best they can by working with their family doctor,” said Rohit Dhall, MD, director of neurodegenerative disor-
CARTI Renovation Combines Two Conway Clinics Into One Facility
ders and associate professor in the Department
Renovation is underway on the existing CARTI
of Neurology in the UAMS College of Medicine.
Radiation Oncology facility at 2605 College Ave-
“With the clinic, they can receive the expert care
nue. When complete, all CARTI Conway services
they need in one place, working with our sched-
will be offered from this facility, maximizing effi-
ulers to have their needs met with as few trips as
ciency and patient access.
possible.”
is Nabholz Construction. The project is expected to be complete in mid-September.
UAMS Professor Named Chairelect of the Board of Governors of National Doctors’ Group Omar T. Atiq, MD, FACP, has been named chairelect of the board of governors of the American
The newly renovated 13,400-square-foot cen-
College of Physicians (ACP), the national organi-
Huntington’s disease is an inherited neuro-
ter will fully integrate clinical services for medical
zation of internists. His term began during Inter-
logical condition that slowly causes a break-
and radiation oncology, as well as diagnostic radi-
nal Medicine Meeting 2018, ACP’s annual scien-
down among the nerve cells in the brain, which
ation. Radiation therapy and medical oncology
tific meeting held in New Orleans in April.
Healthcare Journal of little rock I JUL / AUG 2018 59
Hospital Rounds
Omar T. Atiq, MD, FACP,
Katie Brown, OD
Martin G. Radvany, MD
A resident of Little Rock, Atiq is a professor of
leadership, and volunteers their time. Brown was
medicine and otolaryngology—head and neck
nominated and selected by an awards committee
is a member of the Arkansas Optometric Associ-
surgery at the University of Arkansas for Medical
comprised of optometric physicians.
ation and the American Optometric Association.
Sciences (UAMS). He also serves as director of the
Brown has been at UAMS since 2013. She sees
Cancer Service Line at the UAMS Medical Center
patients at the eye institute, performing compre-
and associate director of the UAMS Winthrop P.
hensive eye exams, diabetic eye exams, glaucoma
Rockefeller Cancer Institute.
screenings, and contact lens fittings. She treats
and the Arkansas State Board of Optometry. She
Arkansas Department of Health Recognizes Hospitals for Stroke Care Performance
He most recently served as governor of the
conditions such as corneal abrasions, pink eye,
The Arkansas Department of Health (ADH) rec-
Arkansas Chapter of ACP. Governors are elected
corneal ulcers, dry eye syndrome, and glaucoma.
ognized 15 hospitals for excellence in stroke care
by local ACP members and serve four-year terms.
She works closely with cornea and retina spe-
performance at the Arkansas Chronic Disease
Working with a local council, they supervise ACP
cialists to provide prosthetic contact lens fittings
chapter activities, appoint members to local com-
for vision rehabilitation due to corneal dystrophies
The ADH awards are based on hospital perfor-
mittees, and preside at regional meetings. They
or after ocular trauma and corneal transplantation.
mance as documented in the Arkansas Stroke
also represent members by serving on the ACP
Brown is also an assistant professor in the UAMS
Registry between July of 2016 and June of 2017.
Board of Governors. He has been a fellow of ACP
College of Medicine’s Department of Ophthal-
They are given to hospitals for providing defect-
(FACP) since 1993. FACP is an honorary designa-
mology and teaches ophthalmic medical technol-
free stroke care (90 percent or higher adherence).
tion that recognizes ongoing individual service
ogy students, medical students, and ophthalmol-
Defect-free care is based on the seven American
and contributions to the practice of medicine.
ogy residents.
Heart Association/American Stroke Association
Forum held at the Little Rock Crowne Plaza.
Atiq earned his medical degree from the Khy-
Brown is involved with the association’s student
(AHA/ASA) achievement measures of the Get
ber Medical College, University of Peshawar, Pak-
membership, education, and recruitment. She
With The Guidelines®-Stroke Patient Manage-
istan. He is board-certified in medical oncology,
also volunteered this year with a UAMS medical
ment Tool. These measures are benchmarked
hematology, and internal medicine.
students’ nonprofit, ROOTS, which provided eye
according to the standards of evidence-based
The main areas of professional interest for Atiq
exams to children. She is the coordinator at the
stroke care guidelines to ensure stroke patients
include national health reform, Arkansas health-
Shepherd’s Hope Neighborhood Health Center’s
receive appropriate and timely care.
care access, scope of practice, private and com-
free eye clinic in Little Rock.
munity practice, and payment reform.
Katie Brown, OD, Chosen Young Optometrist of the Year
“I have a passion for optometry and providing high-quality eye care for Arkansans,” she said.
“We are delighted to see the improvement in stroke care as demonstrated by these hospitals”, said Appathurai Balamurugan, MD, DrPH, state
Brown graduated magna cum laude from South-
chronic disease director and medical director for
ern College of Optometry in Memphis. She com-
the ADH Chronic Disease Branch. “Through our
Katie Brown, OD, an optometric physician at the
pleted internships at the Air Force Academy in
work with the communities, EMS, and hospitals
UAMS Harvey & Bernice Jones Eye Institute, is the
Colorado Springs, Colorado, and The Eye Cen-
we hope to improve quality of stroke care among
Arkansas Optometric Association’s 2018 Young
ter in Memphis. She received contact lens train-
Arkansans with this devastating condition.”
Optometrist of the Year award recipient.
ing at Alcon Academy for Eye Care Excellence
The Arkansas Stroke Registry (ASR) is the ADH
The award is given to an optometrist who has
in Fort Worth, Texas, and at Vistakon Vision Care
stroke surveillance and quality improvement pro-
practiced at least four years, shows promise and
Institute in Jacksonville, Florida. Brown is certified
gram. Oversight for the ASR is provided by the
interest in Arkansas Optometric Association
by the National Board of Examiners in Optometry
Acute Stroke Care Task Force (ASCTF). The ASR
60 JUL / AUG 2018 I Healthcare Journal of little rock
For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com
partners closely with the AHA/ASA, Emergency
at UAMS has worked hard to achieve these high
Medical Services (EMS), the ASCTF, Arkansas
standards of care for our patients and to sustain
Stroke Assistance through Virtual Emergency Sup-
that level of excellence each and every year since
port (AR SAVES), and the Mercy Telestroke sys-
we first reached them,” said Matthew Mitchell,
tem. The primary goal of the ASR is to perform
MNSc, RN, director of the UAMS Stroke Program.
stroke surveillance, monitor stroke care perfor-
“We’re grateful for these honors from the Amer-
mance, and provide stroke education and quality
ican Heart Association and Health Department,
improvement assistance to improve stroke patient
which motivate us to maintain our achievements
care and outcomes.
and even work to surpass them.”
Hospitals receiving stroke care performance awards for defect-free patient care include: Baptist Health Medical Center-Little Rock Baptist Health Medical Center-Heber Springs CHI St. Vincent Hospital Hot Springs
Martin Radvany, MD, Named Chief of Interventional Neuroradiology at UAMS
Susan Long, EdD
Martin G. Radvany, MD, an internationally
CHI St. Vincent Morrilton
known leader in interventional neuroradiology
on Accreditation of Healthcare Organiza-
CHRISTUS St. Michael Health System
and specialist in vascular disorders of the brain
tions (JCAHO) as a Comprehensive Stroke Cen-
Five Rivers Medical Center
and spine, has joined the Department of Radiol-
ter within three years.
Forrest City Medical Center
ogy at the University of Arkansas for Medical Sci-
Radvany has contributed chapters to more than
Medical Center of South Arkansas
ences (UAMS) as professor and chief of interven-
15 textbooks on endovascular treatment of neu-
Mercy Hospital Fort Smith
tional neuroradiology.
rovascular disorders, and published more than
Mercy Hospital Northwest Arkansas
Radvany received his medical degree from
50 articles in medical journals. He is a reviewer
Methodist University Hospital
Northwestern University in Chicago in 1991. He
for several medical journals and has lectured
Sparks Regional Medical Center
completed a residency in diagnostic radiology at
internationally.
University of Arkansas for Medical Sciences
Tripler Army Medical Center in Honolulu and a fel-
Wadley Regional Medical Center
lowship in interventional radiology at the Johns
Washington Regional Medical Center
Hopkins Hospital in Baltimore. After completing
Visit www.healthy.arkansas.gov for more infor-
his fellowship, he served for nine years at Brooke
mation on stroke prevention.
UAMS Stroke Program Wins Two Awards for Excellence in Care
Susan Long, EdD, Named Dean of UAMS College of Health Professions
Army Medical Center in San Antonio, where he
Longtime educator and administrator Susan
was promoted to lieutenant colonel and served
Long, EdD, has been named dean of the College
as chief of the Interventional Radiology Service.
of Health Professions at the University of Arkan-
Radvany returned to Johns Hopkins in 2007 for
sas for Medical Sciences (UAMS).
Excellence in treating stroke patients recently
a fellowship in endovascular surgical neuroradi-
Long, a UAMS faculty member since 1992, had
garnered two awards for the University of Arkan-
ology, and then joined the faculty as an assistant
been serving as interim dean since the retire-
sas for Medical Sciences (UAMS) Stroke Program.
professor of radiology, neurosurgery, and neurol-
ment of Douglas L. Murphy, PhD, on December
The American Heart Association honored the
ogy. He served as director of interventional neuro-
31, 2017. She has also been associate dean for
program with the Target: Stroke Honor Roll Elite
radiology at the Johns Hopkins Bayview Medical
academic affairs since 2012, which she continued
and Get with the Guidelines-Stroke Gold Plus
Center and director of the Endovascular Surgi-
while serving as interim dean.
award. The Arkansas Department of Health rec-
cal Neuroradiology Training Program in the Johns
ognized the program with a Defect Free Stroke
Hopkins University School of Medicine.
Patient Care award for the overall quality of
“Susan has proved herself a dedicated leader in the College of Health Professions, and I believe
Radvany worked with teams of internationally
she will accomplish great things as dean of the
known specialists developing endovascular tech-
college,” said Stephanie Gardner, PharmD, EdD,
The Target: Stroke Honor Roll Elite recognition
niques and medical devices for the treatment of
senior vice chancellor for academic affairs and
acknowledges the program’s compliance with
brain aneurysms, stroke, vascular malformations,
provost.
standards for quick and timely treatment of stroke
and pseudotumor cerebri syndrome, a condi-
“UAMS is incredibly important to me and
as well as counseling and follow-up treatment at
tion that arises when pressure inside the skull
to Arkansas,” said Long. “I am honored to be
discharge. The Get with the Guidelines-Stroke
increases.
selected as dean of the College of Health Pro-
UAMS’ stroke care.
Gold Plus status recognizes the program’s con-
In 2015, he was recruited to York, Pennsylva-
fessions, and I look forward to leading the col-
tinued high performance by those measures for an
nia, to establish the Interventional Neuroradi-
lege as we educate the allied health profession-
entire year after receiving a Gold or Silver award.
ology Program at WellSpan York Hospital. The
als of tomorrow.”
“For several years in a row, the stroke care team
program was certified by the Joint Commission
The college offers programs that provide
Healthcare Journal of little rock I JUL / AUG 2018 61
Hospital Rounds education, service, and research in the allied health professions. Educational programs include audiology and speech pathology, dental-general practice residency, dental hygiene, dietetics and nutrition, emergency medical sciences, genetic counseling, health information management, imaging and radiation sciences (diagnostic medical sonography, nuclear medicine imaging sciences, radiologic imaging sciences), laboratory sciences (cytotechnology, medical laboratory sciences), occupational therapy, ophthalmic technol-
Nicki Hilliard, PharmD
C. Lowry Barnes, MD
ogies, physical therapy, physician assistant studies, and respiratory and surgical technologies. Long joined the UAMS faculty in 1992 as an assistant professor in the college’s dental hygiene
(UAMS), recently became the first Arkansan to
Orleans at the 2018 Winter Meeting of The Hip
program, where she is now a professor. In addition
serve as president of the American Pharmacists
Society.
to associate dean for academic affairs in the col-
Association (APhA), the largest pharmacy profes-
Barnes is chair of the Department of Orthopae-
lege, she has been serving as associate director of
sional organization. Hilliard will serve for the 2018–
dic Surgery in the UAMS College of Medicine. He
clinical programs in the UAMS Center for Dental
2019 term.
also holds the Carl L. Nelson, MD, Distinguished
Education. She was appointed an inaugural professor in the Clinton School of Public Service for her contribution to the development of the cur-
Hilliard is a professor in the College of Pharmacy Department of Pharmacy Practice.
Chair in Orthopaedic Surgery. Barnes is the only Arkansas member of The Hip Society since the
After serving for a year as president-elect, she
death of Nelson, the former chair of the Depart-
became president at the association’s annual
ment of Orthopaedic Surgery for whom the dis-
She completed her undergraduate training at
meeting in Nashville, Tennessee. In 2019, Hilliard
tinguished chair is named.
The Ohio State University in Columbus, Ohio, in
will become past-president and will continue to
1986. She received a master’s degree from the
serve on the board of trustees.
riculum for the Master of Public Service degree.
Barnes graduated with honors from the College of Medicine in 1986 and completed his internship
University of North Florida in 1992, and in 1997,
Hilliard is a former APhA-Academy of Phar-
and residency in orthopaedic surgery at UAMS.
earned a doctoral degree from the University of
macy Practice and Management president and
He completed a fellowship in adult reconstruc-
Arkansas at Little Rock.
an APhA trustee. She now also serves on the APhA
tive surgery and arthritis surgery at Harvard Med-
As associate dean, she has been responsible for
Finance and Executive Committees and repre-
ical School and Brigham and Women’s Hospital
the administrative leadership of the college’s aca-
sents the association on the Joint Commission of
in Boston.
demic affairs, including curriculum, new program
Pharmacy Practitioners.
Barnes is one of Arkansas’s and the region’s
development and approval, educational meth-
In 1996, Hilliard earned her doctorate in phar-
foremost joint replacement experts. He is also a
ods and technology, interprofessional education,
macy, and in 1983, she earned her bachelor’s
member of the prestigious Knee Society, an exclu-
regional and specialty accreditation, faculty devel-
degree in pharmacy, both from the UAMS Col-
sive organization of the world’s experts in ortho-
opment, and policy development and implemen-
lege of Pharmacy. In 1990, she earned a master’s
paedic surgery, where he is also the only Arkan-
tation. During her tenure, she has received nearly
degree in health services administration from the
sas member.
a total of $1.4 million for service projects in which
University of Arkansas at Little Rock.
she has collaborated, mostly in the area of oral health. In 2008, she was named a Public Health Hero by the Arkansas Department of Health in recognition of her work to increase access to oral health for the underserved.
UAMS College of Pharmacy Professor First Arkansan to Serve as American Pharmacists Association President Nicki Hilliard, PharmD, a pharmacy professor at the University of Arkansas for Medical Sciences
C. Lowry Barnes, MD, Inducted into Prestigious Hip Society
Barnes is president of the Mid-America Orthopaedic Association and a past president of the Arkansas Orthopaedic Society, the Southern Orthopaedic Association, and the Society of
C. Lowry Barnes, MD, an orthopaedic surgeon,
Arthritic Joint Surgery. He has served as treasurer
professor, and department chair at the University
and is currently president-elect of the American
of Arkansas for Medical Sciences (UAMS), has
Association of Hip and Knee Surgeons.
been inducted into The Hip Society, a national
Barnes has published extensively and is on the
organization dedicated to the advancement of
editorial boards of peer-reviewed publications
knowledge relating to the hip joint. Its members
including the Journal of Arthroplasty and Clini-
are recognized thought leaders in the field of hip
cal Orthopaedics and Related Research. Barnes
surgery.
is known nationally for his expertise in healthcare
Barnes was recognized as a new member in New
62 JUL / AUG 2018 I Healthcare Journal of little rock
quality and efficiency. n
It’s in our DNA...
Healthcare Journal of Llittle Rock was created to provide high quality healthcare news, information, and analysis. It is our mission to improve the health of Little Rock citizens through a community approach of shared information. With an impressive publication, distribution plan, eNews, and community-based website, Healthcare Journal of Little Rock connects your message to the local healthcare industry. For information about sponsorship contact us at
[email protected]
+($/7+&$5(
-2851$/ of Little Rock
Reviews by the bookworm
For the last few days, you’ve had a tickle in your throat. It’s not much, just a hrrumph that’s gone from occasional to annoying. You’ve looked it up online and, well, it’s either allergies, a cold, or you’re going to die. But, as author Nina Shapiro, MD says in her new book, “Hype” (with Kristin Loberg), be careful what you think you know. Your doctor may be rolling her eyes at you. But don’t worry. Says Shapiro, showing up at an appointment armed with sheaves of print-outs, having “done… research” is often a good thing; most physicians are glad to serve better-educated patients. The problem is that some of your new education may be false and some of it may be dangerous. So how do you know the difference? To start, if you’re looking for information online, be superspecific in your search and bear in mind that websites with colorful ads are often “exaggerated.” Pay attention to what comes after the “dot” because it matters in a web address. And just because the website looks authentic doesn’t mean its information is. Remember that we tend to panic about that which is newsworthy, while ignoring what’s good for us; you may worry about Ebola, for instance, (a threat that’s truly small) but you don’t use your seat belt. Learn how to assess risk and remember that sometimes, not acting is the riskier choice. Also remember that even the most benign substances can kill you if they’re consumed in excess. In this book, Shapiro explains how to tell if a “study” is really of any use for you, and how to properly use the information you’ll get from genetic testing. Find out why there is no “best” diet or exercise. Get the final word on vaccinations. And that handful of supplements you were about to take? Hold off a minute… Lie-ins and thyroids and scares, Oh, My! What do you do when you’re feeling poorly? “Hype” lets you separate the help from the hooey. Don’t, however, think that this is just another voice in the medical jungle. Author Nina Shapiro, MD (with Kristin Loberg) doesn’t tell readers what to do; instead, she offers the tools to figure out the best
“‘Hype’ lets you separate the help from the hooey.”
By Nina Shapiro, M.D. with Kristin Loberg c.2018, St. Martin’s Press
next step based on calm truth, not rumor. Shapiro doesn’t hyperventilate in her writing, which is handy and reassuring when you’re faced with a lot of decisions or too much conflicting information. On that conflict, Shapiro is careful to show both sides to a medical coin – few things, as she points out, are all good or all bad. To that point, she reminds readers that there’s no onesize-fits-all when it comes to healthcare; she’s also refreshingly candid about her own medical superstitions and practices. For anyone who wants to be extra proactive in their healthcare choices, this is a book to have. Even though it’s pretty no-nonsense, it’s got a breezy feel to it and sometimes, the authors have a little fun with readers, too. “Hype” is down-toearth, informative, and your funnybone may even be tickled. n
Healthcare Journal of little rock I JUL / AUG 2018 65
advertiser index
ACUPUNCTURE
Neuroscience
ORTHOPEDICs
Evergreen Acupuncture • 67 2 Van Circle, Suite 1 Little Rock, AR 72207 501.663.3461 www.EvergreenHealth.net
CHI St. Vincent Arkansas Neuroscience Institute • 63 5 St. Vincent Circle, Suite 210 (Blandford Building) Little Rock, Arkansas 72205 501.552.6400 www.chistvincent.com
OrthoArkansas • 3 Locations: Arkadelphia, Benton/Bryant, Camden, Clinton, Conway, Heber Springs, Jacksonville 501.604.6900 www.OrthoArkansas.com
FINANCIAL ADVISORS
Oncology
substance abuse/ mental Health
insurance-professional
CARTI Cancer Center • 2 8901 CARTI Way Little Rock, AR 72205-6523 501.906.3000 www.carti.com
The BridgeWay • 9 21 Bridgeway Road N. Little Rock, AR 72113 501.771.1500 www.TheBridgeWay.com
The Doctors Company • 31 8315 Cantrell Rd., Suite 300 Little Rock, AR 72227 501.614.1134 www.TheDoctors.com
CARTI Clinic Locations: Benton, Clinton, Conway, El Dorado, Heber Springs, Mountain Home, North Little Rock, Russellville, Searcy and Stuttgart
Urology
David Lukas Financial • 54 9804 Maumelle Blvd. North Little Rock, AR 72113 501.218.8880 www.DavidLukasFinancial.com
LAMMICO • 23 1 Galleria Blvd., Ste. 700 Metairie, LA 70001 800.452.2120 www.LAMMICO.com/lr State Volunteer Mutual Insurance • 68 101 Westpark Drive, Suite 300 Brentwood, TN 37027 800.342.2239 www.SVMIC.com
66 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK
Arkansas Urology • 6 1300 Centerview Dr. Little Rock, AR 72211 501.219.8900 www.ArkansasUrology.com