Oklahoma DO - March 2013 by Oklahoma Osteopathic Association

The Journal

of the

Oklahoma Osteopathic Association

Oklahoma D.O. March 2013

Volume 77, No. 9

113th Annual Convention

IN THIS ISSUE: q 2013 ANNUAL CONVENTION PROGRAM q AOOA REVISED BYLAWS q OOA NOMINATING COMMITTEE

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Oklahoma D.O. |March 2013

The Journal of the Oklahoma Osteopathic Association

Oklahoma

May/June 2012 January 2012 November2013 2012 March

OOA Officers: Layne E. Subera, DO, FACOFP, President (Tulsa District) Bret S. Langerman, DO, President-Elect (South Central District) Michael K. Cooper, DO, FACOFP, Vice President (Northeastern District) LeRoy E. Young, DO, FAOCOPM, Immediate Past President (South Central District)

OOA Trustees: Kenneth E. Calabrese, DO, FACOI (Tulsa District) Dale Derby, DO (Tulsa District) C. Michael Ogle, DO (Northwest District) Gabriel M. Pitman, DO (South Central District) Richard W. Schafer, DO, FACOFP (Tulsa District) Christopher A. Shearer, DO, FACOI (Northwest District) Kayse M. Shrum, DO, FACOP (Tulsa District) Ronald S. Stevens, DO (Eastern District) OOA Central Office Staff: Lynette C. McLain, Executive Director Lany Milner, Director of Operations and Education Rachel Prince, Director of Communications Allison Rathgeber, Director of Member Services & Foundation Administrator

The Oklahoma D.O. is published monthly from the Oklahoma Osteopathic Association Central Office: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335. Lany Milner, Graphic Designer and Associate Editor Copy deadline is the 10th of the month preceding publication. Advertising copy deadline is the 15th of the month preceding publication. For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org

Volume 77, No. 9

Lynette C. McLain, Editor Lany Milner, Associate Editor

President’s Message provided by Layne E. Subera, DO, FACOFP, 2012-2013 President

113th Annual Convention Program

Convention Registration Form

OOA Golf Classic Registration Form

Convention Module

Foundation Update

OOA Bureau News

Doctor of the Day Schedule

“Purpose and Fun” provided by Walli Daniel, 2012-2013 AOOA President

“Can Motivational Health Beliefs Help Explain the Relationship Between Education and Health Behaviors” provided by Denna L. Wheeler, PhD., Director of Rural Research

“Analysis of the Side Effect Profile in HIV Patient’s Converting from Lopinavir/Ritonavir to Darunavir/Ritonavir”

What DO’s Need To Know

Student Scoop provided by Jeremy Ransdell, OMS-II

Health for the Whole Family: “Imaginary Friends OK but Excessive Lying Could Be Troublesome” Provided by the American Osteopathic Association

Classifieds & Calendar of Events

The OOA Website is located at www.okosteo.org

Oklahoma D.O. | March 2013

Presidentâ&#x20AC;&#x2122;s Message by Layne E. Subera, DO, FACOFP, 2012 - 2013 OOA President

The three-year CME cycle that reset effective January 1 also will bring changes to the convention. The American Osteopathic Association has made rule changes to CME certification process that will allow for more varied content in the programs. In the past, CME lectures had to be completely clinically oriented in order to grant 1-A credit. The new rules allow attendees to obtain 1-A credit for attending lectures on interpersonal communication, healthcare technology and other pertinent but not necessarily clinical healthcare topics. I encourage you to utilize to the new OOA website, www.okosteo.org. There you can view the convention curriculum, register and purchase tickets for the associated events such as the banquet and other dinner parties. The venue has been very well received by our members in the past and we are looking forward to hosting another excellent meeting this year. The legislative session is also upon us. I would also like to invite all of our members to support the Oklahoma Osteopathic Political Action Committeeâ&#x20AC;&#x2122;s special effort on behalf of Oklahoma State University Medical Center. Many of our members are trained at OSUMC and the hospital needs financial support to continue training physicians for our state. Though all teaching hospitals require a subsidy to stay financially afloat, OSUMC receives no state funding. It needs state funding. This year the legislature has the opportunity to stabilize the hospital for years to come by setting up a support structure like they did for the OU Medical Center in 1998. By supporting OOPACs awareness drive; you

will be able to directly support the legislative effort to stabilize the hospital and preserve it and our schools future for years to come. Northeast Oklahoma and the entire profession in Oklahoma need this hospital to survive and stay strong. We hope that you will be part of this effort. okDO

We look forward to seeing you in Norman.

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Spring is upon us and brings with it the 113th Oklahoma Osteopathic Association Annual Convention that will be held in Norman, Oklahoma from April 18-21, 2013. Bret S. Langerman, DO, convention chair, and Michael K. Cooper, DO, convention program chair, have been hard at work developing a sound and interesting educational program that should be especially pertinent to specialty physicians this year. To attract more specialty physicians, we have changed the format to allow for specialty interest tracks in the curriculum. Physicians will be able to take a pathway through the curriculum that appeal to their specialty while still gaining full credit for the program. Specialty tracks include Emergency Medicine, Psychiatry, OBGYN, OMT, Internal Medicine, Sports Medicine, Anesthesiology, and Radiology. We're hoping that this year's approach to the convention will appeal to a broader range of physicians while still satisfying the needs of our primary care base.

113th OOA Annual Convention Individualizing a Program for Your Specialty Needs Saddle up April 18-21, 2013

Individualizing a Program for Your Specialty Needs

Saddle up April 18-21, 2013 Bret S. Langerman, DO

General Convention chair

Michael K. Cooper, DO, FACOFP Convention Program Chair

SEE PAGE 6 FOR THE COMPLETE PROGRAM

Oklahoma D.O. |March 2013

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Oklahoma D.O. | March 2013

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113th OOA Annual Convention Individualizing a Program for Your Specialty Needs Saddle up April 18-21, 2013

WEDNESDAY, April 17, 2013 11:00 am

Golf Classic Registration Willow Creek Golf Club

11:30 am

Golf Classic Lunch

1:00 pm

Tee Off-Golf Classic

Noon – 5:00 pm 9:00 – 11:00 pm

Registration – Conference Center President’s Reception Honoring OOA President Layne E. Subera, DO & First Lady Amy Subera

THURSDAY, April 18, 2013 7:00 am–5:00 pm 8:00-9:00 am

Registration – Conference Center

9:30 am

“AOOA Annual Business Meeting” Presiding: Walli Daniel, AOOA President (Bixby, OK) Special Guest: Nancy Granowicz, AAOA President (Waterford, MI)

9:00 -10:00 am

“Stage 1 and 2 Meaningful Use” Lindsey P. Mongold (Oklahoma City, OK) www.ofmq.com

“Medicare Program” David B. Vaughan (Vice President & JH Project Manager Novitas Solutions, Inc) www.novitas-solutions.com

10:00-10:30 am 10:30 am-12:00 pm 12:00-2:00 pm

“Medical Apps” Layne E. Subera, DO, FACOFP (certified family practice, Tulsa, OK) http://mobihealthnews.com/19206/apples-top-80-apps-for-doc tors-nurses-patients/ “Opening Session: Rescue of the Chilean Miners” J.D. Polk, DO, MS, MMM, CPE, FACOEP (certified emergency medicine, Haymarket, Virginia) Physician Luncheon with Exhibitors

2:00 – 3:30 pm “OOA ANNUAL BUSINESS MEETING” Presiding: Layne E. Subera, DO, FACOFP, OOA President (certified family practice, Tulsa, OK) www.okosteo.org 3:30 – 5:00 pm “AOA House of Delegate Meeting” Presiding: Bret S. Langerman, DO, Chairman of Delegation (certified emergency medicine, Oklahoma City, OK) www.okosteo.org 5:00 – 6:00 pm “ACOFP UPDATE” Presiding: Bobby N. Daniel, DO, President, Oklahoma Society ACOFP (certified family practice, Tulsa, OK) Special Guest: Jeffrey S. Grove, DO, FACOFP, ACOFP President (certified family practice, Largo, FL) 4:00 – 6:00 PM

Cocktail Hour with Exhibits with Drawings for Physicians & Exhibitors

Oklahoma D.O. |March 2013

SPURRING THE 113TH ANNUAL CONVENTION

LAYNE E. SUBERA, DO, FACOFP

BRET S. LANGERMAN, DO

MICHAEL K. COOPER, DO, FACOFP

OOA President

OOA President-Elect General Convention Chair

OOA Vice President Professional Program Chair

national guests

NORMAN E. VINN, DO President-elect of the American Osteopathic Association

RAY E. STOWERS, DO, FACOFP dist. President of the American Osteopathic Association

DAVID COFFEY, DO AAO President Oklahoma D.O. | March 2013

JEFFREY S. GROVE, DO ACOFP President

Nancy Granowicz President of the AAOA

FRIDAY, April 19, 2013 7:00 am–5:00 pm

Registration – Conference Center

8:30 – 10:00 am

OOA Past Presidents’ Breakfast

8:00-9:00 am

“Treating the WHOLE Patient with Trauma Osteopathically-Part I” Ronnie B. Martin, DO, FACOFP, dist (certified family practice, Blacksburg VA) Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL) Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL)

SPECIALTY TRACK PROGRAMS

EMERGENCY SPECIALTY TRACK

9:00-10:00 am

“Current Sepsis Management in the Emergency Department ” Chelsea D. Gilbertson, DO (emergency medicine, Oklahoma City, OK) www.news-medical.net/health/Toxicology-What-is-Toxicology.aspx

9:00-10:00 am

10:00-11:00am

“Patient Care-Toxicology Care in the ER” Kristopher K. Hart, DO (certified emergency medicine, Oklahoma City, OK) www.medscape.org/viewarticle/587247

10:00 am-12:00 pm “Hands on OMT Workshop” David Coffey, DO, FAAO, AAO President-Elect (certified family practice, Montgomery, AL) https://netforum.avectra.com/eweb/StartPage.aspx?Site=AAO

OMT SPECIALTY TRACK “AAO Update” David Coffey, DO, FAAO, AAO President-Elect (certified family practice, Montgomery, AL) https://netforum.avectra.com/eweb/StartPage.aspx?Site=AAO

11:00 am -12:00 pm “Patient Care-Cardiology Care in the ER” Daniel P. Kite, DO (emergency medicine, Norman City, OK) www.medscape.org/viewarticle/587247

Noon – 2:00 pm “ONE Leadership Luncheon” Presiding: Layne E. Subera, DO, FACOFP, OOA President (certified family practice, Tulsa, OK) Special Guests: Norman E. Vinn, DO, FACOFP,MBA, AOA President-Elect (certified family medicine, San Clemente, CA) Jeffrey S. Grove, DO, FACOFP, ACOFP President (certified family practice, Largo, FL) Nancy Granowicz, AAOA President (Waterford, MI) Walli Daniel, AOOA President (Bixby, OK) Bobby N. Daniel, DO, President, Oklahoma Society ACOFP (certified family practice, Tulsa, OK) www.osteopathic.org 2:00-3:00 pm

“Holistic Leadership” J.D. Polk, DO, MS, MMM, CPE, FACOEP (certified emergency medicine, Haymarket, Virginia) www.valuesbasedleadershipjournal.com/issues/vol4issue1/holistic _leadership.php

SPECIALTY TRACK PROGRAMS

OBGYN SPECIALTY TRACK

3:00-4:00 pm

“Evidence-Based Treatment Strategies for the Menopausal Patient” Guy W. Sneed, DO, FACOOG (certified obstetric & gynecological surgery, Owasso, OK) www.womenshealth.gov/publications/our-publications/ fact-sheet/menopause-treatment.cfm

4:00-5:00 pm

“Abnormal Pap Smear Results” Tammie L. Koehler, DO (certified obstetric & gynecological surgery, Miami, OK) http://americanpregnancy.org/womenshealth/ abnormalpapsmear.html

4:00-5:00 PM 6:00 – 11:00 pm

Visit Exhibits with Drawings for Physicians & Exhibitors

ANESTHESIOLOGY SPECIALTY TRACK

3:00-4:00 pm

“Postoperative Cognitive Dysfunction (POCD)” Dale Derby, DO (certified anesthesiology, Owasso, OK) http://www.trialsjournal.com/content/12/1/170

4:00-5:00 pm

“Pre-op Evaluation of Patients by Primary Providers, What We Really Need to Know” John B. Hill, DO (certified anesthesiology, Norman, OK) http://journals.lww.com/anesthesiology/fulltext/2011/03000/prac tice_guidelines_for_preoperative_fasting_and.13.aspx

Let the Chips Fall-Casino Night

Oklahoma D.O. |March 2013

SATURDAY, April 20, 2013 7:00 am – 5:00 pm

Registration – Conference Center

7:30 – 8:30 am

AOOA Past Presidents’ Breakfast

7:30-8:30 am

“Treating the WHOLE Patient with Trauma Osteopathically-Part 2” Ronnie B. Martin, DO, FACOFP, dist (certified family practice, Blacksburg VA) Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL) Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL)

8:30-9:30 am

SPECIALTY TRACK PROGRAMS

RADIOLOGY SPECIALTY TRACK “Proton Therapy” Robert C. Gaston, DO (certified Radiation Oncology, Norman, OK) www.procure.com/ProtonTherapy/WhatIsProtonTherapy.aspx?

8:30-9:30 am

SPORTS MEDICINE SPECIALTY TRACK “Pre-participation Screening for the Prevention of Sudden Cardiac Death in Young Athletes” Thomas W. Allen, DO (certified sports medicine, Tulsa, OK) www.ncbi.nlm.nih.gov/pubmed/22324860

9:30-10:30 am “Sports Injuries in the Female Athlete from Peewee to 9:30-10:30 am “RADIOSURGERY-Shorter is Better:How We Can Go From Boomeritis” 44-Treatments to 5-Treatments” Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL) Diane M. Heaton, MD (certified radiation oncologist, Tulsa, OK) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213798/ www.oklahomack.com/?gclid=CPSovL6Qr7UCFad_QgodmX QA1w 10:30 -11:00 am ROGME Poster Symposium Presentations 11:00-11:30 am ROGME Poster Symposium Presentations 11:30-12:00 pm ROGME Poster Symposium Presentations Noon – 1:30 pm Alumni Update Luncheon Presiding: Bret S. Langerman, DO, OOA President-Elect (Oklahoma City, OK) www.okosteo.org 1:30 – 2:00 pm Alumni Meetings www.okosteo.org 1:30 – 2:00 pm OSU-COM Alumni Meeting www.okstate.edu

SPECIALTY TRACK PROGRAMS

INTERNAL MEDICINE SPECIALTY TRACK

2:00-3:00 pm

“COPD: The Old and the New” James S. Seebass, DO, FACOI (certified pulmonary medicine & internal medicine, Tulsa, OK) www.touchrespiratory.com/articles/myths-and-misconceptions- about-copd-new-look-old-disease

PSYCHIATRY SPECIALTY TRACK

2:00-3:00 pm

“VIBRANT: To Heal and Be Whole” R. Murali Krishna, MD (certified psychiatry, Oklahoma City, OK) http://integrisok.com/mental-health/art-of-happy-living

3:00-4:00 pm

3:00-4:00 pm “Influence of Social Media” Brent D. Bell, DO (psychiatry, Oklahoma City, OK) http://health.howstuffworks.com/mental-health/depression/ques tions/social-media-depression.htm

4:00-5:00 pm

“Addressing the Need for Rural Psychiatry” Vincel R. Cordry, Jr., DO (certified psychiatry, Oklahoma City, OK) www.apa.org/about/gr/education/rural-need.aspx

6:00 – 7:00 pm

“Silver Buckle” Reception

7:00 – 9:00 pm

“Silver Buckle Banquet”

9:00 – Midnight

New President Reception honoring Dr. Bret and DeLaine Langerman Music by I.J. Ganem Band

Oklahoma D.O. | March 2013

4:00-5:00 pm

“Glycemic Control in the Critically Ill Patient” Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL) www.ncbi.nlm.nih.gov/pubmed/14559958 “Coordinating Care From the VA to a Private Practice” Thomas D. Schneider, DO, FACOI, MPH (certified internal medicine, Muskogee, OK) www.va.gov/

SUNDAY, April 21, 2013 7:00 – 11:00 am

Registration – Conference Center

8:00 – 9:00 am

“Risk Evaluation and Mitigation Strategies (REMS) – Enhancing Patient Safety: An Introduction for Prescribers ” Mukesh Mehta, DPh, MBA, RPh., (VP, Clinical & Regulatory Solutions PDR Network, Montvale, NJ) www.pdrnetwork.com

9:00 -10:00 am

“Opioid Abuse/Withdrawal...The Missed Diagnosis” Melinda R. Allen, DO, FACOI (certified internal medicine, Blackwell, OK) www.emedicinehealth.com/narcotic_abuse/article_em.htm

10:00 am– 12:00 pm

“Risk Management and the Use of Social Media in Your Practice” Sponsored by Medical Protective-Sign-In Required for Credit Melanie Osley, RN, MBA, CPHRM, CPHQ, ARM, DFASHRM Senior Clinical Risk Management Consultant www.medpro.com

annual convention activities Enter to win an iPad mini! Within the exhibit hall are hidden silver buckle drawing cards that will enter you into the drawing for the iPad mini’s. One can find these hidden silver buckle cards by locating the secret exhibitor. Be on the lookout for clues directing you to these exhibitors.

giveaway

Participants are able to enter more than once into the drawing.

HOTEL RESERVATIONS For hotel accommodations, please contact Sandie at Embassy Suites Norman - Hotel and Conference Center at 405-253-3547. Standard Suite is $154.00 a night. Check in: 3:00 pm/ Check out: 12 Noon. To avoid cancellation charges, reservations should be cancelled by 3:00 pm Room Cut-off is April 1, 2013 Room Amenities include: Two 32” televisions , Two phone lines with voicemail and data ports, Wireless Internet access, Hospitality center with microwave, refrigerator, and coffee maker.

SeekingSitters

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PRE-REGISTRATION is greatly appreciated! register online or on the convention form on page 13

Don’t forget to mention you are with the OOA!

Oklahoma D.O. |March 2013

EVENING activities COCKTAIL HOUR WITH EXHIBITORS

drinks are on the OOA in the exhibit hall during happy hour

LET THE CHIPS FALL CASINO NIGHT

Test your luck on friday evening during the casino night

SILVER BUCKLE BANQUET featuring IJ GANEM BAND

Join us Saturday evening for a night filled with celebration and dancing

Oklahoma D.O. | March 2013

DOT TRAINING WORKSHOP PROGRAM DOT FMCSA NRCME PROGRAM CORE CURRICULUM SYLLABUS This program has been approved for 8.5 Category 1-A AOA CME Credits. This program will be in conjunction to the OOA Annual Convention on Saturday, April 20, 2013. This is a full day program and seperate registration is required-Register on Page 13 For further information, please visit the OOA Convention Module or call the OOA Central Office at 405.528.4848.

Faculty:

• • • • • • •

Dan Callan, DO, MPH, FAOCOPM Elizabeth P. Clark, DO, MPH&TM, FAOCOPM Scott C. Jones, DO, MPH, FAOCOPM Bret Holland, DO, FAOCOPM Earl Miller, DO, FAOCOPM Lance Walker, DO, MPH Charles Werntz, DO, MPH, FAOCOPM

8:00-10:00 a.m. An Introduction to the Medical Program Update (2 credits) • Core Competencies of CME; Background, history, rationale, mission, & CME’s role • Commercial Medical Examiner route to certification • CMV; driver’s responsibilities & work; • CMV; driver’s identification. • Obtaining, reviewing, & documenting medical history • Prescription & over-the-counter medications. • Medications/non-disqualifying medical conditions needing care 10:00–12:30 p.m. Clinical Medical Standards, by Body System; Medical Examination; Performing & Documenting. (2.5 credits) • Hypertension • Respiratory Diseases • Diabetes • Hearing • Vision • Other Diseases 12:30 1:30 pm, FMCSA Overview (1 credit) • FMCSA reporting & documentation requirements. • Determining driver certification outcome, and period for which certification is valid 1:30 4:00 p.m. Clinical Medical Standards, by Body System; Medical Examination; Performing & documenting. (2.5 credits) • Musculoskeletal • Cardiovascular • Neurological • Psychiatry (including alcohol & drug abuse) • Additional diagnostic tests or medical opinions, as needed • Obtaining medical specialist/treating physician opinion 4:00 -4:30 p.m. Panel Discussion, Questions (.5 credit) AOCOPM, as a training organization, will stay current with FMCSA’s regulations & guidelines and provide timely, up-to-date continuous safety education and training 12

Oklahoma D.O. |March 2013

Oklahoma Osteopathic Associationâ&#x20AC;&#x2122;s 113th Annual Convention April 18-21, 2013 Embassy Suites Norman - Hotel and Conference Center 2501 Conference Drive, Norman, OK 73069 Full name: _____________________________________________________________________________________________________________________ Preferred Name / first name for name badge: __________________________________________________________________________________________ Office address: _________________________________________________________________________________________________________________ City: ____________________________________________________________________ State: ____________________ Zip: _____________________ E-Mail: _______________________________________________________ Phone: ________________________________________________________ CONVENTION SYLLABUS: q I wish to receive my professional program syllabus in print. Note: all presentations will be available on the convention module. OTHER NAME BADGES NEEDED FOR: Spouse: ______________________________________________________________________________ Guest(s): _____________________________________________________________________________ check the box, if you Children/Teens : plan to register this child in SeekingSitters

q_______________________________________________(age)__________________ q

(age)

NOTE: All convention registrants, Teens, Children, and Guests MUST wear an OOA name badge to enter the exhibit hall. We suggest listing all of your guests above to save you time during the registration process. On/Before April 11, 2013 q DO Member Registration (or other AOA divisional society member) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 (Includes Sundayâ&#x20AC;&#x2122;s Proper Prescribing Lecture and Risk Management Program) q Retired DO Member Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 q DO Nonmember Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,090 q Spouse/Guest/Exhibitor Events Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $220 q MD and Non-Physician Clinicians Registration* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 q Osteopathic Medical Student: q OMS-I q OMS-II q OMS-III q OMS-IV . . . . . . . . . . . . . . . . . . . . .$0 q Intern q Resident q Fellow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0

After April 11, 2013

$565

$325 $1,115 $245 $565 $0 $0

Registration is complimentary for osteopathic students and physicians in postgraduate training. They are welcome to attend all programs and convention functions at no charge. Please make event ticket requests at the OOA Registration desk. Badge required.

q q q

DO Member Registration for Proper Prescribing & MedPro Program (Sunday Program Only**) . . . . . . . . . . . . $195 DO Nonmember Registration for Proper Prescribing & MedPro Program (Sunday Program Only**) . . . . . . . . $745 MD and Non-Physician Clinician Registration for Proper Prescribing & MedPro Program (Sunday Program Only**) $195

$220 $770 $220

q q

Non-registered OOA Members may purchase Banquet tickets. I would like to purchase ________ Banquet ticket(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 each DOT FMCSA NRCME PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$450 each this is a seperate registration fee

$100 each $450 each

TOTAL AMOUNT DUE:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ $______________ Registration includes name badges(s), registration gift and all meals and social events unless otherwise noted. *Registration includes name badge, certificate, and registration gift. **Registration DOES NOT include registration gift or meal tickets. q

Charge my VISA, MASTERCARD, AMEX, DISCOVER:

Card #: ________________________________________________________________________________________________ Exp. Date______________ CID # (3 digit number on back of card or 4 digit number on front of AMEX card) _______________ Zip code for cardholder: ____________________________ q

My check in the amount of $______________ is enclosed and made payable to the Oklahoma Osteopathic Association.

Mail this form and payment to: Oklahoma Osteopathic Association: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335 or FAX: 405.528.6102 NOTE: All DO attendees must be members in good standing with their respective state association in order to attend at the announced fees. Otherwise, a DO may attend the convention by paying an additional $550, which may be applied towards OOA membership dues with completed application. Students, interns, residents, and fellows are not required to pay a registration fee and are welcomed to attend all convention functions at no charge. Requests for refunds must be received before April 11, 2013, and a $45 service fee will be charged. NO REFUNDS AFTER APRIL 11, 2013. Oklahoma D.O. | March 2013

Oklahoma Osteopathic Willow Creek Country Club Association 6501 S. Country Club Dr.

Golf Tournament Golf Chair: Paul F. Benien, JR, DO

Oklahoma City, OK 73159

Wednesday, April 17, 2013

Registration includes Goodie Bag, All course fees, Range Balls, Golf Cart, Lunch, Beverage Cart Service, and Full Service Bag Drop

11:00 am............Check-in 11:30 am................Lunch 1:00 pm......Shotgun Start Awards at End of Play

Shirts Sponsored by:

Sponsorship Opportunities

Hole-in-One Sponsor- $2000

Includes: Team of 4, custom sign at 1st hole, listed on marketing material

Birdie Sponsor- $1000

Includes: 2 player registrations, custom sign placed at a hole, listed on marketing material

Hole Sponsor- $500

Tee Sponsor- $100

Includes: 1 player registration, custom sign placed at a hole, listed on marketing material

D L O S Sign me up!

Lunch Sponsor- $500

Includes: Custom sign placed at a hole, listed on marketing material

We will place a sign with your logo out during the player lunch

Beverage Cart- $500

A sign with your logo will be placed on the beverage cart servicing all players

Payment Information

Sponsors

NAME:

Sign my team up! ONE: TWO:

Hole-in-One Sponsor- $2000 Birdie Sponsor- $1000 Hole Sponsor- $500 Tee Sponsor- $100 Lunch Sponsor- $500 Beverage Cart- $500

THREE: FOUR:

Players

One Player- $150 Two Players- $300 Three Players- $450 Four Players- $600 2 Mulligans- $30 One set per player

Total: Credit Card Number

Expiration Date

Shirts will be available for all players who register before March 20, 2013 Shirt Size: Shirt Size: Shirt Size: Shirt Size:

I think Iâ&#x20AC;&#x2122;ll need mulligans. 2 Mulligans- $30 One set per player

Signature

Contact information! Address: City, State, Zip: Phone Number: E-Mail: Oklahoma D.O. |March 2013

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2012-2013 Directory Order Form I would like to order______ copies of the 2012-2013 directory @ $55 per directory. Shipping and Handling is not included in the price, please call for pricing (405) 528-4848 or (800) 522-8379

PAYMENT INFORMATION: I have enclosed a check in amount of $__________.

Please bill my credit card Check card type: ______VISA ______MC ______AMX ______ DSC Card Number:_________________________________________________________ Name on Credit Card: __________________________________________________

Signature: _______________________________________Exp. Date____________

BILLING INFORMATION:

Company: __________________________________________________________________ Contact Person: _____________________________________________________________ Address: ___________________________________________________________________ City: _____________________________________ State: _______ Zip: _________________ Phone: ___________________________________ Email: ____________________________

PLEASE RETURN FORM BY MAIL OR FAX MAIL: FAX TO: 4848 N. Lincoln Blvd. (405) 528-6102 Oklahoma City, OK 73105-3335 Oklahoma D.O. | March 2013

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Oklahoma D.O. |March 2013

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Oklahoma D.O. | March 2013

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Oklahoma D.O. |March 2013

Foundation Update ... For the next few months, the foundation will use their column space to highlight lay members of the OEFOM Board of Trustees. We began the series with a salute to the OEFOM President, Mary Shaw, followed with a grateful acknowledgement of the 20 years service of Steve Whitfill whose term on the board recently expired and most recently a tribute to Sherri Wise with the Osteopathic Founders Foundation. This month we would like to highlight some of the accomplishments of local attorney and lay member and past president of the OEFOM Board of Trustees, B. Gore Gaines, J.D. Mr. Gaines is an alum of both the University of Oklahoma where he earned his bachelor’s degree in Economics and Oklahoma City University where he earned his Juris Doctorate and graduated Cum Laude. During his time in school, he was involved in many activities including Phi Delta Phi, a legal fraternity, and political work. Since 1998, Mr. Gaines has been associated with Lytle, Soule & Curlee, P.C., Oklahoma City’s oldest law firm, of which he is a shareholder. His work principally involves representation of companies and other entities in corporate matters, employment law issues, and

litigation. He serves as outside counsel for a large Oklahoma Citybased financial institution, and is employment law counsel for a state-wide public trust. Gaines was recognized as outstanding associate, and later, as outstanding barrister, by the Ruth Bader Ginsburg American Inn of Court. He is rated AV Preeminent by the Martindale Hubbell, reflecting that organization’s highest accreditation for legal ethics and ability, and was recognized for his abilities by Distinctly Oklahoma magazine in 2011. As a young man, Mr. Gaines worked for U.S. Senator David L. Boren, and was a campaign coordinator for Robert S. Kerr, III. During his time in law school, Mr. Gaines was the Pardon, Parole, and Extradition Coordinator in the Oklahoma Governor’s Office. He served as Assistant Attorney General for the State of Oklahoma upon graduation from law school. He and his wife, Julie Gaines, have two children, Casey and Colby, who keep them very busy in scouting and sporting activities. The OEFOM is blessed to be able to call Gore Gaines a member of their Board of Trustees and we thank him for his years of service. okDO

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Oklahoma D.O. | March 2013

OOA’s Bureau News 2013 Nominating Committee

Members from the OOA Nominating Committe and their respective Districts met Thursday, January 3, 2013 at the OOA Central Office to make nominations to fill vacancies on the OOA Board of Trustees, Delegates, and Alternate Delegates of the American Osteopathic Association (AOA) House of Delegates. Members in attendance were: Thomas H. Conklin Jr., DO-Eastern District; James I. Graham, DO-North Central; Chad Owens, DO-Northwestern; Bret S. Langerman, DO-South Central; Kenneth E. Calabrese, DO-Tulsa; Trudy J. Milner, DO-President 2007-2008; Gilbert M. Rogers, DO-President 2008-2009; Duane G. Koehler, DO-President 2009-2010-Northeastern; Scott S. Cyrus, DO-President 2010-2011; LeRoy E. Young, DO-President 2011-2012.

Recommendations for consideration by the Membership of the Oklahoma Osteopathic Association: 2013 Vacancies To Be Filled: President-Elect (Becomes President): Vice President (One-Year Term): Trustee (One-Year Term ending 2014): Trustee (One-Year Term ending 2014): Trustee (Three-Year Term ending 2016): Trustee (Three-Year Term ending 2016):

Michael K. Cooper, DO C. Michael Ogle, DO Melissa A. Gastorf, DO Timothy J. Moser, DO Ronald S. Stevens, DO Dale Derby, DO

2013 AOA House of Delegates (Delegates) 1. Bret S. Langerman, DO, Chairman of Delegation 2. Michael K. Cooper, DO, Vice Chairman of the Delegation 3. David F. Hitzeman, DO 4. Joseph R. Schlecht, DO 5. Scott S. Cyrus, DO 6. Stanley E. Grogg, DO 7. Layne E. Subera, DO 8. LeRoy E. Young, DO

2013 AOA House of Delegates (Alternates) 1. Melissa Gastorf, DO 2. Timothy J. Moser, DO 3. William J. Pettit, DO 4. Bobby N. Daniels, DO 5. Dennis J. Carter, DO 6. Justin S. Sparkes, DO 7. James P. Riemer, DO 8. Gordon P. Laird, DO

9. 10. 11. 12. 13. 14. 15. 16.

Duane G. Koehler, DO Kayse M. Shrum, DO C. Michael Ogle, DO Gabriel M. Pitman, DO Christopher A. Shearer, DO Ronald S. Stevens, DO Trudy J. Milner, DO Thomas J. Carlile, DO

9. 10. 11. 12. 13. 14. 15. 16.

H. Zane DeLaughter, DO Gregory H. Gray, DO Gilbert F. Rogers, DO John F. Rice, DO Terence E. Grewe, DO Jeffrey Jones, DO Tammie L. Koehler, DO Ray E. Stowers, DO

2013 Proposed OOA Bylaw

The proposed Bylaws will be voted on during the Association’s annual business meeting at 2:00 pm, Thursday, April 18, 2013 at the Norman Embassy Suites. During the December 6, 2012 meeting, the OOA Board of Trustees approved the following dissolution clause to be added to the OOA Bylaws and Constitution. According to the OOA Bylaws, Article IX. Amendments, the Bylaws may be amended by this Association at any annual session by a two-thirds vote of the accredited voting members in attendance at such session... “Upon dissolution or other termination, all remaining assets, after payment in full of all its debts, obligations, and necessary final expenses, or after the making of adequate provision therefore, shall be distributed to such tax exempt organizations with purposes similar to those of the organization as shall be chosen by the then existing Board of Directors.”

Bureau on Membership

The OOA Board of Trustees welcomes the following new members to the OOA family!

Aliyeah Ayadpoor, DO Family Medicine Glenpool, OK

Christina M. Rhodes, DO Anesthesiology Oklahoma City, OK

Louise E. Price, DO Family Medicine Tulsa, OK

Casey L. Snodgress, DO Family Medicine Coweta, OK

Jeremy D. Thomas, DO Orthopedic Surgery Claremore, OK

Oklahoma D.O. |March 2013

Doctor of the Day Schedule Date

Doctor/Home Add

Senator/Rep

M-March 4

Lori Gore-Green, DO PO Box 116331 Carrollton TX 75011-6331

Senator Jabar Shumate Rep Kevin Matthews

T-March 5

Mike Simulescu, DO 715 Meadowlark Lane Durant, OK 74701

Senator Josh Brecheen Rep Dustin Roberts

Gordon P. Laird, DO 39451 E 41st Morrison, OK 73061

Senator Ann Griffin Rep Dennis Casey

W-March 6 Th-March 7 M-March 11 T-March 12

Stanley E. Grogg, DO 4520 S Birmingham Pl Tulsa, OK 74105 Bobby N, Daniel, DO 11729 S 66Th E Ave Bixby, OK 74008-8210

Senator Gary Stanislawski Rep Ron Peters Senator Mike Mazzei Rep Fred Jordan

Jay D. Cunningham, DO 18808 Saddle River Dr. Edmond, OK 73012

Senator Rob Johnson Rep Mike Turner

W-March13

Thomas H. Osborn Jr., DO Senator Susan Paddock PO Box 572 Rep Steve Kouplan Holdenville , OK 74848-0572

Th-March 14

Keith S. Patterson, DO 9303 N 161st E Ave Owasso, OK 74055

Senator Sean Burrage Rep David Derby

M-March 18 T-March 19

Vacant

W-March 20

H. Zane DeLaughter, DO RR 1 Box 34682 Comanche, OK 73529

Senator Corey Brooks Rep Dennis Johnson

Th-March 21 M-March 25

Michael E. Salrin, DO 11487 S 354Th Earlsboro, OK 74840-9011

Senator Ron Sharp Rep Justin Freeland Wood

Vacant

T-March 26

Vacant

W-March 27

Martin D. McBee, DO 11000 Old River Trail Edmond, OK 73013

Senator Ron Sharp Rep Mike Shelton

Th-March 28

Scott S. Cyrus, DO 11204 S. Winston Ave

Senator Gary Stanislawski Rep Fred Jordan

Oklahoma D.O. | March 2013

Purpose and Fun! Provided by Walli Daniel, RN, 2012-2013 AOOA President It has been a mild winter for most of us this year and we look forward to spring and the promise of new beginnings. But whether it is winter, spring, summer or fall, it’s always an exciting time to be an Advocate for the State of Oklahoma.

Advocates participate in the Jewelry Making Event during the 2013 Winter CME Seminar

During the 2013 Winter CME, the AOOA hosted a Jewelry Making Event and invited Flo Conklin, Past AOOA President, an accomplished jewelry designer and business owner, to teach the class. We made beautiful necklaces with fresh water pearls, enjoyed a wonderful time of refreshments provided by the OOA and renewed friendships from around the state. The event was well attended and everybody had a great time. We reacquainted ourselves with past SAA and District Presidents and were delighted to make new friends as well. Vickie Stevens, PresidentElect, and I handed out flyers and recruited new members the night before our big events and were thrilled they came and many new members were added that day. There were even a couple of “Manvocate” officers who attended and we were glad to have them! Following the jewelry party we asked members to bring their portable electronic devices to a Mobile Device Class with instructors from Apple and AT&T to provide updates, tips and a question/answer session. This was worthwhile and sparked a lot of interest. The word spread among some of the physicians who also want to attend – some did! We plan to do this again.

On Saturday evening there was a Mentor/Mentee reception where the physicians and spouses enjoy a lovely evening with the students. Last year the OOA approved the AOOA to have a wine pull at Winter CME. This year we asked the OOA to approve the Wine/Cigar Pull Fundraiser be passed on to the SAA/ Manvocates to subsidize their budgets and they agreed. We donated most of the wine and cigars, instructed, supervised and fully supported them. The OOA members were very supportive of the students. They did a fantastic job from providing a beautiful presentation to sewing custom, monogrammed wine bags and creating a positive energy that was contagious. People crowded around the tables laughing and had a great time making it a huge success which increased revenues in their treasury by twenty-five percent! Thank you OOA staff for your support and to all of the physicians and families who generously made purchases!

(l-r) AOOA Board work the Wine Pull and Cigar Pull during the OOA Mentor/Mentee Recetpion (l-r) Bavette Miller, Andy Ting & Diane Cooper 22

Oklahoma D.O. |March 2013

An OOA board members wife called last month and asked one question, “All I want to know is – Can anyone be a “Manvocate?” I laughed and replied, “Yes, of course!” She was thrilled and said she wanted to make sure she and her husband could attend all these fun functions and hated to miss out. It’s a moment I won’t forget and they quickly secured tickets they were wanting. These functions are for EVERYONE around the state and geared for families. We promote friendships and strong marriages by promoting events that keep our osteopathic families healthy. The AOOA hosted a “Manvocate” event on February 15thDarryl Starbird’s Hot Rods, Monster Trucks and Music and were amazed by the response! It is the largest indoor car show in the nation. Let us know which events you like the most. We welcome your ideas.

State Convention is coming April 18-21, 2013 and the AOOA is going to be raffling high end electronics and products along with a Silent Auction, Casino Night and the yearly OOA Golf Tournament! We welcome all of your Silent Auction Gifts and sponsorships. This year’s AAOA President, Nancy Granowicz, Sherri Martin, Immediate Past President AAOA and Linda Adams, Past AAOA President from Michigan are all planning to attend along with our own three past national presidents. She is bringing an interactive piece of equipment to educate Oklahomans on the dangers of “Texting and Driving.” She lost her own son to this tragedy and has since become proactive in advocating prevention. The Advocates are planning a presentation featuring a special guest speaker, Dr. Tammie Koehler, Chairman of the Speaker Bureau and our current Parliamentarian, Orpha Harnish, Past AAOA President as she recounts her story of how she tackled the legislature and made an important contribution to osteopathic medicine. The Advocates plan to honor those who okDO have distinguished themselves. Below is the Advocate Program during the OOA Annual Convention, come join us for a time of fellowship and fun.

Percy Brown, with OSU Prevention Programs tests out a new bike while attending the AOOA sponsored Manvocate event at Darryl Starbird’s Rod and Custom Show

Thursday, April 18, 2013 9:30 am AOOA Annual Business Meeting 10:30 am Installation Ceremony 11:30 am “Surviving Medical School Twice” presented by: Tammie Koehler, DO 12:00 pm “Honoring Distinguished Advocates” Orpha Harnish, AAOA Past President Come as she shares the story of her historic Contribution to Osteopathic Medicine!

The AOOA’s most ambitious “Manvocate” event of the year is the Oklahoma Thunder Game on March 15th. Two hours after making the formal announcement tickets sold out and we started a waiting list! This is a statewide event with blocks of excellent seats reserved and transportation by the OSU bus from Tulsa. How exciting to meet up with friends from around the state in Oklahoma City for a special night with the NBA!

World renowned “Lil’ Toot” pinstripes a pedal car as show attendees observe.

Oklahoma D.O. | March 2013

(l-r) Walli Daniel, AOOA President and Dowana Carr, SAA President

PROPOSED AMENDMENTS

TO BYLAWS OF THE ADVOCATES FOR THE OKLAHOMA OSTEOPATHIC ASSOCIATION Codes used in text for proposed bylaws amendments Bold = insert or add Words underlined = strike out Amendment #1 ART I, NAME CURRENTLY STATED: The name of this organization shall be the Advocates to the Oklahoma Osteopathic Association, hereinafter referred to as AOOA.

PROPOSED AMENDMENT: Amend by deleting to and inserting for ……..

IF APPROVED, WILL READ: The name of this organization shall be the Advocates for the Oklahoma Osteopathic Association, hereinafter referred to as AOOA. (This change shall be made wherever it appears in these bylaws.)

RATIONALE: This is to conform to the bylaws of AAOA. Amendment #2 ART. II OBJECT CURRENTLY STATED:

PROPOSED AMENDMENT:

IF APPROVED, WILL READ:

The object of this organization shall be to correlate the activities of the state and district advocate groups for the purpose of promoting and supporting the public health and educational activities of the osteopathic profession, and to render service to community health endeavors which are within the general objectives of the Advocates to the American Osteopathic Association. (AAOA).

Amend by inserting, after “organization”, The Advocates for the Oklahoma Osteopathic Association (AOOA), a 50l (c) 3, non-profit organization, shall be to correlate the activities of the state and district advocate groups………

The object of this organization, The Advocates for the Oklahoma Osteopathic Association (AOOA), a 501 (c) 3, nonprofit organization, shall be to correlate the activities of the state and district advocate groups for the purpose of promoting and supporting the public health and educational activities of the osteopathic profession, and to render service to community health endeavors which are within the general objectives of the Advocates for the American Osteopathic Association (AOOA).

RATIONALE: This is to clearly state that AOOA is a non-profit organization. Amendment #3 ART. III MEMBERSHIP CURRENTLY STATED:

PROPOSED AMENDMENT:

IF APPROVED, WILL READ:

Sec. 1.A—Regular membership shall be granted to the members of the immediate family of an osteopathic physician in good standing in the Oklahoma Osteopathic Association (OOA).

Regular membership shall be granted to any person interested in supporting AOOA, as stated in ART. II, deleting “the members of the immediate family of an osteopathic physician in good standing in the Oklahoma Osteopathic Association (OOA).”

Regular membership shall be granted to any person interested in supporting AOOA as stated in ART. II.

RATIONALE: Again, this is to conform to AAOA bylaws.

Oklahoma D.O. |March 2013

Amendment #4 ART III MEMBERSHIP Sec. I. C CURRENTLY STATED:

PROPOSED AMENDMENT:

IF APPROVED, WILL READ:

Associate Membership may be granted to: (1) The spouses of those who are eligible for associate membership in the AOA, OOA, or those who retain such membership as follows: (a) Graduates of accredited schools of medicine, dentistry, holding teaching, research, or administrative positions in AOA-approved hospitals and colleges, or who practice jointly with osteopathic physicians. (b) Doctors of Philosophy or Education and other non-doctoral personnel holding teaching, research, or administrative positions in AOA-approved hospitals and colleges. (c)Administrative employees of the OOA, affiliated organizations, and divisional societies. (d) Any other professionals as determined by the AOA or OOA excepting Doctors of Osteopathy and students in osteopathic colleges. (2 Any family member of an AOOA member.

Amend by deleting the entire Sec. l-C and inserting Associate Membership may be granted to those persons interested in supporting AOOA and their objectives, as stated in ART. II, but shall be without voice or vote.

Associate Membership may be granted to those persons interested in supporting AOOA and their objectives, as stated in ART. II, but shall be without voice or vote.

RATIONALE: This class of membership is for anyone other than physicians and/or spouses or significant others who may wish to join at a lesser dues’ rate but without voice or vote. Amendment #5 ART III MEMBERSHIP, Sec. I.D CURRENTLY STATED: Student Associate Membership shall be granted to the spouses enrolled in a provisionally or fully accredited osteopathic educational institution.

PROPOSED AMENDMENT:

IF APPROVED, WILL READ:

Amend by deleting the entire section D, and inserting the following: Student Advocate Association membership shall be granted to the spouses or significant other of students in a provisionally or fully accredited osteopathic educational institution.

Student Advocate Association membership shall be granted to the spouses or significant other of students in a provisionally or fully accredited osteopathic educational institution.

RATIONALE: This amendment changes the wording “student associate” to “student advocate”. Amendment #7 ART III MEMBERSHIP, (to add a new Section F.) CURRENTLY STATED: None.

PROPOSED AMENDMENT: Amend by adding Section F, to read: “Manvocate” membership shall be granted to those male members of any class of membership within AOOA who are supportive of AOOA and willing to promote the objectives of AOOA, as stated in ART. II.

IF APPROVED, WILL READ: “Manvocate” membership shall be granted to those male members of any class of membership within AOOA who are supportive of AOOA and willing to promote the objectives of AOOA, as stated in ART. II.

RATIONALE: This is felt to be a necessary, new category of membership for the growing number of spouses and significant others of female students and physicians who wish to support the profession in a more diverse and creative way that captures the male interests, thereby increasing Advocate membership. Oklahoma D.O. | March 2013

Amendment #8 ART III MEMBERSHIP, (to add a new Section G.) CURRENTLY STATED: None.

PROPOSED AMENDMENT:

IF APPROVED, WILL READ:

Amend by adding a new Sec. G, to read: Sec. G. Retired or Widowed membership shall be granted to the spouses or significant other of a retired or widowed osteopathic physician.

Sec. G. Retired or Widowed membership shall be granted to the spouses or significant other of a retired or widowed osteopathic physician.

RATIONALE: This group of people have not been included or addressed and the committee felt it should be. Amendment #9 ART. III MEMBERS, Sec. 3 CURRENTLY STATED: The annual dues shall be: A. Regular member (except 1 & 2).. $50 1. Widows and spouses, spouses of retired osteopathic physicians..$5 2. Spouses of interns, resident physicians, and physician in first year of practice.. $1 B. Honorary Life Membership.. Exempt C. Associate members…. $1.00 D. Student Associate …. Exempt

PROPOSED AMENDMENT: Delete the present Sec. 3, and insert the following as Sec. 3: Dues and Assessments—The Board of Directors shall determine and set all classes of membership dues and assessments annually, and shall follow the prescribed AOOA procedures for dues’ dates, delinquency dates, and any special requests relating to membership dues.

IF APPROVED, WILL READ: Dues and Assessments—The Board of Directors shall determine and set all classes of membership dues and assessments annually, and shall follow the prescribed AOOA procedures for dues’ dates, delinquency dates, and any special requests relating to membership dues.

RATIONALE: It is customary that bylaws do not include the amount of dues of the various classes of membership, since they are changeable and would, therefore, require a bylaw change on each occasion, so it is recommended that the dues be included in the Standing Rules, which are subject to the approval of the Board of Directors. Amendment #10 ART. III MEMBERS, Sec. 5 CURRENTLY STATED: The annual dues shall be collected in the following manner: A. Through the OOA office along with the physicians’ dues; B. By the Treasurer of the AOOA.

PROPOSED AMENDMENT: Delete Section 5-A.

IF APPROVED, WILL READ: Sec. 5. The annual dues shall be collected by the Treasurer of the AOOA.

RATIONALE: The OOA has requested that they no longer shall be responsible for collection of AOOA dues. This is to comply with the OOA request. Amendment #11 ART. III MEMBERS, Sec. 7 CURRENTLY STATED: Associate members shall not be eligible to hold office, serve on committees or serve as delegates to the House of Delegates.

PROPOSED AMENDMENT: Insert “except by approval of the AOOA Board of Directors.”

IF APPROVED, WILL READ: Associate members shall not be eligible to hold office, serve on committees or serve as delegates to the House of Delegates, except by approval of the AOOA Board of Directors.

RATIONALE: This is giving more opportunity for leadership experience to the various membership classes. 26

Oklahoma D.O. |March 2013

Amendment #12 ART. III MEMBERS, Sec. 7-B CURRENTLY STATED: 7-C. Student Associate members shall be eligible to serve on committees but shall not hold office. The President or Alternate shall serve on the AOOA delegation to the AAOA House of Delegates.

PROPOSED AMENDMENT: Delete the first sentence, Student Associate members shall be eligible to serve on committees but shall not hold office, and insert Student Advocate, Intern and Resident Advocate and “Manvocate” members shall be eligible to serve on committees and hold office, with the approval of the Board of Directors, and shall have served on the AOOA Board of Directors for no less than two years before being eligible to become President or President-Elect.

IF APPROVED, WILL READ: Student Advocate. Intern and Resident Advocate and “Manvocate” members shall be eligible to serve on committees and hold office, with the approval of the Board of Directors, and shall have served on the AOOA Board of Directors for no less than two years before being eligible to become President or President-Elect. The President or Alternate shall serve on the AOOA delegation to the AAOA House of Delegates.

RATIONALE: This amendment gives the option of SAA, IRAA and/or “Manvocate” members to serve and be a voting member of the Board of Directors, with approval of the B-D and with some restrictions. Amendment #13 ART. III MEMBERS, Sec. 8 CURRENTLY STATED: A. Regular membership shall be automatically terminated: 1. If the license of the osteopathic physician has been revoked, suspended, or recalled; 2. Upon divorce from the osteopathic physician; 3. Upon remarriage outside the osteopathic profession. B. Life membership cannot be terminated. C. Associate membership shall be terminated when life member no longer meets the criteria for associate membership.

PROPOSED AMENDMENT: Delete A-1, 2, 3, B and C and insert Regular membership may be automatically terminated upon non-payment of dues but Life and Honorary membership cannot be terminated. Delete Associate and insert Advocate, Intern and Resident Advocate, or “Manvocate” members, if applicable, shall be terminated when the stated member ends the relationship with the osteopathic educational institution or completes his/ her internship, residency, or fellowship program.

IF APPROVED, WILL READ: Regular membership may be automatically terminated upon non-payment of dues but Life and Honorary membership cannot be terminated. Student Advocate , Intern and Resident Advocate, or “Manvocate” Association members, if applicable, shall be terminated when the stated member ends the relationship with the osteopathic educational institution or completes his/ her internship, residency, or fellowship program.

Sec. D. Student Associate membership shall be terminated when the student ends the relationship with the osteopathic educational institution. RATIONALE: This is bringing the various membership categories in agreement with previous bylaws and amendments.

Oklahoma D.O. | March 2013

Amendment #14 ART. IV OFFICERS, Sec. 8 CURRENTLY STATED: E. (12) The bank account shall be at the same bank as the Oklahoma Osteopathic Association. The signature card shall require the signature of the current President, President-Elect and Treasurer. Any amount over $500 requires two signatures.

PROPOSED AMENDMENT: Delete bank account shall be at the same bank as the Oklahoma Osteopathic Association, with the remainder of the section remaining as is.

IF APPROVED, WILL READ: The bank signature card shall require the signature of the current President, PresidentElect and Treasurer. Any amount over $500 requires two signatures.

RATIONALE: This practice is no longer followed by vote of the Board, but the bylaws were never changed. Amendment #15 ART. VI EXECUTIVE BOARD, Section 8. CURRENTLY STATED: ART, VI Executive Board

PROPOSED AMENDMENT: Amend the title of this ART VI by deleting Executive Board and inserting Board of Directors, and further amend these AOOA Bylaws wherever the words “Executive Board” exist.

IF APPROVED, WILL READ: ART VI Board of Directors

RATIONALE: Since there is inconsistency in the use of “Executive Board” and “Board of Directors”, this change would clarify the term of Board of Directors rather than “Executive Board”. Amendment #16 ART. VI MEETINGS, Sec. 3 CURRENTLY STATED: Sec. 3-A Regular meeting of the Executive Board shall be held:

PROPOSED AMENDMENT: Amend to insert as needed, but no less than….

IF APPROVED, WILL READ: A. Regular meeting of the Board of Directors shall be held as needed but no less than: (1) Immediately following the Annual Meeting; (2) Midsummer; (3) Midwinter: (4) Immediately preceding the Annual Meeting.

RATIONALE: This change allows the Board to meet as needed without calling a “special” meeting. Amendment #17 ART. VII COMMITTEES, Section I-I CURRENTLY STATED: Student Associate Auxiliary Advisor

PROPOSED AMENDMENT: Amend to delete Student Associate Auxiliary Advisor and insert Student Advocate, Intern and Resident Advocate and “Manvocate” Association Liaison.

IF APPROVED, WILL READ: I. Student Advocate, Intern and Resident Advocate and “Manvocate” Association Liaison.

RATIONALE: Updating the language. 28

Oklahoma D.O. |March 2013

Amendment #18 ART VII COMMITTEES, Sec. 5 CURRENTLY STATED: AAOA Scholarship Committee shall consist of a Chairman who shall be the Immediate Past President and who shall: A. Encourage donations to the AAOA Scholarship Fund (district and individual);

PROPOSED AMENDMENT: Amend by deleting Sec. 5 in its entirety. Insert AOOA Scholarship Committee shall consist of a Chairman who shall be the Immediate Past President and who shall encourage donations to the AOOA scholarship efforts.

IF APPROVED, WILL READ: AOOA Scholarship Committee shall consist of a Chairman who shall be the Immediate Past President and who shall encourage donations to the AOOA scholarship efforts.

B. Coordinate scholarship interview C. with the AAOA Scholarship Chairman;

D. Provide interviews for all students

who have applied to the AAOA for scholarship and see that all interviews evaluations are forwarded to the AAOA Scholarship Committee by the appointed date to be reviewed by the AAOA Scholarship Committee.

RATIONALE: This change was needed inasmuch as AAOA no longer has a scholarship program but the AOOA does. Amendment #19 ART VII COMMITTEES, Sec. 10 CURRENTLY STATED:

PROPOSED AMENDMENT:

Sec. 10-A—Encourage contributions to the OEFOM and the National Osteopathic Funds (student loan and research, National Osteopathic Seals, and Osteopathic Progress Fund); and AAOA Endowment Fund.

Amend by deleting “and the National Osteopathic Funds (student loan and research, National Osteopathic Seals, and Osteopathic Progress Fund);”

IF APPROVED, WILL READ: Sec. 10-A—Encourage contributions to the OEFOM and AAOA Endowment Fund.

RATIONALE: Student Loan and Research, Seals, and OPF no longer exist. Amendment #20 ART VII COMMITTEES, Section 13 CURRENTLY STATED: The Student Associate Auxiliary Advisor shall consist of the Chairman who shall act as a liaison between AOOA, the Student Associate Auxiliary, and the AAOA Student Auxiliary Counselor.

PROPOSED AMENDMENT: Amend by deleting the entire sentence as it now reads Insert The SAA, IRAA and Manvocate Committee shall consist of a Chairman who shall be the liaison for each group to AOOA, and who may appoint committee members as needed for each group in cooperation with AAOA.

IF APPROVED, WILL READ: The SAA, IRAA and “Manvocate” Committee shall consist of a Chairman who shall be the liaison for each group to AOOA, and who may appoint committee members as needed for each group in cooperation with AAOA.

RATIONALE: This is updating the names of the respective groups in this committee. Oklahoma D.O. | March 2013

Amendment #21 ART. VIII PARLIAMENTARY AUTHORITY CURRENTLY STATED:

PROPOSED AMENDMENT:

The latest edition of Robert’s Rules of Order Revised shall govern AOOA in all proceedings……

Amend by inserting Newly Revised……..

RATIONALE: This is the complete title.

IF APPROVED, WILL READ: The latest edition of Robert’s Rules of Order Newly Revised shall govern AOOA in all proceedings not provided for in these Bylaws and any special rules of order AOOA may adopt.

Amendment #22 ART. IX METHOD OF AMENDMENT CURRENTLY STATED:

PROPOSED AMENDMENT:

IF APPROVED, WILL READ:

Sec. 1. These Bylaws may be amended by a two-thirds vote of those attending the Annual Meeting provided notice of such amendment shall have been presented in the OKLAHMA D.O. or in writing at least fifteen days prior to the meeting.

Amend by inserting members between “those” and “attending”……

These Bylaws may be amended by a two-thirds (2/3) vote of those members attending the Annual Meeting provided notice of such amendment shall have been presented 9 in the OKLAHOMA D. O. or in writing at least fifteen days prior to the meeting.

RATIONALE: This word “members” needs to be inserted to indicate only members can vote.

PROVISO With the adoption of these amendments, it is requested that the Bylaws Committee has the authority to correct Article and Section designations, if needed, punctuation and cross references, if needed, or other technical changes as may be necessary to reflect the intent of The Advocates for the Oklahoma Osteopathic Association, and these Bylaws.

2013-2014 Slate of AOOA Officers for consideration by the Membership of the Advocates for the Oklahoma Osteopathic Association:

President: President Elect: Vice President: Treasurer: Recording Secretary: Corresponding Secretary: Immediate Past President:

Vicki Stevens Donna Cannon Bavette Miller Andy Ting Maghin Abernathy Apryl Pritchett Walli Daniel

BYLAWS COMMITTEE: Orpha Harnish, Chairman Bavette Miller Donna Cannon Walli Daniel, President, ex-officio 30

Oklahoma D.O. |March 2013

Can Motivational Health Beliefs Help Explain the Relationship Between Education and Health Behaviors Provided by Denna L. Wheeler, Ph.D., Director of Rural Research

The Partnership to Fight Chronic Disease recently produced a list of unhealthy truths about how chronic diseases are fueling a national health care crisis (PFCD, 2012). The list included the following: â&#x20AC;˘ Chronic diseases are the primary cause of death and disability â&#x20AC;˘ Chronic disease treatment accounts for 75% of health care spending â&#x20AC;˘ The vast majority of chronic disease cases could be prevented or better managed. With Oklahoma currently ranked 43rd in overall health (United Health Foundation, 2012) these unhealthy truths are disproportionately affecting Oklahomans. There are certainly no surprises in this list for persons connected to Oklahoma healthcare delivery but awareness has not contributed to improvement in health behaviors or rates of chronic disease. In spite of wide spread public health messages to encourage healthier behaviors, rates of obesity and preventable chronic disease continue to rise. In addition to public health initiatives, there have been a number of programs designed to improve patientprovider interaction including health literacy interventions, cultural competence training, and population-based medicine. The goal of these initiatives is to empower patients to more fully participate in health information seeking, shared decision

CENTER FOR HEALTH SCIENCES

making regarding treatment options, and self-care in order to improve health behaviors and treatment compliance leading ultimately to better health outcomes (Center for Advancing Health, 2010). The results of these initiatives have been mixed. For example, cultural competence has been empirically shown to improve patient provider communication and satisfaction but this has not translated to improved clinical outcomes (Lie et al., 2010). Likewise, health literacy interventions have improved information comprehension but have inconsistent relationships with patient outcomes (Berkman et al., 2011). Inconsistent results like these often indicate the presence of one or more moderators. That is, the effectiveness of these interventions depends on one or more other factors. Health literacy initiatives have been driven, in part, by the strong relationship between education and health factors (See Figures 1 & 2). Figure 1 represents the county level distribution of adults in Oklahoma with less than a high school education and Figure 2 represents a county level ranking of a composite of health factors including health behaviors, clinical care, and social and economic factors. The pattern reflected in the two maps is nearly identical, not only for Oklahoma but nationally as well. The areas with the lowest rates of high school graduation also have the worst health factors. This strong association between

Figures 1.

Oklahoma D.O. | March 2013

Figures 2.

education and health factors has led some to impose a cause and effect relationship education and health (Feinstein et al., 2006). Many health literacy interventions implicitly assume that lack of education causes poor health behaviors and ultimately poor health outcomes. The inconsistent effectiveness of interventions previously mentioned point to the possibility of a common cause. That is, rather than educational attainment causing health behavior, both may be influenced by a third variable. In the case of cultural competence and health literacy interventions, the evidence seems to point to motivation as the “missing link” in these models. Information delivered in culturally appropriate ways and at a sufficiently easy reading level may influence how a health related message is received but action requires a motivational component (Carter & Kulbok, 2002; Kelly, et al., 1991). In the following paragraphs I will describe a motivational construct that has been extensively researched in educational contexts as a moderator between academic aptitude and educational outcomes and may likewise moderate the relationship between health literacy and health behavior.

targeted study, Hampson, Glasgow, and Toobert (1990) found that personal models of diabetes (i.e., beliefs and feelings about treatment efficacy and disease course) were related to self-care activities including healthier diet and exercise while participation in diabetes education activities and overall educational level had no relationship with self-care activities.

Motivation is reflected in one’s personal beliefs. A systematic review of cultural differences and low health literacy on chronic disease outcomes and screening utilization (Shaw et al., 2009) indicated that failure to address beliefs about health and illness (i.e., the motivation to engage in health-related behaviors) limited the efficacy of programs to improve health literacy. Similarly, an analysis of the literature on shared decision making found that the integration of decision support tools in clinical practice did not consistently improve shared decision making (Robinson & Thomson 2001). Robinson and Thomson concluded that clinicians need to better understand the motivation behind patient’s views about their role in decision making. In a more

Motivation has been studied extensively by educational psychologists who have produced a number of empirically tested theories of personal motivation. Several theories utilize a construct generally referred to as personal epistemological beliefs (EBs). EBs is a well-researched multidimensional construct that represents beliefs about knowledge and learning. Collectively, EBs reflects an individual’s views on the source and stability of knowledge as well as capacity for learning: Examples include: 1) Knowledge is passed down by authority figures (i.e., passive learning) vs. knowledge is gained through experience (active learning). 2) Knowledge is stable vs. knowledge is tentative and evolving. 3) Learning capacity is fixed vs. capacity for

Health educators and health psychologists have developed comprehensive models of relationships among health literacy, motivational health beliefs, patient-provider communication, and health outcomes (Paasche-Orlow & Wolf, 2007; von Wagner et al., 2009). To date, these models remain empirically untested largely because there is no consistent understanding, definition, or measurement of some model components including motivational health beliefs (Miller, 2010). Noar et al. (2004) concluded after a review of theoretical models of health behavior that “health related interventions may become more effective if researchers acknowledge and utilize current research and theory from the field of educational psychology” (p. 60).

Oklahoma D.O. |March 2013

learning is malleable and can grow. The influence of EBs as a motivational factor in both education and health contexts may help to explain the strong association between positive health related behaviors and persistence in education. I hypothesize that people engage or dis-engage from health activity for the same or similar reasons that they engage or dis-engage from educational activity. Further study of EBs in health contexts may provide insight into motivators of patient engagement (i.e., actions taken to obtain the greatest benefit from available health care services). I have studied EBs in educational contexts for several years (Wheeler, 2007; Wheeler & Montgomery, 2009) and more recently have begun to explore their utility in health-related research (Barnes et al., 2012). It seems to make intuitive sense that just as EBs have been linked to student engagement (i.e., participation in effective practices leading to measurable outcomes) in educational contexts (DeBacker & Crowson, 2006), EBs could be similarly associated with patient engagement. Further, EBs have been empirically associated with propensity for lifelong learning, self-efficacy, and aspects of change readiness (Bath & Smith, 2009), characteristics also

associated with better health outcomes. This year, the Center for Rural Health in collaboration with colleagues from OSU CSH and OSU-Tulsa are beginning a more comprehensive research agenda to study the measurement and application EBs in the clinical relationship. First, we are refining the measurement of EBs. Colleagues at OSU-Tulsa and I developed and published a measure of EBs related to medical knowledge and learning (Barnes et al., 2012). The instrument demonstrated adequate psychometric properties and was related in expected ways to other constructs like Health Locus of Control. We are currently revising the instrument for ease of use in clinical settings. Medical educators at OSU CHS are looking to explore the relevance of the inclusion of EBs in cultural competence training and finally, we have plans to test the moderating effects of EBs on the relationship between health literacy and health outcomes in a high risk sample of persons with type 2 diabetes. Stay tuned as we will continue to provide updates okDO on our progress in future issues of the Oklahoma DO Journal.

References Barnes, L.L.B., Wheeler, D.L., Laster, B., McGaugh, M., & Morse, A. (2012) Development of a scale to measure laypersons’ beliefs about medical knowledge. Health Education Journal, Retrieved from http://hej.sagepub.com/content/ early/2012/01/19/0017896911430764.

Miller, L. M. S. (2010). Cognitive and motivational factors support health literacy and acquisition of new health information in later life. California Agriculture, 64, 189194.

Bath, D.M., & Smith (2009). The relationship between epistemological beliefs and the propensity of lifelong learning. Studies in Continuing Education, 31, 173-189.

Noar, S. M., Anderman, E. M., Zimmerman, R. S., Cupp, P. K. (2004). Fostering achievement motivation in health education: Are we applying relevant theory to school-based HIV prevention programs? Journal of Psychology & Human Sexuality, 16(4), 59-76.

Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J., Viera, A., Crotty, K., . . ., & Viswanathan, M. (2011, March). Health Literacy Interventions and Outcomes: An updated Systematic Review. Evidence Report/Technology Assessment No. 199. (Prepared by RTI International-University of North Carolina Evidence-based Practice Center under contract No. 290-2007-10056-I. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. Carter, K. F., & Kulbok, P.A. (2002). Motivation for health behaviours: A systematic review of the nursing literature. Journal of Advanced Nursing 40: 316-330. Center for Advancing Health (2010). A New Definition of Patient Engagement: What is Engagement and Why is it Important? Retrieved from http://www.cfah.org/pdfs/ CFAH_Engagement_BehaviorFramework_2010.pdf DeBacker, T.K., & Crowson, H.M. (2006). Influences on cognitive engagement: Epistemological beliefs and need for closure. British Journal of Educational Psychology, 76, 535-551. Feinstein, L., Sabates, R., Anderson, T.M., Sorhaindo, A., & Hammond, C. (2006). Measuring the Effects of Education on Health and Civic Engagement: Proceedings of the Copenhagen Symposium. Retrieved from http://www.oecd.org/edu/ educationeconomyandsociety/37425753.pdf. Hampson, S.E., Glasgow, R.E., Toobert, D.J. (1990). Personal models of diabetes and their relations to self-care activities. Health Psychology, 9: 632-646. Kelly, R.B., Zyzanski, S.J., Alemagno, S.A. (1991). Prediction of motivation and behavior change following health promotion: Role of health beliefs, social support, and self-efficacy. Social Science Medicine, 32: 311-320.

Paasch-Orlow, M. K. & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behaviour, 31, S19-26. Partnership to Fight Chronic Disease (PFCD, 2012). Retrieved from http://www.fightchronicdisease. org/facing-issues/about-crisis Robinson, A., & Thomson, R. (2001). Variability in patient preferences for participating in medical decision making: Implication for the use of decision support tools. Quality in Health Care, 10(SupplI): i34-i38. Shaw, S.J., Huebner, C., Armin, J., Orzech, K., & Vivian, J. (2009). The role of culture in health literacy and chronic disease screening and management. Journal of Immigrant Minority Health, 11: 460-467. United Health Foundation (2012). America’s Health Rankings. Retrieved at http://www.americashealthrankings.org/ von Wagner, C., Good, A., Whitaker, K. L., & Wardle, J. (2011). Psychosocial Determinants of Socioeconomic Inequalities in Cancer Screening Participation: A Conceptual Framework. Epidemiologic Reviews, 33, 135-147. Wheeler, D.L. (2007). The Development and Construct Validation of the Epistemological Beliefs Survey for Mathematics. (Unpublished dissertation). Oklahoma State University, Stillwater, OK. Wheeler, D.L., & Montgomery, D. (2009). Community college students’ views on learning mathematics in terms of their epistemological beliefs: A Q-method study. Educational Studies in Mathematics, 72, 289-306.

Lie, D.A., Lee-Rey, E., Gomez, A., Bereknyei, S., Braddock, C,H. (2010). Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. Journal of General Internal Medicine, 26, 317-325.

Oklahoma D.O. | March 2013

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CENTER FOR HEALTH SCIENCES David F. Hitzeman, DO, FACOI, Editor Professor of Medicine Department of Internal Medicine Analysis of the Side Effect Profile in HIV Patients Converting from Lopinavir/Ritonavir to Darunavir/ Ritonavir Jeffrey S. Stroup, PharmD, BCPS Associate Professor of Medicine Oklahoma State University Center for Health Sciences Email: Jeffrey.Stroup@okstate.edu Lindsey Keeley, PharmD PGY1 Pharmacy Resident Oklahoma State University Medical Center Tulsa, OK Nathan Voise, DO Gastroenterology Fellow Oklahoma State University Medical Center Tulsa, OK Johnny Stephens, PharmD, AAHIVE Associate Professor of Medicine Oklahoma State University Center for Health Sciences

Abstract Protease inhibitors (PI) are common components of anti-retroviral therapy because they have a higher barrier to resistance than regimens that contain nonnucleoside reverse transcriptase inhibitors (NNRTI). There are numerous PIs to choose from based on pill burden, sideeffect profile and drug interactions. Kaletra® (lopinavir/ritonavir) is the only PI that is co-formulated with ritonavir making it advantageous for patients because it decreases pill burden; however, common side effects such as diarrhea and cholesterol abnormalities can limit its use. The POWER 1 and POWER 2 trials showed that darunavir/ritonavir is effective at sustaining viral suppression as well as having a favorable safety profile. The ARTE36

Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998

MIS trial directly compared darunavir/ ritonavir to lopinavir/ritonavir which showed darunavir to be superior in virologic response as well as having a smaller side effect profile (diarrhea, triglycerides, cholesterol). Our goal was to evaluate our clinic population to determine if we could replicate the outcomes from the ARTEMIS trial. After reviewing and assessing the data from the charts of eighteen patients that had been transitioned from lopinavir/ritonavir to darunavir/ ritonavir we did not find a statistical difference between glucose and metabolic abnormalities. Gastrointestinal side effects were more difficult to assess due to a lack of documentation. Introduction Protease inhibitors (PI) are common components of anti-retroviral therapy because they have a higher barrier to resistance than regimens that contain nonnucleoside reverse transcriptase inhibitors (NNRTI) (1,2). Initial therapy for antiretroviral-naïve patients with human immunodeficiency virus (HIV) infection typically includes two nucleoside reversetranscriptase inhibitors (NRTI) and either a NNRTI, a PI, or an integrase inhibitor (1). Therapy selection is dependent upon virologic resistance, pill burden, side-effect profile, comorbidities, drug-drug interactions, drug-disease interactions, and if the patient is a female of child-bearing potential (3). Commonly, therapy including an NNRTI is initiated along with two NRTIs as first line therapy. The NNRTI typically utilized is efavirenz, which is included in a once daily combination tablet (Atripla®) along with tenofovir and emtricitabine. Patients who do not tolerate or develop virologic resistance to Atripla®

are commonly changed to a regimen that includes a PI. In addition, a previous hypothesis was that patients with a high viral load burden should be initiated on a PI as compared to a NNRTI because of increased virologic potency (4). This hypothesis has been refuted by studies demonstrating that NNRTIs provide virologic potency at a similar and in some cases greater level than PIs (5,6). PIs have demonstrated a higher barrier to resistance than NNRTI regimens because they require multiple mutations to confer resistance whereas resistance to NNRTIs can occur after a single mutation (1,4). There are several PIs to choose from based on drug interactions, pill burden, and side-effect profile. Kaletra® (lopinavir/ ritonavir) is the only PI that is co-formulated with ritonavir making it advantageous for patients because it decreases pill burden. It can be administered once or twice daily and the common side effects are diarrhea and cholesterol abnormalities (7). Until the end of 2009, lopinavir/ ritonavir was the preferred PI based on national treatment guidelines (8). In the last few years, lopinavir/ritonavir has been compared to other PIs since the unfavorable side effects of this agent have often forced clinicians to change the PI of the antiretroviral regimen (9,10). In the POWER 1 and 2 trials, Prezista® (darunavir), another PI boosted with ritonavir, was shown to be effective at sustaining undetectable viral loads as well as having a favorable safety profile (11). In the ARTEMIS trial, treatment-naïve patients were randomized to receive either boosted darunavir or boosted lopinavir (12). After 96 weeks of treatment, darunavir/ Oklahoma D.O. |March 2013

ritonavir was shown to be superior in virologic response compared to lopinavir/ ritonavir (12). During this trial it was also noted that darunavir had a very favorable side effect profile as compared to lopinavir (12). Only 4% of patients taking darunavir had diarrhea as compared to 11% of lopinavir patients (12). Darunavir also had a statistically significant difference in increases in triglycerides and total cholesterol compared to lopinavir (12). The POWER trials and the ARTEMIS trial have observed that darunavir/ritonavir had a favorable side effect profile as compare to other PIs, specifically studied was lopinavir/ritonavir. The positive effects observed by utilizing darunavir/ritonavir as compared to lopinavir/ritonavir on metabolic parameters has been demonstrated in several recent publications (13,14). With HIV treatment becoming more advanced, the current problems encountered are adverse effects from the HIV therapies and chronic disease complications, such as myocardial infarction, stroke, and diabetes (15-18). We proposed a retrospective study, through medical record review, to be performed at the OSU Internal Medicine Specialty Clinic to determine if the conversion from lopinavir to darunavir is in fact accompanied by a significant decrease in side effects that include metabolic abnormalities (lipid abnormalities [lowdensity lipoprotein, high-density lipoprotein, total cholesterol, and triglycerides], glucose abnormalities [fasting glucose and hemoglobin A1C]) and gastrointestinal side effects in our clinic population. Methods A computer generated list of patients seen in the OSU Internal Medicine Specialty Services Clinic was generated for patients receiving darunavir from January 1, 2006 to August 30, 2011. Utilizing this list, the medical records were assessed to identify patients converted from lopinavir/ritonavir to darunavir/ritonavir. Patients that met the criteria were included in the analysis. The evaluation of included patients identified a baseline visit (when lopinaOklahoma D.O. | March 2013

vir/ritonavir was switched to darunavir) and a follow-up visit (a minimum of 90 days while on darunavir). The retrospective evaluation included a review of home medications (including HIV regimen), current and previous medical illnesses, age, gender, race/ethnicity, HIV viral load, CD4 count, total cholesterol, lowdensity lipoprotein, high-density lipoprotein, triglycerides, blood glucose level, hemoglobin A1C, and side effects (diarrhea, gastrointestinal complaints). Results A total of thirty-nine charts were reviewed for conversion from lopinavir/ritonavir to darunavir/ritonavir. Twenty-one patients were excluded due to loss of follow-up, lack of laboratory data, or use of other regimens in between converting from lopinavir/ritonavir to darunavir/ritonavir. The average age for the eighteen patients included in the study was 45 years old and 83% (15/18) patients were male. The baseline and follow-up laboratory values are listed in Table 1. Hemoglobin A1C was not recorded for every patient, therefore, it was not included in the statistical analysis. The number of loose stools per day was difficult to assess due to poor documentation by the providers prior to and after conversion to darunavir/ritonavir. Discussion Prior to analyzing the data, it was hypothesized that patients who were converted from lopinavir/ritonavir to darunavir/ ritonavir would experience an improve-

ment in metabolic abnormalities, glucose levels, and gastrointestinal side effects. After assessing the data, we did not find a statistical difference between glucose and metabolic abnormalities. A positive trend on all lipid parameters was identified. This data was limited due to the sample size of 18 patients. In the ARTEMIS trial, over 340 patients in each treatment arm were evaluated (10,12,19). Boosted darunavir has also been evaluated to boosted atazanavir. In that analysis, there was no difference identified between the treatment groups in regards to lipid or glucose parameters (20). A hypothesis for the positive metabolic effects of darunavir as compared to other PIs is the effects on adipocytes (21). A recent study on murine and human adipocytes revealed that darunavir did not affect adipocyte function as compared to lopinavir or atazanavir (22). The clinical implications of HIV therapy effects are important to evaluate because of the effects of HIV itself on CVD. The SMART study identified that inadequately treated viral infection itself increase the risk of CVD (23). In addition, a recent meta-analysis identified that the relative risk of CVD among patients with HIV not on therapy compared to HIV-uninfected individuals was 1.61 (24). Some HIV infected patients have traditional risk factors as identified through the Framingham Risk Score. Yet, a recent study that evaluated arterial inflammation in HIV patients identified that patients with controlled HIV (HIV-RNA <48 copies/

Table 1: Baseline Follow-up CD4 (cells/µL) 246±233 234±164 Viral Load (copies/mL) 69,952±101,469 Total cholesterol (mg/dL) 200±41 183±33 LDL (mg/dL) 120±37 109±29 HDL (mg/dL) Triglycerides (mg/dL) Blood Glucose (mg/dL)

46±19 172±69 90±10

48±12 130±65 94±14

P-value 0.56 0.056 0.49 0.69 0.19 0.49 0.40

n=18 37

mL) and comparable risk scores had higher arterial inflammation, identified by positron emission tomography, compared to a non-HIV control group (25). Therefore, several mechanisms are involved in this inflammation process that leads to CVD. These mechanisms include: HIV replication, T-cell depletion, T-cell activation, T-cell senescence, cytomegalovirus coinfection, microbial translocation, and monocyte activation (25-27). The implication that arterial inflammation occurs in HIV patients despite adequate management complicates the scenario. Therefore it is important to avoid additional metabolic complications with the addition of HIV therapy. Conclusion CVD risk in patients with HIV has been identified to be caused by HIV itself and also HIV therapy. PIs are effective therapy options for patients with HIV. They can complicate the metabolic profile of patients. Darunavir has been shown to be effective and also more metabolically friendly as compare to lopinavir. Research needs to continue to identify how to decrease the CVD event rates in patients with HIV. References

1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. January 10, 2011; 1-166. Available at http://www.aidsinfo.nih. gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed August 26, 2011. 2. Flexner C. HIV-protease inhibitors. N Engl J Med. 1998; 338:1281. 3. Thompson MA, Aberg JA, Cahn P, et al. Antiretroviral treatment of adult HIV infection. JAMA. 2010; 304: 321-333. 4. McKeage K, Perry CM, Keam SJ. Darunavir: a review of its use in the management of HIV infection in adults. Drugs. 2009; 69: 477-503. 5. Riddler SA, Haubrich R, DiRienzo AG, et al. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med. 2008; 358: 2095-2106. 6. Hirschel B, Calmy A. Initial treatment for HIV infection-an em- barrassment of riches. N Engl J Med. 2008; 358: 2170-2172. 7. Croxtall JD, Perry CM. Lopinavir/Ritonavir: A review of its use in the management of HIV-1 infection. Drugs. 2010; 70: 1885-1915. 8. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Servic- es. January 10, 2011; 1-166. Available at http://www.aidsinfo.nih. gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed August 26, 2011. 9. Chaix ML, Sahali S, Pallier C, et al. Switching to darunavir/rito - navir achieves viral suppression in patients with persistent low replication on first-line lopinavir/ritonavir. AIDS. 2008; 22: 2405- 2407. 10. Ortiz R, Dejesus E, Khanlou H, et al. Efficacy and safety of once- daily darunavir/ritonavir versus lopinavir/ritonavir in treatment- na誰ve HIV-1 infected patients at week 48. AIDS. 2008; 22: 1389- 1397. 11. Clotet B, Bellos N, Molina JM, et al. Efficacy and safety of darunavir-ritonavir at week 48 in treatment-experienced patients with HIV-1 infection in POWER 1 and 2: a pooled sub- group analysis of data from two randomized trials. Lancet. 2007; 369: 1169-1178.

12. Mills AM, Nelson M, Jayaweera D, et al. Once-daily darunavir/ ritonavir vs. lopinavir/ritonavir in treatment-na誰ve, HIV-1-infected patients: 96-week analysis. AIDS. 2009; 23: 1679-1688. 13. Currier JS, Martorell C, Osiyemi O, et al. Effects of darunavir/rito navir-based therapy on metabolic and anthropometric parameters in women and men over 48 weeks. AIDS Patient Care STDS. 2011; 25: 333-340. 14. Tomaka F, Lefebvre E, Sekar V, et al. Effects of ritonavir-boosted darunavir vs. ritonavir-boosted atazanavir on lipid and glucose pa rameters in HIV-negative, healthy volunteers. HIV Medicine. 2009; 10: 318-327. 15. Giannarelli C, Klein RS, Badimon JJ. Cardiovascular implications of HIV-induced dyslipidemia. Atherosclerosis. 2011; 219: 384- 389. 16. Feeney ER, Mallon PW. HIV and HAART-associated dyslipidemia. Open Cardiovasc Med J. 2011; 5: 49-63. 17. Estrada V, Portilla J. Dyslipidemia related to antiretroviral therapy. AIDS Rev. 2011; 13: 49-56. 18. Lo J. Dyslipidemia and lipid management in HIV-infected pa tients. Curr Opin Endocrinol Diabetes and Obes. 2011; 18: 144- 147. 19. Lascar RM, Benn P. Role of darunavir in the management of HIV infection. HIV AIDS (Auckl). 2009; 1: 31-39. 20. Aberg JA, Tebas P, Overton ET, et al. Metabolic effects of daruna vir/ritonavir versus atazanavir/ritonavir in treatment-na誰ve, HIV type-1 infected subjects over 48 weeks. AIDS Res Hum Retrovi ruses. 2012 Apr 2. [Epub ahead of print]. 21. Zanni MV, Grinspoon SK. HIV-specific immune dysregulation and atherosclerosis. Curr HIV/AIDS Rep. 2012; 9: 200-205. 22. Capel E, Auclair M, Caron-Debarle M, Capeau J. Effects of ritonavir-boosted darunavir, atazanavir, and lopinavir on adipose functions and insulin sensitivity in murine and human adipocytes. Antivir Ther. 2012; 17: 549-556. 23. Post WS. Predicting and preventing cardiovascular disease in HIV- infected patients. Top Antivir Med. 2011; 19: 169-173. 24. Islam FM, Wu J, Jansson J, Wilson DP. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012; 13: 453-368. 25. Subramanian S, Tawakol A, Burdo TH, et al. Arterial inflammation in patients with HIV. JAMA. 2012; 308: 379-386. 26. Hsue PY, Deeks SG, Hunt PW. Immunologic basis of cardiovascular disease in HIV-infected adults. J Infect Dis. 2012; 205: S375- S382. 27. Pandrea I, Cornell E, Wilson C, et al. Coagulation biomarkers predict disease progression in SIV-infected nonhuman primates. Blood. 2012; 120: 1357-1366.

Oklahoma D.O. |March 2013

What DO’s Need To

KNOW

Centers for Medicare & Medicaid Services EHR Incentive Program - Stage 2 Webinar Wednesday, March 20th, 12:30 CDT/11:30 MDT / Register at: http://www.eventbrite.com/event/5083520948 CMS Regions VI, VII and VIII are pleased to announce a new EHR webinar focused on the EHR Incentive Payment Program – Stage 2. For Eligible Professionals (EPs) and Eligible Hospitals (EHs) who have met meaningful use for a 90 day period plus at least one, one-year period, Stage 2 requirements will be effective in 2014. The webinar will include: • The Office of the National Coordinator (ONC) with information on new EHR certification requirements, • CMS on Stage 2 – what’s new, what’s changed, and • An opportunity for you to ask CMS experts your Stage 2 questions.

Flu Season Isn’t Over—Continue to Recommend Vaccination While each flu season is different, flu activity typically peaks in February. Yet, even in February, the flu vaccine is still the best defense against the flu. The Centers for Disease Control and Prevention recommends yearly flu vaccination for everyone 6 months of age and older; and although anyone can get the flu, adults 65 years and older are at greater risk for serious flu-related complications that can lead to hospitalization and death. Each year in the United States, about 9 out of 10 flu-related deaths and more than 6 out of 10 flu-related hospital stays occur in people 65 years and older. Every office visit is an opportunity to check your patients’ vaccination status and encourage flu vaccination when appropriate. Getting vaccinated is just as important for health care personnel, like you, for many reasons. You can get sick with the flu and spread it to your family, colleagues and patients without knowing or having symptoms. Be an example by getting your flu vaccine and know that you’re helping to reduce the spread of flu in your community. Note: – influenza vaccines and their administration fees are covered Part B benefits. Influenza vaccines are NOT Part D-covered drugs. For More Information: • 2012-2013 Seasonal Influenza Vaccines Pricing list • MLN Matters® Article #MM8047, “Influenza Vaccine Payment Allowances - Annual Update for 2012-2013 Season” • Visit the CMS Medicare Learning Network® 2012-2013 Seasonal Influenza Virus Educational Products and Resources and CMS Immunizations web pages for information on coverage and billing of the flu vaccines and their administra tion fees • HealthMap Vaccine Finder is a free, online service where users can find nearby locations offering flu vaccines as well as other vaccines for adults • CDC website offers a variety of provider resources for the 2012-2013 flu season

ICD-10 MS-DRG FY 2013 Software Now Available ICD-10 Medicare Severity Diagnosis Related Grouper (MS-DRG), version 30.0 (FY 2013) mainframe and PC software is now available. This software is being provided to offer the public a better opportunity to review and comment on the ICD-10 MS-DRG conversion of the MS-DRGs. This software can be ordered through the National Technical Information Service (NTIS) website. A link to NTIS is also available in the Related Links section of the ICD-10 MS-DRG Conversion Project website. The final version of the ICD-10 MS-DRGs will be subject to formal rulemaking and will be implemented on October 1, 2014.

Oklahoma D.O. | March 2013

Now Available: New and Updated FAQs about the EHR Incentive Programs CMS has recently added one new and two updated FAQs related to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We encourage you to take a minute to review these changes below. New FAQ: 1. What funding sources may States use to fund the 10 percent non-federal share of HITECH administrative expenditures? Read the answer here. Updated FAQs: 1. What are the specific medical specialty codes associated with anesthesiology, radiology, and pathology for the specialty-based determination for the granting of a hardship exception... Read the answer here. 2. For the Medicare EHR Incentive Program, how are incentive payments determined for eligible professionals practicing in a Health Professional Shortage Area (HPSA)? Read the answer here. To search and access more FAQs related to the EHR Incentive Programs, please use the CMS FAQ System. Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

New HCPCS G-code for Pharmacologic Management Service Furnished via Telehealth to Inpatients For 2013, the Current Procedural Terminology (CPT) Editorial Panel adopted a new structure for CPT codes used to report a set of psychiatric and psychotherapy services. Among other changes, the CPT code that was used by practitioners to report pharmacologic management services was deleted. CPT instructs that practitioners should now report the appropriate Evaluation/Management (E/M) code when furnishing pharmacologic management services. Existing Medicare telehealth payment policies will continue to apply for these services for 2013, and practitioners should be able to report the appropriate E/M code, as CPT suggests. However, when furnishing services to hospital inpatients and Skilled Nursing Facility (SNF) patients, physicians should use the new G-code to ensure that the telehealth frequency restrictions that apply to hospital and SNF E/M services do not also apply to pharmacologic management services furnished to hospital inpatients and SNF patients. The new G-code is: • G0459 — Inpatient telehealth, pharmacologic management, including prescription use and review of medication with no more than minimal medical psychotherapy

New MLN Provider Compliance Fast Fact A new fast fact is now available on the MLN Provider Compliance web page. This web page provides the latest MLN Education Products and MLN Matters® Articles designed to help Medicare FFS providers understand common billing errors and avoid improper payments. Please bookmark this page and check back often as a new fast fact is added each month.

AOA Unified Graduate Medical Education The following letter was submitted to the AOA supporting the Unified Graduate Medicial Education efforts. If you have any questions, please feel free to contact the OOA Central Office at 405/528.4848

Oklahoma D.O. |March 2013

Oklahoma D.O. | March 2013

Health Care Law Allows Consumers to Easily Find and Compare Options Starting in 2014 New rule will expand mental health and substance use disorder benefits to 62 million Americans Department of Health and Human Services (HHS) Secretary Kathleen Sebelius Wednesday announced a final rule that will make purchasing health coverage easier for consumers. The policies outlined will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act. “The Affordable Care Act helps people get the health insurance they need,” said Secretary Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.” The rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans. A new report by HHS, also released, details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans. In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services. The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways: (1) By including mental health and substance use disorder benefits as Essential Health Benefits (2) By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets (3) By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services To give states the flexibility to define essential health benefits in a way that would best meet the needs of their residents, this rule also finalizes a benchmark-based approach. This approach allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan. Twenty-six states selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest. The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage. Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors. In addition, the health care law limits the annual amount of cost sharing that individuals will pay across all health plans – preventing insured Americans from facing catastrophic costs associated with an illness or injury. Policies in today’s rule also provide more information on accreditation standards for qualified health plans (QHPs) that will be offered through the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices. Together, these provisions will help consumers compare and select health plans in the individual and small group markets based on what is important to them and their families. People can make these choices knowing these health plans will cover a core set of critical benefits and can more easily compare the level of coverage based on a uniform standard. Further, these provisions help expand choices and competition on the Marketplaces. For more information, visit: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html To view the rule, visit: http://www.ofr.gov/inspection.aspx For more information on how today’s rule helps those in need of mental health and substance use disorder services, visit: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm

Oklahoma D.O. |March 2013

Health Care Law Protects Consumers Against Worst Insurance Practices Key health insurance protections for all Americans moves forward The U.S. Department of Health and Human Services (HHS) issued a final rule that implements five key consumer protections from the Affordable Care Act, and pledges to make the health insurance market work better for individuals, families, and small businesses. “Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.” Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans. The final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans: • Guaranteed Availability Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.

• Fair Health Insurance Premiums Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premims based on age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.

• Guaranteed Renewability Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option.

• Single Risk Pool Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.

• Catastrophic Plans Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

In preparation for the market changes in 2014 and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. And, HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law’s transparency provisions have already resulted in a decline in double-digit premium increases filed: from 75 percent in 2010 to, according to preliminary data, 14 percent in 2013. In addition, today the U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or costsharing reduction as a result of participating in a Health Insurance Exchange, or Marketplace. Additional information is available at www.dol.gov/opa/media/press/osha/osha20130327.htm or www.osha.gov. For more information on how this final rule helps create a better health insurance market for consumers, please visit: http://cciio.cms.gov/resources/factsheets/marketreforms-2-22-2013.html For information on the rights and protections guaranteed by the health care law, please visit: http://www.healthcare.gov/law/features/rights/ For the full text of the proposed rule, please visit: http://www.ofr.gov/inspection.aspx Oklahoma D.O. | March 2013

Thank you, OSU Medical Center Doctors.

Tradition. Teaching. Trust. In Celebration of National Doctorsâ&#x20AC;&#x2122; Day, OSU Medical Center says Thank You to our doctors who make a difference...and have for over 69 years. Thank you for providing excellent, compassionate care to our patients and outstanding leadership and training for the physicians of tomorrow. Exceptional health care, Every patient, Every time.

O S U M E D I C A L C E N T E R / 7 4 4 W E S T 9 T H S T R E E T / T U L S A , O K L A H O M A / ( 9 1 8 ) 5 9 9 - 1 0 0 0 / w w w. o s u m c . n e t

Oklahoma D.O. |March 2013

Student Scoop Provided by Jeremy Ransdell, OMS-II OSU-COM Student Government Association President

It’s a tall order to begin describing the average spring semester of a 2013 OSU medical student; however, I think we can all agree that “consistent” and “predictable” are two words that would never be used. The first few months of 2013 have not been an exception to the understanding that the everyday in the life of a doctor-in-training can be as unpredictable as the weekly Oklahoma weather. The new incoming class is beginning to slowly grow in number as the interview season approaches its end and the topic of interest, which can’t be avoided amongst the growing list of freshmen, is the new OSU-CHS curriculum. When also considering the new residency match program destined for my own graduating class of 2015 and the upcoming changes for the OSU Medical Center, the tomorrow’s of each OSU medical student often resemble a rollercoaster ride with new surprises around every turn. However, it’s moments like these, when the future can appear a little foggy, that the OSU-CHS family excels directing our attention toward improving the tasks at hand so that we stand prepared for the ever-changing climate of medicine. On the home front, leaders are stepping-up to the call as incoming officer positions for the student senate, class leaders and many other campus clubs have recently been decided. The new leadership hardly let a day go by without considering new and innovative ways to improve the campus. It is exciting to hear about their creative brainstorming in areas like increasing efficient study space, improved security measures, and even methods to enhance the existing software that conveys our curriculum. As for me, long standing goals of mine have been to see the student political action committee expand its duties as well as the instillation of permanent positions with updatable documents to ensure that each new assembly of SGA officers will have the proper feedback needed to adequately serve the school. With that being said, March signifies the fruition of numerous innovative ideas at the Center for Health Sciences. The past several months have been made witness to OSU medical students proudly displaying the strength of our osteopathic roots off campus as well. January was kicked started by a National Student Senate Convention in Ft. Lauderdale, Florida where I had the opportunity to help organize a health fair and charity run. Todd Thomas, a fellow OSU SGA officer, and I also represented the school in the Ft. Lauderdale health fair by training students, families, and runners in methods to stay healthy in today’s fast-paced lifestyle. Now in the month of March, even more student participation is noted as we proudly present OSU medicine at off-campus events. On March 6th, OSU-COM stuOklahoma D.O. | March 2013

dents gathered at the Oklahoma’s capital for DO Day on the Hill in Oklahoma City. There, we spoke with our local representatives regarding the future of medicine in Oklahoma and where we stood as medical students. The Oklahoma Osteopathic Association was also kind enough to host the event and make the appointments with the legislators. Reaching even beyond our borders, OSU-CHS recently gathered students from every class to walk the halls of our Nation’s Capital in this month’s trip to Washington DC. It was truly an honor to wear our white coats on such a grand occasion and in a city so rich with history. With the whirlwind of political struggles arising every week in Washington and the shifting climates surrounding Osteopathic medicine and healthcare as a whole, the days ahead seem to roll in carrying a nervous excitement about the mysteries of what lays ahead. As the activity on and off campus reaches a peek this month, I believe March brings with it a change in season for OSU Center for Health Sciences and one that we are ready to face head on. Following the lead of our campus faculty, administration and clinical educators, this month has come to represent, for OSU medical students, an opportunity for improvement and innovation. It is truly a great thing to be a part of the OSU medical family. okDO

From the American Osteopathic Association Communications Department

HEALTH FOR THE WHOLE FAMILY DOs and other members of the profession consider the American Osteopathic Association’s “Health for the Whole Family” series a great way to promote the profession and educate patients about a variety of health topics. To use this month’s article, you have permission to simply make copies of the article (see page 44).

Imaginary Friends OK but Excessive Lying Could Be Troublesome While most children and adults lie at some point, excessive lying could potentially lead to trust issues, explains Lalith K. Misra, DO, who discussed concepts, models and treatments of lying in children during the American Osteopathic Association’s (AOA) OMED 2012, the Osteopathic Medical Conference & Exposition in San Diego. The types of lies and the purpose of lies tend to change as children age. Fear of punishment and cover-ups are the main sources of lying for all ages. “White lies, like the existence of imaginary friends, are harmless,” explains Dr. Misra, an AOA board-certified psychiatrist. “But when lying exceeds a certain limit it can lead toward a loss of trust.” Why Lie? Ages 3-4: Lies tend to be based on fantasy and imagination. Purpose of a lie is to play make-believe or to avoid punishment.

Ages 5-7: Test limits and manipulate to get what the child wants.

Teens: Protect their privacy and their friends’ privacy. Teens also lie to obtain power and achieve autonomy from parents.

“No matter what age a child is, at some point too many lies can lead toward distrust,” says Dr. Misra. “Lying is a learned behavior but it can be changed although it can be hard to do.” The following are Dr. Misra’s tips for parents to combat their children’s lying: • Watch your own behavior. Children model their parents’ behavior and notice when parents lie and cheat. • Praise honesty. Acknowledge when children tell the truth. • Use small rewards. It is more effective for children to achieve small goals that come with small rewards than it is to achieve goals that come with larger rewards. • Point, through a specific gesture, when a child is lying. Using a specific hand signal helps parents communicate they know their child is lying without embarrassing the kid. It is counterproductive to call a child a liar. • Record frequency of children’s lying. • Practice stress reduction. Since some children lie as a stress reliever, breathing exercises or other stress reducers might help.

Preventive medicine is just one aspect of care osteopathic physicians (DOs) provide. DOs are fully licensed to prescribe medicine and practice in all specialty areas, including surgery. DOs are trained to consider the health of the whole person and use their hands to help diagnose and treat their patients.

Oklahoma D.O. |March 2013

Classified Advertising

OFFICE BUILDING FOR SALE: 6501 S. Western, OKC, OK 73139. Over 1 1/2 acres total size, 10,000 sq ft building divided into 3 doctors offices. 1200 sq foot private office upstairs with private bathroom and shower. 2 double sided fireplaces, over a dozen chandeliers, rough wood cathedral ceilings. Alarm and phone system in place, double glass doors in entrance, back patio with separate storage building. Larger office is fully equipped with exam tables, Pap table, chairs, medical instruments, QBC (CBC) machine, autoclave, medical supplies, and much more. For information contact: Captain David Simpson at (405) 820-5360.

CLINIC FOR SALE: by owner. Fully equipped: LAB, XRAY, EKG. Well established clinic, near Integris Southwest Medical Center is available for sale. Clinic is well equipped and is ideal for one or more physician practice as well as a variety of specialties. Clinic has: waiting room with refrigerated water cooler, wheelchair accessible restroom, reception and staff work stations, Nurses station, 5 - 7 exam rooms with sinks and running water, large multipurpose procedure room, 3 private offices with built-in bookcases, (One Office with 3/4 Bath), additional staff and patient restrooms, large upstairs (currently used for storage) and variety of other medical equipment. Misys Medical Software. Large Parking Lot. “Must See Inside” the all steel building located at 2716 S.W. 44th St. in OKC to appreciate the effort placed upon providing convenient and up to date medical care. Price: $425,000-PRICE IS NEGOTIABLE. Doctor prefers to sell, but would consider leasing. If interested, please call: Evelyn Francis at (405) 249-6945.

OFFICE FOR LEASE: Great Location - Central to Norman Reg. Hospital & Healthplex! 2121 W. Main. Approx. 1700 s.f. available, incl. 5 rooms & 3 restrooms. Gas, Elec. & Water paid. Call (405) 321-1497 or email adoverstr@yahoo.com. Also for Sale: 2 Hamilton Exam tables. Call (405)321-1497 or email adoverstr@yahoo.com.

DOCTORS WANTED: to perform physical exams for Social Security Disability. DO’s, MD’s, residents and retired. Set your own days and hours. Quality Medical Clinic-OKC, in business for 16 years. Call Jim or JoAnne at 405-632-5151.

IMMEDIATE NEED: for FP & ER (and more) Physicians, PAs and NPs: PT, FT and temp jobs. Bimonthly pay. Pd Malpractice and expenses. Call Sonja @ 877-377-3627 and send CV to sgentry@oklahomaoncall.com Oklahoma D.O. | March 2013

IMMEDIATE OKLAHOMA OPPORTUNITY with largest family medicine clinic in Muskogee, Ok. Excellent opportunity to assume a practice that is up and running. Senior physician of four physician group leaving to pursue new career opportunities. 2,000 active patients need a physician. Two physicians currently practice OB. Surgical OB experience a plus. On site x-ray and CLIA certified lab. Nursing and support staff in place. Income guarantee. Be your own boss, work hard and practice family medicine in its historical tradition with respect and loyalty of small town patients. Contact Evan Cole, DO, 918-869-2456, ecoledo@yahoo.com, Brad McIntosh, MD, 918-869-7356, drbamc@ yahoo.com Jason Dansby, MD, 918-869-7387, jasonddansby@yahoo. com or Judy Oliver, RN, practice administrator, 918-869-7357. (leave a message if temporarily unavailable) Find us on the web at www.mfpclinic.com.

Calendar of Events March 14, 2013 DO Day on the Hill Washington, DC

April 3, 2013 Bureau on Legislation

April 4, 2013 OOA Bureau & Board of Trustee Meeting

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PHYSICIAN NEEDED: The practice of Terry L. Nickels, DO is currently seeking a part-time Family Physician with OMT Skills to help cover the office. If interested please contact Dr. Terry Nickels at (405) 301-6813.

FULL or PART-TIME OPPORTUNITY / TREATMENT OF OPIATE DEPENDENCE WITH SUBOXONE: I have been practicing addiction medicine for three years and have reached the 100-patient limit for treating opiate dependent patients with SUBOXONE. I have a waiting list of interested persons and adjoining office space is available for lease in the CITYPLEX Towers near ORU at 81st Street and S. Lewis Avenue. Whether you want to begin prescribing SUBOXONE or plan to continue treating current patients with SUBOXONE, I am interested in sharing the waiting room, office staff, phone/fax/Internet, and billing services. Contact: Constance Honeycutt, DO 918-779-5907 or e-mail suboxone-rocks@hotmail.com

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OFFICE FOR RENT: 7300 S Western, OKC. Excellent area with high traffic count. Established location. Utilities are paid. Completely remodeled, very nice. Easy access from all areas of town. $1250 per month. Please call Dr. Buddy Shadid 405.833.4684 or 405.843.1709.

113th OOA Annual Convention Individualizing a Program for Your Specialty Needs Saddle up April 18-21, 2013

Prsrt Std US Postage Paid Okla City OK Permit #209

OKLAHOMA OSTEOPATHIC ASSOCIATION 4848 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105-3335

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