Best Practices First Quarter 2013

www.BestPracticesMD.com The Resource Guide to Your Medical Community

First Quarter 2013

Men Go Red For Women Local Healthcare Leaders Rally Resources to Fight Heart Disease

The Heart and Pregancy Page 12

PLUS Quit Smoking for Good in Six Simple Steps March of Dimes Celebrates 75 Years Bay Area Hospital News

Medical Community Tries to Keep Up With Growth Page 14

Your Personal Guide to the 2013 Flu Season Page 30

CONTENTS

First Quarter 2013

Economy 14 Medical Community Frantically Trying to Keep Up With Growth Feature 16 Men GO RED For Women Letter From the Medical Director 7 Four Horsemen of the Apocalypse - The Pale Horse Local Focus 15 American Heart Association Luncheon 23 CCEF Breakfast at Lakewood Yacht Club 26 Three Area Hospitals Earn National Recognition Deborah McGrew to Fill UTMB COO Post Pasadena Hospital Earns Improvement Award

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Kelsey-Seybold Named Accredited Accountable Care Organization

Medicine 10 Patient Care Magnified Beyond the Microscope 22 MD Anderson to Target Eight Deadly Cancers Wellness 24 Six Simple Steps to Quit Smoking for Good 25 A Healthier You in 2013 30 A Special Guide to Influenza Women’s Health 12 The Heart and Pregnancy 20 March of Dimes Celebrates 75th Anniversary 4 |www.BestPracticesMD.com | First Quarter 2013

PUBLISHER/CHAIRMAN Rick Clapp President Santiago Mendoza Jr.

EDITORIAL Editor Mary Alys Cherry Medical Director Victor Kumar-Misir, M.D. Contributing Writers Mary Alys Cherry Linda A. Goodrum, M.D. Ashley Karlen Victor Kumar-Misir, M.D. Santiago Mendoza Jr. Dianna Villarreal, M.S., CHES

ART Creative Director Brandon A. Rowan Graphic Specialist Victoria Ugalde Photography/Editing Brian Stewart

ADVERTISING Director of Advertising Patty Kane Account Executives Patty Bederka Natalie Epperly Santiago Mendoza Jr. Amber Sample

PHONE: 281.474.5875 FAX: 281.474.1443 www.BestPracticesMD.com Best Practices Quarterly is trademarked and produced by Medical Best Practices Group, LLC. Best Practices Quarterly is not responsible for facts as presented by authors and advertisers. All rights reserved. Material may not be reproduced in part or whole by any means whatsoever without written permission from the publisher. Advertising rates are available upon request.

Best Practices Quarterly P.O. Box 1032 Seabrook, TX 77586 R.Clapp@Baygroupmedia.com

From the Medical Director

LETTER

Four Horsemen of the Apocalypse

THE PALE HORSE

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By Victor Kumar-Misir, M.D.

n November 2012, I had the distinct pleasure of meeting David Quammen, National Geographic writer and author, promoting awareness of the ever-present, apocalyptic threat of ‘spillover’ global pandemics, including SARS, influenza and biological weapons of mass destruction.

In the third quarter of 2002, local outbreaks of a severe infectious respiratory disease in the South China Pearl River Delta, quickly spread to Hong Kong, and from there, by airplane, worldwide, with thousands of infected patients, hundreds of deaths, and devastated national economies – all within a few months. This represents the first incidence in this century of dreaded zoonotic disease – the spillover of infectious, lethal microorganisms from animal reservoirs to humans, and subsequent human-to-human transmission, which, leading to a global pandemic, can quickly and substantially alter the geo-political, socio-economic landscape of the planet, as has happened in previous episodes of human history.

On November 16, 2002, a 46-year-old male chef in the Foshan region of South China, was exposed to domestic civet cats, and developed a severe respiratory illness that quickly spread to his wife, daughter, and her husband. In December, in nearby Zhonghshan province, 28 similar cases appeared.

On January 30, 2003, Zhou Zuofeng, who had visited Zhongshan, checked in at a Guangzhou hospital with pneumonia, and within 2 days, infected more than 30 healthcare workers. He was transferred to a teaching hospital, and infected the ambulance driver en route, and 23 health care workers.

On February 21, 2003, one such infected healthcare worker, a 64-year-old nephrology professor, Liu Jianlun, went to Hong Kong to attend his nephew’s wedding. He checked into the Kowloon Metropole Hotel, Room #911, and infected 16 hotel guests within 1 day. He died on March 04, 2003.

One of the infected guests was a 78-year-old grandmother from Canada, staying in Room #904, across the corridor from him, for only 1 night – February 21, 2003. She then flew home to Toronto, where she became ill, and infected her son.

Very quickly, several hundred residents of Toronto contracted the disease, of which 31 died, including her son. The city of over 2 million was plunged into a public health and socioeconomic crisis.

One such Toronto resident, a Filipino nurse attendant, flew home for an Easter visit, checked into a Luzon hospital, causing a major outbreak across the Philippines.

On February 21, 2003, Esther Mok, a Singapore resident, who had flown to Hong Kong on a shopping vacation, checked into the Metropole Hotel, Room #938. She returned to Singapore where she was hospitalized with pneumonia.

Very quickly, there were 200 cases, of which 33 died, including Ms. Mok’s father, mother, uncle and her pastor. She herself survived. The Singapore officials notified the WHO in Geneva that they had an outbreak of what they termed “severe acute, respiratory syndrome of unknown origin.” The WHO adopted

the acronym “SARS,” and issued a global travel advisory alert.

A doctor, who had taken a throat swab from Ms. Mok, boarded a plane, on his way to New York to attend an infectious disease conference. A Singapore co-worker, noticing he had respiratory symptoms, notified the Singapore authorities, who in turn notified the WHO in Geneva, which then alerted German officials, who met the plane in Frankfurt and quarantined him. As a result, New York and the United States escaped.

On March 15, 2003, China Airlines Flight #112 was flying from Hong Kong to Beijing, China, with a feverish male passenger. By touchdown in Beijing, 22 passengers and 2 crew members were infected and spread to 70 hospitals, involving 400 healthcare workers, patients and their visitors.

During the same period, a Chinese-American businessman traveled from Hong Kong to Hanoi, resulting in 150 cases in Vietnam. While in Hanoi, he was examined by Dr. Carlos Urbani, an Italian parasitologist, the local WHO communicable diseases expert. He traveled to Bangkok, where he died 12 days later, but had brought SARS to Thailand.

The SARS-CoV, RNA virus reservoir in South China Horseshoe bats, had undergone a mutant spillover from bitten civet cats to humans, and had circled the earth by plane, going global in just a few months, infecting 8098 individuals, 774 of whom died, with devastating costs to national economies, before the contagion could be contained. The last case identified was in Taiwan, on June 15, 2003, prompting Toronto Mayor Mel Lastman to declare “SARS IS DEAD.” But was it? On November 2012, the WHO issued an alert that a SARS-like, contagious syndrome had appeared in Saudi Arabia and Qatar.

But for the fact that the SARS virus was transmitted via large, airborne droplets, only to very close contacts, there could have been a major pandemic. Not so for H1N1 influenza, which killed 50 million people in 1918, 2 million in 1957, and 1 million in 1968.

Are we prepared for the Next Big One? Hell no! “There’s still no magical defense, no universal vaccine, no foolproof and widely available treatment, to guarantee that such death and misery don’t occur again. So influenza is hugely dangerous, at best. At worst it would be apocalyptic.” – So notes David Quammen in his monumental work, “Spillover.”

Readers may download and share my free Flu app at the Android App Store. Search for “migsclient” (must be one word). This application does the hard work to help you get best care at home, and when traveling abroad. It is good for influenza, SARS and other respiratory infections.

Victor Kumar-Misir, M.D., is an international physician, who has spent the past 40 years integrating translingual, cross-cultural healthcare delivery with emerging information-management technologies, with the goal of delivering healthcare to all individuals, regardless of language, literacy, location or level of income.

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interaction with patients and surgeons that exponentially reduces false positives and negatives. “The hours spent talking directly with patients and in the operating rooms with surgeons during biopsies, truly provides the best possible diagnosis with least room for error,” said Moore.

The pathologist’s conversations with patients may reveal previously unknown symptoms or family histories.

“The hours spent talking directly with patients and in the operating rooms with surgeons during biopsies, truly provides the best possible diagnosis with least room for error.”

Patient Care Magnified Beyond the Power of the Microscope

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t used to be that when primary care physicians were trying to decide where to send their patients for the uppermost levels of diagnostic testing and skill, they would turn to large academic facilities and healthcare institutions found only in the biggest cities— often trading the sensitivity of healing care for the sensitivity of the test. However, community hospitals are now luring the highest trained physicians to their campuses with the ability to offer more personalized, convenient treatment for enhanced patient outcomes.

Accurate initial diagnosis and test interpretation often falls to the expertise of the pathologist who, in large institutions, is trapped for countless hours behind the microscope or in the lab analyzing specimens. But for Dr. Jeffrey Moore, Medical Director for CHRISTUS St. John Hospital Laboratory, it’s his team’s

“Conducting and attending biopsies with surgeons, a practice not common in most hospitals, allows cell samples to be evaluated on site to assure that enough cells are obtained to make an accurate diagnosis—often eliminating the need for additional procedures” says Moore. His team organizes cancer conferences, bringing Dr. Jeffery Moore, the entire treatment Medical Director team together to design for CHRISTUS St. John Laboratory, an optimal care plan, studies a sample. through review of highresolution video imaging of microscopic biopsy images. This outlines small details of the disease that might influence the surgical or chemotherapeutic approach to treatment.

Employing these critical tools may not be possible in overcrowded metroplexes, but is becoming the standard of care for community hospitals caring for their neighbors. And when it’s your neighbor, your friend, your coworker faced with a difficult diagnosis, you can’t compromise on expertise and skill. Moore states, “St. John is home to three medical-center trained pathologists, each with American Board of Pathology subspecialty certification in needle aspiration cytopathology. It’s often difficult to find one in a community based hospital, but all of us chose the opportunity we have here to look beyond the microscope, directly into the healing of the patient.”

AND PREGNANCY

By Linda A. Goodrum, M.D.

MOST PEOPLE do not associate

pregnancy with heart disease. It is a misconception that women with serious medical problems cannot conceive. here have been tremendous advances in the surgical correction of cardiac birth defects and in the management of heart disease in general.

More women are postponing childbirth until later in life, when the risk of heart disease increases. Obesity is becoming more common, and this is a risk factor for heart disease. As a result, there are a larger percentage of women of reproductive age with cardiac issues.

Pregnancy can pose a challenge to a woman with preexisting heart problems, and in some cases, may even increase her risk of death during or after the pregnancy. It is important that any woman with a history of structural heart defects or acquired heart disease seek consultation with a cardiologist and maternal fetal medicine specialist before considering pregnancy.

There are significant cardiovascular changes that occur in pregnancy. These changes begin as early as the first trimester and are most profound during labor and delivery and postpartum. These adaptations allow for increased blood flow and oxygen delivery to the developing fetus and also provide a ‘cushion’ from blood loss at delivery.

“It is important that any woman with a history of structural heart defects or acquired heart disease seek consultation with a cardiologist and maternal fetal medicine specialist before considering pregnancy.”

The changes that a mother’s body undergoes are fascinating.

The maternal blood volume increases by as much as 50% (even more so with multiples) with a gradual increase in heart rate. The contractility (pumping strength of heart muscles) increases and the arteries put up less resistance to the blood being pumped out of the heart to the body. As a result, the output and the workload of the heart increase. As much as 25% of this increased output goes to the pregnant uterus! The heart works especially hard during labor. Pain, anxiety and metabolic and blood volume shifts combine to increase heart rate and cardiac output. The heart can pump as much as 9 liters of blood per minute during labor and immediately after birth!

Significant cardiovascular changes are also seen during a planned cesarean section. The postpartum period is generally the most dangerous time for women with cardiac problems. There are large

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volume shifts that occur, and decreased mobility from discomfort can increase the risk for blood clots (thrombi). As can be seen, women with precarious cardiovascular systems can be ‘pushed over the edge’ from the challenges of pregnancy.

I have seen a variety of maternal cardiac conditions during my years of practice. The scope of problems ranges from uncorrected heart defects, heart defects that have been surgically corrected, abnormalities in heart rhythm and rate (arrhythmias), abnormally thick heart muscle (cardiomyopathy) and coronary artery disease.

Not all heat conditions lead to significant risks to the mother during pregnancy. Also, some heart problems may not develop until after pregnancy (cardiomyopathy, heart failure, severe high blood pressure). Regardless of the type of heart problem, women desiring a pregnancy should seek counseling and a thorough check up before conceiving.

“The heart can pump as much as 9 liters of blood per minute during labor and immediately after birth!”

There are several factors to take into account when performing a preconception evaluation: 1) Baseline activity level: The degree of activity that produces symptoms of fatigue, shortness of breath, chest pain or high heart rates is an indicator of risk to the mother during pregnancy.

2) Co-existing medical problems: The presence of hypertension, respiratory problems, diabetes, autoimmune diseases such as lupus, tendency to form blood clots (thrombi) and other problems increase risks for pregnant women.

3) Type of heart defect and whether it has been corrected: In general, uncorrected defects that produce cyanosis (“blue baby”) pose significant risks to a pregnant woman. Many defects that have been corrected are well tolerated in pregnancy. In general, the more complex the heart defect and the more surgeries needed to correct it, the greater the risk to the pregnant woman, as the architecture of the heart chambers and vessels can be altered and the heart may be less able to tolerate the changes of pregnancy. It is helpful to me to have a copy of the surgical report and any subsequent cardiac checkups.

4) Special conditions: Some women born with septal defects (‘holes in the heart’) will not have had it surgically corrected.

Small holes are generally well tolerated in pregnancy. A large defect can lead to unoxygenated blood bypassing the lungs and crossing into the left side of the heart because of decreased pressures on the left side as compared with the right side of the heart in pregnancy. This can lead to Eisenmengers syndrome which has a mortality rate in pregnancy approaching 30-40%.

Also, Marfan’s syndrome (a genetic condition) with an enlarged aorta has a high mortality rate in pregnancy. In addition, women with certain cardiomyopathies and women with coronary artery disease should not attempt pregnancy.

5) Age of the woman: Women over the age of 40 with a history of heart problems may have increased risks in pregnancy.

6) General health of the woman: I check for any habits such as street drug use, smoking and poor eating habits.

7) Medication use: Some medications that the woman is taking for her medical problems may need to be changed prior to pregnancy due to risk of birth defects to the developing fetus. It is easier to change medications and achieve a therapeutic dose before conception.

The full range of cardiac conditions and the effects on pregnancy are beyond the scope of this article.

However, pregnancy is not necessarily contraindicated and an unplanned pregnancy does not necessarily need to be terminated. Unfortunately, there are some situations that pose a high risk of death to the mother, and early pregnancy termination may be recommended in order to save the life of the mother.

That is why it is important to seek counseling with a high risk specialist in these situations.

Research has shown a genetic component to heart defects and heart disease. The etiology of heart defects is multifactorial with the environment and life choices also contributing to the risks. A woman who was born with a heart defect has an increased risk of having a fetus with a heart defect. There are also some heart defects that are seen in every generation. There is also a strong correlation between heart defects and chromosome problems such as Down’s syndrome.

There is a very long list of syndromes and genetic diseases in which heart defects are prominent. The development of the heart begins very early and is very complex. Exposure to certain chemicals or medications at specific days in early pregnancy can cause a heart defect.

Therefore, if a woman is considering pregnancy and was born with a heart defect or has a current heart condition, she should: 1) 2) 3) 4)

Seek preconception counseling with a perinatologist.

Receive a full cardiac evaluation with her cardiologist.

Have other medical problems under control.

Seek counseling with a geneticist if there is a strong family history of heart defects or genetic syndromes.

5) Take a daily multivitamin for general health.

6) Have her weight under control.

7) Stop smoking!

Pregnancy is an important milestone in the life of a woman. In many women with heart disease, it can be safely accomplished.

Linda A. Goodrum is a doctor at the Maternal Fetal Medicine Associates of South Texas, LLP.

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Medical Community Frantically Trying to Keep Up With Growth

By Mary Alys Cherry

Few sectors are growing faster in the Bay Area Houston than the medical community.

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our new Pearland facilities were completed or in the works this past year as the Brazoria County city continued to boom. But it was not alone.

Webster has construction under way at two hospitals, while League City, Galveston, Dickinson and Pasadena all have several new projects as doctors try to keep pace with the area’s rapid growth.

Here’s a rundown:

in one location, at 15015 Kirby Drive near McHard and Beltway 8. The 13,000-square-foot facility is on the ground floor of a three-story medical office complex with two main operating rooms and room for future expansion.

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University General Health Systems plans to build University General Hospital, a medical complex on a 31acre Pearland Parkway site that will include a 50-bed acute care hospital, a 10-bed emergency room, an 8-bed intensive care unit, 4 operating rooms and an endoscopy and cardiac catheter lab, plus a 50,000-square-foot medical office building adjacent to the hospital, and a 42-unit memory care facility. It hopes to begin construction in 2013.

HCA Gulf Coast Division announced in October it is building Pearland Medical Center, a 30-bed acute care hospital at Highway 288 and County Road 2234 (Shadow Creek Parkway) on the 48-acre site that is currently home to a 24-hour emergency department, imaging center and a three-story, 80,000 square foot medical office building.

Groundbreaking for the 144,000-squarefoot, $71 million facility will be this year, with completion by the end of 2014.

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Clear Lake Regional Medical Center is celebrating its 40th anniversary with a $92 million expansion that will include a 154,000-square-foot Patient Tower with state-of-the-art operating rooms, pre-op and recovery rooms, plus a 30-bed adult Intensive Care Unit and a wide range of innovations. The hospital on Medical Center Boulevard has been providing care for the Bay Area since 1972 and for a number of years was the only medical center in the area.

Bay Area Regional Medical Center, the new 375,000-square-foot, $160,000 million, 176-bed facility with 10 operating rooms at the intersection of Highway 3 and Blossom Street, moved a step closer to opening in late 2013 as work began on its six­-story, 674-space parking garage. It will offer a full complement of medical and surgical clinical services and is designed to withstand 225 mile-per-hour winds – well in excess of a Category 5 hurricane.

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The University of Texas Medical Branch announced plans for an $82 million expansion at its Victory Lake Specialty Care complex that will include emergency services. The 142,000-square-foot addition to the 110,000-square-foot Specialty Care Center, built at a cost of $61 million and opened in 2010, will include 39 impatient beds, more operating rooms, an emergency department and support space that will allow for procedure and surgeries requiring up to an average 72hour stay.

Methodist Retirement Communities also announced plans to build a $75 million project, The Crossings, a 190-unit skilled nursing facility offering memory support and assisted living on 18 acres along Egret

UTMB also announced plans for two major projects at its complex in Galveston. One is a $15.3 million project to modernize 75,000 square feet of corridor and lobby space at John Sealy Hospital there, using flood resistant building material to minimize potential flooding damage.

UTMB also broke ground this past spring on the new $438 million Jennie Sealy Hospital, which will contain 310 patient rooms, a 28-unit surgery unit and 20 operating suites. Being built on the site where the former Jennie Sealy building stood before it was demolished, the new facility is expected to be completed in 2015.

PASADENA •

Kelsey-Seybold Clinic is building a new clinic on a 5.6-acre site at 5049 E. Sam Houston Parkway near Crenshaw Road with completion expected this spring. The two-story building will have 36,400 square feet of space and offer many specialties, additional capacity for OB/GYN and primary care physicians and medical and diagnostic testing.

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Medical Resort at Bay Area, a 55,919-square-foot facility offering skilled nursing for short-term stays plus physical, occupational and speech therapies, expects to open soon at 4900 E. Sam Houston Parkway. The $11 million facility will employ about 200.

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Pristine Hospital of Pasadena, a 32-bed special acute care hospital with two psychiatric partial hospitalization programs has opened at 1004 Seymour St. When all three floors are eventually built out, it will include a psychiatric ward, in-patient and out-patient services, an emergency department and ob-gyn, lab and diagnostic services and employ 150 initially and ramping up to 300 within three years.

LEAGUE CITY

Kelsey-Seybold has started construction on its new 170,000-squarefoot administrative building on an 18acre site on Kirby Drive and Shadow Creek Parkway and expects to complete it this summer. The $21 million office project will support Kelsey-Seybold’s 370 physicians, who provide primary and specialty care at 20 Houston area clinics and is expected to provide 800-1,200 Pearland jobs.

Pearland Surgery Center opened the city’s first state-of-the-art multispecialty Ambulatory Surgery Center in July – offering a broad continuum of procedures including ENT, pain management, endoscopy, general surgery, orthopedic, spine and podiatry

GALVESTON

WEBSTER

PEARLAND •

Bay Boulevard near FM 518 that will provide 150 full-time jobs. Construction is expected to start in 2014.

DICKINSON •

A new 24,000-square-foot medical office building is in the works on FM 517 West near the intersection of Highway 646.

They’ll be there to raise money to support the American Heart Association’s educational programs and lifesaving research it funds to reduce the effects of heart disease in women.

Currently, there is more than $1.4 million in active research grants being funded in the Galveston Bay Area Division.

Chairman Brandy Gates, whose day job is as director of sales at Big League Dreams, says to expect an afternoon of fun with the irrepressible Dayna Steele as mistress of ceremonies.

Team members include Bonnie Benkula and Annette Macias Hoag, UTMB; Marti Boone, Griffin Communications; Santiago Mendoza Jr., Best Practices magazine; Meridell Sloterbeek, Kindred Hospital Clear Lake; Carla Mary Colombo, right, Medlenka, Change magazine; and Louis Reyna, stops to say hello EmergiCare. to Phyllis McCulley, left, and Dorothea Sub-committee chairmen are Lauri Dahse, Pongetti during last Sandy Adams, Santiago Mendoza Jr., Jill year’s Go Red for Williams, Monique Spence and Nancy Suarez.

Women Luncheon benefitting the Major sponsors are Bay Area Regional Medical American Heart Center, UTMB Health, EmergiCare, San Jacinto Association.

Methodist Hospital, Bayer, Big League Dreams, Griffin Communications, Kindred Hospital Clear Lake and Merrill Lynch.

Tickets, which are $85 if purchased before Feb. 1, may be reserved by visiting the websitewww.heart.org/bayareatxgoredluncheon For more information, contact Katie Gallagher at 713-610-5072 or

By Mary Alys Cherry at katie.gallagher@heart.org “We’re in our 10th year of fighting heart disease in women. More ore than 250 women -- all dressed in red – and quite a few than 627,000 women’s lives have been saved, but the fight is far from guys, will fill up the South Shore Harbour Resort’s Crystal over. Join us at the luncheon and be a part of the movement that Ballroom on George Washington’s birthday, Friday, Feb. is FOR women, BY women. Together, we can end heart disease,” 22, for a very lively luncheon.

Gallagher said.

But they’re not coming to celebrate the birth of our first president.

Sorry, George.

You’ll Be Seeing Red at this Lively Luncheon

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End of the World Party Photos by Gloria Wong

Ready Yourself for the Flu

By Victor Kumar-Misir, MD

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(Top Left) Dr. David Gordon and his wife, Lauri, left, welcome Cindi and Karl Priebe, who were among the crowd at the Gordon’s Bay Oaks home in Clear Lake rejoicing that the world did not come to an end and celebrating Dr. Gordon’s birthday Dec. 21. (Top Right) Dr. Rod Turner, left, stops to say hello to Bryan and Dr. Kimber Holmes during party celebrating Dr. David Gordon’s big 5-0 and rejoicing that the world did not come to an end that day. (Bottom Left) Jan and Dr. Brent Bailey, left, and Sonya and Dr. Jeff Moore mingle with the crowd at the Dec. 21 birthday celebration at the Bay Oaks home of Lauri and Dr. David Gordon in Clear Lake. (Bottom Right) Sonya Moore, right, joins Angie Weinman, Gloria Wong and Jan Bailey, from left, for a photo as they awaited the countdown of the Mayan Calendar and found the world still intact.

he annual flu season has come to Texas early this year. There were 1,580 flu-like illness visits to the Houston emergency rooms during the week of November 18, compared to 249 last year during the same period according to the Houston Department of Health and Human Services. Similarly there have been 123 cases of Type A Influenza compared to just two in the same period last year at the Texas Children’s Hospital. Flu disrupts families and businesses, has untold widespread human suffering and an attributable death incidence of up to 49,000 in the US each year.

Please visit page 30 at the end of this publication for a progressive Influenza guideline I have prepared to help with self assessment and monitoring, as well as triage and treatment. You may also download and share my free Android Flu App (search migsclient) that does the hard work to help you get best care at home and when traveling abroad.

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Photo: Sandy Adams Photography

Men Go Red For Women

Bay Area Healthcare Leaders Seeing Red

ocal Entrepreneur and Community Healthcare Leader Santiago Mendoza Jr., retired NBA legend Hakeem Olajuwan and other prominent community and healthcare leaders will gather for an exclusive event benefiting the American Heart Association of Bay Area Houston’s Inaugural “Men Go Red For Women” at DR34M in the historical West Mansion in Clear Lake on February 19, 2013.

This exclusive and by invitation only event will allow these area

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community and healthcare leaders to celebrate the men who advocate for the heart health of the women in their lives. The event will raise funds in support of the American Heart Association of Bay Area Houston Go Red For Women Luncheon.

Since this is the first event of its kind in the Bay Area, prominent healthcare leaders will have a chance to join the exclusive “Men Go Red” Founding Member Club.

(From left to right) Dr. Patrick Briggs, Podiatrist Ron Castagno, COO of Bay Area Regional Medical Center Dr. Marcus Giacomuzzi, Podiatrist Matthew Emory, Local Entrepreneur Santiago Mendoza Jr., Local Entrepreneur & Men Go RED Chair

Men Go Red For Women is a dynamic, committed group of men who are rallying their resources to fight heart disease, the number one killer of women and men. They’re standing behind the women they care about - wives, mothers, daughters, sisters and friends - while influencing and inspiring communities. The Bay Area Houston Go Red For Women Luncheon is locally sponsored by Bay Area Regional Medical Center, UTMB Health, EmergiCare, San Jacinto Methodist Hospital, and many other

local Bay Area businesses and healthcare organizations. For more information on “Men Go Red For Women” or how you can help raise funds and awareness for the Bay Area Houston Go Red For Women Luncheon, please visit our local website – www.heart. org/bayareatxgoredluncheon or contact Katie Gallagher at 713-610-5072.

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From the Research Lab to the Playground

75 Years towards Healthier Babies

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others-to-be have a lot on their plate as they baby proof their homes, decorate their baby’s nursery and celebrate their future bundle of joy with family and friends. Amongst the hubbub in the months preceding the delivery date, most mothers worry about their baby’s health, but few truly imagine that their child will be the 1 out of every 8 children in Texas that is born prematurely.

The March of Dimes Foundation helps mothers with premature babies by partnering with families, as well as funding many research initiatives relating to the problems that face premature babies.

The $150,000 Basil O’Connor Starter Scholar Award was recently awarded to Muge Kuyumcu-Martinez, an assistant professor at the University of Texas Medical Branch at Galveston. This grant will further support the research she and her team have been working towards on congenital heart defects as they study the heart from its early embryonic stages to adulthood.

“I am so grateful and I’m honored to get the grant from them because I know it will eventually help the babies, said KuyumcuMartinez. “We are grateful to the people that donate the money, too, because it goes to help support the research and clinical studies. It is really a privilege and an honor.”

Kuyumcu-Martinez found distinctions in some of her experimental research with differentiated cells in diabetes. Along with her past studies working with Muscular Dystrophy, these distinctions piqued her interest to investigate the differentiation amongst genes leading her to shift her research to focus on congenital heart defects.

“Our main focus is to understand how the heart develops as the No. 1 cause of birth defects is a problem with the heart,” Kuyumcu-Martinez said. “The heart goes through a lot of changes during its growth: so many things happen, so many signals are required during this period telling which cells to go where and which cells to develop, which cells to become more differentiated, etc.

“A lot of these signals are known, but we are trying to understand these signals at each stage. We are really trying to understand how these signals get information to these cells, how the cells do gene expression, the proper development, and if we block those things, do they affect development. Those are the types of things we are doing to try to understand the heart development.”

The development of this research is still at its earliest stages, but as it develops,

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By Ashley Karlen

Dr. Jonas Salk and Dr. P. L. Bazely, Virus Research Laboratory, University of Pittsburgh, PA; 1954. (54-1157) ©MOD

FDR and Basil O’Connor (President, National Foundation for Infantile Paralysis) counting dimes at the White House; c. 1938 (FB108) ©MOD

Smiling children show “where the needle went” after their vaccinations during the vaccine field trial.

Polio Pioneer button inset; 1954 (54-1046)© 2005, March of Dimes.

it has huge implications for the future of healthy babies. As a mom herself, KuyumcuMartinez knows her research has great value, especially as she delves in with her emphasis on genetic mutations, as most sets of multiples are born prematurely.

Courtney Wright, a member of the Bay Area Mothers of Multiples group, gave birth prematurely to her twins at 23 weeks and 5 days. As a result of such an early birth and several complications, the twins spent over 140 days in the NICU at Clear Lake Regional Medical Center.

“With me being a twin, I should have been more aware but I was born at full term. I was

aware there was a high risk pregnancy but I had no clue about prematurity or premature birth,” Wright said. “It was wake up in the morning and kids were born that day not like many women I know who were on bed rest or there was a doctor’s visit and kids were born a few weeks later.”

Around 28 weeks, most doctors typically have a conversation detailing prematurity and risk factors with moms-to-be, although the treatment and precautions taken during the pregnancy vary from doctor to doctor.

With Wright’s twins being born at just under 26 weeks, her babies were already in the NICU by the time she would have had that conversation with her doctor. Even though Wright received excellent prenatal care, she was still in shock that her babies had been born prematurely, as she hadn’t seen it as a possibility for her pregnancy.

“I wish I had known how likely it was to have babies prematurely,” Wright said. “It really just didn’t occur to me. A big thing that I wanted when my kids were in the NICU was other parents who had been through that and had come out to talk to those whose children hadn’t survived.”

For other moms facing possible prematurity with their pregnancy, it is suggested to keep a close relationship with your doctor, be aware and monitor symptoms as well as any predisposed dispositions that could cause a premature birth.

“There’s the major hurdle to get over of wanting to feel like you’re tough and brave and that you can handle this,” Wright said.

“I think if someone had told me to not try to channel the pain, to not channel the discomfort, but to call the doctor every time and leave the decision in the doctor or nurses hands. If someone had taken the stigma out of the ‘oh, I’m just whining,’ everyone needs to hear that in advance of them feeling that.”

Six years after their time in the NICU, the Wright twins are healthy and running around on the playground enjoying their playtime just as any other kids would. These twins are among many premature babies that the March of Dimes is celebrating during 2013 with their 75th anniversary -- along with everything they have achieved, from helping to eradicate polio to researching prematurity and birth defects.

One of the many ways to help celebrate is to join the Bay Area Mothers of Multiples Group at the Houston March for Babies Walk benefitting the March of Dimes Walk on April 28th. To find out more about the Houston Walk, visit marchforbabies.org Happy 75th Anniversary March of Dimes!

MD Anderson to Target Eight Deadly Cancers

By Mary Alys Cherry

The University of Texas MD Anderson Cancer Center has launched an unprecedented $3 billion effort to dramatically curtail cancer deaths.

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aking its inspiration from NASA’s highly successful Apollo program that culminated with landings on the moon, the top rated Houston cancer institution said it hopes its initiative, called the Moon Shots Program, will greatly accelerate the pace of converting scientific discoveries into clinical advances that reduce the number of deaths from cancer.

Initially, the program is targeting eight cancers by bringing together sizeable groups of MD Anderson researchers and clinicians to mount all-out attacks on: • • • • • • • •

Lung cancer Prostate cancer Acute myeloid leukemia Chronic lymphocytic leukemia Myelodysplastic syndrome Melanoma Ovarian cancer Triple-negative breast cancer

“Humanity urgently needs bold action to defeat cancer,” said Dr. Ronald A. DePinho, MD Anderson president, in making the announcement. “I believe we have many of the tools we need to pick the fight of the 21st century. Let’s focus our energies . . . with the precision of an engineer, always asking, ‘What can we do to directly impact patients?’”

Each of the moon shot teams will receive an infusion of funds and other resources needed to work on ambitious and innovative projects prioritized for patient impact, he said.

The program takes its inspiration from President John F. Kennedy’s famous 1962 speech at Rice University – just a mile from the main MD Anderson campus – which launched America’s Apollo program. “Generations later, the Moon Shots Program signals our confidence that the path to curing cancer is in clearer sight than at any other time in history,” DiPinho said.

“Even as the number of cancer survivors in the U.S. is expected to reach an estimated 11.3 million by 2015, according to the American Cancer Society, cancer remains one of the

“The program takes its inspiration from President John F. Kennedy’s famous 1962 speech at Rice University which launched America’s Apollo program.” most destructive and vexing diseases,” “An estimated 100 million people worldwide are expected to lose their lives to cancer in this decade alone. The disease’s devastation to humanity now exceeds that of cardiovascular disease, tuberculosis, HIV and malaria – combined.”

Funds for the initiative, DiPinho said, will come from institutional earnings, philanthropy, competitive research grants and commercialization of new discoveries

“An estimated 100 million people worldwide are expected to lose their lives to cancer in this decade alone.”

and will not interrupt the cancer centers vat research program in all cancers but will, in fact, help support all other cancer research at MD Anderson, as the ultimate goal is to apply knowledge gained from this process to all cancers.

Meanwhile, Dr. Richard Ehlers, medical director of the MD Anderson Regional Care Center in Bay Area said his team is proud to be part of the initiative.

“Our clinical trials program now brings innovative treatments to our area’s patients, but in the future, they will have even greater access to more treatment options. Plus, their participation can impact cancer survival in generations to come worldwide.”

A year ago when DePinho was named MD Anderson’s fourth president, he proposed the idea of a moon shot moment, urging the institution to think boldly.

While President Nixon began a War on Cancer in 1971, the Moon Shots Program is new in that it targets specific cancers.

“Nothing on the magnitude of the Moon Shots Program has been attempted by a single academic medical institution,” said Frank McCormich, Ph.D, the president of the American Association for Cancer Research.

“The Moon Shots Program takes MD Anderson’s deep bench of multidisciplinary research and patient care resources and offers a collective vision on moving cancer research forward.”

DePinho said the Moon Shots Program is among the most formidable endeavors mounted to date by MD Anderson, which is ranked the No. 1 hospital for cancer care by US News & World Report’s Best Hospitals survey for nine of the past 11 years, including 2012.

CCEF Breakfast

1. Retired Clear Creek ISD Superintendent Dr. Ron McLeod catches up on the news with BP Communications Director Ruth Rendon at the CCEF breakfast.

2. Banking executives Leon Coe, Jim Stewart and Mike Huss, from left, visit as they await the start of the Clear Creek Education Foundation breakfast at Lakewood Yacht Club.

at Lakewood Yacht Club Photos by Mary Alys Cherry

3. Clear Creek Education Foundation Chairman Scott Rainey, right, welcomes Bay Area Regional Medical Center CEO Dr. Michael Lyons, center, and Best Practices magazine President Santiago Mendoza Jr. to annual CCEF breakfast at Lakewood Yacht Club.

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4. Leslie and Walt Huff, left, are happy to see Margaret and Danny Snooks as they arrive at Lakewood Yacht Club for the annual Clear Creek Education Foundation Breakfast.

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Six Simple Steps to Quit Smoking for Good

University of Texas MD Anderson experts share the most effective ways to break your smoking habit 1. Set a Date It’s important to pick a date and plan ahead.

“Picking a quit date, particularly at a time when you know your motivation is high and there will be less stress or distraction, is generally a good idea,” said Paul M. Cinciripini, Ph.D., director for MD Anderson’s Tobacco Treatment Program and professor for the Department of Behavioral Science.

2. Get Help Few people quit for good on their first try, so support is crucial during this difficult time. Medication and help from a behavioral counselor or psychologist can boost chances of success.

“A counselor can help you identify what triggers you to smoke and determine what’s most likely to work for you,” said Vance Rabius, Ph.D., instructor for MD Anderson’s Department of Behavioral Science and former senior scientist at the American Cancer Society Quitline.

That may include using a nicotine replacement product like the patch, gum or nasal spray, and cleaning out your car and home so you’re not constantly reminded of cigarettes.

3. Swap Habits Prior to quitting, it is important that smokers identify the moods or situations that lead them to smoke. Then, they need to remove those smoking triggers from their

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environment and replace them with activities or habits that help them avoid tobacco.

Those that smoke because they like to chew on something may be able to satisfy the craving by drinking water or chewing lozenges. Those that light up when they are anxious need to find new ways to cope with stress.

4. Distract Yourself It is common for those who have recently quit to spend a lot of time thinking about their habit and cravings. Whenever possible, it helps to create positive distractions.

Picking up a new hobby or focusing on a project is a great way to redirect attention to something constructive.

5. Take it One Day at a Time “Never again” can seem daunting during your first days without a cigarette.

Focus instead on short-term goals. Quitting smoking is a journey that needs to be taken one day at a time.

6. Reward Yourself Rewarding yourself for even small successes can reinforce that you’ll benefit from quitting very soon. Consider setting milestones for rewarding yourself. Something to look forward to after one week, one month or one year without smoking will keep you motivated to stick to it.

For additional tips on smoking cessation, visit www. mdanderson.org/focused.

Here’s to a Healthier New You in 2013!

By Dianna Villarreal, M.S., CHES

It is New Year’s Resolution time! Have you thought of what you would like to do differently this year than last year? Here are some tips on goal setting to consider when creating a healthy New Year’s Resolution: 1. It is better to focus on one goal at a time. Prioritize your list by level of importance.

2. Identify your barriers to reaching your goal. Remember that success requires sacrifice in some way. Always have a Plan B in place in case you face an unforeseen or unplanned obstacle.

3. Make sure that you set a SMART goal. a. Specific – The more specific you are about your goal, the better you are to maintain it. For example: if your goal is to lose weight or eat healthier, start exercising, or decrease stress, etc., these are very generalized. b. Measureable – Use numbers as a way of measuring your goals. Then, keep a journal/record of what you are measuring so you can review your accomplishments. c. Attainable – How easy or difficult will it be for you to reach your goal? Think baby steps! The smaller the goal, the easier it is to reach. Then, you can build on these smaller changes towards your overarching goal. d. Realistic – Is this goal humanly possible? Do you have the means to make this happen? Is it safe?

e. Time – Think of the time and dedication it will take, not only to accomplish your overall goal, but on a daily basis. We all have 24 hours in our day, and how you spend your day makes a big difference. What can you and can’t you sacrifice in your day to make this happen?

4. Follow up on your accomplishments on a periodic basis. Make weekly or monthly notes to evaluate how you are doing with your goal.

5. It is important to have a strong support group. Include family, friends, co-workers to provide emotional support to help you stick to your goal.

6. Remember to REWARD yourself. Rewards and incentives can be great motivation tools.

7. Forgive yourself ! No one is perfect, so if you skip a day or fall off track, that does not mean you have to quit or start over. Identify what went wrong and plan accordingly to avoid that situation from reoccurring.

8. Make it FUN! Use your creativity to make your goal enjoyable and entertaining to reach!! Try different approaches to minimize boredom and stress, and increase motivation and focus.

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UTMB Health System Taps McGrew to Fill COO Post

Three Area Hospitals Earn National Recognition

By Mary Alys Cherry

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hree Bay Area hospitals have come in for honors in recent days for the quality of the health care they offer.

Clear Lake Regional Medical Center in Webster, Christus St. John Hospital in Nassau Bay and Mainland Medical Center in Texas City have received the nation’s “Top Performers on Key Quality Measures” recognition by The Joint Commission, the leading accreditor of health care organizations in America.

The three are among 620 American hospitals earning the distinction for attaining and sustaining excellence in accountability measure performance.

Clear Lake Regional was recognized for its achievements in the treatment of heart attack, heart failure, pneumonia and surgical care. The ratings are based the total accountability measures reported to the Joint Commission for 2011.

Christus St. John was cited for exemplary performance in using evidence-based clinical processes that improve care for certain conditions such as heart attack, heart failure, pneumonia, surgical care, children’s asthma, stroke and venous thromboembolism.

Mainland was recognized for its achievements in the treatment of heart attack, heart failure, pneumonia and surgical care for the 2011 calendar year and was chosen based on its quality improvement efforts in these areas to create better outcomes for patients and ultimately a healthier community — a tremendous improvement in performance has been measured over the past ten years.

The list of Top Performers increased by 50 percent from its debut last year and represents 18 percent of more than 3,400 eligible accredited hospitals reporting data.

“We know that what’s most important to our patients at Clear Lake Regional Medical Center is safe, effective, high-quality care from a compassionate, skilled staff,” said CEO Stephen Jones, while Mainland CEO Michael Ehrat said, “The recognition of Mainland Medical Center by The Joint Commission as a 2011 ‘Top Performer’ is a testament to the work of the hospital’s physicians and staff and their dedication to the patients of Galveston County.”

Christus St. John CEO Tom Permetti added, “For over 30 years, we have strived to bring excellent health care to the Greater Bay Area. It is an honor to be recognized by The Joint Commission – and a testament to the hard work and dedication of our team of physicians, therapists, nurses and associates.”

“Comprehensive patient care,” said Dr. Henry Muniz, president of the CLRMC medical staff, “requires a multidisciplinary approach by an entire team, and we have developed a culture here where evidence-based medicine and world class service has led to remarkable outcomes for our patients.”

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By Mary Alys Cherry

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eborah McGrew is the new chief operating officer for the University of Texas Medical Branch Health

System.

McGrew will be in charge of leading, planning and integrating numerous aspects of the UTMB Health System, including its hospitals, clinics and ancillary services, as well as managed care.

“We’re so pleased to have Deborah joining the UTMB Health System,” Donna Sollenberger, executive vice president and CEO of the UTMB Health System, said.

“She’ll be working closely with me, as well as with the executive vice president, provost and dean of the School of Medicine, Dr. Danny Jacobs. Deborah’s extensive experience will help to provide innovative health care delivery systems

and educational solutions to pressing societal needs for access to and quality of care.”

McGrew is currently associate vice president at the University of Alabama Birmingham Hospital, and formerly was administrative director of transplant services at the University of Wisconsin Hospitals and Clinics.

A graduate of Drury College in Springfield, Mo., she earned her Master’s in Health Administration from the Washington University School of Medicine in St. Louis and completed an administrative fellowship at the City of Hope National Medicine Center in the Los Angeles area.

She is a member of the American College of Healthcare Executives, served on the board of the Alabama Kidney Foundation and was appointed by the governor to the Alabama Department of Mental Health.

Pasadena Hospital Earns Improvement Award

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ayshore Medical Center has received the Texas Health Care Quality Improvement Award from TMF Health Quality Institute, the Medicare quality improvement organization for Texas.

TMF established the awards program in partnership with the Texas Hospital Association, Texas Medical Association, Texas Organization of Rural & Community Hospitals and Texas Osteopathic Medical Association.

Texas Health Care Quality Improvement Awards honor Texas hospitals that are performing quality initiatives aimed at improving outcomes in patient care by recognizing those hospitals that have improved their performance on specific national quality measures.

The awards acknowledge hospitals for improving care related to acute myocardial infarction or AMI (heart attack), heart failure, pneumonia and surgical care. These clinical areas have been designated as national health care priorities by the Centers for Medicare & Medicaid Services and The Joint Commission, an independent nonprofit,

standards-setting and accrediting body in health care.

“This is a significant achievement that demonstrates our commitment to patient safety and quality healthcare,” said Jeanna Barnard, Bayshore Medical Center CEO. “Our physicians, nurses, employees and volunteers are dedicated to putting in the tremendous number of hours required to enhance quality improvement efforts because using proven standards saves lives.”

The awards recognize hospitals that are active in quality improvement and have made the required improvement on a composite scoring system, called the Appropriate Care Measure. For acute care hospitals, the ACM consists of 24 quality indicators: eight AMI, four heart failure, seven pneumonia and five surgical care measures. Critical access hospitals used an ACM score based on 11 quality indicators: four heart failure and seven pneumonia measures.

Out of 227 participating Texas hospitals, 27 met the criteria and were presented with the Texas Health Care Quality Improvement Award of Excellence.

Kelsey-Seybold Named Nation’s First Accredited Accountable Care Organization

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elsey-Seybold Clinic has become the first U.S. healthcare organization to receive accreditation as an Accountable Care Organization. It was one of six organizations seeking ACO accreditation through the National Committee for Quality Assurance when it began accepting submissions in March 2012.

“We are honored to receive the first ACO accreditation,” said Dr. Spencer R. Berthelsen, chairman and managing director of Kelsey-Seybold Clinic. “It confirms our successful creation of a fully coordinated, accountable model of care at Kelsey-Seybold.

We believe the model of care coordination, high-quality outcomes and efficiency has always been the future of healthcare.”

The NCQA Accountable Care Organization Accreditation is voluntary and evaluates an organization’s ability to deliver coordinated, patient-centered care; to improve clinical quality; to enhance the patient experience; and to reduce costs through quality clinical practices.

Being named an accredited ACO by the NCQA helps purchasers and providers

identify effective partners. It also helps patients find physicians who are committed to providing the quality care they need, when they need it.

To receive accreditation, which is valid for three years, Kelsey-Seybold Clinic underwent a rigorous assessment that focused on the evaluation of 14 standards and 65 elements that include: • ACO Structure and Operations • Access to Needed Providers • Patient-Centered Primary Care • Care Management • Care Coordination and Transitions • Patient Rights and Responsibilities • Performance Reporting and Quality Improvement The NCQA also collected data on key clinical and service measures such as mammography screening rates, comprehensive diabetes care and consumer satisfaction. Based on the comprehensive survey, NCQA assigns a level status to the organization.

“By being the first organization to earn NCQA ACO Accreditation, Kelsey-Seybold has demonstrated to payers and other

purchasers that it has met challenging requirements designed to show the efficiency, integration and high quality expected of an accountable care organization.

“NCQA Accreditation also shows patients and providers that Kelsey-Seybold is prepared to deliver on the promise of better care on all these dimensions,” said NCQA President Margaret E. O’Kane.

Kelsey-Seybold scored high marks under the accreditation review process and was named a Level 2 ACO – the highest level of achievement that can be reached in this first year of accreditation. Level 3 achievement calls for additional reporting and outcomes that cannot be measured in this early stage of the program.

Kelsey-Seybold Clinic is Houston’s premier community-based physician group, founded in 1949 by Dr. Mavis Kelsey in Houston’s famous Texas Medical Center. More than 350 Kelsey-Seybold physicians practice at 20 locations in the greater Houston area.

First Quarter 2013 | www.BestPracticesMD.com|

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FLU GUIDE:

Providing Practical Public/Physician Partnerships

INFLUENZA, an airborne, highly contagious, often lethal viral infection, has the potential for extensive dissemination, local epidemics, even a global pandemic, that can result in widespread death, disability and socio-economic disruption.

The virus is spread airborne via sneezing, coughing, spitting, or finger-to-face contact with contaminated objects, e.g., doorknobs.

The germ initially causes toxic symptoms, including fatigue and malaise, fever and chills, aches and pains, headaches and nausea. It targets the upper respiratory tract, causing nasal congestion, blockage and discharge and can be easily confused with the common cold or allergic rhinitis. In the event of a local epidemic, assume that the patient has influenza until otherwise proven.

Complications arise from the spread of the viral agent itself, or from other invading, opportunistic microorganisms, and include: Pharyngitis – sore throat, with or without tender, swollen neck glands.

2. Sinusitis – frontal headaches, sinus congestion and postnasal drip with irritant coughing and phlegm.

3. Otitis media – earache, decreased hearing, and sensation of ear fullness and crackling.

4. Laryngitis – hoarse voice and having to clear the throat often.

5. Bronchitis – cough with mid-chest soreness and colored sputum.

6. Croup – barking cough, stridor (noisy breathing) and difficulty breathing in.

7. Epiglottitis – excessive drooling of saliva, stridor (noisy breathing) and difficulty breathing in.

8. Bronchiolitis – coughing with wheezing and difficulty breathing out.

9. Pneumonia – spitting up blood, breathlessness, and one-sided chest pain when breathing in.

10. Septicemia – high fever, rigors, extreme weakness, prostration, faintness, shortness-of-breath, cyanosis.

1.

Personal Assessment and Response Ask the individual: “In the past 10 days, have you been in an area with diagnosed cases of influenza?”

If the answer is “No”, advise: “Keep abreast of the news for flu outbreaks and official advisories in the home and work areas.”

FLU-SPECIFIC TRIAGE GUIDELINES Influenza and flu-related complications As time passes, flu-related symptoms may appear and disappear as the infection progresses or recedes. Moreover, pre-existing problems may worsen, and co-existing conditions in other body systems may develop. Periodic evaluation is essential to determine the urgency of professional consultation (triage), and management (treatment) options.

The MIGS™ Flu Triage Chart is designed to help you review your medical condition periodically, and to make more informed, timely, triage and treatment decisions.

Monitor your illness periodically with this chart, to determine CLASS level (1-4), and hence, your response.

If the answer is “Yes”, advise: “Follow local health advisories, protect yourself, and check periodically for infection.”

Follow local health advisories: Consult media, public health departments, health care providers, special phone hotlines, text messaging or web sites, regularly.

Protect yourself at all times: 1. Avoid public congregation and unnecessary contact with others, especially in emergency rooms and doctors’ offices.

2. Stay at home as much as possible, stock up with food and supplies, and avoid unnecessary socialization.

3. Tele-commute – conduct occupational affairs online, or by phone, as much as possible, from your home or private office.

4. Wear a mask when in areas where infected people may be present, and avoid individuals with nasal congestion or coughing.

5. Avoid touching contaminated objects and keep your fingers away from your face, especially your eyes, nose and mouth.

6. Wash hands frequently, but avoid public restrooms. Carry and use convenient alcoholbased hand lotions when not at home.

7. Provide antiseptic hand lotions at all entrances to your home, offices and cars, and insist everyone entering use it.

8. Isolate infected individuals. Have them wear surgical masks, use disposable tissues, and limit touching shared objects.

9. Use disinfectants and disposables in treatment facilities. If you enter an area with infected individuals, wear disposable caps, NIOSH N95 masks, gowns and overshoes before entering, and dispose of these in special containers when leaving.

10. Shed possibly contaminated clothing when you enter your front door, bag and launder them, then shower and shampoo.

The extent to which the client should follow the above ‘ten commandments’ should be dictated by the infectivity, morbidity and mortality associated with the local influenza epidemic, as well as by the individual’s susceptibility and current state of health.

Check periodically for infection: The human defense mechanisms and immune systems will actively combat microbial infections, but may fail if the virus is particularly virulent, if there are pre-existing chronic conditions, e.g., asthma, emphysema, diabetes, leukemia, immune suppressive therapy, or if there are co-existing acute illnesses, e.g., vomiting and diarrhea.

Use the ‘Specific Triage Guidelines’ to detect influenza syndrome and flu-related complications. Then review the findings, triage suggestions, as well as the diagnostic possibilities above, to determine the urgency of professional consultation, and to describe the illness confidently, in order to get more informed medical responses.

For minor symptoms, one can use over-the-counter medications, and consider preventive vaccines and antivirals, if recommended. Medical attention, including investigations, prescription drugs, even hospital admission, may become necessary, depending on the extent of illness, complications and comorbidity.

Referring to the numbered ‘complications list’ above, the greater the number, the more urgently one should consider consulting a healthcare provider, preferably by phone, fax or e-mail. Always remember: At any level of expertise, medical decisions are only as good as the amount of information given to the health care provider.

This publication enables anyone to detect complications quickly, determine urgency confidently, and describe illness competently to health care providers, in order to get more accurate professional medical responses – directly in person, or remotely, by telephone, fax, e-mail or text messaging.

Use the following symbols to chart symptom progress over time in the dated columns: “–” for not present | “+” for onset of symptom | “ ” for getting worse | “ ” for getting better | “=” for unchanged | “0” is stopped *Note: The class number (1-4) is defined by the highest section with one or more positive symptoms.

FLU-RELATED SYMPTOMS To Monitor & Evaluate

POSSIBLE DIAGNOSES

DATE DATE DATE DATE DATE DATE

Suggested response

ASYMPTOMATIC CONTACT

CLASS 1

No flu symptoms

Consider vaccines/antivirals

MILD FLU SYMPTOMS

CLASS 2

Fever and chills

Use regular over-the-counter medicines and consider antivirals and/or vaccine if recommended.

Nasal congestion Sore throat Hoarseness Cough MODERATE FLU SYMPTOMS

CLASS 3

Colored spit

Consider contacting an MD as you may need prescribed medication and/or investigations.

Past asthma / wheezing Deafness Persistent fever & chills SEVERE FLU COMPLICATIONS

CLASS 4

Drooling saliva

Contact an MD as soon as possible as you may need special treatment and investigations.

Difficulty breathing Bloody spit Painful breathing Shortness of breath

*Note that these are general guidelines, and you are advised to err on the side of caution. Do not use these criteria to delay or avoid medical consultation. This guide is not intended to dissuade anyone from consulting a doctor. On the contrary, it is meant to exhort you to seek help earlier than you would have otherwise. Weigh all the information you have collected, and then make your decision.

This Chart is Compliments of Bay Area Best Practices and Victor Kumar-Misir, M.D.

*Download and share my free Flu app at the Android App Store. Search for ’migsclient’ (must be one word), to help you get best care, at home and abroad.