Birmingham Medical News October 2023 by Birmingham Medical News

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Neuro Robots at St. Vincent’s By Jane eHrHardt

Ascension St. Vincent’s Birmingham was the first in the nation to equip their neurological team with three Mazor X Stealth robots. That unmatched record only recently changed when Nashville bought their third last month. Used for spinal fusion surgeries, the robotic guidance system, made by Medtronic, has been in use for two years now at St. Vincent’s. “They do ten to twenty times more surgeries than any other hospital,” says Lauren Hobson, a Medtronic surgical synergy clinical consultant at St. Vincent’s. That efficiency has built the hospital’s neuro team into the largest in the metro area with nine (CONTINUED ON PAGE 4)

Screen display of the Mazor X Stealth robotic guidance system during a spinal surgery utilizing the navigated interbody.

Health Partners Tackles Loneliness in Rural Alabama By anSley Franco

In 2005, John Dorsey, MD, MBA moved from California, where he had been on the faculty at Loma Linda University Medical Center, to Greensboro, Alabama to provide psychiatric care at Hale County Hospital. Two years later, seeing a need in the area, Dorsey established Project Horseshoe Farm, a nonprofit dedicated to helping improve the lives of vulnerable community members, and developing future service leaders. Over the next few years, Dorsey and the small Horseshoe Farms staff were busy. Working with Greensboro Elemen-

tary School, they launched an after-school tutoring program for 4th and 5th graders. They created a one-year educational grant-supported Community Health Fellowship for recent college graduates. Fellows live together in housing provided by Horseshoe Farm, and in 2009 they welcomed their inaugural class of Fellows. That same year, they opened Horseshoe Farm's first Enhanced Independent Living home for women. A few years later, they opened a community center for hosting social, health, and wellness programs and activities for seniors and adults living with mental illness. Senior Fellow Chris Cho visits with a partner.

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Health Partners Tackles Loneliness in Rural Alabama, continued from page 1 Loneliness has a deleterious effect on physical and emotional health. So much so that the U.S. Surgeon General estimated that loneliness and social isolation have roughly the same negative health impact as smoking 15 cigarettes per day. Dorsey wanted to help alleviate this problem for the large number of seniors and others in rural Alabama who are shut-in and isolated. With that in mind, Horseshoe Farm launched the Health Partners Program in 2013. The program pairs each of their Fellows with seven to 10 seniors, adults living with chronic illnesses (including mental illness), or other vulnerable individuals. The two sites – Greensboro and Marion, both in Alabama, host 13 first-year Fellows and three Senior Fellows. “Rural communities are overlooked when it comes to access to healthcare and transportation, and I think it’s very easy to put the blame on the people. It’s pretty amazing what we can all do together. You talk to people, and there becomes this shared uplifting spirit,” said Chris Cho, Senior Fellow. “When you focus on what makes our communities strong, it comes down to the relationship aspect. This program is allowing people to come together. We’re like an avenue for people to reach out to each other.” Senior Fellow, Mackenzie Christensen, says that the people they work with are actively striving to improve their quality of life, but generally do not have a support system to do so. The people who come into the program are labeled as health partners because they are not patients or clients – both partner and Fellow have a mutual bond that comes from the shared experiences during their visits. Fellows foster caring relationships with their health partners by meeting with them for one hour once a week. The type of visit depends on the needs of the individual and can range from going to a doctor’s visit, taking a walk in the park or cooking tacos for a family dinner. “There is a wide range of people who enter the program,” said senior fellow, Mary Sophia Reich. “We do have some youth that we partner with. That relationship is more focused on school and education. And it’s also about building healthy habits like nutrition, making the right choices and behavioral things. Towards the other end of the spectrum, one of my partners was 98 years old. She was more of the social visits.” According to the 2020 Census Study Report conducted by the National Academies of Sciences, Engineering, and Medicine, “Over four decades of research has produced robust evidence that lacking social connection – and in particular, scoring high on measures of social isolation – is associated with a significantly increased risk for early death

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A Fellow and one of her partners.

from all causes.” “Each relationship takes on its own purpose and helps support them in any way they need it,” Christensen said. “It’s really important because many of these partners don’t have consistent people to show up in their lives, and we get to come in and provide that social support. They know that someone is going to show up every week and that reduces a lot of loneliness.” To further combat social isolation, people who are not in the program can visit the community center for the twiceweekly get-together. “A lot of these people are suffering from isolation, and now they’re able to get out and meet new people,” Cho said. The community center is also used for health partner visits to go to a new environment and play games or use workout equipment. When not with their health partners, fellows will spend a few hours once a week working with several community engagement sites. In Greensboro, Christensen is working with the Hale County Hospital to refer patients to the Health Partner Program as a transitory partnership. This would provide extra support for those who may need help getting their prescriptions, setting up future appointments and giving them social resources that they may be lacking. Other fellows work with neighboring organizations such as the emergency management agency, local high schools and gardens. “We get to know a side of the community that I don’t often come in contact with,” Christensen said. Community engagement sites in Marion include work at the local library, city hall and Sewing Seeds of Hope – a local non-profit. Fellows also can work at Spencer’s Farm, a nearby farm where extra produce is taken to the community. “You can see how important it is for the community,” Christensen said. “I learned that if you just show up, people see that you're there to help, and then often they will let you in. And I feel like that's a lesson I'll take with me for the rest of my life.”

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Neuro Robots at St. Vincent’s, continued from page 1 neurosurgeons and seven operating rooms. The efficiency derives from multiple aspects. With the software-enhanced planning using 3D imagery and the realtime visual tracking of the movement of the tools during a procedure, surgery time for a single-level lumbar fusion can be as

short as 90 minutes. In addition, what used to take around twenty scans during a procedure to assess placements, now takes three. Those time savings mean the option to serve more patients. “St. Vincents on average does fifteen to thirty robot posterior fusions a week,” Hobson

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says, adding that at one point, they were performing the most in the world. The machine requires a Medtronic robot consultant to serve as a type of software tech for surgeries. That person performs a 200-step preparation process involving pre-surgery scans, image registration to the actual patient, and finalizing the surgical plan details, such as rod alignments, screw placements, and incisions. “The surgeon will know exactly where the screw is going,” Hobson says. “We’re talking millimeters here.” For surgeons, the transition to robotic surgery can be daunting. “It is a disruptive tech. It changes your workflow,” says Josh Menendez, MD, neurosurgeon with Neurosurgical Associates, which is one of the two practices comprising St. Vincent’s neurosurgical team. “If you’re not willing to go through the growing pains, you’re not going to get the benefit of the tech.” When St. Vincent’s brought in the first generation of the Mazor, it took about two months for the benefits to consistently emerge. The buy-in to learning the system involved everyone from radiography techs to scrub nurses. “Our whole team was committed to fighting through the learning curve,” Menendez says. “However, shifting from the first generation to this second generation was wonderful. That made us quicker instantly. The second generation robot is better engineered and moves much more rapidly. Doing a long segment fusion with the first generation Mazor device could take 90 minutes to put in the screws. With the second generation, it only needs 30 minutes. That’s why we’re able to do more cases than other centers.” This version also has better reach. Since the surgeon must dock the robot at a certain location on the patient’s spine, the robot arm has only limited range for

Josh Menendez, MD

reaching along the spine. Moving that anchor means re-registering the patient, which requires multiple scans and time to realign the imagery in the software to the new position of the patient. “But this second generation has a much longer reach, so the process of registering is one or two fewer times, and that’s a ton of time saved,” Menendez says. The second generation also expanded from the option of only posterior access to lateral as well, which Menendez says is about 20 percent of his surgeries. But the number of spinal fusion procedures is not all that sets St. Vincent’s apart. “St. Vincent’s uses robots on all their fusions,” Hobson says. “That makes them unique. That volume pushes the hospital to first on the list for software updates, including the major upgrades every few years that cover new options that required FDA approvals. So even if Mazor looks the same as it did when it came out, it’s constantly upgrading.” Menendez, who performs about seven to nine fusions a week, says what he looks forward to next in robotic spinal surgeries, is single-position surgery. “When you have multiple parts of a surgery with a patient in different positions, changing position is very inefficient,” he says. It’s being done now, but it needs notable improvement. Figuring out how to more efficiently and safely allow for those needed shifts in position while using a robot would decrease the time under anesthesia and the resulting complications, including heart attacks, infections, and blood clot development. That’s the next real promise of robotics.”

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Bariatric Surgery Provides Successful Options for Weight Loss By Marti Webb Slay

According to the CDC, Alabama has 36 counties with obesity prevalence of over 40 percent. Nationwide, obesity affects 110.1 million adults and 14.7 million children, costing approximately $147 billion a year for health care. Justin Hughes, MD with Eastern Surgical Associates offers robotic bariatric surgery for patients seeking solutions to obesity. “We will eclipse the 50 percent mark for obesity in the U.S. by 2030,” Hughes said. “It’s a big deal, especially when you think of healthcare costs and how much of a burden obesity is on the healthcare system. For instance, there are 13 different cancers associated with obesity.” Joint problems, sleep apnea, and mental health disorders are also often associated with obesity. New medications are helping some patients lose weight, but Hughes says surgery can have better outcomes for many. “So far, none of those have the same weight loss, and they don’t have the same control over metabolic associated diseases such as diabetes, hypertension, heart disease, and strokes.”

Ultimately, Hughes sees more overall weight loss for his patients following bariatric surgery as opposed to using medications. “We talk in terms of excess body weight loss rather than overall body weight loss,” he said. “We typically see 50 to 90 percent excess body weight loss with surgery.” Patients with serious heart disease or lung problems are not good candidates for bariatric surgery, and candidates should be under the age of 75. “Older indications are BMI greater than 40 or greater than 35 with any obesity-associated metabolic problem, such as diabetes, hypertension, hyperlipidemia, fatty liver disease, or obstructive sleep apnea,” Hughes said. “There are newer guidelines now that have dropped those by 5 BMI, especially with uncontrolled diabetes. With Asian patients, they are even considering bariatric surgery for BMI greater than 27.5 because the effects of comorbidities are even higher in that population. “Usually primary care physicians will refer patients to us for a surgical consultation. We’ll meet with patients to discuss their options. It’s important to tailor the decision of which surgery to pursue, based on the individual patient.

Justin Hughes, MD.

“One type of surgery is restrictive surgery which limits the size of the stomach, such as a lap band or a sleeve gastrectomy. The sleeve takes away the ability of the stomach to hold food and makes it a tube between the esophagus and small intestine. It’s a quick, easy surgery with good recovery.” Another type of surgery, Roux-en-Y is restrictive and metabolic altering, bypassing parts of the small bowel that control and regulate certain hormones. “You are getting rid of 90 to 95 percent of the

stomach and pull up a piece of the small intestine and connect it sort of downstream,” Hughes said. “You will usually see higher weight loss and better control of diabetes, hypertension and high cholesterol. Those can start to resolve even before people start losing weight. “Another surgery we can use is a combination of the sleeve and Roux-enY, a duodenal switch, and it’s become more popular in recent years. Initially these were done with two anastomoses, (CONTINUED ON PAGE 12)

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ACL Repair Without Grafts

UAB Sports & Exercise Medicine Performs Alabama’s First Bridge-Enhanced Procedure By Laura Freeman

Whether you want to get in shape, stay in shape, or just have fun, most people enjoy playing sports a lot more than counting sit-ups. The problem comes when fast, twisting motions and sudden slips pull or turn joints in ways they aren’t built to go. One of the injuries that can occur is an ACL tear. Anterior cruciate ligaments are strong bands of tissue that connect the femur to the tibia at the knee. When damaged, repair is necessary to restore function. “In the past, there were only two options: graft other tissue taken from the patient, or graft donor tissue. Either choice came with a risk,” said Amit Momaya, MD, an orthopedic surgeon in the Department of Orthopedic Surgery at UAB. “When a graft is taken from the patient, it can permanently affect stability, strength and balance. If the graft comes from a donor, there is the possibility of rejection and side effects from measures to prevent it. “The Bridge-Enhanced ACL Restoration, also known as BEAR, uses an

Amit Momaya, MD.

implant that will dissolve when no longer needed to hold the tissue edges in place and protect blood flow in the gap while the body uses its own blood to heal itself. A natural clot forms, and within eight weeks, the implant dissolves and is replaced with cells, collagen and blood vessels. The tissue continues to remodel and strengthen over the next few months.”

The FDA has approved use of the sponge-like implant that provides a scaffolding for the torn edges of the ACL to heal together. The implant was pioneered by Martha Murry, MD, founder of Miach Orthopaedics , at the Boston Children’s Hospital department of orthopaedic surgery. Research was funded by the NFL Players Association, Boston Children’s Hospital and the National Institutes of Health. UAB Sports Medicine and Exercise participated in the multicenter randomized controlled trial for the BEAR procedure with Momaya as medical monitor for the past several years. “This procedure gives patients the option for their original ACL to heal itself, which may help maintain strength in the knee and balance which can be lost when other knee tissue is harvested for a graft and the original ACL is completely removed,” said Momaya, who also serves as Chief of Sports Medicine at UAB. “Maintaining strength and balance are important for professional athletes who are concerned about their careers and for young athletes on high school and college teams who have their lives ahead of them.

“Many of the ACL tears we see happen while playing team sports like football, basketball, soccer, and baseball, but it can also occur in weekend warriors out playing tennis or climbing, or in ordinary work activities involving knees such as jumping from a fire truck or van, as well as in traffic accidents.” However the injury occurred, the Sports and Exercise Medicine clinic at UAB can evaluate the injury and follow up with the care most likely to deliver the optimum outcome. The time between the tear and full healing for ACL damage can take a while, but the BEAR procedure seems to improve the odds for getting nearer the “back to 100 percent” goal patients hope to reach. Ideally, the procedure should be performed soon after the injury while edges of the tears can be easily repositioned together. To learn more or schedule a BEAR evaluation for your patient, call (205 930Bone) or visit UABMedicine.org.

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Building a Bridge for Patients Beyond Hospital Walls By Ansley Franco

For many patients, there is a disparity between their physical well-being when discharged from a hospital and their financial well-being. Baptist Health Foundation aims to close the gap and extend quality care beyond hospital walls. Baptist Health System’s affiliated hospitals provide charity care for indigent patients in need of medical assistance. Alison Scott, Executive Director of the Baptist Health Foundation, says the foundation provides a bridge for these patients when they are discharged. “We make sure that we’re continuing to provide these patients with that extra support and help they need as they recover,” Scott said. “Care doesn’t stop at the end of their hospital stay.” The hospital absorbs all the costs for indigent patients, and social workers, doctors and nurses collaborate to determine what else these patients need when they are discharged. For patients who are transitioning to a homeless shelter, an addiction recovery program or some another step towards recovery, the foundation covers medication costs, transportation to these facilities and intake fees.

Baptist Health Foundation helps patients and employees when in need.

While there are social services in Birmingham that assist indigent patients with medications or transportation, it takes around 30 days to get into their system. “We (Baptist Health Foundation) often operate at that bridge between the time they leave the hospital until they

get into their support system so that they don’t back slide when they’re trying to get better,” Scott said. “The Foundation follows a healing ministry of Christ, and strives to do for others as Christ has loved them. Building on this principle, we also offers pastoral care. This is not something

that is required by law in a medical facility, but it is something the founders felt strongly about.” In all five Baptist Health hospitals, there is always a chaplain, along with chapels to pray in and daily prayers are offered. “Baptist Health hospitals do a lot of work with our chaplains to make sure that not only our patients and families are supported when they want that kind of care, but we also make sure that it's available for our staff,” Scott said. “We’ve seen an uptick in staff seeking spiritual since COVID. “We always knew pastoral care was important, but Covid is probably what made it vital, because there was a point in time when no one else at the hospital could come in, and people inside the hospital couldn't go out. The only kind of bridge between those two were our chaplains. Basically, they became a lifeline to the outside world.” To provide additional support to their staff, Baptist Health Foundation has established the Employee Benevolence Fund, which is sustained through donations from both employees and outside individuals who wish to contribute to what is an emergency fund for the hospital staff. (CONTINUED ON PAGE 12)

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HHS OCR/ONC Announce an Updated Version of Its HIPAA Security Risk Assessment Tool By Jim Hoover

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The Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office for Civil Rights (OCR) have recently launched a joint HIPAA Security Risk Assessment (SRA) Tool. The tool is designed to assist small and medium-sized health care practices and business associates in complying with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Particularly, the SRA Tool helps entities identify and assess risks and vulnerabilities to their electronic protected health information (ePHI) and can be downloaded at no cost. It is designed to help smaller organizations identify risk and make a plan for remediation and compliance. All e-PHI created, received, maintained or transmitted by an organization is subject to the HIPAA Security Rule. The Security Rule requires entities to evaluate risks and vulnerabilities in their environments and to implement reasonable and appropriate security measures to protect against reasonably anticipated threats or hazards to the security and integrity of e-PHI. The SRA Tool is a desktop application that walks users through the security risk assessment process using a simple, wizard-based approach. Users are guided through multiple-choice questions, threat and vulnerability assessments, and asset and vendor management. References and additional guidance are given along the way and reports are available to save and print after the assessment is completed. Version 3.4 contains several key updates based on user feedback, including a remediation report, which allows users to track responses to vulnerabilities inside the tool and log remediation efforts. In addition, the tool now contains a glossary and tool tips section, where users can learn more information and easily navigate the tool’s features. Other improvements include bug fixes, usability improvements, and references to the 2023 edition of the Health Industry Cybersecurity Practices (HICP) publication. The Security Rule requires that covered entities and its business associates conduct a risk assessment of their organization. A risk assessment helps an organization ensure that it is compliant with HIPAA’s administrative, physical, and technical safeguards. Although use of the tool does not mean an organization is compliant with the HIPAA Security Rule or other federal, state or local laws and

Jim Hoover

regulations, it does, however, assist organizations with the HIPAA Security Rule requirement to conduct periodic security risk assessments. In addition to an express requirement to conduct a risk analysis, the Security Rule indicates that a risk analysis is a necessary tool in reaching substantial compliance with many other standards and implementation specifications. For example, the Security Rule contains several implementation specifications that are labeled “addressable” rather than “required.” An addressable implementation does not mean the specification is optional; rather, if an organization determines that the implementation specification is not reasonable and appropriate, the organization must document why it is not reasonable and appropriate and adopt an equivalent measure if it is reasonable and appropriate. The outcome of the risk analysis process is a critical factor in assessing whether an implementation specification or an equivalent measure is reasonable and appropriate. Accordingly, organizations should use the information gleaned from their risk analysis to design appropriate personnel screening processes, identify what data to backup and how to back it up, decide whether and how to use encryption, address what data must be authenticated in particular situations to protect data integrity and determine the appropriate manner of protecting health information transmissions. There are numerous methods of performing a risk analysis and there is no single method or “best practice” that guarantees compliance with the Security Rule. The scope of a risk analysis that the Security Rule encompasses includes the potential risks and vulnerabilities to the confidentiality, availability and integrity of all e-PHI the organization creates, receives, maintains, or transmits. This (CONTINUED ON PAGE 12)

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“When one of our employees has a crisis: maybe a death in the family, a house fire, an eviction, or they fall behind on their bills, the Employee Benevolence Fund is there to provide a helping hand,” Scott said. “Once again, it's kind of like our patient assistance fund. It’s there to be a bridge for them. To get them back on their feet.” Baptist Health Foundation not only supports behavioral health units within their hospitals but also aids other organizations within the central Alabama area by providing an annual grant. Last year, they distributed 32 grants to mental health organizations and healthcare-related nonprofits to ensure those ancillary services remain accessible. “Mental health needs do not stop,” Scott said. “If you are in a mental health crisis, and you're admitted to the hospital,

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but more recently they are done with one anastomosis where you just pull a loop up and hook it without cutting it downstream. It seems to work just as well from a weight loss perspective.” Hughes recommends that patients contact their insurance provider early in the process. “For most insurance plans, we have to show six months of medical weight loss program, or that patients have tried diet and exercise and been addressing the issue before jumping to surgery,” he said. “It’s important for patients to talk to their insurance early to understand the hoops they have to jump through. “Next the patient does a psychological evaluation, with a third party. One of the hardest things to change is human behavior, so we have to make sure it’s the right time to pursue this.” A nutritional evaluation is also required. “It’s important to get the patient’s diet moving in that direction,” he said. “It’s hard to move from one type of diet to another post-surgery. You are not able to eat as much and will have to eat smaller meals several times a day. It’s also impor-

tant to quit smoking before the surgery.” Hughes stressed that post operative follow-up is important, with appointments two weeks after surgery, every three months for the first year, and then annually. While there are always risks to any surgery, the percentages of major problems with bariatric surgery are in the single digits. Hughes prefers to do bariatric surgery using robotics rather than doing them laparoscopically. “It’s more precise, and you have better control of the instruments,” he said. “You have better vision, because it has two cameras that give you 3-D vision. Robotics has a shorter recovery than laparoscopic as well.” “I’d love to see more physicians discussing weight loss with their obese patients. It’s a topic that’s difficult to bring up, but it’s important because of the effect on people’s health and mortality. I think doctors are worried about offending patients, but there’s a considerate way to let people know that you’re worried about them. It’s a doctor’s office, not a place of judgment.”

Building a Bridge, continued from page 9

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Bariatric Surgery, continued from page 6

the providers will get you to a certain point and get you well enough to be discharged. But often your needs are going to go on for months, years, and possibly your lifetime afterwards. It's going to take all of our community’s joint efforts to wrap our hands around the mental health crisis.” This year, the foundation has had 46 applications and have allotted $350,000 among the chosen recipients. Decisions are made by a small committee of volunteers who determine the best way to address as many needs as possible. Through all their programs, the Baptist Health Foundation has provided $2.1 to $2.2 million annually, both in the hospital and in Alabama communities. To learn more about the Baptist Health Foundation, which has been operating since 1967, visit https://baptisthealthfoundation.com.

HHS OCR/ONC Announce an Updated Version, continued from page 12 includes e-PHI in all forms of electronic media, such as hard drives, floppy disks, CDs, DVDs, smart cards or other storage devices, personal digital assistants, transmission media, or portable electronic media. Electronic media includes a single workstation as well as complex networks connected between multiple locations. Thus, an organization’s risk analysis should take into account all of its e-PHI, regardless of the particular electronic medium in which it is created, received, maintained or transmitted or the source

or location of its e-PHI. A risk analysis is the first step in an organization’s Security Rule compliance efforts. Risk analysis is an ongoing process that should provide the organization with a detailed understanding of the risks to the confidentiality, integrity, and availability of e-PHI. The latest SRA Tool can help an organization with this first step. Jim Hoover is a health care trial and compliance Partner at Burr & Forman LLP practicing exclusively in the firm’s health care group. Jim may be reached by telephone at (205) 458-5111 or by E-mail at jhoover@burr.com.

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Joy Dupree

By laura FreeMan

When your patient gets results saying her mammogram was negative, does she worry about having cancer? When her husband gets news that his chest x-ray was positive, does he take it as good news suggesting he can keep smoking a while? Healthcare, like most professions, has a language of its own and the differences between its vocabulary and that of everyday conversation can make it difficult for patients to understand their diagnosis and follow instructions. “One popular movie line that is probably the best advice for helping patients understand is ‘Tell it to me like I’m a fifth grader.’ That’s the level most Americans understand. Then get them to tell back to you what they are hearing, and ask them if they have any question,” Joy P Dupree, PhD, MSN, RN, said. Founder and Chair of the Alabama Health Literacy Initiative which is working to advance health literacy policy and advocacy, Dupree is Director of UAB’s Health Policy Partnerships and Office of Clinical and Global Partnerships, as well as a professor in the Department of Acute, Chronic and Continuing Care. October is Health Literacy Month, an effort to improve healthcare policy and advocacy. A highlight of the month was a webinar Monday, October 2, on Health Literacy in Government. It was recorded for later viewing online. When available, a link will be posted on the Integrated Healthcare Association website. “The vocabulary of healthcare may be the primary issue, but there are plenty of other considerations that can get between you and a clear understanding of the meaning you are trying to communicate,” Dupree said. “English is a second language for more patients these days, and important nuances can be lost in the translation. Likewise, declining vision, hearing and cognition may cause communication difficulties. Poor reading skills, dyslexia and other learning disabili-

ties, limited education and low cognitive function can interfere with understanding and make following instructions on medicine bottles difficult.” Verbal instructions may not be much clearer when distraction from unfamiliar words, awe of doctors, feelings of inferiority or embarrassment from examination gowns, touches and conversation about intimate body functions are involved. There are some patients who want to please their doctors and not disappoint them, so getting an accurate report on how they are doing on their new medicine might be difficult. How often do you greet patients by asking them how they’d doing and their response is fine. Just as they are about to leave, you finally hear that they are having “a few dizzy spells” from their new blood pressure medicine. When it’s necessary to explain something in medical terms, follow it with the plain language definition, such as: “I can see right here that you have a concussion and a bruise they call a hematoma. We need to keep an eye on it while it’s healing up. You have to take it easy. Rest and no hard work. You have to rest your brain, too. No hard studying for tests or anything until I say so? Deal? Okay. If you treat your head right and call me if you have any trouble, you should be healed up in a month or two.” When the discussion is going to be serious, it may be good to ask patients to bring a second pair of ears to listen and take notes. A tape recorder or pad and pencil can be useful if you are comfortable with it. If you have written materials or an online video you can recommend, it could be helpful. Remember, even a physician may not recognize every term a physician in another field says. Things are changing too fast for anyone to keep up with everything. If you go to a provider and need to ask a question, ask it. Good communication leads to good outcomes.

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OCTOBER 2023 • 13

CMS Proposes Minimum Staffing Standards for LongTerm Care Facilities Alabama DDS Needs Part-time Medical Consultants The Alabama Disability Determination Service (DDS) invites letters of interest from physicians wanting to work part-time as a medical consultant. The work involves reviewing disability claims in the Birmingham or Mobile offices. An Alabama medical license is required. The DDS is committed to maintaining a diverse workforce; and therefore, the DDS encourages minority applications.

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Birmingham Medical News

Abbey Mansfield Ruby

Taylor P. Monnig

By Abbey Mansfield Ruby and Taylor P. Monnig

hardship exemption from the minimum hours per resident day requirements. To receive the exemption, a facility must meet specific criteria, including location, good faith efforts to hire and demonstrated financial commitment, among other requirements. The exemption is for one year, unless the location becomes a Special Focus Facility or is cited for widespread insufficient staffing with resultant resident harm. Under the current proposal, an exemption may be extended on a yearly basis. According to federal labor statistics, nursing homes lost more than 200,000 workers from February 2020 to December 2022, and industry observers view skilled nursing facilities as the only sector of the healthcare industry that has not yet recovered from staffing losses associated with the COVID-19 public health emergency. A recent study conducted by the American Health Care Association estimated that a federal staffing mandate based on a 4.1-hour standard (the level recommended in a 2001 CMS study) would cost $11.3 billion to $11.7 billion annually and require more than 187,000 new workers to service the industry. The CMS proposal does not include any direct funding to facilities or increased reimbursement rates to cover recruiting, training or payroll costs.

The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on September 1, 2023, that, if finalized, would impose minimum staffing standards for long-term care facilities participating in Medicare or Medicaid. Under the proposed rule, long-term care facilities would be required to provide a minimum of three hours of direct care per patient day, including a minimum of 0.55 hours of care by a registered nurse and 2.45 hours of care by a nurse aide. Implementation of these individual minimum nurse staffing standards would be required within three years for nonrural facilities and five years for rural facilities. Facilities would also be required to staff a registered nurse on site 24 hours a day, seven days a week – an increase from the existing staffing regulations that require a registered nurse to be on site eight consecutive hours each day. Implementation of the registered nurse staffing standard would be required within two years for nonrural facilities and three years for rural facilities. Impact on Long-Term Care Providers The proposed rule was introduced as part of the Biden-Harris Administration's Nursing Home Reform initiative and is the first of its kind. CMS estimates that approximately 75 percent of long-term care facilities will be required to add staffing to comply with the proposed standards. If finalized, facilities that fail to comply with the mandates would be subject to enforcement actions, with remedies that could include termination of Medicare or Medicaid provider agreements, denial of Medicare or Medicaid payments, and civil monetary penalties. In response to feedback from providers and others, the proposal includes a

Public Comment Period CMS has solicited public comment for the 60-day period following publication of the proposed rule generally and, in particular, on various specific provisions, including consideration of a more demanding 3.48 hours standard. Comments may be submitted electronically or by mail. CMS will consider all comments received during the comment period and issue a final rule thereafter. Abbey Mansfield Ruby is a partner and Taylor P. Monnig is an associate in Holland & Knight's Nashville, Tennessee, office.

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OCTOBER 2023 • 15

UAB Offers New Spinal Cord Stimulator Therapy for Chronic Pain One of the First in U.S. By Marti Webb Slay

Patients with chronic pain now have a new treatment option with a spinal cord stimulator that is designed to offer longterm relief. The University of Alabama at Birmingham Pain Treatment Clinic at UAB Hospital-Highlands is one of the first clinics in the U.S. and the first in Alabama to offer the procedure. The stimulator, which is implanted during outpatient surgery, sends electrical impulses into the spinal cord. The device responds to the spinal cord in real time and can adjust the electrical output 50 to 100 times per second based on what is happening in the spinal cord. Christopher Paul, MD, a physician in the clinic and assistant professor in the UAB Department of Anesthesiology and Perioperative Medicine, explained what is involved. “The way most stimulators on the market work is that the device is programmed by a representative,” he said. “The patient can turn up the intensity, but it’s within a general program. As a patient’s situation changes over time,

Christopher Paul, MD

they could be underdosed or overdosed with electrical stimulation, leading to the patient’s spending more time outside of their therapeutic window. This device reads the action potentials at spinal cord level and reacts to that, so it is modulating the output of electricity in therapeutic ranges. It’s really kind of revolutionary. “It is fascinating to look at what is going on at the spinal cord level in clinic and adjust therapy to what is happening physiologically in the patient’s body.

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We’ve never been able to do that before. It’s potentially like a cardiologist seeing an EKG for the first time. We are getting direct feedback from the spinal cord.” Indications include patients with postlaminectomy syndrome, persistent spinal pain syndrome, or lumbar radiculopathy. Generally, the leads will be implanted in the mid-thoracic spine in the epidural space, which is where the fibers are passing through that are being stimulated. To qualify for the procedure, patients must have had persistent pain for at least six months without relief from more conventional treatment such as injections and physical therapy. Most payers require a neuropsychological evaluation as well. “We make sure they have reasonable expectations and no untreated depression or anxiety,” Paul said. “They have to have a qualifying diagnosis. Stimulators are not all things to all people. We really try to have patients that are likely to succeed with this. “Once the patient has qualified, they enter into a trial. We place the leads through needles and then remove the

needles, leaving the leads in place. The patients have these leads for seven to 10 days. It’s like a test drive. They go home and work with us, the device, and the device representative. And at the end, we take off the bandages and remove the leads. There are no incisions. If they get at least a 50 percent reduction in pain, the vast majority of payors will let them go on and get the permanent implant. That usually occurs three to four weeks after the lead pulls.” The implant requires outpatient surgery under general anesthesia. Two small skin incisions are required during the one-hour procedure. “Most patients recover quite well from it, and go home two to three hours after surgery,” Paul said. He sees an expanding future for this new technology. “It’s starting to take off,” he said. “A lot of this technology is going to get rolled out to other devices long-term. This company happens to be the first to bring this to market. It may be a little while before others catch up, but I do see the long-term outcomes that (CONTINUED ON PAGE 17)

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Birmingham Medical News

Cyberbullying Can Be Devastating By Becky Gillette

Cyberbullying, can be devastating to young people because there is a large audience, and it can be persistent. The child or teenager might even know who is bullying them. Even worse, it could be multiple people. And the experience can be constant because youth can be online at any time, said Sarah E. Domoff, PhD, an associate psychology professor at Central Michigan University. Bullying correlates with suicidal ideation. And it can be something people don’t want to talk about. “In interviewing clinicians who work with teens who have experienced online victimization, we learned that there's a great fear in disclosing harmful online interactions because youth worry that their access to social media could be limited or removed,” Domoff said. “This can be upsetting because removing online access would mean a loss of social connection and support for some youth.” Youth seeking mental health treatment and older teen girls experience cyberbullying more often. Domoff said many of adolescents' social experiences occur online so it is critical to help youth develop coping skills related to online interactions and help them shape their online experiences to yield more positive connections. “It’s important to help teens learn how to engage with social media in healthy ways and have resources available for when online victimization occurs,” Domoff said. “There are some great resources online, such as https://www. stopbullying.gov/cyberbullying/whatis-it and https://www.missingkids.org/ theissues/sextortion.

UAB Offers New Spinal Cord Stimulator, continued from page 16

have been published exceeding what is currently on the market. I feel like this is going to catch on pretty quickly.” Paul has treated four patients with this procedure so far, but several more are in the process to receive the device, and he expects that he and his colleagues will be performing the procedure more, and sooner rather than later. “We try to get the right device for the right patient with the right diagnosis,” Paul said. “There may be reasons why patients would get something besides this; maybe a different brand or a different technology. But largely this is going to make a big difference for a lot of patients.”

Natashia Bottoms, MD

Sarah E. Domoff, PhD

“There are also lessons available for teachers to implement to help prevent cyberbullying and get support. Our team has developed an intervention to help teens after they have experienced harmful online interactions that includes a component for parents. https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC9483492/ “It's important for parents to have regular, supportive conversations with their children about their online experiences.” A helpful resource from the American Psychological Association provides more detail: https://www.apa.org/ topics/social-media-internet/socialmedia-parent-tips It is estimated that cyberbullying impacts 16 percent of U.S. youth. There are other negative online social interactions, as well. When you extend the definition to include any type of online harassment,

the prevalence jumps to about half of U.S. teens. “It is possible for cyberbullying to happen anywhere,” Domoff said. “For example, some harassment can happen in gaming chat rooms. “Cyberbullying is found most commonly on Instagram for adolescents, followed by Facebook and Snapchat, said Natashia Bottoms, MD, assistant professor of the Department of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences. “TikTok is an emerging problem area. I think one of the things that makes cyberbullying more difficult than with in-person bullying is at least with in-person bullying, there are safe places you can go like your home. Cyberbullying is on your phone and your phone is everywhere. We’ve seen a lot of issues with focus in school, grades dropping, sleep issues, anxiety and depression.”

When people can say things anonymously online without others intervening, it is just the victim and the bully. In addition to negative comments, it is common for bullies to post pictures or memes that are hurtful or disclose personal information meant to embarrass others. “Parents can do a lot to facilitate awareness,” Bottoms said. “You can offer comfort and support. Let them talk to you and intervene if you notice things getting to an unsafe place. It is important to let your kids know it is not their fault. You are in it together and will work on it together. But also, be careful of how you respond to children bullies on social media. You can get wrapped up in the same situation. Keep screenshots of messages or texts you find or that the child brings to you. Encourage children not to respond to cyberbullying because it just makes it worse. “There is a point when some parents have to monitor social media use and reduce time allowed on their phone. Or turn off certain apps if one in particular is causing problems. “A lot of the time in those apps, direct messages are from people anonymously sending nasty responses. In high school and middle school, all you need is the hint of something to get embarrassed. It’s a hard world for teens right now. Most devices have a way to block certain people and messages. It’s important to block those people so they can’t have access to the person being bullied.”

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OCTOBER 2023 • 17

Revolutionizing Healthcare: Embracing Innovation for a Better Future Empowering Patients through Technology Introduction One of the most sigIn this age of rapid technificant ways innovation nological advancements, it is has impacted healthcare is crucial for healthcare profesthrough the empowerment sionals to explore innovative of patients. Technological ideas that have the potential advancements have given to transform the way we aprise to tele-health, wearable proach healthcare. With that devices, and health apps, Courtney N. Haun in mind, let's dive into the enabling individuals to take realm of healthcare innovacharge of their health like tion and the positive impact it can have never before. From monitoring vital signs on our lives. to scheduling virtual consultations with healthcare professionals, these tools proThe Importance vide convenience, personalized care, and of Embracing Innovation increased accessibility to medical services. Innovation is a driving force behind progress in any field, and healthcare is Artificial Intelligence no exception. By embracing innovative in Healthcare ideas and technologies, we have the opArtificial Intelligence (AI) has portunity to improve patient outcomes, emerged as a game-changer in the healthenhance efficiency, and make healthcare care industry. AI algorithms can analyze more accessible to all. While traditional vast amounts of medical data, helping methods have served us well for centuphysicians make accurate diagnoses and ries, the time has come to further explore develop tailored treatment plans. Adinnovative tools and embrace change. ditionally, AI-powered robots can assist in surgeries, reducing the risk of human By Courtney N. Haun, PhD

error and improving surgical outcomes. The integration of AI in healthcare is revolutionizing the way medical professionals deliver care, resulting in better patient experiences and improved health outcomes. Blockchain Technology and Data Security Data security is a paramount concern in healthcare, and blockchain technology offers a potential solution. Blockchain ensures the integrity and confidentiality of patient data by providing a decentralized and transparent platform for storing medical records. This technology enables secure sharing of information among healthcare providers while maintaining patient privacy. By leveraging blockchain, we can build trust, streamline operations, and safeguard sensitive healthcare data. Virtual Reality for Pain Management and Rehabilitation Virtual Reality (VR) technology has found its place in healthcare, particularly in pain management and rehabilitation. VR applications can distract patients from physical discomfort, providing re-

lief during medical procedures or chronic pain episodes. Moreover, VR is increasingly utilized in physical therapy sessions to enhance rehabilitation exercises. By immersing patients in simulated environments, VR promotes engagement, motivation, and faster recovery. Challenges and Ethical Considerations While healthcare innovation presents remarkable opportunities, it's crucial to address the challenges and ethical considerations that accompany these advancements. Patient privacy, data security, and regulatory compliance must be prioritized to ensure the responsible implementation of new technologies. Additionally, healthcare professionals must adapt to changing practices, embracing lifelong learning to remain competent in this rapidly evolving landscape. Conclusion Innovation is the driving force propelling the healthcare industry into the future. Embracing technological advancements empowers patients, improves healthcare outcomes, and enhances the (CONTINUED ON PAGE 21)

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All of Us Research Program will Lead to Personalized Healthcare By Jennifer Davis Burns, MS

ter mobile apps to encourage healthy habits, and better medicine, and information The All of Us Research on medicine specific to an Program is introducing the individual. next breakthrough in mediPatients often turn to cine. You! physicians for questions about We’re all different, but their health, and in some when we visit the doctor, our cases, the decision on whether treatments are often the same. or not to participate in mediWhat if your health care was cal research. Unfortunately, Jennifer Davis Burns, M.S tailored to you? This is called some patients are distrustful precision medicine, and research can help of medical research due to our nation’s us get there. Precision medicine is healthhistory of unethical research. Studies like care that is based on each person as an the Tuskegee study or the Contraceptive individual. It is made up of three factors: Trials in Puerto Rico, have sown seeds of environment, lifestyle, and biology. distrust for decades in minority groups in The goal is to help build one of the the US, many of whom are now underworld’s largest and most diverse datasets represented in biomedical research. This of its kind by enrolling over one million is understandable, and is why physician individuals over the course of 10 years. participation in this program as a trusted People who join will share information voice is invaluable. about their health, habits, and what it’s “As an All of Us participant and phylike where they live. It might also be sician, I recommend this program to my about family history and genes. This will patients and teach medical students about help researchers understand more about it as well. I see it as a unique opportunity why people get sick or stay healthy. With to make patients aware of the program this type of knowledge, research may and actionable genes tested, which have help develop: better diagnostic tests, betthe potential to impact their quality of life.

Not only does it benefit patients i n d i v i d u a l l y, the program also benefits the community and science as a whole by looking for environmental trends directly impacting health within certain areas. By signing up, an individual contributes to building one of the most diverse databases to date. I feel comfortable sharing this program with patients because the data is deidentified and the program utilizes strict security protocols.” - John V. Irle, MD When a community is left out of medical research, they may miss out on the benefits of earlier prevention, more accurate treatments, and possibly even cures. This is about improving the future of care for all of us. To date, over 690,000 people have registered with the program by creating an online account. Participants not only receive compensation for their time but also have the option to receive free DNA results, including ancestry, genetic traits, information about

potential medical conditions or diseases, and genes that could have an adverse drug reaction. Taking part is free and is open to anyone in the United States over the age of 18 (age 19 in Alabama). UAB Huntsville Regional Medical Campus is a local partner with the All of Us Research Program. Office hours are Monday through Friday, 8am -5pm at 301 Governors Drive, Huntsville, AL 35801. If you would like more information, call (256) 551-4420. If you are interested in participating, go to JoinAllofUs.org/UABHuntsville • Create an account • Give your consent • Agree to share your electronic health records • Complete the consent to get DNA results • Answer health surveys • Have your measurements taken (height, weight, blood pressure, etc.) and give a blood and urine sample. • After completing these steps, you’ll receive $25.

Birmingham Medical News

OCTOBER 2023 • 19

Top 10 Real Estate Questions Asked by Physicians By Peter C. Jameson, CCIM

As medical real estate consultants, we meet with physicians weekly to discuss their real estate needs. Naturally, we hear many of the same questions from doctors and practice managers on a regular basis. This Q & A article covers many of the main topics we review with our clients. 1.What are the differences in the main types of leases (Triple Net vs. Modified Gross vs. Full Service)? Triple Net is most common in retail settings and stand-alone buildings. This lease passes through

all building operating expenses to the tenant. This typically includes property taxes, insurance costs and common area maintenance (CAM.) Full Service leases are most common in Peter C. Jameson larger multi-tenant buildings or oncampus environments. A Full Service rate includes most operating expenses so the rental amount per square foot

will be higher but it is intended to be all inclusive. Modified Gross is a hybrid of Triple Net and Full Service where certain expenses can be included in the rental rate and others may not be included. The tenant’s expenses in this lease form can vary and it’s important to understand what your obligations are under whichever type of lease you sign. 2.What is CAM? Common Area Maintenance is a portion of a building’s operating expenses. This can account for services such as common area janitorial / cleaning, parking lot & sidewalk repair and maintenance,

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5.When buying a building, can I get a loan for my equity? There are ways to do this, but we believe equity for ownership projects should always be cash. Do not over leverage yourself just because a bank or other institution is offering it. 6.How can I get upgrades to my space? The best times to improve your suite is when signing a lease renewal document. Tenant Improvement money is offered by most landlords when renewing or signing a new lease. Often, a certain amount of TI is included in your rental rate and if that is not enough, most landlords will offer more and include the amortized cost as additional rent.

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3.Why am I getting charged a large lump sum at the end of the year when I’ve been paying CAM and operating expenses the whole year? This invoice is an annual reconciliation statement. CAM and other operating expenses are charged based on an estimate at the beginning of the year and each tenant pays their pro rata share of the building’s expenses. Typically, the landlord’s estimate is not a perfect one and the tenant is billed to make up the difference. Sometimes landlords can overestimate annual operating expenses and tenants can receive a credit instead of a bill. 4.Should I build my own building? Most doctors tend to think owning their own building should be their ultimate real estate goal, however, this is not always the case. We believe that finding the best real estate, owned or leased, should be the goal for the practice. Leasing in a great building and location will likely be more advantageous for your practice than owning a property of lesser quality in an inferior location. It is important to weigh all your real estate options and analyze them apples to apples. Real estate should never be an anchor to your practice’s success.

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7.Why does my rental rate keep going up? Landlords can give you many reasons for annual escalations such as: Inflation / cost of living increases, real estate tax increases, bank / investor requirements or simply operating expenses constantly rising. The good news is you can negotiate with your landlord and if your rate is out of market at the end of your term, then it is possible to have it lowered as opposed to a continuing escalation.

10 Real Estate Questions, continued from page 20

8.Can I get out of my lease early? There is no easy way to do this. The most beneficial method for all parties is to find someone to sublease your space (if your lease allows). Other options typically involve the tenant going into default which likely leads to a legal battle. Do not be afraid to ask your landlord for help if you are in trouble. Most of them are willing to work with you and try to help. Remember, the last thing a landlord wants is an empty building. 9.Why am I being asked to sign a personal guaranty? It is not uncommon for physicians to be asked to sign a personal guaranty on their leases, especially if you are a solo practitioner or part of a newer practice. This is an item that can sometimes surprise you at the end of deal negotiations so it’s important to be aware of this and try to avoid it when possible. Landlords know that many medical practices have limited assets and that the credit of their tenant is only as good as the physician owners. The larger the practice is and the more revenue it produces, the more comfortable a landlord will get with accepting just the practice guaranty. 10. Should I sign a long-term lease? There are circumstances when signing a 10-year lease makes sense, but there is not always a need to commit your practice to such a lengthy term. There needs to be significant benefits from the Landlord in order to justify a 10-year deal. These benefits commonly include lowering the rental rate or providing you with ample tenant improvement allowance so you don’t have to come out of pocket on your build out.

GRAND ROUNDS

Grandview Medical Group Adds to Its Physician Network Grandview Medical Group has added three physicians to its network. Johnny Gibbs, MD has joined Lemak Health, an affiliate of Grandview Health. Gibbs received his medical degree from the University of South Florida. He completed his residency at the University of North Texas and The John Peter Smith Hospital in Fort Worth, TX. He returned to the University of South Florida for a fellowship in Orthopedic Sports Medicine. Alexia Novara, MD has joined Women’s Health Specialists of Birmingham, an affiliate of Grandview Health. She earned her medical degree from the UAB School of Medicine, and completed her residency in obstetrics and

Johnny Gibbs, MD

Alexia Novara, MD

gynecology at Ochsner Clinic Foundation in New Orleans. Tatiana Sanchez, MD has joined Grandview Primary Care in Helena. Sanchez received her medical degree

Tatiana Sanchez, MD

from the American University of the Caribbean, and completed her family medicine residency at the University of Alabama.

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Earn $50,000 a year! The Alabama Rural Medical Service Award (ARMSA) incentivizes primary care physicians and NPs to practice in rural, medically-underserved areas in Alabama. Eligible PCPs receive $50,000 a year and NPs receive $30,000 a year for up to 3 years as a service loan payable by years of service. PCP and NP must not have practiced in the rural area within 3 years of October 1, 2023.

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Peter C. Jameson is a real estate consultant with Veritas Medical Real Estate Advisors.

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ProxsysRx to Operate Pharmacy at Florida Hospital

Hardware Park Held the MedTech Device Experience

Birmingham’s ProxsysRx has contracted with Tallahassee Memorial HealthCare (TMH) to own-and-operate a retail pharmacy, George Salem and build-and-operate a specialty pharmacy on the hospital’s property. TMH is a 772-bed, not-for-profit healthcare system serving 21 counties in North Florida and South Georgia. Benefits ProxsysRx will bring to the hospital include:

Covering two city blocks in downtown Birmingham, Hardware Park serves as a hub for physical product development, providing resources including tools, equipment, and workshops for tenants. In July, the facility held the MedTech Device Experience, which was a master class for medical device prototyping. The program was an effort to plant a flag for Birmingham in the national medical device creation landscape. With Birmingham's recognized strength in medical care, the city's burgeoning tech scene, and Hardware Park’s ability to design and engineer state-of-the-art medical devices, the city is uniquely positioned to become a destination for medical device manufacturing. Eight talented high schoolers from a mix of Birmingham metro schools participated in the two-week program. The students attended intensive morning and afternoon sessions, gaining hands-

• Expanded local access and purchasing options for high-cost, life-saving medications. • Implementation and operation of bedside prescription delivery service for patients. • Free ship-to-home refills and oncampus prescription delivery. • A Prescription Savings Card for lower costs on many prescriptions. • Expansion of the hospital’s 340B prescription-savings program.

ProxsysRx has begun construction of both the Retail and Specialty Pharmacies, which will open later this year, and will provide medications to patients at their bedside as they discharge. “Specialty Pharmacies handle the most expensive drugs, for the sickest patients,” said George Salem, the founder and CEO of ProxsysRx. “It’s commonly done from remote pharmacies, often located states away from hospital campuses. With its own Specialty Pharmacy, TMH patients can have their care serviced by local Pharmacists.”

Randy Johansen Assumes CEO Role at American Family Care American Family Care (AFC) has ap-

pointed Randy Johansen to be the new Chief Executive Officer. This transition follows the passing of AFC's founder and CEO, Bruce Irwin, MD. "It is with mixed emotions that I assume this new role. While I feel profound sadness for the circumstances that led to this transition following the passing of Dr. Irwin, I am deeply honored to Randy Johansen step into the position," Johansen said. Johansen joined American Family Care in June 1992 as the Chief Operating Officer and assumed the position of president in 2005. He has more than 40 years of experience in the healthcare field, primarily in finance, business administration,

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A student demonstrates the wristband inhaler prototype.

on experience in medical device design and prototyping. By the end of the course, each student team had created a medical device prototype. The high schoolers came up with some great ideas. For example, after a lady spoke to the class about her son, who was on an IV that made their home feel like a hospital, one of the boys created an IV stand that looks like a tree. One group designed a wristband asthma inhaler that can be used by runners and anyone who is engaged in sports or physical activity. Lloyd Cooper, the owner of Push Product Design, and Mark Conner, Executive Direc-

and operations. AFC currently operates in 28 states with more than 300 locations. The organization is poised for further growth, with more than 100 clinics to open in the near future.

UAB Study Links Poverty to ALL Cancer Relapse A study from the UAB Marnix E. Heersink School of Medicine suggests that the economic status could be associated with excessive relapse in children diagnosed with acute lymphoblastic leukemia. “Acute lymphoblastic leukemia, or ALL, is a type of blood cancer in which uncontrolled production of cancer cells occurs

tor at Hardware Park and former Director of Engineering at Hoover High School, spearheaded the experience. As a design leader, Cooper has been involved in crafting a number of medical devices, including working with Dr. Robert Foster to develop the Rampart, a radiation shielding device. Conner crafted a fouryear engineering curriculum for The Engineering Academy at Hoover High. Uphill Design has created a documentary of the MedTech Design Experience, which will premiere at Hardware Park November 7th.

in the bone marrow,” said Aman Wadhwa, MD, assistant professor in the UAB Division of Pediatric Hematology-Oncology. “This prevents formation of normal blood cells. Dr. Aman Wadhwa Treatment of ALL requires several years of chemotherapy, but cure rates exceed 90 percent.” The study monitored over 600 participants who were diagnosed with ALL. Participants enrolled in this study were an average of six years old and were followed for eight years after the completion of their treatment. For the study, families with incomes under 120 percent of the federal threshold were considered to be living in extreme poverty. Overall, 12.3 percent of the study participants met this criteria. Researchers found that patients living in households with extreme poverty were 14.3 percent more likely to have a relapse of ALL three years after diagnosis, compared to 7.6 percent for patients who were not in extreme poverty. “Looking forward hops that pediatric oncologists caring for children with ALL screen for poverty and use available resources, such as gas cards and food vouchers, to help families struggling with these basic needs,” Wadhwa said.

Latshaw Joins ENT Associates Michael Latshaw, MD has joined ENT Associates of Alabama. Originally from St. Louis, Latshaw studied Religion and History at Oklahoma Baptist University, graduating in 2004, be- Michael Latshaw, MD fore attending the University of Oklahoma College of Medicine. He then completed

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Brookwood Baptist Food Drive In September, Brookwood Baptist Medical Center completed a Food Drive in partnership with Community Food Bank of Central Alabama. The drive collected 791 pounds of food, the equivalent to 691 meals, as well as $1,909.33 in donations, equivalent to 7,637 meals for a grand total of 8,296 meals, which far surpassed the original goal of 2,000 meals.

his residency training at the University of Oklahoma Health Sciences Center in the Department of Otolaryngology—Head & Neck Surgery in 2017. He is Board Certified by the American Board of Otolaryngology Head and Neck Surgery. His clinical interests include sinus and allergy disorders, sleep disorders, laryngology, pediatric ENT, and hearing disorders. ENT Associates has opened two new clinics, one in Bessemer where Latshaw is practicing, and another in Pell City.

New Physician at Eastern Surgical Associates Justin Hughes, MD has joined Eastern Surgical Associates. After earning his undergraduate degree in Biology at the University of Alabama, Hughes received his medical de- Justin Hughes, MD gree from the University of South Alabama College of Medicine in Mobile. He went on to complete his general surgery residency at East Tennessee State University where he served as administrative chief resident. He has a special interest in minimally invasive and robotic surgery.

Andrews Sports Medicine Opens Second Hoover Location The 4,098 square-foot clinic is located within the Lake Crest Center at 2321 John Hawkins Parkway, and is easily accessible from I-459 and Hwy. 150. The new clinic Daniel Kim, MD is staffed by Drs. Matthew Beidleman and Daniel Kim. Beidleman is a fellowship-trained, non-surgical sports medicine & orthopaedic physician. He treats all types of orthopaedic issues, includ- Matthew Beidleman, MD ing sports-related and non-sports related injuries and osteoarthritis in joints. Kim is a fellowship-trained, orthopaedic surgeon who specializes in the spine. He was the first spine surgeon in Birmingham to offer endoscopic spine surgery.

Grandview Team Performs First EDGE Procedure

pital’s first endoscopic ultrasound (EUS) directed transgastric ERCP, known as the EDGE procedure. This procedure allows access to the bile ducts and pancreas in patients with Roux-en-Y Dr. Mohannad Dugum Gastric Bypass (RYGB). Currently, only a few medical centers in the country perform this procedure. Patients with RYGB are at an increased risk for developing bile duct stones. They can also be diagnosed with pancreatic cysts, bile duct cancer, or pancreatic cancer. “These conditions require a variety of complex endoscopic procedures such as EUS and ERCP,” said Mohannad Dugum, MD, Director of Advanced Endoscopy at Grandview. “However, management of pancreatic and biliary diseases in patients with RYGB has been historically challenging due to the altered anatomy prohibiting direct endoscopic access to the pancreas and bile ducts. Traditional options include the utilization of long endoscopes or surgical assistance through laparoscopic-assisted ERCP. The former option has relatively low technical success rates, while the latter introduces additional risks related to surgery.”

Grandview Medical Center’s Endoscopy team recently performed the hos-

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