FOCUS TOPICS CARDIOLOGY • RURAL HEALTH • OPHTHALMOLOGY • COVID VACCINATIONS
January/February December 2021 2009 >> $5
Some Healthcare Workers Refusing COVID-19 Vaccinations, Mandating Shots Not Currently the Answer
Uptick in Ablation Procedures Linked to Improved Technology
Cardiac electrophysiologist Monica Lo touts efficiencies at Arkansas Heart Hospital Cardiac electrophysiologist Monica Lo, MD, is highly regarded at the Arkansas Heart Hospital, not only for her expertise Monica Lo as a cardiac electrophysiologist, but for being vibrant, kind and adept at explaining procedures to patients and helping them navigate what can be a difﬁcult and frightening time in their lives. Profile on page 2
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National Vaccine Advisory Committee Chair wants fully-approved vaccine before mandating for healthcare workers By BECKy GILLETTE
It has been well publicized that many healthcare workers, along with the general public, are concerned about the safety of the COVID-19 vaccines and might be listening to bogus conspiracy theories. But a healthcare worker who refuses the vaccine could be a danger to patients and other staff. Should vaccinations be mandatory for healthcare workers? Not yet, said Robert Hopkins, MD, a University of Arkansas for Medical Science (UAMS) professor and division chief of internal medicine and a practicing internal medicine-pediatric physician who is also chair of
the National Vaccine Advisory Committee. Hopkins said failure to get vaccinated does reduce the level of protection for employees and all those they come in contact with. But much as he wants to see all healthcare workers vaccinated, he does not think mandatory vaccination is the right way to go until there is a fully approved vaccine under the usual FDA licensure process. “Current vaccines are being used under an emergency use authorization which does not require as long a follow-up period as full licensure,” Hopkins said. “Once we have licensed vaccines, I would (CONTINUED ON PAGE 5)
Six Years and Going for a Healthier Arkansas St. Vincent’s Chad Aduddell committed to quality care for more Arkansans By MELANIE KILGORE-HILL
Chad Aduddell is on a mission to create a healthier Arkansas. Now in his sixth year as CEO of CHI St. Vincent, Aduddell oversees a growing Central and Southwest Arkansas footprint that includes four acute care facilities and some 70 clinics statewide. (CONTINUED ON PAGE 4)
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Uptick in Ablation Procedures Linked to Improved Technology Cardiac electrophysiologist Monica Lo touts efficiencies at Arkansas Heart Hospital By BECKY GILLETTE
Cardiac electrophysiologist Monica Lo, MD, is highly regarded at the Arkansas Heart Hospital, not only for her expertise as a cardiac electrophysiologist, but for being vibrant, kind and adept at explaining procedures to patients and helping them navigate what can be a difficult and frightening time in their lives. Lo, a native of Taiwan who moved to Texas when she was 12, had never been to Arkansas before finishing her electrophysiology fellowship at the University of Texas (UT) Southwestern Medical Center in Dallas, where she also received her medical degree in internal medicine and did a fellowship in cardiology. She was recruited along with her husband, Daniel Sherbet, MD, an interventional cardiologist, by Arkansas Heart Hospital in 2013. “We had never been to Arkansas, but when we interviewed at the Arkansas Heart Hospital, we thought, what an incredible place to practice medicine,” Lo said. “And we took a chance and moved.” Electrophysiology is highly specialized, so it is often a mystery to many. Lo said the technology and therapeutics have changed and improved drastically. “Now we often have a cure for arrhythmia, rather than life-long mediations,” she said. “Even though many arrhythmias are not life threatening, they definitely affect quality of life. This is important as people live longer.” Catheter ablation procedures that can be used for arrhythmias, atrial fibrillation and other common problems with abnormal electrical signals in the heart are be-
coming more and more common. Lo said patients are savvy: they often have already researched and read about the procedures before they come to an office visit. Lo said because of the efficiency of the Arkansas Heart Hospital, they are able to provide excellent care to a high volume of patients weekly. There has been an uptick in that procedure in the past decade because of the success linked to improved technology. Patients who undergo ablation report being happy to feel better and not need medications long term. One thing Lo likes about her specialty is that she gets to see a wide range of patients. “Many patients with supraventricular tachycardia are younger (late teens, early 20s),” she said. “Atrial fibrillation is related to age, but because of risk factors (hypertension, obesity, alcohol use, genetics), we are seeing younger patients with atrial fibrillation.”
When Lo moved from Taiwan to a small coastal town in Texas, she didn’t know any English and had to translate her school work into Mandarin, learn the material, then translate it back to English to take her tests. “Additionally, I had to learn the culture and figure out the pre-teen/teenage years as a complete outsider,” she said. “It was quite an adjustment. My parents both worked, so my main caretaker was my paternal great-grandmother. My great-grandmother immigrated with us to the U.S. when she was 80 years old, as my mother stayed in Taiwan because of her job.” In high school, she took her greatgrandmother to her doctors’ appointments. Lo saw how the diagnosis of colon cancer was made and treated. She had great admiration for how her great-grandmother’s physician teams interacted with her and saved her life. “I wanted to make a difference in
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people’s lives as they had,” she said. Lo loved every rotation in medical school. When it was time to decide on a residency, people asked, “Are you a doer or are you a thinker?” The thought is, if you’re a doer, you would enter a surgical field. If you’re a thinker, you would enter a primary care field. “I loved both – to have a relationship with the patients, to think about complex issues, but also to do procedures to fix the problems,” Lo said. “Cardiology offers all of the above.” In addition to ablation, Lo also implants devices such as pacemakers, and defibrillators to correct low heart rate and prevent sudden cardiac death. Some studies have shown the heart is damaged in as many as 75 percent of COVID-19 survivors. “Many COVID survivors have dysautonomia, with a heightened adrenaline tone,” Lo said. “Their heart rate can increase quickly with any activity. This takes time to resolve and really needs cardiac conditioning. Like any virus, COVID can cause myocarditis. This can potentially cause sudden cardiac death. So, for very active individuals like student athletes, we usually get an EKG and an echocardiogram to evaluate heart muscle function. If the above is abnormal, we would also consider cardiac MRI.” She recommends primary care providers obtain an EKG from COVID-19 survivors who are having difficulties, and make referrals to a specialist if the EKG is abnormal. Despite having English as a second language, Lo has excelled in academics. She graduated with honors from Rice University in Houston, Texas, and was inducted into the Alpha Omega Alpha Honor Medical Society at UT Southwestern. Lo has been awarded the American Heart Association Women in Cardiology Trainee Award for Excellence. An active member of the American College of Cardiology and the Heart Rhythm Society, Lo has given several presentations at the organization’s national meetings. Lo and her family love to travel and she likes to plan events, so the past year with the COVID-19 restriction have been very different. “My family and I have taken some car trips and enjoyed the lake, hiking, outdoors activities to socially distance,” she said. “My husband and I have a 7-year-old daughter, Olivia, who is an aspiring veterinarian and artist, and keeps our hands full.”
ACC Releases Latest Information on Treating HFrEF Expert Consensus Updates 2017 Clinical Considerations By CINDY SANDERS
Heart failure (HF) continues to rise alongside an aging population. The most recent statistical update from the American Heart Association notes: “An estimated 6.2 million American adults ≥20 years of age had HF between 2013 and 2016, compared with an estimated 5.7 million between 2009 and 2012.” The report added approximately half of hospitalized heart failure events are characterized by reduced ejection refraction (HFrEF). To optimize heart failure treatment, the American College of Cardiology (ACC), along with its partner the American Heart Association (AHA), published an in-depth heart failure clinical practice guideline in 2013 and produced a focused update four years later. However, since that last update, exciting new therapies for HFrEF have emerged. The ACC has just published the latest evidence-based update, including details on new drugs that have a clinically demonstrable impact on hospital readmissions, mortality and disease progression. Thomas M. Maddox, MD, MSc, FACC, chaired the writing committee for 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart Failure: Answers to Pivotal Issues About Heart Failure with Reduced Ejection Fraction. He recently sat down with Medical News to discuss the Thomas M. Maddox importance of ACC guidance and new opportunities to improve patient management.
“The College is the largest professional society for cardiac care teams,” said Maddox, who is an incoming American College of Cardiology Trustee and chair of the Science and Quality Committee. “Part of our mission is to provide actionable knowledge and clinical guidance to those teams to optimize cardiac care.” He continued, “The centerpieces of our clinical guidance efforts are the clinical practice guidelines, and we produce those with the American Heart Association.” Maddox added the clinical practice guidelines are major undertakings with enormous literature reviews that typically come out every four to five years. “But four or five years is a long time … so we issue interim clinical guidance, such as expert consensus decision pathways, to arkansasmedicalnews
bridge the gap between guidelines.” The ACC has made “actionable knowledge” a priority with an emphasis on presenting guidance in a way that is easier to read, share, update and integrate into clinical practice. This clinical guidance is organized into solution sets, which bring together related activities around a specific cardiovascular condition, such as heart failure. Solutions sets include policy updates, decision support and mobile apps. Another key component of these sets are expert consensus decision pathways (ECDPs) like the one just released for HFrEF. “The last five years has seen an explosion of new pharmaceutical targets for heart failure, which is great but dizzying if you’re trying to quarterback a patient’s care,” said Maddox, who is a professor of medicine and executive director of the Healthcare Innovation Lab, a joint effort of BJC HealthCare and Washington University School of Medicine in St. Louis. “One of the things we try to do with these expert consensus decision pathways is make them really practical for the frontline clinician.” The hands-on information and decision flow charts can easily be translated into machine language and imported into an electronic health record. There is also a downloadable TreatHF smartphone app that puts this latest information at a clinician’s fingertips.
New & Noteworthy
Maddox said the new ECDP highlights the use of two newer therapeutics for HFrEF. “We are now recommending people use ARNIs, which are angiotensin receptor-neprilysin inhibitors,” he explained. “It’s a combination medicine of an ARB (angiotensin receptor blocker), which
we’ve had for a long time, and a neprilysin inhibitor.” He said both molecules primarily exert their impact via relaxation of the relative blood pressure and improvement in the efficiency of cardiac function. “We learned that the combination of these two molecules reduced heart failure readmissions and morality by 20 percent compared to the ACE Inhibitors, which was the previous standard of care,” Maddox said of clinical trial results, adding the 20 percent reduction occurred in both outcomes. The second significant recommendation is to incorporate a sodium-glucose cotransporter-2 (SGLT2) inhibitor. “It’s a molecule that blocks the kidney from absorbing both sodium and glucose,” Maddox said. The mechanism behind SGLT2 inhibitors is that patients urinate out glucose and sodium, which is why this particular therapeutic got its start in the diabetic patient population. However, clinicians also observed better heart failure control in patients with both diabetes and heart failure. Since diuretics work much the same way, perhaps seeing some improvement in HFrEF control wasn’t completely surprising. The 2019 DAPA-HF (dapagliflozin) trial focused on the benefits of the SGLT2 inhibitor vs. placebo specifically for heart failure patients. “Only about half the patients (in the trial) had diabetes, but the group that didn’t have diabetes saw the same benefits,” said Maddox. “This drug works on heart failure regardless of your need to control glucose.” The cardiologist added, “In my mind now, this is more a heart failure drug than a diabetes drug.” In May 2020, the FDA approved dapagliflozin specifically for treatment of HFrEF. Barring a contraindication, Maddox
said he couldn’t see a reason not to use a SGLT2 inhibitor in HFrEF patients. “We just have such good evidence on this,” he noted. Maddox added that if he had a new heart failure patient not already on a treatment regimen, in short order he would get them on a beta blocker, ARNI, aldosterone antagonist and a SGLT2. The new ECDP also provides guidance on 10 critical issues from how to initiate, add or switch to new evidence-based therapies for HFrEF and how to address challenges of care coordination to ways to improve medication adherence and how to help patients with cost and access to medications. Maddox said the high price tag on newer therapies remains an initial barrier for many patients. However, he added, “There’s a variety of strategies now to try to knock those costs down.” From apps like GoodRx to financial assistance programs from manufacturers, there are a number of routes for physicians and patients to explore to ensure everyone has access to the best care. Maddox noted this ECDP “does not supersede or take away from the clinical practice guidelines but is a bridge between guideline updates. As part of the College’s mission to transform cardiovascular care and improve heart health, we need to provide the best clinical guidance possible as ongoing evidence evolves.”
A Deeper Dive
To fully explore the 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart Failure, go to the Journal of the American College of Cardiology (jacc.org) and do a search for ‘2021 HFrEF Update’ or go online to our site, ArkansasMedicalNews.com, for a link to the pdf. The TreatHF app is available through both the App Store for Apple and Google Play. There is also a web version available through the American College of Cardiology site. For more information, go to the “Tools and Practice Support” tab on the ACC.org homepage and click on ‘Mobile and Web Apps’ to access this and other interactive tools.
Follow us on @arkmednews JANUARY/FEBRUARY 2021
CMS Finalizes Severe Medicare Cuts to Ophthalmology
Six percent cuts place financial burden on ophthalmology practices, jeopardizing timely access to care. On Dec. 1, the Centers for Medicare & Medicaid Services (CMS) released its final physician fee schedule for 2021. Despite outcry from the American Academy of Ophthalmology and other surgical specialties, CMS’ final 2021 Physician Fee Schedule policy on evaluation and management/office (E/M) visits still results in an overall cut of six percent to ophthalmology. The cut is a result of the significant boost to the E/M code values and the creation of a new add-on code in a budgetneutral environment (i.e., all codes are paying for the increase to office visits). Increases in these E/M payments will not be applied to post-operative visits surgeons provide in the global surgical payment. Giving equity to the E/M in the global surgical payments could have softened the
impact to surgical codes but CMS refused to do so. As a result, these cuts will deal a substantial blow to ophthalmologists. CMS’ unwillingness to provide equity to surgical specialties after an outcry from surgeons and the American Medical Association is an affront to providers. CMS’ decisions in the 2021 Physician Fee Schedule threaten ophthalmologists’ financial viability and our ability to run a successful ophthalmology practice. These cuts are even more devastating during an extremely financially stressful time due to the COVID-19 pandemic. “Our practice has already suffered greatly this year, and this final rule adds salt to the wound. It appears that CMS is tone deaf to the plight of private surgical practices,” said John T. McAllister, M.D, a cataract surgeon who operates the
Northern Virginia Ophthalmology Associates with 14 physicians and surgeons. “Even despite congressional and CMS efforts to help us through the pandemic earlier this year, physicians in my practice have needed to take severe self-imposed salary cuts for most of 2020 in order to have the resources necessary to care for our patients. We all voluntarily took a 50 percent pay cut for almost half of the year and worked at 75 percent for months afterwards. At the same time, each of our physicians have families to feed and care for. Ophthalmology practices are just returning to our pre-pandemic clinical or surgical volumes but may face setbacks with current surges in COVID-19 cases in some parts of the country. If these cuts are allowed to take effect, patient care will
be compromised. The final rule may likely force ophthalmologists to restructure our practices and take fewer Medicare patients, leading to longer wait times and reduced access to care for older Americans. It may also force more ophthalmologists, who already have the highest overhead in medicine, to back out of Medicare participation entirely. “The COVID-19 crisis has placed severe economic strain on my practice and my ability to maintain four employees while caring for our vision impaired geriatric population. The early CMS shut down, followed by a gradual return to clinical visits in an entirely new reconfigured office, has drastically limited my ability to practice,” said Dr. Daniel Briceland, a cataract surgeon who runs a small private group (CONTINUED ON PAGE 6)
Six Years and Going for a Healthier Arkansas, continued from page 1 A natural leader
Originally from Oklahoma City, Aduddell was drawn to leadership at a young age – a quality that resonated in his early years as track captain at the University of Tulsa. “As an undergrad I was drawn to leadership and impacting groups of people, from team sports to fellow students in college organizations,” he remembered. After earning his Bachelor of Science, Aduddell was introduced to healthcare administration while pursuing his MBA from Oklahoma City University’s Meinders School of Business. “While the idea of being a provider wasn’t necessarily a draw to me, I was very intrigued by the healthcare delivery system and the teams that it takes to ultimately provide that care,” he said. “I fell in love with that.” Finding inspiration Aduddell went on to serve as vice president of CHRISTUS Health before accepting the role of president of Bone and Joint Hospital at St. Anthony, SSM Healthcare. In 2012 he joined Catholic Health Initiative as president of St. Vincent Infirmary in Little Rock and was soon appointed to executive vice president and chief operating officer of CHI St. Vincent. The following year he was named market CEO of CHI St. Vincent, where he continues to lead a ministry committed to whole-person healing. “There’s the science of medicine component, but there’s also the spiritual and healing component that goes beyond physical healing,” he explained. “Being part of a team and contributing to the system, making sure it’s supported and cared for to provide physical as well as spiritual care, is something that has inspired me for the past 25 years, and is really why I get up every day.”
A growing footprint
Since 2012, the organization’s footprint has grown to include acute care 4
facilities in Hot Springs, Morrilton, Sherwood and Little Rock, as well as CHI St. Vincent Little Rock Diagnostic Clinic. CHI St. Vincent also has established management partnerships with Conway Regional Health System and in 2019 launched the $17 million CHI St. Vincent Arkansas Neuroscience Institute in Sherwood. Led by Ali Krisht, MD, the center offers world-class neurosurgical care and serves as an education and research center for students, residents and neurosurgeons from around the globe. “We’re very fortunate, because it’s rare that a community and hospital of our size is able to bring together five or six neurosurgeons who can also host conferences, learn from one another and share pioneering techniques and practices,” Aduddell said.
Arkansas Health Network
Shortly after arriving at CHI St. Vincent, Aduddell became instrumental in development of the Arkansas Health Network (AHN) – now the largest and most successful accountable care organization in the state. The clinically integrated network initiative builds on the strengths of participating providers to improve patient health, increase efficiency and enable physicians to succeed in today’s changing health care payment and delivery environments. “Since the beginning of the Affordable Care Act, there had been discussion at all levels about the cost of healthcare spiraling out of control, and a focus on quality and value of care rather than just volumes,” Aduddell said. “It’s taken us a decade and nobody in healthcare would say that we’re where we need to be, but we’ve made great strides.” Today, AHN has ushered in a much-needed shift through its physician-led board and contracts with government payers, local insurers and employers to help improve wellness while decreasing costs. “I’ve seen
it go from a concept eight years ago to over 100,000 Arkansans we’re taking care of in some sort of value-based model,” Aduddell said. “We’re just at the beginning, as organizations are trying to find ways to incentivize the workforce to be healthier and invest the dollars they’re saving.”
Navigating a pandemic
Like most healthcare organizations, CHI St. Vincent was forced to shift efforts in 2020, and is now prioritizing vaccine rollout to protect staff and community members: To date, the system has administered more than 6,000 doses of the COVID-19 vaccine. “While COVID is unprecedented, our story began at St. Vincent because of something similar – the yellow fever epidemic – and the courageous young Sisters of Charity of Nazareth and Sisters of Mercy who responded to the needs of their day,” said Aduddell. “Now, 130 years later, we’re trying to answer that call and follow their example.” Aduddell’s team recognized early on the pandemic would be a marathon and worked proactively to address PPE and staffing needs amid an already critical nationwide nursing shortage. “We’re just now in the middle of this battle,” he said. “Everyone’s tired and ready to go back to normal life, but we really need to remain vigilant. This is the moment – the surge we’ve heard about for many months is really here. We’ve all been preparing to get here, and we’re blessed that we’ve had 10 months to prepare. We can’t let our guard down.” The pandemic also has fueled discussion about nationwide critical care capacity, which Aduddell said is often misunderstood. “People don’t realize that, even in normal times, we don’t have many critical care beds empty,” he explained. “It’s pretty normal for a healthcare system to manage critical care capacity close to 85 percent, so when something like this hits,
it doesn’t take much for us to hit 95 or 100 percent.”
Despite recent challenges, Aduddell said CHI St. Vincent’s mission remains as strong as ever: The system has proceeded with addition the of a cardiac cath lab and continued renovations to hospitals and clinics and is recruiting more providers to expand their robust general surgery program. By late 2021, they’ll also welcome the addition of an addiction recovery program at CHI St. Vincent Infirmary. “Our mission as a Catholic, not-for-profit ministry is first and foremost to care for the poor and vulnerable, and it’s what we do every day and continue to do, regardless of the financial implications that COVID has had,” Aduddell said. “We’re also continuing to improve on our quality journey to deliver the highest quality care possible and making sure we create a supportive environment for coworkers and physicians, to give them resources to provide high quality care.” He also looks forward to finding new ways to deliver affordable, value-based care across communities.
A team approach
Despite his success, the CEO is quick to attribute any accomplishments to his team. “I view my leadership style as a coach,” said the father of four daughters. “I’ve spent a large amount of my adult life participating in coaching and youth athletics, and I take a similar approach to work. I want to surround myself with the best team members possible and make sure everyone understands their role and is given the resources they need; to run the game plan and get out of the way. Our support staff, co-workers, nurses and doctors are delivering incredible, compassionate care every day to the communities we serve, and they get all the credit.” arkansasmedicalnews
Some Healthcare Workers Refusing COVID-19 Vaccinations, continued from page 1 be in support of mandatory vaccination of all healthcare workers.” As of late January, UAMS had administered vaccines to about 13,000 representing about 70 percent of its workforce including UAMS staff at Arkansas Children’s Hospital and across their regional programs. More vaccination drives were underway and UAMS was expecting to reach 90 percent of its workforce very soon. “Most employees I have spoken with have been excited and hopeful that they are taking a step toward better safety for themselves, their families and their patients, and toward an end to the pandemic,” Hopkins said. Some hospitals and other businesses are offering incentives such as gift certificates for their employees to Robert Hopkins get vaccinated. Hopkins said while there may be some increase in uptake with incentives, he sees those as ethically challenging in much the same way that a mandate would be with an authorized, but not approved, vaccine. “I think the best way to increase uptake is to have open – ideally one-onone or small group and best if face-toface, despite the challenge of this in our pandemic – communication with those with concerns by local and trusted members of the healthcare community pro-
viding honest answers to their questions and concerns,” Hopkins said. “I think it is also useful to emphasize the uptake of the vaccine by the hesitant person’s peers and coworkers and to focus on the positive experiences of others who have been vaccinated.” As of late January, about 35 percent of the 1,555 employees at Jefferson Regional Medical Center had received the vaccine. That includes the hospital and all clinics, in and outside of Pine Bluff. “After the first round of vaccines were given, we had more than 200 additional employees who requested it,” said Jefferson Regional Director of Quality Management, Erin Bolton, RN. “We were able to vaccinate all of them by the 22nd of January. We continue trying to educate all our Erin Bolton employees about the importance of the vaccine. At this time, we are moving ahead with community vaccination clinics.” Mitchell Nail, media relations manager, St. Bernards Medical Center, Jonesboro, said they have seen good vaccine acceptance from frontline healthcare workers. “Seeing the devastating impacts of COVID-19 every day, most of our frontline healthcare workers eagerly received
the vaccine,” Nail said. “We administered more than 1,100 first doses before Christmas, and our employees often referred to the vaccine as an ‘early Christmas present.’ Nearly 2,000 of our employees were fully vaccinated by the end of January.” Nearly 8 percent of COVID cases in Arkansas have been healthcare workers. So, some frontline workers delayed getting the shot because of an active or recent COVID infection. “As the prescribed waiting period shrank for a person recovering from COVID to receive the vaccine, more have signed up,” Nail said. “Other team members have cited factors, such as health history as their reasons to wait. Because our sign-up is voluntary, we have encouraged those individuals to contact their doctors and follow their recommendations.” The vaccines have also been offered to support staff including those in maintenance and record keeping. Nail said that like many providers, they have encountered unfounded or anecdotal safety concerns among clinicians and non-clinicians alike. “Universal screenings and masking as well as social distancing and good hygiene requirements protect unvaccinated persons within our premises, but high community spread continues to be our biggest problem,” Nail said. “With limited vaccine doses for the foreseeable future, these prevention tools are important for the community as well.”
Nail said St. Bernards prioritizes steady and consistent vaccine education that connects with patients, however long it takes. “Because the COVID vaccines are new, the general public understandably craves information,” he said. “If local healthcare providers—who often have the trust of their communities—do not consistently provide information about the vaccine’s safety and effectiveness, patients will find information elsewhere, including sources without good data.” In addition, he thinks it is important that the process itself should convey confidence in the vaccine. A poor experience can translate into a poor view of the vaccine, and word-of-mouth travels quickly in the digital age. “At St. Bernards, we have dedicated logistics teams to ensure patients have scheduled appointments and that we have the exact number of doses on hand,” Nail said. “We believe all vaccine recipients should walk away from the experience with confidence in the care they’ve received.”
For more information, go online to: UAMS Covid Research: COVID-19 Research | Research and Innovation (uams.edu)
GET YOUR HEARTBEAT BACK ON TRACK. As the state leaders in electrophysiology, our EP team identifies the source of an abnormal heartbeat – and then finds the solution. From medication or a pacemaker to cardiac ablation or surgery, we can treat arrhythmia and restore heart health.
GrandRounds Arkansas Children’s Promotes Erin Parker to Chief Information Officer LITTLE ROCK – Arkansas Children’s has promoted long-time system leader Erin Parker, MBA, CHC, CHPC, CHRC to the position of senior vice president and chief information officer. Parker, who had served as interim in the role since July, brings to the posiErin Parker tion a deep knowledge of the state’s only pediatric health system, as well as dynamic leadership experience and a track record of driving culture, strategic development and compliance. As she steps into the position fulltime, Parker will be responsible for building partnerships while leading the organization’s focus on systems security, infrastructure and digital initiatives that make healthcare more accessible and seamless for workforce, providers and patients and their caregivers. She will lead a division of more than 200 team members, drawing on her experience designing and implementing compliance initiatives with the system’s electronic health record.
Baptist Health Breast CenterNorth Little Rock Named Breast Imaging Center of Excellence LITTLE ROCK – Baptist Health Breast Center on the campus of Baptist Health Medical Center-North Little Rock has been designated as a Breast Imaging Center of Excellence by the American College of Radiology (ACR). Breast Center of Excellence is a certification given by the ACR for earn-
CMS Finalizes, continued from page 4
practice in Arizona. “Further CMS cuts will severely impact our already strained practice’s economic recovery with the potential risk of practice closures and loss of employees.” The Academy continues to work with partner societies and the American College of Surgeons to press Congress to stop the finalized drastic cuts to ophthalmologists and other surgeons before implementation. For more information on how this fee proposal will affect ophthalmologists and the patients they serve, visit AAO.org The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org. 6
ing a voluntary accreditation in addition to the mandatory accreditation in each modality of mammography. Radiologists at Baptist Health Breast Center are board-certified with a specialty in mammography. We have two registered ultrasound technologists, and two stereotactic technologists. In addition to this, we are able to provide extended testing with the use of our breast MRI. All of these combined make a comprehensive program to provide exceptional care. For more information about the services provided or to request a mammography appointment, visit baptist-health.com or call Baptist Health HealthLine at 1-888-BAPTIST.
UAMS Physician Establishes Second International Guidelines for Treating Castleman Disease LITTLE ROCK — Frits van Rhee, MD, PhD, a myeloma researcher and clinician at the University of Arkansas for Medical Sciences (UAMS), was lead author on a recently published paper that establishes consensus diagnosis and treatment guidelines for a form of Castleman disease, a rare disorder of the lymph nodes and related tissues. The recommendations were created to improve outcomes in patients with a form of the disease called unicentric Castleman disease (UCD) that affects a single lymph node area and can compress vital structures such a blood vessels, nerve bundles or the airways. In others, UCD can give rise to night sweats, fevers, weight loss and anemia Castleman disease is rare so people don’t know how to treat it and until recently there has not been any systematic approach to UCD according to van Rhee, an international expert on Castleman disease. Van Rhee is a professor of medicine, clinical director of the UAMS Myeloma Center and holds the Charles and Clydene Scharlau Chair for Hematologic Malignancies Research. The paper, “International Evidencebased Consensus Diagnostic and Treatment Guidelines for Unicentric Castleman Disease” was recently published in Blood Advances, an online publication of the American Society of Hematology. It included research and input from van Rhee and 41 other specialists, researchers, and clinicians from 10 countries. The expert panel convened in a number of meetings organized by the Castleman Disease Collaborative Network, which van Rhee cofounded in 2012 with his patient David Fajgenbaum, M.D. The panel based the guidelines on published literature, a review of treatment in published cases of UCD, and data from an international registry from the network for patients with Castleman disease. If it cannot be removed surgically and you have symptoms because the mass is pressing on something vital, treatment can be much more difficult. A
classic example is a mass in the chest that is near one of the major airways like the windpipe or the two main branches of the windpipe. Sometimes the only way to remove the mass is to remove one of the lungs and obviously you want to try to avoid that. In those cases, the guidelines recommend partial surgical removal or treatment with other agents, including corticosteroids, antibodies or radiation. Castleman disease occurs when an abnormal overgrowth of cells occurs in the lymph system, which serves as the main part of the body’s immune system. The disease, which affects 5,000 to 6,000 patients across the nation, was identified by Benjamin Castleman, M.D., in 1954. Van Rhee was previously the principal investigator on a worldwide trial with siltuximab, which led to the first FDA-approved treatment for multicentric Castleman disease and led to the approval of the drug by the European Medicine Agency.
ments. Participants must be over 18 and there is no upper limit to participate. This is not a vaccine. Instead the antibodies bind to the COVID-19 spike protein and prevent COVID from replicating and thereby prevent disease. Of the participants, 67 percent will get the antibody in the form of a shot and 33 percent of participants will receive the placebo. AstraZeneca’s long-acting antibody combination will advance into Phase III clinical trials with approximately 5,000 participants in and outside the U.S. These antibodies have been engineered so that they last longer in the body, as long as six to 12 months following a single administration. The trial will evaluate the safety and efficacy of these antibodies to prevent infection for up to 12 months. Long-acting antibodies mimic natural antibodies and have the potential to (continued on page 7)
Radiation Oncologist Richard Crownover, MD, PhD, Joins UAMS LITTLE ROCK - Radiation oncologist Richard Crownover, MD, PhD, has joined the University of Arkansas for Medical Sciences (UAMS). He sees patients in the UAMS Radiation Oncology Center and specializes in the treatment of gynecological Richard cancers, breast cancer Crownover and sarcoma. Board-certified in therapeutic radiology by the American Board of Radiology, Crownover serves as professor in the UAMS College of Medicine Department of Radiation Oncology. Known for his innovative development of a tracking system to deliver radiosurgery to moving targets within the body, Crownover most recently served as professor and Radiation Oncology Residency Program director at the UT Health San Antonio MD Anderson Mays Cancer Center.
Baptist Health Center for Clinical Research to Study Novel COVID Prevention Agent LITTLE ROCK – Baptist Health Center for Clinical Research has been selected as one of the first two sites in the U.S. to study a novel COVID prevention agent, using two monoclonal antibodies instead of a vaccine. This new study could begin in the next few days. Baptist Health Center for Clinical Research’s study coincides with a broader nationwide effort, Operation Warp Speed, which was announced in May as a public-private partnership to facilitate, at an unprecedented pace, the development, manufacturing and distribution of COVID-19 measures including vaccines, diagnostics and treat-
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GrandRounds be given as preventative intervention prior to exposure to the virus. These antibodies are a combination of two long-acting antibodies derived from convalescent patients after COVID-19 infection. If you are interested and would like more information, please visit arkansascovidvaccine.com and fill out the contact form. Filling out the form does not commit you to the study, but you will be contacted to provide more information and to answer additional questions. Study-related care is available to participants at no cost and health insurance is not required nor needed. Participants will be compensated for time and travel if they qualify and enroll in the study. Baptist Health Center for Clinical Research operates as the clinical research arm for Baptist Health. Since 2013, it has participated in over 100 studies in areas like internal medicine, neurology, vaccines, infectious disease, orthopedics, men’s health and women’s health. For more information about the Center for Clinical Research’s current studies and how to participate, visit bhccr.com.
Dr. Steven Graham Joins Washington Regional Neurology Clinic FAYETTEVILLE — Steven D. Graham, MD, recently joined the Washington Regional Neurology Clinic, part of the J.B. Hunt Transport Services Neuroscience Institute, where he provides evaluation, diagnosis and treatment of neurological disorders Steven D. alongside Jay Hinkle, Graham MD, Margaret Tremwel, MD, PhD and Felicia May, APRN. Dr. Graham received his medical degree at the University of Alabama and completed residencies in internal medicine and neurology at Vanderbilt University Medical Center. He has more than 27 years of experience in private practice and specializes in adult neurology and electromyography. Dr. Graham is board certified and a member of the American Academy of Neurology. To make an appointment with Dr. Graham, call 479.404.1250.
Fellowship-Trained Surgical Oncologist Michail Mavros, MD, Joins UAMS LITTLE ROCK — Michail Mavros, MD, a fellowship-trained surgical oncologist who specializes in gastrointestinal cancers, has joined the University of Arkansas for Medical Sciences (UAMS). He sees patients in the Surgical Oncology Clinic at the Winthrop P. Rockefeller Michail Mavros Cancer Institute.
Mavros holds accredited subspecialty training in complex general surgical oncology and in hepato-pancreatobiliary surgery, a complex surgery for treatment of benign and malignant diseases of the liver, pancreas, gallbladder and bile ducts. He also is trained in minimally invasive and robotic-assisted surgery and is an assistant professor in the UAMS College of Medicine Division of Surgical Oncology.
Arkansas Hospice President & CEO Receives 2020 ACHE Regent’s Award LITTLE ROCK – Arkansas Hospice President & CEO Judy Wooten has received the 2020 ACHE Regent’s Award for Senior Level Healthcare Executive. The recognition is given by the American College of Healthcare Executives, an international professional society of more than 48,000 leaders who oversee hospitals, healthcare systems and other healthcare organizations. The award recognizes an Arkansas senior-level healthcare executive who has displayed innovative and creative management skills, contributed to the development of others in the healthcare profession, demonstrated leadership in local and state hospital and health association activities, and participated in community activities and projects. Wooten is a fellow of the American College of Healthcare Executives and is active in its local chapter, the Arkansas Health Executives Forum. She is also a certified hospice administrator. She joined Arkansas Hospice, the state’s largest non-profit provider of hospice services, as Vice President and Chief Operating Officer in 2002, and was named President and Chief Executive Officer in 2011. In addition, Wooten currently serves as President of the Hospice and Palliative Care Association of
Arkansas and was elected to the board of directors for the National Hospice and Palliative Care Organization in 2019. Arkansas Hospice was named a “Best Place to Work” by Arkansas Business in 2020.
Jefferson Regional Welcomes Physician, Opens Rheumatology New Clinic PINE BLUFF - Jefferson Regional in Pine Bluff is pleased to announce that Rheumatologist Maaman Bashir, M.D. has joined the hospital medical staff as well as a new clinic, Jefferson Regional Rheumatology Associates. Dr. Bashir received her medical degree in Maaman Bashir Karachi, Pakistan. She then completed an Internal Medicine Residency at Presence Saint Francis Hospital in Evanston, Illinois and a Rheumatology Fellowship at the Medical College of Wisconsin in Milwaukee. She is Board Certified in Internal Medicine and Rheumatology. Dr. Bashir is now seeing patients. Jefferson Regional Rheumatology Associates is located at 4747 Dusty Lake Drive in Pine Bluff.
CARTI Expands Services, Opens CARTI Urology LITTLE ROCK – CARTI recently announced the opening of its newest specialty clinic, CARTI Urology, and the acquisition of South Arkansas Urology in Pine Bluff. CARTI Urology offers comprehensive urology services for men and women. CARTI Urology’s medical team will include Dr. David C. Jacks, MD, F.A.C.S., a Pine Bluff native who founded David C. Jacks
South Arkansas Urology in 1981. Currently undergoing renovations, CARTI Urology will be located in Pine Bluff at 4303 South Mulberry Street, the former location of South Arkansas Urology. The clinic is set to open in February 2020, but patients will start being seen immediately on the campus of the future CARTI Cancer Center in Pine Bluff, located at 5001 Bobo Road. Dr. Jacks serves as Clinical Assistant Professor of Urology at UAMS in Little Rock, AR and the UAMS-South Central Family Medicine Residency Program in Pine Bluff, AR. He was a member of the Arkansas State Medical Board for 16 years where he previously served as Member Representative, Secretary, Vice Chairman, and presently serves as Expert Reviewer.
NARMC Recognized for Stroke Program HARRISON - North Arkansas Regional Medical Center (NARMC) has been recognized by the UAMS IDHI Stroke Program (formally known as AR Saves). The Stroke Program connects patients who are suffering from a stroke in our rural communities directly to a board certified neurologist within minutes through telemedicine to obtain an evaluation when seconds mean brain cells living according to Lauren Elliott, ER/Trauma Nurse Manager at NARMC. NARMC was one of five hospitals throughout the state recognized at this level. This award was given to sites who meet all of the performance requirements between their hospital and the IDHI Stroke Program. These sites also improved internal processes related to stroke care, were actively engaged in stroke outreach within their communities and maintained the Education requirements related to the care of stroke patients.
Medical Center of South Arkansas Launches Telemedicine Services to Expand Patient Access to High Quality Specialty Care EL DORADO – Medical Center of South Arkansas (MCSA) has announced the implementation of their new telemedicine services allowing patients and hospital-based healthcare providers to connect to physicians specializing in pulmonology, neurology and cardiology. Expanded telemedicine services means that patients will receive rapid high quality specialty care close to home. This new technology allows MCSA’s team to connect with board-certified physicians via secure, high-resolution technology in minutes of a patient arriving to the hospital. On-site nurses and other physicians have access to the highest level of consultation to diagnose and treat patients with neurological disorders including; strokes & epilepsy, respiratory illnesses including; pulmonary diseases and COVID-19, MCSA Hospitalist and Chief of Staff Dr. Ezinne Nwude exhibits one of the hospitals new telemedicine carts that carries a high-precision digital and cardiac conditions including; arrhythmias and congescamera and remotely operated stethoscope tive heart failure. The specialists, who appear on a high definition screen, can look closely at a patient’s eyes to check the reactivity of the pupils and converse directly with the patient and attending physician in order to diagnose and treat patients quickly and effectively. The cart also carries a microphone-backed stethoscope, which allows the telemedicine physician to listen remotely to heartbeat and blood flows. Telemedicine services will provide our hospital with 24/7, 365 days a year specialty coverage -- enabling our hospital to keep more patients closer to home and improving access to care.”
CARING cardiologists & surgeons
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CHI St. Vincent Infirmary #1 hospital in Arkansas for cardiology and cardiovascular surgery.
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