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FOCUS TOPICS NEUROLOGY • COVID-19 • REIMBURSEMENT • PAIN MANAGEMENT

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UAMS Neurosurgeon J.D. Day, Internationally Known Leader, Developing Improved Complex Cranial Surgery Techniques Neurosurgeon’s techniques providing better outcomes, less chance of injury J.D. Day, MD, chair of the Department of Neurosurgery, University of Arkansas for Medical Sciences (UAMS), was born into a medical family J.D. Day with a father who was an OB\ GYN before becoming a pathologist, and a mother who was a dietician. Profile on page 3

Memphis Physician Discusses Treatment of Covid-Induced Chronic Pain By now, we are all too familiar with the fatal devastation COVID-19 has wrought on this country, with hundreds of thousands dead. Article on page 7

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Expanding Evidence-Based Care for Dementia

Alzheimer’s Association Creates Training, Certification Program By CINDY SANDERS

The Alzheimer’s Association recently launched a new training program with certification exam to advance the deployment of evidence-based dementia care. Targeted to care professionals in both long-term and community-based settings, Person-Centered Dementia Care Training Program with essentiALZ Exam®, is based on the nationally recognized Dementia Care Practice Recommendations, which were updated in 2018.

Scope of Alzheimer’s

“Today in the United States, there are more than six million age 65 and older living with Alzheimer’s dementia,” said Monica Moreno, senior director of Care and Support for the Alzheimer’s Associa(CONTINUED ON PAGE 4)

HealthcareLeader

CEO of Baptist Crittenden Tackles the Challenge of I-40 Bridge Shutdown New Hospital Meets the Needs of County Residents after CRH Closure By BECKY GILLETTE

WEST MEMPHIS - Humility and empathy are two of the most important characteristics any hospital administrator needs, said Brian Welton, the CEO of Baptist Memorial

Hospital-Crittenden. “We are in the business of taking care of people,” Welton said. “We have to set examples for the team. Healthcare is very complex. There is so much information out there in

(CONTINUED ON PAGE 6)

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Patients with Severe COVID-19 Twice as Likely to Require Future Hospitalizations for Other Illnesses By JILL PEASE

ate COVID-19. The rest tested negative for COVID-19. The People who have recovered researchers continued to track all from a bout of severe COVIDhospitalizations for these patients 19 may still have reason for conover six months, as well as hoscern about their health. A new pitalizations for cardiovascular, University of Florida study has respiratory or blood clotting isfound that patients who had a sues — complications that can be severe case of the disease were caused by COVID-19’s effects more than twice as likely than on organ systems. After adjusting patients who had mild or moderfor factors including age, race, ate COVID-19 to need hospitalgender, insurance status and seization again for health problems lect existing medical conditions, caused by COVID-19 complicapatients who had recovered from tions. severe COVID-19 had more “People who recover from than twice the risk of being hosCOVID-19 hospitalization are pitalized again for an issue such significantly more likely to be as heart attack, stroke, pneumohospitalized later for something nia or pulmonary embolism than else that is likely a complication patients who had not contracted of COVID-19. In other words, COVID-19 or who had a mild or your risk of having other bad moderate case. outcomes beyond COVID-19 “Data are, unsurprisingly, is increased even after you reshowing that people who aren’t cover,” said Arch G. Mainous vaccinated are more likely to get Becky Hunter, R.N., tends to one of her patients with COVID-19 on ICU Unit 82 at University of Florida Health in Gainesville. III, Ph.D., the study’s led invessick,” Mainous said. “Unfortu(Photo by Louis Brems) tigator and a professor in the nately, our data show that even department of health services research, ing, Mainous said. The UF study, which “The primary implications are that if people are willing to take their chances management and policy at the UF College appears in the Journal of the American people who are at risk for severe COVIDwith COVID-19 because they are not of Public Health and Health Professions, Board of Family Medicine, is among the 19 episodes are the ones most at risk for concerned about the disease, they are now part of UF Health. first to explore serious outcomes among future complications and so we really need more likely to have a complication like a More than 2 million Americans have people who have recovered from the disto get them vaccinated,” said Mainous, heart attack or stroke because of this. Vacbeen hospitalized for COVID-19 since ease. also vice chair for research in the UF Colcination is critical.” Aug. 1, 2020, according to the Centers for The team’s findings reinforce the lege of Medicine’s department of commuIn addition to Mainous, the research Disease Control and Prevention. need for every eligible person to receive nity health and family medicine. team included Benjamin J. Rooks, M.S., While a growing number of studies a COVID-19 vaccination, particularly For the study, the UF team analyzed a clinical research coordinator, and Frank have explored long-term health complicapeople at higher risk of developing severe data from electronic health records of A. Orlando, M.D., an assistant profestions among people who have recovered COVID-19, the researchers said. That in10,646 patients treated at one health syssor and assistant medical director, both from COVID-19, most have focused on cludes older adults and those with obesity, tem. Among the group, 114 had severe in the department of community health more mild symptoms such as altered sense diabetes or other chronic medical condiCOVID-19 requiring hospitalization and family medicine at the UF College of of smell or taste or difficulty concentrattions. and 211 patients had mild or moderMedicine.

UAMS Releases Findings from Statewide COVID-19 Antibody Study LITTLE ROCK — A statewide COVID-19 antibody study led by UAMS found that by the end of 2020, 7.4 percent of Arkansans had antibodies to the virus, but there were wide disparities among racial and ethnic groups. UAMS researchers released their findings this week to a public database, medRxiv (med archive). The study included analysis of more than 7,500 blood samples from children and adults across the state. It was conducted in three waves from July to December 2020. The work was supported by $3.3 million in federal coronavirus aid that was then allocated by the Arkansas Coronavirus Aid, Relief and Economic Security Act Steering Committee created by Gov. Asa Hutchinson. Unlike diagnostic tests, COVID-19 antibody testing looks back into the immune system’s history. A positive antibody test means the person was exposed to the virus and developed antibodies against SARS-CoV-2, the virus that causes the disease known as COVID-19. An important finding of the study is the significant differences in COVID-19 antibody rates detected within specific racial and ethnic groups according to Laura James, M.D., the study’s principal investigator and director of the UAMS Translational Research Institute. Hispanic populations were almost 19 times more likely to have SARS-CoV-2 antibodies than whites, and Blacks were five times more likely to have antibodies as whites during the course of the study. These findings highlight the need to understand factors that impact SARS-CoV-2 infection in underrepresented minority populations, she added. The UAMS team collected blood samples from children and adults. The first wave (July/August 2020), revealed low rates for SARS-CoV-2 antibodies, averaging 2.6 percent in adults. However, by November/December, 7.4 percent of adult samples were positive. Blood samples were collected from individuals seen at medical clinics for non-COVID reasons and who were not known to have had COVID-19 infection. The antibody positivity rates reflected cases of COVID-19 in the general population. While the overall positivity rate in late December was relatively low, the findings are important because they indicate previously unrecognized COVID-19 infections, said UAMS’ Josh Kennedy, M.D., a pediatric allergist and immunologist who helped lead the study. The team found little difference in antibody rates between rural and urban residents, which surprised researchers who thought rural residents might be less exposed. The antibody test was developed by UAMS’ Karl Boehme, Ph.D., Craig Forrest, Ph.D., and Kennedy. Boehme and Forrest are associate professors in the College of Medicine Department of Microbiology and Immunology.

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PhysicianSpotlight

UAMS Neurosurgeon J.D. Day, Internationally Known Leader, Developing Improved Complex Cranial Surgery Techniques Neurosurgeon’s techniques providing better outcomes, less chance of injury By BECKY GILLETTE

J.D. Day, MD, chair of the Department of Neurosurgery, University of Arkansas for Medical Sciences (UAMS), was born into a medical family with a father who was an OB\ GYN before becoming a pathologist, and a mother who was a dietician. Early on, Day knew he wanted to become a physician, but when he told his mother that he had decided to specialize in neurosurgery, she cried. In the 1960s and 70’s, neurosurgery was a tough field. The chance patients were going to be significantly neurologically impaired or would die was high. His mother was afraid his career would be stressful and sad. Little could Day’s mother have envisioned the tremendous explosion in technology for neurosurgery since the 1980s, nor that her son would become an internationally known leader developing improved neurosurgery techniques, a specialist in microsurgery and tumors and vascular disorders of the brain and skull base. Day has since written four textbooks on skull base surgery, and published more than 80 articles in medical journals on neurosurgical topics. He has been on the editorial boards of Neurosurgery and Acta Neurochirurgica, and

taught skull base surgery techniques and lectured extensively in the U.S., Europe, Africa and Asia. “We’re able to do things now that when I started in medical school in the 1980s, you would really not even think about doing because the chances of success were so low, especially with brain tumors,” Day said. “We are able to do a much better job with less chance of causing major neurological injury to patients. A lot of that has to do with the development of complex surgical techniques.” Previously neurosurgeons would open up the skull, move the brain out of the way and attack the tumor. That typically didn’t work out so well for patients.

“We learned how to remove bone at the base of the skull, get around vessels and nerves traversing the base of the skull, how to expose the tumor, and then get to the base of the tumor in order to cut off the blood supply and safely remove it. Also, these techniques are utilized for access to vascular lesions and have made a tremendous difference in reducing neurological morbidity.” The tools for microsurgery are far superior to those available 30-40 years ago. Tumors can be broken up with ultrasonic waves and removed with ultrasonic aspirators with far better tissue differentiation than in the past. For deep-seated tumors, there are ways to get to them with much

less injury to the brain. “We use a computerized image guidance system to pre-plan a trajectory working through parts of the brain to get to a deep-seated tumor, and then pass a port the diameter of a nickel that spreads out the white matter instead of cutting it,” Day said. “We view the deep area with the tumor with an exoscope, which gives a highresolution digital image on a large screen that can also be viewed in 3-D. This is many times an improved view in comparison to our standard operating microscope.” This miniaturized computer guidance and imaging technology has only developed in the past eight or nine years. Day said it wasn’t until around 2012 that technology caught up with people’s ideas in this area of accessing deep brain tumors through a small tubular port. “There have been huge changes in imaging, surgery options, and neuroanesthesia techniques,” he said. “Combined, we can treat a lot of things neurosurgeons would have previously considered inoperable. They could do surgery, but with more risk.” Day’s family is from this part of the country, but when he was a teenager, his family lived in Boise, Idaho, where Day played junior high and high school (CONTINUED ON PAGE 8)

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Expanding Evidence-Based Care for Dementia, continued from page 1 tion. “So many of the general population believe developing Alzheimer’s is a normal part of aging, but we know that’s not the case.” While age is the greatest risk factor, Monica Moreno most seniors do not develop Alzheimer’s while approximately 200,000 Americans under age 65 do. Gender and ethnicity also play a role in developing the progressive disease (see Facts & Figures box). Moreno added it’s important for people know and understand the warning signs and to eliminate other health concerns. “You want to make sure your symptoms are getting addressed appropriately,” she said. Moreno pointed to urinary tract infections and thyroid disease as two potential issues that could cause symptoms that mimic some dementia behaviors.

Person-Centered Care

“Alzheimer’s disease affects every person differently. That’s what makes it really challenging for caregivers,” noted Moreno. She added the new program is designed to educate caregivers on evidencebased best practices around assessment, detection and care planning including

medical management, dementia-related behaviors, activities of daily living, supportive environments, transition and coordination of services and other recommendations. “All of that information can prepare and empower caregivers to be better prepared for the future,” pointed out Moreno. “They’re actually being proactive instead of reactive.” While many individuals with Alzheimer’s still live in the community, care needs do increase as the disease progresses. “Statistically, about 48 percent of nursing home residents have some form of dementia, and about 42 percent residing in assisted living have Alzheimer’s or another form of dementia,” said Moreno. It’s particularly important in longterm care settings where those providing care aren’t intimately familiar with someone’s history to make an effort to learn about the person as an individual. “The practice recommendations are grounded in person-centered care,” Moreno stated. “The diagnosis is only part of who they are … it’s not who they are.” Personal preferences and life experiences should shape approaches. Moreno cited an example of a resident who unlaced her shoes and tied the closet door shut each day. If caregivers touched her closet, she became extremely agitated. As it turns out, the woman had been forced to flee with the clothes on her back earlier

in life. That experience impacted how she felt about her possessions. “She didn’t want them to even take clothes to the laundry, but it would not be serving her to allow her to wear soiled clothes,” Moreno recalled. “So, they devised a strategy to get her clothes while she was in an activity and get the clean clothes back before she even knew they were gone.” A simple accommodation, it made a big difference in the woman’s quality of life.

Creating the Program

“The training is reflective of the practice recommendations. While these recommendations were peer reviewed and evidence based, which was critically important, it wouldn’t move the needle if they just sat on a shelf,” Moreno said of the impetus to disseminate the information. “There’s really a larger footprint we’re trying to create.” The goal, she continued, was to access professionals across the full array of care settings – nursing homes, assisted living, home care, home health, adult daycare and hospice. At the end of 2020, the Alzheimer’s Association debuted the new online training, which has six modules and is self-paced. Once completed, the essentiALZ Exam® tests the individual’s knowledge (CONTINUED ON PAGE 4)

FDA Approves Controversial Alzheimer’s Drug On June 7, the Food & Drug Administration approved Aduhelm (aducanumab) to treat Alzheimer’s patients, making it the first new drug approval for a disease impacting more than six million Americans in almost 20 years. While the Alzheimer’s Association strongly supported FDA approval, citing a 22 percent reduction in cognitive and functional decline in clinical trials, the drug by Biogen Inc. was approved without the recommendation of the Peripheral and Central Nervous System Drugs Advisory Committee. By mid-June, three members of the advisory panel had resigned in response to the controversial approval. In an article outlining the FDA’s process, Patrizia Cavazzoni, MD, director of the FDA Center for Drug Evaluation and Research, noted Aduhelm’s late-stage development program consisted of two phase 3 clinical trials where one study met the primary endpoint in showing reduction in clinical decline but the second trial did not meet that endpoint. 4

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“At the end of the day, we followed our usual course of action when making regulatory decisions in situations where the data are not straightforward,” Cavazzoni wrote. “We ultimately decided to use the Accelerated Approval pathway — a pathway intended to provide earlier access to potentially valuable therapies for patients with serious diseases where there is an unmet need, and where there is an expectation of clinical benefit despite some residual uncertainty regarding that benefit. In determining that the application met the requirements for Accelerated Approval, the Agency concluded that the benefits of Aduhelm for patients with Alzheimer’s disease outweighed the risks of the therapy.”

In response to the uproar, the Alzheimer’s Association reaffirmed their support, noting their research experts and advisors are deeply familiar with the science that led to the approval and agreed with the decision. The organization also called on the confirmatory trial that was part of the approval process to begin promptly. The statement further reads: “Our focus has and will continue to be access to this treatment for all likely to benefit. Approval is the fundamental first step to access. The first drug in a category invigorates the field, increases investments in new treatments and encourages greater innovation. “Following approval, the manufacturer, Biogen, announced their intention to price Aduhelm at $56,000 per year. This price is simply unacceptable. For many, this price will pose an insurmountable barrier to access, it complicates and jeopardizes sustainable access to this treatment, and may further deepen issues of health equity. We call on Biogen to change this price.”

The Latest Facts & Figures Alzheimer’s Disease Facts and Figures, an annual report released by the Alzheimer›s Association, reveals the burden of Alzheimer›s and dementia on individuals, caregivers, government and the nation›s healthcare system. The 2021 publication reports: Prevalence: An estimated 6.2 million Americans age 65 and older (11.3 percent, or 1:9) are living with Alzheimer’s today. That number is projected to hit 12.7 million by 2050. Risk: Women and people of color are disproportionately affected. Almost two-thirds of Americans with Alzheimer’s are women. Older Black Americans are about twice as likely and older Hispanic Americans about 1.5 times as likely to have Alzheimer’s or other dementias as older White Americans. Disparities: Despite increased risk for Alzheimer’s and other dementias, Black and Hispanic Americans are less likely to be diagnosed than White Americans. Half or more dementia caregivers – 63 percent of Native Americans, 61 percent of Black Americans, 56 percent of Hispanic Americans and 47 percent of Asian Americans – said they have faced discrimination while trying to navigate healthcare settings for their care recipient. People of color want healthcare providers who understand their unique experiences and backgrounds by fewer than 3 in 5 believe they have access to culturally competent providers. Mortality: One in three seniors dies with Alzheimer’s or another dementia. Between 2000 and 2019, deaths from heart disease decreased 7.3 percent. Deaths from Alzheimer’s have increased 145 percent. On top of that, just during the COVID-19 pandemic, Alzheimer’s and dementia deaths have increased 16 percent in the U.S. Cost: In 2021, Alzheimer’s and other dementias are projected to cost the nation $355 billion, including a combined $239 billion in Medicare and Medicaid payments. Without a treatment to slow, stop or prevent the disease, the figure is projected to rise to more than $1.1 trillion by 2050. Caregivers: More than 11 million Americans provide unpaid care for people with Alzheimer’s and other dementias. In fact, 83 percent of the help provided to older adults in the U.S. comes from family members, friends or other unpaid caregivers with nearly half of that group providing help to someone to someone living with Alzheimer’s or another dementia. Last year, those caregivers provided an estimated 15.3 billion hours of uncompensated care valued at nearly $257 billion.

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And in Other Alzheimer’s News … AFA Unveils Full-Scale Apartment Model as Teaching Tool In late May, the Alzheimer’s Foundation of America (AFA) unveiled “The Apartment,” a full-scale model of a dementia-friendly home, as a teaching tool for families and caregivers. Located at the organization’s New York headquarters and accessible for online virtual tours, the residence showcases more than 30 practical design and technology enhancements to make a home safer and improve quality of life for those living with dementia and their care partners. The model includes an entryway, kitchen, bedroom, bath, living room and dining area. “The Apartment was created as a teaching tool for the growing population of families who have loved ones living with dementia,” said Charles J. Fuschillo, Jr., president & CEO of AFA. “Because Alzheimer’s disease and other dementia-related illnesses impact the mind, they can make many facets of daily living very difficult,” he continued. “Safety and quality of life are two of the most important concerns for families, which is why we want them to know about steps they can take to make their homes more dementia-friendly — from

appliances to paint colors, whether they live in a house, apartment, condominium or townhouse.” AFA’s Apartment showcases a host of dementia-friendly adaptations, from simple measures like putting a red wreath on the front door as a visual cue to more high

tech safety solutions. A few of the featured modifications include using: Optimum glare-free lighting that operates with circadian rhythms, natural night-day patterns of high and low blue light, plus floor-level night lights in the bedroom and bath that turn on automatically in the dark. A motion paging system to be placed by an individual’s bedside or bedroom door to detect motion, sending a wireless signal to the care partner pager; an alert system/video doorbell, and smart smoke & carbon monoxide alarms. A smart refrigerator that enables caregivers to see inside remotely, an electric tea kettle that automatically turns off, and clear-front cabinets to aid with memory recall and help those whose vision is challenged. An ergonomic motion chair, large number/photograph telephone, adjustable style bed, and round end tables to prevent injury from sharp corners. Color contrast dishware and place settings, elevated plates to bring food closer, weighted silverware, coated spoon, and ergonomic mugs. To take a virtual tour, go online to alzfdn.org/TheApartment. In addition

to the practical video suggestions, a free companion piece, The Apartment: A Guide to Creating a Dementia-Friendly Home, is available to caregivers. The 20-page booklet showcases each of the rooms with detailed, step-by-step summaries of dementiafriendly modification, as well as a sample product listing appendix.

Expanding Evidence Based Care for Dementia, continued from page 4

with a 45-question exam. Moreno said a score of 90 percent or higher results in a two-year certification. Individuals who wish to become certified can access the program and exam for less than $60. There are also packages for providers committed to training staff. And, Moreno continued, the association has a curriculum review program that compares an organization’s training program to the practice recommendations with feedback on how to address gaps in care. “It’s another channel to make sure direct care works have access to content that is reflective of these evidence-based practices,” she concluded.

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CEO of Baptist Crittenden Tackles the Challenge of I-40, continued from page 1

medicine and science that no one individual can understand how to safely care for a surgical patient or a patient in the ER. It takes a great team of experienced people to deliver high-quality care. We have a rock star team here at Baptist Crittenden. Part of my job description is to be chief meaning officer helping connect team members to the exceptional work they are doing and the vital outcomes they are delivering. My job is to deliver inspiration, connecting with why what they are doing matters.” Baptist Crittenden opened in December 2018 after the community had been left without a hospital for four years following the closure of the Crittenden Regional Hospital. Baptist chose a new location more accessible to the heart of West Memphis. Voters in the county of 55,000 residents approved a .5 percent sales tax for five years to help build the hospital. “Voters felt like a new hospital would be a good thing for this community,” Welton said. “Baptist felt it contributed to our mission and that this was a great opportunity. We purchased the land and equipment, so Baptist invested a lot. Before we opened, people in Crittenden County had to leave the community to go to an ER department. That is just one of the vital services we brought back. We are also offering seriously needed services such as cancer treatment, GI and general surgery procedures.” The hospital has 11 beds, and an emphasis on the current trend to minimize the need for hospitalizations by providing a lot of services on an outpatient basis and managing patients’ health better. The 1-40 bridge between West Memphis and Memphis closed abruptly May 11 after a crack was found in a support beam. Welton said even before that time, Crittenden Baptist had been seeing a rise in demand for ER and other services. He attributes part of that to people coming 6

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out of the height of Covid-19 getting treatment that might have been delayed earlier. There have also been more injuries, possibly due to people becoming more active again. “The bridge closure definitely made it a challenge for transferring patients to hospitals with a higher level of care,” Welton said. “There had to be a lot of additional coordination with EMS services to transfer patients to some of our sister hospitals that provide a higher level of care.” A lot had to happen quickly. The

bridge got shut down with little notice. Traffic has been backed up past the hospital since the bridge closure, but the situation has been improving. Welton said the Arkansas Department of Transportation has been working hard to keep traffic flowing diverting vehicles to the 1-55 bridge until the 1-40 bridge can be reopened. Since most of their patients come from the Arkansas side of the Mississippi River, Welton said the situation has not been overly challenging. The hospital is conveniently located off a service road. There are a few ways for local residents to get to the hospital, so it is not too difficult. And having the ER is critically important. “People with serious medical issues may not be able to get across the bridge fast enough to be taken care of,” Welton said. “We are able to provide life-saving interventions. If we don’t have the service needed, we stabilize patients, get them under control, and transport them to another hospital with the next level of care.” Baptist Crittenden faced the same issues as other hospitals dealing with the pandemic. But Welton said there were numerous advantages to being part of

the Baptist Memorial Healthcare system whose leadership worked to make sure all the hospitals had the correct amount and type of PPE for staff. During most of the pandemic, they did not experience staff shortages. “Some nursing staff left for lucrative travel nursing jobs in hot spots,” Welton said. “But over the pandemic, we have had a great team that has been able to adapt. Definitely it was challenging the first few months because of how quickly information was changing regarding the types of PPE and cleaning products needed, and how to treat patients. We were able to stay on top of that, so our patients and staff were well protected throughout the pandemic. I feel for some of these smaller hospitals trying to figure it out on their own. It was challenging.” At the time he was interviewed in early July, Welton had concerns about the more contagious and dangerous variants and lower vaccination rates in the county and state. But at the time, they had not seen an increase in new Covid cases in their area. Seven-day rolling average cases were down and there was no increase in cases or hospitalizations. “I’m hopeful we can continue to encourage people to get vaccinated before we start to see a potential increase in the Delta variant,” Welton said. “We have to just keep putting the information out there, get the experts’ voices out there, and continue to battle the vaccine misinformation that has been out there.” arkansasmedicalnews

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Memphis Physician Discusses Treatment of Covid-Induced Chronic Pain By now, we are all too familiar with the fatal devastation COVID-19 has wrought on this country, with hundreds of thousands dead. We view those who recovered from the virus as lucky, and most are. However, what we are learning and seeing now is that those patients’ stories don’t end By MOACIR when their obvi- SCHNAPP, MD ous symptoms go away, or they walk out of the hospital on their own. Instead, many “recovered” COVID patients who have gotten back to their normal lives are finding themselves plagued by something unexpected: chronic pain. Chronic pain can develop after many viral infections, not just COVID-19. An example is mononucleosis, caused by the Epstein-Barr virus, which can cause long term pain and fatigue. Another, is the common flu virus; while most of us “get over” the flu, some affected individuals never recover completely. In general, there is a connection between the severity of a viral illness and the development of long-term symptoms such as pain. Neurological damage from direct brain involvement caused by the coronavirus or by the body misdirecting its defenses towards the brain are often blamed for chronic pain and fatigue. The so called “long Covid” may belong to that category, with tiredness, loss of concentration, sleep

disturbances and a myriad of other problems. While the virus is gone, some of the sequelae or aftereffects persist. Even people with moderate illness - the kind that does not require medical care - can go on to develop chronic symptoms. A special neuropsychological condition called “central sensitization” can occur after viral infections such as COVID-19. Due to certain chemical and cell alterations in the central nervous system, a person’s body may become hypersensitive to pain, to the point that even touching the skin may hurt. While COVID-19 itself is responsible for many of the ongoing effects patients will experience, the treatment itself may similarly contribute to long lasting pain. Of those severely ill patients requiring hospitalization, many landed in the ICU, where prolonged bedrest can cause stiffness of the joints and severe loss of muscle mass (up to 10 percent in 10 days). Long stays in ICU may also cause peripheral neuropathy, a painful damage to the nerves in the legs and arms that can also lead to weakness and numbness. Invasive procedures such as chest tubes inserted between the ribs to expand the lungs and all sorts of procedures including IVs and catheters (common among the treatments required for COVID-19 patients) add to the problem. Being in an ICU is very stressful, but it can be terrifying when you cannot count on the presence of family and friends due to infection precautions. Pain and suffering go hand in hand. Our mental health can deteriorate when we are sick or preoccupied with family members and isolated

from friends and the community. The ensuing psychological changes may actually intensify chronic pain and vice versa. The treatment of any severe, chronic pain begins with a proper diagnosis. The rehabilitation of these individuals requires a multidisciplinary team of dedicated specialists including doctors, nurses, physical and occupational therapists, psychologists, and others. Such a team is responsible for the diagnosis of the specific needs of each individual and tailoring his or her treatment accordingly. Doctors commonly subdivide the pain into three categories: mechanical (bones, joints and ligaments), neuralgic (nerves and central nervous system), and visceral (lungs, gut etc.). This helps us choose the most effective treatment. For example, pain medication such as ibuprofen or codeine don’t do much for nerve pain but can help the bones and joints, while some drugs used for epilepsy, like gabapentin, are commonly prescribed for the treatment of neuralgias (nerve pain). Early intensive intervention with daily exercises, respiratory rehabilitation, psychological support and preparations to resume home and work activities are the mainstay of such a program. Despite the recent controversies regarding the use of strong pain medication, such as opiates, they remain an invaluable tool for the treatment of pain, and it can mean the difference between a person being independent or ending up confined to a wheelchair. It is worth remembering that the vast majority of deaths and overdoses from opiates in this country are due to the illegal use of these substances.

One of the most effective therapies for chronic pain consists of injections around the affected nerves, known as nerve blocks. The purpose is to temporarily stop the pain, without causing damage to the nerve. We compare this to rebooting a computer that crashed, allowing the nerves and the central nervous system to “reset itself.” The vicious cycle of the pain may be so interrupted, facilitating the rehabilitation process. By reducing the pain from neuralgias, nerve blocks also improve the quality of sleep and allows for the reduction in pain medications. Typical of this type of treatment are epidural blocks, often used in the treatment of sciatica. In the past, mental health issues were labeled as “psychological” or “neurological.” Today, this distinction mostly disappeared and the treatment of depression, anxiety, and PTSD, among others, is best accomplished by combining counseling and medications. We understand now that both the severe stress from an illness and the brain impairment from a viral infection can lead to similar behavioral and personality changes. Hope can, however, be the greatest healer, but it hinges in great part on the support from family and friends and the encouragement from doctors, nurses, and therapists who are focused on reducing a patient’s pain and restoring function. The rehabilitation process can be arduous, tiresome and sometimes boring. Hope helps. Moacir Schnapp, MD, is a neurologist and Medical Director of Mays & Schnapp, Neurospine and Pain, the only CARF-accredited outpatient pain clinic in the Mid-South. Visit https://www. maysandschnapp.com

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HFMA Offers Best Practices for Fair Debt Resolution By CINDY SANDERS

It’s a subject no one really wants to discuss, but communication is key when it comes to addressing a patient’s financial responsibility for medical bills. To help with those uncomfortable conversations, the Healthcare Financial Management Association (HFMA) recently released “Best Practices for the Fair Resolution of Patients’ Medical Bills.” Designed to be used by providers, their business affiliates and credit bureaus, the best practices were jointly published with the Association for Credit Collection Professionals. The 28-page report, published last fall, updates guidance originally released in 2014. The HFMA Medical Debt Collection Task Force – which includes diverse representation of providers, consumer advocates, collections agencies and credit bureaus – reconvened in 2020 to update and add best practices, particularly financial assistance response to COVID-19 and future health emergencies. HFMA Senior Vice President for Content & Professional Practice Guidance Richard Gundling, FHFMA, CMA, said strains from the pandemic, changes in collection laws, increased transparency expectations and available tools made it the right time to update the guidance. “Let’s make Richard Gundling sure these are fresh, up to date and top of mind,” he said of reviewing the accounts receivable process. The release coincided with the up-

heaval surrounding the pandemic. “We saw a big spike in unemployment and loss of insurance. Hospitals were backing away from collection policies because communities were hurting,” said Gundling. Yet, he added, that’s the time to have solid processes in place. Gundling noted a job loss should serve as a trigger for provider entities to discuss options the patient might not know are available, including Medicaid eligibility, ACA Marketplace plans and financial assistance programs. The updated guidance provides detailed information on each step in the accounts receivable process from recommendations for pre-service financial communications and best practices for resolution of medical debt post-discharge to working with account resolution business affiliates and accounts sent to a collection agency. Gundling said the best opportunity to avoid difficult conversations down the line is to clearly outline financial responsibility and collection procedures up front in the pre-service time frame whenever possible. “It’s all about communication. Everybody has such variable coverage and costs,” he explained. “You should be able to get a good estimate of what your cost will be. Can you afford that? If the answer is ‘no,’ then ask why.” He continued, “It’s not a matter of just giving them a laundry list of prices, you have to explain the costs.” Gundling added, this pre-service conversation provides a natural opportunity to discuss other coverage options, interest free medical financing, and financial assistance programs from pharmaceutical companies, manufacturers and provider entities. Even with coverage in place, provider par-

ticipation changes over time, so it might warrant a discussion about finding an in-network provider. Timing for elective procedures or the course of treatment are also topics to be considered. Do two drugs work equally well with one being less expensive or covered on the patient’s plan? Those are options that can be explored on the front end. Even when there isn’t much opportunity to reduce pricing, Gundling said setting expectations is valuable. “It’s better to know up front than to get home and have a bill you didn’t anticipate,” he pointed out. Of course, he added, emergency situations often don’t allow for pre-service conversations. In those cases, discussing financial responsibility has to come later. “You want (the conversation) as soon as possible in the course of treatment, but if the patient is not ready, then follow up when they are. Again, its communicating.” To that end, Gundling said provider entities should review their bills to ensure they are as clear and concise as possible without a lot of medical jargon. That said, bills should provide necessary information on treatment costs, patient’s financial responsibility and a contact number to call for clarification. “A patient is much more likely to pay a bill they understand and were expecting,” Gundling pointed out. The HFMA best practices report notes all account resolution efforts should follow the formally documented provider collection policies that have been approved by the board or other authorizing body. This is also true for all business affiliates under contract with providers. Additionally, affiliates need timely and accurate information to service accounts,

making regular reconciliations between the provider’s system and affiliate’s system critical to ensure balances are accurate and in sync. For accounts deemed a bad debt risk, those outstanding balances are often turned over to a collections agency after other steps have failed. “Work with collection agencies to make sure those agencies are also following best practices and the mission of the hospital,” Gundling said. Providers should have a formal policy established regarding the use of extraordinary collection actions (ECAs) as defined by the IRS. These ECAs could include a lien on property, wage garnishment or lawsuits. However, HFMA’s best practice document notes using ECAs is optional and must be weighed in light of potential negative impacts. The report includes a checklist of internal controls to consider before moving to this step. “There’s always a balance with collections,” said Gundling. Providers, he continued, need resources to run but also want to make sure patients receive the care they need. “Providers need to have people who are empathetic and compassionate explain financial policies to people up front. I think they get tripped up by not being clear and trying to avoid an uncomfortable conversation.” “Best Practices for Resolution of Medical Accounts” is freely accessible on the HFMA website. From the hfma. org homepage, click on the Industry Initiatives tab and then select Healthcare Dollars and Sense for the report and additional resources. A direct link to the page is also available in the online version of this article on our site at ArkansasMedicalNews.com.

UAMS Neurosurgeon J.D. Day, Internationally Known Leader, Developing Improved Complex Cranial Surgery Techniques, continued from page 3 football and baseball. He graduated from Whitman College, a small liberal arts college in Walla Walla, Washington. During college he worked as a phlebotomist. “That was my first exposure to being around the hospital and sick patients,” Day said. “That is how I knew I wanted to be a physician. When I was in medical school at the University of Washington School of Medicine, I wasn’t sure what I was going to do, but I knew I would end up doing something surgical. I played a lot of sports and thought that would be the direction I would go. But my first neuroscience course really intrigued me. There was a lot to learn. I really liked that.” The second year he took neuroanatomy and loved it. It was also very stimulating when he did his neurosurgery rotation. He was trained at the LA County/University of Southern California Medical Center in Los Angeles, 8

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which he said was quite an experience in the late 1980s and early 1990s. “An awful lot was going on with gang violence and so forth,” Day said. “There were indigent people who came up from Mexico for their care with incredible problems. People would come in much later in their disease than we would see with the U.S. citizen population. It was a really exciting place to train.” Day said he has been really blessed in terms of his mentors at USC and his fellowship. He did his fellowship training in cranial base surgery and anatomy at the University of Vienna Medical School in Austria, training under pioneering neurosurgeon Dr. Wolfgang T. Koos. He worked with renowned neurosurgeon Dr. Takanori Fukushima in residency and then in practice for a year at Allegheny General Hospital in Pittsburgh. Day then joined the Lahey Clinic in Boston as Director of Cerebrovascular and Skull Base Surgery. In 1995 Day joined the

faculty of the USC School of Medicine in Los Angeles, where he was also director of neurological surgery at the worldrenowned House Ear Clinic. In 2001, he returned to the Pittsburgh and Allegheny General Hospital as the director of the Center for Cerebrovascular Surgery and Stroke through 2004. He practiced in Colorado for the next three years, until being recruited to the University of Texas Health Sciences Center in San Antonio in 2007. He was named vice chairman for academic affairs and associate residency program director in the Department of Neurosurgery at UTHSC the following year. Day thought he might finish his career in Texas, but ended up being recruited to UAMS, where he has been now for 11 years. Every now and then Day will see someone who was diagnosed eight or ten years ago with a benign tumor. The patient may not have been referred to a

neurosurgeon earlier because the patient was not symptomatic. But Day often ends up wishing he had seen the patient five years earlier when the condition could have been treated more easily. “Waiting and following could be to a detriment in the future,” Day said. “I do like it when I see somebody even before their physician thinks they would be headed for the operating room or some form of treatment. Sometimes instead of open surgery, the right choice is stereotactic radiosurgery. So, it is my preference to see someone sooner rather than later. There are plenty of people I’m just following. There are others that I tell it isn’t going to get any easier than right now. It is going to be to your benefit to have an earlier operation before you have a lot of symptoms.”

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GrandRounds Arkansas InCharge 2021 Listing Omission Arkansas Medical News acknowledges the omission of a listing for Josh Brown, Principal of Haag Brown Medical Development in our 2021 InCharge magazine that was published in June. Josh has done some fine work in Northeast Arkansas and we want to recognize him here: Joshua Brown, CCIM Principal Haag Brown Medical Development 2221 Hill Park Cove, Jonesboro, AR 72401 870-336-8000 josh@haagbrown.com

Brown has served as the Principal of Haag Brown Medical Development since 2017. As such, he has been a project partner for physicians, health systems and medical related industries, developing general clinics, urgent care facilities, and more complex surgery related facilities. Over his career, Brown has transacted $200 million in medical real estate and has developed almost 100,000 SF of medical office in 3 states. Some of his most notable projects include the $17MM sale-leaseback of several medical urgent care clinics across Northeast Arkansas and the creation of the Reserve at Hill Park, Jonesboro’s first life-style oriented medical/office park.

Nurse Practitioner Julie Wylie Joins South Arkansas Adult Medicine Clinic EL DORADO - South Arkansas Physician Services Practice Administrator Danna Taylor announced that Julie Wylie, APRN has joined South Arkansas Adult Medicine Clinic as an Adult Medicine Nurse Practitioner. Wylie has been a nurse practitioJulie Wylie ner for over 14 years with experience in specialty care clinics including cardiology, nephrology, and cardiothoracic post op surgical care. As an adult medicine primary care provider, Wylie specializes in the treatment of adults ages 18 years of age and older. Wylie’s focus is to prevent, diagnose, and treat a range of health conditions and diseases ranging from simple to complex, acute and chronic. Born and raised in Camden, AR, Wylie and her family now reside in El Dorado, AR. Wylie is currently President of Arkansas Nurse Practitioner Association and has been on the board of directors for the past five years in various roles. Wylie received her Bachelor of Science Nursing at the University of Arkansas in Fayetteville, AR and a Master of Science as an Adult Health Nurse Pracarkansasmedicalnews

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titioner at Texas Woman’s University in Dallas, TX. Wylie will be joining South Arkansas Adult Medicine Clinic with Internal Medicine physician Joseph DeLuca and Adult Medicine Nurse Practitioner Tiffany Lucas. The clinic is located in the Grove Medical Complex at 620 West Grove Street, Suite 202 on the Medical Center of South Arkansas (MCSA) campus. Julie Wylie is accepting new patients at South Arkansas Adult medicine Clinic, which is located at 620 West Grove Street, Suite 202, El Dorado.

CARTI Expands Executive Leadership Team LITTLE ROCK - CARTI has announced the expansion of its executive leadership team with the appointment of Melissa Masingill as chief business development officer, a new position for the organization, and David Muns, FACHE as chief Melissa Masingill operating officer. Masingill and Muns bring more than 55 years of combined experience in the healthcare sector. They will report directly to Adam Head, president and CEO of David Muns the statewide cancer care provider. A member of CARTI’s executive team since August 2018, Masingill previously served as SVP, Business Development and Marketing. In her new role, Masingill leads the organization’s growth, including service line expansion opportunities, physician recruitment, government relations, marketing and communications. For more than 20 years, Masingill has specialized in healthcare policy, government relations and communications, utilizing her experience and skillset to increase brand awareness, solidify stakeholder engagement and cultivate business opportunities. Before joining CARTI, Masingill served as chief public affairs officer for the Arkansas Foundation for Medical Care, leading the organization’s federal and state government relations advocacy and strategic communications efforts. Masingill holds a Bachelor of Arts degree in psychology from the University of Arkansas at Little Rock. Muns will oversee clinical and business operations for the statewide cancer care provider, which operates 19 treatment locations in 16 communities across Arkansas. Most recently, Muns served as chief operating officer at Merit Health Wesley Medical Center in Hattiesburg, Miss., where he was responsible for the daily operations of a multispecialty health-

care organization that includes 10 clinics and 1,000 employees. He previously served as vice president, system development at Memorial Hospital in Gulfport, Miss., where he led 100 physicians and midlevel providers in a variety of operational settings. Muns is a Fellow of the American College of Healthcare Executives (FACHE), and previously served as president of the Mississippi Chapter of the American College of Healthcare Executives. He is a retired Air Force Master Sergeant with 23 years of service. Muns holds a Master of Public Health in health administration from the University of Southern Mississippi, and a Bachelor of Science in human resource management from Faulkner University in Montgomery, Alabama.

NIH Funding to Help ACRI and UAMS Collaborative Track COVID-19 Variants Circulating in State LITTLE ROCK – A National Institutes of Health (NIH)-funded collaboration between scientists at Arkansas Children’s Research Institute (ACRI) and the University of Arkansas for Medical Sciences (UAMS) will help the Centers for Disease Control and Prevention (CDC) and the Arkansas Department of Health (ADH) understand more about the variants of COVID-19 circulating in the state by increasing capacity for genomic sequencing, tracking and analyses of virus samples. The $770,000 NIH grant will be devoted to the powerful collaboration between UAMS, Arkansas Children’s, Baptist Health and ADH. The “Arkansas Sequencing (ArkSeq) Consortium” will be a source for samples from across the state to be used for sequencing COVID-19 variants. ACRI will provide an additional $200,000, in part from Arkansas Biosciences Institute funds, to expand sequencing capacity. ACRI’s NIH-funded Center for Translational Pediatric Research (CTPR) and UAMS’ IDeA Network of Biomedical Research Excellence (INBRE) will lead the collaborative efforts. The grant is awarded to Dr. Alan Tackett, CTPR director, professor in the UAMS College of Medicine Department of Biochemistry and Molecular Biology and deputy director for the UAMS Winthrop P. Rockefeller Cancer Institute, and Dr. Josh Kennedy, associate professor in the UAMS College of Medicine Department of Pediatrics, Division of Allergy and Immunology, is the project leader. Kennedy said the work will help the state understand which variants of COVID-19 are present in Arkansas and could even help identify new variants. Data ranging from demographics to collection dates, symptoms and vaccination status will all be essential to the project, which will result in actionable data provided to the CDC and ADH.

State-of-the-art, next generation sequencing platforms will allow the researchers to sequence COVID-19 positive samples from the ArkSeq Consortium over the next year. Findings from this sustainable SARS CoV-2 genomic surveillance data and analyses will be shared with state of Arkansas to improve ongoing pandemic response and preparedness. Today, Arkansas has sequenced fewer than 1,000 COVID-19 samples – a total of only 0.28% of all cases. That ranks the state 48th nationally for total samples sequenced. The scientists expect to yield eight times more sequences from Arkansas for national databases, also producing additional samples for future study. Crucial bioinformatics support for the project will be provided by Drs. Stephanie Byrum, assistant professor in the UAMS College of Medicine Department of Biochemistry and Molecular Biology, and David Ussery, professor in the UAMS College of Medicine Department of Biomedical Informatics. This research is supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number (P20GM121293).

Washington Regional Dedicates New J.B. Hunt Transport Services Cancer Support Home FAYETTEVILLE - Washington Regional Medical System held a dedication ceremony and ribbon cutting for the new Washington Regional J.B. Hunt Transport Services Cancer Support Home. The 9,980-square-foot facility, located at 488 E. Longview Street in Fayetteville, provides hope and comfort for those on a cancer journey with overnight lodging with eight accessible guest suites, a wig and prosthesis boutique and support services. The home is the only one of its kind in Northwest Arkansas, and services are offered at no charge to patients regardless of where they receive care. The new building was made possible by gifts from many generous donors, including J.B. Hunt Transport Services, for which the facility is named. The John and Tamara Roberts family chaired fundraising campaign efforts for the new home. Washington Regional President and CEO Larry Shackelford said the new facility allows the system to continue fulfilling its mission. Construction on the J.B. Hunt Transport Services Cancer Support Home began in February 2020, and the facility began welcoming clients in March 2021. Since that time, the new J.B. Hunt Transport Services Cancer Support Home has provided 177 nights of overnight lodging to 18 families. JULY/AUGUST 2021

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GrandRounds UAMS Breaks Ground on New Radiation Oncology Center and First Proton Center in Arkansas LITTLE ROCK - The University of Arkansas for Medical Sciences (UAMS) broke ground on an expanded Radiation Oncology Center, which will be home to Arkansas’ first Proton Center. The Radiation Oncology Center, part of the UAMS Winthrop P. Rockefeller Cancer Institute, already offers cutting-edge technologies to provide the latest radiation treatments. It will continue to provide those services, as well as new ones using the expanded capabilities of three new linear accelerators, as it relocates in 2023 to a new 52,249 square-foot-building facing Capitol Avenue, between Pine and Cedar streets. The new three-story structure, located southeast of the BioVentures building, is being built primarily to accommodate a proton center — one of fewer than 40 that exist nationwide — in partnership with Arkansas Children’s, Baptist Health and Proton International. An alternative to radiation therapy, proton therapy is a state-of-theart technology that uses a precisely focused high-energy beam to target

tumors, often in hard to reach areas, without affecting surrounding tissue. Proton therapy is particularly effective in treating solid cancer tumors, including tumors of the brain, spine, head and neck, lung, prostate, colon and some breast tumors. It is ideal for pediatric patients because the high-energy proton particles it delivers to kill tumors limits radiation exposure to healthy, growing tissues. UAMS’s radiation oncology center is the only one in the state that treats children. Michael Birrer, M.D., Ph.D., director of the Cancer Institute, said the proton center “brings cutting-edge therapy to our patients and will be the basis of many new and novel clinical trials that will benefit our patients and move the cancer research field forward. It will also help us on our journey to receive National Cancer Institute Designation.” The three new linear accelerators — machines that customize high-energy X-rays — provide edge radiosurgery, a specialized nonsurgical technique used to destroy tumors in the brain and spine with end-to-end accuracy of less than 1 millimeter; radiotherapy with motion management, which controls radiation directed at tumors that move as

Mercy Hospital Fort Smith Announces $162 Million ER, ICU Expansion FORT SMITH – Mercy Hospital Fort Smith has announced plans for a $162 million expansion of its emergency room and intensive care unit. Mercy Fort Smith will expand its ER from 29 to 50 rooms and increase ICU capacity from 38 to 64 in a concept that provides better workflow and flexibility. The new Emergency Department will allow for about 25,000 more patient visits per year and include special considerations for infectious disease as well as behavioral health patients. For the convenience of patients, an additional 140 parking spaces will be added to accommodate the expansion, with parking closer to the new ER entrance. The increase in ICU beds will more than double the number of rooms capable of supporting ventilators. The building automation system is designed to allow for floors or pods to be turned into isolation areas as needed. The new garage and lower-level emergency department entry will be set up to allow for dealing with a mass casualty event and quick set-up for pandemic response. The ER and main entry proximity will provide separation of non-pandemic from pandemic-related patients without interruption to normal operations, should the need arise. The project includes a five-room area for behavioral health patients that is completely secured and designed for patient and co-worker safety. Additional plans include a 22-bed observation unit requiring no renovation in the former ICU space and helipad relocation to improve patient transport. Groundbreaking for the ER/ICU is expected in early 2022, with construction expected to last just over two years. Plans are being developed to minimize the impact to Mercy patients during the construction process.

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patients breathe; and adaptive therapy, the most advanced form of cancer treatment, which allows clinicians to adapt to daily changes in the tumors’ shape and position over the course of treatment to better target the cancer and spare normal tissues. The first floor of the new building will include a consultation room, a computerized tomography (CT) room, treatment rooms, clinical rooms, an exam area, a staff lounge and a conference room, as well as several physician offices in the clinical space. The proton machine will be housed on the second floor, as will a CT room to prepare patients for proton therapy, a high-dose radiation (HDR) room, gowning rooms, recovery rooms, an anesthesia room, work rooms, eight exam rooms, a large work room for physics staff and more physician offices.

Family Physician Joins Conway Medical Group and Graduate Medical Education Faculty CONWAY – Clark Trapp, MD has joined the team at Conway Regional Health System. Trapp is now seeing patients at Conway Medical Group in Conway. Additionally, Trapp is practicing alongside Sarah Robertson, MD, Jeremiah Keng, MD, Clark Trapp and Darren Freeman, MD, as a core faculty member for the Family Medicine Residency Program. Trapp completed his family medicine residency training at UAMS West in Fort Smith. He has been practicing in the Morrilton area for nearly four years, serving as the Vice Chief of Staff for CHI St. Vincent Morrilton. Conway Medical Group is located at 437 Denison St. For more information or to make an appointment, call 501327-1325.

North Arkansas Regional Medical Center Welcomes Dr. Nicole Caton HARRISON - NARMC is pleased to welcome Dr. Nicole Caton who will be offering family medicine and obstetrics services at The Family Medicine Clinic. Dr. Caton graduated from Family Medicine Residency at the University of TennesNicole Caton see in Jackson where she was a chief resident. She received her master’s in public health and her Doctorate of Osteopathic Medicine from UNT Health Science Center Texas College of Osteopathic Medicine in Fort Worth.

Aaron Beckham Named Director of Patient Access FAYETTEVILLE — Washington Regional recently named Aaron Beckham, RN, as its new director of patient access. Beckham has more than 15 years of nursing experience and has been with Washington Regional since 2012. He previously served as Aaron Beckham a clinical nurse educator and registered nurse in the ICU at Washington Regional before taking on the role of interim director of patient access in February 2021. Beckham holds a Master of Science in Nursing Leadership in Health Care Systems and a Bachelor of Science in Nursing from Grand Canyon University. He also earned designation as a Stroke Certified Registered Nurse (SCRN) from the American Association of Neuroscience Nurses (AANN).

PUBLISHER Pamela Z. Haskins pamela@arkansasmedicalnews.com EDITOR P L Jeter editor@arkansasmedicalnews.com ADVERTISING SALES 501.247.9189 pamela@arkansasmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Becky Gillette, Jill Pease, Cindy Sanders, Moacir Schnapp, MD All editorial submissions and press releases should be sent to pamela@memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Arkansas Medical News is now privately owned by Ziggy Productions, LLC. P O Box 164831 Little Rock, AR 72206 President: Pamela Z. Haskins Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. Arkansas Medical News will assume no responsibility for unsolicited materials. All letters sent to Arkansas Medical News will be considered the newspaper’s property and unconditionally assigned to Arkansas Medical News for publication and copyright purposes.

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GrandRounds Murphy Foundations Pledge $1 Million For UAMS Regional Campus in El Dorado EL DORADO - The Murphy Family Foundation and the Murphy USA Charitable Foundation recently pledged $1 million over three years to the University of Arkansas for Medical Sciences (UAMS) to support the creation of a new regional campus in El Dorado. The gifts will have a far-reaching impact, not only for El Dorado, but for patients in south Arkansas and across the state. The El Dorado campus represents a joint effort by UAMS and the Medical Center of South Arkansas to increase medical access throughout south Arkansas by training primary care physicians to serve Union County. UAMS expects to open its campus in January 2022 and begin training family medicine residents by July 2023. The El Dorado campus will be UAMS’ ninth regional campus. The majority of family practice physicians in rural areas of the state are trained at one of UAMS’ eight regional campuses. Creating a regional campus in El Dorado will provide an influx of physicians and health care professionals in Union County and south Arkansas to create a sustainable educational and training pipeline and make it easier to maintain consistent levels of care. Regional Campuses, originally called Area Health Education Centers (AHECs), began in 1973 through the efforts of then-Gov. Dale Bumpers, the Arkansas Legislature and UAMS to train medical residents and provide clinical care and health education services around the state, with eight current regional campuses located in Batesville, Fayetteville, Fort Smith, Helena-West Helena, Jonesboro, Magnolia, Pine Bluff and Texarkana.

UAMS Graduates 936 Health Care Professionals LITTLE ROCK – Degrees and certificates were conferred to 936 graduates of the University of Arkansas for Medical Sciences’ (UAMS) five colleges and graduate school. Because of the ongoing COVID-19 pandemic, no commencement ceremony was held; however, the various colleges held independent virtual commemorations this month. Degrees were awarded to 177 in the College of Medicine, 218 in the College of Nursing, 105 in the College of Pharmacy, 72 in the Fay W. Boozman College of Public Health, 302 in the College of Health Professions and 62 in the Graduate School. Degrees and certificates conferred include the doctor of philosophy, doctor of medicine, doctor of pharmacy, doctor of nursing practice, master of science, master of nursing science, bachelor of science in nursing, master of public health, doctor of public health, master of health administration, postbaccalaureate certificate in public health, master of science in healthcare analytics and a variety of degrees in allied health disciplines including certificates, bachelor of science degrees, postbaccalaureate certificates, master of communication sciences and disorders, master of physician assistant studies, doctor of audiology and doctor of physical therapy. The following graduates received their Doctor of Medicine (M.D.) degree. Arkadelphia Jace Bradshaw

Crossett Mason Harper

Garner Jared Gowen

Bald Knob Cordell Crisp

Dardanelle Morgan Gongola Hunter Ramey

Glenwood William Buck

Batesville Christopher Elms Beebe Annlee-Taylor GlassHicks Benton Jonathan Gardner Alaina Smith Bentonville Kelsey Parks Bigelow Catherine Thomas Cabot Hayden Elliott Roger Gillum Ahmed Stivers Calamine Lane Gay Charleston Hamilton Newhart Cherokee Village Karam Sra Conway Morgan Bridgforth Charles Hunter Jacob Linna Austin Morgan Madison Morris Tyler Thompson Bryce Woods

Des Arc Joshua Walls DeWitt Carole Jennings East End Brittany Flippo El Dorado Gelina Buslig Matthew Cordell Victoria Davis Laney Sideroff Forrest Woods Fayetteville Mohammed Soliman Jessica White Flippin Alexis Mallett Fordyce Michael Richardson Fort Smith Mouad Abdulrahim Christina Chapman Melissa Eckes Caitlin Hirsh Michelle Huynh Spencer McClure Jordan Spencer Courtney Wright Hannah Yasin Jesse Young

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Greenwood Riley George Cameron Parsley Harrison Samuel Patton Katie Stahler Hensley Joseph Koon II Hermitage Dustin Brown Hot Springs Jackson Arnold Hayden Dunn Adam Larey Melissa Plumley Huntsville Rachel Goff Hunter Vines Jonesboro Jacob Carter Lillie Pitts Reid Shelton Lake Village Einnod Williams Little Rock Muhammad AbuRmaileh Adam Angel Nicholas Baltz Sarah Beckwith John Block

Autumn Brown Katherine Caid Arhita Dasgupta Parker Davidson Amanda Ederle Joshua Estes Sara Frankowski Vikram Gondhalekar Daniel Griffin Heather Hirsch Ryan MacLeod Joel McGowan Mary Moore Rachel Moore Dmitry Nedosekin Patrick O’Brien Danica Angela Ordonez Merry Peckham David Polk Christopher Randall Emily Reiners Jennifer Saccente Bradley Stone Emily Tharp Victor Ventrano Bryce Wall Wesley White Jonathan Williamson Magnolia Anjali Patel Maumelle Moriah Hollaway Sehrish Sardar Allison Schneider Mountain View Kaitlynn Butler North Little Rock Olivia Brasher

Star City Jackson Haynes

Doniphan, Missouri Austin Ivy

Osceola Jaskiran Kaur

Van Buren Skye Heckman Rachel Mayo

Joplin, Missouri Griffin Sonaty

Oshawa Jordyn Wolfe

Wheatley Jasmine McKissick

Paragould Brandi Mize Jacob Smith

White Hall Courtney Hunter

Karl Goshen Justin Klucher Jackson Massanelli

Pea Ridge Tyler Estes Pine Bluff George Bloom II Pocahontas Kevin Thomas Rogers Nadia Khan Pratheepa Ravikumar Tyler Rose Russellville Johnathan Marasco Humaira Saleem Alex Smith Searcy Micah Clay Brianna Klucher Sherwood Zachary Reiners Siloam Springs Catherine Scarbrough Shelby Webb

Springfield, Missouri Connor Wilson

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Garner, North Carolina Matthew Madujibeya

Dana Point, California Victoria Ly

Jacksonville, North Carolina C’Asia James

Cape Coral, Florida Stephen Menefee

Hanover, New Hampshire Gregory Corwin

Conyers, Georgia John Norton Bloomington, Illinois Adam Neuhouser Palos Park, Illinois William Christy Raceland, Louisiana Jeanne Rabalais Hattiesburg, Mississippi Mary Andrews Mound Bayou, Mississippi Ansley Scott Columbia, Missouri Amy Scott

Altus, Oklahoma Alexander Rivas Tulsa, Oklahoma Nathan Klammer Knoxville, Tennessee Katelyn Ragland Frisco, Texas Blake Wiggins Houston, Texas James Mazzo Richmond, Texas Evan Laman Rockwall, Texas Spencer Taylor

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GrandRounds UAMS’ First Phase 1 Cancer Clinical Trial Testing New Way to Protect Hearts While Treating Cancer LITTLE ROCK - The drug dexrazoxane has a reputation akin to someone who both fights and sets fires. On the one hand, this Food and Drug Administration (FDA)-approved drug prevents heart damage caused by doxorubicin, which is used in chemotherapy. On the other hand, dexrazoxane may undermine the cancer treatment, causing many doctors to leave it on the shelf. UAMS researcher Hui-Ming Chang, M.D., MPH, believes she may have found a way for dexrazoxane to protect the heart without hampering doxorubicin’s cancer fighting ability. With the support of a five-year, $3.5 million National Institutes of Health (NIH) grant, she has begun testing her laboratory findings at the newly opened UAMS Winthrop P. Rockefeller Cancer Institute Phase 1 Cancer Clinical Trial Unit. Her study is the first phase 1 cancer clinical trial at UAMS. Cancer clinical trials at UAMS were previously limited to phase 2 and 3 studies. Chang named her study the Phoenix Trial, an aspirational reference to the mythical bird that rises from the ashes. Dexrazoxane has been on the market since 2007, and doctors traditionally administered it to cancer patients at the same time as doxorubicin. In the lab,

Chang discovered that if she gives dexrazoxane to mice eight hours before doxorubicin, it completely protects the heart from doxorubicin’s side effects and does not interfere with doxorubicin’s ability to kill cancer cells. The eight-hour timeframe relates to dexrazoxanes’ two-hour half-life, meaning it dissipates from the body within eight hours (four half-lives). The earlier infusion of dexrazoxane degrades a protein that would otherwise allow doxorubicin to damage the heart. This protein remains degraded long enough for dexrazoxane to leave the system so that it does not inhibit doxorubicin’s beneficial effects said Chang. The phase 1 clinical trial aims to determine the most effective dose and timing for dexrazoxane prior to doxorubicin. The project will evaluate whether the dexrazoxane pre-treatment prevents heart damage caused by doxorubicin in breast cancer patients. Chang notes that preventing heart damage is especially important given the long-term survival of cancer patients, breast cancer patients in particular. The study is now recruiting 25 healthy women volunteers, ages 18-65. It will also recruit 120 breast cancer patients with non-metastatic, HER2-negative breast cancer. Women interested in volunteering for the study can email PHOENIX1@ uams.edu. Compensation is available.

The Phase 1 Cancer Clinical Trial Unit is part of the Cancer Institute’s state-ofthe-art infusion center that opened in November 2020. Chang arrived at UAMS the same month, bringing the new Phoenix Trial with her from the University of Missouri School of Medicine. Phase 1 clinical trials are the first to involve human participants. Almost every cancer treatment offered to patients today has come about because of a clinical trial.

Arkansas Health Network Appoints Dr. Lubna Maruf as Chief Medical Officer LITTLE ROCK – TheArkansas Health Network (AHN), a physician-led, Clinically Integrated Network (CIN) serving Arkansas patients, providers and employers, announced that Dr. Lubna Maruf has been appointed as its new Chief Medical Officer and Vice President. Dr. Maruf will oversee all aspects of clinical quality improvement, provider engagement efforts, performance in quality metrics across the network and provide medical leadership for AHN’s strategic initiatives. In its latest performance year, AHN’s emphasis on quality and value-based care saved Medicare $12.9-million, the highest total savings of any individual accountable care organization (ACO) participating in the Medicare Shared Savings Program through CommonSpirit Health, a 21 state nonprofit health system that includes CHI St. Vincent. AHN is the largest and most

Want to learn more about telehealth? The South Central Telehealth Resource Center (SCTRC) provides telehealth education and assistance to healthcare providers in Arkansas, Mississippi and Tennessee. The SCTRC website, LearnTelehealth.org, focuses on telehealth media and education, offering a range of items from podcasts, webinars, course modules, resources, telehealth training, and so much more. Join us for our monthly webinar, “Telehealth 101: The Easy Basics of Telehealth & Telemedicine” to get started on your telehealth journey! Register at UAMS.info/Telehealth101. Proud to be part of the National Consortium of Telehealth Resource Centers.

successful CIN in the state of Arkansas, managing over 125,000 patients across the state and partnering with a growing network of nearly 2,600 providers, 27 Skilled Nursing Facilities and 17 hospitals. With the rising cost of healthcare growing as a concern for employers across Arkansas, AHN also partnered with Arkansas Children’s Care Network and NextHealth Integrated Network to provide a unique healthcare delivery model designed specifically for employers. The model leverages technology and big data to pre-emptively identify high-risk and rising risk patients and then connects them with a multidisciplinary care team of registered nurse health coaches, social workers, pharmacists and others to proactively manage their care with an emphasis on preventive, rather than reactive services. Dr. Maruf previously served as medical director for Centene/QualChoice Health Insurance based in Little Rock where a significant portion of her work focused on Value-Based Care while maintaining clinic practices across the state. She has also served as adjunct faculty for the University of Arkansas for Medical Sciences with their residency training program. Dr. Maruf holds a medical degree from Aga Khan University in Karachi, Pakistan. She received her internal medicine fellowship from Michael Reese Hospital at the University of Illinois, Chicago and has an MBA degree from the University of Arkansas at Little Rock.

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July-August 2021 Arkansas Medical News  

your primary source for professional healthcare news

July-August 2021 Arkansas Medical News  

your primary source for professional healthcare news

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