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FOCUS TOPICS WOMEN’S HEALTH • DERMATOLOGY • PRACTICE MGT/TELEMEDICINE

May/June 2020 December 2009 >> >> $5 $5 ON ROUNDS

Dermatologist Aaron S. Farberg, Loves Sharing Expertise Patients and family practitioners advised to carefully check for signs of skin cancer

Aaron S. Farberg, MD, Arkansas Dermatology Skin Cancer Center, initially trained in plastic surgery, but developed an increasing interest in skin cancer. He decided to further his focus in dermatology and devote his career to treating skin cancer and other dermatologic concerns.

Profile on page 3.

New Study Looks at Cost Impact of OTC Birth Control By CINDY SANDERS

On May 9, ‘the pill’ celebrates 60 years of approval from the Food and Drug Administration. While no over-the-counter option is currently available, a growing chorus of women’s health providers, researchers and advocates is calling for improved access to oral contraceptives. In April, new findings on the impact of over-the-counter costs for birth control pills on both use and unintended pregnancy were released in Women’s Health Issues, a peer-reviewed, bimonthly journal of the Jacobs Institute of Women’s Health. “Modeling the Impacts of Price of an Over-the-Counter Progestin-Only Pill on Use and Unintended Pregnancy among U.S. Women” primarily looked at data from a nationally representative 2015 survey of more than 2,500 American women ages 15-44 to assess interest in using an OTC progestin-only pill at different price points. The analysis also utilized the National Survey of Family Growth 2013-15, which was released from the National Center for Health Statistics in 2016, as well as 2017 population data from the U.S. Census. According to the analytical study: “In a model assuming no (CONTINUED ON PAGE 4)

Utilizing Telemedicine in Your Practice During the Pandemic and Beyond

HealthcareLeader

The Balancing Act

PCMS president Kay Chandler redefining priorities while caring for patients, the medical community and self

Is extensive use here to stay?

By MELANIE KILGORE-HILL

Telemedicine use has skyrocketed during the COVID-19 health crisis: Is it here to stay?

Kay Chandler, MD, has been changing the lives of women in central Arkansas for more than two decades. Now, the president of the Pulaski County Medical Society is encouraging providers and medical students with a call to partnership and purpose.

Story on page 5.

The road to medicine A native of Benton, Ark., Chandler de-

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veloped an interest in medicine at a young age. “My mom was an RN, and one of my earliest memories is her sitting me down around age five and showing me embryology pictures,” she said. “Those things, and my mom’s desire to help others, piqued my interest even then.” Chandler also recalls reading about the first female physicians in sixth grade, and being encouraged by teachers to pursue science and healthcare. In junior high, (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Dermatologist Aaron S. Farberg, Loves Sharing Expertise Patients and family practitioners advised to carefully check for signs of skin cancer By BECKY GILLETTE

Aaron S. Farberg, MD, Arkansas Dermatology Skin Cancer Center, initially trained in plastic surgery, but developed an increasing interest in skin cancer. He decided to further his focus in dermatology and devote his career to treating skin cancer and other dermatologic concerns. “Dermatology is a continuously evolving field that allows for the opportunity to see a variety of complex medical and surgical cases,” Farberg said. “I am truly passionate about helping others; medicine is incredibly interesting and rewarding. It’s the perfect blend of my interests in engineering, science and business.” Farberg said medicine is constantly evolving with the creation of new devices and technologies. He is currently working on developing genomic tests to help determine prognosis for various skin cancers - a topic on which he recently published a book, as well. Skin cancer rates continue to increase every year. The most common type of cancer in the world is skin cancer (specifically basal and squamous cell). Farberg said that, unfortunately, people often ignore early signs and detection which can result in a deadlier outcome. “I recommend performing a selfskin check every month,” Farberg said. “Using a handheld mirror to assist, examine every inch of your skin – it doesn’t take more than a couple minutes. You are looking for the ABCDE’s of melanoma, or spots that are bleeding, crusting, painful, or changing.” He also recommends that family practice physicians and nurses carefully check patients for signs of skin cancer. “The skin is quick and easy to examine during a routine physical,” Farberg said. “Even with self-skin checks, it can be incredibly valuable for a physician to help identify areas of concern and recommend they see a dermatologist.” The evolution of treatments in acne has greatly impacted the field in a positive patient-centric way. Farberg said although there are a lot of over-the-counter acne treatments and internet skincare fads, it is important to see a dermatologist directly to address initial concerns which arkansasmedicalnews

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will get you on the right path to clearer skin. The field of dermatology reaches far beyond cosmetics and acne. And patients don’t have to get on a long waiting list to be seen. “We are available to help any time and see same day appointments,” Far-

berg said. He is accepting patients at locations in Little Rock, North Little Rock, Conway, Stuttgart and Russellville. Farberg has published more than 50 articles in professional medical journals on topics including skin cancer, surgery, sun-protection/sunscreen, aesthetic treatments, regenerative medicine, and molecular testing in cancer. While in New York, he served as a consultant dermatologist for the New York Yankees. Farberg has been a clinical investigator on several studies including FDA clinical trials. He has been recognized with numerous awards and honors, including taking first place on several occasions at regional and national medical conference competitions. He was lead editor for the October 2017 edition Dermatologic Clinics, a scientific journal that is published quarterly covering a diverse array of dermatology topics including covering technologies in the diagnosis of skin cancer. The full citation is Farberg AS, Rigel DS: Non-Invasive Technologies for the Diagnosis of Skin Cancer. Dermatologic Clinics. Elsevier. Oct 2017.

Farberg grew up in Wilmette on the North Shore of Chicago, Ill. A summa cum laude graduate of Emory University, he received his medical degree at the University of Michigan. Post graduate training included additional time at the University of Michigan in plastic and reconstructive surgery and, in New York, as a clinical research fellow in association with the National Society for Cutaneous Medicine and New York University. He completed a residency in dermatology at the Icahn School of Medicine at Mount Sinai Hospital in New York where he served as chief resident. He volunteers his time by mentoring several colleagues across differing medical fields and sharing experiences within his academic and professional career. Farberg is married to his best friend, Jessie. They recently welcomed their first baby, Amelia, born in February. They also have a Rhodesian Ridgeback dog named Archie. They are enjoying a lot of family time together and love exploring new restaurants and taking hikes up Pinnacle Mountain. Farberg and his wife are excited to be new Arkansans and look forward to following the Arkansas Travelers and the Hogs, besides his hometown Chicago Cubs. They have been enjoying getting to know their new state. “It’s a beautiful state that’s filled with kind, thoughtful, and generous people from all walks of life,” he said.

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New Study Looks at Cost Impact of OTC Birth Control, continued from page 1 out-of-pocket costs, more than 12.5 million adults and 1.75 million teens reported likely use of an OTC progestin-only pill if available. Among adults, this resulted in an estimated 8 percent decrease in unintended pregnancy in one year. Adult and teen women on average were willing to pay $15 and $10, respectively, resulting in 7.1 million adult and 1.3 million teen users and an estimated 5 percent decrease in unintended pregnancy among adults.” Lead author Alexandra Wollum, MPH, senior project manager with Ibis Reproductive Health, noted, “These results show that an over-thecounter, progestinonly birth control pill at a low or no out-ofpocket cost has the potential to decrease unintended pregnancy Allie Wollum rates and expand access for people of all ages.” Improving affordable, equitable access to healthcare is a timely topic with experts at the International Monetary Fund projecting a nearly 6 percent con-

traction in the U.S. economy in 2020. In the wake of layoffs resulting from COVID-19 business closures, more than 26 million Americans filed for unemployment over a five-week period between March and April, wiping out nearly a decade’s worth of job gains and decreasing access to employer-sponsored insurance coverage. “The findings of this study are particularly important in the middle of the public health crisis we’re facing now,” said Wollum. “As people struggle with mounting job losses and economic insecurity as a result of the COVID-19 pandemic, they must be able to obtain an affordable birth control pill over the counter to control their reproductive health. This study highlights the need for low or no out-of-pocket cost progestin-only birth control pills that are available over the counter to better meet people’s healthcare needs.” “This study shows that people are willing to pay something out-of-pocket for the convenience of getting progestin-only pills over the counter,” added co-author Dan Grossman, MD, professor in the Department of Obstetrics, Gynecology and Reproductive Science at the University of

California San Francisco and director of Advancing New Standards in Reproductive Health (ANSRH) at UCSF. “But in order to best meet people’s needs and help them plan their fertility, over-the-counter pills should be fully covered by insurance without co-pays and available at a very low cost or no cost for those without insurance,” An earlier study published in February 2015 in the journal Contraception demonstrated affordability as a key factor for using OTC oral contraceptives among low-income populations. However, that study – led by Diana G. Foster, PhD, of ANSRH and co-authored by Grossman – did not use data that specifically looked at progestin-only pills (POP) in comparison to combined oral contraceptives (COC), which use both estrogen and progestin to prevent unintended pregnancies. While there are a wider choice of prescription COC options compared to prescription POPs (also known as the minipill), both are effective forms of contraception if taken appropriately. The new study specifically looked at the POP option, which has garnered growing consensus among industry groups as the more likely version

to gain FDA approval to become the first oral contraceptives available without prescription. The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion highlighting barriers to access as one of the key reasons women don’t use contraceptives consistently. Furthermore, the committee also found cost to be part of the larger access issue. “Pharmacist-provided contraception may be a necessary intermediate step to increase access to contraception, but over-the-counter access to hormonal contraception should be the ultimate goal,” the opinion states. In addition to OTC oral contraceptives, ACOG has also called for similar access to vaginal rings, the contraceptive patch and depot medroxyprogesterone acetate injections without age restrictions. The Jacobs Institute of Women’s Health was founded in 1990 and is part of the Milken Institute School of Public Health at George Washington University in Washington, D.C. Women’s Health Issues focuses on research related to women’s healthcare and related public health policy.

for patients, while teaching them to make the best decisions for themselves and their families. She has been named Best OB-GYN by Little Rock Family Magazine and AY Magazine, and has been included on the national Best Doctors, Inc. list since 2005.

the state’s medical students. “It’s been so exciting to support projects the students really want to do,” she said. That includes learning medical Spanish through LULAC (League of United Latin American Citizens), and planting a garden to gift patients with fresh, free produce at Harmony Health Clinic, which provides Little Rock’s underserved with medical and dental care.

it may not be my calling. At the end of the day, no one says they wish they spent more time at work. It’s tough to make those decisions.” Chandler credits her ability to remain flexible to the support of her husband, Little Rock dentist Jeffrey Chandler, DDS, whom she married her first year of medical school.

The Balancing Act Chandler’s interest in women’s health grew when Benton OB-GYN and family friend, the late Robert “Tony” Council, MD, allowed her to job shadow. Following high school, Chandler majored in chemistry at Hendrix University before earning her doctorate at the University of Texas Southwestern Medical School in Dallas, and completing her residency at the University of Arkansas for Medical Sciences. Cornerstone Clinic for Women In 1997 Chandler joined Cornerstone Clinic for Women, a Little Rock practice that now includes seven physicians and nine APRNs. Chandler demonstrates her commitment to integrative care by training her team on hormone management, nutrition supplements and providing individualized, excellent care

PCMS Chandler also serves as president of the Pulaski County Medical Society, where she’s focused on educating members about and promoting Safe Surgery Arkansas, a coalition of medical doctors with years of experiences in eye surgery who are challenging Act 579 of 2019. The coalition includes members from the Arkansas Ophthalmological Society and the Arkansas Medical Society. She’s also committed to creating healthcare leadership opportunities for

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A balancing act As part of her personal commitment to integrative and preventive health, Chandler also is passionate about encouraging others to maintain a healthy work/family balance, and strives to hit the mark herself. “As providers, so many things are pulling on us, from more documentation to changing EMRs,” she said. “There are things we love about those, but it also means I’ve hired more personnel to help alleviate that stress. I love my work and what I do, but I’ve also got my family and have had to make some tough decisions.” One of Chandler’s toughest professional decisions came in 2006, when she made the difficult choice to stop practicing obstetrics. “I went into OB because I loved delivering babies, but I also had four children and was missing things with them by being on call,” she said. “It was also affecting my personal health, but I didn’t want to let my partners down.” Today, Chandler has found that balance, and has grown to love the surgical and clinical aspects of gynecologic care – as well as family meals and a good night’s sleep. “I’m constantly figuring out which things I need to do and finding my niche and my calling,” she said, referencing the “80/20 rule.” “When I see a need I want to do it, but just because there’s a need

Care in the time of COVID-19 Chandler also addressed unique challenges facing healthcare providers in 2020. Under her leadership, PCMS has made a contribution to the Little Rock Cares COVID-19 Emergency Relief Fund, which is being used to provide PPE for Pulaski County healthcare workers and first responders as well as providing meals. As a board member of the Arkansas Medical Society, Chandler also is helping providers navigate unprecedented challenges. “The AMS has done a fantastic job of helping physicians throughout the state navigate all the challenges of caring for patient during COVID-19, including telehealth, getting needed PPE and much more,” she said. Looking forward Chandler also is committed to reaching her goals, both personally and professionally. She hopes to expand her work in hormone therapy, grow her practice and host community events to educate the public on healthcare issues related to domestic violence, sex trafficking, nutrition and overall health. “Every day I’m striving to be the healthiest me I can be, from diet and exercise to spiritual enrichment, sleep health and quiet time,” she said. “I also want to be my best at helping others, including my family and patients, be the best they can be.” arkansasmedicalnews

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Utilizing Telemedicine in Your Practice During the Pandemic and Beyond Is extensive use here to stay? By JUSTIN JOY, JD, CIPP

Telemedicine use has skyrocketed during the COVID-19 health crisis: Is it here to stay? Prior to the COVID-19 pandemic, the vast majority of patients were unfamiliar with telemedicine, and relatively few medical practices offered any form of virtual care. According to a J.D. Power report released in late 2019, only 10 percent of U.S. healthcare consumers had used telehealth services. Fast forward to March 2020 and across the nation, telemedicine has become a lifeline connecting practices to their patients. As of April 2020, the research company Forrester predicts there will be more than 1 billion U.S. virtual care visits in 2020. The company went as far to state it expected “time and resource constraints to create a supply crisis for virtual care during the pandemic.” Many medical practices have embraced telemedicine to deliver high-quality care to their patients during a time when the dynamics of office visits have dramatically changed. Whether a medical practice is new to telemedicine, or a group has recently expanded its use of the technology, like other areas of healthcare, practices must be aware of and focus on numerous laws and regulations, liability risk, and patient expectations. As part of continuously improving their virtual care offerings, practices should develop telemedicine policies and procedures, which may include checklists, to help assure that all regulatory requirements are met at each visit for the applicable jurisdiction. These regulatory requirements vary from state-to-state and address things such as telemedicine encounter documentation requirements, consents, patient and provider identification, and providing virtual care to minors. Practices must also be aware of licensure and HIPAA privacy and security requirements. In recognizing the value of telemedicine as means to keep patients and providers connected safely at a distance, states across the country, as well as federal agencies, have made numerous— albeit temporary—changes to encourage the use of telemedicine. Changes in state licensing requirements and federal privacy and security standards have eased several administrative burdens on telemedicine deployment. The Federation of State Medical Boards has maintained an updated catalog of COVID-19 related state waivers and modifications for telehealth. It is expected, however, that these interim emergency provisions will revert when no longer justified, and the normal requirements will apply once again. Practices should familiarize themselves with the applicable standing laws and regulations in anticipation of the cancellation of these modifications once the current health criarkansasmedicalnews

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sis subsides. One of the more important aspects of a telemedicine visit, especially for a new office patient, or an existing patient who is new to telemedicine, is appropriately educating the patient about telemedicine before the visit begins. While there are some similarities to the traditional informed

consent process for a medical procedure, where risks, benefits, and alternatives are discussed with the patient, obtaining a patient’s informed consent for a telemedicine visit is just as much an exercise in expectation management as it is meeting a legal requirement. Where technology permits, obtaining a patient’s informed consent

for telemedicine should be done in writing by way of an informed consent form, including capturing the patient’s written acknowledgment on the document. After obtaining the patient’s written consent, the provider or assistant should confirm whether the patient has any questions (CONTINUED ON PAGE 6)

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GrandRounds Burke Therapeutics Signs Exclusive Marketing and Supply Agreement with Coeptis Pharmaceuticals for Consensi® HOT SPRINGS — Burke Therapeutics, a commercial stage pharmaceutical company, has announced it has signed an exclusive marketing and supply agreement with Coeptis Pharmaceuticals, Inc. for the U.S. market. Burke will market the fixed-dose combination drug, Consensi®, a prescription medicine for adults who need both treatment with amlodipine for hypertension, to lower blood pressure, and celecoxib for the management of the signs and symptoms of osteoarthritis. Commercial launch is anticipated in June of 2020. Consensi is a fixed-dose combination of amlodipine besylate, a calcium

channel blocker for the treatment of hypertension, to lower blood pressure, and celecoxib, a nonsteroidal anti-inflammatory drug (NSAID) for the management of the signs and symptoms of osteoarthritis. The U.S. Food & Drug Administration (FDA) approved Consensi oral tablets for marketing on May 31, 2018. Consensi is indicated for adult patients for whom treatment with both amlodipine for hypertension and celecoxib for osteoarthritis are appropriate. Amlodipine is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal CV events, primarily strokes and myocardial infarctions. Celecoxib is indicated for the management of the signs and symptoms of osteoarthritis.

Utilizing Telemedicine, continued from page 5

about the form that was electronically signed. It should be noted in the visit record that all questions were answered or that the patient did not have any questions. In instances where the communication technology used for the telemedicine visit does not have the capability of transmitting a written consent form or capturing the patient’s written acknowledgment on the form, a verbal consent is acceptable, recognizing the verbal discussion, and documentation of that verbal discussion, is paramount. In addition to covering some of the risks of telemedicine that are not present in the office setting, such as the possibility of being unable to adequately assess the patient’s condition due to camera resolution or lighting limitations, disruption of the audio/visual telecommunication connection or other equipment failure resulting in abrupt discontinuation of the visit, patients need to understand that by participating in a virtual visit, there is no guarantee they will receive a prescription or other medical order. While some visits are more susceptible to these unrealistic expectations than others, patients need to appreciate at the outset that their provider will use his or her professional judgment to determine whether telemedicine is appropriate for the visit, and determine whether the technology is capable of allowing the provider to properly assess the patient to render a diagnosis and develop a plan of care. In some cases, such a determination cannot be made until the provider has begun the evaluation of the patient and reached a conclusion that the patient cannot be properly assessed remotely, necessitating an in-person visit or a referral elsewhere. If patient expectations are not adequately managed, this can lead to patient disappointment and frustration, either because the visit was not covered by insurance or for cost-sharing responsibility, particularly if patient payment for the service is expected. Much of this friction can be reduced by providing patients with adequate information that properly shapes 6

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their expectations for care and payments before the visit begins. Changes by the Centers for Medicare and Medicaid Services (CMS) and many commercial payers have greatly expanded reimbursement for telemedicine services during the pandemic. As a result of these changes and emergency modification of state laws, in recent months, many patients have used telemedicine for the first time. As patients become increasingly accustomed to and comfortable with virtual visits, the desire by patients to remotely consult with their providers where appropriate is likely to grow in the future. If reimbursement remains generally available for telemedicine, patient demand will likely result in higher telemedicine adoption and utilization rates in the private practice setting. For medical practices who have recently deployed or significantly expanded the use of telemedicine during the health crisis, now is the time to identify and continue to develop best practices in providing virtual care. Beyond the obvious in establishing and maintaining legal compliance with applicable state laws and regulations, practices should be persistently thoughtful about improving patient experience and efficiencies in delivering care by way of telemedicine. In doing so, practices are putting themselves in the best position to increase patient satisfaction, maximize revenue, and reduce liability risk. Detailed information about telehealth, particularly during the COVID-19 crisis, is available on SVMIC’s COVID19 Resource Center. Justin Joy is an attorney with Lewis, Thomason, King, Krieg & Waldrop, P.C., and is Lewis Thomason’s chief privacy officer. He has a variety of experience in the area of information privacy and cybersecurity including security incident investigation, security awareness and policy drafting, cyber risk management including insurance policy coverage consultation and breach response management. He also provides counsel in healthcare liability defense and healthcare compliance matters. Justin has earned the Certified Information Privacy Professional/United States (CIPP/US) credential through the International Association of Privacy Professionals (IAPP).

Dawn Hannah, DNP, APRN, Joins Washington Regional Emergency Department FAYETTEVILLE — Heather “Dawn” Hannah, DNP, APRN, AFN-BC, FNPBC, recently joined the Washington Regional Emergency Department. Hannah earned a Doctorate of Nursing Practice and a Master of Science in Nursing from Arkansas State Dawn Hannah University and a Bachelor’s of Science in Nursing from Baptist College of Health Science. She is a member of the American Nurses Association and International Association of Forensic Nurses.

Melanie Edens Accepts COO Position at NEA Baptist JONESBORO - Melanie Edens has accepted the role of Chief Operating Officer for NEA Baptist Health System. Formerly Associate Administrator, Edens has served various positions at NEA Baptist throughout her over 20-year tenure. She holds a Bachelor’s of Melanie Edens Science in Radiologic Sciences, and an M.B.A. from Arkansas State University. She has been recognized as an Outstanding Alumnus of ASU’s College of Nursing and Health Related professions as well as the ACHE’s Early Career Award for Healthcare Executives. In her new role, Edens will oversee all operations at NEA Baptist Clinic in addition to a wide range of hospital departments. This new role will continue to empower NEA Baptist to offer the most integrated health system in the region.

Baptist Health-UAMS Family Medicine Residency Program Receives Full 10-Year Accreditation LITTLE ROCK — The Baptist Health-UAMS Family Medicine Residency program has received a full 10year accreditation from the Accreditation Council for Graduate Medical Education (ACGME). The program was started in 2019 to provide more positions to train medical school graduates and address the physician shortage in Arkansas, especially in rural areas. Studies show that physicians are more likely to practice close to where they did their residencies: 75% stay within 75 miles of where they trained. The family medicine residency launched in summer 2019 and trains up to 12 residents per year over the course of the three-year program. Twelve new residents have matched into the program for 2020 and will begin in July. When full of trainees at the three-year

point, it will be one of the larger family medicine residency programs in the nation. In a further sign of dedication to the project, Baptist Health opened a new building in January 2020 in North Little Rock built specifically for the medical education program. Julea Garner, MD, of UAMS is program director of the Family Medicine Residency. She said the 10-year accreditation drew only positive remarks from the accrediting agency. The review committee said it was evident from touring the program that this was a huge collaborative effort from top to bottom at both institutions, and the commitment to the program on all sides was evident according to Garner. While Arkansas graduates a large number of medical students, there are not enough residency slots for those students to stay in Arkansas. Projects like this Baptist-UAMS partnership aim to address that gap.

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GrandRounds Johnson Joins Baptist Health Neuroscience Center-Fort Smith FORT SMITH – Arthur Johnson, MD, recently joined Baptist Health Neuroscience Center-Fort Smith. Dr. Johnson is a board-certified neurosurgeon with more than 30 years of experience. He has practiced medicine in the River Valley since 1998. His Arthur Johnson services include minimally invasive spine surgery, as well as surgery of the neck, brain and back. Dr. Johnson earned his medical degree from the University of Mississippi School of Medicine. Prior to coming to Arkansas, Dr. Johnson was in the Air Force and served as a staff Neurosurgeon and Lt. Colonel for the 59th Medical Wing of the Wilford Hall Ambulatory Surgical Center in San Antonio, Texas. Baptist Health Neuroscience Center-Fort Smith is located inside the Baptist Health Medical Plaza at 1500 Dodson Ave. Mohammad Owais, MD, and Elizabeth Holmes, APRN, also provide care at this location.

Samar Qedan, APRN Joins Walker Heart Cardiovascular Clinic FAYETTEVILLE — Samar Qedan, APRN, recently joined Washington Regional Walker Heart Cardiovascular Clinic where she provides care to patients with acute and chronic cardiovascular conditions. Qedan earned a Master of Science in Samar Qedan nursing from the University of Arkansas for Medical Sciences and a bachelor’s degree in nursing from the University of Arkansas. Qedan is an adult gerontology acute care nurse practitioner and has more than five years of cardiology experience in hospital and ambulatory settings.

CHI St. Vincent Enrolls Country’s First Patient in PROACT Xa Clinical Trial LITTLE ROCK - CryoLife, Inc., a leading cardiac and vascular surgery company focused on aortic disease, announced it has initiated enrollment in the PROACT Xa clinical trial to determine if patients with an On-X mechanical aortic valve can be maintained safely and effectively on apixaban (Eliquis®) rather than on warfarin. Pat Mackin, Chairman, President, and CEO of CryoLife, said, “We are pleased to announce that the first patient in our PROACT Xa clinical trial has been enrolled at CHI St. Vincent Heart Institute…Under the PROACT Xa trial, we will study the use of apixaban in patients with the On-X Aortic Valve, the first and only mechanical aortic heart arkansasmedicalnews

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valve to receive both FDA approval and the CE Mark for labeling to permit use with a reduced warfarin dosage, based on results of the original PROACT trial that demonstrated a greater than a 60 percent reduction in bleeding events without increased risk of stroke. Despite the ongoing COVID-19 pandemic, many institutions are continuing to enroll patients in important clinical trials. As a result, if the trial meets its endpoints, we believe we can still achieve FDA approval for the use of apixaban with the On-X Aortic Valve in 2024.” Patients with mechanical heart valves are anticoagulated with warfarin which requires routine blood testing to manage their INR (International Normalized Ratio) within a certain range to minimize the likelihood of bleeding and stroke. Despite multiple studies showing that tissue valves are associated with worse outcomes, including higher reoperation rates compared to mechanical valves, younger patients sometimes opt for a tissue valve to avoid the need to take warfarin due to its side effects. Providing an alternative to warfarin, such as apixaban, gives younger patients a strong incentive to choose an On-X Aortic Valve with greater durability, generally better long-term survival and better clinical outcomes. Dr. Thomas Rayburn III, MD, CHI St. Vincent Heart Institute, said, “The CHI St. Vincent Heart Institute is pleased to be the first site in the United States to take the next step in this important research. We look forward to answering this vital clinical question and are especially excited that we can continue to collaborate remotely using telehealth technologies to maintain momentum at this time. Our role in this important research is indicative of CHI St. Vincent’s healing ministry and commitment to delivering the most advanced, compassionate care to our communities.” The PROACT Xa trial consists of approximately 1,000 participants. Participants will be randomized to either continue warfarin or switch to apixaban. Each participant will be followed for at least 2 years.

UAMS Graduates 914 Health Care Professionals LITTLE ROCK – Degrees and certificates were conferred to 914 graduates of the University of Arkansas Medical Sciences’ (UAMS) five colleges and graduate school. Because of the COVID-19 pandemic, no commencement ceremony was held. Degrees were awarded to 165 in the College of Medicine, 255 in the College of Nursing, 112 in the College of Pharmacy, 67 in the Fay W. Boozman College of Public Health, 257 in the College of Health Professions, and 58 in the Graduate School. Degrees and certificates conferred include the doc 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 and a variety of degrees in allied health disciplines including certificates, associate and bachelor of science degrees, postbaccalaureate certificates, master of communication sciences and disorders, master of genetic counseling, master of physician assistant studies, doctor of audiology and doctor of physical therapy.

Conway Regional Health Foundation Receives Blue & You COVID-19 Relief Grant CONWAY – The Blue & You Foundation for a Healthier Arkansas has awarded Conway Regional Health Foundation with a $150,000 grant as part of its Rapid-Response COVID-19 Relief program. In addition to Conway Regional, six additional grants were awarded to recipients throughout the state. The program has now funded $1.7 million in grants to organizations in Arkansas working to prevent the spread of COVID-19 or helping communities deal with its effects. The $150,000 grant will aid Conway Regional in providing lifesaving treatment, protecting the system’s healthcare workers, and minimizing community risk by creating a 26-bed critical care unit with 24 isolation rooms installed with new air-filtration systems and cameras. In addition to Conway Regional, grant recipients include Mercy Health Foundation in Fort Smith, Drew Memorial Hospital in Monticello, Centers for Youth and Families in Little Rock, City of Eureka Springs, Madison County Medical Group in Huntsville, and Nevada County in Prescott. These recipients received the third-round of Rapid-Response COVID-19 Relief Grants awarded by the Blue & You Foundation.

Depression, Anxiety Relieved with Free Cell Phone App LITTLE ROCK – A cell phone app designed to treat depression showed a dramatic reduction in symptoms compared to those who relied on other methods or received no treatment at all, according to a recent University of Arkansas for Medical Sciences (UAMS) study. The results of the study were published earlier this month in the American Medical Association’s JAMA Psychiatry journal. The Intellicare app was developed by a research team at Northwestern University and tested by participants recruited by UAMS researchers led by Carolyn Greene, PhD, of the UAMS Psychiatric Research Institute’s Center for Health Services Research. Intellicare is actually a suite of apps that use interactive design and tasks to lead patients through cognitive behavioral therapy exercises to treat depression and anxiety.

Participants included 146 Arkansans of varying age, ethnic and financial backgrounds who were referred to the study after taking a standard depression screening. Data from Greene’s study showed that people using Intellicare had significantly faster improvement and greater reductions in depression and anxiety compared to those who did not use the app. Fifty-nine percent of those with depression and 57 percent of those with anxiety reached a full recovery and were still recovered through a four-month follow-up period. None of the people involved were already receiving therapy for depression according to Greene, a clinical psychologist. For the eight weeks they relied on the apps, some helped them recognize negative thoughts while others offered relaxation exercises. The only human interaction they had was with the coaches who were texting them to help them meet specific goals. Greene worked with researchers at Northwestern to analyze the data collected during the study. She is encouraged by the users’ response to the apps and hopes they will be beneficial during health crises like the current COVID-19 pandemic. This project was supported by the UAMS Translational Research Institute, Clinical and Translational Science Award U54 TR001629, through the National Center for Advancing Translational Sciences at the National Institutes of Health.

Pioneering UAMS Study Warns of CBD Supplements’ Harm to Gut Health LITTLE ROCK – Researchers at the University of Arkansas for Medical Sciences (UAMS) and the University of Mississippi are warning in the first study of its kind that CBD supplements in high doses can be harmful to the gut microbiome. The study, “Potential Probiotic or Trigger of Gut Inflammation – the Janus-Faced Nature of Cannabidiol-Rich Cannabis Extract,” is published in the Journal of Dietary Supplements. While sales of cannabidiol (CBD) have skyrocketed, little is known about its potential side effects, said UAMS’ Igor Koturbash, MD, PhD, the study’s senior author and principal investigator. Cannabidiol significantly affects the gut microbiome, which in turn may affect the mucosa according to Koturbash, associate professor in the College of Public Health, Department of Environmental and Occupational Health, and co-director of the Center for Dietary Supplements Research. In low doses, it may potentially improve gut health as a probiotic, but in high doses it can cause leaky gut syndrome. Koturbash said the study’s findings point to the need for clinical trials to determine the safest, most effective CBD dosages for people.

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GrandRounds Arkansas Medical Society Elects Officers LITTLE ROCK - The Arkansas Medical Society (AMS), a physician group advocating for health care improvements statewide, recently elected new officers who will help lead the organization in 2020 and 2021. Little Rock Pediatrician Chad Rodgers, MD, FAAP, has been named president of the Arkansas Medical Society (AMS) effective May 1, 2020, and will lead the physician advocacy group the remainder of 2020 and in 2021. Dr. Rodgers has been in private practice pediatrician Chad Rodgers for 19 years at Little Rock Pediatric Clinic. He also serves as the Chief Medical Officer for Arkansas Foundation for Medical Care. He has been active in organized medicine for over two decades dedicating time to the Arkansas Medical Society, the Arkansas Chapter of the American Academy of Pediatrics (AAP), and the National AAP. He spends much of his time in child advocacy as well as patient health literacy, preventive health, and Trauma Informed Care. When determining his agenda for the upcoming year, Dr. Rodgers initially wanted to focus on self-care for physicians, as he is personally and professionally passionate about the topic. Other newly-elected leaders include President-Elect Danny Wilkerson, MD (Little Rock); District Trustees Garry Stewart, MD (Conway); Mark Ramiro, MD (White Hall); Mark Wren, MD (Texarkana); Jennifer Doyle, MD (Little Rock); Amanda Novack, MD (Little Rock); Joshua Hagood, Student Trustee (UAMS – Little Rock). These physicians will work to continue the medical society’s mission of improving Arkansas health care through legislation, education, and the day-today support of patients and medical practices. Significant legislative advances for Arkansas patients and physicians supported by AMS in the past also include: establishing a statewide trauma system, passage of the Clean Indoor Air Act, funding tobacco prevention and cessation programs, funding cancer research, providing vision screening in schools, and protecting an Arkansan’s right to choose their physician through “Any Willing Provider” legislation. During the COVID-19 pandemic, the Arkansas Medical Society has been instrumental in securing and distributing PPE to medical clinics across the state, as well as working with insurance carriers on telemedicine payment issues and advocating for physician liability protections during the emergency. The Arkansas Medical Society is a voluntary professional association, established in 1875, representing more than 4,300 physicians, residents, and medical students, as well as the patients and communities they serve.

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Profile for Medical News

May-June 2020 Arkansas Medical News  

your primary source for professional healthcare news

May-June 2020 Arkansas Medical News  

your primary source for professional healthcare news