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Cross-specialty Partnership Group Fights GERD By Ann B. DeBellis

New Laser Surgery for Epilepsy An epilepsy diagnosis will change a person’s life ... 4

The Office for Civil Rights Announces Additional Help with Fighting COVID-19 On January 19, 2021, the Office for Civil Rights (“OCR”) at the U.S. Department of Health and Human Services (“HHS”) announced that it will exercise its enforcement discretion and will not impose penalties for violations of the HIPAA Rules in connection with the good faith use ... 6

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Recent studies have found that up to 28 percent of Americans suffer from gastroesophageal reflux disease (GERD). Many of these people have to deal with daily heartburn, regurgitation and other symptoms such as chronic cough and hoarseness. When left untreated, GERD can contribute to the onset of a serious disease like esophageal cancer. Unfortunately, many GERD patients are not satisfied with current treatment options. With this in mind, Brookwood Baptist Medical Center has become the first hospital in Birmingham to offer a comprehensive team approach for treating the anatomical problems associated with GERD. Gastroenterologist Raj Parikh, MD, of Birmingham Gastroenterology and Brookwood general surgeons Brenden Haikes, MD, and Cameron Askew, MD, have joined together in the new surgical approach with cross-pollination (CONTINUED ON PAGE 3)

Brenden Haikes, MD in surgery

Prescott Atkinson, MD, PhD Honored as Avocational Paleontologist By Marti Webb Slay

T. Prescott Atkinson, MD, PhD has a lifelong love of biology, a passion that led him to his career as a pediatric allergist at Children’s of Alabama, and kindled his avocation in paleontology. His dedication to that hobby has resulted in Atkinson receiving the first-ever Alabama Avocational Paleontologist Award from the Alabama Museum of Natural History and the Department of Museum Research & Collections, both of which are part of the University of Alabama Museums. Atkinson has spent five decades collecting and donating thousands of fossils to multiple museums, including verte-

Excavating the bones of a mosasaur, a large Cretaceous marine reptile,at the UA Museum’s Harrell Station field site near Selma.

brates, invertebrates, plants, and tracks. He has made a number of interesting discoveries in Alabama, including a Late Cretaceous dinosaur egg from Harrell Station and rare insect wings from the Pennsylvanian of northern Alabama. He also played a key role in the preservation and management of the Stephen C. Minkin Paleozoic Footprint Site (Union Chapel Mine) in Walker County. Atkinson serves on the Board of Regents for the University of Alabama Museums. “They have a very substantial (CONTINUED ON PAGE 3)

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Prescott Atkinson, MD, PhD, continued from page 1 paleontology collection at the Museum of Natural History in Tuscaloosa. This award was established to try and foster paleontology in the state and encourage amateurs to go out and look for things and contact people at the museum. Occasionally very important specimens have been found by amateurs. They just have more eyes out there,” he said. “I’ve always been interested in biology,” said Atkinson. “The study of fossils is really the study of ancient biology. I’m interested in natural history of all stripes, including non-biological subjects such as geology and astronomy. But I’ve always been drawn to biology and was a biology major in college.” After serving six years in the Navy, Atkinson chose medicine as his career, because he felt “it was a way to follow my interests and do some good for people at the same time.” But his love for fossils has remained with him for life. He grew up hunting fossils in the Montgomery area, finding sharks teeth

At a dinosaur dig with the Bighorn Basin Paleontological Institute in southern Montana.

by walking creeks with his friends. Under the guidance of a professor of biology at Auburn University, James Dobie, Atkinson and his friends visited sites and learned more about fossils as teenagers. Now, as vice president of the Alabama Paleontological Society, Atkinson continues to study, visit sites and organize speakers in order to pass that

knowledge along to others, as the Auburn professor did for him. “When you take groups of kids out, you may spark an interest that will last a lifetime,” he said. “It may be like it is for me: an avocation that’s really lifeenriching. It may change the course of their life for the better.” Atkinson said he was honored to receive the award for his work. “I was totally shocked. It was the first year the award was given, and I didn’t know anything about it. I hope it stands as an encouragement for amateurs to know they can go out and make a difference in the science of geology and paleontology by interacting with professionals. Not everyone can be a museum curator or a professional paleontologist, but almost anyone can go into amateur paleontology and contribute.” He stressed the importance of the work by non-professionals, when they work with experts, and for seeking advice about whether to donate a specimen to a museum or keep it in a private collection.

“Not all fossils need to be in museums,” he said. “But if they are scientifically important -- a one-of-a-kind fossil or one of very few, or a spectacular example of a relatively common fossil – the best way to preserve them is to donate them to a museum. The professionals cannot really publish findings related to a specimen from a private collection. Other scientists need to be able to come and inspect a collection, which isn’t a guarantee in a private collection.” His decades of pursuing this avocation have not dented his passion for the subject. “Even common sharks teeth are so beautiful,” he said. “To look at it and realize how old it is and how long ago the animals that these teeth came from were swimming around in the ocean, it gives me a real thrill. When you find something like that and you hold it in your hand, you realize you are the first person in the world to ever look at this particular piece, and that goes for whether it’s a common fossil or something relatively rare and unique.”

Cross-specialty Partnership Fights GERD, continued from page 1 of specialties to mesh their knowledge and expertise for fighting GERD. Parikh points out that while the surgical procedure for GERD is not new, the cross-specialty partnership between these physicians is. “This collaboration provides expertise from both the GI and general surgery perspectives,” he says. Askew and Haikes repair the hernia and Parikh follows directly with an endoscopic Transoral Incisionless Fundoplication (TIF) procedure. “The TIF procedure has been around for over 10 years, but with the combination of Dr. Parikh’s TIF 2.0 procedure and the hiatal hernia repair done by me and Dr. Haikes, we are seeing better outcomes and fewer side effects,” Askew says. “We no longer do the traditional surgical wrap due to the high side effect profile.” Haikes says that 60 percent of the population over the age of 50 has a hiatal hernia but only 10 percent are symptomatic or have reflux or dysphagia. “If you think about it, that’s still a large number of patients in the population of 300 million Americans. It’s still a prevalent disease,” he says. “Due to a nationwide increase in obesity, we are seeing a higher incidence of hiatal hernias and reflux disease which is directly proportional to weight gain.” For patients who present with both GERD and a hiatal hernia smaller than two centimeters, laparoscopic hiatal hernia repair may be performed immediately prior to the endoscopic TIF procedure. The hiatal hernia repair plus TIF procedure can be performed in the same anesthesia setting should patient anatomy dictate repair of both a hernia and the anti-reflux valve.

These patients are often a high risk for esophageal cancer. “We do frequent surveillance endoscopies to keep an eye on patients to see if they develop cancer,” Parikh says. “With the advent of HALO with radiofrequency ablation, we burn suspicious cells to try to avoid a morbid surgery. Our goal is always to improve the esopho-gastric (EG) valve.” The EG valve should be one-way, but with reflux it becomes a two-way valve. “Not only does liquid go down, but it also comes up. If we can repair that valve, which is the goal of these surgeries, it is still useful,” Parikh says. “There are a variety of techniques to fix

reflux, but our goal is to do something less invasive with fewer long-term side effects, if possible.” “The impact of TIF 2.0 is better for patients,” Haikes says. “It has less impact on the stomach by not reducing the gastric volume or altering normal anatomy as much as a traditional fundoplication. Sometimes patients have gas trapping and more difficulty with dysphagia long-term, but with TIF, most patients have less dysphagia.” Parikh says the Birmingham program is growing rapidly, and patients are already coming from as far as south Alabama. “TIF has been around for

eight or nine years, but it is becoming more mainstream. We are getting the word out. Surgeons are looking at gastroenterologists to do these procedures less invasively, and we are repairing small perforations with stents, new clips, and other devices we have now,” he says. “If we can do something to fix a complication or do something less invasive to prevent a big surgery, it is certainly a goal for both gastroenterologists and surgeons. The TIF 2.0 procedure allows me to effectively treat the root cause of moderate to severe GERD and fills the treatment gap between pharmacology therapy and more traditional surgical options.”

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FEBRUARY 2021 • 3


New Laser Surgery for Epilepsy By Laura Freeman

An epilepsy diagnosis will change a person’s life. He loses his legal ability to drive, depriving him of independence. It will affect the type of work she is able to do, maybe end her career dreams, and even restrict the recreational activities she can enjoy. It can become difficult to plan his future since he is limited by a disease that can disrupt his neural functions at any time. Fortunately, for patients whose seizures tend to begin in the same place, preferably in a location not too near critical areas of the brain, surgery may offer hope. However, any open brain surgery comes with its own risk of complications and recovery time. Now a new MRI-guided ablation procedure, laser interstitial thermal therapy (LITT), can often eliminate seizure trigger areas with less risk, a shorter hospital stay and faster recovery. “Laser surgery only requires a tiny incision about the size of a pencil eraser,” UAB neurosurgeon Kirsten Riley, MD, said. “The key is matching the right patient to the right procedure. While in some patients epilepsy is generalized, this procedure is for those whose seizures arise from the same area. We need to be able to precisely identify the tissue to target for ablation. The problem is frequently found in the temporal lobe, though it can be triggered in other areas. We also carefully map the prob-

Kirsten Riley, MD

lem location in relation to areas that control speech, memory, cognitive functions and other critical structures so we can be sure there is a safe margin. “Since the incision is small, risks are lessened and we can expect a faster recovery. Patients also tend to report less post procedure pain. It’s a great option for patients whose epilepsy has a singular-seizure focus.” Candidates for LITT need to be well enough to undergo general anesthesia. Although it doesn’t require removing part of the skull as an open procedure would, an entry point is drilled. A small hollow bolt is then positioned for introducing the laser tip, which can be withdrawn and reintroduced as needed. It also allows the introduction of a steroid medication which will be gradually tapered as the patient recovers. “We guide the laser tip into place and check the exact position with an MRI before and after the procedure,”

LITT surgery offers fewer side effects than traditional epilepsy surgery.

Riley said. “This step will become much easier soon when our new intraoperative MRI is in the operating room and we can bring imaging to the patient rather than transporting the patient to imaging. We continually monitor temperatures in the surrounding tissue as thermal energy from the laser ablates the problem area. “Patients who need the procedure but are uncomfortable with the idea of having brain surgery seem to be more at ease with undergoing a laser procedure. While open surgery has a

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cure rate of 75 percent, laser ablation comes close behind it with a 65 percent success rate and it can be repeated if needed. It can also be followed with an open procedure later in rare cases where it might be indicated.” Before UAB purchased its own LITT equipment, neurosurgeons tested units from each of the two manufacturers who make them, which allowed them to test the capabilities of each and select the best match for their work. “There are only two LITT lasers in Alabama. In addition to our laser, which we use to treat patients 18 and over, Children’s of Alabama also has a unit to treat epilepsy in younger patients,” Riley said. LITT ablation has been used in neurosurgery for a few years in other areas of the country and is likely to become more common here as insurance approves it for more types of procedures. Riley says there is a great deal of interest in using the technique in other types of neurosurgery. “The equipment lends itself to very well controlled procedures. In addition to seizures originating in other areas of the brain, it could be very useful in treating tumors and radiation necrosis,” Riley said. “This is particularly true in difficult areas since it allows more precision and less risk of bleeding when working near tissues responsible for critical neural functions.”

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FEBRUARY 2021 • 5


The Office for Civil Rights Announces Additional Help with Fighting COVID-19 By Jim Hoover

On January 19, 2021, the Office for Civil Rights (“OCR”) at the U.S. Department of Health and Human Services (“HHS”) announced that it will exercise its enforcement discretion and will not impose penalties for violations of the HIPAA Rules in connection with the good faith use of online or web-based scheduling applications (collectively, “WBSAs”) when used for scheduling individual appointments for COVID-19 vaccinations during the COVID-19 nationwide public health emergency. The enforcement discretion takes effect immediately but has retroactive effect to December 11, 2020. The Notification of Enforcement Discretion for Use of Online or WebBased Scheduling Applications during the COVID-19 Nationwide Public Health Emergency may be found at https://www.hhs.gov/sites/default/ files/hipaa-vaccine-ned.pdf. During the COVID-19 national emergency, many covered health care providers, particularly large pharmacy chains and public health authorities,

or business associates acting on the providers’ behalf, are choosing to use a WBSA for the limited purpose of scheduling individual appointments for COVID-19 vaccinations. A WBSA is a non-public facing online or web-based application that provides scheduling of individual appointments for services in connection with large-scale COVID-19

vaccination. It is important to note that for purposes of this enforcement discretion, “non-public facing” means the WBSA allows only the intended parties (e.g., a covered health care provider, the individual or personal representative scheduling the appointment, and a WBSA workforce member) to access data created, received, maintained, or

transmitted by the WBSA. A WBSA does not include appointment scheduling technology that connects directly to the electronic health records system used by the covered entity. During the COVID-19 public health emergency, many health care providers need to quickly schedule large numbers of individuals for appointments for COVID-19 vaccinations and may use WBSAs to schedule such appointments. Some of these applications may not fully comply with the requirements of the HIPAA Rules. Additionally, the vendors of such applications may not be aware that HIPAA-covered health care providers are using the scheduling software. OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with regulatory requirements under the HIPAA Rules against covered health care providers and their business associates, including WBSA vendors, in connection with the good faith use of a WBSA for scheduling appointments for individuals for COVID-19 vaccination during the COVID-19 nationwide public health emergency. (CONTINUED ON PAGE 7)

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The Office for Civil Rights Announces Additional Help with Fighting COVID-19, continued from page 6 The OCR’s Notification also applies to all vendors of WBSAs whose technology is being used regardless of whether the WBSA vendor has actual or constructive knowledge that it meets the definition of a business associate under the HIPAA Rules. However, OCR encourages covered health care providers and their business associates using WBSAs to implement reasonable safeguards to protect the privacy and security of individuals’ PHI. Such safeguards include using and disclosing only the minimum PHI necessary such as the individual’s name and phone number, using encryption technology to protect PHI, enabling all available privacy settings to hide names or show only individuals’ initials instead of full names, and ensuring that storage of any PHI by the vendor is only temporary. OCR’s enforcement discretion does not apply to activities of a covered entity or its business associates other than the scheduling of COVID19 vaccinations. Activities such as the handling of PHI unrelated to the scheduling of COVID-19 vaccinations are not included within the scope of the

enforcement discretion. Additionally, the enforcement discretion does not apply when the covered entity or business associate fails to act in good faith. Examples of failing to act in good faith include the WBSA selling personal information, conducting services other than scheduling appointments for COVID-19 vaccination, a lack of reasonable security safeguards to prevent the PHI from being readily accessed or viewed by unauthorized persons or using the WBSA to screen individuals for COVID-19 prior to individuals’ inperson health care visits. Notwithstanding the restrictions, OCR’s exercise of enforcement discretion with the use of WBSAs for the scheduling of individual appointments for COVID-19 vaccinations should greatly assist the scheduling and administration of vaccines.

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Jim Hoover is a partner at Burr & Forman LLP and works exclusively within the firm’s Health Care Practice Group and predominantly handles healthcare litigation matters.

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MEDICAL CANNABIS

Will Medical Cannabis Pass in Alabama? By Steve Spencer

In November, Mississippi voted to establish a medical cannabis program while New Jersey, Arizona, South Dakota and Montana legalized cannabis for adults over 21, bringing the number of states with some degree of legalization to 35. The Alabama State Legislature plans to consider medical cannabis in this year’s session which began February 2nd. The first medical cannabis bill in Alabama was actually introduced in 2019 by Republican Senator Tim Melson, MD, who serves District 1, which includes Huntsville, Athens and Florence. Melson, an anesthesiologist practicing in Sheffield, was initially opposed to medical cannabis but changed his mind after reviewing research that showed benefits for some patients with chronic pain and other conditions. After the 2019 Senate-approved bill was stalled in the House, lawmakers established a commission to study medical cannabis and make a recommendation to the legislature. The 15-member commission, which included representatives from medicine, law enforcement, addiction treatment, agriculture, pharmacy and others, held several public hearings and examined the regulations of the federal and state governments relating to the medical use of cannabis. In December 2019, the commission voted to support the passage of a bill that would establish a medical cannabis program. This bill again passed the Senate in the spring 2020 session, but the COVID-19 pandemic stymied efforts to bring the bill for a vote in the House. The bill will be re-introduced this year. “SB 165 – the Alabama Com-

Medical cannabis legislation bill will be re-introduced in the Alabama senate.

Will Steineker

passion Act –establishes a process by which a patient with a qualifying condition would see a doctor,” said Whitt Steineker, who is co-chair of Bradley’s Cannabis Industry team in Birmingham. “The doctor will examine the patient, and when appropriate, issue them a physician’s certification which enables them to access a medical cannabis card.

Then they bring the card to a dispensary to fill their prescription.” The qualifying conditions are anxiety or panic disorder; autism; cancerrelated pain, nausea, or weight loss; Crohn’s; epilepsy; fibromyalgia; HIV/ AIDS-related nausea; persistent nausea unrelated to pregnancy; PTSD; Tourette’s; spasticity related to a motor neuron disease, multiple sclerosis, or spinal cord injury; terminal illness; menopause; premenstrual syndrome; intractable or chronic pain in which conventional therapeutic intervention and opiate therapy is contraindicated or has proved ineffective. The bill sets up the Alabama Medical Cannabis Commission to regulate the program. Their duties include creating an electronic registry and issuing medical cannabis ID cards. The commission will also determine the maxi-

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mum daily dosage of THC that can be recommended for each qualifying condition, but the maximum dosage cannot exceed 75 milligrams of THC per day. The Medical Cannabis Commission will license no more than four cultivators, four processors, and four dispensaries, as well as five integrated facilities. Majority ownership in the integrated licenses and cultivator licenses must be by residents of Alabama for at least eight years. Dispensaries cannot locate within 1,000 feet of schools, and their staff must be trained and certified by the commission. The State Board of Medical Examiners will license doctors to participate in the program. In order to be eligible, doctors will need to complete a medical cannabis CME course. It remains to be seen whether or not this bill becomes law. “There are two tailwinds that could help the legislation,” Steineker said. “First, it is a new source of revenue to help cover budget shortfalls because of COVID. The second positive factor is that more states have passed it, including Mississippi. A lot of people were surprised by the overwhelming support in Mississippi, with over 70 percent of the population voting in favor of it. They had it as a ballot initiative. Voters had three choices: to vote no; to vote for the citizen proposal that was put on the ballot by petition; or to vote for a competing medical cannabis proposal put forth by the legislature that was much more restrictive than the citizen proposal. For either the citizen or legislature’s proposals to pass, they had to get over 50 percent of the total votes. And the citizen’s proposal, which again was the more robust proposal, did that. “I haven’t seen any polling in Alabama on the subject, but given the relative similar populations of the two states, it stands to reason that it could have strong citizen support in our state.”


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MEDICAL CANNABIS

What Does the Research Say About Medical Cannabis? By Steve Spencer

In 1988 researchers discovered a collection of receptor sites in the brain that were activated by Tetrahydrocannabinol (THC), which is one of 113 different cannabinoids that have been isolated from the Cannabis plant. A few years later, scientists found the first endogenous cannabinoid neurotransmitters (endocannabinoids), produced by the body, that bind to these receptors and named the complex of receptors and metabolic enzymes the Endocannabinoid System (ECS). Subsequent research has revealed how vast and important this system is in regulating many processes in the body, including immune response, communication between cells, appetite, metabolism, memory, and more. Understanding the Endocannabinoid System (ECS), which includes a set of receptors in the brain and central nervous system (CB1) as well as receptors (CB2) in peripheral organs, is the key to gaining perspective into the health benefits of activating the system through

medicinal cannabis. In that regard, the Laboratory of Physiologic Studies at the National Institutes of Health stated in 2013: “Modulating the ECS activity may have therapeutic potential in almost all diseases affecting humans, including obesity/metabolic syndrome, diabetes and diabetic complications, neuro-degenerative inflammatory, cardiovascular, liver, gastrointestinal, skin diseases, pain, psychiatric disorders, cachexia, cancer, chemotherapy-induced nausea and vomiting, among many others.” The research conducted to date on medical cannabis has led to approval for a number of conditions. For example, Florida has authorized cannabis for over 20 disorders, ranging from chronic pain to epilepsy to Crohn’s disease and irritable bowel syndrome. In regards to chronic pain, cannabis may prove to be a good substitute for opioids. A longitudinal analysis of the number of opioid prescriptions filled under Medicare Part D showed that when medical marijuana laws went into effect in a given state and dispensaries opened, prescriptions for opioids fell

by 3.74 million daily doses per year. Another study published in JAMA showed that states with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. A number of studies have shown cannabis to be an effective treatment for drug resistant epilepsy. In fact, G W Pharmaceuticals has developed an oral formulation of purified cannabidiol (CBD) called Epidiolex that was approved by the U.S. Food and Drug Administration for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. Several studies have indicated that cannabis may be an effective treatment for migraines. Over a three-year period, researchers at the University of New Mexico conducted a study of people who suffered from migraines. The subjects recorded the real-time details of

their self-administered cannabis application including their symptom intensity levels prior to and following cannabis intake. 94 percent of the users experienced relief within two hours. The average symptom intensity reduction was 3.3 points on a zero to 10 scale. Because the ECS is present in the GI tract and cannabinoids can affect gut motility, some researchers have postulated that administration of synthetic or phytocannabinoids may help with irritable bowel syndrome. Unfortunately, although cannabis is authorized for IBS conditions in several states, most study results are mixed, with one study showing a slight benefit in reducing symptoms. One of the more promising properties of cannabis is its powerful antiinflammatory effects. Researchers at the University of London found that THC has twenty times the anti-inflammatory potency of aspirin and twice that of hydrocortisone, but in contrast to all (CONTINUED ON PAGE 11)

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MEDICAL CANNABIS

Medical Cannabis and Seniors By Michael Patterson

Since this study only included a single patient, the results must be taken with a grain of salt. Nonetheless, the outcome would appear to point the way toward similar studies with larger populations.

Medical Cannabis Appeared to Improve Neuropsychiatric symptoms in Alzheimer’s Patient A recent study published by the US National Institutes of Health (NIH) and Frontiers of Psychiatry found that the use of a synthetic cannabinoid medicine (dronabinol) decreased Neuropsychiatric symptoms (NPs) in a clinical study of a female patient with severe Alzheimer’s Disease (AD). Alzheimer’s Disease affects approximately 17 percent of people in the world from ages 75 to 84. Neuropsychiatric symptoms (NPs) such as delusions, agitation, anxiety, and hallucinations are present in up to 95 percent of patient in all stages of dementia. Currently, there is no prescription drug that has been approved specifically for the treatment of NPs. The clinical case study involved is from a female patient diagnosed with AD with continuous cognitive decline and dementiarelated behavioral symptoms. Between 2008 and 2019, the patient was examined every six months at the memory clinic of the Medical University in Innsbruck, Austria. During each visit, the patient’s cognitive state and pharmacological treatment were evaluated via the neuropsychiatric inventory. In 2018, the patient progressed to severe AD stage and presented with progressive NPs. At this time, off label treatment with low-dose dronabinol (synthetic THC) was initiated. Once low-dose dronabinol

What Does the Research Say, continued from page 10

nonsteroidal anti-inflammatory drugs (NSAIDs), it demonstrates no cyclooxygenase (COX) inhibition at physiological concentrations. So there is some hope that cannabis or various cannabinoid compounds may show therapeutic efficacy with conditions like arthritis and other inflammatory conditions. In fact, 29 percent of respondents to a poll conducted by The Arthritis Foundation use CDB for arthritis and although the majority reported improvements in sleep and well-being, a minority experienced improvement in pain or stiffness. The bottom line is that, while cannabis holds promise for some medical conditions, more research needs to be done to reach solid conclusions. In the end, the most efficacious results might come from targeted drug therapies that are synthesized from one or a combination of several cannabinoids.

Study Shows No Cognitive Decline in Seniors Using Medical Cannabis

Seniors are the fastest growing users of medical cannabis in the USA.

use commenced, the patient’s emotional state improved, while disruptive behavior, aggression, and sedation decreased significantly. Furthermore, the patient was decreased from six psychotropic drugs to three after starting dronabinol due to no longer requiring the added psychotropic drugs. The results in this study are consistent with anecdotal results seen in patients using THC or synthetic THC medical cannabis. There is evidence that cannabinoid therapy can break up amyloid plaques in the brain which are caused by AD, and therefore decrease NPs of Alzheimer’s.

Senior Citizens are the fastest growing demographic of users of medical cannabis in the United States. A recent study published in the September 2020 edition of the Drug and Alcohol Review, determined that the use of medical cannabis does not create a cognitive decline in senior citizens. The study was performed at Israel’s Haifa University School of Public Health by Sharon R. Sznitman PhD; Simon Vulfsons MD; David Meiri PhD; and Galit Weinstein PhD. The study included 125 cannabis users who were 50 years and older. Out of the 125 study participants, 63 had Israeli government permission to use cannabis and 62 did not have permission. Each participant was put through a multitude of tests consisting of CogState computerized brief battery used to assess cognitive performance of psy-

chomotor reaction, attention, working memory and new learning. Regression models and Bayesian t‐tests examined differences in cognitive performance in the two groups. Furthermore, the associations between medical cannabis use patterns (dosage, cannabinoid concentrations, length and frequency of use and hours since last use) with cognition were assessed among medical cannabis licensed patients. Patients were tested before use of medical cannabis and after use of medical cannabis. The result of the study showed no detectable difference in cognitive ability before or after use of medical cannabis. Drs. Sznitman and Weinstein noted that the results of the study do not show any widespread change on cognition in older chronic pain patients. Considering use of medical cannabis is increasing in older populations, this study could be a first step toward a better risk-benefit assessment of the use of medical cannabis with seniors. The researchers also noted that “previous studies have shown that medical cannabis can have long-term effects on the brain when consumed at a young age. Those affects are not necessarily the same when consumed in old age.”

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Analysts Outline Expectations for the Healthcare Industry By Cindy Sanders

market. “Where is a lot of the capital being allocated? And there is a lot in the payer solutions-oriented sector,” he said of companies working to provide data analytics, population health intel and solutions for employers.

As President Joe Biden was taking the oath of office in Washington, D.C., healthcare financial analysts gathered via video to share their thoughts on what a new administration and ongoing pandemic might mean for various industry sectors in 2021. The virtual event brought together three national analysts for a panel discussion to share insights into how healthcare fared in 2020 and where it’s headed in 2021. Whit Mayo, Managing Director, UBS: Mayo said the sheer velocity and volatility within the market was surprising in 2020 as he and colleagues went from analyzing “a lot of solvency risk” to a quick transition “towards excessive liquidity that was injected into the system.” He added, “I think we saw a corresponding reevaluation to levels, across many asset classes, that I wouldn’t have anticipated.” Mayo also marveled at recent IPO activity. “Maybe a final point in just stepping back and reflecting on 2020 was the material surge we saw in equity

Ann Hynes, Managing Director, US Equity Research, Mizuho Securities USA:

capital markets activity,” he said while noting that 11 IPOs were filed in a twoweek period in early January. “I feel like I’ve spent the better part of the last decade taking companies private, and so it’s refreshing to see many of these organizations looking to become public.” Mayo has a positive bias over the next six to nine months around the provider market. “I think it’s really underappreciated the sustainability of the cost structure today,” he said, adding that environment has an exceedingly posi-

tive skew for certain providers. “Taking a stock like Tenet as an example, it’s not inconceivable they could be generating over 30 percent of their market cap in real, discretionary, free cash in the next 12 to 24 – closer to 24 – months.” Thinking about where stocks are currently trading, Mayo said, “There’s a much more interesting risk/reward, I think, in the provider world.” When it comes to innovation and investment, Mayo looks at the topics through the lens of the venture capital

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Hynes was most excited about how CROs (clinical research organization), hospitals and clinical labs navigated a tough 2020 and positioned themselves going forward. “The CROs were very resilient during COVID,” she said. “Obviously patients didn’t have access to a lot of sites, but they were able to adjust to telehealth very quickly.” Their participation in vaccine trials kept them busy in 2020, and Hynes thinks that carries forward into 2021. “This group trades on the IPO market, and it was such a hot market through the pandemic, and that incremental funding, especially in the biopharma industry, is going to propel revenue growth probably for the next (CONTINUED ON PAGE 13)


Analysts Outline Expectations for the Healthcare Industry, continued from page 12

two or three years.” Hynes was also impressed at how flexible and resilient hospitals proved to be. “When admissions went down as elective procedures stopped, hospitals adjusted their cost structures,” she said. “And I there are positive headwinds on the political front in 2021 because Biden is in favor of expanding the ACA and expanded coverage helps hospitals. From an operational perspective, I think there is a lot of delayed care, which should also benefit hospitals.” Lastly, Hynes said clinical labs are one of the sectors she is most excited about. “They’ve been a huge part of the COVD solution with the testing,” she said. “I think one of the things that has been underappreciated for both LabCorp and Quest is that they will probably generate an extra billion or more of free cash flow that they otherwise wouldn’t have because of COVID testing, and they are getting elevated reimbursement right now. That extra infusion of cash gives both companies a lot of optionality from accelerating growth to M&A.” Gary Taylor, Senior Equity

Research Analyst & Managing Director, JP Morgan:

Taylor’s work is mostly focused on health insurance and providers. He noted the title of the group’s 2021 outlook for these sectors was ‘Mixed & Complex.’ However, he added with a

laugh, “The feedback I got was ‘When in the last 30 years has healthcare services not had a mixed and complex outlook?” – so touché.” “I think in the first half of the year, there is momentum behind providers, particularly hospitals,” he said. “Acuity is high, the commercial mix is strong and there is deferred care that will be addressed. I think investors are going to chase that to some degree. In the back half, where the comps get tough, I’m not sure that trade continues to have legs.” Taylor thinks insurers have a huge amount of uncertainty in the face of historically difficult comps. “UnitedHealthcare put up good numbers in January and their stock was still trading lower,” he said. “I think managed care has a really difficult first part of the year.” On the flip side, Taylor thinks the interest in 2021 is going to be on thematic growth companies oriented around value-based care like capitated medical groups and site of care options like home health and telehealth. “Interest in these concepts combined with interest rates near zero are big drivers in the market for investment,” he said. “There are more IPOs in this sector than I’ve ever worked on in my career by a factor of five or six. All of them are telling investors that they can take down unnecessary hospitalizations and ER visits, and that they can move more patients to a lower cost site.”

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Political Considerations With a new administration in the White House and Democrats holding a slim majority in the House of Representatives and the narrowest possible majority in the Senate, what changes do analysts anticipate? Ann Hynes: “I think what is clear about Biden is that he wants to strengthen and expand the ACA. That’s a positive sentiment driver for healthcare, but especially for healthcare providers.” She added that in her universe that focuses on the drug supply chain, she has to worry about drug pricing. While there might be some appetite to include legislation to control pricing, she doesn’t think it is likely to happen with the current makeup of Congress. Whit Mayo: “I don’t think we know exactly the direction that Biden is going to take with his entire healthcare agenda, but if he governs any way remotely close to how he campaigns and debates, I think we can just call it ‘slightly left of center,’ so I’m anticipating a much more moderate type of approach to policy.” Gary Taylor: “The conventional wisdom is that there is not much he can get done with the Senate makeup the way it is. The only thing Biden has ever expressed support that, in our view, would be harmful to providers would have been the public option, which seems off the table. “There remains some conversation around lowering Medicare eligibility age but that comes with a Congressional Budget Office price tag of about $4 trillion. I think trillions eventually matter, so I’m kind of skeptical there.” Looking at Xavier Becerra, President Biden’s pick for Health and Human Services, Taylor wondered what that might mean for provider consolidation moving forward. As California Attorney General, Becerra was instrumental in reaching a settlement to resolve antitrust allegations against Sutter Health. In January, the Federal Trade Commission announced the agency would look at provider consolidation in south Florida. “So already, there seems to be some signaling of a more adverse stance out of the FTC with respect to provider consolidation,” Taylor said.

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Birmingham Medical News


ACC Releases Latest Information on Treating HFrEF By Cindy Sanders

Heart failure (HF) continues to rise alongside an aging population. The American Heart Association notes that an estimated 6.2 million Americans over 20 years of age had HF between 2013 and 2016, compared with 5.7 million between 2009 and 2012, with approximately half of hospitalized heart failure events characterized by reduced ejection refraction (HFrEF). To optimize heart failure treatment, the American College of Cardiology (ACC), along with the American Heart Association, published a heart failure clinical practice guideline in 2013 with an update four years later. However, since that last update, which was titled The Expert Consensus Decision Pathway for Optimization of Heart Failure, new therapies for HFrEF have emerged. In light of this, the ACC has just published a new update, including details on new drugs that have a demonstrable impact on hospital readmissions, mortality and disease progression. “The last five years has seen an explosion of new pharmaceutical targets for heart failure, which is great but dizzying if you’re trying to quarterback a patient’s care,” said Thomas Maddox, MD, FACC, who chaired the writing committee for 2021 Update, which highlights the use of two newer therapeutics for HFrEF. “We now recommend that physicians use ARNIs, which are angiotensin receptor-neprilysin inhibitors,” said Maddox who is a professor at Washington University School of Medicine. “It’s a combination medicine of an angiotensin receptor blocker (ARB), which we’ve had for a long time, and a neprilysin inhibitor. “Both molecules primarily exert their impact via relaxation of the relative blood pressure and improvement in

Thomas Maddox, MD

the efficiency of cardiac function. We learned that the combination of these two molecules reduced heart failure readmissions and morality by 20 percent compared to the ACE Inhibitors, which was the previous standard of care.” The second significant recommendation in the update is to incorporate a sodium-glucose cotransporter-2 (SGLT2) inhibitor, which is a molecule that blocks the kidney from absorbing both sodium and glucose. The mechanism behind SGLT2 inhibitors is that patients urinate out glucose and sodium, which is why this particular therapeutic got its start in the diabetic patient population. However, clinicians also observed better heart failure control in patients with both diabetes and heart failure. The 2019 DAPA-HF (dapagliflozin) trial focused on the benefits of the SGLT2 inhibitor vs. placebo specifically for heart failure patients. “Only about half the patients in the trial had diabetes, but the non-diabetic group saw the same benefits,” Maddox said. “This drug works on heart failure regardless of your need to control glucose. I think this is now more a heart failure drug than a diabetes drug.” In May 2020, the FDA approved dapagliflozin specifically for Contact Us Today! info@thevallettagroup.com

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treatment of HFrEF. “Barring a contraindication, I can’t see a reason not to use a SGLT2 inhibitor in HFrEF patients,” Maddox said. “We just have such good evidence on this. If I had a new heart failure patient not already on a treatment regimen, I would get them on a beta blocker, ARNI, aldosterone antagonist and a SGLT2.” The new update also provides guidance on 10 critical issues from how to initiate, add or switch to new evidencebased therapies for HFrEF and how to

address challenges of care coordination to ways to improve medication adherence and how to help patients with access to medications. “The high price tag on newer therapies remains an initial barrier for many patients,” Maddox said. “However, there are a variety of strategies now to try to knock costs down with apps like GoodRx and financial assistance programs from manufacturers.” To fully explore the 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart Failure, go to the Journal of the American College of Cardiology (jacc.org) and do a search for ‘2021 HFrEF Update’ or go online to BirminghamMedicalNews. com, for a link to the pdf. The TreatHF app is available through both the App Store for Apple and Google Play. There is also a web version available through the American College of Cardiology site. For more information, go to the “Tools and Practice Support” tab on the ACC.org homepage and click on ‘Mobile and Web Apps’ to access this and other interactive tools.

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Let’s Use the Current State of SNF Therapy as a Springboard to More Positive Outcomes By Ian Oppel, CCO RESTORE Skills

approach to SNF therapy. The tired therapy exercises of batting at balloons and using cones or a pegboard are not enough to motivate patients to reach new goals. I despised going through the motions of cookie-cutter therapy. I knew I wasn’t providing the best opportunity for healing to my patients. The SNF therapy industry needed a shakeup, and now we have it. The change to PDPM means the number one focus is on patient outcomes. This should always be our goal as therapists and SNFs, and COVID-19 doesn’t change this goal either.

at

Therapy today in skilled nursing facilities (SNF) looks vastly different than it did before the pandemic. What is yet to be determined is whether or not these changes can result in positive outcomes for all parties involved — patients, therapists and SNFs. Last fall, the federal government released a $5 billion aid package to SNFs. That funding, combined with the collective will to improve therapy challenges that existed in the industry even prior to COVID-19, provides a rare opportunity for a possible total redesign of how SNFs provide therapy. I propose that that the vastly different climate in SNFs since COVID-19 hit should be a springboard for a more positive future for therapy in SNFs. In October 2019, CMS replaced the Prospective Payment System, RUG-IV, which primarily determined payment by the number of minutes spent with the patient, with the new Patient-Driven Payment Model (PDPM). Under PDPM, therapy minutes were removed as the basis for payment in favor of resident classifications and anticipated resource needs during the course of a patient’s stay. The immediate effect of that change

Ian Oppel enjoys an engaging therapy session.

was that 43 percent of operators reported laying off therapists, as well as a reduction in hours. Facilities started providing more group therapy and concurrent therapy sessions, offering patients a chance to be motivated by one another as they each worked toward personal goals. That was until COVID-19 hit in March 2020. We in the industry would still be sorting out the ripple effect of the move to PDPM this year, except that a bigger tsunami hit the skilled nursing facility industry in the form of the global pandemic. Although vaccines hold out the promise of a return to some kind of normal, most long-term care patients

are still spending the majority of time in their rooms, with limited visitation. Therapy gyms are closed or only available to a limited number of patients at a time. And skilled nursing facilities are no longer getting reimbursed by therapy minute thresholds. Therapists are now providing therapy within patient rooms, but this is limited to the creativity, experience level and motivation of each individual therapist. You could look at this as a disaster for the state of therapy in SKNs, but I see it as an opportunity. As an experienced occupational therapist (OT), I long ago recognized the need for a new

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Four Ways We Can Use 2020’s Changes as a Springboard for Better Therapy • Focus on our ability to accelerate outcomes

Patients, therapists and SNFs are all now aligned around one goal: achieving the best outcome in the shortest, most responsible period of time. This has always been what the patient wants and what is best for the facility, but now the PDPM reimbursement aligns with that goal. We achieve this by focusing on the patient experience. We make therapy fun and rewarding. Patients who are motivated will reach a more positive outcome in a shorter span of time. Therapists need tools they can use to make therapy more engaging. For example, our company uses therapy gaming technology and the early adopters of this kind of therapy will be among those who are best poised to achieve accelerated outcomes for their patients. • Focus on connectivity and transparency Prior to COVID-19, SNF facilities could rely on family visits to keep families connected to their loved ones. Families could easily pop in, ask a question to a nurse or social worker and schedule a care consultation. Now with limited visitation, facilities must proactively keep families in touch with their loved ones and informed about their care. Connectivity and transparency needed to always be a priority, but now all SNFs are forced to make this happen. Most facilities have succeeded in scheduling Zoom and Facetime calls with families. But imagine if instead of talking from a chair or bed, families joined parts of a therapy session? Technology offers an incredible level of transparency, as families can motivate patients and celebrate their achievements as they watch. Families will recognize the value of long-term care rehab (CONTINUED ON PAGE 17)


Let’s Use the Current State of SNF Therapy, continued from page 16

and rest assured their loved one is getting excellent treatment. Gone are the concerns about what is happening behind the walls of a SNF when the relatives aren’t there. • Improve continuity of care SNFs have always had high turnover and a constant need to hire new staff. And in therapy, the use of PRNs can mean that new therapists frequently join the care team. COVID-19 escalated this issue as SNF employees were suddenly called upon to soldier through a battle they hadn’t realized they signed up for, and facilities faced more shortages than ever. The need to standardize care for every person providing treatment has always been a priority, but now it’s an absolute necessity. This is where technology comes in. With therapy technology, every therapist on the team can facilitate a similar session experience, regardless of how well they know the patient. Obviously, rapport in therapy is key to overall success, but when that’s not possible, it is still essential that the patient continues to reach individual goals. Technology that tracks this progress and helps therapists facilitate the actual exercises is key. Skilled nursing facilities that do this well will have an evidence-based practice to identify patients’ needs and show progress. • Differentiate the care approach and share success stories Competition is fierce for the same type of patient now with PDPM. It’s not enough to just have an aesthetically beautiful facility. SNFs have to offer a higher quality of care than their competition and then share those stories through marketing. Those skilled nursing facilities that differentiate themselves from their competitors by offering better therapy outcomes will be positioned to succeed in the future. Ultimately, when it comes to creating positive outcomes for patients, all SNF employees must work as a team. This involves more than just a morning meeting. It’s one where every team member realizes that they are one piece of a puzzle, working together for a greater goal that can only be achieved with all of them together. As we continue to deal with the ripple effect of this past year, I have no doubt that more innovation and new ways of thinking about SNF therapy will develop. Those skilled nursing facilities that embrace this technology and look for ways to achieve more accelerated positive outcomes will come out on top.

GRAND ROUNDS

Princeton Names McGrue Chief Nursing Officer Van McGrue, RN, MSN, PhD has been named chief nursing officer (CNO) at Princeton Baptist Medical Center. Most recently, McGrue Van McGrue, RN, MSN, PhD served as CNO of Citizens Baptist Medical Center. A nurse executive with over 25 years’ experience, McGrue began her career in Talladega in 1992 at the Northeast Alabama Kidney Clinic and previously worked for Citizens Baptist Medical Center for several years in the late 1990’s. Following a decade in private healthcare administration with oversight of territories in Alabama, Georgia, and Tennessee, McGrue rejoined Citizens Baptist in 2009 as the infection preventionist before assuming the role of director of outcomes, where she was pivotal in improving reimbursement by six percent within six months following the implementation of the CDI program. She later served as management director of nursing for Medical Surgical where she contributed toward achieving the highest improvement in Hospital Consumer Assessment of Healthcare Providers and Systemsat Citizens Baptist in 2015. Preceding her appointment as CNO of Citizens Baptist, she served as Director of Quality where she was instrumental in helping the hospital to achieve its first status quality goal, earning the number one ranking among Tenet hospitals for quality for four consecutive months. McGrue holds a bachelor’s, master’s and doctorate in nursing, all of which she earned from Jacksonville State University. Among her many pro-

fessional affiliations, she is a member of the American Nurses Association, Association of Perioperative Nursing and Association of Professionals in Infection Control and Epidemiology, as well as the American Nephrology Nurses Association. In addition, she serves as an adjunct professor with CCI Curriculum.

Study of Genetic Factors That Shape Human Gut Microbiome Recently, an international study by the MiBioGen consortium, an international collaboration involving more than 20 labs across the world, Haydeh analyzed the common Payami, PhD genetic factors that influence the composition of the human gut microbiome in more than 18,000 people. The results were published January 18 in Nature Genetics. Haydeh Payami, PhD, professor in the Department of Neurology at the University of Alabama at Birmingham, and Zachary Wallen, a postdoctoral fellow in the Payami laboratory, were collaborating authors on the study. “The last decade has greatly expanded our understanding of the human microbiome, the trillions of microbes that inhabit the internal and external surfaces of our bodies,” Payami said, whose research focuses on the gut microbiome as a potential missing link between genetic and environmental causes of Parkinson’s disease. “We have come to appreciate vital role the microbiome plays in human development from infancy to adulthood and their active participation in many human functions: helping us to digest food, training our immune system and affecting our brain function via the gut-brain axis.” The largest and richest human mi-

crobiome inhabits the gut and contributes substantially to our health. Yet the factors that shape its composition, although widely studied, remain unclear, and the more than 80 percent difference in gut microbiome between individuals remains unexplained. In general, environmental factors such as diet and medication play a major role. However, a role for human genetic variants has also been suggested by the identification of heritable bacteria. The MiBioGen consortium study concludes that at least two human genes have a major impact in shaping our gut ecosystem: the lactase gene LCT, which influences the abundance of lactose-digesting Bifidobacteria, and the fucosyl transferase gene FUT2, which determines the abundance of Ruminococcus torques. They also show that other human genes affecting microbiome composition are involved in important aspects of host metabolism, nutrition and immunity. The analyses stretch as far as establishing relationships between several bacterial species and human diseases. “We could see that genetic variants in the lactase gene determine Bifidobacteria abundance in adults, but not in children, and that this effect is more pronounced in European populations,” said Alex Kurilshikov, the first author of the study. “The large sample size also allowed us to apply genetic methods and show that some bacteria are causal for developing diseases.” The MiBioGen researchers have made their results available to other scientists and the scientific community for additional and future analyses. All results are uploaded to http://mibiogen. org, supported by the Genomics Coordination Center in the Department of Genetics, UMCG.

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GRAND ROUNDS

Williams Joins Urology Centers Heather Williams has the UCA Women’s Center as a Board-Certified Adult-Gerontology and Women’s Health Nurse Practitioner. Williams ob- Heather Williams tained a Master of Science in Nursing at UAB and Bachelor of Science in Nursing at Tuskegee University. Her clinical interest includes urodynamics, pelvic organ prolapse, urinary incontinence, overactive bladder, urinary tract infections, and sexual dysfunction.

Forbes Names Kassouf 2021 Top Firm Forbes named Birmingham-based Kassouf & Co one of the top firms of 2021 in their annual America’s Best Tax and Accounting firms list. Forbes and Statista, a database company specializing in market and consumer data, created the list based on surveys of tax and accounting professionals and their clients. Kassouf is one of 178 companies recommended for both tax and accounting services. “Kassouf is honored to be recognized by America’s leading business magazine as a top firm. We continually strive to help our clients succeed, whether it’s through tax accounting, healthcare consulting or wealth management,” said Kassouf Director and Shareholder Gerry Kassouf. With four office locations in Alabama and Louisiana, Kassouf provides accounting, assurance, business advisory, estate

planning, healthcare advisory, financial planning and wealth management for a variety of industries and individuals.

Elie Named Chair of UAB Department of Emergency Medicine Marie-Carmelle Elie, MD has been named chair of the Department of Emergency Medicine at the UAB School of Medicine, a role she will Marie-Carmelle Elie, MD assume on June 1, pending provost approval Elie obtained her undergraduate degree from Columbia University and her medical degree from the State University of New York with a distinction in research. Following her emergency medicine residency at Mount Sinai Medical Center, she completed the Critical Care/Trauma Fellowship at the R. Adam Cowley Shock Trauma Center at the University of Maryland. She is triple board-certified in emergency medicine and critical care, as well as hospice and palliative care medicine. “My greatest privilege over the course of my career has been to care for patients,” Elie said. “I am excited about the opportunity to join UAB leading an emergency department committed to the advancement of patient care through education, discovery and community outreach.” Elie currently serves as associate professor in the Department of Emergency Medicine and the Division of Palliative Care, at the University of Florida’s College of Medicine. In addition to her

role as director of Research and Clinical Trials at the university, she serves as chief medical officer for Gainesville’s Haven, a hospice and palliative medicine organization that spans services across the state of Florida. Elie co-chaired the hospital sepsis committee for the University of Florida Health where she spearheaded the hospital-wide sepsis protocols, instituted the emergency room sepsis alert, and coordinated plans to establish a communitywide program that has engaged neighboring facilities and the pre-hospital system.

Jackson Thornton Technologies Awarded Blue Diamond Partnership Jackson Thornton Technologies (JTT), a subsidiary of Jackson Thornton CPAs and Consultants have been named a Datto Blue Diamond Global Partner. Blue Diamond is the top tier of the Datto Global Partner Program and only two percent of the Datto community of managed service providers have achieved this level. Datto is the world’s leading provider of cloud-based software and technology solutions built for delivery by managed service providers. “Because of the importance of business continuity to our clients, JTT decided years ago that we should leverage the expertise of a best-of-breed partner who Brian Driskill, Vice President was focused on developing of JTT state-of-the-art business continuity solutions, said Brian Driskill, JTT’s Vice President and General Manager. “We selected Datto’s technology be-

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Bradford Launches Medication-Assisted Clinics Bradford Health Services is expanding of its services in Alabama with the launch of the Bradford Clinic, a new program with outpatient centers that combine Bradford’s counseling with Medication-Assisted Treatment (MAT). The company opened its first Bradford Clinic location in Montgomery in September. The new program applies an evidence-based approach of incorporating psychological and behavioral therapies with prescription medications to treat substance use disorders. “Research has shown that successful long-term recovery is directly linked to a patient spending an adequate length of time in treatment,” said Valeta Neal, Vice President of Bradford’s Outpatient division. “To provide them that time, patients must have access to convenient, quality care to begin or to continue their treatment. The Bradford Clinics will provide that care in outpatient settings with a coordinated care team.” In the ongoing opioid epidemic, MAT has become increasingly utilized as an effective treatment method for helping patients sustain recovery. The prescribed use of medications such as naltrexone and buprenorphine reduce withdrawal symptoms and cravings, minimizing the occurrence of relapse. According to the Substance Abuse and Mental Health Services Administration, MAT is most effective when provided as part of a whole-patient treatment program that includes counseling and other behavioral therapies. “Bradford recognizes the chronic nature of addiction,” said Brent Boyett, MD, Medical Director of the Bradford Clinic program. “Patients with addiction disorders may require lifelong therapies, and they require lifelong vigilance to maintain functional recovery. For many patients, MAT is an essential component of this chronic disease management.”

Vaughan Retires After over 40 years in practice, Tom Vaughan, Jr., MD has retired from Children’s of Alabama. Vaughan, who is a leader in child and ado- Tom Vaughan, Jr., MD lescent psychiatry, earned his M.D. from the University of Alabama in 1967, and went on to do his internship and residency at John Hopkins Hospital. He completed a residency in child and adolescent psychiatry at the University of Alabama School of Medicine in 1974. He holds two lifetime certifications from professional Boards – one in General Psychiatry and one in Child and Adolescent Psychiatry, both by the American Board of Psychiatry and Neurology. He has been a pioneer in tele-psychiatry and provided services to patients in rural Alabama for more than 15 years.


GRAND ROUNDS

EDITOR & PUBLISHER Steve Spencer VICE PRESiDENT OF OPERATIONS Jason Irvin CREATIVE DIRECTOR Katy Barrett-Alley CONTRIBUTING WRITERS Cara Clark, Ann DeBellis, Jane Ehrhardt, Laura Freeman, Cindy Sanders, Marty Slay Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 Ad Sales: Jason Irvin, 205.249.7244 All editorial submissions should be mailed to: Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: editor@birminghammedicalnews.com —————————————— All Subscription requests or address changes should be mailed to: Birmingham Medical News Attn: Subscription Department 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: steve@birminghammedicalnews.com FOLLOW US

Callahan Clinic Opens in Trussville The new UAB Callahan Eye Hospital Clinic opened in Trussville on January 19. The 5,200-square-foot clinic offers pediatric and comprehensive eye care specialists and houses a state-of-theart diagnostic imaging center. Patient services include family eye care, eye exams, cataract evaluations, glaucoma screenings, dry eye evaluation and treatment, and contact lens evaluations

Alabama Genomic Health Initiative Publishes First Major Data Set Some of the first results from the Alabama Genomic Health Initiative (AGHI)were recently published in Genetics in Medicine. The AGHI, launched in 2017, is one of the nation’s first statewide efforts to harness the power of genomic analysis to find answers for children and adults with undiagnosed developmental and medical challenges, and to identify individuals who are at a higher risk for developing certain diseases in the future. The program, which is a collaboration between the HudsonAlpha Institute for Biotechnology and the University of Alabama at Birmingham, provides genomic testing, interpretation and counseling free of charge to Alabama residents. The goal is to engage at least 10,000 Alabamians in genetic testing, while educating the participants about their genomic health. “AGHI is helping to improve pa-

tient care, not only by providing diagnoses, but also by giving the general public a foundational understanding of the importance of being informed about their genomic health,” said Greg Barsh, MD, PhD, senior scientist at HudsonAlpha . “Through AGHI, we are able to provide an opportunity to physicians and geneticists to confirm or identify a diagnosis that has gone undiagnosed despite a vast array of previous medical testing.” AGHI engages two groups of participants in Alabama: children and adults with undiagnosed rare disease, and adults in the general population who do not have a significant personal or family history suggestive of a genetic condition. The published data reflects the first 176 rare-disease participants and 5,369 participants in the population screening group. Participants, who were recruited across the state, provided a blood sample, as well as information about their personal and family health history. DNA was extracted from the blood sample and analyzed. Participants in the population screening group received a genotyping test, while participants in the rare-disease group received genome sequencing. Genotyping tests look at a preselected group of variants that are known to increase a person’s likelihood of disease, while whole-genome sequencing looks at every single letter of the genetic code. Participants received a report summarizing their test results. Individuals whose results include actionable find-

ings received genetic counseling and a referral to appropriate medical care. “We speak by phone with participants who have an identified genetic risk factor,” said co-author Whitley Kelley, a genetic counselor at HudsonAlpha. “We explain what it means to have a genetic risk factor. Then we provide recommendations for clinical resources that can guide their next steps in prevention and personalized health management. It is important to us to make sure the participants understand their results.” In the rare-disease group, of the 176 affected individuals, 35 (19.9 percent) received a pathogenic or likely pathogenic result, meaning a genetic variant was found that is believed to contribute to disease. In addition, 42 individuals (23.9 percent) received an uncertain result, meaning a genetic variant was found that is not well understood, but may contribute to disease. The new genetic knowledge, combined with the individual’s symptoms, often allows doctors to make a diagnosis for a disease that had remained undiscovered for months or years. To date, 5,369 individuals, representing all 67 Alabama counties, have been enrolled in the population screening group of AGHI. 81 positive genotyping results among 80 individuals (1.5 percent) were identified in the population cohort. These results include risk-increasing variants for hereditary cancer, cardiomyopathy, malignant hyperthermia and hypercholesterolemia.

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