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All of Us Looks to Improve Care for Each of Us
When What You Can’t Watch as a Youngster, Becomes Your Focus
NIH Precision Medicine Project is Changing the Research Landscape Historically, medicine has been a ‘one size fits all’ proposition. It’s only been in the last few decades, as researchers have begun to uncover specific mutations and mechanisms driving disease, that the concept of precision medicine has really begun to take root and flourish. While the field is still in its infancy, a bold initiative from the National Institutes of Health – the All of Us Research Program – is working to move the science forward dramatically. “Our goal is to improve health and medical breakthroughs for everyone,” stated All of Us CEO Joshua Denny, MD, MS. The ambitious initiative looks to enroll one million individu-
Jeffrey Gillis, DO, practices in the same hospital where he and his twin sister Rachel were born.
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AMA Issues New Privacy Principles Organization Looks to Restore Trust, Power to Patients
als in the United States across the full spectrum of age, gender identity, race, ethnicity, sexual orientation, socioeconomic status, education, geography, health status and other factors influencing health. Denny noted many segments of the population have been underrepresented or left out of research projects in the past. “We specifically said we wanted this population to be reflective of the diversity of the United States,” he explained. By capturing this huge amount of deidentified data, the hope is to build one of the most comprehensive precision medicine platforms in the world, allowing researchers to speed discovery by PHOTO CREDIT: NATIONAL INSTITUTES OF HEALTH.
By CINDy SANDERS
Dr. Jeffrey Gillis finds that Gastroenterology turns out to be the right thing
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Pioneering the Future: Orthopaedic Advancements in a Changing Field
From wearables and ﬁtness apps to EHRs and patient portals, an individual’s health data resides in a lot of different places. In the wake of rising privacy concerns, however, the American public has grown increasingly worried about how their information is used and with whom it is shared.
Laura Whitsitt, M.S., SVP, Research & Development- Orthopaedics, Smith+Nephew, Inc. By JUDy OTTO
During more than 30 years with global medical technology leader Smith+Nephew, (S+N) Inc., Senior Vice President of Research & Development-Orthopaedics Laura Whitsitt has seen a lot of history, and made some of it – as reflected, in part, by some of the patents S+N has acquired on her watch: for an artificial spinal disc, an artificial bone graft implant, bone fixation apparatuses, and more. Recognized as an Outstanding Alumna of the University of Memphis Herff College of Engineering, where she acquired her undergraduate and M.S. degrees, Whitsitt continues to serve her alma mater as a member of the College of Engineering Advisory Council, and her community as a member of the FedEx
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When What You Can’t Watch as a Youngster, Becomes Your Focus Dr. Jeffrey Gillis finds that Gastroenterology turns out to be the right thing By LAWRENCE BUSER
Jeffrey Gillis, DO, practices in the same hospital where he and his twin sister Rachel were born. Jackson-Madison County General Hospital also is where his interest in medicine was piqued 20 years later in a summer medical observership while a student at Freed-Hardeman University. “As pre-med students, we rotated every day in a different specialty or discipline, watching and learning and getting a feel for how medicine and healthcare worked,” Gillis recalled. “I saw a cardiac bypass surgery, cardiac catheterization, geriatrics, and pediatrics, just to name a few. It was great exposure. “At the end of the observership, I was often asked what specialty I liked best, and I said I liked them all except GI. It hated it. I only spent about a half day watching a guy do colonoscopies - who I now work with by the way – and I didn’t like it. But here I am. It turned out to be the right thing for me.” Gillis is a physician with West Tennessee Gastroenterology specializing in gastrointestinal wellness and nutrition, autoimmune digestive disorders, therapeutic endoscopy and, of course, colonoscopies. The COVID-19 pandemic caused a sharp cutback of colonoscopies and other elective procedures, primarily because of the initial shortage of personal protective equipment for those on the front line. He said that as the PPE became less of an issue, their elective-procedure practice has returned to normal. “Routine screening colonoscopies are recommended starting at age 45 to 50 for most people - talk to your PCP about what age is appropriate - and the whole experience for patients has gotten better over the years,” said Gillis. “In the past, most seda-
tion was administered by the gastroenterologist and was a lighter sleep. Now, sedation is mainly administered by anesthesiologists and nurse anesthetists and tends to allow for a bit of a deeper sleep and an overall better experience for patients. “The colon preps are better, too. In the past, most people had to drink a full gallon of salty liquid which often caused nausea and bloating. Now, several smallvolume preps are available that still have an unpleasant taste but are more tolerable due to the smaller volumes.” Like one of his partners, Gillis is a Doctor of Osteopathic Medicine, or DO. They have the same medical school training as an MD, take the same boards, prescribe medicine and perform surgical procedures. The main difference is a DO also learns more hands-on manipulative medicine that includes moving a patient’s muscles and joints with stretching, gentle pressure and resistance.
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Gillis earned his Doctor of Osteopathic Medicine from Edward Via College of Osteopathic Medicine in Blacksburg, Va., and completed his residency in internal medicine at the University of Tennessee Health Science Center in Memphis. He then did fellowship training in gastroenterology and hepatology at the University of Arkansas for Medical Sciences in Little Rock. He has been practicing in Jackson for two years. “One of the biggest changes we’re seeing is in the cause of cirrhosis of the liver,” Dr. Gillis says. “When you hear cirrhosis of the liver, especially in an older person, most people think they must have been an alcoholic. That is a common cause of cirrhosis, but hepatitis B and alcohol combined are really nasty, and hepatitis C has become the most common cause for a person to need a liver transplant.” He said a rise in obesity is affecting all areas of healthcare, including the liver. “Along with that rise there’s been an exponential rise in what we call non-alcoholic fatty liver disease which is associated with obesity, number one, and the metabolic syndrome in general which includes obesity, diabetes, high blood pressure, high cholesterol, sleep apnea, those kinds of things,” he said. “We’re expecting nonalcoholic fatty liver disease to become the most common reason for liver transplantation. That’s kind of what’s expected with the obesity epidemic.” Also, on the rise, Gillis adds, are cases of inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis. “The jury is out on why there’s an increase,” he says. “Both of those are autoimmune diseases which attack the gut. Autoimmune diseases across the board are increasing, but I don’t have a good answer
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for why. There are a lot of different theories.” Until the observership program he did as a college student, Gillis hadn’t really considered medicine as a career. The only family member in medicine was his greatgrandfather, who passed away before he was born. In fact, Dr. Gillis almost had an aversion to the healthcare field. “The first moment I decided I didn’t want to become a doctor was when my dad was sick,” he remembered. “I was 18 and my dad had esophageal cancer and died at 51. His cancer was diagnosed by a gastroenterologist like myself. You might think that inspired me, but it really didn’t, at least not in a direct way. “The thing I remember was going to the hospital to see him and thinking ‘Who wants to spend every day of their lives in this place full of sick and suffering people?’ Also, there was the weight of the responsibility of taking care of people and having people’s lives at stake. But then I did the observership and saw what was required, and I felt very strongly that I could do a good job of it and do it well.” He is currently helping a student in the same program with medical school applications, noting that “the cycle continues.” When not seeing patients, Gillis likes snowboarding, mountain biking, swimming, hiking and camping with his wife, Suzanne, and their three children, ages 7, 5 and 2. (Two boys and a red-headed girl in the middle.) His wife, who helped support him through medical school as a portrait and wedding photographer, is focused on raising the children. She also has a blog offering encouragement and support to mothers, especially those with small children. It’s title: A Joyful Roar.
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AMA Issues New Privacy Principles Organization Looks to Restore Trust, Power to Patients By CINDY SANDERS
From wearables and fitness apps to EHRs and patient portals, an individual’s health data resides in a lot of different places. In the wake of rising privacy concerns, however, the American public has grown increasingly worried about how their information is used and with whom it is shared. In response to this unease, the American Medical Association released new privacy principles in May that support an individual’s right to control, access and delete personal data collected about them. Jesse Ehrenfeld, MD, MPH, immediate past chair of the AMA Board of Trustees, said it was important for the organization to take a leadership role on the topic. “Trust is a fundamenJesse Ehrenfekd tal component of the physician-patient relationship. For me to provide the best care to my patients, my patients have to trust they can share information with me they might not want anyone
to know,” he said, adding there’s only one opportunity to get it right. “Once privacy is lost, you can’t get it back. Privacy has to be fiercely protected.” Rock Health and Stanford Center for Digital Health recently released a white paper outlining findings from the 2019 Consumer Adoption Survey. In its fifth year, the study highlighted another reason the AMA is well positioned to take the lead in outlining privacy expectations – physicians remain the most-trusted group when it comes to sharing health data. Even physicians, however, have seen consumer confidence slip a little over the last three years. Yet, nearly three-quarters of respondents still were willing to share information with physicians and more than half with insurance companies compared to 23 percent willing to share with health tech companies, 12 percent with the government, and only 10 percent with general tech companies. Confidence has been shaken by a number of tech sector breaches and scandals over the last few years, said Ehrenfeld, a public health policy expert who serves as director of the Advancing a Healthier Wisconsin Endowment. Additionally, there is growing recognition and frustration over
the tech business model that quietly collects personal data, often without consumer knowledge or consent and without the strictures that accompany HIPAA. “We fully support the right of patients to be able to access, download and share their data,” Ehrenfeld stated, adding that control belongs with the individual not an entity. To address these concerns and issues, he said the AMA Privacy Principles outline transparency expectations across five main categories – individual rights, equity, entity responsibility, applicability and enforcement. Ehrenfeld noted part of the impetus for AMA publishing these new principles stems from the spring release of final rules on data sharing and patient control from the U.S. Department of Health and Human Services in connection to the 21st Century Cures Act and the MyHealthEData initiative. “We advocated strongly and regularly to HHS to include controls in those final rules that would promote how apps use health data and how patients can prevent an app from using their information without consent,” he said. “Unfortunately, HHS didn’t take any action in that final rule to promote transparency.” Ehrenfeld added, “HIPAA is a law that
predates almost all modern digital technology. HIPAA does not cover data that is created or managed by a patient or third party app.” Without appropriate privacy controls, he said health information collected by apps or wearable fitness trackers could be shared with an employer or added to a credit score. “Once health information goes out the door and goes to a broker, you have the perfect recipe for harmful profiling and discrimination,” he pointed out. Yet, he continued, data collection is both ubiquitous and important to optimizing care. Trackers and apps can improve activity levels, diet, hydration and disease management. Data collection can highlight risk factors, identify at-risk populations or help clarify symptoms and spread of an infectious disease like COVID-19. “The more assurances people have about how entities will use that data, the more willing society will be to use technologies – whether it’s telehealth or contact tracing,” he said. “We think that having guardrails and transparency is key to building trust and not inhibiting data exchange. We want to restore confidence in data privacy, and that’s what our principles are all about,” Ehrenfeld concluded.
Pioneering the Future: Orthopaedic Advancements, continued from page 1 Institute of Technology Advisory Board, the Memphis Research Consortium, and the Greater Memphis Chamber Board of Directors, among others. Her early aptitude and love for math and science – and two favorite teachers –guided her into engineering, but it was during a graduate internship at Smith+Nephew that her fascination with the medical aspect of engineering burgeoned. Her current role at S+N is trifold, encompassing RTI (Research, Technology, and Innovation), which assesses and evaluates the feasibility of early stage technologies; Product Development that addresses the needs of surgeons and patients; and continuing Product Support. Recently launched S+N technologies she and her colleagues have shepherded into the marketplace include the Real Intelligence brand of enabling medical technology solutions throughout the continuum of care – and the CORI surgical system, a new generation handheld robotics platform with faster camera function and more efficient cutting technology, sized for ambulatory surgery centers (ASCs). A new total hip arthroplasty (THA) option, the OR3O Dual Mobility System, also offers increased range of movement and jump distance in an implant created from S+N’s proprietary OXINIUM™ oxidized zirconium alloy, with its superior wear- and corrosion-resistant characteristics. More than two million patients have already received hip and knee replacement implants made from OXINIUM, 4
and its unique properties and performance record are inspiring Whitsitt’s team to develop more products that utilize the material. They’re also focusing on the pandemic-driven universal need for more data, more telehealth products, and more digital ways to utilize products. With many treatments now being done remotely, she explains, “any way that we can facilitate remote pre- and post-operative care for patients with our devices and equipment will be welcomed. “Some of our programs are looking at a more digital focus for trauma devices – allowing patient interaction,” she hints. “— like using an app to help adjust an external fixation device stabilizing their fracture.” Her short-term goals, in fact, focus on continuing to develop such products, and to improve the processes used to get those products into users’ hands more efficiently. Her long-term goals are broader and include not only continuing to serve her community by sharing her insights and experience on a lengthy list of civic and charitable boards, but doing corporate board work, as well. And while she justly values those professional accomplishments that have delivered innovative and unique orthopaedic products like OXINIUM to surgeons and patients, possibly the successes closest to her heart involve her work in mentoring. “To me, helping others to begin or advance their careers is extremely important. I’ve mentored a number of men
and women within Smith+Nephew to help them better grow their careers or address challenges in their current roles, and I also reach out to young women in environments where they may not have knowledge or access to all their career opportunities.” “We’re starting to see a lot more women in college programs – particularly in biomedical engineering,” she notes with pleasure. In her 30 years, she’s also seen “a big change in orthopaedics as the healthcare system overall has changed its focus – from a focus on product ‘bells and whistles’ to products that provide efficiency and value. I think the future is going to include a lot of data, and digital technologies are going to be very important.” She points to the growing number of orthopaedic procedures that are moving to ambulatory surgical centers (ASCs). S+N surgical technology is consequently designed to be compact and efficient. “In order to be successful, ASC’s have to have very streamlined processes and products because they don’t have a lot of room or a lot of time; they have to be very efficient in their turnover of the rooms.” Aware of research concerning arthritis treatment alternatives to joint replacements, Whitsitt notes that S&N is also working on products that address the disease earlier in the process, potentially helping to delay the need for a hip or knee replacement. How has the pandemic impacted S+N?
“Our business has been hurt, as have other businesses that are focused on elective surgeries. But instead of layoffs, we’ve implemented unique programs to support employees dealing with family COVID issues,” she points out. “And we’ve been extremely productive working from home; it really hasn’t slowed our research efforts.” In fact, they’ve turned the COVID challenge into an opportunity to support Church Health: “While our 3D printers weren’t fully utilized during the surgery slow-down, we were able create a COVID Product Response (CPR) team – which is continuing to print 5,000 headbands and 15,000 disposable face shields for Church Health to use in their clinic and in COVID testing,” she notes. “It’s been a rewarding effort!” Balancing the many demands on her time has guided her to “be present in the moment and make sure I don’t neglect the very important things – family, work, community involvement, church, etc.” With three children and four grandbabies to enjoy, she still makes time for summer weekends at a lake house in Lexington, supporting her husband’s not-for-profit home renovation business that trains refugees and immigrants for construction careers, and for remodeling a 1940’s-vintage abandoned home for their own use. To our readers – and those she mentors – Whitsitt offers advice: “Find a career that you can be truly passionate about – and share your experience generously to guide those who follow, so they can benefit from your successes – and mistakes!” westtnmedicalnews
All of Us Looks to Improve Care for Each of Us, continued from page 1 tapping into a breadth and depth of information that is not currently available. Moreover, Denny said the goal is to make this rich dataset easily accessible. “We really believe that the best science is done in a broad, open fashion,” he noted. Denny has been involved with the iniJoshua Denny tiative from the very beginning. He was part of the NIH’s Precision Medicine Initiative Working Group while serving in his previous role as director of the Center for Precision Medicine and vice president for Personalized Medicine at Vanderbilt University Medical Center in Nashville. The work group released a detailed report in September 2015 that became the framework to create the All of Us research platform. At the end of last year, Denny was tapped to lead the NIH effort.
las had a rare mutation that corelated with significantly lower cholesterol and was protective of heart disease. That discovery by geneticists at UT Southwestern ultimately led to a new class of drugs for lowering LDL cholesterol in the broad population. “Those two stories highlight the power of genomics and how data can impact specific populations and everyone,” Denny said. Having easy access to rich data allows researchers to move more quickly and with greater assurance, he said of the repository of millions of pieces of infor-
mation All of Us will contain that can be easily sorted by population characteristics, disease characteristics, geography, age, exposures, medication regimens, genetic signatures and more. “You don’t have to recruit a new population of participants,” he pointed out. “Once you have a research database that’s large and has dense disease data and molecular information like genetics, it’s almost a look up.” Denny added the current COVID-19 pandemic underscores the need for this type of information that could provide scalable insights into who is protected and affected by the virus.
“We’re trying to rethink the whole process of doing research,” he said, adding the goal is to allow broad access for both public and private researchers following beta testing, which launched at the end of May. Once researchers have registered and gone through the onboarding process, All of Us uses a ‘data passport’ model that provides wide access to explore data rather than having to be granted permission for each study on a project-by-project basis. As part of beta testing the All of Us Researcher Workbench, participating (CONTINUED ON PAGE 6)
Participation was purposefully made easy. Anyone aged 18 or older who lives in the United States is eligible to become part of the large study by simply logging onto JoinAllofUs.org. Participants answer health surveys, share electronic health records and might be asked to provide key physical measurements and biospecimens of blood and urine. Some will also be asked to provide saliva for lab and DNA tests. Those asked to share biosamples are able to visit a convenient partner site. However, participants decide how much data they are willing to share. Those who opt not to share their EHR can still participate in health surveys but wouldn’t be included in other aspects of the program. Denny noted active engagement among participants sets the program apart. “We’re not a typical research study that just collects information and does research … we engage participants,” he said of actively seeking input and sharing information.
At the heart of All of Us is the desire to move science forward in a safe, effective, efficient manner by building one of the world’s largest and most comprehensive databases. “It is really to drive medical care, treatment and prevention,” Denny said of the massive undertaking. “It is both about population research and precision medicine research.” He pointed to cystic fibrosis research that led to the 2013 debut of the first drug targeting a specific CF mutation. “It only worked in 5 percent of the population, but it was almost curative,” he said of the breakthrough. Building off that genetic knowledge led to further discovery. By 2019, novel treatments were available to improve function and quality of life for 90 percent of CF patients. From a population health standpoint, Denny said researchers discovered a small population of African-Americans in Dalwesttnmedicalnews
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GrandRounds JMCGH Earns Two Stars in Vascular Quality Initiative Registry Participation Award
The Society for Vascular Surgery’s Vascular Quality Initiative (SVS VQI) has awarded Jackson-Madison County General Hospital two stars for its active participation in the Registry Participation Program. The mission of the SVS VQI is to improve patient safety and the quality of vascular care delivery by providing web-based collection, aggregation and analysis of clinical data submitted in registry format for all patients undergoing specific vascular treatments. The VQI operates 14 vascular registries. The participation awards program began in 2016 to encourage active participation in the registries program and recognize the importance of that participation. Participating centers can earn up to three stars based on actions that lead to better patient care, including: The completeness of long-term, follow-up reporting, based on the percentage of patients for whom they have at least nine months of follow-up data Physician attendance at semi-annu-
All of Us Looks to Improve Care for Each of Us, continued from page 5
researchers have begun using the study’s initial dataset and tools and have been asked to provide feedback. “We really welcome any U.S. academic researcher at this beta phase,” Denny added. Go to ResearchAllofUs.org for more information on applying for access.
al meetings of a regional quality group Initiation of quality improvement activities based on VQI data The number of vascular registries in which the center participates VQI’s registries contain demo-
graphic, clinical, and procedural and outcomes data from more than 670,000 vascular procedures performed in the U.S. and in Canada. Each record includes information from the patient’s initial hospitalization and at one-year
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Baptist Ambulance Begins Providing 911 Ambulance Response to Tipton County
Baptist Ambulance has begun responding to all 9-1-1 calls within Tipton County. The Tipton County Commission selected Baptist Ambulance to provide exclusive 911 emergency ambulance service to the county through a competitive request for proposal process earlier this year. Baptist Ambulance will staff five ambulances 24 hours a day, seven days a week with an additional ambulance available to be staffed by a supervisor during times of high call volume. Baptist Ambulance’s vehicles will be furnished with new, advanced medical equipment, such as the latest model cardiac monitors and power stretchers. Baptist Ambulance is the preferred ambulance service provider for Baptist Memorial Health Care, which includes Baptist Memorial Hospital-Tipton located in the county.
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To date, All of Us has more than 349,00 individuals who have taken the first steps of enrolling. Of that group, over 271,000 have completed the initial stages of the program, which include completing the in-person visit for measurements and biospecimens, offering consent for EHR access, and finishing the initial surveys. Denny noted progress has been slowed over the past few months during shelter-in-place orders that accompanied COVID-19. He added genetic testing was slated to begin just as the pandemic hit. “We’ve actually paused our in-person recruiting right now,” he explained, adding the team is assessing safety and timing to restart visits to partner facilities. Despite that pause, Denny encouraged anyone interested in being part of this seminal study to begin the enrollment process now. In addition to providing important information online that could be immediately useful, it also puts participants in a ready position when in-person visits start back. While Denny said it is crucial for physicians to share the importance of All of Us with patients to increase representative enrollment, he encouraged providers to become part of the cohort, as well.
follow-up. The wealth of data allows centers and providers to compare their performance to regional and national benchmarks. All centers and providers receive biannual dashboards and regular performance reports, so they can use their data to support quality improvement initiatives. Biannual regional meetings allow physicians of different specialties, nurses, data managers, quality officers and others to meet, share information and ideas, and learn from each other in a positive and supportive environment. Members have used VQI data to significantly improve the delivery of vascular care at local, regional, and national levels, reducing complications and expenses.
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West TN Medical News is now privately and locally owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 Sean Deeney, Urology Consultant with NeoTract UroLift, Dr. Timothy Davenport, Jackson Clinic urologist, and Mark Allen CEO of The Jackson Clinic
Dr. Timothy Davenport Awarded UroLift® Center of Excellence
Dr. Timothy Davenport, a board-certified urologist, with The Jackson Clinic has been designated as a UroLift® Center of Excellence. This title recognizes Dr. Davenport’s high level of training and experience with UroLift® as well as his commitment to exemplary care for his patients. UroLift®, a recommended treatment for men suffering from Benign Prostatic Hyperplasia (BPH), is a transurethral, minimally invasive, outpatient procedure. Men are able to receive treatment for their enlarged prostate without cutting, heating, or prostatectomy. The Jackson Clinic is a multi-specialty group practice of over 140 providers in 25 specialties and subspecialties. For more information visit our website at www. jacksonclinic.com.
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GrandRounds Tennessee Dementia Friendly Community Grant Awarded
Jackson Madison County General Hospital (JMCGH) is one of four recipients to be awarded a grant from the Tennessee Department of Health for a pilot program that will implement dementia-friendly community principles. The Tennessee Dementia Friendly Community initiative focuses on reducing the stigma associated with dementia, increasing public awareness of risk factors associated with cognitive decline, increasing early detection and accurate diagnosis of dementia, and supporting faith communities in addressing the impact of dementia in their respective congregations. Alzheimerâ€™s disease accounts for 60 to 80 percent of dementia cases. According to the 2019 Alzheimerâ€™s disease Facts and Figures report, minority communities suffer a disproportionate burden, older African Americans are twice as likely to be diagnosed with Alzheimerâ€™s and older Hispanics are 1.5 times more likely to be diagnosed with the disease than older whites who are not Hispanic. In Tennessee there are approximately 120,000 Tennesseans living with Alzheimerâ€™s disease and other Dementias. Alzheimerâ€™s disease is the fifth leading cause of death in Tennessee, and Tennessee has the fourth highest Alzheimerâ€™s death rate in the nation. The Tennessee Department of Health has developed a toolkit to help guide community efforts in raising awareness of risk factors associated with dementia, encouraging early detection and accurate diagnosis, and working with local community groups to support those living with dementia and their caregivers. JMCGHâ€™s Senior Services Department will oversee the project focusing on populations in both Madison and Crockett Counties. Jackson Madison County General Hospitalâ€™s Senior Services Department also provides a Resource Center for those with Alzheimerâ€™s and other Dementias, a local caregiver support group, and an Annual Caregivers Conference. For more information on the TN Dementia Friendly Community Project and other efforts to educate and support those families experiencing Alzheimerâ€™s and other Dementias, please contact JMCGHâ€™s Senior Services Department, 731-541-8757 or Regina. Smith@WTH.org.
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Appointments: 731.422.0213 jacksonclinic.com/urology 700 West Forrest Ave., Jackson,711 Most common side effects are temporary and can include discomfort when urinating, urgency, inability to control the urge, pelvic pain, and some blood in the urine. Rare side effects, including bleeding and infection, may lead to a serious outcome and may require intervention. Visit UroLift.com. 1. Lokeshwar, 7ransl Androl Urol 2019; 2. Miano, Med Sci Monit 2008; 3. Mirakhur, Can Assoc Rad J 2017; 4. Woo, BJUI 2011 and McVary, J Urol 2015; 5. McVary, J Urol 2015; 6. Gilling, Can J Urol 2020; 7. Kadner, World J Urol 2020 ÂŠ2020 Neo7ract, Inc. All rights reserved. MAC01342-14 Rev A
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