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Lucius M. Lampton, MD Editor D. Stanley Hartness, MD Richard D. deShazo, MD AssociAtE Editors Karen A. Evers MAnAging Editor PublicAtions coMMittEE Dwalia S. South, MD chair Philip T. Merideth, MD, JD Martin M. Pomphrey, MD Leslie E. England, MD, Ex-Officio Myron W. Lockey, MD, Ex-Officio and the editors thE AssociAtion Thomas E. Joiner, MD president Steven L. Demetropoulos, MD president-elect J. Clay Hays, Jr., MD secretary-treasurer Lee Giffin, MD speaker Geri Lee Weiland, MD vice speaker Charmain Kanosky executive director Journal of the Mississippi state Medical association (issn 0026-6396) is owned and published monthly by the Mississippi State Medical Association, founded 1856, located at 408 West Parkway Place, Ridgeland, Mississippi 39158-2548. (ISSN# 0026-6396 as mandated by section E211.10, Domestic Mail Manual). Periodicals postage paid at Jackson, MS and at additional mailing offices. correspondence: Journal MSMA, Managing editor, Karen a. evers, p.o. Box 2548, ridgeland, Ms 39158-2548, ph.: (601) 853-6733, fax: (601)853-6746, www.MsMaonline.com. suBscription rate: $83.00 per annum; $96.00 per annum for foreign subscriptions; $7.00 per copy, $10.00 per foreign copy, as available. advertising rates: furnished on request. cristen hemmins, hemmins hall, inc. advertising, p.o. Box 1112, oxford, Mississippi 38655, ph: (662) 236-1700, fax: (662) 236-7011, email: firstname.lastname@example.org postMaster: send address changes to Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS 391582548. The views expressed in this publication reflect the opinions of the authors and do not necessarily state the opinions or policies of the Mississippi State Medical Association.
PPI S T
copyright© 2012 Mississippi state Medical association.
I L A SSOC
official publication of the MsMa since 1959
Scientific ArticleS Simultaneous Liver Metastasectomy at Operation for Primary Colorectal or Gynecologic Malignancy
J. Jarrett Corley, MD; Mary Kinney Corley, MD; Christopher J. Lahr, MD; David G. McIntosh, MD; Mildred Ridgway, MD and Naveed A. Ahmed, MD
Top 10 Facts You Need to Know About Kidney Transplantation
Fauzia K. Butt, MD and Ashley H. Seawright, DNP, ACNP-BC
Resolve Towards a Healthier Mississippi
Thomas E. Joiner, MD; MSMA President
Public HeAltH rePort cArd Poster Insert
MSMA In Celebration of Health Awareness Day
Karen A. Evers, Managing Editor
Notice of Proposed Changes to MSMA Constitution
Council on Constitution and Bylaws
Focusing on Professionalism
Ralph Didlake, MD, FACS and Patrick O. Smith, PhD
Mississippi State Department of Health
Placement/Classified Una Voce
Harry G. Frye, Jr., MD
About tHe cover:
“Sea Treasures from the Viewbox” is the title W.F. Pontius, MD gave this black and white cover image. This photograph was on display and auctioned at the MSMA Annual Session in Tupelo. Dr. Pontius created these images using radiologic and photographic imaging. The three treasures are the starfish, the spindle, and the spotted tuns. Dr. Pontius resides in Ocean Springs with his wife Mollie. He retired from the practice of radiology in 2001 and continues his hobby of photography. r February
February 2012 JOURNAL MSMA 33
From the Editor
ack in January 2009, our Journal published the first annual Public Health Report Card, a collaboration of the Mississippi State Medical Association and the State Department of Health. Dr. Patrick Barrett, then President, called the report card “a huge office visit for our entire state population.” The annual report card explores each year the current health data for our “patient” (the state of Mississippi). The intent of the report card is to energize our efforts as physicians in transforming our “patient” by addressing its principal health problems and promoting healthy lifestyles and personal responsibility. On January 19th at the state capitol, our current president, Dr. Thomas Joiner, and State Health Officer Dr. Mary Currier released in a press conference the fourth annual Mississippi Public Health Report Card which is included in this issue. Unfortunately, our state remains the fattest in the country and first in teen birth rate, infant mortality, and traffic fatalities. We also have dismal rankings for diabetes, hypertension, cancer mortality, and adult tobacco use. However, let us pick our spears and swords and charge at these public health enemies. We as physicians can change patient behavior in all of these negative rankings. Yes, we are the poorest state, and yes, we have tragic deficits in education, but state docs can reverse Mississippi’s statistics. Each day let us make a difference in the lives of our patients. Also at the capitol on January 19th was the State Medical Association Alliance, hosting the seventh annual CSI (Capitol Screening Initiative). Nancy
Smith, wife of McComb ER physician Dr. Scott Smith, was the “chief” alliance officer who directed this outstanding public service event. This health fair for legislators featured booths, exhibits, blood pressure screenings, and eye screenings. This event is also a great public relations effort by our Alliance for state physicians, garnering the good will and thanks of legislators who vote on physician and public health issues. As docs, we benefit so much from the often unrecognized work of our Medical Alliance. They deserve our accolades every day, and certainly now for their wonderful CSI Lucius M. Lampton, MD project! Encourage your spouse to participate! Editor The Journal remains YOUR publication, created by and for physicians, with all the beauty and frailty such involves. The brilliant Dwalia South, who is out with a recent book, returns this month with a lovely poem, and the second “Asclepiad” photo features Dr. Harry Frye, long a member of the MSMA fifty year club! I invite our readers to submit letters to the editors, scientific articles, essays, book reviews, poetry, or photographs to grace this publication’s pages. It’s only as good as our physicians make it! — Lucius Lampton, MD, Editor
Journal editorial advisory Board R. Scott Anderson, MD, FACR Chair, Journal Editorial Advisory Board Radiation Oncologist and Medical Director, Anderson Regional Cancer Center, Meridian Diane K. Beebe, MD Professor and Chair, Department of Family Medicine, University of MS Medical Center, Jackson Claude D. Brunson, MD Senior Advisor to the Vice Chancellor for External Affairs, University of Mississippi Medical Center, Jackson Jeffrey D. Carron, MD, FAAP, FACS Associate Professor, Department of Otolaryngology & Communicative Sciences, University of Mississippi Medical Center, Jackson Gordon (Mike) Castleberry, MD Urologist, Starkville Urology Clinic Mary Currier, MD, MPH State Health Officer Mississippi State Department of Health, Jackson Thomas E. Dobbs, MD, MPH Health Officer, District VII/VIII Mississippi State Department of Health, Hattiesburg Sharon Douglas, MD Chair, AMA Council on Ethical & Judicial Affairs Professor of Medicine and Associate Dean for V A Education, University of Mississippi School of Medicine, Associate Chief of Staff for Education and Ethics, G.V. Montgomery VA Medical Center, Jackson Daniel P. Edney, MD Executive Committee Member, National Disaster Life Support Education Consortium, Internist The Street Clinic, Vicksburg
34 JOURNAL MSMA
Owen B. Evans, MD Professor of Pediatrics and Neurology University of Mississippi Medical Center, Jackson Maxie L. Gordon, MD Assistant Professor, Department of Psychiatry and Human Behavior, Director of the Adult Inpatient Psychiatry Unit and Medical Student Education, University of Mississippi Medical Center, Jackson Scott Hambleton, MD Medical Director Mississippi Professionals Health Program, Ridgeland John Edward Hill, MD, FAAFP Residency Program Director North Mississippi Medical Center, Tupelo John D. Isaacs, Jr., MD Infertility Specialist, Mississippi Fertility Institute at Women’s Specialty Center, Jackson Kent A Kirchner, MD Chief of Staff G.V. Montgomery VA Medical Center, Jackson Brett C. Lampton, MD Internist/Hospitalist Baptist Memorial Hospital, Oxford Philip L. Levin, MD President, Gulf Coast Writers Association Emergency Medicine Physician, Gulfport
Gailen D. Marshall, Jr., MD, PhD, FACP Professor of Medicine and Pediatrics, Vice Chair for Research, Director, Division of Clinical Immunology and Allergy, Chief, Laboratory of Behavioral Immunology Research The University of Mississippi Medical Center, Jackson Alan R. Moore, MD Clinical Neurophysiologist Muscle and Nerve, Jackson Paul “Hal” Moore Jr., MD, FACR Radiologist Singing River Radiology Group, Pascagoula Jason G. Murphy, MD Surgeon Surgical Clinic Associates, Jackson Ann Myers, MD Rheumatologist Mississippi Arthritis Clinic, Jackson Jimmy L. Stewart, Jr., MD Program Director, Combined Internal Medicine/ Pediatrics Residency Program, Associate Professor of Medicine and Pediatrics University of Mississippi Medical Center, Jackson Samuel Calvin Thigpen, MD Hematology-Oncology Fellow, Department of Medicine University of Mississippi Medical Center, Jackson Thad F. Waites, MD, FACC Clinical Cardiologist, Hattiesburg Clinic
William Lineaweaver, MD, FACS Editor, Annals of Plastic Surgery Medical Director JMS Burn and Reconstruction Center, Brandon
Chris E. Wiggins, MD Orthopaedic Surgeon Bienville Orthopaedic Specialists, Pascagoula
John F. Lucas, Jr., MD Surgeon Greenwood Leflore Hospital
John E. Wilkaitis, MD, MBA, CPE, MS Chief Medical Officer Brentwood Behavioral Healthcare, Flowood
Medical Assurance Company of Mississippi Partnership keeps physicians focused on medicine For the physicians of Biloxi Internal Medicine, Medical Assurance Company of Mississippi is not just their insurance company, but also a member of the team. MACM’s Risk Management Department is invited into the clinic for risk assessments and staff presentations on a regular basis. The physicians want to keep their focus on providing professional care and seek out MACM’s assistance to do just that. Having MACM available to them and to their office staff is just one of the benefits they realize as insureds. With MACM’s help and advice, they can improve on what they already love to do.
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February 2012 JOURNAL MSMA 35
â€˘ ScientiFic articleS â€˘
Simultaneous Liver Metastasectomy at Operation for Primary Colorectal or Gynecologic Malignancy J. Jarrett Corley, MD; Mary Kinney Corley, MD; Christopher J. Lahr, MD; David G. McIntosh, MD; Mildred Ridgway, MD and Naveed A. Ahmed, MD
Background: Treatment of synchronous resectable colorectal liver metastases has traditionally involved a staged surgical approach. Specialized centers have demonstrated good results with simultaneous resection. We aim to report our outcomes at the University of Mississippi Medical Center (UMMC) with simultaneous liver metastasectomy at the time of operation for primary colorectal or gynecologic malignancy Study deSign: From January 2010- September 2011, 6 patients underwent simultaneous resection of liver metastases and primary colorectal or gynecologic malignancy. Operative, postoperative, and pathologic data were retrospectively reviewed. reSultS: Four patients with colorectal primaries underwent simultaneous resection. One received abdominoperineal resection with resection of lesions in hepatic segments II and VII. A second received right hemicolectomy with en bloc resection of gallbladder and segments IV and V. The third and fourth patients both underwent left colectomy with resection of segments IV and V, respectively. All resections were nonanatomic, and frozen-sections were confirmed to be negative at the resection base. No patients suffered additional postoperative morbidity or mortality related to liver resection.
AutHor AffiliAtionS: Resident, Department of General Surgery (Dr JJ Corley), Resident, Department of Obstetrics and Gynecology (Dr MK Corley). Colorectal surgeon, Department of Surgery, (Dr Lahr). Department of Obstetrics and Gynecology, specialized training in gynecologic oncology (Drs McIntosh and Ridgway). Department of Surgery, specialized training in hepatobiliary surgery (Dr Ahmed).University of Mississippi Medical Center, Jackson, MS. correSPonding AutHor: Naveed Ahmed, MD, 2500 North State Street, Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216. (601)984-5120. (email@example.com).
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Two patients had ovarian cancer with metastatic disease to the liver. The first underwent en bloc resection of gallbladder and segments IV and V along with extensive debulking. The second had recurrent ovarian cancer with metastases with liver segments VI and VII. Both patients underwent simultaneous resection with no added postoperative morbidity or mortality attributed to hepatic resection. For gynecologic malignancy, the objective is to remove bulky disease, and although microscopic margins were positive, the goal of tumor load reduction was achieved. concluSionS: Liver resection at the time of operation for primary colorectal or gynecologic primary can safely be performed with the benefit of avoiding morbidity of a second laparotomy without compromising safety. key WordS:
Stage IV colorectal cancer; HepatIc metaStaSectomy; cytoreductIVe tHerapy for oVarIan cancer.
introduction Approximately 25% of patients with colorectal cancer present with synchronous hepatic metastases- a subset of patients that may encompass nearly 35,000 people annually.1 Survival in stage IV colorectal cancer has traditionally approached 10%, and the mainstay of treatment has been systemic chemotherapy. Surgical resection of liver metastases remains the only potentially curative therapy with five-year survival rates of nearly 25% reported in the literature.2-6 Treatment of synchronous resectable colorectal liver metastases has traditionally involved a staged approach with resection of the primary cancer followed by metastasectomy 2-6 months later.7-11 Some highly-specialized, high-volume centers have demonstrated good results with simultaneous resection, reporting a perioperative mortality <5%.4,12-16 Similarly, resection of liver metastases during cytoreductive surgery for ovarian cancer favorably affects survival.17-19
The aim of this article is to review our experience with simultaneous resection of synchronous colorectal or gynecologic malignancy with hepatic metastases at the University of Mississippi Medical Center (UMMC). Also, we will review current resectability criteria and benefits of a one-stage operative approach. MethodS We retrospectively review six patients who underwent simultaneous hepatic metastasectomy at the time of operation for colorectal or gynecologic malignancy from January 2010- September 2011. Our review examines the type of primary cancer resection, location of resected hepatic segments, number of liver lesions, surgical margins of the primary cancer, surgical margins of the metastasectomy, patient age, and complications such as postoperative bleeding or bile leakage. All patients who underwent simultaneous resection of synchronous colorectal or ovarian cancer with hepatic metastases were included. The Brisbane 2000 nomenclature was used to define the segmental anatomy of the liver (Figure 1).29 Figure 1. Segmental Anatomy of the Liver
before resections showed two lesions- both resectable based on their distance from major vasculature. Frozen sections from the base of the lesion representing the 3,6,9,and 12 oâ€™clock positions were sent to confirm negative margins. The patient had no postoperative complications related to liver resection. The second patient underwent right hemicolectomy with en bloc resection of the gallbaldder and hepatic segments IV and V after intraoperative ultrasound demonstrated no other lesions. Intraoperative frozen sections were taken in a similar manner, and there were no complications related to liver resection. The third and fourth patients had left sided colon cancers with a single liver metastasis in segments IV and V, respectively. Again, intraoperative ultrasound confirmed preoperative CT findings, intraoperative frozen sections confirmed negative margins, and there were no complications related to liver resection. Gynecologic The first patient had ovarian cancer with hepatic metastasis. At operation, she underwent right salpingo-oophorectomy, omentectomy, bladder resection, right colectomy, and sigmoid colectomy by the GYN-Oncology team. There was gross invasion of tumor into the gallbladder and a lesion in segment V of the liver (Figures 2,3). Simultaneously, she underwent radical cholecystectomy with en bloc resection of liver segments IV and V. The bowel resection margins were negative for tumor. All gross disease was removed from the liver, keeping with our goal of cytoreduction. The hepatic resection margin was focally positive for metastatic disease. She had no postoperative bleeding or bile leakage from her liver resection but did suffer anastomotic leak of her rectosigmoid anastomosis and related intraabdominal abscess. Postoperative CT is shown (Figure 4). The second patient underwent omentectomy and low anterior resection with diverting ileostomy for recurrent ovarFigure 2. CT abdomen with a large ovarian mass with involvement of right colon and liver
Source: ACS Surgery - 2003 WebMD Inc.
reSultS Colorectal We have treated four patients, all men, with average age of 53. Planning was patient-centric with multidisciplinary cooperation. All patients had preoperative CTs for staging and underwent intraoperative liver ultrasound to confirm location of tumor, any change from preoperative imaging, and resectability. Intraoperative ultrasound was surgeon-performed, utilizing intraoperative radiology consultation for lesions that were difficult to visualize or characterized. All hepatic resections were non-anatomic. The first patient received abdominoperineal resection of the colorectal primary tumor with resection of two liver lesions in segments II and VII. Preoperative CT showed a lesion in segment VII only, but intraoperative ultrasound of the patients liver
February 2012 JOURNAL MSMA 37
Figure 3. CT specific for liver showing invasion of gall bladder and anterior liver in the patient
Figure 4. Post-operative CT
Figure 5. CT shows involvement of posterior liver, in a patient 5. omentectomy and low anterior resection with thatFigure underwent diverting ileostomy for recurrent ovarian cancer
38 JOURNAL MSMA
ian cancer involving the sigmoid colon, residual omentum, and liver (Figure 5). She concurrently underwent two separate wedge resections of segments VI and VII. Pathology was positive for metastatic ovarian adenocarcinoma at the distal sigmoid resection margin. Postoperatively, she suffered no bleeding or bile leak. Postoperative CT is shown (Figure 6). Regardless of the primary tumor type or type of liver resection, no patient suffered postoperative complication related to the liver resection such as bleeding or bile leak. No patient suffered additional morbidity, mortality, or increased hospital stay due to simultaneous liver resection at the time of primary tumor resection (see Table 1). Cure is possible for a number of patients with stage IV colorectal cancer undergoing hepatic metastasectomy. Five year survival rates of patients undergoing resection of liver metastases has been reported as approximately 25% in selected patients. Patients with stage IV colorectal cancer should be discussed at a multidisciplinary tumor-board with an experienced hepatic surgeon to assess resectability status. Criteria for resectability includes likelihood of complete removal of all metastatic disease while maintaining adequate liver reserve. Currently, the best timing for resection of synchronous colorectal liver metastases and the primary tumor has not been well defined. The traditional approach has been staged resection. Safety of simultaneous resection has been shown at highly-specialized high-volume centers. Preoperative evaluation includes imaging modalities such as computed tomography (CT), preoperative and intraoperative ultrasonography, as well as positron emission tomography (PET). Use of triple-phase contrast enhancement during CT scanning helps define vascular anatomy and aids operative planning. Additionally, we use intraoperative ultrasound to ensure safe distance of tumors from vascular structures to confirm resectability and also to identify any other lesions. Hepatic colorectal metastases are currently deemed resectable when the diseased area can be completely resected, two Figureg6. Post-operative CT
Table 1. Results
Primary Tumor Location
Type of Liver Resection
adjacent liver segments can be spared, adequate vascular supply and biliary drainage can be preserved, and the future liver remnant is adequate-25% of the total liver volume. Modalities such as portal venous embolization can be used in cases of insufficient remnant liver volume to convert to resectable status by enhancing growth of the future liver remnant.20-22 This is true even in the setting of neoadjuvant chemotherapy which can lessen tumor burden and help convert to resectable status.23-24 The principles of cytoreductive surgery in stages II, III, and IV ovarian cancer involve aspiration of ascites or peritoneal lavage for cytologic examination, total hysterectomy, bilateral salpingectomy, bilateral oopherectomy, omentectomy, aortic lymph node dissection, and pelvic lymph node dissection. In an effort to achieve maximal cytoreduction, defined as less than 1 cm residual disease or resection of all visible disease, partial hepatectomy may be required.25-27 This is safe when performed with an experienced hepatic surgeon and significantly prolongs life-expectancy.28 Our data demonstrates safety of a simultaneous approach to synchronous colorectal and ovarian cancer liver metastases. This approach avoids second laparotomy and does not increase morbidity or mortality. Overall, there is a shorter overall treatment time than with staged resection. referenceS
1. American Cancer Society. Colon/Rectum Cancer Detailed
Guide. http://www.cancer.org/Cancer/ColonandRectumCancer/ DetailedGuide/colorectal-cancer-survival-rates. Accessed September 6, 2011.
Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818-827.
Fernandez FG, Drebin JA, Linehan DC, et al. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography
with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg. 2004 Sep;240(3):438-47. 4.
Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15:938-946.
Tuttle TM, Curley SA, Roh MS. Repeat hepatic resection as effective treatment of recurrent colorectal liver metastases. Ann Surg Oncol. 1997;4:125-130.
Nadig DE, Wade TP, Fairchild RB, et al. Major hepatic resection. Indications and results in a national hospital system from 1988-1992. Arch Surg. 1997;132:1515-119.
Nordlinger B, Guiguet M, Vaillant JC, et al; Association Francaise de Chirurgie. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996; 77:1254-1262.
Bolton JS, Fuhrman GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg. 2000;231:743-751.
Cady B, Stone MD. The role of surgical resection of liver metastases in colorectal carcinoma. Semin Oncol. 1991;18:399406.
10. Bismuth H, Castaing D, Traynor O. Surgery for synchronous hepatic metastases of colorectal cancer. Scand J Gastroenterol Suppl. 1988;149:144-149. 11. De Santibanes E, Lassalle FB, McCormack L, et al. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg. 2002;195:196-202. 12. Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg. 2003;90:956-962. 13. Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233-241. 14. Lyass S, Zamir G, Matot I, et al. Combined colon and hepatic resection for synchronous colorectal liver metastases. J Surg Oncol. 2001;78:17-21.
February 2012 JOURNAL MSMA 39
15. Jaeck D, Bachellier P, Weber JC, et al. Surgical treatment of synchronous hepatic metastases of colorectal cancers: simultaneous or delayed resection? Ann Chir. 1996;50:381-390.
24. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist 2008;13:51-64.
16. Doko M, Zovak M, Ledinsky M, et al. Safety of simultaneous resections of colorectal cancer and liver metastases. Coll Antropol. 2000:24:381-390.
25. Bristow RE, Puri I and Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 2009;112:265-274.
17. Huang PP, Weber TK, Mendoza C, Rodriuguiez-Bigas MA, et al. Long-term survival in patients with ovarian metastases from colorectal carcinoma. Ann Surg Oncol. 1998;5:695-698.
26. Aletti GD, Dowdy SC, Gostout BS, et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 2006;107:77-85.
18. Rayon D, Bouttell E, Whiston F, Stitt L. Outcome after ovarian/ adnexal metastasectomy in metastatic colorectal carcinoma. J Surg Oncol. 2000;75:186-192.
27. Eisenhauer EL, Abu-Rustum NR, Sonoda T, et al. The effect of maximal surgical cytoreduction of sensitivity of platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecol Oncol 2008;108:276-281.
19. Knowles B, Bellamy CO, Oniscu A, Wigmore SJ. Hepatic resection for metastatic endometrioid carcinoma. HPB (Oxford). 2010. Aug;12(6):412-417. 20. Vauthey JN, Pawlik TM, Abdalla EK, et al. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg. 2004;239:722-32. 21. Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique, and future prospects. Br J Surg 2001;88:165-75.
28. Winberger P, Lehmann N, Kimmig R, et al. Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 2007;106:69-74. 29. Strasberg SM, Belghiti J, Clavien P-A, et al. The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000;2:3339.
22. Charnsangavej C, Clary B, Fong Y, et al. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1261-8. 23. Covey AM, Brown KT, Jarnagin WR, et al. Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg. 2008;247(3):451-5.
Feel the Burn Exercise at a moderate intensity to get the most benefit from your workout. A light sweat, faster breathing and some strain in your muscles are all good indicators you’re exercising effectively. If you have a health condition or any other physical barrier, it’s a good idea to talk to your doctor before you begin. be healthy. exercise.
www.bcbsms.com Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.
40 JOURNAL MSMA
• top 10 FactS you need to Know •
About Kidney Transplantation Fauzia K. Butt, MD and Ashley H. Seawright, DNP, ACNP-BC
Renal transplantation is the preferred therapy for end-stage renal disease (ESRD). Compared to continued dialysis, successful transplantation is associated with enhanced survival and improved quality of life.1 Patients in early stage 4 chronic kidney disease (glomerular filtration rate [GFR] between 15 and 29 ml/min) should be referred for transplantation.2 When the GFR is ≤ 20 ml/min, patients can start accruing time on the wait list for deceased donor kidneys. The United Network for Organ Sharing (UNOS), a nonprofit organization under contract with the federal government, distributes all deceased donor organs. The allocation of kidneys is based on a formula that takes into consideration the blood type, length of time on the wait list, presence of antibodies in the blood, and the human leukocyte antigen (HLA) match between the donor and recipient, with prioritization for pediatric recipients.
1. Established guidelines assist with the evaluation of potential kidney transplant recipients. 3 Developed by the Clinical Practice Guidelines Committee of the American Society of Transplantation, these evidence-based recommendations facilitate the evaluation of renal transplant candidates. Potential recipients undergo extensive medical and psychosocial testing to determine their eligibility for transplantation. While specific selection criteria may vary AutHor AffiliAtionS: Dr. Butt is board certified in general surgery and ASTS-certified in abdominal transplant surgery. She is an Assistant Professor of Surgery at the University of Mississippi Medical Center (UMMC) and served as Interim Division Chief of Transplant Surgery from late 2010 until August 2011. Ms. Seawright is a board certified acute care nurse practitioner with transplant surgery at UMMC, who recently received her doctorate of nursing practice from Johns Hopkins. correSPonding AutHor: Dr. Fauzia K. Butt, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216.
slightly by transplant center, their main purpose is to ensure that potential candidates lack any unacceptable medical or psychosocial risks. Repeat testing after initial listing may be indicated for certain patients, such as those with cardiovascular disease, in order to determine continued suitability.4 2. A deceased person may donate tissues and solid organs after declaration of death by either neurologic or cardiopulmonary criteria.5 Neurologic criteria are used to identify the typical “brain dead” organ donor, and the guidelines followed in the United States are clearly defined.6 In an effort to prevent deaths on the wait list and honor the wishes to donate of patients who do not meet brain death criteria, donation after cardiac death (DCD) is an acceptable option in cases of severe neurological injury without any chance of meaningful recovery. Donation can proceed once withdrawal of the mechanical ventilator results in cardiac and respiratory cessation. Death is declared by a physician independent of the organ recovery team to avoid any potential conflicts of interest. In order to demonstrate irreversibility, termination of circulatory and respiratory function must exist for at least 5 minutes before the organ recovery process can begin.5 3. A living person may donate a kidney after extensive screening for any medical conditions or psychosocial issues that would preclude donation.7 Living donors can be genetically, or emotionally, related to the recipient, should be free of any significant medical problems, and must not be coerced into donation.7 Potential living donors undergo an extensive medical and psychosocial evaluation. Neither life expectancy nor the risk of developing kidney disease is altered by donating a kidney.8 Laparoscopic donor nephrectomy has less morbidity than the open technique and is now routinely offered at most transplant centers.9 An independent donor advocate ensures that the interests of the living donor are not compromised.7
February 2012 JOURNAL MSMA 41
4. Donor kidney quality affects post-transplant outcomes.10 Generally, kidneys from living donors are associated with superior graft function and survival. The current 1-year graft and patient survival rates for adult recipients of a deceased donor renal transplant in the United States are 91.8% and 95.7%.11 These numbers improve for adult recipients of a living donor renal transplant to 96.5% and 98.5%, respectively.11 There are several types of deceased donors.12 A standard criteria donor (SCD) is a young, healthy donor whose death is the result of a sudden, traumatic event, and this type of donor is associated with the best results in deceased donor transplantation. All donors â‰Ľ 60 years of age are considered to be expanded criteria donors (ECD). Donors between the ages of 50-59 are also included in the ECD category if they have two of the following three criteria: 1) death due to a cerebrovascular accident, 2) history of hypertension, or 3) terminal creatinine â‰Ľ 1.5. Deceased donor kidneys that are recovered in less than optimal circumstances may experience delayed graft function (DGF), necessitating the continuation of dialysis after transplantation until adequate recovery of graft function. ECD and DCD kidneys are associated with an initial risk of DGF; however, the benefits of discontinuing dialysis long-term may significantly outweigh this initial risk.10 ECD and DCD kidneys will be offered only to patients who have previously agreed to accept them. DCD kidneys from donors < 50 years of age have equivalent long-term graft survival as SCD kidneys.13 5. The number of listed patients awaiting kidney transplantation drastically exceeds the number of available donor organs.14 There are currently over 89,000 listed candidates who are awaiting kidney transplantation in the United States.14 In 2010, there were a total of 13,523 kidney donors, and 54% were deceased donors.15 The existing organ donor supply cannot even begin to meet the current demands, and the number of patients needing transplantation increases daily. During the first decade of this century, a 260% increase in the waiting list was accompanied by a mere 16% increase in the number of deceased donor transplants performed.13 The continual challenge to the transplant community to increase the availability of deceased donor organs has resulted in the utilization of ECD and DCD donors. Innovative approaches to living donation have also been developed, including paired donation exchanges and transplant chains.16 Occasionally, a transplant chain may be started by an altruistic, living donor without a designated recipient, thus enabling multiple recipients with incompatible donors to be transplanted.16,17 6. Post-transplant outcomes are improved with early transplantation.18,19 One important factor influencing post-transplant outcomes is the amount of time spent on dialysis. Increased pretransplant dialysis time is associated with inferior graft and
42 JOURNAL MSMA
recipient outcomes.2,18,19 In fact, the superior outcomes associated with living donor transplantation may be partly due to decreased dialysis time in addition to better quality donor kidneys. This effect is so striking that a deceased donor renal transplant recipient on dialysis < 6 months has the same graft survival as the recipient of a living donor renal transplant on dialysis > 2 years.19 The best results are achieved with preemptive transplantation.2,18,19 With early referral, patients may be transplanted before the initiation of dialysis, especially when a living donor is available. In order to minimize the time spent on dialysis and maximize outcomes, it has been suggested that the standard of care should be to refer appropriate patients for transplantation at the same time as referral for vascular access.2 7. Potential recipients may choose to be listed at multiple centers.20 According to UNOS policy 3.2.2, patients have the option to be listed at multiple transplant centers which may reduce the time it takes to receive a transplant if the centers are located in different organ procurement organization (OPO) service areas. Locally listed candidates close to the donor hospital are usually considered ahead of those listed at more distant centers, so multiple listing may increase the patientâ€™s chances of receiving a local organ offer. UNOS policy 188.8.131.52 also allows patients to transfer their waiting time from one transplant center to another, which may occur when patients relocate from one geographical area to another, permitting their position to be maintained on the wait list without the loss of any accumulated waiting time. 20 8. Optimal management of co-morbid conditions maximizes the full benefits of transplantation.21 Significant improvement in patient and graft survival rates in renal transplant recipients has resulted in an older patient population with multiple co-morbidities. Hypertension, diabetes, cardiovascular disease, and other co-morbidities must be optimally managed in order to maximize the benefits of renal transplantation. Transplantation reduces long-term mortality in diabetic patients by >50%;1 however, cardiovascular disease (CVD) is the leading cause of death in patients with a functioning graft.21 The highest risk of death occurs in the immediate posttransplant period (within the first 3 months), and then it decreases dramatically to much less than that for patients remaining on the wait list.22 Managing CVD, especially in diabetic recipients, may further improve patient survival post-transplantation.21 9. Native nephrectomy may be indicated before transplantation. 23 Typically, the diseased kidneys are left in place and the new kidney is placed extraperitoneally in the pelvis, where it is attached to the iliac vessels and the bladder.24 Although
not routinely performed, native nephrectomy may be indicated in cases of malignancy, chronic pyelonephritis, severe proteinuria, or uncontrollable hypertension. The presence of extremely large polycystic kidneys may also necessitate a native nephrectomy to create space for the transplant. 10. Established guidelines assist with the management of kidney transplant recipients.25 Increased survival after kidney transplantation requires community physicians and nephrologists to become increasingly familiar with the management of these particular patients.26,27 Comprehensive evidence-based practice guidelines developed by the National Kidney Foundation (Kidney Disease: Improving Global Outcomes [KDIGO] transplant work group) assist with the clinical management of kidney transplant recipients.25 The post-transplant regimen consists of a combination of several medications: immunosuppressive, antiviral and antibacterial agents. Although individual protocols vary by transplant center, immunosuppression generally consists of three agents: a calcineurin inhibitor (cyclosporine or tacrolimus), an antiproliferative agent (mycophenolate mofetil or azathioprine), and steroids.28,29 Immunosuppressive agents are powerful medications associated with multiple side effects, including drug interactions,28,29 and account for the majority of transplant-related morbidity. A delicate balance must be achieved between too little immunosuppression, which results in rejection, and too much immunosuppression, which leads to opportunistic infections and neoplasias. This balance is maintained through lifelong clinical and laboratory monitoring, including medication levels. Patients are typically required to attend clinic frequently during the first month after transplantation and then progressively less often. After several months, when kidney function and medical therapy are relatively stable, patients will return to their primary nephrologist for continued management. The transplant team will follow up regularly, but less frequently, and will always be available for any questions and concerns that may arise. For optimal management of these complicated patients, there must be consistent communication between their primary care providers and the transplant center. concluSion There are approximately 325,000 patients currently on dialysis in the United States.30 After receiving a successful kidney transplant, the majority of patients are able to return to work or school. Cognitive function steadily improves and reproductive capacity is restored. Some recipients may become competitive athletes and participate in the U.S. and World Transplant Games. Unfortunately, the number of patients awaiting transplantation has increased significantly over the years without a concomitant increase in available donor organs. In 2008, 4.6% of the nearly 100,000 patients on the kidney wait list died while awaiting transplantation.31 Maximal utilization of organs can be achieved by encouraging everyone to regis-
ter as an organ donor and inform one’s immediate family of this important, life-saving decision. Multiple resources regarding information on transplantation and donation are available for health care providers and their patients (see below). Available resources for additional information on transplantation: •
American Association of Kidney Patients: www.aakp.org
American Society of Transplant Surgeons: www.asts.org
American Society of Transplantation: www.a-s-.t.org
Association for Multicultural Affairs in Transplantation: www.asmhtp.org
Department of Health and Human Services: www. organdonor.gov
Donate Life America: www.donatelife.net
Mississippi Kidney Foundation: www.kidneyms.org
Mississippi Organ Recovery Agency: www.msora.org
Minority Organ Tissue Transplant Education Program: www.nationalmottep.org
National Kidney Foundation: www.kidney.org
National Transplant Assistance Fund: www.ntafund.org
National Foundation for Transplants: www.transplants.org
Organ Procurement & Transplantation Network: http:// optn.transplant.hrsa.gov
Scientific Registry of Transplant Recipients: www.srtr.org
Transplant information provided by Astellas: www. transplantexperience.com
United Network for Organ Sharing: www.unos.org
Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725-1730.
Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/ Kidney Disease Outcomes Quality Initiative (NKF/ KDOQI) conference. Clin J Am Soc Nephrol. 2008;3:471-480.
Kasiske BL, Cangro CB, Hariharan S, et al. The evaluation of renal transplant candidates: clinical practice guidelines. Am J Transplant. 2001;2(suppl 1):5–95.
Bunnapradist S, Danovitch GM. Evaluation of adult kidney transplant candidates. In: Danovitch GM, ed. Handbook of Kidney Transplantation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:177-178.
February 2012 JOURNAL MSMA 43
Bernat JL, Dâ€™Alessandro AM, Port FK, et al. Report of a national conference on donation after cardiac death. Am J Transplant. 2006;6:281-291.
Wijdicks EFM. Determining brain death in adults. Neurology. 1995;45:1003-1011.
The Authors for the Live Organ Donor Consensus Group. Consensus statement on the live organ donor. JAMA. 2000;284:2919-2926.
Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med. 2009;360:459-469.
Flowers JL, Jacobs S, Cho E, et al. Comparison of open and laparoscopic live donor nephrectomy. Ann Surg. 1997;226:483-490.
10. Merion RM, Ashby VB, Wolfe RA, et al. Deceased-donor characteristics and the survival benefit of transplantation. JAMA. 2005;294:2726-2733. 11. Scientific Registry of Transplant Recipients (SRTR) data. www. srtr.org. Accessed July 19, 2011. 12. Rao PS, Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD: fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol. 2009;4:1827-1831. 13. Locke JE, Segev DL, Warren DS, et al. Outcomes of kidneys from donors after cardiac death: implications for allocation and preservation. Am J Transplant. 2007;7:1797-1807. 14. HRSA/ OPTN website. Current U.S. waiting list, overall by organ type. http://optn.transplant.hrsa.gov/latestData/rptData. asp. Accessed June 17, 2011. 15. HRSA/ OPTN website. Donors recovered in the U.S. by donor type. http://optn.transplant.hrsa.gov/latestData/rptData.asp. Accessed June 17, 2011.
25. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9(suppl 3):S1â€“S157. 26. Howard AD. Long-term posttransplantation care: the expanding role of community nephrologists. Am J Kid Dis 2006;47(suppl 2):S111-S124. 27. Cohen D, Galbraith C. General health management and long-term care of the renal transplant recipient. Am J Kid Dis 2001;38(suppl 6):S10-S24. 28. Danovitch GM. Immunosuppressive medications and protocols for kidney transplantation. In: Danovitch GM, ed. Handbook of Kidney Transplantation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:77-100. 29. Gaston RS. Current and evolving immunosuppressive regimens in kidney transplantation. Am J Kid Dis. 2006;47(suppl 2):S3-21. 30. American Association of Kidney Diseases website. Dialysis over the last 35 years. Available at http://www.aakp.org/newsletters/ Renalife-Magazine/Doctor-Articles/Dialysis-Last-35-Years/. Accessed May 27, 2011. 31. 2009 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1999-2008. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Rockville, MD; United Network for Organ Sharing, Richmond, VA; University Renal Research and Education Association, Ann Arbor, MI.
16. Butt F, Gritsch HA, Schulam P, et al. Asynchronous, out-ofsequence, transcontinental chain kidney transplantation: a novel concept. Am J Transplant. 2009;9:2180-2185. 17. Rees MA, Kopke JE, Pelletier RP, et al. A nonsimultaneous, extended, altruistic-donor chain. N Engl J Med. 2009;360:10961101. 18. Cosio FG, Alamir A, Yim S, et al. Patient survival after renal transplantation, I: the impact of dialysis pre-transplant. Kidney Int. 1998;53:767-772. 19. Meier-Kriesche HU, Kaplan, B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation. 2002;74:13771381. 20. HRSA/ OPTN website. Policies, 3.2 Organ Distribution: UNOS Patient Waiting List. http://optn.transplant.hrsa.gov/ PoliciesandBylaws2/policies/pdfs/policy_4.pdf. Accessed June 17, 2011. 21. Ojo AO, Hanson JA, Wolfe RA, et al. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57:307313. 22. Meier-Kriesche, HU, Schold JD, Srinivas TR, et al. Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant. 2004;4:1662-1668. 23. Bunnapradist S, Danovitch GM. Evaluation of adult kidney transplant candidates. In: Danovitch GM, ed. Handbook of Kidney Transplantation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:169. 24. Veale JL, Singer JS, Gritsch HA. The transplant operation and its surgical complications. In: Danovitch GM, ed. Handbook of Kidney Transplantation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:181-185.
44 JOURNAL MSMA
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• preSident’S page •
Resolve Towards a Healthier Mississippi
t’s February and the new year is still full of optimism for a better 2012. Your MSMA has again issued the third annual public health report card which you’ll find in the centerfold of this JMSMA. I encourage you to hang the poster in a prominent place and use it to help your patients with their resolutions whether it is to lose weight, quit smoking, get fit, drink less alcohol, or eat healthier. These New Year’s resolutions are popular year after year. MSMA has taken the pulse of Mississippi, and our health is in critical condition. To make an impact on Mississippi’s health crisis we physicians should talk to our patients about undesirable health consequences and help them commit to make healthier choices. Hopefulness for a healthier Mississippi will require changing bad habits and substituting better behavior. People spend countless hours and dollars each year attempting to break bad habits, often without success. Why? Because there is no magic pill. Change is hard work and there is no short cut to achieving it. The public health report card has healthy resources to assist you in helping your patients thomaS e. Joiner, md achieve their goals. 2011-12 mSma preSident You’ll find resources like the 1-800-QUIT-NOW Mississippi Tobacco Quit Line listed on the back of the report card. This valuable resource offers telephone and online cessation counseling, referral to local cessation programs (when available), self-help materials, nicotine replacement therapy assistance (for eligible callers), a fax referral program for healthcare providers, and cessation program options for employers. Speaking of resources, physicians can help break the obesity cycle by simply outlining healthier choices. The December Journal included a portion and calorie program for Mississippi. Download it from MSMAonline.com and use it to effect a change in eating habits. You can teach your patients how to regain the ability to make healthier eating choices by showing them how to use the Southern Remedy Health Living dietary and lifestyle change tool. Even modest weight reductions are associated with decreased diabetes, hypertension, and stroke, all downstream effects of obesity. If it can work for the individual, it can work for the state. It is part of our job to advise and encourage. When you look at the report card found a few pages over, you will find the data for our patient (the public health report card for Mississippi). We have our work cut out for us. We are #1 in too many detrimental categories (adult obesity, infant mortality, teen birth rate, heart disease deaths, and traffic fatalities) and #2 in others (hypertension and sedentary adults). We are #3 in cancer mortality and diabetes cases, and #4 in adult tobacco usage. Take a moment and look at the rest of the data. The saddest part of all: hundreds of thousands of people die prematurely due to these entirely preventable behaviors. It doesn’t take a brain surgeon to know we need to focus more on the prevention of disease and the promotion of health than on the management of illnesses. As a long journey starts with a first step, we take this step together with the people of Mississippi with the hope and resolve of a new year. If it can work for the individual, it can work for the State. It is part of our job to advise and encourage. You know what they say about changing behavior: ultimately, it’s up to you.
P.S.: The Triple Crown season is off and running, and the horse to watch from Fair Grounds is Mr. Bowling, winner of the Lecomte Stakes. The Lecomte is annually a good gauge for what types of horses will be coming to the Kentucky Derby from Louisiana and surrounding areas. The long stretch of Fair Grounds, which is similar to the extensive stretch at Churchill Downs, also helps provide a better idea of whether a horse has the proper running style to be successful in the Kentucky Derby. As the season continues, more races will define more horses to watch. I’ll keep you informed on the races.
46 JOURNAL MSMA
SMAonline.com • 1-800-898-0251 • www.M -6733 • Fax 601-853-6746 -853 601 • 57 391 e Plac 548 • 408 West Parkway geland, Mississippi 39158-2
P.O. Box 2548 • Rid
ippi State l Association and the Mississ the Mississippi State Medica to teen by ity red rtal nso mo spo nt d, infa Car and ort m obesity to diabetes ual Public Health Rep Fro ann es. i’s ipp issu siss lth Mis hea ing you to elm t We presen direction. herself with overwh st make a move in a better once again, our state finds care access, we simply mu lth Department of Health. And hea and s STD to s litie and traffic fata and economic issue. birth rate, from tobacco use blem is both a healthcare pro sity obe i’s ipp siss Mis . lthcare spending. state is obesity ning to public health in our will also decrease overall hea ate and thre es, st bet mo dia es ng issu udi the incl s, of One onic disease rates will reduce related chr ugh lifestyle Therefore, reducing obesity Obesity is preventable thro cial public health epidemic. cru this re. inst futu aga the rge and cha tion the era for this gen across the state to lead to put an end to obesity… This year, we urge physicians ts to eat better and get active ien pat r you age our enc , ion to fight changes! So physicians read how you can take act in the years to come. Below, and now lth hea ter bet to h huge difference on the pat Small steps today make a es! Mississippi’s health cris to exercise at least 30 How to Fight the Crisis: le grains; make it a priority who pi: and sip s, ble sis eta Mis in veg ts, sis Health Cri Eat a diet rich in frui Physical Activity per week. Adult Obesity and Lack of minutes three to five times mote smokefree air in your sissippi Tobacco Quitline. Pro mokeFreeAirMS.com. Mis the for OW IT-N QU 00Call 1-8 e at www.S the SmokeFree Air Initiativ Adult Tobacco Use community; get involved with re to second-hand smoke; smoking and reduce exposu p sto s; ing een scr lth hea Get regular annual . family history of the disease Cancer Mortality use sunscreen; know your es per 30 minutes three to five tim pressure; exercise at least od reducing ut blo r abo you tor trol doc r con g; you to okin Stop sm n and whole grains; talk nsio s, erte ble eta Hyp / veg es ts, bet frui Dia of / t e die Heart Diseas week; eat a healthy the risk of heart attack. ippi be pregnant; call the Mississ if you are or think you might ly ate edi imm an sici phy r See you 848-5683. Infant Mortality Pregnancy Hotline at 1-800prevented by seat belt deaths each year could be fic traf of t cen per paired 50 ut Abo in the US involve alcohol-im Wear your seatbelt! ries one-third of traffic fatalities ut abo e; driv and k drin ’t Traffic Fatalities / Trauma Inju use. Don drivers. avior. Teens, get educated s of irresponsible sexual beh risk the ut ings are abo n dre chil r e and private STD/HIV screen Parents, talk to you s/HIV before having sex. Fre STD and , ncy gna pre , Teen Birth Rate / STDs, HIV sex about department. available at your local health ize with drugs and alcohol. Util dren about risky behavior chil r you lth with Hea Talk s e. Kid um Parents, do not ass erica (drugfree.org) and Use tnership for a Drug-Free Am Teen Alcohol and Marijuana resources such as The Par lthy decisions. hea ke ma kids to help your (kidshealth.org) to learn how
PUBLIC HEALTH IN MISSISSIPPI
Yours in making Mississip
Thomas E. Joiner, MD Medical Association President, Mississippi State
lth Mary Currier, MD, MPH ippi State Department of Hea State Health Officer, Mississ
ippi. ho Care for Mississ The Physicians W
MISSISSIPPI STATE DEPARTMENT OF HEALTH
Report Card 2012 PROOF.indd 1
1/13/12 9:52 AM
Report Card 2012 PROOF.indd 2 1/13/12 9:52 AM
Sources: United States Department of Health and Human Services – Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, National Vital Statistics Report, Mississippi Vital Records - Mississippi State Department of Health (MSDH), Behavioral Risk Factor Surveillance System – CDC, MSDH STD/HIV Office, Henry J. Kaiser Family Foundation – State Health Facts.
The 2012 Mississippi Public Health Report Card is brought to you by the Mississippi State Medical Association and the Mississippi State Department of Health.
Mississippi ranks #1 in adult obesity and heart disease deaths #2 in hypertension cases and in adults reporting no physical activity in the past month and #3 in diabetes cases. Mississippi is 4th in adult tobacco use 1st in teen birth rate 1st in infant mortality 1st in traffic fatalities 5th in trauma and unintentional injuries 3rd in cancer mortality 2nd best in breast cancer incidence but 7th worst in breast cancer mortality and 15th in suicide rates. 39.2 percent of high school kids have consumed alcohol and nearly 18 percent have used marijuana. 28,943 new STD cases were reported in 2010 in Mississippi including 550 cases of HIV. Mississippi ranks 50th in physicians per capita.
• mSma • In Celebration of Health Awareness Day Karen A. Evers, Managing Editor
Health Awareness Day—Members of the MSMA Alliance and physicians join MSMA President Dr. Tom Joiner and State Health Officer Dr. Mary Currier at a press conference to release the Fourth Annual Public Health Report Card.
Patrick House, winner of the NBC-TV reality show “The Biggest Loser: Season 10,” poses with the size 58 pants he used to wear. House is working with the MSMA Alliance encouraging children to be active and make healthy choices. As he tours, he shows kids how they, too, can set goals and achieve them. “It’s about getting them active, raising awareness about how bad fast foods and fried foods are for them. Letting them know you can still eat healthy foods and it tastes good,” House said. Shown l. to r.: Carole Kelly, Communications Manager at Information & Quality Healthcare (IQH) exhibits for the Mississippi Chronic Illness Coalition (MCIC) with Ann Sansing, community health coordinator with the Mississippi State University Extension Service; House and Aundria Range, MCIC community-based prevention committee chair.
ealth Awareness Day,” Thursday, January 19, was eventful at the State Capitol building as the MSMA Alliance hosted the seventh annual Capitol Screening Initiative (CSI VII) targeting members of our State Legislature and a media press conference was held to release the fourth annual public health report card. The report card, issued by MSMA in collaboration with the Mississippi State Department of Health, appears in the centerfold of this Journal MSMA. The activities were planned to get Legislators’ attention and let them know our MSMA wants to help them stay in the best physical and mental condition to make the critical decisions they face during the legislative session, particularly the health issues on MSMA’s legislative agenda. A variety of health screenings were offered at no charge to elected officials and staff. Members of our Alliance were on hand to meet and direct legislators through the screenings as well as to provide healthy snacks for consumption after the tests. Both events, the report card press conference and CSI VII, showed the Legislature the medical community cares about them. In the four years since the first Public Health Report Card release, most statistics have yet to improve. Some have worsened. To further enhance our MSMA’s advocacy efforts, we encourage members to display the report card by hanging it in a prominent place. Physicians can use the poster to inform patients, prompt dialogue, and encourage those who seek their advice. The 2012 Public Health Report Card is available on the MSMA website: MSMAonline.com. For extra copies, you may call MSMA headquarters and request a reprint of the poster. —continued p. 55....
Capitol Screening Inititive (CSI) — Rep. Joe C. Gardner was one of about 200 people who browsed exhibits and received a screening from over 20 exhibitors. Screenings included BMI, blood pressure, glucose, cholesterol, EKG, glaucoma, and diabetic retinopathy. Flu shots were also offered.
February 2012 JOURNAL MSMA 51
Be sure to join us for a beachside celebration on Friday, June 8 at the Annual Session President’s Reception…
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MSMA Annual Session Schedule Thursday, June 7 (Registration 1pm – 5pm) 8:30 10:30 CME Presented by MACM (2hrs CME) 11:00 until MACM Golf Tournament Grand Marriott Golf Club 3:00 5:00 Medical Affairs Forum (2hrs CME) 5:30 7:00 MSMA / UMC Welcome Reception 7:30 until Committee on Publications Meeting/Dinner Friday, June 8 (Registration 7am – 5pm) 7:00 8:00 MSMA Board of Trustees 7:30 9:30 Breakfast with Exhibitors 7:30 8:30 Reference Committee Orientation/Breakfast 9:00 11:30 House of Delegates 11:30 1:00 Lunch with Exhibitors 11:30 12:30 MPCN Executive Committee Meeting 12:30 1:30 MPCN Board of Directors Luncheon 1:00 1:30 MSMA Board of Trustees Meeting 1:30 3:30 Reference Committee Hearings 3:30 4:30 Journal Editorial Advisory Board Meeting 3:30 4:30 MMPAC Board of Directors Meeting 3:30 4:30 YPS Business Meeting 3:30 4:30 Women in Medicine Business Meeting 3:30 5:00 MSMA Surveyor Training Workshop/ Council on Medical Education 6:30 8:00 President’s Reception – Crawfish Boil 8:00 9:00 Southern Medical Ice Cream Social Saturday, June 9 (Registration 6:30am – 5pm) 6:30 8:00 Breakfast 7:00 12:30 Medical Affairs Forum (5hrs CME) 12:30 1:30 Candidate Speeches to Caucuses/ Boxed Lunch 1:30 2:30 Specialty Society Meetings 2:30 4:30 Guest Speakers with Book Signing Topic: World War II 3:30 5:30 MSMA Board of Trustees 6:30 7:30 MSMA Reception and Alliance Raffle 7:30 11:00 President’s Inaugural Dinner Dance Tickets: $120 per person Sunday, June 10 (Registration 7am – 11am) 7:15 7:45 Worship Service 7:30 9:00 Voting 7:30 9:00 Continental Breakfast 8:00 9:00 VIP Breakfasts: 50-Year Club and Past-Presidents’ 8:00 9:00 MSMA Board of Trustees 9:00 11:00 House of Delegates 11:00 11:15 MSMA Board of Trustees
MSMA ALLIANCE SCHEDULE Friday, June 8 10:00 am 12:00 pm
Pre-Convention Board Meeting Luncheon (Dutch Treat)
Saturday, June 9 8:30 am 12:00 pm
House of Delegates Installation Luncheon
Sunday, June 10 8:00 am
Past Presidents’ Breakfast
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THURSDAY, JUNE 7