January 10, 2014
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 32, No. 20
Before Bringing Home THaT Bacon A simple and healthy New Year’s Resolution may be just learning what ‘AGE’ your food is By Dawn Brazell Public Relations
H
ere’s an easy New Year’s resolution to create a healthier you. Add the word AGE or advanced glycation end product to your vocabulary. It’s one you’ll be hearing about more this year, especially if David P. Turner, Ph.D., has anything to do with it. The harder part, though, is what to do when you know what it is. For Turner, who is an assistant professor in the Department Pathology and Laboratory Turner’s Top of Medicine, it meant giving up DieT Tips bacon. However, before anyone panics, there are other simpler See page 7 diet changes he recommends or visit www. that can have a significant musc.edu/pr/ impact on a healthier diet. newscenter/2014/ His recommendations stem AGE.html from what he’s learned in doing cancer health disparities studies in ethnic minorities. One of those studies was presented last month at the sixth American Association for Cancer Research in Cancer Health Disparities conference. It is known that African-American men are 1.5 times more likely to develop prostate cancer and more than twice as likely to die from the disease compared with non-Hispanic white men. “We found that AGE levels were highest in AfricanAmerican men with prostate cancer,” said Turner, “Because obesity, poor eating habits, and an inactive lifestyle all promote AGE accumulation, and these factors are often more evident in African–Americans, we hypothesize that there is a link between these factors
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A doctor sees monumental success in treatments for HIV/AIDS.
Fried bacon has an extremely high AGE or advanced glycation end product level, which research is showing may contribute to cancer health disparities. that could help explain why African–American men are more likely to develop prostate cancer and die from the disease.” Turner and colleagues examined circulating AGE levels as well as those within tumors in African– American and non–Hispanic white men with prostate cancer. They found that AGE levels were higher in serum from cancer patients compared with individuals
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without cancer. When analyzing AGE levels in prostate tumor samples, levels were highest in tumor samples from African–American patients. It’s an important finding that warrants future research, and adds to existing evidence that Turner and colleagues want to educate the community about AGEs
MUSC takes a proactive stance on providing choices.
READ THE CATALYST ONLINE - http://www.musc.edu/catalyst
See AGE on page 7 4
MUSC Health Plan
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Meet Melinda
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Classifieds
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Medical Center
‘Making a difference every day’ Employees of the Month Award Julie Hanover, Hollings Cancer Center “Julie Hanover just went an extra mile to get a wheelchair for her patient that lives out of state. This patient had a recent stroke, no insurance and needed one to be transported back home. She thought that FAP had been completed and that the patient would be eligible for our DME company to provide one. She went and called many DME companies and found out that Apria has a location three hours away from the patient. She called CVS, Goodwill and other sites to check on cost and availability. Concerned about the cost to this patient and family, Julie didn’t stop there. She searched Craigslist and was able to find a wheelchair for $40. She worked it out with a family member and transported it to MUSC for the patient to be discharged. The wheelchair didn’t even looked like it had been used. Julie put on gloves and helped the family clean it so that they could be on their way. This is truly dedication to both the patient and MUSC. Exceptional job and well done!” Nominated by Ellen Ruja
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723 Interim editor: Cindy Abole catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu
Lou D’Eugenio, Interventional Radiology “On more than one occasion Lou has answered requests to place ultrasound– guided peripheral IV’s in patients who are not in his work area. These patients with histories of difficult IV access would otherwise require central lines. He is always courteous on the phone when his skill is requested and promptly comes to perform the task. On arrival to the patients’ bedsides he is calm, confident and reassuring. The patients are satisfied because multiple, unnecessary venipunctures have been avoided.” Nominated by Michelle Thompson Jessica Shaw, ART 5 West “Jessica has developed a brochure that is given to patients on admission to help aquaint them with the unit and our routines. She has also The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.
developed an On-Call sheet that not only lists the physicians and their contact information, but also includes a photo of the individuals. This helps floats, eShift and new personnel to know who’s–who. Jessica had been participating in Dragon Boat racing and is now raising funds for Light the Night and the patient and family funds we use on the unit to aid with medications and sponsoring patient families at Christmas. She also runs the unit council each month and produces a newsletter. Jessica also participates in the local ONS chapter and includes new employees by inviting them as guests to the monthly meetings.” Nominated by Katherine Wanstall
Alex Herlocker, 9 East “Alex has only been a nurse for a few months but he has already exhibited compassion way beyond his tenure as a nurse. Alex took care of a special needs patient admitted to the unit due to a neurosurgical condition. The patient
See Awards on page 9
Oncology nurse wins award The December DAISY (disease attacking the immune system) award winner is Stephanie Greiner, R.N., who works in the Hollings Cancer Center. Greiner was nominated by Tess Morris also of HCC. Below is her nomination: “Stephanie works hard to coordinate chemotherapy and radiation therapy for her head and neck cancer patients. The standard of care is for treatment at the same time. Many times Stephanie is contacted at the last minute that radiation therapy is ready to start. We now have new financial processes that require chemotherapy orders be submitted two days before treatment begins to allow time for financial pre-certification, making the process even more challenging. One Monday, Stephanie was concerned because she had not been notified of the start date of one of her pending patients and later learned that the patient was scheduled to start the next day. When the patient found out he wasn’t scheduled for chemo he was quite angry. Being very pro-active, Stephanie got Dr. O’Brien to write chemotherapy orders right away and she took them to the financial team
and explained that she needed a rush precertification. Stephanie then called and made appointments for labs and chemo. Unfortunately she came across some people’s Greiner disapprovals because she was breaking some rules. Once she got the financial approval and chair time she personally called the service line director to verify that it was OK to treat despite the fact that the orders were not on time. The patient got their chemo and radiation the next day as scheduled thanks to Stephanie’s persistence. She truly is a patient advocate and changing what’s possible.” Each month, MUSC nurses are honored with the DAISY Award. The award is part of the DAISY Foundation’s program recognizing the efforts that nurses contribute daily to their jobs. To nominate a nurse, visit www.musc.edu/ medcenter/formsToolbox/DaisyAward/ form.htm.
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Cervical Cancer-Free SC to hold Lowcountry sumStaff Report Cervical Cancer–Free South Carolina will hold its inaugural summit Jan. 9-10 at the Doubletree Hotel in Charleston. Representative Bakari T. Sellers will deliver the closing keynote talk addressing cervical cancer in the state and the need for HPV (human papilloma virus) education and vaccination for adolescent girls and boys. The summit, aimed at health care providers, researchers and community advocates, will feature sessions on cervical cancer screening, eliminating disparities in cervical cancer, the role of the HPV vaccine in preventing cervical cancer and advocacy and education. Heather Brandt, Ph.D., a faculty member in the Arnold School of Public Health at the University of South Carolina and co–chair of Cervical Cancer–Free South Carolina, emphasized the summit’s role in bringing together a diverse audience of stakeholders.
“There are a lot of people in South Carolina working to address the burden of cervical cancer through prevention, including HPV vaccination, screening, and follow-up care. The summit offers an opportunity for these stakeholders to discuss the problem and explore solutions,” Brandt said. The summit is sponsored in part by the Sherman Financial Group for Cervical Cancer Prevention, the MUSC Hollings Cancer Center and MUSC’s Department of Gynecology and General Obstetrics. Cervical Cancer–Free South Carolina is a member state of the Cervical Cancer–Free Coalition focused on eliminating cervical cancer through screening, follow-up care, vaccination, and education. The group consists of individual and organizational partners committed to increasing participation in cervical cancer screening; increasing adherence to follow–up care of abnormal screening results; increasing rates of HPV vaccination; and seeking additional funding to support cervical cancer screening and HPV vaccination in South Carolina. For more information or to register for the Cervical Cancer–Free Summit, visit: http://hcc.musc.edu/ research/conferences/CervicalCancerFreeSC/ CervicalCancerFreeSC.htm.
Cervical Cancer in S.C. Facts q Cervical cancer is the 9th most commonly diagnosed cancer among white women and the 5th most commonly diagnosed cancer among black women. q It is estimated that more than 190 women will be diagnosed with cervical cancer in 2014, with about 75 women dying from the disease. q Cervical cancer death rates are almost two times higher in black women as compared to white women. q South Carolina ranks 14th in new cases of cervical cancer and seventh in cervical cancer deaths in the United States. For more information about the HPV virus and cervical cancer, visit: http://tinyurl.com/mcx9nxz.
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MUSC medical center communications corner MUSC Health Plan: Frequently Asked Questions Effective Jan. 1, all MUSC and MUHA employees who were previously enrolled in the Standard State Health Plan are now enrolled in the MUSC Health Plan. MUSC Health Plan participants who receive care within the MUSC Health Plan Network, which is based on a Patient–Centered Medical Home model, will now have lower total out of pocket costs. Employees’ premiums for the MUSC Health Plan will be the same as the Standard SHP and will not increase in 2014. Here are answers to several of your frequently asked questions regarding the MUSC Health Plan: Q: If I already have an MUSC Primary Care physician will I have to “reselect” my current physician when the program is rolled out? A: No, you will automatically be assigned to that physician. Q: MUSC has so many primary care providers in so many locations. What information is available to help me and my family decide which primary care doctor might be best suited for me and my family? A: The select a doc tool contains links to all of our providers’ specific profile pages, including his/her degree, residency, clinical interests, bio, photo, locations, and a brief “get to know” video if one is available. http://mcintranet.musc.edu/musc-health-plan. Q: Can my OB-GYN be my Primary Care Physician? A: No, OB–GYN is recognized as a specialty, not as primary care. For the MUSC Health Plan, specialty copayments apply to OB–GYN outpatient and inpatient services. However, no referral is necessary for a well-woman exam. Q: Where can a list be found of existing Primary Care providers who are not employed at MUSC? A: You can review in–network physicians through the same Blue Cross Blue Shield website as you have in the past. www.southcarolinablues.com (Click on “find a provider” on the right side of the page) Q: I just received a letter that my MUSC primary care physician is leaving the practice and that a new physician has been hired. Do I need to choose another primary care physician? Or will the new physician “automatically” take over the departing doctor’s patients? A: You may pick any other MUSC primary care provider that you prefer. And you can always change at anytime. The full list of doctors is available on the MUSC Health Plan website and will be updated periodically. Q: I wish to change my OB-GYN from an outside group to an MUSC OB–GYN. Do I need to get a referral from my primary doctor (I am already assigned to someone in Family Medicine)? A: No referral is necessary for a well–woman exam.
Q: Will there be any “facility charge” bills associated with the MUSC Health Plan? In the past, there were two bills sent for every doctors visit: one for the physician and one for the facility charges. A: For care delivered in-network at MUSC by an MUSC provider, you will only be responsible for the copay amount for the service. However, facility fees will still apply in hospital-based clinics for state employees and other patients who are not insured by the MUSC Health Plan. Q: Will I have coverage out of state and out of country under the new plan? A: The MUSC Health Plan includes the “in” and “out” of network coverage through the Standard SHP plan. There are SHP in-network providers in other states and other countries (through the BlueCard program). You can review providers on the website: https://www.southcarolinablues.com/web/public/sc/ (Click on “find a provider” on the right hand side of the page). If you are in Charleston, out of the state, or in another country, BCBS would still pay out–of–network benefits at 60 percent after you have met the deductible. Q: In the past I have had to go to a facility like LabCorp to have labwork drawn. Will any phlebotomy centers like these be considered in-network for the MUSC Health Plan? A: If you get any covered lab work drawn at MUSC, you would pay a simple copay of $20 starting Jan. 1. If you go elsewhere, your claims will be processed as they are today via the Standard State Health plan. Q: How does the MUSC Health Plan affect the State’s dental or vision plans? A: The MUSC Health Plan is separate from the dental and vision plans that are offered for state employees to choose. Q: Since switching to the MUSC Health Plan, why have I noticed different copayments for certain medications? A: Our prescription drug plan has advantages of lower copays when using our on–campus pharmacies. The entire state changed to Catamaran Health Benefits Processor on Jan. 1, and there is a formulary associated. Some medications may have changed tiers (copay levels) from the Medco/Express Scripts Plan in 2013 to the Catamaran Plan in 2014. This will affect all state employees, not just those at MUSC. Please check the benefits website to see about the tier level of your specific medications: https://www. catamaranrx.com/uploadedFiles/Documents/Physicians_Page/CATAMARAN%20 NATIONAL%20COMPREHENSIVE%20FORMULARY_010114.pdf
For answers to more frequently asked questions and additional information on the MUSC Health Plan, visit https://www.musc.edu/medcenter/MUSChealthplan/index.html or http://www.eip.sc.gov/faq/changes-to-state-health-plan-prescriptiondrug-ben-16.aspx
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Meet Melinda
Melinda Anderson Department director, Office of Parking Management How you are changing what’s possible at MUSC Helping others by working to find solutions to the commuting and parking challenges that many students and employees face. How long at MUSC 37 years Children and pets and their names Stephanie, Margaret, Melinda, Melody, Scott and Reid. We have a six-month-old black lab, Stella, who is being trained for duck hunting and learning to stay on her pillow when she’s inside the house. What do you do on rainy days I love rainy days. I learned to love them as a child living on Shemya and Adak in the Aleutian Islands, Alaska. The best thing about living in Charleston Living the Lowcountry life in a cosmopolitan city Greatest moment in your life Each of my children’s births but especially the birth of twin sons on Christmas Eve
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Creative literary outlet adds deeper dimension By Dawn Brazell Public Relations
Art puts the soul back into medicine. That is what Diann Krywko, M.D., has found, and writing helps her do just that. Take her piece, “They didn’t know,” recognized as an outstanding submission in the prose category in MUSC’s HUMANITAS 2013 ( reprinted at right). She had treated a heartbreaking case of a young mom and writing the piece helped her process the grief. As the call for submissions opens for MUSC employees, faculty and staff for the next HUMANITAS publication, Krywko encourages other health professionals to get involved. Krywko, who has submitted pieces for the past four years, said she’s amazed how emotional she gets when writing because she is not when seeing patients. When she’s with them, she has to stay focused; writing frees her up to feel. She’s been an emergency medicine physician for almost 14 years, all of those spent in an academic, level 1, inner-city trauma center. “During this time, I have been involved in countless heartbreaking, as well as soul-lifting, patient encounters. Like most emergency medicine providers, I, consciously or unconsciously, forget what I have experienced when I leave through the doors in order to survive. Occasionally, the effect of the encounter is lasting. Writing about those repairs part of the soul that’s touched so strongly.” Krywko is division director of faculty development and mentoring. She encourages residents she’s training to write down their experiences. “We probably have a story every day. I tell residents they should always write something down because what they see every day is so incredible that you kind of forget that you do see that magnitude of emotion and suffering.” Practicing some type of art is critical in balancing the demands of the profession, she said. “We’re so science black and white — left brained. It’s completely the opposite of what we do. It’s the opposite of walking in and taking care of somebody
“They didn’t know” They didn’t know. They didn’t know that they would lose their 33-year-old mother that day. They didn’t know that they would lose their 33-year-old daughter that day. They didn’t know the terms sepsis, shock, intubation and hypoxia. They didn’t know the right place to die wasn’t in the emergency department. They didn’t know the noise and chaos weren’t taking away from her care. They didn’t know the politics in getting a bed for a vented withdrawal of care patient. They didn’t know that I struggled with my emotions and cried outside of the curtain. They didn’t know. But I did. (Written by Dr. Diann Krywko and reprinted with permission from HUMANITAS 2013)
and no matter how horrible it is, you walk in and take care of the next person. Writing gives you time to process the emotion.” Alex Clarke, HUMANITAS 2014 editor, became involved with the publication during his second year of medical school for 2012-2013. His primary artistic outlet in the past has been music, though he sees himself branching out into woodwork and metalwork in the future. This year HUMANITAS is adding a music category, which he’s excited about. See the box below for submission requirements. “Now I’m spending more time in the domain of drawing, design and tinkering. Following years of songwriting and musical performance, I’ve started to become interested in making pieces that exist in physical space.” Having an artistic outlet is important for all people, Clarke said. “I do believe
HUMANITAS 2013
Calm of the Wild Horses by David B. Williams, College of Medicine that it holds special importance for people in careers that are heavily geared toward logic and algorithmic thinking. Any amount of time you spend in the creative process grows your personal insight and capacity immensely. In the rush of life and pursuit of perfection of your trade - whatever it may be - it’s easy to forget to carve out time for personal reflection, exploration and invention.” Engaging in creative pursuits has the power to make medical professionals better at their jobs, he said. “This practice of forcing yourself to step
outside of the conventional thought path, to analyze your thoughts to intentionally create something brand new has endless applications in the sciences and is deeply important to medicine and the human experience.” HUMANITAS is a snapshot into that journey. “HUMANITAS is a way to remind people how important this aspect of life is — to highlight the talented individuals that walk amongst us daily, celebrate their ideas in the public domain and encourage others to join the discussion.”
WanT To SuBmiT?
photographers at MUSC, but we also know that there are many incredible musicians in our ranks, and we think it’s important to shine a light on all of our talented creators. If you’ve got an original song, composition, or vocal track that you’re proud of, we want to hear it.” Deadline for submissions is Jan. 24. . Submissions should include the title of the work in the description box. For all digital format submissions, the higher the resolution the better. People also may photograph their work. For other questions about submissions and contact information, visit the MUSC News Center at www.musc.edu/pr/ newscenter/2013/humanitas.html.
It’s time to find your artistic side. MUSC employees, faculty and staff may submit work for the 18th edition of MUSC’s HUMANITAS. Every year, HUMANITAS publishes a journal of prose, poetry and visual arts from the ranks of MUSC. There is a $100 prize for the top submission in each of the categories: prose, poetry, visual art and the new category of music. Alex Clarke, HUMANITAS 2014 editor, said he’s excited to announce the addition of auditory submissions. “We all know that there are are countless talented authors, poets, artists, and
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aGe Continued from Page One
Turner’S Top TipS
and how to reduce its effects. “As our bodies use the sugars that we consume for energy they generate waste products, or metabolites, including molecules called advanced glycation end products, or AGEs,” Turner said, explaining there’s no way to completely eliminate AGEs. “AGEs naturally accumulate in our tissue as we grow older, and they have been implicated in diseases associated with aging such as diabetes, heart disease, and Alzheimer’s disease. They can also cause increased inflammation and the generation of potentially harmful chemicals known as reaction oxygen species, which both promote cancer.” A common source of the AGEs that accumulate in the body comes from foods that are eaten and how they are prepared, which has significant implications for cancer health disparity and overall health, he said. “AGE content in the Western Diet has consistently increased over the last 50 years due to increased consumption of sugar-laden and cheap, processed, manufactured foods which are high in reactive AGE metabolites and can promote obesity.” So what are sample AGE levels? Studies have shown that one hundred grams of carrots have an AGE kilounit of 10. Raw chicken has an AGE level of 800, compared to poached chicken at 1,000 and fried chicken at 8,000. Bacon, fried for five minutes with no oil, racks up a tally of 91,577 AGE kilounits/100g. Turner said he has people beg him during educational community talks he presents not to reveal what’s in a Big Mac or other popular fast food fare. “They don’t want me to ruin it for them. It’s the usual suspects — the high sugar, the high fat — the red meats,” he said of foods that score high. “Where it stands out, though, is the way we cook our foods that has the real impact on the AGE we find in the food.” One hundred grams of a steak, for instance, has around 800 kilounits of these AGEs. “You fry it and it actually goes up to 8,000 because frying drives the reaction and further AGE formation.” Research is being done on the effect of
r Stick to consuming raw, unprocessed foods whenever possible. r When cooking use moist heat, such as braising, poaching or using a slow cooker. Limit foods that use dry heat – particularly fried, blackened and charred food, which pack in AGE products. r Use acidic marinades, such as citrus or vinegar, which slows down the AGE reaction process. r Cut meat in smaller pieces so it cooks faster.
Dr. David P. Turner
r Reduce the amount of fullfat dairy products you consume. Eat fewer foods that are high in fat and protein, such as animalderived meats and highly processed foods.
r Watch out for highly processed foods. Tofu is thought to be healthy, but it is very high in AGE products because it’s synthetic, he said. The same can be true with breakfast bars with processed oats. Unrefined oats are really healthy, but the refined oats are surprisingly high in these AGEs.
r Increase the consumption of fish, legumes, low-fat milk products, vegetables, fruits and whole grains.
r Exercise regularly - regular moderate exercise can help prevent or at least reduce AGE accumulation.
r Avoid browning foods before putting them in stews.
exercise on AGEs. It is thought to slow down the accumulation of these products and may actually reduce them slightly, he said. Diet is where the most impact can be made, though. “These AGE products are involved with diseases of old age, diabetes, Alzheimer’s, stroke, cancer and cardiovascular problems. We want to get out the message that if you can cut down your child’s AGE content in three or four meals a week, over a lifetime, that’s a lot of AGEs you can reduce down, and you may be a lot less likely to get the diseases associated with old age.” Their recent study focused on African– Americans within South Carolina. Research shows that more than 50 percent of African–Americans live below the poverty line and exercise very little. “We know that low poverty drives the use of low cost processed foods, which are unhealthy and are generally higher in AGEs. We saw these AGE accumulation levels were higher in African–Americans than they are in European–Americans. It
was our hypothesis that we would see a difference, but the extent of the difference was a surprise. It’s significantly higher in African–Americans.” Turner wants to confirm the results in another study using a larger group that also examines the impact of poverty. Higher socio–economic groups tend to eat healthier foods. “It could be a low-income factor as much as it is a race issue when it comes to these glycation products.” Another promising area of research is the role of exercise in counteracting AGE accumulation. Turner is involved with a feasibility study with breast cancer survivors who will participate in a cardiac rehabilitation program for 12 weeks. Researchers will take blood samples and analyze AGE markers as well as other markers of breast cancer. “We’re going to see if they’re indicative of recurrence in these breast cancer patients. In cardiac rehab you can get all this with insurance, but there’s nothing like this for cancer patients. This might
turn into a landmark study if we can show this in the feasibility study and then in a larger grant. Maybe in the longterm, we can get some type of exercise intervention for all cancer patients, as well.” Turner also will be studying if AGE levels can be biomarkers — powerful diagnostic tools — for physicians in treating cancer. For example, with prostate cancer, around 75 percent of patients won’t develop an aggressive type. However, 25 percent will need treatment. “We need biomarkers that will indicate the level of treatment needed so we can say your glycation products are low so that probably indicates your cancer isn’t aggressive. We’d need a lot of further studies to be able to say that though.” In the meantime, Turner and colleagues are focusing on what they do know, such as the AGE-RAGE signaling pathway that can promote cancer. RAGE, or the receptor for advanced glycation end products, can get switched on by AGE metabolites in the body, he said. “When RAGE is switched on, it alters what genes are actually expressed so we produce these proteins. These proteins that are activated increase the inflammation within our bodies. This is what is involved in the diseases associated with growing older. It also increases stress responses. If you have a more inflammatory cancer, it tends to be more aggressive.” Turner, who provides community outreach with Hollings Cancer Center’s Cancer Disparities Program, loves leaving his lab to translate this information into practical terms for the lay public. “The take-home message is that these advanced glycation end products or reactive metabolites seem to be elevated in cancer. They seem to be particularly elevated in African–American prostate cancer patients. This might be across all cancers, but at the moment, we have mainly looked at prostate.” Turner has been getting requests for dietary information, which he sees as a good sign the message is getting out. “I might be a basic scientist, but I like working with cancer disparities groups. The more this gets out there, the better. It’s actually a lot of fun. It reminds me why I’m in the lab.”
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Infectious disease chair reflects on HIV/Aids progress By Janie Thomas Center for Global Health
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hirty–four years ago, the world recognized HIV/ AIDS for the first time. The disease disrupted long– standing medical and public health advances. The research community scrambled for answers. The disease — for some time — caused widespread confusion and hysteria due to misinformation about its origin, the natural history of the virus and the supposed demographics impacted. J. Michael Kilby, M.D., professor and chief of MUSC’s Infectious Disease Division, entered the medical profession at the peak of the Kilby HIV/AIDS epidemic and joined many other medical professionals in the hunt for the cause and treatment of this new disease. “There was a demand for specialized infectious disease knowledge during a time when the cause and the route of transmission of this disease was poorly understood,” said Kilby. “It was an exciting but somber time — I wanted to take part in contributing to the growing knowledge base and a viable solution.” Watching the prognosis of HIV/AIDS shift from imminent death to a long, relatively healthy life with the right regimen of medicines has made working in this once–seemingly hopeless area of medicine more worthwhile and fulfilling.
Kilby has been involved with HIV/AIDS research from the beginning of his career at the University of Alabama, Birmingham, including a program project funded by a National Institutes of Health and Prevention grant he directed from 2002 to 2007 relating to the earliest immunologic and virologic events following initial transmission of HIV infection. One component of this large collaborative project involved enrollment and serial study of serodiscordant couples (one spouse infected with HIV and one not) in Zambia. “The time I spent working with researchers in Zambia taught me many lessons, one of the most important being to appreciate the vast amount of resources available to patients in the United States,” said Kilby. He has continued to contribute to HIV/AIDS research by focusing on clinical and translational trials, funded by the NIH, CDC, and pharmaceutical companies such as Gilead and GlaxoSmithKline. Recent breakthroughs in HIV treatment have made therapy much more convenient and simple (often just a single tablet a day, due to co–formulation of multiple medications in one pill) and these improvements have demonstrated that widespread treatment is one of the most effective forms of prevention, because patients with suppressed viral levels are much less likely to transmit infection to others. Whereas some were skeptical that adherence to HIV therapy would be problematic in regions with limited resources, some studies suggest adherence is better in Africa than in the US.
“Nothing is worse than taking your medications the wrong way,” said Kilby. “So many complications can be avoided if patients simply make it a habit to take their medication as prescribed. Erratic adherence leads to resistant virus that becomes much more challenging to treat in the future.” Most HIV/AIDS patients no longer have the hassle of taking multiple pills each day (Kilby remembers when approximately 50 pills per day was quite common in this setting) to suppress their infections. Kilby works to educate his patients on the importance of treatment adherence to avoid the complications that arise from drug resistance. Even more important than treatment strategies is the initial identification of those who were HIV infected and were not aware. Kilby and his colleagues at MUSC have assisted in implementing an HIV/AIDS opt-out testing policy in the emergency department to minimize stigma associated with the test and catch the disease early enough to administer timely, efficacious treatments. His group also offers rapid, “point of care” HIV testing for partners or friends of patients, or others interested in finding out their status on campus. One of the future goals for Kilby and others involved in HIV/AIDS research is to end the stigma of testing for HIV/ AIDS by integrating it into the routine of other health screenings, simply making it as normal as checking a patient’s weight, blood pressure or hemoglobin A1C. Although developing an HIV vaccine
photo provided
MUSC’s Dr. Michael Kilby lectures at a medical school in Lusaka, Zambia. has been very challenging, Kilby notes important new insights have been developed and research is ongoing on this important front. “We’re seeing monumental successes in HIV/AIDS treatments,” said Kilby. “The so–called Berlin Patient and others who may have been cured by bone marrow transplants; the ground– breaking clinical trials showing that pre-exposure prophylaxis and community-wide therapy programs can drastically reduce transmission rates. These interventions are more promising than vaccines at present, in part because the virus can mutate and escape from immunizations (in much the same way that influenza changes each year, requiring annual changes in vaccines, but at a rate of change approximately 1,000–fold greater). As research shows, it takes innovation, preparation and an enterprising spirit for progress to be realized. Kilby supports global health initiatives at MUSC not only to attract the best students, trainees and faculty, but because the global community has a shared interest in minimizing the spread of infectious disease. “Innovation is not bound
by borders or oceans; MUSC can play an important role in combating global health challenges like HIV every day,” said Kilby. According to Kilby, students and faculty considering MUSC often ask about the university’s global presence. He shares that it is an important consideration for the university to recognize the draw of global programs. As MUSC continues to develop a global presence through the Center for Global Health and the increasing amount of faculty working abroad, the caregivers and researchers will likely receive exposure to a new group of professionals with the desire to collaborate no matter the geography. “The best recruits for programs at MUSC are asking questions about MUSC’s involvement with global health, because they are interested in investing their time and education into global medicine,” said Kilby. “If we want to attract great minds to choose MUSC, we need to provide global options for them.” Editor’s note: Reprinted with permission from MUSC Center for Global Health, http:// globalhealth.musc.edu.
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was used to having Child life services available during her hospitalization from the state where she’s originally from. Child life services usually helps her cope with hospitalization and the associated procedures during the hospital stay. Alex went out of his way to provide the patient with arts and crafts materials during his shift. He also spent a considerable amount of time during his shift to ensure that the patient was coping well in her new surroundings. In addition, he bought the patient a jewelry–making kit and other materials during his off day and brought them the following day for the patient. The patient’s parents could not believe that such nurses exist and are very much pleased with their experience at MUSC.” Nominated by Leah Ramos Amy Thompson, UIM Resident Clinic “I am submitting this on behalf of Colleen O’Rourke. Amy Thompson really went above and beyond to help me Sept. 25 with a patient in the UIM clinic. Amy is always helpful, so her effort was not out of character; however, this patient was particularly challenging. This patient has medical problems and is on four or five blood pressure meds in addition to other daily medications. I suspected she wasn’t taking some of her blood pressure medications, so I asked her to bring in her pills, pill bottles and daily pill box from home.
She brought in five gallon-sized Ziplock bags–full of medication bottles and boxes, some that expired in 2009, some assorted pills mixed in unidentified bottles, and other medications. I sent the tech to find a pharmacist and Amy came immediately to help. Amy identified all the miscellaneous pills in the pill box and helped me and the tech sort through all the medications in the bags, going so far as to identify the mixed pills in the unlabeled bottles. She identified duplicate medications and removed them; which pills needed to be distributed in the box; and which were absent because they needed refills. This task should have been overwhelming for any pharmacist, but Amy didn’t even hesitate — she just dived into the work with a great attitude. She suggested a good follow–up plan and she even volunteered to call the patient’s pharmacy to make sure that her refilled medications would be delivered in time for her next appointment. Ultimately, the patient left the appointment with only one bag of medication and a much more organized medication regimen thanks to Amy’s efforts. Amy was extremely knowledgeable, professional, efficient, patient, and even cheerful. I am so thankful for her help on that day and I am thrilled to work with her in my weekly UIM resident clinic.” Nominated by Lynn Uber
10 The CaTalysT, January 10, 2014
Coca-Cola partners with SC hospitals to promote choices By mikie hayes Public Relations
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here is a debate brewing in South Carolina – one that boils down to choice: choice as it relates to whether sugary soft drinks should be offered in hospitals. Proponents for instituting policy against sugar-laden beverages in hospitals include president of the S.C. Medical Association, Bruce Snyder, M.D., who asserts that health statistics prove people are making choices that are deleterious to their health and the medical community should step in to combat these behaviors. Recently, Snyder wrote a letter to hospital administrators urging them to eliminate sugary drinks from their facilities as part of the fight against obesity. “Obesity is an epidemic in our state and its effects are so detrimental in our society that we must begin to come together and take the necessary steps to promote a more healthy lifestyle,” Snyder said. “Physicians and health care leaders are role models for South Carolina patients, and healthy, positive steps begin through our personal choices and leadership.” Some at the S.C. Hospital Association agree with Snyder’s stand and similar to the SCMA, they have stated that sugary drinks will not be readily available at meetings they host. SCHA’s philosophy is such beverages are “not compliant with their ‘Work to be Fit’ wellness program.” MUSC, on the other hand, has taken a different tack: providing options. "I applaud Dr. Snyder for sparking this debate amongst hospital leaders. MUSC has been a leader in workplace wellness and we know that the first step towards improvement is an honest, open discussion of the issues. Dr. Snyder helped push that issue across South Carolina hospitals. We have had extensive discussions about sugary beverages served at MUSC and have decided that an outright ban is not the right approach for us. We prefer to aggressively educate about choices and portion control," said Patrick Cawley, M.D., CEO of the MUSC Medical Center. Susan Johnson, Ph.D., director of MUSC Health Promotion, supports
Cawley’s hands–on approach. "What I try to emphasize is that number one, just because we are part of the medical community and our goal is to prevent disease and educate our patients and employees, we are not the food police – that's not our purpose," said Johnson. "The purpose is not to take away foods, but to add options and emphasize healthy food choices. You also lose the ability to educate when choice is removed, especially when there are countless places where those choices are available." The subject is a complicated one as South Carolina has some of the worst statistics related to obesity in the nation. The 2011 South Carolina Obesity Burden Report, a comprehensive report published by the Department of Health and Environmental Control, reports that 67.4 percent of all adults and nearly 30 percent of high school students in South Carolina are either overweight or obese. Both statistics represent a move in the wrong direction and the regular overconsumption of sugar-laden soft drinks has been at the heart of the discussion. While beverage companies are receiving the brunt of the blame, no one factor can be blamed exclusively for the obesity crisis. MUSC has long been considered a leader in both wellness and weight management and has improved the lives of countless employees and people in the community – not by restricting access to foods and beverages, but by offering many options, healthier selections, price breaks on certain nutrient-rich meals, as well as exercise programs and even specials on Wellness Center membership packages. The idea is to create a culture of wellness through education and options. In April 2013, the MUSC Board of Trustees passed a resolution encouraging a culture of wellness through a healthy food environment, physically active workplace, and tobacco–free campus and committed the necessary resources and support to ensure such a workplace could be achieved. MUSC is enjoying recognition in the wellness arena for this forward-thinking approach. In 2011, the Duke Endowment awarded a multi-year grant to SCHA to launch a new initiative called Working
photo by Sarah Pack, Public Relations
MUSC employees are fortunate to have numerous choices as well as access to nutritional guidance. Wellness expert Dr. Susan Johnson promotes healthy options. Well, a collaboration between the South Carolina Hospital Association and N.C. Prevention Partners. The program is aimed at providing the highest standards in creating a physically active workplace. Since then, MUSC has been named a Working Well Center of Excellence and a Gold Triple Threat hospital for reaching the highest standards of excellence in all three pillars: tobacco, nutrition and physical activity. The Working Well program, like MUSC, does not support restricting products. “The Working Well campaign doesn’t advocate banning any foods from the workplace. Instead, it emphasizes healthy choices, portion control, product placement and pricing strategies, all of which are designed to make healthy foods more attractive and affordable,” said Thornton Kirby, president and CEO of the South Carolina Hospital Association. Collaborating with corporately responsible partners in the quest to develop and implement innovative wellness programs is important to MUSC leadership. Coca-Cola Bottling Company Consolidated is one such partner, owing to its ongoing commitment to providing healthful options. They have partnered with South Carolina hospitals to encourage consumers to make beverage choices
that fit their lifestyles and are working with MUSC through their participation in the Working Well campaign and the Cooking Well Invitational. Through its Clear on Calories initiative, Coca-Cola Consolidated provides calorie information on the front of bottles, and equipment and dispensers will feature “health-disks” informing consumers that there are “lots of choices — calories optional.” Consumers will also be able to choose from a wider selection of beverage choices that includes juices, vitamin-fortified waters, regular and zerocalorie sports drinks, teas and purified water, in addition to their regular and zero-calorie drinks. While Johnson is clear to state that MUSC doesn’t promote any particular choice, but rather she advocates educating consumers and provides incentives through access, pricing and marketing to make the healthy choice the easy choice. “We are pleased that Coca-Cola Consolidated is looking for additional ways to educate consumers on healthy beverage decisions, and we are excited about the goals they have in store for South Carolina hospitals” said Johnson,. “It is important for all consumers, in the health care setting and beyond, to understand how each food and beverage they consume fits into a healthy, balanced lifestyle.”
The CaTalysT, January 10, 2014 11
Furniture Full Mattress Set with Euro Pillow Top New $115. Please Call: 843-270-4283 King Size Plush Set New, will sacrifice for $275 843-270-4283 Bed-Queen Pillowtop that is Brand New in Plastic. Will take $125. Please call 843-270-4283
Recycle your Christmas tree Some municipalities will pick up trees curbside or they will be taken to a Charleston County Environmental Management convenience center. Remove all dĂŠcor such as lights, tinsel, ornaments, etc. Trees picked up curbside will be transported to the Bees Ferry Landing Compost Facility (West Ashley) to be ground and composted. Residents can drop off a tree at the Bees Ferry Landing facility until Jan. 11 and receive a free bag of compost.
12 The CaTalysT, January 10, 2014