Vol. 31, No. 9
MEDICAL UNIVERSITY of SOUTH CAROLINA
October 12, 2012
Brain science explored T
his year’s annual Thomas A. Pitts Memorial Lectureship in Medical Ethics, titled, “Brain Science in the 21st Century: Clinical Controversies and Ethical Implications,” will be held Oct. 26 – 27 in the MUSC Bioengineering Building. The event is open to MUSC faculty, physicians, nurses, and health professionals. More than 10 hours of continuing medical education credits will be offered. The event begins with registration and a continental breakfast from 7:30 to 8 a.m., Oct. 26, followed by a welcome address from Mark S. Sothmann, Ph.D., MUSC vice president for academic affairs and provost, and introduction by Robert Sade, M.D., Institute of Human Values in Health Care director. Highlights from session one feature a discussion about brain trauma in sports with presentations by Jonathan Edwards, M.D., professor of neurosciences and director of MUSC’s Comprehensive Epilepsy Center, and Dan Larriviere, M.D., Ochsner Medical Center, who will discuss legal and ethical perspectives of sports brain injuries. The final segment features NFL Hall of Famer Joe DeLamielleure, formerly with the Buffalo Bills and Cleveland Browns. DeLamielleure, a spokesperson for NFL retired players, will speak from personal experience about concussion injuries in sports. Later sessions scheduled include stroke prevention, managing stroke complications in sickle cell disease, post-traumatic stress disorder in violent
To register for the 2012 Pitts Lectureship, visit http://www.values. musc.edu. For questions, email fier@ musc.edu or call 876-0177. crime and among combat soldiers and the controversy in using beta blockers to reduce stress. Other speakers include: Ronald Acierno, Ph.D.; Robert Adams, M.D.; Nicholas Avgeropoulos, M.D.; Michael K. Gusmano, Ph.D.; Mark Hamner, M.D.; Wally Smith, M.D.; and Peter Tuerk, Ph.D. A total of 10 speakers are scheduled to present Oct. 26 with a brain science controversy seminar Oct. 27. Sade, whose Institute of Human Values in Health Care office has managed the lectureship since 1999, leads a program that is dedicated to interdisciplinary biomedical ethics and ethical conduct in research and studies relating to human values in health policy, legislation and patient care delivery systems. “This year’s Pitts Lectureship features a great lineup of local, national and internationally-known experts who will lead discussions on several timely issues,” Sade said. The conference is partly supported by a bequest from former MUSC board of trustees member and chair Thomas Antley Pitts II, M.D., in support of teaching medical ethics and addressing bioethical issues through this conference. Proceedings will be published as a symposium in an issue of the Journal of Law, Medicine & Ethics.
CliniCal trial targets Military Omega-3 smoothies may help in reducing depression and suicides among veterans.
Children’s hospital initiative
Case Management Week
Staff are encouraged to support each other’s healthy lifestyle, in order to help patients.
Great Southeast Shake Out
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2 The CaTalysT, October 12, 2012
Dedicated faculty member touched many lives Editor’s note: The following article is written by Joseph F. Thompson Jr., assistant dean for finance and administration, James B. Edwards College of Dental Medicine, in memory of Gordan B. Stine, DDS. Stine was a faculty member of MUSC and served as special assistant to the president, director of Dental Continuing Education, state dental coordinator for the South Carolina Area Health Education Center, and founder of the University Cultural Affairs Council. Stine passed away April 11.
any of us have made a commitment to volunteerism for the betterment of our community and MUSC. Because so many give their time and talents, it is sometimes hard to single out someone for individual contributions. But every now and then, a person comes along who has gone so Stine far outside the normal bounds that we have to stop and take notice. Such was the case with Dr. Gordan B. Stine. In April, Dr. Stine passed away after a long illness. Gordan Bernard Stine was born in Charleston and was educated in our public school system and personified what was the charge of the High School of Charleston: “Enter to learn, leave to serve.” In 1944, he graduated from the College of Charleston with a Bachelor of Science in chemistry. After serving in the Marine Corps during World War II, he earned his professional degree in dentistry from Emory University in 1950 and returned to active duty in the Navy for several years before settling back home in Charleston. What followed was a remarkable career of professional and public service where the highest standards were always more than met. Dr. Stine was often described as a true “Renaissance man.” In fact, he was a leader and achieved distinction in many areas including education, science, government, business, and the arts. His exemplary accomplishments were many, and clearly attest to the extraordinary breadth of his interests and selfless service to others. The following are only some of the highlights of the many leadership positions he held throughout his life. In the fields of education and science, Dr. Stine was instrumental in the chartering of our state’s College of Dental Medicine at MUSC. He served as the president of the Charleston Dental Society and the South Carolina Dental Associations and also the president of the Pierre Fauchard Academy. He was a past president of the College of Charleston Alumni Association, former vice chairman of the College of Charleston
board of trustees and retired from the board as a trustee emeritus. He also served as chairman of the Clemson University State Extension Advisory Committee and the Charleston County Extension Service advisory board. In the areas of government and business, Dr. Stine’s leadership roles included chairman of Charleston County Council, chairman of the Berkeley-CharlestonDorchester Council of Governments, chairman of the South Carolina Council of Regional Governments, president of the Palmetto Safety Council, president of the Charleston Trident Chamber of Commerce, president of the South Carolina Downtown Development Association and served as a member of the board of directors of the Charleston County Aviation Authority. His dedication to the arts was illustrated by his service as president of the Charleston Symphony Association and by working as a board member of the Charleston Civic Ballet, the South Carolina Art Alliance, the Charleston Concert Association, the Charleston Opera Company and the Charleston Museum. Some more examples of Dr. Stine’s outstanding community leadership include president of the Coastal Carolina Council of Boy Scouts, president of the Trident United Way, president of the Exchange Club of Charleston, president of the Coastal Carolina Fair Association, chairman of Charleston Pride and chairman of the Charleston Heart Association. In addition, Dr. Stine’s strong commitment to his faith was demonstrated in his having served as president of Congregation Beth Elohim and president of the Hebrew Benevolent Society and the Hebrew Orphan Society. Other community boards, especially those involving children, which have benefited from Dr. Stine’s dedicated service are the Trident Area Foundation, the YWCA of Greater Charleston, the Robert Shaw Boys’ Center and the Charleston Neighborhood Housing Services Board. These examples of service to others just touch the surface of Dr. Gordan Stine’s good works while he also maintained a dental career for more than 50 years. In 1983, after 30 years of private practice, Dr. Stine became a faculty member of MUSC and served as special assistant to the president, director of Dental Continuing Education, state dental coordinator for the South Carolina Area Health Education Center and founder of the University Cultural Affairs Council. Through his generosity Dr. Stine established a Dental Lifelong Learning Fund, which was given his name in 1994 as a tribute to his energy and efforts on behalf of continuing education in the college. Dr. Stine’s appreciation from those he served as well
as from his peers is clearly documented by the many honors and awards he received. The list is long but a few of the most notable include College of Charleston Alumnus of the Year, Exchange Club Man of the Year, South Carolina Academy of Dentists’ Man of the Year, Boy Scouts of America Silver Beaver Award, Shofar Award and the Gordan B. Stine Scout Camp Health Center, which was named in his honor. Dr. Stine was also awarded the State of South Carolina’s highest honor, the Order of the Palmetto, by three different governors. Gordan Stine’s dedication to serving others was only surmounted by his devotion to his family. He was married to Barbara Berlinsky Stine for more than 60 years and they raised two sons, Steven and Robert. Gordan Stine was indeed a man of many facets. His life embodied all the attributes that we strive to instill in our graduates by becoming leaders and outstanding citizens of their respective communities. The measure of his success is calculated in the leadership qualities that he inspired in the lives he touched.
MUSC wants to honor employees during Veteran’s Day event MUSC is honoring the service of MUSC veterans this Veteran’s Day. A formal recognition program will be held Nov. 9. Information will be forthcoming. If you served honorably in any branch of the United States military and would like to be recognized, email your name and branch of service to email@example.com by Oct. 19.
The Catalyst Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723 Editor: Kim Draughn firstname.lastname@example.org Catalyst staff: Cindy Abole, email@example.com Dawn Brazell, firstname.lastname@example.org 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. email@example.com.
The CaTalysT, October 12, 2012 3
Clinical trial aims to reduce suicide among veterans M
ore than 300 U.S. veterans will be drinking omega-3 smoothies as part of a multiorganizational research study attempting to demonstrate that the best weapon against suicide in the military, and among veterans, may just be a common dietary supplement. Bernadette Marriott, Ph.D., a professor in the clinical neuroscience division of the Institute of Psychiatry, proposes that daily supplementation of omega-3 highly unsaturated fatty acids (HUFAs) will reduce the risks of mental illness and suicide among veterans who are determined to be at increased risk for suicidal behaviors. A pilot sub-study of the trial will look at the impact of omega-3 supplementation and alcohol consumption in suicidal veterans and suicidal veterans with alcohol use disorders. The Military Operational Medicine Joint Program Committee (JPC-5) funded the study, and will be managed by the Congressionally Directed Medical Research Programs. Researchers from MUSC, the Ralph H. Johnson VA Medical Center and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is part of the National Institutes of Health, will be awarded a $10 million contract to carry out the research during the next three years. The award comes at a time of unprecedented number of suicides in the military.
In July, the Army announced that 38 soldiers were presumed dead by suicide that month alone, marking the highest number of recorded suicides since reporting began. According to the American Foundation for Suicide Prevention, suicide is the fourth leading cause of death in the U.S. among adults 18-65, the second leading cause of death among teens and young adults, and individuals ages 65 and older account for 16 percent of all suicide deaths. Capt. Joseph R. Hibbeln, M.D., of NIAAA’s Laboratory of Membrane Biochemistry and Biophysics, and a co-investigator on the MUSC omega-3 trial, is a leading researcher in the effects of omega-3 fatty acids on psychiatric disorders. Based on previous studies, he has long maintained the potential of dietary supplementation with omega-3s to substantially impact mental illness. “Research conducted in our lab during the last 20 years points to a fundamental role for omega-3 fatty acids in protecting against major depression, substance abuse and other problems,” he said. “Here we hope to be successful in understanding if omega-3 may play a role in reducing risk of severe suicidal behaviors among U.S. military veterans." Ron Acierno, Ph.D., co-principal investigator with dual appointments at MUSC and the Ralph H. Johnson VA Medical Center, believes that based on what investigators already know about how omega-3
Memorial service for first black graduate slated for Oct. 13 A memorial service for Bernard “Bernie” W. Deas Jr., M.D., will be held at 10 a.m. Oct. 13 at St. Luke’s Chapel. Deas, the first African- Deas American to graduate from the College of Medicine in 1971, died June 29. A repast will be held for the family and guests following the memorial service in the lobby and board room of Colcock Hall. Deas, of El Paso, Texas, was a Charleston native and valedictorian of the Burke High School Class of 1961. He attended Iowa State University and was named a Distinguished Military
Graduate. Upon graduation, he was commissioned as a second lieutenant in the U.S. Army. He later returned to Charleston for his medical education. As a medical oncologist, Deas enlisted in the Army Medical Corps and eventually served as commander of health services at White Sands Medical Health Clinic. He retired in 1994 with the rank of colonel. He received many honors during his career, including the MUSC College of Medicine’s Distinguished Alumnus Award in 1992. Donations in honor of Deas may be made through the College of Medicine’s online donation form at http://tinyurl.com/8r4zlh6. For information on how to donate, contact Candace Gillespie at firstname.lastname@example.org or 792-9243.
levels affect the brain, study findings could prove to be far-reaching. “Suicidal thoughts and behaviors cut across a variety of emotional problems faced by active duty personnel and veterans, from PTSD to depression to grief at losing a fellow soldier. If we establish that this omega-3 treatment, a treatment with virtually no side effects, is effective at reducing the risk of suicide, we will have begun to pay back the debt of service we owe our Armed Forces personnel,” he said. Another co-principal investigator of the study, Hugh Myrick, M.D., associate professor of psychiatry at MUSC and associate chief of staff for mental health at Ralph H. Johnson VA Medical Center, said, “This study represents a novel intervention that could reduce the risk for suicide. If the results are positive, the impact on veterans, our current military personnel, and society will be immeasurable.”
Community walk to raise awareness The Out of the Darkness Community Walk to Prevent Suicide will take place at 1 p.m., Oct. 28, in Hampton Park. The walk raises funds for research and prevention initiatives, and to provide survivor support, education programs and conferences to bring attention to the impact suicide has on society. Visit www.OutOfTheDarkness.org.
4 The CaTalysT, October 12, 2012 National Case Management Week Oct. 14 – 20
Managers practice patient-oriented, outcome-driven care By Mary CaTherine DuBois Social Work Case Manager, Digestive Disease MUSC’s Case Management and Care Transitions Department team is proud of providing its patientoriented, outcome-driven care to patients. The team, composed of 35 nurse case managers and social work case managers, works 24 hours a day, seven days a week. The team provides clinical assessments, care coordination, patient education, counseling, case monitoring and clinical pathway management, discharge planning, resource management and patient advocacy support to all MUSC patients. According to the Commission for Case Management Certification���s website, in order “to obtain optimum value for clients and reimbursement sources, case managers identify appropriate providers and facilities across the continuum of health care and human services while ensuring that available resources are timely, cost-effective, and efficient. Consumers, who are our patients, gain an advocate and emotional support. Physicians and hospitals have complex cases facilitated, and payers’ costs are reduced.” At MUSC, patients are assigned a nurse case manager or a social work case manager based on the medical or social complexity of their illness and needed care. To celebrate Case Management Week, the department will feature a booth from 11 a.m. – 3 p.m., Oct. 15 near the university hospital cafeteria, and 11 a.m. – 3 p.m., Oct. 16 at Ashley River Tower. According to Florence Simmons, R.N., and nurse case manager, MUSC’s goal is to educate staff as to the role of case management. Everyone is invited to stop by the booth and learn more about various skills and talents case manager’s use in providing for a diverse patient population. Many of the case management and care transitions staff will participate in case management certification training next February to become nationally certified case managers. Glenn Richmond, interim department director, can’t emphasize the value of working with certified case managers at MUSC. “Having nationally certified case managers will validate our expertise as case managers; prove that we know what to do in providing case management services to our patients, especially those with many complex medical issues; and ensure we can provide the right services to the right patients across the health care continuum of care.” MUSC case managers were interviewed on their views of their roles: How do you see your role in the new Medicare guidelines that impose financial consequences for readmissions?
MUSC’s Case Management and Care Transition Department team “I monitor length of stay and address barriers to discharge; by identifying trends now, I can develop solutions for future improvements to these issues.” —Grace Galloway, R.N., nurse case manager, Adult Medical & Surgical Oncology What would surprise people most about what you do as a case manager? “Because some young patients have multiple hospitalizations with their chronic illness, I often follow them from birth through high school, watching the child and family unit grow despite their health challenges.” —Robin Hollinger, R.N., nurse case manager, Pediatric Cardiology, Cardiothoracic Surgery What is the most rewarding part of your job? “When a family says “thank you,” I know I have made a difference in their lives.” —Jessica Winkler-Metz, social work case manager, Pediatric Orthopedics, Urology, Oral Maxillary, Neurology, Plastics, and ENT You follow complex patients with high readmission rates, both when they are in the hospital and at home, to decrease readmissions. What are some of the ways
you do this? “I identify the psychosocial factors involved in the patient’s illness and care, then offer the patient the resources to find assistance, or make those contacts myself if the patient or family is not able. The poor economy has negatively impacted many community resources with many unable to provide what they did a few years ago. This deficit in community resources, like housing and affordable outpatient medical care, negatively affects our ability to discharge patients.” —Renee Bligen, continuum social work case manager, Digestive Disease Center You are with HealthLinks, an MUSC-initiated program that utilizes student volunteers to assist patients with accessing resources in their local communities. Tell us more. “I enjoy showing students that health is influenced not only by medical intervention but also a range of social, economic and environmental factors — the crux of holistic case management. Students have the opportunity to impact these factors in MUSC’s population. As future health care providers, I hope the experience will influence the way they care for their patients.” —Chrysta Schaaf, social work case manager, HealthLinks
The CaTalysT, October 12, 2012 5
Janet Davidson Department Ambulatory OR How long at MUSC 23 years How are you changing what’s possible at MUSC By maintaining optimal patient satisfaction during their stay on our unit. Pets My two cats, Elvis and Pressley Dream job Working for a philantrophic foundation and mission work. Who in history would you like to meet Abraham Lincoln. I admire him for who he was. Favorite restaurant The Boathouse at Breach Inlet (Isle of Palms) Favorite quote and by whom “Love Christ, love yourself, love others.” — My mother, who is my inspiration. Favorite radio station 101.7 What do you do on a rainy day Read a book and have a cup of tea
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New initiative targets employee wellness A recent survey of Children’s Hospital employees found that 76 percent thought it highly important to talk to patients and their families about health behaviors. However, just 37 percent of that number reported that they do this type of wellness counseling. That disconnect is part of the reason for rolling out an innovative new program called the Children’s Hospital Wellness Initiative that recently launched at a luncheon sponsored by the Boeing Center for Children’s Wellness. “The initiative will focus on getting more employees involved with wellness, nutrition and fitness activities so they can encourage patients to adopt healthier lifestyles,” said Janice D. Key, M.D., codirector of the center’s Lean Team. “You can’t be preaching wellness without practicing it.” That message played out with the Lean Team’s efforts to create healthier school environments. The Lean Team was created in July 2007 as a partnership between MUSC’s Division of Adolescent Medicine and the Charleston County School District with the goal of preventing and treating childhood obesity through family-centered clinical programs paired with policy and environmental changes in schools and communities. Research revealed that the healthiest schools were ones that had a robust staff wellness program. Similarly, research suggests that health care providers who engage in healthy behaviors are more likely to counsel their patients on these issues. The initiative, led by Key, director of adolescent medicine, and Susan Johnson, Ph.D., director of the Office of Health Promotion, will be a collaborative project involving different groups to target Children’s Hospital employees, including Employee Wellness, Weight Management, Sodexo, Boeing Center and dietetic interns. There will be preventative services, including worksite screenings, mobile mammograms and sleep screenings. The program will be managed through the Boeing Center for Children’s Wellness by registered dietitian Lucie Maguire Kramer.
Registered nurses Ryan Curry, left, and Jill Evans are offering up office space for one of the mini-gyms. Both love the idea of making health and fitness more convenient. Evans said employees can push each other by working out together.
“You can’t be preaching wellness without practicing it.” Dr. Janice Key Kramer interprets the survey results and works collaboratively to implement programs. “I am enthusiastic about working with Children’s Hospital staff to bring them the programs they want to facilitate an environment of wellness. This is a very unique endeavor for a children’s hospital, which makes it even more exciting.” Weight Management will be providing a 10-week program, Healthy Happy Hour that will start Oct. 8. The interactive class-based program teaches healthy behavior changes. There is a 50 percent refund for successful completion of the $98 program, an incentive paid by the Boeing Center. To register, email email@example.com. In the arena of physical activity, there will be fitness testing, a walking program, a desk workout program, signage for indoor and outdoor walking and biking trails, a stairwell program, development of a physical activity and break policy as well as the creation of break room
mini-gyms. As far as nutrition goals, employees will receive incentives for purchasing wellness items in the cafeteria and various educational opportunities, including cooking classes, will be provided. There also will be a seminar series on topics from stress management to sleep hygiene. Key said she’s amazed at the scope and depth of the project and how it pulls together so many of MUSC’s resources to support Children’s Hospital employees in adopting healthier lifestyles. Johnson added that there’s a big push nationwide for hospitals to be leaders of change in creating a culture of health. They will be providing assessments and evaluations to see what parts of the program do well or may need to be revamped. What they learn will help shape expanding this program to other areas of the hospital. Through work with the S.C. Hospital Association and the Working Well program, her office has access to nationally recognized, evidence-based assessment tools that allow comparisons against industry standards for hospitalbased employee wellness. “This pilot is an excellent opportunity for us to move beyond the initial criteria for healthy hospitals and provide evidence that could support the expansion of prevention efforts on a
national level,” said Johnson. Part of the initiative is getting good employee feedback. A Wellness Program Needs and Interest Survey was completed by 312 participants in the Children’s Hospital. It was administered to Children’s Hospital faculty, nurses, food and environmental services, child life specialists, volunteer services, faculty and residents between February and August to assess current health status and behaviors, to generate baseline data and guide program development. Among its findings were that 26 percent of employees reported being 20 pounds or more overweight and 36 percent, up to 20 pounds overweight. Eighteen percent said they rarely exercised and 45 percent reported lower back pain in the past six months. Twenty-eight percent reported that they regularly practice stress management with 47 percent reporting that they allow themselves a five to 10 minute break. “With more than 12,000 employees, individualized programming is virtually impossible, so the pilot was designed with the creation of target groups based on job responsibilities as well as current health levels and interests,” said Johnson. The survey highlighted health issues specific to work groups, which gave insight into program development and in particular, scheduling. However, baseline data and needs assessments aren’t enough to guarantee success. “We could have the best program in the world but if people don’t know about it, we won’t be successful,” said Johnson, adding that’s why they created a wellness committee and are recruiting individual wellness champions. Kramer said Wellness Champions are an integral part of the team, serving as the primary contact for their area. “Serving as a wellness champion will not take a lot of extra time but is essential to the success of the overall wellness program and can be rewarding.” For information about the program or being a champion, visit www.musc. edu/lean_team/chwellness/index.htm or contact Kramer at firstname.lastname@example.org or Johnson at email@example.com.
The Catalyst, October 12, 2012 7
Surgery department professor elected president of society D
avid Adams, M.D., was elected to serve as president of the Halsted Society for the 2013 term. The society is limited to 80 surgeons and other individuals in allied branches of medicine and membership is by invitation only. David J. Cole, M.D., McKoy Rose professor and chairman of the Department of Adams Surgery who is also a member of the Halsted Society, said the honor is quite a coup for MUSC and an honor for the Department of Surgery. “I can think of no one better suited to lead the group’s mission ‘to encourage exchange of ideas, free and informal discussion, and a spirit of sociability and good fellowship among its members.’ David has spent more than 25 years at MUSC earning respect and admiration as an avid mentor, clinical leader and champion of the most difficult surgical cases while brilliantly serving our profession on a national level.” Adams served as medical director of 1W trauma center, program director in the General Surgery Residency training program and is course director of MUSC’s Department of Surgery Annual Postgraduate Course in Surgery. He is chief of the Division of Gastrointestinal and Laparoscopic Surgery and codirector of the Digestive Disease Center.
His research interests center on gastrointestinal and laparoscopic surgery, with special interests in the surgical management of chronic pancreatitis. He has published more than 100 works and presented more than 100 talks related to his clinical interests. Lewis Flint, M.D., in the Division of Education for the American College of Surgeons and who was in MUSC’s Surgical Residency Class of 1974, said that since Adams joined MUSC’s faculty in 1986, he has built a nationally recognized gastrointestinal surgery unit. In the course of this growth, he has repeatedly been recognized in Charleston and in South Carolina for clinical and teaching excellence. Flint said that Adams’ scholarship has been recognized at the national level, and this has led to election to leadership positions in the American College of Surgeons, the Southern Surgical Association, and the Southeastern Surgical Congress as well as appointment to the editorial board of the Journal of Gastrointestinal Surgery. “In my opinion, David Adams is the quintessential class act in American academic surgery,” he said. “The scholarly contributions he has personally produced and those he has stimulated in others are consistently of the highest quality. These characteristics have brought significant additional luster to an already strong academic surgical unit at MUSC. All of us with a Charleston connection can be proud of his election to the office of president of the Halsted Society, and we wait eagerly for the inevitable additional honors.”
Daisy sepTeMBer awarD winner
Registered nurse Jamie Greer, center, is presented with the DAISY Award. Supporting Greer are two coworkers. To nominate a nurse, visit https://www.musc.edu/medcenter/formstoolbox/DaisyAward/ index.htm. To see more on the DAISY Foundation, visit http://www. daisyfoundation.org.
The MUSC DAISY (Diseases Attacking the Immune System) Award winner for September is Jamie Greer, R.N., Pediatric Hematology/Oncology Unit. The following is Greer’s nomination letter, submitted by Amelia Little, R.N. “Jamie is a selfless nurse who quietly brings supplies to the clinic such as baskets and blue books that she purchases. Jamie sent me this email describing the value of primary nursing. I believe this story she shared with me describes her expert nurse intuition identified by our clinical ladder nursing theorist Pat Benner and her caring that nursing theorist Jean Watson would applaud. The following story is Jamie’s words from an email: ‘I recently became the primary nurse for a
16-year-old patient. She completed a phase of her treatment which required her to come to the clinic three times per week for four weeks. About two weeks ago, she came for a chemo appointment and seemed withdrawn. No matter what I did I could not get a smile from her or get her to talk much, just continued complaints of being tired. It turned out she had arrived at the clinic with a blood sugar of over 900 due to high dose steroids she had been taking. Because of the quick response and team work of everyone in the clinic we were able to get the patient to the hospital quickly.’ This is just one example of Jamie’s expert nurse intuition and caring, both of which are invaluable to our patients at MUSC.”
8 The CaTalysT, October 12, 2012
Training becomes shaped by physicians, patients Editor's note: Chelsey Baldwin of Little River is a third-year medical student. This column follows the journey of her class in becoming doctors.
new era in our education has begun. Third year is the time we shed the preprescribed recipes for achieving our academic and professional goals. Each student’s training has become unique, shaped by our patients and the physicians, nurses and other professionals who care for them. Despite reading over the various conditions our patients Chelsey Baldwin suffer from countless times in my past, the word associations finally begin to have concrete meaning beyond the loosely connected mnemonics and rhymes that got us through the last two years of medical school. Now patient stories, symptoms, and mannerisms live within the letters and rhymes of old memory tricks. The animations of such pneumonics began with my experiences on the psychiatry wards. Toward the end of my six-week psychiatry rotation, I met patient X. She had spent the weekend in the emergency department because of a lack of available beds on our ward. During her time in our emergency department, she had received the diagnosis of bipolar NOS (not otherwise specified). Given the “NOS” status of our patient, we began our discussion with her focusing on her likely manic symptoms. Manic characteristics we summarize by: DIGFAST. “D” is for distracted. Patient X took a seat in front of the team of health care workers during morning rounds. “Can you tell me briefly, Mrs. X, what brought you here?” I began the interview, fulfilling the designated role of the medical student in getting as far as efficiently possible.
“Let me tell you, my son has been friends with ‘Joe’ since they were this high,” she gestured as she talked in a rapid manner. “‘Joe’ was always a sweet boy and he liked me the best of all the neighborhood moms. I’m the cool mom; the kids all hang out at my house, because I let them do what they want.” I checked off “I” for irresposibility as she went on talking without so much as taking a breath. “Much cooler than ‘Joanne,’ who moved to the neighborhood back in... Oh, '97. She is probably jealous of me, but really it isn't my fault.” “G” is for grandiosity. “Mrs. X ...” my resident calmly intervened, “You were telling us why you were brought here.” “F” is for flight of ideas. “Oh honey, I know. I was getting there. Well my son never brought ‘Joe’ over to hug me, and that's the first thing he normally does when he comes to town. So when I saw my son, I confronted him.” The patient jumped up to act out her and her son’s interaction. She drew herself upright and looked down her nose at her imaginary self as she mimicked her son. “A” is for increased activity. “You're not my mother," she shook all over as she mimicked her son. She spun around to resume the role of herself, clasping her hands at her chest. ‘Son, yes I am your mother.’” “S” is for decreased sleep, a question we were never able to squeeze into her narrative. However it’s easy to observe “T,” for talkativeness. Despite 30-plus minutes of a group effort of trying to guide Mrs. X to make sense of her presence in our mental health facility, we were left with little more than an understanding of neighborhood dynamics. We resolved to try again later. After psychiatry, I began an obstetrics and gynecology rotation. I teemed with excitement at the chance to deliver a baby. However, one of the first deliveries where I was present was surrounded by circumstances of an extremely ill mother. Preeclampsia I remember by the letters: PRE. “P” is for protienuria. Ms. Z was a young woman at 28 weeks
pregnant with her blood pressure ranges of 170s/100s and protein in her urine. “R” is for rising blood pressure. Shortly after her arrival, I went to the room to introduce myself and conduct a physical exam. She looked acutely ill, flushed cheeks, sweat at the roots of her hair. She complained of an unbearable headache, undoubtedly caused by the elevated pressures coursing through the arteries of her head. I prodded her about pain in her upper right quadrant, as I imagined a swelling liver, a part of the constellation of findings in the still unclear pathophysiology of preeclampsia. The skin of her lower extremities remained indented after I pressed my fingers onto her shins. “E” is for edema. I tapped her on the patellar tendon, and her leg jumped so rapidly and with such force that it startled me. Hyperreflexia, associated with worsening preeclampsia. I finished my exam and excused myself. My resident met me in the hallway. “Chelsey, what are the risk factors for this patient predisposing her to preeclampsia.” Luckily, or not, I had been “prepped” on these by an attending the previous morning and had to learn them the hard way. “This is her first pregnancy, she falls in the bimodal age range, and she has a history of chronic hypertension.” “What is the treatment for preeclampsia?” “Delivery,” I said and with that answer, I knew we were in for a long night. She was one of four Cesarean sections scheduled to take place before the morning shift began. As our pneumonics come to life, the heaviness of memorization lessens. We are able to spend less time rhyming and more time understanding. We are indebted to those that we are able to learn from. I'm often delighted with what ease our patients will reveal the hidden workings of their bodies and their eagerness to be a part of our journey to physicianhood. *The specifics of patient conversation have been modified to protect the anonymity of patients
MUSC to participate in national lumbar spinal stenosis study MUSC and surgeons Barton Sachs, M.D., and John Glaser, M.D., are participating in the ACADIA Facet Replacement System clinical study for the treatment of lumbar spinal stenosis (LSS). MUSC is one of only 30 sites nationwide chosen for the study. The study focuses on a new concept in spine surgery called facet joint replacement. The study will evaluate the safety and effectiveness of the ACADIA Facet Replacement System. ACADIA is an investigational device designed to treat LSS while maintaining
the motion of the spine. LSS is a painful and sometimes debilitating condition in which the spinal canal narrows and compresses the spinal cord and nerves, causing painful symptoms in the legs, thighs, buttocks, and back. Currently, a surgical option to treat LSS is removing the compressing structures and fusing the spine. With spinal fusion, a loss of motion occurs that may affect adjacent motion segments of the spine, creating degeneration and instability. Now, a treatment is being studied that
What it is
ACADIA Facet Replacement System is designed to restore the natural anatomy of the spine while providing pain relief and stability to the spine. Visit http://www.facetsolutions. com/AFRSproduct.html or call 7923131. Interested participants also may email firstname.lastname@example.org. does not require fusion. ACADIA is designed to allow motion after removing
the degenerated facet joints that are compressing the nerves. Sachs and Glaser are investigators in this study. The study is open to men and women between the ages of 21 and 85 who have been diagnosed with LSS and have had at least six months of nonsurgical treatment, such as medication, injections, and physical therapy. Additional criteria must also be met for inclusion in this study. For more information, contact the MUSC research team at 792-3131 or email email@example.com.
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Oct. 18 drill to prepare employees for shake up At 10:18 a.m., Oct. 18 MUSC is going to practice the appropriate earthquake response called the Great Southeast Shake Out. More than 100 years ago, Charleston experienced the most damaging earthquake in the eastern United States. This 7.3 magnitude earthquake that rocked the city, damaged nearly 90 percent of brick structures and killed 100 people. Charleston is still at risk for an earth-
quake of this magnitude so now is the time to prepare. If you feel the ground shaking, stay calm, drop to the floor, seek cover under a desk or sturdy furniture, and hold on to that piece of furniture until the ground stops shaking. For information, call Amanada Ritsema at 792-8514 or MUSC Risk Management at 792-3055. Information also may be found at www.musc.edu and click “The Great Southeast Shakeout.”
October is time to make changes October is the month to make certain changes to insurance benefits. All changes go into effect on Jan. 1, 2013. highlights q No changes to the premiums for vision, long term disability or basic dental insurance coverage q Medical insurance premiums for the Savings and Standard State Health plans will increase by 4.6 percent for employees and employers: for example, the employee rate for single coverage under the standard plan will increase by $2.25 per paycheck and by $7.05 for full family. q BlueChoice HMO medical insurance premiums will be raised between approximately 16 percent and 28 percent depending on the level of coverage. Single subscribers who remain on this plan will see a $24 per paycheck increase and for full family coverage, the increase will be $110.98. q There will be some small adjustments to the subscriber co-pays under the BlueChoice plan. q Cigna HMO medical insurance plan will be discontinued as of Jan. 1, 2013. q State dental and dental plus plans will begin covering dental implants as a class III procedure. q Very slight increase to the premiums for dental plus insurance ranging from 12 cents per pay check for single coverage to 37 cents for full family coverage.
q Term life insurance rates for employees and spouses will increase by approximately 10 percent to 18 percent depending on your age category. q You may increase the term life insurance on your life by up to $50,000. q You cannot increase spousal life insurance without answering medical questions. q The maximum annual contribution to a Medical Spending Account will reduce from $5,000 to $2,500 – you must re-enroll in this plan annually for it to continue in 2013 If you do nothing in October, all current insurance benefits will roll over to next year with the exception of medical spending and dependent day care accounts which both require annual re-enrollment. If you add a spouse or children to vision coverage or kids to child life insurance and you currently do not insure them in any other way with the State, you will be required to submit to the HR office proof of your relationship to them such as a marriage license or joint tax return for spouses or long form birth certificates for children. These documents may be faxed to 7920853 but be sure to put your full name on them. Annual enrollment briefings for medical center staff will be held at 8 a.m., and 1:15 p.m., Oct. 15 at 2W Amphitheater or call the Benefits Desk at 792-0826.
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Students win gold for service, humanism in medicine By CinDy aBole Public Relations
Third-year medical student Joy Dean receives her Gold Humanism Society pin from Dr. Rusty Turner, program faculty co-advisor, at the Sept. 11 induction ceremony of 23 students. The students were selected by their peers for demonstrating the values of humanism and professionalism in medicine. The Gold Humanism Honor Society was established at MUSC in 2005 to recognize students, residents and role-model faculty in medical education for demonstrating patientcentered medical care. More than 90 percent of U.S. medical schools sponsor a Gold Humanism Honor Society.
ollege of Medicine students, honored for their humanism in medicine and patient care, were recognized Sept. 11 as the newest members of the Paul B. Underwood Jr. Chapter of the Gold Humanism Honor Society (GHHS). A total of 23 student inductees joined College of Medicine Dean Etta D. Pisano, M.D., chapter namesake Underwood, faculty advisors Sherron Jackson, M.D., and Robert Turner, M.D., and GHHS faculty at an induction ceremony held in their honor. “Each of you elevates the values of humanism and service as medical students by providing clinical care, leadership, compassion and dedication to service. There’s no greater honor than to be recognized by your peers for demonstrating these empathetic and honorable values,” said Pisano. The students were presented with a certificate and pin and later recited the society’s pledge committing themselves as role models and mentors to humanism in medicine, inspiring colleagues to promote humanism and advocate for quality patient care and improving health care for all. Bonnie Brooks, a third-year medical student from Columbia, said she chose medicine as a career because of the care she can continually provide and the ability to give back to society. “I try to give the best level of care to my patients all the time. I’m proud to receive this honor.” Fellow student Craig Thomas, a native of Jamaica, was humbled that the award recognized excellence as voted on by his student peers. “In our training, sometimes we wonder how we’re doing in our efforts to provide patient care. Receiving this type of feedback is invaluable and encouraging. It reminds me that I’m on the right path in the work that I do in providing quality patient care.” The 2013 inductee class includes Brooks, Amy E. Brown, Jessica S. Connett, Shana N. Coshal, Thomas
Criswell, Thomas Cunningham, Sarah Dean, Brett Hoffecker, Jocelyn Kerpelman, Ryan Kroll, Spencer Lovelace, Neil Naik, Ashekia Pinckney, Stephen Potter, Daniel Reed, Stefanie Robinson, Phillip Rodriguez, Andrea Shipp, Mary Darcy Slizewski, Thomas, Thomas Tyner, Chelsea Webb and Rahim Wooley. The recipient of the Leonard Tow Humanism in Medicine Faculty Award also was recognized during the luncheon. The award was presented in May to Ashlyn H. Savage, M.D., by the Arnold P. Gold Foundation. The dean recognized Savage, assistant professor in the
Department of Obstetrics and Gynecology, who works at MUSC Women’s Health at Cannon offices. Savage, who is a 2002 COM alumnus, is the director of OBGYN’s residency training program. She was chosen for her compassion and empathy with patients and her mentorship with students, residents and colleagues. Savage was joined by previous Tow Humanism awardees Rachel Sturdivant, M.D., and Marian Taylor, M.D. The Leonard Tow Humanism in Medicine Award also is sponsored by the Arnold P. Gold Foundation and honors practitioners who value humanism in medicine.
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Green fair to offer healthy cooking demonstration Celebrating its fifth year, the Carolina Green Fair in Marion Square will be held Oct. 13 and 14. On Oct. 13 from 10 a.m. – 2 p.m., the fair will host a “green is good and healthy” cooking demonstration. The demonstration will feature local ingredients from the Charleston farmers market. There also will be wellness workshops, local exhibitors, interactive yoga, Zumba and a variety of fitness classes. Admission is free. The purpose of the Carolina Green Fair is to create excitement and enthusiasm for green principles, lifestyle, products, services and technologies available to South Carolina residents using an environmentally responsible forum of education and entertainment. MUSC Office of Health Promotion is a sponsor of this event and will host a large tent on Oct. 13 featuring many of the health and wellness resources offered at MUSC, including Employee Wellness, Urban Farm, Sleep Lab, Weight Management, Wellness Center, Nutrition Services, dietetic interns and more. In addition, local chefs will showcase the use of local and homegrown ingredients to create healthy and delicious dishes. The Culinary Institute of Charleston will bring out the Demo Kitchen from noon to 12:30 p.m. Join MUSC Sodexo chef Ferando Middleton and registered dietitian Debbie Petitpain as they prepare pan-seared local fish with beet sauce and fall greens and grilled vegetable salad with tomatoes, olives and cheese.
MUSC Employee Wellness events q MUSC Employee Fitness Series: Join fitness expert Katie Blaylock from 4:15 to 4:45 p.m. Oct. 17 for a Tae Bo class. Registration is required and space is limited. Send your name and email to: musc-empwell@musc. edu. See MUSC Wellness Center Membership Desk upon arrival for sign-in and directions to the classroom. q Flu shot satellite clinic: Flu shots will be given from 11 a.m. to 1 p.m., Oct. 17 in the lobby of Ashley River Tower (outside the cafeteria). For faster service bring completed influenza consent form, found in My Records. q Worksite screening: A worksite screening will be held from 7 to 11 a.m., Oct. 24, university hospital, 2West classroom. This screening, valued at about $350, is available to employees with the State Health Plan for $15 (covered spouses can also participate for $15). Employees and spouses without this insurance can participate for $42. To register, go to www.musc.edu/ employeewellness and click Worksite Screening. q Feed the Need: Donate non-perishable food to the community and help kick off National Food Day. Food collection barrels will be at the following locations until Oct. 24: university hospital cafeteria, Ashley River
Tower cafeteria, Colbert Education Cener & Library lobby, MUSC Urban Farm, Wellness Center lobby and the Office of Health Promotion (17 Ehrhardt St.). q Farmers markets: Fresh fruits and vegetables are available from local farmers each Thursday behind the Drug Discovery Building 10 a.m. to 2:30 p.m., and Friday from 7 a.m. to 3:30 p.m. at the horseshoe and the area next to Ashley River Tower. q Urban Farm: Early bird maintenance from 7:30 to 8:30 a.m., Oct. 16 and 17. q Carolina Green Fair: MUSC Health & Wellness Tent, 10 a.m. to 2 p.m., Oct. 13, and noon to 5 p.m., Oct. 14, Marion Square. q Porcher Medicinal Garden Dedication: 5:30 p.m., Oct. 18, Drug Discovery Building Auditorium Contact Susan Johnson, Ph.D., at johnsusa@musc. edu for more information on the Office of Health Promotion at MUSC and Suzan Benenson Whelan at firstname.lastname@example.org for specific information about Employee Wellness. Events, speakers, classes, or any other ideas are welcome. Find us on Facebook. Like our page and keep up with all the wellness events at MUSC.
Creative name needed for medical center’s access initiative As a result of MUSC’s growing national reputation, the demand for its services and providers has increased. According to MUSC Physicians Chief Medical Officer Peter Zwerner, M.D., MUSC Health has gone through a tremendous amount of growth. “MUSC has hired more than 100 faculty members, expanded its primary care network and increased outpatient services including the opening of MUSC
Health East Cooper.” The demand has highlighted one of MUSC’s biggest challenges — access. “The organization must improve access or MUSC will not be able to meet current and future patient demand,” Zwerner added. Zwerner, and MUSC Physicians Chief Operating Officer Jeff D’Agostino, have formed a team leadership approach along with leaders from the clinical enterprise
to drive the access initiative. During the next year it will be an institutional priority, but it is missing one thing, a name. Leadership is asking the MUSC community to help come up with a creative name to brand the access initiative. The requirements for this name are: name focused on patient experience/ satisfaction; must be linked to patient access; name should be simple; action
word; and name should be professional and not offensive Individuals who create the top three names will be given a monetary reward. First place: $100, second place: $50, and third place: $25. Submit your name ideas to email@example.com by Oct. 26. The winner will be selected by vote through a survey sent out to the MUSC Health community. The winning name will be announced on Nov. 9.
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