MUSC Catalyst

March 30, 2012

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 30, No. 31

Virtual reality adds punch Sitting ducks not a bad thing for stroke rehab patients

By Dawn Brazell Public Relations

H

erbert Pinckney settles in to punch some ducks in the video game, Duck Duck Punch, letting researcher Michelle L. Woodbury, Ph.D., get him scanned in to create his avatar arm.

His 11 grandchildren would think the game way too easy, but for Pinckney it’s Olympic-caliber work. Having had a stroke about eight months ago, he struggles to lift his arm.

He’s trying to score points by knocking over a series of ducks on the screen. The level gets harder as some seagulls begin flying across. Woodbury, an occupational therapist and research director of the upper extremity motor function lab in MUSC’s Center for Rehabilitation Research in Neurological Conditions, allows him to use his other arm to assist.

“Bend and get that duck. Can you get that duck? That’s a tough one,” she said, encouraging his competitive streak.

Pinckney is making history, both personally, in regaining lost mobility in his impaired left side, and medically. He became the first participant in a feasibility study aimed at the development of the first generation of games designed to help a segment of stroke patients for whom very few therapy options exist.

Woodbury, who still is recruiting for the study, praises Pinckney and points out the huge difference in his ability since he first started. She said she’s been amazed by early

3

See Ducks on page 8

SMOkeleSS TObaCCO Cadets participate in a study to determine if using dip may contribute to lesions.

Stroke survivor Herbert Pinckney tries to earn points on a video game as Dr. Michelle Woodbury offers encouragement.

6

COM Dean

2

National Doctors’ Day

Dr. Etta Pisano is featured as part of Women’s History Month.

4

Child Life Month

5

Meet Stacy

READ THE CATALYST ONLINE - http://www.musc.edu/catalyst

2 The CaTalysT, March 30, 2012

Applause Program The following employees received recognition through the Applause Program for going the extra mile:

Medical Center

Margaret Dunning, 6W; Melvena Nelson, Environmental Services; Ema Brown, ART Dietetic Services; Sara Sullivan, ART 6E; Ashli Fender, ART 6W; Mautisha Jenkins, ART 6E; Elaine Sola, ART 6E; Becky Hank, ART 6W; Patricia Brown, ART 6W; Bill Huck, ART PACU; Dena Middleton, ART 6W; Rebecca Ladson, Environmental Services; Valerie Weeks, Volunteer & Guest Services; Shinika Phillips, Volunteer & Guest Services; Harolyn Smith, Volunteer & Guest Services; Dianna White, Payroll; Lori Pope, Radiology; Kendra Ostrander, Medical Records; Brett Mills, 10W; Corey Slusarski, 10W; Fred Scruggs, 10W; Eleanor Hollington, PACU; Marlene O’Leary, Heart & Vascular Center; Queen Haynes, Department of Family Medicine; Kathleen McFarland,

Family Medicine Center; Karen Moskos, Department of Family Medicine; Ben Atkins, Transplant; Arty Burns, Patient Transportation; Daniel Williams, Patient Transportation; Michelle Hudspeth, Pediatric Hematology/Oncology; Cindy Stokes, Pediatric Hematology/Oncology; Chris Moore, DDC; Jenice Edney, ART Dietetic Services; Evelyn Polite, ART OR; Leslie Rice, CTICU; Khoi Do, Radiology; Suzanne Ramage, Volunteer & Guest Services; Laura Finklea, Cardiology; Dean Shabeldeen, 9PCU; Lashunda Laboard, 4E; Kristy Wilkerson, CTICU; Ann Montgomery, DDC; Deveat Anderson, Environmental Services; Darnell Eady, 8W; Anne Bromley, Revenue Cycle Operations; David Soper, OB/GYN; Ana Virella, Women’s Services; and Kate Miccichi, Revenue Cycle Operations.

University Christopher Carter, College of Dental Medicine; and Sandra Morris, Enrollment Management.

National Doctors’ Day National Doctors’ Day is recognized each year on March 30. According to the National Doctors’ Day website it is a day to celebrate the contribution of physicians who serve the country by caring for its citizens.

A March U.S. News & World Report identifies the top 1 percent of physicians in the country; of those practicing in the Charleston area, 93 percent are at MUSC. Following are comments made to MUSC physicians from patients: “I would like to say thank you MUSC staff for the best care. My doctor, Juan Manual Gomez (Infectious Diseases) is wonderful.”

“Dr. Soonho Kwon (Endocrinology Diabetes & Medical Genetics) and his staff were wonderful.”

“Dr. James Mooney (Pediatric Orthopaedic Surgery) and his staff are amazing. They take time with each patient, clearly answer any and all questions. Dr. Mooney is extra gentle and sensitive to small children and does his best to make them feel comfortable.”

“Thank you Dr. Woody Coker (General Internal Medicine) for your kindness and support of my brother and our family during our stay at MUSC. We have been privileged to have had you serve as my brother’s physician while he was at MUSC. MUSC is very fortunate to have you.”

“Dr. Elisha Brownfield (General Internal Medicine, Geriatrics) came in and was wonderful, warm, caring, sincere and genuine.

I love being her patient.”

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 catalyst@musc.edu Catalyst staff: Cindy Abole, aboleca@musc.edu Dawn Brazell, brazell@musc.edu

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.

“I am always satisfied when I visit the doctors at MUSC. If I miss or am late for labs or X-rays, they always fit me in at that time so I don’t have to come back.”

“Dr. Faye Hant (Rheumatology & Immunology) is one of the best doctors I have dealt with and is very caring.”

“Dr. Charlie Strange (Pulmonary & Critical Care Medicine) is the best pulmonary doctor I have ever known. He really cares about his patients and is dedicated to his profession. He has a great bedside manner and no matter how bad you feel, you always

feel better when you leave his office. We need more doctors like him.”

“My physician, Dr. Eric Chapman (Emergency Medicine), was excellent. Very professional and had an excellent bedside manner.”

“We brought our daughter to MUSC to make sure she had the best doctor who would take care of her needs and issues. We found that in Dr. Steven Glazier (Pediatric Neurosurgery). He was an answer to our prayers. We have a lot to be thankful for and we are extremely thankful for Dr. Glazier and his staff.”

“I am particularly grateful to Dr. Brenda Hoffman (Gastroenterology). She is second to none.”

“I can not say enough about Dr. Neal Christiansen (Hematology/Oncology). My family physician called him on a Thursday afternoon and on Friday morning Dr. Christiansen called me to let me know I had an appointment for a mammogram, ultrasound and biopsy for the following week.

He met with me on the afternoon of the tests to tell me how we would proceed. The next evening he called with the pathology results to say there was no cancer. He was so caring and concerned.”

“Thank you so much for the service of Dr. Robert Black (Ophthalmology). He has been treating my eyes for about eight years and all is well. He does a great job and is very dedicated and committed to his profession.”

“My care with Dr. Carolyn Reed (Surgery) has been nothing short of outstanding. My husband and I are impressed with every aspect of care I received at MUSC prior to my surgery and post-operative and on an ongoing basis.”

“Dr. Sarah Book (Psychiatry) shows great concern and gives me advice to get me on the right track. She is always very nice and thoughtful. Thanks for saving me!”

The CaTalysT, March 30, 2012 3

Study compares smokeless tobacco use among cadets

By CinDy aBole Public Relations Studying the use of smokeless tobacco among men, ages 18 to 24, and evaluating their risk for oral cancer at The Citadel were the goals of third-year dental students Laura Tulga and Jennie Odom. What’s especially interesting is that these students were comparing research used today from a study conducted a decade ago by fellow students. They were under the guidance of J. Mark Barry, DDS, associate dean for clinical affairs in the College of Dental Medicine.

In December, the pair initiated some on-site screenings of smokeless tobacco use among volunteer participants at The Citadel’s campus. Using the Dream Center’s mobile dental clinic van (the vehicle previously belonged to the college), participants completed a brief survey and oral examination conducted by a member of the study team.

“This project allows us to study

Third-year dental student Laura Tulga inspects for lesions in the mouth of Citadel cadet Henry Mills. and assess the alarmingly high use of smokeless tobacco among Citadel cadets,” said Barry.

Cadets who presented with

precancerous lesions were advised to refrain or reduce their use of smokeless tobacco products for a six-week period.

In January, those individuals were invited

to return to the van to be evaluated for any visual changes in their cheeks, gums or mouth. The team compared results from both screenings and with national averages.

“Our goal was to determine if Citadel cadets were still experiencing a higher rate of precancerous lesions than smokeless tobacco users in the general population as they were in 2001,” according to Odom.

Results showed that Citadel cadets screened for smokeless tobacco keratosis decreased in the 10 years since the 2001 study from 72.3 percent to 56 percent.

This study resulted in a lower incidence of finding precancerous grade lesions in the mouth compared to the 40 to 60 percent national average reported in 2001.

The study caught the attention of cadet Henry Mills who was among a several dozen Citadel students who use smokeless tobacco and consented to participate. As smoking is banned within

See Tobacco on page 9

4 The CaTalysT, March 30, 2012

WAYS TO HELP MUSC child life specialists address misunderstandings, focus on coping effectively

H

ealth care experiences and hospitalization can be stressful and overwhelming to children and can lead to feelings of fear, confusion, loss of control, and isolation. If these feelings are not addressed they may have negative effects on children’s physical and emotional health as well as inhibit normal development. Children need to be assisted when navigating medical environments to help them effectively cope with their circumstances.

Many children have misconceptions about medical experiences and hospitalization. For example, when a 6-year-old patient came in for surgery he was told that the doctors would make a hole in his body. He asked, “Will they use a shovel?” Another patient thought the video electroencephalogram could read her thoughts.

Children also may come with knowledge of someone else’s medical experiences that can lead to misunderstandings and anxiety. For example, a 4-year-old patient came into the hospital, but refused to get off his knees. The medical staff was perplexed and could not understand why he would not stand. Through play, the child expressed that his uncle had gone to the hospital and had his legs amputated and he was protecting himself.

Children who understand and are prepared for medical events demonstrate less fear and anxiety, and tend to more effectively cope with future medical experiences.

Here are a few tips to help clarify children’s misunderstandings:

1.

Get down on the child’s eye level.

Kneel down when speaking with children. This lets them know you

are interested in what they have to say and helps build rapport.

By getting on their eye level, you demonstrate that the child is important.

2.

3.

Select words carefully.

Medical jargon can be difficult for children to understand. Be sure to use clear, concrete language and explain everything in simple, sensory terms. The chart below contains a list of common words or abbreviations that can be confusing or threatening.

Offer choices when possible.

Children in hospitals have very little control over their environment and routines. By offering choices, you can promote autonomy, which then encourages coping. For example, “Would you like to take your bath before you eat or after?” Also, it is important to remember not to offer a choice when one is not available. An example of this would be asking, “Do you want to take your medicine now?” You are not actually giving the child a choice in Common Words/Abbreviations Urine (“You’re in?”)

I.V. (“Like ivy that grows outside?”)

Dye (“Die?”) Cut Shot Put to sleep “Like my cat that died?”

Child life specialist Cory Prescott visits with Matthew Debarros in the Children’s Hospital Atrium. this situation. the child did well. For example, you could say, “Great job holding Give the child a job to do. your arm still!” This helps a child This encourages children to focus on the positive things. become active participants in the

4.

medical experience or procedure.

For example, “Your job today is to take deep breaths and count to 10.”

5.

Advocate for comfort positioning.

Comfort positioning can not only help children be more cooperative during procedures, but can promote family-centered care. Being in an upright position supports a child’s sense of control.

6.

Offer praise and encouragement.

Praise and encourage things that Clearer Pee or other familiar term Small tube that goes in your vein

Medicine that will help the doctor see more clearly Make a small opening Give your medicine through a small needle Medicine that will make you fall asleep

aBouT our sTaff Child life specialists are experts in the field of child development with knowledge regarding the needs of children in medical settings. These professionals have earned a bachelor’s or master’s degree, and have undergone a rigorous certification process including an internship and certification exam.

Child life specialists provide therapeutic play, self-expression activities, developmentally appropriate preparation, coping strategies, and emotional support to promote understanding, reduce anxiety, and encourage cooperation.

MUSC Children’s Hospital has 11 child life specialists in all MUSC inpatient units, the operating room, ambulatory surgery, the emergency department, procedural areas and outpatient oncology clinic.

To learn more about MUSC’s Child Life Department, visit http://www. musckids.com or call 792-8805.

The CaTalysT, March 30, 2012 5

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6 The CaTalysT, March 30, 2012

Dean promotes women, diversity in leadership

By CinDy aBole Public Relations

O

n College of Medicine Dean Etta Pisano’s bucket list is an unusual item. She wants to write a play on the changing role of women in society.

It’s no wonder. One of the strongest role models in her life was her mother, who was an electrical engineer running an office of 30 men in charge of computerizing the telephone system.

Unfortunately when she married Pisano’s father in 1955, she lost her job.

“It was a different time back then, but I’m sure that must have been incredibly difficult – to have to choose between her professional life and her personal life. I like to think that if she had the opportunity she would have rejoined the workforce. My mother passed away when I was 15 – and as the oldest of seven children I gained a lot of responsibility at a young age. I believe that experience shaped who I am to a large degree.”

It also instilled in her a desire to stop women from dying too young – and that is one of the reasons she selected breast cancer as an area of focus. Pisano, M.D., is regarded as an expert in the field of women’s imaging and recognized among the top 20 most influential people in radiology.

Pisano certainly has learned to handle tough issues within her area, at her former institution, the University of North Carolina-Chapel Hill (UNC), and throughout her life.

She made history at MUSC in 2010 when she became the institution’s first female medicine dean. Her leadership comes at a challenging time when deans in academic medicine face pressure with difficult issues, including state funding cuts, reduced federal research funding, doctor shortages and the implementation of health care reform.

Mark Sothmann, Ph.D., vice president for academic affairs and provost, is among campus leadership works closely with Pisano on a variety of programs such as the College of Medicine’s

progress with the institution’s new funds flow financial model and alignment with the 2010 Strategic Plan.

“Dr. Pisano has one of the most difficult jobs at any academic health center. The challenges are immense with such forces as the changing fiscal climate and health care reform. Being one of just a few women in these positions nationally, her successes at MUSC will be hugely symbolic not just regionally but across the country,” Sothmann said.

a sTrong founDaTion An accomplished physician and researcher, Pisano has proven herself as a pathfinder for women’s issues in academic medicine and higher education.

Pisano credits her parents, the nuns who helped educate her as a child and other successful professionals for laying down a strong foundation. Aside from her mother’s influence, she also learned much from her father, a radiologist, who took time to introduce her to several female physicians who were successful at balancing career and family.

The mother of four has been creative in making the balancing act work for her family.

“There was often the perception that a woman couldn’t have a medical career and be a wife and mother. As a junior faculty member, I had to assert myself to be allowed to work part-time for several years while I had young children at home. I encountered resistance, because that was not the norm. But it was during those years that I got my first grants and learned how to be a researcher. They were incredibly productive years.”

During her 20-year tenure at UNCChapel Hill, Pisano emerged as a passionate voice and champion for women and diversity projects. In 2007, she founded the university’s Working on Women in Science program, an initiative established to enhance the recruitment, retention and promotion of women faculty through leadership training, mentoring and networking. She

Dr. Etta Pisano with husband, Dr. Jan Kylstra and children Carolyn, Schuyler, Jimmy and Marijke. Bottom photo: Dr. Pisano with College of Medicine student Danielle Bersabe during Match Day. Pisano is being recognized as part of MUSC’s National Women’s History Month. led UNC’s Association of Professional Women in Medical School and also chaired UNC’s Committee on the Status of Women, addressing tenure clock issues and gender-based salary inequities among faculty.

The tenure clock extension policy in higher education is defined as an adjustment of extra time granted to a tenure-track faculty member due to circumstances and conditions in the management of family responsibilities or health issues.

“I believe it’s important that we accommodate life changes for women and men – to allow our faculty to have a career and raise children. MUSC does not have a ‘tenure clock’ for its faculty, so there is not the same degree of pressure that exists at many other institutions for faculty to move up or out. This ‘tenure clock’ time period typically coincides with when faculty would be having and raising their children.”

wisDom of CrowDs As dean, Pisano is challenged with attracting and retaining talented women and minority recruits who choose an academic career.

Within her own college, she advocates for the presence of women

See Dean on page 10

Dr. Etta D. Pisano Dean of the College of Medicine; Vice President for Medical Affairs; Professor of Radiology Education: Duke University School of Medicine, M.D. (1983); Residency, Radiology, Beth Israel Deaconess Medical Center (Harvard University); Dartmouth College, Bachelor of Art in Philosophy (1979) Family: Husband, Jan Kylstra; and four children Hobbies: Reading, water sports, walking on the beach, spending time with family and friends, enjoying the Charleston area

The Catalyst, March 30, 2012 7

Children’s Hospital hosts taste panel By hollen DoDDs Public Relations

MUSC Children’s Hospital is taking a stand against childhood obesity by incorporating various nutritional programs.

A children’s taste panel was held March 21 in the university hospital cafeteria. The goal of the panel was to encourage kids to make healthier meal choices.

The taste panel is one of the first patient-focused efforts of the Children’s Hospital Wellness Initiative, sponsored by the Boeing Center for Children’s Wellness. Boeing donated $1 million to the Children’s Hospital last year to establish a center aimed at promoting better health among the state’s young people.

According to the National Association of Children’s Hospitals, 16.9 percent of children and adolescents, ages 2 to 19, are obese.

Twelve children were dubbed judges at the taste panel. Parents and siblings of patients also attended the tasting. MUSC dietetic interns collaborated with Sodexo to organize a variety of foods that were served to the children. By choosing their favorites, their selections will help to guide the planning of the hospital’s future menu.

Clinical nutrition manager Mary Basel said the

Will Smith gives approval of the healthy Action Meals served at the taste panel March 21. event was a huge success, and the children had fun participating. “Establishing healthy eating habits is important in the prevention and treatment of medical issues. We decided to conduct the taste panel so we could educate children and their parents on the importance of nutrition, while allowing kids to have a say in making healthier choices.”

MUSC is answering the Autism Speaks’ Light It Up Blue call. In honor of the event, employees are asked to wear blue April 2 to support World Autism Awareness Day. In its third year, the campaign helps raise awareness about the growing public health concern of autism by engaging communities to light up iconic landmarks on April 2 in support.

Pay attention to the university hospital’s North Tower to see MUSC’s support.

An estimated 1 in 110 children in the U.S. is on the autism spectrum — a 600 percent increase in the past two decades that is only partly explained by improved diagnosis.

For more information, visit http://www. lightitupblue.org/.

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DuCks

Continued from Page One

results that suggest patients are benefitting more than was expected.

The innovative virtual reality system is the brainchild of an ongoing collaboration between Woodbury and the research teams of Larry Hodges, Ph.D., the endowed chair and director of the Clemson School of Computing.

Using a low-cost motion tracking device, a stroke patient’s real world arm movement is translated into virtual world arm movements. Patients see the avatar arm from the same perspective as they see their own arm and are able to control the avatar arm with their own arms. Although the patient’s actual arm movement may be small, the avatar arm responds with full reaching motions in the virtual world to play an interactive virtual game.

Woodbury controls what the ratio of real to virtual arm movement is based on the patient’s degree of disability. For example, this threshold may be set so that a patient may need only five degrees of voluntary elbow extension to control the avatar. As the patient improves, this threshold can change to require 10 degrees.

Patients are given the illusion of performing full normal reaching movements and accomplishing specific tasks. This is exciting given new research that is showing the advantage of activating and reorganizing the neural networks in the brain that have been affected by illness and injury to enhance rehabilitation, she said.

“This is never in place of a therapist,” she said of the game, “but this gives a therapist another tool for the toolbox.

The virtual enviroment offers things the real world can’t. In the virtual world, we

The video game simulates full range of motion for a stroke survivor with limited motion. To see a video, visit http://bit.ly/MUSC_Virtual_Reality. make the world easier for them.”

Eventually, therapists will be able to send their patients home with a Kinect game that will challenge them in a fun way and reinforce therapy being done in the clinic. She has enjoyed collaborating with Hodges and his group, although they’ve had to be patient with each other at times in translating the respective jargon of their fields.

Woodbury also is working with a group of 10 volunteers from the gaming community for the study and has been amazed by their contributions about how to make the game more entertaining.

They are incorporating their comments to improve future generations of the game.

Hodges said his expertise is in the design, implementation and testing of virtual environment software. Teaming with application content experts to understand and contribute to solutions that support their clinical goals is both challenging and rewarding.

“Many of my graduate students chose to study computer science with me

because they wanted to build solutions that address real-world problems.”

He has been doing collaborative research with clinical partners since 1993 and has supervised the design and implementation of virtual environments for use in the treatment of balance disorders, anxiety disorders, posttraumatic stress disorder in Vietnam Veterans and for pain distraction with pediatric cancer patients. He has talented graduate students who are committed to building computing systems that have a positive impact on society, he said.

For his team that means seeing if their virtual environments are helpful to clinicians and resolving the numerous technical issues that crop up.

“Building real systems causes us to address computing challenges in animation, geometric modeling, motion tracking, artificial intelligence, software engineering and real-time rendering.”

It’s all worth it, though.

“The continued decline in cost and increase in performance of computers, tablets, smart phones and interface

devices such as the Kinect is opening up vast opportunities for new clinical collaborations.”

Woodbury certainly is thrilled.

It enhances her ability to use her extensive stroke rehabilitation experience and is the culmination of a type of project she has always wanted to do. Her study pairs occupational therapy with use of the game and in three weeks, Pinckney just about doubled his movement range.

The majority of the 795,000 people annually affected by stroke cannot resume daily activities because of the impairment in their motor abilities in their upper extremities. Current neurorehabilitation occupational and physical therapy programs incorporate intensive, repetitive practice of meaningful tasks to improve this movement and function.

Task-practice interventions are based on contemporary neuroscientific studies showing that high-dose repetitive practice of the tasks of reaching, grasping and manipulation tasks improves the excitability of the damaged cortex and can improve recovery.

Unfortunately, it is estimated that only about 25 percent of stroke survivors have enough function to do this type of therapy. Virtual reality can change that scenario.

She grins. Plus, they get to punch ducks.

“They love it, and they think it’s fun.

It’s fun to do something they can’t do anymore.”

For more information: Visit SCresearch.org. to find out more about the study: A Virtual Reality Environment for Post-Stroke Upper Extremity Motor Rehabilitation.

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The CaTalysT, March 30, 2012 9

MUSC, AHA partner for National Walking Day Many MUSC employees will join the American Heart Association’s nationwide celebration April 4, taking 30 minutes to walk and pledge to live heart-healthy lives.

The celebration kicks off at 11:45 a.m. in the MUSC Horseshoe with opening remarks by MUSC President Ray Greenberg, M.D., Ph.D. Participants are asked to check in at the registration table or pre-register by emailing musc-empwell@musc.edu to receive a walking trail map and walk Susan Johnson the 1-mile trail in support of a healthy and active lifestyle.

Participants will be eligible for prizes in several categories, including most spirited walker and team walker spirit award. Departments are encouraged to

Health at work

ToBaCCo

walk as a group and consider making this a regular activity. Free water and apples will be available to walkers, along with information on fitness and nutrition. Vendors will also be on hand to provide a quick and healthy lunch after the walk.

Adults are spending more time at work than ever before and becoming more inactive. This is a problem when one considers the fact that physical inactivity doubles the risk of heart disease. American Heart Association’s National Walking Day seeks to raise awareness of the risks associated with a sedentary lifestyle by hosting the event.

Employee Wellness events q MUSC's Pitch the Pack Program: Free smoking cessation program offered to MUSC employees and students. Classes, counseling and a one-month supply of medications are available to eligible participants.

Continued from Page Three

the Corps of Cadets, Mills and other students choose to use smokeless tobacco to relax and destress. The cadet from Myrtle Beach said he had been dipping for the past five years and admitted that he had considered quitting as part of his New Year’s resolution.

Tulga asked participants to complete a consent and questionnaire that asked participants if they were smokers or users of smokeless tobacco, how often they had used these products and if they attempted to quit. During the noninvasive oral exams, she conducted a visual and finger check of participants’ mouths looking for suspicious lesions.

Tulga and Odom were looking for some wavy lines and suspicious wrinkles in the cadet-participant’s gum line.

Research shows that early detection and treatment of a precancerous lesion significantly decreases the likelihood that

the lesion will develop into cancer.

If something looked suspicious, both Tulga and Odom presented the patient with some American Cancer Society smokeless tobacco literature and other support materials. For participants identified with precancerous lesions, they were referred to their dentist for treatment.

The study revealed a lower incidence of precancerous lesions than the national average but a higher occurrence of multiple lesions for those who were affected. Results revealed almost no change in the severity of smokeless tobacco keratosis among Citadel cadets in the last decade.

On Feb. 26, the pair joined other dental students who presented their oral health research in the junior category of table clinics of the College of Dental Medicine’s Scholar’s Day activities.

Receive a complementary “success kit” with enrollment filled with gifts. Enroll online at http://ceii.muschealth. com/SCP/SCPRegistration.aspx. q Worksite Screening: There will be a worksite screening April 3 in Room 102, Colbert Educaiton Center & Library. 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 http://www. musc.edu/medcenter/health1st and click “Worksite Screening.” q MUSC Garden Project: Learn through working with the soil and seeds in the MUSC Urban Farm from noon to 1 p.m., April 4. To register, email muscempwell@musc.edu. There’s also an Afternoon Work & Learn from 4:30 to 6 p.m., April 4. The event is open to all MUSC employees, students and their families.

JOin ‘lighTen Up CharleSTOn’

Numerous MUSC employees celebrated the launch of Lighten Up Charleston March 26, a regionwide plan to shed 100,000 pound in 356 days. Participants can visit http://www.lightenupcharleston. com to find diet and workout programs. To work out with MUSC team members, contact Dr. Susan Johnson or Janis Newton for information. Dr. Patrick M. O'Neil, director of the MUSC Weight Management Center, is co-chair of the event and recommends teaming up with people for the best chance of success. From left are O’Neil; Dr. Janice Key, MUSC Adolescent Medicine Clinic; City of Charleston Mayor Joe Riley; Johnson and Newton.

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10 The CaTalysT, March 30, 2012

Ethic issues pose dilemmas for medical students

Editor's note: Chelsey Baldwin of Little River is a secondyear medical student. This column follows the journey of her class in becoming doctors.

“Are you going to let her starve to death?” our patient’s adult son questions us during a scenario constructed to test our ability to apply ethical theory to clinical settings. The harshness of the question induces a transient episode of blank stares and ruffled brows in our group classroom.

We progress to muddling over definitions of futility, best interests, Chelsey Baldwin positive and negative rights. We eventually decide that allowing the patient to die because of a lack of nutritional supplementation was an ethical course of action guided by the principle of medical futility. In this scenario, we discuss an 82-year-old woman with end stage dementia who is no longer able to take nutrition orally. Given the patient’s grim prognosis, we rationalized that there was no medical benefit to placing a percutaneous endoscopic gastrostomy (PEG) feeding tube, which would merely be a medical intervention applied to prolong the inevitable without the hope of improving the patient’s quality of life or chances of survival.

This decision is supported by the literature, yet despite this support net, how would we possibly convey this morbid conclusion with mortal implications to our patient’s son? Does our mastery of definitions and pockets full of literary support translate into promises

Medical musings

of genuine intentions for a grieving family member?

I had often wondered how a physician might come to be competent in such ethical matters and not surprisingly have come to discover that we take a course on this, too. As a part of the second year curriculum, we have been introduced to medical ethics, a course which will continue for the remainder of medical school.

The course aims to increase the medical student’s competency, not only regarding our moral duties to our patients, but also the legal restraints that may alter the way we practice medicine. In an attempt to obtain these goals, my teammates and I debate the correct course of action in practice scenarios.

As we move toward approaching the family with our medical conclusions, we aim to not only give them advice. We also want to incorporate family and those who feel they have a close relationship with the patient.

Integration of the family fits with the latest medical theories of patient- and family-centered care. According to the Institute for Patient And Family-Centered Care, “Patient and family-centered practitioners recognize the vital role that families play in ensuring the health and well-being of infants, children, adolescents, and family members of all ages. They acknowledge that emotional, social, and developmental support are integral components of health care.”

Our discussion leader asks the group, “how will you proceed when an agreement cannot be reached despite your best attempts at eliciting the family’s understanding of the situation and presenting them with needed information?” The answer is seemingly clear, since the law has set forth the order by which surrogates will resume the power of making decisions.

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Dean Continued from Page Six

However, this too can be muddied by our perception of the surrogate’s intentions. If the surrogate is not acting in the best interest of the patient, we are obligated to intervene. This creates yet another complicating layer as the group discusses the possibility of causing the patient more harm by informing them of the suspicious intentions on the part of the surrogate.

Our scenario is further complicated by the patient’s depleted financial support. We are then asked how this should shape our decisions about treatment. Our sole philosophy major spouts off theories pertaining to the allocation of resources for the greater good.

Even I, as a biology major, am not foreign to these theories of utilitarianism; however, the thought of them being applied at the bedside is cringe-worthy. These concepts demanding consciousness of the masses are overwhelming when staring into the face of a patient.

No, this is not our job, and we must grant ourselves leeway from such social burdens and be a doctor to our patient.

By the end of our student discussions, we have talked in circles and come to few, if any, solid conclusions. It is the journey through this process that our preceptor says is the most important. Dr. Joseph John, an internist at the veteran’s hospital and clinical professor of medicine and microbiology, is a physician well-seasoned in our ethical dilemmas. He assures us that the process has produced physicians before his eyes and guarantees that we too will follow in their footsteps.

While our minds swim in the sea of our future responsibilities to make the morally correct decisions, for now it is a relief to know the fallback answer remains: Answer Choice C. Consult the Ethics Board.

and minorities in leadership groups, committees and work panels.

“I’m a believer in the wisdom of crowds. It’s important that a variety of viewpoints are heard and that we hear from people who think differently – representing a diversity of generations, race, gender, background and specialty.

This is the key to making well-reasoned decisions.”

To maintain an academic career pipeline for women and minorities in her college, faculty are encouraged to attend professional development conferences, participate in the Executive Leadership in Academic Medicine program or attend Association of American Medical Colleges workshops and meetings.

In the 21 months she has been dean,

Pisano and her team have achieved many accomplishments. She and her staff have recruited more than a dozen department leaders, collaborated with a faculty-led committee to implement the college’s Research Strategic Plan and initiated the Clinical Enterprise Strategic Plan sponsored by the College of Medicine, MUSC Physicians and MUHA. She’s guiding faculty and staff in preparing for the medical school’s reaccreditation with the Liaison Committee on Medical Education scheduled for January 2013.

Pisano said she has learned the importance of striking a balance in her life and recognizing her limitations.

“It’s important to have strong support systems, both in your personal life and professional life. Reach out and learn from others. Have good mentors and be a mentor to other people.”

The CaTalysT, March 30, 2012 11

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12 The CaTalysT, March 30, 2012