MUSC Catalyst

April 27, 2012

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 30, No. 35

before you stArt PACking …

Inside Child Abuse Prevention

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Providing parents with the necessary tools to raise their children in a safe environment is the key.

tumor

AwAreness

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B Check out BPublicD Relations tips from I MUSC’s Travel Medicine experts y

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razell

f you happen to grab lunch with Joseph Cantey, M.D., or physician assistant Cameron Oswald, be sure to steer clear of certain subjects.

The infectious disease and travel medicine experts are loaded with information on how best to prepare for international travel, particularly to Third-World countries, so that you’re best protected. But, they also have the rare horror story.

Take the botfly, for example.

Fortunately, it’s very rare, but travelers in certain tropical regions sometimes become this insect’s victim. An egg-laden female botfly will capture a mosquito and glue her eggs onto the mosquito in hopes that the eggs will find their

way to a human host. When the mosquito bites a victim, the host’s body heat triggers an egg to hatch, fall off and burrow in. The larva secures itself and grows, forming a small mound beneath a person’s skin.

Oswald said it’s particularly unpleasant when the mounds start to move around. Fortunately, there’s a relatively simple cure of suffocating it and providing antibiotic treatment. Oswald has seen only one case in his clinic.

While treating illnesses acquired traveling is part of the job, a larger portion of the work of MUSC’s Travel Medicine clinic is dedicated to prevention. Given the growth in the field of travel medicine, it keeps health experts busy.

International tourist arrivals grew by more than 4 percent in 2011 to hit the 980 million

See Travel on page 8

Events held to raise research funding and awareness in brain tumors.

4 Epic update 5 Meet Antwan 11 Classifieds

t h e C AtA ly s t online http://www. musc.edu/ catalyst

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Ignoring child maltreatment doesn’t make it go away

By Gale horinBein Transplant Social Worker April’s observance of Child Abuse Prevention Month is an annual opportunity to highlight the role we play to prevent the abuse and neglect that is endangering children.

Child maltreatment is a significant and preventable public health problem in our country. Yet in 2010, the most recent year that national child maltreatment statistics are available, at least four children died every day and about 3.3 million reports were made to child protective services concerning the safety of about 5.9 million children.

That’s nearly six reports every minute.

An estimated 695,000 children were reported to be found victims of child abuse or neglect. Of these victims, 78.3 percent were neglected, more than 15 percent were physically abused, less than 10 percent were sexually abused and less than 10 percent were psychologically maltreated.

The number of reported fatalities due to child abuse and neglect has fluctuated during the past five years. Sadly, the highest rate of child maltreatment occurs to children under the age of 4. In addition, children younger than age 4 account for 80 percent of deaths and 47.7 percent of child fatalities were younger than one year. More than 30 percent of child fatalities were attributed exclusively to neglect and abusive head trauma or Shaken Baby Syndrome, which is the leading cause of death of physically abused children.

No group of children is immune.

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

Victimization was split between the sexes with boys accounting for 48.5 percent and girls accounting for 51.2 percent.

Eighty-eight percent of victims were comprised of three races or ethnicities: African-American (21.9 percent), Hispanic (21.4 percent) and White (44.8 percent).

At least four out of five victims are abused by at least one parent and no matter how fatal abuse occurs, one fact of concern is that the perpetrators are, by definition, the very individuals responsible for the care and supervision of their victims.

Experts believe many more cases go unreported and will never be brought to the attention of the state’s child protective agencies or law enforcement.

This is unfortunate since reporting abuse can help connect families with counseling and other services to relieve stress, which in turn can save a life.

For survivors, the impact of child maltreatment can be profound.

Research shows that a history of child abuse and neglect has been associated with increased risk of mental illness, substance abuse, developmental disabilities or learning problems, social problems, teen pregnancy, lack of success in school, alcohol or other drug use, domestic violence and chronic illnesses.

In addition to the impact on the child and family, child maltreatment exacts a financial burden to society.

According to a study funded by the Centers of Disease Control and Prevention, the total lifetime costs – health care, child welfare, criminal justice and the value of lost future productivity 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.

reporTinG aBuse If you suspect a child is being harmed within his or her home and resides in Charleston County, call the Department of Social Services 24-hour hotline at 953-9422. Your suspicion of child abuse or neglect is enough to make a report. You are not required to provide proof and South Carolina law protects people who make good faith reports of child abuse. and earnings – are $124 billion each year. These costs dwarf those spent on prevention by 400 to 1. Understanding this imbalance between what is invested on the front end to prevent abuse and neglect before it happens and what is spent as a consequence after it occurs is critical for our policymakers.

Although all the causes of child abuse and neglect are not known, research has identified many factors relating to the child, family, community and society that are associated with an increased risk of child abuse and neglect. Studies also have shown that when multiple risk factors are present, the risk is greater.

For example, young mothers and fathers unprepared for the responsibilities of raising a child, overwhelmed single parents with little support and families placed under stress by poverty, divorce or a child’s disability

can all lead to abusive or neglectful behavior. Some families are stressed by worries about foreclosure, employment, health, substance abuse, mental health, domestic violence or other problems.

Parents also may lack knowledge of the health, hygiene and nutritional needs of their children. These circumstances, combined with the inherent challenges of raising children, can result in otherwise well-intentioned parents causing their children harm or neglecting their needs.

One of the keys to prevent child abuse and neglect from happening is to provide parents with the necessary tools they need. Helping parents who might be struggling reduces the likelihood that their children will be abused or neglected. Prevention efforts build on family strengths. Through prevention activities, such as parent education, home visitation and support groups, families are able to find the support they need to stay together and care for their children in their homes and communities.

The cycle of child abuse can be prevented through early intervention, support and preventive services being provided to families. Until the value of prevention and investment of adequate resources to support prevention activities is recognized, child abuse and neglect will never be eradicated.

Free viewing of concert tells story of musician In 2011, Charleston-based singer and songwriter Mac Leaphart got a diagnosis no one wants. He had a plum-sized tumor in his brain and needed immediate and invasive surgery.

Fellow musicians and friends gathered to raise $10,000 for Leaphart given the financial strains of surgery and the need for him to take time off from touring.

Born of the experience came “Mac’n At The ‘Drome,” a documentary concert film based on the benefit concert held for Leaphart Jan. 28.

On April 29 the Charleston music community will come together for a free viewing of the film that features concert footage, interviews with participants and the telling of a story of

a blue-collar musician.

The event begins at 5:30 p.m. at the Cinebarre in Mount Pleasant with live music from some of the film’s cast as well as a few songs from the honoree.

Leaphart welcomes a chance to give back. “I have an opportunity to support neuroscience/brain tumor research and give back to the community that has been so generous to me. Who knew that a city known for its hospitality and warmth had one of the most innovative neurosciences departments in the country.”

The concert will be available for download April 30 at http://www. macleaphart.com/. All of the proceeds from the sale of the DVD will benefit MUSC Brain Tumor Research Fund.

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Alcohol: Weighing benefits, risks for a healthy life By raymonD F. anTon, m.D. Center for Drug and Alcohol Programs There is a growing concern about, and emphasis on, healthy lifestyles. Weighing the benefits and risks of alcohol consumption should find a place in every lifestyle assessment, a recommendation encouraged by the Center for Drug and Alcohol Programs.

Alcohol has been around for thousands of years.

The Bible makes frequent reference to wine being the centerpiece of many religious rites and rituals for ages.

Beer was the preferred safe beverage during the Middle Ages when water lacked purity and could cause disease.

In Western societies in general, and in the United States in particular, alcohol is part of the cultural fabric.

It is a social lubricant and enjoyed by many, with 90 percent of all Americans having had at least one alcohol drink in their lifetime.

Luckily, for those who are moderate social drinkers, men who drink less than 14 drinks a week and no more than two drinks a day, or those women drinking less than seven drinks per week or no more than one per day, alcohol has considerable health benefits. A standard drink is 1.5 oz. of liquor, 12 oz. of beer, or 5 oz. of wine. At these drinking levels, alcohol is known to reduce heart attacks, increase good cholesterol, have

ConTaCT inFo For information on MUSC’s Center for Drug and Alcohol Programs in the Department of Psychiatry and Behavioral Sciences, visit http:// clinicaldepartments.musc.edu/cdap or call 792-2727. a mild anti-clotting effect and might even reduce the risk of dementia. However, as drinks per day increase above these limits, there are increasing negative health consequences.

For instance, it is well documented that drinking more than two drinks per day for men and one for women will elevate blood pressure and at four to five drinks per day for men and three to four drinks for women, the odds of having high blood pressure are substantially increased. It is not widely appreciated that heavy alcohol consumption is the number one leading preventable cause of hypertension.

Many heavier drinkers take antihypertensive medications when a reduction of alcohol consumption might do just as well to lower blood pressure.

At these drinking levels there is a significantly increased risk of heart attack, stroke, and many forms of cancer. For instance, for women receiving hormone replacement and who drink seven to 14 drinks a week, the risk of developing breast cancer goes up tenfold.

For the 7 percent of Americans (14 million adults) who have genetic risk or stress-induced heavy alcohol consumption that leads to life problems (alcohol abuse or dependence) additional problems may occur. For instance, those who drink more than six drinks a day might have problems with memory, concentration and sleep. They accomplish less, might withdraw from social and family activities, and put themselves and others at risk from accidents, such as fires, auto accidents and falls. It is known that about half of all trauma admissions to hospitals involve heavy alcohol use.

The elderly, who already have reduced balance and coordination problems, are more sensitive to alcohol, leading to a higher risk for falls. Since heavy alcohol use can also lead to osteoporosis (softening of bones), the falls can easily cause broken hips, wrists, ribs and vertebrae, as well as head trauma – thereby creating a double health risk. Since alcohol can interact negatively with many medications, these risks are even higher in senior citizens since they are taking more and varied medications.

The good news is that treatments to assist individuals curtail, or stop, their alcohol use are available and new ones are being discovered more frequently at MUSC and at other major alcohol research centers in the country.

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Epic pilot clinics shed light to ease May 17 go-live T

he five MUSC ambulatory clinics did their due diligence in preparation for the March 22 Epic Pilot Go-Live.

Now, with “Big Bang Go-Live” just around the corner on May 17, seasoned pilot physicians tell their stories of what it has been like transitioning to the new electronic medical record – and they’re hoping their colleagues, who soon will be going through the same experience, will take some friendly advice.

According to the Epic leadership team the message from the clinics are clear: Epic is a powerful system with the capability to change what’s possible in health care for both patients and providers at MUSC. That said, pilot clinics have learned making Epic work in a clinical environment takes an abundance of focused advance preparation. They also know that implementation of Epic is only the beginning of a larger process meant to eventually enable providers to take advantage of its full potential and capabilities.

Pediatric cardiologist Mark Scheurer, M.D., is an Epic pilot physician and describes the system as a very good product. “It has the potential to work as well as I’d hoped, and better than some I have used before. The clinic support teams are helpful and implementation issues have been resolved in a timely manner.”

That report does not indicate that the system is neither completely intuitive nor problem free. Scheurer goes on to caution other clinics preparing to go live that, “planning and adapting clinic workflow to the Epic product is time well spent.” Beyond the challenges of implementation, Scheurer sees the potential of Epic.

“After better familiarizing myself with Epic workflow and documentation during go-live, it became clear that improvements in patient care and efficiency will come with optimizing Epic for specific areas and patient populations. It will be important to continue the

Important Epic Go-Live Dates Go-Live Training: April 9 – May 5 Personalization Labs: Late April, Early May (check CATTS) Go-Live for MUSC Ambulatory Clinics: May 17 current level of energy and technical support well into the months ahead during optimization.”

Andrew Savage, M.D., another pediatric cardiology pilot doctor, remarked on the system as being “phenomenally robust,” but is careful to mention that physicians should not expect to master Epic during the mandatory training sessions.

“Clinics need to be prepared for a learning process and that could take a year if not more. The investment in analyzing clinic workflow details prior to go-live is the most important and best use of time when getting ready to transition to Epic.” To Savage, that meant considering all the details surrounding the day-to-day running of a clinic – everything from how a patient gets admitted to how notes are sent to a referring physician.

Personalization labs have proven to be an effective way for doctors and their clinics to make Epic their own and have been unanimously recommended by physicians currently using Epic.

Rebecca Freeman, R.N., director of Epic training and chief nursing information officer, advises that setting up things like personal short cuts and “smart tools” are good examples of ways physicians can utilize the labs to decrease the amount of time they will spend documenting in Epic when they go live.

“Personalization labs allow end users to create Smart Tools, personalize their schedule, establish filters, and share their In Basket folders. Doing this work ahead of

musC CelebrAtes eArth dAy

time really allows users to hit the ground running on go-live day one,” Freeman said.

Another message from pilot clinics centers on in-clinic rehearsals with entire clinic teams. That means literally walking through an entire patient visit experience and considering every detail of what happens or could happen during a visit.

Michelle Hudspeth, M.D., a pilot physician in the pediatric hematology/oncology department, echoes the messages of her colleagues. “Abstract as much as you can before you go live because it will take longer than you expect. Get into the weeds when it comes to your clinic’s workflow and get those details down well ahead of go-live. This is especially important if you are a clinic that writes a lot of orders or are heavy on midlevel workflow.” Hudspeth also recommends training early and taking advantage of all training opportunities offered.

The Epic leadership team said users won’t be alone as they experience the growing pains of learning and customizing Epic in their clinics. The project’s credentialed trainers, technical support specialists and project management team are ready to help facilitate the transition and meet the needs of users as they arise before and during the implementation phases and into optimization. While it’s hard to find a pilot physician who doesn’t see the potential Epic holds to improve health care delivery, the overwhelmingly message seems to be that like most things in life, Epic is a system that gives back what is put into it.

Need to sign up for Big Bang Go-Live training?

Training sign up forms and schedules can be accessed online at the main MUSC Epic project website, http:// epic.musc.edu.

Epic support can be reached at epic@musc.edu or 792-EPIC (3742).

Charles Ryan, housekeeping supervisor, shows off the environmentally-friendly cleaning supplies that MUSC uses in cleaning April 12 at the Earth Day celebration. A variety of vendors attended the event with information ranging from how to compost to how to attract more birds to a yard.

This was the fourth annual celebration. For more information on MUSC’s green efforts, visit www.musc.edu/gogreen or go to Facebook at www.facebook.com/ MUSCgogreen.

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MeeT anTwan

Antwan D. Walters Department Interpreter Services & Cultural Competency How long at MUSC 2 months How are you changing what’s possible at MUSC I am the first in-house staff sign language interpreter in the department.

Dream job Owning your own business — you are the boss so you can set your own hours and give yourself a raise whenever you want.

Meal you love to cook Fried chicken smothered in gravy, mash potatoes, green beans and cheese biscuits Most embarrasing moment Losing my wedding ring nine days after my wedding (June 4, 2011) A must-have in the pantry I am a snacker so I have to have some type of junk food. My favorite is Doritos.

Dream vacation Long summer days, beautiful beaches and exotic animals. In one word — Costa Rica.

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Brain tumor awareness events offer fun options MUSC Brain Tumor Action Month will be held April 30 through May 18.

In honor of National Brain Tumor Awareness Month, these events are hosted by the MUSC Brain & Spine Tumor Program in an effort to educate the local community about brain tumors and increase research funding and awareness for brain tumors.

Included in the nine events planned will be a Brain Tumor Action Fair from 11 a.m. to 2 p.m., April 30 in the Horseshoe. It will feature food, informational displays and the band The 3 Dudes. Another major event will be a benefit concert and silent auction at 6:30 p.m. May 12 at the King Street Grille featuring multiple bands and musicians.

Tickets will be $10 in advance.

Other events will be educational lectures and an informational display table, a fair, vigil service and an awareness night at the Charleston RiverDogs baseball game.

The majority of these events are free and open to all. There also will

be T-shirts and tanks specially designed for this year that will be for sale.

The events are coordinated by Rachel Beard and facilitated by staff of the Neurosciences Department and community volunteers.

The idea for it first started when Pierre Giglio, M.D., approached Beard about having some educational materials during National Brain Tumor Awareness Month.

In the past five years, the event has grown from an informational table to a week-long celebration with nine events.

Last year, more than $10,000 raised went to MUSC Brain Tumor Research.

MUSC’s Brain & Spine Tumor Program is a multidisciplinary collaboration among neurosciences, radiation oncology, neuroimaging, neuropathology and Hollings Cancer Center.

To find out more, visit www.MUSC. edu/neurosciences/BTAM or contact Rachel Beard at beardr@musc.edu or 792-6592. illustration by Emma Vought, Neurosciences

InternatIonal Bazaar 2012

Musicians and dancers entertain the crowds April 19 in the Horseshoe during the 2012 MUSC International Bazaar.

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Travel Continued from Page One mark, according to the United Nations World Tourism Organization. With growth expected to continue in 2012, international tourist arrivals are on track to reach the milestone one billion mark later this year.

Cantey encourages travelers going to exotic locales to get appointments a couple of months before their trips.

MUSC travel medicine experts check immunizations and consult TRAVAX, an interactive website to which the department subscribes that provides the latest travel health information for health care professionals. There is an entry on TRAVAX for every country in the world, including details on general health risks, outbreak news, immunization recommendations, malaria prevention and other infection risks and the best places to go for medical services at the destination.

“We know what’s going on to the very last minute,” said Cantey. “We’ve been trained in all these diseases and infectious diseases.”

Although there are more travel medicine vaccination centers opening, Cantey said it’s important that patients seek out a center staffed by physicians with access to a subscription service such as TRAVAX. “It’s far more complicated than just giving vaccines.”

MUSC travel medicine experts examine patients and assess their current health status before making vaccination and other health recommendations. They also give patients packets of information based on the regions to which they are traveling as well as general

educational tips, such as remembering not to rinse toothbrushes with tap water for those traveling to places with unsafe water.

Oswald said travelers will be careful not to drink the water, but then eat something that’s been washed in it or rinse their toothbrushes just out of habit. They also may not know that dairy products such as cheese, yogurt, ice cream and milk may be unpasteurized in some areas. She does what she can to raise awareness so they can minimize their risks.

“People travel all the time without vaccines and malaria pills,” she said. “They’re taking a big risk. We want to make people more aware and minimize that risk.”

Sometimes the tips are as simple as clothing choice.

Cantey said tsetse flies prefer blue clothing, so they advise patients going to areas known to be a problem for that, such as Kenya, to wear light-colored clothing since insect repellants don’t work. Tsetse flies cause African trypanosomiasis or sleeping sickness. It is a tropical disease caused by a parasite that is transmitted to humans by an infected tsetse fly and can be fatal if not treated.

One of the most common problems is malaria, which they’ve seen in cases of returning travelers. This disease is caused by a parasitic microbe spread by mosquitoes.

Each year, malaria infects at least 300 million people living in tropical regions. It can cause brain damage or death if red blood cells infected with malaria parasites

Cameron Oswald, physician assistant, holds up the yellow vaccination card, approved by the World Health Organization, that she makes sure travelers keep up to date. build up in the brain’s blood vessels.

Also, parasitic worm diseases can be picked up by wading in certain waters, so they warn travelers what waters are known to be contaminated.

Travel can be a wonderful, fun adventure, especially if travelers get educated about the tricks of the travel medicine trade to protect their health. Oswald said she enjoys being a travel medicine specialist because generally patients are happy and excited to be going on fun trips.

“I live vicariously,” she said smiling. Cantey agreed.

Their goal for happy travelers: To keep them that way.

For more information, visit The Travel Clinic, at www.muschealth.com/travelclinic/.

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CLASSIFIED P AGE • Household Personal Items for MUSC employees are free.

All other classifieds are charged at rate below. Ads considered venture-making ads (puppy breeder, coffee business, home for sale, etc.) will be charged as PAID ADS •• PROOF OF ELIGIBILITY REQUIRED * NO MORE THAN 3 LINES * FREE ADS RUN 2 WEEKS ONLY!

PAID ADS are $3 per line ( 1 line = 35 characters) DEADLINE: TUESDAY – 10:00 AM * CLASSIFIED ADS CAN BE E-MAILED TO sales@moultrienews.com, OR MAILED (134 Columbus St., Charleston SC 29403) Please call 849-1778 with questions. *Must provide Badge No. and Department of Employment for employees and Student I.D. Number for MUSC Students.

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