September 20, 2013

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 32, No. 6

photos provided

Staff from the College of Health Professions place oyster shells in mesh bags at Fort Johnson Road, James Island. The bags will then be used to build community reefs along the coast of South Carolina.

Day of Caring in hearts of staff

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ourteen groups, totaling about 300 employees from MUSC, participated in Trident United Way’s Day of Caring, Sept. 13. According to Whitney McLuen, Office of Development employee campaign coordinator, this year’s Day of Caring has recruited the most number of MUSC volunteers. “These groups performed landscaping work, school playground improvements, food collection drives, school supply drives and more,” she said. The Day of Caring also kicks off MUSC’s annual campuswide Trident United Way Campaign. “Every employee is eligible for a matching gift. The gifts must be from $250 to $500,” McLuen said. To make a contribution, visit musc.edu/tuw or call 792-1973.

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Department of Psychiatry and Behavioral Sciences’ Bruce Cross and Mike McGinnis shovel soil into raised boxes. Right photo: Pharmacy Services’ Brian McKinzie works on the landscaping at St. Andrews Middle School.

Dental practice The MUSC Dental Faculty Practice has created a one-stop dentistry facility.

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Zombie Fright Night

2 LEAN for Life

Running scared during Boone Hall’s fall event will raise funds for MUSC Children’s Hospital.

5 Meet Marla

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

8 Honoring CDI specialists

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Student group promotes weight management interventions By ashley Barker Public Relations The MUSC student group “Improved Access to Weight Management” offers students from all six colleges the chance to learn evidence-based weight management interventions that they can provide to their future patients. The group, which began its second academic year in September, was started by the collective efforts of Rebecca Knackstedt, Tonya Turner and Josh Brown, Ph.D. Knackstedt, a graduate student pursuing an M.D., Ph.D., volunteered at the student-run CARES Clinic in Mount Pleasant two years ago and was a member of its board of directors. “I noticed that so many of the patients could have benefitted from a nutritional intervention because they were suffering from things like diabetes, hypertension, obesity and had no understanding of healthy ways to eat,” Knackstedt said. She tried to implement a series of nutrition classes using a curriculum developed at the Weight Management Center in the Department of Psychiatry and Behavioral Sciences, but the high turnover in patients and volunteers made it difficult. Brown, a psychologist and director of Clinical Services and Training at the MUSC Weight Management Center, along with Turner, a Weight Management Center registered dietitian, approached Knackstedt about creating a student group on campus to accomplish a two-fold mission. “Creating this student group has allowed us to work toward two very important missions: one, to better and experientially teach our future health care providers how to effectively treat one of the most prominent medical diseases they’ll face, and two, have these students go into the community and deliver an evidence-based obesity intervention to folks who

Editorial office 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 Ashley Barker, barkera@musc.edu

how to cover the class material arguably need it the most, but “Pretty much whatever for the actual community who can least afford it,” Brown participants,” Brown said. For said. specialty students go into, maximal student engagement, There is very little emphasis they’re going to be faced each group meeting is recorded on nutrition in medical school and posted in an online in particular, according to with people who need to classroom for students to review. Knackstedt. The nutritionStarting this year, participation focused information that learn about healthy in the group will count towards students receive comes in the eating.” fulfillment of the MUSC form of “Obesity Day,” which is Interprofessional Education a single-day of lectures devoted to Rebecca Knackstedt Fellowship requirements. obesity-related issues put on by Jake Bowers, who is also an the Weight Management Center M.D., Ph.D. student, said he joined the group because once a year for second-year students. he loves fitness and teaching.“This group appealed to “Pretty much whatever specialty students go into, me because it was a proactive solution to the health they’re going to be faced with people who need to dilemma of the poor demographic in our country,” he learn about eating healthy,” Knackstedt said. “Whether they’re in family practice or radiology, there are patients said. “I see a great deal of benefit coming not only to the individuals that participate in the class, but their who might require an intervention and doctors need families, friends, and I see the benefits spreading to to be empowered to talk to those patients about their our community in decreasing the burden on a strained diet and exercise, and have a foundation of knowledge health care system.” that they feel comfortable talking about it with their A total of 20 participants enrolled in the LEAN for patients.” Life program in April. At the conclusion of the 10-week Brown and Turner, the group’s supervisors, teach class there were nine who officially completed. They student members how to deliver a 10achieved an average weight loss of 4.2 percent. This is week weight loss class to community impressive weight loss from such a low-intensity and members who fall below a specific short program, and both the attrition and weight loss income level. The community class is are in line with the other 10-week weight loss programs named LEAN (Lifestyle + Education + provided by the MUSC Weight Management Center, Activity + Nutrition) for Life. according to Brown. “I really enjoyed working with the students. We “The group of participants we had were truly engaged were lucky to have an enthusiastic group that was truly into the program,” Turner said. “They were excited to interested in weight management and improving the attend the classes each Saturday to not only weigh in health of the participants involved in the program,” and see their progress but also to discuss and exchange Turner said. “I hope that the group will continue to strategies for successful lifestyle change with the leaders grow in the upcoming year.” and other participants. It was a great experience to see a The MUSC student group meets once a week, and such a diverse group of people support one another.” Brown and Turner use observational learning to teach Anyone interested in taking a LEAN for Life class students the material for the upcoming week. “By teaching the students as though we were teaching may call 792-5577 or email WMC@musc.edu. MUSC students should email browjosh@musc.edu. the actual weight loss class, they’re able to see firsthand

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.

Time to renew decal, hang tags at parking management Renewal of annual employee parking decals and hang tags will continue until Sept. 30. This renewal and re-registration applies to the following groups: Hagood Commuter Park-and-Ride system; after-hour employee-parking program; ungated MUSC monthly-contract parking locations listed below: All F-lots; Anderson Property (GG); H; 59 Bee St. (JJ); 55 Bee St. (RR); S; V; and X. To renew hang tags and decals, visit

academicdepartments.musc.edu/ vpfa/operations/Parking/Annual%20 Renewal.pdf. For information or to receive a 2014 hang tag or decal, visit parking management at 91 President St., second floor, from 8 a.m. to 5 p.m. Monday through Friday,. To speak to a customer service representative, call 792-3665, 792-0690 or 792-8245 or email parkit@ musc.edu.

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Teenager thrilled to get transplant ‘payback’ By Dawn Brazell Public Relations

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areedah Cue sits on the edge of her daughter’s hospital chair, unusually cheery as she describes the suffering she’s seen her daughter endure. “I always keep an optimistic attitude,” her mother said, putting her arm around her daughter. “I always keep faith knowing that everything is going to be all right. I always told her that her healing was coming. It didn’t matter how God did it. Whether he did it by healing her kidney or by giving her someone else’s kidney – her healing was coming. And she’s got it,” she said, explaining the reason for her good spirits. It was time for the Cues, of Cheraw, to have a bit of good luck. First came the diagnosis at age 9 that her daughter, Amber, had lupus. It was a rollercoaster ride figuring out what was wrong with her and getting her the right treatment. They did well until September 2007, when Amber began swelling and had to be flown to MUSC. She was diagnosed with end stage renal failure and had to be placed on dialysis. Then in December, that same year, Amber began having difficulty breathing. Cue took her to the emergency room, and Amber had to be flown to Richland waTCh Memorial Hospital in a ViDeo Columbia. In flight, Amber went into cardiac arrest and had musc.edu/pr/ a mini-stroke, her mother said. newscenter/2013/ “Her blood pressure was sky ambercue.html high. She had to learn to walk and talk all over again. Prayer got me through it,” she said of the tedious and scary process of rehabilitation. It was one of the worst moments of her life. They have lived with dialysis ever since with Amber restricted by a dialysis schedule that has her chained to a machine for endless hours, not being able to go swimming or spend the night with friends. Both said it’s a hard life. “Finally, we decided it was time to stop carrying the machine with us everywhere we go,” Cue said. “We want to travel.” They decided to put Amber’s name on the waiting list for a kidney transplant about seven months ago. Fortunately, they didn’t have to wait long. On Aug. 16, Amber became the “payback” recipient of MUSC’s first living donor kidney chain. MUSC is one of 70 different centers that participate in the National Kidney Registry’s living donor kidney program, and it is the only transplant center in this state. Michael Denson, Ph.D., director of Marine

photos by Sarah Pack, Public Relations

Amber and mom, Fareedah Cue (left), share a happy moment after her transplant. Dr. Michael Denson donated a kidney April 3 to start a living donor chain, the first for MUSC that resulted in a payback kidney for Amber. Read his story on the MUSC News Center: www. musc.edu/pr/newscenter/2013/donorchain.html. Amber made a celebration poster for her transplant date so she can remember the day.

Resources Research Institute with the S.C. Department of Natural Resources, became MUSC’s first Good Samaritan donor April 3. He started the chain that led to Amber getting a payback kidney last month from a donor who was a police officer. Cue was amazed how well her daughter was doing. As they packed up on her release date Aug. 20, Amber began her negotiations. “Mom, I want to go swimming today,” she pleads. “No, it’s too soon, yet. We’re not taking any chances,” her mother is quick to reply. They will have to be careful for three months as her daughter heals, and they make sure the kidney is not rejected. Amber is enrolled in the Children and High PanelReactive Antibody (PRA) Program (CHIP), which helps

children who are unlikely to find a donor because they’ve developed immunological sensitivities making them likely to reject organs from most donors. As a registry-affiliated institution, MUSC is granted 50 CHIP slots and Cue’s kidney, which came from a police officer, is considered “payback” for Denson’s nondirected donation of April 3. Her surgeon, Prabhakar Baliga, M.D., said the living donor chains allow patients to overcome the barriers of blood type compatibility or HLA antibodies that make transplants difficult to find for such recipients. Living donor chains allow multiple recipients to be transplanted and is the maximum benefit that can be derived from a donated kidney. “So unlike in the past where only one patient got the benefit, in a chain on an average as many as half a dozen can get a successful high quality transplant.” Baliga said the MUSC Children’s Hospital places all of its children at high immunological risk on the exchange registry. “We felt that they should receive the maximum benefit of a living donor kidney,” he said. Kidneys transplanted from living donors are preferred because they last nearly twice as long as kidneys transplanted from deceased donors, according to data from the Scientific Registry of Transplant Recipients. Baliga said Amber’s procedure went extremely well. “She had immediate excellent graft function with her serum creatinine decreasing from 10 to 1.2 in less than 72 hours.” Cue, who now is home with her daughter, said they are thankful Amber has done so well. Cue said they weren’t aware of the living donor program until they came to MUSC. Many in her family who might have been matches have high blood pressure or other conditions and were not good candidates. Amber said it’s been a rough journey, but she’s glad she’s had the surgery. She’s eager to swim, travel and visit with friends without having to worry about bringing her machine. They plan to go to Myrtle Beach after she’s recovered sufficiently. Her mother smiles. “Then we’ll be ready to rock and roll. We plan to stay in a hotel with a heated pool,” she said. “She’s going to get in that pool.” They are thankful to all the donors in the chain who made it possible, but particularly Denson who started the chain and the police officer who was her direct donor. Amber nods, adding, “Thank you very much. I’m going to take good care of it.” Her mother echoes the sentiment. “I’m so thankful and blessed that he is such a Good Samaritan that he allowed my daughter to get his kidney and that it works perfectly and is going to continue to work perfectly, and we’re just so grateful for it,” Cue said.

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Meet Marla

Marla Martin College Pharmacy, a P1 student Pets I have a dog named Murphey. What music is in your player right now? Of Monsters and Men Unique talent I was a hula and Tahitian dancer. Meal you enjoy cooking I can’t cook, but I love to eat beef stew and rice. Most embarrassing moment My cap fell off at high school graduation. Favorite place in the world El Salvador A must-have in the freezer Ice cream Favorite radio station NPR Greatest moment in your life Being accepted at MUSC Best thing about living in Charleston There are so many outdoor activities and, of course, the beach.

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Faculty practice provides quality, one-stop dental care By CinDy aBole Public Relations

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hen it comes to finding a dental provider who provides one-stop, comprehensive dental care in an academic setting, MUSC employees, their families and others may look to the James B. Edwards College of Dental Medicine Dental Faculty Practice. Skilled in a variety of patient care, these dentists provide specialty and emergency care that includes check-ups and evaluations, cleanings, dental fillings, crowns, bridges, periodontal treatment, root canals, dentures (prosthodontics), dental implants, sealants, veneers, whitening, and treatment of disease and injury. Patrick Wamsley, university chief financial officer, and wife, Susan, along with their adult children, Katie and Ben, have been patients of the Dental Faculty Practice since moving to Charleston in 2002. The family members have been proactive with their oral health care needs through annual dental checkups, teeth cleanings, fillings and other specialized care, which included a broken tooth where they were treated with same-day accommodations. According to Wamsley, the faculty practice location is ideal. “We really like the fact that the Dental Faculty Practice is the place to come for state-of-the art dental procedures, which some may not be available to area dental practices for months or years. The new clinical facility has really enhanced this by providing services like digital radiography, impressions and patient records to CAD/CAM technology for dental restorations,” Wamsley said. Employee-patients Pamela and James Smith are new DFP patients. Pamela, who is a neonatal nurse in the MUSC Children’s Hospital, was recommended by one of the clinic’s hygienists. “We were unhappy with our general dentist and decided to try the Dental Faculty Practice. What we liked was the level of confidence, trust and dental expertise the dental specialists and practice staff provide. They’re convenient and fast, and the facilities are new and clean. Help is just a phone call away,” Pamela said. The DFP is one of three dental clinical settings available to patients at MUSC. The others include the Dental Student Clinic and the Graduate Residency Clinics. But the DFT provides specialized care in endodontics (root canals), periodontics (gum treatments), prosthodontics (crowns and bridges), oral surgery, oral pathology, orthodontics and pediatric dentistry. The practice is matched in expertise that includes highly trained dental professionals, hygienists, technicians and support staff. According to Mark Barry, DDS, professor and associate dean for clinical

photo by Anne Thompson, Digital Imaging

Prosthodontist Dr. Gabriel Ingraham is among a team of practicing and board-certified general dentists, specialists, hygienists and support staff at MUSC’s Dental Faculty Practice.

“Our goal is to provide evidence-based dentistry to the Tri-county community.” Dr. Mark Barry affairs in the dental college, the general dentists and specialists work side-by-side in the office setting, offering a seamless continuity of care for patients. “Our goal is to provide evidence-based dentistry to the Tri-county community. We’ve created a onestop dental practice for patients in an academic environment. We offer general and specialized dentistry using the latest diagnostic tools housed within a private practice-like environment,” Barry said. Some of the latest technology includes CAD/CAM dentistry, which uses advanced ceramics to match natural teeth for restorations and same-day permanent crowns reducing the need for temporary crowns. The DFP is located on the fifth floor of the James B. Edwards College of Dental Medicine Clinical Education Center, 29 Bee St. The clinic is open from 8 a.m. to 5 p.m., Mondays through Thursdays and 8 a.m. to noon, Fridays. A full-time dental faculty member is

Dental Plus open enrollment available The year 2014 is an open enrollment year for MUSC employees who wish to add or drop the Dental Plus insurance plan. The supplemental plan, effective Jan. 1, 2014, is available to an employee who registers during the October 2013 open enrollment period and keeps the Dental Plus program for two years until they are eligible to drop it again on the next odd October. For information, visit academicdepartments. musc.edu/hr/university/benefits/insurance/ ins_dental.htm. available on call for after-hours emergencies at 792-3444 (follow recorded instructions). Parking is located across the street at the 30 Bee St. lot. The DFP welcomes and can file with all dental insurances. The practice is a fee-for-service dental practice with fees comparable to private dental practices in the Tri-county. Payment is expected for all services at the time services are rendered. To schedule an appointment, call 792-3444 or visit http://www.musc.edu/dfp.

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Zombie run fundraiser pulls out creatures’ good sides By Dawn Brazell Public Relations

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t may not seem like zombies and the MUSC Children’s Hospital have much in common, but for one day, Sept. 22, they will. A new addition to the traditional Boone Hall Fright Nights held each fall is a 5K Running Scared event that will benefit MUSC Children’s Hospital. The course will go through the zombie- infested woods of Boone Hall Plantation and end up in zombie town, a set designed to mimic the television shows of deserted towns left in the wake of zombie attacks. It’s all in good fun, said Trey Smith, owner of Dream Vision Entertainment productions, which handles waTCh Boone Hall Fright Nights a ViDeo every year. Smith was looking for a way to kick off the event Visit MUSC’s and decided the zombie run News Center to was perfect. When it came see a multimedia to picking a charity, MUSC package at http:// Children’s Hospital came right tinyurl.com/ to mind. mlucjjt. “The reason I and Boone Hall chose them is because of the incredible work they do here in Charleston. They’re local and do incredible stuff for the children. We thought this would be a great way to give back to the community and help with the work they do,” Smith said. Those who register for the run can be in one of three categories: a runner, a feasting zombie (who is hungry and tries to remove any of the three life flags hanging from a runner’s waist band) or part of the zombie horde (decoy zombies along the route who don’t pursue runners.) Runners will face obstacles and other challenges as they flee the attacking zombies while attempting to successfully cross the finish line and then to join in on the Ultimate Zombie Bash Party. Smith said runners who are used to setting a pace and sticking with it will find this Smith run, which isn’t timed, to be a different kind of workout. The goal is to make it to the finish line without being infected, in other words, without having all your flags taken. To do the event, Smith and his wife, Traci, had to be good at putting on zombie makeup and coaching zombie acting, including how to do zombie running, a little trickier to do with stiff, ‘rotting’ limbs. The

photos by Sarah Pack, Public Relations

Tracie Smith, of Dream Vision Entertainment, applies zombie makeup to Casey Lever. Check out her makeup magic in the video on the MUSC News Center.

Zombies will be roaming the grounds of Boone Hall Plantation and Zombie Town Sept. 22 for the Running Scared 5K that will kick off Boone Hall Fright Nights. accompanying video features some of their tips on how to quickly but effectively create a zombie look. Smith said they had to get quick about it because of the number of zombies they have to get into costume.

Smith gives a quick tour of the zombie town they’ve created, complete with jump-out zombies and desolate storefronts. One of their costuming tips that aspiring zombie wannabes seem to love: Mix Hershey’s chocolate syrup with red food coloring or yogurt with green food coloring, take a big mouth full and spew it down your clothing. Smith smiles. It’s the small touches that make for great special effects. He said, “I enjoy the creativity of it. We keep the theatrics as real as we can.” The Running Scared 5K will be held from noon to 6 p.m. and the Zombie Bash from noon to 8 p.m. on Sept. 22 at Boone Hall Plantation. For more information about the run, visit boonehallfrightnights. com/zombie_run_2013.php. If you can’t participate in the run, but would like to donate to the MUSC Children’s Hospital, visit The MUSC Children’s Hospital Fund website at musckids. org/giving/childrenshospitalfund/donate.htm.

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CDI specialists ensure accurate medical records Registered nurse and CDI specialist Tina Smith, third from left, round with, Drs. Savanna, Dincman, from left, Lisa Hunt, Jennifer Jaroscak Andrea Whitfield and Becky Cafiero. MUSC currently has 12 CDI specialists.

By karen BriDgeman, r.n., CCDs Clinical Documentation Integrity What is a Clinical Documentation Integrity specialist? A CDI specialist reviews the medical record for incomplete, ambiguous or conflicting information. Their role is to help ensure that the medical record accurately captures the patient’s condition, ensuring that the severity of illness and risk of mortality is measures are maximized for the patient. When documentation in the medical record is incomplete, ambiguous or conflicting, the CDI specialist must seek clarification by asking the medical team to provide clarification. The CDI specialist is the liaison between the medical staff and the coding department, as they strive to have the most accurate and complete medical record available for coding. They must abide by the coding and reporting regulations set forth by the Centers for Medicare & Medicaid and the National Center for Health Statistics using the International Classification of Diseases, ninth revision. Who are CDI specialists? An important characteristic for a specialist is to possess a strong clinical background with the ability to critically think, as the specialist needs to recognize treatments and documentation that are not clearly documented in the medical record. MUSC began its CDI program in 2005 with two nurses. The specialist initially reviewed only the Medicare population with an emphasis on reimbursement. The program expanded in 2007 and has grown to 12 CDI registered nurses. There are nine CDI nurses who do concurrent reviews, physician education and rounding with the medical team, along with two CDI nurses who review records after discharge for unanswered queries and coding discrepancies. The reviews have expanded to include a large percentage of the MUSC patient population. In 2009, the emphasis shifted from reimbursement to quality. This ensures that MUSC uses a severity of illness and risk of mortality measurements to provide greater detail of a patient’s health status. To reflect this change of focus, the MUSC CDI department changed its name from Clinical Documentation Improvement to Clinical Documentation Integrity. This change reflects the belief that documentation must uphold the standards for accuracy as well as veracity. The CDI program expanded further in 2012 by initiating the Pediatric CDI program, including the neonatal ICU and Level 2 nursery. The CDI specialists include Tina Smith, R.N., and Pam Parris, R.N., who both have been with the MUSC program from the beginning. Others include registered

photos provided

nurses Jackie Robinson, Randy Massingale, Cindy Kicklighter, Marsha Cisa, Marilyn Willis, Priscilla Browder, and CDI manager Sylvia Odom. The CDI staff serves on a variety of hospitalwide committees, including the Hospital CDI Committee, Pediatric CDI Committee, Clinical Integration Committee for ICD-10 (Physician Education), Hospital Forms Committee, and the EPIC build team. Why is the CDI specialist role emerging? According to the Association of Clinical Documentation Improvement Specialists, the growth of the CDI specialist profession has mirrored the health care industry’s increased focus on compliance with regulations, managed care profiles, payment for services rendered and liability exposure. All these factors are increasingly dependent on the integrity of complete and specific clinical documentation in the medical record. With the implementation of ICD-10 [a coding system change for medical diagnosis], set to begin Oct. 1, 2014, there will be additional documentation specificity that the CDI specialist will need to ensure is documented in the

See CDI on page 10

Registered nurse Jackie Robinson, CDI specialist, reviews a medical record.

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CDi

Continued from Page Eight

medical record. The current ICD-9-CM has 24,000 codes; whereas, ICD-10-CM/PCS has more than 150,000 codes. This will increase specificity and capture a more accurate picture of the patient’s condition and care. Capturing this data will accurately demonstrate disease trends, improve health care and assist in clinical research. The Certified Clinical Documentation Specialist credential has been created to recognize, support and identify a high level of experience as a mark of distinction of CDI specialists demonstrating proficiency and knowledge in clinical documentation improvement. Why is a week of national recognition needed? q To recognize the skills and expertise of Clinical Documentation Integrity specialists q To increase public awareness of the CDI profession q To positively affect the personal and organizational performance of CDI specialist q To provide broader education on the importance of the quality connection of documentation of care A work group supported by the Association of CDI Specialists declared that the Clinical Documentation Improvement Week will occur annually during the third week of September. This year, it is Sept. 15 - 21.

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Benefits fair to be held

Misc. Services

Furniture

Companion level of care needed for Elderly Female Patient w/ Alzheimer and Dementia. 2-3 nights per week, 7pm-7am, in Mt. Pleasant near Town Center. $10 per hour. References: 843-478-8569

King Size Plush Set New, will sacrifice for $200 843-501-3485 Bed-Queen Pillowtop that is Brand New in Plastic. Will take $150. Please call 843-270-4283

The university and medical center benefit offices will be holding the Annual Benefits Fair from 7:30 a.m. to 1:30 p.m. on Friday, Sept. 27 in the Colbert Education Center & Library Building and surround area. Benefits staff and representatives will be available to answer questions.

Thank a postdoctoral scholar this week In 2010, the U.S. Congress established the third week of September as National Postdoctoral Appreciation Week. Take a moment to let postdoctoral scholars and fellows know much they are appreciated.

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