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Saving Lives One Kidney at a Time Nearly 60 Years In, Dr. Robert Metzger Reflects on the Evolution of the AdventHealth Transplant Program 1

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CONTENTS 4

COVER STORY Saving Lives One Kidney at a Time: Nearly 60 Years In, Dr. Robert Metzger Reflects on the Evolution of the AdventHealth Transplant Program

PHYSICIAN SPOTLIGHT. Veronica Acosta, MD: New Home, New Role, New Hospital

EOCC. Recognizing Greatness Among Us

To Measure and Reduce Diagnostic Error, Start with the Data You Have

Working with Obsessive Compulsive Disorder in our Patients

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Saving Lives One Kidney at a Time: Nearly 60 Years In, Dr. Robert Metzger Reflects on the Evolution of the AdventHealth Transplant Program Nearly 60 years ago, Robert Metzger, MD, considered the Father of the AdventHealth Transplant Program, was a co-founder, developing the program at Florida Hospital. Through those years, critical advancements were made, and memorable surgeries have marked milestones in the program. Now, as Dr. Metzger begins retirement, he reflects, in his own words, on what was, and what he sees on the horizon for the next 1015 years.

Dr. Metzger celebrates the changing of the guard at his retirement party. Pictured left to right – the incoming OurLegacy Medical Director, Dr. Bobby Niphanupudy, Dr. Robert Metzger, and the OurLegacy Consulting Medical Director, Dr. Amay Parikh.

BY ROBERT METZGER, MD, NEPHROLOGIST

When I started my medical career in nephrology in the late 1960s, the best treatment we could offer patients with end-stage kidney disease was dialysis, a life-prolonging procedure that takes its toll on the body and can result in premature death. As luck would have it, the timing of my medical career coincided perfectly with the early days of kidney transplant exploration, which allowed me to grow as a physician right alongside these clinical advancements. I am honored to have played a role in establishing a program at one of the nation’s first community hospitals to offer kidney transplant surgery. This lifesaving procedure once required special approval by hospital administration, but is now a standard of care, and in 2020 alone, my colleagues and I at AdventHealth Orlando collectively performed 180 kidney transplants.

Dr. Robert Metzger studying in medical school with fellow classmates.

The Calling As a medical student at the Creighton University School of Medicine in Nebraska, I was assigned a 16-yearold patient who had rapidly developed kidney failure. One of the only kidney transplant surgeons at the time resided in Colorado, and we tried everything we could to transfer this patient to him, but ultimately weren’t successful. As I sat with this boy’s parents and watched him pass, I decided I was going to learn as much about kidney disease as I possibly could in an effort to prevent such heartbreaking loss.

teenage patient on dialysis in Orlando named Rochelle, and while he had some experience in nephrology, he wanted to learn more to better care for her. Soon after he completed the training, Dr. Fleming invited my family to spend the weekend with him and visit Walt Disney World, which had just opened. My wife and I fell in love with the area and decided to move to Orlando where I established my nephrology practice in 1972. I began taking consults at what is now AdventHealth Orlando and started a small dialysis unit where Dr. Fleming’s patient Rochelle, became one of my first patients. I also met Dr. Don Jablonski, a urologist who had recently moved to town after serving as a transplant surgeon in Michigan. Together, we learned that Rochelle had a brother who was willing to donate a kidney, and after tissue testing, we determined he was compatible. We approached Don Welch, the hospital’s administrator, who approved us to perform the hospital’s first kidney transplant in January 1973, which was successful and gave Rochelle a new lease on life. A few months later in July, the federal government launched the end-stage renal disease program under Medicare which helped increase access to life-saving kidney care for patients under age 65. Health care institu-

The AdventHealth Transplant Center — A Serendipitous Beginning After completing a kidney disease fellowship at the University of New Mexico, I entered the U.S. Air Force and started duty at Wilford Hall USAF Medical Center in San Antonio, Texas, which had one of the few kidney transplant programs in the country at that time. Two years later, I was honorably discharged and accepted a position at the University of Miami where a chance meeting eventually led me to AdventHealth Orlando’s first successful kidney transplant patient. Her name? Rochelle. While serving as director for a kidney dialysis physician training program, I met Dr. John Fleming, an internist from Florida Hospital (now AdventHealth). He had a

TransLife organ procurement coordinators with the first organ transportation vehicle.

tions that had performed a kidney transplant prior to this new legislation were automatically grandfathered in as a transplant center. We had already performed five at what would one day become AdventHealth Orlando, and thus AdventHealth’s kidney transplant program was officially born, becoming one of the first community hospitals in the country to offer this life-saving surgery.

The Growth of Kidney Transplantation In the 1980s and 1990s, numerous medical advancements helped improve the safety and effectiveness of kidney transplantation, including innovations in tissue typing, organ preservation and immunosuppressive drugs to decrease rejection. Another important development, and one I worked hard on, involved improving the organ procurement process. In the early days of kidney transplantation, one of our greatest challenges involved identifying and securing donor kidneys. As transplant physicians, we were typically responsible for finding organs on our own. I frequently

CONTINUED P.14 4

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New Home, New Role, New Hospital Veronica Acosta, MD the same hospitalists throughout their stay. “This continuity of care is proven to produce better outcomes for the patients,” said Acosta. This is Acosta’s first leadership role, and you can tell she loves it. “The people you work with are your colleagues,” she said. “So, leadership is about empowering them to be their own boss and to ensure they have the support they need. Brian Wetzel (Horizon West Hospital president) is focused on us supporting each other. Brian’s superpower is that he’s the nicest guy, ever.” That sense of collegiality is one of the defining characteristics of Horizon West Hospital, she said. We are a small hospital that is driven to serve our patients. Small it may be, but Horizon West Hospital is also growing fast, and it has the full support of the Orlando Health system, giving patients access to highly trained professionals and technology. Conceived more than 20 years ago, the idea behind the 40-acre Orlando Health Horizon West medical campus was to be prepared to grow along with this West Orange County community. Although the hospital has been open only one year, Acosta notes that “We’ve been saving lives in the community for four years.” It was 2018 when the Orlando Health Emergency Room and Medical Pavilion – Horizon West opened to the community. The 78,000-square-foot emergency department and medical pavilion features 24 patient beds plus an added six observation beds, while the medical pavilion supplied much-needed healthcare services, including primary care, family medicine, OB/GYN, general surgery, a diagnostics laboratory, orthopedics, neurology, urology, cardiology, a pharmacy, outpatient rehabilitation and a center for health improvement. Now, patients from the emergency department who need longer care can transfer seamlessly into Horizon West Hospital. In fact, about 90 percent of hospital ad-

Looking at the brief history of Orlando Health Horizon West Hospital through the eyes of Veronica Acosta, MD, gives you a sense of the pace of change in this part of Central Florida and of the growing need for high quality medical services. Acosta has led the internal medicine program at Horizon West since doors first opened a year ago. Members of her team are the hospitalists: the doctors who take charge of a patient’s overall care. Hospitalists fill a vital niche of modern medicine that many people outside of healthcare might not even be fully aware of. However, the specialty is now an essential part of treatment. “We are like the quarterback on a football team,” Acosta said. “We’re usually the first physician you see in the emergency department,” she said. “If you are so sick that you are going to spend the night – or longer – that’s what we are really good at.” The hospitalist becomes the patient’s primary care physician during their hospital stay. This physician develops an understanding of what the patient needs, and then coordinates the patient’s care among the various specialists and professionals. Most patients are in a hospital for less than a week, so most full-time hospitalists work a seven-day-on/sevenday-off schedule. This allows patients to be cared for by

missions come through the emergency department. “We treat an average of 30 patients per day,” said Acosta. “And I am really proud of the care they are receiving here. She then rattled off a list of key performance indicators to prove her point. “We had 2,000 admissions last year. Of those, 800 were for surgeries, and we had zero... that’s ZERO... hospital-acquired infections.” Later this spring, the hospital will add 30 more beds. Eventually the 214,000-square-foot hospital will have a capacity of 120 patient beds. The attitude among the professionals goes beyond key performance statistics, Acosta said. It includes seeing the whole person and not just the patient. This can manifest itself in unexpected ways. For example, staff makes sure that patients who want to on the third floor of Horizon West, can look out the windows at 9 p.m. and see the fireworks display at Walt Disney World. Acosta came to her profession after having begun her career as a chiropractor. “I like treating the patient as a whole,” she said. “And that’s what we were doing in chiropractic care. But I kept feeling that there was more that I could be doing, and that led me to become a medical doctor.” Like many of the people near Winter Garden and the Horizon West community, quality of life was a significant factor in Acosta’s decision to move from Chicago to Orlando. She and her three-year-old daughter Olympia are still getting to know the community. Olympia is a ‘total rascal’ who loves the weekend farmer’s market, her Barbie ‘motorcycle,’ and has just begun to take swimming lessons and is learning to play soccer. “Orlando Health has been so welcoming to me and my family,” Acosta said. “They really celebrate diversity and celebrate the whole family. And that shows in how we care for our patients.”

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TUESDAY, FEB 8 | 12:30 – 1:30 PM Goodfella’s Pizzeria, Italian Restaurant & Catering 11873 E Colonial Drive, Orlando, FL 32826

The Hybrid Member Academy: Roadmap to Member Success

WEDNESDAY, FEB 9 | 8:30 AM – 10:30 AM Hybrid Event - East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828

Quarterly Healthcare Council Collaborative Meet & Greet WEDNESDAY, FEB 10 | 7:30 – 9:00 AM Encore at Avalon Park Assisted Living 13798 Cygnus Drive, Orlando, FL 32828

EOCC Advocacy Advisory Council FRIDAY, FEB 11 | 10:00 – 11:00 AM Virtual Meeting. Register to participate

“No one can do everything, but everyone can do something” -Max Lucado Volunteers can be an important resource of many nonprofit organizations. The effectiveness of these “nonpaid staff” help to meet the needs of the organizations’ mission, goals and objectives in direct service delivery and indirect program support. As a 501 (c)(6), the East Orlando Chamber of Commerce values the contributions of the many members who commit their time, talent, and treasures to catapult this 75-year-old organization forward. In January we celebrated the installation by The Honorable Judge Eric DuBois, of our 2022 Board of Directors, representing the interests of the chamber’s stakeholders. Led by Martha Santoni (Nemours Children’s Hospital) these twenty-four community leaders are poised to take the East Orlando Chamber to the next level, meeting the needs of members and community. Joining Martha is her executive committee:

EOCC Real Estate Advisory Council Planning Meeting

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Members of the Board of Directors include:

TUESDAY, FEB 15 | 9:00 – 10:00 AM East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245. Orlando, FL 32828

WEDNESDAY, FEB 16 | 8:30 AM – 12:00 PM East Orlando Chamber office. 12301 Lake Underhill Rd., Ste. 245, Orlando, FL 32828.

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Karen Jensen (Orlando Health), Immediate Past Chair Eric Gray (Christian Service Center Central Florida), Vice Chair Barbara Bombalier (Welbro), Treasurer Jennifer Englert (The Orlando Law Group), Legal Counsel Don Whyte (Suburban Land Reserve | Deseret Ranches), Trustee Liaison

• Jessi Blakely (Tavistock Development Company) • Evelyn Cardenas, Ph.D., MBA, PMP (Central Florida Auto Dealers Association, Inc.) • Heather Frebe (Orlando VA Healthcare System) • Joseph Genovesi (Kolumi Corp.) • Dr. Cap Jadonath (Orange Technical College) • Christine Kefauver (Brightline) • Fred Kittinger, Jr. (University of Central Florida) Advocacy Advisory Co-Chair • Roger Lear (OrlandoJobs) • Erich S. Maschhoff (TD Bank) • Lora Miller (CHEP North America) • Graciela Noriega Jacoby (Heart of Florida United Way) • Sanjay Parekh (Amson Consulting) • Sabrina Persaud (Nadini Printing & Marketing), Ambassador Chair • Brenda Sanabria (Hampton Inn & Suites UCF) • Dena Sandy (Cubix, Inc), Realty Advisory Council Chair • La’Tonya Stark (Orlando Regional Realtor Association) • Chase Tikker (AdventHealth) • Ray Villegas (University of Central Florida)

During our annual installation luncheon, James Holmes, bestselling author of The Last Disciple series and Scare Squad series, a 22-volume series aimed at showing children the “real monsters” of the modern world, offered an inspirational message to guests. In addition to his eye-opening perspective on taking a leap of faith to

follow your dream, the East Orlando Chamber recognized exceptional contributions of Chamber members during 2021. Among our winners were: • Lora Miller with CHEP North America was recognized as our 2021 Board Member MVP for outstanding contributions, leadership, and commitment. • Olivia Barakat with Barakat Insurance was named 2021 Rising Star as a new chamber member who made their mark during their first year with the organization. • Our 2021 Ambassador Star Extraordinaire was Yesha Patel of Platinum Signs and Designs. Yesha has been a role model for engagement within the Chamber and in welcoming others into the organization. • With her trusty sidekick, #sillylittlellama, Amy Robl with Signarama North Orlando captured the 2021 Chamber Volunteer Award. • Open to hosting everything from Feast in the East, Buzz4Biz, After Hours, Ribbon Cuttings, Healthcare meet and greets and more, Avalon Park Group took the 2021 Most Engaged Member award easily. • The #EOCC is very appreciative of the continued partnership, support, and engagement of our 2021 Chamber Partner of the Year, John Kelly, and Orlando Medical News.

We would like to extend our sincere congratulations and appreciation to each for their dedication to the East Orlando Chamber. Cheers to many more years of continued engagement and partnership. Hungry for more? We have just what the doctor ordered with our upcoming Feast in the East “Mardi Gras” 2022. This Business Restaurant & Catering Showcase hosted by the Avalon Park Community Center Pavilion, 13401 Tanja King Blvd, Orlando, FL 32828, features the #EOCC’s finest including: Bonefish Grill Lake Underhill Cap’s Kitchen Creations Cheba Hut Goodfellas Pizzeria, Italian Restaurant and Catering Mejana Mediterranean Grille Metro Diner University Blvd.

match made in heaven are $35 for unlimited food and drinks starting at 4:30 PM. Grab your Bingo Card from sponsor MIDFLORIDA Credit Union, then mosey to the Wine Pull with Signarama for $10. Prizes will be given throughout the evening starting at 5:30 PM. Don’t miss your chance to win The Big Green Egg sponsored Premier Home Funding. Tickets will be available 1 for $5 or 5 for $20. A portion of the proceeds will support the East Orlando Chamber Foundation. Get your tickets today and make it a date night. Are you an East Orlando Chamber member restaurant? Sign up to be one of our featured feast beasts. For more information or to register call (407) 277-5951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4.

THURSDAY, FEB 24 | 12:00 – 1:00 PM

Feast in the East “Mardi Gras” 2022

THURSDAY, FEB 24 | 4:30 – 9:00 PM Avalon Park Community Center “The Pavilion” 13401 Tanja King Blvd, Orlando, FL 32828. $35 per person.

EOCC Advocacy Advisory Council FRIDAY, FEB 25 | 10:00 – 11:00 AM Virtual Meeting. Register to participate

Visit EOCC.org for a complete listing of February events

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To Measure and Reduce Diagnostic Error, Start with the Data You Have BY DAVID L. FELDMAN, MD

follow-up? What Dr. Singh’s team found is that each might think it’s the other. To address ambiguous responsibility, all organizations should create, formalize, and promote a crystal-clear policy regarding who is responsible for follow-up of abnormal test results and in what time frame.

As a patient safety problem, diagnostic error differs from wrong-site surgery or medication errors. While we have not yet eliminated these errors, we know that systems-safety interventions like checklists and time-outs make an impact. But in considering diagnostic errors—when we are often trying to get inside someone’s head to determine why they did or didn’t think a certain thing—it is a totally different proposition. Moreover, at times, we lack clear distinctions between true diagnostic error and the natural progression of a disease. We know that diagnostic errors occur across specialties and patient populations, but surprisingly, we see that common conditions are often missed. Progress has been made over the past decade, as shown by Hardeep Singh, MD, MPH, during his recent presentation for the Healthcare Risk Advisors (HRA) Virtual Conference Series. Dr. Singh, an expert in diagnostic safety for the VA Medical Center in Houston and a Professor of Medicine for Baylor College, says that healthcare is striding through the 2020s with its best tools yet to continue improving. To improve diagnostic safety, he recommends focusing not just on individual performance, but also on the performance of the system where clinicians practice. For example, an organization must first measure its current rate of diagnostic error—which is easier said than done.

Close the Calibration Gap with Feedback Calibration is the alignment between diagnostic accuracy and a physician’s confidence in that accuracy. For a vignette study,1 physicians were presented with sample cases, both relatively easy and hard to diagnose. Physicians were asked for their differential diagnoses and their confidence in their differential diagnoses. Before they rendered their final diagnosis for each case, physicians were asked if they had resource requests, such as wishing to consult a colleague, desk reference, or web-based tool. Dr. Singh and fellow researchers had hypothesized that when cases were more difficult, clinicians would seek more assistance, because they would be very uncertain—but that turned out not to be the case. For the easier-to-diagnose cases, physicians were right about 56 percent of the time, and fairly confident. But accuracy for the difficult cases was below 6 percent—with confidence almost unchanged. That’s the calibration gap—and it can be closed with feedback. Finding ways to close it will be crucial to our longterm efforts to improve diagnosis. At HRA, among other things, we are working with our emergency department (ED) collaborative on missed strokes. From a small review of 43 HRA cardiovascular diagnostic cases, we saw that 20 of those patients returned to an ED after their first presentation. Of those, 10 presented at a different ED, so the clinicians they first saw probably did not know those outcomes. Physicians, like all other professionals, need accurate and timely feedback to gauge performance. When patients simply go elsewhere, we lose valuable information.

Use Accessible Data to Measure Diagnostic Error For those planning to improve diagnostic safety in their own institutions, Dr. Singh suggests four potential sources of data: • Use the data that are already available. Adverse event reports, medical malpractice data, and patient complaints present learning opportunities. • Solicit reports from clinicians about diagnostic errors and near misses. Most reports come from nurses, pharmacists, and other allied health professionals. Many clinicians are reluctant to report. Find a way to invite their information that makes sense for your organization.

Make a System-Wide Effort Dr. Singh’s findings align with our claims experience at HRA and The Doctors Company. Roughly 20 percent of claims involve diagnostic error, and what we learn from such claims has implications for patient safety in all areas of ambulatory, inpatient, and ED care. Examining our medical malpractice claims through the lens of the diagnostic process of care framework created by CRICO, the risk management arm of the Harvard medical institutions, we see that care most often diverges from an optimal outcome early on, with an incomplete history or with a cognitive bias like anchoring or premature closure. To address these ongoing concerns, which affect clinicians and patients across the spectrum of care, we are engaging in a variety of efforts—from a new project looking at primary care, to partnering with national societies to improve diagnosis and prevent errors. In envisioning healthcare’s next decade, Dr. Singh sees many promising developments in diagnostic safety, but says we still have miles to go. As we implement new tools and best practices to foster learning and improvement, it’s time to make diagnostic safety not just an individual priority, but also an organizational priority. David L. Feldman, MD, MBA, FACS, is Chief Medical Officer of The Doctors Company and TDC Group; Senior Vice President, Healthcare Risk Advisors. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Choose a Resource We have more tools than ever before to help us improve diagnostic safety. To begin implementing them, start with any of the valuable, open-source resources below. • Agency for Healthcare Research and Quality (AHRQ): Operational Measurement of Diagnostic Safety: State of the Science

• Learn from patients. At many institutions, patient complaints are being gathered but not being harvested for signals for improvement. Meanwhile, researchers hear patients say things like, “I kept telling them about this specific concern, but they didn’t listen to me.” Whether it is a case of misaligned expectations or actual diagnostic error, every patient complaint is an opportunity to learn. Open notes could also be leveraged for improvement opportunities. • Make your EHR work for you. Your EHR can help you identify patients with diagnostic concerns by flagging records selectively with e-triggers. For instance, you might view only records that fit a certain clinical profile versus all records. Two examples include: (a) a lowrisk patient who is transferred to ICU or initiates a rapid response team within 15 days of admission, or (b) a patient who visits primary care, followed by an unplanned hospital admission within 14 days. These scenarios invite us to ask if there was a missed red flag.

• Institute for Healthcare Improvement (IHI): Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era • World Health Organization (WHO): Diagnostic Errors: Technical Series on Safer Primary Care • WHO: Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care

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Address Ambiguous Responsibility with Clear Policies In healthcare, and especially in any fragmented healthcare systems, the responsibility of who is doing what may not always be clear. Here is an example of ambiguous responsibility that Dr. Singh discussed: A primary care physician refers a patient to a pulmonologist. The pulmonologist orders a test that returns an abnormal finding. An EHR will alert both clinicians of that result, so who is responsible for

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Working with Obsessive Compulsive Disorder in our Patients BY MARY-CATHERINE SEGOTA, PSY.D

helped researchers identify specific areas of the brain that function differently in people with OCD. The research suggests symptoms may involve communication errors among different parts of the brain, including the orbitofrontal cortex, the anterior cingulate cortex, the striatum, the thalamus, and abnormalities in neurotransmitter systems. Environmental factors may trigger OCD symptoms, including TBI's, or post bacterial or viral infection in children (such as strep or flu), in those who are genetically predisposed, as well as the experience of chronic stress. According to the DSM, OCD is defined by the presence of Obsessions, Compulsions, or both. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress. Additionally, the individual attempts to ignore or suppress such thoughts, urges, or images or neutralize them with some thought or action (i.e., by performing a compulsion). Typical obsessions include contamination, disturbing sexual images, fear of yelling obscenities, concern with order and symmetry, intrusive thoughts of sounds, images, words, or numbers, and fear of losing or discarding something important. Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession. These actions aim to prevent or reduce distress or prevent some dreaded event or situation but are not connected in a realistic way with what they intend to neutralize or prevent or are excessive. Typical compulsions are excessive washing, repeated cleaning, ordering or arranging things, repeatedly checking locks, switches, or appliances, constantly seeking approval or reassurance, and repeated counting to a certain number. Further complicating the diagnostic picture is the presence of Co-existing disorders, as well as OCD related disorders including, Anxiety Disorders, Major Depressive Disorder, Bipolar Disorders, Attention-Deficit/Hyperactivity Disorder (AD/HD), Feeding/Eating Disorders, Autism Spectrum Disorder (ASD), and Tic Disorders/Tourette Syndrome (TS). According to the DSM V, OCD falls into a category with related disorders including: Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania (Hair-Pulling) Disorder, Excoriation (Skin-Picking) Disorder, and Other Specified Obsessive-Compulsive and Related Disorders, e.g., body-focused repetitive behavior disorder (such as nail-biting, lip biting, cheek chewing and obsessional jealousy).

According to the NIMH (2014), patients diagnosed with Obsessive Compulsive Disorder experience more physical ailments, including heart disease, blood pressure issues, migraines, respiratory disease, allergies, thyroid disease, and other conditions. Additionally, medical interventions can be less successful in this population due to high anxiety, distorted beliefs, obsessive rumination, and compulsive behaviors. People with OCD experience incredible pressure and exhaustion from the condition and have fewer coping skills to manage other aspects of life.

What is OCD? Memorable characters fill television and movie screens with comical symptoms that highlight many of the foundational characteristics of Obsessive Compulsive Disorder (OCD). But by taking a closer look, we can understand the difference between OCD and similar conditions. Melvin Udall from the movie As Good as it Gets demonstrates classic debilitating OCD. In comparison, Monica Geller from Friends reflects perfectionism, and Sheldon, from The Big Bang Theory, presents with Obsessive-Compulsive Personality Disorder (OCPD). A better understanding of which condition is present allows us to predict responses, treat the condition and improve our patients' quality of life. Many of your patients who struggle with managing anxiety may actually be dealing with OCD. The perfectionist often describes themselves as being OCD. Perfectionism is a component of OCD, but not all perfectionists have OCD. Both may enjoy cleaning, organization, and are highly detailed with tasks or daily routines. The difference between OCD and perfectionism is the anxiety associated with thoughts and behaviors. Anxiety is not necessarily present in someone who is perfectionistic but is always present for someone with OCD. Additionally, the level of impairment in daily functioning differs significantly. Another area where OCD is often confused is with Obsessive-Compulsive Personality Disorder. People with this disorder can be perfectionists, pay excessive attention to detail, have a poor work-life balance, be rigid, stubborn, and preoccupied with lists and tasks, and lose sight of the big picture. However, these are ingrained patterns that do not align with society's norms and cause interpersonal dysfunction, impulse control challenges, and cognition difficulties. An individual with OCPD experiences ego-syntonic thoughts and habits - meaning the person is not distressed by the distortion, doesn't think they are irrational or abnormal, and often likes the experience. The true OCD patient experiences ego-dystonic obsessive thoughts – meaning they are aware that their thoughts and actions are abnormal or irrational. These thoughts typically center around orderliness, cleanliness, symmetry, safety, doubting of one’s own thoughts and perceptions, and aggression or unwanted sexual ideas. These thoughts are difficult to stop or shift and are often associated with compulsions. Compulsions are acts one feels compelled to complete repeatedly to reduce anxiety or to manage the fear that something terrible will happen. OCD has neurological, genetic, behavioral, cognitive, and environmental factors. Everyone experiences intrusive, random, and strange thoughts. While most people can ignore these thoughts, individuals with OCD get stuck on them; the thoughts build up and become overwhelming and anxiety-producing. Neuroimaging has

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So how do we help our patients? You may see patients that can’t manage their anxiety around health fears or are stuck with obsessions and compulsions and notice that they struggle with their general wellness. They have greater difficulty with changing behavior, have exaggerated fears, are easily stressed and fail to comply with medical advice. When you see patients who report these symptoms, medication is often the first consideration. However, studies have indicated that Cognitive Behavioral Therapy (CBT) is the treatment of choice for OCD. Specifically, CBT that involves the use of two evidence-based techniques: Exposure and Response Prevention therapy (ERP) and Cognitive Therapy (CT). In more severe cases, CBT is utilized in conjunction with a medication regimen to better help patients. When medication is utilized, serotonin reuptake inhibitors have been shown to be the most effective. However, it is important for patients to be educated about the length of time to reach therapeutic doses of the medication which is typically 10 to 12 weeks. When serving patients, you suspect may have OCD, it is important to differentiate between perfectionistic behavior, personality disorder, and those behaviors that are distressing and impairing daily functioning. Most importantly, collaborating with a licensed mental health professional experienced in the treatment of OCD and related behaviors is key to addressing the complexities of the diagnosis and helping patients overcome these challenges and improve their quality of life. With a doctorate in clinical psychology and over 20 years of experience in the field, Dr. Mary-Catherine Segota has conducted university-based behavioral medicine research, acted as a consultant to professionals and organizations, and worked with a diverse number of psychological and medical conditions. By identifying unique needs, the source of distress, and what’s perpetuating the problem, she will help develop the tools to overcome seemingly insurmountable circumstances. Visit www.CounselingResourceServices.com

Why Early Childhood Education in these Unprecedented Times? BY JOANNA ANDERSEN

parents understand how vital it is for our littlest learners to have this experience. For an early childhood operator to achieve all of the above, it starts with finding the right candidate, the right teacher or educator who truly has the passion to educate. For without the right teacher in place, all the above, does not matter because families will not stay enrolled if they do not feel the “warm fuzzies,” as I like to call them. Having a positive high-quality educator can mean the difference between positive outcomes, and less advanced development. They become that active ingredient in driving development, as they form essential relationships to scaffold and build upon a child’s learning. Research has shown that consistent, positive childcare has even shown better cognitive function and language development across the first three years of life. Being an Early Childhood Educator in today’s modern world is not easy. From finding the right place to build, to the right curriculum to implement, not to mention meeting all the regulatory requirements, and finding qualified teachers that like being around children all day. Not an easy undertaking, however, that is what Early Childhood Educators do because at the end of the day we are not in it for the money. We are in it for the love of children and being a part of something bigger than us, making a difference in the life of a child, even if just one. Our world and environments are ever changing which requires Early Childhood Educators and Early Childhood companies to change and adapt with it or get left behind. For example, people may have concerns about opening a new preschool during a pandemic, why? The reason is simple, CHILDREN. They need this. Though some adults

I know that growing up there were no daycares, home daycares, or anything remotely resembling an early childhood preschool of today. It was your next-door neighbor who did the “babysitting” and plopped you in front of the television set watching cartoons like Bugs Bunny and The Road Runner. Or perhaps you might have been given some crayons and paper and told to simply color. But these days are long gone as research has given way to the importance of an Early Childhood Education (ECE) and the role it plays in children’s development birth to five years old. We have learned that it’s during these early years that a child will develop 90 percent of their brain growth. If we do not help foster this development, which is more than just learning basic skills, it will be that much harder to learn later in life. Early Childhood Education focuses on so much more. Children exposed at an early age also learn cognitive and social-emotional skills, motivation, self-esteem, and critical thinking; all keys in developing healthy, happy, and successful adults. And isn’t this what we all want to see for our children and all young minds of the 21st century? Research continues to demonstrate that high quality ECE has the chance to close opportunity and wage gaps, and even result in lower crime rates. The long-term impact shows that ECE improves communities, physical health, economies, and overall quality of life. In fact, Early Childhood Education directly relates to a child’s pre-math, pre-writing and pre-literacy skills, affecting school readiness and executive functioning that prove vital to cultivating a strong, innovative work force that can contribute to a successful global economy. In today’s current economy, jobs in the fields of science, technology, engineering, and math (STEM) are more prevalent than ever before and play a powerful role as we move into the future. So, early childhood centers that can incorporate STEM, or STEAM (adding the arts) into their curriculum, is crucial in shaping and giving way to a well-rounded young mind. Offering project-based learning models will also strengthen the child(rens) curiosity, encourage collaboration, and help build on critical thinking skills; all needed for STEM related jobs. This is a big draw for today’s families and has become one of the key ingredients for them to enroll in an early childhood center whose curriculum is embedded with STEAM, and whose atmosphere revolves around this concept. Parents see this as an added benefit that will hopefully inspire their child’s life-long learning and development. Getting an early start in learning is not the only reason why early childhood centers are so essential in our society today. These centers provide a safe environment for some of our most vulnerable children while parents head off to work. Sometimes the ECE center is also one of the only places where a child(ren) gets at least one healthy meal a day. And having a healthy meal is another crucial element in the child(ren)’s learning. ECE centers become that “home away from home” for a lot of children. It’s a place offering children and families a sense of tranquility and a sense of freedom to explore and learn. Without having a place to bring their child(ren), parents cannot return to the work force as their job may not offer or have a work from home option. Parents want their child(ren) to learn socialization skills, build those long-lasting friendships and have those ever-important routines that create a sense of security and stability in their child(ren) lives as well for the parents. Even during the most difficult of times,

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may argue they need it more. Parents want a caring environment where their child will thrive socially, academically, and emotionally. Nobody knows for sure what the future will look like. However, one thing is for sure, our leaders of tomorrow must be equipped with the knowledge and skills to navigate the future. And it starts with an Early Childhood Education. Amazing Explorers Academy wants to continue to be part of something extraordinary, changing the minds and lives of those 21st century learners. Educating them for tomorrow’s world and a future that has not yet been imagined. Joanna Andersen is the mother of a now 22-year-old son, who grew up in an early childhood center. She is the Director of Business Development and Human Resources for Amazing Explorers Academy and has over 17 years of experience in ECE; starting out as a two-year old teacher. Joanna worked varies positions within the preschool, and eventually became the director of two centers. She also worked for the Early Learning Coalition of Osceola County who handled all the State Funded programs for early childhood centers. She is passionate about her job and truly wants to make a difference. Email her at ja@aexplorers.com or visit www.aexplorers.com

Email Marketing Changes to Worry About in 2022 BY SCOTT RICHARDS

Once again, the internet and its associated technologies are changing in 2022. Email in 2022, for example, is seeing vast numbers of changes, mainly for security and spam purposes. These changes are accompanied with their own challenges to overcome for businesses, small and large. With laws against “spam” email and “illegal” email there seems to be a lot of confusion and misconceptions. Luckily, if you have a good sales and marketing team on your side, they can target specific people for specific reasons and with specific messages. It’s a tricky subject which we’ll explore throughout this article.

IP Reputation identifies how many people want to get your email based on your IP address. There are some red flags that internet service providers look for; content filters, such as a virus attached to an email. Your content reputation can also go down if your newsletters have low open rates or your readers flag them as inappropriate, block them or unsubscribe. So, making sure you’re crafting great content and sending them to appropriate addresses is crucial. Your sender reputation also comes into play. If you make sure to send great content, that your subscribers want, you should maintain a positive domain reputation. If you sender score sits at 90 or above, you’re considered to have an excellent sender score.

only IP address reputation declining, thus preventing you from sending email campaigns. Without a good IP reputation, your emailing efforts may be futile and remain undelivered. Another way to achieve the same goal is to use a shared IP pool. This is a prime option for small businesses that don’t have the high email volume necessary to get a good sender reputation score. Also, a shared IP pool can protect smaller senders from possible impacts of mistakes thanks to the high email volume shared in the pool. If you need further help with your email campaigns, read the blog that we wrote about running an email campaign here.

IP Rotation and Email In 2022

Scott Richards is CEO of Faceless Marketing. Faceless Marketing develops engaging websites that speak clearly and directly to your target audience. Our marketing experts work with businesses, large and small, to develop their customer base and number of subscribers. Reach out to Faceless Marketing for a quote or FREE consultation. Call 1-800-357-1299 or email info@ faceless.marketing and check out our YouTube channel for helpful videos. Scott can be emailed at scott@faceless.marketing or visit www.Faceless. Marketing

One work around for the issues we’ve discussed is by rotating your IP address. Most of these metrics are based on and tracked by your IP address. If you can “rotate” your IP address then you don’t run the risk of having your one and

Is Spam Legal Through Email In 2022? “Spam” is a solicitation that isn’t personalized. Usually it is used for pharmaceuticals, weight loss products, or investment opportunities. We’ve seen our fair share of these emails and we’re betting you have too. Thankfully, most of them are caught by spam filters and end up in spam folders. If an email is technically “spam” then it may still be technically “legal.” As of now, in the U.S., it is legal to send unsolicited commercial emails. However, you must comply with certain rules when sending those unsolicited emails. If not, the penalties for not following the rules can be very harsh. This was put into effect with the “CAN-SPAM Act” and they have some guidelines for you to follow to make sure you remain on the correct side of the guidelines. 1. Offer an option to “Opt-Out” 2. Make sure the “Opt-Out” is honored within 10 days. 3. Do not use misleading subject lines. 4. Just be yourself. 5. Make sure to include your companies address in the email.

Cold Email in 2022 What is cold emailing? Cold emailing is like cold calling. It’s when you send out unsolicited emails to, for lack of a better term, random email addresses in hopes of making a sale, conversion etc. Therefore, email services such as MailChimp have cracked down on what you are and aren’t allowed to send by using a “reputation score.” You can cut your risks down by utilizing a professional marketing firm to run your email campaigns. When it comes to emailing, reputation matters. If you’re using MailChimp for example, every account has a reputation. These reputations range from poor to excellent. If you’re sending cold emails, and you receive a high bounce rate or a lot of spam complaints, you could end up with a poor reputation. This is an extremely important aspect to consider, because if your reputational score falls too low then you may not be able to send emails at all. If you’re sharing an IP address with other departments of a company, you could also lower their score. You can learn more about your reputation score here.

Newsletters in 2022 The good thing about Newsletters is that you have a reason to send that group of people an email. They’ve subscribed to your newsletter. Newsletter sending reputation is comprised of complex metrics and they focus on different standings that decide the fate of your email deliverability to your clients’ email inboxes. 1. IP reputation 2. Content reputation 3. Domain reputation

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How Skipping the Design Phase Could Derail Your eLearning Project BY CHERYL POWELL, CEO OF LEARN2ENGAGE

Take a good look below at this word cube. What word is missing from this entire list of project planning terms?

Compare those rework hours, to the 10 or 15 hours it would have taken to create that Design Document and the difference is crystal clear. It’s simply not worth it to skip this phase. So, let’s talk about what goes into a design document. In the end, it should be your ‘shell’ for the entire course. Your go-to document when creating your storyboard, prototype, and modules. I’ve listed the sections to include in your design document above. As you can see, it is quite comprehensive, but will ultimately save you time, money, and many headaches later on in the project. Be sure to present your document in Word format and have the client use Track Changes to make edits and add

If you guessed ‘Design,’ you are correct! Most organizations tend to skip this phase due to time constraints, and sometimes because they believe it is optional. A luxury. A nice-to-have. “What could possibly go wrong?” they ask. Well, I have seen situations where this phase was skipped either in the Storyboarding phase or even the final stages of eLearning development. The client looks at the deliverable presented to them with a furrowed forehead and says, “This is not what I asked for?” No one wants to hear those words. Time to break out the Change Request document and start calculating those rework hours and costs. Ugh!

pertinent information. Afterward, have them sign off on the document to confirm agreement to the course design. With this as your ‘shell,’ you can feel more confident that each phase thereafter will match this design and give the client exactly what they want. In the end, your phased process for your eLearning project should look like this: Cheryl Powell is CEO of GC Learning Services, LLC, dba Learn2Engage, a virtual custom elearning and Training Development Solutions provider for businesses in Healthcare and Pharmaceuticals among others. Educate your employees, new hires, or even clients on a new policy/procedure, product/ service, or skill, with engaging, interactive, custom e-Learning modules with high retention rates. If you’re considering an eLearning project for your organization, give us a call toll-free for a FREE 30-minute consult at 1-888916-3918 or email at info@learn2engage.info or visit www.learn2engage.info

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How to Fail Forward to Early Retirement BY JACKIE JACKSON

“I have not failed. I've just found 10,000 ways that won't work.” -Thomas Edison I don’t know about you, but I think failure is amazing. Really, I do. In fact, I welcome it. Think about your own life. Do you regret any of the failures in your life? Maybe your knee-jerk reaction is to say: “Of course I regret my failure.” Failure is bad.” “I’m a failure,” or any number of negative affirmations around failure. If you beat yourself up about failure, you will just put yourself under mental torture. You will be so wrapped up in your self-imposed identity as a ‘failure,’ you will fail to see bad ideas coming from a mile away. In short, your ‘failure’ mindset will just leave you open to more failure! In short, it is not a winner’s mindset. So even if you have failed a million times in your life, you are not a failure! Don’t let failure define you. Anyone who is ‘successful,’ or done anything of note did not get things right the first time. They were not born ‘a success.’ They changed their fate with their own mindset and tenacity.

Change Your Perception of Failure Once and For All…

• That people who don’t fail are better than you, and most importantly: • People who fail lead poorer lives.

What Failure Means: • You tried something new; • You did something that few people are willing to; • You found something that doesn’t work; • You learned something; • You can use this failure to drive towards success, and most importantly: • Some of the most successful people in the world have failed more than most people ever will.

What is the Meaning of Failing Forward?

What Failure DOESN’T Mean: • That you are a failure; • You are a bad person; • You are lazy or unintelligent;

The book ‘Failing Forward: Turning Mistakes into Stepping Stones for Success,’ by John C. Maxwell, is full of mindset-shifting gold. Even the title tells what failing forward means - a stepping stone toward your goals! ‘In life, the question is not if you will have problems, but how you are going to deal with your problems. If the possibility of failure were erased, what would you attempt to achieve? ‘Achievers are given multiple reasons to believe they are failures. But in spite of that, they persevere. The average for entrepreneurs is 3.8 failures before they finally make it in business. ‘When achievers fail, they see it as a momentary event, not a lifelong epidemic. ‘Life is playing a poor hand well. The greatest battle you wage against failure occurs on the inside, not the outside. ‘The less you venture out, the greater your risk of failure. Ironically the more you risk failure — and actually fail — the greater your chances of success.’

Remove these thoughts from your mental vocabulary IMMEDIATELY. If you do find yourself experiencing a failure, don’t let a negative mindset take hold. One thing to know: we all have heard the phrase “actions speak louder than words,” but we don’t put it into practice with ourselves. Remember the Law of Attraction. If you go into the world every day defining yourself as someone who fails, that’s what people will perceive in you, too. You will be so preoccupied with your fear of failure. What’s Stopping You? Jackie Jackson is a Real Estate Expert & Tax Deed Investor. She Teaches How to Create Wealth With Real Estate. Jackie offers Virtual Courses, Webinars and Workshops. Sign up to our VIP Investors List at www.TheJackieJackson.com

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How Failure Can Fast-Track You to Retirement 5 Tips to Propel Yourself to Early Retirement: 1. Start Early 2. Have a Plan 3. Buy In to Your Hustle 4. Learn from Others’ Failure 5. Remember it is Possible Let me tell you a story: When I first entered the real estate industry, I joined a real estate investing association. I befriended a more senior investor who took me under his wing and offered me invaluable mentoring. You would think the best lessons I learned from him would be facts and figures like optimum cash reserves or how to conduct comparative market analysis. No. All of that can be learned from books and online courses anyway. My mentor helped me foster a winning mindset of an investor. One of the first things he said to me is that you need to be clear in your why. He was adamant he was going to retire before he was 40. That gave him less than 10 years to achieve that goal.

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20th Annual ‘State of Tobacco Control’ Report Reveals Florida Still Lags Behind on Policies to Reduce Tobacco Use • Level of Federal Tobacco Taxes (2022 grade – F) • Federal Mass Media Campaigns to Prevent and Reduce Tobacco Use (2022 grade – A)

New report reveals Florida tobacco control successes over past 20 years, and outlines path to end tobacco use and save lives

• Federal Minimum Age of Sale for Tobacco Products to 21 (2022 grade – I*) * The Incomplete grade is for the FDA being more than 18 months overdue in publishing the final Tobacco 21 regulations as required by statute.

If you or someone you love is struggling with tobacco or nicotine addiction, here are four steps and additional resources that can help.

The American Lung Association’s 20th annual “State of Tobacco Control” report reveals significant progress in the work to end tobacco use, but products like e-cigarettes and other flavored tobacco products, including menthol cigarettes, create concern for losing another generation to nicotine addiction. The report finds that Florida made no progress on passing policies to reduce and prevent tobacco use, including e-cigarettes. The “State of Tobacco Control” report evaluates state and federal policymakers on actions taken to eliminate tobacco use, the nation’s leading cause of preventable death. The report recommends proven-effective tobacco control laws and policies to save lives. The 2022 “State of Tobacco Control” reveals that the country has made substantial progress in advancing tobacco control policies over the past 20 years, including comprehensive smokefree laws in more states, increased tobacco taxes across the nation and more Americans with access to treatments to help them quit smoking through state Medicaid programs. Here in Florida in the last 20 years, lawmakers have made some strides to reduce tobacco use by continuing to fund the Tobacco Free Florida program and enacting the constitutional amendment to prohibit smoking in certain indoor workplaces, however, there is more work to be done. Many workers are still exposed to secondhand smoke with high rates of youth tobacco use statewide while restricting local governments authority to respond with local tobacco prevention and control laws. The smoking rate is 14.7 percent, and the high school tobacco use rate is 25.2 percent.

Agree on Smokefree Spaces While your partner or your housemates may continue to smoke, agreeing on some smokefree spaces where you are free of temptation is essential and all part of the compromise of shared housing situations. Establish certain spaces — your car, your bedroom and if possible certain shared spaces—as smokefree zones where your housemates respect your journey toward quitting smoking. Your housemates need to understand that you’re undertaking a personal journey and it has nothing to do with their behavior. By making this clear you’re ensuring that they don’t feel pressured to quit on your behalf and you’ll be more likely to have their support.

Get Ready to Go If you’re living with smokers, it’s sadly unavoidable that there will be times where you’re witnessing the very behavior you’re trying to cut out and the temptation

to partake might be rising. Preempt this temptation by having an exit strategy—a bag packed and an escape plan are essential. Whether that means going for a walk around the block, a long drive into the countryside or having alternative accommodation available for a night or two, if you’re serious about quitting smoking, you need to be ready to do what it takes.

Try to Distance Yourself from Other Smoker’s Environments If there’s temptation in the home, it’s all the more important that you try to avoid places where smokers are congregating in your daily life. Whether this is social gatherings or smoke breaks at work, you’ll need to distance yourself from smoke-filled places while you’re overcoming your addiction. Taking a temporary break from alcohol can provide a big benefit at this stage too. It’s incredibly easy to relapse into a cigarette after a drink and bar settings are often filled with temptation. You don’t have to quit forever, or to isolate yourself from your social networks, just take a short break.

Build a Non-Smoker’s Mindset Rather than thinking of yourself as a smoker who’s trying to quit, reconceptualizing yourself as a non-smoker can make a huge difference to your mindset around cigarette. As well as the physical and chemical elements of addiction, behavior and mindset play an important role.

ADDITIONAL RESOURCES For over 35 years, the American Lung Association has been helping people quit smoking through our Freedom From Smoking program as well as offering assistance through our online communities. E-cigarettes and Lung Health: Find answers to common questions about e-cigarettes, including health consequences, risks of secondhand emissions, kids and e-cigarettes and FDA oversight. Learn More The American Lung Association recognizes the need for lung health and smoking cessation programs for the

Florida’s Grades “State of Tobacco Control” 2022 grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives. Florida received the following grades: 1. Funding for State Tobacco Prevention Programs – Grade F 2. Strength of Smokefree Workplace Laws – Grade B 3. Level of State Tobacco Taxes – Grade F 4. Coverage and Access to Services to Quit Tobacco – Grade D 5. Ending the Sale of All Flavored Tobacco Products - Grade F This year’s report noted the need for Florida policymakers to focus on repealing the state laws that prevent local governments from passing stronger tobacco control laws. These types of laws are a favorite tactic of the tobacco industry and its allies as it denies local governments the ability to pass meaningful public policies to prevent and reduce tobacco use, including addressing the youth vaping epidemic.

Federal Grades Overview “State of Tobacco Control” 2022 also grades the federal government in five areas: • Federal Government Regulation of Tobacco Products (2022 grade – D) • Federal Coverage of Quit Smoking Treatments (2022 grade – D)

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business environment. To assist employers, we offer several programs for businesses and managed care providers. Contact us at 1-800-LUNGUSA (1-800-5864872) or WorkplaceWellness@Lung.org to learn how we can provide our gold standard tobacco cessation program, Freedom From Smoking®, to your business. Get involved with the Freedom From Smoking® program by either bringing it to your organization or becoming a trained Freedom From Smoking clinic facilitator.

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Saving Lives One Kidney at a Time

Nemours Children’s Health Welcomes Pediatric Urologist and Surgeon

made rounds in the intensive care units at nearby hospitals to let them know we were interested if they had someone who might be a donor candidate. Fortunately, the National Organ Transplant Act passed in 1984, which established the Organ Procurement and Transplant Network (OPTN). This new network began providing a national system for organ recovery and allocation, alleviating transplant physicians from this difficult task. The nonprofit United Network for Organ Sharing (UNOS) received the federal contract to operate OPTN and has maintained that responsibility ever since. In the mid-1980s, there were four Florida transplant centers located in Orlando, Tampa, Gainesville and Miami, and each center assumed counties of responsibility. I became the founding medical director of TransLife (now OurLegacy), Central Florida’s organ procurement organization assigned by OPTN/UNOS to recover organs from the hospitals in 10 counties of east Central Florida. This new system improved access, especially with deceased donor transplantation, enabling physicians to help more patients in-need. Despite the ever-increasing need for transplants, there were still a lot of kidneys discarded, and as a result, patients dying each day. I felt passionate about addressing issues and regulations related to organ procurement and allocation and became involved in both the Association of Organ Procurement Organizations (AOPO) and OPTN/UNOS, focusing on increasing organ donation nationally. In 2002, as chair of the organ availability committee of OPTN/UNOS, I led the establishment of the expanded criteria donor (ECD) allocation system that allowed us to procure kidneys for higher-risk patients who are lower on the transplant list from any donor over the age of 60, or a donor over the age of 50 with two of the following: a history of high blood pressure, a creatinine greater than or equal to 1.5, or death resulting from a stroke. This enabled us to salvage additional donor kidneys for patients who weren’t expected to live long enough to make it to the top of the list. Our data demonstrated that transplanting these patients provided extra years of life as well as a better quality of life than dialysis alone. In 2004, I was elected president of OPTN/UNOS and participated in the development of allocation policies for all organs. The Kidney Donor Profile Index (KDPI) eventually replaced ECD, which combines a variety of donor factors into a single number that summarizes the likelihood of graft failure after deceased donor kidney transplant. The KDPI indicates how long a deceased donor kidney is expected to function relative to all the kidneys recovered in the U.S. during the last year. Lower KDPI scores are associated with longer estimated function, while higher KDPI scores are associated with shorter estimated function.

Nemours Children’s Health has hired Abhishek Seth, MD, MS, FAAP, a board-certified pediatric urologist, to see patients at Nemours Children’s Hospital, Florida in Orlando. Dr. Seth has previously held positions as an attending surgeon in pediatric urology at Texas Children’s Hospital/ Baylor College of Medicine in Houston. “The urology division is excited to have Dr. Seth join the team,” said Pamela Ellsworth, MD, Division Chief of Urology at Nemours Children’s Hospital, Florida. “Dr. Seth will be the first basic science researcher in the division of urology and his research focuses on a common pediatric urologic problem, hypospadias [a congenital condition in males].” In addition to his scientific research, Dr. Seth will develop and oversee the multidisciplinary spina bifida clinic in conjunction with Sarah Villalpando, PA. Dr. Seth is a robotic trained surgeon and will work with Manuel Omar Cruz-Diaz, MD, who has pioneered the robotic program at Nemours Children’s Health, Orlando to provide minimally invasive options for pediatric patients, added Dr. Ellsworth. Dr. Seth attended University of British Columbia for Medical School and completed his residency in urology surgery there. Dr. Seth also did a fellowship in pediatric urology at Boston Children’s Hospital and Harvard Medical School. “The privilege to work with children and their families is what inspired me to choose this career path,” said Dr. Seth, whose brother is an ophthalmologist. A scientist surgeon conducting NIH funded research that examines the genetic causes of urological birth defects, Dr. Seth was awarded the annual research grant from the Society for Pediatric Urology in 2017. He was twice named a Rising Star in the Texas Super Doctor awards by Texas Monthly magazine. As a researcher, he obtained independent funding from the NICHD in 2020 to investigate the role of ubiquitination pathway in the development of lower genitourinary tract. Dr. Seth is board certified in both urology and pediatric urology by the American Board of Urology.

HCA Healthcare Announces Alex Romero as Chief Executive Officer of Poinciana Medical Center HCA Healthcare North Florida Division announced the appointment of Alejandro “Alex” Romero, as Chief Executive Officer of Poinciana Medical Center, effective March 7, 2022. In his new role, Romero will oversee the growing 76-bed hospital which has served Osceola and Polk counties for nearly 10 years. A native of El Paso, Texas, Romero has more than a decade of experience in healthcare administration. “Alex is a mission-driven leader who is dedicated to fostering clinical excellence and a culture of caring like family for our patients and colleagues,” said Richard Hammett, President, HCA Healthcare North Florida Division. “We are excited to have him join the dedicated team of professionals at Poinciana Medical Center.” Romero most recently served as Chief Operating Officer and Ethics and Compliance Officer at HCA Healthcare’s Methodist Hospital Metropolitan, a 378-bed facility in San Antonio, Texas. Prior to joining Metropolitan Hospital, Romero served as the Assistant Chief Operating Officer and Co-Ethics and Compliance Officer for Methodist Hospital and Methodist Children’s Hospital. He began his career with HCA in 2008 at the Del Sol Medical Center in his hometown of El Paso, where he was instrumental in growing the bariatric program to one of the largest in the entire HCA network of facilities.

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Through the subsequent years, I continued to work through UNOS to ensure that kidneys with a KDPI index of 85 percent or greater remain available to higher-risk patients who are lower on the transplant list.

Kidney Transplantation Today and in the Future Today, thanks to continuous innovation and improvement in our transplantation processes, more and more patients are able to receive the gift of life. Since 1988, more than 515,000 kidneys have been transplanted in the U.S., including over 28,500 in Florida and more than 4,000 at AdventHealth Orlando. In 2020 alone, AdventHealth Orlando performed 180 kidney transplants, even during the global pandemic. While these numbers are certainly impressive, the need remains great, and there is still work to do. Within the transplant community, our primary goal is to get the right organ to the right patient at the right time. A living donor kidney provides the best transplant option, as they yield better patient outcomes and typically function more effectively. On average, living donor kidneys function almost twice as long as kidneys from deceased donors. Because of this, more living organ donors are needed to increase access to transplantation. In addition, UNOS is leading an exciting new data-driven development called continuous distribution, in which several AdventHealth staff members are actively involved serving on UNOS committees that will review the implementation of the system. This process provides a more equitable and flexible approach to allocating organs, including kidneys, creating a better use of the limited supply of organs. Continuous distribution leverages big data analytics to consider multiple factors, instead of only evaluating limited categories, such as blood type and location. This new framework will help ensure that no single factor determines a patient’s priority on the waiting list. Furthermore, throughout my career, transplant researchers have been studying the feasibility of porcine (pig) kidney transplantation in humans, as this could significantly expand the availability of organs to meet growing patient need. While there are still significant hurdles and ethical concerns to address with porcine kidney transplantation, this could be an important step forward. As I retire and reflect on the last 60 years, I believe we are in the midst of another exciting era for transplant medicine, and I can’t wait to see where it will take us. I remain proud of all we have accomplished so far. However, my greatest reward will always be the individual patients I was privileged to serve and the renewed, better lives we were able to give them through the gift of transplantation.

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ORLANDO || GRAND ROUNDS cians (RBT), clinical psychologists, occupational therapists, speech language pathologists and other industry professionals. Positions are available to apply at hopebridge.com/jobs.

“I am honored to join the HCA Healthcare North Florida Division and become CEO of Poinciana Medical Center. I have heard wonderful stories of the caring team at Poinciana Medical Center; they have a true heart for serving the community within and outside the walls of our sites of care,” said Alex Romero, incoming Chief Executive Officer, Poinciana Medical Center. “I look forward to working with our team as we continue to adapt to the changing healthcare needs of our communities and continue our mission-driven approach to healthcare delivery. Above all else, we are committed to the care and improvement of human life.” Romero received his Bachelor of Science in Business Marketing from the University of Phoenix and a Master of Business Administration from the University of Texas at El Paso. He is also a member in the American College of Healthcare Executives.

Orlando Medical News Honored by East Orlando Chamber of Commerce The Orlando Medical News is proud to have been honored with the 2021 East Orlando Chamber of Commerce “Partner Award.” “I am humbled and need to recognize the OMN Team that made this possible: Pepper Jeter, Editor, Katy Barrett-Alley, Graphic Design, Jennifer Cerna, Social Media, Kyle Fleckenstein, North Florida Sales Mgr. They make the OMN GO!” said publisher John Kelly. The Orlando Medical News engages a Total Monthly Audience of 16,000-Plus Physicians & Healthcare Professionals 5 Times Monthly via Digital Media.

New Hopebridge Locations to Offer Autism Therapy Services to Children in Orlando Area

PSCF Encourages Vaccination and Reflection Given the Suspension of the Orange County Health Director The Physicians Society of Central Florida (PSCF) is calling upon public officials and the community at large to continue to encourage vaccination as the best defense for preventing severe illness and death from the COVID-19 virus. Furthermore, the organization urges reflection and deliberation on the potential perils of limiting the communication of scientifically supported medical advice by physicians given the suspension of the Orange County Health Director, only as it pertains to his encouragement of the Department of Health employees to receive COVID-19 vaccination. The PSCF reminds the community that vaccination against COVID-19 remains the most effective tool available for preventing severe illness and death from infection by the virus. Clinicians across our community have seen the toll of the virus on those unvaccinated given the vast majority of patients that are hospitalized and in our intensive care units are those that are not fully vaccinated. Furthermore, the organization strongly supports the independence of clinicians to offer sound medical advice based on current scientific literature without fear of repercussions. While we are certain the pandemic will end and our community will manage the lingering impacts of a COVID-19 endemic, future generations will be harmed greatly if physicians do not have the freedom to educate and counsel their patients and the public on the most effective, evidence-based ways to prevent disease and promote health. While we cannot comment on the specifics surrounding the ongoing investigation, we encourage the state to act swiftly to resolve the situation so the Health Department can continue their work in preparing and caring for our community.

As the prevalence of autism increases and the national focus is placed on early identification and intervention, Hopebridge Autism Therapy Centers is bringing its innovative mix of multidisciplinary services closer to home for Orlando’s children. One of the largest autism therapy providers in the nation, Hopebridge is bringing nearly two decades of knowledge, experience and care to the city beginning in March. The first two centers to open in the area will be in Mount Dora and Ocala. “Hopebridge’s mission is to increase access to care and improve quality of life for children and families living with autism,” said Taylor Thomas, Hopebridge Regional BCBA. “The new Orlando centers will do just that by bringing comprehensive autism care to children in underserved areas.” Orlando children living with autism will receive a wide range of benefits and services at Hopebridge, including: • Diagnostic and applied behavior analysis evaluations – Now Scheduling • State-of-the-art facilities designed specifically to enhance pediatric therapy for a spectrum of functioning levels • Centers with approximately 20 rooms designed to reduce distractions and enhance therapy sessions, including specific rooms to focus on integration into a school environment • Large gyms and playrooms to build gross and fine motor skills • Socialization with peers to target specific social and pragmatic goals • A full-service Care and Benefits team to help families navigate their insurance coverage options, including Medicaid • Parent training and education specifically designed to maximize the effects of therapy outside center walls • The Hopebridge centers will be located at: Mount Dora Hopebridge Autism Therapy Center: 6909 Old Hwy 441, #119, Mount Dora, FL 32757 • Ocala Hopebridge Autism Therapy Center: 3001 W Silver Springs Blvd., Building 200, Ocala, FL 34475

Orlando Health Cancer Institute Rolls Out New Tools in the Fight Against Prostate Cancer Oncologists at Orlando Health Cancer Institute are deploying two new tools in the fight against prostate cancer. The first, called prostate-specific membrane antigen (PSMA), is a new radioactive tracer drug designed to make locating lesions easier in advanced prostate cancer cases. The drug is injected into patients just prior to PET imaging and works by attaching itself to prostate cancer cells. The PET scan detects the high levels of PSMA, allowing oncologists to pinpoint exact locations of can-

The six new Orlando centers will create more than 275 new jobs in their communities to ensure every child receives one-on-one, personalized therapy. The coordinated, complementary teams will consist of top Board Certified Behavioral Analysts (BCBA), registered behavior techni-

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cerous lesions that may have metastasized throughout the pelvic region and other parts of body. “The current standard of care to detect advanced prostate cancer can often miss lesions that have spread beyond the prostate,” says Daniel Landau, MD, medical oncologist and hematologist at Orlando Health Cancer Institute. “PSMA PET imaging gives us the ability to catch those undetected lesions growing outside the prostate so that we can offer our patients the best treatment options and potentially improve outcomes.” PSMA PET imaging is recommended for patients initially diagnosed with prostate cancer that has a higher risk of spreading to other parts of the body and those who experience a recurrence of the disease after previous treatment with radiation or prostatectomy. In addition to PSMA, Orlando Health Cancer Institute is introducing stereotactic body radiation therapy (SBRT) as a new option for the treatment of prostate cancer. SBRT is an advanced form of radiation therapy utilizing much larger doses of radiation per day compared to conventional treatment, which can take up to nine weeks of daily treatment for prostate cancer. SBRT compresses that timeline to just five days, and when combined with a hydrogel spacer, like SpaceOAR, it can offer greater protection to the rectum from radiation injury. “We know that prostate cancer responds well to radiation treatment and now SBRT allows us to hone that technology to the point where we can offer patients a proven treatment in a shorter amount of time and without harming surrounding tissue,” says Akash Nanda, MD, director of urologic and hematologic radiation oncology at the Orlando Health Cancer Institute. “We’re very excited to add SBRT to the assortment of tools we have to treat prostate cancer at Orlando Health Cancer Institute.” Margo Shoup, MD, president of Orlando Health Cancer Institute, adds that “the expertise from Dr. Nanda in prostate radiation and Dr. Landau in urologic cancers along with PSMA, SBRT and many other advancements in oncologic medicine clearly set us apart as a leader in cancer treatment.”

NORTH CENTRAL FLORIDA || GRAND ROUNDS Additional Opportunity for Local Covid-19 Testing

vent serious illness or hospitalization from COVID.” The U.S. Centers for Disease Control and Prevention kept Marion County’s community transmission rating as “high,” defined as having more than 100 new cases per 100,000 people over the most recent seven-day reporting period and having a positivity rate of 10% or higher. From COVID-19 cases reported during the week of Jan. 21 to Jan. 27, Marion County saw: An average of 565 new cases per day 32.3% positivity rate A total of 510 people vaccinated

Ocala —The Florida Department of Health in Marion County announces an additional opportunity for local COVID-19 testing. Beginning Feb. 4, Statlab Mobile, a mobile clinical testing service, will offer free, drive-through testing at the campus of the former Evergreen Elementary School, 4000 W. Anthony Rd. in Ocala. Testing will occur 8 a.m. to 5 p.m., Fridays through Mondays, and will continue at the site until further notice. Testing will not be done at that location on Tuesdays, Wednesdays, or Thursdays. Statlab Mobile will offer a diagnostic PCR test with results available within 24 to 48 hours. The company will notify test recipients of their results via a text message and email. For more information about Statlab Mobile and its services, visit statlabmobile.com or call 1-844-4MY-LABS. COVID-19 testing by CovidTestFL.Org, a COVID-19 mobile clinical testing service, continues at the First Baptist Church of Ocala. CovidTestFL.Org offers free drive-through testing 8 a.m. to 4 p.m., Monday through Friday, and from 8 a.m. to noon on Saturdays at the church, 2801 SE Maricamp Rd. Call CovidTestFL.Org at 866-826-8430 for additional details about testing. CovidTestFL.Org offers a diagnostic PCR COVID-19 test that provides results within three days via a text message or an email containing a link to results on a web portal. Expedited test results are available for an additional fee. People who seek to be tested must enter the church parking lot entrance on SE 30th Ave. To be tested, individuals should bring a valid photo ID; minors under age 18 will only be tested if they are accompanied by a parent or legal guardian. People should be prepared to stay in their vehicles while awaiting testing. Additionally, testing can be done at private labs, physicians’ offices, pharmacies and walk-in clinics throughout Marion County. For more information, call the Department of Health in Marion County at 352-644-2590.

AdventHealth Opens Health Park in Clermont

By Jose Luis Dieppa CLERMONT — Residents of Clermont have a new option for specialty care with the opening of the AdventHealth Clermont health park. The state-of-the-art facility will provide a wide range of specialty services to Clermont and Lake County residents. “We are pleased to expand our care network to better serve Clermont and the surrounding South Lake County community,” said Kari Vargas, CEO of AdventHealth Winter Garden and the West Orange and South Lake market. “This growth demonstrates our commitment to provide convenient whole-person care in a setting that’s close to home.” Located right next to the AdventHealth Clermont ER near the intersection of State Road 50 and Citrus Tower Boulevard, the two-story, 36,000-square-foot Clermont health park includes a range of primary and specialty practices, including PrimaryCare+, diagnostic imaging, sports medicine and rehab, lab services, a sleep lab, cardiology, gastroenterology, urology/UroGYN, endocrinology and digestive care. These new services will meet a significant need in Clermont, which has seen a shortage of physicians in nearly every specialty. “We’re excited about the opening of the AdventHealth Clermont health park providing a new way to deliver care, which is designed around each guest’s needs,” said Jake McKelvy, vice president of retail services at AdventHealth. “With an emphasis on convenience and technology, our new health park is built to make accessing health care easy and friendly.” Patients will be able to go online to schedule appointments, complete registration and talk to their providers before they walk through the doors of the new facility. Upon arrival, an engagement specialist will greet patients by name and offer a personalized experience that is tailored to their needs. Additionally, there will be early, late and weekend appointments. AdventHealth opened its first health park, in Osceola County, in August 2020. Health parks are currently also under construction in Lake Mary and Port Orange.

Marion County Sees Drop in New COVID-19 Cases, Positivity Rate Ocala - The number of new COVID-19 cases in Marion County dropped significantly over the past week, according to the most recent state report, released Friday. The local positivity rate also dipped. Marion County reported 3,955 new cases for the week of Jan. 21 to Jan. 27. That was 741 fewer new cases than were reported last week. With this report, the number of new cases has fallen for two consecutive weeks. The county’s cumulative total of COVID-19 cases was 76,962 as of Jan. 27. The positivity rate for the past week declined to 32.3%. That was down slightly from the pandemic high of 33.3% recorded the previous week. Overall, the daily positivity rate for all new COVID-19 cases throughout Florida during the previous week was 23.5%. The state’s new report indicates 510 people in Marion County received vaccines between Jan. 21 and Jan. 27. That was a decrease of 134 vaccinations from the previous week. The ratio of Marion County residents aged 5 or older who have been vaccinated remained at 63% during the latest reporting period. “We are cautiously optimistic that this latest variant has peaked, as shown by the decline in new cases and the positivity rate,” said Department of Health in Marion County Administrator Mark Lander. “However, the transmission rate remains very high, and the decline in vaccinations is a cause for concern. We maintain our emphasis on protective measures, such as frequent hand-washing, staying home if you are sick, and considering getting a COVID vaccine if you have not gotten one, or getting a booster, if eligible. Vaccines remain the most effective tool to pre-

VOLUSIA/BREVARD OMNI Healthcare Announces New COVID 19 Treatment Recommendations MELBOURNE, FL – OMNI Healthcare has administered monoclonal antibody treatments (mAb) to more than 100 patients after receiving its weekly allocation. In response to updated recommendations from the National Institute of Health (NIH) Covid-19 Treatment Panel, OMNI will only be administering sotrovimab and rem-

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desivir to patients with mild to moderate symptoms of Covid-19 who are at high risk for hospitalization. OMNI will no longer be providing (bamlanivimab/etesevimab and casirivimab/imdevimab) as treatment for non-hospitalized patients with symptomatic Covid-19. While OMNI Healthcare will continue to administer sotrovimab, which is recommended by the NIH Covid-19 Treatment Panel, the healthcare group has exhausted its weekly allocation of sotrovimab. OMNI Healthcare Director of Operations Andrew Waterman says OMNI expects to receive additional sotrovimab next week. Due to the national shortage of sotrovimab, and new data regarding the severity of the Omicron variant, OMNI will be limiting eligibility to non-vaccinated patients who meet the CDC’s criteria. The demand to treat Covid positive patients outside a hospital is high and there are many people who meet the CDC’s criteria for receiving these treatments,” said OMNI Healthcare President and CEO Dr. Craig Deligdish. Dr. Deligdish has seen an overwhelming response from the public to OMNI’s new monoclonal antibody treatment clinics in recent days, “We’re happy to be able to provide some relief to patients who are suffering with this virus. In many cases, patients start to feel better the next day following treatment,” he added. The FDA has announced the approval the antiviral remdesivir (Veklury) which can administered to outpatients providing another therapeutic option during the Omicron surge. The drug has been approved for patients with mild to moderate COVID-19 who are at high risk of progressing to severe COVID-19. NIH’s COVID guidelines recommended a 3-day course of remdesivir as an option for the treatment of mild to severe Covid-19 based on data from the PINETREE study which demonstrated an 87% relative risk reduction in COVID-related hospitalizations with remdesivir OMNI will resume its monoclonal antibody (mAb) treatments at the following locations as soon as it receives additional sotrovimab and will begin administering remdesivir.

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VOLUSIA/BREVARD || GRAND ROUNDS disease: “The lithotripsy emitters at the end of the catheter create pressure waves that are intended to break up the calcification that is restricting blood flow in the vessels of the heart. This helps open the blood vessels when the balloon is inflated (angioplasty). After using the Shockwave system, the doctor will implant a different device called a stent, which is a metal tube that helps keep the vessel open.” More than 125 Floridians a day die of heart disease, making it the state’s leading cause of death. Nationally, more than 600,000 people die annually of heart disease[1]. As heart disease, specifically coronary calcification, progresses, plaque buildup on the arterial wall narrows and eventually restricts blood flow. IVL, as described, is a better way to bring a healing experience for cardiac patients. “Medical technology, once approved for use, is of value only to patients when they have access to it. We’re delighted at PMC to be the only hospital in Brevard presently making IVL treatment available to patients in need of this vital service,” said Dr. Mathews. Parrish’s first IVL treatment was performed in November by Dr. Mathews. IVL is PMC’s latest cardiovascular advancement offered as a part of the hospital’s cardiovascular patient care services. PMC was also the first to offer other cardiovascular advancements such as the world’s smallest pacemaker, the Micra AV. For more information visit parrishhealthcare.com/IVL. To schedule an appointment with Dr. Mathews, call 321383-7600.

1344 S. Apollo Blvd. Suite 303,Melbourne (321) 727-3495 9 a.m. to 4 p.m. 845 Century Medical Dr. , Suite B | Titusville (321) 529-6202 - 1 p.m. to 4 p.m. Anyone interested in receiving the treatments at OMNI will require evidence of a positive Covid-19 test result. Individuals must have symptoms and meet CDC criteria for administration of the monoclonal treatment. Interested individuals will be screened by phone to ensure they meet the criteria before appointments are scheduled. Monoclonal treatments are helpful for people who are at risk for serious Covid-19 infection and have tested positive for the virus. The mAb treatment can block the SARS-CoV-2 virus (the virus that causes COVID-19) from entering the body’s cells and limit the amount of the virus within your body. This may result in milder symptoms and may decrease the likelihood of a hospital stay.

Parrish Medical Group Welcomes Dr. Steven Holmes Parrish Medical Group is pleased to welcome occupational health physician Steven Holmes to the Brevard community. Dr. Holmes is now offering primary care and occupational health services at Parrish Healthcare Center at Port Canaveral, 390 Challenger Road, Cape Canaveral, FL 32920. Dr. Holmes earned his medical degree from Wayne State University School of Medicine in Detroit, Michigan. He was a recipient of a Health Professions scholarship from the United States Navy where he received training in General Surgery and Aerospace Medicine and practiced as a Flight Surgeon. Most recently, Dr. Holmes held the position of Medical Director of Ascension Medical Clinic in Ascension Parish, Louisiana. Dr. Holmes strives to provide the highest quality of health care services while promoting the wellbeing of workers, their families and the local community through preventative health measures. Dr. Holmes is a past-president of the Mid-South Occupations & Environmental Medical Association, a component society of the American College of Occupational and Environmental Medicine. He is also a member of the American College of Lifestyle Medicine and the Alpha Omega Alpha Honor Medical Society. Parrish Medical Group and Dr. Holmes are now accepting new patients. To schedule an appointment with Dr. Holmes, call 321-633-8640 or visit parrishhealthcare. com/Holmes.

Andrew Hayden, M.D. Joins Halifax Health | UF Health – Medical Center of Deltona Dr. Andrew Hayden is a board-certified orthopedic surgeon who will be joining fellow orthopedic surgeon Richard Rhodes at Halifax Health | UF Health – Medical Center of Deltona. He earned his medical degree at the University of South Florida before completing his orthopedic surgical residency at State University of New York (SUNY) Downstate Medical Center. Following his orthopedic residency, he pursued specialized training in sports medicine at Emory University. Dr. Hayden specializes in sports medicine and uses minimally invasive techniques to treat injuries and conditions of the knee, shoulder, hip and elbow. He is an expert shoulder and knee surgeon with specialty training in rotator cuff, labrum, ACL, meniscus and cartilage injuries. Dr. Hayden also offers minimally invasive joint replacement of the shoulder, knee and hip. Halifax Health partners with DME Academy to benefit student athletes local to Volusia County. Andrew Hayden, M.D., will provide orthopedic care to student athletes as a part of Halifax Health’s collaboration with DME.

Innovative Technology for the Treatment of Advanced Heart Disease Available Only at Parrish Medical Center

Rachel Cohen-Shohet, MD, joins UF Health Plastic Surgery and Aesthetics at Halifax Health

Advanced heart disease treatment that reduces the risk for heart attack and stroke while increasing patient safety and comfort is now available in Brevard County, exclusively at Parrish Medical Center (PMC). Shockwave Intravascular Lithotripsy (IVL), uses sonic pressure waves to break up arterial calcium deposits that cause atherosclerosis (hardening of the arteries), which decreases blood flow and can also lead to heart attacks and strokes. IVL was approved by the U.S. Food and Drug Administration (FDA) in Feb. 2021. “In our Cardiac Cath Lab, we are using IVL to treat complicated calcified coronary heart disease in a safer and easier way than ever before,” said Cath Lab Director and Chairman of Medicine Dr. Biju Mathews. “With this technology we are able to achieve better lasting results through better lesion preparation and a higher degree of stent expansion that reduces the need for future procedures,” says Dr. Mathews. The FDA describes how IVL is used to treat heart

Cohen-Shohet will be joining fellow plastic surgeon, Noah Prince, MD, at UF Health Plastic Surgery and Aesthetics located Halifax Health Medical Center in Daytona Beach. Cohen-Shohet graduated Summa Cum Laude with a degree in Biochemistry and a minor in Mathematics at the University of Florida. She went on to continue her education at UF Health, obtaining a Doctorate of Medicine and then completing her residency in Plastic and Reconstructive Surgery. While there, she was inducted into the AOA medical honors society and was selected for the Gold Humanism Honor Society. Cohen-Shohet then elected to pursue a fellow-

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ship in hand surgery at the Medical College of Wisconsin in Milwaukee, WI, where she received additional training in complex hand, wrist and peripheral nerve pathologies. Cohen-Shohet has authored many peer reviewed articles within the specialties of Plastic Surgery and Hand Surgery. She continues to present at national surgical society meetings. She has a special interest in oncologic reconstruction, extremity salvage and reconstruction, microsurgery, hand arthritis, peripheral nerve compression and aesthetic surgery. Cohen-Shohet’s most rewarding part of practice is to build a lasting relationship with the patient. Her primary goal is to achieve the highest level of results so that each patient may have an aesthetic and functional outcome. “I am very excited to be at UF Health Plastic Surgery and Aesthetics at Halifax Health and look forward to serving Volusia County and surrounding areas. As a plastic surgeon who specializes in reconstructive, hand and aesthetic procedures I’m excited to help my patients live a better quality of life. “ Cohen-Shohet said.

Gina Lawrence, RN Accepts New Role with Halifax Health – Center for Oncology as the Gastrointestinal Cancer Navigator Gina Lawrence, RN, has accepted a new role as the Gastrointestinal Cancer Navigator at Halifax Health – Center for Oncology. Gina began her nursing career with Halifax Health seven years ago and most recently worked as a nurse supervisor for the Clinical Decision Unit in the Emergency Department. As the Gastrointestinal Cancer Navigator, Gina is an advocate for patients newly diagnosed with GI cancers. As a navigator she will provide emotional support, education and act as a resource so that patients can make well-informed decisions regarding care options. The navigator serves as a point of contact to create a seamless approach to care, helps expedite scheduling appointments and collaborates with physicians and healthcare providers to provide real time answers to patient questions. These services are offered complimentary to patients of Halifax Health – Center for Oncology. Halifax Health is the only healthcare system that offers a Gastrointestinal Cancer Navigator in the Volusia County area. “A cancer diagnosis can leave you and your family feeling overwhelmed. We believe in taking care of the whole patient, providing emotional support and comfort from your initial diagnosis and throughout your cancer treatment,” said Julie Roth, Service Line Administrator with Halifax Health – Center for Oncology. Roth continued, “When your life has been touched by cancer, you deserve the very best care – from a first-class team of expert oncologists and a team of navigators to help support you every step of the way.” Halifax Health – Center for Oncology is accredited by the American College of Surgeons Commission on Cancer and offers a full-range of diagnostic testing, aggressive treatment, clinical trials and support to cancer patients and their families at locations in Daytona Beach, Ormond Beach, Port Orange and New Smyrna Beach. Our Navigator program includes a Breast Cancer Navigator, Gastrointestinal Navigator, Hereditary Risk and Genetic Navigator, Lung Cancer Navigator, Rehabilitation Oncology Navigator, Head and Neck Navigator and Survivorship Navigator. All navigator services are provided as a complimentary service. For more information on the programs and services offered by Halifax Health – Center for Oncology, call 386.425.4211 or visit halifaxhealth.org/cancercare