October/November 2023 Memphis Medical News

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October/November 2023 >> $5 ON ROUNDS

Flu, RSV, or COVID-19? Convergence of Three Viruses Creates Risk of Diagnostic Errors By DEBRA KANE HILL, MBA, RN

For This UTHSC Researcher, Effective Stroke Treatment is Personal A family history of strokes and the devastating toll exacted on his loved ones led Memphis professor and researcher Jianxiong Jiang to embark on a study to better understand one of the leading causes of death among adults. Jiang, associate professor in the Department of Pharmaceutical Sciences and the Department of Anatomy and Neurobiology at the University of Tennessee Health Science Center, recently received a grant of more than $1 million from a division of the National Institutes of Health to conduct a study on strokes.

As we transition into colder weather, it is possible that healthcare practitioners will again see a spike in influenza (flu), respiratory syncytial virus (RSV), and COVID-19 cases—particularly with the circulation of newer Omicron subvariants. Last year, RSV infection peaked unusually early, flooding primary care offices and hospital emergency departments while creating severe shortages of pediatric hospital beds. Public health officials declared the three viruses as a public health “triple threat” in 2022/2023, but this year we have reason for good news: Vaccines are now readily available for all three viruses—flu, RSV, and COVID-19. In 2023, the FDA approved RSV vaccines for adults ages 60 and over and pregnant women during weeks 32 through 36 gestational age, providing protection for infants from birth through six months of age.


Lindsey Blevins, CEO of Crestwyn Behavioral Health

AMA President Sounds Alarm on National Physician Shortage, Health System in Crisis

People are ending up in crisis situations due to a lack of early mental health care.

In a national address, American Medical Association President Jesse M. Ehrenfeld, MD, MPH, spotlighted the growing national physician shortage and corresponding health system in crisis.

Article on page 6


For unvaccinated patients manifesting illness, the bad news is that all three viruses have similar symptoms, and testing must be


Article on page 4

See more local news in Grand Rounds on page 7


performed for each to effectively confirm a correct diagnosis. Understanding the differences between the flu, RSV, and COVID-19 will help prevent misdiagnosis or delayed diagnosis when patients present with respiratory symptoms. The American Academy of Pediatrics offers information on differential diagnosis between the three viruses, and the CDC provides specific guidance on distinguishing between the flu and COVID. General information for practitioners about each virus is available from the CDC as follows: flu, RSV, and COVID-19. The CDC addresses signs and symptoms, incubation periods, length of time for spreading the viruses, how the viruses spread, individuals at higher risk for severe illness, potential complications, and approved treatments.

Lindsey Blevins

By BECKY GILLETTE Lindsey Blevins, LPC-MHSP-S, spent the early years of her career working with children in crisis in the juvenile justice and foster care systems. She provided the children with an assessment before being placed in a psychiatric hospital. A native of Wisconsin, Blevins earned her bachelor’s degree in Psychology and Human

Development from the University of WisconsinGreen Bay in 2005. She received a master’s degree from Concordia University Wisconsin in Counseling in 2009. After graduating, she was ready to leave the cold winters of Wisconsin behind and came to Memphis to work for Youth Villages. (CONTINUED ON PAGE 3)


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Lindsey Blevins, CEO, continued from page 1 During her time at Youth Villages, she spent time providing trauma therapy to children in foster care and residential treatment, completing crisis assessments, and several years managing the specialized crisis program for West Tennessee. Her work with Youth Villages required her to be on call 24 hours per day, which was difficult with two young children at home. So, in 2017, she started working at Lakeside Behavioral Health System, which operates the largest freestanding psychiatric hospital in the country. “They have 365 beds,” Blevins said. “I loved working there. I started in business development and community relations, working with schools, law enforcement, businesses, churches – really anyone needing education about mental health or substance abuse. I talked about how to gain access to treatment and how to help loved ones and co-workers manage whatever was going on. As I transitioned into this role, I felt my skills were having more impact by helping people help other people. It seemed like it was having more of a ripple effect. So, I really enjoyed that position and that role.” She transitioned from business development to administration becoming chief operating fficer of Lakeside. She worked there from 2017 until March of this year when she was chosen to become CEO for Crestwyn Behavioral Health in Memphis, an 80-bed acute psychiatric in-patient hospital for adults. Memphis, like most other areas of the country, is experiencing a shortage of mental healthcare professionals. Blevins said outpatient mental health is definitely struggling


with people encountering months-long wait lists to see a therapist and even longer to see a psychiatrist. “There is a massive shortage of psychiatrists in this area,” Blevins said. “Luckily, we do have some psychiatric mental health nurse practitioners, but the wait list to see psych NP is sometimes several months. Accessing outpatient services in general is a struggle, and that leads to an influx of people needing inpatient care. More people are ending up in a crisis situation because they can’t access care before it gets to the point they need hospitalization, which is really sad. That is where the need is coming from for our planned 48-bed expansion. We are about to break ground on that, and it should be done close to the end of 2024.” Blevins thrives on the challenge of managing 200 full- and part-time employees. “The workforce has changed a lot in the past three or four years with Covid,” Blevins said. “A lot of our direct care staff left during Covid. People’s mindsets have changed about working in healthcare. We are constantly hiring people and trying to keep people, and the other psychiatric hospitals are doing the same thing. You have to get creative about how you engage people and create a culture where people want to stay and work. We try to do fun activities to get people involved and feel like this can be a place where they want to work.” Part of the Crestwyn philosophy is making sure they are providing individualized patient care. Chronically mentally ill patients have been going through treatment for years. Those coming in for the first time, particularly working professionals with

medium to high economic status, hesitate to seek out treatment and are reluctant to participate with group therapy—which is a big part of inpatient and intensive outpatient therapy. “When people come in, they often don’t want to talk in a group,” Blevins said. “We really push them because once they do it, once they start sharing, and other people start sharing, it is a huge eye opener. You realize you are not the first person Crestwyn Behavioral Health is located in historic dealing with this. It is really Germantown district empowering for them to have that sense of community even if Crestwyn is a joint venture partner with it is short lived. You get strength from the Baptist Memorial Healthcare.” group. At times it can be more helpful than Blevins and her husband, Dustin, have individual therapy.” been married for 10 years, and have two Blevins said they are definitely seeing boys. Cooper, 9, and Carson, 7. They live an uptick in the use of fentanyl; there are out in the country on 27 acres and spend a a lot more accidental overdoses and deaths lot of time outdoors with their sons. because of it. “I have done a lot of research on screen “Fentanyl use also is often linked to time and how it affects youth mental health,” mental health issues, domestic violence and Blevins said. “Because of that, my kids don’t economic issues related to not being able to play video games. There are plenty of adults maintain a job,” she said. “It is very sad.” addicted to phones and social media. But Healthcare workers, first responders for kids, especially, too much screen time and others who work in high-stress jobs can definitely scares me.” sometimes turn to substance abuse for relief. Their sons love Legos, and the family It is important people find the more approrecently went to LegoLand in Florida. A priate coping skills that work for them. LegoLand trip to California is planned in “I think that is why education about the future. the resources for patients, their families “Most of our trips are family adventures,” she said. “My family is from and friends is so important,” she said. “We Wisconsin, so we go up there several times partner with local hospitals to educate them a year. They have a good time.” and their patients on the resources out there.


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For This UTHSC Researcher, Effective Stroke Treatment is Personal By JAMES DOWD A family history of strokes and the devastating toll exacted on his loved ones led Memphis professor and researcher Jianxiong Jiang to embark on a study to better understand one of the leading causes of death among adults. Jiang, associate professor in the Department of Pharmaceutical Sciences and the Department of Anatomy and Neurobiology at the University of Tennessee Health Science Center, recently received a grant of more than $1 million from a division of the National Institutes of Health to conduct a study on strokes. Along with Jiawang Liu, director of the Medicinal Chemistry core at UTHSC, Jiang aims to develop new ways to treat ischemic strokes. Offering expertise in stroke models is Thaddeus S. Nowak, professor in the Department of Neurology at UTHSC. “I have a history of strokes on my mother’s side and my father’s side, so it’s personal for me,” Jiang said. “That

was my initial motivation, and my major focus since coming to Memphis has been research on strokes.” The overwhelming majority – more than 85 percent – of acute stroke cases are ischemic strokes, Jiang said. Although treatments for ischemic strokes, which include intravenous thrombolytic therapy and mechanical thrombectomy, have improved over the years, risks remain. Treatments must be delivered relatively quickly and even when successful, some patients suffer permanent disabilities. “When I arrived in Memphis, I began collaborating with researchers to develop new treatments for stroke patients,” Jiang said. “I’m trying to use compounds that can help prevent poststroke cognitive decline like my father experienced after his stroke.” Originally from China, Jiang earned undergraduate and master’s degrees there before moving to the United States. He earned a PhD in cellular and molecular biosciences at Auburn University and completed

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Researching treatment options for stroke victims is a passion for Jianxiong Jiang.

six years of post-doc training in pharmacology and chemical biology at Emory University before accepting an academic position at the University of Cincinnati. He joined the faculty at UTHSC in 2018, focusing on neurological diseases. “I’m not a chemist, but chemical compounds are necessary for our research so I came here because there are a number of chemistry labs in my department that I can collaborate with,” Jiang said. “There are so many amazing things they’re doing with the development of drugs for treatment and it’s great to work with them.” Researching treatment options for stroke victims is a passion for Jiang. As a high schooler, his maternal grandmother suffered an acute stroke and was rushed to the hospital, where she died several hours later. Years later his father had a stroke and survived, but suffered effects of the condition for the rest of his life. “My grandmother died the same day she had a stroke and that was traumatic for our family. My father didn’t die when he had a stroke, but his personality completely changed,” Jiang said. “He had memory and cognition issues, developed dementia and eventually died due to post-stroke complications.” As researchers continue to work on new treatments, Jiang urges anyone who may have experienced even mild stroke warning signs to visit a health care professional immediately. Even with new treatments, time is of the essence. “My father had some very mild stroke symptoms like confusion, but he did not take it seriously at first and by the time he went to a doctor, his

condition had gotten much worse,” Jiang said. “I’m a researcher, not a doctor, but I want to encourage anyone who exhibits stroke symptoms to go to a hospital and be checked out as soon as possible.” Treatments have advanced dramatically in the three decades since his grandmother’s death from a stroke, Jiang said, and research continues to provide brighter outlooks for stroke victims. Still, many challenges remain. “Today we have better drugs to give patients and the outlook for stroke victims is higher than it was years ago, but we still have a long way to go because some treatments continue to have limited benefits depending on how quickly they can be administered following a stroke,” Jiang said. “We’re working to develop ways to combine our compound with treatments to help those who survive and help prevent post-stroke dementia or post-stroke impairment.” Jiang and his fellow UTHSC researchers hope to further advance ischemic stroke treatment by developing a drug to reduce inflammation and protect neurons in the brains of stroke victims. A longer window of time would be afforded by this treatment, which would help greater numbers of patients and reduce post-stroke impairments. “In this field there are so many people working on new compounds to offer protection for the brain after strokes and we’re making great strides,” Jiang said. “The advantage of collaborating with people in this department is improving what we’re able to offer patients, and I’m grateful for the ability to work together and share expertise. Collaboration is key.” memphismedicalnews.com

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stronger. When your patients need help, lean on us to support them every step of the way. We offer a continuum of care through inpatient and outpatient services. Our professional teams can treat depression, anxiety, bipolar disorder and other mental health issues as well as those with co-occurring addiction issues. We’ve recently instituted a new referral process especially for healthcare professionals to help make the admissions process easier and more efficient.

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2911 Brunswick Road | Memphis, TN 38133 | lakesidebhs.com Universal Health Services, Inc. (UHS) is a holding company that operates through its subsidiaries. This document has been prepared by UHS of Delaware, Inc. Any reference to “UHS” or “UHS facilities” refers to UHS’ subsidiaries. Further, the terms “we,” “us,” “our” or “the company” refer to the operations of the subsidiaries of UHS. Any reference to employees refers to employment with a subsidiary of UHS. Physicians are on the medical staff of Lakeside Behavioral Health System but, with limited exceptions, are independent practitioners who are not employees or agents of Lakeside Behavioral Health System. The facility shall not be liable for actions or treatments provided by physicians. For language assistance, disability accommodations and the nondiscrimination notice, visit our website. Model representations of real patients are shown. 230002-2424 10/23

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Flu, RSV, or COVID-19?, continued from page 1 Prevention

During flu season, it is possible that all three of the viruses may spread at the same time and patients could become infected with one or all three of the diseases. To counter this possibility, it is important to continue offering appropriate screening, testing, and vaccinations. Refer to the CDC’s guidance on “Frequently Asked Influenza (Flu) Questions: 2022-2023 Season.” Note that according to the CDC, both flu and COVID vaccines may be given on the same day if patients are eligible and vaccines follow the appropriate administration schedule. Some infectious disease experts recommend, however, that the RSV vaccine be given separately.

Patient Safety Strategies

Enhance patient safety by taking the following actions:

Patient Care

• Follow testing guidelines. Testing is the best method for determining which virus the patient may have while guiding your decisions about the appropriate treatment. • Review the CDC’s “Information for Clinicians on Influenza Virus Testing” for patients with acute respiratory illness symptoms. • Educate staff and patients on the new vaccine for RSV: See ABRYSVO information by Pfizer and the CDC’s RSV Vaccine Information Statement. • Encourage your patients to get appropriate age-related vaccines. • Ensure that the patient’s health record includes standard documentation about the possibility of contracting the flu, RSV, and/or COVID-19—including vaccination informed consent and informed refusal discussions. • Adopt a shared decision-making approach for patients at high risk for flu, RSV, or COVID-19 who are reluctant to get vaccines. Ensure that patients understand the risks of not being vaccinated. Learn more about this process with the Agency for Healthcare Research and Quality’s “The SHARE Approach.” The shared decision-making/consent discussion should be well documented in the patient’s record. For additional information, see our articles “Reduce Patient Safety Risks With Vaccinations, Including COVID-19” and “Communicating with COVID19 Vaccine-Hesitant Patients: Top Tips.” • Prescribe antivirals as necessary to prevent complications. See the CDC’s “What You Should Know About Flu Antiviral Drugs” and “COVID19 Treatments and Medications.” From the American Academy of Pediatrics, see “Updated Guidance: Use of Palivizumab Prophylaxis to Prevent Hospitalization From Severe Respiratory Syncytial Virus Infection During the 2022-2023 RSV Season.” 6 > OCTOBER/NOVEMBER 2023

Office Measures

• Encourage all staff members to get vaccinated for the flu. Offering it at no cost to employees increases vaccination rates. • Follow the CDC’s “Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.” • Appoint someone in the office to maintain all policies and procedures related to flu, RSV, and COVID-19 in a central location. • Maintain, date, and document all changes in office policies related to personal protective equipment or other infection control protocol. • Ensure that all vaccinations stored in the office are current.

Patient Education

• Distribute or display the American Heart Association infographic “Flu Shot 411.” Flu shots reduce the risk of death for people with heart disease. • Use other infographics and print resources in your office for the flu, RSV, and COVID-19. • Offer a free video in your waiting area to educate patients about getting vaccinated. For an example, see the Mayo Clinic Minute: “Why getting vaccinated for the flu is doubly important this season.” • Educate patients to stop the spread of germs: • Wash hands frequently. • Maintain respiratory etiquette (including masking when possible). • Avoid touching eyes, nose, and mouth. • Avoid close contact, particularly with those who are sick. • Disinfect frequently touched surfaces and objects. • Encourage self-isolation if sick.

Community Monitoring

• Adhere to local government or public health department recommendations for additional precautions. Check transmission levels in your community: “Weekly U.S. Influenza Surveillance Report,” “RSV Surveillance,” and “COVID-19 by County.” For additional assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

Debra Kane Hill, MBA, RN, is a Senior Patient Safety Risk Manager for The Doctors Company. 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.

AMA President Sounds Alarm on National Physician Shortage, Health System in Crisis In a national address, American Medical Association President Jesse M. Ehrenfeld, MD, MPH, spotlighted the growing national physician shortage and corresponding health system in crisis. In remarks delivered at the National Press Club, Dr. Ehrenfeld outlined critical strains on physicians, including enormous administrative burdens, burnout, attacks on science, increased consolidation across health care, a broken Medicare payment system, and health crises that worsen each day. Dr. Ehrenfeld enumerated five steps to get us out of this crisis, including specific legislation and solutions from the AMA Recovery Plan for America’s Physicians: • Pass meaningful Medicare payment reform; • Reduce administrative burdens like the overused, inefficient prior authorization process; • Pass bipartisan legislation to expand residency training options, provide greater student loan support, and create smoother pathways for foreign-trained physicians; • End the criminalization of health care; • and ensure physicians are not punished for taking care of their mental health needs “The physician shortage that we have long feared - and warned was on the horizon - is already here. It’s an urgent crisis … hitting every corner of this country – urban and rural – with the most direct impacting hitting families with high needs and limited means,” Dr. Ehrenfeld said in remarks as prepared for delivery. “Imagine walking into an emergency room in your moment of crisis – in desperate need of a physician’s care – and finding no one there to take care of you. “That’s what we’re up against. “And so while our current physician shortage is already limiting access to care for millions of people, it’s about to get much worse.” Other points in Dr. Ehrenfeld’s speech: “Consider that roughly two in three doctors admitted to experiencing burnout during the pandemic, according to a survey from the AMA, the Mayo Clinic and Stanford Medicine. That’s the highest level of burnout ever recorded by the AMA.

Consider that one in five physicians surveyed during the pandemic said they planned to leave medicine within the next two years, while one in three said they’d cut back on their hours. Consider that nearly half of all practicing physicians in the U.S. today are over age 55. And while medical school applications are up, it can take continued on next page >

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AMA President, continued from page 6 a decade or more to educate and train a physician. Consider that foreign-trained physicians, called International Medical Graduates or IMGs, face enormous obstacles – such as immigration and green-card delays - to practice medicine in the U.S. Consider that the average young doctor now leaves medical school more than $250,000 in debt, and that this heavy debt load has huge implications for our health system, often forcing aspiring physicians to bypass primary care and less populated, rural areas in favor of more lucrative specialties in or near large cities. It’s no wonder why the American Association of Medical Colleges projects a national physician shortfall of at least 37,000 – and possibly well over 100,000 – over the next decade. Why is this happening? Ask physicians and they’ll tell you: • An increasingly impersonal and bureaucratic health care system that places enormous administrative hassles and burdens in our lap each day, and leaves us feeling powerless to make any meaningful change. • Physicians today, on average, spend about two hours on paperwork for every one hour we spend with patients. • An attack on science that undermines trust in our medical institutions, and too often leads to threats and hostility directed at us and other health care workers. • Government intrusion into health care decisions and aggressive efforts in many states to criminalize care supported by science and evidence. • Increasing consolidation across health care that is giving more power to our nation’s largest hospitals, health systems and insurers, and less autonomy and fewer choices to patients and doctors. • Widening health disparities for historically marginalized communities, by race and by gender, between wealthy and low-income, and people living in urban and rural settings. • The twin health crises of firearm violence and drug overdose. • And for the last 20 years, a shrinking Medicare reimbursement rate for physicians that has pushed many small, independent practices to the brink of financial collapse and jeopardized care for millions of America’s seniors. See the entire speech on the Memphis Medical News website at http://memphismedicalnews.com/ memphismedicalnews.com

GrandRounds Scientists at St. Jude Children’s Research Hospital have pinpointed in DNA the gene therapy for safe cures of infants with SCID-X1 Patients with X-linked severe combined immunodeficiency disorder (SCID-X1), sometimes called “bubble boy disease,” are born with a defective gene that prevents them from producing immune cells. Gene therapy from St. Jude Children’s Research Hospital restored the immune system in multiple infants with SCID-X1 in 2019 by supplying copies of the corrected gene. Through ongoing efforts to monitor patient safety, St. Jude scientists recently documented where the gene copies integrate into patient DNA, providing a foundation to understand the biology and safety of using lentiviral vectors. The findings were published in Science Advances. “We now have a robust pipeline to monitor the safety of lentiviral gene therapies,” said senior co-corresponding author Jiyang Yu, PhD, St. Jude Department of Computational Biology interim chair. “This really gives hope to patients with genetic diseases that can be cured by lentiviral gene therapy. It looks like we cured bubble boy disease safely in these patients.” The St. Jude team published the entire computational pipeline together with the manuscript. Several years after treatment, the St. Jude lentiviral gene therapy for SCID-X1 appears both effective and safe, unlike earlier retroviral approaches. The researchers identified where the gene was added to patients’ DNA and why the vector integrated in that particular place. Scientists previously knew that lentiviral gene therapies integrated into different areas of DNA that appeared safer than earlier technologies, but they could not address why.

was in patient cells, to what extent the gene was expressed, and the chromatin organization at a single-cell level,” said first author Koon-Kiu Yan, Ph.D., St. Jude Department of Computational Biology. “Before this study, we could measure the general gene expression of a bulk group of cells. But with bone marrow samples from two patients, we saw at a single-cell level which genes were expressed in which cell types.” Using that single-cell analysis, along with their other work, Yan showed that the safety and efficacy of treatment are also related to integration into compartments near the nuclear pore. Previous gene therapy efforts integrated into promoters near to or directly into oncogenes, ultimately causing cancer. The lentiviral vector used by St. Jude selectively avoids promoters without disrupting oncogenes, improving treatment safety. The same pattern was observed with a lentiviral gene therapy used to create chimeric antigen receptor (CAR) T cells, suggesting that the phenomenon may be a general mechanism not restricted to the SCID-X1 vector. “The integration pattern data could serve as a map of potentially safe integration sites,” Yu and Gottschalk explained. “The single-cell analysis is like deep cartography, a map with a near pixel-perfect resolution. The large number of integration sites could be used as a safety reference for future lentiviral gene therapies.”

One case was especially notable: the patient who required a second dose of the gene therapy to achieve a cure was found to have a different integration pattern than the patients who had responded to the first dose. After receiving the second dose, the patient’s integration pattern resembled the others’, and the therapy was effective. This study provides a foundation for understanding differences in treatment response so that future gene therapies may be improved.

Authors and funding The study’s other authors are Jose Condori, Zhijun Ma, Jean-Yves Metais, Bensheng Ju, Liang Ding, Yogesh Dhungana, Lance Palmer, Deanna Langfitt, Francesca Ferrara, Robert Throm, Hao Shi, Isabel Risch, Sheetal Bhatara, Bridget Shaner, Timothy Lockey, Aimee Talleur, John Easton, Michael Meagher, Sheng Zhou and Ewelina Mamcarz, all of St. Jude; and Jennifer Puck and Morton Cowan, University of California San Francisco Benioff Children’s Hospital. The study was supported by grants from the National Institutes of Health (R01-GM13482, P01-HL053749 and U54AI082973), National Institute of Allergy and Infectious Diseases (U54-AI082973), California Institute of Regenerative Medicine (CLIN2-09504 and CLIN2-10830), National Cancer Institute Comprehensive Cancer Center (P30CA021765), Assisi Foundation of Memphis and ALSAC, the fundraising and awareness organization of St. Jude.

3D genome structure holds the key to SCID-X1 gene therapy The scientists found that copies of the new, corrected gene had been inserted into certain genomic hotspots for the patients in the study. The reason was deceptively simple: From a 3D structural perspective, the hotspots are regions the lentiviral vector first encounters after entering the cell’s nucleus through a channel called a nuclear pore. “It’s like someone coming into a room and taking the first available seat near the door,” said co-corresponding Stephen Gottschalk, M.D., St. Jude Department of Bone Marrow Transplantation and Cellular Therapy chair. “The room is the nucleus. The seats are these DNA elements right near the door of the nuclear pore. That never occurred to me before this study, but it’s a very simple principle in the end.” The St. Jude group found that the integration site pattern of the gene therapy into patient cells shed light on the safety and efficacy of the approach. “We performed a comprehensive single-cell multi-omic analysis of this gene therapy to understand whether a functional copy of the corrected gene OCTOBER/NOVEMBER 2023

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The High Price Of Financial Illiteracy Common financial mistakes add up—and can be costly! A lot of people don't realize how much money they could save if they stopped nickels, dimes, and dollars from leaving their online accounts, pockets and wallets for reasons that could have been avoided-if they'd been more financially literate. In a survey in late 2022, the National Financial Educators Council (NFEC) asked this question: "During the past year (2022), about how much money do you think you lost because you lacked knowledge about personal finances?"1 The range of answers from 3,001 responding adults averaged $1,819. If the same average were applied nationwide among American adults, the cost of financial literacy would have been $436 billion, according to NFEC calculations.

something else. But is that really a good idea? Someone may love that $175,000 Chirag Chauhan, crocodile Hermes AIF®, CFP® handbag they saw for sale online-but wouldn't a $75 handbag work just as well? • Identity theft scams and fraud: The FBI reported that Americans lost nearly $7 billion to identity theft in 2021.5 Although financial illiteracy may not be the reason why people fall for fraud, those who lack money knowledge and awareness are more susceptible to scams, according to the NFEC.

Ways that financial literacy may improve

Just like reading skills, financial literacy requires learning, practicing what you've What is financial illiteracy? learned, and-if you have a willing listenerBeing financially illiterate means you're not sharing what you've learned. That can help particularly savvy about managing money, others become more financially literate too. which can impact not only your bank accounts, but also your work, relationships, The National Endowment for Financial lifestyle-and physical and mental health.1 Education (NEFE) surveyed adults in 2022 Some common mistakes that suggest about whether high school financial education financial illiteracy include: should be required for graduation, and which • Credit card fees and interest: In the key topics should be taught.6 The fourth quarter of 2022, the average results showed: credit card interest rate was 20.40%, • 88% said their state should require a according to Federal Reserve data.2 semester-long or year-long financial Because that's an average, those with education course for graduation. bad credit scores faced higher rates. In • 80% said they wish they had been April 2023, the Consumer Financial required to take a semester-long or Protection Bureau estimated year-long financial education course outstanding credit card debt may during high school. continue to set records and could • 75% said that spending and budgeting is hit $1 trillion.3 the most important financial education • Overdrafts: The NFEC reports that topic to teach for personal finance American consumers spend $17 billion a education, followed by managing credit year on overdraft and (55%), saving (49%) and earning income non-sufficient-funds fees-and that the (47%). median bank fee for an overdraft on a The most recent numbers of the Council for debit card is $34 even though most overdrafts are for transactions costing Economic Education (CEE) reveal that 25 states now require students to take a course in $24 or less. The Consumer Financial economics in order to graduate, and 23 states Protection Bureau (CFPB) reported in require students to take a course in personal December 2021 that banks are finance in order to graduate. Although the dependent on overdraft fees, with non-sufficient penalties making up number of states adding these requirements is two-thirds of their fee revenue.4 small, CEE reports personal finance education is making slow but steady increases. • Luxury spending: Some people may want to get a luxury car or impress As we know, small steps add up-just as small friends or coworkers with to-die-for savings do. handbags, glasses, clothing, jewelry-or Financial Illiteracy Cost Americans $1,819 in 2022 Business Insider The average credit card interest rate by credit score and card March 27 2025 CFPB, As outstanding credit card debt hits new high, the CFPB is focusing on ways to increase competition and reduce costs. April 17. 2023 4 CFPB Research Shows Banks' Deep Dependence on Overdraft Fees. Dec. l. 2021 5 Federal Bureau of Investigation Internet Crime Report. 2021 6 NEFE: New Data Highlights Demand During Financial Capability Month, April 25, 2022 7 CEE: 2022 Economic and Personal Finance Education in our Nation's Schools, Survey of the States 1



Important Disclosures This material is for general information only and is not intended to provide specific advice or recommendations for any individual. There is no assurance that the views or strategies discussed are suitable for all investors or will yield positive outcomes. CDs are FDIC Insured to specific limits and offer a fixed rate of return if held to maturity, whereas investing in securities is subject to market risk including loss of principal. The Standard & Poor's 500 Index is a capitalization weighted index of 500 stocks designed to measure performance of the broad domestic economy through changes in the aggregate market value of 500 stocks representing all major industries. All performance referenced is historical and is no guarantee offuture results. All indices are unmanaged and may not be invested into directly. This material was prepared by LPL Financial. Securities and advisory services offered through LPL Financial (LPL), a registered investment advisor and broker-dealer (member FINRA/SIPC). Insurance products are offered through LPL or its licensed affiliates. To the extent you are receiving investment advice from a separately registered independent investment advisor that is not an LPL Financial affiliate, please note LPL Financial makes no representation with respect to such entity.

Chirag Chauhan, MBA, AIF®, CFP® is the managing partner of Bluff City Advisory Group in Memphis, Tennessee. For more info, please visit bluffcityadvisory.com.


GrandRounds BMHCC Celebrates 30-year Anniversary of Heart Transplant Patient The Baptist Heart Institute at Baptist Memphis, the only Mid-South hospital that performs adult heart transplants, recently celebrated the 30-year Anniversary of one of its heart transplant patients. While this is exciting on its own, the most remarkable part of the story is that this patient’s uncle is the current longest heart transplant survivor, living 32.8 years before his death in 2020. Fifty percent of heart transplant patients live about 13 years post-transplant. The very first heart transplant in Memphis was performed Oct. 21, 1985, and that patient lived 21 years. The Baptist Heart Institute offers comprehensive heart services in one location and includes Baptist’s heart transplant program. The Advanced Heart Failure Program is located within the Baptist Heart Institute and provides comprehensive cardiac care for patients diagnosed with advanced heart failure but who no longer respond to medication and require frequent hospitalizations.

Campbell Clinic Adds Five New Physicians Campbell Clinic, a national and international leader in orthopaedic medicine, surgery, teaching and research, recently added five new physicians to its growing team of providers. The new physicians are: • Dr. Joshua Brandon, primary care sports medicine physician • Dr. Christopher Holland, total joint replacement surgeon • Dr. Jimmie Mancell, internal medicine/ employee health • Dr. Omar Medina, orthopaedic spine surgeon • Dr. Austin Murphy, hand and wrist surgeon “Attracting talented physicians enables us to provide the highest level of care to our valued patients,” says Dr. Frederick Azar, Chief of Staff for Campbell Clinic. “We’re thrilled to have Drs. Brandon, Holland, Mancell, Medina, and Murphy join our team and we are grateful for the value they are already bringing to their patients, staff, and fellow physicians.” Dr. Joshua Brandon will serve patients via Campbell Clinic’s Germantown and medical district locations. He is a board-certified, fellowship-trained primary care sports medicine physician specializing in the evaluation and management of nonJoshua surgical musculoskeletal Brandon issues and sports medicine. Dr. Brandon earned his undergraduate degree from Winona State University and his medical degree from the University of Minnesota before completing his residency at the Halifax Health Family Medicine Program and a fellowship in primary care sports medicine from Wake

Forest. In addition to his clinic patients, Dr. Brandon will also provide sports medicine coverage for several local sports teams including the Memphis Redbirds, 901 FC, University of Memphis football and basketball, USFL, Christian Brothers University, Rhodes College and Center Hill High School. He is a proud member of the American College of Sports Medicine and the American Medical Society for Sports Medicine. For more information on Dr. Brandon, visit https://www.campbellclinic. com/physician/joshua-brandon/. Dr. Christopher Holland will serve patients in Campbell Clinic’s Germantown, Oxford and Southaven locations. He is a fellowship-trained total joint replacement surgeon. Dr. Holland earned his undergraduate and master’s degree in biochemistry and Christopher Holland molecular biology from the University of California (Riverside) before completing his residency in orthopaedic surgery at the University of California (Davis) Medical Center and the Shriners Hospital for Children. He completed his fellowship in adult reconstruction surgery at Duke University, Department of Orthopaedic Surgery. He is a proud member of the American Academy of Orthopaedic Surgeons (AAOS); the American Association of Hip and Knee Surgeons; Duke Orthopaedic Piedmont Society; and the American Orthopaedic Association. For more information on Dr. Holland, visit https://www.campbellclinic. com/physician/christopher-holland/. Dr. Jimmie Mancell will focus his practice on employee health, providing support for Campbell Clinic’s team of 850+ team members across the MidSouth region. Dr. Mancell graduated from the University of Tennessee at Martin and went on to Jimmie earn his medical degree at Mancell the University of Tennessee Health Science Center. He completed both his internship and residency at Methodist University Hospital of Memphis. He has served as the Associate Dean for Clinical Affairs at the University of Tennessee Health Science Center and is currently an Associate Professor in UTHSC’s Department of Medicine. He is a proud member of the American College of Physicians, the NBA Physicians Association, the Tennessee Medical Association and the Memphis Medical Society. For more information on Dr. Mancell, visit https:// www.campbellclinic.com/physician/ jimmie-mancell/. Dr. Omar Medina will see Campbell Clinic patients via its Wolf River Parkway location. He is a board-certified, fellowshiptrained orthopaedic spine surgeon. Dr. Medina Omar earned his undergraduate Medina degree from the University of California (Irvine) and his Master memphismedicalnews.com

GrandRounds of Public Health degree from UCLA’s Fielding School of Public Health. He earned his medical degree from the David Geffen School of Medicine at UCLA and completed his internship and residency at the Harbor-UCLA Medical Center. He completed a fellowship in spine surgery at Vanderbilt University Medical Center. He is a proud member of the American Academy of Orthopaedic Surgeons (AAOS); the American Association of Latino Orthopaedic Surgeons (AALOS); the J. Robert Gladden Orthopaedic Society; and is active with both the Scoliosis Research Society and the Cervical Spine Research Society. For more information on Dr. Medina, visit https://www.campbellclinic. com/physician/omar-medina/. Dr. Austin Murphy will treat patients at Campbell Clinic’s Collierville and Germantown locations. He is a fellowship-trained hand and wrist surgeon. Dr. Murphy earned his undergraduate degree at Samford University and his medical degree from Austin the University of Alabama Murphy at Birmingham. He completed his residency at Campbell Clinic – University of Tennessee’s Department of Orthopaedic Surgery and his orthopaedic hand fellowship at the Indiana Hand to Shoulder Center. In addition to his clinic patients, Dr. Murphy will also provide sports medicine coverage for the Memphis Redbirds. He is a proud member of the American Association for Hand Surgery; American Society for Surgery of the Hand; Mid-America Orthopedic Association; American Academy of Orthopaedic Surgeons (AAOS); Tennessee Medical Association and the Memphis Medical Society. For more information on Dr. Murphy, visit https://www.campbellclinic. com/physician/austin-murphy/.

TMA Sets Legislative Agenda Ahead of 2024 Tennessee General Assembly The Tennessee Medical Association has identified the top four issues upon which the association will focus during the second session of the 113th Tennessee General Assembly. Proposed by TMA’s Legislative Committee and approved by the organization’s Board of Trustees, the priorities are Scope of Practice, Physician Wellness, Insurer Clawbacks and Combatting Violence Against Healthcare Professionals. • Scope of Practice – Advance practice professionals, like registered nurses and physician assistants, have actively lobbied to practice medicine without the collaboration of a physician. TMA, along with its multispecialty partners in the Coalition for Collaborative Care (CCC), will continue to promote the team-based care model as the most effective solution for Tennesseans to have access to high-quality, comprehensive healthcare no matter where they live. • Physician Wellness – TMA is working to prioritize physician well-being by memphismedicalnews.com

removing stigmatizing questions on licensure, renewal, and credentialing applications, which may serve as barriers to efforts to seek routine mental health treatment. • Insurer Clawbacks – TMA will work to reform audit and overpayment protocols to prohibit health plans from recouping inappropriate amounts of adjudicated claims and place specific requirements on overpayment recovery processes, including advance overpayment notification, payment transparency, due process rights, and clawback time limits. • Combating Violence Against Healthcare Professionals – While Tennessee currently has legal protections for assaults committed against first responders and nurses, TMA would like to see these protections extended to physicians as well. Ensuring that offenders receive appropriate punishment for violent behavior will help keep our healthcare heroes safe from harm so they can continue to deliver high-quality care. Staff lobbyists, the organization’s legislative committee, TMA’s political action committee (TMA PAC) and physicians from across the state will coalesce to advocate during the 2024 General Assembly to achieve the desired outcome surrounding these top four issues. In addition, TMA’s lobbyists will review hundreds of bills to identify measures that promote or threaten good healthcare policies, and work to organize member physicians, group practices and other collaborative organizations to carry TMA’s support or opposition. “TMA eagerly looks forward to the 2024 legislative session,” said TMA President Andrew Watson, MD. “We remain committed to protecting the physician-patient relationship through the physician-led, team-based collaborative approach to care, confident that it is the most patient-beneficial and safest practice of medicine for all Tennesseans. In addition, we will continue to fight the insurance industry over tactics that trap practices with audits and recoupment financial penalties which are grossly unfair and penalizing to physicians and their practices.” In 2019, TMA was named the most influential advocacy organization on Capitol Hill – not limited to healthcare but across all industries – by Capitol Resources, LLC, a multi-state government relations firm with offices in Tennessee. TMA prides itself on physician member involvement and legislative engagement on policy initiatives throughout each legislative session. The Tennessee General Assembly will reconvene Tuesday, Jan. 9, 2024, at 12 pm CT. The Tennessee Medical Association is a nonprofit advocacy organization, representing nearly 10,000 Tennessee physicians. The organization advocates for public policies, laws and rules that promote healthcare safety and quality for all Tennesseans and improve the nonclinical aspects of practicing medicine.


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GrandRounds Regional One Health’s Labor & Delivery and NICU Awarded Gold “5 Star” Designation Regional One Health’s Labor & Delivery and NICU recently received theTennessee Initiative for Perinatal Quality Care’s (TIPQC) Gold “5 Star” recognition for optimal cord clamping. The Optimal Cord Clamping (OCC) project is a quality improvement statewide initiative by TIPQC to promote waiting to clamp the umbilical cord until at least 60 seconds after birth. Regional One Health worked diligently to meet all the criteria to earn gold recognition. OCC allows more blood to transfer from the placenta to the baby. The iron in the blood increases the newborn’s iron storage, which is vital for healthy brain development. Given the benefits to both full-term and preterm babies, the American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping for at least 30–60 seconds after birth for most babies.

UTHSC College of Health Professions Receives $3.25 Million Grant The College of Health Professions at the University of Tennessee Health Science Center (UTHSC) is celebrating a significant milestone as it secures its largest grant to date. The Health Resources and Services Administration (HRSA) has awarded UTHSC a grant totaling approximately $3.25 million to support a new Health Careers Opportunity Program (HCOP). This groundbreaking five-year grant, known as Reimagining Education for Advance Careers in Healthcare (REACH), aims to strengthen health care education while addressing the critical need for a skilled and diverse health care workforce in West Tennessee. Chermale Casem, MBA, PHR, CDE, assistant dean of Finance and Operations in the College of Health Professions, leads the charge as the principal investigator Chermale and project director. She Casem is joined by dedicated

co-investigators: Jacen Moore, PhD, MLS (ASCP), associate professor in the Department of Diagnostic and Health Sciences; LaToya Green, DPT, EdD, PT, associate professor of physical therapy; and Pamela Lewis-Kipkulei, PhD, OTD, OTR/L, associate professor of occupational therapy. Allied health professionals are often the hidden and unsung heroes who comprise a significant portion of the health care workforce and assist primary care professionals in preventing, diagnosing, and treating various medical conditions across specialties. The REACH project’s core objectives include increasing recruitment, retention, and graduation rates for underserved students aspiring to pursue careers in health care professions, with a primary focus on medical laboratory science, occupational therapy, and physical therapy. The REACH project comprises three structured programs catering to various stages of a student’s academic journey. Ms. Casem said, “The first program is the HCOP Saturday Academy, geared towards juniors and seniors in high school from underserved communities, providing them with exposure to health professions through academic enrichment activities, career exploration, mentoring, tutorial support, and SAT/ACT preparation.” The second program, the HCOP Pre-Matriculation Academy, targets undergraduate students in their junior and senior years aspiring to enter a health care profession. Ms. Casem said, “This program equips them with the skills and knowledge needed for successful matriculation into a graduate program, including application requirements, mock-program interviews, job shadowing, standardized testing preparation, and resume building.” The third program, the HCOP National Ambassadors Program, serves graduate students already enrolled in UTHSC’s College of Health Professions. According to Ms. Casem, this program aims to enhance professional development opportunities and offer advanced training in community-based settings to address social determinants of health effectively. Each academy within the REACH project employs evidence-based curricula

and leverages innovative teaching methods such as flipped classrooms and virtual, augmented, and mixed-reality tools. Students will receive financial support through stipends and scholarships, academic assistance, social support from tutors and mentors, and professional development opportunities, including clinical practicum experiences and soft skills training. Eligibility for these programs is based on HRSA’s criteria for educationally or economically disadvantaged students. Collaboration with community partners, including high schools, undergraduate institutions, historically black colleges and universities (HBCUs), and clinical practices, enhances these resources, creating a competitive educational pipeline. Stephen Alway, PhD, FACSM, dean of the College of Health Professions, expressed his excitement about the potential impact of this grant, saying, “We are excited about both the size and the impact that this award will have for our college and the state of Tennessee. This grant provides the potential to reach students from underserved communities who might not have had access to information or training related to health professions. Furthermore, we expect the new scholarship funding provided by this grant to encourage increased retention of the great students we have enrolled in health professions. This award allows the College of Health Professions to take a crucial step towards addressing our college’s mission to provide the people of Tennessee with access to quality higher education and enhanced quality-of-life opportunities.” The REACH project represents a significant investment in the future of education and workforce development in health professions, promising to not only transform the lives of underserved students but also strengthen the health care workforce in West Tennessee, ultimately improving health outcomes and equity in the region.

Farah Cardosi Returns to Methodist Le Bonheur Healthcare Farah Cardosi, DNP, returns to

primary care practice with Methodist Le Bonheur Healthcare. She joins Robert Kraus, MD, and Gordon Kraus, MD, at Methodist Medical Group on Wolf River in Farah Germantown. Cardosi Cardosi has over 12 years’ experience in family medicine, earning her doctorate of Nursing Practice from The University of Tennessee Health Science Center. Her areas of expertise include chronic disease management of hypertension, diabetes and allergies, and treating minor illnesses and injuries like skin conditions, joint pain, cold and flu, and ear and throat infections. To schedule an appointment, please call 901-761-9097.

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Your patients deserve nothing less than a 5-star experience from OrthoSouth.

What does that look like? URGENT CARE

Patients with urgent injuries or in acute pain may be sent directly to our Urgent Orthopedic Care office at 6286 Briarcrest Ave. in Memphis.


Patients in acute pain needing to see a provider the same day may be seen by walking in or making a same-day appointment at one of our 9 convenient locations.


Early, weekend, lunchtime, and after hours, your patient’s time is our time.



Use our convenient Book Online portal to book your patient’s visit before they leave your office.


From streamlined processes to comfortable waiting spaces and personable team members, the OrthoSouth experience is designed to provide fast, friendly, and convenient care to the most important person in the room - your patient.


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Comprehensive Behavioral Healthcare in Germantown Crestwyn Behavioral Health Hospital is a premier provider of mental health and substance use treatment for adults. Offering inpatient care, detox, a partial hospitalization program, and an intensive outpatient program, our treatment center aims to foster hope and provide the tools for lifelong healing.

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