Austin Medical Times

October Edition 2020

Inside This Issue

The Importance of Self-Care for Healthcare Professionals during COVID-19

By Tom Florence, EVP Merritt Hawkins

S Prevent a “Twindemic” —Get Your Flu Shot Now See pg. 10

INDEX Legal Matters....................... pg.3 Mental Health...................... pg.6 Oncology Research......... pg.8 Healthy Heart....................... pg.9

ince the COVID-19 virus began its rapid spread across the U.S. healthcare professionals have been tirelessly working and caring for patients, risking their own health and even their lives each day they walk through the hospitals’ and doctors offices’ doors.

When constantly looking out for others, it can be easy to neglect the importance of taking care of oneself.

However, self-care is an essential practice for all individuals, particularly for those who are being exposed to the coronavirus and seeing the significant and sometimes fatal impacts that it has had on countless individuals throughout the entire world.

While everyone responds to situations differently and has different methods of coping with stress and anxiety, below are options for healthcare workers to employ in order to practice self-care and help minimize the risks of burnout and mental and physical illnesses as a result of working through the COVID-19 pandemic.

Vocalize your feelings.

Don’t hesitate to talk with your coworkers or an on-site chaplain regarding how you are feeling.

Caring for coronavirus patients and consistently facing the dangers it presents to you and to others can have

activities that you enjoy.

Exercising on a regular basis carries significant benefits and helps to improve an individual’s overall quality of life. Not only does it change your body, metabolism, heart, and spirits, but it also allows you to set aside specific time in your routine to focus on you.

Stay connected to the people in your life.

While socialization and spending time with loved ones may look different during this time, technology has made it possible for individuals to stay connected with their friends and family members when they are unable to see them in person.

By regularly communicating with and connecting with others, health professionals reduce the risk of anxiety and depression. In fact, one study of social relationships and health found that connectedness leads to a variety of additional health benefits, while lack of social connection with others can lead to an increased risk of death.

Properly nourish your body.

When always focusing on patient care and not self-care, it can be rather easy for doctors and nurses to neglect

By regularly communicating with and connecting with others, health professionals reduce the risk of anxiety and depression.

VA Expands Veteran Access To Telehealth with iPad Services See pg. 13

a tremendous emotional impact on you and your well-being. It would also be wise to speak to a therapist, especially if you begin to experience “compassion fatigue,” in which your desire to provide care and help to others diminishes.

Participate in the hobbies and

see Self Care... page 14

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Legal Matters Top Antitrust Issues in Physician-Hospital Alignment

By Matthew C. Hans, J.D. Herbert F. Allen, J.D. Polsinelli, PC

A

great realignment is underway among America’s doctors. The shift away from independent practice towards full hospital employment or affiliation with a hospital system has been motivated by growing costs for independent practices, including rising physician salaries, and flat or declining reimbursement. The antitrust laws will play an important role in determining how this wave of physician and hospital alignment will play out.

Hospital Acquisition of Physician Practice – Reduction in Competition?

When a hospital acquires an independent physician practice or employs its doctors directly, the

antitrust laws treat the transaction as a merger between the hospital and the physician practice. Antitrust concern arises when the combination of the newly-hired physicians with physicians already employed by the hospital creates new market power that may substantially lessen competition, or tend to create a monopoly in violation of Section 7 of the Clayton Act. But how do courts and agencies determine whether or not an acquisition that has not yet occurred may substantially lessen competition at some point in the future? At a very high level, the analysis includes the following steps: 1. Geographic Market.

This analysis focuses on patients’ willingness to travel for particular services, as well as the degree to which health plans need certain physicians in a geography to market a successful plan to employers.

Generally, geographic markets for primary care doctors may be narrower than the market for specialists who perform elective procedures, since

patients may be willing to travel for elective procedures, while many patients prefer local access to a primary care service.

Geographic market definition can be outcome-determinative in many antitrust cases, since it determines how many other physicians are included in the denominator when it comes to calculating market shares.

2. Market Share. Transactions that result in market shares of less than 30% have been held not to present competition concerns. On the other hand, very high market shares can be sufficient for a plaintiff to make out a prima facie case that the transaction will probably lead to anticompetitive effects.

3. Other Evidence. While courts recognize that market concentration statistics are of great consequence,

they are not conclusive indicators of anticompetitive effects.

Other evidence might include documents from the parties about the motivations for the transaction and testimony from payers about any changes in bargaining leverage that might be attributable to the transaction, or evidence that the transaction will yield efficiencies that will enhance the merged firm’s ability and incentive to compete.

Professional Services Agreements: “Employment Light”

The professional services agreement (PSA) has become a very popular model for physician practices that wish to affiliate with a hospital, yet retain some degree independence.

In the typical PSA, a hospital will see Legal Matters...page 14

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Austin Medical Times

St. David’s Healthcare Facilities Recognized

by Healthgrades For Excellence in Women’s Care Austin Hospitals Recognized Among Top 5% In the Nation for Labor and Delivery, as well as Obstetrics and Gynecology

S

t. David’s HealthCare announced today that all of its Austin hospitals received a Healthgrades 2020 Women’s Care Award. St. David’s Medical Center (including St. David’s Georgetown Hospital), St. David’s North Austin Medical Center (including St. David’s Women’s Center of Texas) and St. David’s South Austin Medical Center are among the top 5% of eligible hospitals in the nation to receive a Healthgrades 2020 Labor and Delivery Excellence Award™ and Healthgrades 2020 Obstetrics and Gynecology Excellence Award™.

Healthgrades—the leading resource that connects consumers, physicians and health systems—evaluated clinical outcomes for women treated at each facility during labor and delivery, as well as gynecologic procedures, from 2016 through 2018.

St. David’s North Austin Medical Center and St. David’s Medical Center also received a Healthgrades 2020 Gynecologic Surgery Excellence Award™, making St. David’s North Austin Medical Center among the top 5% of eligible hospitals in the nation

and St. David’s Medical Center among the top 10% in the nation to receive the award. This distinction recognizes these facilities for outstanding performance in gynecologic surgery, including hysterectomy and other surgeries related to the female reproductive system.

“This recognition underscores our unwavering commitment to providing the highest quality care for women at every stage of their lives,” David Huffstutler, president and chief executive officer of St. David’s HealthCare, said. “We understand that childbirth is one of the most important moments in a mother’s life, and we continue to ensure a family-focused approach to maternal care in a safe environment during the COVID-19 pandemic.”

Healthgrades 2020 Labor and Delivery Excellence Award™ Hospitals that received the Healthgrades 2020 Labor and Delivery Excellence Award demonstrated exceptional care provided to mothers during childbirth.

If all hospitals in the analysis

Texas Cardiac Arrhythmia Institute Physicians Participate in Clinical Trial For 4D Imaging Technology For Complex Heart Procedures

P

hysicians with the Texas Cardiac Arrhythmia Institute (TCAI) at St. David’s Medical Center are among the first in the world to participate in a clinical trial to evaluate a new intra-cardiac echocardiography catheter. Andrea Natale, M.D., F.H.R.S., F.A.C.C., F.E.S.C., cardiac electrophysiologist and executive medical director of TCAI, and Amin Al-Ahmad, M.D., cardiac electrophysiologist at TCAI, recently participated in the first-in-human October 2020

trials of this catheter in Europe, in preparation for conducting in-human trials at St. David’s Medical Center in Central Texas next year.

What distinguishes this catheter—the NuVision™ ICE Catheter—from previous versions is 4D imaging, which is designed to better guide complex cardiac procedures, improve outcomes and reduce procedure times, all of which are beneficial to the patient.

As ablation technologies

performed at the level of award recipients, complications in 124,867 patients could have potentially been avoided.

In addition, Healthgrades found that patients treated in hospitals receiving the award had, on average, a 40% lower risk of experiencing a complication while in the hospital than those treated in non-recipient hospitals.

Healthgrades 2020 Obstetrics and Gynecology Excellence Award™

Healthgrades 2020 Obstetrics and Gynecology Excellence Award recipient hospitals demonstrated excellent clinical outcomes while caring for women during and after childbirth, and in procedures to treat diseases and conditions affecting the female reproductive system.

If all hospitals in the analysis performed at the level of award recipients, complications in 141,823 patients could have potentially been avoided. In addition, Healthgrades found that patients treated in hospitals receiving the Obstetrics and Gynecology Excellence Award had, on average, a 34% lower risk of experiencing a complication while in the hospital than those treated in non-recipient hospitals.

Healthgrades 2020 Gynecologic Surgery Excellence Award™

St. David’s North Austin Medical Center and St. David’s Medical Center also out-performed peer hospitals

continue to evolve, and procedures become increasingly complex, there is a growing need for advanced intracardiac imaging beyond the capabilities of 3D imaging,” Dr. Natale said. “4D imaging provides a high-resolution view of the heart structure during a complex intervention to lessen the likelihood of complications during ablation procedures. We are committed to providing leading-edge treatment to our patients, and we look forward to bringing this important advancement to St. David’s Medical Center.”

This catheter offers all of the imaging capabilities of previous imaging platforms with the added spatial benefits of real-time intracardiac 3D guidance, giving physicians an advanced view of the heart in motion during complex structural heart surgeries, appendage closures and cardiac ablation procedures. This enhanced

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in providing surgery on the female reproductive system.

Healthgrades found that patients treated in hospitals receiving the Gynecologic Surgery Excellence Award had, on average, a 46.7% lower risk of experiencing a complication while in the hospital than those treated in non-recipient hospitals. If all hospitals in the analysis performed similarly to award recipients, complications in 10,121 patients could have potentially been avoided.

“The healthcare experience in this country has changed significantly over the past few months, and the hospitals that have achieved a Healthgrades 2020 Women’s Care Award go above and beyond to provide the best care possible for women. We commend all of the organizations that have had to create new protocols, adapt and evolve to keep women and their newborn babies safe amidst COVID-19,” Brad Bowman, MD, Chief Medical Officer, Healthgrades, said.

visualization allows physicians to better assess complex cardiac structures with the potential to improve patient outcomes while reducing procedure times and fluoroscopy (X-ray) exposure.

It also gives physicians better control of the image generation by allowing them to guide the catheter throughout the procedure.

“Through the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, we are committed to advancing the level of care for patients with cardiac conditions,” Dr. Al-Ahmad said. “Having the ability to view direct images of a procedure in real time allows us to more safely and effectively treat patients.”

4D imaging also allows doctors to perform structural heart procedures under conscious sedation, which is associated with a lower risk of complications for patients.

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Page 6

Mental Health POV: The Benefits of Mindful Living How Taking A Moment to Live In The Present Can Improve Overall Sense Of Well-Being

By Isaac Saldivar, PhD

T

he importance of maintaining mental health seems to be a universal endeavor that we often ignore or set aside until the metaphorical battery of our lives starts to run low, at which point we run for the nearest outlet looking for a recharge. The capacity to improve and maintain good health is fundamental to our overall quality of life. However, being “mentally healthy” can be difficult to define, even amongst behavioral scientists—and that’s their job. Even when we define mental health in our personal lives, it can be difficult for us to personify or embody that within everyday life.

You may ask yourself, How exactly

do I go about promoting mental health?

How does that even look or feel? How on earth do I find the time? I mean, who wouldn’t want to feel less stressed and more relaxed? Certainly, we would all welcome the lessening of burdens that, without a doubt, life will place squarely on our shoulders. But where do we begin? One of the essential lessons I have learned, both personally and professionally as a clinical psychologist, is that living a healthy life does not spontaneously combust into existence.

It requires deliberate and continuous effort. This means making a habit of living healthy is a choice, and we must actively choose to promote it.

One simple and practical way to help improve the quality of my mental life is through cultivating a healthy and resilient mindset simply by the practice of paying attention, or being mindful. Mindfulness involves placing our attention on self-awareness in the present moment, or the “here-and-now.”

Not only does mindfulness provide a

useful tool for promoting a happier, healthier lifestyle, it is also simple, accessible and—best of all—costs nada (nothing).

That’s it, folks. It is that simple.

There is no joining of a monastery, years of meditation or chanting of mantras required. These are all adequate ways of practicing mindfulness, but the simple act of self-awareness seems to be a natural state of the mind and requires no one particular or specific technique in order to engage in present-moment awareness.

The quality of our thoughts determines the quality of our mental experiences. Naturally we can see that

our mental states create the subjective experience we refer to as “self.” Through self-awareness, mindfulness strengthens not only our mental capacity to be resilient but also our capacity to attend optimally when dealing with whatever life throws our way. So, whether you’re peacefully meditating or in the middle of a chaotic day, mindfulness can help re-center one’s awareness and help you be your best. Additionally, the immediate and long-term effects of mindfulness promote a mind that functions better, is more emotionally stable and overall mentally healthy.

A common misconception of see Mental Health...page 14

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Austin Medical Times

Page 7

OPPORTUNITIES FOR STROKE RECOVERY HAVE NEVER BEEN GREATER UPDATED GUIDELINES EMPHASIZE IMPORTANCE OF QUICK ACTION

690,000

795,000

U.S. strokes are caused when a clot cuts off blood cy rc A kAnr cS rUN InAVa (called an ischemic stroke).

Americans will have a new or recurrent stroke this year.

Stroke is the No. 5 cause of death in the United States, killing more than 142,000.1

PER YEAR

More than

About

QUICK TREATMENT = LESS BRAIN DAMAGE! Importance of Getting to the Hospital Quickly

1 in 19 DEATHS

Nr rc rUN UcokVrA^ Ar rUN nor oVTa cS ornc]N oc {cs JAa IN evaluated and receive treatment in time. Stroke treatment begins in the ambulance. Calling 9-1-1 can help patients get treated more quickly and get them to a hospital that specializes in stroke care.

LEARN AND SHARE THE WARNING SIGNS OF STROKE Spot a Stroke F.A.S.T.

F A S T

AS SOON AS POSSIBLE

FACE DROOPING

ARM WEAKNESS

24

4.5 HOURS in select patients

UP TO HOURS AFTER STROKE BEGINS2

IV alteplase

mechanical thrombectomy

WITHIN

Does one side of the face droop or is it numb?

AS SOON AS POSSIBLE WITHIN

in select patients

Clot busters and clot-removal procedures must be administered within a few hours of stroke symptoms to lessen the chance of being disabled after a stroke.

Is one arm weak or numb?

Mechanical thrombectomy is a procedure that can physically remove a large blood clot from a blocked artery in the brain.

SPEECH DIFFICULTY

Is speech slurred, are they unable to speak, or are they hard to understand?

TIME TO CALL 9-1-1

If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get to the hospital immediately.

9-1-1

1. Heart Disease and Stroke Statistics-2019 Update: A Report from the American Heart Association 2. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke

Call 9-1-1 at the rst sign of stroke.

stroke.org

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Austin Medical Times

Page 8

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Flu Season During COVID-19: Is Your Family Prepared?

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his year’s impending flu season will be like no other given the overlap with the continuing COVID-19 pandemic. Late September marks the start of Fall, and October means lower temperatures and seasonal influenza. It’s also time – especially for those living with cancer, and their families and caregivers – to get an annual flu shot.

Yes, even during a global pandemic, flu shots are strongly recommended.

We’re already coping with one contagious respiratory virus. How are we supposed to prepare for another widespread infection? While it’s still unclear how COVID-19 will impact the severity of flu season, we do know that cancer patients and those 65 years and older are at higher risk for flu c o m pl ic at io n s, according to the National Institutes of Health (NIH).

Because of the current pandemic, we’re already taking many of the preventative steps helpful for fending off the seasonal flu, such as washing hands more often, disinfecting frequently touched surfaces, and wearing face coverings in public. But there can be significant risks if the viruses overlap and infections begin to overwhelm healthcare systems, deplete testing supplies, and harm those with compromised immune systems, including cancer patients. That’s why everyone should practice extra caution this year, taking the necessary steps to slow COVID-19 and stop the flu in its tracks.

Get your flu shot.

Yes – especially during COVID-19.

The World Health Organization (WHO) recommends everyone 6 months of age or older should be vaccinated for the flu every season. This is crucial for cancer patients, their caregivers, and families.

The flu shot is proven to be safe and effective for people with cancer, and healthcare providers have been issued guidance that ensures the safety of

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administering the flu vaccine during COVID-19.

Wear a mask.

In the same way that masks protect you, and those near you, from spreading and contracting COVID-19, masks can help control the spread of the flu through mucus and respiratory droplets. Cancer patients, and those they interact with, should be mindful of public mask policies, especially in public places where social distancing is difficult to maintain and during in-person visits to receive care.

Socialize responsibly.

As the holidays approach, it’s hard to avoid spending time with loved ones, but continuing to practice safe social distancing will help slow the spread of the flu and COVID-19, while minimizing additional strain on hospitals amid flu

season. It’s important for cancer patients and their loved ones to know the risks and discuss any questions with your doctor.

Stay home if you’re sick.

In the era of COVID-19, flu-like symptoms can be a sign of a serious infection that is not the flu. Symptoms shared between COVID-19 and the flu include, but are not limited to: • Cough • Sore throat • Runny or stuffy nose • Fever or chills • Headache • Body aches

If you have any of these symptoms, stay home. Make a plan with your family or a caregiver for medical supplies or other necessities. It’s important for people with cancer to call their doctor immediately if they get a fever.

It’s understandable to experience anxiety about the impending flu season and COVID-19. Talk to your doctor about concerns related to your risk for infection. Don’t wait until flu season hits close to home. Get your flu shot and continue being vigilant to prevent the spread of COVID-19 and the flu.

Austin Medical Times

Page 9

Healthy Heart Keys to The Best Possible Stroke Recovery Even Now The COVID-19 Pandemic Shouldn’t Reduce Access To Stroke Rehabilitation

By The American Heart Association

W

orld Stroke Day is October 29, and, for the 795,000 lives changed by stroke in the U.S. each year, rehabilitation offers a way to achieve the best possible recovery from a stroke. Even as the COVID-19 pandemic changes the way healthcare is delivered, it is important for stroke survivors to take advantage of the first three months after a stroke. Though recovery continues for years after a stroke, this “golden” time is when the brain is able to most quickly adjust to the damage done by the stroke so the survivor can learn new ways to do things.

An individualized rehabilitation program is critical. The pandemic has required rehabilitation professionals to get creative to deliver essential therapies to stroke survivors, such as sessions via video call.

The American Stroke Association

with a team of health care providers as some challenges – such as remembering medications or depression - may not be immediately clear.

• Support from friends and family is especially important during stroke rehabilitation. If a stroke survivor is in a rehabilitation facility that has visitor restrictions due to COVID-19, stay connected.

On October 29, 2020, World Stroke Day, the AHA will come together as One CycleNation, uniting across the US to raise funds and awareness for prevention and treatment of heart disease and stroke. CycleNation is the American Heart Association and American Stroke Association’s nationwide movement aimed to empower Americans to get heart and brain healthy.

Global architectural firm, Gensler, is supporting the movement

THE STRENGTH TO HEAL and get back to what I love about family medicine provides recovery tips and resources for stroke survivors and their caregivers: • Ask the doctor for an assessment of physical and cognitive challenges you face after stroke and a specific plan to address each challenge.

• Work with your doctor to get a plan to manage risk factors to prevent another stroke. This may include being physically active, not smoking and managing your blood pressure.

• As soon as your medical team gives the “all clear,” start your personalized rehabilitation program right away. Don’t delay.

• Talk with your health care provider about any financial constraints, such as ability to pay for medications, so a plan can be developed to identify alternative community resources.

• Communicate and follow up regularly

in Houston. “We are thrilled to be a part of this year’s One CycleNation and the Houston Heart Walk,” said Mark Talma, Technical Designer at Gensler. “The work of the American Heart Association is critical, and I am excited that Gensler can support it. The American Heart Association plays a huge role in supporting and educating the public about some of the biggest medical challenges facing our communities today. As we approach World Stroke Day in October, I am reminded of my grandmother who suffered a stroke shortly after I was born.

I watched as she struggled through the many challenges and subsequent effects that strokes can bring and the lessons in strength and perseverance she embodied. It is for this reason I am proud to be a participant and team leader for Gensler and join the AHA in support of heart health and awareness.”

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Austin Medical Times

Page 10

Prevent a “Twindemic” — Get Your Flu Shot Now

D

octors and public health officials in Austin and around the country are urging the general public to get vaccinated for the flu— and the sooner, the better.

They’re concerned that the convergence of the seasonal flu and COVID-19 might create a “twindemic” that could overwhelm hospitals.

“Every year in America, about 40 million people get the flu,” says Coburn Allen, M.D., a pediatric infectious disease specialist at Dell Medical School. “So… it’s very confusing to try and make sense of

who has COVID and who has the flu in the middle of a season that has both.”

Like COVID-19, the flu spreads via tiny droplets that shoot through the air when people cough, sneeze or talk. In this video, Allen says the flu vaccine will help reduce the amount of severe flu cases which may require hospitalization, allowing health care workers to focus their efforts on caring for coronavirus patients.

Allen says a good model for the U.S. is the Southern Hemisphere, where flu season runs from April to September.

Pandemic Pregnancy: How Do Depression and Anxiety Affect Expecting Moms, Babies During COVID-19?

A

mother’s mental health during pregnancy and in the first few weeks after delivery can have a profound impact on not only her health outcomes, but her child’s as well, according to a meta-analysis

published this September in JAMA Pediatrics. Reproductive mental health expert Jeffrey Newport, M.D., is available this week to explain this study, and to delve further into how the pandemic might

Australia, for example, just experienced a record low flu season. That’s likely because about four times as many people have been vaccinated for flu in Australia than this time last year.

“The flu vaccine works.

We know that it prevents about 40 to 60 percent of cases, on average,” says Allen.

“It’s not perfect, but when you look at the severe cases, it decreases hospitalizations significantly.”

The benefits are even more stark in children, Allen says. They’re about 50 percent less likely to die of the flu, if they’ve been vaccinated for the virus.

worsen mental health for pregnant women.

“This pandemic is definitely taking its toll on our collective mental health, and for pregnant moms, the depression and anxiety many of us are experiencing during COVID could be more pronounced and potentially dangerous,” said Newport, director of UT Health Austin’s Women’s Reproductive Mental Health clinic and a professor of psychiatry at Dell Medical School.

In addition to discussing the study’s implications, Newport is available to

Almost everyone over the age of six months should get a flu shot, especially those in high-risk groups. That includes adults over 65 years old, those with underlying conditions like heart disease, pregnant women, caretakers and essential workers.

answer questions including: • How might pandemic-related stress affect moms and babies?

• Should you delay getting pregnant until after the pandemic?

• How can you protect your mental health during COVID-19 if you’re already pregnant?

• How safe is it to treat anxiety or depression during pregnancy with medication?

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Page 12

Alternative Stroke Treatment Proposed to Protect Emergency Health Care Workers Against COVID-19

R

esearchers are proposing the use of an alternative treatment for acute ischemic stroke to reduce health care workers’ exposure to COVID-19 in hospital emergency departments, according to an editorial published in the latest edition of JAMA Neurology.

Specifically, the researchers are suggesting replacing the commonly used stroke drug alteplase with a similar but less frequently used treatment called tenecteplase.

Alteplase and tenecteplase both fall in the category of clot-busting drugs known as tissue plasminogen activators, or tPA. “Treating patients suffering from acute stroke in the emergency department during the pandemic is an especially vulnerable situation for clinicians, because stroke victims can’t always provide their own

history to screen for COVID-19 and the urgency of assessing and treating stroke requires action before the results of COVID testing are known,” said co-author Steven Warach, M.D., professor of neurology at Dell Medical School at The University of Texas at Austin.

Before the COVID-19 pandemic, some stroke centers across the country had switched from alteplase to tenecteplase for treatment of stroke, because it is quicker and simpler to use, costs less, and randomized clinical trials compared to alteplase showed it is at least as effective in limiting disability caused by stroke and may even be better in opening the blocked arteries causing the stroke, according to the editorial. Tenecteplase is given as a single, five-second injection that requires about two minutes to mix, prepare and administer. In

contrast, the conventional alteplase treatment takes about an hour to deliver.

Warach co-wrote the editorial with Jeffrey Saver, M.D., a neurology professor at the David Geffen School of Medicine at UCLA. The pair contend that the simpler tenecteplase treatment may have additional advantages during the pandemic, because it cuts the amount of time health care workers spend near potentially infected patients.

Additionally, unlike alteplase, it does not require an intravenous infusion pump that follows the patient through other hospital departments and wards, possibly providing more surfaces for the virus and staff to touch.

Because alteplase is effective at reducing blood clots, it is being used to treat severe lung complications in COVID-19 patients. Some regions have experienced shortages of alteplase because of this increased demand, according to Warach.

“Tenecteplase treatment of acute stroke may be an efficient adaption to some of the challenges of the COVID-19 pandemic – reducing the exposure to health care workers to the virus and addressing shortages of alteplase supplies that might arise, especially in regions that are experiencing prolonged surges in COVID-19 hospital admissions,” said Warach.

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VA Expands Veteran Access to Telehealth With iPad Services

T

he U.S. Department of Veterans Affairs (VA) announced a new collaboration with Apple to increase Veterans’ access to virtual care benefits.

VA’s iPad program provides qualifying Veterans with cellular-enabled iPads to access telehealth services and currently helps more than 50,000 Veterans across the country connect to VA health care services virtually.

“VA will continue working diligently to provide Veterans with the tools and resources necessary to access quality health care when and where they need it,” said VA Secretary Robert Wilkie. “VA’s partnership with Apple is an integral step in helping to bridge the digital divide for Veterans everywhere. This is particularly critical during the COVID-19 public health emergency, when telehealth is being leveraged to protect the safety and well-being of both our Veterans and clinicians.”

VA has been a leader in telehealth services for decades and began the Connected Tablet program

in 2016. A VA studyfound Veterans who received tablets, reported high levels of satisfaction with care, were less likely to miss appointments and found it easier and more convenient to access VA care.

To standardize the program and provide Veterans a consistent, quality experience, VA will exclusively distribute iPads to Veterans. iPads offer Veterans the combination of portability, user experience, data privacy and security made possible through Apple’s integrated

with Apple’s expertise to help enhance the platform and ensure Veterans and health care professionals have the best telehealth experience.

“The VA’s iPad program provides unparalleled convenience and flexibility when attending my VA appointments,” said Fiona Garcia, a U.S. Air Force Veteran who served from 2001-2011. “After receiving an iPad in March, I’ve been able to receive

VA’s iPad program provides unparalleled convenience and flexibility when attending my VA appointments

— Fiona Garcia U.S. Air Force Veteran

hardware and software platform. The collaboration between VA and Apple, facilitated by the VA Secretary’s Center for Strategic Partnerships, provides VA

VA care when and where I need it most. The technology also allows me to stay connected with my doctors when I am not near a Wi-Fi connection or near the VA medical center.”

As part of VA’s commitment to supporting Veteran health care, patients can also securely view and download their personal medical data using the Health Records on iPhone feature from Apple.

Veterans who don’t currently have a video-capable device or internet service and are interested in VA’s telehealth iPad program should consult their VA health care team to determine their eligibility.

HELP US BUILD A HEALTHIER AUSTIN

Access to nutritious food is essential for a healthy, thriving community.

Learn about how we’re leading the fight against hunger at centraltexasfoodbank.org. austinmedtimes.com

October 2020

Page 14

Austin Medical Times

Self Care

Continued from page 1 proper eating and sleeping habits.

However, in order to be capable of providing the best care possible for their patients, healthcare providers must make sure that they are sustaining their energy with healthy diets and adequate sleep (at least 7 hours). Additionally, making concerted efforts to drink water throughout the day is essential, as well.

Staying hydrated not only benefits an individual’s physical health, but it also helps to improve cognitive abilities.

Take time for yourself.

Whether it’s meditation, a

brief walk outside, or a number of other methods, taking time to escape the stressful environment within a COVID-19 hospital setting is imperative for the mental and emotional well-being of healthcare professionals. Doing so allows time for processing your thoughts and feelings and gives your mind a chance to reset, which will ultimately help you focus and maintain your concentration better when you are back at work.

Remember that it is difficult to effectively help others if you are not

mentally and physically well yourself.

Monitoring your own self-care habits will help to ensure that you are in the best condition to help those who need care most during the global pandemic.

Web Development Lorenzo Morales Distribution Brad Jander

Continued from page 3 under Section 1 of the Sherman Act. 1. The Rule of Reason. Under the Rule of Reason, a Court will assess whether the anticompetitive effects of an agreement outweigh its legitimate justifications in a properly defined relevant market.

2. The per se rule. The per se rule is reserved for types of agreements that are so plainly anticompetitive that no elaborate study of the industry is needed to establish their illegality.

The Supreme Court has cautioned that the per se rule is appropriate only after courts have had considerable experience with the type of restraint at issue, and only if the courts can predict with confidence that it would be invalidated in all or almost all

instances under the rule of reason.

To date, no court has conclusively determined which rule of decision should apply to PSAs that do not result in a single entity.

Physicians and hospitals are increasing working together in a variety of ways, each with its own antitrust risks. Hospital acquisitions of physician groups raise concerns over market concentration. Contractual arrangements that are less than full acquisitions, like PSAs, can receive antitrust scrutiny for market concentration, but also for conspiring to harm competition.

Hospitals and physicians should both remain cognizant of these issues as they work together. 

you’re interested in starting your own mindfulness routine, the next time you have one minute, I encourage you to try this mindful listening exercise. If you like, it’s fine to set a timer, but the idea is just to start of small and gradually increase one’s capacity to be mindfully present.

Start off simply by closing your eyes and allowing yourself to hear all the sounds around you. Take a moment to really just immerse yourself in all the sounds going on around you. There is no need to label what you hear, don’t try and identify anything, just listen.

Let the sounds just play on your ears and just listen. That’s it. After your minute of mindful listening check-in with yourself on the quality of your experience. What did you notice? What

sounds did you hear? Were there any sounds you attended to that maybe you were previously unaware of? One minute of mindful listening can be a great illustration of how being in the present moment enriches our experiences. This simple practice is a great way to start practicing mindfulness.

The only other requirement of mindfulness is the manner in which self-awareness is cultivated: that is non-judgmentally and with a great sense of self compassion. In essence, we learn to cut ourselves some slack and allow ourselves to just be. I believe this, above all else, to be the most fundamental to living mindfully, because through cultivating a life of non-judgment and self-compassion, we cultivate a capacity to show ourselves kindness.

Mental Health

Continued from page 6 mindfulness is that the goal is to promote a relaxed state of mind, or that picturesque images of nature should be passing through the mind’s eye like some mindfulness screen saver. However, the actual practice of mindfulness more accurately deals with the deliberate cultivation of present moment self-awareness. The goal is simply being self-observant in the always present, always-changing, here-and-now. So, whatever that is for you, if it’s happening now, you’re doing it right!

One simple and easy way to start practicing mindfulness is to start off small. For starters, practicing mindfulness for just one minute sounds doable and can help build familiarity and still have benefit. So, if October 2020

Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo

Legal Matters

contract to purchase all the clinical services of a physician practice to treat patients of the hospital. The physician practice retains responsibility for day-to-day practice management and assigns its right to bill for its services to the hospital. The hospital will assume responsibility for price setting and negotiating payer contracts.

Historically, PSA arrangements have been viewed as similar to direct employment of the physicians by the hospital, which means merger law will apply. If a court determines that a PSA arrangement does not result in a single merged entity through employment or otherwise, then the antitrust statute applicable to agreements will apply: Section 1 of the Sherman Act. There are two rules of decision

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Our Profound Debt of Gratitude to all our Healthcare Professionals and First Responders

#SocialDistancing

#WearAMask

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#WashYourHands

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