Houston Medical Times News

Serving Harris, Brazoria, Fort Bend, Montgomery and Galveston Counties

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Volume 10 | Issue 8

Inside This Issue

August Edition 2020

Coping with Stress, Anxiety and Sleep Issues Amid Current Events Sleep Problems Are on The Rise For Americans, But There Are Ways To Manage Them

By Katie Console and Carlos Aleman, Doctoral students of Counseling Psychology Expert review by Carly McCord, PhD,

W Texas Heart Institute Announces 2020-21 Cardiovascular Disease Fellows See pg. 12

INDEX Legal Matters ...................... pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart....................... pg.8

Vitamin D and Your Immune System See pg. 13

ith the magnitude of COVID-19 in the United States, stress, anxiety and depression are on the rise. What’s more, reports and videos of police brutality toward Black Americans have sent the nation into outrage, and this chaos is certain to cause anxiety, stress and loss of sleep.

Even before the events of 2020 began, sleep problems have been prevalent. Insomnia is the most common sleep disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and is characterized by difficulty falling asleep, staying asleep or sleeping too little. It is estimated that about a third of adults report symptoms of insomnia.

How are recent events impacting my sleep?

Sleep problems are often associated with other mental health issues like stress, anxiety and

depression. With the restrictions put in place in many areas of the United States, more people are working from home, increasing screen time and getting less physical activity. This alone may be enough to increase stress levels, but there are also economic, medical, family and safety stressors. People are having to find new ways to adjust to

their current situation and new coping tools to manage stress. Amidst all of this, it may be normal to not sleep as well at night.

How much sleep should I get?

Many people believe the amount of sleep we need decreases as we age. However, there is actually little see Sleep... page 14

Cigna and Memorial Hermann Reach Agreement to Keep Quality Care Affordable

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igna and Memorial Hermann Cigna customers will have continued Health System have reached a access to Memorial Hermann’s multi-year agreement that ensures hospitals, facilities and providers for quality care at predictable, affordable rates.

The new agreement is structured for long-term stability and improvement of Houston’s health, while further strengthening Cigna and Memorial Hermann’s network relationship.

“We appreciate Memorial Hermann’s commitment to a lasting, value-based relationship that will provide access to quality care for

Cigna’s customers. I look forward to working with the Memorial Hermann team to deepen this relationship in the years ahead,” said Jim Hickey, President of Cigna’s South Texas market.

“Our unequivocal and enduring commitment is to the needs and best interests of the people who live here—to be an advocate for Houston’s long-term health. This new agreement with Cigna is a reflection of that commitment,” said Dr. David L. Callender, President & CEO, Memorial see Quality Care... page 14

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Legal Matters CMS To Assess Permanent Expansion of Telehealth Following Claims Data Review

By Joelle Wilson, JD, Polsinelli, PC

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eema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently released an article highlighting the impact that telehealth, which has been significantly expanded as a result of the COVID-19 Public Health Emergency (PHE), has on beneficiary access to care. The article outlined several steps that CMS will take to assess whether telehealth expansions and flexibilities should become permanent policy following the expiration of the PHE. Prior to the pandemic, Medicare covered telehealth services in very limited circumstances.

Namely, Medicare beneficiaries had to be located at a certified rural originating

site, practitioner’s had to be located at a distant site, and the telehealth services were required to be provided via an interactive audio and video telecommunications system that permits real time communication.

While CMS has long supported telehealth and telemedicine innovation efforts, the COVID-19 pandemic accelerated the use of telehealth by enabling beneficiaries to remain at home, to reduce risk of exposure to COVID-19, and access care at the same time. The use of telehealth has surged as a result of the PHE waivers and flexibilities, some of which include: • Elimination of geographic restrictions: Beneficiaries can receive telehealth from any location, including their home.

• Expansion of services: CMS added 135 allowable services.

• Pay Parity: Providers are paid for telehealth at the same rate they would receive for an in-person service.

• Expansion of Provider Type: CMS expanded the types of health care providers that can provide telehealth services, which now includes physical therapists, occupational therapists, and speech language pathologists.

• Payment for Telephone-Only Services: Medicare will pay for evaluation and management (E/M) visits provided by audio-only technology.

In addition to the aforementioned waivers and flexibilities, the Department of Health and Human Services (HHS) Office of Civil Rights and the HHS Office of Inspector General will exercise enforcement discretion with regard to certain communication technology HIPAA violations and cost sharing requirements, respectively.

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As a result of these flexibilities and the resulting increased use of telehealth, CMS analyzed Medicare FFS claims data from March 17, 2020 through June 13, 2020. The data shows that over 9 million beneficiaries received telehealth services during that time frame. CMS reports that approximately 1.7 million beneficiaries received telehealth services in the last week of April 2020 alone, compared with approximately 13,000 Medicare fee-for-service (FFS) beneficiaries receiving telemedicine in a single week prior to the PHE. Claims data shows that a significant number of beneficiaries are seeking services via telehealth, often at similar rates across demographics. see Legal Matters...page 14

August 2020

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Next-Gen Micro-CT Scan Can Lower Radiation, Offer Better Pictures Research Could ‘Transform the Landscape’ of Micro-CT Imaging

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ith a five-year, $3.2 million grant from the National Institute of Biomedical Imaging and Bioengineering, Mini Das, associate professor of physics at the University of Houston, will help usher in the next generation of micro computed tomography (CT) imaging. The project’s goal is to lower radiation dose in X-ray micro-CT imaging while improving the resolution and enhancing the contrast of three-dimensional pictures of small specimens, like tumors or biomaterials.

“This has the potential to transform the landscape of micro-CT imaging,” said Das, who recently developed the theory, instrumentation and algorithms for spectral phase-contrast imaging (PCI) to enable the use of much lower doses of radiation while delivering higher levels of image detail.

August 2020

Das’s work addresses the challenge of current in-vivo micro-CT scanning – long imaging times, harmful, yet required, high radiation dose levels needed to follow the same subject over time, and poor image contrast.

“Current X-ray and CT systems have inherent contrast limitations and dense tissue and cancer can often look similar. Even if you increase the radiation dose, there is a limit to what you can see. In addition, image noise becomes significant when increasing resolution to see fine details, often desirable when scanning small objects,” said Das. PCI detects how X-rays bend, or refract, particularly at the interface between tissues, providing a higher amount of contrast between different types of tissue. It also measures absorption and phase changes from X-ray transmission through the body. The resulting phase-enhanced

contrast depicts high fine-structure visibility adding new image features. The developed methods can also translate to-large scale CT systems.

Detecting the bending Mini Das, associate professor of physics at the University of Houston of X-rays is challenging because the bend is small and they are both bending and being the energy of every light particle absorbed in tissues at the same time, and will develop a unique spectral micro-CT system with both PCI and complicating interpretation.

“X-rays, like visible light, exhibit non-PCI capabilities. what is called dual nature - they “We are the first to show how to behave both as particles, called use photon-counting detectors in a photons or packets of light, and phase-contrast imaging setting while waves. Phase imaging methods extracting the absorption and phase capture information relevant to wave effects with quantitative accuracy. nature of X-rays unlike conventional This accurate phase retrieval, or imaging systems found in clinics recovery, is so important if you want today,” said Das. see Micro-CT Scan...page 13 Das is using a new multi-energy, or spectral, detector which can see

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Oncology Research A Caregivers Guide to Covid-19 and Cancer

By Susan M. Escudier, M.D., FACP Texas Oncology– Houston Medical Center

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aregivers play a critical role in the health and safety of cancer patients – a role that took on new meaning when the COVID-19 pandemic changed the world overnight. Whether you’re a full-time caregiver to a family member, a neighbor picking up groceries, or a trusted friend – your support and commitment to safety matter. Caregivers and other close contacts can take extra steps to protect cancer patients from COVID-19.

Understand the risk.

People with cancer, including patients currently receiving treatment, are vulnerable to illness and have a higher risk of infection and complications from COVID-19. According to the American Cancer Society (ACS), COVID-19 can impact cancer patients more seriously than those who don’t have cancer for reasons including the cancer itself, a

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weakened immune system, and certain types of cancer treatment, among others.

If you aren’t sure whether your loved one is at a higher risk, make sure the patient gets clarification from their healthcare team, with information specific to the disease and condition.

Take action and stay vigilant.

A cancer patient’s safety precautions alone aren’t enough if their caregivers and close contacts aren’t taking precautions too. The Centers for Disease Control and Prevention (CDC) provides a comprehensive list of safety guidelines at www.cdc.gov/coronavirus.

Start with the basics: • Wear a face covering – regardless of setting • Practice social distancing.

• Avoid crowds and contact with those who are sick.

• Wash your hands often.

• Disinfect surfaces.

Another important measure: stay home. With cases of COVID-19 on the rise in Texas and across the U.S., now is not the time to let the guard down on safety. Consider the potential exposure risk even with family and close friends and make decisions with the highest

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safety measures in mind.

Because COVID-19 can be spread by people who are asymptomatic, a caregiver’s actions can unknowingly expose cancer patients and others at higher risk of contracting the virus.

Know the symptoms.

Some people experience minor symptoms with COVID-19, and symptoms may look different for cancer patients or those with a weakened immune system. The ACS advises caregivers to call their physician if they or the person they’re caring for has symptoms. The most common are cough, fever, shortness of breath, loss of smell or taste, nausea, and diarrhea. Call the patient’s physician or dial 911 for more serious symptoms like difficulty breathing, pain or pressure in the chest, confusion or being hard to wake, or bluish-colored face or lips.

Mind your loved one’s mental health – and your own.

Navigating cancer during a pandemic can feel isolating to patients who are secluded from friends, family, and their communities. Isolation can lead to depression and feelings of hopelessness. Being healthy requires a focus on mental and emotional wellness along with physical wellness. Reach out

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to their physician if you feel your loved one is experiencing feelings of isolation or depression.

The stress, anxiety, and fear caused by the COVID-19 pandemic also adds a layer to the deep physical and emotional commitment made by caregivers. Self-care is critical for caregivers. Find ways to relieve stress, communicate openly, and connect in ways that adhere to safety guidelines.

The COVID-19 pandemic challenges caregivers and close contacts of cancer patients to reevaluate safety measures at home and in public. At Texas Oncology, we believe everyone plays a role in protecting vulnerable cancer patients from additional illness.

Together, we can make a difference.

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Mental Health Social Isolation: The Covid-19 Pandemic’s Hidden Health Risk for Older Adults

By Marcia Ory, PHD, MPH

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s coronavirus cases rise again, it can be hard for older adults to see any end to the need for social isolation and the loneliness that can come with it.

For months now, they have been following public health advice to reduce their risk of exposure by staying home, knowing an infection can have life-threatening complications. But sheltering at home has also meant staying distant from family, friends and the places that kept them active and engaged.

Inadvertently, the COVID-19 safety guidelines to self-isolate have created new health risks by leaving many older adults even more socially isolated and inactive than before.

We have been examining social connectedness in old age and the detrimental effects of social isolation and loneliness on physical and mental health. We’re concerned about the paradox of government directives for physical distancing that protect older

adults from COVID-19 but that might actually result in more social isolation.

We believe public health officials need to look closely at this potential risk in their messaging and identify strategies to minimize the unintended consequences.

Even before the pandemic began, national studies indicated that nearly a quarter of older Americans were socially isolated and about one-third of middle-aged and older adults experienced loneliness.

Having few social connections and feeling isolated have been associated with myriad health-related conditions, including chronic diseases and psychiatric disorders. Social isolation is now viewed as a risk factor for premature death, similar to cigarette smoking, physical inactivity or obesity.

Social distancing during the pandemic was never meant to thwart social connections, but many family members, friends and neighbors of older adults are staying away to avoid exposing their loved ones to the

virus. While that protects older adults from some health risks, the limited physical interactions reduce feelings of connectedness with others. It can also exacerbate other health risks.

Without frequent and meaningful social interactions and stimulation, older adults’ cognitive functioning can decline. As the days of isolation wear on, older adults are especially susceptible to depression and anxiety, and even suicidal thoughts.

Remaining at home also makes it harder to engage in healthy lifestyles, including physical activity and eating well.

Without exercise, muscles can

weaken, leaving older adults more prone to falling. Inactivity can also lead to weight gain and other health problems, including declining heart and lung capacity. Access to healthy food is also necessary for staying healthy and for preventing and managing chronic conditions.

While not everyone will see the same impacts, the older adults most likely to be affected include those who already experience social isolation, live alone or have limited financial resources, as well as those with multiple physical ailments, mental health see Mental Health...page 13

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August 2020

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Healthy Heart Recent Survey Shows That 7 In 10 Respondents Worry Poor Health Will Limit Their Life Experiences

By The American Heart Association

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he survey of U.S. adults from the American Heart Association and American Diabetes Association amid COVID-19 explores the role health plays in living a full life.

Seven in 10 U.S. adults worry poor health will prevent them from doing all the things they’d like to do in life, according to a new survey from the American Heart Association and American Diabetes Association.

The research was conducted by OnePoll for Know Diabetes by Heart™, a joint initiative of the American Heart Association and the American Diabetes Association which combats two of the most persistent U.S. health threats – type 2 diabetes and cardiovascular disease – and the devastating link between them.

The survey asked 2,000 U.S. adults how the COVID-19 pandemic has impacted their views on time with friends and family, and generally, the role health plays in experiencing a full life.

August 2020

Missing out on milestones and time with loved ones is a reality for millions of people in the U.S. living with type 2 diabetes. In addition to being at a higher risk of death from COVID-19 if blood glucose is poorly controlled, people with type 2 diabetes are at double the risk of developing and dying from heart disease and stroke. For adults at age 60, having type 2 diabetes and cardiovascular disease such as heart attacks, heart failure and strokes shortens life expectancy by an average of 12 years, but there is a lot people can do to lower their risk.

The survey found respondents with type 2 diabetes, heart disease or stroke are more worried that health will limit their experiences (89%, 90% and 87%, respectively) compared to respondents who don’t have those conditions (58%).

COVID-19 Pandemic Created Greater Appreciation for Daily Moments with Loved Ones Survey results revealed the COVID-19 pandemic has changed the way many think about daily moments, and how

respondents view their experiences with others. Eight in 10 respondents said the pandemic has made daily moments with their loved ones more special. Even more, 85%, said the pandemic has made them more grateful for the time they spend with their loved ones.

Eduardo Sanchez, M.D., MPH, FAAFP, American Heart Association chief medical officer for prevention, said COVID-19 shines a direct spotlight on chronic health conditions and the additional health risks they present.

“Controlling blood glucose and managing and modifying risk factors for heart disease and stroke has never been more important,” Sanchez said. “If there’s a silver lining in all of this, perhaps it’s a new

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appreciation for wellness and emphasis on controlling the controllable, the existing threats to our health that we know more about and have more tools to manage.”

Lharissa Jacobs, Vice President of Health Strategies for the American Heart Association in Greater Houston, emphasized the importance of maintaining a healthy lifestyle.

“Spending more time at home with our loved ones can be an opportunity to focus on our overall health and wellbeing.

We can make healthy eating a priority and take the time with our families to go outside together and achieve the recommended amount of exercise (150 minutes) per week,” said Jacobs.

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Financial Forecast Home Equity Loan or Line of Credit?

PlAN WISElY. YOU

WON'T GET A

By Grace S. Yung, CFP secured by your home, you could risk Midtown Financial losing the property if you default on Group, LLC your repayment.

It is also important to note that a home equity loan is not the same thing as refinancing. That’s because refinancing actually entails getting a new mortgage on your property and s we move through life, our paying off the old one with those financial priorities tend to funds. change. But one thing that usually Home Equity Line of Credit remains the same is the need (or (HELOC) want) for additional capital. Whether A home equity line of credit, your goal(s) include remodeling your or HELOC, differs from a home kitchen, expanding your business, equity loan in that it provides you saving for a child’s college education, or with a revolving amount of funds up reducing high-interest debt obligations, to a certain limit. In this case, you a home equity loan or line of credit can “draw” on the funds if and when could be a viable solution. they are needed, while leaving the How Home Equity Financing remaining amount untouched.

Works

There are usually several options

Home equity financing uses the that you can choose from when equity that you have in your home to accessing these funds, such as writing secure a loan. Because of the underlying a check and/or using a credit card.

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collateral, banks and other lenders will typically offer lower interest rates on home equity loans compared to other types of loans – especially if those other loans are not secured.

There are two forms that home equity financing can take. These include a: • Home equity loan • Home equity line of credit Home Equity Loans

A home equity loan can provide you with a fixed amount of money that must be repaid over time. Generally, up to 80% of the equity you have in your home can be borrowed. These loans – which are oftentimes referred to as a “second mortgage” – advance the full amount of borrowed funds at the beginning of the loan’s term.

Home equity loans will typically carry a fixed interest rate. Similar to many other types of loans, the monthly repayments include both principal and interest until the entire loan has been paid off.

While home equity loans can offer a number of advantages, there are also some items to keep in mind. For instance, because a home equity loan is

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Unlike a home equity loan, the interest rate on a HELOC can vary over time.

In addition, because you may not use 100% of the available credit on a HELOC, you are only responsible for repaying the amount that you actually borrow. Because of that – along with the variable interest rate – the dollar amount of your repayments can differ from one month to another.

Before committing to a home equity line of credit, there are some important questions to ask the bank or lender. These should ideally include how often the interest rate is adjusted, how long the borrowing term will last, and whether or not there is an option to convert the credit line to a fixed-rate, fixed-term loan.

Is a Home Equity Loan or Line of Credit Right for You?

In many instances, using the funds from a home equity loan or line of credit could allow you to move forward with your other financial goals. But prior to making a commitment to this type of financing, it can help to discuss all of your objectives – as well as the possible solutions - with a financial professional. 

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Texas Heart Institute Announces 2020-21 Cardiovascular Disease Fellows The Highly Coveted Program Has Played an Integral Role at THI For 55 Years

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exas Heart Institute (THI) – the world-renowned research and educational center dedicated to the prevention and care of heart disease – has announced the 13 men and women who will comprise the prestigious THI Cardiovascular Disease Fellowship at Baylor St. Luke’s Medical Center, sponsored by Baylor College of Medicine, for the 2020-21 academic year. The program dates back to 1965 and has attracted some of the brightest clinical minds from the very best medical residencies in the country.

The new class of fellows entering the program include six first-year students who will embark upon the prestigious three-year Accreditation Council for Graduate Medical Education (ACGME) General Cardiology fellowship. The 13 fellows accepted into the highly competitive program were selected out of more than 750 worthy applicants.

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“The pool of applicants is more competitive every year. Our faculty truly embraces their responsibility to provide an intellectually stimulating environment for clinical learning that includes experiences beyond the clinic, such as research, education, and outreach,” noted Dr. Stephanie Coulter, THI Fellowship Program Director. Graduates of the three-year THI/Baylor St. Luke’s Medical Center General Cardiology fellowship are subsequently invited to continue studies at Texas Heart Institute as part of an advanced subspecialty fellowship in either electrophysiology, interventional cardiology, advanced heart failure, or cardiac imaging. This year, six graduates of the program accepted invitations to pursue additional subspecialty training.

In addition to these six, THI is honored to welcome Giancarlo Acosta, who comes to THI for subspecialty training after completing a cardiology

Program Director Dr. Stephanie Coulter

fellowship at the Joan Edwards School of Medicine at Marshall University.

These fellows will stay an additional one to two years, expanding their clinical training and engaging in progressive research and education programs related to their subspecialty.

Specifically, four fourth-year students will study Interventional Cardiology, two fourth-year students will study Clinical Cardiac Electrophysiology, and aforementioned fifth-year student Giancarlo Acosta will study Advanced Heart Failure.

In conclusion, Dr. Coulter expressed, “Our cardiology and subspecialty fellowships have been meticulously stewarded for over 50 years by stalwart clinical educators who take tremendous pride in creating a uniquely diverse learning matrix for our doctors in training. While the teaching faculty provide the matrix, the fellows are the real glue that holds

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the system together. Their curiosity and drive elevate the caliber of our program and, in turn, patient care in this complex healthcare ecosystem.”

THI 2020-21 CARDIOVASCULAR DISEASE FELLOWS The 2020-21 class entering the THI Cardiovascular Disease Fellowship at Baylor St. Luke’s Medical Center are as follows: General Cardiology Fellows Anish Badjatiya Medical School: Case Western Reserve University School of Medicine Residency: Duke University, Isabel Balachandran Medical School: University of Connecticut School of Medicine Residency: Beth Israel Deaconess Medical Center, Adam Brouillard Medical School: Jacobs School of Medical and Biomedical Sciences at University of Buffalo Residency: Washington University in St. Louis/Barnes-Jewish Hospital, see THI 55 Years...page 13

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Vitamin D and Your Immune System

By Denise Hernandez, role in bone health but studies have MS, RD, LD also shown that vitamin D enhances Houston Medical Times

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itamin D deficiency is a global public health issue. About 1 billion people worldwide have a deficiency and 50% of the population demonstrate a vitamin insufficiency. The Institute of Medicine considers blood serum levels of <50 ng/mL to mark a deficiency or insufficiency in most of the general population. This is based on what is generally considered adequate for bone and overall health.

Because of this, vitamin D has been of vast interest in the health and wellness sector. It is well known for its

antimicrobial effects in immune cells, which in turn allows your body to fight against pathogens. The pathway to doing so is intricate and works through many aspects of the immune system.

Vitamin D comes from three potential sources: food, skin contact with UV rays, or supplements. Very few foods contain (natural, non-fortified) relevant amounts of vitamin D: fatty fish (salmon, mackerel, sardines, cod liver oil) or some types of mushrooms (Shiitake), especially if sundried.

Getting adequate amounts from the sun depends on the following factors: season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen. The suggestion is to get approximately 5-30 minutes of sun exposure between 10 AM and 3 PM

at least twice a week to the face, arms, legs, or back without sunscreen.

Dietary supplements include both D2 (ergocalciferol) and D3 (cholecalciferol) forms. Both appear to be effective for bone health, but D3 tends to be more potent at high doses.

Adults without deficiencies should aim to get at least 600 IU per day, not exceeding 4,000 IU. The amount of vitamin D required to treat a deficiency depends largely on the degree of the deficiency and underlying risk factors.

If you find yourself having a deficiency, speak to your doctor or a dietitian to determine the best route for you.

Addressing vitamin D deficiencies and insufficiencies is crucial to not

only supporting bone health but also supporting immune health. If you would like to see whether you have a deficiency, the Results Center now offers functional testing that can test for 33 vitamins and minerals, including vitamin D. We also offer supplements that contain both vitamin D and K because of their synergistic relationship. A particular study called the Framingham Offspring Study, found that higher serum levels of both vitamins D and K were associated with stronger immune function and a balanced inflammatory response.

Contact us at nutrition@houstonian. com for more information.

leaving home. For example, when Planning time for online classes, going outside, practice everyday calls with friends, reading, puzzles, preventive actions: Carry a cloth cooking, gardening or home repairs face covering, tissues and hand can give meaning to the days.

2. Stay physically active. Find sanitizer; encourage others to wear exercises that can be done at home cloth face coverings when out in or in the immediate neighborhood, public; and avoid close contact like walking. Many virtual and with others who are not wearing online physical activity and face masks to the extent possible. health promotion programs are 5. Think of others. Regularly reach available, which can remotely out to others who may need to foster engagement and connection hear a friendly voice on the phone. to others.

Volunteering has been shown to have many positive health benefits, 3. Know your risk. Take the AARP and there are online opportunities Foundation’s Connect2Affect tool for doing so. to assess your risk for being socially isolated, and refer to the local 6. Accept help from others. Many assistance directory for support individuals and organizations are working hard to keep seniors services you might need.

4. Don’t be afraid to leave home, socially connected. Remain open but do so wisely. New CDC to accepting the kindness and guidelines emphasize what older support from family members, adults can do to stay safe when friends, health care providers and

social service agencies.

Strategies for a healthier response

Despite the ongoing COVID-19 pandemic and need for social distancing, there are ways to help older adults remain connected.

Phone calls and online platforms offer older adults ways to safely connect with peers and professionals, as well as friends and family. Online learning and internet-based volunteering can also provide interaction and intellectual stimulation.

For older adults, staying healthy and safe means also staying socially connected while following public health recommendations. Public health efforts to stop the spread of COVID-19 should also take into account the importance of social connectivity for maintaining older adults’ physical and mental health.

Mental Health

Continued from page 6 concerns and memory problems.

What can older adults do?

Although the immediate demand for COVID-19 screening, testing and treatment has made it more difficult for health care and aging organizations to reach out to older adults, many still offer opportunities for older adults to engage in a variety of meaningful ways within their homes or communities and to connect with helpful resources, services and programs. Some states, like Iowa, have set up free programs to connect isolated residents with counselors and support groups by phone and online during the pandemic.

Older adults can also take steps on their own to stay active and engaged: 1. Plan your day. While the days may seem to be an endless blur, keep up with daily routines like getting out of bed, getting dressed and being engaged with small activities.

Micro-CT Scan

THI 55 Years

Continued from page 4 to discriminate between cancers and normal tissues,” she said.

Multiple patents and publications from her group have shown significant preliminary data and feasibility for the new methods.

Both physics and engineering

Continued from

page 12 students will work together on the project, which involves international collaboration. Das also has a dual appointment in physics and biomedical engineering allowing an interdisciplinary and collaborative approach to her work. 

Milad El Hajj Medical School: Louisiana State University, New Orleans Internship: Medical University of South Carolina, Jordan Gales Medical School: Case Western Reserve University School of Medicine Residency:

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Duke University, Patrick Marcus Medical School: Loyola University Chicago Stritch School of Medicine Residency: University of Washington, Interventional Cardiology Fellows Aaron Bush, Justin Maxfield, Michael Millard, Agam Patel Clinical Cardiac Electrophysiology Fellows Austin Howard, Grant Heberton Advanced Heart Failure Giancarlo Acosta  August 2020

Page 14

Sleep

Continued from page 1 research to support this belief and more evidence to support that we are more likely to have sleep disorders as we age.

Adults should get seven to nine hours of restful sleep every night.

What can I do about my sleep issues?

Fortunately, there are many interventions to help manage sleep issues as well as other mental health problems that may be causing sleep issues. First are the things you can still control while the environment around you feels uncertain. Having variety in your schedule within the boundaries of physical distancing is important.

Try exercising, eating healthy or trying new hobbies during blocks of free time.

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Whatever you choose, incorporating these activities in your everyday routine will physically target mental health symptoms that contribute to sleep problems.

It’s also essential to continue to feed your social functioning through phone conversations, video chatting or small, physically distanced interactions.

With in-person interactions, the Centers for Disease Control and Prevention recommends wearing a face mask, keeping a distance of 6 feet and gathering outdoors if possible to reduce risk of spreading COVID-19.

With these guidelines in place, you could talk with a friend in a park, set up an outdoor movie or even play a game like charades with a few friends in your backyard. Another suggestion is making sure that you maintain good sleep hygiene. For example, avoid

caffeine, exercise and screen time close to bedtime. Instead, try relaxing activities like reading, meditating or journaling. It can also be helpful to create a relaxing bedtime routine and go to bed at the same time daily.

If you are struggling with keeping up with your daily routine, social interactions or your mental health throughout these difficult times, consider reaching out to a mental health professional. Mental health professionals can provide much needed interaction, hold you accountable to your goals and help you find new perspectives amid this pandemic and social justice awakening. It may also be helpful to consult a medical professional on the use of supplements and sleep medication as needed.

as communities continue to face a variety of challenges due to COVID-19.

“We know this is a difficult time for everyone and we are happy we were able to resolve this,” Hickey said. “I’d like to extend thanks to our clients and customers for their patience during these negotiations. We recognize

the uncertainty these discussions created and we’re glad we were able to reach an affordable solution without interrupting access to quality care at Memorial Hermann.” 

Management (E/M) visits are among the most common form of telehealth service being provided, with 38% of beneficiaries receiving such visits via telehealth. Mental health services have similarly seen frequent use amid the pandemic, with 60% of beneficiaries receiving such services via telehealth.

CMS claims data provides significant and timely insight into the benefits that telehealth has on beneficiary access to care. CMS announced several steps, outlined below, the agency is taking to assess the temporary waivers and flexibilities to determine their potential for permanent implementation via regulatory action.

1. CMS will assess whether telehealth is clinically appropriate and safe for patients compared to in-person visits.

This would include examining outcomes related to new versus established patients receiving telehealth services, particularly with regard for those with acute needs.

2. CMS will assess Medicare payment rates for telehealth services. Such assessment will take into account resource needs for telehealth visits and determine if rate adjustments are necessary.

3. CMS will assess program integrity implications to protect beneficiaries and tax payer dollars.

Such assessment will take into account the potential for fraud and abuse in telehealth.

While the current telehealth waivers and flexibilities are set to end in line with the expiration of the PHE, there is hope that many of the temporary policies will become permanent. The steps CMS is taking to assess the current state of telehealth is vital for a future that seeks to expand access to care in line with technological advances. 

Legal Matters

Continued from page 3

August 2020

Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Robert Cox Brad Jander

Office: 713-885-3808 Fax: 281-316-9403

Continued from page 1

Beneficiary Use of Telehealth by Location Rural 22% Urban 30% Beneficiary Use of Telehealth by Sex and Age Female 30% Male 25% Below age 65 34% Age 65-74 25% Age 75-8 29% Over age 85 28% Beneficiary Use of Telehealth by Race/Ethnicity Asian 25% Black 20% White 27% Hispanic 28% Other 26% Beneficiary Use of Telehealth

by Dually Eligible (beneficiaries that qualify for both Medicare and Medicaid) vs Medicare-only Beneficiaries Dually Eligible 34% Medicare-Only 26% Office visits or Evaluation and

Published by Texas Healthcare Media Group Inc.

Accounting Liz Thachar

Quality Care

Hermann Health System. “We’re pleased to work together on behalf of the people we jointly serve and we are grateful to our patients and families for their patience during these uncertain times.”

The announcement comes at an important moment for greater Houston

HOUSTON

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All submissions sent to Houston Medical Times are considered property and are to distribute for publication and copyright purposes. Houston Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430

Houston Medical Times

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