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

HOUSTON

Volume 11 | Issue 5

Inside This Issue

May Edition 2021

Physician Shortages in Medical Specialties By Linda Beattie

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Houston Methodist, Rice University Launch Neuroprosthetic Collaboration See pg. 12

INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Healthcare Real Estate... pg.6 Healthy Heart..................... pg.10

hysician shortages have been affecting America’s healthcare workforce for decades, contributing to a range of problems, from limited patient access and poorer outcomes to physician burnout. Despite ongoing efforts by many healthcare leaders and academics to sound the alarm and find long-term solutions, “there doesn’t seem to be a solution in sight,” said Andy Olson, divisional vice president of recruiting for internal medicine subspecialties at Merritt Hawkins, the nation’s leader in physician recruitment. “The physician shortage has always been part of the conversation, unfortunately,” said Olson who has worked in physician search and recruitment at Merritt Hawkins for more than 15 years. “We see the challenges every year, but sadly nothing has changed. Multiple bills have been introduced, and Merritt Hawkins’ leaders have even testified before Congress.” While Congress recently voted to add graduate medical education

funding to last year’s COVID-19 relief package and support 1,000 new residency slots, this increase will not come close to bridging the gap between physician supply and demand. The projected shortfalls in physician specialties The most recent projections from the American Association of Medical Colleges (AAMC) in June of 2020 show that the United States could see a shortage of between 54,100 and 139,000

physicians by 2033. This would include shortfalls in both primary and specialty care. The range of physician shortages projected by 2033 include the following: • Primary care -- between 21,400 and 55,200 physicians • Nonprimary care specialties – between 33,700 and 86,700 physicians see Physician Shortage...page 14

New Discoveries of Deep Brain Simulation Put It on Par with Therapeutics Museo Medical Office Building Tops Out In Museum District See pg. 13

Possibly Speeding the Process and Allowing Personalized Treatment

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espite having remarkable utility in treating movement disorders such as Parkinson’s disease, deep brain stimulation (DBS) has confounded

researchers, with a general lack of understanding of why it works at some frequencies and does not at others. Now a University of Houston biomedical engineer is presenting evidence in Nature Communications Biology that electrical stimulation of the brain at higher frequencies (>100Hz) induces resonating waveforms which can successfully recalibrate dysfunctional circuits causing movement symptoms. “We investigated the modulations in local field potentials induced by electrical stimulation of the subthalamic nucleus (STN) at therapeutic and

non-therapeutic frequencies in Parkinson’s disease patients undergoing DBS surgery. We find that therapeutic high-frequency stimulation (130–180 Hz) induces high-frequency oscillations (~300 Hz, HFO) similar to those observed with pharmacological treatment,” reports Nuri Ince, associate professor of biomedical engineering. For the past couple of decades, deep brain stimulation (DBS) has see Deep Brain ... page 14

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Houston Medical Times

Legal Matters Keeping Virtual Meetings and Electronically Distributed Documents Secure By Erin L. Muellenberg Polsinelli, PC

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OVID-19 has pushed the healthcare industry across the Rubicon on the legitimacy of virtual meetings and it appears there is no going back. The COVID-19 pandemic has created a rapid transition to a world of “new” technology where meeting virtually will be strongly favored over in-person meetings. Privacy and security are of the utmost importance for medical staff meetings because of the sensitive nature of the issues presented. There will be discussion of specific peer review issues and practitioner performance that require absolute confidentiality. When a case is identified for peer review as the result of an adverse event or near miss, the practitioner reviewing the case is charged with determining whether the event or near miss was avoidable. While the initial review usually occurs outside

a meeting, questions may arise requiring collaboration to determine whether the care was appropriate. This may result in the committee seeking to review the record during a meeting. With the electronic medical record comes the challenge of sharing records during a peer review committee meeting without violating patient privacy or leaving a footprint in the record that later becomes discoverable. The convenience of virtual meetings with screen sharing provides a secure way to share only certain portions of a record allowing for collaboration and full discussion. This requires the medical staff to think in advance and develop policies that will address information security issues. When crafting policies and protocols for virtual meetings, medical staff members should keep the following tips in mind: • Ensure that the conferencing platform the medical staff is using meets the enhanced requirements for telehealth conferencing. There are multiple platforms available with enhanced security features to protect sensitive healthcare information. • Password protect meetings to prevent uninvited attendees. When

possible, create a new meeting login ID for each meeting and require each participant to have a unique participant ID. The host should ask each attendee to identify him or herself and not allow any unidentified attendee to participate. • The meeting host should utilize a “waiting room” for participants. For the greatest level of protection, the meeting host should also disable the “Join Before Host” function and admit each participant individually. Ensure that the meeting host “locks” the meeting once all participants have joined. The host should expel any individual from the meeting who is not an invited participant if the hosting platform allows the host that ability. • As a confidentiality requirement, a rule or policy can be established requiring individuals to keep their video on at all times and use earphones. They may also be asked to confirm they are in a secure private location and based on the type of meeting can be asked to show the

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group a video of the area from where they are taking the meeting. The chair of the meeting should issue a confidentiality reminder at the start of all meetings. • Many video conferencing platforms have the ability to record the meeting. A medical staff may want to record its video conferences for record-keeping purposes in certain circumstances which should be clearly defined in a policy. One instance might be in the event of a hearing or appeal procedure from an adverse action. Medical staff legal counsel should be consulted to determine if this is appropriate under the circumstances. Otherwise, see Legal Matters...page 13

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New Study Looks at Long-Term Outcomes and Costs Of High-Risk Non-Muscle Invasive Bladder Cancer Treatment Study Provides Data to Assist Physicians in Treating a Potentially Lethal Type Of Bladder Cancer

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new research study leveraging a database from the largest equal access health system in the US, the Department of Veteran Affairs, offers insight into the outcome of specific treatment patterns for advanced bladder cancer patients. Lead author Dr. Stephen Williams of the University of Texas Medical Branch says it is one of the first comprehensive studies looking at both the outcomes and the costs of treating a potentially lethal and devastating type of bladder cancer. The study was published today in JAMA Network Open, a medical journal focused on clinical care, and healthcare innovation. The study looked at the results of

using bacillus Calmette-Guérin (BCG) therapy for patients with high-risk non-muscle invasive bladder cancer (NMIBC). The analysis involved 412 high-risk NMIBC patients culled from a database of 63,139 patients diagnosed with bladder cancer who had received more than one dose of BCG within VA centers across the United States from Jan. 1, 2000, to Dec. 31, 2015. “Studies like this are incredibly important in allowing physicians to understand the effectiveness of a specific treatment and downstream costs. It is particularly important when dealing with a cancer that is increasing in numbers over the last three decades with a high mortality rate with advanced cases,” said

Williams, who is Tenured Professor and Chief of the Division of Urology as well as Director of Urologic Oncology at UTMB. In addition, the study looked at the costs of treating bladder cancer for this same population. Bladder cancer has one of the highest lifetime treatment costs of all cancers. The cost of treating bladder cancer in the United States in 2020 approached nearly $6 billion alone. According to the study, total median costs at one, two and five years from start of BCG induction were $29,459 ($14,991-$52,060), $55,267 ($28,667-$99,846), and $117,361 ($59,680-$211,298), respectively. Patients who progressed had significantly higher costs (5-yr, $232,729 median cost), with outpatient care, pharmacy, and surgery-related costs contributing largely to the higher costs associated with disease progression.

“This study allowed us to determine where differences in treatment patterns led to differences in outcomes according to specific features of this disease. This is important as this group of patients are at increased risk of progression to advanced stage disease which is a deadly diagnosis. It also underscores the need for additional therapies to reduce the risk of disease progression and further improve outcomes,” Williams said.

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Oncology Research Wellness Tech 101: Get the Download on Tracking Your Health By Gurjyot Gury K. Doshi, M.D., Texas Oncology

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hen it comes to fighting against and preventing cancer, we’re getting smarter every day. While each development in cancer research teaches us more about how to fight the disease, new technological adva ncements are also equipping patients with novel tools for prevention and early detection. Knowing and listening to your body is especially important during cancer treatment. Telemedicine, wearable technology, and smartphone applications make it more convenient than ever to take control of your health. Telemedicine Telemedicine, sometimes called telehealth, is not new, but the COVID-19 pandemic expanded

use of the technology that allows patients and providers to meet virtually by computer, smart phone, or tablet. Telemedicine offers patients direct access to a range of providers and specialists, while saving time and expense by limiting travel. While telemedicine does not completely eliminate the need for patients to travel for certain aspects of treatment and in-person appointments, it allows patients to connect with their care teams from the comfort of their homes between in-person treatments. Wearable technology A potentially lifesaving accessory, wearable technology is more than a fashion statement. Smart devices like watches typically rest directly on your skin, which enables it to closely monitor cancer-related risk factors like physical activity. According to the American Cancer Society, 26% of adult Americans report no leisure-time activity, and the National Cancer Institute reports nearly 70% of adults are considered overweight or obese.

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Smart watches can help track your daily activity, with personalized goals and reminders to encourage you to get up and moving. Evidence shows that losing just 5% to 10% of one’s body weight may result in improved health, and maintaining an active lifestyle can reduce your risk of disease, including cancer. For those already fighting cancer, physical activity has been shown to improve quality of life. Benefits of regular exercise include a lower risk of heart disease; healthier bones, muscles, and joints; improved balance and circulation; reduced nausea and fatigue; a lower risk of anxiety and depression; improved self-esteem; improved capabilities to maintain social contacts and quality of life; and more control over weight. Health apps Smart phone applications – commonly known as apps – can help track and manage your health in ways that are personalized for your needs and health goals. Health apps can help you monitor specific symptoms such as weight, mood, sleep, and nutrition, as well as track patterns and detect changes in your symptoms over time. By consistently logging symptoms in health apps,

you can collect important data to guide your health decisions and potentially share with a physician. For cancer patients, research has shown patients who used apps to track their symptoms typically had a higher quality of life. Health apps can also help you track toward goals such as smoking cessation. Nearly one in five deaths in the U.S. is linked to smoking, and 30% of all cancer deaths are attributed to smoking. Apps for smoking cessation can help users stay accountable and on track while trying to quit. It’s important to take an active role in your health, and technology is making it easier than ever to do just that. As with anything new, there’s a learning curve – but the results could reveal details and patterns that will help you and your care team better manage your symptoms, making the time investment well worth it.

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Special Focus

Healthcare Real Estate Diagnosis on Houston Healthcare Real Estate By Ashley Cassel, Senior Vice President of Healthcare Advisory Services at Transwestern

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s a Medical Real Estate specialist, I field many questions from doctors and practice groups regarding the current condition of Houston’s medical office market and new trends as a result of COVID. Below are a handful of notable trends our team is seeing on rates, term, design, and construction. Rates. Although tenants are hoping to see a softening of economic lease terms, rental rates in most medical office buildings are holding firm. While traditional office buildings face the challenges of the work from home model, most of our medical tenants are back in full swing. We have seen some of our solo practitioner and smaller tenants downsize, consolidate, or opt to retire during the pandemic but on the flip side, we are seeing many of our larger

tenants expand and grow. Inner loop, The Woodlands, and Clear Lake are strong sub-markets and doctors should expect to pay a premium for medical spaces there. Katy, Sugar Land, Spring, and Pasadena/ Baytown are going to be the best bet for a bargain rental rate or the flexibility of a shorter lease term. Tenants may have an opportunity for some free rent (which they wouldn’t have seen in 2018 or 2019) but most of the institutional landlords would prefer to increase the construction allowance versus offering any rent discounts. For dentists and doctors that prefer the visibility of a shopping center location, there may still be a deal to be had if they act quickly but the retail market is coming back robustly in 2021. Term. When the pandemic began there was an abundance of uncertainty and some landlords were offering shorter term leases. Now that things are stabilizing and the medical demand has returned, it will be harder to find a short-term lease option. Typically lease terms are 3-5 years on renewals and 5-10 years for new leases. If you are nearing retirement or need some time to

consider an employment opportunity, merger, or consolidation, it’s probable that you can work with your landlord on a short-term lease but you should expect a rate premium associated with the extra flexibility. Design Trends. Right or wrong, patients associate the quality of care they receive with the quality of the office or facility they are visiting. Now more than ever we see a trend where doctors’ offices and hospital lobbies resemble high-end hotels. A suite must be efficient and functional but it is also equally vital to have the quality touches that give patients confidence and comfort. It’s common to see medical suites incorporate the go-to designs found in residential real estate such as trendy light fixtures, earth tones, quartz countertops, luxury wall coverings, wooden furniture, and gold accents. Construction. Construction costs continue to rise even with the 2020 slowdown. There are supply

chain constraints worldwide which puts construction material costs on the rise. The nation-wide residential demand is also very high with remodels and new construction which is also limiting the supply of labor and materials. Landlords understand that medical groups may need extra help with build-outs due to their lost revenues from 2020 and might offer an above standard construction allowance or offer to amortize the overage costs into the rental rate. Tenants should look at cost-saving options by working with credible architects and contractors but should be careful not to skimp on quality. Real estate decisions are critical to the success of a medical practice. My best advice is to work with brokers, architects, contractors, and landlords that specialize in healthcare real estate and understand your business’s needs, constraints, and will provide solutions and ideas to help elevate your practice.

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Recent Nursing Graduate Joins U.S. Navy Nurse Corps Class of August 2020 College Of Nursing Graduate Earns National Defense Service Medal and Begins Nurse Residency Program at U.S. Naval Medical Center By Kala McCain

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acy Failla, BSN, RN, knew she wanted to challenge herself after graduating in August 2020 from the Texas A&M University College of Nursing. Applying to join the United States Navy Nurse Corps provided an opportunity to do just that. “I have lived in the College Station area my whole life close to family, and although I loved every bit of it and it will always be my home, I wanted to challenge myself and be more independent for a little while,” Failla said. “I looked into several ways to do that, and knew it would be a great honor to serve in the military, and provide quality health care to the men and women who serve our country as well as their families.”

May 2021

The U.S. Navy Nurse Candidate Program offers graduates an avenue to serve on active duty for at least four years. In return, they receive a stipend that helps offset the investment made to earn a bachelor of science in nursing degree. After her acceptance into the competitive program, Failla completed five weeks of didactic classroom instruction, sexual assault prevention and response training, officer etiquette and a 50-yard swim qualification. She also underwent intense simulation training aboard the USS Buttercup where she worked alongside classmates conducting damage control procedures to prevent ship compartment flooding and fire suppression training wearing total encapsulated Level-A Hazmat

suits. Failla joined 78 fellow graduating naval officers at the U.S. Navy Officer Development School – Officer Training Command in Newport, Rhode Island, to receive the National Defense Service Medal. Failla has now started her six-month long nurse residency program at the U.S. Naval Medical Center in San Deigo, California, where she is preparing to become a nurse on the Perinatal Specialty Care Unit. She will complete a 12-week orientation and ultimately provide care to critical antepartum patients on this specialized mother/

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baby unit. When asked by Lt. Col. (ret) LeRoy Marklund, DNP, MPH, RN, CNS, CCRN, CEN, CNRN, clinical assistant professor at Texas A&M College of Nursing, how her initial U.S. Navy Nurse Corps training went, Failla replied with a smile. “I was hesitant at first about leaving home and reporting for the U.S. Navy Officer Development School in Rhode Island, but I soon realized as I ventured through military training that serving with my fellow shipmates was the most honored moment in my life.”


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Nearly One in Three Young Adults In The U.S. Does Not Know Common Stroke Symptoms By American Heart Association

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t a time when stroke is on the rise among young adults, nearly 30% of U.S. adults younger than age 45 do not know all five of the most common stroke symptoms, according to research published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association. MayisNationalStrokeAwareness Month and stroke is the No. 5 cause of death and a leading cause of disability in the United States. Each year, 10% to 15% of the nearly 795,000 people in the U.S. who have a stroke are young adults — between ages 18 and 45. Recent studies suggest stroke incidence is declining in the general population, yet stroke incidence and hospitalizations have increased by more than 40% in young adults in the past several decades. “While the medical community

this survey were noted as: • • Numbness of face/arm/leg; • Confusion/trouble speaking; • Difficulty walking/dizziness/loss of balance; • Trouble seeing in one/both eyes; and • Severe headache. The researchers found: • Almost one in three respondents were not aware of all five common stroke symptoms. • About 3% of respondents, representing nearly 3 million young adults, were not aware of any stroke symptom. The researchers also found that nearly 3% of young adults surveyed would not contact emergency medical services if they did see someone experiencing perceived stroke symptoms. “That finding could be a matter of life and death,” said Mitchell S. V. Elkind, M.D., M.S., FAHA,

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has made significant improvements to reduce the severity and complications of strokes with early interventions, these efforts are of limited value if patients do not recognize stroke symptoms,” said study author Khurram Nasir, M.D., M.P.H., M.Sc., chief of the division of cardiovascular prevention and wellness at Houston Methodist DeBakey Heart and Vascular Center in Houston, Texas. “Time is critical for treating stroke. The earlier people recognize symptoms, the better their chances are to reduce long-term disability from stroke.” To assess how well the U.S. population understands common stroke symptoms, Nasir and colleagues reviewed responses to the 2017 National Health Interview Survey. As part of the annual survey, adults are asked several questions about stroke including identifying five of the most common stroke symptoms, which in May 2021

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FAAN, president of the American Heart Association. “With proper, timely medical attention, stroke is largely treatable. The faster you are treated, the more likely you are to minimize the long-term effects of a stroke and even prevent death,” said Elkind. Elkind says the American Heart Association/American Stroke Association advocates the use of the letters in “F.A.S.T.” to spot stroke signs and to know when to call 9-1-1: • Face drooping • Arm weakness • Speech slurred • Time to call 9-1-1 Nasir said F.A.S.T. is among a number of creative and community-engaged initiatives that have aimed to increase public recognition of common stroke symptoms.


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Screening for Skin Disease on Your Laptop New Artificial Neural Network Design Can Differentiate Between Healthy and Diseased Skin

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he founding chair of the Biomedical Engineering Department at the University of Houston is reporting a new deep neural network architecture that provides early diagnosis of systemic sclerosis (SSc), a rare autoimmune disease marked by hardened or fibrous skin and internal organs. The proposed network, implemented using a standard laptop computer (2.5 GHz Intel Core i7), can immediately differentiate between images of healthy skin and skin with systemic sclerosis. “Our preliminary study, intended to show the efficacy of the proposed network architecture, holds

In artificial intelligence, deep learning organizes algorithms into layers (the artificial neural network) that can make its own intelligent decisions. To speed up the learning process, the new network was trained using the parameters of MobileNetV2, a mobile vision application, pre-trained on the ImageNet dataset with 1.4M images. “By scanning the images, the network learns from the existing images and decides which new image is normal or in an early or late stage of disease,” said Akay. Among several deep learning networks, Convolutional Neural Networks (CNNs) are most commonly

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promise in the characterization of SSc,” reports Metin Akay, John S. Dunn Endowed Chair Professor of biomedical engineering. The work is published in the IEEE Open Journal of Engineering in Medicine and Biology. “We believe that the proposed network architecture could easily be implemented in a clinical setting, providing a simple, inexpensive and accurate screening tool for SSc.” For patients with SSc, early diagnosis is critical, but often elusive. Several studies have shown that organ involvement could occur far earlier than expected in the early phase of the disease, but early diagnosis and determining the extent of disease progression pose significant challenge for physicians, even at expert centers, resulting in delays in therapy and management.

used in engineering, medicine and biology, but their success in biomedical applications has been limited due to the size of the available training sets and networks. To overcome these difficulties, Akay and partner Yasemin Akay combined the UNet, a modified CNN architecture, with added layers, and they developed a mobile training module. The results showed that the proposed deep learning architecture is superior and better than CNNs for classification of SSc images. “After fine tuning, our results showed the proposed network reached 100% accuracy on the training image set, 96.8% accuracy on the validation image set, and 95.2% on the testing image set,” said Yasmin Akay, UH instructional associate professor of biomedical engineering.  medicaltimesnews.com

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Houston Methodist, Rice University Launch Neuroprosthetic Collaboration Center for Translational Neural Prosthetics and Interfaces to Focus On Restoring Brain Function After Disease, Injury

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eurosurgery’s history of cutting diseases out of the brain is morphing into a future in which implanting technology into the brain may help restore function, movement, cognition and memory after patients suffer strokes, spinal cord injuries and other neurological disorders. Rice University and Houston Methodist have forged a partnership to launch the Center for Translational Neural Prosthetics and Interfaces, a collaboration that brings together scientists, clinicians, engineers and surgeons to solve clinical problems with neurorobotics. “This will be an accelerator for discovery,” said center co-director Dr. Gavin Britz, chair of the Houston Methodist Department of Neurosurgery. “This center will be a human laboratory where all of us — neurosurgeons, neuroengineers, neurobiologists — can work together to solve biomedical

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problems in the brain and spinal cord. And it’s a collaboration that can finally offer some hope and options for the millions of people worldwide who suffer from brain diseases and injuries.” Houston Methodist neurosurgeons, seven engineers from the Rice Neuroengineering Initiative and additional physicians and faculty from both institutions form the center’s core team. The center also plans to hire three additional engineers who will have joint appointments at Houston Methodist and Rice. Key focus areas include spinal cord injury, memory and epilepsy studies, and cortical motor/ sensation conditions. “The Rice Neuroengineering Initiative was formed with this type of partnership in mind,” said center co-director Behnaam Aazhang, Rice’s J.S. Abercrombie Professor of Electrical and Computer Engineering, who also directs the neuroengineering initiative,

which launched in 2019 to bring together the brightest minds in neuroscience, engineering and related fields to improve lives by restoring and extending the capabilities of the human brain. “Several core members, myself included, have existing collaborations Behnaam Aazhang Marcia O’Malley with our colleagues at Houston Methodist in the area of neural prosthetics. The creation blend of talent,” said Rice’s Marcia of the Center for Translational Neural O’Malley, a core member of both the Prosthetics and Interfaces is an exciting new center and university initiative development toward achieving our and the Thomas Michael Panos Family common goals.” Professor in Mechanical Engineering. The physical space for the center’s “We will be able to design studies to test operation includes more than 25,000 the efficacy of inventions and therapies square feet of Rice Neuroengineering and rely on patients and volunteers Initiative laboratories and experimental who want to help us test our ideas. The spaces in the university’s BioScience possibilities are limitless.” Research Collaborative, as well as Houston Methodist an extensive build-out underway at neurobiologist Philip Horner describes Houston Methodist’s West Pavilion the lab as “a merging of wetware with location that’s expected to be completed hardware,” where robotics, computers, late this year. The Houston Methodist electronic arrays and other technology facility will include operating rooms — the hardware — is incorporated and a human laboratory where into the human brain or spinal cord ongoing patient/volunteer diagnosis — the wetware. The centerpiece of and assessment, device fabrication and this working laboratory is a zero-gravity testing, and education and training opportunities are planned. see Brain Function...page 13 “This partnership is a perfect

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The Framework Museo Medical Office Building Reaches Construction Milestone as Cutting-Edge Institute For Specialty Surgery Tops Out In Museum District Next-Gen Professional Medical Building Marches Steadily Toward Its Anticipated Q421 Debut

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useo Medical Office Building (5115 Fannin Street) celebrated a major construction milestone yesterday with an intimate topping out ceremony hosted by Mann Eye Institute’s Dr. Mike Mann, whose Testa Rossa Properties is spearheading the forward-thinking mixed-use project designed by PJMD Architects principal and Philip Johnson protégé Marko Dasigenis in tandem with Dallas-based Huitt-Zollars. The 10-story Class “A” LEED

Attendees on the 7th Floor Balcony

Certified Medical Office Building takes its cues from early 20th Century analytical cubism and will be defined by the art movement made famous by Pablo Picasso and Georges Braque that used fragmentation to break up the forms and reconstruct them in abstract fashion to create an illusion of depth and perception. Like the avant-garde art form that is Cubism, Dasigenis’ architectural vision utilizes similar compositional tools that carves up Platonic geometric forms to create a sculptural building that deviates from convention. CBRE Vice President Brandy Bellow Spinks organized the event attended by a robust mix of medical professionals and commercial real estate brokers specializing in Healthcare & Life Sciences. Welcoming guests as they arrived, Dr. Mann and the CBRE brokerage team ushered attendees up to the building’s 7th Floor Balcony, where they toasted the building’s progress with champagne and individual charcuterie offerings courtesy of Event Elementz. “The ability to open the

Legal Matters

paramount. The medical staff should distribute documents via secure or encrypted means whenever possible. Continued from page 3 In circumstances where participants need to share their screen to share documents, the individual should be the bylaws or virtual meeting policy mindful to close all other applications should state that recordings of the and documents before activating the meetings are not kept and minutes screen sharing function to avoid of the meeting are kept in the usual unwanted sharing of information. course of business. • Security of documents disseminated If the nature of the meeting is to medical staff members before particularly sensitive, video conferencing or during virtual meetings is may not be appropriate. There are some

Brain Function

Continued from page 12 harness connected to a walking track, with cameras and sensors to record feedback, brain activity and other data. While the Houston Methodist space is being built, collaborations already are underway between the two institutions, which sit across Main Street from one another in the Texas Medical Center. Among them are the following: • O’Malley and Houston Methodist’s Dr. Dimitry Sayenko, assistant

professor of neurosurgery, will head the first pilot project involving the merging of two technologies to restore hand function following a spinal cord injury or stroke. O’Malley will pair the upper limb exoskeleton she invented with Sayenko’s noninvasive stimulator designed to wake up the spinal cord. Together, they hope these technologies will help patients achieve a more extensive recovery — and at a faster pace. • Rice neuroengineer Lan Luan, assistant professor of electrical and computer engineering, and Britz,

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doors of this long-envisioned project – even just to a select few for the time being – is a true achievement, but this topping out milestone would not be possible without the tremendous teams tasked with building it from the ground up, including but not limited to Mission Con st r uction,” Rendering of Museo Medical Office building noted Dr. Mike Mann, whose eponymous Mann Eye “Museo will be a dynamic place Institute will occupy the building’s top for a new generation of medical service floor. Houston-based medical practice providers who will be attracted to the Texas Laparoscopic Consultants (TLC) building’s state-of-the-art facilities and previously announced it had also signed oversized floorplates – not to mention a 9,130-square-foot lease on the ninth the dramatic marble-clad entrance to floor with several additional lease the soaring lobby. We can’t wait to open announcements coming soon. Museo to the entire Houston community All told, Museo MOB will not this Fall,” added Mike Mann. only be a new kind of specialty surgery Museo Medical Office Building center for internal medicine specialists, represents Phase I of an expansive and dermatologists, plastic surgeons, and forward-thinking mixed-use urban other medical and nursing practitioners, project inspired by the surrounding it will become a destination for neighborhood’s dedication to art, science cutting-edge treatments of all kinds and culture that will ultimately serve as with the added convenience of a prime the Gateway to the Museum District.  Museum District location.

circumstances in medicine where there is no getting around face-to face contact. The same rings true for medical staff meetings. There will be situations of a nature so sensitive, that face-to-face meetings are required. In those cases, consider small limited attendance or a hybrid between virtual and in-person. Full virtual and hybrid meetings are likely here to stay and will set the standard for meetings in the future. Conclusion Although adversity pushed us into

the virtual world, our natural resilience and creativity has led to a “now-normal” that includes remote meetings thru digital technology with the direct benefit of increased participation in meetings, renewed interest in peer review, and substantial cost savings compared to in-person meetings. With the resulting increased efficiency and economy in time and expenses, virtual meetings will likely remain for the foreseeable future.

a neurosurgeon, are collaborating on a study to measure the neurovascular response following a subarachnoid hemorrhage, a life-threatening stroke caused by bleeding just outside the brain. Two-thirds of people who suffer these brain bleeds either die or end up with permanent disabilities. Luan invented very small and flexible electrodes that can be implanted in the brain to measure, record and map its activities. Her work with mice could lead to human brain implants that may help patients recover from

traumatic brain injuries caused by disease or accidents. • Aazhang, Britz and Taiyun Chi, assistant professor of electrical and computer engineering at Rice, are collaborating on the detection of mild traumatic brain injuries (mTBI) from multimodal observations and on alleviating mTBI using neuromodulations. This project is of particular interest to the Department of Defense.

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May 2021


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Physician Shortage

Continued from page 1 ∆∆ Surgical specialties – between 17,100 and 28,700 physicians ∆∆ Medical specialties – between 9,300 and 17,800 ∆∆ Other specialties (i.e. pathology, radiology, psychiatry) – between 17,100 and 41,900 physicians The annual AAMC study found that physician demand will continue to grow faster than supply, largely driven by the aging population and an expected 10.4 percent population growth between 2018 and 2033. The population under age 18 is projected to grow by only 3.9 percent, indicating low growth in demand for pediatric specialties. Yet the 65 and older population is projected to grow by 45.1 percent, indicating high demand for physician specialties that predominantly care for older Americans. Additional findings showed that if currently underserved populations are given equal access to healthcare during this time period—which is a national goal—it could create even deeper shortages, with demand rising by an additional 74,100 to 145,500 physicians. Demographics affecting shortages in medical specialties “The country’s demographics are definitely changing, and as we age as a nation, our physician population is impacted greatly,” Olson said. “We have made great advances in how we care for our elderly population,” he continued. “The average life span continues to increase, which is wonderful, but the number of babies being born each year also continues to rise, or at minimum remain steady. What that tells us is there are more patients to care for now than ever before in our history.” “Most medical specialties also have roughly 50 percent or more of their physicians at the age of 55 or older,” Olson noted. “We are on the verge of a perfect storm.” He pointed out that older patients

Deep Brain

Continued from page 1 been the most important therapeutic advancement in the treatment of Parkinson’s disease, a progressive nervous system disorder that affects movement in 10 million people worldwide. In DBS, electrodes are surgically implanted in the deep brain and electrical pulses are delivered at certain rates to control tremors and other disabling motor signs associated with the disease. May 2021

Houston Medical Times

have more chronic conditions and issues that affect physician demand in a variety of specialties, including a greater number of neurologic conditions, endocrinology issues, gastrointestinal issues and even cancer diagnoses. Physician shortages are also expected to get worse as physician supply will be negatively impacted by a wave of retirements and older physicians who tend to cut back their hours. ”Without a plan to increase supply, it will get worse before it gets better,” Olson said. According to the 2020 American Medical Association Physician Specialty Report, (using data up through December 2019), 44.9 percent of all active physicians were 55 or older. The specialties with the largest number of physicians in the near-retirement group included: • Pulmonary disease physicians – 90.1 percent are age 55+ • Preventive medicine physicians – 69.6 percent are 55+ • Anatomic/clinical pathologists – 67.7 percent are 55+ • Cardiologists – 62.8 percent are 55+ • Psychiatrists – 61.3 percent are 55+ • Thoracic surgeons– 60.1 percent are 55+ • Orthopedic surgeons – 57.7 percent are 55+ “Although many of the physicians in these specialties extend their careers to help cover the need, they reduce their total hours worked, and many hospitals have bylaws that no longer require them to take call,” said Mike Jowdry, vice president of recruiting for Merritt Hawkins, who has worked in various divisions of the company for the last 20 years. “We have yet to properly address increasing our residency and fellowship programs to make up for the perfect storm of physicians retiring or slowing down and the increase in overall demand for their services,” Jowdry added. The top physician specialties in “absolute demand” A June 2020 white paper by Merritt Hawkins outlined a number of factors that are affecting physician

supply, demand and staffing during and post COVID-19. In the months leading up to the pandemic, the following specialties were found to be the top 10 in “absolute demand” – i.e., number of job openings vs. number of physicians in a given specialty: 1. Neurology 2. Psychiatry 3. Gastroenterology 4. Hematology/Oncology 5. Dermatology 6. Urology 7. Otolaryngology 8. Geriatrics 9. Rheumatology 10. Family Medicine While it’s hard for anyone to predict how these specialties experiencing shortages may change in the new COVID environment, the paper’s authors note several emerging trends, including an increase in overall demand for physicians: “Most of the factors driving physician supply and demand, including an aging population, widespread chronic illness, and a static supply of physicians, will remain in place. It can be expected that general health, both physical and mental, will be negatively affected by the pandemic, accelerating demand for doctors. Added to these factors will be increased volatility in the physician workforce, as doctors react to what for many has been an extremely challenging time that has compromised their finances and their health.” “The ‘new normal’ therefore is likely to resemble the old normal in at least one regard -- shortages of both primary care and specialist physicians will prevail,” they concluded. Pressing on toward future solutions “What to do about physician shortages is long-term question; a lot of conversations still need to take place to overcome that expected shortage of more than 130,000 physicians by 2033,” said Jowdry. “There is a lot of work that needs to be done. Telehealth will certainly allow for some physicians to have greater reach in their coverage, which will help, but that’s just one piece of the puzzle.”

Until now, the process to find the correct frequency has been time consuming, with it taking sometimes months to implant devices and test their abilities in patients, in a largely back and forth process. Ince’s method may speed the time to almost immediate for the programming of devices at correct frequencies. “For the first time, we stimulated the brain and while doing that we recorded the response of the brain waves at the same time, and this has been a limitation over the past years. When you stimulate with electrical pulses,

they generate large amplitude artifacts, masking the neural response. With our signal processing methods, we were able to get rid of the noise and clean it up,” said Ince. “If you know why certain frequencies are working, then you can adjust the stimulation frequencies on a subject-specific basis, making therapy more personalized.” DBS is also being explored for the treatment of many other neurological and psychiatric indications, including Obsessive-Compulsive Disorder. 

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