USA Health Magazine Spring 2020 by USA Health

Vol. 2, Issue 1

Getting back to work

Lane Frazier returns to normalcy after reconstruction surgery

Ways to stay safe in the heat and sun

Match Day

Class of 2020 celebrates residency matches

Vol. 2, Issue 1

Top: USA Health providers test patients for COVID-19 at the drive-through testing site set up at Ladd-Peebles Stadium. On the cover: Lane Frazier of Flomaton, Ala., had chest wall reconstruction surgery in April 2019. After recovery, he was able to return to his job as a landscaper and enroll in community college.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Table of Contents WELCOME.............................................4 NEWS USA Health.............................................5 College of Medicine.............................8 Research................................................11 By the Numbers...................................15 Watch Us Grow....................................16 Prevention............................................18 FEATURES Class of 2020 celebrates Match Day – at a distance...............20 Senior medical students share their journeys to residency.

Chest wall reconstruction surgery gives teen back his life......................24 Lane Frazier no longer lives in fear that his heart or lungs will fail because of a birth defect. An integrative approach to managing diabetes.......................28 USA Health Integrative Health and Wellness offers services to treat the whole person. Neurosurgeon develops complex spine center to change lives.............30 Richard Menger, M.D., dramatically improves patient Renea Richards’ quality of life. Virtual reality creates immersive learning environment........................34 Students explore human anatomy through virtual reality.

Increasingly, cancer treatment comes in a pill..................36 An in-house specialty pharmacy provides the latest targeted cancer drugs. Med School Café................................38 Outreach............................................ 40 Faces/Achievements/ Retirements/In Memoriam.............. 44

30 USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

WELCOME

VOLUME 2, ISSUE 1 SPRING 2020 USA HEALTH MAGAZINE 2451 University Hospital Dr. Mobile, AL 36617 www.usahealthsystem.com EXECUTIVE EDITORS John V. Marymont, M.D., MBA Owen Bailey, MHA, FACHE MANAGING EDITOR Lindsay Lyle ASSOCIATE VICE PRESIDENT OF MARKETING & COMMUNICATIONS Gary Mans

ear Friends: What a strange time we are living in. The COVID-19 pandemic truly has changed our lives in so many ways. Your regionâ&#x20AC;&#x2122;s only academic health system has distinguished itself as the leader for the upper Gulf Coast. From a member of our faculty serving on the state pandemic task force, to our chief medical officer providing the public with vital health information, to our USA Health Physicians Group standing up a drive-through test site with the City of Mobile, to researchers exploring the use of microscopic particles on gloves to prevent exposure, USA Health was there to help make our community safe. We will share with you much more about our efforts related to COVID-19 in a future issue. In this issue of USA Health Magazine we share with you several ways we are helping people in the region live longer, better lives. You can read about how one of our neurosurgeons is transforming complex spinal care for our patients. Our efforts related to developing innovative ways to train the next generation of physicians, and the results of those efforts through where they match for their residency training, are highlighted. And you can learn about how we are providing our patients a fully integrated approach to managing their diabetes. We anticipate you will find this issue informative and hope you enjoy it.

Owen Bailey, MHA, FACHE Chief Executive Officer & Senior Associate Vice President for Medical Affairs

USA HEALTH MAGAZINE

John V. Marymont, M.D., MBA Vice President for Medical Affairs Dean, University of South Alabama College of Medicine

VOL. 2, ISSUE 1

DIRECTOR OF MARKETING & COMMUNICATIONS Paul Taylor DIRECTOR OF CREATIVE SERVICES Marie Katz CONTRIBUTING WRITERS Casandra Andrews, Lindsay Lyle, Gary Mans, Carol McPhail, Lindsay Mott, Brittany Otis, Nichelle Smith, Paul Taylor PHOTOGRAPHY Mike Kittrell, Bill Starling

NEWS

Robotic technology takes aim at lung cancer Alabama has the worst mortality rate from lung cancer in the United States, with the five-year survival rate at only 16.8 percent, according to a 2019 report by the American Lung Association. A high death rate suggests that patients are being diagnosed at a late stage. “When you have a cancer at an advanced stage, we usually have pretty low cure rates,” said Robert Gilbert, M.D., radiation oncologist and assistant professor of interdisciplinary clinical oncology at the Mitchell Cancer Institute. USA Health now is using advanced technology to improve the prognosis for the state’s lung cancer patients. This year, USA Health became the only academic medical center in Alabama (and one of only 32 sites nationally) to combine two technologies to diagnose lung cancer more quickly and accurately. USA Health teamed up with Pulmonary Associates of Mobile to combine the robot-assisted Auris Health Monarch for bronchoscopy with rapid onsite evaluation (ROSE). These technologies are part of USA Health’s comprehensive lung cancer program that encompasses pulmonology and pathology, and surgical, medical and radiation oncology. “The Monarch and ROSE technologies provide the most advanced lung bronchoscopy,” said Karen A. Fagan, M.D., professor of internal medicine and pharmacology and chief of the pulmonary and critical care medicine division at the USA College of Medicine. “They allow us to see directly inside the lung and evaluate tissue samples immediately.” Taken together, the Monarch and ROSE enable physicians to view, biopsy and test lung nodules in a single visit. Such advances

A physician uses a controller to perform a robot-assisted bronchoscopy using the Auris Health Monarch. USA Health is the only academic medical center in the state of Alabama to combine Monarch technology with rapid on-site evaluation.

offer patients the promise of immediate answers rather than partial results that could require more diagnostic procedures. “Using these kinds of technologies that allow us to get at tumors at a much earlier stage will create more survival for patients,” said Peter Lutz, M.D., a pulmonologist with Pulmonary Associates of Mobile. To conduct a bronchoscopy, a specially trained physician uses a computer-assisted controller that borrows its design from the gaming industry. Cameras provide continuous vision while GPS navigation offers guidance based on 3D models of the patient’s lung. The physician navigates the scope to see into hard-to-reach areas of the lung and inserts tiny tools to obtain a tissue sample – achievable with Monarch in 93 percent of patients.

Alternative diagnostic options currently available for lung cancer, such as needle biopsy, are limited in accuracy, safety or invasiveness. They can lead to false positives, false negatives or side effects such as a collapsed lung. With rapid onsite evaluation, the physician can have the tissue tested for cancer by a pathologist then and there. The pathologist peers into a microscope to determine whether the patient has cancer. “We can have a preliminary diagnosis in minutes,” said Elba Turbat-Herrera, M.D., director of pathological services at the Mitchell Cancer Institute. “This saves time and expense for the patients.” Quick results also allow physicians to obtain additional samples as needed for diagnosis and additional testing, she said.

NEWS BRIEFS NIH Instrumentation Grant enhances biomedical research Together, 11 investigators at the USA College of Medicine and the Mitchell Cancer Institute were awarded a Shared Instrumentation Grant from the National Institutes of Health (NIH) to purchase a Seahorse XFe24 extracellular flux analyz-

er. “This instrument measures the bioenergetic health of the cells and tissues by measuring various parameters of mitochondria – the cellular powerhouses,” said Mikhail Alexeyev, Ph.D., professor of physiology and cell biology at the USA College of Medicine and principal investigator on the grant.

University Hospital named Comprehensive Stroke Center University Hospital has earned a Comprehensive Stroke Center designation from DNV GL Healthcare, reflecting the highest level of competence for treatment of serious stroke events. University Hospital is the only certified comprehen-

sive stroke center in southwest Alabama and one of only three in the state. The certification is based on standards set forth by the Brain Attack Coalition and the American Stroke Association, and affirms that the medical center addresses the full spectrum of stroke care – diagnosis,

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

NEWS

Resident physicians partner with Orange Beach EMS to improve emergency care

Andrew Warner, M.D., center, an emergency medicine resident physician with USA Health, prepares the ambulance for a call with Orange Beach firefighters/paramedics James McMurray, left, and Zachary Lavender, right.

Patient care doesn’t start when a patient is offloaded from a gurney in the hospital’s emergency department. “It starts in the field,” said Paul Henning, M.D., associate program director of the Emergency Medicine Residency Program at USA Health and medical director of Orange Beach Fire/Rescue. “The expertise that a patient gets in the field can determine outcomes.” Henning, who also serves as an associate professor of emergency medicine at the USA College of Medicine, said it is vital that physicians understand what happens in the prehospital stage of care. For that reason, residents in USA Health’s Emergency Medicine Residency Program, established in July 2019, are given the opportunity to rotate with emergency medical services (EMS) in Orange Beach, Ala. Stationed at the Orange Beach Fire Department, resident physicians respond to emergency calls alongside paramedics and firefighters. “It bridges the gap between the physician and the paramedic. Seldom, if ever, do physicians have this kind of exposure to prehospital emergency services,” Henning said. “It also gives the physician more perspective of what the paramedics are doing in the

field. If we have an opportunity to improve the prehospital scope of practice, then we have accomplished our goals.” Justin Thomas, M.D., was the first USA Health resident to rotate in Orange Beach. He said the experience opened his eyes to the constraints paramedics endure while working in the field. “It’s much different being at a hospital with all the resources at your disposal versus working from an ambulance with limited capabilities,” Thomas said. Andrew Warner, M.D., took a nonlinear path to emergency medicine. A former Green Beret, Warner served with the U.S. Army 5th Special Forces Group on tours in Iraq and Afghanistan. He went on to earn his medical degree from the University of Cincinnati College of Medicine. Warner has great respect for the Orange Beach first responders, who “epitomize true dedication to patient care and outcomes,” he said. “I have further learned to appreciate just how critical those precious seconds in the prehospital setting are for patient survivability.” The partnership is mutually beneficial for USA Health’s emergency medicine residency program and Orange Beach’s paramedical and fire-rescue services. Resident physicians and paramedics are able to provide a higher level of care to patients while learning from one another. “I love to hear the interaction between our staff and the residents,” said Orange Beach Fire Chief Mike Kimmerling. “Even when they’re not running calls, there is a tremendous amount of knowledge being transferred in their conversations.” Residents gain more diversity of exposure in Orange Beach than in a larger city like Mobile, Henning said. “Most fire and rescues in large cities are close to hospitals, so the transport time is usually 10 minutes or less, whereas in Orange Beach the time could be significantly longer,” he said. “When they are able to render care for a longer period of time, they have the chance to sharpen their skills and have more patient exposure.” Before starting the EMS rotation, the residents are required to be fully licensed by the state and to have completed an online medical direction course, Henning said. If any questions or concerns arise, Henning and other emergency medicine attending physicians with USA Health are always available to provide their medical direction.

NEWS BRIEFS treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes.

nephrolithotomy (mini PCNL) – for the treatment of kidney stones. “By combining the kidney access with the stone treatment and removal procedures, what was once multiday, multi-procedure process, becomes a one-day event,” said urologist William Terry, M.D. “This, combined with the

Urology introduces mini PCNL for kidney stone removal University Urology now offers a minimally invasive procedure – mini percutaneous 6

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

less invasive nature of the mini system, potentially decreases length of stay, length of recovery and overall cost.” Medical students and faculty share artistic talents The USA College of Medicine’s Wellness Council hosted an Arts In Medicine presentation this

past winter. About 50 medical students and faculty members gathered in a coffee house in downtown Mobile to support one another’s artistic endeavors, such as visual art, music and poetry. Medical student Zachary Lazzari, a member of the Wellness Council, said, “A physician is tasked with caring

NEWS

Surgical oncology team has expertise and experience treating sarcoma Because sarcomas vary widely and are so rare, they require a multidisciplinary approach with a high level of expertise and experience to treat them successfully. At USA Health, the surgical oncology team – J. Harrison Howard, M.D., Spencer Liles, M.D., and Annabelle Fonseca, M.D. – provides just that. Sarcoma is a rare cancerous tumor that occurs in connective tissues – fat, nerve, muscle and bone – impacting anywhere from 5,000 to 10,000 patients each year in the United States, which is just 1 percent of all cancers reported annually. The rare nature of these tumors underscores the need for unique expertise and experience for successful treatment.

There are about 50 types of sarcomas, and they range in treatment difficulty, from slow growing and easy to treat to aggressive and more difficult to treat. “There’s a huge spectrum in how the tumors behave, and that’s why it’s important to have a physician with extensive training and experience treat these,” said Howard, who is fellowship-trained in treating sarcomas. The treatment for these tumors also varies: surgery alone, radiation and surgery, or chemotherapy and radiation followed by surgery. J. Harrison Howard, M.D., center, is part of USA Health’s surgical oncology team.

Fonseca performs first robotic liver resection in south Alabama In the fall of 2019, Annabelle Fonseca, M.D., performed the first robotic liver resection in the southern part of Alabama at University Hospital. Fonseca is a surgical oncologist specializing in hepato-pancreatobiliary and foregut surgery and serves as assistant professor of surgery at the USA College of Medicine. Robotic liver resection is an advancement in surgical techniques that makes it possible for a surgeon to reach and remove some liver tumors using tiny incisions in a minimally invasive approach, thus avoiding the need for a large incision and potential complications such as wound infections.

for any human who presents with a complaint, so we must develop culturally, emotionally and socially in order to treat the disease and care for the patient. I believe art allows one to grow in all these ways and more.”

The robotic system also allows for enhanced operative visualization during surgery. The approach reduces the patient’s hospital stay significantly, provides better pain control with less medication, decreases the formation of scar tissue, and allows a quicker return to daily activities. According to Fonseca, faster recovery from surgery also allows cancer patients to start or return to chemotherapy more quickly, which results in better treatment results. Surgery is an important part of the treatment of many types of liver cancers, both those that start in the liver and those that

Networking event connects female physicians and medical students With the goal of bringing together local women in medicine, the USA College of Medicine, in conjunction with the Medical Society of Mobile County, hosted the first Women in Medicine Social in Novem-

spread to the liver from other organs. However, the liver often is not easily accessible for surgery because it is tucked away in the upper-right portion of the abdomen. “The use of robotic procedures for hepatopancreato-biliary diseases is still in its infancy, in a sense. Most of these operations are still done with conventional ‘open’ surgeries,” Fonseca said. “Our surgical oncology team is excited to bring new and advanced treatments for patients in the area by offering robotic resections for liver and pancreatic tumors, as well as other gastrointestinal tumors.”

ber. Medical student and event organizer Megan Hood, president of USA’s chapter of the American Medical Women’s Association, said, “The women physicians in our community are outstanding humans, and they really humbled all of us by being so genuinely interested in creating connections with

the medical students who look up to them.” Muslims in Medicine interest group addresses physician burnout Spiritual practices can improve the mental well-being of physicians and even their patients. Medical student Arslan Arshad,

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

COLLEGE OF MEDICINE NEWS

Virtual clinic enhances curriculum for first-year medical students

Medical students collaborate on a case in the Virtual Continuity Clinic.

On the first day of medical school at the USA College of Medicine, a team of firstyear students is already meeting its first patient — a 29-year-old female specialist in the Alabama National Guard who’s at risk of developing diabetes and hypertension. The professor wants to know: How can she improve her health? He also asks: Will her insurance cover it? Welcome to the Virtual Continuity Clinic, where first-year students at the USA College of Medicine are assigned virtual patients as part of the Foundations of Human Health course. The students will make recommendations based on medical, social and financial information and follow up throughout the academic year as if they were the patients’ primary care providers. “We want to start them out with a challenge,” explained Jeffrey Sosnowski, M.D., Ph.D., assistant dean for medical ed-

ucation. Sosnowski developed the virtual patient clinic with colleague David Weber, Ph.D., associate professor of physiology and cell biology at USA. “This curriculum gives them a taste of what’s to come,” Sosnowski said. The virtual clinic builds upon educational changes made in 2010, when the USA College of Medicine adopted an integrated organ-systems-based approach for the first two years of medical school. Faculty wanted to broaden the students’ education, incorporate more active learning, and equip them with the tools they need to treat the whole patient. First-year USA medical student Jade Kantzler and her team considered the case of a 38-year-old man, an engineer who is married with three children and earns $120,000 a year. He has a family history of diabetes, hypertension and lung cancer. A

smoker, he also eats mostly fast food and drinks beer every day. Kantzler and her team were excited. “I thought this project was a great idea because we were given the opportunity to think about practical situations doctors face each day,” she said. Her team recommended nutritional counseling, exercise three to four times a week, support to quit smoking, health screenings and low-cost day care for his children. “Teams were chosen to present their plans as clinical faculty commented on how to better present plans or pointed out faults,” Kantzler said. “I have learned that each patient I’ll see will be different in their own way and that the best way to treat them is to take into consideration all of the factors that influence their health.” Professors tested the concept of virtual patients last year and continue to add nuances. Weber, a certified health coach and personal trainer, developed a grading rubric for students incorporating exercise, nutrition, stress reduction, mental health and social support, and even the impact of military service. This year, students are choosing health insurance plans for their virtual patients. They use the virtual patient’s budget and health history to select a plan that is affordable and best meets the patient’s needs. The faculty plan to weave the virtual clinic throughout medical curricula, perhaps into the third and fourth years when students are working in hospitals and clinics. “This is just the beginning,” Sosnowski said. “We’re hoping to continue to develop this over time.”

NEWS BRIEFS a member of the Muslims in Medicine interest group, took this message to USA students this past fall. In a year when research findings described physician burnout as “a public health crisis,” it was a timely topic. “Research has demonstrated that overall long-term mental health is optimized 8

USA HEALTH MAGAZINE

more so by finding meaning within life as opposed to simply experiencing pleasant emotions such as happiness,” Arshad said. Prakash publishes article on mitochondrial DNA Aishwarya Prakash, Ph.D., assistant professor of biochem-

VOL. 2, ISSUE 1

istry and molecular biology at the USA College of Medicine, was published in Environmental and Molecular Mutagenesis. Her article, titled “Mitochondrial DNA: Epigenetics and Environment,” also was selected as the editor’s choice for the edition.

Bassam presents at national meeting Bassam Bassam, M.D., professor of neurology at the USA College of Medicine and director of the neuromuscular program at USA Health, spoke at the American Association of Neuromuscular & Electrodiagnostic Medicine annual

COLLEGE OF MEDICINE NEWS

Learning on the job: Students explore specialties in CLINIC rotations Using an otoscope, Jessica Pham, a second-year student at the USA College of Medicine, looked into a pediatric patient’s ears. There was only one problem: she didn’t know what she was supposed to be looking for, exactly. Her clinical preceptor, pediatrician Matthew Cepeda, M.D., noticed Pham’s hesitation. Later, he sat down and let her look into his own ear while holding up a picture of an eardrum for reference. Once she understood, Pham became more confident at identifying inflamed eardrums – a condition she saw frequently in her pediatrics rotation. “I loved how Dr. Cepeda took that much time out of his day to teach me,” Pham said. Cepeda, a 2003 graduate of the USA College of Medicine, is in private practice in Mobile. He gives back to his alma mater by serving as a preceptor in the Clinically Integrated Introductory Course (CLINIC), which provides first- and second-year medical students experiences in career exploration as they rotate through various specialties. Traditionally, medical students begin clinical rotations during the third and fourth years of medical school. Cepeda said his role as a preceptor means “slowing down the pace of practice to allow for teaching and preparing students for what life may look like in the future.” This entails priming his staff to operate in a teaching-friendly environment, preparing families to interact with medical students, and reviewing his patients’ conditions ahead of time to develop teaching points. First-year USA medical student Clay Crout connected what he encountered in clinic and the material he was learning in class. “We saw a patient that gave Dr. Cepeda the opportunity to teach me about croup and RSV,” Crout said. “The very next day we learned about croup in class, and I was able to connect the clinical presentation with the pathological cause.” Pooja Revanna, a first-year USA medical student, rotated with Richard Jason Valentine, M.D., a family medicine physician in private practice in Saraland, Ala. “Family practice is great because you get to see a variety of patients with a wide spectrum of symptoms,” Revanna said. “You can see an entire family starting from a child to their grandparent. It’s a long-term relationship you keep with these patients, and trust is extremely important.” Valentine said he is able to show medical students the variety

meeting in Austin, Texas. During the event, Bassam was the course chair and led two faculty workshops. Pomrenke named patient safety manager Becky Pomrenke was named patient safety manager for USA Health. Pomrenke is work-

ing to grow a “culture of safety” that empowers employees on the front lines to play a key role in improving safety for patients and employees. She brings years of experience in safety, clinical systems analysis, education and nursing to the position.

Jason Valentine, M.D., a family medicine physician, talks with first-year medical student Pooja Revanna. Valentine, a 2001 USA College of Medicine graduate, serves as a CLINIC preceptor for medical students.

of care that family medicine offers – from inpatient hospital care to acute illness and injury in the clinic through chronic disease management and industrial medicine. Students quickly integrate into the care team, he said, becoming the initial contact with patients on their first day. “It was very much like the standardized patient encounters we practice, just less formal,” said first-year USA medical student Chris Johnson. The experience helped Johnson become more comfortable with gathering patient history and relaying the information to the attending physician in a concise manner, he said. A 2001 graduate of the USA College of Medicine, Valentine has served as a clinical preceptor every block since the class of 2011. “I have loved every minute of it, and, in a way, I have been paying back the opportunity given to me by others,” Valentine said. “The most rewarding aspect has been helping students toward their goal of graduation and into their particular specialty, hopefully instilling them with a respect for the art of medicine, patient relationships, as well as understanding the unique and difficult role that family physicians fill.”

USA Health welcomes care access director Shelby Smith was named director of care access for USA Health’s outpatient academic practice, which includes clinic locations in both Mobile and Baldwin counties. In this new position, Smith is responsible for planning and implementing a

comprehensive system that improves patient access to faculty physicians and advanced care providers as well as their patient experience. Prior to joining USA Health, Smith worked with Indiana University Health, the largest healthcare system in Indiana with 17 hospitals and approximately 30,000 employees.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

COLLEGE OF MEDICINE NEWS

Satisfaction high among USA College of Medicine graduates

Reflecting on their satisfaction with their medical education experiences, graduates of the USA College of Medicine give their alma mater high marks. Results from the 2019 Medical School Graduation Questionnaire, administered annually by the Association of American Medical Colleges, showed that 98 percent of graduating students at the USA College of Medicine were satisfied overall with their medical education, compared with 89 percent nationwide. The stellar results are not new. Satisfaction rates among USA College of Medicine graduates have remained between 92 percent and 98 percent since at least 2014, according to AAMC statistics. “It is extremely rewarding to see that stu-

dents value the quality of the educational program put together by a fantastic group of dedicated faculty,” said T.J. Hundley, M.D., associate dean for medical education for the USA College of Medicine. Hundley praised faculty members for investing time and effort into designing, implementing and continuously improving the medical education program. “Our medical educators work incredibly hard to organize and deliver a high-quality product every year,” he said. Data from the AAMC questionnaire allow medical schools to monitor trends and address them. “The results are used by course directors, faculty and the curriculum committee to further refine and improve the curriculum,” Hundley said.

The USA College of Medicine class of 2019 participates in Honors Convocation.

Among other results from the 2019 questionnaire: • 91 percent of USA College of Medicine students agreed or strongly agreed that basic science education included sufficient illustrations of clinical relevance, compared with 75 percent of students nationally. • 91 percent of USA College of Medicine students agreed or strongly agreed that their required clinical experiences integrated basic sciences content, compared with 80 percent of students nationally. • 95 percent agreed or strongly agreed that they acquired clinical skills required to begin a residency program, compared with 91 percent of students nationally.

NEWS BRIEFS Bullock appointed staff development director Betty Bullock, RN, MSN, was appointed director of staff development for USA Health. In this new position, Bullock is developing a systematic, coordinated approach for USA Health’s hospital employee education and development. 10

USA HEALTH MAGAZINE

She has been recognized on numerous occasions for her outstanding service, dedication and professionalism. MCI welcomes development director Caroline Smith joined the Mitchell Cancer Institute as the director of development.

VOL. 2, ISSUE 1

In her new role, she is creating and implementing a strategic, comprehensive development program for the Mitchell Cancer Institute. Prior to her appointment, Smith was a corporate and foundation relations officer at USA.

New members elected into USA Chapter of GHHS Ten USA College of Medicine students, three residents and one faculty member were named to the USA Chapter of the Arnold P. Gold Humanism in Medicine Honor Society (GHHS), a national society that celebrates compassion-

RESEARCH NEWS

Intramural grants provide funding for faculty research The Faculty Intramural Grants Program at the USA College of Medicine supports new research ideas, preliminary data collection for extramural proposal submissions, and sustained laboratory progress between extramural grant funding periods. The program provides funding to five full-time faculty members in the basic science departments. Each year, the College of Medicine commits $250,000 to the program to provide one-year awards of up to $50,000 in direct costs. The 2019 awardees are as follows: Robert A. Barrington, Ph.D., associate professor of microbiology and immunology, is further investigating a rare lung disease. “The funds are instrumental for generating preliminary data on human patient samples with autoimmune pulmonary alveolar proteinosis, an uncommon lung disease,” Barrington said. “Our work is part of a multi-institutional effort with groups at UCLA and Cincinnati Children’s Hospital to understand how heterogeneous the disease is, and whether we can determine if gene signatures in individual patients can predict responses to various therapies.” Raymond J. Langley, Ph.D., assistant professor of pharmacology, and graduate student Grant Daly are analyzing the genetic data. Natalie Bauer, Ph.D., associate professor of pharmacology, seeks to understand how extracellular vesicles interact with target cells and deliver their messages – good or bad. “In each of us every day, both when we are healthy and when we are sick, we have circulating extracellular vesicles that are released from our cells,” Bauer said. “These tiny vesicles play important roles in keeping our blood vessels healthy and functioning. During various diseases such as heart disease, diabetes, and pulmonary hypertension, these vesicles change and can cause damage.” Steve Lim, Ph.D., associate professor of biochemistry and molecular biology, is investigating the pathological contribution of vascular smooth muscle cells (VSMC) in atherosclerosis. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on artery walls, which can restrict blood flow. Although atherosclerosis is often considered a heart problem, it can impact arteries anywhere in the body. Two postdoctoral fellows, James Murphy, Ph.D., and Kyuho “KJ” Jeong, Ph.D., are performing the work in Lim’s lab. Jon Simmons, M.D., associate professor of surgery and phar-

ate, patient-centered care. This year, the following were selected: Nkemdi Agwaramgbo, Grayson Domingue, Dala Eloubeidi, Tyler King, W. Hamilton Moore, Raymond Moosavi, Ravi Rajendra, Jordan M. Smith, Gisella Ward, and Zachary White; Linda Ding, M.D., assistant professor

of surgery; Sara McConnell, D.O., resident in pediatrics; Taylor Twiggs, M.D., resident in obstetrics and gynecology; and Jonathan Bernard, M.D., resident in surgery. BMS graduate student publishes new research Barnita Haldar, M.D., a

Robert A. Barrington, Ph.D., associate professor of microbiology and immunology, works in the lab with medical student Brandon Rivers. Barrington was one of five awardees of the 2019 Faculty Intramural Grants Program.

macology, is studying whether the transfusion of inflammatory cellular debris from stored plasma results in pro-inflammatory signals leading to organ failure. The research in this intramural project could potentially persuade the blood banking industry to filter out leukocytes from plasma products prior to use. The research is essential for establishment of an experimental model of traumatic shock, which is expected to attract further federal and industrial research for USA Health. The research in this project incorporates the expertise of Larry Lee, M.D., assistant professor of surgery; Michele Schuler, Ph.D., associate professor of microbiology and immunology; and Ray Langley, Ph.D., assistant professor of pharmacology. Xiangming Zha, Ph.D., associate professor of physiology and cell biology, is researching the functional importance of GPR4 in brain microvascular endothelial cells. “The main goal of this project is to determine whether GPR4 mediates acid signaling in microvascular endothelial cells in the brain,” Zha said. Zha said this award allows his team to generate critical preliminary data on the underlying molecular mechanism, which will strengthen a full extramural grant application.

fifth-year Ph.D. student in the USA Basic Medical Sciences Graduate Program, published an article in the Journal of the Federation of American Societies for Experimental Biology. The research paper, titled “S100A6 is a positive regulator of PPP5C-FKBP51-dependent regulation of endothelial calci-

um signaling” was included in the January 2020 edition. Lions Club donation supports vision research and training USA researchers received funding from local Lions Clubs that will be used to buy equipment for conducting high-quality vision research

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

RESEARCH NEWS

USA College of Medicine awarded $4.4 million to improve health in underserved areas The Health Resources and Services Administration (HRSA) awarded the USA College of Medicine a $4.4 million grant to improve the health of underserved areas and increase the number of primary care physicians. USA’s medical school was one of five institutions across the United States that received grant funding through the HRSA Population Care Pathway Program. “This funding allows us to expand the curriculum for our medical students in order to better serve the needs of citizens

who live in underserved and underresourced areas of our county,” said Allen Perkins, M.D., M.P.H., professor and chair of family medicine, who also serves as the principal investigator for the project. According to Perkins, the grant will expand opportunities for the USA College of Medicine students to work with health centers located in underserved areas in southern Alabama. Through a partnership with Franklin Primary Health Center and AltaPointe Health, students will be able to

complete rotations locally in these community health centers. T.J. Hundley, M.D., associate dean for medical education, and Benjamin Estrada, M.D., assistant dean for medical education, also played key roles in this project. Of the USA College of Medicine’s nearly 2,800 graduates, 43 percent practice in Alabama, 36 percent in underserved areas, 27 percent in primary care disciplines, and 10 percent in rural areas.

Gassman awarded 2019 Mayer Mitchell Award for Excellence in Cancer Research

Natalie Gassman, Ph.D., and graduate student Griffin Wright research DNA repair.

Cancer researcher Natalie R. Gassman, Ph.D., who specializes in DNA damage and repair, was named the recipient of the 2019 Mayer Mitchell Award for Excellence in Cancer Research.

Gassman, assistant professor of physiology and cell biology at the USA College of Medicine and a cancer researcher at the Mitchell Cancer Institute, focuses her work on characterizing the influence that environmental exposures have on DNA repair and characterizing how DNA repair proteins are altered or modified in the context of cancer. In her lab, Gassman has also developed a versatile detection method that helps identify deficiencies in repair mechanisms that give cancer cells a survival edge. She hopes that the results can be applied in a clinical setting to tailor therapies for cancer patients. “Our team is trying to find the magic formula: how much DNA damage you have and how you will respond to treatment,”

she said. “It’s personalized medicine for your genome.” Since joining MCI in July 2015, Gassman has submitted more than 20 scientific articles that have been accepted for publication. Prior to joining MCI, she held post-doctorate positions at the National Institute of Environmental Health Sciences and the Wake Forest University School of Medicine. The $10,000 award is presented annually to a promising scientist at the Mitchell Cancer Institute upon the recommendation of a faculty committee. The award was established in 2009 by USA trustee Arlene Mitchell in memory of her late husband, Mayer Mitchell, a Mobile businessman, longtime USA trustee and formative figure in the establishment of MCI.

NEWS BRIEFS and training the next generation of vision scientists. Board members of the USA Lions Eye Research Institute presented a check for $25,000 to the USA College of Medicine eye research team, led by Robert Barrington, Ph.D., associate professor of microbiology. During the meeting, recent 12

USA HEALTH MAGAZINE

Ph.D. graduate Steffani Fitzpatrick and medical students Brandon Rivers and Jack Friend shared research project presentations with the group.

VOL. 2, ISSUE 1

Children’s & Women’s earns Antibiotic Stewardship Award The Hollis J. Wiseman Neonatal Intensive Care Unit at Children’s & Women’s Hospital has been designated as a “Center of Excellence in Education and Training for Antibiotic Stewardship in Newborn Care” from the Vermont Oxford

Network (VON). From 2016 to 2018, an interdisciplinary team including neonatologists, infectious diseases specialists, nurses and pharmacists at the hospital took part in “Choosing Antibiotics Wisely,” an international quality improvement collaborative developed by VON in partnership with the

RESEARCH NEWS

USA scientists collaborate with Yale on West Nile research To better understand the evolution of mosquito-borne viruses, USA College of Medicine researchers are working with faculty at the Yale School of Public Health to reconstruct a picture of how the West Nile virus has spread and adapted during the past 20 years in the United States. The West Nile 4K Project is a partnership between West Nile virus surveillance laboratories and academic institutions in the U.S. The University of South Alabama was the first academic institution in the state to take part, according to Nathan Grubaugh, Ph.D., assistant professor of epidemiology of microbial diseases at the Yale School of Public Health. Genetic material taken from infected mosquitoes is sent to Yale to be sequenced. “They are looking at how the virus has evolved over time by sequencing genomes,” said Jonathan Rayner, Ph.D., associate professor of microbiology and immunology, and director of the Laboratory of Infectious Diseases at the USA College of Medicine. A genome is an organism’s complete set of genetic material, in this case RNA, including all of its genes. Each genome contains all the information needed to propagate and perpetuate that organism. “Our goal is to use genomics to understand how outbreaks occur and help design targeted control measures,” Grubaugh said. “For this ambitious goal, we are sequencing thousands of West Nile virus genomes from across the nation, and are using the genetic relatedness of the viruses to uncover the spatial and temporal patterns of West Nile outbreaks and spread.”

Centers for Disease Control and Prevention to address the overuse and misuse of antibiotics in newborn care. New Cancering Show episodes released The Cancering Show podcast, created by the Mitchell Cancer Institute, released three new

Jonathan Rayner, Ph.D., associate professor of microbiology and immunology and director of the Laboratory of Infectious Diseases at the USA College of Medicine, is studying the evolution of mosquito-borne viruses.

Mosquito-borne viruses containing an RNA genome are known to mutate quickly, Rayner said, which is why studying how a virus such as West Nile adapts over time is vital to figuring out how to develop vaccines and therapeutics to protect or treat people. According to the Centers for Disease Control and Prevention, in 2018 there were 2,647 cases of West Nile virus in the United States, resulting in 167 deaths. West Nile virus was first detected in the United States in 1999 in New York. Within a few years the virus spread across the nation. Now, West Nile virus is endemic and has become a serious threat to people and animals in the United States and Europe. While outbreaks have occurred, little prog-

episodes: “Fear, Anxiety and the Chasing Tiger,” with Ronald Franks, M.D.; “Cancer Patients and Coronavirus,” with Jennifer Scalici, M.D.; and “Surviving Survivorship,” with Casey Daniel, Ph.D. The podcast aims to demystify cancer by serving as a platform for knowledge, stories, coping advice, life

ress has been made in controlling them. The data generated from the West Nile 4K Project – which now includes 48 institutions in 33 states – is being released to the public via the westnile4K.org website. This data, along with other entomological data, will be used to uncover local transmission dynamics. For more than 18 months, Rayner has been screening locally captured mosquito samples collected by the Mobile County Health Department for other viruses as well, including Eastern equine encephalitis, St. Louis encephalitis, dengue, Zika and chikungunya. The insects collected are delivered to the Laboratory for Infectious Diseases at USA, and positive samples are used in the West Nile 4K Project.

tips, inspiration and humor. It is hosted by Jennifer Young Pierce, M.D., leader of Cancer Control and Prevention at MCI. Episodes can be found on Apple podcasts, Spotify and YouTube, or at cancering.com.

New coalition celebrates cultural diversity The USA Health Pediatric Residency Program formed a new coalition to promote and celebrate cultural diversity, with the long-term goal of better connecting with patients from diverse backgrounds and ultimately improving the health

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

RESEARCH NEWS

Macaluso examines federal efforts on tick-borne diseases

Kevin R. Macaluso, Ph.D., the Locke Distinguished Chair of Microbiology and Immunology at the USA College of Medicine, serves on a 14-member national panel tasked with providing subject matter expertise, review of federal efforts for all tick-borne diseases, and examination of research priorities for the federal government. The Tick-Borne Disease Working Group, on which Macaluso serves, was established by Congress in 2016 as part of the 21st Century Cures Act. It focuses on the development of a report to the U.S. Secretary of Health and Human Services and Congress on the findings and recommendations of the group for the federal response to tickborne disease prevention, treatment and

research, and how to address gaps in those areas. Tick-borne diseases are a serious public health problem. Lyme disease is the most common tick-borne disease, but there are at least 20 different infections that are transmitted by ticks in the United States. More than 300,000 new cases of Lyme disease are diagnosed each year, health records show. The number of new cases has increased in recent years, and the areas where ticks are found are expanding, placing more people at potential risk. Since 2002, Macaluso has been funded by the National Institutes of Health (NIH) to study tick- and flea-borne rickettsial diseases. He serves on the executive committees of several professional scientific

Kevin Macaluso, Ph.D., chair of microbiology and immunology, and graduate student Hanna Laukaitis work in the Laboratory of Infectious Diseases.

societies, including the American Society for Rickettsiology and Rickettsial Diseases and the American Society for Tropical Medicine and Hygiene, and has been active in the NIH Vector Biology Study Section. Macaluso has published more than 60 scientific papers and several book chapters, and he contributed to the latest version of the Arthropod Containment Guidelines for laboratory research. He is also a subject editor for the Journal of Medical Entomology, a publication of the Entomological Society of America.

NEWS BRIEFS of those patients. The Pediatric Residency Diversity Coalition hosted an event that drew more than 80 people – an encouraging turnout, said Myra Mack-Williams, M.D., associate program director for the pediatric residency program. Organizers plan to develop a curriculum to cover topics 14

USA HEALTH MAGAZINE

such as unconscious bias, discrimination and healthcare disparities. MCI scientists study role of NAD+ in cancer treatment Research conducted by scientists at the Mitchell Cancer Institute was highlighted in the January 2020 issue of Scien-

VOL. 2, ISSUE 1

tific Reports. The article titled “Extracellular NAD+ enhances PARP-dependent DNA repair capacity independently of CD73 activity” outlines the importance of NAD+, also known as an “energy molecule,” and its role in cancer treatments.

For the latest in USA Health news, log on to usahealthsystem.com.

BY THE NUMBERS

Faculty Impact A yearâ&#x20AC;&#x2122;s worth of journal articles, abstracts, presentations and nationally recognized individuals among basic sciences and clinical faculty at the USA College of Medicine. (Oct. 1, 2018, to Sept. 30, 2019)

170 Published abstracts

178

14 150

Journal articles, book chapters and patents

Presentations

Cancer researchers

Number of basic sciences faculty

215 Number of clinical faculty

130

Nationally recognized individuals USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

USA Health shines at Dauphin and I-65 USA Health continues to increase patient access throughout Mobile and Baldwin counties. Last fall, a new USA Health sign was installed on the Bancorp South building at 3290 Dauphin St., transforming the city’s skyline along I-65. University Urology celebrated its one-year anniversary of opening in the location. Plans are under way to expand and relocate other services to the building.

Mobile Diagnostic Center returns to Midtown One of Mobile’s iconic medical practices – USA Health Mobile Diagnostic Center (MDC) – is returning to the Midtown area. A new 10,000-square-foot, two-story building on Old Shell Road will bring the internal medicine providers back to the neighborhood where it began in 1982. The practice moved to West Mobile in 1987. USA Health and MDC partnered in 2017, bringing together the area’s largest group of community-based physicians. The new facility is scheduled to open this summer. “Returning to Midtown always has been one of our goals,” said Robert Israel, M.D., a founding member of the USA Health MDC practice. “We were fortunate that many of the families from our original time at the Midtown location followed us to West 16

USA HEALTH MAGAZINE

Mobile. It is exciting that we will now be back to where it is more convenient for them.” MDC will occupy the first floor of the building, and USA Health specialty practices will occupy the second floor, providing patients with the convenience of a single location for many of their healthcare needs. “One of the most important things that we can do as a health system is to increase access to healthcare near where people live,” said Owen Bailey, chief executive officer of USA Health. “Working with community-based physician groups like Mobile Diagnostic Center is one strategy to make this happen. Through their 24 physicians and more than 30 overall providers, we are enabling people throughout the city to have easier access to high-quality healthcare

VOL. 2, ISSUE 1

Robert Israel, M.D., one of the founding members of Mobile Diagnostic Center, speaks at the groundbreaking ceremony for the new facility in Midtown Mobile.

that is supported by the innovative ideas generated through academic medicine.” In addition to its current location on Airport Boulevard, USA Health MDC has offices at University Commons across from the University of South Alabama.

WATCH US GROW

USA Health welcomes pediatric bariatric surgeon

Katrina Weaver, M.D., a pediatric surgeon, offers bariatric surgery option for young patients.

Trained in pediatric/adolescent bariatric surgery, Katrina Weaver, M.D., is now offering this new surgery option for young patients at Children’s & Women’s Hospital. Weaver also serves as assistant professor of surgery in the division of pediatric surgery and in the division of trauma, critical care and burns at the USA College of Medicine. Having recently returned from a clinical pediatric surgery fellowship at Children’s Mercy Hospital in Kansas City, Mo., Weaver said she is thrilled to be back with USA

Health and to bring new surgery options to young patients in the region who are struggling with their health and weight. “Childhood obesity impacts one out of every five children in the United States, with the majority of these children suffering from the same comorbidities as obese adults but at a much earlier age,” Weaver said. “I am eager to help bring change for our morbidly obese adolescent population by providing bariatric surgery options. I have seen surgery be successful for many morbidly obese adolescents, with most of them having significant improvement or even complete resolution of their weight-related comorbidities.” Weaver earned her medical degree at the University of Utah School of Medicine and completed her surgery residency training at USA Health. She then completed a surgical scholar research fellowship and a surgery critical care fellowship at Children’s Mercy Hospital. She is board certified in general surgery and surgical critical care. At USA Health, she plans to develop a pediatric/adolescent bariatric surgery program.

Certified genetic counselor joins the Mitchell Cancer Institute

As the region’s only certified genetic counselor specializing in cancer, Cassie Gurganus provides genetic testing and counseling to cancer patients who have personal or family histories of cancer, or have known hereditary cancer syndromes. She is based at the Mitchell Cancer Institute. “I review a patient’s personal and family history with them,” Gurganus said. “We discuss the process of genetic testing and what the results mean for them and for

their families.” While all cancer involves genetic mutations, not all of those mutations are inherited, Gurganus said. The National Cancer Institute estimates that inherited genetic mutations play a role in about 5 percent to 10 percent of all cancers. Patient health histories raise red flags when one or more first- or second-degree family members are diagnosed with cancer before age 50, the same type of cancer, two or more different cancers, a rare cancer, or a BRCA1 or BRCA2 mutation. A mutation in a BRCA gene, for instance, significantly increases a woman’s lifetime risk of developing breast and ovarian cancers. Gurganus earned a bachelor’s degree in chemistry and a master’s degree in genetic counseling from the University of Alabama at Birmingham.

Autism family navigator joins USA Regional Autism Network There’s a new resource in south Alabama for the families of children with a pediatric autism diagnosis. Dana Handmacher joined the USA Regional Autism Network as an autism family navigator. She is available to assist parents and caregivers with planning and problem-solving, direct them to educational opportunities, and encourage their self-advocacy skills. A mother of four, Handmacher has a teenage son who was diagnosed with autism at an early age. “Having a child with autism comes with great challenges,” Handmacher said. “Often for families, the future is worrisome and full of unknowns. Not only does the USA Regional Autism Network provide guidance and resources to individual families, but it also helps to build resources and provides awareness in our greater community through educational programs and collaborations with other local organizations and service providers.” “We specifically want to focus on people with a new diagnosis or someone who has a child and is in the process of seeking a diagnosis, which can take as long as a year for a final determination,” said Amy Mitchell, director of the USA Regional Autism Network. “Early intervention is key, and Dana can tell families about the resources available in our area.” Handmacher earned a bachelor’s degree in social work and a master’s degree in elementary education at the University of Georgia.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

PREVENTION

Temperatures rising: stay safe in the heat and sun As the weather shifts from mild and pleasant to hot and humid, the risk for heat-related illnesses increases. Daniel Holleyman, M.D., an emergency medicine physician with USA Health, explains how to recognize the signs of heat exhaustion and heat stroke, ways to prevent heat illnesses, and when to seek medical treatment.

Heat exhaustion versus heat stroke Heat illness begins as the core body temperature exceeds normal levels. “The main difference between heat exhaustion and heat stroke is neurological dysfunction,” Holleyman said. “Heat stroke is a more serious condition because it potentially damages the brain.” Heat exhaustion occurs when the body’s ability to maintain normal cardiovascular function is inadequate for its needs. Signs and symptoms include weakness, fatigue, dizziness, headache, nausea and vomiting. These patients are still awake, alert and oriented. Sometimes blood pressure can drop and fainting or collapse occur. Holleyman said, “They first should be removed from the hot environment if possible, given oral fluids, and any hot, constrictive clothing should be loosened or removed. Skin can be cooled with fanning or wetting the skin to allow for evaporative cooling.” Heat stroke is a more concerning disease process because of underlying organ damage. Heat stroke can be recognized by signs of central nervous system dysfunction: behavior changes, poor coordination, staggering walk, speech changes, seizures or coma. “This is a true medical emergency and caregivers or bystanders should call 911,” Holleyman said. “First aid should include similar measures that were provided for heat exhaustion, but additional care should be taken to address the underlying neurological damage.” Comatose patients should be placed in the recovery position (on their side with mouth open), he said, and active cooling measures should be started. “If there is any concern that the patient may vomit or is unable to protect their airway, oral fluids should be avoided,” Holleyman said. However, “in most cases, water is enough until more definitive care can be accessed.” Only trained personnel should place the patient in an ice-water bath, and salt tablets are never recommended, he added. 18

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Other heat-related illnesses Heat cramps, heat rash and sunburn are additional heat-related conditions. Heat cramps are muscle spasms that occur because of underlying dehydration. Treatment includes rest and rehydration. Heat rash occurs because of blocked sweat glands. This leads to a local inflammatory process that causes redness and blistering. Sunburn is a thermal burn of the skin layers and limits sweating efficiency. “Until a sunburn completely heals, it can increase the likelihood of suffering from a subsequent heat illness and make any subsequent heat illness more severe,” Holleyman said.

Risk factors Heat illness is associated with certain risk factors, and these play a key role in prevention. Two groups of people typically suffer from heat stroke: the “classic” group and the “exertional” group. “The classic group includes the very young and the very old, the chronically ill, and those taking certain medications. The exertional group is typically athletes or military trainees engaging in strenuous exercise in the hot environment,” Holleyman said.

Prevention If you plan to engage in outdoor activities during hot weather, Holleyman offers the following tips: • Check the forecast and avoid the hottest times of the day (midday), if possible. • Wear loose-fitting clothing and sunscreen on exposed areas. Clothing should be lightweight and breathable to allow for evaporation of sweat. • Take regular breaks from physical activity to rehydrate. • Do not wait until you are thirsty to drink water. • Alcohol use can worsen heat-related dehydration and masks the early signs of sunburn. Furthermore, the mind-altering effects of alcohol can make diagnosing heat stroke more challenging. Avoidance of alcohol, both during heat exposure and during the following recovery phase, is advised.

Eat better, feel better LeAnne Bolton, M.S., RDN, a clinical dietitian at the Mitchell Cancer Institute, shares one of her favorite recipes from Health Meets Food: The Culinary Medicine Curriculum.

Quinoa Salad with Lemon Shrimp Ingredients: For quinoa: 2 teaspoons olive oil 2-3 cloves garlic, chopped 1 red onion, diced 1 3/4 cups vegetable stock or water 1 orange, zested and juiced 1 cup quinoa 1 cup chickpeas, canned, no salt added, rinsed and drained 1 cucumber, diced 1 tomato, diced 2 ounces feta cheese, crumbled 1 tablespoon dill, fresh, chopped 1/2 teaspoon kosher salt Black pepper, to taste

For shrimp: 3/4 pound shrimp, raw, peeled and deveined 1/4 teaspoon kosher salt 1/8 teaspoon black pepper 1 lemon, zested and juiced 1 teaspoon olive oil 1 ounce dry white wine Directions: 1. Toss the peeled and deveined shrimp with the lemon juice and zest, salt and pepper. Marinate while preparing other ingredients. 2. In a medium-sized pot, heat oil over medium-high heat. SautĂŠ the onion and garlic about 1 minute. 3. Add the vegetable stock or water and orange juice and bring to a boil. Once boiling, add the quinoa, reduce heat and cover. Cook quinoa for about 15 minutes or until all the liquid has been absorbed. 4. Add chickpeas and place mixture in a mediumsized bowl and set aside. 5. In a medium-sized sautĂŠ pan, heat oil over mediumhigh heat. Remove shrimp from marinade and add to pan. Cook, stirring occasionally, until shrimp is almost cooked through, about 3 minutes. 6. Remove shrimp from pan and place in a small bowl. Set aside. 7. Deglaze pan by adding white wine and scraping the bottom of the pan, and cook until most of the wine evaporates, about 2 minutes. Pour over shrimp and set aside. 8. Fluff the quinoa and chickpeas mixture with a fork. Toss in the cucumber, tomato, fresh herbs, orange zest, feta cheese, salt and pepper into a large bowl. 9. Add the shrimp to the mixture. Toss together and serve warm or cold. USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Class of

BY LINDSAY LYLE

n mid-March, everything changed. The global pandemic caused medical schools across the United States to cancel traditional Match Day events. The USA College of Medicine’s much-anticipated gathering was no exception. But, the resilient class of 2020 adapted its celebrations, cheering on classmates’ successes from behind phones and laptops. Instead of gathering in one room and opening their envelopes simultaneously, most medical students opened emails to find out where they would be doing their

USA HEALTH MAGAZINE

residency training. And rather than taking to the stage to announce their placements and pin them on a map, students took to social media to share their news. “Because of our duty to our community as responsible current and future healthcare providers, we had to cancel aggregated Match Day celebrations for these soon-to-be graduates of our program,” said Kelly Roveda, M.D., associate dean of student affairs at the USA College of Medicine. “However, the inability for us to celebrate together does not diminish our pride and

VOL. 2, ISSUE 1

excitement for our students.” After interviewing with residency programs across the nation, medical students ranked their top-choice programs in order of preference. Training programs, in turn, ranked the students who interviewed. The National Resident Matching Program then used an algorithm to designate each applicant into a residency program. The process culminated on March 20, 2020 – Match Day – when USA College of Medicine seniors learned their residency placements. Here are some of their stories.

FEATURE

DESTINI SMITH Match: Child Neurology, UAB Hospital in Birmingham Growing up in Birmingham, Destini Smith had a clear vision of her calling and has been working toward that goal ever since. “I knew I wanted to be a child neurologist ever since I was little and have it documented in my journal,” Smith said. “I have grown up wanting to be the doctor to care for children with seizures, and that has continued to be a passion of mine to this day.” In her first year at the USA College of Medicine, Smith went to a meeting for the Student Interest Group in Neurology, but she was the only student in attendance. Now she serves as president of the interest group, which has significantly higher meeting attendance these days. A highlight of her medical education was performing research with Errol Crook, M.D., professor and Abraham Mitchell Chair of Internal Medicine, and Kenneth Hudson, Ph.D., associate professor of sociology and anthropology at USA. Their work, which was published in Preventative Medicine Reports, focused on healthcare utilization and the doctor-patient relationship. She is also a member of the Student National Medical Association (SNMA) and has been involved in planning the SNMA Health Fair, which provides free medical services and health education to immigrant families.

PATRICK YOUNG

BONNIE HOLLEY

Match: Orthopaedic Surgery, USA Health A lifelong athlete, Patrick Young has been involved in sports since childhood. He even went on to play football as an undergrad at Auburn University, where he majored in biomedical sciences. Over the years, the student-athlete received his fair share of sports injuries, which necessitated frequent visits to the orthopaedic clinic in his hometown of Trussville, Ala. His interactions with orthopaedic surgeons, both as a patient and student, inspired Young to pursue orthopaedics as a career. “Ever since I can remember I’ve wanted to become a physician, specifically an orthopaedic surgeon,” he said. “As I continued through medical school, my passion for the field only grew as I learned more about the musculoskeletal system and surgery. What better way to spend your life than helping people get back to doing the things they love most!” Young matched in his desired specialty at USA Health. He is grateful for the support of his wife, Lucy, his family, and faculty mentors, Lee Grimm Jr., M.D., associate professor of surgery; and Jeffrey Brewer, M.D., professor of orthopaedic surgery. “Much like orthopedic surgery, medical school is a team game,” he said, “and I would not be where I am today without the help of others during the past four years.”

Match: General Surgery, Gundersen Lutheran Medical Center in LaCrosse, Wis. Bonnie Holley has countless stories from international mission trips over the years. As a USA medical student, she joined the Christian Medical Ministry of South Alabama on trips to Senegal, Honduras, Costa Rica and, most recently, Rwanda. “I have always had a heart for overseas mission work, and I thought I wanted to be an engineer to help create clean water projects and other infrastructure in developing nations,” Holley said. “However, over time I realized that engineering just wasn’t for me.” So, after two years of studying engineering at Auburn University, Holley changed her major to biomedical sciences and later applied to medical school at the USA College of Medicine. “I was honored to be invited to be a part of USA,” said Holley, of Arab, Ala. “I know that with my undergrad GPA, I might have been a risk to matriculate. I am incredibly grateful to have been given this chance, and I like to think that it paid off.” With the intent to do global mission work after completing her residency training, Holley said, “I tried to choose programs that have a rural surgery focus and/or a wide variety of operative training as I will likely have a very broad scope of practice wherever I end up.”

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

JAZMÍN SCOTT

JOSH OUSLEY

TAYLOR OUSLEY

Match: Internal Medicine, UAB Hospital in Birmingham

Match: Psychiatry, UAB Hospital in Birmingham

Married medical students Josh and Taylor Ousley took part in the match process as a couple, which allows applicants to rank residency programs in pairs. Then, the couple matches to the highest ranked pair where each partner has been offered a residency position. “Our biggest factors we considered when applying to residency were that we wanted to have a successful couples match and end up together, and we wanted to stay in the Southeast to be close to both of our families,” said Josh Ousley, of Alabaster, Ala. The couple met and started dating during their first year of undergrad at the University of Alabama at Birmingham. They applied for early decision and were accepted into the USA College of Medicine’s class of 2020. On New Year’s Eve of their first year of medical school, Josh Ousley proposed to Taylor at the Moon Pie Drop in downtown Mobile. They married five months later on June 3, 2017. “The past four years of us both being in medical school has been a learning experience for us as we started our marriage, but it has also been one of the most rewarding and fulfilling times of my life. We have really learned to rely on each other for support and this has made our marriage that much stronger,” said Taylor Ousley, of Helena, Ala. “Medical school is hard for anyone, but I think it made it easier to always have someone by my side going through the same thing that I was.” The Ousleys have thoroughly enjoyed their training at USA College of Medicine. “South is such a special place and has prepared us to be very strong residents,” Josh Ousley said. “From day one, seeing patients in the clinic and hospital, you are treated as an equal and respected member of the healthcare team. The faculty and staff have been so dedicated to our medical education and our success, and we could not be more thankful for that.” Taylor Ousley agreed, “I believe that the faculty at South are truly the best, and I am so honored to have so many of them as trusted mentors.” 22

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Match: Psychiatry, Tripler Army Medical Center in Honolulu, Hawaii Jazmín Scott received her match results in December as part of the military match. But, she kept her placement a secret from her family and friends until the rest of her classmates found out on Match Day. Having grown up with both parents in the military, Scott made the decision to join the U.S. Army as a senior in high school. The decision to go into medicine came later. She graduated from the University of Oklahoma with a degree in health and exercise science but felt unfulfilled in her career. “I spent a lot of time that summer exploring my options and realized that a career in medicine would give me the opportunity to give back to the community,” said Scott, of St. Martin, Miss. The Health Professions Scholarship Program offered by the military allowed Scott to pursue medical school at the USA College of Medicine, where she has formed close friendships and had a positive educational experience. “Recently, I had the best experience of seeing a patient again after over a year and realizing that they remembered me, too,” Scott said. “It was really meaningful to me because I was glad to see how well they were doing, but it was also incredible to realize that I had made a positive impact on another person.”

2020 Match Day Results

45,000 national applicants COMPETED FOR

34,266 residency positions

DAVIS DIAMOND Match: Dermatology, Medical College of Georgia in Augusta Working with Mobile’s underserved population during his third year of medical school left a lasting impression on Davis Diamond. “As third-years, South gives us enough autonomy so that we can get to know our patients on a personal level,” said Diamond, of Norcross, Ga. “That’s what I have always wanted from this field: the opportunity not only to help others but also to forge relationships along the way.” On campus, he has been involved in the Curriculum Committee as well as the Student Promotion and Evaluation Committee. He also helped to restart the Dermatology Interest Group, which he hopes leads more USA medical students to pursue the field in the future. “This is a goal I have been working towards for about a decade, with the final payoff being landing a residency spot in my desired specialty of dermatology,” he said. “I have been so lucky to have an amazing support system in my wife, family and friends. I just want to make them proud.” As he prepares for residency, Diamond affirms that the USA College of Medicine has exceeded his expectations for medical school. “This is a place where you are truly valued as an individual, a place where faculty and staff go out of their way to accommodate you, foster your interests, and help you achieve your dreams,” he said.

WILL MARTIN Match: Anesthesiology, Wake Forest Baptist Medical Center in Winston-Salem, N.C. Will Martin knew from an early age that he wanted to be a doctor. As a Native American, he witnessed family members manage chronic health issues such as heart disease and diabetes. When Martin graduated from the USA College of Medicine, he became the first physician from his tribe, the Poarch Band of Creek Indians. “I hope that my path to higher-level education provides encouragement and guidance to those who come behind me seeking advanced knowledge,” he said. “It was not until the late 1960s that members of my tribe were even allowed to attend education higher than the 6th grade. Therefore, there is not as much of a push for tribal members to strive for upper-level education, and I hope to change this mindset.” A native of Spanish Fort, Ala,, Martin is grateful for the hands-on training he received at the USA College of Medicine. He remembers seeing an active code in the emergency department and volunteering to assist with CPR. “While I was giving compressions, I felt the patient’s heart knock against my palms,” he said. “That was the moment I realized that my actions truly had an impact on the life of another human being.”

65 USA medical students 23 states represented

65%

matched out of state

35%

matched in Alabama

placed in hospitals

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

CHEST WALL RECONSTRUCTION SURGERY GIVES TEEN BACK HIS LIFE BY LINDSAY MOTT

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

FEATURE

ollege student Lane Frazier can live the rest of his life without fear his heart or lungs will fail him because of a birth defect. Frazier was born with pectus excavatum, also known as sunken chest, but didn’t realize how severe it was until ninth grade. When he had it checked out, a doctor told him he would grow out of it. Then, in early 2019, he started having pain in his chest caused by the deformity. He was sent to the USA Health Chest Wall Reconstruction Program clinic and evaluated by Charles Hartin Jr., M.D., chief of pediatric surgery at USA Health. During the visit, Hartin used a CT scan of Frazier’s chest to determine the severity of the defect. He also ordered an echocardiogram and pulmonary function test to measure his lung capacity. Hartin concluded that Frazier needed to have the surgery to repair the pectus excavatum, and he needed to have it quickly. As the young man grew, his chest wall had sunken in to the point of almost touching his back bone. That caused Frazier’s heart to move. Over time, if not corrected, this could cause heart failure. “Lane had a pretty severe case,” Hartin said. “Sunken chest can cause long-term health problems if it’s not fixed.” The psycho-social effects can also be devastating for children in their adolescent years, leading to lifelong mental health and social consequences, he added. In April 2019, Hartin performed the minimally invasive pectus excavatum surgery on Frazier while Hanna Alemayehu, M.D., pediatric surgeon, performed a cryoneuroablation. In this instance, cryoneuroablation used nitrogen ice to freeze nerves in the chest area to cause numbness and ease pain for an extended period of time. Everything went as planned. The evening following his surgery, Frazier said, he was able to get up and walk for a short period of time. He experienced some initial pain and was homebound for about a month, but returned to classes at the end of May to graduate from FlomaLane Frazier had chest wall reconstruction surgery in April 2019 and was able to finish high school and graduate with his class that May.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

ton High School. He also resumed work as a landscaper and enrolled in Coastal Alabama Community College. Frazier said it took two to three months to get to a point where the pain wasn’t as noticeable. While he was never bothered with breathing issues before the surgery, he said, now he can tell a big difference in the cosmetic look of his chest. “It’s something I can put behind me because it’s something I was ashamed of having,” Frazier said. “I didn’t like the look of it.” He also doesn’t have to worry about his chest wall collapsing any further. “That’s the benefit of it all. I don’t have to worry about it causing more damage than it already has,” he said. Now, the 19-year-old Brewton native is looking to his future without fear for his health. He is working toward a welding certification at Coastal Alabama.

Chest Wall Reconstruction

The USA Health Chest Wall Reconstruction Program repairs pectus excavatum deformities with a minimally invasive surgery known as the Nuss procedure, in which a metal bar is inserted behind the sternum to move the chest wall into a normal posi26

USA HEALTH MAGAZINE

tion. The procedure is painful and often has a prolonged recovery period. To address this intense pain, pediatric surgeons at USA Health use the cutting-edge pain control modality known as cryoneuroablation, which has dramatically changed the post-operative course for patients. This technique allows patients to avoid prolonged hospital stays and limits narcotic use. It also allows for young patients to return to school sooner. The USA Health Chest Wall Reconstruction Program is the only provider of cryoneuroablation for pectus excavatum in the region (Alabama, Mississippi, Florida and Georgia), with Children’s & Women’s Hospital being one of only a few hospitals using the procedure in the United States. Alemayehu, who is also an assistant professor of surgery and pediatrics at the USA College of Medicine, joined USA Health in September 2018. USA Health has been offering cryoneuroablation since Alemayehu joined the faculty. She trained at Children’s Mercy Hospital in Kansas City, Mo., which is one of the highest volume pectus centers in the nation. According to Alemayehu, cryoneuroablation completely numbs the chest wall for 24 hours. The numbness gradually decreas-

VOL. 2, ISSUE 1

es over time but can last up to six months. Research from Children’s Mercy Hospital in which Alemayehu was involved shows the traditional pain control methods of epidural anesthesia and patient-controlled analgesia with narcotics were equally successful in controlling post-operative pain. But, new data on cryoneuroablation indicates it can cut the length of a hospital stay for these patients from an average of four days to one day. Time on narcotics also decreases from 18 days to 8 days compared with traditional pain control methods. “This is pretty significant, especially with the opioid crisis,” Alemayehu said. For children with sunken chest condition, it often is something they are born with and becomes more significant as they go through puberty, according to Alemayehu. Boys are more likely to have the condition, which can impact exercise tolerance, breathing and body image. Typically, the surgery is performed when patients are 13 to 15 years old. “As a pediatric surgeon, your goal is to repair problems that children are born with and to provide a quality of life that is excellent for their whole life,” Alemayehu said. The Chest Wall Reconstruction Program at USA Health also provides cutting-edge

treatment for pectus carinatum, an abnormal protrusion of the chest. USA Health is the first and only in the region – and one of only 15 centers in the nation – to use the FMF Dynamic Compressor System to treat pectus carinatum. This non-surgical treatment, also known as pectus carinatum corrector system, uses a custom-fit brace to flatten the chest wall back into place. The brace allows the pressure to be customized for each patient, using only enough compression to correct the problem. The dynamic brace is more comfortable and, therefore, more successful than a traditional brace. Alemayehu likened it to braces for the teeth.

“

Being able to change a child’s life, their comfort, their body image and self-esteem in this way for a lifelong impact on physical and mental health, is what being a pediatric surgeon is all about. - Hanna Alemayehu, M.D.

”

Bracing has become the first-line treatment for pectus carinatum, and has changed the outlook for these patients who no longer need to undergo painful and complicated operations to improve their daily lives, she said. “Being able to change a child’s life, their comfort, their body image and self-esteem in this way,” Alemayehu said, “for a lifelong impact on physical and mental health, is what being a pediatric surgeon is all about.” The USA Health Chest Wall Reconstruction Program Clinic is held at the Strada Patient Care Center located at 1601 Center St. in Mobile. Call 251-415-1475 to schedule an appointment.

Opposite: Pediatric surgeon Hanna Alemayehu, M.D., uses cryoneuroablation to numb the chest wall, while Charles Hartin, M.D., chief of pediatric surgery, performs surgery to correct the chest deformity. This page: Lane Frazier was able to return to his job as a landscaper and enrolled in college to earn his welding certification.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

An integrative approach to managing diabetes

BY NICHELLE SMITH-RODGERS

Elisabeth Dupuy always had a feeling she’d have diabetes one day – and when she was diagnosed as pre-diabetic in 2010, her concerns became her reality. Now, officially diagnosed with type 2 diabetes, Dupuy was forced to make lifestyle adjustments to ensure her glucose levels were tightly controlled. According to the Centers for Disease Control and Prevention, 30.3 million U.S. adults have diabetes – a chronic health condition that affects how the body turns food into energy – and one in four is unaware he or she has it. With patients such as Dupuy in mind, Robert Israel, M.D., FACP, an internal medicine physician at USA Health Mobile Diagnostic Center, sought to fill a gap that he noticed during his many years of practice – the lack of focus on illness prevention, and 28

USA HEALTH MAGAZINE

the need to foster healthy behaviors and skills for effective self-care that can be used by patients throughout their lives. “It’s not easy to accept that for the rest of your life you’re going to have a chronic disease that you’ll have to manage each and every day,” Dupuy said. “I’m beyond thankful for the support from Dr. Israel and his team as I navigate this life-changing journey.” Coined USA Health Integrative Health and Wellness, the new service offers an array of evidence-based treatment options that address the whole person – mind, body and spirit – by coupling conventional Western practices with complementary and alternative therapies. “Integrative health is a collaborative approach that puts each patient at the center and develops an approach to wellness of the entire person,” Israel said. “It includes

VOL. 2, ISSUE 1

all evidence-based methods – traditional Western medicine, nutrition and other lifestyle choices – along with complementary medical treatments such as acupuncture, massage therapy, yoga, meditation and other stress management strategies.” For patients with diabetes, a key component for keeping symptoms at bay is knowing exactly what to eat. To address this need, the new program hosts cooking classes to help patients learn how to maintain a healthy lifestyle with good food choices. “Once I found out about the cooking classes, I made it a priority to attend Phyllus Justice, RDN, left, nutritionist and certified diabetes educator with USA Health Mobile Diagnostic Center, and patient Elisabeth Dupuy cook a healthy recipe together at the new test kitchen housed at the Mobile Diagnostic Center University Commons location.

FEATURE

Additional services offered by USA Health Integrative Health and Wellness include: ACUPUNCTURE: This compleone,” Dupuy said. Housed at the Mobile Diagnostic Center at the USA Commons, located at 75 S. University Blvd., the space recently was renovated and now includes a test kitchen – a one-of-a-kind feature along the Gulf Coast. The kitchen is equipped with tables and chairs, allowing patients to easily and efficiently practice cooking alongside the instructor and even sample their creations at the end. “I was able to learn valuable information and prepare delicious recipes. At the same time, I formed a sense of community with the other participants,” she said. “It was amazing to see everyone working to better their health by trying foods we’d never had before. It felt great.” Phyllus Justice, RDN, a nutritionist and certified diabetes educator with Mobile Diagnostic Center, said the new services focus on the whole person to optimize wellness and manage the challenges of chronic medical issues. The program covers components of a healthy diet of vegetables, legumes, fruits and nuts, cereals and whole grains, fish, plant-based oils/fats, low-fat or fat-free dairy and lean meats, Justice added. “Classes allow participants to prepare and taste healthy recipes in an effort to improve their cooking skills and health,” Justice said. “From the novice to the proficient, these cooking classes are fun and informative.” “Wherever you are on the health and wellness spectrum, we give you the best assistance available to identify and reach

your health goals,” she said. Whether a patient’s diet needs a complete overhaul, a few minor changes, or help to better manage a medical condition, individualized sessions with Justice provide the guidance needed to make positive changes in his or her nutritional status. “Condition-specific nutrition therapy may include weight management, diabetes, pre-diabetes, gastrointestinal disorders, dyslipidemia and hypertension,” she said. “Follow-up sessions offer an opportunity to answer additional questions and provide accountability for success.” As a certified diabetes educator and insulin pump trainer, Justice said essential outcomes of diabetes education include not only improved glycemic control and overall risk reduction, but also sufficient knowledge to perform necessary skills and make lifestyle modifications needed to control diabetes and achieve a satisfactory quality of life. “We incorporate the latest technology when appropriate, including continuous glucose monitoring, which can often replace finger-stick glucose checks,” she said. Services offered by Integrative Health and Wellness aren’t limited to just nutrition or diabetes care. “Outcomes include prevention of cancer, heart disease, diabetes, stroke, dementia and other common illnesses, and mitigating effects of disease as well,” Israel said. “It also makes the whole community healthier, as the lifestyle changes influence other family members and friends.”

mentary medical practice entails stimulating certain points on the body, most often with a needle penetrating the skin, to alleviate pain or help treat various health conditions.

MEDITATION: Patients learn about mindfulness and how to reduce stress while rejuvenating the mind, body and spirit. Leave with evidence-based skills to help refocus, gain happiness and inner peace.

YOGA: Whether a patient is new to yoga or has more experience, these sessions are appropriate for everyone. Practice conscious relaxation through select yoga postures designed to calm, comfort and restore. This gentle, restorative and restful experience assists with improving balance, stretching and easing tension.

MASSAGE THERAPY: A certified massage therapist works to relieve tension and pain using hands-on techniques.

BEHAVIORAL HEALTH SERVICES: Patients are assisted by specialists in such areas as stress, geriatrics and smoking cessation.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Renea Richards took a gamble. Complex spine reconstruction surgeries come with a real measure of risk. Sometimes the unexpected can happen. But after a year and a half of living with a severe chin-on-chest deformity – making it impossible to look up and hard to swallow, and keeping her in horrific pain – she decided the potential benefit was worth the risk. After a previous surgery with a different 30

USA HEALTH MAGAZINE

surgeon in May 2018, Richards knew something was wrong in her neck, as her head began tilting forward. Eventually, her head became locked in a position where her chin touched her breastbone, and she couldn’t move. She could barely eat or talk. She was unable to look people in the eye, eventually only able to look at the floor. Richards was searching for help and was referred to Richard Menger, M.D., MPA, a USA Health neurosurgeon who specializes

VOL. 2, ISSUE 1

in complex spine reconstruction surgeries. Over multiple visits, Menger and Richards spent hours discussing her problem, the surgery, associated recovery and risks. Richards decided to proceed with the surgery because her life had deteriorated to the point that she could no longer do the things she loved to do. “I didn’t have any quality of life,” she said. “I had to try something.” Her surgery took place in October

Neurosurgeon develops Complex Spine Center to change lives

FEATURE

patients. This type of surgery can require six months to a year to recover fully. Richards still has a lot of work in front of her, including intensive physical therapy, but she is well on her way. “Now, I can do more things,” Richards said. “I don’t have to be confined at home and be embarrassed that I’m looking down all the time.” She said a friend recently remarked, “I can see your eyes!” She responded, “Oh, yes, I can see yours, too.” The Gulf Shores resident said she is most looking forward to being able to work in her yard again and visit the beach with her children and grandchildren. “I can’t wait to go to the beach with my girls and not have everybody staring at me,” Richards said, adding that she hopes she can get in the water without getting knocked down. “The main goal for this type of surgery is to increase a patient’s quality of life,” Menger said, adding that these types of surgeries are only for significant problems, and he always makes sure his patients have a clear understanding of what to expect. “This is an invasive and aggressive surgical approach for spinal deformity, and a vertebral column resection is one of the more complex surgical techniques we perform. Every step, from the positioning to the last stitch, is important to the outcome.”

BY LINDSAY MOTT

Comprehensive spine care

2019. It took approximately 11 hours and involved a large incision from the top of her neck to the bottom of her back, taking out old spinal instrumentation and adding new ones across 15 spinal levels, having her spine bones disconnected and reconstructed in the proper position, and slowly repositioning her head over her body. She then spent seven days at University Hospital, including time in the Neuroscience Intensive Care Unit. Richards said the

staff there were wonderful to her and took care of her needs. “They were awesome to me,” she said, adding that after she went home, both Menger and Marcelo Gerjoi, PA-C, called to check on her. “It was so impressive that they would take time out of their busy schedules and call and check on me at home.” After three months, Menger said that Richards is doing better than most

This type of complex spine reconstruction surgery is just one of the new procedures now available at USA Health with the expertise brought by Menger, who is also the chief of complex spine surgery and assistant professor of neurosurgery at the USA College of Medicine. He and the dedicated spine team form the USA Health Complex Spine Center. Menger assembled the spine team based on national best practices. Research published in The Journal of Bone & Joint Surgery and the Journal of Neurosurgery: Renea Richards’ quality of life has changed dramatically since her complex spine reconstruction surgery in October 2019, performed by Richard Menger, M.D., M.P.A.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

After a previous surgery with a different surgeon, Renea Richardsâ&#x20AC;&#x2122; head began tilting forward. Eventually, her head became locked in a position where her chin touched her breastbone. Since her surgery at USA Health, Richards is able to do more things and look people in the eye. She is most looking forward to working in her yard and visiting the beach with her children and grandchildren, right. Opposite: Richard Menger, M.D., M.P.A., has formed the USA Health Complex Spine Center, bringing his expertise in complex spine surgery and creating a dedicated spine team at USA.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Spine shows that having a dedicated spine team can improve outcomes for patients facing complex cases and reduce complication rates. “It was essential for us to create a dedicated team and to meticulously track all of our outcomes with real data,” Menger said. “The more often we do things in a consistent way, the better our outcomes will be. We want our patients to have the best experience and outcomes possible.” The spine team spans both outpatient and inpatient settings. It starts in the specialty clinic and includes each professional who will interact with the patient during the entire delivery of their care. Clinical spine nurse Erin Roberts is the lifeline for all patients visiting the clinic. According to Carmen Morehead, inpatient spine team coordinator at University Hospital, each person on the spine team has a clearly defined role, and they are in communication with Menger and the clinic team before the surgery as well as right after to ensure that each patient gets the personalized care they need, since each case is unique. This team approach ensures that each patient is improving at the right rate and hitting recovery outcomes on schedule.

Specialized spine care

Anthony M. Martino, M.D., a neurosurgeon at USA Health who also serves as professor and chair of neurosurgery at the USA College of Medicine, said these types

of complex surgeries were not previously offered at USA Health or in the broader healthcare community, but it was something that was needed in our region. “There are a number of surgeons that can do spine surgery, and there’s a lot of spine surgery that’s being done, but many patients were falling through the cracks because they were really beyond the surgical expertise available in this area,” he said. Menger and the dedicated spine team expanded the breadth of care offered by USA Health, and now these patients do not have to leave the area to receive the specialty care they require. In addition, Menger performs minimally invasive spine procedures in both children and adults. Trained in neurological and orthopedic spine surgery, Menger can assess patients from an interdisciplinary perspective. As a neurosurgeon, he completed the Advanced Pediatric Spinal Deformity Orthopedic Fellowship at Columbia University Medical Center in New York. During his neurosurgery residency at Louisiana State University in Shreveport, he received additional training with an enfolded fellowship in adult and pediatric spinal deformity at LSU and Shriners Hospital for Children. Menger is an honors graduate of Cornell University. He completed medical school with honors at Georgetown University School of Medicine, where he received the

Barbara Bregman, Ph.D. Award as the top graduate in neuroscience. To further his research mission, he received a Master of Public Administration from the Harvard Kennedy School of Government where he was awarded the Hale Champion Public Service Fellowship. Martino said the neurosurgery department as well as USA Health is focused on attracting physicians with special areas of expertise to strengthen and enhance the subspecialty care provided in the area. Moving forward, Menger’s passion is in performing surgeries for children with severe scoliosis. He is also actively researching new treatment options for young patients with scoliosis.

Benefits of academic medicine

Menger said that having the backing of an academic medical center like USA Health makes these types of complex surgeries possible. “I have gifted partners in our department and across the health system,” he said. “We need the resources that come from within an academic medical center to deliver a high level of care to our patients.” “In an academic medical center, you have to be at the tip of the spear clinically with your technique and in your decision-making,” Menger said. “We have to drive the field forward; we’re not just reading the scientific literature, but we are writing it.”

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Virtual reality creates immersive learning environment BY NICHELLE SMITH-RODGERS Using a sophisticated tool to “peel away” layers of the human anatomy, second-year medical students at the USA College of Medicine are transported inside human organs using 3D images and virtual reality (VR) goggles. With a nearby laptop running software projected into his headset, Zachary Aggen, a second-year USA medical student, carefully explores the intricacies of the human vasculature and respiratory tract. Initiated under the direction of Michael Francis, Ph.D., assistant professor of physiology and cell biology, second-year medical students recently began integrating the use of virtual reality during their respiratory 34

USA HEALTH MAGAZINE

module. So far, nearly 50 faculty, medical and graduate students have participated in this technique and have provided nothing but positive feedback. Originally, diagrams and static snapshots of chest radiographs were used to teach the subject, but by utilizing VR, they can now interact with computed tomography (CT) scans as three-dimensional structures. This method allows students to actively view and dissect patient anatomy, without removing it, from any position. “The driver can zoom into different planes of view and also manipulate the items you are reviewing by turning, cutting or slicing,” Aggen said. “Seeing these struc-

VOL. 2, ISSUE 1

tures up close gives the viewer a deeper appreciation for how complex the body is and the great detail that goes into making it function properly.” A typical lesson consists of using the SyGlass visualization system and loading images from the National Institutes of Health (NIH) imaging database into VR. SyGlass – a scientific data visualization and annotation system – allows rendering of large, volumetric data in its true threeor four-dimensional form. With this technique, the patient’s anatomy is revealed as a 3D composite of CT images. Then, Jennifer Knighten, a graduate student who works in Francis’ lab, maneu-

FEATURE vers the view and slices the plane while another student shares the same virtual space from a different computer. That virtual space is projected on the overhead screen for the rest of the medical students, who are not participating in the VR experience, to see. This method of teaching pulmonary anatomy is being used to augment the knowledge the students have already gained. “This approach enables us to explore the anatomical subtlety of the living body, which is not possible with conventional techniques,” Francis said. “Our aim is to use the novelty of VR and its ability to reveal real life, intact patient anatomy to solidify this knowledge in a unique way.” As a visual learner, Aggen said using VR helped him to further understand the relationships between adjacent and distant structures, as the 3D view highlighted the relationship of the airway to vasculature. “It also helped me to understand how disease could affect various areas and relate that to the symptoms the patient would display,” he said. The educational design of USA’s medical degree program is a competency-based curriculum across all four years, with the first two years of medical school comprising an integrated organ systems-based approach taught on campus. Aggen and his classmates haven’t yet had the opportunity to scrub in on any surgeries; however, they have become well-accustomed to the gross laboratory – that is, studying the human body with the use of cadavers. Though still beneficial, gross lab has traditionally been the only technique available to medical students to study organs. “Gross lab limits you to what is visible to the naked eye,” Aggen said. “In the gross lab, you are able to see the large bronchioles and tissue, but with VR, you can follow the tiniest bronchioles to near their end point. This is incredibly important when learning about diseases such as chronic obstructive pulmonary disease (COPD).” “Virtual reality gives you real-life experiences without the real-life consequences,” said Melody Zeidan, another second-year student at the USA College of Medicine. “Patients don’t typically respond well to being sliced into sections to see their insides, which VR makes possible. It is a great way to get a feel for the orientation of anatomical structures in many different

Opposite: Medical students Melody Zeidan and Zachary Aggen use virtual reality software in the lab to explore human anatomy. Michael Francis, Ph.D., assistant professor of physiology and cell biology, integrates the use of virtual reality while teaching the respiratory module to second-year medical students. Above: SyGlass virtual reality software captured this 3D composite view of a rat pulmonary artery and adjacent alveoli.

planes, which is a great benefit, particularly for surgical training.” Zeidan and Aggen agree that a blend of gross lab and VR enhances their medical education when learning about organ structures. “Being able to see CT sections in a 3D orientation makes correlating the imaging with the actual human body much more accessible,” Zeidan said. “Also, the resolution of the 3D system and the depth component it incorporates is just not possible with traditional 2D imaging.” Zeidan compares her experience using the SyGlass software to playing a video game. “Once you put on the headset, you are immediately transported into another world,” she said. “The system is controlled by intuitive head, arm and hand motions, so the steepest part of the learning curve for me was about gauging the amplitude of my motions in real life as compared to the motions I was making in the VR world.” Osama Abdul-Rahim, M.D., assistant

professor of radiology at the USA College of Medicine and an interventional radiologist with USA Health, was among the faculty members testing out the VR system. “The VR system opens up many doors as a new educational tool for medical trainees – from medical students to residents and fellows,” he said. “Learning anatomy is an integral part of medical training, and this system allows them to immerse themselves into the body at a scale and with a method not previously seen. It also makes learning this material fun, which promotes further learning and better ability to retain the information.” Rahim sees enormous potential in the VR system, and he is excited to see what Francis and his team are able to accomplish in the world of medical education. “As they continue to refine the product and as technology improves, the potential uses are vast and will likely find their way into clinical practice,” he said.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Increasingly, cancer treatment comes in a pill BY CAROL MCPHAIL Every day at 3 p.m. John Pruett’s cell phone buzzes, telling him it’s time to take his cancer medication. The mid-afternoon schedule suits the 68-year-old retiree, who worked shift work for decades at area paper mills. At that time, no matter the shift, he was sure to be awake, whether he was reporting for work or leaving for home. When his phone alarm goes off, Pruett pops a tablet from a blister pack and takes it with water to treat his chronic lymphocytic leukemia (CLL), a type of blood cancer in which the bone marrow produces too many abnormal white blood cells. Diagnosed more than 20 years ago, Pruett has been taking ibrutinib, a targeted therapy drug, since 2014. “With traditional chemo, it attacks everything,” he said, referring to side effects such as nausea and hair loss that sometimes accompany traditional cancer treatments. “This is targeted therapy. It doesn’t attack all your cells – just what causes the 36

USA HEALTH MAGAZINE

cells to multiply.” Pruett, who lives in Satsuma, is among a growing number of patients who receive their cancer treatment from a pill rather than from an intravenous line or by using radiation therapy. Currently, there are 101 oral medications approved by the Food and Drug Administration for the treatment of cancer, according to the National Cancer Institute; and 44 medications for cancer are being evaluated for approval. Some of these oral oncolytics target cancer so precisely that they produce few or no side effects. At the Mitchell Cancer Institute, oncologists coordinate with an in-house specialty pharmacy to provide the latest oral cancer drugs to patients in a convenient manner. Pharmacists, meanwhile, counsel patients regularly to make sure they are taking their medications appropriately. “Oral chemotherapy provides several advantages over the traditional intravenous form,” said Omar Alkharabsheh, M.D., a

VOL. 2, ISSUE 1

medical oncologist and assistant professor of interdisciplinary clinical oncology at the Mitchell Cancer Institute. “Other than less time in the infusion center or the need for an inpatient hospital stay, most of the oral chemotherapy agents target the genetic makeup of cancer cells, which have personalized our treatment approaches.” On a recent Thursday, Pruett takes the elevator to the second floor to visit the MCI Specialty Pharmacy after his clinic visit. He picks up his refill for ibrutinib, chats with the pharmacist and is ready to head home in just a few minutes. “This is one of our most commonly dispensed medications,” said Brittney Carden, Pharm.D., manager of the MCI Specialty Pharmacy. Sold under the brand name Imbruvica, ibrutinib was the first drug on the market to block a specific protein in B cells called Bruton’s tyrosine kinase, or BTK. By blocking BTK, the medication is designed to move abnormal B cells out of

FEATURE their nourishing environments in the bone marrow, lymph nodes and other organs. Approved in 2013, it is used to treat several B cell cancers, including Pruett’s CLL. Opened in 2018, the MCI Specialty Pharmacy fills an estimated 500 prescriptions a month for 120 patients at the Mitchell Cancer Institute’s three locations. Some prescriptions are for anti-cancer drugs, while others are for medications to control side effects or other health problems. The pharmacy does not dispense controlled substances.

“

This is targeted therapy. It doesn’t attack all your cells – just what causes the cells to multiply. - John Pruett

”

“Increasingly, oncologists are prescribing oral chemotherapy, which requires special handling, real-time monitoring and more support than most other prescription drugs,” Carden said. “The majority of chemotherapy drugs that are in the pipeline for future cancer treatments are oral.” Having an in-house specialty pharmacy gets the medications to patients quicker, Carden explained. “Our goal is two days,” she said. At the Mitchell Cancer Institute, the oncologist or advanced practice provider writes the prescription, and the medical assistant sends it directly to the specialty pharmacy. If there are questions, Carden can check the patient’s electronic medical record. Plus, the doctor is close by. “Once the prescription comes here, we are the hub,” she said. “We can even coordinate delivery, but we prefer pickup.” The rise of oral oncolytics places more pressure on pharmacists and their staffs

Cancer survivor John Pruett of Satsuma stops by the MCI Specialty Pharmacy to pick up his medications. He has been taking ibrutinib, a targeted therapy drug, since 2014. Opposite: Pharmacist Brittney Carden takes a call while fellow pharmacist Jana Cox confers with Carolyn DeMouy, coordinator at the MCI Pharmacy located on the second floor of the Mitchell Cancer Institute in Mobile.

to help ensure that patients take their medications appropriately at home. “Oral chemo is not for everyone,” Carden said. “If the patient is not compliant, it can be an issue.” For that reason, Carden or her fellow pharmacists counsel first-time patients for about 30 minutes. They go over plans to set a schedule, review drug interactions and suggest ways to reduce side effects, such as taking pills at bedtime to cut down on fatigue. Pruett takes his once-a-day tablet faithfully at 3 p.m. The pharmacy staff reminds him not to drink grapefruit juice, eat grapefruit or eat Seville oranges while taking ibrutinib. The main side effect for him so far has been rashes on his arm. “I’ve got salves and creams for it,” he said. Pruett also wears a monitor to track his atrial fibrillation, an irregular heartbeat

that can be a side effect of his medication. The specialty pharmacy staff is also on hand to coordinate prior authorizations for insurance coverage and help patients find ways to afford their treatment to cut down on what the healthcare industry calls “financial toxicity.” With the newer medications, the cost can be significant – thousands or tens of thousands of dollars per month. If a patient has Medicare Part D, it typically covers 80 percent of the cost of medication for the first month and 95 percent of the cost of refills, Carden said. Even with good coverage, the co-pay can be a burden to a patient on a fixed income. Pharmacy coordinator Carolyn DeMouy searches her online sources to identify foundations that provide co-pay assistance. “Our goal is for everyone to get out of here paying zero,” Carden said.

In February, the Mitchell Cancer Institute achieved accreditation from the Utilization Review Accreditation Commission (URAC) for its specialty pharmacy – one of about 455 specialty pharmacies to hold the URAC accreditation. It has been accredited by the Accreditation Commission for Health Care (ACHC) since 2018. USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

MED SCHOOL CAFÉ

A Healthy Dose of Academic Medicine Med School Café is a free community lecture series presented by USA Health. Each month, faculty from the USA College of Medicine offer insight into specific medical conditions.

Sports Injuries, Treatment and Prevention

“Prevention is the best treatment for injuries if you pay attention to the warnings your body is giving you.” That was the message Brad Clay, M.D., assistant professor of orthopaedic surgery at the USA College of Medicine and a sports medicine orthopaedic surgeon with USA Health, wanted the audience to learn at Med School Café. Clay said some injuries can be avoided if athletes follow a few guidelines, such as not playing while fatigued or in pain, practicing core strengthening, stretching before and after a game, and relying on the team for help. To keep athletes healthy, he said, parents, coaches, trainers and doctors must work together to recognize the warning signs before an athlete suffers an injury. He explained two injuries baseball players often sustain. Superior labrum anterior to posterior (SLAP) tears in the glenoid labrum are common injuries to the shoulder, while ulnar collateral ligament (UCL) tears are commonly seen after repeated stress in the elbow. Clay referenced athlete Tommy John, a former Major League Baseball player who suffered a UCL tear in his elbow in the 1970s. John’s injury led to the development of new technology and treatment for UCL tears. Clay performs what is known as the “Tommy John Surgery” as well as other surgical and nonoperative treatment options for athletic injuries at USA Health. 38

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Chronic Constipation in Children

Chronic constipation is a common condition in children and one that pediatric gastroenterologist Ananthasekar Ponnambalam, M.D., often sees in his clinic. Constipation – a term used to describe the infrequent passage of stool or dry, hardened feces – can be described as either functional or organic. Functional constipation has no underlying cause for disease. On the other hand, organic constipation has an underlying cause for the disease, and many conditions can cause this. “Constipation is common among children between 4 and 6 months of age when solids are introduced, at one year of age when cow’s milk is introduced, during the time of toilet training, and when children start full-day school,” said Ponnambalam, professor of pediatrics at the USA College of Medicine. When a child presents with symptoms of constipation, Ponnambalam said gathering an in-depth history is key, along with examinations and tests. Key symptoms of constipation in children include: • Abdominal pain – before a stool • Pain that can last for several days and is relieved after stooling • Longstanding, vague abdominal pain • Pain usually in the center • Vomiting with straining • Poor appetite • Irritability • Urinary symptoms

New treatments offer hope for those with chronic skin condition

Psoriasis, and new topical and systemic treatments for it, was the topic of a community lecture by Fred Bodie, M.D., a dermatologist with USA Health Dermatology. More than 8 million Americans suffer from the chronic skin condition, according to the National Psoriasis Foundation. “It can be a devastating disease that can lead to other health conditions such as diabetes, heart disease and depression,” said Bodie. “It’s important for patients to know that treatments are available and can help even with severe cases.” Psoriasis usually impacts the elbows, knees or a scalp, though it can appear anywhere on the body, according to Bodie. The condition can be itchy or can cause a burning or stinging sensation. If someone develops a rash that doesn’t go away with over-the-counter medication, Bodie recommends seeking medical attention from your physician. Bodie served as lead investigator for more than a dozen clinical trials that tested the effectiveness of new medications known as biologics on patients with psoriasis. He’s seen good results with the biologics when other treatments fail. The dermatologist said about 20 percent of those with psoriasis can develop a severe form of arthritis. “If you take the biologics early enough, you may be able to prevent joint damage,” he said. Most treatments for psoriasis must be continued indefinitely or the psoriasis will recur.

Pandemic Relief Funds USA Health’s Pandemic Emergency Fund supports the USA Health system and its critical needs in response to the COVID-19 pandemic. Contributions to the USA Health Pandemic Emergency Fund are greatly appreciated and will be directed immediately to where they will have the greatest impact. The USA College of Medicine CARES Fund was created in response to unforeseen financial hardships brought about by the COVID-19 pandemic. Your gifts will help provide emergency support to future physicians and will be matched dollar for dollar up to $100,000. To make a donation, visit giving.usahealthsystem.com/ pandemic-relief, or call Kelly McCarron, associate vice president of medical affairs for USA Health Development, at 251-445-8423.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

OUTREACH

Comprehensive concussion program aims to change the sports game

James Toldi, D.O., a primary care sports medicine physician at USA Health, assesses Murphy High School student-athlete Napoleon Colston.

USA Health’s Comprehensive Concussion Awareness and Treatment Program has the potential to change the lives of athletes for the better by accurately and rapidly diagnosing concussions through a series of cognitive and physical assessment tests. The program is led by James Toldi, D.O., a primary care sports medicine physician with USA Health and assistant professor of family medicine at the USA College of Medicine. It is designed to decrease the number of missed concussions and shorten the recovery process for student-athletes who sustain head injuries. USA Health partnered with the United States Sports Academy on the cognitive testing portion and with Mobile and Baldwin counties’ public and private high schools for student-athletes to participate in the program. While injuries are often a part of sports, some injuries can have lifelong, debilitating effects. According to Toldi, a concussion is caused by a blow to the head. It could be a short-lived injury that is self-resolving; however, the aftermath of a concussion could lead to more serious issues, he said. 40

USA HEALTH MAGAZINE

“Post-concussion symptoms can last months or years,” Toldi said. “Research shows repetitive head trauma or concussions can lead to health problems such as memory loss, mood changes and chronic headaches.” According to the Centers for Disease Control and Prevention, concussions can also increase the risk for brain disorders such as Alzheimer’s and Parkinson’s diseases as well as chronic traumatic encephalopathy, a common brain injury in athletes. The need for change in how concussions are handled sparked USA Health to start this initiative to keep athletes safer. In 2014, Anthony Martino, M.D., professor and chair of neurosurgery, and Ashley Marass, DNP, associate professor at the USA College of Nursing and a pediatric nurse practitioner with USA Health, decided to participate in an educational challenge aimed at changing concussion safety. The program was created by the National Collegiate Athletic Association and the U.S. Department of Defense. Martino and Marass created an educational video, which was chosen as one of the top six in the country, to help athletes learn more about concussions.

VOL. 2, ISSUE 1

The educational portion of the program includes a pre-test, a video and a post-test to measure knowledge about concussions. Toldi said he wants to make the program more comprehensive. “In addition to the education piece, we added concussion assessment tools that can be used on the sidelines when there is an injury,” he said. Two tests are used to diagnose a concussion from the sidelines, leading to the quick removal of an athlete from a game. The Sideline Concussion Assessment Tool 5 measures cognitive and physical changes, while the King-Devick test measures eye movement and vision. “The added bonus of the King-Devick test is that anyone on the sideline can administer it, whether it’s a parent, coach or athletic trainer.” Toldi said he hopes to expand the program to more schools in Mobile and Baldwin counties and the surrounding area. “Arming trainers with the access to these tests and how to perform them is a powerful tool that could limit further injury and create a safer environment for athletes,” he said.

Toldi presents at research conference in Canada James Toldi, D.O., presented on the Comprehensive Concussion Awareness and Treatment Program at the 47th annual North American Primary Care Research Group Conference in Toronto. USA Health’s program was chosen for the “Research in Progress” poster at the conference. Toldi’s poster outlined the research gathered from the educational portion of the program and how it significantly increased an athlete’s knowledge about concussions. “This conference was a perfect opportunity for USA Health’s research into concussion prevention and treatment to be highlighted,” Toldi said. “The fact that another country is interested in hearing what USA Health is doing to educate athletes and create a safer environment for them shows that the work we are doing is making a difference.”

Student-Run Free Clinic makes an impact in 2019 Two of the biggest challenges facing many patients are access to healthcare and health literacy. The USA Student-Run Free Clinic (SRFC) helps to bridge these gaps for under-served individuals in Mobile. Under the guidance of preceptors, the student-led teams are able to spend more time explaining the complex conditions patients face compared with the time spent during a typical clinical office visit. In addition, the interdisciplinary approach at SRFC helps ensure patient problems are talked about from multiple angles, which allows both patients and students to learn about the healthcare problems many Mobilians face. According to the clinic’s 2019 impact report, new services offered this past year at the USA SRFC included:

• Free HIV screenings through partnership with AIDS Alabama • Free dental screenings through partnership with Franklin Primary Health Center • New occupational therapy-driven pediatric evaluation and treatment program focused on appropriate physical, mental and social development at Salvation Army Family Haven • Innovative ambulant clinic where SRFC directly provided care to Spanish-speaking patients in the community through partnership with the Medical Spanish Interest Group and local nonprofit BELONG • In-house physicals and documentation for those beginning rehab programs at Salvation Army See more of the SRFC’s impact in the infographic below.

2019 BY THE NUMBERS

226 volunteers 8 disciplines

> 1,000 hours of service learning

358 patients served

Estimated $49,000 in care provided at no charge

>$7,500 in grant funding received

USA Health employees help feed those in need As part of National Hunger Action Month and in celebration of Advanced Practice Provider Week, USA Health employees contributed 370 pounds of food items to a food drive organized by the Advanced Practice Provider Council. The donations were distributed through Feeding the Gulf Coast and provided 310 meals to local individuals and families in need. USA Health units with the greatest contributions per employee included the operating room at Children’s & Women’s Hospital (pictured). USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

OUTREACH

Students, providers serve on medical mission trip to Rwanda Practicing medicine in remote areas presents challenges and learning opportunities for even the most seasoned clinicians. Representing the USA College of Medicine and USA Health, a group of 25 clinical faculty members, fourth-year medical students, advanced care providers and support personnel spent the month of February on a medical mission trip in Rwanda. Since 2012, the Christian Medical Ministry of South Alabama has led the annual trip to Kibogora Hospital, a rural referral hospital in southwest Rwanda. Serving a population of 250,000, the hospital has two standard operating rooms, a C-section room and a minor procedure room. “Other than the rare occasion in which a patient is referred six hours away to the university teaching hospital in Kigali, every type of surgical case is done in those four rooms,” said Lauren Roberts, CRNA, a nurse anesthetist with USA Health. “Back home, several different hospitals and surgery centers would be needed to support a city of that size, yet somehow this small hospital manages to meet their needs.” Fourth-year student Kelsea Wright assisted in anesthetic procedures for surgery. “At USA, we are encouraged to be very hands on and to take responsibility for our patients, even as students, which helped prepare me for the increased autonomy I was given during this trip,” Wright said. “During my anesthesiology rotation at USA, I performed multiple intubations and spinal blocks, so when the opportunity came for me to perform those procedures at Kibogora Hospital, I felt confident in my abilities, with some guidance from the CRNAs.” Andrew Bright, D.O., assistant professor of surgery at the USA College of Medicine, has participated in the Rwanda mission as a medical student, resident, fellow and twice as an attending physician. Each trip is unique in terms of the pathology encountered, group dynamics, and intended specialties and goals of the students. “I have noticed that senior medical students, displaced from their normal environment, tend to have that same amazement that they had when they saw their 42

USA HEALTH MAGAZINE

first patients,” Bright said. “I get to witness a new beginning of sorts when they see 30 to 40 patients in the same ward, which is a large room. There is barely enough room to walk bed to bed, as the whole room is full.” As a fourth-year student going into emergency medicine, Travis Goodloe III worked mostly in the minor procedure room performing laceration repairs, abscess drainages, minor excisions, burn and wound care, and dressing changes.

“

The local staff that we interacted with during our trip made it very clear how grateful they are for this. It truly keeps the hospital afloat in a lot of ways. - Travis Goodloe III

”

“There is an endless flow of patients that funnel into Kibogora Hospital, thus having USA physicians, residents, and medical students present for a month really allows for a stress reliever on the existing medical system,” Goodloe said. “The local staff that we interacted with during our trip made it very clear how grateful they are for this. It truly keeps the hospital afloat in a lot of ways.” Bright, who also serves as a trauma, critical care and burn surgeon with USA Health, said the hospital’s lack of tools and technologies he is accustomed to in the United States forced him to become a more resourceful surgeon. The staff at Kibogora, which includes only one general surgeon, has become adept at maximizing the reach of materials and minimizing waste, he said. “We operated successfully on a 94-yearold man with large chronic burn-related wounds of the legs. I had to set up the whole case from start to finish, not just ‘my part,’” Bright said. “There were no blood transfusions available, and blood loss was expected, as he had significant tissue destruction. We had to find enough ACE dressings in the hospital to facilitate

VOL. 2, ISSUE 1

mechanical hemostasis, and mix our own epinephrine bath for hemostasis.” Roberts said the greatest challenge in administering anesthesia at Kibogora Hospital was troubleshooting equipment to maintain patient safety. “Each machine or monitor had at least one major flaw and sometimes several,” she said. In addition to the patients’ medical needs, the hospital staff and volunteers tended to the patients’ spiritual needs. “The Rwandan people are often more vocal and intentional about their faith than many of us are here in the United States,” Goodloe said. “Their freedom of worship even within the hospital during spiritual rounds on Sunday afternoons was powerful and eye opening to many of us. I do believe that these spiritual rounds consisting of praying, singing and dancing, and worship provided just as much healing as any medical care that we were able to provide.” A particularly moving experience for Goodloe was a home visit. The patient lived high in the mountains, in a small mud home with dirt floors and no electricity. Goodloe, classmate Will Martin, and the palliative care nurse from the hospital provided care for the patient, who was a quadriplegic and no longer able to provide for his family of eight children. As they talked with him about how to care for his wounds at home, the patient described how he trusted in God’s plan for him and his family. “This experience demonstrated the value of a robust and healthy faith, even in light of unhealthy and unfortunate physical conditions,” Goodloe said. “For all of these reasons, this experience was the most impactful of the trip for me, far more so than any specific medical care, procedure or surgery that we were able to provide over the course of our month in Rwanda.” As an advanced practice provider, Roberts called the experience in Rwanda career and life changing. “The challenges we faced and the experiences we encountered tested our knowledge, skill and faith,” she said. “The impact the people at Kibogora Hospital have had not only on my clinical practice but also my spiritual journey is one I am truly thankful for.”

Faculty and medical students from the USA College of Medicine and providers from USA Health cared for patients at Kibogora Hospital in Rwanda as part of a medical mission trip with the Christian Medical Ministry of South Alabama.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

USA Health Faces a fellowship in gynecologic oncology at the University of Virginia Health System in Charlottesville.

Physicians appointed chief medical information officers for USA Health

Scalici named chief of gynecologic oncology

As a physician-scientist, Jennifer Scalici, M.D., is passionate about discovering better treatments that can help women with reproductive cancers. Informed by her research background, she now takes on a clinical leadership role as chief of the gynecologic oncology service at USA Health Mitchell Cancer Institute. Since joining MCI in 2012, Scalici, an associate professor of interdisciplinary clinical oncology, has built a clinical practice emphasizing advanced surgical techniques for gynecologic malignancies. She served as principal investigator for a clinical trial that evaluated fluorescent sentinel lymph node dissection in endometrial cancer. She also focuses on basic research that tests new therapies for treating women’s cancers. Her current research, funded by a grant from the U.S. Department of Defense, examines the effectiveness of a novel compound developed at the Mitchell Cancer Institute for potential prevention of ovarian cancer. Scalici serves on numerous national committees focused on advancing the science underlying the treatment of gynecologic cancers. At USA Health, she has worked with colleagues to enhance the level of patient care with the development of an early warning system, an enhanced recovery program and a multidisciplinary and holistic approach to the treatment of gynecologic cancers. Scalici earned her medical degree from the University of Alabama at Birmingham. She completed a residency in obstetrics and gynecology at Northwestern University McGraw Medical Center in Chicago and 44

USA HEALTH MAGAZINE

Three physicians at USA Health serve as liaisons between the health system’s information technology department and its care providers. Christine Fouty, M.D., Dean Naritoku, M.D., and Spencer Liles, M.D., were appointed chief medical information officers (CMIO) for different areas of USA Health. Together, these three leaders focus on optimizing the electronic health record to ideally suit the needs of our patients, providers and staff, and serve as advisers and change agents in all aspects of information technology as it pertains to the provision of healthcare. Fouty, a hospitalist at University Hospital and an internal medicine physician with USA Health, serves as the CMIO of inpatient services. As a practicing hospitalist within USA Health, Fouty is familiar with all aspects of the electronic health record as it relates to inpatient care. Naritoku, a neurologist with USA Health, professor and chair of neurology, and professor of pharmacology at the USA College of Medicine, serves as the CMIO of outpatient services. Naritoku has done extensive work optimizing the electronic health record in the outpatient setting. Liles, a surgical oncologist with USA Health and assistant professor of surgery at the USA College of Medicine, serves as CMIO for surgical services. Liles has been involved with the development of the electronic health record since it became available for use at USA Health across the entire spectrum of surgical care. In these roles, they collaborate with Steve Travers, Ph.D., chief information officer for USA Health. Travers said the new organizational structure gives employees better access to the information technology department through these points of contact. “These individuals serve as a conduit between IT and the physicians and other providers,” Travers said. “This new approach stresses that the IT solutions we provide

VOL. 2, ISSUE 1

for the health system are patient-focused based on the clinical experience of these physicians. It ensures that we consider the clinical perspective as we develop programs and projects.”

Achievements “As president, my role includes increasing enthusiasm for new surgeons to join this society, as well as encouraging member participation in the annual meeting and through submission of papers to the American Surgeon,” he said.

Chief medical officer chairs national trauma meeting

Richard Menger, M.D., left, chief of complex spine surgery at USA Health, was named to the North American Spine Society’s 20 under 40 list.

Neurosurgeon named to national 20 under 40 list

Richard Menger, M.D., MPA, assistant professor of neurosurgery at the USA College of Medicine and chief of complex spine surgery at USA Health, was named to the North American Spine Society (NASS) SpineLine’s 20 under 40 list for 2019. SpineLine, the journal published by the NASS, showcases the society’s bright physicians under the age of 40. A committee selects these physicians based on accomplishments, community service and philosophy of care. In addition to his appointment in the USA College of Medicine, Menger serves on the faculty of USA’s department of political science and criminal justice.

Wright receives COM Predoctoral Fellowship Award

Griffin Wright, a third-year student in USA’s Basic Medical Sciences Graduate Program, is the recipient of the USA College of Medicine Predoctoral Fellowship Award. He is working with Natalie Gassman, Ph.D., assistant professor of physiology and cell biology at the USA College of Medicine and a cancer researcher at the Mitchell Cancer Institute, to study the response of DNA repair pathways following environmental exposures. “My research primarily focuses on the regulation of a major pathway of DNA repair, base excision repair (BER), in triple negative breast cancer (TNBC),” Wright

said. “A greater understanding of how BER is regulated in TNBC would improve treatment selection for the disease.” He graduated with a Bachelor of Science from the Auburn University College of Agriculture in 2017.

Simmons completes Harvard surgery leadership program

Jon Simmons, M.D., associate professor of surgery and pharmacology at the USA College of Medicine, recently graduated from the Harvard Medical School Surgical Leadership Program. He also serves as chief of trauma and acute care surgery at USA Health. The one-year postgraduate certificate program focused on understanding how technology impacts the field of medicine and transforming ideas into intellectual property that can enter the market. Simmons’ capstone project concerned a device that measures the thickness of burned skin and predicts the need for surgery and skin grafting – an idea that he has been working on since 2013.

Richards named president of regional surgery organization

William Richards, M.D., professor and chair of surgery at the USA College of Medicine and director of the USA Surgical Weight Loss Center, was installed as president of the Southeastern Surgical Congress (SESC) at the group’s annual meeting in New Orleans.

As chair of the Trauma Quality Improvement Program (TQIP), Michael Chang, M.D., chief medical officer for USA Health, led the American College of Surgeons’ (ACS) Committee on Trauma annual meeting in Dallas. More than 2,000 healthcare providers from across the United States gathered for continuing education on treating patients with traumatic injuries. With a focus on how to deliver the highest quality care to injured patients to optimize outcomes, the meeting was designed to improve management of trauma centers and to ensure that each trauma center is compliant with the ACS’s Committee on Trauma’s optimal standards. Chang has served as chair of TQIP for the past four years and is a recognized national expert in quality assessment and performance improvement.

USA Health and USA College of Medicine represented in Mobile Bay’s 40 Under 40

Four representatives from USA Health and the USA College of Medicine were named to Mobile Bay’s 40 Under 40 Class of 2019. Each year, Mobile Bay recognizes 40 individuals under the age of 40 who demonstrate leadership, professional excellence and a commitment to the Mobile Bay area. Hanna Alemayehu, M.D., is an assistant professor of surgery at the USA College of Medicine and a pediatric surgeon with USA Health. She recently helped establish the pediatric chest wall reconstruction program at USA Health. Alemayehu uses a cutting-edge pain control modality known as cryoneuroablation, which dramatically reduces hospital stay and pain for a historically painful procedure. Alemayehu has performed extensive research in pediatric surgical outcomes

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

and has authored dozens of manuscripts. She has won several awards, including the Children’s Mercy Hospital Every Time Award. She received her medical degree from Weill Cornell Medical College in New York and completed her residency at New York Medical College in Valhalla. Following her residency, she completed a fellowship in pediatric surgery at Children’s Mercy Hospital in Kansas City, Mo. Brittany Brown, RN, MSN, is director of operations for internal medicine at USA Health. She manages and directs all aspects of operation for more than 15 specialty clinics, where her professionalism, passion and leadership shine through. An avid member of Aubreigh’s Army, a national movement supporting a young girl who died from a rare brain tumor, Brown raised more than $15,000 for St. Baldrick’s Foundation. Each year, Brown visits several local high schools to work with juniors and seniors on resume writing, interview skills and career-focused concepts. She also works with the USA Health Internal Medicine Residency Program to collect donations for Feeding the Gulf Coast. Brown previously served as a clinical

adult registered nurse at the USA Comprehensive Sickle Cell Center and as a pediatric critical care nurse at Children’s & Women’s Hospital. She earned her bachelor’s degree in nursing and her master’s degree in nursing administration. LoRen Burroughs Modisa, MPA, is the diversity coordinator at the USA College of Medicine, where she helps foster a supportive and inclusive environment for students, faculty and staff through programming and targeted initiatives. She also oversees various USA College of Medicine pipeline programs in an effort to give high-achieving students from underrepresented groups access and exposure to careers in medicine. Prior to her appointment at USA, Modisa served as a HIV/AIDS civil society capacitybuilding volunteer with the Peace Corps in Botswana. She facilitated training, programming and initiatives centered on gender-based violence and its connection to HIV, reproductive health, female empowerment and children’s rights advocacy. Modisa also has served as a health policy and advocacy intern for the Bill, Hillary and Chelsea Clinton Foundation. She earned her bachelor’s degree in

professional health management from USA, and her master’s degree in nonprofit management and community development from Eastern Kentucky University. Jeremy Towns is a fourth-year student at the USA College of Medicine. He is a member of the Arnold P. Gold Humanism in Medicine Honor Society and has served on the College of Medicine’s Clinical Skills Advisory Committee, Curriculum Committee, and the Liaison Committee on Medical Education accreditation team. A former NFL player, Towns had stints with the Washington Redskins, Buffalo Bills and Philadelphia Eagles. In 2010, he founded the Radical Athlete and Student Oasis Ministry (RANSOM), which provides mentorship and ministry to undergraduate students at five college campuses. The following summer, he established Next Level Sports Camps, oneday football and volleyball camps that now serve more than 600 youths each summer. Participants receive sports training and develop leadership and decision-making skills at no cost to them. Towns also gives back to the community through motivational speaking engagements.

Retirements Sharon Bull, former associate director of financial aid at the USA College of Medicine, retired after 30 years of service. A USA alumna, Bull earned a degree in communications and started working at the College of Medicine about seven years after graduation. During her career, Bull assisted 30 classes and 2,015 graduates with financing their medical education, helping with debt management, teaching financial literacy and distributing scholarships. “I’ve loved this job, and I appreciate the

chance I was given 30 years ago,” Bull said. “It has been extremely rewarding. Having the opportunity to help the students is why I’ve stayed so long.” Penny Cook, former manager for the department of physiology and cell biology at the USA College of Medicine, retired after 40 years of service. “For the first 10 years, I did the research illustrations, line drawings and photography work for their journal publications,” she said.

As technology evolved, Cook soon realized that computers were able to produce the same images that she was developing by hand. Her responsibilities shifted as she started to handle the grants for the department. “I worked with great people and everyone had a great sense of humor,” she said. “I would not have stayed for 40 years had it not been an enjoyable job with people who know how to work hard, have fun and be friends.”

In Memoriam Joseph Potter Michalski, M.D., who served as professor of internal medicine at the USA College of Medicine and a rheumatologist with USA Health, passed away on March 13, 2020. The Mobile resident was 75 and recently retired from USA Health. A Montgomery native, Michalski 46

USA HEALTH MAGAZINE

received his medical degree from the University of Maryland-Baltimore in 1970. He completed a residency at San Francisco General in San Francisco. He did research for many years in California and at Louisiana State University in Baton Rouge before joining USA.

VOL. 2, ISSUE 1

“It was an honor to work with Dr. Michalski,” said Errol D. Crook, M.D., professor and Abraham Mitchell Chair of Internal Medicine and director of the USA Center for Healthy Communities. “He was a great physician and a great colleague. He will be greatly missed.”

He could be the reason your grandfather remembers your name. Dr. Mike Lin’s research may change everything we know about common brain diseases like Alzheimer’s and dementia .

Find out all the ways we do things differently at HowWeSeeIt.com.

Transforming Medicine

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1

Non-Profit U.S. POSTAGE PAID Mobile, AL Permit No. 506

2451 University Hospital Drive Mobile, AL 36617

Members of the community show their support of USA Health employees at Light It Up Mobile. The event honored healthcare heroes who are on the front lines of the COVID-19 pandemic.

USA HEALTH MAGAZINE

VOL. 2, ISSUE 1