Vol. 2, Issue 8
2011 December South Dakota and the Upper Midwest’s Magazine for Physicians and Healthcare Professionals
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Contents Midwest Medical Edition
December 2011
Regular Features 2 | 26 |
Cover Feature
From Us to You Off Hours Sports Medicine Doc Goes After the Big Game
31 |
Grape Expectations
32 |
N ews & Notes
33 |
Learning Opportunities
In Praise of Tradition By Heather Taylor Boysen News from around the region Upcoming Symposiums, Conferences and CME Courses
In This Issue
6 |
MEDPAC to Congress: Repeal SGR Now By Dave Hewett
8 |
Smartphone Apps: The New Trend in Medicine By Jenice M. Deming
9 |
Winners of AMA’s App Challenge
18 |
Avera Dedicates New Centennial Sculpture
19 |
Avera Campus to be ‘In the Pink’ by May
20 |
Healthcare in the Home By Dr. Michael Fleming
21 |
Iowa Proclaimed “Purple State”
22 |
New Scholarship Helps At-Risk Students
24 |
IC Research at Stanford
25 |
A MA Takes on Drug Shortages
30 |
B lack Hills Cardiovascular Research Seeks Study Participants
In Review Tales of the Super Sib Squad By Tina Melanson, MD
page
28
It has been another year of growth and progress for the region’s medical community. In our annual wrap-up, we highlight the area’s large new Eye Bank, outstanding physician musicians, a dynamic rural clinic’s 65th anniversary, Sanford Children’s new pediatric specialists, Sturgis rally time at Regional Health, and robotic technology in action locally. We hope it inspires your nomination for 2012
Top Stories page
11
2011
From Us to You
Staying in Touch with MED
A letter from the VP and Editor
A
lthough we always take the opportunity to look back at the top stories from the past year, December is also a time for looking forward. This is the time of year when we begin planning our editorial calendar for the coming year, preparing to cast a spotlight on the outstanding local doctors, technologies and Steffanie Liston-Holtrop institutions that are building South Dakota and surrounding states into a world class medical market. We invite you to take a moment to think of worthy subjects you would like to see us feature in 2012. To make it easy, you will find a nomination form in this issue. We hope you will find inspiration in some other parts of this issue, too. We have local experts weighing in on topics ranging from healthcare apps for your smartphone to Alex Strauss Congressional actions that affect your bottom line and toasts for your New Year’s bash. We introduce you to a sports medicine doctor whose own sport has taken him to some of the remotest parts of the globe. And we will find out what inspired a kidney doctor to try her hand at kids’ books. Plus, all the local medical news and events that you have come to expect from MED. Enjoy! From the entire local MED team, blessings to you and yours this holiday season. — Steff & Alex
Publisher
MED Magazine, LLC Sioux Falls, South Dakota
Steffanie Liston-Holtrop Alex Strauss Corbo Design Darrel Fickbohm 5j Design Darrel Fickbohm
VP Sales & Marketing Editor in Chief Design/Art Direction Cover Design Web Design Contributing Editor
Contributing Writers
Heather Boysen Jenice Deming Michael Fleming Dave Hewett
Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com
2012 Advertising / Editorial Deadlines
The Med Magazine Advisory Board
Jan/Feb Issue December 5
June Issue May 5
November Issue October 5
March Issue February 5
July/August Issue June 5
December Issue November 5
April/May Issue March 5
Sep/Oct Issue August 5
Reproduction or use of the contents of this magazine is prohibited.
John Berdahl, MD, Ophthalmology Vance Thompson Vision, Sioux Falls
Dan Heinemann, MD, Family Practice/ Administration Sanford Health, Sioux Falls
Bradley Randall, MD. Forensic Pathology Dakota Forensic Consulting, Sioux Falls
Timothy Metz, MD, Anesthesiology Anesthesiology and Pain Management, Sioux Falls
©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com.
Patty Peters, MD, Family Practice Avera McGreevy Clinic, Sioux Falls
Luis A. Rojas, MD, Gynecologic Oncology Avera Women’s Center for Gynecologic Cancer, Sioux Falls
e Woruits! t
Daniel W. Todd, MD, Otolaryngology Midwest Ear, Nose & Throat, P.C., Sioux Falls
2
James W. Young, DO, FAOCD, Dermatology Yankton Medical Clinic, PC, Yankton
r
t ccep We a mission r sub ea d e
MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.
Midwest Medical
My word is
compassion
Dr. Michele Corsini’s compassion helps her recognize victories in the cancer journey. We’re proud to offer mastery, innovation and personalized care at every stage. For all the victories you seek, Sanford Cancer. View my victory story at cancer.sanfordhealth.org.
MED Magazine 2012 Call for Nominations MED Magazine is seeking Nominations for Cover and Feature Article topics for 2012. MED is committed to focusing on pioneering physicians, institutions, programs and technologies that are paving the way for the future of healthcare in our region. No one knows these pioneers better than MED readers. If you know of a person or program that deserves a closer look, tell us about them. (Self-referrals are permitted!) Send us the following information via fax, mail or email.
Med Nomination Form Please include the following information: Name of Nominee_______________________________________________________________________________________________________ Location of Practice______________________________________________________________________________________________________ Reason for Nomination___________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ Your Name_____________________________________________________________________________________________________________ Your Contact Information_________________________________________________________________________________________________ Mail / Fax or email this form to: PO Box 90646 Sioux Falls, SD 57109—Fax 605-271-5486—email Alex@midwestmedicaledition.com
Intensive Care for Newborns
In whose hands will you place her?
Physicians’ Priority Line
1.888.592.7955
When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small. www.ChildrensOmaha.org
Med Mag.Sept., 2011indd 1
8/2/11 2:22 PM
MEDPAC to Congress
Repeal SGR Now By Dave Hewett , President/CEO, SDAHO
T
he Medicare Payment Advisory Commission (MEDPAC) has sent a special report to Congress recommending the repeal of Medicare’s Sustainable Growth Rate (SGR) system – that program’s methodology for paying physicians and other health care professionals. Describing the system as “fundamentally flawed” and as “creating instability in the Medicare program for providers and beneficiaries”, MEDPAC has concluded that the risks of retaining the SGR now outweigh the benefits and the cost of elimination will only increase in the future. So, eliminate and replace with what? MEDPAC is proposing a ten year freeze of payment rates for primary care physicians. Medicare fees for non-primary care services would be reduced by 5.9% each year for three years and then frozen for the remaining seven. MEDPAC justifies this differentiation by noting that based on surveys primary care providers are more likely to limit the number of Medicare patients they see compared to specialists and other Medicare providers. But there are other recommendations that will also impact payment rates. The first is how data are collected to establish Relative Value Units (RVU’s). MEDPAC believes several of the current data sources are biased and is recommending that the Department of Health and Human Services (HHS) collect data on a cohort of practitioner offices – offices that represent a broad range of specialties and practices with features that make them efficient. In other words, RVU’s would not be based on “the average” but rather those deemed to be more cost effective – thereby further penalizing those deemed to be less efficient. In a related recommendation, MEDPAC asks HHS to identify overpriced fee-schedule services and reduce their RVU’s accordingly. This requirement is to be budget-neutral but clearly would reconfigure reimbursement levels among and between the different providers.
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Finally, MEDPAC attempts to inject “value based” rather than “volume based” incentives into its revised payment system by rewarding physicians and health professionals who join or lead Accountable Care Organizations (ACO’s) – especially those ACO’s that would assume both financial risk and reward. The “reward” would be to exempt all participating physicians from the three year fee reductions described above. Keep in mind that these are just recommendations to Congress. MEDPAC has no actual authority to implement the recommendations it produces. And for a whole host of reasons, I’m assuming that Congress won’t be getting around to passing this kind of program any time soon. That said, it is instructive to note the growing discontent with SGR – like there wasn’t enough already. More importantly, these recommendations offer a glimpse as to how Medicare payments to physicians may be altered to replace in part “volume-based” or fee-for-service payment incentives with those that reward value and efficiencies of care. Two related observations are necessary. First, the dollar reductions in this proposal are massive ($219 billion) but they are less than if the 1996 program were allowed to proceed without adjustments ($300 billion). If there is even a glimmer of a silver lining in this for South Dakota, it is that providers in this state will likely be harmed less than those in other parts of the country where greater concentrations of specialists and lesser commitments to integrated care exist. It’s unlikely that these specific recommendations will ever come to fruition. But as the public policy debate on Medicare physician reimbursement moves from patching up the current SGR system to one of reform, it is important to know just how new practice incentives might be woven into that system and how that impacts providers’ planning for the future. ■
Midwest Medical Edition
Bankers Trust Company of South Dakota
From AMA President
Peter W. Carmel, MD “The release of the Medicare physician fee schedule rule serves as a reminder to Congress that there is a looming crisis in the Medicare program only they can stop, and the clock is ticking. Without swift action by Congress, on January 1 physicians who care for Medicare patients will be hit with a 27.4 percent cut caused by the broken Medicare physician payment formula. “Many physicians are already struggling with inadequate Medicare payment rates and the ongoing threat of future cuts from this broken physician payment formula. Payments for Medicare physician services have fallen so far below increases in medical practice costs that there is a 20 percent gap between Medicare payment updates and the cost of caring for seniors. The Joint Select Committee on Deficit Reduction must include repeal of the formula in their recommendation to Congress to protect access to care for seniors and stabilize the Medicare program.” ■
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December 2011
MidwestMedicalEdition.com
7
Smartphone Apps
Photo courtesy of AirStrip Technologies Inc AirStrip OB™ is a trademark of AirStrip Technologies Inc.
The New Trend in Medicine By Jenice M. Deming, JD, Risk Management Consultant, ProAssurance
A
smartphone isn’t just a phone. It’s a miniature computer. We surf the web, email, play games, and—thanks to the rapidly expanding world of smartphone applications (“apps”)–use our smartphones and other wireless devices as tools for the workplace. The field of medicine is changing rapidly with the growth of available medical apps. Today, physicians can monitor a patient’s vital signs, download their patient schedules, access current patient medical records, dictate office notes, and consult with other physicians without entering a clinical setting. One of the first medical apps in use and arguably the most widely used medical app today—is Epocrates,1 which provides clinical information on thousands of prescription and over-the-counter drugs.2 Another useful tool, Mediquations, is a medical calculator that includes 229 medical formulas and scoring tools.3 Examples of apps available to specialty fields include the ACC Pocket Guidelines for cardiology, Anesthesiology
i-pocketcards, and CORE—Clinical Orthopedic Exam for orthopedic surgeons. Such apps provide a multitude of up-to-date references immediately accessible at the time of care. Unlike reference apps, AirStrip OB is a semi-interactive app that is taking the obstetrical world by storm. AirStrip OB allows physicians to monitor fetal heart tracings and maternal contractions in real time on their mobile devices.4 AirStrip Technologies has created additional apps to include more areas of inpatient and home care management. While patients may be comforted knowing their physician can remotely monitor what is occurring, such apps should not take the place of face-to-face interaction. Another recent trend includes mobile dictation, which allows physicians to dictate information that can be transmitted and/or directly transferred to an electronic health record. In some cases, these apps also allow physicians to view patient lists, search patient IDs, and display current patient information on their mobile device.5
References 1, 2, 3. Neal, H. “The Best Medical iPhone Apps for Doctors and Med Students.” Software Advice Blog, December 9, 2010, www.softwareadvice.com/articles/medical/the-best-medical-iphoneapps-for-doctors-and-med-students-1100709/#ixzz1B34Cg6c4 (accessed January 11, 2011). 4, 9. Farrel, J. “Marketing Deal to Extend AirStrip OB Reach.” The Mobility Blog, August 31, 2010, www.mobilehealthwatch.com/blog/marketing-deal-extend-airstrip-ob-reach (accessed December 17, 2010). 5. Dolan, B. “3M Launches Smartphone Physician Dictation App.” December 16, 2009, wwwmobilehealthnewscom/5793/3m-launches-smartphone-physician-dictation-service/ (accessed January 12, 2011).
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AirStrip OB™
New Technology—New Risks As with any new medical device, there are risks. Unsecured smartphones can be “plundered by cybercriminals for data,” and smartphone apps are “often overlooked when it comes to testing the security of smartphones.”6 The Health Information Technology for Economic and Clinical Health (HITECH) Act requires notification whenever a breach of unsecured protected health information (PHI) occurs.7 Additionally, the Department of Health and Human Services requires security of PHI on storage devices (hard drives), transmission media (cyberspace), and portable electronic media (e.g., smartphones).8
6. Wysopal, C. “Smartphone App Security Issues Being Overlooked by Companies.” July 21, 2010, http://www.infosecurity-us.com/view/11133/smartphone-app-security-issues-beingoverlooked-by-companies (accessed December 17, 2010). 7, 8. Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements Under Section 13402 of Title XIII of the American Recovery and Reinvestment Act of 2009; Request for Information, 74 Fed. Reg. 19,006 (2009). Copyright © 2011 ProAssurance Corporation. This article is not intended to provide legal advice, and no attempt is made to suggest more or less appropriate medical conduct.
Midwest Medical Edition
Consider the types of information stored on your mobile device. Reference guides such as Epocrates should not be a HIPAA risk. However, PHI saved directly to the device by dictation apps should be secure. Beyond storage issues, physicians should consider the security of PHI transmitted via mobile devices. Apps such as Airstrip OB that transmit PHI could be intercepted by hackers and/or corrupted by a virus. This risk can be mitigated by using encryption software that makes the data unusable by any party who may intercept it during transmission. Some app creators, like AirStrip Technologies, advertise their products as HIPAA compliant.9 Regardless of whether a physician’s mobile device is used to access, transmit, or store PHI, consider all HIPAA and HITECH requirements. HIPAA requires data security and proper destruction, and/or file retention of PHI when appropriate. Before discarding devices with apps, physicians should have PHI removed to ensure HIPAA compliance.
What Can You Do?
Ama Announces 2011
APP Challenge Winners CHICAGO – The American Medical Association has announced that Cynthia L. Beamer, M.D., of Texas and Michael Ray Bykhovsky of Georgia, have won the 2011 AMA App Challenge with their ideas for the next great medical app. “Out of the hundreds of ideas submitted, two were selected by AMA members as the next great medical app ideas,” says AMA Chair-Elect Steven J. Stack, M.D. “Apps are among the many ways physicians learn, stay connected and juggle busy schedules.” Dr. Beamer’s idea, the Rounder app, won the physician category, and Mr. Bykhovsky’s idea, the JAMA Clinical Challenge app, won the resident/ fellow/medical student category. The Rounder app would provide a
data capture point for information on hospital patients, allowing physicians to easily keep track of their patients’ progress. The JAMA Clinical Challenge app would present clinical vignettes and images along with medical case information, serving as a learning tool. Earlier this year,U.S.physicians, residents and medical students were invited to submit their unique app ideas for a chance to have the AMA bring it to life. Out of the hundreds of submitted ideas, 10 were selected as finalists, and AMA members voted for their favorite app ideas. The winners each received $2,500 in cash and prizes, plus a trip for two to New Orleans for the unveiling of their winning ideas at the AMA’s semi-annual policy-making meeting in November. ■
You’re always there for them.
s Review potential wireless apps to ensure security of PHI at all levels; s Limit the type of apps that can be used based upon the individual app’s level of security; sD evelop a security policy addressing mobile devices and apps that can be used, along with the appropriate use and destruction of PHI data; s Develop an eDiscovery policy requiring assistance from defense counsel or your local ProAssurance risk management office in retaining PHI in the event of litigation; and
We’re always here for you. We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally committed to protecting you from the risks you face every day. To learn more, call 888-397-3034 or visit MMICGroup.com
s Work closely with IT personnel to address all security issues. ■ Exclusively promoted and recommended by the South Dakota State Medical Association.
December 2011
MidwestMedicalEdition.com
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December 2011 Dear MED Reader, For more than 20 years, the creators of MED (Midwest Medical Edition) Magazine have had their finger on the pulse of medicine in the South Dakota region. Before the first laparoscopic surgery was performed in our area or the first MRI suite installed . . . Before the first freestanding Heart Hospital, acute care Children’s Hospital, Cancer Center or Surgical Hospital opened . . . Before HIPAA, Medicare cuts, or Electronic Medical Records . . . Even before the words ‘Sanford’ and ‘Avera’ were household terms . . . we were committed to producing compelling and relevant local medical news. Through years of getting to know so many of you, we have come to understand that the healthcare professionals who read this news are more than a set of technical skills. You are also parents, volunteers, teachers, artists, entrepreneurs, athletes and more. So our vision for a local medical magazine expanded to encompass the rich artistic, educational, business and cultural interests that make you not only better physicians, but also better people. And MED was born. With MED, you will never see a ‘cookie cutter’ approach to publishing. Instead, every issue is a truly local, truly customized publication created with you in mind. Only MED invites you to reminisce, gives voice to controversial ideas, celebrates physician talent, lifts up volunteer efforts, takes you inside new facilities and, as always, covers every major clinical advance. Written, designed and printed right here in our area, with the support of local advertisers, MED is also a proud part of our region’s economy. With the direction of a local physician advisory board, the dedication of a Sioux Falls-based design and sales team, and the contributions of professionals who live here, we are excited to keep growing and changing right along with this vibrant medical community. Sincerely, The MED team
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Midwest Medical Edition
MED Magazine is proud to feature a wide variety of cover article subjects each year, from the largest health systems, to the most progressive independent practices and exceptional individual providers. We not only look at extraordinary people, programs and institutions, but we examine issues and trends that impact the evolving practice of medicine in our region. As has long been our tradition, we wrap up our publication year with another look at this year’s MED Top Stories. Following are excerpts from this year’s MED Magazine.
Top Stories
2011 By Alex Strauss
A Season In Review
If you know of a person, institution, or program that you would like to see featured in MED, please share your ideas with us. Look for the Nomination Form in this issue.
Alan Berdahl, Tissue Distribution Specialist, examines a cornea to determine its integrity.
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Hope is in Sight
January February
The South Dakota Lions Eye Bank Expands its Services
F
or 20 years, the South Dakota Lions Eye Bank has been quietly helping to restore sight to thousands of people in South Dakota and surrounding states. “In 2010, we have provided corneal transplants to nearly 500 people,” says Eye Bank Executive Director Jens Saakvitne. With the need for transplantable corneas and tissues continuing to rise, the Eye Bank recently opened the doors of a new, expanded facility. In addition to added space for tissue processing and storage, the 14,000 square foot building features surgical suites with hospital grade HEPA filtration for on-site recovery and more space for eye and tissue research projects, staff training, and even
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training space for emergency first responders workers. This year, the Eye Bank added the word ‘Tissue’ to its title to reflect the expansion of its procurement services over the past decade. Eye Bank professionals now regularly collect a variety of tissues other than corneas, including bone, connective tissues like tendons and ligaments, heart valves and veins. Tissues procured by the Eye Bank are shipped to one of several national processing centers to be prepped for national distribution. Even though improved facilities, new equipment and advanced technology are enabling the Eye Bank to touch more lives, Saakvitne says it is still the donors and their families who must get the greatest credit.
“It starts with a family. It if weren’t for people being willing to sign up as donors and families being willing to say, in the midst of unspeakable grief, ‘Yes, we believe in this’, none of these miracles could happen. It is their incredible kindness that makes all of this possible.” •
News Flash
Rodney R. Parry, M.D., retired in June 2011 as Dean of the Sanford School of Medicine of The University of South Dakota as well as USD’s Vice President of Health Affairs. In 2004, Parry was named Interim Dean and became Dean in 2005. He had been a medical school faculty member for 35 years.
March
Music and Medicine
T
here is an immense
Different, yes, but both give a lot of leeway for creative intelligence. It doesn’t surprise me at all that many physicians tend to music. I think part of that is how the medical culture always seems to push the achievement/perfection thing to the limit. Nothing is ever good enough, and I think that carries on into the music, too. It’s a balancing act, between the medical and musical worlds. You don’t want to put all your eggs in one basket, which works the other way around, too. The therapy and Psychology makes drumming that much more fun—it’s such a release. They both benefit from each other, though. The drumming is creative, but it’s also very physical, so it’s also like a workout for me.
011 moving through the
medical community,
inspiring a passion for creating and performing matched only by the desire to excel in medical practice. We chose three musicians to launch MED’s ongoing coverage of physicians in the arts and encouraged them to tell us their stories in their own words.
Chris Carlisle, MD
Emergency Physician and Cellist
I actually majored in music my first year…and wasn’t as good as I thought I was. So I switched to engineering. But I kept playing; we had an excellent orchestra in the community. It came back to me after I had kids and they started taking piano lessons. I was gradually inspired to try out for the South Dakota Symphony Orchestra. A couple things happened that got me seriously inspired: The Pavilion was built, and it was such a beautiful facility, and then Yo Yo Ma, the great cellist, was going to come play here. All of a sudden I had no excuses, and I had to at least try. Some of my most admired scientific minds were also musical, and I think there must be some crossover in the brain that causes the two to have many more similarities than I’m able to put together. Albert Einstein, a violinist, comes to mind.
Donald Baum, PhD Psychologist and Drummer
I think there’s definitely a correlation between the scientific and the artistic. Especially with drumming, there’s a correlation between patterns. It’s mathematics and rhythm. Just as musicianship and psychology work together; they both have sort of a creative perspective. December 2011
South Dakota Symphony Cellist and ER Physician, Chris Carlisle, MD.
Marian Petrasko, MD, PhD Cardiologist and Pianist
It was at the end of high school when I started thinking about choosing between a “real job” or music—I decided to keep it [music] as a hobby. But there are always chances to play. After I moved here, I found out that they have this wonderful Doctors in Recital program. So I made a call to the Children’s Care Hospital and School to see if I could audition and be a part of it. It’s totally different to play something for someone besides yourself or your family. It’s more difficult. You practice to perfection. Music to me is something between the rational and the emotional. As a physician you start to see the vulnerability as a race and how little the difference is between life and death, or ill and healthy. Perhaps you are looking for something to recharge you after looking at such issues. After a difficult day, it sort of just washes out the brain. • MidwestMedicalEdition.com
Dr. Petrasko performing with Julie Melik-Stepanov in the annual CCHS fundraiser, Doctors in Concert.
Photos by Reistroffer Designs, Courtesy Children’s Care Hospital and School
artistic current
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April/May
Hometown Healthcare 65 Years of Progressive Care in Yankton
F
ormed by the merger of two separate clinics, the Medical Clinic and the Yankton Clinic, both of which were established in 1946, the Yankton Medical Clinic, P.C. opened in its new incarnation in 1982 and has looked forward ever since. “Yankton has a long tradition of having very progressive health care,” says board-certified dermatologist James Young, DO, FAOCD who joined the Yankton Medical Clinic 13 years ago. Not only did the clinic bring his and other specialties to town, but it also opened the first Ambulatory Surgical Center there in the late 1980’s. What began with just a handful of primary care physicians has grown into a regional practice of 39 primary care doctors and specialists and 5 physician assistants. These providers represent more than 16 areas of expertise, including primary care – family medicine, internal medicine, ob/gyn and pediatrics – and medical and surgical specialties. Comprehensive diagnostic imaging, including MRI and other ancillary services such as an onsite pharmacy owned and operated by the clinic have helped to make the Yankton Medical Clinic a ‘one stop shop’ for healthcare. The newly-constructed Ambulatory Surgery Center features fully-equipped operating rooms in which surgeons perform outpatient procedures such as ear tubes and tonsillectomies, colonoscopy and flexible sigmoidoscopy, hernia repair, breast, prostate and skin biopsies, laparoscopic cholecystectomy, appendectomy, vasectomy and a number of ob/gyn procedures. “For a town of 13,000, this is quite unique,” says Daniel Megard, MD, a board-certified Internal Medicine physician who joined the clinic 19 years ago. Update: Yankton Medical Clinic has recently added a nephrologist and will welcome a rheumatologist and launch a hospitalist program in 2012. •
Dr. Young
Dr. Megard Photos courtesy YMC The Medical Clinic merged with the Yankton Clinic 65 years ago to form Yankton Medical Clinic, PC.
News Flash
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Kurt Stone, M.D., Medical Director at Rapid City Regional Hospital (RCRH) Family Medicine Residency Clinic was named the South Dakota Academy of Family Physicians (SDAFP) 2011 Family Doctor of the Year. Stone has been practicing in the Rapid City area since Midwest 1993. Medical Edition
Sanford Children’s atrium
Photo courtesy Regional Health As many as 500,000 attend the Sturgis Motorcycle rally each year.
July August June Gearing Up Turning Two Sanford Children’s Hospital . . . Here to Stay
I
n the last two years, Sanford Children’s Hospital has matured into a regional center for tertiary care, not only in South Dakota but in Western Minnesota and the adjoining states,” says Sanford’s Chief Pediatric Medical Officer, Dr. Gene Hoyme, Chair of the Department of Pediatrics at the Sanford School of Medicine. “One of the most important things that having the hospital has allowed us to do is recruit a significant number of high quality pediatric specialists.” Sanford Children’s includes a number of pediatric specialties, such as pediatric urology, nephrology, infectious disease, hospitalists, and soon, pediatric ENT that are available nowhere else in the region. In the past two years, Sanford has added 9 pediatric specialists including a gastroenterologist, nephrologist, urologist, hematologist/oncologist, optometrist, infectious disease specialist, and three additional hospitalists. The pediatric hospitalist program is one of the faster growing subspecialty areas for the hospital. One of the biggest changes at Sanford Children’s since the hospital opened is the addition of the region’s first pediatric residency program. Accredited last May by the Accreditation Council for Graduate Medical Education, the new 3-year program accepted its first class of six residents this summer. A successful first residency program also opens the door to other types of residency programs in the future. It may even pave the way for a fellowship program at a time when the number of pediatric subspecialists, and the programs to train them, is inadequate to meet the demand. •
December 2011
How Regional Health Gets Ready to Rally
F
or 11 months out of the year, Regional Health serves a population of about 400,000 people. But in early August, during the Sturgis Motorcycle Rally, another 500,000 people flow into this rural area. Regional Health approaches the influx like a planned natural disaster. In addition to regular planning meetings with all Regional Hospitals beginning in March, Rapid City Regional Hospital takes part in a multidisciplinary task force that includes law enforcement, FEMA, the National Guard and EMS services. “The operational footing of the hospital definitely takes on the tenor of a major disaster response,” says trauma surgeon Justin Green, MD, Director of Trauma and Surgical Critical Care Services at Rapid City Regional Hospital. During the course of the Rally, the system usually logs about 800 Rally-related Emergency Department visits and on its busiest day has about 40 Rally-related inpatients. Although accidents and assaults used to account for most of the Rallyrelated emergencies, the changing demographics and the sheer size of the crowd have resulted in a gradual shift in the types of medical problems seen. Chronic conditions like heart disease and diabetes are far more common than they used to be and physicians routinely see heart attacks, strokes, diabetic reactions, muscles pulls and orthopedic injuries, births and, sometimes, deaths. “We take the attitude that it is better to sweat in practice than to bleed in war,” says Regional Health COO Tim Sughrue. “We are a better organization because of this.” •
MidwestMedicalEdition.com
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Septem Octo The Electric Doctors How Robots are Transforming Medicine
O
nce the stuff of science fiction, robots are now a scientific fact. Rolling robots are streamlining medication management in local hospitals; humanoid robots serve as life-like training tools for medical students and EMS workers; and telemedicine-equipped robots are bringing specialists into underserved parts of the region. But perhaps the most profound and far-reaching application for robotics in medicine is inside the operating room. Sanford acquired its first daVinci robotic surgical system in 2004 and Avera in 2007. Both hospitals later added second systems. “Any time you can improve exposure and visualization, you are going to have a better outcome,” says Sanford gynecologic oncologist Maria Bell, MD, who has performed more than 700 robotic assisted operations. “Here at Avera, we now do about three quarters of our minimally invasive surgeries with the robot,” says gynecologic oncologist Luis Rojas, MD. In South Dakota, gynecologic procedures are the most common robotic procedures followed by urologic surgeries including prostatectomy. General surgeons in the region have also used the robot for adrenalectomy, Nissen fundoplication, colon and esophageal procedures. Sanford head and neck cancer surgeon John Lee, MD, recently began offering transoral robotic surgery for incision-free excision of tumors in the tonsil or base of the tongue which may reduce radiation exposure and help some patients avoid chemotherapy. At Avera McKennan, rolling Aethon tub robots distribute medications that can’t be delivered via the pneumatic tube system because of composition, size, weight or other factors. “The longevity of surgeons could definitely be lengthened with robotics,” says Dr. Bell. • 16
Aethon ‘tug’ robots deliver medications that can’t be sent through the hospital’s pneumatic tube system.
News Flash
Sanford Health assumed operation of a primary care clinic in Cape Coast, Ghana and announced new clinics in Baja, Mexico and Carmiel, Israel. The three new clinics are part of a group of seven clinics announced by Sanford as part of the initiatives outlined in 2007.
News Flash
The Careflight Air Transport program at Avera McKennan Hospital & University Health Center is celebrating its 25th year in service. Careflight averages 1,200 flights a year.
mber November ober Telling the Story Avera’s First Hundred Years
A
vera McKennan Hospital & University Health Center is celebrating a hundred years of providing healthcare to Sioux Falls and the surrounding communities. Open in December 1911, Avera McKennan is now a 545-bed tertiary hospital and health network that also includes 14 regional hospitals, over 70 primary and specialty care clinics, long term care facilities and more. Annual inpatient admissions are now approaching 22,000 with over 260,000 outpatient visits and a million clinic visits a year. It has been run by the Presentation Sisters of Aberdeen since it opened. “When we joined with the Benedictine Sisters to form Avera, it was a real shift for us, to give up sole ownership of something that we had really put our blood, sweat and tears into,” says Sister Mary Thomas, Senior Vice President of Mission. “But we knew that it was the right thing to do as the hospital grew.” “Even though our ability to serve patients is far more sophisticated and broadbased, somehow the Presentation and Benedictine Sisters have managed to preserve a philosophy of healthcare being a ministry that is rooted in the gospel,” says retired general surgeon Pat McGreevy, MD, who practiced at Avera for 36 years. “If your mission is just to meet needs, it guarantees that you are going to remain relevant to your community,” says Avera Health COO and longtime McKennan CEO Fred Slunecka. “That is why I have no doubt that in another 100 years our successors will be celebrating the 200th anniversary.” •
News Flash Both Sanford and Avera utilize the da Vinci Robotic System for many types of surgical procedures.
The number of Physician Assistants in South Dakota – and the amount of money they are earning – is on the increase, reflecting a national trend that has more PAs in practice than ever before. Approximately 450 PA’s now practice in the state. MidwestMedicalEdition.com
17
Avera McKennan Dedicates
Centennial Sculpture Song of Creation
Part of Avera McKennan’s celebration of its centennial included the unveiling of a 31-foot high stainless steel sculpture entitled Song of Creation. The commissioned sculpture was designed and created by South Dakota sculptor Dale Lamphere of Sturgis. It has been installed on the lawn just north of the Prairie Center. The cost of the work was covered by the Avera McKennan Foundation. “Avera McKennan has long recognized the important role the arts play in healing the whole person – body, mind and spirit. And, celebrating a centennial is a once-in-a-lifetime opportunity. We thought it was only fitting to commission a special sculpture that commemorates our centennial, and serves as an icon of all that Avera McKennan has been, is, and will be in the future,” said Dr. David Kapaska, regional president and CEO of Avera McKennan. “We thank our many donors who join in this commitment, making it possible to share this and other expressions of the arts with our community.” The sculpture’s design includes elements of spirituality, an important component of Avera McKennan’s Catholic heritage, as well as the advancing science of medicine and technology. Lamphere said the sculpture includes the Benedictine cross, and six major elements that honor the Presentation heritage. “Woven into it is a double helix form, which speaks of science and DNA. Through its spiritual elements, the piece points toward the ultimate source of life. A melodic, lyrical line flows through the piece, as it does our lives.” ■
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Midwest Medical Edition
Avera Campus to be ‘In the Pink’ by May Tulip bulbs will bring awareness in time for breast cancer race A new crop of pink tulips at the Prairie Center on the campus of Avera McKennan Hospital & University Health Center next spring will serve as a visual reminder of breast health awareness. The Avera Cancer Institute and the Prairie Center purchased 1,000 pink tulip bulbs from the American Cancer Society Cancer Action Network (CAN)’s “Plant it Pink” program. Bulbs planted in the fall will bloom in May. “We planted the bulbs in the month of October, which is National Breast Cancer Awareness Month. When they bloom in May, it will be just in time for the annual Avera Race Against Breast Cancer,” said Dr. Amy Krie, oncologist with Avera Medical Group Oncology and Hematology, and medical director of the Avera Breast Center. Proceeds from the sale of “Plant it Pink” tulip bulbs benefit ACS CAN, the nation’s leading cancer advocacy organization. ■ December 2011
MidwestMedicalEdition.com
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By Dr. Michael Fleming, Chief Medical Director of Home Health, Amedisys Home Health of Sioux Falls
When it comes to helping older, chronically ill patients get healthier while reducing medical costs, there’s no place like home.
Health care in the home offers benefits for patients and doctors
H
ealth care in the meet the physician’s need, from direct home benefits doctors by phone conversations to communication offering a skilled team of via fax machine. Health care in the home has an added nurses, therapists and benefit to rural patients, who generally aides to work closely with primary care live in medically underserved areas physicians and specialists to coordinate without easy access to hospital faciliall aspects of patient care for the treatties. The recession has led to a cutback ment of chronic diseases such as COPD, in the medical facilities in many rural CHF and diabetes. Advanced homecounties. A qualified nurse or therapist based health care methods are also caregiver can provide patients with available for stroke recovery, wound the skilled service in their home. A treatment and behavioral health management. Along with providing the whole range of services are available care, home health clinicians will give without requiring patients to undergo regular updates on patient progress to the expense and trouble of arranging to a hospital or medical doctors in the format best tailored to ISSUEtransportation Quarter Page Horizontal 3.875 x 5.275 DEC 2011 - FINAL 2011-10-26_Layout 1 10/26/2011 10:01 AM
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clinic that may be hours away. The benefits of health care in the home are obvious: coordinated high quality patient care in a comfortable setting with lower medical costs. And the service is easily accessible to elderly patients on a fixed budget or to lowincome households. Home health care services are covered by Medicare and many private insurers. Many state Medicaid programs offer full or partial coverage for home health. Often for physicians, the issue isn’t the benefits of home health care, but when to refer patients for the service. care in the home isn’t just for PageHealth 1 patients who are primarily confined to bed. The sooner patients enter the home health system, the more effective the treatment can be. A patient with a normal inability to leave the house, unless they put up considerable effort or use assistive devices, who needs skilled nursing care on an intermittent basis or regular therapy session, is typically eligible for home health. Any patient with a newly diagnosed condition and new medication who needs education and monitoring; or patients who habitually call on doctors with questions about medication or symptoms; or patients who need follow up care and have difficulty getting to a doctor’s office could be a good candidate for home health. Hospitalization may even be avoided if a patient enters home health
Midwest Medical Edition
early enough so they can start receiving the care they need. New requirements from the Center for Medicare and Medicaid Services mean that doctors must document a face-to-face evaluation of a patient in order to start home health care. The evaluation must take place 90 days before the start of care or 30 days after care begins. The evaluation can even be performed by a nurse practitioner
or clinical nurse specialist or physician’s assistant, under a doctor’s supervision. While there are a lot of concerns about the new requirements for face-toface evaluations, it’s a task that can be easily met right in your notes. See an overview of how to be compliant with face-to-face at www.amedisys.com/Face toFace and a simple check- list used to quickly assess a patient’s homebound status can
be found at www.amedisys.com/ HomeboundChecklist. The medical field is changing – with more of an emphasis on collaborative care and cost controls. Health care in the home offers all of that, with benefits for both patients and physicians. Doctors get the help of a strong safety net that will monitor patients, while patients can receive care in a familiar environment. ■
Iowa proclaimed “Purple State” National organization honors statewide shaken baby syndrome prevention collaboration The National Center on Shaken Baby Syndrome (NCSBS) has proclaimed Iowa a “Purple State” for its statewide efforts to prevent Shaken Baby Syndrome. Approximately 80 percent of Iowa births are in hospitals that provide evidence-based education and resources to prevent Shaken Baby Syndrome through the Period of PURPLE Crying program. Prevent Child Abuse Iowa, the Iowa Department of Public Health, Early Childhood Iowa, Blank Children’s Hospital and other partners were honored. Locally, St. Luke’s contributed to the state’s success. In Sioux City, St. Luke’s is the only birthing hospital that is using the Period of PURPLE Crying program. “Iowa is only the fifth state in the country that has received this designation,” says Steve Scott, Executive Director of Prevent Child Abuse Iowa. “The success we achieved after organizations collaborated to prevent Shaken Baby Syndrome is an example of what can be done, and needs to be done, to prevent all child abuse in the state of Iowa. Child abuse really is preventable.” Shaken Baby Syndrome (SBS) is a term used to describe a collection of signs and symptoms resulting from the violent shaking or slamming of an infant or young child. SBS is by far the leading cause of young child homicides. Long crying episodes are cited as the number one trigger in cases of SBS. The acronym PURPLE is used to describe specific characteristics of an infant’s crying and to let parents and caregivers know that
“SBS is by far the leading cause of young child homicides”
December 2011
what they are experiencing is simply a phase in their child’s development that will pass. P – Peak of crying: Your baby may cry more each week; the most at 2 months, then less at 4 to 5 months. U – Unexpected: Crying can come and go and you don’t know why. R – Resists soothing: Your baby may not stop crying no matter what you do. P – Pain-like face: A crying baby may look like they’re in pain, even though they’re not. L – Long lasting: Crying can last as much as five hours a day or more. E – Evening: Your baby may cry more in the late afternoon and evening. The curriculum is designed to teach parents that crying is normal and provide them with action steps they can follow to manage their own frustration while calming a crying infant. As part of the evidence-based program, nurses provide education to parents prior to discharge from the hospital. Parents are sent home with a DVD and booklet to help them understand the serious nature of SBS, as well as techniques to prevent it, and are encouraged to share the materials with anyone who cares for their baby. ■
MidwestMedicalEdition.com
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New Avera Scholarship Helps At-Risk Students
A new college scholarship program targeted toward at-risk students has been developed at University Center by Avera McKennan Hospital & University Health Center. The Avera McKennan Sister Sheila Schnell Scholarship Endowment has been developed specifically to provide opportunities to area students who graduate from high school after completing the USucceed program. USucceed, a new initiative of Sioux Empire United Way and Lutheran Social Services, will be launched in area high schools in January. Through the program, volunteer mentors will commit to work with at-risk high school students through the duration of high school. The goal of USucceed is to provide support and encouragement for young students to complete high school. “Helping at-risk students pursue a college education is an outreach that helps fulfill our mission at Avera McKennan, and the mission of the Sisters. Supporting higher education also helps us develop a strong workforce for the future. This scholarship program addresses both goals,” said Dr. David Kapaska, regional president and CEO for Avera McKennan. “Sister Sheila highly values education and at the same time is dedicated to helping people who are underprivileged. Naming this scholarship after her honors her commitment and example.” 22
In addition to the scholarship strong support system with someone to guide them all the way through high opportunity, plans are underway to school,” said Scott Lawrence, Sioux create a higher education resource network called USucceed University. Empire United Way Board Chair. “This Beginning in their first year of the proscholarship fund has taken that concept gram, USucceed students and mentors even further by showing our first class will have access to information and of participants that our community is educational workshops on navigating ready to see them through high school, the world of post-secondary education. college, and beyond.” ■ All post-secondary schools in the Sioux Empire have been invited to participate. The US Department’s National Center for Education Statistics shows that young adults with a bachelor’s degree earned 114 percent more than those without a high school diploma, 50 42 physician independently owned multi-specialty clinic seeking percent more than BE/BC Family Medicine physician to staff our urgent care Clinic. young adult high Current schedule is Sun, T-F with Saturday and Monday off but school completers, could be subject to change with the right person; Urgent care clinic and 25 percent is open 5-9 M-F and 12-5 Sat and Sun. Competitive salary and outstanding benefits; No State Income Tax; work closely with 3rd more than young year medical students from USD Sanford School of Medicine; adults with an teaching opportunities. associate’s degree in 2009. “ U S u c c e e d 1104 West 8th Street • Yankton, SD 57078 was designed to 605-665-7841 • www.yanktonmedicalclinic.com provide students So Much Care, So Close to Home. who might lack a
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Then & Now Our Changing Medical
Landscape
ce Examining Malpracti By Darrel fickbo
hm
which prevents up, you file a report, and they use that you from being fined, e out how to improv information to find benefits. the system—ever yone ctice apparatus— of course the malpra the process—are those who profit from re structu a and this, completely against would have to be for compensation would have to established, and people a tough sell. it’s so es; mistak admit their e a lot of information But it would generat the system. of what’s wrong with if you lose a in this environment, message is, “Don’t malpractice case, the get caught next time.” trying to monitor the hospitals are job than better a do these things and no doubt that of the have staff that looks there’s absolutely they used to. they and that i’ve exames, but most of R. BRAD RANDALL thousands of pap smears at errors and mistak the i just is internal and not I were having lunch missed something. i’ve ation that inform ined this out l. ow misinterpreted outside the hospita other day, looking didn’t see or someh available to people view. to the fact that cell out of the thouover the 18th street We come back around that one important to changes in the that unavoidable have the freedom I asked him about sands on a pap smear. hospitals should ion and eventually have to be called, in s internally while healthcare profess human error would right these problem the things ly so some ent.” proper of are list s “neglig , patient we got to his wish this legalistic system assuring that the ed out of different: be stretch so should t that he though term has gotten compensated. ■ tation work i do poor doc who’s some of the consul propor tion that some on both sides. the is labeled this way. ctice, error malpra human a on is made e it has become ball on malpractice doctors dropped the they’re labeled becaus redress. a long time ago. the patient’s only have set up happened is we the profession should What should have to us! ating bad results. “Yes, Mrs. smith, some way of adjudic should have said, Do you have a l interna an been wrong. it’s a rare media review? there should have someth ing went s gee Mrs. smith, part of the proces A book, film, or article? system that said, “oh, but unavoidable nsate an opinion bad result.” it compe a about had will How you’ve We we see that someti mes. on a current event? gotten to a legal doesn’t mean someshould never have you something—it ourselves so the write to us at: ing wrong—it just system. We didn’t police one did someth edicalEdition.com Alex@MidwestM to do it for us. s.” courts ended up having happen of emulating lawsuit, an attorfor a succes sful there have been talks negligence, but the n Administration’s ney has to prove the federal Aviatio . if you screw ence has gotten definition of neglig manner of filing reports e: pathology practic too broad. take
D
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author Paul a. offit,
In Review
What You’re Readin
M.D
Autism’s False Pr ophets
Bad Science, ris ky Medicine, and
reviewed by
a
dr. Albert J.
Strauss, Jr.
the Search for a
g, Watching,
Hearing
Cure
utism’s false Proph ets by scientific eviden Paul a. offit, ce that the “contr MD, is a oversy” is nonsense. thorough treatm ent of The legal, politi the histor y, backg cal, and highly round, scientific evide publicized celebrity nce, and hyste involvement is ria surrounding the also discu ssed. This involv controversy regard ement is what ing vaccines and the prima rily characterized cause(s) and treatm the subsequent ent of autism. 12 years of contin ued anecdotal stories The word “cont and machinatio rover sy” is used ns which kept advisedly since the controversy alive. there is no medic as Dr. offit points al controversy at all. out, the celebrity and as the author Tv involvemen obser ves, all of the credib t was and is, unfor tunate le medical institu ly, a continued tions involved in the force that counteracts study of vacci logic with emoti nes have stated, unequivoca on. He notes that it is hard lly, that vaccines to mention “scien do not in any way ce” and “studies” when contribute to the Jenny McCarthy development of autism says, “My scienc . The only contro e is Evan, and versy is outside of the medic he’s at home. That’s my al community. science.” McCa rthy is as a Professor clearly a loving of vaccinolog , highly conce y and rned and Pediatrics at the involved mothe university of Penns r who just “know ylvania and Chief s” what contributed to of infectious Disea her child’s autism ses at the Children’s . Celebrity bias has been Hospital of Philad rampant on televi elphia (CHoP), one sion. oprah, at the time of the most presti autism’s False gious children’s hospi Prophets was published, tals in the nation had never had . Dr. offit is well equip an articulate defen ped to discuss der of the scient and explore the autism ific facts of this issue on her show. The issue. He initia closest she lly delves into the came, says offit, histor y of vacci was to present nes and points out that a faceless statement from vaccination is the CDC. at the time arguably the most signifi that this review Prophets was cant medical advan is written, that an enjoyable read ce of continues the 20th century. to be the case. – well written, inform in terms of lives ative and very hard saved and miser y spare 17 to put a fair amount of down. Medical d, vaccination the books is devot folks as well as against the diseases that ed to the political the laity will thoroughly ravaged child aspects of vacci enjoy Dr. offit’ ren as recently as 30 nation and s examiautism. Some nation of the or 40 years ago of this is fascin certainly facts and fanta fulfills that criter ating readin sies g surro as one learns about ion. unding vaccination politicians and autism in Dr. offit then goes with little or no the unite d States. ■ on to explore the scientific know bad and probably ledge or background speak fraudulent scienc ing and pontifi e that started the mis-in cating vehemently on formation about the subjec t. at the end, autism and vaccines. incred before the index Have you read a book, seen ibly, one article , the book is a movie, by 13 authors (11 heavily heard a concer annot ated with of whom t, etc. that moved Dr. offit’s sourc you? this odyssey which recanted) began Whether it made es, giving acoly tes you mad or make , to this day, or skeptics the life is short but art endures you laugh, MED wants still — Hippocrates oppor tuexists in spite nity to do furthe to help you share of legal, medic r research, if desire it with your colleag al, and d ues. on the whol Send your review e, autis m’s s to Alex@ Midwe False stMedicalEdition.co
“. . . celebrity and TV involvement was and is, unfortunately, a continued force tha counteracts logic t with emotion.”
Medicine
m
November 2010 MidwestMedicalEdi
tion.com
Passionate Pursuits Outside the Office
Patrick Collison, MD
By Darrel Fickbohm
I
t took very little coaxing to convince Dr. Patrick Collison, an Ear, Nose and Throat specialist with Yankton Medical Clinic, to in talk about his long-standing interest to archaeology. But he was also quick an differentiate between a “hobby” and “avocation.” As with many other physihis cians, Dr. Collison’s passion for to extracurricular occupation turned out be much more than merely dabbling. “My interest in archaeology first came to me while I was doing research chilin for an article on mastoiditis dren” says Dr. Collison. “I came across an some articles by Dr. John Gregg, ENT in Sioux Falls, who had developed a second career in archeology. He had
published articles about fascinating in things like evidence of ear diseases 500- or 600-year-old Native American skulls. It just caught my interest.” Dr. Collison, who was in his 50’s at the time, began to feed his growing interest with Internet classes through USD and the University of Iowa, evente tually completing an undergradua he degree in archaeology. After that, took a seminar class per semester that he met once a week – the only schedule could manage with his ENT practice. he Eventually, over a number of years “cobbled together” a course of study in that earned him a Masters Degree Interdisciplin ary Studies, primarily Archaeology and Anthropolog y.
“It was like getting a second life or without actually being illegal immoral,” jokes Dr. Collison who calls his archaeology studies a “mood
elevator”. “On the other hand, it wasn’t easy. You must interact with professors without being a know-it-all, obviously. And I will never have the traditional student’s quick memory or computer skills. But it stretches you. I took way more classes than I needed to—I didn’t want I it to end. The study was the end, so dragged it out.” Among other things, Collison says his his academic studies helped revive express to ability his and skills writing or himself without using jargon Midwest Medical Edition
In Review shines a light on what you’re reading, watching and writing. Don’t keep it to yourself – share your recommendations – or critiques – with fellow readers.
dr. shirley Kunkel,
&Violinist
retir ed oBGyn 29
Off Hours
Otolaryngologist and Student of Archaeology
Then & Now is an opportunity to share your memories. How has time changed the way you practice medicine?
&Arts
MED: tell us a little ab out your history w ith the violin
Dr. Patrick Collison
At MED Magazine, we believe the knowledge and experience of readers like you are the medical community’s most valuable resource. We invite you to share your thoughts, memories, and insights with your peers through regular reader columns.
archaeol“medicaliese”. More than that, he says ogy has broadened his world view. opposed to “Archaeology is a social science as he explains. a biological science like medicine,” to a positivism scientific emphasizes “Medicine in its world strict degree, so it’s very different al outlook. Looking at things from an anthropologic worldview. standpoint gives me a more inclusive by its very Archeology dovetails with medicine my practice, contrast, if you will. It helps me in different of indirectly. It gives me an overview perspectives.” began to Over time, Dr. Collison’s passion also student pay off in practical ways and the devoted also became a teacher. to do “Suddenly, they were giving me research of figuring and I loved it! I enjoyed the challenge from?’ And out ‘Who made this? Where did it come to describe it then I was coming up with a report Meanwhile, too.) all. (And I got paid for some of it, that day and if I needed to, I could drop everything suddenly go work in the ER.” at USD on Dr. Collison began teaching classes studying histhe study of artifacts and methods of the analysis of torically important diseases through records of the skeletal remains. He has analyzed the diseases, 7th Cavalry for Ear, Nose and Throat which will soon be part of a new book. says “All of this gives me a widening future,” this to a nice Dr. Collison. “I’m hoping to stretch of the practice. part-time retirement job after I’m out kids roll their My family supports this, although my details eyes when I’m ranging into some obscure out loud. My wife actually goes along on some of the fieldwork. “When you think of archeolto us! ogy, you think of Indiana Jones Tell us about your going after the Arc of the Coveown ‘passionate nant. That’s the wrong attitude. pursuits’ outside the office. What we’re trying to acquire is understanding, not stuff. That’s what motivates me.” ■
Dr. Kunkel: i started violin w hen i was eleven, and i continue d until i was a sophomore in high school. i played i n a little college orchestra when i was in pre med, as well as the Purdue sym phony orchestra. While i was in practice , i played very minimal ly—once a year with the Aug ustana or community orchestr a just to keep my hand in. i’d play once or twice a year on piano. t hen when i was a resident in rocheste r i didn’t play at all. it was just too busy as a doctor. And that’s h ow life was for me. it was an eighty-hour work week and i had kids. now, i’m “Interview and photo high-energy, but i had by Darrel fickbohm to sleep sometime. i just always tho ught that there would be a time in my life when i’d get back to it. We’ve always had a piano in the house, but i’ve alwa ys liked the violin better. W hen i had in-house call (24 hours), i’d actuall y take the violin into the clinic with me, sometim es, and play. i wouldn’t do t hat at home because i had the kids at home so th ere was just no quiet time. MED: When you restarted the violin, how long did it take to get your chops up. Dr. Kunkel: First i thought, “i ’m way too old for this.” i w as a wreck. i was really ner vous for the symp hony audition. it all came b ack much slower than i thought it would, but twe nty-fi ve years is a long time for a talent to rest. luckily, i was retired by th at time so i fi nally had some tim e to practice. i think my fi eld of Obgyn is also a fi eld of ar t, more s o than science. there’s a lot of hu man con tact and more than one wa y to skin a cat—more than one way to solve a pr oblem. it’s creative. now, w hen i’m in surger y, i’m not exactly weaving d esigns, but otherw ise there ’s a lot of creation going on. i think they are both the sa me kind of discipline. to b e able to excel in music or in medicine you h ave to be dedicated and wil ling to put in the time. they go together. ■ 14
Medicine & the Arts gives recognition to the vast undercurrent of artistic talent ine’our local medical community. ‘BiG GRAp WInE tAStInG
Tell us about the art you love.
Benefit set for April 14
tHe big grAPe reserv e, a premier wine and food tasting event to benefi t pediatric patients and their families, will take place 6:3 0-9:30 p.m. thursday, April 14 at the museum of visual materials in sioux Fa lls. this event is designed as an e lite wine and food tasting experience, which also raises awareness and funds in suppor t of pediatric patients’ needs. li ve music and a silent auction are also part of the event. Proceeds and donation s benefit children and their families at A vera Children’s Hospital & Clinics through equipment acquisition, staff education, training, and charitabl e health care. Among programs supported through big grape funds are pediatric soci al workers, Child life specialists, the Avera Children’s Champion progr am. Avera Children’s is a “hospit al within a hospital” comprised of 114 beds devoted to the care of infants, childr en and adolescents in Avera Children ’s level iii neonatal intensive Care U nit (niCU), newborn nursery, Pediatric Unit, and Pediatric intensive Care Uni t (PiCU), as well as the child and adolesc ent units at the Avera behavioral Health Center. Along with the Avera mcKennan Foundation, presenting spo nsors of the event are JJ’s Wine, spirits & Cigars; Cadillac of sioux Falls; an d republic national Distributing Comp any. For more information call (6 05) 3228900 or visit www.thebigg rape.org. ■
Off Hours follows the passionate
pursuits – from mountain climbing and hang gliding to gourmet cooking and wine making – that fill your time outside the office
We want to hear from you! Look is h for t riter w e ty p cha nce r for aave you h to say!
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Send your submissions and ideas to Editor Alex Strauss at Alex@MidwestMedicalEdition.com or 605-759-3295.
IC Research at Sanford A Sanford doctor’s research may lead to a less invasive way to more accurately diagnose a bladder problem that affects quality of life for many patients. Kevin Benson, MD, MS, recently presented results of a one-year study of patients with interstitial cystitis (IC), an often misdiagnosed condition hallmarked by pelvic pain and urinary urgency and frequency, at the annual meeting of the International Incontinence Society in Scotland. The Sanford specialist in Urogynecology and Reconstructive Surgery was one of a select group of physicians chosen by his peers to present research findings at the event. The objective of the study was to explore whether differential gene expression was seen in IC and to develop a non-invasive new testing method for IC that could be used to both diagnose the condition and to let patients know if they are predisposed to the disease. Preliminary results of the study involving 28 women showed that patients with IC had a unique gene expression, with different genes expressed in cells in their urine than patients without the disease. Currently, most patients are not diagnosed with the
condition until after they have suffered symptoms for years. The diagnosis is often not uniform and is difficult to make without biopsies and invasive testing. Many patients are misdiagnosed as having urinary tract infections, or other conditions, and miss out on the chance for early treatment that could improve their health and lifestyle. Prior to the conference, the project was one of a select group of scientific abstracts chosen by society members for presentation to other specialists in urogynecology. There were approximately 2800 physicians at the conference. Dr. Benson is now conducting a second study with a larger number of participants. This follow-up research will help determine if genetic testing of urine can be consistently used as a good diagnostic tool for IC. Dr. Benson, a graduate of the Sanford School of Medicine at the University of South Dakota, practices at Sanford Clinic Urogynecology and Female Pelvic medicine in Sioux Falls. ■
Denny Sanford
Named International Outstanding Philanthropist Businessman Denny Sanford, long-time supporter of health programs, children’s services and other charitable causes in South Dakota and across the US, has been selected to receive the 2012 Award for Outstanding Philanthropist, given by the Association of Fundraising Professionals’ (AFP) as the organization’s top philanthropy honor. Sanford has given more than $600 million over the past four years, including the largest donation to a healthcare organization in history. In 2007, Sanford committed $400 million to the Sioux Valley Health System, now renamed Sanford Health. The donation led to the establishment of Sanford World Clinics in Oklahoma, Oregon, California, Israel, Ghana, Mexico and Ireland with several more under consideration. The gift also 24
supports several Sanford Research Centers including the Sanford Children’s Health Research Center—which focuses on the health needs of children. Sanford has given millions of dollars to variety of organizations, including his first significant contribution of $16 million for the Sanford Children’s Challenge in 2004, a campaign to build the only free-standing state-of-the-art children’s hospital in South Dakota. In 2008, he provided $30 million to the San Diego Consortium for Regenerative Medicine (now the Sanford Consortium for Regenerative Medicine) and $20 million to the Burnham Institute of Medical Research in La Jolla, Calif. Later, he issued a $50 million matching gifts challenge to benefit the organization now known as the Sanford-Burnham Institute.
Some of Sanford’s other contributions include $70 million to the South Dakota Sciences and Technology Authority that is turning the former Homestake Mine into an underground laboratory; $20 million to expand educational programming at the University of South Dakota School of Medicine; $15 million to the Mayo Clinic; and $15 million to the Children’s Home Society, a home for abused children. The Association of Fundraising Professionals (AFP) represents 30,000 members in 227 chapters throughout the world, working to advance philanthropy through advocacy, research, education and certification programs. The association fosters development and growth of fundraising professionals and promotes high ethical standards in the fundraising profession. ■ Midwest Medical Edition
In the past few years, shortages of medically necessary drugs have worsened appreciably
AMA Takes on
Drug Shortages The American Medical Association has adopted a policy to combat national drug shortages during its recent semi-annual policy-making meeting. In the past few years, shortages of medically necessary drugs have worsened appreciably. In 2010, almost 180 shortages of medically necessary drugs were identified by the FDA, triple the number from 2005. New AMA policy supports drug shortage legislation, such as H.R. 2245 and S. 296, that would require manufacturers to notify the FDA of any discontinuance, interruption, or adjustment in the manufacture of a drug that may result in a shortage. The new policy also calls on the AMA to advocate that the FDA and/or Congress require drug manufacturers to establish a plan for continuity of supply of vital and life-sustaining medications and vaccines to avoid production shortages whenever possible. A drug shortage may compromise and delay treatment, leading to progression of disease, adverse outcome, or therapeutic failure. When physicians are forced to use less familiar alternative drugs, errors and preventable adverse drug events are more likely. Health care
costs are increased due to clinical hours that are diverted to managing drug shortages and the additional acquisition costs of alternatives. The AMA’s new policy also supports the recommendations of the 2010 Drug Shortage Summit convened by the American Society of Health System
Pharmacists, American Society of Anesthesiologists, American Society of Clinical Oncologists and the Institute for Safe Medication Practices and calls on the AMA to work in a collaborative fashion with these and other stakeholders to urgently implement these recommendations. ■
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December 2011
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Off Hours
Passionate Pursuits Outside the Office
After the Big Game
Dr. Reeves and his son in Africa
Dr. Brad Reeves
Orthopedic & Sports Medicine Specialist, Big Game Hunter
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anford’s Director of Sports Medicine, orthopedist Brad Reeves, MD, discovered the thrill of the hunt early in life, as a young man growing up in Arkansas. “I am a bow hunter and have always hunted deer and turkey, etc. and have taught my kids to do it, too,” says Dr. Reeves. Now in his third season with Sanford, and a long way from his Arkansas roots, Dr. Reeves has taken his passion for big game hunting in recent years to some of the wildest and most
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challenging places on earth, including Saskatchewan and his favorite, Africa. “Africa is really the dream place to hunt,” says Reeves who this summer marked his sixth trip to the continent where he has pursued kudu, eland, waterbuck, zebras, impalas, bush pig, water buffalo, leopard and Cape buffalo, among others. “It is the place that Roosevelt and Capstick and Robert Ruark wrote about. It is the fantasy place for a hunter to go and requires all of your skills. You are really out in the middle of nowhere and there are no rules.”
“The first time I went to Africa, we sat at a water hole and waited for the game to come,” Reeves recalls. “Now, I get dropped off with a radio and I go off by myself. In that kind of setting, you spend a lot of time thinking about things like what kind of dad you are, what kind of husband you are. In Africa, it is all about you and your boots on the ground and you have to rely on what you can sense and what you can read. So it is a real challenge.” Always on the hunt for a bigger challenge, Reeves travelled to Calgary,
Midwest Medical Edition
The big prize: a cape buffalo. Africa 2006
Alberta, Canada in 2005 in search of black bear. “This was a one-on-one hunt and I ended up taking a 7-foot black bear at 5 yards. But it was supposed to be my really big hunt, and in a sense it came a little too easy. So I started to think what would be the hardest hunt of all.” He settled on Africa’s Cape buffalo, widely considered to be the most dangerous and most challenging game of all. In addition to rigorous physical training, Dr. Reeves spent a year reading up on Cape buffalo, watching videos, and keeping in close contact with the professional hunter who would serve as his guide and backup on the trip before embarking on the adventure this past May. “It was just a surreal thing,” says Dr. Reeves. “My arrow hit in the right spot but deflected off the ribs and into the abdomen, so then he was wounded and we had to track him. Every time we would get in the jeep, he would charge the jeep. Finally we decided that I should get out of the jeep and we would lure him with the jeep. The second shot went right through his heart.” This summer marked one of Reeves’ most memorable trips to Africa, hunting warthogs and wildebeest in the company of his college-age son, Matthew. Although he does not deliberately go after record-breaking animals, Dr. Reeves holds the record for the 19th largest eland ever shot and a waterbuck that is ranked 79th. In 2013, he plans to fly to a remote river in the Yukon to hunt moose… a trip that he predicts will be his last before he expects to need a knee replacement. With so much hunting experience the world over, it may come as a surprise to know that Dr. Reeves found one of his biggest hunting challenges right here in the fields of South Dakota. “Last year was the first time I had ever been pheasant hunting and I lost two of my best arrows. After a couple of hours and a couple of wayward arrows into the sky, I finally gave up and switched to a shot gun!” ■
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December 2011
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In Review What You’re Reading, Watching, Hearing
Author Tina Melanson, MD
Tales of the Super Sib Squad Interview by Darrel Fickbohm
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ephrologist Tina Melanson, MD, has recently moved from Sioux Falls to the Prairie Lakes Health System in Watertown after nine years at Avera. She remarks laughingly at the transitions she has made. “My husband is from the big city, from Boston, and I was afraid he would have some kind of reaction to the move,” she says. “We’ve downsized three times: Boston to Sioux Falls, and then to Watertown. But when we visit Boston, nowadays, it’s not very long before we start wanting to go home. We all love it here, and we’ve done well.” And that is not the only transition Dr. Melanson has made in recent years. She is also the author of three books, who is quick to talk with passion about her interest in writing. “I never envisioned myself as a writer,” Dr. Melanson admits. “Growing up, I never was a big fan of the language arts. I majored in physiology and went right into med school. My first book is related to my work. ‘Heeling the Boys’ Club’ is a self-published work of fiction about being a woman in the ever-changing field of medicine.” After her first book, Dr. Melanson turned her attention to children’s literature, at the request of her children. “Some of the content in my first book was not appropriate for their ages. They challenged me to write something that ‘they could read’ and that someone else would publish.” The resulting series, “Tales of the
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Super Sib Squad” about a trio of superhero siblings, became something of a family project. “The kids came up with a lot of the character details and some plot lines,” says Dr. Melanson, whose two most recent books were published by Tate Publishing. “Suddenly, there were so many ideas that it led to three, going on four, books. They’re funny stories— often sarcastic, the way I talk.” When asked how a busy professional and mother finds time to write, Melanson gives partial credit to her medical career and insomnia. “It started when I was at Avera. I was on call and you know that pager is always there—I just couldn’t sleep, even when nothing was going on. So, I would just sit with my laptop. One day I started writing and it just took off. Now I write whenever I can. “I think that doctors are interested in mysteries because that’s what medicine is. You develop a plot and you go along and try to find out what’s happening with a particular case. Writing fiction is often the same. I get my best ideas while I’m driving or showering,” she says, laughing. When asked why physicians often tend to achieve so much with their hobbies, Dr. Melanson thinks about the question for a moment before answering. “I think as physicians we tend to be overachievers who are used to lack of sleep and are in need of distraction of some sort. I think it’s great when
there’s something besides medicine that we can spend some time on. A life dedicated to medicine is special, but there’s so much more than that. “It makes me cool with my kids. And that’s a huge step these days.” Dr. Melanson’s books are available on line through Amazon or Barnes & Noble or directly from Tate Publishing. Copies are available in More Than Words at the Watertown Mall and in Cover to Cover Bookstore in downtown Brookings. ■
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Alex @ ition.com icalEd d e M t s idwe
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Black Hills Cardiovascular Research
Seeking Participants for Cholesterol Study
Black Hills Cardiovascular Research is seeking participants for a clinical research study on the tolerability and efficacy of AMG 145 co-administered with statins in patients with hypercholesterolemia. The study entitled LAPLACE-TIMI 57 will compare the effects of two-week and four-week dosing schedules with placebo for percent change in LDL. The study aims to include 600 randomized patients within the United States, Canada, and Europe during an eight-month recruitment period. To participate in the study, a patient must be between 18 and 80 years of age and on an approved statin (i.e. Zocor, Lipitor, Crestor, etc.), with or without ezetimibe, on a stable dose(s) for at least four weeks. “We are excited to be part of this study and for the potential benefit it might provide for patients who aren’t able to get their LDL down with the use of a statin,” says Drew A. Purdy, M.D., Cardiologist with Regional Heart Doctors. “This pivotal study will potentially give us another tool to aid in our fight against heart disease, the leading cause of death in the U.S.”
Other ongoing studies include a study of canakinumab in prevention of recurrent cardiovascular events in post-myocardial infarction patients with elevated hs-CRP, a study comparing Edoxaban to Warfarin for patients with atrial fibrillation, and a study on the effects of dronedarone on atrial fibrillation burden in subjects with permanent pacemakers. For more information and participant criteria, contact Lynn Kimball, Clinical Research Coordinator, at (605) 718-6295 or visit the website at www.regionalhealth.com/bhcr. ■
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The 18-bed specialty hospital at Children’s Care offers cost-effective care for children through age 21 who need 24-hour medical monitoring. Services include: • IV Medication Delivery • Suctioning, Oxygen Administration • Tracheostomy Care • Ventilator Use & Weaning • Skilled Nursing Observation following casting or surgeries • Nutritional therapy via gastrostomy, jeujostomy, NG or NJ
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December 2011
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The Avera Surgery Center
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Grape Expectations
Tradition!
“ Here’s to holly and ivy hanging up, and to something wet in every cup.” —Ogden Nash
By Heather Taylor Boysen
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or those of you who love musicals, the word may probably brings to mind the father Tevye from Fiddler on the Roof who constantly laments the loss of family traditions. For some reason, the resonance of this work plays in my mind over and over as we go into the Christmas season, perhaps because I participated in the musical in high school and the songs just seem to stay in my head whenever I think of them. Yaw da da da da da da da da da da……… But I am reminded constantly as I get older that traditions change. Some, because they no longer fit with the family dynamic, but others because they fade in our memory or for some reason become generational. I was asked the other day at a wine tasting event to present a toast and was concerned that I didn’t have one to offer. “Mud in your eye” just didn’t seem appropriate and many toasts that I have witnessed have been less than eloquent. I believe our generation (I’m 44 by the way) has lost the ancient art of the toast. In our family we have begun a tradition of clinking our glasses together
December 2011
frequently, but not in the form of a toast. We bring our glasses together as a signal that all around the table must pay attention and then our children tell us what they were thankful for that particular day. It isn’t a toast, but it is a conversation begun with the symbolic raising of the glass even if two of the glasses are filled with milk and covered with various super heroes and flowers. Like cursive writing in today’s world of touch screens and texting, many of us are not taught the proper way to acknowledge our guests, companions or loved ones in a public way where we can all “clink” glasses in a show of solidarity for that moment. Do you remember the last time you saw a toast presented other than at a wedding celebration or a business function? With great fear of being embarrassed in public by a less than stellar performance, I did what anyone might do in such a situation… I bought a book of toasts. Little did I know that I had a purchased a book that not only gave me the history of the toast, but also gave me much fodder to use as appropriately or inappropriately as the situation warranted. In the business of selling wine and spirits, we are often asked about products, how to mix them, when to serve them and how much to serve. To be honest, I can answer those questions with my eyes closed. But what toast is appropriate for what setting? That is another story. So I bought the book, did the research, and would love to lead the crusade to bring back the toast!
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“ May all your troubles last as long as your New Year’s resolutions.” ― Joey Adams “ Here’s to holly and ivy hanging up, and to something wet in every cup.” ― Ogden Nash “ As you slide down the banister of life may the splinters never face the wrong way.” –Irish “ May love and laughter light your days and warm your heart and home. May good and faithful friends be yours, wherever you may roam. May peace and plenty bless your world with joy that long endures. May all life’s passing seasons bring the best to you and yours!” –Irish blessing So during this Christmas season, raise a glass and let the toasts flow. Toast in celebration, friendship and good food. “ So prepare your feasts, purchase your libations, and have a safe and happy holiday season!” –Heather Taylor Boysen
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News & Notes
Happenings around the region
Avera Avera McKennan Hospital & University Health Center has recently welcomed Amy Lindaman, MD, family practitioner with Avera Medical Group McGreevy 7th Avenue. Dr. Lindaman has a medical degree from the University of Iowa College of Medicine at Iowa City. She completed residency at the University of Iowa Hospitals and Clinics at Iowa City, and is certified by the American Board of Family Medicine.
Regional Regional Cancer Care Institute Radiation Oncologist Daniel Petereit, M.D., was recently inducted as a Fellow, along with 20 other physicians, at an American Society for Radiation Oncology (ASTRO) special ceremony in Miami. Members of ASTRO are eligible to become a Fellow if they have been a member for at least 15 years, served in a leadership role for the organization and have made a significant contribution to the field of radiation oncology. The primary pathways to becoming a Fellow are research, patient care, education and leadership/service. The nominations were reviewed by a nine member Fellows Selection Committee who made recommendations to the ASTRO Board of Directors to make the final decision. Regional Health’s Infection Control departments have announced the organization’s 2011 Infection Prevention and Patient Safety Ambassadors. Six Regional Health employees have been selected for the honor
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based on their commitment to keeping hospital patients, employees, and visitors free from infection. Recipients include: Maureen Bauer, RN, Rapid City Regional Hospital, Peggy Erb, RN, Spearfish Surgery Center, Becky Jetson, Environmental Services Aide, RCRH, Roanna Pope, LPN, Sturgis Regional Hospital, Judy Shannon, Environmental Services Director, Lead-Deadwood Regional Hospital, and Geri Smith, RN, Same Day Surgery Center. Crystal Gruetzmacher, Regional Heart Doctors, Certified Clinical Research Coordinator, recently earned additional certification in Healthcare Research Compliance (CHRC) by the Health Care Compliance Association. To obtain CHRC status, one must have one year of full-time compliance experience or at least 1,500 hours/ two years of compliance-related experience. Candidates must also obtain 20 Continuing Education Units (CEUs) in the 12 months prior to taking an exam.
Sanford The South Dakota Safety Council has awarded a Governor’s Safety Award to Sanford USD Medical Center for excellence in workplace safety and health. Sanford USD Medical Center is one of 41 employers recognized. Since 1993, the annual Governor’s Safety Awards have spotlighted South Dakota employers with above average safety records. Participants submit injury information which is compared with state and national data, as well as the entrant’s past performance. Ongoing safety programs and activities are also considered. Sanford USD Medical Center has been recognized the last four years and has received the Award of Honor, the highest award, the last two.
and a master’s degree in Health Services Administration from the University of Kansas. Merkely assumed his new responsibilities December 5th. Brookings Health System includes a 49-bed hospital, a 79-bed nursing home and the Brookhaven Estates apartments.
The Coordination of Rare Diseases at Sanford (CoRDS) registry welcomes Lauren Beaumont to the CoRDS team. Lauren began as a research associate in September. The CoRDS registry is a national registry for all rare diseases. This central registry will help researchers identify participants who may be eligible for clinical research studies related to rare diseases.
Yankton Medical Clinic otolaryngologist Patrick Collison, MD, is now offering Baha implants to patients. The Baha is a surgically implantable system for treatment of hearing loss that works through direct bone conduction. Baha is used to help people with chronic ear infections, congenital external auditory canal atresia and single sided deafness who cannot benefit from conventional hearing aids.
Other Jason R. Merkley has been appointed the new CEO of Brookings Health System. Merkley has been VP of Professional Services at Avera Queen of Peace Hospital. Merkley holds a bachelor’s degree in Business and Health Services Administration from Augustana
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Learning Opportunities
Happenings around the region
December 2011 December, multiple dates
Perinatal Nurse Fellowship
8 am – 5:00 pm
605-328-6353
January 25, 2012 8 am – 4:15 pm
38th Annual Perinatal Conference
February 24, 2012 8 am – 4:15 pm
Information on dates and locations: nikki.terveer@sanfordhealth.org,
Location: St. Luke’s Regional Medical Center, Sioux City, IA Information: 712-279-3235 Website: www.stlukes.org/professional-education
Tri-State Pulmonary Care Conference Location: St. Luke’s Regional Medical Center, Sioux City, IA Information: 712-279-3235 Website: www.stlukes.org/professional-education
MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.