MED-Midwest Medical Edition-November 2010 by MED- (Midwest Medical Edition)

World-Class Cancer Care Right Here in Sioux Falls Join us for our Community open House at tHe avera CanCer institute

Sunday, November 7, 2010 1-4 p.m. Avera Cancer Institute â&#x20AC;˘ Prairie Center 1000 E 23rd Street â&#x20AC;˘ Sioux Falls, SD 57105 See first hand how the Avera Cancer Institute and the Avera Surgery Center are using state-of-the-art services and equipment to provide the highest level of cancer care to build hope for those with cancer. From diagnosis and treatment to survivorship and beyond, the Avera Cancer Institute is truly providing world-class cancer care for the Sioux Falls region.

www.AveraCancer.org Midwest Medical Edition

Contents Midwest Medical Edition

November 2010

Regular Features 2

20 |

Publisher’s/Editor’s Page Then & Now Conversations with Blackie

By Dr. Charles Monson

— A rural doctor reminisces on his career with his closest ‘partner’ – his trusty black bag. Grape Expectations Festive Finds for your Holiday Table

12 |

By Heather Taylor Boysen

29 |

In Review Autism’s False Prophets by Paul A. Offit, MD

31 | News & Notes News from around the region

In This Issue 5

| Sioux Falls Researchers Receive Multi-Million Dollar Grant Renewal to Help American Indians

11 |

Perspectives on Several Aspects of Healthcare Reform

By Dave Hewett

16 |

Avera McKennan First to Run New HIV Test

Medical Economics ‘Top Advisor’ Winner

22 | Family Owned Business Helps Doctors Weather Rough Financial Times 20 | Developing a Highly Skilled Health Information Technology Workforce By Jamie L. Husher

30 | Injury Prevention and Management in Healthcare Safe Patient Handling Programs By Jeff Roach

page

Cover Feature

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32 | Learning Opportunities – Upcoming Symposiums, Conferences and CME Courses

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A New Home for Cancer Care in South Dakota By Alex Strauss Cancer will overtake heart disease as the number one killer of Americans this year. Avera is facing the challenge with its a state-of-the-art new Cancer Institute. By bringing services including diagnostic imaging, oncology practices, radiation, chemotherapy, and support services together under one roof, ACI promises more efficient and more effective cancer care than ever before.

From Us to You Staying in Touch with MED

A letter from the Publisher

elcome to the fifth issue of MED magazine. We are excited to have crossed the halfway point in our first year and our thanks to all of you who have helped make it such a success. This month, I would like to especially thank everyone Steffanie Liston-Holtrop who stopped by our booth at the SDAHO conference in September! It was nice to get to know some SDAHO members on a personal level when we did the poker run on Thursday night at the conference. Our congratulations to E-Providers for winning the ½ page ad in our drawing. Med is all about highlighting and celebrating advances in our medical community. We are looking forward to seeing many of you at the various opening festivities taking place at the new Avera Cancer Institute. For those of you who have not yet gotten a look inside, we give you a first glimpse in this month’s Cover Story. I was amazed to learn that this building is not only beautiful, but one of the ‘greenest’ in the state. Congratulations to Avera on this new facility. We continue to welcome ideas for Cover Stories for the upcoming year. These are chosen from among nominations from our readers, so that we can make sure we are highlighting the very ‘best and brightest’ our region has to offer. Do you know of a physician or institution that would make a great story? Please take a minute to look over the nomination form in this issue and share your ideas with us. See you in December! —Steff

A letter from the Editor

s a journalist who has spent the past two decades covering medical news in the Sioux Falls area, there is no greater thrill for me than to witness another important leap forward for this medical community. The Avera Cancer Institute constitutes such a leap. As cancer care advances, Avera has followed the trend Alex Strauss of the nation’s top medical centers, and consolidated care in one carefully designed center where diagnosis, treatment, and support can be delivered more effectively and efficiently than ever before. We take a tour of new ACI for this month’s Cover Feature. Here at MED, we believe there are few things more satisfying than good conversation. That’s why, in addition to advice from area experts on subjects ranging from changing tax laws and IT training for your staff to wine picks for your holiday table, we have introduced some new opportunities for you to have your ‘2 cents worth’. We want to encourage those of you who are readers to share what you’re reading and why as part of our new ‘In Review’ column. For ‘Then & Now…’ we welcome your reminiscences and observations about our constantly changing medical landscape. We welcome other suggestions for regular columns and reader contributions. As we approach the season of Thanksgiving, we are deeply grateful for the advertisers, advisers, and readers whose support makes MED possible. Hoping that you, too, may find much for which to be thankful. —Alex

Steffanie Liston-Holtrop Alex Strauss

Publisher Editor in Chief

Cover Design Darrel Fickbohm Design/Art Direction Corbo Design Web Design 5j Design

Contributing Writers Charlotte Hofer Heather Boysen Dave Hewett Dr. Charles Monson Dr. Albert Strauss Jeff Roach Jeff Boonstra Dr. Vance Thompson Cheri Kraemer Nick Garry Jamie Husher Advisory Board John Berdahl, MD Mary Berg, MD Michelle L. Daffer, MD James M. Keegan, MD Timothy Metz, MD Patty Peters, MD Juliann Reiland-Smith, MD Luis A. Rojas, MD Daniel W. Todd, MD Published by

MED Magazine, LLC Sioux Falls, South Dakota

Contact Information Steffanie Liston-Holtrop, Publisher 605-366-1479 Steff@midwestmedicaledition.com Alex Strauss, Editor in Chief 605-359-8897 Alex@midwestmedicaledition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com

2010/11 AD / Editorial Deadlines December Issue Nov 5th

March Issue Feb. 5th

July/August Issue June 5th

Jan/Feb Issue Dec 5th

April/May Issue March 5th

Sept / Oct Issue August 5th

June Issue May 5th Reproduction or use of the contents of this magazine is prohibited.

©2010 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. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

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n’s and that we anford Childre S ed in jo ve pediatric ha ns nephrology and n new physicia ic ve tr se ia d at pe th , n gy lo ow Let it be kn pediatric uro new specialties: e re th d de ad have se. care can be infectious disea best care. That e th r fo ay aw r fa ians and travel to lands am of pediatric te to s y n’ ar re ss ild ce h ne C it n in ford No longer is all of the childre of Care™. San e of tl s as ed C e ne th al ic in e unique med found right here ready to meet th is s st li ia ec sp pediatric the our region. look forward to e w d an rs be r newest mem ren’s welcome ou ild h C rd fo an S e we serve. We at e needs of thos th t ee m to y it opportun ns.o sanfordchildre

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From You to Us Staying in Touch with MED

A Note to the readers of MED – As I prepare to step down after 18 years at Make-A-Wish, I want to share what a delight it has been to work with MED Magazine and Publisher Steffanie Liston-Holtrop. Steff is a “little Energizer Bunny” whose commitment to MED and its advertisers has helped to enhance the mission of the Make-A-Wish Foundation of South Dakota. In October, Paul Krueger will take over as the new President and CEO of Make-A-Wish. Steffanie is one of the first people I intend to introduce to Paul. At Make-A-Wish, we have hundreds of donors and volunteers who support our efforts every day of the week. But, a respected publication like MED and its staff, dedicated to helping us spread our message through advertising and editorial opportunities, is hard to come by. Steff, thank you for your friendship and your commitment to Make-A-Wish® and our many children suffering with life-threatening medical conditions. A note to all physicians, nurses, social workers and those of you who read MED: If you know of a child, in South Dakota, suffering with cancer, leukemia, a brain tumor, fast occurring muscular disorder or a heart condition, and more, please call us at 800-640-9198. Our mission is to reach every child in our state suffering with a life-threatening medical condition. Thanks to all of you who support that mission.

Call for Nominations MED Magazine is seeking Nominations for Cover Article topics for 2011. 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. If you know of a person or program that deserves a closer look, please let us know.

MED Nomination Application Nominee:__________________________________ Title:_______________________________________ Location of Practice:________________________ City:_______________________________________

Mary Olinger President and CEO Make-A-Wish Foundation of South Dakota

State:_____________________ Zip______________ Phone_____________________________________

The Med Magazine Advisory Board

Email:______________________________________ Reason for Nomination:_____________________ ___________________________________________ ___________________________________________ ___________________________________________

John Berdahl, MD, Ophthalmology Vance Thompson Vision, Sioux Falls

Mary Berg, MD, Family Practice Sanford Clinic Family Medicine, Sioux Falls

Michelle L. Daffer, MD, Dermatology Midlands Clinic, PC, Dakota Dunes

James M. Keegan, MD, Infectious Disease Regional Health System, Rapid City

___________________________________________ ___________________________________________ Your Name:_ _______________________________ Title:_______________________________________ Phone: _ ___________________________________

Timothy Metz, MD, Anesthesiology Anesthesiology and Pain Management, Sioux Falls

Juliann Reiland-Smith, MD, Patty Peters, MD, Breast Surgery Family Practice Comprehensive Breast Avera McGreevy Clinic, Care, Sioux Falls Sioux Falls

Email:______________________________________

Please fill out the form and fax or email to: Luis A. Rojas, MD, Gynecologic Oncology Avera Women’s Center for Gynecologic Cancer, Avera Cancer Institute, Sioux Falls

Daniel W. Todd, MD, Otolaryngology Midwest Ear, Nose & Throat, P.C.

Steffanie Liston-Holtrop, Publisher Midwest Medical Edition 4609 S. Baha Ave #201 Sioux Falls, SD 57106 Phone: 605-366-1479 Fax: 605-271-5486 steff@midwestmedicaledition.com Midwest Medical Edition

Sioux Falls Researchers Receive Multi-Million Dollar Grant Renewal to Help American Indians (Sioux Falls, SD) – Sanford Health has announced a more than $7 million grant to help address health disparities among American Indians. The grant will help establish a National Center for Minority Health Disparities (NCMHD) Exploratory Center of Excellence. The five-year award totaling $7,162,047 from the U.S. Department of Health and Human Services is a collaborative grant with the University of South Dakota and the Sanford Research/USD Health Disparities Research Center. This award is a renewal of a five-year program project lead by Amy Elliott, PhD. Collaborative partners for this project include the University of South Dakota, Sanford Health, the Aberdeen Area Tribal Chairman’s Health Board and Sinte Gleska University. This grant will create infrastructure and unite resources to conduct health disparities research, provide educational

opportunities for Native American students and increase the dissemination and utilization of scientific and health information relevant to health diversity population. “Oftentimes, grant-funded initiatives receive only three to five years of funding. Having the National Institutes of Health support this work for ten years of funding allows for greater impact and outcomes from our collaborative efforts,” said Dr. Elliott. The more than $7 million grant will help support the following research initiatives: • Recruiting American Indian Students to pursue careers as health research professionals • Increasing awareness of health disparities among American Indians, health professionals and the public • Developing programs to address critical health issues such as obesity

among American Indian children • Conducting a significant study on a treatment for urinary incontinence in American Indian women • Evaluating a model for promoting best practices to women of reproductive age to increase healthy births The first phase of the study investigates the incidence and prevalence of lower urinary tract symptoms in Native American females. The second phase of the study will stratify treatment of urinary incontinence into three groups. Depending on symptoms, patients will be treated with surgery, medications or physical therapy. The surgical arm of this trial will be first to utilize an office based surgical therapy for stress urinary incontinence. When successful, this will change the paradigm for treatment of stress incontinence worldwide. ■

WE LEAD. For 25 years, we’ve set the standard for quality and patient care.

910 E. 20th Street, Sioux Falls 605-334-6730 • www.sfsurgical.com

Before inpatient or outpatient surgery, Befo doctor about Sioux Falls Surgical Hospital. ask your do

November 2010

MidwestMedicalEdition.com

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A New Ho for Cancer Care in South

By Alex Strauss

vera McKennan has a long history of commitment to cancer care. Eight years after the hospital opened its first inpatient oncology unit in 1982, it became the first in the region to open a free-standing cancer center. In 1996, the hospital launched South Dakota’s first and only bone marrow transplant program, which is still going strong. And in 2009, the American College of Surgeons Commission on Cancer recognized the hospital with its Outstanding Achievement Award. But despite these accomplishments, Senior Vice President of Environmental Services Richard Molseed says now is not the time for Avera McKennan to be content with past success. “In 2010, cancer will overtake heart disease as the number one killer in America,” says Molseed. “One in two men and one in three women will personally experience cancer in their lives. Here at Avera McKennan, we have seen the demand for cancer services grow by about 20 percent over the last five years. This has far exceeded our expectations.” In response to those statistics, Avera has opened the doors of its most farreaching cancer care effort to date – a 260,000 square foot, 5-story, $93 million cancer center. The largest building project in the hospital’s history, the new Avera Cancer Institute unites clinical, diagnostic, treatment and support services in a building that was designed to be as aesthetically pleasing as it is technologically advanced. “We had a great deal of input not only from physicians but also from patients

and families in planning this building, so this is truly a building designed to meet the needs of everyone who uses it,” says Kris Gaster, RN, MSN, Assistant Vice President for Outpatient Cancer Clinics. “We have created a space that supports the highest level of cancer services, while at the same time giving patients a unique healing environment. And we have done it all in a building that ‘does no harm’.”

Designed for Healing ACI’s innovative design is the result of not only focus group input, but also site visits to some of the country’s top community cancer centers. Recognizing efficiency and ease of use as hallmarks of those centers, ACI gathered under one roof cancer care services that had been spread across the campus. The goal was to improve access to care for faster diagnosis and treatment. “As a ‘one-stop-shop’ for cancer services, there is no question that this new building is going to help us provide better care,” says Gynecologic Oncologist Luis Rojas, MD, of the Avera Women’s Center for Gynecologic Oncology. “When a patient is dealing with cancer, there is frequently a lot of moving around that has to happen. Our goal at Avera is to have a diagnosis within 48 hours and have treatment underway within a week. The new ACI is going to make it much easier to achieve that.” In addition to Dr. Rojas’ clinic, ACI houses Avera Hematology and Transplant, Avera Radiation Oncology and Avera Medical Oncology and Hematology. Like other Avera clinics, these clinic areas were designed according to LEAN

In 2010, cancer will overtake heart disease as the number one killer in America.

The new Avera Cancer Institute bring together in one place a continuum of diagnostic, treatment and support services that had been spread across the Avera McKennan campus.

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Photo Courtesy Avera McKennan

Hematologist Kelly McCaul, MD and Kris Gaster, RN, MSN, Assistant VP for Outpatient Cancer Clinics

Photo By Kristi Shanks

Gynecologic Oncologist Dr. Luis Rojas says the consolidation of cancer services will allow for more efficient cancer care.

Like many details of the new building, the custom designed infusion chair and flexible layout of the infusion center were influenced by patient input.

principles to maximize patient privacy and staff efficiency. Other clinical features include a dedicated imaging suite and a separate area for breast health and imaging, lead-reinforced radiation vaults, infusion centers, a pharmacy, and a blood draw station. Integrative Medicine services such as massage and nutritional counseling are also available on site. The fourth f loor houses the Avera Surgery Center’s eight operating suites and 28 pre- and post-operative rooms and the fifth f loor remains free for expansion. From an aesthetic standpoint, the operative word is ‘natural’. In response to focus group suggestions for more connection with nature, ACI’s architects adopted a Prairie Wind theme and used plenty of natural wood and stone. There are East and West indoor gardens behind a glass wall, with plants and architectural features resembling Eastern and Western South Dakota. The West garden ends in a waterfall with a meditation room underneath. Outside, there are more native plants and a walking trail. Other main floor amenities include a fireplace and stage, retail store, art gallery, library and bistro. “I would venture to say that it is one of the nicest cancer buildings in the United States,” says Hematologist Kelly McCaul, MD, of Avera Hematology and Transplant. “We have incorporated positive design features from all over the

country to create an ideal cancer care environment.”

Superior Technology

More than just a ‘pretty face’, the Avera Cancer Institute is also home to some of the area’s most advanced cancer technology. The center will be one of only a handful of in the U.S., and the only one in the region, to own Siemens’ newest linear accelerator, the ARTISTE. The machine offers advanced treatment delivery tools that enable clinicians to make critical adjustments instantly and deliver individualized Adaptive Radiation Therapy (ART) with the highest speed and precision. Another first for the region is ACI’s new Intra-operative electron-beam radiation therapy (IORT), made possible by a $2.5 million grant from the Helmsley Charitable Trust. IORT uses a mobile device to deliver high-dose radiation to tumors during surgery. It will primarily be used for the treatment of breast cancer on a research basis, with the goal of helping more women take advantage of breast-conserving surgery. IORT may eventually also be utilized in the treatment of advanced pelvic and abdominal tumors to shorten the course of treatment. “We are the first community hospital in our region to have IORT,” says Molseed. “We felt it would be valuable for our patients because it can reduce the

“Our goal is to have a diagnosis within 48 hours and have treatment underway within a week. The ACI is going to make it easier to achieve that.”

number of radiation treatments a person needs, which is important in our area given the fact that some patients travel great distances for treatment.” Brachytherapy can deliver targeted radiation treatment directly into a tumor through the implantation of tiny radioactive ‘seeds’. Although this used to mean the patient had to be transported to multiple rooms, ACI has a dedicated brachytherapy suite in which imaging, applicator placement, planning and treatment can all happen in one place, allowing for greater accuracy and efficiency. High Dose Rate (HDR) brachytherapy, which delivers the maximum level of radiation in a minimum number of visits, is an option for select patients with prostate, breast, and cervical cancer as well lung, head and neck and most recently, skin cancer. Another advantage for patients: ACI’s status as an NCI-designated community clinical research site for the region opens the door for patients to take advantage of multiple clinical trials.

last longer but they may get more infusions over the course of their disease. Patients spend more time in these areas, and they told us that what they really wanted was to be comfortable, to decide when and if they wanted to be with other people, and to be able to connect with nature. Our infusion centers provide all three.” Custom- desig ned infusion chairs have patient-friendly features like a built-in warmer, adjustable supports for the head, back and feet, and the ability to recline and elevate. Every infusion chair is positioned in sight of a window and movable partitions make it possible to block off treatment areas for privacy, or open them up for company. In response to statistics that more than 70 percent of cancer patients will turn to some type of complementary therapy, Avera has incorporated Integrative Medicine into the new ACI. Services such as aromatherapy, massage and fitness classes, all available on site, are thought to help relieve side effects of cancer treatment, such as pain or nausea and help patients stay strong, calm and positive. “Even some of the biggest cancer centers in the country neglect the spiritual and complementary aspects of cancer care,” says Dr. Rojas. “But we recognize that these things can make a difference in people’s lives. Our goal was to provide everything a cancer patient needs for a successful outcome.”

“We felt it would be valuable for our patients because it can reduce the number of radiation treatments a person needs, which is important in our area given the fact that some patients travel great distances for treatment.”

Patient-Centered Care

Patients had input on many areas of the new ACI, but nowhere is that more apparent than in the infusion suites, where many of the smallest details were patient-directed. Because patients on chemotherapy may spend whole days in the infusion center, comfort and convenience were high priorities. “Cancer treatments have become more complex,” says Gaster. “They not only

Photo By Kristi Shanks

“Cancer treatments have become more complex. They not only last longer but they may get more infusions over the course of their disease.”

Siemens’ newest linear accelerator, the ARTISTE, allows for faster critical adjustments and greater precision during radiation therapy.

“Even some of the biggest cancer centers in the country neglect the spiritual and complementary aspects of cancer care.”

he building includes a meditation room as well as indoor and outdoor meditation areas. And, because life does not stop for cancer treatment, ACI’s business center is equipped with fax, printer and wireless Internet so patients and families can continue to work and communicate. When treatment is over, survivor groups, which will meet in the building, can help the healing continue. “There are so many aspects to dealing with cancer,” says Dr. McCaul. “It disrupts your life, your work, there are emotional aspects. Of course, patients need to have access to all of the technology, but Avera has always had that piece in place. With this new building, we are able to bring it all together and provide the high level of care that we have always provided in an even more beautiful and functional space.” ■

Natural light and plants not only enhance the building’s aesthetic appeal, but have helped qualify it as a Leadership in Energy and Environmental Design (LEED) project by the U.S. Green Building Council. Courtesy Avera McKennan

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Green. . . more than a corporate color

Photo By Kristi Shanks

n keeping with the idea of “doing no harm,” The Avera Cancer Institute is the hospital’s “greenest” building. “It did not make sense to build a building to try to cure cancer out of materials that are known to cause cancer,” explains Senior Vice President for Environmental Services Dick Molseed. Non-carcinogenic building materials, including no-VOC paints, adhesives and fabric finishes, as well as locally-sourced sustainable, green and recycled materials were used wherever possible. ACI also integrates energy and water conservation, a passive solar design and lots of native plants. “We have the largest green roof in South Dakota,” says Molseed. “It not only gives people a chance to look out over all of this greenery, but it also helps to reduce the cost of heating and cooling the atrium below.” ACI is the first construction project in South Dakota to utilize Xcel Energy’s Energy Design Assistance (EDA) program, saviwng an average 28 to 30 percent over energy code. The building is registered as a Leadership in Energy and Environmental Design (LEED) project by the U.S. Green Building Council. The building is also approved to receive three Green Globes through the Green Globes® assessment and rating system. ■

Grape Expectations

Festive Finds for the Holiday Table By Heather Taylor Boysen

think all of us can agree that there are two sides to every story and I firmly believe this applies to the months of November and December. Some of us love how beautiful the world is covered in a blanket of pristine white snow while others grumble about the cold and having to shovel piles of that pristine white stuff. Some of us love holidays with relatives and friends, others would rather stay home and hibernate. Whatever camp you are in, one thing is certain during the next two months. Life can get crazy during the holidays if you let it, so I am choosing this year to employ the K.I.S.S. method. Many of you know this as “Keep It Simple Stupid.” I think of it as “Keep Insisting on Sipping Something”. Setting goals is always a good thing for me–it keeps me on track and less frantic. My husband may not agree that I am less frantic, but that is where KISS comes in, especially when you’re sharing a glass of “something” at the end of a day. My first goal for the holidays was to get all of my Christmas shopping completed by the end of October so that is off my plate. I don’t buy online

because I am a firm believer in shopping locally and keeping money in our local community. Goal reached–sipping “something” accomplished. My second goal was to make a list of the holiday entertaining and party-going in which my family will host and partake. The calendar is the ultimate holiday defense in making sure the family is taken care of first and everyone gets their Santa Claus moments. Goal reached– sipping “something” accomplished. My third goal was to go through my current inventory of beverages and purchase what I need to have to get through the holidays. Then I don’t have to worry about not having something at the last minute, such as a hostess gift or a bottle of my husbands favorite wine while we are wrapping Christmas presents. Goal accomplished–don’t sip the entire inventory! With the first three goals accomplished by the end of October, the most important goal in my retail life is now front and center: Help my customers as much as possible throughout the holiday season to make their lives easier and just a little more special. I want that in my own life, now I get to share my expertise and hopefully pass along some “sipping” insights. I love seeing people come to our store with their holiday food menus asking for pairing advice. I feel like a wine detective in many instances, searching out the clues in the food that will lead to the best pairing and best possible

experience for our clients. The traditional turkey and ham dinners have multitudes of possibilities depending on your wine preferences. I have many wines that work wonders with nontraditional fare as well and if you are hosting a party with many small plates or hors d’oeuvres, look out! If you are not a wine person, don’t worry. We have done entire menus based on beer pairings! Did you know that a dark stout is wonderful with chocolate? The choices are really endless for the holiday season. Whether you are a “beautiful snow” person or an “I have to shovel” person, claim this holiday season as your own and make it wonderful for you. And remember the K.I.S.S. method – Keep Insisting on Sipping Something! ■

Midwest Medical Edition

Customized Medication

May Offer Advantages for Palliative Care By Cheri Kraemer, RPh

alliative care during cancer treatment requires a high level of individualiza tion. Compounding pharmacies can provide tailored solutions for pain management as well as control of side effects such as nausea, vomiting, dry mouth and stomatitis. Custom made compounds can also be utilized to help with wound care issues such as decubitus ulcers, skin irritations and odor. There are many examples of ways in which a customized approach to palliative care can be advantageous. Change in dosage form— If a patient is unable to swallow medications, the compounding pharmacy can often compound the needed active ingredients into

November 2010

a different dosage form, such as a transdermal gel for absorption through the skin. Other alternate medication advminstrationg strategies include suppositories, troches, lozenges, lollipops, lip balms, or freezer pops. Combination preparation—Compatible drugs can be combined into a single dosage form to improve compliance and simplify medication administration. Unavailable medications—When a commercial product is out of stock or temporarily unavailable, a compounding pharmacy can often obtain the needed active ingredients as bulk powder and compound a suitable preparation. Flavoring— Cancer patients may be unable to tolerate sweetness and would prefer a medication with a bitter flavor.

MidwestMedicalEdition.com

A compounding pharmacy is able to alter a medication’s flavor to please the individual’s palate, and eliminate aftertastes. Elimination of problem causing fillers – Medications can be formulated free of dyes, sugar, lactose, alcohol, preservatives, and gluten, to name a few. Dosage modification – A compounding pharmacy can create a preparation that contains the most appropriate strength of medication to provide the needed benefit but avoid adverse effects. This can be particularly important for a patient with kidney failure or liver disease. ■ Cheri Kraemer is a Registered Pharmacist with Pharmacy Specialties in Sioux Falls.

Art that can save lives A conversation with Dr. Delf Schmidt-Grimminger, researcher American Cancer Society looking to fund more researchers Dr. Delf Schmidt-Grimminger, scientist at Avera Research Institute and professor with USD Sanford School of Medicine, is heading a research project that is using art and storytelling as a method to communicate cancer education to Native Americans. The project involves the Cheyenne River Sioux Tribe in South Dakota and is sponsored by a $50,000 grant from the American Cancer Society. Charlotte Hofer, American Cancer Society, caught up with Dr. S-G to ask him some questions about the project. CH: Tell me about the project. What’s the goal? DSG: It’s to increase awareness and prevention of cervical cancer among the Northern Plains American Indians. Native Americans in the Northern Plains have a cervical cancer rate that is 2 to 3 times higher than that of the general population. CH: How is art involved in your research? DSG: Art can be used as a way to tell a story about cancer prevention. I’ve teamed up with Native American artist Chholing Taha of Tacoma, Washington to create a piece of art that emphasizes the importance of cervical cancer screening and prevention. CH: The art is very beautiful. But more than that, it has meaning. Can you describe its meaning? DSG: There are 10 hands in the picture; the 10 hands represent 10 women in a tribe. Four of them have circles, which represent the HPV virus. The small dots around the virus represent anti-bodies that fight the virus, and promote good health. The center cradleboard depicts mother-child connection. 14

CH: How do you see the art being used? DSG: Well, it could be used in many venues to educate about screenings — — in health clinics, community centers, in schools. It can be used as a template for other tribes — with their local artists able to fill in their own colors and symbolism to reflect their specific culture and community. And it could even be used with other audiences, including non-Native populations. CH: What’s the secret to the success of this project? DSG: At least 70% of the success of the project is directly attributed to Native American involvement. You have to involve the community in creating materials: they guide us in the right direction. One size does not fit all when it comes to cancer education. We have to be a lot more sensitive to cultural diversity and incorporate different ideas and traditions to promote health. CH: You’re half-way into the research project. What’s the most exciting discovery so far? DSG: For me the most exciting discovery is how welcome we are in this community and how supportive the people have been to us. CH: What do you like best about being a researcher? DSG: I think giving back to communities; seeing that we can make a difference — that we can better women’s health. ■ The American Cancer Society has research funds available. Eligible applicants can receive up to $1.2 million. Prior research experience is not required and any level of researcher can apply. Contact the American Cancer Society at 1.800.227.2345 or www. cancer.org/research. ■ Midwest Medical Edition

“For me the most exciting discovery is how welcome we are in this community and how supportive the people have been to us”

Artwork designed to educate Native American women on cervical cancer prevention.

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MidwestMedicalEdition.com

Avera McKennan First in the Country to Run New HIV Test Avera McKennan Hospital & University Health Center in Sioux Falls was recently the first facility in the country to run an important new HIV test which can detect the virus sooner, so that patients understand their HIV status earlier and take measures to stop the spread of the virus. Previous HIV tests detected only antibodies – the body’s reaction to the virus. Abbott’s ARCHITECT HIV Ag/ Ab Combo assay is a simple blood test that detects antibodies as well as HIV antigen – a protein produced by the virus immediately after infection. This first fourth-generation HIV assay was approved by the U.S. Food and Drug Administration in June. “This is very significant, because HIV could potentially be detected several days earlier,” said Dr.

Aris Assimacopoulos, infectious disease specialist at Avera McKennan. “When patients know they are infected with HIV, they are much more likely to change their behavior patterns to prevent spread of the disease. Also, like most viruses, HIV is most infectious within the first eight weeks after infection. For these reasons, this test ultimately has the potential to reduce HIV infections.” The Avera McKennan Laboratory has gained the rigorous ISO 15189SM accreditation from the College of American Pathologists, and was named Laboratory of the Year in 2010 by Medical Laboratory Observer magazine. Lab testing accuracy is measured at 99.99993%. More than 1 million people in the United States are infected with HIV, and one in five of those people don’t even

know they are infected. In fact, up to 50 percent of ongoing transmissions come from people who were recently infected. Studies conducted by the Centers for Disease Control and Prevention (CDC) show that current antibody-only tests miss up to 10 percent of HIV infections in some high-risk populations because they do not detect antigens. However, because the new assay detects the HIV-1 p24 antigen, or the direct presence of HIV, it allows for the diagnosis of early infections days before antibodies emerge. “While you hear less about HIV in the United States these days, the war against HIV is far from over. More than 56,000 people are newly infected each year. The approval of HIV combination assays in the United States represents an advancement toward controlling the spread of the virus,” Serrano said. “We are pleased to be the first institution in the United States to provide this test so patients and physicians can get their results sooner.” ■

Pictured is Trisha Lauterbach, MLS (ASCP), medical laboratory scientist

Midwest Medical Edition

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.

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MEd Midwest Med Ed, Oct. Oct, 2010.indd 1

10/5/10 10:47 AM

Advanced Implants Revolutionizing Cataract Surgery By Vance Thompson, MD, FACS

cataract is a clouding of the normally clear lens in the eye. Though painless, cataracts can blur the vision by restricting the amount of light that enters the eye. Other symptoms can include increasing night-time glare, poor night vision and a change in how the eyes perceive colors. An example of this was in the art of Claude Monet who noticed an overriding yellowish cast and a loss of subtle color discriminations that affected his art (Ravin). Most people’s lenses will naturally become somewhat cloudy with age, but when the ability to carry out normal activities is hindered, cataract surgery is often the best solution.

implant. The aging natural lens first becomes stiff, (hence the need for bifocals), and second becomes cloudy, (hence blurry vision). A traditional lens implant will replace the cloudiness but do so with a stiff implant that requires reading help for the rest of the patient’s life. In

(Abbott Medical Optics) and the ReSTOR (Alcon). Both are known for powerful near vision, but patients should be told about the risk of night time glare and potential low light image quality issues. If the goal is to ultimately be able to

Advancements in Cataract Surgery

An accommodative Crystalens by Bausch & Lomb.

An AcrySof ReStor multifocal lens by Alcon.

Most patients are comfortable wearing glasses after surgery, but for the up to 40% who say they would prefer to be able to function without glasses, advanced implant technology may be an option. For these patients we ask: Would you prefer an implant that gives quality daytime and night time distance vision and good intermediate vision, but will mean you may still need reading glasses . . . or would you prefer an implant that gives powerful near vision without glasses and a quality daytime image, but may cause some night time glare? The first half of this question is describing an accommodating lens

contrast, accommodating lens implants replace the clouded lens with a clear, more flexible lens that can ‘accommodate’ more like the natural lens they had in their 40’s, 50’s and 60’s. The most common accommodating lens at the time of this writing is the Crystalens (Bausch and Lomb) The second half of the question is describing a multi-focal lens. Multifocal lens implants have some of their optics dedicated to distance, some to intermediate, and some to near. The two most commonly implanted multifocal lenses are the Tecnis MultiFocal

function without glasses, then patients should understand that it may be a two step process — first the lens, then a refractive enhancement, such as laser vision correction. The entire fine-tuning process could take 4 to 6 months, but when it’s over patients have the satisfaction of having an optical system that will not deteriorate like their own natural lens once did. ■

References Ravin JG. Monet’s cataracts. JAMA. 1985;254:394-399. Midwest Medical Edition

Perspectives

“. . . these programs . . . will reshape the way health care is delivered and paid for in this country.”

on Several Aspects of Healthcare Reform By Dave Hewett, President/CEO, SDAHO

edicare reimbursement for physicians: It’s been the number one federal advocacy issue for physicians for what seems to be an eternity. And with no permanent solution in sight, Congress will likely return to Washington in mid-November to, once again, approve a short-term extension of current payment levels, thereby avoiding a 23% reduction in rates. Between now and then, physicians will likely be singularly focused on lobbying members of Congress to pass the extension. Meanwhile, literally the hundreds of new health reform initiatives passed as part of the Affordable Care Act of 2010 (ACA) are in some form of development or implementation. Among those initiatives are defining the scope and structure of accountable care organizations ACO’s), meeting still unclear “meaningful use” criteria for implementing electronic medical records, health insurance reforms and new provider reimbursement penalties for meeting certain quality and/or patient safety goals to name a few. While most of these programs are now in the hands of a litany of federal and state agencies, members of Congress can be instrumental in refocusing the efforts of over-zealous bureaucrats who may stray from Congress’ intended purpose of certain programs. More importantly, these programs – ACO’s, EMR’s, an Independent Payment Advisory Commission (IPAB), patient safety improvement programs and the many others will reshape the way health care is delivered and paid for in this country. November 2010

And with those programs now in their formative stages, it is imperative that physicians, hospitals, and other providers remain informed and involved in shaping these important programs. Certainly, physicians must remain vigilant in advocating for Medicare payment reform and the avoidance of a 23% reduction in their reimbursement ra tes. I can assure you that it is a major priority for hospitals and health systems as well. But as a provider community, we don’t have the luxury of being singularly focused. It is imperative that physician voices be heard on the many other issues

that confront health care during this critical time of implementation and experimentation. ■

353 Fairmont Boulevard Rapid City, SD 57701 (605) 719-2300 (800) 232-0115 www.regionalhealth.com 14148-1010

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Then & Now Our Changing Medical Landscape

The More Things Change . . . Conversations With Blackie By Charles D. Monson, MD; Parkston, SD

sat down the other day and had a conversation with my old black bag, Blackie. We have been together since 1959 when I graduated from K.U., and he was placed in my care by one of the drug companies. Our first forays into the fields of medicine were in Wichita, where, for two years, we called on patients in their homes and the nursing homes of the elderly infirmed. One of Blackie’s compartments held Thiomerin (the diuretic for failing myocardiums), lots of Penicillin, and Thorazine for whatever. Darvon was the new wonder drug for pain. The next 37 years found him becom-

AMA OFFERS NEW ONLINE TOOL FOR PHYSICIAN PRACTICES In response to government calls for more transparency in healthcare, the American Medical Association (AMA) has launched a new online tool it claims can help physician practices prepare for billing and payment audits by insurers and federal contractors. The AMA’s Practice Analysis Tools

ing familiar with the confines of Parkston and the surrounding farm area in all four directions. He was along when I placed a cold little two year old body in the back seat of a new ‘62 Chevy—the victim of a farm stock tank drowning. He was familiar with at least one home on every square block in Parkston, and crossed the threshold of some of the homes as many as 20 times. He never complained about being roused at night, but I sensed a slight animosity when I would forget him in the car overnight at 20 below zero. He would wait patiently in the car for me after an early morning delivery, for I think he sensed that leaving the

hospital with the sun rising on a beautiful spring or fall morning, post delivery, was the most satisfying recurring moment of my medical career. We are 90% retired now, though we still make an occasional house call. Blackie has a bit of duct tape on his handle, and I have a bit of sciatica in my hip. Sometimes these days, like old hunting dogs, we just sit and reminisce. ■

for Healthcare (AMA PATH™) offers three independent modules designed to work as an “online consultant”, allowing physician practices to set fees and identify coding and billing risks by: Developing a practice-specific fee schedule that accurately reflects business costs and the value of their medical services Comparing the practice’s fee schedule against national average billed charge amounts and the Medicare Physician Fee Schedule by locality Analyzing coding and billing patterns for individual physicians and comparing them against national averages by specialty

Assessing compliance risks and pinpointing areas of potential improvement AMA President Cecil B. Wilson, M.D. cautions that billing audits are expected to increase in frequency. “AMA PATH can simplify the preparation process and help physicians gauge financial and billing data against market standards that were typically only available to insurers, auditors and consultants,” says Wilson. The cost of AMA PATH is $199 ($149 for AMA members) until December 31, 2010. For more information visit the AMA website at www.ama-assn.org/ go/amapath. ■

Midwest Medical Edition

Developing a Highly Skilled Health Information Technology Workforce By Jamie L. Husher, MS, RHIA, CHPS

number of important, nationwide efforts are in motion by the Office of the National Coordinator for Health Information Technology (ONC) to support health care providers in their quest to adopt electronic health records (EHR) and achieve meaningf ul use criteria outlined by the Centers for Medicare and Medicaid Services (CMS). Achievement of meaningful use will qualify physicians to receive Medicare or Medicaid incentive payments. Early on, the ONC recognized the need for a supply of highly skilled, highly qualified health information technology (HIT) professionals to:

• Ensure the adoption of EHRs • E nable information exchange across •

health care providers and public health agencies F acilitate the redesign of workflow in health care settings

The ultimate goal is to gain quality and efficiency of EHRs while maintaining the privacy and security of patient’s health information. According to the ONC, the current supply of qualified HIT professionals is a rate-limiting factor that may be one of the greatest barriers to EHR adoption and achieving meaningful use. The ONC launched a two-year program, Community College Consortia to Educate HIT Professionals, in early 2010 to fund the rapid development or expansion of health IT programs. Awards were dispersed regionally to 70 member community colleges in all 50 states. November 2010

Six Months – Six Roles The training programs are designed to be completed within six months or less and must target one or more of the six HIT workforce roles identified by the ONC. Training programs must prepare individuals to perform a defined set of competencies. • Practice Workflow and Information • Management Redesign Specialist • Clinician/Practitioner Consultant • Implementation Support Specialist Implementation Manager • • Technical/Software Support Staff • Trainer

HIT Training in South Dakota In South Dakota, Dakota State University was awarded funding as a Region A member college to provide HIT training within the state. From this funding, DSU recently launched three HIT workforce development programs in efforts to enhance and grow the statewide HIT workforce. As well, DSU is partnering with Mitchell Technical Institute and Western Dakota Technical Institute in South Dakota and the University of Alaska, Anchorage to offer HIT training programs through their institutions. DSU along with its partners will issue certificates to individuals who successfully complete the non-degree, workforce development, training programs. DSU, along with its partners, aim to train 300 HIT professionals over the next two years. Target trainees are: Individuals looking to gain employment in HIT-related positions Individuals with a background in MidwestMedicalEdition.com

health care or information technology and desiring focused cross training to become an HIT professional Individuals employed in HIT roles seeking to gain advanced HIT skills and knowledge

Validating Competency In mid-2011, competency exams will be available for trained students to complete as an independent validation of their HIT skills and knowledge. The competency exams are being created through a separate ONC grant by Northern Virginia Community College and the American Health Information Management Association.

10,500 Trained After the two year program concludes in 2012, ONC’s desired impact is that 10,500 skilled HIT professionals are trained annually by the participating community colleges. The increased population of skilled HIT workers will be readily available to support healthcare providers and facilities as they fully adopt electronic practices. The ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced HIT and the electronic exchange of health information. ■ Jamie Husher is an HIT Educational Specialist with Dakota State University’s HIT Workforce Development Training Program.

The Medical Economics ‘Top Advisor’ award recognizes financial planners with

Family-Owned Business

Helps Doctors Weather Rough Financial Times

very physician understands the importance of malpractice insurance. But financial expert Nick Garry says too many medical professionals believe that malpractice insurance alone will be enough to protect their assets in today’s litigious society. That, he contends, can be a financially dangerous assumption. “Unfortunately, physicians can be targets for issues that have nothing to do with medi“Our goal is to go cine. So one of beyond standard the things we do is look to put financial planning protective walls to address the up that would cover situations things that keep over and above our medical malpractice clients awake i n s u r a n c e ,” says Garry. at night.” Garry holds an MA in Tax from Notre Dame and grew up around the complex world of wealth management as part of Garry Associates, the Sioux Falls company his grandfather started in the early 1960’s. Today, Garry and his father, Steve, provide financial advice to physicians and entrepreneurs through Garry Private Wealth Resources. “Our goal is to go beyond standard financial planning to address the things 22

that keep our medical clients awake at night. We believe that people should be able to have peace of mind about what they have accumulated over a lifetime of work.”

Recognized Success Although this family-owned business maintains a deliberately low profile, Garry Private Wealth Resources now has approximately 300 clients including entrepreneurs, CEO’s and other successful people in 27 states. Garry estimates that medical professionals make up 40 percent of the firm’s current client base and account for about sixty percent of new clients. This growing physician client base has attracted the attention of one of the country’s top medical business publications: Medical Economics. The magazine recently awarded Garry its ‘Top Advisor’ award. Extended to around 200 financial advisors nationwide, the ‘Top Advisor’ award recognizes those with proven expertise in managing the unique financial needs of medical professionals. “The advantage of working with someone who deals with a lot of medical clients is that we have clients who are all experiencing the same types of problems and issues,” says Garry. “Because there is not much we have not dealt with over the years, we are able to parlay that into workable solutions for our current clients.”

Simplified Money Management Managing a significant financial portfolio can be complex, especially in today’s volatile market. Individuals and their financial planners have to consider tax and insurance issues, creditor protection, business continuity and estate planning, among other things. As tax laws become more complex and the list of considerations grows, the process can be frustrating for time-pressed professionals, many of whom have turned to Garry for help. “We have found that a lot of successful, busy people are tired of segmented or disorganized planning,” says Garry. “A large part of my job is to bring all of these elements together and to help simplify, so that their financial lives can be less complicated and, at the same time, more purposeful.” Garry says the fact that his own business is not owned by a bank, investment firm or insurance company, allows him to operate more simply, as well. “We are unencumbered by the kind of bureaucracy you often find in larger corporations,” he says.

Beyond Investing: Asset Protection Although savvy investing is an important part of managing clients’ financial assets, Garry says finding ways to protect those assets is just as important. Midwest Medical Edition

proven expertise in managing the unique financial needs of medical professionals.

“We are looking for methods of shielding them from issues such as litigation, taxes, and market decline. For example, many of the vehicles that offer tax free investing aren’t available to wealthier people. But even those that are available may not be the best choice now because we don’t know where tax rates are going to be in ten or twenty years. This is an important consideration for today’s younger doctors.” Garry says his firm helps creatively shield client assets by taking advantage of proprietary strategies and financial tools such as South Dakota’s ‘domestic asset protection trust’. “This can be a wonderful tool for protecting assets, but it requires a fair amount of sophistication and many people are not even aware of it,” says Garry. Beyond any particular product or strategy, Garry contends that it is frequent, open communication and what he calls an ‘experience monopoly’ that continues to attract new clients and accounts for a retention rate close to a hundred percent. “Many clients believe that they have their financial lives pretty well laid out when they come to us. But we tell them what they need to hear, not just what they want to hear. The truth is that our job usually starts when most people think they have already done all they need to do.” For more information about Garry Private Wealth Resources, visit them on line at www.garrywealth.com. ■

Rehab and Encouragement are Key to Recovery for Amputees By Jeff Boonstra, CP

he loss of a limb is always a catastrophic event. Patients often face weeks or months of recovery waiting for their incision to fully heal before their residual limb can accept the forces and environment of today’s advanced prostheses. During their recovery patients often experience a physical decline that manifests itself through muscle deterioration, limited joint mobility, and even impaired body awareness. In contrast to the ‘super prosthetic users’ whose inspiring stories are sometimes the subject of television shows, most amputees struggle with the new challenges of daily living. The simplest 24

things like taking a shower, using the bathroom, or standing at the kitchen sink are suddenly much more difficult. But at least some of those the adjustment challenges can be managed with the right rehabilitation program and a change in attitude for both the amputee and their rehabilitation team. The Power of High Expectations A amputee’s attitude toward him or herself, as well as the attitude of others toward the patient, can have a profound impact on limb loss outcomes. A lack of sufficient encouragement early in the process can stand in the way of optimal recovery. As health care professionals, our positive reinforcement is just as important as timely care in helping

these patients achieve their goals. Too often, amputees are told by healthcare professionals that they can never return to their previous level of activity. We often hear patients say, “I was told that’s just the way it is, and you will get used to it.” This is a disservice to the amputee population. These individuals need to be motivated and encouraged. It is also imperative that proper follow up is provided to ensure the correct prosthetic fit, alignment, and technology for each patient’s needs. With the right care, there is no reason that the long time golfer, hunter, or snow skier cannot return to these activities following an amputation. Deflating a patient’s expectations early encourages them to accept their loss as a disability instead of an opportunity to develop their abilities. It is unfortunate that the simple act of walking is perceived as a great accomplishment. But poor strength, poor flexibility, decreased endurance, and insufficient physical therapy are the primary reasons for unfavorable rehabilitation outcomes. To most lay people, and even many rehabilitation professionals, walking with a limp or an assistive device is often regarded as acceptable because they are simply surprised that the patient is walking at all. The fact is that very few patients are able to overcome the loss of a limb on their own. Most need a structured program to teach them how to adapt and reach their fullest potential. But with the right team in place, many amputees can walk without any deviations or with a Midwest Medical Edition

“We often hear patients say, ‘I was told that’s just the way it is, and you will get used to it.’ This is a disservice to the amputee population” lesser assistive device. This is not to imply that the need to use an assistive device with a prosthesis is a failure – these devised are often necessary for balance and safety. The loss of a limb is a catastrophic and life changing event. But a patient’s future achievements will be the direct result of their recovery and rehabilitation experiences. The amputee population may be relatively small, but it takes a high level of commitment to help them succeed. Medical professionals prepared to make that commitment can help these patients live more active, productive lives than was ever thought possible. ■

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Chances are your protection is coming up short.

Record Growth for

Sanford Health Sanford Health added 103 providers to the health system this summer. The recruiting class from June-August includes 75 doctors, 25 physician assistants and nurse practitioners, and three other medical professionals. “In an average year, we add around 60-70 new physicians, so this summer’s recruiting efforts are exceptional. It takes anywhere from six months to several years to recruit one doctor and those with unique specialties, like the ones we have recruited this summer, may take even longer to recruit.” Says Dr. Bruce Pitts, President, Sanford Clinic Fargo. “I can’t thank our staff enough for all the hard work they have put in. With these additions, patients are getting access to more services in a timelier manner, closer to home.” ■ November 2010

Protecting Your Peace of Mind

Until you retire, your most important asset is your ability to earn income. Yet the average employee disability program covers only about 60% of your salary. At Northwestern Mutual, we offer disability insurance that can help close the gap, leaving you and your income protected if you’re sick or hurt and unable to work.

Michael Mohr Financial Advisor The Lowrey Financial Group (605) 995 - 0300 michaelmohr-nm.com

05-2844 The Northwestern Mutual Life Insurance Company, Milwaukee, WI (Northwestern Mutual). Michael W Mohr is an Insurance Agent of Northwestern Mutual (life and disability insurance, annuities) and a Registered Representative and Investment Adviser Representative of Northwestern Mutual Investment Services, LLC (securities), a subsidiary of Northwestern Mutual, broker-dealer, registered investment adviser and member FINRA and SIPC.

MidwestMedicalEdition.com

Regional Health Seeks Volunteers for Type 1 Diabetes Research Study Regional Health Clinical Research (RHCR) is involved in research that could impact the lives of people with diabetes in the future. According to the American Diabetes Association, Type 1 diabetes is caused by antibodies that attack the insulin producing beta cells in the pancreas. Eventually, a person requires insulin injections to keep their blood glucose under control. RHCR’s most current research involves the use of the novel investigational agent, Otelixizumab, to preserve a person’s own

insulin production in newly diagnosed Type 1 diabetes. This agent counteracts the antibodies that destroy a person’s insulin producing beta cells in Type 1 diabetes. RHCR was involved in the original phase II and phase III research for Otelixizumab. The original study utilizing this agent was called DEFEND-1 (Durable-response therapy Evaluation For Early or New-onset Type 1 Diabetes). RHCR is now enrolling people in the subsequent study, DEFEND-2, in which research participants will receive a series of infusions of the study drug or placebo over a single eight-day period. “People with Type 1 diabetes often have unpredictable swings in their blood glucoses, otherwise known as having ‘brittle’ diabetes. Their blood glucose can go from too low to too high without warning. Besides making them feel bad, these fluctuations can be dangerous, even deadly,” said Thomas Repas, D.O., FACP, Endocrinologist with Regional Health Physicians. “The goal of DEFEND-2 is

to find out whether Otelixizumab can help people with Type 1 diabetes by preserving their ability to make their own insulin.” To be eligible to participate in this study, people must be newly diagnosed (within 90 days) with Type 1 diabetes, be between 12 and 45, and be willing to follow through with the required follow-up visits for the duration of the two-year study. “One barrier we have had is that many people with newly diagnosed Type 1 diabetes are not aware that such research is available and by the time they do find out, the 90 day window has passed,” Dr. Repas said. “Because South Dakota is a small rural state, many people have a perception that to receive cutting-edge medical care and the latest in investigational therapy, they must travel somewhere else. This is a misconception.” Additional information about the study can also be found at www. regionalhealth.com by clicking the “Research” tab. ■

The less cancer there is, the more birthdays there will be. Patients count on you to remind them of what they can do to prevent cancer. Remind your patients of appropriate screenings and healthy lifestyle choices.

You can help create a world with more birthdays. Visit morebirthdays.com. Or call 1-800-227-2345. Together we’ll stay well, get well, find cures and fight back.

Midwest Medical Edition

November 2010

MidwestMedicalEdition.com

Tax Consideration Post 2010 As of September 2010

“If you are concerned about how these changes will affect you and your planning situation, we encourage you to visit with your professional advisors.”

By Nick Garry, MS, CPA/PFS he anticipated 2011 tax changes may have a fairly significant effect on the spending power of high income earners. Below are some of the key aspects of the anticipated 2011 tax changes. *25% for Section 1250 property and 28% for collectibles and small business stock Other key tax changes include the return of the marriage penalty; whereby married taxpayers, filing jointly, will receive a standard deduction approximately 167% of the amount for singles. The child tax credit also decreases from $1,000 to $500. A phase-out of itemized deductions and personal exemptions returns whereby these deductions are reduced for higher income earners. Finally, high income earners may notice an additional 3.8% Medicare tax on certain investment income. If you are concerned about how these changes will affect you and your planning situation, we encourage you to visit with your professional advisors. The information provided represents our understanding of the generally applicable rules and is for informational purposes only. ■

U.S. Federal Income and Estate Tax under Current Law Comparison of 2010 to 2011

TAX

2010

Ordinary Income Tax Brackets

10%, 15%,

15%

25%

28%

31%

33%

36%

35%

39.6%

Capital Gains*

0% (for 10%, 15% tax brackets) 15%

10% 20%

Dividends

0% (for 10%, 15% tax brackets) 15%

Ordinary income tax rates 15% to 39.6%

Estate Tax Exemptions

Unlimited ($3.5 million in 2009)

$1.0 million

Estate Tax Rate 0% (45% in 2009)

2011

55% (plus 5% surcharge for some estates exceeding $10 million)

Fast Facts Health Care in South Dakota SDAHO represents 54 hospitals and 34 longterm care facilities across SD providing a unified voice for its members with state and federal advocacy. Advocacy, information, education and networking are SDAHO’s premier member services. 2009 Population:................................812,383 Number of residents 65+:...................118,000 2009 Annual Births:............................. 11,930 2009 Annual Deaths:.............................6,913 Uninsured Adults:................................ 84,000 Uninsured Children.............................. 20,000 Medicaid Recipients:......................... 140,000 Medicare Recipients:......................... 136,000

Midwest Medical Edition

In Review What You’re Reading, Watching, Hearing

Author Paul A. Offit, M.D

Autism’s False Prophets

Bad Science, Risky Medicine, and the Search for a Cure Reviewed by Dr. Albert J. Strauss, Jr.

utism’s False Prophets by Paul A. Offit, MD, is a thorough treatment of the history, background, scientific evidence, and hysteria surrounding the controversy regarding vaccines and the cause(s) and treatment of autism. The word “controversy” is used advisedly since there is no medical controversy at all. As the author observes, all of the credible medical institutions involved in the study of vaccines have stated, unequivocally, that vaccines do not in any way contribute to the development of autism. The only controversy is outside of the medical community. As a Professor of Vaccinology and Pediatrics at the University of Pennsylvania and Chief of Infectious Diseases at the Children’s Hospital of Philadelphia (CHOP), one of the most prestigious children’s hospitals in the nation. Dr. Offit is well equipped to discuss and explore the autism issue. He initially delves into the history of vaccines and points out that vaccination is arguably the most significant medical advance of the 20th century. In terms of lives saved and misery spared, vaccination against the diseases that ravaged children as recently as 30 or 40 years ago certainly fulfills that criterion. Dr. Offit then goes on to explore the bad and probably fraudulent science that started the mis-information about autism and vaccines. Incredibly, one article by 13 authors (11 of whom recanted) began this odyssey which, to this day, still exists in spite of legal, medical, and

November 2010

scientific evidence that the “controversy” is nonsense. The legal, political, and highly publicized celebrity involvement is also discussed. This involvement is what primarily characterized the subsequent 12 years of continued anecdotal stories and machinations which kept the controversy alive. As Dr. Offit points out, the celebrity and TV involvement was and is, unfortunately, a continued force that counteracts logic with emotion. He notes that it is hard to mention “science” and “studies” when Jenny McCarthy says, “My science is Evan, and he’s at home. That’s my science.” McCarthy is clearly a loving, highly concerned and involved mother who just “knows” what contributed to her child’s autism. Celebrity bias has been rampant on television. Oprah, at the time Autism’s False Prophets was published, had never had an articulate defender of the scientific facts of this issue on her show. The closest she came, says Offit, was to present a faceless statement from the CDC. At the time that this review is written, that continues to be the case. A fair amount of the books is devoted to the political aspects of vaccination and autism. Some of this is fascinating reading as one learns about politicians with little or no scientific knowledge or background speaking and pontificating vehemently on the subject. At the end, before the index, the book is heavily annotated with Dr. Offit’s sources, giving acolytes or skeptics the opportunity to do further research, if desired On the whole, Autism’s False

MidwestMedicalEdition.com

“ . . . celebrity and TV involvement was and is, unfortunately, a continued force that counteracts logic with emotion.” Prophets was an enjoyable read – well written, informative and very hard to put down. Medical folks as well as the laity will thoroughly enjoy Dr. Offit’s examination of the facts and fantasies surrounding vaccination and autism in the United States. ■

Have you read a book, seen a movie, heard a concert, etc. that moved you? Whether it made you mad or make you laugh, MED wants to help you share it with your colleagues. Send your reviews to Alex@MidwestMedicalEdition.com

Injury Prevention and Management in Healthcare Safe Patient Handling Programs By Jeff Roach, MS, OTR/L, CEES

he expanded problem of obesity has put added strain on nursing staff working in hospitals and skilled nursing facilities. It has been estimated that one nurse lifts up to 1.8 tons per shift. Nurses and aides continue to assume that aches and pains are part of the job. With the projected shortage in health care workers for years to come, there has never been a better time to invest in equipment and training to protect caregivers. It can be difficult for a health care facility to decide how and where to begin when it comes to reducing strain injuries. Surveying employees is helpful to determine what specific tasks are causing the perceived strain. Solutions can be developed based on the results of the strain survey. These solutions are not necessarily expensive or difficult to implement. It is also helpful to determine the percentage of patients that are totally dependent or require extensive assistance. That determines the percentage of rooms that should be equipped with overhead or ceiling lifts. The costs of the overhead lifts are justified when considering the cost of just one back injury

Fast Facts

is like family”

Health Care in South Dakota

SD AGGREGATE DATA Hospital Admissions

(can cost up to $85,000 if injury results in surgery). Floor based lifts can help decrease strain compared to manual lifting, but research has shown increases in stress to the body when pushing and turning the lifts especially in confined spaces such as bathrooms. Training on equipment use and culture change is critical to the success of the lifts in reducing injuries. An assessment of the patient should be completed to determine the transfer status. Patients should be transitioned to a lifting device when they are no longer the equipment and the training of safe able to bear weight and move their feet work practices that will effectively reduce injuries. ■ when standing. If they cannot at least partially bear weight and move their Jeff Roach is an Ergonomic and Loss Control feet, they are placing too much strain Specialist with Risk Administration Services and on the caregiver and should be transia Clinical Assistant Professor for the Occcupational Therapy Program at USD. tioned to either a powered stand assist or full body sling lift. Manual lifting can also cause injury to the patients’ joints and skin. Whenever possiCheri Kraemer, RPh ble, use equipment or Some compounded Clinic prescriptions require engineering changes Pharmacies, Inc. 48 hours for preparation. to solve problems. It “Where your pharmacy • Hormone Replacement Therapy is the combination of

2006

2007

2008

96,964

99,931

102,116

Patient Days

1,022,716

1,008,378

1,005,766

Outpatient Visits

1,772,779

1,788,725

1,857,956

Hospital Births ER Visits Home Health Visits Resident Days

12,125

12,258

226,131

239,192

Not Available

89,739

83,470

2,396,882

2,367,974

2,363,101

CHECK WITH US FOR ALL YOUR COMPOUNDING NEEDS! Yankton Trail Professional Park 2333 W. 57th St., Suite 107 Sioux Falls, SD 57108

Linda Pierson, RPh

2333 West 57th St. Sioux Falls, SD 57108 605-331-3190

0000193355

11,380 222,244

• Free in-town delivery • Fast, courteous service • Accepts most insurance • Helpful counseling

• Saliva Testing • Nutritional Consultation • Pain Management • Sterile Products • Sports Medicine • Pediatrics • Dental • Veterinary • Specialized Disease Management

Phone: 605-334-1672 Fax: 605-335-0855 Midwest Medical Edition

News & Notes Happenings around the region

Avera Avera Doctors Plaza 2 Pharmacy has earned the designation PCAB Accredited compounding pharmacy from the Pharmacy Compounding Accreditation Board (PCAB). Avera Doctors Plaza 2 Pharmacy is the first pharmacy in the state of South Dakota to earn this national accreditation. ADP2 Pharmacy has been tested against a challenging set of national standards. As a compounding pharmacy, ADP2 Pharmacy prepares medication according to a physician’s prescription using USP pharmaceutical grade ingredients, in particular bioidentical hormones for women being treated through Avera Midlife Care for Women. CFRE International has named Geri Beck as a Certified Fund-Raising Executive (CFRE). Geri Beck, Foundation Director at Avera Queen of Peace, joins over 5,200 professionals around Geri Beck the world who hold the CFRE designation.

Sanford Lennox Area Medical Center is joining Sanford Health and will now be called Sanford Clinic Lennox. Sanford Clinic Lennox has been open for more than 20 years. Larry Sittner, MD and Scott Rogers, PA-C provide a wide range of family medicine services including annual physicals, immunizations, pediatrics, medication management and chronic disease management. Ronald D. Anderson, MD, OB/ GYN, has joined the newly opened Sanford Clinic Mitchell. Dr. Anderson specializes in obstetrics and gynecology and has been providing care in Mitchell for more than 20 years. Services at the clinic will include a full spectrum of care including annual exams, pregnancy care, high risk pregnancy care, infertility, menopausal management and birth control options. Rosholt native Lisa Braun, PA-C, is returning to her home town to practice as the primary care provider at the new Sanford Clinic in Rosholt. She will

November 2010

also practice at Sanford Clinic Wahpeton. Prior to joining Sanford, Braun practiced with Dr. Kass at Rosholt Care Center for six years. Braun has 20 years of acute and long term care nursing experience, including the Director of Nursing role at Rosholt Care Center. The clinic, which opened in September, is located in the Countryside Inn assisted living facility. Services at the clinic will include acute and chronic care, phlebotomy and laboratory services. Construction has begun on the new Sanford YMCA in Fargo. Groundbreaking ceremonies took place Wednesday, September 22. The project is an equal partnership between Sanford Health and the YMCA of Cass and Clay Counties. This $12 million, 78,000-square-foot comprehensive fitness center is expected to serve 3,500 members and employ 30 people following the projected opening in October 2011. Orthopaedic Associates (OA), Fargo and Sanford Health have officially merged, the final step in a negotiation process that was first announced this summer. The OA building will become Sanford Orthopedics and Sports Medicine.All outpatient Sanford Fargo orthopedic physicians and staff will be moved to that single location to streamline care for patients.

Chamberlain Nursing Home

Regional Kohl’s Department Store in Rapid City made a donation of $18,625 to the “Don’t Thump Your Melon” program at Rapid City Regional Hospital in September. Don’t Thump Your Melon is a helmet safety and head injury prevention education program at Rapid City Regional Hospital. As part of the Kohl’s Cares program, the store in Rapid City offers special items for sale four times a year and during the holiday seasons. One hundred percent of the net profits from those sales are donated to help children at RCRH. Radiologist Garry Dunn, M.D. has joined the staff of Regional Medical Clinic. Dunn is board-certified in radiology and earned his Medical Degree from Baylor College of Medicine, in Houston, Texas. He completed his residency in Radiology at Baylor University Medical Center in Dallas. Dunn provides general radiology services at Spearfish Regional Hospital and Spearfish Regional Medical Clinic. Susan MacMillan Kains, Chaplain and Coordinator of Spiritual Care at Rapid City Regional Hospital, was ordained to the ministry in the United Church of Christ in October. Kains is a member of South Park United Church of Christ in Rapid City. She has been employed at Rapid City Regional Hospital since November 2009. The 14th Annual Hitting for Hospice benefit golf tournament at Spearfish Canyon Country Club on Aug. 21 raised more than $17,000. The tournament was co-sponsored by Hospice of the Northern Hills (HNH) and Spearfish Wal-Mart. One hundred and sixteen golfers took part. The tentative date for next year’s tournament is Aug. 20, 2011.

Christopher J. Seime, B.S., RRT is the new director of Regional Home Medical Equipment. Seime worked at a local Christopher home medical J. Seime supply business for the past 10 years, most recently as the director for clinical services. He has more than 14 years of respiratory therapy/home medical equipment experience including several years at Rapid City Regional Hospital.

Other: South Dakota doctors once again helped support this year’s Komen Race for the Cure breast cancer fundraising event. The Doctors for the Cure is a program that pays for survivors to attend the Race, which took place this year on September 25th in Vermillion. Doctors for the Cure pays for the registration of 4 survivors and the participating doctor. Organizers of the Race hope that Doctors for the Cure will eventually be able to fund the participation of all survivors who want to be a part of the race. NBC News correspondent and South Dakota native Tom Brokaw was the honorary chair of this year’s event. Seventy-five percent of the money raised stays in South Dakota to fund breast health research, diagnostics, screening, treatment services and education for uninsured or underinsured women.

The Komen Race

Sanford Care Center Chamberlain officially welcomed to the public to the newest nursing home in South Dakota in October. The facility, attached to the west end of the Sanford Medical Center Chamberlain, offers five different room configurations for 44 residents. Each wing has its own living and dining room area. Funding for the project was provided by Sanford Health with nearly $850,000 raised locally through a capital campaign effort.

MidwestMedicalEdition.com

Learning Opportunities Happenings around the region

November and December 2010 November 4-5 Innovations in Pediatric Research and Clinical Care Location: Sanford USD Medical Center, Schroeder Auditorium, Sioux Falls November 4 American Heart Association, Mission: Lifeline STEMI Summit Location: Sioux Falls Contact: Rebekah Cradduck Contact Email: cradduck@sdaho.org November 4 American Heart Association, Mission: Lifeline STEMI Summit Location: Sioux Falls November 19 8 :00 am – 4:00 pm

10th Annual Pediatric Symposium Location: Avera McKennan Education Center Auditorium

November 10 12:00 pm

Internal Medicine Grand Rounds: Pre-Diabetes and Prevention of Type 2 Diabetes Location: Sanford School of Medicine–HSC–Room 10 Credits Offered: AMA PRA Category 1–1.00; Attendance–1.00

November 12 12:00 pm

Obstetrics and Gynecology Grand Rounds: Preimplantation Genetic Diagnosis Location: Sanford School of Medicine–HSC–Room 10 Credits Offered: AMA PRA Category 1–1.00; Attendance–1.00

November 18 8:00 am

Pediatric Grand Rounds: Munchausen Syndrome by Proxy Location: Sanford USD Medical Center–Schroeder Auditorium Credits Offered: AMA PRA Category 1–1.00; Attendance–1.00

November 30 2:00 pm

VA ACLS Renewal Class Location: VA Medical Center–Educ Ctr Auditorium Credits Offered: AMA PRA Category 1–4.00; Attendance–4.00

December 1 Internal Medicine Grand Rounds: Survivors of Pediatric Cancer: 12:00 pm From Specialty to Primary Care Location: Sanford School of Medicine–HSC–Room 106 Credits Offered: AMA PRA Category 1–1.00; Attendance–1.00 December 10 12:00 pm

Obstetrics and Gynecology Grand Rounds: TBA Location: Sanford School of Medicine–HSC–Room 106 Credits Offered: AMA PRA Category 1–1.00; Attendance–1.00

Midwest Medical Edition