JANUARY FEBRUARY
2017
Vol. 8 No. 1
INTERNATIONAL MEDICAL GRADUATES Meeting the Need on the Prairie
Do Your Security Systems
Need a Checkup?
Estate Planning and Your 529
Recognizing Signs of an
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MIDWEST MEDICAL EDITION
Contents
International Medical Graduates
VOLUME 8, NO. 1 ■ JA N UA RY / FEBRUA RY 2017
MEETING THE NEED ON THE PRAIRIE
REGULAR FEATURES
ON THE COVER
JAN UARY FEBRUARY
4 | From Us to You 5 | MED on the Web Life after injury, Does valet parking 6 | Hometown Advantage –Fourth generation SD physician knew he’d “come back home”
10 | N ews & Notes New providers, awards, accreditations and more
31 | Learning Opportunities
18 | Case Report: The Untriggered Alert When EHRs Cause Patient Harm
■ By Lori Atkinson
Do Your Security Systems Need a Checkup? Earthbend’s Shawn Mendelsays, if you’re connected to Internet, the answer is probably yes
21 | Lean Beef and Metabolic Syndrome Comparing lean beef to DASH in reducing risk factors for metabolic syndrome
■
By Holly Swee
22 | Avera ALS Clinic Honored by ALS Association 22 | Mercy Implements Palm Scanning to
9 An Educated Investment: Estate Planning Benefits of a 529 Plan
■
By Nathan Quello
Enhance Patient Security
23 | Routine Blood Pressure Measurement for Children: Is it Necessary?
24 | New Trial to Test Stem Cells for Rotator Cuff Repair An interview with principal investigator Jason Hurd, MD, on this first-of-its-kind study
25 | Sanford Creates Board to Guide International Work
26 | Reducing Anesthesia-Related Dental Risk
■
By Jeremy Wale
28 | U SF Healthcare MBA Program Now Available Online
Vol. 8 No. 1
7
Upcoming Spring CME opportunities and conferences
IN THIS ISSUE
2017
improve patient care?, Free digital promotion for your practice
20 Recognizing the Signs of an Eating Disorder Advice for healthcare providers from Brandy Bunkers of Clarity Counseling
INTE RNAT IO NAL M E D ICAL G R AD UATE Meeting th S e Need on the
Do Your Secu rity Syst
Need a Check ems up?
Estate Plann ing and Your 529
Prairie
Recognizin g Signs of an
EATING DIS ORDER
TH E SOU TH DAKOTA REG ION’S PRE FOR HEA MIER PUB LTHCAR E LICATION PROFES SIO NAL S
By Alex Strauss
An estimated one quarter of physicians now practicing in the US — more than 800,000 doctors — were born and educated outside the country. As the pool of American-born primary care providers diminishes and the healthcare needs of baby boomers grow, the contributions of these immigrant providers are more vital than ever. We meet five so-called “IMGs” practicing in our region in this month’s cover feature.
page
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Cover Photo: Drs. Olufemi and Olawunmi Lawal, Avera Medical Group, Aberdeen Photo By Dawn Sahli Photography
From Us to You Staying in Touch with MED
Welcome to a New Year of MED!
W
E ARE KICKING OFF OUR NEW YEAR with six foreign-born doctors who have made their homes and practices in our region. As you’ll hear, it took much more than medical expertise for these tenacious professionals to uproot their lives and rebuild them across the world. We hope their positivity and hope inspires you, wherever you’re from. Do you have a child or grandchild headed for college? We have expert advice to help you navigate the complexities–and reap the benefits–of 529 Plans. Lori Atkinson’s article, “The Untriggered Alert”, details the disturbing case of a missed diagnosis. And we speak with an IT security specialist to help you know when and if your office really needs an assessment of your computer system security. As always, this issue of MED also contains all the latest news and an event calendar to help you plan for spring. Remember–if you or your organization has news or an event to promote, let us help. It is always free and takes just a minute to send your news via email or post an event yourself on MED’s online calendar at www.MidwestMedicalEdition.com. All the best, —Alex and Steff
PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota
VICE PRESIDENT
SALES & MARKETING Steffanie Steffanie Liston-Holtrop
Liston-Holtrop
EDITOR IN CHIEF Alex Strauss
GRAPHIC DESIGN Corbo Design
PHOTOGRAPHER studiofotografie Alex Strauss
WEB DESIGN Locable DIGITAL MEDIA
DIRECTOR Jillian Lemons CONTRIBUTING WRITERS Lori Atkinson
Nathan Quello Holly Swee Jeremy Wale STAFF WRITERS Liz Boyd Caroline Chenault John Knies
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©2011 Midwest Medical Edition, LLC
The 2016 Circle of Red Holiday Party in December. MED's Steffanie Liston-Holtrop (bottom right) is a proud member of the group, which raises awareness of heart disease in women. Photo courtesy Julie Prairie Photography.
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Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 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.
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 605-231-0432 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE MidwestMedicalEdition.com
MORE than a magazine
A Medical Community Hub! Clean out your office! Your MED is safe
MED welcomes reader submissions! 2017 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 1
Ready to get organized for the new year? If you’re holding on to back issues of MED, don’t worry. Every back issue is now available instantly online. Read any issue cover-to-cover by clicking on the “Archives” button or use the search bar to find previous articles. MED makes it easy to find the information you want, when you want it. And keep your office tidy!
This month only on the Web: Kudos for Regional Health All four of Regional Health’s critical access hospitals have been recognized as 2016 top performers, receiving national leadership awards for excellence in rural health care, some in multiple categories. Read the full story.
Madison Regional Enhances ICU Service
March Issue February 1
Madison Regional Health has added eICU services. Find out what this concerted
April/May Issue March 1
New Nursing Program
June Issue May 1 July/August Issue June 1 Sep/Oct Issue August 1 November Issue October 1 December Issue November 1
approach to ICU care could mean for patients in the Madison area.
St. Luke’s College–UnityPoint Health and Northwest Iowa Community College (NCC) have announced a new advanced nursing program to begin immediately. The agreement will allow graduates of NCC’s Associate Degree Nursing program to transfer up to 78 credits of coursework to St. Luke’s College.
List Your Spring Event–For Free! Let MED help you fill your upcoming conference, open house, seminar or other event. Thousands of area healthcare professional’s read MED’s website every month. It takes just two minutes to add an event to our popular online calendar.
Stay up-to-date between issues of MED Sign up for previews of upcoming articles and advance notice of the next digital edition.
HOMETOWN ADVANTAGE
Fourth generation SD physician knew early that he’d “come back home”
Like many physicians, orthopedic sports medicine specialist Peter Looby, MD, the son, grandson, and great-grandson of South Dakota
doctors, travelled far from home for his training. After medical school at Washington University in St. Louis, he did his residency at the University of New Mexico and completed an orthopedic sports medicine fellowship at Massachusetts General. But Looby says he knew even as an undergrad at Stanford, that he’d eventually return to his home state. “When I was a junior, I had to drive from Palo Alto to San Francisco on Interstate 480. I remember that I was standing outside my vehicle, in four lanes of traffic, and as far as I could see in each direction,
traffic was completely still. I thought, ‘When this is all done, I’m going back home!’” he recalls. Although that return was still 12 years away at the time, Dr. Looby says he was delighted, both personally and professionally, when he was finally able to join Orthopedic Institute in Sioux Falls. “You can practice as good a medicine in South Dakota as you can practice anywhere in the country,” says Looby. “We have great facilities, a strong core of physicians, and all specialties represented here. As a result, we are able to recruit and attract tremendously
good practitioners. I work with a group at OI that is as good as any group I’ve ever seen.” He’s also found no shortage of opportunities and challenges in his field with multiple sports teams and an aging population. “We take care of a larger number of orthopedic conditions here because we are the primary medical center for the region,” observes Dr. Looby. “Difficult trauma cases, difficult spine cases, and difficult knee reconstructions all tend to come to Sioux Falls, which is unusual for a city our size.” ■
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Midwest Medical Edition
Do Your Security Systems
Need a Checkup? By Alex Strauss
A
NY MEDICAL OFFICE using
a computer system knows that it is vital to keep that system secure. But did you know that security systems put in place when you set things up may no longer be doing the job? How do you know when it’s time to reassess your cybersecurity protocols? Shawn Mendel, Director of Engineering Services at Earthbend, says if you’re connected to the Internet and you can’t remember your last cybersecurity assessment, you’re overdue. “Here in the Midwest, we have had a mindset that the hackers don’t care what we have here,” Mendel told MED. “What we are seeing is that that is not the case. They are targeting small businesses with ransomware. They essentially steal your data and then demand hundreds of dollars to return it to you. We have seen this happening in every area of business, including medical.” In fact, Mendel says that cyberattacks identical to those in larger cities which have made national news have happened in our area. In one case, a single area clinic was attacked twice. In the US, Mendel says there are an estimated 20 data loss incidents per day, specifically because of ransomware. “A medical record is the most valuable data on the black market right now,” he says. “It’s more valuable than credit card numbers. If I have someone’s medical record, I can use it for Medicare fraud and other types of fraud
“
that can last for a longer period of time. Who checks your medical records?” To ward off ransomware and other types of attacks on your office computer systems, Mendel recommends a layered approach, comparable to protecting physical valuables with fences, locked doors, and safes. The layers start with the perimeter firewall and move deeper to include network security, endpoint security (each computer workstation, for example), security of the applications being used on those computers, data security, and overall office policy. “We look at whether the office has a policy in place to engage a third party to perform a quarterly assessment, for instance,” says Mendel. Policy would also include considerations such as what data each computer user is allowed to access and whether or not they are allowed to work remotely on office business. The final layer is the users themselves, the area that Mendel says is most likely to be overlooked. “What we are finding, especially in the last 18 months, is that this is the most vulnerable area because of social engineering and phishing schemes,” says Mendel. “It is much easier to fool a user than to compromise an entire system.” For this reason, in addition to assessing and implementing office cybersecurity systems, Mendel now regularly runs 75-minute training workshops specifically for the people who use the computers. “I
Here in the Midwest, we have had a mindset that the hackers don’t care what we have here.
”
January/February 2017
MidwestMedicalEdition.com
think what surprises most people is how big a probShawn Mendel lem it really is,” he says. “They are surprised that these attacks are happening to people in their own community, to the business down the street.” Mendel recommends that medical offices plan to have a thorough annual assessment of their computer security systems–including all of the “layers”–by an IT professional at least once a year. “What an assessment does is show an organization where their gaps are, whether they need a new policy in place or a new piece of hardware or software,” he says. “The bottom line is, if you are connected to the Internet, you are at risk and the risks that we face continue to change and evolve. Security systems from last year are no longer useful this year because the threat landscape is constantly changing. There is no one silver bullet. It’s an ongoing, neverending battle” ■ Shawn Mendel is Director of Engineering Services at Earthbend in Sioux Falls.
Vital Statistics on Ransomware Attacks • 77 percent of attacks bypass email filters • 95 percent bypass firewalls • 52 percent bypass anti-malware solutions
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An Educated
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W
Estate Planning Benefits of a 529 Plan
By Nathan Quello
“
You’re not only investing in your beneficiary’s education . . . you’re protecting yourself from taxes that could be devastating to your estate.
”
ITH EDUCATION COSTS CLIMBING every year, it’s hard to imagine a better gift for a young student than a solid education fund. Fortunately for the giver, establishing a 529 education savings account can be just as beneficial for the account owner as its beneficiary.
TAX FREE GROWTH
EXCEPTIONAL CONTROL
The owner of the plan does not receive any deductions or write-offs for contributions to a 529 plan, but once the funds are in place they grow tax-free if used by the beneficiary for any type of post-secondary education. Whether they pursue undergraduate, graduate, or vocational programs, a 529 plan provides your beneficiary with a tax-efficient way to pay for tuition.
When you establish a 529 plan, you’re not only investing in your beneficiary’s education and future, you’re protecting yourself from taxes that could be devastating to your estate, all the while maintaining complete control of the account. Any funds you place in the 529 plan remain entirely in your control, but are considered a completed gift—meaning they grow outside of the owner’s estate and are protected from estate taxes or penalties. Current law states that you can avoid paying estate taxes if you have less than $5.5 million in assets, but anything above that number gets taxed up to 45%. For people like small business owners and farmers, this can be a devastating tax. Imagine leaving your farming operation to your family only to force them into debt just to pay the estate taxes on your legacy. Anyone can start a 529 plan for any beneficiary and contribution limits are tied to standard annual gifting limits—$14,000 (individual) or $28,000 (married couple) per year, per beneficiary. In the case of 529 plans, though, this gift limit can be accelerated to $70,000 or $140,000—the equivalent of five years of giving. With so many tax advantages and no associated legal fees to establish, 529 plans are a good option for anyone who is saving for education, but excellent for people who want to defer taxes and maximize the value of their estate. ■
LOW RISK, LOW PENALTIES While there are penalties for using 529 plans for non-education purposes—like starting a new business or other venture—they are quite modest. The account principal is returned to the beneficiary tax-free, and without penalties. The fund growth is subject to a relatively small 10% penalty, plus regular income tax rates. Considering most beneficiaries are young in their careers and in a lower tax bracket, these penalties tend to be very manageable.
Nathan Quello is a Certified Financial Planner Professional with Loft Advisors in Sioux Falls.
January/February 2017
MidwestMedicalEdition.com
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Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes AVERA Avera Marketing recently received two awards for website excellence from Strategic Health Care Communications at its 2016 ceremonies in Las Vegas. Avera.org was named a gold-award winner in the “Health Care System” class, one of only three gold-award winners in the Best Overall Internet Site category. The Avera eCARE website was named a silver-award winner for the “Other Health Care Facilities” class for best site design. Strategic Health Care Communications is a national healthcare communications service.
BLACK HILLS Rapid City Regional Hospital has been recognized as one of the top three hospitals in South Dakota (along with Avera McKennan and Sanford USD Medical Center in Sioux Falls) for 2016-17 by US News & World Report. The US News Best Hospital rankings is in its 27th year and is used by patients to guide them to outstanding hospitals across the country. Rapid City Regional Hospital was the only hospital in Rapid City to receive this ranking.
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The Rapid City Regional Hospital (RCRH) pharmacy residency program has been reaccredited through 2019 by the American Society of Health-System Pharmacists (ASHP). The postgraduate year-one (PGY1) pharmacy residency program was founded at RCRH in 2012 to meet the nationwide growing need for clinical pharmacists.
SANFORD Tonya Pitts, a registered nurse with The Birth Place at Sanford USD Medical Center received a DAISY Award for nursing excellence this fall. Kristi England, PhD, an associate scientist from the Cancer Biology Research Center at Sanford Labs, has found that patients with higher levels of the protein SUSD2 experience less metastasis of ovarian cancer cells and survive an average of 18 months longer than those with lower levels. Her findings were published in a recent issue of Oncogenesis. This new Sanford Research study could support the development of new therapy options to improve ovarian cancer survival. The American Cancer Society reports that ovarian cancer accounts for more deaths than any other cancer of the female reproductive system.
SIOUXLAND Mercy Medical Center through its Community Benefit Ministry is has donated trauma packs for emergency situations to the Sioux City Police Department and the Woodbury County Sheriff’s Office. The Trauma Packs include a tourniquet, compression bandage, gauze, gloves and safety cutter. With time being one of the most critical elements for survival when the worst happens, Tac-Med training along with the proper field supplies are vital in life-threatening situations Iowa Hospitals provided the community benefits valuing more than $1 billion, including more than $246 million in charity care, $520 million in uncompensated care, and $370 million in Medicare/Medicaid at-cost care in 2015. The results for the Sioux City hospitals are included in a statewide report by the Iowa Hospital Association Mercy Medical Center has announced that Natalie Olorundami Hughes is the new Wellness Specialist at Mercy Business Health Services. Hughes will be responsible for the development and implementation of worksite health and wellness programs. Hughes earned her BS in Exercise Science & Sport/Fitness Management from Buena Vista University and has worked at CNOS as the Sports Performance Director.
Christina Severson, BSN, LNHA is the new Administrator and Director of Nursing for the new Skilled Nursing Unit at Mercy Medical Center. Severson will oversee the operation of the new skilled nursing unit, which opens this winter. She received her BSN from Briar Cliff University and became a Licensed Home Administrator in 2013. Severson has been the assistant administrator at Holy Spirit Retirement Home for the past 5 years. Mercy Medical Center is pleased to welcome Mary Hendricks as the new Director of Mission Integration. In her new role, Hendricks will be responsible for all components related to the Catholic identity of the organization. Hendricks has been with Mercy since 1987.
The Siouxland Chapter of “100+ Women Who Care” recently presented a check for $8,200 to Mercy’s Child Advocacy Center. “100+ Women Who Care” is made up of local women who contribute to local charities. Mercy’s Child Advocacy Center serves more than 16,000 abused children and their families free of charge.
Midwest Medical Edition
OTHER SPH Analytics (SPHA) named Midwest Pain Specialist, A division of Sioux Falls Speciality Hospital, the winner of the 2015/2016 National APEX Quality Award. The APEX Quality Award is based on patient satisfaction scores. This year more than 800 healthcare facilities were eligible for the award, and 78 were selected. Dr. Rick Kooima, pediatrician at Avera McGreevy Clinic in Sioux Falls, was elected as a new medical advisor for Make-A-Wish South Dakota. Dr. Kooima will assist the chapter in outreach for referrals and in helping to qualify kids for wishes Sioux Falls Specialty Hospital (SFSH) has opened two new walk-in clinics under Midwest Family Care in Sioux Falls: Midwest Family Care at GreatLIFE Woodlake and Midwest Family Care at D1 Sioux Falls. The two clinics expand the convenient walk-in healthcare options needed for patients in Sioux Falls and the surrounding areas. WorkFORCE Occupational Health and Medical Services, a division of Sioux Falls Specialty Hospital, has opened its second location in Sioux Falls. This new, centrally located clinic provides employers and workers a second option for occupational health services including drug screenings, physicals, lift tests, Workers’ Comp injury treatment, hearing/vision exam, and fit testing. WorkFORCE also provides on-site medical services to businesses in and around the Sioux Falls area. Two years after its groundbreaking, Madonna Rehabilitation Hospitals’ Omaha Campus is now ready to serve patients. The grand opening celebration and ribbon cutting took place in September, followed by self-guided tours. Madonna Rehabilitation Hospital—Omaha is a 260,000 square foot, 110 private-room rehabilitation specialty hospital. According to a 2012 independent study, more than 1,300 individuals each year would qualify for rehabilitation in the metro area but have been referred to nursing homes or sent home instead.
January/February 2017
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IMGs
International Medical Graduates
Meeting the Need on the Prairie By Alex Strauss
IMAGINE THAT YOU ARE A PHYSICIAN or medical student facing the prospect of caring for patients without access to the most advanced technology, the full range of medications, or ancillary services to support your patients’ recovery. In the US, even isolated rural doctors can typically access specialists electronically or, in the worst cases, refer their patient to a larger medical center. But for a quarter of doctors practicing in America–and about the same number in our area–the limitations described above are often all too familiar. These are foreign born physicians and surgeons who, for a wide range of personal and professional reasons, have chosen to leave their homes, extended families, and familiar worlds behind to establish new lives and practices in the US. With the supply of US-born primary care providers and generalists dwindling and the healthcare needs of baby boomers on the rise, the contributions of these international medical graduates are more vital than ever, especially in underserved and rural areas like ours. Despite the limitations of the federal immigration system and complex state-level credentialing requirements (not to mention the lack of foreign restaurants), the six foreign-born doctors we spoke to say they are happy with their decisions to resettle in the South Dakota region. But what does it really take to make such a move? Here are some insights from our conversations.
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Dr. Marian Petrasko, cardiologist, who was born and educated in the former Czechoslovakia, now heals hearts at Sanford Heart Hospital.
You have to have high standards. SA N FOR D CA R DIOLOGIST Marian Petrasko, MD, PhD, a native of Czechoslovakia (from the part of the country that is now Slovakia) applied to a US residency program shortly after the fall of the Berlin Wall. Petrasko had begun his medical career in the large and historic city of Prague, where he had attended Charles University School of Medicine. But, despite the city’s size (more than 1.26 million) and status, Dr. Petrasko was acutely aware that his cardiology practice was destined to be limited. “Certain things were not available there,” he recalls. “There was just one beta blocker available, for instance. People would take a long time for testing. So I didn’t like it too much.” Petrasko moved to the US with his wife and one-year-old daughter for an internal medical residency at the State University of
January/February 2017
New York followed by a cardiology fellowship at Brown University and was impressed by the technology available in the US. Like many foreign-born physicians we spoke with, he took advantage of the opportunity to gain US residency by agreeing to practice for a time in an underserved area which, in his case, was rural Oklahoma. In 2004, his search for a permanent position led him to Sioux Falls where he now works at Sanford Heart Hospital. “We liked the Midwest and Sioux Falls was close to the size of the town where I grew up,” says Petrasko, who, had five children by the time he moved to Sioux Falls. After 12 years here, he retains his rich Slovak accent but says it has rarely been a problem. “For most of the time, nobody minds it. It’s more like curiosity. People always ask you where you are from. But it is good the way everybody melds together here and works together.”
MidwestMedicalEdition.com
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TO PRACTICE IN THE US, AN INTERNATIONAL MEDICAL GRADUATE MUST: • Have a four-year medical degree from a school listed in the International Medical Education Directory • Acquire a visa • Pass the first two steps of the United States Medical-Licensing Exam (USMLE) • Become certified by the Education Commission for Foreign Medical Graduates (ECFMG) • Be accepted into an accredited US or Canadian residency program • Go back and pass the third step of the USMLE Drs. Olawunmi and Olufemi Lawal: From Africa to Aberdeen
• Complete these steps within 7 years.
You have to be forward-thinking (and so does your partner) PULMONOLOGIST OLUFEMI (Femi) Lawal, MD, MBA, and his wife, internal medicine physician Olawunmi (Ola) Lawal, MD, were both raised in medical families in southern Nigeria. Femi earned his medical degree from Olabisi Onabanjo University and Ola from the University of Lagos. They both did residencies at Harlem Hospital in New York and Femi went on to fellowships there and at Memorial Sloan Kettering. Ola has been with Avera in Aberdeen for two-anda-half years with the couple’s two children. Femi joined her after a year
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and they welcomed their third child this summer. “We have a friend here who told us a lot about Aberdeen. They told us it was a small, family-oriented place and a good place to raise kids,” says Dr. Ola Lawal. “It was a difficult decision to leave Nigeria but we projected forward and thought about what kind of lives we wanted to have. Being together gave us strength. I would not have done it alone!” Although Aberdeen is far less diverse than New York was, and getting authentic African food requires a trip to Fargo or Sioux Falls, the Lawals say
the trade-off has been worth it for the friendlier, more relaxed atmosphere. Both talk of the warmth and acceptance of the community and the high quality of medical care in Aberdeen. “In Nigeria, we follow the same medical standards but the difference is that the resources are much more limited,” says Dr. Femi Lawal. “Physicians are more limited so practice is more intense because one doctor is going to care for so many people. In the US, we have an abundance of everything, including the ancillary services and resources that make it easier to take care of the patient.”
Midwest Medical Edition
The Nazir family on vacation in London. Pictured (l to r) are his son Fahd, Dr. Nazir, wife Ayesha and daughter Areej.
You have to be a good communicator LIKE MANY MIDDLE class Pakistanis, Infectious Disease specialist Jawad Nazir, MD, already had good English when he started his residency at the University of Pittsburgh in 1998. It was even better by the time he finished his fellowship at Cornell and moved to Sioux Falls in 2003. Which is why he was puzzled by the reaction of one of his earliest South Dakota patients, a farmer from a small town. “I was explaining things to him and he just kept staring at me silently. Finally, I said, ‘Sir, why do you keep staring at my face?’ and he said ‘I just can’t understand how you can speak English so well!’,” recounts Dr. Nazir. A graduate of King Edward Medical University in Pakistan, Dr. Nazir practiced for several years at an 1800-bed hospital in Lahore before deciding to make the move to the US. “To be honest, my reasons for coming here were pretty much the same as the founding fathers...A better future, a better economy, job opportunities,” says Dr. Nazir. Nazir took advantage of the opportunity to earn citizenship by going where the need was greatest and joined Infectious Disease Specialists, PC, in 2003. “Sioux Falls was my best path to citizenship. We had no idea what it would be like here, but now it is our home,” he says. He became a citizen three years ago.
January/February 2017
“When you come as international medical graduates, there are challenges,” says Dr. Nazir. “It is always an adjustment to get used to a new culture and to become familiar with that community’s medical needs. This is the case even if you move from Alabama to Sioux Falls. So there is a feeling that you have to always be proving yourself equal to or better than those around you.” While Nazir has not been immune to antiMuslim sentiment (especially in New York on 9/11), he says he has been encouraged by the support of the local health systems and believes the key to acceptance is for everyone to remember that international medical graduates like him are filling a need. “The basic thing to understand is that there is a need,” says Dr. Nazir. “Patients need to look at their physician as a person, someone who has left his country and come to another place. And we, as physicians, need to show them that we are here to care for them.” As cities like Sioux Falls become more diverse, international medical graduates are also helping to make them more welcoming for other immigrants, including new doctors. A case in point is the Muslim Community Center in Sioux Falls, which Dr. Nazir and some colleagues established with support from Avera.
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Facilitating Communication Between Patients and Their Foreign-Born Doctors
Nigerian-born Habiba Ikoghode, MD, (seen here at her wedding) now practices family medicine in Jackson, Minnesota.
You have to be easygoing and adaptable LIK E THE LAWA LS, Habiba Ikoghode, MD, grew up in Nigeria. A family medicine physician with Sanford in Jackson, Minnesota, Ikoghode says (in her near-perfect English) that she, too, has sometimes felt the need to “prove” herself in her new home. “When I first started here, I had to wear my badge all the time,” says Ikoghode. “When I walked in, people would be like ‘Where’s the real doctor?’. But that didn’t last long. For the most part, my colleagues just want to know about my culture. Sometimes I get teased about the way I pronounce things, but I feel like I have had their respect from the beginning. After all, not everybody wants to come to Jackson!” Dr. Ikoghode herself did not imagine that she would want to come to a place like Jackson until she happened to pass by Creighton University Medical Center in Omaha on a visit to the States while she was in medical school. “That was around the time that I lost my grandfather who was hit by a car while crossing a road. The nearest medical center was hours away and he died before he could get there. Seeing Creighton, I thought that there were probably a lot of things going on in medicine here that we didn’t have back home.” Ikoghode left Nigeria for Windsor University School of Medicine in St. Kitts, and went on to complete her residency and fellowship at Southern Illinois University School of Medicine. After clinical rotations in Atlanta, Ikoghode relocated to Jackson with her husband three years ago and now has two small children, ages 2 and 4, and a third due next year. “I am from a very family-oriented culture so I feel comfortable in a small community where I know my children’s teachers,” says Dr. Ikoghode. “You have patients who come and give you oranges to say thank-you. The hardest thing I’ve had to learn in this small community is don’t go to Walmart without makeup!” Minnesota’s cold winters also took some getting used to, as did the fact that Minnesotans don’t show up at each other’s houses without calling first. Overall, though, Ikoghode says she has come to feel at home in Jackson and even her parents enjoy the community when they visit. “It has been a great time with these people,” she says. “When they get to know you, you become part of their family, as well.” ■
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Although international medical graduates must be competent in English in order to be licensed to care for patients, a heavy accent can still pose a problem, especially in regions with limited diversity where patients may be unused to hearing foreign speakers. Speech Language Pathologist and South Dakota native Treva Graves remembers well her own frustration as she struggled to understand her doctors when she adopted a baby with health problems in California. “It was an area with a lot of diversity and our daughter’s pediatrician was from Ethiopia, her neurologist was from Lebanon, and her cardiologist was from Syria,” says Graves. “It was so hard to build a relationship and have that trust because we just couldn’t understand them.” Today, eleven years later, Graves is a Communication Coach offering foreign accent reduction training to help international medical graduates communicate more effectively with their Midwestern patients. “The three things we look at are intonation, pronunciation, and grammatical differences,” explains Graves who says foreign-born speakers may stress the wrong syllables, mispronounce or over-pronounce certain letters (such as the American “t”), or fail to use contractions. In the worst cases, these kinds of differences can lead to medical errors. But even when they don’t, communication differences may still widen the gulf between provider and patient. “If you have patients who aren’t satisfied because they can’t understand their physician, that can impact your bottom line,” says Graves, who underwent a specialized program to become a preferred trainer in Foreign Accent Reduction. “Communication in a medical setting is critical for establishing rapport, obtaining medical releases, and just communicating about treatment and medication.” Graves offers a 3-month program of weekly sessions and says a 40 to 60 percent accent reduction is possible.
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CASE REPORT The Untriggered Alert
By Lori Atkinson
A PULMONOLOGIST MISSES AN ABNORMAL CT REPORT IN THE EHR, WHICH CONTRIBUTES TO A DEADLY DELAY IN THE DIAGNOSIS OF LUNG CANCER.
FACTS OF THE CASE A family physician referred a 78-year-old man with a history of emphysema to a pulmonologist for a prolonged productive cough and other respiratory symptoms that were not responsive to treatment. The pulmonologist ordered a chest X-ray that showed worsening interstitial primarily bibasilar infiltrates that had been present for a year. The pulmonologist felt the cough was likely related to active airway disease and recommended the patient continue his Symbicort medication, as well as return in three to four months for reevaluation. The pulmonologist also ordered a high resolution chest CT be done prior to that appointment. Four months later, the patient returned to see the pulmonologist after having the chest CT done. The patient reported he was doing better. The pulmonologist diagnosed mild interstitial fibrosis and instructed the man to follow up as needed. The report of the chest CT done that day revealed an indeterminate 1.5 cm left lower lobe pleural-based soft tissue mass. The radiologist commented that lung carcinoma was not able to be excluded and recommended a dedicated enhanced chest CT and biopsy sampling be done. The pulmonologist did not see the abnormal chest CT report. Eight months later, the patient returned to see the pulmonologist for complaints of increasing shortness of breath. When the pulmonologist went into the EHR to order a chest X-ray, he noticed the previous
abnormal chest CT results. The pulmonologist discussed the results with the patient, noting the concern for malignancy. He ordered a thoracentesis and repeat chest CT, which showed a primary lung malignancy with combined small cell and non-small cell features. The patient chose not to have chemotherapy and hospice care was ordered. Several months later, the man was found unresponsive at home and died later that afternoon. The cause of death was determined to be metastatic adenocarcinoma of the lung. The family filed a malpractice claim against the pulmonologist alleging failure to timely diagnose and treat lung cancer.
DISPOSITION OF THE CASE The case was settled with payment against the pulmonologist
PATIENT SAFETY AND RISK MANAGEMENT PERSPECTIVE The experts who reviewed this case argued whether or not the delay in diagnosis resulted in any lost chance of survival for this man. However, they could not support the pulmonologist clearly missing an abnormal chest CT report that recommended further testing to rule out malignancy. The pulmonologist testified that he did not know how he missed the patient’s abnormal chest CT report in the EHR, but that his clinic had just implemented a new lab module that may have failed to trigger the result notification. He testified that after a root cause analysis
of this adverse event, his clinic changed the workf low process for test result management.
WHEN EHRS CAUSE PATIENT HARM In an analysis of EHR-related malpractice claims submitted to the claims database at CRICO Strategies/Risk Management Foundation of the Harvard Medical Institutions, researchers found that 59 percent of these cases originated in an ambulatory care setting, and that most cases were the result of an error involving medications (31 percent), a diagnosis error (28 percent) or a complication of treatment (31 percent).1 In many cases, more than one contributing factor was identified, with 63 percent of cases involving user-related issues and 58 percent involving technology-related issues. User-related issues included incorrect information, pre-populating/ copy-and-paste, or training and education. System-related issues involved technology and software design, routing of electronic data, system malfunction, integration problems, or failure of alerts/decision support. The researchers suggested that strategies to reduce patient harm should target the settings most at risk (ambulatory care) and the processes that account for the most errors (medication and diagnosis). ■ LORI ATKINSON, RN, BSN, CPHRM, CPPS is Patient Safety Solutions Manager in Research, Development & Education at MMIC. She has been with MMIC for 26 years.
To read Atkinson’s Three Key Patient Safety and Risk Management Tips and to access free resources for managing electronic health risk, see the extended version of this article online.
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Midwest Medical Edition
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19
Recognizing the Signs of an
Eating Disorder
A
By Alex Strauss N ESTIMATED 20 million
women and 10 million men suffer from eating disorders at some time in their lives, according to the National Eating Disorders Association. Although healthcare professionals may immediately think of anorexia or bulimia, which are most often seen first in adolescents, clinical social worker Brandy Bunkers, CSW-PIP, of Clarity Counseling in Sioux Falls says binge eating disorder should also be on the healthcare professional’s radar. “Bulimia and anorexia are often about control issues,” says Bunkers. “With binge eating, it’s a feeling of being out of control. A person may eat beyond full, eat very fast, eat alone, or eat when they are not hungry. They often feel very bad about themselves afterward. It’s more than just occasional overindulgence.” Although some of Bunkers’ clients are sent to her by concerned parents, many are referred by healthcare providers who have learned to recognize the warning signs of a potential eating disorder. These may include weight fluxuations, a tendency toward chronic dieting, amenorrhea, regurgitation issues, elevated creatinine, metabolic disturbances or bradycardia. “Another situation to be aware of, if an eating disorder is suspected, is a family history of chemical dependency, anxiety, eating problems or depression,” says Bunkers. “As with many mental health issues, there can be more than one component. Sometimes, a trauma will underlie the problem or may even have triggered it.” Even providers who know the signs may be reluctant to broach the sensitive subject of eating disorders with patients. But Bunkers warns that it can be a mistake to try to
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“lighten the mood” or allay patient concerns with a dismissive comment. “Sometimes, providers don’t realize the potential impact of a casual or flippant remark,” says Bunkers. “For a patient who is struggling with an eating disorder, the number that they get on that scale can represent a lot more than their physical health. It can be closely connected to a their feelings of control, self-esteem, and even self-worth.” Patients struggling with such issues may also have problems concentrating, may exhibit mood changes, foggy thinking, low energy and even changes in the way they socialize. “Patients with eating disorders may isolate themselves,” says Bunkers. “Asking questions about how they are spending their time can sometimes indicate if there is a problem.” Fortunately, eating disorders typically respond well to a combination approach of nutritional counseling and cognitive behavioral therapy to work through the emotional
issues underlying the disorder. Bunkers says counseling records should be shared with the referring physician to ensure a continuum of care for the patient. “It is important that everyone is one the same page,” she says. Counseling may last three to six months and may require ongoing maintenance visits. ■ Brandy Bunkers, CSW-PIP, owns Clarity Counseling, LLC, in Sioux Falls. She s a member of the Academy for Eating Disorders and The International Association of Eating Disorders Professional Foundation.
Midwest Medical Edition
HEART HEALTH and Lean Beef
A
By Holly Swee RECENT STUDY TITLED “Let Them Eat Beef:
Effects of Beef Consumption on Markers of Metabolic Syndrome” conducted at South Dakota State University reveals lean beef can be part of the solution for heart health and weight management. The study published in the Functional Foods in Health and Disease Journal assessed the impact of a dietary pattern with 30 percent of daily energy needs from protein with half of the protein coming from lean beef on risk factors of Metabolic Syndrome. The study tested the lean beef dietary pattern intervention against the control “Dietary Approaches to Stop Hypertension” (DASH) dietary pattern. The research revealed that participants with Metabolic Syndrome who followed the beef intervention dietary pattern displayed similar outcomes on serum lipid concentrations and body weight as the research participants who followed the DASH dietary pattern. ■ Holly Swee, RD, LN, is Director of Nutrition & Consumer Information with the South Dakota Beef Industry Council Source: Olson, Kristin et al, “Let Them Eat Beef: Effects of Beef Consumption on Markers of Metabolic Syndrome”, 2016, Functional Foods in Health & Disease, http://www.ff hdj.com/index.php/ff hd/ article/view/255/511
January/February 2017
MidwestMedicalEdition.com
Ask ur tO Abou dge Lo e! g Packa
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Avera ALS Clinic Honored by ALS Association THE ALS ASSOCIATION, MINNESOTA, North Dakota, South Dakota Chapter has presented its Honoree Award to staff and leadership of the Avera ALS Clinic at Avera McKennan Hospital & University Health Center. The Avera ALS Clinic, which started in 2010, was launched after neurologist Karen Garnaas, MD, facilitated a meeting between Avera and the ALS Association. Dr. Garnaas had lost her brother to ALS and her experience, coupled with her work as a neurologist, motivated her to help make the clinic a reality. David Kapaska, DO, President and CEO of Avera McKennan, said Garnaas’ request exposed a critical need, and that receiving this honor underlines the clinic’s important role in the region. “We aimed to develop a clinic built on the multidisciplinary model which allows individuals living with ALS to meet with a team of specialists during a single visit,” Kapaska said. “That greatly reduces scheduling and accessibility barriers for families traveling to Sioux Falls from greater South Dakota.” “Over these six-plus years of serving ALS families in our area, we have come to realize just how important a dedicated clinic can be to helping them live more fully,” says Mary Jones, PT, MBA, the director of the Avera Brain & Spine Institute, which is home of the Avera ALS Clinic. “Every person who works in this clinical setting is honored to
David Kapaska, DO, center, President and CEO of Avera McKennan Hospital & University Health Center, accepted the ALS Association Recognized Treatment Center honors from the ALS Association, Minnesota, North Dakota, South Dakota Chapter at its recent gala. Kapaska is shown with his wife, Mary Ann, left, and their daughter, Katie Smidt
have received this recognition because it shows that our daily dedication . . . is valued not only by our patients and their families, but on a national level as well.” The Avera ALS Clinic is recognized as an ALS Association Recognized Treatment Center. Organizations that earn the Honoree Award have exceeded expectations in helping raise awareness and funds for ALS research and supporting the regional ALS Chapter. ■
Mercy Implements Palm Scanning to Enhance Patient Security MERCY MEDICAL CENTER has implemented
be immediately confirmed at registration, with
a new high-tech approach to registering
no risk of human error in matching individuals
patients. New PatientSecure palm-scanning
to their correct personal medical records.
technology went live on October 25th. Hospital
PatientSecure is highly accurate and works
officials says the goal is to enhance the patient
by scanning the vein pattern of a new reg-
experience and protect patient identity and
istrant’s or registered patient’s palm. Vein
privacy.
patterns are unique to every individual. The
The PatientSecure identification system
scan uses harmless near-infrared light, like
uses biometric technology to streamline patient
the light used in television remote controls.
registration and ensure that patients are quickly
It processes vein patterns to create an encrypted
and accurately identified before receiving care.
and protected digital file which is linked to a
Once they have registered, users’ identities can
specific medical record. ■
MED QUOTES
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Let us love winter, for it is the spring of genius.
—Pietro Aretino
Midwest Medical Edition
Routine Blood Pressure Measurement for Children
Is it Necessary? THE INCIDENCE OF PEDIATRIC hyperten-
sion is on the rise. Although providers may not routinely check the blood pressure of small children, pediatric nephrologist Melissa Muff-Luett, MD, assistant professor at UNMC College of Medicine says it is vital. “Hypertension in children is different than adult hypertension,” says Dr. MuffLuett. “Finding the cause and taking action to correct it is important for children because they would have to endure many more years of the adverse effects of high blood pressure on their health, particularly effects on the heart, kidneys and eyes.” Dr. Muff-Luett says children under 3 should have their blood pressure checked if they have certain risk factors including prematurity, low birth weight, history of a NICU course, congenital heart disease, known kidney disease, urologic malformations or a history of urinary tract diseases. Pediatric hypertension may be classified as either primary (also known as essential) or secondary. Primary is more common in
adolescents, children with a family history or genetic predisposition, and overweight or obese children. “A diagnosis of primary hypertension has to be a diagnosis of exclusion,” says Dr. Muff-Luett. “We really should look for a secondary cause for hypertension in any child.” Secondary causes may include renal parenchymal disease, renovascular disease, congenital renal anomalies, bronchopulmonary dysplasia, coarctation of the aorta, renal vein thrombosis, and congenital adrenal hyperplasia. For children and adolescents, additional causes include renal and renovascular diseases, pheochromocytoma, increased intracranial pressure and druginduced hypertension. “If it appears to be pre-hypertension, it would be reasonable to check the blood pressure again in six months,” says Dr. Muff-Luett. “If the child appears to have stage one hypertension, we should recheck in one to two weeks, which can be done either at the medical office or at home or by
a school nurse prior to initiating a further evaluation for hypertension.” If stage two hypertension is suspected, Dr. Muff-Luett recommends that an initial hypertension evaluation occur within 1-2 weeks. She advises primary care providers to consider contacting a pediatric nephrologist if guidance is needed or if therapy is indicated, particularly in cases with significant hypertension, symptomatic hypertension or evidence of end organ damage. ■
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January/February 2017
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Clinical Spotlight
New Trial to Test Stem Cells for Rotator Cuff Repair LAST MONTH, SANFORD OPENED A first-of-its kind FDA-approved clinical trial to treat rotator cuff tears with a patient’s own adipose-derived stem cells. The goal is to determine whether an injection of these cells can safely repair small and partial thickness tears by activating the body’s natural healing process. Orthopedic surgeons Jason Hurd, MD, of Sioux Falls and Mark Lundeen, MD, of Fargo are the study’s two principal investigators. MED spoke with Dr. Hurd about this common type of shoulder injury and the significance of the new trial. DR. HURD: The problem with rotator cuff injuries is that, in contrast to other types of injuries, they do not spontaneously heal on their own. Several studies following patients with rotator cuff tears suggest that, in some patients, small tears even progress and get bigger. If 50 percent of your rotator cuff is torn, it is going to cause pain and discomfort. MED: How are these types of injuries typically treated? DR. HURD: A lot of times we perform surgery to try to get them to heal. We go in and reattach the tendon to the bone with anchors and sutures. The goal is to try to get it to heal back to the bone.
MED: What do you hope that the adipose stem cells will do for rotator cuff tears? DR. HURD: Because the tendon is still in proximity to the bone, we want to see if injecting the patient’s own stem cells into this area will help the body heal naturally. We don’t know yet whether this is going to work, but we want to find out. MED: Why are you using adiposederived cells? DR. HURD: There are several reasons. For one, these cells are easy to get and almost everyone has some. The process is also less painful for patients than taking stem cells from bone marrow. Using enzymes to concentrate these adipose stem cells into a solution, we are able to use them within an hour or two of harvesting. MED: Why is this trial significant?
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DR. HURD: We are good at mechanically fixing rotator cuff tears, but we know that that is only part of the process. To get healing to happen, we have to improve the biology. You can fix the tear as well as you want, but if the patient’s own body does not heal it back to the bone, the repair will never really be what you want it to be. It is very exciting to be the first to test this method. ■ About the trial: This year-long trial, which began in December, will include 18 patients. Twelve patients will receive stem cell injections and six controls will receive cortisone shots. Patients will be monitored with an MRI at baseline, six months, and one year after the procedure and will undergo a progress therapy regimen. This trial, which was developed in conjunction with the FDA, is the first and only FDA-approved clinical trial testing the safety and efficacy of adipose stem cells for this type of injury.
Midwest Medical Edition
Sanford Creates Board to Guide International Work SANFORD HEALTH HAS SELECTED NINE MEMBERS to lead its newly created Sanford International Board, which provides guidance, direction, oversight and promotion of the health system’s global efforts. The Sanford International Board, which recently held its inaugural meeting, also helps determine growth and monitors and evaluates the financial and operational performance of Sanford World Clinic and other international activities involving Sanford Health. The following individuals were selected for the Sanford International Board: Andy North (chair); retired professional golfer
Take Heart Today’s Lean Beef in a Heart-Healthy Lifestyle
and two-time winner of the US Open Gary Hall Jr. (vice chair); three-time Olympic swimmer and winner of 10 gold medals Miles Beacom; president and CEO of Premier Bankcard Pam Davis; system CEO of Edward-Elmhurst Health Manny Ohonme; founder of Samaritan’s Feet Kirk Penney; shooting guard for the Australian National Basketball League’s New Zealand Breakers Cindy Rarick; professional golfer and entrepreneur Robin Smith, MD; chairman and president of the Stem for Life Foundation
People often look for new ways to enjoy a variety of protein foods in a healthy lifestyle. Heart-healthy diets recommend focusing on lean protein, and that includes lean cuts of beef like Top Sirloin, Strip Steak and Flank Steak.
The good news is today’s beef is much leaner and lower in saturated fat than ever before.
Kelby Krabbenhoft (ex officio); president and CEO of
GO LEAN FOR HEART HEALTH
Sanford Health “The Sanford International Board was created to challenge Sanford Health to think bigger,” said Krabbenhoft. “As our organization pioneers the next generation of treatments and cures, it’s increasingly important that those advancements be available on a global scale.” Through Sanford World Clinic, Sanford Health has a presence in several countries, including the United States, Ghana, China and Germany. Since its inception, the program has opened domestic and international sites using a model that emphasizes permanent infrastructure and expert care. ■
Did you know that lean beef can be as effective as fish and poultry in managing cholesterol as part of a heart-healthy diet? In fact, significant research shows that people can enjoy 4-5½ ounces of lean beef, daily, as part of a heart-healthy lifestyle to lower blood pressure and improve cholesterol levels.1, 2, 3 1 Maki KC, et al. A meta-analysis of randomized controlled trials that compare the lipid effects of beef versus poultry and/or fish consumption. J Clin Lipidol 2012;6:352-61. 2 Roussell MA, et al. Beef in an Optimal Lean Diet study: effects on lipids, lipoproteins, and apolipoproteins. Am J Clin Nutr 2012;95:9-16. 3 Roussell MA, et al. Effects of a DASH-like diet containing lean beef on vascular health. J Hum Hypertens 2014;28:600-5.
MED QUOTES
“
In winter, I plot and plan. In spring, I move.
January/February 2017
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Visit www.BeefItsWhatsForDinner.com for beef recipes. Funded by The Beef Checkoff
—Henry Rollins
16-20232-SD-HeartHealth-Ad.indd MidwestMedicalEdition.com
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11/28/2016 25 2:23:36 PM
Reducing Anesthesia-Related
Dental Risk By Jeremy Wale
G
ENERAL ANESTHESIA DEMANDS A PATIENT’S AIRWAY BE PROTECTED,
and may require a patient to be intubated. As such, related risks include, but are not limited to, dental and airway injuries and respiratory issues. Other potential risks associated with anesthesia delivery include incomplete informed consent discussions, inadequate patient monitoring, and delivery of inadequate or inappropriate medications.
PREVENTING DENTAL INJURY DURING ANESTHESIA One of the most common general anesthesia injuries is dental injury.1 Examples include broken or chipped teeth, broken bridges, or dislodged implants. Oftentimes the anesthesiologist may not realize dental damage has occurred. It is not uncommon for cracked teeth or chipped veneers to go unnoticed until the patient detects and communicates the issue. The patient’s dentition, emergencies, poor intubation or extubation technique, or tools used by the anesthesiologist can factor
in dental injuries. Injuries most often occur “during intubation with a laryngoscope in patients where there is limited visibility to the hypopharynx.”2 In fact, “50-75% of dental injuries occur during tracheal intubation.”3 Two types of patients are highest risk for dental injury: difficult patients to intubate and those with poor dentition. Difficult patients to intubate have a 20 times greater risk of dental injury.4 Patients with poor pre-existing dental status present a five-times greater risk of dental trauma than patients with good pre-existing dental status. How can anesthesiologists help mitigate
dental injury risk? Ensure familiarity with the patient’s general dental condition, which can help identify potential issues before they occur. This also may help in the event of an emergency. Ensure the patient removes all removable appliances from his or her mouth prior to any procedure. This helps prevent damage to the patient’s appliance(s) or teeth. A well-documented pre-anesthesia assessment of each patient’s dental condition provides an optimal start. This gives the anesthesiologist an opportunity to identify potential problems before he or she begins administering anesthesia—and to discuss those and formulate a plan to mitigate dental injury risk. Additionally, a thorough, documented informed consent discussion identifying potential issues with the patient’s dentition can be invaluable if dental injury occurs.
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Likewise, a detailed pre-anesthesia assessment to evaluate the patient for difficulty of intubation will assist the anesthesiologist in avoiding dental injuries.5 Knowing areas of concern ahead of time aids preparedness to overcome challenges without damaging a patient’s dentition. Such an assessment is part of a comprehensive informed-consent patient discussion. Some anesthesiologists add a dental exam to the pre-anesthesia form. That form may include a diagram of the teeth with space for anesthesiologist notations regarding potential areas for concern. This not only serves as strong documentation, but provides a good reminder to complete dental exams for each patient. Several devices are available to minimize dental injury risk during general anesthesia.6 These devices typically are placed on or around the teeth to protect against damage. One institution, the University of Iowa Department of Otolaryngology, “has incorporated dental guards into a protocol for reducing dental injury during laryngoscopy.” 7
OVERSEEING ANESTHESIA FOR MULTIPLE PATIENTS In hospitals and surgery centers, it is not uncommon to have one anesthesiologist responsible for multiple patients simultaneously—supervising or consulting for multiple procedures at the same time. This typically occurs when there is a Certified Registered Nurse Anesthetist (CRNA) with each patient, and the physician anesthesiologist is responsible for supervising CRNA care. Issues can potentially arise when the patient and/or family members are not informed of this team approach. While CRNAs generally are well qualified with specialty training and certification to administer anesthesia, patient knowledge is key. Most patients expect the anesthesiologist will be in the room for the entire procedure unless told otherwise. If your facility uses the team-care anesthesiology approach, a thorough informed consent discussion explaining the care plan and anesthesiologist availability is advised. This discussion informs the patient and/or family members of the care to be provided and allows questions and concerns to be addressed. ■
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For more advice on preventing dental injury and a complete list of article sources, see the extended version of this article online.
January/February 2017
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USF Healthcare MBA Program
Now Available Online
By MED Staff
I
N THE TWELVE YEARS since the University of Sioux Falls introduced its Healthcare-focused MBA program, an estimated 150 students, most of whom were already working in healthcare in the region, have completed the coursework. “For people in the healthcare industry who have found themselves responsible for managing others, managing a budget, etc., the Healthcare MBA gives that confid e nc e a nd for m a l training in leadership, management, teamwork, and how the organization needs to work as a whole,” says Steve Horan, MBA, CPA, CGMA, who directs USF’s MBA program. Program graduates include doctors, nurses, pharmacists, marketing professionals, healthcare managers, those who hope to be managers, and others. But, although every cohort to complete the program has been different, every participant up to now has had two things in common: They all had to carve out one night a week to attend class for 21 months and they all had to live within driving distance of the Sioux Falls campus. “What we have found is that both of these factors have been limiting for some people, especially healthcare professionals,” says Horan. “In healthcare, you may have lengthy hours, shifts that change, or night shifts. Some people have told us that they just
cannot commit to one night every week.” In order to accommodate these limitations, respond to student feedback, be on par with competing schools, and open their program to a broader market, USF is now offering an online version of the Healthcare MBA program. Taught by the same professors and offered over the same 21-month period, the 12-class online program does away with the need to come to campus for a weekly class. “We’re trying to make it as achievable as possible,.” says Horan. “We want to meet students where they are. They are telling us that that one night a week commitment is too difficult because of work or family commitments. This way, they have the flexibility and freedom to get things done according to a schedule that works for them.” The new online option could even make the program more doable for students who choose the on-campus option, but run into time problems part way through. “We are offering all of our students the ability to mix and match,” says Horan. “Any class can be done either online or on campus. If an online student knew that they were going to have a slower time of year and could make it to a night class, then they are welcome to attend that class.” The fact that the professors, assignments, and timelines are the same online and on
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Now our geographic reach is really unlimited.
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campus will make the “mix and match” option seamless for students who need extra flexibility. “The hope is that this is going to expand the Healthcare MBA program,” says Horan. “Now our geographic reach is really unlimited. This allows us to offer the option to anyone who is interested in a degree.” The new online program is offered via the Webex platform, which uses technology to simulate the kind of collaboration students would normally get by meeting in person. “Depending on the class, there may still be group work to do,” says Horan. “So, even as an online student, you still have the opportunity to meet people and to work together. You are just not physically together every week.” The length of the program and cost is the same with the online and on-campus versions of USF’s Healthcare MBA program. More information is available on the school’s website. ■
See the website for the story of a pharmacist believes his Healthcare MBA has given him a “bigger voice”.
Midwest Medical Edition
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Rehabilitation Specialists For Your Patients of All Ages
Kate Sigford, MD
Physical Medicine & Rehabilitation specialists at LifeScape work with onsite therapists, orthotists, a prosthetist, and durable medical equipment experts to solve your patients’ mobility difficulties. ■ Assessment, prescription, and follow-up for all orthotic types ■ Management of durable medical equipment, including wheelchairs and other mobility aids ■ Tone management for neuromuscular disorders and other causes of spasticity ■ Botox & Baclofen pump managment ■ Management of therapies
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Julie Johnson, MD
Charlie Broberg, PA-C
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For referrals, call 605.444.9700
Midwest Medical Edition
Learning Opportunities Winter/Spring 2017 January 21, 2017 7:15 am–4:00 pm Sanford Neuroscience Symposium, Fargo Location: Ramada Plaza & Suites, Fargo Information/Registration: 800-437-4010, LearningServices@sanfordhealth.org
February 16, March 16, April 20 12:00 pm–1:00 pm Sanford Imagenetics Lecture Series Location: Schroeder Auditorium, Sanford USD Medical Center Information: 605-312-6513 or Norma.Eie@sanfordhealth.org Registration: sanfordhealth.csod.com
February 24 & 25, 2017 UnityPoint Health EMS Conference 2017 Location: Sioux City Convention Center Information: http://www.unitypoint.org/siouxcity/services-professional-education.aspx
February 25 7:30 am–12:00 pm Current Trends in Spine Care Symposium Location: Schroeder Auditorium, Sanford USD Medical Center
March 14–15 7:00 am–7:00 pm SD Winter Conference on Emergency Medicine Location: Rushmore Plaza Holiday Inn, Rapid City Information/Registration: 605-719-8222, sdacepconf@gmail.com
March 16–17 5:00 pm–8:00 pm, 7:30 am–5:45 pm Avera eEmergnecy Airway Program Location: Holiday Inn Downtown, Sioux Falls Information: 605-322-7879, averaeducationevents@avera.org Registration: avera.org/classes-events
April 28–29 8:00 am–6:00 pm, 8:00 am–4:30 pm Sanford Sports Medicine Symposium Location: Ramkota Hotel & Conference Center, Sioux Falls Information: 605-312-7808, tryg.odney@sanfordhealth.org Registration: sanfordhealth.csod.com
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.
TOP ROW: Richard Clark, MD; Orvar Jonsson, MD; David Maziarz, MD; Verlyn Nykamp, MD MIDDLE ROW: Marian Petrasko, MD, PhD; Scott Pham, MD; Naveen Rajpurohit, MD; Lloyd Solberg, MD, PhD BOTTOM ROW: Christopher Stanton, MD; Kelly Steffen, DO; Adam Stys, MD; Maria Stys, MD; Tom Stys, MD
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Every trained specialist, every innovative piece of technology, every room within the Sanford Heart Hospital is here for one very important reason: your patient.
For more information or to refer a patient, call Sanford Heart Hospital at (605) 312-2200 or (877) 220-2929.
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Regardless of what your patient’s heart needs may be, you can rely on our team to find the best solution to keep them safe, healthy and strong. At Sanford Heart Hospital we guarantee same day appointments for referring physicians.
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