MED-Midwest Medical Edition-March 2017

2017

MARCH

Vol. 8 No. 2

Midwest Medical Edition

ANTIMICROBIAL

STEWARDSHIP "Magic Words"

IN THE DIGITAL

AGE

and your invoices

Helping Patients with

ANXIETY

BROOKINGS

Opens Expanded Hospital

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MIDWEST MEDICAL EDITION

Contents

page

VOLUME 8, NO. 2 ■ M A RCH 2017

14 2017

MARCH

REGULAR FEATURES

Vol. 8 No. 2

4 | From Us to You 5 | MED on the Web The best states for dental care and other content avaible exclusively on our website.

12 | News & Notes – Awards, appointments, additions, and accreditations from around the Region

Midwest Medical Edition

ON THE COVER 11

31 | Learning Opportunities Upcoming Spring Conferences, Events, and CME Opportunities

These Magic Words Could Get You Paid

IN THIS ISSUE

22

An interview with Dr. Michael Saba

Reducing the Weight of Anxiety

8 | Could Your Business Continue Without a Key Employee?

■ By Brandy Bunkers How to know when to refer your patient for help

■ By Jerry Weiler New technologies help healthcare facilities track and prevent the spread of pathogens.

23 | UnityPoint Health Recognized for Excellence in Patient Financial Communications

25 | First Fellow Chosen for Interventional Cardiology Fellowship in Sioux Falls

27 New Brookings Hospital Welcomes its First Patients

26 | Coping with Pediatric Bowel and Bladder Dysfunction 28 | New Program Boosts Native American Interest in Health Professions

29 | What is an Industrial Athlete?

■ By Kelly Marshall Expert advice to ensure that your “training camp” is sufficient to prepare and protect your own “industrial athletes”.

30 | The Value of Early Exposure to Medicine for Career Choice ■ By Julia Stys with Maria Stys, MD

Cover photo: A biofilm of antibiotic resistant Escherichia coli bacteria in closeup.

"Magic Words"

IN THE DIGITAL

AGE

and your invoices

Helping Patients with

ANXIETY

BROOKINGS

Opens Expanded Hospital

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

Graduates Presents Opportunities

18 | Technology for Infection Control and Prevention

STEWARDSHIP

■ By Jill Heyden

6 | Influx of International Medical

■ By Dave Starr Imagine what would happen if your business suddenly had to continue without you, a partner, or an especially valuable employee.

By Peter Carrels

ANTIMICROBIAL

ANTIMICROBIAL page 16

STEWARDSHIP IN THE DIGITAL

AGE

In the same month that the CDC announced the death of a Nevada woman from an un-killable CRE infection, the Joint Commission instituted new standards for fighting microbial resistance.

In this month's cover feature, we examine the multiple facets of hospital antimicrobial stewardship programs, including Avera's efforts to support ASPs in smaller hospitals through its telehealth network.

From Us to You Staying in Touch with MED

S

UPERBUG. It may sound like the title of the newest Marvel movie to many lay people. But to healthcare professionals who understand the potentially devastating implications of a microbe that cannot be stopped, the word has a much more sinister meaning.

An estimated 23,000 people die each year as a result of resistant bacteria and thousands more from related C. difficile infections. Too often, these infections are hospital-acquired.

In this month’s cover story, a closer look at Antimicrobial Stewardship, including Avera’s use of its extensive telehealth network to support mandated AS programs in its facilities across the region.

On the business side of medicine this month, could your organization survive the loss of a key employee? We’ll have advice to ensure that the answer is yes. Plus, how the words you use on your invoices can influence your ability to get paid. They don’t call them “magic words” for nothing.

Finally, be sure to take a moment to review Learning Opportunities on the back page and get those spring events on your calendar! (While you’re at it, please send us any we are missing) As always, we welcome your contributions and your comments. Reach us any time at Info@MidwestMedicalEdition.com.

With warm wishes for a healthy and productive transition into spring, —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 Brandy Bunkers

Peter Carrels Jill Heyden Kelly Marshall Dave Starr Julia Stys Jerry Weiler STAFF WRITERS Liz Boyd Caroline Chenault John Knies

MED QUOTES

“

Always laugh when you can.

It is cheap medicine.

—Lord Byron

Next contribution deadline: March Next advertising deadline: March

4

”

1 5

Reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical Edition, LLC 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

MED welcomes reader submissions!

MORE

Than a Magazine

A Medical Community Hub! Got a Spring Event Planned? List it for FREE in MED! MED can help you fill your upcoming conference, open house, workshop or other event. Thousands of area healthcare professionals visit MED’s website every month.

2017 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 1 March Issue February 1 April/May Issue March 1 June Issue May 1 July/August Issue June 1 Sep/Oct Issue August 1

Take a moment to list your event for free in our popular online calendar.

This month

only on the Web:

2017’s Best and Worst States for Dental Health In honor of last month’s Children’s Dental Health Month, WalletHub has released it’s list of states with the best and worst dental health. A state in our region tops the list.

Find out where your state ranks.

Keeping Providers in ND Sanford’s new School of Medicine and Health Sciences at the University of North Dakota is part of the state’s strategic plan to train and retain more healthcare workers and reduce the state’s overall disease burden.

Avoid Professional Liability Claims Keeping your office staff well trained and informed about best practices can help cut your risk of a professional liability claim. Check out this handy checklist from the experts at ProAssurance to ensure you’re protected.

November Issue October 1 December Issue November 1

Stay up-to-date between issues of Sign up for previews of upcoming articles and advance notice of the next digital edition.

Influx of International Medical Graduates Presents Opportunities Dr. Michael Saba, Development Consultant for International Health, Avera McKennan Foundation MED: What is your connection with the International Medical Graduates of our region?

is expected to continue to go up. In the future, as many as half of our doctors may be foreign born.

Dr. S: My job is to help Avera expand its work overseas. I originally came to Sioux Falls to help Sanford start putting Children’s Clinics abroad. Prior to that, I was doing the same thing at St. Jude’s. In all three cases, I started by doing a sort of internal personnel and materials audit to determine what these institutions had to work with in terms of international opportunities.

MED: What kinds of assets do you think these practitioners bring in terms of furthering Avera’s international work?

MED: What did you find?

Dr. S: That all had physicians and researchers from other countries who were often keen to do something for their home countries.

Many come from third world countries where help is needed and some offer that help through mission work. About a fifth of doctors at Avera are now foreign born and that

Dr. S: I think the things these doctors bring to the table are not always considered outside the realm of their particular areas of expertise. But they are also assets because of their ability to speak the language, make connections, navigate their home countries, as well as their desire to help.

MED: Besides filling a need for providers, how do you think IMGs strengthen healthcare in our region?

Dr. S: There are more and more immigrants coming into South Dakota. Not only can there be a language barrier, but they may bring

diseases such as malaria that many of our doctors have never seen before. Our foreignborn doctors not only speak the language but have often seen these diseases and are adept at treating them.

In addition, new doctors are often very interested in doing international work, which is a relatively new phenomenon. Having strong international programs in place, with the support and involvement of our IMGs, can not only help keep some of our own people here but can help us recruit. It’s what progressive institutions do. ■

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Could Your Business Continue

Without a Key Employee?

I

By Dave Starr MAGINE WHAT WOULD HAPPEN if your business suddenly had to continue

without you, a partner, or key employee. Could the loss of this individual cause the business to lose something valuable, such as experience, knowledge, time or money? What can you do to protect yourself and your business?

KEY PERSON PLANNING Since the financial loss could be severe enough to destroy a business, enough cash should be available to compensate for this loss. here are two common ways to accumuT late cash: 1. Cash Fund – a specified amount saved each month by a company 2. Purchased assets that generate a return These methods allow businesses to set aside cash to help offset expenses and/or losses should a key person die. But with both methods, businesses risk the chance that:

 The key person may die within a year.

 M ore than one key person dies.  The business needs cash prior to the death and withdraws from the cash fund to meet other obligations.

KEY PERSON INSURANCE Another way to ensure the continuation of a business is to insure key employees. Life insurance can guarantee a cash payment upon the death of a key employee. The company owns the policy and is the beneficiary.

The death benefit amount of the policy is determined by how important the employee is to the success of the business. If the insured dies, death proceeds are paid income tax-free to the company. Accumulated cash values are carried as a current asset on the books and are available for the use of the business.

8

HOW TO DETERMINE AN EMPLOYEE'S VALUE Determining an employee's value to the business – a dollar amount – is difficult.

But there are several commonly used methods for placing a monetary value on a key person’s worth to your business:

expenses when a valuable employee dies.

Do not overlook one of your most valuable resources, human resources, when reviewing your risk management program. Key person planning can help ease your business through a difficult transition. ■ * Subject to surrender charges. Unpaid loans and loan interest will be subtracted from the accumulated value.

Dave Starr is Regional Managing Director with Principal Financial Group in Sioux Falls.

 Multiply the salary of the employee by three to 10 times. As the key employee's value to the business rises, the multiple used can also increase.

 Determine the difference between the key employee's salary and the salary that would be paid to a replacement for the employee. Then multiply the excess by the number of years projected to find and train the replacement employee.

Key employee valuation is flexible. Your financial professional can help you determine which method works best for you.

WHAT IF THE EMPLOYEE QUITS OR RETIRES? Some policies allow you to change the insured from the terminating employee to another key employee. Another option is to cash in the life insurance policy*. Or your business can continue to hold the insurance until death – and still collect tax-free death benefits. If your key employee retires, you may decide to sell the policy to the employee for its cash or replacement value.

Key person insurance helps you and your business by providing funds for hiring a replacement, training costs and business

Midwest Medical Edition

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Midwest Medical Edition

These Magic Words Could Get You Paid

By Jill Heyden

S

OMETIMES THE BEST solutions

are so elementary, we overlook the obvious. In a recent study performed by the accounting software, Freshbooks, this was indeed the case. It was not only what was stated on invoices, but how it was stated that prompted payments.

According to the study, a simple thank you at the end of an invoice increased both the percent of invoices paid as well as the speed at which payments were completed.

By adding the word ‘please’to an invoice, this changed perception from a demand into a request. For example: instead of stating “Payment due within 21 days,” it was suggested to opt for a more polite phrase such as “Please pay within 21 days.”

When invoice terms sound as if they were written like an individual letter, it becomes more personalized. A more personalized approach has also been shown to generate more payment activity.

Payment terms and expectations should be clearly articulated to the patient on each statement. Keep in mind that not every person who receives an invoice has the same education level. Any form of documentation

that a patient receives should be written in a way that can be understood by all who read it. If an invoice or statement is too complicated, the patient will likely throw it aside and it will go unpaid because it is misunderstood. Taking the time to make a call to solicit assistance or explanation is often not a high priority.

Set a payment date that is easy to mark on a calendar and gives the customers enough time to pay, but not so much time that they forget.

Requesting payment on a specified calendar date when the payment is due could be effective since it will give patients a date for their calendar, however, it could also prevent them from paying earlier than that date. Though opinions on this ‘magic time frame’range from 10 days to 30 days, the Freshbooks study identified that 21 days produced successes.

Offering a convenient way to make payments will be beneficial for both you and your patients. Electronic payment options are vastly growing in popularity because of their convenience, speed, and the consistent nature of arrangement. Many medical providers promote secure online

“

When invoice terms sound as if they were written like an individual letter, it becomes more personalized [which] has also been shown to generate more payment activity.

”

March 2017

bill pay options through their website.

This drives traffic to the website to encourage information sharing as well as offers the convenience that many patients are interested in.

Educating patients is imperative to timely payments. If patients do not have a clear understanding of procedures and policies, this may become an excuse or stall tactic used to delay or avoid payment. One of the most effective ways to succeed in patient education is to have a Patient Advocate or Financial Counselor available to explain medical procedures, as well as policies and financial responsibilities. This person also needs to clearly articulate the expectations of the provider. Expectations should be in a written format and also be provided to the patient in this consultation.

Providers may also want to explore the possibilities of implementing additional technological advances such as reminders for appointments or upcoming appointments via text or email. Though compliance is a major factor in the consideration of this technology, young adults respond well to this method of communication.

Team members who work in medical billing offices often have a firm grasp on patient behavior. Tap into their expertise, experience and opinions. Often being creative will prompt patients to make prompt payments. ■ Jill Heyden is Director of Business Relations

Thank you.

MidwestMedicalEdition.com

at Advanced Asset Alliance in Sioux Falls.

11

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA Keri Nebelsick, OD, has joined Avera Medical Group Optometry in Mitchell.

Nebelsick is originally from Canistota and is a graduate of Dakota Wesleyan University. She received her Doctor of Optometry at Illinois College of Optometry and completed her residency at the Indiana University School of Optometry. Her professional experience includes work in Stillwater, MN and Sioux Falls, SD.

SANFORD Tracy Bieber, immunization strategy leader at Sanford, has been selected as the 2017 recipient of the Becky Nelson Leadership Fellowship. This year-long

fellowship focuses on professional development for an aspiring Sanford Health nursing leader. The fellowship includes expanded leadership experiences, special projects and executive mentorships throughout the Sanford Health organization.

12

Sioux Falls oncologist Jonathan Bleek, MD, and Fargo oncologist Amit Panwalkar, MD, are co-principal investigators exploring the immunotherapy drug pembrolizumab as a treatment for advanced esophageal cancer as part of the Merck Keynote 181 trial.

Sanford Health is also studying other applications of pembrolizumab for FDA approved uses with lung cancer and melanoma.

Sanford Health will break ground on a new clinic in West Sioux Falls this spring.

The 42,000+ square foot clinic will be located southeast of the Sanford Wellness Center Tea/ Ellis location and will offer family medicine, Ob-Gyn, walk-in care, acute care, mammography, behavioral health, and occupational medicine as well as lab, radiology and home medical equipment.

It is scheduled to be finished in the fall of 2018.

A grand opening for the new Sanford Health Pierre Clinic was held on Tuesday, January 24th. At 13,000 square feet,

the facility is more than triple the size of the previous clinic and is designed to provide more convenience and privacy for patients and families. In addition to family medicine, the clinic includes procedure rooms, a full-service lab, X-ray capabilities and a stress testing lab. Sanford Health Pierre Clinic opened for patients on Dec. 5.

The latest winners of DAISY Awards for Nursing at Sanford Mindi Smith, BSN, RN

of Sanford Clinic Mitchell and Terese Kenner, LPN

of Sanford Infectious Disease & Travel Clinic

Tami Proskovec, MBA, is now Director of Organized System of Care, Population Health, and Process Excellence at UnityPoint Health–Sioux City.

Proskovec earned her Master of Business Administration degree from the University of South Dakota and held positions in finance, sales and teaching prior to joining UnityPoint Health– Sioux City. Proskovec joined UnityPoint Health in September of 2015.

SIOUXLAND UnityPoint Health–St. Luke’s Cardiology Services and Cardiovascular Associates are the only Siouxland heart team to receive the American College of Cardiology’s NCDR ACTION Registry–GWTG Silver

Performance Achievement Award for 2016. Only 21 hospitals throughout the nation received the honor. To receive this achievement, St. Luke’s and Cardiovascular Associates consistently followed the treatment guidelines in the ACTION Registry.

The Accreditation Committee of the College of American Pathologists (CAP) has awarded accreditation to UnityPoint Health –St. Luke’s

Laboratory Services based on results of a recent on-site inspection. The US government recognizes CAP Laboratory Accreditation Program, which began in the early 1960s, as being more stringent than its own inspection program.

The UnitedHealthcare Children’s Foundation (UHCCF) donated Grins to Go bags to Mercy's Child Advocacy Center in December as part of

UnitedHealthcare’s statewide initiative to support some of Iowa’s youngest patients.The initiative will deliver 1,000 bags full of toys, games and books to providers and patients across Iowa this year. The UHCCF created the Grins to go program to fund their medical grants that help children receive care not paid for by commercial insurance. Since 2007, UHCCF has awarded more than 8,600 grants.

Midwest Medical Edition

Siouxland Paramedics has moved to a location close to the interstate on Dace Avenue.

This new location offers convenience in response time for 911 calls. Siouxland Paramedics has 10 ambulances and 45 employees and is the sole 911 ambulance provider for Sioux City, North Sioux City, and Western Plymouth County.

They serve more than 10,000 patients a year.

Tiffany Elias is the new manager of the Mercy Family Birth Center and Pediatrics at Mercy Medical Center-Sioux City.

Elias’ experience as a Registered Nurse has been focused on labor and delivery and women's health.

Elias obtained her Bachelor of Science in Nursing from Frontier Nursing University in Hyden, Kentucky and her Master's Degree from Nebraska Methodist College in Omaha, Nebraska.

Mercy Medical Center will host the sixteenth annual Women’s Night Out (WNO) on April 6th at the Sioux City Convention Center. WNO is the largest

annual event for women in the Siouxland region and has played to sold-out crowds since its inception. Proceeds from this event will benefit Mercy's Child Advocacy Center. For more information, see Learning Opportunities on the inside back cover.

March 2017

Mercy Medical Center’s trauma center has been verified as a Level II Trauma Center by the Verification Review Committee (VRC) and the Committee on Trauma (COT) of the American College of Surgeons (ACS).

The program verification process encompasses both trauma care and an entire spectrum of care from the prehospital phase through the rehabilitation process.

The cardiac rehabilitation program at UnityPoint Health–Sioux City has been certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). AACVPR is the only peer-review accreditation process.

OTHER Cathy Wiebers, Wound Ostomy Continence and Foot Care Nurse at the Sioux Falls VA Medical Center,

has been selected as a member of the VA Office of Nursing Services Field Advisory Committee for Pressure Injury Prevention and Management.

Matthew McDougall, MD, recently joined the Sioux Falls

VA Health Care System as the Medical Director for the Mental Health Service Line. Dr. McDougall is also a member of the SD Army National Guard.

Changes are on the way for the VA Black Hills Health Care System. The Department of

Veterans Affairs has given the go-ahead to VA’s preferred plan, which includes the renovation of an outpatient and dialysis center in Hot Springs and the relocation of the residential rehabilitation Treatment Program into a new outpatient clinic in Rapid City.

VA says the move will increase access and reduce long-distance travel for Black Hills Veterans.

Brock Rops, MEd has been elected chair of the national board of directors for HOSA-Future Health Professionals. Rops’

employment includes being the Education Coordinator for the Area Health Education Center (AHEC) at USD since 2011.

He has led South Dakota HOSA since its inception in 2012.

Michael Lawler, MSW, PhD, Professor and Dean at the University of South Dakota School of Health Sciences, Vermillion, South Dakota, has been named to the national Committee on Children, Youth and Families by the American

Haifa Abou Samra, PhD, has been named chair of the Department of Nursing at the University of South Dakota.

Samra earned a PhD in biological sciences and a master’s degree in nursing from South Dakota State University, and a bachelor’s degree in nursing from American University, Beirut, Lebanon. In 2016, Samra received the Faculty Research Achievement Award from USD’s School of Health Sciences.

Drs. Indy Chabra and Michelle Daffer of Midlands Cosmetic, Dermatology & Skincare in Sioux City are now offering a light-based treatment called SculpSure for fat reduction. The

procedure is FDA cleared and has been clinically tested on more than 100 patients. According to the clinic, SculpSure is capable of permanently destroying up to 24% of treated fat in a 25-minute procedure.

Psychological Association’s Board for the Advancement of Psychology in the Public Interest.

Lawler joins five other committee members to address issues relative to the health and wellbeing of children and their families. His appointment runs for two years.

MidwestMedicalEdition.com

13

ANTIMICROBIAL

STEWARDSHIP IN THE DIGITAL

AGE

Avera Health’s Extensive Telemedicine System Helps Keep “Superbugs” at Bay

Antimicrobial susceptibility testing in culture medium plate

14

Midwest Medical Edition

Photo courtesy Infectious Disease Specialists.

The board-certified physicians of Infectious Disease Specialists take turns handling a daily ASP consultation for Avera hospitals via telemedicine. Left to right: Jawad Nazir, MD, Robert Kessler, MD, Brian Pepito, MD, and Fares Masannat, MD. Not pictured is Asma Syed, MD.

By Alex Straus

A

Photo courtesy Avera.

NTIMICROBIAL resistance is on the rise nationwide. Despite years of warnings about the dangers of antibiotic overuse, and despite ongoing research and development of ever more powerful antimicrobial agents, the bugs appear to be winning, albeit stealthily.

In January, the CDC announced the September, 2016 death of a Nevada woman from a carbapenem-resistant Enterobacteriaceae (CRE) infection resistant to 26 different antibiotics–the entire US arsenal. The microbe which led to the woman’s death may have been acquired

The same system used by various Avera specialists to provide medical consultations for outlying hospitals is now supporting ASP programs in these hospitals with a daily call.

March 2017

in India as the patient had been hospitalized there repeatedly for complications related to a femur fracture.

Brad Laible, PharmD Though hers is an extreme case, infectious disease specialists and those on the front line of the fight against so-called “superbugs” say it may be a harbinger of things to come if we stay on the current course.

“In 2013, 23,000 people died as a direct result of antibiotic overuse, according to CMS,” says infectious disease specialist Jawad Nazir, MD, Medical Director for Avera’s Antimicrobial Stewardship Program (ASP).

“Another 14,000 die of C. difficile infections brought about by antibiotic overuse. This is especially disturbing when you consider that the CDC estimates up to 50 percent of antibiotic use is unnecessary.”

Patients infected with resistant organisms have significantly higher rates of morbidity and mortality.

Those who survive such an infection have longer hospital stays, as do patients who contract C. diff, the most common cause of diarrhea in hospitals and a risk factor for death in people over 55.

“The nature of this infection is that it keeps on coming back,” says Dr. Nazir. “It is very hard to treat and can be very bad. There is a huge cost to this.”

Beyond the pain, suffering and expense it creates for patients, unnecessary or inappropriate antibiotic use also has the potential for significant economic impact on healthcare institutions; for many hospitals, antibiotics account for a third of the pharmacy budget.

MidwestMedicalEdition.com

15

Photo courtesy VA The VA Health System antibiotic stewardship committee meets regularly to review all cases of antibiotic use.

The team includes (L-R): Kyle Hendre, PharmD, Lea Rowe, PharmD, Sandy Omodt, RPH, Veronica Soler, MD, and Andrea Aylward, PharmD.

16

Antibiotic Ertapenem Imipenem Meropenem Amoxicillin/Clavulanic acid Ampicillin/Sulbactam Cefazolin Cefdinir Cefepime Cefotaxime Ceftazidime Ceftriaxone Ampicillin Piperacillin/Tazobactam Ciprofloxacin

Shigella spp.

Proteus spp.

Extended spectrum beta‐ lactamase (ESBL) E. coli‡

Gram negative organisms

Escherichia coli

Antibiogram of Selected Pathogens, South Dakota 2015 Southeast Region Pseudomonas aeruginosa

As more and more cases of CRE and extended-spectrum beta-lactamases (ESBL) resistance continue to render large groups of

Klebsiella pneumoniae

SETTING A NEW STANDARD

antibiotics ineffective, the Joint Commission announced in January a new Medication Management standard that addresses antimicrobial stewardship in hospitals, critical access hospitals and nursing homes.

Among other things, the new standard requires that critical access hospitals establish an antimicrobial stewardship multidisciplinary team that includes an infectious disease physician and a pharmacist with expertise in antibiotic use. The program is to make antimicrobial stewardship an “organizational priority” and must demonstrate “leadership commitment” in the form of financial and human resources, accountability, tracking of prescribing patterns, reporting, strict formularies, and education of providers and patients.

But what happens to smaller hospitals that may not have an infectious disease specialist, a specialized pharmacist, or the resources to create a true Antimicrobial Stewardship Program?

For Avera, the answer was clear–utilize its extensive existing telemedicine

Salmonella spp.

“Most experts in the field will say that we’re losing the battle,” says clinical pharmacist Brad Laible, PharmD, pharmacy co-leader for Antimicrobial Stewardship at Avera.

“There have been some new antibiotic agents in the last decade that give us more options, but they have not been able to keep up. If we continue to persist in our current practices, we are destined for failure.”

Such dire predictions are not news to most medical professionals, who have been hearing about the dangers of antibiotic overuse for years. So why is the problem continuing to worsen? And why are there so many unnecessary prescriptions?

“There is still a lot of pressure placed on providers to prescribe antibiotics,” says Laible. “Patients are often upset. They have taken a day off work, they may be losing money. They feel like they should get something out of it. They are expecting a prescription for an antibiotic.”

And, as often as not, they get it. A case in point is Zithromax, one of the most frequently prescribed antibiotics in the US. Although the number of Zithromax prescriptions outmatches most other agents, Laible says it is not recommended as a first-line treatment for any infection. “Providers are just overly comfortable with prescribing it,” he says. “It is a bad practice.”

Supplied by Brad Laible, SDSU College of Pharmacy

PRESSURED TO PRESCRIBE

infrastructure to provide the expertise its smaller institutions need to get a handle on antibiotic use and comply with the new standard.

“What we have done is develop a model for implementing this in small, rural hospitals using technology and the resources we have,” says Dr. Nazir whose team has been doing infectious disease consultations via telemedicine since 2003. “It just made sense to use this same system to help other hospitals run their own ASP.” Pharmacists at Avera facilities in Yankton, Pierre, Mitchell, Aberdeen, Parkston, Brookings, Marshall (MN), Worthington (MN), and O’Neill (NE) have been trained to recognize potentially problematic cases of infection in the hospital and present them via telemedicine to Avera infectious disease doctors at a daily virtual meeting.

Dr. Nazir says these pharmacists watch for the same red flags that Avera McKennan pharmacists like Brad Laible and his team are constantly monitoring–patients on two or more antibiotics for more than 48 hours, those who may be on the wrong antibiotic, any patient with a C. diff infection, and others.

“I get a list of the people who have cases to present,” explains Dr. Nazir. “The patient record comes up on my screen and I can see the medication list, the progress notes, etc. It is as though I am actually at the hospital looking at the computer with the pharmacist.”

After review, Dr. Nazir (or one of his four infectious disease partners who share the ASP duties) may recommend deescalating the antibiotic dose, changing

% Susceptible and (n) number of isolates tested

99(443)

99(2358)

100(349)

100(138)

99(234)

100(25)

46(120)

99(989)

^95(159) ^94(1473)

99(1764)

99(5319)

100(116)

100(93)

96(103)

90(774)

100(39)

88(2628)

66(15375)

87(192)

92(15460)

59(192)

99(1153)

94(1538)

98(6455)

99(145)

96(207)

99(103)

98(774)

100(39)

98(1193)

93(1593)

97(6577)

99(192)

98(2585)

97(15363)

100(192)

100(25)

61(15370)

74(190)

^96(123)

1(967)

83(192)

97(2665)

99(1559)

97(15381)

25(480)

100(192)

99(118)

99(2650)

86(1597)

83(15493)

13(481)

71(192)

99(189)

An example of a regional antibiogram prepared by the SD Department of Health and South Dakota State University

‘FRONT END’ VS. ‘BACK END’ APPROACHES Reviewing cases of infection after an antibiotic has been prescribed–known as prospective audit and feedback–is an example of what Laible calls a “back end” approach to antimicrobial stewardship. It is the same approach followed since 2011 by the Sioux Falls VA Health Care System, where infectious disease specialist Veronica Soler, MD, is the Clinical Director of the ASP and Andrea Aylward, PharmD, is its Pharmacy Director.

“This is one of the core elements of our antimicrobial stewardship,” says Aylward, who conducts formal stewardship rounds twice a week and participates in a formal sit-down review panel with Dr. Soler and others weekly. “We go through every patient, discuss their antibiotic, look at the lab results and cultures and decide if they are on the right drug at the right dose. We recommend changes in about 15 percent of cases.” Afterwards, they track compliance, which is typically over 90 percent.

“The ultimate goal is to have less resistance,” says Dr. Soler. “We want susceptible, easy-to-treat common bacteria that respond to narrow antibiotics that may have been used for 20 or 30 years and not have to turn to the expensive new antibiotics that drive so much of the resistance.”

On the “front end” of antimicrobial stewardship are things like formularies laying out which antibiotics are encouraged and which ones are off-limits except on the recommendation of an infectious disease doctor.

“Maintaining and updating the guidelines on antibiotic use in our computer system is a big part of our job,” says Aylward. “When

Photo courtesy Avera.

medicines, or even stopping a particular antibiotic (the most common recommendation). The local pharmacist then relays that information back to the prescribing doctor.

After more than 1,000 of these ASP consultations, Nazir says about 95 percent of the recommendations have been accepted, compared to a national average of just 80 percent.

From monitoring antibiotic prescriptions to helping prepare the annual antibiogram, the pharmacy department is a large part of antimicrobial stewardship in the hospital.

guidelines change, we make sure our system is up to date with the CDC.” Another important front-end element of an ASP is an antibiogram, a spreadsheet created by microbiologists and pharmacists each year that illustrates patterns of use and resistance over time in a particular region or institution.

“We might have a bacteria that is common in the urine and one year 90 percent of that bacteria might be susceptible to a particular antibiotic then the following year we can look at the antibiogram and see that it has dropped to 85 percent and the following year it may have dropped to 80 percent,” says Dr. Soler, who may consult the antibiogram before prescribing to make sure she’s using the best drug for the job.

A change in resistance patterns is an indication that intervention, such as the one Avera staged around the drug levofloxacin (Levaquin), may be needed.

“People used to joke that it was ‘Vitamin L’,” says Laible. “At Avera, we were using enough of this drug that we had created some resistance. But through provider education and dissemination of the antibiogram, we have seen more than a 50 percent reduction in the amount of Levaquin being used, which resulted in a dramatic change in susceptibility to that agent again.”

Similar progress has been made at Avera in recent years to turn around antibiotic resistance in E. coli and pseudomonas and to reign in a CRE outbreak in Aberdeen. The VA reports a reduction in C. dff and Methicillin-resistant

MidwestMedicalEdition.com

Staphylococcus aureus (MRSA) infections.

“Awareness is the key,” says Laible.

TURNING THE TREND AROUND

In an effort to support healthcare institutions like Avera and the VA in their ASP efforts, the CDC has created educational materials for providers to share with their patients.

Additionally, through the CDC’s National Healthcare Safety Network, an infection tracking system, hospitals can get a clearer picture of their own antibiotic usage as well as that of others.

“It has been helpful for us to be able to see ourselves and our own usage patterns each month and compare them with hospitals in Minneapolis or Omaha,” says Dr. Soler, whose hospital has one of the lowest rates of antibiotic utilization in the region. “This is a very valuable tool.”

In the end, Laible says no tool will be a substitute for hospitals and providers taking a harder line in the fight for safe and effective healthcare.

“We know that there are stewardship approaches that do work, but it can mean tough decisions and difficult conversations with patients and even colleagues sometimes,” says Laible.

“We do not need to reinvent the wheel,” agrees Dr. Nazir. “Our goal is to implement the interventions that have been proven effective in many other hospitals for decades.

So far, we have done about 20 percent of what needs to be done in this area. Many specialties are continuing to overprescribe. There is room for lots of improvement.” ■

17

Technology for Infection Control and Prevention

By Jerry Weiler

W

ITH MICROBIAL resistance on the rise nationwide, it’s more important than ever to control the spread of infectious diseases in the healthcare setting. In hospitals and clinics, this is a never-ending battle because of the prevalence of bacteria. Medical facilities are necessarily held to

a high standard and are subject to a range of regulations.

In response to this increasingly microbe-aware environment, new technologies

have been developed with the express aim of preventing the spread of diseases by helping facilities understand how they spread.

The ability to track staff, patients and equipment in real time as they move from room to room and throughout the hospital is a central part of these new technologies, known as Real Time Locating Systems (RTLS).

Examples of Available Technologies JERON NURSE CALL Communications, Workflow, Rounding and Patient Safety

VERSUS RTLS Patient Flow, Safety, Situational Awareness, Infection Control, Analytics

ACCUTECH Wander Management, Infant Protection, Pediatric Elopement, Electronic Access Control

RTLS technologies like Versus Technology also work together with the current alerting or Nurse Call systems to help prevent possible mistakes or oversights when working in a fast-paced healthcare environment.

Here’s an example: Imagine that you are making your rounds. As you move from room to room, wouldn’t it be helpful if the soap or sanitizer dispenser knew what was required for that room and automatically dispensed it? What if it could record the fact that you soaped in? Or could even send an alert to your phone or pager if you inadvertently failed to do so?

Let’s take it a step further. What if it recorded everyone and everything that moves in or out of that room, including equipment? You could identify everyone and everything that has possibly been exposed to an infectious agent. This technology exists and is already in use.

RTLS technology is not only used for infection control, but can also be used to

 increase efficiency  protect patients and staff  locate equipment quickly in an emergency  increase compliance  make reporting easier  provide many other cost-saving benefits A system integrator can bring together these technologies and help hospitals and clinics create a workflow ecosystem that will provide a smarter, safer, and more secure way to track and control the spread of microbes. ■

Jerry Weiler is the Vice President for Business Development at DTB Systems, Inc.

MED QUOTES

“ 18

Wherever the art of medicine is loved, there is also a love of humanity.

”

—Hippocrates

Midwest Medical Edition

step up. extends beyond your medical practice,

If your vision of success

loftadvisors.com | 605.338.8266 Private Banking | Trust | Investment Management* | Insurance | Loft Experience A Division of First Dakota National Bank | 101 N. Main Avenue Suite 201 | Sioux Falls, SD 57104 *Securities offered through Raymond James Financial Services, Inc., member FINRA/SIPC, and are not deposits, not insured by FDIC or any other governmental agency, not guaranteed by First Dakota National Bank, subject to risk, and may lose value. Loft Advisors and First Dakota National Bank are independent of Raymond James.

March 2017

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19

Out of State, Out of Mind

Make-A-Wish urges physicians to make referrals before children leave the area for treatment

By MED Staff

M

OST AREA HEALTHCARE

professionals are familiar with the work of Make-AWish South Dakota, the organization that supports children with life-threatening illnesses and their families by granting smile-inducing “wishes” –everything from trips and celebrity meet-ups to room makeovers and other adventures.

Make-A-Wish South Dakota grants about 60 such wishes a year and has granted more than 1,200 since its inception in 1984.

And yet, according to president and CEO Paul Krueger, too many potential wish kids may still be slipping through the cracks, losing out on the boost a wish can provide to them and their families in the midst of challenging circumstances.

“Our vision is not to miss any child who may quality for a wish,” says Krueger. “But one thing we are finding is that when children, either because of the severity of their condition or the treatment process, end up being referred out of state, they may never be referred to Make-A-Wish.”

Make-A-Wish referrals come from a variety of sources within healthcare including social workers, advanced practice providers, doctors, nurses and child life specialists.

Parents or other family members can also refer a wish kid, along with the kids themselves.

“Ultimately, though, it is the physician that will help us determine if a particular child qualifies,” says Krueger who works with four medical advisors across the state when there is a question about a child’s

qualification for the program.

But the entire process has to start with a referral. Krueger says once a child is sent to an out-of-state institution for care, it can be “out of sight, out of mind”.

“Sometimes, a child may be in and out of here so quickly, that the provider may not even think about Make-A-Wish. But Mayo Clinic and Denver Children’s Hospital are much bigger institutions. It’s much easier for a child to be passed over there,” says Krueger.

Krueger says the answer to the problem lies in awareness. Doctors can refer any child between two-and-a-half and 18 with a lifethreatening–progressive, degenerative, or malignant condition, even if the child is on his way out or has left the region for treatment. Once parents have given consent for referral, Make-A-Wish can go through the process to determine if the child qualifies.

“It really doesn’t hurt to go through the process, even if a child does not end up qualifying,” says Krueger. “We would love to have every medical clinic and hospital in the state making this a part of the process when they initially give parents and kids information about their illness.”

To that end, Make-A-Wish has launched a quarterly eNewsletter for referral sources.

To get on the mailing list, visit info@southdakota.wish.org. ■

MAKING A REFERRAL Make-A-Wish has made the referral process as easy and efficient for busy healthcare professionals as possible. To get information or to make a referral Ellie, 6, of Brookings, had her face painted each day during her wish trip to Walt Disney World.

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visit MD.wish.org or call the SD office at 605-335-8000.

Midwest Medical Edition

“

SOMETIMES, A CHILD MAY BE IN AND OUT OF HERE SO QUICKLY, THAT THE PROVIDER MAY NOT EVEN THINK ABOUT MAKE-A-WISH. BUT MAYO CLINIC AND DENVER CHILDREN’S HOSPITAL ARE MUCH BIGGER INSTITUTIONS. IT’S MUCH EASIER FOR A CHILD TO BE PASSED OVER THERE

”

— Paul Krueger President and CEO

Logen, 12, of Newell, wished for a room makeover.

21

Reducing the Weight of Anxiety

F

By Brandy Bunkers ORTY MILLION ADULTS strug-

gle with anxiety, according to the Anxiety & Depression Association of America. So when should you refer your patient to therapy for help? It’s as easy as knowing what triggers to look for.

With generalized anxiety, it’s present most days of the week and has been occurring for at least six months. Your patient may tell you it may be difficult for them to control their thoughts of worry. The patient might make statements about not being able to turn off his or her thoughts. These thoughts could be interfering with their sleeping and eating patterns.

Many times, the intrusive thoughts make it difficult to fall asleep or may cause interrupted sleep. In some cases, individuals with excessive worry might find themselves engaging in different eating patterns; either not eating because they can’t set aside those thoughts long enough to take care of their needs or possibly overeating to cope with the stress of the worry.

Other patients might identify feeling on edge or may become irritable about what would normally be viewed as daily functions of life. Muscle tension and indigestion, in combination with the symptoms listed above could be a good indication that your patient is affected by generalized anxiety.

Anxiety can display itself in many ways, including panic, phobias, and social anxiety which are often proclitic in allowing your patients to have a full and vibrant life.

Other disorders that are closely related to anxiety include areas such as obsessivecompulsive disorder and post traumatic stress disorder. Remember, at times patients may not able to identify that they are struggling with a mental health condition; they are paying more attention to the physical changes they are experiencing. Patients are not usually aware of the impact the additional stress is having on their day-today life and it manifests as physical symptoms or irrational thoughts.

Anxiety disorders, which include panic disorder, generalized anxiety disorder,

posttraumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population according to the Centers for Disease Control and Prevention.

If you think your patient is struggling with anxiety, it’s time to bring up options for treatment, including psychotherapy, which can be a very successful form of treatment because it often includes a focus of Cognitive Behavioral Therapy.

Seeking treatment for anxiety is often full of stigma and self-critical consequences.

However, if a patient can visit with you, their trusted physician, about their symptoms, it may be a way to help reduce barriers and create an avenue toward successful treatment and recovery. ■ Brandy Bunkers, CSW-PIP, owns Clarity Counseling, LLC, in Sioux Falls. She is a member of the Academy for Eating Disorders and The International Association of Eating Disorders Professional Foundation.

South Dakota Medical Group Management Association

Spring Conference

April 26-28, 2017 Featuring:

@ The Lodge – Deadwood, SD

Theresa Rose

Robert S. Thompson, JD, MBA

Author & Motivational Speaker

Director of Education, MMIC

Duane J. Kavanaugh, MS, LPC-MH Director, Lutheran Social Services

Tresha Moreland

VP of Human Resources, Regional Health

For the full schedule or to register, visit our website at

Buzz Hillestad

Senior IS Consultant, SBS CyberSecurity

John Marshall

Professional Risk Services, Silverstone Group, Inc.

sdmgma.org

Like us on Facebook at www.facebook.com/sdmgma Follow us on Twitter @SDMGMA

22

Midwest Medical Edition

UnityPoint Health Recognized for Excellence in Patient Financial Communications UNITYPOINT HEALTH has been recognized for excellence in its financial interactions with patients by the Healthcare Financial Management Association. The health system has adopted the HFMA’s Patient Financial Communications Best Practices, which include 100 best practices covering all aspects of financial interactions in both the inpatient and outpatient settings.

UnityPoint Health joins a select group of fewer than 200 hospitals, health systems, and physician practices nationwide that have received this first-of-its-kind recognition.

“The work performed by our revenue cycle leaders, registration leaders, patient financial assistance counselors and many others in our organization made this recognition possible,” says Lynn Wold, President and CEO, UnityPoint Health–Sioux City.

“In 2017, we will continue our efforts to improve our patients’ financial experience, including providing easier ways to pay bills online and providing additional clear and concise information to help them.”

To achieve Adopter recognition, organizations attest they have well-established processes in place to help patients understand their health insurance coverage and their out-of-pocket responsibility for the services they receive, and that compassion, patient advocacy, and education are part of all their financial discussions.

“In a time when patients are concerned about costs associated with paying more outof-pocket for their healthcare, the financial conversations we have with patients have never been more important,” says Kevin Vermeer, President and Chief Executive Officer of UnityPoint Health.

The best practices are part of HFMA’s Healthcare Dollars & Sense initiative. ■

March 2017

While doctors search for new cures, we’re finding new ways to minimize risk.

Medical liability and more.

MMIC is the Midwest’s leading provider of medical liability insurance and risk management services, helping health care providers improve patient safety and enhance performance. MMICgroup.com.

MidwestMedicalEdition.com MED August 2016.indd 1

23 8/8/2016 8:30:25 AM

Fargo Neurosurgeon Uses Unique Clot-removal Technique on Neonate NEUROSURGERY recently published a unique case performed by neurosurgeon Alexander Drofa, MD, of the Sanford Brain and Spine Center in Fargo.

The case involved an infant who suffered a stroke. Drofa and his surgical team were able to reestablish blood flow to the brain by administering clot-dissolving drugs while also mechanically clearing the blockage with a stent retriever designed to apply force to the clot.

Dr. Drofa says the case was especially challenging because the baby had entered a coma. According to a 2005 study in Brain, coma in such cases is a strong predictor of death. Additionally, mechanical removal of stroke clots is rare in children, who rarely suffer strokes.

PEDIATRIC

“We believe this to be the youngest stroke patient in the world to have been successfully treated with a stent retriever and drugs,” says Drofa. “Because of the severity of this case, it was necessary for the neurosurgery team to explore an aggressive therapy to give the infant a better chance of survival. The positive outcome is promising for future cases of this nature.”

Dr. Drofa is a fellowship-trained cerebrovascular neurosurgeon who practices at the Sanford Neuroscience Clinic in Fargo.

The study entitled “Successful Endovascular Management of Massive Pansinus Thrombosis: Case Report and Review of Literature” appeared in the October 2016 issue of Pediatric Neurosurgery. ■

Avera and Hy-Vee Offer OTC Naloxone AVERA AND HY-VEE PHARMACIES in

South Dakota have started providing naloxone without a prescription in an effort to prevent opioid-related deaths.

24

In 2015, more than 40 people in South Dakota died due to accidental overdose. Naloxone can be administered to any person who has overdosed on a wide range of

opioids, including hydrocodone, oxycodone, morphine and codeine, as well as heroin.

While naloxone is known to reverse the effects of an opioid overdose, the medication has no effect if opioids are absent. Pharmacists in South Dakota now can dispense naloxone without a prescription through a physician-signed protocol.

Naloxone will be available as nasal spray or by injection at all Avera pharmacies in Sioux Falls and at all Hy-Vee pharmacies in South Dakota, which includes locations in Sioux Falls, Brookings, Vermillion, Watertown and Yankton.

“We know the availability of this medication has the very real potential to save lives for those at risk,” says Matthew Stanley, DO, Vice President for Avera’s Behavioral Health Clinical Service Line.

In addition to the partnership with Hy-Vee, Avera has implemented several key initiatives to prevent opioid abuse including promoting recommended protocols for responsible prescribing, provider education, and a controlled-substances agreement for physicians and patients to sign that stays in the patient’s EMR. ■

Midwest Medical Edition

First Fellow Chosen for Interventional Cardiology Fellowship in Sioux Falls SHENJING LI, MD, PHD, A THIRD YEAR Cardiovascular

Disease Program Fellow at Sanford, is set to be the first person to enter Sanford Heart Hospital and the USD Sanford School of Medicine’s new Interventional Cardiology fellowship program. The program, which will begin in July, has been approved by the Accreditation Council for Graduate Medical Education and will train one new interventional cardiologist a year.

“This is the most elite and competitive fellowship in cardiology,” says program director Adam Stys, MD, an interventional cardiologist at Sanford. “This is why we focus on only one fellow and train that person very well,” Fellowship training will include areas such as coronary diagnostic and interventional procedures including percutaneous transluminal coronary angioplasty, stent placement, intravascular ultrasound, fractional flow reserve, percutaneous valve implantation and repair, as well as ASD closure procedures.

One of just 147 ACGME-approved interventional cardiology fellowship programs nationwide, the one-year-long Sanford program is already attracting plenty of attention. Stys says more than 70 people have applied to fill the single 2018 spot.

“One good thing about our program is that it is just one year long,” says Dr. Stys. “We are able to do this here because of the high volume and our high density of interventional procedures.”

Dr. Li will graduate from Sanford’s Cardiovascular Fellowship Program in June. That three-year program was established in 2012 and accepts two new fellows each year for a total of six in the program. Admission to that program has also been highly competitive with more than 300 applicants each year.

“We are very proud of our first batch of fellows who were national champions in the American College of Cardiology Jeopardy competition,” says Dr. Stys. “This speaks to the quality of our program. Everyone in the cardiology world knows us now.”■

Take Heart Today’s Lean Beef in a Heart-Healthy Lifestyle 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.

GO LEAN FOR HEART HEALTH 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

“

Medicine is a science of uncertainty and an art of probability. —William Osler

March 2017

Visit www.BeefItsWhatsForDinner.com for beef recipes.

Funded by The Beef Checkoff

”

MidwestMedicalEdition.com 16-20232-SD-HeartHealth-Ad.indd

1

25 PM 11/28/2016 2:23:36

Coping with Pediatric Bowel and Bladder Dysfunction PEDIATRIC BOWEL AND BLADDER DYSFUNCTION, which can

include daytime incontinence, nocturnal enuresis, overactive bladder, frequency, dribbling, urinary urgency, underactive bladder and constipation, are rarely caused by physical conditions.

“The great majority of the children we see are going to be anatomically and neurologically normal,” says fellowship-trained pediatric neurologist Carlos Villanueva, MD, who works with the Bladder Dysfunction Clinic at Children’s Hospital & Medical Center in Omaha. “The reason they’re having accidents could be a delay in normal maturation or some behavioral form of dysfunction they acquire by voluntarily holding their bowel or bladder.”

In children who do have anatomic problems, Villanueva says the cause is often multi-factorial, making their cases particularly complex.

Villanueva says patients who are experiencing daytime urinary symptoms older than age 4, or who start having symptoms after more than 6 months of being dry, should be referred to the clinic. Children with nocturnal enuresis after the age of 5 who are emotionally upset about the issue and motivated to improve the condition should also be referred.

Initial treatment includes basic urotherapy (timed voiding, double voiding and hydration), bowel management and extensive education encompassing an explanation of the urinary system,

behavior modification and how to complete a voiding diary.

“If they follow what we recommend initially – urotherapy and constipation management – about 45 percent of the patients we see have an improvement in symptoms,” says Tara Goesch, DNP, APRN-NP at Children’s. If problems persist, the investigation moves to the next level of studies, which can include:

 Renal ultrasound  Noninvasive urodynamics, such as uroflow with electromyogram

 Invasive urodynamics studies  Voiding Cystogram (VCUG) In addition to diagnosis and treatment, the clinic specializes in comprehensive follow-up. “We follow them very closely because they need reassurance, retraining of poor habits, reinforcement of urotherapy strategies and ongoing support,” Dr. Villanueva says.

Educating parents and the child is also a critical part of the treatment process. ■ To read more about the treatment options for bowel and bladder problems, see the extended version of this article on our website.

Do you like our publication?

Do you want one of your own?

WE CAN HELP. Finding clarity in the expected, unexpected and everything in between.

Brandy Bunkers, CSW-PIP

Contact Brandy today!

101 S. Reid Street, Suite 307 • Sioux Falls, SD 57103 p (605)221-6244 • f (605)221-6201 • claritycounselingsf.com

26

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Midwest Medical Edition

New Brookings Hospital Welcomes its First Patients

THE NEWLY EXPANDED Brooking Hos-

pital opened its doors to patients in early February and renovation work has started on the original 1964 hospital building. After a 16-month construction project, all services, including radiology, surgery, pharmacy, obstetrics and inpatient care, are moved into the building and are operational.

“We’re able to give patients easy, direct access to outpatient care services like imaging procedures and same-day surgery. We’ve also increased our capacity, added amenities and accommodations for families and visitors, and increased efficiency in our staffing

model in order to spend more time on patient care,” says CEO Jason Merkley.

The expansion features private patient transport corridors separated from public hallways. Surgery includes 12 private sameday surgery rooms located near the three OR suites and two procedure rooms. It also has a private family consultation room.

Radiology is now located closer to the ER with a private patient transfer hallway connecting the two departments. The department also has a new MRI with a wide bore opening to accommodate all body types.

Obstetrics increased from three to five

LDRP suites and includes a private patient elevator with direct access to the OR for emergency Caesarean deliveries. Inpatient Care features 24 private patient rooms, each with its own private bathroom and shower.

The unit also has ample space for families and visitors to gather.

Construction of the 62,500 square-foot hospital completes the second leg of Brookings Health System’s entire hospital expansion and renovation project. The space currently being remodeled will house ancillary services such as outreach, cardiac rehab, and respiratory care. Staff currently located off campus will have room to move back to the campus.

Remodeling is slated for completion late this summer. More information about the hospital expansion and renovation project can be found online at www.brookingshealth. org/renovation. ■ For additional photos of the hospital project, visit our website

MARCH IS NATIONAL EYE DONOR MONTH In 1983, March was designated “National Eye Donor Month” as an opportunity to raise awareness of the need to donate eyes, and to recognize donors and their families and to celebrate corneal recipients.

For more information about eye donation, please visit our website at www.dakotasight.org

1-800-245-7846

WWW . DAKOTASIGHT . ORG

March 2017

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27

New Program Boosts Native American Interest in Health Professions

By Peter Carrels

R

Red Cloud Indian School student Stephanie Emery worked with scientists at the University of South Dakota on streptococcal infection research. She later presented about that research to the national American Indian Science and Engineering Society conference in Minneapolis.

ECOGNIZING THE NEED for

more Native Americans working in health professions, the University of South Dakota’s Sanford School of Medicine and the USD School of Health Sciences have initiated programs such as Indians into Medicine (INMED) and the USD Healthcare Career Summer Camp (HCSC), to encourage and support Native American high school students to pursue post-secondary education and careers in healthcare and medicine.

The newest initiative, the Native American Healthcare Scholars Program (NAHSP), which is funded by the US Department of Health and Human Services–Office of Minority Health, works with eight select Native American students at Red Cloud and Wagner high schools (four from each school).

In its first year, the program has already produced some promising results.

Red Cloud high school junior Stephanie Emery of Pine RIdge joined NAHSP as a junior, following the advice of a high school counselor. “I like science and math, and I

want to continue working in healthcare as a researcher in a medical laboratory,” says Emory. “I am Oglala Lakota and I see a great need for healthcare professionals on my reservation.” She has now been accepted to USD where she plans to prepare for a career in healthcare.

This is precisely the type of success story Kathy VanKley, the NAHSP coordinator at USD, envisioned when the program was launched. “Our aim is to encourage each of our students to pursue healthcare careers,” says VanKley. “Students who attend USD can remain in the scholars program and enjoy NAHSP benefits all the way through college. However, if they choose to attend college elsewhere we will do our best to stay in contact with them, and urge them to continue preparing for a healthcare profession.”

Program benefits for students include attendance at state and national American Indian Science and Engineering Society (AISES) conferences, support to attend summertime academic enrichment programs,

research and internship opportunities, and regular mentoring by experienced healthcare professionals, academics and university students. Mentor advice can range from how to apply to a university to what to expect when working in various healthcare professions.

Emery’s research experience at USD had her working with two seasoned scientists investigating streptococcal infections. “It was a terrific experience in a really beautiful building,” says Emory. Emery also presented about her research involvement at the national AISES conference in Minneapolis.

VanKley reports that all the program’s first participants have expressed interest in healthcare as a career and that four of the scholars have committed to attending USD in the fall of 2017. Red Cloud or Wagner high schoolers interested in applying for the scholars program can talk with their school counselor for more information. ■ Peter Carrels is Communications Coordinator for the University of South Dakota School of Medicine.

Read about the experience of another Red Cloud high schooler in the program in the extended version of this article on our website.

28

Midwest Medical Edition

What is an Industrial Athlete?

By Kelly Marshall

INDUSTRY:

diligence in an employment or pursuit; steady or habitual effort.

ATHLETE:

a person who is trained or skilled in exercises, sports, or games requiring physical strength, agility, or stamina.

(Source: Merriam-Webster Dictionary)

INDUSTRIAL ATHLETE:

by simple wordsmithing, a person who is trained or skilled (in) employment.

Perhaps that’s not the most precise definition of an Industrial Athlete, but it’s a pretty good starting point. The concept of the Industrial Athlete is a relatively new one. Within the last decade, the term Industrial Athlete has been an increasingly popular way to refer to anyone who makes their living using their knowledge, skills, and abilities to perform a job that requires a wide range of physical demands, such as strength, endurance, flexibility, and coordination.

Industrial athletes “perform” at their worksites day after day, often logging long hours completing physically demanding tasks. But there is no spring training or special camp for many new employees just stepping into these Industrial Athlete roles.

No intensive regimen of therapy and training from a highly specialized, multidisciplinary team designed to return them to the job just as quickly as is safely possible.

So, how do employers shift their focus from treating their employees simply as a producer of goods or services to treating

March 2017

them like the Industrial Athlete they truly are? Here are some good places to start.

Give your new Industrial Athletes a pre(season) hire physical and some (spring) training to assure they are ready for opening day on the job. A pre-employment physical and job-specific test, coupled with a period of ramping up, will reduce the risk that the first week on the job finds the employee already on the injured (reserve) list.

Provide feedback and training that is specific to the work and environment of your employees. Ergonomics intervention can help address concerns before they become injuries. Provide employees with the tools, equipment, and knowledge that allow them to do their jobs in the safest and most efficient ways. The one-size-fits-all approach doesn’t work well for fitting cleats to football players and it doesn’t work well for fitting employees to their jobs, either.

Address symptoms immediately. Provide employees with the tools and resources they need to remain “on the playing field” of their jobs. Timely first aid can play a crucial role in alleviating aches and pains before they develop into an injury.

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Create a culture that supports staying at and returning to work as soon as is safely possible following a work-related injury. This means treating your injured employee just as you would your highest paid player who needs to be on the field for the big game on Sunday! Regaining the strength and endurance to return to work becomes their full time job.

Value the overall health and wellbeing of employees. Consider the impacts of things like sleep, nutrition, hydration, and mental wellness and how those components play a role in the overall health and safety of your Industrial Athletes. You wouldn’t expect your best results from an athlete that you put on the field in a starved, sleep-deprived state, so you shouldn’t expect your safest and highest quality work from an employee in that state, either.

By shifting the focus towards treating employees as Industrial Athletes, you improve overall health and wellbeing for everyone in the workplace. And that’s most definitely one for the “W” column. ■ Kelly Marshall is an occupational therapist and a member of the South Dakota Occupational Therapy Association and the American Occupational Therapy Association. She is a Job Analysis and Ergonomics Specialist with RAS. Find out how some simple tweaks to your office ergonomics could impact your bottom line

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The Value of Early Exposure to Medicine for Career Choice MY INTERNSHIP EXPERIENCE AT SANFORD CARDIOVASCULAR INSTITUTE

By Julia Stys with Maria Stys, MD

A

S I COME FROM a

family of physicians, I might be expected to know well what medical career, if any, I should pursue and what a physician’s job is really like. But I have had an eye-opening experience while rotating as a pre-med college student at University of South Dakota Medical Center. I compare it to reading about a famous painting versus looking at it directly. I thought I knew, yet I learned so much more about what the job of a physician is really about.

My work at Sanford Cardiovascular Institute (SCI) as a Summer Live Learn Research Intern consisted of completing a database of all of the transcatheter aortic valve implantation (TAVI) procedures performed since December 2012, along with shadowing the cardiologists and cardiovascular surgeons from the admission of the TAVI patients, to the valve replacement procedure, and then to their discharge from the hospital.

Aside from being able to observe the doctors performing the TAVI, I was also able to stand directly over patients during open-heart valve replacements in order to understand the difference in recovery and procedure performed. This experience further fueled my ambitions of being a physician.

TAVI is a complex, interesting, and fairly new procedure performed by a team of physicians. Exposure to such a high tech, precise, and minimally invasive procedure that results in instant improvement of patients’ wellbeing is very impressive for a young student like me. It motivated me more than anything else to study even harder to become a physician.

Moreover, during my time at SCI, I was also involved in TAVI research. I was instructed and mentored to create a database of all of the 145 patients who received the TAVI at SCI. Being part of this process was also eye-opening for me.

In addition to working on TAVI, I was able to observe cardiology teaching rounds (team of attending, fellow, resident, nurse and students) daily that covered patients across all wards of the hospital. I could follow

TAVI patients that my research rotation was about.

Aside from teaching rounds, I was able to see patients with my mother, who is a cardiologist at SCI. I loved her bedside manner and approach towards her patients.

In summary, my month of time at SCI gave me a very valuable and insightful experience preparing me for what’s ahead in my career. It gave me a headstart on research and motivated me further to study hard to be a doctor. I would advise that every college student planning on a medical career seek an experience like this. I am very thankful for mine. ■ Julia Stys is in her second year at Loyola University in Chicago. Her mother, Maria Stys, MD, FACC, is an academic assistant professor at USD Sanford School of Medicine and cardiologist at Sanford Cardiovascular Institute in Sioux Falls.

To read more about Julia’s experience at SCI, see the extended version of this article on our website.

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Midwest Medical Edition

Learning Opportunities Spring 2017 March 10 8:00 am – 4:15 pm 10th Annual Avera Brain & Spine Institute Conference

March 31 8:15 am – 4:30 pm 6th Annual Avera Transplant Institute Symposium

Location: Hilton Garden Inn Downtown

Location: Avera Education Center

Information: 605-322-7879, Avera.org/conferences

Information: 605-322-7879, averaeducationevents@avera.org

Registration: avera.org/classes-events

Registration: avera.org/conferences

March 14–15 7:00 am–7:00 pm SD Winter Conference on Emergency Medicine Location: Rushmore Plaza Holiday Inn, Rapid City

April 5–6 7:30 am–8:30 pm, 7:30 am–1:10 pm Collaborative Research Center for American Indian Health Summit

Information/Registration: 605-719-8222,

Location: Sanford Center, Sioux Falls

sdacepconf@gmail.com

Information and Registration: CRCAIH.org/summit, info@CRCAIH.org

March 16–17 5:00 pm–8:00 pm, 7:30 am–5:45 pm Avera eEmergency Airway Program Location: Holiday Inn Downtown, Sioux Falls

April 12 7:30 am – 4:00 pm 25th Annual Avera McKennan Trauma Symposium

Information: 605-322-7879, averaeducationevents@avera.org

Location: Sioux Falls Convention Center

Registration: avera.org/classes-events

Information: 605-322-7879, averaeducationevents@avera.org Registration: avera.org/conferences

March 15–16 7:00 am–8:30am, 11:30 am–1:00 pm Integrating Palliative Care into Comprehensive Cancer Care

April 28–29 8:00 am–6:00 pm, 8:00 am–4:30 pm Sanford Sports Medicine Symposium

Location: Mercy Medical Center, Sioux City

Location: Ramkota Hotel & Conference Center, Sioux Falls

Information: 712-252-9301, vandesteegk@jencc.com

Information: 605-312-7808, tryg.odney@sanfordhealth.org

Registration: mercysiouxcity.com under Classes & Events

Registration: sanfordhealth.csod.com

March 16, April 20, May 18 Imagenetics Lecture Series

May 16 8:30 am – 4:00 pm Avera Caring Professionals Conference

12:00 pm–1:00 pm

Location: Schroeder Auditorium, Sanford USD Medical Center

Location: Sioux Falls Convention Center

Information and Registration: sanfordhealth.org/classes-

Information: 605-322-7879, averaeducationevents@avera.org

and-events/courses/sanford-imagenetics-lecture-series

Registration: avera.org/conferences

March 30 7:30 am–4:00 pm Perinatal, Neonatal and Women’s Health Conference Location: Schroeder Auditorium, Sanford USD Medical Center

Save the Date: June 8 and 9 Avera Sports Medicine Symposium

Information and Registration: sanfordhealth.org/

Location: Ramkota Hotel, Sioux Falls

classes-and-events/2017-perinatal-neonatal-and-womens-

Information: averaeducationevents@avera.org

health-conference

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.

SANFORD LAUNCHES NEWEST ORTHOPEDIC TECHNOLOGY

Brian Aamlid, MD

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Introducing MakoTM robotic-arm assisted surgery Sanford Orthopedics & Sports Medicine is proud to offer this highly advanced technology for knee and hip procedures – giving our experts a 3D model of the joint to prepare before surgery, and unparalleled precision, flexibility and control during surgery.

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Timothy Walker, MD

Call (605) 328-2663 to learn if Mako™ robotic-arm assisted surgery is right for your patients.

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