April 29, 2011
MEDICAL UNIVERSITY of SOUTH CAROLINA
GENE THERAPY
Medical illustration by Emma Vought
Gene therapy involves nerve growth factor being injected into a critical area of the brain called the Nucleus Basalis of Meynert.
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CLARION COMPETITION Students make good recommendations on real-life cases, take home $5,000.
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Vol. 29, No. 35
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n what could be a science fiction scenario, Dvora Beeri became MUSC’s first patient to undergo brain surgery March 29 as part of a clinical trial to see the effectiveness of CERE110, a new type of gene therapy treatment for patients with Alzheimer’s disease. Jacobo E. Mintzer M.D., co-principal investigator with neurosurgeon Istvan Takacs, M.D., said Beeri is the first in the state and the 19th in the world to have the procedure done as part of a Phase 2, double-blind study involving patients with mild to moderate Alzheimer’s disease. “We’re skeptically optimistic. We’re opening a new door that we don’t know where it’s going to lead us, but we’re opening it locally in a way that puts us on par with the top Mintzer centers in the world,” Mintzer said. MUSC is one of 10 leading centers across the U.S. that has been selected to be a part of the study, which is being conducted in collaboration with the Alzheimer’s Disease Cooperative Study (ADCS). Mintzer, who is director of the Department of Neurosciences a Division of Translational Research, said
the trial is a sign of the success of ADCS, a national research consortium funded by the National Institute on Aging that conducts multi-center clinical trials. Given the prevalence and devastation of Alzheimer’s disease, this work required a network of sites with state-of-theart capabilities where any new treatment or approach could quickly and effectively be put in the pipeline and tested, Mintzer said. It was noticed that true innovation wasn’t necessarily coming from pharmaceutical companies but from small biotech companies who oftentimes did not have the resources to move the science forward. The ADCS selected the 30 top centers in the country to form a network to aid these small companies and implement clinical trials on a national level to move this science forward faster through its grant system. Of those centers, 10 were selected for this study. The science being promoted in See Gene on page 8
BY DAWN BRAZELL - Public Relations
EARL B. HIGGINS AWARDS
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Project Spring Blossom
Recipients share compassion for underserved through dedication.
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Meet Kimberly
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Classifieds
READ THE CATALYST ONLINE - http://www.musc.edu/catalyst
2 THE CATALYST, April 29, 2011
English as a Second Language students contributed their April lesson fees to the Japanese Red Cross as part of Project Spring Blossom.
Project Spring Blossom supports Japan’s effort in cleanup following earthquake BY ROBERT KOEPPER, PH.D. MUSC International Programs Every Saturday morning, some MUSC international employees forego a morning of rest and gather to form what has become a unique family. These are the English as a Second Language (ESL) students. This group has formed a tight bond through the common challenges they share in a new culture, including learning American English. The recent earthquake and tsunami have brought new challenges: past and present Japanese ESL class members have had tragedy strike close to their families. The wife of Eishi Nishimoto, a former MUSC postdoctoral scholar, had two relatives killed in the recent tragedy. Eiji Suzuki, an MUSC postdoctoral scholar, his wife and two children are here now. Suzuki’s parents and brother live about 30 miles from the center of destruction
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723 Editor: Kim Draughn catalyst@musc.edu Catalyst staff: Cindy Abole, aboleca@musc.edu Dawn Brazell, brazell@musc.edu
The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.
and remain in their home despite the threats to their welfare. Suzuki’s wife and children postponed their return to Japan. MUSC postdoctoral scholar Masayuki Wada’s family lives in the far Southwest of Japan. They were not directly impacted by the tragedy but are sharing in the difficulties of seeing their country recover. As the ESL instructor, I suggested the class initiate Project Spring Blossom. The fees students contribute for their weekly lessons in the month of April will be collected and sent to the Japanese Red Cross, the recipient suggested by the Japanese students and agreed to by the members of the ESL family. Editor’s note: Project Spring Blossom raised $300 which will be donated to the Japanese Red Cross. During the April 21 International Bazaar, the Japanese Earthquake Relief (all Japanese faculty) raised nearly $3,000. To donate to the Japanese Red Cross Society, visit http://tinyurl.com/4eqb6ye.
The 2nd Annual Weston Cup May 13- 14 Miler Country Club, Summerville Friday Dinner and Silent Auction, $30 per person Saturday Golf Tournament, Noon Shotgun Start, Tee Gifts, Prizes $100 Entry Fee All proceeds will benefit MUSC’s preeclampsia research. To register, visit http://www.MUSChealth.com/women/westoncup
THE CATALYST, April 29, 2011 3
MUSC team takes 2nd place at national competition BY ROBY HILL South Carolina College of Pharmacy
When Jacqui Pratt decided to enroll at the South Carolina College of Pharmacy, she didn’t expect to see snow in April. But then Katherine Schichtel asked her to participate in the Clarion 2011 Interprofessional Team Case Competition. And then the team of Schichtel and Hailey James, both students in health administration, Ted James in medicine and Pratt in pharmacy won the MUSC campus competition. And then they were in Minneapolis for the national competition. In the snow. Clarion or CLinician/Administrator Relationship Improvement OrganizatioN—is a University of Minnesota student organization created to improve health care through interprofessional collaboration. “They asked me how cold it got in Charleston, and I said it got to about 20,” said Pratt, a first-year student at the MUSC campus of the South Carolina College of Pharmacy. “They weren’t impressed with our temperature range.” They were impressed with the MUSC team. On April 16, the team took second place and $5,000 in the Clarion competition. The team’s faculty advisor was
Students Hailey James, from left, Ted James, Jacqui Pratt and Katherine Schichtel placed second in the national Clarion competition April 16 held in Minnesota. Del Schutte, M.D., although Dave Morrisette, Ph.D., accompanied the team to the national competition. A team from the University of Missouri won first place and $7,500; the third place finish went to a team from Texas Tech University Health Sciences Center. Since 2005, Clarion has hosted a national competition with teams of four students in at least two disciplines presenting a root cause analysis in the context of real world standards of practice. MUSC has been participating since 2007, when a team from MUSC also placed second. “We were supposed to act like a consulting team
presenting to a board at a hospital and give them our recommendations on how to handle a specific case study,” Pratt said. All teams were given the case study in January. Eleven teams entered the preliminary competition at MUSC in March and judges selected the top three, which then competed for the chance to go to the national competition. The competition was created in response to the Institute of Medicine report released in 1999 that indicated as many as 98,000 people in America may die each year due to medical errors. MUSC has been a leader in interprofessional initiatives and has its own interprofessional department, Creating Collaborative Care, which utilizes case studies and collaborative root cause analysis within classes and other campus activities. “I was actually more nervous when we were competing at MUSC,” said Pratt. “It was in a big auditorium with a lot more people. When we presented there, it was smaller and I didn’t know anybody in the room, and we had done it so many times, we were pretty relaxed.” Based on an actual event, the case study involved two patient deaths related to a physician overprescribing narcotics. Pratt’s team met regularly to discuss the case, See COMPETITION on page 10
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EMPLOYEE WELLNESS In observance of Employee Health & Fitness Month during May, MUSC Employee Wellness will challenge employees to create Healthy Moments, form Healthy Groups and commit to wellness at work. Healthy Moments are short-term changes in eating, physical activity or personal and environmental health that add up through time, occur daily, even multiple times a day and are created by individuals and groups. Healthy Groups are small groups of employees who gather to participate in an activity intended to create a sustainable activity continuing even beyond the month. Participants will be able to log these activities on the Employee Health & Fitness Month (EHFM) website throughout the month, providing a way to track, share and promote individual and group activities. The EHFM held each year in May is an international and national observance of health and fitness in the workplace, created by two non-profit organizations, the National Association for Health and Fitness and ACTIVE Life. Its goal is to promote the benefits of a healthy lifestyle to employers and their employees through worksite health promotion activities and environments. Formerly National Employee Health & Fitness Day, EHFM has been extended to a month-
long initiative in an effort to generate sustainability for a healthy lifestyle and initiate healthy activities on an ongoing basis. More information will be available via broadcast messages and on MUSC Employee Wellness Facebook. Employee Wellness events q Fitness Series: A free Pilates class will be held from 12:15 to 12:45 p.m., May 10 at the wellness center. Participants will receive a free one-day pass to the wellness center. E-mail musc-empwell@musc.edu. q Worksite screening: The next screening will be held May 25 in Room 125, Gazes Building. The screening is $15 with the State Health Plan and $42 without. Register at http://www.musc.edu/medcenter/ health1st. q Farmers market May schedule: Horseshoe: 7:30 a.m. – 3:30 p.m., May 3 and May 27; Charleston Memorial: 7:30 a.m. – 3:30 p.m. every Friday beginning May 6; Harborview Office Tower: 7:30 a.m. – 3:30 p.m. every Friday, beginning May 13. Like the MUSC Employee Wellness Facebook page and keep up with all the wellness events at MUSC. Contact Susan Johnson at johnsusa@muscedu.
CARES Clinic offers free services
Department of Family Medicine’s Dr. Wanda Gonsalves, right, and first-year College of Medicine (COM) student Karla Williams explain the operations of the MUSC CARES (Community Aid, Relief, Education and Support) Clinic to a group of physicians and pharmacists from the Netherlands April 21. COM’s Global Health Initiative and the Department of Medicine hosted an international health symposium with the purpose of sharing, learning and discussing the differences in the health care system in their respective countries to better improve quality and outcomes. From left are Drs. Willem van Dam, Michel Bury, Theo Schoone and Wim van der Hooft. To volunteer at the clinic, contact Darcy Slizewski at slizewsk@musc.edu, Matthew Ewald at (732) 371-9304 or visit http:// www.thecaresclinic.org.
Events to support MUSC‘s Brain & Spine Tumor Program A wide range of free events will be held the first week of May in honor of Brain Tumor Action Week (BTAW). Pierre Giglio, M.D., medical director of the MUSC Brain & Spine Tumor Program, said BTAW is an important nationally-recognized initiative of the brain tumor community to shed light on an area of need. "MUSC's Brain Tumor Action Week is designed to improve education and research for brain and spine tumors. Education and research are the best tools physicians have in their fight against these cancers," he said. Rachel Beard, administrative assistant for the Brain & Spine Tumor Program, said this is the fourth year of Brain Tumor Action Week. The Brain & Spine Tumor Program sets up events during the week with the goals of education, awareness and fundraising to support brain tumor research efforts at MUSC. Beard said this year they are excited to
have the first panel discussion, featuring physicians representing neuro-oncology, neurosurgery, radiation oncology/ gamma knife, neuroradiology and neuropathology. One of the main reasons the week continues to be successful is the support of the members of the MUSC Brain Tumor Support Group, said Beard. “Patients and their friends and families are the reason that we do this every year, and we always welcome their involvement. We always have patients who volunteer throughout the week to greet people at our display table in Hollings, and some of their family members have reached out to help in everything from collecting items for our drawing and silent auction to assisting in the planning of some of our events.” For information and a listing of activities, contact Beard at beardr@musc. edu, 792-6592 or visit http://www.musc. edu/neurosciences/BTAW.
THE CATALYST, April 29, 2011 5
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6 THE CATALYST, April 29, 2011
Endodontics residency prepares clinicians, scientists improve oral health care in South Carolina," said Rivers. Dental endodontics was recognized as a dental specialty by the American Dental Association in 1963. Levitan was recruited in 2006 from the University of Tennessee’s School of Dentistry after directing their endodontics program and establishing digital radiology services within their program.
BY CINDY ABOLE Public Relations
M
USC’s newest dental residency program is focused on preparing the state’s endodontic professionals. The program uses the latest technology, research and clinical experience to train future endodontists at the James B. Edwards College of Dental Medicine Dental Clinical Education Center. Endodontist Marc E. Levitan, DDS, is the program’s postgraduate director. He and his three postgraduate endodontists can be considered dental heroes when it comes to performing tooth-saving emergency techniques by diagnosing facial pain and helping patients preserve their natural teeth. Mostly, they enjoy the challenge that their work offers and the opportunity to teach and promote good oral health among their patients. Endodontists are root canal specialists who are focused on managing pain, treating dental injuries and preventing tooth loss using advanced technologies, skilled techniques and procedures. Endodontists complete some additional years of specialty training and education in diagnosis and root canal treatment following graduation from dental school. “Our goal was to build a postgraduate endodontic program that could support the specialized dental needs of South Carolina residents. As the state’s only dental school, we need to provide training programs in endodontics and other dental specialties because all aspects of dentistry are becoming intricate,” said Levitan. The program's three endodontic residents are completing their first year of residency and preparing to welcome a second group of residents. Current residents include Justin McAbee, DMD, a spring 2010 MUSC dental alumnus; David Woodard, DMD, a University of Missouri-Kansas City School of Dentistry graduate; and Tom Heeren, DDS, who received his degree from the University of Tennessee Health Science Center's College of Dentistry and former U.S. Navy dentist. According to Heeren, the program operates successfully with a good balance
TAPPING TECHNOLOGY, TREATMENTS
Drs. Marc Levitan, left, and Justin McAbee review a digital X-ray of a patient’s teeth during a procedure. between clinical experiences, research work and the educational-teaching component. “The program offers great exposure to all aspects of endodontics,” Heeren said.
A FLEXIBLE CURRICULUM MUSC’s postgraduate endodontic program is a 26-month dental residency that focuses on both clinical and research components. The didactic component includes treatment planning, case review, literature review and endodontic lecture presentations. Residents are expected to complete a combined Master of Science in Dentistry (MSD) and certificate program. A combined MSD and certificate program also is available. Endodontic residents are expected to complete a research project that includes a thesis defense and a publishable scientific manuscript. Residents read and evaluate scientific literature, discover resources and tools, plus test and review dental products to share their findings at dental professional meetings across the country. In addition to conducting research, residents will guide senior-level dental students rotating in the college's endodontics clinic also located at the dental clinical education center. Additionally, endodontic postgraduate
students teach a new technologies course for second-year dental students and support emergency clinic calls. Levitan, who has more than 25 years clinical experience in clinical endodontics, approached CDM Dean John Sanders, DMD, in 2006 to discuss plans for creating the postgraduate endodontics program. James A. Rivers, DMD, professor and chair of the Department of Oral Rehabilitation, was excited to develop the program following the recruitment of Levitan and other dental faculty. Rivers tried to initiate the program in the 1980s, but the timing was not right. Instead, Rivers led the division to move forward in other areas including dental technology, new instruments and equipment that enhanced the school’s undergraduate endodontics clinical practice. In 2009, the college opened the dental clinical education center which expanded space and opened collaboration to establish vital partnerships with dental businesses and manufacturers to create the 120,000 square foot dental education and research facility, according to Rivers. “That building allowed us to secure space in a modern facility and bring together modern dental technology, practitioners and students to let us
A year after observing and defining MUSC’s endodontics program mission, Levitan shared some foundational recommendations with Sanders and dental leadership to enhance the clinical endodontics enterprise. Levitan suggested the use of newer, more efficient technologies such as digital X-ray imaging and new systems for treating patients. These were technologies that Levitan previously used and introduced at Tennessee’s dental school. With the new digital imaging system, residents and practitioners can take, process and view large, enhanced images in seconds as opposed to traditional film X-rays that takes time to process. “New dental technology is only beneficial if our students can be taught to utilize it when treating patients. All of this enables us to provide patients with better treatments and more predictable outcomes and fewer problems associated with root canals and other endodontic procedures,” Levitan said. At the dental school’s initial 2010 accreditation visit with the American Dental Association's Commission on Dental Accreditation, accreditors were impressed with their findings and progress of the postgraduate program. According to Levitan, accreditors cited that MUSC's program was “ahead of the curve” in dental technologies and other areas compared to other postgraduate endodontics programs around the country. Currently, Levitan and his colleagues have completed the selection process for the program's second group of residents. They will begin the program in June.
The Catalyst, April 29, 2011 7
Higgins Award recipients serve as ‘MUSC’s newest angels’
CAROLYN JENKINS
Jenkins has dedicated more than 30 years to improving health care among African-American communities. Her focus is on improving care for high-risk diabetes patients. She has written more than 25 publications in peer-reviewed journals and books on this topic. Jenkins also has actively recruited minority students into health professional education programs. The REACH program is another accomplishment of Jenkins. This is the only center focused on reducing disparities for African-Americans with diabetes in the nation that is funded by the Centers for Disease Control and Prevention. KELLY LAMBRIGHT
The student recipient, Kelly Lambright, contributed her time to advancing health care in the Hispanic
Lavalle Higgins, left, welcomes Dr. Carolyn Jenkins as an Earl B. Higgins Award recipient. communities. She has participated in the Alliance for Hispanic Health (AHH) for all four years of her studies. Lambright has learned Spanish to better serve these communities. She then used these abilities to volunteer in interpreter services at the hospital and participate in several health fairs. The ultimate goal for Lambright’s involvement in AHH was to collect research data assessing the health needs of the Charleston Hispanic community in hopes it could be better served Lambright in the future. Not only did Lambright volunteer in the local community, she also served internationally through work she has done in the Dominican Republic, Ecuador, El Salvador and Honduras.
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8 THE CATALYST, April 29, 2011
Alzheimer’s patients hope gene therapy study works Avri Beeri knows his research. He can tell you everything there is to know about Alzheimer’s disease—about the myriad of clinical trials, the vitamins and supplements thought to slow the process, and how he helped his wife to be part of an elite group of only 50 people who will be in Phase 2 of the CERE-110 clinical trial. He can tell you what it’s like to live with a spouse who suffers from a disease that requires him to be watching with “10 eyes all the time what is going on.” He smiles lovingly at Dvora, his wife of 44 years, who has returned to MUSC for a check up following her brain surgery March 29, where she may have received gene therapy as MUSC’s first patient to enroll in the trial. Their hope is that this therapy will stop and possibly even improve her condition. Sporting a new cap to cover her closely-cropped hair, Dvora smiles at her husband. “I just need to remember,” she said of her decision to enter in a doubleblind clinical study that required her to
Avri and Dvora Beeri have a portion of her head shaved for a treatment she may or may not have received when she underwent surgery. Beeri nods at his wife’s response. He needs to know he did everything he could to help her do just that. He’s the memory keeper for both of them now. Beeri met his wife when he went to take music lessons from her brother. “He invited me to come home
with him, saying ‘I will teach you some lessons.’ I never learned how to play the guitar, but I learned her,” he said, smiling. Beeri found out his wife had Alzheimer’s disease four years ago, when his life researching the disease began. He reads everything he can trying to find out what can break the cycle and stop the disease. “I’m constantly Googling all over the world to find out what study she could go on.” When he ran across the nerve growth factor research, he knew he wanted to get her into a study. On a wait list at Duke University, the couple decided to move forward with doing the clinical trial at MUSC, where they had participated in a previous study. “I was following it very closely to see where it was going to be, and when I found out it was going to be here, I thought, ‘Good, I know these people.’” Beeri said they’ve been to MUSC so much, his car comes on auto-pilot now. The decision to participate in the trial
was simple for him, but not as much for Dvora. “She was the one who had to be drilled,” he said of the holes that surgeons have to make for the patient to receive the gene therapy. “I told her, ‘If I were the one who had it, I would do it.’ If anything could stop it, it’s worth trying it even with all the pain.” Consulting with their internist in Charlotte, Beeri said he was relieved it took the doctor 10 seconds to advise to do it. “We talked to him together. He said he would do it for himself.” Dealing with the disease takes patience. He advises other caregivers to know how fast the research changes and how much more there is to know about how to help those who suffer from the disease. If his wife had the “sham” surgery, he wants her to get the gene therapy should the trial show promising results. Beeri knows it might not work, but still thinks it was worth doing. “It will help for the future, even if it doesn’t help us right now.”
GENE Continued from Page One
this case studies how best to get NGF or nerve growth factor to a critical area of the brain called the Nucleus Basalis of Meynert (NBM), a brain region where cell degeneration occurs in Alzheimer’s disease. CERE-110 is composed of an adeno-associated viral vector carrying the gene for NGF, a naturally occurring protein that maintains the survival of nerve cells in the brain. CERE-110 is surgically injected into the NBM, where it is hoped the delivery of NGF gene using a “virus” will allow NGF to replicate itself through the patient’s own cell machinery and stop the progression of the disease or even potentially cause improvements. “We have to get it in the right place in a way the cell can incorporate it,” said Mintzer. “We need to get the cell to generate it by itself on an ongoing process. The only way you can do that is by injecting new DNA into a cell.” Beth Safrit, nurse practitioner III and clinical director of the Department of Neurosciences Alzheimer’s Research and Clinical Programs, will oversee the monitoring of the five to 10 patients who will be participating in the trial. The patients are followed for 24 months. “It’s the only thing out there that can offer any true hope of improving,” she said of the study, which accepts patients who have only a mild level of Alzheimer’s. “If these patients can stabilize themselves or maybe even get
a little bit better with this one-time treatment, because that little virus is producing for the rest of their lives, it’s an amazing thing. If it proves to be effective, it’s going to change their lives forever.” Mintzer said one of the main challenges is pushing the science forward, while managing people’s expectations. It will be years before a therapy can be developed should the therapy prove effective. Having begun his research into Alzheimer’s disease in 1981, Mintzer said he’s seen impressive changes from when it was difficult just trying to convince people that such a disease existed. “Now we have come to a moment where we are inserting new genetic material into cells.” It’s been a complex process to bring the study to MUSC, with more than 400 people having to be trained in the MUSC family, from the pharmacists and doctors involved to the person cleaning the OR. Safrit holds up a thick file folder of all the employees who had to be checked off. Though they received no extra pay, they were willing to do the training. “They were enthralled with what we were accomplishing here,” she said. “They were happy to be a part of it.” The other critical part that enables the study to proceed are the patients who are willing to take the risk of a double-blind study, which means they will have
their head shaved and may go through a “sham” surgery where they don’t receive the gene therapy. The patients and researchers won’t know until the end of the twoyear study who received the real treatment, although eligible patients who received the sham surgery will be offered the therapy at the end if they want it. Mintzer said it takes a very strong commitment from the person. It takes a commitment from MUSC as well. “A few years ago, this appeared to be science fiction. I’m excited not only about this particular study but about the possibilities it opens for us scientifically. It lays the groundwork for gene therapy for other organs. There is a path that has been laid out, and that puts MUSC clearly on the forefront for this type of research and eventually, this type of therapy.” MUSC has one of the few neuroscience programs in the country to have neurosurgery working with neurology and Alzheimer’s specialists, which is not a common event, he said. “This project requires a very close collaboration between neurosurgery and the dementia specialists. We have both together at MUSC. The core of our MUSC mission is to bring to South Carolina what would not be available if the resources of a university of this caliber were not here.” For more information about the clinical trial, call 740-1592, ext. 14 or visit http://academicdepartments.
THE CATALYST, April 29, 2011 9
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10 THE CATALYST, April 29, 2011
COMPETITION Continued from Page Three then broke off into their respective areas to work on the case before getting back together to collaborate. “The thing about Clarion is that you can’t totally divide into specialties because everyone has to be able to present about any aspect of the case,” Pratt said. As the pharmacist, she had primary responsibility to provide analysis regarding the narcotics. “So while I’m learning about pain management, my teammates learn just as much. And while they are figuring out the finances and the cost benefit analysis, I learn about that.” The case study had a myriad of factors including the difficulty of developing pain management criteria, a culture of fear in the health care system, reluctance to report problems, a small-town environment with only three pharmacies, no system of checks in place and a leadership gap without a CEO in place. The team was given the prescription charts of the deceased patients and transcripts of interviews with emergency medical technicians, pharmacists, nurses and others related to the case. The team developed five
recommendations to address the case: 1. Create a culture of excellence to reduce intimidation and revitalize interprofessionalism 2. Hire a hospitalist, a nurse practitioner, and a clinical pharmacist to improve the quality of care and place two physicians on the hospital’s board of directors 3. Implement a computerized provider order entry (CPOE) and start programs of medication use evaluation and medication reconciliation 4. Implement a pain contract to be reviewed by the patient and care provider 5. Execute an emergency room letter program to chronic pain patients about frequent emergency room visits for narcotic refills “We were supposed to come up with interprofessional, systematic solutions with both short-term goals and long-term goals,” said Pratt. The team offered goals at intervals of two months, six months and one year and presented a cost benefit analysis showing the recommendations would save the hospital nearly $600,000 annually.
Theon! t Carl
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