June 28, 2013
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 31, No. 44
Attitude of gratitude
15 years later, patient returns to say thank you BY ASHLEY BARKER Public Relations
M
ore than 15 years ago, a 17-year-old selfproclaimed “country boy” was rushed to MUSC from North Myrtle Beach with severe closed-head injuries, nine broken ribs and a broken pelvis. Prior to the car accident, Jason Harrison was president of his junior class, a straight-A student and a member of his high school’s golf team. His father, Jim Harrison, remembers the afternoon of Sept. 24, 1997, the day that all changed, like it was yesterday. “It was pouring down rain. As I drove to Grand Strand Regional Medical Center, I was saying that little prayer, ‘Let it be a bumped head, let it be a broken leg, let it be this or that,’” he said. “When I went by the car on the way to the hospital, my prayer changed to ‘Let me say goodbye.’ They had to cut him out of the car. It was that bad.” When Jim arrived at the hospital, more than 50 of Jason’s classmates were already pacing the floors. Within minutes, Jim was told he needed to call his family in because his only son wasn’t going to make it through the night. Members of Jason’s family, who had to drive four and a half hours to make it to the hospital, didn’t know what to expect when they arrived. “He was a mess. His head was as big as a basketball, and I’m not exaggerating,” Jim said. After surviving three days, Jim decided his son’s best option was to be moved to MUSC. Again, he was told Jason wouldn’t even survive the ambulance ride. Jason’s heart stopped beating three times. But he made the trip. Jason was in a coma for three months in the care of Karl Byrne, M.D., associate professor of surgery. Once he woke up, he survived a 106.5-degree temperature,
4
Jason Harrison, then 17, reached out for his dad following a car accident in 1997. three bouts of pneumonia and went through multiple surgeries to relieve muscle contractions, repair broken bones and to insert water-proof material between his vocal chords in hopes that he’d be able to speak again. “There was no hope. Everything bad happened. We were told again he wouldn’t make it through the night when his temperature spiked,” Jim said. “We continued to pray and pray and pray and pray. I kept praying for a miracle, a Christmas miracle.” His family members rotated taking care of Jason, constantly staying by his side and refusing to give up on him. Jim’s miracle came when Jason was moved to the Children’s Hospital after meeting Lyndon Key, M.D. Jason, who had been a juvenile diabetic since he was 9 years old, turned 18 in a coma on Nov. 18. Key, who was division director of pediatric endocrinology at the time, said Jason’s diabetes qualified him for care as a child.
GOVERNOR’S AWARD Distinguished University Professor honored with Excellence in Science Research award.
6
Now 33, Jason Harrison returns to MUSC to tell
See THANK YOU on page 10 his story of survival. GRANT SUPPORTS PROJECT
4
First female to chair CPOS
Robert Wood Johnson winner uses money to promote healthy eating and active living.
5
Meet Kevin
7
Communications Corner
READ THE CATALYST ONLINE — http://www.musc.edu/catalyst
2 THE CATALYST, June 28, 2013
New medical-code sets, physician training planned BY CINDY ABOLE Public Relations
H
ospitals and health care industry staff are bracing for a change in the world of diagnostic coding. By Oct. 1, 2014, all U.S. health care providers must adopt the newest medical procedure coding structure, ICD-10-CM/PCS, to accurately report inpatient procedures and activity at health care centers and inpatient hospital settings. The change is a significant upgrade from the outdated ICD-9 coding structure, increasing the number of medical codes to 68,000, which allows for more detail and flexibility. This national mandate also aligns the United States with Canada, France, Germany, Australia, China and other countries that already use these detailed code sets to classify morbidity and mortality data and track health statistics. In the U.S., ICD coding is used for insurance claim reimbursement, resource allocation and data management. To prepare for this conversion, the medical center launched its own journey to synch the ICD-10 conversion with the new Epic electronic medical record system. The first step in the actual implementation of the use of ICD-10 terminology will begin in outpatient and emergency room settings in February 2014. The plan will be for coders to utilize dual coding for both ICD-9 and ICD-10 until go-live for inpatient, scheduled for next July. By October 2014 all clinical areas will use and select from the ICD-10 CM (diagnosis) codes and ICD-10 PCS (procedure) codes for their documentation. ICD-10 CM is the tenth version of the International Statistical Classification of Diseases and the National Center of Health Statistics under the World Health Organization. ICD-10 PCS was developed by the Centers for Medicare & Medicaid Services. What’s new about the ICD-10 codes is that they are more specific, according to Sue Pletcher, Health Information Services director, who represented her area on the ICD-10 implementation executive oversight committee. For example, congestive heart failure, a condition when the heart fails to pump blood properly through the entire organ, is coded as 428.0 under the old ICD-9 code and requires coders to use 15 codes (ICD-10) to describe heart failure in the left ventricle (428.1), systolic heart failure (428.2), diastolic heart failure (428.3,) or a combined systolic and diastolic (428.4). In ICD-10, code descriptions are more specific such as heart failure following surgery, heart failure related to hypertension, heart failure and hypertension with chronic kidney disease, heart failure during obstetric surgery or rheumatic heart failure. During project planning, teams reviewed the hospital’s health information systems status, consulted
“We’re committed to helping during this transition period and offering solutions that will increase specificity.” PJ Floyd, R.N. with Epic electronic health record system managers, assessed documentation practices and policies, reviewed and developed coder, staff and physician training, and numerous other activities. Phyllis J. “PJ” Floyd, R.N., Health Information Services Clinical Documentation Integrity & Abstraction director, a co-chair with the ICD-10 Clinical Integration Subcommittee, leads physician training and the preparation of physician support staff, operations staff, coders, department schedulers and other groups. Floyd and her team have been involved since the first day of planning from multiple perspectives. For the training piece, Floyd’s team prepared materials to accommodate all types of learning styles. They also prepared an array of tools — pocket cards, instruction materials, tip sheets, eLearning technologies as well as classroom instruction — to assist physicians and coders. To ensure a successful rollout, leadership has hired Deloitte Consulting to conduct assessments and guide the transition. “Adjusting to these new code sets will require more time and patience from coders, physicians and trainers. We’re committed to helping during this transition period and offering solutions that will increase specificity,” said Floyd. According to Floyd, the launch for physician training with ICD-10 began in January with an orientation session and brief review with the surgery department including the vascular surgery division. Bruce M. Elliott, M.D., professor and chief of the Division of Vascular Surgery, sees changes and consequences with the ICD–10 coding updates. Elliott, who is a member of MUSC Physicians’ executive committee, sits on the hospital’s payment policy committee, and has followed the hospital’s progress regarding physician and staff training. Elliott’s area is slated to be among the first surgical departments to complete physician training. “It’s imperative that our physicians and staff be successful to learn this new coding system both quickly and accurately. It’s also essential that the right tools and support plans are in place for this transition
! ! ! ! ! ! ! !
Comparing ICD-9 and ICD-10 ICD-9 (13,000 codes) Three to five characters in length First digit may be alpha or numeric Limited space for new codes Difficult to analyze ICD-10 (68,000 codes) Three to seven characters in length Digit 1 is alpha, digit 2 and 3 are numeric, digit 4 through 7 are alpha or numeric Flexible for adding new codes Very specific
to be successful.” MUSC is among a handful of institutions taking a proactive approach to the new code set conversion with communications, multiple levels of training and departmental support. According to Elliott, the medical center was tested in 2012 with the first launch of the Epic electronic medical record system in the ambulatory and emergency departments. “Although Epic’s implementation process was well organized and training was coordinated, roll out in specific areas was complicated and disruptive. With a project of this scope and size, it’s realistic to expect some disruptions throughout this conversion period,” Elliott said. The ICD-10 readiness is being led by hospital leadership and guided by an ICD-10 Steering Committee, compliance team members and other planners to assess the needs of departments and medical specialties, schedule training for physicians and staff, create support tools and conduct field testing to support the full implementation.
THE Catalyst 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 Ashley Barker, barkera@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. sales@moultrienews.com.
THE CATALYST, June 28, 2013 3
Award presented to MUSC for healthy environment M USC was awarded a Hospital Prevention Excellence Award by N.C. Prevention Partners, a public health leader that offers the worksite wellness program WorkHealthy America. Prevention Excellence awards are given to individuals and organizations for making the nation a healthier place to live, work and learn. Awards were given during NCPP’s annual meeting on June 5 at the University of North Carolina at Chapel Hill’s Carolina Club. Meg Molloy, DrPH, N.C. Prevention Partners president and CEO, said, “Successful prevention stems from good health policies. One of the best ways to accelerate the adoption of good healthy policies is by recognizing and sharing the success stories that make them possible.” As a Working Well Center of Excellence, MUSC has made healthy food the norm by creating an on-site Urban Farm for employees, students and community members to have access to fresh, local produce and to learn about the benefits of a healthy diet. “We are honored that MUSC was awarded this recognition and consider it to be a milestone in our wellness efforts. It has been a long and challenging journey to get where we are and to know that we are being recognized by our peers for our work was
N.C. Prevention Partners senior program manager Dr. Melva Fager Okun, from left, presents a Hospital Prevention Excellence Award to MUSC’s Drs. Pat Cawley and Susan Johnson. Representing Prevention Partners also is Dr. Meg Molloy, president and CEO. extremely gratifying to all who have committed so much to the working well program,” said Susan Johnson, Ph.D., director of MUSC’s Office of Health Promotion. “We look forward to continuing this collaboration as we expand our efforts to the business community through a new ‘Healthy Business Challenge’ project.”
MUSC officials have also worked to create and enforce a campuswide tobacco-free policy. That policy served as a driving force behind passing legislation H. 4092, which gives authority to governing bodies of public colleges and universities in South Carolina to legally declare and enforce tobacco-free campuses to include outdoor spaces. MUSC, in conjunction with Roper St. Francis and the City of Charleston, also created a smoke-free medical district in the heart of downtown Charleston. These and other major accomplishments at MUSC have been shared with others across the state through site visits, blogs and webinars. “The Medical University of South Carolina is serving as a leader and role model in the Carolinas and across the country,” said Lindsey Bickers Bock, program manager at N.C. Prevention Partners. “The team at MUSC has done extraordinary things to ensure that the people who work, learn and receive medical care on their campus are surrounded by a healthy environment. Along the way, they have truly embraced the opportunity to share their successes and challenges with other hospitals and institutions of higher education in order to help other organizations make similar changes.”
4 THE CATALYST, June 28, 2013
Excellence in Science Research awarded to professor BY BILAN WILLIAMS Public Relations Established in 1989, the Governor’s Award for Excellence in Science Research is annually awarded to a person who has made major contributions to the state of South Carolina in any area of science. The 2013 recipient was MUSC’s Rosalie Crouch, Ph.D., Distinguished University Professor in the Department of Ophthalmology. Gov. Nikki Haley gave the award to Crouch on June 14 at the South Carolina State House in Columbia. Crouch joined the MUSC faculty as an assistant professor in 1975 and has done extensive research in the fields of ophthalmology and biochemistry. “I am very grateful to all those who made this possible,” said Crouch. “I have always considered myself a nerd who loved chemistry, numbers and puzzles, so obviously research would be my thing.” Crouch is no stranger to state recognition. She also received the State of South Carolina Governor’s Award for Outstanding Service in 2002 and was awarded the MUSC Distinguished Faculty Service Award in 2003. She hopes her accomplishments in science encourage more advancement in all professional fields: primarily an increase in the amount of women who aim to achieve their highest aspirations and are recognized for it. One of Crouch’s greatest accomplishments was being
Dr. Rosalie Crouch accepts the Governor’s Award for Excellence in Science Research from South Carolina Gov. Nikki Haley, far left. With Crouch is her son, Richard, daughter-in-law Heather and grandchildren William and Kelsey. named MUSC’s first female provost and vice president for academic affairs in 2000. “I am pleased to have broken some barriers. Women in science deal with a biological impediment – namely the desire to have children — at a critical point in their career,” she said. Although Crouch believes women are more likely to encounter hindrances than men, she is optimistic about the future. “Things are improving, and society
is certainly more accepting. I am sure we will see more women in leadership positions.” Many of Crouch’s past trainees have gone on to nationally renowned leadership positions in the field of science and have made vital innovative discoveries in their respective research areas. “One of my trainees, Michael Redmond, discovered the protein that when mutated results in blindness and has been used in the first successful gene therapy trials. The understanding of the role of this protein and this disorder is based on our decades of study on vitamin A,” Crouch said. Despite her passion for vision research, Crouch, who owns a home on Edisto Island, delights in her time spent away from the laboratory as well. While she enjoys number-based activities such as bird watching, change-bell ringing and duplicating bridge, she also said baby-sitting her three grandchildren is one of her favorite hobbies. “The children are 2, 3, and 4 and are too young to know if they will be interested in science yet. But they can count, which is encouraging,” she said. Crouch is a member of the Board of Scientific Counselors of the National Eye Institute, a senior scientific investigator of Research to Prevent Blindness, and serves as a principal investigator of a 30-yearold National Institutes of Health grant. She also is a recipient of an NIH Special Career Achievement Award.
First female to chair Clinical Pharmacy, Outcomes Sciences BY ROBY HILL S.C. College of Pharmacy
K
elly Ragucci, PharmD, believes a department chair should be an agent of change. As the first female — and youngest — department chair at the South Carolina College of Pharmacy, she already is one. The tenured professor and assistant dean of the curriculum at SCCP has been named chair of the Department of Clinical Pharmacy and Outcomes Sciences at the college. The chair oversees the CPOS faculty at both campuses of SCCP founding institutions MUSC and the University of South Carolina, as well as at the SCCP’s satellite campus at Greenville Health System. “Dr. Ragucci is an accomplished faculty member who has been heavily involved with coordinating our
curriculum change process,” said Joseph T. DiPiro, PharmD, executive dean of SCCP. “Department leadership has been and will continue to be crucial for the college’s continued growth and success. Dr. Ragucci is highly respected by her peers and has the skills and experience to help us build on that momentum.” Outgoing chair John Bosso, PharmD, will remain a professor in the department. On the USC campus, Brandon Bookstaver, PharmD, will continue to serve as vice-chair. With a vision focused on increased cross-campus collaboration, supporting innovative teaching techniques and scholarly endeavors, recruiting/retention, and faculty development, the new chair plans to meet with individual faculty for in-depth discussions on goals so she can lead development of the department’s strategic plan. As chair, she believes an important part of that is to analyze long
term strategic, political and cultural implications of resource allocation decisions. “The department should really be run by faculty and facilitated by the chair,” said Ragucci, whose scholarly interests have included the scholarship of teaching and interprofessional education. “We have a great faculty who are doing great things so it is really just a matter of building on that.” A finalist for Governor’s Teacher of the Year in 2013, she has been recognized both for her teaching and clinical work. She won back-to-back MUSCwide awards when she was honored with the MUSC Teaching Excellence Award in 2012 and the Outstanding Clinician Award in 2011. She has been named professor or preceptor of the year six times and has more than a dozen other college and university recognitions. Ragucci earned her bachelor’s in
pharmacy with high honors from Ohio Northern University and her PharmD from the University of Toledo College of Pharmacy. She did a primary care specialty residency in family medicine at MUSC in 1997-98 and has earned certifications in Basic Life Support, Physical Assessment, Board of Pharmacotherapy Specialists, Diabetes Education and Advanced Cardiovascular Life Support. After serving as assistant professor at Wilkes University, she joined MUSC in 2000 and was promoted to associate professor in 2004. She became a full professor in 2011. She is chair of the Clinical Practice Affairs Committee for the American College of Clinical Pharmacy and has served in several national positions, including as chair of the Ambulatory Care Practice and Research Network and the Constitution and Bylaws Committee.
THE CATALYST, June 28, 2013 5
MEET KEVIN
Kevin Wiley Jr. Department Center for Global Health How long at MUSC Going on two months What music is in your player I love all music — Queen, the Carpenters, Miguel, Wale, the Bee Gees, John Denver, Oscar Peterson and Frank Sinatra are all in my iPhone right now. Unique talent I play the drums occasionally. I’ve played since I was 12 years old and mastered the snare, quince and all other marching percussion instruments. Dream job I would love to work in a position where I am able to teach people how to navigate through life. Some of us have the resources to get through it rather easily and some of us have a hard time making it. If I could provide people with great opportunities that lead to awesome outcomes that would be an amazing job. Favorite restaurants Southeast Asian cuisine. So, it’s a tie between Mi Xao (Vietnamese cuisine) in Mount Pleasant and Suwan Thai Cuisine in Old Port Royal.
6 THE CATALYST, June 28, 2013
Winner uses grant money to fund HEAL Project BY ASHLEY BARKER Public Relations
L
ast October, Debbie Bryant, DNP, R.N., became South Carolina’s first Robert Wood Johnson Foundation Community Health Leaders Award winner. The assistant director of cancer prevention, control and outreach at MUSC’s Hollings Cancer Center, was one of 10 leaders to earn a $105,000 grant to support a project created by the winner. Bryant decided to use her grant money to fund the HEAL (Healthy Eating and Active Living) Project within Community Compass, the annual outreach event that helped earn her the RWJ Foundation award. The project, which focuses on the Tri-county area, aims to develop guidelines for five organizations to implement into their meetings, seminars and events. Fraternal, civic, social and faith-based organizations were asked to apply to receive consultations with experts in the areas of nutrition, food preparation, exercise and physical activity, and smoking cessation. “We want to really make this uniquely tailored for that organization,” Bryant said. “An organization could say something as simple as, ‘For the next year, we’re going to never serve anything fried.’ We’re going to help them develop their own guidelines then implement their guidelines.” Once the guidelines are created and being implemented, the HEAL team will evaluate the organizations on how well they are following them. The organization that incorporates their guidelines best during the course of two years will then receive an advertisement in The Post and Courier. “We had about 25 organizations to submit their names for participation. Now we’re reviewing and deciding who will meet the challenge,” Bryant said. In order to participate, organizations must have a membership of at least 20 and a leader who is committed to the organization’s goal. They also have to put together an eight-to-10-person committee to focus on the project. Organizations that join and implement the guidelines will receive a stipend of $1,200 to spend however they so choose. “Our role is to bring the expertise of Hollings Cancer Center, the medical center and the prevention and control program together so the organizations can drive what they’d like to do as it relates to health and lifestyle changes,” Bryant said. “We’re not trying to drive everybody into the same pot. We’re just trying to be here as a support service to help them do what they want to do.” In addition to the HEAL Project, Bryant’s grant was used to fund a recipe dish contest at the most recent Community Compass event. Organizations were asked to submit a healthy recipe, which was judged
WCBD TV 2 anchor Carolyn Murray, left, and Dr. Debbie Bryant, right, present Cynthia Wilcher with a $350 check for winning the Best Recipe Grand Prize. on appearance, creativity, taste and how healthy the dish was by two dietitian experts and a community member. Cynthia Wilcher, of Arabian Temple #139, won the contest with her maple roast veggies recipe. All of the healthy recipes that Second place winners were were submitted will Brandi White, Tamika & be compiled into a Friends Inc. They served up book for members to fresh fruit kabobs. share. “This is taking our education awareness and bringing people together to take the next step into an action place where our partners and community members could be involved in developing a plan to change what’s possible as it relates to the lifestyle interventions,” Bryant said. For more information, visit http://hcc.musc.edu/ commitments/outreach.htm.
Maple roast veggies
Serves 6 Ingredients ! Seven peeled carrots sliced in half lengthwise then cut into two-inch pieces ! Two red bell peppers cut into large chunks ! One squash, unpeeled and split lengthwise with the seeds removed and cut into half moons (you could also use peeled butternut squash) ! One yellow onion cut into wedges ! Two tablespoons of maple syrup ! Two teaspoons of oil ! One tablespoon of kosher or sea salt Preparation 1. Preheat oven to 425 degrees 2. Place all of the ingredients in a bowl and toss to coat the vegetables (at this point you can place the vegetables in a large zipper bag and refrigerate overnight) 3. Pour the vegetables onto a foil-lined sheet tray and roast for 50 minutes, stirring halfway through, or until tender and golden 4. Serve
THE CATALYST, June 28, 2013 7
Medical Center Communications Corner Why these goals? ! Service HCAHPS and CG CAHPS
(Consumer Assessment of Healthcare Providers and Systems)
1. The patient’s experience is an important factor in the quality of care, recovery and MUSC’s reputation. 2. MUSC utilizes CAHPS surveys when possible: (a) these are standardized surveys that are being used across the U.S., (b) the results are reported online, and (c) MUSC can compare performance with other area providers and other academic medical centers. 3. These surveys: (a) are required by the Center for Medicare and Medicaid services, (b) impact the amount MUSC is paid for its services.
! People Employee commitment, physician engagement How employees and physicians feel about the work they do and where they work is important. High levels of commitment and engagement are associated with: higher patient, family satisfaction; lower errors, accidents; better patient outcomes; lower absenteeism; lower turnover; and higher profitability.
! Quality Ideal care, hand hygiene Proper hand hygiene is the most important thing MUSC employees can do to prevent health care
associated infections. The ideal care composites include: Mortality: a global indicator of the quality and safety of the care provided; a measure of whether patients live more often, about the same, or less often than would be expected given how serious their illness. Care process measures: how consistently MUSC provides certain elements of care that have been demonstrated to lead to the best patient outcomes. Readmissions: Measures how often patients come back into the hospital within 30 days of being discharged; a global measure of the effectiveness of (a) the care delivered while in the hospital, (b) the preparation of the patient (and their caregivers) to take care of themselves at home, and (c) the post-discharge follow up plan prepared with the patient; readmission rates for some diseases are publically reported and impact the amount paid for its services. Health care acquired infections: central venous line infections, catheter associated urinary tract infections and ventilator associated infections are serious, usually avoidable, complications that increase patient pain and discomfort, increase mortality and extend hospital stays; patients do not deserve to experience illnesses they did not have before coming to MUSC; rates of health care acquired infections are reported and impact the amount
MUSC is paid for its services.
Cultural of safety: in order to provide the best care, MUSC must create an environment that supports attention to safety for patients and employees (a) measured with a clinical employee survey, (b) assesses employee perceptions of importance of quality and safety within the organization, and (c) provides information about the strength of key safety processes. Outpatient electronic medical record meaningful use: greater use of technology is vital to improving the quality of care; health care is being guided through time to use electronic patient information by increasing expectations for information collection, documentation and reporting; at this time compliance rates with capture and reporting of certain data elements are used to determine potential for increased payments.
! Finance
Cost, margin Cost per discharge: an important measure to assure that costs for providing care are not more than
MUSC is paid for that care; payments will decrease during the coming years; it is important that MUSC reduces the costs before payments are reduced. Margin: what is left from payments after MUSC has paid for its costs; it is important to have a margin left so that funds are available for purchasing new equipment, maintaining the facilities and maintaining competitive pay rates.
! Growth
Inpatient discharges, new patients visits In support of our mission, MUSC wants to provide services to an increasing number of citizens; improve the process for admitting, treating and discharging patients
so that MUSC makes the best use of its capacity to serve patients; and the outpatient focus is on new patients to support the intent to offer patients an opportunity to benefit from MUSC services who may not have done so before.
8 THE CATALYST, June 28, 2013
Powerful imaging technology unveils new clues BY DAWN BRAZELL Public Relations
A
s a physicist, knowing the language that water speaks offers benefits, particularly if you’re gifted in translating that language in a way that potentially uncovers a method for the early detection for Alzheimer’s disease. Establishing neuroimaging biomarkers for the early detection of this disease is crucial for the development of earlier interventions when treatments could be more effective and at least delay the disease’s progress, preserving the quality of life, said Joseph A. Helpern, Ph.D., a SmartState Endowed Chair in Brain Imaging. A recent article from his research group, “Novel White Matter Tract Integrity Metrics Sensitive to Alzheimer Disease,” appeared in the American Journal of Neuroradiology. Helpern is no newcomer to imaging. The director of MUSC’s Center for Biomedical Imaging is credited with building the first 3-Tesla MRI almost 23 years ago and now considered the clinical state-of-the-art. He and longtime collaborator Jens H. Jensen, Ph.D., also developed diffusional kurtosis imaging, the MRI method that was highlighted in this latest study and being used to study a wide range of diseases. This is the beauty of being a researcher in the field of imaging, WATCH which cuts across all fields of RELATED VIDEOS medicine, he said. “The research we’ve been http://youtu.be/ doing and the development of fWs6F6BYwK8 technology that we’re translating into the clinic is really exciting because it’s showing that we have exquisite sensitivity into imaging biomarkers early on into diseases such as Alzheimer’s disease, epilepsy, attention deficit hyperactivity disorder, stroke and many others.” Researchers applied DKI-based tissue modeling of the white matter in the brain to investigate the sensitivity, diagnostic accuracy and associations of specific microstructural changes that happen through the course of Alzheimer’s disease. Findings suggest that there is widespread breakdown in myelin integrity in the transition from normal aging to a stage of amnestic mild cognitive impairment, with a loss in axonal density occurring later in the disease. The bottom line is that the imaging works to depict those changes. “Perhaps someday quantitative neuroimaging will be included with annual medical checkups in order to detect the earliest signs of AD before clinical symptoms arise,” Helpern said in the conclusion of the paper. “Then we will intervene with a future therapy that prevents the progression of this devastating disease.” Developing potential neuroimaging biomarkers is one of the key strategies included in the 2012 National Alzheimer’s Project Act, as well as for President Barack Obama’s BRAIN (Brain Research through Advancing
ek} {mjxlt f} |xqlxkn hjxj ysvvhjsmncq rhkimjsj socusnu im wny snjsutij snim jhzt zmnysismnj cj Alzheimer’s disease, stroke, epilepsy and ADHD.
Magnetic resonance brain imaging of a healthy person is shown in top row, a patient with mild cognitive impairment (middle) and a patient with Alzheimer’s disease (bottom) using DKI. Innovative Neurotechnologies) initiative. “A biomarker tries to detect something that changes early on in the disease that sends up a red flag and notifies us that things are going bad,” Obama said. MRI is based on the ability to get signals from water molecules in the body and turn them into images for clinicians. It can be done non-invasively and without the radiation concerns of other types of scans. For DKI, Helpern said it all involves studying the random walk of a water molecule, which is called diffusion. “Water communicates in a language that allows us to ask
certain things about its environment. I can ask the water molecule, for example, how far can you travel before you bump into something? The water molecule, through all the technology of computers and big magnets says, ‘I can travel about 10 microns before I bump into something.’” He then can ask if it can travel in all distances equally or if there is one hallway that’s easier to travel. In scientific terms, that’s called anisotropy, and it turns out that axons or the wiring in the brain are like tubes that water can travel down easily. Interestingly, the water molecules behave differently in various sections of the brain, such as traveling through white and gray matter, for example, and researchers can use this information to assign different color scales in DKI. Imaging scientists then can use DKI to see the microarchitecture of neural tissue and identify early changes that could be predictive of Alzheimer’s much as a structural engineer could note cracks and structural changes in a building’s walls and avert danger. “This paper shows that our diffusional kurtosis imaging is sensitive enough to be able to separate people with normal aging from people with mild cognitive impairment. That’s actually pretty big because we’re already pretty good at diagnosing Alzheimer’s disease. We need to be better at diagnosing them earlier in the disease.” DKI, which has been licensed to Siemens Medical, is currently implemented in scanners at more than 150
sites worldwide. The goal is to develop the tool’s power. “It’s a language we’re developing, but we haven’t
See IMAGING on page 9
THE CATALYST, June 28, 2013 9
MUSC, RiverDogs support N.Y. Yankees’ HOPE Week T he New York Yankees, the parent organization of the Charleston RiverDogs, will celebrate HOPE Week beginning July 8. The Yankees’ HOPE Week initiative (Helping Others Persevere and Excel) is rooted in the belief that acts of goodwill provide hope and encouragement to more than just the recipient of the gesture. The RiverDogs will participate in events to garner awareness for highlighted causes, individuals and organizations. MUSC’s Office of Health Promotion and the RiverDogs will team up to support the American Lung Association for a day of fitness on July 9. To recognize the work of the ALA and to help promote its annual Fight for Air event, the RiverDogs will host two trial climb events – one at the North Charleston Coliseum and the other at MUSC. All students, faculty, staff, and members of the community are invited to participate in the 1,000-step challenge throughout the day. All who complete the challenge will receive a free ticket to the RiverDogs home game that evening. The main event, which will feature a visit from RiverDogs players and giveaways, will be held in the North Tower stairwell between 11 a.m. and 1 p.m. All participants must complete at least one trip up and down the North Tower stairwell, which is 200 steps, during that time. All other steps may be completed at any point, in any stairwell on July 9. Participants are required to keep track of their own steps completed throughout the day. During the main event, the Outta My Huevos food truck will be parked at the Horseshoe, and Sodexo employees will sell boxed lunches, including bottled
water, for $5. There will also be an ALA representative available to help sign participants up for the Fight for Air climb on July 20. Each person who signs up for the climb during MUSC’s trial event will receive a pedometer. To learn more about the American Lung Association’s Fight for Air climb, visit www.lung.org/ pledge-events/sc/north-charleston-climb-fy14/.
Employee Wellness events ! Farmers markets: Fresh fruit and vegetables are available from local farmers on Friday from 7 a.m. to 3:30 p.m. at the Horseshoe. ! Employee Fitness Series: Pilates will be held from 12:15 until 12:45 p.m., July 17. The free class will be led by Katie Blaylock from the MUSC Human Performance Lab. Participants should check in at the Wellness Center membership desk for directions to the class and will receive a free one-day pass to the Wellness Center. E-mail musc-empwell@musc.edu to register. ! Worksite screening: A screening, valued at $350, will be available July 17 in the 2 West classroom of the university hospital. The screening is available to employees and their covered spouses with the State Health Plan for $15. Employees and their spouses without the insurance can participate for $42. The screening includes: height, weight, blood pressure and a blood draw for a blood chemistry profile, hemogram, and a blood lipid profile. To register, go to www.musc. edu/employeewellness and click “Worksite Screening Appointment.” ! MUSC Healthy Challenge Tuesdays with the RiverDogs: Tuesday night games are geared toward
living and promoting a healthy lifestyle and feature a sponsorship from the MUSC Wellness Center, Healthy Charleston Challenge and MUSC Urban Farm. Healthy concessions are available throughout the season and feature the farm’s veggie taco, which is made from crops grown on the farm. Discounted tickets to all Tuesday games with reserved group seating just for MUSC are available online. Tickets must be purchased by noon the day of the game. Gates open at 6 p.m., and the game time is 7:05 p.m. To purchase discounted tickets, visit http://cr1.glitnirticketing.com/crticket/web/gpcaptcha. php. When prompted to enter the group password, type “healthy.” Be sure to stop by the MUSC table to enter a drawing for free Wellness Center passes and other health and wellness giveaways. MUSC Urban Farm ! Lunch & Learn: On June 27 from 12:15 until 12:45 p.m., sustainability manager Christine Von Kolnitz Cooley will demonstrate various types of composting suitable for home use. ! Early-bird maintenance: Get your day started with a little Urban Farm tender loving care from 7:30 until 8:30 a.m., July 3. ! Work and Learn with child-friendly activities: On July 6, from 9 until 11 a.m., bring a plastic bag and take home some fresh produce in return for work efforts or help gather for donations. Wear closed-toe shoes. No experience or prior knowledge is necessary. The event is open to the general community. Email johnsusa@musc.edu for information on the Office of Health Promotion or email whela@musc.edu for information on Employee Wellness.
IMAGING Continued from Page Eight developed it enough so that we can ask all the right questions.” Yet, that is. The pieces are coming together to radically shape imaging diagnosis in a variety of medical areas. Helpern and colleagues have another paper coming out in the journal Human Brain Mapping highlighting work being done in ADHD, which affects so many children now. “This paper shows that the developmental trajectory – how the brain forms, its wiring and how it builds itself in the early stages between 8 and 18 in normal children is different than in ADHD children. This is hard physical, imaging evidence that these children are different. There are real microstructural differences. That’s really significant because we need better quantitative and objective tools for diagnosis.”
Researchers assign color scales in DKI to identify the microarchitecture of neural tissue. It’s also significant because it provides an objective tool to see the effectiveness of medications, an area of interest for upcoming studies. Helpern said that two other areas of excitement for DKI are in the areas of stroke and epilepsy. “The hot area in stroke right now is in rehabilitation. If someone has a stroke
the question is whether or not there are enough other areas in the brain that can help regain the loss of function, such as motion and talking.” Helpern said researchers are measuring the functional activity of stroke patients along the cortical spinal track, an area related to the ability to move their legs properly. The images are taken preand-post physical therapy to see which patients will respond to this kind of therapy. It could potentially be a very helpful prognostic tool for therapists, he said. With epilepsy, it can be very difficult to locate exactly where in the brain the problem of seizures originates. Some patients don’t respond to drugs and have to have surgery, where a part of their brain causing the seizures is removed. “I think everyone can understand why it’s so important to get that right.”
It’s a very costly process to get the matrix right using a variety of medical techniques to make this determination, he said. “The initial results that we’ve gotten from DKI are really are quite spectacular. We’ve stumbled onto a new imaging modality that is exquisitely sensitive to brain changes in epilepsy.” It can radically affect research into treatment options. For example, conventional imaging used for temporal lobe epilepsy shows primarily one area of the brain lighting up. Using DKI, larger areas of the brain light up as well, giving researchers new clues into the disease. “Now we can start to formulate hypotheses about what is going on and what we can do for treatment, as well.” For additional information, visit http://tinyurl.com/helpern or http:// musc.edu/pr/newscenter/2013/ccad. html.
10 THE CATALYST, June 28, 2013
Study improves pretreatment seizure care The Society for Clinical Trials has awarded the 2012 Trial of the Year to a study conducted by MUSC’s Data Coordination Unit and sponsored by the National Institute of Neurologic Disorders and Stroke. The study, Rapid Anticonvulsant Medication Prior to Arrival Trial (Silbergleit, Durkalski et al, New England Journal of Medicine, Feb. 16, 2012), was conducted in children and adults by the NINDS-funded Neurological Emergency Treatment Trial Network. As a result of this year’s winning study, emergency medical technicians have a faster and more practical way of treating a lifethreatening seizure condition before patients reach the hospital. Each year the Society for Clinical Trials presents an award to the randomized clinical trial published in the previous year that best fulfills the following standards: improves the lot of humankind; provides the basis for
a substantial, beneficial change in health care; reflects expertise in subject matter, excellence in methodology, and concern for study participants; overcomes obstacles in implementation; and, presents its design, execution, and results in a model of clarity and intellectual soundness. At MUSC, DCU played a vital role in the statistics and data management for the Rampart trial. “It was a unique trial that had several challenging aspects,” said Valerie Durkalski, Ph.D., the lead biostatistician for Rampart and DCU director. “It takes several years for a study of this magnitude to get to this stage, and we are very excited to share results that could potentially change clinical practice for the pre-hospital treatment of status epilepticus.” Lead investigators from the winning trial addressed the society at a plenary session during the annual meeting held in Boston in May.
THANK YOU Continued from Page One Rehabilitation would be the next difficult hurdle for the family to cross. Initially, Jason was denied access to rehab because he couldn’t hold up two fingers. A chance meeting during a smoke break changed all of that. “I went down to a smoking area MUSC used to have. I was crying and mad. This guy walked up to me,” Jim said. “His name was Rob Merenbloom, and he asked if I was OK. I shared with him what had just happened. He said, ‘Walk with me.’” The next day, Jason was in rehab. “The old saying is ‘It ain’t what you know; it’s who you know,’” Jim said. It took a moment in the middle of a bridge at 2 a.m. for Jim to understand what he feels is the real reason his son is still alive. During an exceptionally difficult time in the hospital, Jim became outraged and blamed God for his son’s situation. While driving across the Cooper River Bridge, Jim said his outlook suddenly changed. “God spoke to me on that bridge. He said, ‘Jimmy, the boy was mine before he was yours; ain’t nothing you can do about this.’” Jimmy pulled over, and his wife, Patricia, who was driving behind him, followed suit. “I got down on my hands and knees in the median out there. I said, ‘Lord, I ain’t mad at you anymore. If you want him, he’s going to be better off with you than with me.’ I said, ‘You gave me your
Jim Harrison, right, with his son, Jason, visited MUSC. Jim believes ‘God worked through this hospital, putting the right doctors in the right place.’ son, Jesus. I’ll give you my son, Jason.’ You want to talk about a burden lifted. Everything got good then.” The following day, Jason’s life support was unplugged, and he began breathing on his own. “God worked through this hospital, putting the doctors in the right place. MUSC is the greatest place to be,” Jim said. “I’ve said it to everyone I know. If you’re sick, go to your doctor. But if you’re really sick, go to MUSC.” Jason was discharged from MUSC on May 14, 1998. Back at home, one Sunday morning around 5 o’clock, Jim
remembers Jason ringing a bell that his family had placed by his bed. “Jason wrote on a computer that was built especially for him, ‘Go buy me a walker.’ I said, ‘What do you want a walker for? You can’t walk.’ He said, ‘I can’t now, but I will walk in two weeks,’” Jim said. “Jason said, ‘Jesus sat on the foot of this bed and said I’d be walking, brushing my teeth and combing my hair in two weeks.’” Fourteen days later, Jason picked his walker up and started down the hall. Jim said it took him 45 minutes to make it to the bathroom, where he combed his hair
and brushed his teeth, before walking back to his bed. That day is something that Jason can look back on with pride. He’s now living on his own just a mile away from his father in a two-bedroom brick home on the corner. He still has some speech difficulties, but keeps busy by working as a cashier at Goodwill and driving his own truck around town. “Life is wonderful,” Jason said, as he sat in the Horseshoe near the Children’s Hospital in late May. He lives independently but calls his father every morning just to check in with him. “You want the best for your children,” Jim said. “When they get up in the morning and they say, ‘Hey old man, I just wanted to call you and let you know that I love you,’ it doesn’t get any better than that. That’s what life is all about.” Jason still golfs and is working on his game so that he can beat his father again, the way he could in high school. “I’m trying to get it back. I struggle. My body just won’t let me do what I know how to do sometimes,” Jason said. Now he has new hobbies that his body can handle easily. “I love to cook. I cook all the time. You name it, I cook it,” Jason said. He enjoys making chicken bog periodically, along with fried pork chops, rice and gravy. The now 33-year-old man, who wasn’t supposed to survive the night, is also known for whipping up a “killer mac and cheese.”
THE CATALYST, June 28, 2013 11
Items for Sale Mac Pro 2.66 Quad core. 16GB ram OSX ML. 843-696-1331
End of life decision to be held July 25 A seminar titled, “End of Life Decisions,� will be held at 6 p.m., July 25 at the Charleston County Library, 68 Calhoun St. The seminar will be presented by Dr. Stuart Sprague, of the AnMed Family Residency program. As medical advances enable people to live longer, increasing life spans introduce complicated ethical, spiritual, political and economic issues. Space is limited. For questions, call 805-6930 or email eagerp@ccpl.org. Visit www.ccpl.org.
12 THE CATALYST, June 28, 2013
SAVE THE DATE FACULTY CONVOCATION 5+0/.9+ 1,,<+::* ROBERT M. SADE, M.D.
9="@28&- 1=A=@? ')- ')(6 $ 3*6) #7 ,!=A ,>@4%;"!& 1=2>?%!>=7 $ ,,(()
THE MARALYNNE D. MITCHAM INAUGURAL LECTURESHIP “East & West: Cross-Cultural Implications on the Construction of Theory and Knowledge in Occupational Therapy” 10:15 a.m. to Noon, Friday, July 19 MUSC Institute of Psychiatry Auditorium Speaker: Michael Iwama, Ph.D., OT (c) Professor and Chair, Department of Occupational Therapy Georgia Regents University
Dr. Iwama is an internationally known champion for culturally relevant occupational therapy. He created the conceptual Kawa Model, now taught in occupational therapy education and adopted in clinical settings. The Mitcham Fund was established in 2005 to create, in perpetuity, an annual lectureship program for the division. For information, call 792-2239.
Women’s Club accepting nominees for scholarships The Medical University Women’s Club is accepting applications for scholarship recipients. All full-time MUSC students in their second or subsequent years from any of the six colleges are eligible. Previous applicants may also apply. Applications may be downloaded from http://academicdepartments. musc.edu/womensclub/scholarship.
htm. The deadline for submission is 4 p.m., Aug. 27. Applications may be submitted via email to muwcscholarship@gmail.com or dropped off at the Volunteer Services Office, 101 North Tower (behind admissions desk). For information on the scholarships, email Tiffany Talacs at muwcscholarship@gmail.com.