Orlando Medical News May 2022 by Orlando Medical News

MAY 2022

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The Sound of Healing: How Assembling an Orchestra can Improve Physician Well-Being

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CONTENTS 4

LEAD The Sound of Healing: How Assembling an Orchestra can Improve Physician Well-Being

PHYSICIAN SPOTLIGHT. “In Other Words”….with Scott A. Zenoni, MD

EOCC. EOC Foundation Helps the Community Grow

If Your Employees Still Use Remote Desktop Protocol to Work Remotely, Read This Now! (IT series part 3) Too Much Fat in the Liver Is the Leading Cause of Liver Disease in Adults and Children!

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When Depression Doesn’t Look Typical – Identifying the Signs

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The Sound of Healing:

How Assembling an Orchestra can Improve Physician Well-Being IN TWO PARTS

PART ONE: The Silent Epidemic Among Physicians

water and perform at such a high-level day after day, week after week, month after month, and now, year after year. This is burnout and it’s becoming the silent epidemic among physicians. Out of this pandemic, a need to decompress and connect emerged for many of us and, thus, something beautiful was born: the AdventHealth Orchestra. This new project started July 2020 at AdventHealth Orlando, at the height of the Delta surge, and it’s become more than a creative outlet for physicians. The AdventHealth Orchestra offers physicians, clinicians and health care workers the incredible opportunity to reflect, bond and heal through music.

By VINCENT HSU, MD, Epidemiologist and AdventHealth executive director of infection prevention

Just over two years ago in March 2020, the AdventHealth Central Florida Division cared for our first COVID-19 patient. Since then, our physicians and clinical teams have battled a virus that’s ravaged our patients; some have been friends and loved ones, and, unfortunately, it’s ongoing. During this “new normal,” the days have gotten longer, our sleep is shorter, and we hit the ground running to complete our ever-increasing to-do list at work – there’s never enough time in the day. The exhaustion, stress and depression mount. For many, myself included, it’s a struggle to keep your head above

Tuning in to Physician Burnout Music is a universal language. Personally, I have always used music to decompress – whether it be playing piano, violin or listening to music, as all can be especially soothing during tough times. When I sit down at our periodic practices and play, I can feel the stress melting away. Physician burnout is real, and as someone on the front-

lines, I’ve fallen victim to it during the pandemic. In fact, a recent Physician Burnout and Depression report researchers surveyed 13,069 physicians across 29 specialties between June 29, 2021, and Sept. 26, 2021, to assess their experiences with burnout, stress, and more. Of the physicians surveyed, 47 percent reported feeling burned out—an increase from the 42 percent who said the same a year prior. I can count myself as part of these statistics and I unequivocally know that participating in the AdventHealth Orchestra has helped improve my overall well-being. When playing an instrument, I can focus on the present and engage with other orchestra members in a meaningful way. I have known some of my colleagues in the orchestra for years, but others I only knew as acquaintances and some I had never met before until we sat down to play music together. We share a common bond as health care workers, managing the same internal struggles of stress and burnout. But now we have a stronger bond and friendship through our music together. It’s a double dose of healing therapy for me and a great source of joy.

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PART TWO: The Healing Power of Music By OMAYRA MANSFIELD, MD, Emergency medicine physician and chief medical officer for AdventHealth Apopka, as well as the chief medical officer for the AdventHealth Central Florida Division’s physician experience.

As an emergency medicine physician, I’ve seen just how easy it is for those who are overwhelmed and stressed to fall into negative habits. And for those on the frontlines of the pandemic, finding constructive relief from COVID-19’s constant, chronic stress has never been more important. We all need to heal from the trauma of the pandemic and surrounding yourself with others who are facing similar challenges – like the team does through the AdventHealth Orchestra – is a fantastic example of healthy and healing outlet for clinicians. A National Institutes of Health study shows playing a musical instrument is a prescription to guard against the daily pressures of life. Therapeutic outcomes of playing

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CONTINUED... Another form of healing therapy for some is talking things through. In fact, a recent Becker’s Healthcare article identified that for physicians struggling with overwhelming stress, confidential therapy sessions provided significant help. AdventHealth believes so strongly in supporting the health and well-being of our physicians and advanced practitioners that we’ve developed a website, AdventHealth.com/ProviderWellbeing, full of resources designed specifically for clinicians’ unique needs. Within our organization’s Central Florida Division, we’ve gone a step further and now offer all credentialed physicians and advanced practitioners – as well as their family members – six complimentary counseling sessions through The Center for Physician Wellbeing. I’m proud of the investments AdventHealth has made to address burnout, but know we still have more to go on this journey. The work that we’ve already accomplished in improving the physician experience is just beginning, but it is critical work and its work I’m honored to be part of.

music include better communication skills, improved emotional release, and decreased anxiety and agitation. In addition, musical training promotes cognitive function and a connection to others. AdventHealth’s orchestra offers colleagues both opportunities, creating a beautiful, memorable positive experience. If you think about it, an orchestra is similar to how we collaborate in health care. If we do not work together cohesively, we lose harmony. But when we work and play with our colleagues, the outcome can be magnificent. It’s these encouraging moments that give me hope to push forward into the next day.

Finding your Rhythm to Self-Care There are a multitude of healthy outlets to engage in. Some may choose to create music, while others are more drawn to reading or mediation. Another popular activity is anything physical – yoga and running are particularly good. No matter what it is – it has to work with your schedule, you have to do it regularly and it has to bring you joy.

Vincent Hsu, MD, is an epidemiologist and AdventHealth executive director of infection prevention and Omayra Mansfield, MD, is an emergency medicine physician and chief medical officer for AdventHealth Apopka, as well as the chief medical officer for the AdventHealth Central Florida Division’s physician experience.

WELL-BEING RESOURCES American Medical Association (Feb. 2022 well-being resources article) Coalition for Physician Well-Being (online resources page) American Medical Association (Ed Hub Module on physician burnout)

The AdventHealth Orchestra: The First All-Employee Orchestra in the National Health Care Systems History Watch the full performance Learn more A look behind the music

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PHYSICIAN || SPOTLIGHT SPONSORED BY

IN OTHER WORDS WITH

Scott A. Zenoni, MD We Can Curb Pedestrian Traffic Injuries – Be Seen, Be Safe Our Physician Spotlight this month features Scott A. Zenoni, MD, a trauma and acute-care surgeon at Health First’s Holmes Regional Medical Center, the Space Coast’s only Level-II Trauma Center. He is board certified in Surgical Critical Care as well as General Surgery and serves as the Trauma Center’s EMS liaison. He served in the US Marine Corps and is a combat veteran having been deployed during Operation Desert Storm in Iraq. Before becoming a surgeon, he had an extensive career in emergency medical transport. Starting off first as an EMT and Paramedic, he then went on to acquire his degree as a Registered Nurse (RN). As a Paramedic/RN in the ER, he transitioned to the helicopter EMS team First Flight in 2004. Zenoni then completed his Doctor of Medicine degree at Saint Matthews University School of Medicine in the Cayman Islands. He completed his General Surgery residency at Florida Hospital Orlando, followed by his fellowship in Surgical Critical Care at Orlando Regional Medical Center.

In Other Words ... by Scott A. Zenoni, MD

Away from medicine, Scott is an avid outdoorsman and committed triathlete. Before becoming a doctor, he was a touring wakeboarding professional. Earlier this year, he spoke about post-crash care at a symposium hosted by the Space Coast Transportation Planning Organization. During this time, he became increasingly passionate about getting the crash numbers down in the state of Florida, and therefore, hospital trauma admissions. His goal is simple – if you are on the road as a bicyclist, runner or pedestrian and you wear a light, it could save your life. So, Be Seen, Be Safe. The Be Seen, Be Safe campaign is about to launch, with Dr. Zenoni helping to provide lights to the community for public safety. Do not be surprised if you see him on a causeway or at your community park handing out lights in person. He’s also working on a community outreach program that will supply kids with bicycle helmets slated to begin this fall. This month, in our forum, Zenoni writes about an issue he faces too often in his work as a trauma and acute-care surgeon.

crucial hours. We must wear small lights before heading out to walk, run or cycle. I run and cycle with a solid LED white light clipped to my front, almost like a headlight, and a blinking red light clipped to my back, simulating a brake light.

Florida is No. 1 for pedestrian-versusauto injuries and deaths. Orlando is the No.1 metro in the nation. As a trauma surgeon, I see the carnage – as a triathlete and a fellow Floridian, I care. My message is, wear lights and look out.

There are three parts to this. Be Seen:Wear a light as well as reflective and bright clothing Be Safe: Walk, run and ride defensively. Keep your eyes off your phone. Don’t expect cars to see or stop.

Pedestrian safety on the nation’s roadways is an issue, but in Florida, it’s downright alarming. A recent report ranked metros in the nation by the incidences per 100,000 people of pedestrian-versus-automobile injuries and fatalities. Orlando came in No. 1, followed by Bakersfield, California, and Memphis, Tennessee. My own home area of Brevard County is No. 4, followed by seven more Florida metros in the next nine spots. Why? Like a lot of us living and working to make Florida great, I didn’t start out here. After high school, the call of year-round outdoors activities and watersports beckoned me. I became a touring wakeboard professional, then a paramedic and air transport nurse before medical school. Today, I’m a trauma surgeon and training triathlete. You might think I’m wondering, Why are so many Florida communities dangerous for pedestrians, runners and cyclists? No. That question doesn’t send me far for answers. Our climate is perfect for walking. We attract athletes and families alike. We’re a top trip destination. At night, we go for a bite or a drink often by foot or bicycle. Sadly, drivers are more distracted than ever before. Here on the Space Coast, our local newspaper reported distracted-driving crashes have soared 31 percent the past five years in Brevard County even as total crashes (including speeding, intoxication) are flat. Most of the deaths that resulted were of “vulnerable road users” – pedestrians, bicyclists and motorcyclists. Statewide, the Florida Department of Highway Safety and Motor Vehicles shows 70 percent of the hit-and-run crashes in 2021 killed non-drivers. These crashes, it found, were most frequent at night, dusk and dawn. No, the question I’m asking is, what can be done? At Health First’s Holmes Regional Medical Center, the Level-II Trauma Center I call home, we preach preventive medicine. We had 99 bicycle and 88 pedestrian-versus-auto accidents out of 2,875 total patients last year. They arrive mostly at night or daybreak. Let’s light non-motorists on our roadways at night. My awareness campaign, Be Seen, Be Safe, aims to change the culture around “vulnerable road users” during these

Consider the available light: If there’s no streetlamps, or there is fog – steer clear of road shoulders. As clinicians and healthcare leaders in our community, we must speak up about distracted driving, for sure. But we want to move the needle on pedestrian-versus-auto accidents, so we must also push pedestrians and athletes to do a better job of being seen at night. Common, clip-on LEDs are the bicycle helmets of our moment. Bicyclists, runners, even walkers should get in the habit of clipping lights on the front and on the back of the body. These LEDs are bright, affordable and last a long time (many are rechargeable).

I commute to work between about 3:45 and 5 a.m. It’s always dark, and I lose count of the number of people I see running and walking with no lights on who I don’t notice until I pass them. Kaitlin Donner, who coaches a lot of distance athletes in the area and co-owns New Wave Physical Therapy in Rockledge, told me, “I’ve almost run into several walkers or runners out walking dogs, and I’m moving at the speed of a runner and I don’t see them. Even the number of cyclists I see legally cycling to go to the beach on cruisers that don’t have lights on. I worry about motorists who aren’t going to have time to react to them, even in a 25-mph zone.” In the trauma department, the pedestrian-versus-auto injuries we see aren’t often fatal. But these patients have devastating traumatic brain and musculoskeletal injuries that leave them debilitated for life. It costs billions of dollars annually to treat these patients once they make it to rehab. As a department, we preach preventive medicine. Distracted drivers are dangerous to everyone on our roadways – themselves included – but the shortest distance to slashing the number of pedestrian-versus-auto accidents must be made by pedestrians and athletes. Let’s do better. Let’s Be Seen and Be Safe.

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EAST ORLANDO CHAMBER OF COMMERCE

EOCC || MEDICAL CITY

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EOC Foundation Helps the Community Grow

Coffee Club East: Often imitated, never duplicated…the ORIGINAL Coffee Club THURSDAY, MAY - 8:30 – 9:30 AM (1st Thursday of the month) Diversify Yourself for the Summer

BY DOROTHY HARDEE

Testimonial Tuesday on Location

TUESDAY, MAY 10 - 9:00 AM – 12:30 PM LIVE of Facebook & On Location

“The price of success is hard work, dedication to the job at hand, and the determination that whether we win or lose, we have applied the best of ourselves to the task at hand.” Vince Lombardi

Misters & Sisters Great Lunch Adventures

TUESDAY, MAY 10 - 12:30 – 1:30 PM Rock & Brews Oviedo

Having worked for the East Orlando Chamber of Commerce for six years, I am at no loss for interesting phone calls, inquiries, and information requests. I appreciate that people trust the Chamber as the new voice for business and the community. I chuckled to realize one caller used us as her turn-by-turn navigation system and another spent 20 minutes loudly expressing their displeasure with a company only to discover we were NOT in fact the “EEOC.” Just one letter off – so close. Outside of offering relocation and vacation information, one of the calls that strikes the biggest chord, especially in 2020 – 2022 is the individual seeking to start a new business and needing information about how to start. According to Sunbiz the number of business entities filing with the Department of State increased by 24,5464 between 2018 and 2021. Even in the wake of a pandemic, the Orlando region is welcoming more than 1,000 new residents a week according to the Orlando Economic Partnership. QuickBooks reported that the pandemic influenced how they wanted to work, ramping up their plans to startup a new business. The US Census Bureau has projected seventeen million businesses will launch this year based on early projections. Those dipping their toe into entrepreneurship have a desire to be their own boss and control their future. To fund these ventures, 67 percent use personal savings. We often get calls from soon to be self-employed asking what they need to do to start. Chukwuma Asala with Gaebler Ventures examined a few of the “rookie mistakes” people made when starting a small business. Common pitfalls included: • Lack of mentorship • Focusing on results, not growth & • Underestimating the time and effort required

The Hybrid Member Academy: Roadmap to Member Success WEDNESDAY, MAY 11 - 8:30 AM – 10:30 AM Hybrid Event - East Orlando Chamber office

Healthcare Council Meet & Greet

THURSDAY, MAY 12 - 7:30 – 9:00 AM Hosted by Modern Eyes at Alafaya and featuring April Boykin, MSW on Behavioral Health Modern Eyes at Alafaya

EOC Foundation “Day of Learning”

FRIDAY, MAY 13 - 9:00 AM – 2:00 PM Valencia College Lake Nona Campus $25 per person includes continental breakfast, lunch, and workshops from industry experts

EOCC Advocacy Advisory Council FRIDAY, MAY 13 - 10:00 – 11:00 AM Virtual Meeting Register to participate

EOCC Real Estate Advisory Council Planning Meeting TUESDAY, MAY 17 - 9:00 – 10:00 AM East Orlando Chamber of Commerce

Coffee Club Nona: Often imitated, never duplicated…the ORIGINAL Coffee Club THURSDAY, MAY 19 - 8:30 – 9:30 AM (3rd Thursday of the month) Speed Networking Sam’s Club Lake Nona FREE to EOCC Members | $10 for Non-Members

SmallBizClub also included: • Cash flow problems • Trying to do everything yourself • Not having passion • Not evaluating the market and • Marketing matters

#Buzz4Biz Meet & Greet for Chamber Curiosity Seekers MONDAY, MAY 23 - 10:00 – 11:00 AM East Orlando Chamber of Commerce

When Orange County shut down businesses for all non-essential business in April 2020, we heard the concerns of our members and spent a great deal of time listening to their needs to stay afloat. The newly formed EOC Foundation transformed from scholarships for college students seeking a degree in business to focusing on the needs of new business owners and those taking the next step of growth. Countless people we encountered had appreciation, but no idea the steps involved to build a solid foundation for sustained growth. A handful of resolute volunteers took a concept morphing it into a way in which to help new and existing businesses. Working in harmony with the East Orlando Chamber to be the leading resource in business advocacy, community engagement and regional connectivity, the EOC Foundation launched. As a 501c3, the EOC Foundation supports entrepreneurial trailblazers. The aim is to support small and medium enterprises to launch and expand their footprint with East Orange County. The Foundation will provide financial support, mentorship and guidance while paving the way for a suitable environment for the establishment and development of projects.

EOC Foundation Planning Meeting TUESDAY, MAY 24 - 9:00 – 10:30 AM East Orlando Chamber of Commerce

EOCC Nonprofit Roundtable

WEDNESDAY, MAY 25 - 9:00 – 10:00 AM “Value of Professionals in your Fundraising” Workshop Featuring Joe Girvan, Alpert Enterprises East Orlando Chamber

EOCC Ribbon Cutting: Freedom Solar WEDNESDAY, MAY 25 - 4:00 – 6:00 PM

EOCC Brain Trust

THURSDAY, MAY 26 - 8:00 – 9:30 AM East Orlando Chamber office

Memorial Day – EOCC Office Closed MONDAY, MAY 30 - 9:00 AM – 5:00 PM

Visit EOCC.org for a complete listing of May events

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We successfully launched a series of workshops in collaboration with member businesses including a successful MWBD certification workshop with Orange County. One reported that they have completed their application after years of feeling overwhelmed. In support of small business additional workshops will include funding and accounting, as well as marketing. On May 13, the EOC Foundation is partnering with Valencia College Lake Nona Campus and many of our East Orlando Chamber members to conduct a workshop during the Day of Learning. We are offering six sessions for attendees covering key content to build a strong business model and to expand into phase 2. Topics cover: • Business Plan, Elevator speech, MWBE Certification overview & Finances • Marketing, Branding & websites, establishing social media presence, creating client experience and vision, Press releases & Printing and promotion • Sales, HR & Payroll, Staffing • Tech IT, platforms, automation & e-commerce • Legal • Accounting, budgeting & balance sheets • Medical & liability insurance During the summer, the EOC Foundation will launch their microgrant application followed by a “Pitch Competition” for those successfully completing the process and meeting all the qualifications. Information about microgrant applications will be available at the EOC Foundation page. Are you or your company interested in sponsorship opportunities to support the microgrants? Contact me for more details. For more information or to register for events call (407) 277-5951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4.

If Your Employees Still Use Remote Desktop Protocol to Work Remotely, Read This Now! BY JAMES GENTRY

So, why does this matter to you? In 2017, an estimated 4.5M RDP ports (3389) were open to the Internet. Most were professionally deployed with the proper security measures. But everything changed in response to COVID-19. Suddenly millions of employees were forced to work from home, and in 2020, more than 10M new RDP ports were opened to the Internet. Unfortunately, in the rush, many RDP ports were opened to the Internet without proper security measures. Cyber criminals soon noticed the massive increase of unsecured RDP ports, and they exploited vulnerabilities to gain access to business networks. According to one cyber insurance provider, the number of Ransomware attacks tripled between March and April 2020, and the volume of successful attacks became so high that threat actors began bumping into each other during their criminal adventures. By the end of August 2020, some businesses were being extorted by multiple extortionists at the same time, and by the end of 2020, Ransomware attacks had increased by over 700%.

(Part 3 of a multipart series)

What is Remote Desktop Protocol (RDP)? Remote Desktop Protocol gives users the ability to connect to another computer over a network connection. When you connect to a remote computer using RDP, you are able to see the screen of the remote computer as if you are sitting in front of it. But RDP is also the leading cause of cyber insurance claims, as you will learn below. I’ll also give you some information about how to disable it, how to use it in a secure manner, and also some alternatives if you cannot secure RDP.

Here are some details and definitions you will need to know: • Remote Desktop Protocol: RDP was developed by Microsoft and has been included with every Microsoft Operating System since Windows XP. RDP already had widespread use prior to COVID-19, but once lockdowns forced employees to work from home, RDP use exploded. • Ports: Two types of ports exist:

How can you tell if RDP ports are open or if RDP is enabled?

• Physical Ports: The female jacks into which you plug network cables, these ports are on computers, servers, network switches, firewalls, etc.

If you have an IT department or have an outsourced provider, they can determine if you have open RDP ports. Because this probably requires access to your company firewall, it’s not something that you would be likely to find out on your own.

• Logical Ports: Known as “software” ports, these are assigned to different services and will be important for our discussion. More on this below. • Firewall/Router: Used to connect your business network safely to the Internet (but ONLY if properly configured), firewalls allow or deny access to certain ports on your network from the Internet. More on this below as well…

How do you disable open RDP ports?

www.cisecurity.org/insights/white-papers/intel-insights-how-to-disable-remote-desktop-protocol), but conferring with your IT folks first would be best. If you can’t use RDP, how can you connect to your work PC remotely? • Many vendors of software to allow remote access exist, including LogMeIn, Citrix, GoToMyPC, and others. These can be secure and relatively safe. But as before, you will want to consult with your IT people on this. You need to ensure the configuration is as secure as possible. • Have your IT people set up Multi-Factor Authentication (MFA) for your remote access, no matter what tool you use. • You can safely connect to your work PC if you have a VPN between your remote location and your company network. • You can have your IT people set up a Remote Desktop Gateway Server, but this is an expensive option for small businesses.

Final comments: RDP is useful but very unsecure. You MUST NOT have open RDP ports into your network unless they have been properly secured by a professional. Third-party remote software can be a great option, but MUST be configured properly, in particular with MFA. If you don’t have anyone to help, you can reach out to Atlantic Data Team, and we will help you determine—at no charge—if you have open RDP ports. We are committed to making the Web a safer place. In next month’s article, I will discuss Multi-Factor Authentication (MFA) and how effective it can be at stopping unauthorized access to your stuff. Until then, stay vigilant! James Gentry is the president of Atlantic Data Team, a central-Florida-based business IT company. If you cannot get a straight answer on whether you use filtering or not, we will be happy to help you, at no charge to determine if you are protected. We are committed to making the web a safter place. For more information go to www.atlanticdatateam.com or email office@atlanticdatateam.com

Your best bet is to have your IT folks help with this. You can disable RDP on your own PC, (https://

Part 1 Cybersecurity series Cyber Insurance Applications: New Stringent Requirements Are NOT Designed to Protect YOU

Part 2 Cybersecurity series Do You Use SPF, DKIM, and DMARC to Authenticate Outgoing Email?

JUNE 4, CLINICAL 2022 ADVANCES IN POLYCYSTIC OVARY SYNDROME

Let’s expand on Logical Ports for a moment. The best analogy I’ve seen for Logical Ports is telephone extensions. You make phone calls using a phone number, and then you connect to the proper phone by using an extension. Computers “phone” each other, using IP addresses, and they use ports to “talk” only to the correct service or application. For instance, all web browsers are designed to use port 80 or 443 to access websites. If a web address starts with HTTP://, it’s using port 80. If a web address starts with HTTPS:// it’s using port 443. The correct port is accessed automatically, so you don’t have to remember which port to enter. There are 65,536 Logical Ports, but we need to focus on port 3389—used for RDP. But first, let’s expand on Firewalls. When properly configured, firewalls allow “good” traffic to pass through from the Internet to your network and vice-versa. Most importantly, though, firewalls deny “bad” traffic from passing through. Key takeaway: We want to close all ports that might allow “bad” traffic to get to your network and potentially cause a malware infection or worse. If we open a port that is vulnerable, your network can be compromised with little effort.

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Too Much Fat in the Liver Is the Leading Cause of Liver Disease in Adults and Children! BY JOSEPH WEBSTER, MD, MBA, FACP

clinician must treat each patient as a possible candidate for fatty liver disease if the patient has any of the “high risk profile” variables listed previously. In the case of advanced liver disease with cirrhosis, the bedside exam may reveal either a very large liver or a shrunken liver with or without excessive fluid called ascites. Such cases are beyond medical intervention and may need liver transplantation for treatment or cure. A leading liver transplant surgeon highlights the “cycle of doom” that the NAFLD and ALCOHOLIC STEATOHEPATITIS creates because the pool of available “healthy livers” is shrinking as the pandemic spreads unmitigated. There are not enough healthy livers to keep up with the demand. An abdominal ultrasound is an inexpensive exam that does not expose the patient to radiation, and it has a degree of sensitivity that renders it cost effective as a screening test in the appropriate circumstances. Elastography is a more sensitive and specific test for liver stiffness, and it is a surrogate marker for liver fibrosis – the precursor to cirrhosis. Unfortunately, elevation of the liver chemistries is not specific for fatty liver, and they may remain normal for an extended period even though there is significant liver damage ongoing.

“The ills that have plagued civilized man are as much a part of civilization as are their prevention and cure”…. Frederick F. Cartwright, “Disease and History” 1972 The “developed nations” of the world have been blessed with “way too much food” per capita and the obesity pandemic is but one reflection of the unintended consequences of this blessing. However, a more devastating trade off has been the concomitant rise of liver disease in adults and children. Today, the leading cause of liver failure in the developed world is Fatty Liver Disease. There are two broad categories of Fatty Liver: Nonalcoholic fatty liver disease (NAFLD) and Alcoholic fatty liver disease or (Alcoholic Steatosis). NAFLD (Nonalcoholic fatty liver disease) is the type that is not associated with excessive alcohol use and there are two kinds: Simple fatty liver - excessive fat in the liver but no inflammation or liver cell damage. The other type is Nonalcoholic steatohepatitis (NASH) – excessive fat, plus inflammation and cellular damage. The cell damage leads to fibrosis and scarring of the liver, destroying the functional capacity of the liver and causing life threatening cirrhosis of the liver.

seven billion people may have NAFLD and it is the most common chronic liver disorder in the United States of America. On the other hand, Alcoholic Fatty Liver disease only happens in people who drink heavily for long periods of time. Obesity and postmenopausal women are more susceptible. Recent research suggests that there is some protective effect from estrogen levels, but the data requires further substantiation.

What is the cause of fatty liver disease? The cause(s) of NAFLD is unknown. Research indicates that is more common in certain circumstances: Type 2 diabetes; obesity; middle age; Hispanic or White; (less common in African Americans); high fat in the blood (triglycerides and or cholesterol); high blood pressure; certain medications (steroids; NSAIDS; methotrexate; etc.); metabolic syndrome; Hepatitis C; and rapid weight loss. Gut-derived Lipopolysaccharides and Oxidative Stress may contribute to the development of fatty liver disease. The suggestion is the gut biome and a ‘leaky gut’ and subsequent increase in oxidative stress leads to liver inflammation under the appropriate conditions. It is estimated that nearly 25 percent of the world’s

What are the Symptoms? Unfortunately, there are no symptoms until the liver is severely damaged with irreversible cirrhosis and end stage liver failure.

How is Fatty liver diagnosed? The “standard” history, physical examination and routine labs will not render a diagnosis of Fatty Liver with any degree of sensitivity over 95 percent of the time. The

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Who is

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Can fatty liver be treated? There are no approved medications for treatment. For NAFLD aggressive weight loss (at least 7 percent of body weight) has been associated with reversal of fatty deposition and inflammation as well as fibrosis. Any contributing factors such as medications should be discontinued, working in conjunction with the PCP (primary care physician). For Alcoholic Steatosis the first line of treatment is complete abstinence from alcohol. Both ALD and Alcoholic Steatosis can lead to cirrhosis. There is no treatment for ‘reversal of cirrhosis’ but the medical management of liver failure has been established by consensus of multiple professional associations nationally and internationally.

Do children get NAFLD? NAFLD is the most common cause of liver transplants in young adults (< 50 years old) and between 5 percent and 10 percent of children globally have NAFLD according to the Study of Child and Adolescent Liver Epidemiology (SCALE). Over 50 percent of children with NAFLD have inflammation and fibrosis, or NASH at the time of diagnosis. The risk factors for children include prediabetes and obesity. In children the microbiome appears to be a definite risk factor and the lack of “diversity” or gut dysbiosis, increased the risk of severe NASH. However, the strongest risk factor in children is obesity. Additional risk factors include male gender, Hispanic, and older age. It is less common in girls and African Americans.

Can NAFLD in children be treated? There is no specific treatment. The best treatment is a high index of suspicion and early diagnosis in the high-risk group. OBESITY PREVENTION should be the target for all children and their families. NAFLD often is a ‘family affair’! The medical community cannot cure NAFLD, but collaborating with the broader community - we can PREVENT IT. We often spend too much time hoping for something in the future – instead of taking charge of that which is clearly at hand! Together, we can Prevent and Cure Obesity! Our civilization is hanging in the balance!

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URINE AND ORAL TOXICOLOGY RESPIRATORY PATHOGEN PANEL FILMARRAY GASTROINTESTINAL PANEL

Joseph Webster, MD, MBA, FACP is a gastroenterologist at the Digestive and Liver Center of Florida. He received his medical training at the Miller School of Medicine at University of Miami and U.C.L.A Medical Center in Los Angeles, California. His research interests are obesity and diabetes in children and adolescents while making sure he provides value-based care for families. His innovations in gastroenterology led to professional and community honors, invited to seminars and medical research.

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When Depression Doesn’t Look Typical – Identifying the Signs BY APRIL BOYKIN, LCSW

more additional symptoms required from the following: depressed mood that is worse in the morning, waking 2 hours earlier than usual, observable psychomotor slowing or agitation, significant weight loss or anorexia, or excessive or inappropriate guilt. This subtype is more common in inpatients or those with comorbid psychotic features. It is shorter in duration, more episodic, and features diurnal variation – that is an early-morning worsening of mood, with an afternoon slump or evening worsening.

Many times, patients self-identify as “depressed” which triggers clinicians to probe deeper in making a proper diagnosis. But often patients are not able to thoroughly assess and communicate their symptoms. What does depression look like when it doesn’t follow the typical pattern? Here we explore the different signs and symptoms that could often lead to an undiagnosed clinical depression. The DSM V identifies major depressive disorder (MDD) as requiring 5 of the following symptoms: depressed mood, loss of interest, weight loss or gain (5%+), sleep disturbance (insomnia or hypersomnia), psychomotor changes (agitation or slowing), fatigue, worthlessness, difficulty concentrating or making decisions, or suicidal ideation. These symptoms persist most of the day, daily, for 2+ weeks. This form of depression is the most commonly diagnosed. In the United States, the annual prevalence is 7%, with a peak age of onset in the mid 20’s. 18 to 29-year-olds have a prevalence three times higher than individuals 60 and older. Females have a 2 to 3 times higher rate than males. The course varies greatly ranging from chronic to large episodes of being symptom free, and 50% of depressive episodes are brief and resolve within three months. MDD is associated with chronic medical conditions including heart disease, arthritis, back pain, chronic pulmonary disease, asthma, hypertension, and migraine, and associated lifestyle risk factors include a more sedentary lifestyle, obesity, and cigarette smoking. But what about symptoms that don’t fit the usual clinical presentation? Atypical depression (AD) has a different presentation which is more difficult to identify. In AD, there is a significant mood reactivity – meaning the patients mood brightens in response to actual or potential positive outcomes. Additional criteria include two or more of the following symptoms: significant weight gain, increase in appetite, hypersomnia, leaden paralysis, and a long-standing pattern of interpersonal rejection sensitivity that results in significant social or emotional impairment. In AD, we can see that the mood reactivity may cause a misleading presentation of the depression and thus may result in the underdiagnosis of depression. Additionally, the interpersonal rejection sensitivity many mislead the clinician to a diagnosis of personality disorder. AD depression is associated with conduct disorder, social phobia, interpersonal dependency, low self-esteem, and parental substance abuse, and higher rates of early childhood trauma, whereas melancholic depression is not. When assessing for Atypical depression, it is helpful to remember the acronym RAILS:

• • • • •

Catatonic Depression – AD requires differentiation from another subtype of depression including catatonic depression. This is characterized by 3 or more of the following psychomotor features during most of the depression episode: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, not influenced by external stimuli, grimacing, echolalia, or echopraxia.

Anger and Irritability – The public perception is that sadness is the leading symptom of depression. However, irritability or anger can be the dominant symptom presented. In these individuals, they experience being easily triggered which is well noted by either themselves or those around them. Try asking “is anger something you notice experiencing most days? Have you experience this most of your life or is it new to you?” It is important to consider depression presenting as anger versus the irritability and anger that can be seen in individuals with bipolar disorder. Vague Physical Complaints – Many individuals have a hard time identifying their own emotional state. In asking them about mood symptoms, they may minimize or deny their existence. Some patients more readily express physical symptoms. When patients present with vague physical

R - Reactivity in mood A - Appetite increase I - Interpersonal rejection sensitivity L - Leaden paralysis S - Sleep increase

Interview questions that will help to differentiate Atypical Depression from Major Depressive Disorder. These include: Do you notice if your mood improves when people try to cheer you up, or give you a complement? Do you notice that your depression lifts if the situations around you stay positive? Have you noticed an increase in appetite or weight? Have you noticed feeling sensitive about being rejected by others? Has this always been the case? How much more? Have you noticed feeling heavy, or weighted down in your arms or legs a few hours each day? Do you notice that you are sleeping more than usual?

Melancholic Depression – AD requires differentiation from other related subtypes including depression with melancholic features. This subtype presents as a near complete loss of pleasure in almost all activities or a lack of reactivity to usually pleasurable stimuli. What differentiates it from the other depressive diagnoses includes the 3 or 11

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complains, or moving physical ailments without identifiable medical conditions, a diagnosis of depression should be considered. Try asking “when did you start to notice this physical sensation? Can you tell me what life events were going on at that time? Can you tell me what you are thinking/feeling when you notice this physical sensation?”

Treatment – regardless of the presentation type of the depressed patient, a multi-pronged approach is key. Education about the benefits of healthy behaviors including movement, exposure to sunlight, proper sleep hygiene, and social support begins the process. In some cases, a psychiatric medication trial may be necessary. Most importantly, research indicates that participating in psychotherapy (specifically CBT), vs medication alone creates the most optimal and longer lasting therapeutic outcomes. In fact, research indicates that medication monotherapy has a recovery rate of 30%. Identifying the type of depression greatly effects the type of medication treatment utilized. The first line of treatment for Major Depressive Disorder is typically SSRI’s. However, research suggests that Melancholic Depression responds better to TCAs and ECT. IN contrast, Atypical Depression has a poor response to TCAs and ECT, but excellent response to MAOIs. Partnering with a mental health professional can help you identify the specific mental health diagnosis, as well as aid in the development of a treatment plan that will help the patient regain their quality of life. April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults. She can be reached at april@counselingresourceservices.com

CME Symposium on Clinical Advances in Polycystic Ovary Syndrome to Convene in Orlando Nationally recognized clinicians and researchers to offer presentations FROM PCOS CHALLENGE

and anxiety. As there is no cure, goals for management of PCOS include alleviation of clinical signs of hyperandrogenism, ovulation induction for infertility, and appropriate therapeutic screening for metabolic disorders that increase cardiovascular risk. Weight loss and calorie restriction is recommended with exercise in women with BMI>25 kg/m2 given the unique condition of insulin resistance in women with PCOS worsened by weight gain more than in non-PCOS women. Metformin is recommended for women with impaired glucose tolerance or type 2 diabetes and may benefit women with an elevated BMI. Hormonal contraception is first line to improve menstrual cycle irregularity, hirsutism, and acne while the progesterone component protects against estrogen-medicated endometrial proliferation. A multidisciplinary approach to the management of PCOS is vital given the broad reach of this medical disease. Because PCOS is so heterogenous and is a diagnosis of exclusion, and the understanding of the pathophysiology and recommended treatments has changed with time there are gaps of knowledge and a lack of consensus in the definition of PCOS as well as the diagnosis, management before and in pregnancy, and

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women with a prevalence ranging from 10-20 percent. It was first described in 1935 by Stein-Leventhal based on the signs of obesity, hirsutism, irregular periods and polycystic appearing ovaries at the time of surgery. As a prominent etiology of female infertility, PCOS is diagnosed when two of the following three criteria are present - hirsutism or elevated androgens, ovulatory dysfunction, and ovarian morphology on ultrasound. Not limited to impairing fertility, PCOS is associated with a 2 to 4 times higher rate of the metabolic syndrome (MS) than in the general population, with a prevalence rate of nearly 40 percent. MS is a collection of diseases that increase morbidity and is diagnosed with 3 of the 5 criteria – blood pressure greater than 130/85, fasting glucose 100 mg/dL or higher, waist circumference of 35 inches or higher, triglycerides greater than 150 mg/dL or higher, HDL 50 mg/dL or lower. Other non-fertility related conditions of PCOS include uterine cancer, sleep apnea, cardiovascular disease, depression

the long-term risks and complications associated with PCOS. Therefore, we have organized a symposium to collaborate with diverse experts in the field of PCOS including internal medicine, scientists, geneticists, and reproductive endocrinology and infertility specialists to summarize new treatments and breakthroughs in PCOS. The CME Symposium on Clinical Advances in Polycystic Ovary Syndrome offers expert presentations from clinicians and scientists who are nationally recognized as leaders in this field. The topics cover the multifaceted disease that is PCOS. Drs. Laurel Stadtmauer and Mark Trolice from The IVF Center and Professors at the University of Central Florida College of Medicine are Co-Program Directors and will discuss “PCOS: Past, Present, and Future” as well as “Infertility Management in PCOS,” respectively. Lucy Chen MD from the Johns Hopkins University School of Medicine will address “Genetics of PCOS.” Anuja Dokras MD, PhD from the University of Pennsylvania will present “PCOS and its Effect on Pregnancy and the Peripartum Period.” Katherine Sherif MD will address, “Optimizing Preconception Health in PCOS Patients.” Shruthi Mahalingaiah MND from the Harvard T.H. Chan School of Public Health presents “Findings from the Apple Women’s Health Study.” The symposium will take place June 4, 2022, at the Bohemian in downtown Orlando and the target audience is providers involved with Women’s Health. For registration – http://pcos.ch/cap-2022

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Orlando Health Orlando Regional Medical Center Uses New Technology to Train Surgeons Virtually Expert surgeons use the new telepresence technology to train and mentor surgeons from around the world in robotic-assisted surgery techniques

procedures safer for patients.” The surgeon-led education experience takes place using the telepresence platform that features two-way audio and video communication. While the surgeon performs the procedure, observation participants can select from multiple camera angles for up-close views of the surgical system and tools. In addition, the surgeon performing the procedure can use a tablet view to show participants more specific views. “While virtual, this platform closely resembles in-person surgery case observations,” said Dr. Sanchez. “The experience eliminates the time and cost constraints of travel, while allowing for needed ongoing training. Surgeons can continue their commitment to learning without leaving their location.” Orlando Health ORMC will use the platform for bariatric and thoracic surgeries – two surgical specialties marked by growth in robotic surgery in recent years. Luis Herrera, MD, thoracic surgeon, medical director of the Rod Taylor Thoracic Care Center at Orlando Health Cancer Institute, and Andre Teixeira, MD, bariatric sur-

Orlando Health Orlando Regional Medical Center is on the cutting edge of virtual training for surgeons in robotic-assisted surgery techniques. Orlando Health ORMC uses the Intuitive Telepresence Platform to train and mentor surgeons and surgical teams throughout the state, across the country, and around the world. The addition of the new technology strengthens the hospital’s distinction as a leader in robotic surgery with its 2,000 such surgeries in fiscal year 2021, and as a designated da Vinci robotic surgery case observation site. Case observation site selection is based on a surgeon’s expertise, experience, and excellent outcomes. Criteria includes a requirement of more than 700 cases using the da Vinci technology, made by Intuitive. Annually, less than two percent of all active surgeons in the United States qualify. “As leaders in the field of teaching innovative surgical techniques, we embrace the opportunity to help surgeons increase their knowledge and skills,” said Alexis Sanchez, MD, MS, MBA, senior director, Robotic Surgery Program, Orlando Health. “Peer-to-peer learning and development is a key factor in surgical education and in making surgical

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geon, Orlando Health Weight Loss and Bariatric Surgery Institute are the expert surgeons leading the surgery case observations. Robotic-assisted surgery is an advanced minimally invasive technology for patients. Benefits include smaller incisions, less trauma, shorter recovery time, and quicker return to normal activities. For surgeons, the benefits include more precise instruments, increased vision, and total control of more aspects of the operation. Orlando Health offers robotic-assisted surgery in the following surgical specialties: colorectal surgery, gynecologic oncology surgery, gynecologic surgery, head and neck surgery, reproductive endocrinology and infertility, robotic general surgery, thoracic surgery, urogynecologic surgery, urologic surgery, and weight loss/bariatric surgery.

ORLANDO || GRAND ROUNDS

more than 11,000 physicians, 77,000 colleagues, 49 hospitals and more than 450 physician practices, freestanding emergency rooms and urgent care centers.

HCA Florida Lake Monroe Hospital Expands Joint & Spine Program

AdventHealth Winter Garden Opens Inpatient Tower AdventHealth Winter Garden has opened its new inpatient tower, a $229.5 million expansion that includes all private rooms and the ability to provide critical services for residents in fast-growing West Orange County. The five-story tower has 80 private rooms and space for new services, including orthopedics, advanced gynecology, cardiology, gastroenterology, general and robotic surgery, neurology, spine health, colorectal, and urology. The expansion adds about 227,000 square feet to the campus in Winter Garden. “We are thrilled to bring inpatient services to the city of Winter Garden,” said Kari Vargas, CEO of AdventHealth Winter Garden and the West Orange and South Lake market. “Our commitment to our patients is to provide accessible, state-of-the-art care, and we are keeping that promise to our community.” The new inpatient tower will bring an estimated 400 medical and support jobs to the community. The completion of this project is the latest in a series of additions to the campus since the opening of the emergency room in 2016. “Providing care in a convenient location close to home is a key part of our mission,” said Dr. Miles Bennett, chief medical officer for AdventHealth Winter Garden. “We know that the presence and emotional support of loved ones during a hospital stay helps the healing process.”

SANFORD - HCA Florida Lake Monroe Hospital, an affiliate of HCA Florida Healthcare, recently announced an expansion of its Joint & Spine Program, providing a boutique experience for patients undergoing joint or spine surgery. “Our team is committed to meeting the growing needs of our community,” said Trey Abshier, CEO of HCA Florida Lake Monroe Hospital. “Many adults are immobilized by back or joint pain at some point, making it one of the most common reasons people go to the doctor. With the expansion of our Joint & Spine Program, our patients are able to address these issues from diagnosis to treatment and rehabilitation in one place, ensuring they receive seamless care.” The Joint & Spine Program expansion adds six beds, allowing HCA Florida Lake Monroe Hospital to care for more patients in need; an additional rehabilitation gym specifically designed for joint and spine surgical patients; and a new multipurpose room for patient and family education, pre-op classes and dining. The expansion also includes private parking with a new convenient pick-up location for all discharged patients. In addition to the facility expansion, HCA Florida Lake Monroe Hospital is also expanding the unit’s staff with additional ortho-certified nurses to provide industry leading care. All patients receiving orthopedic or spine surgery also have access to the hospital’s Ortho/Spine Nurse Navigator, a central point of contact to guide patients through the surgical process as seamlessly as possible while also helping to streamline communication among the care team. HCA Florida Lake Monroe Hospital is a certified Total Joint Program by The Joint Commission. Last month, Central Florida Regional Hospital in Sanford changed its name to HCA Florida Lake Monroe Hospital, signaling its connection to the state’s largest collaborative health care network. More than 450 affiliated sites of care across the state officially adopted the new HCA Florida Healthcare name on March 3. This transformation connects HCA Florida Lake Monroe Hospital to

U.S. Rep. Murphy Secures $400,000 Appropriation for Adventhealth’s Opioid Treatment Center SANFORD — Congresswomen Stephanie Murphy on Monday announced a $400,000 federal appropriation for AdventHealth’s Hope & Healing Center, ensuring that Seminole County residents can continue to access transformative treatment for opioid addiction. The Hope & Healing Center opened in 2019 as a partnership between the Seminole County Sheriff’s Office, Seminole County EMS/Fire Rescue, the Board of County Commissioners and AdventHealth to address the opioid crisis through a holistic, compassionate approach. “In the last dozen years, over half a million Americans have died as a result of opioid overdoses and countless others have had their lives destroyed,” Murphy said. “And we should never lose sight that behind every abstract statistic about opioid addiction, there’s a very real and a very personal tragedy. It’s a shattered human life, it’s a brokenhearted family and there’s a distraught community and spiritually and economically diminished nation.”

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With the help of local, state and now federal funding, the Hope & Healing Center offers a 30-day inpatient program as well as intensive outpatient treatment, including individual and group counseling, substance-related and recovery-focused education, reflection and spiritual healing groups, and career and housing assistance. This latest funding will enable AdventHealth to continue offering treatment to anyone who needs it, regardless of socioeconomic status or if they have insurance. “We don’t turn people away,” Tim Cook, AdventHealth Seminole County CEO, said at a news conference Monday morning. Cook added: “The people who come here come from multiple different places in their life. Most of them would come potentially after an overdose or a near overdose and show up in our emergency department. But then where do they go? Maybe back home to the same neighborhood, same environment. Here, now they have a bridge where they can take a pause, get some support, therapy, treatment and then re-enter their lives from a different perspective.” Since the Center opened it has served about 180 people, and already the Seminole County community has seen a decline in opioid overdoses and deaths. “As we’re seeing numbers rise across the country and state of Florida, we’re starting to see promising results here in Seminole County. We have had a 25% decrease in overdoses and 39% decrease in overdose deaths,” Seminole County Sheriff Dennis Lemma said. “One life less than what you had last year is progress, but we never anticipated we’d see these kinds of results.”

Dementia-friendly Dining Restarts Orlando — Dementia-friendly Dining restaurants are food service establishments that provide friendly, safe, and enjoyable places where families and friends may bring their loved ones who are living with Alzheimer’s and other forms of dementia. Initially starting in January 2020, Dementia-friendly Dining in Central Florida was put on hold due to COVID. Now that our positive cases are lowered, we can resume sharing a meal out of the house among families and friends that reduces isolation, increases social contact, encourages opportunities for engagement, stimulation, communication and creates memories. These quality-of-life experiences expand making our community more dementia-friendly. Compassion, understanding, shared caregiving and a more relaxed and enjoyable meal is a joy for all! Dementia-friendly Dining in Central Florida was started by Dennis Dulniak, Care Partner for his wife Nancy who was diagnosed with Early Onset Alzheimer’s in 2015. Though she passed on in January 2021, he continues to team with Toni Gitles, author and Certified Caregiving Consultant for identification and training of restaurant staff and servers. Oviedo’s The Townhouse Restaurant, 139 N Central Avenue, will lead the Central Florida Dementia-friendly places when they open their back room every Wednesday from 2 – 5 pm. Be prepared, some staff are expected to be there in Star Wars costumes – “may the Fourth be with you!”! Two more restaurants have established Dementia-friendly Dining days and times: Sanford’s Patio Grill, 2900 South Orlando Drive, will open to serve every 2nd Tuesday from 9 am to 2 pm beginning May 10th; and, Orlando’s The Meatball Stoppe,7325 Lake Underhill Road, returns as the first Central Florida Dementia-friendly Dining spot every Tuesday from 2 – 5 pm beginning May 10th. Instrumental in bringing Dementia-friendly Dining to Orlando has been the coordination and support with the Senior Resource Alliance (Area Agency on Aging of Central Florida) and the Central Florida Dementia Care and Cure Initiative (Florida Department of Elder Affairs) who continue to work toward creating dementia-friendly communities with services and supports in place to make that our community hospitable to someone living with dementia, their care partners, and loved ones. Additional information is available at https://www.centralfloridadementia-friendlydining.com

Orlando Health Opens New Emergency Room at Reunion Village

Children’s ‘well beyond medicine’ strategy that supports each child’s whole health, including the social, economic, behavioral, and environmental factors that affect their lives and future health,” said Mary M. Lee, MD, Nemours Children’s Chief Scientific Officer and Physician-in-Chief in the Delaware Valley. “I look forward to see communities, researchers and physicians come together as part of this newly established center, all with the shared vision to create the healthiest generations of children.” Nemours Children’s Health, as one of the nation’s largest multi-state pediatric health systems, is uniquely positioned to serve as a hub for children’s health equity research. Currently, research is underway to meet the criteria of this grant. Thao-Ly Phan, MD, a physician within Nemours Children's Weight Management Clinic, is working to advance technology to improve access to care for children with obesity in rural Delaware. Erica Sood, Ph.D, a Nemours Children's clinical psychologist is developing ways to help families cope and educate themselves about a prenatal diagnosis of congenital heart disease in preparation for their baby’s arrival. In an effort to address infrastructure, a training program focused on state-of-the art research approaches will be available to multidisciplinary investigators within Nemours and across Delaware through the IMPACT (Intervention Methods: Provision and Connections through Technology) Core, led by Kimberly Canter, PhD. In addition, the PROMISE (Pediatric Research Optimizing Methods in Stakeholder Engagement) Core, led by J.J. Cutuli, PhD, will support investigators in taking a community-based, participatory approach in their research. Finally, REACH Center staff will provide extensive mentoring to assure that scientists will be successful in growing their innovative research and will fund competitive pilot grants for projects in the early stages of development.

Davenport – To continue to meet the growing need for emergency services driven by Central Florida’s rapidly increasing population, Orlando Health is preparing to open its newest freestanding emergency room, the Orlando Health Emergency Room – Reunion Village. The full-service emergency room will be open 24 hours a day, 7 days a week and will be fully staffed by Board-certified emergency room physicians, registered nurses, and other clinicians. Located along the I-4 corridor at 8011 Osceola Polk Line Road in Davenport, the Orlando Health Emergency Room – Reunion Village will be the seventh freestanding emergency room Orlando Health has opened since 2018. “We don’t have to look beyond our hospital lobbies to see how the population growth in our region is increasing the demand for emergency medical services,” said Brian Wetzel, president of Orlando Health Horizon West Hospital. “Facilities like this new emergency room are an integral part of our healthcare system and serve a vital role in allowing us to extend access to Orlando Health’s high-quality level of care. The 12,000 square foot freestanding ER is designed to efficiently deliver high-quality medical services to patients seeking emergency care for serious injuries or life-threatening conditions. The facility has 11 treatment rooms, which includes a specially designed resuscitation room. Clinicians at the site will have access to an array of imaging services including ultrasound, X-ray, and CT scan, as well as a fully operational laboratory for on-site testing and results. “There’s no ‘one size fits all’ approach to emergency medicine,” said Mr. Wetzel. “While it is imperative that we provide our clinical staff here at Reunion Village access to the tools and technology they’ll need to treat a multitude of emergency situations, there is no doubt that some patients will require, once assessed by our clinical team here, a level of care beyond what can be found within an emergency department. That factored in heavily to the way we designed this free-standing emergency department facility.” Patients determined to be in need of additional care that cannot be managed entirely within an emergency department setting will have access to Orlando Health Horizon West Hospital, Orlando Health’s newest hospital that is a short transfer drive from Reunion. When patient transport is needed, an oversized ambulance bay allows the facility to accommodate multiple EMS units simultaneously and a helipad is located on-campus to allow for flight transfers to any one of Orlando Health’s in-patient, acute care hospitals.

NORTH CENTRAL FLORIDA || GRAND ROUNDS HCA Florida Ocala Hospital Announces Isaiah Zirkle as Chief Operating Officer OCALA - HCA Florida Ocala Hospital announces the appointment of Isaiah Zirkle as Chief Operating Officer for HCA Florida Ocala Hospital, effective April 4, 2022. “Isaiah’s comprehensive knowledge and extensive skillset will be imperative in guiding our hospital system’s current expansion projects to better serve the commu-

Nemours Children’s Health Researchers Awarded $10.9 Million NIH COBRE Grant Supporting Work ‘Well Beyond Medicine’ The National Institutes of Health (NIH) recently awarded a Phase 1, 5-year $10.9 million Center of Biomedical Research Excellence (COBRE) award, entitled Research Expanding Access to Child Health (REACH) Center to Anne Kazak, PhD, Enterprise Director, and Melissa Alderfer, PhD, Director of the Center for Healthcare and Delivery Science (CHDS) at Nemours Children's Health. It has long been known that there are many factors outside of the health system that affect a child’s overall health. Therefore, the goal of this award is to address the myriad of complex social and ecological factors that hamper access to child health and contribute to health inequities and disparities in care. The grant and Nemours supported REACH Center will work with community partners to harness the power of technology to address barriers to health care access and foster the development of new, innovative care models. By elevating existing expertise and research infrastructure through core resources, the Center will support health equity research for children, and establish a core group of independent multidisciplinary investigators. “We are thrilled to advance the creation of the REACH Center which will further expand upon Nemours

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nities of Marion, Lake and Sumter counties,” said Chad Christianson, Chief Executive Officer of HCA Florida Ocala Hospital. “His dedication to these projects will be essential in our commitment to provide colleagues and patients with the resources they need.” Zirkle most recently served as the Chief Operating Officer at HCA Healthcare’s West Hills Hospital & Medical Center in West Hills, CA, a 260-bed, Accredited Chest Pain Center, which also provides specialized care in the emergency department, intensive care unit, outpatient services, cardiac catheterization labs and The Grossman Burn Center. At West Hills Hospital & Medical Center, Isaiah partnered with cardiologists to implement the first structural heart program in the San Fernando Valley. Additionally, he managed perioperative services, cardiovascular services, emergency services, nine ancillary departments and functioned as the Chief Staffing Officer. Prior to this role, Zirkle was a Vice President of Operations with HCA Healthcare’s MountainView Hospital, an Assistant Chief Executive Offier with MountainView Regional Medical Center, and an Administrative Specialist at Alliance Health Midwest. “My leading priority is to supply our colleagues with the tools they need to provide the highest level of care to our patients,” said Isaiah Zirkle, incoming Chief Operating Officer, HCA Florida Ocala Hospital. “I am thankful to join the talented team at HCA Florida Ocala Hospital, and I look forward to working with our colleagues in achieving clinical excellence and continue our mission-driven approach to healthcare delivery.” Zirkle is regarded as a Fellow with the American College of Healthcare Executives (2021), received the HCA Executive Development Program (EDP) “Outstanding Capstone Project” award (2019) and is a graduate of the HCA Executive Development Program (2018). He was actively involved in the West Hills community, serving on the board for the West Valley Warner Center Chamber of Commerce, School on Wheels LA and is a Career Mentor for the American College of Healthcare Executives. Zirkle’s appointment follows HCA Florida Ocala Hospital’s recent news of joining more than 450 HCA Florida Healthcare affiliated sites of care across the state to unite as HCA Florida Healthcare. HCA Florida Healthcare connects approximately 11,000 physicians and 77,000 colleagues serving their communities at 49 hospital campuses, more than 350 physician practices and freestanding emergency rooms and more than 50 urgent care centers.

Orlando Health South Lake Hospital Celebrates 75 Years of Serving the Community

optimistic, forward-thinking leader, and I’m eager for him to join our team.” Koovakada earned a bachelor’s in nursing from the University of St. Francis, a master’s in nursing and a master’s in healthcare administration from California State University Long Beach. He is also a member of the American College of Healthcare Executives (ACHE).

Clermont - Orlando Health South Lake Hospital celebrated 75 years of serving Clermont and South Lake County by creating a time capsule. Physicians, nurses and team members filled the time capsule with photos, memories about Orlando Health South Lake and letters to the next generation of healthcare workers to honor the hospital’s rich history and celebrate its longstanding commitment to meet the healthcare needs of the community. What is known today as Orlando Health South Lake was first an idea birthed in 1938 by a group of young women from the Clermont area who saw a great need for a hospital to meet emergency healthcare needs. Three-quarters of a century later, what was once a small, 9-bed hospital in a rural community is now a 150-acre health, education and wellness campus trusted to provide the best healthcare possible while also promoting healthy lifestyles among the residents of South Lake County. “What sets the hospital apart is our longstanding dedication to this community,” said Lance Sewell, Orlando Health South Lake Hospital president. “Over the course of 75 years, we have grown and strived to ensure that every resident who calls South Lake County home can receive the highest quality, necessary care to live healthier lives. We’re proud to say that we have never wavered in this commitment and look forward to continuing this legacy for the next 75 years to come.” The first hospital in Central Florida to have a piped-in oxygen system, Orlando Health South Lake has been named a leader among Central Florida hospitals several times since its doors first opened. The hospital’s most recent accomplishments include its sixth consecutive national recognition for patient safety by the Leapfrog Group in addition to being named a Fortune/IBM Watson Health 100 Top Hospital with the added recognition of being an Everest Award winner for excellent clinical outcomes among all medium community hospitals in the country. In alignment with Orlando Health South Lake’s commitment to meet the growing healthcare needs of South Lake County, the hospital marked the beginning of a major expansion project in September 2021. The completed project will increase Orlando Health South Lake’s bed count by 95 beds, expand the volume of women’s services that are currently provided and provide those who call Clermont and its surrounding areas home with more access to various services in their own community.

VOLUSIA/BREVARD || GRAND ROUNDS AdventHealth Opens Simulation Center in Palm Coast PALM COAST — AdventHealth has opened a hightech facility to provide nurses with the highest level of training, using leading-edge simulation technology. With five classroom labs that mimic patient rooms, the regional simulation center is the largest in AdventHealth’s Central Florida footprint, which extends from Flagler County to Osceola County, south of Orlando. The center will provide realistic training for nurses of all skill levels, using interactive realistic manikins that can simulate a range of health conditions and scenarios. Trainers, working from a central command center, can make the manikins “speak” and introduce new challenges that nurses then must respond to. "We want our team members to be able to deal with any clinical situation, after having experienced different scenarios multiple times in a safe, simulated environment," said Lee Wright, manager of the sim center, which is located on the AdventHealth Palm Coast campus. For front-line caregivers, the sim center offers a great opportunity to refine their skills while learning new ones. “As an ER nurse, I’ve helped treat coding patients many times,” said Shirley Rosario Cruz, referring to when a patient’s heart stops beating. “It’s an extremely stressful situation, so it’s great to practice and improve procedures and communication. This sim center will be extremely helpful, both for experienced nurses like me and brandnew team members.” Training will even extend beyond clinical care, including teaching nurses how to interact with patients and deal with family members who may become difficult as they navigate their loved ones’ health challenges. The center will also help develop the next generation of health care workers, serving as a training site for nursing students from the University of North Florida and Jacksonville University. “We know how important it is to maintain and grow a strong health care workforce,” said AdventHealth Palm Coast CEO Dr. Ron Jimenez. “We're proud to have this facility right in Palm Coast, where we can train present and future nurses to serve all of North Florida.”

Philip Koovakada Named New President of Orlando Health – Health Central Hospital Ocoee – Orlando Health has named Philip Koovakada as the new senior vice president, Orlando Health southcentral region, and president, Orlando Health – Health Central Hospital. He will serve as the senior leader of Orlando Health – Health Central, as well as coordinate the region’s operations with Orlando Health’s senior executive team. Philip comes to Orlando Health from Baptist Health System in San Antonio, Texas, where he served as president and CEO for St. Luke’s Baptist Hospital. Under his leadership St. Luke’s served the community as a comprehensive stroke center, a STEMI/Level IV trauma-receiving organization and a Level IV maternal/Level IV NICU-designated facility by the Texas Department of State Health Services. Prior to his role in San Antonio, Philip served as the chief executive officer for NMC Health Network in Nacogdoches, Texas, and held various leadership roles for Tenet in Nacogdoches and Palm Springs, California. “Philip comes to us with an outstanding background with broad experience in acute and outpatient care, quality improvement, strategic development and operational/ financial management,” said Jamal Hakim, MD, chief operating officer Orlando Health. “He will be a dynamic,

St. Francis Reflections Lifestage Care Announces Opening of New Hospice Care Center in Brevard County TITUSVILLE — Residents of central and south Brevard will now have increased access to high-quality hospice care through the new St. Francis Reflections Melbourne Care Center located inside Melbourne Regional Medical Center. Hospice patients and their families in Brevard County will find compassionate, clinical support and comfort-focused care at the new St. Francis Reflections Melbourne Care Center. The dedicated hospice care center is located on the second floor of Melbourne Regional Medical Center, offering a comforting setting and home-like environment. "We are excited to expand our footprint in Brevard County and meet the growing needs of our community," said Joe Killian, President and CEO of St. Francis Reflections. "St. Francis Reflections has more than four decades of experience offering quality and compassionate care with an individualized focus on what matters most for each patient and family.” Patients and their families experience private rooms with

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en suite bathrooms and space for visitors to spend sacred time with their loved ones. Family and friends can visit around the clock and use overnight accommodations to remain by their loved one's side. A family room with a kitchenette is available for families to enjoy their own meals and a quiet room offering a tranquil place to read or reflect. “The compassionate, palliative care services that are available to the Melbourne community are so greatly appreciated,” said Ron Gicca, president of Melbourne Regional Medical Center. “We are thankful the community will have now have access to hospice care close to home to service the growing need.” The St. Francis Reflections Melbourne Care Center offers a temporary home away from home for patients when acute symptom management can no longer be managed in another setting of care. Patients can expect compassionate care offered by St. Francis Reflections clinicians, board-certified hospice and palliative medicine physicians, social workers, volunteers, chaplains and bereavement counselors. Together, the St. Francis team attends to the medical, emotional and spiritual needs of patients and their families. “We are honored to partner with Melbourne Regional Medical Center, a Steward family hospital, to offer comprehensive, compassionate care to their patients and families,” said Cami Leech Florio, Chief Strategic Officer of St. Francis Reflections. The St. Francis Reflections Melbourne Care Center is the organization’s third hospice care center in Brevard County, with other hospice care centers located in Titusville and Merritt Island.

Joan Baliker Brings Peace to Halifax Health – Hospice Ormond Beach Care Center DAYTONA BEACH - Local artist, interfaith minister, and former hospice volunteer, Joan Baliker, has donated her highly-regarded, bronze sculpture, Peace, to Halifax Health – Hospice. Joan Baliker is a 90-year-old, Ormond Beach resident with a long-standing passion for interpreting and communicating powerful messages through art. Her sculpture, Peace, is a life-sized, self-sculpture of a little Lutheran girl meditating that demonstrates an intersection of faiths. “I believe every religion is saying the same thing at base level,” said Joan Baliker. After studying a vast array of religions, Joan grew to honor all spiritual paths and worked to incorporate the sentiment in a collection of sculptures known as Peace Seekers. The sculpture being donated to Halifax Health – Hospice was the first of the series and speaks to the demand for increased communication and connection around the world. It is Joan’s belief that art can heal as the laborious act of building a sculpture is better described as a translation without words. Joan Baliker has exhibited her works at art shows around the country to help observers find some understanding of the common ground of humanity. For years, Peace has elicited emotional responses from viewers of all backgrounds and experiences. “It is my hope that just viewing Peace will help us find some measure of hope for the future,” said Joan Baliker. Visitors and patients walking through the Halifax Health – Hospice’s outdoor garden will be able to interpret the imagery and reflect upon its nameplate’s inscription, “Peace Begins Within”. “We are honored to be installing an incredible work of art like Peace at the Halifax Health – Hospice Ormond Beach Care Center,” said Kathryn Nagib, Foundation Manager at Halifax Health. “Joan Baliker’s demonstration of quiet meditation will enrich the lives of many by serving as both a conversation and reflection piece for patients and their loved ones.” In the future, Halifax Health is looking to further enhance facilities with additional artworks. To learn more about Halifax Health Foundation, visit us online at halifaxhealth.org/services-treatments/our-services/foundation