Orlando Medical News January 2022 by Orlando Medical News

JANUARY 2022

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Recent UCF PhD Nursing Grad Develops App to Help Youths with Epilepsy Transition to Self-Managed Care App also helps caregivers manage care 1

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CONTENTS

FEATURES 4

COVER STORY Recent UCF PhD Nursing Grad Develops App to Help Youths with Epilepsy Transition to Self-Managed Care PHYSICIAN SPOTLIGHT 5 Orlando Health Surgeons Initiated into American College of Surgeons

EOCC Happy New Year: Looking Ahead & Elevating Your Business

What’s New in Pilonidal Sinus Disease Treatment?

Anoxic Stroke Brain Injury Stroke Spinal Cord Injury

Spinal Cord Injury Multiple Trauma Multiple Trauma Neurological Disorders Neurological Disorders Complex Orthopedic Complex Orthopedic Joint Replacements

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Is Conventional Wisdom Costing You Money?

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Why Medical Clearance Is Really a Preoperative Evaluation

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Recent UCF PhD Nursing Grad Develops App to Help Youths with Epilepsy Transition to Self-Managed Care App also helps caregivers manage care Michelle Tall, MSN, PhD, recently completed her Nursing PhD at the University of Central Florida after developing and testing the Medilepsy app to help youths ages 16-24 transition from caregivermanaged to self-managed care. One of only two nurses awarded a McKnight Doctoral Fellowship for research in 2018, Tall was inspired to develop the app after many years of frustrating misdiagnoses for her son, Josh, who has a rare type of epilepsy. In addition to reminder notifications to help adhere to their medication schedule, the app teaches self-management skills, and allows patients to set goals and earn personal rewards. The app also notifies caregivers if intervention is needed. Other features include medication side effects information, suggested questions to ask a doctor, and a private social platform to provide a sense of community. Tall, a nurse since 1989, was inspired to pursue higher education in nursing because she saw that children with epilepsy were not well understood in the schools and the community. “I also witnessed how stigmatized the disease was in modern-day times,” Tall said. “That lack of awareness and misinterpretations were two main drivers for me to start a non-profit, The Epilepsy Leadership Foundation Inc, in Maitland, and pursue a higher education. My goals are to advocate for youth living with epilepsy and their families and examine new interventions to help support self-management.” Raising Josh posed many challenges. She had to stop working as a nurse because Josh needed full-time care. Josh was on a special diet for 18 months, which required weekly meal plans under major restrictions. They traveled to New York City six or more times a year for many years for medical treatment with an epileptologist. “Josh’s epilepsy did not respond favorably to many medications, so he underwent very involved treatments, but did not require surgery,” Tall said. It was challenging to be treated differently at school, and hard for Josh to develop a social network. “Even in modern days, many people do not fully understand that people who live with epilepsy have the same desires to have fun, learn, be a part of their community, and have a social life with a friend,” Tall said. “However, epilepsy is a highly stigmatized disease rooted in misperceptions and lack of awareness.” Josh’s syncope episodes began when he was six months old, but he was diagnosed with breath-holding spells. As we know now, the “breath holding spells” were highly suggestive of seizures- epilepsy was never mentioned. At seven, Josh was misdiagnosed again with benign epilepsy that did not require any medications. Symptoms and seizures worsened, and he was hospitalized multiple times. After many interactions with specialists and no major improvement for almost two years, they took Josh to New York City for medical treatment at the NYU Comprehensive Epilepsy Center. At nine, he was diagnosed with a rare type of epilepsy. Tall and her husband, a spine surgeon, are grateful for the care he received there. A comprehensive medical treatment plan was initiated that has been successful. Josh has been seizure-free since September 2016, when he was 13. He is

still being treated, but is currently weaning off his antiepileptic medications. “Patients and families should know that out-of-state treatment at different tertiary centers will sometimes help pay for travel and lodging expenses,” Tall said. “Further, doctors out of state-listed as in-network providers are covered typically as in state and usually are not charged at an out-of-network rate.” Josh was very fearful of hospitalizations, procedures, and doctors (rightfully so). His parents feared for his life every day. They felt alone, scared and confused despite both being healthcare professionals. “We never gave up. And Josh never gave up even in his weakest/sickest moments and hospitalizations,” Tall said. “I would say that the feeling of giving up, feeling tired, and burnout are a reality for many families with a loved one with a chronic illness. And, yet, these families are among the most determined and kindhearted families I have ever met during our journey. The determination to help your child have the best medical and quality of life is an ongoing process with many moving parts unique to each individual and family.” Tall said the right protocol is unique to the type of epilepsy a person has and the person’s symptoms and response to treatment both physically and mentally. “Josh’s protocol was a slow and gradual process trialing different medications, special diets, and having many diagnostics and electroencephalogram (EEGs) studies,” Tall said. “The ‘right’ protocol essentially was a combination of meds, therapy, and tons of support to help Josh build self-confidence, including the involvement of tutors, teachers, family, friends, church, and healthcare providers to meet his physical, spiritual, and mental needs. This intensive process took many years, and I acknowledge the ‘village’s support’ to make a difference in Josh’s quality of life.” Her idea to design a mobile app was multifactorial: 1) through personal experience as a parent navigating through a complex health care system with a son with complex medical needs, 2) stigma and misperceptions associated with epilepsy that can impact social and mental health, 3) years of researching complex issues regarding the lack of preparation for adolescents and young adults living with epilepsy to adhere to their treatment plans and transition from a pediatric health care model to an adult

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JANUARY 2022

model of care. “I prioritize self-management for patients and families into two areas: medication adherence and transition readiness skills,” Tall said. Often when adolescents turn 18-21 years, they are considered adults and are expected to integrate into an adult health care system to manage their epilepsy confidently. For some, transfer of care can be very stressful because of the loss of a long-term relationship with a provider and anxiety about building a new relationship with a healthcare provider and establishing rapport and trust, which can be stressful. Tall said it was essential for the app to also keep involved caretakers aware of their loved one’s behaviors using the app to track things like medicine status. As part of her dissertation, Tall did a four-week study to test the effect of the Medilepsy app on medication adherence for patients with epilepsy aged 16-24, with and without caregiver support. “The study included patients and caregivers from 16 states and had promising results,” Tall said. “Participants showed significant improvement in appointment keeping and managing medications. Feedback from study participants was also positive. Participants especially liked the text messaging feature and overall reported Medilepsy as a reliable resource to support medication adherence and transition needs.” Tall plans to release the app in the future once she has retained the resources to expand it. Her future plans are to apply for grant funding to build an interdisciplinary team to enhance the app to include Android users (version one only supports iPhone users) and expand testing internationally. She also plans to develop similar apps to help adolescents, young adults, and families self-manage other chronic conditions, such as autism, asthma, and diabetes, with the integration of artificial intelligence. She estimates needing a minimum of $250,000 dollars to have a team and a comprehensive app that positively impacts lives.

You can help by donating to the Epilepsy Leadership Foundation, Inc., https://elfcares.org/

PHYSICIAN || SPOTLIGHT SPONSORED BY

5 Orlando Health Surgeons Initiated into American College of Surgeons

Omar Beidas, MD is a board-certified plastic and

Five Orlando Health surgeons recently became Fellows of the American College of Surgeons (FACS) during their recent Convocation ceremony at the College’s virtual Clinical Congress 2021.

reconstructive surgeon with the Orlando Health Aesthetic and Reconstructive Surgery Institute, where he specializes in breast surgery and body contouring after weight loss. He also founded Orlando Health’s “surgery after weight loss” program to increase the level of care available to the weight loss community. Commonly known as SAWL, the program is the first of its kind in the southeastern United States. In addition to improving the appearance of the face and body, aesthetic surgery typically improves a patient’s confidence, outlook and quality of life. Many patients seek aesthetic surgery to address the impact of trauma and deformities on their bodies. Rebuilding and refinement for restored confidence are the purpose of reconstructive surgery. In conjunction with physicians across a number of specialties, Dr. Beides provides general reconstructive procedures beneficial to patients after cancer, cardiac, dermatologic and orthopedic surgeries. An experienced and accomplished surgeon, he performs advanced aesthetic and reconstruction procedures

For each surgeon who was acknowledged, the FACS designation means they’ve passed a rigorous evaluation and they’re committed to providing a high standard of surgical care. During the five-day long, annual ceremony attended by registrants from 85 countries, 2,350 surgeons from around the world received their FACS. The five physicians, who operate in various surgical specialties across the Orlando Health system, have now earned the distinguished right to use the designation of FACS after their names.

Orlando Health Surgeons initiated were: Emilio Alonso, MD is a fellowship-trained surgical oncologist with the Gastrointestinal Cancer Center at Orlando Health Cancer Institute. He is board-certified in general surgery and holds a specialty certificate in hepatobiliary and pancreatic surgery, using minimally invasive options whenever possible. Dr. Alonso earned his medical degree and bachelor’s degree in biochemistry from the University of Florida in Gainesville. After his general surgery residency at the University of California, Riverside, he completed a fellowship in hepatobiliary and pancreatic surgery at Providence Portland Cancer Institute in Oregon. In addition to patient care, Alonso is involved in several research projects, some of which involve translational tumor immunology and neoadjuvant chemotherapy and immunotherapy. He is a national and international presenter at medical conferences and has been published in peer-reviewed medical journals such as Molecular Pharmacology, Molecular Medicine and World Journal of Clinical Cases. Dr. Alonso is a member of the American College of Surgery, Society of Surgical Oncology, American Pancreatic Association, International Hepato-Pancreato Biliary Association, and Americas Hepto-Pancreato Biliary Association. He also sits on the International Relations Committee for the Americas Hepato-Pancreatico-Biliary Association.

including breast implants and lifts, breast reconstruction and reduction, body contouring, fat grafting and transfer, gender confirmation surgery, injectables like Botox and fillers, Lipedema treatment, liposuction and plastic surgery after weight loss. After earning his medical degree from Temple University in Philadelphia, Beidas completed a residency in plastic and reconstructive surgery at the University of Oklahoma in Norman. He concluded his postdoctoral training at the University of Pittsburgh with a fellowship in body contouring after weight loss. While at the University of Pittsburgh, he trained with notable surgeons who developed many of the techniques used for the most complex cases and served as a clinical instructor in the department of plastic surgery at the university’s medical center. Dr. Beidas is a member of the American Medical Association, American College of Surgeons, American Society of Plastic Surgeons, and American Society for Aesthetic Plastic Surgery. His work has appeared in peer-reviewed medical journals, and he has written several book chapters and presented his work at national meetings.

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EAST ORLANDO CHAMBER OF COMMERCE

CALENDAR:

Testimonial Tuesday on Location TUESDAY, JAN 11 | 9:00 AM – 12:30 PM LIVE of Facebook & On Location Tijuana Flats Avalon Park

Misters & Sisters Great Lunch Adventures TUESDAY, JAN 11 | 12:30 – 1:30 PM Tijuana Flats Avalon Park | 1024 Avalon Park N, Bldg. #108, Orlando, FL 32828

EOCC Advocacy Advisory Council TUESDAY, JAN 14 | 10:00 – 11:00 AM Virtual Meeting | Register to participate

EOCC Real Estate Advisory Council Planning Meeting TUESDAY, JAN 18 | 9:00 – 10:00 AM East Orlando Chamber office | 12301 Lake Underhill Road, Ste. 245. Orlando, FL 32828

The Hybrid Member Academy: Roadmap to Member Success WEDNESDAY, JAN 19 | 8:30 AM – 10:30 AM Hybrid Event - East Orlando Chamber office | 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828

Coffee Club Nona (3rd Thursday of the month) THURSDAY, JAN 20 | 8:30 – 9:30 AM Sam’s Club Lake Nona | 11920 Narcoossee Road, Orlando, FL 32832 | FREE to EOCC Members | $10 for Non-Members

Joint Ribbon Cutting After Hours (Apiary Title & GreatFlorida Insurance Lake Nona THURSDAY, JAN 20 | 5:00 – 7:00 PM Apiary Title & GreatFlorida Insurance 1380 S Narcoossee Road, St. Cloud, FL 34771

Chamber Luncheon: 2022 Board Installation & 2021 Awards Luncheon

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Happy New Year: Looking Ahead & Elevating Your Business and abundance the Swiss drop a dollop of ice cream on the floor at midnight.

BY DOROTHY HARDEE

“Tomorrow is the first blank page of a 365-page book. Write a good one” – Brad Paisley Happy 365 Days of the New Year! Ringing in the New Year is nothing new. Babylonians started the practice about 4,000 years ago with an 11-day festival; now that is a party. Around the start of the 1900’s New Year’s Eve celebrations came to America with the first Ball drop on Time Square in 1907. English and German folklore held that the first person you encountered in the New Year would determine the year’s destiny. Over time this tradition evolved to choosing who you wanted the years good luck to be shared with, sealing it with a kiss. Countries throughout the world have embraced their own unique traditions to usher the New Year in, including:

In addition to traditions, come superstitions thought to contribute the luck of individuals including not doing laundry on New Year’s Day to avoid washing good fortune down the drain. For me, it was a German mom that had extremely strict rules about entering the new year, which included putting EVERYTHING Christmas away and out of the house (the attic was acceptable) before December 31. Mom adopted southern traditions for our New Year meal as well. Accompanying a tasty pork roast (symbolizing prosperity) were greens for wealth, black-eyed peas (symbolizing coins for prosperity), Cornbread (symbolizing gold for extra spending money in the new year). What traditions have you developed with your family? For businesses, 2022 is an opportunity to reflect on victories, struggles, and develop new habits for personal and professional growth. David Finkel, author of “The Freedom Formula” shared 4 Realistic New Year’s Resolutions for Business Owners in Inc.

• Columbia - Wearing brand new yellow underwear & running around the house with a suitcase to ensure a year filled with travel

1. Set Boundaries on How Many Hours a Week you will work 2. Follow the 1/50 Rule (1 percent of your day that produces 50 percent of your results)

• Danish – The Danes jump off a chair at the stroke of midnight to literally “Leap” into a luck filled new year. • Spain – Eating twelve grapes at or before midnight • Brazil – Everyone wears white because the color signifies luck, prosperity and is meant to ward off bad spirits

3. Hire a business coach or find a mentor 4. Practice Gratitude Korn Ferry describes 2022 as the new era of humanity identifying seven areas dominating the future of work.

• Greece – An onion hung on the door of homes symbolizing rebirth. On New Year’s Day parents wake children by tapping them on the head with an onion.

1. Reinvention: the flipside of disruptive change. 2. Scarcity: surviving the talent shortage 3. Vitality: employee wellbeing takes center stage 4. Sustainability: walk the talk for a sustainable CONTINUED P.7

• Switzerland – To channel good luck, wealth,

Featuring James (Jamie) Holmes & the Honorable Judge Eric DuBois WEDNESDAY, JAN 26 | 11:30 AM – 1:10 PM Bonefish Grill Waterford Lakes | 12301 Lake Underhill Rd., Ste 100, Orlando, FL 32828 Registration required.

EOCC Brain Trust THURSDAY, JAN 27 | 8:00 – 10:00 AM East Orlando Chamber | 12301 Lake Underhill Rd., Ste 245, Orlando, FL 32828 | Member Exclusive with Limited space

Ribbon Cutting: Solvera Tech THURSDAY, JAN 27 | 4:00 – 6:00 PM University Club | 150 East Central Blvd., Orlando, FL 32801

Ribbon Cutting: Creative World School UCF FRIDAY, JAN 28 | 3:00 – 5:00 PM Creative World School UCF 5016 N Dean Road., Orlando, FL 32817

Visit EOCC.org for a complete listing of January events

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CONTINUED ...

CONTINUED ... PHYSICIAN || SPOTLIGHT Five Orlando Health Surgeons Initiated into American College of Surgeons Esther Han, DO is a board-certified urologist

he graduated Cum Laude. Hanna also earned a Master of Biomedical Sciences from the University of Medicine and Dentistry in New Jersey. His areas of expertise include structural heart therapies including TAVR and MitraClip, minimally invasive aortic valve surgery, minimally invasive mitral valve surgery, coronary artery bypass surgery, redo valve surgery, aortic, root and aneurysm repair surgery, laser lead device extraction and arrhythmia surgery. Dr. Hanna is a recipient of the AATS Foundation Graham fellowship grant in robotic thoracic surgery. He also has several publications in peer reviewed journals as well as numerous presentations in regional and national meetings. He is a member of the Society of Thoracic Surgeons and American College of Surgeons. He is also fluent in Arabic.

with Orlando Health Medical Group who is fellowship trained in Female Pelvic Medicine and Reconstruction Surgery (FPMRS). She specializes in the diagnosis and treatment of various urologic conditions in men and women. These conditions include urinary incontinence, voiding dysfunction, urethral strictures, overactive bladder, kidney stones, neurogenic bladder, chronic urinary tract infections, pelvic organ prolapse, pelvic floor dysfunction, pelvic pain, vaginal fistulas and more. After graduating from the University of North Texas Health Science Center in Fort Worth, Texas, with a Doctor of Osteopathic Medicine degree, with Honors, she went on to complete a Urology residency at Detroit Medical Center through Michigan State University. After residency, Han completed a two-year fellowship in Female Pelvic Medicine and Reconstructive Surgery at Beaumont Hospital in Royal Oak, Michigan. She is also a previous Fulbright Scholar and Fogarty Fellow. Dr. Han is a frequent presenter at medical conferences and has published articles and book chapters on a variety of urologic topics. She is a member of numerous professional organizations, including the American Urological Association, Society of Women in Urology, Société Internationale d’Urologie, American College of Osteopathic Surgeons, American Medical Association and American Osteopathic Association. She is fluent in both English and Mandarin and is conversant in French.

Sabrina Pavri, MD is a plastic surgeon with the Aesthetic and Reconstructive Surgery Institute at Orlando Health. She is board certified in plastic surgery and reconstructive surgery, specializing in microsurgical reconstruction of the breast, head and neck, and extremities, as well as general reconstruction of traumatic and oncologic defects. Pavri received her undergraduate degree from Johns Hopkins University and went on to earn her medical degree as well as a Master of Business Administration with a concentration in Health Systems Management at Case Western Reserve University, in Cleveland, Ohio. She completed an integrated residency in plastic and reconstructive surgery at Yale New Haven Hospital, in New Haven, Connecticut, serving as chief resident in her final year. Dr. Pavri has authored several peer-reviewed articles and book chapters in the field of plastic surgery.

Michael Hanna, MD is a board-certified cardiac surgeon with Orlando Heart & Vascular Institute. He completed his thoracic surgery residency from Allegheny General Hospital in Pittsburgh, Pennsylvania. He trained in all aspects of cardiac surgery including minimally invasive valve surgery, structural heart therapies including Transcatheter aortic valve replacement (TAVR) and Mitraclip as well as mechanical support devices such as LVAD and heart transplantation. During that time, he also participated in multiple clinical trials for TAVR and LVAD devices. Hanna is board certified in general surgery after completing his residency at Texas Tech University in Lubbock, where he also served as chief resident. He received his medical degree from St. George’s University School of Medicine in Grenada, where

“We are very proud of the surgeons who were initiated as Fellows of the American College of Surgeons,” said Dr. Sunil Desai, president of the Orlando Health Medical Group and a senior vice president at Orlando Health. “Their dedication and talent will continue to play a significant role in the quality of surgical care being offered to our patients.” The American College of Surgeons, comprised of surgeons, was founded in 1913. Its goal is to raise the standards of surgical practice and to improve the quality of care for the surgical patient. The College is dedicated to the ethical and competent practice of surgery.

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Happy New Year: Looking Ahead & Elevating Your Business future 5. Individuality: employee experiences are personal 6. Inclusivity: unleashing the power of all 7. Accountability: trust or bust The East Orlando Chamber is here to help too with more benefits, events, opportunities, and customer service you can count on in 2022. The calendar includes industry specific groups, meeting, opportunities to connect and build lasting relationships. We continue to offer traditional group health benefits for members, employees and their families building plans customized to meet their individual needs. Kick off the year joining us for our January Chamber 2022 Board Installation and 2021 Volunteer Recognition Luncheon featuring James (Jamie) Holmes, author of The Last Disciple at Bonefish Grill Waterford Lakes. In February Feast in the East is back. It is a culinary match made in heaven featuring member restaurant partners catering excellence. Great food, prizes, wine pull and more. Get your tickets today and make it a date night. Are you an East Orlando Chamber member restaurant? Sign up to be one of our featured feast beasts. For more information or to register call (407) 277-5951 or visit our website at eocc.org. The East Orlando Chamber of Commerce everywhere East of I-4. Dorothy Hardee is the Chamber Administrator

What’s New in Pilonidal Sinus Disease Treatment? BY SERGIO LARACH, MD, FASCRS, FACS; AMY MORRISON, BS

Surgical management of pilonidal sinus disease more often involves a large, wide, en bloc excision of inflammatory tissue in the presacral area. For simple pilonidal disease, it is possible to perform a more minimally invasive technique to reduce healing time and improve cosmetic outcome. Pre-op image showing pits, tracts, and abscess

Pilonidal sinus disease occurs in roughly 70,000 people per year in the United States, however the global incidence is estimated at 20-30 people per 100,000 people globally. It is characterized as an inflammatory disease of the gluteal region, usually appearing as an erythematous, tender area in the gluteal cleft that may or may not contain purulent contents. Additionally, these lesions might be a source of embarrassment for patients. Pilonidal sinus disease is generally accepted to be an acquired disease, which begins with penetration of hair into the skin, which causes deep pits, tracts, and associated inflammatory reaction. Risk factors include obesity, hirsutism, those with deep gluteal clefts, and male sex. In fact, males are affected two times more than females. The disease usually presents in these patients by age 40. Patients often complain of pain, discomfort, and visible purulent drainage in the gluteal area. Treatment of the disease involves complete removal of any associated pits, tracts, hair, and debris, and any treatment decisions balance between excising the diseased area and the lowest rate of morbidity and recurrence. The most common accepted technique for surgical management of pilonidal disease is wide excision with or without closure. However, minimally invasive techniques are becoming more widely used for certain patients. The Gips procedure is a minimally invasive technique that is suitable for use in patients with simple disease. The Colorectal Surgery team at the Digestive and Liver Center of Florida has seen success using the Gips procedure on patients with minimal inflammation, and we hope to emphasize the benefits of this technique on simple pilonidal sinus disease as compared to a wide excision. Wide excision of pilonidal sinus disease involves the removal of any skin, sinuses, inflammatory tissue, tracts, or abscesses en bloc, down to the sacral fascia. It is either left open or closed at either the midline, off-midline, or with a flap. Patients report pain and discomfort for weeks following the surgery, as full healing time is approximately 8 weeks. Although the area of disease is fully removed, a large cosmetic defect is left whether the area is closed or left open They will also require help from a caregiver for dressing changes and care of the area given the location of the wound. While this technique is applicable for more complex pilonidal disease, for simple pilonidal disease, a more minimally invasive approach can be considered. The Gips procedure begins with injection of local anesthetic at the affected area. A probe is used to localize the fistulous tracts, and skin trephines are used to remove any pits and tracts until the pilonidal cavity is reached. These small openings allow the removal of the cyst cavity, tracts, and any associated inflammatory tissue. In the post-operative period, patients report minimal pain and discomfort, and they return to work in approximately 1 week. While debate still exists regarding which surgical technique is superior for treatment of pilonidal sinus disease, at the Digestive and Liver Center of Florida, we are seeing great outcomes with the use of the Gips procedure in patients with simple pilonidal sinus disease. Di Castro et. al

Operative image showing trephine openings

detailed that, in a study of 2,347 patients who underwent the Gips procedure, only 102 of patients experienced complications such as bleeding (66 patients), prolonged analgesic use (27 patients), wound infection (19 patients), and reduced local sensation (3 patients). Because there is no skin separation between trephine openings, wound healing time is decreased, and patients can resume normal activities quickly. Out of the 2,347 patients who underwent the Gips procedure, the median time in the hospital was 6 hours, the median time to daily activities was 1 day, and the median time to wound healing was 4 weeks. In conclusion, along with the benefits of quick recovery and low complication rate, the Gips procedure also may be performed under local anesthesia, reducing cumulative risk of the procedure. Finally, the Gips procedure provides good cosmetic outcome, with minimal scarring, as compared with the traditional en bloc excision which overall produces a longer recovery time and larger, deeper scarring in the presacral area.

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JANUARY 2022

8 weeks post-op

Case Example In June 2021, a 21-year-old male patient presented to the Digestive and Liver Center of Florida Clinic for consultation of a pilonidal cyst. It had been previously treated one year ago with antibiotics but his inflammation in the area waxes and wanes intermittently. Physical exam showed multiple pits, induration, and scarring of his presacral area. He underwent the Gips procedure for removal of his pilonidal cyst. The patient reported minimal pain at two days post-op, and returned to work at 10 days post op. Sergio Larach, MD, FASCRS, FACS is a colorectal surgeon at the Digestive and Liver Center of Florida. He is devoted to his work allowing him to become a pioneer in performing laparoscopic surgical procedures and co-creator of the TAMIS procedure. Besides taking in patients at DLCFL, he also dedicates his time to educating colorectal surgeons, and future doctors as a Clinical Assistant Professor at University of Central Florida and Florida State University. Amy Morrison, B.S. is an MD candidate at the University of Central Florida.

Is Conventional Wisdom Costing You Money? BY J. MICHAEL BASS

We have been the victims of conventional wisdom since the beginning of time.

A couple of caveats here. You must have an arbitrage between your borrowing rate and your investment rate. And you can make the payments without interrupting the funding of your investments. If you can’t do that, you can’t afford it.

The earth is not flat. Bloodletting is not a valid medical treatment. A human being can run a mile faster than 4 minutes. Elvis really is dead! Let’s just say, conventional wisdom is often wrong. A very wise man once asked me, “If what you know to be true, turns out not to be true, when do you want to know it? This issue can be even more compelling when it comes to our personal financial picture. Stephen Covey, in his book, The 7 Habits of Highly Effective People, pointed out we can get caught up in climbing the ladder of success only to discover it’s leaning against the wrong wall. You’re only going to retire once; you think you might want to get it right? The following statements represent some of the conventional wisdom of the day concerning financial matters. But are they true?

You’ll pay less taxes in retirement. Sorry to disappoint you, but the only way this one is true is if you’re living off Social Security. One of the many reasons you will pay more taxes in retirement is you deferred the taxes on most if not all your retirement savings. Remember 401(k)s and IRAs? You did not defer it, you just postponed it. In retirement, when you have little or no ability to control your income, you will be paying 100 percent ordinary income tax on every dollar. Oh, and you get to pay taxes on up to 85 percent of your Social Security. Not to mention you may get the privilege of paying extra for your Medicare.

Picking the best investments will make you wealthy.

Net worth is a measurement of wealth.

Too many people believe the path to riches is finding the best investments. This is wrong on so many levels. First, it ignores what you’re doing with the rest of your money. What if you’re making mistakes in how you pay your taxes; making major purchases like cars, college educations, and weddings; saving for retirement; selecting the right insurances; handle debt; etc.? The truth is making better decisions with your money is the path to riches. When you make poor financial decisions, you put more pressure on your investments to make up the difference. This can cause you to take too much risk. Speaking of risk, this is the most overlooked factor of selecting investments or an investment strategy. Looking at return without considering the risk is like driving a car without brakes! The risk/return tradeoff is imperative. If you can’t stand the risk, you will sell out too soon and not be around to enjoy the return. The fact of the matter is investments are not good or bad. They’re like tools. You use the one that fits its intended purpose. To do that you need an investment strategy that works. Most people don’t even have an investment strategy, and if they do, they are likely to abandon it when it looks like it’s not working. The point is, trying to pick the winners is not the answer to growing your wealth!

Who came up with this one? Your net worth statement is nothing more than a point in time estimate of what your assets are worth. It’s really a personal balance sheet. Ask any business owner if they use their balance sheet to run their business? Of course not! They use their Profit

and Loss statement and manage cash flow. Remember this, assets that cannot be converted to cash or cash flow when you need it are worthless. The dirty little secret in the financial services industry is they do not know how to create sustainable cash flow when you need it. The main reason is they cannot figure out how to get paid to do it. Here’s a novel idea, if what you want in retirement is cash flow, why don’t you plan for that in the beginning?

Revenue – Expenses = Profit This one actually is true! Unfortunately, it leads one to believe profits are what fall out after everything else has been accounted for. What’s worse when you do make a profit have you ever wondered where it went? I’m reminded of the old Wendy’s commercial, “Where’s the beef?” So, where’s the cash? A simple adjustment to the formula produces a dramatically different outcome. Revenue - Profit = Expenses. Many of us learned this principle when we were children with our piggy bank. Pay yourself first! So, it turns out your mother may have been the best business coach you ever had. We just wanted you to know there is a better way. J. Michael Bass, CFP®, CIMA®, is the President and CEO of PrimeQuest Wealth Strategies in Altamonte Springs, FL. He has over 30 years’ experience helping business owners and professionals learn to make better decisions with their money so they can achieve financial independence. Visit https://primequestwealth.com

MEDICAL OFFICE SPACES FOR LEASE

Pay your house off as soon as possible! Pay cash for everything!

1915 S Dean Road, Orlando, FL 32825

DESIGN YOUR OWN MEDICAL OFFICE SPACE!

The problem is, most people think if they owe money they are in debt. There is a difference between debt and leverage. Debt is when you owe money you can’t pay back. Leverage is when you choose to borrow money to pay for something even though you have the money to pay for it. There are a couple of issues here. First, paying your house off gets you nothing. Equity does not grow. Real estate appreciates whether the house is debt free or mortgaged to the hilt. Therefore, the equity you have in your house earns nothing. It’s dead money! Second, there is no such thing as paying cash. What you’re really doing is self-financing. When you take money out of an investment to pay for something, you not only lose that money forever, but you also lose the growth on that money. Even if you pay yourself back, you will never make up for the money you lost.

Construction Status: Completed Min. Space Allowed: 1,200 Sq.Ft. Building Size: 13,200 Sq.Ft. Space Depth: 60 Sq.Ft. Current Build-Out: Grey Shell Condition Parking Spaces: 91 Located on Dean Road, less than 1 mile east of the 417 3 miles from AdventHealth East Orlando Hospital Click For More Information 9

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LAKE UNDERHILL RD

CURRY FORD RD

Marie Shorey, CCIM

(407) 383-8142 | marie@palkiper.com

Seven Key Advantages of a Proven SEO Strategy In it for long-term exposure BY SCOTT RICHARDS, FACELESS MARKETING

An online survey, conducted by the Consumer Reports Research Center, asked 1,264 women what they find most stressful when shopping; 33 percent said checkout lines. I have an online business why should I be concerned? You should be concerned because loading times is the online equivalent of checkout lines. Faster loading pages are very essential to a positive user experience. I recently read Website Optimization, by Andy B King, and was surprised by some of the statistics in it. It shows how there is a clear correlation between page load times and conversion rates (Sale Rate). Google’s and Amazon’s statistics show that an increase in load time has a direct and drastic impact on user engagement. Properly validated and optimized files will be smaller and leaner, meaning less sever requests, overheads and quicker download times.

This month we provide you with 7 key advantages of having an SEO strategy in place and while there are others, these are very important points to consider. SEO has proven very effective to businesses looking to increase their online visibility and sales. An often, over-looked benefit of having professional SEO service is that it helps to make your websites favorable, to both site visitors and search engines alike. A good SEO service provider offers a client-focused and cost-effective search engine optimization service, together with several Internet marketing solutions including viral marketing, social media marketing, web development and many more. A good SEO agency understands that despite there being thousands of websites on the internet, each one is personal and unique. Use these tactics below to increase your page rank and strength for your website. These will work and provide results if they have not been completed already.

5. Content - Separate Yourself from Your Competitors It’s important to be the black sheep; at least in the world of SEO. Search Engines, such as Google and Bing, look for unique content when indexing pages. The general advice these days is to create subject-specific content on your website; and to categorize and label that content in a way that will deliver a boost to your keyword strategy. Blogs, such as WordPress, are an excellent way to go about this. If you invest in unique content, you’re building a valuable intellectual property asset that will benefit other areas of the business as well as improve your search

1. Displace Your Competition- Be First to Be Seen, Be the One That Makes the Sale. The old children’s story, The Tortoise and The Hare, is a perfect analogy to describe the lifespan benefits of SEO compared to PPC (Pay Per Click). PPC, the Hare, will always be the first to move up the rankings and the first to generate ROI, but rarely continues to. While SEO, or in this case the Tortoise, gradually increases to the top and will generate 4x-10x more income than PPC in the long term. A properly designed and optimized site that utilizes a SEO strategy diligently and regularly will always generate higher revenues than PPC. PPC is today’s version of Newspaper Ads, costs a fortune and only works a little.

2. Be Found Where They Are Searching Don’t Place Your Billboard in the Desert “If you build it, they will come.” Having a great website is the first step to online marketing, but isn’t the most important. A great website doesn’t guarantee that you will receive visitors, but SEO does. A website without SEO, is like placing your billboard in the desert; no one will see it. If your website is ranking high for popular terms, you will receive site visitors. Traffic is the middle-man between brand awareness and sales. Once consumers become aware of your brand you will receive more visitors to your website and the more visitors you receive, the higher the chances you will make a sale.

3. Opt-In Promotion- Reach Your Customers 24/7 Without Being Intrusive As globalization continues to increase and time zones begin to fade; it’s very important for your business to become ’24/7.’ Online marketing in comparison to traditional marketing mediums, such as print newspaper, is non-intrusive, noninterrupt or as we call it in the business “Opt-In.” A customer can research all about your company, products, clients etc. in their own time, without having to fit it into 9-5pm day. This allows you to capture their attention when they are MOST attentive, during their free research time. A SEO strategy is like having your own marketing and promotions company working exclusively for you. One that works, 24 hours a day, 7 days a week and 365 days a year. 24/7 global exposure for your website, means your company can reach people in areas that traditional marketing cannot.

4. Faster Load times - Don’t Keep Your Customers Waiting in Line 10

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rankings. A professional SEO company will know how to create unique content, which is properly designed for readers and google.

6. Brand Awareness - Be Seen, Be Noticed, Be Remembered Google “Glass Doors,” how many results do you get? Out of those results, how many names do you actually remember? I got over 153,000,000 results and I remember two; great odds... no? An effective SEO strategy will bring your website to the top. Sometimes that doesn’t result in an immediate sale, but will gain you more revenue in the long run. SEO increases your brand awareness and its memorability. The truth is most people don’t know what SEO is or even that it exists; they will assume the reason you come up on top of Google’s search results is because you provide a good service and offer the answer to their search query.

7. Increase Revenue: ROI - Earn While You Save At the end of the day, marketing’s main objective is to gain more sales. SEO is an extremely effective tool for online marketing. In addition, search engine optimization is low cost compared to other forms of marketing and is arguably one of the most effective apparent by its High

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Read This if You Feel Out of Control and Powerless to Change BY JACKIE JACKSON

If you feel this way, it is difficult to get anything in life solved without solving this issue first. That’s why I have written this guide to helping yourself out of a pit of hopelessness and lack of control.

When I hear people say, “I’m a total control freak,” I think: ‘Sure, aren’t we all?’

What Happens to Us When We Feel Powerless

I mean, we’re all human - we all desire control. We long to be in the place we want to be doing the things we want to do. This is control over your actions and surroundings. It’s why we spend so much time and money getting our homes exactly right, as it is our domain that we can control. If we get what we want, we feel free. If not, we can feel trapped. For most people, much of their life means chaos. Maybe they have an evil boss who is overly demanding or verbally abusive. Anyone who has suffered this will feel completely out of control because someone has power over you. In fact, that boss’ desire for control over other people is what causes the suffering in the first place. Ever been in a car crash? Anyone who has will know that split second where you lose control, and your life is in the hands of fate. This feeling of helplessness is one of the worst feelings in the world. The tragedy is many people feel helpless and powerless all too often. Some feel like their life is careering out of control 24/7. When I was a struggling single mother, I looked at other people and thought: ‘How on Earth can everyone else keep it together? Everyone’s life seems perfect, whereas I feel like mine’s completely out of control.’ After experiencing many years of being a wealth coach, I can tell you that this feeling of powerlessness is common. Feeling helpless is a powerful yet negative emotion.

We need to feel in control to maximize our psychological well-being. So many people feel helpless and out of control, we may think this mindset is normal and so not a problem. Hey, we’re all in the same boat, right? Life is for suffering together! This is how skewed our perceptions can be if we don’t know anything else. If feeling like your life is out of control is normal for you, it can be very hard to get into the right mindset to change it. You might feel like you should stick with your current mindset out of habit, or some kind of perverse loyalty. If you try to change, other people might shame you by accusing you of thinking you are “better than them.” Of course, this is their pain talking. People can talk and act in all kinds of ways if they feel their limited control is threatened even further. If we feel hopeless and powerless we feel like we have no choice. This makes sense: if we thought we had a choice to stop being powerless then wouldn’t we take it? It seems like a no-brainer. The truth is the habit and pain of powerlessness puts blinkers on how you see the world. People who feel out of control often don’t realize that there ARE choices available to them. Instead, they fail to see alternative courses of action and their life never changes.

When you change your mindset to a more open and positive one, you will begin to see the choices that were there all along. You don’t have to take abuse from your boss. It is not your lot in life. Nothing is “down to fate.”

• You can take things higher. • You can change departments. • You can quit. • You can stand up to him/her. Sometimes taking a step back can open up routes of action you never realized were an option. So, the first step to overcoming your feelings of being out of control is to see that in every part of your life there IS a choice to be made. Read on to find out how to do this and where to go from here.

How to Stop Feeling Weak and Powerless Part of feeling in control is recognizing that something bad is going to happen in the future. Unfortunately, it is inevitable. Does this mean that it’s pointless to strive for control and positive well-being in your life? Of course not! Part of being in complete control is being aware and accepting of everything that could go wrong. This is an important part of mental preparation for the challenges of life.

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As a healthcare provider, patient satisfaction matters most to you and your staff. You need advanced communication services from a provider like Smart City Metro who will take care of you as well as you take care of your patients. To ensure that your facility delivers the best patient care, we deliver the most advanced communication services over a state-of-the-art fiber network, dedicated account management, professional technical support, and the most responsive locally based customer care you won’t find anywhere else. Highly flexible, scalable fiber Internet network to keep up with the pace of healthcare Digitally transform legacy systems with a secure SD-WAN solution Easily and securely connect care teams and patients with Hosted Voice and Unified Communications Connect locations site-to-site or site-to-multi site Ethernet solutions over a secure fiber network Whatever size of your facility, and if you staff is on-site or remote, let Smart City Metro’s network be the backbone of your infrastructure that enables you to provide the world class care your patients deserve.

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Why Medical Clearance Is Really a Preoperative Evaluation BY DEBRA DAVIDSON, MJ, CPHRM AND DAVID L. FELDMAN, MD, MBA, FACS

The evaluating physician and/or the surgeon should also make use of a presurgical risk calculator, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. This allows for a discussion with the patient that is specific to the procedure and includes the individual’s quantifiable risks. If it is determined that the patient can proceed with surgery, the evaluating physician should communicate the findings to the surgeon verbally and in writing. Document the patient’s medical record with the evaluation and findings and when and how they were communicated to the surgeon. Occasionally, a high-risk patient will not be able to proceed because the risks of the procedure outweigh the benefits, even with a change in medical therapy. The reason(s) for the denial should be well documented. In those instances in which a surgical procedure is considered urgent or emergent, the surgeon will need to use his or her best judgment to determine if there is time for a preoperative medical evaluation, an assessment that would typically be performed by an in-hospital medicine physician such as a hospitalist.

The term medical clearance is subject to debate in the medical community. Depending on how the term is used, it can have different meanings in different situations. For example, a fitness trainer might require a client to have medical clearance before beginning an exercise program, or a student athlete might need clearance before participating in sports. The term is often used by surgeons requesting a medical evaluation before performing surgery on a patient. In the context of surgery, a medical clearance is, essentially, considered to be an authorization from an evaluating doctor that a patient is cleared, or deemed healthy enough, for a proposed surgery. Arguably, clearance is an inaccurate description of what is accomplished during a preoperative medical evaluation. Dr. George Marzouka, a cardiologist who is often asked to perform preoperative cardiovascular evaluations on patients prior to elective procedures, believes that “calling a preoperative evaluation a ‘clearance,’ in fact, belittles the purpose of the assessment, and provides little in terms of meaningful information to the surgeon. It misleads patients, and possibly surgeons, by implying a sense of security that is not based on reality.” Instead, as Marzouka reminds us, “the purpose of the preoperative evaluation is to assess what medical problems are present and how those problems might affect a person’s operative risk.” It offers the patient and surgeon “some realistic expectations of what complications may arise during and after surgery.… The evaluation is further helpful for determining interventions the patient can do that may lower that risk.”1

Malpractice Liability Considerations As with any patient-physician encounter, the preoperative medical evaluation should be carefully documented in the patient’s chart (either inpatient or outpatient, depending on the patient’s preoperative status). In some hospitals, a template is used to ensure that all systems are evaluated during this process, and the template also serves as a checklist. As mentioned previously, the decision to have the patient undergo a preoperative medical evaluation is ultimately up to the operating surgeon, though some hospitals and ambulatory surgery centers may have rules and regulations specifying when a preoperative medical evaluation must occur. As in all medical decisions, there is always a risk of liability to both the surgeon and the evaluating physician should the patient have an adverse perioperative event. The physicians’ use of good medical judgment and docu-

Evaluate, Communicate, and Document A preoperative medical evaluation may not be necessary for all patients having surgery. Otherwise, healthy patients—often most easily categorized by the American Society of Anesthesiologists’ (ASA’s) Physical Status Classification System as an ASA I or II—don’t usually require a preoperative medical evaluation, subject to the discretion of the surgeon and/or their primary care physician. For patients with significant comorbidities (ASA III and above) the surgeon who recommends surgery refers the patient for a preoperative medical consultation. It begins with the patient’s primary care physician, who may seek additional consultation from a specialist, such as a cardiologist. It is the surgeon’s responsibility to provide the evaluating physician with up-to-date information about the patient’s medical condition, the type and expected length of surgery, the kind of anesthesia that is anticipated, how long the patient may be immobile, and details about the patient’s rehabilitation and expected recovery period. Before determining the patient’s risks for surgery, the evaluating physician considers all information and may request additional labs, tests, or other consults. It is possible that recommendations for adjustments to medical therapy may occur to help the patient get to an optimal place for surgery that mitigates perioperative risks. The surgeon and evaluating physician should agree, for example, about which medications to stop preoperatively and which to continue. Anticoagulants are often an issue in surgical claims. If the patient takes anticoagulants, the surgeon and the evaluating physician should agree on the best approach given the individual’s risk factors.

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mentation of these decisions in the medical record are the best defense against such a claim. This is also true when the surgeon and the evaluating physician disagree about an aspect of perioperative care or even whether the patient should undergo surgery at all. Ultimately, if the surgeon decides to proceed, he or she will need to document the reasons for choosing a course that might differ from the preoperative consultant’s recommendation. This is no different from any other physician consultation when the physician in charge disagrees with the consultant’s recommendation. Deviation from the recommendation requires documentation of the reasons for doing so.

Opportunity for Partnership and Health Improvements Preoperative medical evaluations are excellent opportunities for patients to gather more information about their health status and obtain recommendations for improved health. Remind patients to take advantage of the opportunity; a medical exam may provide an early warning sign of something serious. Avoid using the term medical clearance as it is a misnomer implying that the patient is cleared and free of risks. No patient is free of risk, however, when undergoing a procedure. The goals of the preoperative evaluation are to determine the level of risk and to identify opportunities to mitigate risk—with the surgeon and the evaluating physician working together. The decision about whether to proceed with the surgery belongs to the surgeon and the patient. Debra Davidson, MJ, CPHRM is Senior Patient Safety Risk Manager for the Department of Patient Safety and Risk Management, and David L. Feldman, MD, MBA, FACS is Chief Medical Officer for The Doctors Company and Healthcare Risk Advisors The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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Read This if You Feel Out of Control and Powerless to Change

And guess what: coming to terms with this is part of you being in control. You have a choice:

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plete control over their life. They don’t wait until someone gives them permission to do something, they exercise their choice right in the moment. Receiving abuse from a friend or colleague? That person is no longer a part of their life. Are you getting no enjoyment or benefit from a part of your routine? Why are you wasting your finite life on such things? Eliminate it. Do things in a way that you can control. If you are in a public space, you can remove yourself from a toxic situation. There is no need for conflict - you are in control! In short, you have the power to control your life if you just give yourself permission to do so. Everything is a choice, and you have a choice if you want to approach life powerfully and in control, or not. It is the mindset that primes you for this success. Once you feel that you have the power and mental resources to control how things affect you in life, you will start to view the world differently. You will no longer be a victim who lets life happen to you. You will notice the infinite opportunity that is available to us in the world and have the capacity to pursue what you want. There will be so much good stuff going on in your life, your biggest problem will be how to fit it all in. These are the high-quality problems that you will have when you are on top of your life. So, remember, you are in control. Next up, we’ll go right back to Real Estate Investing and some of the choices that are out there and which might be right for you. Until we meet again.

1. To be caught off-guard by the unexpected and feel powerless as you constantly try to play catch-up or; 2. To be fully prepared to deal with any eventuality, confident that while you may not be in control of everything that happens to you, you can be in control of how you react to it. Read that again if you have to. This is the mindset shift you need to start feeling in control again. Like anything else, your mindset is your mental habits. It takes time and perseverance to replace the mental software you have with a more positive and powerful one. Take every challenge as it comes. Don’t let problems pile up. Appreciate every little victory. Find a tribe of like-minded people. After some time, you will have the mindset of someone who is in complete control.

Go Ahead and Live a Powerful Life! One of the hallmarks of the personality of a self-made millionaire is that they can perform under pressure. It makes sense - if you have multiple deals floating around that could make or lose you millions of dollars you need to keep a cool head. T. Harv Eker, author of Secrets of the Millionaire Mind outlines 17 ways the money mindset of the rich differs from the middle class and poor. One of them is that rich people believe: “I create my life.” This contrasts with what most people believe: “Life happens to me.” Eker points out that every rich person he knew has com-

Jackie Jackson is a Real Estate Coach & Mentor based in Central Florida. After working over a decade in corporate America and climbing the success ladder to vice president, she walked away from it all. As a result, she pursued her calling as a mentor, motivator, and business coach. She does one-onone coaching, offers boot camps and speaks at seminars and teach courses.

January 19 3:00PM-5:00PM TOPIC

SO THE PANDEMIC PANIC IS OVER, NOW WHAT?

INDUSTRY LEADING SPEAKERS

Clinical Perspective Tony Cowan, Certified Senior Clinical Research Associate Contractor at Cowan Research & Consulting, LLC Human Resource’s Perspective Wendy Sellers, MHR, The HR Lady, LLC Financial Perspective - Jeffrey Holt, VP, CMPE, Senior Healthcare Business Banking Advisor at PNC Bank

CLICK TO RSVP VIRTUAL MEETING COVID FREE 13

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Seven Key Advantages of a Proven SEO Strategy ROI. A monthly fee to a SEO agency will be much cheaper than buying traffic through PPC. Also, SEO costs tend to lower with time. As search engine optimization drives more traffic to the site, you will receive more sales and if you aren’t receiving these sales, then it is a huge indicator that there are issues within your website. ROI can be measured by analyzing statistical data from search engines: know the amount of traffic your website receives, what keywords consumers are using to find your website, which pages on your website they are visiting, plus much more. These are some hidden benefits of having the proper Search Engine Optimization (SEO) plan in place for your brand & business. Make sure these strategies are built in your plan and site and you will see the results on an organic level. Having the strong page rank and strength online is like getting published with findings in your field or making the right discoveries. It marks you as an expert in the field, and that’s what SEO can do for your site. Have its trust authority on a high level so search engines see your site as an expert in that field. After all we have been through the past 2 years, let’s all do what we can to have a strong year with our practices and businesses. Happy New Year to everyone. Scott Richards is CEO at Faceless Marketing, a Full Service Marketing Firm Providing Complete Marketing Plans/Campaigns and: Graphic Design, Printing, Direct Mail, Social Media Marketing, Public Relations, Multimedia and everything that a business needs to assist in creating success. Offices in Orlando, Miami & Denver. Contact him at Scott@faceless.marketing or visit www.Faceless.Marketing

ORLANDO || GRAND ROUNDS UCF College of Medicine Announces 11th Annual MedPACt Global Health Conference VIRTUAL EVENT FROM 8AM-5PM JANUARY 15 To register visit: https://www.ucfglobalhealth.org

AdventHealth Kissimmee Opens New Floors in Patient Tower la Rankin, CEO of AdventHealth Kissimmee. “We are dedicated to providing whole-person care close to home for the growing population of Osceola County in the years to come.” Rapid population growth has contributed to the need for additional capacity at the campus, as reflected in the number of patients seen in the last two years. AdventHealth Kissimmee had about 17,100 admissions and more than 83,500 emergency room visits in 2020-2021. The completion of this project is the latest in a series of improvements on the campus, going back to the expanded emergency room that opened in 2014, followed by the original patient tower in 2015.

AdventHealth Kissimmee has opened new floors in its patient tower, an $84 million expansion that includes new private rooms and the ability to provide crucial services for residents in Osceola County. The approximately 123,000-square-foot expansion adds 80 private patient rooms, bringing the campus licensed bed count to 242 and bringing the tower from three stories to six. Later this year, there will be an additional $20 million investment to open a fifth operating room and a second cardiac catheterization lab to serve the community’s surgical and cardiovascular needs. Furthermore, a parking garage will be opening at the end of the year. “This investment illustrates our ongoing commitment to the health of the Kissimmee community,” said Shei-

Opera Orlando Announces Medical Patrons Society packages that allow their logos to appear on all signs and banners associated with a given season including season banners, posters, brochures, sponsor reels, lobby monitors, etc.

Opera Orlando is pleased to announce a new affinity group program for doctors, nurses, medical administrators, and other medical group members entitled the Medical Patrons Society. Members of this group receive exclusive access to the Opera’s events and artists while connecting and receiving visibility with a highly desirable segment of the Central Florida community. Visibility opportunities include program book ads, logo credit on outdoor advertising, venue signage, and public recognition at a variety of events and performances. Members will also enjoy special entertainment opportunities through VIP opera tickets, VIP treatment at events, complimentary memberships, and elite networking opportunities.

PLAYBILL AD: Members receive a quarter page advertisement in Opera Orlando playbills for the entire season, plus a discounted offer for half page or full page ads. PUBLIC RECOGNITION: Opera Orlando gives public recognition to donors and members at the Company’s largest events and performances throughout the season. SPECIAL EVENTS: Members receive free access to VIP after parties with the cast and before MainStage productions a special happy hour event is held just for affinity group members. Special events can be created or tailored specifically for affinity groups.

MEMBER BENEFITS WEB PRESENCE: Members are listed on the Opera Orlando website donors pages with click-thru links to their respective practices or websites.

PLAYBILL RECOGNITION: Members are listed in all Opera Orlando playbills on the donor pages. TICKETS: Affinity group members receive early access to individual tickets and receive early bird discounts for season tickets for themselves and their constituents.

SOCIAL MEDIA: Opera Orlando features its members with a continuing presence on Facebook, Twitter, and Instagram platforms via in-membership spotlight posts and community spotlight posts.

ELITE NETWORKING OPPORTUNITIES: Season sponsors receive exclusive invitations to Opera Orlando luncheons, galas, fundraising events, and behind the scenes tours.

VENUE SIGNAGE: During the term of the season, members get special discounts on season sponsorships and advertising

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The medical student-run conference is geared towards health professionals, medical, nursing and pharmacy students, as well as anyone is interested in the topic of global health. This year’s focus is Healthcare Activism and the New Scope of Practice. The COVID-19 pandemic has shaken people and institutions worldwide – healthcare is no exception. New challenges associated with healthcare delivery are being discovered and old ones are now even more visible. As we look forward to a post-pandemic world, a new kind of healthcare provider emerges. Armed with the understanding that patient care goes beyond the clinic, the new guard finds ways to advocate in the governments, businesses, and streets of the world. The conference will feature keynote speaker Christine Ngaruiya, MD, MSc, DMTH, Researcher, Emergency Medicine Physician Assistant Professor in the Department of Emergency Medicine (DEM), Yale School of Medicine as well as panel discussions, workshops and major disaster simulation training.

Five Lessons Learned During the COVID-19 Delta Surge Physician leaders from the AdventHealth Central Florida Division recently published a New England Journal of Medicine (NEJM) article outlining how clinical leaders moved beyond their traditional focus on quality and safety and drove change and innovation in the midst of the COVID-19 pandemic. As the state of Florida became one of the epicenters of the pandemic in the U.S. during the summer of 2021, AdventHealth was overwhelmed and stretched beyond capacity, Victor Herrera, MD, vice president and chief medical officer of AdventHealth Orlando, and Neil Finkler, MD, chief clinical officer of the AdventHealth Central Florida Division, explain in the NEJM’s Innovations in Health Care Delivery section. “As clinical leaders, we developed, out of necessity, new knowledge in order to respond to the pandemic,” Finkler said. “This knowledge became our new skillset to aid in problem solving and it will be necessary for the next generation to implement in order to design the next version of health care.” The two physician leaders enlisted the help of the entire clinical leadership team to identify five main areas that presented unique challenges and the lessons that emerged, such as:

• Using new data sources (e.g., the community positivity rate) to effectively forecast COVID-19 dynamics in the hospital setting • Designing a COVID-19 Clinical Performance Dashboard to track actionable data and accountability on the fundamental clinical processes instead of only tracking outcomes • Creating and leveraging external partnerships and developing new ways to interact with media to reduce the transmission and impact of COVID-19 through community education • Learning to accept failure as part of innovation to transform care as well as adapting to a workforce transformed by the pandemic that’s burnt out • Finding hidden health disparities, such as a digital literacy and/or language barrier, and problem solving to improve access to all populations “In researching these best practices, COVID-19 has shown us where our strengths lie and how we can improve in the future,” Herrera said. “By sharing these

NORTH CENTRAL FLORIDA || GRAND ROUNDS that we have not seen in a few months,” said Department of Health in Marion County Administrator Mark Lander. “We encourage our community to heed the guidance for slowing the spread of the virus. That includes frequent hand-washing, staying home if you are sick, and considering obtaining a COVID vaccine or a booster, if you are eligible for one. We reiterate that vaccines are the most effective way to prevent serious illness or hospitalization from COVID-19 for everyone age 5 or older.” Because of the surge in the positivity rate, the U.S. Centers for Disease Control and Prevention has downgraded Marion County’s community transmission rate to “high,” which is defined as having more than 100 new cases per 100,000 people over the seven-day reporting period and having a positivity rate of 10% or higher. The state’s new report indicates 961 people in Marion County received vaccines between Dec. 24 and Dec. 30. That was a decrease of 315 vaccines from the previous week. Despite that, the ratio of Marion County residents age 5 or older who have been vaccinated increased from 61% to 62% during the latest reporting period. The state’s new report also indicates that Marion County has reported its highest daily average of new cases since the week of Sept. 10-16. From COVID-19 cases reported during the week of Dec. 24 to Dec. 30, Marion County saw: An average of 220.4 new cases per day 17.4% positivity rate A total of 961 people vaccinated

ORLANDO || GRAND ROUNDS insights with other physicians and clinicians through the NEJM, we hope our findings will be implemented across hospitals globally to improve patient outcomes.” These focus areas also provided opportunities to acquire new skills and new knowledge, with the potential to redefine aspects of clinical leadership into the future. Both Herrera and Finkler agree, in order to do this, organizational changes may be required to continue to provide clinical leaders with the necessary tools to improve and maintain their effectiveness in the post-pandemic world.

Nemours Children’s Hospital, Florida Earns 2021 Leapfrog Top Hospital Award for Outstanding Quality and Safety Highlighting its nationally recognized patient safety and quality achievements, Nemours Children’s Hospital, Florida was named a Top Children’s Hospital nationally by The Leapfrog Group. This marks the fifth time in the nine years since the hospital opened that Nemours Children’s made the prestigious list. The Leapfrog Top Hospital award is widely acknowledged as one of the most competitive designations for quality and safety that American hospitals can receive. The Leapfrog Group is a national watchdog organization of employers and other purchasers recognized as the toughest standard-setters for health care safety and quality. “We are honored to receive this prestigious award recognizing the commitment of our doctors, nurses, care teams and administration to safe, high-quality care,” said R. Lawrence Moss, MD, President and CEO of Nemours Children’s Health. “We recognize that Leapfrog ratings are an important tool for making healthcare decisions, and we appreciate how well it aligns with Nemours Children’s culture of safety and compassionate care.” Over 2,200 hospitals were considered for the award. Nemours Children’s Hospital, Florida, was among 149 hospitals nationwide and one of only eight children’s hospitals to receive the Top Children’s distinction. The quality of patient care across many areas of hospital performance is considered in establishing the qualifications for the award, including infection rates, surgery, maternity care, and the hospital’s capacity to prevent medication and other errors. The rigorous standards are defined in each year’s Top Hospital Methodology. To qualify for the Top Hospitals distinction, hospitals must rank top among peers on the Leapfrog Hospital Survey, which assesses hospital performance on the highest quality and patient safety standards. To see the full list of institutions honored as 2021 Top Hospitals, visit www. leapfroggroup.org/tophospitals.

People with amnestic mild cognitive impairment typically experience a change in their ability to remember important information, such as appointments or recent events. The proportion who go on to develop dementia ranges from 17.7% to 40.4%, according to the paper. “What’s really exciting is the idea that we can use this information to say, ‘OK, you’re at a stage where you’re at high risk to develop dementia or Alzheimer’s disease.’ This can tell us that we need to work full force to apply any number of clinical approaches to attempt to ameliorate these effects, slow this progression,” said Adam Woods, Ph.D., associate director of UF’s Center for Cognitive Aging and Memory and a study co-author. The study was a collaborative effort with the 1Florida Alzheimer’s Disease Research Center, a UF-led consortium of five research institutions in the state, and participants were evaluated at the University of Miami. The algorithm incorporated two MRIs for each participant — one reflecting brain structures and the other a measurement of brain activity detected by subtle changes in blood flow. “A key value of this artificial intelligence-empowered prediction tool is to fully recognize the individual variability in preventing dementia,” said Ruogu Fang, Ph.D., an assistant professor of biomedical engineering at the UF College of Engineering and a study co-author. “We hope that this study will pave the way for more personalized intervention strategies by helping researchers determine which patients to treat first, when to treat them, which clinical approach to use and how to apply the intervention at an early stage.”

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Parrish Medical Group Welcomes Physician Assistant Denise McBroom

UF Study Shows Artificial Intelligence’s Potential to Predict Dementia BY MICHELLE KOIDIN JAFFEE AND TODD TAYLOR

New research shows that a form of artificial intelligence combined with MRI scans of the brain has the potential to predict whether people with a specific type of early memory loss will go on to develop Alzheimer’s disease or other form of dementia. University of Florida researchers studied 55 participants who had been diagnosed with amnestic mild cognitive impairment, a condition in which a person has more memory problems than expected for their age. The findings were published in the journal Frontiers in Aging Neuroscience. By applying a type of computer algorithm known as a support vector machine model to a 45-minute MRI brain scan, the researchers reported that the algorithm could predict progression from amnestic mild cognitive impairment to dementia with over 94% accuracy. Furthermore, they reported that the algorithm produced 92.7% accuracy when using a 10-minute MRI brain scan alone. Of the participants, 14 developed dementia and 41 remained stable over a study period that averaged about 15 months. “A unique aspect of this study is that we were able to identify the exact areas of the brain that differentiated the two groups. This is crucial for predicting which participants are more likely to develop dementia and is also important for our future research efforts,” said Joseph Gullett, Ph.D., a research assistant professor in the department of clinical and health psychology in UF’s College of Public Health and Health Professions who led the study.

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Marion County Covid-19 Positivity Surges OCALA —Marion County’s COVID-19 positivity rate rose sharply during the last week of 2021, reaching its highest level in more than three months, according to the most recent state report, released Friday. Marion County reported 59,663 cumulative cases as of Dec. 30, with an increase of 1,543 new cases from the previous week. Marion County’s reported COVID-19 cases between Dec. 24 and Dec. 30 had a positivity rate of 17.4%. That was up from 5% last week. The new positivity rate is Marion County’s highest since Sept. 16, when the county’s rate was reported at 17.9%. Overall, the daily positivity rate for all new COVID-19 cases throughout Florida was 26.5%. “We anticipated this increase to some degree because of the holidays, and the possibility of crowded gatherings, especially with guests from out of town. But we’re concerned that we’ve reached a point with new infections

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Parrish Medical Group is pleased to welcome physician assistant Denise McBroom to the Brevard community. Denise is now offering primary care and occupational health services at Parrish Healthcare Center at Port Canaveral. Denise McBroom is a graduate of the Medical College of Georgia and has over 22 years of experience. Passionate

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VOLUSIA/BREVARD || GRAND ROUNDS about health, wellness and preventative care, Denise has a strong history of success in meeting patient needs by leveraging health care expertise to diagnose and treat a multitude of conditions. Some of the services that Denise will be offering in at Parrish Healthcare Center at Port Canaveral include acute care visits and injury assessments, patient care management, respirator clearance and Department of Transportation physicals. Parrish Medical Group and Denise McBroom are now accepting new patients. To schedule an appointment with Denise, call 321-633-8640 or visit parrishhealthcare. com/McBroom.

Parrish Medical Group Welcomes Dr. Mara De La Vega Parrish Medical Group is pleased to welcome board-certified primary care physician Mara De La Vega, MD, to the Brevard community. Dr. De La Vega has over 25 years of experience and is now offering primary care services at Parrish Healthcare Center at Titus Landing. Dr. De La Vega earned her medical degree from Universidad Metropolitana in Barranguilla, Columbia. Following her studies, Dr. De La Vega completed her residency in family practice at the Albert Einstein College of Medicine in Jamaica, New York. Most recently, Dr. De La Vega held the position of Medical Director at EternaMD. Fluent in both English and Spanish, Dr. De La Vega is passionate about meeting every patient’s needs. She is a member of the American Academy of Family Physicians, the American Academy of Hospice and Palliative Medicine and the American Society for Laser Medicine and Surgery. Parrish Medical Group and Dr. De La Vega are now accepting new patients. To schedule an appointment with Dr. De La Vega, call 321-268-6868 or visit parrishhealthcare.com/DeLaVega.

Health First and Crane Creek Surgery Center Announce Strategic Joint Venture to Expand Care in Brevard County Rockledge – Officials with Health First and the Crane Creek Surgery Center have announced a new strategic joint venture to expand surgical specialties and practice reach – providing increased high-quality care for the Brevard County community. The new partnership, which includes The B.A.C.K. Center becoming part of Health First Medical Group, will provide Health First with the opportunity to align resources in a way that better serves and delights customers while upholding the organization’s ‘One Health First’ mission and value promise. Rather than reopen its Melbourne Same-Day Surgery Center (MSDS), which was previously closed due to the COVID-19 pandemic, Health First and Crane Creek Surgery Center will work to grow surgical services at the Crane Creek location – located just south of downtown Melbourne. The Crane Creek location is a beautifully appointed, modern facility with five large operating rooms - and the ability to accommodate future growth. The Melbourne Same-Day Surgery Center will ultimately be repurposed as part of Health First’s Wellness Villages, first

Parrish Healthcare named Founding Member of the Children’s Advocacy Center of Brevard’s Ambassador Circle Parrish Healthcare is proud to partner with the Friends of the Children’s Advocacy Center of Brevard (CACB) to create a premier level of giving called the Ambassador Circle. The Friends of the CACB’s Ambassador Circle will serve as a prestigious group of businesses and investors who pledge significant levels of financial support ($10,000 or more) on a multi-year basis in support of improving our community’s response to child abuse and neglect. “Guided by our vision, Healing Families–Healing Communities, the creation of the Friends of the CACB’s Ambassador Circle serves to help address two significant needs identified from our community health needs assessment; access to mental health services and support for victims of abuse,” said Parrish Healthcare President/ CEO George Mikitarian. “Through meaningful partnerships between business and community-based programs like The Friends of the CACB, we help to build a better Brevard, and, ultimately, stronger families,” added Dr. Mikitarian. “Parrish Healthcare, as the founding member of Friends of the CACB’s Ambassador Circle, has committed $50,000 over a five-year period. Those funds will help support the many child protection programs and services offered through the CACB, such as specialized mental health counseling, medical exams, forensic interviews, and consultation services among other services,” said CACB President Susan Moore. To learn more about the Friends of the Children’s Advocacy Center of Brevard and how they support the programs and services of the CACB for abused children visit https://www.friendsof thecacb.org

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announced in late 2019, as part of a 5 year $600 million development, in which each wellness village will have different health care concepts, including fitness and medical offices. “Health First is dedicated to the wellness and health of our community, and this joint venture will allow us to expand our surgical specialties and practice reach to provide the highest quality care to our customers of Brevard County and beyond,“ said Frank Letherby, CEO for Community Health Services at Health First. “We have long explored a partnership with Crane Creek Surgery Center and The B.A.C.K. Center, as we share the same goals and dedication to patient care, quality of services, and plans for growth. Together, our teams have an opportunity to align resources in a way that better serves and delights our customers, and we look forward to launching this new partnership in Spring 2022,” Letherby continued. Although agreements have been signed, work remains to integrate our operations with officials anticipating a “go-live” in late spring 2022.

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