Orlando Medical News August 2020 by Orlando Medical News

AUGUST 2020

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COVID-19 Demands Correspond with Uptick in Burnout Among Healthcare Professionals

Many nurses expressing disillusionment from overworking and lack of administrator support

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CONTENTS || FEATURES

Four Women are Redefining What it Means to be a Urologist THESE PHYSICIANS AT ORLANDO HEALTH ARE UNIQUE IN THEIR SPECIALTY

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FEATURES

———————

Elisa Maria Bianchi, MD,

CONTRIBUTING WRITERS S. Lamar Barnett,

COVER STORY COVID-19 Demands Correspond with Uptick in Burnout Among Healthcare Professionals

Becky Gillette, Dorothy Hardee, Michael C. Patterson, Matthew A. Shlapack, MD

EOCC MEDICAL CITY The Impact of COVID-19 on Medical Practices

Robotic Surgery in the Treatment of Colorectal Cancer

8 10 11

——————— SOCIAL MEDIA DIRECTOR Jennifer Cerna ———————

The Explosion of U.S. Cannabis Sales and its Effecton America’s Healthcare System

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American Lung Association Calls on Florida Residents to Pledge to Stand Up for Clean Air, Take Action on Climate Change

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Preventing Osteoporotic Fractures and Preserving Independence

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COVID-19 Demands Correspond with Uptick in Burnout Among Healthcare Professionals Many nurses disillusioned due to overwork and lack of support from administrators BY BECKY GILLETTE

Burnout among nursing professionals was an issue long before the coronavirus disease 2019 hit the U.S. beginning in March putting nurses on the front lines of the worst pandemic seen in 102 years. As of early August, Florida had nearly a half million people test positive for COVID-19, and 7,279 deaths. The state is experiencing one of the worst outbreaks in the country. Even before going to work carried a risk of contracting a highly-contagious and potentially deadly disease – and the risk of bringing the virus home to loved ones at high risk for complications from COVID-19 – nurses were leaving the medical field due to high stress and poor mental health. Many reported becoming disillusioned due to being overworked and lacking support from administrators. Now with some hospitals overwhelmed by the number of COVID-19 patients, nurses and other healthcare professionals are working longer hours while struggling to balance high-quality patient care with the increasing amount of paperwork required to document COVID-19 cases. “An uptick in COVID-19 cases corresponds with an uptick in burnout among healthcare professionals at a time when more than ever before we need nurses to pull together during this crisis and step up in partnership with nursing leadership,” said Dr. Renee Thompson, a nursing professional development/bullying and incivility thought leader, and founder of the Healthy Workforce Institute. “We can’t wait until this crisis is over before we take positive action to protect our front-line nurses and healthcare teams from burnout and mental exhaustion.” The pandemic resulted in many non-urgent surgeries being stopped temporarily, and a trend toward patients avoiding hospitals and clinics out of fear of the virus. With revenues down drastically and losses mounting, some hospitals and clinics have cut staff, resulting in even more work for the remaining employees. “Many nurses, including my colleagues in Central Florida, have observed that the healthcare environment is getting more and more stressful and that they are being asked to do more and more with less and less, thereby adding to feelings of not being able to keep up with the demands,” Thompson said. “Since the global pandemic hit, healthcare leaders started cutting back on their resources to the point where they have stopped investing in their people – stopped offering the very same programs that could help their teams protect their physical, emotional, and mental energy to ride this additional wave. When things get tough financially, administrators cut back on education and development first. Over a period of time, they realize their mistake and then spend more time, energy, and financial resources to compensate for that mistake. Yet, here they go again making the same mistake.” After leaders realize it is a huge mistake to stop

developing their people, they have to double up and spend even more money to re-develop their people when the crisis is over. A Kronos Incorporated study in 2017 reported 98 percent of hospital nurses report their work is physically and mentally demanding. More than half – 63 percent – said their work resulted in burnout. “That was in 2017,” Thompson said. “Fast forward to 2020, the physical and mental demand on nurses is extraordinary. Now they’re battling exhaustion and burnout due to COVID-19. When COVID-19 hit, healthcare teams were called upon to save the world. And they did. They made it through and when cases started to drop, they claimed victory over the virus.

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AUGUST 2020

However, they didn’t realize that the battle had just begun. Before they had a chance to recover and recuperate, they’ve been called upon yet again. The world went from praising the healthcare team as heroes to worrying about their physical, mental, and emotional health as this crisis drags on. As COVID-19 cases rise, so do physician and nurse burnout.” Some nurses are quitting. Thousands have come down with COVID-19 themselves requiring them to take off work for at least a couple of weeks. Kaiser Health News estimated in late July that 898 frontline healthcare workers in the U.S. have died of COVID-19.

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Thompson offers following strategies to reduce nurse burnout:

COVID-19 Correspond with Uptick in Burnout The crisis of today raises concerns for the future. “During a time when we need more people to enroll in nursing programs, the programs are struggling to properly educate their students by providing them with good clinical experiences,” Thompson said. “Also, more and more people who considered becoming a nurse are now having second thoughts. After all, why would they put their lives and potentially, the lives of their families, at risk? I’m concerned the nursing shortage that we have been fighting to stop will see epic numbers in the future.” Compounding all that is layoffs because of declining revenues. “There’s already a fear response occurring among healthcare teams,” Thompson said. “And now they’re watching their colleagues being furloughed, laid off, or quitting. Nurses are worrying that they might be next. Before the pandemic, there used to be breaks in the schedule that helped with resilience. “You had good days with stable patients,” she said. “Sometimes the unit was quiet and you could get caught up on education, attend committee meetings, and work on projects. Now, there is NO break. Nurses and physicians have gone from ‘normal’ burnout to consistent, unrelenting burnout and now, exhaustion. Anyone can handle a crisis when it’s short term. Not when the crisis becomes the new norm.” Thompson advises against waiting until the pandemic subsides to address the issues. When people are exhausted and burned out, not only do they underperform, but they also spread that stress and burnout to others. Nurse burnout begets more nurse burnout. “When nurses don’t feel valued, they become disengaged,” she said. “When they disengage, they don’t advance the science of nursing and, may not have the mental and physical capacity to effectively care for patients. Therefore, healthcare executives need to focus just as much on strategies to reduce their healthcare team’s stress and burnout as they do managing their influx of COVID-19 patients.” During the pandemic, some healthcare teams have pulled together and put aside their differences to meet the unprecedented demand. Some organizations are learning how to live with COVID-19 and not be paralyzed because of it. Other healthcare teams have fallen apart. “During this time we’ve seen more complaining, nitpicking, arguing, and myopic attitudes – even from some of the ‘nice’ nurses,” Thompson said. “Some of this uptick in disruptive behavior is because of the extreme stress nurses and physicians are under. We can all misbehave when under stress. However, when there is no relief from that stress, we just accept the bad behavior as the new norm. Nurses and physicians are misbehaving. Increased, ongoing, relentless stress is at the root of their behavior. Leaders are even more reluctant to confront them because the leaders understand why they’re behaving this way. When disruptive behaviors go unaddressed, they escalate.”

processed, high fat, and artificially-laden foods.

Protect your brain from negative news.

The food we eat should increase–not decrease–

Your brain is the primary source of energy because it controls the release of hormones that play a significant role in where your available

our energy. Choose wisely.

Tip:

As Michael Pollan says, eat real food–mostly plants–not a lot. So, put down the donuts

energy is spent. The brain is the conductor in an

and eat a banana instead. Take “baby steps” in

orchestra of chemicals. Just three minutes of neg-

changing bits and pieces of your eating habits.

ative news in the morning increases your chances of having a bad day by 27 percent.

Tip:

Instead of listening to negative news on your way into work and on your way

home, listen to inspiring music, an audiobook, or even have a conversation with a great friend who is upbeat and positive. You are influenced by everything your brain is exposed to. Be careful

Ask for help. Many nurses think that by asking for help, they are admitting failure or that they are weak. Smart people ask for help to solve problems. They get advice on handling complex situations and delegating appropriately to others.

Tip:

what you put into it.

Identify one thing that you struggle with at work (for Thompson, it was chest

tubes) and ask for help from a colleague who

Laugh as often as you can.

excels at it. Graciously thank this colleague and

When you laugh, like exercise, you release en-

tell them what his or her support meant to you.

dorphins that act as powerful stress busters. And

Research has demonstrated that tying the goal

here’s the good news: your brain doesn’t know if

(e.g., insert a chest tube) with the result (e.g.,

you’re laughing for real or laughing for fake. When

better patient care), we are more apt to achieve

you laugh, even if you just force yourself to laugh,

this goal. Caring for patients is a team sport.

you release magical stress-fighting chemicals.

Tip:

Watch a funny cat video (or two), practice laughter yoga, share funny stories at work,

or have a break with a colleague who is upbeat and funny. Laughter is one of the most powerful cortisol squashing weapons we have – and it’s free!

Stay away from “energy vampires.” Unfortunately, there may be people you work with who suck the life out of you. Imagine how draining it can be if negative people constantly surround you. Over time, you can become negative too.

Eat real foods.

Therefore, the key is to move away from them.

We spend half of our energy digesting our food, and that’s if we’re eating healthy foods that our bodies recognize. We use more energy digesting

Tip:

If you’re in the break room and a vampire starts complaining, just leave.

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LET’S TALK

PHYSICIAN || SPOTLIGHT

Four Women are Redefining What it Means to be a Urologist These physicians at Orlando Health are unique in their specialty system with other women urologists really helped seal the deal for Dr. Han. “Women have issues that urology can specifically treat,” said Dr. Han. “Gynecologists and primary care physicians treat reoccurring urinary tract infections to some degree, but you may need a urologist for voiding issues, incontinence surgeries, kidney stones and the like.” One of the elements of urology that Dr. Han especially likes is its blend of surgery and “a lot of medicine in the more traditional sense. It’s a good balance of both. There are not a lot of emergency issues,” she said. “But helping patients improve their quality of life can really make a huge difference.” Making a difference in people’s lives drew Nahomy Calixte, MD, into the practice. She’s part of the PUR group at Orlando Health South Lake Hospital. She had grown up in the Caribbean and was inspired to become a doctor by reading about the medical heroics of Doctors Without Borders, the international organization that sends physicians to trouble spots around the globe. With the support of her male and female mentors the idea of becoming a doctor to help others, which seemed a dream, became a reality. During her rotations in medical school at Boston University, Dr. Calixte discovered that many urologists were able to overcome the awkwardness of their interactions with patients through gentle humor and that was one of the aspects of the field that she found appealing. And since most of her patients are men, the ability to make light of what might otherwise be embarrassing, helps a great deal. This area of practice also enables her to indulge in her original passions, traveling the world to provide medical care and helping those who are without the financial or

Everybody has a heart. Everybody has lungs. Everybody has a digestive tract and nervous system. We have these things regardless of whether we are male or female. Everybody also has a urinary tract, but because that system is interrelated with our reproductive systems, there has traditionally been a divergence in the genders of the physicians in these practice areas: Obstetrics and Gynecology (OB/GYN) for women and Urology for men. Now, if you accept the proposition that patients generally prefer to be treated by a member of their own gender, especially when it comes to matters relating to their reproductive system or sexuality, it probably makes sense that more than 80 percent of OB/GYN’s are women. After all, obstetrics and gynecology deal with bodily systems that are uniquely female. But if that’s true, why is urology so dominated by male physicians? According to the latest census by the American Urological Association, only nine percent of urologists are women. And yet, as Jacqueline Hamilton, MD, of Orlando Health Medical Group is quick to point out, “Women and children also have urological issues; anyone who has a urinary tract can have issues.” So, while that statistic might look like a hurdle for some doctors to overcome, it has become an inspiration and an opportunity for Dr. Hamilton and three other urologists at Orlando Health who are the only women urologists in Orlando. Dr. Hamilton, who has been in practice for 22 years, the longest in the group, said it’s about time that attention turns to women in this profession, hoping that it will help inspire more women in medical school to consider urology. Dr. Hamilton was drawn into medicine by her father who was a general surgeon. From the time she was a little girl, she spent hours in his office. By the time she was a pre-med student in in college she was allowed to scrub in to watch her father perform surgical procedures during breaks from school. She knew she wanted to be a surgeon, but it wasn’t until a woman urologist gave a presentation at Howard University College of Medicine that she knew urology was the field for her. “I pulled her aside after her lecture and asked her about women in urology and what her practice was like. And she allowed me to come in and shadow her, and that was eye-opening. I decided then that urology was the career I wanted to pursue.” Years later, Dr. Hamilton had the opportunity to reprise her own experience. At a urology conference, she met Esther Han, another urologist sub-specializing in Female Pelvic Medicine and Reconstructive Surgery. How small the number of women in urology is really obvious at professional conferences, said Dr. Han. “I joke that when you go to a Urology conference, there’s never a line outside the women’s restroom.” So, while the prospect of living in Orlando’s sunny climate was very enticing, the opportunity to work in a health care

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AUGUST 2020

family support structures. For example, several years ago, she was in Mongolia with International Volunteers in Urology. The fourth woman urologist in the Orlando Health system came to the United States from Albania with her parents when she was a child. Ruth Strakosha, MD, often served as a translator for her family members, including her grandfather when he needed to visit a urologist. That doctor, David Jablonski, MD, would go on to lead the Medical Group in which she is now a urologist, herself. Dr. Strakosha says this is an exciting time to be a woman in urology. “It’s exciting because I see more and more women in the field. When I started in this field there weren’t many women at all, but now there are more every day.” The lack of role models can be a challenge, she said, but emphasized the support she has gotten from mentors and teachers regardless of their gender. In fact, that’s a point each of these women took pains to note. The field of urology is the least gender-diverse specialty in modern medicine, but it is also a deeply collaborative and collegial profession where excellence matters more than one’s sex.

PRESENTED BY

EAST ORLANDO CHAMBER OF COMMERCE

EOCC || MEDICAL CITY

CALENDAR:

The Impact of COVID-19 on Medical Practices

Healthcare Council Collaborative Virtual Peer-to-Peer Referral Forum & Breakout

How the East Orlando Chamber is Helping

THURSDAY, AUGUST 6,2020 8:00-9:00 AM

BY DOROTHY HARDEE, CHAMBER ADMINISTRATOR

Virtual event Powered by Powernet

It comes as no surprise that COVID-19 has had a significant impact on most business across the board.

The Member Academy: Roadmap to Member Success

In April, Alexandra Wilson Pecci reported that 97 percent of physician practices took a financial hit as a result of the pandemic. Patient volume reduced by 60 percent and revenues declined by an average of 55 percent. Decreased revenue caused many practices to furlough and lay off employees anticipating additional cuts to increase as the pandemic continues to thrive. To rally their practice and reduce the spread, many offices dramatically changed how outpatient care was delivered implementing the use of telemedicine. This shift rose rapidly in mid-April according to a report by Commonwealth Fund. However, the peak leveled and even declined slightly in mid-May. Smaller private practices around the country reported some of the most significant losses causing some to resort to GoFundMe. In fact, results of a recent survey by Primary Care Collaborative and the Larry A. Green center, it is anticipated that the pandemic is going to accelerate the closure of the smaller practices with nearly 40 percent of revenues going to overhead. Strangely enough, with stay at home orders and many restrictions lifted, people who have flocked to beaches, parks, boardwalks and flooded streets in protest, are however, still reluctant to make appointments for necessary physician visits. This is compounded by the increasing number of people without jobs and insurance. Now that I have bombarded you with this gloomy outlook, lets find the silver lining. Peer to peer referrals and the relationships you devel-

WEDNESDAY, AUGUST 12, 2020 9:00 – 10:00 AM

Virtual event Powered by Powernet

Virtual Chamber Luncheon Featuring UCF President Dr. Alexander N. Cartwright WEDNESDAY, AUGUST 19, 2020 12:00 – 1:00 PM

Virtual event Powered by Powernet Free to Members | $10 Non-members

Virtual Coffee Club Nona THURSDAY, AUGUST 20, 2020 8:30 – 9:30 AM

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OPTIC – When Social Media is too Social: Social Media Security & Impact to Small Business Ean Meyer. Who should attend? Your marketing and IT team, as well as anyone using TikTok & other social media apps for your business

FRIDAY, AUGUST 21, 2020 10:30 AM – 12:00 PM Virtual event Powered by Powernet Free to Members | $10 Non-members

Virtual Non-Profit Council Roundtable: Sponsorship Proposal Strategies WEDNESDAY, AUGUST 26, 2020 9:00 – 10:00 AM

Member Exclusive Event Virtual event Powered by Powernet

6 Watch the EOCC.org Calendar for Career Month in September!

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AUGUST 2020

op among colleagues is essential. Our Healthcare Council Collaborative members have offered candid feedback on what a medical practice and physicians need NOW. Physician and Referral coordinators are seeking relationships with individuals from other medical practices as potential referral sources. During our last meeting, a virtual breakout forum not only offered the safety of your home or office while saving precious time, but also provided small group networking attendees sought. On August 6th, the East Orlando Chamber will host a Virtual Peer to Peer referral forum and breakout, inviting physicians and referral coordinators to attend at no cost. The goal is to help start the conversation among healthcare professionals supporting our independent groups throughout East Orange County and beyond. Curious? Then join us by registering to receive the login information. If you could expand your book of business through solid referrals from other healthcare providers, wouldn’t it be worth it? What do you have to lose? Register today and let’s get the conversation started. Our goal is to help your practice grow through referrals, community outreach and provide new opportunities with increased revenue potential. What else can we do for YOU? The East Orlando Chamber of Commerce (EOCC) understands and works diligently to further the interest of businesses providing valuable benefits, industry focused programs and networking and connections to encourage growth in and around East Orange County. Identifying this critical need to support small business, the EOCC offers health benefits to its members in-

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Robotic Surgery in the Treatment of Colorectal Cancer BY DR. ELISA MARIA BIANCHI

Each year in the United States about 150,00 new cases of colorectal cancer are diagnosed and approximately 53,000 Americans will die of the disease. Even as the mortality rate for colorectal cancers has been on the decline since 1990, it continues to be the third most common cause of death for both men and women in the United States. In contrast to the overall mortality decline, the incidence in patients under the age of 50 has been steadily increasing since 1992. This represents a chilling trend, especially given the low likelihood that patients under 50 will undergo screening colonoscopy. Laparoscopic assisted colorectal surgery is widely used in the treatment of this disease. Many colorectal surgeons have adapted laparoscopic surgery as their technique of choice for most of the abdominal procedures they perform. Laparoscopic surgery for the treatment of colorectal cancers is widely used because it does not compromise oncological outcomes and allows for rapid postoperative recovery. However, laparoscopic low pelvic dissections are extremely technically demanding, particularly in male patients who tend to have narrow pelvises. Furthermore, laparoscopic instruments are nonarticulating, thus requiring unnatural coordination and non-ergonomic positioning. This is all done with imaging systems that only provide flat, 2-dimensional views. What’s more, laparoscopic low rectal cancer surgery has a high rate of conversion to open surgery and has an increased rate of postoperative male sexual dysfunction. While we have made many advances in the last decades, laparoscopic surgery still has numerous drawbacks. Robotic surgery is an alternative method of performing minimally invasive colon and rectal surgery. The technology has evolved greatly since it was first used for colon and rectal surgery in 2001. The modern iteration of robotic assisted surgery begins with NASA, developed as an outgrowth of virtual reality systems for visualizing data being returned from the Voyager mission. This idea then developed into telepresence surgery, or remote robotic surgery. First developed as a prototype for use by the military to provide remote immediate surgical care on the battlefield. Eventually, the PUMA 560 system was the first robotic device used to perform robotic assisted surgery, a percutaneous brain biopsy in 1985. Robotic surgery has evolved over the years and is today largely used by surgeons who are physically in the same room as their patients. In 1999, the da Vinci Robotic Surgical System entered the market. This robotic system was notable for its three-dimensional vision system, three arms and EndoWrist® technology. In 2014 the Xi system was introduced and has fast become the most widely used system. This robotic platform has four arms, allows for multi-quadrant surgery, has upgraded optics and technology that improves arm positioning.

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The Explosion of U.S. Cannabis Sales and its Effect on America’s Healthcare System BY MICHAEL C. PATTERSON

first-hand experience that Seniors are tired of taking so many medications and dealing with a barrage of side effects from constipation, nausea, headache, fatigue, decrease in immune response, and more. As more Seniors are recommended medical cannabis, they see the benefits of its use and they tell their friends. As more Seniors continue to use cannabis as a medicine and have a positive experience, the acceptance of medicinal cannabis will continue to accelerate. Furthermore, as adult use cannabis becomes legal in more states, more Seniors will be by-passing their physician and going directly to the cannabis dispensary in an attempt to self-medicate. Health care companies will need to acknowledge cannabis as a medicine and begin to look at recommending medicinal cannabis or eventually incorporating adult use cannabis into a treatment regimen (similar to using vitamins or nutritional supplements) in order to maintain or increase current patient services and revenue.

The Marijuana Business Factbook, provided by Marijuana Business Daily, has recently projected that the U.S. Cannabis market (medical and adult use cannabis) will exceed $36 Billion in sales by 2024. This overwhelming acceptance by the American public is changing the US healthcare system in unexpected ways. In 2019, the USA sold approximately $13.6 Billion in legal cannabis ($7.6 Billion- Adult Use, $6.0 Billion Medical Use). Cannabis sales continue to increase 30 percent per year on average across the country. With over 90 percent of Americans approving medical cannabis use and 67 percent approving adult use (recreational use), legal cannabis in our society is here to stay. In Florida, medical cannabis sales are projected to surpass over $1 Billion in 2020 with over 350,000 qualified medical cannabis patients as of July 2020, and patient counts steadily rising 3,000-5,000 per week. With the continued increase in use and acceptance of cannabis, how is this currently affecting America’s healthcare system and what effect will cannabis have on the future of healthcare?

Big Pharma is on the sidelines, but ready to get into the game Big Pharma companies are already involved in the global cannabis industry. Companies are performing research on cannabis (where legal) and studying current cannabis companies in the market. As the US moves toward legalization of cannabis, innovation will increase dramatically. You will see more interest and money flowing into the cannabis industry for R & D of the cannabis and hemp plant, the development and study of minor cannabinoids (CBG, CBN, THCA, THCV, etc.) for medicinal use, and the development of patented

The sky is not falling Prior to legalization, the prohibitionists attempted to squash legalization at every turn. Their most common tactic was turning to physicians and medical experts to publicly state that cannabis will be the downfall of our society. That people will become addicted at very high rates, crime will increase and overdose deaths from cannabis will become an epidemic. In reality, the exact opposite is happening. No human has ever died from cannabis (in any form) in human history, which makes cannabis one of the safest medicines, if not the safest, on the planet. To put that figure of ZERO deaths in perspective, people die every year from water intoxication (drinking too much water). Furthermore, studies are beginning to demonstrate patients who use cannabis as a medicine decrease the use of two to three prescription drugs per month because they don’t need them anymore. Cannabis decreases inflammation at the cellular level across the body, which can decrease pain and keep the body closer to a homeostatic state.

cannabis formulations which have proprietary blends of cannabinoids for a specific medical purpose. Also, there will be an increase in the use of non-euphoric cannabinoid formulations to be used as nutritional supplements (similar to fish oil, krill oil, resveratrol, and other natural supplements).

Insurance companies are already looking into how to reimburse cannabis as a medicine Once cannabis goes legal at the federal level, federal insurance programs (Medicare, Medicaid) will begin paying for cannabis. This will lead to private insurance companies paying for medical cannabis as well (if it comes from a physician script). The FDA has already begun to study the Canadian market to see how Canada is covering medical cannabis prescriptions. In regard to insurance payment of cannabis medicine, it is different than any other medicine that has come before. There will have to be a lot of issues worked out to pay for cannabis via insurance due to the many forms of cannabis (flower, edibles, oil-based medicine, tinctures, spray, patch, etc.), implementing cannabis into the current CPT code payment system, and payment amounts per gram of product.

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Senior Citizens are the fastest growing demographic of cannabis users On average, persons over 65 years old in the USA take 13 prescription medications per day. I have seen from

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Cannabis Sales and its Effect on America’s Healthcare System

Robotic Surgery in the Treatment of Colorectal Cancer

Healthcare companies who begin to embrace all types of cannabis (medical and adult use) will be rewarded with more patients and more revenue

Robotic assisted surgery, especially in the pelvis, provides many advantages over laparoscopic techniques. It eliminates many of the technical difficulties inherent to laparoscopic surgery, as its multiple, flexible surgical arms are not limited by lack of articulation or narrow spaces, such as in the male pelvis. It allows for 3-dimentional views, which makes it much easier to identify structures like the inferior hypogastric plexus. Surgeons are also able to directly control the camera and are not dependent on an assistant to “hold the camera steady.” Another advantage of the robotic system is that it allows surgeons to have more ergonomic positioning while operating, which then causes less physical strain and fatigue. All of these factors represent technical improvements over the laparoscopic technique. Therefore, in my practice I favor the use of the robotic system anytime that it is feasible. Minimally invasive surgery, broadly speaking, has shown advantages for patient’s outcomes, in both the long and short term. However, the lack of complete adoption of minimally invasive techniques in colorectal surgery and other fields may be due to the difficulties associated with laparoscopy. Although robotic surgery technology was initially developed for telepresence surgery, it has evolved as an answer to the technical difficulties that surgeons face with laparoscopic surgery.

Cannabis is already becoming a value-add service to many physician group practices. Cannabis physician recommendations have the ability to offer a new private pay revenue stream for a physician practice that did not exist before. This new service has the potential to bring in new patients for cannabis related recommendations, but also offering traditional healthcare services (lab, x-ray, general medicine, consultation, etc.). Also, cannabis patients who have a very pleasant experience with their recommending physician, are more likely to recommend other patients to their physician. The physicians that I personally know who write medical cannabis recommendations tell me that over 75 percent of their new patient referrals come from existing patients. Furthermore, in adult use cannabis states, 40 percent of people using adult use cannabis are using it for medical reasons (sleep and chronic pain are the most common reasons for use). Therefore, many of the patients who are coming into the health care facilities are already using cannabis as a medicine, and not telling their physician. Healthcare groups that open up a mutual dialogue of education and respect for the cannabis plant as a medicine, will be able to offer “wellness services” related to adult use cannabis as a form of a supplement for wellness. As I have seen for years in the cannabis industry, one of the most difficult issues for users is figuring out proper dosage of cannabis for each individual patient. Since our bodies have an endocannabinoid system (ECS) each person processes cannabis at different rates. This does not allow for consistent dosing across an entire population. The ECS creates a tremendous opportunity for physicians to educate and offer paid services which will assist patients in determining their best cannabis dose and delivery method (flower, edible, oil, vapor, etc.) to provide the most relief with the least amount of side effects. One of the most consistent things in life is change. Cannabis is leading the charge in the healthcare world as being one of the biggest changes to modern healthcare in a generation. The healthcare companies who embrace this change will ultimately be more successful than companies that refuse to acknowledge that cannabis used as a medicine has gone mainstream and is here to stay.

Robotic colorectal surgery has developed to offer multiple approaches that include hybrid and non-hybrid operations (using the robot exclusively or with hand and/or laparoscopic assistance). There are multiple docking strategies and designs to improve mobilization and dissection. This technique continues to evolve over time and provides safety and flexibility to surgeons as they tackle the treatment of colorectal cancer. These benefits are notable in low rectal cancers and, in particular, with male patients. As a Colorectal Surgeon, I look forward to the improvement and evolution of robotic surgery, including areas such as single port systems and endoscopic robotic surgery. The increased adoption of this technique promises to improve the outcomes for colorectal cancer patients and help stem the tide of colon and rectal cancers. Elisa Maria Bianchi, MD, is a Board-Certified general surgeon at Digestive and Liver Center of Florida who completed a colorectal surgery fellowship at Zucker School of Medicine at Hofstra/Northwell Health in New York where her specialty training encompassed a variety of small bowel, colon, rectal and anal pathologies which included malignant, benign and inflammatory disease (Crohn’s disease and ulcerative colitis). She previously completed her residency in general surgery at Loma Linda University Health with particular emphasis in robotic techniques. Bianchi completed her medical training at the University Illinois at Chicago. Prior to that she completed an undergraduate degree in bioengineering at the University of Illinois and worked as an engineer at Abbott Laboratories. Dr. Bianchi is fluent in Spanish. www.dlcfl.com

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AUGUST 2020

American Lung Association Calls on Florida Residents to Pledge to Stand Up for Clean Air, Take Action on Climate Change Stand Up for Clean Air initiative encourages collective action to address public health threats of climate change and air pollution. The Clean Air Act, which celebrates its 50th anniversary this year, is responsible for reducing air pollution in much of the nation and saving hundreds of thousands of lives each year.

Learn more about climate change and lung health, as well as simple steps to make a difference, and critical opportunities to hold leaders accountable at Lung.org/air.

Despite this public health success, climate change poses new challenges to protecting the nation’s air quality because it makes air pollution worse, placing the health of Florida at risk. Through the Stand Up for Clean Air initiative, the Lung Association asks Central Florida residents to pledge to take action on climate change and air pollution, including raising awareness about the need for clean air. Today, the Lung Association is announcing a new effort to encourage everyone to share why clean air matters to them through the #MyCleanAirStory social media campaign. This campaign will also help raise awareness about the health impacts of climate change and air pollution faced by Central Florida residents, such as Karen Deitemeyer who lives with COPD and asthma. “I have both COPD and asthma, making it hard for me to breathe when the air is polluted. I have to stay indoors on days when the air quality index is high, since breathing polluted air inevitably causes an exacerbation (flare up), further damaging my lungs.” said Deitemeyer. “I also care about clean air because I have a grandson with asthma, who should be able to enjoy being outdoors with his friends without having to check the air quality index first. He often has to use his “rescue” inhaler before marching band practice in order to participate.” Karen goes on to explain even more reasons why the Stand Up For Clean Air initiative is important to her from a patient perspective: it’s now become understood that COPD is not just a smoker’s disease – some 25 percent of people with COPD never smoked, but were exposed to pollutants in the air that damaged their lungs. Some of the most common sources of outdoor air pollution include motor vehicles, fires, and industrial facilities. She has come to recognize that something as simple as a fire pit in the yard may cause your neighbor to have a flareup of their respiratory disease. Deitemeyer believes the Stand Up For Clean Air initiative is extremely important from an advocacy perspective. “Join initiatives to reduce air pollution from manufacturing plants and to make sure that any new plants meet strict standards,” Deitemeyer said. “Contact your representatives in Congress and ask them to commit to not weakening the Clean Air Act;

any weakening of the Act increases climate change. Become involved with groups like the American Lung Association whose mission is to improve lung health and prevent lung disease”. Everyone is encouraged to share their personal experiences and concerns with air pollution and climate change on social media with a selfie, photo or video with the #MyCleanAirStory hashtag. Whether you love to bike or run, live near a power plant or highway, or your child experiences asthma symptoms on bad air quality days – we all have reasons why we want and need clean air. “Air pollution is not just an issue for those with underlying health issues like asthma, breathing air pollution is harmful for everyone. But some groups do face an even higher risk – including pregnant women, babies, children, teens, older adults and many communities of color,” said Janelle Hom, Executive Director, American Lung Association. “Through Stand Up For Clean Air, we hope to elevate conversations around the health impacts of air pollution and climate change and motivate people to take action. The reality is that

T E S T I N G

climate change is not only a future threat but is harming the health of Americans today.” Climate change is worsening our air quality through increased levels of wildfire smoke, increased formation of ozone pollution, and more extreme storms and frequent flooding, which leave behind mold, polluted floodwater residue and other damage, exposing people to indoor air pollution as they clean up and repair homes. Many sources of climate pollution – power plants, oil and gas operations, and cars and trucks – also produce air pollution that is directly harmful to lung health. Air pollution can trigger asthma attacks, and can cause coughing and wheezing, heart attacks and stroke, developmental and reproductive harm, and lung cancer. Air pollution can even be deadly. “Most Americans support more clean air protections, but not all Americans know what action they can take,” Hom said. “From urging your elected officials to take action on the federal level to helping to reduce air pollution in your community, actions large and small can add up to make a significant impact.”

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AUGUST 2020

CONTINUED ...

Preventing Osteoporotic Fractures and Preserving Independence

The Impact of COVID-19 on Medical Practices

BY MATTHEW A. SHLAPACK, MD

several years, concerns have been raised about possible adverse effects associated with medications used to treat Osteoporosis. These adverse effects have received excessive social media attention to the detriment of the care of our patients. The reality is that while all medications have potential adverse effect, Osteoporotic medications are generally well tolerated and the rate of adverse effects is not only extremely low but is vastly outweighed by their known benefits. Osteoporosis is an expected part of normal aging. The great new is that when this occurs, it can be addressed.

Osteoporosis is unfortunately an extremely common disease affecting 10.2 million Americans and resulting in 2 million fractures each year in the U.S. alone. Of further concern, 43.4 million Americans have low bone mass and are also at risk for fractures and progression to Osteoporosis. The great news is that our understanding of Osteoporosis is excellent and with the current treatment approaches available, the likelihood of fractures can be greatly reduced. The catastrophic potential of an Osteoporotic fracture cannot be over emphasized. Research shows a mortality rate of 12-20 percent within the 2 years following an osteoporotic fracture. Further, more than half of survivors of hip fractures are unable to return to independent living. Vertebral fractures not only lead to permanent disfigurement but can lead to lifelong pain. This means that if a patient has an osteoporotic fracture, they may not survive it and even if they do, they are unlikely to return to their previously quality of life and independence. The danger of Osteoporosis is that it is largely asymptomatic. The first warning sign can be a major fracture. For this reason, screening for Osteoporosis is essential. The analogy I often use for my patients is a porcelain vase on a high shelf. The vase may look secure, but only a small fall can cause it to shatter The gold standard for screening is a DEXA scan. Both men and women require this screening. The age at which to complete a first DEXA scan depends on risk factors but, as a simple guide, all patients over the age of 65 should have a DEXA scan. Postmenopausal women under the age of 65 and men should be considered for a DEXA scan if they have risk factors for osteoporosis such as a history of smoking, need for treatment with glucocorticoids, or family history, to name a few. The comprehensive management of Osteoporosis involves 3 crucial domains. The first of these is lifestyle measures designed to remove negative influences on bone health and promote measures that have been found to increase bone density and reduce fractures. The second is a group of interventions which help to reduce falls. Finally, pharmacologic agents are essential in patients with Osteoporosis. We are fortunate in that we now have multiple medications which have robust date showing fracture prevention efficacy. Choosing among these different agents requires consideration of the patient’s baseline bone density and fracture history, as well as possible barriers such as tolerance, compliance, and cost. In that last

Matthew Shlapack, MD, is a Board-Certified Endocrinologist practicing at Orlando Endocrinology with a mission to ensure that patients benefit from all the latest advances in medicine, helping to preserve their health and maintain their independence. Shlapack completed both his Internal Medicine Residency and his Endocrinology Fellowship at The University of South Carolina, School of Medicine, and was awarded his Doctor of Medicine degree from Ross University Medical School. He graduated from The University of Maryland, College Park with bachelor’s degrees in both Neurobiology, Physiology, as well as Psychology. He attended Ross University Medical School. Visit http://orlandoendocrinology.com

cluding Telehealth for $14 per month per household. It is also offering Direct Primary Care, the newest addition to valuable chamber benefits. EOCC members can offer our health benefits package of Telehealth, Allstate Accident, Allstate Cancer (& 23 specified diseases plan) plus Wellcard to their employees. Our insurance representative with Avalon Insurance Services does all the administration of the plan(s) selected by you &/or your employees. Are you an Independent physician seeking ways in which to increase exposure, revenue, and attract talent to grow with your practice? Joining the East Orlando Chamber, becoming actively involved in all it has to offer is the perfect way to start. We are promoting our members through our Ambassador Shout Outs, SB511 Member Deals & Steals and Member Shout Outs, creating video snippets letting members and community know member hours, specials and protocols for keeping guests and staff safe. Need more? Give us a call at 407-277-5951 or visit our website at eocc.org. Your Business is Our Business at the East Orlando Chamber. Don’t forget to register for the EOCC’s Healthcare Council Collaborative Virtual Peer-to-Peer referral forum and breakout. The East Orlando Chamber has nearly 75 years of thinking differently for members. Dorothy Hardee is the administrator of the East Orlando Chamber of Commerce.

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have sufficient backups to rebuild their system. In the past, it’s been easy to find organizations where all these factors align. But with growing awareness of the importance of hardening and effective backups, fewer system owners are such a good target. Because of this, many ransomware hackers have changed their strategy. It’s becoming more common for the threat actor to silently inject malware into systems, remaining hidden while finding and exfiltrating confidential data. Regardless of whether patient data is held on a local system or maintained in the cloud (often through an encrypted portal), the hacker can gain access to it by a variety of methods. Once a significant portion of sensitive data is extracted, the hacker will spring the trap. They now have options to extort the owner by threat to publish the stolen patient data or to employ classic ransomware tactics. The system owner is faced with the choice of paying extortion fees or accepting loss through litigation and reputation damage. How often does this happen? You may already be aware that the incidence is rapidly increasing. A recent estimate is that 30 percent of all systems in the U.S. are infected with malware. Adherence to HIPAA requirements doesn’t guarantee a breach won’t occur. It does assure that the impact to the business by HIPAA fines will be minimized. Not all aspects of HIPAA Security Rule involve technical configuration manipulations or modification to systems. In fact, a large portion don’t, such as user training. It pays for all employees to be aware of risky behaviors. Estimates are that 85-95 percent of successful breaches occur through phishing, i.e., using email communication to deliver a malware payload to a user’s device. Common phishing techniques are to include a link which takes the user to an infected server, or to attach a file containing malware, injected when

HIPAA SECURITY RULE:

Even More Crucial BY S. LAMAR BARNETT, MS

I shook my head as I carried the second of two clinic desktops to my car. I would never return to Dr. Langston’s (named changed) office, closed permanently due to massive HIPAA fines. These systems couldn’t simply be discarded; all patient data must be irretrievably destroyed. Why is this tragedy played out so commonly when a little investment of time to assure HIPAA compliance would prevent it? Fines can pile on within a few weeks of the pain of having to announce a breach. Sadly, it’s all completely avoidable. As it turned out for Dr. Langston, there was abundant need for destroying patient data. The two systems were full of files resplendent with patient details, stored without encryption or access security. Not only that, but the main Windows login, with administrative rights, did not require a password. It defies explanation. How could a clinician be so careless with the security of their patient data? HIPAA regulations are designed to secure the data, and the requirements provide a clearly detailed checklist. Once implemented, audit by the federal Office of Civil Rights (OCR) becomes much less scary. But all the components of the HIPAA checklist must be continually addressed, so the security of the patient data management system adapts to constant changes which inevitably occur – new data entry personnel or other users, computer program changes, computer device replacements, new equipment added to the network. For instance, the requirements for system security, user training, and policies and procedures must be initially implemented, followed by activities which document and assure continued compliance. When clinics aren’t accustomed to HIPAA requirements, it takes some time to evolve the culture to consistently keep logs of required activities, conduct periodic audits, and assure each user is effectively trained and routinely refreshed on effective practices. For example, one of the most well-known of security breach methods, a ransomware attack, is much less probable when HIPAA security is implemented. This alone would seem adequate justification for assuring careful adherence to the HIPAA Security Rule. Why has ransomware become so popular with hackers? The answer is that a little investigation gains the hacker knowledge of a system with a lot of sensitive data, held by an organization with ample resources. Then with a single breach, a large payoff is possible. The success of this attack model relies on three factors, which until recently have been common in the hackers’ targets. First, the owner’s system must contain vitally important data. Second, the systems must not be securely hardened. And third, the owner must not

the attachment is opened. The more convincing an email is, the more likely a user will fall prey to it. Spear phishing—incorporating a user’s personal interests to craft a more enticing email—is now often employed to improve the chances of user complicity. Where do they get this personal information? A hacker need go no further than Facebook, Instagram, or LinkedIn. These media are usually rich with data about an individual’s hobbies, family, and work, and an email touching on one of these areas is much more likely to be opened without a second thought. Believe your users are protected from this sort of attack by antivirus programs? Think again. One recent estimate is that 360,000 newly developed malware programs are launched in the world each day—programs for which no recognizable signature is available. These are known as zero-day exploits, unrecognized by antivirus definition lists. Continual user training is a must. Keeping hacker tactics in the forefront of users’ minds means they can be more aware when phishing emails land in their inbox, resulting in fewer breaches. Knowledge that every device on a network can be a source of malware infection increases awareness and thereby more effective network hardening. Any device which uses network WiFi is capable of introducing malware. No system is completely secure. All we can do is apply layer upon layer of hardening techniques. With each layer of protection, the risk of breach is lowered, and HIPAA kindly provides a road map to apply key protections. Lamar Barnett is Founder and President of Steel Bubble, LLC, specializing in cybersecurity for small businesses and individuals. With more than 30 years of experience in software development and IT in organizations such as Capital One, NCR, and Memorex-Telex, he now shares his expertise to ensure HIPAA compliance and help lower risks associated with conducting business online. Find him at www.intromybiz.com/steelbubble

ELISA BIANCHI, MD OPENS OVIEDO COLORECTAL CLINIC Colorectal Surgeon Holistically practicing medicine and exploring all options, not only surgery • Engaging Patients as equal partners in Medical decision-making • Board-Certified General Surgeon who completed a Colorectal Surgery Fellowship at Zucker School of Medicine at Hofstra/Northwell Health in New York • Specialty training encompassed a variety of Small Bowel, Colon, Rectal and Anal Pathologies, including Malignant, Benign and Inflammatory Disease (Crohn’s & Ulcerative Colitis) • Specializing in Da Vinci minimally invasive laparoscopic or robotic-assisted surgery

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AUGUST 2020

LHC Group and Orlando Health Finalize Joint Venture Agreement

ORLANDO || GRAND ROUNDS

LHC Group, Inc. (NASDAQ: LHCG) announced that it has finalized a new joint venture (JV) agreement with Orlando Health System in Orlando, Fla., effective August 1. LHC Group first announced the purchase agreement on June 24, 2020. The JV will include six total locations – three current Orlando Health providers and three current LHC Group providers in Orlando, Clermont, Kissimmee, and Altamonte Springs. The home health providers will operate under the name Mederi Caretenders, and the home and community based services (HCBS) location will operate under the name Mederi Private Care. LHC Group expects annualized revenue from the Orlando Health joint venture of approximately $3.5 million and that it will not materially affect its 2020 diluted earnings per share. Hospital and home health JV partnerships focus on delivering patient-centered care in the comfort of the patient’s home or place of residence. They are an increasingly key component in helping patients manage their conditions, avoid unnecessary hospital readmissions, and achieve the best possible health outcomes in the most cost-efficient manner. LHC Group and its partners deliver a level of in-home healthcare service that is recognized industry-wide for consistent quality. Working together, they enhance home health services, facilitate better coordination of care delivery, and seamlessly transition patients from the hospital to the recovery setting. Quality in-home healthcare helps patients regain strength and independence, attain the quality of life they deserve, offers valuable guidance and support, and provides the educational tools and resources patients and families need to make an informed decision on care for themselves or a loved one. Orlando Health is a not-for-profit healthcare network based in Orlando. The system spans nine Florida counties with nearly 450 locations that include 13 wholly-owned hospitals and emergency departments; rehabilitation services, cancer centers, heart institutes, imaging and laboratory services, wound care centers, more than 300 physician offices for adults and pediatrics, and 11 urgent care centers in partnership with CareSpot Urgent Care. LHC Group is a leading national provider of in-home healthcare services and the JV partner of choice for 350 hospitals across the United States.

AdventHealth Celebration Opens New Patient Tower AdventHealth Celebration’s new patient tower is open, allowing the hospital to keep pace with increasing demand for health care in fast-growing Osceola County. The five-story, Mediterranean-themed tower adds 80 all-private patient rooms to the hospital, with space for a total of 120 rooms at buildout once the additional capacity is needed. The tower will also allow further expansion of cardiac services and interventional neurological services. The expansion of these services will make AdventHealth Celebration a comprehensive stroke center in 2021 — the first in the area. “AdventHealth Celebration was founded more than 20 years ago with the goal of creating a world-

HEALTH CAREERS

class hospital with a unique healing environment,” said Doug Harcombe, CEO of AdventHealth Celebration. “The addition of this patient tower will help us serve the growing health-care needs of the community and provide sophisticated cardiac and neurological care close to home.” With the new tower, AdventHealth Celebration Health will eventually have about 350 patient beds. Physicians perform more than 17,000 procedures and surgeries at AdventHealth Celebration each year, the hospital logs more than 73,000 Emergency Department visits and nearly 17,000 inpatient admissions annually. The new patient tower is made possible by the generous support of community donors, including the AdventHealth Foundation of Central Florida.

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AUGUST 2020

Orlando Health Orlando Regional Medical Center Recognized by U.S. News & World Report as a Best Hospital and a High Performing Hospital

ORLANDO || GRAND ROUNDS

Embraer Announces the Phenom 300MED, a Unique Light Jet Medevac Solution Melbourne FL - Embraer has announced the Phenom 300MED, a unique Medevac solution for Phenom 300 series aircraft, which is also available for retrofit, through a partnership with umlaut and Aerolite. Embraer and umlaut are jointly developing and certifying a new supplemental type certificate (STC) utilizing Aerolite equipment. The Phenom 300MED, which is now available for customer configuration, is representative of Embraer’s modern and versatile product portfolio and the company’s intent to deliver the ultimate experience in business aviation, now including the Medevac segment. Designed as an ideal solution for both civil and government applications, the Medevac solution will be installed exclusively by Embraer’s award-winning Services & Support organization, ensuring the highest quality, reliability, and service experience, direct from the manufacturer. Together, Embraer and umlaut are developing a comprehensive set of configuration alternatives for the Phenom 300MED, which will feature either one or two stretchers, as well as the ability to carry an incubator and additional medical equipment. The aircraft will also feature hospital-grade trim and finishing. As a purpose-built Medevac solution, created in collaboration with the lead-

Orlando Health Orlando Regional Medical Center (ORMC) has been recognized as a Best Hospital and as a High Performing Hospital for 2020-21 by U.S. News & World Report. ORMC earned a Best Hospital designation for Central Florida, ranked No. 2 in the Orlando Metro Area, and ranked No. 9 in Florida. As a High Performing Hospital in several specialties, ORMC was recognized for care that was significantly better than the national average, as measured by factors such as patient outcomes. “High Performing” is the highest rating U.S. News awards for those types of care. ORMC rated high performing in all four cardiovascular procedures and conditions — transcatheter aortic valve replacement (TAVR), heart bypass surgery, heart failure, and aortic valve surgery. High performing marks were also achieved for chronic obstructive pulmonary disease (COPD), colon cancer surgery, hip replacement, knee replacement, and lung cancer surgery. The annual Best Hospitals rankings and ratings, now in its 31st year, is designed to assist patients and their doctors in making informed decisions about where to receive care for challenging health conditions or for common elective procedures. The annual Procedures & Conditions ratings, now in its 6th year, is designed to assist patients and their doctors in making informed decisions about where to receive care for common conditions and elective procedures. These ratings extend the U.S. News mission of providing consumers with patient decision support beyond the Best Hospitals rankings, which are geared toward complex specialty care. The U.S. News Procedures & Conditions methodology is based entirely on objective measures of quality such as risk-adjusted outcome rates, volume, quality of nursing and other care-related indicators.

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ing companies in the industry, the Phenom 300MED is designed to be quickly and easily configured to meet the various needs of both healthcare providers and patients. The Phenom 300MED benefits from the platform’s heritage of best-in-class cabin pressurization, low operating costs, high mission flexibility, state-of-the-art avionics, plus its speed and range capabilities. With best-in-class cabin altitude of 6,600 feet, passengers and crew enjoy more oxygen in the cabin. This feature equates to a healthier flight experience, which is essential for medical staff and patient care. The Phenom 300MED is further distinguished by the integration of Aerolite medical equipment. Aerolite is a leader in the design, engineering, production, and installation of Air Medical interiors. With over 500 Medevac interiors delivered, the company offers the ideal blend of equipment for the mission. Embraer’s products, including the Phenom 300 series, are recognized for high reliability and utilization. More than 550 Phenom 300 series aircraft have been delivered since the aircraft entered the market in December 2009, and it has accumulated more than one million flight hours. According to VREF’s 15-year business aircraft residual value forecast, the Phenom 300E will retain one of the highest residual values in the industry.

AUGUST 2020

ORLANDO || GRAND ROUNDS

Osceola Regional Medical Center Appoints Ross Taylor, MD, as Chief Medical Officer

New Orlando Health Imaging Centers Opens on South Orange Avenue A modern 7,520-square-foot specialized diagnostic imaging center is accessible to residents of downtown Orlando and the surrounding areas now that the Orlando Health Imaging Centers – South Orange has opened its doors. To celebrate the opening of the new facility, a ribbon cutting ceremony was held with Greg Ohe, senior vice president, Ambulatory Services, Orlando Health, Dr. Wei-Shen Chin, president, Medical Center Radiology Group (MCRG), and Mayor Buddy Dyer, City of Orlando. The ceremony unveiled the facility located at 1800 S. Orange Avenue. “Orlando Health is committed to providing superior care to our patients across Central Florida,” said Mr. Ohe. “The addition of this technologically-advanced and well-designed imaging center in busy downtown Orlando assures community members easy access to affordable imaging services.” The new center provides high-quality services such as 3D mammography/tomosynthesis, bone densitometry, digital x-ray, wide-bore 3T MRI, high-field 1.2T

Open MRI, 128-slice CT and ultrasound. Unlike most stand-alone imaging centers, Orlando Health Imaging Centers are fully integrated with all Orlando Health hospitals, departments and physicians. This assures complete visibility of current and relevant patient information to support clinical decision-making. Additionally, all images are interpreted by MCRG’s board-certified radiologists experienced in numerous specialties and sub-specialties. Results are sent directly to referring physicians ‘same day’ to support clinical decision-making in a timely manner. Orlando Health’s 70-year relationship with MCRG is key to providing exceptional care to the community. The Orlando Health Imaging Centers – South Orange is the newest imaging facility to open in the Orlando Health network. The organization already provides imaging and diagnostic services at centers located in Altamonte Springs, Lake Mary, Spring Lake, Summerport and Winter Park, with a new consolidated and expanded location to open in Ocoee this Fall 2020.

Orlando Health St. Cloud Hospital Expands Healthcare Services with New Medical Pavilion The Orlando Health Medical Pavilion – St. Cloud located on the corner of U.S. Highway 192 and Budinger Avenue is now officially opened to the public. A ribbon cutting ceremony was held on Monday, July 27 with Brent Burish, president of Orlando Health St. Cloud Hospital; Thibaut van Marcke, senior vice president, Orlando Health Southeast Region, and president of Orlando Health Dr. P. Phillips Hospital; and Mayor Nathan Blackwell, City of St. Cloud to unveil the new facility. The 50,000 square feet, two-story building on the hospital’s campus comprises the St. Cloud Medical Group physician practices, which includes both specialty care practices and primary care offices. Ancillary hospital departments have also moved into the new space, which features space for private retail, new outpatient services, and private physician offices. By late August 2020, a walk-in clinic will open with extended hours to provide medical services for minor or acute illness. An outpatient lab is set to open at the same time. Florida-based Catalyst Healthcare Real Estate developed the new medical pavilion. The facility was built with input from the City of St. Cloud to become part of the city’s Medical Arts District designation.

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AUGUST 2020

Osceola Regional Medical Center, an HCA Healthcare North Florida Division – Orlando Market hospital, has announced the appointment of Ross Taylor, MD, as Chief Medical Officer. Before joining the Osceola Regional Medical Center team, Dr. Taylor served as Chief Medical Officer at McLeod Health Loris Seacoast Hospital in Loris, South Carolina, where he also practiced as an orthopedic surgeon specializing in foot and ankle surgery. Prior to that position, he expanded healthcare access to the rural and underserved communities of Southern Virginia as Chief Medical Officer for Sovah Health. He also served as president of Coastal Orthopedics in Conway, South Carolina, where he practiced for 15 years. “Dr. Taylor is known for his innovative work as a physician leader across the Southeast, and we’re thrilled to have him on board,” said Davide Carbone, Chief Executive Officer at Osceola Regional Medical Center. “His hands-on experience as an orthopedic surgeon, combined with his visionary leadership, made him the ideal candidate to oversee our hospital’s daily clinical operations, ensuring all of our patients continue to receive medical care of the highest quality.” Dr. Taylor earned his medical degree from the Medical College of Virginia and received a master’s degree in business administration from Auburn University. He completed his orthopedic surgery residency at Georgetown University, as well as a fellowship in adult reconstructive foot and ankle surgery in Cincinnati, Ohio. He is board certified in orthopedic surgery.

Perceived Discrimination Increases Health Risks Among African Americans, UF Health Research Finds BY DIANA TONNESSEN

University of Florida Health researchers have found a significant association between perceived discrimination and worsening severity of a health condition known as metabolic syndrome in African Americans. “We found that African Americans who reported higher scores for everyday and lifetime discrimination also had more severe metabolic syndrome,” said Michelle Cardel, Ph.D., R.D., an assistant professor in the UF College of Medicine’s department of health outcomes and biomedical informatics. Other studies have shown that as many as one in three African American adults has metabolic syndrome, making them five times more likely to develop Type 2 diabetes and twice as likely to develop heart disease as healthy people with fewer or no risk factors. According to Cardel, poor diet, physical inactivity and cigarette smoking all contribute to the development and severity of metabolic syndrome. But Cardel’s research, published recently in the Annals of Behavioral Medicine, suggests perceived racial discrimination also plays a significant role. “Our findings suggest that discrimination may be an important risk factor for heart disease and diabetes in African Americans,” Cardel said. Cardel’s team evaluated data collected over eight years from 3,870 African American adults participating in the Jackson Heart Study, the largest longitudinal study of African Americans ever conducted. Since 2000, researchers with the Jackson Heart Study have been collecting data from thousands of African American women and men living in Jackson, Mississippi, to help understand why African Americans have higher rates of cardiovascular dis-

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ease, or CVD, and higher rates of premature deaths from CVD than non-Hispanic white Americans do. The Jackson Heart Study is funded by the National Heart, Lung and Blood Institute, a branch of the National Institutes of Health. The UF Health team calculated the severity of metabolic syndrome using data collected from the study participants at the beginning of the study period and again eight years later. The researchers used participant responses to questionnaires to assess their individual experiences with and reactions to three categories of discrimination: everyday discrimination, lifetime discrimination and the lifetime burden of discrimination. To measure everyday discrimination, participants were asked how often during a typical day they felt they were treated less courteously, given poor service or treated unfairly. They were also asked how often others treated them as dishonest or threatening. Responses ranged from “never’’ to ‘‘several times a day.’’ To assess lifetime discrimination, participants were asked about the number of times in their lifetime they experienced unfair treatment at school, getting a job, at work, getting housing, getting resources or money, getting medical care, on the street or at another public place, and getting services. Participants who reported experiencing lifetime discrimination in at least one area were asked questions about the burden of lifetime discrimination, such as, “When you had experiences like these over your lifetime, have they been very stressful, moderately stressful or not stressful?” The team also gathered information on participants’ education and income level, along with health habits

AdventHealth Ocala Named Safest Hospital in Marion County

UF Health Leesburg Hospital Receives Get with The Guidelines Target: Stroke Honor Roll Silver Plus Quality Achievement Award

University of Florida Health Leesburg Hospital has received the American Heart Association/ American Stroke Association’s Get With The Guidelines® Target: Stroke Honor Roll Silver Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence. UF Health Leesburg Hospital earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health; have a follow-up visit scheduled; as well as

other care transition interventions. UF Health Leesburg Hospital additionally received the association’s Target: StrokeSM Honor Roll award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. “We are pleased to recognize UF Health Leesburg Hospital for their commitment to stoke care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and executive vice chair of neurology, director of acute stroke services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

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such as cigarette smoking, alcohol consumption, diet and physical activity. Across both visits and controlling for other variables, the team found that participants who had higher scores for everyday and lifetime discrimination also had more severe metabolic syndrome, especially middle-aged adults. Previous studies have found correlations between perceived discrimination and prevalence of metabolic syndrome in other minority groups. Cardel said one way discrimination can undermine physical health is by activating a stress response in the body, which releases a flood of hormones like cortisol. Repeated activation of the stress response can lead to wear and tear on the body over time and increase an individual’s risk for diabetes and heart disease. “This study, as well as the work of others, highlights the adverse health outcomes that result from racism and discrimination,” Cardel said.

At a time when patient safety in our hospitals and health care facilities is top of mind across the globe, AdventHealth Ocala has earned a Leapfrog grade “B” for patient safety by the nationally recognized Leapfrog Group, the highest grade in Marion County. When AdventHealth acquired the Ocala campus in August 2018, the hospital had a Leapfrog grade “D.” Improving the safety grade from a “D” to a “B” shows the hospital has done a better job of protecting patients from mistakes, injuries, accidents and infections. The health care ratings organization announced its safety ratings for over 2,600 hospitals across the country. Leaders at AdventHealth Ocala have continued to implement key strategies to enhance patient safety since acquisition in 2018, including: Deploying hundreds of new IV pumps and dozens of teleboxes which allow care teams to monitor patients and medications in real time - significantly decreasing medication errors to patients. Implementing electronic health records which allow physicians to place the patient medication orders directly into the computer and allows nurses to scan a patient’s medications prior to administering medications – which has been shown to significantly decrease medication errors to patients. Renovating the emergency room to provide all private patient rooms to decrease infection rates and offer complete privacy during care. Reinstating safety huddles each morning to ensure all departments are informed of hospital and patient needs each day. Training over 2,000 team members on a change in culture to enhance how team members care for patients and each other.

AUGUST 2020

Melbourne Regional, Steward Medical Group Welcome Mark Davis, MD, Groundbreaking Surgeon

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Mark Davis, MD, is part of an elite team of orthopedic surgeons instrumental in bringing a partial knee-replacement procedure from Europe to the United States in 2004. Melbourne Regional Medical Center, a member of Steward Health Care, is welcoming Dr. Davis to its surgical team. Earning his medical degree from the University of Iowa College of Medicine, Iowa City, Iowa, Dr. Davis completed an orthopedic residency at West Virginia University/ Ruby Memorial Hospital in Morgantown, W.V. His joint replacement fellowship was at the Anderson Orthopaedic Research Institute in Arlington, Va. Among Dr. Davis’ specialties are joint replacement and adult joint reconstruction. “I take people who have arthritic knees or hips and help them cope with that condition, whether it’s through surgery or through more conservative treatment,” he said. Educating others has long been a part of Dr. Davis’ work. In 2010, he visited Amsterdam to instruct 250 physicians from 19 countries on a procedure that involves fashioning a mold of a patient’s knee from an MRI or CT scan. The company that created the implant for this procedure contacted Dr. Davis to appear in its instructional video. Melbourne Regional Medical Center started construction to expand their surgical suites in April 2020. Therefore, adding an experienced and talented orthopedic surgeon to the growing medical staff will help meet the surgical volume in Brevard County.

Caption: Jennifer Lowery, RN ER Nurse Educator, Kelly Ramos, RN, Amanda Berry, RN, Shawn Mcloughlin, RN, Nicole Crohan, RN, Hannah Ferreira, RN, Denise Rubel, RN, Natalie Housley, RN, Carley Clinton, RN, Anna Martinez, RN, Kendall Hodgins, RN, and Lindsay Martin, RN Nurse Manager of Emergency and Trauma Services

Emergency Medicine Nursing Residency at Halifax Health If you want great nurses, you have to invest in educating them to work in the only largest emergency department and only trauma center in the area. Nine Daytona State College Nursing School graduates and One Florida State College Nursing School graduate chose to grow their careers at Halifax Health. They came to Halifax Health partially because of the new Emergency Nurse Residency Program. The one-year program, the only in the area, features four hours of didactic learning each week taught by physician and nurse subject matter experts. In addition, the nurses will complete the following certifications; Basic Life

AdventHealth Performs Nearly 400 Free Physicals for Volusia County Schools Student Athletes In July, AdventHealth performed more than 380 free physicals for Volusia County Schools student athletes grades 6-12. Representing a more than $10,000 gift to the families of student athletes in Volusia County, AdventHealth conducted these free physicals at the Daytona International Speedway’s Rolex Lounge. Due to the COVID-19 pandemic, AdventHealth provided this service with several

Orthopedic Surgeon Joins AdventHealth’s Physician Group Orthopedic surgeon Dr. Mark Zunkiewicz has joined AdventHealth Medical Group. Board certified in orthopedic surgery and fellowship trained in orthopedic sports medicine and arthroscopy, Zunkiewicz most recently served as an orthopedic surgeon at the Upper Valley Medical Center in Troy, Ohio, for 10 years. In addition to general orthopedic medicine, he has a special interest in sports medicine rehabilitation and wellness as well as arthroscopic shoulder and knee procedures. He also performs knee and shoulder replacements, fracture care, and hand, wrist, foot and ankle surgery. A summa cum laude, Phi Beta Kappa graduate of Ohio Wesleyan University where he was a varsity track and field athlete, Zunkiewicz earned multiple academic scholarships and has been an Eagle Scout since 1996. He earned his medical degree at the Medical College of Ohio – currently known as The University of Toledo College of Medicine – and completed his internship and residency at Allegheny General Hospital in Pittsburgh, capping his tenure there as chief orthopedic surgery resident. He also completed an advanced fellowship in orthopedic sports medicine and arthroscopy at the Mississippi Sports Medicine and Orthopaedic Center in Jackson. Dr. Zunkiewicz will perform surgery at AdventHealth Daytona Beach – the area’s only Joint Commission-certified Centers of Excellence for hip, knee, shoulder and spine surgeries, representing a best in class orthopedic surgery program.

Support, Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, National Institute of Health Stroke Training, Trauma Nursing Core Course, Emergency Nursing Pediatric Course, and Certified Emergency Nurse. The program was such a success that Halifax Health will be starting a new cohort every six months. The education curriculum is designed to prepare the nurses for the Certified Emergency Nursing Exam. This first cohort has had a 100 percent pass rate for their trauma course and will graduate from the program in December 2020.

additional precautions to ensure the safety of all attendees, including symptom and temperature screenings, mask usage and social distancing. These free physicals were provided as part of AdventHealth’s partnership with the Volusia County School District, which addresses three key issues affecting students: student-athlete health, chronic absenteeism and health care career development.

Family Medicine Physician Joins AdventHealth’s Physician Group Family medicine physician Dr. William C. Douglass III has joined AdventHealth Medical Group. Board certified in family medicine, Douglass has 20 years of experience providing family and emergency medical services in hospitals, Veterans Affairs medical centers and urgent care centers. He joins AdventHealth Medical Group from the VA in Daytona Beach, where he has been a primary care physician for the last seven years. A graduate of the University of Florida, Douglass earned a Master of Science in nutrition at Purdue University, followed by a medical degree at Loma Linda University in California. During medical school, he completed a medical mission to Mexico, as well as elective training in traditional Chinese medicine in Beijing, China, and a general surgery rotation in Bangkok and Chaing Mai, Thailand. He returned to Florida for a family practice residency at AdventHealth Orlando.

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AUGUST 2020

Practical Management and Nutrition in Fatty Liver and Cirrhosis Tuesday, August 18, 2020 6:00 PM ET Featured Speaker Andreas G. Zori, MD Assistant Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition University of Florida College of Medicine Click Here to Register!

Orlando Medical News August 2020

Articles inside

The Explosion of U.S. Cannabis Sales and its Effect on America’s Healthcare System

COVID-19 Demands Correspond with Uptick in Burnout Among Healthcare Professionals

American Lung Association Calls on Florida Residents to Pledge to Stand Up for Clean Air, Take Action on Climate Change

Robotic Surgery in the Treatment of Colorectal Cancer

Preventing Osteoporotic Fractures and Preserving Independence

COVER STORY COVID-19 Demands Correspond with

The Explosion of U.S. Cannabis Sales and its Effecton America’s Healthcare System

HIPAA Security Rule: Even More Crucial