Houston Medical Times by Rick Delarosa

Serving Harris, Galveston, Brazoria and Fort Bend Counties

HOUSTON

November Issue 2015

Inside This Issue

FIVE THINGS HEALTHCARE PROVIDERS CAN DO TO REDUCE MEDICAL IDENTITY THEFT By Mark ArmStrong, JD EBSTEIN BECKER GREEN

Harris Health to Help Fend off Cyberattacks See pg. 12

INDEX Money Matters..............pg.3 Mental Health...............pg.4 Oncology Research......pg.6 Healthy Heart................pg.8 The Framework............pg.10

Baylor College of Medicine, Texas Children look at best Treatment for prolonged seizures See pg.19

Medical identity theft is the appropriation or misuse of a patient's or a provider's medical identifying information (such as a Medicare identification number) to fraudulently obtain or bill for medical care, prescription drugs, or supplies. It can lead to errors in patient medical records and may also lead to significant financial losses for patients as well as government and commercial payers. Medical identity theft is a growing problem. In 2014 alone, more than 3,300 physician and patient cases of medical identity theft were reported.

and credit card and bank account information or Protected Health Information (PHI), such as health history, medical diagnoses, services rendered, or health care billing or payment information, is stolen and Medical identities are misused misappropriated. While the theft of in two primary ways: (1) consensual such medical information can result – when an individual knowingly in significant financial loss, it can also provides her identity to someone result in patient harm when incorrect information in entered into a personal else in order to allow that person medical record. to obtain medical goods or services, Here are five simple things and (2) nonconsensual – when an individual does not know that healthcare providers can do to reduce someone is misusing her lost or the risk of medical identity theft: stolen identification. Under either 1. Tr a i n your Staff. approach, Personally Identifiable Conduct pre-employment Information (PII), such as Social background screening of all Security numbers, dates of birth, individuals who have access to patient information and medical records. Once qualified individuals are hired, they should be trained to identify potential dangers. For example, registration staff should be trained on how to monitor for suspicious patterns or practices, such as a patient using a suspicious driver's license or insurance card. Coding and business

office staff should be trained to report medical record inconsistencies with regard to patient history or treatment and unusual billing patterns. 2. Know your Patients. Require patients to show a copy of their health insurance card at registration. Consider requiring a photo ID and training employees to check whether the photograph and descriptive details (such as race, gender, height, weight and hair and eye color) match the ID. Place a photo of the patient in the EHR or supplementary database, however, a copy of government-issued ID, such as a driver’s license, should not be incorporated into the patients’ medical record as it may increase the risks of identity theft. 3. Educate your Patients. Healthcare providers should educate patients about their right to review and request corrections to their own see Medical Identity Theft page 24

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Money Matters

A Closer Look at What the Future Holds for Freestanding Emergency Rooms By Azhar Hirani Vice President-Private Equity ZT Wealth

would have to stand in line, fill out tons of paperwork, and queue up again. By the time the doctor is ready to see you, your situation could have worsened and there is no choice but to go to the nearest hospital’s emergency clinic. But because of the accessibility Doctors in the last four years have of freestanding emergency rooms, you witnessed the growth and emergence do not have to travel far and you could Taking care of one’s health is of freestanding emergency rooms in easily get emergency healthcare services regarded with higher importance over Texas and wondered if it’s still a hype?, in no time. having a lot of money. Freestanding is the market in growth mode? Or has Excellent service is also one of emergency rooms are here to it matured and the opportunities have the selling points of freestanding stay. While it may seem that such passed by. Have you ever wondered if emergency rooms. In a typical hospital adding this to your portfolio can be facilities have already saturated Texas, emergency room setting, you will beneficial? Well look into this. opportunities still abound for those see people scampering around and There are some areas where rushing in order to attend to people who are burdened with the passion of freestanding emergency clinics are set who might have more serious injuries providing excellent healthcare services up at every block. Some may not know than what you have. If you find yourself to others. There are still a lot of people, why or how such facilities have spread in such a situation, there is no other especially in the rural areas, who do like wildfire. However, its success can recourse but just to wait for your turn. not have access to such facilities and be attributed to two things: accessibility Freestanding emergency rooms, on the can be the next growth market as and excellent service. other hand, are designed to cater to the metropolitan areas are currently Going to the nearest doctor’s a handful of clients, making it easier saturated with them.

compared to a big hospital, more and more people are seeing great potential in investing in such facilities. If you decide to be part of this thriving and growing industry, you will not only be able to make significant earnings; you will also be able to help out in the cause to save more lives and offer speedy and excellent health care to more people. Opportunities are still plenty, just the right location, population, less competition are needed.

After getting some extra perspective on this, do you think this a good or a Because freestanding emergency bad addition to your portfolio? You clinic for a minor gash in the head to gain access to the healthcare service can easily turn into a nightmare. You that you need. rooms are easier to set up and maintain decide.

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Houston Medical Times

Mental Health

You Asked: What’s the difference between anxiety and a panic attack? By Lauren Thompson Texas A & M Health Science Center

are a number of different types of anxiety disorders.

We all become anxious or nervous from time to time–when studying for a big test, for instance, or when going through financial hardship. For some people, overwhelming thoughts and behaviors become so frequent and forceful that they begin to overtake their lives.

“Anxiety becomes unhealthy when it progresses from occasional worries to a state of worry that changes your thinking and everyday behaviors. If anxiety is disrupting your life, you need to seek help from a health care provider,” Roblyer said.

GAD affects 6.8 million adults in the United States in any given year. Women are more likely to suffer from an anxiety disorder but it will impact both men and Kathleen R o b ly e r, a women, according to the Anxiety psychiatric-mental health nurse and Depression Association of practitioner America. (PMHNP) G A D and clinical often occurs assistant g r a d u a l ly professor at and the the Texas risk for the A & M disorder H e a l t h is highest Science between C e n t e r childhood College of and middle Nursing, a g e . specializes Although in treating the exact patients cause of with anxiety GAD is and mood unknown, research has shown disorders. She said, “Anxiety is a common experience. When the biological factors, family background presentation of anxiety meets certain and life experiences–particularly criteria, such as in generalized stressful ones–play a significant role. Panic attacks may occur abruptly anxiety disorder (GAD), it becomes a disorder. Panic attacks can occur from a calm state but are often alone or as a symptom of a panic brought on because of a stressor disorder and are diagnosed when or trigger that creates more anxiety. someone displays four or more Panic attacks are short, very severe, specific symptoms.” and then resolved, usually within Anxiety is a protective minutes. Anxiety may be a period of mechanism related to fight or flight, elevated worry that can last minutes, and small amounts of anxiety in hours or even days. your life are expected and normal. The Diagnostic and Statistical If there is not a recurring threat, Manual of Mental Disorders, Fifth your brain archives the response Edition (DSM-5) defines a panic to fear and doesn’t store it as a attack as the abrupt onset of intense trigger. Anxiety disorders, such as fear or discomfort that reaches a GAD, can develop when people peak within minutes and includes experience exaggerated worry and at least four of the following tension even when there is no symptoms: see Mental Health page 24 reason for apparent concern. There How do you tell if your everyday anxiety has crossed the line or maybe even developed into a panic disorder?

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Oncology Research

The future of Peptidomics for cancer treatment By: Jorge Augusto Borin Scutti, PhD Houston Medical Times

Tumor immunotherapy initiated almost a century ago with the first experiments with bacillus Calmette-GuĂŠrin (BCG) in bladder cancer. Currently, several approaches have been developed using synthetic and bioengineering-based strategies to overcome challenges in the design of more useful cancer vaccines. The recent developments of checkpoint antibodies blocking such PD-1 and CTLA-4 proteins further exemplified the power of cytotoxic T lymphocytes (CTLs) in the control of tumors, reverse cancer-induced immunosuppression and induce durable therapeutic responses in certain cancer patients. Unfortunately due only some patients respond to checkpoint blockade therapy, there is a need for predictable

biomarkers that identify individuals most likely to respond to such treatment. During the cancer development and progress (â&#x20AC;&#x153;cancer immunoeditingâ&#x20AC;?) several tumor cells can reduce the ability to raise an immune response or provide an immunosuppressive tumor microenvironment. Immunotherapy is an astonishing advance in cancer treatment and identifying relevant peptides presented by major histocompatibility complex (MHC) class I on tumors is critical for this course. In the September issue of Blood Magazine 2015, Simon Walz and cols describe the antigenic landscape using mass spectrometry experiments to identify suitable peptides presented by multiple myeloma (MM) cells. Curiously the authors reveled that these peptides represent just normal antigens. How then do normal peptides induce a tumor-specific immune response? According to the author this is only possible when such peptides have been missed in the negative selection process in the thymus allowing specific cytotoxic

T cells (CTLs) to progress into fully functional entities. Traditionally immune peptides are readily characterized after being mapped in antigenic proteins. In the case of human melanoma, MHC-restricted peptides from TRP2, NY-ESO-1, Melan A/MART-I, tyrosinase, and gp100/Pmel17 have been used as immunogens. Due to the heterogeneity of antigen expression several groups tried whole melanoma cells expressing cytokines by gene transduction. Most promising is the use of genetically engineered lymphocytes reactive with NY-ESO-1. The NY-ESO-1 cancer/ testis antigen, is expressed in 85% of patients with synovial cell sarcoma and approximately 25% of patients with melanoma. Blockade of CTLA-4 increases CD8 (+) T cells to a broader array of prei-mmunized melanoma antigens. In the other hand, several natural peptides with anti-tumor activity have been described from a variety of sources. Some of them are free molecules and others are internal sequences from proteins that are liberated by proteolysis or are chemically synthesized. The anti-tumor activities

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resemble ancient molecules of innate immunity that have been effective in the protection against threatening conditions, infective or others, before the emergence of antibodies and adaptive T cell immunity. Luciano Polonelli and cols 2003 described internal sequences in an anti-idiotypic antibody that exhibited anti-infective activities and further studies showed that CDRs (Complementarity Determining Region) from different monoclonal antibodies showed cytotoxic activities against Candida and HIV but also against the highly aggressive murine melanoma. A typical caspase-dependent apoptosis ensued, documented by a number of cellular alterations and organelle disruptions. Peptidomics is a relatively new and few studies of explorations and characterization have yet been published.

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Healthy Heart

The American Heart Association’s Guide To Healthy Diet and Lifestyle. Challenge yourself to live a heart healthier life! By The American Heart Association

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or more calories depending on several factors including age, gender, and level of physical activity. If you are trying not to gain weight, don’t eat more calories than you know you can burn up every day. Also, increase the amount and intensity of your physical activity to match the number of calories you take in. Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity – or an equal combination of both – each week.

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Limit saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages. If you choose to eat red meat, compare labels and select the leanest cuts available. Most healthy eating patterns can be adapted based on calorie requirements and personal and cultural food Regular physical activity can help preferences. you maintain your weight, keep off Eat less of the nutrient-poor foods. weight that you lose and help you reach physical and cardiovascular fitness. If The right number of calories to it’s hard to schedule regular exercise eat each day is based on your age and sessions, try aiming for sessions of at physical activity level and whether least 10 minutes spread throughout you're trying to gain, lose or maintain the week. If you would benefit from your weight. You could use your lowering your blood pressure or daily allotment of calories on a few cholesterol, the American Heart high-calorie foods and beverages, but Association recommends 40 minutes you probably wouldn’t get the nutrients see Healthy Heart page 24 of aerobic exercise of moderate to

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The Framework

Quality Healthcare Has a New Name: Memorial Hermann Greater Heights Hospital The Greater Heights now has a hospital to call its own – Memorial Hermann Greater Heights Hospital – and along with it new service offerings that will significantly expand access to quality health care for area residents. The renaming of the Memorial Hermann Greater Heights Hospital will be accompanied by enhancements to the facility as well as new service offerings to the area such as a Memorial Hermann Convenient Care Center at I-10 and Studemont and the launch of a Memorial Hermann Urgent Care at Washington Ave. and Fowler in early 2016.

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“Our name change is a direct reflection of the growth and evolution we have seen in our community over the past several years,” said Senior Vice President and Memorial Hermann Greater Heights CEO Susan Jadlowski. “The name change to Memorial Hermann Greater Heights and our continual expansion of services – like the planned Convenient Care Center and Urgent Care– is a declaration to our patients and staff that we are dedicated to providing expert quality healthcare as members of the Greater Heights community.” The new name is one of many changes at the hospital. Already home to a number of nationally-accredited programs, Memorial Hermann Greater Heights, located at Loop 610 and Ella Blvd, has steadily broadened its spectrum of service and specialties in recent years. The hospital added 88 credentialed physicians in the last year and plans to hire 150 staff by the end of 2016. “We are proud to have Memorial Hermann Greater Heights Hospital as a great community partner,” said Craig Atkinson, Chairman of the Greater Heights Area Chamber of Commerce. “For nearly 50 years, the hospital has provided a wide range of medical specialties to our growing community and has been an instrumental partner to many businesses in this community.” Memorial Hermann Greater Heights also hosted or sponsored 20 community wellness events in the past year and actively supports school programs in the area. To

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commemorate and celebrate the name change, Memorial Hermann Greater Heights will host a community event on Saturday, Oct. 24 from 10 a.m. to 2 p.m. There is more to come from the hospital. Within the next two years, Memorial Hermann Greater Heights will be able provide access to the various levels of care provided by Memorial Hermann. Memorial Hermann Greater Heights recently had plans approved for a 44,000-square-foot Convenient Care Center in the Heights. The planned facility will provide one-stop, highly-coordinated access to adult and pediatric primary care, specialty physicians, sports medicine and rehabilitation, outpatient imaging and lab services, and a 24-hour emergency room to the area when it is completed in 2017. In early 2016, the new Memorial Hermann Urgent Care in the Heights will offer the surrounding communities the ease and convenience of extended medical care while also serving as an extension of a primary care physician’s office. The Memorial Hermann Urgent Care will not require an appointment but will provide walk-in care for non-life-threatening health conditions and will be staffed with board-certified Memorial Hermann Medical Group family medicine physicians. It is the second such facility, joining its sister site in Friendswood. The look of Memorial Hermann Greater Heights will also soon change. Future enhancements include a new hospital entrance on the south side of the facility, an additional hybrid surgical suite and state-of-the-art renovation of the first floor for expanded rehabilitation services. “Houston and the Greater Heights have changed and will likely continue to change,” Jadlowski said. “Our commitment to providing excellent patient service and expertise at every level of care is steadfast and we will always adapt to meet the needs of our growing community.” A full-service facility that originally opened its doors in 1966, Memorial Hermann Greater Heights is a 260-bed hospital with 1,200 employees. More than 500 affiliated physicians provide vast medical specialty service to the campus, including heart and vascular, cancer screening and treatment, total joint replacement, top tier rehabilitation, women’s care and a Level III Trauma emergency center. Memorial Hermann Greater Heights proudly serves The Heights, Garden Oaks, Oak Forest and Rice Military neighborhoods, and many other communities in the area.

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Harris Health Lone Selection to Help U.S. Fend Off Healthcare Cyberattacks

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Harris Health System is the only healthcare system in the nation awarded a $150,000 grant to help the U.S. Department of Health and Human Services (HHS) develop and improve ways to share cybersecurity threat information and protect the critical cyber infrastructure of the nation’s public and private healthcare sector. In February, President Barack Obama signed an executive order directing agencies to tackle the threat of cybersecurity attacks. The order encourages the development of information sharing and analysis organizations (ISAOs) to serve as focal points for cybersecurity collaboration within the private sector and between the private sector and government.

Between 2010 and 2014, news agencies have reported that approximately 37 million healthcare records have been compromised in data breaches. However, in the first four months of 2015 alone, more than 99 million healthcare records have been exposed through 93 separate attacks. The trend seems to be increasing, Vinson said.

“Through this grant, Harris Health System will identify the cybersecurity information needs and gaps of hospitals and other healthcare organizations across the country,” said Steve Curren, director of the critical infrastructure protection program in the U.S. Department of Health and Human Services' office of the assistant secretary Jeffrey Vinson, vice president and for preparedness and response.

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Harris Health “will propose a strategy for enhancing the sharing of cybersecurity information among the federal government and private sector partners to better protect the critical cyber infrastructure of the nation’s healthcare system,” he added. “This planning grant represents a preliminary step toward future activities that HHS “Over the past decade, healthcare may undertake to work with and stakeholders have implemented a health support information sharing and information technology infrastructure to analysis organizations focused on the access, send and receive electronic health healthcare and public health sector.” data,” he said. “However, unlike other “A strong cyber defense strategy industries such as finance, which have already been transformed by technology, should address how to prepare and many healthcare organizations have monitor attacks, respond and ultimately not invested sufficiently in robust IT recover from breaches,” Vinson says. security measures that can protect and “At a minimum, security architecture encrypt health data in electronic health across sectors should be able to stall record systems, interfaces, repositories, adversarial efforts, thwart attacks at each databases, connected medical devices phase and facilitate a rapid response.” and personal devices.” chief information security officer, Harris Health System, said Harris Health is at the “tip of the spear” in terms of cybersecurity noting the cyber-threat intelligence it receives and sees can be leveraged to help others nationwide secure sensitive healthcare and patient information.

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“IMRT was developed more than a decade ago and because it’s been shown to reduce toxicity, it has been accepted to treat prostate, brain, and head & neck cancers,” said Chun, the study’s lead author. “There have been a number of smaller studies, including research led by MD Anderson, looking at IMRT and lung cancer. This the first analysis of a prospective clinical trial to show a reduction of toxicity associated with Stephen Chun, M.D., fellow, IMRT in locally advanced lung cancer Radiation Oncology at The University and could lead to a major change in the of Texas MD Anderson Cancer Center, way radiation therapy is delivered for the presented the research at the American disease. Society for Radiation Oncology’s 57th “The data from our study makes Annual Meeting. a strong argument that we should According to the American Cancer An analysis of an international, cooperative-led trial of patients with locally advanced non-small cell lung cancer (NSCLC) has shown that those who received intensity modulated radiation therapy (IMRT) had less severe lung toxicity and were able to better tolerate their chemotherapy, compared to patients who received 3–dimensional conformal radiation therapy (3-D CRT).

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Society, in the United States, 221,200 will be diagnosed with lung cancer in 2015 and 158,040 will die from the disease – making it the deadliest of all cancers. About a third of all lung cancers are diagnosed when the cancer is locally advanced, said Chun. The standard of care for locally advanced lung cancer is concurrent chemotherapy and radiation, with most patients receiving either 3-D CRT or IMRT. For decades, 3-D CRT has been the standard of care for the treatment of lung cancer. The technique shapes radiation beams aimed in straight lines to match the shape of the tumor. In contrast, IMRT is a newer, more-advanced technique that sculpts and molds radiation beams to tumor targets, using substantially more complex radiation beam arrangements than 3D-CRT. In turn, IMRT can spare more normal tissue than 3D-CRT with high doses of radiation, explained Chun. November 2015

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routinely consider use of IMRT in locally advanced lung cancer,” Chun continued. This study is a secondary analysis of data collected from the NRG/RTOG 0617, a large, multi-center phase III randomized trial of patients with locally advanced NSCLC. The study originally enrolled patients from 2007 to 2011 and compared a high dose of 74 Gy to the standard dose of 60 Gy. All underwent concurrent chemotherapy (carboplatin/paclitaxel, with or without cetuximab) and either 3-D CRT or IMRT. In the study, NRG/RTOG 0617, 482 patients were treated with radiation – 53 percent with IMRT and 47 percent with 3-D CRT. The study found 44 percent fewer cases of severe pneumonitis (defined by the researchers as lung inflammation that required oxygen, steroids or mechanical ventilation, and/or led to death) in patients who received IMRT see Lung Cancer page 26

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Menninger Announces New Outpatient Services Including Comprehensive, Multi-Day Pediatric Psychiatric Assessments

Recognizing Houston’s shortage of pediatric mental health care, Menninger offers convenient outpatient care with no waitlist One of the nation’s leading psychiatric hospitals, The Menninger Clinic today announced that it is now offering comprehensive, multi-day outpatient assessments for children and adolescents in response to the growing demand for mental health services in Houston and shortage of providers. The hospital also announced an expansion in its outpatient therapy services for individuals, couples and families. With this expansion of outpatient services, there is no current waitlist and Menninger clinicians are usually able to see patients within a week of scheduling. According to the Mental Health Needs Council, there are over 14,000 children and adolescents as well as 79,300 adults with severe mental illnesses who cannot access either public or private mental health systems in Houston. These statistics underscore the importance of Menninger’s expanded outpatient services, which reflect the hospital’s focus on prevention and early intervention. “We’re excited that individuals and families will now be able to turn to Menninger for outpatient mental health care that provides greater understanding about mental illnesses as well as practical guidance for improving interpersonal relationships and day-to-day functioning,” said Dr. Jonathan Stevens, Menninger’s clinical director of outpatient services. “Ultimately we believe that our outpatient care initiates lasting change, resulting in fewer crisis hospitalizations as well as a reduced incidence of suicide.”

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Stevens adds that Menninger’s outpatient clinicians help patients and families to understand the genetic factors contributing to a mental illness. This, he says, supports families who are working to overcome the stigma that is often associated with mental health treatment. Another unique component of Menninger’s outpatient care is its emphasis on medication management that ensures patients are taking medicine that their bodies can properly metabolize.

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psychiatric excellence and restoring hope to patients is further exemplified through its one-of-a-kind comprehensive, multi-day assessment. Developed by the clinicians at Menninger, the four-and-a-half day assessment employs a multidisciplinary approach that gives patients –pediatric and adult-an understanding of how their lives are affected by a behavioral illness. The Menninger assessment team is comprised of specialists in psychiatry, psychology, neurology, addiction, diet and nutrition as well as others who are called upon to participate in assessments based on individual patient needs. Stevens and his team believe parents will find the pediatric assessment extremely helpful for families seeking thorough diagnostic assessment and treatment planning for complex brain conditions such as attention deficit hyperactivity disorder, depression, autism spectrum disorders, concussions and traumatic brain injuries. Following the four-and-a-half day assessment, Menninger provides patients their comprehensive assessment reports the same week as their visit. The report is a result of the clinicians working in collaboration to unite multiple streams of data into a single report that details how findings are interrelated. It also provides a recommended, best-practices treatment approach that patients can share with their regular outpatient healthcare providers. “It’s not a collection of individualized reports,” said Stevens. “Menninger’s comprehensive assessment gives patients and their providers a thorough diagnosis and a well-rounded approach to treatment. We developed this model based on what we see with Menninger’s inpatient program where 80 percent of patients have co-occurring illnesses. Using our outcomes data, we’ve found that this comprehensive reporting style is optimal because it allows patients the best chance to address core issues that have previously impeded their success.”

Houston Medical Times

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Baylor College of Medicine, Texas Children’s Hospital study will look at best treatment for prolonged seizures A study to determine which of three drugs commonly used to treat a condition called status epilepticus is most effective begins this month under the direction of Baylor College of Medicine and Texas Children's Hospital pediatric emergency medicine physicians. Status epilepticus means prolonged seizures that are not controlled by usual treatment with drugs called benzodiazepines.

condition will receive a benzodiazepine first. Benzodiazepines, usually prescribed short-term for anxiety and insomnia, are used in the treatment of status epilepticus.

Patients coming into the Texas Children's Hospital emergency center with prolonged seizures that are not controlled after a full dose of benzodiazepines will be enrolled in the emergency research under a special emergency protocol that does not require

All three drugs in the study are commonly used in emergency medicine departments and approved by the U.S. Food and Drug Administration. They include phenytoin (fPHT), valproic acid (VPA), and levetiracetam (LVT).

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If the seizure does not resolve, doctors will give them one of the three medications. Later, they will study the effects of the medicine to determine which of the three is most effective and safe in treating status epilepticus.

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immediate informed consent. The study is part of the Established Status Epilepticus Treatment Trial, a multi-center network funded by the National Institute of Neurological Disorders and Stroke. "There are no definitive studies that show which treatment is most effective in stopping status epilepticus or prolonged seizure episodes," said Dr. Daniel Rubalcava, assistant professor of pediatrics - emergency medicine at Baylor and Texas Children's Hospital, and the principal investigator for this study at Baylor/Texas Children's. Status epilepticus is a life-threatening condition defined as a seizure lasting longer than five minutes that does not stop on its own and from which the patient does not wake. All patients who come to the emergency department with this

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that will not stop cannot give consent at the time he or she is enrolled in the study and because the unending seizure must be treated quickly, there is often not enough time to obtain consent from his or her mother, father or guardian, particularly if that person is not present at the hospital. For that reason, the patient may be enrolled in the study without the health care giver obtaining such consent. These are frequently called emergency studies and are approved under federal rules that govern research. As soon as a parent or guardian (legal representative) is located, that person will be asked to give permission for the patient to continue in the study. (All patients will be 17 or under and must have a legal representative to give consent for the study to continue.) The Baylor/Texas Children's site is one of three study sites in Houston including Memorial Hermann and Lyndon Baines

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Houston VA Nurse Competes for Team USA Every morning at 3:30 a.m., Edwin Lacson jumps out of bed and heads to the gym for a two-hour training session before heading to his job as an Operating Room Nurse at the Michael E. DeBakey VA Medical Center in Houston. After his shift, Lacson commutes home to take care of his family and then heads back to the gym or outside for

Department of Veterans Affairs as he heads over to Australia with his VA t-shirt and hat packed and ready to wear. “I have always had great admiration and respect for men and women who have served our country and I’m so proud of the top quality health care we provide them at the VA,” Lacson said. “When people tell me they are impressed with

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another long training session my training regimen for this before calling it a day. Why is competition, I always remind them and myself that what I’m he training so hard? Lacson is an accomplished doing is nothing compared to athlete who will be competing what the Veterans I serve have done and continue to do. They in the 2015 Duathlon World are the real heroes.” Championships in Adelaide, Lacson, a longtime triathlete, Australia in mid-October. Top athletes from around the world qualified to be a member of will compete in the Duathlon, Team USA at the Duathlon which consists of a running National Championships in leg, followed by a cycling leg Minneapolis in 2014. In and then another running addition to his strict and leg in a format that is similar monastic training regimen, to triathlons. As proud as Lacson credits his success in Lacson is to be a member of great part to the unconditional support of his wife Eleanor Team USA in this elite athletic (a former collegiate swimmer competition, he says he is and avid runner) and their equally proud to represent the 13 year old daughter Renzi

(a competitive age group swimmer), who are both traveling to Australia with him to cheer him on in the competition. “My goal in the World Championships is to do my family and my country proud,” he said. He also wants to use his platform as a member of Team USA to bring attention to the great work done at the VA.

when I see a news story that is less than positive about the VA,” he said. “I want people to know that the VA is at the forefront of medicine and that the people who work here are hardworking, dedicated professionals who truly care about the Veterans we serve. I’m as proud to be a member of Team VA as I am to be a member of Team USA.”

Good luck to Edwin. Go “I take it very personally Team USA!

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Medical Identity Theft Continued from page 1

medical records. Inform patients that medical identity theft is a crime, which includes using someone else’s medical identification. Encourage patients to request and review medical bills, which may enable them to identify medical identity theft by spotting services they did not receive. 4. Implement Fraud Detection and Prevention Measures. Establish “red flags” to tag discrepancies in appropriate

systems. Enact clear written policies and procedures for investigating a flagged record and determining if the problem is the result of a registration or operational error, or an actual medical identity theft. Train employees to check for and follow-up on red flags at various contact points, including, patient registration, administrative processing, financial processing, periodic audit of electronic health

records and during clinical encounters. Require business associates and downstream vendors to implement red flag policies and procedures. 5. Take Corrective Action. Implement a medical identity theft response plan to correct internal medical and financial records that were affected by the theft. Coordinate the corrective action with the victim’s other providers, insurers and any third parties that maintain medical

records. Direct the victim of the medical identity theft to information on how to check and correct any possible impact on his or her credit records. Medical identity theft can cause significant financial losses, but it is often difficult to detect. By taking a few important steps, healthcare providers can increase their awareness of medical identity theft and take action to significantly reduce their risk of it occurring in their practice.

Mental Health

Continued from page 4 of unreality) o r cause the onset of the attack. “It’s depersonalization (being extremely important for a person to begin talking to a counselor to detached from oneself) Sweating ∙∙ Fear of losing control or begin processing after significant Trembling or shaking traumatic events. Since it is possible “going crazy” Sensations of shortness of to treat anxiety and panic disorders ∙ ∙ Fear of dying breath or smothering with talk therapy rather than “A panic attack is a specific with medication, it is best not to Feelings of choking event that occurs with defined delay treatment. As the condition Chest pain or discomfort characteristics and involves feelings becomes more severe, it may require Nausea or abdominal of intense fear, danger or doom,” medication,” she said. Roblyer said. “Anxiety is a more distress Roblyer emphasized that general term, related to stress and people who utilize illicit drugs like Feeling dizzy, unsteady, worry.” marijuana, methamphetamines, light-headed or faint According to Roblyer, people in and cocaine can actually make Chills or heat sensations her practice who suffer from panic their anxiety or panic disorders Paresthesia (numbness or attacks have often experienced a worse. “We see people use drugs tingling sensations) traumatic event in their past, and like cannabis (marijuana) to try Derealization (feelings a mental or physical trigger may and relax or calm their fears, but

∙∙ Palpitations, pounding heart or accelerated heart rate ∙∙ ∙∙ ∙∙ ∙∙ ∙∙ ∙∙ ∙∙ ∙∙ ∙∙ ∙∙

in doing so, they actually exacerbate the anxiety. When the drugs wear off, the anxiety may become more severe.” Excessive caffeine can also contribute to higher levels of anxiety. Roblyer said any person who experiences severe symptoms of anxiety or panic should contact their health care provider for an assessment. “People don’t need to try to differentiate between the two,” she said. “If you are experiencing distress that interferes with your daily life then you should seek help.”

Healthy Heart

Continued from page 8 your body needs to be healthy. Limit foods and beverages high in calories but low in nutrients. Also limit the amount of saturated fat, trans fat and sodium you eat. Read Nutrition Facts labels carefully — the Nutrition Facts panel tells you the amount of healthy and unhealthy nutrients in a food or beverage. As you make daily food choices, base your eating pattern on these recommendations: ∙∙ Eat a variety of fresh, frozen November 2015

and canned vegetables and fruits without high-calorie sauces or added salt and sugars. Replace high-calorie foods with fruits and vegetables. ∙∙ Choose fiber-rich whole grains for most grain servings. ∙∙ Choose poultry and fish without skin and prepare them in healthy ways without added saturated and trans fat. If you choose to eat meat, look for

the leanest cuts available and prepare them in healthy and delicious ways. ∙∙ Eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids (for example, salmon, trout and herring). ∙∙ Select fat-free (skim) and low-fat (1%) dairy products. ∙∙ Avoid foods containing partially hydrogenated vegetable oils to reduce trans

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fat in your diet. ∙∙ Limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat. see Healthy Heart page 26

Houston Medical Times

Page 25

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Construir Un Negocio Saludable • Desarrolle un ingreso secundario •

weeks to three months of smoke-free living: your circulation and lung function begin to improve. Your overall health will improve and you will decrease other health risk factors:

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Healthy Heart

Continued from page 24 ∙ ∙

∙

Cut back on beverages and foods with added sugars.

eye on your portion sizes.

Don’t smoke tobacco — and avoid Choose foods with less secondhand smoke. sodium and prepare foods You probably know smoking is with little or no salt. To lower bad for you, but do you realize exactly blood pressure, aim to eat no how dangerous it is? It’s important to more than 2,400 milligrams understand your risks, but there’s a of sodium per day. Reducing lot more to quitting than frightening daily intake to 1,500 mg is statistics. Your journey to smoke-free desirable because it can lower living will help you turn your life blood pressure even further. If around in many positive ways. you can’t meet these goals right After one month of living now, even reducing sodium intake by 1,000 mg per day smoke-free, you’ll soon be able to exercise or perform activities with can benefit blood pressure. less shortness of breath. According to If you drink alcohol, drink the American Heart Association and in moderation. That means the U.S. surgeon general, within 20 no more than one drink per minutes after quitting your body starts day if you’re a woman and no to recover. This includes decreased more than two drinks per day blood pressure and carbon monoxide if you’re a man. levels in your blood returning to Follow the American Heart normal. After 12 hours of smoke-free Association recommendations living: the carbon monoxide levels in when you eat out, and keep an your blood return to normal. After two

∙

One year after quitting smoking, a person’s excess risk of coronary heart disease is reduced by 50 percent. After 5 years: Your risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Your risk of cervical cancer and stroke return to normal. After 10 years: You are half as likely to die from lung cancer. Your risk of larynx or pancreatic cancer decreases. After 15 years your risk of coronary heart disease is the same as a non-smoker’s.

It’s important to understand your risks, but there’s a lot more to quitting than frightening statistics. Your journey to smoke-free living will help you turn your life around in many positive ways. Learn more about heart healthy living and join the American Heart Association in celebrating National Eating Healthy Day on November 4. Be sure to check out the great resources available online that can provide more information on health and wellness, risk factors of heart disease, stroke, and more at www.heart.org.

Lung Cancer

Continued from page 14 – 3.5 percent of patients, despite having larger tumors, compared to 7.9 percent of the 3-D CRT group. While the benefit of IMRT was seen in all tumor sizes, the reduction of severe pneumonitis was more pronounced in larger tumors, explained Chun.

advanced lung cancer.

increased by IMRT had no association with any severe toxicity outcome. This finding suggests that we should be optimizing radiation treatment by the high and intermediate dose region, and not the low dose region,” said Chun.

One of the principles of IMRT, explained Chun, is to bring in many complex beams to converge on a target, producing a high dose on the target and dramatically sparing nearby adjacent tissue. By using multiple beam IMRT is more time-intensive and Additionally, those who received arrangements, this leads to spreading of costly, said Chun, yet the study showed IMRT were more likely to complete a low-dose bath such as the volume of a dramatic reduction in severe toxicities. consolidative chemotherapy – 37 lung that received 5 Gy of radiation. These findings have the potential percent, compared to 29 percent in “It’s been unclear what the to reduce the number of hospital those treated with 3D-CRT. High dose chemotherapy after completing consequences of that low dose bath are. admissions and improve quality of chemotherapy with radiation, is What we’ve seen in this study is that life for this patient population, he considered to be standard for locally indicators of the low dose bath that’s explained. November 2015

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Published by Texas Healthcare Media Group Inc. Editor Sharon Pennington Director of Media Sales Richard W DeLaRosa Creative Director Lorenzo Morales Distribution Vincent DeLaRosa Accounting Liz Thachar Contributing Writers Jorge Augusto Borin Scutti, PhD Denise Hernandez MS,RD,LD Oﬃce: 713-885-3808 Fax: 281-316-9403 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com

Houston Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Houston Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Houston Medical Times are considered property and are to distribute for publication and copyright purposes. Houston Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430

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