February Issue 2019
Inside This Issue
Training Law Enforcement to Reverse Opioid Overdoses
Texas A&M Opioid Task Force’s Opioid Overdose Education and Naloxone Administration Training for emergency responders from across the Brazos Valley By Mary Leigh Meyer
T Ascension Seton Named Title Sponsor of Austin Marathon See pg. 10
INDEX Financial Forecast............. pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart....................... pg.8
St. David’s Healthcare Opens New Emergency Center in Buda See pg. 11
he Centers for Disease Control and Prevention (CDC) estimates around 68 percent of last year’s more than 70,200 drug overdose deaths involved an opioid. In other words, an average of 130 Americans die each day from an opioid overdose. The Texas A&M Health Science Center Opioid Task Force is dedicated to decreasing these alarming mortality rates, partly through expanding access to the opioid overdose reversal agent known as naloxone, or Narcan. The Opioid Task Force, in collaboration with the Brazos Valley Council of Governments, facilitated naloxone training sessions for law enforcement and emergency service departments from seven counties across the Brazos Valley this week. “Law enforcement will most likely be the first responder on the scene, especially in a rural setting, so it is important they feel empowered and comfortable using naloxone,” said Joy Alonzo, M. Engineering, PharmD, clinical assistant professor at the Texas A&M College of Pharmacy, who is leading the naloxone training effort. In December 2018, the Task Force trained over 200 law enforcement and emergency responders i n rever si ng opioid overdoses using naloxone. Additionally, the Task Force held a training at Texas A&M University at Galveston for the University’s Police Department last June. During the training, participants learn how to identify a potential opioid overdose and employ the Opioid Overdose Action Plan, which spells
Police officer (first responder ) seen here with Joy Alonzo PharmD, clinical assistant professor at the Texas A&M College of Pharmacy, who is leading the naloxone training effort.
out the exactly what to do to render assistance during an opioid overdose and use naloxone to reverse the opioid overdose. The trainings also review
In December 2018, the Task Force trained over 200 law enforcement and emergency responders in reversing opioid overdoses using naloxone. the basics of opioid pharmacology, factors influencing the opioid crisis, officer safety during an opioid overdose situation and Texas specific legislation pertaining to naloxone. This information helps to debunk any common myths about opioids, opioid overdose and the use of naloxone.
An integral part of the workshop is the hands-on opioid overdose simulation exercise. The exercise requires participants along with trainers to simulate an opioid overdose situation and implement the Opioid Overdose Action Plan, which includes activating 911, naloxone administration, rescue breathing, reassessment and monitoring. The naloxone trainings are only one intervention that the Opioid Task Force is employing to decrease opioid-related mortality and expand access to substance use treatments. They are also evaluating the contributing factors to opioid use disorder for further interventions. “It will take a multi-faceted and multi-disciplined approach to reverse the number of mortalities occurring in the opioid epidemic,” said Joy Alonzo. “We are training all Health Science Center students on every campus how to recognize an opioid overdose see Texas A&M... page 12
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Financial Outlook Beyond Classifieds When Recruiting a Physician By Reed Tinsley, CPA CVA, CFP, CHBC
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ou’ve run the analysis and know that not only do you need to hire a physician (or specialist, staff member, etc.), but you have the resources to support the addition. You’ve presented your findings to your partners and they’re all on board. You’ve done your prep work and you’re ready to dive into the recruiting process. The following is a sampling of the recruitment tools available to help get you started: Direct mail Consider buying direct mail lists so they can target physicians in a specific specialty who might be willing to move to the area. If candidates you’re interested in are practicing medicine 10 minutes from the university where they earned their BS and MD degrees, chances are they’re attached to that location. But if there are physicians on this list who attended medical school or completed their residencies
in your area and are practicing across the country, they might be willing to consider uprooting for a position in your practice. For physicians, the first choice about whether to make a move is about vicinity, then practice opportunities. You’re targeting people who are already familiar with the area and are more likely to make a change. Site visits Site visits can be expensive, but they’re also a great way to impress a candidate you’re trying to woo. Instead of inviting only the physicians for a site visit, increase this line item in your recruiting budget and invite the whole family. Even if paying for the extra lodging, meals, and transportation limits the number of physicians you can afford to honor with site visits, it makes more sense to go all-out for your top choices than to offer less to many candidates who aren’t as appealing. The right leader If you’re planning on appointing a member of your staff to lead the recruiting process, don’t underestimate
the power of picking the right person. The person in charge should possess the following: • Good listening skills • Time to perform initial screens • An understanding that his or her job isn’t just to fill the position, but to fill the position with the right person • The ability to articulately address any of the candidate’s concerns • The ability to ask candidates questions in a way that develops a rapport, but also determines the candidate’s wishes • Determine the extent of the candidate’s clinical expertise. • Determine the candidate’s potential fit with your practice’s
culture. • Understand the needs of the candidate and their family. External recruiters If your staff are so crunched that handling the recruiting process in-house might swamp them, consider hiring an external recruiter. Not only can recruiters pre-screen candidates, but they can also listen to your needs and help you evaluate them. As outside observers, recruiters may be in a better position to illustrate how you might be better served by a half-time physician rather than a full-time physician, for example. see Financial Outlook...page 14
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Legal Matters Deal Breaker – Cyber Security Risk in Health Care Transactions
By Iliana L. Peters, J.D. Lidia M. Niecko-Najjum, J.D. Polsinelli, PC
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ealth care organizations’ lack of compliance with the data privacy and security requirements of both state laws and the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy, Security and Breach Notification Rules and the resulting cyber security risk could be a literal “deal breaker” for mergers and acquisitions. Buyers must prioritize fulsome due diligence in investigating the data privacy and security practices of their targets, and sellers must be prepared to provide excellent documentation regarding their policies
and practices to buyers to ensure that the deal does not stall, or worse, based on concerns about potential state and federal regulatory enforcement actions. Recent business deals in other industries have been affected by cyber attacks, causing a lowered purchase price or resulting in buyers acquiring big liabilities related to previous information breaches. In health care, buyers must also consider state privacy and security laws, and particularly the HIPAA Rules. Generally, most health care organizations must ensure they are compliant with: • The HIPAA Privacy Rule which requires the permitted uses and disclosures of Protected Health Information (PHI) and individuals rights to it. • The HIPAA Security Rule which requires the necessary physical, administrative and technical safeguards that must be put in place to protect confidentiality, integrity, and availability of PHI.
• The HIPAA Breach Notification Rule which requires parties to be notified when a breach of PHI has occurred. Violations of HIPAA have serious consequences. These include civil penalties that range from $50,000 per incident up to $1.5 million per incident for violations that are not corrected, per calendar year. “Per violation” means that any particular investigation of a breach incident could result in $1.5 million in penalties for each year of a six-year statute of limitations for each requirement of the Privacy, Security or Breach Notification Rules that may be implicated. Both the Department of Health and Human Services (HHS) and the State Attorneys General have jurisdiction to enforce civil penalties. HIPAA violations may also result in
criminal penalties that end in more fines and violators facing up to 10 years in prison; the Department of Justice (DOJ) enforces the criminal provisions of HIPAA. Too many potential buyers do not conduct the requisite HIPAA compliance due diligence and expose themselves both to HIPAA penalties and general cybersecurity liability. At the same time, many sellers do not anticipate that buyers will inquire about HIPAA compliance and are unable to provide key information that should be necessary to complete the deal. To avoid HIPAA liabilities and cybersecurity risk, due diligence should include a review of the following: 1. Copies of HIPAA Policies and Procedures for the previous six years: see Legal Matters...page 14
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Oncology Research Top Five Cancer Trends In 2019 By James Uyeki, M.D., Texas Oncology South Austin
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edical science and technology are constantly advancing, creating innovations in oncology that provide more and better options for cancer patients. Trends shaping cancer treatment and prevention in 2019 blend a focus on the opportunities that lie in deeper understanding of what is unique to each patient with insights gleaned from probing what is common to many. 1. Immune Systems Go Chemotherapy remains a primary treatment for cancer; however, the use of immune-based therapies continues to grow. Oncologists increasingly will recommend immunotherapy, which uses the body’s immune system to fight cancer, as a treatment option for some patients. Immunotherapy is a personalized
treatment option that can be more effective and less toxic than chemotherapy. This is a particularly promising development for higher risk patients. A patient’s best opportunity to be treated with this promising new therapy may be on a clinical trial. At Texas Oncology in Austin, 130 patients are enrolled in clinical trials every year. 2. Big Data = Big Picture of Cancer This year, we’ll continue to see advancements in the use of big data to help inform treatment plans and analyze patient outcomes. Advancements in technology have made it possible for providers like Texas Oncology – which treats tens of thousands of patients each year – to discover powerful ways to provide the most optimal care. For example, patient tracking data required in the Oncology Care Model, a novel program through the Centers for Medicare and Medicaid Innovation, is giving us the clearest ‘big picture’ look we’ve ever had about our patients’ treatment and outcomes. Patient data help healthcare providers better understand genetic risk, new
approaches to therapeutics, and trends in healthy living post-treatment. In turn, we can improve patient outcomes. 3. Putting Patient Priorities First Managing a cancer diagnosis requires an ongoing dialogue with medical teams and caregivers. Patients are becoming more empowered to put their values and priorities forward in treatment decisions – enabled by the evolving approach physicians take in communicating with patients. For example, more providers are embracing telemedicine which adds convenience and provides more immediate and actionable access to care. This helps break silos between patients and providers, allowing cancer patients to be more involved in their treatment decisions.
4. On the Lookout for Cancer Early detection has long been an emphasis when it comes to health. We will continue to see providers promote screenings and early detection, as well advancement in screening solutions like liquid biopsies. A recent American Cancer Society study found that the cancer death rate dropped by 27 percent in the last 25 years, primarily because of advancements in early detection and treatment, and decreases in smoking. We are engaging primary care physicians on early detection and genetic testing to provide patients with a better understanding of cancer risk and the opportunity to treat cancer sooner, with greater success. see Oncology...page 11
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Mental Health ADHD: The Disorder, Treatments, and Risks By Lourdes Valdes, Ph.D. Clinical Psychologist
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ttention-Deficit/Hyperactivity Disorder (ADHD) is one of the most frequently diagnosed (and misdiagnosed) disorders. In the US, 3 to 7% of the population suffers from it (according to the CDC). Contrary to conventional wisdom, one does not grow out of it. Hallmarks of ADHD include distractibility, impulsivity, and hyperactivity. Working memory problems, social struggles, and poor academic achievement also mark suffers. Academic problems, incidentally, are the most frequent reasons parents seek professional help. Think of ADHD as a sleepy brain trying to stay awake by seeking stimulation. Stimulating activities, like video games, hold its attention very well. Monotonous activities, like homework, lose its attention too often. The sleepy brain metaphor is a theory that says decreased dopamine is the culprit. Dopamine, a neurotransmitter that regulates
depression, sleep apnea, vision problems, and substance abuse. It also co-occurs with oppositional defiant disorder, language disorder, anxiety disorder and learning disorders. As a result, the diagnosis of ADHD is not always easy to make and children with ADHD are often misdiagnosed. The diagnosis of ADHD requires a thorough evaluation that includes ruling out differential diagnoses and assessing symptoms and their effects on functioning in various settings. Good assessment will then lead to good treatment. Effective clinical management options for ADHD include psychotherapy, medical treatment, school based interventions, treatments based on neuroplasticity, and most effective, a combination of several treatment modalities. Psychotherapy includes behavioral and cognitive interventions that support the individuals and their families with setting priorities for which behaviors to target, establishing consistent rules, managing aggression, frustration,
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February 2019
mental stimulation, is transmitted at abnormally low levels in those with ADHD. Other theories include genetic heredity, brain damage and hypoxia, toxins such as lead and pesticides, delays in normal brain maturation, hyperthyroidism, allergies, and more. While the etiology of ADHD remains unclear and there are a number of competing theories, there indeed appear to be pathophysiological abnormalities in prefrontal cortex areas of the brain and other areas that are involved in the control and regulation of behavior (basal ganglia, cerebellar vermis). ADHD frequently shares symptoms with other psychiatric and medical problems, such as anxiety,
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and anxiety, establishing reward systems, and improving concentration and attention. Medical treatments for ADHD include stimulants (e.g., amphetamine, dexmethylphenidate, methylphenidate), non-stimulants (e.g., atomoxetine), and long-acting prodrug stimulants (e.g., lisdexamfetamine dimesylate). School based interventions include educational accommodations and modifications that support the child academically and socially. Treatments based on neuroplasticity, while relatively new in the field of ADHD interventions, are showing promising initial results! These include neurofeedback (a painless, non-invasive treatment that helps a person see Mental Health...page 12
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Recognizing Diabetes Risk Factors and Symptoms Ignoring the Signs Of Diabetes Can Lead To Major Health Complications By Leslie Cockrell
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ymptoms of diabetes can be difficult to spot, so the Centers for Disease Control and Prevention (CDC) recommends those vulnerable to the disease learn about diabetes risk factors. At-risk individuals who ignore the signs, symptoms and risk factors of diabetes could encounter major health complications in the future. “Uncontrolled diabetes can lead to serious complications,” said Patsy Guerra, MSN/MHA, RN, health educator for the Texas A&M Healthy South Texas Diabetes Education Program. “Some possible complications are losing a limb, blindness, kidney failure and heart attack.” Nearly 3 million Texans have been diagnosed with diabetes. An additional 663,000 people in Texas have diabetes and don’t even know it. This is, in part, because symptoms of all types of diabetes can vary between people. Sometimes symptoms of diabetes develop slowly over time,
making it difficult for the person affected to know there’s a problem. There are three types of diabetes: types 1 and 2, as well as gestational diabetes. Becoming familiar with the symptoms and risk factors associated with diabetes can help prevent or delay a diagnosis for those at risk.
• Very dry skin • Sores that are slow to heal • An increased number of infections
Common signs of all types of diabetes The CDC says that individuals who experience any of the following symptoms should see their health care provider to have their blood sugar checked during their annual checkup. These physical signs can point to all three types of diabetes. • Frequent urination, often in the evening • Excessive thirst • Unexplained weight loss • Extreme hunger • Blurred vision • Numbness or tingling hands or feet • More tired than usual
Type 1 diabetes Previously called juvenile diabetes, type 1 diabetes typically develops in children, teens and young adults, but can start at any age. Type 1 diabetes requires lifelong management with insulin, and overlooking the signs can result in death. Symptoms usually develop over a few weeks or months and can be severe. The ADA describes an infant or child who exhibits the following behaviors or conditions as “the classic picture of a child with new-onset type 1 diabetes.” • Frequent urination: also, if a child is potty-trained and dry at bedtime,
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• • • •
but starts wetting the bed, diabetes could be the culprit Drinking more water than usual Excessively tired Losing weight Becoming ill more often
Other symptoms of type 1 diabetes are nausea, vomiting and stomach pain. It is important that parents or guardians report these symptoms to their health care provider and ask for a blood test. Type 1 diabetes can be difficult to diagnose in adults because it is often mistaken for type 2. For those who have been diagnosed with type 2 diabetes, but aren’t responding to typical see Diabetes...page 14
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Healthy Heart February is American Heart Month By Joel Rice Executive Director American Heart Association
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his month we are celebrating American Heart Month, and we kick it off with National Wear Red Day on Feb.1st. Did you know that more than one in three women is living with some form of cardiovascular disease? The more a woman knows about heart disease, the better chance she has of beating it. That is why on Feb. 1st we are encouraging all Central Texans to wear red to increase awareness of cardiovascular diseases and inspire others to take charge of their health. Some heart conditions are genetic for both men and women, but there are many other factors outside of genetics that can lead to better heart health. The American Heart Association’s research cites six factors as being critical to heart health. They are healthy eating, physical activity, weight
management, stress management, smoking and workplace health. It’s also important for all people to know their five key numbers: total cholesterol, HDL (good) cholesterol, blood pressure, blood sugar and Body Mass Index. These numbers are important because they can help determine risk for developing cardiovascular disease. One easy way to improve your heart health is by making simple changes to your diet by including nutrient-rich foods that provide the protein, minerals and vitamins you need. Select plenty of fruits and vegetables and try to work them into every meal and snack. Other foods to emphasize in a healthy eating pattern are whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes and non-tropical vegetable oils. Research shows cigarette smoking leads to a higher risk of dying of coronary heart disease. Smoking increases the effects of other heart disease risk factors, such as high blood pressure, high cholesterol and physical
inactivity. Never smoking is the best option and can be a factor in improving life expectancy. For those who do smoke, quitting is key. You can find more resources on how to quit smoking or using tobacco at www.heart.org. Research also recommends that men and women drink in moderation. Consuming too much alcohol can result in higher risk for various health problems. It can increase the level of some fats in the blood, known as triglycerides, and can lead to high blood pressure, heart failure and certain cancers. It can also increase your calorie consumption, which can increase obesity and diabetes risk. The AHA considers moderate alcohol consumption to be an average of one to two drinks per day for men and one drink per day for women. (A drink is 12 ounces of beer, 4 ounces of wine,
1.5 ounces 80-proof spirits, or 1 ounce 100-proof spirits.) We’re excited about National Heart Month and all the events we have coming up including: The Go Red For Women Summit on March 1st and the Austin Heart Ball on May 11th. A special thank you to St. David’s HealthCare which serves as the presenting sponsor of these two events. We also will be rolling out a new event called CycleNation this May and will have more information in future editions. Please join us on our Facebook page – www.facebook.com/ ahaaustin and follow us on Twitter @ahaAustin to keep up with all the latest news! And please see many valuable additional resources available for Womens’ heart health at Go Red for Women– www.goredforwomen.org
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Single-Incision Surgery Speeds Recovery for Cancer Patient
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hen Rafael Roa of Colleyville learned he had prostate cancer, he was understandably nervous. “When someone tells you that you have cancer, many things go through your head. But this cancer, in particular, is something you don’t want to talk about,” said the 57-year-old global technology service company executive. “For a Latin male, maybe
for any male, there are psychological effects.” It eased Mr. Roa’s mind a bit to learn that his surgery could be done using a new robotic surgery device. The technology allows for all of the necessary surgical tools to be inserted through one 1-inch hole, whereas standard laparoscopic surgery requires five or six small incisions. Dr. Jeffrey Cadeddu, Professor of Urology and Radiology, was the first to use the new single-port robotic surgical device in Texas. When Dr. Cadeddu described the new robotic surgery device and what it could do, Mr. Roa thought carefully. “I’ve been around technology all of my life. I wondered, Dr. Jeffrey Cadeddu at the controls of a new robotic surgery device that allows ‘Is this technology the surgeon to operate four surgical tools through a single 1-inch incision.
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too new?’ But then I spoke with my cousin, who is a physician, and he assured me that this was a good option, that it would lower the chances of complications.” Dr. Cadeddu said the idea of reducing the number of incisions arose about 10 years ago. “Every hole you create in a patient has a risk associated with it. Every incision means increased pain, increased risk of hitting a blood vessel,” said Dr. Cadeddu, who is a member of the Harold C. Simmons Comprehensive Cancer Center. From an aesthetic standpoint, fewer incisions also mean fewer scars. The single-incision laparoscopic surgery was performed using a robotic device called the SP (Single Port) Robot that has four arms that insert through a single 1-inch hole. Intuitive Surgical Inc., the company that makes the SP Robot, is initially rolling it out to a handful of medical centers, including UT Southwestern, which is one of the nation’s leading medical centers in robotic surgeries performed. So far, fewer than 10 medical institutions around the world are using the single-incision robot. Mr. Roa spoke about his cancer and his concerns before the surgery: “I
Business executive and family man Rafael Roa, pictured with his youngest child and his granddaughter, said the new single-incision robotic device helped him get back to his busy life quickly.
have had challenges before in my life, but this is different. It’s humbling,” he said. “Here are my hopes: That they get all the cancer out. That my sexuality will be intact and I can maintain my relationship with my wife. That I can get back to work quickly.” Mr. Roa said it was comforting to know he was in good hands, and he believed the single-incision surgery see Surgery...page 12
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Ascension Seton Named Title Sponsor of Austin Marathon
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igh Five Events recently announced Ascension Seton as the title sponsor and Official Medical Provider of the Austin Marathon . The title sponsorship includes naming rights, race weekend activations, and community engagement opportunities. The Ascension Seton Austin Marathon presented by Under Armour® will take place on February 17, 2019. “Ascension Seton is excited to be the title sponsor and Official Medical Provider for the Austin Marathon,” said Adam Bauman, vice president of business development at Ascension Seton. “The Austin Marathon reflects the community’s commitment to be an active and vibrant city, and through our partnership with
High Five Events and friends of the Austin community, we are committed to promote, support, and facilitate activities for a healthy lifestyle.” As the Official Medical Provider, Ascension Seton doctors and nurses will staff the finish line medical tent and work with Travis County EMS on course. During race weekend, Team Ascension Seton will participate in all events, volunteer time, and have a major presence at the Health and Fitness Expo. Outside of race weekend, Ascension Seton will be involved with local running clubs and attend community runs. Ascension Seton will also raise funds and spread awareness as an Official Austin Gives Miles charity.
The Austin Marathon will celebrate its 28th year running in the capital of Texas in 2019. Austin’s flagship running event annually attracts runners from all 50 states and 30+ countries around the world. Having start and finish locations in the heart of downtown Austin puts participants and spectators near
all the action and within walking distance of restaurants, hotels, and shops. Finishing with the picturesque Texas State Capitol as your backdrop is icing on the cake for the perfect running weekend destination. Participants can register on the Austin Marathon website.
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St. David’s Healthcare Opens New Emergency Center in Buda, Providing 24-Hour Emergency Care
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t. David’s HealthCare began treating patients with medical emergencies at the new St. David’s Emergency Center in Buda. St. David’s Emergency Center in Buda serves as an extension of St. David’s South Austin Medical Center, a Level II Trauma Center. The hospital’s emergency department (ED) is the largest volume ED in Central Texas, serving more than 110,000 patients each year. “St. David’s South Austin Medical Center has long been a leader
in providing quality healthcare and exceptional outcomes to patients in Central Texas, including Hays County,” Todd Steward, chief executive officer of St. David’s South Austin Medical Center, said. “The Buda community has seen significant growth over the past few years, and the new emergency center will allow us to meet the increased demand for advanced, comprehensive emergency care closer to home.” St. David’s Emergency Center in Buda is a full-service, free-standing
emergency department staffed by board-certified physicians and nurses trained in trauma care. It features 12 treatment beds; a fully equipped trauma room; a CT scanner; advanced lab and imaging diagnostics, including CT scans, X-ray, ultrasound and radiological testing; teleneurology capabilities for n e u r o l o g i c a l emergencies; and a medical lab. Patients requiring inpatient care will be transported from the facility to area hospitals. The emergency center, located at 15610 Interstate Highway 35, operates
Oncology
detect and diagnosing cancer. Though still in the trial/study phase, recently developed blood tests are being used to detect cancer cells in the bloodstream. As for using blood testing as a widespread method of testing for cancer, it’s still very early, but developments in this area hold great promise.
As we look to the future, new developments in cancer detection and treatment are exciting. These trends represent advancements that will continue to pave the way forward, leading to better outcomes and quality of life for patients during and after treatment, and ultimately delivering
S
Continued from page 5 5. It’s in Your Blood In 2019, we expect to hear more about advancements in a variety of blood tests as a new approach to
24 hours a day, seven days a week. For more information about St. David’s Emergency Center in Buda, visit StDavids.com.
greater hope to everyone impacted by cancer. James Uyeki, M.D., is a medical oncologist at Texas Oncology–South Austin, 4101 James Casey Street, Suite 100, in Austin, Texas. For more information, visit TexasOncology. com.
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Austin Medical Times
Texas A&M
Continued from page 1 and use naloxone as well as educating them about opioid use disorder and the contributing factors.” She said their goal is to eventually train Texas A&M undergraduates and resident assistants in the dorms on Texas A&M campuses as well as place naloxone kits in high traffic areas on all campuses. The Texas A&M University Health Science Center is the first
health science center in the nation to commit to training all health sciences students on factors contributing to opioid misuse, recognizing an opioid overdose and opioid overdose reversal. This huge enterprise will include training Health Science Center students in every discipline on every campus. “We are all responsible for finding a better way forward,” Alonzo said. “This is why we want
our students to understand the best practices regarding medical treatment with opioids, how to recognize opioid misuse and intervene appropriately when necessary.” The Task Force is working every day to decrease opioid overdose mortality rates and spread awareness about naloxone as an opioid overdose reversal agent. Everyone plays a role in stopping the opioid epidemic,
especially law enforcement. Frequently, they find themselves first on the scene of an overdose, and need to respond immediately to avoid another opioid overdose related death. “If we can work together, then we can not only reduce the number of deaths related opioids but we can also start to change the way people view opioid use disorder and those affected by it, thus increasing successful treatment outcomes.”
the impact of leaving ADHD untreated. In fact, research shows that untreated ADHD is one of the most impairing disorders for people to live with. The most well known longitudinal follow up studies comparing the life course outcome of children with ADHD and those without ADHD are the UMass Study and the Milwaukee Follow Up Study. Comparisons included a sample of young adults who had been diagnosed with ADHD as children and whose symptoms persisted to adulthood, a sample of children who were initially diagnosed with ADHD and no longer met criteria as adults, and the original community control sample selected from the same schools and neighborhoods. These follow up studies have sobering implications for the choice of not treating. In most domains (including work, home, social, community, education, and dating) the difference in functioning between the individuals no longer meeting criteria for ADHD and the control group was negligible; however the difference between the individuals who continued to meet criteria for ADHD and the other two groups was considerable. Differences included a greater likelihood of psychopathology. Major depressive disorder, dysthymia, and anxiety disorders were significant more frequent in the group of adults with ADHD than the control and treatment groups as were a higher frequency of suicidal ideation and attempts. This
finding is not surprising as individuals who frequently experience failure are likely to have diminished self-esteem, to feel less hope, and to worry more. As expected, oppositional defiant disorder and conduct disorder were also more frequent in the group of adults who still met criteria for ADHD. Poor academic achievement was also characteristic of the adult group with ADHD: individuals with continued ADHD were more likely to report having to retained in grade, receive special education, be diagnosed with learning disabilities, and have lower grade point averages. Not surprisingly, the individuals with ADHD also went on to fare worse in occupational functioning and career attainment. These problems were related to getting along with others, demonstrating behavior problems, being fired, quitting out of boredom, and being disciplined by supervisors, all of which were more frequent in the work histories of the adults with ADHD than in either of the control groups. With regards to drug/alcohol use, the UMass Study and the Milwaukee Longitudinal Study both indicated that individuals in both ADHD groups were at greater risk for smoking, using alcohol, getting drunk, or using illegal substances. Further, the Milwaukee Study found no evidence that treatment with stimulants in childhood was associated with increased drug use or abuse. In fact, some evidence showed
that being treated with stimulants as a child reduced the likelihood of using speed (amphetamines) or the illegal use of prescription drugs. These findings are consistent with the vast majority of other research that solidifies the conclusion that childhood stimulant treatment is not associated with risk for later drug use or abuse. These findings are not surprising. It is likely that untreated individuals with ADHD, who struggle with more problems are more likely to attempt to self medicate and are more vulnerable to drug and alcohol abuse. Other findings in these follow up studies suggest that adults with untreated ADHD more often report problems with physical health, social relationships, motor vehicle safety, and money management. Much of the writing, thinking, and focus of ADHD is centered round the very real difficulties that children and adults experience with this disorder. However there is another side to ADHD. ADHD symptoms can also come with some unique and, desirable qualities, like creativity, high energy, exceptional drive and determination when something is engaging, and intuition. And when children and adults with ADHD receive adequate treatment and learn to use those unique assets and ADHD symptoms in a positive direction, they can convert what were previously thought of as weaknesses into strengths!
Cadeddu made a small incision, about 1-inch wide above the belly button. A port was inserted and then Dr. Cadeddu stepped over to the controls of the robot. Using the robot controls, four surgical instruments were “docked.”
An additional surgical instrument was inserted that Dr. Cadeddu controlled using a magnet on the surface of Mr. Roa’s abdomen. Dr. Cadeddu is a pioneer in magnet-controlled surgical instruments and he incorporates a
magnetic-controlled instrument in all of his single-incision surgeries, giving him five surgical tools to work with. All told, the surgery to remove the cancerous prostate tissue from Mr. Roa took about three hours.
Mental Health
Continued from page 6 learn how to modify her brainwave activity to improve attention, reduce impulsivity, and regulate hyperactivity) and interactive metronome (a computer-based intervention tool that combines auditory feedback and movement exercises to promote improved attention, timing, rhythm, motor planning and sequencing). The difficulties with which children and adults with ADHD struggle are varied and occur in many areas; likewise, treatment in just one area is not powerful enough to alleviate the problems. Medical treatment, for example, is one of the single most effective interventions for attention and motor hyperactivity; however, it does not teach the family or the child the skills to manage frustration and anxiety or the social skills to get along with peers. There is also evidence from a study conducted in at the University of Buffalo in 2004 that suggests that when both medical and behavioral approaches are combined, the amount of medication needed to achieve the same results as drugs alone is reduced by two-thirds. This and other empirical evidence consistently indicate that the optimal and most powerful treatment approach for ADHD is combined treatment. Despite the amount of researching supporting our understanding of ADHD, there seems to be a tendency to question the validity of ADHD as a diagnosis, to recognize that ADHD is a life long disorder, and to underestimate
Surgery
Continued from page 9 would help him restore his quality of life more quickly. “Someone has made a huge investment to bring this to the hospital for a reason. That’s why I think God is with me.” The surgery went smoothly. Dr. February 2019
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Financial Outlook
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Continued from page 3
they’re more likely to have the time and freedom to talk openly about the opportunities at your practice.
Sourcing services These services call candidates on behalf of the group. By using sourcing services, your practice can target candidates who weren’t looking to switch jobs and would not have otherwise known about the position. Generally speaking, these services research the physician’s home information, and then call them when
Networking Networking is a powerful recruiting tool that is often overlooked so your practice should be networking constantly. If your practice has let this slide, start by making contacts at your local medical schools and residency programs, and make sure you take advantage of all your local medical associations. Networking can help
Legal Matters
• Updated policies and procedures regarding administrative, physical and technical controls • Designation of HIPAA Security Officer • Evidence of technical safeguards required by the HIPAA Security Rule, including encryption, malware protection, access and audit controls, device and media controls, and facility access controls
Continued from page 4 Privacy Rule • Updated policies and procedures regarding uses, disclosures, and safeguards to protect PHI • Updated policies and procedures regarding individual’s rights • Updated policies and procedures regarding Business Associate Agreements and sample forms • Designation of HIPAA Privacy Officer • Notices of Privacy Practices • HIPAA Authorization Forms Security Rule • Copies of required enterprise Risk Analyses and Risk Management Plans (these are not security audits or gap analyses, for example). Roughly 80% of HHS’s settlement agreements and civil money penalties include violations of these requirements
Diabetes
Continued from page 7 treatment, the ADA advises them to talk to their health care provider about receiving further testing. Type 2 diabetes The signs and symptoms of type 2 diabetes advance gradually over time. In fact, many people have diabetes and don’t know it. The CDC recommends people become familiar with its risk factors. “Diabetes risk factors are important to look for,” said Guerra. “Identifying these factors can help manage symptoms, as well as help prevent further complications.” Common diabetes risk factors for developing type 2 are: Having prediabetes (a condition where blood sugars are elevated, but not enough to be called diabetes) • Being overweight • Being 40 years old or older February 2019
Breach Notification • Updated policies and procedures regarding investigating suspected or actual breach incidents and providing notice • Updated policies and procedures regarding record retention and destruction • Updated policies and procedures regarding training of employees 2. List of Business Associates and confirmation of existing BAAs 3. Documentation regarding any data security incidents or security breaches,
• Having a close relative (such as a parent or sibling) with diabetes • Being physically active fewer than three days per week • Having had gestational diabetes or giving birth to a baby weighing more than 9 pounds • Being African-American, Hispanic/Latino American, American Indian, Alaska Native, Pacific Islander The CDC says there are no symptoms of gestational diabetes. Therefore, it is important to learn the risk factors. The following factors can increase the chances of developing gestational diabetes. • Previously having had gestational diabetes • Previously giving birth to a baby weighing more than 9 pounds • Being older than 25 years old • Being overweight • Having a family history of type 2 diabetes • Having polycystic ovary syndrome
you find a candidate before you launch into a recruitment program. Internet Few practices are using paper-based advertising alone. The Internet is crawling with pages where you can list your position or find listings of physicians looking for jobs. Plus, many physicians prefer to be contacted via e-mail because they can read and respond to your message when it’s convenient for them. and any open HHS investigations 4. List of complaints received related to HIPAA, and any open HHS investigations 5. Documentation of current cyber liability insurance Buyers should consider that reoccurring HIPAA compliance issues found at health care organizations include failure to manage identified cybersecurity risk and insider threats, lack of encryption, lack of appropriate access controls, lack of mobile device controls, improper disposal of PHI, insufficient data backup and contingency planning. Entities also fail to obtain requisite business associate agreements, conduct risk analyses, ensure information transmission security, conduct appropriate auditing and patch their software. These failures, if investigated by HHS, State Attorneys General or the DOJ, would be a real eye opener for potential buyers, maybe even “deal breakers.”
(a common health issue which can cause missed or late menstrual periods) • Being African-American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, Pacific Islander Planning ahead Knowing common diabetes risk factors and symptoms and putting a plan together to prevent or delay being diagnosed with diabetes, can reduce the chance for health complications. A plan for preventing diabetes should include a healthy diet and getting about 30 minutes of exercise on most days. “Those at risk should work with their health care provider to avoid getting diabetes,” Guerra said. “Providers can create a strategy that incorporates a nutritious diet and physical activity to keep blood sugar at normal levels.”
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Austin 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. Austin Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Austin Medical Times are considered property and are to distribute for publication and copyright purposes. Austin Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430
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