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Volume 9 | Issue 8
Inside This Issue
August Edition 2019
Memorial Hermann Life Flight Announces New Leadership
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Demand for Specialist Physicians Driving Physician Recruitment See pg. 11
INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart..................... pg.10
E-Cigarette Use Is Climbing Among Cancer Patients and Cancer Survivors See pg. 13
he Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center is proud to announce two new leaders for the Memorial Hermann Life Flight® program. Lesley Osborn, MD, emergency medicine physician and assistant professor of emergency medicine at McGovern Medical School at UTHealth, has been named Medical Director of Life Flight, and David Meyer, MD, trauma surgeon and assistant professor of surgery at McGovern Medical School, has been named the program’s Assistant Medical Director. “We are excited to have Drs. Osborn and Meyer join the Life Flight team. Dr. Osborn’s experience and expertise in emergency medicine make her an ideal leader to carry the program forward,” said Tom Flanagan, Vice President of Trauma Service Line and System Integration for Memorial Hermann Health System. “Drs. Osborn and Meyer will help build upon Life Flight’s 40-year legacy of providing high-quality, pre-hospital care to Greater Houston and its surrounding areas.” Life Flight, the only hospital-based air ambulance service in Houston, retrieves critically ill and injured patients within a 150-mile radius of Red Duke Trauma Institute, where patients can receive life-saving care. Since the program was founded in 1976 by legendary trauma surgeon James H. “Red” Duke Jr., MD, it has flown more than 140,000 missions. Dr. Duke served as the program’s first and only medical director until his death in 2015. Dr. Osborn is Life Flight’s third medical director. In her role, she provides clinical oversight for Life Flight’s 21 flight nurses and 18 paramedics and dispatchers by developing and maintaining best practice medical protocols, reviewing patient records for appropriate application of medical
Memorial Hermann Life Flight Medical Director Dr. Lesley Osborn (left) and Life Flight Assistant Director Dr. David Meyer (right) Photo by: Memorial Hermann Health System
care and preparing for flight review. In addition, she is responsible for continuing medical education for the crews and guidance on research, quality improvement and professional development.
Houston and Southeast Texas areas.” Dr. Osborn earned her bachelor’s degree from Clemson University and her medical degree from the University of South Carolina School of Medicine. She completed her residency in emergency medicine at Palmetto Health. In 2016, she served her fellowship in emergency medical services (EMS) at the Red Duke Trauma Institute and UTHealth and became a full-time faculty member in 2017. Dr. Osborn is board certified in emergency medicine and EMS. Dr. Osborn was commissioned as a captain in the Medical Corps of the U.S. Air Force and Air National Guard in March 2018 and currently serves in this role as a member of the 169th Medical Group in McEntire, S.C. Dr. Meyer, a native of Raleigh, N.C., earned his bachelor’s and master’s degrees from East Carolina University. He earned his medical degree from The Ross University School of Medicine and completed his residency in general surgery at the University of Arizona. Dr. Meyer joined UTHealth and the Red Duke Trauma Institute in 2015 as a fellow in trauma and surgical critical
Drs. Osborn and Meyer will help build upon Life Flight’s 40-year legacy of providing high-quality, pre-hospital care to Greater Houston and its surrounding areas —Tom Flanagan “I am extremely humbled to lead one of the country’s first hospital-based air ambulance services and to be part of such a rich history and legacy, working alongside the paramedics and flight nurses,” Dr. Osborn said. “I am passionate about the role of pre-hospital care in saving lives and will continue the precedent that Dr. Duke set for delivering the highest quality care possible to our patients in the Greater
see Life Flight... page 14
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Legal Matters Azar V. Allina Health Services: Hospitals Claim (Procedural) Victory in DSH Dispute follows proper administrative procedure as this dispute continues to develop. I. Background The Allina case arose out of a longstanding clash between hospitals and CMS regarding the calculation of additional payments made to disproportionate share hospitals By Colleen M. Faddick, Jd (“DSH”) under the Medicare Program. Ryan B. Thurber, Jd At a high level, DSH payments are JD Polsinelli, PC calculated based on the sum of two ecently, the United States Supreme fractions, the first of which is known as Court issued an eagerly anticipated the Medicare or SSI fraction: Medicare/SSI Entitled Days opinion in Azar v. Allina Health Medicare Entitled Days Services, a decision with far-reaching implications both for the calculation The denominator represents the of disproportionate share payments total number of days in a year that a and provider disputes with the Centers particular hospital spent caring for for Medicare and Medicaid Services patients who are entitled to Medicare (“CMS”) over changes to CMS manual Part A. The numerator represents and policy guidance. While the the number of Medicare days for decade-long dispute between CMS and beneficiaries who are both entitled hospitals over disproportionate share to Medicare Part A and also receive calculations is far from over, the recent supplemental security income (“SSI”) payments. The larger the fraction, the Allina decision provides hospitals 1with Hou_Med_times_ad_7_2019.pdf 7/22/19 3:16 PM additional ammunition to ensure CMS higher the DSH payment a hospital
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receives. CMS and hospitals disagree as to whether Part C (Medicare Advantage) beneficiaries should be included in the Medicare fraction. Hospitals have argued that Part C beneficiaries, who tend to be better-off than traditional Medicare beneficiaries, should be excluded. CMS’ position on this issue has changed over time, but the agency’s current position is that Part C days should be included in the fraction. The practical effect of including Part C days is to reduce the Medicare fraction and, by extension, hospital DSH payments. The Allina case arose from a 2014 CMS decision to unilaterally calculate hospital DSH percentages for FY 2012 to include Part C days, posting these percentages on its website without prior notice to hospitals or the opportunity to comment. Hospitals objected to this decision and filed a lawsuit alleging that CMS violated the Social Security Act’s procedural requirements for substantive changes in policy. Though the District Court
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ruled against the hospitals, the Court of Appeals reversed that decision, and the Secretary of HHS appealed to the Supreme Court. II. Procedural Victory for Providers The Supreme Court issued a 7-1 decision, with Justice Kavanaugh not participating, in favor of the hospitals’ argument that CMS violated procedural requirements through its unilateral inclusion of Part C days without notice and comment. Although the Court did not reach the substantive issue of whether Part C days should be included in the Medicare fraction, the Court did find that CMS violated the Social Security Act’s procedural requirements for changes to a “substantive legal standard” see Legal Matters...page 14
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Remote-Controlled Drug Delivery Implant the Size Of A Grape May Help Chronic Disease Management Nanofluidic Device Delivered Controlled Doses
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eople with chronic diseases like arthritis, diabetes and heart disease may one day forego the daily regimen of pills and, instead, receive a scheduled dosage of medication through a grape-sized implant that is remotely controlled. Researchers from Houston Methodist successfully delivered continuous, predetermined dosages of two chronic disease medications using a nanochannel delivery system (nDS) that they remotely controlled using Bluetooth technology. The nDS device provides controlled release of drugs without the use of pumps, valves or a power supply for possibly up to year without a refill for some patients. This technology will be tested in space next year.
August 2019
A proof-of-concept paper recently published in Lab on a Chip (online June 25) explains how the Houston Methodist nanomedicine researchers accomplished long-term delivery of drugs for rheumatoid arthritis and high blood pressure, medications that are often administered at specific times of the day or at varying dosages based on patient needs. “We see this universal drug implant as part of the future of health care innovation. Some chronic disease drugs have the greatest benefit of delivery during overnight hours when it’s inconvenient for patients to take oral medication. This device could vastly improve their disease management and prevent them from missing doses, simply with a medical professional
Nanomedicine scientists at Houston Methodist Research Institute created a remote-controlled implantable nanochannel drug delivery system (nDS) the size of a grape.
overseeing their treatment remotely,” said Alessandro Grattoni, Ph.D., corresponding author and chair of the department of nanomedicine at Houston Methodist Research Institute. Grattoni and the Houston Methodist researchers have worked on implantable nanochannel delivery systems to regulate the delivery of a variety of therapies for medical issues ranging from HIV-prevention to cancer. As basic research progresses with the remote-controlled device, the Houston Methodist technology is planned for extreme remote communication testing
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on the International Space Station in 2020. The team hopes that one day the system will be widely available to clinicians to treat patients remotely via telemedicine. This could provide both an improvement in the patients’ quality of life and a reduction of cost to the health care system. The battery-powered implant contains a microchip that is Bluetooth enabled and relies on wireless communication. To prove the technology worked as planned, the see Implant...page 14
Houston Medical Times
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Oncology Research Fighting Fear Itself and Finding the Courage to Seek Support During Cancer By Jamie E. Terry, M.D., FACS, Texas Breast Specialists– Houston Medical Center
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ewilderment. Confusion. And perhaps most of all, fear. All of these feelings can accompany a diagnosis of cancer, one of life’s most uninvited and unwelcome challenges. But there’s also a certain kind of lonely fear. A sense that this is your challenge. That only you can fight your fight. Overcoming that isolated fear and asking for help when you need it itself is an act of courage. For some, it means showing vulnerability during a time when they want to be strong for themselves and those around them. The truth is cancer patients almost always benefit from seeking and accepting support. Following are considerations for reaching out for assistance. Open the lines of communication from the beginning.
The first step in overcoming fear is communication. Communicating with your care team and loved ones allows for honest dialogue around your fears to help you overcome them. Don’t wait to talk about how you’re feeling. Communicate early and often. It can help you better understand your diagnosis, treatment and side effects, and outcomes. Communication can positively impact your experience as a patient. Learn to accept support from those close to you. Having cancer affects you and those around you. Common concerns among patients are the fear of burdening others and asking for help. We hear patients say their family members and friends are busy, and they don’t want to interfere with their lives. The response from loved ones is almost always that they want to provide this much-needed support – whether it’s helping clean or cook meals, providing transportation to and from appointments, or listening and being a source of emotional support. Everyone has different ways
of facing their fears, but many patients and their loved ones cope best with all that cancer involves when they face it together. Find support groups and seek others with shared experiences. It’s true that every patient’s cancer journey is unique. But cancer patients also share a common and profound life experience. That’s why support groups that allow you to share with those who also have been through it are helpful. Bringing patients together to address cancer-related concerns can be cathartic, whether discussing fear of recurrence or finding a new normal during and after cancer treatment or
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other issues. The groups are often led by current or former patients and may be focused on specific cancer types. Texas Oncology provides resources on support services for patients and caregivers, as does the American Cancer Society and the National Cancer Institute. You can also talk to your cancer care team about getting connected to the right resources for you and your family. Keep in mind this kind of exchange is two-way. Seeking support from those who have experienced similar things may help you cope with your fears. In see Oncology Research...page 14
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Mental Health Unveiling Brain Circuits That Control Addiction Connections in The Brain’s Striatum Point to Possible Therapeutic Targets To Curb Addictive Behavior By Vandana Suresh
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common distress among people who are addicted is the pressing urge to acquire their substance of abuse, be it alcohol or drugs. Thus, targeting connections in the brain that coordinate compulsive behaviors could be a solution to overcoming these intense cravings. Using alcohol as addictive agents for animal models, Texas A&M researchers have recently discovered a microcircuit in a brain region called striatum that might regulate the drive towards excessive alcohol consumption. They reported their findings in the journal Neuropsychopharmacology earlier this year. The striatum is part of a larger pathway in the brain that controls voluntary movements. Nerve endings from the midbrain supply the striatum with copious doses of a neurochemical called dopamine that is a major player in addiction. Studies show that
exposure to addictive substances like alcohol can alter dopamine function and affect the normal working of this dopaminergic pathway. “Addictive substances can highjack the brain’s dopaminergic system,” said Jiayi (Ada) Lu, MD, graduate student at Texas A&M College of Medicine and primary author of the study. “If these substances are used continuously, they can increase dopamine levels in the brain high enough to cause addictive behaviors.” Specialized cells called medium spiny neurons (MSNs) make up most of the striatum. They either express the D1 or D2 type of dopamine receptors. D1 MSNs initiate goal-directed movements or behaviors via the “go” pathway whereas the D2 MSNs inhibit the same movements or behaviors via the “no-go” pathway. Hence, MSN-regulated pathways have been implicated in behaviors related to addiction.
Also, MSNs receive connections from many parts of the brain including the cortex. Much like the volume knob on a radio can change the intensity of sound but not its tone, dopamine via their receptors can turn the connection strength (or synaptic strength) between MSNs and their cortical inputs up or down to influence drinking behavior. In particular, experimentally enhancing synaptic strength between cortex and D1 MSNs increases alcohol-seeking behavior in animal models. By influencing the way dopamine is regulated in the striatum, addictive substances can also alter connection strength between cortical inputs and D1 MSNs, however, the mechanisms are unknown. Lu’s study addresses this research gap by zooming into cortical-MSN synapses that are enriched with dopamine receptors. “I hoped to dissect the cortical-MSN synapse based on dopamine receptor expression, patterns and combinations,” she said.
Using a combination of optogenetics and transgenics, she found that even in animal models that were teetotalers, synaptic strength between D2-expressing cortical inputs and D1 MSNs were naturally stronger than all other dopamine receptor-expressing cortical-MSN connections. Furthermore, in alcoholic animal models, this “D2-D1” connection was further strengthened suggesting that alcohol was influencing this circuit more than others. According to Lu, her findings have direct biological relevance in addictive behaviors: “Excessive alcohol see Mental Health...page 14
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VA Telestroke Program Improving Care for Veterans Improving Veteran Access to Emergency Stroke Care
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mergency stroke care for Veterans continues to improve thanks to the expansion of VA’s National Telestroke Program, one of the first nationwide telestroke programs in the world. The program was launched in 2017 to improve Veteran access to stroke specialists. “In just two short years, the VA National Telestroke Program has grown to provide acute stroke services in over 30 VA medical centers from coast to coast,” said Dr. Glenn Graham, VHA Deputy National Director of Neurology. “We’ve built an extraordinary team of over 20 stroke neurologists across the United States, united in their passion to improve the care of Veterans in the first hours after stroke. “We’ve developed new technological tools dedicated to the task, such as the Code Stroke mobile app, and have improved the consistency and quality of stroke care in VHA nationally.” Stroke is the fifth leading cause of death in the United States and the
leading cause of serious long-term disability. When it comes to stroke, time is brain! During a stroke, 1.9 million brain cells die every minute. Delaying treatment one-hour ages the brain 10 years. Treatment of stroke with a clot-busting drug reverses the effects of a stroke and reduces long-term disability. Having a stroke neurologist readily available to guide treatment improves outcomes for stroke patients. However, emergency access to a stroke neurologist 24/7/365 is often limited. Telestroke solves this problem by using technology to bring a stroke neurologist to a patient’s bedside anywhere in the country in seconds. In minutes, stroke victim talking to neurologist via video The VA program uses an innovative approach to providing services by using low-cost, highlyreliable commercial technology: iPads. When a patient has stroke symptoms, the telestroke neurologist initiates a FaceTime video call to the iPad at the
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patient’s bedside and has a live conver sation with the patient, caregiver, and on-site providers. The neurologist examines the patient, reviews the medical record, and guides Telestroke go-live training at the VA Medical Center treatment. In the first two years of operation, the program users worldwide. The app is designed to has conducted over 1,000 emergency be used during a stroke code to reduce consults and feedback has been time-to-treatment by providing realoverwhelmingly positive. “Specialty time information to all team members doctors, really good ones, are not able regardless of location. to be in every place at every time. We “The Code Stroke app focuses had a way to connect the doctor with on accelerating the episode of acute me when I needed it,” said one Veteran. care by organizing and managing the The program has attracted repetitive aspects of care while providing stroke neurologists from around the decision support, structured interaction country. “It’s the ability to serve Veterans between neurologist and ICU/ER staff, in a new way and to serve Veterans and automatic documentation,” said that otherwise wouldn’t get that care, William Cerniuk, Director of VA’s bringing a new service to those areas. Mobile Program. It’s been really gratifying,” said a VA Need for quick expert decision is telestroke neurologist. critical The reach of the program will “While our initial focus was on extend beyond VA with the upcoming small, rural VA medical centers with worldwide release of the Code Stroke little or no specialty care in neurology, App. The VA-developed app scheduled see Telestroke...page 13 for release this summer will be free to
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Healthy Heart Pregnant Women Can Suffer Special Health Risks Due to The Summer Heat By American Heart Association
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ouston summers can be very dangerous, especially to pregnant women who are among those most likely to become overheated. According to the Centers for Disease Control and Prevention. Pregnant women who have a body temperature above 102.2 degrees Fahrenheit are at greater risk for heatstroke, heat exhaustion and dehydration. What are the risks for expectant mothers? Symptoms of overheating include: • warm skin • headache • dizziness • muscle cramps • nausea “When you’re pregnant, your body is already working hard to keep you and your baby healthy, so adding the hard work of keeping cool can push you over the edge,” said Dr. Elizabeth Suzanne Langen, an
assistant professor at the University of Michigan’s Department of Obstetrics & Gynecology in Ann Arbor. Dehydration is one of the causes of Braxton Hicks, or so-called practice contractions, and it also can increase the incidence of dizzy spells and fainting, said Dr. Alisse Hauspurg, an OB-GYN specialist and assistant professor at the MageeWomen’s Hospital of the University of Pittsburgh. “If a pregnant woman gets dizzy and falls, that can cause more significant complications, including early labor or placental abruption, which might necessitate early delivery,” Hauspurg said. “That doesn’t mean pregnant women should avoid the outdoors,” she said. Exercising is OK when precautions are taken, like checking the weather before planning extended outside activities. Recommendations include: • stay hydrated • wear loose-fitting clothing • avoid high heat
• Avoid high humidity Dehydration is not the only risk associated with overheating: High fever or hot tub use in the first trimester has been associated with changes in the structure of the fetal heart and neural tube defects, which can result in conditions such as spina bifida. It’s not clear exactly how overheating impacts fetal development, but animal studies suggest it may cause cell death or interfere with certain proteins involved in fetal development
during the first trimester. “Having a temperature of 101 or higher and flu-like symptoms isn’t necessarily dangerous for you or your fetus, but you should be seeing your doctor,” Langen said. “Pregnant women get sicker a lot faster, so we tend to be a little more aggressive about treating fevers in pregnancy than we would a normal healthy person.” It’s always important to listen to what your body signals are trying to tell you.
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Demand for Specialist Physicians Driving Physician Recruitment Shortages Emerging in Surgery, Psychiatry, Geriatrics, Infectious Disease, and Other Specialties By Phillip Miller Merritt Hawkins
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doctors, internists ,and pediatricians) declined by 8%year-over-year and by 38%compared to four years ago. In its latest report on physician supply and demand, the Association of American Medical Colleges (AAMC) projects a shortage of up to 67,000 specialists by 2032. The report reveals that search engagements are growing in a number of medical specialties where severe shortages are anticipated. For example, a study published in Arthritis Care & Research projects that by 2030 demand for rheumatologists will exceed supply by 100%.The number of infectious disease training programs now fill fewer than half their classes, according to Singleton, while deaths due to drugresistant pathogens are predicted to rise rapidly, resulting in a looming shortage of infectious disease specialists. There are approximately 7,300 certified geriatricians in the United States
today, and the American Geriatrics Society projects 30,000 will be needed by 2030. Merritt Hawkins’ report also shows that for the fourth year in a row, psychiatry was the firm’s second most requested search, highlighting a critical shortage of psychiatrists nationwide. “The shortage of medical specialists flies under the radar, but it is a serious public health concern that deserves more attention,” Singleton said. Highest Starting Salaries Physicians practicing invasive cardiology have the highest average starting salaries tracked in Merritt Hawkins’ report at $640,000, followed by orthopedic surgeons at $536,000, gastroenterologists at $495,000, and urologists at $464,000. Family physicians are at the lower end of the physician pay scale with an average see Specialist ...page 12
RELAX
n a continuing trend, hospitals, medical groups, and other healthcare facilities are seeking more medical specialists and fewer primary care physicians, according to an annual report tracking physician starting salaries and other recruiting incentives. Prepared by Merritt Hawkins, the nation’s leading physician search firm and a company of AMN Healthcare, the 2019 Review of Physician and Advanced Practitioner Recruiting Incentives tracks a sample of 3,131 physician and advanced practitioner recruiting engagements that the firm conducted from April 1,
2018,to March 31, 2019.Now in its 26th year ,the report indicates that in the 12 months covered by the report, Merritt Hawkins has been conducting a growing number of search assignments for medical specialists while conducting fewer searches for primary care physicians relative to recent years. While demand remains strong for primary care physicians, specialists are increasingly needed to care for an older and sicker population,” said Travis Singleton, Executive Vice President of Merritt Hawkins. “In some medical specialties, shortages are emerging that will pose a serious challenge to public health.” The findings are that 78% of Merritt Hawkins’ recruiting assignments in the last year were for medical specialists, up from 67% four years ago. By contrast, the number of searches the firm conducted for primary care physicians (family
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HI St. Luke’s Health – This week, The Vintage Hospital is opening a second cardiac catheterization lab (cath lab), furthering the high-quality cardiovascular services available at the hospital. Cath labs are special rooms in the hospital for testing and treating patients with cardiovascular diseases and disorders. A cath lab has special imaging equipment used to see the arteries and check how well blood is flowing to and from the heart. This information helps the care team to diagnose and treat blockages and other problems in the arteries. “We’re thrilled to open our second cath lab and expand the number of patients we can serve in the community. Significant planning went into this project, including garnering the input of the current cath lab physicians and staff on what was needed to better care for our patients,” said Mario Garner, president, CHI St. Luke’s Health – The Vintage. “This addition solidifies our position as one of the top cardiac care hospitals in the area and we look forward to continuing to provide compassionate, high-quality cardiovascular care close to home.” The second cath lab includes state-of-the-art tools and technology to care for cardiac patients and allow cardiologists
to see more accurate and flexible imaging. The additional room increases efficiency for the hospital to schedule cases, accommodate emergency procedures and may help improve its door-to-balloon (DTB) time, which is the time elapsed from the arrival of a patient in the Emergency Department to the restoration of blood flow via angioplasty. The Vintage’s average DTB is already less than 60 minutes, which is a common goal for hospitals across the country. Interventional Cardiologist Maged Amine, MD, FACC, Assistant Professor of Interventional Cardiology at Baylor College of Medicine, has practiced at The Vintage since 2011 and is proud of the new addition. “The Vintage Hospital has excellent cardiologists, nurses, and technicians, advanced equipment, and the ability to treat all major cardiovascular diseases,” Dr. Amine said. “Building a second cardiac cath lab reflects and furthers the growth of cardiovascular services, and it speaks to the trust patients and their physicians place in our hospital.”
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Continued from page 11 starting salary of $239,000. The average signing bonus offered to physicians during this time period was $32,692, according to the report. Value-Based Payments Rise Merritt Hawkins’ report suggests that the use of value-based physician payments is gaining
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momentum. Of those Merritt Hawkins clients offering physicians a production bonus last year, 56% were based in whole, or in part, on value-based metrics such as patient satisfaction and outcome measures, up from 43% the previous year and 39% two years ago.
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E-Cigarette Use Is Climbing Among Cancer Patients and Cancer Survivors, According To A New Study By A UT Southwestern Medical Center Oncologist By Patrick McGee
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-cigarette use among people with a cancer diagnosis increased from 8.5 percent in 2014 to 10.7 percent in 2017. • The increase happened even as conventional smoking remained stable. • E-cigarette use is especially high among young cancer patients (under the age of 50). More than a quarter of them use e-cigarettes, and it keeps going up: 23 percent of cancer patients under 50 reported using e-cigarettes in 2014 compared with 27 percent in 2017. “The gradual but steady increase is quite striking,” said Dr. Sanford an Assistant Professor of Radiation Oncology and doctor who specializes in treating cancers of the gastrointestinal tract. “The high prevalence of e-cigarette use among younger cancer patients and survivors
is concerning.” Dr. Sanford’s analysis was based on data from the Centers for Disease Control and Prevention’s National Health Interview Survey, which included more than 13,000 cancer patients from 2014 to 2017. Her findings were published in the journal JAMA Oncology in February. The study findings shed new light on e-cigarette use as the products gain increased attention ranging from federal government crackdowns on e-cigarette sales to claims that e-cigarettes can be used to quit traditional smoking. Usage of e-cigarettes, also called “vaping,” has medical experts concerned because of the addictive nicotine and potentially harmful toxins they deliver. The battery-operated products produce an aerosol that users inhale into their lungs like traditional smoking.
The Role of Racial Discrimination in Alcohol Abuse
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Telestroke
Continued from page 8 it is clear that even large, urban VA hospitals can benefit from participating
cigarettes. “I don’t encourage it, but I also am honest that the jury is still out on what the long-term effects of e-cigarette use are,” she said. “These are not an FDA-regulated product. There’s wide variation of what goes into them. When you pick up an e-cig in the store, you really don’t know what’s in it.” Regulation of e-cigarettes has just begun and so have studies of the products. Dr. Sanford said medical experts need to know much more, and it will take decades to know if e-cigarettes cause cancer. “It’s a new area, and there’s just no long-term data on e-cig use so there’s going to be a lot of controversy on what to do until more rigorous studies are published, particularly given the diverse entities involved, ranging from cancer organizations to e-cigarette companies,” she said.
are different than those of non-Hispanic whites and other ethnic or racial groups. According to the NIAAA, understanding these differences can help prevention, intervention and treatment programs better serve the Hispanic community. “Latinxs who drink tend to drink more on their drinking days than whites who drink,” said Viana. “There is also evidence that Latinx men experience the highest rates of alcohol-related liver cirrhosis of all racial and
ethnic groups.” Viana and his team will study a group of 150 self-admitted Latinx drinkers and will examine whether negative experiences, such as racial discrimination, increase their anxiety and drinking patterns. “ T h e s e sociocultural experiences have been overlooked in the treatment of ethnic minorities, particularly among Latinxs,” said Viana. If his work validates his theory, it can inform the work of therapists. “When therapists are out in the community working with Latinxs who drink excessively,
it may be important for them to consider experiences such as prejudice, racial discrimination, and lack of access to services, as potential reasons for their alcohol abuse.” The ultimate goal is to raise awareness of these factors increasing risk for addiction, he said.
in the VA Telestroke Program,” said Dr. Graham. “This is really no surprise, as with the increase in stroke treatment options, the need for expert decision making at the bedside and without delay is greater than ever. I can imagine
a time when all VAs not having a resident or attending neurologists in the hospital at all times will use telestroke to fill these gaps. There is much exciting room for growth, and much important work to be done.”
Call 9-1-1 right away if you or someone you are with shows any signs of a stroke, such as the abrupt onset of weakness, numbness, vision loss, difficulty speaking or understanding, or loss of coordination. Act FAST!
UH Researcher Exploring Impact on Latinxs niversity of Houston associate professor of psychology Andres Viana has received a $900,000 Mentored Patient-Oriented Research Career Development Award from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to examine the impact of racial discrimination in moderate-to-heavy drinking adult Latinxs. Viana prefers the gender-neutral term Latinx. Research shows that drinking patterns among Latinxs
Dr. Sanford said she seized on the opportunity to study the data because there is so little known about e-cigarette use in cancer patients. “Because e-cigarettes are relatively new, we don’t have the longterm data on their side effects yet,” she said. With so little known about e-cigarettes and what they do to the body, Dr. Sanford said the best bet is to avoid them all together. She noted that e-cigarettes often produce harmful chemicals such as lead, nickel, and acetaldehyde. Conventional smoking can impede healing from surgery and radiation therapy so it is possible that e-cigarettes could cause similar difficulties, she said. Dr. Sanford said patients often ask about e-cigarettes, and she recommends staying away from all kinds of smoking instead of trying to substitute e-cigarettes for traditional
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August 2019
Houston Medical Times
Page 14
Life Flight
HOUSTON
Continued from page 1 care. He joined the UTHealth faculty in 2017. “It is a privilege to serve as the
new assistant medical director of Life Flight,” Dr. Meyer said. “I look forward to working alongside Dr. Osborn and
the many experienced, highly-skilled professionals as we provide life-saving support to Southeast Texas residents.”
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Legal Matters
Senior Designer Jamie Farquhar-Rizzo
Continued from page 3 impacting payment. Hospitals argued the unilateral inclusion of Part C days constituted such a change, while the government argued the change was a mere interpretive rule, attempting to rely on an analogy to more general Administrative Procedure Act (“APA”) provisions. The Court ultimately sided with hospitals for three primary reasons: 1. The administrative procedure requirements in the Social Security Act specifically contemplate that statements of policy (such as the 2014 calculation) can establish or change a substantive legal standard;
2. The government’s proposed interpretation would result in additional ambiguity under the Social Security Act’s procedural provisions; and 3. Congress could have simply adopted APA rulemaking requirements but chose not to do so. Although the Court sided with hospitals, it expressly declined to rule on whether the hospitals’ position on the inclusion of Part C days in DSH payment calculations is correct, leaving this issue for resolution another day - most likely through the original Allina cases. At a minimum, however,
the Allina ruling ensures two key procedural victories for providers. First, it is clear that in order for CMS to adopt a policy including Part C days in the DSH payment formula, CMS needs to go through notice and comment rulemaking. Second, Allina has provided all types of health care providers with additional ammunition to challenge CMS policy changes that impact substantive legal requirements on procedural grounds. For now, however, the ongoing dispute between CMS and hospitals over Part C days and DSH calculations will continue.
Continued from page 4 as pain or insulin implants, rely on pumping mechanisms or external ports and typically need refills every couple of months. The Houston Methodist device is implanted under the skin and uses a nanofluidic membrane made with similar technology used in the silicon
semiconductor industry. The drug dosage and schedule can be tailored to each patient, and the implant delivers the drugs for many months, even a year, before refills are needed.
Oncology Research Continued from page 5 turn, you may positively impact other patients by sharing your story. There is nothing to fear when it comes to seeking and accepting the support of others. Whether it’s through your cancer care team, loved ones, or
your local community – leaning on others can greatly enrich your cancer journey. At Texas Oncology, we work tirelessly to ensure our patients never face cancer on their own. Ensuring each patient is supported is a part of
our commitment to caring for the whole patient.
drinking.” Lu noted that D2-D1 connections may not be affected only by alcohol, and it is possible that this circuit is influenced by other addictive drugs. If so, inhibiting the D2-D1 circuit may help curtail addictive behaviors in
general. “We hope that in the future, our results on the striatal D2-D1 circuit will contribute to identifying new therapeutic targets for addiction,” she said.
Mental Health
Continued from page 6 consumption particularly affected the strongest (D2-D1) synapses which is an interesting result because it makes sense at the behavioral level,” she said. “They kind of promote the go pathway, and as a result, people with alcohol use disorder cannot really stop recurrent August 2019
Web Development Lorenzo Morales Distribution Robert Cox Accounting Liz Thachar Office: 713-885-3808 Fax: 281-316-9403 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com
Implant
microchip was programmed for three different drug release settings - standard, decreased and increased. With each setting, a specific voltage was applied to a silicon nanochannel within the implant to control drug release. Current drug delivery devices, such
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