Mississippi Medical News January 2016

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Intermittent Pneumatic Compression May Reduce Cardiovascular Disease in Spinal Cord Injury Patients

ON ROUNDS

Possible New Treatment Breakthrough for Cardiovascular Disease Prevention

PHYSICIAN SPOTLIGHT PAGE 2

Pamela Tuli,

A Clearer Picture: Imaging Rhodopsin Could Shed Light on Retinal Disorders A collaborative effort between Bascom Palmer Eye Institute and Florida International University (FIU) has resulted in what the team of biomedical engineers and physician-scientists believe to be a true breakthrough in retinal imaging ... 3

By CHRISTOPHER CUSSAT

HATTIESBURG – A University of Southern Mississippi (USM) study was recently conducted to determine if new therapies could reduce the risk of cardiovascular disease in patients with spinal cord injury.

According to Daniel Credeur, PhD, assistant professor in USM’s School of Kinesiology and the study’s coprincipal investigator, people living with spinal cord injury (SCI) are twice as likely to develop and die from cardiovascular complications, compared to able-bodied individuals. “We believe this is largely driven by extreme physical inactivity due to paralysis following their injury. Any activity or stimulus which increases blood flow, such as muscle contractions, will have a positive impact on the body.”

Credeur explained that prior to the past half-century, SCI patients experienced a drastically shortened life-span.

Today, due to medical advances, the life expectancy of this

Dr. Daniel Credeur of the Southern Miss School of Kinesiology, conducts intermittent pneumatic compression (IPC) on spinal cord injury patient Chris Williams.

(CONTINUED ON PAGE 8)

Children with Special Needs Have a Guiding and Caring Light in Central Mississippi Making a Difference in the Lives of Hundreds of Children Healthcare Social Workers are an Integral Part of Patient Care

NMMC’s Tobie Gillean Named 2015 Health Care Social Worker of the Year TUPELO – The Mississippi Society for Social Work Leadership in Health Care recently named Tobie Gillean, LCSW, CCM, Health Care Social Worker of the Year for 2015 ... 5

By CHRISTOPHER CUSSAT

JACKSON – Central Mississippi is blessed with a beacon of light and hope for special needs children and their families.

Since January 2006, The Little Light House - Central Mississippi (TLLH) has been helping children with special needs by providing support and resource for them and their families. Providing tuition-free educational and therapeutic services for children with special needs from birth to age six, TLLH students come from a variety of religious and ethnic backgrounds and have been diagnosed with developmental delays, resulting from physically and mentally challenging conditions. Their disabilities include cerebral palsy, Down syndrome, hydrocephaly, autism and a range of other disorders.

This tradition of academic and therapeutic outreach was first initiated more than four decades ago by the original TLLH location in Tulsa, Okla. It was founded on October 3, 1972 by Marcia Mitchell when she was unable to find early childhood education (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Career in Oncology Holds Rewarding Surprises Gulfport Physician Appreciates Patients’ Perspectives on Life

By LUCY SCHULTZE

MISSISSIPPI GULF COAST – Pamela Tuli, MD, pursued a double major in art and biology in college. She was fascinated by the work of art that is the human body and charmed by the visual appeal of slides under the microscope.

But beyond the academic interests that ultimately led her into oncology and hematology, she has been delightfully surprised by the richness of her chosen field.

“I feel lucky, because I didn’t realize how rewarding oncology is,” said Tuli, who serves on the staff of Memorial Cancer Center in Gulfport.

“You get to know your patients in a way you don’t in any other field of medicine,” she said. “We see our patients so often, and we get to know the entire family as well. We end up having a very intimate relationship with our patients. It’s a nice aspect of oncology that I wasn’t necessarily planning for when I chose this field.”

A native of Pennsylvania, Tuli completed her undergraduate studies at Seton

Hill College before studying medicine at Temple University in Philadelphia.

She then joined the U.S. Air Force for a term of service, beginning with a twoyear general internal medicine residency

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at Lackland Air Force Base in San Antonio, Texas. She completed a fellowship in hematology and oncology through a combined U.S. Army-Air Force program, followed by additional training in bone marrow transplantation.

“I got involved with the Air Force because of the stipend it offered on top of the low salary that residents receive,” Tuli explained. “It turned out to be a great thing.

I loved my time in the Air Force.”

During her eight years of service, Tuli completed two deployments to Qatar in 2002 and 2008. Her husband, Raj, a radiologist, was on active duty in the U.S. Air Force at the same time and also completed a deployment to Iraq.

Based at Lackland from 2003 to 2007, the couple had planned to complete their military service in San Antonio and then return to the Northeast. Instead, Tuli was reassigned to Keesler Air Force Base in hematology-oncology, among specialists charged with restarting its residency programs in the wake of Hurricane Katrina. Her term of service with the military ended in 2009, and she joined Memorial.

Her husband now practices with the VA Gulf Coast Veterans Health Care System in Biloxi. They live in Ocean Springs.

“When we got to the Gulf Coast, we loved it here,” Tuli said. “We love the warm weather and the southern hospitality – both of which are very different from where we come from in Pennsylvania.

“I also enjoy the opportunity to practice in a midsize hospital that has quality physicians and state-of-the-art equipment.

It’s a level of medicine I enjoy practicing – rather than at a large academic center or a small community hospital. Plus, we get to enjoy the small-town environment of living in Ocean Springs.”

At Memorial, Tuli is part of a group of six medical oncologists, each of whom cares for all types of malignancies and noncancerous hematologic problems. The group primarily works from Memorial Cancer Center in Gulfport, but also sees patients at Garden Park Medical Center in Gulfport and Merit Health Biloxi (Biloxi Regional Medical Center).

While Tuli maintains a broad practice in oncology and hematology, she has a particular interest in treating blood cancers and malignancies, including lymphomas and leukemias.

“Oncology is rapidly growing in the knowledge and tools we have to fight

cancer,” Tuli said. She recalled how just 15 years ago, diagnosing a patient with chronic myelogenous leukemia (CML) meant a likely death sentence.

“When I was in training, that was pretty much a uniformly fatal leukemia unless you had a bone marrow transplant,” she said. “But then we had the introduction of Gleevec® as our first targeted or ‘smart’ therapy. It’s kind of like a silver bullet, in that it blocks a very specific mechanism, causing remission. Now, over 90 percent of people with that leukemia are cured, and this drug is very well tolerated.

“I think we’re going to be seeing more and more developments like this as time goes on.”

Tuli looks forward to seeing how the development of new drugs will continue to transform her practice in oncology.

“The most exciting things are the new drugs that allow the immune system itself to act against the cancer,” she said. “The new targeted therapies have a better effect on the tumor, but cause fewer side effects for patients. So in the near future, we’ll see a lot more cancers becoming chronic diseases or curable with less side effects.

It’s a very exciting time to be in this field.”

For Tuli, the rewards of oncology also come through lessons learned through interactions with patients.

“A great benefit is the way oncology changes your perspective on life,” she said. “You come to appreciate, in a way you might not otherwise, how things can change very quickly – how you never know whether you’re going to be here a year from now or five years from now.

It affects what you think is important, in terms of what you have to worry about.

I think that’s a gift we’re given when we work in this field.”

In her off-hours, Tuli has redefined her long-held love of art by focusing on the living masterpieces currently climbing her front-porch columns and picket fences: she maintains a collection of climbing roses and some 40 traditional roses growing outside her home in Ocean Springs.

“Gardening is my art now,” she said.

“The roses are like this living art you’re constantly reshaping and reforming.”

She and her husband have one son still at home, 12-year-old Sam. Her older son, Adam Hopkins, is a college graduate now living and working in California.

Learn more at GranthamPoole.com Grantham, Poole, Randall, Reitano, Arrington, & Cunningham, PLLC 1062 Highland Colony Pkwy, Suite 201, Ridgeland, MS 39157 | P 601.499.2400

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A Clearer Picture: Imaging Rhodopsin Could Shed Light on Retinal Disorders

By CINDy SANDERS

A collaborative effort between Bascom Palmer Eye Institute and Florida International University (FIU) has resulted in what the team of biomedical engineers and physician-scientists believe to be a true breakthrough in retinal imaging.

Building on the foundation of traditional optical coherence tomography (OCT), the group created technology to image the light-sensitive receptor protein rhodopsin. Three years of hard work recently culminated in the successful test of the first technology based on visible-light optical coherence tomography (VISOCT).

Shuliang Jiao, PhD, an associate professor of biomedical engineering at FIU who led the project, said OCT is an established imaging technique that has been used extensively in clinical settings and allows ophthalmologists to map and measure layers of the retina.

Yet, OCT on its Dr. Shuliang Jiao own has limits to the information it can yield.

Byron Lam, MD, and Rong Wen, MD, PhD, both professors of ophthalmology at Bascom Palmer and key members of the research team, said OCT is very good at un- Dr. Byron Lam covering the anatomy of the retina but cannot tell whether a cell is functional or not.

Assessing Functionality Wen explained the photoreceptors in the retina that convert light signals to the neuronal signals degenerate at rates that vary by patient and condition. Currently one of the most common ways to assess the extent of vision loss is to simply ask a patient ‘what’ and ‘how well’ they see.

As Wen pointed out, it’s a reasonable test but also a subjective one. “We wanted

to come up with an objective way to tell if the photoreceptors are functional,” he said.

To assess functionality, the research team focused on rhodopsin, also known as visual purple, Dr. Rong Wen which converts light into electrical signals and is exclusively found in the photoreceptors of the retina. Wen explained rhodopsin has two states – dark adapted and light adapted.

“Rhodopsin will flip a switch after it absorbs a photon, and that flip of the switch starts a process called phototransduction that will send out a signal to the brain. In that flip of the switch,” he continued, “rhodopsin’s optical absorption spectrum changes.”

Lam added, “It’s really the first step of how we see. It’s the cornerstone of the visual process.”

It’s also measurable. Lam explained that by quantifying the efficiency of photon absorption, it should be feasible to assess the functionality of rod photoreceptors in the retina. By calculating the difference between the two states of rhodopsin – light adapted and dark adapted – the theory was that the research team should be able to accurately determine the amount of rhodopsin in the retina … thus providing an objective answer to the question of visual acuity.

“When you want to detect rhodopsin, you want to use the wavelengths at the peak of the absorption spectrum,” Wen continued. “That particular wavelength for rhodopsin is around 500 nanometers.

We actually used 520 nm.”

Noting that visible light isn’t easy to handle, Wen explained conventional OCT uses the much longer wavelength near-infrared light, whereas VIS-OCT employs green light.

Jiao added that in order to see the difference in dark-adapted absorption and light-adapted absorption, it was imperative to have both resolution and contrast, which necessitates the use of shorter

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wavelengths in the visible spectrum. “The intensity of the reflection from photoreceptors is affected by the bleaching state of rhodopsin,” he noted.

will become reality in the near future,” Wen said. “When that time comes, this technology will be used to see whether the new photoreceptors are functional.”

Crunching the Numbers Obtaining an objective measure of rhodopsin is the first step in being able to improve diagnostics and treatment of retinal disease, Lam said. “The important clinical implication is that it can give you a gauge of how the photoreceptors are functioning,” he noted.

That, in turn, could give ophthalmologists a new diagnostic tool and a baseline number to assess how disease is progressing and to evaluate therapeutic effectiveness. “It also gives you a topographical map so you also know the specific areas where rhodopsin is functioning … or not,” Lam added.

Wen, a photoreceptor cell biologist, also believes VIS-OCT could be useful to study future photoreceptor regeneration, including transplant stem cell-derived photoreceptors, gene therapies and neuroprotection therapies.

“The rapid development in regenerative medicine to restore vision has raised a hope that regeneration of photoreceptors and restoration of photoreceptor function

Moving from Bench to Bedside

While this first successful test was conducted in vivo on rats, Lam said it should be relatively easy to transition the imaging technique to humans. Wen stressed VISOCT is “absolutely non-invasive” and that the ultimate goal is to make the test office-based and widely accessible.

To conduct the study, the research team designed and built a 3D retinal densitometry system. Jiao said he is currently modifying the design a bit to improve the prototype and make the system easier to use in a clinical setting.

While there is still a long way to go … and no one could commit to an exact timeframe … Wen said it was feasible this technology could be available within the next five years.

For those tasked with diagnosing and treating a range of conditions from retinitis pigmentosa to age-related macular degeneration, any new technology that could more accurately assess a patient’s condition should be a welcome addition to the toolkit.

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Obesity Worsens Lung Function in Young Adults with Asthma

Washington University Study Chronicled Asthmatic Patients from Elementary Age to Post College function as they age,” said thought participants with more asthma Strunk. “We want to emsymptoms might exercise less and thereST. LOUIS, MO. – A new phasize that doctors and pafore gain more weight. “Or that those who study following nearly 800 asthtients need to pay attention to gained weight were the sickest and took matic patients over 15 years weight.” more steroid medication,” he said. “Neishows the progression toward Strunk noted it’s encourther symptoms nor steroids were related to worse lung function in those who aging that obese young adults the changes in lung function … and thus on become obese as they age. in the study don’t report gaining weight.”

None of the participants worse asthma symptoms.

Trial patients were enrolled in CAMP, of the Washington University “But it’s worrisome a nationwide study originally designed to School of Medicine study were that their lung function has determine best practices in treating asthobese at the beginning of the reclearly gotten worse,” he matic pediatric patients. In 2000, the study search project (ages 5-12), yet 25 quickly added. produced a landmark paper in The New percent were obese by the end of The CAMP (Childhood England Journal of Medicine that altered the the study (early twenties).

Asthma Management Prostandard of care for children with asthma Researchers reported that gram) research group has when it demonstrated that a regular medipediatric asthma patients who published more than 150 cation routine was superior to as-needed had become obese by their early articles on the study results, asthma treatments. twenties had measurably worse with many publications fo“That paper launched a whole new lung function than those with cusing on the genetics of approach to childhood asthma manageasthma who didn’t become obese asthma and/or clinical outment, changing the guidelines for phyby the end of the study. comes. sicians treating those patients,” Strunk Surprisingly, both groups “We’re now working on pointed out. “We were fortunate to be able showed no difference in the se- Dr. Robert C. Strunk treats patients at St. Louis Children’s Hospital in St. Louis, Mo determining characteristics of to continue following this group of children verity of their asthma symptoms. the children when they were all the way to their mid-twenties. Nobody “In extreme situations in school age that were associhad been able to do that before. We could collect data to examine this possibility in adults (morbid obesity), the chest wall is ated with the onset of smoking cigarettes,” answer a lot of questions with data gathour study population, but the obstruction so thick that it interferes with movement he said. “In spite of our best efforts and ered over such a long period of time.” in those who became obese is likely to be and there are decreases in lung function on their asthma, yes, some 20 to 25 percent Because CAMP study patients were related to some type of increased inflamthat basis,” explained Robert C. Strunk, were smokers.” only their twenties, they weren’t old mation related to the fat tissue.”

MD, a pediatrics professor at WashingStrunk noticed no difference in outenough to have developed COPD. “Good Study findings differ from research in ton University, who treats patients at St. comes by gender. “Young men and women studies show that childhood asthma is older obese patients with asthma, who have Louis Children’s Hospital in St. Louis, Mo. gained weight and had decreased lung a clear risk factor the development of more difficulty controlling their symptoms “This is a different kind of abnormality (a function,” he said.

COPD,” he said. and as a result, need more medications. restriction because of the interference with When asked about indications Research from the Washington Univer“Our study suggests that younger movement) than we found, which was obwhether asthma symptoms had any efsity study was published in a 2015 edition of obese patients can expect worsening lung struction due to the airways being more fect on gaining weight, Strunk said many The Journal of Allergy and Clinical Immunology. narrow and nothing to do with the chest wall. Others have shown in adults with asthma and obesity (and the same obstruccontinued from page 1 tion we found) that there’s likely to be some for her young special needs daughter. Even who work with TLLH’s TLLH sponsors three major fundraising connection between the airways being narthough it’s closely affiliated with this foundchildren as part of their events annually: The Garden Party, Tees row and molecules that come from fat tising branch, TLLH-Central Mississippi is coursework and experienfor Tots golf tournament, and Laps for sue and cause inflammation. We didn’t financially and operationally independent. tial studies. Hollingsworth Little Ones fun run and walk.

When TLLH first opened its doors at noted she’d like to furThe truly good and inspiring work Briarwood Presbyterian Church in Jackson, ther expand relationships being done every day by the caring profesit had one classroom, six students, six emwithin the local healthcare sionals and volunteers of TLLH is someployees (including three therapists) and a few community. thing that Hollingsworth said you must see Faye volunteers. Today, TLLH has 14 employBecause TLLH has Hollingsworth for yourself with a visit. “You’ll leave with ees and more volunteers dedicated to work long realized that families a warm heart and a smile on your face,” closely with nearly three dozen special needs with special needs children already incur a she promised. students. Through the assistance of TLLH, mountain of medical debt, it’s a major reamany students have learned to walk, read, son why it has always been a tuition-free recite numbers and overcome major barrifacility. A 501 (c) 3 non-profit, it doesn’t Save-the-Dates ers to eating. Some have transitioned into receive state or federal funding. The or2016 Upcoming Fundraising preschools for typically developing children. ganization has long held onto the goal of Events for The Little Light According to Faye Hollingsworth, exnever taking on debt; in fact, it’s debt free.

House: ecutive director of TLLH, “we’re a Chris“That’s why we’re so very appreciative of March 5: The Garden Party will tian developmental center providing highly every donation, regardless of the amount,” include a guest speaker, appetizers, specialized educational and therapeutic said Hollingsworth.

To date, gifts rangThe American Lung Association is leading and a raffle for approximately 40 services in a Christ-centered environment ing from $10 to tens of thousands of dolthe fight against the deadliest cancer there differently themed baskets. to children with special needs.” lars have made TLLH possible. “We have is—lung cancer.

Within the local medical community, weekly and monthly individual donors, May 11: Tees for Tots, an allJoin the fight by giving a gift to the TLLH has made close connections with as well as businesses small and large that day golf tournament including lunch, American Lung Association today.

Batson Children’s Hospital in Jackson and support our fundraisers and give either snacks and awards. TLLH students has students from the University of Mismonthly or yearly. We’ve also received will have an opportunity to meet the sissippi Medical Center (UMMC), Hinds several different grants,” she added. golfers.

Community College and Mississippi College To assist with its fundraising goals,

By LYNNE JETER

Children with Special Needs,

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Healthcare Social Workers are an Integral Part of Patient Care

NMMC’s Tobie Gillean Named 2015 Health Care Social Worker of the Year

By CHRISTOPHER CUSSAT

TUPELO – The Mississippi Society for Social Work Leadership in Health Care recently named Tobie Gillean, LCSW, CCM, Health Care Social Worker of the Year for 2015.

Gillean serves as director of North Mississippi Medical Center’s (NMMC) Rehabilitation Institute and the NMMC Skilled Nursing Facility in Tupelo. Her professional résumé is not only impressive, but it also illustrates the impetus behind her award. As a licensed clinical social worker and certified case manager, Gillean also leads and serves on several hospital committees—including the Rehabilitation Process Improvement Team, Rehabilitation Institute Advisory Board, Skilled Nursing Facility Quality Review Board, and Post Acute & Rehabilitation Services leadership teams. She oversees social worker continuing education at NMMC and for three years has

Tobie Gillean (left), Health Care Social Worker of the Year, is congratulated by Angie Everett, NMMC administrator for NMMC Post Acute & Rehabilitation Services.

served as program chair for the Northeast Mississippi Program Unit for the National Association of Social Workers. In addition, Gillean serves on the board for the Mississippi Society for Social Work Leadership in Health Care.

The Tupelo resident earned her social work degree in 1994 from Mississippi

State University, master’s degree in social work in 2004 from the University of Southern Mississippi, and complete certification as a LCSW in 2006.

Her first indication that she might be interested in social work as a profession happened during high school, when Gillean’s grandmother was admitted to the hospital.

“Seeing the interaction of so many caregivers to provide the best possible care was a blessing. It was then that I knew I wanted to be in some sort of helping/caregiver profession.” Later, in college, Gillean was inspired by visiting class speakers who discussed their professions. “One group of speakers included medical social workers. Their stories of the diverse population served and the ability to provide assistance

(both tangible and supportive) was very inspiring; it was then that I chose to pursue the profession.” About five years later, Gillean completed an internship at NMMC. “Having hands-on experience with patients, families and the system as a whole, I knew that was my area of focus.”

Gillean explained that social work is an important aspect of total healthcare for individuals because social workers are able to provide so many services to patients all throughout the healthcare system. “We’re able to link people with resources they need to assist in their care, as well as provide a connection between the caregivers and the team.” She noted that healthcare providers are more focused on managing the medical issues of the patient. “While the social worker can assist in helping patients maintain their health through linkage to resources needed, (one may also provide) emotional support and being an advocate for their needs.”

Angie F. Everett, LCSW, CCM, service line administrator at NMMC Post Acute & Rehabilitation Services and a colleague of Gillean’s also agreed that social work is a vital cog in the healthcare wheel.

(CONTINUED ON PAGE 8)

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Evidence-based Design: Marrying Form & Function on the Front Line

By CINDY SANDERS

When is a painting much more than just a pretty picture?

When it promotes health and healing.

Designers and healthcare industry leaders from around the nation recently gathered in Washington, D.C. for the annual Healthcare Design Conference. Convened by The Center for Health Design (CHD) and Healthcare Design Magazine, the four-day meeting and exposition unveiled the latest in evidence-based strategies and products.

Rosalyn Cama, president and CEO of Connecticut-based health design firm CAMA, Inc. and the immediate past chair of CHD summed up the conference experience as ‘awesome.’

“It’s rich in attendance with folks who are well-versed in the business of healthcare … not Rosalyn Cama only how you design it, but how to build it and then manage it and sustain it over time,” Cama said of the multidisciplinary professionals in attendance.

No doubt the event also held special

significance to Cama this year as she was presented with the Russ Coile Lifetime Achievement Award. Cama, who has served as CHD board chair for 14 years, was also named chair emeritus of the organization, which is dedicated to bringing together a community of designers, architects, executives, manufacturers and students to improve quality of care and outcomes through evidence-based design principles.

With dozens of educational tracks, facility tours, and keynote presentations, Cama said the conference covered a broad spectrum of topics and provided insights for veteran designers, as well as those newer to the field. “Because this is a research conference, they are revealing new data,” she noted. “You can’t think that what you heard five years ago is how you are going to operate. Demographics change, culture changes, operational models change. You have to stay current.”

One major change, she continued, is how technology is integrated into care and the built environment. “Technology is forcing us to change dramatically.

It affects how care is delivered and how patients move through space and the system.”

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While technology dominated many conversations on the acute side of the equation, Cama said, “On the ambulatory side, we heard a lot about patient experience – how to know your customers, deliver a more meaningful experience, and then measure it.” Additionally, she noted there were an increasing number of conversations centered on health and wellness and moving care from the hospital into the community.

Nature equals Nurture Roger Ulrich, PhD, is often credited as the pioneering researcher whose work transformed how nature is viewed within the healthcare setting. Cama noted a landmark study Ulrich performed more than two decades ago underscored the difference in outcomes between patients whose rooms had a view of a brick wall compared to those who saw a stand of trees. In the study, patients recovering from abdominal surgery with a view of nature required less pain medication, had fewer complications, and were discharged from the hospital earlier than their counterparts viewing the brick wall.

The study, Cama continued, caused healthcare designers to really consider how to create environments that speak to the human condition … particularly when that condition is in a fragile and vulnerable state. “Looking at a wall of technical outlets is not a calming view,” she pointed out.

However, Cama was quick to add that same clinical equipment is critical to quality care. Therefore, the task of the designer is to place technology in a way that is easily accessible to clinicians while preventing it from being the focal point for patients and families so as to lower their stress levels.

She said there are a number of ways to bring nature indoors – from rooftop gardens and water features to rooms with a view and artificial illumination that simulates natural lighting. Cama also pointed out these features aren’t just for the benefit of patients but also speak to the needs of families and healthcare staff.

A Hint of Hospitality While much has been made of the hospitality industry’s influence on healthcare, Cama cautioned that it should only go so far. “It can look inviting and beautiful if that’s how one interprets ‘hospitality.’ But it can’t be fussy, and it has to be clean,” she stressed of healthcare design.

Cama added products have evolved over time to give healthcare designers many beautiful options that marry the twin needs of form and function. “The manufacturing industry has grown up with us. Now there are so many more choices that have been engineered for this setting. Our kit of parts is much broader,” she said.

Cama noted one of the highlights of

the conference is that it introduces attendees to new and improved products each year. Cama said there is now a luxury flooring product that truly has the look of hardwood. “I’ll look at real wood now and say, ‘Is that vinyl?’” she laughed.

This year, the designer was actually one of the exhibitors, as well. The IOA Cama Bed Chair debuted at the 2015 meeting. Although designed for use in any number of care settings, Cama said the idea really emerged out of conversations and requests from worried parents.

Her firm does a lot of design for pediatric hospitals. For nearly 20 years, she has heard parents say they wished they could just crawl in the hospital bed with their children to comfort them at night.

Since that option is neither safe nor feasible with children who might be hooked up to monitors, Cama came up with a stylish alternative – a chair that rises and reclines. At night, a parent can stretch out at equal height to the hospital bed and easily touch and comfort their child without disturbing critical equipment.

“The research around the power of touch, is compelling” Cama added, pointing to the work of Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami. Since the design conference, the Cama Bed Chair won the BOY (Best of Year) award in the Healthcare Furniture Category.

In the inpatient setting, Cama noted that increasing attention is being focused on the ‘time between’ seeing clinicians, going for tests, or waiting for a loved one to come out of surgery. “There are long bits of time where you’re waiting. Where do we allow people to relax and be nourished?” she questioned.

Whether it’s by creating a chair, designing a curated program, incorporating a healing garden or botanical walk, or employing the power of local art to trigger pleasant memories, designers around the country are focused on enhancing outcomes by improving the outlook, even for a little while.

Cama concluded, “If you can get a family member or patient to pause and just forget for one second, then that’s pretty awesome … and you can do that through design. At Cama, we strive to design a better life indoors where you can thrive and flourish. We are seeking to design interiors that improve our health and wellbeing while supporting our constantly evolving lives.”

Mark Your Calendar The next Healthcare Design Conference is scheduled for Nov. 12-15, 2016 in Houston, Texas. For more information, go online to healthdesign.org.

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Wellness Programs Beginning to Pay Off

By DINESH SHETH

Current wellness programs have two primary, interrelated goals: to save employers’ money and to keep employees and their families healthy. These programs have matured over time and are very similar to each other.

For employers, having something in place is better than having nothing. While today’s programs have made some progress in terms of participation, there is still an opportunity to increase employee engagement and improve the overall results. Wellness programs focus on early detection through testing for medical conditions, as well as behavioral changes to improve health. To change behaviors, promote healthier lifestyles and facilitate more effective management of medical conditions, we need to change the existing wellness model from one of open-ended occasional contact with a wellness coordinator to a closed-loop feedback system that hinges on constant collaborative feedback and ongoing remote monitoring between employees and their families. The resulting ROI from this new approach to wellness programs would be an order of magnitude better than current levels, which are hovering between $1 and $3 for every dollar invested (depending on who you ask).

Right now, wellness programs have a

limited ROI because they tend to attract highest participation from the healthiest people. These individuals, who already display plenty of motivation, are not attracted by the incentives provided by employers.

They surely enjoy the benefits, but these rewards aren’t the drivers of their healthy life style and compliance with treatment protocols. Instead, the healthy people continue their healthy habits, while those who could benefit the most often abandon the wellness programs within a few weeks or months. Rather than focus on just the total number of employees participating in wellness programs, employers could look at the needs of various sub-groups of participants within the program. There is no shortage of data on current epidemics like high blood pressure, diabetes and obesity in each employee pool. To identify the employees who have the most critical needs, wellness programs need to function as a closed-loop process control system that generates constant feedback, resulting in desired behavioral change. In this system, a program would collect weight, caloric intake, activities, blood sugar or blood pressure levels from employees and their families, process the information and provide practical and usable directions on how best to remedy or address any issues.

Ongoing monitoring and communication are important features that are lacking in the majority of today’s wellness programs,

which instead tend to be somewhat reactive in nature. Studies suggest that having a voice in their ear that is proactively providing advice will lead to behavioral changes much faster and provide the ROI that is noticeably absent in existing programs.

A coach-driven wellness program is proven to be more effective than any other model, but for most employers, this immediately raises concerns about the cost of providing a dietician and dayto-day coach for each employee. This is where new technologies with remote monitoring and self-service are positioned to have the greatest impact, as systems exist that can cost-effectively monitor employees on a large scale, enabling employers to identify the employees who have the highest need for active participation with healthcare providers using both virtual and live coaches. This is essentially a targeted-coaching approach where each person gets ongoing assistance from a virtual coach on daily basis, with referrals to health professionals as need. Such an approach will maximize the effectiveness of wellness programs.

The majority of employers in the U.S. provide some type of wellness program, but they do not do enough. They are supposed to provide feedback and guidance to change lifestyles to make employees and their families healthy, but they lack

the crucial elements of collaboration and consistency in providing ongoing chronic condition management and healthy lifestyle development.

Time and again, we have heard doctors say that they have patients who they see once or twice a year and that these patients do not follow their suggestions on the little things that, over time, could have significant impact on their health.

This turns a preventable condition into an unfortunate diagnosis that costs more time and money in the long run. Employees and their families have good intentions to take the advice, but they fail to keep up with the plan. Employers must use the tools that many physicians have now begun to accept for ongoing collaboration with patients and monitor them continuously.

The results will be healthier employees and their families, better compliance with healthcare protocols, higher engagement, reduced healthcare costs and thus an increased ROI from a stronger wellness program.

Dinesh Sheth is founder and CEO of Green Circle Health, a medical services technology platform provider. Sheth oversees the development and deployment of the company’s patent-pending patientto-provider communications gateway, the GCH Platform, which enables the real-time exchange of patient vitals and health records among physicians, patients, and insurers.

www.bcbsms.com Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

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Intermittent Pneumatic Compression (IPC), continued from page 1 population has dramatically improved.

“However, as a result of lifestyle factors, particularly physical inactivity, a number of pathological complications develop, many of which occur rapidly following injury,” he said.

Within the context of this study, Credeur noted that most importantly, cardiovascular disease has emerged as a primary cause of death in SCI; meanwhile, obesity, metabolic syndrome and diabetes have also been reported to be elevated in this population, compared to able-bodied individuals.

Current therapies involving electrical stimulation applied to the paralyzed legs of people with SCI have consistently shown to provide positive adaptations following treatment, including decreased fatmass and a lowered risk for cardiovascular disease. However, this technology can be expensive, and isn’t widely available outside the clinical setting. “Our research laboratory (team) in USM’s School of Kinesiology is interested in studying novel therapies to increase blood flow through the body,” he said. “We’re currently in-

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vestigating a treatment that involves inflation and deflation of a blood pressure cuff placed around a limb, called intermittent pneumatic compression, or IPC for short.”

Using Doppler-ultrasound, investigators were able to examine the function of peripheral arteries, and also measure blood flow through a limb.

Preliminary evidence from the IPC study demonstrated that leg blood flow increases by about 50 percent within the first 15 minutes of treatment. “Furthermore, we’re finding that just one hour of this therapy seems to improve leg artery function – approximately a 10 percent increase on average – in a majority of the participants studied,” noted Credeur. This was at first somewhat surprising, since a previous study examining IPC in able-bodied people found that an hour of therapy was insufficient to significantly improve artery function.

“However, we believe that because blood flow is already so limited in the legs of people with spinal cord injury, any stimulus that will increase it will significantly impact blood vessel function,” he added. This is important, he pointed out, because research has shown that any marginal change in artery function will have significant impact on cardiovascular risk.

The new therapy is performed an hour at a time, consisting of three inflation-to-deflation cycles per minute ap-

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plied to the calf and foot region. IPC is commonly used to treat symptoms of peripheral arterial disease and venous insufficiency, but hasn’t yet been utilized for treating vascular dysfunction in SCI patients. “We believe IPC therapy will provide a simple and economical, yet effective alternative to electrical stimulation for improving cardiovascular health outcomes in this population,” said Credeur.

This study is important because, depending on the type of spinal injury acquired, – vertebrae level and classification, complete versus incomplete injury – these individuals may be able to participate in some upper-body activities. Credeur pointed to a recent report that suggests upper-body exercise alone in SCI patients may not be sufficient enough of a stimulus to truly counter the cardiovascular and musculoskeletal deconditioning experienced by this population. “Therefore, we believe activities which stimulate blood vessels in the lower extremities, like IPC, may further enhance the benefits achieved from upper-body exercise alone in people with spinal cord injury.”

Credeur emphasized that engaging in a physically active lifestyle may be challenging for individuals with physi-

cal disabilities, or those sequestered to long periods of inactivity, such as prolonged sitting by most office workers.

He quickly added that even minimum physical movement may induce healthier outcomes. “Any activity or stimulus which increases blood flow through a limb will bring about positive adaptations, which in turn will benefit us in terms of cardiovascular health. As researchers, we can evaluate the efficacy of simple therapies, like IPC, for increasing blood flow.” This therapy isn’t designed to replace physical activity, he quickly added, but also said it may serve as a facilitator in some cases.

USM plans to expand on this research by conducting a full clinical trial investigating whether IPC could serve as stand-alone treatment or adjuvant with other therapies such as electrical stimulation, to counter cardiovascular health declines and improve overall quality of life in people living with physical disabilities.

“Moreover, our future goal is to establish a center here in south Mississippi by which the School of Kinesiology at USM can work alongside the community to translate our scientific efforts into clinical practice,” concluded Credeur.

Healthcare Social Workers, continued from page 5

“It addresses both the psychological and sociological impacts of health in concert with the biological issues related to disease, injury and medical treatment. Social work addresses the needs of patients and their families as they navigate the healthcare system to advocate for resources, education and support.”

Receiving this recognition was a very meaningful and unexpected surprise for Gillean. “To think that someone felt led to even nominate me was such a blessing. I’m very honored that I received the award and thankful to all social workers in every field.”

Everett acknowledged the recognition “means a great deal to me in that this award is a reflection of her hard work, commitment to excellence in the profession, and to the patients—as well as to her calling. Although she’s moved from a direct care social work role to a supervisory role, and now to the role of directing a program, she continues to use her skills, talents, knowledge and social work ethics to improve patient care, coach and mentor employees, bring about positive change and advocate for programs and services to improve the lives of the people we serve across the spectrum of rehabilitation services.”

According to Gillean, healthcare social work continues to excel because healthcare social workers play a vital role connecting patients to resources needed to maintain their health. She added the greatest area of opportunity where healthcare social work can be improved is in establishing services in the outpatient and clinic setting. “I don’t believe we have enough social workers in these areas to

fully understand the issues that patients and families face and to assist that population with problem identification and resource linkage.”

Gillean hopes this recognition will educate others about the positive and healing contributions that social workers provide to patients and families in need— and perhaps even inspire a new generation of social workers to dedicate themselves to the healthcare field. “We were led to this profession to help others and hopefully make a difference in the lives of others.

That’s what we do; to be recognized for that makes it such an honor.”

The following examples show how social workers assist patients daily in the healthcare field: • If patients are uninsured or have limited pharmacy benefits, social workers make sure medications are reviewed and generic brands are prescribed when appropriate.

• When patients lack transportation, social workers help arrange in-home services rather than having a patient scheduled with numerous follow-up visits that they will be unable to attend.

• If a patient has little to no family support, linkage to community resources is arranged; social workers excel in identifying needs and connecting patients and families to the resources to meet those needs.

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Findings on Fat Cell Metabolism

New Insights Could Lead to Novel Approaches to Treating Obesity, Diabetes

GUARANTEED

A recent study out of the University of California, San Diego uncovered new insights into what nutrients fat cells metabolize in order to make fatty acids.

Christian Metallo, PhD – an assistant professor of bioengineering in the Jacobs School of Engineering at UCSD and senior author of the study that was published Microscopy image depicting fat cells (or adipocytes) after differentiation. The online in the Nov. 16, cells are stained with Oil Red O, which highlights lipid or fat droplets that 2015 issue of Nature accumulate with the fat cells. The metabolic study indicated that fat cells produce Chemical Biology – said these fatty acids, in part, from essential amino acids rather than sugar only. a better understanding of how fat cells de“We quantitatively showed that this velop, change, consume and metabolize branch-chain amino acid pathway was their surrounding nutrients could help realmost equivalent to the contribution of searchers find new approaches to treating sugar or carbohydrate to fat production,” a number of diseases.

Metallo said. “We used metabolic tracers “This study highlights how specific and mass spectrometry-based metabolotissues in our bodies use particular nutrimics to track or trace the carbon in differents,” he explained. “By understanding ent nutrients to quantitatively determine fat cell metabolism at the molecular level, where it went in the adipocytes. By visuwe are laying the groundwork for further alizing the biochemistry in that way, we research to identify better drug targets for could quantify how amino acids, or protreating diabetes and obesity.” teins, contribute to fat production.”

The research team discovered that as He added, “The importance of this fat cells develop, they change the types of study is that it shows branched-chain nutrients they metabolize to produce fat amino acids are highly metabolized by and energy. In the pre-adipocyte state, normally functioning adipocytes.” A which is the precursor to fat cells, glucose working hypothesis, then, is that higher is the meal of preference to grow and accumulation of branched-chain amino make energy. However, acids occurs when there are irregularities as the cells mature into in fat cell metabolism. actual fat cells, the team While this first step toward underfound they not only mestanding how amino acids are accumutabolize simple sugars lating in the blood of those with obesity but also the more comand diabetes is important, the next step is plex branched-chain to figure out how and why the metabolic amino acids, a small set Dr. Christian pathways become impaired. “This gives of the essential amino Metallo us a pathway to understand and look at acids for humans. its function … or dysfunction … in deThe team induced pre-adipocytes to tail,” Metallo said. He added, “We have differentiate into fat cells and cultured the a couple of different lines of investigation cells in a media containing nutrients ento determine what might cause dysfuncriched with carbon-13 isoptopes, which tion of this pathway in adipose tissue in are a form of carbon atoms used as metadiabetics.” bolic tracers in cells, animals and people.

Metallo also noted that studies such By doing this, the research team could as this one are significant because they see what carbon-based nutrients the cells have the power to change the questions metabolized and what they produced at being asked. Is someone obese or diabetic different stages of the cell differentiation because they eat too much and move too process. little, because they are not burning corTheir findings are important in rectly at the cellular level, or some combishowing fat cells play a role in regulating nation of factors? “Knowing that answer the body’s levels of branched-chain amino can change treatment approaches,” he acids, which typically are elevated in indipointed out. viduals who are obese or diabetic. mississippimedicalnews

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PHOTO CREDIT: METABOLIC SYSTEMS BIOLOGY LAB AT UC SAN DIEGO.

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GrandRounds Pediatric Hospitalist Joins Women’s Hospital Dr. Viswanath “Vishwa” Gajula, assistant professor of pediatric critical care at the University of Mississippi Medical Center, is caring for seriously ill pediatric patients at the North Mississippi Medical Center Women’s Hospital.

Since January the Dr. Viswanath University of Mississippi Gajula Medical Center has been providing pediatric hospitalist services in Tupelo 24 hours daily. The pediatric hospitalist consults with pediatric patients in the Emergency Department and provides hospital care for children on the Pediatrics unit. Dr. Gajula works with pediatric hospitalist Dr. Jana Sperka.

Dr. Gajula holds a master’s degree in environmental health management at the University of Findlay in Findlay, Ohio, degrees in medicine and surgery from Gandhi Medical College and Hospital/ NTR University of Health Sciences in Hyderabad, India, and degrees in biology and physics from Sri Chaitanya University in Vijayawada, India.

A pediatric critical care fellow at Children’s Hospital of Michigan/Wayne State University School of Medicine, Dr. Gajula did his pediatric residency at Michigan State University-Kalamazoo Center for Medical Studies. His areas of specialty are hospitalist medicine, pediatric critical care and emergency care.

Experienced as a researcher and principal investigator in pediatrics, Gajula is a member of the Society of Critical Care Medicine, the American Academy of Pediatrics, the Educational Commission of Foreign Medical Graduates, the Medical Council of India and Andhra Pradesh State Medical Council of India.

St. Dominic’s Ranked No. 1 Hospital in the Jackson Metro Area According to Health Grove

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St. Dominic’s was recently ranked the No. 1 hospital in the Jackson Metro Area and No. 2 overall in Mississippi according to Health Grove, a health information site that provides in-depth comparisons of physicians, facilities, nutritional information and health conditions.

St. Dominic’s received an overall rating of 89 out of 100, with the stroke death rate below the national average at 1.23 percent per thousand and a similarly low heart attack death rate of 1.43 percent per 1,000. St. Dominic’s received an overall patient experience score of 4 out of 5, and 77 percent of patients surveyed rated the hospital a 9 or 10.

According to Health Grove, the rating is an unbiased score that incorporates expert ratings by U.S. News & World Report and Thomson Reuters as well as a quantitative rating based on Medicare data.

This data is related to patient experience, patient outcomes, staff communication and the number of cases performed for the most common procedures.

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GrandRounds Bell Awarded for Outstanding Service with Southern Pain Society A Hattiesburg Clinic physician has been awarded for outstanding service in the area of pain management. The Southern Pain Society has awarded P. Lynn Bell, DO, a physical medicine and rehabilitation provider, the President’s Distinguished Service Award.

Dr. Bell was recently elected as a member-at-large for the Southern Pain Society, a regional division of the American Pain Society that provides education and training to increase knowledge and skill of pain management professionals.

The President’s Award recognizes outstanding and dedicated service to the organization.

Bell received a bachelor’s degree in biological sciences from The University of Southern Mississippi in Hattiesburg, Miss. and his medical degree from West Virginia School of Osteopathic Medicine in Lewisburg, W.Va. He completed an internship at West Virginia School of Osteopathic Medicine in Clarksburg, W.Va. and his residency in physical medicine and rehabilitation at University of Texas Southwestern in Dallas, Texas.

He is board-certified by the American Board of Physical Medicine & Rehabilitation as well as the American Board of Independent Medical Examiners. Dr. Bell is also a member of the American Acad-

emy of Physical Medicine and Rehabilitation and the American Pain Society.

Baptist Golden Triangle Earns “Top Performer on Key Quality Measures®” Recognition from The Joint Commission Baptist Memorial Hospital-Golden Triangle has been named a Top Performer on Key Quality Measures® by the Joint Commission, one of 1,043 hospitals in the United States earning the 2014 Top Performer distinction.

The Joint Commission, the organization which accredits hospitals, recognized the hospitals for exemplary performance in using evidence-based clinical processes that are shown to improve care for certain conditions. The recognition is based on accountability measure data reported to The Joint Commission during the previous calendar year. This year’s program results are based on data that were reported for 2014. Forty-two hospitals in Mississippi submitted data, and only 10 received the Top Performer distinction.

Baptist Golden Triangle was recognized for top performance in six areas: heart attack, heart failure, pneumonia, surgical care, stroke and immunization.

This is the fourth year that Baptist Golden Triangle has been recognized as a Top Performer. The hospital was recognized in 2012, 2013 and 2014 for its perfor-

mance on accountability measure data for four areas: heart attack, heart failure, pneumonia and surgical care. The stroke and immunization accountability measures were added in 2014. Of the 1,043 Top Performer hospitals recognized this year, only 221 have achieved the distinction for the past four consecutive years, including Baptist Golden Triangle.

Hematology/Oncology Welcomes Myers Bradley Myers, CNP, recently joined Hattiesburg Clinic Hematology/Oncology as a nurse practitioner.

Myers earned his Bachelor of Science in nursing through The University of Southern Mississippi in Hattiesburg, Miss.

He received his Master of Science in nursing from Bradley Myers Mississippi University for Women in Columbus, Miss. Myers is board certified as a Family Nurse Practitioner.

Garden Park Medical Center Recognized by The Joint Commission Garden Park Medical Center (GPMC) is being recognized by The Joint Commission as a Top Performer on Key Quality Measures® for 2014, five years in a row. This achievement demonstrates

that Garden Park Medical Center’s commitment to assuring that evidence-based interventions delivered in the right way and at the right time – because it’s the right thing to do for the patients.

The Joint Commission’s Top Performer on Key Quality Measures program recognizes accredited hospitals that attain excellence in accountability measure performance. Recognition in the program is based on an aggregation of ORYX® accountability measure data reported to The Joint Commission during the previous calendar year. The data report on evidence-based interventions for heart attack, heart failure, pneumonia, surgical care, children’s asthma care, hospital-based inpatient psychiatric services, stroke, venous thromboembolism (VTE), immunization and perinatal care.

GPMC is one of 1,224 hospitals surveyed. Garden Park Medical Center is being recognized for the following four measure sets: Heart Failure, Pneumonia, Surgical Care and Perinatal Care.

The Joint Commission launched the Top Performer on Key Quality Measures program to encourage hospitals to consistently improve their performance on accountability measures by publicly recognizing those that ultimately achieve excellence in this arena. The ultimate goal is to improve the care provided to patients in all aspects addressed by these accountability measures.

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