Medical News of Arkansas November 2013

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PHYSICIAN SPOTLIGHT PAGE 3

Grant Morshedi, MD

UAMS Opens Unique Women’s Only Psychiatric Unit

By BECKy GILLETTE

ON ROUNDS

Advances in Colon Cancer Helping Prolong Lives Being a research institution, the University of Arkansas for Medical Sciences (UAMS) is doing research while it is caring for patients ... 8

When a woman has been traumatized by rape or other abuse by men, it may be more difficult to heal when placed in a mixed-sex psychiatric unit. That is the reason why the University of Arkansas for Medical Sciences (UAMS) Psychiatric Research Institute (PRI) has recently opened an innovative women’s only psychiatric unit.

“The women’s inpatient unit opened in March and it’s already shown great success,” said Jeff Clothier, MD, the interim director of the Psychiatric Research Institute. “This approach is new to Arkansas and one that we think will make a big difference in helping women not only in this state, but all over the region. We’re breaking new ground here and it’s beginning to pay off for a lot of patients.”

The thought behind it is a lot of times women have issues unique to them that are difficult to manage in a mixed unit, said Lou Ann Eads, MD, medical director of the PRI’s women’s inpatient unit and an assistant professor at the UAMS Department of (CONTINUED ON PAGE 6)

Lou Ann Eads, MD, medical director of the Psychiatric Research Institute’s women’s inpatient unit, stands beside the painting “Scarlett’s Sun Hat.” Painted by Julie Woods of Fayetteville, the painting won first place in a contest held by the Psychiatric Research Institute. More than 20 pieces submitted for the contest will be displayed on the walls of the inpatient unit.

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Mohammed Mahmoud Moursi, MD UAMS Division Chief, Vascular and Endovascular Surgery

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On a typical day, Mohammed Moursi, MD, may start his work day at 7 a.m. with a UAMS Department of Surgery morbidity and mortality conference. Then he’ll head to the OR for big cases or several smaller ones. In between cases, he’ll manage scheduling and rotating issues as the division head and program director for vascular surgery, and other issues in

his administrative role, such as working toward better efficiency in the OR. If time allows, he may have a lunch date to speak with a church or civic group about his Muslim faith to help bridge the gap of understanding between religions. At 4 p.m., he may have a 2-hour vascular conference with surgeons and residents.

He might end the day with a high-energy racquetball session with a regular group of doubles (CONTINUED ON PAGE 5) COURTESY OF UAMS/TIM TAYLOR

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PhysicianSpotlight

Grant Morshedi, MD UAMS Ophthalmologist, Cataract/Glaucoma Specialist, Assistant Professor

By LYNNE JETER

When Grant Morshedi, MD, got involved as a young medical student with the Student Sight Savers Program through UAMS Jones Eye Institute, he was smitten with ophthalmology.

Under the direction of Dr. Tom Canon, Morshedi and fellow students would conduct glaucoma screenings one Saturday a month to the underserved population in Central Arkansas.

“I found the eyes extremely fascinating and sought additional opportunities to follow up on in clinic,” said Morshedi, a cataract and glaucoma specialist and assistant professor at UAMS. “Then once I saw a single cataract surgery, I thought it had to be one of the most elegant and amazing life-changing interventions you could do for somebody.”

A native Arkansan, Morshedi spent his early childhood in Little Rock; the family moved to Conway when he was 10.

The middle of three children born to Ali, a medical technologist, and his wife, Sherry, a practice manager for a family physician clinic, Morshedi grew up around hospitals and doctor’s offices.

“I found it fascinating,” he said.

As did his siblings. His older brother, Brandon, a physical therapist, is now a fourth-year medical student. His sister, Jennifer, is a nurse practitioner. “Most medical students don’t get much exposure to ophthalmology, thought it’s a bit different now. In the last couple of years at UAMS, all third-year medical students have a full week of ophthalmology (rotation) with us in clinic, so there’s more exposure now.”

Morshedi was immersed in volunteer work even as an undergraduate at Hendrix College in Conway, where he earned a chemistry degree. For example, he traveled with a group on spring break to work on a Habitat for Humanity home in Austin, Texas.

“I learned woodworking from my dad, and love it,” he said. “The Habitat trip was a natural extension of volunteerism – and having fun with some tools.”

Ironically, he met his wife, Anna, whose hometown is the Texas capital, after the school trip.

“Volunteering from a medical and non-medical standpoint has always been important to us,” he said.

During his third year of medical school, the couple married. A year later, they were off to Salt Lake City, Utah.

“That’s where I did my residency, internship, and fellowship, and where our first child, Miles, was born,” he said, noting the nearly 1-year-old is “babbling and crawling, but not talking and walking just yet.”

“I always knew I’d be back in Arkansas,” he said. “With residency matching, medicalnewsofarkansas

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you don’t get to pick where you go, but I loved our time there, especially taking advantage of their fantastic ophthalmology residency program while also seeing new sights, enjoying the outdoors, snow skiing. It was a very nice opportunity for good training, to see how things are done elsewhere, and then return home.”

Back in Little Rock, the Morshedis bought a home and started a garden,

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while he flourished at UAMS helping Arkansans with cataracts and glaucoma.

“In the United States,” he pointed out, “cataracts have been found in older people and may affect vision and cause problems. With a 10- to 20-minute surgery, their vision can be completely restored. To this day, it’s one of the most cost-effective interventions in all of medicine. It’s also very fun for the surgeon to see very happy patients following cataract surgery.”

Worldwide, people have gone completely blind because of cataracts, Morshedi noted.

“I’ve been on international mission trips and to completely restore someone’s vision with simple cataract surgery is, without a doubt, one of the most exciting rewards in medicine,” he said. “Cataracts here may give you trouble reading or driving, but usually don’t cause complete blindness. In third world countries where someone’s completely blind, people aren’t able to work and help their family. You can change not only their vision and life, but also completely their socio-economic condition.”

Glaucoma, on the other hand, is the silent thief of sight, said Morshedi.

“It happens asymptomatically, and can creep up on you and you don’t know it until it causes irreversible blindness,” he said. “The reason I specialized in it is be-

cause I saw a need for glaucoma specialists in Arkansas, where there’s quite a bit of bad glaucoma. It happens in older people, especially African-Americans. Early diagnosis provides a chance to make a difference in people’s lives and try to prevent blindness with treatment.”

Nepal and Ghana, Morshedi said, are both densely populated areas with a high percentage of population with acute cataracts and glaucoma. “There are almost equal parts happy and sad endings,” he said.

Morshedi got a head start on research projects, working with Thomas Goodwin, PhD, a well-known organic chemistry professor at Hendrix who championed involving undergraduates in all research projects. Most of Morshedi’s research now revolves around glaucoma-related medical issues.

When he’s not on campus, Morshedi can likely be found outdoors, from puttering in the yard to camping, hiking and fishing. Otherwise, he can often be found with a musical instrument in his hands.

“It’s become a tradition that every time I graduate, my family gets me a new musical instrument,” he said, with a laugh.

“When I finished medical school, I got a guitar … then a banjo after residency and a mandolin after my fellowship. If I could play them all at once, I could be a oneman bluegrass band.”

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Intervention by Vascular Surgeons Can Help Prevent Limb Loss in Diabetics

By BECKy GILLETTE

The diabetic population is increasing, in part caused by a growing percentage of older people in America. The risk of peripheral artery disease is about 20 times more common than with non-diabetics, and diabetics have a 15 to 20 times increased chance of lower extremity amputation versus non-diabetics.

But vascular surgeons can intervene to help prevent amputations, said Mohammed Moursi, MD, division chief of the University of Arkansas for Medical Sciences (UAMS) Vascular and Endovascular Surgery. His advice to healthcare providers is once there is any slight indication of diabetic foot ulceration, refer the patient to a vascular specialist to make sure the blood flow is adequate to heal the ulceration.

“If it is not adequate, we can work to treat that so they have the right amount of blood flow,” Moursi said. “This is very important because once you amputate a limb on a patient, they may be restricted to a wheelchair and their quality of life can decline significantly. And the incidence of other complications increases.”

Diabetics are very prone to atherosclerosis of the arteries, which occurs mostly in the lower extremities.

“In addition, diabetics can develop ulcerations in their feet due to a combination of factors such as lower blood flow and neuropathy,” Moursi said. “They

can’t feel if they have an ill fitting shoe and end up developing an ulcer. It is also harder for them to resist infections.”

Healthcare providers can help prevent the problems that can lead to amputation first by making sure patients are educated about diabetic foot care. To prevent developing an ulcer, patients should not go barefoot, they should make sure the bath water is not too hot and wear well-fitting shoes. Feet should be checked regularly.

“When you have a diminished blood flow due to atherosclerosis there are different degrees and stages of the ischemia.

The first stage is claudication,” Moursi said. “It occurs when there is mild to moderate blockage in the arteries, usually in the superficial femoral arteries. It usually leads to lower blood flow in the calf muscles. So when a patient tries to walk, after some distance, they develop cramping in their calves which necessitates them to stop walking. Claudication is not usually limb threatening. You can live with it for a while.”

Rest pain is the next stage. That is where the patient has pain in the foot at rest. Usually when they elevate their leg to sleep or lay down, it is at the same level as the heart, and there is not enough blood flow in the foot, which causes pain.

“That is a limb threatening condition,” Moursi said. “Patients who have rest pain left untreated will eventually lose their leg. Then the third stage, mentioned

earlier, is foot ulcers or tissue loss.”

When a diabetic patient presents with peripheral artery disease, an ankle brachial index (ABI) is done to measure the blood pressure in their arm and in their leg just above the ankle. The ratio between the two is measured. A normal person will have an ABI of one. With a diabetic with peripheral artery disease, it will be less than one. With claudication, you would see a level of .6 or .7. With rest pain, it could be .3 or .4. With patients with tissue loss, you will see a lower ABI. “If we determine intervention is necessary, we order an arteriogram,” Moursi said. “We have a CAT scan incorporated into an arteriogram so we can see where the blockages are. Once we have identified the blockage, there is a whole set of treatment options.”

The two main options are endovascular or catheter based, which are less invasive, or open surgical options. The endovascular options involve putting a needle in the groin, and passing a wire into the arterial tree under fluoroscopic guidance.

“Once we are at the narrowing, there is a whole host of options open to us,” Moursi said. “We can blow up a balloon in the stenosis. We can put in a stent, and there are a variety of types of stents we can use. We can use a bare metal or a covered stent. If we find clots, we can put drugs right into the clots to dissolve them. Or we can use an atherectomy device, which is

a type of roto-rooter with a device on the end of a catheter that can mechanically remove plaque. We also have other options including using a laser on the plaque.”

If the patient is not amenable to endovascular repair, the surgeon can do open surgery. Open surgery can include an endarterectomy, which physically removes the plaque under direct vision.

“Other things we can do is open up the artery at the area of the narrowing, and reclose using a patch, getting the artery back to the size it was supposed to be,” Moursi said. “Another option is to bypass around the area with the blockage.

We can bypass using a patient’s own veins, veins from the side of the leg, the greater or lesser saphenous vein, or an arm vein.

We can also use synthetic conduit material, but that is not as effective.”

Moursi said if a stent is needed in the iliac artery by the pelvic area, that stent has a five-year patency of 80 percent.

As you move down the leg putting stents above or below the knee, patency is only 50 percent over a year. A vein bypass should be able to generate two-year patency of about 80 percent.

“If you can do a good bypass or put in a good stent, there is an 80 percent chance of limb salvage,” he said. “What we do is watch patients carefully. If I do a bypass, we check them in the vascular lab every six months. We look at the entire length of the graft to make sure they don’t develop some narrowing. If they do, we fix the narrowing before the entire graft occludes. You may have to go in and revise the stent or bypass at some time, but ultimately the limb salvage should be quite good with those procedures.”

Managing the diabetes well is also very important. Good glucose control has the most effect on retinopathy and nephropathy. For prevention of amputations, what helps most is smoking cessation.

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Breastfeeding: A Hospital’s Journey to Improving Rates

By TINA HEDRICK, BSN, RN, CPHIT

The benefits of breastfeeding are widely known, yet increasing the rates of mothers who breastfeed their babies remains a complex challenge. In 2011, U.S. Surgeon General Regina M. Benjamin issued a “Call to Action to Support Breastfeeding,” and the Arkansas Foundation for Medical Care (AFMC), in partnership with the Arkansas Department of Human Services (DHS) Medicaid program, began a statewide breastfeeding initiative to improve the state’s breastfeeding rates and duration. AFMC promotes breastfeeding across the state through hospital and clinic visits, offering assistance to make sure national breastfeeding recommendations are being followed. AFMC and DHS encouraged breastfeeding by providing bilingual educational materials for hospitals, clinics, practitioners and patients.

Increasing rates and duration of breastfeeding takes a hospital-wide effort and requires dedication and followthrough. One successful example is the Center for Women’s Health at North Arkansas Regional Medical Center (NARMC) in Harrison, which raised its rates of newborns given breast milk exclusively from 32 percent to 56 percent.

The Center for Women’s Health understands that efforts towards improvement require commitment, time, energy, persistence and patience. The center hired Sandra Guidry, its first International Board Certified Lactation Consultant (IBCLC), in the spring of 2011 as AFMC launched its statewide breastfeeding promotion. The staff immediately began working towards improving the hospital’s breastfeeding rates and duration, and allowed AFMC to assist in their journey. The Center for Woman’s Health has made breastfeeding a priority, and providing every woman with the knowledge, skills, and opportunity to breastfeed or provide breast milk to their infants is both a passion and a mission. The center’s current director, Dawn Brown, RN, inherited the breastfeeding initiative during the summer of 2012 and accepted the challenge of taking the program to the next level.

The process for breastfeeding improvement established at NARMC is a multi-layer approach involving hospital staff, clinic staff, practitioners, hospital administration, patients and members of the community. NARMC has implemented several practices in support of breastfeeding, including a comprehensive written breastfeeding policy; immediate skin-toskin contact for all healthy newborns for a minimum of one hour with reflective documentation (implementation of this practice proved to be a true game changer); complete rooming in for all healthy newborns, with all infant care provided in the mother’s room; and discontinuing formula discharge bags for all patients. In addimedicalnewsofarkansas

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tion, a lactation consultant conducts daily rounds, which include a lactation plan of care for nurse-to-nurse communication, a nipple shield consent/information form and a high-risk assessment tool for anticipated concerns placed on the infant’s chart for pediatrician review.

Staff education is a significant focus.

The Women’s Health Center holds monthly breastfeeding in-services, testing and yearly skill competencies. Staff attendance and participation are required. Inservice programs, known as Lactation 101, emphasize specific areas such as breast pump basics — types, assembly, operation and cleaning — and the nurse’s responsibility regarding breastfeeding, which includes

assessment and documentation. All new employees must attend breastfeeding education as part of new employee orientation.

The Women’s Center extends its education efforts to patients as well, offering free childbirth, breastfeeding and newborn classes. Brown provides a personal guided tour to each patient during pre-registration. Relationships and personal connections begin during the tour. Breastfeeding services, “Go the Full 40” (the Association of Women’s Health, Obstetric and Neonatal Nurses’ national consumer campaign giving women with healthy pregnancies 40 reasons to go the full 40 weeks of gestation) and the significance and benefits of immediate skin-to-skin contact during the first hour after birth are discussed. Following the tour, patients and family members view “The Magical Hour,” an award-winning DVD that illustrates the nine distinct observable changes that occur with infants held skin-to-skin with their mothers during the first hour after birth. Implementing such processes has set the tone for what patients have come to expect and desire during the birth of their babies at the Center for Women’s Health.

Post-discharge breastfeeding support is a key component for improving breastfeed-

ing duration. In October 2012, the Center for Women’s Health held its first TLC (The Lactation Club) luncheon. TLC is a monthly breastfeeding support group led

by Guidry. The Lactation Club offers a time for breastfeeding moms to connect, share concerns and celebrate successes.

The luncheons include celebration cakes for mothers meeting 6-month and 1-year exclusive breastfeeding milestones.

The staff at North Arkansas Regional Medical Center is making great strides towards improving breastfeeding rates and duration. Brown and Guidry shared NARMC’s breastfeeding journey at the 2013 AFMC Quality Conference. Breastfeeding promotion is part of a vast movement not only in the state of Arkansas but across the nation, and breastfeeding decisions made today have a direct impact on the generations of tomorrow.

For a short video on NARMC’s program, go to YouTube.com and search “The Lactation Club.”

Tina Hedrick, BSN, RN, CPHIT, is Medicaid quality improvement project manager for the Arkansas Foundation for Medical Care.

Mohammed Mahmoud Moursi, MD, continued from page 1 players. Then he’ll head home to his wife, Wendy, and children Nasreen, 19, and Ashraf, 17, where the close-knit family will share a halal meal and restful evening.

“I’m very, very blessed,” said Moursi, who was named chief of vascular and endovascular surgery at UAMS on Aug. 1. “I had a great upbringing, I have a wonderful family, and I’m doing just about everything I ever dreamed of. As an academic surgeon I get to teach residents and fellows, do research and administrative work, and I truly enjoy caring for my patients.”

In Moursi’s world, something’s always percolating.

Born in Alexandria, Eygpt to Mahmoud and Sohair Moursi, the family moved to the United States when Moursi was a toddler so his dad could earn a doctoral degree from New York University (NYU). After six years of training and teaching there, the Moursi family relocated to Mount Pleasant, Mich., where his dad joined the faculty of Central Michigan University as a business professor.

Soon, Moursi and his 16 months younger brother, Amr, were entrenched in science and biology, even though none of their immediate relatives were in the medical field.

“When I got to the University of Michigan, I started working in the human physiology research lab in the Department of Human Physiology and came into contact with many vascular surgeons, including Dr. James Stanley, head of vascular surgery and recognized worldwide as a giant in the specialty. I saw how vascular

surgery could very much help people.”

After graduating from the University of Michigan Medical School in 1987, Moursi completed eight years of residency and fellowship training in Ann Arbor. While there, he was chief resident and completed three fellowships - one as a research fellowship under the National Institutes of Health, and the other two in surgical critical care and vascular surgery.

Sanjay Gupta, MD, a neurosurgeon more famously known as the Emmy®-award winning chief medical correspondent for CNN, was among his residents.

In 1995, UAMS recruited him to act as an assistant professor at UAMS, Little Rock Veterans Administration and the Arkansas Children’s Hospital. He quickly rose in the ranks; during the first year, he began as chief of vascular surgery for the Central Arkansas Veterans Healthcare System and eventually was promoted to full professor and division chief. When he was named division chief of vascular and endovascular surgery, one of the first calls of congratulations was from his brother, now head of pediatric dentistry at NYU. “I feel so fortunate to have a great job here in Little Rock after my medical training, and our family absolutely loves it here,” said Moursi, who enjoys small mouth bass and trout fishing in Arkansas waters, as well as duck hunting.

Moursi enjoys the challenge of vascular and endovascular surgery, which has changed dramatically in the last two decades.

“When I finished my fellowship in 1995, we didn’t do any operations using the endovascular approach,” he said. “As a vascular surgeon, we really didn’t do wires, ballooning or stenting, and certainly didn’t fix aneurisms with endografts. Now probably 50 to 60 percent of what we do is catheter-based. It’s been a very exciting challenge. The field is ever evolving; it’s certainly not stagnating. I’m always keeping up with bettering endovascular treatment.”

If Moursi had time to do nothing but research, he’d focus on intimal hyperplasia, which can impact the blood flow in affected areas.

“We don’t understand it well and it compromises arterial reconstructions, whether open or catheter-based,” he explained. “I’d like to investigate why it happens and more importantly, provide a better treatment or prevention for this process.”

Moursi is also heavily involved with the Islamic Center of Little Rock. “My faith is very important to me,” he said.

“We have a strong community here, and I’ve had the opportunity to speak to many groups, the mayor, and the governor about my religion. It’s important to increase the dialogue about it while also learning about other religions. Churches and organizations have graciously invited me to share in the discussion.”

When asked the secret to his seemingly boundless energy, Moursi smiled and said: “Life is great.”

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UAMS Opens Unique Women’s Only Psychiatric Unit, continued from page 1 Psychiatry. “They may have been a victim of rape or abuse from a husband or domestic partner, and may be suffering from post traumatic stress syndrome,” Eads said. “Some might be acutely suicidal. It can be difficult sometimes for women to open up to discuss theses issue when they are in a male-female group.”

The women’s unit that opened up in March is designed to give women patients a place where they feel easier about discussing and working on painful issues.

“Dealing with some issues like rape or trauma, sometimes women feel more comfortable talking about this and getting some stability before they have to go out into the real world and deal with men,” Eads said. “It is easier to talk about their feelings. They get a lot of support from each other because they have been in similar situations. They talk about things we would not see them talk about if we had them on a mixed unit.”

The response from patients has been very positive.

“We have gotten quite a bit of good feedback from women because when they compare it to places they may have been hospitalized before, it is a much better experience,” Eads said. “They find it easier to relate to other peers in the unit.

The therapy and activities are specifically directed to the women, whether it is the therapy or the topics that are of specific interest to them. A lot of therapy and group activities take place before they are transitioned to outpatient care.”

Eads said the staff has been pleased at how well the new unit has been received, and some of the results that they have seen.

“We wanted to do something a little different that Arkansas didn’t have,” Eads said. “We wanted a special, unique program that would be of benefit to the state.

In order to try to provide an environment so the women feel safe and able to work together, we put together an all female staff. We had quite a few nurses who felt this was an interesting concept and something they wanted to be involved with. So it actually came together pretty quickly.”

The planning even goes down to the way the unit is decorated. All the rooms are private, and the décor is similar to what you would see in women’s units in hospitals.

“We wanted something that would make them feel a little more comfortable,” she said. “Also, we did a kind of contest and chose some local art work that is get-

Read Medical News of Arkansas Online: MEDICAL NEWSOF ARKANSAS.COM

ting framed and hung up to make the unit soothing. There are also going to be quilts made by local quilters hung up in the rooms to make it more homey for these patients. The rooms are very beautiful, and feel a lot warmer with the quilts and artwork. We also ordered special comforters for the units.”

Another unique thing about the unit is that patients can receive care from a specialist in fetal maternal psychiatry.

Zackary Stowe, MD, takes care of women through a pregnancy or post partum, both times when women can suffer from a lot of hormone imbalances that can set them up for a high risk of emotional instability.

They also try to make some allowances for having the baby in the room with them for part of the time.

“The women’s unit is making great strides in helping women from all over

results,” Eads said. “There is no torture.

The patient goes to sleep, we do the procedure and they wake up. They may have a headache but we can take care of that.

There are some very good results with that. In the local area we and Bridgeway Behavioral Health are the only two places in Little Rock that do ECT, so we have inherited some of the more medically challenging patients. ECT keeps growing for us. ECT has been noted to be more effective than our medications, safer than medications and it works quicker. It just got a bad reputation back in the 1950s when they weren’t putting people to sleep.”

Another function of the PRI is training residents. PRI is part of the UAMS academic center that works to train the next group of psychiatrists for the community.

Expanding our team, improving your care The Arkansas Neuroscience Institute is pleased to announce Dr. Tarek Abuelem and Dr. Stephen F. Shafizadeh are joining our team of highly specialized neurosurgery experts. Dr. Abuelem served as a post-doctoral fellow at Harvard Medical School and completed his residency at Baylor College of Medicine and MD Anderson Cancer Center. Dr. Shafizadeh completed his training at Northwestern University with an advanced surgical training-infolded fellowship in cerebrovascular and skull base surgery. Both physician completed a fellowship in microneurosurgery, cerebrovascular and skull base surgery at ANI. Along with ANI director, Dr. Ali F. Krisht, and ANI neurosurgeons Dr. Ali I. Raja and Dr. Stylianos K. Rammos,, these new physicians will add to our comprehensive range of neurosurgical services and continue to make ANI the leading destination for neurosurgical patients.

Call 501-552-6400 to make a referral.

Left to right: Tarek Abuelem, M.D., and Stephen F. Shafizadeh, M.D., PhD Arkansas Neuroscience Institute Five St Vincent Circle • Suite 210, The Blanford Building • Little Rock, AR 72205 StVincentHealth.com/ANI

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who couldn’t get care anywhere else, especially if they were pregnant,” Eads said.

PRI has two inpatient floors. In addition to the women’s unit, there is a ten-bed child diagnostic unit. There is also outpatient care and some research going on in the building.

PRI has an electro convulsive therapy (ECT) program, which can be used to treat severe depression that doesn’t respond to medication. This can be useful for psychotic depression when patients are a risk to themselves, are acutely suicidal and need to be stabilized quickly. It can also be used for pregnant women who are having significant problems.

It used to be called shock therapy, and had a very bad reputation for traumatizing the patient.

“ECT is much, much different than it was in the 1950s, and provides some good

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OCTOBER/NOVEMBER 2013

Advances in Colon Cancer Helping Prolong Lives

By BECKY GILLETTE

Being a research institution, the University of Arkansas for Medical Sciences (UAMS) is doing research while it is caring for patients.

“As a result, we sometimes enroll patients in clinical trials that benefit everyone,” said Jonathan Laryea, MD, assistant professor of surgery, Division of Colon and Rectal Surgery at UAMS. “The knowledge we get from clinical trials helps us improve the care we give to future patients.

We are improving the Dr. Jonathan care on a daily basis.

Laryea We also teach medical students and residents, which means we have to be on the cutting edge. We are always at the forefront of new knowledge and techniques.”

Laryea, a colon and rectal surgery specialist, is the only surgeon in the state to use the da Vinci robot for colorectal surgery. The da Vinci robot is being used by other surgeons for hysterectomies, heart surgery and prostate surgery, and Laryea said he believes others will soon be using it for colorectal surgery.

“The advantage of the robot over open surgery is the same advantage you get with laparoscopic surgery,” Laryea said. “In effect, the benefits are related.

You have smaller incisions, fewer complications, a quicker recovery, and a quicker return to normal activity. It has a lot of benefits to the surgeon. The surgeon sits down at a console so the surgeon doesn’t get as tired. When you use the robot, you have 3-D vision, the image is magnified, and all the instruments are under the control of the surgeon. With laparoscopic surgery, you have medical students and residents holding some of the instruments, and they can get tired. With the robot, the machine is holding the instruments so they stay where you want until you change the position.”

Another advantage is that the tips of the robotic instruments can move in all different directions. So even in an awkward corner, the surgeon can still suture.

With laparoscopic surgery, he might not be able to suture in a corner.

Laryea said from the patient’s perspective, the benefits from the robot are the same as the benefits from laparoscopic surgery when you compare them to the open procedure.

Another advance in treating colon and rectal surgery is that specialists are doing more personalized medicine in terms of chemotherapy.

“We remove the cancer and do spe-

cialized tests looking at some of the genetic information to determine which chemotherapy it will respond to and which ones it will not respond to,” Laryea said.

For most cancers, patients with stage 4 disease cannot be cured and therefore most of the treatments for these patients are palliative. However, for colon cancer, some stage 4 patients can be treated with curative intent. “Some patients live a long time after that,” he said.

Laryea said it is important to understand that colon cancer and all cancers at UAMS are treated by multidisciplinary teams, and not just individual physicians.

“We discuss patients in a multidisciplinary setting and discuss the best treatment based on each patient’s situation,” he said.

Colon cancer is the third leading cancer diagnosis in both men and women in the U.S., and also the third leading cause of cancer deaths in the U.S. This year about 143,000 new cases are expected, with about 51,000 expected to die.

“So, it is a big deal,” Laryea said.

“However, over the past two decades, the death rate from colon cancer has been going down. That is a good thing. Most of that is due to the fact that there is more screening. Screening the at-risk population can prevent cancer by removing polyps before they get the chance to develop into cancer. The majority of cancers will start as polyps. If they are left alone, they can grow in size and transform into cancer. Having polyps is a risk factor. However, not all polyps are premalignant.”

Age is also a risk factor. Usually people who develop colon cancer are older than 50 years old, even though younger people are now developing colon cancer, as well. The incidence rate in younger people is increasing slowly.

“That is a concern,” Laryea said.

“Other risk factors include family history, especially if it is a first-degree relative like parent or sibling. There are some hereditary conditions that predispose people to color cancer. Diet can also be a risk factor, especially a diet high in red meat and fat, and low in fiber. It is recommended that starting at age 50 people should get screened for colon cancer. If a family member has cancer, screening should start ten years younger than the age when the youngest person in the family had cancer.

For example, if a parent had colon cancer at age 40, the children should start screening at age 30.”

Screening is important because the majority of patients will not have any symptoms. When there are symptoms, they can include abdominal pain or discomfort, blood in the stool, changes in bowel habits, weight loss, poor appetite, and general malaise.

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Relieving the Burden

Less waiting, lower cost and spa-like setting gaining fans for Velocity Care Urgent Treatment Center

By BECKY GILLETTE

LITTLE ROCK--Velocity Care Urgent Treatment Center has an advertisement that says, “Come in wheezing, come out breathing.” Recent patient Fay Jean Royce found out that the care she received was exactly as advertised.

Royce had an illness with a lot of trouble breathing and coughing. It got worse over the weekend.

“Go to the hospital emergency room on a Saturday night?” she asked herself.

“I don’t think so. But I was feeling so terrible. I found out about Velocity Care. I went in, they did an EKG, an x-ray of my lungs, and a 30-minute breathing treatment. It was just the most marvelous relief. The whole experience was almost life saving. The office is beautiful and well equipped. It is just wonderful.”

Mid week she got a call from her physician, John McLean, MD, asking how she was doing.

That sort of thing had never happened to her before, and she was very impressed.

Dr. John “Next Friday I went McLean in for another breathing treatment and they arranged for me

to see a pulmonary doctor,” Royce said.

“It can be hard to get appointments with a pulmonary doctor. Now I’m under the care of someone who is going to address this issue.”

Kelsey Lowder found Velocity Care more helpful than the emergency rooms she had visited in the past. They asked her more questions. They were trying to get to the root of the problem rather than just trying to get her in and out.

“It was a very relaxed setting,” Lowder said. “I wasn’t scared. It wasn’t

rushed. They figured out the problem and got me out as soon as possible.”

Lowder was impressed by the short wait time and excellent care.

The Velocity Urgent Care Treatment Center, which opened in June, has been working to educate the public and the medical community about the type of services offered. It has a different business model than urgent cares that are staffed with mid level practitioners like nurse practitioners. Velocity Care is staffed by former emergency room (ER) doctors.

McLean also said they are working to make sure that local physicians understand the new center is not stealing patients, but filling a gap in patient care.

“Even for emergency rooms (ERs), they realize we are helping them out,” said McLean. “We help unload ERs so they can be seeing the more serious cases they need to be attending to. That really helps them to stay focused on the patients who need to be in the ER so they are not overwhelmed with patients. Our number one referrals are physicians. We are a nice, friendly place for you to be treated. We can treat everything from a sinus infection to pneumonia, from sprained ankles to major fractures. Savings are anywhere between 70 to 80 percent compared to ERs.” The average cost to see a doctor and get treated is $115 with basic lab work running $45 and x-rays from $45 to $60.

“So many people are self insuring, and we want to make it so they can afford treatment,” McLean said.

During his 20 years as an ER doctor, McLean said it was often frustrating to look at the computer and see how many people were waiting to be seen. They might be passing kidney stones, or dealing with a broken hand. But they would be waiting sometimes for hours while more (CONTINUED ON PAGE 10)

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Relieving the Burden, continued from page 9 serious cases were being seen.

“We can take in patients with minor to moderate emergencies who don’t quite need the ER,” McLean said. “Many things don’t really require the expense of an ER and the length of time it takes to get to the doctor.”

Studies are predicting that access to physicians is going to get even tougher in the future because of shortages of physicians. That is particularly true with ER doctors.

“The attrition rate for ER doctors is 12 years,” McLean said. “They get burned out because of the pace. Here at Velocity Care, we have been hiring 43- to 50-year-old former ER doctors who are highly trained, and very experienced treating anything coming in. Having the higher quality physicians in the clinic is what is setting us apart. We are ER doctors without the ER. “Anything that walks through the door from minor to moderate emergencies, we take care of it and get them where they need to go. If someone comes in for abdominal pain, in 45 minutes after an ultrasound, a radiologist can diagnose him with appendicitis. We get a line in him, give him IV antibiotics, and get him ready for the operating room. I skip the ER. I

call the surgeon and give him the information on the patient.”

McLean said that Velocity Care particularly gets a lot of referrals from physicians when the flu season is filling their waiting rooms with patients.

The Velocity Care Urgent Treatment Center in Little Rock is the fourth, with clinics in Shreveport and Bossier, La., open for several years.

“Our hopes are to branch out,”

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McLean said. “We intended to expand relatively quickly because we think the need is going to continue to be there. It is going to get harder for patients to receive care as the healthcare system expands. We help patients get access to healthcare in a timely, efficient and inexpensive way. I think the insurance companies are starting to see that as well. We accept most health insurance policies. We do a little of the occupational medicine as well. We

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help small businesses with drug screens, preparations for the diesel truck driving category, and give physicals for employees who need to be cleared to work in their factories.”

The waiting room at Velocity Care is designed to feel more like a spa than a doctor’s office.

“I want people to be able to relax in an atmosphere that helps them be calm,” McLean said.

“It is a plush waiting area with unique lighting and rock walls.

We want patients to come in and feel like they’ve gotten a breath of fresh air, and know they will be treated graciously and tenderly.

We are staffed with RNs and LPNs, as well as radiation technicians. We can do all x-rays on site. We can do blood counts and chemistries. There are TVs in every room, and free coffee and bottled water.”

They also take appointments online by registering at www.velocitycare.com, and paperwork can be filled out in advance. The Little Rock Velocity Care Urgent Treatment Center is seeing 15 to 20 patients a day, with the centers in Louisiana seeing 60 to 120 patients in a 12-hour period. McLean said most people are in and out in 45 minutes.

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The New Catalogue of Insanities Brain & Behavior, an odd couple: News from the outskirts of psychiatry, epidemiology, and neurosciences

By ERICK MESSIAS, MD, PhD

Under a storm of commentary, full of sound and fury, the new edition of the Diagnostic and Statistical Manual, sometimes referred to as “the Bible of psychiatry,” was released by the American Psychiatric Association in May. This is the fifth edition of the manual, the official list of accepted psychiatric diagnoses in America, thus named DSM-5. On that same month, two books were published addressing the new DSM, “Saving Normal” and “The Book of Woe.” Several editorials were published, from the Annals of Internal Medicine’s “The New Crisis in Confidence in Psychiatric Diagnosis” to the Wall Street Journal’s “A Manual Ran Amok.” Even the director of the National Institute of Mental Health, Tom Insel, had a blog post titled “Transforming Diagnosis,” where he stated “patients with mental disorder deserve better” and defended the new NIMH-sponsored Research Domain Criteria. Why should a diagnostic manual stir so many strong opinions and emotions?

It has stirred all of these emotions because psychiatry has taken the role to explain the unexplainable, and it does that by describing, categorizing, and naming sets of unusual, sometimes dysfunctional, sometimes bizarre behaviors. Thus we find among the new disorders, listed in the DSM-5: one to diagnose those that eat too much too frequently, named Binge Eating Disorder; one to categorize those that cannot control their gambling habit, Gambling Disorder; one for those unable to discard or parting with possessions, Hoarding Disorder. We even have one for children that have severe recurrent temper outbursts, Disruptive Mood Dysregulation Disorder. All these newly minted diagnoses will join the ranks of Social Phobia (which some accuse of being the medical version of shyness), Intermittent Explosive Disorder (recurrent violent outburst in adults) and Genito-Pelvic Pain/ Penetration Disorder (a category created to combine the previous diagnoses of vaginismus and dyspareunia). All of this raises the question that psychiatry is now elevating – or downgrading – to the category of medical illness, with the consequent medical treatment, a series of normal, albeit unpleasant human experiences. For example, the sadness of losing a loved one, the classic experience of mourning and grief, is a normal reaction that resembles a major depressive episode. The latter few would question as a brain dysfunction, while the first has been accepted for millennia as a normal reaction to loss.

As Aristotle helped us understand over 2,000 years ago, the truth probably is in the midway between considering all bizarre behaviors pathological and considering all such behaviors a “normal reacmedicalnewsofarkansas

.com

tion to an abnormal society” as proposed by some in the antipsychiatry movement.

The DSM-5 is the most recent iteration of the model started in 1980 by the third edition of the manual, the DSM-III; until DSM-5 the APA used roman numerals.

The DSM-III was a major departure from the two first editions but listing a specific

set of criteria for each disorder and making sure good reliability was achieved.

That was a major change, a watershed moment in psychiatry, because until then psychiatric diagnosis was determined to a great extent on the school the psychiatrist was trained not as much on what the patient presented. This problem was clear in

two now classic studies, the US-UK project and the Rosenhan experiment. The US-UK study compared the diagnoses on the same set of patients given by British and American psychiatrists. When the results were in, it was clear the Americans tended to use the diagnosis of schizophre(CONTINUED ON PAGE 12)

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Wellness Programs’ Impact on the Medical Field

By JENNIFER PATEL

With rising healthcare costs companies are searching for ways to not only reduce costs, but also create healthier employees. Stats highlighting a decrease in used sick days and reductions in overall healthcare costs have many employers looking into health and wellness initiatives to encourage employees to live healthier lives. As more companies begin to incorporate wellness programs, the time for healthcare providers to become directly involved is now.

While today’s employers are beginning to see the benefits of wellness programs and preventive care, they didn’t always. In the past, employees have been left to worry that taking time off for doctors appointments or tending to other preventative care issues will result in a negative reaction from management.

Because of this, employers have to find ways to encourage employee participation in wellness programs. One successful method of encouragement that employers have discovered is to have direct participation from healthcare professionals.

The following are ways healthcare professionals can, and are beginning get involved with health and wellness plans.

Encourage Preventive Care

The Centers for Disease Control and Prevention (CDC) estimate that 68 percent of adults and 33 percent of youth are currently overweight or obese. Chronic obesity-related conditions, including heart disease and diabetes, have a big impact on health and wellness. In addition, chronic diseases reduce the overall quality of life with half of all chronic disease-related deaths occurring in people under the age of 70.

Healthcare professionals are in an ideal position to offer tools for employees to be healthy. In an effort to combat employees’ reluctance to leave work for such care, employers are beginning to bring in healthcare professionals to offer biometric and preventative screenings in the workplace. This is beneficial for both parties as less time is spent away from work.

Offer Expertise

Generally speaking, most employers are not healthcare experts, which gives physicians extra advantages. When putting together a wellness program, employers look at screenings, physical activity and incentives for positive results. But what constitutes positive results and what is the best way to get there?

Not only can the healthcare industry provide valuable insight when designing these programs, but it can assist in educating employees on what they should be doing, why it’s important, and then monitoring to ensure that no issues arise. Inviting additional healthcare professionals to implement a wellness program will provide extra validation to the importance of a healthy workplace.

Build Relationships

One of the biggest obstacles that employers face when encouraging employees to take part in health and wellness programs is a desire to not be the squeaky wheel. Whether or not it is admitted, employees still feel that taking time off work is seen as something that can affect their growth within the company.

The way businesses address this issue is by building positive relationships with their employees and letting them know it’s more beneficial for the entire team if one employee is too sick and needs to stay home and get well. By encouraging preventative care, as well as offering educational opportunities, employees build positive relationships with both their bosses and the healthcare professionals. Through relationships with employers, healthcare professionals are given access to a wealth of potential new clients at no cost to them.

Invest in Your Employees

As the healthcare industry’s role within workplace health and wellness plans increases, it’s important to turn the looking glass upon itself. While providers may have the closest access to the care, it can be difficult to find time to care for themselves. With high rates of smoking, stress levels and long hours, the healthcare industry suffers from many of the same ailments it attempts to rectify.

By implementing a health and wellness plan of their own, healthcare professionals are able to practice what they preach. By providing the necessary time to take part in the program, determining what programs are needed, as well as offering incentives, healthcare professionals can not only be a part of others’ programs, but their own.

Invest in employee enrichment and see how a wellness program positively impacts a company’s bottom line.

Hallmark Business Connections, the business-relationships unit of Hallmark Cards, helps businesses build and strengthen relationships that help them thrive. One valuable service the company provides is corporate wellness program development. For guidance on strategic wellness program implementation, email Jennifer Patel at Jennifer.Patel@ hallmarkbusinessconnections.com or visit www.hallmarkbusinessconnections.com.

The New Catalogue, continued from page 11

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nia while the British counterparts would call it manic depressive illness. That classic study set the stage for the questioning of the validity and reliability of psychiatric diagnoses. The Rosenhan experiment completed the challenge by sending volunteers to report “hearing voices” into the care of psychiatrists, promptly being admitted and treated for schizophrenia across 12 psychiatric hospitals in America. The results were published in Science in 1973 under the title “On Being Sane in Insane Places” and it was an instant classic.

To address these very public and embarrassing shortcomings the American Psychiatric Association embarked in the process of rigorous self-assessment and engaged a committee to study the process of diagnosis. That group, led by Robert Spitzer, used a set of diagnostic criteria developed at the Washington University in Saint Louis and developed then into the DSM-III. The third edition of the manual brought reliability of diagnosis

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into psychiatry and was widely adopted around the world as the gold standard for psychiatric classification and nosology.

The fourth edition, DSM-IV, came up in 1994, building on the same model of reliability and being quite conservative in the expansion of mental disorders. At that time, most people believed that by 2010 that model of sets of observed behaviors would be replaced by a model based on biomarkers for mental illnesses. That set of biomarkers ended up turning into a kind of Holy Grail for psychiatry and, just like Holy Grail itself, has yet to be found.

With the lack of sensitive and specific biomarkers for mental disorders, the field had to content with another, hopefully last iteration of the observed behavior and mental states model and that’s how we get to the DSM-5. It is a collection of sets of criteria to reliably identify and categorize mental disorders. It is a model that has served psychiatry well for 33 years, and it was not written by gods but by human beings and, as religious people remind us, we are far from perfect and so are our works.

Erick Messias, MD, PhD, is the medical director of the Walker Family Clinic in the University of Arkansas for Medical Sciences’ Psychiatric Research Institute and an associate professor in the UAMS Department of Psychiatry.

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GrandRounds Dr. Deepak Thomas Joins Physicians at St. Bernards Heart and Vascular Dr. Deepak Thomas has joined the medical staff at St. Bernards Heart and Vascular, the largest cardiology practice in the region.

The cardiologist comes to St. Bernards after completing a threeyear fellowship in cardiolDr. Deepak Thomas ogy at the University of Nebraska Medical Center in Omaha.

Prior to that Thomas served a fellowship in non-invasive cardiovascular imaging at Brigham & Women’s Hospital, Harvard University, as well as a residency at Interfaith Medical Center in Brookland. He holds a medical degree from Jawaharlal Nehru Medical College, Belgaum, India.

He is board certified in cardiovascular medicine by the American Board of Internal Medicine and holds professional membership in the American College of Cardiology.

Thomas has served on medical staffs at hospitals in Nebraska, Massachusetts and New York as well as hospitals in India.

He will see patients at St. Bernards Heart and Vascular, Jonesboro.

Dr. Daryl Burrows joins Mercy Endocrinology Clinic in Hot Springs Mercy Hospital Hot Springs and Mercy Clinic are proud to announce the arrival of Dr. Daryl Burrows to the Mercy Endocrinology Clinic in Hot Springs.

Dr. Burrows is a native of Rogers and graduate of Dr. Daryl Burrows the University of Arkansas in Fayetteville and UAMS in Little Rock.

He joins fellow Endocrinologist Dr. Jonathan Stringer.

Dr. Burrows comes to Mercy after spending the past three years at St. Vincent Diabetes and Endocrinology Clinic in Little Rock.

He said he chose Endocrinology as his specialty because he is able to help patients get started in their treatment.

UAMS Awarded $8.7 Million for Radiation Research The Biomedical Advanced Research and Development Authority (BARDA) has exercised two contract options worth approximately $8.7 million with the University of Arkansas for Medical Sciences (UAMS) to proceed with advanced development of a promising treatment for use in radiological or nuclear emergency situations.

The first option by BARDA, which is part of the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and

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Response (ASPR), is for $7.5 million over two years. A second one-year option for $1.24 million is for research to be done as part of an interagency agreement between BARDA and the U.S. Department of Defense (DOD).

Including the base BARDA contract for $4.5 million entered into in 2011, the total value awarded is more than $13 million.

Under the contract, UAMS’ Martin Hauer-Jensen, M.D., Ph.D., an internationally renowned radiation researcher, will lead the evaluation of the drug, pasireotide, formerly known as SOM230, to treat gastrointestinal injuries after radiological or nuclear accidents or terrorist attacks. Hauer-Jensen will be assisted by an 18-person team of UAMS researchers.

The intestine and bone marrow are most susceptible to radiation because of their rapidly proliferating cells. Treatments exist for irradiated bone marrow but not for the intestine.

Radiation damage to the intestine often determines whether a person lives or dies after exposure, Hauer-Jensen said.

The potentially life-saving pasireotide inhibits the secretions from the pancreas, giving the intestine a chance to heal after radiation exposure. Assuming the drug also receives FDA approval to treat gastrointestinal injuries from radiation exposure, it would be a breakthrough for emergency preparedness as one of a very small number of drugs that protects people after they’ve already been exposed to radiation.

Hauer-Jensen said that it is his hope that the drug will someday be available to address public health emergencies and to benefit cancer patients receiving certain radiation therapies.

The research contract is the largest in the UAMS College of Pharmacy’s 60-year history, said Stephanie Gardner, Ed.D., Pharm.D., dean of the College of Pharmacy.

Novartis developed the pasireotide to treat hormone disorders known as Cushing’s disease and acromegaly. The U.S. Food and Drug Administration (FDA) and the European Union recently approved the drug for the treatment of Cushing’s disease.

In the first phase of the research begun in 2011, Hauer-Jensen and his team generated data Novartis needed to initiate discussions with the Food and Drug Administration about using pasireotide for radiological emergencies. During the next two years of the contract, the team will perform a range of studies to continue the development process.

UAMS Winthrop P. Rockefeller Cancer Institute and Highlands Oncology Group Announce Collaboration A new collaboration between the Winthrop P. Rockefeller Cancer Institute

at the University of Arkansas for Medical Sciences (UAMS) and Highlands Oncology Group will advance research in Arkansas and give greater access to care.

The collaboration will allow the Cancer Institute, located in Little Rock, and Highlands, located in Fayetteville and Rogers, to work together in providing the highest-quality care for Arkansas patients and families living with cancer while remaining close to home.

Patients at Highlands will now have a more expedited process for enrolling in research clinical trials offered concurrently through Highlands and the Cancer Institute, giving them access to new and innovative treatment options unavailable at other cancer centers. Clinical trials are an important area of research in which patients work with doctors to find new ways to prevent, diagnose and treat cancer. The Cancer Institute offers about 200 clinical trials to patients who qualify for participation.

Patients at Highlands also will benefit from the use of telemedicine, in which their physicians consult in real-time with their counterparts at UAMS via video conferencing. This use of technology will give patients in northwest Arkansas the expertise of UAMS specialists without requiring them to travel to Little Rock.

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GrandRounds Baptist Health Welcomes New Pulmonology And Sleep Clinic The latest addition to the Baptist Health healthcare system, Baptist Health Pulmonology and Sleep Clinic-North Little Rock, opened Oct. 1.

Located at Baptist Health Medical Center-North Little Rock, the new pulmonology and sleep clinic is home to Drs. Stan Kellar, Dominika Szwedo, and Sridhar Badireddi. Dr. Kellar began seeing patients the first of Dr. Stan Kellar October and Drs. Szwedo and Badireddi will join the practice later in December.

All three physicians are board certified in pulmonology and internal medicine. Dr. Kellar is also Dr. Dominika Szwedo certified in sleep medicine and Dr. Szwedo has an additional certification in critical care. Their educational and professional backgrounds are as follows.

Dr. Kellar received his medical degree from the University of Arkansas for Medical Sciences, his residency at UAMS, and fellowship at UAMS & Veterans Affairs Hospital. He has been in private practice in Arkansas and Texas for the past 34 years and was previously practicing at the Arkansas Pulmonary, Sleep, and Infectious Disease Clinic.

Dr. Szwedo received her medical degree from Medical University of Lublin, Lublin Poland, her residency at Montefiore Medical Center/Albert Einstein College of Medicine, NY, and fellowship at Tulane University, New Orleans. She was previously a hospitalist at Kindred Hospital in New Orleans.

Dr. Badireddi received his medical degree from Andhra Medical College NTR, his residency at St. Agnes Hospital, Baltimore, and fellowship at UAMS. He is practicing at the University Arkansas Pulmonology Clinic in Little Rock until joining the clinic at the end of the year.

Baptist Health Pulmonology and Sleep Clinic-North Little Rock will offer extensive healthcare services for patients with chronic cough, shortness of breath, asthma, emphysema, and Chronic Obstructive Pulmonary Disease (COPD) as well as being equipped to perform pulmonary function tests. In addition, the physicians offer assessment of sleep issues and provide continuous positive airway pressure (CPAP) services.

Cancer Drug Developed by UAMS Professor Awarded FDA Approval Valchlor, a breakthrough gel for treating lymphoma developed with the help of University of Arkansas for Medical Sciences (UAMS) College of Pharmacy Professor Peter Crooks, Ph.D., recently won marketing approval from the U.S. Food and Drug Administration.

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Valchlor gel is for the topical treatment of stage 1A and 1B mycosis fungoides-type cutaneous T-cell lymphoma (CTCL), a rare form of non-Hodgkins lymphoma. Developed by Ceptaris Therapeutics, the gel is the first and only FDA-approved topical formulation of mechlorethamine, commonly known as nitrogen mustard. Patients can apply Valchlor once a day, and it dries on the skin.

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma.

It has no cure, and its cause is unknown.

The malignant T-cells migrate to the skin, causing lesions to appear. Lesions first appear as a rash and then may grow into disfiguring tumors.

Crooks was a cofounder and chief scientific officer (CSO) of Yaupon Therapeutics, the company that later became Ceptaris, which is located in Malvern, Penn. He began developmental work on Valchlor in 2004. He helped solved such problems as how to chemically stabilize the drug in the topical gel formulation, and how to keep it from entering a patient’s bloodstream. He stepped down as CSO of the company in 2011 when he joined UAMS. During his work on Valchlor, Crooks said he learned a tremendous amount about drug development, manufacturing and the FDA approval process. He is applying that knowledge to new research and new projects at UAMS, such as clinical development of new drugs for the treatment of acute myelogenous leukemia (AML), the most common form of leukemia, and for the treatment of Alzheimer’s disease.

UAMS COM Recognized as National Leader in Conflictof-Interest Standards The University of Arkansas for Medical Sciences (UAMS) College of Medicine has been recognized in a nationwide study as being among the top five medical schools in meeting national clinical conflict-of-interest (CCOI) standards.

Institute on Medicine as a Profession (IMAP) surveyed policies at 127 medical schools and published the results in the October issue of Academic Medicine.

In the study Managing Conflicts of Interest in Clinical Care: The Race to the Middle at U.S. Medical Schools, investigators evaluated CCOI policies in 2011 for accredited medical schools. The evaluations were based on policy recommendations issued by the Association of American Medical Colleges, the Institute of Medicine and the ABIM Foundation and IMAP. The researchers also compared 2011 and 2008 data to see how much change had occurred. IMAP did its first CCOI study in 2008.

The study also analyzed whether a school’s status, hospital affiliation, or source of funding influenced CCOI policy strength.

Many people helped achieve the recognition, notably former College of Medicine Dean Debra Fiser, M.D.,

Margaret Ward, faculty group practice coordinator, and Bob Bishop, UAMS vice chancellor for institutional compliance. UAMS College of Medicine Dean G. Richard Smith, M.D., and the entire UAMS administration are committed to maintaining its strong conflict-of-interest policies and enforcement, he said.

Others in the top five recognized by the IMAP are Emory University School of Medicine, University of Massachusetts Medical School, University of Iowa Carver College of Medicine and Boston University School of Medicine.

IMAP’s study found that U.S. medical schools have made significant progress to strengthen their management of clinical conflicts of interest (CCOI), but that most schools still lag behind national standards.

Nursing Director Wins National Leadership Award Carla Rider, RNC, BSN, director of nursing for women’s services at Washington Regional Medical Center, won the 2013 National Association of Neonatal Nurses Leadership Award at NANN’s 29th annual educational conference in Nashville, Tenn.

Rider was recognized for her innovative leadership of Washington Regional’s Johnelle Hunt Center for Women, which includes family-centered Labor and Delivery, Mother-Baby Care, Nursery and 12-bed Level III Neonatal Intensive Care Unit. Under Rider’s direction, Washington Regional was the first hospital in Arkansas to be recognized by the March of Dimes for improving newborn health by lowering the rate of non-medically necessary elective deliveries prior to 39 weeks gestation. She also has been instrumental in Washington Regional’s successful participation in the exclusive breastfeeding perinatal core measure as defined by the Arkansas Foundation for Medical Care, developing a program to ensure that all 80 staff nurses at the center for women become certified breastfeeding educators by the end of 2013.

Washington Regional now has one of the highest breastfeeding success rates in the state.

A native of Southwest Missouri, Rider has more than 30 years healthcare experience. She earned a bachelor of science degree in nursing from Texas Woman’s University and a master of business administration degree from University of Phoenix. Rider is currently earning her doctorate of nursing practice in nursing leadership at Bellarmine University. She joined Washington Regional in 2010.

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