Orlando Medical News June 2013 by FW Publishing

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PHYSICIAN SPOTLIGHT PAGE 3

Ndidi N. Nwamu, DO, MBA ON ROUNDS

Turning Point

Nemours Children’s Hospital ED expedites triage process with RN as pivot person By LyNNE JETER

Before the Nemours Children’s Hospital opened in Orlando last October, newly minted Emergency Department (ED) chief Todd Glass, MD, collaborated with Nemours’ nursing director Nicole Johnson on the best and most expeditious way for pediatric patients arriving in the ER to see a doctor. “We focused on designing processes comprehensively to deliver early assessments and get care to the patient as soon as possible,” said Glass, board-certified in pediatrics and pediatric emergency medicine. Glass joined Nemours (CONTINUED ON PAGE 6)

Incentivizing Residencies

Florida leaders work on ways to increase residency slots, keep COM graduates in state ... 5

Lucky ‘13

UCF COM Dean discusses graduation of charter class, celebrating 50th anniversary with main campus ... 11

ONLINE: ORLANDO MEDICAL NEWS.COM

Physician Workforce Report Inaugural Physician Workforce Assessment and Development Strategic Plan aims to strengthen capabilities, improve practice environment By LyNNE JETER

Only 14 percent of the state’s 44,804 licensed, practicing physicians are younger than age 40, according to the Florida Department of Health’s inaugural Physician Workforce Assessment and Development Strategic Plan. Released late last year, the plan is chock full of expected and surprising trends in a snapshot to strengthen the state’s physician workforce capabilities while also enhancing the practice environment. “The strategies proposed …

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lay the groundwork required in pursuit of that goal,” explained John H. Armstrong, MD, state surgeon general and council chairman, about physician attraction, retention and retraining. “Florida shapes a stronger physician workforce today by reviving existing incentive programs, targeting specific types of non-practicing physicians for incentives or retraining opportunities, and improving Florida’s practice climate to reduce physician departures.” Creating Graduate Medical Education (GME) opportunities to narrow the gap between medical school graduates and (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Ndidi N. Nwamu, DO, MBA Nephrologist, Delta Kidney & Hypertension By JEFF WEBB

ORLANDO - Ndidi Nwamua was lovestruck her second year of medical school. It came at the conclusion of her very first lecture about nephrology. “I can never forget the silence at the end. The proverbial smoke that came out of our heads as we looked at each other, in awe at the level of complexity, was classic. It was at that moment I fell in love with nephrology,” said the 36-year-old solo practitioner at Delta Kidney & Hypertension. It was a career epiphany for a woman who has known since she was a little girl that she was destined to doctor. “Any time there was a medical issue at hand I would take action,” she said. “My childhood friends laugh at the fact that I always knew that I would become a healer.” Nwamu’s family emigrated from Nigeria to New York City about 40 years ago. They moved to London and then back to Nigeria before returning to the U.S., eventually settling in Los Angeles, where Nwamu, the second of six children, attended high school. “I was very athletic. I played soccer, basketball, softball, was on the diving/swim team and a cheerleader,” she said. But her favorite extracurricular activity is one she started when she was 5 years old – dance – and continued when she left L.A. and headed back east to attend Herbert H. Lehman College in the Bronx. “I wanted to experience New York as an adult,” said Nwamu, who earned her bachelor of science majoring in anthropology, chemistry and biology, with a minor in dance. Nwamu was accepted into a dual program that allowed her to earn her medical doctor and masters of business administration degrees at the New York Institute of Technology College of Osteopathic Medicine. An internal medicine residency followed in Stamford, Conn., before Nwamu completed a two-year fellowship in nephrology at the University of Medicine and Dentistry of New Jersey in 2012. Like many who move to Florida, Nwamu said the climate was a prime motivation, and her decision to choose Orlando was endorsed enthusiastically by her 5-year-old daughter, Gabrielle, a fan of Disneyworld who has declared this “the ‘bestest’ place she’s ever lived,” said Nwamu. Joining Nwamu in her new home are her younger sister and their mother, Ekudika. Nwamua’s father Patrick Ike Nwamu, PhD, has returned to his home in Nigeria to claim his traditional tribal titles of Obi Chief and the Odogwu Asaba, said Nwamu, a full-blooded African princess who speaks Obi. The name of Nwamu’s medical practice is taken from the oil-producing region her parents hail from in west Africa, the Niger Delta.

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In addition, “Delta signifies change,” she said, and that certainly has been a big part of her life the past year. In addition to her practice, Nwamu also is medical director of the dialysis unit of the downtown Central Florida Kidney Center, and recently became medical director for Mobile Dialysis, Inc. She said her business management training is “definitely coming in handy” at her practice, where she does her own budgeting, bookkeeping and marketing. For now, she employs only one medical assistant, she said, but “I’m hoping to expand one day, God willing, but I am not in a rush.” Nwamu’s office is adjacent to Florida East Hospital, where she does rounds for many of her patients. “I really enjoy working there. The entire Florida Hospital system is pretty incredible. The staff has been really attentive,” she said, adding that one perk for her is “you can actually use the G-word there – God.” Nwamu said she “was raised Christian and I believe in the doctrine of the Holy Bible. Its tenets involve unconditional love, turning the other cheek, and treating others the way you want to be treated. Doing this involves constant, daily reflection, which is easier said than done.” “My faith is associated with everything I do. It’s pretty much my entire being,” she said. “But the society we are

in now, everyone is hyper-sensitive about religion. I don’t go around beating people over the head about (faith), but studies have clearly shown that prayer and meditation work. And if I see a patient who might be open to it, or who is talking about it, I let them know I feel the same way and encourage them,” she explained. “My faith definitely plays a role in that.” “I’ve really dedicated myself to being a good listener and being compassionate and understanding. To be a good leader you have to be a good servant first, and being a good physician means being a servant. It is disheartening to see some physicians forget they are servants,” she said. Jerisa Johnson, DO, has known Nwamu since they were in medical school in New York, and admires how she deals with patients. “She fights for her patients and she has a passion to educate them,” said Johnson, an emergency medicine physician who works in the Chicago area. “She takes time to explain everything and make sure the patients and their families understand the treatment plan. Her patience is amazing,” said Johnson. Nwamu nourishes that approach with morning meditation and yoga sessions. “It helps me center and be positive, and release tension. It gets my day started on a good note. If I skip yoga, my friends tell me I’m a little irritable,” she laughed.

When she’s not seeing patients or marketing her practice – she’ll have a website soon – Nwamu cherishes her roles of mom and homemaker. “People would be surprised how domestic I can be. I like to cook, clean, do laundry, and take care of my home,” she said. And, just as Nwamu was at age 5, daughter Gabrielle is deeply involved in dance classes, and mom draws on her own experience to teach. Nwamu also has carved out time to teach at work. The first two of what she hopes will be a steady stream of medical students have completed four-week rotations in her practice, and she lectures at the University of Central Florida College of Medicine. Recalling her personal revelation as a med school student, Nwamu said she “just loves seeing those light bulbs go off when the students realize the intricacies of nephrology.”

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Incentivizing Residencies Florida leaders work on ways to increase residency slots, keep COM graduates in state By LYNNE JETER

Two years ago, 282 graduates of Florida medical schools left the state to pursue PGY-1 (first-year) residencies because of a shortage of in-state slots that continues to exacerbate the growing physician shortage in one of the nation’s fastest-growing and fastest-aging states. “Unfortunately, we lack sufficient residency slots for the number of medical students we graduate in the medical schools in the state,” said Tampa General CEO Jim Burkhart. “We have a great exodus every year of very talented graduates of medical schools who can’t stay … because we don’t have enough slots.” For example, only 10 of 33 graduates of the University of Central Florida (UCF) College of Medicine’s (COM) charter class found in-state residency slots; only two will remain in Orlando. This fall, 100 students will enter the UCF COM; next fall will signal the first full class of the four-year-old school when 120 students are admitted. “The state and local community are especially hard hit because residency programs haven’t kept pace with population and medical school growth,” said Deborah German, MD, vice president for medical affairs and founding dean of the UCF COM, noting that Florida has fewer than 18 residents and fellows on duty per 100,000 population, ranking it 42 of 50 states nationally. Orlando produces 102 graduate medical education (GME) graduates annually from core nationally-accredited residency programs. By comparison, Tampa produces 145, and Gainesville, 148. Of Florida’s nine medical schools – two private osteopathic schools, one private allopathic school, and six public allopathic schools – an informal statewide chart released in 2011 shows 510 graduates with a surplus of 260 Florida PGY-1 residency slots in 2000, compared to a projected number of 1,317 graduates with a shortage of 490 slots estimated for 2020. Challenges and Solutions Robust medical school growth has drawn attention to the minimal growth of residency programs to provide post-graduate training to Florida’s graduating medical students, while also attracting quality medical school graduates from around the country to provide the foundation for Florida physician workforce of the future, and positioning Florida to best work to develop residency programs to provide such training. Florida State University welcomed its first crop of medical students in 2001, Lake Erie College of Osteopathic Medicine (LECOM) in 2008, UCF and Florida International University (FIU) in 2009, and Florida Atlantic University (FAU) in 2011. UCF and FIU represent the tail-end of graduating their first full classes, in 2017. “When graduates stay in the area to complete their medical training, there’s orlandomedicalnews

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a very high probability they will remain after training, and set up practice or join an established practice. This is the best way to respond to the physician shortage in Florida,” said LECOM associate dean Robert George, DO, in Bradenton. Of 152 LECOM medical students who graduated on June 9, 36 percent (55) will remain Dr. Robert George in-state to complete residencies and internships. Statistics show that residents and fellows retained from Accreditation Council for Graduate Medical Education (ACGME) programs are highly likely – roughly twothirds, according to the Association of American Medical Colleges (AAMC) – to practice medicine in the area in which resi-

dencies and fellowships are completed. Various solutions have been put into place via innovative partnerships to address the residency shortage. For example, Tampa General Hospital, a teaching hospital for the University of South Florida (USF) Health Morsani COM, has 200 residency slots, yet hosts 310 residents. “That additional 110 slots, the hospital pays for out of pocket,” said Burkhart. “That’s $100,000 plus for every resident. We can’t afford to keep doing that, particularly when reimbursement from Medicare, Medicaid, commercial insurance and everything else continues to take a hit.” PCP Focus In keeping pace with primary care needs, 51 percent of 2013 PGY-1 slots in Florida fall under PCP status (internal medicine, pediatrics, family medicine and obstet-

rics and gynecology), according to the Patient Centered Medical Home model. AAMC’s 2011 State Physician Workforce Data Book lists Florida with 16,060 total active primary care physicians for a population of 18.7 million, resulting in a ratio of 9.2 per 100,000. “We’ll need more primary care doctors, but why would anyone want to go into primary care when they’re not paid as well, yet have the same level of student loan debt as other students? The real debt occurs when you’re going to medical school,” said Burkhart. “When you’re a resident, at least you’re making some money. Radiology, for example, pays significantly more than primary care (for the ROI). We have to do something to maybe help offset or cover or forgive debt for medical students going into primary care, and not just in rural areas. Not everybody lives in a rural area. A lot (CONTINUED ON PAGE 9)

FLORIDA RESIDENCY MATCH RECAP FOR 2013 According to the National Resident Matching Program for 2013, PGY-1 quotas and matches per major medical centers in Florida: Bayfront Medical Center in St. Petersburg: 12 of 12 matched. Cleveland Clinic in Weston: 18 of 20 matched. Florida Hospital-Orlando: 36 of 36 matched. Florida State University in Tallahassee: 22 of 23 matched. Halifax Medical Center in Daytona Beach: 10 of 10 matched. Jackson Memorial Hospital in Miami: 210 of 211 matched. Larkin Community Hospital in South Miami: 8 of 8 matched. Mayo School of Graduate Medical Education in Jacksonville: 35 of 39 matched. Miami Children’s Hospital in Miami: 24 of 24 matched. Mt. Sinai Medical Center in Miami: 29 of 30 matched. Orlando Health in Orlando: 62 of 66 matched. St. Vincent’s Medical Center in Jacksonville: 7 of 7 matched. Tallahassee Memorial Healthcare in Tallahassee: 11 of 11 matched. University of Florida in Jacksonville: 81 of 81 matched. University of Florida-Shands Hospital in Gainesville: 153 of 163 matched. University of Miami-Palm Beach in Atlantis: 30 of 30 matched. University of South Florida in Tampa: 128 of 128 matched. West Kendall Baptist Hospital in Miami: 4 of 4 matched. TOTAL: 880 OF 903 MATCHED.

Breakdown of Florida PGY-1 match rates by the most popular specialties: Internal medicine: 233 Family Medicine: 79

Pediatrics: 112

General Surgery: 84

Emergency Medicine: 53

Obstetrics and Gynecology: 39

Psychiatry: 43

Anesthesiology: 32

Radiology: 12

Breakdown of 23 unfilled residency slots by specialty: Anesthesiology: 7

Family Medicine: 3

Medicine-Preliminary: 2

Neurology: 1

General Surgery: 3 Surgery-Preliminary: 7

SOURCE: Association of American Medical Colleges (AAMC)’s 2011 State Physician Workforce Data Book.

JUNE 2013

Turning Point, continued from page 1 from Cincinnati Children’s Hospital Medical Center (CCHMC), where he served as the medical director of the ED at CCHMC’s second hospital campus, which opened under his leadership in 2008. “Before we opened Nemours, we wanted to take away obstacles that would delay a child being seen by a doctor. We asked parents what they wanted, and they said ‘to see a doctor!’” By placing a registered pediatric nurse as the ED pivot person – the first point of contact for incoming patients and their families – Glass was able to fast-track the triage process and see patients more quickly. Since opening in October, the Nemours ER average waiting time to see a doctor or nurse practitioner is less than 10 minutes. “A few years ago in Cincinnati, when we first put a nurse at the greeter desk, it was new, but made perfectly good sense. It only takes a minute or two for a nurse to assess a patient,” said Glass. “The Dr. Todd pivot nurse inputs the Glass patient’s name and birth date into the system, and then we move from there, effectively eliminating 30 minutes usually required upfront for full registration, which is done on the back end of the ER visit.” The ED front-door assessment has

JUNE 2013

already had a life-saving impact. “Several weeks ago, a pediatric patient with complex medical problems became ill at home,” said Glass. “Her mother pulled up to the ER entrance and asked for help with her child. The nurse picked up the child from the car and was aware right away the child was critically ill. She had gone into cardiac arrest. He took her immediately from the doorway to the resuscitation area, where she was successfully resuscitated. Typically, the first point of contact in an ER who answers questions – a clerical staffer or a security person – wouldn’t have been as aware of the symptoms. On his way to the resuscitation room, he told the staff to activate the code to page the teams. The child’s care was initiated

within 1-2 minutes of the mother pulling up to the door. That’s one of the things that saved her life – expediency of care – in addition to receiving very good care.” Glass has established an ER protocol that a team – the physician, nurse, and paramedics – works together for patients, whether critically ill or cases not as complex, as soon as they get in a room. Nemours’ ED has 18 private rooms where patients’ families are invited to stay during procedures. To help the medicine go down a little easier, the ED has a Slushee machine for children. “We don’t want a child to take medicine too fast, so this prompts them to drink slower and there’s less chance of vomiting,” said Glass. “Plus, a Slushee just tastes good.”

The ER triage process and elimination of time-consuming front-end paperwork has improved the average length of stay for patients – 80-100 minutes in the ED. “Obviously, groups with the shortest lengths of stay are critically ill,” said Glass. “We focus on getting care started to stabilize the patient and get them transferred to the critical care unit. The other group with very short lengths of stay, an average of 45-70 minutes, includes those who have very straightforward cases. It takes longer during peak hours; that’s the nature of an ER. We’ve never had a 6-8 hour wait time. Almost everyone goes home (or is admitted to the hospital) in less than two hours.”

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JUNE 2013

Physician Report, continued from page 1 first-year residency slots is a top priority. “Preventing the annual export of qualified GME candidates to other states is the crucial first step toward shaping the physician workforce of the future,” noted Armstrong. A demographic snapshot shows the average Florida physician is mid-career (59 percent between ages 40 and 60), male (75 percent), and white (63 percent). Every week, a majority spend 36 to 40 hours on patient care, seeing an average of 76 to 100 patients in a single specialty group practice. Two-thirds don’t provide on-call emergency room coverage because of hospital by-law exemption (20 percent), lifestyle considerations (16 percent) and undisclosed reasons (45 percent). Of active, licensed physicians reporting an impending move out of state (4 percent), one-fourth don’t yet have a planned destination. Others plan to relocate to Texas (153), California (120), South Carolina (85), Georgia (85), and New York (66), with the balance scattered around the country, mostly on the East Coast and in the South. Notable trends:

• Twenty-four percent of OB-GYNs no longer deliver babies because of liability exposure, cost of professional insurance, medical malpractice litigation, declining government reimbursement rates, and other reasons. • With most of the state’s 1,797 radiologists working in a hospital setting, their practice characteristics reflect reading diagnostic mammograms and sonograms (79 percent), reading screening mammograms (77 percent), performing ultrasound and stereotactic-guided core biopsies (55 percent), reading breast MRIs (48 percent), and reading MRI-guided core biopsies (33 percent). The Physician Workforce Advisory Council is a 19-member group established by state lawmakers in 2010 to address physician workforce needs in Florida. “These strategies, objectives, and progress measures make up the Department (of Health’s) inaugural strategic plan, with an objective of strengthening the state’s physician workforce assessment and development capabilities,” Armstrong emphasized.

PHYSICIAN WORKFORCE SPECIALTY COUNTS BY COUNTY: ORANGE COUNTY: 2,281 Family medicine: 345 Medical specialist: 306 Surgical specialist: 263 Internal medicine: 247 Pediatrics: 168 Emergency medicine: 167 Anesthesiology: 142 Pediatric subspecialist: 131 OB-GYN: 119 Radiology: 99 Psychiatry: 96 Pathology: 60 General surgery: 53 Neurology: 39 Dermatology: 25 Other: 21

LAKE COUNTY: 450 Internal medicine: 76 Family medicine: 74 Medical specialist: 68 Surgical specialist: 53 Pediatrics: 32 Radiology: 28 Anesthesiology: 26 OB-GYN: 24 Emergency medicine: 19 Pathology: 13 Psychiatry: 12 General surgery: 9 Dermatology: 6 Neurology: 5 Other: 5 Pediatric subspecialist: 0

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(Note: 157 unique specialties have been divided into 16 main specialty groups.)

SEMINOLE COUNTY: 562 Family medicine: 141 Internal medicine: 94 Medical specialist: 68 Surgical specialist: 52 Pediatrics: 44 Psychiatry: 29 OB-GYN: 29 Emergency medicine: 25 General surgery: 17 Anesthesiology: 16 Dermatology: 14 Neurology: 9 Radiology: 8 Other: 7 Pathology: 5 Pediatric subspecialist: 4

OSCEOLA COUNTY: 348 Medical specialist: 66 Family medicine: 60 Internal medicine: 59 Surgical specialist: 34 Pediatrics: 29 OB-GYN: 28 Emergency medicine: 14 General surgery: 14 Anesthesiology: 13 Psychiatry: 11 Neurology: 7 Dermatology: 4 Pathology: 4 Radiology: 3 Other: 1 Pediatric subspecialist: 1

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Incentivizing Residencies, continued from page 5 of people in urban areas need primary care doctors. It’s a universal problem.” Last month, UCF COM took a fresh step in training more PCPs when the ACGME approved its first university-sponsored residency program in partnership with the Orlando VA Medical Center and Osceola Regional Medical Center. The internal medicine residency will create 20 slots in 2014 and increase to a maximum of 60 MD graduates annually. “Residency programs are part of the promise that was made to this community and an important element in a medical school that will anchor a medical city,” said German. “If we have more residencies, we’ll have more trained doctors in our community because many doctors practice where they complete their residency programs.” Here’s how it works: Participating hospitals pay residents a stipend and cover the salaries of physician instructors; those costs may be reimbursed through federal Medicare and Medicaid funds. The COM will provide administrative support and oversight of the GME program from its existing state budget. UCF’s program will use an innovative scheduling of residents called the 4+1 rotation schedule, which alternates traditional 4-week hospital and specialty rotations with 1-week blocks of ambulatory or out-patient care. Residents support the 4+1 because it allows them to focus on specific clinical facilities and cuts down on time-consuming travel and logistical problems that occur when residents are dashing from facility to facility in the middle of a rotation. By the end of 2013, Osceola Regional, which is undergoing an expansion program, will have 317 beds. In addition to planning its Level II Trauma Center and meeting the needs of Osceola and Orange counties, Osceola Regional offers specialty programs, such as its Central Florida Cardiac and Vascular Institute and Orthopedic and Spine Center. “As a part of HCA West Florida, we view creating residency programs as an investment in the future of medical care for our community,” said Osceola Regional CMO Aida Sanchez-Jimenez, MD, who will serve as GME site director. Florida Hospital is also strengthening Orlando’s PCP workforce with accreditation for a pediatric residency program. The first residents will begin training at the Florida Hospital for Children next July. “The hospital is educating the doctors of tomorrow while helping fill an area of medicine where we’re seeing a shortage of physicians,” said Stacy McConkey, MD, pediatric resiDr. Stacy McConkey dency program director at Florida Hospital for Children. (Of 112 PGY-1 positions available this year, all were matched.) The 3-year pediatric residency program will have six residents per year, with a total of 18 residents when completely orlandomedicalnews

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FLORIDA RESIDENTS & FELLOWS Of 3,512 total residents and fellows in Florida (1.4 per 100,000) on duty as of Dec. 31, 2010 in ACGMEaccredited programs, the breakdown is: 2,176 allopathic school graduates 266 osteopathic school graduates 1,064 international medical graduates (IMGs).

full. Residents will complete their inpatient rotations at Florida Hospital for Children, and have a variety of outpatient pediatric subspecialty rotations including dermatology, urology and neurology. The residents’ primary outpatient experience will be at the new Florida Hospital Center for Pediatric and Adolescent Medicine Clinic in Winter Garden. State and National Movement In Florida, the Governor’s Office attempted this year to increase funding for residency programs, which might incentivize development of positions in the state. The increased funding was included in the Appropriations Act that state lawmakers passed several weeks ago; a “conforming bill” addressed funding for Medicaid-supported residencies. In Senate Bill 1520, which Gov. Rick Scott approved May 20, the Statewide Medicaid Residency Program expands primary care specialties beyond the PCMH scope to include preventive medicine, geriatric medicine, osteopathic general practice, and emergency medicine.

Because of complicated formulas regarding changing reimbursement methodologies for hospitals, the money represented in the GME budget line item doesn’t represent all new money. For GME expenses from the general revenue fund, $33 million was the tally. Add to that $46.9 million from the Medical Care Trust Fund. SB 1520 calls for a complex allocation formula to particular medical schools or hospitals, up to $50,000 per FTE (full-time equivalent) resident. Nationally, to help fill the gap between first-year residents and residency slots, the American Medical Association (AMA) in mid-January announced a $10 million competitive grant initiative, “Accelerating Change in Medical Education,” to be distributed over the next five years to fund projects that support a significant redesign of undergraduate medical education. Eighty-two percent of the nation’s 141 accredited medical school submitted proposals by the Feb. 15 deadline, necessitating an additional vetting process. This month at its annual meeting, the AMA will determine the disbursement.

Note: Florida has the third most IMGs, accounting for roughly one-third of all active physicians. SOURCE: Association of American Medical Colleges (AAMC)’s 2011 State Physician Workforce Data Book, National Resident Matching Program.

“Florida schools will hopefully get some of the money, for which we’re grateful, but it’s not anywhere close to putting a dent in our needs,” said Burkhart. Additionally, to address the gap of medical school graduates who won’t match to a residency program, legislation was reintroduced in March in both houses of Congress to create new residency positions for Medicare-supported training slots via the Resident Physician Shortage Reduction Act of 2013. Senators Bill Nelson (D-Fla.), Chuck Schumer (D-NY) and Harry Reid (D-Nev.), and Representatives Aaron Schock (R-Ill.) and Allyson Schwartz (DPa.) led the reintroduction of the bills (S. 577, H.R. 1180) to create the additional GME positions, according to the AMA. (At press time, GovTrack estimated a 1 percent chance of S. 577 moving from the Senate Finance Committee, and a zero percent chance of H.R. 1180 moving from House committees.) Editor’s note: Next month, Florida Medical News will continue to focus on the needs for residency programs in the state.

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More Information – Contact Larry Henry, St. Louis Medical News Phone: 314-917-6107 Email: lhenry@medicalnewsinc.com Seminar Registration – Seminar registration begins July 26. You can register on-line at www.stlouismedicalnews.com where you can also view detailed information about each seminar. Directions – Physicians Business Conference will be held at the Sheraton Westport Lakeside Chalet at 191 Westport Plaza, St. Louis, MO 63146. We suggest those flying to St. Louis Mapquest directions from Lambert International airport to the Conference site. Hotel Accommodations – Rooms can be booked at the conference site for $99 per night when you register for seminars at www.stlouismedicalnews.com.

JUNE 2013

Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis diarrhea is the main symptom of MC. Episodes of diarrhea can last for weeks, months or years. Most cases are interrupted by similarly long periods of remission – times when diarrhea goes away. The clinical course is mainly intermittent, but is sometimes continuous or rarely consists of a single episode. Other common symptoms of MC include abdominal cramps or pain and abdominal bloating. Less common symptoms of MC include mild weight loss, dehydration, nausea, weakness and fecal incontinence.

By SRINIVAS SEELA, MD

What is microscopic colitis (MC)? Microscopic colitis is inflammation of the bowel that is only visible using a microscope. Microscopic colitis is a common cause of chronic watery diarrhea and gastrointestinal symptoms. Diarrhea can range from mild and intermittent to severe and persistent, and can adversely affect quality of life, especially if there is significant fecal incontinence. The disorder gets its name from the fact that it’s necessary to examine colon tissue under a microscope to identify it. Microscopic colitis causes diarrhea without bleeding and can also be associated with fecal urgency and typically occurs in middleaged women. Rates of MC are similar to other forms of IBD, affecting about nine people in 100,000. Although it affects both men and women, collagenous colitis is much more common in women. Microscopic colitis is less severe than other types of IBD because it does not lead to cancer and rarely requires surgery. However, it can cause considerable pain and discomfort. Microscopic colitis affects the colon and rectum.

Two different types of MC have been generally recognized: Collagenous colitis and lymphocytic colitis. • The symptoms of and treatment for both are identical. Some scientists believe the two forms may be different presentations of the same disease. Slight differences in the way intestinal tissues appear when seen with a microscope set them apart. In both forms, an increase in white blood cells can be seen within the intestinal epithelium – the layer of cells that lines the intestine. Increased white blood cells are a sign of inflamma-

tion. But with collagenous colitis a thick layer of protein (collagen) develops in colon tissue Collagen is a structural protein in bones and cartilage. In the intestines, collagen anchors the intestinal epithelium to underlying layers of tissue. The thicker collagen layer seen with collagenous colitis may result from inflammation. Lymphocytic colitis is a condition, in which white blood cells (lymphocytes) increase in colon tissue. What are the symptoms of MC? Chronic watery and non-bloody

Pathogenesis The pathogenesis of the different forms of MC is unknown despite a detailed description of their pathology. It remains uncertain whether collagenous and lymphocytic colitis are related. The inflammatory cell response is similar in the two disorders. Furthermore, there is often significant histologic overlap. In one study, colonic biopsy was performed in 30 patients with chronic watery diarrhea and normal radiographic and endoscopic studies: 6 showed lymphocytic colitis alone; 7 showed collagenous colitis alone; (CONTINUED ON PAGE 12)

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Lucky ‘13 UCF COM Dean discusses graduation of charter class, celebrating 50th anniversary with main campus By LYNNE JETER

When the University of Central Florida College of Medicine (UCF COM) opened the door in 2007 for applications to the 2008 charter class, offering each student a full ride covering tuition and living expenses, 4,307 pre-med students applied for a coveted spot. Last month, the charter class of 35 graduated from the Lake Nona campus, marking a significant achievement for the 4-year-old medical school. In August, another landmark event will occur when the first full enrollment class of 120 new students arrives on campus. “We have all kinds of great things happening this year,” said Deborah German, MD, vice president for medical affairs and founding dean of the UCF COM, who still meets with every student accepted into the program during the application screening process. “Even though we’ve met some wonderful milestones on our journey, we’re just getting started.” Orlando Medical News spoke with German about highlights and insights for 2013. What has been the greatest delight for you this year?

That so many wonderful things would happen without any new initiatives. Special events included learning about our full accreditation, the first Match Day, graduation for the charter class, and the matriculation of 120 students into the fifth class of the COM, bringing us to our full size. On New Year’s Day, we knew that 2013 would be a beautiful year, and one for celebration. It’s a wonderful position for all of us in the Central Florida medical community to have. How does the UCF COM continue to add value to the Central Florida community? Perhaps the greatest benefit adding value to the community in many ways is that the College of Medicine has assembled a wonderful team to work on research, education and patient care. We’re a very fluid medical school. As we grow, we constantly keep our eyes on what’s been happening in healthcare and education around the world. We’re constantly refining our model. Our faculty redesigns the curriculum every year. Our scientists are using new discoveries this year, determining how to chart their path next year. So we’re not the kind of

school that puts in place a particular model and then is completely wed to it, because when or if you have that type of model, you miss the opportunity to make progress.

run by medical students and international work overseas with undeveloped countries. They’ve embraced the facultyorganized medical mission trips and are helping us acquire donations for personal hygiene items for the summer trip.

What has surprised you about community Dr. Deborah German response to the Share with us UCF COM? a quick global There have view of other been a thousand delightful surprises, and I COM accomplishments. couldn’t begin to list them all. The commuOur faculty has won national recogninity has really stepped up to the plate. We tion, research grants and leadership roles. have hospital and business partners, scholJust one of a number of accomplishments: arship donors, and more than 2,000 volOur students helped our medical school unteer faculty members. We just had our reach No. 1 in the world in a research first golf classic with the assistance of local competition online. businesses, which raised about $35,000 for scholarships. What are your hopes for the future? What has surprised you about the That the community will continue to medical students? partner with the medical school. We’re The students have continually amazed still growing; we’re still young. As long as me with their establishment of a free clinic we build together, we’ll be successful.

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Microscopic Colitis, continued from page 10 and 17 showed a mixed form with both thickening of the collagenous plate and an increased number of intraepithelial lymphocytes. The extent to which there may be a genetic predisposition to MC is unclear. However, familial cases have been described. Interestingly, different members of the same family developed either lymphocytic or collagenous colitis, supporting a similar underlying pathophysiology. The cause of MC is unknown. Many scientists believe it is an abnormal immune response triggered by something in the gastrointestinal (GI) tract. Normally, the immune system is triggered by germs, but sometimes it reacts to harmless bacteria, pollen, food, or even the body’s own cells. The belief that something in the GI tract causes MC is supported by evidence that the colon, when empty for a long time, recovers from inflammation. Keeping the colon empty is accomplished through a surgical procedure called an ileostomy, which diverts digestive waste away from the colon to an opening in the abdomen. The belief is further supported by the fact that inflammation returns when the ileostomy is reversed and the normal digestive route through the colon is restored. Harmful and harmless bacteria Some people get MC after being sick with certain harmful bacteria, including Yersinia enterocolitica, Campylobacter jejuni, and Clostridium difficile. Other people test negative for these and other harmful bacteria, but their condition improves with antibiotic treatment, suggesting normally harmless bacteria in the colon may trigger MC in some people. Medications No medications have been proven to cause MC but several have been linked to it, including acarbose (Prandase), aspirin, lansoprazole (Prevacid), nonsteroidal antiinflammatory drugs, ranitidine (Zantac), sertraline (Zoloft) and ticlopidine (Ticlid). Food Certain foods appear to trigger MC in some people. Although no specific foods have been identified, following a caffeineor lactose-free diet sometimes improves symptoms. How is MC diagnosed? Microscopic colitis can only be diagnosed by examining intestinal tissue removed during colonoscopy or flexible sigmoidoscopy. The term microscopic colitis implies that the diagnosis is made by histology. Thus, colonoscopy usually reveals macroscopically normal colonic mucosa, although slight edema, erythema,

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and friability may be seen. In small case series, chromoendoscopy using indigo carmine highlighted mucosal alterations that correspond to the histological distribution of MC. However, larger studies are needed before routine use of chromoendoscopy can be recommended for diagnosis of MC. Although specimens obtained by flexible sigmoidoscopy are frequently sufficient to establish the diagnosis, the severity of histologic changes declines from the proximal to the distal colon; thus, biopsies obtained from the right colon are optimal. Collagenous colitis can be patchy, with normal mucosa being found mainly in specimens from the rectosigmoid. In several reports, rectosigmoid biopsies alone would have missed the diagnosis of collagenous colitis in up to 40 percent of cases. In a retrospective analysis of histologic specimens from 56 patients, the highest diagnostic yield was achieved in biopsies from the transverse colon (83 percent) and right colon (70 percent), and lowest in the rectosigmoid (66 percent). Thus, total colonoscopy is necessary to establish the diagnosis of collagenous colitis and to exclude other inflammatory diseases. While colonoscopy is generally safe in such patients, an increasing number of perforations have been described in patients with severe collagen deposits (fractured colon). Crypt architecture is usually not distorted, but focal cryptitis may be present. How is MC treated? Treatment for MC often begins with eliminating medications with suspected links to MC and cutting out foods that can make diarrhea worse, including foods containing caffeine, high-fat foods, and dairy products. Antidiarrheal medications such as bismuth subsalicylate (Pepto-Bismol) and loperamide (Immodium) are effective for some patients. If diarrhea persists, corticosteroids may help, including prednisone and budesonide (Entocort). Corticosteroids have many potential side effects including insomnia, fluid retention, and mood swings. Budesonide has fewer side effects than other corticosteroids and has been shown to be effective for treating MC. Other medications used to treat MC include mesalamine and cholestyramine (Questran). What is the treatment outlook for those with MC? People with MC generally achieve relief through treatment, although relapses can occur. Some patients require long-term therapy because they experience prompt relapse when treatment is stopped. Unlike other forms of IBD, MC usually does not progress to other IBDrelated problems, such as arthritis, bowel obstruction, or colon cancer. Srinivas Seela, MD, finished his fellowship in Gastroenterology at Yale University School of Medicine. He is board certified in both Internal Medicine and Gastroenterology.

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Luxury, of course, does come with a price. Gjullin said residents pay a onetime entrance fee and ongoing monthly fee, both of which vary depending on the size of the residence selected. The monthly fee, he continued, “covers everything you could possibly think about that you would be paying if you were living in your own residence.”

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For a growing number of senior adults, continuing care retirement communities (CCRCs) provide the best answer – supporting active, independent lifestyles while offering increasing levels of care when required. That continuum allows residents to age in place. Headquartered in Des Moines, Iowa, Life Care Services has been developing and managing senior living communities for more than four decades. As the nation’s leading manager of full-service senior living communities, the company owns or operates more than 80 communities in 28 states and the District of Columbia and serves nearly 30,000 residents. Erik Gjullin, vice president/director of marketing & sales for Life Care Services, explained that residents arrive while independent with the knowledge that assisted living, Erik Gjullin skilled nursing and memory care facilities are available onsite. Key draws for living in CCRCs are the socialization aspect and knowing that once you are in, you have a home for life. Yet, Gjullin said, the focus of their communities is on maintaining wellness and independence. “The driver for our prospects, who are looking for solutions to senior housing, is to live somewhere where it’s easy to participate in a lifestyle that enhances health,” he said. Gjullin explained Life Care Services takes a ‘whole person’ approach to wellness. “Our HealthyLife™ Services program is really the overall health and wellness program that we practice in all our communities. It’s not just fitness,” he continued, “It’s nutrition. It’s socialization. It’s education. It’s ongoing lifestyle that really creates the wellness for the whole person.” While a number of programs and services are consistent across Life Care Ser-

tions from apartment-style residences to garden villas to detached cottages. Manicured lawns, gardening plots, walking and biking trails, guest accommodations, a clubhouse with restaurant-style menus, day spa, putting green, cocktail lounge, fitness center, library, convenience store, weekly cleaning service, 24-hour security and more are part of the well-appointed surroundings.

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vices developments, the communities are far from ‘cookie cutter.’ Gjullin said, “The unique part of it is people live in different geographic regions for a reason. They like the lifestyle. They like the architecture. So if you go into our community in Phoenix, Ariz., it looks like it belongs in Phoenix. It’s got local architecture, spaces and cuisine. It’s got the flavor of the southwest.” Residents enjoy a range of living op-

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your assets, what other program would you select?” he questioned. Again, Gjullin stressed, the goal is to keep seniors spiritually, physically, mentally and emotionally healthy for as long as possible to enjoy the array of options that come with this type of community. On any given day, seniors can be found attending a yoga class, planning community outings, choosing from chef-inspired cuisine, working out in the fitness center, sipping cocktails with friends or enjoying a relaxing manicure. “Our philosophy is choice, flexibility, and control,” Gjullin said. “That’s what we offer people who live here. That’s what seniors want. They didn’t get to the point where they could afford to live in a community like this and not have that as a basic philosophy.”

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The Trust Factor

Nashville firm reveals results of 7th annual payor survey; trust represents greater factor than rates By LYNNE JETER

NASHVILLE – In the wake of national health reform, the trust factor between hospitals and health insurance companies is perilously low. That’s the consensus of 373 hospital and health system administrators responsible for negotiating contracts with major health plans in the seventh annual National Payor Study. Conducted by Nashville-based ReviveHealth, the 2013 survey paints an interesting picture of administrators’ opinions about various private payor trends, including rates, payment of claims, denials and other actions. “The trust factor is huge when it comes to hospitals and health plans being able to play nice in the new world order of risk— sharing and improved health outcomes,” said ReviveHealth CEO Brandon Edwards. For the second consecutive year, hospital and health system leaders who negotiate managed care contracts with national health insurance companies pointed to WellPoint/Anthem as the nation’s worst plan, with only a 16 percent favorability rating. WellPoint manages health plans in 14 states, including Anthem Blue Cross in California. “Even though WellPoint now has a CEO with a strong provider background, he’s got to turn around an aircraft carrier, and that takes time,” said Edwards, noting that business practices and corporate behavior have contributed to the company’s poor reputation. “Their major imperative has to be improving their reputation and rebuilding trust with providers.” For the third consecutive year, UnitedHealthcare exacerbates its perennial poor showing, ranked worst in all areas of contract negotiations except payment plans. The payor held firm as the health plan with the most consistently poor reputation among hospitals – and the slowest to pay. “Honesty and candor represent United’s biggest challenges,” noted Edwards. “Hospitals year in and year out cite UnitedHealthcare’s low rates, slow payments, bureaucracy, and honesty as reasons for their poor rankings.” Aetna was given high marks for the best rates, followed closely by Cigna. “Honesty and easy business dealings seem to matter more than rates,” said Edwards. “Otherwise, Aetna would be the best rated plan in every category.” This year, independent Blue Cross and Blue Shield (BCBS) plans and Cigna tied for the top favorability spot, with 49 percent. Last year, Cigna held the spot alone. In this year’s survey, Aetna’s approval rating was 46 percent, followed by Coventry and UnitedHealthcare at 30 percent each, and Humana at 25 percent. Despite having the lowest rates for three consecutive years, BCBS plans earned top ranking for best overall business practices. orlandomedicalnews

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‘‘

The trust factor is huge when it comes to hospitals and health plans being able to play nice in the new world order of risk— sharing and improved health outcomes

’’

– ReviveHealth CEO Brandon Edwards.

“Independent BCBS plans, however, ranked well ahead of Cigna (30 percent compared to 19 percent) in terms of overall best to deal with, despite having the lowest ranking in payment rates to hospitals,” said Edwards. “For several years in a row, the survey revealed a complete lack of correlation between payment rates from any payor, and a hospital’s perception of that payor.” The survey, conducted in partnership with Catalyst Healthcare Research (CHR) and The Godbey Group, is the only one of its kind in the United States to target hospital leaders who negotiate managed care contracts with national health insurance companies. Respondents included CEOs, CFOs, and managed care/payor relations executives who negotiate on behalf of about one-third of the nation’s hospitals. “The goal of the study is to provide a national perspective of hospital leaders’ opinions of large health plans,” said Edwards, who initiated the survey after notic-

ing a void in payor ratings. “Even though health plans rate hospitals and their physicians routinely, no one was rating the health plans.” On an optimistic note, nearly half of all participants believe their negotiated rates will improve this year. Providers have varying strategies for success, with wellness programs a top priority for their employees, and clinical integration a second focal point. “Hospitals are taking the lead on wellness and population health programs with their own employees,” said Edwards. “Now they need to take that experience and go out to local employers with solutions to keep those employees healthy and costs down.” Nearly 40 percent of respondents reported their hospital had been in at least one public contract dispute in the past five years that resulted in non-participation. Also, the gap between rates for the largest payor and rates for the second and third

largest payors have widened considerably. “This ‘payor cost shift’ drives up profitability for the biggest plans at the expense of the smaller market share plans,” said Edwards. “That’s proven by the fact that more than one-third of hospitals would fail to meet profit margin goals if all private payor rates were the same as their largest payor.” Contracting priorities for the upcoming year – the top three are the same as 2012 – involve: 1. Increasing rates with the largest payor. 2. Producing better language protection against denials. 3. Increasing rates with the second and third largest payors. 4. Balancing the threat and opportunity of narrow networks within the hospital’s market. 5. Having better contracting language with the largest payor. 6. Procuring better reimbursement for high-cost drugs, implants and other carve-outs. 7. Expediting claims processing and payments. 8. Improving rates for Medicare Advantage plans. 9. Shifting reliance away from the largest payor. 10. B undling payments for medical home, ACO, or other population health strategies. SOURCE: ReviveHealth.

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GrandRounds $12,000 Worth of Orthopaedic Equipment Donated to Grace Medical Home The Orlando Orthopaedic Center Foundation donated $12,000 worth of durable medical equipment (braces, walking boots, crutches, etc.) to Grace Medical Home as a result of the 2nd Annual EmBrace Our Community drive. The donation is up $2,000 from last year’s inaugural campaign. Items for the EmBrace drive were collected from patients and community partners at all six of Orlando Orthopaedic Center’s office locations (Downtown Orlando, Winter Park, Lake Mary, Sand Lake, Oviedo and Lake Nona). Grace Medical Home is a non-profit medical care facility serving residents of Central Florida who reside at or below 200 percent of the federal poverty level. The EmBrace Our Community donation drive compliments similar Foundation efforts to help the underserved population in Central Florida. Each year the Foundation hosts separate fundraising campaigns to send underprivilegedchildren to summer sports camp and provide identified homeless children with a new pair of sneakers.

Sand Lake Imaging Hosts Open House To Community Physicians The radiologist team at Sand Lake Imaging; Stephen Bravo MD, Robert Posniak MD, Alexandra Osorio MD, Charlotte Elenberger MD, Catherine Gardner MD, Diana Wilson MD and Patricia Dycus RA; hosted an Open House event to showcase the most sophisticated technological imaging state-of-the-art services now available at both Sand Lake Imaging Centers. The event was catered by Arthurs Catering, entertainment provided by saxophonist; Johnny Mag Sax and was attended by over fifty community physicians, practice managers, referral coordinators and nurses. Sand Lake Imaging serves as the South East regional show site for Siemens Medical Corporation and as such, both outpatient facilities are equipped with the latest 3T MRI and MRA , Skyra; the newest multi-channel 3T MR by Siemens which offers a software sophistication and technology that is unparalleled at any other center in Central Florida. The 64-slice PET/CT now available is equipped with TrueV technology and enables PET scans to be acquired within a rapid time frame, with the least dose of ionizing radiation dose to the patient, as well as offering the ability to conduct sophisticated CT examinations such as coronary CT arteriography, CT aortography and runoff arteriography, CT colonography, CT enterography, and high resolution musculoskeletal and spinal CT reconstructed imaging. This sophisticated technological combination now provides the most exquisite scanning detail of a whole body PET/CT which can now

JUNE 2013

be performed in 15 minutes. The radiologists at Sand Lake Imaging are proud to continue to provide community physicians and patients with their unparallel level of expertise, latest technology and their commitment to patient care. In Caption from L to R: Sand Lake Imaging Radiologists; Robert Posniak MD, Charlotte Elenberger MD; Alexandra Osorio MD; Patricia Dycus RA and Stephen Bravo MD. Not pictured; Catherine Gardner MD, and Diana Wilson MD.

Sanford-Burnham collaborates with Florida-based research organizations to accelerate drug discovery Sanford-Burnham Medical Research Institute at Lake Nona (Sanford-Burnham) announced the selection of the first five research organizations that will participate in the Florida Translational Research Program (FTRP) to advance drug discovery in the state. The projects focus on cancer, diabetes, and obesity, and are led by scientists from the University of Central Florida, the University of Florida, the University of Miami, Scripps Florida, and Sanford-Burnham. The Program provides Florida-based scientists with access to drug discovery expertise and state-ofthe-art infrastructure at Sanford-Burnham. Three of the projects focus on discovering new treatments for cancer and other tumors. Claes Wahlestedt, M.D., Ph.D., and his team at the University of Miami are trying to find chemical compounds that stop MLL3, a protein that plays a central role in the development of several leukemias, as well as breast and colon cancers. Researchers led by Daiqing Liao, Ph.D., at the University of Florida have shown that a novel drug target for cancer, acetyltransferase p300, is a master regulator of cancer-cell survival. Novel inhibitors of p300 are thus expected to prevent the development of tumors in a variety of cancers. Cristina FernandezValle, Ph.D., at the University of Central Florida and her team seek compounds that block the protein merlin, which has a similar function as p300. While the research focus of each project varies greatly, all participating scientists agree that having access to state-ofthe-art screening technology enhances their ability to do research. The other two projects represent the first steps in the discovery of new medicines to treat diabetes and obesity. Patricia McDonald, Ph.D., at Scripps Florida will collaborate with Sanford-Burnham to identify molecules that block the function of a protein called GPR21, which is known to reduce the effects of insulin on the body. Fraydoon Rastinejad, Ph.D., and his lab at Sanford-Burnham seek to block the action of two other proteins that control metabolism and the expansion of fat cells, Rev-Erbα and Rev-Erbβ. The Florida Department of Health and Sanford-Burnham established the FTRP as a competitive grant program

that provides funding for collaborative drug discovery projects. The overall goal of the program is to translate research discoveries made in Florida laboratories into the medicines of tomorrow. This first year of the FTRP is a pilot phase with five project slots that were available; the number of projects is expected to increase next year. Applications were invited from investigators who had already developed innovative assays for use both in basic research and in therapeutic development, and who were interested in having their assay screened using Sanford-Burnham’s small-molecule library. In the future, the program will accept proposals for more comprehensive projects that may have a chemical component, not yet be ready for high-throughput screening, or require assay development services from Sanford-Burnham.

Dr. Sandeep Thaper and Dr. Marays Veliz Join Florida Cancer Specialists & Research Institute Florida Cancer Specialists & Research Institute (FCS) is pleased to announce that Dr. Sandeep Thaper and Dr. Marays Veliz, of Central Florida Hematology and Oncology, will be joining the statewide practice May 1, 2013, thereby bringing two new clinical locations to the group. The new offices will be located in Leesburg and Lady Lake, FL and will expand services to cancer patients in those two communities.

After earning his M.D. from the University of Delhi, New Delhi, India, Dr. Thaper completed his internal medicine residency at Helene Fuld Medical Center in New Dr. Sandeep Thaper Jersey. He then went on to do his fellowship in Hematology and Medical Oncology at Long Island College Hospital, State University of New York. Dr. Thaper sees patients Dr. Marays in three hospitals and Veliz has held positions of Vice Chief, Chief of Oncology, Vice Chief and Chief of Medical Staff at Leesburg Regional Medical Center. Dr.Veliz finished her residency in Internal Medicine at University of Medicine and Dentistry in NJ (UMDNJ) – where she served as Chief Medical Resident. Dr. Veliz was awarded a fellowship in Medical Oncology and Hematology at the H. Lee Moffitt Cancer Center in Tampa. She is board certified in Medical Oncology and Hematology and Internal Medicine. Florida Cancer Specialists & Research Institute offers a full range of oncology and hematology services, including clinical research and the use of evidencebased medicine and proactive patient support services. FCS is a strategic site of the Sarah Cannon Research Institute, one of the largest community-based clinical trial organizations in the United States.

Florida Hospital’s Mobile Health Program for Women Hits the Streets Florida Hospital’s Healthy 100 Women’s Mobile Health Coach is bringing health services into the community to make preventative screenings more available and convenient for all women. According to the American Association for Cancer Research, only 50 percent of eligible women get their annual mammogram. The Coach recently made a stop at the Nickelodeon Suites Resort (Nick Hotel) to offer convenient health screenings for female employees. The screenings available on the

Coach include: mammography, ultrasound, DEXA scan, electrocardiogram (EKG), body mass index (BMI) and skin analysis. The Coach also features wellness and spa services including various types of massages. The Coach has visited a variety of homes and businessaes throughout Central Florida including local hotels, government agency offices and more. To schedule the Healthy 100 Women’s Mobile Health Coach, visit www. Healthy100Women.org

The Florida Hospital’s Healthy 100 Women’s Mobile Health Coach travels throughout Central Florida to provide health screenings in a more convenient manner. orlandomedicalnews

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GrandRounds Local School Visits St. Cloud Regional Medical Center After having finished the FCATs at the end of April, most students would be excited to go on a field trip to a zoo or a park. In May however, a special group of 3rd graders, were excited to come to St. Cloud Regional Medical Center and “test drive” the surgical robot they affectionately named “S.I.R.E.N.” In February, 3rd-grader Briana Roberts, gave “S.I.R.E.N.” its name by winning the hospital’s “Name Our Robot” contest. Each student in Briana’s class got behind the controls of “S.I.R.E.N.”, the da Vinci® Surgical System, using the Skills Simulator to test the 3DHD vision and su-

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The students and surgical staff received tshirts made especially for the occasion.

perior dexterity that the robot provides. They also enjoyed an afternoon full of puzzles, games, food, and facts about the da Vinci® Surgical System. St. Cloud Regional’s surgical team led the visit and interacted with the students the entire time. They spoke about the importance of teamwork in a surgical setting and the significant roles that each person plays on a surgical team. “The children asked insightful questions about the robot, surgery, patient care, and teamwork” said Sherry Cooper, RN, Director of Surgical Services. “They are an impressive group of children with bright futures ahead of them.” To learn more about minimally invasive surgery using the da Vinci® Surgical System or the other services St. Cloud Regional offers the community, please visit StCloudRegional.com or call407-8912920 to find a physician. About St. Cloud Regional Medical Center St. Cloud Regional Medical Center is situated in the heart of St. Cloud, Florida. The modern 84-bed, acute care facility offers a comprehensive medical support system for both inpatient and outpatient needs. For more information about the hospital and its services, visitwww.stcloudregional.com.

Cornerstone Hospice Named as 2013 Hospice Honors Recipient

Florida Hospital Kissimmee Breaks Ground on Emergency Department Expansion

Cornerstone Hospice and Palliative Care’s mission to provide excellent care has been recognized. Cornerstone has been named a 2013 Hospice Honors recipient, a prestigious award recognizing hospice agencies providing the best patient care as rated by the patient’s caregiver. Cornerstone serves seven Central Florida counties with at-home, inpatient and in-facility care. Three of the organization’s hospice houses were specifically named as providing exceptional care to patients and their families: • Frank and Helen Discipio Hospice House in Tavares • Mike Conley Hospice House in Clermont • The Villages Hospice House in The Villages Established by Deyta, this esteemed annual honor recognizes the top 100 agencies that continuously provide the highest level of satisfaction through their care as measured from the caregiver’s point of view. Deyta used the Family Evaluation of Hospice Care (FEHC) survey results from over 1,200 partnering hospice agencies contained in its national, FEHC database with an evaluation period of January through December 2012. Deyta used the five key drivers of caregiver satisfaction as the basis of the Hospice Honors calculations.

Florida Hospital Kissimmee is expanding its emergency department to better serve the more than 43,000 patients it sees each year as Osceola County continues to grow. The hospital recently held a groundbreaking ceremony to celebrate the expansion that will more than triple the size of the emergency department from 7,023 to 22,560 square feet. As a result of the high demand for emergency care, the hospital plans to increase the bed count from 15 to 35 beds. The expansion will also include the addition of several kid-friendly rooms. Construction for 29 of the 35 beds is expected to be complete by end of the year, and the final phase will be completed by summer of 2014. Florida Hospital Kissimmee is currently an 83-bed facility and has been a part of the Osceola County community since 1993.

New Test Takes “Panoramic Photo” of Blood to Identify Risk of Blood Clotting A newly patented testing method from researchers at the Florida Hospital Center for Thrombosis Research is getting one step closer to being able to determine a particular individual’s chance of suffering a blood clot. Around 900,000 people suffer a blood clot every year in the US alone, and this number is pro-

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GrandRounds jected to double over the next 30 years. Blood clots are a leading cause of death and are especially common in surgical and cancer patients. The new testing method could help physicians tailor treatment options to an individual cancer or surgical patient to decrease or completely avoid the complication of blood clots. The new test does this by giving researchers and physicians a ‘global’ picture of how a person’s blood cells and proteins work together to form a clot. “Think of the new testing method like taking a panoramic photo,” said Dr. John Francis, Director, Florida Hospital Center for Thrombosis Research. “When you take a panoramic photo, you can fit the entire object in the picture. Now we are able to take a full ‘picture’ of a person’s blood clotting potential, including both plasma and blood cells, and not have to rely on piecing together multiple individual tests.” In addition, most traditional tests were designed to tell physicians how likely a patient is to bleed, not clot. This new global approach provides information on both possibilities and is a closer representation of how the blood clotting system actually works in an individual patient’s body. “The truth is that blood clots are far more dangerous than bleeding and one of the most common complications for cancer and surgical patients,” said Dr. John Francis. “While the results we’ve been able to gather in the past about how likely a patient is to bleed are important, our ability to better understand an individual patient’s risk of developing a blood clot will ultimately save more lives.” Central Florida patients will be the first to have access to this test at the Florida Hospital Center for Thrombosis Research, which is currently beginning clinical trials with the new method. As research continues, the hope is that this testing method will become standard for cancer and surgical patients.

It was the first note I ever got in crayon. “Thank you for making my daddy feel better.” I keep it on my desk, where I pore over patient records and cash flow statements. Because even if the medical field seems to be changing by the day, the reasons I practice never do.

Tuskawilla Nursing and Rehab Center Receives Governor’s Gold Seal Award The Florida Agency for Health Care Administration (AHCA) has awarded Tuskawilla Nursing And Rehab Center the coveted Governor’s Gold Seal Award for 2013-2014. This award recognizes facilities that demonstrate the highest standards of quality of life and care for their residents. Gold Seal Award recipients are selected by the Governor’s Panel on Excellence in Long Term Care. Of the 678 licensed facilities in Florida, only 19 currently hold the Gold Seal Award. The Gold Seal Award program was established in 2002 and recognizes facilities that have exceptionally high standards and display excellence in the quality of care delivered to their residents.

Our Medical Specialty Group provides a dedicated team with tailored solutions to meet the unique financial needs of physicians and their practices. Visit suntrust.com/medicine to find an advisor near you. Securities and Insurance Products and Services: Are not FDIC or any other Government Agency Insured • Are not Bank Guaranteed • May Lose Value. SunTrust Private Wealth Management Medical Specialty Group is a marketing name used by SunTrust Banks, Inc., and the following afﬁliates: Banking and trust products and services, including investment advisory products and services, are provided by SunTrust Bank. Securities, insurance (including annuities) and other investment products and services are offered by SunTrust Investment Services, Inc., an SEC registered investment adviser and broker-dealer, member FINRA, SIPC, and a licensed insurance agency. SunTrust Bank, Member FDIC. © 2013 SunTrust Banks, Inc. SunTrust is a federally registered service mark of SunTrust Banks, Inc. How Can We Help You Shine Today? is a service mark of SunTrust Banks, Inc.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.

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ROBOTIC SURGERY

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Performed the first robot-assisted gallbladder removal in December 2012.

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