Oxford Health & Life Winter 2023

THE MARK OF NURSING EXCELLENCE

THANKS TO a top-flight nursing staff, McCullough-Hyde Memorial Hospital |TriHealth (MHMH) is in select company. The hospital has been granted Magnet designation by the American Nurses Credentialing Center (ANCC), one of the highest honors a hospital can achieve. “Magnet designation indicates to patients and the public that McCullough-Hyde Memorial Hospital has met the most stringent, evidence-based standards of nursing excellence in patient care,” says Amy Keller, MSN, RN, NPDBC, Professional Excellence Specialist for TriHealth Nursing Administration.

Only 601 of the nation’s nearly 6,100 hospitals are Magnetdesignated, and the journey to earning the ANCC Magnet credential is demanding. After applying, hospitals must provide nearly 90 documents that provide evidence of meeting or exceeding the requirements of the Magnet Manual. The documentation period occurs over 48 months. Once the documents are approved, the organization is granted a three- to four-day site visit from ANCC’s appraiser team to validate that the nursing staff—and the hospital overall—aligns with the required Magnet standards. After that, all findings are submitted to ANCC’s Commission on Magnet Accreditation, a volunteer governing body of nursing executives, experienced nurses and the public. The Commission reviews the findings and decides whether to

grant designation. The total process takes about five years, and hospitals must reapply every four years. MHMH’s leadership team believes the effort is very worthwhile.

The Magnet credential means patients can rest assured they’ll be in good hands. Patient satisfaction ratings are significantly higher among Magnet hospitals than among nondesignated hospitals, 2014 findings in the journal Policy, Politics, and Nursing Practice suggest. Patient outcomes also are more favorable, with decreased rates of pressure injuries and falls and lower death rates, Keller says.

“For our nurses, achieving Magnet designation is a strong source of pride,” says Jennifer Skinner, MSN, RN, NEA-BC, TriHealth Senior Vice President and Chief Nursing Executive. “It’s an external evaluation of excellence and one that’s not easily achieved.” In addition, Keller notes, nurses at a Magnetdesignated hospital reap tremendous professional benefits, including overall better working conditions, collaboration with more highly educated colleagues, and higher overall job satisfaction compared with nurses in non-Magnet hospitals.

“We have nurses who have joined us because we are Magnetdesignated,” Skinner adds. “They could trust that our organization met this high standard of excellence and would have a culture that supports nursing excellence and high-quality care.”

OUR MAGNET DESIGNATION FOR NURSING IS NATIONAL RECOGNITION THAT WE PROVIDE THE HIGHEST QUALITY PATIENT CARE.

Our Magnet Champions: Back row—Jackie Woodruff, BSN, RN, CAPA; Kelley Alvey; Brittney Simpson, RN; Deborah Bommer, BSN, RN. Front row—Amy Arndt, BSN, RN, TNCC; Amanda Reiboldt, MSN, RN, CNML; Vicki Cheng, BSN, RN, ACM-RN. Below: Rachel Lathery, BSN, RN

FAST ACTION FOR STROKE

M c CULLOUGH-HYDE MEMORIAL HOSPITAL IS NATIONALLY RECOGNIZED FOR QUALITY STROKE CARE.

WHEN A PATIENT suffers a stroke, McCullough-Hyde Memorial Hospital | TriHealth (MHMH) is ready to act fast.

In July, MHMH was certified as an Acute Stroke Ready Hospital (ASRH) by The Joint Commission, the nation’s preeminent healthcare credentialing organization. “McCullough-Hyde Memorial Hospital is committed to providing evidence-based stroke care and treatment right here in Oxford,” says Pamela Otten, MSN, RN, FF/NR-P, CEN, SCRN, who coordinates stroke certification activities for the hospital.

Every minute counts during an ischemic stroke, which occurs when blood flow to the brain is slowed or interrupted. Fast treatment is critical to preserving brain function and preventing disability or death.

THE IMPORTANCE OF SPEED

For eligible patients, ischemic stroke is treated with tissue plasminogen activator (tPA), an intravenous clotdissolving medication that restores blood flow to the brain and halts neurological damage. American Heart Association guidelines recommend administering tPA within 60 minutes of a stroke patient’s arrival in the ER to maximize recovery and function. This arrival-to-treatment interval is called door-to-needle time (D2N).

To achieve Joint Commission ASRH certification, hospitals must achieve a median D2N time of less than 60 minutes

and must meet this timeline for at least 50 percent of ischemic stroke patients. Over four months, MHMH’s median D2N time was 52 minutes, and 83 percent of ischemic patients were treated within 60 minutes, Otten says.

Another critical metric, door-in-doorout time (DIDO), measures the ability to transfer ischemic stroke patients who need specialized care within 120 minutes of ER arrival. MHMH achieved a median DIDO of 102 minutes.

Otten credits the efforts of all MHMH patient-care departments—from the ICU to housekeeping—with optimizing the inpatient stroke alert response. Strategic partnerships with MidWest Transportation, MedFlight of Ohio, UC Air Care and the Oxford Fire Department also have helped MHMH improve DIDO times by transferring stroke patients more efficiently to the Comprehensive Stroke Center at Good Samaritan Hospital, TriHealth’s closest stroke center, Otten adds.

MHMH’s commitment to prompt, local stroke care is critical because other stroke-treatment centers are a distance from MHMH’s Southwestern Ohio and Southeastern Indiana patient base, Otten says.

“Patients constantly tell us they worry that their families won’t be able to see them if they’re transferred,” Otten says. “Being able to receive acute stroke care at MHMH means some stroke patients can stay at MHMH.”

SIGNS OF A STROKE

If you have any of the following symptoms—which are represented in the “BEFAST” acronym—seek medical treatment immediately:

sudden headache, dizziness)

B is for balance (loss of balance,

E is for eyes (blurred vision) F is for face (one side is drooping) A is for arms (weakness or numbness) S is for slurred speech or trouble talking

is for time to call 911

PEDIATRICS PARTNERS IN

MARRIED PHYSICIANS BRING UNIQUE EXPERIENCES TO THEIR NEW ROLES AT OXFORD PEDIATRICS.

GIVEN THE pressing need for quality family healthcare, TriHealth is fortunate to welcome not one, but two highly trained pediatricians to McCulloughHyde Memorial Hospital | TriHealth. With deep roots in the Oxford community,

Timothy Richmond, MD, and Heather Mandrell, MD, PharmD, say they’re happy to remain firmly grounded in their hometown.

“Heather and I are both from Oxford. Having grown up here, it was

a natural choice for us to return,” says Dr. Richmond of the married couple’s decision to join Oxford PediatricsBrookville.

“Oxford and the surrounding communities are closer knit than larger

metropolitan areas,” says Dr. Mandrell, “which lends itself to a more personal approach and closer relationships between families and medical providers—that’s important to us.”

OHIO EDUCATED AND TRAINED

Drs. Richmond and Mandrell met when they were young. “Heather and I were on the swim team at Talawanda High School,” says Dr. Richmond, who continues to participate in alumni swim events. After graduating from high

school, the duo obtained bachelor’s degrees in chemistry from Miami University. They married and moved to Columbus, where Dr. Richmond attended medical school at Ohio State University, graduating in 2015.

At the same time, Dr. Mandrell completed a doctoral degree in pharmacy at Ohio State. She soon realized that she wanted more in-depth interaction with patients than the field of pharmacy allows. Pediatrics was a natural fit. “I enjoy working with children and love the lighthearted atmosphere that surrounds them,” she says.

The couple moved to Akron, where Dr. Richmond completed a pediatric residency at Akron Children’s Hospital and then joined the hospital’s outpatient pediatrics department. Meanwhile, Dr. Mandrell attended medical school at Northeastern Ohio College of Medicine and completed a pediatric residency at Akron Children’s Hospital in 2022.

SHARING EXPERTISE

Drs. Richmond and Mandrell are excited to build their clinical practices at Oxford Pediatrics - Brookville, where they provide the full spectrum of medical care for children—from newborns through the transition to adulthood. “We enjoy our work and it’s nice to be able to readily draw on each other’s experience,” says Dr. Richmond. He brings a background in food allergies and allergic conditions and Dr. Mandrell has a pharmacy PhD and specialized experience in medication management.

The doctors acknowledge that the field of pediatrics faces many challenges, among them the recent formula shortage, vaccine hesitancy and pressing childhood mental health concerns. “Our role is to help families navigate these challenges,” says Dr. Richmond, whose office helps families secure formula or alternatives as supply-chain issues resolve.

Noting that vaccine hesitancy has been at the forefront in recent years, in part due to the COVID-19 pandemic, Dr. Richmond says: “Our stance is that vaccination is central to the

management of infectious disease in infants and children. When working with families who express hesitancy, we listen closely to their questions and concerns so we can create an appropriate vaccination plan.”

Mental health in children, similarly, has become a topic of growing concern across the country, notably attentiondeficit/hyperactivity disorder (ADHD), anxiety and depression. “At Oxford Pediatrics, we care for patients who have all of these conditions,” says Dr. Richmond. “We personalize mental healthcare plans for each child so they can feel their best at home and at school.”

RESPECT FOR THE INDIVIDUAL

With a shared philosophy of care rooted in communication and respect, Drs. Richmond and Mandrell say they treat patients and families the way they’d want to be treated. “We respect the individuality and autonomy of our pediatric patients,” says Dr. Mandrell. “We believe it’s important to bring children into the discussion of their medical care, often from an early age, so they feel included and begin building the foundation for shared, and eventually independent, medical decision-making. And we pay close attention to the concerns of family. Their input helps us arrive at the most accurate diagnosis.”

While Drs. Richmond and Mandrell care for their individual patients in a shared pediatric practice, they’re also navigating married life. “It can be a challenge syncing our on-call schedules,” laughs Dr. Richmond. But the perks of working and living together outweigh any negatives. “We enjoy our jobs and everything the town of Oxford has to offer,” says Dr. Richmond. An added benefit for the avid cyclists: “We can ride our bikes to work!”

TIMOTHY RICHMOND, MD, AND HEATHER MANDRELL, MD, ARE ACCEPTING NEW PATIENTS. TO MAKE AN APPOINTMENT AT OXFORD PEDIATRICS, CALL 513.523.2156 .

Raised and educated in Oxford, Timothy Richmond, MD, and Heather Mandrell, MD, PharmD, are happy to return to practice pediatrics.

A TIME OF CHALLENGES

PARENTS PLAY AN IMPORTANT ROLE IN KNOWING WHEN ADOLESCENTS MIGHT NEED HELP.

ADOLESCENCE is a time when bodies and minds are changing rapidly. Adding the social challenges that come with school and peer groups—not to mention the added stress of navigating a pandemic—can create a perfect storm for young people.

As adolescents move toward independence, they may struggle with the mental, emotional and physical changes they’re experiencing.

Issues such as body image, gender identification and bullying (particularly cyber-bullying) have come to the forefront of parents’ radar in recent years. These and other challenges carry with them anxiety, which can make it difficult to cope.

It’s important for parents to understand what is and isn’t normal behavior during adolescence, so here’s an overview.

WHAT’S NORMAL

Teenagers are known for occasionally behaving impulsively. This is because the amygdala region of the brain, which is associated with emotions, impulses and aggression, develops before the frontal cortex, which controls reasoning. So it’s not unusual for adolescents to occasionally:

• Act impulsively

• Engage in fights

• Misinterpret social cues and emotions

• Take part in risky behavior

WHAT’S NOT

Adolescents are also known to have occasional moodiness as the result of developmental changes. However, ongoing negative behavioral changes are key signs

to watch for. Parents should be aware of negative behavioral trends, including:

• Prolonged moodiness or irritability

• Withdrawal from activities once enjoyed

• Regular expressions of hostility, worries or fear, or crying

• Extended avoidance of parents

• Abandonment of longtime friendships for a different group of friends

• Regularly feeling “sick”

SUPPORT FOR PARENTS

If your teen displays warning signs, you can get help from your child’s primary care physician. In addition, information about issues affecting children are offered on the websites of the organizations listed below.

The American Academy of Child and Adolescent Psychiatry ( www.aacap.org ) has details on the emotional and cognitive development of children and adolescents.

The Anxiety and Depression Association of America ( www.adaa.org ) has information on those disorders and other challenges adolescents are facing.

The Centers for Disease Control and Prevention provides information on risk behaviors for parents of teens at www.cdc.gov/parents/teens/risk_Behaviors.html

IS IT A COLD, FLU OR COVID-19?

THEY’RE ALL VIRAL, AND THEY SHARE SOME SYMPTOMS. HERE’S SOME HELP TELLING THE DIFFERENCE.

IT’S HAPPENING now and likely to increase over the winter: Patients have upper-respiratory symptoms and worry that they may have COVID-19. What do do?

First, it’s important to stay calm. The likelihood that you’re going to recover well from a cold, the flu or COVID-19 is very high. The important thing is to seek medical attention when you need it.

Call your primary care doctor and describe your symptoms to find out what your next steps should be. However, if you feel that your symptoms warrant a trip to the Emergency Department—for example, if you’re having difficulty breathing— don’t delay.

Statistics show that people with underlying health issues, such as cancer or diabetes, are most likely to have serious complications from COVID-19.

Because the flu and COVID-19 share many symptoms, it’s not possible to tell them apart without specific testing. But this chart can be used to get an idea of what your symptoms may mean.

HOW IT SPREADS

KEY SYMPTOMS

COLD FLU COVID-19

Droplets expelled by coughing, sneezing or talking; touching a surface that has the virus on it

Nasal congestion, sore throat, headache, possibly mild cough

Droplets expelled by coughing, sneezing or talking; touching a surface that has the virus on it

Fever, chills, muscle aches, exhaustion; runny nose, sore throat, headache; possible nausea, vomiting, diarrhea

Droplets expelled by coughing, sneezing or talking; touching a surface that has the virus on it

A wide range, including fever, cough, shortness of breath; sometimes, lack of taste or smell, which may come on suddenly. Some people experience only a few of these symptoms or none at all.

HOW IT’S DIAGNOSED

TREATMENT

No test; diagnosis based on symptoms

Bed rest; fluids; over-the-counter medications, such as decongestants, pain relievers and cough suppressants

Swab test performed by healthcare provider

Bed rest; fluids; overthe-counter medications to relieve symptoms. In severe or highrisk cases, antiviral medications may be prescribed.

Usually, swab or saliva test

Bed rest; fluids; overthe-counter medications. Antiviral medications or monoclonal antibodies may be used to treat those at increased risk of severe illness.

RECOVERY TIME

PREVENTIVE MEASURES

A few days to two weeks

Wash hands often; don’t touch face; avoid close contact with infected persons

A few days to two weeks, if no complications, such as pneumonia, develop

For mild cases, about two weeks; for more severe cases, six weeks or more

Wash hands often; don’t touch face; wear mask; maintain 6 feet of distance from others outside your home; avoid contact with infected persons; get recommended vaccinations

VISIT OXFORD PRIORITY CARE MONDAY—SUNDAY, 10 AM TO 6 PM AT 5151 MORNING SUN ROAD IN OXFORD. PHONE: 513.524.5522

BE WINTER SMART

Prepare

Water in clean containers

A battery-powered

least one

first-aid

phone

Make

your car winter-safe

• Wear layers of light, warm clothing, as well as mittens or gloves, a hat and a scarf.

• Instead of sneakers, opt for waterproof boots with high-traction soles.

• If you have a history of heart problems, don’t shovel without your doctor’s permission.

• Shovel only fresh snow, which is lighter, and work at an easy pace.

• Push the snow instead of lifting it out of the way.

• When you must lift snow, bend your legs and use their strength, sparing your back.

• Use a small shovel, or only fill part of a large one, to avoid straining.

• Take a break if you feel out of breath.

OXFORD HEALTH & LIFE | WINTER 2023 9

ESOPHAGUS

STOMACHACHES, constipation and diarrhea are common discomforts that usually pass fairly quickly. When they don’t, unfortunately, many people will suffer with them for a long time before they seek help.

Two of the most prevalent and most treatable types of gastrointestinal distress are gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). If you have ongoing symptoms of either of these conditions and it’s having a negative impact on your quality of life, you should see a doctor. Follow these guidelines to assess your situation.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

WHAT IT IS: Irritation of the esophagus (the tube that connects the mouth and stomach) that occurs when your stomach contents come back up into your esophagus.

SYMPTOMS: A burning sensation in the chest after eating, a sour taste in the back of the throat, difficulty swallowing, hoarseness, chest pain and the feeling that there’s a lump in the throat.

WHAT CAUSES IT: Aggravating factors include stress, being overweight or obese, being pregnant, smoking and hiatal hernia (bulging of the top of the stomach up into the diaphragm). Certain foods and beverages worsen reflux, including spicy foods, tomatobased sauces, chocolate and caffeinated drinks, especially if consumed close to bedtime. Some medications, such as sedatives, calcium channel blockers and nonsteroidal anti-inflammatory drugs, can

contribute to GERD. Aging is also a factor.

WHEN TO SEE A DOCTOR: If you experience reflux three or more times a week for several weeks. Your doctor will likely recommend dietary changes and may consider prescription medication. If you’ve been experiencing reflux for longer than a month, your doctor may recommend an upper endoscopy—a 10-minute test done with a flexible camera under IV sedation in a hospital or surgical center—so that any damage to the esophagus can be assessed.

IRRITABLE BOWEL SYNDROME (IBS)

WHAT IT IS: A chronic disorder in which the contents of the colon can’t move along smoothly.

SYMPTOMS: Abdominal pain, cramping, bloating, gas and changes in bowel movements (diarrhea or constipation). WHAT CAUSES IT: Severe infection and changes in gut microbes are suspected. Stress also seems to play a role.

WHEN TO SEE A DOCTOR: If you’ve experienced symptoms for more than two months. In most cases, doctors first rule out easily-treatable conditions that might be causing symptoms, such as celiac disease or a parasitic infection. If the cause of your symptoms remains unclear, your doctor might order a colonoscopy to check for signs of inflammation.

Treatment for IBS can include dietary and other lifestyle changes, medication and mental health therapies.

IBS should not be confused with inflammatory bowel disease (IBD), which is an umbrella term used to describe debilitating and sometimes life-threatening disorders, including Crohn’s disease and ulcerative colitis.

TO SCHEDULE A GASTROENTEROLOGY APPOINTMENT IN OXFORD, CALL DR. ROBERT CUCINOTTA’S OFFICE AT 513.853.9250

Stomach acid moving up into the esophagus causes acid reflux symptoms. GERD is a severe form of acid reflux.

Is Brown Rice Too Nice?

LET’S FACE IT: Brown rice has an image problem. It’s an unexciting, take-it-for-granted side dish, a health-food cliché, a typecast bowl of everyday earnestness. How long has it been, after all, since you drove across town because a Chinese restaurant was reputed to have good brown rice?

But take a fresh look at this world-feeder. Rice provides more than one-fifth of the calories consumed by the human race. It’s a staple in many cultures, and it originated either in China or in India, depending on which archaeologists you ask. Though there are many types of this cereal grain—white, jasmine, purple and red, for example—none are quite as nutrient-packed as the brown variety. White and brown rice, aka whole-grain rice, are both made from the same grain, but brown has only the inedible outermost hull layer removed, leaving behind the nutritious bran layer and cereal germ, both of which the refined white rice lacks. It has just as much versatility, not to mention many more health benefits, vitamins and minerals. And it has an appealing, nuttier taste. Brown rice may not often be the star, but it’s the kind of supporting player that carries the show.

POWER UP

Brown rice is gluten-free and high in folate, vitamin B2, potassium and calcium, and has only about 215 calories per one-cup serving. Its claim to fame, though, is that it’s exceptionally high in manganese, a mineral integral to healthy bone development, muscle contraction, nerve function and wound healing. Whole grains in general also contain lots of fiber, which helps lower cholesterol, aids in digestion and keeps you feeling fuller longer. And if you or a loved one has diabetes, it’s worth stocking up on the stuff because brown rice has a low glycemic index,

which means it’s digested more slowly and doesn’t cause a spike in blood sugar.

Though brown rice is technically a carb, it’s nonetheless a good option if you’re looking to reduce or maintain your weight. In part maybe that’s simply because the fiber in it fills you up and thus prevents you from overeating. But a study published in the American Journal of Clinical Nutrition done by Harvard Medical School/Brigham and Women’s Hospital found that women who consumed more whole grains such as brown rice consistently weighed less than those who ate less of these fiber-rich foods.

BUY/STORE/SERVE

Brown rice is generally harvested in the fall but available yearround at grocery stores. It’s stocked on shelves loose and in large plastic bags, or you can buy it in a zippered bag or a cardboard box filled with individual serving-sized portions that require a fraction of the cooking time (but contain just as many nutrients). The bagged varieties can be heated up in the microwave or boiled on the stove, while loose rice needs to be cooked or steamed for about 30 minutes, generally at a 2:1 ratio of water to rice.

You can easily store brown rice in the box or bag it came in or in an airtight plastic container. It will last up to a week in the fridge after it’s cooked and months in your pantry uncooked. (Yep, rice’s shelf life is another major plus.)

The two most common types of brown rice are short grain and long grain. Short grain has plump kernels, a chewy texture and a nuttier flavor, whereas long grain is lighter, fluffier and not quite as sticky. Short kernels work best in a risotto or sushi, while long tastes great in a stir-fry or a pilaf. Actually, the options for both types are endless: Stir your brown rice into a salad or soup, bake it into a veggie burger with corn and beans or enjoy it as the base of a grain bowl with veggies and protein. Essentially, brown rice works for breakfast, lunch and dinner. How many other foods boast such versatility?