December 2009 >> $5 Ndidi N. Nwamu, DO, MBA PAGE 3 PHYSICIAN SPOTLIGHT PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ON ROUNDS June 2013 >> $5 PRINTED ON RECYCLED PAPER PROUDLY SERVING CENTRAL FLORIDA ONLINE: ORLANDO MEDICAL NEWS.COM Now Available! Register online at OrlandoMedicalNews.com to receive the new digital edition of Medical News optimized for your tablet or smartphone! 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 (CONTINUED ON PAGE 8) (CONTINUED ON PAGE 6) BY LYNNE JETER Before the Nemours Children’s Hospital opened in Or- lando last October, newly minted Emergency Department (ED) chief Todd Glass, MD, collaborated with Nemours’ nurs- ing 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 Turning Point Nemours Children’s Hospital ED expedites triage process with RN as pivot person 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 capabili- ties while also enhancing the prac- tice environment. “The strategies proposed … lay the groundwork required in pursuit of that goal,” ex- plained John H. Armstrong, MD, state surgeon general and council chairman, about physician attraction, reten- tion 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) opportuni- ties to narrow the gap between medical school graduates and Physician Workforce Report Inaugural Physician Workforce Assessment and Development Strategic Plan aims to strengthen capabilities, improve practice environment
Transcript
December 2009 >> $5
Ndidi N. Nwamu, DO, MBA
PAGE 3
PHYSICIAN SPOTLIGHT
PRSRT STDU.S.POSTAGE
PAIDFRANKLIN, TN
PERMIT NO.357
ON ROUNDS
June 2013 >> $5
PRINTED ON RECYCLED PAPER
PROUDLY SERVING CENTRAL FLORIDA
ONLINE:ORLANDOMEDICALNEWS.COM
Now Available!Register online at
OrlandoMedicalNews.com to receive the new digital edition of
Medical News optimized for your tablet or smartphone!
Incentivizing ResidenciesFlorida leaders work on ways to increase residency slots, keep COM graduates in state ... 5
Lucky ‘13UCF COM Dean discusses graduation of charter class, celebrating 50th anniversary with main campus ... 11
(CONTINUED ON PAGE 8)
(CONTINUED ON PAGE 6)
By LyNNE JETER
Before the Nemours Children’s Hospital opened in Or-lando last October, newly minted Emergency Department (ED) chief Todd Glass, MD, collaborated with Nemours’ nurs-ing 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-certifi ed in pediatrics and pediatric emergency medicine. Glass joined Nemours
Turning PointNemours Children’s Hospital ED expedites triage process with RN as pivot person
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 capabili-ties while also enhancing the prac-tice environment.
“The strategies proposed …
lay the groundwork required in pursuit of that goal,” ex-plained John H. Armstrong, MD, state surgeon general and council chairman, about physician attraction, reten-tion and retraining. “Florida shapes a stronger physician workforce today by reviving existing incentive programs, targeting specifi c 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) opportuni-ties to narrow the gap between medical school graduates and
Physician Workforce ReportInaugural Physician Workforce Assessment and Development Strategic Plan aims to strengthen capabilities, improve practice environment
2 > JUNE 2013 o r l a n d o m e d i c a l n e w s . c o m
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PhysicianSpotlight
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 ne-phrology,” said the 36-year-old solo prac-titioner 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 Ni-geria 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 at-tend 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 an-thropology, chemistry and biology, with a minor in dance.
Nwamu was accepted into a dual pro-gram that allowed her to earn her medical doctor and masters of business administra-tion degrees at the New York Institute of Technology College of Osteopathic Medi-cine. An internal medicine residency fol-lowed in Stamford, Conn., before Nwamu completed a two-year fellowship in ne-phrology 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 Pat-rick 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 Afri-can 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.
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 di-rector for Mobile Dialysis, Inc. She said her business management training is “defi-nitely coming in handy” at her practice, where she does her own budgeting, book-keeping and marketing. For now, she em-ploys 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 work-ing there. The entire Florida Hospital sys-tem 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 every-thing 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 peo-ple over the head about (faith), but stud-ies 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 ser-vant. It is disheartening to see some physi-cians 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 pa-tience is amazing,” said Johnson.
Nwamu nourishes that approach with morning meditation and yoga sessions. “It helps me center and be positive, and re-lease 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 web-site 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 rota-tions in her practice, and she lectures at the University of Central Florida College of Medicine. Recalling her personal rev-elation as a med school student, Nwamu said she “just loves seeing those light bulbs go off when the students realize the intri-cacies of nephrology.”
Ndidi N. Nwamu, DO, MBANephrologist, Delta Kidney & Hypertension
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By LyNNE JETER
Two years ago, 282 graduates of Flor-ida 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 resi-dency slots for the number of medical stu-dents 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 pro-grams haven’t kept pace with population and medical school growth,” said Deborah German, MD, vice president for medical af-fairs and founding dean of the UCF COM, noting that Florida has fewer than 18 resi-dents and fellows on duty per 100,000 popu-lation, ranking it 42 of 50 states nationally.
Orlando produces 102 graduate medi-cal 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 al-lopathic 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 esti-mated for 2020.
Challenges and SolutionsRobust medical school growth has
drawn attention to the minimal growth of residency programs to provide post-graduate training to Florida’s graduating medical stu-dents, while also attracting quality medical school graduates from around the country to provide the foundation for Florida physi-cian workforce of the future, and positioning Florida to best work to develop residency pro-grams to provide such training. Florida State University welcomed its first crop of medical students in 2001, Lake Erie College of Osteo-pathic 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
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 Braden-ton. Of 152 LECOM medical students who graduated on June 9, 36 percent (55) will remain in-state to complete resi-dencies and internships.
Statistics show that residents and fel-lows retained from Accreditation Council for Graduate Medical Education (ACGME) programs are highly likely – roughly two-thirds, 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 ad-dress the residency shortage. For example, Tampa General Hospital, a teaching hospi-tal for the University of South Florida (USF) Health Morsani COM, has 200 residency slots, yet hosts 310 residents.
“That additional 110 slots, the hospi-tal pays for out of pocket,” said Burkhart. “That’s $100,000 plus for every resident. We can’t afford to keep doing that, particu-larly when reimbursement from Medicare, Medicaid, commercial insurance and every-thing else continues to take a hit.”
PCP FocusIn keeping pace with primary care
needs, 51 percent of 2013 PGY-1 slots in Florida fall under PCP status (internal medi-cine, 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 mil-lion, resulting in a ratio of 9.2 per 100,000.
“We’ll need more primary care doc-tors, 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
Dr. Robert George
Incentivizing ResidenciesFlorida leaders work on ways to increase residency slots, keep COM graduates in state
FLORIDA RESIDENCY MATCH RECAP FOR 2013According 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 23 unfilled residency slots by specialty: Anesthesiology: 7 Family Medicine: 3 General Surgery: 3
Breakdown of Florida PGY-1 match rates by the most popular specialties:Internal medicine: 233 Pediatrics: 112 General Surgery: 84
Family Medicine: 79 Emergency Medicine: 53 Psychiatry: 43
Obstetrics and Gynecology: 39 Anesthesiology: 32 Radiology: 12
SOURCE: Association of American Medical Colleges (AAMC)’s 2011 State Physician Workforce Data Book.
(CONTINUED ON PAGE 9)
6 > JUNE 2013 o r l a n d o m e d i c a l n e w s . c o m
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 pa-tient,” said Glass. “The pivot nurse inputs the patient’s name and birth date into the system, and then we move from there, effectively eliminating 30 min-utes usually required upfront for full regis-tration, which is done on the back end of the ER visit.”
The ED front-door assessment has
already had a life-saving impact. “Several weeks ago, a pediatric pa-
tient with complex medical problems be-came 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 re-suscitation 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 symp-toms. 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 ad-dition 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’ fami-lies are invited to stay during procedures.
To help the medicine go down a lit-tle easier, the ED has a Slushee machine for children.
“We don’t want a child to take medi-cine 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 stabi-lize 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.”
Turning Point, continued from page 1
Dr. Todd Glass
o r l a n d o m e d i c a l n e w s . c o m JUNE 2013 > 7
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“ Regions is always there when I have questions. My relationship with my Regions banker is personal and Ihave her on my speed dial.”
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fi rst-year residency slots is a top priority. “Preventing the annual export of qualifi ed GME candidates to other states is the cru-cial fi rst 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 report-ing an impending move out of state (4 per-cent), one-fourth don’t yet have a planned destination. Others plan to relocate to Texas (153), California (120), South Car-olina (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 li-ability exposure, cost of professional insurance, medical malpractice liti-gation, declining government reim-bursement rates, and other reasons.
• With most of the state’s 1,797 radi-ologists working in a hospital setting, their practice characteristics refl ect reading diagnostic mammograms and sonograms (79 percent), reading screening mammograms (77 percent), performing ultrasound and stereotac-tic-guided core biopsies (55 percent), reading breast MRIs (48 percent), and reading MRI-guided core biop-sies (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 prog-ress measures make up the Department (of Health’s) inaugural strategic plan, with an objective of strengthening the state’s phy-sician workforce assessment and develop-ment capabilities,” Armstrong emphasized.
Physician Report, continued from page 1
PHYSICIAN WORKFORCE SPECIALTY COUNTS BY COUNTY:
(Note: 157 unique specialties have been divided into 16 main specialty groups.)
o r l a n d o m e d i c a l n e w s . c o m JUNE 2013 > 9
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-spon-sored residency program in partnership with the Orlando VA Medical Center and Osceola Regional Medical Center. The in-ternal 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 prac-tice 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 innova-tive scheduling of residents called the 4+1 rotation schedule, which alternates tradi-tional 4-week hospital and specialty rota-tions 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 prob-lems that occur when residents are dash-ing from facility to facility in the middle of a rotation.
By the end of 2013, Osceola Re-gional, 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 in-vestment 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 strength-ening Orlando’s PCP workforce with accreditation for a pediatric residency program. The first residents will begin training at the Florida Hospital for Chil-dren 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 resi-dency program director at Florida Hospital for Children. (Of 112 PGY-1 positions avail-able 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
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 MovementIn Florida, the Governor’s Office at-
tempted this year to increase funding for residency programs, which might incentiv-ize 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-sup-ported residencies.
In Senate Bill 1520, which Gov. Rick Scott approved May 20, the State-wide Medicaid Residency Program ex-pands primary care specialties beyond the PCMH scope to include preventive medi-cine, geriatric medicine, osteopathic gen-eral practice, and emergency medicine.
Because of complicated formu-las 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 be-tween first-year residents and residency slots, the American Medical Association (AMA) in mid-January announced a $10 million competitive grant initiative, “Ac-celerating Change in Medical Education,” to be distributed over the next five years to fund projects that support a significant redesign of undergraduate medical edu-cation. Eighty-two percent of the nation’s 141 accredited medical school submitted proposals by the Feb. 15 deadline, neces-sitating an additional vetting process. This month at its annual meeting, the AMA will determine the disbursement.
“Florida schools will hopefully get some of the money, for which we’re grate-ful, 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 po-sitions 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 (D-Pa.) 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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Incentivizing Residencies, continued from page 5
FLORIDA RESIDENTS & FELLOWSOf 3,512 total residents and fellows in Florida (1.4 per 100,000) on duty as of Dec. 31, 2010 in ACGME-accredited programs, the breakdown is:2,176 allopathic school graduates266 osteopathic school graduates1,064 international medical graduates (IMGs).
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.
Dr. Stacy McConkey
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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 com-mon 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 disor-der 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 middle-aged 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 sur-gery. 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 differ-ent presentations of the same disease. Slight differences in the way intesti-nal 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) de-velops in colon tissueCollagen 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 coli-tis may result from inflammation. Lym-phocytic 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
diarrhea is the main symptom of MC. Episodes of diarrhea can last for weeks, months or years. Most cases are inter-rupted by similarly long periods of remis-sion – times when diarrhea goes away. The clinical course is mainly intermittent, but is sometimes continuous or rarely con-sists of a single episode.
Other common symptoms of MC include abdominal cramps or pain and abdominal bloating. Less common symp-toms of MC include mild weight loss, dehydration, nausea, weakness and fecal incontinence.
Pathogenesis The pathogenesis of the different
forms of MC is unknown despite a de-tailed 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;
Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis
(CONTINUED ON PAGE 12)
o r l a n d o m e d i c a l n e w s . c o m JUNE 2013 > 11
of these problems:• Tired, heavy-feeling legs• Leg pain• Swollen ankles• Leg cramps• Discoloration of the skin• Family history of vein problems
Spider Veins Varicose Veins Skin Changes Ulcer
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 liv-ing expenses, 4,307 pre-med students ap-plied 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, an-other landmark event will occur when the first full enrollment class of 120 new stu-dents arrives on campus.
“We have all kinds of great things happening this year,” said Deborah Ger-man, 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 ap-plication screening process. “Even though we’ve met some wonderful milestones on our journey, we’re just getting started.”
Orlando Medical News spoke with Ger-man 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. Spe-cial 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 as-sembled a wonderful team to work on re-search, 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 fac-ulty 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.
What has surprised you about community response to the UCF COM?
There have been a thousand delightful surprises, and I couldn’t begin to list them all. The commu-nity has really stepped up to the plate. We have hospital and business partners, schol-arship donors, and more than 2,000 vol-unteer faculty members. We just had our first golf classic with the assistance of local businesses, which raised about $35,000 for scholarships.
What has surprised you about the medical students?
The students have continually amazed me with their establishment of a free clinic
run by medical stu-dents and interna-tional work overseas with undeveloped countries. They’ve embraced the faculty-organized medical mission trips and are helping us acquire do-nations for personal hygiene items for the summer trip.
Share with us a quick global
view of other COM accomplishments.
Our faculty has won national recogni-tion, research grants and leadership roles. Just one of a number of accomplishments: Our students helped our medical school reach No. 1 in the world in a research competition online.
What are your hopes for the future?
That the community will continue to partner with the medical school. We’re still growing; we’re still young. As long as we build together, we’ll be successful.
Lucky ‘13UCF COM Dean discusses graduation of charter class, celebrating 50th anniversary with main campus
Dr. Deborah German
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and 17 showed a mixed form with both thickening of the collagenous plate and an increased number of intraepithelial lym-phocytes.
The extent to which there may be a genetic predisposition to MC is unclear. However, familial cases have been de-scribed. Interestingly, different members of the same family developed either lym-phocytic or collagenous colitis, support-ing a similar underlying pathophysiology. The cause of MC is unknown. Many sci-entists 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 ileos-tomy 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, sug-gesting 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 anti-inflammatory drugs, ranitidine (Zantac), sertraline (Zoloft) and ticlopidine (Ticlid).
FoodCertain foods appear to trigger MC
in some people. Although no specific foods have been identified, following a caffeine- or lactose-free diet sometimes improves symptoms.
How is MC diagnosed?Microscopic colitis can only be di-
agnosed 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,
and friability may be seen. In small case series, chromoendoscopy using indigo carmine highlighted mucosal alterations that correspond to the histological distri-bution of MC. However, larger studies are needed before routine use of chromoen-doscopy can be recommended for diagno-sis of MC.
Although specimens obtained by flexible sigmoidoscopy are frequently suf-ficient to establish the diagnosis, the sever-ity 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 sev-eral reports, rectosigmoid biopsies alone would have missed the diagnosis of collag-enous 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 ex-clude other inflammatory diseases. While colonoscopy is generally safe in such pa-tients, an increasing number of perfora-tions 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 con-taining 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 includ-ing 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 re-lapses can occur. Some patients require long-term therapy because they experi-ence prompt relapse when treatment is stopped. Unlike other forms of IBD, MC usually does not progress to other IBD-related 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.
Microscopic Colitis, continued from page 10
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Nearing retirement in an era when 70 is the new 50, it can be difficult to picture a time when you won’t be able to hop in your car to run errands, swing a club or a racquet, attend an exercise class, or enjoy an evening out with good friends. Perhaps in the recesses of your mind the possibility exists that you might need a little assistance at some point in the very distant future … but that time is cer-tainly not now.
Still, in your most prudent moments, you know the big house and big yard are really too big now that the children are grown and gone. And you hate the thought of your spouse or the kids hurriedly having to make critical decisions should something happen to you.
Still, you just aren’t ready to give up your self-sufficiency. And why should you when a solu-tion exists that allows you to keep your indepen-dence while having a contingency plan in place?
For a growing number of senior
adults, continuing care retirement com-munities (CCRCs) provide the best an-swer – 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 communi-ties 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 commu-nities in 28 states and the District of Co-lumbia and serves nearly 30,000 residents.
Erik Gjullin, vice president/director of marketing & sales for Life Care Services, ex-plained that residents arrive while indepen-dent with the knowl-edge that assisted living, 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 hous-ing, is to live somewhere where it’s easy to participate in a lifestyle that enhances health,” he said.
Gjullin explained Life Care Ser-vices 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 socializa-tion. It’s education. It’s ongoing lifestyle that really creates the wellness for the whole person.”
While a number of programs and ser-vices are consistent across Life Care Ser-
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 cui-sine. It’s got the flavor of the southwest.”
Residents enjoy a range of living op-
tions from apartment-style residences to garden villas to detached cottages. Mani-cured 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.
Luxury, of course, does come with a price. Gjullin said residents pay a one-time entrance fee and ongoing monthly fee, both of which vary depending on the size of the residence selected. The monthly fee, he continued, “covers every-thing you could possibly think about that you would be paying if you were living in your own residence.”
A Sense of Independence
Erik Gjullin
(CONTINUED ON PAGE 14)
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At death or upon moving, there are two return-of-capital plans that give back either 80 percent or 90 percent of the en-trance fee to the resident or the estate. If residents needs to move to a higher level of care … either temporarily or perma-nently … they are guaranteed a bed, and the monthly fee remains the same as in the independent living phase.
“As you move through the contin-uum of services, your monthly fee does not increase,” Gjullin said of a unique as-pect of Life Care Services. In comparison to a skilled nursing facility where a room could cost $300-$400 a day, those who transition within the CCRC continue to pay their monthly fee … for a couple in an apartment-style residence that typically runs under $200 a day and under $100 a day for an individual in a one-bedroom apartment. “If you wanted to preserve
your assets, what other program would you select?” he questioned.
Again, Gjullin stressed, the goal is to keep seniors spiritually, physically, men-tally 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 commu-nity 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 com-munity like this and not have that as a basic philosophy.”
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By LyNNE JETER
NASHVILLE – In the wake of na-tional health reform, the trust factor be-tween hospitals and health insurance companies is perilously low.
That’s the consensus of 373 hospital and health system administrators respon-sible for negotiating contracts with major health plans in the seventh annual Na-tional Payor Study. Conducted by Nash-ville-based ReviveHealth, the 2013 survey paints an interesting picture of administra-tors’ 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 out-comes,” said ReviveHealth CEO Brandon Edwards.
For the second consecutive year, hos-pital and health system leaders who nego-tiate 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 be-havior 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, Unit-edHealthcare 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 repu-tation among hospitals – and the slowest to pay.
“Honesty and candor represent Unit-ed’s biggest challenges,” noted Edwards. “Hospitals year in and year out cite Unit-edHealthcare’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 Ed-wards. “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 ap-proval 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 busi-ness practices.
“Independent BCBS plans, however, ranked well ahead of Cigna (30 percent compared to 19 percent) in terms of over-all best to deal with, despite having the lowest ranking in payment rates to hospi-tals,” 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 hos-pital 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 Ed-wards, who initiated the survey after notic-
ing a void in payor ratings. “Even though health plans rate hospitals and their phy-sicians 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 pri-ority for their employees, and clinical in-tegration 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 solu-tions to keep those employees healthy and costs down.”
Nearly 40 percent of respondents re-ported 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 ex-pense 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 upcom-ing year – the top three are the same as 2012 – involve:1. Increasing rates with the largest
payor.2. Producing better language protec-
tion against denials.3. Increasing rates with the second and
third largest payors.4. Balancing the threat and opportu-
nity 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 Ad-vantage plans.
9. Shifting reliance away from the larg-est payor.
10. Bundling payments for medical home, ACO, or other population health strategies.
SOURCE: ReviveHealth.
The Trust Factor Nashville firm reveals results of 7th annual payor survey; trust represents greater factor than rates
‘‘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.
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GrandRounds
$12,000 Worth of Orthopae-dic 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 An-nual EmBrace Our Community drive. The donation is up $2,000 from last year’s in-augural campaign.
Items for the EmBrace drive were collected from patients and community partners at all six of Orlando Orthopae-dic 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 dona-tion drive compliments similar Founda-tion efforts to help the underserved pop-ulation in Central Florida. Each year the Foundation hosts separate fundraising campaigns to send underprivilegedchil-dren 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 Pa-tricia Dycus RA; hosted an Open House event to showcase the most sophisticat-ed technological imaging state-of-the-art services now available at both Sand Lake Imaging Centers. The event was catered by Arthurs Catering, entertainment pro-vided by saxophonist; Johnny Mag Sax and was attended by over fifty commu-nity physicians, practice managers, refer-ral coordinators and nurses.
Sand Lake Imaging serves as the South East regional show site for Sie-mens 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 Sie-mens which offers a software sophistica-tion 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 en-ables 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 aortog-raphy and runoff arteriography, CT colo-nography, CT enterography, and high resolution musculoskeletal and spinal CT reconstructed imaging. This sophisticat-ed technological combination now pro-vides the most exquisite scanning detail of a whole body PET/CT which can now
be performed in 15 minutes. The radiolo-gists at Sand Lake Imaging are proud to continue to provide community physi-cians and patients with their unparallel level of expertise, latest technology and their commitment to patient care.
In Caption from L to R: Sand Lake Im-aging Radiologists; Robert Posniak MD, Charlotte Elenberger MD; Alexandra Osorio MD; Patricia Dycus RA and Ste-phen 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 partici-pate in the Florida Translational Research Program (FTRP) to advance drug discov-ery in the state. The projects focus on cancer, diabetes, and obesity, and are led by scientists from the University of Cen-tral 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-of-the-art infrastructure at Sanford-Burnham.
Three of the projects focus on discov-ering new treatments for cancer and oth-er 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 sev-eral leukemias, as well as breast and co-lon 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 mas-ter regulator of cancer-cell survival. Novel inhibitors of p300 are thus expected to prevent the development of tumors in a variety of cancers. Cristina Fernandez-Valle, 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 proj-ect varies greatly, all participating scien-tists agree that having access to state-of-the-art screening technology enhances their ability to do research.
The other two projects represent the first steps in the discovery of new medi-cines to treat diabetes and obesity. Patri-cia 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 con-trol 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 ex-pected to increase next year. Applications were invited from investigators who had already developed innovative assays for use both in basic research and in thera-peutic development, and who were inter-ested in having their assay screened using Sanford-Burnham’s small-molecule library. In the future, the program will accept pro-posals for more comprehensive projects that may have a chemical component, not yet be ready for high-throughput screen-ing, or require assay development servic-es from Sanford-Burnham.
Dr. Sandeep Thaper and Dr. Marays Veliz Join Florida Cancer Specialists & Research Institute
Florida Cancer Specialists & Re-search Institute (FCS) is pleased to an-nounce that Dr. Sandeep Thaper and Dr. Marays Veliz, of Central Florida He-matology and Oncology, will be join-ing the statewide practice May 1, 2013, thereby bringing two new clinical loca-tions 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 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 in three hospitals and 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 In-ternal Medicine at University of Medicine and Dentistry in NJ (UMDNJ) – where she served as Chief Medical Resident. Dr. Ve-liz 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 oncol-ogy and hematology services, including clinical research and the use of evidence-based 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.
Dr. Sandeep Thaper
Dr. Marays Veliz
The Florida Hospital’s Healthy 100 Women’s Mobile Health Coach travels throughout Central Florida to provide health screenings in a more convenient manner.
Florida Hospital’s Healthy 100 Wom-en’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 mam-mogram. 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, ultra-sound, DEXA scan, electrocardiogram (EKG), body mass index (BMI) and skin analysis. The Coach also features well-ness 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 Wom-en’s Mobile Health Coach, visit www.Healthy100Women.org
Florida Hospital’s Mobile Health Program for Women Hits the Streets
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Cornerstone Hospice Named as 2013 Hospice Honors Recipient
Cornerstone Hospice and Palliative Care’s mission to provide excellent care has been recognized. Cornerstone has been named a 2013 Hospice Honors re-cipient, a prestigious award recognizing hospice agencies providing the best pa-tient care as rated by the patient’s care-giver. Cornerstone serves seven Central Florida counties with at-home, inpatient and in-facility care. Three of the organi-zation’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 VillagesEstablished 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 Eval-uation of Hospice Care (FEHC) survey re-sults 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 sat-isfaction as the basis of the Hospice Hon-ors calculations.
Florida Hospital Kissimmee Breaks Ground on Emergency Department Expansion
Florida Hospital Kissimmee is expand-ing its emergency department to better serve the more than 43,000 patients it sees each year as Osceola County con-tinues 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 in-crease the bed count from 15 to 35 beds. The expansion will also include the addi-tion of several kid-friendly rooms. Con-struction for 29 of the 35 beds is expect-ed to be complete by end of the year, and the final phase will be completed by summer of 2014.
Florida Hospital Kissimmee is cur-rently 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 get-ting one step closer to being able to de-termine 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-
After having finished the FCATs at the end of April, most students would be ex-cited 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 affection-ately 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 be-hind the controls of “S.I.R.E.N.”, the da Vinci® Surgical System, using the Skills Simulator to test the 3DHD vision and su-
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 im-portance 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 team-work” said Sherry Cooper, RN, Director of Surgical Services. “They are an impres-sive group of children with bright futures ahead of them.”
To learn more about minimally inva-sive surgery using the da Vinci® Surgical System or the other services St. Cloud Regional offers the community, please visit StCloudRegional.com or call407-891-2920 to find a physician.
About St. Cloud Regional Medical Center St. Cloud Regional Medical Cen-ter 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, visit-www.stcloudregional.com.
Local School Visits St. Cloud Regional Medical Center
The students and surgical staff received t-shirts made especially for the occasion.
o r l a n d o m e d i c a l n e w s . c o m JUNE 2013 > 19
GrandRounds
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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 de-crease or completely avoid the complica-tion 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 clot-ting 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 informa-tion on both possibilities and is a closer representation of how the blood clotting system actually works in an individual pa-tient’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 indi-vidual 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.
Tuskawilla Nursing and Rehab Center Receives Governor’s Gold Seal Award
The Florida Agency for Health Care Administration (AHCA) has awarded Tus-kawilla 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 select-ed 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 fa-cilities that have exceptionally high stan-dards and display excellence in the qual-ity of care delivered to their residents.
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.
ROBOTIC SURGERYROBOTIC SURGERYROBOTIC SURGERYW I T H O U T T H E S C A R S
Now, as easy as...
Fuad Shahin, M.D.Board Certified General Surgeon at
Osceola Regional Medical Center.
Performed the first robot-assisted gallbladder
removal in December 2012.
Single-Incision Robotic Surgery offers many benefits for patients:
n Less Blood Lossn Less Risk of Complicationsn Less Length of Stayn Faster Recoveryn Minimal Pain
For more information about Single-Incision or Robotic Surgery, please call 1-877-762-6801 or visit OsceolaRegional.com.
700 West Oak St • Kissimmee, FL 34741 • (407) 846-2266 • www.OsceolaRegional.com
1 Incision.Virtually invisible scars
masked by the belly button.
3D View.Enhanced 3D visualization.
2 Sets of Hands.Improved dexterity,
precision, range of motion and repetitive maneuvers.
700 West Oak St • 700 West Oak St • 700 West Oak St • 700 West Oak St • 700 West Oak St • 700 West Oak St • Kissimmee, FL 34741Kissimmee, FL 34741Kissimmee, FL 34741Kissimmee, FL 34741Kissimmee, FL 34741Kissimmee, FL 34741Kissimmee, FL 34741Kissimmee, FL 34741 • (407) 846-2266 • www.OsceolaRegional.comwww.OsceolaRegional.comwww.OsceolaRegional.comwww.OsceolaRegional.comwww.OsceolaRegional.com700 West Oak St • Kissimmee, FL 34741 • (407) 846-2266 • www.OsceolaRegional.com
