Medical News of Arkansas November 2013

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Grant Morshedi, MD

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UAMS Opens Unique Women’s Only Psychiatric Unit

COURTESY OF UAMS/TIM TAYLOR

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

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By BECKy GILLETTE

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

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

The thought behind it is a lot of times women have issues unique to them that are diffi cult to man-age in a mixed unit, said Lou Ann Eads, MD, medi-cal director of the PRI’s women’s inpatient unit and an assistant professor at the UAMS Department of

By LyNNE JETER

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

his administrative role, such as working toward better effi ciency in the OR. If time allows, he may have a lunch date to speak with a church or civic group about his Muslim faith to help bridge the gap of understanding between re-ligions. At 4 p.m., he may have a 2-hour vas-cular conference with surgeons and residents. He might end the day with a high-energy rac-quetball session with a regular group of doubles


HealthcareLeader

Mohammed Mahmoud Moursi, MDUAMS Division Chief, Vascular and Endovascular Surgery

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

2 > OCTOBER/NOVEMBER 2013 m e d i c a l n e w s o f a r k a n s a s . c o m


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

PhysicianSpotlight

By LyNNE JETER

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

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

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

A native Arkansan, Morshedi spent his early childhood in Little Rock; the family moved to Conway when he was 10. The middle of three children born to Ali, a medical technologist, and his wife, Sherry, a practice manager for a family physician clinic, Morshedi grew up around hospitals and doctor’s offices.

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

Morshedi was immersed in volunteer work even as an undergraduate at Hen-drix College in Conway, where he earned a chemistry degree. For example, he trav-eled with a group on spring break to work on a Habitat for Humanity home in Aus-tin, Texas.

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

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

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

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

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

“I always knew I’d be back in Arkan-sas,” he said. “With residency matching,

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

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

while he flourished at UAMS helping Ar-kansans with cataracts and glaucoma.

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

Worldwide, people have gone com-pletely blind because of cataracts, Mor-shedi noted.

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

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

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

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

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

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

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

“It’s become a tradition that every time I graduate, my family gets me a new musical instrument,” he said, with a laugh. “When I finished medical school, I got a guitar … then a banjo after residency and a mandolin after my fellowship. If I could play them all at once, I could be a one-man bluegrass band.”

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By BECKy GILLETTE

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

But vascular surgeons can intervene to help prevent amputations, said Mo-hammed Moursi, MD, division chief of the University of Arkansas for Medical Sciences (UAMS) Vascular and Endovas-cular Surgery. His advice to healthcare providers is once there is any slight indi-cation of diabetic foot ulceration, refer the patient to a vascular specialist to make sure the blood fl ow is adequate to heal the ulceration.

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

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

“In addition, diabetics can develop ulcerations in their feet due to a combi-nation of factors such as lower blood fl ow and neuropathy,” Moursi said. “They

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

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

“When you have a diminished blood fl ow due to atherosclerosis there are dif-ferent degrees and stages of the ischemia. The fi rst stage is claudication,” Moursi said. “It occurs when there is mild to moderate blockage in the arteries, usually in the superfi cial femoral arteries. It usu-ally leads to lower blood fl ow in the calf muscles. So when a patient tries to walk, after some distance, they develop cramp-ing in their calves which necessitates them to stop walking. Claudication is not usu-ally limb threatening. You can live with it for a while.”

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

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

earlier, is foot ulcers or tissue loss.”When a diabetic patient presents

with peripheral artery disease, an ankle brachial index (ABI) is done to measure the blood pressure in their arm and in their leg just above the ankle. The ratio between the two is measured. A normal person will have an ABI of one. With a diabetic with peripheral artery disease, it will be less than one. With claudication, you would see a level of .6 or .7. With rest pain, it could be .3 or .4. With patients with tissue loss, you will see a lower ABI.

“If we determine intervention is nec-essary, we order an arteriogram,” Moursi said. “We have a CAT scan incorporated into an arteriogram so we can see where the blockages are. Once we have identifi ed the blockage, there is a whole set of treat-ment options.”

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

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

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

If the patient is not amenable to endo-vascular repair, the surgeon can do open surgery. Open surgery can include an end-arterectomy, which physically removes the plaque under direct vision.

“Other things we can do is open up the artery at the area of the narrowing, and reclose using a patch, getting the ar-tery back to the size it was supposed to be,” Moursi said. “Another option is to bypass around the area with the blockage. We can bypass using a patient’s own veins, veins from the side of the leg, the greater or lesser saphenous vein, or an arm vein. We can also use synthetic conduit mate-rial, but that is not as effective.”

Moursi said if a stent is needed in the iliac artery by the pelvic area, that stent has a fi ve-year patency of 80 percent. As you move down the leg putting stents above or below the knee, patency is only 50 percent over a year. A vein bypass should be able to generate two-year pa-tency of about 80 percent.

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

Managing the diabetes well is also very important. Good glucose control has the most effect on retinopathy and nephropathy. For prevention of amputa-tions, what helps most is smoking cessa-tion.

Intervention by Vascular Surgeons Can Help Prevent Limb Loss in Diabetics

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

By TINA HEDRICK, BSN, RN, CPHIT

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

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

The Center for Women’s Health un-derstands that efforts towards improve-ment require commitment, time, energy, persistence and patience. The center hired Sandra Guidry, its first Interna-tional Board Certified Lactation Con-sultant (IBCLC), in the spring of 2011 as AFMC launched its statewide breast-feeding promotion. The staff immediately began working towards improving the hospital’s breastfeeding rates and dura-tion, and allowed AFMC to assist in their journey. The Center for Woman’s Health has made breastfeeding a priority, and providing every woman with the knowl-edge, skills, and opportunity to breastfeed or provide breast milk to their infants is both a passion and a mission. The cen-ter’s current director, Dawn Brown, RN, inherited the breastfeeding initiative dur-ing the summer of 2012 and accepted the challenge of taking the program to the next level.

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

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

Staff education is a significant focus. The Women’s Health Center holds monthly breastfeeding in-services, testing and yearly skill competencies. Staff atten-dance and participation are required. In-service programs, known as Lactation 101, emphasize specific areas such as breast pump basics — types, assembly, operation and cleaning — and the nurse’s responsibil-ity regarding breastfeeding, which includes

assessment and documentation. All new employees must attend breastfeeding edu-cation as part of new employee orientation.

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

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

ing duration. In October 2012, the Cen-ter for Women’s Health held its first TLC (The Lactation Club) luncheon. TLC is a monthly breastfeeding support group led by Guidry. The Lactation Club offers a time for breastfeeding moms to connect, share concerns and celebrate successes. The luncheons include celebration cakes for mothers meeting 6-month and 1-year exclusive breastfeeding milestones.

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

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

Breastfeeding: A Hospital’s Journey to Improving Rates

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

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

In Moursi’s world, something’s al-ways percolating.

Born in Alexandria, Eygpt to Mah-moud and Sohair Moursi, the family moved to the United States when Moursi was a toddler so his dad could earn a doc-toral degree from New York University (NYU). After six years of training and teaching there, the Moursi family relo-cated to Mount Pleasant, Mich., where his dad joined the faculty of Central Michi-gan University as a business professor. Soon, Moursi and his 16 months younger brother, Amr, were entrenched in science and biology, even though none of their im-mediate relatives were in the medical field.

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

surgery could very much help people.” After graduating from the Uni-

versity of Michigan Medical School in 1987, Moursi completed eight years of residency and fellowship training in Ann Arbor. While there, he was chief resident and completed three fellowships - one as a research fellowship under the National Institutes of Health, and the other two in surgical critical care and vascular surgery. Sanjay Gupta, MD, a neurosurgeon more famously known as the Emmy®-award winning chief medical correspondent for CNN, was among his residents.

In 1995, UAMS recruited him to act as an assistant professor at UAMS, Little Rock Veterans Administration and the Arkansas Children’s Hospital. He quickly rose in the ranks; during the first year, he began as chief of vascular surgery for the Central Arkansas Veterans Healthcare System and eventually was promoted to full professor and division chief. When he was named division chief of vascular and endovascular surgery, one of the first calls of congratulations was from his brother, now head of pediatric dentistry at NYU.

“I feel so fortunate to have a great job here in Little Rock after my medical training, and our family absolutely loves it here,” said Moursi, who enjoys small mouth bass and trout fishing in Arkansas waters, as well as duck hunting.

Moursi enjoys the challenge of vascu-lar and endovascular surgery, which has changed dramatically in the last two de-cades.

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

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

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

Moursi is also heavily involved with the Islamic Center of Little Rock. “My faith is very important to me,” he said. “We have a strong community here, and I’ve had the opportunity to speak to many groups, the mayor, and the gover-nor about my religion. It’s important to increase the dialogue about it while also learning about other religions. Churches and organizations have graciously invited me to share in the discussion.”

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

Mohammed Mahmoud Moursi, MD, continued from page 1


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Psychiatry. “They may have been a victim of rape or abuse from a husband or do-mestic partner, and may be suffering from post traumatic stress syndrome,” Eads said. “Some might be acutely suicidal. It can be diffi cult sometimes for women to open up to discuss theses issue when they are in a male-female group.”

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

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

The response from patients has been very positive.

“We have gotten quite a bit of good feedback from women because when they compare it to places they may have been hospitalized before, it is a much bet-ter experience,” Eads said. “They fi nd it easier to relate to other peers in the unit. The therapy and activities are specifi cally directed to the women, whether it is the therapy or the topics that are of specifi c in-terest to them. A lot of therapy and group activities take place before they are transi-tioned to outpatient care.”

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

“We wanted to do something a little different that Arkansas didn’t have,” Eads said. “We wanted a special, unique pro-gram that would be of benefi t to the state. In order to try to provide an environment so the women feel safe and able to work together, we put together an all female staff. We had quite a few nurses who felt this was an interesting concept and some-thing they wanted to be involved with. So it actually came together pretty quickly.”

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

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

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

Another unique thing about the unit is that patients can receive care from a specialist in fetal maternal psychiatry. Zackary Stowe, MD, takes care of women through a pregnancy or post partum, both times when women can suffer from a lot of hormone imbalances that can set them up for a high risk of emotional instability. They also try to make some allowances for having the baby in the room with them for part of the time.

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

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

PRI has two inpatient fl oors. In addi-tion to the women’s unit, there is a ten-bed child diagnostic unit. There is also outpa-tient care and some research going on in the building.

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

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

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

results,” Eads said. “There is no torture. The patient goes to sleep, we do the pro-cedure and they wake up. They may have a headache but we can take care of that. There are some very good results with that. In the local area we and Bridgeway Behavioral Health are the only two places in Little Rock that do ECT, so we have in-herited some of the more medically chal-lenging patients. ECT keeps growing for us. ECT has been noted to be more effec-tive than our medications, safer than med-ications and it works quicker. It just got a bad reputation back in the 1950s when they weren’t putting people to sleep.”

Another function of the PRI is train-ing residents. PRI is part of the UAMS ac-ademic center that works to train the next group of psychiatrists for the community.

UAMS Opens Unique Women’s Only Psychiatric Unit, continued from page 1

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served as a post-doctoral fellow at Harvard Medical School and completed his residency at Baylor College of Medicine and MD Anderson Cancer Center. Dr. Shafizadeh completed his training at Northwestern University with an advanced surgical training-infolded fellowship in cerebrovascular and

, these new physicians will add to our comprehensive range of neurosurgical services and continue

Left to right: Tarek Abuelem, M.D., and Stephen F. Shafizadeh, M.D., PhD

Read Medical News of Arkansas Online:

MEDICALNEWSOFARKANSAS.COM


By BECKy GILLETTE

Being a research institution, the Uni-versity of Arkansas for Medical Sciences (UAMS) is doing research while it is car-ing for patients.

“As a result, we sometimes enroll pa-tients in clinical trials that benefit every-one,” said Jonathan Laryea, MD, assistant professor of surgery, Di-vision of Colon and Rec-tal Surgery at UAMS. “The knowledge we get from clinical trials helps us improve the care we give to future patients. We are improving the care on a daily basis. We also teach medical students and residents, which means we have to be on the cutting edge. We are always at the forefront of new knowledge and techniques.”

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

“The advantage of the robot over open surgery is the same advantage you get with laparoscopic surgery,” Laryea said. “In effect, the benefits are related. You have smaller incisions, fewer compli-cations, a quicker recovery, and a quicker return to normal activity. It has a lot of benefits to the surgeon. The surgeon sits down at a console so the surgeon doesn’t get as tired. When you use the robot, you have

3-D vision, the image is magnified, and all the instruments are under the control of the surgeon. With laparoscopic surgery, you have medical students and residents holding some of the instruments, and they can get tired. With the robot, the machine is holding the instruments so they stay where you want until you change the position.”

Another advantage is that the tips of the robotic instruments can move in all different directions. So even in an awk-ward corner, the surgeon can still suture. With laparoscopic surgery, he might not be able to suture in a corner.

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

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

“We remove the cancer and do spe-

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

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

Laryea said it is important to under-stand that colon cancer and all cancers at UAMS are treated by multidisciplinary teams, and not just individual physicians. “We discuss patients in a multidisciplinary setting and discuss the best treatment based on each patient’s situation,” he said.

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

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

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

“That is a concern,” Laryea said. “Other risk factors include family history, especially if it is a first-degree relative like parent or sibling. There are some heredi-tary conditions that predispose people to color cancer. Diet can also be a risk fac-tor, especially a diet high in red meat and fat, and low in fiber. It is recommended that starting at age 50 people should get screened for colon cancer. If a family member has cancer, screening should start ten years younger than the age when the youngest person in the family had cancer. For example, if a parent had colon cancer at age 40, the children should start screen-ing at age 30.”

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

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By BECKy GILLETTE

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

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

“Go to the hospital emergency room on a Saturday night?” she asked herself. “I don’t think so. But I was feeling so ter-rible. I found out about Velocity Care. I went in, they did an EKG, an x-ray of my lungs, and a 30-minute breathing treatment. It was just the most marvelous relief. The whole experience was almost life saving. The office is beautiful and well equipped. It is just wonderful.”

Mid week she got a call from her physician, John McLean, MD, ask-ing how she was doing. That sort of thing had never happened to her before, and she was very impressed.

“Next Friday I went in for another breath-ing treatment and they arranged for me

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

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

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

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

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

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

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

“Even for emergency rooms (ERs), they realize we are helping them out,” said McLean. “We help unload ERs so they can be seeing the more serious cases they need to be attending to. That really helps them to stay focused on the patients who need to be in the ER so they are not overwhelmed with patients. Our number one referrals are physicians. We are a nice, friendly place for you to be treated. We can treat everything from a sinus infection to pneumonia, from sprained ankles to major fractures. Savings are anywhere be-tween 70 to 80 percent compared to ERs.”

The average cost to see a doctor and get treated is $115 with basic lab work running $45 and x-rays from $45 to $60. “So many people are self insuring, and we want to make it so they can afford treat-ment,” McLean said.

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

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

Dr. John McLean



serious cases were being seen.“We can take in patients

with minor to moderate emer-gencies who don’t quite need the ER,” McLean said. “Many things don’t really require the expense of an ER and the length of time it takes to get to the doctor.”

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

“The attrition rate for ER doctors is 12 years,” McLean said. “They get burned out be-cause of the pace. Here at Ve-locity Care, we have been hiring 43- to 50-year-old former ER doctors who are highly trained, and very experienced treating anything coming in. Having the higher quality physicians in the clinic is what is setting us apart. We are ER doctors without the ER.

“Anything that walks through the door from minor to moderate emergen-cies, we take care of it and get them where they need to go. If someone comes in for abdominal pain, in 45 minutes after an ul-trasound, a radiologist can diagnose him with appendicitis. We get a line in him, give him IV antibiotics, and get him ready for the operating room. I skip the ER. I

call the surgeon and give him the informa-tion on the patient.”

McLean said that Velocity Care par-ticularly gets a lot of referrals from phy-sicians when the flu season is filling their waiting rooms with patients.

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

“Our hopes are to branch out,”

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

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

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

“I want people to be able to relax in an atmosphere that helps them be calm,” McLean said. “It is a plush waiting area with unique lighting and rock walls. We want patients to come in and feel like they’ve gotten a breath of fresh air, and know they will be treated graciously and tenderly. We are staffed with RNs and LPNs, as well as radiation tech-nicians. We can do all x-rays on site. We can do blood counts and chemistries. There are TVs in every room, and free coffee and bottled water.”

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

“Your time is valuable,” he said.

Relieving the Burden, continued from page 9

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By ERICK MESSIAS, MD, PHD

Under a storm of commentary, full of sound and fury, the new edition of the Diagnostic and Statistical Manual, sometimes referred to as “the Bible of psychiatry,” was released by the Ameri-can Psychiatric Association in May. This is the fifth edition of the manual, the of-ficial list of accepted psychiatric diagnoses in America, thus named DSM-5. On that same month, two books were published addressing the new DSM, “Saving Nor-mal” and “The Book of Woe.” Several editorials were published, from the An-nals of Internal Medicine’s “The New Crisis in Confidence in Psychiatric Diagnosis” to the Wall Street Journal’s “A Manual Ran Amok.” Even the director of the National Institute of Mental Health, Tom Insel, had a blog post titled “Transforming Diagno-sis,” where he stated “patients with mental disorder deserve better” and defended the new NIMH-sponsored Research Domain Criteria. Why should a diagnostic manual stir so many strong opinions and emo-tions?

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

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

tion to an abnormal society” as proposed by some in the antipsychiatry movement. The DSM-5 is the most recent iteration of the model started in 1980 by the third edition of the manual, the DSM-III; until DSM-5 the APA used roman numerals. The DSM-III was a major departure from the two first editions but listing a specific

set of criteria for each disorder and mak-ing sure good reliability was achieved. That was a major change, a watershed moment in psychiatry, because until then psychiatric diagnosis was determined to a great extent on the school the psychiatrist was trained not as much on what the pa-tient presented. This problem was clear in

two now classic studies, the US-UK proj-ect and the Rosenhan experiment. The US-UK study compared the diagnoses on the same set of patients given by British and American psychiatrists. When the re-sults were in, it was clear the Americans tended to use the diagnosis of schizophre-

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

deck


By JENNIFER PATEL

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

While today’s employers are begin-ning to see the benefits of wellness pro-grams and preventive care, they didn’t always. In the past, employees have been left to worry that taking time off for doc-tors appointments or tending to other preventative care issues will result in a negative reaction from management. Because of this, employers have to find ways to encourage employee participa-tion in wellness programs. One successful method of encouragement that employers have discovered is to have direct partici-pation from healthcare professionals.

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

Encourage Preventive CareThe Centers for Disease Control and

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

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

Offer ExpertiseGenerally speaking, most employers

are not healthcare experts, which gives physicians extra advantages. When put-ting together a wellness program, employ-ers look at screenings, physical activity and incentives for positive results. But what constitutes positive results and what is the best way to get there?

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

Build RelationshipsOne of the biggest obstacles that em-

ployers face when encouraging employees to take part in health and wellness pro-grams is a desire to not be the squeaky wheel. Whether or not it is admitted, em-ployees still feel that taking time off work is seen as something that can affect their growth within the company.

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

Invest in Your EmployeesAs the healthcare industry’s role

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

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

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

Wellness Programs’ Impact on the Medical Field

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

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

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

into psychiatry and was widely adopted around the world as the gold standard for psychiatric classification and nosology. The fourth edition, DSM-IV, came up in 1994, building on the same model of reliability and being quite conservative in the expansion of mental disorders. At that time, most people believed that by 2010 that model of sets of observed behaviors would be replaced by a model based on biomarkers for mental illnesses. That set of biomarkers ended up turning into a kind of Holy Grail for psychiatry and, just like Holy Grail itself, has yet to be found. With the lack of sensitive and specific bio-markers for mental disorders, the field had to content with another, hopefully last iteration of the observed behavior and mental states model and that’s how we get to the DSM-5. It is a collection of sets of criteria to reliably identify and categorize mental disorders. It is a model that has served psychiatry well for 33 years, and it was not written by gods but by human be-ings and, as religious people remind us, we are far from perfect and so are our works.

The New Catalogue, continued from page 11

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

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Dr. Deepak Thomas Joins Physicians at St. Bernards Heart and Vascular

Dr. Deepak Thomas has joined the medical staff at St. Bernards Heart and Vascular, the largest car-diology practice in the re-gion.

The cardiologist comes to St. Bernards after completing a three-year fellowship in cardiol-ogy at the University of Nebraska Medical Center in Omaha.

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

He is board certifi ed in cardiovascu-lar medicine by the American Board of Internal Medicine and holds professional membership in the American College of Cardiology.

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

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

Dr. Daryl Burrows joins Mercy Endocrinology Clinic in Hot Springs

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

Dr. Burrows is a native of Rogers and graduate of the University of Arkansas in Fayetteville and UAMS in Little Rock. He joins fellow Endocrinologist Dr. Jona-than Stringer.

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

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

UAMS Awarded $8.7 Million for Radiation Research

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

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

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

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

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

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

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

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

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

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

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

In the fi rst phase of the research be-gun in 2011, Hauer-Jensen and his team generated data Novartis needed to initi-ate discussions with the Food and Drug Administration about using pasireotide for radiological emergencies. During the next two years of the contract, the team will perform a range of studies to con-tinue the development process.

UAMS Winthrop P. Rockefeller Cancer Institute and Highlands Oncology Group Announce Collaboration

A new collaboration between the Winthrop P. Rockefeller Cancer Institute

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

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

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

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

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Baptist Health Welcomes New Pulmonology And Sleep Clinic

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

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

All three physicians are board certified in pul-monology and internal medicine. Dr. Kellar is also certified in sleep medicine and Dr. Szwedo has an additional certifi-cation in critical care. Their educational and professional backgrounds are as fol-lows.

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

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

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

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

Cancer Drug Developed by UAMS Professor Awarded FDA Approval

Valchlor, a breakthrough gel for treating lymphoma developed with the help of University of Arkansas for Medi-cal Sciences (UAMS) College of Phar-macy Professor Peter Crooks, Ph.D., re-cently won marketing approval from the U.S. Food and Drug Administration.

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

Mycosis fungoides is the most com-mon type of cutaneous T-cell lymphoma. It has no cure, and its cause is unknown. The malignant T-cells migrate to the skin, causing lesions to appear. Lesions first appear as a rash and then may grow into disfiguring tumors.

Crooks was a cofounder and chief scientific officer (CSO) of Yaupon Thera-peutics, the company that later became Ceptaris, which is located in Malvern, Penn. He began developmental work on Valchlor in 2004. He helped solved such problems as how to chemically stabilize the drug in the topical gel formulation, and how to keep it from entering a pa-tient’s bloodstream. He stepped down as CSO of the company in 2011 when he joined UAMS.

During his work on Valchlor, Crooks said he learned a tremendous amount about drug development, manufactur-ing and the FDA approval process. He is applying that knowledge to new re-search and new projects at UAMS, such as clinical development of new drugs for the treatment of acute myelogenous leukemia (AML), the most common form of leukemia, and for the treatment of Al-zheimer’s disease.

UAMS COM Recognized as National Leader in Conflict-of-Interest Standards

The University of Arkansas for Medi-cal Sciences (UAMS) College of Medi-cine has been recognized in a nation-wide study as being among the top five medical schools in meeting national clin-ical conflict-of-interest (CCOI) standards.

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

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

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

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

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

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

IMAP’s study found that U.S. medi-cal schools have made significant prog-ress to strengthen their management of clinical conflicts of interest (CCOI), but that most schools still lag behind nation-al standards.

Nursing Director Wins National Leadership Award

Carla Rider, RNC, BSN, director of nursing for women’s services at Wash-ington Regional Medical Center, won the 2013 National Association of Neona-tal Nurses Leadership Award at NANN’s 29th annual educational conference in Nashville, Tenn.

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

A native of Southwest Missouri, Rid-er has more than 30 years healthcare ex-perience. She earned a bachelor of sci-ence degree in nursing from Texas Wom-an’s University and a master of business administration degree from University of Phoenix. Rider is currently earning her doctorate of nursing practice in nursing leadership at Bellarmine University. She joined Washington Regional in 2010.

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