Mississippi Medical News January 2014

December 2009 >>

Samuel C. Pace, MD

PAGE 2

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Curbing Medical CostsUnitedHealthcare unveils cost estimator tool for Mississippians

Physicians who share frustrations over signifi cant price variations for healthcare services and procedures now have an integrated online and mobile tool to recommend to patients for better educated cost and quality decisions that should translate to signifi cant savings for medical services. ... 3

New Smoking Alternatives Present Challenges for Health Offi cialse-Cigs, hookah particularly attractive to teens

While overall tobacco use among middle school and high school students declined slightly between 2011 and 2012 in the United States, the percentage of adolescents using e-cigarettes nearly doubled during that same time period according to data from the 2012 National Youth Tobacco Survey ... 7

Ramping Up ‘Heart Studies v2.0’New coalition to connect and expand historic cardiovascular disease investigation

(CONTINUED ON PAGE 6)

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Making their Mark as Nation’s FirstNMMC cardiologists implant new investigational stent for heart attack patient

By LyNNE JETER

TUPELO — North Mississippi Medical Center (NMMC) cardiologists recently implanted the nation’s fi rst self-expanding bare metal stent designed specifi cally for heart attack patients.

Cardiologists Benjamin Blossom, MD, and Barry Bertolet, MD, per-formed the procedure with STENTYS, an investigational stent that has been used in Europe for several years and is now being studied in the United States.

“They felt good about the new stent, and they made me feel good about

By LyNNE JETER

The American Heart Association (AHA) recently de-buted a coalition establishing formal research ties between the University of Mississippi and Boston University and their renowned population studies of cardiovascular disease, the Jackson and Framingham heart studies.

“We’ll be transferring that success into 21st century ge-nomics developments and network medicine,” said Joseph Loscalzo, MD, PhD, chairman of the AHA’s Science Over-sight Group for this AHA-sponsored relationship.

The collaboration, with a placeholder name of Heart Studies v2.0, will add dimensional breadth to the two major population studies, allowing researchers to more deeply an-alyze genetic and other patient information collected in the studies’ extensive data banks.

Such research holds the promise of more effective and personalized medical treatments based on an individual’s genetic makeup, environment, history, particular disease sub-type and other variables.

“This collaboration will allow the continued devel-opment of the science to better understand the causes of

Dr. Barry Bertolet (left) and Dr. Benjamin Blossom (right) were part of the team that implanted the nation’s fi rst STENTYS coronary stent in heart attack patient James Haney.

2 > JANUARY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

Samuel C. Pace, MDPhysicianSpotlight

By LUCy SCHULTZE

Lung cancer, kidney cancer – that would have been one thing. But for a gas-troenterologist to be battling colon cancer, the irony just seemed to amplify the mis-fortune.

“It hit me really hard,” said Samuel C. Pace, MD, a senior member of Tupe-lo’s Digestive Health Specialists, PA.

“I hear my patients say all the time, ‘Why me?’” he said. “But having spent 37 years in practice — fi ghting so hard to prevent colon cancer — I found it to be so ironic when I was diagnosed with the disease myself.”

Identifi ed during a routine screening in 2011, Pace’s colon cancer was removed during surgery at that time — only to re-turn, against the odds, two years later.

In late 2013, Pace had stepped away from patient care to undergo chemother-apy, with good results so far.

“I don’t need to be trying to take care of my patients when I’m feeling discom-fort or tired,” he said.

“I’m still helping in the offi ce in an administrative role, and with strategic planning and recruiting. But I owe it to my patients – as all physicians do – to be 100 percent focused on what they need when I’m with them.”

A member of the Tupelo medical community since 1980, Pace is a native of Coffeeville and a graduate of Mississippi State University. He earned a medical de-gree at the University of Mississippi Medi-cal Center, followed by an internship in internal medicine.

Pace served as a lieutenant com-mander in the U.S. Navy from 1978-80 at Camp Pendleton in southern California. He followed college friend and medical-school roommate David Irwin, MD, to

Tupelo to launch his practice.While Irwin trained in cardiology,

Pace opted for gastroenterology after hav-ing the chance to shadow a GI specialist during his Navy service. He completed a fellowship in gastroenterology at UMMC in 1986.

In Tupelo, Pace’s practice has grown from four physicians two nine, with the addition of a nurse practitioner. The group continues to recruit actively and has opened a second clinic in Starkville. Its patients come from across northeast Mississippi as well as southern Tennessee and western Alabama.

“We became busy from the get-go, and knew we needed to recruit,” Pace said. “We really wanted to develop the practice to where there were areas of spe-cialty within the group, so that only a few people would do certain procedures.”

The strategy has paid off, Pace said, in that it’s fostered a team approach within the group.

“When a patient comes to our clinic,

they’re not getting one doctor; they’re get-ting nine,” he said. “It has been a wonder-ful concept for us.

“You’ve got to have the right makeup of people to make that happen, and you’ve got to have everyone willing to say, ‘I’m doing this for the benefi t of the patients.’ But it ends up benefi tting the individual, too.”

While all the physicians perform standard colonoscopies and gastroscopies, Pace has primarily focused on esophageal troubles, such as Gastroesophageal Refl ux Disease and problems with swallowing. At the Center for Digestive Health Heart-burn Center at North Mississippi Medi-cal Center, Pace and his colleagues have performed assessments and evaluations on patients.

“Being able to specialize has been a bonanza to me personally,” Pace said. “I’ve gone to meetings focused primarily on this, and gotten to meet doctors who are internationally famous in esophageal work. It’s opened a lot of doors in the

practice as well, for things like the new LINX procedure for refl ux.”

Over the years, Pace has served as president for the Mississippi Gastroenter-ology Society, as Mississippi governor for the American College of Gastroenterol-ogy and as chairman of NMMC’s medi-cal staff.

While stepping away from his prac-tice to focus on his own health has been diffi cult, it’s also added new dimensions to how he feels about his work.

“Being on the other side of the knife is something nobody wants,” he said. “But believe it or not, in some ways, I think it has completed me in a personal sense and in understanding what patients have gone through.

“As physicians, we do our best to be sympathetic and understand what they’re going through. But unless you walk in their shoes, you really can’t.”

Deepening the experience further: When Pace goes in for his chemotherapy appointments, he’s often greeted by fellow patients whom he himself has cared for.

“As weird as it sounds, it’s been re-warding to me for them to express their concerns, and for them to tell me, ‘Thank you and we’re praying for you,’” he said. “That as much as anything, other than my family and my faith, has been such a bol-ster to me.”

Supporting him in his fi ght against cancer has been his wife, internist Mary Pace, MD, as well as sons David Pace of Tupelo and Gordon Pace of Richmond, Va. Pace has a grandson in Virginia and three granddaughters locally; the elder two he’s lately been driving to school in the mornings.

“There are a lot of things I’ve not been able to do that I’m enjoying now,” he said. “As a physician, time constraints are such that we don’t really get to spend time with our family as we would like to.

“But you learn a lot about what’s im-portant, when this sort of thing happens. I’m focused on ‘making the main thing the main thing,’ as my wife has said many times.”

Outside of his practice, Pace also en-joys photography, following Mississippi State athletics and singing in the choir at First Presbyterian Church.

His enthusiasm for golf once prompted his son as a fi rst-grader to tell his class: “My mom is a doctor and my dad plays golf.”

“Mary has laughed about that and enjoyed telling that so much,” Pace said.

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By LyNNE JETER

Physicians who share frustrations over significant price variations for health-care services and procedures now have an integrated online and mobile tool to rec-ommend to patients for better educated cost and quality decisions that should translate to significant savings for medical services.

To create price transparency, Unit-edHealth Group (NYSE: UNH) recently unveiled a new comparison shopping fea-ture – myHealthcare Cost Estimator™ – for in-patient services, including knee re-placement, spinal surgery and childbirth.

“Adding inpatient services enables my-Healthcare Cost Estima-tor to provide consumers even more crucial in-formation that’s per-sonalized, relevant and accurate,” said Glen Golemi, CEO of United-Healthcare’s Gulf States Region. “MyHealthcare Cost Estimator enables people to make better care deci-sions, by better understanding their treat-ment options, comparing services and anticipating future costs.”

Curbing costs should make a dent in the total cost of hospital stays in-state. In 2010, a Mississippi Department of Health inpatient discharge report showed Mis-sissippians spent $9.6 billion.

As patients are held more account-able for healthcare costs, the new con-sumer tool is especially helpful in areas where prices vary significantly for

healthcare services and procedures. In Metro Jackson, for example, an emer-gency room visit for a heart attack may range from $763 to $4,475. The total cost for childbirth, including prenatal and postnatal care, ranges from $6,918 to $11,091. For knee replacement surgery, the cost is between $19,705 and $26,115.

MyHealthcare Cost Estimator pro-

vides cost estimates for more than 550 services across more than 220 “episodes of care,” based on negotiated contracted rates of 540,000 healthcare professionals and 4,500 hospitals in 165 geographic lo-cations in the United States. The online and mobile service is more precise than cost estimation tools that may rely solely on historical claims data or provide esti-mates based on geographic averages.

Also, estimates are personalized to mirror an individual’s own health plan benefits, including real-time account bal-ances when applicable. They provide a comprehensive view of what consumers should expect throughout their course of treatment, including out-of-pocket costs, employer-paid portions, and real-time account balances. The tool also provides common alternate treatment options to educate patients on their choices, and fo-cused information about how their ben-efits work and costs are determined.

UnitedHealthcare is among the first national healthcare companies to allow consumers to comparison shop for inpa-tient medical services. The insurer has made the personalized, integrated tool available to more than 21 million consum-ers nationwide.

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Most physicians try their best to pro-vide quality care for their patients and do not anticipate being the subject of a medical malpractice lawsuit. However, legal complaints are a reality with which doctors have to contend. Once the pa-tient becomes plaintiff and their attorney proceeds with formal allegations of negli-gence, the parties to the lawsuit then go about collecting as much pertinent infor-mation as possible well before trial occurs. This discovery phase of litigation includes carrying out legal procedures like inter-rogatories which are written questions to the other party in the suit that must be answered under oath. Requests for documents are also made as well as the taking of oral depositions. A deposition is another discovery procedure by which a witness’s testimony is taken under oath prior to trial. A stenographer or court re-porter transcribes all of the questions and answers creating a resultant manuscript. It is the defendant physician’s deposition which is of chief importance. During the deposition, opposing counsel typically has an expansive agenda with the goal to obtain as much information as possible.

Another objective that they have in mind is to “lock-down” testimony so that what was said at deposition can be used for im-peachment in the event there is inconsis-tent testimony at trial.

The deposition experience is indeed stressful as a physician suddenly finds their integrity and actions called into question. Nevertheless, the defendant needs to be well prepared. Remember that the strengths and weaknesses of the witness are being assessed so the impres-sion being made could potentially influ-ence the case in a way which would aid the defense. Preparation begins with a review of the entire database so that there is a clear recollection of the case. A pre-deposition conference with the defense attorney is also obligatory and should in-clude clarification of any potentially con-fusing matters. Do not attempt to conceal any information, even that which you per-ceive to be unfavorable from your defense team. Honesty and candidness are thus a necessity. The physician’s CV should also be checked for any discrepancies, and counsel should be alerted to any web sites or online profiles that are relevant. It is advisable to conduct a mock deposition to further increase the witness’s prepared-

ness. Despite any practice demands, the physician should plan ahead and accord-ingly allow sufficient time scheduling for the deposition. It is also important to be clear about the deposition’s location and do not allow it to occur at the defendant’s office. Following these suggestions will re-inforce confidence during the deposition which will in turn be reflected in the final written transcript.

Once the deposition begins, remem-ber that a sworn witness is required to tell the truth. Opposing counsel will ask questions in an attempt to foster answers which might reveal new facts or open up problematic areas. The physician should make every effort to keep their answers clear and concise. Listen carefully and pause before answering to allow time so that each question asked receives prudent consideration. It is helpful to remember that the written transcript itself does not reflect the length of time it takes to answer a question. Exceptions to being brief may occur when an explanation is necessary as well as when defense counsel provides specific instruction. A particularly decep-tive scheme to watch out for is a pattern of questioning by opposing counsel intended to prompt only “yes” answers making it hard to say “no” in response to a subse-quent ambiguous question. The witness may ask for clarification of confusing or convoluted questions, but should never speculate, guess, or make inaccurate/un-founded statements. If the question is ul-timately not understood, it should not be answered with the response simply being “I don’t know.” Alternatively, an answer may be qualified by saying “approxi-

mately” or “to the best of my memory.” Definitely avoid the use of adjectives and superlatives such as “always” or “never” as these qualifiers can be later used to distort testimony. If questions are asked about a particular document, ask to see that document and take time to review it to make sure that it has not been quoted out of context or mischaracterized. Any pertinent concerns should be noted by the witness on the record. There are cir-cumstances where both attorneys may wish to have a discussion “off the record.” For the witness however, remember that nothing said is ever “off the record.”

Many attorneys reserve especially important questions for later on into the deposition hoping that the defendant will be less guarded, so it is important to be well rested and ask for breaks when needed. Composure and concentration must be maintained while resisting the urge to become overly emotional and hostile as there is vulnerability to be-have in ways which could negatively af-fect the outcome of the case. Opposing counsel will test the defendant and hope for mistakes which are recorded in the transcript. Alternatively, they may wait and later on prompt for such behavior at trial. If a mistake is made, simply state for the record that you were in error and correct your statement. There are times where the physician is approached in a congenial manner as a tactic to attempt to gain additional information. And if the attorney becomes silent after an answer, the witness should resist the compulsion to continue talking. Never volunteer extra information, agree to supply any additional documents or provide other evidence. Some physicians going into a deposition believe that if they are allowed to explain their case, opposing counsel will dismiss the complaint which is in fact unlikely to occur. If the deposition is to be videotaped, realize that the recording will likely be played for the jury. It would therefore be important to dress appropri-ately, look directly at the camera, speak clearly and avoid long pauses in this cir-cumstance.

Fortunately, initiating a medical mal-practice lawsuit and winning it are entirely different matters for the plaintiff. Only about 7 percent of medical malpractice lawsuits ultimately go to trial, and most of these, about 80 percent, result in a verdict for the defense. By being educated and thoroughly prepared, the defendant phy-sician will not only be better able to cope with completing their deposition, but they will also enhance their likelihood of a fa-vorable judgment.

Coping with Medical Malpractice Depositions

Karl G. Sieg, MD, MRO, FAPA is Medical Director of La Amistad Behavioral Health Services located in the Orlando metropolitan area. Dr. Sieg has also served as a litigation consultant and expert witness in civil matters including medical malpractice and personal injury cases over the past twenty years.

Since myHealthcare Cost Estimator was launched, consumers have compared the quality and cost of various treatments and services, generating more than $200 million in estimates. In a recent survey of myHealthcare Cost Estimator users, 67 percent of the people surveyed said the tool gave them confidence to make better cost choices; 84 percent said they would use it again.

The tool has benefitted employers who sponsor benefits plans by encourag-ing employees to access it via webinars, health fairs, direct mail campaigns and other marketing efforts.

MyHealthcare Cost Estimator builds on the success of UnitedHealthcare’s Treatment Cost Estimator™, created in 2007 to help consumers comparison shop for health services and understand how costs differ from doctor to doctor. The tool is also integrated with additional in-formation and resources, including nurse support.

Curbing Medical Costs, cont. from page 3

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The new obesity guidelines – updated for the first time in 15 years – are geared to primary care providers (PCPs) and offer an algorithm for managing obesity.

The protocol for the management of over-weight and obese adults is among four updated guidelines commissioned by the National Heart Lung and Blood Institute, and developed by the American Heart Asso-ciation and the American College of Cardiology to identify at-risk patients and prescribe appropriate interventions. The timing coincides with the Ameri-can Medical Association’s recent classifi-cation of obesity as a “disease.”

To guide weight management deci-sion-making, an algorithm focuses on the identification of patients with excess body weight and those at risk for obesity-related health problems.

Most information is straightforward: • Patients with a BMI of 30 or higher

are considered obese and need treatment. • Patients with a BMI 25 to 30 are

considered overweight and should be treated if they have additional risk factors, such as an elevated waist circumference of 35 inches or more for women, or 40 inches or more for men.

However, even though research soundly shows the higher the BMI, the greater the risk for cardiovascular disease, diabetes, and cancer, the question about the use of BMI as a screening tool has drawn debate.

Healthcare providers agree that every 5 to 10 percent of total body weight lost is a milestone that reaps health benefits. But with so many diet programs avail-able – the guideline committee reviewed 17 different plans and concurred that as long as there’s a negative energy flow, and the intake of calories is reduced daily to 1,000 or less, it should work – determining the right one, and the amount of weight that’s safe to lose over the course of weeks and months, has also been the center of controversy.

The diet, guidelines say, should be a component of a comprehensive lifestyle intervention including physical activity and behavioral changes, delivered by a trained counselor. The guidelines suggest that patients meet with the interventionist 14 times in the first 6-month period.

Donna Ryan, MD, co-chair of the

guideline committee and a professor emeritus at Pennington Biomedi-cal Research Center in Louisiana, admitted the current approach is for PCPs to simply tell pa-tients to lose weight but “they don’t really en-gage in helping patients achieve weight loss, either through referral or providing counseling or prescribing. They’ve been reluctant … but that’s changing.”

What’s not ad-dressed: the reason why some patients make adjustments to lead a healthier lifestyle, but still cannot successfully reach a more optimal weight for their body

frame.“It’s not as simple as telling a patient,

‘you need to lose weight,’” said Gus Vick-ery, MD, a North Carolina family medi-cine physician. “Sometimes, it takes some investigating to determine the source. It might be thyroid issues, or a combination of medical problems. Unfortunately, we (PCPs) stay so busy … it’s helpful when patients come prepared. It’s OK for a pa-tient to say, ‘I can’t lose weight and I don’t know why. It doesn’t always seem to be a matter of willpower.’”

After Vickery talked to a colleague about the colleague’s doctor-supervised weight loss clinic focusing on a well-rounded, low-calorie, low-carbohydrate food plan, he ditched his own in-house program and began referring patients there. One couple, patients of Vickery, lost a combined 140 pounds in less than a year. Other patients returned to Vick-ery tens of pounds thinner – and much healthier.

“My colleague,” said Vickery, “does the heavy lifting; I monitor the results.”

The impetus for the proactive move-ment of PCPs may be practice for the fu-ture, when they may be accountable for patients who haven’t made sincere efforts to lose weight to get healthier. Patients could eventually be penalized by insur-ers for not taking documented action to achieve a healthier weight.

“I could see (insurers) really increas-ing people’s premiums if they don’t fol-low certain preventive measures in the future,” said urologist Stan Sujka, MD, a partner of Orlando Urology Associates in Central Florida. “Unfortunately, we’re becoming a society of regulations. A lot of people don’t seem to want take personal

Obesity: The New Chronic Disease?Updated guidelines encourage PCPs to focus on obesity

The “My Fitness Pal” app allows patients to meet pre-set calorie and exercise goals.

(CONTINUED ON PAGE 8)

6 > JANUARY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

heart disease and stroke,” said Univer-sity of Mississippi chancellor Dan Jones, MD, and former Jack-son Heart Study (JHS) principal investigator. “It moves us closer to the day when this lead-ing cause of death can be prevented in more people.”

Representatives from the AHA, Boston Univer-sity, the University of Mississippi, and other scientific thought leaders appointed by the collaboration’s Scientific Oversight Group will govern the new research pact.

“This research collaborative provides an opportunity for scientists in Mississippi to work with scientists from around the country,” Jones noted. “And it enlarges opportunities for participants in the Jack-son Heart Study and others in Mississippi to benefit from the best science minds in our country.”

The Framingham Heart Study, founded in 1948 at Boston University, is the nation’s longest-running cardiovascu-lar disease investigation. Its researchers have collected massive amounts of health data over decades from seven cohort groups comprised of thousands of partici-pants.

Framingham has published several crucial findings, including identification of risk factors for heart disease and stroke, and insights on the effects of these factors,

including smoking, obesity, blood pres-sure, cholesterol and physical activity.

The JHS is the largest study in history to focus on the genetic factors related to cardiovascular diseases in African-Ameri-cans, a group that faces increased risk for heart disease and stroke.

It’s an extremely important study, because, while the Framingham study has provided decades of important data, its subjects have lacked racial diversity, said Jones, who helped establish the JHS in the late 1990s and served as AHA president from 2007-08.

The JHS draws together the University of Mississippi Medical Center, Jackson State University (JSU) and Tougaloo College. The study has followed 5,300 African-Americans in Jackson for more than a decade, compil-ing data from voluminous medical tests, scans, exams and interviews, while also ana-lyzing the effects of lifestyle factors such as diet and community – and church involve-ment – on their overall health.

“The University of Mississippi Medi-cal Center is proud to work with its part-ners at JSU and Tougaloo College in the Jackson Heart Study,” he said.

JHS researchers have identified links between social conditions and specific risk factors for diseases, uncovered differences in metabolic syndrome between races, and identified how location of fat in the body affects African-Americans – a topic previ-ously characterized mainly in Caucasians.

The new research collaborative is just

getting under way, but major results could come in the next decade, maybe a few years sooner, said Loscalzo, also chairman of the Department of Medicine and phy-sician-in-chief at Brigham and Women’s Hospital and editor-in-chief of the AHA journal, Circulation.

Heart Studies v2.0 will bolster the JHS’s training mission, giving new oppor-tunities to the next generation of research-ers and health-care providers, Jones said.

Through JSU, the JHS has served as

a springboard for community health out-reach and graduate-level training oppor-tunities.

Through Tougaloo, the JHS has recruited and helped train dozens of un-derrepresented high school and under-graduate college students interested in careers in science, medicine and public health. Many have become researchers and medical professionals at prestigious institutions.

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Ramping Up ‘Heart Studies v2.0’ continued from page 1

Dr. Dan Jones

it,” said James Haney, a 60-year-old Amory man whose family rushed him to Gilmore Memorial Hospital’s emergency department when he showed signs of a heart attack. After tests confirmed that Haney was enduring an ST-segment el-evation myocardial infarction (STEMI), he was transported by CareFlight medical helicopter to NMMC in Tupelo, where doctors met him on the landing pad. “I asked them if they’d ever put one of these in before, and they told me I would be the first in the nation. I said, ‘that’s not really what I wanted to hear.’ But, I thought, God has opened this door for some rea-son, so I agreed to participate in the study. If not me, maybe it will benefit someone down the road.”

Made of nitinol, this stent’s self-ex-panding trait makes it unique.

“Our goal is to restore blood supply as quickly as possible,” noted Bertolet. “Traditionally in the cath lab, we inflate a balloon to re-open the artery where it’s narrowed, and oftentimes we implant a stent to keep the blood vessel open.”

Doctors may find it tricky to prop-erly “size” the stent because of changes in the blood vessel caused by a heart attack. When the heart spasms, blood vessels contract and get smaller. Once the dam-age begins to resolve, the vessel typically resumes its normal size. However, it can leave a gap between the stent and the ves-sel wall. Blood clots and plaque can accu-mulate in these gaps and lead to another blockage and another heart attack.

Because the STENTYS stent ex-pands on its own without the use of a balloon, it’s believed the stent may have

better adhesion to the heart vessel wall. “The vessels in the heart aren’t stag-

nant tubes,” said Blossom. “They change size and shape, especially after a heart at-tack. A traditional stent doesn’t adapt to these changes, but this stent takes into ac-count the variability of the blood vessels.”

Haney, who was awake through-out the procedure, spent three days at NMMC.

“We’re so blessed to have gotten care as quickly as he did, and that everyone is so good at what they do,” said Haney’s wife, Beverly. After recovering at home for a few weeks, he returned to swing shift duty at Tronox in Hamilton, where he has worked for nearly a quarter-century.

“I felt extremely good afterward,” Haney said. “I didn’t realize how bad I was feeling before this.”

The STENTYS stent can also pro-vide a better fit for people whose vessels are “lumpy,” or a mixture of accessible sizes. Because the STENTYS conforms so well to the blood vessel, it also lowers the risk that blood clots will form in gaps between the stent and the blood vessel wall.

NMMC was the first site in the na-tion enrolled in the study and has now implanted nine STENTYS stents. Even though four sites in the nation are now open to enrolling patients, NMMC re-mains the only site where the stent has ac-tually been used. Because of this success, Bertolet recently made a presentation, by request, to cardiologists and nurses at the international Transcatheter Cardiovascu-lar Therapeutics conference in San Fran-cisco last fall.

Making their Mark, continued from page 1

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Life Is a Sport.

By CiNDy SaNDERS

While overall tobacco use among middle school and high school students declined slightly between 2011 and 2012 in the United States, the percentage of adolescents using e-cigarettes nearly dou-bled during that same time period according to data from the 2012 National Youth To-bacco Survey.

“We found a big increase in middle school and high school students in emerging tobacco products,” said Brian King, PhD, senior scientific advisor for the Centers for Disease Control and Prevention’s Office on Smoking and Health. He added e-cigarettes and hookah led the way.

When asked about e-cigarette usage in the last 30 days, middle school students partici-pating in the National Youth Tobacco Survey

(NYTS) had an increase from 0.6 percent in 2011 to 1.1 percent in 2012. In high school students, the rate rose from 1.5 to 2.8 percent. For all students grades 6-12, ‘ever’ usage – students reporting ever having tried an e-cig even if not a regular user – rose from 3.3 percent to 6.8 percent during the same time frame. Among high school students, ‘ever’ usage jumped from 4.7 percent in 2011 to 10 percent in 2012. Hookah use among high school teens also rose from 4.1 percent in 2011 to 5.4 per-

cent in 2012. Drilling down further, the

NYTS data found from 2011 to 2012 the use of e-cigarettes more than doubled for middle school males (0.7 percent to 1.5 percent), high school females (0.7 percent to 1.9 percent) and Hispanics in both age groups (middle school 0.6 percent to 2 percent; high school 1.3 percent to 2.7 percent). The informa-tion was published in Septem-ber and November 2013 in the CDC’s Morbidity and Mortality Weekly Report.

Although the numbers seem rela-tively small, King said they are troubling. First, nearly 90 percent of adult smokers in America began smoking by age 18 so trends in youth tobacco usage could have long-lasting public health consequences. Also, he explained, “A majority of the e-cigarette users are also using traditional cigarettes so there is a lot of dual use.” In fact, the data showed more than 75 percent of those using e-cigarettes also smoked conventional cigarettes.

Often marketed as a safer alterna-tive to traditional smoking, an e-cigarette is a battery-powered device that converts liquid nicotine and other additives into a vapor that is inhaled by the user. Some-times referred to as ‘vaping,’ the solution cartridges can be purchased with varying amounts of nicotine … including none at all … mixed with flavorings. Although e-cigs mimic traditional smoking, the de-vices don’t use tobacco or tar. Still, the Food and Drug Administration has an-nounced the intention to classify e-cigs as a tobacco product and to begin regulat-ing their use. However, King noted, “We don’t know when or what that will entail.”

King said that just because e-ciga-rettes don’t use tobacco doesn’t mean they are safe. “The nicotine, itself, is not with-out health risks,” he pointed out. “Studies have shown nicotine can have an adverse effect on brain development in youth.” And, he added, “Nicotine Is highly addic-tive.”

As to why the jump in the number of middle school and high school students trying many of these emerging tobacco

New Smoking Alternatives Present Challenges for Health Officialse-Cigs, hookah particularly attractive to teens

Brian King (CONTINUED ON PAGE 8)

8 > JANUARY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

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products, which also includes fl avored lit-tle cigars, King said there are a number of likely reasons. First, it is still legally permis-sible to sell these items to minors in most states. Hookah cafes are popping up across the country and appeal to a sense of social connection. In the absence of legislation, e-cigarettes often are allowed to be used in locations where tobacco is restricted. And, King said, price is another factor. Typically, a disposable e-cig is signifi cantly cheaper than a pack of conventional ciga-rettes, in part because states are still trying to fi gure out how to tax the devices and solution used in them.

Then there is the fl avor. Both hookah and e-cig solutions come in a wide vari-ety of fl avors ranging from ‘tobacco’ and ‘menthol’ to more youth-friendly options like bubble gum, gummy bears, cotton candy, white chocolate and waffl es. King pointed out the FDA banned fl avors, ex-cluding menthol, years ago in traditional cigarettes and also stopped other market-

ing efforts to appeal to teens.“The tobacco industry will tell

you they’re not specifically marketing to youth,” he said of advertising efforts around e-cigarettes. Yet, King pointed out, “Manufacturers are using methods to market that we haven’t seen in decades … the most notable of which is television.” King noted celebrity endorsements also are being used to glamorize the products. Additionally, a heavy social media pres-ence keeps emerging tobacco products in front of youth.

Currently, the CDC is relying on general tobacco cessation messages to cover these emerging products. King said healthcare providers also have an impor-tant role to play in educating young pa-tients and serving as a deterrent to tobacco use in any form.

“We know that health professionals … and physicians in particular … are an effective means to deliver credible health information about all tobacco products.”

New Smoking Alternatives Present Challenges, continued from page 7

Cigar Use Also Rising

Among high school students, cigar use also increased between 2011 and 2012, rising from 11.6 percent to 12.6 percent. According to the CDC, about one-third of cigar smokers are using fl avored little cigars or cigarillos. While there was a 1 percent overall increase in the usage of cigars, the increase was much sharper among non-Hispanic black high school students. In this group, 16.7 percent reported smoking cigars in 2012 as compared to 11.7 percent in 2011. Furthermore, the 2012 fi gure was more than double the estimated usage in 2009 for non-Hispanic blacks.

responsibility for their well-being.”Recently, to set an example for pa-

tients and to improve his health, Sujka dropped 36 pounds in nine months with the assistance of a diet app on his smart phone, a practice he en-courages patients to fol-low as a fi rst course of action for losing excess weight.

“Your smart phone can serve as your personal coach to shed those unwanted pounds,” he said. “It’s easy, free, and stud-ies show it works.”

The two most popular free apps are “Lose It” and “My Fitness Pal,” which al-lows patients to meet pre-set calorie and

exercise goals. Sujka’s partner, Albert Ong, MD,

gave him a kickstart on the new lifestyle modifi cation by downloading the “Lose It” app on Sujka’s smart phone and program-ming it to lose one pound per week. Sujka is now very close to his college weight goal of 200 pounds.

“Since losing weight, a lot of my pa-tients have asked, ‘how did you do it?’ After explaining to them about using their (smart) phones to lose weight, many of them have come back to the offi ce and told me their doctors for years have been telling them to lose weight but have never told them how,” explained Sujka. “They’ve told me they’ve found the app simple and effective. As a result, I wrote up the prin-ciple of using your smart phone to lose weight. A lot of patients appear more ex-cited about losing weight than the effects of Viagra or Cialis!”

Overall, the guidelines don’t focus on specifi c obesity medications. Only orlistat (Alli or Xenical) was available during the committee review process. Since then, the FDA has approved new diet drugs – lor-caserin (Belviq) and phentermine/topira-mate (Qnexa) – that are recommended for use as “an intensifi cation approach.”

Bariatric surgery for weight loss was the fi fth and fi nal recommendation “when other interventions fail.”

Obesity, continued from page 5

Dr. Stan Sujka

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By LyNNE JETER

ST. LOUIS – Just before Thanksgiv-ing, St. Louis vascular surgeon Brian Pe-terson, MD, made history as the world’s fi rst surgeon to successfully implant the iliac branch stent-graft.

The St. Anthony’s Medical Center patient who received the investigational device was the fi rst one enrolled world-wide in the Gore Excluder Iliac Branch Clinical Study to test the safety and ef-fectiveness of the new stent used to treat aortic and iliac aneurysms.

“This new device allows more pa-tients to undergo a less invasive endovas-cular procedure, which implants the stent through an artery, rather than open sur-gery,” said Peterson, associate professor of surgery at Saint Louis University (SLU). “The less invasive surgery helps speed up recovery time. This new stent-graft is also designed to preserve vital blood fl ow to the pelvis by including an additional branch in the stent, compared to the traditional device used now.”

In October, the device maker, W.L. Gore & Associates, won CE Mark ap-proval in the European Union for its Excluder iliac branch stent graft, and is available in the United States for investi-gational purposes only. Peterson believes the device will “absolutely” be main-streamed expediently.

“The industry sponsor of the trial is actively undergoing site visits and en-rolling centers across the country,” said Peterson, about the U.S. goal of 49 sites for the prospective, multi-center, non-random-ized, single-arm study. “We hope that, within a year or so, we’ll have enough patients enrolled in the trial to come up with some conclusions and hopefully make this widely available.”

Gore’s Ryan Takeuchi said the fully engineered system “fulfi lls an unmet clini-cal need.”

Peterson concurs. “About 40 percent of patients with abdominal aortic aneu-rysms also have aortic aneurysms of their iliac arteries,” he said. “This allows us to treat those all in one setting.”

The 767-bed St. Anthony’s Medical Center, one of the largest hospitals in the metro area, with a Level 2 trauma center and four urgent care facilities, became the site of the world’s fi rst surgery of its kind.

“We were in a good relationship with our industry sponsor,” said Peterson. “Most of my work is done at St. Anthony’s, where processes are very streamlined, from the IRB (Investigational Review Board) to the vascular team, which does a high volume of endovascular aneurysm repairs. The industry sponsor of the trial recognized we’d be a good center because of our volume and outcomes. And every-thing went very smoothly. We set up our site visit in a very timely fashion. We had

a couple of patients lined up, and sure enough, ended up being the fi rst ones in the world to implant this device.”

Peterson discussed the case at Gore’s principle investigators’ meeting in late No-vember in New York City. Since then, one other implant has been performed.

“The most exciting aspect for primary care physicians to know about this new de-vice is, prior to the device being available, we’d usually have to sacrifi ce one of the major blood vessels that supplies blood to the pelvis. Virtually everyone in follow-up had symptoms, as the decreased blood fl ow most commonly manifested as pain while walking, cramping, and discomfort of the rear. It resulted in the worst case scenario: poor circulation to the intestines. That’s all virtually eliminated with this device. It preserves the blood fl ow to the pelvis, and patients are able to return to work sooner and resume their daily activi-ties quicker in a symptom-free manner.”

Since 1984, the Gore Medical Prod-ucts Division has produced vascular grafts, endovascular and interventional devices, surgical meshes for hernia repair, soft tissue reconstruction, staple line reinforcement and sutures. A consistent “Best Company to Work For,” Gore has provided more than 35 million devices worldwide.

Peterson is optimistic about how the Gore iliac branch stent-graft could revolu-tionize the treatment for abdominal aortic aneurysms.

“There’s great interest across the country as the medical community real-izes this is an option for patients that will soon be available closer to home,” he said.

World’s FirstSt. Louis surgeon fi rst in world to implant new stent-graft at St. Anthony’s Medical Center

Dr. Brian Peterson

The surgical team gathers in the OR immediately after successfully implanting the world’s fi rst iliac branch stent-graft. (L-to-R:) Gore fi eld sales associate Paul Hoog; St. Anthony’s vascular surgery OR team members Anna McCormick, RN, and Karen Kanyuck, RN; Dr. Brian Peterson; SLU vascular surgery fellow Michael Williams, MD; St. Anthony’s vascular surgery OR team member Becky Fister, RN; and Gore product specialist Steve Korte.

PHO

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F W

.L. G

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Medical News markets are well represented in the Gore Excluder Iliac Branch Clinical Study. Among the sites being set up for the prospective, non-randomized, single-arm study to test the safety and effectiveness of a new stent used to treat aortic and iliac aneurysms, and the physicians representing them:

Florida Vascular Consultants Maitland, Fla. Robert Winter, MD

Saint Anthony’s Medical CenterSt. Louis, Mo. Brian Peterson, MD

Ochsner Health SystemDepartment of SurgeryNew Orleans, La. W. Charles Sternbergh III, MD

University of Alabama Medical CenterVascular SurgeryBirmingham, Ala. William D. Jordan Jr., MD

University of Mississippi Medical CenterDivision of Vascular SurgeryJackson, Miss.Zachary K. Baldwin, MD

Vanderbilt University Medical CenterNashville, Tenn. Thomas Naslund, MD

SOURCE: W.L. Gore & Associates.

10 > JANUARY 2014 m i s s i s s i p p i m e d i c a l n e w s . c o m

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GrandRoundsAlliance Health Center Earns “Top Performer on Key Quality Measures®” Recognition from The Joint Commission

Meridian, MS – Alliance Health Cen-ter was named Top Performer on Key Quality Measures® by The Joint Com-mission, the leading accreditor of health-care organizations in America. Alliance Health Center was recognized by The Joint Commission for exemplary perfor-mance in using evidence-based clinical processes that are shown to improve care for certain conditions. New this year for the inpatient psychiatric services is admission screening for violence risk, substance abuse, psychological trauma history and patient strengths completed.

Alliance Health Center is one of 1,099 hospitals in the U.S. earning the distinction of Top Performer on Key Quality Measures for attaining and sus-taining excellence in accountability mea-sure performance. Alliance Health Cen-ter was recognized for its achievement on the following measure sets: hours of physical restraint use,

hours of seclusion use, multiple an-tipsychotic medications at discharge, multiple antipsychotic medications at discharge with appropriate justification, post discharge continuing care plan cre-ated, and post discharge continuing care plan transmitted to next level of

care provider upon discharge. The ratings are based on an aggre-

gation of accountability measure data reported to The Joint Commission dur-ing the 2012 calendar year. The list of Top Performer organizations increased by 77 percent from last year and it represents 33 percent of all Joint Commission-ac-credited hospitals reporting accountabil-ity measure performance data for 2012. Alliance Health Center and each of the hospitals that were named as a Top Per-former on Key Quality Measures must: 1) achieve cumulative performance of 95 percent or above across all reported ac-countability measures; 2) achieve perfor-mance of 95 percent or above on each and every reported accountability mea-sure where there are at least 30 denomi-nator cases; and 3) have at least one core measure set that has a composite rate of 95 percent or above, and within that measure set all applicable individual accountability measures have a perfor-mance rate of 95 percent or above. A 95 percent score means a hospital provided an evidence-based practice 95 times out of 100 opportunities.

River Oaks Hospital Receives Prestigious Awards For Spine Surgeries

River Oaks Hospital is among the top 10 percent of U.S. hospitals for spine surgery, a ranking that places the

Flowood hospital in the category of America’s Best 100 Hospitals, according to a new report from Healthgrades, the leading provider of information to help consumers make an informed decision about a physician or hospital.

For the 12th consecutive year, Riv-er Oaks Hospital’s orthopedic services program received a 5 Star Award from Healthgrades. Additionally, the hospi-tal received a Spine Surgery Excellence Award and 5 Star Award for spinal fusion surgery.

The findings are part of American Hospital Quality Outcomes 2013: Health-grades Report to the Nation, which eval-uates the performance of approximately 4,500 hospitals nationwide across nearly 30 of the most common conditions and procedures. Healthgrades bases its ob-jective measures solely on clinical per-formance.

River Oaks’ President & CEO Dwayne Blaylock said the prestigious ranking meets important criteria for pa-tients seeking to make serious choices about healthcare, particularly surgery.

Patients are especially relieved to find that River Oaks is ranked as one of the safest medical facilities in the nation at which to receive medical care, Blay-lock said. According to the Healthgrades report, patients were 61% less likely to experience a major in-hospital compli-cation when being treated at a hospital receiving 5 stars when compared with hospitals receiving 1 star across a range of common procedures.

Additionally, patients were 42 per-cent less likely to experience an in-hos-pital complication in hospitals receiving 5 stars versus all other hospitals. River Oaks has one of the lowest complication and infection rate in the nation, accord-ing to Blaylock.

Healthgrades independently mea-sures hospitals based on data that hospitals submit to the federal govern-ment. No hospital can opt in or out of the analysis, and no hospital pays to be measured.

Memorial Physician Clinics Welcome Internal Medicine Physician

Memorial Physician Clinics wel-come Virginia Blalack, MD, in the prac-tice of Internal Medicine. Dr. Blalack joins Dr. Nabil Azar, Dr. David LaRosa, and Dr. Mousa Maalouf at 1340 Broad Ave. Suite 310, Gulfport.

Dr. Blalack gradu-ated Magna Cum Laude with her undergraduate degree from Delta State University in Cleveland, Mississippi. She earned her medical doctorate from the University of Mississippi Medical Center in Jackson. Dr. Blalack completed her residency in internal medicine and fellowship in ge-riatrics at the University of Mississippi Medical Center.

Dr. Virginia Blalack

m i s s i s s i p p i m e d i c a l n e w s . c o m JANUARY 2014 > 11

Singing River Health System Awarded Advanced Certification For Primary Stroke Centers From The Joint Commission

The Joint Commission, in conjunc-tion with The American Heart Associa-tion/American Stroke Association, re-cently recognized Singing River Health System with Advanced Certification for Primary Stroke Centers. Achievement of Primary Stroke Center Certification signifies an organization’s dedication to fostering better outcomes for patients. SRHS’s Primary Stroke Center Certifica-tion has demonstrated that their pro-gram meets critical elements of perfor-mance to achieve long-term success in improving outcomes for stroke patients.

SRHS underwent a rigorous on-site review in September 2013. A Joint Com-mission expert reviewed SRHS’s compli-ance with the requirements for The Joint Commission’s Disease-Specific Care Certification program as well as primary stroke center requirements, such as col-lecting Joint Commission core measure data and using it for performance im-provement activities.

Developed in collaboration with the American Stroke Association and launched in 2003, The Joint Commis-sion’s Primary Stroke Center Certification program is based on the Brain Attack Coalition’s “Recommendations for the

Establishment of Primary Stroke Cen-ters.” Certification is available only to stroke programs in Joint Commission-accredited acute care hospitals.

SRHS will be able to display The Joint Commission’s Gold Seal of Ap-proval® and the American Heart Asso-ciation Heart-Check mark for their Ad-vanced Certification for Primary Stroke Centers. Displaying the seal and Heart-Check mark signifies that SRHS is pro-viding the “next generation of stroke or heart failure care,” and will help patients easily identify this facility as one of qual-ity that has surpassed numerous goals in the treatment of stroke.

Woman’s Hospital Receives Award for Patient Satisfaction

Woman’s Hospital is proud to an-nounce it has been named a 2013 Guard-ian of Excellence Award winner by Press Ganey Associates, Inc. The Guardian of Excellence Award recognizes top-per-forming hospitals for patient satisfaction.

The Press Ganey Guardian of Ex-cellence Award is a health care industry symbol of achievement. Fewer than 5 percent of all Press Ganey clients reach this threshold. Press Ganey partners with more than 10,000 health care facili-ties, including more than half of all U.S. hospitals, to measure and improve the patient experience.

According to CEO Sherry Pitts, the award represents an important recogni-tion few hospitals achieve.

Baptist Names Whit Hughes Chief Development Officer and Foundation President

Whit Hughes has joined Baptist Health Systems as the chief develop-ment officer and presi-dent of the Baptist Health Foundation, the philan-thropic division of Baptist.

Recently, Hughes was founder and president of P3 Elevations, LLC, an economic development and strategic consulting firm. He previ-ously served as deputy director and chief operating officer for Mississippi Devel-opment Authority.

Hughes received both his under-graduate degree in marketing and a Master of Business Administration from Mississippi State University.

He resides in Madison, Miss. with his wife Shelley, their two sons and one daughter.

Hattiesburg Clinic Welcomes Abdel Nour

Souheil M. Abdel Nour, MD, recent-ly joined Hattiesburg Clinic Pulmonary Medicine.

Abdel Nour earned his medical de-

gree at the Lebanese University Faculty of Medical Sciences in Beirut, Lebanon.

He completed an internship, inter-nal medicine residency and pulmonary medicine and critical care medicine fel-lowship at East Tennessee State Univer-sity in Johnson City, Tenn.

Abdel Nour is board certified by the American Board of Internal Medicine in internal medicine and pulmonary medi-cine.

SRHS Welcomes New Oncologist to the Community

Singing River Health System wel-comes Elizabeth Her-rington, DO, oncologist, to the community.

Herrington received her medical degree from Kansas City University of Medicine in Kansas City, M.O. She performed an internal medicine resi-dency at University of Mississippi Medi-cal Center in Jackson, M.S. She also completed a hematology/oncology fel-lowship at the University of Mississippi in Jackson, M.S. She is board certified in Internal Medicine and board eligible in medical oncology and hematology.

Herrington is now accepting patients at the Regional Cancer Center, a part of Singing River Health System, with offices in Pascagoula and Ocean Springs.

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