Serving Harris, Galveston, Brazoria and Fort Bend Counties December Issue 2014 HOUSTON PRSRT STD US POSTAGE PAID PERMIT NO 1 HOUSTON TX Ebola has become a worldwide threat, forcing employers to think about how to protect their employees. Employers also must consider how Ebola might impact employment policies and procedures, including those addressing attendance, leaves of absence, discipline, and medical testing. What Is the Ebola Virus Disease? Ebola is a rare virus that initially presents symptoms similar to those of the flu and can appear anywhere from two to 21 days after exposure. Some common symptoms are headaches, diarrhea, body aches, vomiting, unexplained bleeding, stomach pain, and a sore throat. In the majority of cases, hemorrhagic fevers cause internal bleeding, and complications from the disease can cause organ failure. While the virus can be transmitted through direct contact with body fluids of an infected individual, it is not an airborne virus (e.g. the flu). While the risk of transmission to the general population in the US has been described as being extremely low, direct contact transmission creates higher levels of concern in the health care industry. Concerns and Practices for Employers Employers should take an individualized approach to requesting health information about employees with respect to Ebola. Under the Americans with Disabilities Act ( “ ADA ” ) an employee with Ebola would likely fall within the definition of a “ qualified individual with a disability. ” Even individuals exposed to Ebola, or thought to be exposed, such as those who have traveled to the areas near the current outbreak, might be able to present ADA claims under the theory that the employee was “ regarded as ” having the illness. Under the ADA, employers may only make medical inquiries of employees where the inquiry is voluntary or job-related and consistent with business necessity. Further, employers must follow ADA guidelines regarding medical records: (i) maintaining medical information confidentially (and apart from the employee’ s personnel file), and (ii) limiting distribution of such information to individuals with a legitimate need to know. If the department of health in the jurisdiction where the employer is located requires notification of Ebola cases, employers may inform the department of the employee’ s identity. However, with respect to divulging such information to others, employers may always ask employees with Ebola to voluntarily permit disclosure of that fact to co-workers If an employee poses a direct threat to the health or safety of himself/ herself or others, an employer can require the employee to disclose health information. Similarly, an employer will likely be permitted to require an employee to undergo medical testing (e.g. monitoring his or her temperature) if the employer reasonably believes, based on an individualized assessment, that an employee demonstrates symptoms of Ebola. To ensure consistent messaging, a single person or department should be appointed as the “ point person ” on all Ebola-related questions and concerns. This point person should be involved in all personnel decisions related to Ebola—e.g., whether medical testing is appropriate, whether an individual should be barred from the office, what happens if an employee refuses to come into the workplace or to go on a business EBOLA: A GUIDE FOR EMPLOYERS see EBOLA page 16 By: Susan Gross Sholinsky, JD and Nancy L. Gunzenhauser, JD EPSTEIN BECKER GREEN Memorial Hermann Life Flight® Wins 2014 EMS Air Medical Service of the Year Award See pg. 9 Inside This Issue David Osmond is living life on his terms See pg. 10 INDEX Mental Health...............pg.3 Healthy Heart ...............pg.5 Marketing Essentials......pg.6 The Framework .............pg.8 Age Well Live Well .......pg.12
Serving Harris, Galveston, Brazoria and Fort Bend Counties
December Issue 2014
PRSRT STDUS POSTAGE
PAIDPERMIT NO 1HOUSTON TX
Ebola has become a worldwide threat, forcing employers to think about how to protect their employees. Employers also must consider how Ebola might impact employment policies and procedures, including those addressing attendance, leaves of absence, discipline, and medical testing.
What Is the Ebola Virus Disease?
Ebola is a rare virus that initially presents symptoms similar to those of the flu and can appear anywhere from two to 21 days after exposure. Some common symptoms are headaches, diarrhea, body aches, vomiting, unexplained bleeding, stomach pain, and a sore throat. In the majority of cases, hemorrhagic fevers cause internal bleeding, and complications from the disease can cause organ failure. While the virus can be transmitted through direct contact with body fluids of an infected individual, it is not an airborne virus (e.g. the flu). While the risk of transmission to the
general population in the US has been described as being extremely low, direct contact transmission creates higher levels of concern in the health care industry.
Concerns and Practices for Employers
Employers should take an individualized approach to requesting health information about employees with respect to Ebola. Under the Americans with Disabilities Act (“ADA”) an employee with Ebola would likely fall within the definition of a “qualified individual with a disability.” Even individuals exposed to Ebola, or thought to be exposed, such as those who have traveled to the areas near the current outbreak, might be able to present ADA claims under the theory that the employee was “regarded as” having the illness.
Under the ADA, employers may only make medical inquiries of employees where the inquiry is voluntary or job-related and consistent with business necessity. Further, employers must follow ADA guidelines regarding medical records: (i) maintaining medical information confidentially (and apart from the employee’s personnel file), and (ii) limiting distribution of such information to individuals with a legitimate need to know. If the department
of health in the jurisdiction where the employer is located requires notification of Ebola cases, employers may inform the department of the employee’s identity. However, with respect to divulging such information to others, employers may always ask employees with Ebola to voluntarily permit disclosure of that fact to co-workers
If an employee poses a direct threat to the health or safety of himself/herself or others, an employer can require the employee to disclose health information. Similarly, an employer will likely be permitted to require an employee to undergo medical testing (e.g. monitoring his or her temperature) if the employer reasonably believes, based on an individualized assessment, that an employee demonstrates symptoms of Ebola.
To ensure consistent messaging, a single person or department should be appointed as the “point person” on all Ebola-related questions and concerns. This point person should be involved in all personnel decisions related to Ebola—e.g., whether medical testing is appropriate, whether an individual should be barred from the office, what happens if an employee refuses to come into the workplace or to go on a business
EBOLA: A GUIDE FOR EMPLOYERS
see EBOLA page 16
By: Susan Gross Sholinsky, JDand Nancy L. Gunzenhauser, JDEPSTEINBECKERGREEN
Memorial Hermann Life Flight® Wins 2014 EMS Air Medical Service of the
Year Award See pg. 9
Inside This Issue
David Osmond is living life on his terms
See pg. 10
Healthy Heart ...............pg.5
Marketing Essentials ......pg.6
The Framework .............pg.8
Age Well Live Well .......pg.12
Houston Medical TimesPage 2
December 2014 medicaltimesnews.com
Houston Medical Times Page 3
the addiction process is usually unable to recognize what a trained and objective third party can. Furthermore, skilled interventionists can facilitate the group’s empathy and love to replace anger and judgment. Today, there are many methods of interventions, however, those that do not utilize an approached based on dignity and respect can cause more trauma and damage. Interventions Work
Over the last 12 years of specializing in treating addiction, I’ve discovered two “laws.” The first is that no one comes into treatment prematurely. The need for treatment is present long before treatment actually takes place. The second is that no one comes into treatment on a winning streak. There is usually an intervention with teeth (leverage) that motivates addicts to enter
Although these two “laws” are challenging, they are not insurmountable. No matter how fall someone falls and no matter what the leverage may be, the possibility of success is the same. Those who come into treatment because the law has intervened have the same chance of a successful recovery as those whose spouse threatens to leave or whose job is threatened.
Initial willingness alone is not an accurate predictor of success. However, consistency and engagement in the recovery process are good predictors of success. Habits are not formed by giant leaps. We are what we repeatedly do. Those who are initially unwilling but who persist in creating healthy recovery habits are more likely to succeed than the willing who fall back into self-sufficiency and complacency. Like the Aesop’s Fable, The Tortoise And The Hare, slow and
I began my career as an interventionist after I entered recovery and began working in the field of addiction medicine. I entered treatment myself only as a result of an intervention. I decided that entering treatment was easier than facing the consequences of not doing so – not uncommon for the person being intervened upon. I disagreed with the folks intervening on me and colorfully offered them options as to where they could go. My outsides were angry, but something incredible and entirely different happened deep
within me. I can best explain it by saying that my addiction was protesting the intervention while my soul took a deep, long sigh and said, ‘What took you guys so long?” I will be forever grateful for having people who cared enough to act so bravely on my behalf.
What Is An Intervention?
An intervention can be defined as any intentional course of action that introduces transformation into people’s thoughts, behaviors, and feelings. Interventions come in many shapes and sizes. When a concerned group meets in order to communicate their observations and concerns, an intervention happens. The group of concerned individuals is composed of friends, coworkers, and family members. There are several ways in which a group can conduct one of these meetings. A group may conduct an intervention without a trained professional, but it is not recommended. The group system engaged in the dysfunction caused by
By Jason PowersMD, MAPPChief MedicalOffi cerRight Step & SpiritLodge
Mental HealthOn A Personal Note…
see Mental Health page 16
Houston Medical TimesPage 4
December 2014 medicaltimesnews.com
For the patient and their day-to-day caregivers (e.g., family members), technology can be leveraged for issues ranging from wound care to training on diet, according to Peres. For example, it would be much more efficient for a home health nurse to take a picture using a tablet device of a patient’s wound to document how well the wound is healing from one visit to
the next than writing a description. Further, if the nurse sees anything about the wound that is concerning, he or she could send it to the patient’s primary care provider for review. Also, if the patient has a tablet similar to the nurse’s tablet, the nurse can download training videos that show the patient (and his or her caregivers) what foods to avoid during the recovery period.
Technology drives advances in home health care
Technology is giving the home health care industry a much-needed upgrade that is helping patients live healthier lives.
During the last decade, there has been a remarkable increase in the number of individuals receiving health care services within their homes, with an estimated 12 million currently receiving some form of in-home service. Although this trend largely results in better outcomes and lower costs, it requires an infrastructure of support from home health providers, caregivers and patients to ensure it works well. Technology has proven to be key in this effort and is giving the home health care industry a much-needed upgrade that is helping patients live healthier lives.
Camille Peres, Ph.D., assistant professor at the Texas A&M Health Science Center School of Public Health, is measuring the usability of
current home health technology and developing new innovative technology to make home health care an even more beneficial service for all involved. Her work in this area provides an insider’s view on some of the benefits and drawbacks that technology can provide in patient care.
“For the home health nurse, we expect that in the near future technology can facilitate the actual home visits by making record keeping easy and fast,” Peres said. “Home health nurses will be able to manage their activities through the use of mapping and scheduling programs that organize their days based on the patients they are scheduled to see, the location of those patients and the time they need to spend with each one.”
Further, if an emergency arises and the schedule must be changed, these types of programs could help reschedule the nurse’s day to best accommodate the information associated with that
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Houston Medical Times Page 5
walk the dog, take a lunchtime walk, catch up with friends or spend time with your significant other during an evening walk, or bundle up your kids and walk as a family. There are dozens of way to fit in bursts of walking this season.
∙ It’s customizable. By changing up the time, distance, pace and route, you can create the right walking program for you.
It can be challenging for some, especially during the holiday season, to stick to an exercise schedule even if it is as simple as going for a daily walk. Anyone who has ever successfully met their fitness goals will agree that accountability plays a huge role in helping them to stay focused. In fact, American Heart Association research shows that American adults are 76 percent more likely to take a walk if another person is counting on them.
Having a support network is key to keeping you on track your fitness goals. Keep in mind that a support network, can be virtual or a physical network like joining a fitness program at your gym or local community center. Friends and family can also be a great support in motivating you to stay on track with your
any other form of exercise? That’s great news for five important reasons:
∙ It’s efficient. Just 30 minutes of walking a day can help improve your circulation, lower your cholesterol and blood pressure and help you lose weight.
∙ It’s free. The only thing you need to start is a pair of supportive walking shoes.
∙ It’s simple. There’s no equipment required, nothing complicated to learn, and you can do it right where you are. Just step outside.
∙ It’s easy to fit in. Run errands,
Healthy HeartStaying motivated and overcoming fi tness plateaus
The weather is getting cooler, the days are getting longer and you are finding it harder to stay motivated and on track with your health goals. Don’t let chillier temperatures keep you from reaching your fitness goals! Physical activity along with a healthy diet is important in preventing heart disease and stroke, the nation’s No. 1 and No. 4 killers. To improve overall cardiovascular health, the American Heart Association suggests at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). To put it in perspective, that can be as simple as committing to thirty minutes a day, five days a week. You can even divide your time into two or three segments of 10 to 15 minutes per day. Use that time to go for a walk, clear your brain and give
By Apiyo ObalaDirector of CommunicationsAmerican Heart Association
your heart a healthy work out.
For people who would benefit from lowering their blood pressure or cholesterol, the AHA recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week to lower the risk of heart attack
Walking is one of the easiest ways to exercise since the only requirement is your time. Did you know that you are more likely to stick with walking than see Mental Health page 18
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Most doctors recognize that healthcare’s “starting line” moved some time ago.
The typical care continuum now begins online, long before the first medical office appointment or doctor-patient face-to-face encounter. Among the chief propellants of this digital shift are the:
∙ Mainstream proliferation of rapid Internet access;
∙ Wide adoption of mobile devices such as smartphones and tablets;
∙ Instant online availability of health and medical information;
∙ Strong public popularity of major social media sites;
∙ Empowerment of the informed patient/consumer; and
∙ Increasing emphasis on wellness, prevention and healthy living.
The Internet-related communications channels have become, for most medical practices, a primary means to reach, engage and attract new patients. In short, a doctor’s marketing and new business development efforts will be most productive when “fishing where the fish are biting.”
But…few doctors embrace the social media opportunity
As a rule, doctors tend to embrace technology, and, as users, they are often Early Adopters for things Internet and information resources. A smartphone and tablet are as ubiquitous as the standard issue stethoscope.
But when it comes to embracing social media, Dr. John Mandrola writes, “…we continue to keep our heads down, stay in the weeds, out of trouble. Don’t wiggle; don’t rock the boat; check the boxes; fill out the forms and accept what comes. Don’t dare
engage in the online conversation. Choosing this path is like not treating a disease: less ownership confers less personal risk.”
Blogger, writer and regular columnist at Medscape and elsewhere, Dr. Mandrola is also a cardiac electrophysiologist practicing in Louisville, KY. In an editorial piece first appearing on his blog, Dr. John M, he makes a compelling, doctor-to-doctor case “about social media and why it is time that doctors make the leap from analog to digital.”
The full text of his article titled, Doctors and Social Media — It’s time to embrace change, provides considerable depth and insight, but as an introduction, here’s an abridged slice:
“As a multi-year participant in social media, I see more benefit and opportunity than risk. Here are five factors to consider while pausing at that fork in the road.
“First, consider the blank-slate status of the playing field for health care social media. Beyond common sense and decency, there are few rules. Digital natives—like me, and
perhaps you—will make the rules. Pause for a moment here and consider that idea: making rules rather than following them. Sounds good, doesn’t it?
“Second, as a doctor, you are different. People will listen to you; your voice matters. What patients really want to read is what their doctor says.
“Third, social media can be therapeutic. It’s an understatement to say morale amongst caregivers is low, and sinking lower. What’s more, the social aspect of social media connects you with colleagues across the world, not just your hospital’s doctors’lounge. I regularly connect with colleagues in Germany, Australia, and the UK.
“Fourth, social media can make you a better doctor. The pace of change in health care is increasing. Staying current and informed has never been more important. The micro-blogging platform Twitter allows easy curation of content from trusted sources as it comes available. Another aspect of creating content is the depth of knowledge it requires. In this way, I have no doubt that participating in social media has made me a more informed clinician.” www.healthcaresuccess.com
By Lonnie HirschCo-founder,HealthCareSuccess Strategies
Houston Methodist announced plans to build a new 193-bed hospital in The Woodlands and a 390-bed inpatient tower
on the Houston Methodist Hospital campus.
Groundbreaking on the new 470,000 square foot hospital in The Woodlands, which will be built at the intersection of TX 242 and I-45, is expected in early 2015, with the
hospital completed in 2017. Construction
includes a 135,000 square foot medical
building which will open in late 2015.
The new patient tower in the Texas
Medical Center will replace patient beds
in Houston Methodist Hospital’s original
Main building and add highly advanced heart
and neurosurgery operating rooms. It is also
expected to be completed in 2017.
“Houston Methodist has served the greater Houston community for almost 100 years,” said Marc Boom, M.D., president and CEO of Houston Methodist. “We are excited to bring our long history of leading medicine and excellent patient care to the residents of The Woodlands.”
The new hospital, which will be the eighth in the Houston Methodist system, will offer The Woodlands community a full service, acute care hospital capable of delivering services similar to what is available in the Texas Medical Center. The $328 million campus will be modeled after Houston Methodist West Hospital near Katy.
The Woodlands community is expected to grow 11 percent over the next five years, and Houston Methodist is eager to meet the growing health care needs of the area, Boom said.
The inpatient tower next to Houston Methodist Hospital will have capacity for 390 beds, including 102 intensive care beds, expanded operating suites, hybrid suites and a dedicated cardiology floor with 14 interventional catheterization labs. The new tower, which will cost about $540 million, will include high tech operating rooms that will dramatically expand Houston Methodist’s ability to provide image guided heart and brain procedures. These procedures allow for minimally invasive treatment of conditions
that once required open surgery.
“Houston Methodist continues to see increased demand from the community for the high quality care provided in our facilities,” Boom said. “Over the next three years, Houston Methodist will invest more than $1 billion into expanding and replacing our facilities throughout the Houston area. We are investing in new facilities for our patients, meeting the needs of our growing community.”
Paul Layne, executive vice president of Master Planned Communities for The Howard Hughes Corporation said, “We are pleased to have an exceptional health care system like Houston Methodist come to The Woodlands. Houston Methodist offers a valuable amenity through its services to The Woodlands’ community.”
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Houston Methodist will build a new 193-bed hospital in Th e Woodlands, at the intersection of Texas 242 and Interstate 45. Groundbreaking on the 470,000-square-foot hospital is expected early next year, with a planned opening in 2017. Th e new community hospital, the eight in the Houston Methodist system, will off er Th e Woodlands a full service, acute care hospital capable of delivering services similar to whatis available in the Texas Medical Center. Rendering courtesy of Houston Methodist.
Rendering of ne 390 bed inpatient tower to be built on the Houston Methodist Hospital campus in the Texas Medical Center. Th e tower will include 102 ICU beds, expanded OR suites, hybrid suites and a dedicated cardiology fl oor with 14 interventional catheterization labs. Rendering courtesy of Houston Methodist.
Th e FrameworkHouston Methodist announces new community hospital in
Th e Woodlands andNew patient tower in the Texas Medical Center
Houston Medical Times Page 9
the service operates around the clock –24-hours a day, 365 days a year – retrieving critically ill and injured patients in the greater Houston area. Crews perform more than 3,000 missions each year, making the John S. Dunn Helistop one of the busiest helipads in the world. Since its inaugural flight, Life Flight has flown more than 140,000 missions.
Accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS), Life Flight is committed to excellence in aviation safety and clinical care. Each f light is staffed by highly skilled personnel and equipped advanced emergency equipment and necessary medications, and can transport up to two patients.
Life Flight already has a long list of advanced, in-flight capabilities, including: pre-hospital blood product administration, LVAD capabilities, ECMO capabilities, intra-aortic balloon pump, portable blood warmers, ultrasound diagnostics, clot-busting agents for STEMI, hemostatic agents for blood clotting and night vision goggles for all crew members, just to name a few.
Last week, the service added yet another groundbreaking capability to that list, becoming the first program in Southeast Texas to be granted authority to conduct flights under instrument flight rules (IFR) by the Federal Aviation Authority (FAA). This new capability allows Life Flight crews to continue caring for the community when weather conditions might restrict flights under visual flight rules (VFR).
“While some flights may still not be possible in cases of extremely inclement weather, the use of IFR will significantly expand Life Flight’s ability to safely serve the greater Houston area and surrounding communities,” said Christopher “Todd”Grubbs, ATP, chief pilot of Life Flight.
Memorial Hermann Life Flight® Wins 2014 EMS Air Medical Service of the Year
Memorial Hermann Texas Trauma Institute is proud to announce that Memorial Hermann Life Flight® has been named the winner of the Texas Department of State Health Services’ 2014 EMS Air Medical Service of the Year Award. This prestigious award honors a public or private air medical service in Texas that has demonstrated the highest standards in providing patient care, leading the way in innovation and commitment to patient care.
Winners in 13 different categories were announced Tuesday at the annual Texas EMS state conference in Fort Worth. Each category honors a person or organization
that exemplifies the best that the Texas EMS and trauma system has to offer. This year marks the third time that Life Flight has achieved this recognition, winning previously in 2001 and 2004.
“We are so grateful and humbled that our esteemed EMS colleagues around the Lone Star State have elected to honor us with this significant award once again,” said Tom Flanagan, chief operating officer of Memorial Hermann-Texas Medical Center, home to the Texas Trauma Institute. “It reinforces and rewards the amazing work our Life Flight teams do every day, providing the highest quality of in-flight care possible while helping to revolutionize the air medical field by constantly introducing new advancements and technologies.”
Memorial Hermann Life Flight is a critical care air medical transport service based in Houston – the city’s only hospital-based air ambulance – that serves the community within a 150-mile radius of the Texas Medical Center with helicopters and worldwide using fixed-wing transport.
Founded in 1976 by James “Red”Duke, M.D., who still is medical director,
By Heather DickMemorial Hermann
Houston Medical TimesPage 10
December 2014 medicaltimesnews.com
David Osmond is living life on his terms
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“I can do this – Just stick around, you’ll see. Going through this – takes every part of me. What I’m feeling down inside’s like a roller-coaster ride. But it’s true, yes – I can do this,” are upbeat lyrics from David Osmond of the musical Osmond family. Despite the challenge of a debilitating disease, the singer/song writer approaches life with uncompromising optimism. David was in Houston Sunday, November 9, for the annual Walk MS event to share his message and to increase awareness about Multiple Sclerosis.
David, a solo music artist, Broadway performer, motivational speaker and nephew of the long-running sibling duo, Donnie and Marie Osmond, was diagnosed with relapsing MS in 2006 at the age of 26. Relapsing Multiple Sclerosis is a chronic autoimmune disease—a type of condition in which the immune system mistakenly attacks healthy body tissue. Relapsing MS is characterized by clearly defined attacks of worsening neurologic function, which are followed by partial or complete recovery periods (remissions). With MS, the tissues that come under attack are in
the body’s central nervous system, which is made up of the brain, spinal cord, and nerve fibers to the eyes.
David says, “I noticed my first symptoms while performing in a show in my twenties.” He experienced vision problems, and then issues progressing from his feet, through his legs, arms and to his fingers. After multiple visits to a number of doctors and numerous medical tests, relapsing MS was finally diagnosed as the cause.
“It took me a while to come to grips with the diagnosis.” However, today David considers it as “one of the best things that could have happened,” because it gave him a new outlook on life. Rather than accepting and coping with the relapsing MS, he realized he had to be proactive about managing the disease. “I also realized I was in a position to encourage others to do the same.”
He recognized the need to raise awareness, to empower people living with multiple sclerosis and their families to take charge of how they manage the disease. Dr. Flavia Nelson, MS Specialist and Associate
Professor at The University of Texas Health Science Center at Houston, is a big proponent of people being their own advocate. She says, “People who may suspect they have an issue need to get a correct diagnosis and have it confirmed.” Those who have been diagnosed with MS, the most common, non-traumatic disease for young adults, she adds, should talk to their family and friends to make sure everyone understands. Support is very important.
David is an advocate for living with a positive attitude. The power of positive thinking and meeting the challenge head-on is imperative he adds. Dr. Nelson encourages people not to ignore the problem, but to seek out an expert or specialist.
David’s father, Alan Osmond, a founding member of the family singing group, the Osmonds, was diagnosed with MS more than 20 years ago. At that time, according to David, he was given an aspirin and told to return in six months. While there is still no cure, today offers far more hope for those with MS. First, Dr. Nelson says new
criteria for diagnosing MS have led to early and more definitive diagnoses. Secondly, she adds medical advances in the last 25 years have yielded 10 medications approved by the FDA for MS, with two trials ongoing at the University of Texas.
David’s legacy for himself and for the MS community is to never give up. His mantra is “I can do this.” He is promoting his message through an awareness campaign “Our Voice in Song” in partnership with Swiss pharmaceutical company Novartis for the oral MS drug, Gilenya, which David takes to manage his MS. As part of the campaign, Novartis is providing the song “I Can Do This” for free at www.OurVoiceInSong.com. Listeners are encouraged to download it and share the joyful message with others.
Through the universal language of music, David hopes to inspire people with relapsing MS to do more than simply cope with the disease, but to take charge and not let MS define them.
By: Rose Rougeau
David Osmond performing at the annual Houston, Walk MS event
Houston Medical Times Page 11
Houston Medical TimesPage 12
December 2014 medicaltimesnews.com
This list of ideas may help you to provide care and support when you visit.
∙ Ask permission to visit and then plan your visits in advance. By asking their permission to visit, you allow residents to have control over at least one aspect of their schedule. Because there are two parts to a visit (looking forward to the visit, and the visit itself ), plan your visits ahead of time rather than just dropping by. Planning ahead allows a resident the enjoyment
of anticipating your visit.
∙ When you visit, be supportive and affectionate. Personal contact with others is extremely important, and many times the only touch that residents get is when they are dressed or bathed. If they are receptive, hold their hand, give them hugs when you arrive and leave, and make eye contact when they are talking to you.
∙ Listen attentively. Do not dominate the conversation or talk “at” them. Being a good listener allows them to enjoy their memories or current thoughts by sharing them with you.
∙ Make a point to say “hello” to other residents who may not receive many visitors.
Learn more about volunteering at www.dads.state.tx.us/volunteer
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Houston HospiceLife Matters
One of the best things about the
holiday season is spending time with
family and other loved ones. But many
residents of long-term care facilities have
no nearby family with which to share
Residents of long-term care facilities
need to be reassured regularly that they
are still an important member of the
family. This is particularly true during
the holidays, which are traditionally
times that families get together.
Residents need to know they are loved
and not forgotten.
Consider making the holidays
brighter for them. Your care is welcome
and needed. While each facility may
be looking for particular items for
residents, some items are frequently
requested, such as slippers or lap
blankets, personal care items such as
lotion, shampoo, books, magazines
and puzzles. Also welcome are friendly
How You Can Help
The Texas Department of Aging
and Disability Services (DADS) state
supported living centers are residential
facilities for people with intellectual
and developmental disabilities. If you
would like to help make the holidays
happier for a center resident, contact the
center’s community relations director
(CRD). You can find a list of centers
By Jeff CarmackManaging Editor,Texas Department ofAging and Disability
Houston Medical Times Page 13
they remain fixed in test tubes. In the field of antibiotics development, test tube research is often followed by tests conducted with elaborate systems that attempt to mimic the ways antibiotics are eliminated by the human body.
“By doing this, we’ll be gaining efficiency,” Tam said. “And, ideally, that would eliminate the need for physicians to run excessive numbers of tests in a clinical setting.”
UH Team Fights Antibiotic-resistant Bacteria with NIH Grant
Engineering, Pharmacy Professors Collaborate to Accelerate Treatments, Develop New Drugs
Addressing the relentless game of cat and mouse played between antibiotics and bacteria, a pair of University of Houston professors recently received a $519,000 grant from the National Institutes of Health.
Longtime collaborators on combatting drug-resistant bacteria, chemical and biomolecular engineering professor Mike Nikolaou and clinical sciences pharmacy professor Vincent Tam produced a patented equation to assess the effects of antibiotics on bacteria. By the end of 2015, the researchers anticipate developing the first working prototype of a methodology and associated software that improves the process of determining effective antibiotic cocktails for patients in clinical settings, as well as expedites the development and approval of new antibiotics.
“This is a race of humans developing antibiotics against nature’s evolving bacteria,” Nikolaou said. “It’s very difficult to win that race because bacteria evolve fairly rapidly.”
Nikolaou says the process of antibiotic development and approval is painstaking. Discovering a bacteria-killing molecule that is safe and effective for patients can easily take a decade. Nikolaou and Tam’s work can more efficiently analyze data to find drug combinations that are both effective against bacteria and safe for patients.
“Single antibiotics are becoming less and less effective against bacteria, so very frequently you have to use combinations of antibiotics,” Nikolaou said. “In recent years, we’ve been using more combinations of antibiotics so that we can have a combined effect that can make the antibiotics more potent and perhaps kill bacteria that would otherwise be resistant.”
Numerous possibilit ies for interactions between antibiotics exist. An example of an interaction might involve one antibiotic opening pores in bacterial cell walls so another antibiotic might easily enter to do the killing,
“Physicians are presented with the challenge of considering overwhelming permutations of antibiotic combinations and dosing regimens for patients,” Tam said. “Time restrictions necessitate eyeballing results and making best guesses about treatments based on their expertise and intuition.”
With time being extremely precious to both doctors and patients, Nikolaou and Tam are working to optimize the process by reducing the amount of time and guesswork needed to assess which drug combinations are the most effective at killing bacteria.
“Our approach is empirical, so it relies on experimental data rather than detailed prior knowledge,” Nikolaou said. “This way, you don’t need to know the type of bacteria, the type of killing mechanism or the mechanism of resistance.”
Nikolaou and his team of students composed their basic mathematical model based on Tam’s observations of the effects of antibiotics on bacteria populations over time. Through better use of collected data, their equations predict the course of bacteria populations in realistic situations reasonably well.
“The equations do not define logic,”Nikolaou said. “Instead, they augment logic and intuition more accurately.”
The professors plan to use existing image analysis technology to automatically record the effects of various antibiotic cocktails on bacteria. A laser detector modified for their purposes can feed the data to computer software the team is in the process of developing that runs the patented mathematical model.
“The user will simply have to push the button, and the software will do the calculations that guide the doctor on what antibiotic or combination of antibiotics to use,” Nikolaou said.
Automation provides opportunities to collect additional data at more frequent intervals. The detector can record data every hour, for example, rather than once at the end of a 24-hour time period. Instead of plotting two
points on a graph, the software can plot 24 or more and create an entire curve that helps to more accurately predict outcomes beyond 24 hours. Furthermore, longitudinal analysis can provide more precise information, such as the extent and the rate of decline of bacteria populations.
The software also can account for differences between patients and test tubes. Concentrations of antibiotics decline over time in patients while
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Chemical and Biomolecular engineering professor Mike Nikolaou and clinical sciences Pharmacy professor Vincent Tam
Houston Medical TimesPage 14
December 2014 medicaltimesnews.com
lower total cholesterol and higher HDL cholesterol across the life span. Further research is needed to determine if reducing total cholesterol and increasing HDL cholesterol decreases the risk for cognitive and vascular diseases among adults who carry APOE e4 alleles.”
Another surprising finding of the study is that higher cholesterol in older adults may be associated with longevity. The researchers observed that adults who lived past 90 years of age had higher total cholesterol during late life compared to adults who did not live past 80 or 90 years of age. This may have
important implications for continuing the practice of prescribing cholesterol-lowering medications to older adults.
“The relationship between APOE, cholesterol and longevity is complex and it is important to continue conducting research in this area so that older adults know how to appropriately manage cholesterol levels during old age,” said Downer.
One could argue that it may be harmful to prescribe medications to lower cholesterol based on evidence that low cholesterol and a decline in cholesterol in older adults is associated with increased mortality. However, further research will be needed to confirm whether a decline in cholesterol plays a direct role in mortality or if this decline is a result of changes that occur during the period of terminal decline prior to death.
“The findings from this study have important implications to public health,”said Downer. “To efficiently modify cholesterol, and as a result, disease risk, it is important to consider how APOE allele status influences cholesterol levels from midlife through late life.”
It’s known that cholesterol levels typically rise as people age and that high cholesterol levels are associated with increased risk of cardiovascular disease. What’s less known is that cholesterol levels begin to decline the more a person ages. Recently, researchers from the University of Texas Medical Branch at Galveston and the University of Kentucky found that differences in one gene can influence a person’s cholesterol
levels from midlife to late life.
The study analyzed data from the blood samples of more than 590 people from the Framingham Heart Study Original Cohort. The specific gene, APOE, encodes proteins involved in maintaining cholesterol levels. People have different alleles, or variations, of APOE. Three of these alleles are APOE e2, APOE e3 and APOE e4. The APOE e4 allele is associated with an increased risk for several aging-related diseases, including Alzheimer’s disease and cardiovascular diseases such as stroke and coronary heart disease. The APOE e2 allele, on the other hand, is associated with a decreased risk for these diseases.
“The increased risk for cognitive and cardiovascular diseases among older adults who carry an APOE e4 allele may be due, in part, to the fact that these individuals are predisposed to having higher total cholesterol and lower HDL cholesterol from midlife through late life, compared to people with the APOE 3 variant,” said Brian Downer, lead author and UTMB Sealy Center on Aging postdoctoral fellow. “The decreased risk for these diseases associated with the APOE e2 allele may be due to the
By Donna RamirezTh e University of Texas-Medical Branch at Galveston
UTMB scientist fi nds marker that predicts changes in cholesterol levels as
people grow older
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Houston Medical Times Page 15
Houston Texans Players Deliver Baskets of Hope to Patients at Children’s
Memorial Hermann Hospital
‘Tis the season for giving and football – two things the Houston Texans take very seriously. Earlier this week, seven players from the team came to Children's Memorial Hermann Hospital to surprise patients and family members with gift baskets provided by the organization Basket of Hope.
Basket of Hope is a Christian organization that partners with hospitals throughout the U.S. to deliver baskets full of age-appropriate toys, games, crafts, books, movies, gift certificates and more in an effort to provide comfort to pediatric patients during hospitalization. The hope is that the basket, filled with inspirational materials, will nourish the patients mentally, emotionally and spiritually.
Led by Houston Texans center Chris Myers and his wife, Jenny, the Houston chapter donated over 120 gift baskets and totes to the hospital’s patients. Myers was joined by fellow teammates – many of whom were also accompanied by their wives –quarterback Ryan Fitzpatrick, linebacker Brooks Reed, tight-end Garrett Graham, offensive guard Cody White, offensive lineman Xavier Su’a-Filo, and offensive guard Ben Jones.
“We are so grateful for the generosity of organizations like Basket of Hope,”said Susie Distefano, CEO of Children’s Memorial Hermann Hospital. “Events like this are such a treat for our kids. Nothing helps the healing process quite like a child getting to meet one of his or her real-life heroes.”
The players handed out baskets
and totes, posed for photos, signed autographs, and chatted with patients and their families. Fitzpatrick even played a quick game of catch with one of the young patients, using a football the boy brought from his room for the occasion. In addition, for the children unable to leave their hospital beds, the players did a round of room-to-room deliveries before heading out.
One of the more humorous event highlights was when Anthony Eisfelt, father of nine-year-old pediatric patient Cameron, was temporarily confused by some attendees for Fitzpatrick. Because Eisfelt has a beard that looks eerily similar to the NFL quarterback’s, he was mistakenly asked by some to pose for photos and sign autographs. Eisfelt later revealed he is a huge Texans fan and even dressed as the player for Halloween last month.
Houston Texans center Chris Myers chats with Children’s Memorial Hermann Hospital pediatric patient 13-year-old Harrison Fason before giving him a “Basket of Hope” and signing the football fan’s cast.
Anthony Eisfelt (left), father of Children’s Memorial Hermann Hospital pediatric patient nine-year-old Cameron (front), was temporarily mistaken by some event attendees for Houston Texans quarterback Ryan Fitzpatrick (right).
Houston Medical TimesPage 16
December 2014 medicaltimesnews.com
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trip, and what types of business travel may be prohibited.
The most important thing that employers can do, however, is educate employees as to the CDC’s guidelines regarding Ebola and its symptoms.
1. May an employer ask an employee to leave the premises or stay out of work if there is a reasonable belief that the employee has been exposed to, or has contracted, Ebola?
2. Must an employer pay an employee who is required to stay out of work because of a reasonable belief that he/she has Ebola?
∙ It depends. Generally, if an employee performs work for the employer while s/he is out of work, s/he must be paid. Otherwise, the employee may use paid sick time or other paid time off in accordance with company policies or local law.
3. May an employer restrict travel to affl icted countries?
∙ Yes, if travel is for business. Employers may not restrict personal travel in states where employees’ lawful off-duty
conduct is protected (e.g., NY, CA). Further, an employer may be subject to a claim of national origin discrimination if it prohibits an employee from traveling to a location that is his or her home country, and may be restricted under the FMLA from allowing an employee to travel to an affected area to care for a family member.
4. Can an employer terminate or discipline someone who refuses to come into work out of fear of Ebola?
∙ It depends. If an employee reasonably believes that he or she is in imminent danger, an employer may not terminate or discipline that individual for refusing to come to work under the Occupational Safety and Health Administration’s anti-retaliation guidelines. If multiple employees join together and refuse to come to work, this would likely be considered “protected concerted” activity under the National Labor Relations Act.
5. Must employers pay employees who refuses to come into work out of fear of Ebola?
∙ No, unless they are performing work while out of work.
EBOLAContinued from page 1
steady wins the race every time.
Recovery Is Not A Spectator Sport
When the addict comes into treatment, the family system also enters treatment – directly or indirectly. When one family member has a chronic disease, in a way, the whole system has it, too. When my mother in law, Myrna, was diagnosed and treated for cancer, we all shared in the experience. Without a doubt, she had the most direct, painful, and ultimately final experience with it, but our lives were majorly changed as we all took turns helping out with doctor
visits, late night vigils, and so forth.
Addiction is more insidious but just as encompassing as other chronic diseases with less esoteric presentations, such as cancer. Addiction slowly erodes family systems because changes are usually gradual enough that the other members learn to adapt to their new roles without awareness of much, if any, change taking place. This adaptation is too slow to notice and helps to perpetuate the disease.
Over time, families and friends try almost anything to help the addict. Energy is invested in trying to control or ‘fix’
Mental Health Continued from page 3
see Mental Health page 18
Houston Medical Times Page 17
Houston Medical TimesPage 18
December 2014 medicaltimesnews.com
and the affected family system from pain and suffering. The intervention is not the end of the process but merely the beginning. When the addict goes into rehab, the recovery process is only just starting.
Again, recovery is not a spectator sport; it demands action from all those affected. Family members are asked to participate in therapy, but they can often be reluctant to do so because of the misconception that the addict is the only one who needs help. How can family members expect the addict to be the only one in a dysfunctional system to get help? When the family understands that all members have contributed in some way to the problem, they can accept that a solution also requires everyone’s involvement. A formal intervention can be the start of the path to health and wholeness for the entire family.
him or her. Addiction cannot be cured, controlled or fixed by these attempts, and a sense of learned helplessness develops. The failed attempts to make the situation better can be extremely frustrating and confusing. Anger builds. It is very easy for any one person to be manipulated or simply beaten down emotionally when attempting to intervene upon the addict on their own without the determined, united support of a group. Besides, it is irrational to try to reason with an illogical disease. The dysfunction usually progresses for quite some time. Without professional guidance and counseling, most families are not equipped to identify and manage addiction. On the other hand, a unified group of people is difficult to influence - there is strength in numbers. Properly implemented, an intervention that empowers group cohesiveness is most effective in assisting the addict’s entrance into treatment,
avoids further trauma for the family and the addict, and most importantly, helps to heal all the members of the group.
A New Definition of Success
I used to think that a successful intervention was measured solely on whether or not the addict entered treatment. Time and learning have taught me that while that is indeed a very valuable goal, the larger goal involves the whole family system. As an interventionist, the majority of time I spend is with the addict’s family and friends. I educate and coach them on overusing their love (“enabling”), and I help them see how self-care for themselves and tough love for the addict stop their contributions to the downward progression of addiction. The addict’s support system often experiences the intervention process with a fair amount
of trepidation, doubt, and anger. There is often a sense of betrayal and guilt. These are perfectly normal feelings, considering the difficult and naturally conflicted decision that must be made.
A successful intervention teaches everyone involved how to remove themselves from participating in the disease process and move forward into the future with an enlightened perspective. The goal of an intervention is to start the journey of recovery for both the addict and the support system. A successful intervention assists with self-care for all those affected by a loved one’s active addiction, establishing a new set of thoughts, feelings, and actions and bringing some relief from suffering.
In It For The Long-Haul
An intervention is an effective tool to start the process of freeing the addict
Mental Health Continued from page 16
Technology also can make it easier for patients to access their medical records and coordinate their own medical care. With the inclusion of sensors that can monitor heart rate, blood pressure and even blood sugar levels, patients will be able to communicate certain elements of their health status to their medical providers in real time.
Although these innovations are helpful, there are some risks involved in integrating technology into home health. In 2010, the Food and Drug Administration launched the Medical Device Home Use Initiative, an effort
that regulates medical home health devices to ensure that they are safe and effective for use in the home. Another group who advocates for those using home health technology is the Emergency Care Research Institute (ECRI), who in 2011 issued a report strongly recommending doctors consider the usability of home health devices before prescribing them for their patients.
With usability being a main concern, researchers like Peres have been investigating and providing solutions to these issues. Further, Peres
and her colleagues are identifying those types of devices that physicians, home health care providers, patients and caregivers alike need to know more about before they are prescribed for home health care use.
Regardless of the usabilit y challenges, the benefits far outweigh the risks. Patients are able to decrease medical bills as a result of fewer hospitalizations, increase effectiveness of care by being in a familiar and convenient environment and improve their overall quality of life. Physicians
are able to collaborate with other physicians and experts in new ways and use computers to analyze patient and medical data, allowing them to provide better and more efficient treatment for their patients.
“As technology continues to expand the horizons of medicine and medical interaction, it’s becoming clear that we’re entering a new era of health care,” Peres said. “By developing new, safe technology, these benefits will increase, and likely better the life of many individuals.”
Health Home CareContinued from page 4
fitness goals. Loved ones who live with you can be essential in helping you meet your goals and in the process you can motivate them to improve their health. Suggest a daily or weekly “workout date” with a friend or family member and promise to hold each other accountable to keep the date. Doing an activity with another person doubles as social time and will make fitness seem like less of a chore.
Just remember, your health is a long
term commitment to yourself. Focus on the task at hand, living the healthiest life possible by taking proactive steps to reduce your risk for heart disease and stroke. The AHA recently launched our “Life Is Why” Campaign because we want people to experience more of life's precious moments. It's why we've made better heart and brain health our mission. And until there's a world free of heart disease and stroke, we'll be here, working to make a healthier, longer life possible
for everyone. As you push through your fitness challenges this winter, and in the spirit of the AHA’s “Life is Why” campaign, think about what motivates you to live a heart healthy life and use that as motivation to push through your fitness plateaus.
The American Heart Association has great resources available online that can provide more information on health and wellness, risk factors of heart disease, stroke, and more at www.heart.
To find out about upcoming AHA Houston events like the Paul “Bear” Bryant Coach of the Year award on January 14, 2015, visit us at bryantawards.com. Be sure to join the conversation online on Twitter and Facebook at @ahahouston #houstonheart.
Healthy HeartContinued from page 5
Houston Medical Times Page 19
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