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November 16, 2012 MEDICAL UNIVERSITY of SOUTH CAROLINA Vol. 31, No. 14

T he MUSC Children’s Hospitalafter-hours care and specialty clinic

in Mount Pleasant opened for businessNov. 5. The clinic is specifically gearedtoward children, up to the age of 18, whoneed non-urgent care.

The clinic’s procedures include, butare not limited to, pediatric cardiology,pediatric genetics and heart health.The after-hours care clinic, which is thefirst one in the area, is hoping to servepatients during off hours. The clinic isalso open from 8 a.m. to 4 p.m., Mondaythrough Friday, for specific pediatricspecialty clinics.

This 10-exam room facility run byDan Kitchens, R.N., clinic manager, willwork closely with the MUSC Children’sHospital after-hours care and specialtyclinic in North Charleston. Due to thelimited scope of services, provisions canbe made for patients requiring transfer toanother facility.

“Our after-hours clinic allows us toreally meet the needs of the community,”said Kitchens. “Our North Charlestonsite has done a lot for the pediatricpopulation and their families in overa year that they have been open. Weare hoping to do the same thing in theMount Pleasant area.”

According to Kitchens, the Children’sHospital after-hours care and specialtyclinics at MUSC are committed toproviding family- and child-centeredcare. The staff, through collaborationand commitment, provides excellence inpatient care, teaching, and research in anenvironment that is respectful to others,adaptive to change and accountable foroutcomes.

For information on the clinic, call876-2222.

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4ReseaRch

Day

The Storm EyeInstitute received

a grant fromthe Lions Clubto help pay forretinal imaging

equipment.

More than 220abstracts were

presented duringthe annual

Perry HalushkaResearch Day.

Inside

The caTalysTOnline

http://www.musc.edu/

catalyst

VisiOnsympOsium

Mount Pleasant welcomes firstpediatric after-hours care clinic

By Gerry Le

Public Relations

Eleanor Ross, 11, cuts the ribbon officially opening the new Children’s HospitalAfter Hours Care & Child Specialties clinic in Mount Pleasant. Helping celebrateare Isle of Palms representative Mike Sottile, from left, Mount Pleasant Mayor BillySwails and Sullivan’s Island Mayor Carl Smith. MUSC’s John Sanders, right, holdsthe ribbon.

Registrationrepresentative SophiaBacani, left, discussesoperation procedureswith registered nurseCindy Dollason at the

new pediatric After HoursCare & Clinic Specialties.

The clinic is located at2705 Highway 17 North,(corner of Highway 17

North and Hamlin Road).Hours of operation are 4 to10 p.m., Monday throughFriday and noon to 7 p.m.,

Saturday, Sunday, andholidays. For information,

visit MUSCkids.com/afterhours.

Applause

Meet Andrew

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2 The CaTaLysT, November 16, 2012

The Catalyst is published once a week.Paid adver tisements, which do notrepresent an endorsement by MUSCor the State of South Carolina, arehandled by Island Publications Inc. ,Moultrie News, 134 Columbus St. ,Charleston, S.C., 843-849-1778 or843-958-7490. E-mail: [email protected].

Editorial of ficeMUSC Office of Public Relations135 Cannon Street, Suite 403C,Charleston, SC 29425.843-792-4107Fax: 843-792-6723

Editor: Kim [email protected]

Catalyst staff:Cindy Abole, [email protected] Barker, [email protected]

Applause ProgramDigestive Disease Center; Elizabeth De-vereaux, OR; Lori Wilson, Central Sup-ply; Patrenia Franklin, Dietetic Services;Tiffany Carter, Meduflex; Erika Medina,6E; Adrienne Gregory, Revenue CycleOperations; Ruth Pinckney, RevenueCycle Operations; Cheryl Capers, StormEye; George Magrath, Storm Eye; BettyCapers, Environmental Services; Tam-my Kindt, Respiratory Therapy; JosephTkach, 9W; Alanese Champaign, Reve-nue Cycle Operations; Lisa McCormick,7C; Ashleigh Millen, 10W; Jill Norman,10W; Tosha Thomas, 10W; Sam Guffey,10W; Bette Tezza, 10W; Philip Egloff,Pharmacy; Gerald Silvestri, Pulmonary,Critical Care, Allergy & Sleep Medicine;Kimberly Rodenberg, Hollings; JessicaBonavita, Revenue Cycle Operations;Sharon Dupree-Capers, Revenue CycleOperations; Elouise Elliott, 8W; AustinYounger, Residents Surgery; Jordan Ne-meth, Transplant; Henrietta Spencer,Rheumatology; Krystal Gooden, Rev-enue Cycle Operations; Sheri Stewart,Pediatrics, Clinical Resource; CarolineDelongchamps, Children’s Services; LaciDickson, 9E; Angel Grant, 9E; and Da-vid Frisby, Central Supply.

The following employees received recog-nition through the Applause Program forgoing the extra mile:

Medical CenterJessica Johnson, Safety & Security; JohnParler, Volunteer & Guest Services;Coco Dumont, Volunteer & Guest Ser-vices; Emily Shaver, Med/Surg ICU;Dena Middleton, 6W; Melissa Parker,6W; Darian Epps, 6W; Theresa Ste-phens, 6W; Janessa Sumter, DieteticServices; Moya McFadden, Radiology;Darryl Lee, Revenue Cycle/Operations;Stacy Sergent, Pastoral Care; Ana Virel-la, Women’s Services; Hiram Graves, En-vironmental Services; Kathy Chessman,Clinical Pharmacy & Outcome Sciences;Dedra Bennett, Family Medicine Lab;Kathleen McFarland, Family Medicine;Bret Johnson, Meduflex; Nora Holling-sworth, Radiology; Keri Walker, Peri-An-esthesia; Israel Singleton, MedSurg Reg-istration; Debbie Cepeda, Revenue CycleOperations; Deborah Stewart, NewbornSpecial Care; Paul Herndon, Transplant;Kathy Martin, Pre-Op Testing; DonnaChapman, Revenue Cycle Operations;Lisa Klasek, 8E; Kellyn Schroeder, 8E;Fletcher Springer, Radiology; Ava Good-hue, PACU; Steven Saef, EmergencyMedicine; Nick Garn, Volunteer & GuestServices; Michelle Sharp, Children’s Ser-vices; Melissa Parker, 6W; Faye Parker,Volunteer & Guest Services; Shatora Wil-liams, GI Clinic; Michelle Turner, Wom-en’s Services; David Soper, OB-GYN;Suzanne Richardson, Heart & Vascu-lar Heart Valve Center; Cornelia Spitz,Surgical Services; Patricia Brown, 6W;Maude Smith, 6W; Dorothy Weiss, 6W;Brandon Gates, 6W; Christina Moore,

Mark Adams, Engineering & Facilities;Barbara Ball, Grants & Contracts Ac-counting; Dwight Chamberlain, Engi-neering & Facilities; Lester Dempsey,Engineering & Facilities; Melva Dobson,MUSC Foundation; RhaShun Grant,Engineering & Facilities; Lou Mada-ta, Engineering & Facilities; K. GaleO’Neal, Human Resources; Josh Turner,Engineering & Facilities; and AntonioWright, Engineering & Facilities.

University

Close to half of those with post-traumatic stress syndrome (PTSD) alsosuffer from substance use disorders.

That’s why MUSC researchersKathleen Brady, M.D., Ph.D., andSudie Back, Ph.D., hope to educatetherapists and the public about aninfluential change in how to best treatthis population.

These MUSC researchers collaboratedwith colleagues in Australia to testexposure therapy, an evidence-basedcognitive-behavioral treatment for PTSDand addiction developed by the MUSCresearch group, in the treatment ofindividuals with co-occurring PTSD andaddictions. The study was conducted inSydney, Australia in collaboration withinvestigators from the University of NewSouth Wales.

Brady said that she wasn’t surprised bythe findings, published in the Journal ofthe American Medical Association, thatthis patient population could be treatedfor their PTSD without worseningsymptoms of addiction. (Read theabstract at http://tinyurl.com/bdaqsot)

“Because this was almost an hereticalidea in terms of how the treatment forthis difficult portion of the populationhad been, it really has opened up a newavenue for treatment of people with co-occurring PTSD and stress disorders andaddictions that is much more efficaciousand more humane.”

The fact that these findings set anew standard for handling treatment isexciting to Brady, a longtime researcherin this area. “This is a common problemand so pertinent because we have somany veterans returning from our recentwars with problems related to PTSD andaddictions. Therapists need effectivetools to address these problems.”

Another aspect that made this studyinteresting is the collaboration withMUSC and University of New SouthWales researchers, who used the manual“Concurrent Treatment of PTSDand Substance Use Disorders Using

By Dawn BrazeLL

Public Relations

Prolonged Exposure (COPE)” that wasdeveloped based on work by Brady andcolleagues.

“We have been working in PTSD for along time. We were the first group whoconducted trials exploring medicationtreatments for this comorbidity andhave been involved in neurobiologicexploration of the stress response inindividuals who have co-occurringdisorders,” she said, adding that it’s onereason MUSC has become a specialtycenter for PTSD treatment.

“Once you get a critical mass in anarea, it becomes a magnet for newtrainees and more experienced colleagueswho want to collaborate and be part ofthe excitement of new discovery.”

Colleagues in Australia read aboutthe manual and asked to collaborate ona study. Brady said they’ve developed aclose partnership, and it was helpful toconduct the research there given fundingwas easier to obtain and the timeframefor the completion of the study could beshorter. “It’s such a rich experience tointeract with others who come from adifferent perspective.”

For the study, researchers enrolled 103

Stress syndrome, addictionshave common treatments

See sTress on page 9

Dr. Kathleen Brady with her latestmanual on PTSD.

The CaTaLysT, November 16, 2012 3


Undergraduate I Poster—First place: Sloan Miler;second place: Hannah HughesClinical/Professional/Masters I Poster—First place:Allison W. Prince; second place: Lauren A. StokesClinical/Professional/Masters II Poster—First place:Caitlin J. Moore; second place: Daniela A. RileyClinical/Professional/Masters III Poster—First place:Douglas J Roberts-Wolfe; second place: Matthew J. Duf-finClinical/Professional/Masters IV Poster—First place:Mandev G. Guram; second place: Kaelyn M. RogersClinical/Professional/Masters V Poster—First place:Danielle N. Woodford; second place: Benjamin A.Harlan

PhD I Poster—First place: James B. Small; second plce:Sara D. JohnsonPhD II Poster—First place: Krystal Dole; second place:Brittney M. CoxPhD III Poster—First place: Denise M. Kimbrough (Ki-nard-Gadsden Award); second place: Haley B. Lindner

Congratulations to the winners of the Perry V. Halushka MUSC Research Day, held Nov. 2. For information, visit http://www.musc.edu/grad/srd.

PostDoc/Resident/Fellow I Poster—First place: YazhiXing; second place: Wei ChenPostDoc/Resident/Fellow II Poster—First place: YingXiong; second place: Kamala P. Sundararaj

Undergraduate II Oral—First place: Leopold Adler IV;second place: Matthew BergerClinical/Professional/Masters VI Oral—First place:Tanisha R. Hutchinson; second place: Chris D. ClarkClinical/Professional/Masters VII Oral—First place:Shivani S. Patel; second place: Shivangi LohiaClinical/Professional/Masters VII Oral—First place:Taylor M. Stukes; second place: James C. GrayPhD IV Oral—First place: Kimberly Sauls; secondplace: Christopher B. JohnsonPhD V Oral—First place: Oday Alsarraf; second place:Jordan D. GruberPhD VI Oral—First place: Lindsay T. McDonald (EricJames Award); second place: Caitlyn EllerbePhD VII Oral—First place: Joseph J. Taylor (Willard& Betty Peterson Award); second place: ShanmugamPanneer SelvamPostDoc/Resident/Fellow III Oral—First place: PhilipJ. O'Herron; second place: Michelle H. Nelson

Special AwardsInnovation—First place: Benjamin Josey; second place:Jonathan ZurcherSigma Xi—First place: Amy YoungInterprofessional—First place: Lauren E. Shuler; sec-ond place: Stephanie A. ScheppmannHealth Disparities Poster—First place: Benson Lang-don; second place: Dion Foster.Health Disparities Oral—First place: Kathleen Cart-mell; second place: Ellen MaherVA Oral—First place: Lindsay McDonald; secondplace: Jessica Trombetta-eSilva.VA Poster—First place: Dayvia Laws; second place:Daniela Riley

ReseaRch Day hOnORs sTuDenTsT he annual Perry V. Halushka 2012 MUSC

Research Day was held Nov. 2 at the WellnessCenter Gym and in the College of Health Professions.The research day was open to all students, postdoctoralresidents and fellows at MUSC and students,postdoctoral residents and fellows at other instituteswho had participated this past year in research programsat MUSC.

During the research day, more than 220 abstractswere presented. This consisted of 140 posterpresentations and 87 oral presentations in 20 differentcategories.

This year’s keynote address was presented by MaryKennedy, Ph.D., in the Division of Biology and theAllen and Lenabelle Davis Professor of Biology at theCalifornia Institute of Technology.

The winners are listed below:Top photo: JoyBuie, Departmentof Microbiology& Immunology,explains herposter to theevent keynotespeaker Dr. MaryKennedy.Left photo:Danielle Lowe,left, listens toLauren Stokesduring theNov. 2 posterpresentation.Stokes placedsecond inthe Clinical/Professional/Masters I Poster.


Meet Andrew

Andrew Brock, M.D.DepartmentMedicine— GastroenterologyHow long at MUSCA total of more than 8 yearsChildrenBenjamin, 6, Maggie, 4, and a third one onthe wayMeal you enjoy cookingAny fresh fish wholeFood you must have in the pantryTrader Joe’s Almond and Cashew granolaFavorite radio stationPandoraDream vacationAnywhere I can get a full night’s sleepPetsCats, Sebastian and Okar. We also have 10fish.Music in your player right nowThey Might Be Giants, Here come theABC’s


Faculty members at the Storm Eye Institute (SEI)spent part of Tuesday, Oct. 30 speaking to members ofthe South Carolina Lions Club about the latest in careand research in ophthalmology for the third S.C. LionsVision Symposium.

The symposium featured 15-minute presentationsfrom 10 clinicians and vision scientists, who discussedscleral contact lenses, new research on the retina andthe risks of lipofuscin accumulating in the back of theeye causing vision degeneration.

Associate professor Mae Millicent Peterseim, M.D.,who happens to be a Lion, shared her research on newequipment that detects risk factors for amblyopia, orlazy eye, in children.

Amblyopia occurs when vision doesn’t developproperly in one eye. The condition occurs in 2 to 4percent of children, but it’s responsible for vision loss inmore children than all other causes combined, she said.

About 80 percent of cases can be successfully treated.The problem is the lack of vision screening in youngchildren, which is necessary to detect the disorder.Schools in South Carolina only have recommendationsfor vision screenings in children, not requirements.

“They don’t know any better. I’ve had 8-year-olds and9-year-olds say to me, ‘Oh I thought everyone had onegood eye and one bad eye.’ Those are the ones whowe are trying to pick up because we can treat it,” saidPeterseim. In order for the treatment to work, patientshave to be identified before age 9.

Peterseim has been doing research comparingequipment to help detect risk factors for amblyopia,such as eye misalignment, cataracts and droopy lids, aswell as a need for glasses.

PlusoptiX has a vision screener that takes a picturein less than one second from a distance of 3.3 feet. Thepicture is used to estimate prescriptions for glasses. Thecomputer also instantly provides a “refer” or “pass”result. Refer patients are encouraged to go to a doctorfor a more in-depth exam; no problems were identifiedin patients who receive a pass result from the screener.

Peterseim said the scanner works well onuncooperative children because no physical contact isrequired. When the trigger of the scanner is pulled, a“sound target” attracts the eyes and the picture is taken.

“PlusoptiX worked well as a screener and as an auto-refractor,” said Peterseim, who has been conducting astudy at MUSC on the various scanners on the market.Her staff has been looking at preliminary data andusing the screener in the Charleston County schoolsystem in conjunction with the Association for theBlind. The MUSC study has more than 200 childrenenrolled.

“We felt good about the way that it worked in the

Lions learn about importance of screening in childrenBy ashLey Barker

Public Relations

schools,” Peterseim said. “We liked the change inreferral criteria because then you’re not doing examson all the children—you’re just kind of narrowing in onthose that you really need to see.”

Cyd McDowell, president of plusoptiX, explainedthat the idea for the equipment originally came fromwork to measure refraction in chimpanzees before andafter Lasik eye surgery. “(the plusoptiX founder) hadsaid, ‘If we can do this for chimpanzees, let’s do this forlittle kids. Chimpanzees can’t read an eye chart, neither

can a 2-year-old. Let’s actually start catching amblyopiawhen we can.’”

The approximately 75 Lions who attended thesymposium represented all four districts in S.C. Theywere treated to a demonstration of the plusoptiX S09and were shown the future model, which is powered byrechargeable batteries, has a screen similar to an iPhoneand will be released in January 2013.

In addition to learning about the importance ofvision screening in children, the Lions were taughtabout new advances in the treatment of dry eyesyndrome, the process of taking a new drug to themarketplace, advancements in ocular-plastic surgery,and how scientists are using human skin cells toregenerate the retina in the SEI laboratories.

The group was invited to the symposium to bethanked for the financial support of research at the SEIand to learn about how their gifts are being used.

“The Lions of South Carolina and Lions ClubsInternational have been very supportive of the StormEye Institute since the 1970s,” said Toni McHugh,SEI’s director of development. They donated $750,000in the 1990s to help build the top three floors of theSEI, and they go out into their local communities toeducate residents about the Storm Eye facilities.

SEI recently received a $62,000 grant from the LionsClubs International Foundation to help pay for anOptos-TX, a sophisticated camera and computer thatdoes retinal imaging, according to McHugh.

For more information about the S.C. Lions,visit www.SCLions.org. To read about Lions ClubInternational, visit www.LionsClubs.org.

“They don’t know anybetter. I’ve had 8-year-oldsand 9-year-olds say to me,‘Oh I thought everyonehad one good eye and onebad eye.’ Those are theones who we are trying topick up because we cantreat it.”

Dr. Mae Millicent Peterseim

Left photo: PlusoptiX PresidentCyd McDowell shows SouthCarolina Lions Club membersthe plusoptiX S09. Thescreener, above, takes a picturein less than one second from adistance of 3.3 feet. The StormEye Institute received a $62,000grant from the Lions ClubsInternational Foundation tohelp pay for an Optos-TX,a sophisticated camera andcomputer that does retinalimaging.

The Catalyst, November 16, 2012 7


seRVice Of RemembRance

The family of David Willis lights a candle to remember their childduring the Service of Remembrance Nov. 2 at St. Luke’s Chapel.Megan Bennett, R.N., left, and Emily Dorman, right, helped light acandle for each of the 82 children who died this past year at MUSCor at home following care at MUSC. Lacey McInish, center, read thenames of each of the children, along with Dr. Mark Scheurer andNatalie Emanuel, R.N. (not pictured).


participants, who met the diagnosticcriteria for both PTSD and substancedependence. The subjects were randomlyselected to either receive both prolongedexposure therapy and treatment forsubstance dependence or to only receivetreatment for substance dependence.

Those participants involved with theintegrated approach spent the first fewsessions learning cognitive behavioraltherapy strategies to deal with substanceabuse, and then they were treated fortheir PTSD symptoms.

Brady said they focused on teachingthe patients the relationship betweentheir trauma and their addictions andhow the conditions are in a “feed-forward, vicious cycle.”

At a nine-month follow-up visit, bothgroups experienced reductions in PTSDsymptoms, but subjects in the integratedgroup also showed a reduction in theseverity of their PTSD symptoms withoutany increase in the severity of their

substance use.Brady said they’ve had good experience

with the integrated approach so far.“We were true believers that this works.We think this study will change theway clinicians approach this particularpopulation, which is a substantialnumber of people with addictions.This will improve their treatment andrelieve their suffering more rapidly thananything that has been used before.”

Beyond the scope of the study is abigger message. “The message I’d liketo get out to the public is that addictivedisorders are treatable disorders. There’sa neurobiology to these disorders andthere are effective treatments. We needto support that. There are a number ofpeople in this country and throughoutthe world who can live much happierlives and make greater contributions.Why have people suffer with addictions,waste their lives and drain the resourcesof our society when a small investment intreatment can lead to incredible gains atthe individual and societal level?”

sTress Continued from Page Two


The third annual Healthy Holiday Live! will be heldat noon, Nov. 16 in front of the Drug Discovery

Building. The event, sponsored by the MUSC Office ofHealth Promotion and Sodexo, willfocus on tips for creating eco-friendlyholiday meals and celebrations.

In keeping with MUSC’s missionto improve health and maximizequality of life, MUSC is becoming aleader in promoting local, healthy,sustainable choices and celebratesthese efforts at this event.

The MUSC Sustainability andRecycling Program strive to reducethe environmental impact ofthe campus by advancing energyefficiency, water conservationand encouraging recycling. MUSC Urban Farmdemonstrates and educates participants on organicfarming techniques and composting. Sodexo Diningis working to reduce the environmental impact ofour hospital by advancing energy efficiency, waterconservation, composting and recycling. In addition,MUSC Sodexo is an official participant of the CertifiedSouth Carolina Grown Fresh on the Menu program,

committing to use at least 25 percent local producein its food operations. Buying local and organic helpspreserve the environment by minimizing transportationand chemical pollutants.

A panel of speakers will discuss topics related togreening holiday cooking, decorating, gifting and more.The main event features live cooking demonstrations byMUSC executive chefs Brett Cunningham and FerandoMiddleton using organic, healthy and sustainableingredients and culinary methods.

Tasting samples and recipes will be provided andrepresentatives from MUSC and the Charlestoncommunity will be available to answer questions andprovide information on keeping it green and healthythis holiday season. The MUSC farmers market andlocal businesses will also be on hand, providing greenproducts and services for the holidays and throughoutthe year.

Free samples include: (first course) roasted beet andcitrus salad with balsamic dressing; (second course)blackened local shrimp with a citrus glaze; (third course)local stone claw crab cakes with a spicy remoulade,accompanied with Carolina rice pilaf and toastedsesame seed green beans with garlic; and (fourth course)sweet potato pudding parfait.

Employee Wellness eventsq MUSC employee appreciation day at Charles TowneLanding will be held from 9 a.m. to 4 p.m., Nov. 17.Free admission with employee ID for up to four familymembers.q Flu shot satellite clinic: A flu shot clinic will beheld from 11 a.m. to 1 p.m., Nov. 28 in the Children’sHospital lobby. For faster service bring a completedinfluenza consent form, found in My Records.q Fitness series: The free fitness series continues from12:15 to 12:45 p.m., Nov. 21 at the MUSC WellnessCenter. Pilates and yoga includes stretching whileelongating muscles. Email [email protected] toregister. A free day-pass to the Wellness Center will begiven to all participants.q Farmers markets: Fruits and vegetables are availablefrom local farmers from 7 a.m. to 3:30 p.m. at thehorseshoe and the area next to Ashley River Tower. OnNov. 16, the farmers market will be in front of the DrugDiscovery Building as part of Healthy Holiday Live.

Contact Johnson at [email protected] forinformation on the Office of Health Promotion atMUSC and Suzan Benenson Whelan at [email protected] for specific information about Employee Wellness.Visit http://mcintranet.musc.edu/employeewellness/.

Demonstrations for eating healthy during holidays

Healthat workSusan Johnson


CLASSIFIED PCLASSIFIED PAGEAGE• Household Personal Items for

MUSC employees are free.All other classifieds are charged at rate below. Ads considered venture-making ads

(puppy breeder, coffee business, home for sale, etc.) will be charged as PAID ADS •• PROOFOF ELIGIBILITY REQUIRED * NO MORE THAN 3 LINES * FREE ADS RUN 2 WEEKS ONLY!

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On Nov. 17, hundredsof conferences forsurvivors of suicideloss will take placethroughout the countryand around the world.

This unique networkof healing conferenceshelps survivors connectwith others who havesurvived the tragedy ofsuicide loss and expressand understand thepowerful emotions theyexperience.

International Survivorof Suicide (ISOS)Day is for survivors ofsuicide loss, their familyand friends, and theclinicians who supportthem. Participants mayattend a conference inperson or watch online.There will also be a liveonline chat with othersurvivors of suicide loss.

ISOS Day will beheld from noon to 3p.m. at Trident UnitedWay, 6296 Rivers Ave.,North Charleston. Forinformation, emailCharlotte Anderson [email protected].

Survivor of SuicideDay to be held

The mission ofMurray CommunityMedical Clinic, locatedin Summerville, is tohelp members of thecommunity achievehealthier lifestyles byproviding reliable, easy-to-comprehend healthinformation and services.

Volunteer help isneeded from medicalassistants, physicianassistants, pharmacytechnicians, nurses, andother clinical staff. Thenext day of operationis Nov.30. If interested,email [email protected].

Community medicalclinic needs help
