June 28, 2013 MEDICAL UNIVERSITY of SOUTH CAROLINA Vol. 31, No. 44

BY ASHLEY BARKER

Public Relations

More than 15 years ago, a 17-year-old self-proclaimed “country boy” was rushed to MUSC

from North Myrtle Beach with severe closed-headinjuries, nine broken ribs and a broken pelvis.

Prior to the car accident, Jason Harrison waspresident of his junior class, a straight-A student and amember of his high school’s golf team. His father, JimHarrison, remembers the afternoon of Sept. 24, 1997,the day that all changed, like it was yesterday.

“It was pouring down rain. As I drove to GrandStrand Regional Medical Center, I was saying that littleprayer, ‘Let it be a bumped head, let it be a broken leg,let it be this or that,’” he said. “When I went by the caron the way to the hospital, my prayer changed to ‘Letme say goodbye.’ They had to cut him out of the car. Itwas that bad.”

When Jim arrived at the hospital, more than 50of Jason’s classmates were already pacing the floors.Within minutes, Jim was told he needed to call hisfamily in because his only son wasn’t going to makeit through the night. Members of Jason’s family, whohad to drive four and a half hours to make it to thehospital, didn’t know what to expect when they arrived.

“He was a mess. His head was as big as a basketball,and I’m not exaggerating,” Jim said.

After surviving three days, Jim decided his son’s bestoption was to be moved to MUSC. Again, he was toldJason wouldn’t even survive the ambulance ride. Jason’sheart stopped beating three times. But he made thetrip.

Jason was in a coma for three months in the care ofKarl Byrne, M.D., associate professor of surgery. Oncehe woke up, he survived a 106.5-degree temperature,

Attitude of gratitude

15 years later, patient returns to say thank you

64 GRANT SUPPORTS PROJECTGOVERNOR’S AWARDRobert Wood Johnson winner uses moneyto promote healthy eating and active living.

4

7

5Distinguished University Professor honoredwith Excellence in Science Research award.

First female to chair CPOS

Meet Kevin

Communications Corner

READ THE CATALYST ONLINE — http://www.musc.edu/catalyst

Jason Harrison, then 17, reached out for his dadfollowing a car accident in 1997.

three bouts of pneumonia and went through multiplesurgeries to relieve muscle contractions, repair brokenbones and to insert water-proof material between hisvocal chords in hopes that he’d be able to speak again.

“There was no hope. Everything bad happened. Wewere told again he wouldn’t make it through the nightwhen his temperature spiked,” Jim said. “We continuedto pray and pray and pray and pray. I kept praying fora miracle, a Christmas miracle.” His family membersrotated taking care of Jason, constantly staying by hisside and refusing to give up on him.

Jim’s miracle came when Jason was moved to theChildren’s Hospital after meeting Lyndon Key, M.D.Jason, who had been a juvenile diabetic since he was9 years old, turned 18 in a coma on Nov. 18. Key, whowas division director of pediatric endocrinology at thetime, said Jason’s diabetes qualified him for care as achild.

See THANK YOU on page 10Now 33, Jason Harrison returns to MUSC to tellhis story of survival.

2 THE CATALYST, June 28, 2013

BY CINDY ABOLE

Public Relations

New medical-code sets, physician training planned

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

Editor: Kim Draughncatalyst@musc.edu

Catalyst staff:Cindy Abole, aboleca@musc.eduAshley Barker, barkera@musc.edu

The Catalyst is published once a week. Paidadver tisements, which do not represent anendorsement by MUSC or the State of SouthCarolina, are handled by Island Publications Inc. ,Moultrie News, 134 Columbus St. , Charleston,S.C., 843-849-1778 or 843-958-7490.sales@moultrienews.com.

Hospitals and health care industry staff are bracingfor a change in the world of diagnostic coding.

By Oct. 1, 2014, all U.S. health care providers mustadopt the newest medical procedure coding structure,ICD-10-CM/PCS, to accurately report inpatientprocedures and activity at health care centers and in-patient hospital settings.

The change is a significant upgrade from theoutdated ICD-9 coding structure, increasing thenumber of medical codes to 68,000, which allows formore detail and flexibility. This national mandate alsoaligns the United States with Canada, France, Germany,Australia, China and other countries that alreadyuse these detailed code sets to classify morbidity andmortality data and track health statistics. In the U.S.,ICD coding is used for insurance claim reimbursement,resource allocation and data management.

To prepare for this conversion, the medical centerlaunched its own journey to synch the ICD-10conversion with the new Epic electronic medical recordsystem. The first step in the actual implementation ofthe use of ICD-10 terminology will begin in outpatientand emergency room settings in February 2014. Theplan will be for coders to utilize dual coding for bothICD-9 and ICD-10 until go-live for inpatient, scheduledfor next July. By October 2014 all clinical areas willuse and select from the ICD-10 CM (diagnosis)codes and ICD-10 PCS (procedure) codes for theirdocumentation.

ICD-10 CM is the tenth version of the InternationalStatistical Classification of Diseases and the NationalCenter of Health Statistics under the World HealthOrganization. ICD-10 PCS was developed by theCenters for Medicare & Medicaid Services. What’s newabout the ICD-10 codes is that they are more specific,according to Sue Pletcher, Health Information Servicesdirector, who represented her area on the ICD-10implementation executive oversight committee.

For example, congestive heart failure, a conditionwhen the heart fails to pump blood properly throughthe entire organ, is coded as 428.0 under the old ICD-9code and requires coders to use 15 codes (ICD-10)to describe heart failure in the left ventricle (428.1),systolic heart failure (428.2), diastolic heart failure(428.3,) or a combined systolic and diastolic (428.4).In ICD-10, code descriptions are more specific suchas heart failure following surgery, heart failure relatedto hypertension, heart failure and hypertension withchronic kidney disease, heart failure during obstetricsurgery or rheumatic heart failure.

During project planning, teams reviewed thehospital’s health information systems status, consulted

with Epic electronic health record system managers,assessed documentation practices and policies, reviewedand developed coder, staff and physician training, andnumerous other activities.

Phyllis J. “PJ” Floyd, R.N., Health InformationServices Clinical Documentation Integrity &Abstraction director, a co-chair with the ICD-10Clinical Integration Subcommittee, leads physiciantraining and the preparation of physician supportstaff, operations staff, coders, department schedulersand other groups. Floyd and her team have beeninvolved since the first day of planning from multipleperspectives. For the training piece, Floyd’s teamprepared materials to accommodate all types of learningstyles. They also prepared an array of tools — pocketcards, instruction materials, tip sheets, eLearningtechnologies as well as classroom instruction — to assistphysicians and coders. To ensure a successful rollout,leadership has hired Deloitte Consulting to conductassessments and guide the transition.

“Adjusting to these new code sets will require moretime and patience from coders, physicians and trainers.We’re committed to helping during this transitionperiod and offering solutions that will increasespecificity,” said Floyd.

According to Floyd, the launch for physician trainingwith ICD-10 began in January with an orientationsession and brief review with the surgery departmentincluding the vascular surgery division.

Bruce M. Elliott, M.D., professor and chief ofthe Division of Vascular Surgery, sees changes andconsequences with the ICD–10 coding updates. Elliott,who is a member of MUSC Physicians’ executivecommittee, sits on the hospital’s payment policycommittee, and has followed the hospital’s progressregarding physician and staff training.

Elliott’s area is slated to be among the first surgicaldepartments to complete physician training.

“It’s imperative that our physicians and staff besuccessful to learn this new coding system both quicklyand accurately. It’s also essential that the right tools andsupport plans are in place for this transition

to be successful.”MUSC is among a handful of institutions taking

a proactive approach to the new code set conversionwith communications, multiple levels of training anddepartmental support.

According to Elliott, the medical center was testedin 2012 with the first launch of the Epic electronicmedical record system in the ambulatory and emergencydepartments.

“Although Epic’s implementation process was wellorganized and training was coordinated, roll out inspecific areas was complicated and disruptive. Witha project of this scope and size, it’s realistic to expectsome disruptions throughout this conversion period,”Elliott said.

The ICD-10 readiness is being led by hospitalleadership and guided by an ICD-10 SteeringCommittee, compliance team members and otherplanners to assess the needs of departments andmedical specialties, schedule training for physicians andstaff, create support tools and conduct field testing tosupport the full implementation.

Comparing ICD-9 and ICD-10ICD-9 (13,000 codes)

! Three to five characters in length! First digit may be alpha or numeric! Limited space for new codes! Difficult to analyze

ICD-10 (68,000 codes)! Three to seven characters in length! Digit 1 is alpha, digit 2 and 3 are numeric, digit

4 through 7 are alpha or numeric! Flexible for adding new codes! Very specific

“We’re committed tohelping during thistransition period andoffering solutions that willincrease specificity.”

PJ Floyd, R.N.

THE CATALYST, June 28, 2013 3

Award presented to MUSC for healthy environmentMUSC was awarded a Hospital Prevention

Excellence Award by N.C. Prevention Partners,a public health leader that offers the worksite wellnessprogram WorkHealthy America.

Prevention Excellence awards are given to individualsand organizations for making the nation a healthierplace to live, work and learn. Awards were given duringNCPP’s annual meeting on June 5 at the University ofNorth Carolina at Chapel Hill’s Carolina Club.

Meg Molloy, DrPH, N.C. Prevention Partnerspresident and CEO, said, “Successful prevention stemsfrom good health policies. One of the best ways toaccelerate the adoption of good healthy policies is byrecognizing and sharing the success stories that makethem possible.”

As a Working Well Center of Excellence, MUSChas made healthy food the norm by creating an on-siteUrban Farm for employees, students and communitymembers to have access to fresh, local produce and tolearn about the benefits of a healthy diet.

“We are honored that MUSC was awarded thisrecognition and consider it to be a milestone in ourwellness efforts. It has been a long and challengingjourney to get where we are and to know that weare being recognized by our peers for our work was

extremely gratifying to all who have committed so muchto the working well program,” said Susan Johnson,Ph.D., director of MUSC’s Office of Health Promotion.“We look forward to continuing this collaborationas we expand our efforts to the business communitythrough a new ‘Healthy Business Challenge’ project.”

MUSC officials have also worked to create andenforce a campuswide tobacco-free policy. That policyserved as a driving force behind passing legislation H.4092, which gives authority to governing bodies ofpublic colleges and universities in South Carolina tolegally declare and enforce tobacco-free campuses toinclude outdoor spaces. MUSC, in conjunction withRoper St. Francis and the City of Charleston, alsocreated a smoke-free medical district in the heart ofdowntown Charleston.

These and other major accomplishments at MUSChave been shared with others across the state throughsite visits, blogs and webinars.

“The Medical University of South Carolina is servingas a leader and role model in the Carolinas and acrossthe country,” said Lindsey Bickers Bock, programmanager at N.C. Prevention Partners. “The team atMUSC has done extraordinary things to ensure thatthe people who work, learn and receive medical care ontheir campus are surrounded by a healthy environment.Along the way, they have truly embraced theopportunity to share their successes and challenges withother hospitals and institutions of higher educationin order to help other organizations make similarchanges.”

N.C. Prevention Partners senior programmanager Dr. Melva Fager Okun, from left,presents a Hospital Prevention ExcellenceAward to MUSC’s Drs. Pat Cawley and SusanJohnson. Representing Prevention Partners alsois Dr. Meg Molloy, president and CEO.

4 THE CATALYST, June 28, 2013

Established in 1989, the Governor’s Award forExcellence in Science Research is annually awardedto a person who has made major contributions to thestate of South Carolina in any area of science. The2013 recipient was MUSC’s Rosalie Crouch, Ph.D.,Distinguished University Professor in the Departmentof Ophthalmology.

Gov. Nikki Haley gave the award to Crouch on June14 at the South Carolina State House in Columbia.Crouch joined the MUSC faculty as an assistantprofessor in 1975 and has done extensive research inthe fields of ophthalmology and biochemistry.

“I am very grateful to all those who made thispossible,” said Crouch. “I have always considered myselfa nerd who loved chemistry, numbers and puzzles, soobviously research would be my thing.”

Crouch is no stranger to state recognition. She alsoreceived the State of South Carolina Governor’s Awardfor Outstanding Service in 2002 and was awarded theMUSC Distinguished Faculty Service Award in 2003.She hopes her accomplishments in science encouragemore advancement in all professional fields: primarilyan increase in the amount of women who aim toachieve their highest aspirations and are recognized forit. One of Crouch’s greatest accomplishments was being

named MUSC’s first female provost and vice presidentfor academic affairs in 2000.

“I am pleased to have broken some barriers. Womenin science deal with a biological impediment – namelythe desire to have children — at a critical point in theircareer,” she said.

Although Crouch believes women are more likelyto encounter hindrances than men, she is optimisticabout the future. “Things are improving, and society

is certainly more accepting. I am sure we will see morewomen in leadership positions.”

Many of Crouch’s past trainees have gone on tonationally renowned leadership positions in the fieldof science and have made vital innovative discoveries intheir respective research areas.

“One of my trainees, Michael Redmond, discoveredthe protein that when mutated results in blindness andhas been used in the first successful gene therapy trials.The understanding of the role of this protein and thisdisorder is based on our decades of study on vitaminA,” Crouch said.

Despite her passion for vision research, Crouch,who owns a home on Edisto Island, delights in hertime spent away from the laboratory as well. While sheenjoys number-based activities such as bird watching,change-bell ringing and duplicating bridge, she alsosaid baby-sitting her three grandchildren is one of herfavorite hobbies. “The children are 2, 3, and 4 and aretoo young to know if they will be interested in scienceyet. But they can count, which is encouraging,” she said.

Crouch is a member of the Board of ScientificCounselors of the National Eye Institute, a seniorscientific investigator of Research to Prevent Blindness,and serves as a principal investigator of a 30-year-old National Institutes of Health grant. She also isa recipient of an NIH Special Career AchievementAward.

BY BILAN WILLIAMS

Public Relations

Dr. Rosalie Crouch accepts the Governor’sAward for Excellence in Science Research fromSouth Carolina Gov. Nikki Haley, far left. WithCrouch is her son, Richard, daughter-in-lawHeather and grandchildren William and Kelsey.

Kelly Ragucci, PharmD, believes adepartment chair should be an

agent of change. As the first female —and youngest — department chair at theSouth Carolina College of Pharmacy, shealready is one.

The tenured professor and assistantdean of the curriculum at SCCP hasbeen named chair of the Departmentof Clinical Pharmacy and OutcomesSciences at the college. The chairoversees the CPOS faculty at bothcampuses of SCCP founding institutionsMUSC and the University of SouthCarolina, as well as at the SCCP’ssatellite campus at Greenville HealthSystem.

“Dr. Ragucci is an accomplishedfaculty member who has been heavilyinvolved with coordinating our

curriculum change process,” said JosephT. DiPiro, PharmD, executive dean ofSCCP. “Department leadership has beenand will continue to be crucial for thecollege’s continued growth and success.Dr. Ragucci is highly respected by herpeers and has the skills and experience tohelp us build on that momentum.”

Outgoing chair John Bosso,PharmD, will remain a professor inthe department. On the USC campus,Brandon Bookstaver, PharmD, willcontinue to serve as vice-chair.

With a vision focused on increasedcross-campus collaboration, supportinginnovative teaching techniques andscholarly endeavors, recruiting/retention,and faculty development, the new chairplans to meet with individual faculty forin-depth discussions on goals so she canlead development of the department’sstrategic plan. As chair, she believes animportant part of that is to analyze long

term strategic, political and culturalimplications of resource allocationdecisions.

“The department should really be runby faculty and facilitated by the chair,”said Ragucci, whose scholarly interestshave included the scholarship of teachingand interprofessional education. “Wehave a great faculty who are doing greatthings so it is really just a matter ofbuilding on that.”

A finalist for Governor’s Teacher ofthe Year in 2013, she has been recognizedboth for her teaching and clinical work.She won back-to-back MUSCwide awardswhen she was honored with the MUSCTeaching Excellence Award in 2012 andthe Outstanding Clinician Award in2011. She has been named professor orpreceptor of the year six times and hasmore than a dozen other college anduniversity recognitions.

Ragucci earned her bachelor’s in

pharmacy with high honors from OhioNorthern University and her PharmDfrom the University of Toledo Collegeof Pharmacy. She did a primary carespecialty residency in family medicineat MUSC in 1997-98 and has earnedcertifications in Basic Life Support,Physical Assessment, Board ofPharmacotherapy Specialists, DiabetesEducation and Advanced CardiovascularLife Support.

After serving as assistant professor atWilkes University, she joined MUSCin 2000 and was promoted to associateprofessor in 2004. She became a fullprofessor in 2011.

She is chair of the Clinical PracticeAffairs Committee for the AmericanCollege of Clinical Pharmacy and hasserved in several national positions,including as chair of the AmbulatoryCare Practice and Research Network andthe Constitution and Bylaws Committee.

BY ROBY HILL

S.C. College of Pharmacy

First female to chair Clinical Pharmacy, Outcomes Sciences

Excellence in Science Research awarded to professor

THE CATALYST, June 28, 2013 5

MEET KEVIN

Kevin Wiley Jr.DepartmentCenter for Global HealthHow long at MUSCGoing on two monthsWhat music is in your playerI love all music — Queen, the Carpenters,Miguel, Wale, the Bee Gees, John Denver,Oscar Peterson and Frank Sinatra are all inmy iPhone right now.Unique talentI play the drums occasionally. I’ve playedsince I was 12 years old and masteredthe snare, quince and all other marchingpercussion instruments.Dream jobI would love to work in a position whereI am able to teach people how to navigatethrough life. Some of us have the resourcesto get through it rather easily and some ofus have a hard time making it. If I couldprovide people with great opportunities thatlead to awesome outcomes that would be anamazing job.Favorite restaurantsSoutheast Asian cuisine. So, it’s a tiebetween Mi Xao (Vietnamese cuisine) inMount Pleasant and Suwan Thai Cuisinein Old Port Royal.

6 THE CATALYST, June 28, 2013

BY ASHLEY BARKER

Public Relations

L ast October, Debbie Bryant, DNP, R.N., becameSouth Carolina’s first Robert Wood Johnson

Foundation Community Health Leaders Award winner.The assistant director of cancer prevention, control

and outreach at MUSC’s Hollings Cancer Center, wasone of 10 leaders to earn a $105,000 grant to support aproject created by the winner. Bryant decided to use hergrant money to fund the HEAL (Healthy Eating andActive Living) Project within Community Compass, theannual outreach event that helped earn her the RWJFoundation award.

The project, which focuses on the Tri-county area,aims to develop guidelines for five organizations toimplement into their meetings, seminars and events.Fraternal, civic, social and faith-based organizationswere asked to apply to receive consultations withexperts in the areas of nutrition, food preparation,exercise and physical activity, and smoking cessation.

“We want to really make this uniquely tailored forthat organization,” Bryant said. “An organization couldsay something as simple as, ‘For the next year, we’regoing to never serve anything fried.’ We’re going to helpthem develop their own guidelines then implementtheir guidelines.”

Once the guidelines are created and beingimplemented, the HEAL team will evaluate theorganizations on how well they are following them.The organization that incorporates their guidelinesbest during the course of two years will then receive anadvertisement in The Post and Courier.

“We had about 25 organizations to submit theirnames for participation. Now we’re reviewing anddeciding who will meet the challenge,” Bryant said.

In order to participate, organizations must havea membership of at least 20 and a leader who iscommitted to the organization’s goal. They also have toput together an eight-to-10-person committee to focuson the project. Organizations that join and implementthe guidelines will receive a stipend of $1,200 to spendhowever they so choose.

“Our role is to bring the expertise of Hollings CancerCenter, the medical center and the prevention andcontrol program together so the organizations candrive what they’d like to do as it relates to health andlifestyle changes,” Bryant said. “We’re not trying todrive everybody into the same pot. We’re just trying tobe here as a support service to help them do what theywant to do.”

In addition to the HEAL Project, Bryant’s grant wasused to fund a recipe dish contest at the most recentCommunity Compass event. Organizations wereasked to submit a healthy recipe, which was judged

on appearance,creativity, taste andhow healthy thedish was by twodietitian expertsand a communitymember. CynthiaWilcher, of ArabianTemple #139, wonthe contest with hermaple roast veggiesrecipe. All of thehealthy recipes thatwere submitted willbe compiled into abook for members toshare.

“This is takingour education awareness and bringing people togetherto take the next step into an action place where ourpartners and community members could be involved indeveloping a plan to change what’s possible as it relatesto the lifestyle interventions,” Bryant said.

For more information, visit http://hcc.musc.edu/commitments/outreach.htm.

Winner uses grant money to fund HEAL Project

Serves 6Ingredients! Seven peeled carrots slicedin half lengthwise then cutinto two-inch pieces! Two red bell peppers cutinto large chunks! One squash, unpeeled andsplit lengthwise with the seedsremoved and cut into half moons (you could also usepeeled butternut squash)! One yellow onion cut into wedges! Two tablespoons of maple syrup! Two teaspoons of oil! One tablespoon of kosher or sea salt

Preparation1. Preheat oven to 425 degrees2. Place all of the ingredients in a bowl and toss to coatthe vegetables (at this point you can place the vegeta-bles in a large zipper bag and refrigerate overnight)3. Pour the vegetables onto a foil-lined sheet tray androast for 50 minutes, stirring halfway through, or untiltender and golden4. Serve

WCBD TV 2 anchor Carolyn Murray, left, and Dr. Debbie Bryant, right, present Cynthia Wilcherwith a $350 check for winning the Best Recipe Grand Prize.

Maple roast veggies

Second place winners wereBrandi White, Tamika &Friends Inc. They served upfresh fruit kabobs.

THE CATALYST, June 28, 2013 7

Medical Center Communications CornerWhy these goals?

! ServiceHCAHPS and CG CAHPS(Consumer Assessment of HealthcareProviders and Systems)1. The patient’s experience is animportant factor in the qualityof care, recovery and MUSC’sreputation.2. MUSC utilizes CAHPS surveyswhen possible: (a) these arestandardized surveys that are beingused across the U.S., (b) the resultsare reported online, and (c) MUSCcan compare performance withother area providers and otheracademic medical centers.3. These surveys: (a) are requiredby the Center for Medicare andMedicaid services, (b) impact theamount MUSC is paid for itsservices.

! PeopleEmployee commitment, physicianengagement

How employees and physiciansfeel about the work they do andwhere they work is important. Highlevels of commitmentand engagementare associated with:higher patient, familysatisfaction; lowererrors, accidents; betterpatient outcomes; lowerabsenteeism; lowerturnover; and higherprofitability.

! QualityIdeal care, hand hygiene

Proper hand hygiene is the mostimportant thing MUSC employeescan do to prevent health care

associated infections.The ideal care composites include:Mortality: a global indicator of

the quality and safety of the careprovided; a measure of whetherpatients live more often, about thesame, or less often than would beexpected given how serious theirillness.

Care process measures: howconsistently MUSC provides certainelements of care that have beendemonstrated to lead to the bestpatient outcomes.

Readmissions: Measures howoften patients come back into thehospital within 30 days of beingdischarged; a global measure ofthe effectiveness of (a) the caredelivered while in the hospital,(b) the preparation of the patient(and their caregivers) to takecare of themselves at home, and(c) the post-discharge follow upplan prepared with the patient;readmission rates for some diseasesare publically reported and impactthe amount paid for its services.

Health care acquired infections:central venous lineinfections, catheterassociated urinary tractinfections and ventilatorassociated infectionsare serious, usuallyavoidable, complicationsthat increase patient painand discomfort, increasemortality and extendhospital stays; patients donot deserve to experience

illnesses they did not have beforecoming to MUSC; rates of healthcare acquired infections arereported and impact the amount

MUSC is paid for its services.Cultural of safety: in order to

provide the best care, MUSC mustcreate an environment that supportsattention to safety for patients andemployees (a) measured with a clinicalemployee survey, (b) assesses employeeperceptions of importance of qualityand safety within the organization,and (c) provides information aboutthe strength of key safety processes.

Outpatient electronic medicalrecord meaningful use: greater useof technology is vital to improvingthe quality of care; health care isbeing guided through time to useelectronic patient informationby increasing expectationsfor information collection,documentation and reporting; atthis time compliance rates withcapture and reporting of certaindata elements are used to determinepotential for increased payments.

! FinanceCost, margin

Cost per discharge: an importantmeasure to assure that costs forproviding care are not more than

MUSC is paid for that care;payments will decrease during thecoming years; it is important thatMUSC reduces the costs beforepayments are reduced.

Margin: what is left frompayments after MUSC has paidfor its costs; it is important tohave a margin left so that fundsare available for purchasingnew equipment, maintainingthe facilities and maintainingcompetitive pay rates.

! GrowthInpatient discharges, new patientsvisits

In support of our mission,MUSC wants to provide services toan increasing number of citizens;improve the process for admitting,treating and discharging patientsso that MUSC makes the best use ofits capacity to serve patients; and theoutpatient focus is on new patients tosupport the intent to offer patients anopportunity to benefit from MUSCservices who may not have done sobefore.

8 THE CATALYST, June 28, 2013

As a physicist, knowing the language that waterspeaks offers benefits, particularly if you’re gifted in

translating that language in a way that potentially uncoversa method for the early detection for Alzheimer’s disease.

Establishing neuroimaging biomarkers for the earlydetection of this disease is crucial for the developmentof earlier interventions when treatments could be moreeffective and at least delay the disease’s progress, preservingthe quality of life, said Joseph A. Helpern, Ph.D., aSmartState Endowed Chair in Brain Imaging.

A recent article from his research group, “NovelWhite Matter Tract Integrity Metrics Sensitive toAlzheimer Disease,” appeared in the American Journal ofNeuroradiology.

Helpern is no newcomer to imaging. The director ofMUSC’s Center for Biomedical Imaging is credited withbuilding the first 3-Tesla MRI almost 23 years ago andnow considered the clinical state-of-the-art. He and long-time collaborator Jens H. Jensen, Ph.D., also developeddiffusional kurtosis imaging, the MRI method that washighlighted in this latest study and being used to study a

wide range of diseases.This is the beauty of being a

researcher in the field of imaging,which cuts across all fields ofmedicine, he said.

“The research we’ve beendoing and the development oftechnology that we’re translatinginto the clinic is really excitingbecause it’s showing that we have

exquisite sensitivity into imaging biomarkers early on intodiseases such as Alzheimer’s disease, epilepsy, attentiondeficit hyperactivity disorder, stroke and many others.”

Researchers applied DKI-based tissue modeling of thewhite matter in the brain to investigate the sensitivity,diagnostic accuracy and associations of specificmicrostructural changes that happen through the courseof Alzheimer’s disease. Findings suggest that there iswidespread breakdown in myelin integrity in the transitionfrom normal aging to a stage of amnestic mild cognitiveimpairment, with a loss in axonal density occurring later inthe disease.

The bottom line is that the imaging works to depictthose changes.

“Perhaps someday quantitative neuroimaging will beincluded with annual medical checkups in order to detectthe earliest signs of AD before clinical symptoms arise,”Helpern said in the conclusion of the paper. “Then wewill intervene with a future therapy that prevents theprogression of this devastating disease.”

Developing potential neuroimaging biomarkers isone of the key strategies included in the 2012 NationalAlzheimer’s Project Act, as well as for President BarackObama’s BRAIN (Brain Research through Advancing

Innovative Neurotechnologies) initiative.“A biomarker tries to detect something that changes

early on in the disease that sends up a red flag and notifiesus that things are going bad,” Obama said.

MRI is based on the ability to get signals from watermolecules in the body and turn them into images forclinicians. It can be done non-invasively and withoutthe radiation concerns of other types of scans. For DKI,Helpern said it all involves studying the random walk of awater molecule, which is called diffusion.

“Water communicates in a language that allows us to ask

certain things about its environment. I can ask the watermolecule, for example, how far can you travel before youbump into something? The water molecule, through all thetechnology of computers and big magnets says, ‘I can travelabout 10 microns before I bump into something.’”

He then can ask if it can travel in all distances equallyor if there is one hallway that’s easier to travel. In scientificterms, that’s called anisotropy, and it turns out thataxons or the wiring in the brain are like tubes that watercan travel down easily. Interestingly, the water moleculesbehave differently in various sections of the brain, such astraveling through white and gray matter, for example, andresearchers can use this information to assign differentcolor scales in DKI.

Imaging scientists then can use DKI to see themicroarchitecture of neural tissue and identify earlychanges that could be predictive of Alzheimer’s muchas a structural engineer could note cracks and structuralchanges in a building’s walls and avert danger. “This papershows that our diffusional kurtosis imaging is sensitiveenough to be able to separate people with normal agingfrom people with mild cognitive impairment. That’sactually pretty big because we’re already pretty good atdiagnosing Alzheimer’s disease. We need to be better atdiagnosing them earlier in the disease.”

DKI, which has been licensed to Siemens Medical,is currently implemented in scanners at more than 150sites worldwide. The goal is to develop the tool’s power.

“It’s a language we’re developing, but we haven’t

Powerful imaging technology unveils new clues

ek} {mjxlt f} |xqlxkn hjxj ysvvhjsmncq rhkimjsj socusnu im wny snjsutij snim jhzt zmnysismnj cjAlzheimer’s disease, stroke, epilepsy and ADHD.

BY DAWN BRAZELL

Public Relations

Magnetic resonance brain imaging of a healthyperson is shown in top row, a patient with mildcognitive impairment (middle) and a patientwith Alzheimer’s disease (bottom) using DKI.

http://youtu.be/fWs6F6BYwK8

WATCH

RELATED VIDEOS

See IMAGING on page 9

THE CATALYST, June 28, 2013 9

IMAGING Continued from Page Eight

developed it enough so that we can askall the right questions.”

Yet, that is.The pieces are coming together to

radically shape imaging diagnosis ina variety of medical areas. Helpernand colleagues have another papercoming out in the journal HumanBrain Mapping highlighting work beingdone in ADHD, which affects so manychildren now.

“This paper shows that thedevelopmental trajectory – how the brainforms, its wiring and how it builds itselfin the early stages between 8 and 18in normal children is different than inADHD children. This is hard physical,imaging evidence that these children aredifferent. There are real microstructuraldifferences. That’s really significantbecause we need better quantitative andobjective tools for diagnosis.”

It’s also significant because it providesan objective tool to see the effectivenessof medications, an area of interest forupcoming studies.

Helpern said that two other areas ofexcitement for DKI are in the areas ofstroke and epilepsy.

“The hot area in stroke right now is inrehabilitation. If someone has a stroke

the question is whether or not there areenough other areas in the brain that canhelp regain the loss of function, such asmotion and talking.”

Helpern said researchers are measuringthe functional activity of stroke patientsalong the cortical spinal track, an arearelated to the ability to move their legsproperly. The images are taken pre-and-post physical therapy to see whichpatients will respond to this kind oftherapy. It could potentially be a veryhelpful prognostic tool for therapists, hesaid.

With epilepsy, it can be very difficultto locate exactly where in the brain theproblem of seizures originates. Somepatients don’t respond to drugs and haveto have surgery, where a part of theirbrain causing the seizures is removed. “Ithink everyone can understand why it’sso important to get that right.”

It’s a very costly process to get thematrix right using a variety of medicaltechniques to make this determination,he said. “The initial results that we’vegotten from DKI are really are quitespectacular. We’ve stumbled onto anew imaging modality that is exquisitelysensitive to brain changes in epilepsy.”

It can radically affect research intotreatment options. For example,conventional imaging used for temporallobe epilepsy shows primarily one areaof the brain lighting up. Using DKI,larger areas of the brain light up as well,giving researchers new clues into thedisease. “Now we can start to formulatehypotheses about what is going on andwhat we can do for treatment, as well.”

For additional information, visithttp://tinyurl.com/helpern or http://musc.edu/pr/newscenter/2013/ccad.html.

Researchers assign colorscales in DKI to identify themicroarchitecture of neural tissue.

MUSC, RiverDogs support N.Y. Yankees’ HOPE WeekThe New York Yankees, the parent organization of

the Charleston RiverDogs, will celebrate HOPEWeek beginning July 8.

The Yankees’ HOPE Week initiative (Helping OthersPersevere and Excel) is rooted in the belief that acts ofgoodwill provide hope and encouragement to morethan just the recipient of the gesture. The RiverDogswill participate in events to garner awareness forhighlighted causes, individuals and organizations.

MUSC’s Office of Health Promotion and theRiverDogs will team up to support the American LungAssociation for a day of fitness on July 9. To recognizethe work of the ALA and to help promote its annualFight for Air event, the RiverDogs will host two trialclimb events – one at the North Charleston Coliseumand the other at MUSC.

All students, faculty, staff, and members of thecommunity are invited to participate in the 1,000-stepchallenge throughout the day. All who complete thechallenge will receive a free ticket to the RiverDogshome game that evening.

The main event, which will feature a visit fromRiverDogs players and giveaways, will be held in theNorth Tower stairwell between 11 a.m. and 1 p.m. Allparticipants must complete at least one trip up anddown the North Tower stairwell, which is 200 steps,during that time.

All other steps may be completed at any point, in anystairwell on July 9. Participants are required to keeptrack of their own steps completed throughout the day.

During the main event, the Outta My Huevos foodtruck will be parked at the Horseshoe, and Sodexoemployees will sell boxed lunches, including bottled

water, for $5.There will also be an ALA representative available to

help sign participants up for the Fight for Air climb onJuly 20. Each person who signs up for the climb duringMUSC’s trial event will receive a pedometer.

To learn more about the American LungAssociation’s Fight for Air climb, visit www.lung.org/pledge-events/sc/north-charleston-climb-fy14/.

Employee Wellness events! Farmers markets: Fresh fruit and vegetables areavailable from local farmers on Friday from 7 a.m. to3:30 p.m. at the Horseshoe.! Employee Fitness Series: Pilates will be held from12:15 until 12:45 p.m., July 17. The free class will be ledby Katie Blaylock from the MUSC Human PerformanceLab. Participants should check in at the WellnessCenter membership desk for directions to the class andwill receive a free one-day pass to the Wellness Center.E-mail musc-empwell@musc.edu to register.! Worksite screening: A screening, valued at $350,will be available July 17 in the 2 West classroom ofthe university hospital. The screening is available toemployees and their covered spouses with the StateHealth Plan for $15. Employees and their spouseswithout the insurance can participate for $42. Thescreening includes: height, weight, blood pressure anda blood draw for a blood chemistry profile, hemogram,and a blood lipid profile. To register, go to www.musc.edu/employeewellness and click “Worksite ScreeningAppointment.”! MUSC Healthy Challenge Tuesdays with theRiverDogs: Tuesday night games are geared toward

living and promoting a healthy lifestyle and feature asponsorship from the MUSC Wellness Center, HealthyCharleston Challenge and MUSC Urban Farm. Healthyconcessions are available throughout the season andfeature the farm’s veggie taco, which is made from cropsgrown on the farm. Discounted tickets to all Tuesdaygames with reserved group seating just for MUSC areavailable online. Tickets must be purchased by noon theday of the game. Gates open at 6 p.m., and the gametime is 7:05 p.m. To purchase discounted tickets, visithttp://cr1.glitnirticketing.com/crticket/web/gpcaptcha.php. When prompted to enter the group password, type“healthy.” Be sure to stop by the MUSC table to entera drawing for free Wellness Center passes and otherhealth and wellness giveaways.

MUSC Urban Farm! Lunch & Learn: On June 27 from 12:15 until 12:45p.m., sustainability manager Christine Von KolnitzCooley will demonstrate various types of compostingsuitable for home use.! Early-bird maintenance: Get your day started witha little Urban Farm tender loving care from 7:30 until8:30 a.m., July 3.! Work and Learn with child-friendly activities: OnJuly 6, from 9 until 11 a.m., bring a plastic bag and takehome some fresh produce in return for work efforts orhelp gather for donations. Wear closed-toe shoes. Noexperience or prior knowledge is necessary. The event isopen to the general community.

Email johnsusa@musc.edu for information on theOffice of Health Promotion or email whela@musc.edufor information on Employee Wellness.

10 THE CATALYST, June 28, 2013

Rehabilitation would be the nextdifficult hurdle for the family to cross.Initially, Jason was denied access to rehabbecause he couldn’t hold up two fingers.A chance meeting during a smoke breakchanged all of that.

“I went down to a smoking areaMUSC used to have. I was crying andmad. This guy walked up to me,” Jimsaid. “His name was Rob Merenbloom,and he asked if I was OK. I shared withhim what had just happened. He said,‘Walk with me.’”

The next day, Jason was in rehab.“The old saying is ‘It ain’t what you

know; it’s who you know,’” Jim said.It took a moment in the middle of a

bridge at 2 a.m. for Jim to understandwhat he feels is the real reason his sonis still alive. During an exceptionallydifficult time in the hospital, Jimbecame outraged and blamed God forhis son’s situation. While driving acrossthe Cooper River Bridge, Jim said hisoutlook suddenly changed.

“God spoke to me on that bridge. Hesaid, ‘Jimmy, the boy was mine beforehe was yours; ain’t nothing you can doabout this.’” Jimmy pulled over, and hiswife, Patricia, who was driving behindhim, followed suit.

“I got down on my hands and kneesin the median out there. I said, ‘Lord, Iain’t mad at you anymore. If you wanthim, he’s going to be better off with youthan with me.’ I said, ‘You gave me your

son, Jesus. I’ll give you my son, Jason.’You want to talk about a burden lifted.Everything got good then.”

The following day, Jason’s life supportwas unplugged, and he began breathingon his own.

“God worked through this hospital,putting the doctors in the right place.MUSC is the greatest place to be,” Jimsaid. “I’ve said it to everyone I know.If you’re sick, go to your doctor. But ifyou’re really sick, go to MUSC.”

Jason was discharged from MUSCon May 14, 1998. Back at home, oneSunday morning around 5 o’clock, Jim

remembers Jason ringing a bell that hisfamily had placed by his bed.

“Jason wrote on a computer that wasbuilt especially for him, ‘Go buy mea walker.’ I said, ‘What do you want awalker for? You can’t walk.’ He said, ‘Ican’t now, but I will walk in two weeks,’”Jim said. “Jason said, ‘Jesus sat on thefoot of this bed and said I’d be walking,brushing my teeth and combing my hairin two weeks.’”

Fourteen days later, Jason picked hiswalker up and started down the hall. Jimsaid it took him 45 minutes to make it tothe bathroom, where he combed his hair

and brushed his teeth, before walkingback to his bed.

That day is something that Jason canlook back on with pride. He’s now livingon his own just a mile away from hisfather in a two-bedroom brick homeon the corner. He still has some speechdifficulties, but keeps busy by workingas a cashier at Goodwill and driving hisown truck around town.

“Life is wonderful,” Jason said,as he sat in the Horseshoe near theChildren’s Hospital in late May. He livesindependently but calls his father everymorning just to check in with him.

“You want the best for your children,”Jim said. “When they get up in themorning and they say, ‘Hey old man, Ijust wanted to call you and let you knowthat I love you,’ it doesn’t get any betterthan that. That’s what life is all about.”

Jason still golfs and is working on hisgame so that he can beat his father again,the way he could in high school.

“I’m trying to get it back. I struggle.My body just won’t let me do what Iknow how to do sometimes,” Jason said.Now he has new hobbies that his bodycan handle easily.

“I love to cook. I cook all the time.You name it, I cook it,” Jason said. Heenjoys making chicken bog periodically,along with fried pork chops, rice andgravy. The now 33-year-old man, whowasn’t supposed to survive the night, isalso known for whipping up a “killer macand cheese.”

THANK YOU Continued from Page One

Jim Harrison, right, with his son, Jason, visited MUSC. Jim believes ‘Godworked through this hospital, putting the right doctors in the right place.’

The Society for Clinical Trials has awarded the 2012Trial of the Year to a study conducted by MUSC’s DataCoordination Unit and sponsored by the NationalInstitute of Neurologic Disorders and Stroke.

The study, Rapid Anticonvulsant Medication Prior toArrival Trial (Silbergleit, Durkalski et al, New EnglandJournal of Medicine, Feb. 16, 2012), was conducted inchildren and adults by the NINDS-funded NeurologicalEmergency Treatment Trial Network. As a result of thisyear’s winning study, emergency medical technicianshave a faster and more practical way of treating a life-threatening seizure condition before patients reach thehospital.

Each year the Society for Clinical Trials presents anaward to the randomized clinical trial published in theprevious year that best fulfills the following standards:improves the lot of humankind; provides the basis for

a substantial, beneficial change in health care; reflectsexpertise in subject matter, excellence in methodology,and concern for study participants; overcomes obstaclesin implementation; and, presents its design, execution,and results in a model of clarity and intellectualsoundness. At MUSC, DCU played a vital role in thestatistics and data management for the Rampart trial.

“It was a unique trial that had several challengingaspects,” said Valerie Durkalski, Ph.D., the leadbiostatistician for Rampart and DCU director. “It takesseveral years for a study of this magnitude to get to thisstage, and we are very excited to share results that couldpotentially change clinical practice for the pre-hospitaltreatment of status epilepticus.”

Lead investigators from the winning trial addressedthe society at a plenary session during the annualmeeting held in Boston in May.

Study improves pretreatment seizure care

THE CATALYST, June 28, 2013 11

A seminar titled, “Endof Life Decisions,” willbe held at 6 p.m., July25 at the CharlestonCounty Library, 68Calhoun St. The seminarwill be presented by Dr.Stuart Sprague, of theAnMed Family Residencyprogram. As medicaladvances enable peopleto live longer, increasinglife spans introducecomplicated ethical,spiritual, political andeconomic issues.

Space is limited. Forquestions, call 805-6930or email eagerp@ccpl.org.Visit www.ccpl.org.

End of life decisionto be held July 25

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Women’s Club accepting nominees for scholarshipsThe Medical University Women’s

Club is accepting applications forscholarship recipients. All full-timeMUSC students in their second orsubsequent years from any of thesix colleges are eligible. Previousapplicants may also apply.

Applications may be downloadedfrom http://academicdepartments.musc.edu/womensclub/scholarship.

htm. The deadline for submissionis 4 p.m., Aug. 27. Applicationsmay be submitted via email tomuwcscholarship@gmail.com ordropped off at the Volunteer ServicesOffice, 101 North Tower (behindadmissions desk).

For information on thescholarships, email Tiffany Talacs atmuwcscholarship@gmail.com.

10:15 a.m. to Noon, Friday, July 19MUSC Institute of Psychiatry Auditorium

Speaker: Michael Iwama, Ph.D., OT (c)Professor and Chair, Department of Occupational Therapy

Georgia Regents University

Dr. Iwama is an internationally known champion for culturally relevant occupational therapy.He created the conceptual Kawa Model, now taught in occupational therapy educationand adopted in clinical settings. The Mitcham Fund was established in 2005 to create, inperpetuity, an annual lectureship program for the division. For information, call 792-2239.

THEMARALYNNED. MITCHAM INAUGURAL LECTURESHIP“East & West: Cross-Cultural Implications on the Construction of

Theory and Knowledge in Occupational Therapy”