solutions magazine - march 2014

UNT HE ALTH SCIENCE CENTER

MARCH 2014

f o r a h e a l t h i e r c o m m u n i t y

INSIDE:A caregiver

who still makes house calls

Seniors’ fear of falling

returning a

triathlete to competition

SOLUTIONS FOR A HEALTHIER COMMUNITY

SOLUTIONS

01

In a few short weeks, the state of pediatric care in Fort Worth will undergo a dramatic change when UNT Health Science Center’s mobile pediatric clinic hits the road.

The specially equipped state-of-the-art mobile clinic, now being prepared, will bring

high-quality health care directly to children living in underserved areas of Fort Worth.

When it is operational, the clinic will offer routine physicals, sick visits, immunizations, screenings and laboratory testing. And it will provide education in

nutrition, physical activity and dental health.

To find out how you can support this important community outreach, contact Susan Smith in the Office of Institutional Advancement at 817-735-2174.

health care on the go

coming soonPediatric care to arrive for children in underserved neighborhoods

CONTENTS MARCH 2014

02 Three questions

COMMUNITY BRIEFS 03 Nuclear technology impacts cancer treatment, and how eating behavior affects your health

04 The Vial of Life provides medical information, and care communication tested for HIV patients

05 The pediatrics department scores 100, and mild cognitive impairment among Mexican Americans

06 Value that stands the test of time, and keeping blood pressure under control

POSITIVE PATIENT OUTCOMES 07 A physician assistant who still makes house calls

09 Teamwork that saved a life

11 COVER STORY Helping a shattered athlete dream of competing again

12 Testing a device to save trauma victims

13 The unexpected benefits of medical research trials

15 Seniors confront fear of falling

17 Gift ensures educational legacy

UNT Health Science Center3500 Camp Bowie Blvd. Fort Worth, TX 76107 [email protected] 817.735.5190

facebook.com/unthsc www.unthsc.edu twitter.com/unthsc

Copyright © 2014, All rights reserved

Dr. Christina Robinson, Medical Director of mobile pediatric clinic

UNT HEALTH SCIENCE CENTER

SOLUTIONS

3

02

1. What advice do you provide to women wanting to get pregnant?

Take care of your health before trying to conceive. Women wanting to become pregnant should start with a visit to their nurse-midwife to discuss healthy lifestyle, healthy diet, healthy weight, exercise, and to have a medical assessment to evaluate chronic health conditions.

2. Why should women consider going to a nurse-midwife for their prenatal care?

Nurse-midwives believe every person has a right to complete and accurate information and to self-determination and active participation in health care decisions.

Nurse-midwives honor the normalcy of women’s lifecycle events and believe in consultation, collaboration and referral with other members of the health care team as needed to provide optimal health care.

3. What is one of the most common misconceptions you hear about midwifery services?Today, approximately one quarter of all babies are welcomed by midwives, and this number is on the rise. But some misconceptions still exist. For instance, one myth is that midwives only deliver babies at home. Today, 98 percent of births attended by midwives are in hospitals. Another is that midwives reject medical technology and obstetricians. Most midwives practice in a collaborative relationship with an obstetrician.

what our experts say

Amy Perilman is a Certified Nurse-Midwife at UNT Health Science Center. She practices at UNT Health at Alliance, 12650 N. Beach, Ste. 148. To make an appointment with her, contact 817-735-DOCS (3627).

QUESTIONS

Amy Perilman, Certified Nurse-Midwife


SOLUTIONS

03

A national team of researchers is seeking a way to use nuclear technology for better cancer treatment that

alleviates some

of

the negative side effects for patients.

Anthony J. Di Pasqua, PhD, of UNT Health Science Center is part of a team formed during a national conference organized by the National Academies. It includes top scholars from institutions such as UCLA, Yale and the SUNY College of Nanoscale Science and Engineering.

Along with collaborator Kenneth J. Balkus,

PhD, at UT Dallas, Dr. Di Pasqua, Assistant Professor of Pharmaceutical Sciences, is developing drugs containing radioactive materials, such as nano-materials for targeted chemo-and radiation-therapy.

“These may reduce side effects and allow for the use of less radiation in therapy,” he said.

community briefs

The key to preventing and curing many chronic diseases is not another drug intervention or surgery but a healthy diet.

That’s the lesson being taught to first-year medical students at Texas College of Osteopathic Medicine at UNT Health Science Center in a new course called Culinary Medicine.

The course, which details how eating behavior affects health, fits well into the TCOM curriculum that teaches a whole-person approach to health care. In addition to online

instruction, the trial course will include four three-hour hands-on cooking sessions.

“If we can teach our patients how to eat healthy before the onset of disease such as diabetes, we will be able to reduce the number of patients diagnosed with most preventable diseases,” said class participant Jennifer Brekke, TCOM ‘17.

Nuclear technologyaids cancer treatment

To be well, you have to eat well

It takes energy to make energyExercising three times a week for

30 minutes a day can have an

enormous effect on men’s health.

It can help you lose weight,

bring down your blood pressure

and improve your cholesterol.

All of these can benefit your

overall health, including

decreasing risk for heart attack,

stroke, diabetes and increasing

your stamina and energy level.

“You’ve heard of the old adage

that ‘it takes money to make

money.’ Well, I add that ‘it takes

energy to make energy,’” said

Jaremy James, DO, Assistant

Professor of Internal Medicine at

UNT Health Science Center. “In

doing this, your overall health will

improve, and you will lessen your

risk of future health problems.”

Health tip

Dr. Jaremy James


SOLUTIONS

04

As a paramedic, Joe Godwin always was relieved when he was called to an emergency and spotted a Vial of Life decal on the home’s front window.

It meant that even if the resident was unconscious, he would be able to easily find medical information about the person.

Today, geriatric patients at UNT Health Science Center are benefiting from the same Vial for Life program. Godwin, a medical student at UNT Health Science Center’s Texas College of Osteopathic Medicine, led a volunteer effort to bring the free program to campus.

The concept is simple: An over-sized medicine bottle stuffed with information about the person’s medical history, medications and allergies is kept in the refrigerator. A decal on the front door or window tells responders where to look for the vial.

community briefs

Patrick Clay, PharmD and Professor of Pharmacotherapy at UNT Health Science Center, will lead a national team of researchers trying to improve outcomes for HIV patients by studying communication patterns between their primary care physicians and pharmacists.

The goal is to identify best practices that will improve care for HIV patients across medical disciplines.

“HIV can now be a life-long, chronically managed condition, but only if the patient is able to tolerate and remain adherent to arguably the most complex

drug regimen ever used in medicine,” Dr. Clay said. “Getting all these pieces to work in harmony requires teamwork that seamlessly transitions patients from first testing positive through achieving undetectable viral loads and stable immune systems.”

He said the hope is that project results will be applicable to other populations that take complicated medication regimens, such as patients with diabetes, asthma and high blood pressure.

When seconds count, Vial of Life provides data fast

Better communication to improve HIV patient outcomes

Health tip

Muscle imbalance causes most low-back painMore than 90 percent of acute episodes of low back pain are

caused by an imbalance of the muscles related to posture

and balance.

How can you resolve low back pain and reduce the likelihood

of recurrent episodes? David Mason, DO, Chairman of Osteo-

pathic Manipulative Medicine at UNT Health Science Center,

offers these ways:

• Osteopathic manipulative treatment

• Physical therapy

• Stretching

• A strengthening exercise program

Dr. David Mason


SOLUTIONS

05

Advancing age, rather than established risk factors such as diabetes and hypertension, appears to be the only consistent predictor for mild cognitive impairment among Mexican American elders, UNT Health Science Center researchers have found.

Previously established risk factors among non-Hispanics may not be applicable for Mexican Americans, said Sid O’Bryant, PhD, Associate Professor of Internal Medicine at UNT Health

Science Center and lead author of the study in Alzheimer’s and Dementia.

“This means the disease may develop in Mexican Americans for different reasons than non-Hispanics,” he said.

Established risk factors such as gender, low education, obesity, diabetes and hypertension have previously been shown to be related to developing mild cognitive impairment, a transitional stage between normal aging and Alzheimer’s disease.

Scoring a 100 is nothing to sneeze at.

That’s the perfect rating handed out recently by Tarrant County Public Health to UNT Health Science Center’s Pediatrics Department in an evaluation of its vaccination-handling procedures. The average score for such audits by Tarrant County is 85 percent.

The county health department provides immunizations to UNT Health through a state-funded program. This program allows doctors, nurse practitioners, physician assistants, and certified nurse-midwives to administer vaccinations to children at a minimum cost to the patient.

community briefs

Mexican Americans and mild cognitive impairment

UNTHSC Pediatrics Department scores

100

Keep exercise playfulPLAY = Productive Living Always Young

The word “exercise” has a negative connotation to many of Dr. Madge Barnes’ patients.

So she doesn’t use it when discussing their health. Instead, she uses the word “PLAY,”

see definition above, which puts a more positive spin on the same process.

“As children, we had play days, so why not as adults?” said Dr. Barnes, MD,

Assistant Professor of Community Medicine at UNT Health Science Center. “Find

an activity that you enjoy and PLAY every day. Don’t worry if you miss a PLAY day;

just start back the next day. Let those ‘feel good’

endorphins kick into higher gear and do an activity

that will make you smile.

Health tip

Dr. Madge Barnes


SOLUTIONS

06

UNT Health is engaged in a national campaign to help control high blood pressure, a condition that affects 1 out of 3 adults in the United States.

UNT Health Science Center’s physician group will be one of more than 100 health organizations and sponsors to take part in the three-year Measure Up/Pressure Down campaign.

The goal of the campaign is to see that 80 percent of high blood pressure

patients have their condition under control by the time the effort ends in 2016.

“Measure Up/Pressure Down hopes that Americans will take part in blood pressure screenings and seek out ways to make lifestyle changes to help prevent/control high blood pressure,” said Frank Filipetto, DO, Chairman of Family Medicine who will lead local efforts.

“The one thing that stands the test of time, the one thing that sustains an organization and its mission, is the value it provides.”

That’s the message delivered by UNT Health Science Center President Michael R. Williams to a group of business leaders.

Dr. Williams, DO,

MD, MBA, told attendees at an on-campus Fort Worth Chamber luncheon that he wants UNTHSC to be “one of the top assets not only in Fort Worth, but in all of Texas.”

“Extraordinary, remarkable value: the kind people talk about, the kind they can’t get enough of. This is the kind of experience by which we will be defined,” he said.

community briefs

Effort aims to control blood pressure

Value that stands the test of timeSteps to stay healthy

as season changes Looking for ways to prevent sickness as the season is changing?

Radhika Vayani, DO, Assistant Professor of Internal Medicine

at UNT Health Science Center, offers this advice:

• Get adequate sleep every night, which is between

7-9 hours for adults.

• Get at least 30 minutes of exercise 3-4 days a week

and drink plenty of water (50-64 ounces daily).

• Take Vitamin C to prevent colds.

Health tip

Dr. Radhika Vayani


SOLUTIONS

07

a physician assistant who still makeshouse calls

SOLUTIONS in the community


SOLUTIONS

08

Twice a month, Vic

Holmes, MPAS, PA-C,

gathers his medical

examination instruments

and makes the 20-mile

drive from Fort Worth

to a two-acre camp for

adults with disabilities

in Mansfield.

As goats, horses and a mule graze outside, Holmes spends four hours inside an examination area with camp attendees, measuring blood pressures, testing glucose and listening to heartbeats. Holmes knows each patient’s name, personality and health ailments.

This may seem like an unusual setting in which to practice medicine, but it allows Holmes, a Physician Assistant Studies instructor and clinician, to fulfill UNT Health Science Center’s mission to provide effective primary care in the community. Autistic and intellectually and developmentally disabled patients can grow upset during visits to unfamiliar clinical settings, making them difficult to treat.

“It’s basically a house call,” Holmes said. “The familiar setting makes it much more comfortable for patients and much easier for me to meet their basic medical needs and keep them healthy.”

Holmes started making the trek to Mansfield about one year ago. The camp, which offers outdoor activities and cooking and fitness lessons, is operated by A-Trinity HCS Services. Some camp attendees live in residential support homes around North Texas. Others live with their families or independently in the community.

Camp administrators converted a room into a sterilized exam area. Holmes usually sees eight to 16 patients during each visit.

UNTHSC physician assistant students who seek experiences with underserved communities occasionally request to visit the camp. An A-Trinity administrator says this arrangement has made a difference in individuals’ lives.

“Instead of having any anxiety about traveling to a clinic, our individuals just walk to the other side of the building,” A-Trinity President Allen Gould said.

in the community

PA Vic Holmes consults with medical assistant Santiago Calderon.


SOLUTIONS

a few days before Thanksgiving, Allan Kell staggered into his living room, his skin pale and sweating, and collapsed into a chair.

“I think I’m dying,” he gasped to his wife, Valerie.

Valerie called 911, but when paramedics arrived, the episode was over. Kell, 72, declined a trip to the emergency room. Already taking blood-thinning medication and with an artificial pacemaker in his chest, he had dealt with heart problems for years.

Two days later, Kell made a routine visit to the UNT Health Coumadin Clinic. He mentioned his experience to Physician Assistant Julia Reynolds. What followed was an example of how UNT Health medical providers use swift interdisciplinary teamwork to deliver extraordinary care — and, in this case, to save Kell’s life.

After listening carefully to Kell, Reynolds marched down the hall to his primary care physician, Howard Lund, MD, who moved Kell to an exam room.

After talking to Kell, Dr. Lund called upstairs to the UNT Health Cardiology Division. It was late afternoon and Abdul Keylani, MD, was reviewing files. He immediately headed downstairs.

Using a device that extracts data from Kell’s pacemaker, Dr. Keylani was able to determine the cause of Kell’s episode: ventricular tachycardia.

“That means his heart was going at a very fast rate — a rate that usually ends in death,” Dr. Keylani said. “It could happen again at any time and, if it did, he could very easily die.”

Dr. Keylani told the Kells, “I’m sorry, but you cannot go home today.”

Kell was sent to Plaza Medical Center at Fort Worth. The next day, Dr. Keylani performed a cardiac catheter procedure on Kell to make sure no arteries were blocked, and an electrophysiologist implanted a cardioverter defibrillator, which will detect and correct ventricular tachycardia when it occurs.

Kell was released at noon on Thanksgiving Day. He and Valerie enjoyed plates of turkey prepared for them by neighbors. Kell said he’s more active and feels better than he has in years.

“I honestly believe that if Julia hadn’t listened to me so well, then hit the ground running and gotten all these other doctors involved, I wouldn’t be alive today,” he said. “They truly saved me.”

09

positive patient outcomes

Teamwork that savedDr. Howard Lund, Allan Kell and PA Julia Reynolds

Dr. Abdul Keylani examines Allan Kell.


SOLUTIONS

10

positive patient outcomes

Teamwork that saved a life

“I think I’m dying,” he gasped to his wife,Valerie.

Dr. Howard Lund, Allan Kell and PA Julia Reynolds


SOLUTIONS

11

Life can change in the blink of an eye. Just ask triathlete Todd Hamilton, who went from riding his bike one moment to being comatose in a hospital ICU the next.

After being hit by a car in the summer of

2012, Hamilton suffered a broken upper

arm, radial nerve damage, neck injuries

and brain damage, which left him in a

coma for two weeks.

Fortunately, Hamilton, 46, recovered

quickly from his brain injury. His broken

right arm was repaired immediately

after his accident, but the athlete was

left with a significant radial nerve injury

that limited function and threatened his

ability ever to compete again.

That’s when Timothy Niacaris, MD,

PhD, an orthopedic surgeon for UNT

Health, the physicians group at UNT

Health Science Center, was called in. A

subsequent surgical procedure restored

function in his right arm.

Hamilton praised Niacaris for his

willingness to listen and to allow his

patient to make informed choices about his

medical care. And he’s grateful that Niacaris

understood the importance to Hamilton of

returning to triathletic competition.

“Dr. Niacaris earned my respect and

appreciation and was always very caring

and compassionate to my family,”

Hamilton said.

Hamilton still is on the road to recovery.

Thanks to Niacaris, he’s able to cycle

again and is optimistic he’ll one day be

back in competition.

To make an appointment with Dr. Niacaris, or any of UNT Health’s bone and joint specialists, call 817-735-2900.

Helping a shattered athlete dream of competing again

SOLUTIONS positive patient outcomes

Timothy Niacaris, MD, PhD, Assistant Professor of Orthopaedic Surgery

Dr. Timothy Niacaris examines the thumb Todd Hamilton feared he would never be able to use again.


SOLUTIONS

12

An easy-to-use device that could keep trauma victims alive until they reach definitive medical care is being tested by UNT Health Science Center researchers.

The impedance threshold device, or ITD, is designed to improve blood flow to the brain and other vital organs following a traumatic injury.

Although the device is being tested as part of the $350,000 grant from the U.S. Department of Defense for applications in battlefield settings, it has obvious civilian uses as well.

The device works by decreasing pressure in the chest with each breath, thus

bringing more blood back to the heart so it can then pump blood to vital organs, said Caroline Rickards, PhD, Assistant Professor of Integrative Physiology.

“We are exploring whether breathing on the ITD improves brain blood flow and oxygenation, which may improve survival from bleeding injuries,” Dr. Rickards said. “Also, some patients have lost so much blood that their veins collapse, and it’s difficult to get an IV line to deliver fluids and medicine.

“This device could potentially be used to open a line, providing access for essential interventions and helping the patient stay alive long enough to get to a hospital.”

To stimulate extreme blood loss, volunteers lie inside a chamber sealed from the waist down.

“A vacuum effectively sucks blood into the lower body, which reduces the volume of blood returning to the heart and the brain,” Dr. Rickards said. “Volunteers are taken to the point just before fainting, indicating blood flow from the brain is reduced.”

Device could save civilian trauma victims,

battlefield casualties

discoveries

Dr. Caroline Rickards and the impedance threshold device


SOLUTIONS

13

Santiago Perez assumed he was fairly healthy when he volunteered for the North Texas Healthy Heart Study, a UNT Health Science Center research project conducted from 2006 to 2009.

The

unexpected benefits of

medical research trials

discoveries

But the free medical examinations and a CT scan he underwent with more than 500 other volunteers led to surprising news: Four of his arteries were clogged, a life-threatening ailment that required the insertion of four stents.

Had he not volunteered for the study, Perez said, “I wouldn’t have known until the day they rushed me to the emergency room.”

Perez was one of 169 participants in the heart study who discovered they had clinically significant medical conditions ranging from leukemia to lung cancer. UNTHSC researchers say Mr. Perez’s case is an example of how participation in research studies can benefit not only medical research, but also one’s personal health. The Health Science Center offers

thousands of research study participation opportunities each year.

An article about the personal benefits recently was accepted for publication by The Journal of the American Board of Family Medicine.

“People who didn’t know they had a serious medical condition were alerted to follow up with their physician,” said Anna Espinoza, MD, senior project coordinator at the UNTHSC Texas Prevention Institute and the article’s first author. “Those conditions otherwise might have gone undetected and untreated.”

The North Texas Primary Care Practice-Based Research Network (NorTex) conducted the North Texas Healthy Heart Study. When tests suggested

Mr. Perez may have clogged arteries, his primary care physician made the diagnosis. A few months later, the stents were inserted.

Today, Perez, 74, said he enjoys playing with his grandchildren and taking walks with his wife. He said he encourages friends to sign up for UNTHSC research studies.

“I am very glad I did,” he said.

For more information about collaborating with NorTex researchers or to participate in a research study, contact Kimberly Fulda, DrPH, at 817-735-0225 or [email protected]


SOLUTIONS

14

discoveries

Had he not volunteered for the study, Perez said, “I wouldn’t have known until the day they rushed me to the emergency room.”

Santiago Perez

Dr. Anna Espinoza


SOLUTIONS

15

One day last summer, 73-year-old retiree Darold Klamt, surveying his well-kept yard, walked backward a few steps so he could take in the whole scene.

Seniors get helpin facingfear offalling

“The next thing I knew, I was face-down in the grass,” said the Benbrook, Texas, grandfather. “I tripped over the garden hose, hit my face on the ground and banged my glasses into my nose.” With only minor cuts and bruises, he added, “I was lucky.”

Indeed he was. “A fall often leads to the nursing home,” said Sarah Ross, MS, DO, Assistant Professor of Internal Medicine at UNT Health Science Center, who uses special criteria to screen patients for

their risk of falling. “Worse, every 29 minutes, an older adult dies from a fall.”

In 2012, the Fort Worth Fire Department recorded 1,321 calls involving falls with injury, about 7.2 percent of all EMS calls. Half were by persons over 60.

With Nicoleta Bugnariu, PT, PhD, Assistant Professor of Physical Therapy; Janice Knebl, DO, Chief of Geriatrics; and the UNTHSC Office of Professional and Continuing Education, Ross developed

in the community

Joel Terjak, left, assists Alfredo Martinez dur-ing a falls prevention class run by UNT Health Science Center physical therapy students at Handley-Meadowbrook Senior Center.


SOLUTIONS

16

guidelines for physicians and health care providers to use in assessing patients’ risk of falling and ways to minimize those risks.

They also collaborate with community organizations to present classes in falls prevention. Klamt and his wife, Patsy, enrolled in a free Matter of Balance course at Harris Southwest hospital, led by UNTHSC health care professionals and students.

“We learned to be more aware of our surroundings, use handrails on stairs and recognize hazards,” said Patsy Klamt, 63.

“They also showed us exercises for your back and for balance,” Darold Klamt said. “They’re simple exercises, and you don’t need equipment. You can do them sitting or standing.”

For more than six months since finishing the class, the Klamts have been fall-free, even during the December storm that coated the city with ice.

in the community

Record the time it takes to:1. Rise from a hard-backed chair with arms 2. Walk 10 feet3. Turn4. Return to the chair5. Sit down

Most older people can complete in 10 seconds.

14 seconds or more indicates an increased falls risk.

More than 20 seconds indicates the need for a comprehensive medical evaluation.

How to get help • The Centers for Disease Control provides a home falls prevention checklist at www.cdc.gov/features/olderamericans; or call 800-CDC-INFO (800-232-4636) to request brochures.

• Find A Matter of Balance class at the website of Senior Citizen Services of Tarrant County, www.scstc.org. Click on “Wellness Programs.” Or call 817-413-4949, ext. 214.

• To contact a UNTHSC health care provider, call 817-735-DOCS (3627).

What’s your risk of falling? Ask your physician about the Timed Up and Go Test

Faye Giddings practices stepping over an obstacle during a falls prevention class at the Handley-Meadowbrook center.


SOLUTIONS

!17

Between them, Drs. Alan and Marianne Levine spent 38 years turning medical students into new generations of pediatricians.

The married faculty members loved seeing young men and women, initially anxious about treating a child, grow into talented and caring doctors.

Marianne retired in 2009; Alan died in 2012 after a long illness. But through a generous planned gift to UNT Health Science Center, the Levines ensured that their legacy of education will impact students for years to come.

Before Alan died, the Levines turned an old, unneeded life insurance policy in Alan’s name into a planned gift to UNT Health Science Center, essentially making the institution the beneficiary. The gift created the Drs. Alan and Marianne Levine Scholarship and supported a philanthropic fund with the flexibility to meet the institution’s greatest needs.

“The Health Science Center was such a big part of our lives, and Alan wanted to leave a legacy,” Marianne said. “To him, education and interacting with the

students was so important. The school gave him the opportunity to experience that.”

Alan taught pediatrics for 28 years before he retired in 2006. Marianne, a 1985 UNTHSC graduate, taught there from 1999 to 2009.

While teaching, the Levines worked in adjacent offices in the Pediatrics Department. Yet they each kept a photo of the other on their desk.

“We took some ribbing for that,” Marianne said, laughing. “People would say, ‘He’s right next door. Do you really need a picture?’”

Mandy Dix, Alan’s youngest daughter and Marianne’s stepdaughter, said she hoped to personally present the scholarship in her father’s name to a deserving student.

“He loved every moment he spent teaching,” Dix said. “He would be so happy to help a student again.”

Gift ensures educational legacy will continue

giving and contributions

Did you know it is possible to make charitable gifts with assets other than cash?

Check out our new planned giving website at unthsc.edu/pg to learn the many ways you may be able to make a significant contribution to your favorite school or program at UNT Health Science Center with assets other than cash.

Drs. Marianne and Alan Levine

Solutions for a healthier community.

UNT Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX [email protected] 817.735.5190 www.unthsc.org

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Center for Biomedical Health

solutions magazine - march 2014

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