Remembering Alan R. Dimick, MD

February 1, 2021 // Randy Glick

Written by Vicki Baugh
Southern Region Burn Conference Program Manager Emeritus

On behalf of the Southern Medical Association (SMA), I would like to acknowledge and honor my friend and colleague, Alan R. Dimick, MD.  

The wind was knocked out of me, when I learned he would not be here any longer to champion the Southern Region, to teach and influence, or to send his daily email jokes.  He inspired all of us, regardless of one’s level of training or background. 

I had the honor of working with Dr. Dimick for the past 25 years.  To know him was to rub shoulders with one of the great minds of our time.  He was a pioneer of team care long before burn units adopted the concept….not to mention the creation of the UAB Burn Center, American Burn Association, improved burn care outcomes, trauma, and the EMS world

His compassion and dedication to burn care led to the creation of the Southern Region Burn Conference.  In 1987, Dr. Dimick along with Dr. Bill Hickerson and a group of southeastern burn center directors decided to have an annual regional burn conference that would provide educational programs for all members of their burn teams, as well as further disaster planning. Dr. Dimick was a lifetime member of SMA and asked SMA to partner with the group to manage all aspects of their vision. I was the fortunate one to be asked to manage this meeting and worked with Dr. Dimick to make this the largest burn care meeting in the country following the American Burn Association’s national meeting.  My professional success is due in large part to him and his tireless commitment to the Southern Region group and burn care across the continuum of healthcare.  His legacy is immense.

Ida Martha (his wife) planned a birthday party for him at The Club in Birmingham.  I attended not knowing he had prepared a speech acknowledging those of us that were instrumental in helping him further his dreams.  He always gave credit where credit was due.  

He will be missed, but certainly never forgotten.

Read UAB full tribute to Dr. Dimick.

Welcome Elizabeth Schaffer to the SMA/SMAS family!

January 26, 2021 // Randy Glick

At SMA, we talk a lot about how important our members are to us… because you are. We talk a lot about how we’ll always be there to pick up the phone for you… because we will. When we say that we’re a family of medicine, we mean it.

That’s why it was important to us that we find the perfect person to bring on board as our new Member Relationship Manager. We wanted to find someone who knows what family is all about; someone who’s willing to put in the effort to know you, and accept you, as an individual with unique needs; someone who knows what it is to really care.

We’re excited to tell you that we’ve found that person.

Please join us in welcoming Elizabeth Schaffer as SMA’s Member Relationship Manager.

A New Orleans native, Elizabeth is uniquely equipped to help you navigate the products and services available to our members. She’s a licensed life and health insurance agent with more than two decades of experience working in employee benefits.

More importantly, she knows what it is to be responsive to the needs of our members. Maybe it’s her years of experience in the insurance industry; maybe it’s the nurturing qualities she developed as a wife, mother, and grandmother; or maybe it’s just who she is. It’s as important to her as it is to us that everyone feels cared for — that no one falls through the cracks.

Please feel free to call her at with any questions (800) 423-4992 ext. 109, or email her at eschaffer@sma.org. We appreciate all you do for SMA; and we’re confident that you’ll appreciate what Elizabeth can do for you.

SMJ : January 2021 Vol. 114, No. 01

January 12, 2021 // Randy Glick

The Southern Medical Journal(SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Physician Well-Being and Medical Ethics

Ramin Walter Parsa-Parsi, MD, MPH

Opioid Education in Obstetrics and Gynecology Training Programs

Alexis A. Dieter, MD, Marcella Willis-Gray, MD, Erin T. Carey, MD, MSCR

Examining Pediatric Residency Voting Practices

Cassi Smola, MD, Nipam Shah, MBBS, MPH, Kathy Monroe, MD

Using a Hybrid Lecture and Small-Group Standardized Patient Case to Teach the Inclusive Sexual History and Transgender Patient Care

Sarah E. Stumbar, MD, MPH, Nana Aisha Garba, MD, PhD, Maria Stevens, MD, Elizabeth Gray, MD, Emiri Uchimaya, MD, Prasad Bhoite, MPH

CME Article: Historical Alternans in the Emergency Department (H.A.t.E.D.) for Pain: An Analysis of Patient Pain Descriptors to Attending and Trainee Clinicians

Brandon M. Carius, DSc, MPAS, PA-C, Michael D. April, MD, PhD, Craig S. Pedersen, MD, Steve G. Schauer, DO, MS

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Twins Compared with Singletons

Alexander Sabre, MD, Giovanni Sisti, MD, Kecia Gaither, MD, MPH

Early Initiation of Combination Feeding among Latina Mothers in the Deep South: Perspectives for Clinicians

Jennifer Mandelbaum, MPH, Anna Mesa, MSPH, Maryam Alhabas, MSPH, Christine E. Blake, PhD, RD

Do Geographic Region, Pathologic Chronicity, and Hospital Affiliation Affect Access to Care Among Medicaid- and Privately Insured Foot and Ankle Surgery Patients?

Charles Pitts, MD, Haley McKissack, MD, Bradley Alexander, BS, Mohit Jain, MD, Jun Kit He, MD, Aaradhana Jha, MD, Amit Momaya, MD, Ashish Shah, MD

Patients Desire Personalized, Specific, and Continuous Advice on Weight Management

Elizabeth R. Pfoh, PhD, MPH, Russell Flench, MDes, N. Homa Varghai, MD, Michelle King, , Leslie J. Heinberg, PhD

Efficacy and Safety of Nonvitamin K Oral Anticoagulants following Cardiac Valve Replacement

Mary K. Stuart, PharmD, BCPS, Sarah B. Blackwell, PharmD, BCCCP, Hillary B. Holder, PharmD, BCPS, Elizabeth L. Wood, PharmD, Jessica A. Starr, PharmD, BCPS

Additional Resources

Posted in: Business

How to Help Your Senior Loved One Transition into Assisted Living

November 5, 2020 // Randy Glick

Photo via Rawpixel

Moving a senior loved one into an assisted living facility can be challenging, no matter how prepared you think you are for the process. This is a major transition for both seniors and close family members like you. Family caregivers face all kinds of emotional and logistical barriers as they try to make the best possible decision for their senior loved ones. As you approach this complicated move, consider the following tips to make the process a little easier.

Recognize Behavioral Signs

Certain behavioral signs may indicate that a move into assisted living would be beneficial for your senior loved one. According to Nation, some serious red flags to watch out for include recent accidents in the home, slow recovery from illnesses, and rapidly declining medical conditions. Some more subtle signs may include changes in weight, increasing physical weakness, neglect to personal hygiene, and isolation. If you notice these indicators, it may be time to start talking about assisted living.

Get Your Loved One Involved 

Moving into assisted living can be very upsetting for seniors, especially when they aren’t included in the decisions being made. So, make sure to get your loved one involved and keep them up to date on everything that is going on.

Choosing an assisted living community together is important for finding a good fit. Your loved one may have specific desires or requirements that you’re not aware of, so listen to their opinions and concerns with an open mind. Research facilities to find a few that offer the kinds of features and amenities that your loved one is looking for, and take some time to visit them together in person. AARP recommends encouraging your loved one to talk to staff, administrators, and residents when you visit so they can get a sense of what the assisted living facility is like. With the average cost of assisted living at $4,000 a month, you’ll need to consider your or your loved one’s budget as well. A long-term care insurance policy will likely help cover the cost of assisted living, but you may still have to pay some out of pocket. 

Be Gentle and Respectful

Being sensitive with your senior loved one is essential for having productive, solution-oriented conversations about assisted living. Guideposts.com recommends picking your time and place carefully, avoiding noisy locations where your loved one may have a hard time hearing you or focusing on the conversation. Try to ask open-ended questions that prompt insightful answers. Be patient and listen to everything your loved one has to say, ensuring that they feel heard. While it’s perfectly normal to feel emotional during these discussions, try not to use emotionally loaded statements that will make your loved one feel guilty for causing worry.

 Pay Attention to Your Own Feelings

Remember, moving a loved one into assisted living can be tough on you too. Pay attention to signs that you’re facing caregiver burnout, like declining mental or physical health and feelings of increasing irritation or anger over things that didn’t use to bother you. These signs may indicate that moving your loved one into assisted living is important for your own health and wellbeing as well. Caregivers can also benefit from the support of counselors or therapists. An expert can give you advice and tools to help you cope with the challenges you’ll face.

 Find Support to Ease the Transition 

Your senior loved one may also benefit from professional support as they make the move into assisted living. You can ease the transition by being involved in their move and helping them set up their new living area with familiar décor and furnishings. Visit frequently, and talk to the staff about your loved one’s preferences. You can also encourage them to participate in available activities and ask for their opinion on the kind of care they’re receiving. If your loved one is having a hard time accepting the change or struggling to feel at home in their new surroundings, encourage them to talk with a therapist

While transitioning a senior loved one into an assisted living community can have an emotional toll on all involved, it may be the best decision for your family. Your loved one will get the assistance they need while maintaining as much independence as possible. At the same time, you will finally get some peace of mind knowing your loved one is getting the level of care they deserve.

About the Author

Lydia Chan is the co-creator of Alzheimers.net, a website that aims to provide tips and resources to help caregivers. After her mom was diagnosed with Alzheimer's, she found herself struggling with finding balance between the responsibilities of caregiving and her own life. She is passionate about sharing her knowledge and experiences with caregivers and seniors.

Posted in: Patient Education

The Year of “C”

November 5, 2020 // Randy Glick

2020 has been the year of “C” - challenging, chaotic, concerning and of course, COVID. Day to day life has changed greatly on multiple fronts. Unfortunately, there is no road map as one navigates; no history or experience to guide us on this path. Experts have differing opinions on how to traverse the challenges. As stated by many, the real answer to what’s next is no one knows. 

Yet in medicine, the more things change, the more things stay the same. Medicine is indeed essential. Patients are still in need of doctors and arguably more now than ever. As COVID research continues, testing becomes more readily available and the advent of a vaccination approaches, the need for primary care and specialty care for patients is still of great importance. With no definite answer, the challenge of navigating how to provide best of class care is ever present.

Telemedicine

One path that is being traveled more is telemedicine. Although telemedicine has been around for years, approximately one percent of practitioners have utilized this option of care. With the recent lift of restrictions and regulations, this path of providing care has evolved. Physicians and practitioners initially hesitant of the effectiveness of care and the financial uncertainty of telemedicine have now tested the care by fire. Although clinical outcomes are premature, the benefits of virtual care look good. Telemedicine saves money by decreasing overhead, offers  more flexibility for both patients and providers due to care being available during nontraditional work hours, doctors are now checking in patients which refines triage, and very importantly, care is offered in more rural areas that may not have had access to care otherwise. Additionally, there is a trend noted that younger patients are reaching out and wanting to be connected, not having any issue with “Zoom” care, especially technically speaking.  Once predicated as one patient at a time, a physician now can be in a hundred places in a day, seeing patients from his/her office. "I think the genie's out of the bottle on this one," Seema Verma, the CMS administrator, said. "I think it's fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there's absolutely no going back."

Telemedicine is one argument that supports the thought that patients will frequent physician offices less and less, leading to the need of smaller office space. As with all industry, the effects of COVID in the medical real estate market is uncertain. In addition to fewer visits to a physical office, there is the argument that COVID has proven that some of our support staff can perform job tasks remotely. Realizing that total square footage is the most expensive factor of an office space, the need for efficient design and flow is of great importance, even more so in today’s climate. Therefore, a first thought may be that the need for square footage would decrease.

Argument to Consider

Of course, telemedicine will not take the place of all health care. There are multiple situations and specialties that will continue to dictate face to face care for physicians and patients. Additionally, there are many patients who desire to see his/her practitioner in person, requesting to continue the relationship with a healthcare team to remain as it has been. The demand for medical office space continues to be a reality in the commercial real estate market, however the plans to accommodate such space may look different than what is now considered a traditional medical office. 

The challenge with decreasing clinical space is greater than simply a decrease of patient numbers. The challenge is to access and redefine the needs of “today’s care”. This assessment may include an interior change of an office or utilizing present square footage and space differently. With the need and adapting of social distancing, there may be additional space needed for waiting rooms or areas that are used for monitoring post injections, infusions or treatments. In addition to considering patient flow, there is a concern focusing on safe work areas for employees. Those working within the office will need additional space or change of space in order to maintain a safe working environment.

Other thoughts of change for office space may include the need for updated technology such as touchless entry and upgrades in ventilation and HVAC systems. Marketing what makes a clinic COVID friendly could be important to the consumerism of medicine. Innovation in how medicine is delivered is crucial.

Future Possibilities

As practices have faced the turbulence of COVID, another trend may include the change in the structure of practices. Some practices are entertaining the idea of merging together to share overhead costs and in turn, offset certain financial challenges. Independent groups are considering private equity mergers and becoming part of a mega group. With reimbursement changes, practices are realizing changes in coverage of procedures typically being done as inpatient care moving to the outpatient setting. The desire for elective procedures has not been affected by consumer spending as initially feared. These considerations may encourage incorporating ambulatory surgery and/or procedure rooms to clinical space. Regardless of the practice structure, any change encourages and arguably dictates a practice to rethink the efficiency and effectiveness of the medical office.

Again, there are no concrete answers or road maps as the new norm is navigated. The challenge, chaos and concern of COVID has definitely introduced fear and uncertainty. Yet, one positive of COVID may be the assessment of how medicine is delivered, challenging the profession to look at new and innovative ways to provide excellent care. The proverb “necessity is the mother of all inventions” will continue to add insight to the Modern Oath inspired by Hippocrates: “I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow”.

About the Author

Nancy Ferren, RN, BSN is a Medical Real Estate advisor, combining experience in Nursing, Medical Sales and Real Estate. Nancy works with Veritas whose mission is to provide exceptional real estate advisor services to physicians and medical groups based on the core principles of Truth, Integrity and Hard Work. Veritas is located in Birmingham, Alabama, serving clients throughout the Southeast.

Posted in: Business

SMJ : November 2020 Vol. 113, No. 11

November 4, 2020 // Randy Glick

The Southern Medical Journal(SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Evidence for Cancer Literacy Knowledge Retention among Kentucky Middle and High School Students after a Brief Educational Intervention

Lauren Hudson, , Chris Prichard, BS, L. Todd Weiss, BS, MSPH, Nathan L. Vanderford, PhD, MBA

Gynecological Care and Contraception Considerations in Women with Cerebral Palsy

Madeline Fasen, DO, Brittany Saldivar, Suhane Elamsenthi, Jordan Thompson, Lina Fouad, MD, Linda Edwards, MD, Rafik Jacob, MD

Less Toxic Chemotherapy in Locally Advanced Breast Cancer

John Carpenter, MD, Andres Forero, MD, Carla I. Falkson, MD, Lisle M. Nabell, MD, Jennifer F. De Los Santos, MD, Helen Krontiras, MD, Kirby I. Bland, MD, Yufeng Li, PhD, Sejong Bae, PhD

Factors Affecting Patient Adherence to Lung Cancer Screening

Christina Bellinger, MD, Kristie Foley, PhD, Frank Genese, MD, Aaron Lampkin, DO, Stephen Kuperberg, MD

Impact of Obesity in Hospitalized Patients with Heart Failure: A Nationwide Cohort Study

Rama Dilip Gajulapalli, MD, Amer Kadri, MD, Mohamed Gad, MD, Johnny Chahine, MD, Leen Nusairat, MD, Florian Rader, MD

Cognitive Tests and Stool Frequency at Hospital Discharge Do Not Predict Outcomes in Hepatic Encephalopathy

Patricia P. Bloom, MD, Samuel J. Miller, MD, Rahul K. Nayak, MD, Muhammad Sarib Hussain, BA, Ashwini Arvind, MBBS, Camden Bay, PhD, Raymond T. Chung, MD

Evolving Approaches to Antithrombotics in Stroke Prevention and Treatment

Vijayakumar Javalkar, MD, MCh, Okkes Kuybu, MD, Abdallah Amireh, MD, Roger E. Kelley, MD

Outcomes of Clostridioides difficile in Patients with Vitamin D Deficiency: A Propensity-Matched National Inpatient Sample Analysis

Vijay Gayam, MD, FACP, Amrendra Kumar Mandal, MD, Chobufo Muchi Ditah, MD, Jasdeep Sidhu, MD, Venu Madhav Konala, MD, Sreedhar Adapa, MD, Srikanth Naramala, MD, Pavani Garlapati, MD

OPEN: Immune Checkpoint Inhibitor-Related Pulmonary Toxicity: Focus on Nivolumab

Hazim Bukamur, MD, Heather Katz, DO, Mohamed Alsharedi, MD, Akram Alkrekshi, MD, PgDip, MRCP(UK), Yousef R. Shweihat, MD, Nancy J. Munn, MD

Posted in: SMJ

Opinion Piece: Disparities Teaching in Medical Education

November 2, 2020 // Randy Glick

Should medical school curriculums educate medical students about the disparities that plague the American healthcare system, and play a large part in driving negative healthcare outcomes, especially in disadvantaged communities? This is a question I have been pondering, especially since I started my curriculum at Alabama College of Osteopathic Medicine (ACOM) in the fall of 2019. Academically, I come from a liberal arts background, and when I started medical school I didn’t truly know what I was getting myself into. I was still a little surprised when I realized there was minimal coverage of social issues within the curriculum, even given the massive impacts they have on patient outcomes. In my second semester I met with the president of the student body, the dean of my college and a faculty member to try to understand why issues like nutrition, healthcare access (or a lack thereof), and racism in medicine were largely left out of the curriculum, but I never felt fully satisfied with the responses I got.

Whether we are talking about access to healthcare or differences in treatment based on some superficial characteristic if clinical outcomes are being meaningfully impacted, shouldn’t part of medical college curriculums be dedicated to making medical students aware? I think it might be easy to write off these issues as marginal, but the reality is patients are delaying their own needed care leading to worse clinical outcomes due to healthcare access and affordability. That is an ethical quandary for physicians. How can I, as a healthcare provider, in one breath encourage my patients not to smoke and to exercise more, and in the next deny needed care because a patient cannot afford their insurance premium? Along the same lines, how can medical curriculums leave residents and doctors wholly unprepared for that reality when they enter practice? Given the well-settled premise that our core obligation as healthcare providers is to do no harm, is there not harm in this? Isn’t harm through inaction still harm?

There is an enormous amount to learn in medical school, but I think that understanding the social context of medicine is just as critical as understanding the principal biological change in COPD is proliferation of goblet cells. I think many people know that medical outcomes are different across class and race in the U.S. but I’m not sure many people know how stark they are. Black American mothers are three to four times as likely to die in childbirth, and their children are twice as likely to die compared with white babies. I believe the reasons go back to issues of healthcare access, comorbid conditions preceding the birth process, as well as racism, mostly the structural kind. These are concrete realities in America, and I cannot imagine a more important group to inform about these realities than medical students, if society wants these outcomes to be improved and ultimately eliminated.

These issues became especially poignant for me, as it did in some form for much of America, during the spring of 2020 when Black Lives Matter was again thrust into the middle of the national dialog in the wake of the killing of George Floyd. My college like many other institutions across America made a statement expressing sadness and support for the members of the student body who have faced discrimination for any reason. That was an important act, especially given the fact that my school is located in Alabama, a state with an outsized position in the history of American Civil Rights. Coming out of that period my school added an Unconscious Bias in Medicine online module, and started a diversity committee. There were other changes to the curriculum that will be added to subsequent years' coursework, but I am left with the feeling that medical schools can and should do more. Medical professionals should be experts on many aspects of what causes our patients to be unwell, both biological and social. Many of my peers who come out of a pure hard science background simply have not had the opportunity to study the social drivers of health, and if they don’t learn in medical school what other opportunity will they have? 

With these thoughts in mind, I thought of a project and I’m looking for co-conspirators. I’m interested in connecting with organizations working on these issues (if they exist?) and assembling a task force associated with interested individuals to brainstorm solutions to this education gap in medical schools. My thought was we will meet once per month to discuss developing a curriculum, or other strategies to address these issues, such as gathering best practices from various medical schools and associations. Bottom line, if you think there is an issue here, and you’ve got ideas, enthusiasm or experience let’s get together and brainstorm! My email is rrhalas1@gmail.com.

About the Author

Ryan Halas
OMS II
Alabama College of Osteopathic Medicine
rrhalas1@gmail.com

 

COVID’s effects on cancer care in the UK and US

October 23, 2020 // Randy Glick

The COVID-19 pandemic is creating a significant shift in the delivery of healthcare services, as providers have prepared for a large surge in severely ill patients. 

Unprecedented steps are being taken to ensure that services do not become overwhelmed. These measures taken include the cancelling of planned operations and a reduction in the number of face-to-face consultations.

The extent to which non-COVID care has been disrupted, and the impact of this shutdown over the longer term is being investigated by teams around the world.

In the UK, the COVID-19 outbreak had a huge impact on National Health Service (NHS) provision. During lockdown, most NHS outpatient clinics were closed while hospitals worked to deal with thousands of patients infected with COVID. The impact is expected to be greatest among individuals with chronic diseases. 

The extensive shift in the package of care provided by the NHS, combined with fewer patients seeking care during lockdown, meant that there was a significant drop in elective procedures, urgent cancer referrals, first cancer treatments and outpatient appointments.

The NHS is now facing a large backlog of non-COVID care, potentially storing up greater problems for the future. 

A recent report by the British Medical Association states, “Millions of patients living with health problems (including life-threatening conditions such as cancer) have been affected, with their treatment postponed or cancelled. And millions of patients will have missed vital opportunities to receive initial assessment and diagnosis for health problems in the first place.”

Regarding cancer specifically, it says, ”There has been a significant drop in elective procedures, urgent cancer referrals, first cancer treatments and outpatient appointments.”

They estimate that in April, May and June 2020 there were about 280,000 fewer urgent cancer referrals by General Practitioners than expected. “This is due to a combination of patients not presenting and GPs having difficulty referring those who do; many of these untreated and undetected cancers’ prognoses will worsen over time and require more urgent treatment,” they write.

They also estimate that 23,000 fewer patients started first cancer treatments following a decision to treat, and 13,500 fewer patients starting first cancer treatments following an urgent GP referral.

“The development of cancers can be highly time-dependent and delays in treatment are very taxing for patients,” the report states. “It is extremely worrying considering cancer services were supposed to be un-impacted during the pandemic.”

On a more positive note, the crisis has produced great steps forward in a range of innovative technology to improve cancer care and treatment.

Scientists are currently working on an effective and rapid diagnostic point-of-care antibody test for cancer patients, highlighting those with COVID immunity and enabling the safe restarting of cancer treatments. 

Researchers are also investigating whether a blood test can be used to support prompt cancer diagnosis and treatment. The test provides information that cannot currently be gained from invasive procedures such as endoscopy, many of which have been cancelled.

A separate team of researchers are trialing the use of artificial intelligence to help analyze scans from cancer patients, providing clinicians with data quickly to help inform treatment decisions and improve outcomes for patients. They aim to identify whether lung changes in cancer patients are due to COVID-19, caused by another infection, or are side-effects from cancer treatment. 

A further study is looking at the interactions between cancer patient’s immunity, COVID-19, and cancer treatment. This will allow analysis of the virus behaviour and its impact on cancer patients and their treatments, and identify ways to better protect cancer patients. Another group are focussed on studying the impact of radical changes made during the pandemic to radiotherapy treatment, such as shorter, more intense treatment, delaying or even omitting radiotherapy. Researchers want to understand how these changes have impacted patient outcomes and can inform clinical decisions in the future.  

Professor David Cunningham of the Institute of Cancer Research, London, UK, says these studies will provide an immediate wave of information about COVID-19. He said, “Teams have been working at pace to establish studies with a focus on immediate impact through to longer term understanding of this novel virus. We hope this research will have a national and international impact.” 

Chief executive of the NUS, Sir Simon Stevens, added, “Since the first case of COVID in England six months ago, NHS staff have fast tracked new, innovative ways of working so that other services, including Accident & Emergency, cancer and maternity could continue safely for patients and it is thanks to these incredible efforts that 65,000 people could start treatment for cancer during the pandemic.

“We are now adopting new treatment options which are not only effective but safer for use during the COVID-19 pandemic and more convenient for thousands of patients, who can take medication at home or be given medicines with less harmful effects on their immune system.”

In the US, cancer care has also been limited, and provided in different ways, due to the epidemic. Numbers of new consultations have fallen and hospitals are moving as many appointments as possible online. Ongoing travel restrictions and fear of infection are also likely to play a part in the number of would-be patients not setting up appointments or attending cancer screenings.

A physician from New Jersey, Sharyn Lewin MD FACS, of Teaneck, Bergen County, NJ, explains, “The hospital I work in was hit very hard very early by COVID. It’s definitely changed dramatically how we take care of our cancer patients. Very quickly we realized the importance of telemedicine to really help decrease foot traffic into the hospital. So for example, a lot of patients that have routine surveillance visits, we are performing that via telemedicine.”

She added, “Currently we are still seeing our patients on chemotherapy. Some of the patients though that are older, in their 80s or 90s, or have other risk factors who are pretty much asymptomatic for their cancer, we’re talking to them about the risks and benefits of treatment, and to be honest most of them are having a chemo holiday now during the pandemic and will hopefully be able to be re-treated once it’s a little safer in the near future.”

Her team also had to postpone their surgeries, she explains. “We’re starting to do cancer cases sparingly, so we’ve had to employ other modalities to treat patients’ cancers, for example chemotherapy or radiation first, or hormonal therapy. So we’ve had to really look at the data and have a lot of interdisciplinary meetings about how to handle these patients.”

However, Dr Lewin highlighted one adaptation that could continue to improve the quality of cancer care over the long term. “One thing that’s been very helpful is we have had a lot of national webinars so that we can talk to our colleagues around the country and try to get a consensus on how to manage these patients,” she said.

A TIME magazine report in late August suggests that, during the March and April lockdown, the pandemic led to a roughly 80% drop in routine screening appointments that could identify new cancers. While rates have recovered somewhat, hundreds of thousands of missed exams nationally are expected to lead to the loss of many potential early diagnoses and interventions.

One estimate suggests that the number of weekly diagnoses for breast, colorectal, lung, pancreatic, gastric and esophageal cancers dropped by about half during the early months of the pandemic. Most cancer screenings simply are not possible virtually, as they require an in-person procedure such as colonoscopy, mammogram or a pap smear.

Disruptions have also been experienced by patients diagnosed prior to the pandemic, with difficult decisions being made to balance the risk of COVID-19 infection against the urgency of cancer treatment. 

The National Cancer Institute, part of the US National Institutes of Health, has attempted to estimate the number of excess cancer deaths over the next 10 years due to pandemic-related delays in screenings and care. They put the figure at around 10,000 excess deaths from breast and colorectal cancer alone, though most say it is too soon to tell for sure.

For now, most hospitals and physicians are encouraging patients to attend for routine care, alongside safety protocols including limits on visitors, no waiting rooms, and routine COVID-19 testing for staff and some patients. Telemedicine continues to be encouraged whenever possible for cancer patients with risk factors and comorbidities.

Researchers across the two countries are calling for urgent steps to address the consequences of delayed cancer diagnoses and treatment, all encouraging the wider use of robust digital technology to strengthen clinical telehealth services across cancer specialties.

About the Author

Jane Collingwood is a medical journalist with 17 years experience reporting on all areas of medical research for online and print publications. Jane has also worked on a range of medical studies funded by the UK National Health Service within the University of Bristol in the South West of England. Jane has an academic background in psychology and has authored books on stress management and respiratory infections. Currently she is combining journalism with a national coordinating role on the UK's largest surgical research trial.

Immediate Past President: Christopher R. Morris, MD

October 19, 2020 // Randy Glick

Christopher R. Morris, MD, a board certified rheumatologist with more than 25 years’ experience, is in private practice in Kingsport, Tennessee at Arthritis Associates. Additionally, he has served as a clinical educator for internal medicine residents at East Tennessee State University in Johnson City, Norton Community Hospital in Norton, Virginia, and Johnston Memorial Hospital, in Abingdon, Virginia.

A native of Springfield, Illinois, Dr. Morris received his undergraduate degree from Tulane University in New Orleans, Louisiana, and received his medical degree from the Universidad Autonoma de Guadalajara, Guadalajara, Jalisco, Mexico. He completed his Internship and Residency at the University of Tennessee Medical Center in Knoxville, and he performed rheumatology fellowships at the Bowman Gray School of Medicine, Winston-Salem, NC, and at the Medical College of Georgia in Augusta.

Dr. Morris is an active member of the Southern Medical Association (SMA) and he previously served as an SMA Councilor for the state of Tennessee, as well as a member of several of the Association's Education Design Groups. Additionally, Dr. Morris has served on 5 Committees for the American College of Rheumatology, currently serving on the Insurance Subcommittee of the ACR, which advocates for the specialty of Rheumatology, as well as-for the patients with arthritic diseases.

Dr. Morris is married to Jane and together they have 2 children, Christopher Jr, and Amanda.

Announcing the Winners of the Digital Poster Abstract Competition

October 12, 2020 // Randy Glick

Congratulations to all of our winners from the 2020 Southern Regional Assembly!

Click each button in each section to watch each abstract being presented.

The winners of Session 1A are:

1st Place - Wesley  Field, MD, Internal Medicine Resident PGY2, Department of medicine, Northeast Georgia Medical Center, Gainesville, GA - Abstract Title: “Pain in the Back: A Case Report of Pulmonary Sarcomatoid Carcinoma”

2nd Place - David Vo, BA, Medical Student MS4, Department of Medicine, Tulane University, New Orleans, LA - Abstract Title: “An Uncommon Bacteria Causing Septic Arthritis: Streptococcus Agalactiae”

3rd Place - Laura Kay Hanson, DO, Emergency Medicine Resident PGY1, Department of Emergency Medicine, Magnolia Regional Health Center, Corinth, MS - Abstract Title: “Euglycemic Diabetic Ketoacidosis”

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The winners of Session 1B are:

1st Place - Jeremy Mark Hess, DO, Internal Medicine Resident PGY-2, Department of Medicine, New Hanover Regional Medical Center, Wilmington, NC - Abstract Title, “Hepatitis C Screening Disparities in America's Opioid Capital: What Do We Have to Learn?”

2nd Place - Isabella Dreyfuss, BS, Medical Student, Department of Osteopathic Medicine, Nova Southeastern University, Davie, FL - Abstract Title, “COVID-Toes: The Clinical Correlation between Chilblains and SARS-CoV-2”

3rd Place - Toria Rose Gargano, BS Biology, OMS-IV, Doctor of Osteopathic Medicine (D.O.) Candidate, Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Davie, Florida - Abstract Title, “A Case Study of Aberrant Thenar Motor Branch of the Median Nerve Discovered During Carpal Tunnel Release ”

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The winners of Session 2A are:

1st Place - Nayab  Ahmed, MBBS, Internal Medicine Resident PGY2, Graduate Medical Education, Department of Medicine, Northeast Georgia Medical Center, Gainesville, GA - Abstract Title, “Double Trouble: Pulmonary Venous Thrombosis in the setting of Factor V Leiden Mutation”

2nd Place - Adithi  Vemuri, MS, OMS-III, Department of Osteopathic Principles and Practice, Nova Southeastern University, Davie, Florida - Abstract Title, “The Effect of Osteopathic Manipulative Treatment on Lower Limb Muscle Rigidity in a Parkinson’s Patient”

3rd Place - Aksiniya Krasteva Stevasarova, MD, Internal Medicine Resident PGY2, Department of Medicine, Division of Internal Medicine, North Alabama Medical Center, Florence, Alabama - Abstract Title, “Apical Takotsubo Cardiomyopathy in Young Female with Bipolar Disorder – A Rare Case Report”

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The winners of Session 2B are:

1st Place - Jeremy Morgan Watson, BS, MMS, Medical Student Research Assistant, Department of Otolaryngology, Head & Neck Cancer Surgery, LSU Health Sciences Center - Shreveport, Shreveport, Louisiana - Abstract Title, “Comparing the Effects of Radiotherapy and Rapamycin in PIK3CA Wild Type and Mutant Head and Neck Squamous Cell Carcinoma Cell Lines”

2nd Place - Nicholas  Baltera, BS, Medical Student - MS4, Department of General Surgery, Stony Brook Southampton, Southampton, New York - Abstract Title, “A Mesenteric Desmoid Tumor Causing Recurrent Intermittent Bowel Obstruction”

3rd Place - Anita Kumary Motwani, MD, MPH, Obstetrics & Gynecology Resident PGY3, Department of Obstetrics & Gynecology, University of Texas Rio Grande Valley, Edinburg, Texas - Abstract Title, “Spontaneous Bilateral Ectopic Pregnancy: Diagnosis and Management”

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The winners of Sessions 3A & 3B are:

1st Place - Karishma  Kadariya, MD, Internal Medicine Resident PGY1, Department of Medicine, North Alabama Medical Center, Florence, AL - Abstract Title: “Anomalous Left Coronary Artery from the Pulmonary Artery Presenting in an Adult with Heart Failure”

2nd Place - Daniel  Kitner, MD, MSc, Internal Medicine Resident PGY2, Department of Medicine, AdventHealth Orlando, Winter Garden, Florida - Abstract Title: “Assessing the burden of COVID-19 on the mental health of internal medicine residents”

3rd Place - Michael Anthony Pietrangelo, DO, Internal Medicine Resident PGY2, GME Internal Medicine, NHRMC, Wilmington, North Carolina - Abstract Title, “Paternalism in the Medically Underserved Patient: A Case Report”

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