SMJ : October 2020 Vol. 113, No. 10

October 7, 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.

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Improving Preventive Care for Women through a Provider Reminder Tool

Suellen A. Romero de Mello Sa, MD, Lazarus K. Mramba, PhD, Maryam Sattari, MD, MS

Association of Prepregnancy BMI, Gestational Weight Gain, and Child Birth Weight with Metabolic Dysfunction in Children and Adolescents with Obesity

Kelsey Pearson, MS, RD, Kristine C. Jordan, PhD, MPH, Julie Metos, PhD, MPH, Richard Holubkov, PhD, M. Nazeem Nanjee, PhD, Nicole L. Mihalopoulos, MD, MPH

CME Article: Use of e-Cigarettes and Development of Respiratory Conditions in Women of Childbearing Age

Tarang Parekh, MBBS, MSc, Constance Owens, MPH, Kathryn Fay, RN, MHA, Joseph Phillips, MHA, Panagiota Kitsantas, PhD

Promoting Wellness and Resiliency: Faculty Development Professionals Respond to a Mass Shooting

Zuber D. Mulla, PhD, Consuelo Rosales, BS, Eduardo Vazquez, MS, Marco A. Rodriguez, MS, Med, Sanja Kupesic Plavsic, MD, PhD

Novel Opiate-Free Anesthetic Technique for Major Urologic Procedures

Susan A. Smith, MD, Hussam Ghabra, MD, Daniah G. Dhaifallah, MD, Alexander Rahnema, MD, Bryan M. Evans, MD, Bobby D. Nossaman, MD, William D. Sumrall, MD, Stephen F. Bardot, MD, Daniel J. Canter, MD

Streamlining Electronic Medical Records: Remove the Copy-Forward Option

Bruce F. Farber, MD, Vasupradha Vethantham, PhD, Prashant Malhotra, MD

Discharge against Medical Advice

Gururaj J. Kolar, MD, Eric D. Valder, DO

Cardiovascular Diseases Health Literacy among Patients, Health Professionals, and Community-Based Stakeholders in a Predominantly Medically Underserved Rural Environment

Hadii M. Mamudu, PhD, MPA, Liang Wang, DrPH, MD, Amy M. Poole, MS, Cynthia J. Blair, BA, Mary Ann Littleton, PhD, Rob Gregory, BA, Lynn Frierson, BA, Carl Voigt, BA, Timir K. Paul, MD, PhD

Fatal and Nonfatal Snakebite Injuries Reported in the United States

Ricky Langley, MD, MPH, Marilyn Goss Haskell, DVM, MPH, Dariusz Hareza, MD, Katherine King, MPH, MSW

Arboviruses and Their Vectors

Zachary J. Madewell, PhD, MPH

College Students’ Knowledge, Attitudes, and Beliefs about the 2017–2018 H3N2 Influenza Virus and Vaccination

Alexander P. Oliver, MS, M. Allison Ford, PhD, Martha A. Bass, PhD, Marie Barnard, PhD

Mesothelioma is a rare, but preventable, cancer. It’s only known cause is from exposure to asbestos. For asbestos to be a threat, it needs to disturbed or broken. The tiny particles can easily be inhaled and become trapped in the lungs.

There are three main types of mesothelioma: pleural (develops in the lining of the lungs), peritoneal (develops in the lining of the abdomen), and pericardial (develops in the lining of the heart).

Since the symptoms of mesothelioma are similar to other illnesses – such as lung cancer – it is very hard to diagnose, and it can take decades for the symptoms to even begin appearing. On average, most people who are diagnosed are between the ages of 50 and 70. Each year about 3,000 people are diagnosed, and unfortunately are given on average of 10 to 21 months to live. Although there isn’t a cure for mesothelioma, there are some promising treatments that can help extend the lives of those affected...

Mesothelioma Awareness Day is an annual observance started by the Mesothelioma Applied Research Foundation. The day sheds light on mesothelioma in the hopes of increasing funding to find a cure.

If you would like to get involved with the Mesothelioma Awareness Day efforts please check out:

Mesothelioma Cancer Alliance

Mesothelioma Applied Research Foundation

TLC-Childhood Cancer Survivorship Program

August 19, 2020 // Randy Glick

In recognition of September being Childhood Cancer Awareness Month, SMA revisits the 2013 interview with Dr. Kimberly Whelan who discussed the Taking on Life After Cancer (TLC)  Childhood Cancer Survivorship Program at Children’s of Alabama, the only multidisciplinary clinic in Alabama specifically for survivors of childhood cancer.

As survival rates for childhood cancer continue to rise and the outlook for survivors continually improves, there is now increased interest in, and emphasis on, the risks and complications related to survivors’ diagnosis and treatment. SMA had the opportunity to speak with Kimberly Whelan, MD, MSPH, Associate Professor of Pediatrics at the University of Alabama at Birmingham (UAB) and Director of  the Taking on Life After Cancer (TLC)  Childhood Cancer Survivorship Program at Children’s of Alabama the only multidisciplinary clinic in Alabama specifically for survivors of childhood cancer.

About the TLC-Childhood Cancer Survivorship Program
Established in 2004, the TLC program focuses on the needs of cancer survivors and helps educate them, as well as their families, regarding the aspects of the patient’s diagnosis and treatment. “We share with them the things that, at this time, we know they might be at risk for, which could be anything from fertility and cardiac complications to secondary cancers, and to really empower them to be advocates for themselves,” Dr. Whelan explained.

Treating survivors who are at least two years off treatment, the clinic has seen patients ranging in age from 4-49 years.  The TLC program strives to help survivors lead successful lives by informing them and their families about their diagnosis and therapy; educating them about long-term effects of cancer treatment; screening for late effects; offering psychosocial support; and providing referrals to appropriate specialists when necessary. In meeting the needs of those they serve, the clinic staff are mindful of the relationships between the survivors and their physicians. “We don’t want to take over the role of the primary oncologist; they have a special bond with the family and with their patients.” Dr. Whelan said. “In a lot of cases, it’s really meant to be an educational and risk-based screening visit to let the family and survivor know the things that they need to be looking out for.”

With evidence indicating the potential for significant risks and complications associated with a patient’s diagnosis and treatment that can continue several decades beyond their initial cancer treatment, Dr. Whelan noted that a majority of childhood cancer survivors will likely develop a chronic disease by the age of 40 and of those, 25% could have a serious or life-threatening chronic medical condition, thus making follow-up treatment and care of utmost importance. “Many survivors may deal with multiple health conditions related to their diagnosis and treatment and that risk does not seem to plateau,” she said. “The risk for developing chronic conditions related to their treatment continues to increase as the survivors age.” Dr. Whelan further explained that risks are dependent on several things, including the age of the child at diagnosis, his underlying cancer diagnosis, and the types of treatment he received. She also indicated that certain therapies may yield greater risks and that  some patients, such as brain tumor survivors, bone marrow transplant survivors, or some sarcoma survivors who were treated with more intensive therapies,  are more at risk for having late complications of their treatment.

The majority of patients are referred to the program  by their primary oncologist and the goal of the TLC program is for 100% of survivors to come for at least one clinic visit during which they receive a treatment summary that details their original diagnosis, known complications related to their cancer, surgeries they had, and the chemotherapy protocol and drugs that were used. “With drugs such as anthracycline agents, knowing the cumulative dose the patient received is very important in determining his risks for certain complications like cardiac dysfunction and how often he needs to be screened,” Dr. Whelan explained. Because communication among the medical team is key, survivors are not the only ones who receive the copies of the summary information. “We provide a copy to their primary care physicians because that’s where the majority of these survivors are being followed decades down the road,” Dr. Whelan said. “We want to let them know the details of the treatment and things that they may need to be aware of and screening for.”

Years of Progress
Dr. Whelan, who was in fellowship training at UAB when the clinic first opened, has witnessed its evolution over the past nine years. “There have been a lot of advances in the way that we treat children with cancer, particularly in trying to move toward more focused or targeted therapies that may potentially be less toxic down the road than our older chemotherapy agents,” she said.  As with any new treatment regimen, Dr. Whelan acknowledges these therapies will require monitoring. “We do not yet have a lot of that long-term information and data to know what we will need to be aware of in regards to late effects.”

Therapy and treatment protocols are not the only things to have evolved since the program’s  beginning. “Over the past decade there has been an increasing awareness among medical providers, the families, and the survivors themselves of the impact their cancer treatment could have on their current or their future health,” Dr. Whelan said. “We have certainly seen an increase in willingness from our pediatric oncologists to refer patients to come see us and receive [education] and risk-based screening.” Physicians, however, are not the only ones who can make referrals to the clinic. Survivors and their families also call or self-refer to the clinic due to problems they are concerned may be related to their past treatment or because they found information making them realize they needed to learn more about their treatment details.

Through her dedication to, and involvement in, the TLC program, Dr. Whelan recognizes changes that she herself has experienced. “What I’ve also come to appreciate is that when you’re talking to the family and the survivor [who is] 8 years old, you’re talking to the parents and then when [the survivor] is 18 or 20, you are having that conversation with the survivor herself,” she observed. “And what they’re concerned about at 8 years old, maybe school and neurocognitive issues, [is different] when they are 20, when they may be more concerned about future fertility.”

A Bright Future
Although much time at the TLC clinic is spent focusing on the high rate of chronic conditions, risks, and complications in survivors, Dr. Whelan said that data from the Childhood Cancer Survivors Study in which 9 out of 10 participants indicated “good” or “excellent” when asked to rate their quality of life and quality of health, have shown that the majority of survivors are doing very well. “This speaks to the fact that [many] of the late effects or complications that may occur are things that can be well managed and it also speaks to the real resiliency of this population as a whole,” she said. “There are so many survivors out there who are living their lives to the fullest and having a lot of success at it and they inspire me every day.”

Other articles in the Focus on Childhood Cancer Series:
In recognition of Childhood Cancer Awareness Month

SMJ : August 2020 Vol. 113, No. 08

August 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.

Responding to COVID-19: Perspectives on Curricular Changes in a Rural Medical School

Loni Crumb, PhD, LCMHCS, Kendall M. Campbell, MD, Allison Crowe, PhD, LCMHCS, Janeé Avent Harris, PhD, LCMHCA, Cassandra Acheampong, PhD, LCMHC, Janae Little, MS

Narrative Medicine Rounds: Promoting Student Well-Being during the Third Year of Medical School

Sarah E. Stumbar, MD, MPH, Adriana Bracho, MPH, Gregory Schneider, MD, Marquita Samuels, MBA, Marin Gillis, PhD

Exploring Knowledge, Beliefs, and Attitudes about Teen Pregnancy among Latino Parents in Arkansas

Alexandra Bader, MD, MSGH, Kristie Hadden, PhD, Micah Hester, PhD, Jennifer Gan, MBA

Patient and Hospital Characteristics of Newborns with Neonatal Withdrawal Syndrome

Brook T. Alemu, PhD, MPH, Olaniyi Olayinka, MD, MPH, Beth Young, MSW, LCSW, LCAS, Dolly Pressley-Byrd, PhD, MSN, Tyler Tate, BS, Hind A. Beydoun, PhD, MPH

Presentation with Anosmia and Ageusia: Possible Hidden Carriers of COVID-19

Elham Iran-Pour, MD, Amir Ali Tavabi, MD, Ali Seifi, MD

Association of Renal Clearance with Cerebral White Matter Vascular Disease in Hospitalized Veterans With and Without Delirium

Mark B. Detweiler, MD, MS, Brian W. Lutgens, MSW, Devasmita Choudhury, MD, Arline Kenneth, MD, Naciye Kalafat, MD, Rathnakara M. Sherigar, MD, Geoffrey Bader, MD

Social Norms and Self-Management Ability among Uninsured Primary Care Patients

Akiko Kamimura, PhD, MSW, Rebecca Higham, BS, Samin Panahi, BS, MS, Edward Lee, BS, Jeanie Ashby MPH

Posted in: SMJ

Comparative Analysis of Chronic Diseases in the Southeastern United States vs. the United Kingdom: Focus on Cancer

July 30, 2020 // Randy Glick

This is the second in a series of comparative investigations into the prevention and management of the main chronic diseases and causes of death in the United Kingdom versus those in the Southeastern United States.

The series continues with cancer, a group of over 200 different diseases in which cells in a specific part of the body grow and reproduce uncontrollably. Cancerous cells can invade and destroy surrounding healthy tissue, including organs.

About half of the population will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are breast, lung, prostate, and bowel cancer. Together these comprise about 53% of all new cancer diagnoses in the UK.

In total, there are around 367,000 new cancer cases in the UK every year, or about 1,000 every day. More than a third of cancer cases in the UK are diagnosed in people aged 75 and over, with the highest rates for all cancers in people aged 85 years and above.

In terms of mortality from cancer in the UK, there are around 165,000 cancer deaths per year, or around 450 every day, accounting for 28% of all deaths in the UK. The four main cancer types together account for 45% of all deaths from cancer in the UK. Again, rates are higher in people aged 75 and above, with the highest mortality in people aged 90 or above.

In the US, as in the UK, the top causes of cancer are breast, lung, prostate, and bowel cancer. In terms of mortality, lung cancer poses the highest risk, followed by breast, prostate and bowel cancer.

About 1,700,000 new cases of cancer are diagnosed in the US annually, and there are about 600,000 deaths from cancer, about 1,640 per day. This accounts for one in every four deaths in the US, a similar rate to the UK.

Cancer rates are measured for each state by the Centers for Disease Control and Prevention. The highest rate for cancer overall is seen in Kentucky, both in number of diagnoses and number of deaths. 10,135 people died of cancer in 2018 in the state, the last year of record. That comes out to 181.6 deaths per 100,000 people per year being caused by cancer.

The four next highest rates - all of those with more than 170 deaths per 100,000 people - are also in the Southeastern states.  The state of Mississippi follows up Kentucky with a mortality rate of 179.7. Next is West Virginia with 179.5, then Oklahoma at 178.1, and Alabama with 170.4.

Below these, the states with the next three highest cancer mortality are also in the Southeast: Louisiana, Arkansas and Tennessee.

Cancer prevention in the UK is largely focused on giving the public advice and support on how to reduce risk factors: quit smoking, reduce alcohol, stay safe in the sun, improve diet, exercise more and keep within a healthy body mass index. This information is provided by initiatives from the Government’s Department of Health as well as several cancer charities. 

The largest cancer-related charity, Cancer Research UK, is a household name and funds a very wide range of research every year. Their leaflets are a common sight at many healthcare providers, both within the National Health Service and the much smaller private healthcare sector.

The NHS gives universal health coverage free at the point of use, funded via taxation. Its Long Term Plan, created in 2019, aims for 55,000 more people every year to reach five-year survival by 2028. It also aims to diagnose 75% of people with cancer at an early stage (stage one or two) by 2028.

In order to reach these aims, more investment is being made in the NHS national screening programmes. These include cervical screening at 3-5 year intervals for women aged 25 to 64, breast screening for women aged 50 to 70, and bowel cancer screening for men and women aged 60 to 74. There is no national screening programme for lung cancer in the UK.

Screening programmes are overseen by separate organisations in each of the four nations of the UK. These are Public Health England, Public Health Wales, Public Health Scotland, and Northern Ireland’s Public Health Agency.

Local primary care providers called general practitioners administrate these services from their practices. If possible cancer symptoms are found, the patient is referred by their general practitioner to an oncology consultant who is based at a nearby hospital. The consultant will carry out clinical Investigations, leading to a diagnosis and treatment when necessary. Alternatively a patient might attend a hospital’s accident and emergency department with symptoms that require urgent assessment. 

Once diagnosed, cancer treatment in the UK - most often surgery, chemotherapy and/or radiation therapy - is also usually provided by the NHS. Patients can access cancer treatment from private providers which charge fees, but usually treatments for cancer are the same under both systems. Some tests or treatments can be done more quickly in private practice, with shorter waiting lists. But some cancer treatments which specialised equipment, such as radiotherapy, may not be available in private hospitals.

The NHS sets out detailed standard treatment pathways for each type of cancer. It also sets a range of performance targets, for example, a maximum two week wait before being seen by a specialist after urgent referral for suspected cancer by their GP. In 2018-19, this target was met in 92% of cases.

In addition, 97% of NHS patients began cancer treatment within 31 days of diagnosis. One further national target is a maximum delay of 62 days for treatment following referral from an NHS cancer screening service. This rate was 88% in 2018-19.

In the US, the Centres for Disease Control and Prevention encourages cancer prevention by providing support and prevention over a lifetime. It gives advice on how to completely or partially avoid the modifiable risk factors, for example, avoiding or quitting smoking, not drinking or limiting alcohol intake, and using sun protection.

The CDC encourages screening for breast, cervical, colorectal, and lung cancers as recommended by the US Preventive Services Task Force. It suggests that women who are 50 to 74 years old get a mammogram every two years, and a pap smear test every three years from age 30 to 65. Some women will be eligible for free or low-cost mammograms under the CDC’s National Breast and Cervical Cancer Early Detection Program. 

The CDC also recommends regular screening for colorectal cancer from 50 to 75 years, and yearly lung cancer screening for current or former smokers aged 55 to 80 years. In addition, HPV vaccination is recommended for preteens aged 11 to 12 years.

The National Cancer Institute - the federal government's main agency for cancer research - released its latest Annual Report to the Nation on the Status of Cancer on March 12, 2020. It explains that deaths from cancer continue to decrease in men, women and children, and their ‘Healthy People 2020’ targets were met for lung, prostate, breast, and colorectal cancer mortality.

Unfortunately, national improvements in the cancer statistics have not reached the individual states equally. The southeastern states continue to show higher than average rates of cancer diagnoses and mortality. Where healthcare is geographically accessible in very rural states such as Texas, barriers related to care can still exist. Such barriers often relate to finances, transportation, cultural and language differences, lack of insurance and family support.

However, state-level comprehensive cancer control plans created by the CDC are in place, and renewed every five years. These “blueprints for action” identify how the burden of cancer in each geographic area can be addressed in ways specific to each region.

Much remains to be accomplished, but in the United States overall, cancer rates are declining nationally for the first time in history, as a result of risk reduction, education, early detection advances, and novel treatments based on good quality research.

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.

SMA Welcomes Betsy Schaaf, J.D. to SMA Services, Inc.

July 7, 2020 // Randy Glick

We are pleased to announce that Betsy Schaaf has accepted the position of Director of Compliance Services, effective July 7, 2020. Betsy is an ERISA attorney bringing over 20 years experience in ERISA Compliance, including retirement plan administration and customer service. She is a proven leader with significant experience aligning teams across locations, document drafting and system conversions. She has served as an ERISA subject matter expert for multiple financial institutions and offered ERISA training to a variety of audiences.

She lives in Loveland, Ohio (a suburb of Cincinnati) with her husband Andy, daughter Katy (17), son Will (15) and our black lab “Putnam”. Her hobbies include reading, taking walks with her family, spending time at the pool and on the golf course.  Her family loves college basketball (Xavier University season ticket holders for 20+ years.). They are also a big Disney family and frequently travel to Disney World. They also enjoy visiting her husband's family in Wisconsin.

Relevant Experience

  • As an ERISA consultant, Betsy identified and engaged a solution for the client’s Automatic IRAs and lost and missing participants
  • As an independent consultant with a National Insurance Company, Betsy served as a subject matter expert for the implementation of DOL Fiduciary regulation across all product lines, successfully utilizing an Agile approach. Although the Rule was eventually overturned, the client was well-positioned to fully implement the recommended courses of action in advance of the effective date of the Rule
  • Betsy has led teams through multiple document restatements, with a focus on plan improvement and client satisfaction. All of these projects were completed on time and under budget
  • She has served as a leader during system conversions at two major insurance companies
  • Betsy has fostered and maintained relationships throughout the Retirement Plan Industry, cultivating a strong network of associates with valuable expertise

Specialities

ERISA expertise, Plan design, Customer service, Agile Project Management, Leadership, Change Management, Service Optimization

Prior Positions Held

  • DOL Fiduciary and Compliance Consultant – Ohio National Financial Services
  • ERISA and Retirement Plan Project Consultant – Ohio National Financial Services
  • Vice President, ERISA Plan Services – Ameritas Life Insurance Corp.
  • Vice President, ERISA Plan Services & Administration – Ameritas Life Insurance Corp.
  • Vice President, ERISA Plan Services – Union Central Life
  • Former Board Member – The SPARK Institute

SMJ : July 2020 Vol. 113, No. 07

July 6, 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.

Reflections on the Hippocratic Oath and Declaration of Geneva in Light of the COVID-19 Pandemic

Satyaseelan Packianathan, MD, Srinivasan Vijayakumar, MD, Paul Russell Roberts, MD, Maurice King, MD

Impact of Do-Not-Resuscitate Orders on Nursing Clinical Decision Making

Rebecca Engels, MD, MPH, Casey Graziani, MD, Ixavier Higgins, BS, Jessica Thompson, NP, Roberta Kaplow, PhD, APRN-CCNS, Theresa E. Vettese, MD, Annie Massart, MD

The Minority Doctors We Create

Kendall M. Campbell, MD, Michaela M. Braxton, BSW

Who’s Flying the Plane?

Paul L. Friedlander, MD, David J. Doukas, MD, Marc J. Kahn, MD, MBA

Salary Disparities in Academic Urogynecology: Despite Increased Transparency, Men Still Earn More Than Women

William D. Winkelman, MD, Andrea Jaresova, MD, Michele R. Hacker, ScD, Monica L. Richardson, MD, MPH

Increased Prevalence in Alzheimer Disease in the Northeast Tennessee Region of the United States

Sylvester O. Orimaye, PhD, MPH, Jodi L. Southerland, DrPh, Adekunle O. Oke, MD, MPH, Aderonke Ajibade, MD, MPH

Primary Care Perceptions and Practices on Discussion and Advice Regarding Sexual Practices

George G.A. Pujalte, MD, Isaac I. Effiong, MD, MPH, Livia Yumi Maruoka Nishi, MD, Adrianna D.M. Clapp, MD, Thomas A. Waller, MD

Posted in: SMJ

Jeremy Schubert

June 11, 2020 // Randy Glick

Divisional Vice President, USO Commercial Operations
Abbott Diagnostics Division
Conway Park, IL, USA
jeremy.schubert@abbott.com
(224) 399-5317

Jeremy has dedicated his entire professional career to Abbott joining in 1993.  He has held several commercial and leadership positions across multiple divisions of Abbott, including Managing Director for Northern Europe and Divisional Vice President of Latin America and Canada.  Jeremy assumed his current role as Divisional Vice President for US ADD Commercial Operations in 2017.

Jeremy attended Texas A&M University where he received a degree in International Marketing.  Jeremy is a member of the International Health Economic Association and earned an MBA from The Kellogg School of Management with an emphasis in strategy, marketing, and healthcare economics.

Jeremy also possess a Master’s in Public Health (MPH) from the University of Liverpool in the UK with expertise in health system performance improvement, social determinants, and building healthier communities.

Posted in: Hidden

John Hackett, Ph.D

June 11, 2020 // Randy Glick

John Hackett is divisional vice president of Applied Research and Technology for Abbott's diagnostics business. In this role, he manages diagnostics R&D in the areas of infectious diseases, oncology, cardiovascular, metabolic biologics design and discovery, and clinical chemistry.

John is responsible for managing Abbott’s Global Viral Surveillance Program, which was established more than two decades ago to detect and actively monitor emerging HIV and hepatitis strains around the world. The Surveillance Program houses more than 78,000 samples containing HIV and hepatitis viruses, making it one of the largest libraries in the world. If a new strain is discovered, Abbott’s scientists check that the current blood screening and diagnostic tests can detect it.

John also manages a multi-year collaboration between Abbott and the University of California San Francisco (UCSF), the UCSF-Abbott Viral Diagnostics and Discovery Center (VDDC). The VDDC uses deep sequencing and ultra-rapid pathogen identification technologies to identify and characterize novel human viruses – to help safeguard public health against these potential threats.

John joined Abbott in 1992 and has more than 125 patents and publications to his name, having spent his career helping to keep Abbott one step ahead of these evolving viruses. He joined Abbott in 1992, was inducted into Abbott's Volwiler Society as an Associate Research Fellow in 1999, promoted to Research Fellow in 2005, and Senior Research Fellow in 2012.

He received his Ph.D. in immunology from the University of Texas Southwestern Medical Center at Dallas and completed his postdoctoral training at the University of Chicago.

John is a member of the International Society of Blood Transfusion, Industry Liaison Forum for the International AIDS Society, and serves on the Executive Council of the Autumn Immunology Conference.

 

Posted in: Hidden

Comparative Analysis of Chronic Diseases in the Southeastern United States vs. the United Kingdom: Focus on Cardiovascular Disease

June 11, 2020 // Randy Glick

This is the first in a series of comparative investigations into the prevention and management of the top chronic diseases and causes of death in the United Kingdom versus those in the Southeastern United States. It will cover primary and secondary prevention, pharmacological management, lifestyle factors, patient education, access to care, and outcomes. 

The series begins with cardiovascular disease, or CVD, which is a general term for conditions affecting the heart or blood vessels. It's usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) and an increased risk of blood clots, but can also be linked with damage to arteries in organs such as the brain, heart, kidneys and eyes.

The four main types of CVD are: coronary heart disease and resulting heart attack or heart failure; stroke and transient ischaemic attack; peripheral arterial disease; and aortic disease. 

Risk factors include high blood pressure, atrial fibrillation, high cholesterol, diabetes, smoking, inactivity, and being overweight or obese, family history of CVD, and certain ethnic backgrounds. Additional risk factors are older age, being male, unhealthy diet, and excessive alcohol.

In the UK, there are around 7.4 million people living with CVD: 3.9 million men and 3.5 million women. If high blood pressure is included, the figure reaches about 39% of adults. The condition causes about 27% of all deaths in the UK - around 167,000 deaths each year – an average of 460 deaths each day.

In the US, about 121.5 million American adults have some form of CVD, including high blood pressure - around 37% of adults. It accounts for about 860,000 deaths each year, that’s one in three deaths. The leading cause of death attributable to CVD is heart disease (42.6%), followed by stroke (17.0%), high blood pressure (10.5%), heart failure (9.4%), diseases of the arteries (2.9%), and other cardiovascular diseases (17.6%).

Some of the highest rates of cardiovascular events occur in the Southeastern region, according to a January 2020 report from the American Heart Association. Two of the three states with the highest CVD event rates (comprising deaths, hospitalizations, and ED visits) are the Southeastern states Kentucky and Tennessee. 

The AHA report says, “A region of higher CVD mortality extends from southeastern Oklahoma along the Mississippi River Valley to eastern Kentucky.” It adds that this trend seems to be driven by dietary, blood pressure, and body mass index risk factors.

However, there is a huge opportunity to make a difference in improving CVD outcomes, given that the majority of CVD cases are preventable. Patient education often targets the potentially modifiable risk factors: diet, physical inactivity, smoking and drinking at unsafe levels.

Primary prevention strategies in the UK are coordinated by the government’s Department of Health, which creates salt, sugar and calorie reduction targets, some of which are enforced by legislation such as the Soft Drinks Industry Levy, or “sugar tax”, and high tobacco taxes.

All UK residents can access care from the National Health Service, both primary and secondary care. People with CVD symptoms will either visit their General Practitioner at a local NHS clinic, who may refer them to a consultant at a nearby hospital. Or if the symptoms need urgent treatment, the patient will be taken by ambulance to the emergency department of the nearest hospital. There are over 157,000 hospital visits each year due to heart attack alone.

Guidelines set out by the UK’s National Institute for Health and Care Excellence outline best practice prevention and management of CVD in the UK. These guidelines are designed to help primary care providers - General Practitioners - to identify those who are at high risk. They outline lifestyle behaviours and treatment options that can help reduce the onset of CVD or help manage it if already developed.

The latest guidelines advise that people aged over 40 years should have their estimate of CVD risk reviewed on an ongoing basis, at least every five years. Pharmaceutical treatment is recommended if an individual has a greater than 10% risk of developing CVD, measured with the “QRISK” assessment tool, an algorithm that calculates 10-year risk of developing CVD. 

The recommended therapy is 20mg atorvastatin (Lipitor) per day to lower blood lipids, if there are no contraindications.

People with established CVD are at high cardiovascular risk and need intensive lifestyle interventions and ongoing drug therapy. This group includes people with angina pectoris, coronary heart disease, myocardial infarction, transient ischaemic attacks, cerebrovascular disease or peripheral vascular disease, and those who have had coronary revascularization or carotid endarterectomy.

Following a full lipid profile measurement, the drug treatment currently recommended in the UK is lipid modification therapies, starting with the statin atorvastatin at 80mg per day, if appropriate for the patient.

The goal is a greater than 40% reduction in the patient’s non‑HDL cholesterol after three months of treatment. If this is not achieved, adherence to the drug and lifestyle improvements are discussed, and the patient is reviewed again on a regular basis.

In the US, the American College of Cardiology and the American Heart Association Task Force issued clinical practice guidelines in 2019 on the primary prevention of CVD. They write, “The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.” 

In addition, they recommend that evaluation for CVD risk should include an atherosclerotic cardiovascular disease (ASCVD) risk estimation, which provides measures of 10-year and lifetime risk based on factors such as age, blood pressure and cholesterol.

The ASCVD estimator has many similarities to the UK’s QRISK tool, however the QRISK includes socioeconomic data, but lacks the ASCVD’s lifetime risk calculation. ASCVD is often used instead of the previously-recommended Framingham Risk 10-year CVD calculation.

Patients are considered to be at "elevated" risk if the ASCVD predicted risk is 7.5% or above. The ACC/AHA guidelines recommend that. “Only when a person’s risk is sufficiently high should medications to reduce ASCVD risk be considered as part of a shared decision-making process for optimal treatment.”

When necessary, individuals with an ASCVD predicted risk of 7.5% or above, or LDL cholesterol of 190mg/dL or above, or diabetes plus an LDL of 70 to 189 mg/dL may benefit from moderate- or high-intensity statin therapy.

As with the UK, atorvastatin at up to 80mg per day is recommended as a first-line treatment, or alternatively, rosuvastatin (Crestor) at up to 40mg per day. Following pharmacological therapy, the target blood pressure is 130/80 mm/Hg. Again, this is the same target as that set in the UK.

The ACC/AHA guidelines state that cholesterol-lowering or antihypertensive medication can be used in intermediate-risk individuals, when deemed suitable by the physician and patient.

They add, “The clinician must balance an understanding of a patient’s estimated ASCVD risk with potential benefits and adverse risk from pharmacological therapy.” 

Both the prevalence and cost of CVD are expected to increase over the coming decades due to an aging population and projected increases in obesity and diabetes. Health care providers in both the UK and the US are placing a strong emphasis on prevention, with public health efforts, including policy measures, to limit risk factors in order to decrease the likelihood of CVD morbidity and mortality later in life.

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.

Posted in: Public Health & Environmental Medicine

Meet Bennet Omalu, MD, MBA, MPH, CPE, DABP-AP,CP,FP,NP

June 8, 2020 // Randy Glick

Bennet Omalu is a Nigerian born physician who holds eight degrees and certifications in the medical sciences and business management. He attended medical school and holds a Doctor of Medicine [MB,BS] degree from the University of Nigeria, Enugu from where he graduated in 1990. He holds a Masters in Business Administration degree from the Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania. He also holds a Masters in Public Health degree in Epidemiology from the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. Dr. Omalu holds four board-certifications from the American Board of Pathology in four subspecialties of medicine including forensic pathology, neuropathology, clinical pathology and anatomic pathology. He is also holds a board certification in medical management from the American Association of Physician Leadership and is a Certified Physician Executive.

Dr. Omalu has received three honorary PhD and Doctor of Science degrees from two universities in the United States, and from the Royal College of Surgeons of Ireland in recognition of his work and expertise in brain injury and trauma. He has received numerous awards from across the world in recognition for his work and expertise in brain injury and trauma in both living and deceased patients. Dr. Omalu has received the “Distinguished Service Award” from the American Medical Association [AMA], which is the highest and most prestigious award a physician can receive from the AMA. He has been honored by the United States Congress for his work on brain injury and trauma and he has appeared on multiple occasions before committees of the United States Congress and committees of State Legislatures across the United States advising them on matters relating to brain injury and trauma, death investigation and the administration of justice.

Dr. Omalu identified and described Chronic Traumatic Encephalopathy [CTE] in a retired football player, when he performed an autopsy and examined the brain of Mike Webster. Subsequently, he identified CTE in other high-impact, high-contact sports athletes and in military veterans suffering from Post-Traumatic Stress Disorder [PTSD]. His work and life have been featured extensively in all media platforms across the world, and in a major Hollywood film, “Concussion” released in December 2015 by Sony Motion Pictures, in which the renowned actor, Will Smith, played him as Dr. Omalu. Several New York Times best-selling books have also been published on his life and work including “The League of Denial” and “Concussion”. He has published several books and his memoir “Truth Doesn’t Have a Side” was published in August 2017. His latest book was published in 2018 and is titled “Brain Trauma in Contact Sports: What Parents Should Know Before Letting Their Children Play”. He has published extensively in the medical and scientific literature authoring many scientific papers and book chapters, with a major focus on brain injury and brain trauma. He continues studying brain trauma and is currently collaborating with other researchers looking for ways to definitively diagnose and treat CTE in living patients.

Dr. Omalu is the President and Medical Director of Bennet Omalu Pathology and is a Clinical Professor of Medical Pathology and Laboratory Medicine at the University of California, Davis medical school. He is an appointed member of the Traumatic Brain Injury Board of the State of California. Dr. Omalu is married to his wife Prema and they have two children, Ashly and Mark. They live in Vineyard, California.

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