CONSULT

A Newsletter for Medical Professionals FALL 2018

UAMS MEDICAL CENTER CERTIFIED AS FIRST AND ONLY COMPREHENSIVE STROKE CENTER IN

UAMS Medical Center has According to the Joint “This is truly an extraordinary become the first and only health Commission, the certification is accomplishment that will save care provider in Arkansas to be the most demanding accreditation lives,” Patterson said. certified as a Comprehensive and is designed for those Stroke Center by The Joint that have the specific abilities to AR SAVES Commission. receive and treat the most complex The Comprehensive Stroke The Joint Commission is stroke cases. It also means certified Center designation adds to an independent, nonprofit hospitals can provide endovascular UAMS’ leadership in the area of organization that evaluates and procedures and post-procedural stroke already established by accredits more than 20,000 health care and have an emergency the Arkansas Stroke Assistance care organizations and programs in department with a dedicated though Virtual Emergency the United States. stroke-focused program. Support (AR SAVES) program. “Achieving the standard “Achieving Comprehensive Stroke AR SAVES allows 54 partnering of care required by The Joint Center designation places UAMS emergency rooms across the Commission to be certified as a among the top stroke centers in the state to consult with network Comprehensive Stroke Center country that have the resources and neurologists 24/7 through two- means a stroke patient at UAMS highly skilled health care teams with way live video. The consultation has a better chance here than advanced training to handle the allows doctors to quickly assess anywhere else in the state of not most complex stroke cases,” said whether a stroke patient is a only surviving but leaving our UAMS Chancellor Cam Patterson, candidate for alteplase, the clot- care with the best possible health M.D., MBA. “I am extremely proud busting drug that can be life- outcome,” said Martin Radvany, of our medical center and our saving and function-preserving for M.D., a professor and chief of stroke team for their dedication to the patient. Interventional Neuroradiology achieving this designation to provide For more information, visit at the for Arkansans with access to the most ARSAVES.UAMS.edu. Medical Sciences (UAMS). advanced stroke care possible. (Continued on page 2) September 2018 Message from (Continued from page 1) Dr. Jansen

Dear Colleagues,

Investments in statewide telemedicine are bearing fruit in the lives of Arkansans from all walks of life. In 2010, Arkansas was awarded a Broadband Technology Opportunities grant, enabling the creation of more than 420 telemedicine sites across the state. From that initial vision, some truly amazing tools for better health care have emerged. The UAMS Medical Center stroke team along, with other UAMS physicians and staff, recently achieved Comprehensive Stroke Center designation from The Joint Commission. UAMS Medical Services such as Antenatal and Center is the first and only health care provider in Arkansas with the certification. Neonatal Guidelines, Education and Learning System (ANGELS) have helped many women and Achieving Comprehensive J.D. Day, M.D., is the chairman their families through high-risk of the UAMS College of Medicine’s pregnancies, reducing the risk of Stroke Status travel. Many walking and talking In July 2017, UAMS formed Department of Neurosurgery and Arkansans are direct beneficiaries of a team to work on getting director of the neurosciences Arkansas Stroke Assistance through the Medical Center ready for clinical program that includes the Virtual Emergency Support (AR the Comprehensive Stroke stroke service and multidisciplinary SAVES), which connects emergency Certification. A gap analysis was team leaders. room doctors across the state with neurologists who can determine performed to show what points To be a Comprehensive Stroke the appropriate and safe use of of care needed to be addressed Center, a or clinic must clot-busting medications to salvage for certification. Multiple aspects be able to provide 24/7 care for brain function. of the stroke program had to be patients suffering from a stroke This method of virtual care is documented as well. and any cerebrovascular disorder, exploding. We are committed at An application for the including ruptured brain aneurysms UAMS to exploring more applications certification was sent to The Joint for its use. However, we don’t just and bleeding into and around do it because it’s “cool.” We apply Commission in August. In May, two the brain. The Joint Commission evidenced-based principles to assure commission surveyors conducted requires the provider hospital that care is high quality and furthers the comprehensive survey over the or clinic to have the following our mission of providing the best to course of two days. They toured all available to do that: an acute everyone in the state. areas that care for stroke patients. stroke team, neurointensive care In addition, the surveyors reviewed Sincerely, unit beds for complex stroke files and chart reviews and patients, the ability to meet the interviewed staff and patients. concurrent needs of two complex “This effort elevated the stroke patients, and neurosurgical Mark T. Jansen, M.D. requirements of 24/7 coverage Medical Director services. A center must be for all stroke providers at UAMS,” UAMS Physician Relations & Strategic said Matthew Mitchell, director of able to offer comprehensive Development the UAMS Stroke Program. “It took diagnostic services; have on-site everyone working in the program coverage by a neurospecialist using all their experience and energy for its neurointensive care unit; Gut Club Meets Quarterly to achieve the highest possible participate in patient-centered research that is approved by The Nov. 29 meeting will feature a certification. It was the culmination presentation on “Innovations in ADR of years of work. We will keep giving an institutional review board; Improvement and Removal of Large our all to maintain this standard and track, monitor and report Polyps” from Harry R. Aslanian, M.D., performance measures. professor, Department of Internal and to provide the best care for the Medicine, Section of Digestive state’s stroke patients. Dr. Radvany, To make a neurology referral, Diseases, Yale University School of Dr. Day and I, along with everyone call 501-686-5838. To make a Medicine. at UAMS, couldn’t be prouder of our neurosurgery referral, call Meetings are 6-8 p.m., 12th floor, UAMS Jackson T. Stephens Spine stroke team.” 501-686-5270. n & Neurosciences Institute. Details: Melanie Meyer at [email protected] or 501-686-8206.

2 News to Know: Updates from UAMS Physician Relations

Martin Radvany, M.D., Heads Clementino Fraga Filho, Rio Physician Relations de Janeiro, Brazil. Machado & Strategic Development Interventional Neuroradiology Mark T. Jansen, M.D. completed a laparoscopic robotic Martin G. Radvany, M.D., an [email protected] internationally known leader in surgery fellowship at the Clinique interventional neuroradiology Saint Augustin, Bordeaux, France. Michael Manley, RN, MNSc and specialist To make a referral, call 501-526-1000. [email protected] in vascular disorders of Movement Disorders Adds Director the brain and Huntington’s Clinic Melanie Meyer, M.Ed. spine, has joined The UAMS Movement Disorders [email protected] the UAMS Clinic is offering a monthly clinic for Huntington’s disease, featuring Manager Department Carla Alexander, M.Ed. of Radiology a multidisciplinary approach for a [email protected] as professor one-stop shop for patients. and chief of The clinic’s multidisciplinary Byron Jarrett & Brian Mann interventional neuroradiology. team includes movement disorder [email protected] Radvany was director of neurologists, nurses and nurse interventional neuroradiology practitioners with expertise in at the Johns Hopkins Bayview Huntington’s disease, social Medical Center and director workers, nutritionists and speech CONSULT of the Endovascular Surgical and physical therapists. The clinic is produced by the UAMS Office Neuroradiology Training Program partners with neuropsychologists, of Communications & Marketing in the Johns Hopkins University psychiatrists and genetic and Physician Relations & School of Medicine. He also counselors for quick referrals. Strategic Development. established the Interventional To make a referral, call 501-526-5443. Editor Neuroradiology Program at Amy Widner WellSpan York Hospital in Sign up with EpicCare Link Pennsylvania. to Prevent Large Faxes Designer To make a referral, call 501-686-5745. When patients are discharged Norma Edwards from UAMS, continuity of care Bruno Machado, M.D., documents are sent to their Vice Chancellor for Joins UAMS Urology primary care physician. These Communications & Marketing Urologist Bruno Lopes documents can be lengthy and Leslie Taylor Cancado Machado, M.D., has can default to your fax machine. If joined UAMS as a fellowship- you do not wish to receive faxes, trained specialist in urinary system sign up for EpicCare Link. surgeries and minimally invasive EpicCare Link is a web-based endoscopic techniques. tool providing community Machado specializes in treating physicians secure access to UAMS’ benign and malignant prostate Epic electronic medical record diseases, surgical system to view patient medical bladder diseases records and receive electronic and vasectomy messages from UAMS physicians. CONSULT reversal. He uses For more information, visit minimally invasive UAMSHealth.com/MD. Quiz of the Month techniques to Alternately, if you have an treat kidney, internet service provider, you can Question ureter and subscribe to a Health Information A patient presents with polyarthritis. bladder stones. Service Provider such as State What is the best serological study to He also screens for prostate Health Alliance for Records confirm or refute your suspicion of cancer and uses the latest Exchange (ShareArkansas.com) rheumatoid arthritis? management practices for or Allscripts (Allscripts.com). A: ANA benign prostate enlargement and After you join, provide UAMS B: C-reactive protein vasectomy procedures. with a list of all providers in your C: Anti-CCP antibodies

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3 News to Know: Updates from UAMS For a list of new physicians, visit (Continued from page 3) UAMShealth.com/MD Free Patient Engagement Participants will also have Resources Available the opportunity for in-person How to Talk to Your Doctor telemedicine consultations with an and How to Talk to Your Child’s addiction psychiatrist from UAMS’ Doctor – informative handbooks Center for Addiction Services Cancer Institute. to improve doctor-patient Treatment. Hutchins has communication – are available To connect to the video served as for free for clinics and hospitals conference, email video@uams. director of in Cleburne, Conway, Faulkner, edu or call 501-686-8666. For clinical research White and Van Buren counties more information, contact Anner at the Cancer thanks to a donation from BHP, an Douglas at [email protected] Institute since Australian energy company. or 501-526-8459, 833-872-7404. 1998. Hutchins The materials were developed is a professor by the UAMS Center for Health CenteringPregnancy® in the Division of Hematology/ Literacy. Prepares Women for Birth Oncology in the College of For more information, contact CenteringPregnancy prenatal Medicine. Alison Caballero at 501-686-5463 care groups are now available Susan Long, Ed.D., has been or [email protected]. at UAMS. named dean of the UAMS College CenteringPregnancy brings of Health Professions. Long has Weekly Video Conferences together about 10 women with served as interim dean since late Help With Opioid Addiction similar due dates for 10 group 2017. She has also been associate The Medication Assisted sessions with their doctor and dean for Treatment Recovery Initiative other health care professionals. academic affairs for Arkansas Rural Communities Together, they learn important since 2012. She (MATRIARC) program in the information about how to care for is a professor UAMS Psychiatric Research themselves and their new babies. in the college’s Institute holds weekly video For more information, visit dental hygiene conferences for community health UAMShealth.com/Pregnant. program. She providers about opioid addiction also serves treatment. Academic Appointments as associate Conferences are noon to 1 p.m. Laura Hutchins, M.D., has been director for Fridays, with experts in addiction, appointed interim director for the clinical programs in the UAMS therapy and case management. UAMS Winthrop P. Rockefeller Center for Dental Education.

UAMS PHYSICIAN RECRUITMENT & PROVIDER PLACEMENT PROGRAM

The UAMS Physician Recruitment & Provider Placement Program has a team of placement specialists dedicated to serving the recruitment needs of our partner communities, UAMS Regional Campuses and UAMS faculty. Physician/provider opportunities are available in all specialties throughout Arkansas. FEATURED JOBS Family Medicine Faculty Opportunity: UAMS Northeast Regional Campus has an immediate opening for a board- certified/board-eligible family medicine physician. Psychiatrist Opportunities: Whether you are looking for an academic or private practice opportunity, we can connect you to one of the many psychiatry openings throughout Arkansas. Rural Medicine Opportunities: Interested in practicing rural health? Opportunities are available throughout Arkansas, including: Arkadelphia, Dumas, Eureka Springs, Fordyce, Green Forest, Jasper, Lake Village, Lincoln and Lonoke, to name a few. Recruitment services contact: Carla Alexander: 501-686-7934 or [email protected]

For a complete listing of job descriptions and opportunities, visit: MedJobArkansas.com

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4 Eustachian Tube Dilation Procedure PHYSICIAN PROFILE Provides Relief for Middle Ear Pressure Alissa Kanaan, M.D., a UAMS LINDSEY SWARD, M.D. otolaryngologist who specializes in Assistant Professor endoscopic nasal and sinus surgery, is Department of Obstetrics and Gynecology offering a new endoscopic nasal procedure called Eustachian tube balloon dilation What inspired you to become a doctor? for the treatment of Eustachian tube A personal experience dysfunction, a condition that can cause ear with an orthopaedic injury as pain, pressure and muffled hearing. a young teen really inspired Using an endoscope and a Eustachian me. The anesthesiologist, tube balloon dilation device, Kanaan enters through the nose who was a young female, to the back of the sinus cavity where the Eustachian tube was so kind and put me at is located. After correctly aligning the endoscopic device, ease. I remember thinking which has a curved, for the first time that I could hook-like tip, she inserts do that – I could be a doctor and take care it into the Eustachian of people physically and emotionally during tube. A balloon at the tough times. tip fills with water and dilates the Eustachian What do you like most about your tube for two minutes. specialty? “I’ve performed this I take care of women of all ages. A lot of procedure on several my patients are nervous at first, and I try to patients who have all make the experience as pleasant as possible. reported they have Delivering babies is by far one of the best experienced benefit parts of the job. I consider it a privilege to from it,” Kanaan said. get to be a part of something so important in The device is inserted into the Eustachian tube. “They hear better, a patient’s life. their middle ear is not collecting fluid anymore, What makes you unique among your peers? and they don’t feel I love to teach – patients, medical students like their ear is under and residents alike. I consider education pressure all of the time. my way of advocating for women and There is no pain related women’s health issues. I also spent a few to the procedure and years in private practice, so I have a deep they are able to return to appreciation for providers around the work the next day.” state who don’t always have access to the The procedure resources we have here at UAMS. Because is performed under of that experience, I think I’ve been able to general anesthesia, but bring a unique perspective to the table. Kanaan anticipates that The balloon at the tip of the device inflates with water and dilates the Eustachian tube. studies will confirm its What are your clinical specialties? safety as an out-patient I am a board-certified obstetrician/ procedure and she will be able to serve patients in the clinic. gynecologist. My practice is a mix of Eustachian tube balloon dilation is appropriate for gynecologic care – preventive care, patients who: contraceptive management, surgical • Have painful ear pressure. management of benign gynecologic • Cannot equalize ear pressure when flying. conditions – and obstetric care – both of low- • Have a history of radiation to their nasopharynx or their and higher-risk pregnancies. head and neck area. • Have had mastoid or middle ear surgery who continue How can doctors make referral to you? to experience recurrent fluid in their ears or are unable For obstetrics transports and outpatient to equalize the pressure in their ears. referrals, doctors can contact the ANGELS Kanaan sees patients in the Ear, Nose and Throat Clinic call center at 501-526-7425 or 866-273-3835. at the Jackson T. Stephens Spine & Neurosciences Institute For gynecologic referrals, doctors can at UAMS. To make a referral, call 501-526-1000. n contact the UAMS physician call center at 501-526-1000.

5 MEDICAL CASE STUDY Maxillofacial Reconstruction and Osseointegrated Dental Implant Prosthetics

INITIAL CONTACT ASSESSMENT Jones’ role in the treatment A 67-year-old male patient had With advancements in cancer of the patient was to manage his been treated with radiation and treatments and surgical techniques, lockjaw and scar tissue, which chemotherapy 15 years previously patients are increasingly surviving prevented full range of motion for a squamous cell carcinoma head and neck cancers, but they are and presented challenges for the at the base of his tongue. He often left with structural limitations procedures. Jones also prepared presented at UAMS in October that impact daily life. Teeth and the soft tissue over the bone graft, 2015 with swelling in his right jaw portions of jawbone are often because the skin was too thick. and was diagnosed with radiation- removed, and high-dose radiation Jones thinned this tissue and the induced sarcoma. Mauricio damages remaining tissue and teeth. patient was allowed to heal for Moreno, M.D., a head and neck These patients benefit from three weeks. surgeon in the Department of dental reconstruction, but Jones removed the patient’s Otolaryngology – Head & Neck traditional implants require deeper unrestorable teeth, leaving one on Surgery, resected the tumor bone than is available with a typical the bottom native jawbone to serve and nearby tissue, including bone graft. Adhesive dentures are as a guidepost later during the soft tissue, teeth and part of the often unusable for these patients creation of the dental prosthesis. jawbone. Moreno reconstructed because of dry mouth. Jones inserted the metal bone the patient’s jaw at the time, using Dental implant prosthetics are screws (implants) into the bone a metal frame and bone and skin an emerging solution and have high graft and native bone, being grafts from the patient’s leg. success rates in native bone and careful to avoid the metal bone The reconstruction – though bone grafts and in both radiated graft frame. successful – did not restore the and non-radiated bone. After about eight weeks of patient’s ability to eat solid food. Many of the procedures involved healing, Howe made impressions Additionally, because of radiation can be performed in the clinic, and of the patient’s mouth, which he at the site, the patient had some without sedation. Typically, used for planning and sent to developed osteoradionecrosis – patients need to wait at least three the dental lab, where the implant bone death – which had damaged months after their tumor removal prostheses were created. He used many of his remaining teeth. surgery before proceeding with a wax and plastic bite rims to set up The patient worked with dental rebuild. the correct positioning of the teeth, Laurence J. Howe, D.D.S., a The patient was beyond that which was challenging because of dentist and assistant professor waiting period and opted for the the patient’s limited ability to open in the UAMS Center for Dental implants. his mouth because of scar tissue. Education, and John K. Jones, Meanwhile, Howe worked M.D., D.M.D., an oral and PROCEDURES to restore the patient’s upper maxillofacial surgeon and assistant 3D cone beam computed jaw, including crowns on some professor in the Department of tomography was used to plan the remaining viable teeth and a Otolaryngology, to restore his diameter, length and position of the removable partial denture. Once teeth and ability to eat. implants. the top row of teeth were complete,

The resected tumor, soft tissue, teeth and jawbone The patient during the jaw reconstruction surgery, with the metal jawbone attached

6 (Continued on page 7) Laurence J. Howe, D.D.S.

Assistant Professor UAMS Center for Oral Health and Dental Education College of Health Professions

Education The patient during the jaw reconstruction An X-ray of the remaining native teeth on the Doctorate of Dental Surgery, University surgery, with metal jawbone and bone graft top row, the implanted metal on the bottom attached row, and the one remaining guidepost tooth of Tennessee Center for Health Sciences near the center College of Dentistry, Memphis, Tennessee

John K. Jones, M.D., D.M.D.

Assistant Professor Department of Otolaryngology The metal implants seen inside the mouth The final fitting – Head & Neck Surgery Department of Surgery – the guidepost tooth on the bottom Everything was finalized after two Division of Plastic jaw was removed and the patient fittings. The implants are held in and Reconstructive Surgery was allowed to heal for two or three place with a metal bar designed for College of Medicine weeks. An impression was made of plastic attachments. the upper jaw to continue working Education on correct placement for the FOLLOW-UPS Doctor of Dental Medicine, University of implant teeth on the bottom row. The patient regained the ability Florida College of Dentistry, Gainesville, The wax and plastic bite rims to chew and eat solid food and Florida were used for the implant teeth reported a much improved quality Medical degree, University of Texas arrangements. Impressions were of life. Health Science Center, San Antonio, made of the implants to fabricate To make a referral to the Dental Texas the connecting bars. With the Clinic, call 501-526-7619. To make position of teeth and implants set, a referral to the Head & Neck Residency then the bar could be fabricated. Clinic, call 866-826-7362. n Oral and maxillofacial surgery, University of Texas Health Science Center, San Antonio

Online Appointment Fellowship Registration Facial cosmetic surgery, American Academy of Cosmetic Surgery, Seattle, For faster, easier, more convenient patient Washington appointment registration:

• Log on to UAMSHealth.com/MD • Go to the online appointment request link, complete the form and submit.

The Appointment Center will contact you to assist with your appointment request.

UAMS Appointment Center • 501-526-1000 7 NONPROFIT ORGANIZATION U.S. POSTAGE PAID 4301 W. Markham St., #727 LITTLE ROCK, AR Little Rock, AR 72205 PERMIT NO. 1973

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OCTOBER 2 NOVEMBER 6 DECEMBER 4 LearnOnDemand.org Neurogenic Bowel Pressure Ulcers Essential Tremor: How to Tom Kiser, M.D. Tom Kiser, M.D. Distinguish from Other Department of Physical Department of Physical Tremor Disorders and A resource of the UAMS Center Medicine and Rehabilitation Medicine and Rehabilitation Manage for Distance Health (CDH), the Rohit Dhall, M.D. LearnOnDemand.org web portal offers OCTOBER 9 NOVEMBER 13 Department of Neurology health care professionals the flexibility New Drug Updates Update of Infertility of earning continuing education (CE) Rachael McCaleb, Treatment: Focus on DECEMBER 11 credits on their own schedule, through an Pharm.D., BCPS PCOS, Obesity and Age Sickle Cell Update expanded array of teleconferences and College of Pharmacy Gloria Richard-Davis, M.D., Collin Montgomery, APRN online courses. FACOG Adult Sickle Cell Program OCTOBER 16 Department of Obstetrics n Track all educational hours and Chronic Pain: Challenges and Gynecology DECEMBER 18 credits earned inside or outside and New Innovations Barrett’s Disease the program Johnathan Goree, M.D. NOVEMBER 20 – Benjamin Tharian, M.D., n Ensure compliance with the CE Department of CANCELED DUE TO MRCP, FACP, FRACP requirements for the national Anesthesiology HOLIDAY Department of Internal accrediting organizations for Medicine physicians and nurses OCTOBER 23 NOVEMBER 27 n Earn certificates of attendance for Cervical Spondylotic Professional Development DECEMBER 25 – a variety of other disciplines Myelopathy: Diagnosis, The Future of Digital CANCELED DUE TO Natural History and Health HOLIDAY Treatment Cam Patterson, M.D., MBA LearnOnDemand.org Samuel Overley, M.D. UAMS Chancellor For information on LearnOnDemand, Department of Special Venue: I. Dodd contact: [email protected] or Orthopaedic Surgery Wilson Building Lecture 1-855-234-3348. Hall, Room 226 Special OCTOBER 30 Location! To request speakers or topics or to learn Professional Development more about how the UAMS Physician The Patient Experience Relations & Strategic Development team Stephen A. Dickens, J.D., can help you, visit UAMShealth.com/MD FACMPE SVMIC

In support of improving patient care, University of Arkansas for Medical Sciences is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the health care team. The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 ANCC contact hour. Nursing contact hours will be awarded for successful completion of program components based upon documented attendance and completion of evaluation materials.