February 2016 Grand Rounds

@font-face { font-family: "Cambria Math"; }@font-face { font-family: "Calibri"; }@font-face { font-family: "Baskerville"; }@font-face { font-family: "AvenirLTStd-Black"; }p.MsoNormal, li.MsoNormal, div.MsoNormal { Adolescents Stress More with Poor Sleep

A new study from UAB indicates that adolescents who experience sleep problems and longer sleep duration are more reactive to stress, which could contribute to academic, behavioral and health issues.

Existing studies show that nearly 70 percent of U.S. adolescents do not receive sufficient sleep. It is also known that insufficient sleep contributes to cognitive problems and poor physical health over time, possibly because of disruptions in a key part of the neuroendocrine system that controls reactions to stress and regulates many body processes —the hypothalamic-pituitary-adrenal axis.

The relationship between sleep and the HPA axis has been studied in both children and adults; but little is known about this link during adolescence, which is a key period of time, as both sleep and the HPA axis are undergoing significant developmental changes related to puberty.

Sylvie Mrug, a psychology professor in UAB’s College of Arts and Sciences, and her colleagues from UAB and Arizona State University sought to further explore the relationship between sleep and reactivity to stress, specifically as it relates to HPA-axis activity, in adolescents.

The researchers examined two dimensions of sleep — sleep duration and sleep problems from the perspectives of adolescents and their parents, as well as cortisol levels before and after social stress. The team also looked at how the results varied based on gender.

“We looked at sleep patterns in urban African-American adolescents, due to information we understood from earlier research in the field,” Mrug said. “This particular population is more likely to experience insufficient sleep, and their functioning is more negatively affected by lower sleep quality, so we knew that finding results for this demographic could be especially important.”

84 adolescents with an average age of approximately 13 took part in the study. During their visit to the research lab, participating adolescents were given the children’s version of a common stress test, called the Trier Social Stress Test, to measure their physiological responses to stress. This test involves speaking and computing mental math problems in front of an audience. Saliva samples were taken from each participant in order to test cortisol levels before and after the stress test.

Participants then reported on their bed times and wake times and any sleep problems, such as insomnia, daytime sleepiness and general sleep quality, during a regular week. Parents of the adolescents were asked to report on their children’s sleep as well.

The adolescents most commonly reported the following sleep problems: the need for multiple reminders to get up in the morning, not having a good night’s sleep, feeling tired during the day, and not being satisfied with their sleep.

The researchers looked at the cortisol levels of the adolescent participants. Cortisol release during and after the stressful lab test was higher for adolescents who reported more sleep problems and longer sleep duration, and whose parents reported longer sleep duration.

“The result of higher cortisol levels in adolescents experiencing sleep problems was exactly what we expected to see,” Mrug said. “We were, however, surprised that longer sleep duration predicted a stronger cortisol response, because previous studies linked shorter sleep duration with higher cortisol levels. Generally, less sleep is related to poor outcomes, not the other way around. In this case, this unexpected result could be explained by considering that longer sleep duration does not necessarily reflect higher-quality sleep, but instead may serve as another indicator of sleep problems, at least among urban adolescents.”

The effects of sleep problems on greater cortisol release during stress were stronger in females than in males, suggesting that adolescent girls may be more sensitive to disrupted sleep.

“Overall, the results of our study confirm what we originally hypothesized — that sleep problems induce greater response to stress in adolescents,” Mrug said.


UAB Study Confirms Efficacy of Chlamydia Drug

In one of the most tightly controlled trials ever conducted of drugs used to treat sexually transmitted infections, researchers at UAB have confirmed that azithromycin remains effective in the treatment of urogenital chlamydia.

The research team compared two of the most commonly used medications for urogenital chlamydia — a single dose of azithromycin versus doxycycline given twice daily for seven days. Azithromycin had a cure rate of 97 percent, against a 100 percent cure rate for doxycycline.

“Recent studies have raised concerns over the efficacy of azithromycin, and there has not been a definitive, well-controlled randomized clinical trial of its effectiveness,” said William M. Geisler, MD, the principal investigator of the study. “For physicians, knowing whether azithromycin is an effective treatment option is important because patient adherence to therapy with doxycycline can be an issue. Azithromycin requires only one dose, while doxycycline requires patients to take multiple pills over seven days.

Geisler’s team enrolled 567 male and female subjects ages 12-21 with chlamydia residing in long-term, gender-segregated youth correctional facilities in Los Angeles. Half were given azithromycin and half doxycycline.

There were five treatment failures among those taking azithromycin and no treatment failures among the doxycycline group.

“The bottom line is that our results show that both medications are effective in the treatment of chlamydia, and that while azithromycin had a limited number of treatment failures, the adherence to the drug regimen is likely to be much greater with the single-dose drug as opposed to the multidose doxycycline,” Geisler said.


UAB Studying Impact of Ketogenic Diet on Cognition in Older HIV Adults

It is estimated that 59 percent of aging, HIV-positive adults demonstrate at least mild cognitive impairment. UAB School of Nursing Assistant Professor Shannon Morrison, PhD is exploring effects of a ketogenic diet — a high-fat, low-carbohydrate diet with adequate protein — in medically stable, older persons living with HIV who have mild to moderate neurocognitive impairment.

 “In studies that have been conducted so far, the ketogenic diet has shown some promising results in improving cognition in other neurocognitive disorders including Alzheimer’s, Parkinson’s and epilepsy,” Morrison said. “We’re hoping to see if similar results will occur to the older, cognitively impaired HIV population.

 A person consumes fewer than 50 grams of carbohydrates per day on a ketogenic diet. When the amount of carbohydrate the body has to process for fuel is limited, it will start to break down fat for energy and, as a byproduct of fat metabolism, produce the ketones. The body, including the brain, is then able to efficiently utilize ketone bodies for energy.

This randomized control trial will compare the effects of a 12-week ketogenic diet versus a patient-choice diet on cognitive function and cardiovascular risks in 20 older persons with stable HIV disease.

Half the participants will be randomly assigned to the ketogenic diet group and half to the patient-choice diet group. Baseline data will be collected as the starting point to look for changes that may be linked to improved cognitive function with the ketogenic diet. In addition, five members of the ketogenic group will undergo functional magnetic resonance imaging after 12 weeks to examine changes in neural activity.

“We hope the ketogenic diet will reduce systemic inflammation that may diminish heart and diabetes risks as well as improve cognitive performance in HIV-positive individuals,” Morrison said.

Morrison hopes the results of this study will lead to a larger clinical trial down the road and ultimately to solutions that will help improve neurocognitive performance in older HIV-positive patients.


Grandview Cancer Center Approved

The Alabama Court of Civil Appeals has unanimously approved Grandview Medical Center’s Certificate of Need for the relocation and consolidation of existing oncology services into a new, freestanding comprehensive Cancer Center.

 This decision follows a unanimous ruling from the CON Review Board in May 2015 granting Grandview a CON for the Cancer Center following a recommendation to approve the project by Administrative Law Judge Jim Ward. Brookwood Medical Center appealed the case to the Alabama Court of Civil Appeals where it has been pending since June 2015.

“This project will allow consolidation of radiation therapy and other oncology related services into a single site, comprehensive center on Grandview’s 280 campus,” said Grandview’s President and Chief Executive Officer Keith Granger. “We look forward to proceeding through the design and construction phase.”


BlueCross and BlueShield of Alabama Recognized

The National Committee for Quality Assurance (NCQA) awarded BlueCross and BlueShield of Alabama ‘Accredited’ status for service and clinical quality which meet the requirements of NCQA’s standards for consumer protection and quality improvement.

NCQA Health Plan Accreditation evaluates the quality of healthcare that health plans provide to their members. Additionally, NCQA evaluates how well a health plan manages all parts of its delivery system to improve the quality of care for its members.

“Earning ‘Accredited’ status from NCQA certifies that we are delivering excellent service to our members,” said Terry Kellogg, President and CEO of BlueCross and BlueShield of Alabama.


Brookwood and Baptist Network Hospitals Name New CFOs

Two hospitals in the Brookwood Medical Center/Baptist Health System network in central Alabama have selected new chief financial officers for their leadership teams.

Brandon Williams joins Brookwood hospital as CFO, succeeding Doug Carter, who was promoted to the market office to serve as chief financial officer in the combined healthcare company.

Williams joins Brookwood from East Cooper Medical Center in Mount Pleasant, South Carolina where he was responsible for oversight of the facility’s financial operations for the previous four years. Brookwood and East Cooper Medical Center are part of Tenet Healthcare. Williams has been with Tenet Healthcare for 12 years, serving in various finance roles in hospitals and at the corporate headquarters.

Amanda C. Dyle, who has more than 18 years of experience in healthcare financial management, joins Walker Baptist in Jasper as CFO. She succeeds John Langlois, who now serves as president of Walker Baptist.

Dyle most recently served as the chief financial officer at Coastal Carolina Hospital in Hardeeville, South Carolina. Prior to that, she served as assistant chief financial officer at the Atlanta Medical Center. She began her career with Tenet as controller at Northshore Regional Medical Center in Slidell, Louisiana. Dyle holds a Bachelor of Science degree in Business Administration from the University of Southern Mississippi and a Master of Business Administration from William Carey College.


Samford Online Nursing Graduate Programs Climb to 13th Nationally

Graduate programs in Samford University’s Ida V. Moffett School of Nursing vaulted into 13th place in new national rankings released in January by U. S. News & World Report. Samford moved up from number 24 last year and number 35 two years ago in the rankings.

Samford was the highest ranked program in Alabama and among its peers in the Southern Conference.

Online programs within the nursing school offer master’s level degrees in family nurse practitioner, nurse educator, and health systems management. Samford also offers the doctor of nursing practice as a distance learning degree, but doctoral programs were not factored in the latest U.S. News rankings.

Nursing school associate dean Jane S. Martin attributed the rise in Samford’s ranking to two factors.

“One is student engagement,” she said. “And a second factor is that our graduate faculty have all received certification in on-line instruction.”

”Our alumni rate the graduate faculty as highly accessible and invested in student success. We are proud of the exemplary programs we have developed and the graduates who go on to achieve their career goals.”

 The U.S. News rankings are based on five criteria: student engagement, faculty credentials and training, student services and technology, peer reputation, and admission selectivity.

Enrollment in Samford’s graduate nursing programs has increased significantly in the last decade, including more than 20 percent in the last five years with the availability of online courses and expansion of graduate programs as two of the factors in that growth.


Laura Crandall Brown Foundation to host Taste of Teal Gala

The Laura Crandall Brown Foundation will host its Taste of Teal Gala on Saturday, March 12 starting at 6:00 p.m. in the Cahaba Grand Ballroom. The annual event is one of the organization’s premier fundraisers, featuring a seated dinner and drinks, live and silent auctions, and casino games and live music.

Proceeds benefit GYN cancer research, awareness, and patient support.

Visit www.thinkoflaura.org/TasteofTeal for more information.

Hardin Named Assistant Administrator of Fayette Medical Center

Mary Ann Hardin, RN, MSN has been named assistant administrator for patient care services at Fayette Medical Center.

Hardin comes to FMC from Bevill State Community College, where she was the clinical nurse associate at the Hamilton campus. Before that, she was administrative director for patient care services at Marion Regional Medical Center in Hamilton.

Hardin has more than 30 years of experience in various departments of the hospital and home health. She has worked as an anesthetist assistant, nursing assistant, LPN and a registered nurse. Hardin returned to school to receive her BSN and completed her Master of Science Degree in nursing administration in 2005.


Jackson Thornton Healthcare Trainer Earns Designation

Rebecca Hanif, with Jackson Thornton, has earned the Certified Professional Medical Auditor (CPMA) designation.

Hanif, an AHIMA Approved ICD-10-CM/PCS Trainer, has worked in the healthcare industry for seven years. At Jackson Thornton, she assists multiple physician practices with process improvement on the Physician Quality Reporting System, Meaningful Use, and Coding Compliance. To achieve the CPMA designation, Hanif demonstrated expertise in the governmental guidelines for medical documentation, fraud, abuse and coding violations; quality assurance and coding risk analysis; and medical record auditing and coding concepts.


Grandview First in Birmingham with Newest da Vinci

Grandview Medical Center is the first hospital in the Birmingham area to upgrade its technology for robotic-assisted surgery to the newest da Vinci system.

The new system allows the surgeon to access some areas of the body, such as the chest or pelvis, which are difficult to reach with delicate surgical instruments. This new robot helps surgeon specialists do more procedures with a minimally invasive approach.

“The latest model of surgical robot is truly an upgrade in technology. This new machine allows us to expand our repertoire and offer minimally invasive surgery to our patients, which equates into quicker recovery,” said urologist Eric Brewer, MD.


Fogger Honored by International Nurses Society

UAB School of Nursing Associate Professor Susanne Fogger, DNP was recently honored by the International Nurses Society on Addictions (IntNSA) with its 2015 Education Award.

Fogger, the specialty track coordinator for the school’s primary care psychiatric nurse practitioner track and the co-program director for the Veterans Administration Nursing Academic Partnership for graduate education, has also recently been placed in two leadership positions within IntNSA as well.

A member of the IntNSA Board of Directors since 2013, Fogger was recently elected board secretary. She was also recently appointed to the editorial board of the Journal of Addictions Nursing, the official journal of IntNSA.


Hundreds of UAB physicians Named to Best Doctors List

Hundreds of the top physicians in the nation practice at the UAB Health System, according to the latest edition of the Best Doctors in America®.

The 2015 list recognizes 391 UAB physicians, the most in Alabama, in 38 specialties listed who are among the top five percent of clinicians in the United States, as voted by their peers.

In bringing together the best medical minds in the world, Best Doctors works with expert physicians from its Best Doctors in America list to help its 30 million members worldwide get the right diagnosis and treatment.

Best Doctors is an independent, knowledge-based medical referral service headquartered in Boston.

Nominations for the list are anonymous, and doctors’ evaluations are confidential, according to the company. The system of review, based on methodology started in 1989, includes catching and correcting bias for or against particular physicians or groups of physicians. Listings cannot be purchased.


UAB Provides Internship Opportunities to Students with Developmental Disabilities

High school students with developmental disabilities are receiving an opportunity to gain experience and employment through the UAB Health System.

Project SEARCH is a business-led, one-year, school-to-work program that takes place entirely at the workplace. Students participating with UAB are given internship opportunities in environmental services, food and nutrition services, central sterile supply, materials management, and many other areas.

“Total workplace immersion facilitates a seamless combination of classroom instruction, career exploration and relevant job-skills training through strategically designed internships,” said University Hospital Senior Associate Vice President Jordan DeMoss.

The internship program not only benefits the students, but allows UAB to train and recruit prospective employees.


First Surgery at St. Vincent’s One Nineteen

On January 29, St. Vincent’s One Nineteen completed the first surgery in its new outpatient surgery center. A Bone Anchored Hearing Aid (BAHA) implant was performed by Grayson Rodgers, MD. The BAHA is a medically implanted device to help patients with hearing loss who are not candidates for a traditional hearing aid.

This surgery is one of the many outpatient surgery options now available at St. Vincent’s One Nineteen, which include general surgery, ophthalmology, orthopedics, podiatry, plastic surgery, pain management, ENT and gynecology.


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