By Katrina Dupins

May. 10, 2019 | A group of women gathered inside a commercial kitchen in Little Rock recently for a UAMS-led culinary medicine cooking class.

Culinary medicine is the practice of helping patients use nutrition and good cooking habits to restore and maintain health. UAMS is developing a culinary medicine program for health profession

students, but this is the first time a class like this has been offered to the community.

Taria Lightner, who works in UAMS nutritional services, served as the chef for the evening. She is a student at the University of Arkansas – Pulaski Technical College Culinary Arts and Hospitality Management Institute.

Laura Norman, a registered dietitian, also offered her expertise. Norman works with patients in the UAMS Fertility and Reproductive Endocrinology Clinic on Mondays and Tuesdays. She organized meal planning for the class and led nutrition discussions.

Lightner started class with the basics: emphasizing the importance of clean hands and sanitized surfaces. Then she showed the students proper techniques for chopping onions and mincing garlic.

Gloria Richard-Davis, M.D., professor and director of the Division of Reproductive Endocrinology and Infertility in the UAMS College of Medicine’s Department of Obstetrics and Gynecology, organized the class as an outreach aimed toward patients with polycystic ovarian syndrome (PCOS), a hormonal disorder that affects one in 10 women of reproductive age. It is a common and treatable cause of infertility. Richard-Davis is board certified in reproductive endocrinology and infertility. She has been working as director of the culinary medicine program.

Women with PCOS often have higher than normal insulin levels, Richard- Davis said. A diet high in refined carbohydrates can make insulin resistance more difficult to control.

A recent study showed that the DASH (Dietary Approaches to Stop Hypertension) is beneficial to patients with PCOS. The DASH diet is very similar to the Mediterranean diet, but adapted to American taste.

After the eight students practiced chopping and mincing, they separated into three groups. Each group would make one item on the menu. They prepared white fish with a chimichurri sauce, brown rice pilaf and a roasted vegetable medley.

UAMS has adopted the culinary medicine curriculum created by Timothy Harlan, M.D., executive director of the Goldring Center for Culinary Medicine at Tulane University. The Goldring Center, which opened in 2013, is the first culinary medicine center in a U.S. medical school. Since then, several schools across the country have adopted Tulane’s curriculum.

“They licensed their courseware to about 52 academic institutions,” Richard Davis said, “There was a collaborative effort among those academic institutions to do research to understand how to better teach patients the appreciation for food as medicine, or as the curriculum says ‘health meets food.’”

“Good nutrition is important to overall health,” Kaylee Lutrell, APRN, told the class. “When it comes to infertility a healthy diet is an important factor.”

Lutrell works in the fertility and endocrinology clinic with Richard-Davis. The class was one way the clinic commemorated Infertility Awareness Week.

“While a healthy diet won’t solve all infertility, it is certainly an added benefit we want all our patients to practice,” she said.

The amount of rainbow colors on a plate is another good indicator your food is nutritious, Lighten told the class.

Once the fish and vegetables were in the oven, and the rice was simmering on the stove, the women cleaned their prep areas and discussed how they could use their newly acquired knowledge.

Angel Smith of Little Rock, one of the students, lives with PCOS and is a patient of Richard-Davis. Smith has been on a weight loss journey and has changed her eating habits to include more fish and seafood.

“When I found out about this class, I thought it could give me more insight on meal ideas,” she said. “The food turned out wonderfully and has a good flavor.”

By Amy Widner

Physician-scientist Donald J. Johann Jr., M.D., has been awarded a $1.47 million grant from the Food and Drug Administration (FDA) to continue a clinical trial to determine if new approaches can be developed to monitor and screen for lung cancer with a blood test.

Johann is an associate professor in the departments of Biomedical Informatics and Internal Medicine in the College of Medicine at the University of Arkansas for Medical Sciences (UAMS).

“We’re coming into the long-promised ‘future’ of cancer treatment,” Johann said. “For the last 50 years, the holy grail of cancer research has been being able to detect the presence of cancer with a simple blood test, known as a liquid biopsy, and treat cancer patients on an individualized basis, which is precision medicine.

“Recent advancements in genetic sequencing technology, computational science and the ability to manage massive amounts of data have made this type of research possible,” he said. “The vision is to combine the power of these approaches with clinical knowledge to improve outcomes. This is the future of cancer medicine, and it’s all doable.”

An innovative and important aspect of this approach is called bioinformatics, a new field in research that uses computational tools to assess medical and public health information, often on a large scale, looking for previously unrecognized patterns that can affect medical and public health science in a broad range of ways.

Lung cancer is the leading cause of cancer-related deaths in the United States and the world, and the incidence in Arkansas has been higher than the national average for the past 20 years.

Researchers believe precision medicine is key to changing these statistics. The current standard treatment for early stage lung cancer is surgical removal of the tumor, with the addition of chemotherapy/radiation when the cancer has spread to nearby lymph nodes. However, the cancer often returns after two to the three years and is deadly.

With Johann’s clinical trial, the surgeons are taking samples of the tumor at the time of its removal. Back in the lab, Johann’s team is running genetic sequencing on the tumor and re-growing it using different methods. Once the sample tumors are big enough, the team tests existing drugs and novel combinations of existing drugs on the tumors to find the most effective treatment.

This information is analyzed and stored so that if that individual patient’s cancer comes back, their doctors will know the best medicines to use. The information is also compiled in large datasets so that researchers can look for aggregate patterns and identify trends regarding which treatments work best for different types of tumors. The idea is that now scientists will be able to genetically test a tumor to identify the best course of treatment for that individual patient.

Liquid biopsies are important because the average diagnosis for lung cancer patients is about age 70. Patients are often in poor health in addition to battling cancer, and traditional invasive biopsies can lead to complications or death.

Patients in Johann’s clinical trial are giving blood samples at multiple stages of treatment. The research team is determining whether the cellular material shed by tumors into blood can help doctors detect cancer earlier and monitor patients during cancer treatments to improve outcomes. Again, compiling big datasets plays a role.

The liquid biopsy part of Johann’s lung cancer work is also being supported by the Blood Profiling Atlas in Cancer (BloodPAC), a nonprofit consortium for data sharing between stakeholders in industry, academia and regulatory agencies with the goal of making liquid biopsies a reality.

BloodPAC is also supporting liquid biopsy clinical trials at Memorial Sloan Kettering Cancer Center for prostate cancer, University of Southern California for breast cancer, and University of Pennsylvania for pediatric cancers.

“The collaborative element to this is very important. We are working with three very prestigious, NCI-comprehensive cancer centers to accelerate the development of liquid biopsies for cancer treatment guidance and less invasive clinical care,” Johann said. “We want to catch disease early and operate on it for cure, be able to monitor it effectively, develop model systems effectively and then look at potential therapies to see what would be the best treatment for each patient, instead of just giving everyone the standard treatment.

“The practice of clinical oncology is rapidly changing, and we need to be part of that and contribute. When I came to UAMS, I believed we should be able to do state-of-the-art cancer research and treatment here. I’m proud to be part of this science, the teamwork and potential for our patients.”

Johann’s work on lung cancer has been underway for three years. During previous phases, his team developed the advanced bioinformatics and infrastructure at UAMS that are necessary to handle the large datasets involved in this research, and he brought firsthand knowledge of the latest molecular technologies to UAMS.

Johann completed fellowships in hematology oncology and clinical proteomics, both at the National Institutes of Health in Bethesda, Maryland. Johann earned his medical degree at Case Western Reserve University in Cleveland, Ohio. He became a physician as a second career, prior to attending medical school he was an engineering group leader for the Unisys Corp. and worked on advanced avionics projects.

By Amy Widner

A group of College of Medicine freshmen recently went toe-to-toe with some of the leading medical schools in the nation. Their weapon of choice? The ultrasound.

Morgan D. Sweere, Hayden Scott and Mason Sifford competed in SonoSlam, hosted by the American Institute of Ultrasound Medicine and National Ultrasound Interest Group, on April 6 in Orlando, Florida.

It was the first time for a UAMS team to compete. They made it into the second round, beating 14 other groups to make it to the top 10.

“This is a great accomplishment,” said Kevin D. Phelan, Ph.D., co-director of the Division of Clinical Anatomy at UAMS. “These guys did really well for our first-ever team.”

Most of the other teams were made up of students in their third and fourth years of medical school, and the competition included more diagnosis than the freshmen have learned at this point in their training. However, they were able to hold their own because of their technical skills with ultrasound.

“There were some big schools, like Dartmouth and Yale, and most of the teams were fourth years who had already matched into residency. So for us to compete against them was kind of like — wait, are we supposed to be here?” Scott said. “But then we kept getting great feedback that we had some of the best technical skills of the competition. So that was really encouraging to know — yes, we do belong among this group of prestigious schools. It was nice to feel like we really were able to represent our program on a national scale.”

Medical students at UAMS use ultrasound in a longitudinal ultrasound curriculum to reinforce anatomy during the first two years of medical school.

As a result, the UAMS team discovered they are ahead of their peers when it comes to their ultrasound skills. Sweere and Sifford are both interested in emergency medicine, where ultrasound plays a big role.

“I think one of the coolest things was realizing that I’ll be able to use these skills I’m developing now every day in my future practice,” Sweere said. “I also feel like studying for the competition put us ahead in that we got to form relationships with the attending physicians and the residents here at UAMS. We even got to attend an ultrasound lecture that was intended for residents.”

Sifford agreed.

“We got to practice ultrasound in a way that showed us not only the importance of ultrasound in clinical medicine, but how much we’ve learned over the past year and how we’re able to apply all that knowledge together to show a full clinical picture and treat patients,” he said.

Scott said he left the experience feeling like UAMS medical students are on the cutting edge.

“I think among our generation of upcoming doctors, it will become more prevalent in a lot of different fields,” Scott said. “I think that’s a good thing. Ultrasound is applicable for pretty much any field if you expand your thinking a little bit and know enough to harness its potential.”

The team received funding from the College of Medicine and from the College of Medicine Parents Club to travel to the competition.

By Amy Widner

Gwen Childs, Ph.D., of the University of Arkansas for Medical Sciences (UAMS), is the 2019 recipient of the highest award offered by the national Histochemical Society.

Childs is a professor and chair of the Department of Neurobiology and Developmental Sciences in the UAMS College of Medicine. She received the George Gomori, M.D., Ph.D., Award, which recognizes outstanding contributions to the field of histochemistry and cytochemistry. It is presented every four years.

She received the award on April 7 at the Histochemical Society Symposium at the interdisciplinary Experimental Biology 2019 meeting in Orlando, Florida. The following morning, she delivered a talk on the history of immunocytochemistry through modern discoveries titled, “Immunocytochemistry: Challenging Paradigms to Illuminate New Discoveries in the Pituitary.”

In histochemistry, scientists use stains, indicators and microscopes to identify and study chemicals in biological tissue.

Childs began her research in the immunohistochemistry field as a graduate student in the early 1970s and continued this focus through the 1990s. Her laboratory originally developed novel histochemical and immunohistochemical approaches to identify and unravel the mystery of multipotential pituitary cells, challenging paradigms of the day. Current studies focus on how the metabolome communicates with pituitary cells.

By Tim Taylor

The Addiction Research Training Program at UAMS was recently awarded $2.1 million from the National Institute on Drug Abuse (NIDA) to renew the program another five years as researchers work to become leaders in the field of addiction science.

The award marks the second time the program has been renewed by NIDA, part of the National Institutes of Health (NIH), since it began at UAMS in 2009. The program has received a total of $6 million in NIH funding. The award provides stipends as well as tuition and training-related and travel expenses for eight to 12 trainees in the area of addiction research.

Seen as a response to the rapidly changing landscape of drug abuse, the program has brought in more than 60 young researchers looking for solutions to an ever-increasing problem. Pre-doctoral students, postdoctoral fellows, medical students and residents, and summer interns have all become part of the program’s diverse approach to translational training in addiction. The trainees have relied on more than 20 faculty mentors from three colleges, six departments and two institutes at UAMS to provide them with the tools to become leaders in the field of addiction science.

“This program is a wonderful tool and a huge boon to UAMS,” said Clint Kilts, Ph.D., director of the Brain Imaging Research Center and head of the program since 2012. “We’ve built a network of mentors, which allows us to provide multiple perspectives to the trainees. They have allowed these young people to challenge conventional thinking when it comes to addiction.”

The NIDA addiction research training program is one of only two NIH T32 awards in Arkansas, the other one housed within the Department of Pharmacology and Toxicology in the UAMS College of Medicine. NIDA funds 55 similar T32 training programs across the country.

“The T32 is a wonderful career development tool designed to create well-trained scientists who are increasingly placed in leading academic faculty positions,” said Kilts, also a professor in the College of Medicine Department of Psychiatry.

Kilts said 14 former program trainees have gone on to become faculty members, including six at UAMS.

One of these is UAMS’ Corey Hayes, Pharm.D., Ph.D., an assistant professor in the Department of Psychiatry. Hayes is overseeing the UAMS AR-IMPACT (Improving Multi-disciplinary Pain Care and Treatment) program. AR-IMPACT is a partnership with UAMS, the Arkansas Department of Health and the Arkansas State Medical Board working with the state’s physicians to reduce their patients’ dependence on opioid painkillers.

“The program gave me protected time to form and mold state and national level collaborations that have accelerated my career trajectory,” said Hayes. “It also exposed me to many areas of addition research, providing a solid foundation in the work being done to combat addiction.”

Kilts, along with the program’s associate co-directors, Michael Cucciare, Ph.D., of the Department of Psychiatry, and Bill Fantegrossi, Ph.D., of the Department of Pharmacology and Toxicology, has seen the program expand into a rapidly responding model based on translational research opportunities.

“It’s the unique trainee outcomes that matters in the end,” said Kilts. “The participants are very team oriented and that will help them build significant collaborative teams in the future capable of providing prevention and treatment solutions for the immense public health problem posed by addiction.”

The UAMS NIDA T32 training program is unique in that it relies on a connected network of 25 faculty members from six departments at UAMS — Psychiatry, Pharmacology and Toxicology, Pharmacy Evaluation and Practice, Pharmaceutical Science, Neurobiology and Developmental Neuroscience, and Health Behavior and Health Education, to mentor the young research scientists.

Sara Tariq, M.D., has been named to the newly established position of associate dean for student affairs in the College of Medicine at the University of Arkansas for Medical Sciences (UAMS).

Tariq is well-loved among UAMS medical students as a compassionate educator and mentor. She is also a nationally recognized leader in medical education and an exceptional physician who teaches by example.

Tariq joined the faculty in 2002. She is a professor of internal medicine and has served as assistant dean for undergraduate clinical education since 2009. She will continue to lead this area as well as serve as medical director of the Center for Clinical Skills Education.

“Dr. Tariq has been integral to many educational initiatives in the College of Medicine, including development of our clinical skills education programs, integration of clinical experiences in the first two years of the curriculum, creation of our Academic Houses, and teaching-focused faculty development,” said Christopher T. Westfall, M.D., dean of the College of Medicine and executive vice chancellor at UAMS. “She is devoted to patients and students alike and brings her remarkable energy to her role as associate dean for student affairs.”

Tariq received her medical degree from UAMS in 1998. She completed her internship and residency in internal medicine at Brown University in Providence, Rhode Island. She served an additional year as chief resident and then joined the UAMS faculty. She was promoted to associate professor in 2008 and was promoted to professor in 2018.

Tariq’s national honors include the prestigious Herbert S. Waxman Award for Outstanding Medical Student Educator from the American College of Physicians in 2010 and being selected for the Hedwig van Ameringen Executive Leadership in Medicine fellowship at Drexel University, which she completed in 2015-2016. In Arkansas, colleagues in the American College of Physicians (ACP) presented Tariq with the Robert Shields Abernathy ACP Laureate Award for Excellence in Internal Medicine in 2013.

Tariq has earned many teaching awards at UAMS, including numerous annual consecutive Golden Apple, Gold Sash and Red Sash awards from students. She has been invited by the graduating class to deliver the Faculty Charge at Honors Convocation eight times. In 2013 Tariq received the Outstanding Woman Faculty Award from the UAMS Women’s Faculty Development Caucus. She received the Leonard Tow Humanism in Medicine Award from the College of Medicine in 2014 and has been the recipient or co-recipient of other faculty honors, including Educational Research and Educational Innovation awards.

Larry Hartzell, M.D., an associate professor in the Department of Otolaryngology-Head and Neck Surgery in the UAMS College of Medicine, was invested in the Benjamin and Milton Waner, M.D., Endowed Chair in Pediatric Facial Plastic and Reconstructive Surgery at Arkansas Children’s Hospital (ACH) on April 24.

“It was an honor to recognize Dr. Larry Hartzell as the chair holder of the Benjamin and Milton Waner, M.D., Endowed Chair in Pediatric Facial Plastic and Reconstructive Surgery,” said Marcy Doderer, FACHE, president and CEO of Arkansas Children’s. “Every day, Dr. Hartzell and the Otolaryngology team deliver our patients and their families a better today and a healthier tomorrow.”

“UAMS proudly celebrates Dr. Hartzell for his expertise and his passion for the highest quality of medicine that changes children’s lives,” said UAMD Chancellor Cam Patterson, M.D., MBA.

Hartzell received his medical degree from the University of Arizona College of Medicine in 2005. He completed his residency in otolaryngology at UAMS and continued his training with a fellowship in pediatric otolaryngology, including an extensive focus on the comprehensive care of cleft patients at ACH. He has directed the cleft lip and palate team and the velopharyngeal insufficiency clinic at ACH since 2012.

Hartzell is board certified by the American; Board of Otolaryngology-Head and Neck Surgery. He is active on multiple local and national committees as well as in research and education. His major research interests include cleft lip and palate, velopharyngeal insufficiency, hemangiomas and surgical management of hearing loss and otologic disease.

He is a member of numerous medical organizations including the American Academy of Pediatrics, the American Cleft Palate-Craniofacial Association, the American Academy of Facial Plastic and Reconstructive Surgery, and he American Academy of Otolaryngology, Head and Neck Surgery.

The Benjamin and Milton Waner, M.D., Endowed Chair in Pediatric Facial Plastic and Reconstructive Surgery was established in 2001 with a generous contribution by an anonymous donor.

Service. Innovation. Selflessness. Gratitude. These were some of the words used as the UAMS College of Medicine honored faculty and staff members for exemplary service and accomplishments in education, research and clinical care at the ninth annual Dean’s Honor Day ceremony on April 24.

“For me, this is one of the most rewarding events of the year,” UAMS Executive Vice Chancellor and College of Medicine Dean Christopher T. Westfall, M.D., FACS, told faculty and staff members, families and other guests in the Fred Smith Auditorium on the UAMS campus.

“It is a time to pay tribute to some of those who have excelled in their work and service to our college,” he said. “I also want to take this opportunity to express my gratitude to all of our faculty and staff who pursue excellence on a daily basis. It is a privilege to be a part of the College of Medicine team.”

G. Richard Smith, M.D., was presented the Distinguished Faculty Service Award for his decades of leadership in psychiatry and dedicated service in many other roles, including dean of the college in 2013-2015.

“Dr. Smith has served in a number of leadership positions and has been excellent in every single one,” Westfall said before joining with Smith’s nominator, Jeff Clothier, M.D., in presenting the award. He added, “Dr. Smith set the bar for what a dean should be.”

Smith thanked his family and colleagues after Westfall and Clothier discussed his broad service and impact and presented him with an art glass bowl by Arkansas artist James Hayes to commemorate the honor.

“This afternoon I am especially grateful to all of the men and women who work alongside me in the college,” Smith said. “It is both an honor to work with you and an honor to work with you to serve the important needs of the people of the state of Arkansas. This place and its people are truly amazing.”

A 1977 UAMS graduate, Smith joined the Department of Psychiatry in 1981. He became the Marie Wilson Howells Professor and Chair of Psychiatry in 2001. The highly regarded UAMS Psychiatric Research Institute (PRI) opened under his leadership in 2008, bringing comprehensive inpatient and outpatient care, research and education together in one location.

“Rick’s perseverance can be seen – literally – in the building that houses our department, the Psychiatric Research Institute,” said Clothier, a professor and executive vice chair of the department and medical director of PRI. “He labored for years to raise the funds to build PRI, along with its expert staff, and to raise public awareness of why the institute was so crucial for Arkansans and for those who may come to Arkansas for treatment here.”

“Dr. Smith’s commitment to PRI and our faculty and staff has been matched only by his dedication to improving the quality of training that we provide, and hence also the quality of care that is provided outside of UAMS,” Clothier said.

After 32 years in the Department of Psychiatry, Smith was appointed executive vice chancellor of UAMS and dean of the College of Medicine in 2013. He stepped down in 2015 to return to the department where he had dedicated so much of his career. He was once again appointed department chair and PRI director in 2018.

Smith founded several nationally renowned research initiatives, including the Central Arkansas Veterans Healthcare System’s Health Services Research and Development Field program for Mental Health and the Center for Outcomes Research and Effectiveness in the Department of Psychiatry. He was also the founding director of the Arkansas Center for Health Improvement and a leader in securing the state’s tobacco settlement and its focus on improving health care for Arkansans.

Clothier noted Smith’s positive impact through numerous other leadership roles, including his current leadership of the Advisory Board for the Arkansas Prescription Drug Monitoring Program and service as medical director for the Arkansas Department of Health’s Substance Misuse and Injury Prevention Branch. Smith works with the Arkansas Medical Society and other organizations in an effort to change physician behavior about opioid prescribing while still ensuring adequate pain relief for patients.

The ceremony included 12 individual awards for faculty and staff; recognition of 58 faculty members receiving promotion in rank or promotion with tenure and six faculty members who were named Professors Emeritus; and the investiture of the sixth Lutterloh Professor for Medical Education Excellence.

In addition to Smith, Faculty Award recipients were:

Master Teacher Award

Robert Arrington, M.D.
Department of Pediatrics

Educational Innovation Award

Kedar Jambhekar, M.D., and Linda Deloney, Ed.D.

with appreciation for Rachel Pahls, M.D. (medical resident)
Department of Radiology

Educational Research Award

Carol Thrush, Ed.D.
Department of Surgery, COM Graduate Medical Education

Excellence in Research Award

Nicola Edge, Ph.D.
Department of Family & Preventive Medicine

Leonard Tow Humanism in Medicine Award
Presented by the Arnold P. Gold Foundation

Michael Mancino, M.D.
Department of Psychiatry

Residency Educator Awards

Jerad Gardner, M.D., Dermatopathology Fellowship

Shashank Kraleti, M.D., Family Medicine Residency

Investiture of the Lutterloh Medical Education Excellence Professorship

David Davies, Ph.D.
Department of Neurobiology & Developmental Sciences

Read more about the 2019 faculty award honorees.

Staff Excellence Award recipients were:

Education
Lacie Covington, M.B.A.
Department of Radiology

Research
Shalese “Fitz” Fitzgerald, M.S.
Department of Family & Preventive Medicine

Clinical
Andrea Easom, M.N.Sc., APRN
Department of Internal Medicine/Division of Nephrology

Administration
Paul Stover, M.B.A.
Department of Orthopaedic Surgery

By Tim Taylor

The UAMS Medical Center, four UAMS physicians and a UAMS researcher were honored April 24 as Healthcare Heroes at a luncheon to recognize individuals, companies and organizations making a significant impact on the quality of health care in Arkansas.

It was the fourth year for the event, sponsored by the Arkansas Business Publishing Group and held at the Embassy Suites hotel in Little Rock.

The UAMS Medical Center was named Large Hospital of the Year.

“We are incredibly honored by this recognition,” said Richard Turnage, M.D., UAMS vice chancellor for clinical programs and CEO of the UAMS Medical Center. He thanked UAMS faculty “who have worked hard to develop a platform to deliver high-quality care” throughout the state.

College of Medicine faculty that were honored included:

Ronda Henry-Tillman, M.D., division chief of Breast Oncology in the Department of Surgery, was named Physician of the Year. Henry-Tillman holds numerous leadership positions at UAMS, including co-director of Health Initiatives and Disparities Research in the College of Medicine and is co-leader of the Breast Tumor Disease Oriented Committee in the Winthrop P. Rockefeller Cancer Institute. She also holds the Muriel Balsam Kohn Chair in Breast Surgical Oncology.

Henry-Tillman is a breast cancer surgeon and advocate for the medically underserved, as well as an advocate for screening, detection and treatment of colorectal, breast, prostate and cervical cancers.

Purushottam Thapa, M.D., medical director of the Student Wellness Program at UAMS, was  named Workplace Wellness Hero. He makes sure that counseling and therapy are provided to medical students, resident staff physicians and their spouses seeking help with emotional and mental health issues.

Lowry Barnes, M.D., chairman of the Orthopaedic Surgery Department and director of the Musculoskeletal Service Line, was named Healthcare Administrator of the Year. In addition to being a nationally known knee replacement surgeon, his leadership has turned the UAMS Department of Orthopaedic Surgery into a program that attracts world-class patients.

Other College of Medicine finalists from UAMS were John Day, M.D., chairman of the Department of Neurosurgery, for Physician of the Year; Gloria Richard-Davis, M.D., a professor in Obstetrics and Gynecology, for Women’s Health & Wellness; and Hari Eswaran, Ph.D., professor in the Department of Obstetrics and Gynecology, for Innovation Hero.

By David Wise

Researchers at the University of Arkansas for Medical Sciences (UAMS) have demonstrated that a culturally adapted family model of diabetes self-management is an effective approach for Marshallese community members in Northwest Arkansas to manage diabetes.

A recently published study by researchers at the UAMS Northwest Regional Campus showed that by using cultural concepts familiar to Marshallese people with diabetes, researchers recorded significant improvements in their levels of blood sugar.

Multiple studies have found diabetes self-management education (DSME) to be generally effective at improving patients’ diabetes-related health outcomes. However, previous DSME interventions with Marshallese community members have been unsuccessful.

The researchers hypothesized that emphasizing family and community as a part of diabetes self-management would be more effective with members of the Marshallese population, who come from a Pacific Islander culture that emphasizes the importance of family and community in day-to-day life.

To test this hypothesis, the researchers recruited 221 Marshallese people with diabetes and compared a standard DSME with a culturally adapted DSME. Changes to the curriculum included presenting the material in Marshallese rather than using an interpreter; using culturally appropriate nature analogies, such as tidal changes, to explain changes in glucose concentrations; integrating culturally relevant food preferences, such as fish and fruit; and emphasizing engagement of participants’ family members.

As a result, participants in the adapted DSME group showed significantly greater reductions (-0.77% units) in mean glycated hemoglobin 12 months after the intervention compared with those in the standard DSME group. Glycated hemoglobin tests reflect a person’s average blood sugar level over the past two to three months. Specifically, these tests show the percentage of hemoglobin – a protein in red blood cells that carries oxygen throughout the body – that is coated with sugar (glycated). The higher your HbA1c level, the poorer your blood sugar control and the higher your risk of diabetes complications.

“This study adds to the body of research that shows the effectiveness of including participants’ family and community members as part of a diabetes self-management plan,” said Pearl McElfish, Ph.D., vice chancellor of the UAMS Northwest Regional Campus and co-director of the Center for Pacific Islander Health at UAMS. “This study also fills several important gaps in the literature. Pacific Islanders are a rapidly growing population that experiences significant health disparities, but they have been underrepresented in research. We plan to change that.”

Health care providers have worked for years to help control the extremely high rates of type 2 diabetes found in the Marshallese population. Estimates of type 2 diabetes among Marshallese adults range from 20%-40%, compared with 12% among the U.S. adult population and 9% among the worldwide adult population. In Northwest Arkansas, type 2 diabetes among Marshallese adults is at 38.4% and prediabetes is at 32.6%. Arkansas has the largest population of Marshallese in the continental U.S. (10,000 residents as of 2016).

“These research results are likely to have positive clinical implications for diabetes self-management, including reduced risks of heart attack, microvascular complications and death from diabetes,” said Peter O. Kohler, M.D., former vice chancellor for the UAMS Northwest Regional Campus and a distinguished professor in the UAMS College of Medicine’s Department of Internal Medicine. “We are excited about the promising implications this study has for patient decision-making and clinical practice.”

The study was conducted from May 2015 to May 2018 in Washington and Benton Counties in Northwest Arkansas. Both DSME interventions covered eight core topics: healthy eating, being active, glucose monitoring, understanding blood glucose and taking medications, problem solving, reducing risks and healthy coping, mitigating complications of diabetes, and goal setting.

“Marshallese culture centers around family and community,” said Sheldon Riklon, M.D., an associate professor in the UAMS College of Medicine’s Department of Family and Preventive Medicine and one of only two Marshallese physicians in the world who were trained at a U.S.-accredited program. “So it is extremely important to engage the entire family and community in behavioral changes. The family approach is particularly important for the family-centered, collectivist nature of the Pacific Islander culture.”

An online copy of the study can be found here: http://care.diabetesjournals.org/content/diacare/early/2019/03/04/dc18-1985.full.pdf.

Financial support for the study was provided by the Patient-Centered Outcomes Research Institute (grant no. AD-1310-07159). Initial funding for a pilot project of the study was provided by a University of Arkansas for Medical Sciences College of Medicine Intramural Sturgis Grant for Diabetes Research from the Sturgis Foundation. Additional support for the community-based participatory research team was provided by the Translational Research Institute grant 1U54TR001629-01A1 through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.