Chancellor Cam Patterson presented the 2024 Chancellor’s Award of Excellence for Clinical Innovation to Dr. Shashank Kraleti during the Town Hall on November 19.
Dr. Kraleti was honored for his collaborative work with the UAMS Office of Patient Experience in creating Patient and Family Advisory Councils (PFACs) in 16 of our clinics across the state. Chancellor Patterson congratulated Dr. Kraleti for being a strong advocate for Arkansas patients and for the team that serves them.
As we approach this holiday season, let’s take a moment to reflect on the importance of Gratitude in Life.
Gratitude is strongly related to wellbeing.
Some benefits of gratitude can be better sleep, better immunity, decreased stress, lower blood pressure, stronger relationships and greater life satisfaction.
Practicing gratitude places a focus on the present, thus helping to magnify positive emotions.
And Gratitude can have a domino effect -If a person experiences gratitude, they are more likely to reciprocate in the future.
Here are some ideas, ways to practice gratitude.
What are you grateful for this year?
The 28th Annual Family Medicine Update: Fueling the Front Line will offer up to 14 hours of online CME/CE Oct. 23–25 for primary care physicians, doctors of osteopathic medicine, advanced practice registered nurses, registered nurses, pharmacists, physician assistants, physical therapists, certified health educators, social workers and substance abuse counselors.
To register, visit https://cvent.me/4X75nd or call 501-686-6626 by Oct. 21.
The annual conference provides an opportunity for health care professionals to learn about the latest advances and information impacting family medicine.
The conference is completely virtual. The first day – All About Opioids – offers six hours of content for only $25. Thursday and Friday sessions are $20 each.
The first day is All About Opioids with talks from local and national experts on opioids, kicking off with Don Teater, M.D. He is a family physician from Denver who has focused on the intersection of pain, opioids and addiction and was medical advisor for the National Safety Council. Another nationally known speaker, Aaron Weiner, Ph.D., will offer ways providers can help those with substance use disorders when abstinence isn’t an option. A team from Boston Mountain Rural Health will give a behind-the-scenes look at how they integrated behavioral health into their clinics to help those with addiction and co-occurring mental disorders. Other speakers include Karen Burks, M.D., a family physician with the UAMS/Baptist Health family medicine residency program, and UAMS’ Bill Fantegrossi, Ph.D., who researches new psychoactive substances such as “bath salts” psychostimulants to amphetamine-like dietary supplements. Kristin Martin, D.O., founder of River Valley Medical Wellness, is bringing her team to talk about their mobile opioid recovery unit which treats patients with substance use disorder in areas where help is scarce.
Talks on the second day will feature topics from UAMS providers on non-alcoholic fatty liver disease with Sheena Colclough, APRN, a syphilis update with Mitchell Jenkins, M.D., chronic kidney disease with Paige Beck, M.D., Ph.D., and Cassandra Fritz, M.D., an assistant professor with Washington University Medicine’s division of gastroenterology, who will speak on early onset colorectal cancer.
The third day of the virtual conference will focus on weight loss medications, presented by Bri Morris, Pharm.D., executive director of the Arkansas Community Pharmacy Enhanced Services Network, and UAMS’ Christopher Johnson, Pharm.D. Patty Harper, CEO of InQuiseek Consulting, will update attendees on Medicare news. The two afternoon sessions will feature pulmonary and cardiology updates with Steven Deas, M.D., a physician with the Central Arkansas Veterans Healthcare System, and UAMS’ Srikanth Vallurupalli, M.D.
Participants who attend the entire conference and complete all surveys will be eligible to attend the Family Medicine Spring Review in April at no cost.
Now that the weather is cooling down, let’s take a quick moment to enjoy the benefits of nature.
Did you know that exposure to nature can help to regulate our sympathetic nervous system?
Even a quick 5-minute walk or work break outside can improve our mental focus and moods.
Take a walk today, eat lunch outside, enjoy a quick break in the sunshine. Try a new outdoor activity like cycling, pickle ball, go for a hike in our amazing state parks. It really can make a difference!
Learn more about how nature can help to reduce stress and increase happiness:
Dr. Kraleti, Dr. Gibson-Oliver, and Dr. Jarrett are the authors of a brand new article in the journal Family Medicine.
Titled “The Importance of a Champion in Leading Major Improvements in Residency Programs,” the article addresses improvements in the numbers of pediatrics patients and procedures performed in the FMC.
It’s online ahead of print now, and it will be included in a monthly issue of the journal later this year.
Dr. Wayne Bryant Jr., Associate Director of the UAMS Little Rock Family Medicine residency program, recently appeared on KATV Channel 7 to discuss how to make sure kids are healthy and ready to return to school.
The video is available at this link.
Dr. Bryant is sought after by the local TV stations because he always does such a good job. We look forward to seeing him again soon.
Hidradenitis suppurativa (HS) is a skin disorder that starts with blocked hair follicles, leading to painful nodules, abscesses and scarring. Front-line providers can work with dermatologists to diagnose and treat this often debilitating condition by asking three questions and following a five-tiered approach to treatment.
Dr. Vivian Shi, former UAMS dermatologist and director of the hidradenitis suppurativa clinic, offered tips to family medicine providers at the UAMS 2024 Family Medicine Spring Review last April. She said, “It requires a multidisciplinary approach. An HS team including all of these specialists and dermatology providers are the principal providers, but we really lean on front-line providers … to detect, treat, refer and to collaboratively manage.”
Most of her HS patients have had it more than 10 years after having seen their providers at least five times, and around 15% are disabled or unable to work because of HS pain. Girls typically show signs in their early teens, and boys start in their mid to late teens. If the teen has severe acne, have the patient lift the arms to check for HS signs. The typical onset is between puberty and age 40, with women being three times more likely to be affected.
Three key diagnostic questions every provider must ask the patient:
1. In the last 12 months, did you repeatedly have big, painful nodules and boils in the armpits or groin?
2. Have you had outbreaks of boils in the last six months?
3. Do you repeatedly have outbreaks of big sores, painful nodules or boils that heal with scars in any of these locations?
If the answer is “yes,” there is a 90 percent chance of HS.
“There’s no reason healthcare providers should be missing this if they ask these questions,” said Dr. Shi.
HS can show up anywhere on the body – behind the ears, outer arms or legs – not just the skin folds and areas with sweat glands. The two exceptions are the palms and soles of the feet. It’s chronic, inflammatory and very painful. Initially, the patient will have inflamed nodules, abscesses, white heads and black heads. The more advanced stage includes draining sinus tracts (narrow channels) and severe scarring, which are especially true in Blacks. Often it is misdiagnosed as cellulitis.
HS is divided into three Hurley Stages. The mildest is Hurley Stage 1: Abscesses that resolve without any trace of scarring, but this is rare. As soon as the patient has any sign of a scar, it’s labeled Hurley Stage 2. This stage includes recurrent abscesses, sinus tracts and scarring, but normal-looking skin will appear between them. The most advanced stage is Hurley 3, characterized by multiple connected sinus tracts and abscesses across the entire area with little to no normal-looking skin between. She describes it as an “over-exaggerated inflammatory response where, over time, the hair follicles connect with each other and form sinus tracts and extensive scarring.”
Dr. Shi recommended a pyramid of treatment. The front-line provider can manage all the treatments except for biologics, the top tier. In early moderate to severe patients (late Hurley 1 to early Hurley 2), Dr. Shi suggested preparing patients for biologic therapy by prescribing oral antibiotics because payors typically require patients to fail 90-plus days of systemic antibiotics to qualify. Regardless of disease stage, providers should refer the patient to a dermatologist for advanced therapy, while collaboratively managing the patient.
Lifestyle Modification
The first tier of the pyramid is lifestyle modifications where the provider would screen for comorbidities and start treatments. In a recent JAMA Dermatology report, patients with HS said diet changes were the most used non-prescription treatment with the Mediterranean diet and intermittent fasting both being effective. The two exercises that HS patients can tolerate are Pilates and swimming. Weight loss surgery is also a strong consideration if the patient is greater than 35 BMI, and if the patient smokes, encourage them to quit since cigarette smoke has dioxin-like compounds that can cause acne and scarring. Loose-fitting clothing and anti-chaffing products applied in skin folds can reduce friction and pain.
If the patient has draining sinus tracts, bathing helps to rinse out the tunnels. Dr. Shi recommends alternating daily with 10-minute baths of Epsom salt, CBD oil and ¼ cup 6% commercial bleach which help with pain, itch, relaxation and decrease biofilm.
Topicals
The next level is topical treatments. She typically uses clindamycin 1%; however, resorcinol 15% elicits a better response in mild to moderate HS. Resorcinol is especially helpful because it breaks down the outer layers of the skin and unplugs the hair follicles. There are also washes such as benzoyl peroxide, chlorhexidine or dapsone. Dr. Shi cautioned against benzoyl peroxide wash used together with topical dapsone because they’ll have reversible yellowing of the hair follicles.
Oral Antibiotics
Dr. Shi’s office typically starts with the tetracycline family because it’s better at reducing inflammation in the hair follicle and less costly. She recommends 100 milligrams of doxycycline or minocycline twice daily or extended release minocycline at a weight-adjusted dose once a day for eight to 12 weeks. Dr. Shi cautioned that dosage may need to exceed 100 milligrams for it to work, so ensure the patient doesn’t have anemia. She uses this for flare-ups or to bridge to biologic therapy.
Rotating through combined systemic antibiotics also works, being careful not to extend beyond three months. One combination is clindamycin with rifampin. A second choice is rifampin with moxifloxacin and metronidazole, which is especially helpful for drainage. And one thing providers want to consider is to stop the metronidazole after six weeks because longer use can cause reversible peripheral neuropathy.
Certain supplements also should be considered. Persons with HS typically have lower serum zinc levels. Prescribing 100 – 200 milligrams of daily zinc (with copper included after two months) has shown to reduce HS severity in 80% of patients. Another supplement to consider is Vitamin D since most patients with HS are deficient. Vitamin D regulates hair cycle and skin cell activity.
Hormonal Treatments
Dr. Shi recommends these hormonal / metabolic therapies:
Biologics
Biologics is the last step of treatment. Dr. Shi said providers should learn the basics of biologics so they can explain how it works before they refer to a dermatologist. The patient must be on at least 90 days of an oral antibiotic before most insurance will allow biologics.
Dr. Shi’s takeaways:
Diane Jarrett Ed.D., M.A. has had a letter to the editor published online ahead of print in JAMA Ophthalmology.
Dr. Jarrett writes in response to a previous article about the need for vision screening for children from socioeconomically vulnerable groups, giving her personal take on being a child who benefited from free school-based vision screening.
View the online article. The print edition will be available in July.
The DFPM was well-represented at the Society of Teachers of Family Medicine’s annual spring conference, which this year was held in Los Angeles. DFPM offerings included:
A Completed Project by Dr. Leslie Stone, Dr. William Ventres, and Dr. Julia Roulier titled “Philosophy of Family Medicine (An Update) –Teaching the Principles and Role of Family Medicine During the Junior Clerkship.” (They are pictured above, along with Dr. Wayne Bryant Jr. on the left and Dr. Stephen Foster on the right.)
A Scholarly Topic Roundtable by Dr. Lauren Gibson-Oliver titled “A Comprehensive Document and Improvement Process for Supporting Residents Through Academic and Professionalism Issues.”
Dr. Shashank Kraleti and Diane Jarrett EdD co-authored a poster titled “Executive Leadership Team Improves Collaboration and Process Improvement Opportunities in an FM Department with 18 Clinics.”
“Developing a POCUS Faculty Credentialing Pathway: From Training to Practice” was the title of a poster co-authored by Dr. Leslie Stone, Dr. David Kelley, Dr. Stephen Foster, and Dr. Kraleti.
Dr. Germán Corrales (PGY2 in the Little Rock program) was lead author of “Telehealth Utilization for Opioid Use Disorder Analysis Before and After the COVID-19 Public Health Emergency Declaration” in the Fellows, Residents, or Students Research category. Kanna Lewis PhD and Dong Zhang PhD from DFPM RED were co-authors.
Dr. Stephen Foster and Kodi Liddell PharmD, BCPS presented “Advance Care Planning: Strategies to Improve Documentation and MIPS (Merit-Based Incentive Payment System) Metrics at an Academic Medical Institution.”
More details and photos are available on our Facebook page.
Dr. Lauren Gibson-Oliver, Program Director of the UAMS Little Rock FM residency, has won the UAMS Clinical Emerging Faculty Mentoring Excellence Award for 2024.
Dr. Steven Webber, COM Dean, presented Dr. Gibson-Oliver with a crystal award at a ceremony in May. This award is presented annually to a junior faculty member who has made exemplary contributions to the professional development of faculty, staff, and students.
