After 42 years of live CME/CE conferences, the Department of Family and Preventive Medicine’s Community Health and Education Division hosted its first virtual conference October 20 – 23 titled the 24^th Annual Family Medicine Update with Tobacco and Disease Symposium. More than 150 healthcare providers joined the conference for up to 16 hours of CME/CE.

Team members who planned the event include Alysia Dubriske, M.Ed., Marybeth Curtis, RN, BSN, and Andrea Hooten, MBA, along with Annemarie McGahagan, B.S.E., Leesa Freasier, M.Ed., Matt Mitchell, B.S., Colleen Lassiter and staff from UAMS Learn on Demand and UAMS audiovisual. Emily Bernard from California was the conference moderator.

Presenters included these UAMS clinicians and faculty:
Tesa Ivey, APRN —  hormone replacement therapy
Dr. Kevin Sexton — improving telemedicine for practitioners
Dr. Stephan Dehmel — colorectal cancer screening
Dr. Bill Ventres and Dr. Melissa Zielinski —  practicing positive family medicine and how to help patients cope during Covid-19
Dr. John Mounsey — AFib and reading an EKG
Kaci Boehmer, Pharm.D. – anticoagulants
Dr. Matthew Steliga — treating lung cancer patients during Covid-19
Pat Franklin, APRN — low-dose CT scans for high-risk tobacco users
Dr. Anand Venkata — bronchiolitis obliterans or popcorn lung.

Tweets and Facebook posts from the meeting can be found at #24thFMU.

August 25, 2020 | Stacy Durham and her husband Clint had the birth of their son mapped out: a healthy baby delivered full-term who easily breastfed, a standard hospital stay and return home to their new nursery. But as Stacy describes it, “it just wasn’t in the cards.”

Everything had gone smoothly during her pregnancy, but after a day of labor and two to three hours of pushing, they discovered that baby Carson had swallowed meconium mixed with amniotic fluid and didn’t take a breath for four minutes. The baby was rushed to NICU where he spent five days.

“They had brought him close to me before they took him away, but I don’t remember ever seeing his face,” Stacy said. “They had to get as much done as they could in the room to get him suctioned out. It was very nerve-wracking.”

Stacy’s primary care physician, Cassie Hunter, M.D., who had encouraged her to breastfeed, said the couple worked diligently to make sure their baby boy had the important colostrum and breast milk he needed while he was in NICU.

“She remained committed despite having to go to the NICU a floor away from where she was with a fresh C-Section wound,” said Hunter. “Since her production was low in the beginning (which is normal), NICU asked if they could ‘top’ off the feedings with formula to give the baby calories it needed. She pumped her heart out and was so worried that, since the baby got a bottle from the beginning of his life, that he would never nurse.” Hunter is also part of the breastfeeding initiative sponsored by UAMS’ State Physical Activity and Nutrition, a CDC grant to combat obesity.

Clint did what he could to help in supplying the baby with breastmilk. He walked the freshly pumped milk upstairs to NICU every two hours and washed the breast pump between sessions.

Carson was born on a Friday, but it wasn’t until Sunday that he got to feed at his mom’s breast.  He transitioned well, though, and every two hours he would latch on with supplements ceasing the following day.

“All in all, I was only able to breastfeed six months, and then I had to pump because I went back to work as a teacher,” Stacy said, who teaches second grade at Hillcrest Elementary in Lynn, Arkansas. Actually, Stacy surpassed the average time moms breastfeed their infants in Arkansas. A recent report by the CDC showed that only 43 percent of Arkansas moms breastfeed to the six-month mark. The American Academy of Pediatrics recommends that all infants be breastfed at least six months to get the full benefits, such as reducing risks of asthma, obesity, Type 1 diabetes and other diseases in infants. But as Stacy’s story illustrates, it’s critical to have the support from healthcare professionals, family and a worksite that is breastfeeding friendly.

She offers this piece of advice to new moms: “Breastfeeding isn’t the easiest route to take and you will have hurdles to overcome, but do your best. It’s worth it.”

July 27, 2020 | The UAMS Department of Family and Preventive Medicine has received $2.5 million from the Centers for Disease Control and Prevention (CDC) for a five-year project to increase colorectal cancer screening in Arkansas.

Partnerships in Colorectal Cancer Screening in Arkansas is a project of the Department of Family and Preventive Medicine’s Community Health and Education Division. Alysia Dubriske, director of Community Health and Education at UAMS, is leading the program and managing the grant.

Arkansas ranks near the bottom of the list at 34th in the nation for the number of people per capita who are screened annually for colorectal cancer. Nationwide, colorectal cancer is the second leading cause of cancer-related deaths when men and women are combined.

The American Cancer Society predicts 1,540 Arkansans will be diagnosed with colorectal cancer in 2020 and 610 will die of the disease. According to CDC guidelines, people over the age of 50 should be screened annually for colorectal cancer, and people with a family history of the disease should start at a younger age.

“This grant allows us to address these disparities in Arkansas by working with both health care providers and the public,” Dubriske said. “We will educate providers on evidence-based approaches for increasing colorectal cancer screening and then partner with them to implement those interventions. This will be supported by a communication campaign directed at the public so they better understand the importance of screening.”

The approaches include automatic reminders for health care providers to touch base with patients who are overdue for screenings, increasing public awareness about screening though media and communication efforts, and reducing structural barriers that allow Arkansans in rural areas access to prevention, early stage diagnosis, and treatment.

The program will target primary care clinics, especially in counties with low screening rates and low average household incomes. The program will work directly with providers to teach them best practices and help them implement the techniques in their clinics.

“Ultimately, our goal is to reduce the amount of late-stage colorectal cancer in Arkansas and the number of colorectal cancer deaths in Arkansas,” Dubriske said. “Colorectal cancer is a highly treatable disease, especially if caught early, and we know that screening saves lives. We’re looking forward to partnering with clinics to make a difference.”

UAMS will work with Federally Qualified Health Centers and Arkansas’ Quality Improvement Organization to implement the project.

March 2, 2020 | Incarcerated women who are new breastfeeding moms at the J. Aaron Hawkins Sr. Center in Wrightsville, Arkansas, will have access to over 200 pounds of breastfeeding supplies recently donated by Medela, a leading manufacturer of breast pumps in the United States.

The donation came about through UAMS’ partnership with the Hawkins’ Growing Together program. Growing Together was formed to support the needs of incarcerated pregnant and postpartum women in Arkansas. It includes a lactation program, prenatal education classes, and a mental health support group. Childbirth support will launch soon as part of a pilot grant provided by UAMS’ Translational Research Institute.

Marybeth Curtis, B.S.N., a nurse educator in the UAMS College of Medicine Department of Family and Preventive Medicine, saw the need for breastfeeding supplies and contacted Medela.

Medela gave hospital-grade breast pumps, storage bags, maternity and nursing shirts, lanolin, and other products to the new breastfeeding initiative. The items were donated through Hope Rises, a Little Rock non-profit that offers services to women impacted by addiction, trauma and incarceration.

Annemarie McGahagan, SPAN nutrition coordinator at UAMS, is breastfeeding coordinator for the CDC State Physical Activity and Nutrition grant that helps support Growing Together.

“When Annemarie shared with me the need for breast pumps and supplies for the Growing Together program, my first response was to reach out to Medela,” said Curtis. “I have always been amazed at their generosity. I have learned that acts of charity are waiting all around us once you make the need known.”

Melissa Zielinski, Ph.D., a clinical psychologist in the UAMS College of Medicine’s Department of Psychiatry and Behavioral Sciences, spearheads UAMS’ involvement with Growing Together.

“Gender-responsive programs like Growing Together are critical. Many people don’t realize that over 75% of incarcerated women are of childbearing age and about 4% are pregnant at intake to prison. Few prisons have specialty services available to meet incarcerated pregnant women’s needs. It will take time, but we are working toward that goal,” said Zielinski.

All pregnant women at the Hawkins Unit receive their routine pre- and postnatal care and deliver their babies at UAMS.

Other groups have joined in the Growing Together initiative: UAMS lactation specialists, the Department of Family and Preventive Medicine, doctoral-level psychology student interns from UAMS and the University of Central Arkansas who co-lead mental health support groups, retired RNs with the Presbyterian Women USA who teach prenatal classes for the women, and one volunteer who offered to sew lactation capes for the women who would like to use them when breastfeeding during visitation.

For more information, contact Zielinski at mjzielinski@uams.edu.

John Bracey, M.D., hand surgeon with the UAMS Department of Orthopaedic Surgery, said that carpal tunnel syndrome affects 2.7 percent of the population and nets 500,000 surgeries a year in the United States, estimated to be a $2 billion annual impact.

Bracey spoke to family medicine providers at the 40^th Annual Family Medicine Intensive Review Course last May, covering how providers can test for carpal tunnel and how to manage it.

A few tests he recommended were:

Tinel’s sign (lightly tapping over the nerve to see if it generates a tingling sensation)

Phalen’s test (pushing the dorsal surface of hands together and holding 30 – 60 seconds)

Carpal Compression Test (Apply pressure with thumbs over the median nerve within the carpal tunnel, located just distal to the wrist crease. The test is positive if the patient responds with numbness and tingling within 30 seconds.)

If the patient shows signs of carpal tunnel syndrome, the provider can conservatively manage with a neutral wrist brace (helpful during sleep), stretching and exercises, ergonomic interventions or steroid injection.