Community Health and Education

Virtual Family Medicine Conference Oct. 24-27 Offers Up to 18 Hours of Content

UAMS’ 27th Annual Family Medicine Update with Tobacco & Disease Symposium will offer up to 18 hours of online continuing education Oct. 24–27, 2023, for primary care physicians, doctors of osteopathic medicine, advanced practice registered nurses, registered nurses, pharmacists, physician assistants, physical therapists, respiratory therapists and certified health educators.

Presented by the UAMS College of Medicine, the annual conference provides an opportunity for health care professionals to learn about the latest advances and information impacting family medicine.

Pilar Murphy, Pharm.D., has the latest updates on pharmacology for heart failure.

The conference is completely virtual. Courses are offered in two-hour blocks, twice daily, at $40 per block, with sessions on Friday, Oct. 27, at no cost. Friday’s session offers three, two-hour blocks of content.

To register, visit https://cvent.me/nRD90O or call 501-686-6626 by Oct. 23.

Several talks on cardiovascular issues will feature Andre Ramdon, M.D., who will speak on peripheral arterial disease and aortic aneurysms, and pharmacist Pilar Murphy will speak on the pharmacology to treat heart failure.

Lester Matlock, CFP, will offer practice tips for providers with his talk on “Work Until You Drop,” and physical therapist Andy Glidewell will give practical physical therapy pointers that providers can use in their practice.

Two experts will speak on opioid issues. Michael Mancino, M.D., professor at the UAMS Psychiatric Research Institute and program director for the Center for Addiction Services and Treatment, will discuss treating Opioid Use Disorder in primary care. Karen Burks, M.D., a family physician, will also be speaking on opioid use and prescribing.

Dr. Michael Mancino — Michael Mancino, M.D., will speak on Opioid Use Disorder

The block on “Cravings to Consequences” will feature a talk on eating disorders with Laura Jones, APRN, who works with adolescents at Arkansas Children’s Hospital, and Elizabeth Cleveland, Ph.D., is slated to talk on fetal alcohol syndrome disorder.

Other topics include maternal depression with Nikki Edge, Ph.D., and Shashank Kraleti, M.D., chair of the UAMS Department of Family and Preventive Medicine, and young onset colorectal cancer with Smita Krishnamurthi, M.D., with the Cleveland Clinic’s Department of Hematology and Oncology.

Friday will be dedicated to the Tobacco & Disease Symposium with talks centered on tobacco cessation strategies, talking to patients about quitting tobacco and how tobacco/nicotine products are engineered to be more addictive.

Symposium speakers include Emily Einstein, Ph.D., chief of science policy at the National Institute on Drug Abuse, who will talk on topics for teens regarding tobacco, alcohol and drug use; Aaron Weiner, Ph.D., owner of Bridge Forward Group; and Angela Criswell, M.A., director for GO2 for Lung Cancer, whose talk will focus on lung cancer screening as part of tobacco cessation.

Crafton Tull, SPAN Win Regional Award for US Bike Route 80

Dave Roberts & Julie Kelso with Crafton Tull and Leesa Freasier with SPAN hold up award — Dave Roberts and Julie Kelso with Crafton Tull flank Leesa Freasier with SPAN

A team from Crafton Tull, State Physical Activity and Nutrition, Arkansas Department of Transportation, Metroplan and Arkansas Department of Parks, Recreation, Tourism and Heritage spent more than a year studying potential routes for the US Bike Route 80 in eastern Arkansas.

The American Society of Landscape Architects Central States recently awarded planning firm Crafton Tull a merit award for its 113-page U.S. Bike Route 80 feasibility study, competing with 100 submissions from eight states. The bicycle route, which connects central Arkansas to the Tennessee border, covers 177 miles of rural byways. UAMS’ State Physical Activity and Nutrition grant from the Centers for Disease Control and Prevention collaborated on the study, evaluating towns along two proposed routes to see which one offered safer and better amenities for long-distance cycling.

The route starts in North Little Rock and meanders through England, Stuttgart, Clarendon, Marianna, Hughes, winding up in West Memphis. It was officially designated as U.S. Bike Route 80 in late 2022 by the Arkansas Department of Transportation.

A team made of up of Crafton Tull, SPAN, Arkansas Department of Transportation, Metroplan and Arkansas Department of Parks, Recreation, Tourism and Heritage began the feasibility study in 2018. The group made notes of city amenities such as health clinics, bike repair stations and cultural attractions which bicyclists would have interest in. They also kept notes on safety issues such as traffic volume, lane and shoulder widths.

The US Bike Route System is a national network of bicycle routes connecting urban and rural communities with signed roads and trails. U.S. Bicycle Routes direct bicyclists to a route through a city, county or state with new routes added each year. The U.S. Bike Route 80 will pull in more dollars from tourism and help economic development with the official designation.

Crafton Tull also won an award in 2021 from the American Planning Association’s Arkansas Chapter for “achievement in comprehensive plan design.”

Photos from US Bike Route 80 Feasibility Study

Two bike riders under trees covering roadway

Team members study wayfinding sign on route

Picture of bicyclist holding bike at Waverly Plantation

Physician Wins Award for High Colorectal Cancer Screening Rate

Dr. Clinton Smith with 1^st Choice Healthcare was named the Arkansas Cancer Coalition Healthcare Provider of the Year at the Arkansas Cancer Summit March 7 for his 75 percent rate of colorectal cancer screening with his patients.

The family physician has participated in the UAMS Partnerships in Colorectal Cancer Screening for Arkansas (PiCS-AR!) since 2020, a Centers for Disease Control and Prevention grant that seeks to raise colorectal cancer screening rates in the state. His 75 percent rate is closing in on the national goal of 80 percent set by the National Colorectal Cancer Roundtable.

Clinton Smith, DO, physician with 1st Choice Healthcare in Corning, Arkansas

Smith’s first year with the PiCS-AR! grant showed a screening rate of 65 percent. His rate grew to 70 percent in 2021 and has escalated in one year to 75 percent. He said the reasons for his higher screening rate stem from frequently reminding the patients of screening, making it easy for them to screen, and relaying the facts.

“Each time I have a checkup with a patient (not even necessarily a wellness checkup), I try to mention (screening) and see if they’re due for anything. And if they are, we try to go ahead and facilitate that and get it set up,” said Smith. “The best time to (mention) it, in my opinion, is when you see them. Sometimes people are non-compliant and you may not see them for a while. Now, it does take extra time, and sometimes I get behind, but I feel that prevention is the key. It’s better to prevent a problem than to have to treat it later.”

Smith gives his patients several screening options: stool-based tests and a colonoscopy. The stool-based tests (FIT or Cologuard) require that the patient send a sample of their stool in the mail, which takes minutes and is not invasive and requires no dieting, fasting or anesthesia. The colonoscopy is considered the most accurate for colorectal cancer screening, but with his rural patient population in northeast Arkansas, arranging a colonoscopy can be cost- and time-prohibitive.

“I tell them about the options and let them decide. I think the FIT tests have helped a lot. We’re rural, so to get a colonoscopy, you not only have to take a day off of work, you have to drive 30 miles outside of town,” said Smith.

Colorectal cancer is the second deadliest cancer for Americans, and it’s on the rise with younger age groups, according to the American Cancer Society. The rate of new colorectal cancer cases among Americans younger than 55 increased from 11 percent of all cases in 1995 to 20 percent in 2019. The recommended screening age for those with average risk is 45, which the U.S. Preventive Services Task Force lowered from age 50 two years ago because of this new trend. Screening at an earlier age means cancer will be caught in its first stage and is highly treatable if detected early.

Smith also credits his employer, 1^st Choice Healthcare, for allowing him to spend more time with his patients who are often chronically ill and require more than the suggested 15 minutes many physicians are tethered to. 1^st Choice is one of two healthcare partners working with the PiCS-AR! five-year grant. Mid-Delta Healthcare System in eastern Arkansas is the latest system to join.

Early Childhood Education Centers Use Grant Money to Make Rooms for Breastfeeding Moms

Leticia Rodriguez, director of the Lovely Sunshine Learning Center in Little Rock, has transformed a room in her childcare center into a place where staff and clients can feel comfortable breastfeeding or pumping breast milk, thanks to a $3,000 subgrant from the UAMS Department of Family and Preventive Medicine’s State Physical Activity and Nutrition for Arkansas (SPAN).

Before and After of Lovely Sunshine Breastfeeding Room — Lovely Sunshine Learning Center

Lovely Sunshine Learning Center is one of 15 early childcare centers that will receive the subgrants from SPAN, which is funded by the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity and Obesity. SPAN seeks to encourage breastfeeding in early childcare settings because research has shown that children who breastfeed six months or more may reduce their risk of obesity as well as severe asthma, SIDS, ear infections and some chronic diseases.

Rodriguez has used the money to buy two nursery swivel chairs, a colorful throw rug, mini-refrigerator, lamp with USB outlets, boppy pillow, bookshelf and framed pictures for décor. She also wants a drape that will separate the room so two mothers can privately breastfeed at the same time. SPAN will also supply milk storage bags, posters and pamphlets.

Sierra and her child Indigo no longer have to breastfeed in the reception area.

“I have a breastfeeding mom (parent of a student) and one staff member that breastfeed. My employee doesn’t care if anyone sees her breastfeed, but the mom was not comfortable in the room. She breastfed in the reception area which isn’t private because staff members and parents are always coming through,” said Rodriguez, who completed the room September 2022. “So far, the response has been good!”

Three other childcare centers have also received the funds, and moms have immediately begun using the made-over rooms. Bingham Road Baptist Child Development Center in Pulaski County took an unused infant room and gave it a breastfeeding makeover, complete with chair, rug, mini-refrigerator, décor and covers for moms as they breastfeed their babies. A staff member and new mom were quick to use the room, with the new mom saying, “It’s so great not having to feed in my car.”

Bingham Road Baptist Child Development Center

Tonya Ritter, director/coordinator for ABC Preschool at Heber Springs Elementary, has redone an unused office at the school with a soft chair, lamp, rug and mini-refrigerator. She plans to add a plant in the corner, brochure stand, framed landscapes for the walls and a shelf to house WIC information and a book about breastfeeding for children. Supplies for the moms are conveniently stored in a basket, and the room connects with the nurse’s office in case of issues.

“It has been used by a few who had to pump in their cars on their breaks,” Ritter said. “They are so appreciative. We have a few expectant mothers who are so excited to have a place to go rather than their cars.”

Heber Springs Elementary’s makeover of its breastfeeding room.

Another childcare center that used the grant money is Janna’s Little Angels in Little Rock. Lanna Horton, director, transformed a room for storage/staff into a light-filled, colorful breastfeeding space for her families. Two moms have started using it, and the center plans to add a refrigerator to store milk. A door connects to the infant classroom, so mothers will now have a space where they can visit on their breaks, a much better solution than the director’s office.

From storage space to breastfeeding room at Janna’s Little Angels

England, AR, Closer to Approving Master Bike and Pedestrian Plan

City Seeks to Encourage Physical Activity and Economic Development

England’s city council will discuss a proposed master bike and pedestrian plan after England citizens had their say with three public meetings and an online survey. Englanders were allowed to offer their opinions on priorities and make suggestions on the plan, which will connect everyday destinations for those who walk, bike and move in a safe, convenient way. Ultimately, this plan will encourage physical activity and economic development.

Isaac Sims (left) with Crafton Tull talks to Lenny Adams about the plan at a recent public meeting.

Isaac Sims, planner with Crafton Tull which created the master plan, said the survey results weren’t particularly surprising. Fifty-five percent of the respondents said they walked three or more times per week for either recreation or transportation. Around 92 percent said they did not ride a bicycle for recreation or transportation. Citizens at the July public meeting offered valuable input on sidewalks and, as a result, Crafton Tull added a sidewalk down Southwest First Street from West Fordyce Street to Cox Drive. The network of shared use trails, sidewalks and bike paths will equal approximately 17.25 miles.

Dave Roberts with Crafton Tull points out the potential for reworked sidewalks and a park to Leesa Freasier, physical activity coordinator with SPAN, on the walk audit in 2021.

The planning began last summer. The State Physical Activity and Nutrition for Arkansas (SPAN), part of the University of Arkansas for Medical Sciences (UAMS), funded the plan and helped organize a walk audit of downtown England to find trouble spots for pedestrians and bicyclists. A year later, the public weighed in on the initial drafts.

Mari Ben Newton, who moved to England in 2000 and attended the second public meeting in July, said she was most interested in a sidewalk on Nichols Street because she sees school kids walking that route every morning without the benefit of a sidewalk.

England’s Chief of Police Bill Duerson was keyed on safety too.

Bill Duerson and Mari Ben Newton decide how to vote on aspects of the proposed plan.

“I really like walking paths and safer routes, especially in the summer when kids are darting in and out of traffic,” said Duerson, who grew up in England riding his bike.

At the July meeting, Julie Kelso, vice president of planning with Crafton Tull, pointed to research that showed Lonoke County residents have a higher percentage of adult obesity than other counties in Arkansas, adding that Englanders could use opportunities to walk and bike to the grocery store, library, their work or school. And with 35 percent of England families having only one vehicle, families need safe options for non-motorized travel.

“What encourages bicycling or walking?” Kelso asked the group. “Safe, comfortable lanes with points of interest. If there are no facilities (for walking or biking), the stress level is high for biking or walking. As we move into safer facilities (safest being a separate trail), the stress is lower, but the ease of installing them is also less, meaning it takes more time and money to put them in place.”

Master bike and pedestrian plan for England

The firm used trip generators to expose “hot spots” of concentrated activity, such as the intersection of U.S. Highway 165 and Arkansas Highway 15. Another factor that Crafton Tull considered was the proposed United States Bike Route 80 (USBR80), which will meander through downtown England. The USBR80 snakes from North Little Rock to West Memphis as part of a larger route system across the United States for long-distance bicyclists. The proposed route will increase economic development in the towns dotted along the path, England being one of them. In addition to the USBR80, Metroplan (a planning agency for four central Arkansas counties) hopes to tie the England master bike and pedestrian plan to its own vision for the Regional Greenways project with more than 170 miles of multiuse paths connecting Faulkner, Lonoke, Pulaski and Saline counties.

Kelso said most of England’s proposed trails are concentrated in the southern part of the town with side paths along Nichols Street, a major corridor for children walking or biking to the high school.

Many of the existing traffic signals will have bike/pedestrian traffic signals added to them, and network trailheads will be centered around parks and schools in the city.

The blacktop will feature a walking path and sunshades. Sims said the block of blacktop in downtown England will have a widened walking path circling it and may be painted green with sunshades along it to protect pedestrians from the heat. Another need is to connect the sidewalk to the Willis H. Sargent Training Academy north of town and on Henderson Road.

Food Banks Going “Green”

Arkansas Food Banks Buying Healthier Foods with Help of Color-Coding System

The six Feeding America food banks in Arkansas are spending more of their money on healthier foods to stock their inventory, growing from 16 percent in 2018 to 47 percent in 2021 because of a simple color-coding system that categorizes foods as “choose often,” “choose sometimes” or “choose rarely” based on their nutritional value. Healthy food purchases at Arkansas food pantries is up

Jill Niemeier, former project manager with UAMS’ Office of Community Health and Research in Springdale, launched the color-coding intervention four years ago, which has spurred the upward trend in healthy food spending. She started at the top level with the State Food Purchasing Program where the six Arkansas food banks purchase much of their inventory. It’s a state-funded grant managed by the Arkansas Hunger Relief Alliance that allows the food banks to buy from Arkansas-based food distributors. Michelle Shope, director of food resourcing and logistics for Arkansas Hunger Relief Alliance who was an early partner with Niemeier, recognized the ease and benefit of using color-coding on their food order forms so food banks could quickly identify healthy options.

Color coding foods at the food bank level trickles down to their partner agencies (food pantries) and the individuals that depend on them for food. They’ll know which foods are healthier without having to interpret complicated nutrition labels. All foods are tagged with green (choose often), yellow (choose sometimes) or orange (choose rarely) depending on their saturated fat, sodium and added sugar. Even fruits and vegetables don’t get an automatic green label because some canned or frozen options have added sodium and sugar. The coding is based on the Healthy Eating Research Nutrition Guidelines for the Charitable Food System, also known as HER.

Jill Niemeier, former project manager with UAMS’ Community Health and Research in Springdale, checks an inventory list with Value Added Food Sales operations manager, Derek Mounce.

The project grew wings when Michigan-based food distributor Value-Added Food Sales entered the state in 2021. Value-Added distributes food to non-profit and other charitable food organizations across the nation. Its new warehouse in Springdale, Arkansas, allowed food banks to buy from it through the State Food Purchase Program. The food distributor has been working with the UAMS team to sort, rank and color-code its inventory, based on nutrition information for its 200-plus food items. Niemeier said the color-coded labeling could expand beyond Arkansas, benefitting any organization that purchases from Value-Added Food Sales. The company distributes to 50 states as well as Puerto Rico.

“This partnership is very exciting,” Niemeier said. “Color coding or otherwise labeling food items is a simple intervention that has the potential for great impact. Taking the burden off of food banks and other purchasing agencies to decipher nutrition labels makes it easier for them to make informed choices about the foods they are purchasing.”

Niemeier had worked alongside the UAMS Department of Family and Preventive Medicine’s State Physical Activity and Nutrition for Arkansas (SPAN) which seeks to lower obesity in Arkansas by promoting healthy eating, physical activity and breastfeeding. The program is funded by the Centers for Disease Control and Prevention with the goal to reduce obesity and the chronic illnesses that come with it, namely diabetes.

It’s especially important that those who are food insecure have healthy options since diabetes is more prevalent in this group. Ten percent of Americans have diabetes and a third have prediabetes, but for those who are food insecure, diabetes is twice as common, according to healthaffairs.org. Food insecurity can worsen diabetes in many ways including less access to nutritious foods, higher distress related to diabetes management, and difficult trade-offs such as choosing between food and medications.

“I believe these kinds of nutrition interventions are meaningful because diet-related diseases are more common among individuals who are food insecure, and it requires both a top-down and bottom-up approach to help mitigate that,” Niemeier said. “I hope projects like these will continue across the charitable food system so individuals will have access to healthy foods for themselves and their families.”

Mid-Delta Joins UAMS PiCS-AR! to Increase Colorectal Cancer Screening Rates

UAMS’ Partnerships for Colorectal Cancer Screening in Arkansas (PiCS-AR!) recently joined with Mid-Delta Health System to expand the number of clinics working to reduce late-stage colorectal cancer in the state. Mid-Delta has a clinic in Clarendon and DeWitt, which are in Monroe and Arkansas counties.

PiCS-AR! is a project of the UAMS Department of Family and Preventive Medicine’s Community Health and Education Division. In 2020, the division received a $2.5 million grant from the Centers for Disease Control and Prevention to increase colorectal cancer screening and reduce late-stage colorectal cancer, the second leading cause of cancer deaths in the United States.

“We thought Mid-Delta would be a good partner because their demographics reflect those at high risk for colorectal cancer,” said Marybeth Curtis, BSN, Program Manager for the grant. “Looking at the counties they serve, they have some of the highest rates of cancer in the state. Also, the percentage of uninsured at each clinic is 12% at DeWitt and 9% in Clarendon, which hinders patients from getting a colonoscopy, the gold standard for colorectal cancer screening.”

Curtis said the rate of colorectal cancer screening in both the Clarendon and Dewitt clinics is low with Dewitt at 29.5% and Clarendon at 44%. The national goal is 80% as set by the National Colorectal Cancer Roundtable. Adults should be screened for colorectal cancer beginning at age 45.

PiCS-AR! team member, Stacey George, APRN, with Arkansas Foundation for Medical Care, works directly with PiCS-AR! clinics to maximize their electronic medical records to flag patients 45 and older who need screening. She also coaches the patient navigators on best practices and monitors how well the clinics are faring with screening rates.

“Mid-Delta Health Systems wanted to join PICS-AR! to increase their colorectal screenings and get our patients the care needed in the early stage of diagnosis,” said Monica Lindley, CEO of Mid-Delta Health Systems.

PiCS-AR! has also been working with 1^st Choice Healthcare in northeast Arkansas since the project began late in 2020. Since 1^st Choice joined the partnership, they’ve seen a 9% increase overall in colorectal cancer screening at their six clinics.

In Memoriam: Kent McKelvey, M.D., CHE Medical Director and Leader in Genetics Research

February 1, 2022 – Kent McKelvey, M.D., 52, of Little Rock died Monday, Jan. 17. He was an Associate Professor in the Division of Genetics and served as Director of Cancer Genetics Services in the UAMS Winthrop P. Rockefeller Cancer Institute. He was also a long-time medical director for the Department of Family and Preventive Medicine’s Community Health and Education division.

Dr. McKelvey had been battling acute myeloid leukemia for the past five years. His devotion to his patients, his mission in his field and his love of life sustained him through three stem cell transplants, the most recent in July 2021.

A faculty member since 2003, Dr. McKelvey was a founding member of the Division of Genetics and served as Director of Cancer Genetics Services in the Winthrop P. Rockefeller Cancer Institute. He was a champion for Arkansans with Down syndrome and other genetic conditions and was instrumental in establishing the Adult Genetics Clinic at UAMS. He was invested as the inaugural recipient of the Winthrop P. Rockefeller Chair in Clinical Genetics in 2009.

Dr. McKelvey was a nationally recognized leader on the ethical use of predictive genetic testing in clinical medicine and was on the forefront of teaching the responsible use of molecular genetics in preventive medicine. Between his own stem-cell transplants, he tenaciously continued his career seeing patients and families via telemedicine and working closely with the Arkansas Down Syndrome Association on their behalf. After many years of research, despite his ongoing battle with AML, he published definitive guidelines for treatment of adults with Down syndrome in JAMA in October 2020, and continued his collaboration with fellow members on the American College of Medical Genetics Secondary Findings Committee, which resulted in authorship of his final publication on genome sequencing in Nature Genetics in Medicine in May 2021.

Dr. McKelvey is one of six doctors from three generations of his family to practice in the state of Arkansas. He received his medical degree from UAMS in 1996 and completed his residency at the UAMS Family Medicine program in Texarkana. After working in emergency departments in DeQueen and Nashville, Arkansas, and two years in private practice in Mountain Home, he completed a fellowship in medical genetics at his college alma mater, the University of North Carolina at Chapel Hill. In 2003, he returned to Arkansas to raise a family and rejoined UAMS as Director of the Family Medicine Pre-doctoral Program in the Department of Family and Preventive Medicine. Dr. McKelvey served in the Division of Genetics following its establishment in 2008, and continued to hold an additional appointment in Family Medicine. He directed the Medical Genetics Course in the College of Medicine, and was elected by his students for numerous teaching awards.

Dr. McKelvey brought his gift of strength and determination to the diverse roles he served at UAMS throughout his life. He was an intense person with a good sense of humor and a force of vitality wherever he went. Although his career goal was to give back to those around him, he spent much of his final years at UAMS as a patient rather than a physician, and he found himself overwhelmed with gratitude for the physicians, colleagues, nurses and staff who would treat him like family at the only hospital that would ever feel like home. He considered these final years to be the happiest of his life. Dr. McKelvey’s family would like to extend their thanks to all those who cared for him.

Service arrangements are on hold due to the recent pandemic surge, but a celebration of life is being tentatively planned both in Memphis and in Little Rock, and dates will be forthcoming.

He is survived by his wife, Elise; his children, Caroline and Kent David McKelvey III; his stepdaughters, Anna Douglas Piper and Mary Catherine Piper; his sister and fellow UAMS faculty member Dr. Samantha McKelvey; his sister and Neonatal Intensive Care CNP, APRN at ACH, Betsy McKelvey Peeler, and their entire family in your thoughts during this difficult time. He is also survived by his mother and stepfather, Don Varner and Josephine Charlotte Egner Varner, and half-brothers Michael Varner and Matthew McKelvey. He was pre-deceased by father Dr. K. David McKelvey Sr.

Colorectal Cancer Screening Up Eight Percent in Northeast Arkansas with Community Health and Education’s PiCS-AR! Project

September 2022 – Colorectal cancer screening rates jumped by almost eight percent in northeast Arkansas clinics that partnered with the University of Arkansas for Medical Sciences (UAMS) during the first year of a five-year project to increase screening in the state.

The Partnerships in Colorectal Cancer Screening (PiCS-AR!) is a project of the UAMS Department of Family and Preventive Medicine’s Community Health and Education Division. In 2020, the division received a $2.5 million grant from the Centers for Disease Control and Prevention to carry out the project.

Since then, its first clinic partner, 1st Choice Healthcare, exceeded its initial screening goals in five out of six clinics it operates in Salem, Pocahontas, Paragould, Corning and Ash Flat. The provider’s screening rate was 37% a year ago, and most of the clinics now hover in the mid-40s, with the Pocahontas clinic making the biggest jump, from 29% to 45% in one year.

Denise Boyer, RN, a patient navigator for 1st Choice Healthcare clinics in Ash Flat and Salem, displays her “Fit Just Takes a Bit” button that clinic staff wore to initiate patient conversations about colorectal screening, and a cookie shared during an educational activity on stool-based screening.

The project targets primary care clinics, especially in counties with low screening rates and low average household incomes. It works directly with providers to teach them best practices and help them implement techniques for increasing screening in their clinics.

Since September of 2020, UAMS and the Arkansas Foundation for Medical Care (AFMC) have coached patient navigators at the clinics. The navigators – experienced registered nurses who educate patients about the risk of developing colon cancer and explain screening options – are credited for making a noticeable impact on screening rates in a short period of time.

“More and more conversations between providers and patients are happening about the importance of colorectal screenings,” said Alysia Dubriske, M.Ed., director of the Community Health and Education Division. “Not only is that an objective of the project, but it’s also the first step in preventing late-stage colon cancer.”

She said provider reminders and chart alerts in the clinics’ electronic health system also worked particularly well, noting, “When patients visited, the clinic staff would check to see if they were due for a screening, and set up appointments for those who were.”

“Screening for colorectal cancer is extremely important in that it is one of the few measures that can prevent cancer from developing,” said Jonathan Laryea, M.D., chief of the Division of Colon and Rectal Surgery at the UAMS Winthrop P. Rockefeller Cancer Institute. “There are very few cancers that can be prevented that way. Not only does it prevent cancer, but it allows cancer to be identified at an early stage, which improves survival and also prevents the complications of cancer.”

A colonoscopy is the clearest, most complete screening, but another option is an at-home screening test that is designed to detect DNA abnormalities or blood in the stool, both of which could be indicators of colon cancer or precancerous conditions.

“The best colorectal cancer screening test is the one that patients are most likely to complete,” said Marybeth Curtis, RN and program manager for the PiCS-AR! Campaign, quoting a senior health analyst at the Mayo Clinic.

“I love that quote,” she said. “Forty-six percent of colorectal cancer deaths in the United States are a result of missed screening opportunities. Patient adherence to screening is the key.”

Curtis said one goal of the grant project is to educate providers and patients that stool-based tests are an effective, low-cost alternative to colonoscopies in screening average-risk patients for colorectal cancer.

She noted that stool-based tests are actually preferred by patients, “which leads to improved follow-up in completing their screening.”

“Screening is the best way to beat colorectal cancer,” Laryea agreed. ”My best advice to all adults 45 years and older is, ‘Get your rear in gear and get screened.’”

“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.

Nationwide, colorectal cancer is the second most common cause of cancer deaths for men and women combined and is expected to cause about 53,000 deaths during 2021, including 500 deaths in Arkansas, according to the American Cancer Society.

MaryBeth Curtis, RN, of the UAMS Department of Family and Preventive Medicine (second from left), holds a card alerting patients that 45 is the new baseline age for colorectal screening. Curtis, PICS AR program manager, is surrounded at 1st Choice Healthcare’s Ash Flat clinic by clinic employees (from left) Deborah King, APRN; Starla Smith, APRN; and Denise Boyer, RN and nurse navigator. The card says “45 is the new FIT-ty” and will be sent to patients as they turn 45, along with a kit they can use for their at-home test.

Husband and Wife Find Breastfeeding Worth the Effort

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.”