CHE

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.”

UAMS Receives $2.5 Million CDC Grant to Increase Colorectal Cancer Screening in Arkansas

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.

Alysia Dubriske

“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.

CHE Staff Secures Large Donation for Prison Breastfeeding Program

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.

Melissa Zelinski, Ph.D. with donated boxes from Medela.

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.

Board members of Little Rock non-profit, Hope Rises.

“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.

Family and Preventive Medicine Receives 5-Year $3.29 Million Grant from CDC to Reduce Obesity

By Amy Widner

The Department of Family and Preventive Medicine at the University of Arkansas for Medical Sciences (UAMS) has received $3.29 million from the Centers for Disease Control and Prevention (CDC) for a five-year project to reduce obesity, increase physical activity and improve nutrition in Arkansas, especially in the Delta.

The State Physical Activity and Nutrition (SPAN) project funding began Oct. 1 and was awarded to 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 grant.

“The whole premise of this grant is to try to reduce obesity rates. The CDC has identified target areas, including access to better nutrition, increasing breastfeeding, encouraging healthier foods and physical activity in early childcare centers, and improving activity-friendly communities,” Dubriske said. “At UAMS’ Department of Family and Preventive Medicine, we already have many projects in these areas, so we are looking forward to combining the progress we’ve already made with the CDC’s support to show measurable improvement on this important health issue.”

UAMS staff will be working in partnership with local leadership and stakeholders across the state, but especially in counties where life expectancy is lower than national and state averages. Many rural counties in the eastern Arkansas Delta fall into this category. Obesity, diabetes, high blood pressure, low physical activity, poverty and lack of access to health care are factors.

The project aims to:

Develop and implement food service guidelines for food pantries, early childhood education centers, developmental disability day centers and local parks.
Support breastfeeding by partnering with family practice clinics, early childhood education centers and developmental disability day centers and by offering continuing medical education hours and early childhood center and developmental disability center professional development training.
Partner with communities to create activity-friendly routes to connect everyday destinations by implementing local policies to include bike routes, sidewalks and trails that increase safety and access for all abilities.
Implement nutrition standards and physical activity standards into early childhood education centers across the state by changing the Quality and Improvement Rating System in Arkansas to increase physical activity, increase nutrition and physical activity education to staff, and decrease screen time.

Assisting Dubriske with the project are Christopher Long, Ph.D., senior director of Research and Evaluation at the UAMS Northwest Regional Campus; and Leanne Whiteside-Mansell, Ed.D., director of the Research and Evaluation Division in the UAMS Department of Family and Preventive Medicine, which is part of the UAMS College of Medicine. Bettie Cook, senior research administrator at UAMS, assisted with the successful grant application.

Three Tests for Carpal Tunnel Syndrome

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.