UAB Magazine Weekly - Features on Health Care
The Great Pretenders
SImulated Patients Help Med Students Learn People Skills
By Matt Windsor
At UAB's Clinical Skills Center, medical students practice patient communication and diagnosis skills with the aid of simulated patients from the community.Bill Moates is sick for a reason. Several times a year, he adopts an alias, carefully rehearses his symptoms, and tries to convince medical students that there is something wrong with him. Tonight, as the students start to visit his exam room, he has a story to tell.
Moates isn’t looking to score some medication or a free night in the hospital. In fact, he’s fulfilling an essential role in the doctor-training enterprise at the UAB School of Medicine. He is a member of the public enacting the part of a standardized patient, commonly known as an SP, in order to help medical students learn the physical and emotional skills they’ll need to care for real patients.
Story continues after video
On this August evening, Moates is preparing for a five-hour shift as UAB senior medical students take their Objective Structured Clinical Exam (OSCE). “I’m having a ball,” he says with a grin. The medical students are not so relaxed. A passing grade on the OSCE is required for graduation, and the tension on the third floor of Volker Hall is palpable.
While the rest of the building is given over to lecture halls, research labs, and offices, the third floor looks a lot like a private medical practice—with some special features. There are 20 exam rooms on the floor, branching off two long corridors. Outside each room is a computer terminal and a chair, and sitting in the chairs are 20 medical students, staring straight ahead with expressions of nervous concentration.
A voice comes over the loudspeakers: “Please enter your rooms now.” In unison, the students stand up, knock on the closed doors of their exam rooms, and get to work.
Dream Cycles
UAB Fertility Advances Bring Help and Hope
By Julie Hall Bosché
Sometimes it takes a little science to help fulfill a dream. At least that’s what it often feels like for people who turn to UAB’s Division of Reproductive Endocrinology and Infertility for answers, help, and hope.
Success stories: G. Wright Bates, director of UAB's Division of Reproductive Endocrinology and Infertility (left, with patient Staci Cornelius and her daughter, Hannah), says that UAB's success rate for in vitro fertilization has more than doubled in less than 10 years and now often exceeds 50 percent in a month. Now more of those dreams are coming true. In less than 10 years, UAB’s success rate for in vitro fertilization (IVF) has more than doubled. Division director G. Wright Bates, M.D., credits much of the success to refinements in IVF techniques. “We have come a long way in treatment cycles,” he says. “Back in 2002, less than one in four women with a good prognosis got pregnant within a month. Now we often exceed 50 percent in a month with IVF.” He adds that increased awareness of infertility issues—and more widespread information on potential solutions—also has helped educate the public and encouraged more patients to learn about their options.
Increasing the Chances
Today, the division, which provides individualized care to both women and men, continues to investigate new advances in fertility treatment that will increase the chances of conceiving and carrying healthy babies. One avenue of research is the multicenter PCOS-II Trial, sponsored by the National Institutes of Health (NIH), which is testing two oral medications, clomiphene citrate (Clomid) and letrozole (Femara), to determine which is the most effective in inducing ovulation and enhancing fertility in women who have irregular cycles, don’t ovulate regularly, or exhibit signs of hormone imbalance.
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WATCH: Infertility: 35 is the new 25
Wright Bates discusses the latest science in fertility treatment in this video presentation. |
“We’re thrilled to be part of this group,” Bates says. “There is no other center in the Southeast participating, and we think it’s a great way for us to improve our treatment options, and better serve the women of Alabama.”
The trial covers basic fertility testing for both women and men and provides four months of treatment. Patients interested in enrolling in the trial can call study coordinator Susan Mason at (205) 801-8207 for more information and a phone screening.
Another revolutionary development, Bates says, is pre-implantation genetic screening, which examines embryos for disease and potential developmental problems. “This doesn’t mean designer babies, or choosing hair color and eye color,” Bates explains. “We’re talking about ensuring a normal chromosomal number and avoiding major developmental issues to enhance the chances of producing a normal, healthy offspring.”
Bates is quick to underscore the division’s emphasis on healthy pregnancies. UAB is committed to avoiding high-order multiples—triplets or more—that can pose a threat to both the woman and the fetuses, he says.
Grading the Curve
UAB Exercise Physiologist Evaluates Popular “Toning” Shoes
By Matt Windsor
When UAB exercise scientist Jane Roy, Ph.D., sees the sexed-up commercials for new “toning” shoes from the likes of Reebok and Skechers, she can’t help but think about something a little less attractive: ankle weights.
Toning shoes feature a curved sole that is intended to re-create the instability of walking on a less stable surface, like sand. Forcing the body to overcome that instability, shoe manufacturers claim, turns a normal walk into a whole-body workout capable of sculpting the legs, bottom, and chest. (These areas get far more screen time in commercials than the shoes themselves.)
The slick ads and celebrity endorsements have fueled blockbuster sales—toning shoes are now the fastest-growing corner of the athletic shoe market. But despite all the hype, the craze is reminiscent of “the ankle-weight fad of the 1980s and ‘power walkers’ swinging hand weights,” Roy says. For modern toning shoes and their fitness cousins, the idea is the same, she notes: “to make movement more difficult and challenging, and to increase energy expenditure.”
The Truth About Diabetes
UAB Comprehensive Diabetes Center Director Sheds Light on Common Myths
By Tara Hulen
Though diabetes is prevalent in Alabama—one recent study placed the state in a Diabetes Belt stretching across the southern United States—there are many myths about its causes and treatment options. And these misconceptions often lead people to make bad decisions based on bad information, says Anath Shalev, M.D., director of the UAB Comprehensive Diabetes Center and professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism. Here, Shalev shares the truth about the most common myths.
Myth: "Sugar or eating sweets is the cause of diabetes."
It’s not the sugar; it’s the effect of too many calories of any kind, because obesity is a major risk factor for type 2 diabetes. Lack of exercise is another major contributor to type 2 diabetes, especially a sedentary lifestyle combined with large portions of high-caloric, fatty, food. But the scientific answer about the cause of diabetes is far more complicated than whether you have fried chicken, fries, sweet tea, and banana pudding at lunch, then take a nap instead of a walk.
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Fact: There is no magic bullet for treating or avoiding type 2 diabetes. Shalev says the best prescription to help avoid type 2 diabetes is simply to eat a healthy diet and maintain a healthy weight and exercise. |
A number of different genetic factors have started to be unraveled and there are different types of diabetes. “Type 1 diabetes is caused by an autoimmune process that destroys the beta cells (which produce insulin) in the pancreas. With that, the sole source of insulin —the hormone responsible for maintaining normal blood sugar—is destroyed,” Shalev says. “Type 2 diabetes, on the other hand is the result of insulin resistance (which is most often caused by obesity) and beta cell dysfunction.”
Myth: “Kids with type 1 diabetes can’t have anything sweet.”
While in the past people with diabetes were discouraged from having any sweets, advances such as fast-acting insulin therapies and different monitoring protocols allow for the occasional treat and make meal planning easier for children and adults, Shalev says. A child can have a piece of birthday cake, for example, as long as parents dose him or her properly beforehand and monitor closely. “It’s an intensive insulin regimen, so patients check more frequently, but they gain more freedom,” Shalev says. “It is a lot of work, but they can enjoy the simple pleasures in life.”
Myth: “Only obese people get diabetes.”
“While obesity is the strongest risk factor for type 2 diabetes, patients with type 1 diabetes or other less common forms of diabetes are often very lean,” Shalev says. “I have seen several triathletes who are type 1 diabetics.” Patients such as these who participate in high-intensity sports or a strenuous exercise programs should have a careful monitoring and dosing plan created in consultation with an endocrinologist, she adds.
Myth: "Type 1 diabetes, in the past often called juvenile diabetes, only affects the very young."
In fact, type 1 diabetes can affect people at any age, though it is more common for younger age groups. “Excessive thirst, urination, and weight loss should always be warning signs and warrant a doctor’s visit,” Shalev says.
Myth: “There is nothing you can do about type 2 diabetes.”
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Healthy Stop |
Some people look at their family tree and their own waistline and assume they are doomed to get diabetes. “Some people will have a constellation of genes that put them at a higher risk,” Shalev says. “But that doesn’t mean they will develop diabetes. In most cases, type 2 diabetes can be delayed and sometimes even prevented with adequate lifestyle modifications, including exercise and healthy diet. Monitoring and early intervention are important to improve the overall outcome.”
Myth: “Starting insulin injections in type 2 diabetes is the beginning of the end.”
“It’s a myth that the prognosis will just get worse and worse once you need insulin,” Shalev says. Still, patients often panic and resist when told the injections are necessary. Actually, it’s just the next logical step if oral medication doesn’t work, Shalev says.
By helping to control blood sugar levels better, insulin can help patients avoid complications such as stroke and heart attack, Shalev says. Emerging research suggests that starting insulin treatment early in the disease process also can reduce strain on the beta cells. “These cells are under continuous stress to produce more and more insulin, and at some point they just can’t do it anymore. That’s when oral medications are no longer sufficient,” Shalev explains. Injections “give beta cells a break.”
She adds that the need for insulin injections is not always permanent. Some patients with type 2 diabetes can eventually stop taking insulin if they also make lifestyle changes to help with their disease.
Primary Address
UAB Clinic Offers Centralized Care
By Jo Lynn Orr
Stuart Cohen is one of a group of physicians and nurse practitioners who have established a Patient-Centered Medical Home at UAB's Kirklin Clinic. The concept, a key component of health-care reform, is focused on providing coordinated care with an emphasis on patient education.Sometimes a trip through the health-care system can seem like an endurance contest, requiring multiple visits to a range of specialists and other health-care providers in offices all over town. But a unique partnership between primary-care physicians at UAB’s Kirklin Clinic and the UAB School of Nursing aims to change that by replacing the poorly coordinated, episodic, acute-care focused model with a more comprehensive, proactive, team-based approach that engages patients as partners in their own health care.
Six physicians at the clinic’s Internal Medicine-1 practice have joined together to establish a Patient-Centered Medical Home (PCMH). The concept has gained popularity in recent years and is a key component of the health-care reform measures passed by the federal government in 2010. A PCMH coordinates all patient care, including referrals to subspecialties such as cardiology, orthopedics, and rheumatology; following up with patients who have been hospitalized; and providing education on managing chronic diseases.
At UAB’s PCMH, all patient information—including X rays, lab results, and hospital and subspecialist records—is available electronically at the touch of a computer keyboard, which allows all providers access to crucial information.
Nurses and Nuance
Because managing chronic disease is the medical staple of primary-care offices, the Kirklin Clinic medical home staff includes a full-time nurse practitioner and two part-time nurse practitioners who are members of the School of Nursing faculty. “In addition to their advanced nursing education and experience, they have experience in teaching, which augments the medical home’s patient education efforts relating to chronic diseases,” says Stuart Cohen, M.D., who heads up the PCMH group and is medical director of Prime Care Internal Medicine at the Kirklin Clinic.
