From the Chairman - School of Medicine
Transcription
From the Chairman - School of Medicine
March & April 2015 IN THIS ISSUE INSIDE: Pellegrino Center for Clinical Bioethics Jane Hickman Teaching Award Winner Volunteer trip to Tanzania Students Present at SHM Conference Congress to Repeal SGR PREVIOUS ISSUES Tips from Department of Medicine Computing Bystanders: Our Nation’s Immediate Responders Contacting Department of Medicine Computing Lockette takes on role as SOM diversity dean Safer drug combination found for patients 2015-2016 Department of Medicine Interns Quality Matters STAFF SPOTLIGHT Scholarly Works Announcements UPCOMING EVENTS: 5/16—School of Medicine Commencement 6/11—Department of Medicine Graduation Banquet Fro m t h e C h a i r m a n Spring is here…finally!...and there is a lot of coming going around campus, as usual. We had an historic resident match this year in both our Categorical Medicine and Med-Peds programs and we will be welcome our incoming residents this June for orientation prior to the start of the training year July 1st. Congratulations to our program directors, Dr. Turi McNamee and Dr. Abby Emmerson, and the whole Education team for a job very well done! Please make our new residents feel at home. At the same time we are saying a bittersweet farewell to our senior residents and fellows who will be moving on but certainly never forgotten. Happily, several will be staying with us on faculty or as fellows. Having several of our own “stay home” with us each year helps me realize that we are doing something right as an academic department of medicine. Each year I also look forward to watching the trajectory of our students and trainees as they cross the threshold in becoming physicians. This year a total of 24 seniors out of a graduating class of 95 chose Internal Medicine—more than any other residency selection at MU and an all-time high for our department these recent years. Several are also staying at MU (Med-Peds, Categorical, and Preliminary Programs), so kudos to all of you for the wonderful teaching and mentoring you are doing! Please don’t forget that we are celebrating the accomplishments of our residents and fellows at the 2014-2015 Department of Medicine Graduation Banquet on Thursday, June 11, 2015 at the Reynolds Alumni Center. One year ago at this time I was thanking you for your support and encouragement as I began my Presidency of the American College of Physicians (ACP). Here we are, a year later, and I am once again thanking you for supporting me this past year while I completed my Presidential duties. On May 2nd, at close of the business meeting at Internal Medicine 2015 in Boston, I officially handed the baton off to Dr. Wayne Riley, the 2015-16 President of ACP. Dr. Riley will be here this fall as a visiting professor and will do Grand Rounds for us September 24th – this is one you don’t want to miss. Needless to say, it has been an amazing year. There has been (as you know) extensive travel; the opportunity to meet, teach, write, and collaborate with colleagues and learners at many levels, both nationally and globally; and opportunities to be involved in policy discussions having an immense impact on health care of our country. It has been a once in a life time experience and I will miss the excitement and energy but I am also happy to be “coming home” to a more normal and settled life (if being a chair can ever be either normal or settled). As Immediate Past President I still have a bit of travel to do in in May for ACP but after that I will look much less travel weary. I’d also like to recognize and congratulate many in the department who continue to excel. A very special congratulations goes to Dr. Carla Dyer who received this year’s Jane Hickman Teaching Award last month, which recognizes excellence in medical student education and teaching. Dr. Warren Lockette was recently FROM THE CHAIRMAN CONTINUED featured on the front page of the Missourian for his integral role as the newly-appointed Senior Associate Dean for Diversity and Inclusion. Several of our students presented at the Society of Hospital Medicine (SHM) Conference: Nila Manandhar presented her poster, “The Effect of Medication Prophylaxis on the Incidence of Delirium in Elderly Patients Undergoing Orthopedic Surgery: A Meta-Analysis;” Courtney Champagne presented her poster, “Predictors of Recurrent Hospital Admission for Patients Presenting with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State;” and David Hayes presented his poster, “Delaying the Inevitable? A Case Series on Lower-Extremity MRSA Osteomyelitis”. Well done to all of you. Let me end my message this month with a bit of food for thought. We have and always will have many challenges but also many blessings, much to be proud of, and much to be thankful for. Our challenges may be many but there is joy to be found – let it be those nuggets of joy that we take with us. They will sustain us in lean times and make the good times even better. Take care and please remember to join us for the annual Department of Medicine BBQ on Tuesday, May 19 at 11:30am! - DAF PELLEGRINO CENTER FOR CLINICAL BIOETHICS David Fleming, MD, MA, MACP, was recently invited to give the Twelfth Annual John Collins Harvey Lecture, “Advocating for the Patient’s Good: Meeting Obligations and Ensuring Trust Through Organized Medicine,” at the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center in Washington DC. The Pellegrino Center provides university-based ethics resources for individuals that shape and give health care. They seek to promote serious ethical reflection and discourse in pursuit of a just society and health care that affirms the dignity and social nature of all persons. 2 JANE HICKMAN TEACHING AWARD WINNER Congratulations to Carla Dyer, MD on being awarded the Jane Hickman Teaching Award at the School of Medicine Education Day April 9! The Jane Hickman Teaching Award is historically the highest recognition of excellence in medical student teaching at the University of Missouri-Columbia School of Medicine. The goal of this award is to reward faculty members who have made sustained, outstanding contributions to medical student education at MU over a period of three or more years. Here is an excerpt from the nomination letter Department of Medicine Chair Dr. David Fleming wrote for Dr. Dyer: “Her teaching commitments are time consuming and require a true passion. As any educator knows, teaching new generations of learners can be challenging. One must also keep in mind that each student differs in their learning style. Dr. Dyer has risen to this challenge by integrating more simulation center time into teaching sessions utilizing the Objective Structured Clinical Examination (OSCE). She has increased the number of faculty using turning point audience response system for learner participation in many of the didactic lectures. Further, she has been actively involved in the scholarly research area of medical education and effectiveness tools and has presented her research in a number of venues. Dr. Dyer’s efforts have been recognized with teaching awards at the School (Curriculum Board Curriculum Innovation Award in 2012), campus (Intercampus Collaboration Award in 2014), and International levels (Academy for Healthcare Improvement Duncan Neuhauser Award recognizing Innovation in Quality Improvement and Patient Safety Education in 2011). These recent awards are true testaments to the professional commitment, dedication, and passion Dr. Dyer has for medical education.” 3 VOLUNTEER TRIP TO TANZANIA Third year fellow and Dr. Michael C. Perry Fellow for 2014-2015, Uladzislau (Vlad) Naidzionak, MD, traveled to Tanzania. Below are some details of his trip. “Here is what I'd like to share about my time in Tanzania. I worked at Muhimbili National Hospital at Dar es Salaam in November. I was the first fellow ever in my volunteering program. First of all I would like to point out that people in Tanzania are much less fortunate having very little available in the medical field. At the same time they have some of the highest rates of aplastic anemia and leukemia in the world. Their medical officers suffer from insufficient training but they try their best to deliver best care possible. Therefore I am proud to be part of their education process. We hope to improve quality of care in Africa through better education and we had eager students. Overall I am very grateful to American Society of Hematology and our department for the rare opportunity to volunteer in Tanzania. I encourage everyone who cares about less fortunate adults and children to offer their help to volunteering organizations. Because disadvantaged but great people of Africa deserve better medicine.” 4 STUDENTS PRESENT AT SHM CONFERENCE University of Missouri School of Medicine students, Nila Manandhar, Nicole Champagne and David Hayes presented posters at the Society of Hospital Medicine Annual Conference in Washington DC March 29—April 1. Nila Manandhar with her poster, “The Effect of Medication Prophylaxis on the Incidence of Delirium in Elderly Patients Undergoing Orthopedic Surgery: A Meta-Analysis” Courtney Champagne with her poster, “Predictors of Recurrent Hospital Admission for Patients Presenting with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State” David Hayes with his poster, “Delaying the Inevitable? A Case Series on Lower-Extremity MRSA Osteomyelitis” 5 CONGRESS TO REPEAL SGR by David A. Fleming, MD, MA, MACP Senate Joins House to Repeal Sustainable Growth Rate (SGR) Averting Future Deep Cuts or Additional Reimbursement Patches April 14, 2015 We all witnessed something quite extraordinary and historic today when the Senate followed the House in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate (SGR) formula (H.R. 2) and transition us to a new value-based system. After consideration of a series of amendments, the Senate passed the measure. This comes on the heels of an overwhelming show of support in the House, where both Republicans and Democrats voted in favor of H.R. 2 on March 26. President Obama is expected to sign the bill immediately, which will avert a 21 percent physician payment cut from taking effect. ACP applauds the efforts of so many in Congress who worked in a bipartisan fashion, over many years, to develop this legislation. Repeal of the SGR has been a priority of ACP’s, and nearly all of medicine, for more than a decade. Physicians and their patients no longer will have to be concerned with impending yearly payment cuts as a result of the flawed SGR formula and no longer will this burden of uncertainty be hanging over physician practices. Equally important, the legislation provides strong incentives for physicians to engage in activities to improve quality; streamlines existing quality reporting programs; and provides additional support to physicians who participate in Patient-Centered Medical Homes, and other alternative payment models, shown to improve outcomes and the effectiveness of care provided. The SGR repeal is finally finished but it did not come about easily. On behalf of all of us at ACP, we say thank you to Congress for seeing the wisdom of repealing this flawed formula and to our 141,000 members for their tenacious advocacy over this long journey to SGR-repeal. ACP’s advocacy efforts will continue, but now with a renewed focus on other key priorities that include: extension of Medicare’s Primary Care Incentive Program beyond 2015, reinstatement of the Medicaid Primary Care Pay Parity program, and support of important physician workforce issues like Graduate Medical Education (GME) financing reform. On this day, we can and should pause for a long-awaited celebration. The exhausting effort to repeal the SGR has finally crossed the finish line. Highlights of the H.R. 2 legislation include: The SGR is permanently repealed, effective immediately; reversing the 21 percent SGR cut that went into effect on April 1. Positive payment updates of 0.5 percent are provided for four-and-a-half years, through 2019. Current quality incentive and payment programs are consolidated and streamlined into a new Meritbased Incentive Payment Program (MIPS), and the aggregate level of financial risk to practices from penalties has been mitigated in comparison to current law. Physicians in alternative payment models (APMs) receive a 5 percent bonus from 2019-2024. Strong incentives are created for physicians to participate in a qualified Patient Centered Medical 6 CONGRESS TO REPEAL SGR by David A. Fleming, MD, MA, MACP Homes (PCMHs), an innovative model of care that has been shown to improve outcomes, patient experience, and reduced costs. Physicians in qualified PCMHs will get the highest possible score for the practice improvement category in the new MIPS program. PCMHs that have demonstrated to HHS the capability to improve quality without increasing costs, or lower costs without harming quality, can also qualify as an APM without having to accept direct financial risk. Technical support is provided for smaller practices, funded at $20 million per year from 2016 to 2020, to help them participate in APMs or the new MIPS program. Funding is provided for quality measure development, at $15 million per year from 2015 to 2019. Physicians retain their preeminent role in developing quality standards. In addition, H.R. 2 provides continued funding of the National Health Services Corps, Community Health Centers, Teaching Health Centers, and the Children’s Health Insurance Program, programs that are especially important to ensuring patient access to primary care. TIPS FROM DEPARTMENT OF MEDICINE COMPUTING How many times have you travelled and worried how you might find your phone if you lost it. Or, what if you were in an accident and unable to let emergency personnel know whom to contact for you. If you use a PIN to lock the screen from prying eyes, no one will have access to your contact information. Fortunately, there are some easy options that could help your phone be safely returned to you or to assist someone getting in touch with your emergency contact if needed. Most simply, if not the prettiest, you can enter the contact information you want to provide into the Notes app found on most phones. Do a screen capture, and then select that image to be your lock screen photo. (Be certain to use a phone number other than your phone.) Android has a way to add “owner info” to the Security settings on the phone. Additionally, there are several apps that allow you to add text over any photo you have on your phone. These go beyond just creating contact cards and could be a lot of fun! Lastly, here are a couple apps with Emergency Contacts in mind (some may cost). Android Acadian I.C.E. app ICE: In Case of Emergency iOS Acadian I.C.E. app Contact Lockscreen Info 7 BYSTANDERS: OUR NATION’S IMMEDIATE RESPONDERS On February 10, 2015 physician leaders of major medical organizations, including Dr. David Fleming, along with key federal personnel and National Security Council (NSC) staff participated in a Physicians Roundtable on a national initiative, Bystanders: Our Nation’s Immediate Responders. This medical preparedness initiative is a direct response to Presidential Policy Directive 8 (National Preparedness). The meeting was held at the Eisenhower Executive Office Building at the White House. The goal of the initiative is to build national resilience by better preparing the general public to save lives by raising public awareness of techniques that can save lives by taking such basic actions as stopping life threatening bleeding. Our national preparedness is the shared responsibility of all levels of government, the private and nonprofit sectors, and individual citizens. As we have seen in such recent tragic incidents as the Boston Marathon bombings, anyone can contribute to safeguarding the Nation from harm. At the meeting, convened by NSC staff, participants in the federal interagency Bystander Workgroup reviewed progress on the initiative and received valuable input from physician leaders. There was unanimous broad support for the Bystander initiative from heads of major national physicians’ organizations. CONTACTING DEPARTMENT OF MEDICINE COMPUTING The Department of Medicine Computing Office no longer has a pager. Due to the fact that it very rarely received pages, and the cost saving initiatives throughout the department, they have canceled the service. The phone is covered the vast majority of the time, however, if no one answers please leave a voicemail and someone will get respond as soon as possible. 8 LOCKETTE TAKES ON ROLE AS SOM DIVERSITY DEAN Lockette takes on complicated role as School of Medicine diversity dean Warren Lockette, the MU School of Medicine's new senior associate dean for diversity and inclusion, is faced with the task of improving the often-criticized lack of diversity within the School of Medicine. Lockette said he takes a panoramic view of diversity that includes women, veterans, people with disabilities and any other marginalized populations that are underrepresented in medical fields, as well as people of different races and ethnicities. See full article from the Missourian here. SAFER DRUG COMBINATION FOUND FOR PATIENTS Safer drug combination found for patients with high-risk atrial fibrillation Patients with high-risk atrial fibrillation, or AFib, often require one drug to regulate heart rhythm and a second drug to thin their blood and reduce the risk of stroke. A recent study led by Greg Flaker, MD, the Wes and Simone Sorenson Chair in Cardiovascular Research at the MU School of Medicine, found that use of a newer blood thinner significantly decreased the risk of strokes for patients with AFib who require both types of medication. Read more about the study here. 9 2015-2016 DEPARTMENT OF MEDICINE INTERNS Congratulations to all of the University of Missouri students on their internship placements! The University of Missouri students that will be starting with the Department of Medicine in July are included below. Grace Carlson Medicine Lucas Blount Preliminary Anesthesiology Merryl Terry Preliminary Ophthalmology Troy Loethen Medicine Ravinder Mankoo Medicine Mark Reed Medicine Emily Cole Preliminary Dermatology Mohammed Khan Preliminary PM&R Kathleen Long Preliminary Dermatology Kara Mohr Med-Peds 10 Jonathan Shirshekan Med-Peds QUALITY MATTERS By Barbara Boshard, RN, BSN, MS, QI Coordinator Effective Management of Patients Leaving AMA – Against Medical Advice The April 2015 Quality Matters revisits a previous quality improvement project conducted in 2007 and 2008 by the Department of Medicine to manage patients who choose to leave against medical advice (AMA). Since this project created a safe protocol and standardization of the process for the Department of Medicine yet this issue continues to be a problem, we wanted to share this with you to see if it still meets the needs of our providers and patients. Several key stakeholders were involved in this project including Hospitalists, a Chief Resident, medicine residents, the Medicine QI Office, Psychiatry, UMHC General Counsel, Nursing, the Office of Clinical Effectiveness, Risk Management, Office of Compliance, Social Services, Regulatory Affairs, Reimbursement Coordination, and a representative from the Patient Rights Committee. Please look this over to ascertain whether you think these are still effective methods by which to manage patients who leave against medical advice and send any recommendations to [email protected]. Department of Medicine AMA Guidelines April 2008 Problem Statement: The Department of Internal Medicine needs a standardized process for internal medicine residents to effectively manage patients who want to leave the hospital against medical advice (AMA). This can impact on the quality of care delivered, the legal and ethical ramifications for the provider, and the processes that are used for documentation and management by IM residents. This is particularly difficult when it occurs during the middle of the night. Standardization is important in order to protect both the safety and health care needs of the patient and the effectiveness, skills, legal protection, and documentation needs of the resident physicians. Recommendations from QI AMA Team: Protocols Recommended 1) Assessing and documenting decision-making capacity (Four standards identified by Dr. Drew Resnick, Department of Psychiatry, UMHC, to determine capacity in decision making includes, 1) Ability to communicate (verbal or non-verbal); 2) ability to understand information provided; 3) appreciation of options available; and, 4) rational decision making), 2) follow-up arrangements determined including signs and symptoms that should prompt an immediate return to the emergency department, planned telephone follow-up, home care needs or arrangements as indicated, planned out-patient follow-up (within 7 days), prescriptions or dispensing of medications, and documentation of these components, and; 3) communication with patient and documentation of the summary with the patient of diagnoses, treatments, medications, follow-up plans, communication with primary medical team and primary care providers, communication with family with patient approval and documentation of each of these discussions. i Documentation Recommended The decision-making capacity of the patient, physician assessment, 3) the patient is able to verbalize his/her understanding of the diagnosis, proposed treatment, alternative treatments, risks of leaving, benefits of staying, plan for follow-up, contact information, scheduled appointments, 4) the patient is informed of his/her welcome to return for admission, 5) potential impact on payment for this visit and return hospitalization if necessary 6) signed AMA and HINN forms or attempt to obtain, 7) prescriptions ordered or provided, 8) home care arranged, and; 9) valuables and prescription/OTC medications returned or arrangements for pick up. 11 QUALITY MATTERS By Barbara Boshard, RN, BSN, MS, QI Coordinator Algorithm: Safe Discharge of Patients Wanting to Leave AMA Wednesday, April 16, 2008 Patient wants to leave AMA On-call/Primary Intern Called Patient Elopes Intern will: 1. Reason for AMA 2. Plan for bedside evaluation ASAP 3. Inform nurse about time of evaluation within app. 30-60 min. 4. Nurse will inform patient about expected time Intern will review chart 1. Reason for admission 2. Current status/issues 3. Why was he not discharged? 4. Medical condition stable/unstable? 5. Clear and present danger to self or others? 6. Capacity to make decision? Document thoroughly Intern at Patient’s bedside Explain potential impact on reimbursement Intern asks patient what (s)he can do to keep patient in hospital Patient has social needs Patient dissatisfied with service Offer info and assistance to patient to submit complaint Contact Social Services Reassurance & Encourage to Stay Call Nurse Mgr if applicable (ex: delayed procedures, nursing concern Social Services can usually assess within 15 min (8a-12p) (Not available after midnight.) Communicate issues between teams Call Attending if applicable Pt. requests Meds No Is it medically necessary? (*pain control *withdrawal *Short term psych meds) Yes Can you give one time dose until primary team arrives in a.m. and no medical contraindication Yes Give one time dose Priority during a.m. rounds Still wants to leave AMA? No Yes Unable to give 1X dose – Explain reasons to patient No Obtain Pt. consent to call family, DPOA a 12 Document assessment, intervention, plan, outcome QUALITY MATTERS By Barbara Boshard, RN, BSN, MS, QI Coordinator Determining Safety of Discharge Revised 04/16/08 Public Health Concern a Determine Capacity & Medical Stability Check http://www.dhss.mo.gov/ CommunicableDisease/ reportablediseaselist2.pdf Capacity: AAO x 3 No Hallucinations No Delusions Able to communicate Understands & reports back info provided regarding Dx, prognosis, current mgmt and options Contact Attending if: Yes Medically Stable No capacity Yes Medically Unstable Capacity Medically Unstable No Capacity Medically stable Capacity yes Are there current medical reasons for poor decision making capacity? Are there current psych issues? yes Yes No Consult Psychiatry to help for confirmation/ assistance Implement IM AMA Protocols Retain until medically stable Questions about capacity, safety, or retaining? No Yes Contact Risk Management (Telephone # 882-1181) Or seek Hospital legal advice through House Manager B 13 Immediately Reportable Reportable within 1 day Reportable within 3 days Contact UMHC Infection Control 882-2264 QUALITY MATTERS By Barbara Boshard, RN, BSN, MS, QI Coordinator AMA Process B Patient chooses to leave AMA and has capacity to decide Implement IM AMA Protocols Discharge Document Assessment Attempt to get patient signature on AMA Form Attempt to get signature on HINN Form Offer prescriptions as possible Discuss follow-up arrangements Document attempt to set follow-up appointments in Resident Clinic within 1 week Inform pt. that resident will contact patient in a.m. Offer home care assistance if needed Document this discussion Return prescribed/OTC home meds and valuables if accessible or schedule return time for pick up with House Manager Communication: Ask pt to repeat back understanding, Communicate with primary care team Communicate with family/DPOA if patient consent Discuss S&S that indicate need for stat return Make sure patient knows they are welcome to return Document conversations Obtain best patient contact number Provide information that leaving AMA may impact on payment for this admission or readmission Resources: Some additional resources provided to us from UMHC and from Ms. Diane Johnson, medical librarian at the J. Otto Lottes Library include: 1. AlfandreD, “I’m Going Home”: Discharges Against Medical Advice, Mayo Clin Proc., March 2009; 84(3):255-260. www.mayoclinicproceedings.com. 2. Bristow DP and Herrick CA. Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review. Lippincott’s case management 7(3):121 – 128, 2002. 3. List of reportable diseases: http://wwwn.cdc.gov/nndss/script/conditionlist.aspx?type=0&yr=2013 4. MooreM, EkmanE, & ShumwayM, Understanding the critical role of the social work in safety net medical settings: framework for research and practice in the Emergency Department, Social Work in Health Care, 51:2, 140-148. http:// dx.doi.org/10.1080/00981389.20011.610872. 5. Social workers cut nonemergent visits 45%, Emergency Department Management, AHC Media LLC, 7/1/2007. 6. TawkR, FreelsS, MullnerR, Associations of Mental, and Medical Illnesses with Against Medical Advice discharges: The National Hospital Discharge Survey, 1988-2006, Adm Policy Ment Health (2013) 40:124-132. UMHC, RI-3 Patient Acceptance and Refusal of Medical Care (AMA), revised 8/7/2014, edited 1/12/15, https:// docushare.umh.edu/dsweb/ApplySimpleSearch 14 SCHOLARLY WORKS AWARDS + HONORS Congratulations to Dr. Sameer Siddique, an American Society for Gastrointestinal Endoscopy (ASGE) trainee and winner of an ASGE Community Outreach Award! This year, ASGE asked trainees to develop an infographic, included here, to create awareness about colon cancer. Dr. Stephen Keithahn has been named to the Board of the Boone County Medical Society for 2015. Congratulations Dr. Keithahn! Congratulations to Dr. William Salzer for being elected Investiture Marshall for Graduation! GRANTS Richard Webel, MD, is Principal Investigator for an Amgen sponsored clinical trial titled, “OLE: Supplemental GLAGOV study for Evolocumab” for $49,868. Akwi Asombang, MD, is Principal Investigator for an American College of Gastroenterology grant titled, “North American International Training Grant” for 6,000. PUBLICATIONS & PRESENTATIONS Shahzad Raza, Mahadi Ali Baigc, Christopher Changa, Ridhima Dabasa, Mallika Akhtara, Areej Khana, Krishna Nemania, Rahima Alania, Omran Majumdera, Natalya Gazizovaa, Shaluk Biswasa, Priyeshkumar Patela, Jaffar A. Al-Hillia, Yasar Shada, Barbara J. Bergera, Mohammad Zamana. A Prospective Study on Red Blood Cell Transfusion Related Hyperkalemia in Critically Ill Patients. J Clin Med Res. 2015;7(6):417-421. Shadi Barakata, Jamie Odemb, Jacqueline R. Bataniane, Shahzad Raza, Uzma Z. Khand. Papillary Thyroid Cancer in Struma Testis with Malignant Transformation in the Lung Associated with Trisomy 17 Successfully Treated with Total Thyroidectomy and Radioiodine Ablation. Case Rep Oncol 2014;7:751–757. Centor RM, Fleming DA, Moyer DV. Maintenance of Certification: Beauty Is in the Eyes of the Beholder. Ann Intern Med. 2014;161:226-227. doi:10.7326/M14-1014 Bosch FH, Fleming DA. Moving to High-Value Care: More Thoughtful Use of Cardiopulmonary Resuscitation. Ann Intern Med. [Epub ahead of print 7 April 2015] doi:10.7326/M15-0492 15 ANNOUNCEMENTS CODE OF CONDUCT MANUAL This link will connect you to the most updated Code of Conduct manual provided by the University of Missouri. MU Health System Code of Conduct • We act with integrity and treat everyone we encounter with dignity and respect as we strive to provide high quality patient and family-centered care. • We abide by laws and regulations that govern our organization. • We are trustworthy and maintain the confidentiality of patient and proprietary information. • We maintain right relationships and avoid conflicts of interest. • We are good stewards of resources entrusted to us — people, money, supplies, equipment and the health system’s reputation. • We demonstrate the highest ethical standards in achieving innovation and discovery. DR. JORDAN METZL VISITS MIZZOU Mizzou alumnus Dr. Jordan Metzl spoke at Department of Medicine Grand Rounds, held a book signing and led his Ironstrength Workout on Thursday, April 30. Dr. Metzl is a sports medicine physician at the Hospital for Special Surgery in New York City. For Grand Rounds, Jordan Metzl, BA ’88, MD ’93, gave a talk entitled “Should Doctors Prescribe Exercise? Trends in Preventative Wellness Through Activity.” Metzl’s exercise philosophy began while in medical school at MU, where he noticed his brain worked better after a run, allowing him to sit and study better. His book "The Exercise Cure" recommends fitness programs to address health issues. Metzl has completed 31 marathons and 11 triathlons. In a country that spends more than $325 billion annually on prescription drugs, “We need to make sure people exercise every day of their lives,” he says. 16 Congratulations to Dr. Joshua Mongler and his wife on the birth of their son, Frederick Eugene "Fritz," on March 5, 2015