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Stroke risk declines in the US and Colorado

Stroke risk

Marcelo Perraillon, PhD, assistant professor at the Colorado School of Public Health
Marcelo Perraillon, PhD, assistant professor at the Colorado School of Public Health

A research team with a faculty member from the Colorado School of Public Health at the CU Anschutz Medical Campus has found that stroke risk has dropped in both black and white older adults. The study analyzed 25 years of Medicare hospitalizations due to stroke.

The study publishes today in the April issue of Medical Care.

The findings are important because black Americans have shown consistently to be at a higher risk of strokes. This study reveals hospitalization rates have decreased in both races; however, black patients had a greater reduction in mortality. Though, black men and women continue to be at higher risk for stroke than white patients.

“Our findings show encouraging declines in stroke hospitalizations and mortality in older adults most likely due to smoking reductions and the increasing use of medications that control risk factors. However, the study also sheds light on critical unresolved disparities in the risk of stroke among minorities,” said Marcelo Perraillon, PhD, assistant professor at the Colorado School of Public Health.

Colorado Stroke Trends

In Colorado, strokes are the fifth leading cause of death, a relatively lower stroke incidence than the average in the US. However, race and income disparities are a concern for incidence and mortality rates on both a local and national level. Similar to national trends, poorer counties in Colorado, as well as black and Hispanic residents, have higher stroke risks and mortality rates.

New Study Finds a Decline Over 25 Years

Using Medicare data from 1988 to 2013, the researchers on this study analyzed trends in hospitalization and mortality after an initial stroke in black or white men and women aged 65 or older. The study included more than 1 million hospitalizations for ischemic stroke, caused by blockage or narrowing of the brain blood vessels; and nearly 150,000 hospitalizations for hemorrhagic stroke, caused by bleeding into or around the brain.

Over the 25-year study period, hospitalizations for stroke decreased for both black and white patients. Adjusted for age, ischemic stroke risk decreased from 1,185 to 551 per 100,000 Medicare beneficiaries among black men and from 932 to 407 per 100,000 among white men. Risk fell from 1,222 to 641 per 100,000 for black women and from 892 to 466 per 100,000 for white women.

Mortality after ischemic stroke also fell, with greater reductions in black patients. Risk of death within 30 days after ischemic stroke decreased from approximately 16 to 8 percent in black men and from 16 to 12 percent in white men. Ischemic stroke mortality declined from about 14 to 9 percent in black women versus 16 to 15 percent in white women.

Although the study can’t show a causal relationship, the reductions in stroke hospitalization and mortality were accompanied by declines in key risk factors: particularly smoking, blood pressure, and cholesterol levels. The improvements in stroke outcomes occurred despite the worsening US epidemic of diabetes and obesity.

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Ovia Health gives growing families support they need

From pregnancy to parenting, it is common that many soon-to-be and new parents and have many questions along the way.

To help answer these questions, the CU Health Plan is now offering Ovia Health to CU Health Plan members.

What is Ovia?

Ovia Health offers a suite of mobile applications to help families throughout each stage of family planning with education on fertility, pregnancy and parenting, as well as specific information about the maternity benefits available through the University of Colorado.

Distinct apps meet diverse needs

Ovia Fertility: Women can learn more about their health and fertility with cycle tracking, expert research and tips and instant data feedback. Use this app to predict periods and ovulation, track symptoms and mood and get pregnant faster.

Ovia Pregnancy: Get answers to pregnancy questions with articles, health and wellness tips. Use this app to track the growth of your baby, research effects of foods and medications, learn about your symptoms and have an overall healthier pregnancy.

Ovia Parenting: Ovia Parenting supports families with expert parenting articles, daily tips and guidance based on your child’s age and the ability to share updates with friends and family. Use this app to identify and understand developmental milestones, track progress and have an easier transition to life with a new family member.

Start using Ovia

To learn more about Ovia and sign up, visit the CU Health Plan online.

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ECHO Colorado at forefront of ECHO Act report to Congress

Doctors conducting telemedicine

The assistant secretary for planning and evaluation of the U.S. Department of Health and Human Services recently released the report called for in the Expanding Capacity for Health Outcomes (ECHO) Act of 2016. The 220-page report was requested as a part of Public Law 114-270 to inform the U.S. Congress on the growing interest, rapid adoption and current status of ECHO and ECHO-like models of telehealth.

‘Virtual care delivery models have demonstrated their ability to deliver on quadruple-aim outcomes.’ – John F. “Fred” Thomas, PhD

With the healthcare marketplace continually evolving in terms of technological innovation, payment models, delivery of care and rural-based workforce development, Colorado, along with the rest of the nation, continues to look for innovative ways to address these challenges. Of the 165 affiliated ECHO hubs in 35 states and 24 countries, nine case studies were highlighted in the report to illustrate the diversity and breadth of the programs. ECHO Colorado’s statewide effort was one of the highlighted programs due to its unique and innovative adaptation of the model.

“Virtual care delivery models have demonstrated their ability to deliver on quadruple-aim outcomes – increasing access, lowering the costs of care, all while improving patient satisfaction and reducing provider burden. This report highlights what we already knew, the need to focus on developing programs that build the evidence of effectiveness in effecting both provider and patient-level health outcomes,” said John F. “Fred” Thomas, PhD, executive director of ECHO Colorado.

ECHO Colorado is a statewide effort with a community-based board of directors and ties to both the University of Colorado Anschutz Medical Campus and the State of Colorado. For more information about ECHO Colorado visit echocolorado.org.

Guest contributor: Halley Hadfield, ECHO Colorado

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Project aims to help prevent burnout among healthcare professionals

When Marc Moss, MD, vice chair of clinical research for the Department of Medicine at the University of Colorado School of Medicine (SOM), delivers presentations about the growing epidemic of physician burnout he shows a clip from the “M*A*S*H” TV show. In the “Heal Thyself” episode, the Army hospital hosts a top-notch replacement surgeon who ends up breaking down amid the unabated stream of wounded soldiers. The strain builds until the surgeon finally crumples to the floor, rubbing his hands together and saying to no in particular, “The blood won’t come off.”

Marc Moss of Department of Medicine
Marc Moss, MD, vice chair of clinical research for the Department of Medicine

Likewise, the real-world working environments for critical care professionals — stress-filled, with high rates of morbidity and mortality — can cause severe psychological distress. “We see a lot of tragedy in the ICU, and no one ever taught us to deal with this,” Moss said. “It’s all pretty similar to what occurred in a war setting. … The wellness of healthcare professionals is the next big issue in health care.”

A first for university

Enhancing wellness and preventing burnout among healthcare professionals, especially critical care providers, is a strong area of interest for Moss, who is also the Roger S. Mitchell professor of medicine in the Division of Pulmonary Sciences and Critical Care Medicine. Last summer, he applied for a cooperative agreement from the National Endowment for the Arts (NEA), which recently awarded $150,000 to CU to create a Creative Arts Therapy (CAT) program for critical care professionals. With additional matching funds from the Department of Medicine and the Division of Pulmonary Sciences and Critical Care Medicine, the full amount of the award is $375,000.

It is the first NEA award of its kind to the University of Colorado Denver | Anschutz Medical Campus, according to the Office of Grants & Contracts. The idea is to establish CAT programs in writing, visual arts, music and dance to help critical care providers connect to the purpose of their work, develop coping skills and provide time to reflect and connect with their peers.

TV show illustrating healthcare burnout
This scene from the TV show “M*A*S*H” features prominently in Dr. Marc Moss’ presentations about the growing epidemic of physician burnout.

The long-term goal is to create a hub of creative outlets that help professionals better cope with the stressful aspects of their work.

Alarming burnout rates

The National Academy of Medicine recently recognized that “The people we rely on to keep us healthy may not be healthy themselves.” The un-wellness trends in the profession are alarming:

  • Over half of doctors feel their families have suffered from their choice of becoming a physician.
  • A 2014 national survey found that 54 percent of U.S. physicians reported at least one symptom of burnout.
  • Physicians have double the suicide rate of the general population.
  • Growing rates of depression and substance abuse.

Burnout in the health care field, which is seeing a workforce shortage amid increasing clerical burdens and pressure to reduce costs, is “really common and has devastating consequences,” Moss said. “It affects patient care, providers’ health and has economic implications.”

Other factors causing stress among health care professionals include:

  • Less autonomy at work (more focus on documentation, and increased shift work);
  • Patients are sicker (more chronic diseases and critical illnesses);
  • Increased patient/family expectations; and
  • Decreased patient trust (in 1966, 73 percent of Americans had great confidence in the medical profession; in 2012, the rate declined to 34 percent).

Trifold goals

Research shows that health care professionals with burnout syndrome (BOS) are more likely to leave the profession, resulting in turnover that drives up health care costs, reduces quality of care, and diminishes staff morale. Through the arts interventions, the CU research group hopes to:

  • Reverse the trend of BOS and other forms of psychological distress in critical care providers;
  • Improve patient care by addressing the well-being of health care providers; and
  • Reduce costs by reversing the high rates of turnover.

In the next two years, CU will design four CAT programs for 150 critical care providers and test their feasibility, acceptability and effectiveness. The Division of Pulmonary Sciences and Critical Care Medicine has a strong history of studying this issue; CU’s critical care research group is one of only two U.S. groups that are funded by the National Institutes of Health to study burnout syndrome in health care providers.

In the NEA initiative, the CU research group is one of four grant awardees in the third cohort. There are two previous cohorts of four awards each, for a total of 12 awards.

Partnering with nonprofits

For the writing CAT, Moss’s group will partner with the Lighthouse Writers Workshop, which engages with many different populations, including cancer patients and at-risk youths, to use creative writing as an outlet as an emotional and relaxational outlet. For the visual arts, music and dance/movement CAT, CU will partner with the Ponzio Creative Arts Therapy Program which serves children and adolescents at the Pediatric Mental Health Institute of Children’s Hospital Colorado.

A fifth area of therapy, horticultural activity in conjunction with the Denver Botanic Gardens, is also being considered.

A major aspect of the problem, Moss said, is the stigma associated with admitting to the difficulty of maintaining personal wellness as a healthcare professional. “We’re supposed to be tough enough to do this kind of work without suffering from mental stress,” he said. Studies have shown that health care professionals are reluctant to share these problems because they’re worried about how it reflects on their medical center or may impact career advancement. “If anything, these symptoms of burnout appear in the most ideal of employees,” Moss said. “They occur in people you’d want to have as your doctor or nurse. There is a stigma; it needs to change.”

Programs to replicate nationally

While the research project hopes to demonstrate how these creative outlets can reduce burnout and restore joy to health care providers in the Denver area, the goal is to reach a broad population of professionals, Moss said. Emerging best practices could be replicated to health care workers, who work in both critical and non-critical positions, nationwide.

“The goal will be to develop these programs and disseminate them across the country,” he said.

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Wellness Center teaches people how to improve their health through nutrition

Cooking at CU Anschutz Health and Wellness Center

When the University of Colorado Anschutz Health and Wellness Center piloted a series of cooking classes to educate the community about the importance of nutrition and health, organizers did not expect it to grow into one of the most popular programs offered on the CU Anschutz Medical Campus.

The Culinary Medicine Series features weekly cooking demonstrations of recipes that are healthy and nutritious for those with chronic illnesses such as cardiovascular disease, diabetes and cancer.

Lisa Wingrove, RD, CSO, a registered dietitian who specializes in nutrition for oncology patients, recently led a session on how to make a butternut squash mac-and-cheese dish geared for cancer patients. She shared basic cooking techniques and other methods for cooking for those with cancer.

“When someone has cancer or is going through chemotherapy treatment, sometimes the foods they liked before are not appealing anymore because certain smells become unappetizing,” said Wingrove.

What is Culinary Medicine?

As a new evidence-based field, culinary medicine blends cooking and medicine to help people access high-quality meals that help to prevent and treat disease. The Culinary Medicine Series, created in partnership with the UCHealth Digestive Health Center, the Integrative Medicine Center and the CU School of Medicine’s Department of Internal Medicine, provides members of the Aurora community as well as faculty, staff and students of CU Anschutz with nutrition resources.

Lisa Wingrove, RD, CS
Lisa Wingrove, RD, CSO

“Many of the attendees of the classes are caregivers, patients or members of the community as well as staff or students on campus,” said Wingrove.

The concept of culinary medicine was created by John La Puma, MD, a physician who recognized a need for further nutrition education for both physicians and patients. According to La Puma, physicians need to learn how to prescribe food as medicine, and patients should become more educated about what foods can help beat disease.

“Many physicians don’t learn about   nutrition in medical school, but it is something that can help people live better with chronic illness,” explained Wingrove.

Learning about nutrition

The Culinary Medicine Series gives anyone the knowledge to eat well and provides a resource to those struggling with chronic illness. “Nutrition is an evidence-based science, so we offer recipes that are beneficial to those living with chronic illness,” she said.

According to Wingrove, the recipes taught are alternatives to classic recipes and are meant to be more palatable for those with additional dietary restrictions.

butternut squash
This butternut squash mac-and-cheese dish is geared for cancer patients.

“One of the goals of the sessions is to provide participants with alternatives while maintaining the flavor of their favorite dishes. A lot of the foods we cook include ingredients that you might already have in your kitchen,” said Wingrove.

The sessions are also intended to be interactive, giving participants opportunities to ask a dietitian questions.

“People come here who have never cooked before,” said Wingrove. “We want to make this an approachable environment where participants can feel comfortable asking us questions so they can learn new skills.”

As medicine continues to advance, so will treatment options. According to Wingrove, it will become more important to incorporate nutrition into treatment plans for patients with chronic illness.

“A lot can be gained from using nutrition as a treatment. For cancer, that means providing patients with a plant-based diet with lean proteins and helping maintain a healthy body weight,” said Wingrove.

The next class for cancer care in the Culinary Medicine Series taught by Lisa Wingrove takes place on March 12. To register, visit the series website.

For the butternut squash mac-and-cheese recipe, click here.

Guest contributor: Katherine Phillips

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What’s on the horizon of artificial intelligence and health care?

Artificial intelligence panel

The explosion of big data promises potential breakthroughs in disease treatments, but, just as in the development of new drugs, scientists and clinicians must exercise caution in how they apply algorithms and other technologies, according to a CU Anschutz panel of experts.

The discussion on “What’s on the Horizon of Artificial Intelligence (AI) and Health Care?” kicked off this year’s series of Transforming Health Care lectures at the CU Anschutz Medical Campus. About 80 people attended the session in Krugman Conference Hall on Wednesday. The panel was made up of Lawrence Hunter, PhD, director of the Computational Bioscience Program in the CU School of Medicine (SOM); Foster Goss, DO, clinical informaticist and assistant professor of Emergency Medicine; and Clay Smith, MD, director of the Blood Disorders and Cell Therapies Center at University of Colorado Hospital and associate chief, Division of Hematology, SOM.

Hunter outlined examples of how machine-learning systems are used in health care. The outcomes show mixed results: while some systems delivered illuminating data that helped clinicians, other instances revealed a machine’s inability to understand the nuances involved in, for example, a basic blood draw. “The goal is not to replace doctors, but to augment them — help them do a better job and spend less time doing boring stuff and more time on doing the things that really matter to patients,” he said.

Algorithmic snake oil?

Only 100 years ago, Hunter reminded the audience, “snake oil” was often passed off as “medicine.” Just as the Food and Drug Administration (FDA) certifies new medicines as safe and effective, the same process should apply to AI, he said. “These algorithms aren’t magic … It’s really important that we treat them the same way we treat all other aspects of medicine: make sure they’re safe and effective.”

Goss, a physician in the Emergency Department, has studied how the documentation demands of electronic health records (EHR), which are intended to improve patient outcomes, can actually create problems for physicians. In one case, he said, the large amount of “free text,” or unstructured data, in a patient’s EHR resulted in a clinician missing the man’s allergy to a particular drug.

In another case, speech-recognition technology — commonly used by clinicians when dictating information into an EHR — took a doctor’s “missed-her-period” comment on a patient and translated the menstrual “period” into a simple punctuation mark. So, when the patient had a complication, her subsequent physician misread the woman’s condition and prescribed a drug that’s dangerous to pregnant women.

Developing AI tools

Goss, along with colleagues, is working to develop an AI tool that can detect errors before they are entered into the electronic record. They are also working on a standardized knowledge base of allergies and reactions, which could be applied in an easily-found fashion in the EHR.

He is also working on a universal tool to help clinicians quickly identify all information in the EHR that’s relevant to a patient’s presented condition. The goal is to ensure that clinicians can make the right care decision at the right moment.

‘Medical errors are the third-leading cause of death behind heart disease and cancer. I think artificial intelligence has tremendous potential to actually improve the safety of the care we provide our patients.’ – Foster Goss, DO

“Right now, medical errors are the third-leading cause of death behind heart disease and cancer,” Goss said. “So, I think artificial intelligence has tremendous potential to actually improve the safety of the care we provide our patients.”

Meanwhile, Smith and a large team of personalized-medicine experts are researching ways to improve therapies for acute myeloid leukemia (AML), a disease that went decades without a significant advance in treatment, and other blood disorders.

Progress was recently made on a novel new therapy, fueled by combining clinical data with new information about cancer cells, and the campus continues to make great strides in other areas of personalized medicine.

Team sport

Chancellor Don Elliman and others here have had the foresight to build such an environment, a compass where we can marry this data together, and then layer on top of it the tools that allow people to analyze the data, visualize the data, and then hopefully give us quick and accurate answers,” Smith said.

Smith noted that the marriage of data and health care knowledge is a “team sport” and requires a diverse group of experts, which exists in spades at CU Anschutz. “That’s the key for all this moving forward,” he said. “This is not an electronic-record problem, it’s not a statistics problem, it’s not a doctor problem. It’s a problem that’s only going to be addressed effectively by a big team of people who have all of these disciplines and can work well together.”

The panel answered questions from the audience, including a query on ways the campus should incorporate AI training into its health care curricula. Hunter said the curricula should be agile enough to adapt to the fast-changing technological environment. As a baseline, the curricula should educate students about the errors that may occur in AI. Beyond that, he said, the curricula could offer, for interested students, a deeper dive into the theories behind AI.

“I do think there is a baseline that ought to end up in the curriculum,” Hunter said. “We don’t have that yet.”

All of the panelists agreed that, ultimately, human capabilities and machine-based technologies must be married in complementary fashion. It’s an exciting time, they said, and the health care advancements will be for the better, but they will arrive incrementally.

“When we have these cool new technologies, we have to figure out where do they actually help in medicine?” Hunter said. “Where are the places we know we could do better, and is there a technology that could help us?”

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Answers To Every Thanksgiving Question You’ve Ever Had

Thanksgiving is almost here, and that means two things. Time spent with family and friends around the television watching football and turkey. Lots and lots of turkey. At this time of year, we often overindulge and loosen our belt and wonder how we fit all that stuffing and gravy into our stomach. Don’t worry. We asked leading health experts from the University of Colorado Anschutz Medical Campus a few of the Thanksgiving questions you’ve always wanted to know the answer to.

Mom’s turkey is legendary! Could I end up blowing a hole in my stomach by devouring too much turkey?

We’ve all been there. The awkward stares around the table as Uncle John says, “Who is going in for the last piece of that delicious bird?” You may wonder if it’s possible to overeat at your Thanksgiving meal to the point of health complications. “Thankfully the stomach has a thick muscular lining that makes it very resistant to stretch and pressure, so a perforated stomach is not really a concern on Thanksgiving Day,” says Paul Menard-Katcher, MD, assistant professor in the Division of Gastroenterology & Hepatology in the CU School of Medicine. “Unless you swallow a sharp turkey bone, so don’t do that,” he adds.

 

My grandma Betty makes her famous Thanksgiving casserole four weeks in advance and brags on how it keeps in the freezer. Needless to say, I’ll be passing on it this year. Is there any actual evidence that frozen food offers less nutritional value than freshly cooked food?

“There is very little nutritional value lost from freezing food in general, and food can be frozen for long periods of time which is one of the advantages of freezing,” says Marsha Miller, MS, RD, at the CU Anschutz Health and Wellness Center. The USDA recommends freezing food as quickly as possible to maintain quality. When it comes to thawing, it’s actually the opposite. Turkeys may take days to safely thaw in your refrigerator, approximately one day for every five pounds of weight.

 

Is it the turkey that leads to Aunt Judy passed out cold on the reclining chair after our meal?

This one is as old as Thanksgiving itself. Turkey contains an amino acid called tryptophan that makes you sleepy, right? Wrong. “Turkey contains no more tryptophan than other foods and actually less than chicken!” says Cristina Rebellon, RD, at the CU Anschutz Health and Wellness Center. “So, it’s likely not the turkey that’s the culprit but the high food and alcohol intake,” she adds.

 

If it were socially acceptable, I would drink right from the gravy boat. How much gravy is too much?


Gravy is the ultimate side at any Thanksgiving dinner. It helps the meal slide right down in all its sodium glory. However, Sarah Funk, RD, in the Division of Gastroenterology says it’s best to take it easy. “Gravy should be added to the meat for added flavor and moisture. If there is more gravy than meat, there’s probably too much gravy,” says Funk.

 

I’ve been told sweet potatoes are a healthier choice than white potatoes. Is that true?

Remember when your mom would tell you to eat all those colorful vegetables growing up? Maybe there is some truth to that. “Sweet potatoes and white potatoes have different nutrients. Sweet potatoes have more fiber (about 2 more grams more than white) and contain Vitamin A, while white potatoes don’t contain vitamin A but do contain more Vitamin C,” says Sarah Funk, RD, in the Division of Gastroenterology. “Include a variety of colors from fruits and vegetables — all in order to receive a variety of nutrients,” she adds.

 

I’ve heard cranberries are good for you and even prevent cancer and heart attacks. Should I load up on Thanksgiving?

Cranberries are commonly referred to as a superfood for their antioxidants and are rumored to help with all kinds of medical conditions from urinary tract infections to diabetes. But is that legit? “There is insufficient reliable evidence to support cranberry has any positive impact in the prevention of cancer and cardiovascular disease,” says Joseph Saseen, PharmD, at the CU School of Pharmacy. “Watch out for cranberry sauces and jellies. One typical serving (about half of an inch of the canned product) contains 86 calories and 22 grams of sugar,” he adds. I can already feel my blood sugar spiking!

 

I’ve heard that eating turkey without the skin is better for me. Is that true?

There are few things better in the world than lightly crisped turkey skin, but you may want to think again this year. “In a 3.5 oz portion of turkey breast, there’s almost double the amount of fat when the skin is left on versus if it is removed,” says Marsha Miller, MS, RD, at the CU Anschutz Health and Wellness Center. “If you’re looking for ways to reduce the calories in the meal, this is certainly one easy way to do it,” she said.

 

What tips would you give someone who wants to eat healthy during Thanksgiving?

This is the toughest time of the year to eat healthy. But there are things you can do to make your holiday less punishing on your body. Experts say a common mistake is not eating all day. “A big mistake people tend to make is to eat very little or nothing at all the whole day of Thanksgiving which often leads to overeating during the big meal,” says Cristina Rebellon, RD, at the CU Anschutz Health and Wellness Center. She recommends eating as you normally would and stay well hydrated. This will put you in a good position to not overeat.

 

How can the Thanksgiving cook make the meal healthier by substituting or preparing the meal in a different way?

 

  • Choose skim milk or 1 percent milk instead of cream or half-and-half.
  • Start with adding a smaller amount of fat and add as needed for taste.
  • To reduce added salt, season with herbs and spices and use low-salt broth or bouillon cubes.
  • Grill or bake instead of frying foods.
  • Try a fruit-based dessert. Substitute applesauce and yogurts for added butter and oils.
  • Leave sauces or dressings on the side to allow diners to choose how much of the higher-calorie items they want.
  • Offer up sparkling water or other low-calories drinks to help ease the calorie load for the meal.

Happy Thanksgiving to all from the CU Anschutz Medical Campus. With a little preparation and a lot of self-control you can have a healthy and enjoyable holiday surrounded by family and friends.

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Teeth restoration delivers beautiful smile, and confidence, for teen girl

A pair of words — beautiful smile — are heard all the time in dental and orthodontic clinics. These days, it’s practically an expectation for teenagers to, after wearing braces, end up with sparkling and picture-perfect teeth.

This wasn’t the case for Courtney Caudill. Whenever the Thornton teenager looked in the mirror, two other words came to mind: shark teeth.

Courtney's teeth starting high school
This photo of Courtney’s teeth was taken at another Denver-area dental clinic about five years ago, when she was starting high school.

“During my entire high school career, I barely found any photos of me showing my teeth,” she said. “It was a little sad and depressing that I was so embarrassed. You know, there was nothing I could do about it.”

Rare condition

She was born with ectodermal dysplasia, a condition that affects teeth, skin, hair, fingernails and eyes. In the mouth, the condition manifests in misshapen and often-missing teeth. Courtney’s permanent teeth didn’t come in until age 11 and her smile betrayed gaps where teeth should be. Many of the teeth that came in as permanents were conical-shaped — resembling those of a shark.

The condition left Courtney reluctant to smile much of her life, telling peers at every opportunity why she lacked “normal teeth.” Fortunately, teasing was kept to a minimum, mainly because her parents taught Courtney to be proud of herself and went out of their way to explain her condition to teachers and classmates. Entering college — she is currently a sophomore at CU Boulder studying psychology — the late-teen resigned herself to possibly no end in sight to this “very, very long journey” and “lifetime struggle.”

CU Dental School a ‘godsend’

Her mother, however, did some research and found the CU School of Dental Medicine and its Adolescent Dental Clinic, operated by Rick Mediavilla, DDS. After Mediavilla saw Courtney in June 2016, he carefully selected Kevin Moore, DDS, who at the time was a third-year dental student, to complete her care. Mediavilla saw a gentle chairside manner and excellent care standards in Moore, who immediately clicked with Courtney and began plotting her course toward a perfect smile.

Her father, Christopher, calls Moore a “godsend.” “When we first came and met Kevin, I just knew God had sent him to us. It was divine intervention.”

Christopher is made of strong stuff — he’s an Army veteran who has done two hitches in the Middle East — but he’s been reduced to tears — once when Courtney got crowns on her bottom teeth in May, and again when she received upper crowns in mid-October. Both procedures were performed by Moore, who is now in the general practice residency program at the CU Dental School, and overseen by Mediavilla and David Gozalo, DDS, a prosthodontist who specializes in replacement and dental implants.

Always smiling

Kevin Moore, DDS, places crowns
Kevin Moore, DDS, places a customized crowns — multiple-teeth bridges — in Courtney’s mouth during the Oct. 19 procedure.

After the latest crowns were placed, Courtney sat still in the dental chair, staring out the window and letting the profound change in her appearance soak in. The teen may have reflected on how, about two years ago, when a different Denver dentist suggested implants, at an out-of-pocket cost of $35,000 (the provider didn’t take her family’s insurance), she weighed the options and declined. Courtney knew that without sufficient upper-shelf bone, which was the case in her mouth, implants can fail.

Undoubtedly, the many disappointments she had endured over the years flooded her mind.

Christopher, meanwhile, stood nearby with reddened eyes. He could see the relief in his daughter’s expression. “We’ve noticed her whole demeanor has perked up incredibly,” he said. “She’s never let it bother her much, but now she’s persevered and she’s always smiling.”

Cutting-edge dentistry

model of Courtney's new smile
A model of Courtney’s new smile was created using a state-of-the-art software program and a 3D printer.

The story of this cutting-edge care in the CU Dental School includes a generous donation from Peebles Prosthetics, Inc., which supplies “removables” — dentures and arches — as well as “fixed appliances” — multiple-teeth bridges — to the CU Dental School. For Courtney’s upper mouth, she received a pair of three-unit bridges, which were fabricated by Peebles in consultation with the CU dentists. Company owner Rick Peebles watched the two fixed appliances — a donation valued at about $1,100 — transform Courtney’s smile at the Oct. 19 appointment.

“Kevin told us about Courtney’s case and asked us about (a donation),” Peebles said. “We thought it was a great cause, and we like what he does as both a person and a dentist. A lot of the kudos should go to Dr. Moore for being a champion for Courtney.”

Emotional and impactful

Moore credited Peebles and his firm, because without their donation the dental work might not have been financially feasible for Courtney’s family. Lonnie Johnson, DDS, senior associate dean of clinics and professional practice in the dental school, ensured completion of the project by covering costs not met by Peebles and the family.

Dental team and Courtney Caudill
Courtney Caudill, center, had a top-flight team working on her case: From left, Rick Mediavilla, DDS; David Gozalo, DDS; Rick Peebles, owner of Peebles Prosthetics; and Kevin Moore, DDS.

Moore had performed a similar procedure on an 86-year-old patient, but Courtney’s case was profoundly different. “This is definitely rewarding,” he said. “With a teenage girl, giving her a smile is pretty emotional and impactful.”

The final product of Courtney’s crowns started with the dental school’s Trios scanner, which makes an oral impression by scanning teeth digitally, allowing them to be designed to the patient’s specifications. A model of her new smile was also created — the analog way — using a state-of-the-art software program and a 3D printer. Lastly, both the model and the digital imaging were sent to Peebles Prosthetics, which fabricated Courtney’s crowns using technology that further improves the design and quality of dental restorations.

‘Loving my teeth’

“Restored” couldn’t be a more apropos term. The journey that has stretched over a dozen years, and taken the Caudills to multiple dentists, has at long last come to an end. Courtney finally has a complete and picture-perfect smile.

‘This is definitely rewarding. With a teenage girl, giving her a smile is pretty emotional and impactful.’ — Kevin Moore, DDS

Christopher said, “I’m just so absolutely grateful. I don’t think I’ll ever be able to repay everyone for everything.” He looks to the CU Dental School to perform a similar miracle on his 13-year-old son, who suffers from an even more severe case of ectodermal dysplasia. “One down, one to go,” he said.

Courtney, meanwhile, finds herself shedding the occasional tear of happiness. Mostly though, she’s flexing those smile muscles that she has restrained for so many years.

“I’m loving my teeth,” she said, after living with her new crowns for a couple weeks. “I don’t think I’ve ever smiled this much in my life!”

Editor’s note: Ryan Nisogi, senior director of digital marketing strategy, Office of Communications, contributed photography and video, while Matt Kaskavitch, director of digital strategy, contributed video packaging to this report. 

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Crisis management and recovery focus of Public Health Case Competition

A flash flood that left a community with contaminated water and facing other public health emergencies was the dilemma given to over a dozen teams at this year’s Rocky Mountain Region Public Health Case Competition.

The sixth annual event took place at the CU Anschutz Medical Campus last weekend. The event, hosted by the Colorado School of Public Health (ColoradoSPH), provides students from all the schools at CU Anschutz and selected disciplines from the CU Denver and CU Boulder campuses, an opportunity to work in collaborative teams to develop innovative solutions to a real-world health problem.

Second place team public health case competition
The second-place team in the competition, along with ColoradoSPH Dean Jonathan Samet: From left: Kathy Pang, Amber Vaughn, Ronald Truong and Hannah Parris.

Prizes for the top three teams were varying amounts of scholarship money up to $1,000. Two teams were selected as people’s choice recipients, with each member receiving $100 each.

“Public health stretches across all disciplines,” said Tonya Ewers, director of communications and alumni relations for the ColoradoSPH. “This is a great practice-learning opportunity for these students to learn to work together to solve health problems.”

The teams each spent 24 hours analyzing the case of the Many Forks flood disaster as well as creating a public health solution. They presented their solutions to a panel of judges.

third-place team public health case competition
The third-place team in the competition, along with Dean Jonathan Samet: From left: Jenny Yoo, Katherine Myers, Hannah Marinoff and Riley Stanton.

The teams came up with holistic, collaborative and far-reaching plans to address the emergency as well as increase the town’s capacity for full recovery. The winning team, whose plan was titled “Many Forks, One Community,” offered a multifaceted response that included the launch of a community-led resource center to act as both an emergency gathering site as well as a resource for mental health services, such as group counseling and social events. It also included neighborhood-tailored recovery plans and a disaster preparation initiative that set up a town-wide disaster alert system (flood siren) to reach residents who don’t own a mobile phone.

The second-place team focused on how the community, in the wake of a crisis, could best respond to the needs of children and youth, who make up 20 percent of the town’s population. The third-place team devised a solution focused on ensuring that community members have access, both immediately and for the long term, to clean drinking water.

Here are the results of the 2018 Rocky Mountain Regional Case Competition

First place ($1,000 scholarship each):

“Many Forks, One Community”

Team members and affiliations

  • Tamara Akers, ColoradoSPH
  • Robert Harr, ColoradoSPH
  • Jennifer Schulte, ColoradoSPH (Colorado State University home campus)
  • Jessica Stubblefield, ColoradoSPH

Second place, ($500 scholarship each)

“Learn, Empower, Action, Progress (LEAP): Many Forks’ Youth Program Helping Our Kids Leap Forward”

Team members and affiliations

  • Kathy Pang, ColoradoSPH
  • Ronald Truong, School of Medicine
  • Hannah Parris, ColoradoSPH
  • Amber Vaughn, ColoradoSPH

Third place ($250 scholarship each)

“Many Forks Clean WARS: Water. Access. Restoration. Sustainability.”

Team members and affiliations

Two teams received People’s Choice Awards ($100 scholarship each)

“Guidelines for Flood Disasters: A Plan for Prevention and What to Expect in the Moment of Crisis”

Team members and affiliations

  • Abdulrahman Alyamani, ColoradoSPH
  • Ann Giesenhagen, ColoradoSPH
  • Alexis Krause, ColoradoSPH
  • Simona Senovaityte, Skaggs School of Pharmacy and Pharmaceutical Sciences

“Flying Toward Better Solutions: Drones as the Future of Emergency Response”

Team members and affiliations

  • Sara Azimi, Skaggs School of Pharmacy and Pharmaceutical Sciences
  • Yuli Chen, ColoradoSPH
  • Leila Diab, ColoradoSPH
  • Elizabeth Kim, ColoradoSPH (CSU home campus)
  • William Windsor, ColoradoSPH

Editor’s note: Katie Brumfield, career services and practicum specialist, Colorado School of Public Health, contributed to this report.

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Study: Home care for knee replacement patients aids in recovery

A team of physical therapy researchers from the University of Colorado School of Medicine have conducted one of the first full-scale studies to assess the effectiveness of in-home physical therapy care for patients who have had knee replacement surgery.

The study analyzes Medicare home health care claims for patients treated with total knee arthroplasty in 2012 who received home health care services for their post-operation rehabilitation.

Generally, patients who received more physical therapy visits at home were able to recover better from the surgery. The optimal number of home-care visits by physical therapists was six to nine. Researchers also found that patients living in a rural area or having other complex medical conditions were associated with fewer, not more, home health care visits.

Jason Falvey, PhD
Jason Falvey, PhD, research physical therapist, CU School of Medicine’s Physical Therapy Program

“This study is important because some people have recommended saving money by curtailing the use of physical therapists for in-home care for patients who receive total knee arthroplasty,” said lead author Jason R. Falvey, PhD, research physical therapist with the CU School of Medicine’s Physical Therapy Program. “But those recommendations are based on a lack of research. Our study shows that patients recover better when they receive appropriate care.”

Based on a review of 5,967 Medicare beneficiaries, those who received fewer than five home health care visits by a physical therapist were associated with greater difficulty returning to activities of daily living. The survey of cases covered urban and rural locations across the United States. About 68 percent of the patients were women. Eighty-nine percent were Caucasian.

“This is one of the most commonly performed surgeries in the United States,” Falvey said, noting that more than 700,000 total knee replacements are performed each year. The number of cases is expected to increase to 3.5 million annually by 2030.

The cost of the procedure averages $23,000 to $27,000, according to the Centers for Medicare & Medicaid Services (CMS), with post-acute care responsible for a substantial portion of that cost. CMS has introduced a bundle payment model that combines the costs of hospital, post-acute-care and outpatient costs associated with total joint replacement. The bundles have the effect of incentivizing the discharge of patients from hospital to home.

“Our study may help care providers prescribe more optimal dosages of at-home physical therapy for these patients who are discharged,” said Falvey. “Low users of at-home physical therapy often had less social support and more complex medical conditions. Patients who don’t get the home health care visits they need can end up needing future hospitalization or institutionalization. The risks of not providing the appropriate level home health care may result in higher overall healthcare costs in the long term.”

The results of the study are published in the current issue of the Journal of Bone and Joint Surgery. Funding to support the study came from a scholarship from the Foundation for Physical Therapy and from grants from the National Institute on Aging, the American Physical Therapy Association Home Health Section, the Foundation for Physical Therapy, and the Center on Health Services Training and Research. Statistical resources were provided by the VA informatics and Computing Infrastructure.

Falvey’s academic appointment is in the School of Medicine’s Department of Physical Medicine and Rehabilitation. There are seven authors on the paper, including senior author Jennifer E. Stevens-Lapsley, PhD, professor in the CU Physical Therapy Program, director of the Rehabilitation Science PhD Program, and member of the Veterans Affairs Geriatric Research Education and Clinical Center.

Guest contributor: CU School of Medicine

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