Rocky the Bull stomped out a giant cigarette, teen-agers got to see computerized photos of how smoking would age them, and would–be quitters got free “cold turkey” sandwiches Thursday as the entire USF Health campus went smoke-free.

     “Today at USF Health we say no more,” said Donna Petersen, ScD, MHS, dean of the College of Public Health. “We will no longer tolerate smoke on the USF Health campus.”

      Banning smoking on campus tells USF Health faculty, staff and students that the institution cares about their health, Dr. Petersen said. USF Health is offering a variety of smoking cessation classes and other programs to help smokers quit.

      She hopes the change also gets attention from the broader community, Dr. Petersen said.

      “We truly believe it is our job to improve the health of the community,” she said. “Today, we send a message.”

     The campus went smoke-free on the same day as the national Great American Smoke-Out.

     Brandi Jacobs, 17, a student at Bowers/Whitley Career Center in Tampa, said she got that message loud and clear. Jacobs got her face electronically aged by the state’s Smokifier van. The van has equipment to take a photo, then electronically “age” it to show the photo subject how much older they will look if they smoke.

      “Ewww, Brandi, it looks like someone folded up your face,”  a friend told her.

      Jacobs, looking at the photo, had to agree.

      “I used to smoke for four months,” she said. “Then my mom caught me, and I quit.”

      Would she try it again? The photo made it an easy choice.

      “No, never, oh my gosh, no,” she said.

      Patricia Burns, PhD, RN, FAAN, dean of the College of Nursing, said the smoking ban is an important way for health care providers to speak out against smoking.

      “We, as health care providers, do not realize the impact we can have on our patient population,” she said.

      Yet one study has shown that if a health care provider spends just three minutes talking to a patient about smoking, those words can have a significant impact in moving the patient to quit, Dr. Burns said.

      One reason the move to ban smoking on the USF Health campus was a success, Dr. Petersen said, was because it started with students. She also praised USF's Area Health Education Center Program for putting the program in place. Dr. Petersen gave special kudos to Leila Martini, assistant director of tobacco prevention and cessation, for “her persistence, her tenacity and her passion.”

     The smokeout also provided an opportunity for AHEC to present its first AHEC Access to Health Care Award. Cynthia Selleck, program director, presented the award to Dr. Charles Mahan, dean and professor emeritus in the College of Public Health.

      Now that USF Health is smoke free, the work isn’t over, said Steven Specter, PhD, associate dean for student affairs and leader of a task force to implement the ban. He hopes students will push to ban smoking on the rest of the USF campus. He also hopes USF and its medical students can work with other medical schools to extend the state’s indoor smoking bans to outdoor areas of state institutions.

      “Today is a beginning,” he said. “Not an ending.”

      -- Story by Lisa Greene, USF Health Communications; photos by Eric Younghans, USF Health Communications

Click here to read about Dr. Lezama's recognition in ACP Hospitalist.

USF Health’s Jose Lezama, MD, FACP, has been named one of the nation’s top 10 hospitalists in the November 2009 issue of ACP Hospitalist, a publication of the American College of Physicians.

Dr. Lezama, associate professor of internal medicine at USF Health and chief of medicine at the James Haley Veterans’ Hospital, was one of two physicians in the Southeast (and the only one in Florida) to be honored in the journal’s second annual Top Hospitalists issue. A hospitalist is a physician, without a private outside practice, whose time is devoted solely to caring for hospitalized patients.

The journal solicited nominations from its readership – hospital-based internists and third-year medicine residents – last spring and summer, asking for hospitalists making notable contributions to the field of hospital medicine, whether through clinical skills, research, innovation, teamwork, community involvement, improved work flow, patient safety, leadership, mentorship or quality improvement. The editorial board reviewed the nominations and selected the top 10, including Dr. Lezama, who are profiled in the November issue.

“He is an outstanding physician with more dedication to his patients than I have seen in my career from anyone else,” said Alexander I. Reiss, ACP member and a colleague who nominated Dr. Lezama as a Top Hospitalist. “His contributions as an expert at our medical morning report have established him as the ‘go-to guy’ for difficult cases and advice for younger faculty.”

One of the youngest chiefs of medicine in the nation in one of the country’s busiest VA hospitals, Dr. Lezama is known for his ability to motivate and inspire younger physicians. He was among 42 doctors nationwide nominated by his peers for the 2007 Humanism in Medicine Award, sponsored by the American Association of Medical Colleges. His board review series has been instrumental in boosting resident pass rates for the past seven years, and USF internal medicine residents have voted him Teacher of the Year for five years running.

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     Jerry Bell got one concussion when he was playing college football and another playing for the Tampa Bay Buccaneers.

     That was 20 years ago, but now Bell wonders if those injuries could have had long-term effects.

     That question brought him to the USF Health Byrd Alzheimer’s Institute Tuesday for the institute’s annual Memory Screening Day. About 100 people came to get free screening, a process that can show whether they should receive further testing for cognitive problems.

     Bell was among them. He sat down with Dr. Amanda Smith, medical director of the Byrd Institute, who asked him a series of questions.

     What’s the date? What city are we in? What county? What building are you in? What floor of the building are we on?

Former Tampa Bay Buccaneers tight end Jerry Bell answers questions on a memory screening quiz given by Dr. Amanda Smith, medical director of the USF Health Byrd Alzheimer's Institute.

     Bell, 50, answered the questions with ease. But he plans to return each year, to make sure his cognitive abilities show no signs of decline. Bell knows early diagnosis can slow progress of Alzheimer’s symptoms.

     “There’s no cure – but I might get to see my grandkids for five years more,” he said.

     Bell is thinking far ahead. His two children are in college, and he has no grandchildren yet.

     But his presence at Tuesday’s event had a larger purpose as well. Bell wants to bring more attention to the increased risk of Alzheimer’s for former NFL players. The potential long-term damage of head injuries to football players has been the subject of national debate recently, with a Congressional hearing held to discuss the risks and whether players are adequately safeguarded and treated.

     “The thing is, let’s find out what the risk is,” Bell said. “Nobody’s saying, ‘Stop playing football,’ because the guys won’t do it. But put some things in place to make it safer.”

     Working to design better helmets, strictly enforcing game rules to help avoid head injuries and treating head injuries with vigilance are among the steps that football coaches and physicians need to take, Bell said.
Both times Bell was concussed, nobody worried much, he said.

     “I played the rest of the game,” he said. “That’s how it was done.”

     Still, he figures he was lucky.  Now a senior account manager for a company that sells computer equipment, Bell played tight end. His linebacker teammates got hit harder and more often.

     “I had about half the amount of contact that some people did,” he said.

     On Tuesday, he fielded Dr. Smith’s questions correctly as they became more complex.

     I’m going to say three words: apple, book, cat. How do you spell “world” backwards? Please count backwards from 100, by 7s. How many words can you say that start with the letter “f?” What were the three words I said earlier?

     The range of questions is meant to test different aspects of how the brain works, Dr. Smith told Bell.

     “People tend to think of Alzheimer’s as just memory and forgetting,” she said. “But some people show up first with language problems. They can’t find words for things. They hold up a pen and call it ‘that thing you write with.’ “

Former NFL players Jerry Bell, left, and E.G. Green, right, stand outside the USF Health Byrd Alzheimer's Institute with Dr. Amanda Smith.

Getting that early screening will become even more important as medications now in development make it easier to prevent the symptoms of Alzheimer’s, said Dave Morgan, PhD, chief scientific officer of the Byrd Institute.

     “The analogy that I like is that it’s better to take your statins before you have a heart attack, rather than after,” he said.

    Bell wasn’t the only NFL player answering such questions at the Byrd Institute Tuesday. Former Colts player E.G. Green, 34, got a screening test as well. Green may seem young to take such a test, but he said it’s important to show that it’s okay for football players to take steps to protect their health.

    “We grew up in a culture where you try to mask all injuries,” he said. “You have to be able to make it. You have to ‘tough it out.’ Once the game is over, it’s hard to think you’re not Superman anymore.”

      Players, their families and their doctors and coaches need to be aware of that mindset, he said, so that former players get appropriate care.

     “You transform from a gladiator to a citizen,” he said. “You need to be able to take care of yourself after football.”

     - Story by Lisa Greene, USF Health Communications; photos by Eric Younghans, USF Health Communications

Nearly 1,500 people of all ages gathered at the University of South Florida this Saturday, Nov. 14, to stride forward together in the American Diabetes Association’s StepOut to Fight Diabetes Walk. The ADA’s signature fundraising walk, coinciding with National Diabetes Day, was held at more than 150 sites across the country.

Hosting the walk was a chance for USF to showcase its bold initiative to fight diabetes on every front – from education and research to family-centered care. The University is planning a new center for people with diabetes – an inviting place that will be a hub for the diabetes community and where patients can practice the healthy eating habits and exercise so vital to diabetes.

The USF community was an integral part of the event. Teams from across the university walked to raise funds that will support critical research, provide community-based education programs and protect the rights of people with diabetes – a chronic disease expected to confront one in three U.S. children if current trends continue.

“It was a great opportunity for us to show the Tampa Bay community our commitment and forward momentum in the fight against diabetes,” said Nicole Johnson, Miss America 1999 and director of communications and education for the USF Diabetes Center. “We were honored to partner with the ADA and play a role in fundraising for better treatment and an ultimate cure for diabetes.”

Johnson worked with the ADA to coordinate the walk, emceed the event, and led post-walk tours of the center’s new educational space. USF Health student volunteers helped conduct health screenings. Staff and faculty volunteered at booths for heart health education, stroke awareness and podiatry screening.

Adults and children had the opportunity to be screened for the TrialNet studies, which seeks to identify those with early signs of Type 1 diabetes to investigate new therapies that may halt or slow disease progression. The NIH-sponsored worldwide network of clinical studies is coordinated at USF by Jeffrey Krischer, PhD, professor and chief of epidemiology in the Department of Pediatrics.

See photo gallery of the day’s activates below:

Dr. Stephen Klasko, USF medical school dean and CEO of USF Health, gives a pep talk before the walk.

Nicole Johnson, director of communications and education for the USF Diabetes Center, greets walkers.

A zumba troupe warms up the crowd.

Walkers assemble at the starting line.

The route started and finished at USF Simmons Park near the Psychology/Communication Building.

Cara Capitena, a first-year USF medical student, checks Diana Persaud's blood pressure.

Nicole Johnson, with daugher Ava, helped lead post-walk tours showing off the USF Diabetes Center's new education space.

Johnson welcomes a group of young walkers to one of the Diabetes Center's child-friendly areas.

- Story by Anne DeLotto Baier, Photos by Eric Younghans; USF Health Communicatons

Theresa Beckie, PhD, of the USF College of Nursing, compared the physical and psychosocial effects of a traditional cardiac rehabilitation to a program geared specifically for women.

ORLANDO, FL. (Nov. 17, 2009) — Depressive symptoms improved among women with coronary heart disease who participated in a motivationally-enhanced cardiac rehabilitation program exclusively for women, according to research presented at the American Heart Association’s Scientific Sessions 2009.

Depression often co-occurs with heart disease and is found more often in women with heart disease than in men. Depression also interferes with adherence to lifestyle modifications and the willingness to attend rehabilitation.

“Women often don’t have the motivation to attend cardiac rehab particularly if they’re depressed,” said Theresa Beckie, Ph.D., lead investigator and author of the study and professor at the University of South Florida’s College of Nursing in Tampa, FL. “Historically women have not been socialized to exercise and their attendance in cardiac rehabilitation programs has been consistently poor over the last several decades. This poor attendance may be partly due to mismatches in stages of readiness for behavior change with the health professional approaching from an action-oriented perspective and the women merely contemplating change --- this is destined to evoke resistance.”

Cardiac rehabilitation programs tailored to the needs of women and to their current level of readiness to change may improve adherence to such programs and potentially improve outcomes for women, she said.

The primary goals of the 5-year randomized clinical trial were to compare multiple physiological and psychosocial outcomes of women who participated in a 12-week stage-of-change matched, motivationally enhanced, gender-tailored cardiac rehabilitation program exclusively for women compared to women attending a 12-week traditional cardiac rehabilitation program comprised of education and exercise. Depressive symptoms of 225 women (average age 63) who completed this trial were examined after the interventions as well as after a 6-month follow-up period.

Women with cardiac disease have unique needs and confront different challenges than men in adopting healthy behaviors as they recover, Beckie says.

Participants completed the 20-item Center for Epidemiological Studies Depression Scale prior to beginning the intervention, one week after completing the intervention, and again six months later. The questionnaire asked them about how often in the past week they felt depressed, hopeful, lonely, happy and fearful.

Depression scores for the women participating in the traditional cardiac rehab dropped from 16.5 to 14.3 in 12 weeks, while scores in the augmented group dropped from 17.3 to 11.0 – “a significant decline compared to the traditional group,” said Beckie.

After a six-month follow-up, the traditional rehab group had an average score of 15.2 and those in the women-specific program had a mean score of 13. Beckie said “we found that improvements in depressive symptoms were sustained at the 6-month follow-up in the augmented group while those in traditional cardiac rehab were essentially unchanged. This intervention also led to significantly better attendance and completion rates than those in the traditional cardiac rehabilitation program.”

The intervention was guided by the transtheoretical model of behavior change and was delivered with motivational interviewing clinical methods. The motivationally-enhanced intervention began with an assessment of their stage of motivational readiness to change regarding three behaviors: healthy eating, physical activity, and stress management. The investigators then applied appropriate stage-matched strategies to promote the uptake of health behaviors.

“The stage-matched intervention used in conjunction with motivational interviewing applied the patient-centered principles of expressing empathy, rolling with resistance to change, respecting patient autonomy and supporting self-efficacy for change” Beckie said.

“We didn’t push them if they weren’t ready to make the changes,” Beckie said. “We have found that if some patients receive long lists of behaviors they are expected to change immediately — such as quitting smoking, eating healthier, exercising regularly — they are overwhelmed. Pushing such patients who are not ready can lead them to tune out or drop out. Instead, for these women, we acknowledged their ambivalence about change and gave them strategies to move toward being ready by reinforcing their own motivations for changing. It’s unrealistic to expect all patients to change their lifestyle all at once, right now in front of you.”

The positive impact of the women-centered program remained six months after the 12-week study ended.

The woman-centered program is a more individualized approach to rehabilitation.

“You can’t treat everyone the same when it comes to changing health behaviors,” she said.

Beckie hopes these results will lead to symptoms of depression being assessed more often in women suffering from heart disease and to more motivationally augmented, women-specific rehabilitation options. The participants may not be completely representative of the national population because they all had health insurance.

Beckie’s co-author is Jason Beckstead, PhD. The National Institute of Nursing Research funded the 5-year study.

- USF Health -

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $380.4 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching.

L to R: Dr. William Dalton, Dr. Richard Roetzheim, Maria Pinzon, Dr. Leslene Gordon, Dr. B. Lee Green and Dr. Ralph Wilcox.

The USF-Moffitt Center of Excellence for Cancer Health Disparities was formally introduced to the community Nov. 12 at a reception attended by community leaders, elected officials and university and Moffitt Cancer Center faculty and staff.

The center’s new name -- Center for Equal Health: Community Partnerships in Research, Education and Training – was unveiled for the audience by community directors Leslene Gordon, PhD, of the Hillsborough County Health Department and Maria Pinzon of the Hispanic Services Council.

The center will focus on reducing cancer-related disparities among Florida’s minority and underserved populations. Researchers will address such questions as why African-American men are much more likely to develop and die from prostate cancer than white men. This summer, USF and Moffitt were awarded a highly competitive $6-million, five-year program grant from the National Center on Minority Health and Health Disparities, National Institutes of Health, to establish the center --- one of three in Florida.

Desiree Rivers, PhD, center director, was emcee for the reception.

“I’ve spent my entire career documenting the toll of health disparities, so it’s very exciting that we have the chance to do something to develop effective solutions,” said Center Co-Director Richard Roetzheim, MD, MPH, professor and director of research for the USF Department of Family Medicine. “It will be challenging, but we’ve assembled a tremendous team of talented people from USF, Moffitt and the community.”

“The community must be a vital and active participant in our Center,” said Center Co-Director B. Lee Green, PhD, professor and vice president of Moffitt Diversity. “The Center is not intended to be about statistics, but about addressing the needs of real people – some of whom unfortunately suffer disproportionately from serious diseases and disabilities.”

USF Provost Ralph Wilcox, PhD, said the legal, socioeconomic, structural and other barriers that lead to inequities in care and poorer health outcomes for minority and disadvantaged populations are daunting, but not insurmountable.

“The Center is exactly the type of partnership model that allows Moffitt and USF to unleash their complementary strengths,” Wilcox said. “I remain hopeful that this collaboration will help us better understand the scope and root causes of disparities and, most importantly, generate solutions to close the gaps of these disparities.”

Florida ranks second in the United States in the number of deaths from cancer, said Moffitt CEO William Dalton, PhD, MD. He noted that USF and Moffitt had a one in 10 chance of securing the highly competitive NCMHD Center of Excellence award. “Competing with the best and brightest in the nation to win this grant speaks volumes about this community and the partnership between USF and Moffitt,” he said.

USF Provost Ralph Wilcox, PhD, with the College of Public Health's Deanna Wathington, MPH, co-leader for the center's Community Engagement Core.

- Story by Anne DeLotto Baier, USF Health Communications
- Photos by Eric Younghans, USF Health Communications

RELATED STORY:
USF-Moffitt Center of Excellence Targets disparities in cancer care and outcomes

     Cindy Schofield was scared as she approached the starting line.

     She had five kilometers to run and she wasn’t sure she could do it.

     Once, it would have been easy.

     Schofield could always count on her body to perform. She grew up in Lakeland playing soccer. She could run fast, kick strong.

     Her athletic ability won her a scholarship and made her a soccer star at Florida State University. It helped her set college scoring records that remain unbroken. It guided her decision to move to Tampa to coach soccer for Tampa Preparatory School and competitive youth soccer teams.

     But all that was before.

     Now, 28-year-old Schofield was scared.

                                                                     ***

          It began on a Sunday afternoon in January 2008. Schofield had been at the soccer fields all weekend, coaching and leading personal training sessions. She started to feel dizzy and confused. 

     “My head was out to here,” she said. “I felt like I had been hit by a bus.”

     She called her mom in Lakeland, who told her she would drive over and take her to a doctor.

     But Schofield decided the pain was too bad. Her head felt like it was going to explode. She drove herself to a walk-in clinic, went in, waited, saw the doctor.

Cindy Schofield didn't know whether she would ever walk again after a sudden illness nearly killed her.

     Her mom met her in the parking lot and asked her what the doctor had said.

     “I don’t remember,” Schofield told her.

     Her mom drove her to a local hospital. Her father and her brother soon joined her. Doctors took her to get an MRI. Later, she wouldn’t remember any of that, either.

     Nor would she remember the MRI results. A doctor came out and delivered the news to her parents.

     “She has a cancerous brain tumor,” he told them. “She’ll be dead in two years.”

                                                                 ***

     Her parents, devastated, began making phone calls. They were determined to get their daughter the best treatment possible. They took her to H. Lee Moffitt Cancer Center & Research Institute.

     There, Schofield underwent surgery. Doctors were prepared to do a biopsy and to remove whatever part of the tumor they could.

     They didn’t find what they expected.

     This part, Schofield does remember: she was with her father when his cell phone rang with the biopsy results.

     He started to cry. It wasn’t cancer.

     Amidst his tears of relief, her father didn’t realize it was something just as deadly.

                                                           ***

     Schofield kept getting worse. Her vision kept blurring. The pain in her head was horrible. She could no longer move the left side of her body. She couldn’t even walk.

     Moffitt doctors believed her problem was related to multiple sclerosis. They suggested that Schofield see Dr. Stanley Krolczyk, USF assistant professor of neurology and director of the USF Multiple Sclerosis Center. Schofield was impressed when he came in to see her on his day off.

     But Dr. Krolczyk wasn’t happy with what he saw. On a disability scale of 1 to 10, Schofield scored an 8.5 – and 10 was dead.

     “She was going downhill very rapidly,” he said. “There was active inflammation in her whole brain, white blood cells attacking the brain, denuding the neurons of myelin and destroying the brain tissue.”

     Myelin is the protective sheath that covers nerve fibers, like insulation around a wire. When the body’s immune system attacks myelin, it can strip nerves bare, creating scar tissue and leaving neurons unable to communicate.

     Schofield had been attacked by an extremely rare form of multiple sclerosis, called tumefactive MS. While the severity and course of MS is different for every patient, most of them become more disabled gradually, sometimes following a pattern of remission and relapse. In contrast, tumefactive MS can hit somebody like a thunderbolt out of a blue sky.

     “There’s no way to predict which individuals develop this,” Dr. Krolczyk said. “It looks like an aggressive brain tumor on an MRI.”

     Nor is the prognosis any better. Most patients die within a few months.

Dr. Stanley Krolczyk, USF assistant professor of neurology and director of the USF Multiple Sclerosis Center, said the inflammation in Schofield's brain was so bad it could be mistaken on an MRI for a brain tumor.

      Schofield’s situation seemed bleak. About 460,000 people in the U.S. now have MS. But Dr. Krolczyk has found only a few dozen published cases that seem as severe as hers.

     With such a rare condition, there were no guidelines – no protocol to guide Dr. Krolczyk on the best way to save Schofield. He had to design his own treatment.

     Schofield’s best chance, Dr. Krolczyk decided, was aggressive action to try to reduce the swelling and inflammation in her brain before it created any more damage. He decided on a combination of three drugs to attack the inflammation in every way possible.

     Schofield received steroids to reduce the inflammation in her brain. Plasma exchange to remove antibodies and inflammatory mediators from her blood. And a special chemotherapy drug to suppress the T-cells that could attack her brain again.

     Schofield was hospitalized for weeks, but she would remember little of her time there. Only one decision stayed with her: sometime in her hospital bed, unable to walk, she vowed this would not be her future.

Schofield wound up in the hospital, unable to move the left side of her body.

      She would recover, she promised herself. She would walk again. And then she would run. Still in the hospital, she decided she would run a 5K.

                                                                  ***

     It was that vow to herself that Schofield thought of as she approached the starting line of her 5K – the Susan G. Komen Race for the Cure, held in St. Petersburg in October.

     She was still scared. Her balance wasn’t good. What if she stumbled? A stubbed toe might send her sprawling.

     But she stepped over the starting line and began to run.

                                                                 ***

     When she left the hospital, Schofield came home to a different world. Her parents left Lakeland and moved in with her. They rented a hospital bed for the living room. The once strong athlete was in a wheelchair. Not only could she not walk, she couldn’t even lift her left arm.

     Her life seemed to have turned into a shuttle between doctor’s visits and physical therapy sessions. At first, there were days when Schofield didn’t even want to get out of bed.

     And then she would tell herself: No. She was not going back to the hospital. She forced herself to do more.

     Her parents and Dr. Krolczyk encouraged her as well. He and Lise Casady, a USF nurse practitioner who works with Dr. Krolczyk, were in constant contact.

     “They pushed me when I needed to be pushed,” Schofield said.

     She set small goals. She had to work just to gain enough hand strength to squish a stress ball. To be able to lift her arm long enough to put her hair in a ponytail.

Schofield was determined to run again.

     She still felt mentally fuzzy as well. She had to work to remember daily routines, dates and even the trauma that had struck her life. She joked about the movie “50 First Dates,” in which Drew Barrymore suffers a brain injury and can’t remember anything for longer than a day. She tried to write things down to help her memory.

     Schofield had been through hard times before. In her sophomore year of college, her fiancé was killed in a skydiving accident. Shattered, Schofield nearly left FSU. It was her close ties to the members of her soccer team that pulled her through.

     “That was my family,” she said. “I don’t know what I would have done without them.”

     Now, she was relying on athletics to help her again.

                                                                ***

     As she ran, her mind began to slip backwards. Everything started to replay through her mind. Her brush with death, her fall into disability, and all she had been through just trying to walk.

     She struggled not to cry. She didn’t even think about the ground that she was covering, or the speed she was traveling. She just relived the struggle, stride after stride.

                                                               ***

      Schofield moved from a wheelchair to a walker, then to a heavy cane. Next to a lighter one.

      She gradually began reclaiming her life. She returned to her passion, coaching soccer, limping along the sidelines with her cane.

      One tournament weekend, she got tired of the cane. It was in the way. She decided on the spot that she could balance without it. So she put it down.

      The next day, she walked into her physical therapist’s office on her own.

      “I told her I graduated,” Schofield laughed.

      Still, Schofield wasn’t sure she could balance well enough to run. In the spring, she began to run on a treadmill – slowly, about 4.5 mph – so that she could hold on to the arm rails.

     Gradually she increased her speed and distance. Dr. Krolczyk was impressed with her determination.

     “She’s a very hard worker,” he said. “It’s great to have patients like that.”

     Schofield was learning as well about taking care of herself, being careful not to get overheated and giving herself more time to rest after exercise or long spells of coaching in the Florida heat. She also remained on a medicine to modify her immune system.

     Although MS patients are known for going through periods of relapse, Schofield and Dr. Krolczyk are cautiously optimistic.

     “So far she only appears to get better,” Dr. Krolczyk said. “We hope this was one unbelieveably bad case that will not recur.”

     Despite her progress, Schofield was still scared to run outside. Her balance remained a little shaky; she couldn’t balance while standing only on her left foot. She was still afraid of falling.

     Four days before the race, she went to the Upper Tampa Bay Trail with something to prove. She turned right, where the trees shade the path and the trail runs true north, and began to run.

                                                                     ***

      Step by step, the distance fell away. Thirty-two minutes after she began to run, Cindy Schofield, a woman left battered by multiple sclerosis, crossed the finish line.

Schofield runs along a sunny section of the Upper Tampa Bay Trail.

     Her mother cheered as she saw her daughter cross the line and then she began to spread the news. She got out the cell phone, calling everyone: Cindy did it. She finished. She really did it.

      But Schofield saw the clock coming over the finish line.

     “That’s it?” she asked herself.

     She had been so scared. She hadn’t run for speed – just to finish. Now, she thought, she could have run faster if she had pushed harder.

     She felt a rush of her old competitive spirit. In November, she decided, she would do another 5K. Then a half-marathon, maybe in the spring. And this time, she’d run faster.

     Then she knew.

     She was back.

Runner 3443, Cindy Schofield

                                                                ***

-- Story by Lisa Greene, USF Health Communications; Trail photos by Eric Younghans, USF Health Communications; Other photos courtesy of Cindy Schofield

The uncommon, high-risk delivery involved more than 20 physicians and other health practitioners

Read St. Petersburg Times story...

Tampa, FL (Nov. 12, 2009) -- A multidisciplinary team of USF Health and Tampa General Hospital physicians recently performed the first Ex Utero Intrapartum Treatment (EXIT) at TGH -- successfully securing an airway for a baby girl with a large benign tumor wrapped around her neck before fully delivering the 7 pound, 11 ounce infant by Cesarean section.

EXIT is an innovative procedure developed to deliver infants with severe congenital abnormalities that may make breathing after delivery difficult or impossible. During EXIT, the newborn is partially delivered in a manner similar to a C-section, but the umbilical cord supplying oxygen from mother to baby is not immediately cut. Instead, the baby is intubated -- a breathing tube is inserted through the mouth or nose into the windpipe – and delivery of the infant is completed and cord cut only after a clear airway has been established.

“The biggest challenge in this type of procedure is establishing an airway for the fetus while maintaining a steady supply of oxygen so that no neurological damage occurs,” said Valerie Whiteman, MD, lead USF obstetrician for the EXIT delivery on Oct. 1. “If you can’t successfully intubate on the first attempt, surgical intervention is required and that potentially increases the risk for both the fetus and mother.”

Dr. Valerie Whiteman, interim director of Maternal-Fetal Medicine at USF Health, led the EXIT delivery.

This challenging, uncommon procedure (only about 100 cases have been documented in the United States) required extensive, seamless coordination by the USF-TGH team of 20-plus physicians, nurses and other health professionals assembled inside and just outside the operating room.

The following were the key physicians on the EXIT delivery team:

• Maternal-Fetal Medicine -- Dr. Valerie Whiteman, USF assistant professor of obstetrics and gynecology and interim director of Maternal-Fetal Medicine, assisted by Dr. Aaron Deutsch, senior maternal fetal medicine fellow

• Anesthesia – Dr. Devanand Mangar, anesthesiologist with Gulf-to-Bay Anesthesiology and chief of staff at Tampa General Hospital, and Dr. Amrat Anand, Gulf-to-Bay anesthesiologist

• Neonatalogy - Dr. Terri Ashmeade and Dr. Laura Haubner, both USF assistant professors of pediatrics, and Dr. Lewis Rubin, professor and chief of neonatology at USF

• Pediatric Surgery - Dr. Charles Paidas, director of USF Division of Pediatric Surgery

Patty Bornick, RN, MSN, perinatal navigator for the USF Health Fetal Care Center of Tampa Bay, coordinated care for the high-risk obstetric patient, a 31-year-old woman who lives in Tampa with her husband and two other children.

Anesthesiologists delivered anesthesia to the mother and a medication to prevent contractions during intubation. Obstetricians performed the high-risk surgical delivery using a special autosuturing device to minimize maternal bleeding. Neonatologists intubated once the infant’s head and shoulders were delivered and assessed the baby after birth. The pediatric surgeon was on standby in case intubation proved difficult, so that some of the tumor could be cut away or a hole could be made in the windpipe. The infant’s heart rate was continually monitored by ultrasound for any signs of oxygen loss.

The USF-TGH team established protocols and contingency plans for the surgery and practiced with two dry runs in the operating room in August and September. During the actual EXIT procedure, intubation was successful on the first attempt.

“We were all familiar with our roles, our equipment and what steps needed to be taken when. We prepared for the best and worst case scenarios. It took teamwork, teamwork and more teamwork,” Dr. Whiteman said. “This EXIT procedure required tremendous collaboration, and the successful outcome speaks well of the partnership between TGH and USF and our extensive resources.”

“Preparing for the procedure with Dr. Laura Haubner, director of the Department of Pediatrics Center for Team Education and Multidisciplinary Simulation was vital,” said Dr. Ashmeade, the neonatologist who placed the breathing tube. “She is an expert in critical resource management and patient safety. I knew that she was aware of the entire situation in the operating room, which allowed me to concentrate solely on securing the baby’s airway.”

USF pediatric surgeon Dr. Charles Paidas has already performed one surgery to begin removing the benign tumor wrapped around the baby's neck.

The baby was discharged home from Tampa General’s neonatal intensive care unit on Oct. 12. The benign tumor, a cystic hygroma, will be resected in two stages because it is attached from the base of her skull to her tongue, and surrounds her heart, windpipe and great vessels. She underwent a first operation Oct. 30 to remove the neck portion of the hygroma. In two to three months, a second operation will remove the remainder of the tumor in her right chest.

“This was not simply a team, but a team that practiced all aspects of the planned procedure and practice makes perfect,” Dr. Paidas said.

- USF Health –
USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With more than $380.3 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

- Tampa General Hospital -
Tampa General is a 988-bed acute care hospital on the west coast of Florida that serves as the region’s only center for level I trauma care, comprehensive burn care and adult solid organ transplants. It is the primary teaching hospital for the University of South Florida College of Medicine. TGH is also one of only 16 comprehensive stroke centers in Florida and is a state-certified spinal cord and head injury rehabilitation center.

- News release by Anne DeLotto Baier, USF Health Communications

Grinning with anticipation, 8-year-old Ty’rique Brock waited patiently to hear if he was one of the lucky few to win a prize at the grand finale celebration of the Scorecard program, held Nov. 7 at Jackson Heights Recreation Center in East Tampa.

Ty’rique has spent the past couple of months filling up his own scorecard with stamps and signatures that verified his participation in physical activity. Football, kickball, relay races, playing in the park; these were some of his choice activities. At the finale, he was among the three dozen young students from two area elementary schools who had filled the 24 spots on at least one scorecard and could now be in the running for one of the grand prizes: two bicycles, a Wii console and games, scooters, tickets to USF basketball and football games and to the Florida Aquarium.

Scorecard Community Coordinator Bonnie Salazar with Ty'rique Brock, his mother Andrenna Brock, and a full scorecard.

The Florida Prevention Research Center (FPRC) at the USF College of Public Health helped Robles and Sulphur Springs Elementary Schools implement the Scorecard program, which offers elementary aged students action outlets for physical activity in their community. The program encourages youth to try new activities with an emphasis on fun rather than health or skill.

“It’s all about providing an opportunity for them to try new things, to spend time with friends and family, to find something they like to do, and to have fun,” said Robert J. McDermott, PhD, professor of public health and co-director of the FPRC with Carol Bryant, PhD.

Students use the card to track their physical activity. When they have been active for a designated period of time (typically one hour) at a Scorecard site or at home, an adult stamps or signs one of the 24 squares on the card. Once all of the squares are filled, the card is redeemed for physical activity related prizes (such as Frisbees, beach towels, water bottles, backpacks), and makes them eligible for grand prizes.

The Scorecard program began in 2004 in Lexington, KY, and USF’s FPRC earned a grant from the Centers for Disease Control and Prevention in 2006 to fund Scorecard locally.

The FPRC ran a pilot Scorecard program for middle school students in Sarasota County in 2006, then the full program for elementary school students in Hillsborough County last spring.

“One key point we learned from the Sarasota program was that it is better to target younger kids because as the kids start to enter their teens, they start to favor sedentary activities, like video games and television,” Dr. McDermott said.

“So the point is to interest them in activities earlier because by the time students are teenagers, it might be too late.”

During the past year, the FPRC worked with Robles and Sulphur Springs Elementary Schools, as well as other community partners in the Sulphur Springs and Robles areas, to build a comprehensive plan for tailoring the Scorecard program to fit local needs, with the goal of helping Tampa’s youth become more physically active throughout the year.

Prior to choosing the schools that would participate, Dr. McDermott’s team assessed the environment surrounding the schools, looking for those that were more kid friendly, with parks that had amenities like bathrooms and benches, and with ample venues for planned activities, such as bowling alleys, skating rinks, etc.

“We want the kids to feel safe, so if the nearby park is littered with broken bottles or drug paraphernalia, we weren’t likely to include that school,” he said.

Local venues participated by hosting regularly scheduled events for the students. Terrace Sports, for example, hosted weekly timeslots when students could bowl for $1 per game with a $1 shoe rental. Weekends were filled with events, such as track meets or baseball clinics at local parks, or activities like the Too Good For Drugs Walk and KidFest at MOSI.

Much of the support provided by FPRC came from public health graduate students John Trainor, Emily Koby, and Alyssa Mayer, Dr. McDermott said. They staffed many of the events and evaluated the programs to provide feedback to the school. In addition, the graduate students collected data from last spring’s program and presented it this month at the annual meeting of the American Public Health Association. Students will also be involved in the data analysis from the fall program, and will probably present or publish those results, as well as share the results with the schools as feedback.

“They learn something new from participants’ feedback and refine the program each time,” Dr. McDermott said.

From left: Alyssa Mayer (MPH student COPH), John Trainor (PhD candidate Applied Anthropology), Andrenna Brock-Cadet (mother of Scorecard student), Emily Koby (master's student Applied Anthropology), Bonnie Salazar (Scorecard Community Coordinator), and Susan Carrigan (USF Social Marketing Ctr.).

In addition to the graduate students, the program received much support from Tonya Thomas as the neighborhood Scorecard coordinator and Sulphur Springs resident.

Next spring, however, the goal is for the schools to take the program and run with it, Dr. McDermott said.

“We have built an infrastructure with the schools and community organizers so that they could run the program on their own.”

Beyond that, the next task is to apply basic marketing principles and develop a tool kit that can be used in schools around the country, he said.

As for Ty’rique and the grand finale celebration, he didn’t win one of the grand prizes but still came away feeling like a winner. His mother Andrenna Brock-Cadet said that the Scorecard program was great for Ty’rique.

“Sometimes we’re surrounded by a lot of negative and this program was a positive thing for my son,” she said.

“As a parent, I enjoyed seeing him participate. And it helped me get out and move, too. Sometimes I would get in there and run around and play. They definitely need to keep this program going.”

Playing up the grand prizes at the Scorecard Finale Celebration are DJ Ekin (left), radio host for WBTP 95.7 the BEAT, and Acafool, a local hiphop artist.

Students get in the mix at the Scorecard Finale Celebration.

Story by Sarah A. Worth, USF Health Communications
Photos by Eric Younghans, USF Health Communications

Dr. Alan Zelicoff (front center) with, from left to right, Wil Milhous, PhD, associate dean for research in the College of Public Health; John Sinnott, MD, director of Infectious Disease and International Medicine; and Phil Marty, PhD, associate vice president for USF Health Research.

A little-known smallpox outbreak in the Soviet Union years ago and its implications for biological weapons defense today was the topic when physician-scientist Dr. Alan Zelicoff visited USF Health last week. His Nov. 3 lecture in the College of Public Health Auditorium was sponsored by the USF Health Office of Research.

Dr. Zelicoff, a smallpox expert, is the former senior scientist at the Center for National Security and Arms Control at Sandia National Laboratories. He and experts from the Monterey Institute of International Studies linked a 1971 outbreak in the Kazakh Republic to a Soviet field test of weaponized smallpox. The Soviet Union did not report the outbreak to world health officials as required by law.

In an interview in the New York Times, Dr. Zelicoff called the outbreak a “watershed” because it demonstrated that the smallpox virus was more easily spread than previously thought and that there may be a vaccine-resistant strain.

“His lecture was a reality check on our continued need for diligence in areas of infectious diseases, disaster preparedness and biowarfare,” said Phillip Marty, PhD, associate vice president for the USF Health Office of Research.

Dr. Zelicoff’s current interests include risk and hazard analysis in hospital systems and office-based practice and technologies for improving the responsiveness of public health offices and countering biological weapons and terrorism. His latest book is Microbe: Are We Ready for the Next Plague?, a comprehensive account of the public health threat posed by microbial pathogens, including naturally emerging disease threats, such as severe acute respiratory syndrome (SARS) or West Nile virus.