USF College of Nursing professor, John Clochesy, PhD, collaborates with engineers on virtual technology to help patients manage their own health.

Dr. Clochesy teamed up with researchers and engineers at University of Central Florida and Case Western University to design an interactive video game technology to help improve patient care.

John Clochesy, PhD, professor and senior assistant dean of the PhD program at the USF College of Nursing.

“The virtual support technology helps patients and caregivers become members of the team that manages their own health,” said Dr. Clochesy, who is also the senior assistant dean of the PhD program at the USF College of Nursing. “Interactions with health care providers are sometimes difficult, but if we give people a chance to practice in the virtual world without putting themselves at risk, maybe they would do better. The technology allows people to experience, learn from that experience and take whatever they learn into the clinical setting.”

Dr. Clochesy and his team created several virtual support technologies. The most recent versions are being evaluated in two different randomized controlled trials.

For the first study, Dr. Clochesy teamed up with Vicki Loerzel PhD, associate professor at UCF, to create a virtual game to help older adults manage their cancer symptoms. The study helps cancer patients better manage chemotherapy-induced nausea and vomiting. This trial, which studies 66 participants, will be completed in 2018.

This version of the virtual game helps older adults manage their cancer symptoms.

For the second study, Dr. Clochesy partnered with Ronald L. Hickman, Jr., PhD, associate professor at the Case Western Reserve University, to help educate caregivers of chronically critically ill patients. This trial aims to help caregivers make informed decisions about critically ill patients at the end of life. This study is planned to be completed in 2020.

This version of the game aims to educate caregivers of the chronically critically ill patients.

The virtual support is developed using an avatar-based decision support technology fit for various digital platforms and devices. The risk-free technology helps improve self-management of chronic illness and health outcomes.

“Patients can learn in a virtual reality focusing on real-life events,” Dr. Clochesy said. “The game goes through different situations in various locations and settings where patients and caregivers can learn and practice at the same time. For example, after cancer patients go through chemotherapy, they are presented scenarios where patient-like avatars go into a drug store to get their medication or interact with pharmacists. The game also presents questions on the screen and asks the patients if they’re thirsty or if they need to take their medication – allowing the patient to not only watch but also interact.”

The two studies are funded by grants from National Institute of Nursing Research (NINR), a part of the National Institutes of Health. The researchers have also previously received funding from American Nurses’ Foundation, a program created by Sigma Theta Tau International.

The virtual support technology is not new. Dr. Clochesy and his team of interdisciplinary researchers initially developed the technology in 2009. Their previous studies were focused on an electronic self-management resource training platform called eSMART to help teach people how to better communicate with their health care providers.

The various adaptations of eSMART have shown significant improvements for people suffering with depression and high blood pressure. Since these studies began, Dr. Clochesy and his team have published more than 10 studies in major publications nationwide.

Dr. Clochesy hopes the new version of the virtual game shows similar improvements on cancer patents and decision makers for critically ill patients.

“Chronic illness is costing a fortune in this country,” Clochesy said. “The majority of the care is done by patients and families themselves. But, if they don’t do it well, they end up in the hospital — spending a lot of money. So, if we can teach people to better take care of themselves, we can have better health outcomes and we can also control health care costs.”

The technology appears promising. So, Dr. Clochesy hopes to eventually take the virtual support game to health facilities or home health agencies to help improve patients’ quality of life and help reduce health care costs.

Story and photos by Vjollca Hysenlika, USF Health Communications. 

//www.youtube.com/watch?v=soX8igiEl8k

For Brittany Hay, DNP, nursing runs in the family. The passion to serve is in her blood. It’s in her DNA.

Dr. Hay, instructor at the USF College of Nursing, is one of seven family members to dedicate her life to nursing.

Brittany Hay, DNP, instructor at USF College of Nursing.

“I come from a large family of nurses,” Dr. Hay said. “My grandfather, my father, my mother, my older sister, my twin brother and one of my aunts, are all nurses.”

(L to R). Breton Blair, twin brother, Kim Hanna, sister, Zarah Blair, mother, Ken Blair, father, and Dr. Brittany Hay.

Dr. Hay, who is one of five children, was born and raised in a small town in Pennsylvania. Since she was a child, she was surrounded by those who served – so, becoming a nurse was an obvious choice.

This journey started with Dr. Hay’s mother after she became a registered nurse through the Citizens General Hospital diploma program in 1962. Shortly after, her grandfather and father decided to change careers and go to nursing school. Then, the rest of the family members followed.

“My family had a calling to serve, and nursing was the vehicle that helped them get there,” Dr. Hay said. “My grandfather and parents saw a need in the community, and they became nurses to fulfill that need — and help people heal. It was a means to an end.”

Dr. Hay’s grandparents turned their farmhouse into a nursing home to provide health care services to older patients in their small community. Their nursing home is still open today.

Dr. Hay’s grandparents, Charlie and Helena Brown. 

“My siblings and I are proud of my grandparents and parents and what they’ve done for their community,” Dr. Hay said. “They have been our inspiration. That’s why we proudly followed into their footsteps.”

Dr. Hay’s twin brother is a nurse practitioner, and her older sister is an acute care nurse. They each have chosen different paths in the nursing field, but their passion to serve remains the same.

“Even though, we’ve moved to different states and are serving patients in various ways, we still practice the strong, compassionate nursing values, which our parents and grandparents instilled in us.”

Dr. Hay’s parents Ken and Zarah Blair in front of the family’s nursing home. They are both fellows in the American College of Health Care Administrators for their dedication to nursing and the patients they served.

For almost 30 years, Dr. Hay has continued to make her mark in the nursing field as a nurse and nurse practitioner — serving patients in diverse communities in Boston and rural areas of Florida.

Dr. Hay receiving her nursing pin during traditional pinning ceremony at Boston University in 1988.

“Becoming a nurse practitioner has been the honor of my life,” Dr. Hay said. “I find tremendous joy in providing care for patients in rural areas where health care is often out of reach.”

After decades of nursing practice, she decided to join USF in 2015 and teach nursing students. While teaching, she also completed her Doctor of Nursing Practice (DNP) in 2016 at the USF College of Nursing.

(L to R): USF College of Nursing’s instructors Marcia Johansson, DNP, Deborah Cantero, DNP, Dr. Hay and Rebecca Lutz, DNP, during their DNP commencement ceremony in Dec. 2016.

“I’m happy to pass on my passion for nursing to my students,” Dr. Hay said. “It’s been exciting to give them the knowledge and the tools in the areas of quality improvement, leadership, and role development to be successful in their own careers.”

Dr. Hay, who is married with two children, is also passing her passion for health care to her children. Her son is a pre-medical student at the University of Central of Florida with the goal to one day attend medical school.

“My mom inspired me to consider health care as a career,” said Jordan Hay, Dr. Hay’s son. “Seeing her improve patients’ lives every day, allowed me to think about those possibilities. I’m hoping that one day I will also join my mom, my grandparents, my aunt and uncle, and be a part of this amazing journey.”

Story and video by Vjollca Hysenlika, USF Health Communications and Marketing.
Most photos provided by Dr. Brittany Hay. 

Dr. Stanley Krolczyk, director of the USF Multiple Sclerosis Center, performs a neurological exam on patient Caroline Holloway during a routine appointment.

The same day that the University of South Florida celebrated the 20^th anniversary of its USF Multiple Sclerosis Center, the U.S. Food and Drug Administration approved a new oral therapy (Aubagio) for multiple sclerosis, a neurodegenerative autoimmune disease.

The news reinforces what Center Director Dr. Stanley Krolczyk says about how recent advances in “disease-modifying” drugs are helping to reduce the frequency and severity of MS relapses and slow the rate of disease progression.

Until recently patients diagnosed with MS typically had to turn to injectable drugs like beta interferons for chronic treatment, while infusions of high-dose steroids are mainly used to treat exacerbations of the disease. While these treatments can help alleviate symptoms, they do little or nothing to alter the course of the disease or delay disability.

Aubagio is the second oral MS medication to enter the market (following the first FDA-approved MS pill Gilenya in 2010), with more disease-modifying prospects expected in the near future.

“Before 1993 there were no treatments for MS,” said Dr. Krolczyk, associate professor and director of the Multiple Sclerosis Division in the USF Health Department of Neurology.  “It’s great that we can now offer our patients more treatment choices than ever before to help improve the quality of their lives.”

Between patient appointments, Dr. Krolczyk stops for a quick hallway conversation with the center’s nurse practitioner Lise Casady. Casady helped establish the multiple sclerosis clinic.

MS is the most common disabling neurological disease among young adults, affecting about 400,000 Americans, according to the National Institute of Neurological Disorders and Stroke. Caused by damage to the myelin sheath – the protective coating of nerves in the brain and spinal cord – MS  can trigger a broad spectrum of symptoms, including fatigue, pain, numbness, muscle spasms, vision loss, problems with balance and other difficulties. The disease – afflicting twice as many women as men — is usually diagnosed between the ages of 20 and 50, and often gradually worsens over time.

MS is still incurable, but the rapid pace at which investigational treatments have moved from clinical trials to market over the last decade encourages patients like Jzon Livingston, Sr., of Clearwater.

Livingston, 33, has relapsing-remitting MS, the most common form of the disease, which is characterized by attacks lasting from days to weeks followed by remission, or periods of little or no symptoms. Diagnosed in 2008, he participates in an ongoing clinical trial for a promising once-a-year infusion therapy for MS (alemtuzumab), a monoclonal antibody designed to target certain cells in the immune system believed to trigger damage in people with MS.

Jzon Livingstong,Sr., says his life changed for the better after he started on a new drug for MS, available through a clinical trial at the USF Multiple Sclerosis Center.

None of the standard MS treatments worked for Livingston, and he battled relapses every two to three months. When the attacks flared, he had a hard time dragging himself off the couch to do anything, he said. “It was a fairly miserable existence.”

Since beginning alemtuzumab as a patient at the USF Multiple Sclerosis Center, Livingston said, his life has changed significantly.  He experiences few relapses and works as a self-employed IT network administrator, travels, and enjoys spending time with his wife and three sons.While not without side effect risks – alemtuzumab is a cancer drug used by doctors to treat leukemia for decades — the investigational MS regimen “has been effective beyond anything I thought possible,” Livingston said. “At USF, I was able to find a path to treatment unavailable anywhere else I had tried. It’s given me, my family and my entire extended network hope for the future.”

Livingston shared his perspective as an MS patient with those who gathered Thursday evening, Sept. 13^th to mark the 20-year anniversary of the USF Multiple Sclerosis Center.

Dr. Peter Dunne, founding director of the center, shared stories about its 20-year history at the anniversary celebration.

Among the speakers was the center’s founding director Dr. Peter Dunne, who provided an entertaining overview of the MS clinic’s history.  The center was opened by Dr. Dunne and nurse practitioner Lisé Casady at Tampa General Hospital in 1993 and moved to the USF Medical Clinic in 2000 before relocating to expanded space in the Morsani Center for Advanced Healthcare in 2008.

While he talked about changes in technology and discoveries that have led to more treatment options, Dr. Dunne emphasized the importance of patients, staff and volunteers in helping build the MS Center.

“Let’s not forget the role people play in this story,” he said. “I think they are all heroes.”

Before retiring, Dr. Dunne tapped Dr. Krolczyk, a new neurology faculty member at USF Health, to serve as the center’s next director. Dr. Clifton Gooch, USF Health chair of neurology, said that Dr. Dunne was instrumental in laying the foundation needed to make the university’s MS center a force in “the therapeutic revolution in neurology,” and Dr. Krolczyk continues to propel the center “to the next level.”

The Center’s Founding Director Dr. Peter Dunne (center)was presented a plaque recognizing his contributions to MS care and research at USF by Clifton Gooch(left), chair of the USF Health Department of Neurology, and Dr. Stanley Krolczyk, the center’s current director.

Under Dr. Krolczyk’s tenure, the MS Center has grown to one of the largest comprehensive MS clinics in the Southeast, serving more than 1,500 patients across Central Florida and overseeing 15 active clinical trials, with six studies currently recruiting patients.

The center focuses on early diagnosis and chronic treatment of MS, while offering eligible patients an opportunity to join clinical studies of potential new treatments years before they may become commercially available.

Because MS is a disease that can impair movement, sensation and thinking, its management requires multidisciplinary expertise. The center’s team includes physicians, a physician’s assistant, nurse practitioner, research coordinator, and neuropsychologist, and patients have ready access to urological care, physical therapy and neuropsychiatric evaluation.

Through USF’s partnership with the mid-Florida Chapter of the National Multiple Sclerosis Society, center patients benefit from educational resources and consultations with the local chapter’s staff.The center actively pursues new avenues for MS therapies, Dr. Krolczyk said, including the identification of biomarkers that may lead to earlier diagnosis and more effective treatments based on an individual’s genetic profile.

Carroll Franklin, president of the Mid-Florida Chapter of the National Multiple Sclerosis Society, recognized the vital partnership between USF’s multidisciplinary MS center and the society.

In addition to news about new treatments on the horizon, MS has attracted more national exposure lately with mentions by high-profile people like Ann Romney, wife of presidential candidate Mitt Romney, and First Lady Michelle Obama. Romney has spoken publicly about her diagnosis with MS in 1998, including last month at the Republican National Convention in Tampa. Obama shared her father’s 30-year struggle with the disease a week later at the Democratic National Convention in Charlotte, NC.

“There’s a positive impact when patients see someone at the podium like Ann Romney who lives with MS, but has successfully managed a full schedule,” Dr. Krolczyk said. “It puts a different face on the disease.”

Dr. Krolczyk remains optimistic about the future of MS research given the remarkable advances in MS treatment over the last 20 years.

“Today MS does not have to take control of patients,” he said. “They have options to take control of MS.”

For more information about the USF Multiple Sclerosis, visit http://health.usf.edu/medicine/neurology/clinicalprograms/multiple_sclerosis.htm

Photos by Eric Younghans, USF Health Communications