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Arthritis Brochures for Rheumatologists

We help lead the fight for the rheumatoid arthritis community and help you to assist your patients in conquering their everyday battles with rheumatoid arthritis through life-changing information and resources, access to optimal care, advancements in science and community connections.

Below, find out how you can access, and download free brochures from the Arthritis Foundation on OA, RA, Fibro and Biologics.

  • Register your free AF Store account at
  • Hover over Brochures, located on the left side of the page.
  • Click the second option, Free Downloadable Brochures.
  • Here you will see the Fibro, RA, OA, and Biologic/Biosimilar handouts.
  • Enter quantity “1”.
  • Add to cart and click Checkout.
  • You will need to submit a credit card number but your total will remain zero dollars.
  • Click Place Order. You will receive a confirmation email for your purchase but your purchase will be zero.
  • Click My Account on the top of your page.
  • Scroll down to Order History.
  • Click the date of your order (may be in blue print)
  • Click the red PDF of the brochure you ordered which will give you access to print the document.

More brochures will be added as the Arthritis Foundation’s goal is to transfer all of their brochures to electronic versions.

Rural hospital closures spike this summer

Over the last two months, the number of rural hospital closures has risen rapidly to 87 total closures (since 2010). In rural America, health care is a pillar of the community. It helps to create and foster a sustainable and livable environment for rural Americans, and without health care, without a hospital, a rural community will crumble.

Here in our home state, Twin Rivers Regional Medical Center, a 116 bed PPS Hospital in Kennett, Missouri closed on June 12, the fourth rural hospital in Missouri to close. Just before its closures ad decision was made for Twin Rivers Regional Medical Center to consolidate operations with Poplar Bluff (Mo.) Regional Medical Center.

“As healthcare delivery evolves and medical innovation makes inpatient services less needed, consolidating operations with the larger resources of Poplar Bluff Regional Medical Center became the most sustainable plan for the future,” Twin Rivers Regional Medical Center CEO Christian Jones said in a statement to KAIT. “We plan to continue offering excellent outpatient care locally, which is how 95 percent of our patients’ medical needs were provided last year.”

Twin Rivers Regional Medical Center’s 259 employees will be laid off when the hospital closes, according to a Worker Adjustment and Retraining Notification Act notice filed April 30. However, those employees had the opportunity to meet with representatives of Poplar Bluff Regional Medical Center last week to help them identify positions they may be able to transfer to, according to the report.

As access to care in rural communities disappears, we need the support of Congress now more than ever to stop the flood of hospital closures and create an environment in which innovation can thrive. A multifaceted approach is necessary to address the struggles of rural health care providers including hospitals:

  • The first prong of this approach is to ensure rural providers reimbursement rates are sufficient to allow them to keep their doors open.
  • second prong is to support measures that reduce the cost of providing care including through regulatory relief efforts that reduce costs without negatively impacting patient care.
  • The third prong of this approach is to support new models that allow communities to retain necessary access to local care including a local emergency room while right sizing their facilities to flexibly meet the needs of the specific community.

Together, these policies can all begin to bring rural health care into the 21stCentury and ensure its successful future.

Review of NSAID Cardiovascular Toxicity

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs for acute and chronic pain. More than 30 billion doses of NSAIDs are consumed annually from more than 70 million prescriptions.

Despite their common use, NSAIDs are not free of serious toxicities. In the pre-Vioxx (rofecoxib) era, gastrointestinal toxicity was the primary concern for many NSAIDs. In 1999, Wolfe et al. demonstrated the increasing rate of hospital admissions due to NSAID toxicity, thought mostly to be due to gastrointestinal (GI) side effects

This led to the development and use of selective cyclo-oxygenase-2 (COX‑2) inhibitors, the first of which was celecoxib, released in 1998, followed soon by rofecoxib in 1999 and several others.4,5 These agents had no effect on COX-1, an enzyme responsible for production of cytoprotective prostaglandin E2 and I2 in the stomach and, hence, had reduced risk of GI side effects.

An exponential rise in the use of these drugs occurred.5 Simultaneously, strong evidence demonstrating that many of these agents confer a risk of myocardial infarction (MI) and other cardiovascular events developed.

The Mechanism of NSAID Cardiovascular Risk

The relation of MI risk and COX-2 inhibition is most noted in a study conducted by Garcia-Rodriguez et al.7 They noted a direct correlation between MI risk and the degree of COX-2 over COX-1 inhibition. The exact mechanism of COX-2 inhibition remains unknown, but the hypothesis of an imbalance between thromboxane

A2 (which promotes platelet aggregation and acts as a vasoconstrictor) and prostacyclin (an inhibitor of platelet aggregation and a vasodilator), produced by both platelets and endothelial cells, has gained the most prominence.8-10

Similarly, it has been postulated that reduced prostaglandin synthesis due to NSAID use augments the Th-1 mediated immune response, which leads to increased proatherogenic cytokines. This ultimately leads to detrimental plaque remodeling, rupture and embolization of plaque.11

Researchers think the inhibition of prostaglandin synthesis increases peripheral vascular resistance and reduces renal perfusion, glomerular filtration and sodium excretion, which would ultimately lead to fluid retention and further contribute to the cardio­vascular toxicity.11

More than 88,000 Americans suffered myocardial infarction due to rofecoxib, & more than 38,000 died.

READ MORE >>>> SOURCE: The Rheumatologist

Rheumatologist joins PSN in Kentucky

PSN Welcomes Dr. Cara Hammonds to the Rheumatology Team

Premier Specialty Network is proud to announce that we have expanded our presence and service in Kentucky with the additions of Benton, Kentucky based Rheumatologist, Dr. Cara Hammonds to the PSN Team.

By extending our reach into new territory at Marshall County Hospital, in Benton as well as Crittenden Health System in Marion, PSN is helping to bring much needed rheumatology services to an undeserved area.

Dr. Hammonds is originally from western Kentucky.  She graduated from the University of Louisville School of Medicine in 2005. She completed specialty training in Internal Medicine at the University of Cincinnati and Rheumatology at Vanderbilt University in Nashville, Tennessee.  Dr. Hammonds is Board Certified in Internal Medicine and Rheumatology.

She is a member of the American College of Rheumatology.

Dr. Hammonds specializes in the treatment of pain from Arthritis, Osteoarthritis, Fibromyalgia, and Rheumatoid Arthritis (RA).

When Should I See a Rheumatologist?

If you think you have a rheumatic disease, call to make an appointment. The sooner you get diagnosed and begin treatment, the sooner you will feel better. We are here to help you through your journey.

Rheumatological Conditions

Comprehensive care is provided for patients with a wide variety of complex rheumatic diseases, including Rheumatoid Arthritis, Osteoarthritis, Osteoporosis, Psoriatic Arthritis, Lupus, Vasculitis, Polymyositis, Sjogren’s Syndrome, Polymyalgia Rheumatica, Temporal Arteritis, Fibromyalgia, Gout and Pseudogout, Dermatomyositis, Behcet’s disease, Ankylosing Spondylitis, Scleroderma, Mixed Connective Tissue Disease, and Granulomatous Polyangiitis.

Extortion Scam Targeting DEA Registrants

The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extortion scheme.

The criminals call the victims (who in most cases previously purchased drugs over the internet or by telephone) and identify themselves as DEA agents or law enforcement officials from other agencies. The impersonators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine.

Victims and Credit Cards

In most cases, the impersonators instruct their victims to pay the “fine” via wire transfer to a designated location, usually overseas. If victims refuse to send money, the impersonators often threaten to arrest them or search their property. Some victims who purchased their drugs using a credit card also reported fraudulent use of their credit cards.

Impersonating a federal agent is a violation of federal law. The public should be aware that no DEA agent will ever contact members of the public by telephone to demand money or any other form of payment.

The DEA reminds the public to use caution when purchasing controlled substance pharmaceuticals by telephone or through the Internet. It is illegal to purchase controlled substance pharmaceuticals online or by telephone unless very stringent requirements are met. And, all pharmacies that dispense controlled substance pharmaceuticals by means of the internet must be registered with DEA.

By ordering any pharmaceutical medications online or by telephone from unknown entities, members of the public risk receiving unsafe, counterfeit, and/or ineffective drugs from criminals who operate outside the law. In addition, personal and financial information could be compromised.

How Can You Help Stop This Scam

DEA is aware that registrants are receiving telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel. The criminals have masked their telephone number on caller id by showing the DEA Registration Support 800 number.

Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.

If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information through “Extortion Scam Online Reporting” posted on the DEA Diversion Control Division’s website,

For more information contact:

Infusion Express Opens It’s Kirksville Location

PSN is excited to announce that our partner, Infusion Express, just expanded into a new state-of-the-art facility in Kirksville!  The new location opened yesterday in the Physicians & Surgeons Building located at 1108 E. Patterson, Kirksville, MO, and is the company’s first rural location in the country.

Infusion Express has additional locations in Kansas City, MO, Chicago, IL, Philadelphia, PA, and San Francisco, CA.

Their vision for coming to rural Missouri is “Start a business in a location where you find a need.”  The business offers IV drug treatments mostly to patients suffering from chronic conditions like M.S. and Crohn’s disease.

Story by Louis Finley/KTVO

Don Peterson, Infusion Express’s CEO says:

We heard people, through Dr. Jackson, that they were driving 50 to 100 miles one way just to get a regular infusion, and that’s a huge inconvenience and when access is that challenging, people tend not to go.

Peterson said treatments are cheaper than hospitals, and it gets those who are mobile out of their houses, working around their schedules.

Infusion Express offers the IV therapy you need in a place and time that works for you. They work around your schedule by offering weekday, evening and Saturday appointments.  All of their patients are treated in private suites fully equipped with WiFi, flat screen TVs, and comfortable recliners and friends and family members are encouraged to come with you. They are committed to making you better in a better way!

10 Tips for Staying Effective

Burnout is defined as emotional exhaustion, feelings of cynicism and detachment, and a sense of ineffectiveness at work. The inverse of burnout is engagement — a persistent, upbeat sense of fulfillment characterized by vigor, dedication, and absorption. I haven’t seen that doctor in the hospital lounge in a long time.

I am a neurologist practicing for 25 years in both academic and community hospital settings. I have a busy outpatient practice, take calls at two hospitals and serve a leadership role within our regional health care system.

I found I was becoming less enthusiastic about the practice of medicine. I was rushing to stay on time, to finish electronic records, complete inbox tasks of patient phone calls, emails, result notifications, disability forms, pre-authorizations for MRIs and medication, and pharmacy requests. Daily practice was becoming a grind; I was neither burnt out nor fired up.

The tipping point was the introduction of Press Ganey patient satisfaction scores. My initial scores were abysmal. Patients didn’t like the long wait times, delays in responding to calls, and they felt I wasn’t listening to their concerns. This was not the caring and engaged doctor I thought I saw in the mirror every day. For the first time, I began to consider other avenues such as an MBA, a full-time administrative role or locum tenens practice.

But here is my confession:

I love my job. At least most of the time. I love the sigh of relief when the patient hears the hand tremor isn’t Parkinson disease or poor memory may be due to depression and not dementia. I love the challenge of staying current on an ever-expanding knowledge base. I am grateful and honored to be in a respected and well-compensated profession.

I am a mostly happy doctor. Despite the frustrations of everyday practice, is there anything more fulfilling than caring for people? I had thought I was doing a good job, but my patients were telling me a different story. The body language of watching a computer is all wrong. Patients don’t believe I am listening if I’m glued to my screen. I needed to resolve the competing demands for documentation and the need to demonstrate presence to my patients’ concerns.

If you are one of the 60 percent of doctors who have experienced symptoms of burnout, here are ten changes I made that have helped reduce resentment and restore a sense of control, engagement and gratitude in clinical practice.

Ten simple changes to defeat physician burnout:

1. Patients complete a card with three questions for the doctor. I make sure we have addressed every issue on the card. No longer does the patient say, “one more thing” as my hand is on the doorknob because all issues have been addressed.

2. The two-minute rule. I spend the first two minutes with direct eye contact and try not to interrupt while asking the patient to tell me their story.

3. After a few minutes of listening, I ask permission to look away and take some notes on the screen.

4. I reassure that the patient is in the right place for their medical concern. I eliminate comments that suggest frustration with the EMR. I thank the patient for entrusting their care to me, offering email contact and regular follow-up and communication until the problem is resolved.

5. Optimize the EMR’s strengths. The EMR can gather data from other physicians, test results and can serve as an educational tool. Use the EMR to demonstrate images and reports to the patient, adding medical articles, online resources for exercise equipment, sleep hygiene courses, etc.

6. I end all encounters with the question: “Is there anything else I can help you with today?” Most of the time, the patient gratefully acknowledges that all questions have been answered.

7. Close the encounter before the patient leaves the room. The note, after visit summary (AVS), orders and letter to the referring provider are completed before the patient leaves the room. Avoid the temptation to complete records in bed or while on vacation.

8. I often finish with a request: “May I give you a hug?” While embracing, I will say a secular blessing, “Be well.” It is a simple act in the doctor-patient relationship that expresses empathy and support. There are caveats, especially in our current cultural awareness of sexual harassment: I always ask permission. An older female is generally safe; a younger female is embraced with caution or not at all, always with family in room; a male — generally not. A hug has the power to lighten the mood, to convey intimacy during a brief encounter and to share the burden of illness.

9. If the patient is smiling at the end of the encounter, I will encourage them to complete the survey. I may also request that they write a review on an online rating service.

10. I maintain resilience for the demands of practice with an intensive regimen of exercise. I became a group fitness instructor, teaching 3-4 classes a week of indoor cycling, including weightlifting and planks. In addition to the personal benefits, teaching has made me a more enthusiastic advocate for exercise with my patients.

What have I learned?

Since the electronic medical record and patient-driven quality metrics are unlikely to disappear soon, I have learned to use them to become a better doctor. The focus has become communication skills- demeanor, physical and emotional presence, listening and explanation of the evaluation and treatment plan. This has lead to a dramatic improvement in patient and physician satisfaction.

The physical contact has changed me more than my patients. I have moved from resentment to gratitude for a deeper relationship I thought wasn’t possible during a brief encounter.

Anticipating the offer of an embrace at the end prepares me to like the patient at the beginning. It opens me to want to know them personally, not simply collect data about their symptoms. Even though we may share hard truths about diagnosis, treatment, and necessary lifestyle changes, the patient may feel that we are in it together.

PSN Provider, Laurence Kinsella is a neurologist, and wrote this article for the KevinMD’s website.

Arthritis Foundation Medical Honoree 2018

Arthritis Foundation Medical Honoree 2018

The Arthritis Foundation is honored to feature Dr. Fred Pfalzgraf as the 2018 Medical Honoree for the Walk To Cure Arthritis in Southern Illinois.

Dr. Pfalzgraf is originally from Wisconsin where he graduated from the University of Wisconsin Medical School. He completed his internship and residency at Fizsimons Army Medical Center in Aurora, Colorado, and went on to finish his rheumatology fellowship at the University of Colorado Health Sciences Center in Denver.

He takes great pride in this honor as an avenue to educate the people of Southern Illinois about arthritis in its many forms and to spread awareness of its growing prevalence in our society today. Currently, Dr. Pfalzgraf is working as a rheumatologist for Premier Specialty Network with clinics in Perryville, MO; and, DuQuoin, Benton, Sparta, and Eldorado, IL.

He asks that you join him and his team in supporting the mission of the Arthritis Foundation to serve those living with the daily challenges of arthritis while leading the fight to find a cure.

Please register and/or donate today at:

Gordon Alloway Joins PSN as Telemedicine Consultant

Gordon AllowayGordan Alloway, healthcare delivery expert, has recently joined PSN as a telehealth and telemedicine adviser. Gordon has served as the Project Director for the Heartland Telehealth Resource Center, one of 14 federally-funded Telehealth Resource Centers across the U.S. coordinating assistance provided in Kansas, Missouri and Oklahoma.

He has also served as a staff member at the University of Kansas Medical Center, a research associate and project manager for the KU Center for Telemedicine and Telehealth in Kansas City, KS and has managed multiple grant-funded projects.

“Telemedicine” is most commonly used to refer to two-way, interactive video conferences that allow patients to “see” their doctor without being in the same room. This helps increase access to medical care, especially for patients living in rural areas.

As with many other technologies, additional devices can be attached to the videoconferencing system to enhance the patient experience. Some of these devices include a digital stethoscope or a dermatology camera that can record a patient’s vitals or health information so that a doctor can assess from a distance.

However, telemedicine is not limited to video conferencing. Remote patient monitoring, store-and- forward and mHealth are other common types of telemedicine.

Through PSN, Alloway will be providing both healthcare providers and facilities with education and assistance to get up to speed on the rules, regulations and technology information that is needed to start or expand telemedicine programs.

PSN’s goal is to show how to make these programs sustainable and assist with providing hands-on training designed to help a practice, clinic or organization provide the best care for patients via telemedicine.

According to Alloway, integrating telemedicine into the everyday workflow is essential to assuring that the technology will be used to the fullest.

“We’ve seen cases where a facility invests the time and start-up costs in the technology, but then the people who are trained on it move on to other jobs and after that it collects dust,” Alloway shared. That’s why it’s important to create a work plan and get everyone using the technology as part of the culture. Using telemedicine should become as routine as making patient referrals.

Mr. Alloway earned both his Bachelor’s and Master’s degrees in Journalism from the University of Kansas and possesses considerable experience as a long-time marketing executive and health care entrepreneur. He resides in Overland Park, KS.

American Telemedicine Association (ATA) 2017 Annual Conference and Tradeshow Wrap-Up

Last month, I (Lisa Thomas, MD, Director of Psychiatry and Telepsychiatry) attended the American Telemedicine Association (ATA) 2017 Annual Conference and Trade Show which was held in Orlando, Florida from April 22 through the 25th.  The venue was just a portion of the Orange County Convention Center, however, it was still a huge space to navigate both for the conference offerings and the Exhibit Hall.  There were an astounding 4500 attendees and 275 vendors!

My goal in attending this event, as a new ATA member and first time attendee, was to learn as much as possible about the latest in telemedicine practice and to engage in extensive networking as well as recruiting.

The conference and vendor exhibits offered information ranging from the basics of getting started with telemedicine, to available hardware and software, to unique niches in which to deploy telemedicine, the challenges of reimbursement, and current as well as future legal issues.   In order to maximize my experience at ATA, I signed up for the pre-conference in addition to the regular conference, and upgraded to the “platinum” package which in another week or 2 will allow me as well as my PSN colleagues access to essentially all of the lectures from the entire event.  Given the format of concurrent sessions, I was only able to attend a small portion of the scheduled talks so by definition there will be much that is new in the “platinum” package.

It should be noted that several of the sessions I was present for are particularly relevant to current PSN practice and issues so will bear re-listening to (esp regarding regulatory and billing issues).

I came away from the conference with new knowledge but also questions to pursue, companies to followup with for potential partnerships, and a few leads on potential clinicians to affiliate with PSN.  It was comforting to learn that the telemedicine issues we at PSN have identified are common in this growing industry and that solutions are being developed in rapid fashion.