Healthy Rounds With Dr. Anthony Alessi

UConn Health

Healthy Rounds covers a range of topics, including new medical technologies and treatments, research, disease prevention, hosted by Dr. Anthony Alessi, UConn Health neurologist and clinical professor of neurology and orthopedics in the UConn School of Medicine.

  1. 20h ago

    Retraining the Brain With Advanced Neurosurgery

    Already on the leading edge of electronic stimulation for new applications like stroke recovery, UConn Health's Dr. Christopher Conner, who specializes in stereotactic and functional neurosurgery, is on the verge of another one! He joins Dr. Anthony Alessi to explain how Vivistim has been opening new doors to regaining function after stroke, who the best candidates are, and how a similar concept for autoimmune disorders may not be far behind. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Christopher Conner: https://www.uconnhealth.org/providers/profiles/conner-christopher UConn Health Department of Neurosurgery: https://www.uconnhealth.org/neurosurgery The Brain and Spine Institute at UConn Health: https://www.uconnhealth.org/brain-spine UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine “UConn Health Neuromodulation Center of Excellence for Veterans” (UConn Today, June 17, 2025): https://today.uconn.edu/2025/06/uconn-health-neuromodulation-center-of-excellence-for-veterans/ “Grateful Stroke Survivor Shares How New Technology Is Transforming His Recovery” (UConn Today, Nov. 25, 2024): https://today.uconn.edu/2024/11/grateful-stroke-survivor-shares-how-new-technology-is-transforming-his-recovery/ UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. Christopher Conner. Dr. Conner is an assistant professor in the Department of Neurosurgery, and he specializes in stereotactic and functional neurosurgery. Chris, welcome to the show. Dr. Conner: It’s fantastic being here, Dr. Alessi. Dr. Alessi: Let’s talk. Can you explain to our listeners what is stereotactic and functional neurosurgery? Dr. Conner: The simple answer is that I get paid money to put wires and batteries into people’s bodies, which is a really weird thing to do with your day-to-day work, but it is what it is. What it really means, though, is that a majority of what I’m doing is trying to improve people’s day-to-day lives. That’s kind of the functional aspect of it, and that can encompass a lot of things. It can encompass chronic pain. It can encompass stroke recovery. It can also involve Parkinson’s disease or movement disorders, and even epilepsy. And so these are some diseases that you might sometimes think of as not something that surgery can, can treat, but this is kind of where someone like myself comes into play. Dr. Alessi: That’s great. Now, let’s go back a little bit. I want to talk, you brought up several different topics, and I know we covered this about two years ago when you were on my radio show. So I want to touch base. Let’s go to Parkinson’s disease, doing deep brain stimulation. You were just starting that at the time here at UConn Health. Where are we with that program? Dr. Conner: The program has really gotten its feet underneath it. We’ve done upwards of, I think, about 25 or 30 patients with deep brain stimulation, primarily for Parkinson’s disease, although we also treat patients with essential tremor and some other disorders with that here at UConn Health. But at this point in time, we have a, a really full-fledged program. My movement disorder neurologists, like Dr. [Sarah] Mancone, Dr. [Bernardo] Rodrigues, Dr. [Chindhuri] Selvadurai, and I, we’re really proud of what we can accomplish here, and we can offer kind of a full-stack treatment for people who have advanced Parkinson’s disease. And again, that deep brain stimulation, when I use that term, stimulation, it generally means applying electricity somewhere in the body, and it’s been really gratifying seeing a lot of our patients now that are coming back in a year or two years who are having life-changing, remarkable improvements in their symptoms. And so we’re finally kind of at that point where we’re getting to our long-term patient outcomes, and I’m really happy to report that we’re doing as well or really much better than what kind of the typical program’s able to achieve. Dr. Alessi: Let me get back to the idea of putting batteries and wires in people How does that work? In other words, when you’re doing deep brain stimulation or, for years we talked about vagal nerve stimulation, right? People were, and still are, obsessed with the vagus nerve. But when you’re doing that, is it the depolarization? Is it the stim? What is actually taking effect when you’re doing something like that? Dr. Conner: So every one of these applications we have works in a different way, and the uncomfortable but honest answer that I have for you is that a vast majority of the time, we don’t understand how the electricity is really working on a pretty fundamental level. And that’s true of deep brain stimulation, of vagus nerve stimulation, of spinal cord stimulation. Every one of those is a different kind of wire. Every one of those is a different kind of thing we’re stimulating, and a lot of the time we don’t completely understand it. We might have a good idea about it, but it’s still more than a little bit of a mystery. Dr. Alessi: And I want to clarify, because I was talking to a patient about it today, and they said, “Oh, is that like ECT?” And this is very different from electroconvulsive therapy which we know how that works. Dr. Conner: Yeah. We have a better idea, kind of generally, of how electroconvulsive therapy works. The difference is that electroconvulsive therapy is, I think it’s fair to say that it’s a less targeted therapy. So when we’re talking about these wires, we’re talking about trying to deliver electricity to something that’s the, you know, maybe two or three millimeters in size. That’s a really small area. It’s really targeted that we’re trying to deliver therapy to. Electroconvulsive therapy is more of a whole-brain kind of style of therapy. And so the difference really is magnitude and targeting when we’re talking about the difference between those different approaches. Dr. Alessi: Let’s go to the vagus nerve, vagal nerve stimulation, I remember, I mean, we’ve been doing this for decades for epilepsy. How effective is it for epilepsy? Dr. Conner: Yeah. So it’s been around and FDA approved for several decades for both epilepsy and then also for depression. Epilepsy is a seizure disorder. Once you’ve had several seizures, you have a diagnosis of epilepsy, and in some people, we can’t really figure out exactly what area of the brain it’s coming from. It’s called generalized epilepsy. And in those patients, sometimes medications work, and in a shockingly large chunk of people, medications don’t work. And then, kind of one of the best therapies we had for a long time was stimulating the vagus nerve, which is a nerve in the neck, and the general kind of way I counsel patients is that in 50% of patients it’ll drop your seizures by 50%. So it’s kind of a 50/50 rule, which, in some people, that’s enough to have them be happy with the outcome and to think that the surgery was worthwhile. But it still wasn’t maybe the best that we could do. Fortunately, now there are some deep brain stimulation, wires inside of the brain, there are some ways that we can do that in order to treat epilepsy as well now. Dr. Alessi: I’ve seen several people using or purchasing these external vagal nerve stimulators. Do they work? Is it garbage? What is it? Dr. Conner: I mean, that’s a really great question. To my knowledge, no one’s ever really validated whether or not external vagus nerve stimulation works. The vagus nerve is not right at the surface. There’s a big muscle in your neck. If you turn your head, there’s a big muscle coming from the back of your skull all the way down to your collar or clavicle, and that muscle, it’s called the sternocleidomastoid, it’s a big, thick muscle, and it’s sitting right over the vagus nerve. I just don’t—it’s tough for me to see how electrical stimulations can get through that muscle and into the nerve and not cause that muscle to painfully contract. So I don’t know if it works or not. I think there’s a lot of people out there selling it to you, and it’s up to them to really tell you whether or not it’s effective and do that study. I don’t think it’s been done, though. Dr. Alessi: Well, it’s interesting because I had a patient who had a concussion, and he was a professional athlete, so he had unlimited means. And someone told him to buy one of these vagal stimulators. Now, professional athletes don’t buy anything, so he had somebody buy it for him, OK? I’m sure that they wanted an endorsement. He used it once and said it was so uncomfortable and painful, he would never touch it again. So I think that’s the idea of trying to get the stim through the sternocleidomastoid and probably made it very uncomfortable. And I’ve not known it to work at all for a concussion. Let’s move on, when we talk about the vagus nerve, and I really wanted to get to Vivistim. Because Vivistim is something we talked about back in February of 2024 when you were on my radio program, and you were really just starting that program. Can you tell people really what is Vivistim, and what are you using it for? Dr. Conner: Awesome question, something I love talking about. So Vivistim is the commercial name for a vagus nerve stimulator. It’s a totally new one, even though it’s very similar to the old one th

    17 min

  2. Jun 2

    Kids on a Pitch Count

    In 1974, a 31-year-old pitcher for the Los Angeles Dodgers underwent a new procedure to repair the ulnar collateral ligament (UCL) in his left elbow. His name was Tommy John, and so would become the name of the surgery. Today, it’s not unheard of for baseball players to get Tommy John surgery before they turn 20. One factor is, it’s become the norm for many child athletes to specialize, for example, playing baseball not just during Little League season, but throughout the year. With that has come an upward trend in upper extremity injuries, and elbow and shoulder surgeries as adolescents. Dr. Cory Edgar, UConn Health orthopedic surgeon and co-director of the UConn Institute for Sports Medicine, joins Dr. Alessi to discuss youth sports injuries, the risks of playing a sport year-round with no downtime, the importance of pitch counts, and what parents might consider when it comes to their children’s participation in youth sports. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Cory Edgar: https://www.uconnhealth.org/providers/profiles/edgar-cory UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine UConn Institute for Sports Medicine: https://sports.institute.uconn.edu  “The Story Behind ‘Tommy John Surgery’” (UConn Health Blog, Oct. 22, 2018) https://health.uconn.edu/health-blog/2018/10/22/the-story-behind-tommy-john-surgery  UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information provided by national and international experts in their field. This podcast is brought to you by UConn Health with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to in any way direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. Cory Edgar. Dr. Edgar is an MD, Ph.D. He is associate professor of orthopedic surgery here at UConn Health, where he also serves as co-director for the UConn Institute for Sports Medicine. He’s also a team physician. Cory, welcome to the show. Dr. Edgar: Thank you, Tony. Always a pleasure to talk to you and be on the show. Dr. Alessi: Let’s talk a little bit about Little League sports. And something we’re always hearing about is throwing injuries in athletes who are younger and younger, and I know that you treat a lot of these in athletes — We talk about Little League, but in all throwing sports. So I really want to emphasize today on upper extremity injuries. My first question is, are we seeing an upward trend in these injuries in general, and especially in a younger population? Dr. Edgar: Yeah, great question. So overall, we have been seeing a trend in injuries, specifically around the elbow, and also the shoulder, with an uptick in people that need surgical intervention. Interestingly, some of the newer data that’s come out suggests that this is trending surgery towards a younger throwing athlete, such that up to 60% of all the UCL reconstructions or Tommy John surgeries that we do on the young throwing elbow is now in the age bracket of age less than 20. So we’re seeing an uptick in injuries to the elbow and the shoulder in younger athletes for a variety of reasons. Dr. Alessi: Let’s talk a little bit about the reasons. Is it because, I mean, it used to be, people played Little League, children played Little League, and that was it, the end of the season, some playoff, everybody got a trophy. But now we’re hearing a lot about travel, and you and I have talked about this at ringside and on the sideline over the years. I mean, it’s now Little League, sectionals, championship, travel, things like that. And in addition to increased expense for parents, it’s also been increased wear and tear on these arms. Is that one of the reasons that we’re facing this problem now? Dr. Edgar: 100%, that’s the primary reason. I think we can talk about differences from region and weather-related and stuff like that, but the No. 1 reason is based on the amount that these kids are playing. There’s really no downtime for a lot of them. With travel baseball, and certainly in Little League and some of the more monitored associated programs, there are pitch count institutions that really help preserve the amount of exposure that these kids have. But when you get in the travel world, which, I have a kid that participates in travel baseball, you can go to a weekend tournament, the kids can play upwards of five, six, seven, eight games, play multiple positions in which they’re throwing regularly, not just pitching, but pitcher, now to catcher, now going to the outfield, and so there’s a lot of use to that arm. So overuse and tired forearms that now put stress across the elbow is what we’re seeing, and this is what we’re getting. Dr. Alessi: So Cory, is there a difference when we see young athletes who play in the north where we have winter, and athletes who live in Florida and in the South, where it’s warm year-round and they’re playing baseball year-round? Dr. Edgar: Yes, yes, there is. We often see Tommy John surgeries in the southern states over the life of an athlete go up. That said, in New England or areas in which there’s kind of extremes of weather changes where you can’t really play baseball regularly in the winter, we’re forced to go indoors, and it kind of forces a shutdown. So there is this phenomenon that we and others are doing some research in, this start-stop phenomenon. So we see an uptick in the early parts of baseball season, so the Januaries, Februaries, and Marches, when the kids maybe get outside, they try to throw, it’s cold, and we see an uptick in the skeletally immature athlete or the little leaguer’s elbow. So we’re trying to allow kids to play other sports and be diversified, but they still need to throw. Meaning throw the football, safe, have a catch one or two days a week, and it keeps mild stress across the elbow and strengthening to the flexor pronator mass so it protects them when they, quote unquote, “jump back into things” because they just go back into it really quickly. And I’ll come up with a program where there’s kind of a throwing transition that happens, so that way there’s a much less risk of acute injury. Dr. Alessi: Cory, I find that amazing, ’cause I thought you were going to talk the other way and tell us that you see more injuries in people who play year-round and in the South. So that’s fascinating, and I’m sure we look forward to the results of that research. Alright, so when we’re looking at throwing injuries, are we talking about because they’re throwing harder? The old thought used to be that you didn’t want a young pitcher to throw curve balls and stuff ’cause they were stressing their elbow more, or is it purely just the number of pitches regardless of velocity and technique? Dr. Edgar: A lot to unpack there. So yes, so I think there’s multiple things. Chasing velo is definitely becoming part of our culture, chasing velocity. And the kids, when we were kids, we were just competing against other kids. Now we’re competing against ourselves and just chasing numbers, with all the information that we’re given with TrackMans or just radar guns. These kids are into it early. So that’s one. Two, the type of pitches that we throw probably doesn’t make as much as different as the technique by which we’re throwing them. So I think having a young kid that still doesn’t have the ability to grip the ball well and is can’t get through a fastball, and now you’re asking them to throw a curve ball, maybe it’s more a mechanics issue, but purely throwing a curve ball as a thrower in the age of skeletally immature 10 through 14, that’s not the danger. One pitch that we do see a higher risk is what we call a power change, when they actually pronate, or the palm goes down as they throw the baseball, ’cause that disengages the protective muscle or the flexor pronator mass, the big wad of tissue on the inside of your elbow that attaches to that bony prominence called the medial epicondyle. Dr. Alessi: When we’re thinking about this, we’ve been talking about Little League and overhand throwing, but are you seeing this in softball as well with underhand pitching, or softball throwers as well? Dr. Edgar: 100% from pitching, totally different mechanics, not an issue in softball pitchers. In fact, they’re much more liberal in the amount of restrictions that we put on softball pitchers for that reason. Now, when they go to overhead throwing, the softball catcher, the outfielder, they still play a lot of games, and we can see really particular shoulder conditions with softball players is more common. Dr. Alessi: Why is that? I mean, when I watch fast pitch softball players, like here at UConn, I mean, it looks like a tremendous amount of stress on their shoulder more than anything. I’m kind of surprised that we’re not seeing more injuries mechanically on the shoulder from a pitcher. Dr. Edgar: If you think about how the kinetic chain generates velocity into a ball that you’re hurling towards a catcher and a batter, two totally different mechanisms, and the body is designed well for the torque that’s put on them with the shoulder in the softball motion. They’re generating a lot of power, they’re stopping quickly, and then everything follows through in a range of motion. And their deceleration phase is just swinging the arm back over the top. So the things that decelerate the shoulder in a pitcher, a baseball pitcher, depending on their kinematics, but with most mechanics, they’re coming across, and so those powerful decelerators are your lat, your posterior shoulder muscles, and

    14 min

  3. May 19

    Hantavirus: How Worried Should We Be?

    An outbreak of an uncommon but not unheard-of illness is responsible for the deaths of at least three people who were on an international cruise ship. With the rest of the passengers and crew under observation in their home countries — including 18 Americans who went to a quarantine facility at the University of Nebraska — how worried do we need to be about hantavirus? Dr. David Banach, UConn Health infectious diseases physician and hospital epidemiologist, explains what we're dealing with, the public health implications, and how, unlike COVID, the medical community at least has some history with this virus. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. David Banach: https://www.uconnhealth.org/providers/profiles/banach-david UConn Health Infectious Diseases Division: https://www.uconnhealth.org/infectious-diseases UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, and that should only be done with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. David Banach. Dr. Banach is an infectious disease specialist and he is head of the infection prevention program here at UConn Health. David, welcome to the show. Dr. Banach: All right. Thank you. Dr. Alessi: Let’s talk. I mean, there’s a lot of information out there about the hantavirus and how this all came about. Let’s go back and really address how this infection developed. What does it mean to our listeners? Dr. Banach: Sure. So, kind of taking it back to the basics, hantavirus is a virus that we’ve known about now for many years, even maybe upwards of decades, that exists in the rodent population. So it’s primarily circulating among rodents, particularly in certain geographic areas. And then on certain situations it does infect humans, typically humans who are in close contact with rodents or rodent excrement. It causes what we call a zoonotic infection, where a virus that typically is present in animals moves into a human host. And in most situations, those are one-offs. Someone will have some sort of environmental exposure, could be in any part of the world, could be here in Connecticut, getting sick from this particular virus, and not pass it on to anyone else. But occasionally we do see it occur in clusters, and that’s what’s happened with this most recent situation on the cruise ship that returned and several individuals on that ship became sick and were eventually diagnosed with hantavirus. I think in terms of the big picture, again, this does seem to have caused a bit of an outbreak on that ship. What it means for the larger public, I think we’re still kind of keeping an eye on it right now. I think the general feeling is that the risk for the general population is low, but I think it’s something that we’ll have to keep a close eye on in the coming weeks. Dr. Alessi: What’s interesting when we talk about hantavirus, I’d never heard the term until Gene Hackman died of it, right? In the, in the past year, right, Gene Hackman and his wife die of hantavirus, and now we hear about hantavirus again. What’s the difference? He wasn’t in South America. Can you talk a little bit about why he’s dead and now these other people are dead. Dr. Banach: Sure. I think the illness that his wife, I believe, contracted was the hantavirus, and that, there’s different strains of hantavirus. This particular strain, on the cruise ship, is the Andes virus. That’s like a type of hantavirus, if you will, that causes a specific illness. But there’s also, as I mentioned earlier, hantavirus that’s present in rodents throughout the world, and I think the situation with Gene Hackman’s wife, I think, was linked to some sort of environmental exposure to rodents that she was in contact with. So it’s same virus, but a little bit different in terms of the way that it’s showing, in terms of individual cases versus, like, a cluster of infections like we’re seeing with this cruise ship. Dr. Alessi: Now, when we talk about viral outbreaks, right, everybody immediately thinks of COVID. And there’s that fear of, are we going to be dealing with another pandemic? And obviously, with the hantavirus, the mortality is much higher than COVID. So can you talk a little bit about the differences and why this should not be similar to COVID? Dr. Banach: Sure. “Viruses” is such a broad term. We think about our seasonal influenza viruses. COVID, of course, got so much attention over the last five years in the light of the pandemic. But then there’s other viruses. You remember Ebola was a big viral outbreak from a few years prior to the COVID pandemic, and they cause a wide range of illnesses. Hantavirus can cause quite severe illness. It causes a very severe cardiopulmonary symptom that can often lead to people needing ICU care and even succumbing to the virus. In contrast to COVID, where the virus tends to be sort of uniformly a respiratory virus, so a little bit different in terms of, like, the clinical illness that they cause. In terms of the way they spread, also different. So COVID was different in a lot of ways. It was a virus that, first of all, we had never seen circulating in human populations. As I mentioned, hantavirus is not new in that sense, so we’ve known about hantavirus, and we’ve seen individual infections. We’ve even seen clusters in the past. There was a large cluster around 2018, 2019 in South America that was well-studied and described. There’s actually a very notable New England Journal of Medicine publication on this hantavirus outbreak that came as COVID was starting to take off, so it went under the radar in that sense. But it was well-described, related to sort of a cluster of hantavirus infections, this particular type of hantavirus specifically. And so we understand a little bit more about how it’s transmitted. It doesn’t spread in the same way that COVID does in the sense that there’s no established sort of asymptomatic or pre-symptomatic spread. Remember, that was a big challenge with COVID, that people could potentially be contagious before they showed signs of illness. But then on the other end of the spectrum, hantavirus does cause quite severe illness, and often has a much higher morbidity and mortality associated with it than COVID. So, yeah, I think there’s differences. I think there’s some differences that make this less likely to spread in a larger fashion as COVID did. But I think it’s still early, that we have to kind of keep an eye on things, and what we’re going to be looking for in the coming weeks are any evidence of secondary transmission. At this point, the people with infections have all been directly linked to the ship and the original cases of the two individuals who were first ill. But if we start to see additional spread, that would raise some concern that there may be a little bit more going on in terms of its ability to transmit to a the broader population. Dr. Alessi: David, do antivirals help? I mean, these people who are being treated now who are symptomatic, and are they treating them with antivirals, or, what are they doing for these people? Dr. Banach: Yeah, at this point, it’s really supportive care. As I mentioned, these patients can develop really severe cardiopulmonary illness, requiring pretty intense supportive care at times. There’s a wide spectrum of illness. Some individuals may recover with sort of minimal support, but some do become quite sick. So it’s really supportive care at this point. We don’t have an established antiviral per se, and there’s no vaccine available for hantavirus at this point, and that’s largely because these infections, although we’ve known about them for many decades, are quite infrequent. I think, and the CDC I think, they reported that there’ve been something like 800 cases described since 1990 of hantavirus in the US. So it’s been circulating, but very sporadically. So there hasn’t been kind of a need for sort of a wide-scale public health intervention. But, I think we’ll have to keep an eye on this particular outbreak and see how things unfold. Dr. Alessi: Do we need to do anything here in Connecticut? Dr. Banach: I think at this point, the most important thing for people here in Connecticut is to kind of listen to what’s happening. There doesn’t seem to be a direct risk to people here in Connecticut from this infection, but listen to what you’re hearing on the news. See what’s being reported by the public health authorities and, how the situation evolves. My optimistic hope is that this will be very limited, and the outbreak will subside with now that the appropriate measures are being taken to try to quarantine people who are exposed and prevent spread, but we’ll have to keep an eye on things. Dr. Alessi: When you say listen, that raises a flag because we don’t know who to listen to anymore, right? We’ve had some issues with scientists leaving the CDC. Do you listen to the WHO? I- if you go on the internet, we’re all going to be dying in the next week from hantavirus. So who do you listen to? I mean, who should, who do you consider the reliable source here for our listeners? Dr. Banach: I think that is a real challenge for the public to really understand how to get accurate information. With this particular situation, the World Health Organization seems to be the most tied in. Remember, this is an

    11 min

  4. May 5

    Stroke Prevention, Treatment, and Recovery

    Gone are the days of stroke having only two outcomes — death or disability — now that we have a window of time to treat what still is very much a medical emergency. For Stroke Awareness Month, Dr. Priya Narwal, medical director of UConn Health’s stroke program, joins to discuss how stroke care, recovery, and even prevention have evolved over the years, how the UConn Health Stroke Center harness that expertise, and why it remains critically important to “BE FAST.” The UConn Health Stroke Center is certified as a Primary Stroke Center by the Joint Commission. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Priya Narwal: https://www.uconnhealth.org/providers/profiles/narwal-priya  UConn Health Stroke Center: https://www.uconnhealth.org/neurology/stroke  UConn Today: “First in Connecticut: Ischemic Stroke Survivors Have Renewed Hope with the Vagus Nerve Stimulation Device Now Available at UConn Health” https://today.uconn.edu/?p=214132 UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal care in any way, but that should only be done in conjunction with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today, Dr. Priya Narwal. Dr. Narwal is an Assistant Professor here at UConn Health in the Department of Neurology. She’s also director of the stroke program. This is especially timely because the month of May is stroke month where we raise awareness about stroke and the treatments for stroke. And what better than to have an expert in that field with us. Priya, welcome to the show. Dr. Narwal: Thanks, Tony. Dr. Alessi: Let’s talk a little bit about your directorship of the stroke program. Again, that’s a fairly new term in terms of having a program in neurology to direct one specific entity. Can you talk about the stroke program here at the University of Connecticut? Dr. Narwal: Sure. So when we say a stroke program, it means that the hospital is equipped to provide specialized stroke care and meet the needs of patients who have stroke or are experiencing stroke-like symptoms. So, what that entails is being able to identify stroke symptoms, realizing how urgent it is to address stroke symptoms, and also have a team in place, a team that consists of different specialties and departments such as emergency department, radiology, neurology, neuro intervention, ICU, to be able to provide expedited care to these patients. Dr. Alessi: Let’s back up a little bit. Let’s define stroke because it’s an old term. We’ve been using this term for many, many decades, and yet it’s still so relevant. Can you share for our listeners a little bit about the specific types of stroke? Dr. Narwal: Sure. So, a stroke is a medical emergency that is caused by interruption of blood flow to the brain. When we typically use the term stroke, in general, we are alluding to ischemic stroke or strokes caused by a blood clot interrupting the blood flow. However, strokes can be ischemic due to lack of blood flow or hemorrhagic or bleeding types of strokes that are caused due to rupture of blood vessels in the brain. Dr. Alessi: So, when we talk a little bit about the history of stroke itself, I’m still old enough to know when it was an untreatable condition, right? Where you brought someone to the hospital and you had them do some physical therapy, but there was nothing to do, right? And then we went to baby aspirin or using aspirin only, and now we’re using terms like “neuroplasticity” and “penumbra” and “antithrombin therapy”. Can you take us through that history of treating strokes a little bit? Dr. Narwal: Right, so as you said, you know, earlier we did not have much to offer to our stroke patients in terms of acute treatment or minimizing the risk of disability going forward. The main focus was on secondary prevention, meaning you had a stroke, and what do we do to prevent it from happening again, which is where the aspirin came in. However, in the late 90s, we had this incredible drug that was FDA approved, which was Alteplays or tPA or loosely called the clot buster, which if patients met certain criteria, we could give that medication and it had a positive impact on their long-term functional outcome. So that was a huge game changer when it came to acute stroke treatment, and that was the case for a long time, however, the treatment window was four and a half hours. So, if you were last known well within, you know, the previous four and a half hours, then we could treat you with the medication. But if you know, someone went to bed, woke up with stroke-like symptoms, there wasn’t much more to offer. Also, if patients have a blood clot in the brain that is large, the clot buster may not work too effectively and those patients may not have as good of an outcome. So, in the past decade or so, we have this new intervention that we’re able to offer to patients, which is called “clot retrieval” or “mechanical thrombectomy”. So again, if patients meet certain criteria based on what their exam findings look like, what their imaging findings look like, and they have a blood clot that we can go after, we will do that, and that has shown to have a positive impact as well. Dr. Alessi: You know, it’s so interesting to me because as someone who doesn’t do that in the field of neurology, I think of it as literally they’re going in there and fishing out a clot from the brain. Dr. Narwal: Right.   Dr. Alessi: It’s something that we would never even think of. And then watching someone get their function back, I think, for of those of us who have used these clot busting drugs, watching someone get better before our eyes after the administration is, it’s a powerful experience. Dr. Narwal: It’s pretty incredible, and I think one particular case that left a mark on me was a patient who came with a top of the basilar occlusion, which as you know can be catastrophic. Dr. Alessi: Right.  Dr. Narwal: And the patient came in, we were able to do a thrombectomy and he was discharged the next day from the ICU. That’s how good the outcome was. The patient had practically no deficits. Dr. Alessi: Alright, and can you describe a little bit, I think our listeners may not know what a "top of the basilar syndrome” is. Dr. Narwal: Mm-hmm. Dr. Alessi: Can you explain that severity to folks? Dr. Narwal: Right, so the basilar artery is a big blood vessel in the back of the brain that supplies several critical areas that are essential to our basic function pretty much like being able to breathe and, you know, move our eyes and just be awake or conscious. So, when someone has an occlusion sitting at the very top of their basilar artery, this whole area of the brain that allows for wakefulness is disrupted and patients look comatose and have a really poor outcome. Dr. Alessi: So that is phenomenal, really. Lately, we’ve used the "BE FAST" acronym. Can you talk a little bit about the acronym itself, and you know, has it been effective? Dr. Narwal: I would like to think so. I do think it has helped a lot with community outreach. I do see patients in office who will tell me, you know, we called 911 because we saw this or read this somewhere. I don’t know if we have a way to measure how effective it’s been, but the "BE FAST" acronym itself stands for “balance issues or dizziness”, “eye problems”, which could be double vision or blurry vision, or missing parts of your vision, “facial droop”, “arm or leg weakness”, “speech changes”, which could be slurred speech or word finding difficulties, and T stands for “time to call 911.” Dr. Alessi: It’s kind of interesting because, you’re right, it’s probably hard to measure the success of it, but you know, I tend to think that anything that empowers a patient is important, whether it be breast exam, testicular exam cell, any self-examination, and certainly "BE FAST” lets somebody do their own self-examination. So, I’d have to think it’s effective. Dr. Narwal: Yeah, I’d like to think that too. And also, you know, earlier it used to be "FAST” and then we added the "BE” because very commonly, again, symptoms affecting the back of the brain can be a little bit subtle, like patients may just feel dizzy or unsteady, and oftentimes they wouldn’t think much of it. So that’s why having the "BE” in there has definitely made a positive impact as well. Dr. Alessi: I want to talk a little bit about the role of rehabilitation. And, I go back to share a story. Back in the early 80’s, actually, I had just finished medical school, it was 1981, and my wife to be’s uncle had a stroke, and her mother would go to the rehab to see her brother-in-law and make him squeeze a ball so many times with this bad hand. I mean, he would have to do it, so every day she would drive this home while he was in the rehab. And, you know, naturally I just graduated medical school, so I knew everything, right? So, I told my fiance at the time I say, “you know, I don’t know what she’s doing. That doesn’t do any good. OK? It’s a stroke, nothing’s going to get better.” And sure enough, the guy regained the use of his hand, left the hospital, went back to enjoy his boating and whatever. So, I was proven wrong. Now we go forward another 40 years, right? And that’s all we do. We know to now use the bad hand to the point where sometimes, right, we i

    14 min

  5. Apr 28 ·  Bonus

    Tony’s Take: Acetaminophen Myths, Messenger RNA

    In between studio guests, Dr. Alessi brings new information to earlier conversations about messenger RNA and how it’s showing promise in treating pancreatic cancer, a study further debunking the Trump Administration’s assertions about the safety of Tylenol, and whether reasonable solutions to physician licensing challenges could improve access to care. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Jan. 27, 2026, with DPH Commissioner Manisha Juthani: https://healthyrounds.podbean.com/e/the-impact-of-public-health/  Jan. 13, 2026: with Dr. Andy Agwunobi, UConn Health CEO: https://healthyrounds.podbean.com/e/premiere-with-dr-andy-agwunobi-uconn-health-ceo/ Feb. 24, 2026: with DSS Commissioner Andrea Barton Reeves: https://healthyrounds.podbean.com/e/medicaid-myths-keeping-ct-families-healthy/ UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information brought to you from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I am your host, Dr. Anthony Alessi, and this week we’re going to chat a little bit about some topics that, some of which we’ve talked about in the past, but now we have new information on, and I think it’s information that we need to provide you, our listeners to provide best healthcare overall, and really pay attention to what’s going on that is publicized and how it affects all of you. And there are three specific topics I want to touch on. The first is pancreatic cancer. I also want to talk a little bit about a exciting study that was just published in The Lancet on Tylenol use in pregnancy, and then we’re going to talk about physician licensing in the United States. So with that, let’s get started. This week at the National Oncology meetings, they presented new data on the treatment of pancreatic cancer. Now, for those of you unfamiliar with pancreatic cancer, it is one of, if not the most deadliest cancer, and the reason being that typically by the time you find evidence for the tumor, it has already metastasized, it is already spread to vital organs. So with that, it’s very difficult to treat. In the studies published, one in particular I want to talk about, they use messenger RNA as the vehicle for treatment. Now, I know I’ve talked about this before, but it bears repeating messenger. RNA is just that, it’s a messenger, and we chatted with Dr. Juthani about this. It does not alter your DNA in any way, shape or form. So the best analogy I could come up with was, it’s a messenger. So if you get a delivery, right, to your house, whether it be from Amazon or GrubHub, a messenger comes and delivers a package, then they leave. That’s exactly how messenger RNA works. So when the messenger comes to your house, they don’t go in your house and start rearranging your furniture, right? And I think that’s the misunderstanding here is they think the messenger RNA goes in the cell and starts mixing things up. That’s not the case. But what it does do, it brings a message that trains your immune system to fight the cancer with your own body. Your own T cells are now redirected to fight the tumor. So in the case of pancreatic cancer, what they do is they go in, a surgeon goes in, removes the tumor. They take the tumor and use material from the tumor to create your own personal vaccine through messenger, RNA, which is injected by infusion. And the cases that were presented, it’s typically eight infusions. And the results have been fairly astounding. Now it’s a small, early study and only 16 people were studied, but eight of those had a positive response. The first patient has actually lived six years beyond the diagnosis, which is astounding for pancreatic cancer. For two people, their tumors actually returned and they worsened, and the other six had no benefit. So it’s interesting to look at this, but we also have to bear in mind that the federal government has stopped all research on Messenger RNA, because the person in charge of Health and Human Services, Bobby Kennedy, he is against messenger, RNA, because it’s a vaccine. Even if it’s a vaccine to kill cancer, he’s against it. So the research being done is being privately funded. Our government has walked away from this, what has become one of the greatest hopes we have in the treatment of cancer, and it just, it makes me personally upset. Because these cancers have affected my family, as many of you who listen to this podcast. So we need to stay on this and really follow this along, and it’s just so hopeful. The next topic is one to revisit, and this is a recent article published in Lancet Obstetrics and Gynecology, where again, there has been misinformation out there regarding the use of acetaminophen, where they are out there saying that during pregnancy, if you use acetaminophen, it increases the risk for autism and other neurodevelopmental conditions. So again, this comes directly from the president of the United States, who says, don’t take acetaminophenm and again, our esteemed director of Health and Human Services, who is a non-physician, non-scientist, Robert F. Kennedy Jr. And I wanna stress the “Junior” because he’s far from his father. But with that, what we have is a situation where they looked at retrospective studies. And they look back at 43 studies, so talk about a waste of time, but here they are. They go back and do a meta-analysis of 43 studies. And once again, when they focused on these studies, they found that there is no evidence that acetaminophen in any way causes ADHD or causes children to be on the autism spectrum. So I’m hoping we could put this aside. The next topic I wanted to touch on was licensure, physician licensure, and what happens is, in the United States, we don’t have national licensure for physicians. Every other country in the world, when you get a license, you could practice anywhere in that country. But in the United States, you have to have an individual license for every state, and it’s pretty costly. Here in Connecticut, I believe it’s now $575 a year we pay for a license. So in every state you, you pay a fee commensurate with that; some states, I know it’s 600, but you have to reapply. And and the reason that this becomes a problem is because there’s a shortage of physicians in many rural areas. So a field of telemedicine has developed, especially for neurology and other specialties, where there aren’t enough people in these rural communities, they can be accessed by video and through telecommunication, something we talk about a lot on this program. So what has happened is that even to do telemedicine in another state, you need a license In that state. That wasn’t the case during COVID. That rule was waived, but now they’re back on it. And it’s really sad, from the standpoint that they are in any way inhibiting physicians who are duly licensed and have credentials that have been presented to a state, from practicing in other states. But here’s what’s happened. So there’s been a push for national licensing, and what they’ve come up with is the Interstate Medical Licensing Compact, and this is the IMLC. This was just approved in March, and it’s basically a system where you can apply with all your credentials, and those credentials can then be shared with other states so that you can more easily get a license in another state. The one thing these states did not give in on was paying those fees in that state. So again, we come up with the problem of greed versus care, and it’s something we talked about with Dr. Andy Agwunobi and the fact that if we’re going to revise our healthcare system in any way, shape, or form, we have to have everybody having their incentives aligned. So the idea of a state saying, “Wait a second. I might be able to get more physicians, give the people of my state more access, should be something I want to do,” without trying to make a few hundred bucks off of a doctor who may only be called on to see one patient or two patients a year in that area in your state. But you want access to those doctors. So again, it’s something we really need to rethink. Apropos to that, commissioner Andrea Barton Reeves and I had a conversation off-mic when she did the podcast with me a few months ago, and that was regarding retired physicians. Many physicians are retiring at a younger age. So when they retire, often they give up the license, they give up their medical license ’cause they don’t want to pay the $575 each year. But many also have the desire to volunteer their time. They’re willing to volunteer to just stay active in medicine without being reimbursed. It’s kind of like paying back the system that supported you all this time. But clearly if you’re going to go volunteer, it’s not worth paying five or $600 so you can volunteer. So I introduced to her the idea that the state of Connecticut may want to consider that if a physician is willing to volunteer in a qualified health facility. And the one we used as an example was the Homeless Hospitality Center in New London, where homeless patients who are discharged from the hospital can come and get some extended care until they’re able to go live independently. So I know of several physicians who would be willing to volunteer and give their time. But again, there’s this hurdle, actually there are two hurdles: One, getting a license, and two, med malpractice insurance. Now, fortunately, when you participate in a federally qu

    15 min

  6. Apr 21

    The Silent Success of Public Health

    It’s impossible to definitively measure how many lives were saved or prolonged, or how much illness or disease prevented or made less severe, as a direct result of public health initiatives. Douglas Brugge, chair of the UConn School of Medicine’s Department of Public Health Sciences, explains the “invisible” benefits of things like policies that regulate toxins in our water or pollution in our air, and discusses how COVID changed the perception of public health (and lessons learned from that). Submit questions for Healthy Rounds: healthyrounds@uchc.edu Douglas Brugge https://health.uconn.edu/public-health-sciences/person/doug-brugge/ UConn School of Medicine Department of Public Health Sciences https://health.uconn.edu/public-health-sciences/ UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome as my guest today. Dr. Doug Brugge, who is professor and chair in the Department of Public Health Sciences here at the University of Connecticut. Doug, I really wanted to have you on the program today to talk a little bit about public health initiatives. You know, it’s been public health initiatives that have provided what are among the greatest contributions to humanity and medical sciences in general. When we think of sanitation, water purification, vaccines, these are all things that make people safe and healthy. And yet I don’t think a lot of people understand and appreciate that these are public health initiatives. Dr. Brugge: Yeah. Thank you for that. And I certainly agree with your introduction to public health. Public health is, I think frequently does not get the attention it deserves because the benefits are more invisible to people. If you have an illness, if you have a heart attack, or you have cancer and you go to a hospital, and you receive treatment, and you get good treatment and it makes you better, that is really tangible. You know that somebody has saved your life or improved your life. If you don’t get cancer or don’t have a heart attack because someone, as you said, regulated toxins in the drinking water, or in my field, the pollution in the air, it’s invisible. You just don’t know that it happens. And so, I think we in public health work in a bit of a obscurity and underrepresented the impact we have now. That said, we have a really nice department here at UConn Health. We’re a very, very vibrant and enthusiastic department within the medical school. We have over 30 faculty. We have over a hundred students in our graduate programs and we represent a very broad range of approaches to research and education, as well as topical foci, in terms of public health, including those you mentioned, but others, substance use, diet, and nutrition, many, many other things as well. And so, I’m proud of the department that I chair. I’m really privileged to sit here and be in this position. Dr. Alessi: Yeah. What’s interesting to me is actually your background and your background was in biology and chemistry. You got a PhD in biology and then went into industrial hygiene. Can you tell us about what pointed you in that direction personally, to go to industrial hygiene? Dr. Brugge: Yeah. From third grade onward, I wanted to be a biologist, basically. And in third grade I thought it was a naturalist, but I didn’t know the difference. But, and I pursued that all the way through college. And at some point in grad school, I began to realize that there were aspects of laboratory science that were not right for me. And the two main ones were one, that it was very far removed from real world impact. You’re doing basic science. Someday, somewhere down the road, someone might use it for good or even not for good. You don’t know. And I wanted to have a more direct impact on the world. The other thing was I found working in a laboratory socially isolating, and I preferred to interact with people. This department is great in that regard. There are all these wonderful people and I’m interacting with them all the time. But, so I had a choice to make. What was I going to do? And I did the degree, it’s a public health degree in industrial hygiene at Harvard School of Public Health in order to shift my emphasis over into public health and do something that was both science, and more directly impacting real world problems. And so that, so it solved a problem for me, and I wish sometimes that I had known about public health in third grade, but no one introduced it to me until much later in my life. So, you know, it’s worked out okay. Dr. Alessi: You mentioned before that, you know, people in public health are relatively anonymous and in the background, but that’s not the case anymore since COVID. Dr. Brugge: Right, yeah. Dr. Alessi: I mean, let’s face it. In the headlines today, right? Canada is going to lose their measles free designation, right? In 1998, they were a hotspot. In 2000, their cases were rare. COVID took away your veil of anonymity. Dr. Brugge: Yeah. Dr. Alessi: And now to the point where there are attacks, there are threats on public health professionals. Can you talk to us what it’s like from the public health side? I know what it’s like from the medical side looking at this, but from the public health side, is there fear? Do people not want to go into public health because of these changes? Dr. Brugge: Those are all very good questions, and probably the basis of several hours of conversation between us, Tony. Dr. Alessi: Absolutely. Dr. Brugge: But anyway, let me see if I can be brief. I agree with you that COVID was an inflection point for public health. Maybe before COVID we were somewhat obscure, but largely, more largely respected. Maybe people didn’t know how polluted the United States was in 1970. Maybe they didn’t appreciate how much public health measures led to clear skies and much better health. Again, to focus on my field of environmental health. But, they weren’t against it. They weren’t angry about it. They weren’t resisting it, I don’t think. COVID was a crisis, and it was a very intense national and global crisis. I remember the early months, it was very hard to tell what was happening, how great the risk was, and what to do. It was a very scary time in my opinion. I remember driving from Hartford to Boston, ’cause my wife and I have a place outside Boston, to hide away for the early month or two of COVID, and thinking how surreal it was that I was running away from this infection that was spreading wildly. So, I think one thing that gets lost in all of this, and some of it is exacerbated by the media and by politics, in my opinion. The media plays up the conflict. That’s what they want because it gets clicks and views. Dr. Alessi: Sure. Dr. Brugge: And politicians play up conflict and accusations in order to get elected and to pursue their agenda. And so, we have this really scary situation that’s exacerbated in the media and the political sphere. And I think it got really, instead of sort of a level-headed public health approach, it became something more than that. And I think public health image was tarnished in the process. Now, I think the biggest problem was the resistance to public health, the pushback, the politicization, the media exaggeration, and drama. But I also think the public health field fell short in communicating well in that context also. And, let me just speak for myself. I’m not speaking for anyone else. Dr. Alessi: Sure. Dr. Brugge: But, I do community-based participatory research where we bring the community in and we have them as partners in our research process. And what I think I’ve learned from that is that if you engage people, and you talk to them, and you respect where they’re coming from, and even if they disagree with you or they have misconceptions, you work with them over time, you can form a good relationship and mutual respect. And maybe it’s partly just things were happening at a national level and really fast, but I feel like public health failed to reach out and engage people who were scared, and then felt that they were being commanded to do things that they either didn’t understand or that they doubted were effective. And so I think that it’s the lesser of the evils, but I think public health could learn something from this experience and hopefully do better in the future if there, hopefully there isn’t another one of these, but if there is, I would hope we’d learn some lessons from the past experience. Dr. Alessi: You know, unfortunately, Doug, I think people don’t realize that as we’re kind of going through this process, people are dying. I mean, right now, I was reading where there are over a thousand state bills in this country addressing public health. Over 400 of them are designed to weaken our protections on vaccines. Right, fluoride, milk safety. Okay. Dr. Brugge: Yeah. Dr. Alessi: I mean, I think a lot of people are confusing ideology and science. And, how do we get past that? I know you’re talking about communication, but as we’re communicating and trying to reach out to these people, people are losing their lives. Dr. Brugge: You’re absolutely correct. And we should be pursuing evidence-based public health measures that are protective and that save lives or improve the quality of life, absolutely. I th

    17 min

  7. Apr 14 ·  Bonus

    Bonus Episode: Quality, Patient Safety

    This week we revisit the conversation with Dr. Scott Allen, UConn Health’s chief medical officer. Dr. Alessi digs deeper into what we mean by the terms “quality” and “patient safety,” exploring the patient experience as well as how to measure quality and how the increasing complexity of medicine makes safety such a priority. He also differentiates between internists and family medicine practitioners. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Scott Allen: https://facultydirectory.uchc.edu/profile?profileId=Allen-Scott  UConn Today: Make It 10 Straight A’s for UConn Health’s Hospital Safety https://today.uconn.edu/2025/11/make-it-10-straight-as-for-uconn-healths-hospital-safety/  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you to really dig deep into some of the topics we discussed last week with Dr. Scott Allen. As you’ll recall, Dr. Allen is the chief medical officer here at UConn Health. He is an internist and specializes in primary care internal medicine, and was he went over his personal history, we can see that he’s always had a passion for improving the quality of medical care, and it has really evolved as, that’s almost as a subspecialty of medicine has evolved. But what was also interesting, and I wanted to clear up some things, is that he is a specialist in primary care internal medicine, and that differs from primary care family physicians. There’s different training involved. So family physicians are primarily people who do general medical care, but includes things like obstetrics and gynecology, different subspecialties may be doing some minor surgeries and other areas, so it’s a more broad field and it’s truly family medicine because they also treat children, so they treat the entire family. And it came about really in people in rural communities as well as now we see more and more this has developed to folks in bigger cities as well, where it’s hard to get access to care. So there’s a difference between primary care family medicine and primary care internal medicine, whereas internists treat adults only, and also a broad range of treatments for those adults. And among the things he talked about and that I really got out of this was the approach to quality of care and patient safety. These are things that I wasn’t familiar with in terms of how they relate to the patient. And as you’ll recall, he talked about the first of the three phases being the patient experience, followed by the quality of care and followed by safety. As he explained it, for patients who come to receive medical care, they want to be treated well; they want high quality care, so they want to get better; and more importantly, they don’t want to be hurt. So let’s talk about the patient experience itself. That’s a lot to do with actual having contact with the patient, that initial contact. And there are a lot of things that I’ve learned over the years that help that contact. So even today when I see a patient, I’m asking things like, “Who sent you here?” “What do you like to do?” try to make things conversational. At the same time. I’m trying to identify the patient, speaking to the checklist that we talked about with Dr. Allen. Things like what side is being affected, right versus left, instead of asking again for their date of birth. Now people ask the date of birth a lot ‘cause that’s a big identifier, but I’ll ask the patient’s age. I’ll try to make this part of a conversation. But by the same token, I’m trying to improve their experience as well as identify the proper patient and why we’re there. One other trick I learned, and it’s not really a trick, it’s actually something that speaks quite well to being in contact with patients, is when I would make rounds with patients and go into their room, often you have all these doctors standing around the bedside, right? So when, when I was the attending, I would primarily be the lead physician. I’ll have residents with me in the whole group. I always made a point of sitting down, whether the patient was in a chair or in bed. I wanted to sit down somewhere so that it wasn’t always this feeling of I’m looking down at them. It also gives the impression that I’m spending more time. I spent enough time to sit down and ask my questions rather than having it seem like I’m on the run, getting ready to get out of this room and get going. So there are those things that affect the patient experience. When it comes to quality of care, there are a lot of different measures, right? We measure outcomes, frequency of infection rate, how often does a patient have to be readmitted after being discharged from the hospital? So those are the quality issues, but safety is another issue. And we talked somewhat about why is safety more of a problem now than it was in the past. And I think from my standpoint, it’s clear that medicine has become much more complex. It’s really like the difference between flying a small aircraft and flying some huge jet liner. So there are a lot of things that can go wrong and it’s important to stay on top of those. And that’s where we got into the checklist and that’s why I used the flight analogy, because you always have these checklists. Now obviously when you’re on a huge jet, the checklist becomes much longer. As opposed to flying a small two-seater plane, and I think that’s what has happened now in terms of the evolution of medicine and its complexity with regard to computers and so many other things that are going on with the patient at the time care is being delivered. One of the things I wanted to mention, we have a grant to do these podcasts from a company called Coverys.  Coverys is an insurance company that provides medical malpractice insurance to physicians, and they’ve been my insurer for many years. What’s interesting is that, you think that, well, it’s insurance, they get the lawyer, and now you go through a process. But at Coverys, they spend a lot of time trying to improve quality by continuing medical education and requiring that continued medical education of the physicians, physician assistants, nurse practitioners who are all their insureds. And some of the courses they take are so important and I’ve learned a great deal from them over the years. So we really appreciate having them on board to support this podcast as we move forward. With that, I want to thank again Dr. Allen for his time that he spent with us. It was really enlightening overall. Next week we’re going to be chatting with Dr. Douglas Brugge. Dr. Brugge professor and chair of the Department of Public Health Sciences here at the University of Connecticut, and we spent a lot of time talking about public health initiatives and the effects that these folks out there who are against science have now really impacted public health, and it’s something we all need to be mindful of. If you have any questions or ideas for future programs, you can reach out to me at Healthy rounds@uchc.edu. Jennifer Walker is the executive producer for Healthy Rounds. Chris DeFrancesco is our studio producer for the Healthy Rounds Podcast, and Tessa Rickert is in charge of our social media. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

    10 min

  8. Apr 7

    Inquiring About Quality and Patient Safety

    We hear a lot in health care about patient safety and quality. While those terms would seem like a given, when it comes to patient care, they in fact are very strategic and measured. As Dr. Scott Allen, UConn Health’s chief medical officer, explains, much has to do with acknowledging the possibility of human error and how to mitigate its impacts, with practices such as daily safety huddles, checklists, empowerment to “stop the line,” and even use of artificial intelligence that can lead to an earlier diagnosis or assist with documentation in real time and enable physicians to focus more on the patient. It’s part of why UConn John Dempsey Hospital is in the running for an 11th consecutive “A” grade from Leapfrog for patient safety. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Scott Allen: https://facultydirectory.uchc.edu/profile?profileId=Allen-Scott  UConn Today: Make It 10 Straight A’s for UConn Health’s Hospital Safety https://today.uconn.edu/2025/11/make-it-10-straight-as-for-uconn-healths-hospital-safety/  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date and timely information that’s brought to you by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coverys. This podcast is not designed to direct your own personal medical care, and that should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to have as my guest today, Dr. Scott Allen. Dr. Allen is the Chief Medical Officer for the University of Connecticut here at UConn Health. He’s also a specialist in internal medicine and specifically in primary care internal medicine. Scott, welcome to the show. Dr. Allen: Thank you for having me. Dr. Alessi: Scott, can you tell our listeners a little bit about your background and how you got here? Dr. Allen: I’m a general internist by training. I actually trained at the University of Massachusetts Medical Center, came down here in 1994, mainly as a medical educator, also functioning as a primary care physician. And over time, I took on responsibilities within residency programs, became a residency program director for eight years, and then really had the opportunity about 15 years ago to kind of morph into the quality world. Became a medical director for our quality department when it was first initiated, and then became the first chief quality officer, now as first chief medical officer. Dr. Alessi: Now, we hear a lot of these terms as physicians here in practice. We hear about quality, we hear about risk management, we hear about patient safety. Can you address those terms and what they all mean to us? Especially patient safety. I find that to be an odd term, right? Because it gives the impression - do you mean it’s not safe? So, can you talk a little bit about those programs and those terms and what they mean to the public as well as physicians? Dr. Allen: So, when patients come to see a physician or a practitioner or come to the hospital, they really are looking for three things. First, “be nice to me”, which really is the patient experience piece of health care. Dr. Alessi: Sure. Dr. Allen:, The second is “heal me”. Maintain my health or restore my health. And that’s really the quality component of health care. And then the last is, “don’t harm me in that process”. So that’s really sort of the patient’s safety. So, all three are really connected to one another. So, the safety piece is really keeping people from harm. And so designing systems of care to allow that. Health care is a very complicated world. It’s high risk. And so, as humans, we’re always subject to making human mistakes, errors. And so, part of our job is to create systems that reduce making those human errors. Dr. Alessi: Very interesting because back about 26 years ago, as I went back and got a master’s degree in medical management, and one of the things that struck me was much of what we were studying were industrial engineering principles, and back then it was all about Toyota and their industrial engineering and how we could take that and apply it to medicine. And it was funny ’cause my father was an industrial engineer. And I never had any idea what he did until I went back to school. Can you talk a little bit about that movement of taking industrial engineering principles and how they kind of cover medical care? Dr. Allen: So, the Toyota model was the ability to quote unquote, “stop the line.” So, anybody on the production line could basically, in essence, push a button and stop production any time they had a concern. And that empowered those individuals to be invested in the quality and, if you will, the safety of their product. Carry forward to health care. We now empower everybody to be able to voice their concern. So, if you have a concern about somebody’s safety or quality, you should be able to quote unquote, “stop the line” and be able to say, “I have a concern.” People stop, listen and address those concerns. So, what we’ve learned from Toyota is that empowerment piece to allow people to raise their voices of concern. Dr. Alessi: Now, that works pretty well, I guess, in the operating room, right? Because now it’s pretty standard. We take a timeout and make sure everybody knows what we’re doing. But how does that work in clinic? I mean, how do you take that and apply it to something that’s so scattered? Is that what the huddle is for and things like that? Can you explain that to me? Dr. Allen: So, the timeout for those that are listening is when you go in the operating room, there’s a formal checklist that we will go down. You know, we’re doing the right procedure, the right side of the body, if you will. All those things, all the equipment is ready. And that’s the checklist. And that’s just making sure that we are in fact prepared to do what we’re supposed to be doing. And so, what we’ve learned from, in this case, the airline industry, when the pilot goes into the cockpit, every single time they go down the checklist. Whether they just flew the plane and they knew it was flying safely, they’re going to go through the checklist. And so, it’s the same mentality now in health care. We go down those checklists because we have to make sure everything is correct, every single time. So, no matter what’s really going on, you actually go through that checklist. That’s in sort of an OR, very sort of structured environment. In a clinic where it’s unstructured, it’s one of those sort of behaviors, safety behaviors that we promote called attention to detail. And it’s really stopping and taking that sort of mini mental timeout. So if I’m in the medical record and I can actually have four charts open, four different patients, and I’m going to put an order in, I have to sort of take that mini mental timeout to say, “am I in the right patient’s chart?” before I hit that send button. So, teaching people to take that, what we call STAR moment: stop, think, act, review. Mini mental timeout, and so that we’re not rushing. We’re all very busy in medicine, but it’s when we rush is when we create those errors. Dr. Alessi: Is that the biggest fault? I mean, is it the rushing, like we’re trying like in the OR was it always “let’s rush ’cause we gotta turn over the room” and things such as that? Is that what we’ve found to be the biggest harm? Dr. Allen: Rushing certainly contributes. And that’s why we actually promote not doing the rushing and actually taking the timeout so that again, we’re prepared every single time that we go in. And so, we do have to sort of take that sort of momentary stop, that pause if you will, so that we are not rushing, and we’re keeping patients safe. Dr. Alessi: Have we applied checklists? I mean, we talked a little bit before this interview about The Checklist Manifesto and Atul Gawande’s efforts in that regard. Do we use checklists in other areas of medicine other than the OR now? Dr. Allen: So anytime patients, let’s say, get admitted to the hospital, there will be checklists that nurses go through in terms of their initial assessment. You do a history and a physical on the part of the practitioners, there are certain elements of that template, if you will. So, there’s a lot of elements of those checklists. We build templates into our electronic medical records so that we don’t forget to add a certain element, if you will. There are questionnaires that have, again, a checklist of items. You go in to have an MRI, that MRI tech is going to ask you a series of questions, probably 15 to 20, and they’re going to go through that checklist every single time to make sure that in this case, you don’t have, let’s say, a ferro metallic object that could be a risk for you when you go into the MRI. Dr. Alessi: How about, let’s talk a little bit about, and you know, now that I’m removed and only in the clinic, I remember we used to have morning huddles, right? Is that still a practice? Dr. Allen: Absolutely. Dr. Alessi: Yeah, can you explain that to our listeners what the morning huddle is? Dr. Allen: Yep. So, we have actually two huddles in the hospital. The first one, we do every morning at 8:30, and it’s about 100, 120 actual middle level, middle management, if you will, folks that are joining that, including senior leadership from the hospital. And we go through the previous 24 hours, all the new safety events that were submitted within our electronic system. A brief review. We will spend time if we feel

    19 min
See All (21)

Ratings & Reviews

5
out of 5
5 Ratings

About

Healthy Rounds covers a range of topics, including new medical technologies and treatments, research, disease prevention, hosted by Dr. Anthony Alessi, UConn Health neurologist and clinical professor of neurology and orthopedics in the UConn School of Medicine.

Information

You Might Also Like