SYSTEMnews -- September 2013 by Penn Medicine

Volume 13

Issue 1

September 2013

SYSTEMnews

`` Joey Bellettiere underwent regular stress tests to measure his heart’s increasing strength as the LVAD speed was reduced. Outpatient coordinator Judy Marble turned down his VAD to the minimal possible support and monitored him for any symptoms of heart failure.

CEO’s corner Ralph W. Muller

CEO, University of Pennsylvania Health System

The last few decades have seen many exciting innovations in health care — and Penn Medicine has regularly been at the forefront of these advances. The latest area we’ve made an innovation priority is personalized medicine. Here we use technology to pinpoint the actual molecular makeup of patients. That’s right; we can develop fine-grained portraits of the very genes and proteins that make up our bodies — one person at a time. Then, armed with these remarkable data, we can customize health care decisions to fit the needs of each individual. This includes identifying patients at risk for certain diseases (so prevention plans can be introduced) and matching identified gene variations with particular medications to ensure that patients get the right drug at the right dose. Custom-made medicine is fast becoming a reality. As you might imagine, such a high level of finetuning calls for sophisticated tools and procedures. Individualized data, decision-support software to help guide physicians, and fully integrated electronic health records are all necessary to make the most of personalized medicine. At Penn Medicine we’re moving forward with three major projects that, taken together, will constitute a major step forward in our goal of achieving genuinely personalized medicine. First, we’re working on two new data analysis programs. “Pennomics” takes all of the raw data we have on patients (for example, a patient’s bloodwork, radiology results, and electronic medical record) and converts them into useful knowledge — allowing physicians to tailor their care decisions to meet the precise needs of each patient. We might use the system to determine that a given patient could respond poorly to a specific blood pressure medication or blood thinner. We can also use the Pennomics platform to analyze populations of patients, such as those with mutations of the BRCA genes that raise the risk of breast cancer. A second tool, the Endeca platform from Oracle, was recently purchased to help us search all of the text in our electronic medical records, even the

Rest  Recovery  Reconditioning The Three R’s of Returning to a Healthy Heart Soon after Joey Bellettiere was born with an enlarged heart, he was brought to CHOP for treatment. Although the newborn was stabilized, his parents were told he might eventually need a heart transplant. This prediction almost came to fruition when, at 19, he started having significant breathing problems that he had never before experienced. Within six months, Bellettiere was at HUP, learning that the left ventricular assist device (LVAD) he needed to survive was being studied as a possible bridge to recovery. Was he interested in participating in this trial? “It was a no brainer.” An LVAD acts as a crutch for a failing heart, helping to pump blood through the body. The LVAD pump and its connections are implanted during open-heart surgery. A computer controller, a power pack, and a reserve power pack remain outside the body. Originally used as a bridge to transplant — ie, keeping patients alive until they were matched with a donor heart — it has also been a ‘destination therapy.’ In these patients, the device is left in place permanently in lieu of a heart transplant. Most recently, the LVAD has been tested as a bridge to recovery, allowing the heart to rest and, hopefully, regain enough strength to beat on its own again. Bellettiere received the LVAD in October 2009. Little by little, the device did less of the work as his heart took over more of the pumping process. By March 2011, his heart

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Inside Clinical Excellence:Inside More than Do You Havetoan Rubenstein Award-Winning Project?...........2 Step Down.................................2 Penn Medicine@Work..............3 From Pastels to PDA’s...............2 Newsmakers..............................4 RoundtableFree Skin Penn’s Medical School Cancer Screening......................3 Camp a Hit with High School Students.....................................5 Shortakes...................................4 26 Penn Medicine Practices Earn Another Title..............................5 Highest National Recognition for Patient-Centered Care............... 5 SOM Ranked #2.........................6 Medical Student Initiative is Catalyst for Asylum Seekers....5 Awards and Accolades.............6

`` Reprinted with the permission of Thoratec Corporation

Skills & Knowledge...................2

was deemed strong enough to remove the device. Today “I feel better than ever,” he said. “I can walk, I can run, without getting out of breath.”

From Implant to Explant: What’s Involved In patients with heart failure, the heart enlarges as an adaptive response to injury. This allows it to keep pumping enough blood through the body, at least temporarily. As Eduardo Rame, MD, medical director of Mechanical Circulatory Support, explained, a normal heart regularly ejects — or pumps — about half of its 40-milliliter volume. Because a damaged heart might pump only 10 percent of its volume, it could enlarge to 200 ml to continue this ejection pace. However, it’s not sustainable. “The heart requires a tremendous amount of energy per day — more than any other organ — to circulate that much blood,” Rame said. “It simply can’t continue doing that much work at that size.” With an LVAD augmenting the blood flow, a patient’s heart can rest and begin the slow process of reverse remodeling, ie, shrinking back to its normal size. Prior to implant, the patient’s heart failure medications are maximized to further help the reversal process. “The LVAD may be a platform that allows them to better tolerate these meds,” Rame said. Routine echocardiograms chart the heart’s changes while the speed of the LVAD is slowly decreased. Echos are the primary imaging modality because they can be done repeatedly with no damage to internal organs. MRIs cannot be used on patients with these implanted devices. The echocardiogram provides detailed information during the turndown, including the heart’s size and function level, how the right ventricle handles the increased blood flow, and a measure of the flow through the aortic valve. According to James Kirkpatrick, MD, of Cardiovascular Medicine, “The LVAD bypasses the aortic valve, but if the heart starts to function as it should, more of the blood starts going out the aortic valve, rather than through the LVAD.” The echo also shows any leakage of the mitral valve, which would occur if the blood went backwards into the left atrium. Most important, if a patient does start to experience symptoms during the turndown, “the echo will tell us why,” Kirkpatrick said. (continued on page 2)

Clinical Excellence: More than Skills & Knowledge Doctor and The Doll, the classic Norman Rockwell painting that graced the cover of The Saturday Evening Post in 1929, harkens back to a simpler time, when the kindly family doctor was always available and willing to take care of any ‘patient,’ human or otherwise. The increasing complexity of medicine has changed that scenario. To be sure, advances in medicine have significantly benefitted patients, with more accurate diagnoses and more successful treatments. But it’s come at a cost: depersonalized care. Indeed, while superior clinical knowledge and skills are essential, clinical excellence comprises much more. Like compassion. And integrity. And open lines of communication, not only with patients and their families but also with colleagues at all levels. The Academy of Master Clinicians, a new program at Penn Medicine, will help ensure that qualities such as these extend throughout the Health System as well as into the practices of future physicians. “Clinical excellence in and of itself is a value that Penn Medicine recognizes and wishes to promote,” said John Glick, MD, president, Abramson Family Cancer Research Institute, vice president, UPHS, and associate dean for Resource Development, who helped create the Master Clinician program. “What we do for our patients is of critical importance to our missions of research, clinical care and education.” Recognizing clinical excellence is not new at Penn. Since the late 1990s, the IS Ravdin Award of Clinical Excellence has recognized Penn physicians “who epitomized all roles of the outstanding clinician. Someone to whom physicians would send a member of their own family. A doctor’s doctor.” The award was named for the surgeon who came to symbolize clinical medicine at Penn. The Academy of Master Clinicians has expanded that concept, not only recognizing this level of physicians but having them “work as a group to promote clinical excellence throughout the Health System.” According to Glick, Master Clinicians will

lead faculty workshops through Advance, the Perelman School of Medicine’s faculty professional development program, as well as other Penn Medicine educational programs. They will also provide feedback to leadership to improve the patient and educational experiences and serve as role models and mentors. In addition, by attending extramural courses, Master Clinicians will enhance their own career skills and bring new knowledge to Penn Medicine. All those elected to the Academy will receive a one-time financial award of $10,000 and more time to dedicate to educational and training pursuits.

Do You Know a Master Clinician? Candidates for the Academy — the highest clinical honor bestowed on a Penn physician — will need to possess:  Exceptional clinical skills and knowledge in their field.  Excellent judgment, integrity, and exemplary interpersonal and communication skills, treating all patients equally, acting as a patient advocate, and demonstrating compassion and empathy toward patients.  Qualities of an outstanding educator, role model and mentor who exemplifies the highest levels of professionalism. Glick stressed that any Penn Medicine employee can nominate a Penn physician for this honor. Any clinician with at least six years of active practice at a Penn Medicine entity (HUP, Penn Presbyterian Medical Center, Pennsylvania Hospital, and Clinical Care Associates) as well as those at CHOP and the Veteran’s Administration are eligible. Department chairs are not eligible. The inaugural group of Master Clinicians will be announced later this year. Every year, a new class will be selected. To learn more about the nominating process, go to www.med.upenn.edu/AOMC. Completed nomination packets should be sent electronically to Victoria Mulhern, executive director, Faculty Affairs & Professional Development at vmulhern@ exchange.upenn.edu. The deadline for nominations is October 1, 2013.

Do You Have An Award-Winning Project? Each year, the UPHS Quality and Patient Safety Awards recognize departments throughout the Health System that have exhibited leadership and innovation in activities that ensure high quality clinical outcomes, patient satisfaction, patient safety, and cost efficiency. Applications for the 2013 Awards will be accepted through September 30. For more information about the awards and the application process, go to http://uphsxnet.uphs.upenn.edu/ceqi and click on“2013 Quality and Patient Safety Awards.”

Rest  Recovery  Reconditioning Eventually, if the patient continues to tolerate the turndowns, the LVAD’s speed is down to a point where the patient is getting very little support from the device. If all gathered data — including the echos and stress tests — show evidence the heart has recovered, the LVAD will be explanted (removed). While no surgical procedure is without risks, removing the LVAD is a fairly simple procedure, said Y. Joseph Woo, MD, director of Penn’s Cardiac Transplantation and Mechanical Circulatory Support Program. The LVAD is removed from the heart and the holes in the heart where the LVAD was connected are repaired. “The entire procedure takes about two hours.” “The sooner the heart starts to get better, the more successful the patient will be long term, ” Rame said, adding that if a patient’s heart has not recovered within six to nine months of implanting the LVAD, “this strategy is not working.”

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In addition, the next generation of these devices “will be smaller and more efficient,” Woo said. While today’s VADs are still powered by a cable through the skin, “in the future, we may be able to implement a new way of charging the device, much like cell phone charger pads.” So far, Penn’s bridge-to-recovery team has explanted five patients, including Bellettieri, and continues to monitor them closely. “Our longtime goal,” Rame said, “is to give our patients a survival free from heart failure and from mechanical assist device.” `` Regular echocardiograms, such as the one performed by Lise Fishman, RDCS, technical director/manager of the Echo Lab, provided detailed information during the tunrdown, including the heart’s size and function level and a measure of the flow through the aorti valve.

Studies in Europe, where the bridge-to-recovery strategy has been used for years, show that, when the LVAD is removed, well over 90 percent of patients have had no recurrence of heart failure for more than two years — and others have gone well beyond five years. Rame said that younger patients with a short duration of heart failure have the greatest chance of recovery. “We don’t know if a patient’s heart will continue to work on its own or might eventually still need a transplant or even another LVAD. But postponing a transplant for years in someone young is a significant benefit,” said Judy Marble, BSN, outpatient coordinator in the Mechanical Assist Device Program. Rame agreed. “The longer you can put off a transplant, the better. In the majority of cases, patients who receive one at an early age will probably need another during their lifetime.”

The Future is Open Cardiac-assist technology for heart failure has progressed enormously in the last several years and will continue to do so. As the number of patients who need a transplant continues to outnumber available donor hearts, devices such as the LVAD – and other approaches using the LVAD – continue to be vital to saving these patients. Woo is part of a multi-site trial in which patients receive stem cells when the LVAD is implanted “to help regenerate the heart along with the device.” Rame said other experimental therapies at Penn are examining the use of gene therapy to replete factors in the heart “that we believe and know to be deficient.”

Restage Heart Failure Trial The Restage Heart Failure Trial is designed for Class 4 non-ischemic heart failure patients with a diagnoses for less than five years. As part of the trial, a Heart Mate II LVAD is implanted and all medical therapies maximized to see if the heart will recover. A series of LVAD turndowns would then test the heart for recovery. The VAD would be explanted if the heart demonstrated sufficient recovery. For more information call Judy Marble, nurse coordinator, at 215.662.2802.

Penn Medicine Practices Earn Highest National Recognition for Patient-Centered Care

Twenty-six practices in the Health System has been designated with level III certification for their efforts to provide coordinated, efficient care through the Physician Practice Connections — Patient Centered Medical Home program (PPC — PCMH) run by the National Committee for Quality Assurance (NCQA). These 20 Clinical Care Associates (CCA) locations and six Clinical Practices of the University of Pennsylvania (CPUP) have now received the highest designation granted by the NCQA.

`` As part of the Perelman School of Medicine’s Medical School camp, high school students tried their hand at minimally invasive surgery, moving blocks onto pegs with grasper tools while watching the live camera image on the screen. Performing this laparoscopic ‘procedure’ becomes even more difficult if someone is timing you!

Penn’s Medical School Camp a Hit with High School Students If you recently heard a bunch of high school students scream at the top of their lungs “Don’t kill the patient!” at the Penn Medicine Clinical Simulation Center at Rittenhouse, relax. Everyone is alive and well — it was just “Laparoscopic Olympics,” one of the many activities from the Perelman School of Medicine’s first ever Medical School camp designed to teach high school students what’s it like to be a doctor. The friendly competition helped these 55 medical hopefuls practice their minimally invasive surgery (laparoscopy) skills, in the same space where residents perfect their surgical techniques with simulations before working with patients. The screaming was to distract and give them a dose of what’s it like to be in a stressful surgery room. The task? Move little rubber, hollow blocks onto pegs with the grasper tools (which look like a pair of scissors with very tiny tips). But do it by relying on a live camera image being projected onto a screen in front of you.

“For the last three years, our CCA practices worked on redesigning their office processes to focus on being as patient-centered as possible,” said Charles Orellana, MD, senior medical director of CCA. “This means providing comprehensive, well-coordinated care in a team-based fashion. Practices worked hard at assuring easy, same-day access for patients, better coordinating care, more fully engaging their patients, and leveraging information technology to monitor and improve the quality of care provided.” Orellana credits providers, staff, and practices for their effort to modernize primary care and notes that increasing the number of level III PCMH practices is a vital step forward in health-care reform. In this model, clinician-led “medical home” teams deliver patient care and coordinate treatment across the health-care system. The medical home clinicians at these Penn Medicine practices exhibit the “benchmarks of patient-centered care, including open scheduling, expanded hours, and appropriate use of proven health information systems,” according to the NCQA. In addition to improving the patient experience, this program helps avoid unneeded hospitalizations and emergency room visits, which can save money for payers, purchasers and patients. For a complete list of our CCA and CPUP practices that have received this designation, go to http://news.pennmedicine.org/inside/system-news/. `` Leaders from the recognized practices include ( l to r) Beth O’Reilley, Phyllis Hennessey, Betty Sheller, Dawn Tice, Jennifer James, Betty Anne Knowles, Jill Esrey, and Tim McInnes.

“This is our next group of surgeons and dentists and radiologists and nurses and internists,” said Gregg Lipschik, MD, manager of the program and co-director of the Sim Center. “They should see what it’s like, and I think if we make it challenging and enjoyable, they’ll really get something out of it.” It’s not all screaming and competition, though. In the four-week program over the summer, students from around the globe — from New Jersey to Venezuela — were guided and taught by faculty and staff and given a taste of the world of medicine as they explore career possibilities, with lectures and lab exercises.

Medical Student Initiative is Catalyst for Asylum Seekers “Physicians are good at looking at a scar and seeing if it looks like a knife wound or a bullet wound,” said Elizabeth Nelson, the clinic’s Operations Director. “They might ask, does this person’s emotional state reflect post-traumatic stress disorder? Courts recognize the expertise of physicians to make that call.” The seven-person staff, all first-year School of Medicine students, is led by Nelson and Adeline Goss. Anthony Rostain, MD, of Psychiatry and Pediatrics, and Alisa R. Gutman, MD, PhD, a fourth year Psychiatry resident at HUP, serve as advisors. The group turned to PHR to conduct a training for medical students and physicians. Based out of Boston, PHR trains physicians to document the effects of torture and persecution on one’s body and psychological state. These clinical evaluations can make the difference `` Members of the Penn Human Rights Clinic include (l. to r.) Leah Seifu, Anastasia Vishnevetsky, Jillian Olsen, Alisa Gutman, Elizabeth Nelson, Brett Dietz, Jenna Peart, Addie between rejection and approval of the asylum application. Indeed, Goss, and Helen Reed the organization estimates that 90% of those examined are granted Imagine being forced to leave your country due to racial, religious, or asylum compared to a success rate of only 29% for all seekers overall. political persecution, fearing for your life and the lives of your loved While the examination is critical, it’s not always available in this ones. This reality sends tens of thousands of people to the United region. It is this need that led Leah Seifu, a first-year student at the States each year in hopes of a safe new home. Unlike refugees, who arrive in the United States after receiving legal status, those applying School of Medicine and PHRC Funding Coordinator, to apply for the CAREs grant. With support from CAREs and the Penn Center for for asylum may have no legal standing until receiving approval. Public Health Initiatives, the group recently hosted a free, six-hour Now, with support from a Penn Medicine CAREs grant, a small PHR training session on campus to train more Penn physicians to group of Perelman School of Medicine students is expanding complete medical evaluations, write an affidavit, and, if necessary, The Penn Human Rights Clinic (PHRC). This new organization testify in immigration court. focuses on one critical but often unavailable part of the U.S. asylum Since the clinic was founded late last year, four physicians have application: the medical evaluation. performed evaluations, and 19 students have been trained to PHRC partners with Physicians for Human Rights (PHR) to provide document physical and psychological signs of persecution and write psychiatric and physical evaluations of those applying for asylum. legal affidavits. Most recently, on June 15, the clinic partnered with Each evaluation is conducted by a physician accompanied by a Physicians for Human Rights to train 13 new Philadelphia-based medical student, who work together to complete a medical-legal physician and psychologist volunteers. affidavit for their client’s court case. “Many of us came to this field with the intention of dedicating our The physician evaluations are not clinical diagnoses, but rather a lives to caring for other people and making positive changes in other forensic investigation presented objectively as evidence supporting people’s lives,” Goss said. “This affords us the opportunity to interact an asylum seeker’s case. in a meaningful, impactful way.”

Newest Penn Medicine CAREs Grant Winners Congratulations to the next round of winners of a Penn Medicine CAREs grant:  Jamie Shuda Perelman School of Medicine Penn Academy for Reproductive Services  Kara Cohen Home Care and Health Services Best Foot Forward  Chiamaka Onwuzurike Perelman School of Medicine PCPC Women’s Refugee Health Clinic  Mawusi Arnett Perelman School of Medicine West Philadelphia Wellness Empowerment  Ellen McPartland Pennsylvania Hospital Stroke Education Prevention

penn medicine

work

`` Tisch Farley and her daughter, Kate, motivated each other to complete their bachelor’s degrees.

For both Tisch and Kate, the experience of working at Penn Medicine and going to school together has been both enjoyable and mutually beneficial. “She’s motivating me to finally finish, and I get to do the same for her,” said Kate. “We’re each other’s boosters!” Tisch added, smiling at Kate.

Getting a Degree A Family Affair

For most people with full-time jobs, there is no “right time” to go back to school. However, finding a program that fits both your lifestyle and career aspirations makes the transition that much easier. Tisch Farley quickly began to realize this after speaking with co-workers who were enrolled in Immaculata University’s Health-Care Management, bachelor’s degree completion program, offered on-site through Penn Medicine Academy. Tisch, an executive administrative assistant in Head and Neck Surgery, was originally enrolled in a liberal arts undergraduate program at the University. After learning from her co-workers about what the curriculum of the Health-Care Management degree had to offer, Tisch decided to seize the opportunity to learn more about the innerworkings of Penn Medicine and develop her skills around patient advocacy, which had always been her passion. Across the street from her office at HUP, Tisch’s daughter, Kate Farley, was working as a patient service representative in the Penn Lung Center at the Perelman Center for Advanced Medicine. Kate had also been accumulating credits, at Temple University, with the intention of completing her bachelor’s degree in psychology, but never quite finished. Knowing that both she and her daughter were eager to earn their degrees, Tisch offered her daughter a proposition: let’s enroll in Immaculata’s on-site degree program together!

Through the on-site courses they have already completed, Tisch and Kate agree that Health-Care Management was the right program to leverage both their current experience and potential mobility within Penn Medicine. “As a Health System employee, we bring a unique perspective to both classmates and teachers. In turn, we get to apply what we are learning in class to everyday life,” Kate said. Another incentive to enrolling in Immaculata’s on-site courses is the cohort-based program, which focuses on building interpersonal skills; acquiring knowledge of health-care regulatory guidelines; and developing research that affects health-care policies, and allows participants to complete degree requirements in an accelerated time. It is structured so students only attend class one night a week each semester with the same group of people. Both Kate and Tisch are expected to receive their bachelor’s degrees next June. What’s next? Both are considering the path of higher education: Kate is interested in learning more about health-care law and Tisch is hopeful to pursue more knowledge around patient advocacy. Penn Medicine Academy collaborates with the University of Pennsylvania, Community College of Philadelphia, Drexel University Online, LaSalle University, and Immaculata University to provide a variety of certificate and degree-completion offerings to Penn Medicine employees. Many of these courses are offered on-site across Penn Medicine. For more information about the On-Site Degree Programs offered through Penn Medicine Academy, please contact Kerry Nihill at 267.414.2838 or kerry.nihill@uphs.upenn.edu .

Earn Your $150 Healthy Rewards Credit & Join NEW Challenges! UPHS’ Wellfocused “Healthy Rewards” is an online program that makes it easier for you to manage your health and well-being and receive rewards. Healthy Rewards lets you create a personal profile, set health goals, complete an online Well-Being Assessment, and take healthy actions. For each activity or action you complete, you earn points that you can redeem for rewards. You can earn a $150 lump-sum payment by » Completing the Well-Being Assessment. » Knowing Your Numbers — Get health screenings that include blood glucose, cholesterol, blood pressure, and BMI. » Participating in healthy actions and challenges — The Healthy Rewards site has challenges for everyone. (Please note: You must complete the Well-Being Assessment and the Know Your Numbers tasks to be eligible for your $150 credit).

NEW Challenges on the Healthy Rewards Site  Sweat for 30 Find a physical activity you enjoy and do it for 30 minutes or more per day on most days of the week at a moderate intensity. You can earn 25 Wellfocused points per week for participating in this challenge.  Penn Medicine Community Events Choose a UPHS Community event to participate in and earn 100 points after you’ve completed the event. Some upcoming events include Penn’s 5K for The IOA & The Memory Mile Walk on Sunday, September 22 and Bike MS City to Shore, Saturday and Sunday September 28 and 29.

For more information on these, and other events, visit www. uphshrandyou.com and click the Wellfocused tab at the top of the page, then click on the link for the ‘Latest and Greatest Health and Wellness News’ in the left column.  Balance the Scales Make healthier food choices and take time to be physically active! Track at least 24 days of balanced living from now until the end of September and earn 200 points!  Have a Bucket List? Check at least 3 things off your bucket list—and earn 100 points!

More new challenges are available to you in the Healthy Rewards site! Visit www.uphshrandyou.com and click ‘Healthy Rewards’ to sign in today. Improve your health and well being, earn points—and maybe even winning prizes—along the way. Quarterly raffle prizes will be awarded for those participating in the Healthy Rewards challenges.

Take Credit for What You Know Each year, all employees are required to complete the Annual Mandatory Education (AME) training in Knowledge Link. Previously, employees were presented with individual courses for Fire and Electrical Safety, the Hazard Communication Program, Security Management, Emergency Management and General Radiation. This year, we looked at ways to lessen the training burden, while still ensuring employees are prepared to carry out their responsibilities to help us maintain a safe environment for patients, and for patients and staff. The result is a new single course — Health System Safety Essentials. The course is designed so that you can “Take Credit for What You Know.” Before starting, you will be presented with a pre-test and if you master (mastery is 100% accuracy) all the questions, you are done! If you master some sections of the pre-test but not others, you are only presented with the content areas you did not master. In addition, you will only be tested in areas specific to your job role. Distinct clinical and non-clinical assessments will help make sure you aren’t being tested on information that is not considered related to your role. The new “Health System Safety Essentials” has been redesigned with updated content. All employees must complete the course by December 31, 2013 – even if you have taken the current AME courses this year. We encourage everyone to take them as soon as possible.

Penn Medicine

NEWSmakers / / / Research Funding Outlook Appears Less Certain

/ / / Researchers Use Dogs to Help Sniff Out Ovarian Cancer

A group of Penn Medicine patients and faculty participated in a roundtable event convened by U.S. Sen. Bob Casey to discuss the impact of the cuts to National Institutes of Health on biomedical research and patient care. An article in The Philadelphia Inquirer quoted Benjamin Abella, MD, MPhil, vice chair of Research in Emergency Medicine and Clinical Research director in the Center for Resuscitation Science, discussing a $2.5 million NIH grant to implement new ways of teaching at-risk families cardiopulmonary resuscitation that will be eliminated when the funding runs out in 2015 — even though the training has already been shown to save lives. NIH funding for Penn Medicine research specifically for the fiscal year that ends Sept. 30, however, has held up relatively well under the sequester, falling $4.2 million, or 0.7 percent, while NIH funding nationally was off $1.7 billion, or 5.5 percent.

Janos Tanyi, MD, PhD, an assistant professor of Obstetrics and Gynecology, was quoted in several stories detailing a unique research collaborative between the Abramson Cancer Center, Penn Vet, and the Monell Chemical Senses Center that is training dogs to use their keen sense of smell to help detect ovarian cancer. The Associated Press article and video about the research ran in newspapers across the United States, including The Washington Post, USA Today and the Boston Globe, and was covered on CBS3 and ABCNews.com.

/ / / Penn Medicine Looks to Expanded Gene Tests for Cancer Patients A front-page article in The Philadelphia Inquirer explored the promise of Penn Medicine’s new Center for Personalized Diagnostics, a joint initiative of Pathology and Laboratory Medicine and the Abramson Cancer Center. David Roth, MD, PhD, chair of Pathology and Laboratory Medicine, and Lynn Schuchter, MD, chief of Hematology-Oncology, are quoted in the story, and Robert Daber, PhD, technical director of Clinical Genomics in the Center for Personalized Diagnostics, appeared in a photo accompanying the article. About 375 cancer patients have gotten the tests since February, and Roth’s team is focusing on clinically “actionable” results. That means results that help doctors choose a treatment or trial or rule out a treatment, such as a bone marrow transplant, that is unlikely to help.

/ / / Docs Can Safely Treat Alcoholism, PTSD Together: Study A new study in JAMA led by Edna Foa, PhD, professor in Psychiatry, found that doctors can safely treat PTSD and alcohol abuse together, despite concerns that prolonged exposure therapy would derail alcohol treatments. The study was covered in Reuters Health, HealthDay News, and other outlets.

/ / / Study Shows Cities Are the Safest Places to Live TIME magazine reported on a new study by Penn Medicine researchers that found large cities in the U.S. are significantly safer than rural areas. The risk of injury death — which counts both violent crime and accidents — is more than 20 percent higher in the countryside than it is in large urban areas. “Perceptions have long existed that cities were innately more dangerous than areas outside of cities, but our study shows this is not the case,” said lead study author Sage R. Myers, MD, MSCE, assistant professor of Pediatrics. Far from being violent death traps, a large city might just about be the safest place to live in the U.S. The study also raised — but could not answer — questions about the adequacy and accessibility of trauma care in rural America. Even when the researchers made mathematical adjustments to offset the fact that most counties lack hospitals with trauma centers, injuries in rural counties were deadlier than in urban counties. Senior author Brendan G. Carr, MD, MSHP, assistant professor of Emergency Medicine and Biostatistics and Epidemiology, said in a Philadelphia Inquirer article that the findings provide a springboard for examining and better targeting rural trauma care. Several outlets covered the research including NBCNews.com, Fast Company, The Atlantic, Reuters, and Parade.

/ / / New Support for Healthy Diet and Lifestyle Against Alzheimer’s The Philadelphia Inquirer reported on two Penn studies of Alzheimer’s disease. In the first, John Q. Trojanowski, MD, PhD, senior author of the study, explained in the journal Brain that while the research does not prove that vascular disease worsens Alzheimer’s, it supports the case for maintaining a healthy diet and lifestyle. “None of this is surprising, but it hadn’t been nailed down,” said Trojanowski, a professor of Pathology and a prominent researcher in the field. Authors of the study also included Jon B. Toledo, MD, and Steven E. Arnold, MD, among others. Another recent study from Penn suggested that some at-risk patients are taking this type of message to heart. Jason Karlawish, MD, professor of Medicine in Geriatrics and Medical Ethics and Health Policy, and colleagues found that patients who learned they had a high genetic risk of developing Alzheimer’s became more active than others in their efforts to exercise and eat healthy foods.

/ / / Patient No. 7 A Philadelphia magazine article in the “Best of Philly” issue profiled the Penn Medicine research team behind the breakthrough treatment that uses engineered versions of patients’ own immune cells to fight their cancers, including Carl June, MD; David Porter, MD; Bruce Levine, PhD; and Michael Kalos, PhD, along with detailing the stories of several patients who are in remission following years of failed conventional therapies. “Science,” the magazine writes, “is incremental. It’s a slow and global grind, a steady accumulation of facts wrested from failure. But every once in a while, there really is a leap, and a small group of people can change how thousands think about the possibilities.”

/ / / After Midnight, Night Owls Gorge, Piling On The Calories NPR reported that people who slept as little as four hours a night in a sleep laboratory gained weight — about two pounds over nine days — while people getting a good night’s sleep didn’t. These findings, from Penn Medicine researchers, came from the largest, carefully controlled study so far on the relationship between sleep deprivation, eating and weight gain. This study tracked the sleeping and eating behaviors of 225 people in Penn’s Sleep and Chronobiology Laboratory. “It was all during the late-night period,” said lead study author Andrea Spaeth, MA, a graduate student working in the Sleep and Chronobiology Laboratory. “That’s a ton of calories.” It’s good to be aware of the lure of late-night food, Spaeth said. Picking a reasonable bedtime and sticking to it consistently might be an effective way for people to keep their weight in check, she said. Additional outlets covering the study include NBCNews.com, US News & World Report, The Huffington Post, the Daily Mail, Philadelphia Magazine’s “Be Well” blog, News@JAMA, Yahoo Health, The TODAY Show, CBS 3, and additional broadcast outlets across the country including CBS Chicago and ABC Miami.

/ / / Scientists Fabricate Rudimentary Human Livers Researchers in Japan used human stem cells to create tiny human livers like those that arise early in fetal life. When the scientists transplanted the rudimentary livers into mice, the little organs grew, made human liver proteins, and metabolized drugs as human livers do. Then the researchers transplanted the liver buds into mice, putting them in two places: on the brain and into the abdomen. The buds grew and developed blood supplies, attaching themselves to the blood vessels of the mice. The researchers put 12 buds in each of two places in the abdomen, compared with the one bud in the brain — which let the investigators ask if the liver buds were functioning like human livers. They were. They made human liver proteins and also metabolized drugs that human livers — but not mouse livers — metabolize. The approach makes sense, said Kenneth Zaret, PhD, professor of Cell and Developmental Biology, in The New York Times. On their own, without those other types of cells, liver cells do not develop or form organs. “They were letting nature do its thing rather than trying to conceive of what the right signals might be,” but, he said, the mice were studied for only a couple of months. He would like to see what happens over a longer time. “We don’t know if the cells will grow out of control or will poop out.” Additional coverage appeared in Science News and Nature.

/ / / New Radiation Therapy Prolongs Prostate Cancer Survival Neha Vapiwala, MD, associate professor and chief of the Genitourinary service in Radiation Oncology in the Abramson Cancer Center, was quoted in several articles detailing the results of a new study of a newly approved radiotherapeutic drug that has shown to improve survival in men with metastatic prostate cancer. Vapiwala authored an editorial about the findings, which were published in The New England Journal of Medicine. Radium-223 mimics calcium and seeks out and binds with minerals in a patient’s bones, where it delivers radiation that destroys cancer cells without inflicting as much damage to surrounding tissues as older radiation therapies. “There are men who have serious disease, and in the years they do live they are often in pain, and in and out of the hospital,” Vapiwala said. The new drug, known as Xofigo, gives an option for at least some of them, she said. The New York Times, U.S. News & World Report, LiveScience, Medscape, and MedPage Today covered the study.

/ / / Penn Medicine Patient Hears Granddaughter Laugh with the Help of a Cochlear Implant NBC’s TODAY Show featured a live segment as Penn Medicine patient Sarah Campbell had her cochlear implant activated. Sarah’s surgeon, Michael Ruckenstein, MD, vice chair and professor of Otorhinolaryngology: Head and Neck Surgery, and audiologist Michelle Montes, facilitated the activation. “Sarah was an ideal candidate [for the cochlear implant] because we could still communicate with her in a proper environment,” said Ruckenstein. “Plus she was highly motivated.”

To reach the Penn Medicine news website, go to www.PennMedicine.org/news

AWARDS AND ACCOLADES Acker Named Director of Heart & Vascular Center Michael A. Acker, MD, chief of Cardiovascular Surgery, has been named director of the Penn Medicine Heart and Vascular Center. With this appointment, the Heart and Vascular Center now encompasses cardiology, cardiac and vascular surgery services for all of Penn Medicine. In his new role, Acker will help to shape the strategic direction of the Heart and Vascular service line as well as further the integration of cardiovascular clinical care across Penn Medicine. In collaboration with our hospitals, CPUP and colleagues from the Departments of Medicine and Surgery, he will lead the growth of the cardiovascular network, including being responsible for strengthening affiliate network relationships, building the community physician network as well as forging linkages with new cardiology practices in priority markets in collaboration with the entity cardiology chiefs. In addition, Acker will take on a key role in developing our managed care strategy as it affects cardiac programs and network development. Acker will also continue to work collaboratively with the Penn Cardiovascular Institute (CVI) and other departments to advance the missions of clinical care, research and teaching.

Skilled Care Center Receives Award For the second consecutive year, Pennsylvania Hospital’s Skilled Care Center received an Award for Health Care Compliance from the state Department of Health. This year it is the only site in Philadelphia and one of only two out of 711 long-term facilities regulated by the DOH to receive this award. To receive this award, facilities are required to have no state citations over the last three calendar years based on annual health survey inspections.

CEO’s corner (continued from cover)

Okala New Senior VP for Business Development Phil Okala has been selected to lead UPHS Business Development efforts, succeeding Mike Dandorph who went to Rush Medical Center in Chicago. A dedicated colleague since 2007, Okala will oversee business development, marketing, service line integration, network development, and patient facilitated services. His responsibilities for the cancer and neuroscience service lines have been transitioned to colleagues in Business Development. Okala successfully led the implementation of an integrated operating model within the Abramson Cancer Center by evolving several discrete practice models into a highly coordinated, multidisciplinary environment that worked closely with physician partners to develop best practices with strong returns both in improved quality and in financial performance. He improved linkages between inpatient and outpatient operations and quality initiatives and worked to establish a multi-departmental shared governance structure. Okala’s work to strengthen our regional referral network through deepening existing relationships and adding new strategic affiliations has resulted in increased vital referrals for tertiary and quaternary care.

Mahmoud Named Chief of Colon & Rectal Surgery Najjia Mahmoud, MD, has been named chief of Colon and Rectal Surgery in the Department of Surgery. Mahmoud has particular expertise in complex pelvic floor reconstructive procedures and minimally invasive approaches to colorectal cancer surgery. She is recognized as a leader within the colorectal surgery community, having been elected to the American Board of Colon and Rectal Surgery and serving in a number of positions, including Program Chair, with the American Society of Colon and Rectal Surgeons. Mahmoud has served as a leader on projects related to colon cancer with other national organizations including the National Cancer Institute and Cancer and Leukemia Group B. She also serves as associate editor for the journal Diseases of the Colon and Rectum.

Claudio Giraudo, PhD, of Pathology and Laboratory Medicine, was named as a 2013 Pew Scholar in the Biomedical Sciences by the Pew Charitable Trusts. The scholarships provide funding to early-career scientists researching the basis of perplexing health problems. Giraudo is investigating the regulation of the immune response against viral infections and cancer. Raina Merchant, MD, MSHP, has been appointed director of the Social Media Lab at the Penn Medicine Center for Health Care Innovation. In this new role, Merchant will lead a program exploring ways in which new communication channels can enhance our ability to understand and improve the health and health care of patients and populations. The potential reach of this endeavor is broad because the relevant disciplinary skills are diverse, and because the likely outputs and activities span fundamental research to practical deployment of communication strategies in clinical and commercial settings. James Mullen, MD, HUP associate executive director, received the 2013 Robert Dunning Dripps Memorial Award for Excellence in Graduate Medical Education. The award is given to an individual who has achieved excellence as an educator of residents and fellows in clinical care, research, teaching or administration. Mullen achieved distinction in all of the categories.

Lifesaving AEDs for Tredyffrin Police (L. to r.) Betty Sheller, Jennifer James, and Steve Bisha of Penn Medicine at Valley Forge donated three life-saving AEDs to Tredyffrin Police Officer Jennifer Cavanaugh. Replacing much older models, the new devices will supplement the Department’s emergency response program. “Penn Medicine has consistently been a true advocate for community programs,” said Tredyffrin Township Police Superintendent Anthony Giaimo.

free form text typed in by clinicians. With this tool, our researchers or quality experts can identify, for example, all patients of a certain age, or those who “complain of persistent cough.” Second, our new pathology initiative, the Center for Personalized Diagnostics, is a joint initiative between the Department of Pathology and Lab Medicine and the Abramson Cancer Center. Using lab and pathology specimens from patients, the Center uses DNA sequencing and advanced information technology to identify the genetic blueprint of individual cancers. Of the patients tested to date, the treatment has been changed in 75 percent of cases to a more suitable, personalized regimen. Third, we’re unveiling an enormously important project that will merge our emergency-department and inpatient electronic medical records with our current outpatient (Epic) electronic medical record. This unifying process will mean that important patient data — often locked away in one system and not easily retrievable by someone operating in another system — will now be merged into a complete whole, resulting in better outcomes for patients. This is a substantial project that will be completed in stages over the course of several years, but will ultimately provide a much more coherent record of each patient — a prerequisite for truly personalized care. At Penn Medicine, our strength results from a dynamic interplay of innovation and continuity. New and fresh ideas such as these continue to come at a fast pace — yet we retain what is best from our time-honored ways. By combining our legacy of excellence with our commitment to forward thinking, we can fully capitalize on the many potential benefits that personalized medicine holds for our patients.

Systemnews Editorial Staff: Sally Sapega, M.A. Editor Trissy Harding Graphic Design

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Susan E. Phillips Senior Vice President, Public Affairs

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