System News by Penn Medicine

Volume 11

Issue 2

December 2011

`` Photo credit: David Cribb

SYSTEMnews `` Two teams worked simultaneously for 11 hours to complete the bilateral hand transplant.

T he first time we met, she gave me a hug, with no hands or arms. For us to give a productive life to these types of individuals ... that’s the meaning of life for them.

CEO’s corner

HUP’S SURGICAL TEAM

Rises to the Challenge

Earlier this fall, a surgical team at HUP successfully completed the region’s first bilateral hand transplant, a complex procedure that required 30 specialists in organ transplantation, orthopaedic

RALPH W. MULLER

CEO, University of Pennsylvania Health System

UPHS has always taken a leadership role in serving the community. In addition to providing care to those who are most vulnerable, we’re also proud to be known for our efforts to strengthen individual lives, families, and whole neighborhoods outside of our hospital walls. The successes we’ve achieved are based on the generosity and enthusiasm of the entire UPHS family. We’ve made our presence felt in many positive, sustaining ways throughout the year. Most recently, more than three of every four of you made generous contributions to Penn’s Way, the combined workplace charitable giving campaign of the University of Pennsylvania and Penn Medicine. I’m extremely proud to report that the Health System attained 117 percent of our goal — a remarkable accomplishment. Your donations will help dozens of extraordinary organizations in our area provide life-changing and lifesaving services to those in need. Here at Penn Medicine, each of our three hospitals, Abramson Cancer Center, Joan Karnell Cancer Center, Sayre Health Center, Scheie Eye Institute, and Penn Wissahickon Hospice all benefit from your generosity. During this season of giving, there are many additional ways you’ve helped to make a real difference. Here are some. [Continued on page 2]

INSIDE Penn Health Policy Experts Brainstorm on Future Ideas, Collaborations...........................2 Random Acts of Kindness Volunteering at Penn Hospice at Rittenhouse............................2 Penn Medicine@Work..............3 Newsmakers..............................4 myPennMedicine......................5 Awards and Accolades.............6 Penn Medicine, Washington Square..................6

surgery, reconstructive micro-surgery, plastic surgery, and anesthesia. Even with two teams working simultaneously, the operation lasted more than 11 hours. While the procedure itself was clearly an achievement, the planning for it was no less impressive. Read below to see how it all unfolded.

First Step: Ethical Considerations Organ transplants are performed to save lives. That fact balances out the risks of both the surgery and the lifelong dependence on powerful drugs to prevent rejection. A bilateral hand transplant was not life-saving; was it worth these risks? That was the initial thought of Abraham Shaked, MD, head of the Penn Transplant Institute, when L. Scott Levin, MD, chair of Orthopaedic Surgery, professor of Surgery, and director of Penn Hand Transplant, first approached him in 2009 with the possibility of doing the procedure at HUP. But that was before Shaked met the patient, a young woman who had lost all of her limbs due to a severe post-surgical infection. “The first time we met, she gave me a hug, with no hands or arms. The minute you have it [the hug], you think about life in a different way,” he said. “For us to give a productive life to these types of individuals … that’s the meaning of life for them.” Art Caplan, PhD, director of the Center for Bioethics and professor of Medical Ethics, initially shared Shaked’s concerns, but “I came to understand that this transplant is not cosmetic; it is truly functional, allowing a patient to carry out activities of daily living. Prosthetics don’t give the kind of function you need for a good quality of life if you are a double amputee.” And they don’t allow a person to literally touch a loved one.

Plastic Surgery, associate professor of Clinical Surgery, and co-director of Penn Hand Transplant. “We’ve all fixed bones, re-attached muscles, repaired nerves, and sewn skin.” The major difference was that this was vascularized composite allotransplantation (VCA). Unlike with solid organs, a hand transplant involves multiple tissues, including blood vessels, bone, nerves, muscles, tendons, and skin. Preparations started 18 months prior to the actual surgery. Using the patient’s measurements and X-rays, the team created a step-by-step transplant procedure specifically tailored to her needs. Chang said they divided the surgery into multiple parts. One team procured the donor limbs, while two other teams opened and prepared the patient’s stumps to receive them. Two teams then prepared the donor arms and, finally, two teams attached the donor limbs to the patient’s stumps. Chang led one team while Levin, who is board certified in both orthopaedic and plastic surgery, led the other team as well as the procurement team. “He was the driving force that made all this possible,” Chang said. [Continued on page 4] Penn Transplant Institute

Forearm Transplant Checklist ( A ) Forearm-level Transplant Harvest

( C ) Recipient Stump Preparation

FFMark basilic and cephalic veins

FFInflate tourniquet

FFCircumferential skin incision at mid humeral level

FFFishmouth skin incision

FFTag cephalic vein and basilic vein

FFElevate anterior and posterior flaps

FFDivide biceps and brachialis muscles

FFTag basilic and cephalic veins

FFTag median nerve and brachial artery

FFTag brachial artery and brachial vein

FFTag ulnar nerve

FFTag medial nerve

FFTag radial nerve

FFTag and transpose ulnar nerve

FFDivide humerus 3 cm proximal to soft tissue

FFExpose the medial epicondyle

FFDivide triceps

FFTag radial nerve and radial sensory nerve

FFDeflate tourniquet

FFExpose lateral epicondyle

FFFlush brachial artery

FFPosterior approach to radial and ulnar shaft

FFAttach prosthetic arms

FFReflect supinator off radius FFPerform radius and ulna osteotomies at same level

( B ) Donor Forearm Preparation FFPosterior incision over the triceps and olecranon onto

the shaft of the ulna

FFAnterior incision over the biceps, across the antecubital fossa FFRaise a medial skin flap down to medial epicondyle.

The surgical techniques used to perform the hand transplant were not new, said Benjamin Chang, MD, associate chief of

FFMeasure distance on recipient stump from lateral epicondyle

to end of radius and from medial epicondyle to end of ulna.

( D ) Forearm Transplant

FFTrace basilic vein down to elbow

FFAlign donor arm to recipient stump

FFTrace ulnar nerve from proximal to distal and dissected out

FFClamp 6 hole small fragment plate to ulna, dorso-lateral side

of the cubital tunnel

FFTrace median nerve and brachial artery down to antecubital fossa FFElevate flexor/pronator origin from medial epicondyle and tag FFRaise lateral skin flap down to lateral epicondyle FFTrace radial nerve down to elbow FFElevate brachioradialis from humerus FFElevate mobile wad from lateral epicondyle and tag FFMeasure distance on recipient stump from lateral epicondyle

to end of radius and from medial epicondyle to end of ulna. Tranfer measurements to donor and mark osteotomy site.

Practice, Practice, Practice

FFDeflate tourniquet

FFExpose ulna and radius from posterior incision. Perform ulna

and radius osteotomy.

FFElevate muscles from proximal radius and ulna and detach

forearm from elbow

FFClamp 6 hole small fragment plate to radius, dorsal side FFCheck alignment under flouro FFDrill and insert screws FFInsert 2 Mitek anchors and attach flexors to medial epicondyle FFInsert 2 Mitek anchors and attach mobile wad to lateral epicondyle FFAnastamose brachial artery FFAnastamose basilic vein FFAnastamose cephalic vein FFRepair median nerve FFRepair ulnar nerve FFRepair radial nerve(s) FFTrim skin flaps: anterior with elbow extended, posterior

with elbow flexed

FFClose skin

`` The team created a checklist of each step of the surgery to ensure that nothing was skipped and that steps were taken in the correct order.

COMING SOON: Penn Medicine Safety Net

`` During an all-day

retreat, Ezekiel Emanuel moderated health policy strategic planning sessions with experts from across the Penn campus.

Penn Medicine will soon bring on board a new event management reporting and tracking system to replace PORTS. Penn Medicine Safety Net is an improved program that is flexible and web-based, and encourages event reporting. The system will help the Health System track and prevent medical errors, increase reporting of incidents and improve patient safety with flexible easy-to-use software. “The American Hospital Association exclusively endorses this reporting system,” said Michael Anderson, associate director, Clinical Effectiveness and Quality Improvement.

PHOTO CREDIT: Hoag Levins/LDI

Penn Medicine Safety Net will allow employees to:

PENN HEALTH POLICY EXPERTS Brainstorm on Future Ideas, Collaborations

• Build better reports to capture, analyze and prevent adverse events.

Penn Medicine has an enormous powerhouse of tools in the vital area of health policy.

• Set up specialized alerts and reminders.

Those in the field work to improve the health of the public by studying the medical, economic, political, and social issues that affect how health care is funded, managed, and delivered in the U.S. Topics range from the benefits — and ethics — of paying people to quit smoking to national health-care reform to public policy on euthanasia. At Penn, practitioners span the disciplinary gamut and include experts from medicine, law, nursing, business, education, philosophy, psychology, sociology, religious studies, and public policy.

• Export data to PSOs or state reporting bodies.

Recently, two of the major institutional homes of health policy research at Penn, the Leonard Davis Institute of Health Economics and the Department of Medical Ethics and Health Policy in the Perelman School of Medicine, hosted an all-day retreat to identify priorities for future work and promote even more cross-departmental collaboration.

• Protect themselves — and their patients — with heightened security features.

• Customize forms to fit an organization’s needs. • Support a culture of safety with anonymous submission.

As the go-live date — early next year — approaches, look for future articles providing more detail about this state-of-the-art system.

Random Acts of Kindness

Volunteering at Penn Hospice at Rittenhouse

Ezekiel Emanuel, MD, PhD, the new chair of Medical Ethics and Health Policy and former chair of Bioethics at the National Institutes of Health, moderated a wideranging discussion of topic areas that could have a major impact on health policy and also spur creative alliances on health policy research across the Penn campus. More than 80 attendees took part in the exchange of ideas and produced a spectrum of suggestions, from which they chose the most promising for further exploration.

Holding a hand.

Priorities that emerged include improving care to low-income people, involving patients more in their own health and health care (including using the new media and social networking), comparing health policies and treatments to identify those that work best, developing better models to project supply and demand for health professionals, expanding health insurance coverage, and modernizing Medicare.

Just being there.

“Penn has an amazing pool of talent in the sphere of health policy,” said Emanuel. “One of the reasons I came here was the opportunity to work with so many leaders in the field. I’m very encouraged about the momentum that developed at the retreat and am excited about the fresh ways of thinking Penn will be bringing to the policy arena.”

CEO’s corner HUP’s Holly Days Program supported two local facilities which shelter women and children by adopting families and obtaining toys and clothing for the children. It also supplied gift cards for food and necessities to homeless and runaway teens living at Covenant House, a crisis center in Philadelphia. The HUP Nursing Community Outreach program provided blankets and clothes to the residents of the St. Ignatius Nursing Home in West Philadelphia. In addition, it worked with Philabundance to help prepare holiday food donations for local food banks. Penn Presbyterian Medical Center Emergency Department’s hospital-wide food and blanket drive provided much-needed items to Fresh Start Emergency Food and Resources Services food pantry in West Philadelphia. PPMC also hosted its annual Children’s Christmas Party for West Philadelphia young people, who received gifts of toys and clothing. Its nurses and other staff members also served dinners and distributed gifts at Councilwoman Jannie Blackwell’s annual holiday party. PPMC’s PACU/ SPU and GI departments adopted families from the People’s Emergency Center and SPU staff members prepared and served hot meals for the shelter’s residents. Pennsylvania Hospital’s Joan Karnell Cancer Center hosted its annual holiday giving program. Social workers identified needy patients, who received gift cards for discount stores and

• Create custom forms with the new Forms Designer.

(Continued from cover) gifts collected from hospital staff. The Center also hosted the annual holiday bake sale, with proceeds benefiting cancer patients and families in need. Kathy Magnes, administrator for the PAH Skilled Care Center, created and personally delivered gifts bags — donated by PAH employees — to homeless persons on the streets of Philadelphia Christmas morning. And the PAH Home-School Connection, an early intervention program providing clinical services to children and their families, conducted a toy drive for the needy children it serves. During Project Santa, Penn Care at Home staff members added caroling and gifts to the home care, rehabilitation and hospice services they provide to homebound patients. Penn Wissahickon Hospice’s Light Up A Life ceremonies featured music, speakers, and the lighting of the Light Up A Life trees. Staff members from throughout UPHS made contributions and dedicated lights on the trees in honor or memory of patients, colleagues, friends, or loved ones. The contributions support the Needy Patient Fund, which helps finance hospice care for those who cannot afford to pay. As these examples show, UPHS employees once more selflessly opened their hearts to brighten the holidays for those in need. Thank you for your inspiring generosity and happy holidays to all.

Listening.

`` Spending time with patients at Penn Hospice at Rittenhouse means a great deal to both patients and volunteer Sharon Civa (shown with patient Miriam Colbert).

Sharon Civa, MBA, has found that the smallest acts of kindness can have the greatest impact on patients in Penn Hospice at Rittenhouse. But she has found that helping these patients has had a great impact on her as well. Civa, Entity Information officer, has worked for Penn Home Care and Hospice (on the technology side) for 13 years, but it wasn’t until a close friend became ill and needed hospice care that she truly understood what it involved. “I watched the staff when I visited and wondered, ‘How can they do this day in and day out and not be depressed?’” she said. But, as she discovered — from watching and in her volunteer work — “helping the patient on this journey brings happiness.” Since that time, after completing 16 hours of core training, Civa has volunteered at Rittenhouse hospice on a regular basis. She doesn’t come with a specific agenda; mostly she lets the patient take the lead. “Sometimes just holding someone’s hand is enough, or I’ll read to them … or pray,” she said. “I’m learning how to listen better.” She often visits patients who don’t have anyone else coming to see them. “I always ask the nurse or chaplain, ‘Who needs a visit?’” Memories of the patients she’s visited remain with her. There was the woman who had just arrived on the unit and was scared. “I stayed with her for two hours. She just needed someone to sit with her,” Civa said. Then there was a patient’s son who asked that she sit with his mom for 15 minutes when he had to leave the room. When Civa returned the next week, he remembered her name and introduced her to to his family. “I get a lot of letters from family after the patient has passed. They often single out people they remember, and many times it’s the volunteer,” Civa said. “Where else can you make an impact like that? That’s what makes me leave with a smile.”

> > > Be a Volunteer and Make

a Difference

Do you have a few extra hours that you would like to spend helping others? Penn Wissahickon Hospice welcomes new volunteers who can make a difference in the lives of its patients and their families. Each volunteer receives the necessary training and tools to join the hospice team — both in the community and at the inpatient facility at Penn Medicine Rittenhouse. For more information, please contact ellen.inglesby-deering@uphs.upenn.edu or call 610.617.2442.

penn medicine

work

Siemens/Penn Medicine Internship `` Lauren Johnson, HR program specialist (center) and other graduate students from the University of The Arts Masters in Industrial Design program.

Penn Medicine’s > > > Destination Programs PREPARING FUTURE LEADERS THROUGHOUT THE HEALTH SYSTEM If you want to teach a person the business, train them. If you want innovative, creative thinkers who can help change the business, develop them. In Talent Acquisition, part of Human Resources, we are working on new programs to help develop the next generation of innovators and leaders in academic medicine. Developing leaders in health care has traditionally been earmarked for administrative fellowship programs with the goal of developing future administrators. We are now looking at several “destination programs” to develop not only future administrators, but also future leaders throughout the organization — operational leaders, practice leaders, information technology leaders, and more. We are also operating programs focusing on “human-centered” design. This is a creative problem-solving process that involves understanding how people interact and operate in real-world settings, in order to improve the products and systems with which they work. In these destination programs, participants gain exposure to all levels of leadership, learning through coaching, mentoring and developing real skills. The programs are designed to provide experiences that enable participants to challenge the status quo and focus on developing ‘next practices’, not just following ‘best practices’.

Penn Medicine offers the following destination programs: Administrative Fellowship The Penn Medicine Administrative Fellowship program is a two-year leadership development experience designed to attract and retain emerging talent in the field of health-care administration. The fellowship program provides participants with the opportunity to: • Directly access senior executive teams, who serve as mentors, through action learning projects • Observe decision making and strategy at the senior level

Last summer, Penn Medicine partnered with Siemens to sponsor a 12-week internship program for two college students with an interest in clinical information technology. Our two interns worked on IT-related projects that focused on using technology to improve patient outcomes and discovering emerging trends in clinical information technology. The internship included project work, supplemented with learning sessions at Penn Medicine and Siemens as well as briefings with executive leaders from both organizations. At the end of the program, the interns presented their project work and key learnings to Penn Medicine and Siemens leadership.

University of the Arts, MiD Program The University of the Arts Masters of Industrial Design program focuses on improving business processes and creating solutions to challenges. This unique approach includes contextual or qualitative research, such as performing individual interviews with employees in their workspace, synthesizing new data, and representing data through visual storyboarding. The goal is to help employees at every level become an active force in realizing solutions to obstacles and ultimately voicing ideas. The students in this program collected and analyzed a semester’s worth of research to develop problem-solving prototypes and implement solutions to employee end-user needs. Using the human-centered design approach, they are working to optimize two new technologies. One is The Square, an internal social networking website to share ideas and collaborate. The second is a new learning-management system aimed at helping employees learn and develop professional careers, replacing ‘Knowledge Link’. For more information on these programs, contact Courtney Brown, Director, Talent Acquisition, at courtney.brown@uphs.upenn.edu.

FREE Benefits for a Healthier, Happier You UPHS believes that providing the best care for our patients is only possible if we provide the best care for our employees. Your health and well-being matter to us, which is why we’re pleased to offer you programs, tools and resources for managing your life — all for free. •Q uit Smoking: We’re pleased to announce a new smoking cessation program

for employees. The 13-week program from Health Advocate will be available for all employees and dependents covered under a medical plan and will include Nicotine Replacement Therapies like the patch, nicotine gum or the lozenge at no cost. Enrollment begins January 1, 2012.

•E at Healthier: Have you noticed new green and white stickers on the hospital vending

machines? Next time you need some nourishment, look for the green tabs that mark Balanced Choice items — those with less than 250 calories and 35% fat.

• Lead and support special projects that are aligned with key strategic initiatives of Penn Medicine

•K now Your Numbers: Whether you’re managing your weight or keeping your cholesterol

• Strengthen leadership and management skills by assuming full operational responsibilities in an inpatient unit, clinical practice and/or specialized shared services (e.g., Information Technology, Finance, Human Resources).

•B alance Life’s Demands: Our Employee Assistance Program offers you eight free,

The Administrative Fellowship model provides exposure to all entities within the Health System with a structured format for feedback so that Fellows have a real-time sense of their performance. Progress in identified growth areas is measured. Personalized assistance to identify full-time career opportunities with Penn Medicine (upon completion of their fellowship) that matches the Fellow’s leadership strengths is provided.

in check, the American Heart Association’s My Life Check tool, free for UPHS employees, can help you track your personal health measurements. confidential counseling sessions each year to help you manage your life. If the holidays have added to your stress, ask about taking advantage of one of these sessions.

You can access all of the tools above and more at Wellfocused, a new section of the HR & You website that offers tools for everything from personal health to financial planning and work-life balance. Visit www.uphshrandyou.com and click the “Well Focused” tab. Enrolling in these programs will help keep you happy and healthy. Stay tuned for future Wellfocused programs and activities coming your way!

HEALTHY SUCCESS STORIES — Sharing Inspiration with all of UPHS Last Open Enrollment, Human Resources introduced a Personal Health Assessment (PHA) and offered free biometric screenings to encourage employees to take a more active role in their health. More than 5,400 employees participated by completing the PHA and are now receiving a $5 credit on their health premiums every pay period. A calling for employees’ Healthy Success Stories went out in early October with the opportunity to win a Kindle. Throughout the month of October, 47 employees shared their stories. The stories were inspiring, exposing people’s most difficult struggles, barriers, accomplishments, and goals. UPHS is thrilled that employees are taking advantage of the tools and resources available to allow them to lead healthier lives. The success stories are posted under the Wellfocused section on the HR & You website. It’s never too late to share your story. To send your story and inspire others, please send to: HRSuccessStory@uphs.upenn.edu.

Penn Medicine

NEWSmakers // / / Surgery and Anesthesia Linked to Alzheimer’s New research from the Perelman School of Medicine adds to the growing evidence that anesthesia and surgery may be associated with the progression of chronic brain diseases, particularly Alzheimer’s disease. “We have long sought a clearer picture of the true impact of anesthesia and surgery on the central nervous system,” said study author Roderic Eckenhoff, MD, the Austin Lamont Professor of Anesthesia, in a HealthDay news syndicate article. “Although not definitive, this human biomarker study gives some credibility to the notion that anesthesia and surgery produce an inflammatory insult on the brain and accelerates chronic neurodegenerative diseases like Alzheimer’s,” Eckenhoff added. “The next step in this line of research is to determine whether anesthetic management can modulate the neuroinflammation caused by surgery, whether this brief inflammatory insult can actually change the trajectory of something like Alzheimer’s disease, and given that surgery is usually not strictly elective, development of a strategy to reduce the inflammatory insult to the brain.”

// / / Reviving a Tired Heart Research scientists are discovering new insights that might help them re-grow damaged heart muscle, causing it to beat like new. Studies suggest that adult heart cells often go through the preparations for dividing, making copies of their genetic material and (in mice at least) forming a new cell nucleus. “It’s as if they are trying to re-enter the cell cycle,” said Jon Epstein, MD, chair of Cell and Developmental Biology and scientific director, Penn Cardiovascular Institute, in a Science News feature. “They make new DNA; they just don’t divide,” says Epstein. It’s not uncommon for heart cells to develop not just one but several copies of their own genetic instructions, as if getting ready for when it is needed at several points during a person’s lifespan. “The difference between a newborn heart and an adult may focus on the ability of cells to divide, and not be related to their ability to create new DNA,” he said.

// / / Hospital Visits for Heart Failure Fall 30 Percent During Decade The Washington Post reported that hospital stays for heart failure fell a remarkable 30 percent in Medicare patients over a decade, the first such decline in the US and evidence that the nation is making headway in reducing the billion-dollar burden of a common condition. But the study of 55 million patients, the largest ever on heart failure trends, found only a slight decline in deaths within a year of discharge, and progress lagged for black men. Explanations for the decline include healthier hearts, better control of risk factors like high blood pressure, and more patients treated in emergency rooms and clinics without being admitted to hospitals, said Mariell Jessup, MD, medical director of Penn’s Heart and Vascular Center. “I think it is extraordinary news,” said Jessup, who wasn’t involved in the study. “Many efforts at changing the natural history of this disease seem to be having an effect, especially with the hospitalization rate. But it’s still a very problematic disease.” The story also ran in USA Today, CBS News, and Fox News.

// / / Can Fertility Treatments Cause Breast Cancer? An article posted on The Wall Street Journal’s health blog discussed the pros and cons of whether fertility treatments cause breast cancer. The topic has received renewed attention recently when Giuliana Rancic, the 36-year-old “E! news” anchor and reality show star, announced she has breast cancer. Rancic publicly announced that her cancer was discovered after her fertility physician insisted she get a mammogram before undergoing another round of IVF. Quoted throughout the article is Samantha Pfeifer, MD, an associate professor

of Obstetrics and Gynecology at Penn who also chairs the American Society for Reproductive Medicine’s practice committee. According to Pfeifer, “Breast cancer rates are higher among women who are older when they first get pregnant, so the disease is something we ‘deal with’ in taking care of fertility patients, many of whom are in their late 30s.” However, there is currently no evidence that shows IVF treatments cause breast cancer.

// / / More Health-Care Spending ≠ Better Quality of Life In a New York Times op-ed, Ezekiel Emanuel, MD, PhD, vice provost for Global Initiatives and chair of Medical Ethics and Health Policy, argued that higher spending on health care does not equate to a longer life, less disability, or better quality of care. Citing the U.S.’s ballooning health-care spending, which now totals $2.6 trillion a year, or over $8,000 per American, Emanuel wrote, “If we continue at this rate of growth, health care will be roughly one-third of the entire economy by 2035 — one of every three dollars will go to health care — and nearly half by 2080.” A 2003 study published in Annals of Internal Medicine found that Medicare patients who lived in areas with higher health-care spending did not get better results. In some cases, more spending even appears to equal poorer health. A 2004 study in Health Affairs found that there was actually worse care in states with higher Medicare spending. “The $2.6 trillion the United States is spending on health care is too much, and we can reduce it without rationing or sacrificing quality,” he wrote.

// / / Ways to Breathe Easier Almost everyone experiences shortness of breath at some point in their lives. “It’s a common form of discomfort,” said John Hansen-Flaschen, MD, chief, Pulmonary, Allergy, & Critical Care, and medical director, Penn Lung Center, in an interview with Consumer Reports. But while occasional bouts of breathlessness can be normal, persistent shortness of breath can be an early warning sign of serious lung or heart disease. Some common conditions that might lead to shortness of breath include asthma, COPD,and even anxiety. To help avoid breathlessness, doctors also say to quit smoking and avoid secondhand smoke, eat well, exercise regularly, and avoid inhaled irritants, such as chemical fumes.

// / / Does Psoriasis Thwart the Benefits of ‘Good’ Cholesterol? Inflammation caused by psoriasis may trigger changes in a person’s cholesterol, including weakening the function of high-density lipoprotein (HDL), the “good” cholesterol, said new Penn research presented at the 2011 American Heart Association meeting. “Anecdotally, many researchers have observed that HDL levels may be lower in states of inflammation, such as psoriasis and even obesity,” said study author Nehal Mehta, MD, MSCE, director of Inflammatory Risk in Preventive Cardiology, in an interview for US News & World Report. In the study, researchers found that patients with psoriasis had a greater number of low-density lipoprotein (LDL), or “bad” cholesterol particles unrelated to other risk factors or obesity. The researchers also noted these particles were smaller. In a second study, the findings revealed that having psoriasis was associated with a reduction in the protective benefit of HDL by about 25 percent. “We’ve been able to show that psoriasis is an important risk factor for vascular disease, and now we may finally be able to identify and ultimately treat the pathways by which psoriasis increases these risks,” said senior study author Joel M. Gefland, MD, MSCE, assistant professor of Dermatology and Epidemiology. Coverage of the research was reported by The Philadelphia Inquirer, the NewsDay news syndicate, and ABC news stations in Philadelphia and Chicago.

// / / A Drug That Wakes the Near Dead The New York Times Magazine reports that, so far, the best hope for minimally conscious patients has come from an unlikely source: Ambien. Rather than put them to sleep, both Ambien and its generic twin, zolpidem, appear to awaken at least some of them. This year, Penn scientists participated in the first large-scale clinical study of zolpidem as a treatment for disorders of consciousness. “Early on, when families have the option to pull the plug, it’s almost impossible to tell what the long-term prognosis will be,” said Soojin Park, MD, a HUP neurointensivist and an investigator on the zolpidem trial. “And then later, when we have the certainty — that this is as good as it’s going to get — that option is gone, because by then, the patient is breathing on their own.”

// / / Cooling Saves Lives, But Technique Remains Slow to Catch on Across U.S. Appearing on CBS’s The Doctors, Benjamin Abella, MD, MPhil, an assistant professor of Emergency Medicine and director of Clinical Research in the Center for Resuscitation Science, discussed therapeutic hypothermia. “Our research has shown that if you employ this cooling therapy, you can double the chance of people surviving and greatly improve brain function and recovery as well,” he said. However, only a quarter to a third of hospitals employ the lifesaving treatment following cardiac arrest. “The problem is it’s not as easy as it sounds — there’s some work to be done, you have to have a program, you have to have training, so it’s been slow to spread to all hospitals,” Abella said. “My fear is that many patients end up at hospitals after cardiac arrest and this therapy may not be offered.”

// / / Exercise Shown to Curb Effect of “Obesity Gene” New research suggests that exercise can help keep those with the “obesity gene” from gaining weight. The research, published in the journal PLoS Medicine, goes against the idea of some overweight individuals who believe their weight is out of their control, but may unfairly give support to those who say people are overweight because of being ‘lazy.’ Robert Berkowitz, MD, associate professor and senior medical director of the Weight and Eating Disorders Program, told HealthDay news syndicate, “It really is a genes-environment interaction. Most of us are faced with sedentary jobs, so we’re not as active as we used to be even 30 or 40 years ago. I think it all makes it difficult for a person coping with a weight problem.”

// / / Small Amounts of Alcohol Can Increase a Woman’s Risk of Developing Breast Cancer Susan Domchek, MD, an associate professor in Hematology-Oncology and director of the Mariann and Robert MacDonald Women’s Cancer Risk Evaluation Center, told CBS-3 about a new study showing an association between small amounts of alcohol consumption and the development of breast cancer. “Even small doses of alcohol, about three to six drinks a week, increase the risk of breast cancer slightly. These risks have to be kept in context, because they’re still not huge elevations of risk,” Domchek said. The research only found an association, not proof that alcohol causes cancer, though Domchek noted the link is “felt to be [credible] because of its interactions with estrogen.”

myPennMedicine:

Easy Access to Your Medical Info and More! “And we’ll be adding access to radiology results shortly.”

What’s a quick and easy way to: • Find out a lab result • Request an appointment

with your doctor • Renew your prescription

SIMPLE. myPennMedicine The Health System’s online healthmanagement tool, which debuted in 2008 (as myPennHealth), offers patients easy and secure access to personal medical information, but it has recently expanded to include much more. For example, you can now access many test results through myPennMedicine, just three business days after they reach your physician’s in-basket folders. “Most results are automatically released, with no physician input necessary,” said Diane Buckles, project manager. Others (such as a pap smear) require a doctor’s ok, while a third group — including genetic testing —is never released to the site.

Another new feature is the link to our health information library. “Simply click on one of your diagnoses — or a medication you’re taking — and it will link you directly to that topic,” Buckles said. myPennMedicine also connects patients to information about their lab results. Have a question for your doctor’s practice? myPennMedicine eliminates the calling and waiting on the phone or for a return call. ‘Contact Your Care Team’ allows you to send a secure, nonurgent email to any outpatient physicians you’ve seen at Penn in the last three years or have a scheduled visit with in the next six months. Drop-down lists automatically display the names of your Penn doctors as well as a list of possible subjects (such as a visit follow-up question). “The subject ensures that the completed message is sent automatically to the appropriate person on the care team,” Buckles said.

This same patient-specific physician list is displayed when requesting an appointment. You simply fill in the reason for the visit and preferred dates and times. You can also cancel an appointment — two or more days in advance — and easily check times and days of future appointments. Gone are the days when renewing a prescription required the ability to decipher the information on the medicine bottle. When you want to renew a prescription, all of the necessary information, eg, dosage and the doctor who prescribed, are available online. myPennMedicine even allows the patient to choose the preferred pharmacy from a list that can be updated at any time. The information in myPennMedicine is always in real time. “As soon as the information is entered in EPIC, the patient’s record is updated,” Buckles said. “No one else in the region has that.” “And it’s personalized information,” added Michael Restuccia, chief IS

officer, “in that it’s focused on the individual needs of each patient,”. myPennMedicine is available to all current Penn Medicine patients. Nearly 50,000 patients are managing their health-care issues on their own time … and, according to Buckles, the feedback is positive. “I really enjoy being readily able to access my information online,” said one user. “I’m such a computer person and this site is easy to navigate and locate information!” “This website is amazing,” noted another Penn patient. “I am in the process of applying for new health-care coverage and even the representative was impressed by the accessibility of my medical info online.”

Joining myPennMedicine is Easy! • Get an access code by going to

myPennMedicine.org and clicking on ‘Request an Activation Code’ or get one from your doctor. • Click ‘Sign Up’ and complete your

personal information. • Once the information is verified, log on

and view your profile at any time! CTA personnel Levin Hand 1 2 3 4

Lin

Plastic Steinberg Bozentka Chang 2 3 4

A) Forearm-level Transplant Harvest Left Right

Left Right Left Right Left Right Left Right Left Right Left Right

D) Forearm Transplant

Bone

Musc Vasc Nerve Veins Skin

Alsalmi

Erdmann Macias

Serlettti

X X X

C) Recipient Stump Preparation Left Right

Transplant Micro Fellow Shaked Nagy Fellow

Kanchwala Wu

B) Donor Forearm Preparation Left Right

Kovach

X X X

X X

(X)

(X) (X)

HUP’S SURGICAL TEAM

Rises to the Challenge

[Continued from cover]

The protocol placed hands first, but “the surgeons knew up front that the solid organs were a priority,” Hasz said. “We would stop the hand procurement if we were in danger of losing any of the organs.” In spite of the challenges, it took Gift of Life only a couple weeks to identify the donor. “Families in this area are very giving, especially if you explain the compelling need,” he said. “This family had amazing strength. They were able to look past their own pain and give that gift to someone else.”

`` As part of the planning process, the team created a spreadsheet assigning each surgeon to specific steps.

Pilots review checklists before flights and the surgical team decided to follow their example. “We created and printed out a checklist of each step and taped it on the OR wall,” he said. “As each team completed a step, Stacey [Doll, director of Quality and Regulatory Compliance — Solid Organ Transplant] checked it off. This ensured that we didn’t miss anything and also guided us in the right order.” They also had sterile engraved tags made so they could identify and then clearly mark each of the many muscles, tendons, nerves and blood vessels that needed reattachment. Doll worked with the hand transplant team from the start to help organize the process and assemble all the available resources in Penn’s solid organ transplant program. The team had several rehearsals and, after each one, they’d debrief and further tweak the procedure to improve it. “We prepared as a team for patient safety and for a predictable outcome,” Levin said, “and there were no surprises to speak of.” Added Chang, “Our extensive planning — and practice, practice, practice — paid off.”

Gift of Life: A Key Partner Penn’s most important partner in this process was Gift of Life, the nonprofit organ and tissue donor program serving the region. It was a unique transplant, said Richard Hasz, VP of Clinical Services for Gift of Life, “presenting challenges on many levels.” The first challenge centered on the donor family. Unlike most transplanted organs, a person’s hands are recognizable. “We needed to understand both the critical medical and emotional aspects of this particular donation process,” Hasz said. Finding a good match was another challenge. As a visible transplant, it had to be the right size, gender, skin type, and age, with no obvious trauma, tattoos, or other visible marks. Gift of Life also created a new protocol for the procurement process, “to establish the timing and sequence of the organ and hand removal,” Hasz said. In addition to the donation of limbs, “five individuals received organs from that donor and at least 50 received tissue.” The protocol also gave family members explicit rights to consent to the donation even if a donor card was located.

Relearning How to Move Preparation for the hand transplant went beyond the surgery; it also presented new challenges to the rehabilitation team. Levin chose Laura Walsh, MS, OTR/L, CHT, Hand Therapy team leader, and Gayle Severance, MS, OTR/L, both occupational therapists and certified hand therapists, to do post-surgical therapy. Walsh and Severance created customized splints to protect the transplanted limbs — especially the point at which they are attached to the patient’s own arms — and also to allow her to use her arms for basic tasks, such as eating and using a computer. While the patient was still in the hospital, they began a rigorous workout schedule of 4 to 6 hours a day, working on “strengthening her shoulder and arm muscles to move the new limbs,” Walsh said. Once the patient can again feel hot and cold (protective sensation) on her new limbs, sensory re-education will begin to help her recover the brain-hand sensory connection. As Walsh explained, when sensation initially returns, the brain is only getting “very global signals. For example, the brain can process that the hand is holding a round object but cannot distinguish a baseball from an orange.” In sensory re-education, the patient touches an object first with eyes closed — to allow the brain to process what is felt — and then with eyes open to “fully educate the brain on what the body is really feeling,” she continued. “We’ll do this type of exercise over and over with varying shapes and textures.” As we went to press, Levin said the patient was doing “superbly,” but she has many months of rehabilitation ahead of her. It will be at least a year before the nerves grow far enough into her arms to have independent motion of her fingers and possibly longer to regain feeling in her fingers. “It could be up to 18 months before we know what her potential function may be.” The multidisciplinary team expects to continue performing bilateral transplants, following the same basic principles but customizing their preparation — as they did with their first transplant — to assure optimal outcomes. “We prepared, we studied, we listened to each other, and then we came together to make it happen. We’re poised to take this program to the next level,” Levin said. “It’s our goal to work seamlessly together in the field of VCA so we can successfully treat these patients and give them their lives back.”

AWARDS AND ACCOLADES `` (L. to r.) Vivian G. Cheung, MD, Paul Offit, MD, and Daniel Rader, MD.

IOM ELECTS THREE NEW MEMBERS FROM PENN Three Penn researchers has been elected members of the Institute of Medicine, one of the nation’s highest honors in biomedicine. They are Vivian G. Cheung, MD, Paul Offit, MD, and Daniel Rader, MD. Cheung, of Genetics and Pediatrics and an investigator of the Howard Hughes Medical Institute, has demonstrated, with her colleagues, that expression levels of genes are variable and genetically regulated. This led to the establishment of the field of Genetics and Gene Expression, which has greatly enhanced the understanding of gene regulation in humans and other organisms. Offit, of Pediatrics, is director of the Vaccine Education Center and chief of Infectious Diseases at CHOP. His research includes developing one of the main vaccines used to fight rotavirus, a disease that is the leading cause of severe, dehydrating diarrhea in infants and young children. He is also one of the most public faces of the scientific consensus that vaccines have no association with autism. Through his advocacy, Offit has successfully cut through misinformation and helped educate parents on the health benefits of vaccinating their children.

Rick Demers, MS, RHh, director of HUP Pharmacy, has received the Pharmacist of the Year Award from the Pennsylvania Society of Health-System Pharmacists. PSHP’s highest honor, it recognizes sustained contributions to all aspects of the profession, including education, research, publications and lectures, and community service. Demers also was awarded the 2011 Clifton J. Latiolais Award from the American Society of Health-System Pharmacists. It recognizes indiviudals of high personal and professional ideals.

Rader is chief of Translational Medicine and Human Genetics, associate director of Penn’s Institute for Translational Medicine and Therapeutics, and director of Preventive Cardiology. His research focuses on genetic and pharmacologic regulation of lipoprotein metabolism and atherosclerosis.

DILLINGHAM NEW PM&R CHAIR Timothy R. Dillingham, MD, MS, has been named chair of Physical Medicine and Rehabilitation. He was formerly chair of Physical Medicine and Rehabilitation at the Medical College of Wisconsin. His research interests include the rehabilitation and long-term outcomes for amputees. He is also widely recognized as an expert in the electrodiagnosis of patients with limb symptoms and musculoskeletal disorders. Dillingham has received numerous honors, including the Distinguished Researcher Award from the American Association of Neuromuscular and Eletrodiagnostic Medicine, and is currently president of the organization’s board of directors. He won the Research Writing Award of the Association of Academic Physiatrists. Dillingham has published extensively in his field and has served in editorial positions on many journals and books.

WINKELMAN NEW CHAIR OF PENN MEDICINE Mark O. Winkelman, a member of the University’s Board of Trustees, has been named chair of Penn Medicine. He replaces James S. Riepe, who oversaw the opening of the Roberts Proton Therapy Center and the Translational Research Center, the renaming of the Perelman School of Medicine, and the transition to new leadership for Penn Medicine. “Mark is a thoughtful leader and a dedicated Penn and Penn Medicine trustee,” said University President Amy Gutmann. “His broad management experience and deep understanding of the Penn landscape will help assure Penn Medicine’s eminence and momentum.” Winkelman, who received an MBA from Wharton School, is a senior director of Goldman, Sachs, & Co. A member of Penn’s Board of Trustees since 2002, he serves on the Executive Committee, is chair of the Budget and Finance Committee, and also sits on the Audit and Compliance, and the Facilities and Campus Planning Committees.

Penn Medicine, WASHINGTON SQUARE Penn Medicine celebrated the official groundbreaking of its new Penn Medicine Washington Square (PMSW) facility. Located at 8th and Walnut Streets, the new 153,000-square-foot, $22 million facility consolidates Pennsylvania Hospital’s ambulatory and support functions in an ultra-modern, eco-friendly space. Medical practices and hospital departments currently housed in various buildings surrounding the hospital will come together in one location including Orthopaedic Oncology, Foot & Ankle Surgery, Urology, Otorhinolaryngology, Urology, Obstetrics and Gynecology, Infectious Diseases, Endocrinology, General Internal Medicine and diagnostic patient services. This additional building will allow Pennsylvania Hospital to reach its ultimate goal of an all-private room, acute-care hospital at its main campus. PMSW is scheduled to open in 2013.

NEW OUTPATIENT SERVICES Last month, Good Shepherd Penn Partners (GSPP) opened an 11,000-square-foot outpatient neurorehabilitation facility on the first floor of Penn Medicine, Rittenhouse. It offers orthopaedic/ sports medicine, rehabilitation and specialized services for people with neurological issues, such as stroke, brain injury, spinal cord injury, and multiple sclerosis. The new facility’s staff members include five specialized neurorehabilitation therapists.

The state-of-the-art outpatient site includes: speech therapy.

• Rehabilitation technology, such

as the AlterG Anti-Gravity Treadmill.

• A 60-foot track with a special

non-slip, lower-impact surface

• Motion analysis equipment for

golf swings, running, and gait.

• Amputee rehabilitation program • Hand therapy

SYSTEMnews SYSTEMnews EDITORIAL STAFF: Sally Sapega, STAFF: M.A. EDITORIAL

GSPP

• Physical, occupational, and

Susan Domchek, MD, director of the Cancer Risk Evaluation Program at the Abramson Cancer Center, received the Cancer Control Award from the Southeast Region of the American Cancer Society. This award recognizes an individual for a non-research activity that made a major or unique contribution to clinical practice, education and training or administration. The focal point of Domchek’s work has been raising awareness for breast cancer and its screening processes to the community at large, while dividing women into risk groups so that the appropriate screening and prevention measures can be utilized.

• An ADL (aids of daily living)

area for helping patients regain the ability to do daily activities at home.

• Wheelchair Seating and

Mobility Clinic

• Separate gyms for orthopaedic

and neurological patients.

For more information or to schedule appointments, call 215.893.2500.

Editor Sally Sapega, M.A. Editor Pamela Furches Design Graphic Design Trissy Harding Graphic Design

ADMINISTRATION: Marc Kaplan ADMINISTRATION:

Director of Communications Marc Kaplan Director of Communications Susan E. Phillips Senior Vice President, Public Affairs Susan E. Phillips Senior Vice President, Public Affairs

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