Penn Medicine News Blog: Posts by Greg Richter

Most Penn Medicine CAREs grants expand existing programs or start new ones that support community health. In the case of the Children’s Hospital of Philadelphia (CHOP) Violence Intervention Program, a CAREs grant extends a program already making a difference that may not have received enough funding otherwise.

As policymakers, patients and healthcare clinicians begin to find their way through the maze of changes outlined and endorsed under the Affordable Care Act, some providers are calling for further restructuring to address what they call missed opportunities in the legislation. While the guidelines aim to improve the quality of care delivered to patients and simultaneously reduce cost growth, it seems to the focus is largely on patients with certain illnesses, such as heart disease. Though the benefit to those patients is no small feat, health care reform directed at the large and costly cancer patient population is being overlooked according to a new commentary published this week by JAMA Internal Medicine and authored by faculty at the Perelman School of Medicine at the University of Pennsylvania.

Now, almost a year later, new prostate cancer screening methods are garnering national attention, and a Reuters article earlier this week discusses the cautious approach towards PSA testing taken by the American College of Physicians. A recent New York Times article suggests that these new tests can decrease the number of “false alarms” from elevated PSA readings and prevent thousands of men from receiving unnecessary biopsies, surgeries, and radiation treatments. Some of the new tests look at the genetic workings of a cancer to identify dangerous tumors that need treatment, rather than slow-growing ones that may be best to monitor only.

Considering these new discoveries, I checked in with David Lee, MD, FACS, assistant professor of Surgery in Urology, to see if any of these new tests influences the treatment he provides for patients.

As an undergraduate student, Bonacci studied Spanish and studied abroad in Argentina. Bonacci also studied tubercolosis epidemiology and tobacco use in Mexico on a Fulbright scholarship. Considering this background, this second year Perelman School of Medicine student jumped at the opportunity to volunteer at Puentes de Salud, a nonprofit health clinic in South Philadelphia supporting all groups, but focusing on its growing Latino community.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all areas of Penn Medicine.

Approximately one in five men aged 40 and older experience moderate to severe erectile dysfunction (ED). Now, a study published Jan. 29 in the journal PLOS Medicine suggests that the problem may go hand-in-hand with an array of heart problems, particularly coronary heart disease.  The Australian study followed 95,000 men ages 40 and older for two to three years. During the study period, more than 7,800 of the participants were admitted to the hospital and 2,304 died.

The study, which accounted for other heart disease risk factors, including smoking, physical activity, and others, found that men with ED were 60 percent more likely than those without erection problems to need treatment for heart disease, and they had double the chance of dying during the study.  

Urologist Joseph F. Harryhill, MD, FACS specializes in these sexual issues when treating his patients. Below, Harryhill discusses if this study changes how he treats ED patients, the connection between ED and heart disease, and treatment options.

Across Penn Medicine, practices continuously seek out ways to support their communities.  During this season, those sites also aim to bring joy to patients and staff; some of whom may not be able to spend the holiday season with loved ones. Many Penn Medicine community practices, Clinical Care Associate practices, and Penn Home Care and Hospice Services celebrated the Holiday season in unique ways. Here are just some of the ways Penn Medicine helped brighten the holidays for those in need:

When Maxine Hobson, program coordinator of Penn’s Biological Basis of Behavior program (BBB) invited schools to this year’s Penn KidsJudge! Neuroscience Fair, she explained that the third graders would not only be learning through hand-on activities, but they would also judge the work of Penn undergraduate and graduate students. One of the third graders cautiously took on this responsibility, expressing to program leaders that he “didn’t want to give one of the Penn students a bad grade.”

Hurricane Sandy’s impact on the Philadelphia region did not dampen the Halloween celebration at the Hospital of the University of Pennsylvania’s Intensive Care Nursery (ICN)! The Third Annual ICN Halloween Party provided a unique way for parents to celebrate the first Halloween of these tiny babies, many of whom were born weeks and months too soon and are now being cared for by specialized nurses and physicians while they gain weight and learn to breathe, eat and grow well enough to go home with their families.

"The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick, the needy, and the handicapped,

Not having a roof over your head, knowing where your next meal will come from, and/or having insufficient access to proper sanitation is a dangerous reality for the estimated 11,757 homeless people in our region, according to the National Alliance to End Homelessness.

Since 1986, Family Promise works to fight these tragic numbers nationwide. Grown significantly from its inception, now 5000 congregations in 41 states comprise 171 networks nationwide. One of those networks started in 2005 in Gloucester County, New Jersey.

It’s 8:30 a.m. at Infant Friendship Center (IFC) of the Montgomery Early Learning Centers (MELC). Already bustling with activity, storytime on one floor, kids learning letters and numbers in the next room, sing-a-longs on another floor, the center has been hopping since it opened at 7 a.m.

Chris Ambrose, MELC center director, explained that this sight is actually scaled down from when child enrollment greatly increases in mid-September.

Now in its 49th year as a nonprofit, MELC strives to deliver high quality, early childhood and school age programs regardless of the families’ ability to pay.

“Too often early childhood education is viewed as childcare, but it really is much more than that,” said Ambrose. “We do lessons, learning standards, and individualize the program for the overall development of each child.”

At MELC, these 2-5 year olds are empowered with beneficial social and academic skills that many of their peers do not have going into kindergarten. The wide majority -- 85 percent -- of a child’s core brain structure is formed by age 3, making places like MELC integral for developing young minds in Philadelphia.

“A child with a good foundation can go on to be a successful learner and do great things in life,” said Ambrose. “Without that foundation, it can be a struggle.”

Groundbreaking research at Penn Medicine improves quality of life for many and saves countless lives every day, so it is easy to imagine how presenting these critical studies in journals and to various audiences can always be a challenge.

So, what is the most effective way to display complex medical research discoveries in journals and in presentations to various audiences?

The office of Biomedical Art and Design offers that solution to many researchers at Penn Medicine.

Operating out of a small office in John Morgan Building, Mary Leonard and Anne Pugh offer important presentation services to the Penn community.

“We have a unique opportunity in Biomedical Art & Design to help scientists and other professionals communicate their ideas and their science visually,” said Pugh. “We strive to do so in a way that is as clear and sound as possible.”

(From left to right: Hugh Hamilton, Peter Chansky, Ranjoo Prasad, OD, and Douglas Worrall)

Six years ago, an assessment surveying the top health needs in East Parkside determined that eyesight was the greatest need. After receiving the results, Ranjoo Prasad, OD, clinical associate at Scheie Eye Institute and UCC, worked with colleagues at Scheie Eye Institute to implement a program to address eyesight issues in East Parkside over the next few years.

In 2009, another assessment found that eyesight was back on top of East Parkside’s health needs. Taking charge, Douglas Worrall, student at the Perelman School of Medicine, applied for a Penn Medicine CAREs grant and secured funding for a vision program at UCC.

From Left to Right: Wanda Rogers, RN; Aliya Rogers, RN BSN; Darlene Andrews, LPN; and Dolores Stanford, RN.

Aliya Rogers, RN, BSN, is well versed in Hospice care. As a nurse case manager at Penn Wissahickon Hospice, Rogers manages a census of hospice or pre-hospice patients, including visiting them three times a week in their homes, overseeing their medication, and serving as a liaison between patients and their doctors.

Her mother, Wanda Rogers, RN, a charge nurse on the skilled care unit at Pennsylvania Hospital (PAH), works with patients who no longer require acute hospital care, but still need medical attention before they are sent home.

In April 2012, Wanda shared with her daughter her lifelong dream of contributing to the community through social and health education. The two brainstormed ideas with Darlene Andrews, LPN, and Delores Stanford, RN, BSN, both of Pennsylvania Hospital’s skilled care team with Wanda, along with Bishop G. Cherry of Hew Hope Outreach Center and close friend June Jones, to find a solution.

The group founded Health Education Referral Outreach Project (HERO), an organization dedicated to providing vital health resources for a diverse population in Philadelphia’s Germantown section, and for seniors living near PAH.

“We’re seeing what my mother wanted to do for so long now come to fruition,” said Aliya Rogers. “She and I work on opposite sides of the continuum of care, and this program assists patients on both sides.”

Working with pre-hospice patients who receive treatment for a chronic disease or cancer, but are not acutely sick and cannot stay for a long period of time in a hospital, Aliya knows gaps in modern medicine.

“There are a lot of people who fall between the cracks. There are people who need monitoring, advice, and more, and do not qualify for home care,” said Aliya. “HERO helps bridge that gap.”

HERO hosts weekly clinics at New Hope Outreach Center with nursing assessment, vital sign screenings, and health care referrals as well as community health fairs with screening and education for Germantown residents. The group also plans to expand Wanda’s innovative Falls Prevention program, originally developed for her patients and colleagues at PAH. HERO hopes to begin presenting the program to selected assisted living and skilled nursing facility residents and staff members beginning this autumn.

After the United States Preventive Services Task Force (USPSTF) recently recommended against routine prostate screening for most men, the American Society for Clinical Oncology (ASCO) says that some of those groups could benefit from regular testing, the Associated Press reports. As the debate on PSA testing continues, Alan Wein, MD, chair of the Division of Urology, weighs in on the ASCO findings and what he recommends for patients.

Top row- left to right-Jean Thelisma, Beth Attig, Kim Wooding, Karla McIntosh

Bottom row-Marisse Thelisma, Johanne Louis, Michelle Edwards, Mitza Jeune

 Since its start in 2004, the Vermase Foundation, a faith-based non-profit relief organization based out of Upper Darby, provides food, medicine, clothing and other necessities to those facing famine, poverty, or natural disaster.  The group’s work in West Philadelphia, often through the First Haitian Church of God at 6219 Lancaster Avenue, is most commonly seen through comprehensive health clinics with screenings and education, and efforts to refer community members to low-cost health care services.

“That population is in real need,” said Johanne Louis, RN, MSN, CRNP, nurse practitioner at the Hospital of the University of Pennsylvania and Vermase nurse volunteer. “As a congregational nurse on Sunday, I see many patients with high blood pressure, diabetes, and other chronic medical problems. All too often, many of them go untreated due to lack of access, low-income, and sometimes not knowing how to get medications and important services.” 

While supporting Philadelphians in need, the organization’s care is also provided as far as Haiti, where it is still vital as the nation continues to rebuild after 2010 cholera outbreak and a 7.0 earthquake claimed the lives of more than 220,000, left more than 300,000 injured and 15 percent of the country’s population homeless.  The foundation sent hundreds of pounds of food and supplies to Haiti after the earthquake. The foundation aims to build a nursing home in Haiti next.

Last April, Vermase worked with the Lions Club and sent 650 eye glasses and hired five doctors from Haiti to see kids and check their eyes. Vermase also helps fund education for youth in Haiti.

With support from a Penn Medicine CAREs grant, the foundation was able to hold a health fair at The Haitian Church of God, and buy new stethoscopes, blood pressure cuffs, water, tables, and other equipment. Many of those supplies will be used in future health fairs.

For more information about the Vermase Foundation, visit their website.

Pelvic floor disorders are not always easy to discuss, particularly as the three most common types of pelvic floor disorders are urinary incontinence (lack of bladder control), fecal incontinence (lack of bowel control), and pelvic organ prolapse (the uterus, bladder and/or bowel may fall into the vaginal area). At the same time, the NIH reports that nearly 25 percent of women experience pelvic floor disorders.

Service Link at Sayre Removes Barriers to Medical Care in the Community

Located at 59th and Locust, The Dr. Bernett L. Johnson Jr. Sayre Health Center is a full-service, primary care health facility serving the needs of West Philadelphia residents since it opened in 2005. Like many health care providers nationwide, Sayre focuses on promoting good health, preventing disease and offering critical primary care services that are sometimes hard to come by for low-income families. Since its founding in 2010, Service Link helps eliminate stumbling blocks to receiving comprehensive care.

First row: Jessica Zha, Lova Sun, Pandora Chua, Nancy Aitcheson Second row: Vishal Arora, Ben Ranard, John E. Nawn, Alex Rosen

Service to the community goes hand-in-hand with becoming a practicing physician, and it shines through the medical clinic operated by Perelman School of Medicine students at the University City Hospitality Coalition (UCHC).

 The UCHC started in October 1984, after a homeless man, Stanley Biddle, froze to death while asleep near 38^th street. Offering one weekly meal at the group’s start, this non-profit organization has grown into a much larger force for good in West Philadelphia, offering a daily meal (except Sundays during Passover) and many other critical services for homeless or low-income community members.

Many of those critical services are delivered by a medical clinic staffed by students from the School of Medicine and other Penn students. The clinic offers various screenings, vitamins, information on social services, and more on Wednesday nights. A legal clinic and dental clinic is also available many Wednesdays. A new $1,500 grant from Penn Medicine CAREs, will further support their work, such as the implementation of an electronic medical records system and a new vaccine program.  

Last year, Sharon Civa, Entity Information Officer, Corporate Information Services, had a lifelong family friend who was admitted to the inpatient hospice unit at Penn Medicine at Rittenhouse. During the month that her friend was in the unit, Civa often visited and admired the work of the team caring for her. After her friend passed away, Civa wanted to give back to those who gave so much in their compassionate care.

“I’ve worked for hospice for 12 years, and I’ve always loved the work that they do,” said Civa. “I’m a big fan and supporter of hospice, but that’s what inspired me to become a volunteer.”

Sharon completed 16 hours of basic training in the volunteer program at Penn Wissahickon Hospice to be a patient visitor, as well as some specialty training sessions. Penn Home Care and Hospice Services has more than 100 volunteers doing a variety of services, including work in the office and spending time with patients both in the inpatient setting and in the community. “Caring for someone at the end of life stage can be hard,” said Civa. “It is very rewarding to help someone make that transition.”

Building on the therapy offerings already available, (including pet and music therapy), Civa joined other direct care staff in completing one of two pilot Reiki programs last year.

Reiki, a Japanese practice that can promote overall balance and wellness, can also support pain management and relieve stress and anxiety for hospice patients. Reiki is never delivered as a solution to any medical condition. Rather, it sometimes serves as a supplement to traditional treatment. For example, Reiki is offered at Penn Therapy and Fitness in Radnor and sometimes supports cancer care for patients at the Abramson Cancer Center.

Seeing Reiki’s success for patients here at Penn at Rittenhouse, Civa applied for a Penn Medicine CAREs grant so that additional volunteers can help meet the Reiki requests from hospice patients. Civa is now among 23 people – staff and volunteers – trained in Reiki.

Thanks to funding from Penn Medicine CAREs, ten existing patient volunteers, including two current employees, completed ten weeks of training, including four, two-hour supervised Reiki clinic sessions. The classes were held at Penn Hospice at Rittenhouse and the clinics were held at both Penn Rittenhouse and Park Pleasant Nursing Home. In exchange for the free Reiki training, the 10 volunteers all agreed to give four hours of Reiki monthly to patients for a year. 

Ellen Inglesby-Deering, BSW, volunteer coordinator, Penn Wissahickon Hospice, is ecstatic to see this available on a greater scale.

“It’s very exciting,” said Inglesby-Deering. “I’ve heard nothing but positive feedback from patients, families and volunteers. Therapeutic touch is so beneficial for our patients.”

“We’ve had reactions of people we saw,” said Civa. “Some laugh, some cry, some talk, some are quiet, it’s totally personal to that person.” Civa mentioned a patient with advanced dementia who giggled after the treatment and then started having a conversation with her daughter. The daughter later commented that she had not been able to have a conversation this beneficial with her mother in over a year.

Much as with traditional medical treatments, patients cannot receive Reiki treatment without consenting first. Depending on the patient’s needs, one Reiki session can range from 10 to 30 minutes.

“The Penn Medicine CAREs support has helped us diversify in the areas we are able to support,” said Inglesby-Deering. For example, one of the Reiki volunteers is a respected minister from a local church who can perform Reiki in addition to pastoral services.

Civa and the other volunteers graduated last week as Reiki Practitioners in the first degree.  (There are four levels in the program. Completing all four makes the participant a Reiki master and qualified to teach the practice.) The Reiki School and Clinic will continue some clinical supervision to ensure the Penn volunteers maintain competency from the training.

“It gave me perspective for what we do every day,” said Civa. “Now we’re done and looking to put it into practice.” 

Civa and others hope to gain more funding to expand the Reiki offerings to more volunteers who can use this skill for Penn at Rittenhouse hospice patients, as well as move on to additional levels of the Reiki practice.

Penn Medicine’s CAREs Foundation Grant Program was established in January 2012 to support and recognize faculty, student, and/or staff efforts to improve the health of the community and increase volunteerism in community-based programs. These programs have addressed health disparities, provided care to seniors, administered free medical care to homeless in Philadelphia, helped fund medical care for uninsured and underinsured, and more.

Each quarter, the Foundation awards grants of up to $2000 per project to community and hospital-based programs on behalf of the employee(s) or Perelman School of Medicine student(s) who volunteer their time to support the program. The funding is eligible for expenses related to initiatives in community health improvement services, health professions education, subsidized health services, cash and in-kind contributions, or community building activities.

For more information and to apply, please visit www.Pennmedicine.org/community and read about the program’s latest recipients on Inside Penn Medicine.

(from l to r: Sandra Kaplan, Jason Cohn, Harry Fisher, Kimberly Fisher, Hayley Fisher, Marion Leary, Jessica Dine, and Erin Sweeney)

Hailey is a five-year-old preschooler who loves Disney princesses, dolls, dressing up, Spongebob SquarePants and Mickey Mouse.  Hailey is also a voracious learner and is always asking questions. One of the top students in her class, Hailey is preparing for the next chapter of learning; her mother signed her up for kindergarten this week.

William Fahringer and Christopher Gorrell, PT, DPT

In 2005, William Fahringer tore his meniscus – the piece of cartilage that acts as a shock absorber for the bones that come together to form the knee -- while working as a plumber for the School District of Philadelphia. What seemed like an easy surgical fix began a cascade of issues that would change his life forever: he underwent 14 procedures in his leg, three knee replacements, and extensive nerve damage, all of which eventually led to his right leg being amputated in 2009.

Born February 22, at 32 weeks of pregnancy, weighing only four pounds, six ounces, young Xion Isiah Pygum experiences many of the same issues found in other babies who are born too soon. But he’s making great progress in the Neonatal Intensive Care Unit (NICU) at the Hospital of the University of Pennsylvania, where he slowly gains weight and learns to breathe better. At first, the tiny boy had to be fed through a tube, but is now breastfed – a key achievement that will help him go home.

Pygum is among the more than 12 percent of babies who are born prematurely -- before the 37th week of pregnancy in the United States each year. Last month, the Department of Health and Human Services designated more than $40 million in grants to combat rising numbers of premature births nationally. The number of preterm births in the U.S. increased by 36 percent over the last twenty years.

Perelman School of Medicine student Dan Hashimoto recently made Penn Medicine proud when he claimed the top spot in the Top Gun Laparoscopic Skills Challenge at the annual Clinical Congress of the American College of Surgeons (ACS). Hashimoto defeated a chief resident and a third year surgical resident from another institution to become the first medical student to place first in the competition since its inception at ACS in 1996!

Dan Hashimoto with Dr. James Rosser, founder of the Top Gun Laparoscopic Skills Challenge

The American College of Surgeons hosts the Top Gun Laparoscopic Skills Challenge on the first three days of the conference. The Penn surgery team advanced to the finals, beating out 30 other medical students, residents, fellows, and attending surgeons.

As Hashimoto writes in his Perelman School of Medicine blog post here, he credits those results to guidance he received from Noel Williams, MD, Kristoffel Dumon, MD, Kenric Murayama, MD, and residents and fellows in the Department of Surgery and helpful training at the Penn Clinical Simulation Center.