Penn Medicine News Blog: Posts by Holly Auer

This week, when Oscar-winning actress and humanitarian Angelina Jolie revealed that she underwent surgery to remove her breasts after learning that she carries one of the BRCA gene mutations that put her at high risk of developing breast and ovarian cancer, the news hit home here at the University of Pennsylvania. Just a year ago, Penn announced the creation of the Basser Research Center for BRCA, which was made possible by a $25 million gift from Penn alums Mindy and Jon Gray, in honor of Mindy Gray’s sister, Faith Basser, who died of ovarian cancer at age 44. As the only center in the United States devoted solely to research on prevention and treatment for cancers related to BRCA mutations, Jolie’s story turned a spotlight on the important work in progress there, and the experiences of the many other families with similar cancer risks.

This week, Susan Domchek, MD, executive director of the Basser Center in Penn’s Abramson Cancer Center, spoke with numerous national and Philadelphia-area media outlets, including the New York Times and Bloomberg News, all of whom were grappling with the larger questions prompted by Jolie’s disclosure. How many other women also face these same risks? Who should undergo genetic testing? Is having a mastectomy the only choice to cut risk?

These are issues that Domchek’s team in the Basser Center – which includes genetic counselors specifically trained to help people understand their genetic risks and create a personalized risk-reduction plan – confront every day, especially as the pace of genetic testing races forward and patients find themselves with more information about their potential risk than ever before.

Women who develop breast cancer while they’re young are often searching for answers about the cause for their disease or what they can do to improve their chances of being cured. While an increasing number of large genetic testing panels promise to scrutinize their DNA to uncover clues, a team of researchers from the Perelman School of Medicine and the Abramson Cancer Center has found that those powerful tests tend to produce more questions than they answer. The group presented their findings earlier this month during the American Association for Cancer Research Annual Meeting 2013 in Washington, D.C.

Sometimes, these tests reveal deleterious – clearly bad – mutations in genes that are associated with an increased risk in developing cancer. When women test positive for mutations of the BRCA 1 and BRCA 2 genes, they may opt for mastectomies and ovary removal surgery – which research shows slashes their risk of developing those cancers. However, there is not yet guidance for clinicians on how to care for patients who exhibit these other types of mutations. The new study also uncovered many of what are known as variants of unknown significance (VUS) – genetic wrinkles that experts don’t yet know how to interpret.

“We’re in a time where the testing technology has outpaced what we know from a clinical standpoint. There’s going to be a lot of unknown variants that we’re going to have to deal with as more patients undergo large genetic testing panels,” said the new study’s lead author Kara Maxwell, MD, PhD, a fellow in the division of Hematology-Oncology in Penn’s Abramson Cancer Center. “It’s crucial that we figure out the right way to counsel women on these issues, because it can really provoke a lot of anxiety for a patient when you tell them, ‘We found a change in your DNA and we don’t know what it means.’”

Researchers will gather to delve further into these topics tomorrow at the first Basser Research Center for BRCA Symposium.

Cover image via TIME.com

This week’s TIME magazine makes an eye-catching, bold proclamation. HOW TO CURE CANCER, the cover reads, with a subhead previewing the story contained inside: “Yes, it’s now possible – thanks to new cancer dream teams that are delivering better results faster.”

Much of that team science is happening right here at Penn Medicine, as part of Stand Up to Cancer’s pancreatic cancer “dream team.” As detailed in a News Blog post last fall before the third Stand Up to Cancer telethon, a Penn-led tumor tissue banking study is one of that dream team’s marquee achievements thus far. Since that trial began here, pieces of tumor from more than 60 patients with pancreatic cancer have kick-started a nationwide scavenger hunt that, bit by bit, is yielding new information that stands to shape a new, hopeful generation of treatments.

Under the direction of Jeffrey Drebin, MD, PhD, chairman of the department of Surgery in the Perelman School of Medicine, each patient’s tumor tissue is divided following their surgery and sent out to the other dream team institutions who study a variety of traits found within these tumors. Together, the team’s findings – essentially, the “secrets” of how pancreatic cancer cells use fuel inside the body, says Dr. Chi Dang, director of the Abramson Cancer Center -- are pooled and used to map out new treatment strategies.

“The needs that call Penn Medicine to action in the community are profound. Twenty-five percent of Philadelphians live in poverty – that’s nearly 400,000 adults and children – and one in seven city residents have no health insurance. Hunger and homelessness remain, still, throughout the city. These societal problems only make health problems that much harder to address, but doing whatever we can to help is in our nature here.”

These words – which open the 2013 edition of Penn Medicine’s Simply Because – are the guiding light behind Penn Medicine’s community service mission, which extends far beyond the walls of our hospitals. Each year since 2007, Penn Medicine has highlighted the work of its faculty, staff and students in Philadelphia and its neighboring communities in Simply Because, and we’re proud to unveil this year’s installment.

The new book is centered around three key themes that are at the core of Penn Medicine’s work in the community. Partnerships, with groups in the city – from churches to Philadelphia city health centers to barbershops – allow us to form unique collaborations that reach populations we might not otherwise be able to serve. Inspiration, often in the form of education, is the spark we hope to light in our faculty, staff, and students who volunteer, and the patients we help. And fresh solutions are what we’re constantly seeking when we consider ways to combat the challenges – like language barriers that keep patients from learning how to take control of their illnesses – that keep members of our community from becoming their best selves.

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.

The Pennsylvania HeartRescue Project, led by the Center for Resuscitation Science in Penn’s department of Emergency Medicine, has partnered with the American Heart Association and the Pennsylvania Bureau of Emergency Medical Services to form the “Lend A Hand, Save a Life” CPR Challenge, which launched last month and will continue through late May. The initiative aims to train 250,000 people across the Commonwealth of Pennsylvania in cardiopulmonary resuscitation (CPR). The goal? To equip more people with the simple skill that is so essential to saving the lives of victims of cardiac arrest, which remains a leading killer across the United States. In most cities, survival rates still don’t exceed 10 percent, and those numbers haven’t budged in 30 years, despite advances in so many other areas of cardiac care. Innovations like therapeutic hypothermia are helping move the needle and cut brain damage among cardiac arrest survivors, but the real opportunity to save lives comes before patients even get to the hospital, in the crucial moments right after they arrest – at home, on the street, on sports fields or running trails, in office buildings. Getting CPR quickly can double or even triple a person’s chance of surviving sudden cardiac arrest.

Although many people who’ve received CPR training in the past may recall it as a complex series of chest compressions and rescue breaths that need to be delivered in a specific ratio, research has shown that bystander CPR delivered “hands-only” style – with no rescue breaths – is also an effective strategy in teenagers and adults, since blood remains oxygenated enough to nourish cells in the brain and other parts of the body for several minutes. Hands-only CPR simplifies the traditional process, by calling for just three easy steps. First, call 911. Second, push hard and fast in the center of the victim’s chest (experts recommend humming or thinking of the Bee-Gees hit, “Stayin’ Alive,” which has the proper tempo – 100 beats per minute – to keep blood flowing adequately throughout the body). Third, send someone to find an automated external defibrillator (AED) and follow the instructions to shock the victim’s heart back into a normal rhythm.

From providing screenings for high blood pressure in West Philadelphia barber shops to arming women who are recovering from addiction with the skills to build new lives with their children, Penn Medicine’s employees reach far beyond our campus community to help, care for, and inspire people to improve their health. Each year since 2007, Penn Medicine has highlighted the work of its faculty, staff and students in Philadelphia and its neighboring communities in Simply Because. Last year’s book is full of the faces and stories of everyone who comes together to be part of these programs.

Production of this year’s book is underway now, and will be available early in 2013. This year, we’ll be featuring programs from across Penn Medicine – from longtime initiatives that grow to help more Philadelphia residents with each passing year to new, innovative ventures sparked with seed money from Penn Medicine CARES Foundation grants, which we’ve been detailing this year here on the News Blog.

Modern day medical imaging exams have become a critical diagnostic tool for conditions of all kinds – from detecting the earliest breast cancers, long before a tumor could grow large enough for a woman to feel a lump in her own body, to finding malformations in the hearts of tiny babies months before they’re ready to be born. The instruments developed to look inside the body to capture these images become more powerful by the day. “A patient can walk in and in just a few minutes, generate a gigabyte worth of data,” says James Gee, PhD, an associate professor of Radiologic Science and Computer and Information Science, who directs the Penn Image Computing and Science Laboratory (PICSL).

But the increasingly detailed pictures typically still require a human being – a radiologist, often with specialized additional training in areas like neuroradiology, musculoskeletal or cardiothoracic imaging – to examine the images, tease out the answers they hold, and use the information to arrive at a diagnosis, which will ultimately be used to shape the treatment plan.

This process can be painstaking: Mapping out the locations of all the different parts of a patient’s brain captured via magnetic resonance imaging, for instance, might take even an experienced clinician nearly a whole day to complete. Using a new computer algorithm developed by medical imaging researchers at Penn Medicine, however, that labeling process happens automatically, taking “zero time.” And perhaps more importantly, the computer’s answers are extraordinarily accurate, Gee says. If he showed unmarked images of a brain that was labeled manually versus one that was segmented automatically by the new algorithm – as shown in the image above -- and presented them to experts, they would “hard-pressed to pick which was done by the human.”

The new algorithm, which automatically finds and labels anatomical strictures in MRI scans, won first place in a Grand Challenge competition held during the recent International Conference on Medical Image Computing and Computer Assisted Intervention. Authors of the submission include Paul Yushkevich, PhD, Hongzhi Wang, PhD, and Brian Avants, PhD. In addition to the team’s win, more than a third of the entries from teams across the world were built using open-source image registration software developed in the PICSL, which won first place in a previous MICAAI competition.

The technology the algorithm is based on – homegrown at Penn beginning in the late 1980s [a1] -- is already widely in use at Penn Medicine in clinical research. Trials comparing changes in the brains of patients with Alzheimer’s disease to those of normal control subjects are one example. In the future, Gee said he hopes the time saved on manual labeling of radiological images of all kinds – across all types of imaging technologies, from those generated during obstetrical ultrasounds to cardiac CT scans – will lead to expedited diagnoses and quicker treatment for patients.

In time, he envisions that actionable diagnostic information will be obtained much quicker, making some of the delays associated making diagnoses a thing of the past. “Imagine taking someone’s blood pressure or temperature and it being some complicated process that took a long time, instead of getting just a number instantly,” Gee says. “Technology like ours is the wave of the future in medical imaging.”

Beach Boys music, hot dogs, sheet cake and feather boas aren’t the tools oncologists usually use to attack cancer. But along with powerful drugs and targeted radiation treatments, they’ve all played a big role in helping Debbie Hemmes, a 52-year-old Abramson Cancer Center patient from Westampton, NJ, fight lung cancer. After she was diagnosed early this summer, Debbie and her family – her husband, Tom, and two adult daughters, Kelly and Karen – learned she would need to undergo seven and a half weeks of radiation treatment, plus two six-day sessions of chemotherapy during that same period of time.

Debbie’s daughter, Kelly McCollister, quickly added her own prescription to the list: a special party during each chemo session to help her mom count down the days until she finished her treatment. “I’d heard of people doing parties for the last day of chemo, but I thought, ‘We should do a party every day!’” Kelly said. A trip to a party superstore got her creative juices flowing, and she and her sister, Karen, worked out a slate of themed parties that would see Debbie through her entire treatment.

Three years after Stand Up to Cancer, the groundbreaking partnership between the nation’s entertainment industry and the cancer research community, announced the formation of a group of scientific “Dream Teams” to fight some of the thorniest challenges in cancer research and care, Penn Medicine’s Abramson Cancer Center is well on its way to delivering on the promise of the innovative initiative. On September 7^th, the third Stand Up To Cancer telethon – a celebrity-studded live telecast to be broadcast on ABC, CBS, NBC, and FOX, featuring concerts from Alicia Keyes, Taylor Swift and Coldplay – will give the world a glimpse of what these physician-scientists have accomplished so far.

Armed with $18 million in funding, a group of Penn Medicine investigators who are a key part of the pancreatic cancer Dream Team are leading the nation’s most innovative pancreatic cancer research projects, which together have enrolled more than a thousand patients – nearly half the number who are participating in clinical trials for the disease across the board. Though pancreatic cancer is not among the most common forms of cancer, it is one of the most lethal, representing the fourth most common cause of cancer death. As many as 80 percent of patients who get the news that they have the disease will die within a year. Since the pancreas is tucked deep inside the abdomen, cancers there often grow silently, prompting no outward symptoms until the disease is advanced or has spread to other parts of the body. By that time, it’s typically not possible to remove the tumors with surgery, but other treatment options were scarce: Until recently, even the best chemotherapy agent for the disease only improved patients’ quality of life – helping them eat more, for instance, and have more energy -- but didn’t extend it by long.

Baligh Yehia, MD, MSHP, MPP, is a fellow in the division of Infectious Diseases in the Perelman School of Medicine. He attended this week's XIX International AIDS Conference and shared his thoughts about the work that lies ahead in the quest to eradicate HIV:

This week, HIV advocates, scientists, and patients gathered at the XIX International AIDS Conference in Washington, D.C. – the first time in 22 years the meeting was held in the United States. The group’s charge: mapping out a strategy to usher in an AIDS-free generation. The speakers came from all corners of the world, from politics and medicine to pop culture and business – Secretary of State Hillary Clinton, Senator John Kerry, President of the World Bank Dr. Jim Yong Kim, Sir Elton John, and Bill Gates among them – with a shared purpose. All highlighted the progress we have made since the last time the conference was held in the United States, and talked about the opportunity to, finally, turn the tide on HIV and AIDS. As the director of the National Institute of Allergy and Infectious Diseases (NIAD), Dr. Anthony Fauci stated, we’re in an era of unprecedented hope for this disease: “We are on scientifically solid ground when we say we can end the HIV/AIDS pandemic.”

Last week, the New York Times covered the story of a 12-year-old boy whose death this spring sheds light on one of the most time-sensitive and tricky-to-detect illnesses in medicine. The pre-teen died of severe sepsis in New York City apparently missed his infection before it spiraled out of control. The boy was seen by his pediatrician and in an emergency room, but clinicians thought he had a stomach bug, treated him for dehydration, and sent him home. Three days later, he died, after bacteria that snuck into his body through a cut on his arm – a small battle wound from a gym class basketball game – prompted a massive inflammatory response that caused his circulation and heartbeat to falter and his organs to shut down.

Sepsis researcher David Gaieski, MD, an assistant professor of Emergency Medicine in the Perelman School of Medicine and clinical director in Penn’s Center for Resuscitation Science, spoke this week with several news outlets about the issues raised by the case. ABCNews.com explored the reasons why these infections can be so difficult to identify when they’re easiest to treat:

The problem is that, in its early stages, sepsis causes symptoms that aren't much different from those of a viral infection that will go away on its own. Consequently, sorting out who can go home from the emergency department and who needs quick hospitalization can be tough.

"The thing that people are always looking for is the crystal ball that will tell whether this kid who doesn't look all that sick really is," says Dr. David Gaieski, assistant professor of emergency medicine at the Hospital of the University of Pennsylvania. "Right now there's nothing that is 100 percent able to do that."

This week, the Food and Drug Administration (FDA) approved a new prescription weight loss drug – the first in more than a decade. Advocates of the drug, which trials showed helped users lose an average of about five percent of their body weight, say it provides an important new weight loss option for the 35 percent of Americans classified as obese. But the medication, which will be sold under the name Belviq, is not without risks. Some studies showed that it could cause heart valve problems, an issue that echoes the reasons why the weight-loss drug combination known as Fen-Phen was pulled from the market in 1997.

A Penn medical toxicologist and emergency physician, Jeanmarie Perrone, played a role behind the headlines about the drug’s approval, as a member of an FDA advisory committee tasked with reviewing the data about the drug and making recommendations to the agency about whether or not it should be approved. Last year, Perrone began work with the Drug Safety and Risk Management Committee, which is convened to review any drugs for which there are safety concerns.

Drugs used in hospitals are meant to save lives – to battle infections, kill cancer cells, control pain, steady uneven heart beats, and prevent blood clots from forming when patients are unable to get out of bed and move around. But despite these healing powers, medication errors are common, and the consequences can be severe. According to the Food and Drug Administration, medication errors cause at least one death every day and injure approximately 1.3 million people each year in the United States. And countless so-called "near-misses" with incorrect dosing or drug mix-ups go unreported. In response, the federal government and hospitals across the nation have made cutting medication errors a cornerstone of patient safety initiatives.

Baligh Yehia, MD, MSHP, MPP, an Infectious Diseases fellow at the University of Pennsylvania’s Perelman School of Medicine, recently published a study in the journal Clinical Infectious Diseases examining the prevalence of antiretroviral medication errors among hospital patients infected with HIV. Medication errors are a risk during hospitalizations of all kinds, but HIV patients are especially vulnerable.

“HIV-infected individuals are at increased risk of medication errors because they have complex medication regimens, often deal with other medical conditions, and may encounter inpatient providers who lack experience with antiretroviral therapy,” Yehia said.

Errors with those medications can have serious long-term consequences if they’re not identified – potentially leading to drug resistance, treatment failure, or even death. Yehia and his co-authors from Penn and the Johns Hopkins University School of Medicine found ART medication errors – including incorrect or incomplete dosing, incorrect timing of administration, or administration of drugs that may have caused adverse reactions with one another -- in nearly 30 percent of cases studied. They noted, however, that the errors were quickly identified and corrected on the second day of hospitalization, at the time when pharmacists reviewed medication orders from the day before.

In a unique partnership between veterinary experts and physician-scientists who study and treat cardiac arrest in humans in Penn Medicine’s Center for Resuscitation Science, the same research that is saving patients who suffer cardiac arrests will now be put to use saving the lives of beloved pets. The Reassessment Campaign on Veterinary Resuscitation (RECOVER), announced this month, provides the first evidence-based guidelines on how to best treat cardiopulmonary arrest in dogs and cats.

Among humans, the survival rate for in-hospital cardiac arrest is around 20 percent, but less than six percent of dogs and cats who experience cardiopulmonary arrest (CPA) in the hospital return home for more opportunities to curl up on their owners’ laps, play fetch in the park, and nibble at special treats. Veterinarian Manuel Boller, medical director of the translational resuscitation intensive care unit in the Center for Resuscitation Science and a senior research investigator in Anesthesia and Critical Care in Penn’s School of Veterinary Medicine, a co-chair of the effort, said the new guidelines aim to settle longstanding disagreement and confusion among veterinarians about how best to treat small animals during these emergencies.

As doctors and medical researchers discover more effective cancer drugs that extend survival and increasingly, turn certain cancers into chronic conditions rather than certain deaths, cancer survivorship care is becoming an increasing focus for patients and doctors in specialties of all kinds.

Attention during last weekend’s American Society of Clinical Oncology meeting focused on studies of treatments that help the immune system battle cancer and approaches known as antibody-drug conjugates that deliver toxic, cancer-killing drugs directly to cancer cells without causing the side effects usually associated with treatment. Two studies presented by Abramson Cancer Center researchers, however, shed light on patients’ experiences as cancer survivors, and provide clues about how health care providers can improve their care for – and communication with – patients as they transition from life as cancer patients to cancer survivors. Their findings provide a road map for the nearly 12 million Americans – 1 in 20 adults -- who have survived some form of cancer.

Penn Medicine's MyHeartMap Challenge wrapped up a month ago, following an eight week, Philadelphia-wide search for lifesaving automated external defibrillators. Next week, we’ll be announcing the winner of the Challenge, so stay tuned to find out more!

Over 350 people/teams participated in the contest, hunting down more than 1,500 AEDs, in about 800 unique buildings around the city of Philadelphia. AEDs were most commonly located in office buildings, gyms and recreation centers, and schools. Each one of the AEDs found represents fresh chances to save lives from sudden cardiac arrest, which claims the lives of more than 300,000 Americans each year.

The Philadelphia residents who participated in the contest served as incredible informants for our research team, who had previously spent months canvassing the city on foot, capturing photos of only a fraction of the devices that the MyHeartMap Challengers were able to snap pictures of. Now, the team is hard at work analyzing the data submitted by contest participants, and they hope to soon publish the results of the nation’s first effort using crowdsourcing to save lives.

Among their goals, both in Philadelphia and in other cities where future MyHeartMap Challenges will be held: To help the city’s business owners make the devices more visible and accessible – many found were stashed away in basements or closets – and push for consistency in where the devices can be found during the emergency, much as fire extinguishers are in common locations.

“Finding AEDs during this contest was a very hard task – many AEDs, we found, are in places people wouldn’t think to look during an emergency,” says MyHeartMap Challenge director Dr. Raina Merchant, an assistant professor of Emergency Medicine. “But we’re so impressed with the creative ways people sought out devices and provided us with information that we’ll now be able to ensure that these devices are in the right place to save lives.”

The Choosing Wisely initiative, announced last week by the American Board of Internal Medicine Foundation, aims to spark conversation among both doctors and their patients about the types of tests and treatments that are likely to be unnecessary, and perhaps even harmful. More tests, the group explains, does not always mean better care – and overuse of these diagnostics is a huge contributor to the United States’ surging medical costs.

Among the potentially unnecessary tests being highlighted by the effort, which pulls together specialty organizations representing physicians who treat everything from cancer to allergies: EKGs or other routine cardiac screening for low-risk patients with no symptoms, CT scans for children suspected of having appendicitis or adults who’ve fainted and don’t have any other red flags for serious problems, and routine follow-up testing for certain breast cancer patients. The New York Times called the new effort "sound medicine and sound economics."

The issue of overtesting is a special challenge for emergency physicians. Most of the time, patients are unknown to them, and sometimes, unconscious or otherwise too sick to explain their symptoms or medical history. That often means starting from scratch with determining what might be wrong, and making calls to their previous physicians doesn’t always yield answers, especially during off hours.  “In the ER, I have to be more cautious because I have no doctor-patient relationship to rely on. I have no baseline for my patients,” says Dr. Judd Hollander, the director of clinical research for Penn’s department of Emergency Medicine, who studies emergency care cost containment issues.

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

Would you be able to find an automated external defibrillator if someone’s life depended on it? Despite an estimated one million AEDs scattered around the United States, the answer, all too often when people suffer sudden cardiac arrests, is no.

In a Perspective piece published online this week in the journal Circulation: Cardiovascular Quality Outcomes, Penn Medicine emergency physician Dr. Raina Merchant outlines the tremendous potential associated with greater utilization of AEDs in public places.  In cases of ventricular fibrillation – a wild, disorganized cardiac rhythm that leaves the heart unable to properly pump blood through the body, which is the leading cause of sudden cardiac death – quick use of an AED and CPR improve a patient’s chance of surviving by more than 50 percent.

But since the devices are sold through wholesalers, manufacturers have no way to track who purchases them and where they’re ultimately placed. That leaves two problems: No reliable way to connect bystanders with AEDs during emergencies, and no way to locate the devices during recalls or for regular servicing and inspection, like the process used to keep fire extinguishers in working order. Without a map of the devices, the more than 300,000 people who suffer cardiac arrest remain in great peril. Nationwide, just over 6 percent of these patients survive.

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

It’s Day 10 of Penn Medicine’s MyHeartMap Challenge, and more than 200 teams have signed on for the hunt, submitting more and more AEDs each day. From the farthest reaches of the city – all the way up in Northeast Philly’s Pennypack Park area to the Philadelphia International Airport in Southwest Philly – and throughout Center City, participants are snapping pictures and sending them to our team.

They’re providing us with lots of other helpful intell along the way, too. We’re already hearing about companies that are beefing up the number of AEDs they have on hand because they’ve heard about the contest and want to make their facilities more heart-safe. But MyHeartMap Challengers are also letting us know that the scavenger hunt isn’t always easy: Our team has received reports of contest participants being blocked from taking photos of devices in certain buildings, particularly when the AED is in a place that isn’t readily accessible near the entrance. Or, as MyHeartMap Challenge Director Raina Merchant’s own team learned when they previously tried to catalog AED locations themselves, some businesses balk at telling contestants if there’s an AED there at all. And when asked, some employees simply have no idea whether their building has an AED – even in some of the places where the Penn research team already knows there’s an AED.

Dr. Merchant’s message to help combat these barriers is simple: AEDs are a lifesaver, not a liability. And the devices can’t save lives if they aren’t there, or are stashed away in a closet or a drawer where no one knows about them. “We understand that businesses may fear that they’ll be held liable if their device doesn’t work, but think of the reverse: What if they don’t have one and someone needs it, or if they have one but no one knows?” says Merchant, an emergency physician. “By keeping the information guarded, no one will even think to reach for it – possibly cheating someone out of a chance to live.”

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

Just in time for the start of American Heart Month, Penn Medicine kicked off the MyHeartMap Challenge yesterday. For the first time, the wisdom of the crowd – and thousands of smart phones – will be put to work saving lives in Philadelphia. The six-week contest calls on “citizen scientists” to help Penn Medicine researchers locate and map the locations of all of the city’s automated external defibrillators, which are an essential piece of the so-called “chain of survival” necessary to save lives from cardiac arrest.

MyHeartMap Challenge Director Raina Merchant, an emergency physician who studies the growing role of social media in emergency preparedness and educating the public about cardiac arrest issues, estimates that there’s about 5,000 AEDs in the city of Philadelphia. But other than the obvious ones – clearly marked, say, on the walls of airport – no one knows where they are, meaning they’re likely to go unused precisely when they’re needed most. The inexcusable result? “Inevitably,” Merchant says, “people die every day, with a device nearby.”

She tried developing a map of the city’s AEDs the old-fashioned way, by sending a team of students out to canvas the city. But the shoe-leather approach proved daunting: In six weeks of searching, they were able to photograph only 100 of the devices, in 1,300 buildings they checked. MyHeartMap Challenge participants, on the other hand, located nearly that many devices during just the first day of the contest this week. After the team validates the information collected during the contest, Merchant plans to create an AED registry for the city’s 911 Center, and an app for the public to access when they witness cardiac arrests. (There’s 300,000 of them each year across the nation – that’s more than 820 a day, in every location you can imagine.)

A year into the Hospital of the University of Pennsylvania’s new Patient- and Family-Centered Care Initiative, big changes are in place to help our patients play a more active role in their care, and improve support for their loved ones during stressful -- and often frightening or unexpected -- hospitalizations.

The cornerstone of the initiative is a council of patient and family advisors -- about 15 current and former patients and family members -- who now have a seat at the table for efforts to improve everything from hospital dietary services to the processes with which patients’ possessions follow them through different locations in the hospital, to eliminate the loss of eye glasses, hearing aids, and dentures. Last summer, a HUPDate story introduced members of the patient and family advisors on the council to our hospital community. Garry Nichols, a two-time transplant patient shared his experiences speaking with Environmental Services staff to discuss the special concerns of transplant patients around hospital and room cleanliness:

He explained to the group that, because of the immunosuppressant drugs he must take to keep his body from rejecting his donated lungs, he must be hyper-vigilant about germs. In the hospital, for instance, he avoids restrooms in high-traffic areas, and seeks out those that have paper towel dispensers that operate by waving your hands in front of them rather than touching the sides of the dispenser. The evaluations that the environmental services staff returned after the discussion, Nichols said, were “absolutely incredible,” thanking him for the opportunity to share his story and provide them with such an personal perspective on why their jobs are so important. Mary Walton, MSN, MBE, RN, director of Patient/Family Centered Care, said she hopes to have more of these “story forums” where patients and their loved ones can connect with staff about issues that there’s so little time to discuss during the hustle and bustle of providing care in in-patient units and clinics.

We’re blogging once a week during Breast Cancer Awareness Month about the latest in breast cancer-related treatment and research at Penn Medicine. This week, we took a look at the latest studies underway around exercise after breast cancer.

The nation’s 2.4 million breast cancer survivors already have strength in numbers, and they’re a powerful lobby for research funding and public awareness campaigns about early detection of the disease, but ongoing research at Penn Medicine offers them the chance to gain literal strength.

Research led by Kathryn Schmitz, PhD, MPH, an associate professor of Epidemiology and Biostatistics and a member of the Abramson Cancer Center, has reversed decades of physical activity advice given to breast cancer survivors. After finishing treatment, these women have typically been told to avoid lifting much of anything heavier than a handbag – no grocery bags, no toddlers, and certainly, no free weights in the gym. Her research, published in the New England Journal of Medicine and the Journal of the American Medical Association, changed all that, laying out a specific weightlifting regimen that has proven to not only improve symptoms in women who already have the dreaded limb-swelling condition called lymphedema, but also to stave it off altogether among those at risk.

The work on lymphedema – so dreaded that women who took part in that trial said they were as afraid of getting it as they were of their cancer recurring – is just the start of Penn’s efforts to integrate the power of exercise into cancer care. Schmitz leads Penn’s new Transdisciplinary Research on Energetics and Cancer (TREC) Survivor Center, which is powered by a $10 million National Cancer Institute grant to study the relationship between exercise, weight loss, and cancer recurrence among the nation's 12 million survivors of the disease.

Media Teleconference Advisory: Penn Bioethicist Takes on Bachmann’s Claims on Vaccine Safety

Arthur Caplan, PhD, director of the Center for Bioethics in the University of Pennsylvania’s Perelman School of Medicine, last week challenged presidential candidate Michele Bachmann to produce evidence to back up her televised claims that the HPV vaccine – which prevents the strains of the virus that cause cervical cancer -- has "very dangerous consequences" including causing “mental retardation.” Combining forces with a University of Minnesota colleague, Caplan called on Bachmann to produce a person within a week that had, indeed, been made “retarded” by the HPV vaccine, as verified by three doctors that Caplan and Bachmann agreed upon. If the claims proved true, Caplan vowed to give $10,000 of his own money to a charity of her choice. If not, she would have to give $10,000 dollars to a charity of his choosing.

The challenge expires Thursday, September 22 at noon. To date, neither Bachmann nor representatives from her campaign have responded to Caplan. Instead, on Tuesday she indicated she had no information to support the allegations she made, and had merely been repeating a story she had been told. No case has been brought forward which satisfies the straightforward terms of Kaplan’s challenge.

But, the fear her statements prompted have important consequences for public health, Caplan says. He will be available to respond to questions from the media during a teleconference at 1:30 p.m. EDT on Thursday, during which he will discuss:

• the importance of providing factual information to the public about vaccines against cervical cancer and other illnesses
• the need for a science- and fact-based discussion about mandates for vaccines during political debates
• the need for partnership between medical professionals and the media to address vaccine fear-mongering tactics and their adverse impact on world health
• the importance of calling on candidates and politicians to account for their sources when citing biomedical science and health information for political purposes

"In running against vaccines, Bachmann is willing to dissemble and lie about vaccine safety to try and score political points," Caplan wrote this week on the Hastings Center Bioethics Forum Blog. "She is also apparently willing to sacrifice the lives of young women in the U.S. and around the world to cancer, as well as others who may die of whooping cough or flu to her political ambition by impugning the safety and efficacy of vaccines and vaccine mandates."

Members of the media who wish to dial in to Caplan’s Thursday teleconference are asked to contact Holly Auer at 215-349-5659 or holly.auer@uphs.upenn.edu to receive dial-in instructions.

UPDATE: Sunday, August 28, 2011
10:15 AM EDT

As Hurricane Irene pulls away from the Philadelphia region, Penn Medicine's facilities - the Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn Presbyterian Medical Center and Penn Medicine at Rittenhouse - report no disruption of service to our patients. We had previously obtained extra medical supplies and other provisions in advance of the storm and staff remained on site overnight to maintain operations. We will continue to monitor the situation closely but anticipate no further problems at this time, and we expect no changes to Monday appointments.

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Friday, August 26, 2011
1:00 PM EDT

As always, Penn Medicine puts the safety of our patients and staff first. With an eye toward the possibility of severe weather conditions associated with Hurricane Irene this weekend, hospital officials are meeting continuously to ensure smooth operations and full staffing for all four hospitals in the health system: the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital and Penn Medicine at Rittenhouse.

We are taking precautions against flood and wind damage within our facilities. Extra supplies of medical equipment, linens, food, and water have been obtained, and sleeping accommodations are being arranged for staff to stay overnight at the hospitals, if needed, to be in place during and after the storm.

Within hours of the U.S. Department of Health and Human Services' announcement that they planned to use a group of "mystery shoppers" to study access to primary care across the country, outcry erupted among physicians who felt the study was deceptive and unfair. "Snooping," one called it in the New York Times' coverage of the plan. A poor use of tax dollars, others said. Days later, the department announced they were putting the effort, which would have surveyed more than 4,000 physicians in nine states, on hold.

This week in the New England Journal of Medicine, Dr. Karin Rhodes, an emergency physician and health care policy researcher here at Penn's Perelman School of Medicine -- herself an expert in studies designed using the "secret shopper" method -- responds to the outcry in a "Perspective" piece aimed at taking the so-called "mystery" out of these studies. The technique is hardly new: It has a long history in other areas of the marketplace, where researchers have used it to tease out discrimination and disparities in employment, mortgage lending and housing access. Some critics of the plan felt it was unethical -- an entrapment of physicians, who would have no idea they were being audited. But when executed properly, Rhodes says, the studies employ concealment as a research tool in ways that are just as rigorous and ethical as the way in which drug trials are randomized and double-blinded to protect results from interpretation biases that may result when patients themselves or the doctors conducting the research know which patients are taking which drug.

A group of Penn Medicine researchers is set to save lives with cell phones cameras -- and they're challenging the public to help. The MyHeartMap Challenge, a contest that will launch this fall, is sending thousands of Philadelphians to the streets to locate as many automated external defibrillators (AEDs) as they can find. Armed with a free app installed on their mobile phones, contest participants will snap pictures of the lifesaving devices -- which are used to restore cardiac arrest victims' hearts to their normal rhythm -- wherever they see them, and use the app to tag the photos with location information and details about the device like its color and manufacturer. Then, they'll send them to the research team via the app itself or the project's web site. The stakes are high: People who find the most AEDs will win cash prizes, and the fruits of their efforts will save lives in the key minutes following cardiac arrest. Anyone can participate.

In pursuit of a cure, cancer patients must turn their bodies over to doctors, nurses and family caregivers. But the human touches that are ultimately meant to be healing – needle sticks for placement of chemotherapy lines and blood samples, positioning on the table for radiation treatments and imaging tests, and countless physical exams – often feel anything but soothing. The Beauty of Healing, a new salon-based program for women dealing with cancer that is helping patients at Penn’s Abramson Cancer Center, aims to inject a unique type of TLC into cancer care.

For one evening each month, the Jason Matthew Salon closes its doors to everyone but clients coping with cancer, who are treated to services and advice for the hair and skincare issues that tend to crop up during treatment – new haircuts, head shaving or wig styling to deal with hair loss, facials, massages, and makeup application to brighten tired eyes and dry complexions. All of the services are performed with an eye toward helping women buoy their self esteem, with a gentle touch to soothe the aches and pains that accompany some chemotherapy and radiation treatments. But the real goals far transcend offering women a fresh manicure and a sudsy shampoo.

“We try to reignite a spirit for them, and hope we can bring about some level of renewed hope,” says Joe Howe, who brought the Beauty of Healing program to Philadelphia after being involved in a similar venture with a salon he worked at in Ohio. “After everything they’ve been through, we just want them to be able to have a night of fun.”

One day after his wedding, construction company program manager Brian O’Keefe attempted a heroic feat – jumping into a parked truck that had begun rolling backward -- that left him near death on a PennStar chopper instead of on a plane to his Dominican Republic honeymoon. The truck ran over him, crushing his ribs, and injuring nearly all his internal organs – severing his liver and creating serious kidney and spleen problems. Under the care of the Penn trauma and surgical critical care team, he spent 17 days at HUP recuperating from his injuries.

Much of O’Keefe’s time in the hospital, back in the summer of 2005, is a blur, but what stands out is that, each time he emerged from unconsciousness, he recalls seeing a family member or a close friend sitting at his bedside. Their constant presence was soothing and reassuring, especially when he wasn’t yet able to understand what was happening to him. Even when he was conscious, O’Keefe felt he usually wasn’t capable of making decisions about his care, and he said the close partnership his family was able to forge with his caregivers was essential to his comfort and safety.

We hosted a group of more than 25 journalists this morning from the Association of Health Care Journalists meeting being held this week here in Philly. One of their stops on our medical campus was to the Roberts Proton Therapy Center, where they were guided by Dr. Zelig Tochner, the medical director of proton therapy in Penn's department of Radiation Oncology.

The Roberts Proton Center has been open for over a year now, and we've been talking to the media about it since the $15 million gift from the Roberts Family that helped build the center was announced back in 2006, when construction began. Over time, questions from the media have shifted -- to those about what this technology actually is, and how it's different from conventional, x-ray radiation -- to more nuanced queries, such as those discussed by reporters today. Among their questions: Since we're one of just a few centers -- and in some cases, the only one -- using proton therapy for certain cancers that are hard to treat with conventional radiation, how do our doctors determine which patients are the most appropriate candidates for the therapy? How does proton therapy make it easier to combine radiation with chemotherapy or surgical treatments? In 10 or 20 years, will proton therapy replace conventional radiation entirely?

Continuing coverage of Patient Safety Awareness Week

6ABC came out to take a peek at our interactive Nursing Patient Safety Unit this week. It's a simulation set up to highlight common hospital safety issues and errors, sort of like the medical error version of the "What's Wrong?" pictures on the back of Highlights magazine for kids. The unit, which is populated by three mannequins -- one a new mom and baby in an obstetrical scenario, one in an operating room setup, and one in a standard patient room -- is filled with safety problems. There's used needles and bloody gauze (all fake, of course) left out in the open, unlabeled medications , cords snaking across the floor, expired drugs, IV pumps that aren't set up properly, and patient confidentiality violations, among other problems. Some of the issues are plain to see even for lay visitors -- a newborn "baby" lying on top of a medication cart, for instance -- while others take the trained eye of the seasoned nursing staff passing through the unit, who fill out a worksheet documenting all the errors they can spot as they pass through the unit.

This mock patient safety unit -- which generated lots of discussion among the dozens of nurses who came to see it -- is one of many ways we're working to engage our staff in keeping hospital safety and quality issue at the top of our staff's collective mind.

But because we want to make sure our patients are our partners in safe care, it also offers lessons for the public. In the 6ABC story, Dr. Jennifer Myers, a hospitalist physician and HUP's Patient Safety Officer, shared her tips for how patients can speak up and work with their doctors, nurses and other hospital staff to meet this goal. Among her tips? Ask your providers if they've washed their hands before they interview or examine you, and always check to make sure your provider is aware of any tests or procedures you're about to have. Watch the segment to take a tour through the Nursing Patient Safety Unit (our portion of the segment begins at :46):

Continuing coverage of Patient Safety Awareness Week

According to the Food and Drug Administration, medication errors cause at least one death every day and injure approximately 1.3 million people each year in the United States. And countless so-called "near-misses" go unreported. The problem isn't specific to hospitals; it's also an issue in nursing homes, retail pharmacies, outpatient clinics, school nurse's offices, and in front of medicine cabinets in homes across the country. Errors can also happen when a doctor, physician's assistant or nurse practitioner writes a prescription, or even further back in the drug pipeline, if medicines are mispackaged or mislabeled at the factory where they're made.

Medication safety is an important priority at Penn Medicine, and steps are taken throughout the hospital, from the pharmacy to the bedside, to make sure patients receive the proper drugs.

Penn Medicine kicked off Patient Safety Awareness Week today, with a plethora of activities and training initiatives designed to get our staff members talking about and learning more about something that’s at the heart of our work here: Keeping patients safe while they’re in our hospitals. The Joint Commission National Patient Safety Goals for hospitals are a great starting point to learn more about why these issues -- which range from medication safety and infection control to staff communication -- are so important to us.

Last week, in a piece covering a new CDC report showing a 58 percent drop in central line infections among intensive care patients, the New York Times noted the terrific strides that HUP has already made at reducing these often-deadly infections even among patients on other units. Dr. Neil Fishman, associate chief medical officer and director of Healthcare Epidemiology and Infection Control and Prevention, shared the story of the Hospital of the University of Pennsylvania’s work to slash those infections throughout the hospital. Over the past six years, a combination of leadership initiatives, electronic infection surveillance, simple checklists to guide line insertion and maintenance, and improved wound care products all helped produce impressive results in central line safety.

In 2005, there were 40 to 50 central-line bloodstream infections at the hospital every month, Fishman told the Times. “That was our peak,” he said. “In 2011, we have zero to two every month. That took a lot of work from a lot of people, and a lot of dedication.”

But that’s just one of many stories we have to tell about why Penn Medicine is a patient safety leader. That team effort that Dr. Fishman mentioned is one key. The special events being held this week recognize the role that every staff member –- from security to our inpatient pharmacy to the labs where patient specimens are processed -- plays in keeping patients safe. This week on the Communications Department’s News Blog, we’ll be bringing you stories highlighting some of our most innovative initiatives for meeting -- and exceeding – these important goals. We’ll take you inside a special nursing simulation unit designed to put staff members’ eyes on potential safety pitfalls at the bedside, tell you about what are pharmacists are doing behind the scenes to ensure safe use of medications, and highlight a new project to prevent blood clots in patients who are confined to bed for long periods of time.

Patient Safety Awareness Week Updates and Stories

• Tuesday, March 8: Celebrating Penn Medicine's Unit-Based Clinical Leadership model: Team efforts to improve care
• Thursday, March 10: Making Medication Safety A Priority
• Friday, March 11: What's Wrong With This Picture? Nursing Safety Unit challenges nurses to identify simulated errors

When news about a practice-changing breast cancer study hit earlier this month following its publication in the Journal of the American Medical Association, newly diagnosed breast cancer patients at Penn Medicine's Abramson Cancer Center had questions. Many of the patients who called or brought up the study during their appointments in the days afterward had seen news stories about the study and were confused. Did these findings apply to them? Did they still need the surgery they had planned?

In stories on CBS3 and WHYY Radio that we pursued after the news broke, Penn breast surgeon Dr. Julia Tchou clarified the findings:

In fact, the study pertains to only a small, specific portion of breast cancer patients. That group includes women who have breast cancer that has spread to one or two of the so-called "sentinel nodes" under their armpit, but whose primary tumors are less than 2 inches (5 centimeters) in size and whose lymph nodes could not be felt during examination by their doctor. The findings show that, although these women must still have a lumpectomy to remove the tumor in their breast, they may be able to avoid having additional surgery to remove extra lymph nodes beyond those taken during their sentinel node biopsy to learn if the cancer had spread. (After surgery, however, patients typically still require chemotherapy or hormone therapy, as well as radiation, to wipe out any traces of cancer in their nodes and halt new tumor growth. Tchou notes that pathology information obtained from the lymph node biopsy can help oncologists to recommend and select the proper chemotherapy.)

Zachary Meisel, an emergency physician at the Hospital of the University of Pennsylvania who is also a Robert Wood Johnson Foundation Clinical Scholar, is Time.com's new "Medical Insider" columnist. A month into his new venture, he has taken on topics including the patient-directed "Google medicine" phenomenon, why abdominal pain is such a difficult, costly and frustrating symptom to treat in the emergency room, and how electronic medical records may -- or may not -- improve patient care. This week, his column convenes other leading minds in academic emergency medicine -- including another Penn emergency doctor, Angela Mills -- to discuss ways to reduce radiation exposure from possibly unnecessary CT scans during ER visits.

I talked with Meisel this week about what he's planning for the Medical Insider, which appears each Wednesday, and how his interest in this type of writing began. He points to his undergrad years at Columbia: As a history major, he wrote a thesis about how the American polio epidemic was framed, shaped, and ultimately transformed by the mass media. Later, in his first venture as a doctor-journalist, writing about quality of care onboard ambulances for Slate back in 2005, he found that writing for a lay audience actually pushed him down new paths for his research. "Much of the stakeholder feedback I got was very rich and helped me formulate the next research questions," he says. Eventually, those insights led to studies that he published in, yes, academic journals. One study that he first presented at the Society for Academic Emergency Medicine conference in 2009, showing that women with chest pain often don't receive proper care en route to the hospital, got plenty of media attention itself, including mentions in Good Housekeeping and Working Mother magazines.

Here's some other snippets from our discussion...

A new study out this week from the bioethics think tank the Hastings Center is giving a voice to a group of patients that we don't hear much from -- the cancer patients who join Phase I clinical trials. For any given early trial, this group is small in number, but taken together, these patients represent the future of cancer therapies. Researchers are asking a lot of these patients: To hand themselves over to science -- and an often rigorous, time-consuming regimen of drug dosing, doctor's appointments, and constant monitoring -- at a time when may have just a scarce few months left to live. At bottom, joining a Phase I trial is an act of altruism, since these studies are designed only to test safe dosage levels and tease out side effects associated with the new drug -- not necessarily heal the patients who sign on. Though their own lives may not be prolonged by the early incarnations of the new drugs, these patients' role in research paves the way for bringing safe and effective new medicines to the masses who will later be diagnosed with the same diseases. Patients join these trials often at the end of a long road of failed therapies or when their disease is diagnosed too late for conventional treatment options. Often, their only other remaining option is to go on hospice care and prepare to die.

The new study shows that, despite going through a detailed informed consent process outlining the risks and (likely small) benefits of the trial, nearly 60 percent of Phase I and II trial participants who were surveyed said that they believed their cancer would be controlled by the study drugs. Fewer than 40 percent of them reported that they believed they would experience a "health problem" from the trial drugs. Those figures are both far out of line with typical early trial outcomes -- the researchers called it "unrealistic optimism." But is it wrong to dash their hopes that they'll be among the lucky ones who are, in fact, helped by the drugs? Or does outsized hope somehow help patients fare better?

Cancer patients often say that their illness changed their lives in fundamental ways, both for better and for worse. Studies show that even amidst the uncertainty that the disease – and sometimes even with a terminal prognosis -- cancer can help patients find a new sense of purpose, peace, and a richer faith or feeling of spirituality. But what doctors don’t know much about -- yet -- is how the specifics of patients’ treatments impact these feelings, and whether any care that hospitals offer may impact this journey.

A new study from Penn Medicine’s Abramson Cancer Center, however, is helping point researchers down a new path for one day developing services that might help more patients find that place of spiritual growth and hope amid their cancer experience.