Penn Medicine News Blog Posts by Katie Delach

On Tuesday, April 9, local residents, sponsors, and 16 of Philadelphia’s best-known restaurants joined forces in the city’s first ever Wine and Dine for Women’s Health event, hosted by Penn Medicine’s Women’s Health Leadership Council. Proceeds from the event will support patient programs at the Helen O. Dickens Center for Women’s Health and the Hospital of the University of Pennsylvania that are critical to the health and well being of underserved women in the West Philadelphia community.

For over 40 years the Center has served generations of women living in the West Philadelphia community. In 1999, the Center was named for Dr. Helen O. Dickens, a remarkable woman and a pioneer who spent her career in academic medicine seeking to find ways to improve the lives of low-income women and their families. Dr. Dickens practiced obstetrics and gynecology in Philadelphia for over 50 years, joining the faculty at the University of Pennsylvania in the late 1960s. In 1967 she established one of the first multidisciplinary Obstetrical Programs in the United States for teen mothers. She was a life-long advocate for women’s health especially among the underserved, the youth, the vulnerable, and minorities in Philadelphia.

“Low income women often believe they must choose between feeding their families and paying for medical care that they personally need to help prevent and/or address health issues,” said C. Neill Epperson, MD, director of the Penn Center for Women's Behavioral Wellness. “Recognizing the unique balance between the physical and psychosocial well being of underserved women, the Helen O. Dickens Center for Women’s Health is providing access to comprehensive healthcare for these women throughout their lifespan. This Center is a great example of Penn Medicine’s dedication to helping improve the lives of women and their families who live within the local 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.

Research studies have shown that medications commonly used to treat attention deficit hyperactivity disorder – such as Adderall, Dexedrine and Ritalin – have a modest effect on blood pressure and heart rate, leading to concern amongst the medical community and the public at large about the potential cardiovascular risks associated with using these drugs. Now, a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania is helping to shed some light on the cardiovascular safety for adults using these common medications.

Using data from Medicaid and the HealthCore Integrated Research Database, Penn Medicine researchers compared the incidence rates of serious cardiovascular events in adults taking ADHD medications to rates in non-users. Incidents of interest were sudden cardiac death or ventricular arrhythmia, stroke, or heart attack.

Although ADHD medication users identified in the study were more likely to have pre-existing cardiovascular or psychiatric disorders, the study ultimately showed that adults using medication to treat ADHD were no more likely to suffer a serious cardiac event than non-users.

“It is reassuring that there’s a growing body of evidence showing no association between using these mediations and serious cardiovascular events,” said says Sean Hennessy, PharmD, PhD, associate professor of Epidemiology, and director of the Center for Pharmacoepidemiology Research and Training at Penn Medicine. “These new data provide further support that cardiovascular events are no more common in users of ADHD medications than in non-users," "The study expands upon previous and similar findings in studies that have focused specifically on cardiovascular health in kids using ADHD medications.”

Later this week, a cast of 15 local actors and actresses will take to the stage at The Playground @ The Adrienne Theater in Center City to share a story of one woman’s journey through life, and cancer. The Healing, billed as “a story of love, fame, hurt, and healing”, was written by Ontaria Wilson, physician secretary in the department of Radiation Oncology, based on her own experiences working directly with Radiation Oncology physicians and patients living “through” – not “with,” Wilson notes – cancer treatment.

The play tells the story of a woman in her 30s who is working as an up-and-coming actress when she is diagnosed with cancer. Wilson says inspiration for the story came from watching the “organic chemistry” she witnesses between patients and their clinical care teams on a daily basis. Focusing mainly on patient interactions with care teams, Wilson says everything in the show was born of a personal experience – either with a patient at Penn Medicine or as part of her father’s support system when he went through chemotherapy after being diagnosed with leukemia in 2006. The main character is loosely based on a former Penn Medicine patient with whom Wilson formed a bond, but Wilson says she hopes audiences will take from the play something much bigger than just the story of a woman living through cancer.

According to the Agency for Healthcare Research and Quality, more than 285,000 total hip replacements are performed each year in the United States. Since 1960, improvements in joint replacement techniques have greatly increased the effectiveness of total hip replacement, allowing adults suffering from chronic arthritis to get back to their daily lives without pain in as little as six weeks. While most artificial hip joints in use today will last 10-20 years, like all devices, the artificial hip joint – which replaces the natural hip bone with a metal ball and resurfaces the hip socket with a metal shell and plastic liner – wears out over time. For younger patients, this means a second surgery (and maybe even a third) will be required to replace the artificial joint. Fortunately, a rare procedure now being offered by specialists at Penn Medicine provides a long-term alternative for younger patients with chronic hip pain.

For 26-year-old Adam Segal, a Penn Medicine patient who started experiencing pain in his hip in the spring of 2011, a temporary fix that would wear out over time was no solution at all. Segal was approaching his final days as a law school student when he first started to feel pain in his hip. With the Bar exam just months away, he pushed the pain out of his mind and focused on his studies. Some time later, as the pain got worse and walking become onerous, Segal sought help from an orthopaedic specialist.

X-rays and an MRI confirmed Segal was suffering from bilateral osteonecrosis, also known as avascular necrosis (AVN) – a condition that occurs when bones lose their blood supply. When translated, “osteonecrosis” means “bone death.” Over time, the condition leads to severe pain and arthritis. “By the time I saw a specialist, I was walking with a limp,” he said. “My MRI showed the necrosis in both of my hips had advanced beyond the point where the typical theraputic procedures would help, so I started looking into my options. I didn’t want to get artificial joints that would wear out in 15 or 20 years, but my options were limited. Then, I heard about FVFG.”

During the first Presidential debate of the 2012 election season earlier this week, President Barack Obama and his challenger Mitt Romney went to the mat to discuss – among other topics – the future of health care in the United States. Though the two have opposing views on how to reform and improve the way health care is delivered in the United States, they did agree that there is a need for streamlined care in order to help reduce costs and readmission rates.

One approach President Obama highlighted was collaboration between doctors. Instead of individual doctors ordering tests, Obama noted the benefits of a team approach, where doctors from multiple specialties meet to confer on each patient’s care. The collaborative approach, he said, helps prevent duplication of services, and provides preventive care.

Also earlier this week, the federal government began its new system for financially penalizing hospitals when too many patients are readmitted within a month of being discharged. Currently, nearly 20 percent of Medicare patients are readmitted within a month, which the government considers a prime symptom of an overly expensive and uncoordinated system.

Recognizing the need for integrated, one-stop-shop care, Penn Medicine has for years focused on implementing programs and facilities that are designed to promote inter-departmental planning and consultation. In fact, the Perelman Center for Advanced Medicine, which opened in 2008, was designed specifically to promote this type of care delivery. Last week, Penn Medicine took another step toward offering comprehensive care in one location when it broke ground on the Penn Center for Specialty Care (PCSC), a new 272,200 square-foot 11-story tower in University City at Market and 38^th Streets that will provide patients with seamless care for same-day specialty consultations with a range of medical specialists.

One man’s refusal to let choroideremia slow him down

Earlier this year, the world paused to watch its greatest athletes take center stage and compete for the gold in the Games of the XXX Olympiad. The United States’ Michael Phelps became the most decorated Olympian in history, and the U.S. women’s gymnastics team became America’s newest sweethearts, seemingly overnight. For two weeks, millions around the world watched as athletes gave it their all for a chance at glory.

One event that we didn’t get to watch, though, was perhaps even more inspirational than Michael Phelps’ 21st medal. What we haven’t heard Bob Costas talk about is Penn Medicine patient 36-year-old E.J. Scott, who is dedicating 2012 to an epic battle against a hereditary disease that is slowly taking his sight. This year, E.J. is taking on 12 marathons, in 12 states, in 12 months -- and he’s running every one blindfolded. Though the self-described “non-runner” won’t be winning any medals, E.J. hopes that by running the marathons, he can inspire people to donate funds in support of research at the Perelman School of Medicine at the University of Pennsylvania that is making strides toward finding a cure for his rare condition. He is running against the clock, in hopes of finding a cure for the condition that also afflicts his brother and young nephew.

For most people, standard peripheral vision allows for a Field of View (FOV) of approximately 180 degrees. In 2003, doctors told E.J. that his peripheral vision was only 70 degrees in each eye. He was ultimately diagnosed with choroideremia – a rare genetic disorder that causes a progressive loss of vision. Now, just nine years later, E.J. is legally blind and has less than 15 degrees of sight in each eye. Though he is already legally blind, E.J. wears blindfolds and relies on the help of experienced guides  when running to help preserve the vision he has left as the harmful rays of the sun threaten to exacerbate his condition.

Though scientists have identified nearly 200 genes that play a role in vision loss due to degeneration of the retina, choroideremia is caused by variations specifically in the CHM gene. The disease – which occurs almost exclusively in males – typically begins with night blindness experienced in childhood, and progresses as “tunnel vision” – an irregular darkened ring that gradually expands over time, ultimately leading to a complete loss of vision. Progression of the disease continues throughout an individual's life. While there is no cure or treatment for choroideremia, researchers at the Penn Medicine are optimistic about treatments currently in development.

According to a recent New York Times article, the Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. By 2025, the gap is expected to double as the expansion of insurance coverage and the aging of baby boomers drive up demand for health care.

While patients will still receive care in the face of a doctor shortage, there is some concern that the process will become slower and more difficult. Looking toward the future and anticipating potential repercussions of a doctor shortage, some government agencies and officials are hoping nurses will be able to help fill the gaps. Despite a recent economic downturn which has negatively impacted many industries, job opportunities for nurses remain strong. In a recent article in ADVANCE for Nurses, Rhonda M. Zaleski, MS, RN, CHPN, corporate director, nurse recruitment and workforce planning at Penn Medicine, said that nurses with BSNs and those advancing their education are especially in demand.

Recognizing this need, on Monday the Department of Health and Human Services (HHS) announced that the Hospital of the University of Pennsylvania, along with four other hospitals across the nation, has been selected to participate in an initiative to train additional advanced-practice registered nurses (APRN). Nurses with this designation generally have post-graduate training and are able to diagnose illnesses, prescribe medication and treatment regimens, and perform procedures consistent with their scope of practice.

The HHS Graduate Nurse Education Demonstration, funded under the Affordable Care Act, aims to strengthen the nation’s primary care work force by placing more APRNs in practice and thereby increasing the ranks of primary and preventive caregivers to help fill gaps in non-hospital community-based settings, including in underserved areas.

When you turn 18, life can change overnight. At 18, you can apply for a credit card, register to vote, and sign your own legal documents asserting that you are officially an adult in charge of your own care. It might even be time to head off to college, or enlist in the military. But turning 18 also means it’s time to leave behind the only doctor you may have ever known – your pediatrician – and find a new adult doctor. During your visits you might be expected to know information about insurance coverage, your family’s medical history, or your previous vaccinations – it’s a process which can be confusing even for the healthiest of patients. But for the patients who rely heavily on their care teams for continued treatment and assistance with chronic diseases, the transition from pediatric to adult care can be downright overwhelming.

Easing the transition from pediatric to adult care for adolescents with chronic gastrointestinal diseases and disorders is the main goal behind the unique CHOP-Penn Transition Program and Center for Digestive, Liver and Pancreatic Medicine. Co-founded by doctors at both Penn Medicine and the Children’s Hospital of Philadelphia (CHOP), the program aims to provide adolescent patients with personalized support, educational tools and guidance that empowers them to take control of their care with confidence.

“Research shows that there’s a lapse in health care for patients right around 18-years-old,” said Anil Rustgi, MD, chief of Gastroenterology at the Perelman School of Medicine at the University of Pennsylvania. “What we hope to do for patients by providing personal guidance is to create a seamless transition from their pediatric to adult gastroenterologist.”

Penn Researchers Encourage Local Participation in Nationwide Cancer Study

This Sunday, more than 30,000 runners from around the world will gather in the athletic field at Philadelphia’s Central High School to take part in the 32^nd annual Blue Cross Broad Street Run, one of the largest ten-mile road races in the United States. This year, the event that takes participants on a course past the varied neighborhoods of Philadelphia will also jump start the enrollment process for a new nationwide cancer prevention study (CPS).  In partnership with the American Cancer Society, representatives from Independence Blue Cross and the City of Philadelphia are encouraging all eligible race participants, friends and family to enroll in the study, which aims to help researchers better understand the factors that cause cancer.

 The project, Cancer Prevention Study 3 (CPS 3), will examine the health and wellness of 300,000 individuals across the country from different backgrounds, ethnicities and geographic locations. The third study of its kind, CPS 3 is expected to provide researchers with valuable insight into the genetic, environmental, and lifestyle factors that cause or prevent cancer.

“There are a lot of factors that change over time, so we can’t assume that what we knew 20 years ago is the same today,” said Anil Rustgi, MD, chief of Gastroenterology at the Perelman School of Medicine. “Our environment and lifestyles have changed dramatically in recent decades, and it’s important to understand the role that these changes might play in cancer development.”

On March 27, 2012, 20 nurses from the Ocean Road Cancer Institute (ORCI) in Tanzania graduated from the first ever OncoLink Cancer Nurse Education Program, a pilot program started in February 2011 that aims to provide oncology nursing training in via e-learning courses. The program was created by oncology nursing experts at OncoLink®, a free cancer information website developed by experts at the University of Pennsylvania's Abramson Cancer Center.

 

With a population of nearly 40 million, Tanzania lies on the east coast of Africa between Kenya and Mozambique. The country sees roughly 21,000 newly registered cancer cases annually, of which more than half result in death. Located in the main coastal city of Dar es Salaam, ORCI is the only specialized center for cancer treatment in Tanzania. It provides both diagnostic and treatment services for cancer patients from all regions in Tanzania as well as other eastern and southern African countries. Of the 21,000 new cancer cases each year, only 10 percent reach ORCI. Of these, 75 percent to 80 percent are already in advanced stages, and, at the rate the number of cancer cases is increasing, cancer will likely be the dominant health issue in Africa for decades to come.

“We first learned about the cancer population in Tanzania and the ORCI at the African Organization for research and Training in Cancer’s (AORTIC) International Cancer Conference,” said James Metz, MD, associate professor and vice chair of clinical operations in the department of Radiation Oncology at the Perelman School of Medicine, who serves as editor-in-chief of OncoLink. “As we learned more about ORCI, we realized that there was this huge patient population, but the health care providers had this major dichotomy in the resources available. The nurses, for example, are an incredibly passionate group of people who are dedicated to their professions, but the education in oncology was almost non-existent. Additionally, though the ORCI had relationships with various organizations and received much of their technology from donations, they were lacking some of the most basic elements to provide quality care.”

In 1962, health care expenditures made up just five percent of the nation’s gross domestic product. Fifty years later, those figures have more than tripled, with the expenses now making up 17 percent of the GDP – the highest rate of spending growth of any developed country in the world. In the face of that ballooning spending, Katrina Armstrong, MD, MSCE, chief of the division of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania, suspects that the fast-growing field of genomics may be a source of meaningful cost savings.

Genomics is the study and testing of one person’s genes, as well as the interactions between those genes and with the subject’s environment. According to the Centers for Disease Control, genetic tests have been developed for more than 2,200 diseases, of which about 2,000 are now available for use in clinical settings.

Writing in the March 14 issue of the Journal of the American Medical Association (JAMA), Armstrong notes that despite being a new technology – and therefore often associated with higher health care costs – genomics can also be used to identify individuals who will show little or no benefit from a medical intervention, possibly because they have a low risk of suffering harm without the intervention, or because they will not benefit from the intervention. In either case, genetic testing could reduce the use of treatments that are unnecessarily expensive or that are unlikely to yield a benefit. The result is an overall cost reduction.

Total knee replacements have been an option for elderly patients with debilitating pain since the 1960s, but it was only recently that the procedure started being a cost-effective and realistic treatment option for younger patients who suffer from obesity, or who just want to maintain an increasingly active lifestyle. New research indicates that in recent years orthopaedic surgeons have seen a dramatic surge in the number of Baby Boomers suffering from rheumatoid arthritis, osteoarthritis, or injury to the joint – often resulting from increased activities such as marathon running, swimming, or even power walking. According to the federal Agency for Healthcare Research and Quality, knee replacements nearly tripled in people ages 45 to 64 between 1997 and 2009. Though still less common in younger patients, current estimates suggest that more than half a million Americans in their 50s have had the procedure. Based on current trends, operations in that age group are expected to increase.

“People are more active than ever before, and they don’t want to slow down or give up doing what they love because of pain in their joints,” said Craig Israelite, MD, orthopaedic surgeon at Penn Presbyterian Medical Center. “Our latest research is showing that with new materials and less invasive procedures, we can help younger patients stay active longer.”

With a growing trend of people opting for knee replacement surgery earlier in life, there is some fear of what that could mean for long-term complications. Research shows that patients with artificial knees can experience infections and other complications that eventually require additional treatment. And, artificial knees can wear out over time, some in as few as 15 years. As the trend continues and younger, more active patients receive artificial knees, there is an added concern that high-impact sports such as jogging will have a bigger impact on the joint than what was previously seen in older generations. The question, then, is: how many of these young will eventually need a second or third replacement?

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.

Due to the complex, interdependent nature of the human body’s internal organs, transplant specialists are constantly working to develop new procedures for disorders that extend beyond a single organ. Increasing success with single solid-organ transplantation over the last 50 years has helped propel the field into the more complicated realm of multi-organ transplantation. The first dual-organ transplant, which provided a 6-year-old Texas girl with a new heart and liver, took place on Valentine’s Day in 1984, but just over 100 heart-liver transplants have been performed in the nearly three decades since. Penn Medicine transplant physicians are at the forefront of this work, performing 19 of these combination transplants since 2002 – the second largest number of any transplant center in the U.S., most of whom have only done one or two of the procedures.

For patients with rare and debilitating conditions, simpler options are often limited – dual-transplantation can be the difference between life and death.

According to Alberto Pochettino, MD, associate professor of Cardiothoracic Surgery and director of the Lung Transplant Program and co-surgical director of the Adult Congenital Heart Disease Program at Penn Medicine, most patients who are considered for the dual heart-liver procedure are in their 20s or 30s and were born with a cardiac defect in which one of the two ventricles in the heart is normal, while the other is extremely small or absent entirely. Several conditions can lead to this malformation, the most common of which is Hypoplastic Left Heart Syndrome (HLHS), in which parts of the left side of the heart fail to develop completely. HLHS affects two of every 10,000 children born – about 7 to 9 percent of all congenital heart defects – but without proper care and immediate attention, the condition is fatal.

With only one normal ventricle, surgeons typically perform an early surgery that changes an HLHS patient’s blood circulation so they become dependent on the one normal ventricle. Blood that would usually be delivered to the lungs through the absent ventricle can be rerouted so that the lungs receive blood passively, without the assistance of a ventricle to pump blood into the lungs.

Patients can live with this passive circulation for years and years, but in order to have passive flow to the lungs, they often have slightly elevated pressure to get the blood down to the lungs. When that pressure remains elevated over the course of 20 years or so, the liver can suffer irreversible damage, resulting in advanced liver disease. 

For many people, feeling healthy is reason enough to put off scheduling a preventive exam, even when it’s doctors orders. For others, a busy schedule often gets in the way and there’s just no time. Still other patients put off exams because of cultural and socioeconomic barriers. Some patients, for example, experience financial constraints, language barriers, transportation needs, conflicts with work, and child or elder care demands that make it difficult or impossible to follow through the process of having a screening test. Regardless of the reasons for putting them off, screening tests are vital to everyday health and can prevent sickness or even death.

“Colorectal Cancer Screening (CRCS) has been proven to be an effective means for CRC control and prevention, yet CRC screening rates remain poor. Despite being preventable, CRC continues to kill a disproportionate number of African Americans each year,” said Carmen Guerra MD, MSCE, associate professor in the Department of Medicine at the Hospital of the University of Pennsylvania. “When we have the means to prevent just about every case of colorectal cancer through screening colonoscopy, these deaths are senseless and the racial disparity is a social injustice.  Each one of those cases is a painful case of cancer for someone's husband, wife, mother, father, son, or daughter.”

 

 

 

 

 

 

 

 

 

Carmen E. Guerra MD, MSCE, Michael L. Kochman, MD, FACP, Alicia Lamanna, Medical Assistant and patient liaison for the program and Josh Ramos, a Penn junior who was awarded a grant to work on the navigation project.

Together with the Wilmott Professor of Medicine, Michael Kochman, MD, FACP, Guerra is launching Penn Medicine and the Abramson Cancer Center’s West Philadelphia Gastrointestinal (GI) Health Outreach and Access Program, a patient navigation program that aims to improve the colorectal cancer screening rates for the residents of West Philadelphia by providing guidance and assistance every step of the way. They’ll help patients better understand the preparation process that comes before the screening, and provide assistance for transportation to and from the procedure, and financial assistance covering the costs. A patient navigator is a trained health care professional who works on behalf of the patient to identify and overcome potential barriers to obtaining a screening test. Patient navigators guide patients through the health care system to ensure completion of the screening test, and make sure that patients receive information that is matched to their level of health literacy. Originally developed to address racial and socioeconomic disparities in breast cancer outcomes, studies demonstrate that patient navigation programs can successfully increase colonoscopy screening rates among urban minorities. Other studies show that patients who receive navigation services report greater patient satisfaction.

In today’s world where many of us often share our most personal and private information online, status messages and photos posted on Facebook and other social media websites are providing health care professionals with an access point to identifying individuals at-risk of causing harm to themselves and others. One recent study from the University of Wisconsin, for example, shows how verbal and visual clues taken from Facebook profiles, such as references to drunkenness, can help health care professionals identify college students who are at risk of developing alcohol abuse problems. Now, a study from the University of Pennsylvania’s Perelman School of Medicine is providing a different twist on how using the Internet can make a difference in the health and well-being of college students.

The new study, published in this month’s issue of Preventing Chronic Disease, examines the websites of 426 colleges, including both small and large, 2- and 4-year institutions, in an effort to characterize how colleges use their web sites to educate about and promote health. The study conducted by J. Jane S. Jue, MD, MSc, a former Robert Wood Johnson Foundation Clinical Scholar at Penn and Joshua P. Metlay, MD, PhD, a professor in the division of General Internal Medicine at the University of Pennsylvania’s Perelman School of Medicine, suggests that many colleges and universities are missing out on this opportunity to make a difference in the health and well-being of students.

In examining the collegiate web sites, Drs. Jue and Metlay looked for the presence of information related to four major health categories: general health, reproductive and sexual health, substance abuse, and mental health. Each health category was further subdivided into specific content areas such as asthma and depression. Researchers also identified three web-based health delivery modes, including health information provided directly on web sites, outside web links to other health-related websites, and interactive web-based health programs such as online assessments or file available to download.