Volume 12

Issue 1

September 2012

SYSTEMnews
CEOs corner
RALPH W. MULLER

CEO, University of Pennsylvania Health System

UPHS is a broad but tightly connected health system. One of the things that unites us is an emphasis on making good use of shrinking health-care resources through programs and research that improve care, lower readmissions, and save dollars. For example, our transitions-in-care initiative keeps patients out of the hospital by making sure that theyre linked to primary care physicians, have the right medications, and in general, know what to do after discharge. Recently, four exciting UPHS projects that also aim to make patients healthier while saving money have been selected for funding by the federal government. The rst two are Health Care Innovation Award winners selected by the Centers for Medicare and Medicaid Services (see page 2). One, led by David Asch, MD, MBA, and Kevin Volpp, MD, PhD, will use remote monitoring and a visual and audible reminder system to improve medicationcompliance among discharged heart-attack patients in our area. It will also train social workers to provide additional monitoring as well as offer incentives to the patients for compliance and enlist the support of family members and friends to help keep patients on their regimens. This project builds on Dr. Aschs and Dr. Volpps impressive work applying insights from behavioral economics to improve patient health. The second, led by David Casarett, MD, chief medical ofcer for Penn Wissahickon Hospice and a member of our Department of Medicine, will test a full set of home-care services for Medicare and Medicaid recipients with advanced cancer but who are not yet eligible for hospice care. The project will provide symptom management, general care, and emotional and spiritual assistance to patients, enabling them to remain in their homes and avoid costly hospitalizations. It will enable Dr. Casarett and Penn Home Care & Hospice Services, where the initiative will be based, to play a leading part in shaping the future of home-based care. Next, our Center for Evidence-based Practice, in partnership with the ECRI Institute, has been selected by the Agency for Healthcare Research and Quality (AHRQ) as one of its 11 new Evidence-based Practice Centers. This major accomplishment means that Penn clinicians and researchers can bid for contracts through AHRQ (continued on page 6)
``  As part of their introduction into the world of quality and safety at Penn, a group of residents from multiple specialties worked together to save members of a Mr. Potato Head Family who were involved in a bus crash. The scenario required teamwork and taught the residents key communication strategies that are necessary for successful healthcare teams.

LEARNING SAFETY & QUALITY FROM DAY ONE

Together, Eugene Lin, MD, a second year Internal Medicine resident, and Kara Chenitz, MD, a fellow in Nephrology, knocked, then gently pushed open the door of the patient room on Silverstein 7. Hooked up to several monitors, the patient was sitting in a chair next to her bed. She seemed happy to have the company. After introducing themselves, and explaining the reason for their visit, the physicians began asking the patient questions about her experience in the hospital with the call bells. Throughout the Penn Medicine hospitals, small groups of residents were visiting patients and asking the same questions. They were all taking part in an exercise to observe how care is delivered in the hospital in real life to collect information, to understand what it is like to be a patient, and begin to think about ways that the process could be improved, said Jennifer Myers, MD, director of Quality and Safety Education at the Perelman School of Medicine and a recipient of a Macy Faculty Scholars grant from the Josiah Macy Jr. Foundation. After each group collected data on how long patients feel it takes a nurse to respond to a call button and related questions, the residents shared the information with the nurses and unit secretaries on the floor. Then, at the end of the day, the data were collected and provided to hospital leaders who plan to use it to make changes. We are learning a systematic way to identify a problem and then develop a way to improve it, explained Yevgeniy Gitelman, MD, a second year Internal Medicine resident. This exercise is actually a component of the Health System Leadership in Quality Track, a new program for doctors in training that is aimed at improving quality and safety across the Health System. It was born out of the Penn Medicine Blueprint for Quality and the new realities of health care. One of the first things we had to do was change the culture, Myers said. Although slightly difficult at first, experiences like the one above get residents to think about the hospital and the quality and safety of care in a whole new way. In order to change the culture, we had to enhance training for residents and get them more involved in quality and safety activities, she said. When a resident begins training at Penn, we set the expectations about quality and safety on day one, said Lisa Bellini, MD, vice dean of Faculty Affairs for the Perelman School of Medicine and program director for Medicine residents. Training the teachers in quality and safety education is another component of these efforts, which starts this month. Each residency program has begun sending one or two of its faculty for skills training to learn how to teach residents key quality areas. The training will cover on some of the most basic issues that involve the hospital patient. This year they will focus on the handoff between doctors, eg, transferring a patient from the operating room to the ICU, the best way to safely relay information between doctors when they change shifts at night, and all the components of patient discharge when patients are handed off to their primary care provider.

INSIDE
Two UPHS Projects Selected for Funding by Health Care Innovation Awards....................2 Penn Medicine@Work..............3 Newsmakers..............................4 If Hippocrates Had a Touch Screen......................... 5 Where Practice Makes Perfect........................... 5 A Camp That Helps Kids Feel Safe .......................... 5 Awards and Accolades.............6

How Patients Benet

Changes throughout the hospitals have already resulted from involving residents in quality improvement. The Discharge TimeOut that was created three years ago on Founders 12 and 14 is an example. It ensures each patient has an accurate medication discharge list. According to Jodi Savitz, MD, medical director of Founders 12, before the new policy was instituted, the discharge process was not clearly defined. There were no double-checks in the system, which can lead to medication errors one of the most dangerous complications of a hospital discharge that can result in return hospitalizations. Under the Discharge Time-Out, a core group consisting of a medicine resident, the patients primary nurse and a pharmacist conduct a medication reconciliation together. They compare the proposed discharge medication list with both the admission medications and the current hospital medications.
(continued on page 6)

see them, said Asch. So many of our health outcomes depend on what happens outside of these visitswhat we do when we are at home or at work, and whether we take our medications, exercise, and follow healthy diets. The project will also retrain social workers as engagement advisors to monitor adherence, offer incentives, and enlist patient support from family and friends. The result will be improved health outcomes and lower cost. The $4.8 million-funded program will train an estimated 21 workers, while creating an estimated seven jobs. The project is estimated to save CMS $2.7 million.
`` (L to r): David Asch, Kevin Volpp, and Davd Casarett.

Meeting the Needs of Advanced Cancer Patients

TWO UPHS PROJECTS SELECTED FOR FUNDING BY HEALTH CARE INNOVATION AWARDS
The Centers for Medicare and Medicaid Services selected 81 innovative projects nationwide for funding through the Health Care Innovation Awards effort. Made possible by the Affordable Care Act, the awards will support projects that will save money, deliver high quality medical care and enhance the health care workforce. Two of the projects selected for funding in this competitive process were submitted by UPHS researchers.

Throughout their illness, many patients with advanced cancer will need a variety of services. Although hospice offers valuable help, it is limited to patients who want to focus on comfort care. In order to better meet the needs of patients with advanced cancer who want to continue receiving cancer treatment, David Casarett, MD, UPHS director of Hospice and Palliative Care, created the CLAIM (Comprehensive Longitudinal Advanced Illness Management) program, the second Penn project to receive CMS funding. CLAIM is designed to provide a comprehensive set of home-care services, enabling patients with cancer to remain in their homes and avoid unnecessary and frequently undesired hospitalizations. CLAIM services will include a visiting nurse trained in palliative care, social worker, and access to a chaplain and to a home health aid (for practical help around the house). Patients will also have access to a pharmacist to assist with what are often complicated medication regimens, he said. CLAIMs overarching goal is to improve the quality of care that patients receive and, in doing so, decrease unnecessary hospitalizations. Casarett described an example of a patient with lung cancer who is in severe pain. She wouldnt want to go to the hospital if she doesnt have to but many patients have to go to the emergency room or the hospital because they cant get the help they need at home, he said. With CLAIM, we can send a visiting nurse who can contact the pharmacist and coordinate with the patients physician, allowing the patient to receive the pain medication she needs without going to the hospital. Casarett said that, while some problems will require a trip to the hospital, this program will help us resolve problems the patient would rather manage at home. Patients in the program would still continue treatment, with the same oncologist. Using the CMS funding, Casarett will test CLAIM for Medicare and/or Medicaid beneficiaries with advanced cancer in five counties in the metropolitan Philadelphia area. The $4.8 million-funded program will create an estimated 16 jobs and train 64 workers. The project is estimated to save CMS over $9.4 million.

Helping Patients Stay Medication Compliant

Almost all people who have had heart attacks will be prescribed several medicines to help prevent them from having another heart attack. But existing research shows that only about half of all patients are still taking their medicines after a year even after something as important and scary as a heart attack. Improving medication adherence and health outcomes in these post-discharge patients is one of the Penn projects selected for funding. We want to find new ways to help people stay on track with their care, said David Asch, MD, MBA who submitted this selected project with Kevin Volpp, MD, PhD, both of the Department of Medicine, Leonard Davis Institute and the Penn Medicine Center for Innovation. A rapid cycle approach to improving medication adherence through incentives and remote monitoring for coronary artery disease patients involves monitoring patients from remote locations such as their home and a visual and audible reminder system that prompts patients to take their medications. We need to find ways to engage our patients outside of the office visits and hospitalizations where we currently

LEARNING SAFETY & QUALITY FROM DAY ONE

(continued from cover)

When completed, the nurse brings the document and discusses it with the patient. Now, the nurse and pharmacist are actually is involved in the process, said Neha Patel, MD, director of the Healthcare Leadership in Quality Track. Another patient benefit also resulted. There are now unit-based pharmacists on the floors. During the initial four-month study to gauge the effectiveness of the Discharge Time-Out, it was determined that the readmission rate for patients in the pilot group was 4.76 percent as compared with the overall rate of 14.37 percent. To continue resident involvement in hospital quality initiatives we created a residentled Quality and Safety Leadership Council to work on initiatives that are closely aligned with the Penn Medicine Blueprint for Quality. This Council is open to all residents from all specialties, Myers said. The Council comprises two resident cochairs, 18 residents, four advanced nurse practitioners, two nurses, and faculty and quality improvement advisors. This year, over 40 residents have signed up. Before this council was created, there was no forum to have such conversations. The residents find value in the collaboration and like being exposed to other areas of medicine. We learn to look at the bigger picture, explained Amana Akhtar, MD, a third year Radiology resident. We are learning to be integrated with hospital quality initiatives, added Alice Goyanes, MD, a second year Internal Medicine resident. Residents were also involved the design of an initiative to help maintain the momentum in Radiology. All reports produced by the on-call resident must be read by the attending. This process is being measured to find how long it takes for the attending to read the report, how long it takes for the attending to get back to the resident and the quality of the report. The Council also took up other communications issues that affect the safety and coordination of patient care. For example, as different residents are responsible for patients throughout their hospital stay, it can be confusing to know who is taking care

``  Nephrology fellow Kara Chenitz, MD, (c.) and Internal Medicine resident Eugene Lin, MD, discuss the data they collected from patients about the call button response time with Anna Fontanilla, unit secretary on Silverstein 7.

of a patient at any given time. The Council worked with Information Services to make changes to a centralized computer where this information could be displayed and updated. This way everyone involved with that patients care knows which resident to contact when there is a change in the plan. Back on Founders, the residents developed a brochure to explain to patients who everyone is. We use terms like residents, interns and nurse managers and figure everyone knows what we mean, Patel said. It also contains a list of questions for patients to ask. Our message is that this is a safe place and we encourage patients to ask specific questions. The ACGME [Accreditation Council for Graduate Medical Education] requirements, which specify the quality and safety of the learning environment for patient care and call for institutions to be monitored and held accountable for their program, will propel all medical schools to include these components in their curriculum, Bellini said. Weve been working on this for four or five years because we recognized early that it is the right thing to do and helps us make better physicians.

penn medicine

work

There is always an opportunity to improve the experience of a Penn Medicine patient. For example, we can enhance employee skills in customer service, improve communication about processes and procedures, or encourage our care teams to become more focused on patient satisfaction. This is the philosophy of the Penn Medicine Experience program, recently launched by the Penn Medicine Academy. The programs first partner has been our Clinical Practices including 1500+ employees across a multitude of practices. The Penn Medicine Experience program provides an opportunity to deliver an outstanding patient experience, said Kristi Pintar, Corporate Director of Organizational Development and Leadership Practice. Patient satisfaction for CPUP practices ranges from the 1st percentile to the 98th percentile. This demonstrates that the patient experience does not always align with the high-quality clinical care we provide. Under the leadership of CPUP Executive Director Beth Johnston, CPUP Chief Operating Officer Scott Schlegel, and the department Business Administrators, CPUP has made positive strides to improve the patient experience in the physician practices as evidenced by an increase in Press-Ganey patient satisfaction scores, as well as energized employees. Manager engagement, interactive and engaging classroom activities, and customized coaching have all resulted in an improvement. The Penn Medicine Experience program aims to prepare managers and supervisors to develop employee skills that will enhance the patient experience. The program began with each manager attending leadership development courses on key topics, such as quality, financial performance, people development and service. Following this broad-based curriculum, each manager participated in a Managers Summit to better understand the activities, behaviors and expectations for their practices. Specific opportunities for improvement such as waiting room rounding, post visit phone calls, and team huddles were identified and reported to CPUP leadership for ongoing tracking. Once CPUP managers were equipped to lead and sustain the increased focus on patient satisfaction, front-line employees refreshed their service skills through interactive classroom learning, as well as realistic simulations and coaching with standardized patients. A standardized patient is a person, sometimes a professional actor, trained to portray a patient scenario for the instruction, practice, and assessment of health-care professionals. They help provide a safe and supportive environment conducive for learning and for standardized evaluation. We have created an opportunity for employees to practice their skills in a safe place and to spend time thinking about how they can further their professional development, said Julie Perilstein, Organizational Development Consultant for the Penn Medicine Experience. This is an experience thats hard to obtain in other learning environments and has been incredibly well-received by participants. As part of the program, CPUP Patient Service Representatives, Medical Assistants, Nurses and other identified employee groups learned Studers AIDET model. AIDET

``  Julie Perilstein, Organizational Development Consultant, works with CPUP staff toward improving the patient check-in process in a recent Penn Medicine Experience session.

provides a framework for consistent and personalized patient interactions, focusing on: Acknowledging the patient Explaining the experience Introducing yourself  Thanking the patient for coming to Penn Discussing duration Videos, script writing, skits and role-playing make this a highly-interactive educational experience. AIDET allows the staff to have a framework to interact with patients. They know what is expected, and they understand the importance of their actions, said Lisa Mills, Administrative Director of Obstetrics and Gynecology. I have had longstanding employees make small changes in their patient interactions, and they have been pleased with the change in the patients responses and reactions. Providing information to patients about what they can expect and who they will see next decreases the patients anxiety level, she continued, which has an overall impact on how the patient approaches and responds to what could be a stressful situation. Decreasing the stress of the patient creates a more employee friendly environment so the staff see that everybody wins from this effort. As CPUPs work with the Penn Medicine Experience continues, there are plans for ongoing organizational change, process improvement, communications, and skill building to sustain the focus on patient experience. With Medicare and Medicaids new financial incentives around patient satisfaction scores, CPUPs work does not end. The Penn Medicine Experience is the most effective customer service initiative that we have been able to offer our employees, said Karen Logan, Director of Administrative Operationsin Cardiology. This interactive approach has everyone engaged in the effort. The feedback from the staff about the simulation has been extremely positive. CPUPs effort has set the example for other entities. The Penn Medicine Experience program has begun planning similar efforts in other organizations across the Health System.

INTRODUCING A BRAND NEW BENEFIT TO YOU AND YOUR FAMILIES!

The University of Pennsylvania Health System is very pleased to announce that we have made the decision to offer Health Advocate, a new and important benefit, to you and your eligible family members. This benefit is designed to handle issues related to health care and insurance by cutting through the red tape and barriers that so often create frustration and problems. Health Advocate will help you: Sort out insurance claims and billing issues. Obtain doctor services for your elderly parents and parents-in-law. Schedule doctor appointments. Explain conditions and treatments when faced with serious illness or injury. Obtain cost estimates for procedures. Secure second opinions. Find the right providers. With access to a Personal Health Advocate, typically a registered nurse supported by medical directors and benefits and claims specialists, youll know that the entire Health Advocate team is working on your behalf to help you with your needs. One of the other unique features of Health Advocate is that your extended family will be able to use its special services. In addition to you, your spouse and dependent children, your parents and parents-in-law will also be covered under this program. Whenever you or an eligible family member encounter issues concerning health care or insurance, all you have to do is call Health Advocate at 866.695.8622!

NEWSmakers
/ / / Penn and Novartis Unite on Anticancer Approach
The New York Times reported on the announcement of an exclusive global research alliance and licensing agreement between the University of Pennsylvania and Novartis to expand the research and development of novel cellular immunotherapies using chimeric antigen receptor technologies. The agreement followed a Penn research teams 2011 publication of breakthrough results in several chronic lymphocytic leukemia (CLL) patients treated with this personalized immunotherapy technique. News of the alliance, which will include a $20 million investment from Novartis in the construction of a new, rst-of-its-kind Center for Advanced Cellular Therapies on Penns campus, was also covered in a front-page story in The Philadelphia Inquirer. Penns intellectual resources, combined with a pharmaceutical industry leader like Novartis, offer a powerful symbiotic relationship in our mutual goal of nding more effective treatments for cancer, said J. Larry Jameson, MD, PhD, executive vice president of the University of Pennsylvania for the Health System and dean of the Perelman School of the Medicine. Carl June, MD, a professor of Pathology and Laboratory Medicine and director of Translational Research at Penns Abramson Cancer Center, said the agreement provides a pathway for expansion of the research into clinical trials for additional types of cancers beyond CLL. I never thought this would happen, that the pharma industry would get into ultra-personalized therapy, June told Bloomberg News. We had lots of venture capital interest, but its hard to be a new company and it takes time to get set up. The fastest route to widespread availability is to use an existing company. Coverage also appeared in the (Newark) Star-Ledger, Nature, MedCityNews, and Genetic Engineering News.

Penn Medicine

/ / / Bug Me: Our Bodies Need Microbes and Worms

Ongoing research by Jeffrey Weiser, PhD, professor of Microbiology, was mentioned in the Mind & Matter column of The Wall Street Journal. It has been clear for a long time that the microbes in the gut are not just passengers but colleagues that help with the digestion of food: releasing vitamins, breaking down toxins and metabolizing nutrients into more useful forms. Whats becoming clear from such experiments is that they are also vital to the immune systems capacity to ght infection. Its as if they train the bodys defense forces. The evidence also suggests that the addition of probiotic supplements to ones diet may help the normal development of the immune system. A recent study by Weiser and colleagues found that immune-system cells called neutrophils were less responsive to pathogens in mice that had grown up germ-free or on antibiotics. This may be why people taking long courses of broadspectrum antibiotics can often get secondary infections.

professor in Hematology-Oncology, told Forbes. This was a pilot study that went wild. David Porter, MD, professor of Medicine and director of Blood and Marrow Transplantation in the Abramson Cancer Center, and Robert Vonderheide, MD, DPhil, associate professor of Medicine and associate director for Translational Research at the Abramson Cancer Center, are the senior authors of the study.

/ / / Test May Help Exclude Benign Thyroid Lesions

MedPage Today and Bloomberg News reported that a gene-expression test correctly identied more than 90 percent of suspicious thyroid nodules as malignant as conrmed by histopathologic testing, according to a new study. Because this group is at high risk for cancer, it might be reasonable to repeat the ne-needle aspiration biopsy or perform a diagnostic hemithyroidectomy even when the gene-expression classier indicates a benign prole, wrote J. Larry Jameson, MD, PhD, executive vice president of the University of Pennsylvania for the Health System and dean of the Perelman School of Medicine, in an editorial accompanying the new study in the New England Journal of Medicine. In this era of focusing on high-quality outcomes at lower cost, this new gene-expression classier test is a welcome addition to the tools available for informed decision making about the management of thyroid nodules, Jameson added.

/ / / A War on Baldness, Fought in the Follicle

George Cotsarelis, MD, chair and professor of Dermatology, and colleagues, have identied a molecule that impedes hair growth in the follicle. The group has also determined the receptor on the cell where this occurs, making it a target for possible future therapies for male pattern baldness, The New York Times reported. The article noted that Cotsarelis has studied hair loss for decades, since he identied hair follicle stem cells in mice in 1990. We were able to show that when we isolated the cells and injected them into another mouse, Cotsarelis said, the mouse made new hair follicles.

/ / / Penn Study Says Neighborhood Cleanups are Good for Health and Safety
Sprucing up vacant lots in a high-crime neighborhood may make people feel safer, researchers reported a seemingly obvious nding that nevertheless adds to a growing body of research showing how cheap and simple interventions may affect the health of a community, The Philadelphia Inquirer reported. The new study from Penn applied the gold standard of clinical research a controlled, randomized trial to a real-world environmental health investigation. Surveys after the May 2011 cleanup found that those near the greened lots felt safer. I cant stress enough how important feeling safe in your neighborhood is, said Gina C. Garvin, MD, a resident in Emergency Medicine and lead author of the paper, published in Injury Prevention. Existing evidence clearly shows that the perception of safety is linked to health outcomes, she said.

/ / / Why Do We Sneeze?
Sure, they blast out germs and other unwanted intruders, but sneezes have another, just discovered purpose, a Penn Medicine study said. When we breathe in foreign particles, sensors in our noses and sinuses detect the objects. The sensors signal the cilia tiny, hair-like paddles that line our nostrils and sinuses to move to expel the irritants. This process is always idling at rst gear, with the cilia ready to spring into action when needed, said study author Noam Cohen, MD, director, Rhinology Research, in an interview with National Geographic. His study found that the burst of air produced by a sneeze not only clears nasal passages but also triggers the cilia sensors to kick the paddles into high gear for an extended period about a couple minutes. In that sense, a sneeze works by resetting the system like Control-Alt-Delete on a PC, he said. The study highlights what an underestimated organ the nose is, especially in terms of keeping us healthy.

/ / / Penn Hospital One of Five Picked for U.S. Nurse-Training Initiative

HUP was among ve nationwide selected by the Department of Health and Human Services to participate in an initiative to train additional advanced-practice registered nurses, The Philadelphia Business Journal reported. This initiative aims to strengthen the nations primary care work force by placing more APRNs in practice and thereby increasing the ranks of primary and preventive caregivers to help ll gaps in non-hospital, community-based settings, including in underserved areas.

/ / / Pregnant Women Not Immune to Eating and Body Image Disorders

The August issue of SELF magazine tackled the tough issue of women with eating and body image disorders throughout pregnancy. According to the article, a question many woman ponder long before they ever take a pregnancy test is: Would having a baby make me appreciate my body or hate it? When women do conceive, many both disordered and nondisordered eaters alike are motivated to eat more healthfully. Yet others continue to struggle. Ann L. Honebrink, MD, associate professor of Obstetrics and Gynecology and medical director of Penn Health Women at Radnor, commented in the article about how most OB/GYNs are sensitive to looking for eating disorders in their patients. But because one of the main side effects we see in women with eating disorders can be infertility, she said, I dont think we are as sensitive to the problem once a woman is pregnant.

/ / / Penn Medicine Policy Experts Weigh In on Impact of Supreme Court Health Reform Ruling
Stories in the Philadelphia Daily News, The Philadelphia Inquirer, on WHYY Radio and in MedCity News featured Penn Medicine health policy experts discussing the impact of the Supreme Courts landmark ruling that upheld the Patient Protection and Affordable Care Act, which called for sweeping changes that provide health coverage for millions of uninsured Americans. CEO Ralph Muller told the Inquirer he thought the decision was a pleasant surprise. If the whole law had been thrown out, he said, it would have been pure chaos out there. Speaking with MedCity News, David Grande, PhD, assistant professor of Medicine and a senior fellow in the Leonard Davis Institute of Health Economics, noted the impact of the newly insured population on the way in which medical schools train physicians. There is probably a sizable number of young healthy people among the newly insured that wont increase demand on the system too much. At the same time, medical schools are starting to graduate more doctors and doctors are starting to practice as part of larger teams, he said. These trends will help build capacity but we will need more primary care doctors in the future.

/ / / HIV Drug Raises Hope for Better Bone Marrow Transplant Recovery
According to new research from Penns Abramson Cancer Center, an existing HIV drug dramatically reduced graft-versus-host disease, the most serious complication of bone marrow transplants in which newly transplanted immune cells attack healthy tissue in the patients body that they perceive as foreign. The Philadelphia Inquirer detailed the approach used in the study, which repurposed the drug maraviroc approved for use in HIV patients in 2007 to redirect new immune cells away from organs in the body they are likely to harm. After the researchers added maraviroc to the standard immune-suppressing regimen for 33 days beginning two days before the procedure, they found that just 6 percent of patients developed a severe form of the disease by six months after transplantation; typically, 22 percent would have. After one year, 15 percent of the patients developed severe disease, compared with the normal 29 percent without slowing the time it took for the patients new immune systems to engraft in their bodies or prompting a greater risk of side effects like infections or a relapse of their cancer. We were surprised we got some good efcacy for the study, lead author Ran Reshef, MD, assistant

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

``  A Perelman School of Medicine iPad will serve as a multipurpose learning tool for new student James Murrett.

`` Photo Caption.

WHERE PRACTICE MAKES PERFECT

Practice makes perfect in every facet of life. At Penn Medicine, doctors often practice new and cutting-edge procedures by applying for grants that will allow them to conduct a study of the new technique, or by using high-tech simulation technology to mimic the human condition. Last year, Penn Medicine opened the new Penn Human Tissue Laboratory a state-of-the art facility where medical students, residents and attending physicians can perform advanced surgical training on fresh human tissue as a means of either practicing or inventing new procedures. Under the direction of L. Scott Levin, MD, director of the Penn Hand Transplant Program, and chair of Orthopaedic Surgery, the PHTL is one of only a few laboratories of its kind in the country. This space is all about education. It underscores our commitment to lifelong, graduate learning in a hands-on environment that provides all the realistic capabilities of an actual operating room, said Levin, who modeled the lab after a similar facility he used as a surgeon at Duke University. The space is open to all allied health personnel across all surgical disciplines to invent or practice procedures. We even work collaboratively with the Perelman School of Medicine to compliment the anatomy course for postanatomy and medical students to train. Equipped with all instruments and equipment necessary to function as an ordinary operating room, the laboratory is also suitable for hosting hands-on courses, and has video technology capable of broadcasting procedures internationally so that colleagues around the world can learn and observe Penn physicians performing the latest surgical procedures. Though training space is not uncommon at leading medical and research centers, what makes the PHTL advanced and unique is the storage space available for fresh human tissue. Most practice labs or gross anatomy courses use embalmed tissue. The difference is that fresh human tissue creates a more accurate simulation to what these surgeons will be working with in the OR, explained Lab manager Lori Kish, adding that the freezers used by the PHTL can stock 16 full cadavers. In addition to Penn Medicine doctors and students, the lab often welcomes visiting professors and even high school students who want to learn about science and biology. The American Society for Reconstructive Transplantation held a two-day, hands-on workshop at the PHTL. Top surgeons from around the world traveled to Penn Medicine to practice hand and face transplant procedures on fresh human tissue samples. In the end, our goal with this space is to create an environment that allows us to better understand disease through practice and observation, said Levin. The Human Tissue Lab is literally a working example of our bench-to-bedside approach to health care. We experiment and practice in order to create and perfect procedures before taking them to our patients. To learn more about the Penn Human Tissue Lab, please visit: www.uphs.upenn.edu/ orthopaedics/education/human-tissue-laboratory.html

IF HIPPOCRATES HAD A TOUCH SCREEN

Perelman School of Medicine Equips New Students with an iPad
Last month, 163 first-year medical students at the Perelman School of Medicine started their journey to becoming doctors at the annual White Coat Ceremony. And for the first time in school history, in addition to receiving two of medicines most time honored symbols the white coat and stethoscope Penn Medicine also equipped these budding doctors with an Apple iPad 3. The new program represents the latest step in a 15-year technology investment by the School to bring medical curriculum into the digital age and enables students to have access to a multipurpose learning tool that they will use throughout medical school, in the hospital, with patients, and beyond, said Gail Morrison, MD, senior vice dean for Education and director of the Office of Academic Programs. To help the new class get the most out of the iPads, the Curriculum Office tested and evaluated the functionality of the devices over the last year in an effort to help improve students learning experience and reduce the schools carbon footprint. The new devices will serve to replace 20,000 sheets (40 reams) of black-and-white print class notes per student. Students now have access to all the electronic resources in the Perelman Biomedical Library at the touch of a finger. They also have the option to select from a collection of apps aimed specifically at medical students, like First Consult, a reference for evidence-based answers to clinical questions at the point of care. Additionally, updates and revisions to lectures can be immediately synced to the iPad. I grew up on paper learning, but Im excited to use the iPad, said James Murrett, a first-year student from Virginia. It seems like a natural next step as medicine evolves and changes with new technology to start our medical education with this kind of tool. The School of Medicine professors are also excited about the new addition to the learning experience. Several have created their own iBooks to guide students in exploring various topics of study. These iBooks offer greater flexibility in sharing course materials, and are easier to update and enhance throughout the course of the school year. The iPad is bringing a new dimension to my teaching, said Neal A. Rubinstein, MD, PhD, of Cell and Developmental Biology. By getting rid of the limitations of paper notes and books, I can teach students how to think critically and act on their curiosity in a way I couldnt before. The textbook no longer defines our students educational experience.

A CAMP THAT HELPS KIDS FEEL SAFE

MAKE IT COUNT

Morgenstein plans to use his Penn Medicine CAREs Foundation grant to help with transportation costs for the kids as well as buy camp supplies. A lot of the kids who come to camp have to keep their guards up throughout the year but camp is a safe environment. By the end of the week, many are crying because they are going to miss it so much. Thats how much the camp means to them. They wait all year for it. Camp Bright Feathers is funded by Haven Youth Center, a nonprofit organization that provides educational, social, and recreational services to HIV youth to support healthy, age-appropriate development and transition into adulthood. To learn more, go to www.havenyouthcenter.org.

Its one of the best things Ive done in my life. Thats how Eric Morgenstein of Home Care and Hospice describes his volunteer work at Camp Bright Feathers, a free, week long sleep-over camp experience for HIV infected and affected children in NJ and PA. Nearly 100 kids, ages 7 to 15, come each summer. The camps goal: let kids be kids. These kids live with a lot of stigma, but, for one week, theyre just normal kids having a good time, Morgenstein said. We share stories, build on a feeling of community. Its amazing what the kids will do for each other, the bonds they form. Morgenstein has volunteered there since he was a teenager and now leads a counselorin-training program. During the year, he helps arrange reunions to keep campers connected and to provide support.

Do you volunteer in community outreach events? If so, be sure to report your efforts on Penn Medicine CAREs (Community Activity Reporting E-niative). Simply go in the Intranet page and click on CAREs Community Outreach on the left side. If you have any questions, contact Government Affairs and Community Outreach at 215.662.7030 or e-mail CAREs@uphs.upenn.edu.

AWARDS AND ACCOLADES

PENN MEDICINES OLYMPIC CONNECTIONS
Two Penn Medicine employees got an up-close-andpersonal look at the Olympics in London, thanks to children who are Olympic athletes. Susan Francia, daughter of Katalin Kariko, PhD, of Neurosurgery, was part of the U.S. Olympics Rowing team that captured gold in the 8-man 2000-meter finals, repeating a championship performance at the 2008 Olympics in Beijing. Also a member of the U.S. Olympic Rowing Team, Stephen Kasprzyk, son of Bruce Kasprzyk, director C, SM-AF-Facilities, came within 3/10 of a second of winning a bronze medal. This was the closest 8-man race since the 1932 Olympic games, his dad said. The competition was intense and the race exciting, down to the last second!
``  Top photo: Bruce Kasprzyk stands proudly with his son, Stephen, an Olympic rower. Bottom photo: Susan Francia, daughter of Katalin Kariko, shows off the gold medal her team won in the 2,000-meter Olympic rowing nals.

Brian Wells, associate CIO of Health Technology and Academic Computing, has been promoted to associate vice president within Penn Medicine Information Services. Wells is responsible for integrating IS activities to support our research needs and creating closer alignment between computer services within the University of Pennsylvania Health System and the Perelman School of Medicine.

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(continued from cover) and other funding organizations to review and synthesize literature on therapeutic and diagnostic interventions to assess which are most benecial to patients. The ndings can be used as the basis for health-care-related decisions by the federal government, states, and national medical societies as well as serve as the basis for future policy and clinical measures, insurance coverage, quality standards, and educational materials.* And the US Department of Health and Human Services has selected HUP as one of ve hospitals that will take part in a nationwide initiative to train more nurses at a higher level. The four-year project, funded under the Affordable Care Act, will enable HUP to increase training opportunities for advanced practice registered nurses nurses with post-graduate training to diagnose illnesses, prescribe medication and treatment regimens, and perform certain medical procedures. The goal is to strengthen the nations primary care work force by placing more such nurses into practice and help ll gaps in non-hospital community-based settings, including in underserved areas. Training will take place at over 200 training sites throughout southeastern Pennsylvania. The project, which will help offset the costs of clinical education of advanced-practice nurses, features a consortium that includes Penn Presbyterian Medical Center, Pennsylvania Hospital, CPUP, CCA, and CHOP, as well as Penns School of Nursing and eight other area nursing schools.* I know you join me in congratulating everyone involved in developing these important projects and in offering best wishes for success in carrying them out. Together they reinforce our system-wide commitment to creating new approaches that bring hope to patients and their families while keeping a keen eye on the need to rein in costs, thus ensuring that our nations health care dollars go farther and with greater effect. This is indeed the Penn way. *Learn more about these projects in the next issue.

Abass Alavi, MD, of Radiology, was honored with the Benedict Cassen Prize from the Education and Research Foundation for the Society of Nuclear Medicine, given to living scientists or physician/ scientists whose work has led to a major advance in basic or clinical nuclear medicine science. Alavi received the award for his contributions in the development of modern imaging techniques, including positron emission tomography, which the societys leaders called revolutionary tools for conducting basic science research and improving patient care. Clifford S. Deutschman, MD, MS, of Anesthesiology and Critical Care, has been named president of the Society for Critical Care Medicine (SCCM). The Society is the largest multiprofessional organization dedicated to ensuring excellence and consistency in the practice of critical care. In his role as SCCM president, Deutschman will serve as the Societys primary spokesperson while helping the organization carry out its mission to secure the highest quality care for all critically ill and injured patients. David Dinges, PhD, associate director, Center for Sleep and Circadian Neurobiology, and Ann Kennedy, DSc, of Radiation Oncology, were chosen by the National Space Biomedical Research Institute to serve as team leaders in its efforts to protect astronaut health during long-duration spaceight. Dinges will lead the neurobehaviroal and psychosocial factors team, and Kennedy will lead the radiation effects team. Ezekiel Emanuel, MD, PhD, chair of Medical Ethics and Health Policy, has been chosen to join the Council on Foreign Relations, an independent, nonparisan membership organization, think tank, and publisher dedicated to being a resource to help people better understand the world and the foreign policy choices facing the U.S. and other countries. Nehal Mehta, MD, director of Inammatory Risk in Preventive Cardiology, has been chosen by the National Institutes of Health (NIH), in partnership with the Albert and Mary Lasker Foundation, as the inaugural Lasker Clinical Research Scholar. Last month, he began as the Lasker Scholar in the Cardiovascular-Pulmonary Branch of the NIHs National Heart, Lung, and Blood Institute. Karl Rickels, MD, co-director of Penns Mood and Anxiety Disorders Treatment and Research Program, has received the 2012 CINP Pioneers in Psychopharmacology Award from the International College of Neuropsychopharmacology (CINP). Established in 2002 and given every two years, the awards honor three individuals worldwide who have made major contributions to the eld. Rickels, one of the Founding Members of the CINP in 1958, received the award for his groundbreaking work in the development of medications to treat anxiety disorders. Donald Silberberg, MD, of Neurology, has received the Vicente Rocaferte Award from the Ecuadorean National Assembly, the rst time its been granted to an American. Silberberg received the award for his efforts to raise awareness, enhance medical education and improve patient care for neurological and psychiatric conditions globally. Michael Restuccia, VP and chief information ofcer, Corporate Information Services, was named to Information Week Healthcares Top 25 CIOs Transforming Healthcare. Among other achievements, the publications prole on Restuccia credits his leadership and team for implementing innovative technology in promoting clinical trials. Thomas A. Wadden, PhD, director of Penns Center for Weight and Eating Disorders, has received the Bud Orgel Award for Distinguished Achievement in Research from the Association of Psychologists in Academic Health Centers. Wadden is well known for his work in the eld of obesity, helping to shape clinical knowledge and national policy through his research and advocacy efforts in an academic health center.

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