Guidance for staff diagnosed with flu or flu-like illness

By Mark Ingerman, chief of Infectious Diseases

Situation:      

  • Guidance is needed early in the influenza season regarding the reporting and treatment options for staff who develop confirmed influenza or influenza-like illness.

Background: 

  • 2020 is anticipated to be a busy flu season. Historically, there has been uncertainty among staff as to where to seek care or to whom to report, when one develops an influenza-like illness or confirmed influenza.
  • Currently Occupational Health/Employee Health Policy states that all confirmed influenza is reportable to Occupational Health/Employee Health. This has created a surge of calls and questions for the Occupational Health/Employee Health Department.
  • We have changed the policy regarding reporting of illness to Occupational Health/Employee Health during the influenza season for 2019-2020.
  • To simplify the process and bring clarity, Infection Prevention and Occupational Health/Employee Health leadership made the recommendations below during the 2018-2019 season and recommend the same for 2019-2020.

Assessment: 

  • Guidance is being requested early in the 2019-2020 influenza season regarding the reporting and treatment options for staff.

Recommendation:    

  • If you have influenza-like symptoms during the flu season, DO NOT REPORT TO WORK AT THE HOSPITAL. Contact your manager.
  • Per policy, MLH staff with influenza should remain out of work for five days from symptom onset and be 24 hours fever free (off antipyretics) before returning to service.
  • Staff with flu-like illness or confirmed influenza outside of a confirmed exposure should seek care from their PCPs.
  • Staff identified as part of an Infection Prevention confirmed exposure will be given additional guidance regarding prophylaxis as indicated, in consultation with the Department of Health.
  • Occupational Health/Employee Health and Infection Prevention continue to be a resource to staff should further guidance be sought.
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2019-2020 MLH Medical Staff Meetings

Attendance at 50% (1) Hospital Staff meeting per Calendar Year is required for Active Staff members by the MLH Medical Staff Bylaws.

You may attend any ONE of the following meetings, at the hospital of your choice, whether that hospital is/is not your primary facility.

THERE ARE NO EXCUSED ABSENCES.

Fall 2019 Meetings

Thursday, October 24, 2019 5:30PM Bryn Mawr Hospital – Pennypacker Auditorium

Spring 2020 Meetings

Tuesday, April 21, 2020 6:00PM Paoli Hospital – Potter Room
Tuesday, May 5, 2020 6:00PM Riddle Hospital – Springfield Country Club
Thursday, May 14, 2020 5:30PM Bryn Mawr Hospital – Pennypacker Auditorium
Tuesday, June 2, 2020 5:00PM Lankenau Medical Center – Center Pew

Auditorium

Questions? Contact the Medical Staff Affairs Office at 484-337-8031

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Clinical Trial of the Week: Device study for patients with severe mitral valve regurgitation

By Donna Loyle, communications specialist, LIMR

The APOLLO clinical trial is for patients who’ve been diagnosed with severe symptomatic mitral regurgitation and who’ve been told they need mitral valve replacement. This is a multicenter, global, prospective, interventional, pre-market trial with two subject groups randomized on a 1:1 basis to either the study device or to conventional mitral valve surgery.

One group of participants will have the Medtronic Intrepid™ transcatheter mitral valve replacement system (TMVR) implanted in their mitral valve, while the other group will undergo conventional surgical mitral valve replacement.

Additionally, patients who are unable to undergo surgical replacement may qualify for the TMVR procedure.

Subjects are seen at pre- and post-procedure, discharge, 30 days, six months, and annually through five years.

Inclusion criteria:

  • Patient must be deemed a candidate for bioprosthetic mitral valve replacement
  • Must not have prohibitive mitral annular calcification or hemodynamic instability
  • Must not have left ventricular ejection fraction <25%

If you have identified a patient who may benefit from this treatment, an evaluation can be performed by the Structural Heart Team at Lankenau Heart Institute. The principal investigator is Dr. Scott Goldman, and sub-investigators are Drs. William Gray and Sandra Abramson. More information is available at https://www.mainlinehealth.org/research/clinical-trials/3809-apollo

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Voting open for Philadelphia magazine’s Top Doctors

Philadelphia magazine’s Top Doctors issue will be published in May 2020. This annual issue will name 2500+ of the region’s Top Doctors in Greater Philadelphia, South Jersey and northern Delaware. Philadelphia magazine works with a third party – Castle Connolly – to develop this list based, in part, on peer nominations by other licensed physicians.

Physicians who are vetted and selected as Castle Connolly Top Doctors will get listed on the Castle Connolly website, and may be eligible to appear in this special issue of Philadelphia magazine.

  • Physicians wishing to nominate someone can register here: www.castleconnolly.com/nominations.
  • Each nominating physician will need to use his or her personal NPI number, first and last name, email, hospital, specialty and zip code.
  • A Nomination Code for 2019 and a link to the nomination site will then be automatically emailed. The Nomination Code will allow access to the site, and consideration for the May issue of Philadelphia magazine until November 8, 2019.
  • Each calendar year, a physician may nominate: 10 in their own specialty, 5 in each Family Medicine/Internal Medicine/Pediatrics, and 3 in each of the remaining specialties.

Those who would like to be featured themselves in Philadelphia magazine Top Doctors issue, and are already a Castle Connolly Top Doctor should make sure to:

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Massive Transfusion Protocol process update

In recent past, several challenges have been identified with the Massive Transfusion Protocol process across MLHS campuses.  An MTP workgroup has been created to standardize and streamline the MTP process and review and improve workflow for the health system.  The MTP workgroup continues to work on logistics of equipment, training, and communication. The following process has been implemented across the system.

When Massive Transfusion Protocol is activated, the provider or designee needs to call Blood Bank to alert them of MTP as well as call the Acute Care Surgeon on call for in-person consultation and support. Riddle Hospital staff should call the Paoli Trauma Center and Bryn Mawr Hospital staff will utilize the Lankenau Trauma Center. The Blood Bank will also alert the respective Acute Care Surgeons when notified of an MTP or when it has dispensed enough product to warrant support. Primary cardiac surgery patients will not be considered part of this pathway and consultation will be left to the discretion of the provider.

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Clinical Trial of the Week: Screening study of patients with stage IV or recurrent non-small cell lung cancer

By Donna Loyle, communications specialist, LIMR

Lung-MAP is a master screening protocol for previously treated, non-small cell lung cancer (NSCLC). This randomized phase II/phase III trial is meant to establish a method for screening the genes of large populations of cancer patients and then assigning those patients, when appropriate, to a sub-study. If assigned to a sub-study, participants then undergo a new, targeted cancer therapy or a combination of standard care.

Eligible patients must have been diagnosed with stage IV or recurrent NSCLC, previously undergone at least one line of systemic therapy for any stage of NSCLC, and have progressed during or after their most recent line of therapy.

Lung-MAP contains a screening component and a clinical trial component:

  • Patients can participate in the screening component either at progression on prior therapy or to be pre-screened while receiving therapy.
  • The clinical trial component consists of studies evaluating drug-biomarker combination for patients determined to have a matching biomarker, and non-match studies evaluating therapies in patients without any of the study biomarkers.

Lung-MAP sub-studies available at Main Line Health:

  • 1800A is testing ramucirumab and pembrolizumab vs. standard of care in treating patients with stage IV or recurrent NSCLC
  • S1900A is a phase II study of rucaparib in patients with genomic LOH high and/or deleterious BRCA 1/2 mutation stage IV or recurrent NSCLC

Contact the clinical trials team for additional details on sub-study eligibility.

Lung-MAP is approved for all Main Line Health acute care hospitals. The principal investigators are Albert DeNittis, MD, and Paul Gilman, MD. For more, email cancertrials@mlhs.org or visit https://www.mainlinehealth.org/research/clinical-trials/lung-map

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Flu vaccination program underway

The Main Line Health 2019-2020 mandatory flu vaccination program is underway for employees, physicians, specified healthcare professionals and volunteers. Since 2010, MLH policy has required all physicians, specified health professionals, employees, contracted clinical personnel and volunteers to be vaccinated against influenza as a condition of employment or use of MLH facilities.

Vaccinations are free and will take place across MLH until December 2, 2019, which is the deadline for compliance with our flu vaccination policy. Open the PDF to view the complete vaccination schedule.

2019-2020 Flu Schedule

An MLH badge is required at the time of vaccination.

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Team MLH again supports ‘Free to Breathe’ lung cancer run/walk

Join Team Main Line Health at the annual Free to Breathe 5K run/walk event at 9am on Sunday, October 27, at Citizens Bank Park, organized by the Pennsylvania Lung Cancer Partnership. Main Line Health Cancer Care is a sponsor of this event which raises awareness about lung cancer.

Pulmonologist Thomas Meyer, MD, and Nurse Practitioner Melinda Milliken are team co-captains.

Visit the Team Main Line Health page to register. Race registration is FREE, although all participants are requested to set a fundraising goal.

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Researchers report low incidence of paravalvular leak following surgical aortic valve replacement

Among 636 patients who underwent surgical aortic valve replacement (SAVR) at Lankenau Heart Institute between 2006 and 2016, only 1.4 percent developed intraoperative paravalvular leak (PVL), according to a new study. That incidence of intraoperative PVL is one of the lowest reported in the literature, noted the study’s authors.

PVL, an abnormal leak around a patient’s prosthetic valve, may lead to heart failure, reoperation or death.

During the study, minimally invasive aortic valve replacement was performed in 410 (64.5 percent) of the 636 patients. In the cohort of 410 patients, postoperative PVL incidence was 4.4 percent at one year in the patients who had sutures that were hand-tied. Meanwhile, among patients who underwent suture tying with Cor-Knot, an automated suture-fastener, the cumulative incidence of postoperative PVL was lower: 1.9 percent at one year.

In this retrospective study, the authors also found that renal failure was a factor significantly associated with postoperative PVL.

“The study is important because it demonstrates the incidence of paravalvular leak in a large contemporary series of SAVRs in the transcatheter era,” said Konstadinos Plestis, MD, the study’s senior author.

Vishal Shah, DO, fifth year general surgery resident at Lankenau and the study’s lead author, noted that the hospital has been at the forefront of minimally invasive cardiac surgery over the past decade. “By publishing our excellent outcomes, we hope to demonstrate that minimally invasive aortic valve replacement is safe and reproducible, particularly with the use of innovative technology,” said Dr. Shah.

The study, “Incidence, Natural History, and Factors Associated with Paravalvular Leak Following Surgical Aortic Valve Replacement,” was published in the October issue of the biomedical journal Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, the official journal of the International Society for Minimally Invasive Cardiothoracic Surgery.

Other Main Line Health authors included Scott Goldman, MD; Matthew Thomas, MD; and Serge Sicouri, MD; as well as Meghan Buckley, MS, biostatistician at the Lankenau Institute for Medical Research.

Disclosure: Dr. Shah reports receiving research funding from LSI Solutions, the manufacturer of Cor-Knot.

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Sixth Ruth Grandin Symposium

By Barry D. Mann, MD, Chief Academic Officer, Main Line Health

 Dear Colleagues –

I’m writing to call your attention to the upcoming Ruth Grandin Symposium, a biennial forum intended to explore the relationship between healthcare and spirituality.

This year’s symposium (the 6th Grandin Symposium) will be held on Wednesday evening, October 16th from 5:00-7:00pm at Lankenau Medical Center.

This year’s topic is particularly timely: The Journey through Addiction: Spirituality as a Source of Strength and Compassion.  The event will highlight the important role of health care workers from all disciplines in caring for those suffering from addiction. Clergy from different faiths, social workers, nurses, physicians, addiction specialists, law enforcement and individuals personally impacted by addiction will come together to discuss the connection between spirituality and recovery.

 This promises to be a very special event. Learn more and register to attend here.

 

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