Celebrating National Women Physicians Day

By: Jon Stallkamp, MD, Interim Chief Medical Officer

 

This week, we celebrated National Women Physicians Day. This day falls every year on February 3, the birthday of Elizabeth Blackwell, the first woman to practice medicine in the US.

 

While we take this day to celebrate you, please know how much we value your leadership, talent and compassion every day. I consider myself privileged to know and work alongside so many talented female physicians here at Main Line Health, and I am grateful for your unwavering dedication to our patients and your colleagues. On behalf of the entire medical staff and Main Line Health leadership team, I want to thank you for all that you have done and continue to do to lead, innovate and inspires others every day.

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Clinical Trial of the Week: Device trial to treat mitral valve regurgitation

By Donna Loyle, communications manager, LIMR

 

The new Repair MR randomized controlled trial seeks to compare the clinical outcome of the MitraClip™ device vs. surgical repair in patients with severe primary mitral regurgitation who are at moderate surgical risk and whose mitral valve is suitable for correction.

 

The MitraClip is a device that is guided through a leg vein to the heart and implanted on the mitral valve to help it close more completely, thus helping to restore normal blood flow through the heart.

 

The primary outcomes being measured in this study include:

  • All-cause mortality, stroke, cardiac hospitalization, or acute kidney injury requiring renal replacement therapy at two years
  • Proportion of subjects with moderate or less MR (≤2+), without mitral valve replacement, and without recurrent mitral valve intervention (surgical or percutaneous) at two years

 

Participants are randomized into two study groups. One receives treatment with the MitraClip. The other group receives surgical repair of the mitral valve.

 

The principal investigator for this trial is Basel Ramlawi, MD, and the trial is approved for Lankenau Medical Center. For more, visit www.mainlinehealth.org/research/clinical-trials/repair-mr

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Vaccine Update from Dr. Jon Stallkamp

Sent on behalf of Jon Stallkamp, MD

 

To our Main Line Health physician partners:

 

Since the state’s expanded criteria for COVID vaccination eligibility was announced last week, I know that your offices and our call centers have dealt with an incredible volume of phone calls, requests, and questions from our patients. I appreciate all you have done so far to address patient concerns and want to provide you an update on our vaccination efforts to date and how we will move forward with contacting eligible patients.

 

Please remember: we are a piece of this puzzle; health systems cannot be solely responsible for the distribution of vaccines to our region. Instead, vaccinating our community will require the work of many including the local departments of health, pharmacies, and health systems. With that in mind, we are encouraging patients to take advantage of the earliest opportunity to receive their vaccine. If a patient is able to schedule an appointment at a pharmacy or vaccination clinic at an earlier date than we can offer them a vaccine at Main Line Health, we encourage them to do so. Where our patients are vaccinated is not as important as making sure they receive the vaccine, if they so choose.

 

Because of the number of patients in our database, we have taken a phased approach to vaccination based on PA state guidance. More than 6,000 invitations have been sent since last week to patients who are: 75 and over and have an active MyChart account and have touched MLH in anyway in the past year (lab, radiology, admission, etc.) We will continue to invite our elderly patients who meet this eligibility as a top priority. All eligible patients with a MyChart account will eventually be invited for vaccination.

 

However, we are also asking for your help in compiling a list of your patients who are at highest risk for COVID. (High-risk conditions beyond age, as defined in state guidance, include cancer, COPD, chronic kidney disease, heart disease, heart failure, obesity (BMI> 30), pregnancy, diabetes, Down Syndrome, sickle cell disease, smokers, and immunocompromised patients.) We will not begin inviting the patients on your lists until after we have invited all patients who meet the criteria listed above: 75+, active MyChart account who have been seen at MLH in the past year.

 

We are going to be preferentially working with our PCPs and will also be reaching out to specialists who can be a patient’s principal physician (oncology, cardiology, etc.) to coordinate vaccination of eligible patients. We ask for your honesty in compiling this list; we know that you may have personal contacts or family members who wish to receive the vaccine, but we have a responsibility to our patients to distribute vaccine supply as equitably as possible.

 

For Private Practice Medical staff members: 

Attached is a template for use by your office staff to compile a list of patients who are at greatest risk. Begin your list with patients over 75, and rank those at highest risk at the top of your list. Next, if you wish, you may compile a list of patients 65-74, and those with the chronic conditions listed above, that you see as your highest risk and thus worthy of priority vaccination.

 

Please label your list clearly to indicate your top 100 patients in order of risk. Because of the limited supply of vaccine, we will be inviting only 10 patients per physician each week to start for vaccination until supplies become more plentiful. This is your opportunity to ensure that the patients who have the greatest need are vaccinated.

 

Once you have compiled your list, please email it to: COVIDVaccineReferral@MLHS.org. This email address is not to be shared with patients or physicians outside of Main Line Health, and is only to be used by our physicians to submit eligible patient names. Our Central Scheduling team will begin outreach and will handle scheduling for these patients you recommend.

 

For MLHC Practices: 

Attached is a template for use by your office staff to compile a list of patients who meet state eligibility criteria. To assist you, MLHC will be distributing a list to each PCP of all your patients over 75 by early next week, and soon after we will share a similar list with our medical specialists. It will have information to assist you in your rank order—including age, high risk conditions, a calculated “risk score”, and presence on the Epic portal or not—but the final decisions are yours.

 

Please organize your list beginning with patients who have the greatest need. All eligible patients with a portal account will eventually be invited for vaccination, but this is your opportunity to prioritize those “portal patients” most needy, plus advise us of which eligible “non-portal patients” need priority outreach.  In the coming weeks we will similarly share lists of patients 65-74, plus those <65 with eligible chronic conditions, for you to review and prioritize.

Please label your list clearly to indicate your top 100 patients in order of risk. Because of the limited supply of vaccine, we will be inviting only 10 patients per physician each week to start for vaccination until supplies become more plentiful. This is your opportunity to ensure that the patients who have the greatest need are vaccinated.

 

We request a collective list for your practice rather than providing one list per physician. Once you have compiled your list, please share it with your practice manager, who will be advised on how to share it with the MLH team managing this list. Our Central Scheduling team will begin outreach and will handle scheduling for patients you recommend.

 

For Private Practice and MLHC Physicians: 

We have put several tactics in place to discourage patients from calling their physicians for vaccine information and updates. However, despite these efforts, I know that your patients are reaching out to you—their trusted providers—for advice and information. Please continue to direct them to our website, where they can find the latest on vaccination eligibility as well as a list of frequently asked questions. We also ask that you encourage patients who have not yet downloaded MyChart to do so. Step-by-step instructions on how to download MyChart are available on our website are available on our website and are also attached.

 

Vaccination updates are provided daily and weekly through our regular COVID communication channels, including Daily Update emails to all employees and medical staff Monday-Friday and our weekly Medical Staff Town Halls. As members of the MLH medical staff, you have access to all this information. Please make time to read through these communications to ensure you are up to date on our vaccine efforts. If you are not receiving this communication, please ensure we have your correct email and contact information on file with the Medical Staff Affairs Office.

 

Additionally, we encourage you to direct your patients to our website for the latest COVID information, and if you maintain a website for yourself or your practice, we invite you to link directly to the MLH website or repurpose some of our web content for your use.

 

We appreciate your patience and partnership.

 

Jon Stallkamp, MD

Interim Chief Medical Officer

Covid-19 Vaccine Enrollment Form

Covid-19 Vaccine Enrollment Form – Sample Data

Step-by-step instructions on how to download MyChart

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Welcome Pam Teufel to Main Line Health

Sent on behalf of Jack Lynch…

 

Colleagues,

 

Following Paul Yakulis’ retirement in September 2020, Main Line Health began an extensive nationwide search for his successor. I am pleased to announce that Pam Teufel will join the team in late March as our new Senior Vice President of Human Resources. Pam brings more than 25 years of human resources experience to her new role—including extensive leadership in healthcare.

 

Pam currently serves as the Chief Human Resources officer for Saint Peter’s Healthcare System in New Brunswick, NJ, leading human resources and employee health. Prior to joining Saint Peter’s in 2017, Pam held executive-level human resources roles at Temple University Health System, Thomas Jefferson University Hospitals and Scripps Health.

 

As our new Senior Vice President of HR, Pam will lead human resources for our 16,000+ employees and medical staff with a focus on employee engagement, leadership development, organizational design and diversity, respect and inclusion. Additionally, she will work closely with her colleagues on the senior leadership team to assess the employee experience and develop strategies for continual systematic improvement that are aligned with Main Line Health’s virtues and values.

 

Pam’s experience leading in a matrixed environment makes her an excellent candidate for this role, as does her commitment to fostering positive, engaging and collaborative workplaces.  Pam is a principled leader who will always have the best interest of our employees and those we serve in mind. I know I speak for the entire leadership team when I say we are excited to welcome her to MLH.

 

As you know, Greg Papa stepped in to serve as Interim Vice President of Human Resources following Paul’s retirement. Over the past several months, Greg has adeptly navigated the challenges of the COVID-19 pandemic and has been an integral part of our efforts to vaccinate MLH staff.

 

Since Greg initially joined Main Line Health as the Human Resources Director at Lankenau Medical Center in 2006, he has been an excellent colleague and leader and I am excited to announce that he will serve as Vice President of Human Resources Operations. This role is new to Main Line Health. Reporting to Pam, Greg will serve as a liaison for our hospital leadership and will provide executive-level guidance to our campus-based HR teams.

 

Please join me in congratulating Greg on his new and well-deserved role and offering Pam a warm welcome to the Main Line Health team!

 

Jack Lynch

President and CEO

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Clinical Trial of the Week: Treatment study for older patients with advanced non-small lung cancer

By Donna Loyle, communications manager, LIMR

 

Researchers seek to determine if there are any side effects of Keytruda® (pembrolizumab) with or without chemotherapy in treating patients aged 70 and older diagnosed with metastatic, stage 4 non-small cell lung cancer.

 

Eligible participants are grouped into two study arms:

  • Group A receives pembrolizumab IV on day 1. Cycles repeat every 21 or 42 days.
  • Group B receives pembrolizumab and the chemotherapies pemetrexed and carboplatin IV on day 1. Cycles for pembrolizumab repeat every 21 or 42 days. Cycles for the chemotherapies repeat every 21 days.

 

Study # A171901 is approved for all MLH acute care hospitals. For more on this clinical trial, email cancertrials@mlhs.org or visit https://www.mainlinehealth.org/research/clinical-trials/a171901

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Latest Clinical Research from LIMR

By Donna Loyle, communications manager, LIMR

 

Research studies with clinical implications for patients with COVID-19, triple negative breast cancer, aortic valve replacement, atrial fibrillation, lung cancer and chronic cough were published in peer-reviewed journals by investigators at the Lankenau Institute for Medical Research (LIMR) in December.

 

Vitamin A as potential anti-viral therapy, including coronavirus

Retinoic acid (RA; vitamin A) may be an effective prophylactic agent in minimizing airway barrier leak and as a potential therapy to prevent cellular leak caused by inflammation. The authors suggest that RA may be a useful adjuvant for anti-viral therapies, including COVID-19 treatments, as cytokine storms caused by inflammation are known to be related to morbidity.

LIMR investigators: James Mullin, PhD, and Sunil Thomas, PhD. The manuscript: “Retinoic acid improves baseline barrier function and attenuates TNF-α-induced barrier leak in human bronchial epithelial cell culture model, 16HBE 14o” in PLoS One.

 

Poorer outcomes seen in TNBC patients with metabolic syndrome

In this study of 177 Main Line Health patients diagnosed with triple negative breast cancer (TNBC) during the time period of 2007 to 2013, metabolic syndrome (obesity, diabetes, hypertension and dyslipidemia) was significantly associated with poorer outcomes. But overall survival was not impacted. The exception was among those TNBC patients with hypertension; these patients had both poorer disease-free and overall survival. “Hypertension management is therefore potentially an important aspect of the multidisciplinary care of the TNBC patient,” the authors noted. LIMR investigators: Kaitlyn Kennard, MD; Meghan Buckley; Sharon Larson, PhD; Ned Carp, MD; and Thomas Frazier, MD. The manuscript: “Metabolic syndrome: does this influence breast cancer outcomes in the triple-negative population?” in the journal Breast Cancer Research and Treatment.

 

Patient outcomes compared after aortic valve replacement

A retrospective review of 68 Lankenau patients who underwent transcatheter valve-in-valve implantation after bioprosthetic valve failure showed they had reduced need for permanent pacemakers, lower rates of atrial fibrillation and shorter hospital stays compared to patients who had minimally invasive reoperative aortic valve replacement. LIMR investigators: Serge Sicouri, MD; Meghan Buckley; and Scott Goldman, MD. The manuscript: “Transcatheter and ministernotomy aortic valve replacement after bioprosthetic valve failure” in Journal of Cardiac Surgery.

 

Biomarkers identified for stroke in afib patients

In patients with atrial fibrillation, the biomarkers most likely to be associated with subsequent ischemic stroke/systemic embolism represent fibrosis/remodeling; cardiac; vascular calcification; metabolism; and mucosal integrity/ischemia. LIMR investigator: Michael Ezekowitz. The manuscript: “Screening of Multiple Biomarkers Associated with Ischemic Stroke in Atrial Fibrillation” in Journal of the American Heart Association.

 

Optimal P-IDL in SBRT for lung cancer patients

The optimal prescription isodose line (P-IDL) range is 75%-80% for stereotactic body radiotherapy (SBRT) with volumetric-modulated arc therapy (VMAT) to treat early-stage lung cancers, according to a new retrospective study. The authors noted that applying optimized approaches can “significantly improve the lung sparing in SBRT VMAT plans with AXB dose calculation algorithm and makes treatment plans more conformal in high, intermediate and low dose regions, while higher dose is delivered to the target.” LIMR investigators: Albert DeNittis, MD; Tracey Evans, MD; and Thomas Meyer, MD. The manuscript: “Optimal prescription isodose line in SBRT for lung tumor treatment with volumetric-modulated arc therapy” in Journal of Radiosurgery and SBRT.

 

Laryngopharyngeal reflux may contribute to chronic cough

A retrospective chart review of 28 patients presenting with chronic cough found that laryngopharyngeal reflux may be a prevalent contributing or etiologic factor. After three months of reflux treatments, 60% reported improvement in cough. Among the possible contributing causes for non-responders were esophageal dysmotility, mycoplasma and pertussis.

LIMR investigator: Robert Sataloff, MD. The manuscript: “The Relationship Between Chronic Cough and Laryngopharyngeal Reflux” in Journal of Voice.

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Clinical Trial of the Week: Phase II treatment study for breast cancer

By Donna Loyle, communications manager, LIMR

 

In this randomized phase II clinical trial, researchers are studying how well docetaxel or paclitaxel work in reducing chemotherapy-induced peripheral neuropathy in a patient cohort comprised of African American women diagnosed with stages I-III breast cancer.

 

Eligible participants must have had no prior taxane therapy and no prior or concurrent platinum-based chemotherapy. Also, they must have no pre-existing neuropathy.

 

Participants are grouped into two study arms:

  • Arm 1 receives paclitaxel IV once weekly. Treatment repeats every 21 days for 4 cycles.
  • Arm 2 receives docetaxel IV once every 3 weeks. Treatment repeats every 21 days.

 

Patients may also receive other medications at the physician’s discretion.

 

Study #EAZ171 is approved for all four MLH acute care hospitals. For more, email cancertrials@mlhs.org or visit https://www.mainlinehealth.org/research/clinical-trials/eaz171

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Serious drug-induced cardiac side effect accurately detected and scored by LIMR researcher

By Donna Loyle, communications manager, LIMR

 

A new study coauthored by investigators at the Lankenau Institute for Medical Research (LIMR) showed the utility of a scoring system enabled by a LIMR-developed assay in predicting drug-induced torsade de pointes (TdP).

 

TdP, a life-threatening polymorphic ventricular tachycardia, occurs in the setting of QT prolongation. Clinicians have known that certain approved and experimental medications can inadvertently cause QT prolongation. In fact, the U.S. Food and Drug Administration (FDA) now requires all drug candidates in development to be tested to ensure they don’t cause QT prolongation before entering into clinical use. But testing in patients isn’t always possible, so the FDA has called for preclinical testing methods.

 

LIMR Professor Gan-Xin Yan, MD, PhD — along with colleagues at the FDA, Janssen Pharmaceuticals, GlaxoSmithKline and Peking University — demonstrated in a recently published, blinded study that the Normalized TdP Score System they developed successfully predicted the proarrhythmic risk of 34 medications.

 

To complete their study, the team used Dr. Yan’s arterially perfused ventricular wedge preparation (wedge prep for short), an invention previously shown to accurately record all electrical signals in the heart, even in its innermost layers. Previously, scientists could record only the signals sensed on the outside of the heart.

 

In the current study, researchers used Dr. Yan’s wedge prep to detect signals on the inside of animal hearts, each of which had been treated with one of the 34 studied medications. They then assigned scores to those drugs, thus enabling an accurate risk assessment of a medication’s ability to induce TdP.

 

“There has long been a need to reliably predict TdP risk among drug candidates,” said Dr. Yan.   “We’ve now shown that using our normalized TdP score by the wedge prep assay can enable pharmaceutical researchers to readily determine drug-induced TdP risk among their compounds. We think this assay will turn out to be a best-practice preclinical drug-safety solution for pharmaceutical development and may eventually reduce the need for human QT studies.”

 

The study, “Utility of normalized TdP score system in drug proarrhythmic potential assessment: a blinded in vitro study of CiPA drugs,” was published in Clinical Pharmacology and Therapeutics.

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Hepatitis C laboratory test process change

Effective Dec 21st we have started Hepatitis C antibody testing with reflex to Hep C by RNA for both employees and source patients for needle stick/other exposures. This is to comply with new CDC recommendation (July 2020) for reflex testing within 48 hours of exposure. The order sets with reflex testing will be built in EPIC soon for both source patients and employees. This will not be process for any other Hepatitis C antibody testing either as hospital in-patients or outpatients.

 

If you have any questions, please contact Dr. Bhagat at 484-476-3521.

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Clinical Trial of the Week: Diagnostic device trial for patients with metastatic breast cancer

By Donna Loyle, communications manager, LIMR

 

Researchers, including those at MLH, seek to evaluate the performance of fludeoxyglucose F-18 (FDG)-PET/CT response criteria as a binary predictor of progression-free survival in patients with bone-dominant metastatic breast cancer treated with systemic therapy.

 

Participants in this phase II, non-randomized clinical trial receive FDG intravenous solution and undergo PET/CT scan over 15 to 30 minutes within 21 days before start of standard treatment, and then again at 12 weeks after start of standard treatment.

 

Inclusion criteria:

  • Must have been diagnosed with metastatic breast cancer that is hormone-receptor positive and with known HER2 status and whose cancer has spread only or predominantly to the bones
  • Must be able to undergo FDG-PET imaging
  • Must be undergoing a systemic therapy such as endocrine therapy, chemotherapy or an HER2-targeted treatment
  • Other inclusion and exclusion criteria apply

 

Study #EA1183 is approved for all MLH acute care hospitals. The principal investigator is Paul Gilman, MD. For more, email cancertrials@mlhs.org or visit https://www.mainlinehealth.org/research/clinical-trials/ea1183.

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