Main Line Health’s new program for Weight & Wellness

Main Line Health’s Comprehensive Weight and Wellness Program office is now OPEN. The program staff are a team of medical weight loss specialists, including a bariatrician, bariatric surgeon, bariatric nutritionists, and nurses who specialize in medically-monitored and surgical weight loss. The team also includes exercise physiologists and behavioral health counselors who specialize in working with bariatric patients. They use education and motivation in addition to traditional medical and surgical interventions to provide an empowering and supportive environment which allows patients to master the life changes needed to lose body fat and regain life, health, and energy. Call 484.476.6230 or visit mainlinehealth.org/weight for more information.

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Lankenau Institute for Medical Research partners with Thomas Jefferson University to commercialize select inventions

Lankenau Institute for Medical Research (LIMR), the research division of Main Line Health, will manage and commercialize several of its biomedical and healthcare inventions through a recently initiated agreement with the Office of Innovation at Thomas Jefferson University (Jefferson).

In addition to conducting biomedical research, LIMR’s resident faculty develop new biopharmaceutical and medical device technologies, particularly in the areas of cancer prevention, prognosis and treatment. Jefferson will assist LIMR in the licensing and commercialization of its growing patent portfolio.

“We’re excited to work with the innovation and technology-transfer experts at Jefferson to help us license selected parts of our portfolio of inventions to the biotechnology and pharmaceutical industries,” said George Prendergast, PhD, president and CEO of LIMR. “In recent years, we have expanded the number of unique technologies developed by our faculty. We look forward to working with our Jefferson colleagues to find partners to help us further develop those innovations so that they can progress to a clinic setting.”

Jefferson has licensed more than 100 inventions and started more than 25 new ventures that have gone on to raise investments of well over $200M to date. Ranked the fifth most innovative university in the North Region by U.S. News & World Report in 2018, Jefferson is considered a national leader in the development and translation of novel medical technology.

“Jefferson is honored to have been selected to partner with LIMR on the translation of its world-class medical research and innovations, and we are very much looking forward to this partnership,” said Dr. Rose Ritts, chief innovation officer and executive vice president of innovation at Jefferson.

The full list of LIMR-developed IP and technologies available for licensing is posted on the LIMR website at mainlinehealth.org/limrtech.

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LIMR Investigator awarded Department of Defense grant for studies on regenerating nerves and tissue lost from amputation

Ellen Heber-Katz, PhD, professor at the Lankenau Institute for Medical Research (LIMR), part of Main Line Health, and two colleagues were awarded a three-year grant from the U.S. Department of Defense (DOD) for their further studies on a drug they developed that shows promise in regenerating nerves and tissue lost from amputation.

By 2050 approximately 3.6 million Americans will be living with the loss of a limb, most likely because of vascular disease and/or trauma. Dr. Heber-Katz made the surprising discovery in 1996 that a certain breed of laboratory mice can spontaneously regenerate lost tissue, similar to amphibians such as newts and salamanders. The mice don’t just heal, Dr. Heber-Katz discovered. Rather, their injured tissue spontaneously regenerates a perfect replica of lost tissue including hair follicles and cartilage, without scarring and with total replacement of normal tissue architecture and function.

Since that discovery, Dr. Heber-Katz and her colleagues followed various clues in their laboratory research and determined that a specific protein, HIF-1a, is the likely cause of the tissue regeneration. That led the team to create a drug that mimics the protein’s action.

“This new DOD grant will help us progress our scientific understanding of HIF-1a and enable us to work on advancing future treatments that could eventually regenerate entire limbs,” said Dr. Heber-Katz, an internationally renowned immunologist who investigates mammalian regeneration. “We are grateful for DOD’s support in this work, which may prove helpful for wounded warriors and others living with lost limbs.”

Dr. Heber-Katz’s colleagues on the grant, entitled “Drug-Induced Regeneration and Re-innervation in a Mouse Digit Amputation and Nerve Transection Model,” are Phillip Messersmith, PhD, of University of California, Berkeley; and Aviram Giladi, MD, of Curtis National Hand Center at MedStar Union Memorial Hospital, Baltimore.

For the research, DOD awarded LIMR $1.58 million, which will cover 88% of the project’s estimated cost. Non-governmental sources will fund $213,000, or 12%, of the project.

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Best read of the week

When A Doctor’s Screen Time Detracts From Face Time With Patients

Kaiser Health News: Electronic health records can help reduce medical errors, but when not used well they can strain the doctor-patient relationship.

Additional news media reports on MLH physicians and the health care industry, excerpted from MLH’s daily Morning News Report:

Main Line Health News…
Central Pa. hospitals rank among the best in the state and the country: U.S. News & World Report

PennLive: PennLive reported on the 2019-20 U.S. News and World Report rankings of the best hospitals in the state of Pennsylvania, which includes MLH hospitals.

Main Line Health’s population health program is taking care of Philly families

6abc: As part of our Well Ahead Philly partnership, Sharon Larson, PhD, executive director of the Center for Population Health Research at LIMR, joined 6abc’s Gina Gannon to share how a revamped group membership initiative is helping Main Line deliver the proper health care to its diverse patient base.

Regional Health News…
Jefferson University agrees to buy Fox Chase Cancer Center from Temple University

Philly Voice: Thomas Jefferson University tentatively has agreed to purchase Temple University’s Fox Chase Cancer Center, the universities announced Monday in a joint statement.

With $12 million grant, Penn cancer center to explore new treatments

Philly Voice: Penn Medicine’s Abramson Cancer Center was awarded a $12 million grant by the Mark Foundation for Cancer Research to establish a new type of cancer research center.

 Quality and Safety News…

5 questions: Penn doctors study why elderly patients become confused after surgery

The Inquirer: Lee A. Fleisher, Robert Dunning Dripps professor of anesthesia and chair of the department of anesthesiology and critical care at the University of Pennsylvania Health System, and Rebecca Trotta, director of nursing research and science and director of the geriatric nursing program at the Hospital of the University of Pennsylvania, spoke to us recently about post-surgery cognitive changes in the elderly.

 Patient Care News…
Lack of doctors fueling health care delays

The Daily Item: Robert Eberly struggles to contain his frustration when he talks about the difficulty he’s had in scheduling a medical appointment at Geisinger. A May 31 appointment with the Lewisburg man’s primary physician that was scheduled nine months in advance was postponed twice, first until October and then until December.

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STEEEP Huddle: E for Effective

This week’s STEEEP Huddle, contributed by Gib Williams, director, Pharmacy, Bryn Mawr Hospital focuses on the mail order benefit offered by the employee pharmacy to MLH employees and their dependents who participate in our medical benefits plan.

The mail order option for the employee pharmacy is an underutilized benefit that is available to all employees and their dependents who participate in our medical benefits plan. Mail order helps us better serve our staff who do not work at one of the hospitals or who do not work day shifts when the pharmacy is open.

The STEEEP Huddle topics are posted on the Performance Excellence 2020 site at landing.mainlinehealth.org/PE2020.

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Clinical Trial of the Week: Post-surgical treatment trial for patients diagnosed with grade II meningioma

Researchers seek patients who’ve been diagnosed with grade II meningioma and whose tumor has been surgically removed. This phase III clinical trial seeks to determine if radiation therapy (RT) can improve outcomes. There are two treatment arms:

  • Arm 1: clinical observation after gross total resection
  • Arm 2:  radiation therapy 5 days per week over 6.5 or 7 weeks for a total of 33 treatments

Inclusion criteria:

  • Newly diagnosed unifocal intracranial meningioma, gross totally resected, and histologically confirmed as WHO grade II
  • For step 1 registration, the operating neurosurgeon must provide the modified Simpson grade (1-3). GTR must be confirmed on post-op imaging following the most recent surgery; pre- and post-operative MRIs are required for patient (see protocol for specifics if second surgery occurs)
  • Prior to step 2 diagnosis of WHO grade II meningioma confirmed by central pathology review

The principal investigators for trial NRG BN003 are Albert DeNittis, MD, and Paul Gilman, MD. More information is available at https://www.mainlinehealth.org/research/clinical-trials/nrg-bn003

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MLH Center for Population Health Research at LIMR Welcomes New Assistant Professor

By Donna Loyle, communications specialist, LIMR

Kyle McGregor, PhD, has been named assistant professor in the Main Line Health Center for Population Health Research (CPHR) at the Lankenau Institute for Medical Research. Dr. McGregor’s interests include empirical research ethics, data analytics, and adolescent health and development. He is an expert in research methodology, focusing much of his efforts on the ethical use of unstructured data related to highly vulnerable populations.

Dr. McGregor completed his PhD on a National Center for Advancing Translational Sciences Award at Indiana University. As a PhD candidate he also completed a fellowship in clinical ethics at the Charles Warren Fairbanks Center for Medical Ethics. He conducted his postdoctoral training in medical informatics at Yale University as a National Library of Medicine postdoctoral fellow. After leaving Yale he completed a second postdoctoral fellowship in the SAFE Lab at Columbia University.

Prior to joining CPHR, he served as director of pediatric mental health ethics at NYU Langone Health, New York City, where he was an assistant professor of child and adolescent psychiatry and population health.

“Dr. McGregor brings to the population health research team a unique perspective that combines data science, social work, adolescent health, and technology use and innovations in health care that can identify crucial needs within our community and propose potential solutions,” said Sharon Larson, PhD, executive director of CPHR. “We are thrilled to welcome him to Main Line Health.”

Since 2014, Dr. McGregor has been a lead author and co-author of studies that have been published in leading peer-reviewed publications, including Pediatrics, Journal of the American Medical Informatics Association, Ethics & Human Research, and Social Science Computer Review. He is a member of the Society for Adolescent Health and Medicine and an ethics committee member for the American Medical Informatics Association.

“I look forward to working with my new colleagues in Main Line Health and CPHR in their efforts to help improve our community’s health and wellbeing,” said Dr. McGregor. “Main Line Health’s advancements in population health in our region are an inspiration, and I am honored to lend my skills and expertise to the ongoing efforts.”

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Lankenau Institute for Medical Research ranked among the top institutes contributing to advances and knowledge about the electrical function of the heart

By Donna Loyle, communications specialist, LIMR

Among scholars in Pennsylvania conducting research and publishing in the field of electrocardiography and electrical diseases of the heart, five of the top 30 are from Main Line Health’s Lankenau Institute for Medical Research (LIMR), according to Expertscape, a website that ranks health care professionals and researchers by the quality and quantity of their publications.

Expertscape examines all medical publications that are indexed in the National Library of Medicine’s MEDLINE database. It then rates the expertise of each author according to the number and type of articles he or she has published on specific conditions, diseases or treatments.

When looking at manuscripts published by the 1,236 electrocardiography scholars in Pennsylvania since 2008, Expertscape highlighted five of LIMR’s researchers:

  • Charles Antzelevitch, PhD, professor and executive director of cardiovascular research at LIMR, (pictured) was ranked #2 in the state. Additionally, Dr. Antzelevitch, who also serves as director of research for Lankenau Heart Institute, was ranked #10 in the United States, and #13 in the world from a field or 72,000 scientists and physicians publishing in the field of electrocardiography and electrical diseases of the heart. This places Dr. Antzelevitch in the top 0.1% of scholars globally contributing to the knowledge base in this field of cardiology during the past 10 years.
  • Peter Kowey, MD, LIMR professor, was ranked #5 in Pennsylvania. Dr. Kowey, chairman emeritus of cardiology at Lankenau Heart Institute, also was ranked #8 in the U.S. Mid-Atlantic region.
  • Gan-Xin Yan, MD, PhD, LIMR professor, was ranked #9 in Pennsylvania and #15 in the Mid-Atlantic area.
  • Jose Di Diego, MD, LIMR research associate professor, was ranked #22 in Pennsylvania.
  • Michael D. Ezekowitz, DPhil, LIMR clinical professor, was ranked #30 in the state.

Among institutions, Lankenau Medical Center/LIMR ranked fourth in the state, just behind three major academic medical schools (University of Pennsylvania, University of Pittsburgh and Thomas Jefferson University).

“We are so proud of LIMR’s scientist-scholars who are striving to advance new discoveries and therapeutic options for patients around the world who have been diagnosed with cardiovascular disease,” said George Prendergast, PhD, president and CEO of LIMR. “It is gratifying to see our researchers get the recognition from their colleagues that they deserve.”

The Pennsylvania rankings are available at  www.expertscape.com/ex/electrocardiography/s/pa

 

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Screening Mammography and Breast Cancer Risk Assessment

By Emma Simpson, MD, Chair of Radiology

 EPIC’s EMR adopted by MLH provides an automatic generation of risk assessment for breast cancer using the modified Gail Risk model.  This risk assessment had been calculated and included in some MLH screening mammograms in the past, but with the adoption of EPIC, this piece of data is included in more of the reports and is commonly in the EPIC record. It is based on an original algorithm derived from a screening database of 280,000 US women ages 35-74 and then subsequently modified to improve the accuracy in women with a previous biopsy.

What are the factors considered in calculating the modified Gail Risk Score?

Personal medical history, reproductive history, first degree relatives with breast cancer, and the number of and results of previous breast biopsies.

Is it accurate for all women?

The main caveat to using the Gail Risk Score is possible underestimation of risk.  While MLHS has implemented the score for women aged 35-74 it is important for all providers to consider the factors that could limit its accuracy.  It is not applicable for women with a history of invasive breast cancer, DCIS or LCIS. It was validated in a population of Caucasian women living in the United States, and therefore may have limited applicability to those with other racial or ethnic backgrounds.  There are other factors that increase risk for breast cancer that are not considered in this model.

How do I use the risk score?

It is important to keep in mind the limitations of the score, some of which are listed above and mostly can result in underestimation.  A normal or low score does not mean a patient won’t get breast cancer.  Average lifetime risk is 12% in the US.  The literature shows that patients with a lifetime risk score of 20% or higher benefit by having a screening MRI and most insurers will cover the study for these high risk patients if their mammogram also show dense or heterogeneously dense breasts.  We also recommend considering referring women with a life time risk score of 20% or higher to a breast surgeon and a genetic counselor who can determine if genetic testing is appropriate.  Patients with known genetic mutations such as BRCA1 or BRCA2 as well as other hereditary syndromes benefit from similar referrals, regardless of the Gail Risk score.

Are there better risk tools available?

MLH is exploring other, newer risk model tools through the system Breast Tumor Work Group.  We will keep you posted.  Please feel free to call one of our breast centers and speak with one of our breast imagers if you have questions.  You can reach the MLH Cancer Risk Assessment and Genetics at 484-565-GENE.  The phone numbers for the Nurse Navigators at each breast center are listed below.

LMC: 484-476-1426

BMH: 484-337-8775

PMH: 484-565-1461

RH:    484-227-3325

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Update on Blood Type Recheck Policy

By Pradeep K. Bhagat, MD, System chairman, Department of Pathology

The ABO/Rh Recheck policy has been developed as a risk reduction process at Main Line Health for several years to prevent transfusion from a misidentified sample. Per the American College of Pathologists (CAP), mistransfusion occurs from misidentification of the intended recipient at the time of collection of the pretransfusion testing sample, during laboratory testing and preparation of units to be issued, and at the time of transfusion. Misidentification at sample collection occurs approximately once in every 1,000 samples, and in one in every 12,000 transfusions the recipient receives a unit not intended for or not properly selected for him/her.

An ABO/Rh Recheck must be done on all patients with no historical record prior to transfusion. Main Line Health verifies the ABO group of the intended recipient of blood products by obtaining a second sample collected by a different phlebotomist at a different time to prevent these types of errors. Main Line Health Laboratory makes no exception to this process and in doubt will reject the specimen and will ask for redraw.

The Blood Bank and Nursing staff will work together to ensure that the ABO/Rh Recheck is performed STAT and that there will be no delay in the issuing of any blood products. In the event that the ABO/Rh Recheck sample cannot be obtained due to patient being in a critical situation, difficult stick or patient refuses, then only Group O red blood cells will be issued. In these cases, the Blood Bank should be notified immediately. This should be reserved for emergency basis only. The laboratory also monitors the effectiveness of the system and considers improvements in procedures and/or educational efforts as part of its program to reduce the risk of mistransfusion.

If you have any questions, do not hesitate to call Liz Klinger, Transfusion Service Manager at Main Line Health at 484-476-8409 or Dr. Bhagat at 484-476-3521.

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