Save the Date for the 2020 Women’s PGA Championship

Main Line Health has been asked to provide medical care during the 2020 Women’s PGA Golf Championship at Aronimink Country Club, and medical personnel are needed to volunteer. Volunteers would need to be present on the following dates:

  • June 23, 2020
  • June 24, 2020
  • June 25, 2020
  • June 26, 2020
  • June 27, 2020
  • June 28, 2020
  • Rain date June 29, 2020

More information will be shared in the future regarding times and how to volunteer for this event.

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STEEEP Huddle: E for Effective

This week’s STEEEP Huddle, contributed by Richard Ing, MD, director, Metabolic and Bariatric Surgery and Stephanie McKnight, MD, bariatrician, focuses on Main Line Health’s recently opened Comprehensive Weight and Wellness Program office. The team uses education and motivation in addition to traditional medical and surgical interventions (e.g., bariatric surgery) 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.

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: Treatment trial for recurrent follicular lymphoma

By Donna Loyle, communications specialist, LIMR

Researchers, including those at Main Line Health, seek to determine the best therapy for patients who’ve been treated for follicular lymphoma but their disease has returned. They are testing how well obinutuzumab (Gazyva®), a monoclonal antibody, works with other drugs.

It’s thought that monoclonal antibodies like obinutuzumab may interfere with the ability of tumor cells to grow and spread. It is not yet known which combination of drugs will work better in treating patients with relapsing or refactory follicular lymphoma.

All study participants are administered obinutuzumab. Participants are then randomized into three study groups that receive the additional drugs as noted below:

  • Group 1: umbralisib (TGR-1202), an oral medication currently in clinical trials for blood cancers
  • Group 2: lenalidomide (Revlimid®), a cancer drug currently approved to treat myelodysplastic syndrome and multiple myeloma
  • Group 3: combination chemotherapy

Study #S1608 is approved for all Main Line Health acute care hospitals. Principal investigators are Albert DeNittis, MD, and Paul Gilman, MD. For more, call 484-476-2649, email cancertrials@mlhs.org or visit https://www.mainlinehealth.org/research/clinical-trials/s1608

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Abstract Competition for Fellows and Residents

The Sharpe-Strumia Research Foundation is calling all Fellows and Residents to participate in an Abstract Competition, which will be held on Thursday, October 10 in the Pennypacker auditorium at BMH. All submitters will receive an Amazon gift card and monetary prizes will be awarded to three winners. Deadline for entry is Monday, September 23, 2019. See flyer for more details and official rules.

Sharpe-Strumia Abstract Competition

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Save the Date! Population Health Day 2019 – Creating Connections: Conversations to Advance a Healthy Community for All

When: October 18, 2019

The focus of this one-day workshop is to define important areas for research and collaboration to address patient health care needs. The day will include presentations from population health researchers and others, as well as roundtables to promote questions and extensive interaction.

This community-wide conversation will offer perspectives on:

  • barriers to health care delivery;
  • strategies for research that lead to the best health outcomes for all; and
  • addressing disparities in health and wellness.

Where: Lankenau Medical Center

Target audience: all health care professionals, insurers, researchers and academics, legislators and policy makers, community health professionals, and the general public.

The day kicks off at 8 a.m. with Grand Rounds in the Lankenau auditorium. Executives from HealthShare Exchange and the Health Promotion Council will be speakers. Continuing medical education credits will be available for Main Line Health Grand Rounds attendees.

Following complimentary breakfast will be an interactive roundtable whose leaders will facilitate a lively discussion to identify key population health concerns in our community, determine the best way to prioritize strategic initiatives and create a plan of action.

Where: Annenberg 101 ABC

A complimentary lunch will be followed by a roundup of the morning’s discussion and insights.

At 2 p.m. Main Line Health residents are invited to discuss research training opportunities with an expert panel.

Hosts: Main Line Health Center for Population Health Research at the Lankenau Institute for Medical Research, and the Center for Population Health Research at Thomas Jefferson University.

This is a free event, and registration is not required of Main Line Health employees to attend Grand Rounds. To register for the rest of the day’s events, please RSVP to Meg Jones, JonesMe@mlhs.org, by Sept. 30.

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Nationwide Critical IVIG shortage

Situation: Hospitals and Health Systems across the country are being forced to manage a nation-wide shortage of intravenous immune globulin (IVIG) with unpredictable product availability for the next 6-12 months.MLH Pharmacy Department is committed to managing available supply, making it available to as many patients as possible, and guiding prescribers to help manage their patients.

Background: Drug shortages are caused by multiple factors. Rising demand for immunoglobulin and insufficient human donors is the main factor in the current IVIG shortage. Also, IVIG is being used for more and more conditions: some with FDA approval and an abundance of evidence; some off-label and with little to no evidence. Lastly, two manufacturing sites have had recent quality issues and there are two new immunoglobulin products that have recently received FDA approval, which will divert supply away from the available market while they ramp up production. Each MLH pharmacy department has been placed on a monthly allocation of IVIG and that allocation will vary depending on what the manufacturer is able to provide for the month.

 Assessment: MLH Pharmacy Department will continue to make IVIG available for patients based on our wholesaler allocation and we commit to redistributing supply within MLH to maximize availability. A warning message has been placed in Epic alerting prescribers that there is a national shortage of IVIG and to consult with pharmacy prior to ordering.

General strategies to conserve IVIG for all MLH sites:

  1. Assess the indication, benefit, and evidence of IVIG for your patient (please see attached reference).
  2. Emergency use of IVIG for inpatients, provided it is FDA approved and demonstrated to be beneficial, will take priority.
  3. For the short term, consider using a lower dose or longer frequency to conserve supply for a larger pool of patients.
  4. Doses should always be rounded down to the nearest vial size to limit the amount of waste
  5. Before ordering or scheduling an IVIG patient, confirm available supply with MLH pharmacy department
  6. Consult with an MLH clinical pharmacist (if needed)

Recommendation: Please review the attached reference for IVIG and help to support a conservation strategy for the foreseeable future.

IVIG summary update 2017

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Physician Burnout Survey

From Walter Klein MD, on behalf of The Physician Wellness Committee

The incidence of physician burnout has worrisomely increased over the last decade and is now a hot topic of conversation. However, the rates reported vary greatly and likely are dependent on multiple factors including one’s own practice setting. To further investigate this issue at Main Line Health, an ad hoc committee on Physician Wellness has been established by the Medical Executive Committee. In an attempt to obtain more information about physician burnout among physicians on the medical staff at Main Line Health we have put together this brief survey. Please take the time to respond to the survey and encourage your colleagues to do the same. The results are important for us to establish a baseline and move forward with our next steps in addressing this critically important issue.

We thank you in advance for participating in this important effort as we move forward.

https://surveys.nationalresearch.com/survey/selfserve/1fd5/190801

Please respond by: October 25, 2019

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Are you set up for E-Rx of Controlled Substances? (EPCS)

By Don Klingen, MD, CMIO

Situation
On October 24, 2019 ACT 96 goes into effect requiring providers to issue electronic prescriptions for Schedule II-V controlled substances (EPCS).

https://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2018&sessInd=0&act=96

Background
Electronic Prescribing of Controlled Substances (EPCS) is a prescriber’s ability to electronically send an accurate, error-free and understandable Schedule II-V controlled substance prescriptions directly to a pharmacy from the point-of-care. EPCS has the potential to minimize medication errors for patients, and reduce prescription forgery, diversion, and theft in Pennsylvania.

EPCS applies to any provider (MD, DO, APP) who write paper prescriptions for controlled substances in the Ambulatory setting or at hospital / procedural discharge today.  EPCS does not apply to controlled substances ordered for patients as part of their inpatient hospital orders.

The DEA has several requirements to set up a provider for EPCS:
– The provider must have their own DEA number (Not an institutional one)
– The provider must have their identity formally vetted by a third party
– The provider must use multifactor authentication when prescribing controlled substances.

Main Line Health supports EPCS today and automatically provisions new medical staff members and employees. However, there remains a group of providers who were not set up as part of our Epic launch that still need set up.

ASSESSMENT
If a provider prescribes controlled substances out of MLH Epic today on paper in the MLH ambulatory office, emergency department, procedural areas or the hospital they need to take steps to get set up to electronically prescribe those medications before October 24th.

RECOMMENDATION
Step 1: Get your Identity formally vetted

  • The DEA requires that we formally vet the identity of our providers who need EPCS.   We’ve been able to partner with our Medical Affairs office to make this as easy as possible

 

  • Bring a formal form of ID (Driver’s license or Passport) and yourself (must be done in person) to the following locations:
    • Bryn Mawr, Riddle, Paoli Hospitals: Medical Affairs office.
      Lankenau: Executive office (1st Floor, MOB South in Suite 100. 484-476-6423)

Step 2: Await email that you’ve been provisioned

  • Once your identity is vetted the Medical Affairs office will kick off the behind the scenes process with MLH IT and Epic. When a provider set up is completed an email will be sent to the provider letting them know the next steps.  Allow 6 business days for this process.

 

Step 3: Download and Install the DUO app per the instructions in the Email

  • After the provider has been set up with EPCS they will receive an email with needed instructions to set up the DUO app.

 

  • DUO is a mobile multifactor authentication application for your smartphone.   It is free to download from the Android / Apple application stores.

*Of Note:
– No security software is required to install these applications they can be downloaded directly from the Android / Apple Stores.
– Downloading the application without first getting vetted by the Med Affairs office will not work- there is internal set up for each individual user that must occur to configure Duo.
– Exceptions to this set up:  Residents who do not have an individual DEA.  Providers who E-Rx out of MyAvatar.  For set up of EPCS out of MyAvatar please open a help desk ticket and be sure to make clear you need EPCS for MyAvatar.

How to e-Rx controlled substances in Epic
Once set up, all controlled substances prescribing default to electronic.  (No change needed by the provider) When a provider writes for a controlled substance at discharge they will be asked for their password.  Once entered – a window will pop up to do the multifactor authentication on their mobile app.  A push notification will go to your phone and when acknowledged the script will go through electronically. This process has been in place since launch and works well.

Additional Information

PA FAQ on e-RX: https://www.health.pa.gov/topics/Documents/Programs/FINAL_EPCS_Public%20FAQ_8-23-2019.pdf

PA Med Society FAQ:
https://www.pamedsoc.org/docs/librariesprovider2/pamed-documents/qc-electronic-prescribing.pdf?sfvrsn=7d2a14e1_6

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Severe Acute Pulmonary Disease Associated with Vaping

A health advisory from the Pennsylvania Department of Health (DOH).

Summary

  • In the last 2-3 weeks, the Pittsburgh Poison Control Center has been hearing increasing reports of lung injury, in some cases severe, which have preliminarily been associated with vaping.
  • In most cases, patients have reported vaping THC containing products though the remaining chemical constituents of the products have not been identified in most cases.
  • In addition, other states have seen other vaping products containing nicotine, CBD, synthetic cannabinoids, or a combination of substances.
  • Clinicians who become aware of cases similar to those described above are asked to report them to the Pennsylvania Poison Centers at 1-800-222-1222.

The Pennsylvania Department of Health (DOH) is forwarding the following information to healthcare providers, Severe Acute Pulmonary Disease Associated with Vaping from the Pittsburgh Poison Control Center. If you have any questions or concerns, please call the Pennsylvania Poison Centers at 1-800-222-1222.

Background

In the last 2-3 weeks, the Pittsburgh Poison Control Center has been hearing increasing reports of lung injury, in some cases severe, which have preliminarily been associated with vaping or dabbing/juuling. A definitive causal relationship has not been determined, but the association is strong. In most cases, patients have reported vaping THC containing products though the remaining chemical constituents of the products have not been identified in most cases. In addition, other states have seen other vaping products containing nicotine, CBD, synthetic cannabinoids, or a combination of substances. At this time, we are gathering as much information as possible related to cases of lung injury that may be related to vaping. We are aware of at least four cases that have been treated in Pittsburgh hospitals in the last week that appear likely to be related to vaping, though the specific products are unknown at this time. Specialists from the Pittsburgh Poison Center are working with a multidisciplinary team of physician experts to identify cases and investigate the incidence, course, and causation in collaboration with the PA Department of Health and the Centers for Disease Control & Prevention.

Reported Cases

Reported symptoms and findings in cases of suspected vaping associated lung injury include:

  • Fever, nausea, vomiting
  • Shortness of breath, cough, and chest pain
  • Bilateral perihilar infiltrates and ground glass opacities, often with peripheral sparing
  • Progression of symptoms over several days with similarities to a viral illness
  • Patients endorse vaping, often THC products, in the days to weeks preceding symptom onset

Evaluation

  1. Be aware of the potential for significant lung injury in patients presenting with pulmonary symptoms or otherwise appearing to have a “viral syndrome”
  2. If a patient has a history of vaping, perform a careful pulmonary examination and provide patient education regarding the potential for severe lung injury
  3. Provide education to any patient who endorses vaping regarding the immediate risk of lung injury in addition to long term health concerns

Case Identification

In patients with lung injury without an apparent alternative cause, obtain a detailed history of:

  1. Vaping activity
    1. Device used
    2. Products used; including substance
    3. Whether the product was purchased from a store vs. from the street or otherwise potentially tampered with
    4. Where, geographically, was it purchased and used (e.g. city, county, zip code)
  2. Chronicity and pattern of vaping
    1. Timing of use relative to symptom onset
    2. Symptom onset and progression
    3. Baseline lung or other systemic disease
    4. Any other drug or environmental exposure
    5. Recent travel
  3. Diagnostics
    1. Vital sign assessment
    2. Pulmonary examination findings
    3. Imaging: plain film and/or CT without contrast according to clinical indication and availability
    4. If possible and appropriate, the following data may be helpful in diagnosis and treatment:
      1. Urine drug screen
      2. Complete blood count, comprehensive metabolic panel, venous or arterial blood gas
      3. Sputum culture
      4. Viral and fungal pathogen testing
      5. Bronchoalveolar lavage findings and specimen evaluation

Treatment

At this time, no additional systemic toxicity has been identified. The goals of therapy are supportive to maintain adequate oxygenation and ventilation through means determined by the patient’s clinical condition and response to therapy. Significant hypoxemia and precipitous deterioration in respiratory illness have been reported. Some reported cases have required mechanical ventilation and VV-ECMO.

Surveillance

The identification of cases will be critical in order to fully assess the impact as well as investigate the cause and prevent further harm. If you suspect a case of lung injury related to vaping, please call Pennsylvania’s Poison Centers at 1-800-222-1222. The poison centers can provide assistance in the evaluation and potentially management of patients. Additionally, cases reported to poison centers will be catalogued in the National Poison Data System which will greatly strengthen the public health response to this potential threat.

If you have any questions or concerns, please call the Pennsylvania Poison Centers at 1-800-222-1222.

Please see the link below to the newsletter, CDC Urges Clinicians to Report Possible Cases of Unexplained Vaping-associated Pulmonary Illness to their State/Local Health Department from the CDC Clinician Outreach and Communication Activity: https://emergency.cdc.gov/newsletters/coca/081619.htm

2019-PAHAN–454-08-16-ADV-Vaping_fin

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Clinical Trial of the Week: Device trial for patients diagnosed with aortic stenosis

By Donna Loyle, communications specialist, LIMR

Main Line Health is participating in a clinical trial that is studying the safety and effectiveness of the ACURATE neo2™ aortic valve system for transcatheter aortic valve replacement in symptomatic patients diagnosed with aortic stenosis. Eligible patients are those at intermediate or greater risk for standard surgical aortic valve replacement.

Study participants undergo implantation with either the ACURATE neo2™ or another commercially available device. Patients will be assessed at baseline, peri- and post-procedure, at discharge, 30 days, six months, one year, and then annually for up to five years.

The Main Line Health principal investigator for the ACURATE IDE trial is Eric Gnall, DO. For more, visit https://www.mainlinehealth.org/research/clinical-trials/acurate-ide

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