|
|
Breaking News
The Daily Telegraph (London)
|
Predicting the Onset of Labor
"Death and taxes and childbirth. There's never any
convenient time for any of them."
--Margaret Mitchell
Mothers know that labor and childbirth rarely happen on the "due
date" given by their practitioner at their first prenatal
visit. Pregnancies can vary substantially from the standard
40-week gestation, and many are cut short by premature labor and
birth. But what controls the labor onset mechanism?
By studying rats, Penn researchers showed that the cells of the
amniotic sac display many characteristic features of apoptosis
(cell death) well before labor even begins. This process leads to
a weakening of the membrane and its eventual rupture, which often
precedes birth. According to Jerome F. Strauss III, MD, PhD,
director of Penn's Center for Research on Reproduction and Women's
Health, "Our observations demonstrate conclusively that the
fetal membranes undergo structural changes in preparation for
labor."
This finding contrasts with the popular belief that fetal
membranes rupture mainly as a result of mechanical forces produced
by uterine contraction. The results were published in the November
issue of The Journal of Clinical Investigation.
Currently, the researchers are trying to determine whether the
identified changes, particularly the appearance of certain enzymes
known as collagenases, might be useful in predicting the onset of
both normal and premature labor. If premature labor can be
predicted, Strauss said, physicians can then try to prolong risky
pregnancies with treatment.
The article appeared December 23.
|
NATIONAL
|
The New York Times
The Baltimore Sun
The New York Times Magazine
Harrisburg Evening News
Minneapolis Star Tribune
Denver Post
Allentown Morning Call
Altoona Mirror
|
Rationing Liver Transplants
The United Network for Organ Sharing, the organization
responsible for the allocation of organs for transplants, made a
controversial decision to change the rules about who gets placed
on the top of liver waiting lists. The organization, a private
group of transplant experts overseen by the Department of Health
and Human Services, revised its former policy of putting the
sickest patients on top of the list, opting to give priority to
those with the best prospects of survival. The new rules apply
only to liver transplants because there is a severe shortage of
the organs.
Under the new rules, patients facing imminent death because of
an unexpected liver failure from something like a poisoning or an
acute virus would be given priority over those with chronic
diseases, such as cirrhosis of the liver, or hepatitis C or B,
diseases that damage the liver over decades.
"This is a real test case for what is fair and efficacious,"
Arthur L. Caplan, PhD, director of the Center for
Bioethics, told The Baltimore Sun. "For many years,
we've allocated livers in this country according to urgency: Who
is, literally, at death's door? When liver transplant surgery
began, it was so risky that to [select] someone who wasn't at
death's door was almost immoral. But as liver transplant has
evolved to better efficacy, that policy doesn't make as much
sense."
Although the decision will make it harder for alcoholics
suffering from cirrhosis or intravenous drug users with hepatitis
to get livers, Caplan said, "The policy has nothing to do
with sin. It has to do with outcome."
Reports began on November 15.
|
|
Science
KYW-AM Radio
WTXF-TV29
|
Multiple Genes, Same Solution?
Among inherited diseases, the heart condition known as
hypertrophic cardiomyopathy (HCM) is the leading cause of sudden
death in young adults.
The disease is believed to interfere with heart cells' ability
to contract. In turn, cells release more calcium, which stimulates
contractions, but also stimulates hypertrophy--or enlargement--of
the heart, which may progress to heart failure. HCM received
notoriety in recent years when several famous athletes, including
Hank Gathers and Reggie Lewis, died suddenly of the condition.
In past research, scientists identified six defective genes
associated with the disease, complicating the search for the exact
mechanism of the disease and for possible treatments.
Now, Penn researchers have shown that although the mutation that
causes this disease affects different proteins, the
result--diminished power in the heart muscle--is the same.
H. Lee Sweeney, PhD, associate professor of physiology
and senior author of the study, reported in the December Journal
of Clinical Investigation that a single therapeutic approach
may work for all HCM patients, whatever the genetic makeup of
their disease.
"This work implies that if there is a common functional
problem, irrespective of which gene is defective, then one type of
treatment may work for all hypertrophic cardiomyopathy patients,"
Sweeney said. He added that the solution to treating the disease
may lie in blocking or decreasing the signals in the heart that
cause it to enlarge.
Reports began December 4.
|
|
The New York Times |
The Breast Cancer Vote
During the 1996 political campaigns, the usual issues were
bantered about between candidates: taxes, the economy, the
candidates' credibility. But this year a new topic was on the mind
of some voters: which candidate will fight the hardest against
breast cancer.
Fear of breast cancer was discussed in several nearby political
campaigns, including those of Senator Alfonse M. D'Amato (R-NY)
and Representative Robert G. Torricelli (D-NJ). Both candidates
vowed to make the fight against breast cancer a top priority if
elected.
"It's no accident that the subject is cropping up now,"
said Amy Langer, director of the National Alliance of Breast
Cancer Organizations. As she told The New York Times, "We
said to elected officials that this is our number one issue of
concern." To officials who will not listen, she said, "We
will vote you out of office."
Barbara Weber, MD, associate professor of medicine and
genetics, called the election strategy "pretty demeaning."
Such tactics imply that "Women don't care about the deficit
or education or Medicare." It suggests that "What we
care about is whether we ourselves will get breast cancer."
The article appeared November 3.
|
|
Northeast Breeze
Hospital and Healthcare News
|
Caregivers' Labor of Love
A recent survey of 500 caregivers of Alzheimer's patients
conducted by the Alzheimer's Association's Southeastern
Pennsylvania Chapter showed that caring for their loved ones is a
daunting challenge. The job can be physically, emotionally, and
financially draining, taking up to 100 hours a week, causing
family stress, and forcing some to quit their jobs. Still, the
vast majority of caregivers call their efforts a "labor of
love." Most caregivers also acknowledge that Alzheimer's is a
progressive illness, and added they do not expect a cure or a "miracle"
within their loved one's lifetime.
The caregivers' expectations are realistic, according to John
Q. Trojanowski, MD, PhD, professor of pathology and laboratory
medicine. Trojanowski told Hospital and Healthcare News
that because of the degenerative nature of the disease, simply
allowing patients to function longer is considered a treatment
success.
"In other words, it would be considered good news if we
could slow the rate of decline in an afflicted individual. But
what constitutes improvement or decline could be very subtle and
subjective, so physicians rely on caregivers for their
observations."
Reports began in October.
|
|
USA Today |
Accessing the Heart Through a Keyhole
A new, less-invasive surgical procedure may allow some heart
bypass patients to recover more quickly with less pain. The
surgery involves making a small incision in the chest to insert
instruments, as opposed to the traditional method of cutting open
the breast bone and exposing the heart. With the new "keyhole"
or "port-access" method, the patient's heart is stopped,
but circulation continues through a catheter in the groin area.
According to the surgeons who have pioneered the procedure at New
York University Medical Center, patients only need to be
hospitalized for three to five days after surgery, as opposed to
seven to 10 days for standard heart bypass surgery.
Timothy Gardner, MD, chief of the division of
cardiothoracic surgery, told USA Today that the
port-access technique is "a very significant development."
However, he added, "the only difference between the
port-access and conventional method is that you avoid opening the
chest." Instead, catheters and other instruments are required
at "multiple" sites in the groin and chest. In addition,
Gardner said, the use of catheters in the groin could make the
surgery inappropriate for patients with arterial diseases in
their legs.
The article appeared December 11.
|
|
Science News
Science
|
Creating Mutant Zebrafish
In the past, developmental biologists studying the process of
early embryonic formation have concentrated their efforts on two
invertebrates--the Drosophila melanogaster fruit fly and the
Caenorhabditis elegans worm. One drawback to researching the two
invertebrates is that, because the organisms do not possess
backbones, findings could not be applied by extension to human
development. To bridge that gap, Mary C. Mullins, PhD, an
assistant professor of cell and developmental biology, chose to
study the Danio rerio zebrafish, a popular vertebrate fish used in
home aquariums.
Mullins developed methods to produce successful mutagenesis
screens of the genome of the zebrafish that gave insights into
vertebrate development. Her system uses a chemical mutagen to
induce point mutations--alterations to a single base pair in the
DNA of a gene. Mullins was fascinated by the mutations that
resulted, she told Science News. "There are some
mutants that would swim upside down, and some that would swim in
circles."
In future research, Mullins and her colleague, Michael
Granato, PhD, will continue to use molecular genetics
techniques to trace the biochemical pathways associated with the
mutations.
The articles appeared in early December.
|
LOCAL
|
The Philadelphia Inquirer
Philadelphia Business Journal
Philadelphia Tribune
Philadelphia Exclusive
Times-Herald
Daily Record
WPVI-TV6
WPHL-TV17
WTXF-TV29
|
UPHS Welcomes Pennsylvania Hospital
In mid-November, Pennsylvania Hospital's board of managers made
the decision to affiliate with the University of Pennsylvania
Health System. The historic institution, founded in 1751 by
Benjamin Franklin and Thomas Bond, will join Penn's system while
retaining its own name and governing board and establishing a
foundation for its endowment funds.
Pennsylvania Hospital is known for its strong neonatology,
neurosurgery, behavioral health, and orthopaedic surgery
departments. In fiscal year 1996, the 739-bed institution
delivered more than 3,700 babies and admitted 22,000 patients.
Pleased with the decision, William N. Kelley, MD, CEO of
the University of Pennsylvania Health System and Dean of the
School of Medicine, praised the board's actions. "Their
forward-looking action not only restores an important historical
association that began nearly 250 years ago, but assures that our
respective institutions--together--will be able to build an
integrated network for providing unparalleled patient care and
medical training into the 21st century."
Reports began November 12.
|
|
The Philadelphia Inquirer
Bucks County Courier Times
The Record
Wayne Daily Independent
KYW-TV3
WPVI-TV6
WCAU-TV10
WPHL-TV17
WTXF-TV29
|
Meningitis Death
In mid-November, Michael Skowronek, a 19-year-old Drexel
University student, was admitted to the Hospital of the University
of Pennsylvania with meningococcal meningitis. He died mere hours
later. Although the case caused a lot of concern in the region,
particularly among college students, medical officials assured
people that meningitis, although quite serious, is not easy to
transmit. In fact, the disease is spread only through close and
prolonged contact. P. J. Brennan, MD, assistant professor
of infectious diseases, hospital epidemiologist, and director of
infection control, explained the transmission to WTXF-TV29's
Jan Fisher. "The bug is spread through what we call droplet
nuclei, moist droplets that are expelled by coughing or sneezing
off the mucous membrane of the mouth and nose." About 50
students who lived with Skowronek in his dormitory were treated
prophylactically with the antibiotic Rifampin.
Reports began November 12.
|
|
Main Line Life |
PennSTAR in the Spotlight
Christina Alex, a Main Line Life reporter, took in a lot
more than a beautiful view when she spent an evening aboard the
Medical Center's PennSTAR helicopter, following its crew as they
did their jobs. The first order of business that evening was to
transport a woman injured in a boating accident from Elkton, MD,
to the Hospital of the University of Pennsylvania. The
crew--flight paramedic Jim McCans, flight nurse Anne O'Connell,
RN, MSN, and pilot Wayne Miller--retrieved the patient, stabilized
her, and provided pain relief. In a short time, they delivered her
safely to the care of C. William Schwab, MD, professor of
surgery and chief of trauma. The patient, who had a broken pelvis,
suffered little during the transport. "You know what that
ride would have been like for two hours in a bumpy ambulance?"
O'Connell said. "This flight helped her out immeasurably."
The article appeared in the November 21 issue.
|
|
The Philadelphia Inquirer |
If You Can't Fight Them, Join Them
Hospitals are teaming up with HMOs to oversee patient care.
According to The Philadelphia Inquirer, four local health
systems--including the University of Pennsylvania Health
System--have taken on the job of delivering managed care to their
patients for certain HMOs. The advantages? Not only are healthcare
decisions overseen by clinicians, not insurers, but patients are
encouraged to stay within a particular system. Health systems reap
the financial benefits of lowering their own utilization.
David Shulkin, MD, Chief Medical Officer for HUP and
assistant professor of general internal medicine, told the
Inquirer that these arrangements will "eliminate the
traditional adversity" between managed-care companies and
hospital systems. "We are no longer getting the phone calls
[from HMOs] that patients are in the hospital too long," said
Shulkin. "What it does is allow the health system to
actually define what is the best care from a quality point of view
and be in full control over adhering to standards."
The article appeared December 1.
|
|
The Philadelphia Inquirer |
Decisions About Death
A five-part series of articles in The Philadelphia Inquirer
(Nov. 17-21) addressed the different ways that people and their
families approach the end of life. The first in the series focused
on Gene Moore, a patient at the Hospital of the University of
Pennsylvania, and his family as they prepared for his inevitable
death.
Moore, a 63-year-old steel worker who suffered from pulmonary
fibrosis, had a lung transplant in February at Penn and made a
temporary recovery. In June, however, Moore was re-hospitalized
because his body was rejecting the lungs. Despite medical efforts
to help him, Moore rapidly deteriorated in Penn's MICU, until his
physicians told the family that there was no chance for his
recovery and that further treatments might actually be causing
Moore discomfort. After much discussion and soul-searching, the
family decided to take Moore off of life support and let him die.
David Gaieski, MD, a MICU resident in internal medicine,
told the Inquirer that families very often have a hard time
accepting the futility of prolonged treatment. "Almost
invariably families want to push on when we want to stop."
MICU nurse Cheryl Maguire, RN, CCRN, echoed Gaieski's
sentiment: "It's only one in 20 that a family comes to us and
says stop. It's much more the case that we see there's no hope,
and we keep working until they get to that point, too."
The Inquirer series examined hospice care, assisted suicide,
living wills, and other end-of-life concerns.
|
|
The Philadelphia Inquirer |
Renewal of a Gene Therapy Trial
In a December installment in its continuing series of articles
on gene therapy research, The Philadelphia Inquirer followed
researchers at Penn's Institute for Human Gene Therapy as they
tried to jump-start an effort that began almost three years ago to
test a new gene delivery vehicle that offers hope to cystic
fibrosis patients.
In early 1994, a low-dose gene therapy was administered to
volunteers. Although the patients fared well, concurrent animal
studies showed that there could be risks for patients at a higher,
therapeutic dose. So the Institute went to work to design a new,
safer gene-delivery vehicle.
The Inquirer traced the Institute's progress as it neared the
finish line in preparing the treatment for trials. The story
recalled how, last summer, James M. Wilson, MD, PhD, chair
of molecular and cellular engineering and director of the
Institute, and his staff worked tirelessly to overcome obstacles,
including major production problems. Their efforts paid off: in
October, the Institute finally received approval to start trials.
Immediately, cystic fibrosis patients were sought, and Christopher
Manzi, a 19-year-old New Jersey college student, became the first
to receive the new vector. "We move fast," Wilson told
the Inquirer. "Industry doesn't move this fast."
This article was the second time in recent months that the
Institute was featured in the Inquirer series. In October, the
paper reported on the Institute's efforts to obtain approval from
the Food and Drug Administration to start human trials of a gene
therapy designed to treat infants born with a deadly inherited
liver disease.
The article appeared December 6.
|
PERSPECTIVES
When reporters need
opinions on current issues, they frequently consult University of
Pennsylvania Health System experts. Below are samples of comments made
to the media on various timely topics:
"When we realize that an actuarial firm decides that radical
breast surgery can be done on an outpatient basis, disregarding the
profound psychological effects on a woman, we know the bell has tolled
on humane medical care in the U.S."
--June E. Greenspan-Margolis, MD, clinical
associate professor of psychiatry
"Cruel Medicine is Good for Business" (Letter
to the Editor)
Wall Street Journal, 11/27
"We've confused death with dignity with a romantic death. Death
usually is not beautiful. It's ugly. Death with dignity is the death
that is right for [patients]. I don't mean futile things, but fighting
and really giving them a chance. Patients are here [in the MICU]
because their family chose an aggressive fight. To die after an
aggressive fight is an honorable thing, appropriate for that person."
--Ronald Collman, MD, assistant professor of
medicine
"A Decision About Death"
The Philadelphia Inquirer, 11/17
"It's one thing to say we've got to relieve pain for the
dying--and we don't do enough to do that in this society. This doctor
tried to be aggressive about that. I think that's a commendable thing.
But he may have well gone too far, in terms of what he was trying to
do."
-- Arthur L. Caplan, PhD, director of the
Center for Bioethics
Subject: Treatment of Patient's Pain Ends in Death,
Murder Charges
MSNBC-TV News, 12/9
"When you hear physicians belly-aching, it's often hard to know
if the dollar figures are unfair, or if the docs are going through the
five stages of accepting the death of the good old days of medicine."
-- Alan Hillman, MD, MBA, associate dean of the School of
Medicine, associate professor of medicine, director of the Leonard
Davis Institute's Center for Health Policy
"HMOs Reduce Payments to Doctors"
The New York Times, 11/25
"The worst situation that I have heard about is a situation in
which a father was so afraid that his daughter would get breast cancer
in a family where it was running very strongly that he insisted that
his daughter be tested at age ten so that he could have her breast
buds removed [if she had the breast cancer gene]."
-- Arthur L. Caplan, PhD, director of the
Center for Bioethics
Subject: Genetic Testing
Wall Street Journal Report, 11/11
SNIPS & CLIPS
SPELLING RELIEF.
. . Heartburn sufferers have many treatment options available to them
today. Many find relief in over-the-counter medications designed to
prevent heartburn. But some people have severe heartburn due to weakened
sphincter muscles, and medication does little good. Fortunately, there
is a new surgical procedure available that can tighten the muscles and
make severe heartburn a distant memory. Jon B. Morris, MD,
assistant professor of surgery, explained the procedure--which can
sometimes be done with a laparoscope--to WCAU-10's Cherie Bank. "The
principal advantages are there is much less pain after surgery, patients
are out of the hospital much quicker, and they recover fully much
faster," Morris said. Aired 11/24.
CANCER RATES DOWN. . . Twenty-five years ago, Congress
passed the National Cancer Act and declared war on the disease. And
according to federal statistics printed in The Philadelphia
Inquirer, the efforts have been effective. National cancer death
rates have fallen considerably. In 1990, 135 out of every 100,000
deaths were attributed to cancer; in 1995, that rate fell to 129.9
deaths per 100,000. Although lung cancer is still a fearsome killer,
smoking rates among men have decreased from almost 60 percent in 1955,
to 28 percent in 1994.
"What we're finally seeing, several decades later, is the
impact of efforts to decrease tobacco use. There's no question men got
the message," said John H. Glick, MD, director of Penn's
Cancer Center. Reported 11/14.
SLEEP DEPRIVATION. . . The average adult needs about eight
hours of sleep a night, but many don't get enough. And while
chain-drinking coffee may keep you awake for the short-term, the
long-term effects will soon become apparent. "You can run from
biology for a while, but you can't hide," David F. Dinges,
PhD, associate professor of psychology in psychiatry, told Men's
Health Magazine. "Today we have a mad, insatiable notion that
time is money and that sleep is wasted time. But the mistakes you'll
make due to sleep deprivation will hurt your career and your personal
relationships, too." His advice? Take the television out of the
bedroom, and take naps when possible. Printed in the November issue.
ALTERNATIVE SOLUTIONS. . . Second-year medical students at
the University of Pennsylvania Medical School can take a course in
alternative medicine called "Meditation and Medicine."
Instructor Michael Baime, MD, assistant professor of medicine,
teaches his students that meditation lowers stress, thereby reducing
the risk of heart disease. "I don't think that I'm unconventional
at all. I think that what I practice is just good medicine and that
good medicine involves paying attention to people and understanding
how their entire life impacts their health," Baime told WPVI-TV6's
Anita Brikman. Aired 11/21.
BEAUTY SECRETS. . . Women spend millions of dollars every
years on lotions and potions designed to make their skin more
attractive. But the key to lovely skin is actually much simpler--and
cheaper--than that, Albert Kligman, MD, professor emeritus in
dermatology, told Health Magazine. "Stay the hell out of
the sun," Kligman emphasized. "People who live 'shady' lives
have beautiful skin, and avoiding the sun also seems to boost the
body's ability to produce collagen." Printed in the
November/December issue.
TODDLER TECHNIQUES. . . Don't drive yourself crazy trying to
reason with a misbehaving toddler or preschooler. Children that age do
not respond well to verbal explanations of right and wrong. "They
have trouble telling the difference between their point of view and
the point of view of others," Nathan J. Blum, MD,
assistant professor of pediatrics, told Redbook magazine. The
best strategy, said Blum, is to anticipate the situations that spark
misbehavior and avoid them. Featured in the November issue.
FLU SEASON. . . You know the feeling. You wake up in the
morning with a raw feeling in your throat and you fear you're getting
a cold. Or worse, the dreaded flu. While a cold can cause sore throat,
cough, muscle aches, runny nose, and sneezing, flu victims may also
experience high fever, chills, and bad headaches. "Often, the flu
is a more serious type of infection that, unlike the common cold, can
lead to serious complications and potentially can kill patients,"
C. Crawford Mechem, MD, assistant professor of emergency
medicine, told WCAU-TV10's Ken Matz. The flu is transmitted
easily: "When you cough, you generate lots of mucous droplets and
respiratory secretions that can be spread from one person to another,"
Mechem explained. "And if you happen to breathe those in, then
you are susceptible to getting the flu yourself." Aired 11/22.
BRAS AND CANCER . . . A new book, "Dressed To Kill,"
asserts that there is a link between wearing bras and breast cancer.
It was written by a husband and wife medical anthropologist team who
developed the theory when they were visiting Fiji. Women in Fiji
usually don't wear bras, and they rarely develop breast cancer. To
follow up, the authors, Sydney Ross Singer and Soma Grismeyer,
surveyed more than 4,500 American women. "We found that women
with breast cancer have a history of wearing bras longer and tighter
than women who do not yet have breast cancer," Singer told WCAU-TV10's
Cherie Bank. But Penn's Lynn Schuchter, MD, assistant
professor of medicine in hematology-oncology, doesn't believe the
theory is scientifically sound. "I think there's absolutely no
link between breast cancer and wearing bras," Schuchter said. She
added that the dietary habits of women in Fiji are very different,
perhaps contributing to the lower incidence of cancer. Aired 11/24.
DANGEROUS DIZZINESS. . . Everyone has experienced dizzy
spells from time to time. They can be caused by missing meals,
illness, or pregnancy. But when is dizziness a symptom of a serious
disorder? Glenn Knox, MD, assistant professor of
otorhinolaryngology-head and neck surgery and director of Penn's
Balance Center, told Redbook magazine that less than one
percent of patients with persistent dizziness have a tumor--usually an
acoustic neuroma--that affects the balance nerve. Knox advises that
anyone who is experiencing dizziness accompanied by nausea or spinning
sensations see a doctor to be evaluated. Post-head injury dizziness
requires immediate medical attention. Knox added that dizziness in not
limited to geriatric patients. Two-thirds of his patients at the
Balance Center are females between the ages of 10 and 40. Printed in
the January issue.
POSTPARTUM FIGURES. . . Any mom knows that, after the baby
is born, the body doesn't easily revert back to its pre-pregnancy
state. "Some women don't go back to their pre-pregnancy weight,"
Jane Fang, MD, assistant professor of obstetrics and
gynecology, told the Jewish Exponent. But the reasons for this
are varied. They may choose to devote more time and energy on their
families, and less to themselves. And aging slows down the metabolic
process. However, Fang insisted, "It's not hopeless. It just
becomes harder, especially with every pregnancy." Printed in the
December 12 issue.
WOMEN AND DEPRESSION. . . Women suffer depression at a much
higher rate than men. Although biological factors can certainly cause
depression, Ellen Berman, MD, associate professor of
psychiatry, believes that societal pressures can also contribute
strongly. "Women are trained to believe in this culture that they
are not as important as men," Berman told WTXF-TV29's
Jill Chernekoff. "For many women, self-image is quite low, and
it's tied to both looks, which you can only control to a limited
amount, and tied to relationships." Berman urges women
experiencing depression that lasts more than a few weeks to seek help
from a mental health professional or family doctor. Antidepressants
are very effective in treating depression, and their side effects are
minimal. Aired 11/11.
|
