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Patients Help Workers Wash Up

"Cleanliness of the body was ever deemed to proceed from a due reverence to God."

--Francis Bacon

Hospital workers should wash their hands before they work with a patient, but they don't always. Hospitals have tried various techniques over the years--rather fruitlessly--to gently remind workers to wash their hands. But Maryanne McGuckin, DrScEd, senior research investigator, decided to see what would happen if she and her research team enlisted the assistance of patients.

Some 441 patients participated in the "Partners in Your Care" program during their hospitalization in one of four New Jersey-based hospitals. As part of the program, the patients asked every health-care worker who entered their room, "Did you wash your hands?" Those who felt too shy or uncomfortable to ask wore small blue banners attached to their hospital gowns that read: "Did you wash your hands?"

The team calculated the results by conducting telephone interviews and measuring the amount of soap used per bed day and handwashing per bed day. The researchers concluded that soap usage by health-care professionals increased 34 percent.

McGuckin presented her findings at the seventh annual meeting of The Society for Healthcare Epidemiology of America in April.

At the end of the study, patients said they were more likely to ask their nurses than their doctors whether they had washed their hands. Almost 90 percent of patients had asked their nurses, but only 28 percent had asked their doctors.

Reminding health-care workers to wash tends to work only in the short-term. "Once you don't remind them, doctors and nurses forget to wash their hands," McGuckin told The New York Times. "You can't get any better than having patients remind them."

Reports began July 23.

U.S. News & World Report

Philadelphia Daily News

The News Journal (Wilmington, De.)

Morning Call (Allentown, Pa.)

WPVI-TV6

HUP Makes the Honor Roll

One of only 16 hospitals in the nation to be so designated, the Hospital of the University of Pennsylvania has been named to the "Honor Roll" in the annual ranking in U.S. News & World Report. HUP is the only hospital in the Greater Philadelphia region to receive the recognition.

To make the Honor Roll, a hospital has to rank high in at least six of 17 specialties in the U.S. News survey. ("Rank high" means at least two standard deviations above the mean.) HUP qualified in eight specialties. In all, HUP appeared among the top hospitals in 13 specialties: AIDS, cancer, cardiology, endocrinology, gastroenterology, geriatrics, gynecology, neurology, orthopaedics, otorhinolaryngology, pulmonary disease, rheumatology, and urology. In addition, The Children's Hospital of Philadelphia, where Penn's pediatric faculty members practice, had the second-highest-ranked pediatrics services in the nation.

No other hospital in the Philadelphia area was cited for excellence in as many specialties as HUP. In addition, in the specialties in which HUP placed high, it was the top-ranked hospital in the Delaware Valley in all except cancer, in which it was ranked second-highest.

This is the eighth consecutive year that U.S. News & World Report has produced its annual guide to "America's Best Hospitals." According to the magazine, the intent of the survey "is to aid people who need maximum skill in diagnosis and treatment." In the absence of national health standards, U.S. News argues, its rankings "remain the sole source of relevant, rigorously conceived information."

Reports began July 28.

Today's Hottest Debates

A few months ago, everyone was talking about the moral dilemmas raised by the news of a sheep in Scotland that had been cloned from a cell of another sheep.

Cloning is the issue of the moment, Arthur L. Caplan, PhD, director of the Center for Bioethics, told USA Today. But it is merely a fad that will pass. Caplan predicted which topics would be on everybody's lips in the near future.

• Assisted suicide. "It will turn into a major socially divisive issue on a par with abortion," Caplan said. "An aging society is going to take the assisted suicide issue very seriously."
• Genetic testing. What should be done with all of the information that we are now able to gain through genetic tests?
• Genetic engineering. Should we be allowed to use technology to create children with desired characteristics? Should fetuses be screened for aggressive or antisocial dispositions or mental illnesses?
• Ethical care in a managed-care era. How will patients' rights be protected?
• Personal responsibility. Who should pay for damage done to a person's health from alcoholism or smoking?

Caplan also touched on some far-out possibilities that may be on the ethical horizon soon, including "extra-corporeal childbearing," in which an egg is fertilized in a dish and then transferred to an artificial incubator that serves as a womb.

The article appeared August 8.

ABCNews.com

Atlanta Constitution

The Chronicle of Higher Education

Consumers Digest

Bucks County Courier Times

Med Ad News

Vitality

OncoLink: More Popular than Ever

OncoLink, the University of Pennsylvania's Cancer Center's information site, continues to be hugely popular among Internet users, with the site being tapped about 2 million times a month by people in 75 countries. In 1996, the site was named one of 60 finalists in the National Information Infrastructure Awards Program.

The site appeals to cancer patients and their families, who typically have a thirst for knowledge about their diagnosis and managing their disease. Consumers Digest said that OncoLink offers paths to both basic information and to the National Cancer Institute's notices of current and forthcoming clinical trials of experimental drugs. "If you're interested in alternative and complementary therapies," the article said, "a University of Pennsylvania Web page will guide you to sites that provide information on acupuncture, herbal remedies, and mind-body techniques."

ABCNews.com featured the story of a woman who had recently learned that she had cervical cancer. The news overwhelmed her, and she couldn't tell her family. After a week of researching the disease and its treatments on the Internet, she felt much more empowered.

"When people get a serious illness, they make a complete about-face and educate themselves about a disease they know nothing about," said Ivor Benjamin, MD, assistant professor of obstetrics and gynecology and editor of OncoLink.

The Best Doctors for Women

The August issue of Good Housekeeping highlighted the "Best Doctors for Women" in the country. The doctors were nominated by more than 260 department chairs and section chiefs in obstetrics and gynecology at medical centers across the county. The question posed to the judges was: "In your opinion, which specialists provide the most expert treatment and are the leading clinicians for diseases in women?" Doctors were instructed not to choose anyone from their own institutions.

Over 1,500 physicians were chosen, and Good Housekeeping chose the 401 whose names appeared most often in the nominations.

Appearing in the list of gynecologic oncologists were John J. Mikuta, MD, the Franklin Payne Professor of Gynecologic Oncology, and Stephen C. Rubin, MD, professor of obstetrics and gynecology. In the category of reproductive endocrinologists, Christos Coutifaris, MD, PhD, associate professor of obstetrics and gynecology, was named, as was Luigi Mastroianni, Jr., MD, the William Goodell Professor of Obstetrics and Gynecology. Mark Allen Morgan, MD, assistant professor of obstetrics and gynecology, was listed as a top perinatologist, and Michael T. Mennuti, MD, professor of obstetrics and gynecology, was listed as a top specialist in reproductive genes.

Herald

Sentinel

Metropolitan News-Enterprise

Arizona Republic

Diuretics Appear to Reduce Heart Failure

Diuretics have been used for decades for high blood pressure patients. Newer drugs may make the medication seem old-fashioned, but a study published in the Journal of the American Medical Association suggests that the old-standby offers great advantages to heart patients.

The study of 4,736 men and women age 60 or older showed that diuretics cut heart failure risk at least 50 percent. In patients who had already suffered a heart attack, the risk was cut by about 80 percent.

Diuretics work by increasing urination. Doctors have prescribed the inexpensive drugs since the 1950s for patients with high blood pressure, believing that the drugs lower blood pressure by ridding the body of excess fluid and dilating blood vessels. Many doctors now use beta blockers to treat the condition, but prescribe diuretics as supplemental medication.

"It's a very important public health issue," commented Daniel J. Rader, MD, assistant professor of medicine and director of preventive cardiology. "This is a very interesting finding because it suggests that you can prevent progression to heart failure in people who have already had a heart attack."

Reports began on July 17.

Investor's Business Daily

Sacramento Bee

No Need to Suffer

There is no need for patients to put up with pain caused by chronic conditions such as arthritis and back problems. Many patients try to treat ailments themselves with over-the-counter medications. But when pain persists and is not alleviated by common treatments, it's time to find a doctor who can take charge of the situation.

"Nobody should have to live in pain," said F. Michael Ferrante, MD, associate professor of anesthesia and director of Penn's Anesthesia Pain Management Program. "There are a number of excellent drugs available for people in pain, and there is sound advice on how to use these medications to take advantage of their benefits and avoid their side effects."

According to data presented in July at a meeting on pain sponsored by the American Medical Association, headaches afflict about 40 million Americans a year, back pain about 36 million, muscle pain about 24 million, and neck pain afflicts about 20 million.

Some doctors are reluctant to prescribe potent analgesics like propoxyphenes (Darvocet) or opioids (Vicodin, codeine). They worry that patients could become addicted easily, and they worry about getting in trouble with regulators for over-prescribing narcotics. But non-steroidal anti-inflammatories have also received attention lately for the risks--such as gastrointestinal bleeding and ulcers--associated with long-term use.

Ferrante spoke out in the Sacramento Bee about the "global" warnings about non-steroidal anti- inflammatory drugs. "Many people can take [them] forever if they are watched judiciously by a physician and taken off the drug at the first sign of trouble," he said.

Reports began July 12.

Philadelphia Business Journal

Hospital & Healthcare News

The New Physician

The Philadelphia Inquirer

WTXF-TV29

Curriculum 2000: Grooming Students for the Future

The implementation of Curriculum 2000--the entire restructuring of Penn's School of Medicine curriculum--was the subject of an article that appeared in Philadelphia Business Journal.

The 150 first-year medical students who arrived this fall were greeted with a totally restructured list of course offerings. "We're interested in preparing students for all facets of medicine--where prevention is just as important as curing and assessing information quickly will help them become self-directed, lifelong learners with the ability to care for the patients over his or her life span," said Gail Morrison, vice dean of education.

The article pointed out that many medical schools are "tinkering" with their curriculum, but Penn has decided to take a more drastic approach. The approach was to "take a clean sheet of paper and create from scratch the ideal curriculum for medical students in the 21st century," said William N. Kelley, MD, dean of the School of Medicine and CEO of the Health System.

"The goal is prevention, not just cure," said Morrison. "We want future doctors to identify those at risk and help prevent the development of disease. Yet the purpose is also to assure that students leaving medical school are well-grounded in the mechanisms and foundations of basic science principles so they are able to care for all types of patients in the variable health-care environment of the future."

The article appeared in the July 18-24 issue.

ComputerWorld

Boston Business Journal

Fingerless Typing

Traditionally, lab workers wearing protective gloves faced quite a challenge when they wanted to input their findings into their computers. But now, speech translation technology--in which the user can verbally instruct the computer what to do--can help workers in this quandary.

Pathologists at the Hospital of the University of Pennsylvania plan to use the technology to bypass the keyboard while they work at the microscope. The technology is also useful for the blind.

"This will help us achieve greater accuracy, specificity, and sensitivity when reporting laboratory results," John Tomaszewski, MD, professor of pathology and laboratory medicine, told ComputerWorld magazine.

The doctors plan to use a system called Clinical Reporter, manufactured by the Kurzweil division of Lernout & Hauspie Speech Products. The software will enable the doctors to dictate lab results that can automatically be added to the hospital database to be analyzed later.

According to one computer expert, the speech translation technology market is about to "take off," because improved systems now enable users to speak naturally into their computers without having to pause.

Reports began August 1.

Drug Ads: Help or Hindrance?

In August, the Food and Drug Administration decided to ease restrictions on broadcast drug commercials. Since then, pharmaceutical company spending on drug ads has increased dramatically, and consumers are being bombarded with commercials for the latest drugs. "Ask you doctor," the ads urge.

Many patients, enticed by images of the perfect, healthy lifestyle that drug ads seem to offer, are asking. And critics fear that this could cause problems. The drug ads can be misleading, they say, claiming that a medication is the "drug of choice," when in fact, it may not be. They also may not offer enough information about potential benefits and risks.

There is also fear that patient requests for particular medication might result in inappropriate prescriptions. Exhausted doctors might prescribe drugs that are not clinically indicated, just to appease demanding patients. Additionally, doctors may be pressured to prescribe newer, brand-name drugs when an older, cheaper drug would do just as well.

According to Brian Strom, MD, MPH, professor and chair of biostatistics and epidemiology, the concept of advertising directly to consumers is flawed. "These are drugs whose use by definition. . . requires medical judgement. Otherwise they'd be available over the counter," Strom said in The Philadelphia Inquirer. "Given that, I'm not sure what direct-to-consumer ads do other than pressure physicians to prescribe--prescribing that won't always be appropriate."

In a letter to the Inquirer, Robert M. Kaiser, MD, professor of medicine, told of his experiences with patients who have seen drug ads. "Patients do not arrive in my office demanding that I immediately prescribe the latest remedy for hypertension, diabetes, congestive heart failure, or obesity. They ask me first for my opinion."

J. Sanford Schwartz, MD, executive director of the Leonard Davis Institute of Health Economics, told the Inquirer that he looks at it this way: "Every so often, patients come in and ask for something or raise an issue that you haven't thought about but that you should have thought about. . . . I'm not proud, I'm not perfect. . . . As long as ultimately the decision comes down to the physicians and the patient about what's best for them, I'm open to suggestions from anybody."

Reports began August 17.

Germantown Paper

Leader

Intelligencer-Record

Infertility Clinic Opens at Chestnut Hill

Last summer, thanks to the affiliation between Chestnut Hill HealthCare and UPHS, the Women's Center at Chestnut Hill HealthCare launched an infertility program that makes Penn's infertility services more convenient for couples in northwest Philadelphia and eastern Montgomery County.

"Penn is on the cutting edge of new developments for treating infertility," said Patricia Bailey, MD, medical director of the Women's Center at Chestnut Hill HealthCare. "Couples who seek help through the Women's Center will be able to take advantage of today's most innovative methods for treating infertility."

The services offered through the Women's Center include diagnosis and treatment for male and female infertility, hormone disorders, failure of ovulation, tubal disease, endometriosis, pelvic pain, recurrent pregnancy loss, and uterine fibroids.

Two of Penn's infertility specialistsÑSamantha M. Pfeifer, MD, assistant professor of obstetrics and gynecology, and Steven J. Sondheimer, MD, professor of obstetrics and gynecologyÑwill be treating patients at the Women's Center.

According to Bailey, there are many different reasons for infertility, which affects one couple in seven. Some problems are relatively easy to resolve, she said, while others require state-of-the-art techniques and expertise.

And helping with infertility is not just a matter of medical techniques, as Joanne Rosenbaum, clinical coordinator of the Women's Center, emphasized. As she put it, "The compassion, personal support, and privacy we provide throughout the process is an important part of our program."

Reports began July 28.