ACMS May 2024 Bulletin

BULLETIN

Allegheny County Medical Society

BULLETIN

Opinion

Editorial

• Spring Nourishment

Deval (Reshma) Paranjpe, MD, MBA, FACS

Editorial

• May is Mental Health Awareness Month

Robert H. Howland, MD

Editorial

• The Changing Landscape

Melanoma and Skin Cancer Management

Charles E. Mount III, MD, FAAD

Editorial

• Cry, Our Beloved Children: An Interview with the Force Behind Listen, Lucy

Anthony L. Kovatch, MD

Society News

Awards

• PAMED Everyday Hero Award

Foundation News

• Listen, Lucy's First Free Mental Health Conference For Kids!

Jordan Corcoran

ACMS News

• PAMPAC Board Update

Michael Aziz, MD

ACMS News

• Specialty Group Updates

ACMS Staff: Nadine Popovich, Eileen Taylor, and Melanie Mayer

ACMS News

• ACMS Honors

April 2024

Article

Articles

• "Doctor Heal Thyself"

Vint Blackburn, MD

Article

• Equity in Skin Health

Aya Al-Nazal MS, MS1; Alexandra M. Johnson, DO, FACP; Charles E. Mount III, MD, FAAD

Medical News

• Reportable Diseases 2024: Q1

Kristen Mertz, MD ACHD

Article

• Hepatitis C Elimination Efforts in Allegheny County

Jennifer Fiddner, MPH, CIC

Cover Photo by Louis A. Ditoppa, DO

Louis A. Ditoppa, DO specializes in Family Medicine

Norway Fjord

2024

Executive Committee and Board of Directors

President

Raymond E. Pontzer, MD

President-elect

Keith T. Kanel, MD

Secretary

Kirsten D. Lin, MD

Treasurer

William F. Coppula, MD

Board Chair

Matthew B. Straka, MD

Directors

Term Expires 2024

Douglas F. Clough, MD

David J. Deitrick, DO

Jan B. Madison, MD

Raymond J. Pan, MD

G. Alan Yeasted, MD, FACP

Term Expires 2025

Anuradha Anand, MD

Amber Elway, DO

Mark A. Goodman, MD

Elizabeth Ungerman, MD, MS

Alexander Yu, MD

Term Expires 2026

Michael M. Aziz, MD, MPH, FACOG

Michael W. Best, MD

Richard B. Hoffmaster, MD

Micah A. Jacobs, MD, FIDSA

Jody Leonardo, MD

PAMED District Trustee

G. Alan Yeasted, MD, FACP

2024 Board Committees

Bylaws

Kirsten D. Lin, MD

Finance

William Coppula, MD

Nominating

Keith T. Kanel, MD

Women’s Committee

Anu Anand, MD & Tiffany DuMont, DO

Bulletin

Managing Editor

Sara C. Hussey, MBA, CAE ACMS Executive Director shussey@acms.org

Medical Editor

Deval (Reshma) Paranjpe, MD reshma_paranjpe@hotmail.com

Bulletin Designer Victoria Gricks victoria@thecorcorancollective.com

Term Ending 2024

Richard Daffner, MD; Anthony Kovatch, MD; Andrea Witlin, DO, PhD

Term Ending 2025

Robert Howland, MD; John Williams, MD; Alexandra Johnston, DO; Charles Mount, MD

Administrative Staff

Executive Director

Sara Hussey shussey@acms.org

Vice President - Member and Association Services

Nadine M. Popovich npopovich@acms.org

Manager - Member and Association Services

Eileen Taylor etaylor@acms.org

Operations CoordinatorACMS & ACMS Foundation Melanie Mayer mmayer@acms.org

Part-Time Controller Elizabeth Yurkovich eyurkovich@acms.org

Bulletin Designer Victoria Gricks victoria@thecorcorancollective.com

EDITORIAL/ADVERTISING

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Spring Nourishment

By: Deval (Reshma) Paranjpe, MD, MBA, FACS

Happy May, everyone. It’s time to get out and about and explore the new culinary offerings of the season. There’s something for everyone to enjoy.

Wei Lai Dim Sum

3200 McIntyre Square Drive, Pittsburgh 15237 McIntyre Square www.weilaidimsumpa.com 412-364-9933

Closed Tuesday

Authentic, accessible and affordable Cantonese Dim Sum has finally come to Pittsburgh—and it’s so good that the first few weeks saw lines out the door with some repeat customers coming back every other day to try more dishes. Located in McIntyre Square in the former location of another beloved Chinese restaurant, Wei Lai is unpretentious and delicious, has a family-run feel, and is helmed by the former chef of Everyday Noodles. You can order online for pick-up, order takeout through a nifty machine on site, or best—get a table and enjoy the best dim sum in Pittsburgh. Try the many varieties of hot, cold and soupbased noodle dishes, the handmade dim sum, bao and dumplings, and boba tea. Weekends bring special dishes such as duck, and Cheung fun-- tasty crisp shrimp encased in a delicate rice noodle envelope. Check out the fried crystal dumplings and the pancake beef rolls.

Great authentic dim sum—a treat rarely found in Pittsburgh, let alone in a strip mall in the suburbs-- plenty of free parking, and a reasonable price point. What’s not to love? Worth the trip.

Turn Club

1298 Freedom Road

Cranberry

724-789-8876

Open daily for lunch and dinner

Where else can you work on your golf game AND enjoy extraordinary golf club cuisine…without going to an actual golf club? Turn Club, owned by Eric Johnson, chief pro at Oakmont Country Club, offers golf simulation training, lessons and other opportunities as well as some of the best and freshest American cuisine at the most reasonable prices I’ve seen in some time. Have a seat at the bar on insanely comfortable barstools while summer breezes blow in from the open air verandah as you enjoy an Arnold Palmer or perhaps something stronger. Outdoor seating will be available soon. You’ll feel like you’re on vacation. Choose from a wide selection of generous and delicious salads, sandwiches, flatbreads, fish tacos and soups, with half and half specials available Tues-Fri for lunch.

My favorite is the Palm Beach Salad—a generous serving of shrimp, lump crabmeat, eggs, avocado, strawberries, oranges served with champagne vinaigrette over fresh greens. Even an old standby like a turkey club sandwich is astounding. You will not be disappointed. The secret isn’t out yet, but it will be soon.

Wild Rosemary

1469 Bower Hill Road

Upper St. Clair

Wild Rosemary, a legendary 12 seat niche restaurant in the South Hills, is

making an unexpected and most lovely comeback. Chef Raymond Mikesell, until recently the owner of Café Raymond in the Strip, will resurrect the bistro as a 27 seat BYOB affair in June after it closed just a few months ago. Reservations are not accepted and seating will be first-come firstserve. The menu will be rustic Italian with locally sourced farm produce and ingredients from Pennsylvania Macaroni in the Strip. Mikesell wants to make you feel like you’ve stepped into his home for a family style dinner. Something tells me that getting a table here will be the foodie prize of the year. Check social media for updates on opening details and contact information.

Otaru Japanese

1200 Grandview Avenue

Mount Washington

Monday-Thursday 4-10pm; Friday to Sunday 4-11pm

Otaru is a new upscale Japanese restaurant with unparalleled views of the city, featuring sushi, nigiri, sashimi, ramen and other hot dishes at the site of the old Vue 412. First quality ingredients, traditional preparation and elevated presentation are sure to impress your special guests, but be warned--the prices may also match. Open for dinner only.

Fet Fisk

4786 Liberty Avenue

Bloomfield

Open Thursday-Monday 5-10pm, closed Tuesday/Wednesday

Fet Fisk has finally put down fins

in Bloomfield at the site of the old Lombardozzi’s restaurant after a career as a pop-up venture since 2019. What to expect? Nordic seafood—everything from Danish caviar to oysters, pickled fish, and smoked sturgeon pate—along with vegetarian and meat options. The $10 cocktails are interesting, excellent and may be the most reasonably priced in Pittsburgh, for all foodies aghast at the $20 dollar price point popping up all over town. Everything has a Nordic touch including the lovely desserts. Fet Fisk means “greasy fish”, but don’t let that scare you. This is cuisine you will not find anywhere else in driving distance, and Chef Nik Forsberg has

a James Beard nomination in case you needed an extra reason to try it. Probably the hottest reservation in town.

Little Viet Kitchen

195 Blazier Drive

North Park (McCandless)

Tuesday-Sunday 11-7 pm, Closed Monday

Take-out or delivery (Uber Eats) only at this time, no dine-in

From the sisters who run the delightful Banh Mi and Ti in the city, here is their northern outpost: an authentic Vietnamese restaurant

featuring Banh Mi, Rice Bowls and Vermicelli Bowls with a $10-12 price point and 8 protein options including drunken beef, pork belly, lemongrass marinated chicken, tofu and vegetableonly. Indulge in hot restorative beef, chicken or tofu pho for $14 (for those of us in the northern suburbs who don’t want to drive into the city for a fix), $6 summer rolls, accompaniments and a wide selection of Vietnamese coffees, bubble teas and flavored lemonades. Catering available.

Enjoy the many fresh flavors of Spring!

On April 19, PAMED honored Prerna Mewawalla, MD with the Everyday Hero Award. Dr. Mewawalla's staff surprised her during an emotional presentation for her outstanding work in Hematology & medical Oncology in Pittsburgh. A patient that credits Dr. Mewawalla with saving his life nominated her for the award and was present along with PAMED President, Dr. Sandel.

Congratulations Dr. Mewawalla and thank you for all your hard work!

The Pennsylvania Medical Society’s (PAMED) Everyday Hero Award program, launched in 2018. In general, the PAMED Everyday Hero Award is open to any PAMED member who through the eyes of colleagues and patients goes above and beyond in providing patient care.

"Dr. Mewawalla is a wonderful doctor.

She goes above and beyond to make sure each one of her patients are taken care of. She specializes in amyloidosis which is a very rare condition. And she co-ordinated my care with multiple specialties to ensure I get the best care possible. I am currently in remission and received a heart transplant a year ago. She is compassionate and has a way of putting patients at ease."

"Doctor Heal Thyself"

By: Vint Blackburn, MD

Why is it so hard for caregivers to take care of themselves? Working as a psychiatrist who treats children and young adults as part of my practice, I am faced with having this conversation, over and over with well-meaning parents who are running themselves ragged trying to care for their suffering child. I explain the idea of enlightened self-interest, where caring for oneself is a necessary part of being available for others. I use the analogy of giving up all of one’s water to someone in need and then dying of dehydration as opposed to keeping the bucket full so that there is water to spare. So often this logic seems to land on deaf ears. “But I have to be there for them because the consequences are too dire. I don’t have time to take care of myself.” I spend an inordinate amount of time reminding them that if they implode from lack of self-care it amounts to the same thing. Unfortunately, and in keeping with the human tendency to view things as binary, either/or, black and white, most of us miss the simple fact that caring for ourselves and others is not mutually exclusive. Actually, I have found that it is not the exception, but the rule that getting caregivers into their own therapy is often one of the best things I can do for my adolescent patients. Taking care of a depressed, anxious, suicidal child is mind-blowingly difficult. As physicians, we do not have one sick person to worry about, we have a whole caseload. After all, it is our job. It is what we chose to do. Yet we are not immune to the significant suffering of our patients, as much as we and our training try to convince us otherwise. This is what is known as vicarious

trauma and it is an inevitable part of the health-care role. At the end of the day, whether we like it or not, most of us take a small part of our patients’ burden home with us and over time it accumulates. Most of us think, “I can handle it,” and yet an average of 300 doctors a year (three times my graduating class in med school) die by suicide. I’m quite sure that they thought that they could handle it, until they could not.

I have thought about this for a long time. Why are doctors so resistant to seeking help for ourselves when we need it, especially when it comes to our mental health? In our field our brain is one of our most prized assets so why are we so reluctant to care for it? We are the first to recommend a specialist for our patients, and often the last to take that advice for ourselves.

A couple of years back, shortly after the “end” of the pandemic, an especially ill patient of mine put me in a very precarious position and I was deeply depressed. While I never formulated a plan to take my own life, during this period I often thought about how much better it would be if I were dead. I have a child, wife and mother that I love and many, many very ill patients, and yet I thought I would just be better off dead. This was not me.

Even as a trained psychiatrist, or perhaps because I am one, it took me a while to recognize the signs: poor focus, difficulty falling asleep, loss of appetite, the feeling that I was trapped and could not see a way forward, dread for the coming day and loss of interest in what I normally love to do. When I did, it look me time to realize that I was

not going to easily talk my self out of this feeling. Sometimes healing thyself means turning to others for help. At that time, I asked for the recommendation of a good therapist from a colleague as well as seeking help from another psychiatrist.

A couple of months of processing and reframing (and a modicum of fluoxetine) and I was starting to feel like myself again. I was enjoying my work as well as my down time. In retrospect the circumstance that was the final straw was not as devastating as I perceived it. The outcome bore this out, but at the time, my brain was not allowing me to see it that way. I too went through the delusion of thinking that I was strong enough to handle anything that was thrown at me. I thought, “If I, a trained psychiatrist can’t figure out what’s going on with me, how will someone else?” Luckily, I know better. I know not to trust a stressed out, tired and chemically shifted brain. I reminded myself of what I am always saying to my patients, “you are not in charge of your brain, your brain is in charge of you.”

Yet hubris is part and parcel to our job. We must believe that we have the capacity to heal, to help those who are not able to help themselves. Furthermore, medical school (and residency) try to convince us that we are above the need for such basics as sleep, time off, healthy food, time with family. Then, we spend day in and day out with people who are sick and often dying. Do not kid yourself, this takes its toll.

Perhaps this is one of the main reasons we will not reach out for help. We do not want to feel that we are one

of those few doctors who cannot handle the job. Yet, depending on the source you choose, the number of physicians reporting significant burnout ranges from 52 to 70%. Feeling this way does not make us the minority, but the majority.

I will not go into the sad and misguided stigma towards mental health, as this would turn into a book rather than an article, but we physicians are not above it. Even though we are trained to see the brain as another bodily organ, we love to tell ourselves that it always does our bidding (a fallacy which is held almost universally). Deep down, though, we should know better. It was for all of these reasons that I was so excited when I was approached by Melanie and Sara of ACMS about

launching a pilot program designed to connect physicians in need to quality mental health providers in a confidential (free for 4 sessions) system. Confidential so that fear of stigma or repercussion can be avoided. Until the day that we are comfortable extolling the virtues of our psychiatrist in the same way we would our cardiologist, this will be necessary. Especially for those working in fields like medicine, where there continues to be inappropriate language around mental health in some of our contracts and licensure standards.

Yet I can not only attest to the huge improvement in the quality of life in the physicians I see in my own practice, but this was driven home to me by my own personal experience seeking help when

I needed it. Like so many other things in medicine, catching issues early is far superior to waiting until things have become overwhelming. This is why I hope that my colleagues will take advantage of this program. If we build it, will they come? Only if we can get past the imagined hurdles that seem more prevalent in mental health than in baseball.

Visit https://www.acms.org/ physicianwellness/ to learn more about this program!

May is Mental Health Awareness Month

By: Robert H. Howland, MD

May in America is Mental Health Awareness Month, which got its start in 1949 thanks to the unfortunate experiences and advocacy efforts of Clifford Beers. Beers, born in 1876, was a highly educated individual who graduated in 1897 from the innovative and renowned Sheffield Scientific School at Yale. Beers was first confined to a private mental institution for depression, paranoia, and suicidality associated with manicdepressive illness in 1900, and for the next three years was hospitalized multiple times in various Connecticut hospitals and institutions. During these admissions he experienced and witnessed serious maltreatment at the hands of institutional staff. Sufficiently recovered and never again to be hospitalized, Beers published an autobiography in 1908 (A Mind That Found Itself), describing his hospitalizations and the mental and physical abuses he and other patients were subjected to. His book, still in print, was widely read and favorably reviewed at the time, and was immensely instrumental in subsequent efforts to reform the treatment of patients with mental illness.

In the wake of the book’s popularity, the ambitious, resilient, and resourceful Beers used his Yale background to gain access to prominent civic leaders, philanthropists, and medical professionals. His goal was to elicit support for creating a national and then international organization to improve standards of care for persons in mental hospitals, to help prevent mental disorders and the need for hospitalization, and to disseminate

sound information about mental illness (namely that recovery is possible). With the approval, encouragement, and financial support of these important people, Beers founded the Connecticut Society for Mental Hygiene in 1908.

The Connecticut Society was expanded in New York City in 1909 to form the National Committee for Mental Hygiene (NCMH), having the following goals: to improve attitudes toward mental illness and people living with mental health conditions; to improve services for people with mental health conditions; and to work for the prevention of mental illnesses and the promotion of mental health. Later Beers would participate in forming an International Committee for Mental Hygiene (1919). The NCMH later became the National Association for Mental Health (in 1950), and this organization today is known as Mental Health America.

In conjunction with the United States Junior Chamber (also known as the Jaycees), the NCMH initiated Mental Health Week in 1949. Mental Health Week eventually became Mental Health Month (now Mental Health Awareness Month). Beers died in 1943, before mental health awareness became a celebrated annual event, but his mission to educate Americans about mental illness, to reduce barriers to treatment and services, and to promote mental health lives on with Mental Health America.

In the spirit of Clifford Beers, what can each of us do to promote mental health not only for our patients but also for ourselves? Lifestyle factors are associated with physical health

as well as ill health, and they also influence the onset, prevalence, and perpetuation of psychiatric symptoms and disorders. Individuals with psychiatric disorders have higher rates of physical comorbidity, and they face poorer health outcomes from chronic physical illnesses. Hence, consideration of the role and application of lifestyle interventions is sensible.

Modifiable lifestyle factors include physical exercise; diet and nutrition; mind-body practices; restorative sleep; and social relationships. Addressing these factors can cultivate well-being; help prevent and manage psychiatric disorders; and serve to optimize brain health.

What is good for the heart is good for the brain. Physical exercise in various forms have been consistently shown in decades of clinical studies to benefit individuals with anxiety, depression, post-traumatic stress disorder, attention deficit disorder, substance abuse, schizophrenia, bipolar disorder, and cognitive aspects of aging. Imaging studies of brain structure and function have demonstrated exercise effects. Exercise-mediated mechanisms include positive regulation of the autonomic nervous system (ANS); down-regulation of an overactive hypothalamic-pituitaryadrenal (HPA) axis; modulation of inflammatory cytokines; and promotion of neurotrophic and neuroprotective neurochemicals. Indeed, the myriad chemical and physiological effects of exercise is suggestive of a broadspectrum drug.

Like any chemical ingested in the body, food can be considered a

medicine or a toxin. A brain healthy diet favors nutrient-dense whole food products (vegetables, fruits, beans, unprocessed grains, nuts, seeds, olive oil, fish), while avoiding processed foods, artificial ingredients, refined grains, and excessive sugar. The Mediterranean diet has been associated with improvements in heart health and brain health, perhaps by fostering a healthy diversity of the gut biome and the production of anti-inflammatory metabolites. The DASH diet (“Dietary Approaches to Stop Hypertension”) has been incorporated into a hybrid together with the Mediterranean diet called the MIND diet (“Mediterranean-DASH Intervention for Neurodegenerative Delay”). Some research has suggested these diets may slow cognitive decline and reduce the risk for Alzheimer’s dementia. Recently, a study examining the association of these diets with post-mortem brain changes found that the deceased subjects had lower levels of brain amyloid plaques (a hallmark finding in Alzheimer’s), which was not influenced by vascular health, physical activity, and smoking.

Mind-body practices include but are not limited to mindfulness, meditation, breathwork, yoga, and tai chi. Mindfulness has been incorporated into structured therapeutic approaches such as Mindfulness-Based Stress

Reduction (MBSR) and MindfulnessBased Cognitive Therapy (MBCT). Mind-body practices positively regulate the ANS and the HPA axis, resulting in favorable effects on heart rate variability, inflammatory cytokines, cortisol, and gamma-aminobutyric acid (GABA). Imaging-demonstrated changes in brain function and structure are correlated with the use of various mind-body exercises. Mind-body practices generally promote well-being, reduce stress, and improve symptoms of anxiety, depression, sleep, and pain.

Restorative sleep is a biologically critical factor for both mental and physical health. Poor sleep is a common symptom of many psychiatric disorders but also can be a risk factor for depression, suicide, neurocognitive disorders, cardiovascular and cerebrovascular disease, metabolic syndrome and diabetes, and other adverse health outcomes. Sleep quality can be improved with sleep hygiene practices: regulating environmental noise and temperature; maintaining a consistent sleep schedule; avoiding sleep outside of a regular sleep schedule; avoiding caffeine and other stimulant-like products for many hours before bedtime (the mean half-life of caffeine is about five hours); avoiding electronic screen time for several hours before bedtime; and utilizing calming bedtime practices such as mindfulness,

meditation, or guided imagery. Humans are inherently social. According to a 2020 report from the National Academies of Sciences, Engineering, and Medicine, individuals who are socially isolated or have limited social supports are at higher risk for anxiety, depression, suicide, dementia, heart disease and stroke, and premature death from all causes. Improving the quantity and quality of social connections is important not only for the prevention and management of psychiatric conditions but also to improve physical and mental health outcomes.

Assessing and educating patients about the important role of lifestyle factors for mental and physical health should be a standard practice that physicians can also apply to themselves.

The Changing Landscape Melanoma and Skin Cancer Management

By: Charles E. Mount III, MD, FAAD - Associate Director of Allegheny Health Network Cancer Institute Skin Cancer Center

The month of May heralds the months of warmth and sun ahead and is the perfect time to share important changes and advancements in skin cancer management as we focus on Melanoma and Skin Cancer Awareness Month. As the most common cancer in the United States more than 5 million people are diagnosed with skin cancer annually including 200,000 cases of melanoma. These numbers mean if you’re reading this with 5 people in the room one of you will develop skin cancer by the time you turn 701. Often more fatal than melanoma Merkel cell carcinoma was in the spotlight this year due to its role in the unfortunate passing of famed singer-songwriter Jimmy Buffet. Despite only about 3000 cases per year the incidence of this neuroendocrine cancer of the skin continues to rise.

Melanoma specific rates continue to rise with multiple attributed causes including an aging population, increased sun and UV seeking behaviors, earlier detection, and potentially over diagnosis of melanomas according to some experts and publications 2,3,4.

As a youth and even in medical school I appreciated metastatic melanoma as a fatal diagnosis for most. However, I was fortunate enough while still in residency to witness the arrival of immunotherapy and checkpoint inhibitors for melanoma treatment just over a decade ago which dramatically improved the survival rates of advanced melanoma. It was like watching a palpable shift in a decades long struggle against a disease that typically failed traditional chemotherapy and

radiation options. Prior to that, Stage IV disease patients 5-year survival was 10-15% whereas at least by 2020 it was above 30-50% depending on the study with rates continuing to climb given newer and more therapeutic offerings. PD1 inhibitor agents such as nivolumab and pembrolizumab initially were reserved for stage IV disease, however, they are now used more and more in earlier disease achieving on-label use in Stage IIB/C and III disease further shifting expected survival rates for our patients. Immunotherapy along with newer options such as oncolytic viruses, tumor infiltrating lymphocytes (TILs) therapies, and vaccine therapies continue to give great hope and expectation to what was previously a grim diagnosis.

What has always been known is earlier detection provides profoundly improved survival in melanoma where Stage 0, I, and II patients collectively exceed 94% survival with Stage 0 and I being typically 98% or higher whereas stage III and IV survival dips significantly. For a cancer that can typically be seen in its earliest stages by the naked eye this argues for focus on adequate screening as well as primary and secondary prevention efforts. A decades long struggle for dermatologists has been performing excessive skin checks on low-risk patients and biopsies of clinically atypical, but benign nevi out of appropriate concern of missing early stage, curable melanomas. Dermoscopy helped advance this effort in the 1990s and has become a standard practice provided by most dermatologists. In recent years other noninvasive methods

have been introduced, but have yet to take as much of a widely practiced role such as confocal microscopy, advanced skin/body imaging systems, other noninvasive devices utilizing ultrasound and light based technology, and adhesive based skin DNA tests. Utilization of these is often limited by initial expense of the devices, lack of insurance benefit coverage for their use, questionable sensitivity/ specificity concerns, and unfamiliarity by providers.

Approximately 70-80% of melanomas arise de novo in normal appearing skin whereas only 20-30% arise from a previous benign nevus5. Hence, documenting new nevi in our middle aged and older patients is of utmost importance. However, timing and duration of their appearance is one of the most common and challenging questions encountered when evaluating moles/nevi. Patients often do not monitor their skin routinely or it is an area of the body unamenable to selfmonitoring (i.e. on their back, genitals, bottoms of the feet). Combine these factors to the limitations of human practitioners’ memory and even the best, most accurate medical chart documentation unfortunately the risk of missing newly appearing melanocytic lesions in their earliest development. The standard in monitoring patients with numerous and/or atypical nevi has long been whole body photography with individual shots using physical or digital photographs taken by providers themselves or medical photographers. Manual review and comparison of these photos to new photos or during the patient’s physical exam can be

extremely time consuming and often frustrating for provider and patient alike. Advanced whole-body imaging systems, such as Canfield’s Vectra WB360 system now in use at Allegheny Health Network’s Skin Cancer Center at West Penn Hospital, look to remove some of these barriers and associated fallible human elements. These efficient systems’ generated photographs and data can be integrated into the electronic health record. The specific system at West Penn, seventeenth of its kind in use in the US, can be utilized by any dermatologist or provider for their patients in the region.

Using algorithms and rules learned from assessing thousands of skin lesions from established databases the goal is to more quickly identify potential skin cancers by providing a preliminary benign versus malignant interpretation and to track skin lesions appearance, growth, and pattern change over time. Thus, continuing our pursuit to identify as many early-stage skin cancers as possible with a secondary goal of reducing unnecessary biopsies of stable, clinically reassuring lesions reducing procedural burden on patients and cost to the healthcare system. After few minutes of the patient standing inside it the Vectra WB360 maps out an entire patient’s skin surface subsequently quantifying and qualifying their skin lesions determining features such as individual lesion size, color, border irregularity, and pigment discrepancies. Immediately after a handheld dermatoscope used by the system operator tags any concerning lesions and scoring them according to an algorithm it has been taught by analyzing thousands of nevi from available databases. While it does not in itself diagnose skin cancer it does become a powerful tool to assist the dermatologist in advancing the care of our patients and the field of dermatology by identifying and tracking existing nevi and monitoring for change over time more thoroughly than standard electronic health record documentation.

Despite these recent advancements in technology available, full skin

exams by trained dermatologists and dermatology advanced practice providers with tissue for histopathologic diagnosis will likely remain the gold standard for early skin cancer detection for many years to come. However, its prevalence combined with a shortage of access to dermatologists in many areas pose significant challenges in our pursuit of early detection and successful treatment of skin cancer in what should be a curable disease in most scenarios. In this growing landscape of new, often attractive, skin cancer detection options with variable strengths and weaknesses we should strive for a coordinated effort of dermatologists with non-dermatologists, in particular primary providers, to utilize the best evidence-based and cost-effective options with an open and forwardthinking, but critical, mind.

Skin cancer bullet points you may have missed in the last few years:

1. While it remains an extremely effective antihypertensive agent at the top of the JNC guidelines hydrochlorothiazide increases nonmelanoma skin cancer risk in particular squamous cell carcinoma. While this should not preclude its use in most patients given its high efficacy, favorable safety profile, and low cost you may want to consider other equally effective and safe alternatives if your patient has had multiple nonmelanoma skin cancers, is high risk for nonmelanoma skin cancers, has extremely fair skin, has an outdoor occupation, or is at a young age of hypertension treatment initiation as the duration of its use is known to be the major driving factor in hydrochlorothiazide and skin cancer risk.

2. Oral nicotinamide and niacinamide therapy typically dosed 500mg twice daily can reduce nonmelanoma skin cancer risk.

3. For our significantly high-risk patients (immune suppressed, solid organ transplant recipients, numerous prior skin cancers) the prescription medication acitretin (Soriatane) which is a vitamin A derivative retinoid

approved on-label for psoriasis can be very effective in preventing and reducing further nonmelanoma skin cancers. In the low doses required it is typically well-tolerated and very safe even in our elderly population. Stopping the medication does not cause a rebound effect, but patients will resume their baseline skin cancer risk prior to starting the medication.

References:

1. Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282

2. Bedikian A.Y., Millward M., Pehamberger H., Conry R., Gore M., Trefzer U., Pavlick A.C., DeConti R., Hersh E.M., Hersey P. Bcl-2 antisense (oblimersen sodium) plus dacarbazine in patients with advanced melanoma: The Oblimersen Melanoma Study Group. J. Clin. Oncol. 2006;24:4738–4745.

3. Middleton M.R., Grob J., Aaronson N., Fierlbeck G., Tilgen W., Seiter S., Gore M., Aamdal S., Cebon J., Coates A. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J. Clin. Oncol. 2000;18:158. doi: 10.1200/ JCO.2000.18.1.158.

4. Korn E.L., Liu P.-Y., Lee S.J., Chapman J.-A.W., Niedzwiecki D., Suman V.J., Moon J., Sondak V.K., Atkins M.B., Eisenhauer E.A. Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials. J. Clin. Oncol. 2008;26:527–534. doi: 10.1200/JCO.2007.12.7837.

5. Cymerman RM, Shao Y, Wang K, et al. De novo versus nevus-associated melanomas: Differences in associations with prognostic indicators and survival. J Natl Cancer Inst 2016 May 27; 108(10). doi:10.1093/jnci/djw121.

Equity in Skin Health: Shedding Light on Skin Cancer in Patients with Skin of Color

By: Aya Al-Nazal MS, MS1; Alexandra M. Johnston

DO, FACP; Charles E. Mount III, MD, FAAD

Skin cancer is the most common cancer in the United States, and May is Skin Cancer Awareness month. It is critical to ensure that physicians are aware of the nuances that differentiate patients with skin of color (SOC) from Caucasian patients when it comes to prevention and detection of skin cancer along with the disparities that account for poorer skin cancer outcomes in this population of patients. SOC as defined by Taylor and Kelly’s Dermatology for Skin of Color textbook is a population that tends to have skin of darker hues than Caucasians including but not limited to Asians, Africans, Native Americans, Pacific Islanders1. The incidence of skin cancer overall is much lower in patients with SOC, but it is associated with significantly higher morbidity and mortality when diagnosed in this population in part due to detection at advanced stages.2

Melanoma

Melanoma, which has the highest rate of mortality among skin cancers has a lower incidence in patients who identify as black, but it has a higher mortality rate in black patients than Caucasian patients. A 2004 study estimated that the 5-year survival rate for melanoma is under 60% in black patients while it is over 80% in white patients. More recent studies showed further improvement in survival rates of Caucasian patients with a lack of improvement in survival of Black Americans.3,4

Risk factors in SOC: Prior radiation, immunosuppression, prior burns, congenital or preexisting nevi (especially in acral areas). Heterogeneity exists in the risk for

melanoma in sun-exposed areas in persons with SOC as there is an inverse relationship between the incidence of melanoma and degree of skin pigmentation. It remains imperative to counsel patients with SOC on the need for sun protection regardless of skin tone.1

Where to look: Sun-protected areas such as acral areas (palms, soles), subungual, mucosal, and ocular are more common than sun-exposed areas such as the head and neck, upper trunk, and sun-exposed extremities seen in Caucasians. Plantar foot surfaces have high rates in Black Americans while Asian Americans and Pacific Islanders are at risk for mucosal melanomas.1,4

What to look for: The frequently used “ABCDEs” used to counsel patients still applies but may not be adequate in patients with SOC as some melanomas may remain symmetric and pigmentation homogenous throughout the lesion. Lesions may be thicker and have a higher propensity to ulcerate. Acral melanomas can be brown, blue-black or red/pink if amelanotic. Don’t forget the subungual surfaces! Melanonychia are physiologic and common in SOC. They appear as parallel, symmetric hyperpigmented lines under the nail but should not increase in size over time and tend to occur on >1 digit. These should be monitored for changes in size, pigmentation, and extension to periungual skin (Hutchinson sign). Providers should recognize that occurrence on one isolated digit is a red flag concerning for malignancy.4 Melanonychia can be monitored with photos, measurements, and serial

exams for stability and referral should be made if changes occur or the patient has concern for changes.

Cutaneous Squamous Cell Carcinoma (cSCC)

Risk factors: In Caucasians, UV damage is classically associated with cSCC, but consider ongoing ulceration or inflammation (chronic, longstanding leg ulcers, lesions related to autoimmune disease like discoid lupus and ulcerative mucosal lichen planus and lichen sclerosis) and scarring, radiation exposure, vitiligo, and solid organ transplant/immunosuppression in SOC.4

SCC is the most common skin cancer in African and South Asian (Indian, Pakistani) populations. HPV infection is a risk factor for cSCC, especially those located in the anogenital region and on the digits.

Where to look: Sun protected areas, especially on legs of Black Americans but also be aware of the anogenital region, which is often overlooked due to lack of sun exposure and are of special concern in transplant patients. SCC can less commonly occur in sun exposed areas such as head and neck in patients with SOC.1,4

What to look for: Tender, superficial elevated lesions that may appear indurated, pigmented, scaley or hyperkeratotic plaques or papules.4 Tenderness of lesions has been shown to be a statistically reproducible feature of SCC, which differentiates it from other types of skin cancer.

Basal Cell Carcinoma (BCC)

Risk factors: UV light exposure (controversial in SOC), chronic scarring and ulcers, immunosuppression,

radiation, xeroderma pigmentosum, physical and thermal trauma.1,4

BCC is most common skin cancer in East Asians and Hispanics similar to Caucasians

Where to look: Most common in middle aged or older patients on sunexposed areas such as head and neck without predilection for less pigmented areas.1

What to look for: Pearly papules with rolled borders and telangiectasias, may also appear pigmented on darker skin tones and are challenging to detect. In Asians populations BCCs are frequently described as “pearly black” in appearance.1,4

Cutaneous T-cell Lymphoma (Mycosis Fungoides (MF) or Sézary Syndrome)

MF is the most common type. Both incidence and mortality rate are higher in black patients with a mortality rate 2.4 times higher in black patients than white patients.1

Risk Factors: Black American and African American populations

Where to look: Some texts refer to a “Bathing suit distribution” including breasts, gluteal areas, and in skin folds but can occur anywhere on the body.1,4

What to look for: Can present heterogeneously as hypopigmented scaly papules or plaques, hyperpigmented lesions, or pruritic lichenified eczematous appearing lesions in SOC rather than more typical erythematous lesions seen in Caucasians.4 Lesions are often overlooked as they are non-specific, in many cases and biopsies are frequently non-diagnostic early in the course, which necessitates repeat biopsies.1 New areas of hypopigmentation should always be evaluated, even in young patients. Physicians should consider CTCL in cases of presumed eczema, psoriasis or tinea that are not responding to therapy as expected, especially when occuring in the bathing suit distribution.

How did we get here and what can we do to improve skin cancer outcomes in patients with SOC?

Several factors contribute to the fact that skin malignancies in

patients with SOC are detected later in the course of disease and tend to have poorer outcomes compared to Caucasian patients. It is estimated that only 4-18% of images in dermatology textbooks represent SOC and research studies have focused on patients with lighter skin tones5. This research has then been utilized in the development of guidelines for both prevention and treatment of skin cancer but may not adequately reflect the nuanced risk factors and presentations of skin cancer in patients with SOC. Our medical community lacks dermatologists with SOC with an estimated 3% identifying as black and 4% as Hispanic.6

Taking Action

If you practice in a non-dermatologic specialty in which patients voice concerns about skin changes such as primary care or in a specialty that you may routinely examine portions of the skin, especially non-sun exposed areas like acral surfaces (hand and wrist surgeon), plantar surfaces (podiatry), anogenital region (gynecology, urology, gastroenterology), actively assess for skin changes and refer as appropriate if there are areas of concern.

Educate patients with SOC on their risk factors for skin cancer, common locations of occurrence, and how their risk factors may differ from those commonly publicized in Caucasian patients.

Educate patients with SOC on importance of sun protection and risk of sun damage and encourage an SPF of 30+ applied 15-30 minutes before going outside and reapplied every 2 hours if remaining in the sun or clothing with built in ultraviolet protection factor. Encourage patients with SOC to complete a monthly full body skin assessment in the mirror. See below in resources for instructions from AAD.

Proactively support increased diversity in the field of dermatology by supporting medical students who may come from less privileged backgrounds by improving mentorship, research opportunities, and experiential dermatologic learning opportunities.

Recommended Resources

Taylor and Kelly’s Dermatology for Skin of Color, 2nd Edition

Mind the Gap: A Handbook of Clinical Signs in Black and Brown Skin

Skin of Color Society (www. Skinofcolorsociety.org)

American Academy of Dermatology -Skin Cancer in Prevention for Darker Skin Tones: https://www.aad.org/ public/diseases/skincancer/types/ common/melanoma/skin-color

References:

1. Washington CV, Mishra V, Soon SL. Taylor SC, Kyei A. Defining Skin of Color. Melanomas. In: Kelly A, Taylor SC, Lim HW, Serrano A. eds. Taylor and Kelly's Dermatology for Skin of Color, 2e. McGraw-Hill Education; 2016. Accessed April 27, 2024.

2. Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006;55(5):741–60.

3. Byrd KM, Wilson DC, Hoyler SS, et al. Advanced presentation of melanoma in African Americans. J Am Acad Dermatol 2004;50(1):21–4.

4. Munjal, A., & Ferguson, N. (2023, July). Skin Cancer in Skin of Color. Dermatologic clinics, 41(3), 481-489. https://doi.org/10.1016/j. det.2023.02.013

5. Adelekun, A., Onyekaba, G., & Lipoff, J.B. (2021, January). Skin color in dermatology textbooks: An updated evaluation and analysis. Journal of the American Academy of Dermatology, 84(1), 194-196. https://doi. org/10.1016/j.jaad.2020.04.084

6. McFarling UL. Dermatology faces a reckoning: Lack of darker skin in textbooks and journals harms care for patients of color. STAT. July 25, 2023. Accessed April 28, 2024. https://www. statnews.com/2020/07/21/dermatologyfaces-reckoning-lack-of-darker-skinin-textbooks-journals-harms-patientsof-color/#:~:text=It%20may%20 be%20no%20surprise,proper%20 treatment%20and%20medical%20 education.

Foundation News

Listen, Lucy's First Free Mental Health Conference For Kids!

By: Jordan Corcoran - Founder of Listen, Lucy

Earlier this month, I hosted my first ever free mental health conference for middle school students – Camp Lucy. We gathered over 200 students from over a dozen different school districts and had an impactful, meaningful day of mental wellness. Through the year it took to plan this event, the detail that was always top priority was making it free for all schools to attend. Because of the support from the ACMS Foundation, I was able to make that dream a reality.

We were able to bring in 4 renowned, powerhouse mental health speakers to the conference where I asked them to not only share their story and their organization’s mission, but challenged them with the request of incorporating an interactive component to help increase our impact. Our speakers did not disappoint. We made friendship bracelets, wrote songs, did yoga, wrote mantras, and danced while we discussed important topics like selflove, depression, suicide, anxiety, gratitude, and coping techniques. The day was so beautiful, so important, and so fun.

We had the support of some incredible vendors like Aetna Health, Charlie Health, and Big Brothers Big Sisters who elevated our breaks in the day with smoothies, virtual reality, games, sweet treats, and collaborative art projects.

As I walked through the crowd and saw this incredible event in full swing with the kids so engaged and having so much fun – while receiving the support I so desperately needed when I was their age – it was impossible for me to not get emotional. I have walked around with a chip on my shoulder for so long about having the end of my childhood robbed from me because of how deeply I was struggling with my mental health. Dealing with Generalized Anxiety Disorder and Panic Disorder in a time when the world was not accepting of these issues, the stigma plagued me from getting the help I needed and deserved. Because of that, the ramifications not only became incredibly severe, but I have spent a majority of my adult life learning to reframe what I have been through, to better my life, and to heal from things that were avoidable had I had an opportunity to be supported and understand my diagnosis the way kids accept their mental health now.

We are in the midst of the biggest mental health crisis we have ever seen. The statistics are staggering and the first-hand experience I have interacting with our kids through Listen, Lucy has shown me that it is more important than ever to make sure our kids feel validated, supported, and equipped to handle life’s adversity. At Listen, Lucy we take that responsibility seriously

and plan to make Camp Lucy an annual event to help increase our impact and to make the world a better, more accepting place.

We have gathered evaluations from students and supervisors to hear what they thought, to figure out what they loved, and what we can improve for next year. Among the evaluations were so many statements like “I wish I could be here every day.’, “I wouldn’t change a thing!”, ‘Thank you for making me feel not alone.”, “I learned to love myself more and to not judge someone because we don’t know what they are going through.” These words make every hour of worry and stress through the fundraising and planning process worth it and I can’t wait to do it again next year.

Thank you to the ACMS Foundation for facilitating this opportunity for our kids. I hope you know this money was spent in the very best way.

Camp Lucy was awarded $5,000 from the ACMS Foundation in the 2023-2024 grant cycle.

Cry, Our Beloved Children: An Interview with the Force Behind Listen, Lucy

By: Anthony L. Kovatch, MD

The prevalence of mental health disorders among children 7 to 17 years of age has skyrocketed since the designation of May as National Children’s Mental Health Awareness Month in 2006. This surge is especially alarming since May was originally selected as the month to acknowledge the crisis globally as long ago as 1949. The initiative’s primary day of recognition in 2024 will be May 9th. Although there has been some abatement of the 20.5% national prevalence of anxiety that accompanied the COVID-19 pandemic, the current statistics among children remain consistent and reproducible in epidemiologic studies across all social strata. Here are the pure percentages and overall number of children 3 to 17 years of age affected by the prevailing psychiatric disorders in the USA in 2024; many kids have a mixture of more than one condition:

ADHD - 9.8 % - 6 million

Anxiety Disorders - 9.4% - 5.8 million (complicated by comorbid depression in 73.8 % of cases)

Behavior Problems - 8.9% - 5.5 million

Depression Alone - 4.4% - 2.7 million

A quarter of a century of internationally acclaimed research has documented that Adverse Childhood Experiences (ACEs) play a significant contribution to the development of depression and its comorbidities (especially suicidality, incapacitating PTSD, and substance abuse) not only downstream in adulthood, but in the formative, and therefore

impressionable, adolescent years as well. Again, the statistics breed true; the existing evidence suggests a strong, dose-related relationship between ACE’s and poor adult mental health outcomes.

Fortunately, the majority of the affected are currently receiving help, amounting to 14.9 % of children overall--including 8% taking a prescription medication and 11.5 % receiving professional counselling. However, the pediatric community is making more and more of an effort to remediate the causative ACEs at the earliest stage possible. Therefore, the Bulletin undertook the initiative of seeking the opinions of Jordan Corcoran---fierce mental health advocate, creator of Listen, Lucy, author of children’s books, and mother of 2---who has fashioned a career counselling elementary school through high school-aged children and their parents regarding stopping emerging psychological problems in their tracks.

Although Jordan and her siblings and my own grown children of Generations Y and Z went to elementary and middle school together (see picture below), only very recently did she relate to me her subsequent odyssey in overcoming panic attacks (primarily due to bullying) as a young adult; this journey galvanized her fervor to alleviate performance anxiety and other conditions in kids as young as two years of age. She is of the firm conviction---as am I---that, while statistically 1 out of 4 individuals in the general population have a diagnoseable mental health disorder, the prevalence in the real world is more like 4 out of 4. Jordan followed her family pattern

of being a superior athlete (lettering in 3 sports in high school), an equally superior student, and a tireless worker, but admits that the social pressures and culture of the times caused her to forget all the coping mechanisms gifted to her by her family previously. “I contend that anxiety is a learned disorder. I had to unlearn everything I had learned wrong in those vulnerable years, and succeeding in accomplishing that was healthy to my life overall. This unlearning would be much harder to do when you’re 60,” she admits. “Or when you’re retired!” I added.

In contrast to the issues of child abuses and negligence that predominate the lists of ACE’s in the scientific studies, Jordan believes that prevailing factors triggering anxiety and depression today are over-emphasis by the media on the existing cultural and political conflicts: abortion, LGBT+ polarity, international turmoil, the disintegration of organized religion and its moral underpinnings, misinformation and bullying on social platforms, deleterious consequences of climate change, social isolation. “Children are strongly affected by the discourse, especially the negativity, they hear in the home. We all need to have mindful discussions. We think the kids are not listening, but I can certainly tell you, they are!” she contends. “The COVID-19 pandemic and the resultant global anxiety served as a distraction for the children, the parents, and the educational system, and we dropped our guard and are just starting to recover.”

Jordan agrees with this pediatrician that cognitive behavioral therapy must

CONTINUED FROM PAGE 15

commence as early as possible, even at 2 years of age---starting with calming and “grounding” technique which give the body time to catch up with the mind. She is insistent that practicing these coping methods is as important a part of life as physical exercise.

“Parents need to have their toolkit ready and stress to their children that talking is not associated with weakness. Children of all ages have to know that struggling with your mental health and facing your adversity is incredibly tough and brave.”

Jordan is insistent that children are not labelled with a diagnosis of any kind (outside of the pediatric and psychiatric specialties) and is adamant that the suffering child never be told by anyone that “they were born that way.” She

Happy middle schoolers celebrate their graduation; included in the proud group is our interviewee Jordan Corcoran (then Zangaro), who is overlooking the left shoulder of this author’s son Kevin.

Jordan tirelessly offers guidance through her Listen, Lucy program to audiences at schools, especially assemblies, and conferences

however, the schools most in need just don’t have the resources in time and energy to implement the cumbersome process necessary to obtain a grant; therefore, they fall by the wayside.”

My interview with this youthful, enthusiastic advocate for our children reinforced what I have personally preached for years---that formal behavioral therapy must commence in the elementary schools. Jordan added “Since high schoolers tend to be embarrassed by these discussions, I feel it is paramount to focus on the middle school students who collectively are most engaged with adults.”

I voiced my personal opinion that “self-disclosure is the breakfast of champions.” Jordan put it more elegantly: “Liberating ourselves from our fears and anxieties gives us confidence in dealing with the proverbial ‘hand you were dealt.’”

References:

1. Danielsdottir, HB, et al: Adverse Childhood Experiences and Adult Mental Health Outcomes. JAMA Psychiatry. Published online March 6, 2024. doi:10.1001/jamapsychiatry.2024.0039

Reportable Diseases 2024: Q1

Allegheny County Health Department Selected Reportable Diseases/Conditions

* Case classifications reflect definitions utilized by CDC Morbidity and Mortality Weekly Report.

** These counts do not reflect official case counts, as current year numbers are not yet finalized. Inaccuracies in working case counts may be due to reporting/investigation lag.

NOTE: Disease reports may be filed electronically via PA-NEDSS. To register for PA-NEDSS, go to https://www.nedss. state.pa.us/NEDSS. To report outbreaks or diseases reportable within 24 hours, please call the Health Department’s 24-hour telephone line at 412-687-2243. For more complete surveillance information, see ACHD’s data reports and infectious disease dashboard: Infectious Disease Epidemiology - Allegheny County, PA.

Hepatitis C Elimination Efforts in Allegheny County

By: Jennifer Fiddner, MPH, CIC – Allegheny County Health Department

The Hepatitis C Epidemic

The bloodborne hepatitis C virus (HCV) is spread primarily through sharing needles or other equipment used to inject drugs. Perinatal transmission can also occur. As the opioid epidemic increased, so did reports of new HCV infections. Healthcare providers can prescribe effective medications to treat the disease with few side effects. Left untreated, people infected with HCV can develop serious liver damage, sometimes leading to liver failure or liver cancer.

Of 709 newly diagnosed chronic hepatitis C cases reported to the Allegheny County Health Department (ACHD) in 2022, 429 (61%) were male. The age distribution was bimodal with peaks in the 30-44 and 55-69 year age groups (Figure 1).

Hepatitis C Testing and Treatment

The CDC recommends HCV testing for all adults at least once during their lifetime, once during each pregnancy, and after any exposure.1 People with ongoing risk factors, including injection drug use, should be tested regularly.1 In 2023, CDC updated testing recommendations for infants born to pregnant people who are infected with HCV, advising healthcare providers to

test all perinatally exposed infants using a nucleic acid test for HCV RNA at age 2 through 6 months.2

Timely access to treatment reduces both the risk of developing serious liver disease and transmitting the virus to others. According to the CDC, only one in three people with private health insurance receive treatment for their infection within a year of diagnosis, with even lower treatment rates for people who are Medicaid recipients.3 In 2022, the ACHD began enhanced case investigations to better assess barriers to confirmatory testing and treatment among persons reported with a positive test. The most commonly reported barrier to confirmatory (RNA) testing was a lack of awareness of the need for additional testing. The most commonly reported barrier to treatment was being unaware that curative medication was available.

Table 1. Reported barriers to confirmatory testing, November 1, 2022 – March 31, 2024

Table 2. Reported barriers to treatment, November 1, 2022 – March 31, 2024

A listening session held with people who inject drugs revealed that physical healthcare providers do not always offer HCV testing despite awareness of patient’s ongoing risk factors. Participants also shared that they were reluctant to make appointments solely for HCV testing or treatment and expressed a preference for seeking HCV testing and treatment service access at medication-assisted treatment clinics.

Hepatitis C Elimination

Achieving HCV elimination requires a collective effort to reduce risks associated with infection and provide timely, consistent, and low-barrier access to testing and treatment services. Healthcare providers, especially those serving people at high risk of HCV infection, should ensure that their clients are familiar with harm reduction practices and offer antibody to RNA reflex testing as well as treatment services as a part of routine healthcare. Training resources for clinicians are available on the CDC website at Hepatitis Training Resources from within CDC and outside | CDC. Hep C Free Allegheny and partner agencies provide a variety of resources, including treatment training opportunities for healthcare providers, at no cost. To learn more about local resources, please visit Home | HCFA (hepcfreeallegheny.org) or contact the ACHD at 412-687-2243.

References

1. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United

States, 2020. MMWR Recomm Rep 2020;69(No. RR-2):1–17. DOI: http:// dx.doi.org/10.15585/mmwr.rr6902a1.

2. Panagiotakopoulos L, Sandul AL, et al. CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023. MMWR Recomm Rep 2023;72(No. RR-4):1–19. DOI: http:// dx.doi.org/10.15585/mmwr.rr7204a1.

3. Thompson WW, Symum H, Sandul A, et al. Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:1011-1017. DOI: http://dx.doi.org/10.15585/mmwr. mm7132e1.

Jennifer Fiddner, MPH, CIC, joined the Allegheny County Health Department in 2010. As an Epidemiology Research Associate Supervisor within the Bureau of Data, Reporting, and Disease Control, Jennifer supervises infectious disease surveillance staff, develops surveillance initiatives, conducts outbreak investigations, and provides support for the department’s emergency preparedness program.

Society News

PAMPAC Board Update

By: Michael Aziz, MD — ACMS Board Member & PAMPAC Board Member

The Pennsylvania Medical Political Action Committee (PAMPAC) is the political arm of the Pennsylvania Medical Society. It is one of the largest bipartisan political action committees in the state, and is supported by physicians interested in making a positive contribution to the medical profession through the political action. PAMPAC supports pro-medicine candidates running for the state legislature or statewide judicial office.

The PAMPAC Board and Staff have been hard at work to advance PAMED's legislative efforts, and PAMPAC board members and staff were able to meet with a bipartisan group of legislators and leadership at our annual spring meeting. Please check your email and be on the lookout for the PAMPAC Pulse. This publication has been redesigned to focus on up-to-date political news and education.

Membership

PAMPAC membership is available to any physician or family member who makes a contribution. Physician trainee and student memberships are also available for as little as $20, in an effort to increase engagement. The budget is thoroughly reviewed annually, and every dollar contributed goes directly to candidate support.

Our staff has successfully modernized our membership process, in order to make membership fast and easy. Unfortunately, a large gap remains between PAMED and PAMPAC membership. Please follow this link in the online version or scan the attached QR code in order to join.

PAMPAC staff has arranged a membership challenge between the

eastern and western Pennsylvania counties. To defend the honor of all of the physicians in Western Pennsylvania, especially those from the City of Champions, I have personally wagered that we will be able to recruit more members than the eastern counties. In a surprise to no one who follows Pennsylvania politics, an attempt was made to gerrymander the map! Thankfully, an even split in our counties was successfully mediated by our staff prior to the involvement of an appeals court. Look for more details about the PAMPAC challenge in the coming weeks.

Legislative Advocacy

If there are time sensitive issues which require physicians to lobby their legislators, PAMED’s Weekly Dose email will have links to contact your elected officials with either custom or prepopulated text. If you have the time and energy, in-person meetings with legislators are also a wonderful way to utilize our influence and social standing as physicians to lobby on behalf of our patients and profession. Even if you feel that you were unsuccessful, building that relationship and offering your advice may be helpful in the future, as many health and healthcare related issues are brought before the legislature annually. Ideally, every elected official in the state should know that they can rely on their local physicians and/or PAMED staff for reliable and evidence-based opinions on the health of Pennsylvanians.

There are a growing number of physicians who have realized that health industry interests and physician/ patient interests do not always align,

and we are doing our best to organize as a foil to those special interests. Engaging with your local legislators can make a significant difference.

House of Delegates

We are expecting non-compete clauses, practice creep, regional access issues, telemedicine, private equity purchases of physician practices, and cannabis legalization to be hot topics over the coming year. If you are interested or an expert in any of these topics, please consider examining our compendium to determine whether or not you would like to submit a new resolution or revision to the PAMED House of Delegates by June 6th.

If you have questions regarding PAMPAC or are interested in political organizing on behalf of our patients and profession, please email me at michaelmazizmd@gmail.com.

Scan this code to join!

Specialty Group Updates

May 2024

By: Nadine Popovich, Eileen Taylor and Melanie Mayer

Allegheny County Immunization Coalition (ACIC) — 2024 Chair - Ashley Ayers, MBA, BS, CIC: The Allegheny County Immunization Coalition is organizing two upcoming events. The first is a volunteering opportunity at the World Refugee Day event on June 10th, where volunteers will operate a vaccination education table. Both experienced volunteers and newcomers are welcome to attend for the full duration or for a time that suits them.

The second event is the general membership meeting on June 20th at the AIU Building in the Waterfront. There will be a hybrid option for members unable to attend in person, and Dr. Diego Chavez-Gnecco will be the guest speaker.

Both events are important, and attendees are encouraged to mark their calendars and participate. More information is available on www. immunizeallegheny.org

American College of Surgeons Southwestern Pennsylvania Chapter (ACS-SWPA) — 2024 President –Richard Fortunato, DO, FACS: The Southwestern Pennsylvania Chapter of the American College of Surgeons (ACSSWPA) is organizing its annual Most Interesting Cases event on Wednesday, May 29 at Eddie Merlots. This event offers surgical residents the chance to present their most compelling cases for review and discussion, with cash prizes awarded to the top three presentations. Abstract applications are due by May 17. Additionally, the ACS-SWPA is seeking candidates to fill several leadership positions. For more information about the event, abstract guidelines, registration, and leadership

opportunities, visit https://acs-swpa. org/page-18068. Keep updated with society news and updates at https:// acs-swpa.org/

Pennsylvania Geriatric Society Western Division (PAGS-WD) — 2024 President - Heather Sakely, PharmD, BCPS, BCGP: The Pennsylvania Geriatrics Society – Western Division recently held its fourth consecutive Virtual Conference, the 32nd Annual Virtual Clinical Update in Geriatric

Medicine, on April 25 – 26, 2024. Over 325 healthcare professionals from 16 states and 2 countries participated in this evidence-based event aimed at improving care for the elderly. The conference also announced the winners of the David C. Martin Award, with details available on their website. Nominations for the Geriatric Teacher of the Year Award are open until May 17. For more society news and updates, visit www.pagswd.org.

ACMS Honors

On April 18, ACMS Members and community partners gathered at the Heinz History Center for ACMS Honors. The PAMED Top Physicians Under 40 from ACMS were honored and attendees heard from grant recipients: Life of Life Rescue Mission & Strong Women, Strong Girls. Additionally, the ACMS Foundation announced the launch of the Physician Wellness program. Visit https://www.acms.org/ events-news/event-photo-gallery/ for more pictures!

1. Rishi Anand, Rachel Groggel & Amanda Ross

2. Dr. Kirsten Lin, Dr. Natalie Gentile, & Top Physician Under 40 award winner Dr. Emily Scott

3. James Latronica, DO & Jamie Latronica, Esq.

4. Brian Kelly, MD & Erica Kelly, Lauren Giugale, MD & Juan Giugale, MD

5. State Rep. Arvind Venkat, MD & Veena Venkat, MD; Raymond Pontzer, MD & Mary Pontzer, MD

6. Melanie Mayer, Nadine Popovich, Sara Hussey & Eileen Taylor

7. ACMS Foundation Board Member Lawrence John, MD

8. Erica Cochran, Kate Brennan, & Ashley Ingram from NuturePA