BCMSScript. Newsletter of the Bucks County Medical Society
Winter 2024
President’s Message It has truly been an honor to steward the role of President of the Bucks County Medical Society (CMS) over this past year. This experience has not only shown me the benefits of being a member (like CME credit, opioid and child abuse requirement resources, contract review services etc.) but also the local, regional and national impact that our advocate voices make both at PAMED and AMA.
OUR MISSION The Bucks County Medical Society strives to advance the professional and personal development of its physician members by providing educational and practice related resources as well as legislative advocacy. Moreover, the Bucks County Medical Society seeks to promote optimal outcomes for our patients as well as the public health of the Bucks County community.
EDITORIAL BOARD Marilyn Heine, MD, Editor in Chief
In October our delegation represented our CMS members at the PAMED House, where we advanced amendments related to physicianled team based care, AI and algorithm utilization used by insurers, and meaningful implementation of recently enacted step therapy reforms. The House of Delegates served as a great forum to advocate for Bucks County physicians and build relationships with PAMED members from across the state. Even further ways that we have advocated for patients and physicians include the Bucks CMS legislative reception where we discussed health care related topics with multiple state legislators, and a physician leader meeting with Congressman Fitzpatrick emphasizing bipartisan ways of addressing important issues such as prior authorization and Medicare reimbursement. I am thrilled to announce that through generous donations and Bucks CMS philanthropy we have met the minimum requirements to fund the Donald E. Parlee, MD Memorial Scholarship fund, to begin awarding the scholarship next year to a deserving medical student from Bucks County. If you would like to donate to the scholarship fund please visit https://www.buckscms.org/scholarship.html. Bucks CMS is here to be a resource for, and advocate on behalf of, all physicians of Bucks County and our patients. Whether your practice is small or large, private, employed or part of private equity, we share the same principle as physicians: taking the best possible care of our patients. We are here to help you do what you do best.
Hannah Do, MD
Thank you, again, for your continued membership and commitment to Bucks CMS. In an ever-changing landscape of medicine, we physicians can provide the constant of a united front advocating for physicians, our practices, and most importantly our patients.
John Gallagher, MD
Sincerely,
John Pagan, MD, MBA
J. Matthew Bohning, MD President, Bucks County Medical Society
J. Matthew Bohning, MD
Heart Smart: Empowering Young Adults Heart Young HeartSmart: Smart:Empowering Empowering YoungAdults AdultstotoConquer ConquerCardiovascular CardiovascularRisks Risks Risks to Conquer Cardiovascular By Subhan MD Shahzad ByMadeeha Madeeha SubhanWaleed, Waleed, MDand andadherence ShahzadAhmed, Ahmed, inflammation. Conversely, to a healthy diet MD such as the Mediterranean diet reduces the BMI and MD
improves the blood glucose levels as well as the blood
pressure. The DASH diet reduces theand risk of Dr. isisChief Internal Medicine, Dr.Waleed Waleed ChiefResident, Resident, Internal Medicine, andDr. Dr.prediabetes by Interventional 65 percent in young adults.at Lower Bucks Ahmed is an Cardiologist, Ahmed is an Interventional Cardiologist, at Lower Bucks Hospital Hospital Young adults’ smoking tobacco is closely tied to the
legal purchasing age, with smoking rates significantly increasing in those aged 18–20. Literature has shown By Madeeha Subhan Waleed, MD and Shahzad Ahmed, MD a direct correlation between smoking and CVD Cardiovascular disease (CVD) poses aasignificant challenge 20-24; Cardiovascular disease (CVD) posesand significantpublic publichealth health challenge amongindividuals individuals aged 20-24; Dr. Waleed is Chief Resident, Internal Medicine independent ofamong cholesterol levels.aged A yearly delay in Dr. Ahmed is an Interventional Cardiologist at Lower Bucks Hospital who comprise 25 percent of the global population. Early signs of atherosclerosis are rising in this group, who comprise 25 percent of the global population. Earlythe signs of atherosclerosis are rising this group, in onset of smoking accounts forinthe reduction largely bybymodifiable risk like poor physical inactivity. However, cardiovascular by 4 percent [8]. Quitting smoking largelyinfluenced influenced modifiable riskfactors factors likesmoking, smoking, poordiet, diet,and andrisk physical inactivity. However, Cardiovascular disease (CVD) poses a significant public improves cardiovascular and this population group and see checkups typically this population groupfeels feelshealthy healthywho anddoes doesnot not seethe theneed needfor forregular regularoutcomes checkupsand and reduces the risk healthtypically challenge among individuals aged 20-24; ofmissed smoking-related deaths. physician consultations. The opportunities to comprise 25 percent of the global population. Early leads physician consultations. Thelack lackofofengagement engagement leadstoto missed opportunities tooffer offerpreventive preventivecare, care, signs education ofeducation atherosclerosis are rising in and this group, largely Moderate alcoholto consumption increases levels of about morbidity ofofCVD, health aboutthe the morbidity andmortality mortality CVD,and and healthinitiatives initiatives toimprove improvecardiovascular cardiovascular influenced by modifiable risk factors like smoking, poor high-density lipoprotein (HDL) cholesterol. outcomes. socioeconomic consequences, prioritizing outcomes.Given Giventhe thealarming alarmingrise riseininrates ratesofofCVD CVDand andits its socioeconomic consequences, prioritizing However, diet, and physical inactivity. However, typically this excessive drinkinghealth posesinin increased health risks and primary and isiscrucial for cardiovascular young primary andprimordial primordialprevention prevention crucial forenhancing enhancing cardiovascular health youngadults. adults. population group feels healthy and does not see the higher rates of hypertension and cardiomyopathy. need for regular checkups and physician consultations. Young populations are more likely to binge drink Young adults bebeencouraged totounderstand Young adultsshould should encouraged understandhow howmodifiable modifiableand andnon-modifiable non-modifiablefactors factorsimpact impact The lack of engagement leads to missed opportunities which can lead to acute health issues and long-term their risk and the benefits ofoflifestyle regular screenings, and discussions with their riskofofCVD CVD and thepotential potential benefits lifestylechoices, choices, regular screenings, and discussions with to offer preventive care, education about the morbidity consequences. Regular heavy drinking can worsen healthcare measures. healthcare providers aboutpotential potentialpreventive preventive measures. and mortality of providers CVD, and about health initiatives to improve health outcomes. cardiovascular outcomes. Given the alarming rise in Promoting stress management can help young rates Regular ofRegular CVD and its socioeconomic consequences, physical activity cardiovascular and risk physical activityimproves improves cardiovascularfitness fitness andfavorably favorably affectscardiovascular cardiovascular riskfactors factors adults developaffects healthy coping strategies, leading to a prioritizing primary and primordial prevention is crucial suchas asblood bloodpressure, pressure, bodylipid lipidlevels, levels,body body massindex, index, and glycated hemoglobin. The CARDIA study wellsuch body mass and glycated hemoglobin. The CARDIA study reduction in risk for CVD and enhanced overall for enhancing cardiovascular health in young adults. determined thatdecreased decreased physical activity increaseshypertension hypertension riskby by percent. Current guidelines determined that physical activity increases risk 22percent. Current guidelines being. Increased stress can elevate blood pressure, Young adults should be encouraged to understand how inflammation, rate, and risk of CVD. suggest150-300 150-300minutes minutesofofmoderate moderateoror75 75toto150 150minutes minutes ofvigorous vigorousheart activity weekly tolower lower theUnder risk stress, suggest of activity weekly to the risk modifiable and non-modifiable factors impact their risk the body releases cortisol and adrenaline that, over of CVD. of CVD. of CVD and the potential benefits of lifestyle choices, time, can damage blood vessels. regular screenings, and discussions with healthcare healthy dietrich richinin fruits,vegetables, vegetables, wholegrains, grains,and andlean leanprotein proteinisisimportant importantto toreduce reducethe therisk riskof of A Ahealthy fruits, whole providers aboutdiet potential preventive measures. Example Techniques to Relieve Stress CVD. An unhealthy diet is linked to a 64 percent rise in cardiometabolic deaths in individuals aged 25– CVD. An unhealthy diet is linkedcardiovascular to a 64 percent rise in cardiometabolic deaths in individuals aged 25– Regular physical activity improves 34, particularly from processed foods, meat, andexcessive excessivesugar-sweetened sugar-sweetened beverages. Poordietary dietary 34, particularly from processed foods, meat, and beverages. Poor fitness and favorably affects cardiovascular risk factors • Mindfulness and Meditation patterns increase proinflammatory markers in early childhood, enhancing long-term cardiometabolic patterns increase proinflammatory markers in early childhood, enhancing long-term cardiometabolic such as blood pressure, body lipid levels, body mass • Regular Exercise risks. Consumption processed meats, rye,potatoes, potatoes,and andbutter butterare areassociated associatedwith withhigher higherlevels levelsof of index,risks. and glycated hemoglobin. The CARDIA study Consumption ofofprocessed meats, rye, • Healthy Diet determined that decreased physical activity increases totaland andlow-density low-densitylipoprotein lipoprotein cholesterol (LDL-C),apolipoprotein-B, apolipoprotein-B,and andC-reactive C-reactiveprotein proteinall allleading leading total cholesterol (LDL-C), • Social Support hypertension risk by 2 percent. Current guidelines suggest to inflammation. Conversely, adherence to a healthy diet such as the Mediterranean diet reduces the to inflammation. Conversely, adherence to a healthy diet such as the Mediterranean diet reduces the 150-300BMI minutes of moderate or 75 to 150 minutes of • Sleep Hygiene andimproves improvesthe theblood bloodglucose glucoselevels levelsasaswell wellasasthe theblood bloodpressure. pressure.The TheDASH DASHdiet dietreduces reducesthe therisk risk BMI and vigorous activity weekly to lower the risk of CVD. • Time Management prediabetesbyby6565percent percentininyoung youngadults. adults. ofofprediabetes A healthy diet rich in fruits, vegetables, whole grains, and lean protein is important to reduce the risktied of Young adults’ smokingtobacco tobacco closely thelegal legal purchasingage, age, with smoking ratesbe changed, yet Non-modifiable risk factors cannot Young adults’ smoking isisclosely tied totothe purchasing with smoking rates CVD. An unhealthy diet is linked to a 64 percent they significantly influence health management significantly increasing in those aged 18–20. Literature has shown a direct correlation between smoking and increasing in those aged 18–20. shown a direct correlation between smoking rise insignificantly cardiometabolic deaths in individuals agedLiterature has prevention strategies. These include genetics, age, and CVD independent of cholesterol levels. A yearly delay in the onset of smoking accounts for the CVD independent of cholesterol yearly delay in the onset of smoking accounts for the 25–34,and particularly from processed foods,levels. meat, Aand gender, family history, and ethnicity. A positive reduction cardiovascular riskbybyPoor percent [8].Quitting Quittingsmoking smokingimproves improvescardiovascular cardiovascularoutcomes outcomes reduction inincardiovascular risk 44percent [8]. excessive sugar-sweetened beverages. dietary family history of CVD increases the individual risk for and reduces the risk of smoking-related deaths. patterns proinflammatory markers in early andincrease reduces the risk of smoking-related deaths. CVD. Genetic predisposition can influence cholesterol childhood, enhancing long-term cardiometabolic levels, blood pressure, and other cardiovascular health risks. Moderate Consumption of processed meats, rye, potatoes, Moderatealcohol alcohol consumption increases levelsofofhigh-density high-density lipoprotein (HDL)cholesterol. cholesterol. However, consumption increases levels lipoprotein (HDL) However, indicators. As age progresses the arteries become and butter are associated with higher levels of total excessive drinking poses increased health risks and higher rates of hypertension and cardiomyopathy. stiffer the risk of CVD Men generally excessive drinking poses increased health risks and higher ratesand of hypertension andincreases. cardiomyopathy. and low-density lipoprotein cholesterol (LDL-C), have a higher risk of developing CVD at a younger age, apolipoprotein-B, and C-reactive protein all leading to whereas women's risk increases significantly after
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healthy habits. Health trackers monitor heart rate, physical activity, sleep patterns, and caloric intake. Goal setters enable personalized fitness and weight goals. Notifications can remind about exercise and medication intake. Progress monitors allow visualization of improvements.
menopause. A family history of CVD poses a higher risk. Certain ethnic groups are at a higher risk for developing CVD due to genetic factors or lifestyle patterns. Obesity substantially amplifies the risk of CVD. In young adults, the incidence of obesity has increased contributing to higher rates of hypertension, Type 2 diabetes, and dyslipidemia. Even if weight is decreased later in life, early obesity can lead to lasting effects on cardiovascular health and an increased risk of hypertension and diabetes. Early intervention can lead to improved heart health.
Recognizing risk factors that lead to the development of CVD in young adults – highlighting the importance of prevention, early detection, and intervention – can foster long-term health benefits that enhance quality of life and reduce the burden of chronic disease. By taking these steps, young adults can help ensure a healthier future for themselves and contribute to a reduction in the prevalence of cardiovascular disease in the broader population.
Dyslipidemia is characterized by abnormal lipid levels and significantly contributes to CVD risk. Elevated LDL-C and elevated lipoprotein(a) (Lp(a)} levels are associated with the development of atherosclerosis. However, testing for Lp(a) markers in younger individuals is still limited. Familial Hypercholesterolemia is a genetic condition often underdiagnosed in young people where early treatment can significantly reduce the risk of CVD. Addressing dyslipidemia in young adults helps mitigate CVD risk.
Hypertension is a significant risk factor for CVD, particularly in young adults. It is estimated that only 25-32 percent of young adults who have hypertension are aware that they have this condition. Effective management and treatment adherence can be impactful but remain low. Conditions such as primary aldosteronism and fibromuscular dysplasia can lead to the development of hypertension especially in younger populations, necessitating targeted evaluation. Addressing hypertension early through regular monitoring and lifestyle changes is essential for reducing the risk of arterial stiffening and CVD in young adults.
The Physicians’ Voice in Politics
Pennsylvania Medical Political Action Committee
JOIN PAMPAC HERE: www.PAMPAC.org
Chronic Kidney Disease (CKD) is a significant health concern that is often linked to diseases such as hypertension. Young adults with CKD are at a higher risk of CVD such as increased arterial stiffness and coronary artery calcification. Effective detection and management of CKD leads to improved long-term health outcomes.
Thank you to the Bucks County Medical Society Members who were PAMPAC Members in 2024 Commonwealth Club Marion E. Mass, MD | John J. Pagan, MD, FACS Capitol Club Judith Gallagher-Braun, MD | Marilyn J. Heine, MD Mary B. Toporcer, MD
Diabetes Mellitus (DM), especially Type 2, is a significant contributor to CVD risk and related mortality in young adults. Management strategies include effective glycemic control with diet and lifestyle changes. Intensive glycemic control in young Type 1 patients has been linked to reduced cardiovascular mortality.
Keystone Club Mitchell M. Greenspan, MD | Robert S. Mirsky, MD Rachael M. Sampson, MD Sustainer Level J. Matthew Bohning, MD | Hannah H. Do, MD George P. Heyrich, MD | Bindukumar C. Kansupada, MD, MBA Felix I. Kremer, MD | Richard T Leshner, DO
Regular health check-ups with appropriate screening in young adults can identify risk factors, detect early signs of cardiovascular issues, monitor blood pressure and cholesterol, manage weight, provide any indicated medication management; and promote healthy diet, exercise, and lifestyle that can contribute to long-term health.
Other Contributors Andrew Ball, MD | Sandra P. Bogota-Angel, MD Arvind R. Cavale, MD | John T. Gallagher, MD Karl W. Helmold, MD | Daniel Latta, MD Philip A. Mandato, DO | Mary E. Pagan, MD David S. C. Pao, MD | Kathy Tran Gast, DO
Apps and Wearable Technology can improve awareness and motivation to adopt and maintain
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BCMSScript.
By Hannah Do, MD
diagnosis, By HannahinDo, MD treatment, and long-term care. One cannot forget the thrill of endoscopic procedures that Retirement Spotlight: Conversation with a Mentor frequently improve a patient’s quality of life and may Retirement Spotlight: Conversation withConversation a Mentor Retirement Spotlight: with a aspect Mentor is aagastroenterologist in Central Bucks Coun Dr.Dr. Do Do is asave gastroenterologist in Central Bucks County. She life. The least satisfying is the snail’s pace of embracing newMD, programs of she patient care,“is high By Hannah Do, MD interviewed Robert Hale, whom wrote a cost of Robert Hale, MD, whom “is a inDo, diagnosis, treatment, and long-term care. she One wrote Byinterviewed Hannah MD medications, insurers with their foot on the break. cannot forget theover thrill of endoscopic procedures that gastroenterologist with 50over years experience practicing gastroenterologist with 50ofyears of experience frequently improve a patient’s quality of life and may Bucks the age 80 is80 stillpace excited toS Dr. Do is aaHe gastroenterologist inofCentral Bucks County. What drives aat patient relationship? Dr. DoCounty. is Q: aCounty. gastroenterologist in Central Bucks County. She save life.retired The satisfying aspect isand the Bucks Heleast retired atphysician the age ofsnail’s and is still A: to face time, listening andwrote staying in of Face embracing new programs of she patient high cost career.” of By Hannah Do, MD provide insights on what it takes to build acare, rewarding interviewed Robert Hale, MD, whom “is acontact interviewed Robert Hale, MD, whom she wrote “is a provide insights on what it takes to build with the patient and family. medications, insurers with their foot on the break.a rewardin Dr. Do is a gastroenterologist in Central Bucks County. gastroenterologist with over years experience practicing in gastroenterologist with50over 50ofyears of experience pra She interviewed Robert Hale, MD, whom she wrote “is a Bucks County. He retired at the age of 80 and is still excited to Q: How did you become interested in gastroenterology? Q: Whathas drives a landscape patient relationship? How of age healthcare changed? County. Hethe retired atphysician the of 80 and is still exc gastroenterologist with over 50 years of experience practicing inBucksQ: A: Everyday Faceon to face time, listening and staying in contact Q: How did you become interested in gastroenterology? By Hannah Do, MD provide insights what it takes to build a rewarding career.” A: there seems to be something new to be a A: In my sophomore I met GI Doc was fresh out of fellowship and had just opened Bucks County. He retired at the age year, of 80 and is stillaexcited to who provide insights on disease what ittotakes to buildand a rewarding ca with the patient family. explored, a newand be identified, new just op provided insights on what it takes to build aBucks rewarding career.” Dr. Do is a sophomore gastroenterologist inyear, Central County. A: practice. In my I met a GI Doc who was fresh out of fellowship and had Over the next 6 years he acted as my mentor. His primary interest was fiberoptic endoscop She interviewed Robert Hale, MD, whom she wrote “is a treatment programs. Our patient population is aging, Q: How did you become interested in gastroenterology? Q:introduction How has the landscape of healthcare changed? gastroenterologist with over 50 years of experience practicing inas The was fascinated and hooked on GI endoscopy. ofprimary fiber and optics and later electronic practice. Over the next 6 years he acted my mentor. interest was fiberopti old diseasesthere areHis changing new ones are appearing. Q: HowQ: didHow become interested in did you become interested into gastroenterology? A: Everyday seems to be something new to be a A:you In my sophomore I met GI Doc who was fresh out of fellowship and had just opened Bucks County. He retired at the age year, of 80 and is stillaexcited Endoscopy has undergone gastroenterology? new of diagnostic possibilities treatments for GIoptics disorders. explored, a and new disease to berevolutionary identified, andchanges new provided on and what it takes avenues toyear, buildon a Irewarding wasplatforms fascinated hooked GI The introduction of fiber and later ele A: practice. Ininsights myopened sophomore met a career.” GIfresh Doc who was fresh out ofinterest fellowship and had just Over next years heendoscopy. acted as my mentor. His primary wasto fiberoptic endoscopy. I and has added major advantages diagnosis and opene A: In my sophomore year, the I met a GI6 Doc who was treatment programs. Our patient population is aging, wasdid fascinated andnext hooked endoscopy. introduction of fiber optics and later electronic platforms opened new avenues of diagnostic possibilities and treatments for GI disorders. treatment, us to evaluate long-term success practice. Over the 6 years he acted my mentor. primary interest was fiberoptic en out of Q: fellowship and had just opened a on practice. Over as The old diseasesallowing areHis changing and new ones are appearing. How you become interested in GI Q: What experiences contributed to your success in the practice of of our Physician education has improved. Endoscopy has undergone changes the next 6 years he acted as my mentor. Hisof primary gastroenterology? platforms opened new avenues diagnostic possibilities and treatments for GIoptics disorders. was fascinated and hooked on GI endoscopy. 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Curb to Needle Time: Curb Time: StrokeCare Careininyour yourDriveway Driveway Curbto toNeedle Needle Time: Innovative Innovative Stroke Innovative Stroke Care in your Driveway GeraldWydro, Wydro, MD and Alvin Wang, ByByGerald Alvin Wang, DODO allergies,MD andand a rapid CT scan of the brain. Then,
By Gerald Wydro, MD and Alvin Wang, DO
Dr.Wydro Wydro Chairman, Department of Emergency the patient undergoes Dr. is isChairman, Department of Emergency a telemedicine Medicine, Jefferson Health Northeast; Regional Medical Medicine, Jefferson Health Northeast; Regional Medical evaluation with a Director,Bucks Bucks County Emergency Health Services. Director, County Emergency Health Services. Dr. Dr. stroke neurologist Wang is Chief, Division of EMS, Jefferson Health Wang is Chief, Division of EMS, Jefferson Health from Jefferson Hospital Northeast; Regional Medical Director, Montgomery Northeast; Medical Director, Montgomery forRegional Neuroscience. County Emergency Medical Services. County Emergency Medical The CT images areServices. quickly reviewed by a
Dr. Wydro is Chairman, Department of Emergency Medicine, radiologist and the MSUa CT The patient develops weakness in theirleft left armand andleg leg while work. Rapidly, a CT scan is performed The patient develops weakness their arm while atat work. Rapidly, scan is performed Jefferson Health Northeast; Regional Medicalin Director, Bucks team and neurologist County and Emergency Health Services. Dr. Wang is Chief, Division there is a decision to administer thrombolytic therapy for a suspected stroke. Happens every and there is a decision to administer thrombolytic therapy for a suspected stroke. Happens every day,day, are notified of the of EMS,right? Jefferson Health Northeast; Regional Medical Director, What ifif we you this happened happenedininthe theparking parkinglotlotofof the patient’s office? right? WhatEmergency we told toldMedical you this the findings. Inpatient’s cases inoffice? Montgomery County Services.
which the patient is
The Health MobileStroke StrokeUnit Unit (MSU) one such programs in the United eligible for thrombolytic TheBensalem Bensalem EMS EMS // Jefferson Jefferson Health (MSU) is is one of of 2020 such programs in the United TheMobile patient States. This innovative and highly sophisticated unit responds to suspected stroke calls in a large therapy, the MSU team will administer TNKase. The develops States. This innovative and highly sophisticated unit responds to suspected stroke calls in a large MSU team can provide intravenous antihypertensive weakness in catchment Bucks County. County. Theunit unitisisa acooperative cooperative between Bensalem EMS, Jefferson catchmentarea area of of Lower Lower Bucks The between Bensalem EMS, Jefferson medications when blood pressure mustpeak be managed their left arm Health, and JeffStat Critical Care Transport. The MSU is in service 60 hours per week during volume Health, and JeffStat Critical Care Transport. The MSU is in service 60 hours per week during peak volume prior to TNKase. In the rare instance of a hemorrhagic and leg while at times. times.
stroke, the MSU crew can administer reversal agents work. Rapidly, for those patients on anticoagulation. The patient is a CT scan is When the Bucks County Emergency Communications Center dispatcher suspects an incoming call transported to a suspects stroke center forincoming definitive care. performed When the Bucks County Emergency Communications Center dispatcher thatthat an call indicates a stroke based on Emergency Medical Dispatch criteria, the MSU is dispatched in addition to and there is Dispatch Since starting over 5 ago, the MSU hastoresponded indicates a stroke based on Emergency Medical criteria, the MSU is years dispatched in addition a decision to the to assure assure rapidresponse. response. The MSU is staffed EMT/Driver, Paramedic, to MSU more 1800 stroke dispatches, providing care theclosest closest911 911 ambulance ambulance to rapid The isthan staffed byby an an EMT/Driver, Paramedic, administer for over 700 patients, with over 12% having received Critical Care Transport Nurse, and CT Technician. Remotely board-certified neuroscience physicians and Criticaltherapy Care Transport Nurse, and CT Technician. board-certified neuroscience physicians and thrombolytic for a suspected stroke. Happens Remotely radiologists collaborate in real-time real-time with theMSU MSUfield fieldtreatment crew. with thrombolytic therapy in the prehospital radiologists collaborate in with the crew. every day, right? What if we told you this happened in the setting. The average “curb” (arrival at scene) to CT time parking lot of the patient’s office? is 9 minutes, and the average “curb” to needle (TNKase
After arrival at the scene, the patient undergoes an initial assessment. If the patient is determined to
After arrival the scene, the patient an initial assessment. theminutes. patient isThese determined to exemplary, infusion) time isIf23 times are The Bensalem EMS at / Jefferson Health Mobileundergoes Stroke Unit meet MSU treatment algorithm inclusion criteria, the MSU team obtains vital signs, blood glucose, especially compared to traditional door to needle (MSU) ismeet one MSU of 20 treatment such programs in the United States. algorithm inclusion criteria, the MSU team obtains vital signs, blood glucose, INR INRtimes testing, NIH Stroke Assessment, detailed patienthistory, history, medications, allergies, and a rapid CT scan inmedications, the hospital allergies, setting. All patients are This innovative andStroke highly Assessment, sophisticateddetailed unit responds testing, NIH patient and a rapid CT transported scan of of to a Thrombectomy Capable Stroke Center. the Then, the undergoesaarea atelemedicine telemedicine evaluation with a stroke neurologist from to suspected stroke calls in patient a large undergoes catchment of thebrain. brain. Then, the patient evaluation with a stroke neurologist from LowerJefferson Bucks County. Thefor unit is a cooperative between Hospital Neuroscience. The CT images are quickly reviewed by a radiologist and the Bensalem EMS Health Mobile Stroke Unit Jefferson Hospital for Neuroscience. The CT images are The quickly reviewed by/aJefferson radiologist and the MSUMSU Bensalem EMS, Jefferson Health, and JeffStat Critical is onin the cutting edge of medicine byfor offering extremely team and neurologist are notified of the findings. In cases which the patient is eligible thrombolytic team andThe neurologist notified the findings. in which the patient is eligible for thrombolytic Care Transport. MSU is inare 60 of hours per weekIn cases rapid assessment, imaging, and treatment for patients therapy, the MSU team service will administer TNKase. The MSU team can provide intravenous antihypertensive therapy, the MSU team will administer TNKase. The MSU team can provide during peak volume times. suffering from acuteintravenous stroke. Theantihypertensive concept of “curb to medications when blood pressure must be managed prior to TNKase. In the rare instance of a
medications whenEmergency blood pressure must be managed prior to TNKase. In the instance of a needle” changes the rare paradigm of expeditious stroke When the Bucks County hemorrhagic stroke, the MSUCommunications crew can administer reversal agents for those patients on anticoagulation. careagents by moving the expertise of the care team directly to stroke, the crew cancall administer reversal for those patients on anticoagulation. Center hemorrhagic dispatcher suspects thatMSU an incoming Theapatient is transported to a stroke center for definitive care. the patient. The MSU indicates on Emergency Medical Dispatch The stroke patientbased is transported to a stroke center for definitive care. program demonstrates criteria, the MSU is dispatched in addition to the closest the benefits of wellSince starting over 5rapid years ago, the The MSUMSU has responded to more than 1800 stroke dispatches, providing 911 ambulance to assure response. Since starting over 5 years ago, the MSU has responded to more than 1800 stroke dispatches, providing is staffed anover EMT/Driver, Paramedic, Critical Care carebyfor 700 patients, with over 12% having received treatment with thrombolyticintegrated therapy incollaboration the careNurse, for over 700 withRemotely over 12%boardhaving received treatment with thrombolytic therapy in the between 911 dispatch Transport and CTpatients, Technician. prehospital setting. The average “curb” (arrival at scene) to CT time is 9 minutes, and the average “curb” setting. The average “curb” (arrival at scene) to CT time is 9 minutes, and the centers, average “curb” local EMS, and certifiedprehospital neuroscience physicians and radiologists to needle (TNKase infusion) time is 23 minutes. These times are exemplary, especially hospitals comparedtotoinnovate collaborate in real-time with the MSU field crew. to needle (TNKase infusion) time is 23 minutes. These times are exemplary, especially compared to traditional door to needle times in the hospital setting. All patients are transported to care a Thrombectomy by enhancing traditional to the needle times in the hospital After arrival at thedoor scene, patient undergoes an setting. All patients are transported to a Thrombectomy Capable Stroke Center. prehospital medical initial assessment. If the patient is determined to meet Capable Stroke Center. access, assessment, MSU treatment algorithm inclusion criteria, the MSU evaluation, and The Bensalem EMS / Jefferson Health Mobile Stroke Unit is on the cutting edge of medicine by offering team obtains vital signs, blood glucose, INR testing, NIH The Bensalem EMS / Jefferson Health Mobile Stroke Unit is on the cutting edge of medicine by offering treatment. rapid assessment, and treatment for patients suffering from acute stroke. The Strokeextremely Assessment, detailed patient imaging, history, medications, extremely rapid assessment, imaging, and treatment for patients suffering from acute stroke. The concept of “curb to needle” changes the paradigm of expeditious stroke care by moving the expertise of concept of “curb to needle” changes the paradigm of expeditious stroke care by moving the expertise of
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Bucks County’s History: Indigenous Len Bucks County’s History: Indigenous Lenape Tribe, Penn’s ByViews David Levin, Bucks County’s History: Indigenous Lenape Tribe, Penn’s Settlement, of the Land DO Settlement, and Conflicting ViewsandofConflicting the Land By David Levin, DO
of friendship and goodwill toward the Lenape people. Although he “owned” the land, he reserved and protected certain regions for the Lenape.
Dr. Levin is a radiolo
Dr. Levin is a radiologist in Upper Bucks County
Although the exact details are unclear, after Penn’s death, his sons reclaimed 75,000 acres of the land that had been promised to the Lenape. As a result, Dr. Levin is a radiologist in Upper Bucks County the Lenape felt cheated out of valuable land along the Delaware. Over the next couple of centuries, the Lenape Bucks County is home of some of the most beautiful wereinpushed out of Pennsylvania one of only a fewWith Bucks County is home of some of the most beautiful land Pennsylvania and in the–United States. land in Pennsylvania and in the United States. With eastern states today that has no federally recognized itsitsnumerous healthcare careand and educational institutions and miles of trails, Bucks is the fourth most numerous health educational institutions Lenape tribes. As recently as 2004, the Lenape populous the is Commonwealth. and miles county of trails,in Bucks the fourth most populous unsuccessfully sued Pennsylvania to regain use of some county in the Commonwealth. of the land. Meanwhile, Lenape communities do survive todayisinthat Newof Jersey parts ofEuropean the Midwest. Themost most documented documented and well-known history of theof the area The and well-known history 17thand century settlers who By David Levin, DO
Bucks County is home of some of the m its numerous health care and education populous county in the Commonwealth
area is of 17th century European who of years prior to their arrival, much of the land we know came tothat Pennsylvania. However, forsettlers thousands Therights, mostHealth, documented and well-known Human and the Lenape came to Pennsylvania. However, for thousands of years as New Jersey, New York and eastern Pennsylvania – including Bucks County – was inhabited by the prior to their arrival, much of the land we know as New Indigenous around the world, including the for tho camepeoples to Pennsylvania. However, Lenape people. Jersey, New York and eastern Pennsylvania – including Lenape and other American Indian nations, believe that Bucks County – was inhabited by the Lenape people.
as New Jersey, New York and eastern Pe Lenape people.
human health is connected to the health of the earth The tribe was also known as “Delaware” after the English of the colony of Virginia, Lord de la and governor the land. This belief contrasts with Euro-American The tribe was also known as “Delaware” after the ideas of health and human rights. Some scholars who English the colony of Virginia, Lord de Warr III.governor The landofwas primeval forest with many Lenape campsites, villages and trails – many of which aim to preserve the Lenape history think reconsidering la Warr The land was primeval forest with many are usedIII.today as streets. a health and human rights approach that connects our Lenape campsites, villages and trails – many of which health to that of the land could be a way to lessen some are used today as streets. of the potential harm of climate change to our health. Perhaps, a reimagined approach would also be a way to The Lenape Tribe: Life and land honor the mindset and lifestyle of native Lenape, too. The Lenape tribes have been in Pennsylvania for millennia; artifacts from settlements as far back as 6,000 years have recently been discovered.
The tribe was also known as “Delaware Warr III. The land was primeval forest w are used today as streets.
The Lenape were nomadic people who belonged to the Algonquin language family. They settled along rivers and creeks and survived as hunters, foragers, and farmers. Because of their dependence on the land, they often settled an area, abandoned it, and moved elsewhere. The health of their people was tied to the The Lenape Tribe: Life and land health of the land, but the Lenape did not believe people could own land.
The Lenape tribes have been in Pennsylvania for millennia; artifacts from settlements as far back as Penn’s “Ownership” of Bucks County 6,000 years have recently been discovered.
In 1682, King Charles II of England granted the land encompassing current Bucks people County to William Penn as The Lenape were nomadic who belonged to the Algonquin language family. They settled along payment for a debt. Penn practiced Quaker principles
rivers and creeks and survived as hunters, foragers, and farmers. Because of their dependence on the land, they often settled an area, abandoned it, and moved The elsewhere. The health theirand people was Lenape Tribe:ofLife land tied to the health of the land, but the Lenape did not believe people could own land. Penn’s “Ownership” of Bucks County
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The Lenape tribes have been in Pennsyl 6,000 years have recently been discover
In 1682, King Charles II of England granted the land encompassing current Bucks County to William Penn 6 as payment for a debt. Penn practiced Quaker principles of friendship and goodwill toward the Lenape The Lenape were nomadic people who people. Although he “owned” the land, he reserved and protected certain regions for the Lenape.
Bucks CMS Legislative Reception: An Opportunity to Strengthen Relationships Bucks County Medical Society’s Bucks CMS Legislative Bucks CMS Legislative Reception: Bucks CMS Legislative Reception: uring the 2024 PAMED AnnualSociety’s Meeting and House of Bucks County Medical Society’s Voice Was Reception: Bucks County Medical Voice Was Voice Was Heard at the PAMED An Opportunity to Several members of Bucks County’s state An Opportunity to Strengthen elegates this past October, the House Bucks CMS delegation An Opportunity to Strengthen Heard at the PAMED of Delegates Heard at the of PAMED House of Delegates House Delegates Strengthen Relationships legislative delegation and staff attended a Bucks ctively engaged in developing policy to guide PAMED Relationships Relationships
ucks County Medical Society’s Voice Was eard at the PAMED House of Delegates
CMS Legislative Reception in September where dvocacy. The delegation successfully advanced During PAMED Annual Meeting House During the2024 2024 PAMED Annual Meeting andand House ofof of Several members of Bucks County’s state legislative During the the 2024 PAMED Annual Meeting and House of discussion included the importance mendments thatpast emphasize the importance of delegation topics Several members of Bucks County’s state of Several members of Bucks state Delegates past October, the Bucks Delegates this past October, the Bucks CMSCMS delegation delegation and staff attended aCounty’s Bucks CMS Legislative Delegates this this October, the Bucks CMS delegation physician-led team-based care to ensure patient legislative delegation and staff attended a Bucks hysician-led team-based care, delineate and legislative and staff attended a Bucks actively engaged in developing developing policy to guide PAMED Reception actively engaged in policy topatient guide PAMED indelegation September where topics of discussion actively engaged in developing policy to guide PAMED safety, a meaningful remedy to noncompetes, CMS Legislative Reception in September where hysician practice safeguards ifsuccessfully insurersadvanced useadvanced algorithms CMS Legislative Reception in September where advocacy. delegation advocacy. The delegation successfully advanced included the importance of physician-led team-based advocacy. The The delegation successfully and mental health care access. The event was a of topics of discussion included the importance nd AI amendments inamendments utilization underscore PAMED’s topics of discussion included the importance that emphasize the importance that emphasize the importance of care to ensure patient safety, a meaningful remedyof amendments thatmanagement, emphasize the importance of of great opportunity to strengthen relationships physician-led team-based care to ensure patient cus on public health, and advocate for meaningful physician-led care tocare ensure patient physician-led team-based care, delineate patient physician-led team-based care, delineate patient and to noncompetes,team-based and mental health access. physician-led team-based care, delineate patient andand between physicians and our state legislators and safety, a meaningful remedy to noncompetes, safety, a was meaningful remedy totononcompetes, mplementation of recently enacted therapy physician practice safeguards ifstep insurers algorithms The physician practice safeguards if ifinsurers use algorithms physician practice safeguards insurers use use algorithms event a great opportunity strengthen their staff. and mental health care access. The event was a and mental between health care access.and The event ininutilization management, underscore PAMED’s relationships forms. Delegates also joined with underscore friends andPAMED’s and and AIand inAIutilization management, PAMED’s AI utilization management, underscore physicians our statewas a great opportunity to strengthen relationships great opportunity to strengthen relationships focus ononpublic health, and advocate for meaningful olleagues, welcomed visiting state medical association focus on public health, andand advocate for focus public health, advocate for meaningful meaningful legislators and their staff. between physicians and our state legislators between physicians and our state legislators andand implementation of recently enacted step therapy residents, and supported PAMPAC and the PAMED implementation of recently enacted step therapy implementation of recently enacted step therapy reforms. their staff. their staff. reforms. Delegates friends oundation. reforms. Delegates alsoalso joined withwith friends andand Delegates also joined withjoined friends and colleagues, colleagues, welcomed visiting state medical association colleagues, welcomed visiting state medical association welcomed visiting state medical association presidents, presidents, and supported PAMPAC and the PAMED ucks CMS represented site) Matthew presidents, and supported PAMPAC andJ.the PAMED andwas supported PAMPAC by: and(on the PAMED Foundation. Foundation. ohning, MD; John Gallagher, MD; Marilyn Heine, MD Foundation. Bucks CMS was represented by: (on site) J. Matthew Delegation Secretary); Marion Mass, MD; and John Bucks CMS was represented by: (on site) J. Matthew Bohning, John Gallagher, MD;site) Marilyn Heine, MD Bucks CMS wasMD; represented by: Latta, (on J. Matthew agan, MD, MBA; (remote) Daniel MD; Kathy Tran Bohning, MD; John Gallagher, MD; Marilyn Heine, (Delegation Secretary); Marion Mass, MD; and John Bohning, MD; John Gallagher, Heine, MDMD ast, MD; Richard Leshner, DO; MD; and Marilyn Judith Gallagher (Delegation Secretary); Marion Mass, MD; Pagan, MD, Bucks MBA; (remote) Daniel MD; Kathy Tran (Delegation Secretary); Marion Mass,Latta, MD; andand JohnJohn raun, MD. Other CMS members at the House Pagan, MD, MBA; (remote) Daniel Latta, MD; Kathy Tran Gast, MD; Richard Leshner, DO; and Judith Gallagher Pagan, MD, Do, MBA; (remote) Daniel Latta, MD; Kathy Tran ere Hannah MD (Women Physicians Section); Gast, MD; Richard Leshner, and Judith Braun, MD. Other BucksDO; CMSDO; members atGallagher theGallagher House Gast, MD; Richard Leshner, and Judith ndu Kansupada, MD (International Medical Graduate Braun, MD. Other Bucks CMS members at the House were Hannah Do, MD (Women Physicians Section); Braun, MD. Other Bucks CMS members at the House ection); and Barry Snyder, MD (Specialty Society). Hannah Physicians Section); Bindu Kansupada, MD(Women (International Medical Graduate werewere Hannah Do, Do, MD MD (Women Physicians Section); Bindu Kansupada, MD (International Medical Graduate Bindu Section); Kansupada, MD (International Medical Graduate and Barry Snyder, MD (Specialty Society). Section); and Barry Snyder, MD (Specialty Society). Section); and Barry Snyder, MD (Specialty Society). Bucks CMS Members Meet with Local State Physicians Leaders Participated in Legislators at our Legislative Reception.
Meeting with Congressman Fitzpatrick Physicians Leaders Participated Physicians Leaders Participated in in Meeting with Congressman Fitzpatrick Meeting with Congressman Fitzpatrick
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400 Winding Creek Blvd. Mechanicsburg, PA 17050-1885
The Bucks CMS Board meets every 2 months. Spring Membership Meeting is being planned. Stay tuned for details. Meetings are open to members. For details, please contact buckcms@ pamedsoc.org We thank you for your membership and welcome you to contact us anytime at buckscms@pamedsoc.org