16687 Bucks Cty Med Society_BCMS SCRIPT Winter NEWSLETTER issuu version

BCMSScript.

Newsletter of the Bucks County Medical Society Winter 2024

President’s Message

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.

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.

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

EDITORIAL BOARD

Marilyn Heine, MD, Editor in

Chief

J. Matthew Bohning, MD

Hannah Do, MD

John Gallagher, MD

John Pagan, MD, MBA

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.

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.

Sincerely,

J. Matthew Bohning, MD President, Bucks County Medical Society

Heart Smart: Empowering Young Adults to Conquer Cardiovascular Risks

By Madeeha Subhan Waleed, MD and Shahzad Ahmed, MD

inflammation. Conversely, adherence to a healthy diet such as the Mediterranean diet reduces the BMI and improves the blood glucose levels as well as the blood pressure. The DASH diet reduces the risk of prediabetes by 65 percent in young adults.

Dr. Waleed is Chief Resident, Internal Medicine, and Dr. Ahmed is an Interventional Cardiologist, at Lower Bucks Hospital

By Madeeha Subhan Waleed, MD and Shahzad Ahmed, MD

Dr. Waleed is Chief Resident, Internal Medicine and Dr. Ahmed is an Interventional Cardiologist at Lower Bucks Hospital

Cardiovascular disease (CVD) poses a significant public health challenge among individuals aged 20-24; who comprise 25 percent of the global population. Early signs of atherosclerosis are rising in this group, largely influenced by modifiable risk factors like smoking, poor diet, and physical inactivity. However, typically this population group feels healthy and does not see the need for regular checkups and physician consultations. The lack of engagement leads to missed opportunities to offer preventive care, education about the morbidity and mortality of CVD, and health initiatives to improve cardiovascular outcomes. Given the alarming rise in rates of CVD and its socioeconomic consequences, prioritizing primary and primordial prevention is crucial for enhancing cardiovascular health in young adults. Young adults should be encouraged to understand how modifiable and non-modifiable factors impact their risk of CVD and the potential benefits of lifestyle choices, regular screenings, and discussions with healthcare providers about potential preventive measures.

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 a direct correlation between smoking and CVD independent of cholesterol levels. A yearly delay in the onset of smoking accounts for the reduction in cardiovascular risk by 4 percent [8]. Quitting smoking improves cardiovascular outcomes and reduces the risk of smoking-related deaths.

Cardiovascular disease (CVD) poses a significant public health challenge among individuals aged 20-24; who comprise 25 percent of the global population. Early signs of atherosclerosis are rising in this group, largely influenced by modifiable risk factors like smoking, poor diet, and physical inactivity. However, typically this population group feels healthy and does not see the need for regular checkups and physician consultations. The lack of engagement leads to missed opportunities to offer preventive care, education about the morbidity and mortality of CVD, and health initiatives to improve cardiovascular outcomes. Given the alarming rise in rates of CVD and its socioeconomic consequences, prioritizing primary and primordial prevention is crucial for enhancing cardiovascular health in young adults.

Young adults should be encouraged to understand how modifiable and non-modifiable factors impact their risk of CVD and the potential benefits of lifestyle choices, regular screenings, and discussions with healthcare providers about potential preventive measures.

Moderate alcohol consumption increases levels of high-density lipoprotein (HDL) cholesterol. However, excessive drinking poses increased health risks and higher rates of hypertension and cardiomyopathy. Young populations are more likely to binge drink which can lead to acute health issues and long-term consequences. Regular heavy drinking can worsen health outcomes.

Regular physical activity improves cardiovascular fitness and favorably affects cardiovascular risk factors such as blood pressure, body lipid levels, body mass index, and glycated hemoglobin. The CARDIA study determined that decreased physical activity increases hypertension risk by 2 percent. Current guidelines suggest 150-300 minutes of moderate or 75 to 150 minutes of vigorous activity weekly to lower the risk of CVD

Regular physical activity improves cardiovascular fitness and favorably affects cardiovascular risk factors such as blood pressure, body lipid levels, body mass index, and glycated hemoglobin. The CARDIA study determined that decreased physical activity increases hypertension risk by 2 percent. Current guidelines suggest 150-300 minutes of moderate or 75 to 150 minutes of vigorous activity weekly to lower the risk of CVD.

Promoting stress management can help young adults develop healthy coping strategies, leading to a reduction in risk for CVD and enhanced overall wellbeing. Increased stress can elevate blood pressure, inflammation, heart rate, and risk of CVD. Under stress, the body releases cortisol and adrenaline that, over time, can damage blood vessels.

A healthy diet rich in fruits, vegetables, whole grains, and lean protein is important to reduce the risk of CVD. An unhealthy diet is linked to a 64 percent rise in cardiometabolic deaths in individuals aged 25–34, particularly from processed foods, meat, and excessive sugar-sweetened beverages. Poor dietary patterns increase proinflammatory markers in early childhood, enhancing long-term cardiometabolic risks. Consumption of processed meats, rye, potatoes, and butter are associated with higher levels of total and low-density lipoprotein cholesterol (LDL-C), apolipoprotein-B, and C-reactive protein all leading to inflammation. Conversely, adherence to a healthy diet such as the Mediterranean diet reduces the BMI and improves the blood glucose levels as well as the blood pressure. The DASH diet reduces the risk of prediabetes by 65 percent in young adults.

A healthy diet rich in fruits, vegetables, whole grains, and lean protein is important to reduce the risk of CVD. An unhealthy diet is linked to a 64 percent rise in cardiometabolic deaths in individuals aged 25–34, particularly from processed foods, meat, and excessive sugar-sweetened beverages. Poor dietary patterns increase proinflammatory markers in early childhood, enhancing long-term cardiometabolic risks. Consumption of processed meats, rye, potatoes, and butter are associated with higher levels of total and low-density lipoprotein cholesterol (LDL-C), apolipoprotein-B, and C-reactive protein all leading to

Example Techniques to Relieve Stress

• Mindfulness and Meditation

• Regular Exercise

• Healthy Diet

• Social Support

• Sleep Hygiene

A healthy diet rich in fruits, vegetables, whole grains, and lean protein is important to reduce the risk of CVD. An unhealthy diet is linked to a 64 percent rise in cardiometabolic deaths in individuals aged 25–34, particularly from processed foods, meat, and excessive sugar-sweetened beverages. Poor dietary patterns increase proinflammatory markers in early childhood, enhancing long-term cardiometabolic risks. Consumption of processed meats, rye, potatoes, and butter are associated with higher levels of total and low-density lipoprotein cholesterol (LDL-C), apolipoprotein-B, and C-reactive protein all leading to inflammation. Conversely, adherence to a healthy diet such as the Mediterranean diet reduces the BMI and improves the blood glucose levels as well as the blood pressure. The DASH diet reduces the risk of prediabetes by 65 percent in young adults.

• Time Management

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 a direct correlation between smoking and CVD independent of cholesterol levels. A yearly delay in the onset of smoking accounts for the reduction in cardiovascular risk by 4 percent [8]. Quitting smoking improves cardiovascular outcomes and reduces the risk of smoking-related deaths.

Moderate alcohol consumption increases levels of high-density lipoprotein (HDL) cholesterol. However, excessive drinking poses increased health risks and higher rates of hypertension and cardiomyopathy.

Non-modifiable risk factors cannot be changed, yet they significantly influence health management and prevention strategies. These include genetics, age, gender, family history, and ethnicity. A positive family history of CVD increases the individual risk for CVD. Genetic predisposition can influence cholesterol levels, blood pressure, and other cardiovascular health indicators. As age progresses the arteries become stiffer and the risk of CVD increases. Men generally have a higher risk of developing CVD at a younger age, whereas women's risk increases significantly after

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.

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.

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.

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.

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.

Apps and Wearable Technology can improve awareness and motivation to adopt and maintain

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.

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.

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

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

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

The Physicians’ Voice in Politics

JOIN PAMPAC HERE: www.PAMPAC.org

Medical Political Action Committee

By HannahDo, MD

Retirement Spotlight: Conversation with a Mentor

By Hannah Do, MD

in diagnosis, treatment, and long-term care. One cannot forget the thrill of endoscopic procedures that frequently improve a patient’s quality of life and may save a life. The least satisfying aspect is the snail’s pace of embracing new programs of patient care, high cost of medications, insurers with their foot on the break.

Dr. Do is a gastroenterologist in Central Bucks County interviewedRobert Hale,MD, whom she wrote “is a gastroenterologist with over 50 years of experiencepracticingin Bucks County. He retired at the age of 80 and isstill provide insightson what ittakes to build a rewardingcareer.”

Dr. Do is a gastroenterologist in Central Bucks County. She interviewedRobert Hale,MD, whom she wrote “is a gastroenterologist with over 50 years of experiencepracticingin Bucks County. He retired at the age of 80 and isstill excited to provide insightson what ittakes to build a rewardingcareer.”

Dr. Do is a gastroenterologist in Central Bucks County. She interviewed Robert Hale, MD, whom she wrote “is a gastroenterologist with over 50 years of experience practicing in Bucks County. He retired at the age of 80 and is still excited to provided insights on what it takes to build a rewarding career.”

Q: What drives a patient physician relationship?

A: Face to face time, listening and staying in contact with the patient and family.

in diagnosis, treatment, and long-term care. One cannot forget the thrill of endoscopic procedures that frequently improve a patient’s quality of life and may save a life. The least satisfying aspect is the snail’s pace of embracing new programs of patient care, high cost of medications, insurers with their foot on the break.

Q:How did you become interested in gastroenterology?

Q: How has the landscape of healthcare changed?

Q: What drives a patient physician relationship?

Q:How did you become interested in gastroenterology?

By Hannah Do, MD

Dr. Do is a gastroenterologist in Central Bucks County. She interviewed Robert Hale, MD, whom she wrote “is a gastroenterologist with over 50 years of experience practicing in Bucks County. He retired at the age of 80 and is still excited to provide insights on what it takes to build a rewarding career.”

Dr. Do is a gastroenterologist in Central Bucks County. She interviewed Robert Hale, MD, whom she wrote “is a gastroenterologist with over 50 years of experience practicing Bucks County. He retired at the age of 80 and is still excited provide insights on what it takes to build a rewarding career.”

A: Face to face time, listening and staying in contact with the patient and family.

Q: How did you become interested in gastroenterology?

Dr. Do is a gastroenterologist in Central Bucks County. She interviewed Robert Hale, MD, whom she wrote “is a gastroenterologist with over 50 years of experience practicing in Bucks County. He retired at the age of 80 and is still excited to provided insights on what it takes to build a rewarding career.”

Q: How has the landscape of healthcare changed?

Q: How did you become interested in gastroenterology?

A: In my sophomore year, I met a GI Doc who was fresh out of fellowship and had just opened a practice. Over the next 6 years he acted as my mentor. His primary interest was fiberoptic endoscopy. I was fascinated and hooked on GI endoscopy. The introduction of fiber optics and later electronic platforms opened new avenues of diagnostic possibilities and treatments for GI disorders.

A: Inmy sophomore year, I met a GI Doc who was fresh outof fellowship and had just opened a practice.Over the next 6years he acted asmy mentor. His primary interest was fiberoptic endoscopy. was fascinated and hooked on GIendoscopy. The introduction of fiber opticsandlater electronic platformsopened new avenues of diagnostic possibilitiesand treatments for GIdisorders.

Q: How did you become interested in gastroenterology?

Q: What experiencescontributed to your success inthepracticeof medicine?

A: Inmy sophomore year, I met a GI Doc who was fresh outof fellowship and had just opened practice.Over the next 6years he acted asmy mentor. His primary interest was fiberoptic was fascinated and hooked on GIendoscopy. The introduction of fiber opticsandlater electronic platformsopened new avenues of diagnostic possibilitiesand treatments for GIdisorders.

Q: What experiencescontributed to your success inthepracticeof medicine?

A: In my sophomore year, I met a GI Doc who was fresh out of fellowship and had just opened a practice. Over the next 6 years he acted as my mentor. His primary interest was fiberoptic endoscopy. I was fascinated and hooked on GI endoscopy. The introduction of fiber optics and later electronic platforms opened new avenues of diagnostic possibilities and treatments for GI disorders.

Q: What experiences contributed to your success in the practice of medicine?

A: Everyday there seems to be something new to be explored, a new disease to be identified, and new treatment programs. Our patient population is aging, old diseases are changing and new ones are appearing. Endoscopy has undergone revolutionary changes and has added major advantages to diagnosis and treatment, allowing us to evaluate long-term success of our treatment. Physician education has improved. Unfortunately, tasks outside of patient care take up to one third of a physician’s time. Development of new, effective and safe GI drugs has saved countless lives. When I started, I was the only GI endoscopist in our community. We now have 11 docs and still it is hard to get an appointment!

A: In my sophomore year, I met a GI Doc who was fresh out of fellowship and had just opened practice. Over the next 6 years he acted as my mentor. His primary interest was fiberoptic endoscopy. was fascinated and hooked on GI endoscopy. The introduction of fiber optics and later electronic platforms opened new avenues of diagnostic possibilities and treatments for GI disorders.

A: Iwas fortunate to have peers who were well educated, demanding, and dedicated to quality care. Interaction with administrators, educating them on the value of gastroenterology, and learning good business practiceswere extremely important.

Q: Whatis the mostand least satisfying aspect of GI?

A: I was fortunate to have peers who were well educated, demanding, and dedicated to quality care. Interaction with administrators, educating them on the value of gastroenterology, and learning good business practices were extremely important.

Q: What experiences contributed to your success in the practice of medicine?

A: Everyday there seems to be something new to be explored, a new disease to be identified, and new treatment programs. Our patient population is aging, old diseases are changing and new ones are appearing. Endoscopy has undergone revolutionary changes and has added major advantages to diagnosis and treatment, allowing us to evaluate long-term success of our treatment. Physician education has improved. Unfortunately, tasks outside of patient care take up to one third of a physician’s time. Development of new, effective and safe GI drugs has saved countless lives. When I started, I was the only GI endoscopist in our community. We now have 11 docs and still it is hard to get an appointment!

A: Iwas fortunate to have peers who were well educated, demanding, and dedicated to quality Interaction with administrators, educating them on the value of gastroenterology, and learning business practiceswere extremely important.

Q: What pearl of advice would you pass on to younger physicians?

A: I was fortunate to have peers who were well educated, demanding, and dedicated to quality Interaction with administrators, educating them on the value of gastroenterology, and learning business practices were extremely important.

Q: What is the most and least satisfying aspect of GI?

Q: Whatis the mostand least satisfying aspect of GI?

A: The most satisfying is the spectrumof patient care as it has progressed. Particularly in Inflammatory Bowel Disease, there have been giant steps forward in diagnosis, treatment, and long-term care. One cannot forget the thrill of endoscopic proceduresthatfrequently improve a patient's qualityof life and may save a life.The least satisfying aspect is thesnail’space of embracing new programsof patient care, highcost of medications, insurers with their footon the break.

A: I was fortunate to have peers who were well educated, demanding, and dedicated to quality care. Interaction with administrators, educating them on the value of gastroenterology, and learning good business practices were extremely important.

Q: What pearl of advice would you pass on to younger physicians?

Q: What is the most and least satisfying aspect of GI?

A: The most satisfying is the spectrum of patient care as it has progressed. Particularly in Inflammatory Bowel Disease, there have been giant steps forward

Q: What is the most and least satisfying aspect of GI?

Q: What drives a patientphysician relationship?

A: The most satisfying is the spectrum of patient care as it has progressed. Particularly in Inflammatory Bowel Disease, there have been giant steps forward in diagnosis, treatment, and long-term care. One cannot forget the thrill of endoscopic procedures that frequently improve a patient's quality of life and may save a life. The least satisfying aspect is the snail’s pace of embracing new programs of patient care, high cost of medications, insurers with their foot on the break.

A: Face to face time, listening and staying in contactwith the patient and family.

A: The most satisfying is the spectrum of patient care as it has progressed. Particularly in Inflammatory Bowel Disease, there have been giant steps forward

Q: What drives a patient physician relationship?

A: Be a driver not always a passenger. It is important for young physicians to get involved in administrative, business, and community programs to help grow your practice. Good quality education is available. Stay in touch with your peers, go to meetings, and enjoy what you have chosen to do as a career. Remember your family, they must come first. Overall, I would rate medicine to be one of the top professions; I would do it all over again.

A: Be a driver not always a passenger. It is important for young physicians to get involved in administrative, business, and community programs to help grow your practice. Good quality education is available. Stay in touch with your peers, go to meetings, and enjoy what you have chosen to do as a career. Remember your family, they must come first. Overall, I would rate medicine to be one of the top professions; I would do it

A: The most satisfying is the spectrumof patient care as it has progressed. Particularly in Bowel Disease, there have been giant steps forward in diagnosis, treatment, and long-term cannot forget the thrill of endoscopic proceduresthatfrequently improve a patient's qualityof may save a life.The least satisfying aspect is thesnail’space of embracing new programsof highcost of medications, insurers with their footon the break

A: Face to face time, listening and staying in contact with the patient and

A: The most satisfying is the spectrum of patient care as it has progressed. Particularly in Inflammatory Bowel Disease, there have been giant steps forward in diagnosis, treatment, and long-term care. cannot forget the thrill of endoscopic procedures that frequently improve a patient's quality of may save a life. The least satisfying aspect is the snail’s pace of embracing new programs of patient high cost of

Q: How has thelandscapeof healthcare

Q: What drives a patientphysician relationship?

Q: How has the landscape

Q: What drives a patient physician relationship?

A: Face to face time, listening and staying in contactwith the patient and family.

A: Face to face time, listening and staying in contact with the patient and family.

Q: How has thelandscapeof healthcare

Q: How has the landscape

A: Everydaythere seems to be something new to be explored, a new disease tobe identified, and new treatment programs. Our patient population is aging,old diseases are changing and newones are appearing. Endoscopy hasundergone revolutionary changes and has addedmajor advantagesto diagnosis and termsuccess of ourtreatment. Physician education has improved uptoone third of a physician’s saved countless lives. When I started, I was theonly GI endoscopist inour community. We now have11 docs and still it is hard to get an appointment!

Q: What pearl

A: Everyday there seems to be something new to be explored, a new disease to be identified, and new treatment programs. Our patient population is aging, old diseases are changing and new ones are appearing. Endoscopy has undergone revolutionary changes and has added major advantages to diagnosis Physician education has improved up to one third of a physician saved countless lives. When I started, I was the only GI endoscopist in our community. We now have 11 docs and still it is hard to get an appointment!

A: Everyday there seems to be something new to be explored, a new disease to be identified, treatment programs. Our patient population is aging, old diseases are changing and new ones appearing. Endoscopy has undergone revolutionary changes and has added major advantages diagnosis term success of our treatment. Physician education has improved up to one third of a physician saved countless lives. W started, I was the only GI endoscopist in our community. We now have 11 docs and still it is hard an appointment!

A: Everydaythere seems to be something new to be explored, a new disease tobe identified, treatment programs. Our patient population is aging,old diseases are changing and newones appearing. Endoscopy hasundergone revolutionary changes and has addedmajor advantagesto diagnosis and termsuccess of ourtreatment. Physician education has improved uptoone third physician’s time. saved countless lives. started, I was theonly GI endoscopist inour community. We now have11 docs and still it an appointment!

A: Be a driver not always a passenger. It is important for young physicians to get involved in administrative, business oodquality education is available. and enjoywhatyouhave chosen to do as career. Remember your family, I would ratemedicine to be one of thetop

A: Be a driver not always a passenger. It is important for young physicians to get involved in administrative, business ood quality education is available. and enjoy what you have chosen to do as a career. I would rate medicine to be one of the top professions; I would do it all over again.

Curb to Needle Time: Innovative Stroke Care in your Driveway

By Gerald Wydro, MD and Alvin Wang, DO

allergies, and a rapid CT scan of the brain. Then, the patient undergoes a telemedicine evaluation with a stroke neurologist from Jefferson Hospital for Neuroscience.

Dr. Wydro is Chairman, Department of Emergency Medicine, Jeﬀerson Health Northeast; Regional Medical Director, Bucks County Emergency Health Services Wang is Chief, Division of EMS, Jeﬀerson Health Northeast; Regional Medical Director, Montgomery County Emergency Medical Services

Dr. Wydro is Chairman, Department of Emergency Medicine, Jefferson Health Northeast; Regional Medical Director, Bucks County Emergency Health Services. Dr. Wang is Chief, Division of EMS, Jefferson Health Northeast; Regional Medical Director, Montgomery County Emergency Medical Services.

Dr. Wydro is Chairman, Department of Emergency Medicine, Jeﬀerson Health Northeast; Regional Medical Director, Bucks County Emergency Health Services Wang is Chief, Division of EMS, Jeﬀerson Health Northeast; Regional Medical Director, Montgomery County Emergency Medical Services

The patient develops weakness in their left arm and leg while at work. Rapidly, a CT scan is performed and there is a decision to administer thrombolytic therapy for a suspected stroke. Happens every day, right? What if we told you this happened in the parking lot of the patient’s oﬃce

The patient develops weakness in their left arm and leg while at work. Rapidly, a CT scan is performed and there is a decision to administer thrombolytic therapy for a suspected stroke. Happens every day, right? What if we told you this happened in the parking lot of the patient’s oﬃce?

The patient develops weakness in their left arm and leg while at work. Rapidly, a CT scan is performed and there is a decision to administer thrombolytic therapy for a suspected stroke. Happens every day, right? What if we told you this happened in the parking lot of the patient’s office?

The Bensalem EMS / Jefferson Health Mobile Stroke Unit (MSU) is one of 20 such programs in the United and highly sophisticated unit responds to suspected stroke calls in a large catchment area of Lower Bucks County. The unit is a cooperative between Bensalem EMS, Jefferson Health, and JeffStat Critical Care Transport. The MSU is in service 60 hours per week during peak volume

The CT images are quickly reviewed by a radiologist and the MSU team and neurologist are notified of the findings. In cases in which the patient is eligible for thrombolytic therapy, the MSU team will administer TNKase. The MSU team can provide intravenous antihypertensive medications when blood pressure must be managed prior to TNKase. In the rare instance of a hemorrhagic stroke, the MSU crew can administer reversal agents for those patients on anticoagulation. The patient is transported to a stroke center for definitive care.

the Bucks County Emergency Communications Center dispatcher suspects that an incoming call stroke based on Emergency Medical Dispatch criteria, the MSU is dispatched in addition to ambulance to assure rapid response. The MSU is staffed by an EMT/Driver, Paramedic, Critical Care Transport Nurse, and CT Technician. Remotely board-certified neuroscience physicians and radiologists collaborate in real-time with the MSU field crew

the Bucks County Emergency Communications Center dispatcher suspects that an incoming call stroke based on Emergency Medical Dispatch criteria, the MSU is dispatched in addition to ambulance to assure rapid response The MSU is staffed by an EMT/Driver, Paramedic, Critical Care Transport Nurse, and CT Technician. Remotely board-certified neuroscience physicians and radiologists collaborate in real-time with the MSU field crew

The Bensalem EMS / Jefferson Health Mobile Stroke Unit (MSU) is one of 20 such programs in the United States. This innovative and highly sophisticated unit responds to suspected stroke calls in a large catchment area of Lower Bucks County. The unit is a cooperative between Bensalem EMS, Jefferson Health, and JeffStat Critical Care Transport. The MSU is in service 60 hours per week during peak volume times.

When the Bucks County Emergency Communications Center dispatcher suspects that an incoming call indicates a stroke based on Emergency Medical Dispatch criteria, the MSU is dispatched in addition to the closest 911 ambulance to assure rapid response. The MSU is staffed by an EMT/Driver, Paramedic, Critical Care Transport Nurse, and CT Technician. Remotely boardcertified neuroscience physicians and radiologists collaborate in real-time with the MSU field crew.

After arrival at the scene, the patient undergoes an initial assessment. If the patient is determined to meet MSU treatment algorithm inclusion criteria, the MSU team obtains vital signs, blood glucose, INR testing, NIH Stroke Assessment, detailed patient history, medications, allergies, and a rapid CT scan of the brain. Then, the patient undergoes a telemedicine evaluation with a stroke neurologist from Jefferson Hospital for Neuroscience. The CT images are quickly reviewed by a radiologist and the MSU team and neurologist are notified of the findings. In cases in which the patient is eligible for thrombolytic therapy, the MSU team will administer TNKase. The MSU team can provide intravenous antihypertensive medications when blood pressure must be managed prior to TNKase. In the rare instance of a hemorrhagic stroke, the MSU crew can administer reversal agents for those patients on anticoagulation The patient is transported to a stroke center for definitive care.

Since starting over 5 years ago, the MSU has responded to more than 1800 stroke dispatches, providing care for over 700 patients, with over 12% having received treatment with thrombolytic therapy in the prehospital setting. The average “curb” (arrival at scene) to CT time is 9 minutes, and the average “curb” 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 a Thrombectomy Capable Stroke Center.

After arrival at the scene, the patient undergoes an initial assessment. If the patient is determined to meet MSU treatment algorithm inclusion criteria, the MSU team obtains vital signs, blood glucose, INR testing, NIH Stroke Assessment, detailed patient history, medications, allergies, and a rapid CT scan of the brain. Then, the patient undergoes a telemedicine evaluation with a stroke neurologist from Jefferson Hospital for Neuroscience. The CT images are quickly reviewed by a radiologist and the MSU team and neurologist are notified of the findings. In cases in which the patient is eligible for thrombolytic therapy, the MSU team will administer TNKase. The MSU team can provide intravenous antihypertensive medications when blood pressure must be managed prior to TNKase. In the rare instance of a hemorrhagic stroke, the MSU crew can administer reversal agents for those patients on anticoagulation. The patient is transported to a stroke center for definitive care.

Since starting over 5 years ago, the MSU has responded to dispatches care for over 700 patients with over 12% having received treatment with thrombolytic therapy in the prehospital setting. The (arrival at scene and the average to needle (TNKase infusion) These times are exemplary, especially compared to traditional door to needle times in the hospital setting. All patients are transported to a Thrombectomy Capable Stroke Center.

After arrival at the scene, the patient undergoes an initial assessment. If the patient is determined to meet MSU treatment algorithm inclusion criteria, the MSU team obtains vital signs, blood glucose, INR testing, NIH Stroke Assessment, detailed patient history, medications,

Since starting over 5 years ago, the MSU has responded to dispatches care for over 700 patients with over 12% having received treatment with thrombolytic therapy in the prehospital setting. The (arrival at scene and the average to needle (TNKase infusion)

These times are exemplary, especially compared to traditional door to needle times in the hospital setting. All patients are transported to a Thrombectomy Capable Stroke Center.

The Bensalem EMS / Jefferson Health Mobile Stroke Unit is on the cutting edge of medicine by offering 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 the care team directly to the patient. The MSU program demonstrates the benefits of wellintegrated collaboration between 911 dispatch centers, local EMS, and hospitals to innovate care by enhancing prehospital medical access, assessment, evaluation, and treatment.

The Bensalem EMS / Jefferson Health Mobile Stroke Unit is on the cutting edge of medicine by offering 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

Bucks County’s History: Indigenous Lenape

Bucks County’s History: Indigenous Lenape Tribe, Penn’s Settlement, and Conﬂicting Views

Bucks County’s History: Indigenous Lenape Tribe, Penn’s Settlement, and Conflicting Views of the Land

By David Levin, DO

of the Land

By David Levin, DO

Dr. Levin is a radiologist in Upper

By David Levin, DO

Dr.

Levin

is a

radiologist in Upper Bucks County

Bucks County is home of some of the most beautiful land in Pennsylvania and in the United States. With its numerous health care and educational institutions and miles of trails, Bucks is the fourth most populous county in the Commonwealth.

of friendship and goodwill toward the Lenape people. Although he “owned” the land, he reserved and protected certain regions for the Lenape.

Bucks County

Dr. Levin is a

radiologist

Bucks County is home of some of the most beautiful land in Pennsylvania and in the United States. With its numerous health care and educational institutions and miles of trails, Bucks is the fourth most populous county in the Commonwealth

The most documented and well-known history of the area is that of 17th century European settlers who came to Pennsylvania. However, for thousands of years prior to their arrival, much of the land we know as New Jersey, New York and eastern Pennsylvania – including Bucks County – was inhabited by the Lenape people.

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, the Lenape felt cheated out of valuable land along the Delaware. Over the next couple of centuries, the Lenape were pushed out of Pennsylvania – one of only a few eastern states today that has no federally recognized Lenape tribes. As recently as 2004, the Lenape unsuccessfully sued Pennsylvania to regain use of some of the land. Meanwhile, Lenape communities do survive today in New Jersey and parts of the Midwest.

Bucks County is home of some of the most its numerous health care and educational populous county in the Commonwealth

The most documented and well-known history of the area is that of 17th century European settlers who came to Pennsylvania. However, for thousands of years prior to their arrival, much of the land we know as New Jersey, New York and eastern Pennsylvania – including Bucks County – was inhabited by the Lenape people.

Human rights, Health, and the Lenape

The most documented and well-known came to Pennsylvania. However, for thousands as New Jersey, New York and eastern Pennsylvania Lenape people.

The tribe was also known as “Delaware” after the English governor of the colony of Virginia, Lord de la Warr III. The land was primeval forest with many Lenape campsites, villages and trails – many of which are used today as streets.

The Lenape Tribe: Life and land

The Lenape tribes have been in Pennsylvania for millennia; artifacts from settlements as far back as 6,000 years have recently been discovered.

Indigenous peoples around the world, including the Lenape and other American Indian nations, believe that human health is connected to the health of the earth and the land. This belief contrasts with Euro-American ideas of health and human rights. Some scholars who aim to preserve the Lenape history think reconsidering a health and human rights approach that connects our health to that of the land could be a way to lessen some of the potential harm of climate change to our health. Perhaps, a reimagined approach would also be a way to honor the mindset and lifestyle of native Lenape, too.

The tribe was also known as “Delaware” Warr III. The land was primeval forest with are used today as streets.

The Lenape Tribe: Life and land

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 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 6,000 years have recently been discovered.

Penn’s “Ownership” of Bucks County

In 1682, King Charles II of England granted the land encompassing current Bucks County to William Penn as payment for a debt. Penn practiced Quaker principles

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 health of the land, but the Lenape did not believe people could own land.

Penn’s “Ownership” of Bucks County

The Lenape Tribe: Life and land

The Lenape tribes have been in Pennsylvania 6,000 years have recently been discovered.

In 1682, King Charles II of England granted the land encompassing current Bucks County to William Penn as payment for a debt. Penn practiced Quaker principles of friendship and goodwill toward the Lenape people. Although he “owned” the land, he reserved and protected certain regions for the Lenape.

The Lenape were nomadic people who

Bucks County Medical Society’s Voice Was Heard at the PAMED House of Delegates

Bucks CMS Legislative Reception: An Opportunity to Strengthen Relationships

Bucks County Medical Society’s Voice Was Heard at the PAMED House of Delegates

During the 2024 PAMED Annual Meeting and House of Delegates this past October, the Bucks CMS delegation actively engaged in developing policy to guide PAMED advocacy. The delegation successfully advanced amendments that emphasize the importance of physician-led team-based care, delineate patient and physician practice safeguards if insurers use algorithms and AI in utilization management, underscore PAMED’s focus on public health, and advocate for meaningful implementation of recently enacted step therapy reforms. Delegates also joined with friends and colleagues, welcomed visiting state medical association presidents, and supported PAMPAC and the PAMED Foundation.

Bucks County Medical Society’s Voice Was Heard at the PAMED House of Delegates

Bucks CMS Legislative Reception: An Opportunity to Strengthen Relationships

During the 2024 PAMED Annual Meeting and House of Delegates this past October, the Bucks CMS delegation actively engaged in developing policy to guide PAMED advocacy. The delegation successfully advanced amendments that emphasize the importance of physician-led team-based care, delineate patient and physician practice safeguards if insurers use algorithms and AI in utilization management, underscore PAMED’s focus on public health, and advocate for meaningful implementation of recently enacted step therapy reforms. Delegates also joined with friends and colleagues, welcomed visiting state medical association presidents, and supported PAMPAC and the PAMED Foundation.

Bucks CMS was represented by: (on site) J. Matthew Bohning, MD; John Gallagher, MD; Marilyn Heine, MD (Delegation Secretary); Marion Mass, MD; and John Pagan, MD, MBA; (remote) Daniel Latta, MD; Kathy Tran Gast, MD; Richard Leshner, DO; and Judith Gallagher Braun, MD. Other Bucks CMS members at the House were Hannah Do, MD (Women Physicians Section); Bindu Kansupada, MD (International Medical Graduate Section); and Barry Snyder, MD (Specialty Society).

During the 2024 PAMED Annual Meeting and House of Delegates this past October, the Bucks CMS delegation actively engaged in developing policy to guide PAMED advocacy. The delegation successfully advanced amendments that emphasize the importance of physician-led team-based care, delineate patient and physician practice safeguards if insurers use algorithms and AI in utilization management, underscore PAMED’s focus on public health, and advocate for meaningful implementation of recently enacted step therapy reforms. Delegates also joined with friends and colleagues, welcomed visiting state medical association presidents, and supported PAMPAC and the PAMED Foundation.

Bucks CMS was represented by: (on site) J. Matthew Bohning, MD; John Gallagher, MD; Marilyn Heine, MD (Delegation Secretary); Marion Mass, MD; and John Pagan, MD, MBA; (remote) Daniel Latta, MD; Kathy Tran Gast, MD; Richard Leshner, DO; and Judith Gallagher Braun, MD. Other Bucks CMS members at the House were Hannah Do, MD (Women Physicians Section); Bindu Kansupada, MD (International Medical Graduate Section); and Barry Snyder, MD (Specialty Society).

Several members of Bucks County’s state legislative delegation and staff attended a Bucks CMS Legislative Reception in September where topics of discussion included the importance of physician-led team-based care to ensure patient safety, a meaningful remedy to noncompetes, and mental health care access. The event was a great opportunity to strengthen relationships between physicians and our state legislators and their staff.

Bucks CMS was represented by: (on site) J. Matthew Bohning, MD; John Gallagher, MD; Marilyn Heine, MD (Delegation Secretary); Marion Mass, MD; and John Pagan, MD, MBA; (remote) Daniel Latta, MD; Kathy Tran Gast, MD; Richard Leshner, DO; and Judith Gallagher Braun, MD. Other Bucks CMS members at the House were Hannah Do, MD (Women Physicians Section); Bindu Kansupada, MD (International Medical Graduate Section); and Barry Snyder, MD (Specialty Society).

Physicians Leaders Participated in Meeting with Congressman Fitzpatrick

at our Legislative Reception.

Physicians Leaders Participated in Meeting with Congressman Fitzpatrick

Bucks CMS Members Meet with Local State Legislators

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