BCMS Medical Record Fall 2023

Your Community Resource for What’s Happening in Healthcare

FALL 2023

Medical record BERKS COUNTY MEDICAL SOCIETY

EDUCATION/RESEARCH EDITION

INSIDE:

The Future of GME in Expanding and Improving Healthcare

by Wei Du, MD 2023 Pat Sharma President’s Scholarship Recipients Lily Palmer and Sophia Emkey Reading Hospital Student Summer Research Abstracts

Contents

Medical record BERKS COUNTY MEDICAL SOCIETY

A Quarterly Publication

To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.

Features

FALL 2023

32

Berks County Medical Society MEDICAL RECORD

Guest Editorial: The Future of GME in Expanding and Improving Health Care

D. Michael Baxter, MD, Editor

Editorial Board

D. Michael Baxter, MD Lucy J. Cairns, MD Daniel Forman, DO

4

Berks County Medical Society “1824 Club”

18 Celebrating a Decade of the BCMS Student Internship Program

William Santoro, MD, FASAM, DABAM

8

Community Health Checkup: A Conversation on the Commissioners’ Health Study

Raymond Truex, MD, FACS, FAANS

19 Student Summer Research Projects

T.j. Huckleberry, MPA

Berks County Medical Society Officers William Santoro, MD, FASAM, DABAM President Ankit Shah, MD President Elect Daniel Forman, DO Treasurer Jillian Ventuzelo, DO Immediate Past President T. J. Huckleberry, MPA Executive Director

Berks County Medical Society 2669 Shillington Rd,, Suite 501 Sinking Spring, PA 19608 (610) 375-6555 (610) 375-6535 (FAX) Email: info@berkscms.org www.berkscms.org

10 A Passion for Photography – Ivan Bub, MD 14 Oncology update: More effective treatments, personalized medicine, and immunotherapy 16 Welcome New Member Michael C. Izzo, MD

Berks County Medical Society BECOME A MEMBER TODAY! Go to our website at www.berkscms.org and click on “Join Now”

32 Guest Editorial: The Future of GME in Expanding and Improving Health Care 34 BCMS Night at the Reading Fightin’ Phils

Shannon Foster, MD Steph Lee, MD, MPH

In Every Issue 3

President’s Message

5

Compass Points

6

Editor’s Notes

12 Resident Rounds 17 Student Vital Signs

The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society.

Manuscripts offered for publication and other correspondence should be sent to 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. The editorial board reserves the right to reject and/or alter submitted material before publication.

The Berks County Medical Record (ISSN #0736-7333) is published four times a year by the Berks County Medical Society, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. Subscription $50.00 per year.

Periodicals postage paid at Reading, PA, and at additional mailing offices.

Content Submission: Medical Record magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Berks County Medical Society. Submissions can be photo(s), opinion piece or article.

Typed manuscripts should be submitted as Word documents (8.5 x 11) and photos should be high resolution (300dpi at 100% size used in publication). Email your submission to info@berkscms.org for review by the Editorial Board. Thank YOU!

POSTMASTER: Please send address changes to the Berks County Medical Record, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501.

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President’s Message

Dear BCMS Member, William Santoro, MD FASAM, DABAM Chief, Section of Addiction Medicine, Reading Hospital/ Tower Health President

C

lubs. We all belong to them. It started when we were children. Some of us belonged to secret clubs. When I was in the first grade, I belonged to a club which met after school and on weekends with my brothers and a few neighborhood friends. We had a clubhouse (otherwise

known as a treehouse) and, of course, held meetings. Because it was a secret club, I was sworn by a blood covenant not to reveal anything further.

As we grew up, we joined less secretive clubs that accomplished more. My sister belonged to the Brownies and then the Girl Scouts. My brothers and I belonged to the Boy Scouts. I belonged to the “Drama Club” in high school as well as the “Chess Club.” In college I belonged to the “Skull & Bones Club” along with all the other pre-med students.

Let me introduce you to the latest club of which I am a member. It is the “1824 Club.” It was 1824 when several local Berks County physicians got together in a physician’s home and started the Berks County Medical Society. In honor of the 200th anniversary of its founding, we at BCMS decided to start this club.

We, the “1824 Club” members, will be holding small events regularly over the next year. Invitations will be to groups of members and non-members of BCMS. A physician can also request an invitation for a specific “1824 Club” event if one was not received. Spouses will always be welcome and, whenever appropriate, we will extend the invitation to include children. We want these club meetings to be very family oriented.

The first event was a nature walk/ice cream social. A group of us met and went on a nature walk led by Lucy Cairns, MD. Binoculars were made available as we walked through the Wyomissing Park system and had Lucy point out interesting facts and birds. The walk ended with an ice cream party.

Minutes of the meeting were not documented, but I assure you a good time was had by all, and if enjoyment and relaxation were the measures, a lot was accomplished.

I hope to see other faces, BCMS members and non-members, spouses, and children at future 1824 Club meetings throughout the upcoming year where we can enjoy each other’s company and expand the club membership. Come for the fun and stay for the collegiality.

FALL 2023 | 3

M e d i c a l R e c o r d F e at u r e

Berks County Medical Society

“1824 Club”

The Inaugural event of the Berks County Medical Society “1824 Club” was held on October 8th in the Wyomissing Park. Led by expert “birder” and Past BCMS President Lucy Cairns, a group gathered at the home of BCMS President Bill Santoro for a “birdwatch” walk through the park. After the excursion the afternoon finished off with an ice cream party at Bill’s house. A great time was had by all.

Watch for future “1824 Club” events ahead.

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C o mpa s s P o i n t s

1824 to

2024

T.J. Huckleberry, MPA Executive Director

O

n a warm Saturday evening on August 7, 1824, the founding physicians of our Medical Society met to form what was then called The Medical Faculty of Berks County. They hitched their wagons and horses and walked into the Public House at 5th and Penn Streets. Their agenda was focused on approving by-laws, appointing leadership, and a standing committee of nine physicians, creating mechanisms for recruitment and retention, and then establishing a monthly reporting process for diseases and deaths throughout Berks County.

It was noted that the chief concern among physicians was the growing smallpox outbreaks in their communities and the physicians’ “undiminished confidence in the vaccination.” It was expressed in Dr. Heister’s Presidential Address that “our institution which is the first of the kind in Pennsylvania, outside of the College of Physicians and Medical Society of Philadelphia, is organized.”

It is unknown if anyone in that room would have ever thought that what was accomplished that evening would be celebrated 200 years later. What is also unknown is what or who served as the catalyst to create such a unique and innovative society. What we do know are

the benefits this new Society was about to bring to each of these new members and their community.

I imagine many months beforehand, in some darkened firelit dining room, Dr. Heister (our first President) and Dr. Baum (our first Secretary) spending several hours in discussion over their care of smallpox patients, or the potential of cholera in the drinking water, or the rumbles and rumors they picked up in passing from other physicians in far out places like Oley and Rehrersburg and Kutztown. They no doubt shared their frustrations over patients who remained in poor condition under their care, and shared suggestions over possible alternative methods.

Perhaps this was not the first or second time these two doctors met after their long days of caring for patients for a little professional discussion and some well-earned decompression time. And perhaps, this was not the only gathering in a physician’s home in Berks County as Dr. Eckert (our first Treasurer) and Dr. Schlemm (our first Vice-President) could have joined them for cards or dinner frequently. But at some point, all these doctors realized that there was power in these meetings and that there was value in sharing and collecting the expertise and findings of their fellow physicians.

In 1824, there were no hospitals in Berks County and the fastest way of mass communication was newspapers and the postal service. These physicians were subject to their location, they practiced where they lived, and their neighbors were their patients. The very idea of these country doctors traveling outside of their region of care to network with their colleagues was entirely ahead of its time.

They met in 1824, because their neighbors’ health and welfare were on their shoulders. They met because they knew medicine was a science and an art, and that neither of these institutions could truly flourish without being shared. They met because they respected each other and needed each other’s company.

Our Society, our County, and the practice of medicine have drastically changed since 1824, but the core reasons for the creation of this Society have not. BCMS has endured throughout history because above all we uphold these values while still adapting to the needs of the time.

As we enter our 200th year anniversary, I hope we will take time to meditate on how we were founded, how we have changed and how we still very much remain the same. It is certainly a time to celebrate and also to honor that great legacy which we inherit.

FALL 2023 | 5

Editor’s Notes

Fall

by D. Michael Baxter, MD

Fall scene at Antietam Lake Reservoir in the City of Reading, Pennsylvania

E

ven at my age, the return of Fall brings thoughts of returning to school. Whether my granddaughter entering second grade, a first-year medical student beginning their arduous but thrilling journey, or a newly minted resident settling into the exciting challenges of a chosen career, there is a sense of anticipatory excitement on the path to learning what lies ahead. Education is the foundation of growth, both personal and professional, and research is essential to the validity and integrity of that education.

It is thus fitting that we focus the Fall edition of the Medical Record on the research and educational topics performed by our summer student interns. We highlight two articles by our Berks County Medical Society Pat Sharma Scholars on the topics of: “Medications for Opioid Use Disorder in the Criminal Justice System: Berks County and Beyond” by Lily Palmer and “The Increase in Incidence of Melanoma” by Sophia Emkey. In addition, we also include several abstracts from research and clinical reviews developed by Reading Hospital summer interns. Most of these summer students are either pre-medical or medical students and all are dedicated to furthering the health of patients and improving our communities. We are very pleased to showcase their work and appreciate their efforts as well as the many mentors among our colleagues who assisted them in their work. We are also reminded of the important role of Graduate Medical Education in the health of

6 | www.berkscms.org

our nation as Wei Du, MD, Sr. Vice President for Academic Affairs, Reading Hospital/Tower Health, writes in his guest editorial “The Future of Graduate Medical Education in Improving and Expanding Health Care.”

This edition also continues our emphasis on exploring activities outside of medicine that excite and re-energize our members. Ivan Bub, MD, demonstrates his skill for specialized photography and how he shares this passion with students throughout Berks County.

We encourage other members to share their avocations with us in future editions of the Medical Record.

Finally, another comment regarding the 200th Anniversary of the Berks County Medical Society which is just ahead in 2024.

This is truly a remarkable commemoration. The Berks County Medical Society is certainly one of the oldest such Medical Societies in continuous existence in the United States, older even than the Philadelphia Medical Society, founded in 1849. During those 200 years, we have had a long tradition of members serving their country (Revolutionary, Civil and World Wars and more) as well as their profession, their community and of course their patients. We look forward to celebrating this historical year with stories, exhibits, presentations, and social gatherings and invite all our members and our community to join in for a fascinating, educational, and fun year ahead.

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M e d i c a l R e c o r d F e at u r e

Community Health Checkup: A Conversation on the Commissioners’ Health Study

by D. Michael Baxter, MD

I

n March of this year, a study requested by the Berks County Commissioners was released by the Health Care Consulting group, Health Managements Associates. “A study of the Delivery of Health and Public Health Services in Berks County” contained a wealth of demographic and public health data for Berks County. (This report was extensively reviewed in the Spring edition of the Medical Record).

As a follow up, the Berks County Medical Society (BCMS), in partnership with the Berks County Community Foundation, sponsored a “Community Health Checkup” event on Thursday, September 28th, at the Stonersville Social Club in eastern Berks County. Over 70 community members attended, including Berks County Commissioners, State Representative Mark Gillen, several BCMS physicians, and other interested community members. The focus of the event was on four panels, each addressing one of the four recommendations of the Study.

1. Create a Berks County Health Director position.

2. Develop a new Berks County Public Health Advisory Panel.

3. Support the establishment of a Healthy Berks Coalition.

4. Create a Berks County Health Analyst position.

I am hopeful and confident that we will come together and we will make sure we have a plan to navigate ahead into the next 10 years and face any challenges when we think about public health and the public health system.

Dr. Jill Hackman Executive Director Berks County Intermediate Unit

8 | www.berkscms.org

1988

PA#5744

Come Alive in

2023

into Having a local voice that really understands what is going on in the community is huge in health care.

Ankit Shah, MD Emergency Medicine Physician Reading Hospital/Tower Health BCMS Executive Director T.J. Huckleberry opened the event and members including Chuck Barbera, MD, Jamie Chmielowski, MD, and Debra Powell, MD, served as panel members sharing their experiences and views regarding the need to further address public health services in Berks County. While BCMS has called for the creation of a Berks County Health Department, the primary focus of this event was to educate the audience and promote implementation of the four recommendations. Video vignettes were shown which included quotes from health care professionals and others.

Berks County Commissioners’ Chairman, Christian Leinbach, also addressed the group with his thoughts on next steps.

There was a very positive consensus from the group that as a community we need to move forward with these recommendations to address our health care disparities and improve public health in Berks County. More events will follow and BCMS will remain in the forefront as a leader for better health for all.

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M e d i c a l R e c o r d F e at u r e

A Passion for Photography

Ivan Bub, MD D

r. Bub has been a Family Physician in Berks County for over 30 years and recently retired from his practice with the Tower Health Medical Group at the Gateway office.

Dr. Bub is a native of South Africa and graduated from Medical School at the University of Cape Town. He emigrated to the United States in 1986 and joined the Reading Hospital Family Medicine Residency Program which he completed in 1989. He then joined fellow South Africans, Drs. Don Karabelnik and Emanuel Wittels, in the Berks Family Practice group for many years until joining Tower Health in 2015.

Vitamin C, Ascorbic Acid – a bright red, orange and blue circular display

Dr. Bub’s wife, Paula, is a therapist in Psychiatry at Reading Hospital Behavioral Health. They have a daughter, Rebecca, who is also a Physician and in practice in Australia.

Dr. Bub has a long-standing interest in photography. In recent years he has explored a variety of forms of this art including photomicrography with polarized light. He currently teaches these techniques to students from across Berks County through a program with Albright College. Dr. Bub shares a few of his photographs with us in this issue.

We thank Dr. Bub for his dedication to Berks County patients and wish him well in his retirement!

Broadacid – appears as silver and gold pinwheels

Adipic Acid – appears like bells floating through the air

Butterfly, Macro Carsonia Park, Infrared Light painting study 1 – which shows an array of vegetables 10 | www.berkscms.org

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M edical R ecord F eature

Resident Rounds The Real Superheroes

B

atman. Superman. Hercules.

Wonder Woman. These are just a few of the names that come to mind when I think of superheroes.

But to me, superheroes look a little different. Superheroes are the physicians leading their departments, directing the operating room suites, and seeing patients in the clinic day in and day out.

As I started residency, I was fueled by the desire to care for patients and provide excellent medical care. Each day was filled with countless patients – each with a unique story and medical diagnosis. But the 80-hour work weeks were long, both daunting and exhausting. As January of intern year began, I found myself settling into the monotony of the patient encounters, as if I was rewinding and replaying each day over and over again. Then life hit the pause button – as I found out that I was pregnant with my son. A flood of emotions rushed over me – excitement for a healthy baby and a growing family, but also anxiety about how I would manage this new role while also providing the same care to my patients.

Would I really be able to balance it all?

The pregnancy was complicated.

Hyperemesis. Preterm labor. Severe preeclampsia. Cesarean section. Each complication felt like its own villain which I had to overcome. Hours of charting and operating were now exchanged for diaper changes and

12 | www.berkscms.org

by Hannah Thompson Herring, DO feeding times. This became our new normal as we adjusted to what our new life would look like.

Every superhero will have these moments where they are forced to remind themselves of their calling and purpose; an opportunity to remind themselves of who they care for and why they protect those around them. So, I too had to self-reflect and reevaluate my own motivations. As I returned to work, it would have been easy to settle again into the monotony of patient encounters and hours of charting. However, I now realized how important it was to shift my perspective to see things from my patient’s viewpoint. Now, I was finally able to fully appreciate and empathize with the anxieties and worries of my patients.

Because of this, these monotonous tasks were replaced with intentionality and purpose. It no longer became just about making the diagnosis, but about making sure that the patient felt heard and supported.

So, I have learned that it is more than a colorful cape and special superpower.

Our superpowers are different. They are about putting on our white coat, pulling up the chair, and being present with our patients.

Our superpower is crying alongside a family as they say goodbye to their child. It is visiting with patients in the ICU and supporting them as

they navigate a long and treacherous journey to recovery. Our superpower is celebrating responses to medical treatments and successful surgical outcomes. It is hearing patients say that they feel valued and heard.

Our superpower is teaching medical students to be compassionate and caring physicians. It is holding our patients as they find out that their baby no longer has a heartbeat. Our superpower is coming in on our days off to celebrate with patients as they are discharged after a long hospital stay.

It is celebrating with families as they deliver a child after a long history of infertility. It is encouraging patients to accomplish their goals. And our biggest superpower is empathy.

As Hercules once said, “A true hero is not measured by the size of their strength, but by the strength of their heart.” I have learned that for me, being a superhero is not really about what you know or what you can do, but truly about how much you care.

Dr. Thompson-Herring is a PGY-3 OB/GYN Resident, Reading Hospital/Tower Health.

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M edical R ecord F eature

Oncology update: More effective treatments, personalized medicine, and immunotherapy

by Daniel Forman, DO Medical Oncologist, McGlinn Cancer Center Reading Hospital/Tower Health

I

remember sitting in a lung cancer lecture during my fellowship 20 years ago at the Penn State Cancer Institute and being underwhelmed. The topic was entitled “Treatment of Non-Small Cell Lung Cancer (NSCLC),” the most common cause of cancer death worldwide, and the data supporting treatment at various stages was scant, and the outcomes were dismal. One trial presented supporting the use of chemotherapy and radiation for stage III NSCLC had only 101 enrolled patients. Another trial in stage IV disease that compared the four best chemotherapy regimens showed they were all equally bad with a median survival of 8 months; toxicities profiles were different but prevalent. Also, during that time, all patients with curable breast cancer were treated similarly; surgery followed by chemotherapy, radiation if they underwent breast conservation, then anti-estrogens if their cancer cells expressed the estrogen receptor (ER). Lastly, in the early 2000s, the median survival for metastatic melanoma was 9 months, and only 5 percent of patients survived five years.

What has changed in the last two decades is everything. In the example of lung cancer, we now recommend screening for lung cancer with annual CT scan for high-risk patients, and this has led to improved early detection and survival. We now have over 60 FDA-approved medications for NSCLC, many coming to the market during the last decade and are “non-chemotherapies.” These medications are better tolerated and much more effective. The treatment of early-stage breast cancer has changed significantly. Due to cancer genomic analysis, we are better able to predict who would benefit from adjuvant chemotherapy (i.e., treatment given before or after surgery to improve the chance for cure by “mopping up” rogue cancer cells), and most women with ER + cancer are now able to avoid

chemotherapy. We sometimes omit radiation for some women who undergo breast conservation, and we rarely perform axillary lymph node dissections. Melanoma, even when advanced, is no longer a death sentence. Patients with stage IV melanoma often live for years with the 5-year survival approaching 50%!

Imatinib was FDA approved for Chronic Myeloid Leukemia (CML) in 2001 and set the paradigm for small molecule targeted therapies. We learned in medical school that CML is caused by a reciprocal translocation of chromosomes 9 and 22, t(9;22) which leads to the fusion gene bcr-abl. This change in the cancer genome results in an abnormal receptor in the cell membrane that is stuck in the “on” position without being stimulated by an extracellular ligand.

Amazingly, one oral imatinib tablet daily shuts off this abnormal switch and virtually all patients have a normalization in their blood counts within weeks. This was a disease that was once a death sentence and only curable with an allogenic stem cell transplant, but now patients live a normal life span.

We have since learned that drugs that can target the bcr-abl malfunctioned receptor can also work in other cancers that express this protein, such as adult acute lymphoblastic leukemia. Furthermore, it has been recognized that drugs like imatinib can be profoundly effective for other cancers that express mutations similar to bcr-abl.

For example, imatinib and second-generation medications that target bcr-abl are profoundly effective at “shutting off” the KIT associated receptor found in a rare sarcoma categorized as Gastrointestinal Soft Tissue Sarcoma (GIST). So, in 2023 if a patient presents with a large mass near the stomach consistent with a GIST, our pathologist will test for “KIT,” and if positive, it confirms the diagnosis and suggests

Illustration of the ICI mechanism of action.

14 | www.berkscms.org

that we can use one of several drugs that were originally FDA approved for CML but have subsequently been proven to be very effective for this rare sarcoma.

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system to treat cancer. There are many immune modulating treatments available today, but the most commonly used drugs are called immune checkpoint inhibitors (ICIs). Cancer cells invade the immune system by expressing a protein named PDL-1. When an immune T Cell encounters this PDL-1 receptor, the T cell becomes inactive. Blocking the cancer cell interaction with the T cell, such as with an ICI, an immune response can be mounted by the body against the malignancy. For some malignancies, such as NSCLC where PDL-1 is strongly expressed on the cancer, or melanoma, these drugs can be profoundly effective.

Unfortunately, when the brakes are taken off the immune system, ANY autoimmune disease can occur. ICs can cause any “___itis.” The most common of which include acute thyroiditis (5%), pneumonitis, and colitis. As an oncologist with a practice focused on hospital care I have seen virtually every autoimmune problem imaginable from these medications; a partial list includes: Hypophysitis causing panhypopituitarism, myasthenia gravis, encephalitis, hepatitis, nephritis, adrenal insufficiency, type 1 diabetes, autoimmune hemolytic anemia, immune thrombocytopenia, and the “usual” problems noted above.

These drugs are indicated for most patients with advanced cancer so their use is pervasive. Therefore, one needs to broaden their differential diagnosis to include autoimmune organ attack when these patients present with a new clinical problem. For example, a patient with profound fatigue or anorexia should be tested for thyroid disease and adrenal insufficiency. Similarly, a patient presenting with unexplained watery diarrhea likely has autoimmune colitis. Most autoimmune attacks

In summary, the field of oncology has dramatically changed over the past 20 years. Treatments are becoming safer, more effective, and more “personalized” based upon the oncogenes expressed by one’s tumor. Most patients with advanced malignancy are treated with immune checkpoint inhibitors that unlock the immune system, and we need to be mindful that such patients are at risk for ANY auto-immune attack known to occur.

References Kim, Tae-You, et al. “A phase III randomized trial of combined chemoradiotherapy versus radiotherapy alone in locally advanced non–smallcell lung cancer.” American journal of clinical oncology 25.3 (2002): 238243.

Schiller, Joan H., et al. “Comparison of four chemotherapy regimens for advanced non–small-cell lung cancer.” New England Journal of Medicine 346.2 (2002): 92-98.

Wolchok, Jedd D., et al. “Long-term outcomes with nivolumab plus ipilimumab or nivolumab alone versus ipilimumab in patients with advanced melanoma.” Journal of Clinical Oncology 40.2 (2022): 127-137.

Kim, Hye Ryeon, et al. “Imatinib in c-KIT-mutated metastatic solid tumors: A multicenter trial of Korean Cancer Study Group. Journal of Cancer Research and Therapeutics (2023).

Jhaveri, Kenar D., and Mark A. Perazella. “Adverse events associated with immune checkpoint blockade.” N Engl J Med 378.12 (2018): 1163

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M edical R ecord F eature

Welcome New Member

Michael C. Izzo, MD

by Lucy J. Cairns, MD

T

he Berks County Medical Society is pleased to welcome Dr. Michael C. Izzo, who recently joined his father, Dr. Domenic C. Izzo, Jr., in practice at Berks Eye Physicians & Surgeons in Wyomissing. A graduate of Boston College in Chestnut Hill, MA, Dr. Izzo earned his MD degree at the Lewis Katz School of Medicine, Temple University, in Philadelphia.

After a Transitional Year internship at The Reading Hospital and Medical Center in West Reading, he completed his residency in ophthalmology at Medstar Georgetown University Hospital / Washington Hospital Center, where he also served as Chief Resident. This was followed by a year as a Clinical Glaucoma Fellow at Wills Eye Hospital in Philadelphia. Dr. Izzo has published and given presentations on a wide variety of topics in ophthalmology.

To get to know Dr. Izzo a little better, we asked him to respond to a few questions.

Describe the focus of your practice and any areas of special interest/expertise.

I am an ophthalmologist, with fellowship training in surgical and medical glaucoma care. While I am a sub-specialist, I also perform general eye care including but not limited to cataract, dry eye, diabetic eye exams, and macular degeneration. Cataract and glaucoma surgery are my primary areas of interest and expertise.

What do you find most rewarding about being a physician?

Being able to form a therapeutic relationship with patients and provide them with care that directly impacts their quality of life is what is most rewarding. Of all sight saving and restoring surgeries that I perform, I am most privileged to be able to perform cataract surgery. This relatively small and predictable procedure has the capability to dramatically improve a patient’s ability to perceive and enjoy the world, often immediately after surgery!

If you could change one thing about the current practice environment, what would it be?

I would like to be able to ensure that patients’ questions and needs are addressed in each and every encounter by doctors in all fields of medicine. Too often, practitioners find themselves forced to shorten encounters to be able to see enough patients and meet certain metrics that may unintentionally make each patient feel “less heard.”

Are you involved in any nonprofit/community groups at this time?

What has brought you to Berks County?

I am an active member of the American Academy of Ophthalmology and the American Glaucoma Society. Since moving from Philly, I look forward to joining local community groups in the near future!

I was born and raised in Wyomissing, and I am fortunate enough to get to work with my dad (Domenic Izzo) who is also an ophthalmologist at Berks Eye!

Please tell us a little about your family and the activities you enjoy outside of work.

My wife, Maura, is a dentist at Dental Arts of Wyomissing (conveniently close to my office!). We enjoy traveling, hiking, exploring new restaurants, and spending time with our friends and family.

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M edical R ecord F eature

Student Vital Signs

by John LeMoine MS III Drexel University College of Medicine/Tower Health Campus

T

he journey to “MD” is long and challenging.

It has been my ultimate pursuit for well over a decade. But now that I am less than two years from becoming a doctor, I have begun to think of what comes next. One of the purposes of the third year of medical school is to explore various specialties so that we may select the field of medicine that we want to practice in for the rest of our lives. I am almost halfway through my third-year rotations, and I have now had experience both in inpatient and outpatient settings. I have worked on surgical and medical floors. I have tended to the needs of the critically ill/ injured and have sat down with children and teenagers to discuss the advantages of a healthy lifestyle. With still much more to experience, I have learned more about myself, various patient populations, care settings, and the lifestyles and attitudes of residents and attending physicians in different fields.

Around December of this year, third-year students will begin applying for elective and “away” rotations at hospitals/programs across the country or even abroad. These rotations will take place in the fourth and final year of medical school. They are usually selected in accordance with the specialty that the student will hopefully match into and begin residency in the following year.

Although no final decisions have been made, my current top choice in specialty is emergency medicine (EM). EM doctors care for every patient demographic and see a large variety of medical cases,

facilitating lifelong learning and utilization of all the knowledge and skills I have learned in my training.

Additionally, EM practitioners are often the first medical professionals to assess and treat patients with urgent and life-threatening conditions, necessitating quick and critical decision making, which is both intellectually challenging and rewarding.

For two years before medical school, I worked in an emergency room in rural North Carolina, and knew that rural medicine was the path for me. Rural medicine offers the potential for strong community connections, increased independence, the reliance on creative problem-solving due to less abundance of resources and personnel, and the opportunity to fill crucial healthcare gaps in underserved populations. I am hopeful to return to the rural setting after medical school, ideally closer to my family in North Carolina.

Although EM is my current first choice, I believe it is still important to keep an open mind about the variety of pathways available to new doctors, and I am eager to continue my exploration of different specialties. This is an exciting time for my classmates and me as we start to narrow down our career path choices. It gives me a sense of pride to watch my closest friends discover their love for a specialty. Two years ago, we sat down at our first genetics lecture together, and in less than two years from now, we will walk across the stage together with our names announced out loud, followed by the letters, “MD.”

“Pick something you would do for free and make that your career. You’ll never live a sad day in your life.”

– Neil deGrasse Tyson

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M e d i c a l R e c o r d F e at u r e

by Lucy J. Cairns, MD Member, Editorial Board

Celebrating a Decade of the BCMS Student Internship Program

A

s of this year, the Berks County Medical Society’s summer internship program for college students has been a pillar of our educational mission for an entire decade!

A total of sixteen capable and highly motivated young people from our community have learned about important topics in healthcare under the tutelage of local experts and taken advantage of opportunities to observe physicians in their clinics and ORs. Through their research and the one-on-one time with mentors, these students gained invaluable insights into the challenges and opportunities of careers in healthcare—insights described by some as life-changing.

This program exists only through the generosity of those physicians who have carved time out of busy schedules to mentor our students, and by those who have funded the program stipend through gifts to the BCMS Educational Trust. In 2018, BCMS past-president and vascular surgeon Pat Sharma, MD, made a major gift to the Trust, after which the program was named the Pat Sharma President’s Scholarship. Retired neurosurgeon and current Medical Director of the Physicians Health Program of the Pennsylvania Medical Society Foundation, Ray Truex, MD, has provided both financial support and mentoring. Space does

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not permit the acknowledgement of the many physicians who have provided clinical observing opportunities, but we appreciate every one of you. If you are inspired to contribute to the success of local students working towards a career in medicine, public health, or health policy by donating to the Trust or by joining the list of physicians willing to mentor our student interns, a quick call to Executive Director T.J. Huckleberry or an email to me at: ljanetcairns@gmail.com will start the ball rolling. We can’t do this without you!

The BCMS also owes a debt of gratitude to Reading Hospital/ Tower Health for allowing our student interns to participate in the onboarding process and the didactic sessions offered to the Reading Hospital’s summer student internship program participants. Both programs run for 6 weeks and offer a stipend. Special thanks to Tower Health Chief of Academic Affairs, Wei Du, MD, for his interest in and support of this relationship, and to Ashley Morris, GME & UME Coordinator, for the seamless coordination we enjoyed this year. It is with pleasure and pride that, for the 10th year, we present to our readers the research conducted by the students in both programs this summer.

The Increase in Incidence of Melanoma

by Sophia Emkey BCMS Pat Sharma President’s Scholarship Recipient Preceptors: Michael T. Brown, MD, Chief, Division of General Surgery, Reading HospitalTower Health, and Lucy J. Cairns, MD, Berks County Medical Society This article has been shortened for publication in hard-copy form. The complete version, including the list of references, can be found in the digital publication available at www.berkscms.org/medical-record.

INTRODUCTION Melanoma is the deadliest of all skin cancers. Melanoma is a type of skin cancer that develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control (Melanoma skin cancer statistics, 2023). The worldwide incidence of melanoma has risen rapidly over the course of the last 50 years (Ward et al., 2017). Melanoma has a special trait that other skin cancers do not express as well, and this is their ability to metastasize throughout the body. This characteristic is why melanoma has the highest mortality rate for skin cancer types. In this paper I will talk about the specific factors related to this increase in incidence of melanoma along with implementations that could hopefully lead to a decrease in the coming years.

MELANOMA BACKGROUND INFORMATION RISK FACTORS Risk factors for melanoma include being older in age, UV light exposure including tanning beds, having very lightly pigmented skin, family history, and being male. Melanoma occurs in both men and women but is overall found more commonly in men.

By age 80, men are 3 times more likely than women in that age group to develop melanoma (Melanoma strikes men harder, n.d.). This susceptibility of males over females is more commonly seen in the older population. In contrast, young adult women appeared to have twice the risk of melanoma as young adult men (Paulson, 2020). This higher risk for young adult females over males has been attributed to the development of tanning beds that came in the 1970s. In 1987, tanning salons were the fastest growing US business, according to the American Business Information (The History of Tanning, 2019).

It is more common to see melanoma develop in people 50 or older. In recent years, there has been a trend toward an increased incidence of melanoma is the older population while the incidence in the younger population has trended slightly downward, partially attributed to the awareness of the side effects of excessive UV exposure and consequently increased utilization of UV exposure protection (Paulson et al., 2020). UV rays are a

concerning factor as they damage the DNA in skin cells which can cause them to become cancerous. A propensity to develop melanoma can be inherited. Familial (inherited) melanomas most often have changes in tumor suppressor genes such as CDKN2A (also known as p16) or CDK4 that prevent them from performing their normal functions (Melanoma skin cancer statistics, 2023).

EPIDEMIOLOGY What Explains the Increasing Incidence of Melanoma?

Melanoma is a leading cancer diagnosis in the developed world and is projected to continue to increase in incidence over the coming decades (Saginal, 2021). There are many reasons speculated as to why we have seen such a rapid increase. Tanning beds have become a major attraction, specifically to young females, which may be why we have seen rates higher in females compared to males at an adolescent age. In the United States melanoma incidence increased from 20.7 per 100,000 in 2001 to 28.2 per 100,000 in 2015 (Coroiu et al., 2021). The older population did not use sunscreen or have as much knowledge of melanoma as we do today. Since melanoma arises more as you get older, this is why we see such a major rise in the number of cases in the older generations. Life expectancy has also increased creating more opportunities for melanoma to affect many more people. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk (Berge et al., 2020). Due to the rapidly increasing incidence over the years, melanoma is taken much more seriously, and efforts are being made that can hopefully lead to a decrease in this deadly skin cancer.

Melanoma and Higher Mortality in African Americans African Americans (AA) are much less likely to develop melanoma due to their protective melanin skin pigment, but their mortality rates are much higher. AAs typically have melanomas on the lower extremities, tumors with greater depth and ulcer rates, and increased lymph-node-positive melanoma rates at the time of diagnosis (Mahendraraj, 2017). Due to these continued on next page > FALL 2023 | 19

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and other factors, AAs have a much lower and shorter survival rate for this disease. Melanoma in AAs tends to appear in hard-to-see areas such as the bottom of their feet and under the nails, which makes it even more difficult to catch at early stages.

Social determinants of health (SDOH) factors that could be connected to AAs’ higher mortality rates include that they are less likely to have private health insurance, transportation to medical appointments, and education on melanoma. These factors have a direct effect on health outcomes. Enabling more of the AA population to have access to insurance benefits, providing social and educational programs to enhance the awareness of this disease, and improving transportation options for skin checkups could reduce the morbidity and mortality rates. Although AAs are less likely to develop melanoma, the greater mortality risk they have is a concerning factor.

Improvement Methods to Reduce Melanoma Incidence and Mortality Due to the advances in medicine, knowledge, and awareness, melanoma has seen a decrease in mortality. Melanoma mortality rates declined rapidly over the past decade (2011 to 2020) because of advances in treatment, by about 5% per year in adults younger than age 50 and 3% per year in those 50 and older (Melanoma skin cancer statistics, 2023). These mortality rates refer to the number of deaths in specific age groups caused by melanoma. The main reason for this decrease is through immunotherapy treatments and spread of awareness. With the approval of 10 new targeted and immunotherapy treatments since 2011, overall mortality decreased by 17.9% from 2013 to 2016 (Berk-Krauss 2020).

Prevention methods are the key factor in lowering the incidence of melanoma, which will in turn lower the number of deaths.

Sociologic and community-based interventions, such as educational and community outreach programs that increase the awareness of melanoma, as well as proper sunscreen application, have demonstrated efficacy in this area (Djavid et al., 2021). Protecting yourself from the sun is the number one way to decrease your chances of developing melanoma. This can be done by wearing and properly reapplying sunscreen, wearing protective clothing such as hats and long shirts/pants, staying inside during the high UV hours, and completely avoiding tanning beds. Protecting children from the sun is extremely critical, as a bad sunburn when young can cause melanoma in adult life. The number of melanoma cases attributed to tanning beds has led to the government taking action to hopefully decrease these rates. To date, 44 states and the District of Columbia either ban or regulate indoor tanning by minors, and numerous counties and cities have enacted their own laws or regulatory measures (Venosa, 2023).

Dermatologists are promoting yearly skin checks, especially to those who have had melanoma in their family, which helps to catch melanoma at as early a stage as possible. Clinical full skin exams have been shown to decrease the number of deep melanomas, which is important because the depth of invasion for malignant melanoma

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is the most important prognostic factor (Chiaravalloti & Laduca, 2014).

METHODOLOGY Data from Tumor Registries illustrate some of these changes in melanoma occurrence and characteristics over time in The Reading Hospital and throughout the United States, showing that while the incidence has increased, the average stage at diagnosis has decreased, contributing to the decrease in mortality rate. Data was provided by the National Cancer Data Bank for Reading Hospital on several aspects of Melanoma from Reading Hospital patients from 2011-2020. This data includes the comparison of patients from the Reading Hospital (My) to all hospitals in all states (Oth) who were diagnosed with one of the 4 different stages of Melanoma in 2011 versus 2020 and the comparison of the age range of patients from the Reading Hospital who were diagnosed with any type of Melanoma in 2011 versus 2020. Here we can see how the factors of different age groups, stage diagnoses, and gender come into play.

RESULTS

Figure 1: Melanoma distribution by age in 2011 in the Reading Hospital RH= Reading Hospital

Figure 2: Melanoma distribution by age in 2020 in the Reading Hospital RH= Reading Hospital (No cases logged for 20-29 age group)

Figure 4: Melanoma distribution of stages in 2020 in the Reading Hospital vs All Hospitals in All States My= Reading Hospital Data (RH) Oth= All Hospitals in All States (AUS)

Figure 5: Melanoma in males or females from 2011-2020 in the Reading Hospital RH= Reading Hospital DISCUSSION

Figure 3: Melanoma distribution of stages in 2011 in the Reading Hospital vs All Hospitals in All States My= Reading Hospital Data (RH) Oth= All Hospitals in All States (AUS)

Melanoma remains the deadliest skin cancer despite the advanced treatments and knowledge we have today. Dermatologists continue to recommend yearly screening checks as early as possible and strongly recommend sunscreen when exposed to the sun.

UV rays both directly from the sun and in places such as tanning beds, seem to be the main driving force in the steady increase in the incidence of melanoma. This data provided by the Reading Hospital and All Other Hospitals in the United States show how the incidence has overall seen an increase and how it relates to some of the factors discussed above.

This rise in incidence is clearly seen comparing Figures 3 and 4 with the total cases increasing. At the RH the increase in number continued on next page FALL 2023 | 21

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of people affected by melanoma was 22 and in AUS was 7,624.

It can also be seen comparing Figures 1 and 2 that the age group between 60-69 had a 16% increase in cases diagnosed confirming that this age group tends to be the most affected by this cancer.

The population of Berks County increased by about 4% between 2010 and 2020, while the number of melanomas diagnosed at Reading Hospital increased by 40%. If there was an increase in people affected by melanoma from outside of Berks County drawn to the Reading Hospital, the true increase in incidence would be less dramatic but likely still significant. There is a decrease in melanoma cases for the 40-49 age group which has an unknown cause but is speculated to be secondary to prevention efforts.

Comparing the data in Figure 3 (2011) with that in Figure 4 (2020) shows an increase in the proportion of cases diagnosed at Stage 0. Stage 0 is the easiest to treat as it is contained within the epidermis. The percentage diagnosed at Stage 0 in the RH had a significant increase from 19% to 33%. This shows how dermatologists have started to catch on to these melanomas earlier and therefore can remove them in the early stages. This has been done by promoting adults as early as 30s to get a yearly check and educating people on how beneficial sunscreen/reduced skin exposure is. The American Academy of Dermatology states how men, especially of older age, are 3x more likely to get melanoma.

This information is backed up in Figure 5 as men comprised 55% of those diagnosed with melanoma at the RH from 2011 to 2020.

Melanoma is a major cause of concern for every generation, and to see a decrease in the incidence in the future several steps can be taken. Parents can make sure that their kids always apply

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sunscreen while receiving sun exposure and wear protective clothes when the UV index is high. Adults of any age can make sure they are also protecting themselves with high SPF sunscreens and protective clothing. Dermatologists can continue to promote yearly skin checks, including for young people, and encourage people of any age to make an appointment if they have skin lesions with any of the suspicious characteristics described in the ABCDEs of melanoma. The data presented above overall supports the conclusion that the incidence of melanoma has been increasing in the population. With the prevention methods listed and discussed, we can hope for a decrease in the near future.

CONCLUSION Melanoma incidence is rising in developed, predominantly fair-skinned countries, growing over 320% in the US since 1975 (Saginala, 2021). The increase in diagnosing melanoma at an earlier stage and advances in treatment, along with a more educated population, will offer the promise of reversing the rise in incidence and continuing the improvement in mortality.

Sophia Emkey is in her senior year at Penn State University, where she is a member of the Biobehavioral Health Society and Pi Beta Phi Sorority. She plans to pursue a career in medicine.

Medications for Opioid Use Disorder in the Criminal Justice System: Berks County & Beyond

by Lily Palmer BCMS Pat Sharma President’s Scholarship Recipient Preceptors: William Santoro, MD, Chief, Division of Addiction Medicine, Reading HospitalTower Health, and Lucy J. Cairns, MD, Berks County Medical Society This article has been shortened for publication in hard-copy form. The complete version, including the list of references, can be found in the digital publication available at www.berkscms.org/medical-record.

Every year, 1 in 5 U.S. adults experience mental illness (NAMI, 2023). Despite these widespread challenges, it is estimated that only 28 percent of the U.S. population is located where there are sufficient resources (e.g. psychiatrists, mental health professionals).

The majority of states have less than 40 percent of what the population needs, and more than half of U.S. counties have not a single practicing psychiatrist (Modi et al., 2022). Even when resources can be accessed, this may not be in a timely manner and/ or may cost too much, with or without medical insurance.

In particular, the recent rise of opioid use and addiction has brought even more challenges to the realms of mental health and addiction medicine. Medications for opioid use disorder (MOUD) and psychosocial treatment for other mental health disorders are highly important for recovery, especially given that people with substance use disorder often have a dual diagnosis with another mental health condition (Cleveland Clinic Staff, 2023). With the already existing issues concerning access to mental health care, those with substance use disorders (SUDs) are gravely impacted.

Since 1999, the number of drug overdose deaths per year is about five times greater, and in 2020 75 percent of the nearly 92,000 drug overdose deaths involved an opioid. From 2000 to 2014, the rate of opioid-related deaths increased by 200 percent (Rudd et al., 2016) and increased by 30 percent just from 2019 to 2020 (CDC, 2022).

The consequences of SUDs spread far and wide and can ultimately result in loss of life. Within one’s family there may be emotional hardship, economic burdens, and overall instability.

Societal consequences consist of housing insecurity, homelessness, criminal behavior, incarceration, and transmission of disease; all of these consequences come with a cost for loved ones, the government, and society as a whole (Daley, 2013).

Research has found that 43 percent of people in state prisons have been diagnosed with a mental health disorder and 44 percent in local jails (Prison Policy Staff, 2022). Furthermore, about 85 percent of the prison population has an active SUD or was incarcerated for crimes involving drugs or drug usage (NIDA, 2020). Yet while mental health issues (such as SUD) for incarcerated individuals are clearly prevalent, 66 percent of people in federal prisons have reported they are not receiving any mental health care while incarcerated (Prison Policy Staff, 2022). Mental illness in prison leads to a variety of harmful outcomes, both during and after incarceration. Poor mental health is associated with higher rates of prison misconduct and higher overall costs for the institution (Fellner, 2006). It can also reduce opportunities for employment and the ability to find housing post-release (MallikKane & Visher, 2008).

Specifically for opioid use disorder (OUD) and its often cooccurrence with other mental illnesses, the lack of access to effective treatment while incarcerated can lead to continuing use upon release and returning to the criminal justice system.

Medications for opioid use disorder (MOUD) are the most effective methods for treating OUD that have yet to be widely adopted in criminal justice systems across the country (Pew Staff, 2020). Where it has been widely introduced in the state of Rhode Island, there are promising preliminary results for their correctional population and the state at large. Within Berks County, strides have been made to provide access to MOUD for incarcerated individuals, but more can be done, and a more extensive model could be put in place to combat the rise in OUD and its detrimental consequences. ****(1) Many studies have found that MOUD is highly underutilized in the criminal justice system. Substance Abuse and Mental Health Services Administration (SAMHSA) relates that the continued on next page > FALL 2023 | 23

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criminal justice system has been slow to implement these FDAapproved treatments, despite the prevalence of OUD in the justice system and the evidence of MOUD’s effectiveness. Matusow et al. (2013) found that only 53 percent of drug court programs studied approve MOUD as a component of treatment; mainly, court policy and political and administrative opposition affected this lack of availability. Furthermore, many jails force complete withdrawal from opioids upon entrance – even previously prescribed medications for OUD that may have been supporting an individual’s recovery (SAMHSA, 2019).

While the justice system has yet to incorporate the widespread use of MOUD, there are numerous benefits for both the patient and society. First and foremost, MOUD assists people that are addicted to opioids on their recovery journeys. Studies show that MOUD helps people not use for long periods, as well as decrease their dependence on drugs. While beginning the process of recovery, MOUD with methadone or buprenorphine can assist patients in coping with withdrawal symptoms – a common trigger for relapse. These medications can help people get through the intense phases of withdrawal and lead them to recovery. Additionally, because MOUD works to reduce cravings, patients are less likely to return to the substance they are addicted to; therefore, they are also less likely to overdose and experience accidental death. In contrast, individuals released without MOUD have a lower tolerance to opioids because they have not used them (illicit or for treatment), which increases their risk for overdose and death. MOUD treatment plans are very individualized, in that they can be integrated with other treatments (e.g. counseling, behavioral therapy, and other medications). This allows MOUD patients to devise a plan with their providers that best meets their individual needs, thus creating a greater chance of not using (PBJ Team, 2022). Since MOUD works to reduce opioid use in its patients, the benefits also reach loved ones, emotionally, mentally, and financially. On a larger scale, MOUD’s effectiveness in combating OUD decreases costs within the health and criminal justice systems, such as reducing emergency visits, extended hospitalizations, and the number of people incarcerated related to drug use.

Despite these studied benefits, criticisms of MOUD highlight the continued stigmatization of substance use disorders and using MOUD in correctional settings. Even though SUDs are medical diseases, they are not always accepted as such by correctional institutions or the public. This causes a large misunderstanding about MOUD and the way it works to treat OUD. For instance, the idea that MOUD is “substituting one drug for another” has undermined MOUD’s positive effects on recovery and has created underutilization of the treatment. There are also concerns about monitoring medication use and limiting diversion. Facilities would need to change their procedures and policies and train their staff to ensure that MOUD is executed properly; however, the lack of MOUD use actually creates the diversion value, as it produces a market for diverted medication in the population deprived of treatment. The effort put into training specified staff for MOUD would reap the benefits in individuals’ recovery being

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more successful while incarcerated and upon release. There is also the concern of cost, as many justice programs may assume that they cannot afford to provide MOUD (e.g. medication, training, certifications, etc.). Incarcerated individuals also often lack insurance, particularly in states where Medicaid coverage has not been expanded, which can limit ongoing treatment upon release.

The process of gaining the licensing in some states to administer MOUD in itself can deter facilities from providing it, as well as required regulations once it is in place. Furthermore, many areas do not have sufficient community-based MOUD providers, and some might not be prepared or willing to serve the criminal justice population (SAMHSA, 2019).

These issues with MOUD are not necessarily concerned with its effectiveness but rather the barriers that can come with implementing it; however, these challenges are worth the work to tackle the opioid crisis and improve incarceration and recidivism rates related to drugs. Within the incarcerated population, it has been found that about 77 percent relapse to opioids within three months after being released, even those who participated in counseling in prison (Kinlock et al., 2008). According to Dr. Jonathan Morrow (M.D., Ph.D.), an assistant professor of psychiatry and a certified addiction specialist with the University of Michigan Addiction Treatment Services, “without medication, relapse rates for opioid addiction are 90 percent within a year, even with intensive treatment. Relapse rates drop to 40 to 50 percent with medication” (Rhodes, 2017). *** (2) In facilities operated by the state of Pennsylvania, MOUD access is not sufficient to support the large incarcerated population that has OUD. The Pennsylvania Institutional Law Project (PILP) argues that the vast majority of P.A. jails provide inadequate care for OUD. According to PILP, “only three of the 62 facilities in the state allow individuals with OUD to initiate treatment with agonist medications, buprenorphine and methadone … If an inmate already has a prescription for agonist [medication], only 18 jails allow the treatment to continue” (Hennen, 2022). In over 70 percent of P.A. jails, individuals are limited to the option of naltrexone, which does not reduce withdrawal symptoms, and may be forced to suffer through withdrawal – “a painful and medically dangerous experience for which they receive little or no care” (Hennen, 2022).

In Berks County specifically, there has been some progress in making MOUD available in the Berks County Jail. Dr. William Santoro, Chief of Addiction Medicine at Tower Health and Berks County Medical Society President, played a role (and continues to) in advocating for MOUD in Berks’ justice system. In his work at Tower Behavioral Health, he has seen outstanding recovery results for patients on MOUD. Dr. Santoro relates that currently if someone enters a Berks County facility actively on an MOUD treatment plan, they are able to continue it while incarcerated; however, one is not able to use MOUD if they did not enter already on the medication. This limits the number of people who can benefit from MOUD during both withdrawal and long-term recovery. Additionally, it decreases the likelihood of individuals

connecting to community treatment post-release and increases the risk of recidivism related to drugs. Although Berks County has a methadone clinic, it has recently discontinued its relationship with the prison. Now, the Berks County Jail has a relationship with a methadone clinic located outside of Berks County. Upon release, individuals may have difficulty or be unwilling to travel outside of the county to continue receiving treatment. This creates yet another barrier of needing to transfer from the out-of-county clinic to the Berks County clinic. Those with OUD that cannot access MOUD while incarcerated may not seek the treatment upon release due to the lack of introduction and experience with MOUD services during incarceration.

Looking to the future, making MOUD available to incarcerated individuals who have yet to try it or have failed in the past could help to address the larger issue of opioid addiction. Pennsylvania has one of the highest rates of drug-overdose deaths in the U.S. Upon release from incarceration, individuals are at a higher risk for relapse and overdose. Introducing them to MOUD before release and setting them on a stable path and plan for treatment can decrease this elevated risk. Sarah Bleiberg Bellos, Independence Legal Fellow with the PILP, relates that “on a systemwide level, if we want to address this issue as a broader community, providing people with treatment is generally going to be less expensive than people constantly cycling in and out of the criminal justice system … By providing full access to MOUD, jails and prisons can be a critical part of the solution in addressing this epidemic that has impacted communities all across Pennsylvania and the country” (Hennen, 2022). Moving forward, organizations like PILP and the addiction medicine community recommend that Pennsylvania jails and prisons grant access to MOUD and break down the existing barriers to OUD treatment, including educating and training staff on the subject and maintaining research on their progress (Hennen, 2022).

Dr. Santoro mentions that Rhode Island has one of the most progressive implementations of MOUD in its criminal justice system. With the support of former governor Gina Raimondo, the task force created to develop a statewide plan to reduce overdose deaths led to the full implementation of MAT/MOUD in R.I.’s correctional system (Clarke et al., 2018). Started with a 2 million dollar initiative in 2016 by the Rhode Island Department of Correction, CODAC Behavioral Healthcare (contracted to provide treatment statewide) made R.I. the first state to offer evidencebased MOUD protocol to the entire correctional population (Joseph, 2017). R.I. correctional facilities were also the first to screen every incoming person for OUD and subsequently offer all three MOUD medications in collaboration with counseling (Joseph, 2017). Not only does this include MOUD services during the incarceration period, but the initiative also incorporates an effective re-entry plan that is created before release so there is no interruption of treatment. Case management staff finds connections for recovery services in the community, such as healthcare providers; specialized healthcare referrals; and aids for housing, occupational training, education, legal support, transportation, and mental health services (Joseph, 2017).

After only a year of implementation, “Rhode Island reported a 60.5% reduction in opioid-related mortality among recently incarcerated people” (Green et al., 2018). Additionally, state-wide opioid-overdose deaths decreased by 12% (Clarke et al., 2018).

A study that observed a sample of those previously incarcerated in Rhode Island found that 12 months post-release, those who underwent MOUD while incarcerated were less likely to report using heroin and engaging in injection drug use in the last 30 days.

They also reported fewer non-fatal overdoses and were more likely to be continuing their addiction treatment in their community (Brinkley-Rubinstein et al., 2018). Because of these promising results in only the first year of the program’s implementation, “other states have started to look to Rhode Island to learn from its MOUD program, and the Obama administration highlighted it as a national model” (Joseph, 2017).

CONCLUSION Considering the abundance of positive results and benefits of medications for opioid use disorder (MOUD), it proves imperative to implement widespread use of MOUD in the criminal justice system. Opioid use disorder (OUD) is a chronic, medical disease; thus, it should be treated no differently than any other condition in the healthcare field and correctional institutions. Individuals with diabetes are not denied their medication if they do not always have their blood sugar under control, if they are obese, or even if they are incarcerated. As with conditions like diabetes, there is no universal cure for substance use disorders, but all humans deserve the opportunity to utilize the most effective treatment available.

Including MOUD as a primary treatment option provides sweeping benefits on individual levels for patients and society at large.

As indicated by the early successes of Rhode Island’s full-access MOUD program, improving access to MAT/MOUD in other state correctional systems would surely reap these life-saving outcomes. This possibility for the future makes it crucial that constituents educate themselves, share information about MOUD, and advocate for its expansion. Specifically in Berks County, advocating for policy changes and funds for MOUD in our correctional system can change the lives of those directly impacted

by OUD and advance the community in areas such as crime and correctional spending. Perhaps most importantly, it will help to promote compassionate care and combat long-standing stigmas associated with substance use disorders.

Lily Palmer is in her final year to earn a B.A. in Psychology and a B.A. in Criminology at North Carolina State University. In addition to her studies, she is employed as a Wellness Coach by NCSU Wellness & Recreation and volunteers as a Mental Health Ambassador for the Compass Center domestic violence hotline. She aspires to become a Clinical Psychologist and work to address inequities in access to mental health care in correctional institutions.

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Reading Hospital/Tower Health

Student Sum mer Research Projects The Relationship Between Socioeconomic Factors and the Rates of Bystander CPR and Community AED Use

by Adam Sigal, MD; Traci S. Deaner, MSN, RN; Tom Wasser; Gopal Topiwala; Allison Atkinson; Kristina Shum; William Davis; Amelia Wildermuth; Jack Kauffman Department of Emergency Medicine, Reading Hospital – Tower Health, Reading, PA INTRODUCTION: Bystander CPR has been shown to double or triple the chance of survival in out-of-hospital cardiac arrests and AED use can additionally increase this chance.1 In the United States, less than one-third of patients who have an OHCA received bystander CPR.3 Bystander CPR training and rates have been associated with socioeconomic factors like income, poverty levels, and educational attainment.2 This study aims to identify relationships between socioeconomic factors, bystander CPR and AED use to better understand barriers to CPR administration and AED application. This will promote initiatives to combat health inequities by increasing CPR training and awareness within the vulnerable populations of the community.

METHODS: Retrospective chart reviews were performed on patients from the Tower Health hospital system who experienced OHCAs from January 1, 2020, to December 31, 2022. Individuals who suffered from traumatic OHCAs or were transferred to another facility to treat the arrest were excluded. The study population was extracted from Epic using SAP reporting tools. Data from charts and relevant ambulance trip sheets were entered into REDCap before becoming de-identified and placed into a protected Excel spreadsheet. Some variables of interest included race, ethnicity, layperson witnessed arrest, bystander CPR, AED use, downtime to initial CPR, cardiac arrest etiology, and outcome. Statistical analysis will be performed by a statistician at the end of the study.

RESULTS: Final analysis of data is yet to be made. Preliminary results from 365 patients were analyzed, finding that Hispanic patients were administered CPR via bystanders 24% of the time, while non-Hispanic patients were administered CPR 42% of the time. Furthermore, out of the witnessed cardiac arrests that occurred in a Hispanic patient’s home, the patient received bystander CPR 18.9% of the time. Conversely, in non-Hispanic households, witnessed cardiac arrests received bystander CPR at a rate of 46.7%, more than double the rate of Hispanic individuals. To determine if these trends were influenced by economic variables, the median household income was obtained for every zip code that cardiac arrests occurred in. Data indicates that Bystander CPR rates were significantly lower in communities with a median household income of $40,000 or less. Data limitations on AED use did not allow for evaluation.

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CONCLUSION: Preliminary results from this study confirm previous findings, indicating that significant health inequities are associated with interventional treatment from bystanders. Both ethnicity and median household income suggest a direct influence on bystander CPR rates. Future considerations for research are to continue expanding across states to gather representative samples from the population. Findings reveal a greater need for cardiac arrest education and accessibility of these resources to all community members, regardless of income or ethnicity.

References: 1. Ibrahim, W. H. (2007, October). Recent advances and controversies in adult cardiopulmonary resuscitation. Postgraduate medical journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600120/ 2. Lee, S., Ahn, K. O., & Cha, M.-I. (2021, January 22). Community-level socioeconomic status and outcomes of patients with out-of-hospital cardiac arrest: A systematic review and meta analysis. Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837968/ 3. Sasson, C., Meischke, H., Abella, B. S., Berg, R. A., Heisler, M., Dowling Root, E., Chan, P. S., Bobrow, B. J., Rea, T. D., Rumsfeld, J. S., Sayre, M. R., Ong, M., Masoudi, F., Link, M., & Levy, J. H. (2013, February 25). Increasing cardiopulmonary resuscitation provision in communities with ... Circulation | AHA/ASA Journals. https://www.ahajournals.org/doi/10.1161/cir.0b013e318288b4dd

William Davis is a senior at Elizabethtown College, with a major concentration in Chemistry.

Amelia Wildermuth is a senior at Cornell University, majoring in Human Biology, Health, and Society.

Jack Kauffman is a sophomore at Liberty University, majoring in Biomedical Sciences.

All three of these students will be pursuing medical school upon graduation. William Davis will attend the Lake Erie College of Osteopathic Medicine.

The Prospective Association Between Breast Arterial Calcifications on Routine Mammography Screening with CAD and Stroke – A 17-Year Follow Up

by Hannah Daley and Maggie Feng MD Candidates, Class of 2026, Drexel University College of Medicine Preceptors: Xuezhi Jiang, MD, and Peter Schnatz, DO Department of Obstetrics and Gynecology, Reading Hospital-Tower Health Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in women worldwide. Although the risk factors and symptoms of CVD are different than that in men, there remains a lack of guidelines for prevention of CVD specific to women, who are asymptomatic with underlying CVD until an unexpected manifestation of a sudden myocardial infarction or death. Previous studies have shown that breast arterial calcifications (BAC) found on routine mammograms are associated with increased risk of developing CVD, but they are only sporadically reported in radiology findings. In this study, we continued to follow up with a cohort from 17 years ago, recruited during routine mammograms to determine if risk of CVD correlated with previous BAC findings.

Previous data from this study at the 10-year follow-up mark reported that BAC was significantly associated with CVD, and therefore should be reported on routine mammograms. The goal is to determine a guideline for clinical practice on measuring BAC levels, reporting, and actionable thresholds for pursuing further care, especially for patients younger than 60.

Works Cited Cho L, Davis M, Elgendy I, et al. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women. J Am Coll Cardiol. 2020 May, 75 (20) 2602–2618. https:// doi.org/10.1016/j.jacc.2020.03.060 Iribarren, C., Chandra, M., Lee, C., Sanchez, G., Sam, D. L., Azamian, F. F., Cho, H. M., Ding, H., Wong, N. D., & Molloi, S. (2022). Breast Arterial Calcification: a Novel Cardiovascular Risk Enhancer Among Postmenopausal Women. Circulation.

Cardiovascular imaging, 15(3), e013526. https://doi.org/10.1161/ CIRCIMAGING.121.013526 Jiang, X., Clark, M., Singh, R. K., Juhn, A., & Schnatz, P. F. (2015). Association of Breast Arterial calcification with stroke and angiographically proven coronary artery disease. Menopause, 22(2), 136–143. https://doi.org/10.1097/gme.0000000000000300 Schnatz, P. F., Marakovits, K. A., & O’Sullivan, D. M. (2011). The Association of Breast Arterial Calcification and coronary heart disease.

Obstetrics & Gynecology, 117(2), 233–241. https://doi. org/10.1097/aog.0b013e318206c8cb

FALL 2023 | 27

Reading Hospital/Tower Health

Student Sum mer Research Projects Comparison of Two Dosing Regimens of TXA in Hip Fracture Patients

by Kyle Stringer Principal Investigator: Thomas A. Geng, Jr., DO, MBA, CPE, FAC Department of Trauma, Surgical Critical Care and Acute Care Surgery Reading Hospital Collaborators: Kenneth McAlpine, MD Christopher Butts, DO, PhD Alison Muller MLS(ASCP) MSPH Kyle Stringer, MS Tranexamic acid (TXA) is a synthetic lysine analogue that binds lysine residues on plasminogen. This interaction with plasminogen inhibits the zymogen’s conversion to plasmin, its active form.

The downregulation of plasmin decreases fibrin degradation in blood clots. Thus, TXA is used clinically as an antifibrinolytic that prevents bleeding.

TXA is endorsed by the American Academy of Orthopaedic Surgeons (AAOS) for hip fracture management. TXA is associated with decreased blood loss and transfusion rates when compared to a placebo. TXA can also be used as a cost-effective substitute for transfusions1. Trauma literature and general practice guidelines have also supported the efficacy of administering TXA in coagulopathy management for hemorrhaging patients. TXA can be administered orally, topically, and intravenously. While TXA intervention significantly decreases blood loss and transfusion rates, the optimal dosing and administrative route remains elusive1.

The Trauma Department in conjunction with the Department of Orthopedic Surgery at Reading Hospital is interested in comparing various dosing regimens of IV TXA in hip fracture patients. The investigative team will be conducting a noninferiority, prospective review of patients who present with hip fracture. The control group will include patients presenting with hip fractures who are not admitted to the trauma service.

These individuals will receive 1 g IV TXA perioperatively and 1 g

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IV TXA at closure. Alternatively, the study group will comprise patients presenting with hip fractures who are admitted to the trauma service. This group will receive 2 g IV TXA perioperatively.

Primary outcomes evaluated include total blood loss, blood product administration, and transfusions required.

For individuals who undergo internal fixation for hip fracture, the hypothesis is that the dosing regimen of perioperative 2 g IV TXA will have similar efficacy to regimen of perioperative 1 g IV TXA followed by 1 g IV TXA at closure. The one-time dosing regimen would also mitigate any potential human error of missing the second 1 g IV TXA dose in a trauma setting.

Please note that the study design is currently tentative and subject to change as we have not yet submitted for IRB approval.

1. AAOS management of hip fractures in older adults. Available: https://www.aaos.org/globalassets/quality-and-practice-resources/hipfractures-in-the-elderly/hipfxcpg.pdf Kyle Stringer is in the Class of 2026 at the Drexel University College of Medicine at Tower Health in West Reading. He is planning to train in a surgical specialty.

Exploring the Link between Pancreatic Neuroendocrine Tumors and Depression: A Case Study

by Gina Maria P. Fiore; Nicole Ann Villa, MS-3; Eduardo D. Espiridion, M.D. Department of Psychiatry, Reading Hospital-Tower Health, Reading, PA

ABSTRACT INTRODUCTION: Extensive literature can be found on the relationship between pancreatic cancer and depression and the prevalence of depression diagnoses in these cancer patients. While there is less focus on pancreatic neuroendocrine cancer (PNET) and depression, associations have also been shown between the two. This case probes the potential temporal relationship between PNET and depression, given the timing of the PNET diagnosis and the patient’s exacerbated depression presentation.

CASE DESCRIPTION: We report on a 58-year-old female with chronic symptoms of depression with no formal diagnosis until within a year of doctors suspecting her diagnosis of pancreatic cancer. Patient reported increased depression symptoms, including sad mood and lack of interest in hobbies, around the time that surgeons consulted with her about an excisional biopsy. She then

started on Zoloft; however, despite medication, she continued to experience worsening depressive symptoms such as unprompted crying spells. Excisional biopsy was performed confirming a Grade-1 neuroendocrine tumor in the pancreas, and post-operative psychiatric consultation confirmed continued elevated depression.

DISCUSSION: This case report presents an illustrative example of the ongoing research questions surrounding the relationship between the timing of a depression diagnosis and a PNET diagnosis. The depression-before-diagnosis relationship in pancreatic cancer patients is important as it raises questions about the temporal relationship between these two diseases. This case corroborates current research findings on the topic and, given the need to increase early diagnoses of pancreatic cancer, encourages further studies to determine if depression could be a valuable early warning sign of pancreatic cancer.

Long-Covid-19 and the Association with Suicide: A Brief Review

by Nicole Ann Villa, MS-3; Gina Maria P. Fiore; Eduardo D. Espiridion, M.D. Department of Psychiatry, Reading Hospital-Tower Health, Reading, PA

ABSTRACT Since its emergence in late 2019, Covid-19 has had many devastating economic, social, mental, and physical health consequences and caused millions of deaths worldwide over the course of the pandemic. While most cases are mild and symptoms resolve within a couple of weeks, some Covid patients’ symptoms can last for multiple weeks, months, or even years after contracting the virus, and these long-lasting symptoms have been identified as Long-Covid. Psychiatric symptoms have been associated with LongGina Maria Fiore is a Berks County resident who graduated from Governor Mifflin High School in 2020. Currently in her senior year at Wellesley College, she plans to apply to medical school after graduation.

Covid in addition to physical symptoms, and impaired cognitive functioning, sleep abnormalities, depression, anxiety, PTSD, and psychosis have been observed in Long-Covid patients. Given the ties between suicide and mental health, particularly during the Covid-19 pandemic, suicide should be a concern for patients with Long-Covid; however, there are limited studies focused on this issue.

This review aims to elucidate the connection between Long-Covid and suicide risk and provide a helpful resource to providers treating Long-Covid patients.

Nicole Ann Villa is in the Class of 2025 at the Drexel University College of Medicine in West Reading. She plans to train in General Surgery upon graduation.

FALL 2023 | 29

Reading Hospital/Tower Health

Student Sum mer Research Projects EMS versus Attending Physician Opinion on the Destination of Patients Presenting to the Emergency Department by Ambulance

by Kirsten Gimbel, PI at Penn State Hershey; Adam Sigal, MD, PI at Reading Hospital – Tower Health; Nikki Rimlinger, MS-2 at Drexel College of Medicine Department of Emergency Medicine, Reading Hospital – Tower Health, West Reading, Pennsylvania

INTRODUCTION: Overcrowding in the emergency department (ED) presents as a barrier to efficient patient care and is a multifactorial issue.1 One potential factor leading to overcrowding is patients being brought to the ED via ambulance for non-lifethreatening complaints that may be treated in an outside facility, such as urgent care. Through experience, emergency medical services (EMS) personnel may develop assessment and triage skills comparable to ED providers. This study aims to determine if EMS providers are able to appropriately triage patients to alternative care sites by comparing EMS to ED provider opinion regarding patient presentation to the emergency department.

METHODS: This study will use a survey to compare EMS to ED provider opinion regarding patient disposition when presenting to the emergency department via ambulance. Upon arrival, patients and providers will be screened using specific inclusion and exclusion criteria, followed by completion of the survey. The primary subject (EMS or ED provider) will report their position and role, years of experience, and answer the following questions regarding the secondary subject (patient): 1) In your opinion, was the patient brought appropriately to the ED? If yes, what is the patient’s presentation? And 2) In your opinion, could this patient have been safely evaluated and treated at an external facility? If yes, what is the patient’s presentation? At least 1888 subjects are required before statistical analysis can be conducted.

RESULTS: A total of 87 surveys have been conducted between Penn State Hershey and Reading Hospital. Of these 87 surveys, provider opinion agreed 83.9% of the time regarding appropriate transport to the ED and 79.3% of the time regarding safe treatment at an external facility. Current trends suggest EMS

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providers are more likely to assume patients could have been treated elsewhere – 28.7% – compared to ED providers at 10.3%.

However, opinions agreed that a majority of the subjects enrolled were appropriately transported to the ED and could not have been treated at an external facility, 77% and 69%, respectively.

CONCLUSION: As this is an ongoing research project, no significant conclusions can be drawn at this time. Study team members should continue to screen and recruit a wide range of subjects to acquire a sample of patients that is representative of the greater population. Limitations of this study include provider’s interpretation of questions, clinical presentation of patients arriving during enrollment period, and current number of surveys conducted. Future studies may analyze tests, treatment, and discharge of patients after the initial survey is conducted to further confirm or deny ability of EMS personnel to be able to appropriately triage patients to alternative care sites prior to ED provider evaluation.

1. Kenny, J. F., Chang, B. C., & Hemmert, K. C. (2020). Factors Affecting Emergency Department Crowding. Emergency medicine clinics of North America, 38(3), 573-587. https://doi- org.ezaccess. libraries.psu.edu/10.1016/j.emc.2020.04.001 Nikki Rimlinger is in the Class of 2026 at the Drexel University College of Medicine at Tower Health in West Reading. Her career goals include completing a residency in Emergency Medicine with an interest in EMS and Pediatrics.

Reading School District News

A Case of Clear Cell Renal Cell Carcinoma with Renal Vein Invasion

by Mackenzie Donatelli Preceptors: Kelly Brenan-Rothschild, MD, and Fernando Garcia, MD Department of Pathology, Reading Hospital-Tower Health For my summer research presentation, I will be presenting on kidney histology. I will be focusing on introducing gross pathology and histological markers of pathology in the kidney. I plan to introduce questions to the audience in order to better engage and empower them. My case study examines a case of clear cell renal cell carcinoma in which there was renal vein invasion. When a tumor invades the renal vein, this means that the cancer staging is increased. In general, when cancer has a higher stage this leads to a worse prognosis making staging an important aspect of a pathologist’s job. I will also be covering Fuhrman nuclear grading of kidney tumors and what this means for the prognosis of the patient as well. I have included some immunohistochemical stains to further illustrate diagnostic tools available to pathologists. At the end of the presentation, I will conclude by examining a diagram that includes a master layout of the process taken when a kidney mass is suspected, to wrap up my presentation.

Help our kids. dream. believe. achieve.

Consider a Gift to the Reading Education Foundation The Reading Education Foundation is an independent 501(c)3 organization dedicated to providing Reading School District students with innovative academic opportunities they, otherwise, never would have. The Reading Education Foundation exists to inspire students to Dream, Believe, and Achieve.

ATE DON E! IN ONL

As we approach the end of the year, please consider a donation to the Reading Education Foundation.

The Reading Education Foundation is an approved Educational Improvement Organization (EIO) through Pennsylvania’s Educational Improvement Tax Credit (EITC) program.

Respectfully,

Elliott Leisawitz, MD, RHS ’65, REF Board Member John Dethoff, MD, RHS ’70, REF Board Member

Visit ReadingEdFoundation.org to learn more!

Berks 1st mails more than 87,000 copies throughout all of Berks County. It is read in print and digital format by more than half the entire adult population of Berks County.

Advertise in the next issue of Berks 1st and reach engaged consumers who live and invest in your community!

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Mackenzie Donatelli is in her senior year at Ursinus College.

She plans to pursue a career in medicine.

Scan to read online!

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FALL 2023 | 31

M e d i c a l R e c o r d F e at u r e

Guest Editorial:

The Future of GME in Expanding and Improving Health Care

by Wei Du, MD, Senior Vice President, Academic Affairs, Tower Health

E

very September marks the beginning of a new residency recruitment season. While I take immense satisfaction in the recruitment achievements of our Tower Health Residency Programs and Fellowships, I am also acutely aware that numerous inspired medical students and international medical graduates were unable to find a position at the conclusion of each recruitment season, a concern compounded by the escalating physician shortage plaguing our nation. Previous reports indicate that the physician shortage could reach a staggering 124,000 by 2033. The COVID-19 pandemic further laid bare the vulnerability of our healthcare system’s staffing across the entire spectrum. Furthermore, burnout became a parallel crisis among physicians, especially the front-line providers.

It is important to recognize that efforts to address the national physician shortage were already underway long before the pandemic, including the establishment of sustainable pipelines through the creation of more medical schools. Between 2002 and 2019, forty-six new medical schools (allopathic and osteopathic) opened. Drexel University College of Medicine and Tower Health jointly opened a new campus in West Reading and welcomed the first class of 40 students in 2020. The American Association of Medical Colleges (AAMC) called for a 30% increase in medical student enrollment in 2006 as a response to the looming physician shortage. While medical school enrollments indeed surged, growing by 52% between 2002 and 2019, the adaptation of the GME (Graduate Medical Education) system to such an alarming shortage and expected growing number of residency applicants, particularly its funding mechanisms for residency and fellowship programs, has lagged behind. The number of training positions funded by the Centers for Medicare & Medicaid Services (CMS) has remained capped since 1997. Although recent legislative changes permit more targeted funding increases, such as funding programs in rural areas, the expansion of medical students has far outpaced the incremental growth in government-funded GME positions.

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The complexity of rectifying the GME funding mechanism is no secret, necessitating a multi-pronged approach involving legislative reform, healthcare system adjustments, and the full recognition of the well-documented benefits of GME programs. Addressing the physician shortage stands as one facet of the multi-dimensional mission and responsibility of the GME community.

Beyond alleviating this shortage, GME programs offer an array of benefits to hospitals, healthcare systems, and communities. Research has consistently demonstrated that hospitals with robust GME programs and educational roles achieve higher scores in key quality performance metrics, including mortality and morbidity rates, 30-day readmission rates, and length of stay. In community hospital settings, GME programs have been proven to enhance community engagement and healthcare access.

Furthermore, studies indicate that over 50% of medical trainees choose to practice and start families within proximity of their training locations.

Tower Health has made earnest efforts to attract our graduating trainees. Many of our faculty completed their training at Reading Hospital and St. Christopher’s Hospital for Children. In Berks County and Montgomery County, our teaching faculty, residents, and fellows are active participants in the Street Medicine programs at Reading Hospital and Pottstown Hospital, providing care and delivering medication to individuals who lack resources or are homeless on the streets. These efforts are truly making a positive difference in our community.

To cultivate capable physicians for the future, proactive adaptation to the rapidly evolving training landscape is imperative. Establishing an environment conducive to learning is paramount, one in which the upcoming generations of learners cannot only acquire clinical skills but also master communication and other “soft” skills that are often pivotal to their future success. GME programs must be firmly committed to creating such a nurturing culture and facilitating the growth of learners with an emphasis on diversity and inclusion in the recruitment process, while also

Great care for your patient starts with a strong team.

Adam J. Altman, MD Angela Au Barbera, MD Helga S. Barrett, OD Jennifer H. Cho, OD, FAAO Christine Gieringer, OD David S. Goldberg, MD, FAAP Marion J. Haligowski III, OD Dawn Hornberger, OD, MS Y. Katherine Hu, MD, MS Lucinda A. Kauffman, OD, FAAO Christina M. Lippe, MD Barry C. Malloy, MD Michael A. Malstrom, MD Mehul H. Nagarsheth, MD Abhishek K. Nemani, MD Tapan P. Patel, MD, PhD Jonathan D. Primack, MD Kevin J. Shah, MD Michael Smith, MD Anastasia Traband, MD Monica Wang, OD Denis Wenders, OD Linda A. Whitaker, OD, MS

With 20+ eye care specialists, Eye Consultants of Pennsylvania is the leading eye care practice in the region. Our doctors are always available for consults and referrals on eye issues, and our entire practice is committed to cooperative management of your patient. That means that we communicate and consult 360°. We share information, and we provide direct cell numbers to our partner physicians. And ultimately, it means better care and outcomes for your patients.

For consultations and referrals, call 610-378-1344.

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Offices in Wyomissing, Pottsville, Pottstown, Lebanon and Blandon

addressing ongoing wellness and mentoring needs for trainees.

It is essential that all GME programs, e.g., our Tower Health residencies and fellowships, continue to grow and flourish, with a primary emphasis on the communities we serve – remember our roots!

Dr. Wei Du is Senior Vice President of Academic Affairs, Chief Academic Officer, Designated Institutional Official, and Medical Director, Behavioral Health Service Line at Tower Health, and Professor of Psychiatry, Pharmacology and Physiology and Chair of Psychiatry Department at Drexel University College of Medicine.

FALL 2023 | 33

M edical R ecord F eature

BCMS Night at the Reading Fightin’ Phils On August 18, our members celebrated our 7th Annual Berks County Medical Society Night at the Reading Fightin’ Phils. It was a great night to sit back with colleagues, friends, and family to watch some great baseball and fireworks. Once again there was a great turnout by our exuberant Drexel/Tower Medical School students.

Thanks to all who came to make the night such a success!

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Check the expiration date on your Narcan opioid overdose reversal medication.

Visit cocaberks.org/narcan or scan here to order a free replacement or a new first-time kit.

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This project is made possible, in whole or in part, by funds received through the Berks County Opioid Settlement Agreement.

FALL 2023 | 35

We are happy to make time for your patients

Eye Emergencies Cataracts Glaucoma Diabetic Eye Exams Macular Degeneration

Yes, we can see your patients same day for emergencies and often same week for consults.

At BERKS EYE PHYSICIANS AND SURGEONS, we are happy to offer state-of-the-art and efficient care. Our doctors provide appropriate diagnosis and treatment, and fast feedback to you. Whether your patient has a sudden change in vision, cataracts, diabetes impacting vision, or even has a family history of glaucoma or macular degeneration, we would be honored to monitor and react to issues related to your patient’s eye health.

Left to Right: Domenic C. Izzo, Jr., MD, Benjamin Nicholas, MD, Francisco L. Tellez, MD, FACS, Kasey L. Pierson, MD, Peter D. Calder, MD, Guri Bronner, MD

610-372-0712 | berkseye.com | 1802 Paper Mill Road, Wyomissing, PA 19610 |