Fall2017

FALL 2017

Health LINES Penn Highlands Healthcare

Working together for a healthy community.

TeleID TeleNeurology Behavioral Health Tele-Assessment Stroke Alert Home Health Telehealth

FALL 2017 | PENN HIGHLANDS HEALTHCARE

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What Is A Family Medicine Resident?

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TeleNeurology

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TeleID

Behavioral Health Tele-Assessment

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Stroke Alert

Q&A - What Is An Advanced Practice Provider?

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New Faces

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ShortScripts

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Advice From A Doctor

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HealthLines is a publication of Penn Highlands Healthcare which includes the hospitals of Penn Highlands Brookville, Penn Highlands Clearfield, Penn Highlands DuBois and Penn Highlands Elk. It is produced quarterly by the system’s Marketing Team and is always available on our website at www.phhealthcare.org/magazine.

If you wish to subscribe to HealthLines electronically, sign up at www. phhealthcare.org/getmagazine. Printed copies may be found in the waiting rooms of Penn Highlands Healthcare facilities throughout the eight-county region and at several local businesses. You may pick one up at anytime.

CEO Perspective Technology is everywhere. We carry smart phones to be connected 24 hours a day. We can see each other via video chat on our tablets and laptops.

Today, Penn Highlands Healthcare is putting similar technology to work for you. In this edition, you will read how technology can be used to help diagnose and monitor patients for the best treatment possible. When time is of the essence, technology can bridge the gap to start treatments faster.

We are always working towards the best ways to care for our patients. This is just one of the many ways that we are always trying to be better tomorrow than we are today.

At Penn Highlands Healthcare, we are always striving to improve and be the best health system for the communities we serve. We value each of you, our readers, patients and staff, and our work is done with you in mind.

We hope that you enjoy this edition of our magazine and learn useful information about the advances in our health system Sincerely,

For more information, please contact the Marketing Team at HealthLines@ phhealthcare.org or call on weekdays from 8:00 AM to 4:00 PM. The Penn Highlands Healthcare HealthLines Team Mary Jo Yebernetsky, Writer/Editor, 814-375-3495 Mary Jo Herzing, Graphic Design/Web Specialist, 814-375-6539 Michele Yale, Marketing & Communications Coordinator, 814-375-3494 The information in this magazine does not take the place of health advice given to you by your healthcare provider. Always call 911 for any emergency.

Next time you’re online Be sure to visit www.phhealthcare.org also check us out on

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Steve Fontaine, CEO Penn Highlands Healthcare

PENN HIGHLANDS HEALTHCARE

Now offering Traditional and 3-D Mammography To schedule your appointment visit us at www.phheatlhcare.org/pink

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THE PATH TO BECOMING A DOCTOR Becoming a doctor typically requires nearly a decade of schooling, and ongoing training and education for years beyond that. Throughout this period, the most influential component for many young doctors is their time in residency. While most of us know doctors to be well-educated, dedicated, even prestigious figures, what actually goes into becoming a doctor is an intense grind. Here is a glimpse into the amount of training every physician receives and a closer look at medical residency — the final step between being a student and being a practicing doctor.

HOW SOMEONE BECOMES A DOCTOR It’s a long road to attaining a medical degree.

Here are steps doctors take to get there: BACHELOR’S DEGREE (4 YEARS) Anyone aspiring to be a doctor will have to earn an undergraduate degree. Many choose pre-med or another relevant, science-based discipline as their major, though doing so is not a requirement for medical school acceptance.

TAKE THE MCAT (MEDICAL COLLEGE ADMISSION TEST): This test is required for application and acceptance into medical school.

MEDICAL SCHOOL (4 YEARS) The first two years of medical school are dedicated to formal instruction about anatomy, physiology, psychology, biochemistry, pharmacology and ethics.

The second two years involve much more hands-on learning, as students begin the integration into the clinical environment at hospitals, clinics and laboratories.

Penn Highlands Healthcare is proud to be a community-teaching hospital and is happy to give patients the opportunity to be cared for by a family medicine resident.

What is a Family Medicine Resident?

After medical school, the doctor must complete a RESIDENCY. Residency training is intensive clinical training working with practicing physicians caring for patients, participation in medical research and ongoing study about diseases and treatments.

Residents have medical licenses issued by the state where they are training and have the ability to diagnose, prescribe medications, and order and interpret tests. Some residents may be trained to perform procedures. Family Medicine Residents spend at least three years in this additional training.

In addition to rotations with various specialists, family medicine residents see patients in a clinic setting, developing relationships with patients, performing preventative examinations, managing chronic medical problems and performing in-office procedures. They care for people of all ages. Residents are always supervised by a board certified family physician in the clinic setting.

All residents are supervised closely by their residency team and precepting doctors to ensure they’re being trained properly and attaining the necessary clinical skills.

GET LICENSED: Once they complete medical school, students will have to become licensed to receive their Doctor of Medicine degree (MD) or their Doctor of Osteopathic Medicine degree (DO).

RESIDENCY (3-5 YEARS) Residency is the final hurdle in being able to practice medicine without supervision.

FELLOWSHIPS (1-4 YEARS) Fellowships occur at the completion of residency training and are specific to the individual medical or surgical discipline.

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

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TeleNEUROLOGY

TELE HEALTH AT PENN HIGHLANDS HEALTHCARE What is Telemedicine?

Telemedicine is another way for Penn Highlands Healthcare to provide patients with quality care and allows them to see a specialist that is located in another city through a computer and special cameras. At Penn Highlands Healthcare, we partner with UPMC Telemedicine to provide this service.

With computers, cameras and other equipment, visits occur in patient rooms or the Emergency Departments with help from specially trained staff who operate the appropriate equipment.

Physicians and providers at Penn Highlands work hand in hand with specialists in TeleNeurology for neurological issues, TeleStroke for stroke symptoms and TeleID for infectious diseases and wounds.

Telehealth is also used in Behavioral Health Services and Home Health Services. Technology connects Penn Highlands staff to Penn Highlands staff or Penn Highlands staff to patients.

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Neurologists are doctors who diagnose, treat and manage disorders of the brain and nervous system. They work with patients who suffer from dementia, Alzheimer’s, Parkinson’s, epilepsy, migraine, ALS, multiple sclerosis, traumatic brain injuries, stroke and similar illnesses.

Penn Highlands Healthcare has a terrific team of neurologists on staff with offices in DuBois and St. Marys.

Being so in demand, they aren’t always easily available for quick consults at the four hospitals in our system – Penn Highlands Brookville, Penn Highlands Clearfield, Penn Highlands DuBois or Penn Highlands Elk.

So, what do we do?

According to Angela Rhodes, Telemedicine RN of Penn Highlands Healthcare, the answer is TeleNeurology.

Using technology similar to Skype, neurology doctors through UPMC MedCall provide patients with urgent and non-urgent consults while they are admitted to our hospitals.

Urgent consults will follow the TeleStroke process through UPMC MedCall. “This will get the UPMC physician on the video within minutes,” Angela said.

“Non-urgent consults take place between the hours of 8:00 AM and 5:00 PM, seven days a week,” Angela added. The request is made and the exact time is communicated to the Penn Highlands physician and primary nurse for the patient.

During the consultation, the doctor in Pittsburgh can see the patient, review vital signs and interact with the patient with the assistance of

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the nurse. The physician also is able to physically review the brain images that are electronically sent to UPMC. “Patients and families are impressed that the UPMC physician is able to actually see the images of the brain and not just read a report,” Angela said. “It’s another set of eyes reviewing the scans along with the radiologists.”

Why have neurology doctors ondemand? Because the need for neurologic care is increasing: • Stroke is ranked as the fifth leading cause of death in the United States.

• Alzheimer’s disease is ranked as the sixth leading cause of death in the United States.

• 5.4 million Americans are currently diagnosed with Alzheimer’s disease. The American Alzheimer’s association projects that the number will triple to 16 million by the year 2050.

• Parkinson’s disease affects 1 million Americans, with at least 60,000 new cases reported annually.

• According to a global study conducted by the World Health Organization, eight out of 10 disorders in the three highest disability classes are neurologic problems.

• In 2008, migraine-related headaches were the first-listed diagnosis for over 3 million emergency room visits in the United States (comprising 2.4 percent of all emergency room visits).

HOME HEALTH TeleHEALTH Some patients stay at home to recuperate from a surgery, accident or illness. They are not ill enough to be in the hospital, but they may still need a helping hand on the road to good health.

That is where Home Health Services come in, such as those from Penn Highlands Community Nurses.

Through PHCN Home Health, specially trained registered nurses, therapists and home health aides provide a wide range of skilled services.

But sometimes, Home Health turns to something other than people to help. They use telehealth monitors. Telehealth monitors are small machines that are programmed to monitor weight, blood pressure, oxygen level in their blood and vital signs. In addition, the patient or caregiver answers questions via the monitor that have been selected specific to that patient’s condition or illness.

Then the results are automatically transmitted to offices for a registered nurse to review.

Used in patients’ homes – just like that of Mark Sicheri Sr., 67, of Brockportthey help keep the healthcare providers apprised of patients’ basic-health measurements and health status during the time between visits.

On the days that Mark has no one visiting, he is still being checked.

At 9:00 AM each morning, the little telehealth monitor machine greets him.

He has been using the monitor for a month or so. “It’s easy to use. All you have to do when it comes on is stand on a scale and it tells you when to get off,” he said. Then it tells you to put a pulse oximeter on your finger or a blood

pressure cuff on your arm, and then push a button. It may also measure your sugar, or glucose, or listen to your heart.

additional home visits, a change in care or even hospitalization may be required.”

“It’s easy to operate. At the end, it asks a question,” Mark said. For him, it asks “Are you short of breath?” The question is tailored to the patient’s specific needs. It can also remind a patient to do something, like take his or her medications.

Monitoring can also gear education for patients to manage their symptoms and lead to healthier habits.

“Once collected, the data transmits over ordinary telephone lines or wirelessly,” Kristen Genevro, RN, BSN, Home Health Operations Manager for Penn Highlands Community Nurses, said. “Home Health nurses at an office read the measurements and assess the patient. If any of the information is out of line, the nurse will call the patient and the physician to determine how the problem can be resolved before it becomes serious.

This also prompts the staff as to when

For more information on telehealth monitors, call Penn Highlands Community Nurses at 1-800-841-9397

“The monitors don’t take our place,” Megan Dickinson, PHCN Home Health registered nurse, said. “It gives us current patient information every day. It complements our visits.”

“It gives peace of mind,” Mark said. “I don’t have to run to the doctor’s office to do the same thing…it is easy to have and it’s convenient.”

Mark Sicheri Sr. of Brockport and Megan Dickinson, RN

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TeleID Unfortunately, the smallest of creatures can be the greatest of enemies to the body. An invasion of an organism as small as a pinhead can lead to disease and infection.

When a patient has an infection in the hospital from anything MRSA, c-diff, wound infections, osteomyelitis, surgical site infections, Lyme disease or other infectious disease processes – the site of the infection must be treated and monitored.

To help diagnose and treat, it’s always best to have a physician who specializes in infectious disease, but there aren’t that many of that specialty.

That is why Penn Highlands Healthcare is working with UPMC Telehealth to provide TeleID to the patients on the floors of Penn Highlands DuBois West.

With help from Angela Rhodes, Telemedicine RN, patients are educated about telehealth and hear how the technology will work.

How does it work?

With TeleID, seeing up-close into a wound with a high-definition videoconferencing camera provides the physicians with a closer look than with the naked eye. The small microscope can go directly into an ear, mouth, nose or wound and display on a screen what is there, and it’s larger than life.

A UPMC TeleID specialist then reviews the patient’s information and images to relay recommendations to Penn Highlands providers.

timely treatment and improved outcomes,” Angela said. “We are pleased we can offer this and help our patients.”

One of the great things about telemedicine is the patient and family is able to see and talk with the physician.

Infectious disease consults take the longest because the physician takes the time and asks the patient tons of questions - to help determine the best treatment - and review the patients plan of care with them. Patients are impressed how thorough the physicians are.

And once a patient is discharged, follow up can be done by local physicians.

“With technology, patients are receiving

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The ID in TeleID is short for Infectious Disease Angela Rhodes, Telemedicine RN, uses telehealth equipment to show a specialist in Pittsburgh the wound of a patient at PH DuBois. The microscopic lens on the wound shows the doctor more on the computer screen than what can be seen with the naked eye.

Behavioral Health TELE-ASSESSMENT SERVICES At Penn Highlands Healthcare, mental health is just as important as physical health. When a person is having trouble with depression, anxiety or any other issue, he or she may need some time to have supervised care, which includes therapy time and perhaps help with regulating a medication.

Behavioral Health Services are provided at each Penn Highlands Healthcare hospital. There are inpatient geriatric units at Penn Highlands Brookville, Penn Highlands Clearfield and Penn Highlands Elk. The Adult Inpatient Unit and the Child/ Adolescent Inpatient Unit are located at Penn Highlands DuBois East.

When a patient is having a difficult time or is in a crisis, he or she may be taken to any of the four Emergency Departments of Penn Highlands Healthcare. While in the ED, an assessment is performed by the ED physician and a specific assessment is completed by a staff member with expertise in the mental health field – someone from Behavioral Health Services.

“Tele-assessment services are now provided within the Penn Highlands system through the Intake Department at Behavioral Health,” according to Arianne Zimmerman, Director of Clinical Operations, Behavioral Health Services. It is primarily used for patients who may qualify for care in the Adult Inpatient or Child/ Adolescent units.

“The Intake Department is stationed at PH DuBois East and is staffed by an intake therapist,” she said. “From there, the therapist completes a mental health assessment through iPad technology using an application called Jabber.”

Jabber is a secure video call system where the therapist can see the patient and the patient can see the therapist.

All of this is done with help from Emergency Department staff.

After the initial interview, the therapist provides the assessment to a psychiatrist who determines the course for mental health treatment. A patient could be admitted for inpatient care, discharged with instructions or transferred to another facility that meets the patient’s needs.

“The goal of implementing the teleassessment process is to increase admission efficiency and reduce the length of stay in the Emergency Department for the patient,” Arianne said.

Tele-assessment services started with Penn Highlands Brookville in December 2016, with Penn Highlands Clearfield in May 2017 and with Penn Highlands Elk in July 2017. “Hospitals and agencies outside of the system have also expressed interest in utilizing the tele-assessment services through PH DuBois,” Arianne said.

“We have received positive feedback regarding this new service from staff and patients. Through the teleassessment process, we eliminated unnecessary steps which previously caused delays in determining patient disposition,” she said.

During any mental health crisis, go to the nearest Emergency Department.

The four-hospitals refer to each other’s units based on the www.phhealthcare best location for a patient’s needs. With .org/ED the distance between them – especially with PH DuBois having the only adult and child/adolescent units – the Behavioral Health staff was looking for a quicker way to have someone assessed and on the road to better health.

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

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STROKE ALERT When you hear “Stroke alert!” paged overhead at a Penn Highlands Healthcare hospital, you might need to step aside. Stroke care at Penn Highlands Healthcare has been taken to the next level.

At all four Penn Highlands hospitals, a collaboration with UPMC for Telestroke services provides even faster times than before for diagnosis and treatment of stroke patients.

Why does faster matter? Because “time is brain and minutes matter,” according to Jolene Barbazzeni, RN, BSN, Stroke Care Coordinator for the system. And using technology is helping us save brain!

Care for stroke patients can start before arrival at the hospital. When a patient begins to experience symptoms of a possible stroke – sudden loss or slurred speech, weakness, facial droop, blurry or loss of vision or dizziness, 9-11 should be called.

Ambulance personnel are trained in life-saving measures. Many have Advanced Stroke Life Support, a newer certification specifically for care of stroke patients offered in this region through a partnership of Penn Highlands Healthcare and AmServ/ DuSan Ambulance of DuBois. EMTs and paramedics can assess the patient and relaying information to the nearest Penn Highlands Emergency Department, or ED. At the hospital, a stroke alert page is announced overhead. This will put a team into immediate action - Laboratory staff, CT staff and

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Emergency Department physicians and nurses will be on the move.

Upon arrival, blood work will be drawn, and the patient will immediately go to CT for a scan of the brain to identify any possible abnormalities.

“While the patient is being transported to CT someone is calling UPMC MedCall requesting a telemedicine stroke physician,” she said. When the patient returns, “the primary nurse will assist the UPMC stroke physician with the video examination.”

Through the use of face-to-face video capabilities much like Skype, a neurologist in Pittsburgh can be called upon within minutes to see a patient.

They are available around the clock and can see the same things that the emergency staff are seeing as it is happening.

The neurologists have the capability to zoom in to see a patient’s pupils and interact with the patient as if they were physically in the room and not miles away.

The Penn Highlands physician will also be present, and together, the two physicians will review the test and exam results in real time. Following the video exam the Penn Highlands physician and

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Stroke is now the FIFTH leading cause of death but remains the leading cause of disability. the UPMC stroke physician will discuss the plan of care.

Why is speed important? Upon the initial onset of a stroke, there is a limited time frame in which a clotbusting drug can be given to help minimize the long term affects of a stroke. “Every minute counts,” Jolene said. “The quicker a patient can get to the hospital, the sooner we can provide treatment for a better outcome.” If a clot-busting drug is to be administered, it must be done within three hours of the first stroke symptoms occurring if the stroke is caused by a clot. (Some strokes are caused by internal bleeding, and this drug cannot be used for those.)

Penn Highlands does have neurologists on staff, but their offices are located throughout the region and they cannot always be on hand. “Our neurologists are still involved in the patient’s care.

The telemedicine neurologist will see the patient while they are in the hospital recovering from the stroke, and Penn Highlands neurologists will continue to follow them long after discharge.” Jolene said. “Because stroke treatment is dependent on the amount of time that passes by, the telestroke service is used to help speed up the diagnosis and treatment to the patient, regardless of the time of day.”

“Improving the availability of stroke expertise will ensure the best outcomes for our patients,” Amy Powell, RN, Director of the Penn Highlands Brookville Emergency Department, said. “Twenty-four/seven bedside access to stroke experts has already proven beneficial to our patients. We recently had a patient with debilitating left sided weakness improve to complete recovery of all motor functions after receiving stroke reversal medication.

The partnership with UPMC Neurology

provides the best care to our patients and their families. We work together to determine the best treatment plan for the patient and strive to keep the care local, including rehabilitation services.”

Stroke care has been and always will be a priority at Penn Highlands Healthcare, according to Jolene.

“We always want to do what is best for our patients.”

WHAT IS STROKE? Stroke is a “brain attack” cutting off vital blood and oxygen to the brain cells that control what we do – speaking, walking and breathing.

Of the 795,000 strokes in the U.S. per year, 87 percent are classified as ischemic. An ischemic stroke occurs when a clot or a mass blocks a blood vessel, cutting off blood flow to a part of the brain.

Others are hemorrhagic stroke that occur when a weakened blood vessel, or cerebral aneurism, ruptures, spilling blood into the brain.

Know the signs of stroke. Think FAST:

• Face drooping - Does one side of the face droop or is it numb? Ask the person to smile. Is the smile uneven?

• Arm weakness - Is one arm or leg weak or numb? Ask to raise both arms or both legs. Does one drift downward?

• Speech difficulty - Is the person’s speech slurred? Is he or she unable to speak or difficult to understand?

• Time to call 9-1-1. If the person shows any of these symptoms, call. Get the person to the hospital immediately.

Beyond FAST, there are other symptoms to know.

They are:

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body.

• Sudden confusion, trouble speaking or understanding speech.

• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, loss of balance or coordination.

• Sudden severe headache with no known cause.

An estimated 7.2 million Americans age 20 and older have had a stroke.

Stroke is a leading cause of long-term disability and the leading preventable cause of disability. Stroke, or vascular dementia, is also a leading cause of memory loss.”

Penn Highlands DuBois received the American Heart Association/ American Stroke Association’s Get With The Guidelines®Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite. The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Hospitals must achieve 85 percent or higher adherence to all Get With The GuidelinesStroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke Quality measures to receive the Gold Plus Quality Achievement Award.

To qualify for the Target: Stroke Honor Roll Elite, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA. If given in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke.

PH DuBois earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These quality measures are designed to help hospital teams follow the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

PH DuBois has also met specific scientific guidelines as a Primary Stroke Center featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the Emergency Department. The Primary Stroke Center staff also collaborates with each hospital in the Penn Highlands Healthcare system. They, too, follow the same quality measures for stroke patients.​

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

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ASK THE EXPERT - What Is An Advanced Practice Provider?

Advanced practice providers, or APPs, have a significant role in providing patient care in hospitals, doctor’s offices and clinics across the region. Penn Highlands Healthcare employs APPs on its patient floors, in its Emergency Departments, operating rooms, physician offices and clinics.

An APP can be either a physician assistant - PA - or a certified registered nurse practitioner - CRNP. These providers are licensed by the State Board of Medicine and credentialed by the Penn Highlands Healthcare Medical Staff Office to practice medicine.

Our experts are answering questions about their roles and how they can help the patients they see.

CAN AN APP DIAGNOSE AN ILLNESS? APPs can diagnose illnesses. We do this in the same manner as a physician, which entails taking a complete history - past and present, reviewing body systems and vitals, conducting a physical exam and possibly ordering and interpreting tests or diagnostic studies. APPs are also able to develop treatment plans and provide health counseling when needed.

CAN AN APP PERFORM SURGERY OR OTHER PROCEDURES? APPs can perform procedures and assist in surgeries. In primary and urgent care, APPs suture lacerations, incise abscesses and perform skin biopsies. In the acute care setting, APPs insert central lines and place chest and breathing tubes.

APPs can act as a first assistant in the operating room with the physician present. The APP could clamp blood vessels, cut sutures or hold instruments.

An APP can work in orthopedics to repair broken bones, reduce dislocations, place splints and casts and perform fluoroscopy (use of x-ray to perform a procedure). APPs are involved in all specialties and the types of procedures they perform depend on the training and experience of the provider.

Seth Astorino, CRNP Certified Registered Nurse Practitioner Penn Highlands Elk Emergency Department 814-788-5895

Jared Ricotta, PA-C Physician Assistant QCare Moshannon Valley 814-342-1872

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CAN AN APP PRESCRIBE MEDICATION? Yes, APPs can prescribe medications. Nurse practitioners and physician assistants have collaborative agreements with a physician. Under this agreement, the APP and the physician have an understanding of the medications the APP is able to prescribe under their own license.

Additionally, most APPs have a DEA (Drug Enforcement Adminstration) number, allowing them to prescribe controlled substances as well. APPs have education in school regarding medication as well as continuing education to remain current on prescribing safely.

APPs are able to prescribe their patients the medications they need for various illnesses, acute and/or chronic.

Heather Griffith, FNP Family Nurse Practitioner Penn Highlands Family Medicine Allegheny Health Center 814-849-0990

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Can be either a physician assistant (PA) or a certified registered nurse practitioner (CRNP).

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Is a healthcare provider licensed by the state of Pennsylvania and credentialed by the Penn Highlands Healthcare medical staff to practice medicine.

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May practice in general medicine or any other medical or surgical specialty.

Duties may include:

• Getting medical histories and conducting physical exams.

• Diagnosing, treating and managing new and ongoing illnesses, injuries and diseases.

• Ordering and interpreting diagnostic tests and results such as labs and x-rays.

• Prescribing medications.

• Ordering therapies and other rehabilitation treatment such as physical, occupational and speech therapy.

• Performing minor surgeries and procedures.

• Working with doctors and other health care professionals.

• Referring patients to specialists as needed.

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CAN AN APP REFER PATIENTS TO SPECIALISTS WHEN NEEDED? Yes, APPs can refer patients to specialists. Although, there are limitations depending on what setting the patient is evaluated in. Personally, I work at QCare DuBois, and we do place referrals at times if necessary.

Unfortunately, some insurances do not cover a referral sent outside the patient’s PCP (primary care provider) office. In these circumstances a second referral needs to be placed by the PCP office, either by the doctor or the APP in that office for insurance purposes only.

Amanda Fremer, PA-C Physician Assistant QCare DuBois 814-371-2200

If you have any questions, please feel free to talk to your healthcare provider.

Visit us at www.phhealthcare.org/findadoc

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AT PENN HIGHLANDS

We’re proud to introduce the newest members of our healthcare team. They look forward to being there for your healthcare needs.

Nathan Scinico, PA-C Certified Physician Assistant Penn Highlands Family Medicine 1100 Million Dollar Highway St. Marys, PA 814-781-6758/814-781-3316

Bradley Shaw, CRNP Certified Registered Nurse Practitioner QCare DuBois 621 South Main Street DuBois, PA 814-299-7520 Walmart Clinic 20 Industrial Drive DuBois, PA 814-375-6072

Joshua Matonak, DMD Oral and Maxillofacial Surgeon Moshannon Valley Community Medical Building 271 Railroad Street Philipsburg, PA 814-375-0500

Find A Doctor Are you looking for a healthcare provider?

Do you want to know a little more about who your next appointment is with?

Penn Highlands Healthcare wants you to know all of your healthcare providers and who is available to help you with your healthcare needs.

Steven Iorfido, DO Interventional Radiologist Penn Highlands DuBois 100 Hospital Avenue DuBois, PA 814-375-3260

Erin Sager, PA-C Certified Physician Assistant The Heart Center Penn Highlands DuBois 100 Hospital Avenue DuBois, PA 814-375-7700

On our website, www.phhealthcare.org/findadoc, you can find a provider by name, by location, by specialty or by hospital. You can even search by gender. Also, a complete listing of all our providers is available by downloading our Physician Directory.

You can download the entire handbook, a specific search or a single page.

Speakers Bureau Suzanne Iorfido, DO Breast Radiologist Penn Highlands DuBois 100 Hospital Avenue DuBois, PA 814-375-3260

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Cydnee Sankey-Deemer, CRNP Certified Registered Nurse Practitioner QCare Moshannon Valley 271 Railroad Street Philipsburg, PA 814-342-1872

As the community’s resource for health information, Penn Highlands Healthcare is always pleased to provide speakers free of charge for your community organization or event.

To make this easier, we now have an online form to make a speaker request at www. phhealthcare.org/speakersbureau.

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Mandie Shaw, CRNP Certified Registered Nurse Practitioner QCare Moshannon Valley 271 Railroad Street Philipsburg, PA 814-342-1872

Alex Sossong, MD Emergency Medicine Physician Penn Highlands DuBois Emergency Department 100 Hospital Avenue DuBois, PA 814-375-3470

Timothy Vollmer, DO Interventional Pain Specialist Penn Highlands Interventional Pain Center Medical Office Building 761 Johnsonburg Road Suite 120 St. Marys, PA 814-788-8577

Conda Weimer, PA-C Certified Physician Assistant Penn Highlands Clearfield Emergency Department 809 Turnpike Avenue Clearfield, PA 814-768-2470

Michael Wingate, MD General Surgeon Penn Highlands General Surgery Penn Highlands Elk 763 Johnsonburg Road St. Marys, PA 814-781-1188

Penn Highlands DuBois Emergency Department 100 Hospital Avenue DuBois, PA 814-375-3470

Penn Highlands DuBois Medical Arts Building, Suite 313 145 Hospital Avenue DuBois, PA 814-375-4000

Penn Highlands Elk Emergency Department 763 Johnsonburg Road St. Marys, PA 814-788-5895

What is Sepsis?

Sepsis is a life-threatening condition. It happens when the body is overwhelmed by an infection and causes it to injure its own tissues and organs. It can even cause death.

Any type of infection that is anywhere in your body can cause sepsis. It is often associated with infections of the lungs/pneumonia, urinary tract, kidney, skin and digestive tract.

Troy Templeton, PA-C Certified Physician Assistant QCare Ridgway 104 Metoxet Street 1st Floor, Side Entrance Ridgway, PA 814-788-5556 QCare St. Marys Medical Office Building 761 Johnsonburg Road St. Marys, PA 814-788-8777

Anyone can develop sepsis from an infection, especially when not treated properly. However, sepsis occurs most often in people age 65 years or older or children less than one year old, have weakened immune systems or have chronic medical conditions.

Get treatment quickly if you have any of the signs of sepsis: • Shivering, fever or very cold • Extreme pain or discomfort • Clammy or sweaty skin • Confusion or disorientation • Shortness of breath • High heart rate See your doctor or visit the nearest Emergency Department immediately.

Can you prevent sepsis? Yes. Get vaccinated against the flu, pneumonia and any other infections that could lead to sepsis.

Talk to your doctor for more information.

Prevent infections that can lead to sepsis by cleaning scrapes and wounds. Take antibiotics as prescribed and only the ones prescribed to you. Also, practice good hand-washing at all times.

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

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Penn Highlands Community Nurses Hospice is coordinating its Tree of Doves for 2017.

ShortScripts

Trees are located in the atrium of Penn Highlands DuBois, 100 Hospital Avenue, DuBois. They will be adorned with doves representing a donation to the program.

100 Great Becker’s Hospital Review

Community Hospitals

Penn Highlands DuBois has been listed as one of the 100 Great Community Hospitals by Becker’s Hospital Review for the second year in a row.

Becker’s Hospital Review is a publication of Becker’s Healthcare, the leading source of cutting-edge business and legal information for healthcare industry leaders. For this list, 100 Great Community Hospitals in America, those mentioned are compiled through a lengthy research and review process.

“We are extremely honored to receive this award for the second time,” John Sutika, President of PH DuBois, said. “Our physicians and staff work tirelessly to care for our patients and provide the best care possible.”

Penn Highlands Healthcare offers online donations.

Visit us at www.phhealthcare. org/donate. You may then choose the hospital you wish to support, and then possible projects or funds are listed for you to further indicate where your donation should go. If you don’t see what you are looking for, you may choose “other” or “general fund.”

All contributions are tax deductible according to IRS regulations and are acknowledged for your records.

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Online Bill Pay Penn Highlands Healthcare is making it easier to pay your bill with online bill pay.

Visit us at www.phhealthcare.org.payyourbill You will be given the choice of the four PHH-system hospitals to choose from. Click on the correct hospital to pay your bill. You will need your access code which is located on your statement. The rest of the information is simple – the patient’s name, birth date and address along with payment information from a credit card.

Penn Highlands has My eHealth Portals available for all patients at www.phhealthcare.org/ myehealthportal.

Get your username and password at your next visit with your health provider.

Send an eCard - Penn Highlands Healthcare invites you to send some cheer to brighten the spirit of a loved one who is in the hospital! A free service, you can send an eCard to patients in any of our hospitals. www.phhealthcare.org/eCard

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Each dove will bear the name of someone special and the person who made the donation in his or her honor or memory. The doves are color coded with white for a memorial or red in honor of someone. Donors may ask for an American flag to be placed on a veteran’s or first responder’s dove.

Trees will be on display throughout the holidays through mid-January.

For more information, call 814-3753300.

Remember or honor someone special through the Penn Highlands Elk Auxiliary Christmas Trees.

For a $5 donation, a printed card with your loved one’s name will be placed on either the hospital or Pinecrest Manor lobby tree for the Christmas season.

For more information about this program, contact any auxiliary member or call 814-834-1646 or send a donation to the PH Elk Auxiliary, 763 Johnsonburg Road, St. Marys, PA 15857.

The 30th Annual Pinecrest Manor Bazaar will be held 9:00 AM to 4:00 PM, Sunday, November 19, 2017!

There will be crafts, a bake sale, a basket drawing, food and more.

All proceeds benefit the Pinecrest Manor residents, and this event is sponsored by the residents and the Activity Department staff.

It’s a great way to do some holiday shopping and support a great cause.

The 107th Penn Highlands Clearfield Charity Ball is scheduled for Saturday, December 9, 2017. The Snowball Masquerade will be $150 a couple with advance ticket purchases only.

Grand Opening December 2017

There is limited seating, and the PH Clearfield Auxiliary encourages everyone to reserve their spaces early. Admission includes a sitdown dinner and live band “Over the Influence” for your dancing and listening pleasure.

Invitations are mailed, however, one is not necessary to reserve your space. To make reservations, please call Gigi Gearhart at 814-592-7968.

Join the Penn Highlands DuBois Auxiliary for the annual Charity Ball! Held at the DuBois Country Club, the ball starts at 8:00 PM on Saturday, December 2, 2017 and lasts until 1:00 AM. Cost is $100 per couple, $50 per person or $25 per college student with ID. Dress your best or wear cocktail attire. Come enjoy the evening!

For more information or tickets, call Paula DuBois at 814-375-9622 or any auxiliary member.

Proceeds from this event and other auxiliary events benefit PH DuBois.

This year’s project for the auxiliary will go towards funding the purchase of a Heart-Lung Machine with Myocardial Protection System ®.

Next time you’re online, be sure to visit www.phhealthcare.org

QCare Clearfield Where is the nearest QCare Walk-in Clinic and when is it open?

QCare Cameron County 416 N. Broad Street Emporium, PA 15834 Monday - Friday 10:00 AM - 5:30 PM Closed Weekends & Holidays QCare Clearfield Clearfield Community Medical Building 1900 River Road Clearfield, PA 16830 Monday - Saturday 8:00 AM - 8:00 PM Sunday - 9:00 AM - 5:00 PM Closed Easter Sunday, Thanksgiving and Christmas Day QCare DuBois DuBois Community Medical Building 621 South Main Street DuBois, PA 15801 Monday - Saturday 8:00 AM - 8:00 PM Sunday - 9:00 AM - 5:00 PM Closed Easter Sunday, Thanksgiving and Christmas Day QCare Moshannon Valley Moshannon Valley Community Medical Building 271 Railroad Street Philipsburg, PA 16866 Monday - Saturday 8:00 AM - 8:00 PM Sunday - 9:00 AM - 5:00 PM Closed Easter Sunday, Thanksgiving and Christmas Day

QCare Punxsutawney Punxsutawney Community Medical Building 551 W. Mahoning Street, Punxy Plaza Punxsutawney, PA 15767 Monday - Saturday 8:00 AM - 8:00 PM Sunday - 9:00 AM - 5:00 PM Closed Easter Sunday, Thanksgiving and Christmas Day QCare Ridgway Penn Highlands Elk- East Campus 104 Metoxet Street, First Floor Ridgway, PA 15853 7 Days A Week 9:00 AM - 7:00 PM Closed Holidays QCare St. Marys Medical Office Building, First Floor 761 Johnsonburg Road St. Marys, PA 15857 7 Days A Week 9:00 AM - 7:00 PM Closed Holidays The Clinic at Walmart Operated by Penn Highlands DuBois 20 Industrial Drive DuBois, PA 15801 Monday - Saturday 8:00 AM - 8:00 PM Sunday - 9:00 AM - 5:00 PM Closed Easter Sunday, Christmas Day and Thanksgiving

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

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Advice From A DOCTOR Matthew Bridgman, PhD Penn Highlands Neurology 814-375-2070

CONCUSSION AND STRESS Most concussions resolve pretty quickly and without much more than a few days of “taking it easy”. This is quite fortunate and encouraging.

Unfortunately, “most” does not mean “all”. There are unfortunately times when concussions and their associated symptoms do not recover so quickly or easily.

To help, there is The Penn Highlands Concussion Clinic to provide quick access for managing concussion symptoms.

Dr. Chris Varacallo and I staff the clinic while working closely with physical therapists, licensed athletic trainers and others.

Although many factors can be involved in prolonging recovery, stress is one of the biggest.

Stress is a physical issue that needs our attention. Let me rephrase that. High stress is a physical issue that needs our attention. Stress is a part of life. A low level of stress is healthy, and short

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periods of high stress can also be good for us; however, frequent or chronically high stress causes big problems and should not be ignored or minimized.

Constant high stress makes many physical conditions worse. Migraines, multiple sclerosis, hypertension and other medical conditions can all be made worse by high levels of stress.

Similarly, stress affects concussion. In my experience, high levels of stress slow down and complicate recovery from concussion.

Because of this, managing stress is an extremely important part of recovering from concussion. This is especially true if there are balance, vision or headache issues that are already a little slow to resolve.

So how do you do it? Realize that we use the word stress to refer to two things: the problems we are dealing with and our body’s reaction to those problems.

Managing stress involves addressing both issues - addressing the problems directly by formally treating the concussion with a concussion specialist, and addressing our body’s reaction to those problems, which is tension.

When we have many problems in life, a lot of stress in life, our body reacts by becoming more tense. This increased

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tension is not simply muscle tension, but can also involve blood pressure changes, heart rate changes, blood flow changes, hormone changes (like adrenaline) and even changes in digestion.

A healthy stress management plan therefore involves doing things to reduce body tension. This can be done in thousands of ways, such as taking a hot shower, getting a massage, engaging in meditation or a relaxation technique, taking a walk outside, getting good sleep or distracting ourselves with a good book or movie. Using positive self-talk or reminding yourself constantly that you will recover and these problems will go away is also extremely important.

When stress is high, strategies such as these need to be used more frequently than usual in order to keep that tension in check.

If you or someone you know is struggling with concussion and stress, contact me, a neuropsychologist and concussion specialist at Penn Highlands DuBois, at 814-375-6379 for more information.

FOR AN APPOINTMENT,

Call the Concussion Clinic at 814-375-6200