HEADMASTERS THE NEW TEMPLE HEAD & NECK INSTITUTE

EPIGENETIC THERAPY A SEA CHANGE FOR CANCER? AGENDA Temple Health Magazine

EDITOR Giselle Zayon [email protected] Health Magazine

DESIGN & ART DIRECTION B&G Design Studios

TWRITERSemple & CONTRIBUTORS HealthMagazine Christopher Guadagnino Rebecca Harmon Eliza Ludwig Meredith Mann Bradley Porter Kara Rogers Ilene Raymond Rush Younndia Rush Jeremy Walter

ADMINISTRATION Alan N. Rosenberg, Esq. Senior Vice President/ Doctoring: True to Essence Chief Administrative O‹cer Christopher Guadagnino, PhD n May, I will have the privilege of conferring the MD degree on the first group Interim Lead, Communications

of medical students I welcomed to Temple when I joined the organization CONTACT US four years ago. I promise you a topnotch medical education, I told them. O‹ce of Communications I promise you the knowledge and skills befitting the title “doctor.” 3509 N. Broad Street Philadelphia, PA 19140 Over time, I watched this group of students develop into true professionals, 215-707-4839 absorbingI concepts and practicing techniques. I also watched some of them struggle. No matter how hard they worked, their faculty — and especially their patients — seemed TempleHealth.org to want something more. 1-800-TEMPLEMED In time, those students recognized what was missing — and then realized that it had Temple University School of Medicine actually been there all along: the very thing that called them to medicine in the first Temple University Hospital place, that innate desire to help and heal. And thus young professionals learn medicine’s Temple University Hospital Episcopal Campus most sacred lesson: patients assume their physicians are competent. But they need to Temple University Hospital know that we care. Northeastern Campus Fox Chase Cancer Center In May, at graduation, I will encourage the Class of 2015 to keep doctoring from this Fox Chase Cancer Center very deep core. It will distinguish every chapter of your career, touch every patient you at Buckingham Fox Chase Cancer Center touch, I will tell them. It’s been the essence of doctoring since ancient times — and will Medical Group remain so, no matter what changes in health care may unfold. Jeanes Hospital Temple Health Oaks Temple Health Center City Temple Health Women’s Care at Elkins Park Temple Health Ft. Washington Temple ReadyCare Temple Physicians, Inc. Temple University Physicians Temple Transport Team

Temple Health refers to the health, education, and research activities carried out by the a‹liates of Temple University Health System, Inc. (TUHS), and Temple University School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member Larry R. Kaiser, MD, FACS organizations or independent health care Senior Executive Vice President for Health Sciences, Temple University providers a‹liated with TUHS member organizations. Each TUHS member Dean & Professor of Surgery, Temple University School of Medicine organization is owned and operated

LOBBY: JOSEPH V. LABOLITO; KAISER: DOMINIC EPISCOPO LABOLITO; V. JOSEPH LOBBY: President & CEO, Temple University Health System pursuant to its governing documents.

SPRING 2015 | TEMPLE HEALTH MAGAZINE | 1 28

DNA: CLINT BLOWERS; TOP RIGHT: JARED CASTALDI; BOTTOM LEFT: SERGE BLOCH; BOTTOM RIGHT: DREAMSTIME illustrated by SciePro ON THE COVER: Havoc wrought by chronic overeating, 40 AlumniNews News Roundup 4 Larry Kaiser, MD, FACS 1 IN EVERY ISSUE The Ultimate Selfie 45 ArtfulEnding Quips andCounts Noted44 So Farewell, “Old Med” 38 Sewing Lesson: Surgical Needles &Suture 36 Tools oftheTrade Marla Wolfson: Liquid Air 34 Quest Scott Charles: Anti-Gun Violence Agent 32 Change DEPARTMENTS BY KARAROGERS A Sea Change for Cancer? 28 BY GISELLEZAYON At-Risk Patients Population Health Programs for 24 BY STEVEN MD ZUNIGA, A Resident’s Story The Head &NeckSpecialty: 20 BY KARAROGERS On theMarch to End Amputation 16 BY GISELLEZAYON Overeating-Related Disease A Full-Service Menufor 10 FEATURES Agenda Currents Timeline Saving Steps Gut Reaction Epigenetic Therapy Home Delivery Headmasters 20 SPRING 2015 SPRING 2015 7 CONTENTS | TEMPLE HEALTH MAGAZINE 32 |

3 EDUCATION & ENGAGEMENT RESEARCH & CLINICAL CURRENTS APPOINTMENTS & ACCOLADES

Close to the Far East Expanding its prominence as a collaborative part- ner for medical educa- CURRENTS tion and research in Asia, Temple University School of Medicine has established an a
liation with Fu Jen Catholic University School At Your of Medicine in Taiwan. The five-year agreement Service reserves four MD-PhD program slots per year at CONCIERGE SERVICE Temple for Fu Jen students HONORED (who will earn their MD from The concierge service managed Fu Jen and their PhD from by Temple University Physicians Temple), and also features Susan Fisher, PhD is the first Philadelphia health- a medical student exchange care organization to be accepted program for six students at into the National Concierge each institution per year. Association, “a distinction we’re The new a
liation fol- honored to receive,” says Lisa Fino, lows in the footsteps of the On Trial Chief Operating O‹cer, Temple partnership forged in 2013 University Physicians. Membership, with China’s Jiao Tong Uni- esearch is the linchpin to progress in with industry sponsors, manage regulatory which is reviewed annually, is versity School of Medicine medicine — especially clinical research, compliance processes, and provide services like contingent on maintaining high in Shanghai — an alliance R which moves innovations from the bioinformatics support. standards. “In addition to helping that’s seen much growth and laboratory into testing with real patients. Two make physician appointments activity, including two cross- new initiatives continue to intensify the power BE THE BREAKTHROUGH: Last summer, for our guests, we assist with hotel cultural academic symposia of Temple’s clinical research engine: Fox Chase launched “Be the Breakthrough,” a and travel plans. We even escort held last fall, one at Hong patient-focused campaign designed to increase patients to their physicians’ o‹ces,” Kong Adventist Hospital INSTITUTE ESTABLISHED: “Each step of the awareness of clinical trials for cancer among pa- Fino says. and another in Shanghai at clinical research process — from conceptualiza- tients, caregivers, and families. Since its launch, Jiao Tong University’s Renji tion of an objective to dissemination of study approximately 60 percent more patients have RAPID ACCESS AT Hospital. Both showcased results — must be supported by a system that been enrolled in clinical trials at Fox Chase than FOX CHASE next-generation innovations optimizes e‹ciency, productivity, and quality,” during the previous year. “Clinical trials have the Taking patient-centered respon- that are changing the way says Susan G. Fisher, PhD, Director of the newly potential to result in better treatments and out- siveness to the next level, Fox medicine is practiced in the created Temple Clinical Research Institute. comes” says Evelyn Gonzales, Senior Director of Chase Cancer Center now o”ers 21st century. Investigators now have ready access to a team Health Communications and Health Disparities. physician appointments to new The Shanghai symposium focused on accelerating the process, with sta” Approximately 325 clinical trials are active at patients within 24 hours of their was held in conjunction to coordinate projects, foster partnerships Fox Chase at any given time. first call. “Patients should not have with the 170th anniver- to wait several days to see a cancer sary celebration of China’s specialist,” says Richard Fisher, second-oldest western-style MD, President and CEO of Fox healthcare facility, Renji Chase. Through the Rapid Access Hospital. Hong Kong’s Sec- Dual Roles as CEO Service, new patients are seen retary for Food and Health, within 24 hours of their first call (or Dr. Ko Wing-man, was the Marc Hurowitz, DO, FAAFP, has been named CEO of Jeanes Hospital. on Monday if they call on Friday) — guest speaker of honor, A physician executive with over two decades of leadership experience, even if they don’t have a definitive and Temple’s Larry Kaiser, Hurowitz joined Temple in 2009 and concurrently serves as CEO of diagnosis yet. Since the program MD, FACS, was the only Temple Physicians, Inc., the Health System’s network of community- was launched in March 2014, Fox American medical school based physician practices. At Jeanes, he succeeds Linda Benfield Chase has seen a significant in- dean invited to speak at the Grass, MBA, FACHE, who was CEO for 12 years, and in all devoted three crease in new patient appointments. event, which attracted inter- decades of outstanding service to Jeanes in a variety of positions.

ANN CUTTING BURKE DAN FISHER & HUROWITZ: national dignitaries.

4 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 5 RESEARCH & CLINICAL CURRENTS

Lung Update FIRST-EVER GUIDELINES Cancer Notes Last fall, the American College of Chest Physicians SKIN PAIN & ITCH lymph nodes from other parts of a patient’s and the Canadian Thoracic Research led by Gil Yosipovitch, MD, Director body to the a” ected area to help drain excess Society released new guide- of the Temple Itch Center, found that itching or lymphatic fl uid. lines for COPD. “Previous pain in a suspicious skin lesion could indicate guidelines addressed man- skin cancer. In his study, published by JAMA RESTAGING CANCER agement of COPD exacerba- Robotic Dermatology, nearly 37 percent of skin cancer The National Comprehensive Cancer Network tions. The new ones aim to Advances lesions were accompanied by itching, while 28.2 Soft Tissue Sarcoma Panel, chaired by Margaret prevent them,” says Temple percent involved pain. Basal cell and squamous von Mehren, MD, Director of Sarcoma Lung Center Director Gerard Last summer, surgeons at cell carcinomas are more likely than melanoma Oncology at Fox Chase, issued updates to the J. Criner, MD, FACP, FACCP, Temple University Hospital to involve itch or pain. Skin cancer is the most soft tissue sarcoma guidelines — specifi cally who chaired the panel that performed the Philadelphia common cancer in the United States, with with regard to preoperative radiation therapy developed the guidelines. region’s fi rst surgery using more than 3.5 million non-melanoma lesions and genetic testing and counseling. Another COPD is the third-leading the new da Vinci® Xi™ diagnosed annually. Fox Chase expert, Richard Bleicher, MD, Co- cause of death in the U.S. Surgical System, a suc- Leader of the Breast Cancer Treatment Team, and the fourth in Canada. cessful minimally invasive LYMPHEDEMA TREATMENT published a study in the Journal of the American robotic mitral valve repair. Fox Chase is one of only two institutions in College of Surgeons recommending that breast PROMISING NEW DRUGS The new robotic technology the Philadelphia region to o” er an innova- cancer staging criteria be changed, too. His Heart and Vascular Institute Two new investigational has broader capabilities Directors, Drs. Eric Choi, T. Sloane tive surgery called vascularized lymph node study notes that patients whose breast tumors Guy, and Daniel Edmundowicz. drugs that could be game- and features not previ- transfer, a new treatment for lymphedema, have spread to the skin are automatically diag- changers for idiopathic ously available, including the painful fl uid build-up and swelling in soft nosed as stage III (advanced cancer with a rela- pulmonary fi brosis (IPF) are advanced endoscopic body tissues common among patients who tively poor prognosis), a classifi cation Bleicher being o¢ ered by Temple in digital architecture; smaller, have had lymph nodes removed during cancer fi nds outdated and unduly grim. “The tumor’s an expanded access program thinner arms with greater treatment. Sameer Patel, MD, and Eric Chang, size — and whether it has spread to underarm New Home Base for Temple in advance of the drugs’ FDA range of motion; and longer MD, who specialize in plastic and reconstruc- lymph nodes — are more important predictors approval. Both pirfenidone instrument shafts for tive surgery for cancer patients, transplant of survival than skin involvement,” he says. (InterMune) and nintedanib greater operative reach. Heart and Vascular Institute (Boehringer Ingelheim Phar- In another advance in maceuticals) show promise surgical robotics, Temple ith the opening of • Next-generation cardiac monitoring with the in slowing the progression of recently became one of a our new facility, we smallest implantable device available — a moni- IPF, a debilitating condition handful of hospitals in the now have physical tor just one-third the size of an AAA battery. that a¢ ects about 140,000 country using the new space refl ective of Americans. “Previously, there da Vinci EndoWrist® our world-class • The City of Philadelphia’s only program for wasn’t e¢ ective drug therapy Stapler, a high-precision, “Wcapabilities in heart and vascular care,” says familial cardiomyopathy, which o” ers special- for IPF,” Criner said. computer-guided device Daniel Edmundowicz, MD, FACP, FACC, ized services such as a minimally invasive robotic that helps surgeons improve Medical Director of the Temple Heart and approach to septal myectomy surgery, which DRUG FOR EMPHYSEMA patient outcomes. Vascular Institute. “Centralizing our experts reduces the bulk of hypertrophic muscle and Temple is one of four medi- and technologies in one location optimizes care improves the ability of the heart to pump blood. cal centers in the country and convenience for our patients — and stream- to take part in a three-year lines our clinicians’ ability to provide prompt • The region’s only hybrid operating room dedi- National Institutes of Health diagnoses, timely interventions, and e” ective cated exclusively to cardiac electrophysiology, study that is testing whether LAST YEAR, ALUMNI, treatment and follow-up care.” where patients with heart-rhythm problems are ibuprofen can reverse the FACULTY & FRIENDS One of the most respected heart programs treated with state-of-the-art devices to ablate e¢ ects of emphysema, which DONATED in the Delaware Valley, the Institute o” ers the cells where electrical disturbances originate. a¢ ects about 3.1 million full range of treatment options for patients with Americans. “If this treat- heart disease. Its innovations include: • Total heart transplantation and implantation ment is successful, it could restore lost lung function $32.6 of devices that serve as a lifeline for patients • Minimally-invasive, endovascular approaches awaiting a donor heart — including ventric- and change the course of MILLION TO to the treatment of thoracic aortic aneurysms ular-assist devices for patients with either left treatment for millions,” says TEMPLE’S HEALTH with devices such as stents with special “an- or right ventricle failure — and total artifi cial Criner, the trial’s local princi- ENTERPRISE

choring” technology. hearts for patients with failure of both. pal investigator. LABOLITO V. JOSEPH DOCTORS: SKIN: DREAMSTIME INC. INTUITIVE SURGICAL, COURTESY TOOL: ROBOTIC

6 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 7 APPOINTMENTS & ACCOLADES

What an Honor New Leaders Hot Numbers Wafik El-Deiry, MD, PhD, Tasuku Akiyama, PhD, is recipient of the 2014 Robert Lux, Senior Vice President and Health FACP, an international Ronald Dubner Research Prize of the Inter- System CFO, was named one of Becker’s Hospi- leader in translational re- donor awareness and designa- national Association for the Study of Pain tal Review’s 150 “Hospital and Health System search, has been appointed Top 100: tions among patients and 1 of 44: — an honor that’s been awarded to only 10 CFOs to Know” for 2014, signifying excellence Deputy Cancer Center Discover Magazine listed their families. For the second consecutive researchers in the world since 1993. in financial management. Director for Translational Glenn Gerhard, MD the news of Temple’s HIV- year, the Joint Commission Akiyama is Assistant Professor of Research and Co-Program eradication research among its named Temple University Dermatology and Anatomy & Cell Stephen Permut, MD, JD, has been Leader in Developmen- “100 Top Stories of 2014.” 2 of 40: Hospital among the nation’s Biology. His research focuses on the appointed Chair-Elect of the Ameri- tal Therapeutics at Fox Genomics Only 40 American Top Performers on Key neural mechanisms of itch and pain. can Medical Association, the nation’s Chase Cancer Center. Most Jumpstart Cancer Society Research Quality Measures. It is one largest and most influential physician recently, El-Diery served as Top 5%: Professorships exist in the of just 44 hospitals in the N. David Charkes, MD, was honored organization. Permut is Chair of Family Chief of the Hematology/ Glenn Gerhard, MD, a trans- Temple University Hospital- nation at any one time. nation — and one of four in with the 2014 de Hevesy and Community Medicine and Oncology Division at Penn lational genomics expert, has Episcopal Campus earned Two of them are currently Pennsylvania — to not only Nuclear Pioneer Award former Senior Associate Dean of State University’s Milton S. joined Temple as the Joseph the 2014 Press Ganey held by Temple faculty: meet, but exceed, the rigorous of the Society of Nuclear Academic A‹liations at Temple. Hershey Medical Center. He and Rebecca Goodfriend Guardian of Excellence Wafik El-Deiry, MD, PhD, thresholds required. Medicine and Molecular was also Associate Director Endowed Chair in Genetics. Award — sustaining scores and Jean-Pierre Issa, MD. Imaging, recognizing Elias Siraj, MD, FACP, FACE, for Translational Research His recruitment — and the in the top five percent of all his outstanding con- received the American As- at the Penn State Hershey establishment of a new De- inpatient behavioral health Top 100: tributions to the field. sociation of Clinical Endocri- Cancer Institute. partment of Medical Genet- hospitals in the nation. 1 of 7: Fox Chase Cancer Center Charkes is Emeritus nologists’ Outstanding Service ics and Molecular Biochemis- Seneca Harberger, a fourth- is one of Becker’s Hospital Professor of Radiol- Award for significant con- Herbert Cushing, MD, FACP, try, was supported by a $6.9 year medical student at Review’s “100 Hospitals and ogy and Professor tributions to endocrinology has been appointed Chief million bequest from Vera No. 1: Temple University School of Health Systems with Great of Medicine. education in Ethiopia. Director Medical O
cer of Temple Goodfriend, a 1940 graduate Temple University Hospital Medicine, has been named Oncology Programs,” 2014. of the Endocrinology Fellowship University Hospital. As of Temple’s College of Educa- was named Pennsylvania’s a Pisacano Scholar by the In addition, last year U.S. John Davidyock, Program at Temple, Siraj played senior physician executive, tion. From risk assessment top-ranked hospital in the American Board of Family News & World Report named MD, SFHM, has been a key role in the launch of he will provide strategic in healthy individuals to 2014 Pennsylvania Donate Medicine. He is one of just Fox Chase Cancer Center one honored as the tri-state Ethopia’s first endocrinol- and clinical oversight for genome-guided treatment Life Hospital Challenge, for its seven medical students in the of the top 20 cancer hospitals region’s Top Academic ogy fellowship training functions related to qual- for patients with complex success in increasing organ nation to be selected last year. in the United States. Hospitalist by the Society program. ity, safety, value, popula- diseases, the exploding field of Hospital Medicine. tion health, and physician of genomics is opening new Davidyock is Chief of the David Wald, DO, received the engagement. Before coming territory in nearly every Section of Hospital 2014 Distinguished Educator to Temple, Cushing was aspect of medicine. Gerhard Medicine and Vice Chair Award of the Clerkship Direc- Indiana University Hospital’s comes to Temple from Penn Guiding National Research of Patient Safety and Quality tors in Emergency Medicine, Chief Medical O
cer. He State College of Medicine Improvement at Temple a national organization com- was also Indiana University where he was Co-Director Seasoned experts, such as the Temple faculty listed below, are invited to serve on panels of the University Hospital. mitted to enhancing medical School of Medicine’s Associ- of the Penn State College Center for Scientific Review, the gateway for peer-review of research grant applications submitted student education in emer- ate Dean of Student A¢airs. of Medicine Institute for to the National Institutes of Health and other federal agencies: Hormoz Ehya, MD, Chief of gency medicine. Personalized Medicine. Cytopathology at Fox Chase James Helstrom, MD, MBA, Joseph Cheung, MD, PhD Electrical Signaling, Ion Transport & Arrhythmias Study Section Cancer Center, received the Robert Uzzo, MD, FACS, received has been named Chief Edna Cukierman, PhD Tumor Progression & Metastasis Study Section 2014 L.C. Tao Educator Award the 2014 American Urologic Medical O
cer at Fox Chase Doina Ganea, PhD Cellular & Molecular Biology of Glia Study Section of the American Cytopathology Association’s Residents’ Commit- Cancer Center. In this role, Thomas Gould, PhD Neurobiology of Motivated Behavior Study Section (Chair) Society. This award recognizes tee Teaching Award, recognizing he will provide leadership, TEMPLE UNIVERSITY Jean-Pierre Issa, MD Molecular & Cellular Hematology Study Section exemplary contributions to outstanding urology educators. direction, and planning for HEALTH SYSTEM Suzanne M. Miller, PhD Behavioral Medicine, Interventions & Outcomes Study Section cytopathology education. Uzzo is Chair of the Department of the Center’s clinical activi- IS A Deborah B. Nelson, PhD Infectious Diseases, Reproductive Health, Asthma & Pulmonary ties and oversee its quality, Surgery and the G.W. Pepper Chair Conditions Study Sections Larry R. Kaiser, MD, FACS, in Cancer Research at Fox Chase. performance improvement, Michael Ruggieri, PhD Urologic & Genitourinary Physiology & Pathology Study Section Temple University’s health sys- and patient safety pro- Rosaria Scalia, MD, PhD Integrative Physiology of Obesity & Diabetes Study Section grams. An anesthesiologist $1.8 tem CEO and medical school Tomasz Skorski, MD, PhD Tumor Cell Biology Study Section dean, was named one of Becker’s Elias Siraj, MD, FACP, FACE with solid healthcare busi- BILLION Hospital Review’s top 100 “Phy- ness acumen, Helstrom has ACADEMIC HEALTH Xiao-Feng Yang, MD, PhD Atherosclerosis & Inflammation of the Cardiovascular System Study Section sicianTK Name, Leaders MD, ofPhD Hospitals and been on sta¢ at Fox Chase SYSTEM

Health Systems,” 2014. since 2008. LABOLITO V. JOSEPH BRANDENBERG RYAN

8 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 9 A FULL-SERVICE MENU FOR OVEREATING-RELATED DISEASE

veryone knows that Americans like to eat. According to the Journal of the American Medical Association, more than 78.6 million American adults are obese. Likewise, most of us know that obesity translates into higher rates of type 2 diabe- Etes, high blood pressure, and a host of other problems. But less well-publicized are the eŒects of overeating on the engine of digestion itself — the stretch of the body that includes the esophagus, stomach, pancreas, liver, gallblad- der, biliary tract, small intestine, and colon. “A properly functioning gastrointestinal tract is the keystone of good health,” says Oleh Haluszka, MD, Chief of Gastroenterology and Professor of Medicine at Temple.

BY GISELLE ZAYON ILLUSTRATIONS BY SCIEPRO GUTTER CREDIT HERE CREDIT GUTTER HERE CREDIT GUTTER

10 | TEMPLE HEALTH MAGAZINE | SPRING 2015 FALL 2013 | TEMPLE HEALTH | 11 Continual overeating, Haluszka says, stresses the entire gas- GI disease aŒects one out of every three Americans, claiming trointestinal (GI) tract, overworking and damaging its organs. more than 200,000 lives each year. Combatting these compli- “The body was not made to handle large quantities of food,” he cated conditions is the job of the nationally known Digestive says. “Moreover, eating too much ‘healthy’ food is just as bad as Disease Center at Temple. “Patients come to us with a wide too much ‘junk’.” range of issues, both common and rare,” says Haluszka. “To When we eat too much, food can stretch the stomach. Fatty diagnose and treat them, we perform approximately 10,000 foods slow down the stomach’s ability to empty, making us feel endoscopic procedures per year.” bloated and nauseated. Over time, overeating, (particularly Recognized by U.S. News & World Report as among the best overindulgence in things high in fructose and sucrose) leads to in the region in this specialty, Temple has earned a reputation far-ranging consequences for the entire GI tract, not to mention for excellent, innovative care for all types of gastroenterological excess body fat. disorders — including those related to overeating itself. Overeating, especially when it comes to too much meat, is particularly hard on the liver, the organ that digests fat, stabilizes blood sugar and cholesterol levels, and detoxifies the FIRST STOP, ESOPHAGUS blood. Over time, the liver itself can become fatty, a condition common and distressing condition linked to presaging nonalcoholic steatohepatitis (NASH), which can lead overeating and obesity is GERD, in which refluxed to liver failure or liver cancer. stomach content causes the lining of the esophagus channel to speed emptying — With millions more Americans diagnosed every year, type to “burn.” The resultant damage sometimes leads or performs surgery to adjust 2 diabetes is the probably the most prevalent and alarming to Barrett’s esophagus, a precancerous condition in the overly constricted muscle. consequence of overeating. The risk of diabetes rises as body Awhich the cells lining the esophagus actually change in char- Frequently, the condition im- mass index increases. Diabetes results when the pancreas acter. About five to ten percent of people with GERD develop proves with the installation of a exhausts itself attempting to keep high blood-glucose levels Barrett’s esophagus, which places them at risk of developing gastric pacemaker that stimu- in check. And diabetes, of course, ushers in a host of serious esophageal cancer. lates the stomach to empty. health problems itself. “The more reflux, the more risk of developing Barrett’s One of the largest centers for Even the most obvious vestige of overeating, accumu- esophagus, and the more risk of developing esophageal cancer,” gastric motility in the country, lated body fat, imperils the digestive system, Haluszka says. says Michael S. Smith, MD, MBA, Medical Director of Temple’s Temple’s gastric pacemaker Abdominal fat increases the probability of gastroesophageal Esophageal Program and Associate Professor of Medicine. program is among the busiest reflux disease (GERD), which in turn can lead to a precancerous Smith uses cutting-edge techniques to detect and remove the nation. condition called Barrett’s esophagus. Excess body fat can also precancerous cells from the esophagus. So, in addition to “Patients are referred to us be a factor in gastroparesis, delayed emptying of the stomach. employing traditional endoscopic forceps biopsies to look for because we have access to in- “Eventually, overeating can cause every organ in the body to Barrett’s cells that may be undergoing dysplasia, or advanced vestigational medicines that are malfunction,” Haluszka notes. precancerous changes, Smith employs a high-tech method not available at most hospitals,” called WATS3D, wide-area transepithelial sampling with Parkman says. One such drug computer-assisted three-dimensional analysis. After a special is domperidone, which speeds stiŒ-bristled brush removes hundreds of thousands of esopha- up stomach emptying. Another, geal cells for testing, advanced computer technology is used to apretitant, is currently approved identify the 200 most abnormal-appearing cells to determine for chemotherapy-induced whether dysplasia or cancer is present. “The WATS3D brush im- nausea. Parkman is determining proves our ability to detect cancer or dysplasia up to 65% when its e¤cacy for nausea related to it is added to standard forceps biopsies,” Smith says. combination with radiofrequency ablation or cryotherapy for gastroparesis. Another, metoclopramide, can be delivered by Smith also utilizes volumetric laser endomicropscopy, in patients with more advanced disease. “These less-invasive op- nasal spray to help with nausea, heartburn, and vomiting. “Since THE BODY WAS NOT which a special laser device scans the walls of the esophagus for tions have largely replaced surgical removal of the esophagus patients with gastroparesis have trouble digesting medications microscopic signs of precancerous change. “In a short period as the preferred method for dealing with precancers or early in pill form, a spray that absorbs through the nasal membranes MADE TO HANDLE of time, we can see where dysplasia or cancer might be hiding, cancers,” Smith says. might work better,” Parkman explains. and target those locations for testing and treatment,” Smith LARGE QUANTITIES says, adding that Temple is the only institution in Philadelphia equipped with the technology. NEXT STOP, STOMACH LIVER & GALLBLADDER WOES OF FOOD. MOREOVER, To eradicate Barrett’s and help reduce the risk of esophageal nother ailment made more prevalent by overeating vereating and obesity have definitely increased cancer, Smith draws on a number of high-tech treatment op- and obesity is gastroparesis, delayed emptying of the number of people with fatty liver disease,” EATING TOO MUCH tions. These include radio frequency ablation, which utilizes the stomach. The condition, which causes nausea says Abdullah Al-Osaimi, MD, FACP, FACG, microwave energy, and liquid nitrogen spray cryotherapy — and vomiting, leads to what Henry Parkman, MD, AGAF, Temple’s Chief of Hepatology. ‘HEALTHY’ FOOD IS both of which kill oŒ abnormal cells during outpatient endo- Professor of Medicine and Director of Temple’s GI A common, often “silent” liver disease, scopic procedures. “In fact, Temple was the first institution in AMotility Program, calls an ironic situation: overweight people ‘‘Ononalcoholic steatohepatitis (NASH) resembles alcoholic liver JUST AS BAD AS TOO the world to use the latest liquid nitrogen cryotherapy system who have trouble eating. disease, yet occurs in people who drink little or no alcohol. The to treat Barrett’s esophagus,” Smith says. Following use of both Parkman employs novel techniques to diagnose and treat major feature in NASH is fat in the liver, along with inflamma- MUCH ‘JUNK.’ techniques, normal esophageal cells replace the precancerous gastroparesis. One diagnostic tool is called Endoflip™, a device tion and damage that can lead to cirrhosis, permanent damage or tumor cells as the tissue regenerates. that measures the stomach’s internal pressure, diameter, and dis- and scarring that may result in the need for liver transplanta- Another outpatient endoscopic technique, endoscopic tensibility. These factors help clinicians decide what treatment tion. Incidence of fatty liver disease has doubled in adults and mucosal resection, is often used to remove larger lesions from might be best. To treat gastroparesis, Parkman sometimes in- tripled in children over the past 10 years. In 2013, Nature the esophagus, including early tumors — sometimes used in jects Botox to relax the band of muscles at the end of the pyloric magazine predicted that it will be the next global epidemic.

12 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 13 Haluszka says the gallbladder, part of the biliary tract, is a common target of trouble as well. Here, the primary disorder associated with overeating and excess weight is the develop- “OPTIMAL PATIENT ment of gallstones, in part because cholesterol production is closely tied to body fat. CARE. THIS IS WHAT When a high concentration of cholesterol is secreted into the bile (the fluid stored in the gallbladder that aids digestion), IT’S ALL ABOUT,” SAYS “sludge” and gallstones can form. These conditions can lead to pain, infections, and even life-threatening attacks of pancre- HALUSZKA. “GIVING atitis. “It is important to note that rapid weight loss can alter concentrations of cholesterol as well — sometimes precipitating PATIENTS COMFORT, gallstone formation,” Haluszka says. Gallstones and their complications have been the driving ANSWERS, OPTIONS, force behind many of today’s endoscopic advances. With tools such as endoscopic ultrasound and endoscopic retrograde AND RESULTS.” cholangiography (ERCP), endoscopy combines diagnostic and therapeutic modalities that enable experts like Haluszka to ac- People with digestive disorders need cess the biliary tree and pancreatic ducts. every advantage they can get. For some “Temple’s success rate — even when treating patients with it’s next-generation devices. For others, surgically altered anatomy —ranks among the highest in the clinical research trials oŒer hope for im- “We are seeing NASH in patients in their 20s, 30s, and 40s. nation,” Haluszka says. proved health. Multiple investigations The majority have diabetes, obesity, and hyperlipidemia,” Under the direction of Michael Edwards, MD, FACS, of new drugs and devices are underway Al-Osaimi says. Temple’s Bariatric Surgery Program, has also had great results. at Temple, some sponsored by govern- Since there are no drugs to treat fatty livers, patients are asked “It’s not just about weight-loss surgery,” says Edwards. “It’s a ment and others by industry. Research to lose weight and increase their exercise to prevent future full menu of services to help patients achieve better health.” is central to the Digestive Disease damage. “A five- to ten-percent weight loss will make a dent, and Center mission. Teaching is, too. maintain a healthier liver,” says Al-Osaimi, noting that patients “Developing new treatments and benefit from Temple’s comprehensive, multidisciplinary ap- THE BOWEL & BEYOND training new specialists are build- proach, which connects them with weight-loss counselors and lthough inflammatory bowel disease (IBD) is not ing blocks of superior patient care,” clinicians in hepatology, endocrinology, and bariatric surgery. “If linked directly to obesity, recent studies suggest its Haluszka says. caught early, liver fibrosis can sometimes regress,” he says. possible link to overconsumption of processed foods Temple is one of just 173 hospitals in “We’ve got to get the message out on fatty liver disease,” warns — which make up most of the typical American diet. the U.S. certified to educate GI special- Al-Osaimi. “We must acknowledge the problem and move for- IBD includes two chronic inflammatory condi- ists. The advanced, three-year training ward with weight loss, diabetes control, and cholesterol reduction Ations: ulcerative colitis, which aŒects the colon, and Crohn’s programs are called fellowships. Their before fatty liver turns into liver cirrhosis and/or liver cancer.” disease, which can aŒect any portion of the intestinal tract. rigorous, comprehensive curricula are Characterized by changes in the designed to produce GI specialists who intestine, IBD brings on pain, di- meet the highest standards. arrhea, and fatigue. The condition biofeedback, stress management, diet therapy, and acupuncture “We limit enrollment to just 12 fellows at a time, which means often strikes young people and it — which make some patients feel more comfortable and help we accept only four new candidates per year. We are highly selec- is di¤cult to treat. with symptom control. “The better able we are to control the tive,” says Paul J. Bandini, MD, fellowship program director. “Our IBD patients get a mul- disease, the better we can help people feel,” Rothstein says. The goal in fellowship training, Bandini explains, is to pro- tifaceted approach — surgeons, Increasingly, gastroenterologists can cure existing early- duce superior diagnosticians, technically accurate and expert radiologists, and GI clinicians stage GI cancer using endoscopic mucosal resection and other clinicians, who are great with patients — and in command of all ready to help,” says Robin D. tissue-ablation techniques, which often limit the need for new procedures and technology. Rothstein, MD, Medical Director radiation, surgery, or chemotherapy treatments. If, however, Under the direct supervision of full-time faculty, fellows of the Inflammatory Bowel cancer has already progressed to a later stage, care of the high- assume increasingly larger roles in the initial workup, evalua- Disease Program. est order is provided by GI cancer experts at Temple and Fox tion, and management of patients. They are involved in making At present there is no Chase Cancer Center. therapeutic recommendations. They learn to perform routine medication that cures IBD, but and complex diagnostic and therapeutic procedures using state- Rothstein and colleagues are of-the-art equipment. looking at new medicines and us- THE BIG PICTURE Another aim is to ground fellows in scholarly research. It is ing new techniques to biopsy the dvanced expertise and advanced technology go essential that they are not only familiar with developments on intestinal lining to help detect hand in hand. Temple works closely with industry the horizon, but personally contributing to them through their precancerous change. This is im- partners to oŒer the most advanced endoscopic own research. “Our fellows have won many awards in regional portant because people who have services in the region, and in 2014 added a multi- and national research competitions,” Bandini says. the disease for eight to ten years million-dollar therapeutic endoscopy room to its “At the end of the day, it all adds up to one thing: optimal are at greater risk for developing Asuite of procedure rooms, a cutting-edge facility that’s just patient care,” says Haluszka. “Giving patients comfort, answers, Oleh Haluszka MD, Chief of the cancer of the lining of the colon. one step short of an operating room. In addition, the team just options — and results.” Digestive Disease Center Temple also oŒers IBD patients opened another high-tech suite at Temple’s ambulatory patient

complementary techniques like ED CUNICELLI care center in the Port Richmond section of Philadelphia. To make an appointment with a GI specialist at Temple, call 1-800-TEMPLEMED.

14 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 15 ADVANCES TO END AMPUTATION BY KARA ROGERS • PHOTOGRAPHY BY CLINT BLOWERS

FALL 2013 | TEMPLE HEALTH | 17

16 | TEMPLE HEALTH MAGAZINE | SPRING 2015 ore than 100,000 foot and leg amputa- at Temple in the last two years. “With advanced imaging equip- Sometimes investigational therapies are part of the pic- tions are performed every year in the ment, we can see blockages better — which means we can do a ture. In neo-angiogenesis, for example, cells extracted from a United States. Most of them should better job of fixing them,” Bashir says. patient’s own bone marrow are implanted in the ischemic leg to never happen. Certain cases are performed in Temple’s brand-new hybrid encourage new blood vessels to grow. These innovative options “Almost every one of those limbs could operating rooms, high-tech facilities that combine the imag- are especially important for patients who are not good candi- be saved,” says Eric T. Choi, MD, Director of Temple’s ing and diagnostic functions of a “cath” lab with the surgical dates for traditional approaches. Limb Salvage Center, the first program in the functions of a traditional operating room. The blending of When Shirley Griswold first traveled from Johnson City, NY, Philadelphia region dedicated to saving patients’ legs technology enables the team to treat multiple issues at the same to see Dr. Choi, she was close to losing her right foot to amputa- with new vascular-rescue techniques and comprehen- time — an approach designed to limit extra procedures, shorten tion. Because the 72-year-old su„ers from critical limb isch- sive therapies. hospital stays, and reduce the chances of complications. emia and heart failure, she was not an appropriate candidate for Word is getting out that the Limb Salvage team traditional vascular procedures. Therefore Choi performed her can help patients that most other hospitals cannot. angioplasty under local anesthesia. “He opened a blood vessel “It was a miracle to find Dr. Choi,” says Helen BEYOND THE LIMB in my foot and saved my toes,” Griswold says. “It was unbelieve- Norris, wife of 81-year-old Patrick Norris, who urgical expertise and next-generation tech- able what Dr. Choi did for me.” underwent vascular surgery at the Center to save nologies are musts — but the real secret to sav- his leg. Mr. Norris had been experiencing extreme ing a limb goes way beyond toes, feet, and legs. pain. A previous doctor attributed the condition to It’s about treating the whole person, about STEPPING UP nerve pain and performed a surgery that produced a getting a handle on the disease that produced hen Eric Choi was recruited to head vascular wound on Norris’s foot that wouldn’t heal. the limb-threatening crisis in the first place,” Choi says. surgery at Temple in 2010, he was given a list of “My problem was probably more vascular than Therefore, patients at the Limb Salvage Center benefit from things to accomplish. Like all new chiefs, he also neurological from the start,” says Norris, whose wound the coordinated care of a multidisciplinary team — specialists had goals of his own. Although the Limb Salvage stayed open due to peripheral arterial disease (PAD), in foot health, cardiovascular health, diabetes, wound care, Center was not part of anyone’s list initially, the a condition that reduces the amount of blood that and many other fields. In all, nearly two dozen highly trained idea took shape with speed and clarity. It was fueled by Choi’s reaches the feet. “I was close to amputation. But Dr. personnel contribute to the e„ort: podiatrists like Dr. Andrew growing sense of alarm at the large number of patients sched- Choi saved my foot.” Meyer; vascular surgeons like Drs. Ravi Dhanisetty and Paul uled for amputation. Seeing so many young patients lose limbs At Temple, amputation is performed as a last resort van Bemmelen; and their colleagues in orthopedic surgery, plas- was especially troubling. — only when a foot or leg becomes so infected that tic surgery, endocrinology, cardiology, and physical medicine Choi knew that limb-saving requires complicated, ongo- leaving it attached does more harm than good. Since and rehabilitation. ing care that extends far beyond vascular surgery (patients founding the Limb Salvage Center in 2011, Choi and New patients undergo immediate evaluation, with testing with limb-threatening diseases often have diabetes, and heart team have spared hundreds of patients like Norris and care centralized in one convenient, comfortable location. and kidney problems, too). Nevertheless, he was passionate from losing a leg or a foot. And, like Norris, most of Onsite services include one of the largest accredited vascular about moving ahead — and delighted to find a groundswell of the Center’s patients have PAD. According to Choi, support among his colleagues. Today, more Chief of Vascular and Endovascular Surgery at Temple, PAD is a Vascular and Endovascular Medicine, used it in a procedure to than a third of the patients who seek help highly underdiagnosed, undertreated condition. About 18 million help save a patient’s leg. at the Center come from distant states and Americans have it, yet at least half have not been diagnosed. The new device marks a major improvement in angioplasty, cities. Norris drives an hour and half to visit Another 3 million Americans su„er from advanced PAD (or a technique that involves inflating a tiny balloon inside a the Limb Salvage Center. Griswold drives critical limb ischemia), obstruction that significantly decreases narrowed vessel to open it up. With traditional angioplasty, I was close to three. Choi hopes to see more patients blood flow to the feet and legs, leading to amputation if left however, scarring can develop in the area where the balloon was amputation, says come to Philadelphia — a journey worth untreated. Patients first describe a heavy feeling in their legs, opened, causing the vessel to narrow again. The balloon every minute, every mile, when limb and with cramping and pain. They have trouble walking. PAD, criti- in the new device Bashir used, however, is coated with Norris. “But Dr. Choi life can be saved. cal limb ischemia, and other circulatory problems are common a low dose of a drug that prevents the vessel from re- “While major amputations are still essen- complications of diabetes. Diabetes can also reduce sensation in stenosing. “Technological advances have changed the saved my foot.” tial in certain life-threatening situations, the the feet and legs, making it more likely that a small sore or ulcer landscape of limb salvage,” Bashir says. evidence is clear that most can be prevented,” on a foot can go unnoticed. If that happens, it can quickly turn Other devices used at the Center employ drugs Choi states. More than two million people into a non-healing and/or infected wound, and gangrene (tissue or ingenious mechanisms to break up clots, or even Eric T. Choi, MD in the United States have already had a limb death) can follow — a condition that once presaged amputation. remove them wholesale. There are also devices that amputated. More than half could lose their But thanks to a host of advanced vascular and wound inter- enable physicians to access lower-limb vessels from remaining leg — or die — within five years if ventions, combined with multiple levels of coordinated care, the wrist or foot instead of using the groin artery vascular disease proceeds unchecked. Choi and team are able to put a stop to the spiral of events that as the point of access. Studies show that the new laboratories in the Delaware Valley, a radiology suite, blood lab, “Any patient with a limb-threatening disorder should be can lead to amputation for the vast majority of patients who access points reduce complications and post- and physical therapy studios. “We develop a prioritized treat- evaluated at a center like ours,” Choi says. “We have helped seek help at the Center. operative pain. Other techniques enable surgeons ment plan — usually by the end of the patient’s first or second many patients who believed their limbs could not be saved.” to remove the blockage from the body with lasers appointment,” Choi says. “Dr. Choi and his sta„ are phenomenal,” Griswold says. “He or devices that shave the blockage away. Blockages Choi says that restoring blood flow is always the priority, but let me see a better side to life.” NEW STEPS can also be broken up with ultrasound, or be suc- that’s just the start. “We employ a comprehensive strategy that “These professionals go above and beyond,” Norris adds. n October 2014, Temple University Hospital became the tioned out. Drug-eluting stents became available might include medical management, physical therapy, shoe- “The nurses, the doctors, the entire Limb Salvage team could first hospital in the Philadelphia region to use an innova- for PAD in 2013, and bio-absorbable stents will modification — whatever it takes,” he says. not be better. We wouldn’t go anywhere else.” tive new device to re-open arteries in the thigh and knee in be available at Temple soon. Nutrition counseling and other forms of patient education

a patient with PAD. In fact, the device had been approved Four ultramodern catheterization labs — facilities equipped are included, too. “Things like quitting smoking and eating a Kara Rogers has written for the International Journal of Cancer. by the U.S. Food and Drug Administration just days before with technologies designed specifically for the visualization, healthy diet can have dramatic impacts on preventing disabil-

one of the Center’s experts, Riyaz Bashir, MD, Director of diagnosis, and treatment of vascular disease — have been built ED CUNICELLI ity,” Bashir adds. To see a specialist at the Limb Salvage Center, call 1-800-TEMPLEMED.

18 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 19 Learning Head & Neck Surgery from the Best

he notion that form follows function is a concept presented to all medical students. This is the idea that the structure and shape of each part of human anatomy is intimately tied with its purpose. Nowhere in the human body is this demonstrated more vividly than in the head and neck. Although they comprise a mere one-tenth of the body, their intricacy and complexity outstrip the rest of the body combined. Herein lies a great tragedy of medical education: a vast volume of infor- mation to master, and only four short years to accomplish the task. Many aspects of medicine cannot be represented comprehensively during medical school. One of them is otolaryngology, or ENT (ears, nose, throat) as it is generally known. Medical students receive an overview of the head and neck. Thus it is left to motivated individuals to explore the beauty and depth of this region of the body on their own.

By Steven Zuniga, MD Illustration by Serge Bloch

20 | TEMPLE HEALTH MAGAZINE | SPRING 2015 efore discovering the true scope of an 31-year old patient named Dana Green finally found her way to One final aspect of ENT training completes the otolarygologist’s practice, I shared the Ahmed Soliman, MD, Director of Laryngology and Associate package here: exposure to research. Several of our common belief that ENT docs simply Department Chair. Ms. Green, an elementary school teacher faculty are funded investigators. For example, Je‘rey removed children’s tonsils and prescribed and mother of two young boys, was desperate, struggling for air. Liu, MD, FACS, one of our four fellowship-trained Flonase® for stu‘y noses. Learning their The source of her trouble had eluded many doctors — but Dr. head and neck cancer surgeons, is working on a $1.7 actual role was a revelatory and career- Soliman pegged it the moment he heard her breathe. million American Cancer Society grant to investigate defining experience for me. Our spe- Ms. Green had idiopathic subglottic stenosis (ISS), a rare why a disproportionate number of African Americans cialty covers disorders as varied as diz- condition in which the airway becomes inflamed and progres- are a‘ected by head and neck squamous cell cancers. ziness, vocal cord nodules, swallowing sively narrows, making it extremely di©cult to breathe. It’s a In a National Cancer Institute-funded project, disorders, and sleep apnea. We address dangerous condition. A simple cold could push an undiagnosed, Oneida Arosarena, MD, a facial plastic and re- cleft palate, hearing loss, thyroid abnormali- untreated ISS patient over the edge into respiratory arrest. constructive surgeon, is mapping out the process ties, facial trauma, cancer, and a wide range of other Five days after that initial visit, Dr. Soliman performed a mini- by which head and neck cancer invades bone. disorders, both common and rare. mally invasive endoscopic surgery to correct the problem. He Fascinatingly, it’s di‘erent from bone metastasis The head and neck houses the organs responsible for our used a laser to make four small cuts in Ms. Green’s airway tissue in other parts of the body — a big reason why the ability to experience the world. Enabling someone to hear after to keep it from tearing, then gently inflated a small balloon inside mortality rate for head and neck cancer basically a life of deafness, taking away chronic dizzy spells, and cur- her airway to open it again. Within days, she was back to working, has not improved in 50 years. A Temple University ing debilitating cancer are just a few of the motivations that playing with her sons again — all the normal things. School of Medicine alumnus, a well-known ENT inspired me to select this specialty. “I spent more than a year trying to figure this out — and after physician named Dr. Eugene Myers, contributed to But the path to becoming an otolaryngologist is not an easy five minutes in Dr. Soliman’s o©ce, I was diagnosed and sched- the funding of her research. Dr. Myers is Emeritus one. Each year, more than 700 medical students compete for uled for surgery,” said Ms. Green. Chair of the Department of Otolaryngology-Head fewer than 300 open residency I, too, was in awe of Dr. and Neck Surgery at the University of Pittsburgh positions. Many extremely quali- Soliman’s deft diagnosis. Medical Center. fied candidates simply don’t get ISS is rare. Only a few dozen Temple alumni tend to stay connected with the in. I consider myself extremely cases are diagnosed in the U.S. program after they graduate. Several came back for fortunate to have been ac- every year. a reunion last year. Farrel Buchinsky, MD, a pediat- cepted — and not only that, To know that 380 As Ms. Green’s story ric otolaryngologist in Pittsburgh, a 1999 graduate but accepted by one of my proves, it takes rare exper- Steven Zuniga, MD of my program, was among them. top-choice programs. physicians tise to diagnose rare condi- “An education at Temple stays with you forever,” My wife and I both tions — which is precisely said Farrel. “Dr. Glenn Isaacson was my mentor grew up in California, applied for my why I wanted to train here. Hospital, to help our growing and much-in-demand group here, and I still hear his voice in my head when I’m performing where “winter” means To know that 380 physicians keep pace with more than 20,000 patient visits per year. certain procedures.” wearing a hoodie to the spot here applied for my spot here at But the really exciting news is that we have taken a major A sentiment like this is music to a resident’s ears. I feel very beach. Hence the prospect Temple is both heartening step forward with the establishment of the Temple Head and fortunate to be learning from true headmasters. of heading east wasn’t the is heartening and humbling. There’s so Neck Institute, integrating both outpatient and hospital care at easiest of discussions. much to learn in this compli- Temple University Hospital, Jeanes Hospital, and Fox Chase To make an appointment at the Temple Head and Neck Institute, call 844-570-1767. My argument for and humbling. cated field. Cancer Center. Head and Neck Institutes are rare. There are Temple was simple. only a handful in the country, so it’s a pretty big deal. Temple’s faculty boasts 20 Institutes use a team approach to provide comprehensive, co- full-time fellowship-trained faculty representing all of the TRUE HEADMASTERS ordinated care. They bring together all the professionals that any otolaryngologic subspecialties. Fellowship training is the patient might require — even specialists outside the traditional highest order of medical education, establishing expertise If you say, “I’m a Triological Society fellow” in a room full of “borders” of ENT, such as audiologists, endocrine surgeons, and HAIL TO THEE, JACKSON above and beyond what’s learned in residency. ENT docs, heads will turn. With only about 400 members in the speech and language pathologists. Collective expertise is great Having just graduated with a master’s degree in child entire United States, gaining entry to this elite medical associa- for patients with unusual or misdiagnosed conditions, like Ms. In the early 20th century, America’s lead- development, my wife soon became excited about moving to tion is the pinnacle accomplishment in the field. Green. But you don’t have to have a rare condition to benefit ing center for esophageal and upper air- Philadelphia too, since the City o‘ers many opportunities to While the majority of medical centers in this country from the Institute approach. Whenever multiple physicians and way disorders was The Jackson Clinic at work with pediatric populations. (And although she can’t say don’t have any members, at Temple, I like to remind my wife, caregivers collaborate, patient outcomes are better. Temple — headed by Chevalier Jackson, it, I’m pretty sure Maya, our German Shepherd/Husky mix, we have three: Dr. Soliman; Dr. Glenn Isaacson, Director of Interestingly, the team approach can motivate patients to MD (1865-1958). Innovator and inventor, doesn’t mind the snow.) Pediatric Otolaryngology; and our Department Chair, John more fully engage in their own care. Imagine, for instance, the Jackson created “the first tube laryngo- I am now nearing completion of my first year at Temple. It’s Krouse, MD, PhD, MBA. di‘erence between a doctor telling you to see an audiologist, and scope with its own light,” a bronchoscope been ideal for me in all the ways I anticipated and more. Had I “Do you know how amazing this is?” I ask her. “What’s more,” actually having that audiologist participate in your appointment that could be passed through the larynx to visualize the known, for example, during my application process that Temple I say, “the Editor-in-Chief of the most important ENT journal, in the first place. In addition to bringing healthcare to patients, bronchi. Patients from all over the world traveled to Temple was also about to launch a brand-new Head and Neck Institute, Otolaryngology — Head and Neck Surgery, is Dr. Krouse. My Institutes also coordinate care for them, from the first appoint- to have foreign bodies removed from their throats and it really would have sold me. But before elaborating further, teachers are the gurus, the headmasters, of head and neck medi- ment through testing, procedures, and follow-up. Patients appre- airways. In fact, more than 2,000 objects Jackson extracted I would like to share one of our stories. cine and surgery,” I say. She groans. ciate the consistent, reliable human point of contact. are displayed at the Mutter Museum in Philadelphia. Jack- With 20 full-time faculty covering every aspect of head Watching the Institute come to fruition has been a great son is also credited with leading the crusade behind the and neck medicine, Temple’s ENT program has seen tremen- experience for all the residents here. We look forward to seeing Federal Caustic Poison Act of 1927, mandating that poison- RARE AND DEADLY dous growth since 2009, when Dr. Krouse was recruited as it grow over time. Dr. Krouse plans to augment it with additional ous and corrosive substances be labeled. Jackson’s son, Department Chair. He has expanded the outpatient program initiatives, such as a specialty service for teachers, actors, singers, Chevalier Lawrence Jackson (1900-1961) succeeded his In the spring of 2014, after spending 14 months going to sev- to four clinical sites in the Philadelphia region, including and other voice professionals, and a comprehensive center for father as chair of the department at Temple University.

eral di‘erent physicians only to see her condition worsen, a a brand-new 4,200 square foot specialty center at Jeanes LIBRARIES TEMPLE UNIVERSITY COLLECTIONS, SPECIAL JACKSON: ED CUNICELLI; ZUNIGA: hearing and balance disorders.

22 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 23 HOME DELIVERY Personalizing Care in the Community

By GISELLE ZAYON Photography by DUSTIN FENSTERMACHER

i anie Mebane has had four heart attacks — and she’s only 33. In 2008, cardiologists implanted a defi brillator in her chest to jumpstart her heart, just in case. “It’s already saved my life at least once,” she says. With congestive heart failure, Mebane must Tminimize stress, take 22 di erent medications daily, and see sev- eral di erent physicians monthly to keep fl are-ups at bay. During the past nine years, she’s been hospitalized 33 times. Mebane is in a diš cult situation, and she’s not alone. Across the nation, especially in socioeconomically challenged regions, people su er from chronic health conditions that, when not well controlled, prompt frequent emergency trips to the hospi- tal. Treating them in this intensive, episodic manner consumes a huge chunk of healthcare spending in the United States. In fact, according to the Agency for Healthcare Research and Quality, 50 times more money is spent on every chronically sick person than every healthy one. “This pattern cannot be sustained — and has made healthcare delivery and fi nance reform a national priority,” says Susan Freeman, MD, MS, Chief Medical Oš cer, Temple University Health System, and President and CEO of the Temple Center for Population Health. “We need to shift the focus from a reactive, crisis-oriented approach to a pro-active, ongoing, coordinated, and preventive one. It’s the right thing to do for patients. And enables the cost-containment principles inherent in high-value care.” To this end, healthcare insurers, both commercial and government-run, are ramping up incentives for hospitals, physicians, and care providers to work together to deliver high- quality, preventive-oriented care at a lower cost. “This enhances our ability to stratify patients into low-, medium-, and high-risk populations,” Freeman says. Programs for high-risk patients have top-shelf importance in the health re- form tool chest. These programs target patients like Mebane, patients who have Ti anie Mebane (seated) says histories of frequent, expensive emer- the bond she shares with her gency hospitalizations — and provide community health worker, them with medical and social supports Desiray Savage, does her to help minimize exacerbations of their heart good. chronic conditions.

24 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 25 Steven R. Carson, RN, BSN, MHA, Chief of Operations for the Temple Center for Population Health, says that proactive outreach makes population-health programs e ective. “We go beyond hospital walls to engage patients. We work with patients, physicians, and community resources to support each patient’s plan of care,” says Carson, who is also VP for Clinical Integration at Temple University Hospital. Value is what we’re really talking about here. Getting better health outcomes, better value to the patient, for the dollars spent.

BREAKING BARRIERS very week, Mebane opens her door to a community health worker named Desiray Savage, one of eight employed by Temple’s Community Health Worker program to visit chronically ill patients at home. The Eprogram’s aim is to keep patients on track with their physicians’ instructions, staying a step ahead of disease. In between visits, Savage checks on Mebane by phone. At any given time, about 150 patients ranging in age from their 20s to their 90s, are in the program’s care. Some patients, like Mebane, are also visited by a registered nurse. “Desiray and I hit it o right away,” says Mebane, smiling. Savage asks Mebane a lot of questions: Do you need refi lls on any of your medicines? Have you taken all the right doses? When is your next appointment with your primary care doctor and your cardiologist? Is it time to get groceries? Because the things that infl uence health go beyond medi- cal care, community health workers address child care, social services, food, and housing diš culties. For example, Savage arranged door-to-door transportation for Mebane’s doctors’ appointments — a service covered by insurance. “I had no idea registered nurse at Temple, who would then use FaceTime to I could even get that,” says Mebane. Population health programs feel right at home. Above and lower video-chat with Terry on Franco’s large tablet. Being able to Mebane has missed a lot of appointments over the years sim- right, Juan Franco and patient Leonard Terry. Upper right: Desiray see one another, to ask and answer questions, Reeves explains, ply because she could not get to them. She has no car, and with Savage (left) with patient Ti anie Mebane. helps alert the nurse to issues that might require physician such a weak heart can barely walk to the nearest bus stop. intervention or treatment protocol change. In this way, Grand “Health can absolutely be swayed by things this ‘simple.’ Aide® programs extend professional nursing care at lower cost. Identifying and mitigating barriers to wellness: that’s what we’re all about,” says Je rey Slocum, RN, MSN, the Community Another population health program underway at Temple and Health Worker program’s director. other hospitals demonstrates a 58% reduction in 30-day hospital MANAGING DISEASES AT HOME Imagine trying to maintain good health if your home lacks a readmission rates nationally. It’s called the Grand Aide® program. he Grand Aide® and Community Health Worker working kitchen, heat, or plumbing. In the most recent census, “The Grand Aide® model was originally developed at the programs are proving successful for many patients with 24% of all households in Philadelphia reported such conditions. University of Virginia. Dozens of Grand-Aide® programs are chronic disease. Both Terry and Mebane remain in In Philadelphia, 26% percent of residents live at or below the operating across the nation, but Temple’s is the fi rst to be imple- relatively stable condition, with no recurrences of ill- federal poverty line; 23% smoke and 17% drink heavily; and the mented in an urban setting for an at-risk population,” says the Tness prompting rehospitalization to date. Both are quick to credit unemployment rate is above average. program’s principal investigator, Kathleen Reeves, MD, Director Temple for making a real di erence in their health. In fact, Philadelphia County ranked last, 67 out of 67, in a of Temple’s Center for Bioethics, Urban Health and Policy. Franco and Savage are proud of the rigorous training they un- trust. Franco hopes to go to medical school someday — perhaps recent ranking of health status across all Pennsylvania counties. Grand Aide® programs certify specially trained workers like dertook for their roles — Franco in the Grand Aide® program’s at Temple, where he completed an undergraduate degree and is “This creates an opportunity for improvement that is being ad- Juan Franco to visit patients at home to teach and reinforce the special curriculum, and Savage at Temple’s Center for Social now partway through a master’s in urban bioethics. “He would dressed by Temple,” Freeman says. self-care behaviors recommended by their physicians. Policy and Community Development. With 104 graduates to make an excellent doctor,” Terry says. In the United States, there are about 90 community health Leonard Terry, a 78-year-old retired Philadelphia dock- date and the only state-certifi ed training program in the tri- Temple has helped millions of vulnerable patients. And now, worker programs like Temple’s — all designed to minimize pre- worker, recently participated in the program. He, too, has state area, Temple University is the regional leader in commu- with population health programs, its commitment and e ec- ventable readmissions among chronically ill patients, thereby congestive heart failure. With more than 30% percent of the nity health worker education. Savage’s natural compassion suits tiveness are increased. “Temple has always been there for me,” decreasing the use of expensive resources like hospital emer- population a ected, heart disease takes a big toll in North her well for the role. And like most of the program’s graduates, says Ti anie Mebane, patting the cushion of her sofa. “And now gency rooms. Philadelphia. For Terry, it’s triggered numerous trips to the she is a Philadelphian, born and bred. She understands her pa- it’s here for me, too. Right here in my home.” “According to Medicare data, in 2011, before we launched emergency department over the years. tients, relates well to them, and they to her. “I am not an author- our Community Health Worker Program, Temple University During every Grand Aide® home visit, Franco checked Terry’s ity fi gure, giving orders or imposing judgment,” she says. Hospital’s 30-day readmission rate was 25.2%,” says Slocum. For more information about the Center for Population Health, contact Dr. Susan weight, heart rate, blood pressure — even monitoring Terry’s For their part, while Grand-Aides® need not be grandparents, Freeman at 215-707-0766 or Steven R. Carson at 215-707-2771. To learn more “Now it’s 16.2% for patients in the program — and the rate at which ankles and feet for edema. Franco then transmitted the data they exhibit the kind of attitudes and behavio rs a good grandpar- about the Center for Bioethics, Urban Health and Policy, visit www.temple.edu/ these patients follow up with their physicians has also improved.” to Temple on a secure wireless network, to be reviewed by a ent would. Their wisdom, experience, and confi dence inspire centers/cbuhp.

26 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 27 A Sea Change for Cancer?

By KARA ROGERS Photography by CLINT BLOWERS GUTTER CREDIT HERE CREDIT GUTTER

28 | TEMPLE HEALTH MAGAZINE | SPRING 2015 FALL 2013 | TEMPLE HEALTH | 29 need two years,” a patient we’ll call Mrs. G silenced, are no longer able to do their job of preventing cancer. “There is a paradox in oncology, that drugs need to be given recalls telling Patricia L. Kropf, MD, a special- But when SGI-110 takes DNMT out of the picture, tumor- to patients until toxicity develops,” Issa says. “But with DNA ‘‘ ist in hematologic malignancies at Fox Chase suppressor genes that were rendered out-of-service by mis- methylation inhibitors, more is worse.” That realization has I Cancer Center. placed methyl groups become active again. come to bear on SGI-110. “Okay,” said Kropf. “I’ll give you two years.” “SGI-110 is at the forefront of epigenetic drug discovery,” “I didn’t take it as gospel,” Mrs. G recalls. “But since the prog- The Cancer–Epigenetics Crossroads says Magid Abou-Gharbia, PhD, FRSC, Director of Temple’s nosis for my disease is usually meted out in months, the doctor’s Moulder Center for Drug Discovery Research, who is collabo- words fl ung hope and light into the air.” he idea for a drug like SGI-110 was virtually rating with Issa to develop other drugs like SGI-110. He believes Mrs. G is participating in a Phase 2 clinical trial at Fox Chase nonexistent only two decades ago. But then that there are other therapeutically useful epigenetic inhibi- that is designed to test the e– ectiveness of a drug called SGI- scientists realized that abnormalities in DNA tors are out there. To fi nd them, the team is testing a screening 110. In June 2014, she had been diagnosed with acute myelog- T methylation are ubiquitous in cancer. library with more than 40,000 compounds. “We used an assay enous leukemia (AML), a cancer that can steal life away quickly. Issa was behind much of the research that developed in Issa’s lab to identify compounds that induce tumor At age 80, she is especially vulnerable to that rapid advance. led science to that realization and, in fact, has spent much of suppressor reactivation,” Abou-Gharbia explains — noting with Conventional therapies often are too toxic for older patients. his career at the crossroads of cancer and epigenetics. In the excitement that several compounds have already shown prom- But SGI-110 is breaking with convention. “The epigenome is what tells early 1990s, he and Stephen Baylin, MD, now Deputy Director ise in preclinical studies. As one of the scientists and clinicians overseeing the SGI-110 DNA to turn an undi erentiated of the Johns Hopkins Sidney Kimmel Comprehensive Cancer trial, Kropf has been keeping tabs on the drug’s e– ects for Mrs. Center, uncovered some of the fi rst associations between Fulfi lling Dreams G and other trial participants. It is too soon for conclusions, but cell into a skin, hair, blood, cancer and changes in DNA methylation and DNMT activity. she is hopeful that SGI-110 will prolong and improve patients’ “By 1997 it had become clear that epigenetic abnormalities ssa and Kropf are part of the Epigenetics Dream quality of life. “Early results are promising,” says Kropf, who is or kidney cell,” Issa explains. were a cause of cancer,” Issa said. “So, we asked: can we Team, an international group of top epigenetics also assistant Director of the Temple Fox Chase Bone Marrow “The epigenome is what intervene therapeutically?” researchers brought together by funding from Transplant Program. That question led Issa to decitabine, a compound that was I the organization Stand Up To Cancer to help In the world of drug development, SGI-110 is riding a wave tells DNA to start or to stop shelved in the 1960s. Decitabine is an analog of the chemother- bring epigenetic drugs center stage. The Dream of revolutionary change in the way scientists think about apeutic agent cytarabine, but produces unusual e– ects, such as TTeameam has facilitated their collaboration with other leaders in cancer and cancer therapeutics. That shift, which has been uncontrolled cell replication — an ability to slow tumor growth at concentrations well below cancer epigenetics research. Of course, FDA approval of SGI- taking shape for nearly two decades, pertains to the study of those required by other chemotherapeutic drugs. In the early 110 would mark a major step toward achieving the team’s goal. chemical modifi cations to DNA and DNA-associated proteins a hallmark of cancer.” 1980s, the drug was found to inhibit DNA methylation. Issa says that if the current Phase 2 study fulfi lls expectations, that dictate gene activity. The fi eld is called epigenetics. And Issa and colleagues found that decitabine was e– ective, a Phase 3 trial to proceed toward the drug’s approval for AML one of the experts at its leading edge is Jean-Pierre Issa, MD, particularly in hematologic malignancies. He worked to get or MDS could come relatively soon. Eventually, it could also be American Cancer Society Professor of Medicine and Director “Patients showed striking responses,” Issa says of that the drug into clinical trials for myelodysplastic syndromes approved for use in combination therapies with conventional of the Fels Institute for Cancer Research at Temple. As the recently completed study. He is cautiously optimistic that the (MDS), and in Phase 1 studies he discovered its dual e– ects. At drugs and possibly even for solid tumors. And now a new grant principal investigator on the SGI-110 trial, Issa has been work- study that Mrs. G is in, the Phase 2 trial underway at Fox Chase high doses, decitabine kills cells. At low doses, it allows cells to makes the Dream Team’s possibilities all the more exciting — ing to characterize the drug’s clinical activity in collaboration (part of a national multicenter study), will yield similar results. survive but slows tumor growth. Decitabine was so successful a commitment of $7.5 million from the Van Andel Research with Astex Pharmaceuticals. that it not only received approval from the FDA, but became the Institute to underwrite more extensive research. “Epi” means “upon or attached to.” Epigenetics, therefore, Targeting the Epigenetic Code standard of care in MDS. It also helped spark a big change in the “Although we cannot change our DNA, we may be able to turn focuses on the internal environment surrounding genes, the way researchers think about cancer therapy. on the activities of the genes that promote better health and turn chemicals that attach to DNA, turning various gene activities t is hard not to be excited about SGI-110. It is a o– the ones that trigger disease,” Issa says. on or o– . Changes in that environment can activate or inacti- new frontier in cancer therapy. The goal, Issa For Mrs. G, despite the struggle of her vate disease processes that are kick-started by genes. Cancer, explains, is not to wage war against cancer cells, disease, the trial at Fox Chase has been an for example, is not triggered solely by mutations in DNA. The I killing them with toxic doses of chemotherapy, uplifting experience. A few months into her way DNA is a– ected by its epigenome is just as important. but rather to reprogram those cells to make therapy she had an opportunity to fulfi ll “The epigenome is what tells DNA to turn an undi– erentiated them behave like normal cells — this time utilizing low doses of her own dream, traveling far away to visit cell into a skin, hair, blood, or kidney cell,” Issa explains. “The a very di– erent kind of drug. her brother. “Looking out at the ocean, epigenome is what tells DNA to start or to stop uncontrolled In technical terms, SGI-110 is known as a second-generation being with my brother — it was the happiest cell replication — a hallmark of cancer.” Epigenetic changes epigenetic inhibitor. It blocks an enzyme called DNA methyl- I’ve been,” she says. “I couldn’t be more probably trigger many other diseases, too, he adds. transferase (DNMT), which attaches methyl groups to DNA. impressed with Fox Chase, to say nothing A process called methylation can incite profound changes in DNMT is constantly at work in cells that are actively dividing. of the results,” she says. gene expression. Methylation entails the attachment of methyl Methyl groups are not permanent fi xtures on DNA. In actively Another patient in the trial, Nora groups — major components of the epigenome — to stretches of dividing cells, they are stripped o– the DNA as it replicates, so George, diagnosed with AML in 2012, said DNA that control gene expression. The function of methylation is each time after a cell divides, DNMT has to go in and reattach SGI-110 helped put her cancer into remis- to silence gene activity. We all have genes that control cell growth, the methyl groups to genes in the daughter cells. If they are not sion. In an interview with CBS television even genes that instruct cells to die. Those jobs need to be carried reset, the genes that are active in the daughter cells will change, in Philadelphia, George said, “It absolutely out faithfully — otherwise cell growth proceeds unchecked. If which in turn changes the cells’ function — in e– ect making saved my life. Never stop fi ghting. Stand up errors in methylation prevent genes from keeping that process them a di– erent cell type. to cancer and say, ‘Hey, you’re not going to under control, cell growth can turn into cancer. “Ultimately, that is what happens in cancer. DNA methyla- beat me. I’m going to beat you.’” Issa’s research is paramount to making a di– erence, epige- tion patterns are altered (often in conjunction with genetic netically. In AML patients, in a fi rst-in-human Phase 1 trial, mutations). Certain genes end up with too many or too few Kara Rogers is a science writer based in Madison, WI. the epigenetic drug SGI-110 sent AML into remission in some methyl groups, causing otherwise normal cells to behave like Jean-Pierre Issa, MD, and Patricia Kropf, MD patients. It did the same for some patients with bone marrow cancer cells,” Issa explains. Genes commonly a– ected by aber- For more information about clinical trials for cancer,

cancers known as myelodysplastic syndromes (MDS). rant methylation include tumor-suppressor genes, which, when ED CUNICELLI visit www.fccc.edu/cancer/clinicaltrials.

30 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 31 CHANGE AGENT

Scott P. Charles TRAUMA OUTREACH COORDINATOR

More than 4,000 gunshot victims a limb? Hell no. Can you think of a movie or hip-hop song about the have been treated in Temple long-term consequences of being shot? Dying, I tell them, that’s easy. You only University Hospital’s trauma have to die once, but the people you center since you started your job leave behind will die a little bit every day for the rest of their lives. in 2006. You’ve seen so much. Q Does anything shock you? Q: You had a challenging childhood. Did you ever imagine your work would be on The Today Show or that you & Every time a gunshot victim is brought to would receive a Robert Wood Johnson the trauma center, I’m notified. Every Foundation Community Health Leader Award? page is still a jolt to me. But what shocks A: When I was nine, my father died. me is apathy. In Philadelphia we barely bat A year later, my sister shot herself to an eye when “only” 1,128 citizens are shot death. Several years later, my oldest brother died of AIDS, and another in a year, when “only” 247 of them die. brother of a drug overdose. My remain- Apathy is the real killer. ing brother, as was once the case for me, is working to overcome a drug addiction. A My mom fought hard for me, but I was Q: When trauma surgeons are able to unclear. I tell the group that we are gone. I was in my early 20s when an save a patient who is near death, they call standing in the very kind of room where aunt and uncle helped me turn it it a “good save.” Lamont had been. I ask one of the around. I’m here today because they A: The ultimate “good save” is when the participants to lie on the gurney. I place o‘ered me unconditional love and patient leaves the hospital less likely to red stickers all over his clothing to show tangible opportunities. This is the work be shot again or to shoot someone else. all the places Lamont was shot: arms, I need to do. If not, we aren’t giving a second chance hands, chest, thighs, back, and legs. I at life, we’re giving a second chance at describe how feverishly the doctors Q: You also counsel gunshot patients death. Amy Goldberg, Temple’s chief worked — but within 15 minutes, Lamont in the hospital. trauma surgeon, brought me here to try was dead. The kids stare at the boy A: No one wants to be seen as a victim or to make the good saves even better. covered in red stickers. We then go to a take a hit to his reputation. So they classroom. I show photos depicting harden themselves, determined not to be Q: You and Dr. Goldberg created Cradle to gunshot injuries and the methods used to a victim again. I do my best to speak with Grave, the violence-prevention program treat them. every gun victim — to help them imagine that’s illustrated the medical realities of Throughout, I ask kids to reflect: possibilities other than retaliation. gun violence to more 10,000 teenagers. Who wanted you to attend this In 2012, we developed Turning Point, A: In this program, I take the teens into a program? What do you mean to them? an intervention that attempts to trauma bay at the hospital. We surround Are you willing to spare their su‘ering? formalize the kind of unconditional love a gurney, harsh lights blaring overhead. I take them to the morgue where and opportunities that helped save me. I then “introduce” them to Lamont Lamont’s body had been. Ultimately, We connect victims of gun violence with Adams, a 16-year-old raised by his they listen to a recording of Lamont’s resources like psychiatry, education, grandmother just a couple miles from grandmother talking about the child employment, and housing that can Temple. One September evening during she raised, the man she will never know. change their circumstances. I’ve given his junior year in high school, a 17-year- I want the young people to see them- my cell number to hundreds of gunshot old jumped out of a car and shot Lamont selves, to see the truth. Are they victims. I want them to feel that they

more than a dozen times. The motive was worried about paralysis, losing a kidney, have a lifeline. HERE CREDIT GUTTER Scott P. Charles

32 | TEMPLE HEALTH MAGAZINE | SPRING 2015 Photograph by JARED CASTALDI QUEST

Liquid Air

In the 1989 James Cameron film The Abyss, Ed Harris blast, Wolfson developed a novel tech- nique to administer aerosolized PFC plays a scuba diver who breathes a space-age liquid through the nose, cooling the brain. that permits him to plumb astounding depths without Such cooling is neuroprotective. worrying about compression sickness. Cameron said It helps to reduce swelling, which is the concept was inspired by a science lecture he had particularly dangerous for the skull- encased brain. She has also tested seen in which an animal breathed a liquid. Ed Harris did PFC’s ability to protect lungs from the e™ects of high altitude — a common not really breathe liquid in the film, but it absolutely is problem for soldiers swiftly deployed possible. This synthetic liquid is called perfluorocarbon to high-altitude areas, where the atmosphere’s oxygen content is low and (PFC). It belongs to the Teflon® family and has a range the body has not had time to acclimate. of unique properties. Again, Wolfson found that PFC deliv- ered by aerosol spray promotes more e“cient distribution of low-level oxy- One of the world’s leading experts on underdeveloped lungs, triggering an gen in the lung, improving ventilation. PFC is Marla R. Wolfson, PhD. The inflammatory response. Often, infants What’s more, drugs can be added to the pulmonary physiologist has been develop bronchopulmonary dysplasia, formulation to reduce the blood-vessel studying the biomedical applications of a condition in which the lungs fail to narrowing and fluid buildup associated PFC at Temple for 30 years. mature normally, compromising over- with high-altitude stress. all health. “PFC can break the cycle,” “PFC is a core technology with a Wolfson says. “We need better approaches for troops variety of uses: respiratory care, brain injured in combat. This technology is injury treatment, diagnostic imaging, Odorless, colorless, and chemically in- easy to use in the field. The ability to treat drug administration, and other applica- ert, PFC is twice as dense as water, but a problem immediately can make all the tions,” says Wolfson, who holds profes- can hold three times more oxygen than di™erence,” says Wolfson. With 1.4 mil- sorships at the School of Medicine in air. Therefore, it enables the exchange lion Americans sustaining brain injury physiology, pediatrics, and medicine. of oxygen and CO2 at much lower every year from strokes, accidents, and pressure than ventilator-supplied cardiac arrest, which interrupts blood Neonate lung support is the focus air. What’s more, PFC bathes every flow to the brain, the technology has of Wolfson’s longest-running PFC nook and cranny of the lung, opening great potential to aid civilians, too. research. With their delicate, underde- up more alveoli for more e“cient gas veloped lungs, preterm infants aren’t exchange. In addition, PFC directly Wolfson’s contributions to science are ready to breathe. In fact, 85% of reduces pulmonary inflammation, and substantial. She has 14 patents to her infants with birth weights of 3.3 pounds provides a novel route for the adminis- credit, including several related to lung or below develop chronic lung disease. tration of drugs. support with alternative respiratory “They are an underserved population,” media. Nevertheless, she won’t rest un- says Wolfson, determined to break the And it isn’t just for kids. Over the years, til the Food and Drug Administration cycle of iatrogenic lung disease. Wolfson has received more than $25 approves PFC for neonatal respiration. million in grants from industry, the Iatrogenic disease is disease caused by National Institutes of Health, and the In small-scale clinical trials, PFC has medical intervention. While mechani- O“ce of Naval Research to study PFC. shown immediate, positive impact on cal ventilation helps neonates breathe, infant health, which is critical for the it can also harm their fragile lungs. Her recent studies aim to benefit mili- prevention of long-term negative conse- The pressure of forced air causes tary personnel who sustain blast-related quences on child development. “That’s trauma to tissue. Even the oxygen injuries of the brain and lung. To help why I’m still at it,” Wolfson says. “I’m in itself can be perceived as “toxic” by the reduce injury to the brain following a it for the long run.” Marla R. Wolfson, PhD

34 | TEMPLE HEALTH MAGAZINE | SPRING 2015 Photograph by GENE SMIRNOV Taper Point Blunt Point Cutting Point TOOLS OF THE TRADE

SEWING LESSON Sutures & Needles

eady to close that surgical incision or create vascular hookups for Here again, there are many factors to that transplanted organ? There are many types of suture material consider, including the location of the Surgical needles are manufactured in a range of and needles out there. You want the best. anatomy. The needle must fi t the “work- shapes and sizes — some even larger, and smaller, ing space” available — even the extreme- than these. They also come in a variety of point “The best depends on many factors,” says James Bradley, MD, types in addition to the three shown above. ly tight space inside a portal or catheter Chief of Plastic & Reconstructive Surgery at Temple University for laparoscopic and robotic surgery. RHospital. “The composition of the tissue in question, the health of the patient, Made of strong, corrosion-resistant the goals of the surgery — many factors. There’s no single best.” stainless steel, surgical needles come in Bradley has his own favorites. Antonio Di Carlo, MD, Chief of Abdominal various shapes and sizes (one-quarter Organ Transplant Surgery, has go-to’s of his own. A completely di˜ erent set. inch, three-eighths inch, half-inch, The two surgeons do very di˜ erent kinds of surgery. fi ve-eighths inch). There are two basic Yet regardless of choice of material, suturing has one goal: to serve a place- needle body types: Straight-body holding step in the body’s healing process. “The goal is to keep tissues in prox- needles, used for tissue that can be manipulated directly by hand, and imity until they adhere on their own,” Di Carlo explains. The goals of suturing curved-body needles, used for “tight (known as Halsted’s principles) are to obliterate space between tissues, achieve spaces.” There are three types of curved proper alignment of the planes to be joined, distribute tension evenly along Fine needle holders, used in conjunction body shapes: the half-curved ski, the with high-magnifi cation loupes, enable suture lines, minimize trauma to the tissue and maintain blood fl ow, and mini- curved body, and the compound curved surgeons to manipulate tiny needles mize risk of infection and scarring. body (whose tight curvature at the tip that pull suture that’s incredibly thin. gradually widens). In addition to the four basic construc- Needles also come in a variety of tions shown below, sutur e comes in a variety of compositions and sizes. SELECTING SUTURE fi bers (such as polypropylene); or surgi- point types. Standard cutting needles “Several factors infl uence suture cal steel, a monofi lament alloy. have three cutting edges. Side-cutting choice,” notes Di Carlo. The fi rst choice “The unique properties of each mate- needles were designed initially for oph- is between absorbable and non-absorb- rial suit it for some surgeries, yet not thalmologic procedures but are now able suture. Absorbable suture, which others,” Bradley says. Memory, for in- used in many types of surgeries. With gradually disappears, is used for tissues stance, is the suture’s tendency to return sharp points that gradually widen, that heal rapidly, like mucosa. Non- to its original shape. The more memory, taper-point (round) needles “spread” absorbable suture is for tissues that heal the less pliable. You want a low-memory tissue without actually cutting it. slowly, like blood vessels. It will remain suture for closing an infl amed wound, Blunt-point needles have points that are permanent unless removed. Both types because it will gradually “shrink” in rounded and blunt, ideal for suturing are made in many di˜ erent sizes — some tandem with tissue as the swelling goes delicate tissue. much thinner than human hair, some down. Although more di¤ cult to handle Now, for surgical sites that are impos- surprisingly thick. Surgeons generally than “cloth-type” suture, steel suture is sible to reach by hand (and/or that choose the thinnest suture that will hold strong, fl exible, and pathogen-repellent, require incredibly tiny sutures), you’re in a “tension-free” manner. ideal for joining tissues that undergo going to need a needle holder, which The next choice is format. Suture the stress of movement (hence a good enables suturing of far greater precision, Monofi lament Multifi lament Stainless Steel Barbed comes in three basic types: monofi la- choice for closure of the sternum and in far tighter spaces, than can be man- ment (single strand), multifi lament tendon repair). Both cloth and steel aged by the unaided hand. You’ll want to (strands twisted or braided together, suture come in a range of sizes. wear loupes, too, to magnify the target sometimes coated with beeswax or sili- anatomy. cone to ease passage), and barbed (self- PICKING THE NEEDLE All this, and we have not yet begun anchoring, no knot-tying required). Now you must select the right needle. to think about what stitch and knot Now you have to think about suture The length, diameter, curvature, and patterns to use: running, locking, inter- composition. There are many choices point-type of a needle can make or rupted, vertical, mattress, and other here, including collagen (bovine in- break a surgical repair. “The ideal types of closures; surgeon’s knot, square testine); synthetic collagen (polymer); needle is the one that will cause minimal knot, granny knot, Aberdeen knot, etc. surgical silk; surgical cotton; synthetic trauma.” Bradley notes. Perhaps a future lesson.

36 | TEMPLE HEALTH MAGAZINE | SPRING 2015 Illustration by MIKE SUDAL ̄ The 1930 Building, shortly after its opening. ̇ In June 1930, the laying of the building’s cornerstone (R-L): William N. Parkinson, MD, Dean; Temple University President Charles Beury, PhD; and Dr. Beury’s daughter TIMELINE and wife. In October 2014, during demolition, a time capsule was opened that had been hidden by the cornerstone for more than eight decades. The relics it contained are now housed in the University archive.

Farewell, “Old Med”

n October 15, 1930, “This building served an epic purpose one year into the Great for 84 years: helping to transform Depression, Temple University School of students into physicians and scientists.” Medicine celebrated the — Larry R. Kaiser, MD, FACS Oopening of a handsome, eight-story, 155,000-square-foot medical education and research building. It was the first brand-new structure ever built exclu- ̆ The dignitaries who spoke at the new sively for the school. The Class of 1934 building’s dedication was the first to receive all of its didactic ceremony on October 15, instruction there. 1930 (L-R): William N. Designed by William H. Lee, a protégé Parkinson, MD, Dean; W. Wayne Babcock, MD, of acclaimed Philadelphia architect Chair of Surgery; Frank Furness, the building cost $1.5 Philadelphia Mayor million to build (approximately $58 mil- Harry Mackey; William lion in today’s dollars). Situated directly Mayo, MD, of the Mayo across from Temple University Hospital, Clinic; Temple University President Charles Beury, it contained everything modern medical PhD; and Emeritus Dean education required: ample classroom Frank Hammond, MD. space; an amphitheater where students observed work-ups and surgeries; a special floor for the teaching of human anatomy; multiple research laboratories; a well-appointed library with private enclaves for reading and study; and con- temporary “dispensaries” where students learned clinical medicine in a dozen fields — even “new” ones like physical medicine and rehabilitation. Throughout, oversized windows let in plenty of natural light, and elegant wrought-iron balconies became invit- ing places to step out for air. With lounges and a fully equipped kitchen ̆ Details from architect William H. Lee’s beautiful hand-drawn plan for the library of the building. The reserved strictly for student use, the ̇ pharmacology laboratory — one of building became a beautiful and func- more than a dozen tional second home. Although originally called the “1930 “This building served an epic purpose state-of-the-art research Over the years, to meet demand for Building” for its founding year, once for 84 years — helping to transform facilities in the building. additional laboratory and o£ce space, other facilities were erected for the students into physicians and scientists,” ̆ Great teachers like John A. Kolmer, MD, who headed the School’s public health and preventive medicine programs, held the building underwent multiple reno- school in the 1960s and 1970s, the reflects Larry R. Kaiser, MD, FACS, court in the building’s amphitheater to teach the art and vations. Its natural light and sense of building became known as “The Old medical school dean and health system science of medicine and surgery. spaciousness gradually diminished, but Med School,” or “Old Med.” It remained CEO. “While it’s hard to see it go, the its Broad-Street façade long remained functional until 2014 when, after much magnificent building we opened in a thing of beauty, with Temple owls and study and discussion, it became clear 2009, thanks to the the generosity of the names of medical giants rendered in that the structure must be razed to make the university and scores of donors, is a stone and concrete, set into brick. way for more modern facilities. fantastic recompense.”

38 | TEMPLE HEALTH MAGAZINE | SPRING 2015 ARCHIVAL PHOTOS: SPECIAL COLLECTIONS, TEMPLE UNIVERSITY LIBRARIES ALUMNI NEWS Temple’s 12,000+ medical school graduates are advancing health and social welfare across the globe.

Don’t Wait; Create The Lesson of Opportunity

ost universities and most physicians United Kingdom at the time than it was in the United States, can only dream of having a friend and but still an unusual achievement. At the Medical College of mentor like Athole Jacobi, MD. Her Pennsylvania, Jacobi was the first-ever female chair of an support of Temple spans two decades academic anesthesiology department in the United States. — and her devotion to her protégé, She prides herself on never having asked for special treatment. Vincent Cowell, MD, Clinical Associate “I’ve always thought that if you want equality, you need to act Professor of Anesthesiology at Temple, equal,” she says. spans decades, institutions, and title changes — for both of them. “Her involvement with Temple is consistent with the ideals MIn the 1980s, Jacobi, an attending physician at the Medical she holds in high regard: creating opportunities for people College of Pennsylvania, took a personal interest in Cowell, an who are willing to work hard,” Cowell says. “That’s Athole. anesthesia nurse assistant there at the time. Impressed with That’s Temple.” his talent, diligence, and intelligence, she encouraged him to As evidence, Jacobi has been the principal supporter of the enroll in medical school, which he did. It was Jacobi who enabled Department of Anesthesiology’s Chairperson’s Fund at Temple, him to continue working part time at the Medical College of which gives the chair discretionary funds to support things like Pennsylvania while he pursued his degree. Throughout his career, resident education, travel, and research. It’s her way of contrib- it was Jacobi who advised him on matters big and small. uting to the education of anesthesiology residents at an institu- Cowell says it was Jacobi’s unfaltering belief in his potential tion she admires today — and she makes those contributions in that helped him navigate the myriad challenges of a medical ca- honor of Cowell. reer. “She was a backer, an educational resource, a role model, an inspira- tion — basically everything I needed,” says Cowell, a member of the Temple “Her involvement with Temple is consistent with the faculty since 2004. “It’s a mutual admiration society,” ideals she holds in high regard: creating opportunities Jacobi says with a smile. Now 84 and retired, the vivacious for people who are willing to work hard,” Cowell says. Scotswoman enjoys an active life, zipping in her sports car between “That’s Athole. That’s Temple.” appointments as vice chair for the Philadelphia Police Athletic League (PAL) and chair of its During her 20-year association with Temple, Jacobi has sup- education committee, secretary of the board of the Methodist ported numerous initiatives — in media and communications, in Home for Children, and volunteer consultant on medical athletics, and in medicine. It seems completely natural to her, malpractice cases. And let’s not forget, her involvement with seeing and seizing the chance to make a di¢erence. Temple athletics. The longtime Owl fanatic is one of the biggest Both Cowell and Jacobi have created a home away from home Temple basketball and football fans around. She likes to invite at Temple. “I’m always very impressed with what I see going on players (and Hooter the Owl) to PAL events, to the awe and here, and I enjoy being a part of it. Temple and I, we’ve adopted delight of the kids there. each other,” Jacobi says. “I’ve always been particularly impressed by how the coaches It’s an important life lesson: Don’t wait for opportunity to at Temple are true makers of women and men — not just ath- come along; create it. A little initiative can go a long way toward letes,” she says. transforming lives and careers. Jacobi herself knows something about being self-made. She first came to the United States in 1961 after completing her Want to consider including Temple Health in your philanthropic plans? Contact the Athole Jacobi, MD

medical degree and anesthesia training — less of a rarity in the Advancement O§ce: (215) 707-4868 or [email protected]. BURKE DANIEL

40 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 41 ALUMNI NEWS  
 MAY 2, 2015 N THE WESTIN PHILADELPHIA A Reunion, Every Day An Auxiliary? alk into the Colon and Rectal Associates sur- reunions. Zebley and Nejman are celebrating their 25th and gical practice in Abington, PA, and you might 35th reunions, respectively, and Fassler his 20th, a celebration We Think Not. think you’d accidentally wound up 10 miles he happily agreed to chair. Most reunion classes make gifts to too far south on Route 611, at Temple, on support student scholarship in their class’s honor, so contribut- hen most people think of hospital auxil- Broad Street. Regardless of which of the fi ve ing means grooming the next generation of medical Owls — a iary groups, things like bake sales come to surgeonsW you were there to see, you’d fi nd a Temple diploma on central part of their o§ ce culture. All these things pay homage mind. “But this is not your grandmother’s DIAMOND AWARD HONOREE the wall. Indeed, with so much common history, familiar stories, to the institution that helped make them the surgeons they auxiliary,” says Mary McNamara, President Temple University Hospital’s Department of Emergency Medicine and inside jokes, these doctors celebrate something like a mini- are today. of the Temple University Hospital Auxiliary. reunion every day. “Temple’s in my blood,” says Nejman, whose parents worked “We are a diverse group of movers and shakers who support AWARDEES W Daniel J. Hilferty Yoshiya Toyoda, MD, PhD Fran Dunphy “It wasn’t as though we only considered adding fellow alumni for Temple and whose daughter is also a School of Medicine grad. Temple’s amazing work.” Independence Blue Cross Temple University School of Medicine Temple University to our practice,” says D. Mark Zebley, MD ’89. In fact, the partners “I always felt I should do what I could to support the school.” Founded in 1944, the Auxiliary’s mission is to assist Temple interviewed the graduates of many dif- University Hospital through volunteering, fund raising, and   ferent medical schools as their practice honoring outstanding members of the hospital community and Temple University Hospital and the patients it serves grew. But at the end of the day, all fi ve sta¢ . The group has been tenacious in raising funds over the surgeons, like Zebley, are Temple gradu- years, producing nearly $2.5 million over the past decade alone, ates: Steven Fassler, MD ’95; Steven to support projects such as the new reference section of the TO LEARN MORE, PLEASE CONTACT: TEMPLE UNIVERSITY HOSPITAL AUXILIARY Harper, MD ’83; Joseph A. Nejman, Ginsburg Health Science Library and the Mary F. and John M. (215) 707-4898 OR [email protected] BA ’75, MD ’79; and Soo Kim, MD Daly Ambulatory Surgical Center. “In an age of limited industry ’97. Although most did not know each support for hospitals, the monies raised by the Auxiliary are no - TUHAUXILIARY.TEMPLEHEALTH.ORG - other during their student days, now small contribution,” McNamara notes. they share not just an alma mater but a On May 2, the Auxiliary will host its annual Acres of bustling practice as well. “It just sort of Diamonds Gala, one of the Health System’s premier events and happened this way,” Zebley says. fund raisers. Another premiere fund-raising event, In Vino Vita, Harper sees the somewhat acci- planned by, and for the benefi t of, Fox Chase Cancer Center, will dental collaboration as a result of the be celebrated by just a few days prior, on April 30. attitude they share about the practice “These amazing events and the advocates who plan themTempleGala2015_3x4Ad_AllInfo_edited.indd are 1 2/20/15 10:14 AM of medicine — an attitude he attributes not auxiliary; they’re central,” says Nina Weisbord, the Health to Temple. Coming together isn’t so System’s chief philanthropy o§ cer. much about the shared degree or a sense of boosterism, but about values. For more about the Auxiliary, visit tuhauxiliary.templehealth.org. For more “There’s just something about Temple information about In Vino Vita, visit vinovita.org. MDs,” Harper says. “It’s a character you can see in Temple students even now. That down-to-earth, hard-working, FOX CHASE CANCER CENTER everyman attitude. The lack of preten- Temple University School of Medicine BENEFIT & WINE AUCTION tiousness. The emphasis on always put- ting the patient fi rst. That’s something we all have.” It was only natural, then, Reunion Weekend that as they went looking for other sur- April 25, 2015 THE geons, they gravitated toward people who shared that philosophy. Save Date This year, Temple University School of Medicine Reunion Besides working alongside one another, they maintain their Alumni in principle and in practice (L-R): Drs. Steven Fassler, Soo Weekend is scheduled for the spring, rather than the fall, to ties with Temple in a number of ways, big and small. They all Kim, Steven Harper, Joseph Nejman, and Mark Zebley. APRIL 30, 2015 coincide with Temple University’s Alumni Weekend. This change hold, or have held, teaching appointments at Temple. They go will provide attendees access to a whole host of new activities to football and basketball games. They reminisce about their fa- “I truly believe in supporting scholarships,” says Fassler. up and down Broad Street. This also means that the 2014 and vorite professors (the name “Schneck” comes up a lot). They’ve “Temple is the reason we get to do what we do. It’s the foundation 2015 reunions have been combined — doubling the number of helped oversee medical student community service projects for our careers. My reunion class is looking for 100% participa- classes celebrating this year. If you graduated from Temple IN PARTNERSHIP WITH THE funded by the Alumni Association. They try to make fi nancial tion towards our class gift. And who knows? Maybe a student we University School of Medicine in a year ending in 4, 5, 0 or 9, BOARD OF ASSOCIATES OF FOX CHASE CANCER CENTER contributions every year (Nejman recently chaired the School’s help will be the sixth member of our practice someday.” RSVP early for one of the largest alumni gatherings in School annual giving program, the Conwell Society). history. Visit alumni.temple.edu/tusmreunion2015 for more And this year, they have an added reason to refl ect fondly For information about class reunion weekend or class giving at Temple, contact the information, and register today!

on their Temple-ness: three of the fi ve are celebrating their Advancement O§ ce: (215) 707-4868 or [email protected]. ED CUNICELLI

42 | TEMPLE HEALTH MAGAZINE | SPRING 2015 SPRING 2015 | TEMPLE HEALTH MAGAZINE | 43 SO NOTED

“Seeing opportunities where others see obstacles: Jeanes Hospital that’s what fuels healthcare transformation.” was founded in – LARRY R. KAISER, MD, FACS (DEAN & CEO)

“When you apply scientific discoveries to novel treatments, 1928 you generate information from the bedside that drives new and joined clinical trials. This is the essence of translational science: Temple’s Health continually revealing new information that helps clinicians System in work faster and more eciently to find eective treatments for challenging diseases.” – GERARD CRINER, MD, FCCP, FACP (DIRECTOR, TEMPLE LUNG CENTER) 1996.

TEMPLE’S MD CLASS OF 2018: “At the core of who Last year, “The root of I am as a physician is Temple’s Ginsburg what I learned at Health Sciences Library the word doctor 11,246 Temple. It’s a place accommodated comes from the where you learn APPLICANTS docere humanity and humility, 314,576 Latin: , not just medicine.” in-person visits. to teach. Good – BRIAN MCDONOUGH, MD At least twice that many 234 (ALUMNUS AND EMMY-WINNING physicians are ENROLLED MEDICAL REPORTER) were made online. always teaching. They teach 3.68 “I consider it an honor and a privilege to AVERAGE GPA accompany my patients on their cancer themselves, journey. I am allowed to witness their their colleagues, strength and courage, to be exposed to their patients, 32 the devotion of their families and friends, AVERAGE MCAT and to become part of their lives in a very and communities.” – VERDI DISESA, MD, MBA special way.” (VICE DEAN & CHIEF OPERATING 22% – MARY B. DALY, MD, PHD, FACP, CHAIR, CLINICAL GENETICS, FOX CHASE OFFICER) NON-SCIENCE MAJORS DURING THE PAST 10 YEARS, MORE THAN 270,000 PATIENT ENCOUNTERS AT TEMPLE UNIVERSITY HOSPITAL HAVE 23 BEEN AIDED BY 327 LANGUAGE-PROFICIENT STAFF. STATES REPRESENTED 13% 459 RESIDENTS and 92 FELLOWS train in 38 DIFFERENT MEDICAL BORN OUTSIDE OF THE U.S. & SURGICAL SPECIALTIES at Temple University Hospital.

44 | TEMPLE HEALTH MAGAZINE | SPRING 2015 ARTFUL ENDING

The Ultimate Selfie Have a daughter or son who’s snapped thousands of selfies? Bet they don’t have a selfie like this. Feroze Mohamed, PhD, created this “selfie” of his own brain with a technology called diffusion tensor imaging. “Combining magnetic resonance imaging with special- ized computer modeling, this technique uses color image processing to depict the neural circuitry in the brain,” says Mohamed, Professor of Radiology. The colors indicate the orientation of the fibers in three-dimensional space. Red indicates white matter tracts

FEROZE MOHAMED, PHD MOHAMED, FEROZE in the X axis (right-left); green, the Y axis (posterior-anterior); and blue, the Z axis: (bottom-top).

SPRING 2015 | TEMPLE HEALTH MAGAZINE | 45 Temple Health NON-PROFIT Magazine ORGANIZATION Temple University School of Medicine U.S. POSTAGE Temple University Health System PAID O ce of Communications PHILA, PA 3509Temple N. Broad Street Health PERMIT 5140 Philadelphia, PA 19140 Magazine

Temple Health Magazine

6:05 PM Translating scientific discoveries into better treatments.

Temple Health researcher Joseph Cheung, MD, PhD, makes key discoveries that shed light on how the body’s cells react to traumatic events such as heart attack and kidney failure. His findings may help accelerate the testing of new therapies for preventing permanent organ damage and potentially helping millions of patients live longer, healthier lives.

Hundreds of researchers at Temple Health are pushing the boundaries of science to help reduce the devastating eects of heart and lung disease, cancer, neurological disorders, and other serious conditions.

Tomorrow is Here. TEMPLEHEALTH.ORG 800-TEMPLE-MED

Temple University Hospital Temple Health Oaks Temple ReadyCare TUH – Episcopal Campus Temple University School of Medicine Temple Health Center City Temple Physicians TUH – Northeastern Campus Fox Chase Cancer Center Temple Health Ft. Washington Temple Transport Team Jeanes Hospital Temple Health Women’s Care at Elkins Park

Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System and by Temple University School of Medicine. Temple University Health System (TUHS) neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.

Temple Health, Tomorrow is Here Ad, Cancer/Cheung Temple Mag Back Cover: 4C 7.5”w x 8”h Insertions: Friday, June 13, 2014