Role Playing to Improve the Patient Experience

By Chuck Finder

Mindy is a University of Pittsburgh music student with an important audition the next day. By the time she walks into the emergency department of this make-believe hospital setting, she has a suspected mass on her trachea, her frantic mother arrives without gleaning much information from staff, and it all takes both way too long and too many twists.

Welcome to Dr. DiGioia’s neighborhood.

As part of his Patient and Family Centered Care (PFCC) program at UPMC, Anthony DiGioia, M.D., infuses conferences with a simulated exercise such as Mindy’s (not a real student). Mindy’s pretend adventures were all a part of the Shadowing workshop Friday at the Wyndham University Center, site of this two-day PFCC VisionQuest conference. Shadowing a patient and family ultimately engages patients as partners in the design of care delivery, which not only has been shown to improve outcomes and the experience but also saves resources and expenses.

“Ever since we started the PFCC Innovation Center in 2006, the program has grown to include more than 60 different care-experience working groups across the UPMC hospital system – and in other clinics and hospitals across the country,” said Dr. DiGioia, the force behind the Bone and Joint Center at Magee-Womens Hospital. “By using a live, stage production to simulate the clinical-care experience, it allows health-care professionals in the audience to shadow the patient and family, then provide feedback. It’s so important, we find, for us to view all care through the eyes of patients and their families  – and, in the end, it enables us to improve our processes as well as the patients’ experience in order  to provide better care and comfort to them.”

John Houde, M.D., an orthopaedic surgeon from central New Hampshire, attended the VisionQuest conference in Washington, D.C., last May. This week, he sent four of his practice’s key workers to Oakland for the next VisionQuest.

“He is very interested in the PFCC model,” said Becky Van Dolah, his physician assistant. They’ve already launched the Shadowing methodology, hoping to simplify a clinical calendar already crammed. “It can be difficult to get into our clinic quickly, so we are looking at that process, getting our patients in faster.

“It has been extremely helpful,” Van Dolah said of this conference. “I’ve been all through the website, reading everything I can. But to be here and go through it. . .  my head is swimming with ideas right now. I can’t wait to get back and get started.” 

World Mental Health Day: Preventing Depression in Developing Countries

By Charles F. Reynolds III, M.D.

Today is World Mental Health Day, when the World Health Organization works to raise awareness of mental health issues around the globe. Recent developments are helping us better understand how to treat depression and anxiety disorders in developing countries, but much work remains.

Depression and anxiety disorders are a significant public health concern in developing countries, also referred to as low and middle income countries (LMICs).  

Late-life depression and anxiety are of particular concern in LMICs. This is due to rapid demographic transition and aging in countries such as India, increased prevalence of social conditions that are recognized as risk factors - such as living alone or living with a chronic disabling condition - and the inability of health systems to address the physical and mental health needs of the elderly due to a lack of mental health resources.

Because of a lack of mental health specialists, there is a large need to focus on prevention interventions that can be delivered by non-specialists and lay health workers in non-health care or primary-care settings. In other words, mental health care services can be provided by caregivers other than mental health experts such as psychiatrists and psychologists.

By equipping lay and non-specialist workers with the skills needed to help individuals in countries with few mental health resources, we can work towards a long-term goal of scalable depression prevention in LMICs. These skills include the use of learning-based psychotherapies, such as problem-solving therapy for primary care and brief behavioral treatment for insomnia, which in the West have shown to reduce depressive and anxiety disorders by 25 percent over one to two years compared to usual care. Such therapies can help individuals cope with stressful relationships and situations that may trigger depressive episodes, and teach more constructive thought patterns to replace thinking habits that magnify feelings of worthlessness and hopelessness.

A recent study conducted in Goa, India, demonstrated that the use of lay health counselors increased recovery rates from common mental disorders - anxiety and depression - in a sample of patients of all ages.

Now, a new study funded by the National Institute of Mental Healthis working to investigate the use of non-specialists in an effort to prevent late-life depression and anxiety in LMICs, specifically in Goa, India.

Researchers  will develop best practices for depression and anxiety depression, and teach learning-based psychotherapies as well. Other tactics will include education about symptoms of depression and anxiety, instruction in breathing exercises and relaxation to manage symptoms of anxiety, and scheduling of activities to manage symptoms of depression.

Charles F. Reynolds III, M.D., is the UPMC Endowed Professor in Geriatric Psychiatry and Director of the Aging Institute of UPMC and the University of Pittsburgh.

Technology is Helping to Reduce Food Waste at UPMC

By Cristina Mestre

Thanks to an innovative computerized food management system, hospital systems across the U.S. are seeing a large decrease in food waste.

Here in western Pennsylvania, UPMC Passavant, UPMC Hamot and Magee-Womens Hospital of UPMC are using the Sodexo corporation’s food management system to save not just food, but dollars, too.

The computer-based system allows you to enter food waste data and portion numbers into an electronic database, and to adjust those numbers based on how many customers are coming through and purchasing food, says Brandon Stapleton, operations manager of food and transport services at UPMC Passavant.

While forecasting menus is not new, the program allows you to calculate your specific food needs based on how many customers you have, he notes.  Plus, it is much more user-friendly than other forecasting methods and can track trends and monthly reports, thereby letting you see patterns in your food usage. 

The key to the system is forecasting your menu in a five-week cycle.  So, if you had turkey five weeks ago and prepared 200 portions but only sold 150, you’d have 50 left. By entering this information into the system, purchasing needs will be adjusted to make fewer portions the next time. 

“One of the biggest parts of the program is getting the staff involved in looking at food and waste versus leftovers. It’s key to understand the difference,” Stapleton notes. “What was prepared does not equal what was wasted – leftovers can be used in safe and nutritious ways.”

“Staff buy-in is key, too. Food waste is tracked manually but then entered electronically, so you have to put in the time and enter the data,” adds Stapleton.

Although cost-savings calculations are still in the works, UPMC Passavant has tracked food savings over the 5-week menu cycle. The percentage of waste reduced ranged from 22 to 32 percent during that time.

Other food waste reduction efforts are happening at Magee-Womens Hospital, in the on-site organic vegetable and herb garden. The produce grown there is utilized in healthy menu options in the cafeteria, café, and patient meals. This year the Magee garden has to date has yielded 1,318 lbs of produce and herbs, thereby $3,366 in food purchasing costs. 

Penguins, UPMC Team Up to Build World-Class Practice Facility

By Chuck Finder and Tim Betler

Mario Lemieux’s name, family and foundation dot the UPMC landscape already. There are Austin’s Playrooms in seven spots around the system, from McKeesportto Mageeto Mercyto Children’s, where there also stands a Lemieux Sibling Center. There are the Children’s Home of Pittsburgh and the Lemieux Family Center plus the Mario Lemieux Center for Blood Cancers opened last December. And more.

So when the NHL Pittsburgh Penguins and UPMC joined together to build in Cranberry a practice facility and Sports Medicine clinic like nowhere else in North America, there was no other name to attach to it: The UPMC Lemieux Sports Complex.

UPMC President and CEO Jeffrey A. Romoff and Executive Vice President Elizabeth B. Concordia stood alongside Lemieux, the Penguins’ co-owner and Hall of Famer, on Oct. 2 for the groundbreaking celebration – sticking engraved shovels bearing Lemieux stick-handles into the soil. Also digging it were: Penguins CEO David Morehouse, COO Travis Williams, General Manager Ray Shero and coach Dan Bylsma; UPMC Vice President of Operations Presbyterian Shadyside Albert Wright; developer Gary Sippel; and Cranberry Manager Jerry Andreeand Board of Supervisors chairman Bruce Mazzoni. 

My Weekend With the Steelers

By Ruth Whelan

Ruth Whelan, a physiotherapy (what we call physical therapy) manager from UPMC Beacon Hospital in Dublin, Ireland, was invited by Pittsburgh Steelers head athletic trainer John Norwig to join the medical staff – including physicians from the team’s official health-care provider, UPMC – on the Steelers sidelines during their game last week against the Minnesota Vikings. Herewith, an Irish view to a completely foreign game (with a few parenthetical Irish-to-American translations):

Ruth Whelan

On Sunday 29^th, Sept. 2013, the Pittsburgh Steelers played Minnesota Vikings as part of the NFL  International Series in the iconic Wembley Stadium before a crowd of 90,000, and I had the privilege to stand pitch side. (Translation: “pitch” is the field.)

Two years ago, Ambassador Dan Rooney introduced me to John Norwig, the head athletic trainer for Pittsburgh Steelers. John was visiting the Rooneys in Ireland and, given his connections with UPMC, John took some time out of his trip to tour our hospital facility: UPMC Beacon Hospital in Dublin, Ireland. From this chance encounter, John and I stayed in contact, and our friendship grew stronger through our mutual affiliations with UPMC and our love of sports rehabilitation. Little did I know at the time that one day John would give me the once-in-a-lifetime opportunity to see first-hand his role with Pittsburgh Steelers.

My invite from John not only included presence pitch side at an NFL International Series game in London, but also unlimited access to the training sessions, mock games (translation: practices) and training rooms in the two days leading up to the game – a truly golden ticket.

The first sighting of the Steelers’ world left me gasping for air. The sheer size of the players, the magnitude of the entourage and the precision of their planning was unimaginable. On day one, I was really struck by the size of the support teams that include a UPMC consultant neurosurgeon, UPMC orthopaedic surgeon, UPMC internal medicine physician, strength and conditioning coaches, position specific coaches. . . . It was an effort to control my emotions with each introduction!

On match day (translation: gameday), the excitement commenced the minute we boarded the coach (translation: transportation, not Mike Tomlin) with a police escort all the way to Wembley and fans waving at our bus as we drove through the streets of London! As if this was not enough, I managed to find myself sitting beside Troy Polamalu and Ryan Clarke (sic) on the coach.

Four hours before Kick-off, it was straight to the locker rooms. The Steelers had two interconnecting locker rooms; one for the offence and one for the defence (translation: hey, that’s how the Canadians spell it, too!), both immaculately presented. Each player’s uniform was presented perfectly in each booth (translation: locker). Players got ready at their own pace and used the cues from the coaches as to when they had to be on the pitch. Calls like “Offence 2 minutes,” “Defence 3 minutes,” “Team 5 minutes” echoed through the locker rooms.  John and his team worked effortlessly to ensure each player’s every need was addressed from taping and stretching to ensuring each player was appropriately hydrated.

Whelan with Steelers
defensive end Brett Keisel.

The calmness in the dressing room was in complete contrast to the roars of the crowds out on the pitch. And then, when you think you have seen everything, a final pleasant surprise: silence descended as they stood while one of the teammates led them in prayer. It was a truly amazing and moving sight to observe.

Just before kick-off, we lined up behind the team in the tunnel and had the privilege of running behind the team onto the pitch to the roars of the crowd – what better way to experience life as a Pittsburgh Steelers footballer!

While the game did not go our way, it was clear that each team player had given it his all; each play carried out with maximum intensity and gritty determination. Coaching staff motivated players during every minute of each play – running up and down the line (translation: sideline), calling players into huddles, scribbling notes for half-time. Athletic training staff had worked hard to ensure players were physically fit for each play and that each stayed hydrated. Medical staff observed every tackle and looked at replays to ensure there were no unaccounted for injuries. It was a true team effort on and off the pitch.

Given my limited knowledge before this weekend of American football, I can readily see why it is the No. 1 sport in the U.S. It offers a true sporting spectrum of strength, skill, speed, agility and pace coupled with passion and nail-biting excitement. The Pittsburgh Steelers game brought this and more to Wembley. They have a new No. 1 Irish Fan. Let’s hope they come to Ireland sometime soon so that more sports lovers can get a taste of what I experienced first-hand!

A huge thank you to John Norwig for this once-in-a-lifetime opportunity!

UPMC Offers Resources for Allergy Sufferers

By Andrej Petrov, M.D.

Medical Director, Allergy and Clinical Immunology (Oakland Campus)

Chief, Allergy-Immunology (Shadyside Campus)

Autumn means back to school, cooler weather and fall foliage. Unfortunately, for many of us, it also means experiencing allergies to ragweed and mold. With about 40 million Americans suffering from allergies, approximately 10 to 20 percent of the public is allergic to ragweed. 

Ragweed flowers from mid-August to late October or until the first frost. And although rain washes pollen away, it can help mold spores to grow quickly outside – a pile of damp leaves is a prime example. Many people that are allergic to pollens released in the spring are also allergic to ragweed. Not only that, but ragweed can travel hundreds of miles from wind and therefore spread to many areas.

Here are some common questions about allergies.

How do I know if I have allergies?

There are indoor and outdoor allergies, and it's important to understand the difference. Pets, dust mites, mold or cockroaches qualify as indoor allergens. Outdoor allergies are trees, grass and weed pollens, as well as mold. Allergy season is determined by pollen count, and varies by region. Usually, tree pollen is active in early spring, grass in early summer, and weed in early fall. For more detailed information, check your local listing which can provide a more precise day-to-day pollen count.

Runny nose, itchy, watery eyes, nasal congestion, and puffy eyes are all typical symptoms of allergies. Difficulty breathing could be a sign of asthma and fever and chills indicate a cold or the flu. Colds get better over a week to 10 days in most people while allergies tend to last longer. Individuals with allergies will remember having the same symptoms at the same time each year.

What can people suffering from seasonal allergies do to relieve symptoms? 

• Don’t open your windows.
• Use air conditioning.
• Clean your filters.
• If you exercise outside, avoid morning workouts when pollen counts are higher. From sunrise to mid-morning, pollen counts are high. Pollen counts are lower in early evening.
• Wear sunglasses to keep pollen out of your eyes.
• Try over-the-counter antihistamines.

What over-the-counter medicine works best?

Every person responds differently to medication. There are non-sedative antihistamine options that are recommended for daytime. Some people like a saline nasal wash which will wash out some of the allergen that gets in the nose. Nasal steroid sprays are prescription only and are the most potent medical therapy. 

There are also allergy (immunotherapy) shots that modify the immune system and improve allergies long-term if you can identify specific things that trigger your symptoms.

For specific treatment, see an allergist for a one-on-one consult.

Where can I get tested for allergies?

If you are experiencing common allergy symptoms for more than two weeks and/or at consistent times throughout the year, visiting a board-certified allergist would be beneficial.

We have four sites at UPMC where you can be tested. The locations are within the Falk allergy clinic in Oakland, our location at UPMC Mercy, and our locations in Monroeville and Greensburg. To schedule an appointment, call 412-648-6161 or visit UPMC's allergy website for more information.

Breaking the Silence on Ovarian Cancer: Guyanna’s Story

By Jessica Krehlik

Guyanna Ackison, an Army health care recruiter, University of Pittsburgh nursing student and mother of two, found her calling with the National Ovarian Cancer Coalition (NOCC).  Watch the video above to learn about her cancer journey with UPMC, where she received genetic counseling and a preventive procedure. 

Ackison underwent a precautionary procedure known as a preventive hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) at the age of 33 after developing severe symptoms of endometriosis, where tissue normally found only in the uterus is present elsewhere in the body.  Due to her extensive family history of breast and ovarian cancer — she lost her mother to cancer at age 14, and only later learned it had been ovarian cancer — she decided a complete hysterectomy with the removal of the ovaries would be the best bet to have a long, healthy, cancer-free life.

After her experience, she was fueled with the desire to become an advocate for awareness of the disease, and to engage in and support the survivor community.

She attended the NOCC’s annual Walk to Break the Silence on Ovarian Cancer ^TM in September, 2011, and found a new type of family amongst the members of the NOCC. “I did not know a single person, and I felt more at home than I probably had ever felt in all my travels,” says Ackison, who was stationed in Germany and Iraq during her career as a military nurse. “It was very calming.”

Also in attendance at the event were staff members from the office of her gynecologic oncologist, Dr. Edwards, who has been involved in and advocated for the NOCC sine the establishment of the organization’s Pittsburgh Chapter. “It’s important to me that the people [who] are our health care providers and take care of us are involved in organizations that the patients find important as well.”

At the walk, Ackison’s first NOCC event, she decided to sign up to volunteer. She recalls thinking, “This would be a nice way to give back,” and found herself jumping right into active volunteer work. She describes her experiences as a NOCC volunteer as extremely fulfilling, and compares it to the fulfillment she found from serving in Operation Iraqi Freedom and during the rest of her Army career.

During her first duty station in the military, Ackison worked in pediatric hematology oncology (cancers and blood-related disorders) and fell in love with her work. After returning from Iraq, she worked in a hospital in Fort Riley, Kansas, where she discovered her passion for education.

Today, Ackison goes to health fairs and talks to people about ovarian cancer—a disease that “that no one talks about because it’s your ovaries,” she says.  She also helps present a lecture on ovarian cancer for one of her nursing classes at Pitt each semester.

“I was very upset when I found out my mom had [ovarian cancer],” Ackison explains. “Obviously then she didn’t understand the effects that it could have on me, but I just feel like it’s something that you need to tell your children.” Ackison’s own daughters are aware of her condition, volunteer regularly with the NOCC, and are her biggest driving force for advocating ovarian cancer awareness.

“It’s kind of hard when your 9-year-old comes to you and asks how it starts, and how do you get ovarian cancer,” she says. “To explain without being too technical, I just told her the cells kind of have a dance party and go a little crazy…but it’s not a good dance party.”

“The girls are absolutely amazing,” says Ackison. “They volunteer with us so they’re aware of what we do and who we are there [to support] — the survivors.”

Ackison is currently part of the NOCC council and works on logistics for the annual Run/Walk event, including signing up new volunteer members and fielding questions.

“I think awareness in being able to offer preventive treatment rather than operating on advanced cancers is how we can have an impact on the disease,” says Dr. Edwards.

 “It’s really important for families to talk to one another. When [women] are experiencing things that just don’t seem right, it’s not always okay to push it off,” Ackison says.

Being aware of family history is key, notes Dr. Edwards. Even so, the current recommendation for any woman who has diagnosed with ovarian cancer is to participate in BRCA testing.

If positive, Dr. Edwards recommends the daughters be screened as well. “If they are positive, then they might want to change their reproductive decisions as they get into their 20s and 30s,” says Dr. Edwards. “And certainly [they] need to be followed by someone who knows the limitations of the available screening tests.”

Read more about Ackison's personal experience with ovarian cancer and her ongoing treatment at UPMC. 

More information on ovarian cancer getting involved in the NOCC is available here.