Penn State Hershey joins international pediatric quality improvement program

The pediatric gastroenterology program at Penn State Milton S. Hershey Medical Center, Penn State Hershey Children’s Hospital, will begin enrolling its first patients into the Improve Care Now (ICN) network in the first quarter of 2014, making it the only hospital in central and western Pennsylvania—and just the second in the state—to become part of this internationally recognized program. ICN is a network of more than fifty pediatric gastroenterology divisions throughout the United States, Canada, and Great Britain focused on the health of children with inflammatory bowel disease (IBD), which includes patients with Crohn’s disease and ulcerative colitis. The network will celebrate its tenth anniversary later this year.

“Improving the quality of care for pediatric patients suffering from IBD always has been our goal,” said Marc E. Schaefer, M.D., M.P.H., Penn State Hershey’s physician leader for the ICN program. “By joining forces with Improve Care Now, our physicians and nurse practitioners have access to medical data to help us treat these children even more effectively.”
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Expanding the Role of Medical Simulation Technology in Medical Digestive Health Student Training

Long before they are admitted to medical school, students have well-honed studying and testtaking skills. But they often lack the skills needed to apply what they’ve learned in the classroom to the clinical setting. Emmanuelle D. Williams, M.D., director of gastroenterology training for second-year medical students for Penn State Milton S. Hershey Medical Center’s Division of Gastroenterology and Hepatology, is working to change that.

“At Penn State Hershey, all of our second-year medical students (currently more than 140) are required to participate in handling initial intake of a simulated ‘patient’ who presents to the emergency department with a gastrointestinal bleed,” said Williams. The case builds directly on classroom lectures about obtaining a medical history, monitoring vital signs and differential diagnosis.

“It’s usually a very emotional experience for the students,” said Williams. “The clinical routine begins to fall apart; they don’t get a proper history, they struggle with differential diagnosis, and professionalism is lacking. It opens their eyes to the difference between book learning and applying that knowledge in the clinic.” Continue reading

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Digestive Health Update: Thomas J. McGarrity, M.D.

The Division of Gastroenterology and Hepatology recently welcomed Karen Krok, M.D. Dr. Krok earned her medical degree and completed internal medicine training at the University of Pennsylvania. She completed a gastroenterology fellowship at Johns Hopkins University which included an additional year of transplant hepatology training. Dr. Krok returned to the Hospital of the University of Pennsylvania as a fulfilled hepatologist for the past five years. At Penn State Hershey, she serves as director of the live donor liver transplant program.

Award presentation photo

Dr. Harold L. Paz, Chief Executive Officer, Senior Vice President for Health Affairs, and Dean, Penn State College of Medicine presented the 2013 Penn State Hershey Medical Center and Penn State College of Medicine Community Service Award for Faculty to Dr. Ian Schreibman.

Transplant hepatologist Ian Schreibman, M.D., recently received the 2013 Penn State Hershey Medical Center and Penn State College of Medicine Community Service Award for Faculty. He was recognized for his ongoing contributions at the Bethesda Mission free medical clinic in Harrisburg, PA. Dr. Schreibman has volunteered many hours of service and has mentored many medical students and internal medicine residents at the Bethesda Mission.

Nurse practitioner Marjorie Lebo, C.R.N.P., received a staff community service Award for organizing the annual Colon Cancer Prevention 5K Run and Fun Walk. This event—held in June for the last seven years—has rapidly become a focal point for the racing community in central Pennsylvania. Proceeds from this event in part support colorectal cancer genetics counseling for individuals without health insurance.

The Penn State Hershey Inflammatory Bowel Disease (IBD) Center works with the Crohn’s and Colitis Foundation of America (CCFA). The IBD Center continues to serves as a major sponsor of the CCFA’s Take Steps for Crohn’s and Colitis contribution to patient awareness efforts throughout Pennsylvania.

Emmanuelle D. Williams, M.D., a member of the IBD Center, also serves on the Advisory Board for the Gluten Intolerance Group of South Central Pennsylvania. Dr. Williams is the recipient of the 2013 American Gastroenterological Association Bridges to Excellence “Recognition for Excellence in the Delivery of Quality Inflammatory Bowel Disease Care”—the only one awarded in Pennsylvania and one of eighteen in the country.

Penn State Hershey physician demonstrating endoscopy techniques to medical students

Dr. McGarrity shares endoscopy techniques as part of the 2013 Ghana Endoscopy Training Program at Korle Bu teaching hospital in Accra, Ghana.

Thomas J. McGarrity, M.D., Professor of Medicine, recently returned from an endoscopy training program at Korle Bu Hospital in Accra, Ghana. With collaborators from Mayo Clinic and Oslo, Norway, a hands-on endoscopy training is provided annually for physicians from Ghana and West Africa. The Ghana College of Medicine has also approved funding for a first-ever gastroenterology fellowship program. The first gastroenterology fellow began training in January 2013.

Finally, Abraham Mathew, Professor of Medicine, was recognized at the annual Penn State Hershey Innovation Ceremony. Dr. Mathew, in collaboration with members of the mechanical engineering department at Penn State University, was awarded two patents for endoscopic devices which will be useful in the development of new endoscopic surgical procedures including NOTES (Natural Orifice Transluminal Endoscopic Surgery).

To learn more about Penn State Hershey Gastroenterology and Hepatology, and to watch a video featuring Dr. McGarrity, please visit http://www.pennstatehershey.org/web/gi/home/aboutus .

photo of Thomas J. McGarrity, M.D.

Thomas J. McGarrity, M.D.

Thomas J. McGarrity, M.D.

  • Professor of Medicine
  • Chief, Division of Gastroenterology and Hepatology
  • Penn State Hershey Gastroenterology
  • Phone: 717-531-1441
  • Fellowship: Gastroenterology, Penn State Milton S. Hershey Medical Center
  • Residency: Medicine, Penn State Milton S. Hershey Medical Center
  • Internship: Medicine, University of Pittsburgh – University Health Center of Pittsburgh; University of Virginia, School of Medicine

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Defining the Role of Intestinal Macrophages in Adaptive Immune Responses, Inflammation, and Dysmotility

graphical depiction of human digestive tractThroughout the gastrointestinal (GI) tract, mononuclear phagocytes, such as dendritic cells and macrophages, play key roles in protective immune responses. A subpopulation of macrophages that resides in the smooth muscle layer of the gut which faces the peritoneum also known as muscularis externa, e.g., muscularis macrophages (MMs), is still poorly understood. Milena Bogunovic, M.D., Ph.D., assistant professor of microbiology and immunology, Penn State Hershey Medical Center, Penn State College of Medicine, explained “Part of the focus of our research is to understand the function of MMs in both homeostasis and in pathologic states such as infection or inflammation.”

During her research training, Dr. Bogunovic, as a member of the team led by Professor Miriam Merad, M.D., Ph.D. at Mount Sinai School of Medicine, participated in the Immunological Genome Project (Immgen) Collaborative Consortium to generate a complete microarray dissection of gene expression and regulation in the immune system of the mouse. She also developed methods to selectively deplete different members of the intestinal mononuclear phagocyte family in vivo. Participating in Immgen and in vivo depletion methods are unrelated and independent, but both provided information that led to a better understanding of MMs. From this work, it is now known that the functional role of MMs appears to go far beyond the traditional understanding of what macrophages usually do. Continue reading

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Basic Research at Penn State Hershey Places Pancreatic Cancer Prevention on the Horizon

Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Usually detected at only the most advanced stages and with median survival time of only three to six months, it leaves little time for treatment or cure. This abysmal clinical outlook has fueled a great deal of research into the nature of pancreatic cancer, as well as key patient factors that place some people at increased risk of the disease.

According to Gail Matters, Ph.D., associate professor of biochemistry and molecular biology at Penn State Hershey Medical Center, Penn State College of Medicine, “The link between patient factors like obesity, chronic pancreatitis, and a family history of pancreatic cancer have provided clues about underlying cellular and molecular pathologies. We know that certain normally-occurring peptides, like cholecystokinin (CCK), are found in elevated concentrations in mice that have been fed a high-fat diet. These peptides have a growth-factor-like effect on pancreatic tumor cells.” Continue reading

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New Developments in the Rapidly Evolving Landscape of Hepatitis C Therapy

Hepatitis C is one of the most dreaded conditions in the United States today, affecting approximately 2 percent of the population. It remains the most common cause for liver transplantation in the United States; 10,000-20,000 patients with hepatitis C die annually. Standard interferon/ribavirin regimens are given for six to twelve months, and only yield a cure rate of 40-50 percent. Furthermore, patients face a high risk of side effects, including, but not limited to, thyroid abnormalities, retinopathy, pancreatitis and blood cell dyscrasias.

Fortunately this clinical picture has brightened considerably in the last two years. Leading hepatologists in the United States and around the world, including those at Penn State Hershey Medical Center, have helped to usher in a new era in hepatitis C treatment. Based on Phase III trials for which Penn State Hershey served as an investigational site, the protease inhibitors boceprevir and telaprevir were approved in 2011. Ian Schreibman, M.D., associate professor of medicine, Division of Gastroenterology, Department of Medicine points out, “Unlike interferon, boceprevir and telaprevir directly disrupt the viral replication cycle. When combined with interferon and ribavirin, dramatically higher cure rates of about 70 percent were seen using a regimen only half as long (about six months). This represents a true paradigm shift in hepatitis C treatment.” Continue reading

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Innovative and Minimally Invasive Techniques for Pancreatic Cyst Ablation and Cancer Prevention

Cancer of the pancreas remains one of the greatest clinical challenges in oncology. With no reliable screening tests and a poor prognosis following identification, the need for novel approaches toward this disease remains largely unmet.

In recent years, however, pre-malignant pancreatic cystic lesions have been increasingly discovered in patients undergoing cross-sectional imaging for unrelated reasons. While over half of pancreatic cystic lesions have little to no malignant potential, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) can carry a high potential for progression into pancreatic cancer.

Discovering a pancreatic cyst poses a new set of difficulties. According to Matthew T. Moyer, M.D. M.S., associate professor of medicine, Penn State Hershey Medical Center, “Either serial radiographic surveillance or surgical resection is generally recommended for these cysts, both of which have significant limitations. Surveillance is inconvenient and expensive with no therapeutic aspect, while surgical resection is associated with a significant risk of morbidity (20 to 40 percent) and mortality (1 to 2 percent).” Continue reading

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