February 6, 2007, Volume 53, No. 21
Penn E-lert Improvements Increase Efficiency
The University of Pennsylvania Health System’s virtual intensive care unit, Penn E-lert, has upgraded by adding new alerts and alarms, equipment interfaces and converting to paperless recordkeeping. These enhancements will add another dimension to the system, increasing the speed, transparency and accuracy of treatment for the critically ill.
Penn E-lert eICU is a remote monitoring system that integrates interdisciplinary intensive-care teams with innovative technology to educate, improve practice, increase efficiency and save lives. Off-site doctors and nurses can track numerous patients through a computer, camera and audio system. The system is programmed to track trends and changes in critically sick patients. Bedside physicians can be made aware of these trends and changes to prevent patient deterioration and complications from arising.
“The biggest improvement is paperless recordkeeping. It’s all right there on the computer,” said Frank Sites, operations director for Penn E-lert. “Typically patient care is documented on a ten-page flow sheet. Sometimes the handwriting is unreadable or something can be lost in translation. Not on the new system. Everything is there on the patient’s page. All medications, treatment, trends, alarms, vital sign changes are right there. It’s all clearly legible. Everyone involved in the patient’s care from nurses, to doctors, to social workers can sign in and check on a patient’s treatment. No more looking for the doctor or looking for a patient’s chart. This also prevents confusion when a new shift of doctors and nurses takes over. They just log on to the computer and it’s all right there.”
He adds that, “The proactive approach of virtual ICU’s, like Penn E-lert, has resulted in lower mortality among the sickest of patients. That’s the most important thing.”
Equity for Black College Students in the South?
Black students are more likely to get their college education in one of the 19 Southern or Southern-border states than in the rest of the country.
But how does their standing compare to white students in terms of enrollment and graduation?
A recent study from Penn GSE shows that, although some progress has been made, public higher education in the South remains highly inequitable for black students.
Details of the study are outlined in “The Status of Equity for Black Undergraduates in Public Higher Education in the South: Still Separate and Unequal,” by Dr. Laura Perna, associate professor of education.
Prospects for black students vary, depending on the kind of institution attended, Dr. Perna found. Public four-year Historically Black Colleges and Universities (HBCUs) and public two-year colleges offer greater opportunity, while flagship institutions provide substantially less opportunity. Public four-year HBCUs are the only sector in which black students consistently approach or achieve equity in enrollment and degree completion across the 19 states.
According to Dr. Perna, federal civil rights enforcement does not guarantee improvement. Eight of the states studied have been ruled in compliance with the Civil Rights Act of 1964, while 11 still remain under federal oversight, either through the courts or the Office for Civil Rights. Nonetheless, in states in all three categories, black students experience considerable inequity in first-time, full-time enrollments and bachelor’s degree completion. Again, the greatest inequity occurs at the public flagship institutions.
Data from this study came from the Integrated Postsecondary Education Data System, the postsecondary education data collection program for U.S. Department of Education’s National Center for Education Statistics.
States in the study are Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia.
Nationwide, these 19 states account for 59 percent of all black students and 41 percent of all students.
Thought-Controlled Artificial Limbs
Investigators at the School of Medicine describe the basis for developing a biological interface that could link a patient’s nervous system to a thought-driven artificial limb. Their conceptual framework–which brings together years of spinal-cord injury research—is published in the January issue of Neurosurgery.
“We’re at a junction now of developing a new approach for a brain-machine interface,” said senior author Dr. Douglas H. Smith, professor of neurosurgery and director of the Center for Brain Injury and Repair at Penn. “The nervous system will certainly rebel if you place hard or sharp electrodes into it to record signals. However, the nervous system can be tricked to accept an interface letting it do what it likes—assimilating new nerve cells into its own network.”
To develop the next generation of prosthetics, the idea is to use regions of undamaged nervous tissue to provide command signals to drive a device, such as an artificial limb. The challenge is for a prosthesis to perform naturally, relaying two-way communication with the patient’s brain. For example, the patient’s thoughts could convert nerve signals into movements of a prosthetic, while sensory stimuli, such as temperature or pressure, provides feedback to adapt the movements.
The central feature of the proposed interface is the ability to create transplantable living nervous tissue already coupled to electrodes. Like an extension cord of sorts, the non-electrode end of the lab-grown nervous tissue could integrate with a patient’s nerve, relaying the signals to and from the electrode side, in turn connected to an electronic device.
This system may one day be able to return function to people who have been paralyzed by a spinal-cord injury, lost a limb, or injured in other ways. “Whether it is a prosthetic device or a disabled body function, the mind could regain control,” said Dr. Smith.
Co-authors are Penn doctoral candidate Niranjan Kameswaran; Dr. Eric L. Zager, professor in Penn’s department of neurosurgery; Dr. Bryan J. Pfister from New Jersey Institute of Technology, and Dr. Jason Huang from the University of Rochester.
Ineffectiveness of Laser Treatment in Macular Degeneration
According to a study that appeared in the November 2006 issue of the Journal of Ophthalmology, researchers at Penn’s School of Medicine and 21 other clinical centers have found that low-intensity laser treatment, which was thought to be beneficial in slowing or preventing the loss of vision from age-related macular degeneration (AMD), is ineffective in preventing complications of AMD or vision loss. This is the major conclusion of the Complications of Age-Related Macular Degeneration Prevention Trial (CAPT), a research study supported by grants from the National Eye Institute (NEI) of the National Institutes of Health (NIH).
According to the NEI, AMD is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. Drusen, yellow deposits under the retina, is the first sign of early AMD. The debate in recent years has been whether or not to treat these patients with preventive laser treatment. “We found that laser treatment had neither a clinically significant beneficial nor harmful effect for these patients. There is no evidence from this trial to suggest that people with large drusen should seek preventive laser treatment,” said Dr. Stuart L. Fine, CAPT chairman and chair of Penn’s department of ophthalmology and director of the Scheie Eye Institute. Currently, the only established way to decrease the risk of vision loss in people with large drusen is daily supplements of vitamins and minerals.
New Therapy to Treat Severe Cholesterol Levels
Researchers at Penn’s School of Medicine have demonstrated the potential of a new type of therapy for patients who suffer from high cholesterol levels. The findings are in the January 11 issue of the New England Journal of Medicine. In this study, patients with homozygous familial hypercholesterolemia (FH), a high-risk condition resistant to conventional therapy, had a 51% reduction in low-density lipoprotein (LDL) or “bad cholesterol“ levels.
“Our study shows that targeted inhibition of the microsomal triglyceride transfer protein (MTP) is highly effective in reducing cholesterol levels in these very high risk patients,” said Dr. Daniel J. Rader, director of Preventive Cardiology and the Clinical and Translational Research Center at Penn, and principal investigator of this study.
Genetic defects in MTP lead to profoundly low levels of LDL. Using this information, Bristol-Myers Squibb began to search for inhibitors of this protein and discovered the study drug, originally known as BMS-201038. Bristol-Myers Squibb then donated it to Penn for use in clinical trials in patients with severe cholesterol problems.
Patients who suffer from homozygous FH have a very high risk of premature cardiovascular disease, developing it in their twenties and generally do not live past the age of 30.
In this study, patients received the MTP inhibitor at four different doses, each for four weeks, and returned for a final visit after an additional four-week drug washout period. Analysis of lipid levels, safety laboratory analyses, and magnetic resonance imaging of the liver for hepatic fat content were performed throughout the study. All patients tolerated titration to the highest dose studied. In addition to the 51% reduction in LDL cholesterol, treatment at this dose also decreased total cholesterol levels by 58%, triglyceride levels by 65% and apolipoprotein B levels by 56% from baseline.