Stop, Drop, and Pass the Rolls!

MSD Offices will be closed on Thursday, November 24 and Friday, November 25 for the Thanksgiving holiday. MSD staff wishes you and your loved ones a safe and happy holiday.

In case you didn't hear, President Biden continued the White House Thanksgiving tradition of pardoning turkeys this week when he absolved two large birds, Chocolate and Chip. In 1963 President Kennedy became the first President on record to pardon a turkey for.... being a turkey.

And, if you need a kid-friendly joke to get even Aunt Sally to smile, here's one: What do you get if you divide the circumference of a pumpkin by its diameter? Pumpkin Pi!

We all appreciate those in our lives who toil to bring our Thanksgiving meal to the table. This year for fun, we took a look at how much the cost of the Thanksgiving meal has risen since 1960 (Source: Self.inc and U.S. Department of Agriculture).

• The average cost of a Thanksgiving meal has increased by 565% since 1960.
• A Thanksgiving feast (turkey and all the trimmings) for 10 people costs $77.52 today ($7.75 per person). In 1960, the same meal cost $11.65 ($1.16 per person).
• Back in 1960, a 16-pound turkey would cost $3.06. Now, that price is close to $30, a 10% increase since last year.
• And for those stuffing lovers, cost of traditional stuffing (bread, eggs, onion, herbs, and homemade broth substitute) was researched showing the onion having the most dramatic price increase jumping 1,700% since 1960. Eggs have seen the slowest price increase at just 189%. Overall, the cost of stuffing rose from $1.03 to $5.44.
• The cost of mashed potatoes saw a sharp increase of 757% in price since the 1960s with the dish now costing $6, up from $0.70 in 1960.
• Costing a mere $0.63 in 1960, a side of green bean casserole has since increased by 727% to $5.21 today. 
• The cost of salad has gone up over 1300% since 1960 and has never been as expensive as it is today.
• The cost of pumpkin pies have seen the lowest price increase out of all Thanksgiving dishes at 193% since 1960, so have another piece!

Tuesday, November 29

As we look forward to food and family gatherings for Thanksgiving tomorrow, we are reminded that Giving Tuesday is less than a week away! That means nonprofits from all over the country will be asking for your support. MSD is no different. With your support, we will continue to fight new threats of overdoses caused by fentanyl on the streets, to ensure that uninsured patients can purchase life-saving medications through the Voluntary Initiative Program, and to provide educational outreach like our OBVIOUS Campaign for Kids.

Your donation to the MSD Mission Appeal always goes far towards these campaigns, but right now, your gift will have twice the impact! The first $1,789 in Giving Tuesday donations will be matched dollar-for-dollar!

Make your Giving Tuesday donation early to DOUBLE your impact and help lock in this anonymous challenge >>

Renewal Deadline is January 2, 2023

The 2023 membership renewals have been prepared for all current members. We are pleased to inform you that 2023 membership renewal rates have remained the same with no increase. MSD has worked hard on your behalf and has expanded its reach to include environmental health and diversity, equity, and inclusion concerns, as well as our continued advocacy for physicians and patients in Delaware. Your 2023 membership renewal can be completed online by logging into the MSD website or by providing payment over the phone or through the mail. All 2023 individual membership renewals are due by January 2, 2023. Group renewals are due December 16, 2022. Please contact MSD Membership Manager Michelle Seymour with any questions at (302) 224-4905 or Michelle.Seymour@medsocdel.org.

Expanded Recommendations to Support Physicians and Patients

The Centers for Disease Control and Prevention (CDC) announced the release of updated

and expanded recommendations for physicians providing pain care for adult outpatients

with short- and long-term pain. These clinical recommendations, published in the CDC

Clinical Practice Guideline for Prescribing Opioids for Pain, will help physicians work with

their patients to ensure the safest and most effective pain care is provided and improve

communication to make informed decisions about safe and effective pain care. The

recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible,

one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical

judgement about personalized treatment. The publication updates and replaces the CDC

Guideline for Prescribing Opioids for Chronic Pain released in 2016.



The 2022 Clinical Practice Guideline addresses the following areas: 1) determining

whether to initiate opioids for pain; 2) selecting opioids and determining opioid dosages;

3) deciding duration of initial opioid prescription and conducting follow-up; and 4)

assessing risk and addressing potential harms of opioid use. The Clinical Practice

Guideline supports the primary prevention pillar of the HHS Overdose Prevention

Strategy – supporting the development and promotion of evidence-based treatments to

effectively manage pain.

Rise in Cholera Infections Worldwide

The Delaware Division of Public Health (DPH) has issued a health advisory to all health care facilities in Delaware providing guidance on travelers returning with symptoms associated with cholera. Cholera vaccine shortages have led international health organizations to temporarily suspend two-dose campaigns for outbreak response in favor of single-dose vaccinations to preserve global stockpiles. On November 18, 2022, the Centers for Disease Control and Prevention (CDC)’s Division of Foodborne, Waterborne, and Environmental Diseases issued an advisory to public health partners on conducting surveillance for travelers returning with cholera. A traveler could arrive in the United States with cholera at any time. Sustained community transmission in the United States is unlikely due to reliable water, sanitation, and hygiene (WASH) infrastructures. However, without treatment, cholera can result in death within hours. The Advisory Committee on Immunization Practices (ACIP) recommends the use of single-dose oral cholera vaccine (CVD 103-HgR) for travelers 2 to 64 years old going to areas of toxigenic Vibrio cholerae O1 transmission. The Centers for Disease Control and Prevention (CDC) defines areas of active cholera transmission as administrative subdivisions where ≥100 cases have been reported within the past year. People who develop watery diarrhea within five days after being in any country where cholera is occurring should seek medical care immediately and inform the clinician about their travel history. Physicians evaluating patients with acute onset of watery diarrhea should obtain a travel history, consider cholera in patients returning from affected regions, and obtain a stool specimen for Vibrio cholerae testing.

Young Leaders, Health Care Professionals, and Legislators Discuss What Is and Isn't Working for Health Care in Delaware

As reported by WHYY, U.S. Surgeon General Vivek Murthy got some insight on what is and isn’t working for health care in Delaware during a meeting on Tuesday this week with young leaders and health care professionals in Wilmington. The closed-door discussion at The Warehouse, a community center for Wilmington teens, also included input from doctors, nurses, and hospital administrators, as well as U.S. Senator Chris Coons and Congresswoman Lisa Blunt Rochester. Throughout Murthy’s tenure in office, two concerns have been dominant: COVID-19 and mental health and well-being. He said the two are intrinsically linked, calling anxiety, stress, depression, and isolation the “invisible wounds.” The pandemic’s toll on mental health has been especially hard on young people and health care professionals. According to the Centers for Disease Control and Prevention, more than one-third of high school students reported they experienced poor mental health during the pandemic. The number of suicides has also soared compared to the decade before the pandemic.

Delays Progression to Stage 3 Type 1 Diabetes

Last week, the U.S. Food and Drug Administration announced approval of Tzield (teplizumab-mzwv) injection to delay the onset of stage 3 type 1 diabetes in adults and pediatric patients 8 years and older who currently have stage 2 type 1 diabetes. Tzield binds to certain immune system cells and delays progression to stage 3 type 1 diabetes. Tzield may deactivate the immune cells that attack insulin-producing cells, while increasing the proportion of cells that help moderate the immune response. Tzield is administered by intravenous infusion once daily for 14 consecutive days. 

Hemgenix Approved by FDA

On Tuesday, the U.S. Food and Drug Administration (FDA) approved Hemgenix (etranacogene dezaparvovec), an adeno-associated virus vector-based gene therapy for the treatment of adults with Hemophilia B (congenital Factor IX deficiency) who currently use Factor IX prophylaxis therapy, or have current or historical life-threatening hemorrhage, or have repeated, serious spontaneous bleeding episodes.

Treatment typically involves replacing the missing or deficient clotting factor to improve the body’s ability to stop bleeding and promote healing. Patients with severe Hemophilia B typically require a routine treatment regimen of intravenous (IV) infusions of Factor IX replacement products to maintain sufficient levels of clotting factor to prevent bleeding episodes. Hemgenix is a one-time gene therapy product given as a single dose by IV infusion. Hemgenix consists of a viral vector carrying a gene for clotting Factor IX. The gene is expressed in the liver to produce Factor IX protein, to increase blood levels of Factor IX and thereby limit bleeding episodes.

Focus on Underserved Populations

This week, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced a new $350 million initiative for HRSA-supported health centers to increase COVID-19 vaccines in their communities, with a specific focus on underserved populations. This funding will support health centers administering updated COVID-19 vaccines through mobile, drive-up, walk-up, or community-based vaccination events, including working with community-based organizations, and other efforts to increase the administration of COVID-19 vaccines.

How Can Patients Protect Themselves?

How can you tell if an online pharmacy is operating legally? The U.S. Food and Drug Administration's (FDA’s) BeSafeRx site can help identify and avoid dangerous online pharmacies. Patients need to be cautious when buying medicine online. Some pharmacy websites operate legally and offer convenience, privacy, cost savings and safeguards for purchasing medicines. But not all websites are the same. The FDA has tips for buying medicines online safely. There are also resource tools for health care professionals to help educate patients on buying prescription medicines from a safe online pharmacy. Learn more.

Empower Patients to Take Charge of Their Own Health

Did you ever want to prevent, arrest, and reverse chronic disease, decrease medication, and feel better? Or perhaps a certain pool of your patients would benefit from a lifestyle change?

The Rochester Life Medicine Institute presents the "Jumpstart 15 Day Whole-Foods Plant-Based Program" that teaches participants how to eat the right foods to heal and reverse chronic conditions, such as heart disease, type 2 diabetes, high blood pressure, and obesity. Many participants report that they were able to greatly reduce or even eliminate their medications after taking the program. The program follows a whole-food plant-based approach to eating, scientifically proven to give you your health back. The Rochester Life Medicine Institute's 15-Day Jumpstart Program is one of 4 programs certified by the American College of Lifestyle Medicine. The Rochester Life Medicine Institute is a nonprofit organization, well-respected for offering high value evidence-based services. They offer an educational program for physicians and other health professionals, with 10+ free hours of CME (choose the Jumpstart Health "Comprehensive" or "Live Participation" course and use discount code freeCME at checkout; choose a month to register for the 15-day Jumpstart Program - do not enter credit card info - and apply discount code JSCMEclinician at checkout). This program can help physicians earn CME credit and learn new skills that can also be used with their patients. Learn more about the Jumpstart Program.

2023: Physician Medical Licensure Renewal Year

Delaware law requires that, in order for medical professionals to renew their license, they must attest that they have completed training on:

• how to recognize child sexual and physical abuse, exploitation and domestic violence
• your reporting obligations under the Medical Practice Act and Regulatory Provisions Concerning Public Health

The 2023 Mandatory Reporting Training for Medical Professionals will be available on January 1, 2023, and features videos from professionals within the child welfare field that walk participants through how to detect and respond to child abuse and neglect.

Licensed physicians must take the 2023 Mandatory Reporting training even if they recently completed mandatory reporting training. This training must be completed before every medical license renewal. Physicians are required to attest to completing the training on their renewal application. Failure to do so will delay the renewal of the medical license.  

This training is provided by the Office of the Child Advocate. To complete the training on or after January 1, 2023, go to https://stateofdelaware.csod.com/default.aspx?c=courts-oca to create an account. If you already have an account, just click the “login in” icon and sign in User ID and Password. Once training is completed, medical professionals can then reapply for licensure through the Division of Professional Regulation's website at https://delpros.delaware.gov/OH_HomePage.

Research Study on Essential Drugs in Hypothetical Post-Apocalyptic Scenario

Imagine you're the health care professional for survivors in a post-apocalyptic world. If you could have a lifetime supply of 20 essential medications to take with you, which drugs would you choose? Georgetown University Medical Center’s PharmedOut is conducting a survey on prescribing choices given this hypothetical scenario, and would greatly appreciate your participation! Find the survey here: https://bit.ly/Top20Drugs. Clinicians found a previous version of this study to be an interesting thought experiment. The researchers are aiming to survey all prescribers (physicians, PAs, and advance practice nurses) and medical students. Georgetown University Medical Center’s PharmedOut advances evidence-based prescribing and educates health care professionals and students about pharmaceutical and medical device marketing practices. PharmedOut provides educational slideshows, videos, events, and information about CME courses free of industry sponsorship. Learn more here www.pharmedout.org. 

Bayhealth

Bayhealth announced its partnership with Unite Us Delaware, a technology company that coordinates health and social care services. The partnership will help Bayhealth provide care beyond the hospital by identifying social determinants of health and ensuring patients have every tool they need at home to stay healthy. Together, Bayhealth and Unite Us Delaware will be able to securely connect people in need with community-based resources that can be difficult to navigate. The network provides a central point of contact where physicians, social service organizations, and individuals can securely access and refer people to needed services while monitoring progress and measuring outcomes. 

Beebe Healthcare

Beebe Healthcare’s Family Medicine Residency at the R. Randall Rollins Center for Medical Education received its accreditation recently from the Accreditation Council for Graduate Medical Education (ACGME). In order to obtain this accreditation, the medical education team completed an extensive application and a virtual site visit conducted by the ACGME. Beebe is now able to begin the interview process for its first class of four resident physicians to begin in July 2023. MSD member Joyce Robert, MD, FAAFP, Program Director, has also been awarded a fellowship with the National Institute for Program Director Development with the Association of Family Medicine Residency Directors. This nationally recognized fellowship accepts a small number of program participants each year following an application process. It is the gold standard for Family Medicine Residency Directors and will allow Dr. Robert to bring the best practices for curriculum design, program development, teaching, and standards of care in academic medicine to Beebe.

Two of Beebe Healthcare’s many multidisciplinary teams have worked diligently over the past year to reduce hospital readmissions for those who suffer from COPD and heart failure. Readmissions dropped by almost 4% in each category to 12.37% and 12.64% for COPD and heart failure, respectively. This is a significant yearly drop and well beyond the anticipated goal. The teams consisted of Population Health, Case Management, Health Information Systems, Quality, Home Care, and Physical Therapy. The teams recently won Beebe Quality and Safety Awards for the successful work in these areas. By reviewing each patient discharged within a 30-day period, the teams are able to reach out to the patient’s primary care physician, skilled nursing facility, and other associated care providers to ensure a patient is getting the needed follow-ups for those who struggle with these conditions. In addition to the patient’s medical condition, social drivers of health are discussed and addressed when possible.

• DPH Flu Dashboard
• DPH Delaware Weekly Influenza Surveillance Reports by week.
• CDC https://www.cdc.gov/flu/weekly/index.htm
• WHO https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenzaupdates/current-influenza-update

• DPH Public Health Alerts: de.gov/publichealthalerts
• DPH Hotline - (866) 408-1899 (Monday -Friday, 8:30 a.m. to 4:30 p.m.) or DPHCall@delaware.gov
• Reporting suspected monkeypox rash in Delaware: Contact DPH Office of Infectious Disease Epidemiology (OIDE), at 302-744-4990 (business hours) or 1-888-295-5156 (after hours).
• Delaware health care facilities that require specimen collection kits can order through OEMS@delaware.gov using a SHOC Request form.
• DPH website: de.gov/monkeypox
• DPH Social Channels: Facebook (@DEPublicHealth), Instagram (@depublichealth), DHSS Twitter (@Delaware_DHSS)
• FDA Monkeypox Response Website
• CDC Monkeypox Website
• CDC Case Definitions for 2022 Monkeypox Response
• CDC Considerations for Monkeypox Vaccination for the recommended use of vaccine in the U.S.
• CDC Monkeypox Treatment Information for Healthcare Professionals
• Specimen collection: Follow Lab Advisory: CDC Updates Specimen Collection Guidelines for Monkeypox Virus 

Information as of 2:00 p.m. on Wednesday, November 23

• Fact Sheet: Data Points on Bivalent COVID-19 Vaccination (November 16, 2022)
• DPH Public Health Alerts: de.gov/publichealthalerts
• DPH COVID-19 Booster Information: de.gov/boosters
• Federal website for information on navigating COVID: COVID.gov
• CDC COVID-19 Quarantine and Isolation Calculator
• COVID-19 Treatment Options
• Medical Provider Guidance for Administering Therapeutics
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker Weekly Review.
• For testing flyers (available in English, Spanish, Haitian Creole): https://covidmaterialsde.com/resources/community-organizer
• For all testing site referral locations, visit: de.gov/gettested
• For vaccination site referral locations, visit: de.gov/getmyvaccine
• Pfizer-BioNTech COVID-19 Vaccine Presentation Wall Chart (updated November 15, 2022)
• Pfizer/Moderna pediatric vaccine information: de.gov/youthvaccine
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Know the COVID-19 Community Level where you live
• DPH COVID-19 Vaccine Fact Check Page to help separate fact from fiction.
• Subscribe to the COVID-19 Update podcast - on Apple Podcasts or Simplecast.