Jake’s take on how to build a hospital

Carlyle "Jake" Jacobsen laying the cornerstone for Upstate's downtown hospital, 1963

Carlyle “Jake” Jacobsen laying the cornerstone for Upstate’s downtown hospital, 1963

More than 50 years ago, Upstate President Carlyle “Jake” Jacobsen PhD (1902-1974) began working on the creation of Upstate University Hospital in downtown Syracuse. As a seasoned college administrator, brain researcher and professor of medical psychology, “Jake” had impressive credentials for the job. But, in a 1964 interview at Columbia University, Jake credited his Minnesota childhood for giving him the real tools he needed.

Here’s what Jake said made him an adept hospital-builder:

1) Delivering newspapers.

As a boy, Jake had a paper route that included  hospitals, and he delivering newspapers directly to patients. This early, close contact with the sick and injured gave Jake a deep appreciation for health care, and his ability to navigate hospital hallways prepared him to finesse the design of Upstate hospital’s physical plant.

2) Drawing maps.

In middle school, Jake created maps for his school district and remembers drawing the intricate streets and road patterns on drafting paper. Jake credits his art classes and map drawing for giving him the ability to “fight with the architects about what was wrong with what they were doing.”

3) Watching wheat.

Jake’s uncles were North Dakota farmers. He saw that, no matter how hard they worked, outside forces (mother nature, chiefly) left them with a sickly wheat crop three seasons out of four. Those were lean years for his uncles, and that was before they were hit by the Great Depression. According to Jake, observing their hardships helped mold his social philosophy—useful for a guy who’d someday lead a public hospital.

4) Running trains.

Jake was only 7 when he told his Dad, “I want to make an invention.” They got together and created a belt-driven, 6-volt generator that powered Jake’s toy train set.

Later, as a college kid who’d run out of money, Jake worked for the railroad. His boss saw he had a knack for the business, and encouraged Jake to make the railroad his career. (Jake chose to finish his education instead.)

Jake’s  boyhood desire to create something new and his young man’s ability to understand a complex business prepared him well for his job at Upstate.

5) Learning Latin and selling trees.

During high school, Jake studied Latin, oratory and debate. After school, he worked at a dry goods store with a nursery. Days feeding his intellect and evenings shoveling dirt gave Jake, as he described it, the “diffuse interests” that made him good at his job as a hospital builder and university president.

6) Pulling taffy.

Jake’s summer job after high school was making taffy. It was hot and involved lots of precise steps — boiling sugar, kneading, twisting, cutting — and he did it all under the scrutiny of impatient customers. It was an early experience in navigating public perception.

7) Studying in public schools.

While Jake was on the faculty of several prestigious private universities – Yale, Harvard, Cornell – prior to joining Upstate, he attended public schools throughout his childhood and earned his bachelor’s and doctoral degrees at a state school: the University of Minnesota.

“I have a strong feeling for public education, whether it is grade school, or on through a PhD,”  he said in the 1964 interview.

Those strong feelings, and his own experiences as a public school kid, made Jake an ideal leader for the newly created State University of New York.

Special thanks to Patricia Numann MD for sharing Dr. Jacobsen’s personal papers with the hospital anniversary committee.

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Urge to smoke begins in utero

Pregnancy and smoking issueBabies born to mothers who smoke during pregnancy are four times more likely to begin smoking in adolescence.

Scientists at Upstate recently showed that nicotine, the most addictive of more than 4,000 chemicals in tobacco, modifies part of the brain responsible for smell and changes the neural sensitivity of the olfactory cells in the noses of the babies in utero. This is what leads them to develop a preference for the sweet, warm and spicy odor of nicotine, according to Nicole Mantella, a graduate student in the lab of professor Steven Youngentob, PhD.

Youngentob’s lab in the Department of Psychiatry and Behavioral Sciences explores what drives kids to have that first cigarette, or that first drink. He has done similar work showing how alcohol exposure in the womb can create a craving in adolescence. 

He is alarmed that with all we know about the dangers of smoking, 25 percent of smoking women who become pregnant continue to smoke during pregnancy. Not only does this put babies at risk for stillbirth or prematurity, but they are also more likely to have behavioral problems such as hyperactivity and impulsivity and defects in learning, memory and attention – and to become smokers, themselves.

Listen to the HealthLink on Air radio interview with Dr. Youngentob

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Roasted delicata squash with mushrooms and thyme

WinterFood

Delicata squash stars in this wintery dish, which is equally happy in a supporting role next to meat or stealing the show as a vegetarian centerpiece. This gourd is called delicata because its skin is delicate enough to eat without peeling.

Ingredients

1 pound fresh delicata squash

10 ounces crimini mushrooms

3 tablespoons olive oil

2 teaspoons minced garlic cloves

1 tablespoon minced thyme

½ teaspoon kosher salt

¼ teaspoon ground black pepper

 Preparation

Preheat oven to 350 degrees Fahrenheit. Wash delicata squash. Cut squash in half lengthwise, scoop out seeds and discard. Slice ½ inch thick and place in a bowl. Remove stems from mushrooms and place caps in a bowl. Divide into each bowl olive oil, garlic, salt and pepper. Place the squash on the pan and the mushrooms on another pan. Roast in the oven until tender, about 10 to 15 minutes. When cooked through, combine vegetables and toss with fresh thyme leaves.

Nutritional information

93 calories

1.7 grams protein

7.5 grams carbohydrates

7 grams total fat

1 gram saturated fat

0 milligrams cholesterol

200 miligrams sodium

2 grams fiber

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Volunteer smocks find second life in schools, missions

Photo courtesy of Ngamije M. Faishal of Kasese, Uganda.

Photo courtesy of Ngamije M. Faishal of Kasese, Uganda.

When Community General Hospital became part of Upstate in July 2011, Volunteer Services Director Kristin Bruce was left wondering what to do with 300 pink volunteer smocks, many  embellished with the old hospital logo. 

The smocks were in great condition, so it made sense to try to recycle them.

Volunteers Dick and Barb Bratt suggested that some of the smocks be donated to Robinson Presbyterian Church USA. There, a missionary group was collecting clothing items for people in need living in Uganda.

Months later, an email arrived from Ngamije M. Faishal of Kasese, Uganda with thanks for the smocks, which were put to use in the distribution of goods to men, women and children.

Closer to home, more than 70 of the smocks were donated to the Syracuse City School District, for students to wear during art classes. And 50 smocks that were not customized with the hospital logo were donated to the team of volunteers serving the Centers at St. Camillus in Syracuse.

“To see these Community General Hospital volunteer smocks being used halfway around the globe is amazing,” says Bruce. “What’s more, the volunteers themselves truly appreciate the legacy of their uniforms and are humbled to see their repurposed use today.”

Today, the volunteers wear navy vests with an Upstate logo.

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Shocking news in ’64: Smoking causes lung cancer

Cigarettes were prominently displayed for sale at the gift shop of  the former Community-General Hospital. ND. Pictures are hospital volunteers Peg Roth and Jayne Hayes. From Health Science Library, Upstate Medical University

Cigarettes were prominently displayed at the gift shop of the former Community-General Hospital, circa 1970. Pictured are hospital volunteers Peg Roth and Jayne Hayes. From the Health Sciences Library, Upstate Medical University.

Fifty years ago, Upstate’s hospitals opened their doors and the US Surgeon General issued the first report on Smoking and Health, linking cigarette smoking to lung cancer and heart disease. That report — the first of 31 issued by the US Surgeon General — laid the foundation for the tobacco control efforts that we know today.

In 1964, close to half of adults in the United States smoked. Televisions blared cigarette commercials  and newspapers were filled with ads that claimed cigarettes “refresh while you smoke” and tobacco’s “good taste never quits.”

Upstate President Carlyle “Jake” Jacobsen PhD smokes a cigarette at the opening ceremony for SUNY Upstate University Hospital, July 1964.

Upstate President Carlyle “Jake” Jacobsen PhD puffs on a cigarette during the opening ceremony for Upstate University Hospital, July 1964.

Hospital gift shops sold cigarettes, and Upstate’s president smoked in the medical school’s corridors and during campus events.

Today, it’s hard to imagine that people ever smoked in hospitals. But Cindy Cary and Linda Veit, both of whom have worked at Upstate for 28 years, remember when social norms were very different, and second-hand smoke was rampant.

“There were ash trays at nurses’ stations. Patient rooms were smoking and non-smoking,” explains Cary, who was a respiratory therapist and is now director of Upstate’s smoking cessation program.

Researchers were in the lab studying the effects of smoke inhalation. Down the hall, secretaries were smoking cigarettes,” describes Veit, who was a lab technician and is now special projects manager for the Upstate Cancer Center. “Most people knew smoking shouldn’t happen in a hospital, but they still did it.”

Today, Cary and Veit are dedicating their careers to tackling lung cancer and tobacco use. Cary runs free smoking cessation classes, year-round, at multiple locations through Upstate’s HealthLink program. Veit administers a lung cancer screening program as part of her work for the Upstate Cancer Center.

Ten years ago, Upstate President Gregory Eastwood MD announced plans to institute a smoke-free campus. At the time, 13 percent of Upstate employees and students smoked. By August 2005, Upstate had become the first smoke-free SUNY campus.

Several years later, Upstate worked with Onondaga County to expand tobacco control at area hospitals. The 2009 Smoke-free Sidewalk Ordinance prevents smoking within 100 feet of hospital property.

Today 17.7 percent of New Yorkers use tobacco.

 

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Good read: Christopher Hitchens travels from ‘Welltown’ to ‘Tumortown’ in ‘Mortality’

By Joel Potash, MD

41hDeBUldEL._SY344_BO1,204,203,200_Christopher Hitchens was a famous author, journalist, and lecturer who loved to debate religion with representatives of various religions. He was an atheist and perhaps best know for his book, “God is Not Great: How Religion Poisons Everything.”

In 2010, on the day of a book signing event for his new memoir, “Hitch 22,” he experienced chest pain and went to a hospital emergency room, where an x-ray showed lung cancer, later found to be metastatic from cancer of the esophagus. “Mortality” tells his story until his death in 2011, from “Welltown” to “Tumortown.”

Hitchens chose aggresssive treatments in hopes of prolonging his life, and if not, then of adding to medical knowledge of cancer treatment that might help others. His treatment side effects included loss of his voice, hair loss, fatigue, inability to swallow food, and nerve weakness that caused the loss of function of his writing arm. Writing and speaking were the two most important things to him.

Yet, he endured.

As he was an avowed atheist, some of the public saw this as fitting punishment. Others set up prayer days, hoping for the efficacy of prayer in his healing. Hitchens disavowed both.

Hitchens is splendid in talking of the etiquette of dealing with a dying person. His comments about treating physicians remind me of the play, “W;t.” Some physicians remain uncertain about what and how much to tell patients about their diseases and treatments.

A physician who cares for dying patients recently wrote in the New York Times that when he asked his oncologist how long he had to live, the oncologist refused to answer — and the physician with cancer defended the oncologist’s choice. I’m not sure I agree, but there is no one approach to all patients with a terminal disease.

So, is it helpful (or depressing) to read books about dying? I have a shelf full of such books, both fiction and non-fiction. Neither doctors nor patients seem to have the time or energy to go in depth into patient experiences of disease and treatments, so I find these books expand my understanding of what patients (and doctors) go through in dealing with the dying process. They may also educate future patients about the medical system so they can deal with it more satisfactorily. 

Medical students and residents should be required to read some of these books. But will they prepare me for the time when I may be dying? I hope so — but all bets are off when that time comes.

Joel Potash, MD is emeritus faculty in Upstate’s Center for Bioethics and Humanities. This book review appears in the winter issue of Upstate Health magazine. 

Other books about death and dying:

“Without,” poems by Donald Hall

“W;t,” a play by Margaret Edson

“Messages from My Father,” a memoir by Calvin Trillin

“Death Be Not Proud,” by John J. Gunther

“How We Die, Reflections of Life’s Final Chapter,” by Sherwin B. Nuland

“The Last Lecture,” by Randy Pausch

“A Death in the Family,” by James Agee

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Adding electronics to patient care

MC900353907Eighty to 90 percent of communication between humans is nonverbal — which means that healthcare providers could overlook important patient information if the provider’s focus is on the Electronic Medical Record computer screen. Body position, eye engagement, gestures and facial expression can provide important information when diagnosing patients, says Joyce Scarpinato, DNP, director of the Doctor of Nursing Practice program at Upstate’s College of Nursing.

She recently spoke on campus about EMRs, urging providers to be mindful of the impact technology has on their provider-patient relationships and on daily personal communication. What are the ethical implication this technology has on the patient-provider relationship and our personal lives?

Research shows that EMRs can improve quality and safety. Scarpinato reports that studies are mixed about patient satisfaction. Some studies found that patients feel more involved in their own health care when the provider is using an EMR; however, others found that broken eye contact and a lack of face-to-face interaction (while the provider enters information into the EMR) decrease patient satisfaction. 

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Obstetrics, gynecology services expand at Upstate

Upstate expands the type of obstetrical and gynecological care it offers with the addition of fellowship-trained faculty members. These are the OB-GYNs who train many of the OB-GYNs practicing in the Syracuse area. Here’s a look at some of the services:

Dr. Spadola

Dr. Alexandra Spadola

* Comprehensive care for any high-risk pregnancy is provided through the Regional Perinatal Center, at the University Health Care Center, 90 Presidential Plaza, Syracuse. The center is one component of the Regional Perinatal Program, which has a new director. Alexandra Spadola, MD, who is fellowship trained and board certified, and oversees the program, which provides clinical support, quality review and educational outreach to 19 affiliate hospitals across a 17-county area of central and northern New York State.

* Complete care for low-risk pregnancies and comprehensive gynecology services are available through the Women’s Health Service, in two Syracuse locations: UHCC at 90 Presidential Plaza, and the Physicians’ Office Building at 725 Irving Ave., Suite 600.

* Group care for pregnant women with diabetes is now offered through Upstate’s Regional Perinatal Center. Called “Centering Pregnancy,” the program is one of the first in the country that focuses on women with diabetes.

Dr. Eddie Sze

Dr. Eddie Sze

* Eddie Sze, MD, Director of Urogynecology and Pelvic Reconstructive Surgery, recently achieved board certification at the first offering of this specialty certification. He and colleagues see patients at the physician office buildings at the Upstate University Hospital Community Campus and at 725 Irving Ave., Suite 600, Syracuse.

* Midwifery services are based at the Upstate University Hospital Community Campus. The team provides personalized pregnancy care before, during and after childbirth and routine gynecology. Deliveries take place at the Jim and DeDe Walsh Birth Center in the hospital.

Dr. Renee Mestad

Dr. Renee Mestad

* Renee Mestad, MD is a fellowship-trained physician who specializes in all aspects of family planning, particularly for patients with complex medical histories.

* Gynecologic oncologists Rinki Agarwal, MD, Douglas Bunn, MD and Mary Cunningham, MD provide comprehensive care for women with gynecologic malignancies to include radical surgery, laparoscopic surgery, radiation therapy and chemotherapy. Also, patients have the opportunity to participate in regional and national clinical trials through the division’s participation with the National Cancer Institute’s Gynecologic Oncology Group. Dr. Agarwal sees patients at 725 Irving Ave., Suite 600.

Dr. Frederick Sengstacke

Dr. Frederick Sengstacke

* Upstate offers assisted reproductive technology through its IVF Program (phone 315-464-7249) and a variety of services for women and men through the Division of Reproductive Endocrinology and Infertility at 725 Irving Ave Suite 600. The division offers evaluation and treatment of all aspects of both male and female reproductive endocrinology, infertility and andrology, and Frederick D. Sengstacke II, MD, the director of the In Vitro Fertilization Program, offers fertility preservation in cancer patients along with other in vitro fertilization services.

In addition, several general Board Certified OB-GYNs have recently joined the department, including Leah Kaufman, MD, Brian Thompson, MD and Jodi Wallis, DO. They are available for the comprehensive care of women in all facets of their life cycle including pregnancy and menopause.

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Modern birth control options for women

Karen Teelin, MD tells her patients the ABCs of sexuality. A is for abstinence, B is for be faithful, and C is for condom. She is quick to point out that condoms have a 10- to 20-percent failure rate and that sexually-active teens need to use two forms of birth control.

Karen Teelin, MD tells her patients the ABCs of sexuality. A is for abstinence, B is for be faithful, and C is for condom. She is quick to point out that condoms have a 10- to 20-percent failure rate and that sexually-active teens need to use two forms of birth control.

Q&A

with Karen Teelin, MD

Q Why are the rates of sexual activity among American teens the same as in other developed countries, but our rates of teen pregnancy and abortion are higher?

A “That’s partially because of the use of highly effective contraception in other countries. 

“There is a 2011 Centers for Disease Control and Prevention study showing 50 percent of teens by 12th grade have had sex, and if you go up to age 20, it’s about 70 percent. There is a decreasing age of menarche (age at a woman’s first period) and an increasing age of first marriage, so there is a longer period of fertility when women need birth control.

“Eighty to 82 percent of teen pregnancies in America are unplanned. It’s a huge public health problem and a very stubborn public health problem and a difficult one to address. Part of the answer, really, is education and contraception.”

Q What is the most effective contraceptive?

A “The LARCs — long-acting reversible contraceptives — are as effective as sterilization, but they are reversible. That would include the implant and two types of intrauterine devices.

“The current implant is one little rod, a couple centimeters long. It goes into the arm. It’s called Nexplanon, and it releases a small amount of progesterone. It lasts for three years. The procedure to implant it is very simple. It takes about 5 minutes. It hurts as much as getting a shot would, or even less than that. Once it’s in there you can completely forget about it for three years.

“The IUD is a small T-shaped device a couple centimeters long that is inserted by a doctor into the uterus. It can be put in teenagers, young women or women who have had children or women . It stays in the uterus. There is one with no hormones that stays in for 10 years. The progesterone IUDs release a small amount of progesterone locally. The Mirena will last five years, and the Skyla, which is smaller and has less progesterone, and will last three years. They’re both highly effective.

“Back in the ‘70s and early ‘80s there was an IUD (the Dalkon Shield) that had been associated with an increased risk of pelvic infections, however those studies were fraught with methodological errors. In the more current studies, there is actually a decreased risk of pelvic infections with some of these IUDs.

“There are noncontraceptive benefits, too. The Mirena, for instance, can reduce menstrual bleeding and menstrual pain, and many women don’t get periods on it. That is one of the reasons they’re so popular.”

Q Are other methods still used?

A “We have a lot of young women who choose the pill, and it can work, but you do need to take it every day.

“The patch is like a birth control pill, except instead of taking it every day, you have a sticker, a little bit bigger than a Bandaid, that you change every week. Some people really like the patch because you don’t have to think about it every day — but you have to remember it each week.

“The shot is commonly referred to as Depo, (short for Depo-Provera.) That is a shot that you would get every 12 weeks. That is also progesterone-only, like the implant, but there might be more side effects.

“The ring is like the birth control pill, with the same medicines of estrogen and progesterone, but it is inserted into the vagina, and it stays for three weeks, and it releases a small amount of the hormones. Some people really like that. The teens can put it in themselves. It’s a small ring. It’s flexible. You just sort of bend it and put it in.”

Listen to an interview with Dr. Teelin on HealthLink on Air

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Doc puts toxicology in a box for medical education

Dr. Brian Kloss. Photo by Susan Keeter.

Dr. Brian Kloss. Photo by Susan Keeter.

An assistant professor of emergency medicine is using comic illustration to teach clinical toxicology.

mouse03“Toxicology in a Box” is a deck of 154 full-color flashcards designed to teach how to recognize and treat drug overdoses and poisonings. Brian Kloss, DO is co-author. 

The backs of the cards provide signs and symptoms and a description of how patients are likely to appear, along with treatments and advice. The collection, with a price of $49, is meant to help doctors and other medical professionals study on the go, quiz themselves or brush up before exams.

Kloss appeared on the AMC Television program,“Comic Book Men,” in the fall to talk about the concept of medical education through comic illustration. He hopes to create a second flash card set on infectious diseases.

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