Every fall since 2016, Palo Alto Medical Foundation doctors, nurses, administrators and researchers have competed for funding through PAMF’s Grants and Disbursements Program. Each team submits a proposal for an innovative project, technology, research study or initiative that will improve care for patients but that needs philanthropic support to get off the ground.
Last fall, 16 teams were selected from 55 applicants to pitch their ideas to the PAMF Community Board of Trustees. After hearing each proposal, the board elected to fund 13 projects, awarding more than $1 million drawn from unrestricted gifts to philanthropy. This brings the three-year tally for the program to $3.5 million.
- Transcranial Magnetic Stimulation Clinical Program
- Acupuncture for Anxiety and Depression
- QbTest for Pediatric ADHD
- Savi Scout Wire-Free Radar Breast Localization
- VersaVision Digital Specimen Radiography System
Transcranial Magnetic Stimulation Clinical Program
Major depressive disorder affects 17 percent of adults in the U.S., many of whom struggle to find relief. While there is an array of antidepressants available, only 33 percent of patients who take one recover, and their odds of success decrease with each successive drug trial. Plus, these medications often carry unwanted side effects that deter patients from staying on them.
“Traditionally, we’ve had very limited ways to manage treatment- resistant depression,” Dr. Rogosin says. “Complicated medication regimens and more invasive treatment modalities such as electroconvulsive therapy are not as well tolerated.”
Now, however, there is hope. Thanks to a $150,000 grant from the Grants and Disbursements Program, PAMF will pilot transcranial magnetic stimulation (TMS) at the San Carlos Center this fall. This Food and Drug Administration–approved noninvasive intervention for treatment-resistant depression and obsessive-compulsive disorder involves placing a magnetic coil over a patient’s scalp to stimulate specific brain regions linked to depression.
“TMS is thought to use magnetic
fields to stimulate nerve cells in the brain to improve symptoms,” says Tam
Nguyen, Ph.D., psychologist, director of behavioral health across PAMF’s Camino,
Peninsula and South Bay divisions and operations lead for this project.
Though it typically involves 36 treatments, TMS is painless, has very minimal if any side effects and is usually covered by insurance. It is also very effective. Following a six-week course, 50 percent of patients report significant improvements in depressive symptoms, while one-third recover fully—including those who’ve failed multiple medication trials.The project leaders aim to implement TMS by September, once they’ve purchased the equipment and designed the workflow and patients have been deemed eligible through insurance.
“It’s very exciting to add another treatment option, allowing for the continuation of care in-house instead of referring patients out like we had been,” Dr. Nguyen says. “We anticipate that patients will appreciate this service, and from there we’ll look at the data to see if it makes sense for other PAMF locations. Because of the high costs of purchasing the machine and setting up the infrastructure, we wouldn’t be able to do this without philanthropy.”
Acupuncture for Anxiety and Depression
A second new project will also benefit patients with depression and anxiety. Along with their TMS funding, Drs. Nguyen and Rogosin secured a $42,000 grant to offer auricular acupuncture via shared medical appointments at the Mountain View Center, part of PAMF’s Camino Division.
Strong evidence shows that auricular acupuncture, which involves inserting thin needles into particular points around the ears, is helpful for anxiety and depression.
“Many individuals, when having emotional problems, look for non-medication options first,” Dr. Nguyen says. “PAMF offers auricular acupuncture in the Alameda Division and it is very popular, with patients reporting improvements in their mental health.”
Because of its effectiveness, Drs. Nguyen and Rogosin wanted to expose more patients to this therapy without referring them outside of PAMF. About five years ago, a Fremont practitioner started an auricular acupuncture group that was very successful, but when she left PAMF, the service was not continued. “We are so excited to add back auricular acupuncture because we know it works and we know patients love it, and this will dramatically improve access to behavioral health services within PAMF,” Dr. Rogosin says.
The Grants and Disbursements funding will pay for two Mountain View physicians to take a 300-hour acupuncture training course at the Helms Medical Institute in Berkeley. Once they’ve completed training, daily groups of up to 12 patients will start this coming fall. “First, we’ll offer group appointments for depression and anxiety, then we’ll introduce additional shared medical appointments to target symptoms such as insomnia and chronic pain,” Dr. Rogosin says. “We hope to expand this service to the other divisions by sending more physicians to receive training.”
QbTest for Pediatric ADHD
Attention deficit hyperactivity disorder is the most common pediatric mental health condition in the U.S., affecting 11 percent of children and teens. Key symptoms include inattention, poor impulse control and hyperactivity, although not all kids have all three, or they may not have all at one time.
According to Brian Tang, M.D., a developmental and behavioral pediatrician at PAMF’s Fremont and Los Gatos centers, it is critical to identify and treat ADHD as early as possible, whether through behavioral intervention or medication. When the condition is overlooked or not managed appropriately, kids often struggle in school and develop anxiety and low self-esteem.“Evidence shows that when we address ADHD, children’s outcomes are better,” Dr. Tang says. “It also gives families and teachers a better understanding of the child, so they won’t mislabel them as stubborn or difficult.”
But evaluating kids for ADHD is not a perfect science, and the condition often goes undiagnosed—or it is misdiagnosed. “Unlike screening for autism and speech delays, which are done during well visits, there is not a recommended ADHD screening procedure that’s used universally,” Dr. Tang says. “Typically, when parents bring up a concern to their pediatrician, they are sent home with a validated checklist or screening tool.” These rating scales are problematic,he adds, because they are largely subjective and prone to bias, and gathering accurate family and medical history can be tricky.
Fortunately, there is now a more objective, accurate way to screen kids for ADHD, which PAMF will begin offering very soon thanks to a $26,696 grant from the Grants and Disbursements Program. QbTest, an FDA-approved, quantitative computerized assessment,rapidly measures inattention, impulsivity and hyperactivity. Patients age 6 and up sit with a laptop for 15 to 20 minutes and complete a standardized test that assesses focus while a camera captures their physical movements. Feedback from this exercise helps physicians make accurate diagnoses, rule out ADHD when appropriate and create individualized care plans.
“We are excited to have a method to screen for ADHD and also measure children’s response to medication and behavioral interventions,” Dr. Tang says. “We couldn’t have launched this project without philanthropy. If we can show that QbTest is sustainable, if parents are pleased with the service, then perhaps it can be leveraged for adults with ADHD.”
Savi Scout Wire-Free Radar Breast Localization
Whenever a woman’s mammogram detects a tumor or other suspicious abnormality in her breast, it can incite an anxious and scary time for her and her family. There are often multiple clinic visits and procedures to follow, and the fear of cancer and how that diagnosis will impact the patient’s life can be quite unsettling. Knowing this, PAMF aims to provide the very best care for each woman in this situation and make her journey as seamless as possible.
But in order to deliver on these goals, it is important that PAMF clinics possess the latest surgical technologies for breast cancer treatment. Now, thanks to funding from the Grants and Disbursements Program, the Camino Division has joined the Palo Alto Division in using Savi Scout Wire-Free Radar Breast Localization, a top-of-the-line tool that streamlines procedures and keeps more aspects of cancer care in-house.With high-tech mammography locating smaller and smaller suspicious tumors, surgeons need assistance finding the exact tissue to excise. Before PAMF acquired Savi Scout, patients underwent a procedure called localization during which a radiologist inserted a six-inch wire into the breast on the day of the surgery. This wire then guided the surgeon to the tumor’s approximate location.
Although this system worked, it presented several issues. “Great care must be taken to avoid the wire being dislodged from the lump until, eventually, surgery is performed,” says Lou Gaspard, surgery manager at PAMF “This means no mobility for the patient and a whole day must be blocked out to place the wire and conduct the surgery.”
But with Savi Scout, a nonradioactive, electromagnetic wave technology, there is no need to implant a cumbersome wire. Instead, a physician or radiologist makes a small incision to insert a tiny infrared reflector the size of a grain of rice into the tumor cavity. Then, on the day of the actual tissue removal, the surgeon runs a handheld probe over the breast that emits a soundwave picked up by the reflector, telling the doctor exactly where to operate.
“Savi Scout is the first technological improvement in this area in at least the 30 years that I have been performing breast surgeries,” says Seth Strichartz, M.D., a surgeon at PAMF’s Mountain View Center. “With the old technology, we had to put in the wire on the same day because we couldn’t have a woman walking around with a wire sticking out. This made scheduling difficult because we had to line up the availability of a radiologist, an operating room and the breast surgeon to make it all work. But because the reflector can be put in well in advance of the surgery, this system uncouples the placement of the localization device from the surgery.”
Along with easing personnel shortages and space constraints, Savi Scout also improves surgical precision. “The wire was not always put as close to the tumor as I would have liked or in the most cosmetically advantageous place,” Dr. Strichartz says. “With Savi Scout, the surgeon decides where to make the incision, and we can almost always put it closer to the tumor.”
This advancement in care also lessens patients’ anxiety and the amount time they must spend at the clinic. And for the small number of women who have a lump that is very likely cancerous, Savi Scout allows them to undergo one less procedure. “If it is obvious to the radiologist that it is cancer, a woman can have Savi Scout put in at the time of her biopsy,” Dr. Strichartz says. “Then when the biopsy comes back cancerous as the radiologist suspected, she does not need to return for a separate appointment to have the reflector implanted.”
When PAMF general surgeons came to Gaspard requesting this technology, he felt philanthropy was the right avenue to pursue. “We knew Savi Scout was the best way to treat our patients, but the technology is expensive — $83,830 — and we just don’t have that kind of money laying around,” he says. “It was suggested that we attempt to obtain funding from PAMF’s Grants and Disbursements Program, and after submitting the application and making our presentation, we were granted the money to purchase Savi Scout.”
Acquiring this technology brings the Camino Division up to date with Stanford and local competitor El Camino Hospital. “Because we didn’t have Savi Scout, there was a period where I had to take cases that I traditionally handled at the PAMF surgery center in my building over to El Camino,” Dr. Strichartz says. Now he can keep those cases at PAMF, simplifying the patient journey and further easing stress.
“Our surgery care is at a higher level as a result of this technology,” Gaspard says. “I like the fact that after coming into radiology and having the chip placed, patients can go about their business—picking up clothes from the cleaners, taking kids to soccer games and enjoying dinner out. Then on the day of the surgery, the patient shows up, has the chip and lump removed and is on her way home.”
VersaVision Digital Specimen Radiography System
It often makes news when PAMF acquires cutting-edge patient-facing technologies, such as robotic surgical equipment or lifesaving cardiology tools. Yet there are many behind-the-scenes innovations that, while maybe not as buzzworthy, also make a tremendous impact on patient care. A prime example is the VersaVision Digital Specimen Radiography System, which PAMF’s pathology department now uses to assess suspicious breast lesions. The Palo Alto–based department acquired this technology with a $116,000 grant from the Grants and Disbursements Program.
VersaVision takes highly detailed images of breast specimens such as core biopsies, mastectomies and lumpectomies, enabling pathology staff to quickly locate lesions and make diagnoses. This state-of-the-art technology marks a major improvement in patient care, as it can significantly shorten a woman’s wait time between undergoing a biopsy or operation and learning whether or not she has cancer.
Upon detecting an abnormality, a radiologist conducts a biopsy and places a 2-millimeter metal clip inside the woman’s breast to indicate the lesion’s location. Next, a pathologist reviews the specimen and determines whether the lesion must be removed completely; if it does, the radiologist and breast surgeon discuss the best way to excise it. Once the surgeon removes the tissue, it goes to the pathologist, who then must find the lesion within the specimen in order to analyze it and offer a diagnosis.
However, locating a lesion and nearby clip within extracted breast tissue can be difficult, especially when the abnormality cannot be seen by the naked eye. Traditionally, pathologists had to make their best guess as to where it was located—and sometimes this required multiple samplings of the tissue, each time delaying diagnosis by one day.
With VersaVision, however, the pathology staff places the tissue directly into the machine, which displays a high-resolution X-ray of the specimen and reveals the exact location of the clip. According to Jorge Rodriguez, M.D., Ph.D., medical director of the pathology laboratory at PAMF, this significantly increases the pathologist’s odds of locating the correct tissue the first time and making the proper assessment.
“The biggest impact for patients is that we can find lesions more quickly and with a lot more accuracy, reducing the wait time for a final diagnosis,” Dr. Rodriguez says. “It also represents a significant reduction in superfluous work that the pathology team must do, because instead of hunting around in the tissue looking for the lesion, we can immediately find and focus on it.”
Along with saving the pathology staff time, VersaVision also slashes costs. “The materials used to cut tissues and make slides for review — the blocks, the wax, the labels, the slides themselves—all cost money,” says Christine Alvares, pathology department manager. “By reducing the materials required for each case, we save money for our department and for Sutter Health.”
Alvares applied to the Grants and Disbursements Program in hopes of acquiring VersaVision as quickly as possible. “Getting approval for medical equipment is challenging because we are competing against other departments that have just as important and necessary items on their wish lists,” she explains. “Because VersaVision is expensive, and because pathology is more behind the scenes than cardiology or surgery, for instance, we knew it would be difficult to receive capital. And even if we did, it could still take another year before we actually got the technology.”
When the pathology team learned they had secured a grant and could purchase VersaVision immediately, they were thrilled. “Some of our staff had worked with this machine in the past and knew how much time it saves and how much it improves patient care,” Alvares says. “Overall, it has been such a blessing for our department to acquire VersaVision — and so quickly, which would not have been possible without philanthropy.”