February 2016 Newsletter

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Department of Medicine eNewsletter
February 2016
:: Interview
:: Department News
:: Department Events
:: Development & Diversity
:: Department Humanities Journal
:: Department Giving
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Welcome to the Department of Medicine Agre Society
department interview
Barbara Gripshover, MD, Medical Director of Special Immunology unit at University Hospitals Case Medical Center, examines common barriers to engaging patients with HIV in health care, talks about the importance of maintaining trusting physician-patient relationships and discusses promising medical advancements in infectious diseases.
What is the range of projects the Special Immunology unit is focusing on?

The Special Immunology unit takes care of over 1,200 patients with HIV. We provide health care to all patients regardless of their ability to pay with the help of the Ryan White funding. We have put together a multidisciplinary team that consists of social workers, pharmacists, nurses and dietitians working synchronously together to engage patients in their health care. We know that the lifespan of HIV patients who take medications and receive regular checkups has increased and is now near the lifespan of people who do not have HIV. In addition, HIV patients who are engaged in health care are much less likely to transmit the virus to someone else; in fact the transmission rate has decreased by over 96 percent. Theoretically speaking, if we could get everyone with HIV into the medical care they need for their own health, we could end the epidemic.

Recently we have added the Pre-Exposure Prophylaxis clinic to offer people who are at high risk the tools that can help them minimize the risk of acquiring the virus. For example, Truvada medication has been tested in multiple clinical trials and research results show that it can decrease the chances of acquiring HIV by over 92 percent.

How has HIV treatment progressed over the past years? How have the lives of patients been affected?

We moved from treatments that were toxic and complicated with multiple side effects to very simple regiments that allow patients to take one pill once a day. The key to staying healthy is for patients to consistently take medication and refrain from smoking.

Currently there are no medications that cure HIV, so researchers are now refocusing their efforts on not only enhancing treatments, but also finding a cure. Current estimates show that there are over 1.2 million people infected with HIV nationally, about 13 percent of them do not know they are infected and 50 percent of people who do know they have HIV are not regularly engaged in care. So we know we need to reach this population and engage them in care to not only improve their health, but also help end the epidemic.

The Centers for Disease Control and Prevention recommends that all patients get an HIV test as part of their routine medical care and repeat it annually if they are at risk. We need to reach the population that is positive and not engaged in care yet to let them know that even with HIV they can still have long and full lives, stay healthy and have kids.

What are the common barriers for HIV patients to taking medications and being engaged in their own health care?

The virus disproportionally affects people who are underserved and do not have access to care or do not know about the opportunities they have at University Hospitals. HIV also affects communities of color who are often less trustful of the medical system, as well as people who have mental health or substance abuse problems that often pose as barriers to engaging in care.

We also know that the fewer pills patients have to take a day and the less toxicity the medications have, the easier it is for patients to stay on top of their health care. In addition, patients who are depressed are less likely to take medications, so treating the underlying mental health issue is imperative for effective health care.

How do you establish trusting relationships with patients who have HIV and may be more emotionally vulnerable?

Studies show that patients with HIV, who believe their doctors know them as individuals and can relate to them on a personal level, are more likely to be compliant and take their medicine. I believe building trusting doctor-patient relationships is key to engaging patients in care; trust becomes an essential element when caring for patients with diseases that still carry a lot of stigma in society. For some patients, their health care team becomes their closest confidants as patients do not always feel comfortable sharing they have HIV with their family or friends. It is important for us to make sure our clinic is welcoming and our communication with patients is consistent. I have some patients I have been following for 20 years or more; I believe continuity of care is critical for establishing trusting relationships with patients.

It appears that over the past few years, media has displayed the lifestyle and struggles of patients with HIV more openly. Do you think this has improved patients' self-acceptance?

I think patients still struggle with coming to terms with the diagnosis and tend to blame themselves; deciding who to tell and how to do it is still very difficult for them. I think the population that feels most alone is women because the lives of female HIV patients have not been publicized as much. Due to the mode of the transmission of the disease many patients struggle with feelings of guilt. What consistently helps patients accept the diagnosis is the support they receive from health care providers and especially their family and loved ones.

department news report
Division of Cardiovascular Medicine

Varun Sundaram, MD, received the Eric N. Prystowsky Early Career Research Award for his abstract entitled "Outcomes with Cardiac Resynchronization Therapy and Standard Implantable Cardioverter Defibrillators in Patients with a Very Wide QRS Duration (QRS≥180 ms): A Medicare ICD Registry Analysis with Propensity Matching" from the Heart Rhythm Society. Dr. Sundaram will be presenting his work at the Heart Rhythm Society Conference in San Francisco in May.

Division of Gastroenterology & Liver Disease

Gregory Cooper, MD, published his work in an article entitled "Changes in Receipt of Cancer Screening in Medicare Beneficiaries Following the Affordable Care Act" in the Journal of the National Cancer Institute. Dr. Cooper found that there was a statistically significant increment in mammography uptake but not colonoscopy. This finding suggests that affordability is a necessary but not sufficient facilitator of preventive services.

Gerald Isenberg, MD Gerard Isenberg, MD, was the first physician in Ohio to perform PillCam COLON, a new endoscopic technology utilizing pill cameras to visualize the colon.

Division of General Internal Medicine

Jill Huded, MD, published an article entitled "Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program" in the Western Journal of Emergency Medicine. Dr. Huded argues that Emergency Department nurses can conduct TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. In addition, Dr. Huded notes that identifying and intervening on high fall-risk patients who visit the Emergency Department has the potential to improve the trajectory of functional decline among elderlies.
In addition, Dr. Huded and her team published their work in an article entitled "The Evolution of Living Kidney Donation and Transplantation in Older Adults" in the Journal of American Geriatrics Society. In the paper, the researchers argue that an expansion of living-donor kidney transplantation in the aging population may offer a solution for organ shortage and thereby improve the quality of life of older adults.

Dual Therapeutics started a strategic collaboration with Bristol-Myers Squibb to advance small molecule compounds for the treatment of cancer and other diseases. Dual Therapeutics is based on the work of investigators at Icahn School of Medicine at Mount Sinai and Case Western Reserve University School of Medicine, including Goutham Narla, MD, PhD. The partnership promises to further develop and commercialize the discoveries made in laboratories and translate them into cancer therapeutics.

Brook Watts, MD, MS, with collaborators Renee Lawrence, PhD, Brigid Wilson, PhD, and the Allies for Better Care in PACT (ABC PACT) team was awarded an $18,000 pilot grant from the Veterans Affairs Office of Health Service Research for the project entitled "Emergency Department Utilization within Instensive Care Interventions for High-Risk Veterans."

Division of Hematology & Oncology

Cynthia Owusu, MD, was selected as one of the health care innovators to watch by Crain's Cleveland Business. Dr. Owusu's premier work with older patients who have breast cancer and long-term health of breast cancer survivors was particularly highlighted.

Division of Infectious Diseases & HIV Medicine

Michael Lederman, MD, Donald Anthony, MD, PhD, Robert Bonomo, MD, in partnership with the Department of Pathology faculty, have launched a new journal entitled "Pathogens and Immunity." The electronic, open access journal focuses on original research in microbiology, immunology and infectious diseases.

Division of Nephrology & Hypertension

Donald Hricik, MD,
published a novel entitled "Escape from Cleveland: A Tale of Two Doctors and a Pre-Retirement Meltdown" with Green Ivy Publishing. The novel overviews some of the key changes that took place in medicine over the past decade and draws readers in with real-life characters and a dynamic storyline.
Schedule a clinical appointment with Nephrology & Hypertension physicians
department conferences & events
Grand Rounds
Time: 12:00 - 1:00 p.m.
Location: Kulas Auditorium

March 1
"Faculty Diversity Initiatives" by Margaret Larkins-Pettigrew, MD

March 8
"Zika: The Good, the Bad and the Ugly" by Leia Teixeira Johnson, MD

March 15
"Management of Pancreatic Fluid Collection" by Ashley Faulx, MD

March 22
"JNC-8 vs. SPRINT: What Should be the BP Target?" by Jackson Wright, MD

March 29
"Breast Cancer Risk" by Phillis Nsiah-Kumi, MD

AGRE Society
Date: Wednesday, March 2
Time: 5:30 - 6:00 p.m.
Location: Carpenter Room, Lakeside, 3rd Floor
Speaker: Stefan Gravenstein, MD, MPH
development & diversity events
Asian Women Faculty Mentoring Meeting
Date: Wednesday, March 2
Time: 12:00 - 1:00 p.m.
Location: FSM Center for Women, Tinkham Veale University Center, Suite 248
Sponsor: FSM Center for Women
Audience: Asian women faculty and trainees

The Learning Climate Across the Continuum: Honoring Our Tradition of Junior Colleagues
Date: Thursday, March 3
Time: 7:30 a.m. - 3:00 p.m.
Location: Tinkham Veale University Center
Speaker: Richard Frankel
Sponsor: School of Medicine
Audience: All School of Medicine faculty and senior trainees interested in improving as educators
RSVP: Register by March 1st at this link

Faculty Happy Hour Mixer
Date: Thursday, March 3
Time: 6:00 - 7:30 p.m.
Location: TBD
Sponsor: Case Western Reserve University Office of Faculty Development
Audience: All Case Western Reserve University faculty wishing to connect/network with other faculty across campus; event particularly suited for new faculty members

Productive Academic Writing
Date: Friday, March 4
Time: 12:30 - 2:00 p.m.
Location: Thwing Center, Hitchcock Hall
Sponsor: Case Western Reserve University Office of Faculty Development
Audience: All faculty who want to improve their academic writing skills

Facilitating the Expression of Clinical Reasoning during Case Presentations
Date: Wednesday, March 9
Time: 12:00 - 1:00 p.m.
Location: Scott Auditorium, MetroHealth Medical Center
Speaker: Klara Papp, PhD, Director, Assessment and Evaluations, School of Medicine
Sponsor: Center for the Advancement of Medical Learning
Audience: Faculty and trainees who want to improve their teaching skills

Interrupting Bias in Faculty Searches
Date: Friday, March 11
Time: 9:00 - 10:30 a.m.
Location: Adelbert Hall, Room M1
Sponsor: Case Western Reserve University Office for Inclusion, Diversity, and Equal Opportunity
Audience: All faculty interested in improving their faculty searches; the session explores barriers within the faculty search process that prevent the fair evaluation of underrepresented candidates

Promotion and Tenure
Date: Tuesday, March 15
Time: 12:00 - 1:00 p.m.
Location: Frohring Auditorium, BRB Room 105
Sponsor: School of Medicine Office of Faculty Affairs, Office of Faculty Development and Diversity
Audience: Faculty interested in learning the standards for promotion and tenure as well as asking specific questions about the topic

Intergenerational Mentoring Circle for Women of Color
Date: Tuesday, March 15
Time: 12:00 - 1:00 p.m.
Location: FSM Center for Women, Tinkham Veale University Center, Suite 248
Sponsor: FSM Center for Women
Audience: Women faculty and trainees of color interested in a workshop where personal best practices are targeted by building circles of women that promote empowerment through storytelling and mentoring

Effective Questionnaire Design and Procedures
Date: Tuesday, March 15
Time: 4:00 - 5:00 p.m.
Location: SOM E408
Speaker: Klara Papp, PhD, Director, Assessment and Evaluations, School of Medicine
Sponsor: Center for the Advancement of Medical Learning
Audience: Faculty interested in improving their data collection skills for research and education
department humanities journal

Lasting Impressions is an online medical humanities journal that serves as an avenue for artistic expression of the Cleveland medical community. It is an outlet for providers to share their reflections on anything from patient interactions to work/life balance. By sharing our lives through artwork and writing, our medical experience is elevated, and our medical community becomes stronger.

Submission Guidelines
What: Poetry, prose, photography or artwork from medical students, trainees, alumni, faculty and health care workers
Deadline: March 1
Detailed Guidelines
department giving
Adel A. Mahmoud Professorship in Global Health and Vaccines

We would like to enlist your help in honoring a central figure at the Department of Medicine, former Chairman, Adel Mahmoud, MD, PhD.
Whether you worked with Dr. Mahmoud as a medical student, resident, faculty or research fellow, you were likely inspired by his commitment to understand and address the major causes of illness and death that disproportionately affect the poor in the developing world.
Over the last three decades, School of Medicine scientists in the Center for Global Health and Diseases, including Dr. Mahmoud, have helped define the emerging field of global health. They encouraged and led other doctors to study infectious diseases in places like Kenya, Uganda, South Africa, Papua New Guinea and Brazil.
To honor Dr. Mahmoud's tremendous contributions, the School of Medicine is establishing the Adel A. Mahmoud Endowed Professorship in Global Health and Vaccines. As you may know, endowed professorships offer unparalleled resources to recruit and retain world-class leadership, and so it is fitting that we have a professorship bearing Dr. Mahmoud's name.

Among the nation's leading academic medical centers, University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a nationally recognized leader in medical research and education.