March 2016 Newsletter

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Department of Medicine eNewsletter
March 2016
:: Interview
:: Department News
:: Department Events
:: Development & Diversity
:: Department Giving
University Hospitals Leadership Academy

Congratulations to the Department of Medicine faculty members selected to participate in the second cohort of the UH Leadership Academy.

Raymond Bermea, MD
Marcos de Lima, MD
Philip Junglas, MD
Christine Koniaris, MD
Neal Meropol, MD
Karen Monheim, MD
Amy Ray, MD
Abirammy Sundaramoorthy, MD
Eric Yasinow, MD
David Zidar, MD
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Welcome to the Department of Medicine Agre Society
department interview
Joshua Augustine MD, Medical Director of Kidney Transplantation Program at University Hospitals Case Medical Center, shares his opinion on donor organ shortage, discusses new dynamics of organ donations and shares his thoughts on promising new discoveries in nephrology.

As a Director of the Transplant Program, what are some of the latest initiatives that you have been focusing on?
In recent years, we have looked at strategies to improve our working relationships and stay in close contact with referring physicians, especially community nephrologists, ensuring that we establish good communication and trusting relationships with them. We have also opened sites in Akron and Westlake that are specifically designed to evaluate patients for transplant procedures. With this expansion, we try to improve the convenience and availability of our medical service to patients. We are currently considering expanding our area of reach further and offering clinics at more locations throughout Ohio.

Clinically, the Transplant Program hit a new high with 129 kidney transplants performed in 2015. Prior to this, we used to average at 85 - 90 transplants a year. It is important to note that, at University Hospitals, we take care of economically disadvantaged patients in Cleveland as well. Statistically speaking, this population does not have living donor transplants as frequently as other patients, yet in 2015 we were able to complete 30 living donor transplants.

What does the program do to increase the number of living donor transplant procedures?

Edmund Sanchez, MD, and I are currently working on creating a video aimed at educating our patients about live donations. In addition, we recently started using a new scoring system that was developed by physicians at The John Hopkins Hospital. This system analyzes and predicts outcomes in living donors, allowing us to show patients right away the chances of having complications or health issues after a transplant. In our practice, we have seen that patients may be worried about the procedure because they are not well-informed and may not realize that the risks are often quite low. We try to let patients know the facts to alleviate their fear and negative emotions that are often associated with the procedure.

Is there any competition for organs between University Hospitals and the Cleveland Clinic?

Both transplant programs are on the same list for organs. So if a deceased donor kidney is available in our region, it generates a list of recipients that includes patients from both institutions and the patient who has been on the list the longest receives a transplant. The Lifebanc of Cleveland with the guidance of the United Network of Organ Sharing ultimately oversees how kidneys are allocated and ensures it is a fair process.

In addition, patients can choose to be on more than one waiting list. Many of our patients join waiting lists in such cities as Pittsburgh, Columbus or Toledo. This may offer patients some advantages in receiving a transplant earlier.

How has the evaluation of potential donors evolved over the past few years?

Our number one priority is for our donors to have excellent outcomes, so we administer very thorough evaluations, including blood tests, scans and X-rays. Over the past few years, we have grown to be more accepting of older living donors, recognizing that patietns can be successful donors even in their 50s and 60s (our oldest living donor at University Hospitals was in his 70s when he went through the procedure to donate a kidney to his wife). We also have a donor advocate team that consists of psychologists and social workers who concentrate on evaluating live donors in an objective way to eliminate any bias. The donor advocate team also ensures that a donor does not feel coerced or pressured from his or her family to undergo the procedure.

Have new ways been developed of addressing organ shortage?

Generally speaking, there have been a fixed number of organs available from deceased donors each year and that number has not significantly changed. However, about a year ago, there was a major change that took place in the kidney allocation system. One of these changes, for example, involves incorporating the time patients have been on dialysis into the time on the transplant waiting list. In the past, patients' waiting time would start only when they actually got on the list. Now, with the changes introduced, patients get the credit for the time that they were on dialysis. Though these implementations did not create new organs, they certainly shifted the queuing and wait list timeline as well as assisted many minority patients with receiving transplants.

Increasing the number of organs available for donation still remains a challenge in the American health care system. One of the discussions that has been going on for a number of years concerns an opt-in policy that is widely accepted abroad. This policy defaults everyone as a donor, unless an individual takes an extra step to decline to participate in the program. If this became our national policy, it would have a great effect in our country, increasing the number of deceased donor transplants and helping patients in need.

What are your thoughts on the ethical dilemma of compensating donors to combat organ shortage?

Though this is a difficult dilemma and I deeply sympathize with patients who need transplants, it is illegal to purchase an organ in the United States. At the same time I have heard interesting arguments on both sides. We know that other countries have created models that allow people to purchase organs and there are even government-sponsored organ donation programs available. The down side of this approach is there are fewer donations coming from family and loved ones. In addition, the demographic studies of donors in other countries show that people participating in these programs tend to be young poor males looking to improve their financial situation. The sad thing is that after an organ donation, they still face the same social and monetary hardships as well as have high levels of dissatisfaction with the donation.

However, I understand that if a patient is desperate to receive a transplant, he or she is looking for any means possible. There is a practice known as transplant tourism where patients travel abroad to receive a transplant, often times with organ payment involved (depending on their travel destination). There have been concerns about this approach; in particular, health care providers are worried about complications after the procedure, as well as hand-offs and continuity of care. Oftentimes patients come back home after receiving a transplant and have to see a doctor right away to resolve complications or acute medical issues they acquired after the procedure abroad.

After receiving transplants many patients are on lifelong immunosuppression therapy. Do you see this changing in the future?

For years there has been a lot of focus on the minimization of immunosuppression because of the concerns for cancer and malignancy. Recent efforts have been a little disappointing because if patients have any transplant rejections or return to dialysis therapy, they are at higher risk for infection and mortality. The main objective of our transplant program is the optimal care of kidneys and our patients' good health. At University Hospitals, we try to create a balance; we have about 2/3 of our patients come off steroid therapy, four to five days after the initial transplant. The vast majority of them do extremely well without steroids. We feel that this is a big advantage because steroid complications such as diabetes, obesity and bone disease are very serious. We have also moved away from immunization knowing that optimal prevention of rejection is very important in successful kidney transplants. Though patients can stay on immunosuppressive therapy for many years, if we see patients experiencing complications we know we need to make a change in the management of their care. It is our job to individualize treatments and adjust medications if we see a problem.

What are some of the latest and most promising advancements in kidney transplantation? How would you evaluate the potential for creating artificial kidneys in the future?

It depends on how we define an artificial kidney. Small portable dialysis machines have been developed recently and they have actually been labeled 'artificial kidneys' even though they cannot replace all the functions that real kidneys would perform. However, by wearing these small portable machines continually, patients have better blood clearance and can enjoy a normal lifestyle.

The ultimate goal in nephrology certainly would be the creation of a kidney from a patient's own cells. This breakthrough would have the advantages of requiring no immunosuppressive therapy or transplant rejection as it would be generated from a patient's own tissue; however, this discovery is definitely further down the road for us.

One of the interesting dynamics in kidney transplantation that has been growing recently is the chains of transplants generated from donors giving an organ to a stranger in order for their loved ones or family members to receive a kidney. This approach is often used by donors when their family members are not compatible with them due to different blood types, for example. The donor has to accept that he or she is giving a kidney to a stranger but it opens a new way for their loved one to receive a kidney. This paradigm has resulted in chains and even domino transplants that have spanned from California to New York, involving as many as 10 - 12 patients.

department news report
The Department of Medicine 2014 - 2015 Annual Report received a Print Excellence Recognition Award from Printing Industries of Ohio - N. Kentucky, a consortium of graphic design and printing organizations covering most of the Midwest. This year over 500 printed pieces were submitted for the competition; the department's report was submitted by Great Lakes Integrated under the consortium's Corporate Communications judging category. This is the third time the Department of Medicine produced an award-winning annual report.

The annual report is the primary printed offering of the department summarizing yearly progress in research, education and patient care. The annual report is a collaborative undertaking between the Chairman, Vice Chairs, Program Directors and Division Chiefs. Report content, photography and overall production coordination is under the direction of Dasha Slobozhanina, the department's Manager of Interactive Media and Communications.

Division of General Internal Medicine

Theresa Dolinar, MD, published an article entitled "Patterns of Benign Prostatic Hyperplasia Associated Urinary Retention: Indwelling Urinary Catheter Use and Clinical Sequelae" in the Journal of Urology Practice.

Division of Hematology & Oncology

Afshin Dowlati, MD, was awarded a $150,000 grant for his project entitled "RUNX1T1 Amplification Induces Small Cell Cancer" from the Department of Defense. The goal of Dr. Dowlati's work is to determine the mechanism by which certain non-small cell cancers transform into small cell. This has emerged as a major mechanism of resistance in EGFR mutation positive lung cancer, but also has implications for diseases such as prostate cancer.

Shigemi Matsuyama, MD, was selected for a VeloSano pilot grant award for his project entitled "Development of New Type of Therapeutics Selectively Targeting Bax or Bak." Dr. Matsuyama's laboratory has been researching cell death regulation by Bcl-2 family proteins, especially Bax and Bak. Recently, it was found that some specific cell types use only one of these two apoptosis-including proteins. Dr. Matsuyama aims to leverage this observation to identify the inhibitors and activators that kill cancer cells and spare normal tissue. Dr. Matsuyama developed a new cell-based drug screening system that allows him to identify Bax or Bak-specific inhibitors or activators, and he plans to use this platform to identify new therapeutics.

Division of Infectious Diseases & HIV Medicine

Robert Bonomo, MD, was selected for the 2016 Excellence Award from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Europe's leading Infectious Diseases society. The award recognizes Dr. Bonomo's outstanding lifetime contributions to science, education and professional affairs in the field of infectious diseases. Dr. Bonomo is the first non-European awardee to receive this prestigious recognition from the ESCMID. Dr. Bonomo will present the Keynote Address entitled "The Renaissance of the Beta-Lactamase Inhibitors" at the annual European Conference for Clinical Microbiology and Infectious Diseases in Amsterdam this April.

Yngve Falck-Ytter, MD,
was found to be one of the most highly cited researchers in 2015 by Thomson Reuters. This recognition speaks highly of Dr. Falck-Ytter's meaningful contributions to clinical epidemiology.

Division of Nephrology & Hypertension
Jackson Wright, Jr., MD, PhD, was selected as one of Cleveland's 2016 Health Care Heroes by Crain's Cleveland Business. This recognition celebrates Dr. Wright's significant contributions to the field of hypertension and his leading role on many clinical trials focusing on African-American population.
Schedule a clinical appointment with Nephrology & Hypertension physicians
department conferences & events
Full-Time Faculty Meeting with the Chairman
Date: Tuesday, April 26
Time: 5:00 - 6:00 p.m.
Location: Wolstein Auditorium

Research Day 2016
Date: Friday, May 6
Time: 1:00 - 3:30 p.m.
Location: Wolstein Lobby & Auditorium
Register: click here
Abstract Submission Deadline: Monday, April 25
Submit Abstract: click here

Team Science Challenge 2016
Application Deadline: Sunday, May 15
Application Instructions: click here

Grand Rounds
Time: 12:00 - 1:00 p.m.
Location: Kulas Auditorium
April 5
"General Internists as Change Agents" by Carolyn Clancy, MD

April 12
"Thoughts on the Origin of Microbial Virulence" by Arturo Casadevall, MD, PhD

April 19
"The Role of the Gut Microbiome in Gastrointestinal Functional Disorders" by Steven Collins, MD

April 26
"Providing Residents and Fellows Successful Experiences in Patient Safety and Quality" by Gregory Bump, MD

AGRE Society
Date: Wednesday, April 6
Time: 5:30 - 6:00 p.m.
Location: Carpenter Room, Lakeside, 3rd Floor
Speaker: Grace McComsey, MD
development & diversity events
Women Faculty School of Medicine Spring Dinner
Date: Monday, April 4
Time: 5:00 p.m.
Location: Allen Memorial Library
Speakers: Carolyn Clancy, MD, Deputy Undersecretary for Health, Safety and Quality; Karen Horowitz, MD, President, Women Faculty School of Medicine
Sponsor: Women Faculty School of Medicine
Audience: All women faculty, other faculty, hospital and university leadership interested in an evening of fellowship, networking and exposure to a national woman leader in medicine

Managing Diverse Relationships Via Emotional Intelligence
Date: Thursday, April 7
Time: 3:00 p.m.
Location: Tinkham Veale University Center, Senior Classrom
Speaker: Melvin Smith, PhD, Associate Professor, Organizational Behavior, Faculty Director, Executive Education, Weatherhead School of Management
Sponsor: Case Western Reserve University Office for Inclusion, Diversity, and Equal Opportunity
Audience: All faculty interested in improving their ability to interact productively with colleagues, supervisors and trainees

Struggling Learners: A Practical Workshop for Clinicians
Date: Thursday, April 7
Time: 4:00 - 5:30 p.m.
Location: SOM E408
Speaker: Susan Padrino, MD, Assistant Dean for Clinical Sciences, School of Medicine
Sponsor: Center for the Advancement of Medical Learning
Audience: Faculty and trainees interested in learning the educational skills to become better supervisors and mentors
RSVP: click here

Tips for Managing Difficult Conversations
Date: Friday, April 8
Time: 12:30 - 2:00 p.m.
Location: Thwing Center, Hitchcock Hall
Sponsor: Case Western Reserve University Office of Faculty Development
Audience: All faculty wishing to improve their comfort level with complex conversations and negotiations

Overcoming the Impostor Syndrome
Date: Wednesday, April 13
Time: 12:00 - 1:30 p.m.
Location: Tinkham Veale University Center, Ballroom A
Speaker: Valerie Young, Author of "Secret Thoughts of Successful Women: Why Capable People Suffer from the Imposter Syndrome and How to Thrive in Spite of It"
Sponsor: FSM Center for Women, Women Faculty School of Medicine, and the CCF Women's Professional Staff Association
Audience: Women faculty and trainees interested in building empowerment and erasing needless self-doubt
RSVP: click here

Climate Control: A Key Skill for Effective Teaching
Date: Wednesday, April 13
Time: 12:00 - 1:00 p.m.
Location: Scott Auditorium, MetroHealth Medical Center
Speaker: Patricia Thomas, MD, Vice Dean for Education, School of Medicine; Susan Padrino, MD, Assistant Dean for Clinical Sciences, School of Medicine
Sponsor: Center for the Advancement of Medical Learning
Audience: Faculty and trainees interested in improving their educational skills

Tips on Developing a Research Proposal and Budget, Finding Funding Opportunities, and Managing Your Funded Research Projects
Date: Tuesday, April 19
Time: 12:00 - 1:00 p.m.
Location: Frohring Auditorium, BRB 105
Sponsor: School of Medicine Office of Faculty Affairs, Office of Faculty Development and Diversity
Audience: All faculty wishing to learn or improve grant application skills

Living Longer, Working Longer in the USA: A Gender Perspective
Date: Tuesday, April 26
Time: 12:30 - 2:00 p.m.
Location: Crawford Hall, Room A13
Speaker: Aine Ni Leim, Visiting Researcher, Sociology
Sponsor: Case Western Reserve University Social Justice Institute
Audience: Faculty interested in hearing perspectives from an international visiting researcher on this topic
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 past 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.