September 2016 Newsletter

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Department of Medicine eNewsletter
September 2016
:: Interview
:: Department News
:: Department Events
Top Doctors 2016

Congratulations to the Department of Medicine faculty members selected as Top Doctors by Castle Connolly Medical Ltd.

Cardiovascular Medicine
Ivan Cakulev
Marco Costa
Barry Effron
Daniel Simon
Thomas Wilson

Baha Arafah

Gastroenterology & Liver Disease
Amitabh Chak
Fabio Cominelli
Gregory Cooper
Ashley Faulx
Pierre Gholam
Jeffry Katz
Anthony Post
Sapna Thomas
Richard Wong

General Internal Medicine
Carla Harwell
Debra Leizman

Geriatrics & Palliative Care
Taryn Lee

Hematology & Oncology
Joseph Baar
Matthew Cooney
Brenda Cooper
Marcos De Lima
Afshin Dowlati
Judah Friedman
Stanton Gerson
Joseph Gibbons
Michael Gibson
Henry Koon
Smitha Krishnamurthi
Hillard Lazarus
Jane Little
Sanford Markowitz
Neal Meropol
Joel Saltzman
Alvin Schmaier
Paula Silverman

Infectious Diseases & HIV Medicine
Keith Armitage
Robert Bonomo
Barbara Gripshover
Michael Lederman
Robert Salata

Nephrology & Hypertension
Joshua Augustine
Donald Hricik

Pulmonary, Critical Care & Sleep Medicine
Lee Baggott
Rodney Folz
Hugo Montenegro
Robert Schilz
Kingman Strohl

Donald Anthony
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department interview
Richard Josephson, MD, Medical Director of Cardiac Intensive Care Unit (CICU) and Cardiovascular and Pulmonary (CVP) Rehabilitation at University Hospitals Cleveland Medical Center, shares his approach on ensuring good patient outcomes, discusses the role of cognitive dysfunction in the lives of patients with heart failure and shares his vision on upcoming innovations in the field of cardiology.

As a Director of CICU, what are some of the approaches you use to ensure quality and good patient outcomes?

The foundation of quality health care is to always be focused on the fundamentals of doctor-patient interaction and maintain a broad viewpoint of a patient's condition, while paying close attention to symptoms. In addition, managing patients in CICU is a team sport, you have to work with all professionals involved in the care of a patient, including physicians, nurses, dietitians, and respiratory therapists. Leveraging these relationships to obtain optimal outcomes for a patient relies on developing mutual respect, optimizing the performance of health care providers, and uniting under the directions of a team captain. With strong leadership, optimization of care and consistent communication across the board we strive to achieve the best outcomes for our patients.

Your leadership role in CICU has not limited your research activities. What is the main focus of your research now?

My research approach is a little unconventional; the common path to achieving success in research endeavors is maintaining a precise focus on a narrow area. However, over the span of my career I have been involved in many different research projects. I have done a variety of studies on cognitive dysfunction in cardiovascular disease and its effects on patient care, cardiac rehabilitation, and cardiovascular disease prevention, as well as frailty and geriatric symptoms among patients with heart failure and other cardiovascular diseases. While cardiovascular disease can affect people of any age, it is certainly more prevalent among older patients. We are currently involved in a multicenter study analyzing cognitive dysfunction and frailty in patients with cardiovascular diseases. One of the unique aspects of this trial is that it not only focuses on scientific research, but also serves as a productive learning and training environment for our cardiology fellows. I believe that the tripartite mission of University Hospitals "To Heal. To Teach. To Discover." is best realized when two missions are combined together. Patient care is delivered more diligently and effectively in an educational environment and research concentrates on the root of the problem when approached in the context of clinical care.

How has cardiac rehabilitation evolved over the past few years? What are some of the common pitfalls of cardiac rehabilitation for older patients?

Nationwide there is a large gap between the number of patients who could benefit from cardiac rehabilitation service and the number of patients who actually enroll, so the biggest pitfall is getting patients into the program. One of the roots of this problem lies in the limited availability of outpatient sites for cardiac rehabilitation. University Hospitals has made strides in addressing this issue by offering the service at an array of sites throughout Northeast Ohio, improving accessibility and convenience for patients and their families.

Importantly cardiac rehabilitation has recently grown to suit a broader spectrum of patients, including younger and older patient groups, as well as women and disadvantaged minorities, who often tend to under-enroll in the program. Cardiovascular rehabilitation's suitability for other cardiovascular diseases such as heart failure has also expanded the population of patients who would benefit from it. In addition, recent studies show the increased benefits of using high intensity interval training in cardiac rehabilitation over training at moderate pace for medium to long periods of time, it is also proven to be safe and effective. Finally, we have also changed the way we educate patients and present important content with more emphasis on patient comprehension, and targeted interventions, as well as psychological guidance and support for patients with anxiety or depression.

What is the significance of cognitive dysfunction and its implications on daily activities of patients with heart failure?

The significance of this issue is enormous. Upon the discharge of a typical patient from cardiovascular service at UH Cleveland Medical Center, he or she is prescribed many medications with complex prescription regiments as well as dietary restrictions and detailed action steps to take if a health care problem resurfaces. It has been shown that patients with cognitive dysfunction have a difficult time following a detailed plan of care, interfering with patient self-care and resulting in higher utilization of the Emergency Department and increased hospital readmissions. There is no question that cognitive dysfunction and heart failure go together; in fact, heart failure worsens cognitive dysfunction. Conversely, being physically active has a positive effect on a patient's cardiovascular health and improves cognitive dysfunction.

In your opinion, what are some key innovations and approaches that promise to shape the field of cardiology over the next few years?

On a broad level, cardiovascular innovations are taking place on many fronts, including preventive medicine. The realization that some risk factors and diseases predispose patients to serious cardiovascular diseases promises to become more of people's common knowledge along with awareness of effective cardiovascular therapies. There have been substantial insights into the prominent roles of diet and physical activity over the past few years, as well as treatments of hypertension and abnormal lipids that have been widely publicized through media channels. This new awareness creates an opportunity for the public to become engaged in their health early on and contribute greatly to their health outcomes by, for example, following the lower hypertension requirements proven effective in Systolic Blood Pressure Intervention Trial (SPRINT) by Jackson Wright, MD, PhD.

Over the past few years there have been significant improvements in developing more effective and user-friendly biomedical interventions, including LVADs and TAVRs. This shift can be clearly observed among our CICU patients with disruptive and innovative technologies. Valvular heart disease is no longer the prerogative of surgeons performing open-heart operations; it has now been transformed into a less invasive catheter-based technique, offering lower morbidity and mortality rates. This path of innovation will unquestionably only continue to grow over the next few years, improving the devices and minimizing their complications, such as infection or thrombosis. The improvements in biomedical technology will increase the number of suitable candidates for the innovative devices, offering better outcomes and fewer disruptions to patients' lives.
department news report
Division of Cardiovascular Medicine
Brian Hoit, MD, received the 2016 Hans-Peter Krayernbuehl Memorial Award for distinguished work in the field of research in cardiac function from the International Academy of Cardiology. Dr. Hoit received the award at the 21st World Congress on Heart Disease in Boston, MA.

Division of Gastroenterology & Liver Disease

Fabio Cominelli, MD Fabio Cominelli, MD, PhD, received a $9.7 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH) to support his work in Crohn's disease. Dr. Cominelli will focus his research on determining the origins of the disease with the aim of developing a cure.




Division of General Internal Medicine
Jill Huded, MD, published her work in the article titled "The Impact of Delirium on Health Care Utilization and Survival after Transcatheter Aortic Valve Placement" in the Journal of Catherization and Cardiovascular Interventions. Dr. Huded identified an over 20-percent delirium occurrence in patients after trans-catheter aortic valve replacement and argues that delirium is associated with diminished survival and increased health care utilization.

Brook Watts, MD, Chief of Informatics and Analytics and Chief Quality Officer at the Louis Stokes Cleveland VA Medical Center, was detailed to the Office of the Deputy Under Secretary of Policy and Services as Senior Field Advisor for Clinical Informatics to support the transformation of the VA's electronic medical record and other clinical informatics programs. Dr. Watts will also assist with the continued expansion of the Intermediate Care Technician initiative, a novel program to leverage former military medics in ambulatory care positions with the VA.




Division of Hematology & Oncology

Sanford Markowitz, MD, and Joseph Willis, MD, found that gene mutations in unique to colon cancers in African-Americans are aggressive and lead to higher recurrence and metastasis. This finding may explain lower survival rates of the African American population compared to other groups for the disease.




Cynthia Owusu, MD, found that the Vulnerable Elders survey can help predict decline among patients with breast cancer. The survey helps identify individuals who lose the ability to complete some tasks of daily living and is associated with high risks for decline among cancer patients. Dr. Owusu argues that the findings are in line with previous research suggesting that functional decline is associated with a decreased likelihood of recovery from this serious illness.




Division of Infectious Diseases & HIV Medicine

Henry Boom, MD, received a $1.45 million grant from the Fogarty International Center at NIH for the project titled "Microbiology and Immunology Training for HIV and HIV-Related Research in Uganda." The five-year grant will focus on biomedical training in basic microbiology to be applied to HIV and HIV/AIDS-related disease research. The grant offers support to PhD-level researchers at Case Western Reserve University and master's-levels trainees at Makerere University in Uganda and promises to further strengthen the collaboration between the two institutions, improving the biomedical research capacity of major universities and medical schools in Uganda.
In addition, Dr. Boom was awarded an $11.08 million grant for his project titled "Resistance to MTB Infection in HIV Infected Individuals in Uganda and South Africa" from the Division of AIDS of NIAID/NIH. This five-year grant focuses on the identification of HIV+ and HIV- individuals who resist latent Mycobacterium tuberculosis infection; understanding the mechanisms of this resistance will offer insight into the understanding of ways humans can protect themselves against this infectious pathogen that causes tuberculosis. This project also promises to develop new approaches to tuberculosis vaccine and host-directed therapy.

Barbara Gripshover, MD, was appointed as member of the Antimicrobial Drugs Advisory Committee of the Food and Drug Administration (FDA) 2016 - 2019.




Carey Shive, PhD,
VA GRECC investigator, received a Career Development award for her project titled "Role of IL-6 and IL-1b in Immune Dysfunction during Aging, HIV, and HCV Infection."







Division of Pulmonary, Critical Care & Sleep Medicine

Frank Jacono, MD
, is leading the first U.S. site for patient enrollment to MUST-ARDS trial. This trial is based on the recent article titled "Mitochondrial Transfer via Tunneling Nanotubes Is an Important Mechanism by Which Mesenchymal Stem Cells Enhance Macrophage Phagocytosis in the In Vitro and Vivo Models of ARDS" published in Stem Cells Journal. The article's authors argue that the mitochondrial transfer from MSC to innate immune cells leads to enhancement in phagocytic activity and reveals an important novel mechanism for the antimicrobial effect of MSC in ARDS.
department conferences & events
Medicine Quality Summit: Remaining Engaged
Date: Saturday, September 24
Time: 7 a.m. - 12 p.m.
Location: Huntington Global Center for Health Innovation & Convention Center

Full-Time Faculty Meeting with the Chairman
Date: Tuesday, September 27
Time: 5:30 - 6:30 p.m.
Location: Wolstein Auditorium

Grand Rounds
Time: 12 - 1 p.m.
Location: Kulas Auditorium
September 13
"Reaching Their Personal Best: Professional Development and Coaching for Learners" by Kerri Palamara McGrath, MD

September 20
"Novel Approaches to Stem Cell Transplantation" by Leland Metheny, MD
September 27
"Geriatric Orthopedic Comanagement in Fragility Fractures" by Mriganka Singh, MD
Harrington Fellowship Program
Harrington Discovery Institute is pleased to announce the Harrington Fellows Program, a new initiative that will recognize and support the most promising early to mid-career physician-scientists in the Cleveland academic medical community.

Program Overview:
Harrington Discovery Institute at University Hospitals in Cleveland, Ohio - part of The Harrington Project for Discovery & Development-aims to advance medicine and society by enabling our nation's most inventive physician - scientists to turn their discoveries into medicines that improve human health.

The new Harrington Fellows Program will award up to three Harrington Fellows with $75,000/year for two years to support the research efforts of local physician-scientists.

Members of the Harrington Fellows Program will have an important role in advancing the efforts of Harrington Discovery Institute through the evaluation and selection of new Harrington Scholars, participation in quarterly research meetings and attending the annual Harrington Scientific Symposium.
Qualified candidates must have the following:
  • An MD or combined MD/PhD degrees
  • A track record of significant research achievements and extramural support
  • The rank of Assistant or Associate Professor
Interested candidates are encouraged to apply by Friday, September 30, 2016. For more information, please visit: