Pathways to Excellence | 2018 | Volume 5 | Issue 1

Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

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VOL 5 | ISSUE 1 | JULY 2018

CLINICAL LABS PREPARE FOR LONG AWAITED MOVE The First Phase

What’s Next

The walls are up, and in just six more months, the long awaited move to Bailey Road will be a reality for many of our clinical laboratories.

The much anticipated development project will move all nonacute and reference testing to the building, which is currently undergoing construction to enlarge and renovate much of the current building to make room for a spacious core lab. The space will also include meeting and breakrooms, in addition to office space and other amenities for staff.

In May, the department hosted two town hall meetings for staff to bring their questions about the project forward and see site floor plans and drawings.

Crews started construction last fall while the project team has been working closely with clinical faculty and supervisors to prepare for the necessary equipment validation period. The full relocation of the first of two phases is planned for early 2019.

While plans are in motion for those moving to Bailey Road, changes are in store for the labs that are being left behind – namely, those located on the ground floor of Strong Memorial Hospital. This is largely due to the Emergency Department’s dire need for more space.

The hospital’s solution is to move the ground floor laboratories into a suitable space(s) to make room for a newly constructed ED tower.

Though this will likely mean more moving – this time, within the hospital – it will serve as a catalyst to much needed renovations for these laboratories.

“We are benefitting from the ED tower project because we will get to escalate our reconstruction of the labs that are being left behind,” said Kelley Suskie, Vice Chair for Administration.

This part of the project is known as Phase 2A. This summer, each of the affected labs will meet with the architectural team to discuss workflow and space needs.

IN THIS ISSUE Bailey Road Project........................................................... 1 From the Chair.................................................................. 2 Smoking Research Grant................................................... 3

Meet the Residents........................................................... 4 Focus on Faculty................................................................ 5 Residency Restructing....................................................... 5

CHAIR’S COLUMN

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Bruce Smoller, M.D.

“Our entire team is working hard and continues to provide fantastic clinical service while preparing the department for the next 25 years.”

nother academic year is ending and with it, the bittersweet goodbyes. We wish our outgoing fellows and residents the best of luck in their next stops.

There is also the anticipation of the upcoming weeks, as new residents, fellows and faculty members join our team! Short introductions of some of our newest members are enclosed in this newsletter and others will follow in subsequent editions.

We are excited to report that our Molecular Pathology unit has begun Next Gen Sequencing and has received New York State approval for two new assays.

This is a terrific advancement for the precision medicine program that the Wilmot Cancer Institute is promoting as it attempts to regain its NCI designation.

All of our clinical services continue to expand at rapid rates and our faculty and technical support staff are working furiously to keep up with the ever-increasing demands on their time. The laboratory is taking on reference work from all of our affiliated hospitals, as well as additional anatomic and clinical pathology reference work from non-affiliates throughout the region. The result of the hard work is that the department remains in a strong fiscal state and is able to continue with its program of building diverse subspecialty expertise in all anatomic and clinical arenas.

It is also exciting to report that Dr. Sherry Spinelli was awarded an R21 Award from the NIH. This, along with her Philip Morris Grant will keep her research program for the next several years.

The plans for re-locating of many of the laboratories to Bailey Road in Henrietta are actually ahead of schedule. The construction team still predicts that their work on phase I will be completed by the end of 2018 and we will be able to enter the labs and begin the on-site validation of all of the assays in the subsequent few months. All are expecting that we will be fully operational in the new setting by mid-spring. In concert with this, the design team has begun discussions with the laboratory leadership teams to plan for relocating some of the laboratories that will remain at Strong Memorial Hospital.

On account of plans to greatly expand the current Emergency Department, portions of the Automated Hematology and Chemistry Laboratories and the Blood Bank will be moving down the hall. Needless to say, this is a complicated exercise. The process of meticulously planning state-of-the-art laboratories takes the combined time, energy and effort of all of our laboratory leaders, working in conjunction with professional laboratory design teams and architects.

All of this is by way of saying that things in the department continue to be in a state of rapid growth and change. Our entire team is working hard and continues to provide fantastic clinical service while preparing the department for the next 25 years. For those of you reading this who are not on-site, I welcome you to come visit our department over the next few months to see all of the changes.

I would be delighted to give you the grand tour.

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CLINICAL LABS PREPARE FOR LONG AWAITED MOVE (CONT.) WHO’SGoing GOINGinINPhase PHASE Who’s 1?1?

• • • • • • • • • •

Automated Lab (all areas)* Biochemical Genetics Client Services Clinical Trials CLSS Couriers Cytogenetics Education Lab Administration Microbiology (includes Serology/Virology)* • Microbiology Specimen Receiving* • Microarray • Molecular Diagnostics

• • • • • • • •

Outreach Outreach Supplies Phlebotomy Management Proficiency Testing Protein Lab QA & Compliance Reference Lab Ridgeland Road Auto/ Outpatient Lab • SMS* • Supply Chain • Toxicology **A core lab will remain at SMH for inpatient and onsite outpatient testing

The renovated facility at 211 Bailey Road will expand upon the existing building structure.

TIMELINE December 2018

Phase I construction complete

January-March 2019

Equipment validation

March-April 2019

Open for business

Spring 2019

Design of Phase 2A complete

December 2019

Phase 2A construction at SMH complete

2021

Phase 2B move complete

EXPLORING EFFECTS OF THERAPY, SUBSTANCE ABUSE IN HIV PATIENTS Sherry Spinelli, Ph.D., has received a two-year R21 grant from the NIH to study the effects of tobacco among HIV-infected persons taking antiretroviral therapy (ART).

Tobacco use is much higher in the HIV population, and this has been shown to double the risk of death in HIV-infected persons on ART. While advances in HIV therapeutics has reversed a death sentence to a chronic management disease, Spinelli says these patients still die younger from co-morbidities such as cardiovascular disease or neurocognitive conditions.

The study will compare smoking and non-smoking ART-sustained HIV patients, as well as nonsmoking HIV-negative persons at high risk for HIV that are taking Pre-Exposure Prophylaxis (PrEP), by specifically examining the interaction between their medications and tobacco. The study hypothesizes that those who smoke in addition to their ART regime exhibit profound changes in cellular vesicle release in the circulation. She will specifically investigate changes in proteins and miRNA that promote chronic inflammation and increase the risk of cardiovascular disease. The study findings will be coupled with bioinformatics and computational methods to develop a predictive model to identify pathways associated with ART and tobacco use.

Spinelli hopes the work will help pave the way for future research on new smokeless products such as e-cigarettes or vaping devices.

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FIRST CLASS OF RISING MEDICAL TECHNOLOGISTS GRADUATES Together with friends, family, and future colleagues, URMC’s first clinical/medical laboratory technology students graduated from the program on Friday, May 18.

The ceremony included formal remarks by Kathy Parrinello, Executive Vice President and Chief Operating Officer, and several leaders from Pathology & Laboratory Medicine including Vicki Roberts, Kelley Suskie, and Drs. Richard Burack and Scott Kirkley.

Two awards were given at the ceremony. John Reichert received the Academic Excellence Award for outstanding academics and professional achievement in the program.

Madalynn Bryant received the Aspiring Leader Award in recognition of academic achievement and leadership. This award was given in honor of the late Judy Miller, who was supervisor of the Flow Cytometry Laboratory at the time of her retirement in 2017, and was passionate about teaching colleagues from fellow technologists to residents and clinical faculty.

The intensive, one-year program was launched in 2017. All of the 11 graduates have since accepted jobs at Strong Memorial Hospital.

Congratulations to those who completed the inaugural URMC clinical/ medical technology training program, shown here after their graduation ceremony on May 18.

MEET THE RESIDENTS

Caroline Miller Sudbury, MA

Lanisha Fuller Frankfurt, Germany

Michael Karasick Gladwyne, PA

Tatsiana Pukhalskaya Mozyr, Belarus

Medical School: Saint George’s University

Medical School: Goethe-Universität Frankfurt am Main

Medical School: Belarusian State Medical University

Undergraduate School: Lehigh University

Hobbies/interests: Video games, reading, hiking, cooking, baking

Medical School: Sidney Kimmel Medical College at Thomas Jefferson University

Hobbies/interests: Horseback riding, reading, traveling, crafting

Fun fact: She loves rabbits and has had one for the majority of her life.

Fun fact: She’s a vegetarian

Undergraduate School: Case Western Reserve University Hobbies/interests: Fencing, reading Fun fact: His first job was as a library page.

Hobbies/interests: Fine art, ballet, theater, sports, gardening, fishing, roller skating Fun fact: She also graduated from music school as a violinist.

WHERE THEY’RE HEADED DEPARTING RESIDENTS:

DEPARTING FELLOWS:

Nisha Patel | Hematopathology fellowship at Cleveland Clinic Raman Baldzizhar | Forensic pathology fellowship at Office of Chief Medical Examiner of the City of New York (OCME) Sohaib Abu-Farsakh | URMC GI pathology fellowship

Meenakshi Bansal | Rochester Regional Health, Rochester, NY Meenal Sharma | Unity Health, Rochester, NY Jian Shen | Norton Healthcare, Louisville, KY Diana Agostini-Vulaj | URMC GI pathology faculty

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FOCUS ON FACULTY: ARCHIBALD PERKINS, M.D., PH.D. Dr. Archibald Perkins has been drawn to research from the beginning of his scientific career. Today he is active as both a hematopathologist and researcher developing mouse models to study leukemia in pursuit of developing targeted therapies for patients.

Perkins came to the University of Rochester in 2007 as the first ever hematopathology fellow at URMC. He joined the faculty that same year and has been here ever since.

The academic journey leading up to URMC was, as he describes, very nontraditional. He completed his M.D.-Ph.D. at Columbia University and did a 2-year residency at Brigham and Women’s Hospital. It was then that he became very interested in leukemia, saying, “It looked like a disease that was just incredibly lethal.”

After residency, he did a postdoctoral fellowship at NCI’s Cancer Research and Development Center in Frederick, MD. This allowed him to establish a research program – a task he compares to starting a small business because of the time and effort involved.

“It’s really a struggle to get a lab established,” he said. “You need 100 percent commitment to keep a research lab going, so that’s why I took the route that I did.”

After four years with NCI, he was hired as an assistant professor at Yale University, where he worked for 15 years. Aside from keeping his research lab running, Perkins was performing autopsies which interestingly included many cases that were leukemia patients.

His research has largely focused on the EVI1, a gene involved in poor-prognosis human leukemia, which has been found to skew all hematopoietic cells toward the myeloid lineage.

This process is usually followed by a genetic mutation that leads to leukemia.The lab has also established that one of the proteins in this locus contains an enzymatic pocket that can be targeted with a small molecule drug.

“Our goal is to thread the needle of killing the cancer cell without killing the normal cell and using all the information we’ve gathered to guide us as to which molecules to target,” he explains.

At Columbia, he published a paper describing use of retroviruses to transfer genes into mammalian cells, a technique that’s still in use today. This topic – retroviruses as genetic elements – would serve as the backbone of his future career.

One of his earliest breakthroughs came when Perkins was an undergraduate doing a semester of research at Massachusetts General Hospital. He published a paper that identified Kupffer cells of the liver as being responsible for cleaving parathyroid hormone produced by the parathyroid gland into forms that circulated in the blood. This helped get his foot into the door of several good medical schools (including Harvard, which he turned down). It also marked the beginning of his interest in molecular genetics just as it was emerging in the late 1970s.

It wasn’t until he was deep into his postdoctoral fellowship at NCI that Perkins started to seriously consider clinical work.

Federal funding was becoming more precarious and he says it was time to “cash in” on his M.D. He went on to Yale where he served on the autopsy service, but at a friend’s suggestion, later tried his hand at hemepath, since it fit perfectly with his interest in leukemia.

Outside of work, Perkins enjoys outdoor activities like bicycling to work, cross country skiing, hiking, and playing piano in a swing band. He is married with three grown children, Matthew, 32, Becky, 29, and Clarissa, 28, and three step children, Emily, 23, Mack, 21, and William, 20. He and his wife Eleanor, an interior designer, live in Pittsford.

RESIDENCY RESTRUCTURING IN THE WORKS The Pathology residency program may see some significant restructuring in the coming 1-2 years thanks to a new collaboration.

A group of 10 select AP and CP faculty met for a full day in May to collectively brainstorm how to take the program structure from “good to great.”

The group discussed topics including making AP or CP-only tracks for first-year residents. On the research end, the group discussed ways to promote its year-out research opportunity which dovetails nicely with the “Physician Scientist Research Pathway” model established by the American Board of Pathology (ABP), or find ways to better involve residents in faculty research projects.

The team also discussed ways to engage the new generation of learners who may be more interested in team-oriented learning environments and receiving formative feedback from instructors.

This may lead to minimizing the number of required teaching conference hours and using the “boot camp” model that has been successful in Surgical Pathology, in other clinical areas during the first year.

“Residents really should be integral members of the team rather than observers only,” said Jennifer Findeis-Hosey, M.D., one of the faculty involved in these discussions. “Faculty can be really thoughtful about planning these core experiences to help give our first-year residents a solid foundation.”

The committee emerged from the planning session with over a dozen action items and plans to take next steps of implementation within the next 12-18 months.

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Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642

As a token of appreciation to our nearly 900 employees, the department provided all Pathology & Laboratory Medicine staff with UR Medicine Labs fleece jackets this spring.