In Touch - Issue 12

Teaching Clinical Research to the Next Generation of Physicians

From the most advanced immune modulating cancer therapies to the first patients treated with penicillin, medical research remains at the core of advancing modern medicine. Bringing the edges of science and technology to the bedside, however, often involves physicians themselves as clinical researchers. With this understanding, the University of Tennessee Graduate School of Medical Education has made a commitment to educating physician residents and fellows alike as leaders within the space of research and academia. At the physician fellow level, Dr. Robert E. Heidel, PhD in addition to several members of his team, conduct a weeklong course for fellows of all disciplines aimed at navigating the research process at the University of Tennessee Medical Center (UTMC). During this course, participants review the topic of biostatistics and its application to clinical research, IRB submission and revision, as well as approaches to study design which may be appropriate for a given clinical question. After this foundation is established, these processes are mapped out as participants build a proposed research project that is ultimately presented to other members of the course.

Dr. Heidi Worth, M.D., a current Hematology and Oncology fellow, when asked about the course, states “Having completed research projects within multiple departments, I feel it provides an insightful experience centered around approaching research at our institution. There is certainly something meaningful to be gained by individuals at

Points of View

multiple stages of training.” In parallel to the physician fellow course, the Evidence Based Medicine rotation (EBM), which is currently part of the internal medicine residency curriculum, provides a very similar experience to physician residents. Conducted by Dr. Daphne Norwood, M.D., and Dr. Robert E. Heidel, PhD, this experience also covers many of the same high-yield research topics and serves as a launch point for residents to begin engaging with research at UTMC. Medicine residents during EBM similarly participate in formulating a study proposal and work towards presenting their idea to their peers at its conclusion. Placed roughly at the midpoint of the PGY-1 year, EBM aims to inform residents on current processes and resources, cultivate enthusiasm for clinical research, and facilitate the process of turning a clinical question into a tangible project which may serve to answer that question and contribute to medical literature as a whole.

As the list of publications within all disciplines continues to flourish, the department of medicine continues to strive towards UTMC becoming a top-tier academic and research institution. With the understanding that providing excellent patient care remains of paramount importance, emphasis on the goal to materialize this realworld experience into larger contributions to the medical community is further recognized. In light of this, UTGSM would like to thank physicians, educators, and researchers at all levels for their invaluable time and effort in making additions to an already impressive body of research conducted at UTMC.

all over the country, indeed all over the world, to seek the help of these renowned physicians. Recruitment of such physicians requires availability of a wide variety of training programs that allows them to thrive in a rich academic environment. Such a milieu allows generation of new ideas for generating research grants and impactful publications. The ability to achieve scientific breakthroughs and innovations is the hallmark of prestigious medical centers and members of such institutions are actively sought as speakers and researchers by other centers nationally and internationally.

Rajiv Dhand, MD, Chair

The University of Tennessee Medical Center (UTMC) recently revised its vision statement. The stated vision of the organization is now to “Transform the health of individuals as a top-tier Academic Health System.” What are the distinguishing characteristics of prestigious health systems? Obviously, the most distinctive feature is that these centers provide very high-quality patient care and state-of-the-art specialized services that are not available at most other centers. Perhaps, the greatest distinguishing feature of prestigious medical centers lies in the quality of physicians recruited and the support services provided to them. These physicians are absolutely dedicated to their profession and are nationally and internationally known for their skills and expertise. Patients gravitate to these centers from

One of our astute administrators recently noted that all prestigious medical centers have renowned departments of medicine. To be recognized as a top-tier academic health system, we in the Department of Medicine will need to be models of excellence and lead this journey while promoting diversity, equity and inclusiveness at all levels of the organization. Our goal is not only to provide high quality patient care but also create new knowledge that facilitates our understanding of diseases as well as provides newer technologies, the application of which improves the health of our patients. Achieving these lofty goals requires

Publications by Department - 2022:

CARDIOVASCULAR DISEASE PUBLICATIONS

Butterstein GM, Hirst C, Castracane VD. Maternal serum leptin in the pregnant rat: fetal-placental implantation number and progesterone. Endocrine. 2022 May;76(2):457-464. doi: 10.1007/s12020022-02984-2. Epub 2022 Feb 18.

Tahir H, Livesay J, Fogelson B, Coombes T, Patel C, Baljepally R. Use of the CHA(2) DS(2)-VASc Score in Assessing Transradial Approach Failure. Cardiovasc Revasc Med. 2022 Mar;36:107-112. doi: 10.1016/j. carrev.2021.05.023. Epub 2021 May 28.

Fogelson B, Tahir H, Livesay J, Baljepally R. Pathophysiological factors contributing to fractional flow reserve and instantaneous wave-free ratio discordance. Rev Cardiovasc Med. 2022 Feb 18;23(2):70. doi: 10.31083/j.rcm2302070.

Stephens S, Fogelson B, Goodwin RP, Baljepally GK, Baljepally R. Takotsubo Cardiomyopathy Secondary to Cryptococcal Meningoencephalitis in a Patient With Multiple Sclerosis. J Med Cases. 2022 Jun;13(6):263-268. doi: 10.14740/jmc3884. Epub 2022 Jun 11.

Livesay J, Fogelson B, Tahir H, Baljepally R. Comparison of Tricuspid Regurgitation Severity Between Cardiac Resynchronization Therapy Versus Right Ventricular Pacing in Patients With Chronic Obstructive Pulmonary Disease. Cardiol Res. 2022 Jun;13(3):128-134. doi: 10.14740/ cr1365. Epub 2022 Jun 16.

Baljepally R, Tahir H, Goodwin RP, Livesay J, Fogelson B, Patel C, Coombes T, Wadi G, Dieter R 3rd. Comparison of Transcatheter Aortic Valve Implantation Outcomes Between Normal-Flow, LowGradient Severe Aortic Stenosis and NormalFlow, High-Gradient Severe Aortic Stenosis. Cardiovasc Revasc Med. 2022 Jun;39:12-17. doi: 10.1016/j.carrev.2021.10.020. Epub 2021 Nov 2.

Fogelson B, Black W, Goodwin RP, Dieter R 3rd, Baljepally R. Asymptomatic Aorto-Atrial Fistula Secondary to Surgical Repair of Ascending Aortic Dissection: When to Do Nothing. JACC Case Rep. 2022 Jul 20;4(14):868-870. doi: 10.1016/j. jaccas.2022.04.013. eCollection 2022 Jul 20.

Fogelson B, Livesay J, Johnson JH. Inferior Myocardial Infarction Secondary to Coronary Artery Vasospasm Following Regadenoson Stress Imaging. J Med Cases. 2022 Jan;13(1):11-14. doi: 10.14740/jmc3850. Epub 2022 Jan 17.

PULMONARY CRITICAL CARE PUBLICATIONS

Swanson CS, Dhand R, Cao L, Ferris J, Elder CS, He Q. Microbiome Profiles of Nebulizers in Hospital Use. J Aerosol Med Pulm Drug Deliv. 2022 Aug;35(4):212-222. doi: 10.1089/jamp.2021.0032. Epub 2022 Feb 25.

Li J, Alolaiwat A, Fink JB, Dhand R. Aerosol-Generating Procedures and Virus Transmission. Respir Care. 2022 Aug;67(8):1022-1042. doi: 10.4187/ respcare.10160. Epub 2022 Apr 6.

Pleasants PA, Chan AH, Mosnaim G, Costello RW, Dhand R, Schworer SA, Merchant R, Tilley SL. Integrating digital inhalers into clinical care of patients with asthma and chronic obstructive pulmonary disease. Respir Med. 2022 Dec;205:107038. doi: 10.1016/j. rmed.2022.107038. Epub 2022 Nov 7. PMID: 36446239

Harnois LJ, Alolaiwat AA, Jing G, Fink JB, Dhand R, Li J. Efficacy of Various Mitigation Devices in Reducing Fugitive Emissions from Nebulizers. Respir Care. 2022 Apr;67(4):394-403. doi: 10.4187/ respcare.09546. Epub 2021 Nov 9.

Li J, A Alolaiwat A, J Harnois L, Fink JB, Dhand R. Mitigating Fugitive Aerosols During Aerosol Delivery via HighFlow Nasal Cannula Devices. Respir Care. 2022 Apr;67(4):404-414. doi: 10.4187/ respcare.09589. Epub 2021 Nov 17.

Dhand R. Inhaled Tobramycin for Treatment of Ventilator-Associated Pneumonia: The Interplay of Patient, Drug, and Device. Respiratory Care January 2022, 67 (1) 151-153; https://doi.org/10.4187/ respcare.09852

Swanson CS, Dhand R, Cao L, Ferris J, Elder CS, He Q. Microbiome-based source identification of microbial contamination in nebulizers used by inpatients. J Hosp Infect. 2022 Apr;122:157-161. doi: 10.1016/j. jhin.2022.01.008. Epub 2022 Jan 23.

Ohar JA, Ferguson GT, Mahler DA, Drummond MB, Dhand R, Pleasants RA, Anzueto A, Halpin DMG, Price DB, Drescher GS, Hoy HM, Haughney J, Hess MW, Usmani OS. Measuring Peak Inspiratory Flow in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2022 Jan 6;17:79-92. doi: 10.2147/COPD.S319511. eCollection 2022.

Sahay S, Balasubramanian V, Memon H, Poms A, Bossone E, Highland K, Kay D, Levine DJ, Mullin CJ, Melendres-Groves L, Mathai SC, Soto FJ, Shlobin O, Elwing JM. Utilization of risk assessment tools in management of PAH: A PAH provider survey. Pulm Circ. 2022 Apr 8;12(2):e12057. doi: 10.1002/pul2.12057. eCollection 2022 Apr.

Soto FJ, Biney IN, Akhtar Y, McKeown PP, Turner JF. Abnormal Cardiac Ultrasound Imaging in a Patient With Sudden Neurologic Deficit. Chest. 2022 Sep;162(3):e145-e148. doi: 10.1016/j. chest.2021.09.043.

Fogelson B, Qu D, Bhagat M, Branca PR. Multi-organ system failure secondary to difluoroethane toxicity in a patient “huffing” air duster: a case report. J Addict Dis. 2022 Jan 19:1-6. doi: 10.1080/10550887.2022.2027207. Online ahead of print.

Gutierrez A, Gerbo M, Treat S, Sharma N, Jordan S, Dudney T. A New Meaning to Chest Tightness: Tension Pneumomediastinum and Bedside Mediastinotomy In SARS- CoV-2. Critical Care Medicine: January 2022 - Volume 50 - Issue 1 - p 131. doi: 10.1097/01. ccm.0000807484.94614.ad

Zarogoulidis P, Kosmidis CS, Hohenforst-Schmidt W, Matthaios D, Sapalidis K, Petridis D, Perdikouri EI, Courcoutsakis N, Hatzibougias D, Arnaoutoglou C, Freitag L, Ioannidis A, Huang H, Tolis C, Bai C, Turner JF. Radial-EBUS: CryoBiopsy Versus Conventional Biopsy: Time-Sample and C-Arm. Int J Environ Res Public Health. 2022 Mar 17;19(6):3569. doi: 10.3390/ ijerph19063569.

AMYLOIDOSIS PUBLICATIONS

Wall JS, Martin EB, Endsley A, Stuckey AC, Williams AD, Powell D, Whittle B, Hall S, Lambeth TR, Julian RR, Stabin M, Lands RH, Kennel SJ. First in Human Evaluation and Dosimetry Calculations for Peptide (124)I-p5+14-a Novel Radiotracer for the Detection of Systemic Amyloidosis Using PET/CT Imaging. Mol Imaging Biol. 2022 Jun;24(3):479-488. doi: 10.1007/s11307-02101681-2. Epub 2021 Nov 16.

HEMATOLOGY/ONCOLOGY PUBLICATIONS

Ansell SM, Radford J, Connors JM, Długosz-Danecka M, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani R, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ; ECHELON-1 Study Group. Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin’s Lymphoma. N Engl J Med. 2022 Jul 28;387(4):310-320. doi: 10.1056/ NEJMoa2206125. Epub 2022 Jul 13.

Hamid MS, Rutherford SC, Jang H, Kim S, Patel K, Bartlett NL, Malecek MK, Watkins MP, Maddocks KJ, Bond DA, Feldman TA, Magarelli G, Advani RH, Spinner MA, Evens AM, Shah M, Ahmed S, Stephens DM, Allen P, Tees MT, Karmali R, Cheson BD, Yazdy MS, Strouse C, Bailey NA, Pagel JM, Ramchandren R. Outcomes Among Classical Hodgkin Lymphoma Patients After an Interim PET Scan: A Real-World Experience. Clin Lymphoma Myeloma Leuk. 2022 Jul;22(7):e435-e442. doi: 10.1016/j. clml.2021.12.012. Epub 2021 Dec 25.

OTHER PUBLICATIONS

Walton MN, Hamilton LA, Salyer S, Wiseman BF, Forster AM, Rowe AS. Major Bleeding Postadministration of Tenecteplase Versus Alteplase in Acute Ischemic Stroke. Ann Pharmacother. 2022 Aug 24:10600280221120211. doi: 10.1177/10600280221120211. Online ahead of print.

Gracie S, Sengupta N, Ferreira C, Pemberton J, Anderson I, Wang X, Rhodes L, Brown K, Balla T, Larson A. De novo loss-of-function variant in PTDSS1 is associated with developmental delay. Am J Med Genet A. 2022 Jun;188(6):1739-1745. doi: 10.1002/ajmg.a.62695. Epub 2022 Feb 27.

Sun J, Wang X, Terry PD, Ren X, Hui Z, Lei S, Wang C, Wang M. Interaction effect between overweight/obesity and alcohol consumption on hypertension risk in China: a longitudinal study. BMJ Open. 2022 Jul 27;12(7):e061261. doi: 10.1136/ bmjopen-2022-061261.

Lindley LC, Svynarenko R, MooneyDoyle K, Mendola A, Naumann WC, Keim-Malpass J. Patterns of Health Care Services During Pediatric Concurrent Hospice Care: A National Study. Am J Hosp Palliat Care. 2022 Mar;39(3):282-288. doi: 10.1177/10499091211018661. Epub 2021 May 25.

Fogelson B, Livesay J, Rohrer M, Edwards M, Hirsh JB. Prevotella bivia cardiac implantable electronic device related endocarditis. IDCases. 2022 Apr 9;28:e01499. doi: 10.1016/j.idcr.2022.e01499. eCollection 2022.

Svynarenko R, Lindley LC, MooneyDoyle K, Mendola A, Naumann WC, Mack JW. Patterns of Healthcare Services Among Children With Advanced Cancer in Concurrent Hospice Care. Cancer Nurs. 2022 Feb 16:10.1097/NCC.0000000000001067. doi: 10.1097/NCC.0000000000001067. Online ahead of print.

McBride CM, Pathak S, Johnson CE, Alberg AJ, Bandera EV, BarnholtzSloan JS, Bondy ML, Cote ML, Moorman PG, Peres LC, Peters ES, Schwartz AG, Terry PD, Schildkraut JM. Psychosocial factors associated with genetic testing status among African American women with ovarian cancer: Results from the African American Cancer Epidemiology Study. Cancer. 2022 Mar 15;128(6):1252-1259. doi: 10.1002/ cncr.34053. Epub 2021 Dec 9.

Peres LC, Colin-Leitzinger C, Sinha S, Marks JR, Conejo-Garcia JR, Alberg AJ, Bandera EV, Berchuck A, Bondy ML, Christensen BC, Cote ML, Doherty JA, Moorman PG, Peters ES, Moran Segura C, Nguyen JV, Schwartz AG, Terry PD, Wilson CM, Fridley BL, Schildkraut JM. Racial Differences in the Tumor Immune Landscape and Survival of Women with HighGrade Serous Ovarian Carcinoma. Cancer Epidemiol Biomarkers Prev. 2022 May 4;31(5):1006-1016. doi: 10.1158/1055-9965. EPI-21-1334.

Fogelson B, Patel K, Spoons J, Stephens S, Edwards M. Hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis, cytomegalovirus viremia, and nontuberculous mycobacteria bacteremia in a patient with recently diagnosed AIDS. IDCases. 2022 Aug 22;29:e01612. doi: 10.1016/j.idcr.2022. e01612. eCollection 2022.

Beekmann SE, Babcock HM, Rasnake MS, Talbot TR, Polgreen PM. Coronavirus disease 2019 (COVID-19) vaccination preparedness policies in US hospitals. Infect Control Hosp Epidemiol. 2022 Sep;43(9):1256-1258. doi: 10.1017/ ice.2021.181. Epub 2021 Apr 19.

Mannemuddhu SS, Macumber I, Samuels JA, Flynn JT, South AM. When Hypertension Grows Up: Implications for Transitioning Care of Adolescents and Young Adults With Hypertension From Pediatric to Adult Health Care Providers. Adv Chronic Kidney Dis. 2022 May;29(3):263-274. doi: 10.1053/j.ackd.2021.11.005.

Baljepally VS, Metheny W. Rural-urban disparities in baseline health factors and procedure outcomes. J Natl Med Assoc. 2022 Apr;114(2):227-231. doi: 10.1016/j. jnma.2022.01.001. Epub 2022 Jan 31.

Solomon A. Management of AL amyloidosis in 2021. Amyloid. 2022 Mar;29(1):66. doi: 10.1080/13506129.2021.1974831. Epub 2021 Sep 12.

Xu Y, Izumi R, Nguyen H, Kwan A, Kuo H, Madere J, Slatter JG, Podoll T, Vishwanathan K, Marbury T, Smith W, Preston RA, Sharma S, Ware JA. Evaluation of the Pharmacokinetics and Safety of a Single Dose of Acalabrutinib in Subjects With Hepatic Impairment. J Clin Pharmacol. 2022 Jun;62(6):812-822. doi: 10.1002/jcph.2013. Epub 2022 Feb 15.

Harrison SA, Manghi FP, Smith WB, Alpenidze D, Aizenberg D, Klarenbeek N, Chen CY, Zuckerman E, Ravussin E, Charatcharoenwitthaya P, Cheng PN, Katchman H, Klein S, Ben-Ari Z, Mendonza AE, Zhang Y, Martic M, Ma S, Kao S, Tanner S, Pachori A, Badman MK, He Y, Ukomadu C, Sicard E. Licogliflozin for nonalcoholic steatohepatitis: a randomized, double-blind, placebocontrolled, phase 2a study. Nat Med. 2022 Jul;28(7):1432-1438. doi: 10.1038/s41591022-01861-9. Epub 2022 Jun 20.

Dowell JA, Marbury TC, Smith WB, Henkel T. Safety and Pharmacokinetics of Taniborbactam (VNRX-5133) with Cefepime in Subjects with Various Degrees of Renal Impairment. Antimicrob Agents Chemother. 2022 Aug 3:e0025322. doi: 10.1128/ aac.00253-22. Online ahead of print.

Madni A, Khan S, Bilbeisi T, Pasli M, Sakaan F, Lahaj SM, Patel R, Kamal AH. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Muslims. J Palliat Med. 2022 May;25(5):807-812. doi: 10.1089/jpm.2021.0575. Epub 2021 Dec 2.

As we embark on the halfway point of our academic year, there have been numerous high points that deserve some recognition. In particularly, the cardiology department has been active in a multitude of scholarly activity. Former UTMCK internal medicine resident and now first-year cardiology fellow Tyler Coombes has continued his academic achievements as a fellow and is currently involved in numerous projects with current residents. He is working on an abstract for Cardiovascular Research Technologies in Washington, D.C. This project is looking at individuals who had a cerebrovascular accident and the utility of ordering troponins on whether or not it changed management. Troponins are ordered in the workup for a CVA and can lead to a cardiology consult that ultimately ends in a left heart catheterization. Thus far in their study, the data suggest that troponins are not needed in the future for CVA workup, and their hope is to eventually eradicate screening troponins.

Additionally, he completed a case report for Tennessee American Cardiology Conference that highlights an individual with an incidentally found congenital abnormality in the right coronary artery that resulted in a malignant course. The patient had anomalous coronary arteries with inter-arterial course between the aorta and pulmonary artery. This was deemed “malignant” due to its likelihood of myocardial ischemia from compression of the coronary arteries leading to sudden cardiac death. Fortunately, this patient was asymptomatic on presentation and has not suffered any adverse affects from this congenital abnormality. Finally, he is working on receiving IRB approval for using the aortic pulsatility index as a scoring system for left ventricular function in individuals with heart failure with reduced ejection fraction. Aortic pulsatility index is calculated by taking the [(systolic blood pressure minus the diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP)]. Their hope is to have another metric to correlate and predict clinical outcomes.

Fellow Spotlight:

Dr. James Livesay completed his residency in Internal Medicine and is now in his final year of his Cardiovascular Disease Fellowship at the University of Tennessee Graduate School of Medicine. Upon completion of his fellowship this year, he will continue his training with an Interventional Cardiology Fellowship here at UT. Throughout his post-graduate training, he has been actively involved in many research projects with his most recent focus being on coronary flow reserve (CFR) to evaluate for microvascular angina. Microvascular angina is suspected in patients with cardiac chest pain without angiographically significant lesions, and Dr. Livesay’s project has focused on evaluating coronary flow reserve and if abnormalities are associated with an elevated left ventricular end diastolic pressure (LVEDP).

Diversity, Equity, & Inclusion – Dr. Francisco Soto

The next diversity member spotlight is Dr. Francisco Soto who is one of our amazing Pulmonary and Critical Care attendings. Dr. Soto is originally from Cali, Colombia and moved to the US in 1995 inspired by Mark Twain’s “Life on the Mississippi”. He comes from a large family (youngest of 11 siblings). He shares that Colombia is famous for its coffee, emeralds, flowers, and its variety of tropical fruits. The beautiful Andes Mountain chain goes through Colombia, and the country enjoys beaches in the Pacific and Atlantic Oceans. He describes Colombians as perseverant, friendly, and very hard working, with strong family ties and a deep sense of solidarity. You can show up unannounced to relatives or friends’ houses and always feel welcomed. Many traditions are centered around religious holidays. An important one is “La Novena”, when families gather to pray in different houses every night for 9 nights before Christmas and enjoy foods like natilla (custard-like dessert) and buñuelos (a fritter made with cheese, cornstarch and yuca flour). His mother would traditionally make these dishes every year around the holidays for friends and family. From Christmas to New Year’s Day, “La Feria” goes on in his hometown of Cali. The city shuts down with daily activities where people gather to enjoy nightly dancing. Places to visit in Colombia include Cartagena, one of the best-preserved colonial cities in the Americas, and San Andres Island in the Caribbean Sea, famous for its “sea of seven colors”. Dr. Soto remembers Colombia fondly and hopes to visit soon.

Points of View

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planning, huge capital investments, and persistence. To achieve our vision, we are recruiting young talented physicians from a variety of backgrounds, starting specialized services, and building our research portfolio. The critical element in building research is to provide physicians with time to pursue scholarly activities away from the unwavering demands of patient care. The expected return on such an investment is that research yields an increase in research funding which together with institutional support further advances this strategy. We also have plans to enhance publications and encourage our residents and fellows to improve their scholarly productivity. The drive to build a nationally recognized and prestigious academic health system at UTMC has been ongoing for some time. I hope each member of the department will be willing partners in this endeavor to advance excellence and share in the work required to achieve our goals with renewed energy.

Faculty Announcements

Several faculty and staff awards were presented at this year’s Annual Faculty Recognition Dinner held on Thursday, December 8th at The Gettysvue Country Club – Ballroom / Westland Room.

•The Beasley Pylon Award for extraordinary leadership and service to the Department of Medicine was presented to Dr. Russell J. Smith.

•The R.A. Obenour, MD, Distinguished Alumnus Award in Recognition of Outstanding Career Achievement in the Field of Medicine was presented to Dr. C. Trey La Charité.

• Dr. J. Mark Pierce received the R.A. Obenour, Jr., Excellence in Teaching Award for steadfast dedication and excellence in teaching.

• Dr. Ross M. Nesbit received the London Award, which is presented to a teacher who exhibits a dedication to excellence. The recipients of this award are chosen by our residents.

Dr. Jonathan S. Wall received the Chairman’s Outstanding Service Award for his extraordinary dedication and service to the Department of Medicine. All of these award recipients have provided superb service to the Department of Medicine. We are delighted to recognize them for their many contributions.

New Faculty

We wish to congratulate Dr. Amit Vora for his appointment to the rank of Associate Professor, Chief of Endocrinology in the Department of Medicine. Dr. Vora completed medical school at South Gujarat University in Surat, India. He completed a residency in Internal Medicine at Cook County Hospital in Chicago, IL. This was followed by a fellowship in Endocrinology, Diabetes and Metabolism at Penn State University Hershey Medical Center in Hershey, PA. Dr. Vora has received an Endocrine Society Travel Award Grant for Abstract Presentation, as well as the Humanitarian Award Cook County Hospital, Dept. of Medicine for two consecutive years.

We are pleased to welcome Dr. Raleigh C. Cutrer for his appointment to the rank of Clinical Assistant Professor in the Department of Medicine. Dr. Cutrer completed medical school at the University of Mississippi Medical Center in Jackson, MS. He completed a residency in internal medicine, followed by a fellowship in hematology and oncology at University of Mississippi Medical Center. Dr. Cutrer was very active in teaching as a consultant and served as Chief Fellow of the hematology/oncology fellowship program.

We are excited to welcome Dr. Shaker Barham to the Department of Medicine as Assistant Professor. He completed medical school at the University of Jordan in Amman, Jordan. Dr. Barham completed residency at New York Medical College at Saint Michael’s Medical Center in Newark, NJ, followed by a fellowship at Saint Joseph’s University Medical Center in Paterson, NJ. He was chosen for the Best Resident Case Presentation Award at NEOMEN’s 17th Annual Research and Scholarship Forum as well as Dr. Philip R. D’Ambola Memorial Resident Award for excellence in teaching.

We are excited to welcome Dr. Wala M. Abusalah for her appointment to the rank of Assistant Professor in the Department of Medicine. She completed medical school at the University of Jordan in Amman, Jordan. Dr. Abusalah completed a residency in internal medicine at Saint Michael’s Medicine Center in Newark, NJ, followed by a fellowship in Nephrology at Newark Beth Israel Medical Center in Newark, NJ, and a fellowship in Transplant Nephrology at Thomas Jefferson University Hospital in Philadelphia, PA. She was chosen for the Inaugural National Kidney Foundation (Pennsylvania Chapter) Rising Fellow Award for the year 2022.

Enjoy Retirement:

We extend our Congratulations to Dr. Law on his retirement as Chief of Endocrinology December 31st, 2022. He has been an integral part of the University of Tennessee Medical Center for over 35 years. Dr. Law has received many awards including the Distinguished Service Award and the Excellence in Teaching Award. We wish him the best of luck in this new chapter.

CME OPPORTUNITIES—MARK YOUR CALENDARS!

Currently hybrid attendance: half joining via Zoom or Microsoft Teams

• Cardiology Conferences, held weekly on Wednesdays in the Medicine Conference Room for .75 hour CME credit.

• Medicine Grand Rounds, held on the 2nd and 4th Tuesdays of each month in the Medicine Conference Room for 1.00 hour CME credit.

• Ethics Case Rounds, held on the 4th Thursday of the month at noon in Wood Auditorium and are available for 1.00 hour CME credit.

• Pulm/HTN Conferences, held on the 2nd Monday of the month at noon in different locations and are available for 1.00 hour CME credit.

Ethics Case Rounds

Ethics Case Rounds are monthly, hospital-wide discussions of morally distressing cases. Cases are deidentified to protect patient confidentiality.

“Hank” is a 62 y/o gentleman who was admitted with pneumonia and partial-thickness facial burns that he suffered due to smoking while wearing his home oxygen. His history includes schizoaffective disorder and COPD. He lives in a rural county in a single-family home with his brother. They have no close relatives. Transportation is difficult as neither brother drives.

Hank did not plan to stop smoking when he returned home. He was aware that he was burned while smoking and wearing oxygen but felt this “wasn’t my fault” because he needs to smoke and needs the oxygen “so I don’t smother”. He agreed to remove his oxygen and go into another room to smoke when home, but later in the conversation had no memory of this strategy.

In a phone call, Hank’s brother said he has been afraid of Hank’s smoking around his oxygen tank but has not been able to prevent him from doing it. He said when Hank took his Risperdal regularly, he was less apt to do risky things, but he often would not take it.

Background

It is estimated that anywhere from 5 to 51% of patients receiving home oxygen continue to smoke. The incidence of burn injuries secondary to smoking while on oxygen appears to be increasing, posing risks to both the patients themselves and to others in their living areas. In some regions smoking is an absolute contraindication to receiving home oxygen, while in others, patients and caregivers are simply counseled on the risks of smoking while using oxygen. Likewise, some experts suggest patients should not be permitted to have home oxygen if they smoke because of the risk to self and others, while others believe the risks of serious harm from smoking on oxygen are comparatively unlikely.

One approach is to assess the individual patient’s need for home oxygen and weigh it against the potential risks in his or her particular situation, along with encouraging smoking cessation and ensuring that oxygen suppliers are aware of the patient’s smoking habits. In Hank’s case, long-acting injectable psychiatric medications, home health visits to increase medication compliance and safe use of home oxygen could be beneficial as well.

Unfortunately, this approach failed. Without supplemental oxygen, Hank’s oxygen saturations dropped to dangerously low levels. He flatly refused to consider smoking cessation, safe practices, or the use of long-acting injectable Risperdal. He was not eligible for home health as he did not have a PCP There are a limited number of providers in his area, and he had been dismissed from most of them.

Since less-restrictive measures failed, a referral for involuntary admission to an inpatient psychiatric facility was made on the grounds that his behavior posed a danger to himself and others. He was discharged to an accepting facility without incident.

Comments on this case may be sent to amendola@utmck.edu

References

• Litt EJ, Ziesche R, Happak W, Lumenta DB. Burning HOT: revisiting guidelines associated with home oxygen therapy. Int J Burns Trauma. 2012;2(3):167-70.

• Sharma G, Meena R, Goodwin JS, Zhang W, Kuo YF, Duarte AG. Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease. Mayo Clin Proc. 2015;90(4):492-499

Presentations, Publications, Awards

Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.

Thank You For Your Support

For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or development@utmck.edu.

If you would like more information about any of the topics in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm.

We look forward to your input. Thank you.

Stay In Touch!

Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you!

In Touch

Vol. 121 Issue 5:

January 2023

Publisher

Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs

Editor

Annette Mendola, PhD

Administrative Director

Jenny Roark

Contributors

Jenny Roark

Robin Underwood

Rajiv Dhand, MD

Annette Mendola, PhD

Cassandra Mosley

James Drew, MD

Marc Oropilla, DO

Shawna Stephens, DO Ashley Gutierrez-Santana, MD

Design

J Squared Graphics

In Touch is produced by the University of Tennessee Graduate School of Medicine, Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities.

Contact Us In Touch

University of Tennessee

Graduate School of Medicine

Department of Medicine

1924 Alcoa Highway, U-114 Knoxville, TN 37920

Telephone: 865-305-9340

E-mail:

InTouchNewsletter@utmck.edu

Web: http://gsm.utmck.edu/ internalmed/main.cfm

The University of Tennessee is an EEO/AA/Title VI/ Title IX/Section 504/ADA/ ADEA institution in the provision of its education and employment programs and services.

Disclaimer: quotes/ interviews are edited for length and clarity