D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 5, Issue 1: Jan. 2016
The Breath of Life
practices for delivering inhaled medications under different conditions are still being developed. Several members of our pulmonary division have been investigating how different variables change the effectiveness of medications for patients who use noninvasive positive pressure breathing support. One recent trial, which used a manikin with a test lung in our Sim Center, investigated the efficiency of aerosol delivery of medication depending on the pressure settings of the ventilator, the type of aerosol device, and their position in the circuit. Their data suggests that there is significant variability of efficiency of medication delivery depending on the device used. Several members of the pulmonary division also contributed to a multi-institution trial concerning treatment for cystic fibrosis patients who have the most common genetic mutation that causes the disease in the US. This study, which was published in the New England Journal of Medicine in July of this year, assessed effectiveness of the combination of two medications, lumacaftor and ivacaftor, to change
East Tennessee is home to the scenic Smoky Mountains, Southern hospitality, and Big Orange football. However, due to high levels of pollen, air pollution, and tobacco use, it is also home to unusually high incidences of obstructive lung disease. As the region’s top academic medical center, UT has ample opportunity to study these debilitating diseases and a heightened sense of responsibility to our community to understand the conditions with which they live. “Obstructive lung diseases are difficult to prevent and difficult to treat,” notes Dr. Michael McCormack. Patients with these conditions are prone to exacerbations, which can lead to recurrent hospital admissions. Moreover, some treatments are difficult for patients to manage at home. Research into different treatment medications and modalities continually improves the lives of these patients. For example, inhalation medications are a promising area of research, as this route may be safer, more effective, and easier to administer than intravenous or oral methods of delivery. Best
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Points of View
foundations, telethons, races and walks to promote interest and research in a variety of illnesses, there has been little organization of a grassroots campaign to promote wellness and comprehensive development of a community-wide network that includes the active collaboration of hospitals and clinics with social workers, health departments, pharmacies, charities, municipalities, insurance agencies, and regional and federal governments in providing effective health care. The concept of involving communities in effective delivery of health care has been proposed since the 1970s, but change has been slow and inconsistently implemented. The emphasis on seeking greater community participation stems from the belated realization that health care delivery cannot be heavily dependent on the health care establishment, and improving the population’s health cannot be achieved by focusing our efforts on developing better treatments and therapies to treat diseases. Increasingly, we need alternatives which are more practical, less expensive, and share the concerns of the public at large. We need an integrated system of health care
In clinical practice, we deal on a daily basis with patients who present enormous barriers to effective health care delivery. These individuals include the poor, illiterate, homeless, mentally ill, underinsured or uninsured, and illegal immigrants who seek treatment at “safety net” hospitals. In addition, addicts, those in chronic pain, or the extremely obese present additional challenges. In these Rajiv Dhand, MD, Chair patients, we find frequent instances of malnutrition, unhygienic living conditions, incarceration, a sketchy record of clinic visits, inadequate adherence to treatment resulting in frequent Emergency Department visits, hospitalizations, and poorer outcomes in terms of disease morbidity and mortality. Despite the active involvement of charities, 1
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Mentoring Research in the Cardiovascular Disease Fellowship Program Since its inception in 2007, helping fellows develop research acumen has been a priority for the cardiovascular disease fellowship at the UT Department of Medicine, Graduate School of Medicine, Knoxville, TN. Dr. Carmelo Venero, himself a 2011 graduate of the program, was the first research director for the fellowship. Dr. Jeremy Mahlow, also a graduate, is the current research director. Dr. Mahlow meets with the fellows every month to support them through the research process, from inspiration to publication. “Mentoring is a key part of generating high-quality research,” he states. Through the efforts of the fellows and attending physicians, the program has generated four book chapters, 27 journal articles, and 24 research presentations at various conferences. Currently, the fellows are participating in several exciting projects. “All of the attendings are very approachable,” said Dr. Madhur Roberts, third year cardiology fellow. She has been working with Dr. Venero on a prospective study that was started by nowgraduate Dr. Pat Crawley during her fellowship. They noted that some clinic patients who need cholesterol medicine cannot tolerate the side effects of those drugs. They hypothesized that by doubling the dose while at the same time taking the medicine less frequently, patients may experience fewer side effects while still benefitting from the treatment. Their study was presented in a poster session at the National Lipid Association’s annual meeting earlier this year. (See http://gsmsimsvr/GSM/ Residents/Presentations/ResidentPresentations.aspx?proid=16) Dr. Roberts is currently at work preparing the manuscript for submission. Dr. Roberts says that the resources available at the UT Medical Center, Knoxville, support quality research. “The Institutional Review Board is very helpful and so is having a good statistician (Dr. Eric Heidel) available,” she said. Regular meetings with Dr. Mahlow also help keep projects on track. It can be difficult to balance the competing responsibilities of a fellowship training program, but with good mentors, support, and coordination, research is part of life for the cardiology fellows.
Resident Highlight: Jennifer Winbigler, MD, PGY-3 By Niva Misra-Sammons, MD “If you care enough to commit to something, you should do it right and see it through.” This is the way that Jennifer Winbigler describes her father and the way he lived his life. Jennifer was recently recognized as the first place recipient of the Tennessee Chapter of the American College of Physicians 2015 Narrative Medicine Contest for her essay “Doctor Daughter.” The essay highlighted Jennifer’s feelings and viewpoint as both a daughter and physician in the later stages of her father’s battle with cancer. Jennifer was inspired to write the essay when she was full of emotion as her father had just been sent home on hospice. Jennifer related that her father is the reason she is who she is today. Her father was a single working dad when Jennifer grew up. She felt her father was a very hard-working man who “excelled at everything he did.” He was not only a dedicated father but also a well-known SEC official and CEO of an electric company. He always told her to “never give up at anything.” Jennifer learned from her dad “to treat people around her well” and to have “a lot of integrity.” She is influenced by her experience with her father’s illness daily as she states she is now more sensitive to what patients’ families are going through and does not impose her medical knowledge on families until they are ready. She says that her father’s influence has taught her to work as hard as she can as a young physician and to be the best parent that she can be to her two sons, Max and Wyatt. Jennifer said that her dad told her every day that he loved her and was proud of her, and she does the same for her sons. Jennifer got an undergraduate degree in chemical engineering at UT, Knoxville, and worked as a chemical engineer for three years before going to medical school. Upon graduation, Jennifer is looking forward to taking a position as a hospitalist in the area.
The Breath of Life
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the receptor processing of the protein that is responsible for cystic fibrosis. The rate of pulmonary exacerbations was significantly lower for subjects receiving the combination compared to those receiving lumacaftor and a placebo. This study was instrumental in gaining FDA approval of this medication regimen. Read the full article here: http://www.ncbi.nlm.nih.gov/pubmed/25981758 “There has been a substantial increase in the amount of pulmonary research here in the last 10 years,” says Dr. McCormack. Patients with COPD, cystic fibrosis, asthma and other pulmonary diseases know they can come to UT Medical Center for compassionate care that is informed by cutting-edge research. 2
Dr. Paul Terry We wish to welcome Paul D. Terry, PhD, MPH, FACE, to the Department of Medicine. Dr. Terry received his PhD in epidemiology from the Columbia University School of Public Health in New York, NY, and his Med. dr. from the Karolinska Institute in Stockholm, Sweden. He received his MPH from the University of Connecticut Health Center in Farmington, CT. He is a Fellow of the American College of Epidemiology. In 2012, he won the University of Tennessee Community Engagement and Outreach Award. Dr. Terry will be a great resource for the Graduate School of Medicine, and we are fortunate to have him on our faculty. As an epidemiologist, Dr. Terry focuses on the prevention of and etiology of illnesses. Dr. Terry deals with the health of populations rather than individuals and is seeking collaborations with other investigators in this institution. He will work with our residents and would like to help physicians with their research projects and presentations.
New Faculty
Spencer D. Gregg, MD
Carley O. Fowler, MD
Nathaniel R. Piel, MD
It is with pleasure that we announce three new faculty appointments to the Department of Medicine: Spencer D. Gregg, MD, Nathaniel R. Piel, MD, and Carley O. Fowler, MD. Dr. Gregg, a graduate of our program, serves as Medical Director of the UT Student Health Clinic. He has supported our department for years by hosting residents on their Student Health rotation, and we are very grateful for his long-term support. Dr. Carley Fowler completed her dermatology residency at Vanderbilt University and is practicing with Dermatology Associates of Knoxville. Dr. Nathaniel Piel practices with the Faculty Internal Medicine group. He attended Georgetown University School of Medicine and completed his internal medicine residency at the Medical University of South Carolina in Charleston.
Faculty Awards And Honors and excellence is teaching. Carol L. Ellis, MD, received the London Award, presented to a teacher who shares a dedication to excellence. The recipient of this award is chosen by our internal medicine residents. The 25-Year Service Awards were presented to Mark D. Anderson, MD, Casey Page, MD, Elise Schriver, MD, and Norman C. Walton, MD. All of these award recipients have provided superb and longstanding service to the Department of Medicine, and we are delighted to recognize them for their many contributions.
Several faculty awards were presented at this year’s Annual Faculty Recognition Dinner held on December 10th at the Holiday Inn World’s Fair site. The Beasley Pylon Award for extraordinary leadership and service to the Department of Medicine was presented to Dale C. Wortham, MD. The RA Obenour, MD, Distinguished Alumnus Award in Recognition of Outstanding Career Achievement in the Field of Medicine was presented to Daniel S. Ely, MD. Mark S. Rasnake, MD, received the RA Obenour, Jr., Excellence in Teaching Award for steadfast dedication
Points of View continued from page 1 with active community participation that is organized to deal with patients’ problems if we are to achieve appropriate, meaningful care for the underprivileged segments of our society mentioned earlier. Greater participation and collaboration by the members of the public with health care professionals should enhance awareness of healthy choices and help in the prevention of illness as well as better management of diseases, especially for populations who have significant barriers in accessing health care. Physicians need to prepare for this formidable challenge in the coming years and provide effective leadership in implementing these changes in health care delivery. 3
CME Opportunities—Mark Your Calendars! • The 4th Annual Medicine CME Conference, Practice Updates for the Primary Care Physician, offering 10.25 hours of CME credit, will be held April 29-30, 2016, at the Holiday Inn World’s Fair Site. We hope you can join us for this informative event. • The 12th Annual Hematology Conference, Update on Selected ASH Topics, will be held Saturday, February 6, 2016, at the UT Conference Center. • Weekly Cardiology Conferences, which are now available for .75 hour CME credit. • Medicine Grand Rounds, which are generally held on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit. • Ethics Case Rounds, which are held on the 4th Thursday of the month at noon in Wood Auditorium, are available for 1.00 CME credit
Annual Medicine Conference
Hematology Conference Register Now
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Guest Speakers, Department of Medicine Grand Rounds
Martha Buchanan, MD, Director, Knox County Health Department, ”Knox County Community Health Assessment,” December 8, 2015
Gregg J. Silverman, MD, “Current Concepts on the Understanding of Rheumatoid Arthritis,” October 13, 2015
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! 4
In Touch Vol. 5, Issue 1: January 2016
Publishers James Neutens, PhD, Dean Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs Editor Annette Mendola, PhD Administrative Director Susan Burchfield, CAP-OM Contributors Susan Burchfield Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Niva Misra, MD Jane Obenour 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.