SUMMER 2013
The University o
The University
The University
Research Collaborations:
The University o
Partnerships Are Changing the Practice of Medicine
Plus...
Tailored Weight Loss Programs Innovative Joint Replacement Therapy Primary Care Responds to Healthcare Reform
For Alumni and Friends
Contents
The University of Tennessee Medical Center and the University of Tennessee Graduate School of Medicine Frontiers
Spring 2013
Editor
Becky Thompson
Publishers
Healing 05
You Have Questions We Have Answers
Education 14
Q & A Session With a Primary Care Physician
06
Tailored Weight Loss Programs
10
18
Responding to the Needs in Our Communities
16
University Bariatric Center Tailors Weight Loss Programs to Fit Your Wellness Goals
08
Primary Care Responds to Healthcare Reform
Discovery
New Educational Programs Help Broaden Pipeline of Physicians
20
Research Collaborations New Partnerships Are Changing the Practice of Medicine
Combining Medicine & Engineering Bridging the Gap for Improved Health Care
A New Way of Life After Successful Weight Loss Surgery
Only one hospital treats more stroke patients than any other. So, when every second counts, count on the only Advanced Comprehensive Stroke Center in the state to achieve the Get With The GuidelinesÂŽ Gold Plus and Target: Stroke Honor Roll and U.S. News & World Report's best regional hospital for Neurology and Neurosurgery for care of stroke patients.
Circle of Families
Contributors
Becky Ashin Katie Bahr Bonnie Horner Amanda F. Johnson
Design/Creative Dean Baker
Frontiers is a magazine produced by The University of Tennessee Medical Center and the University of Tennessee Graduate School of Medicine. This publication was designed to showcase the unique benefits of having an academic medical center in East Tennessee. Copyright Š 2013 The University of Tennessee Medical Center All Rights Reserved. EEO/TITLE VI/TITLE IX Sec. 504/ADA
When Every Step Counts
University Joint Replacement Center Keeps You Moving
12
Joseph Landsman James Neutens, PhD
23
Continuing Education Course Calendar
About the Cover
Research collaborations are standard at an academic medical center like that at The University of Tennessee Medical Center. One such collaboration comprised of an engineer and two neonatologists resulted in a better device that aids the breathing of babies in neonatal intensive care. As the state designated Regional Perinatal Center and only private room Level III Neonatal Intensive Care Unit, this type of collaborative research and the expertise of highly-trained medical professionals, allow us to care for those babies with the greatest need.
Send Correspondence to: Frontiers
2121 Medical Center Way, Ste. 300 Knoxville, Tennessee 37920-3257 Telephone: 865-305-6845 Fax: 865-305-6959 E-mail: frontiers@utmck.edu www.utmedicalcenter.org or http://gsm.utmck.edu
By Amy B. Stevens, MD
Dear Alumni and Friends,
T
he University of Tennessee Medical Center and the University of Tennessee Graduate School of Medicine continue to lead the way in East Tennessee in providing outstanding patient care and advanced education of physicians, dentists, nurses, pharmacists, and other health professionals, while engaging in innovative research in our labs and patient-care centers. We take our patient care, education, and research responsibilities seriously and strive to meet the high expectations of our patients, their families, and the communities we serve.
Our efforts have been recognized. The cooperative and mutually beneficial relationships we enjoy with physicians and health professionals who practice and educate on our campus have allowed us to be recognized by U.S. News and World Report as one of the best hospitals in our region, state, and country and by various other organizations as a provider of quality health care and education. We are pleased to offer in these pages of Frontiers stories about people and programs that contribute every day to our mission of excellence in healing, education, and discovery. These are the people who are impacting healthcare right now. As you read about clinical programs in joint replacement, bariatric surgery, and weight loss, our patient care mission becomes very clear. An important article explains our active preparation for the impact of healthcare reform, and other articles answer why we are increasing our educational programs and how we engage new research partnerships to seek pathways to new treatments and cures. A new feature in the magazine is our Q&A page, which provides readers with expert answers to topical questions. We hope you will find this a helpful resource to aid in discussions with your doctors. We invite you to take a look at some of the different ways we are impacting healthcare right now, and we thank you for your continued interest in and support of The University of Tennessee Medical Center and the University of Tennessee Graduate School of Medicine.
Sincerely,
Joseph R. Landsman, Jr. President and Chief Executive Officer University Health System, Inc.
Q A
You Have uestions & We Have nswers I will turn 50 years old soon. What screenings and tests should I discuss with my doctor? Important screenings to consider after age 50 include colonoscopy, mammogram, prostate screening, vision screening, and bone density assessment. Other considerations might include measurements of cholesterol, thyroid hormone, and Vitamin D level. Your specific screening selections should be made during a detailed conversation with your primary care doctor, while reviewing your personal and family medical history.
What are common risk factors for cancer? The most common risk factor for cancer is tobacco use. Other top risk factors for cancer include excessive weight, poor diet, inactive lifestyle, excessive sun exposure, and high alcohol use. Discuss with your primary care physician how your family history affects your personal risk for cancer.
Where can I find additional information about living a healthy life? Information about healthy living can be provided to you by your doctor. Additionally, you could meet with a dietician or nutritionist; ask your doctor how to arrange this meeting. Many online resources are available through Preston Medical Library at http://gsm.utmck.edu. Seek your physician’s recommendations for appropriate books, magazines, or articles to assist you as you pursue a healthy lifestyle. Amy Barger-Stevens, MD, is a family physician at The University of Tennessee Medical Center. She is also associate professor in the Department of Family Medicine at the UT Graduate School of Medicine. There, she also serves as the director of the Family Medicine residency program.
How does having a family history of certain diseases impact how my doctor and I should proceed with my health care? A detailed discussion with your doctor about illnesses of your family members is vital. Some diseases are more hereditary than others, and your physician can best help you develop a wellness plan only when he or she has a full understanding of your health problems, as well as those of your family members.
James J. Neutens, PhD Dean UT Graduate School of Medicine
For more health information join the conversation online.
Our Mission
To serve through healing, education and discovery
Our Vision
To be nationally recognized for excellence in patient care, medical education and biomedical research.
We Value
Integrity • Excellence • Compassion Innovation • Collaboration • Dedication
Spring 2013 5
Healing
2
Tailored Fit Your Health
University Bariatric Center Tailors Weight Loss Programs to Fit Your Wellness Goals University Bariatric Center offers personalized treatment plans in a structured, educational environment to help patients successfully lose weight. By Becky Ashin It’s well known that obesity has become an epidemic in the U.S. The number of states with obesity rates of 30% or more rose to 12 in 2010. A decade earlier, no state had an obesity rate that high. With our health at stake, and weight as a major struggle, many are left wondering, “What will work for me?” Tennessee has the country’s sixth highest rate of obesity— currently more than 30% among people over 18. Almost 16% of Tennessee teenagers are obese - top 5% in the nation— and 75% of these obese children will become morbidly obese adults (that is, adults so overweight that their health and well-being are at risk). It’s no surprise that today more than 128,000 people in the greater Knoxville area are overweight.
Medical Benefits From Bariatric Surgery
Bariatric surgery has reversed conditions in morbidly obese patients; numerous studies have shown that it can reduce or eliminate diabetes, hypertension, obstructive sleep apnea, and high cholesterol. It can also alleviate other health problems, such as gastroesophageal reflux disease, stress incontinence, infertility, osteoarthritis, and impaired cardiac function.
6 Frontiers
Even as we work to control healthcare expenditures, Tennessee spends more than $2.5 billion a year on obesityrelated care. That’s the sixth highest amount in the country. The reason is that obesity contributes to many debilitating and costly health conditions, including heart disease, stroke, arthritis, type 2 diabetes and certain types of cancer.
Bariatric Surgery For a patient to be considered for bariatric weight loss surgery they must have either a BMI of more than 40 or a BMI of 35 in combination with a serious obesity-related health problem like diabetes or high blood pressure.
Who Is Considered Obese? Often our ideas about what constitutes a healthy weight are misconceptions. In today’s society, many of us think that a person whose weight is in the ideal range is too skinny. We’ve begun to accept that being a little overweight is what a “normal” person should look like. Body mass index, or BMI, is the standard measure for assessing body fat. You can calculate your BMI by determining your body’s weightto-height ratio. The following table allows you to do this by simply finding your height and weight.
“Bariatric surgery is not done for cosmetic reasons. It’s for saving lives,” says Greg Mancini, MD, associate professor in the Department of Surgery, and the University Bariatric Center’s medical co-director and a physician fellowshiptrained in bariatric surgery. Certified by the American College of Surgery as a Level 2 Center of Excellence, the center began offering bariatric surgery in 2008. Brothers, Greg Mancini, MD, and Matt Mancini, MD, associate professor in the Department of Surgery, have successfully performed more than 400 bariatric operations in the past four years. The University Bariatric Center offers the most current laparoscopic surgical options.
Minimally Invasive Surgery • Gastric Bypass Surgery • Sleeve Gastrectomy • Adjustable Gastric Banding All the procedures are done laparoscopically through five small abdominal incisions, a technique that results in easier recovery and less risk of complications. Bariatric surgery isn’t magic; it’s a tool. To achieve long-term success in reaching and maintaining a healthy weight, patients have to be strongly committed to living in a new way and disciplined enough to stay within good nutritional guidelines. The success of patients at the University Bariatric Center demonstrates just how effective its weight loss techniques can be.
Non-Surgical Weight Loss Options Some patients may not meet the criteria for surgery or would prefer another option. University Bariatric Center works with the patient to determine the best and most comprehensive plan for successful weight loss.
Options include individual and group programs: • HMR Meal Replacement System • Medical Management & Weight Loss Medications • Individual Dietitian and Exercise Consultations • L.I.T.E. – Lifestyle Intervention Through Education (Group Classes) Supporting patients through every phase of their weight loss journey is the center’s goal. Its mission is to treat obesity and educate patients about the best weight loss programs tailored to fit their needs and support them on a journey to wellness. University Bariatric Center is a leader in bariatric surgery and non-surgical weight loss options because of its thorough, multidisciplinary approach to care. The bariatric center team includes a bariatric surgeon, a physician assistant, nurses, a psychologist, dietitian, exercise specialist and a patient navigator who guides patients through an individualized program best suited to their needs. Because obesity is a disease whose many dimensions include genetic, psychological, social, and behavioral issues, people who are preparing for the lifelong commitment of adhering to healthier weight goals need education, clinical care, and lifestyle support. The center’s surgery patients, for instance, have three to six months of classes and individual consultations before their procedures. And innovative research programs enable the University Bariatric Center to continue advancing obesity treatment and overall understanding of the disease. The success of University Bariatric Center, and that of its patients, is deeply rooted in the education and preparation they receive while in the program and learning how to integrate healthy eating habits into everyday life.
Spring 2013 7
Healing
A New
way of life
“The educational component, and knowing how to truly change my lifestyle habits, made just as much of a difference to my weight loss as the surgery itself did.”
After Successful Weight Loss Surgery By Bonnie Horner
For Jennifer Henry, 33, it’s not what she lost but what she gained by having gastric bypass surgery at University Bariatric Center.
A Moment of Clarity When Jennifer Henry was a child, "I was always heavier than all the other kids," she recalls. "After high school I slowly gained more weight, and after having children I went from simply being overweight to being obese." Henry weighed 430 pounds in 2009. It was then that she made the decision to change her life for the better. To do that, she realized, she would need to start by making herself happy: “I was in a very negative place, and I knew it was affecting other aspects of my life.”
“I didn’t want my kids to have to suffer like I did, she says. I took what I learned from the University Bariatric Center and put it inside the household.” She began getting nutritional counseling at University Bariatric Center at The University of Tennessee Medical Center, and after one year of maintaining new lifestyle habits, exercising, and eating healthier portions, she’d lost more than 150 pounds. But then the progress stalled. At 280 pounds and after six months at the same weight, Henry couldn’t seem to get any further. “I really started struggling to lose weight,” she says, “and it wouldn’t budge.” So after making the lifestyle changes necessary for successful post-surgery weight loss, she went forward with gastric bypass surgery. The pounds quickly started to come off again. “That was the last tool I needed to finally get to my goal weight,” Henry says.
8 Frontiers
The University Bariatric Center helped Henry by providing a personalized diet plan, education on how to make healthy meal choices, training about proper portions of food, and weight loss tips. “The educational component, and knowing how to truly change my lifestyle habits, made just as much of a difference to my weight loss as the surgery itself did,” she says.
Jennifer Today How is Jennifer these days? She weighs 180 pounds—lost more than 250 pounds—and hasn’t had a single soft drink or eaten any fried food or ice cream in more than four years. Married with six children, she’s happy now. The effects of Henry’s weight loss went far beyond the surgery room and into her home. “I didn’t want my kids to have to suffer like I did,” she says. “I took what I learned from the University Bariatric Center and put it inside the household.” That experience has made her a beacon of inspiration to her friends and family, who are also seeking to begin their journey to successful weight loss.
Visit UTMEDICALCENTER.ORG for more information.
Spring 2013 9
Healing
When Every Step Counts
University Joint Replacement Center Keeps You Moving By Becky Ashin
If you are one of the millions of Americans who suffer from joint pain, The University of Tennessee Medical Center can help you find relief. The University Joint Replacement Center treats conditions ranging from complex trauma care to degenerative disease conditions. Specializing in joint replacement and outpatient rehabilitation, the University Joint Replacement Center is dedicated to getting you back to the life you love.
Many of the orthopaedic disorders that people experience are due to sports injuries or degenerative conditions. An increasingly common problem faced by aging Americans is the need for knee, hip, or shoulder replacement. If this kind of procedure is called for, the surgeons and staff of the medical center’s University Joint Replacement Center can bring sophisticated skills and therapeutic expertise to develop a personalized treatment plan.
University Joint Class The Joint Replacement Center offers a unique, wellnessoriented treatment plan for patients in need of a new knee, shoulder or hip replacement. A standardized process smooths the way, from the initial consultation with a surgeon through a patients' discharge from the hospital. All patients receive educational materials about their planned surgical procedure and ample opportunity to ask questions through the University Joint Class. A personalized pre-admission test is conducted on every patient, and a copy of the Joint Replacement Notebook guides patients through the entire surgical and recovery process. After surgery, patients are admitted to one of the private rooms in the specially designed patient unit, where skilled nursing staff, physical and occupational therapists, and a discharge planner—all of whom work exclusively at the Joint Replacement Center—see to patients' care. Patients who are treated at the center benefit from an environment that fosters wellness, early mobility, and state-of-the-art standards.
University Joint Zone The multidisciplinary team approach at the Joint Replacement Center yields superior outcomes. In the exercise area known as the University Joint Zone, patients take part in group exercise and receive individualized therapy. Patients usually go home in three days, and most are able to do so because of the center’s intensive care and commitment to structured physical therapy goals.
Fracture Care Program The medical center’s University Fracture Care Program came into being in November to provide specialty care for patients with fractured hips. A multidisciplinary team consisting of an orthopaedic surgeon, a hospital physician, therapists, and nurses work daily to help patients make the best recovery possible. Visit UTMEDICALCENTER.ORG for more information.
Higher Standards of Care The University of Tennessee Medical Center’s Joint Replacement Center has seen many successes during the past year. In December, after undergoing a rigorous survey, the Joint Replacement Center became the only hospital facility in East Tennessee to be certified for knee and hip replacement by the Joint Commission, which evaluates the quality of healthcare organizations nationwide. The University of Tennessee Medical Center’s orthopaedics program has also been designated as an Exemplar Hospital by Project JOINTS, an Institute for Healthcare Improvement program developed to reduce surgical site infections. And the medical center has earned a U.S. News & World Report Best Regional Hospital ranking for orthopaedics, plus a designation by the Delta Group, a national healthcare-rating organization, as No. 1 in the state for orthopaedic care and No. 1 in the market for joint replacement. Orthopaedic treatment at University Joint Replacement Center continues to employ highly effective and innovative surgical processes. As part of the region's only academic medical center, it offers newer procedures that require less recovery time, including anterior-approach hip replacement, quadriceps-sparing knee surgery, and the use of arthroscopy in hip replacement or reconstruction. Providing excellent medical care across the whole range of orthopaedic needs, from elective procedures to trauma surgery, is the goal of the orthopaedic surgeons and staff at The University of Tennessee Medical Center. University Joint Center is dedicated to offering the people of our region individualized clinical solutions, patient-centered treatment, and the very highest quality of care.
During knee joint replacement surgery, a prosthetic device replaces cartilage and bone, which can be damaged from disease or aging.
Michael McCollum, MD, an orthopaedic surgeon at The University of Tennessee Medical Center, talks with a patient about knee replacement surgery. 10 Frontiers
Spring 2013 11
Healing
Circle of
Families By Katie Bahr
The birth of a child is an exciting, miraculous, and stressful time for any family, but these emotional highs and lows are even more intense when the newest member of the family needs additional medical care. In January of this year, several women who have experienced what it was like to have a child in the Neonatal Intensive Care Unit (NICU) decided they wanted to help these families in crisis and banded together to form the Circle of Families.
Keri Lattimore, MD, assistant professor in Neonatology, a mother and neonatologist, sees the difference that private rooms make to the health and stability of infants and their families every day. “I truly look forward to when this project is complete and every NICU patient has the utmost tranquil environment in which to heal,” she says. Lattimore, Knapper, and Brewington are just a few of the many women, who have an intimate connection to the NICU or with someone who does, currently making up the Circle of Families. The circle will soon be broadening its horizons. The group hopes to become a philanthropic society that involves everyone in the family—mothers, husbands, children, maybe even pets. It will be reaching out through small events and social media to help educate the community about the NICU campaign and the needs of young families, as well as provide ways for anyone to help in many ways.
About the NICU Campaign
The Circle of Families is a philanthropic society that supports the Center for Women and Children’s Health. Currently its focus is raising money and awareness about the NICU and its effort to become a fully private-room space for newborns and their families. “What many women don’t realize is that about 13% of all newborns are premature and many more need to spend time in the NICU for other reasons. Delivering prematurely is actually a women’s health issue that is more prevalent than breast cancer,” says Mark Gaylord, MD, a professor and program director in Neonatology at the Graduate School of Medicine and a neonatologist at The University of Tennessee Medical Center. “Most people don’t think to make a donation to the NICU because they haven’t had a child or grandchild there. We want to share these miraculous stories throughout our community,” says Deanene Catani, director of Major Gifts at the medical center and the contact for the NICU Campaign. Founding member Mary Ellen Brewington got involved because she wants to see families start strong regardless of circumstances. “This is about the family unit and our community,” she says. “These sick and premature babies are our future, and the families who are caring and praying for them need help, too. They need support from the community,
12 Frontiers
Circle of Families members Jackie Belin and Julie Beeler deliver care packages from the Saving Grace Project to Chansey Sadler and DeWayne Scott, a current NICU family.
Phase I of the NICU renovations transformed roughly half of the nursery from traditional bays containing multiple cribs to private rooms for each family. Phase II will convert the remaining bay space into 29 additional private rooms, making it an all-private-room nursery.
Neonatal Intensive Care Unit Jackie Belin and Julie Beeler are former NICU moms and members of the Circle of Families.
the best facilities possible for their children, and a space where the entire family can bond and heal.” Christie Knapper—one of the founding members of the Circle of Families, along with Brewington—can attest to the NICU experience firsthand. “It’s hard to put into words the roller coaster of emotions that coincide with having a child in the NICU,” she says. “Our hope is to be able to help future NICU families by providing the best facility possible to care for these tiny miracles, letting them see thriving children who have similar birth stories, and giving them the confidence they need to walk through this journey.”
When the tiniest, critically ill patients arrive at The University of Tennessee Medical Center they will enter a private room neonatal care nursery designed to speed their growth and development and shorten their hospital stays. When a newborn needs specialized care, the Level III Neonatal Intensive Care Unit provides the highest level of comprehensive care right down the hall. The Labor and Delivery Center, Neonatal Intensive Care Unit, and newly renovated Mother / Baby Unit are all conveniently located on the third floor of the medical center so the mother and family do not have to go anywhere else for their care. The nursery provides state-of-the-art care and 24-hour physician coverage as well as emergency, laboratory and other specialized services—the only nursery of its kind in the region.
Private rooms are not just a matter of convenience. Research shows that they decrease the risk of infection, lower stress levels for everyone in the family, and result in shorter hospital stays. Not only will this renovation allow our current physicians to provide a whole new standard of care to families in East Tennessee, but it also has the potential to attract even more of the best and brightest young neonatologists to our area—assuring the health of newborns well into the future. The NICU’s goal is to raise $4.8 million. To date it has raised more than $3 million.
If you’d like to get involved in the Circle of Families, please contact Deanene Catani in the Development Office at 865-305-6611 or dcatani@utmck.edu.
Visit UTMEDICALCENTER.ORG for more information.
Spring 2013 13
Education
Healthcare Reform:
Responding to the Needs in Our Communities By Amanda Johnson
Educating Tomorrow’s Doctors Over its 50-year history, the UT Graduate School of Medicine has educated more than 2,000 new physicians and dentists, and of these about 50% chose to practice in Tennessee. Even more important in today’s environment of healthcare reform, nearly 90% of physicians who graduated from the Graduate School of Medicine and chose to stay in Tennessee have served or are serving in the primary care specialties of family medicine and internal medicine. “The shortage of physicians in America is a critical health concern, one that we take very seriously,” says James Neutens, PhD, dean of the Graduate School of Medicine. “We continually look for ways to help alleviate the concern for the good of our region and country.” Addressing the need for more physicians, many U.S. medical schools are increasing enrollments. In response to this increase and to strengthen its residency education, the Graduate School of Medicine has increased its educational programs for medical students.
Family Medicine physicians at the UT Graduate School of Medicine care for patients in a 21-county region. As the population of Americans seeking health care expands and strains an overtaxed physician base, UT Graduate School of Medicine is responding with educational programs and delivery of care that increases the numbers of physicians in the communities and improves patient care.
In March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, essentially overhauling the U.S. healthcare system. Major elements of the law include increasing the number of Americans who have health insurance coverage; reducing the costs of health care overall; improving patient outcomes; and streamlining the delivery of care. Changes began in 2010 and are scheduled to continue rolling out through 2020. According to the American Medical Association, this healthcare reform will result in more than 30 million Americans becoming newly insured beginning in 2014. The swelling of the population seeking health care will significantly strain an already-overtaxed physician base. Add to this demand the steady growth of the number of elderly Americans, whose health care needs are
14 Frontiers
more complex, and the need for more physicians and efficient delivery of care becomes even more apparent.
We ensure full residency classes composed of the highest qualified candidates, resulting in increased access to physicians in the region.
in Grainger County, for example, the physician-to-patient ratio is about 1 to 5,600. The national average is about 1 to 213.
Addressing the Critical Needs In conjunction with The University of Tennessee Medical Center, the UT Graduate School of Medicine is aggressively addressing these critical needs in the healthcare system by
The Association of American Medical Colleges (AAMC) estimates that in 2015, the U.S. will face a shortage of almost • 63,000 physicians, and by 2020, that number will grow to 130,000. The shortage is most keenly felt in the primary • care field. The AAMC estimates that by • 2018, America will face a shortage of 45,000 primary care physicians. • Rural areas of the country already are struggling to provide sufficient healthcare coverage for their citizens. Close to home
Educating primary care physicians to serve our region Expanding opportunities for medical students to learn in Knoxville Delivering primary care through the medical home model of care Educating physician assistants and nurse practitioners and integrating them into primary care settings
“These additional programs bring more students to Knoxville and expose them to the next step of their education: residency,” says Neutens. Often, medical students will end up practicing medicine in the location in which they completed their residencies. [See related story, Pg. 16.] By expanding the pool of candidates for residency programs at the Graduate School of Medicine, the institution is working to ensure well-filled residency classes composed of the most highly qualified candidates.
Interprofessional Education and Improved Care Preparing skilled physicians to serve the community certainly helps meet the demand of 30 million newly insured Americans. Delivering care using the medical home model also helps ease the burden. University Family Physicians at the Graduate School of Medicine recently adopted the medical home model. This innovative care delivery method uses a team approach to health care while providing care coordination and continuity to improve patient outcomes. The medical home model also incorporates expertise of other medical professionals who provide highly skilled care while easing the burden on physicians. Physician assistants and nurse practitioners are both autonomous medical professionals with additional postgraduate education, clinical rotation experience and national licensing requirements. They work as part of a team with physicians and can see patients separately to diagnose, treat, interpret tests, prescribe medication and refer to specialists. Students in both fields train at the Graduate
School of Medicine and The University of Tennessee Medical Center. They are integral parts of the medical home model of care in the Department of Family Medicine, providing assistance with patient care. “Physician assistant students and nurse practitioners learn in our Family Medicine environment and assist physicians in the patient-centered medical home model,” says Gregory Blake, MD, chair of the department of Family Medicine. “This interprofessional education ensures the best elements of the care model are achieved for our patients.” As more Americans become insured and more citizens require elder care, the demands on the country’s healthcare system increase. The UT Graduate School of Medicine is aggressively addressing these challenges through physician and interprofessional education and innovative delivery of care.
Family Medicine: Past, Present, Future For more than 40 years, the Department of Family Medicine has cared for patients young and old throughout East Tennessee. The facility in which this good care is given is in need of renovation and expansion to accommodate an increasingly diverse, complex and aging population, and new technology and training facilities are needed to recruit and educate the best young doctors. Today, Family Medicine needs support from the community it serves. Under way is a $6 million fundraising campaign. Community members can get involved by participating in the Family Tree Program, a simple way to recognize a team member’s excellent care, and the Legacy Society, a largegift program that supports the vision of the founders of the Family Medicine patient care center. As the UT Graduate School of Medicine addresses changes in the healthcare environment to continue to provide quality patient care and research, community members can do their part by supporting the legacy of family medicine in our region. More information is available at the office of Development at 865-305-6611 or development@utmck.edu.
Spring 2013 15
Education
New
Educational Programs Help Broaden Pipeline of Physicians By Amanda Johnson
For more than 50 years, UT Graduate School of Medicine has served as a key provider of medical care, and today the institution is expanding its reach by adding new educational programs for medical students. These programs, called clerkships or rotations, broaden the institution’s pipeline of physicians for the local region and country. “We now offer a complete clinical experience for medical students from the UT Health Science Center in Memphis,” says Eddie Moore, MD, associate dean of Medical and Dental Education at the Graduate School of Medicine. “This means more medical students in Knoxville and potentially more physicians for the region.” The three new programs in neurology, pediatrics, and psychiatry started in May 2013, completing the full curriculum for third- and fourth-year medical students. “While this is important for our many students, it is critical to our mission of recruiting residents who will graduate and practice in East Tennessee,” says James Neutens, PhD, dean of the Graduate School of Medicine. “When medical school
16 Frontiers
training and residency are completed in the same location, we know the new physician is much more likely to remain in that geographic area to practice.” John Prenshaw, a fourth-year medical student who studies at the Graduate School of Medicine, sees the benefit of the new programs. “Students will have more opportunities to learn about different patient populations in these specialties,” he says. The full complement of clinical rotations is indicative of UT Graduate School of Medicine’s continuing recognition of the ever-changing healthcare needs of the community and its effort to broaden the pipeline of highly skilled physicians for the region.
Medical students at the UT Graduate School of Medicine now have the opportunity to complete third- and fourth-year curricula in Knoxville, broadening the pipeline of physicians for the region. Part of the training for some of the current students, (standing, left to right) Shane White and Sara Rutter; (seated, left to right) Jennifer Allison Winbigler, John Prenshaw, Sumaiya Hossain and Andy Harris, and others is in the UT Center for Advanced Medical Simulation.
James Layman, a rising third-year medical student, will be one of the first to take advantage of the new clerkships in Knoxville. “I am grateful to the Graduate School of Medicine for providing the clerkships,” he says. Layman believes studying in Knoxville will help him achieve his dream of some day practicing medicine in his hometown of Niota, a small town about an hour south of Knoxville. “The new clerkships will allow me to meet doctors in the area and get experience working with the very patients whom I hope to one day serve,” he says.
Visit HTTP://GSM.UTMCK.EDU for more information.
Spring 2013 17
Discovery
Research Collaborations:
Partnerships Are Changing the Practice of Medicine
In a recent joint effort, a team comprised of an engineer and two neonatologists improved a device that will impact care of the smallest of patients: babies in neonatal intensive care. Often, neonates cannot breathe sufficiently on their own, so oxygen is supplied through a nasal cannula, a small tube with prongs for the nostrils. Patients who might weigh as little as two pounds—slightly more than a loaf of bread—cannot tolerate the cannula. Irritation and infection can occur, and achieving a seal for proper delivery of oxygen is challenging. At the Graduate School of Medicine, Vichien Lorch, MD, and Mark Gaylord, MD, approached Christopher Stephens, PhD, with a request: improve the cannula. Recently, the unlikely team did just that.
By Amanda Johnson
The power of teamwork to solve today’s medical problems is evidenced through results of unlikely collaborations of professionals at UT Graduate School of Medicine and the University of Tennessee, Knoxville. They invented a soft, hydrated coating for the cannula. The coating, developed in Stephens’ laboratory, improves the seal in infants’ nostrils, decreases the potential for irritation and possible infection, and enables a more constant flow rate of oxygen. A patent is pending for the device. “A new material was created. It didn’t exist before, but it now will help patients survive,” says James Neutens, PhD, dean of the Graduate School of Medicine. “The collaboration demonstrates how basic science can be directly applied to patient care. This invention will change the way we practice medicine.” The collaborations continue and are focused on topics including ICU monitoring; prostate cancer screening; heart valves; sudden cardiac death; gastric bypass surgery; neuroscience; and more. Collaborative exchange can yield results that change the practice of medicine. And simultaneously, a discovery is made: collaboration achieves what individual effort sometimes cannot.
Visit HTTP://GSM.UTMCK.EDU for more information.
Deidra Mountain, PhD, leads the Vascular Research Laboratory in collaboration with the University of Tennessee, Knoxville.
Other Collaborations The Graduate School of Medicine and UT Knoxville have partnered together on other collaborations that are making impressions in medicine: •
Wes White, MD, in the division of Urology, works with Jay Whalen, PhD, of the UT Department of Nutrition, to investigate an herbal supplement that might slow or halt the progression of prostate cancer.
•
Tim Sparer, PhD, in the university’s Department of Microbiology, is collaborating with Deidra Mountain, PhD, in the Vascular Research Laboratory at the Graduate School of Medicine, to understand intimal hyperplasia, a thickening of the vascular walls.
•
The UT Department of Communications teamed with physicians in the division of Trauma Surgery to improve handoffs—the transfer of responsibility for patients across medical specialties.
•
A PhD in UT’s Department of Public Health, Paul Terry, is collaborating with Craig Towers, a physician in maternal-fetal medicine, to investigate toxins in maternal-fetal blood.
Collaborative research has resulted in better care for fragile patients.
18 Frontiers
Spring 2013 19
Discovery
&
Medicine Engineering:
Bridging the Gap for Improved Health Care
The Tennessee River no longer separates the UT Graduate School of Medicine and University of Tennessee, Knoxville. Thanks to the visionary efforts of a handful of medical and engineering professionals, an intellectual bridge between the two has been erected. Built from innovative collaboration, strong leadership, and unity of purpose, the connection links the campuses like never before, and beneficiaries of this collaborative effort are people in Knoxville, the state, and beyond. By Amanda Johnson
“Biomedical engineering” is a relatively new field that applies the design and principles of engineering to medicine for improved diagnoses, treatments, and monitoring. The field fills a gap in medical research: mechanical, electrical, or chemical knowledge. Well-known applications of engineering to medicine include the PET-CT (positron emission tomographycomputed tomography) and MRI (magnetic resonance imaging) technology, prosthetics, medications, stethoscopes—even tongue depressors. “Anything iBME supports in medical research has the direct outcome of helping patients,” says Mahfouz. “The benefits are numerous.”
work required the collaboration of biomedical engineering, neurosurgery, radiology, sports medicine, and physical therapy. Beyond device development, engineers in the iBME are collaborating with physicians and administrators in both the Graduate School of Medicine and The University of Tennessee Medical Center to optimize system-level operations, with the goal of further improving the speed and efficiency of the medical center’s service providers. This effort will make an important impact on day-to-day operations in the hospital and on the safety and quality of care for patients. In addition to encouraging innovative medical research, the iBME vision also enriches academia through outreach to
Physicians at the Graduate School of Medicine and The University of Tennessee Medical Center and faculty and students in UT engineering are first to benefit, as they work with faculty from iBME.
“Biomedical engineering” is a relatively new field that applies the design and principles of engineering to medicine for improved diagnoses, treatments, and monitoring.
Christopher Stephens, PhD, (left) and Mohamed Mahfouz, PhD, help lead collaborative research through the Institute of Biomedical Engineering.
The UT College of Engineering, UT Graduate School of Medicine and UT College of Veterinary Medicine recently formed the Institute of Biomedical Engineering, dubbed iBME. This unique collaboration connects the expertise of researchers from the three institutions with experts from multiple areas of science and medicine to stand shoulder to shoulder in the research laboratory to solve today’s medical problems. It expands the research horizons of the UT Graduate School of Medicine and The University of Tennessee Medical Center and encourages development of clinical care that doesn’t exist now.
“Anything iBME supports in medical research has the direct outcome of helping patients,” says Mahfouz. “The benefits are numerous.”
Solutions to medical problems could include devices for improved delivery of medications and monitoring of patients; better imaging technology; regenerative models to help the body heal itself; and optimized efficiency in the healthcare setting. “We are coming together to capitalize on resources and collaborate on medical problems that can only be solved through such teamwork,” says Mohamed Mahfouz, PhD, a professor in the College of Engineering and director of iBME. “If we confine the field of biomedical engineering to just one department, we lose the perspective of what can be accomplished.”
“We help physicians advance their clinical observations to the development of new treatments. From there, we work toward patents and approvals to bring treatments back for use in the clinic. At the same Biomedical engineering graduate students at the University of Tennessee, Knoxville, analyze a mask pattern for the development of a sensor array in a cleanroom facility on campus. Sensor arrays can be used in time, we pursue our own research to solve medical diagnostic and monitoring devices both inside and outside of the body. problems for health care,” says Christopher Stephens, PhD, a research assistant professor in the College of Engineering and Graduate School of Medicine and director area schools, development of degree programs, and assisting of research and outreach for iBME. faculty with scholarly activity in peer-reviewed publications. “This kind of academic rigor strengthens the reputations of all Three major areas of initial work for iBME faculty include of our institutions, enhances our ability to recruit top faculty engineering to optimize the efficiency of healthcare delivery; and students, and brings more innovation to the labs,” regenerative medicine, including cell and tissue engineering; says Mahfouz. and healthcare imaging and medical devices. More innovation in medical research can result in solutions “iBME has been seeking renewal of a grant from the National for today’s healthcare problems. As the Institute of Biomedical Institutes of Health for technology that improves back-pain Engineering bridges the gap between medical research and diagnosis, treatment, and long-term care,” Stephens says. engineering, physicians and scientists become proactive Using the principle of kinematics (the study of motion), partners, resulting in better medical care for the region instrumentation designed by Mahfouz detects motion patterns and world. to better diagnose and treat pain in the lumbar spine. This For more information about the Institute of Biomedical Engineering, go to http://gsm.utmck.edu/research/ibme/main.cfm.
20 Frontiers
Spring 2013 21
Spring Frontiers 2013 Through 33 certified educational courses in 2012, the Graduate School of Medicine reached more than 2,600 physicians and almost 1,500 nurses, physician assistants, pharmacists, and other professionals. The courses focused on five of the top 10 causes of death for Tennesseans, according to Tennessee Department of Health 2008 data: • • •
Managing an Evolving Field of Medicine Through Education Physicians are lifelong learners who understand that medicine is continually evolving, and they must continue to learn to be able to provide the best health care to their patients. UT Graduate School of Medicine not only educates future doctors but also provides continuing education for practicing physicians and dentists throughout the country. “Our approach to physician learning is proactive,” says Laura Maples, director of Continuing Education and Professional Development. “In collaboration with experts at the Graduate School of Medicine and The University of Tennessee Medical Center, we seek the most current information about the health of Tennesseans, gather experts, and present topical information using innovative educational interventions. Through this work, we act as agents of change to help medical professionals provide excellent care to their patients.” Additionally, the
Continuing Education Course Calendar
Mark your calendar for an educational course offered by the University of Tennessee Graduate School of Medicine this fall.
Respiratory Diseases Heart Diseases Diabetes
• •
Cancer Stroke
Graduate School of Medicine’s courses addressed obesity, high blood pressure, infections, prescription-drug abuse, surgical techniques, primary care issues, integrative medicine, psychiatric conditions, and much more. “Medicine is always changing, so having an infrastructure in place that offers ready access to education on new developments and treatments helps us provide the best patient care possible,” says Stuart Bresee, MD, a clinical associate professor at the Graduate School of Medicine and chief of cardiology at The University of Tennessee Medical Center. Bresee directs an annual educational conference through the Graduate School of Medicine that examines strategies for primary care physicians managing patients’ heart, lung, and vascular diseases. The UT Graduate School of Medicine’s continuing education program helps physicians maintain their high level of competence in an evolving body of knowledge. Even more important, patients can be assured that their physicians understand and are equipped to provide the best care possible.
September 27-28
Approved for AMA credits Heart, Lung, Vascular Update for Primary Care Providers University of Tennessee Conference Center Knoxville, Tennessee www.tennessee.edu/cme Using case-based examples, the Heart, Lung, Vascular Update for Primary Care Providers offers direct contact with experts focusing on cardiovascular disease management and offering guidance on treatment options for patients in the areas of carotid revascularization, pulmonary hypertension and severe aortic stenosis.
For more information about continuing education, call 865-305-9190 or visit our website at www.tennessee.edu/cme. 22 Frontiers
"There are always flowers for those who want to see them." -Henri Matisse
U.S. POSTAGE
PAID
1924 Alcoa Highway Knoxville, Tennessee 37920-6999 www.utmedicalcenter.org
Permit No. 575 Knoxville, TN