December 2013 Newsletter


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December 2013
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department interview
Guilherme Oliveira, MD, Director of Advanced Heart Failure & Transplant Center and Onco-Cardiology Program at University Hospitals Harrington Heart & Vascular Institute, discusses the importance of raising awareness about onco-cardiology among patients, physicians and nurse practitioners, shares his vision for expanding clinical services and growing the Advanced Heart Failure and Cardiac Transplantation Fellowship Program.

 

 

What can be done from the preventive standpoint to minimize heart failure in patients receiving treatment for cancer? How can we improve physician-patient communication in cancer therapy to bring attention to possible complications of the heart?


If patients with cancer have known cardiovascular issues, strong family history, or risk factors associated with cardiovascular disease (hypertension, dyslipidemia, etc.), they should check with an onco-cardiologist prior to receiving any cancer treatment. We know that certain types of chemotherapies as well as radiation therapies can precipitate and worsen heart disease.

In addition, patients should always inquire whether their cancer treatment has any potential for cardiotoxicity. What we often observe is that when patients receive the diagnosis of cancer, all other aspects of their health become forgotten and the focus remains exclusively on the treatment of cancer at any cost. This should not be the case, because it is not infrequent that patients develop life-threatening cardiac illness during cancer treatment.


As for the physician-patient communication, the problem goes deeper and includes physician and nurse practitioner education as well as patient education about onco-cardiology. Lately physicians have been hearing more about onco-cardiology through scientific journals and the media. In addition, professional organizations such as American Heart Association, American College of Cardiology and American Society of Clinical Oncology are active in mobilizing awareness about the issue. The education of patients, however, remains more challenging. I believe the media is a good way to increase consumers' attention to this issue. It may also be beneficial to educate patients about the services available through onco-cardiology pamphlets by distributing them in waiting rooms of major cancer centers.


Onco-cardiology is a relatively new field that offers opportunities for clinical discoveries. How do you see onco-cardiology developing over the next five to 10 years?


There are a lot of clinical questions that have not been answered and will be the focus over the next few years. Specifically, researching the effect of prophylaxis in cardiotoxicity, role of stem cells in prevention and treatment of cardiotoxicity, treatment and prevention of hypertension in patients with renal cell carcinoma treated with TKIs as well as identifying best methods to monitor patients for heart dysfunction. Also, as new drugs are being developed, their side effects uncover new mechanistic pathways of cardiac dysfunction that we previously did not know existed; in this light, onco-cardiology serves as a platform for cardiovascular discovery.


How are you positioning your own research to answer these questions?


Currently we are developing a large clinical database of patients in the echocardiography laboratory to determine how to best monitor and treat patients with cardiotoxicity. We are also designing a trial to treat patients with doxorubicin-induced left ventricular dysfunction with stem cells. Finally, we are looking at translational research in mice models with doxorubicin-induced cardiomyopathy in partnership with Mukesh Jain, MD, and Daniel Simon, MD.


As the director of Advanced Heart Failure & Transplant Center and Onco-Cardiology Program at University Hospitals Harrington Heart & Vascular Institute, what are your plans for expanding the reach of the clinical services?


We are hoping to expand our onco-cardiology services to University Hospitals Ahuja Medical Center and St. John Medical Center in the next 12 - 18 months. We are also hiring new physicians and nurse practitioners for our heart failure center. With more professionals onboard, we will be offering a consult service at UH Ahuja Medical Center and expanding our services to support the Louis Stokes Cleveland VA Medical Center and SummaCare network. We are in a unique position to do that, especially with of the recent arrival of cardiac surgeon Soon Park, MD.


You are also the director of the Advanced Heart Failure and Cardiac Transplantation Fellowship Program. What is your vision for developing the program over the next few years?


The expansion and success of our heart failure fellowship program depends on the success of the Heart Failure Center and amount of LVADs and transplants we are able to do. We are also opening a position for a nonaccredited heart failure fellow and international fellows who are interested in becoming proficient in mechanical circulatory support. The attractive aspects of our fellowship program are the electives that we offer in onco-cardiology, pulmonary hypertension and congenital heart disease. As the program grows, we hope to open more fellowship positions as well as offer a dedicated onco-cardiology fellowship in the next few years.


Schedule a clinical appointment with Dr. Oliveira

department news report

The Internal Medicine Residency training program had the most successful match ever with applicants matching at strong academic subspecialty programs, and getting their first or second choice. Among the institutions where our residents will be continuing their training are Washington University, University of Texas Southwestern, Duke University, University of Pennsylvania, University of Michigan, Case Western Reserve University, Mayo Clinic, and Johns Hopkins University. We want to thank the faculty for their mentorship and advocacy. We are also pleased that a number of our residents will be taking positions in ambulatory care in University Hospitals and the Louis Stokes Cleveland VA Medical Center.

 

 

 

 

The Internal Medicine Residency program director, associate directors, faculty and chief residents have been actively interviewing applicants for the program. A recent survey of applicants showed great enthusiasm about the program. Respondents commented: "CWRU is an awesome program, I'm excited for the opportunity to match", "Fantastic interview day, I really enjoyed every aspect of it", "It was by far the best interview day thus far."

Applicants believe that the focus on the education of the program is outstanding by scoring it 4.7 out of 5.0. One of the applicants commented: "Your morning report was professional, informative and well-organized. I look for a supportive learning environment and I gauge how genuinely interested and engaged the residents are in the discussion. Keep up the professional and supportive attitude that you've already cultivated because I think it's a good indication of camaraderie among your residents."

Applicants were also impressed with the program's marketing efforts noting: "One of the best internal medicine residency websites I have ever visited. Very thorough!", "The website was very well-organized and easy to follow", "You have the most comprehensive and informative internal medicine residency website I have used."

Finally, applicants believe that one of the program's greatest strength is its people. Here are some of the respondents' remarks: "This is an outstanding program with incredible people!", "I love how Dr. Armitage takes time to introduce himself to all the interviewees and learn something of each applicant. We're not just 'another number' to your program", "Case residents take the prize for some of the most enthusiastic residents I have seen on my 10+ interviews." The Department of Medicine would like to thank the faculty, residents, chief residents and program directors for their continued support of the program.

 

 

 

 

Division of Cardiovascular Medicine

Jonathan Stamler, MD, received the 2013 American Heart Association Distinguished Scientist Award. This prestigeous award recognizes Dr. Stamler's remarkable contributions to cardiovascular medicine and is given to individuals whose work has significantly advanced the understanding of cardiovascular disease.

 

Schedule a clinical appointment with Cardiovascular Medicine physicians

 

 

 

 

Division of Hematology & Oncology

 

Lyndsay Harris, MD, presented her latest work at the San Antonio Breast Cancer Symposium. Dr. Harris's team found that changes in breast cancer tumors, after a dose of biologic therapy or chemotherapy, can predict a patient's prognosis. Specifically, the findings indicate that deep genome sequencing leads to a reduction in the most commonly mutated genes in breast cancer after just one dose of preoperative therapy.

 



Alvin Schmaier, MD, presented his work at the American Society of Hematology Annual Meeting and Exposition. Dr. Schamaier's presentation entitled "Thrombosis Protection in Klkb1-/- (Prekallirkein KO) Mice is Mediated by Increased Renal Mas, Plasma Prostacyclin, and Aortic Sirt1" was given as part of "Best of ASH in Hemostasis & Thrombosis" session.

 

 

 

 

Schedule a clinical appointment with Hematology & Oncology physicians

 

 

 

 

 

Division of Infectious Diseases & HIV Medicine

 

Robert Salata, MD, was appointed Vice-Chair of the Research Committee for the Alliance for Academic Internal Medicine and will become Chair in July 2014. The committee is setting forth strategies for areas of Internal Medicine research in the changing landscape of funding and venues for success.

 

 

 

 

 

 

Schedule a clinical appointment with Infectious Diseases & HIV Medicine physicians

 

 

department conferences & events

Grand Rounds

When: Tuesdays, 12:00 - 1:00 p.m.

Where: Kulas Auditorium, Lakeside, 5th Floor

 

January 7

"The New Lipid Guidelines" by Carl Orringer, MD

January 14

"TBD" by Stefan Gravenstein, MD

January 21

"Into the Breach: Protecting Data in the Electronic Age" by Panel of Litigation Attorneys, Compliance & Ethics, IT&S Security

January 28

"Gout and the Metabolic Syndrome: Evolving Concepts" by David Blumenthal, MD

 

 

Morbidity and Mortality Conferences

When: Fridays, 12:00 - 1: 00 p.m.

Where: Kulas Auditorium, Lakeside, 5th Floor

 

January 10
A 65-year old male with thigh mass requiring surgical debulking and developing recurrent intra-abdominal infections.
January 17
An otherwise healthy 55-year-old male presents with pancytopenia and multi-system organ failure.
January 24
A 65-year-old female with a history of rheumatoid arthritis presents with acute abdominal pain and bowel perforation as a complication from her treatment.
January 31
A 64-year-old female with history of recently treated breast cancer presents with neutropenia and septic shock.
Among the nation's leading academic medical centers, University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a nationally recognized leader in medical research and education.