March 2014 Newsletter

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Department of Medicine eNewsletter
March 2014
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
Best Doctors in America 2014

Over 50 Department of Medicine physicians were featured in Best Doctors in America 2014 list. We would like to congratulate our faculty and thank the entire community of University Hospitals Case Medical Center physicians, nurses and staff for the work they do every day.

Cardiovascular Medicine
Mauricio Arruda, MD
Marco Costa, MD, PhD
Michael Cunningham, MD
Barry Effron, MD
Michel Farah, MD
Lloyd Greene, MD
Arthur Halle, MD
Brian Hoit, MD
Richard Josephson, MD
Joseph Krall, MD
Judith Mackall, MD
Sri Krishna Madan Mohan, MD
Carl Orringer, MD
Aaron Proweller, MD, PhD
Daniel Simon, MD
Albert Waldo, MD

Baha Arafah, MD

Gastroenterology & Liver Disease
Amitabh Chak, MD
Fabio Cominelli, MD, PhD
Gregory Cooper, MD
Ashley Faulx, MD
Gerard Isenberg, MD
Jeffrey Katz, MD
Sapna Thomas, MD
Richard Wong, MD

Hematology & Oncology
Joseph Baar, MD, PhD
Erica Campagnaro, MD
Matthew Cooney, MD
Brenda Cooper, MD
Marcos de Lima, MD
Afshin Dowlati, MD
Stanton Gerson, MD
Joseph Gibbons, MD
Lyndsay Harris, MD
Henry Koon, MD
Smitha Krishnamurthi, MD
Hillard Lazarus, MD
Nathan Levitan, MD
Jane Little, MD
Neal Meropol, MD
Charles Nock, MD
Alvin Schmaier, MD
Paula Silverman, MD

Infectious Diseases & HIV Medicine
Keith Armitage, MD
Barbara Gripshover, MD
Michael Lederman, MD
Robert Salata, MD

Internal Medicine & Geriatrics
Peter DeGolia, MD
Carla Harwell, MD
Debra Leizman, MD

Nephrology & Hypertension
Thomas Hostetter, MD
Donald Hricik, MD

Pulmonary, Critical Care and Sleep Medicine
Hugo Montenegro, MD
Kingman Strohl, MD

Mathilde Pioro, MD

Leadership Council
March 2014
Richard Walsh

B. Arafah

K. Armitage

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

S. Gravenstein

C. Hoppel

T. Hostetter

D. Hricik

M. Jain

N. Meropol

R. Salata

R. Schilz

D. Simon

R. Walsh

J. Wright


Recorded by:
A. Staruch
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department interview
Donald Hricik, MD, Division Chief of Nephrology & Hypertension and Interim Director of the University Hospitals Transplant Institute, talks about the institute's current goals, discusses ways technology advancements are influencing transplant procedures and shares how he embarked on writing medical mystery novels.



As the Interim Director of the University Hospitals Transplant Institute, what are the goals you have set for the next few months?


My primary focus will to be to elevate the academic profile of not just kidney transplantation, but the entire UH Transplant Institute. My goal is to increase the institute's visibility and reputation by making it an entity that is known for its excellence in transplant research. I also want to further develop physician and staff education by expanding our CME programs, including an institute Grand Rounds Program. The hospital has established endowments in the names of Dr. Achilles Demetriou and Dr. James Schulak that will help to fund some of these initiatives. We will continue to seek philanthropic support toward the development of a true Transplant Research Center. I will also play a major role in QA/QI and in regulatory affairs within the Institute. Our group is interested in promoting patient education in a way that will promote successful organ transplantation. We have already developed outreach clinics in Akron and Westlake and a third outreach in clinic is being planned.


How is your doctor-patient communication different, given the fact that once patients receive transplants, you have to be involved in their health care most of their lives?


It is true that, often times, we become the primary health care providers for organ transplant patients who were referred to us by their doctors - at least for the first year or so after the organ transplant. Allografts are lasting longer and, as a consequence, transplant patients are living longer, so we are becoming increasingly reliant on getting stable patients back into the community. With the development of our outreach clinic in Akron for kidney transplant recipients, we have developed formal "handoff" mechanisms for returning patients back to their primary doctors, and we will need to expand this model and use it in other practice settings. As a corollary of all this, there will be an increasing need to provide CME to primary physicians so they can stay abreast with transplant medicine. Having said this, it remains true that some patients stay with the transplant program for their primary care indefinitely and, yes, we have bonded with some patients who have been transplanted for more than thirty years.


Have there been any major improvements in technology that, in your opinion, can advance organ transplant procedures?


The public would like to hear that we can now clone a kidney, use stem cells to replace kidney function, or implant miniature artificial kidneys as a substitute for a kidney transplant. Some progress has been made in reconstituting a functioning heart from stem cells, but kidneys and livers are more complicated organs and they will be difficult to replicate using available stem cell technology. Instead, the major efforts in improving the status quo has been the search for immunologic tolerance - that is, somehow tricking one's immune system to tolerate an allograft while retaining immune activity against pathogens. If we could achieve tolerance, we would not require the toxic immunosuppressants that patients now take for life to prevent rejection of their grafts. While true tolerance may not be achieved in the near future, several protocols - often combining bone marrow transplantation with novel immunosuppressive agents - have been used experimentally to achieve what I would call a "state of immune hyporesponsiveness." Related to this concept, our own research in the UH Transplant Institute and the Department of Medicine has been focused on a search for biomarkers that may serve as surrogates for an immune quiescent state. I believe that within the next 10 years we will be able to tell from simple urine or blood tests whether a patient is immunologically quiescent or at imminent risk to reject an organ.


What it is the next area of development for dialysis research and innovation?


There have been few innovations in the hardware used for dialysis in the past decade. We know that hemodialysis as we now perform it is far from perfect, as the artificial kidneys we use for relatively short durations of treatment are not effective in completely removing uremic toxins. There is active research to identify new uremic toxins but few answers about how to remove these toxins more efficiently, aside from lengthening the time of each dialysis treatment. Home hemodialysis programs, providing dialysis for three to four times that provided by conventional dialysis, are remarkably effective in improving the well-being of patients, but are costly and not acceptable to a majority of patients.


You are a widely published author of journal research articles and abstracts. What made you turn to novels in the past few years?


My motivation for getting into creative writing derived in part from my wife who, several years ago, warned me that I could never retire because I had no hobbies to keep me busy and out of her hair! I've always enjoyed scientific writing and editing. My first novel, "Racing to Pittsburgh," is based on a true story of one of my sons who developed acute myeloid leukemia in the 1990s. By the way, he is a long-term survivor and is alive and well and living in Chicago. However, his illness was a major ordeal for me and my family and I promised my wife that, if we ever got through it, I would write a book about the experience. And so, I began a hobby that I really enjoy. My second book, "Nothing to Confess," is another fiction that is loosely based on a true story of a case of a fatal viral infection that was transmitted from a single donor to multiple recipients in 2007. While the novel is a medical mystery, a major intent was to explore the fine line between a medical mistake and an unfortunate occurrence that nobody can prevent. The book also deals with angst of physicians who are subjected to frivolous lawsuits in such cases.


You are currently working on your third novel. What is it about and when can we expect it?


The book is tentatively entitled "Escape from Cleveland" and it is a fictional memoir dealing with my sense of the current direction of medicine in general, and academic medicine in particular. The key character in the book is a Division Chief in a fictional Cleveland hospital and his perceptions are molded in part from his experience as a patient. I take a poke at duty hours, health care reform and EMRs amongst other things and, yes, there will be some characters who will seem vaguely familiar to local readers. I hope to have the book finished by summer 2014 and released in 2015. My first two books are available on either or Barnes& and "Nothing to Confess" is available as an e-book.



Purchase "Nothing to Confess" by Donald Hricik, MD, on Amazon

School of Medicine Climbs to 23rd in U.S. News & World Report Rankings
Case Western Reserve University School of Medicine became 23rd in the nation in the U.S. News & World Report rankings of medical schools for research this year.
This improved position is a recognition of all the School of Medicine faculty and researchers, their innovative ideas, scientific breakthroughs and continuous pursuit of accelerating discoveries in medicine.
Department of Medicine Annual Report 2012 - 2013 Wins Print Excellence Award
The Department of Medicine 2012 - 2013 Annual Report received Silver Award recognition for print excellence and design by Printing Industries of Ohio - N. Kentucky, a consortium of graphic design and printing organizations covering most of the Midwest. This year over 500 printed pieces were submitted for the competition; the department's report was submitted by Great Lakes Integrated Printing under the consortium's Annual Report judging category. This is the second consecutive year the Department of Medicine produced an award-winning annual report.

The annual report is the primary printed offering of the department summarizing yearly progress in our tripate mission of research, education and patient care. The annual report is a collaborative undertaking between the Chairman, Administrative Director, Vice Chairs, Program Directors and Division Chiefs. Report content, photography and overall production coordination is under the direction of Dasha Slobozhanina, the department's Manager of Interactive Media and Communications.


You are invited to review the report which can be found on the Department of Medicine website.

The department news report
Division of Cardiovascular Medicine

Marco Costa, MD, PhD, and his team performed first and second robotic PCI in Ohio.










Saptarsi Haldar, MD, became the Associate Scientific Advisor for Science Translational Medicine (Science's sister journal).








Mukesh Jain, MD, continues his research highlighting Krüppel-like factors. Dr. Jain and Anne Hamik, MD, recently published an article entitled "Regulation of an Inflammatory Disease: Kruppel-Like Factors and Arteriosclerosis" in the Journal of American Heart Association. In the article, the authors state that Krüppel-like factors as key determinants of vascular cell function in atherosclerotic vascular disease. Dr. Jain's trajectory of professional development and personal interests were highlighted in a separate interview in the issue.


Albert Waldo, MD, received the 2014 Special Honors Award from the Academy of Medicine of Cleveland & Northern Ohio (AMCNO). The award is presented annually to a physician who served the medical profession and community with distinction. This award recognizes the work Dr. Waldo has performed in the field of cardiac electrophysiology and his longstanding dedication to the practice of medicine.



Schedule a clinical appointment with Cardiovascular Medicine physicians





Division of General Internal Medicine & Geriatrics

Stefan Gravenstein, MD,
published his research in a number of publications. Among his recently published works are "A Divergent Response of Innate Regulatory T-Cells to Sepsis in Humans: Circulating Invariant Natural Killer T-Cells are Preserved" in Human Immunology Journal, "Is Implementing of the Care Transitions Intervention Associated with Cost Avoidance after Hospital Discharge?" in the Journal of General Internal Medicine, "Does Frailty Drive the Racial Gap in Influenza Vaccination within Nursing Facilities in Michigan 2005-2006?" in the American Journal of Public Health Research, "Association of Dementia with Early Rehospitalization Among Medicare Beneficiaries" in Archives of Gerontology and Geriatrics, and "Caregiver Presence and Patient Completion of a Translational Care Intervention" in the American Journal of Managed Care.


Karen Horowitz, MD, was named Senior Editor of SGIM Forum, a monthly publication of the Society of General Internal Medicine. Dr. Horowitz will also serve as an ex-officio member of SGIM Council, the leadership committee of the organization.

In addition, Dr. Horowitz published an article entitled "Cognitive Function and Brain Structure in Persons with Type 2 Diabetes Mellitus After Intensive Lowering of Blood Pressure and Lipid Levels: A Randomized Clinical Trial" in JAMA Internal Medicine. Dr. Horowitz's other article entitled "Association of Depression with Accelerated Cognitive Decline Among Patients with Type 2 Diabetes in the ACCORD-MIND Trial" was published in JAMA Psychiatry.

Brook Watts, MD, MS,
continues her work in quality improvement and published an article entitled "Implementation of Quality Improvement Skills by Primary Care Teams: Case Study of a Large Academic Practice" in the Journal of Primary Care Community Health. In addition, Dr. Watts's work entitled "ACC/AHA/SCAI/AMA-Convened PCPI/NCQA 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measure, the Society for Cardiovascular Angiography and Interventions, the American Medical Association-Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance" in the Journal of the American College of Cardiology and Circulation Journal.


Schedule a clinical appointment with General Internal Medicine & Geriatrics physicians




Division of Hematology & Oncology


Lisa Arfons, MD, received the School of Medicine Annual Teaching Award. This recognition celebrates the curriculum that Dr. Arfons developed to train hematology and oncology fellows to perform bone marrow biopsies. The novel curriculum includes didactics, video instruction and hands-on training with cadavers.




The article by Cynthia Owusu, MD, entitled "Patient Characteristics Associated with Polypharmacy and Inappropriate Prescribing of Medications Among Older Adults with Cancer" was the most downloaded piece in the Journal of Geriatric Oncology in 2013.



Schedule a clinical appointment with Hematology & Oncology physicians





Division of Pulmonary, Critical Care & Sleep Medicine

Frank Jacono, MD, along with teams from Pathology and Radiology at the Louis Stokes Cleveland VA Medical Center, Engineering at Case Western Reserve University as well as Pathology, Radiology and Thoracic Surgery at University Hospitals, were awarded a grant from Congressionally Directed Medical Research Programs. The funds will support the evaluation of semi-solid lung nodules by CT scanning to help identify benign or malignant lesions. This project has the potential to significantly improve the care of lung cancer patients.


Division of Rheumatology


Donald Anthony, MD, PhD, received a $650,000 VA Merit Award for the project entitled "Role of ENPP2, Immune Activation and Age on Neoantigen Response during HCV." The project will take place over the next four years and will build upon the Louis Stokes Cleveland VA Medical Center GRECC and HCV clinic goals of investigating mechanisms of immune impairment in the aging HCV-infected patient population. This unique work involved the collaboration between GRECC investigators (David Canaday, MD, Robert Bonomo, MD, Robert Kalyjian, MD), HCV Disease/Rheumatology/Immunology investigators (Dan Popkin, MD, Benigno Rodriguez, MD) as well as Metro investigators.

Schedule a clinical appointment with Rheumatology physicians

department conferences & events

5th Annual Department of Medicine Research Day

When: Friday, May 2

When: 12:00 - 3:30 p.m.

Where: Wolstein Research Building Atrium and Lobby

Abstracts Deadline: Monday, April 14

Click here to register for the event



Grand Rounds

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

Where: Kulas Auditorium, Lakeside, 5th Floor


April 1

"ANCA Vasculitis - New Kid on the Block" by Padmapriya Sivaraman, MD


April 8

"Disrupting Actin-Myosin-Actin Connectivity as a Treatment for Asthma" by Julian Solway, MD


April 15

"Ambulatory Training" by Mamta Singh, MD, MS


April 22

"Accountable Care Organization" by Eric Bieber, MD


April 29

"Sickle Cell Disease - Past, Present and Future" by Griffin Rodgers, MD, MACP

(Wolstein Auditorium)





Morbidity and Mortality Conferences

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

Where: Kulas Auditorium, Lakeside, 5th Floor


April 4
A 68-year-old male presents with a pancreatic mass and expires after developing a massive GI bleed.

April 11
A 68-year-old male develops hemoptysis and is found to have a unique pulmonary finding.

April 18
A 56-year-old male presents with jaundice and has an unexpected death.

April 25
A 66-year-old male with abdominal pain and acidosis suffers a cardiac event.

department leadership council minutes

Leadership Council

Dr. Walsh updated the council on the Clinical Chair searches. Dr. Jeffrey Ponsky has stepped down and Dr. Conor Delaney has been named the Interim Chair of Surgery. Dr. Warren Selman has been asked to head the Search Committee for the Chair of Surgery. Dr. Clint Snyder will be the Interim Chair for the Department of Family Medicine.


Leadership Council

At the School of Medicine, Dr. Patricia Thomas has started as the new Vice Dean for Education. Dr. Thomas was previously Vice Chair for Education in the Department of Medicine at The Johns Hopkins University School of Medicine. Dr. Walsh has invited Dr. Thomas to attend the April 14 Leadership Council meeting.

Leadership Council

Dr. Walsh updated the council on the search for the position of Director of the Respiratory Health Institute and Division Chief of Pulmonary, Critical Care and Sleep Medicine. Three outstanding candidates have been identified. All three have completed first visits and one candidate has had a second visit.



Leadership CouncilDr. Walsh announced two special Medicine Grand Rounds. On Tuesday, April 29, Dr. Griffin P. Rodgers, Director, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), will present the 13th Annual Jack Berman Lecture, "Sickle Cell Disease - Past, Present and Future" at 12:00 p.m. in Wolstein Auditorium. On Tuesday, June 3, Dr. Nicholas F. LaRusso from the Mayo Clinic will give a special Medicine Grand Rounds on Innovations in Health Care. He started the Innovation Center at the Mayo Clinic.


Dr. Walsh thanked the council members for their input for the external review. The external review will take place this spring.




Leadership Council


Mr. Creighton distributed data on University Hospitals System, UHCMC & UHPS, YTD 2013 clinical performance including: UHCMC and UHMG Inpatient and Outpatient Activity by Department; UHMG Departmental Productivity to Compensation Comparison; UHCMC Inpatient and Outpatient Margins; and UHCMC Inpatient/Outpatient Combined Margins. He also reviewed data for the month of February 2014 regarding gross charges by division.



Leadership Council

Dr. Walsh reported to the council on a Second Opinion Program Business Plan. This is a service aimed at utilizing the expertise of specialists for patients with complex cases. The program could offer a review of medical records, a diagnosis and initial treatment recommendation.



Leadership Council

Dr. Walsh led a discussion regarding the current status of the Reaffiliation Agreement between University Hospitals Case Medical Center and Case Western Reserve University.