March 2017 Newsletter

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Department of Medicine eNewsletter
March 2017
:: Interview
:: Department News
:: Department Events
:: Development and Diversity
Recently Recorded
Grand Rounds

"Transfusional Medicine: The Quest to Prevent Blood Transfusions" by Moises Auron, MD

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department interview
Kenneth Rosenfeld, MD, Medical Director of Palliative Care at University Hospitals Cleveland Medical Center, spoke about the importance of reengaging University Hospitals health care providers in palliative care, shared the importance of effectively handling strong emotions in patient-physician and family-physician communication and discussed future transformations in palliative care focus.

What is your vision for the Division of Geriatrics & Palliative Care growth? Can you share some of the objectives you will be concentrating on to achieve it?

My overall vision is to make Cleveland a national center for living fully through the end of life. As part of this vision, at University Hospitals Cleveland Medical Center we'll be building support teams and new strategies that help providers care for patients who are living with serious illnesses and who may be approaching the end of life.

Research shows that when palliative care is involved early in the course of a serious illness, patients experience a better quality of life, and less depression, and may even end up living longer. We are working on putting together processes to identify University Hospitals patients early in their advanced illness course and build strong relationships with divisions and departments to optimize how care is coordinated.

Another initiative we have begun is to build a measurement framework that offers a snapshot of the quality and efficiency of palliative care services as well as opportunities for divisional growth. The intent is for the report to be meaningful and actionable for providers and clinical leaders as well as executive leadership. We also want to grow inpatient palliative care operations, reaching out to key services across UH Cleveland Medical Center, with priority areas including the Intensive Care Unit and Emergency Department.

What is your strategy for attracting the best talent so that your vision comes to fruition?

Our overarching goal is to improve palliative care delivery across the entire University Hospitals system. We are designing educational approaches to help UH providers and specialists develop core competencies in palliative care, including symptom management and physician-patient communication, as well as establish collaborative care goals. Our nursing leaders have already begun their own educational program, through the Compass program that trains staff nurses in their own palliative care competencies. Through these mechanisms, we are hoping to energize UH's entire provider group to deliver high-quality care for patients with advanced illness, supported by the additional expertise of palliative care specialists.

In the upcoming years, I am hoping to help UH Cleveland Medical Center stand out as a center where innovation drives growth, and as the preferred location of care for seriously ill patients and families. We recently were able to recruit new providers to our division, indicating that the Division of Geriatrics & Palliative Care is dynamic and growing. With the help of this new talent, our plan is to launch a range of new initiatives to grow and further develop the division, including opening an inpatient palliative care unit and launching a Palliative Care Fellowship Program. Through the Fellowship Program, we hope to train the next generation of UH palliative care leaders.

Hospitals have been under immense pressure to be both efficient and effective in health care delivery. Where do you draw the line between a family's request for aggressive and costly treatment and marginal benefit for a patient? How do you find a balance between cost-effectiveness and acknowledgement of a family's wishes?

There will be situations when families may request non-beneficial treatments for a number of reasons including their cultural beliefs, and deeply held values, as well as due to emotional barriers to sound decision-making. There will always be very difficult situations in which we as a health system must carefully balance the preferences of patients and families with our recognition that we cannot accomplish their goals, and that our treatments are in fact causing harm. That being said, in the vast majority of cases the problem is one of inadequately communicating what can be accomplished by our medical care (and what cannot) as well as of addressing patients' and families' needs for both information and emotional support during a profound life transition. We have a lot to gain by concentrating on providing excellent support, careful symptom management and attentive communication to improve care on a large scale.

Communication between a physician, patient and family plays a key role in palliative care. How do you encourage and validate strong emotions?

One of the things that makes our specialty unique is the advanced training we receive in communication. This allows us to focus on relationship building, which is essential to effective physician-patient and physician-family communication. We have a range of tools we rely on for enhancing relationships; we start utilizing them even before we meet a patient or family member. As we review the medical record, we start picking up on bits of personal information that can give us a sense of who our patients and their families are on a deeper level, so that when we enter the room we are ready to connect with them in a meaningful and respectful way. Something as simple as knocking on the door of the room and asking permission to come in can distinguish our team members as both caring and relationship-oriented.

Given that unaddressed patient or family emotions can trigger conflict with the care team, we use a mnemonic to effectively navigate strong emotions. The mnemonic is NURSE - N stands for Naming the emotion, U is to express the desire to Understand, R signifies Respect for emotions that the person may be experiencing, S stands for offering Support, and E is for Exploring any other things that may be bothering the individual.

Palliative care is known for providing comfort and alleviating pain. How do you see the specialty changing currently? Where do you see the focus shifting?

Currently the shift lies in approaching palliative care through the lens of preventive medicine. Our job is to get involved early and provide multi-modality support. Studies show that patients who are in remission highlight the key role palliative care played in supporting them to recovery.

On a personal level, my interest in palliative care lies in effectively navigating difficult communication and decision-making issues as well as struggles people face around finding meaning in advanced illness. As palliative care providers, we help people live fully with advanced illness as well as embrace dying, when it must come, as a natural part of life that is deeply meaningful and through which people may grow. This is a big cultural leap, and transformation in this direction will require both considerable time and effort.
department news report
Division of Cardiovascular Medicine
Mukesh Jain, MD, was awarded $350,000 from the National Institutes of Health for his work exploring KLF15 in skeletal muscle lipid metabolism. Dr. Jain believes he has identified a novel molecular module that governs skeletal muscle fuel utilization. The results of the research project may serve as the foundation for novel therapies that potentiate the positive effects of exercise and combat obesity and diabetes.




Division of Geriatrics & Palliative Care

William Schwab, MD, PhD, was selected Chair Elect of the Long-Term Care/Geriatrics Shared Interest Group of the American Academy of Hospice and Palliative Care.




Division of Infectious Diseases & HIV Medicine

Robin Jump, MD, was appointed Chair of the Infection Advisory Committee in the Society of Post-Acute and Long-Term Care.




Michael Lederman, MD, received a $2.5 million grant from Gilead Sciences, a California-based biopharmaceutical company to advance his work on AIDS treatment. Dr. Lederman will examine if combining a protein produced by the body that stimulates human killer-cells with a lab-developed monoclonal antibody proves to be more effective when targeting HIV.



Usha Stiefel, MD,
received a $40,000 grant from the Making a Difference in Infectious Diseases Foundation for her work titled "Optimizing Use of Molecular Diagnostics to Improve Therapy of Staphylococcal Bacteremia." The co-investigators of the research project include Amy Hirsch, MD, Sharanie Sims, MD, and Maria Navas, MD.




Division of Nephrology & Hypertension

Niraj Desai, MD, was selected for the VA Innovators Network Accelerator program. The VA Innovators Network was designed to accelerate innovation culture across the VA system to best serve veterans and their supporters. The Spark-Seed-Spread Innovation Funding Program will support Dr. Desai's project for the development of an online, computerized, easily accessible clinical decision support system (CDSS) called CKD Snapshot. CKD Snapshot is designed to provide individualized patient management support based on existing CKD guidelines, in real time, to both primary care providers and nephrologists caring for patients with CKD.
department conferences & events
Grand Rounds
Time: 12 - 1 p.m.
Location: Kulas Auditorium
March 7
"Thyroid Disease in Pregnancy" by Laleh Razavi-Nematollahi, MD
March 14
"Updated Guidelines for the Management of Primary Hyperparathyroidism" by Scott Wilhelm, MD
March 21
"Introduction of Radiation Oncology Featuring Proton Beam Therapy at University Hospitals" by Joseph Mansur, MD
March 28
"Patient Experience" by Joan Zoltanski, MD, MBA
department development & diversity
An American Sickness: How America's Health Care Became a Big Business and How You Can Take It Back
Date: Monday, March 6
Time: 4:30 - 5:30 p.m.
Location: Moot Courtroom (A 59), 11075 East Boulevard
Speaker: Elisabeth Rosenthal, Columnist, The New York Times
Sponsor: Case Western Reserve University School of Law
Audience: Faculty interested in being educated on how the present U.S. health care system came to be and discussing remediation

Power of Diversity: LGBTQ Community Building over the Next Four Years
Date: Wednesday, March 8
Time: 3:00 - 4:00 p.m.
Location: Tinkham Veale University Center, Senior Classroom
Speaker: Liz Roccoforte, Director, LGBT Center, Case Western Reserve University
Sponsor: Case Western Reserve University Office of Diversity and Inclusion
Audience: All faculty, trainees and staff interested in understanding and promoting a culture of diversity and inclusion in the workplace

How to Write an Excellent Grant
Date: Tueday, March 21
Time: 12:00 - 1:00 p.m.
Location: Frohring Auditorium, BRB 105
Sponsor: School of Medicine Office of Faculty Affairs
Audience: Faculty interested in a workshop to improve grantsmanship

Developing Your Teaching Skills
Date: Wednesday, March 29
Time: 7:00 - 8:00 a.m.
Location: MacDonald Women's Hospital, UH Cleveland Medical Center
Speaker: Mimi Lam, MD
Sponsor: Center for the Advancement of Medical Learning
Audience: Faculty and trainees interested in improving their skills as educators