November 2014 Newsletter

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Department of Medicine eNewsletter
November 2014
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
Leadership Council
November 2014
Richard Walsh

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

S. Gravenstein

T. Hostetter

D. Hricik

N. Meropol

R. Salata

L. Sayyed Kassem

R. Schilz

D. Simon

R. Walsh

J. Wright



J. Peters, MD,

Chief Operating Officer, University Hospitals

T. Snowberger, Chief Human Resources Officer, University Hospitals

C. Schaefer, Vice President, Compensation & Benefits, University Hospitals


Recorded by:
A. Staruch
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department interview
Jane Little, MD, Director of the Adult Sickle Cell Anemia Center, discusses the common sickle cell disease misconceptions, highlights promising research developments and addresses key changes that need to take place within the community of patients and physicians to treat the disease better.


How would you compare the clinical program in sickle cell disease at University Hospitals and Albert Einstein College of Medicine in New York where you used to work?


Sickle cell disease affects about 100,000 Americans and over 5 million people worldwide, mostly in Northern and Western Africa. There are two populations in the U.S. who have sickle cell disease: African Americans who have been here for many generations and people who are recent immigrants from Africa or Caribbean.


In New York, we were often working with patients whose disease was milder, as they may have come to the United States as adults and had survived childhood without advanced care. The strength of the clinical program here at University Hospitals has been the commitment of the University Hospitals Seidman Cancer Center to provide health care to patients, utilizing the clinical expertise of Tara Alin, Colleen Castelein, and myself, in a modern facility with excellent nursing and social work support (Rene Crooker and Tiffany Cousino, respectively). Patients at UH benefit tremendously from the Patient Navigator program. This program ensures that patients are not lost between diagnostic tests, treatment and follow-up. The Navigator (Jillian Sprenger) calls patients to remind them of their upcoming tests, and helps them get transportation to their appointments and follow-up with their physicians.


New York had a very strong acute care clinic that was open for 24 hours seven days a week. This was very successful in improving care for patients with sickle cell disease, outside of the emergency room. We have made big strides here at UH in increasing acute care clinic hours. The clinic may be available seven days a week in 2015. As physicians who deal with chronic diseases, we recognize how essential it is to get the rapid and specific care that people with sickle cell disease need.


What has your experience been working with the Cleveland population? Have you noticed any common misconceptions about sickle cell disease?


With 1,000 people in Northeast Ohio who are affected by sickle cell disease, the community as a whole may have many misconceptions about the disease. Some people do not understand that sickle cell disease is not just a red blood cell disease or anemia, but it actually affects all of the blood vessels of a patient. In addition, it is an inflammatory disease. This disease has features that make it quite life-threatening. Patients with SS (which is one the most prevalent sickle cell types) often have kidney disease, lung disease, or may have suffered from a stroke or brain damage due to this illness.


What would you like to see receive more attention in the field of the sickle cell research?


There are questions all across the board that we are interested in, including offering transplant to people, treating complications, understanding the mechanisms of red blood cell dysfunction, and examining ways to improve health care delivery.


One of the key topics that we are focusing on here at University Hospitals is bone marrow transplant. It is important for us to offer transplant for patients who have high-risk disease. For some of our patients, a transplant is the only option they have for prolonging life, so it is critical for us to have it available as well as make it as safe as possible.


It is also important to keep trying to understand why this disease is so dangerous and causes so many complications. For instance, we have a study that examines the reasons why red blood cells "stick" to blood vessels during sickle cell crises. We also have studies looking at kidney disease with magnetic resonance imaging. And we are asking whether correcting acid-base disorders, through alkali (bicarbonate) replacement, will help people stay healthy. Starting next year, we will be researching the best ways to deliver pain relief.


Do you think that with the developments you mentioned we have a chance of curing the disease? Or do you believe that at this point the most that physicians can offer is controlling pain and minimizing side effects as they work on improving the quality of life for patients?


I think it's becoming more likely that some people with sickle cell disease will be cured in the next few decades. However, those cures are not simple and will likely involve performing a transplant procedure or gene therapy. This, however, does not even begin to address the millions of people in Africa, most of who cannot afford anything close to these therapies. Physicians and scientists who are studying sickle cell disease across the country (to quote a colleague, Pat Gallagher, MD, at Yale) "... just have to put their paddles in the water and row." We really do not know where the improvements will come from, as the disease is so multifactorial. We are all working on solving different parts of the same puzzle.


Where do you see your own research developing over the next few years?


The "cellular adhesion" work that we do with Umut Gurkan, Assistant Professor of Mechanical and Aerospace Engineering at Case Western Reserve University, will be essential in helping us define clinically important cellular interactions in sickle cell disease. With this project, we will be monitoring patients in different centers under different conditions to examine the ways red blood cells stick. Once we understand the features of the red blood cell that matter most, we may better understand the reasons certain complications occur and better predict pain crises in patients.


What are the cultural changes that you anticipate need to take place within the community of patients and physicians to address this disease better?


There was a phase in diabetes when people used to be focused solely on blood sugar. Similarly, there has been a lot of emphasis on pain in sickle cell disease. As physicians, we know that there are patients who do not experience a lot of pain but still have severe sickle cell disease. That is, vascular, brain, heart, lung and kidney complications are progressing, even though patients may not be aware of them. We have to help patients understand that we have to monitor these health complications just as much, because they also shape the quality of their life. Pain is an important topic to address, but we do not want to be blinded by it and fail to monitor the overall progression of the disease. In our clinic, we try to partner with patients as active participants in their own health care. We are very fortunate to have patients who come to us for treatment. It is patients who make us better at managing illnesses and in improving the clinical care that we deliver. Ultimately, it is our goal to make each year an improvement on the year before for our patients, in symptom management and in disease progression.

The department news report

Division of General Internal Medicine

Elizabeth Fine Smilovich, MD,
presented a poster entitled "The Bridge Program: Results from Early Post-Discharge" at Gerontological Society of America annual conference.












Division of Hematology & Oncology

Lyndsay Harris, MD,
received a $250,000 grant from the Breast Cancer Research Foundation for her work entitled "Defining Biomarkers of Response to Trastuzumab, Bevacizumab and Microtubule Inhibitors (MTI) in Early Breast Cancer Using In-Vivo and Ex-Vivo Models."



Division of Infectious Diseases & HIV Medicine
A $5 million donation gift from Ms. Green will be used to establish the Roe Green Center for Travel Medicine at University Hospitals. The funding will bring significant transformation to UH's travel medicine clinics that are visited by over 4,500 patients annually as well as support the work of physician-educators in travel medicine and international infectious diseases.

Harrington Discovery Institute at University Hospitals


Harrington Discovery Institute at University Hospitals has formed an affiliation with University of Oxford to create an international initiative to advance early-stage drug discovery and development. Oxford-Harrington Scholarship Program will serve as the center of the affiliation; the newly formed partnership is expected to further expand the support of physician-scientists throughout the United Kingdom.
Harrington Discovery Institute also established a new partnership with the Foundation Fighting Blindness to create a National Center of Excellence in Fighting Blindness, a Gund-Harrington initiative. The initiative is focused on accelerating the translation of research findings in inherited retinal degenerative diseases with the ultimate goal of developing new therapies to improve and restore vision. A $50 million grant from Gund and Harrington families will be used to fund national Gund-Harrington Scholars.




Institute for Transformative Molecular Medicine

Goutham Narla, MD, PhD, became the James T. Pardee - Carl A. Gerstacker Professor of Cancer Research at Case Western Reserve University School of Medicine.

department conferences & events

Grand Rounds

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

Where: Kulas Auditorium, Lakeside, 5th Floor


December 2

"Novel Therapies for Pulmonary Arterial Hypertension" by Mohammad Shatat, MD


December 9

"New Hepatitis C Therapies" by Stanley Cohen, MD


December 16

"End of Life/Futile Care Issues" by Michael Anderson, MD


department leadership council minutes

Leadership Council

Dr. Walsh introduced Jeffrey Peters, MD, Chief Operating Officer, University Hospitals, and Mr. Thomas Snowberger, Chief Human Resources Officer, University Hospitals. Dr. Peters reviewed the UHMG Faculty Physician Compensation Program Initiative with the council. Dr. Peters and Mr. Snowberger will present this information to the Department of Medicine full-time faculty at a meeting scheduled at 5:00 - 6:00 p.m. on Wednesday, December 10 in the Kulas Auditorium, 5th Floor of Lakeside.


Leadership Council

Dr. Walsh requested suggestions from the council members for a speaker to present the annual Berman Lecture.



Leadership Council

Dr. Walsh updated the council members on the following Chair searches: Department of Family Medicine, Search Committee chaired by Dr. Michael Konstan; Department of Urology, Search Committee chaired by Dr. Cliff Megerian; and Department of Surgery, Search Committee chaired by Dr. Warren Selman. He also updated the Council on the search for a Chief of Geriatrics and Palliative Care, Department of Medicine.

Leadership Council

Dr. Bonomo gave an update of the Louis Stokes Cleveland VA Medical Center. He reported on the mission being set by the new Head of Veterans Affairs, Mr. Robert McDonald.


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.