October 2012 eNewsletter

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Department of Medicine eNewsletter
October 2012
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
Latest Grand Rounds Recordings

Leadership Council
October, 2012

Chair ::

R. Walsh


Present ::

K. Armitage

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

C. Hoppel

D. Hricik

L. Kassem

N. Meropol

D. Simon

K. Strohl

R. Walsh
J. Wright


Recorded by ::
A. Staruch
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department interview

Dr. Debra Leizman, a newly appointed Director of Undergraduate Medical Education, discusses the importance of mentorship, challenges of the new duty hours and education that provides trainees with real world experience.


You have been involved with the Internal Medicine Interest group for a long time. How do you ensure that medical student receive real world advice? What resources are available to them?

The Internal Medicine Interest Group has been developed for first and second year medical students with the intention of introducing them to the many facets of Internal Medicine. To ensure a good breadth of experience, we have an activity almost every month where the group exposes medical students to residents, fellows or attendings from within the department.



We always invite Dr. Armitage to our first lunch conference to start off the academic year with a nuts and bolts discussion introducing the students to what constitutes a residency in Internal Medicine. The bulk of our lunchtime conferences are a chance for the students to hear Internal Medicine specialty fellows talk about their clinical responsibilities and how their work corresponds to the basic science topics the students are learning. In yet another format we ask some of our Internal Medicine residents to offer students their insights. Our residents are outstanding role models for our medical students. Not only are the medicine residents exceptional teachers on the wards, but they relate to the students as young professionals who remember the challenges of medical school and the career choices that need to be made by the end of third year.



Another popular evening conference is held in January when we have a panel of attendings from the Department of Medicine talk about balancing a career in medicine with outside life demands. In February, we offer a chance for the students to shadow Saturday morning work rounds. Finally, Dr. and Mrs. Walsh sponsor a fantastic dinner at Case's Squire Valleevue Farm in the spring where students dine with faculty members. Our department really shines in this venue as our faculty are so accessible to the students. It is a great opportunity for both faculty and students to recognize the depth and breadth of our community.





At the recent State of the School of Medicine Address Dean Davis pointed out the importance of a mentor role. In your opinion, how can mentoring provided to residents and medical student be measured?

First and foremost, students are looking for dedicated professionals whom they can relate to and respect, who will teach, inspire and give guidance as students proceed in their careers. It is easy to calculate teaching time if you are giving a one hour lecture but clinical teaching is more challenging to quantify.



The current tuition for medical students at Case is $51,450 and it is frustrating that there is not a more clear line that can be drawn from their tuition dollars to those who teach. Mentors need to realize the importance of their guidance in the careers of medical students and need to be formally recognized for the contributions they are making to educational programs. I hate to advocate more paperwork for any of us, but future initiatives may include a mentoring log or even educational RVUs where teachers track the amount of hours a faculty member contributes to mentoring medical students, residents or fellows.



It is also important to reward the contributions of some of our great teachers. After third year medicine clerks completes their rotation in Internal Medicine, I ask each student to identify one resident who contributed the most to their education over the past two months. The top residents are rewarded with our "Coffee kudos" award which includes public recognition and a gift certificate from Java Jive. The students also evaluate their attendings and residents in order to identify one outstanding resident and attending who is acknowledged with a teaching award at the resident's end of the year Spring Dinner. I agree with Dean Davis that mentors and good teachers are the key to creating outstanding physicians of the future and I hope we continue to try to develop a medical school model that addresses how to identify and reward these teachers.





Since the new duty hours have been introduced for the Residency Program, how have they affected the medical students? What are some of the new challenges you had to face?


One of the things we noticed with the new duty hours is more patients were admitted with the night float teams. Since third year medical students only stay until 11:00 p.m., they were not admitting as many new patients. In order to compensate for this paradigm shift, I devised a new one week night float option to allow the students to work up more undifferentiated patients, to participate in cross coverage and to observe and comment upon resident hand offs. This was presented as an educational innovation at the recent AAIM conference in Arizona to some great reviews. Again, we are indebted to the night float residents who take the students under their wing.





You are about to receive the Ohio Chapter of American College of Physicians Master Teacher Award, a truly outstanding achievement. Can you tell us about some of the contributions to Educational Programs you are most proud of?


I work to help the MD-PhD students in our MSTP program maintain some clinical continuity during their PhD years and my work with these students has been quite fulfilling. A Patient Safety and Quality Initiative represents another addition to our third year Internal Medicine curriculum of which I am quite proud. While we have implemented many changes to the third year clerkship over the years, I am most pleased with the fact that students who complete our rotation receive outstanding clinical training. I personally observe each third year Internal Medicine student at University Hospital performing a history and portions of the physical examination on a hospital inpatient and the student does not move on in their career unless they demonstrate competency. It is a privilege to be involved in medical student education. The students are smart, idealistic and optimistic. Our medical school curriculum is changing constantly and new rules for medical schools and new residency competencies mean more changes down the road. I need to continue to be creative and stalwart teaching our students how to take care of patients and I continue to be grateful to my outstanding colleagues who help me teach these future doctors.

department news report

Division of Cardiovascular Medicine

Dr. Albert Waldo received the 2012 University Hospitals Distinguished Physician award, UH's highest clinical honor bestowed upon a physician. The award was presented by Thomas Zenty, Fred Rothstein and Sheldon Adelman at the Annual Society of 1866 Celebration. Dr. Waldo joins an exceptional legacy of distinguished physicians who received this award in the past, including Dr. Scott Inkley, Dr. Henry Bohlman, Dr. Avroy Faranoff and Dr. Roland Moskowitz.





Three years ago the division received a Chest Pain Accreditation and recently it was time for the renewal. Barbara Demagall, RN, Chest Pain Coordinator led the Time Is Muscle (TIM) team to collect data, develop policies and procedures and to educate staff. Other key players were Kiefah Awandallah, ED nurse educator, and Geoff Patty, nurse in cardiac cath lab. The importance of this accreditation is that it challenges our physicians to look at the process on how they treat Acute Coronary Syndrome (ACS) patients, specifically ST Elevation Myocardial Infarct (STEMI) patients. The AHA/ACC bench mark is to accomplish a door-to-balloon time (D2B) of 90 minutes or less for all STEMI patients and the division was able to accomplish this 100% of the time in 2011. The division continues to be successful with D2B times in 2012 and received Society Chest Pain Centers Re-accreditation with the median time being 47 minutes.



The Division of Cardiology held the second annual Heart Heroes Event celebrating cardiac arrest survivors. The event brings together patients, emergency medical services, physicians, nurses, and technical staff that were involved with the care of the cardiac survivors. The survivors get a unique opportunity to meet the people who saved their lives and recognize them for the care they were able to provide. Three patient speakers talked about their experiences and were joined on the podium by hospital speakers Bob Coleman, MD, Medical Director of UH EMS and Dan Simon, MD, Chief of Division of Cardiovascular Medicine.






Division of Gastroenterology and Liver Disease


The damp fall weather conditions in the region have resulted in significant wild mushroom growth, many of which are of the toxic varieties. Unfortunately, these toxic wild mushrooms are being blamed for hospitalizing a dozen people in Northeast Ohio, and faculty members of the Division of Gastroenterology & Liver Disease are warning of a possible public-health emergency. The doctors advise against picking any wild mushrooms because of the risk of eating a type called amanita, a common woodland genus that can cause severe liver damage or even death. "There's a potential for significant harm if the community is not alerted," said Dr. Pierre Gholam, Associate Professor of Medicine and Hepatologist that is treating some of the patients at University Hospitals Case Medical Center. The mushrooms cause nausea, vomiting, and diarrhea and can lead to liver damage so severe that a transplant is necessary. In some cases, they're deadly. Dr. Gholam said the mushroom's poison is not deactivated by cooking, freezing or boiling. His advice: Don't eat any mushroom you, a friend or family member has picked. Many poisoned patients end up being transferred to University Hospitals because it's participating in a national study of Silibinin, an extract from the herb milk thistle approved in Europe to treat mushroom poisoning. The Division is only one of a handful of sites across the country that is participating in the clinical trial.


Dr. Alan Levine was inducted to the School of Medicine's Academy of Scholar Educators.











Division of General Internal Medicine and Geriatrics

Dr. Sweta Singh joined the division as the Clinical Instructor of Medicine. Dr. Singh will attend the Douglas Moore Clinic with residents and concentrate on covering the Hospitalist services.

Dr. Gerald Strauss was selected for induction into the School of Medicine's Academy of Scholar Educators.




Division of Hematology and Oncology

Dr. Paolo Caimi received an American Cancer Society Institutional Research grant for his proposal, "Finding new predictive and prognostic factors in Chronic Lymphocytic Leukemia: High- resolution flow cytometry analysis of CLL samples from the Eastern Cooperative Oncology Group Randomized Clinical Trial E2997." The $30,000 award will enable Dr. Caimi and his team to explore the relationship between expression of potential apoptotic pathway biomarkers and clinical outcomes in patients treated with fludarabine.




Dr. Afshin Dowlati became this year's recipient of NCI Michaele C. Christian Oncology Development Lectureship Award. The award is intended to recognize the contributions of individuals to the development of novel agents for cancer therapy. Dr. Dowlati was recognized for his scientific accomplishments, program-building, and mentorship of the next generation of clinical researchers in oncology.







Dr. Lyndsay Harris became the Diana Hyland Chair for Breast Cancer.












Dr. Hillard Lazarus was appointed as the George and Edith Richman Chair and Distinguished Scientist in Cancer Research.










Dr. Rami Manochakian joined the division as Assistant Professor of Medicine. Dr. Manochakian will be a member of the Hematology/Oncology section at the LSCVAMC where he will serve as the Medical Director of the Multidisciplinary Lung Cancer Program and medical oncologist for gastrointestinal malignancies within the Specialty Care Center of Excellence. He will also continue his clinical research pursuits examining the effects of metformin in pancreatic cancer.





Dr. Cheng-Kui Qu was awarded an administrative supplement to the parent R01 grant "Metabolic regulation of hematopoietic stem cells." The $12,000 will help Dr. Qu enhance the stem cell research he proposed earlier.








Division of Nephrology and Hypertension

Dr. Thomas Hostetter was appointed the Centers for Dialysis Care's Leonard C. Rosenberg Renal Research Foundation Master Clinician in Nephrology. The award was jointly established with a gift from CDC's Leonard C. Rosenberg Renal Research Foundation and through the efforts of the Department of Medicine at University Hospitals. This is a well-deserved award that recognizes Dr. Hostetter's contributions to the field of nephrology and symbolizes his dedication to the trifold mission of the University Hospitals: "To Heal. To Teach. To Discover."





Division of Pulmonary, Critical Care and Sleep Medicine

Dr. Kingman Strohl was the keynote speaker at the Society for Sleep Medicine and Anesthesia annual meeting in Washington, DC. Dr. Strohl's talk highlighted the genetic dissection of ventilatory traits. Dr. Strohl was also the invited symposia speaker at Anesthesia Society of America meeting in Washington, DC. His talk was entitled "Respiratory Depression: New Insights".






Institute for Transformative Molecular Medicine


Dr. Goutham Narla received the Distinguished Scholar (Early Career) Award, a well- deserved honor for a professional who has made many contributions to medicine. Among Dr. Narla's recent achievements is the awarded James T. Pardee - Carl A. Gertstacker Professorship in Cancer Research.







Dr. Jonathan Stamler and other researcher on Dr. Michael Cutler's team recently published their work on arrhythmia entitled "Aberrant S-Nitrosylation Mediates Calcium-Triggered Ventricular Arrhythmia in the Intact Heart" in Proceedings of the National Academy of Sciences. The researchers found evidence that nitroso-redox imbalance is an important mechanism of ventricular arrhythmias in the intact heart under disease conditions, and that therapies restoring nitroso-redox balance in the heart could prevent sudden arrhythmic death.

department conferences & events

Medicine Grand Rounds

Location: Kulas Auditorium

Time: 12:00 - 1:00 p.m.

  • October 23 - "Atril Fibrillation" by Albert Waldo, MD, Division of Cardiovascular Medicine
  • October 30 - "Clotridium Dificile" by Curtis Donskey, MD, Division of HIV and Infectious Diseases
  • November 6 - "Personalized Medicine for Breast Cancer in the Post-Genomic Era" by Lyndsay Harris, MD, Director of Breast Cancer Program, Division of Hematology and Oncology
  • November 13 - "Benign Hematology: Back to the Future" by Susan Shurin, MD, Deputy Director, National Heart, Lung, and Blood Institute, National Institute of Health
  • November 20 - "Professionalism in Health Care: A Novel and Practical Approach for Physicians and Teams" by Wendy Levinson, MD, Chair, Department of Medicine, University of Toronto
  • November 27 - "Update on HCV Treatments (and a little Hepatitis C)" by Tony Post, Medical Director of Liver Transplantation, Division of Gastroenterology and Liver Disease


Medicine Quality Summit: Moving Forward

Location: Corporate College East, 4400 Richmond Rd, Warrensville Heights

Date: Saturday, October 27, 2012

Time: 8:00 a.m. - 12:30 p.m.

To register click here or contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it



7:15 - 8:00 - Registration and Breakfast

8:00 - 8:10 - Introductions by Dr. Robert Salata

8:10 - 9:00 - Healthcare Reform: Improving the Healthcare World in Cleveland and Beyond by Dr. Barry Straube

9:00 - 9:20 - Family Centered Relationship Based Communication Guide by Jeffrey Beers RN, BSN, MA

9:30 - 10:30 & 10:45 - 11:45 - Breakout Session (Physician Accountability: In the Public Eye; Pain: Healing it Without Feeling it; Communication and Miscommunication: Say What You Mean and Mean What You Say; The Patient Experience: The Good, the Bad and the Ugly)

12:00 - 12:30 - Wrap-up Plenary Summaries and Action Plans


CWRU School of Medicine designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credits.



Dr. Thomas Hostetter Receives Master Clinician Award in Nephrology

Take a look at the photos from Dr. Hostetter's reception on our


department leadership council minutes

Leadership CouncilDr. Bonomo presented an update of the Medical Service, Louis Stokes Cleveland VA Medical Center: Clinical Activity FY 2009 - 2012; Cumulative Research Activity; Education, including Interdisciplinary Conferences; Service Highlights including Centers of Excellence; Geriatric Research Education and Clinical Centers (GRECC) Consolidation and Re-structuring; Future Goals in Translational Research Development and Faculty Recruitment.


Leadership Council

Dr. Strohl presented an update of the newly refunded CWRU Clinical and Translational Science Collaborative (CTSC). The CTSC provides developmental, organizational, financial, and educational support to biomedical researchers and community participants. They coordinate resources relevant to clinical research at CWRU and its hospital affiliates, University Hospitals Case Medical Center, Cleveland Clinic, MetroHealth Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center. Dr. Strohl outlined the CTSC functions including Research Education and Training Programs, Clinical Research Unit Services and Community Research Partnerships. Currently, the CTSC Pilot Grant Partnerships include Core Utilization Grants (rolling applications), Annual Pilot Grants, The Center for Stem Cell & Regenerative Medicine, The Case Skin Disease Research Center and The Coulter Translational Research Award. CTSC resources are easily accessed online and/or in person through the Office of the Research Concierge Service. Dr. Walsh urged the Council to have faculty members access the CWRU CTSC web site at: http://casemed.case.edu/ctsc/. The e-mail address is: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Leadership Council

Dr. Walsh led a discussion on the latest information regarding the indirect cost rate. In addition, data relating to the mortality rate as well as case mix index statistics were reviewed.


Leadership Council

Dr. Walsh distributed a draft of a salary supplement plan for CWRU faculty salaries. The draft plan provides a supplement to a faculty member's salary when a certain level of external salary support is achieved. Additional discussion on a salary supplement plan will be an agenda item at a future Council meeting.


Dr. Walsh presented information to the Council on the Electronic Health Record (EHR) and access to patient information. An increased ease of access to patient information, facilitated by the EHR, creates the potential for HIPPA violations by physicians and staff. Dr. Walsh is suggesting to hospital leadership that there be enhanced physician and staff education on this topic and that all physicians and staff receive a clear and concise hospital policy statement on this issue, including potential penalties. Dr. Walsh urged Council members to discuss this important issue with their faculty and staff.


Leadership Council

Dr. Walsh distributed data (July 2012 YTD) on Cleveland-area hospitals including: Total Surgeries - July 2012 YTD and Total Discharges- July 2012 YTD.