April 2015 Newsletter

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April 2015
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department interview
Gregory Cooper, MD, Co-Program Leader for Cancer Prevention and Control and Gastroenterology Fellowship Program Director at UH Case Medical Center, discusses ways that Cleveland population will benefit from Cleveland Digestive Diseases Research Core Center, talks about the benefits of comparative effectiveness research in improving the delivery of care and shares his insight on the latest technological developments in the field.

What are the key factors influencing the field of gastroenterology today?


The biggest challenge comes with the population getting older. More and more people are at the age where they need to be screened for cancer, in particular colorectal cancer. In addition, increasing obesity has also had a big impact on our clinical services. Many gastroenterological diseases are impacted by the prevalence of obesity; such disorders as acid reflux, Barrett's esophagus, fatty liver disease, colorectal cancer and polyps are more prevalent among these patients.


The Division of Gastroenterology & Liver Disease recently secured a $6 million NIH Silvio O. Conte Digestive Diseases Research Core Center grant. What impact will the Cleveland Digestive Diseases Research Core Center have on patient care in the area?


The center will be one of only 17 in the nation. Case Western Reserve University School of Medicine will collaborate with University Hospitals and Cleveland Clinic in research on digestive inflammation, gastrointestinal cancer and liver as well as metabolic diseases. It really puts the Cleveland team led by Fabio Cominelli, MD, PhD, in the same standing as teams at Stanford, Harvard and John Hopkins centers. The center will provide funding for pilot studies and facilitate clinical research by building on key research strengths of the institutions.


The center will also work on identifying beneficial treatments and medications for patients and design studies to move promising therapies forward. By enrolling more patients in clinical studies, we hope to improve the level of health care we can offer in the long run. We are excited about the opportunity to bring a new level of expertise to the Cleveland community.


What is the role of comparative effectiveness research in today's medicine?


One of the themes I concentrate on is outcomes research or comparative effectiveness research. In our studies, we look at benefits and harms of alternative methods of diagnosis and treatment to improve the delivery of care. As the health care system is evolving, there is more emphasis on the cost of care, and promoting treatments that are not only beneficial to patients but also to the system. We use cost-effectiveness analysis to model two or more alternatives, set up a decision tree, and evaluate possible outcomes to identify the best treatment strategy. Decision modeling that involves cost information is taking on a central role in today's medical environment.


How do you find a balance between benefiting the system and helping patients with whom you have formed a personal relationship with as a physician?


In our medical practice we often treat patients with symptoms indicative of a chronic condition, such as irritable bowel syndrome, that takes a toll on the quality of life though does not necessarily cause major medical problems. These patients tend to get an overly high amount of testing done as they go from one doctor to another. As physicians, we have to evaluate the likelihood of change in medical management compared to the expenditures and risk of complications associated with another costly or invasive test. For patients like these I try to draw the line for repeated tests that are unnecessary.


Ultimately medicine is moving to a new era with the help of genomics that allows physicians to develop a personalized approach to the care of each patient. For example, follow-up guidelines for colon cancer patients are very generic, giving the same recommendation across the board. One of my collaborators is studying the ability to individualize the surveillance testing that we offer based on such factors as the characters of the tumor, as well as a patient's age and medical history.


Where are we heading with the developments in colonoscopy and endoscopy? What can technology offer us in the near future?


One of the biggest advances in technology lately has been improved visualization that can now produce high definition images. Almost all endoscopes have narrow band imaging producing blue light to highlight and characterize regions an endoscopist is examining. These advancements have helped us increase the accuracy and precision of our examinations and assisted in developing better treatment plans for patients.


In addition, endoscopy has spun off interesting applications. For example, instead of sending obese patients for bariatric surgery, scientists have identified methods to perform bariatric procedures endoscopically. Another technique, endoscopic submucosal dissection (ESD), originally developed in Japan, offers ways to remove tumors endoscopically.

Right now colonoscopy is considered the gold standard for screening, yet I believe in the future people may turn to other alternatives, such as blood and stool DNA testing.


What are you currently focusing on in your own research?


I am interested in health policy and the Affordable Care Act (ACA) that has changed the way preventive medicine is delivered. Last year under the ACA, states were given the option to take federal money to expand Medicaid to individuals who were at or below the poverty level. We are currently proposing to study this population to see what their medical challenges are. Specifically, we hypothesize that newly insured indigent patients may not receive preventive services because of other competing health demands, such as untreated chronic illnesses or acute medical problems. This population constitutes more than 450,000 people in Ohio and we want to identify ways that we can help deliver preventive medicine before health concerns become severe for this population.


Schedule a clinical appointment with Dr. Gregory Cooper


department news report

Division of Cardiovascular Medicine

The work of Brian Hoit, MD, was highlighted as one of the top articles received by Journal of the American College of Cardiology (JACC) in 2014. Dr. Hoit's article entitled "Left Atrial Size and Function" examining the ability of left atrial size and function to predict cardiovascular outcomes was one of 150 manuscripts selected by the editor-in-chief, representing less than 3 percent of the papers submitted to the journal in 2014. The selected works will become part of a special two-course issue of JACC.

Mukesh Jain, MD, PhD, was named Chief Scientific Officer for University Hospitals. In this new position Dr. Jain will develop, advance and maintain UH's academic medical leadership through clinical research and teaching initiatives.


Dr. Jain also received the Faculty Distinguished Research Award from Case Western Reserve University. This high honor signifies the university's appreciation and support of Dr. Jain's exemplary scholarly pursuits and leadership in the field of cardiology.



Trevor Jenkins, MD, was awarded a $75,000 grant from the Case Western Reserve University Center for AIDS Research for his project entitled "Exploring the Relationship Between Fitness, Mitochondrial Dysfunction, and Myokines in HIV+ Adults Participating in an Exercise Intervention."








Chris Longenecker, MD,
and his team uncovered key barriers preventing Ugandans with rheumatic heart disease from receiving needed penicillin. Their findings were published in the article entitled "A Qualitative Examination of Secondary Prophylaxis in Rheumatic Heart Disease" in the Global Heart Journal. Researchers discovered that money and transportation were the factors that prevented patients from getting injections most, followed by pain, fear of injection and poor knowledge about the consequences of a missed treatment.




Jonathan Stamler, MD, and his team found that nitric oxide is essential for the delivery of oxygen to the cells and tissues that need it. Dr. Stamler's work entitled "Hemoglobin βCys93 is essential for cardiovascular function and integrated response to hypoxia" was published online in Proceedings of the National Academy of Sciences Journal and could potentially lead to treatment focus on red blood cell dysfunction in cardiovascular diseases and blood disorders.


David Zidar, MD, was awarded $75,000 from the Case Western Reserve University Center for AIDS Research for his project entitled "Heterotypic Cellular Interactions in HIV: Drivers or Bystanders of Cardiovascular Risk?"







Schedule a clinical appointment with Cardiovascular Medicine physicians





Division of Hematology & Oncology

Nathan Berger, MD, and his team found that anti-diabetic drug metformin and vitamin D3 show considerable promise in preventing colorectal cancer. The work detailing the finding was entitled "Combined Used of Vitamin D and Metformin Exhibits Synergistic Chemopreventive Effects on Colorectal Neoplasia in Rats and Mice" and was published in Cancer Prevention Research Journal. The findings of the study give hope to identifying new ways to prevent colon cancer, its recurrence and enhance the chances of survival for patients who suffer from colorectal cancers.

Michelle Treasure, MD,
received a Conquer Cancer Foundation (American Society of Clinical Oncology) Young Investigator award for her proposal entitled "A Pilot Study of Structured Palliative Care for Patients Enrolled on Phase I Clinical Trials." Dr. Treasure will be working on this project under the mentorship of Neal Meropol, MD, Afshin Dowlati, MD, and Barbara Daly, PhD, RN.



Division of Nephrology & Hypertension

The Case Western Reserve University School of Medicine Nephrology Training Grant was renewed for five years, providing three positions for research trainees. John Sedor, MD, from MetroHealth Medical Center, the grant's primary investigator, will be supported at University Hospitals by Donald Hricik, MD. Division's notable contributors to the $1 million grant also include Thomas Hostetter, MD, and Mahboob Rahman, MD, PhD.




Division of Pulmonary, Critical Care & Sleep Medicine

Rodney Folz, MD, PhD, and his team were awarded a $2.3 million grant from the National Institute on Aging to study personal and environmental asthma triggers in older adults. The five-year study will focus on measuring chemical emissions from outdoor and common indoor materials as well as allergens commonly associated with higher risks of asthma.

department conferences & events

Team Science Challenge

The purpose of Team Science Challenge is advancing modern medical research. The awards from the Department of Medicine will provide support for developing a major research proposal to a multidisciplinary team.

Application Deadline: May 1, 2015
Submission: Send applications in PDF format to Martha Salata


Research Day 2015

Date: Friday, May 15

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

Location: Wolstein Research Building Atrium and Lobby

Abstract Submission Deadline: Monday, May 4

Register for the event

Submit your abstract



Spring Dinner 2015

Date: Thursday, May 28

Time: 6:00 - 9:00 p.m.

Where: Thwing Ballroom

Register for the event

Submit your nomination for the Master Clinician Educator

Submit your nominations for the Department of Medicine Awards




Grand Rounds

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

Where: Kulas Auditorium, Lakeside, 5th Floor


May 5

"The New ACC/AHA Guidelines on CVD Prevention: Concept and Controversy" by Sidney Smith, Jr., MD


May 12

"Privacy Protection, Personalized Medicine and Genetic Testing" by Catherine Tucker, MD


May 19

"Palliative Care in the U.S.: How Did We Get Here And Where Are We Going?" by Sean O'Mahony, MB, BCh, BAO


May 26

"TBD" by Mathilde Pioro, MD