November 2013 Newsletter

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Department of Medicine eNewsletter
November 2013
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
Website's New Features and Updates

Core Clerkship



Department of Medicine Audit


Leadership Council
November 2013

Chair ::

R. Walsh


Present ::

B. Arafah

K. Armitage

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

S. Gravenstein

T. Hostetter

D. Hricik
S. Madan Mohan
N. Meropol
R. Schilz
D. Simon
R. Walsh
J. Wright
H. Bhavsar
D. Slobozhanina


Recorded by ::
A. Staruch
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department interview
Stefan Gravenstein, MD, is spearheading trials that have the potential to change the standards of elderly health care. Dr. Gravenstein talks about preventive measures for staying healthy during winter months, discusses the shifts in geriatric culture of care and presents ambitious quality improvement programs he hopes to offer to patients in the near future.


You have a long-standing interest in immunity, inflammation and influenza in elderly. As we are approaching the winter season, are there any precautions elderly should keep in mind?


The most important step to take is to get vaccinated. Those who are over the age of 65 should consider asking for a high dose of flu vaccine as it generates greater immunity. Those with high risk for complications from influenza should consider primary and secondary preventive measures.



How has the culture of elderly health care been shifting lately?


I believe that the greatest shift that we are currently experiencing is moving from a patient-centered to patient-driven model of care. We are shifting from health care about a disease, to about the patient. It is important for patients to engage with doctors in a way that helps them take part in their own care and health outcomes. For example, our patients should seek to know about the medications they are taking, reasons for taking them, warning signs to prompt them to contact their provider and then how to connect adequately. We are moving to a model that demands patients to become engaged participants in their own recovery.


At the same time, this shift calls for a cultural change among health care providers. Physicians can learn to triage patient calls differently; by evolving how we offer SNF care, health care advice over the phone and follow a patient's symptoms, we have the ability to decrease unplanned care, that is, ER utilization and readmissions. In addition, I believe by engaging patients in their own health care, we can reduce the number of difficult patients and increase patient satisfaction scores.



You have recently joined University Hospitals Case Medical Center as a faculty member. How are you planning to structure your research portfolio? What are some of the topics you will be concentrating on?


I will still be concentrating on quality improvement in my research. In addition to patient-driven care, I will also be focusing on fall prevention, delirium prevention, reducing length of stay, reduction and elimination of catheter use, and early removal of intravenous lines. Each of the above topics has the potential to blossom into a research or quality improvement project; moreover, some of the topics have been captured in proposals we are currently developing or have submitted. I'll also continue to work on pragmatic large-scale clinical effectiveness trials.


For example, currently we are conducting one of the largest randomized control trials that compares the clinical effectiveness of high dose and standard dose influenza vaccine in nursing homes. This year we have enrolled over 800 facilities, and over 80,000 nursing home residents have already been vaccinated in this program. In this trial, we are monitoring the vaccination rate among the staff of the nursing homes, too. We hope to determine whether the high dose vaccine is more effective in reducing hospitalizations and deaths than a standard dose vaccine in nursing homes. In addition, we would like to know how staff vaccination impacts the risk of hospitalization and mortality outcomes in the residence. This large-scale trial serves as an optimal platform for similarly designed studies that we hope will assist us in more rapidly establishing new standards of care.



One of the areas you have been concentrating on throughout your career is quality improvement. What are your thoughts on quality improvement programs we could offer to patients to improve our culture of care?


It is important to start at the very beginning, specifically concentrate on the way we teach our college students, medical students and house staff. For our fellows, we should not only teach clinical geriatrics content, such as bedside care and delirium, but also embed leadership skills to position them to improve quality and systems of care.


We are currently concentrating on developing processes to extend our reach of geriatric care beyond the walls of UH Case Medical Center. One of the ways to do so is by creating a virtual environment similar to that of the electronic intensive care unit (eICU). Specifically, we are evaluating how to deploy a virtual ACE unit driven from UH Case Medical Center to our community hospitals. Our hope is that we can extend this model to one of the community hospitals within the next year.


Another program we expect to develop is the Hospital Elder Life Program (HELP). This program, managed by geriatricians who partner with and organize volunteers, helps identify patients in whom we can prevent delirium. We hope to put the program in practice in the next 1 - 2 years and are excited to use it as a robust research platform for future studies.

Schedule a clinical appointment with Dr. Gravenstein

department news report

Division of Gastroenterology & Liver Disease

Pierre Gholam, MD, will be a co-investigator on a new five-year NIH U01 grant centered around transforming the clinical treatment of Alcoholic Hepatitis (AH) by rapidly translating novel and innovative basic science discoveries into clinical practice. This project will supply specimens to the translational/basic science components to identify novel biomarkers and altered pharmacogenetics that predict disease severity and response to pharmacologic therapy as well as identify unique drug targets for novel treatments for AH. A biorepository of the collected clinical data and patient samples will also be established that will be an important national resource for transforming clinical practice for the treatment of AH.


Schedule a clinical appointment with Gastroenterology & Liver Disease physicians



Division of General Internal Medicine & Geriatrics

null Stefan Gravenstein, MD,
published multiple articles detailing his current work: "A Randomized Trial of Heart Failure Disease Management in Skilled Nursing Facilities: Design and Rationale," was published in Journal of the American Medical Directors Association; "Shifting the Dialogue from Hospital Readmissions to Unplanned Care," in American Journal of Managed Care; "Closing the Loop: Best Practices for Cross-Setting Communication at ED Discharge," in American Journal of Emergency Medicine; and "Recruiting Hospitalized Patients for Research: How Do Participants Differ from Eligible Nonparticipants," in Journal of Hospital Medicine.



The Cleveland VA Medical Center General Internal Medicine Division was awarded funding for a collaborative project entitled "Allies for Better Care in Pact: ABC PACT." This four-year $3-million initiative will support the development, implementation, and evaluation of intensive management teams for high-risk patients in the outpatient program. Brook Watts, MD, Scott Ober, MD, and Phyllis Nsiah-Kumi, MD, will champion the program with leadership support of Sarah Augustine, MD, and Mamta Singh, MD.

Division of Hematology & Oncology


Neal Meropol, MD, co-chaired Cancer Trial Accrual Symposium to develop recommendations for overcoming issues related to the accrual of cancer patients in clinical trials. The symposium was sponsored by the National Cancer Institute and the American Society of Clinical Oncology and brought together over 350 cancer research experts, clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators and educators. The recommendations were published in the Journal of Oncology Practice and include steps to overcoming barriers to accrual at the patient, community, physician, provider and site levels.


Shaveta Vinayak, MD, joined the Division of Hematology & Oncology as Assistant Professor of Medicine. Dr. Vinayak's clinical focus is the care of women with breast cancer and genetic risk assessment; she will be working with Lyndsay Harris, MD, and colleagues in the breast cancer program. Dr. Vinayak will also develop a clinical research program involving new therapeutics and use of genomics to tailor treatment.



Schedule a clinical appointment with Hematology & Oncology physicians





Division of Nephrology & Hypertension


The Division of Nephrology and Hypertension had a high profile at this year's meeting of the American Society of Nephrology in Atlanta. The division presented a number of oral abstracts including "Persistent alkalosis is associated with high risk of heart failure in patients with CKD," by Mirela Dobre, MD, Thomas Hostetter, MD, Mahboob Rahman, MD, "No decrease in albuminuria with cholecaliferol in a randomized placebo controlled trial in older patients with heart failure," by Lavinia Negrea, MD, and "Masked and sustained hypertension are associated with increases in left ventricular mass and opulse wave velocity in CKD - The CRIC study," by Mahboob Rahman, MD. Invited presentations included: "Biomarkers in Transplantation: Results from the Clinical Trials in Organ Transplantation," by Donald Hricik, MD, "Hyperlipdidemia in CKD," by Mahboob Rahman, MD, "Is it time to rethink achieved hemoglobin as a measure of success in the management of anemia of ESRD?" and "30-day hospital readmission measure: Assessing what it should?," by Jay Wish, MD. In addition, the Division of Nephrology and Hypertension presented multiple posters. Drs. Rahman and Hricik served as moderators of abstract sessions and educational symposia.
department conferences & events

Grand Rounds

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

Where: Kulas Auditorium, Lakeside, 5th Floor


December 10

"Update on Malaria" by James Kazura, MD


December 17

"Cardiovascular Effects on Cancer Therapies: From Prevention to Advanced Treatment" by Guilherme Oliveira, MD, FACC


Morbidity and Mortality Conferences

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

Where: Kulas Auditorium, Lakeside, 5th Floor


December 6, 2013
A 33-year-old man with systemic lupus erythematous and a hospital course complicated by mesenteric vasculitis and STEMI.
Discussion Leaders: Priya Sivaraman, MD (Division of Rheumatology); Sahil Parikh, MD (Division of Cardiovascular Medicine); Division of Gastroenterology representative

December 13, 2013
A 42-year-old man with MRDD with a prolonged hospitalization complicated by catatonia and difficult ethical dilemmas.
Discussion Leaders: Hiloni Bhavsar, MD (Division of General Internal Medicine); Jeanne Lackamp, MD (Department of Psychiatry); Department of Ethics & Social Work representative


December 20, 2013
A 41-year-old female with follicular lymphoma develops fulminant hepatic failure due to hepatitis B reactivation.
Discussion Leaders: CJ Nock, MD (Division of Hematology & Oncology); Joshua Augustine, MD (Division of Nephrology & Hypertension); Anthony Post, MD (Division of Gastroenterology)
department leadership council minutes

Leadership Council

Dr. Bhavsar presented information on the Department of Medicine Clinical Effectiveness Team (CET). The CET is a multi-disciplinary group that evaluates, facilitates and endorses EMR requests pertaining to the Department of Medicine and its divisions. Dr. Bhavsar covered the background of the CET, process development, types of requests, request flow chart, committee structure/membership, referring committees and CET goals. Dr. Walsh thanked Dr. Bhavsar for her presentation and asked Division Chiefs to have one of their faculty members be the point of contact for CET for their division.

Leadership Council

Ms. Slobozhanina outlined the implementation of a Medical Student Research Survey. This survey will gather information from department faculty regarding research projects available for medical students for either a research block or summer research projects.  She requested Division Chiefs provide feedback on the survey and for faculty participation.


Leadership Council

Dr. Walsh updated the council members on the onboarding of the HealthSpan physicians who are joining the Department of Medicine with privileges primarily at University Hospitals Ahuja Medical Center.

Leadership Council

Dr. Walsh reminded council members that their faculty should plan to attend the UH Physician Services Annual Physician Meeting on Tuesday, December 3 at 6 p.m. at the Cleveland Convention Center.

5Dr. Hostetter gave an update on the Department of Medicine Research committee including Team Science funding and Research Challenge grants with other departments.


Leadership Council

Dr. Armitage reviewed data for intern recruitment including the names of faculty members that have interviewed or are scheduled to interview intern applicants. Dr. Walsh asked that leadership encourage their faculty to participate in this important process.


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.