Newsletter Summer 2013

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Department of Medicine eNewsletter
Summer 2013
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes

2013 Best Hospitals in America

The Department of Medicine is proud to say that UH Case Medical Center has once again received high rankings in U.S. News & World Report's Annual Ranking of American Hospitals. Of special note is the improved position of many of our divisions. Congratulations to our faculty for their strong commitment to quality patient care.


#13 - Gastroentero-

logy & GI Surgery

#15 - Cancer

#19 - Cardiology & Heart Surgery

#21 - Geriatrics

#22 - Nephrology

#26 - Diabetes & Endocrinology

#38 - Pulmonology


Website's New Features

Harrington Physician-Scientist Residency Pathway


Internal Medicine-Pediatrics Residency Program


Resident Noon Conferences


Patient Safety and Quality Improvement Program


Residency Career Development


Resident Travel Blog

Leadership Council
July 2013

Chair ::

R. Walsh


Present ::

B. Arafah

K. Armitage

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

C. Hoppel
T. Hostetter
D. Hricik
N. Meropol
R. Salata
D. Simon
R. Walsh
J. Wright



Recorded by ::
A. Staruch
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department interview

Neal Meropol, MD, Hematology & Oncology Division Chief, discusses the impact of the Affordable Care Act on clinical trials, shares his insight on effective doctor-patient communication and gives his thoughts on critical issues in cancer health care.


How has your outlook on national cancer health care changed since you were appointed to the American Society of Clinical Oncology (ASCO) Board of Directors? What aspect of cancer health care still needs critical improvement in your opinion?

The American Society of Clinical Oncology is the largest professional organization representing cancer physicians and patients. The organization has more than 30,000 members worldwide. Given a large constituency, ASCO is highly involved with discussions on health care policy on a national level, in particular ensuring access to high-quality care for all cancer patients and warranting clinical research in oncology is well-supported. ASCO's focus on research is particularly important given recent advances in cancer genomics and drug design technologies that accelerate finding the cure for cancer.

Both at the local and national level we recognize that over the past few decades the cost of health care has increased dramatically, the cost of cancer health care even more so. In my view, the high cost of care when juxtaposed with the national move toward increased cost sharing raises the potential to widen disparities in cancer care. As out-of-pocket expenses for health care increase, the financial burden of illness has increased for patients over the past few years and will likely increase further over the next decade. I am concerned that without additional health care reform, we won't be able to ensure high-quality care for all patients. For this reason, as a society we now need to pay more attention to the value of care we provide and ensure that as practitioners we are recommending the highest level of treatment to our patients. At the same time, our drug development process should no longer be satisfied with modest gains at high cost.


Given your new role with ASCO, how do you think you will be able to facilitate the introduction of local ideas to the national stage?

The research that is currently taking place in the Division of Hematology and Oncology spans the gamut from basic laboratory discovery to clinical trials of new therapies and health service research. Investigators in the division are contributing new knowledge toward understanding the coagulation of the system, its relation to vascular biology and disease. CK Qu, MD, has made important discoveries in hematopoietic stem cells. Shigemi Matsuyama, MD, has contributed fundamental knowledge about the role of phosphatases in cancer development that has the potential to result in new therapies. Afshin Dowlati, MD, performs first-in-man studies of new agents, some of which were developed in our own laboratories. For example, we are currently conducting clinical trials of methoxyamine. In addition, the agent discoveries in Dr. Stanton Gerson's laboratories inhibit basic scission repair mechanisms, potentiating the anti-tumor effect of the traditional DNA damaging agents.

Many of the Division of Hematology and Oncology faculty members hold leadership roles in national infrastructure for the conduct of cancer clinical trials. I serve as Chair of NCI GI Steering Committee, and Dr. Dowlati serves on the Investigational Drug Steering Committee. Many division faculty are active members of the cancer cooperative groups; our faculty's energetic participation in professional organizations allows us to bring our home-grown ideas into multicenter studies.

We also currently hold competitive funding as members of national consortia for conducting clinical trials. Among them is the pulmonary transplant clinical trials network led by Hillard Lazarus, MD, an early development UO1 contract led by Afshin Dowlati, MD, and a phase II NO1 contract I am leading. In addition, Lyndsay Harris, MD, is spearheading our efforts to apply genomic evaluation of tumors in precision medicine. Marcos DeLima, MD, brings a variety of novel approaches to stem cell therapeutics. Finally, Sandy Markowitz, MD, is the principal investigator of Case Gastroenterology Specialized Program for Research Excellence, a multi-investigator program to conduct translational research in gastrointestinal cancers.


Though you have an outstanding track record as a clinical and translational investigator, you are specifically known for your work in patient decision-making process and doctor-patient communication.

What are some of the key practices you have found to be useful in establishing trusting relationships with patients?

For the past 15 years, I have been studying how patients make decisions about their health care and how best to optimize the communication between patients and their doctors. We have found that patients and doctors often come away from consultations with different views of what actually transpired in the office. We have learned that patients vary in how they prefer to be communicated with: some patients are comfortable with a supportive approach from their physician, while others would rather hear cold hard facts. Therefore, it's important to understand patients' preferences in communication as well as individual goals and values to match our communication style and content to meet individual needs.

It is helpful to ask patients what they want to know and how they would like to learn new information early on. It is also critical to ask patients to repeat back to their physicians the information they were given to ensure both parties see eye-to-eye. In the context of a cancer diagnosis, communication is particularly complex as patients are facing the issue of mortality; there is also a high level of uncertainty associated with the outcomes of treatment and high potential for side effects. Together these features conspire to create an emotionally charged relationship.


Why do you believe it is important to tell the stories of cancer patients? What are some common attitude barriers you see patients have toward phase I clinical trials?

There are a lot of misconceptions about clinical trials and we were pleased that The Plain Dealer realized the importance of educating the general public about cancer research studies. In our own work we have been characterizing the barriers for patients to take part in clinical trials and developing methods to overcome these barriers. In particular, we have found that many patients lack the awareness about clinical trials taking place as well as general knowledge to enable them to consider participating in one. In addition, patients have certain misconceptions about clinical trials. For instance, many patients are afraid of randomization. We have found that by addressing these specific concerns, we can help patients become more comfortable with the notion of a clinical trial, such as if it is an option presented by their doctor, they are more likely to participate. One of the programs we have developed involves providing video segments to patients addressing common concerns patients have reported when considering joining a clinical trial. It is empowering that we can change patients' attitudes toward clinical trials simply by providing general education through text or video.


We know that health care will change when the Affordable Care Act comes out in 2014. In your opinion, how will it influence clinical trials that are essential for advancing cancer health care?

One of the provisions of the Affordable Care Act is that insurance companies will be required to cover the routine costs associated with patients who are participating in clinical trials. Currently some insurance plans tell patients that their health care costs will not be covered at all if they decide to take part in a clinical trial. We have found that this is a problematic issue with many patients as they are concerned about the costs they may incur. The Affordable Care Act will require that routine care costs such as blood tests, CT scans and doctor office visits, are included in insurance coverage. Hopefully with further education about the Affordable Care Act, we will be able to put our patients' these anxieties to rest and open the door for more widespread clinical trial participation.

department news report
The Department of Medicine has enhanced the Research Pathway of the Internal Medicine Residency Program. The formerly known ABIM Research Pathway, is now called the Harrington Physician-Scientist Pathway and will be led Aaron Proweller, MD, and Thomas Hostetter, MD. The pathway has been specifically designed for residents interested in pursuing cutting-edge opportunities in basic, clinical and translational research upon the completion of their clinical training in the Residency Program. The pathway offers training to a new generation of physician-scientists through clinical and laboratory experience, course work and individualized mentorship. Upon the successful completion of the Internal Medicine training, residents are tracked into a fellowship position in the sub-specialty of their choice.




Division of Cardiovascular Medicine

Saptarsi Haldar, MD, discovered a new molecular pathway responsible for causing heart failure. In addition, Dr. Haldar's team developed a novel prototype drug, JQ1, that blocks the pathway and protects the heart from damage, laying the foundation for an entirely novel treatment of heart failure. Dr. Haldar's article entitled "BET Promodomains Mediate Transcriptional Pause Release in Heart Failure" was published in Cell Journal.



Schedule a clinical appointment with Cardiovascular Medicine physicians




Division of General Internal Medicine & Geriatrics


Goutham Narla, MD, received the Health Care Hero award for the Advancement in Health Care from Crain's Cleveland Business. The award recognizes Dr. Narla's forward thinking in advancing cancer health care by identifying and characterizing key genes and pathways involved in human cancer development and progression as well as development of novel drugs to target these genes in various cancers.

Elizabeth Fine Smilovich, MD, received a $6,000 Research Initiative Program grant from VISN 10 Research Subcouncil. These funds will support Dr. Fine Smilovich's work directed at delirium identification in hospitalized patients by validating a screening tool and piloting an assessment protocol. In addition, Dr. Fine Smilovich made a presentation entitled "Disentangling Delirium" at Topics in Geriatric Medicine lecture series at the Louis Stokes Cleveland Veterans Affairs Medical Center.

Division of Hematology & Oncology


Nate Berger, MD, received the Maurice Saltzman Award at the Mount Sinai Health Care Foundation annual meeting. This prestigious honor recognizes a person who performs work of major value to the health interests of Greater Cleveland.





Matt Cooney, MD, received a CTSC Pilot Grant award for his project "Evaluation of Alpha-Methylacyl-CoA RaceMase (AMACR) as a Noninvasive Diagnostic Biomarker for Prostate Cancer." The project represents a transdisciplinary effort with C.C. Liu, PhD, from the Department of Chemical Engineering, Anna Samia, PhD, from the Department of Chemistry, and Cheryl Thompson, PhD, from the Department of Family Medicine. The overarching goal is to develop an inexpensive, noninvasive, point-of-care diagnostic test for the detection of prostate cancer in a blood sample. This biosensor method could be readily applicable for screening in undeveloped countries.


Clark Distelhorst, MD, was awarded a $50,000 grant from the Chronic Lymphocytic Leukemia (CLL) Foundation. The funds will support the development of a novel targeted therapy for CLL and other Bcl-2-positive lymphoid malignancies.







Hillard Lazarus, MD, was presented with the Hematology and Oncology Faculty award for Excellence in Fellow Education. This annual award recognizes a faculty member for special commitment to teaching, mentorship and career development.






Schedule a clinical appointment with Hematology & Oncology physicians





Division of Infectious Diseases & HIV Medicine


Michael Lederman, MD, received the Health Care Hero Award in Physician Research from Crain's Cleveland Business. This award recognizes Dr. Lederman's contribution to AIDS research, education, care and advocacy. Dr. Lederman is currently working on anti-AIDS gel, a discovery that could potentially limit the spread of the epidemic in poor nations.





Schedule a clinical appointment with Infectious Diseases & HIV Medicine physicians





Division of Nephrology & Hypertension

Mirela Dobre, MD, became the latest member to join

as the Nephrology and Hypertension faculty member.

Dr. Dobre was awarded a Fellow-to-Faculty Transition award from the American Heart Association and will focus her research efforts on the study of acid-base abnormalities on the outcome of patients with chronic kidney disease.





Schedule a clinical appointment with Nephrology & Hypertension physicians


department conferences & events

Morbidity and Mortality Conferences

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

Where: Kulas Auditorium, Lakeside, 5th Floor

August 16th

The case of a 24-year-old female with pharyngitis, fever, and pulmonary nodules found to have LeMierre's syndrome complicated by septic shock.

Discussion Leaders: Luis Landeras, MD (Division of Radiology), Stephen Dreyer, MD (Division of Radiology), Howard Meyerson (Division of Pathology), Steven Strausbaugh, MD (Division of Pulmonary, Critical Care & Sleep Medicine), Keith Armitage, MD (Division of Infectious Diseases & HIV Medicine).


August 23rd

The case of a 20-year-old female with sickle cell disease who expired after a prolonged code.

Discussion Leaders: Lalitha Nayak, MD (Division of Hematology & Oncology), Jeffrey Beamish, MD (Internal Medicine Residency Program), Nathan Stehouwer, MD (Internal Medicine Residency Program), Andrea Popa, MD (Pharmacay).


August 30th

The case of a 58-year-old woman with new onset ascites found to have Budd-Chiari syndrome and polycythemia vera.

Discussion Leaders: Anthony Post, MD (Division of Gastroenterology), Erica Campagnaro (Division of Hematology & Oncology), Ismail Dreshaj, MD (Division of General Internal Medicine & Geriatrics).





Vital Signs at Cleveland Museum of Art

Date: Wednesday, September 18

Time: 6:00 p.m.

Location: Cleveland Museum of Art, 11150 East Blvd, Cleveland, OH, 44106

Cleveland Museum of Art invites health care professional to a roundtable discussion and art infused training. Find out how CMA's galleries of art become laboratories for analysis and exploration as well as for building skills in observation, teamwork, and communication.





Chairman's Intern Welcome Dinner

Richard Walsh, MD, invited the interns to join him for dinner at Shoreby Club. The elegant lakeside location served as a perfect spot for residents to mingle with faculty members and enjoy Lake Erie scenery. Click here for more photos.





Summer Picnic

Our residents and their family members enjoyed an afternoon filled with good conversations, outdoor games and an annual pie eating contest at Squire Valleevue Farm. Click here for more photos.





Residency Happy Hour

Our interns and residents got together to socialize and enjoy delicious food at Panini's on Coventry. Click here for more photos.

department leadership council minutes

Leadership Council

Dr. Walsh announced that Dr. Anthony Wynshaw-Boris has been named the new chair of the Department of Genetics and Dr. James Rowbottom has become the Interim Chair for the Department of Anesthesiology. Dr. Walsh updated the Council on the searches for Chairs of Ophthalmology and Cardiovascular Surgery at Case Western Reserve University/University Hospitals Case Medical Center. He also reviewed the search process for a Director of the Respiratory Health Institute where outstanding candidates have been identified. Currently, one candidate is scheduling a third visit and another candidate has a second visit planned.

Leadership Council
Dr. Walsh led a discussion of the CRI Model and accomplishments being utilized by University Hospitals Case Medical Center and Case Western Reserve University.


Leadership Council

Dr. Walsh distributed divisional data from the Patient Satisfaction Survey for the Department of Medicine.


Leadership Council

There will not be a Leadership Council meeting in August. The next scheduled meeting is September 9, 2013.

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.