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October 29, 2010
Table of contents
UW Medicine, a leader in health services and comparative effectiveness research
Ensuring that we achieve health care quality, efficiency, cost-effectiveness, and access is critical to achieving our mission of improving the health of the public. Advances in medical knowledge, technology, and communication tools create new means to improve health. As the health-care environment becomes more complex and the rate of change accelerates, ensuring the highest quality and most patient-centered care depends on the collaboration, careful monitoring, and ongoing dedication of all health-care professionals. It also depends on effective, ongoing research about health technologies and medical information, and up-to-date information about how systems can best deliver care. Health services research and comparative effectiveness research (CER) are key areas of investigation.
UW Medicine is home to some of the most productive and innovative health services and CER researchers and scholars in the nation. The most recent indication of this prominent role is the success of UW Medicine faculty in securing $24 million in patient-centered research grants from the Agency for Healthcare Research and Quality (AHRQ). The principal investigators on these awards are Heidi Crane, UW assistant professor of medicine, Sean Sullivan, UW professor of pharmacy and health services, Jeffrey Jarvik, UW professor of radiology and neurosurgery and director of the Comparative Effectiveness, Cost and Outcomes Research Center, and David Flum, UW professor of surgery and medical director of the Surgical Clinical Outcomes Assessment Program (SCOAP) in Washington State. These projects focus on diverse areas: treatment of cardiovascular risk factors among HIV-infected patients (Crane), low back pain interventions in the elderly (Jarvik), improvement of SCOAP patient registries to track outcomes and measure quality and performance of surgery care throughout Washington State hospitals (Flum), and training researchers in comparative effectiveness (Sullivan). All have the potential to enhance success in improving quality of care.
Drs. Sullivan, Jarvik and Flum are the founding leaders of the UW Centers for Comparative and Health Systems Effectiveness (UW CHASE Alliance). This collaborative multidisciplinary group was started to create and sustain a multidisciplinary research and training environment to disseminate and implement CER. Individuals and centers in the schools of medicine, nursing, public health, pharmacy, and the VA Health Services Research & Development Center at VA Puget Sound Health Care System are participating in the CHASE Alliance.
In its short existence, the UW CHASE Alliance has had remarkable success achieving funding and furthering collaboration to advance CER. Cross-collaboration builds understanding, consensus, and common agendas. I would like to thank everyone involved in the UW CHASE Alliance for outstanding work on behalf of improving the health of the public.
Paul G. Ramsey, M.D.
UW Medicine team develops first implanted device to treat balance disorder
UW Medicine clinicians who developed the implantable device hope that success in a 10-person surgical trial of Meniere’s patients will lead to exploration of its usefulness with other common balance problems.
The device was invented by Jay T. Rubinstein and James O. Phillips. Rubinstein is UW professor of otolaryngology – head and neck surgery and bioengineering and director of the Virginia Merrill Bloedel Hearing Research Center. Phillips is UW research associate professor of otolaryngology – head and neck surgery and director of the Dizziness and Balance Center.
"What we're proposing here is a potentially safer and more effective therapy than exists now," said Rubinstein, who holds multiple U.S. patents.
Meniere’s disease affects hearing and balance. The conditions vary in intensity and frequency and can be extremely debilitating. Its episodic attacks are thought to stem from the rupture of an inner-ear membrane. Endolymphatic fluid leaking out of the vestibular system, causes havoc with the brain's perception of balance.
Many patients respond to first-line treatments of medication and changes to diet and activity. When those therapies fail to reduce the rate of attacks, surgery is often an effective but typically destructive option. The patient sacrifices function in the affected ear to halt the vertigo.
With their device, Phillips and Rubinstein aim to restore the patient's balance during attacks while leaving natural hearing and residual balance function intact.
A patient wears a processor behind the affected ear and activates it as an attack starts. The processor wirelessly signals the device, which is implanted almost directly underneath in a small well created in the temporal bone. The device in turn transmits electrical impulses through three electrodes inserted into the canals of the inner ear's bony labyrinth.
"It's an override," Phillips said. "It doesn't change what's happening in the ear, but it eliminates the symptoms while replacing the function of that ear until it recovers."
A National Institutes of Health grant funded the development of the device and its initial testing at the Washington National Primate Research Center. If human trials are successful, the implant could become the first-choice surgical intervention for Meniere's patients.
Other members of the research team were Steven Bierer, Albert Fuchs, Chris Kaneko, Leo Ling and Kaibao Nie, UW specialists in signal processing, brainstem physiology and vestibular neural coding.
Cochlear Ltd. of Lane Cove, Australia, a maker of devices for hearing-impaired people, will manufacture the device.
The UW is one of 41 research institutions participating in ResearchMatch, a National Institutes of Health (NIH) enterprise that helps match research studies and people who want to volunteer.
This is a nationwide effort to support research projects approved by Institutional Review Boards (IRB) at every level, said Beth Hacker, research navigator at the UW Institute of Translational Health Sciences, and ResearchMatch liaison. The IRB reviews research projects involving human subjects and assures that the safety, rights and welfare of participants are protected.
“Many people would like to participate in studies to advance health research, but they don’t know where to start. And, there are researchers looking for volunteers to participate in studies but finding it difficult to find enough participants to make their research statistically valid,” Hacker said. “A lot of IRB-approved research never advances because not enough people participate in the studies needed to test hypotheses, theories, protocols, that scientists put forth.”
ResearchMatch, funded by the NIH Clinical & Translational Science Awards, helps volunteers easily connect with research studies. It is an innovative national partnership to develop a centralized web-based recruitment registry.
Here’s how ResearchMatch works:
Joann G. Elmore, UW professor of medicine and adjunct professor of epidemiology, has stepped down after 10 years of distinguished service as the Division of General Internal Medicine (GIM) section head at Harborview Medical Center. Thomas D. Rea, associate professor of medicine in the division, will serve as acting section head during a national search for the position. Elmore will continue as a clinician, teacher, mentor, and researcher at Harborview.
GIM Division Head Steve Fihn praised Elmore’s work.
“During the decade that Joann has served as head of the section of GIM at HMC, there has been steady growth in the size and quality of the clinical, teaching, and research programs,” Fihn said. “She maintained a vibrant academic climate and created a robust mentorship program that enabled faculty to succeed. At the same time, her own investigative program flourished. She has become an internationally respected authority on screening for and diagnosis of cancer. I speak for the entire section at HMC in expressing my sincerest gratitude for her leadership.”
Get ready for flu season
A year ago, you could not escape “flu news.” Starting in the spring and peaking in the fall, the 2009 H1N1 influenza virus became the first pandemic, or global outbreak, in more than 40 years. Daily media stories highlighted its fast spread and substantial cases of hospitalizations and deaths.
In contrast to the H1N1 outbreak, our flu season typically begins in October or November when schools are back in session and the weather gets colder. It peaks in January and February, then ends during the spring. Even without a new pandemic, seasonal flu should not be taken lightly. According to the Centers for Disease Control and Prevention (CDC), 5 to 20 percent of Americans get the illness annually on average, and more than 200,000 people are hospitalized from flu-related complications.
Joan Goverman has been appointed chair of the UW School of Medicine Department of Immunology, after a nationwide search. She has been serving as acting chair since her predecessor Christopher B. Wilson retired from the position in 2009.
Goverman joined the UW faculty in 1992 as a member of the Department of Molecular Biotechnology; she joined the Department of Immunology in 1994. Goverman’s research interest is autoimmune disease and the mechanisms of acquiring immunological tolerance to self antigens.
Goverman received a bachelor’s degree in chemistry from Brandeis University and a doctoral degree in biological chemistry from the University of California, Los Angeles, where she also received a postdoctoral fellowship. Goverman received additional training at the California Institute of Technology.
UW School of Medicine faculty and staff will receive three of the Accreditation Council on Graduate Medical Education’s (ACGME) highest awards in March 2011.
Byron D. Joyner (left), UW professor and program director for the Department of Urology and associate dean for graduate medical education, and Karen J. Souter, UW associate professor and vice chair for education in the Department of Anesthesiology and Pain Medicine, and residency program director in anesthesiology, will each receive the Parker J. Palmer Courage to Teach Award. The award acknowledges and honors program directors for their innovative teaching of residents and their dedication to providing quality health care.
Joyner is responsible for the core curriculum and competency-based training of the urology residents at the UW. As associate dean, he is responsible for improving the institution's educational program, and leading efforts to develop and support program directors.
Souter (right), a specialist in neuroanesthesiology, is innovative and highly effective in using simulation and standardized patients to improve training in communication skills surrounding the disclosure of bad news and errors.
Michelle Rickard (left, below), academic programs manager in the Department of Pathology, will receive the ACGME GME Program Coordinator Excellence Award. The award honors and recognizes the crucial role that administrators play in the success of residency programs.
Michelle Rickard has served as program administrator for 13 years. She was recognized for her work as program manager of the Pathology Residency Program, as well as nine ACGME-accredited fellowship programs.
Michelle “has been a leader at the University of Washington,” said Larry Robinson, vice dean for clinical affairs and graduate medical education, in his nomination letter. Robinson singled out Rickard’s creativity and innovation on the job as well as cost-savings efforts and web-based tool and database development. “She has led the growth and expansion of the UW Pathology training programs from 32 trainees in six programs at five training sites in 1997 to the current 44 trainees in 11 programs in 11 training sites.”
Research suggests that the location of a physician’s residency training may be the strongest indicator of where that physician will choose to practice. Expanding graduate medical education (GME) residency training programs in rural areas can help rural communities ‘grow’ their own physician workforce. With a strong need for physicians in rural locales, the imperative is great.
Expanding the physician workforce in the WWAMI states (Washington, Wyoming, Alaska, Montana and Idaho) through GME was the topic of a GME Summit held Oct. 15 at Washington State University in Spokane. More than 150 faculty, administrators and community physicians from throughout the WWAMI region attended the daylong event. They discussed physician shortages and expanding GME training throughout the WWAMI region. The summit was convened by an advisory group to address GME expansion in eastern and central Washington. The advisory group was led by John McCarthy, assistant dean for regional affairs and WWAMI clinical coordinator for eastern and central Washington, and Deborah Harper, assistant dean for regional affairs and WWAMI clinical coordinator for Spokane and eastern Washington. The call for participation was distributed throughout the WWAMI region. As attendance indicated, the interest was widespread.
The UW School of Medicine, WWAMI UW Medicine, and Washington State University hosted the meeting. Participants discussed the future of the physician workforce, GME expansion, physician shortage in rural communities, residency financing and site accreditation and the challenges of expanding GME in specialty areas.
Paul Ramsey, CEO of UW Medicine and dean of the School of Medicine, opened the meeting and introduced State Representative John Driscoll, 6th district Spokane. Suzanne Allen (above, right), vice dean for regional affairs, was the moderator for the meeting. Jeanne K. Heard, senior vice-president of the Accreditation Committee for Graduate Medical Education (ACGME), provided perspectives on the organizational structure of ACGME. She spoke about accreditation standards and institutional commitments that must be made to become an accredited site for GME. Karen Fisher, senior director of Health Care Affairs at the Association of American Medical Colleges (AAMC), gave a detailed overview of the federal funding model for GME and the complexities that institutions may face as they become residency sites.
Other sessions featured the need for and challenges of specialty training programs in regional sites; institutional responsibilities and financing; physician workforce issues; teaching health centers; and regional graduate medical education models. During breakout sessions, community participants gathered by state. They shared thoughts on building the workforce and involving entire communities to ensure that health-care needs are met.
Teaching clinical reasoning at an early stage of medical students' training is a relatively new innovation in medical education and is popular with the students, according to an article written by George Novan, clinical professor of medicine and associate director of WWAMI Spokane Pre-Clinical Education.
It’s Never Too Early to Start appears in the October issue of the Spokane County Medical Society newsletter. In the article, Novan describes a course offered at WWAMI-Spokane for first-year medical students on clinical reasoning. He also discusses the rationale for forming the course, the incorporation of third- and fourth-year medical students in helping to teach first-year students, and other aspects of the course.
The WWAMI-Spokane program, the newest WWAMI site for first-year medical students, began in 2008. In its first two years, WWAMI Spokane held conferences three times each month to introduce first-year medical students to clinical cases. This year, the conferences have become a yearlong clinical reasoning course that students take for credit as a "non-clinical selective," meaning that students are not required to take the course. However, 100 percent of first-year students are enrolled, indicating its appeal.
WWAMI Spokane has expanded the course to include allied health professional students. Three upper division Washington State University College of Pharmacy students are taking the course with the medical students. Novan said that by expanding the teaching of clinical reasoning to first-year students and other health professional trainees, students will get a head start on their clinical years.
The following is a listing of some upcoming events that may be of interest to the UW Medicine community. Additional events are listed on the UW Medicine events calendar.
Bioethics Grand Rounds, Nov. 2
Should hospitals disclose adverse events that might harm multiple patients? 4 to 5 p.m., Tuesday, Nov. 2, Turner Auditorium, D-209 Health Sciences Bldg. Presenters discuss the ethical rationale for disclosure and non-disclosure. Presenters are Denise Dudzinski, UW associate professor of bioethics & humanities and chief of the Ethics Consultation Service at UW Medical Center; Thomas Gallagher, UW associate professor of internal medicine and bioethics & humanities; and Mary Beth Foglia, health care ethicist at the National Center for Ethics in Health Care, Veterans Administration, and affiliate faculty in bioethics & humanities. For more information, visit the Department of Bioethics & Humanities website or contact 206.543.5145 or firstname.lastname@example.org
UW Medicine & Seattle Public Library Lecture, Nov. 3
The gift of giving: How one living donor can start a chain of transplants by Connie Davis, UW professor of medicine and director of Kidney Care and Transplantation Services at UW Medical Center. With the demand for transplants far surpassing the supply of donated organs, new and innovative ideas are essential to helping thousands of patients. Davis will explain how organ transplantation works and how just one living donor can start a chain of transplants. Lecture takes place at 6:30 p.m., Wednesday, Nov. 3, Microsoft Auditorium, Central Public Library, 1000 Fourth Ave., Seattle. Contact Julie Collier at 206.685.1933 or email@example.com for more information. Or visit the Seattle Public Library website.
Continuing Medical Education
Visit Continuing Medical Education for more information on upcoming classes.