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October 5, 2012

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Message from Paul Ramsey

Paul G. Ramsey

Outstanding collaboration makes UW Medical Center's Montlake Tower a reality

Dear Colleagues:

It is a pleasure to announce the completion and opening of the Montlake Tower expansion of UW Medical Center. This 273,000-square-foot, eight-story addition to UW Medical Center’s south side strongly enhances UW Medicine’s ability to provide outstanding healthcare.

The $210 million project, under construction since 2009, features a 50-bed neonatal intensive care unit (NICU), a 30-bed unit for oncology patients, additional MRI and CT scanners, and state-of-the-art interventional radiology and hybrid procedure rooms. Oncology, radiology and the NICU each have a floor in the tower; two other floors will serve computer-service functions and three floors are slated for future clinical use. More detailed information and videos about the new units are available on the UWMC Montlake Tower Expansion webpage.

For those of you who have not yet seen the Tower, staff and faculty are invited to tour the new facility on Friday, Oct. 5, from 7-9 a.m., 11:30 a.m. to 1:30 p.m. and 5-7 p.m. A community open house will be held on Saturday, Oct. 6, 10 to noon.

The Montlake Tower has spacious patient rooms and work areas, beautiful views, and natural and custom lighting. In the planning process, the recommendations of a 2010 energy-reduction study by the UW’s Integrated Design Lab and a consortium of architects, engineers and construction companies were considered. The Montlake Tower is one of the most energy-efficient hospital additions in the Pacific Northwest, outperforming Seattle’s energy code by almost 30 percent. By employing LED lighting, solar shading and other recommendations, this “green building” will save approximately $276,000 in energy costs each year.

UWMC_Montlake TowerThe Tower was designed by NBBJ Architects and built by SKANSKA USA. I extend my thanks to these outstanding companies for their superb work.

Many other individuals and groups also had major roles in making Montlake Tower a reality. Johnese Spisso, chief health system officer for UW Medicine and vice president for medical affairs, University of Washington has been a tireless, dedicated leader, from start to finish. Stephen Zieniewicz, executive director of UW Medical Center, has also been a strongly committed project leader.

Helen Shawcroft, senior associate administrator at UW Medical Center, provided outstanding leadership that contributed to the on-time, on-budget construction. Kathleen Schaefers, design and construction manager, also did a superb job. Others with key roles include the Patient Advisory Council and our corporate partners.

In U.S. News & World Report’s 2012 edition of America’s Best Hospitals, UW Medical Center is ranked No. 1 in both the region and state, with Harborview Medical Center ranked No. 2 out of 35 hospitals in the Seattle metropolitan area and more than 100 hospitals in the state. Valley Medical Center is ranked No. 4 in the metropolitan region and No. 7 in the state. The new expansion of UW Medical Center will further increase the ability of all of our hospitals, clinics and healthcare professionals to offer the best care for our patients. This expansion adds immeasurably to our ability to improve the health of our community members.

Thank you to everyone who was involved in the planning and execution of this superb addition to UW Medicine.


PGRamsey Signature2


Paul G. Ramsey, M.D.
CEO, UW Medicine
Executive Vice President for Medical Affairs and
Dean of the School of Medicine,
University of Washington





Dynamics of DNA packaging help regulate heart formation

Chuck MurryA new regulator for heart formation has been discovered by studying how embryonic stem cells adjust the packaging of their DNA. This approach to finding genetic regulators may have the power to provide insight into the development of any tissue in the body, including liver, brain, blood and others. A stem cell has the potential to become any type of cell.

A UW-led research team was particularly interested in how stem cells turn into heart muscle cells. This knowledge may further research on repairing damaged hearts through tissue regeneration. The leaders of the project were Charles Murry, professor of pathology, bioengineering and medicine, and cardiac pathologist and stem cell biologist (photo, right); Randall Moon, professor of pharmacology, who studies the control of embryonic development; and John Stamatoyannopoulos, associate professor of genome sciences, who explores the operating systems of the human genome. The paper’s lead author is Sharon Paige, a UW M.D./Ph.D. student who completed her doctoral degree in Murry’s lab.

The results are published in the Sept. 28 edition of Cell.

Paige, an aspiring pediatric cardiologist, said, “By identifying regulators of cardiac development, this work has the potential to lead to a better understanding of the causes of congenital heart disease, thereby paving the way for therapeutic advances.”

Previously, UW researchers had examined the signals that lead cells to grow into various kinds of heart tissue. In this case, the researchers entered a relatively unexplored area. They decided to look at the genetic controls behind the transformation of stem cells into heart tissue. Because stem cells keep their DNA code unrevealed until needed, the scientists examined how this packaging is altered over time to permit reading of portions of the code and thereby produce changes in the cell.

The researchers pointed out that it was already known that the patterns that stem cells follow to modify their DNA packaging distinguished them from progenitor cells—cells prepared to begin a lineage of a particular type of cell—and also from cells that already had a working identity, such as blood or muscle cells.

However, the dynamics of the DNA packaging modifications—how the packaging is programmed to change over time—and how these dynamics influence which genes are “exposed” and activated to create, for example, heart muscle cells, were poorly understood.

The UW-led research team learned that, as human embryonic stem cells become heart cells, this differentiation is accompanied by distinctive dynamic alterations in DNA packaging. This tell-tale pattern enabled the scientists to distinguish the key regulators of heart development from other genes.

Read more in UW Today.   

Duplex-sequencing method could lead to better cancer detection and treatment

LoebLabDuplexThe 'simple' idea of two young UW researchers may lead to reduced error rate in DNA sequencing and eventually better treatment and diagnosis of cancer. In a study published in the Proceedings of the National Academy of Sciences, Michael Schmitt, postdoctoral fellow, and Jesse Salk, M.D./Ph.D. candidate, proposed that by reducing the error rate in DNA sequencing, researchers could better pinpoint which cells are mutating. This improvement could lead to early diagnosis of cancer and a better treatment plan once researchers knew which cells were resistant to chemotherapy. 

Two University of Washington researchers, Michael Schmitt and Jesse Salk, talked about a simple but powerful idea to get better results when looking at cancer cells. If they could reduce the error rate in DNA sequencing, then researchers could better pinpoint which cells are mutating.

This improvement could lead to early diagnosis of cancer and a better treatment plan once researchers knew which cells were resistant to chemotherapy.

The idea was to sequence both strands of DNA. If researchers saw a mutation in one strand but not the other, they would recognize it as error from sequencing and not a true mutation. Their results, published online in the Proceedings of the National Academy of Sciences in August, are getting wide accolades.

“If its power is confirmed, duplex sequencing will likely improve our understanding of the clonal substructure of human cancers, modify the catalog of rare mutations, help to pinpoint mechanisms of mutation generation, and potentially identify mutator phenotypes,” wrote Christopher Klein, with the Experimental Medicine and Therapy Research group at the University of Regensburg, in an accompanying editorial. “Eventually, it may open doors to clinical applications in which diagnostic accuracy is the sine qua non for ethical treatment decisions.

Working in Lawrence Loeb’s cancer research laboratory at the UW, the scientists demonstrated an error rate of less than one mistake per half a million nucleotides sequenced and a theoretical limit of less than one error per billion nucleotides. In contrast, the standard method yielded one error for every 200 nucleotides.

“Based on our estimates, we appear to have improved the accuracy of sequencing by 10 million-fold or more,” said Schmitt, the lead author of the paper, “Detection of ultra-rare mutations by next-generation sequencing.” Schmitt, a postdoctoral fellow in the Loeb lab, added, “This theoretically makes it possible to sequence the entire genome of a cell without a single error.”

Read more in UW Today


(Photo: Some of the members of the Loeb lab who worked on the duplex sequencing: Lawrence Loeb, Scott Kennedy, Michael Schmitt and Jesse Salk. Photo by Mary Levin.)






Clinical Care 

UW launches Palliative Care Center of Excellence Oct. 8

Randy Curtis2With its official launch Oct. 8, the UW Palliative Care Center of Excellence will be poised to become an international leader in advancing the science and the delivery of palliative and end-of-life care for patients with chronic and life-limiting illnesses.

The UW Palliative Care Center of Excellence will bring together individual leaders who are recognized for palliative care research, education and clinical care across the health sciences disciplines.

“We are fortunate that the UW has pockets of excellence in palliative care across the health sciences schools and UW Medicine clinical sites,” said J. Randall Curtis, UW professor of pulmonary and critical care medicine and director of the new UW Palliative Care Center of Excellence.

“However, there has not been a systematic coordination and integration of all these activities. The Center will be one of few academic palliative care institutions in the nation to comprehensively advance the science of palliative and end-of-life care by increasing interdisciplinary and interprofessional collaborations in research, education and clinical care. Of course, the ultimate goal is to improve quality of care for patients and their families.”

Curtis, an international authority on critical, palliative and end-of-life care, was recently named the first holder of the A. Bruce Montgomery-American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine. Curtis will co-direct the UW Palliative Care Center of Excellence with Anthony Back, professor of medicine in the Division of Oncology.

Other UW faculty assuming leadership roles in the new center are Stuart Farber, professor of family medicine; Darrell Owens, clinical assistant professor of medicine and director of outpatient palliative medicine servicesat Harborview Medical Center; Wayne McCormick, professor in geriatrics and gerontology and director of the palliative medicine fellowship; Elizabeth Loggers, assistant professor in medical oncology and director of palliative care at the Seattle Cancer Care Alliance; Ruth Engelberg, research associate professor in pulmonary and critical care medicine and associate director of end of life care program at Harborview Medical Center; and Helene Starks, associate professor of bioethics and humanities.

Susan BlockThe new UW Palliative Care Center of Excellence will be officially launched with the center's inaugural visiting lecture by Susan Block, professor of psychiatry and medicine at Harvard Medical School and co-director of the Harvard Medical School Center for Palliative Care (photo, left). Block is chair of the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston.

Block will give the lecture, Moving Conversations about the End of Life Upstream: The Serious Illness Communication Checklist, at 4 p.m., Monday, Oct. 8, in Room T-625, Health Sciences Building. Block, an international leader in palliative care, has directed national and international faculty development programs for palliative care clinicians. She studies interventions to improve communication in the setting of serious illness, psychological issues in palliative care and medical education.

Curtis will be recognized for holding the first endowed chair in pulmonary and critical care medicine at a reception following Block’s lecture.

For more information, please visit the new Palliative Care Center for Excellence website.


UW Medicine medical centers achieve high marks on UHC Quality and Accountability Performance Scorecard

UW Medicine’s Harborview Medical Center and UW Medical Center continue to rise on the UHC Quality and Accountability Study. In the 2012 UHC rankings, Harborview was ranked No. 23 and UW Medical Center was ranked No. 31 overall in the nation out of 101 academic healthcare facilities. Additional highlights included Harborview and UW Medical Center both being ranked #1 for equity; Harborview being ranked in the top three for effectiveness; UW Medical Center being ranked in the top 25 for mortality and both hospitals being ranked in the top 20 for safety.

The UHC Scorecard is an important benchmark that allows participating hospitals to compare their performance to more than 100 peer university hospitals based on the Institute of Medicine’s domains of care. The Quality and Accountability Study was designed to help academic medical centers identify structures and practices that are associated with high performance in quality and safety.

UHC, an alliance of the nation’s leading nonprofit academic medical centers, measures performance on mortality, effectiveness, safety, equity, patient-centeredness and efficiency. At UW Medicine, high performance in these areas is a top priority. As a result of UW Medicine’s Patients Are First initiative, tremendous progress has been made since the first scorecard in 2005. The next goal is to win the UHC Quality Leadership Award by being one of the top 10 institutions in the country.

  • The No. 1 ranking for equity reflects UW Medicine’s mission of providing quality and safe care for patients from all walks of life. Success in this area reflects the provision of excellent care for some of the sickest patients within the UHC membership.

  • Effectiveness scores are based on core measures for quality care related to heart attacks, heart failure, pneumonia, selected surgical procedures and readmissions. In July, UW Medicine’s excellent performance resulted in achieving a first-ever 100-percent score by providing the correct care for every patient included in these sets of core measures.

  • Safety scores are based on hospital-acquired events such as infections, pressure ulcers and events related to operative procedures. UW Medicine’s keys to success in this area include timely review of all events, continual attention to hand washing, careful cleaning of patient rooms, use of bundle practices and a daily commitment to provide safe, evidenced-based care.

  • Efficiency rankings are based on comparing “observed” or actual cost and length of stay to “expected” cost and length of stay. UW Medicine’s progress in this area reflects the work of many teams and medical services in implementing process improvements and standardization methods.

  • Documentation is a key component in mortality rankings, which compares the “observed” or actual number of deaths to the number of deaths “expected” based on the acuity of illness or injury. UW Medicine continued to provide 100 percent mortality review, with a focus on improved accuracy in documentation and coding of patient care.

  • Patient-centeredness measures the 10 HCAHPS patient survey questions. Because UHC uses data that is well over a year old for this score, it is expected that next year’s study will begin to reflect the improvements in patient satisfaction achieved through the implementation of Patients are First across the organization.

The 2012 UHC results are a credit to the continued efforts of UW Medicine faculty and staff and the focus on patient safety, quality and service at each site. 





Education and Training 

MEDEX program expands to UW Tacoma 

Ruth Ballweg

MEDEX Northwest, the UW School of Medicine’s physician assistant training program, has received $887,301 in federal funding to expand its training program to the University of Washington Tacoma campus. The funding is part of a national initiative to increase educational and employment opportunities for returning military veterans and to boost the healthcare workforce in primary care in rural and underserved areas.

Last year, the Health Resources and Services Administration (HRSA) gave funding priority to universities and colleges with physician assistant programs that actively recruit, retain and mentor military veterans. They were also seeking model programs that could be replicated across the country to increase the healthcare labor workforce.

Physician assistants (PAs) are healthcare professionals licensed to practice medicine with physician supervision. PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in virtually all states can write prescriptions. Within the physician-PA relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services. A PA's practice may also include education, research, and administrative services. All PA education programs must be accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

“Of all the PA programs in the country, we are seen as the number one champion for physician assistant training among experienced healthcare workers and the military,” said Ruth Ballweg, MEDEX director. “A big part of our history is training military personnel. Of our nearly 1,900 graduates, about 620 are military people. This funding allows us to add 24 training slots to the UW Tacoma campus, which is actively engaged in outreach with the returning military community and has a good working relationship and partnership with Joint Base Lewis-McChord.”

The new Tacoma training site will join existing MEDEX sites located in Seattle, Yakima, Spokane, Wash., and Anchorage, Alaska. Bachelor’s degree programs will be offered at the Anchorage, Yakima and Tacoma sites, while master’s degree programs will be offered at the Seattle and Spokane sites. The Tacoma program will begin officially in spring 2013 with an online lead-in to later classroom instruction. The site director is Henry Stoll.

Ballweg said the goal of the MEDEX program is to increase educational access for qualified applicants but also to provide affordable primary care in rural and underserved communities throughout the Pacific Northwest. Ballweg noted that, ironically, veterans with medical backgrounds have the highest unemployment among all veterans because members of the civilian community have a hard time translating the medical experience of military medics and corpsmen into actual jobs in healthcare.

“Their training and experience on the battlefield is not understood. They’re not civilian nurses; they’re not paramedics. So, the community asks, ‘What are they?’ The MEDEX program values the experiences and qualities that military folks bring to the table,” Ballweg said.

“Since we’ve been training physician assistants since 1969, we know that military personnel are highly likely to go into primary care and have the experience of, and often the preference for, working in rural and remote communities. They are used to having a lot of responsibility and taking charge.”


New appointments in UW Medicine Alumni Relations

Annie Pontrelli, formerly director of UW Medicine Alumni Relations, has been named director of Medical Alumni Affairs, overseeing regional alumni programs. In this position, Pontrelli will build upon the many relationships she has made while connecting alumni with a vital part of the School of Medicine’s mission—educating students from the WWAMI region for the WWAMI region.

“I can’t believe I’ve been working with UW Medicine alumni for almost 12 years,” says Pontrelli. “Everyone has been so supportive, and I have had the opportunity to work with wonderful alumni. I’m looking forward to meeting many more of you in the months ahead!”

Sarah Brown Rothschild, who joined UW Medicine Advancement in September, succeeds Pontrelli as director of Alumni Relations. Rothschild has a decade of experience in alumni and media relations, with positions at the University of Arkansas Alumni Association, the University of Virginia and the Atlantic Coast Conference in Greensboro, N.C. Rothschild, who holds a bachelor’s degree in psychology from the University of Virginia, is excited to be at UW Medicine.

“I am thrilled to join the UW Medicine family, and I look forward to meeting and working with alumni to continue building a vibrant and relevant alumni association for you,” Rothschild says.

Pontrelli can be reached at pontrell@uw.edu and Rothchild at rothsb@uw.edu.



WWAMI Regional News  

Y. Ki Shin, new assistant clinical dean, helps western Washington WWAMI develop training sites 

Dr. Y.KiShinY. Ki Shin has been named the new western Washington assistant clinical dean. Shin, a general internist in Montesano, Wash., will develop clinical sites and workforce training across western Washington (excluding Seattle).

Shin, who started in his new position July 1, is a 1993 WWAMI graduate and internal medicine Boise Primary Care Track residency graduate. He has been a preceptor in the Rural/Underserved Opportunities Program (R/UOP) since 1998 and teaches third-year students on their outpatient internal medicine rotation.

Since July, Shin has assisted clerkship directors with the development of new clerkships in internal medicine and neurology in Olympia, obstetrics and gynecology in Bellingham, and neurology in Tacoma. He is also working to develop more R/UOP locations and other rural rotations around western Washington. He is also working closely with the MEDEX program to establish rural rotations for physician assistant students.

"Aas a graduate of UW who benefited from multiple WWAMI programs, I am very excited to further expand WWAMI exposure to western Washington, and to improve the work force development to needed communities in our region,” Shin said.

There are five TRUST (Targeted Rural and Underserved Track) sites in western Washington and three of them will have WRITE (WWAMI Rural Integrated Training Experience) students in 2013. WRITE students will participate in a longitudinal integrated clerkship program in the communities of Ferndale, Port Townsend and Shelton. Students will complete a community service project and participate in community activities as part of their experience.

Future plans in western Washington include the development of one to two more TRUST sites and expansion of WRITE to as many as thirty weeks to include emergency medicine and rural surgery. Discussion is also underway with several western Washington communities to develop opportunities in rural training for residents.



Upcoming Events

The following events may be of interest to the UW Medicine community:    


National Primary Care Week, Oct. 8 - 12

UW School of Medicine students host a week of exploration of primary care medicine. Through lectures, discussion and film, students will learn about various aspects of primary care medicine. Topics include community specialization and provider diversity in primary care, local to global approach to primary care, appropriate and accessible care for the LGBTQ community, fellowship opportunities in primary care, and  the National Health Service Corps. For more information, visit the UW Department of Family Medicine's Medical Student Education webpage or contact Morgan Cunningham at morganc4@uw.edu or Lauren Hanson at leh5@uw.edu.

Findlay Wallace Symposium, Oct. 9

The Findlay Wallace Symposium: The Future of Graduate Medical Education, honoring the life and work of James Findlay Wallace, UW professor emeritus of medicine in the Division of General Internal Medicine. Wallace was director of the UW Internal Medicine Residency Program from 1977 to 2007 and led the program to national prominence. The symposium will be held from 1 to 5 p.m., Tuesday, Oct. 9 in Hogness Auditorium in the Magnuson Health Sciences Center. A reception will follow in the center’s lobby. Visit the General Internal Medicine website for more information. 

Science in Medicine Lecture, Oct. 15

New Strategies for HIV Prevention in Africa: Envisioning the End of AIDS, 1 to 2 p.m., Monday, Oct. 15, Magnuson Health Sciences Center, T-733. Jared Baeten, UW associate professor of global health and medicine, will give the lecture. Baeten studies epidemiologic and biologic risk factors for HIV-1 and other sexually transmitted diseases, and conducts clinical trials of novel interventions for prevention of HIV-1 transmission. He is co-chair of the Partners PrEP Study, a randomized clinical trial that demonstrated that tenofovir and emtricitabine/tenovir provided protection against HIV-1 acquisition among 4,758 HIV-1 uninfected heterosexual men and women in Kenya and Uganda who had known HIV-1-infected partners.The free lecture is open to all faculty, staff and students. No registration is required. Visit the Office of Research and Graduate Education webpage or contact Susan McCrary at smccrary@uw.edu or 206.221.5807 for more information.

Faculty Development Workshop, Oct. 15 

Faculty Work-Life Balance, an Interactive Workshop, 7:30 a.m. to noon, Monday, October 15, Magnuson Health Sciences Center, E-202. This workshop will help faculty develop approaches to work-life balance through resources, guided imagery, narrative reflection and other techniques. Presenters will be Paul Ramsey, Chris Surawicz, Claudia Finkelstein, Charles Meredith, Cora Breuner, and Valerie Ross. More information and registration are available on the faculty development website (UWNetID required).  Contact Michelle Walter at mmwalter@uw.edu  or 206.543.6232 for more information.

Faculty Development Workshop, Oct. 16

Skills for Small-Group Teaching in the Health Sciences, 8:30 a.m. to noon, Tuesday, Oct. 16, Waterfront Activity Center, UW Seattle campus. The workshop will cover effective small-group teaching techniques, including the planning and implementation of discussions that actively engage learners in course content. Presenters will be Lynne Robins, Chris Surawicz and Bruce Silverstein. The workshop is sponsored by the Office of Faculty Development and the Department of Biomedical Informatics and Medical Education. The workshop is free to all School of Medicine and health sciences faculty members. Registration is required. For registration and more information, visit the Department of Biomedical Informatics and Medical Education website or contact Rachael Hogan at rhogan@uw.edu  or 206.616.9875.

Medical team volunteers needed for Seattle Marathon, Nov. 25

UW Medicine is seeking medical and administrative volunteers for the Seattle Marathon, Sunday, Nov. 25.  Directed by Mark Harrast, UW clinical associate professor of rehabilitation medicine, orthopedics and sports medicine, the medical teams will manage six stations along the course and two at the finish line. More than 10,000 runners are expected to participate in the Marathon and Half-Marathon races during the Thanksgiving Holiday weekend. Volunteers can sign up for all-day, morning or afternoon shifts. A medical team orientation will take place Tuesday, Nov. 20, in the evening. To volunteer, complete the Seattle Marathon Medical Team Volunteer Registration. For more information, contact Mia Coleman at miac@uw.edu.

Continuing Medical Education

Visit Continuing Medical Education for more information on upcoming classes.



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