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April 29, 2011
Table of contents
Global successes: WWAMI goes to Africa and I-TECH receives new funding
An article in this month’s AAMC Reporter, the flagship news publication of the Association of American Medical Colleges, describes the UW School of Medicine’s success through its WWAMI program in providing health care for large underserved regions of Washington, Wyoming, Alaska, Montana and Idaho. The article goes on to link that success with the goals of a program to provide health training in Africa that was funded last fall. UW Medicine and the UW School of Medicine are having an enormous impact throughout the world, and at least one global health program now has WWAMI as its model.
The UW is one of more than 40 medical schools and health organizations in the United States and Africa that are involved in the president’s Emergency Plan for AIDS Relief’s (PEPFAR) Medical Education Partnership Initiative (MEPI), a program to strengthen medical education and build health infrastructure, research capacity and health workforce in Africa. In late 2010, Carey Farquhar, associate professor of medicine, epidemiology and global health, along with a colleague at the University of Nairobi, received a grant from PEPFAR. Using the WWAMI model, faculty from the UW and University of Nairobi are recruiting local physicians to mentor medical students and residents in outlying areas. The program makes use of distance technology and mobile phone applications.
In addition, this month, the Department of Global Health’s International Training and Education Center for Health (I-TECH) received a $300 million competitive award from the U.S. Health Resources and Services Administration focused on health training in Africa, Asia and the Caribbean. I-TECH has been in existence since 2002. It initially focused on training health care workers about HIV and AIDS and now is addressing broader capacity development efforts.
I would like to offer my congratulations and thanks to Carey Farquhar for her work in Africa, to the faculty and staff of I-TECH for their superb accomplishments, and to all of the faculty and staff in the Department of Global Health.
I would also like to thank the faculty, staff and trainees of the WWAMI program, past and present, who have built an exceptional 40-year-old model that serves our region and that is now emulated worldwide.
Paul G. Ramsey, M.D.
(Photo above, left: A trainee in I-TECH's HIV course for Tecnicos de Medicine in Nampula, Mozambique, sees a pediatric patient under the guidance of an experienced clinician. Photo by Tom Furtwangler.)
The Human Frontier Science Program (HFSP) has awarded Rachel O. Wong, UW professor in the Department of Biological Structure, a three-year program grant for her international research project, Structural and functional assembly of ribbon synapses in the retina.
Wong studies how precise circuit connections are formed and maintained between neurons in the developing nervous system. By studying cellular interactions in zebrafish and mice retina, she and her team hope to reveal how circuits with specific functions are assembled during development.
HFSP collaborative research grants are given for a broad range of projects under the rubric of “complex mechanisms of living organisms.” Particular emphasis is placed on cutting-edge, risky projects. The grants are awarded to international teams and strong preference is given to intercontinental collaborations. Wong’s collaborators and fellow award recipients are: Leon Lagnado, Medical Research Council Laboratory of Molecular Biology in Cambridge, UK, and Frank Schmitz of the Institute of Anatomy and Cell Biology at Saarland University in Homburg, Germany.
This year, HFSP selected 22 program grants from more than 650 original letters of intent and 88 subsequently invited full applications.
Mitral regurgitation is common, with 80 percent of the population having some normal detectable valve leakage. Mild regurgitation rarely leads to problems or disease. Severe regurgitation, while relatively uncommon, can lead to heart-failure symptoms and death if left untreated. Both can be prevented by surgical mitral-valve repair or replacement. As an article in the April 4 New England Journal of Medicine (NEJM) explains, a new nonsurgical approach using an implanted mitral valve clip, if proven safe and effective, may become another treatment option in the future.
As minimally invasive devices become available during the next few years, cardiologists will face some difficult challenges in clinical decision-making, write Catherine Otto and Edward Verrier in an April 4 editorial in NEJM. Otto is a UW professor of medicine and director of the Cardiovascular Disease Fellowship Training Program, Verrier is a professor of surgery and chief of the Division of Cardiothoracic Surgery. He is also vice chair for clinical affairs in the Department of Surgery.
Otto and Verrier write that a cardiologist typically decides when surgery is needed and refers the patient to a cardiac surgeon. As new interventions become available, cardiologists and patients should consider all the choices, such as watchful waiting, medical therapy, percutaneous intervention, and surgical valve repair or replacement.
“To ensure that we do what is best for each patient, we propose a patient-centered approach to decision making in adults with valvular heart disease,” write Otto and Verrier. “Instead of the traditional ‘consensus of one,’ we need a true consensus of experts with review of each case by a multidisciplinary panel that includes, at a minimum, a nonprocedural valve-disease specialist, an interventional cardiologist, and a cardiac surgeon. The panel’s recommendation should be based on documentation of severe valve dysfunction and indications for intervention, a patient-specific procedural risk assessment, expected anatomical and functional results, expected improvement in clinical symptoms and quality of life, potential medication changes (including anticoagulation), long-term outcome data on survival and repeat procedures, and preferences of the patient.”
Read the editorial in NEJM (subscription required)
UW Medicine’s top research awards have been listed for the period of January through March, 2011. The list draws from all awards, regardless of whether for a new project or an additional award installment to an existing project.
The American Academy of Neurology has issued a new guideline on the most effective treatments for diabetic nerve pain, the burning or tingling pain in the hands and feet that affects millions of people with diabetes. Gary Franklin, UW research professor in environmental and occupational health sciences, is co-author of the guideline article, published in the April 11 online issue of Neurology, and presented April 11 at the American Academy of Neurology’s Annual Meeting in Honolulu.
It is estimated that diabetic nerve pain affects 16 percent of the more than 25 million people living with diabetes in the United States. It is often unreported and more often untreated, with an estimated two out of five cases not receiving care.
According to the guideline, strong evidence shows the seizure drug pregabalin is effective in treating diabetic nerve pain and can improve quality of life; however, doctors should determine if it is appropriate for their patients on a case-by-case basis.
In addition, the guideline found that several other treatments are probably effective and should be considered, including the seizure drugs gabapentin and valproate, antidepressants such as venlafaxine, duloxetine and amitriptyline and painkillers such as opioids and capsaicin. Transcutaneous electric nerve stimulation (TENS), a widely used pain therapy involving a portable device, was also found to be probably effective for treating diabetic nerve pain.
These recommendations will be the foundation for a new set of tools the AAN is creating for doctors to measure the quality of care they provide people with nerve pain. The measures will be released in 2012.
The guideline was developed in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation. The guideline will also appear in the April edition of the journal Muscle and Nerve from the American Association of Neuromuscular and Electrodiagnostic Medicine as well as the April issue of PM&R, the American Academy of Physical Medicine and Rehabilitation’s scientific journal.
Read the article in Neurology.
Read the new AAN Guideline for Treating Diabetic Nerve Pain.
Twice in three years: that’s how frequently Washington Secretary of Health Mary Selecky has brought Washington’s Excellence in Health Care Award to Harborview Medical Center.
Selecky presented the 2010 Warren Featherstone Reid Award April 19 to Robert Harrington, medical director of the Madison Clinic at Harborview and UW professor of medicine in the Division of Allergy and Infectious Diseases, and Eileen Whalen, executive director at Harborview, to honor the hospital’s satellite clinics for HIV/AIDS care in Everett and Bremerton. Harborview’s Pioneer Square Clinic earned the award in 2008.
Christian Ramers is the primary clinician at the Everett site and one of four who staff the Kitsap site. Mary Campbell provides back-up at the Everett clinic. Harrington, Shireesha Dhanireddy and Nina Kim are other UW physicians representing UW’s Departments of Allergy and Infectious Diseases and Global Health who started and still staff the first satellite clinic in Bremerton.
“In general the HIV epidemic is becoming de-urbanized, and more rural areas are underserved by both primary care and HIV providers,” said Harrington, a driving force behind the program’s creation. “The enrollment for both clinics has gone up in the past two years. The word is out, thanks to partners like the Evergreen AIDS Foundation in Snohomish. We see a lot of patients who previously have not been in care at all. This is their entry point into taking care for themselves, so it makes a huge impact.”
Selecky thanked Harborview for its motivation to take a quality program beyond King County.
“Recognizing that government doesn't have as much money doesn't stop a person from coming in the (hospital) door, and doesn't stop all of us from having passion to connect with that person, to get them to the right service at the right time,” said Selecky.
She went on to compliment Harborview for leading the way in developing this much-needed service through multiple partnerships.
The HIV/AIDS program is “absolutely part of our mission,” Whalen said in conveying her gratitude to staff assembled at the award ceremony. “We are the safety net. Thank you, all, for your commitment and passion and making a difference in our patient’s lives each and every day.”
(Photo above, right: From left, Washington Health Secretary Mary Selecky, Madison Clinic Medical Director Dr. Robert Harrington, Harborview Executive Director Eileen Whalen, and Everett clinic patient Marilyn Mora. Photo by Clare McLean.)
Nicole Gibran, UW professor in the Department of Surgery and director of the Burn Center at Harborview Medical Center, became the president of the American Burn Association (ABA) April 1 for the 2011 – 2012 term.
The ABA is dedicated to improving the lives of everyone affected by burn injury through patient care, education, research and advocacy. The ABA has more than 3,500 members worldwide. Members include physicians, nurses, occupational and physical therapists, researchers, social workers, firefighters and hospitals with burn centers. Elected by members, Gibran is the first woman to hold this position.
Peter Tarczy-Hornoch, UW professor of pediatrics and of medical education and biomedical informatics, will serve as acting chair of the Department of Medical Education and Biomedical Informatics, effective June 1.
In announcing the news to the department, Dean Paul Ramsey wrote: “Under [Fred’s] leadership, your department has grown substantially and made outstanding contributions to medical education, biomedical and health informatics, and the education of physician assistants. I am very grateful to have had the opportunity to work with Fred during this time.”
Bruder Stapleton, the Ford/Morgan Endowed Chair of Pediatrics, will be honored with the 2011 Founder’s Award from the American Society of Pediatric Nephrology (ASPN) April 30 in Denver, Colo. The award recognizes individuals who have made a unique and lasting contribution to the field of pediatric nephrology.
Stapleton is associate dean at the UW School of Medicine, and chief academic officer and senior vice president at Seattle Children’s. He is president-elect of the American Pediatric Society, effective in May, and is a past president of the American Society of Pediatric Nephrology. Stapleton is the founding editor of Journal Watch Pediatrics and Adolescent Medicine and editor-in chief of UpToDate in Pediatrics, an electronic educational program offered in cooperation with the American Academy of Pediatrics. It is the most commonly used pediatric care resource worldwide.
Stapleton’s research interests have included uric acid disorders and kidney stone disease in children. His research identified excess amounts of calcium in the urine (hypercalciuria) as a cause of blood in the urine (hematuria) of children.
Mary L. “Nora” Disis, UW professor of medicine in the Division of Oncology and associate dean for translational science, was elected to the Association of American Physicians (AAP) and was honored at the association’s annual meeting April 15-17.
Disis is a fellow of the American College of Physicians and a member of the American Society of Clinical Investigation. An authority in breast and ovarian cancer immunology, she is founder and director of the UW Tumor Vaccine Group and director of the UW Institute of Translational Health Sciences.
The AAP is a 125-year-old professional organization dedicated to the advancement and application of medical science. It has over 1,300 members and about 600 emeritus and international honorary members.
Spokane’s first-year medical students were looking for opportunities to improve the lives of people in the community they serve. In 2010, with suggestions from community leaders, the class partnered with the House of Charity, a local homeless shelter serving some of the most disenfranchised members of the community. In conjunction with the Spokane WWAMI Clinical Medical Education office, physician volunteers were recruited and the shelter’s free clinic hours of operation were expanded to include a Saturday morning clinic and extended from two to three half days.
Over the past year, the program has grown to include third- and fourth-year students, as well as more than forty community physicians. The program provides a unique learning environment by connecting the first-, third- and fourth-year students with community physicians.
The House of Charity service learning project has become a valuable tool for students to expand their medical knowledge and clinical skills and appreciate the impact of their efforts. Student participation and dedication to the clinic has been exceptional.
“The House of Charity Saturday Clinic provides us a way to practice clinical skills and develop real world context for our science courses,” said Jenn Hadlock, one of the student clinic coordinators. “We also see how many complex factors affect the well-being of patients in underserved populations. Getting to spend time in the community helps me stay connected with the reasons I chose to go into medicine and motivates me to do everything I can to prepare well for a future of patient care.”
Colette Inaba, second-year medical student and one of the students spearheading the project, presented a poster in Carmel, Calif. at the Western Student Medical Research Forum earlier this year. She postulated that the extension of the clinic’s hours saved the community a significant number of emergency room visits.
Medical students in the project look forward to continuing this community partnership to meet the needs of the underserved and also look forward to collaborating with other students in the health sciences.
At the invitation of medical student coordinators, MEDEX physician assistant students have recently joined the corps of student volunteers. Pharmacy, physical therapy and nursing students have also expressed interest in joining the project.
For more information about Spokane service learning, contact John McCarthy, WWAMI assistant dean, Central and Eastern Washington University, at email@example.com or 509.358.7794.
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.
2011 March for Babies Walk, April 30
The 2011 March for Babies, a national multi-year campaign of the March of Dimes, takes place Saturday, April 30 at Fisher Pavilion at Seattle Center. The 3.1 mile walk raises awareness and funds to reduce the rate of premature birth. Registration begins at 8 a.m. The walk leaves Fisher Pavilion at 9 a.m. UW Medicine faculty and staff are encouraged to participate. To register, select the Greater Puget Sound walk, fill out your personal information and enter "UW Medicine" under "What's your team's name?" All participants will receive a UW Medicine T-Shirt. Contact Christine Sampson, NICU nurse manager, at 206.598.4611 for more information.
18th Annual John Butler Endowed Lecture, May 2
18th Annual John Butler Endowed Lecture, May 2
Pulmonary Surfactant: Soap, Glue and a Link between Innate and Adaptive Immunity by Jo Rae Wright, professor of cell biology, pediatrics and medicine at Duke University, where she is vice provost and dean of the graduate school, 4 p.m., May 2, Orin Smith Auditorium at South Lake Union. Presented by the Division of Pulmonary and Critical Care in the Department of Medicine. Call 206.543.3166 for more information.
Career Development Seminar Series, May 5
Behind Closed Doors: Secrets of a Study Section by Paul Martin, UW professor of medicine, member, Fred Hutchinson Cancer Research Center, 4 p.m., May 5, C123 A&B, Administrative Building, South Lake Union. What happens to your grant once it gets to a study section? Martin will leverage his experience as a seasoned NIH grant reviewer, including his tenure as chair of the Cancer Immunopathology and Immunotherapy Study Section, to provide insight into the workings of NIH study sections. Martin will discuss the fundamentals of grant review, including an overview of study sections, grant scoring and common mistakes of first time grant applicants. The likelihood of a successful grant application is increased by a thorough understanding of the review process. Sponsored by the Institute of Translational Health Sciences Education Core. The event will be Webcast. Contact Lalitha Subramanian at firstname.lastname@example.org or 206.616.4995 for more information.
Cardiothoracic Surgery’s 20th Annual Visiting Professor, May 13
Pre-Curriculum Review Advisory Committee Feedback
Visit Continuing Medical Education for more information on upcoming classes.
UW Medicine magazine
The Spring 2011 issue of UW Medicine, the biannual magazine for alumni and friends of the UW School of Medicine, is now available online. Discover how UW Medicine is pioneering minimally invasive brain surgery with a procedure called TONES and how the UW Medicine Stroke Center saves time and brain with high-tech treatments. Learn about a physician assistant’s journey from Cambodia to Seattle, and read what students think about medical school.