All posts by Greg Hack

Going to the mat: Free yoga class Thursday

To celebrate International Yoga Day, the UMKC Health Sciences District will be offering a free class from 6 to 7 p.m. Thursday, June 21. The class will be taught by a certified instructor and is open to all UMKC students, faculty and staff.

Come enjoy a gentle but effective hour of exercise. The class will be at the northeast corner of Holmes and 25th, in the green space south of the nursing and pharmacy schools.

The district asks that you sign up here or email leslie.carto@tmcmed.org. The first 25 yogis to sign up receive free yoga mats. You’ll also be able to register to win an exciting gift basket.

UMKC’s Gold Humanism chapter recognized nationally

Graduating chapter members and adviser Carol Stanford, M.D. ’79, proudly displayed their award banner at graduation.

The School of Medicine’s chapter of the Gold Humanism Honor Society was one of three nationwide to win this year’s Distinguished Chapter Award.

The med school chapters at Vanderbilt and Georgetown also were recognized. The awards recognize advancement in patient-centered care, sustaining a humanistic learning environment and demonstrating leadership.

The UMKC chapter has been led for several years by Dr. Carol Stanford, who earned her M.D. at UMKC.

The School of Medicine’s 15-year-old chapter has been a leader in the national society, particularly advancing ideas for National Patient Solidarity Week. The week, in February each year, is filled with activities that encourage stronger bonds between patients and their physicians, nurses and other care givers. Those activities include making Valentine’s Day cards for patients at Truman Medical Center and distributing them along with roses, and Tell Me More, a program that encourages learning more about patients so they are known as individuals beyond their medical conditions.

Sojourner Clinic honors volunteers

The awards banquet was well attended.

Hundreds of student volunteers were recognized May 8 at the annual Sojourner Clinic Banquet, which was held at the Diastole Scholars’ Center. Students put in more than 1,500 volunteer hours each year treating more than 300 patients in more than 800 patient visits at the clinic, which offers free care to the homeless in downtown Kansas City.

This year’s award winners:

Top Year 1 Volunteer – Harshita Degala
Top Year 2 Volunteers – Madhavi Murali & Alaya Bodepudi
Top Year 3 Volunteer – Koral Shah
Top Year 4 Volunteer – Komal Kumar
Top Year 5 Volunteer – Jessica Wise
Top Year 6 Volunteer – Rahul Maheshwari
Top PA Student Volunteer – Emma Windham
Top Pharmacy Student Volunteer – Katie Tuck
Brook Nelson Award for Leadership – Michele Yang
Ellen Beck Award for Dedication – Imaima Casubhoy
Angela Barnett Award for Humanism – Koral Shah
Dan Purdom Award for Commitment – Eshwar Kishore

The clinic also has a new board for 2018-2019:

Executive Directors: Danielle Terrill and Adithi Reddy
Laboratory Director: Michele Yang
Patient Assistance Program Director: Priyesha Bijlani
Lead Clinic Manager: Elle Glaser
Financial Chair: Rose Puthumana
Clinic Managers: Seenu Abraham, Jessica Wise, Vishnu Harikumar, Antonio Petralia, Tony Cheng, Shipra Singh, Elizabeth Theng, Raga Kilaru, Vijay Letchuman
Main Operations Director: Kavelin Rumalla
Lab Managers: Alaya Bodepudi, Madhavi Murali, Imaima Casubhoy
PA Reps: TBA
Webmasters: Eshwar Kishore, Mrudula Gandham
PR Reps: Sriram Paravastu, Adnan Islam
Secretary: Angela Nwankwo
Pharmacy Liaison: Riddhi M. Ishanpara
Junior Financial Chair: Shruti Kumar

More on the clinic and award winners is here.

Research fellowship yields award-winning results for UMKC medical student Carlee Oakley

Carlee Oakley was recognized for her research project.

UMKC medical student Carlee Oakley is one of only five students nationwide to win a TL1 Top Poster Award for her research. It was presented recently in Washington at a meeting of the Association for Clinical and Translational Science.

Patients with chronic kidney disease have an increased risk for heart disease and heart attacks, and Oakley’s research identified a possible factor in that risk. She found that the chemical TMAO, trimethylamine-N-oxide, found in higher concentrations in kidney patients, increases the force and rate of cardiac contractions.

“I used a mouse model in my first series of experiments,” Oakley said. “To see if our findings translated to the human heart, we were able to test human atrial appendage biopsy tissue. This confirmed that TMAO directly influences human cardiac function.”

The Association for Clinical and Translational Science awarded blue ribbons to 60 research projects, and 57 of them were presented and judged at the conference. Oakley and four others were judged the best and received blue ribbon awards, significant of being in the top 10 percent of entrants.

The contest is part of the Frontiers CTSA TL1 program, a research fellowship. CTSA stands for clinical and translational science awards. Oakley took a year off between her fifth and sixth years of UMKC’s B.A./M.D. program for the fellowship.

“The Frontiers TL1 training fellowship seemed like an incredible opportunity to focus on my research and to supplement my traditional medical education with formal training in clinical research methodology, biostatistics and epidemiology through the Master of Science in Clinical Research program at the University of Kansas Medical Center,” Oakley said. “My research mentor, Dr. Mike Wacker, and my docent, Dr. Jignesh Shah, were both very supportive and encouraged me to apply.”

Oakley added, “We are taught that the best physicians practice evidence-based medicine. I hope to not only practice but to also contribute to evidence-based medicine. My goal is to become a clinician-scientist. I hope research is a vital part of my future practice, though I do not foresee ever giving up the clinical aspect.”

Her initial research used a mouse heart.

Oakley also recently defended her TL1 thesis, completing her fellowship work with honors. She did substantial work on her research with Wacker and other members of his lab team before going into the fellowship. She said David Sanborn, who is set to graduate and start a residency at the Mayo Clinic this summer, helped her with the project along with other members of the Wacker lab. She also collaborated with Dr. Jason Stubbs, a nephrologist and researcher at the University of Kansas Medical Center’s Kidney Institute, and a team of cardiac surgeons at the KU Medical Center’s Cardiovascular Research Institute.

Oakley, who plans a career in neurology, said she was drawn to UMKC from Sioux City, Iowa, because she was impressed by the School of Medicine’s six-year program and docent system. She met Wacker during the Human Structure Function course he helps teach and joined his cardiovascular research lab shortly after.

The other top finishers receiving the poster award are from the University of Michigan, Duke University, the University of Colorado-Denver and Georgetown-Howard Universities.

Vision crucial for improving U.S. health care, AOA lecturer says

Steve Miller, M.D. ’88, delivered this year’s AOA Lecture.

Improving U.S. medical care while holding down costs will require vision and innovation. Short-sighted adjustments that perpetuate longstanding ways of practicing medicine won’t bring about the changes needed.

That was the message delivered May 4 by Steve Miller, M.D. ’83, in the 2018 AOA Lecture at the UMKC School of Medicine. Miller is senior vice president and chief medical officer of Express Scripts, a large pharmacy benefits manager based in St. Louis.

Miller used St. Louis to illustrate the importance of vision — and the peril of lacking it. At the turn of the 20th century, St. Louis was the Gateway to the West and a city on the rise. It had the first U.S. skyscraper, the Wainwright Building, and in 1904 the largest World’s Fair ever. But the city was about to be eclipsed because of its decision backin the mid-1850s against building a railroad bridge over the Mississippi River, betting on river travel remaining more important than the promise of a transcontinental railroad.

St. Louis had violated an important principle, letting existing resources limit its vision. And, Miller said, “When you don’t have the right vision, others are going to do something about it.”

Today, Miller said, U.S. health care has the same problem of limited vision, spending far more than other developed countries but without better outcomes. A system designed by physicians for their own convenience has limited innovation, to the point where examining rooms look much as they did 100 years ago, and physicians see about the same number of patients as they did in the early 1900s.

Against that stagnant productivity, he said, 12,000 minute clinics have sprung up, but not with any evidence of better results or lower costs. There’s evidence that, for example, they overprescribe antibiotics and don’t produce better health care. But they are growing, he said, because their hours and convenience are what people want.

Medicine has improved greatly in other ways, Miller said, often involving his company’s area of expertise, pharmaceuticals. For example, he said, better medicines have virtually eliminated operating on peptic ulcers, once among the most common surgeries, and also have greatly reduced the number of heart bypass surgeries.

Miller said his company, Express Scripts, besides managing pharmacy benefits, is also the third largest pharmacy company in the U.S. Its automated pharmacies, he said, have improved convenience and greatly reduced errors in the dispensing of medicines. And as a large benefits manager, his company works to hold down drug prices by increasing pharmaceutical makers’ bidding for its business.

Working to hold down prices is becoming even more important, he said, because the pharmaceuticals being developed now are mainly specialty drugs, with the promise of effectively treating relatively rare illnesses.

So the possibilities are exciting, he said, but vision will be crucial to finding innovative ways to make breakthroughs affordable and accessible for everyone.

 

Challenges, perils of new media are nothing new in medicine, lecturer says

Jeremy A. Greene, M.D., Ph.D., gave this year’s Noback-Burton Lecture.

History is a valuable lens through which to view and evaluate the risks and opportunities new media pose throughout health care, Jeremy A. Greene, M.D., Ph.D., said April 27 at the UMKC School of Medicine.

Greene, a professor of medicine and the history of medicine at the Johns Hopkins University School of Medicine, delivered the 2018 Noback-Burton Lecture, titled “The Electronic Patient: Medicine and the Challenge of New Media.”

Among exciting current possibilities, Greene acknowledged the power of smartphones, giving physicians, clinics and millions of patients many ways to bridge distances and track health data. He also noted the World Health Organization’s mHealth initiative, dedicated to using mobile technologies to combat the world’s greatest noncommunicable killers including diabetes, COPD, cancer and heart disease.

But he also noted the “deep well of anxiety” around newer technologies, from threats to privacy to security concerns that were illustrated when a Baltimore hospital was virtually paralyzed by hackers who took down its computer servers.

Greene also argued for using history to evaluate current risks and rewards, and to see that current medicine’s hopes and fears are hardly unique to the 21st century.

New media have long been part of medicine, he said, and have always had wide-ranging effects, but seldom in the ways expected. Some examples:

— The stethoscope at one time was a new medium, “an object of fierce controversy,” through which information from a patient’s heart and lungs was transmitted to the ears of a physician. Medical literature at the time described it as “powerful but dangerous.”

— The telephone profoundly affected medicine, becoming an examination and diagnostic tool for various organs and ailments because of its ability to transmit sound. It also advanced remote medicine; for instance, allowing a physician to hear a child’s cough and lung congestion and determine whether it was croup, requiring immediate attention, or a less severe cough that could be followed up on later.

Telephones also became something of a scourge to physicians and their families as doctors were expected to always be reachable. But predictions that “telephone doctors” would become a whole subspecialty didn’t come to pass, just one example of how new media affect medicine, but seldom as predicted.

— Television, videotaping and the ability to transmit information over coaxial cables also affected medicine and medical education, setting the stage for telemedicine and other innovations.

Dr. Richardson K. Noback talked with Jeremy A. Greene after the lecture.

Greene noted that E. Grey Dimond, M.D., the founder of the UMKC School of Medicine, had made cable part of the school from the outset. The school has long recorded lectures, he noted, making remote and self-directed learning possible. And he said the school’s lecture archives were a great resource for studying the history of medical education.

Outside academia, Greene told about a pioneering telemedicine clinic at Boston’s Logan Airport, which allowed patients there to be “seen” by doctors at Boston Medical Center. The clinic was directed by Dr. Kenneth Bird, who coined the term telemedicine, and came about after some plane crash victims died just three miles from Boston Medical because it took ambulances too long to get through a traffic jam of accident spectators.

Now, Greene said, telemedicine combined with the Internet has made predictions that once seemed like science-fiction come true. But the same was true of the telephone, television and other new media, and such situations probably will keep occurring as technology advances.

In closing, Greene mentioned the Qualcomm Tricorder XPRIZE competition, designed to produce a portable medical device like those used on “Star Trek.” The latest winner can detect 34 health conditions, with the promise of bringing good health care to a wider population.

No doubt, such technology will change health care, he said, but it’s unclear exactly how. And, unfortunately, technology probably won’t change health care in ways that “reduce the practical and resource-based disparities” that keep care from millions of underserved patients.

This was the third year for the lecture series, endowed by James Riscoe, M.D. ’75, a member of the school’s third graduating class. Riscoe started the event to honor Richardson K. Noback, M.D., the first dean of the School of Medicine, and the late Jerry Burton, M.D. ’73, a classmate who is recognized as the first graduate of the medical school.

Riscoe was on hand to introduce Greene, Noback and Burton’s wife, Patricia G. Burton. The Burtons edited the 2014 book “A Proven Experiment: Looking Back at the UMKC School of Medicine.”

Banners mark UMKC Health Sciences District

Banners started going up Monday along the perimeter of the UMKC Health Sciences District.

Monday was truly a banner day for the UMKC Health Sciences District as banners started going up on light poles ringing the area bounded by 22nd Street, Gillham Road, 25th Street and Troost.

The colorful 5- by 6-foot canvas banners each have two halves, one showing the district logo and the other the district motto (Healthier Together) and a photograph depicting one of the district’s four emphases: clinical patient care, research, health sciences education, and community health and outreach.

The banners are the latest effort to raise the profile of the district, which started in May 2017 and brings together UMKC and its Schools of Dentistry, Medicine, Nursing and Health Studies, and Pharmacy; Truman Medical Centers; Children’s Mercy; the Kansas City, Missouri, Health Department; the Missouri Department of Mental Health Center for Behavioral Medicine; the Jackson County Medical Examiner; Diastole Scholars’ Center; and the Ronald McDonald House Charities of Kansas City.

The district earlier this year announced that it is becoming the presenting sponsor for the Hospital Hill Run, to be held June 1 and 2 this year. For the past several years, the School of Medicine has sponsored the Friday evening 5K race that kicks off the weekend.

The UMKC Health Sciences District is unlike any other in the nation. It is one of 18 areas in the country that have public schools of medicine, pharmacy, dentistry and nursing in one location along with a children’s hospital and an adult, acute-care hospital. By including a health department, the medical examiner and a mental health center that bring together agencies of the city, county and state, the UMKC Health Sciences District is one of a kind.

How to Conduct a Good Death

Dr. Gary Salzman delivered the 2018 William T. Sirridge, M.D., Medical Humanities Lecture.

Former UMKC School of Medicine docent and Humanities Department namesake William T. Sirridge, M.D., was a master at connecting with patients, including in their final days.

So it was fitting that this year’s medical humanities lecture endowed in Sirridge’s name was titled “How to Conduct a Good Death.” Gary Salzman, M.D., a 1980 graduate of the School of Medicine, delivered the lecture March 22.

“William Sirridge was my docent and mentor and taught me many things not published in books,” said Salzman, himself a faculty member, docent and Truman Medical Center physician since 1985.

Sharing a half dozen stories about patients at the end of their lives, Salzman told the lessons he had learned from Sirridge and how they had played out in his career. The most important lesson focused on how to connect with patients.

“As we bring more and more technology into medicine, we become less and less able to connect with patients,” said Salzman. “Connecting with patients is as important today as it was 40 years ago when I was in medical school.”

Salzman first told two stories of how, as a student, he had failed miserably in dealing with a patient’s death. In one case, he was ill prepared and “got it all wrong” telling a woman over the phone that her mother had just died at the hospital.

In the other case, he had prepared a case for presentation by examining a woman with a classic case of scleroderma, studying the medical literature on the woman’s dire condition and working up a detailed treatment plan. But he had left out the human element, and was unaware that Sirridge had already tried the recommended treatments – which all failed. Instead, Salzman learned Sirridge was helping the patient and her three daughters take the necessary steps for the woman to die peacefully at home.

“He looked over his glasses and said to me, ‘Salzman, do you know how to conduct a good death?’ ”

After those two instances, Salzman said, he dedicated himself to listening, watching and learning from Sirridge and other veteran physicians. He saw that Sirridge’s skill at connecting with patients had three parts:

  • Physical touch. A gentle hand on a patient’s arm could be “more powerful than morphine.”
  • Common interests. Finding and sharing commonalities with some humor mixed in.
  • Direct and honest conversation.

As Salzman practiced and applied those principals over the years with dying patients and their family members, he began to learn how to conduct a good death, and to pass his lessons on to colleagues, residents and students.

Salzman recounted his education and evolution through cases that took him from trying to do too much for dying patients, to pushing too hard for removing life support. He told of one patient who, after being taken off life support, woke up, looked at him and said, “I need a beer!”

He found equilibrium by listening deeply, respecting patient and family wishes, and then doing his best to find a balanced course of action.

In one case, a hospice patient who recently reunited with his estranged spouse desperately wanted to live and have more time. Salzman, though skeptical, went with the man’s wishes and got him out of hospice and back home with a portable breathing unit. “Eight years later, he still sings my praises as the man who saved his life,” Salzman said. “I just listened to his wishes.”

And for patients “who want you to do everything,” Salzman said, “I tell them, ‘Let’s do everything that will help you, and nothing that will hurt you.’ ” Through that lens, he said, appropriate individual plans can be worked out for each patient.

Salzman closed with a case in which a sixth-year student got to know a patient with severe pulmonary fibrosis and her daughter. They were having trouble letting go even though the patient’s essential life-support mask, not meant for long-term continuous use, was causing her more and more pain and skin deterioration. Eventually, the student was able to describe what would happen if life support was removed, and what medicines would be used so the woman could die comfortably. Eventually, they agreed to remove the mask, and the mother died in peace.

“The student told me she determined the best way to connect with this family was to sit quietly, to just be present while watching television. So she watched ‘Ellen’ with them, most afternoons for two weeks.” Salzman praised the student on her outstanding work

“I told the student that I had a story that I wanted to tell her. It is about a man she never met but influenced her education. It is a story of my docent, William T. Sirridge, and a question he asked me a long time ago: ‘Do you know how to conduct a good death?’”

The lessons Dr. Sirridge taught on connecting with patients and conducting a good death learned by Salzman are now being passed on to current students. And, according to Salzman, these students will carry on, teaching these skills to their students and continuing the legacy of Dr. Sirridge long after his death.

Michael Hinni takes wing

Michael Hinni, M.D., ’88, a pioneer in head and neck surgery, is the 2018 winner of the E. Grey Dimond, M.D., Take Wing Award.

Hinni is professor of otolaryngology and head and neck surgery at the Mayo Clinic School of Medicine and head of the Mayo Clinic’s Department of Otolaryngology at Mayo Scottsdale. He is known for being in the forefront of developing minimally invasive procedures for surgical removal of head and neck tumors.

Those efforts included designing instruments to accomplish better, safer surgery; contributing to the published medical literature on such topics as how much tissue needs to be removed to completely clear malignancy from the throat and surrounding areas; and presenting the evidence for this medical advances at local , national and international forums.

In letters nominating him for the award, his colleagues praised him for displaying substance, purpose, courage, care for and loyalty to followers, integrity and self sacrifice.

As Take Wing winner, Hinni is scheduled receive his award and deliver the annual Take Wing lecture on May 21 at the School of Medicine and to speak as part of the School of Medicine’s commencement ceremony later that afternoon.

Surgeon says interventions can help disrupt cycle of violence

Dr. Moncure.

Violence tears apart too many young lives in minority communities, but interventions at crucial times can help reduce such violence and its effects, Dr. Michael Moncure said at the 2018 Dr. Reaner & Henry Shannon Lecture, held Feb. 23.

In his presentation at the UMKC School of Medicine, “Factors Associated With Interpersonal Violence in Minority Communities,” Moncure recounted anti-violence efforts from his career as a trauma surgeon. And he praised and drew hope from such recent efforts as Kansas City’s AIM4PEACE, which de-fuses violence with effective actions backed by research.

The direct results of violence are devastating, Moncure said, citing Centers for Disease Control statistics for 2015: 44,000 suicides; 17,000 homicides; and $107 billion in lost wages. In Kansas City, Missouri, he noted, homicides spiked in 2016 and remained high in 2017. The toll on minority communities can be devastating, and particularly tragic when young lives are lost or disrupted.

Moncure, a professor in the Department of Surgery at the School of Medicine, said his first job was in Camden, New Jersey, at the time notorious for crime and poverty. Moncure got involved with a program much like the TV show “Scared Straight,” which showed young people in high-crime areas how bad life could be if they committed violent crimes and were imprisoned.

“Those programs had some splash, but they weren’t evidence-based,” Moncure said. The programs ultimately were ineffective. “We even got a little cocky, and shared some of our materials with adults” in the criminal justice system. It was a reality check, he said, when those adults were unimpressed and even incredulous that Moncure and his colleagues thought their efforts would have any effect.

Research on violence and trauma and their causes and effects has come a long way since then, Moncure said, and trauma has come to be seen much more broadly than shootings or other violent crimes. Many studies have associated both recurring violence and adult diseases such as cancer, diabetes, heart failure and hypertension with the number and severity of someone’s ACES — adverse childhood experiences. ACES include poverty, divorce, and incarcerated parent, violence in the home and sexual abuse.

But research also has shown that interventions to support trauma victims at the right times can reduce the effects of such trauma and often prevent more violence.

For example, Moncure said one shooting often leads to another in retaliation. But an intervention specialist quickly summoned to a hospital bedside can help the wounded person and calm friends and relatives who might think they know who fired the shots and are bent on revenge.

In Kansas City, Missouri, Moncure said, the AIM4PEACE program specializes in such interventions, builds healthy relationships and gets results. Those efforts also are part of a community-wide plan that includes social support, counseling, job training and other efforts to combat violence. Another benefit of having research behind these efforts is demonstrating that they are cost-effective. Moncure believes this has helped get support from the Kansas City business community.

Henry and Dr. Reaner Shannon sponsor the annual lecture, given Feb. 23 by Dr. Moncure.

Thankful to be part of the annual Dr. Reaner and Mr. Henry Shannon Lectureship in Minority Health, Moncure noted that the series, developed to create awareness about health disparities affecting underserved and minority communities, encouraged exploring solutions to society’s problems.

“There’s no better use of science,” he said.