All posts by Greg Hack

UMKC alumnus, TMC involved in latest antibiotic research

Mark T. Steele, M.D. ’80.

The addition of a second antibiotic to treat cellulitis skin infections did not result in significantly better cure rates in research recently published in JAMA, the Journal of the American Medical Association.

The study was the latest from an emergency medicine research group that includes Truman Medical Centers and Mark T. Steele, M.D. ’80. Steele is associate dean for TMC Programs at the UMKC School of Medicine and chief medical officer and chief operating officer for Truman Medical Centers.

“I’ve been involved with this group for more than 20 years,” Steele said. “It has 11 sites across the country and studies infectious diseases relevant to emergency medicine. This latest study used five of those sites, including Truman.”

The study involved 500 patients who had cellulitis that was not accompanied by abscess or a wound. Half of those patients were treated with cephalexin, an antibiotic effective against streptococci that typically is used in such cases. The other half got cephalexin plus trimethoprim-sulfamethoxazole, an anti-staph antibiotic that more patients with skin and soft-tissue infections have been receiving “just in case” MRSA — methicillin resistant Staphylococcus aureus — is present.

For the entire group treated, the added antibiotic seemed to help, producing a cure rate of 76.2 percent, versus a 69 percent cure rate for those who received just cephalexin. But that difference was not considered statistically significant. In addition, when the results were narrowed to the patients who were known to have taken at least 75 percent of the recommended doses of their antibiotics, the cure rates were almost identical, 83.5 percent for those who also got the second antibiotic, and 85.5 percent those who received just cephalexin.

MRSA has been showing up as a cause of more severe, abscessed skin infections, which has led to more dual prescribing of the antibiotics. Steele said this study’s results could inform emergency physicians that for cellulitis, absent abscess or a wound, the addition of the second antibiotic wasn’t more effective.

Amy Stubbs, M.D.

Amy Stubbs, M.D., helped oversee Truman’s portion of the research. She’s an assistant professor of emergency medicine at the School of Medicine and director of the school’s emergency medicine residency program. She completed her residency in emergency medicine at UMKC and was chief resident.

The National Institutes of Health sponsored the study, which Steele said was particularly well constructed to meet the standards of JAMA, the world’s most widely circulated medical journal.

It was the third in a series of published studies by the emergency research group, called the EMERGEncy ID NET. One dealt with treatment of abscesses and was published in the New England Journal of Medicine. Another looked at infected wounds seen by emergency physicians and was published in the journal Clinical Infectious Diseases.

Running’s a nice break from School of Medicine studies for 5K winner

Jordann Dhuse shared her division winner’s medal with her dog, Milo.

When fourth-year student Jordann Dhuse crossed the finish line at the 2017 UMKC School of Medicine 5K, she wondered what all the fuss was about.

“I was shocked when I realized I had won my division,” said Dhuse, first among the 930 women in the June 2 race.

“I haven’t run all that many races,” said Dhuse, who enjoyed other sports in high school but took up running just a few years ago. “I had won my age group before, but not my division.”

Dhuse runs more “as a way to decompress from studying” than to be competitive, she said. But she does push herself to improve, and her time in this year’s 5K, 23:11, was almost two and a half minutes better than a year ago, when she placed 30th in the women’s division.

“I try to fit in a run most days, three miles if I’m lucky,” she said, and often can be seen running near the school, or walking her dog, Milo.

“He’s a long-haired chihuahua, so he doesn’t run with me,” she said. “But I let him wear my race medal. I think it weighs more than he does.”

It was the fourth year that the 5K took place the Friday evening before the Hospital Hill 10K and Marathon. The move was made to make the shorter race more family friendly, and it draws parents pushing strollers, along with many teams from various workplaces and non-profits.

“I like the atmosphere of this race,” said Dhuse. “You get families, people in town for the weekend, different groups.”

UMKC School of Medicine advancement director Fred Schlichting congradulates Jordann Dhuse.

Dhuse is from the Chicago area and came to UMKC after earning a bachelor’s degree in health science at the University of Missouri.

“I followed my brother, Kyle, to Columbia,” she said. “He’s a year older and fell in love with the campus.”

Then Dhuse decided to go on for a medical degree and was happy she was accepted at UMKC.

“I was attracted by the program’s whole approach, especially the docent system,” she said. “I love being on a team.”

Many of her Gold 3 docent mates are different from her in at least one respect: “I’m interested in emergency medicine, and most of them are interested in internal or family medicine. But we support each other.”

Refugee care presents compelling needs, big obstacles, Comninellis says

Nicholas Comninellis (left), M.D. ’82, spoke with students after his lecture.

Providing health care to refugee populations faces tremendous obstacles, but it can be done, and everyone can help, Nicholas Comninellis, M.D. ’82, told students, faculty and guests on May 16 at the School of Medicine.

Comninellis, UMKC’s Alumnus of the Year in 2015, spoke on “Refugee Care—Displaced But Not Forgotten,” as part of the school’s International Medicine Lecture Series.

He has been on the faculty at the School of Medicine and in 2004 founded INMED, the Institute for International Medicine, which is based in Kansas City and equips health care professionals to provide primary care for refugees and other displaced people.

Using slides and a brief film from UNHCR, the United Nations Refugee Agency, Comninellis homed in on dire refugee situations stemming from ISIS control of regions in Syria and Iraq. He asked audience members to help him list the obstacles to treating refugee populations, and then he went through the four phases of aiding refugees, from pre-emergency and emergency through post-emergency maintenance and repatriation.

The combination of displacement from their homes, violent emotional and sometimes physical trauma, a severe lack of material and medical resources, and lack of infrastructure for sanitary living makes providing even basic medical care difficult, he said.

High stress is also common, often related to worrying about whether there will be enough to eat. And even when a refugee settlement can achieve some stability and sense of safety away from battle areas, boredom and finding meaningful work then can become a big problem, he said.

Comninellis showed many heart-rending, close-up photographs from refugee camps, and then a photo from Jordan showing a vast expanse of thousands of tents in a desert camp where refugees had lived for the past five years.

In calling on his audience to help, Comninellis said the refugee problem one “of biblical proportions,” and he read verses from Leviticus and Deuteronomy admonishing people to care for and love “the foreigner residing among you.” He noted that his father’s father had been a refugee from Greece during World War II, and that many people in the audience probably had some refugee history in their families.

He also noted that his organization, INMED, offered courses, training, fellowships, service learning and diploma programs so that students, residents and other graduates could develop and practice skills in international medicine.

He also encouraged everyone to volunteer with a reputable organization that aids refugees, to help refugees who settled in their communities, to be aware of changing refugee situations in the world, and to encourage elected representatives to pursue policies that help refugees.

Before Comninellis spoke, Steven Waldman, M.D. ’77, J.D., M.B.A., and associate dean of International Programs, said the School of Medicine on Aug. 22 would have a session outlining opportunities for international service learning and research that will be available through Global Health Learning Opportunities. That’s a collaborative of about 140 international programs, through the Association of American Medical Colleges.

Waldman also said an International Medicine Day was in the works for November, during which posters could be presented, much like the school’s annual Quality and Patient Safety Day.

Noback-Burton lecturer says humanities advance practice of healing art

Arno Kumagai,M.D., delivered the 2017 Noback-Burton Lecture on April 28 at the UMKC School of Medicine..

Several trends in health care make the practice of compassionate medicine more difficult, but integrating the humanities into medical education can help produce more-caring physicians, Arno Kumagai, M.D., said at the second annual Noback-Burton Lecture.

“The first question is, What kind of doctors are we trying to create?” Kumagai asked in his April 28 lecture at the UMKC School of Medicine, titled “Ways of Seeing, Ways of Knowing: A Role for the Humanities in Medical Education.”

Kumagai, vice chair for education in the Department of Medicine at the University of Toronto, argued that medical education should be moral education, promoting justice, compassion and “development of the empathic self.”

He said the rising emphasis on patient-centered care was welcome—and needed to counter current challenges and developments including:

  • Rapid technological change, which despite its possible benefits can be hard to keep up with and disruptive.
  • Turning medicine into a commodity and patients into customers. Conveyor belt medicine and measures of “productivity” work against the best care, Kumagai said.
  • The standardization of medical education. Though a wide range of essential skills must be imparted to every student, individuality and fresh and varied ways to see and engage with patients should be nurtured rather than sacrificed.
  • The ubiquity of electronic medical records, leading to typing into a computer crowding out human interaction, especially during a 15-minute conveyor belt style appointment.

Especially given these developments, Kumagai said, how do medical schools educate future physicians to best provide patient-centered care?

Integrating the humanities into the curriculum is certainly part of the answer, but moreover Kumagai argued for using the many ways that the humanities and art can get people to open their perception and see and know their patients and the world differently.

As an example, he said it had built empathy, and shown students the power of other people’s stories, to match medical students with patients with chronic conditions, and have them really get to know those patients. Valuable lessons come from such “deep listening and dialogue,” Kumagai said, and can keep doctors from seeing patients as their illnesses and not whole people.

“We often forget that at the heart of medicine lies the interaction we have with someone who suffers … a sacred space in which people become different than they are, including ourselves,” Kumagai said. “Medicine is ultimately the opportunity to bear witness to the mystery, tragedy and wonder of being human. And it is our duty as physicians not to look at this as extra. This humanism, humanities, is at the core of medicine. It is not an extra.”

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

Two from med school honored with vice chancellor’s award

Dayne Voelker
Amanda Fletcher

Dayne Voelker and Amanda Fletcher, both set to graduate in May from the School of Medicine, were selected as UMKC Vice Chancellor’s Honor Recipients.

The vice chancellor for student affairs and enrollment management takes nominations from each academic unit to recognize graduating students who have excelled in academic achievement, leadership and service to UMKC and the community.

Voelker, who will head to Rochester, Minnesota, for an internal medicine residency at the Mayo Clinic, was nominated by Gary Salzman, M.D., his docent in the Green 6 unit.

“Dr. Salzman has been even more than a mentor and docent,” said Voelker, of Perryville, Missouri. “He’s really been a second father figure. I have been able to ask him for advice on just about anything.”

Fletcher, whose residency will be in orthopedic surgery at Duke University Medical Center in Durham, North Carolina, was nominated by Marge Weimer, the education team coordinator for her docent unit, Purple 1.

She said Weimer had been “a supportive friend and mother figure I could always look to for guidance.” She also thanked Agostino Molteni, M.D., her research mentor.

Fletcher’s offices and service activities include secretary of the Medical Student Research Interest Group, vice president of the Orthopedic Surgery Interest Group, the Alpha Phi Omega Service Fraternity, Sojourner’s Health Clinic, the Global Medical Brigades medical mission trip to Honduras in 2013 and a surgical mission trip with Project Perfect World in Ecuador.

Childhood trauma echoes in adult health problems, lecturer says

Nancy Hardt, M.D., delivered a Dean’s Visiting Professor lecture on health disparities linked to childhood trauma.

Many serious health conditions are associated with childhood trauma, and medical schools and health care systems need to do much more to recognize that connection and devise effective treatment, said Nancy Hardt, M.D., the latest speaker in the Dean’s Visiting Professor Series.

Hardt, a University of Florida emerita professor of pathology and obstetrics and gynecology, spoke April 27 at the UMKC School of Medicine on “Adverse Childhood Experiences: The Most Important Public Health Topic Missing from Our Curricula.”

Adverse Childhood Experiences — ACES for short — include sexual and physical abuse, growing up in poverty, divorce, alcoholism and other drug addictions, and crime and neighborhood violence. Hardt drew on research indicating the scope of their connection with disparities in health, including findings that:

— Suffering six or more childhood trauma incidents cuts 20 years off life expectancy.
— More than 14 percent of adults in one study had suffered four or more adverse childhood experiences.
— Of people who have suffered five or more adverse events, 90 percent have some sort of developmental delay.
— Each adverse childhood experience increased the rate of everything from asthma and anxiety to heart disease, stroke and diabetes. ACES also correlated with poverty and unemployment, which further increase the likelihood of serious health problems and difficulty in getting them treated.

Hardt cited the work of Michael Marmot, who wrote “The Health Gap” and said, after studying developed countries around the world, that the United States “had a lot of nerve” allowing one-fourth of its children to grow up in poverty. Marmot also did research among British government workers and found that all up and down the pay scale, more money correlated with better health.

Many social service agencies are trying to address ACES and head off the costly health problems they cause, Hardt said. But medical care has lagged behind, she said, in part because medical schools don’t teach prospective doctors about these connections.

She told of one doctor, Vincent Felitti, whose research established a connection between childhood sexual abuse and obesity later in life. He initially was puzzled about why some patients in a weight loss study couldn’t keep off lost weight — until he learned that adults who had been sexually abused often felt safer, less a target, when excess weight made them unattractive.

“He said, ‘I’ve been a doctor for 25, 30 years, and I never knew that. Why didn’t they teach me this in medical school?’ ” Hardt said.

Felitti then met Rob Anda, a Centers for Disease Control researcher who thought childhood trauma correlated with hypertension in adults. Felitti and Anda then did a large study showing the many health problems linked to ACES.

The good news, Hardt said, is that rsearch also has shown that the effects of traumatic experiences often can be reversed with the right treatments and interventions.

An abused or neglected person’s resilience can be aided by everything from mindfulness practices, meditation and yoga to getting sufficient sleep, nutrition, exercise and daily pleasurable experiences, she said.

Researchers and caregivers also are learning more about what to try, she said. For example, in some cases it has been found that traumatized children who cannot attach to adults can connect with younger children and help them, too.

Hardt lectured at the School of Medicine on April 27.

Hardt said it also was important for medical schools and centers to practice care for their own people, so that students and caregivers weren’t themselves stressed or traumatized and thus less able to provide care that’s responsive to trauma. And it’s important for the medical profession to realize and address the secondary trauma that caregivers can suffer.

Hardt noted further that there’s a sound business case for such treatment and interventions, given the large number of serious later-in-life problems that can be prevented or mitigated.

Good treatment requires a team effort, she said, and that provides opportunities for medical schools to work ACES information and experience into their curriculum. Medical students, for example, could provide the sort of staff help that’s always need by community partners treating traumatized youth.

The Kansas City area already is “rockin’ and rollin’” in this area, Hardt said. The Head Start-Trauma Smart program of Saint Luke’s Crittenton Children’s Center is just one example of an area program doing good work, she said.

“I’ve never seen a place with more opportunity to make this happen,” she said.

 

Benefits of student research are worth the challenge, visiting professor says

Donald B. DeFranco, Ph.D., delivering the Dean’s Visiting Professor lecture on March 9.

Donald B. DeFranco, Ph.D., believes involving medical students in research has substantial benefits from developing analytical thinking skills to improving oral and written communication. DeFranco, a University of Pittsburgh research leader, shared his thoughts March 9 as part of the Dean’s Visiting Professor lecture series.

In his lecture, “The Benefits and Challenges of Engaging Medical Students in Faculty Research,” he drew on his experience as the Pittsburgh School of Medicine’s associate dean of medical student research and director of its summer research program.

DeFranco, also a professor and vice chair in that school’s Department of Pharmacology and Chemical Biology, said Pittsburgh encouraged student research and worked hard to line up the hundreds of mentors required.

People from dean’s office administrators to surgeons help with the matching and often serve as mentors, he said. Finding the right mentor for each student was really the key to success, though he said it’s also important to give the students and their mentors incentives and recognition.

Producing physician scientists isn’t easy, DeFranco said, in part because “they really live in two different worlds.” One paper he cited said “medical training is about minimizing risk while medical research is more about increasing risk,” taking chances in search of breakthrough discoveries. Though he didn’t completely agree with that characterization, he said it was crucial to integrate research knowledge into practice.

DeFranco said he saw a couple of places in the 6-year UMKC program where a research project could make the most sense. The first is with Year 1 students, giving research a foothold from the outset in an education that already integrates humanities and clinical experience with patients. The second opportunity is in Year 5 because students “might have found their specialty by then,” he said.

DeFranco’s own areas of research encompass receptor pharmacology, neuropharmacology, signal transduction, cancer pharmacology and the pharmacology of cell and organ systems. His doctorate is in molecular biophysics and biochemistry from Yale University. He also was a postdoctoral fellow at the University of California–San Francisco.

Community partnerships crucial to combat obesity, Shannon lecturer says

Daphne Bascom (right), M.D., Ph.D., talked after her lecture with an audience member. The sponsors of the lecture, Henry and Dr. Reaner Shannon, listened in.

The 2017 Dr. Reaner and Mr. Henry Shannon Lecture in Minority Health, given by Daphne Bascom, M.D., was filled with compelling statistics and fresh insights into the importance of community health efforts. It also reinforced an old saying: An ounce of prevention is worth a pound of cure.

Bascom, the senior vice president of community integrated health for the Greater Kansas City YMCA, focused her lecture, “Collaborating Across the Continuum to Create a Healthy Community,” on efforts to combat obesity.

“The connection between rising rates of obesity and rising medical spending is undeniable,” said Bascom, who spoke Feb. 24 at the School of Medicine.

But she also noted that investing just $10 per person in community efforts to reduce obesity could pay off in an estimated $16 billion in annual health care savings.

Some other bracing numbers:

— Annual obesity-related health care costs are estimated at $315.8 billion, with $14.1 billion related to childhood obesity.

— Businesses lose $4.3 billion a year to obesity-related absenteeism.

— Average health care costs are 42 percent higher for obese people.

— More than one in three U.S. adults are obese, and obesity rates are worse for black and Latino adults.

— Kansas had the 7th worst rate of adult obesity, and Missouri was tied for 10th.

Bascom, a board-certified specialist in otolaryngology and head and neck surgery, also related her own career experience with the need to “build a better bridge” for integrating community institutions with the health care system.

Case in point: Bascom’s efforts beyond surgery involved helping patients with follow up communication and recommendations for better fitness and nutrition. “Sometimes it worked,” she said. “But then there were the patients who couldn’t pay their electricity bills. … It was wearing and frustrating because there weren’t the community resources to help them.”

So Bascom, who received her medical degree at the University of Pittsburgh School of Medicine, looked for broader ways to improve people’s health. She came to Cerner Corp. as chief medical officer, where she provided strategic consulting services on how to use health information technology to improve quality, safety, operations and the fiscal health of their organizations.

Now at the YMCA, Bascom is developing and promoting health partnerships and sustainable programs One area the Y is promoting? Reducing obesity—including working with families, improving access to affordable healthy food, providing safe places to be physically active, and curbing exposure to marketing of less nutritious foods.

Bascom, who herself struggled with her weight in grade school, said, “Obesity is a problem. It’s been a problem. It continues to be a problem. But it is something that can be solved.”

 

New chief medical officer values KC, UMKC roots

For Olevia Pitts, M.D. ’86, becoming Research Medical Center’s chief medical officer was a logical next step in the city she loves.

Dr. Olevia Pitts

 “I’ve always practiced in the Kansas City area,” Pitts said in an interview after her whirlwind first week at her new post. “And it’s an honor to be chosen by one of the city’s finest medical institutions.”

Pitts is a senior fellow of hospital medicine and has been a leader among hospitalists for many years. Most recently she was senior vice president for the Kansas City and Wichita region of IPC -The Hospitalist Company/TeamHealth, and medical director for Encompass Hospice in Lee’s Summit and Kindred Transitional Care Hospital in Kansas City, which provides long-term acute care.

In announcing her appointment, Research noted that Pitts was the first woman and person of color to be its chief medical officer.

But Pitts has been used to “firsts” since 1980 when she says she was one of the first from Kansas City, Kan., to be admitted to the UMKC School of Medicine’s six-year program.

She also was the first in her family to become a physician, though hardly the first to be in medicine.

“I come from a medical family,” Pitts said. “My mother, Pinkie Mitchem, was assistant director of nursing/operating room at KU for 20-plus years. My sister, Leartis Harper, is also a nurse.”

Pitts said her direct patient-care experience at UMKC and then in her residency at Truman Medical Center/Consortium made her comfortable in practice right from the start, so she was “identified early as a leader, to supervise and mentor others.”  

She said Dr. Larry Dall, docent at UMKC, was one of her mentors.

“I practiced with him from 2002 to 2013 until he returned to the medical school,” she said. “UMKC allowed me to interact with the community physicians, fostering relationships that have been supportive and career altering.”

Others encouraged her to follow her ideas for improving management and patient care, she said. A one-year fellowship in 2011-12 at the University California-San Francisco gave her further training and experience in hospitalist leadership, and in 2012 she became senior medical director for IPC.

Pitts’ ascent to chief medical officer at Research was effective Jan. 30. She said she already was busy working with the medical center’s physicians and staff to ensure that everyone was engaged in providing efficient and effective care.

 “I’ve had plenty of opportunities to go elsewhere, but no desire to leave Kansas City,” said Pitts, who is married and has a son studying economics at the University of Chicago. “This is home.”

 

School of Medicine students supported by 2017 awards from UMKC Women’s Council Graduate Assistance Fund

The UMKC Women’s Council Graduate Assistance Fund has announced its awards for 2017, comprising 14 Outstanding Merit Awards and the financing of 74 fellowships. Four of the recipients from across the university are from the School of Medicine: Ravali Gummi, for glaucoma research; Kaitlyn Hill, to attend an anesthesiology conference; Komal Kumar, for pregnancy ultrasound research; and Carlee Oakley, to present research findings at a national conference.
Also on Hospital Hill, the School of Dentistry had three recipients, and the School of Pharmacy and the School of Nursing and Health Studies each had nine. On the Volker Campus, the College of Arts and Sciences led the way with 16 recipients, followed by the School of Education with 13 and the Conservatory of Music and Dance with 10. The recipients will be honored at an awards reception in February.