Department of Medicine Annual Report 2017

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G T H N I E G G D I A R OF HEALTH DISPARITIES

D E PA R T M E N T O F M E D I C I N E C H A I R M A N ’ S R E P O R T 2 0 1 7

Table of Contents

1

Chair’s Message

2 Partners from the Very Beginning: Jackson Memorial Hospital, the Miami Veterans Affairs Medical Center and the UM School of Medicine Division Reports

6 Cardiovascular 8 Clinical Pharmacology

9

BRIDGING THE GAP: Precision Medicine and Health Disparities Collaborative

10 Endocrinology, Diabetes and Metabolism 12 Gastroenterology and Hepatology 14 General Internal Medicine 16 Hematology

17

BRIDGING THE GAP: Resources for the Transgender Population

18 20

Medical Oncology Hospital Medicine

21

BRIDGING THE GAP: Certified Community Health Workers

22 24 26 27 28 29

Infectious Diseases The Katz Family Division of Nephrology and Hypertension Population Health and Computational Medicine Pulmonary, Allergy, Critical Care and Sleep Medicine Rheumatology and Immunology Geriatrics and Palliative Medicine

30

Education

31

Residents and Fellows

32

By the Numbers

33 Philanthropy

34

Research Data and Publication Summary

37

Find Us Online!

Editor: Laura J. Pinzon Director, Business Operations Design, Editorial & Project Management Consulting: Sabia Communications, Inc.

Published by the Chairman's Office of the Department of Medicine of the University of Miami Miller School of Medicine.

All contents, Š2017 University of Miami.

Reproduction in whole or in part without previous written permission by the editor is prohibited.

U H ea l t h | U n i v er s i t y o f M i a m i M i l l er School of Med i c i ne

Chair’s Message Welcome to the 2017 Annual Report of the Department of Medicine at the University of Miami Miller School of Medicine. In this year’s report we focus on the accomplishments of the talented and compassionate faculty who work to BRIDGE THE GAP of health disparities.

Our obligation as physicians, scientists and educators is to assure that every individual has the ability to achieve good health, regardless of race or ethnicity, gender identity, sexual orientation, age, disability, socioeconomic status or geographic location.

We are at the forefront in identifying and conquering the genetic and social determinants that contribute to health disparities. Whether we are treating our patients for asthma, inflammatory bowel disease, heart disease, cancer, or obesity and diabetes, we are discovering new methods of treatment and improved outcomes.

most underserved populations in South Florida, while our affiliation with the Bruce W. Carter Department of Veterans Affairs Medical Center gives us the chance to deliver exceptional health care to America’s veterans.

We are truly unique and I invite you to learn more about us and all we are doing to bridge the gap of health disparities.

All my best,

Roy E. Weiss, MD, PhD, FACP, FACE Professor of Medicine Kathleen and Stanley Glaser Distinguished Chair in Medicine University of Miami Miller School of Medicine

Our longstanding partnership with Jackson Memorial Hospital, the third-largest teaching hospital in the United States, allows us the opportunity to provide care to the

Above: Dr. Weiss presenting at this year’s State of the Department Address (SODA).

Discovering New Treatment Methods D epartmen t o f Medic in e C h air man ’s R e po r t 2017

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Partners from the Very Beginning:

By Mark Gelbard, MD, Associate Professor of Medicine and Miller School of Medicine Applebaum Teaching Scholar and Thomas M. Hooton, MD, Professor of Medicine and Associate Chief of Staff, Medical Service at the Miami VA Healthcare System

Above: Members of the first medical school class work in the laboratory at the Biltmore VA. Above: Alamo, circa 1918. Miami’s oldest surviving hospital building. It got its nickname

In 1951 University of Miami President Ashe negotiated a lease with the VA for space in the

because its Spanish-inspired design is reminiscent of the Texas landmark. The building was

hotel’s old “servant’s quarters” to use as classrooms. The facilities were deplorable by all

moved to its present location in 1979 and now serves as an information center for Jackson

accounts, with temperature control problems, porous infrastructure, and descriptions of

Memorial Hospital. This building was listed in the National Register of Historic Places in 1979.

students attending lectures with water up to their ankles during downpours.

1910 Jackson Memorial Hospital began

1930s JMH is again enlarged with new

as the Friendly Society Hospital, an 18bed facility located near Biscayne Bay to serve those patients who could not afford medical care. Soon financially overwhelmed, it was taken over by the City of Miami and renamed City Hospital.

buildings, departments, and clinics through the efforts of then Chief of Staff, Dr. Robert Crawford Woodard.

1918 Although physically expanded,

the small facility still could not handle its patient load and a new modern concrete building opened at the current location of NW 10 Avenue and 17th Street. The building, still standing at the medical center, we now know as “The Alamo.”

1924 The 107-bed hospital renamed

James M. Jackson Memorial Hospital (JMH) in honor of Dr. Jackson – the first physician hired by the incipient town of Miami in 1896 and the first president of the city hospital’s medical staff.

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1947 The dream of Florida’s first

medical school.

For 26 years, Bowman Foster Ashe, the first president of the University of Miami (UM), envisioned a medical school. Hurricanes, the Great Depression and World War II delayed these plans, as did controversy over state funding of a private medical school.

A 1947 decision to again table the issue led President Ashe to instead form a partnership with a U.S. Army Hospital then in place at the historic Biltmore Hotel, soon to be transferred to the Miami VA. They established a “Medical Research Unit” offering training in anatomy, physiology, biochemistry,

bacteriology and pathology. The VA provided space, utilities and certain basic equipment, and UM provided a medical research staff.

The State of Florida, which had provided subsidized tuition for students to attend medical schools in other states, began exploring the development of an in-state school.

1949 After continued financial

difficulties, Dade County was forced to take control of the JMH facility. This serendipitous event ultimately helped the genesis of the current Miller School of Medicine.

1951 The State of Florida awarded

the University of Miami the state’s first school of medicine, in large part due to its established presence at the Biltmore Veteran’s Affairs Hospital.

State Senator R. Bunn Gautier, for whom a UM School of Medicine

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Jackson Memorial Hospital, the Miami Veterans Affairs Medical Center and the UM School of Medicine

Kathleen Everitt, one of two female students in the first class, prepares complicated formula in a first-year biochemistry lab course.

Above: The medical campus in the 1960s

building is now named, successfully introduced legislation in 1951 to fund up to 75 students at $3,000 per student (about $29,000 in today’s dollars) , but this funding was minimal and only available until June of 1953 – thus, time was of the essence to establish a program.

1952 Amidst uncertainty, UM’s

School of Medicine opened its doors.

Delays ensued when University of Florida alumni legally challenged the use of state funds for a private school, also questioning if the funds should have been allocated to an institution that was without accreditation.

Both cases are ultimately resolved in the favor of UM in the spring of 1952, giving UM a mere six months to establish a school before the money was lost.

The search for a dean and incoming student body began.

Dr. Homer Marsh was recruited from Oklahoma to serve as Associate Dean under Dr. Robert Spicer as Dean, but within the first year Dr. Marsh becomes Dean. Hundreds of applications were received, of which 28 were accepted.

On September 22, 28 daring students began their medical studies at the UM School of Medicine, paying $600 in tuition. These 26 men and 2 women were undaunted by an improvised campus, no arrangements as yet for the third year clinical program, and the possibility of no accreditation before they graduated.

Dade County Commissioner Preston Bird enthusiastically supported the now county-run JMH becoming the training center for the new school. On December 18, a formal agreement between Dade County and the UM School of Medicine was in place, and $2 million from a 1950 bond

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allocated to build two facilities for the school.

Dean Marsh recruited a large number of volunteer community physicians to serve as clinical specialists. A few renowned academicians soon joined them, and they rapidly pieced together the many components of pre-clinical education, clinical education, research and infrastructure, resulting in a patchwork of UM School of Medicine facilities.

1955 An outpatient clinic was

constructed by Dade County to serve as the school’s first clinical teaching unit, under the direction of Dr. John Robinson.

1956 The UM School of Medicine

achieved accreditation by the Association of American Medical Colleges (AAMC) in March, just before the first class graduated.

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Above: Chief Renal Technician Cecil Gunter, left, and Dr. Ben A. VanderWerf, Surgeon, of the Kidney Transplant Center at

Ryder Trauma Center ribbon cutting. (L-R): Richard J. Weiss; Jay Weiss; Congressman William Lehman; Anthony Burns;

the University of Miami School of Medicine, check the opera-

Jose Consela; Dr. Bernard J. Fogel; Dr. Robert Zeppa

tion of a portable kidney perfusion machine.

and the School establish the Public Health Trust, tasked with running the Hospital as an arm of county government and to define the functions of the hospital and the medical school.

The complex was then designated the University of Miami-Jackson Memorial Medical Center.

1980s TO TODAY This triple partnership

Above: Ibis - 1960 Radiology Class

1960s The Medical Research Building

(now the Kathleen and Stanley Glaser) and the Medical Sciences Building (now the Rosenstiel) were completed, and the pre-clinical training programs were moved to the JMH campus.

In 1968, the present VA Medical Center was activated and the Biltmore VA, consisting of 450 general medical and surgical beds, wound down operations.

1970s The JMH buildings were

deteriorated to the point that accreditation from the Joint Commission on Accreditation of Hospitals (JCAH) was in jeopardy. In response, the County, the Hospital 4

allowed a fledgling medical school to develop and mature into a highly ranked educational and research hospital system and one of the largest in the United States. Through the development of a strong research program a post-WWII Veteran’s

Hospital was able to offer the best care to those who served our nation in the armed forces.

Without the symbiotic relationship of these three crucial elements to South Florida’s medical community, Jackson Memorial Hospital, the Miami Veterans Affairs Medical Center and the University of Miami Leonard M. School of Medicine would not be what they are today. Our shared history and deep bonds continue to result in groundbreaking research, unparalleled patient care and excellent training at all three institutions, with the main focus to provide outstanding healthcare to all.

A COMMITMENT TO EVERY PATIENT The formal 1952 agreement designating JMH the teaching hospital for the UM School of Medicine read as follows: “The Dade County Commission agrees to operate Jackson Memorial Hospital to maintain all costs in the hospital incident to its operation, and to supply hospitalization for the indigent sick of the county as well as for such other sick as may present themselves for medical care at their own expense. The University of Miami through their School of Medicine will provide through its faculty all medical teaching in the hospital, and members of its faculty will provide training and care.”

A guiding principle of the first 1976 affiliation agreement is to provide a single standard of care regardless of the patient’s background or ability to pay, a core value that remains to this day.

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REFERENCES A Tradition of Caring: Discovery, Knowledge and Healing.

Published by University of Miami School of Medicine, 2003.

Authors: Gardner, Abby M, Rosen Lisa F, Sahwell Peter A Video Tape: “A History of Caring” Metro-Dade Television Coplan M, Marsh H. An Account of the Birth and Organization of the University of Miami School of Medicine, August 1975.

Above: Students at the School of Medicine Research Library for Pharmacology

MIAMI TRANSPLANT INSTITUTE: JMH AND UM’S PARTNERSHIP TO SAVE LIVES One of the most notable partnerships between the two entities today is the renowned Miami Transplant Institute (MTI). Each year MTI performs over 450 transplant surgeries, and is the only center in South Florida able to provide every kind of organ transplant.

Its interdisciplinary approach combines the groundbreaking research of UM faculty and the superior skills of JMH’s physicians and staff to provide the best care for patients as well as hands-on training for residents and fellows. The MTI currently includes 16 UM faculty members from the fields of Cardiology, Hepatology, Infectious Diseases, Nephrology and Pulmonology and one full-time fellow in Nephrology.

THE VA AND UM: EXCEPTIONAL TRAINING FOR STUDENTS, COMPREHENSIVE CARE FOR VETERANS Through its partnerships with affiliated academic institutions, Veterans Affairs conducts the largest education and training effort for health professionals in the nation.

The VA currently has affiliation agreements with 135 of 141 allopathic accredited medical schools and 35 of 40 osteopathic medical schools for physician education.

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The UM School of Medicine’s very existence may be credited to its early partnership with the hospital run by Veterans’ Affairs at the Biltmore Hotel immediately following World War II. According to Professors of Medicine interviewed, the UMSOM and VA were very integrated in both research and clinical medicine from the early days.

Virtually every UMSOM Department has had a strong relationship with the VA primarily through sponsored research.

Geriatrics started as a specialty at UMSOM, when it was initiated by Drs. Bernie Roos and Guy Howard at the VA Geriatric Research Education and Clinical Center (GRECC).

At present, approximately 12 full-time and 20 part-time VA Medical Service faculty members have regular faculty appointments with clinical or teaching duties at the School of Medicine. Many third and fourth year UM medical students also rotate through the VA outpatient and inpatient services, and approximately 100 Internal Medicine (IM) residents rotate through VA primary care clinic. In addition, during any four-week period approximately 19 IM residents rotate through the VA inpatient and critical care services, and approximately 90 fellows rotate on the subspecialty services at the VA.

Tebeau CW. The University of Miami: A Golden Anniversary History, 1926-1976. University of Miami Press, Coral Gables, Florida, 1976, pp 330 335.

Gardner AM, Rosen LF, Sahwell PA, Clarkson JG, Shalala DE. A Tradition of Caring: Discovery, Knowledge and Healing. University of Miami School of Medicine, Miami FL 2003.

Mr. Koichi Tasa, University Archivist, University of Miami Libraries Miami Hurricane (UM student newspaper) - various issues from the 1950s and 1960s Veritas (newsletter for UM faculty and students) - various issues from the 1960s Christine Kittler, VA librarian Interviews with or advice from current and past faculty: Dr. Lawrence Fishman Dr. Barry Materson Dr. John Byrnes Dr. Gordon Dickinson Dr. Brian Hagenlocker ONLINE SOURCES https://www.miami.va.gov/about/ history.asp http://www.med.miami. edu/50thanniversary/timeline/ timeline_htm.asp www.med.miami. edu/50thanniversary/history.asp

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Cardiovascular Division The University of Miami has a long, rich history in cardiology and cardiovascular research. With leading investigators in the fields of Cardiac Intervention, Cardiac Electrophysiology, Heart Failure, and Cardiac Stem Cells, and as the only institution in Miami with this level of expertise, the Division provides unparalleled options for local patients.

Jeffrey Goldberger, MD, MBA Division Chief Professor of Medicine

CORE PRINCIPLES ACROSS VARIED DISCIPLINES The Division’s commitment to the study of cardiovascular disease begins with a better understanding of risk, disease pathophysiology, critical insights, and a deep exploration of novel therapeutic interventions. As leaders in translational discoveries, the ability to offer new and innovative practices helps bridge the gaps in knowledge and health care delivery for populations in South Florida.

The Division’s clinical practice serves over 10,000 patients per year through both inpatient and outpatient services at University of Miami Hospital, Jackson Memorial Hospital, the Miami Veterans Affairs Medical Center, satellite offices in Boca Raton, Kendall, Plantation, and the newly opened Lennar Foundation Medical Center in Coral Gables.

DEVELOPING NOVEL DIAGNOSTIC AND TREATMENT TOOLS FOR AFIB ACROSS DEMOGRAPHICS Atrial fibrillation (AFib) is the most common arrhythmia in the elderly and constitutes an independent risk factor for stroke and death.

Currently affecting over two million patients in

the United States, its prevalence is predicted to increase over fivefold by the year 2050.

Cardiac risk factors associated with the development of AFib include age, hypertension, obesity, diabetes, coronary artery disease, alcohol abuse, obstructive sleep apnea, and structural heart disease, among others.

Interestingly, there are striking gender, race and ethnic difference in the prevalence of AFib. It is less common in women and in the Black population, despite a higher prevalence of hypertension. Hispanics also may have a lower prevalence of AFib, despite a higher prevalence of diabetes.

The Center for Atrial Fibrillation recently launched the Atrial Fibrillation Risk Factor Modification Program. This unique program focuses in on the risk factors leading to the development of the atrial disease (or substrate) that underlies AFib. Unless these risk factors are properly addressed, the atrial disease will progress and lead to further AFib, despite antiarrhythmic or ablation therapy.

The importance of these risk factors and the best methods to address them in various racial and ethnic populations has not been well studied, but known risk factors for AFib – diabetes and hypertension – likely present different risk profiles in Hispanics and Black populations. The Division is currently assessing the relationship of these factors, particularly in the Hispanic population, to echocardiography and inflammatory biomarkers associated with AFib. By understanding how the known risk factors for Afib influence biomarkers which

Right: “Personalizing Medicine From Patients to Populations” was presented at the Dr. Robert J. Myerburg Endowed Lecture in Cardiovascular Medicine by cardiologist Dan Roden, M.D., Professor of Medicine, Pharmacology, and Bioinformatics and Sr. VP for Personalized Medicine at Vanderbilt University Medical Center. His presentation included how common genetic variants may contribute to variable drug responses, how electronic health records (EMR’s) can be used to discover human disease and drug response genes, as well as how EMR’s can help deliver genomic information to healthcare providers. Gifts from former fellows and grateful patients of Dr. Myerburg’s helped fully establish this lecture two years ago. From left, Jeffrey Goldberger, M.D., Robert J. Myerburg, M.D., Dan Roden, M.D., and Roy Weiss, M.D., Ph.D

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Left: Dr. Jeffrey Goldberger talks to

DIVISION FACULTY LIST

referring doctors about the 4D flow MRI technique to assess cardiac blood flow velocities and its potential for assessing stroke risk in patients with atrial fibrillation.

Professors of Medicine Nanette H. Bishopric, MD Simon C. Chakko, MD Eduardo J. De Marchena, MD Chunming Dong, MD Joshua M. Hare, MD Robert J. Myerburg, MD Rafael F. Sequeira, MD Professor of Clinical Medicine Maureen H. Lowery, MD

represent more direct assessment of the pathophysiological expression of these diseases on the atrium, researchers expect to be able to understand why these risk factors have a differential risk profile for race/ethnicity so that more targeted approaches can be implemented that allow us to better serve patient populations in South Florida.

The UHealth Center for Atrial Fibrillation recently introduced a new tool called Morphology Recurrence Plot (MRP) mapping.

The faculty are evaluating the tool to determine if it can pinpoint the exact locations in the heart that are causing AFib, making ablation more accurate and improving the procedure success rate. This is a unique diagnostic tool for identifying the source of AFib.

my personal achievements have only been possible through the excellence of those who work tirelessly with me every day.”

CONTINUED SUPPORT FROM MIAMI HEART INSTITUTE

Eduardo J. de Marchena, M.D. ’80, has been named the 2017 recipient of the University of Miami Miller School of Medicine Medical Alumni Association’s Hall of Fame Award.

“It is wonderful to be acknowledged for my small part in the extraordinary growth of the University of Miami Miller School of Medicine,

The Miami Heart Research Institute (MHRI) awarded a $2.5 million research grant to the Department of Medicine in 2016. Once again, $500,000 from the MHRI has been awarded between four Division faculty members for the following projects: • Nanette Bishopric, MD “Restoration of Heart Function by Novel Chemical Probes Targeting Remodeling in the Iscppihemic” • Lina Shehadeh, PhD “The Role of Osteopontin in Heart Failure with Preserved Ejection Fraction” • Jeffrey Goldberger, MD, MBA “4D Flow MRI for Assess-ment of Left Atrial Stasis” • Raul Mitrani, MD “Anti-arrhythmic Effects of Mesenchymal Stem Cell Injection in a Swine Model of Post Myocardial Infarct Ventricular Tachycardia”

Eduardo J. de Marchena, MD

Lina Shehadeh, PhD

DR. EDUARDO J. DE MARCHENA HONORED WITH ALUMNI HALL OF FAME AWARD

Nanette Bishopric, MD

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Associate Professors of Medicine Martin S. Bilsker, MD Mauricio G. Cohen, MD Raul Mitrani, MD Associate Professors of Clinical Medicine Eugene J. Bauerlein, MD Sandra Chaparro, MD Claudia A. MartinezBermudez, MD Carl E. Orringer, MD Eugene J. Sayfie, MD Alan H. Schob, MD David M. Seo, MD Assistant Professor of Medicine Lina Shehadeh, PhDx Assistant Professors of Clinical Medicine Carlos E. Alfonso, MD Sharon N. Andrade-Bucknor, MD Amit Badiye. MD Michael Dyal, MD Roberto A. Miki, MD Litsa K. Lambrakos Robert B. Stang, MD

Raul Mitrani, MD

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Division of Clinical Pharmacology

Richard A. Preston, MD, MSPH, MBA Division Chief Professor of Clinical Medicine Director Clinical Pharmacology Research Unit

DIVISION FACULTY LIST Emeritus Professor of Medicine Barry J. Materson, MD, MBA Research Associate Professor David Afshartous, MD

INVESTIGATING THE CAUSE OF HYPERTENSION IN A SPECIAL HIGH RISK POPULATION: POSTMENOPAUSAL WOMEN

NOVEL STUDY OF THE KEY ROLE OF THE KIDNEY IN POSTMENOPAUSAL SODIUM SENSITIVITY AND HYPERTENSION

Hypertensive postmenopausal women constitute a large but under-investigated segment of the US hypertensive population, approximately 25 million women. Hypertension is a major risk factor for stroke, myocardial infarction, heart failure, and end-stage renal disease.

Menopause is associated with a sharp increase in the prevalence of both sodium sensitivity and hypertension. The high prevalence specifically of sodium-sensitive hypertension, where blood pressure increases with sodium intake, may partially explain the marked increase in cardiovascular risk among postmenopausal women. Sodium-sensitive hypertensive patients are considerably more likely to develop significant target organ damage compared to their sodium resistant counterparts.

Despite the enormous burden of hypertension and its consequences in postmenopausal women, there is little information on the mechanisms leading to hypertension in this population. The Division of Clinical Pharmacology has sought to change this through a long and established interest in studying the mechanisms and treatment of postmenopausal hypertension.

The Division’s Clinical Pharmacology Research Unit (CPRU) has designed a sodium loading protocol to measure sodium sensitivity in this population using continuous 24-hour blood pressure monitoring.

Through 16 years of inpatient and outpatient investigations, the CPRU has found that postmenopausal women respond remarkably well to reduced sodium intake and agents that block sodium reabsorption. A recent study found that an increase from low sodium intake to high sodium intake produced a large increase in systolic blood pressure.

The kidney plays a central role in the regulation of blood pressure by regulating urinary sodium excretion. Recent data shows that a specific sodium transporter in the kidney that regulates urinary sodium excretion called the thiazide-sensitive sodium chloride cotransporter (NCC) is key control point for blood pressure regulation.

Building on this newly available data, the CPRU initiated an investigation specifically to determine the role of NCC overactivity in producing sodium sensitive hypertension in postmenopausal women of all races, ages 45-75.

The hypothesis is that abnormal activity of this special transporter may play an important role in human sodium sensitivity and hypertension.

The results of this investigation will be available in 2018 and may have important clinical implications for the treatment of hypertension in this under-investigated population.

Above: In the Department of Medicine Division of Clinical Pharmacology Research Unit, researchers utilize automatic blood pressure measurements over a 24-hour period. By measuring readings conducted during low sodium intake then high sodium intake, investigators have observed a high prevalence of marked sodium sensitivity among hypertensive postmenopausal women.

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BRIDGING THE GAP: Precision Medicine and Health Disparities Collaborative

In 2016, the Department was honored to receive a

The Center’s objectives encompass scientific,

National Institutes of Health U-54 Grant to join the the

educational, and advocacy areas. Its goals include:

Precision Medicine and Health Disparities Collaborative in conjunction with Vanderbilt University Medical Center (VUMC) and Meharry Medical College. The grant funded the creation of the Vanderbilt-Miami-Meharry Center for Excellence in Precision Medicine and Population Health.

Precision Medicine allows doctors to tailor patient

• Filling the cross-training gap between human

Center, the University of Miami

genomics research and disparities research

and Meharry Medical College

• Generating awareness of immediately addressable disparities and proposing practical solutions • Becoming a national resource for disparities The combined resources and expertise of the

the most of preventive care options and aiding in

Department and its partners will yield extraordinary

the selection of the most beneficial medicines and

services and new resources anticipated to propel both

treatments. The Center believes that Precision Medicine

precision medicine and health disparities research. For

holds great promise for relieving health disparities

more information, please visit the project’s website at:

linked to differences present in both our genetics and

http://pmforallpeople.com.

in our social, economic and environmental realities.

Department of Medicine Investigators

The Center is organized around three main projects:

Roy E. Weiss, MD, PhD, Principal Investigator

1. University of Miami: Development of new statistical

Sonjia Kenya, EdD, MS, MA

methods to predict risk of disparities, starting with

Brendaly Rodriguez, MA

cervical cancer.

Nicholas Tsinoremas, PhD

genetic risk factors contributing to health disparities and characterization of the relative contribution of

gather for the launch of the Vanderbilt-Miami-Meharry Center of Excellence in Precision Medicine and Population Health.

knowledge

care to the individual’s specific health needs, making

2. Vanderbilt University Medical Center: Examination of

Above: Researchers from Vanderbilt University Medical

Natasha Schaefer-Solle, PhD, RN Erin Kobetz, PhD, MPH Olveen Carrasquillo, MD

genetic risk factors for asthma and pre-term birth, two conditions that disproportionately affect African Americans and Latinos.

3. Meharry Medical College: Study of person-specific obesity treatment for African American and Latino men.

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Division of Endocrinology, Diabetes and Metabolism South Florida is a true melting pot, and leaders in the Division of Endocrinology, Diabetes and Metabolism have developed a distinctive program to meet the challenge of differing outcomes between populations for patients with endocrine diseases, including diabetes.

A FELLOWSHIP PROGRAM THAT REFLECTS THE POPULATION Ernesto Bernal-Mizrachi, MD Division Chief Professor of Medicine

The Division of Endocrinology fellowship program prides itself in its commitment to education and to including a diverse group of fellows that reflect the cultural background of the South Florida population. While only about 5% of the medical scientists in the United States are African American and 7.9% are Hispanic or Latino, at the Miller School of Medicine 27% of the fellows or students are underrepresented minorities.

The Division embraces this unique opportunity to ensure the diversity of the next generation of physician scientists, and recently applied for a training grant with several School of Medicine departments. The training program will provide research experiences in diabetes and metabolic disorders that enhance existing skills and guide the way to scientific careers in medicine by enhancing trainees’ ability to compete successfully for independent funding.

A sophisticated clinical curriculum, including a Fellows’ Clinic, also reflects the commitment to increased access for patients

and allows fellows as much patient-focused experience as possible.

RESEARCH FOCUSED ON ANALYZING DIVERSITY The newly developed Pituitary Unit, led

by Alejandro Ayala, MD, has been a vital contributor to several multicenter studies of Cushing’s disease. The University of Miami was chosen as a site specifically to ensure diversity, and the unit’s work accurately reflected the U.S. population with 24% Hispanic participation in a cohort of 230 patients. In previous similar studies, minorities (particularly Hispanics) had been underrepresented, and this data will help bridge the gap in knowledge about the behavior of pituitary diseases in underrepresented groups.

At the Fine Needle Aspiration Fellows Clinic at Jackson Memorial Hospital (JMH), Sabina Casula, MD, has developed a database to collect clinical and demographic information from approximately 2,000 JMH patients with a diagnosis of thyroid nodules that underwent fine needle aspiration during the last 10 years.

The initial object of this retrospective chart review study is to correlate the sonographic features of the thyroid nodules with the cytology report, the thyroid function tests, and the demographic characteristics, along with the final pathology when available.

From left to right Dr. Atil Kargi, Dr. Marc Jara, Dr. Megan Zaleski, Dr. Zeina Hannoush, Dr. Fatima Al-Yatama, Dr. Elys Perez, Dr. Pritisheel Banga, Dr. Juan Palacios, Dr. Lila Chertman, Dr. Violet Lagari

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DIVISION FACULTY LIST Professors of Medicine Rodolfo Alejandro, MD Ronald Goldberg, MD Gianluca Iacobellis, MD, PhD Karl Muench, MD Alberto Pugliese, MD Jay Skyler, MD Jay Sosenko, MD Roy E. Weiss, MD, PhD Associate Professors Alejandro Ayala, MD Atil Kargi, MD Violet Lagari-Libhaber, DO

Above: Romero Britto Unveils Colorful ‘Thyroid’ at DOM Reception. With the pull of a black drape, internationally renowned artist Romero Britto unveiled his gratitude to the Department of Medicine with a colorful tribute to a vital part of the human body. The painting called “Thyroid” was introduced at Britto’s newest gallery on Lincoln Road in Miami Beach. From left, Roy E. Weiss, M.D., Ph.D., with Romero Britto.

internal medicine specialties essential to the management of this disease, such as cardiology, nephrology, psychiatry, podiatry and best in the Many patients in South Florida lack the clinical nation ophthalmic care from Bascom Palmer education, language or background to translate Eye Institute.

The Comprehensive Diabetes Center also the overwhelming amount of information being offers several free educational opportunities for communicated to them by their health care team. Providers also lack the time to effectively diabetic patients with classes tailored to the communicate a diagnosis or therapy regimen so population, including cooking healthy Latin food and education geared towards high school patients fully understand their options. students.

This gap in communication is even more pronounced when there is a complex A HOLISTIC APPROACH diagnosis— as is the case with diabetes and other endocrine diseases. At the Comprehensive At the Comprehensive Diabetes Center and in all clinical settings, the Division’s Diabetes Diabetes Center at the Lennar Foundation Education services and nutritionists use Medical Center, there is a multidisciplinary novel tools to educate a diverse population. team approach to support patients undergoing Ronald Goldberg, MD, partnered with Neil diabetes treatment who require a great deal of Schneiderman, PhD, in the Department education, intervention, and support. of Psychology to investigate the effects of At the newly opened center on the Coral lifestyle interventions among low-income Gables campus of the University, different specialties add value by providing personalized minority adults. These studies showed that intervening with educational materials and treatment, proactive counseling, and patient healthcare meetings in Spanish successfully management throughout the course of promoted weight loss and reduced blood therapy. In a single setting, patients can glucose levels. see their endocrinologist along with other

THE COMPREHENSIVE DIABETES CENTER AT THE LENNAR FOUNDATION MEDICAL CENTER

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Assistant Professors of Medicine David Baidal, MD Sabina Casula, MD Silvia Gra Menendez, MD Bresta Miranda-Palma, MD Marcela Perez-Bustamante, MD Maria del Pilar Solano, MD Rodrigo Valderrabano, MD Francesco Vendrame, MD, PhD Research Professors of Medicine, Immunology and Microbiology Luca Inverardi, MD Ricardo Pastori, PhD Research Associate Professors Renzhi Cai, PhD Alejandro Diego CaicedoVierkant, PhD Tengjiao Cui, PhD Armando Mendez, PhD Research Assistant Professors Joana Almaca, PhD Rene Barro-Soria, PhD Manuel Blandino, PhD Rayner Rodriguez-Diaz, PhD

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Divisions of Gastroenterology and Hepatology

Paul Martin, MD, FRCP, FRCPI Professor of Medicine Divsion Chief, Hepatology Interim Division Chief, Gastroenterology

Right: A medical student volunteering with the Wolfson Department of Community Service (DOCS) screens a patient at one of DOCS’

The Divisions of Gastroenterology and Hepatology remain committed to the care of the medically underserved through clinical work in the medical centers, service in the community and research aimed at investigating gaps in health outcomes for different populations. The Divisions also engage in constant evaluation of their care of the underserved to better understand the needs of these communities, leveraging this information to inform others who do similar work.

Faculty also led efforts to provide access to screening tests for potentially lethal but eminently treatable diseases, including the implementation of universal fecal immunochemical testing for colon cancer and Hepatitis C screenings at Wolfson DOCS fairs.

The faculty also unveiled a proof-of-principle screening with the newly approved blood-based screening test in underserved communities.

INVESTIGATING THE RISING INCIDENCE OF IBD IN HISPANICS

WOLFSON DOCS: GUIDING STUDENTS AS THEY SERVE

A team led by Oriana Damas, MD and Maria T. Abreu, MD at the Crohn’s and Colitis Center Many gastroenterology and hepatology faculty (the CCC) is investigating why the incidence members are active in the School’s student-run of Inflammatory Bowel Disease (IBD) is rising Mitchell Wolfson Sr. Department of Community among Hispanics living in the US. Service (Wolfson DOCS), led by physician In a recent study published in the journal advisor and Associate Professor in the GI Alimentary Pharmacology and Therapeutics, Division, Amar Deshpande, MD. Through Damas et.al found the onset of IBD is occurring the program, faculty serve as attendings in much sooner after immigration in more recent student-run nightly clinics. They have also generations of Cuban immigrants compared to implemented “GI night” at the clinic where those who had arrived in earlier decades. faculty and fellows oversee medical students The CCC team, along with Dr. Jacob care for patients with gastrointestinal illnesses. McCauley of the John P. Hussman Institute for The faculty also participate in the nine Human Genomics, received funding from the annual health fairs hosted by Wolfson DOCS National Institute of Diabetes and Digestive in all three South Florida counties. Combined and Kidney Diseases to characterize the these clinics and fairs serve approximately genetics of Hispanics with IBD. 2,500 patients who lack adequate access to Thus far, the team has discovered that routine medical care.

Hispanics with IBD share many common established IBD genetic risk alleles with non-Hispanic whites, and are also working to identify environmental factors, including diet, that may contribute to the onset of IBD in the South Florida Hispanic community.

Dr. Damas and Dr. Abreu have initiated several studies both locally and abroad, including collaborations with gastroenterologists at the University of Havana School of Medicine and the University of Medical Sciences and Hospital Faustino Perez in Matanzas, Cuba. These studies investigate whether changes in Cuba prior to US immigration are contributing to the rising incidence of IBD in Cubans that have more recently immigrated to South Florida.

community health fairs.

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U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

DIVISION FACULTY LIST GASTROENTEROLOGY Professors of Medicine Jaime S. Barkin, MD Jeffrey B. Raskin, MD, FACP, FACG, FASGE, AGAF (retiring June 5th 2017) Maria T. Abreu, MD Martin Kalser Chair in Gastroenterology Professor of Medicine, Microbiology and Immunology In November 2016, Dr. Oriana Damas, Dr. Maria T. Abreu and the Crohn’s

(Instituto de Gastroenterologia), Dr. Felipe Pinol Jimenez (Centro Nacional

and Colitis Center lead research coordinator, Alejandra Quintero,

de Cirugia de Minimo Acceso, Havana Cuba), Dr. Maria T. Abreu (UM), Dr.

traveled to Matanzas and Havana Cuba to begin future collaborations

Alexey Vega Sauders (Instituto de Gastroenterologia), and Dr. Alejandra

with Cuban Gastroenterologists.

Quintero (UM). The UM team of researchers met in Matanzas, Cuba,

Above, from left to right, Dr. Oriana M. Damas (UM), Dr. Maria Elena

to participate and present their work at their annual Gastroenterology

Gonzalez Lopez (Instituto de Gastroenterologia) , Dr. Mirtha Infante

Society Meeting.

RESEARCHING DISPARATE CANCER SURVIVAL AND LIVER DISEASE RATES

South Florida’s Black population, and over the past year has evaluated awareness of this vaccine-preventable cause of liver disease and cancer in the Black community.

This information will be used to develop educational programs and screening campaigns to identify individuals with Hepatitis B infection, so that they can be offered treatment to prevent complications and potentially hepatocellular carcinoma. Dr. Jones also studies the high prevalence of fatty liver disease in other South Florida ethnic groups, most notably Hispanics.

Recognizing that survival from colorectal cancer disparately affects racial and ethnic groups, Daniel Sussman, MD, and colleagues used molecular markers to see the influence of mismatch repair abnormalities and methylation profiles on mortality in patients with colorectal cancer. They determined that tumors from Hispanic, Black, and nonHispanic white individuals have similar rates of a particular molecular change, known as microsatellite instability, and findings were subsequently published in Clinical Gastroenterology and Hepatology.

This investigation is ongoing, now turning to the role of epigenetic phenomena in predicting racial and ethnic differences in survival for patients with colorectal cancer.

Likewise in the field of liver disease, it is recognized that certain ethnic groups have a higher burden of liver disease than others.

Hepatitis B-related cirrhosis and hepatocellular carcinoma have been particularly common in Asians due to the high prevalence of this infection in Asia, and are increasingly found in the Sub-Saharan Black and Afro-Caribbean populations.

Hepatologist Patricia Jones, MD, has confirmed that viral hepatitis is implicated in many cases of hepatocellular carcinoma in D epartmen t o f Medic in e C h air man ’s R e po r t 2017

PREVENTING CANCERS IN LOCAL FAMILIES The past year has also seen the growth of the GI Cancer Prevention Clinic, at which cancer patients and/or their at-risk family members are under the care of a multi-disciplinary team of physicians and genetic counselors.

Patients seen in this clinic are offered genetic counseling, testing of their genes for possible inherited cancer pre-disposition, and an individualized cancer screening and prevention program based on their personal and family histories.

Outreach to family members of cancer patients at Sylvester Comprehensive Cancer Center followed by testing for inherited disorders has resulted in the identification of several unsuspecting patients with high risk for cancers.

Associate Professors of Medicine Amar Deshpande, MD, FACG Jose Garrido, MD Baharak Moshiree, MD Chester Cassel Endowed Chair in Gastroenterology Afonso Ribeiro, MD Daniel Sussman, MD Assistant Professors of Medicine Oriana Damas, MD Paul Feldman, MD Roberto Fogel, MD David Kerman, MD Marcelo Larsen, MD Emory Manten, MD Howard Manten, MD Enrico Souto, MD

HEPATOLOGY Professors of Medicine Lennox J. Jeffers, MD Christopher B. O’Brien, MD Eugene R. Schiff, MD Associate Professor of Medicine Cynthia Levy, MD Assistant Professors of Medicine Leopoldo B. Arosemena, MD Kalyan R. Bhamidimarri, MD, MPH Patricia D. Jones, MD, MSCR Maria D. Hernandez, MD Eric F. Martin, MD

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Division of General Internal Medicine

Olveen Carrasquillo, MD, MPH Division Chief Interim Division Chief, Geriatrics and Palliative Care Professor of Medicine and Public Health Sciences

The Division of General Internal Medicine is dedicated to excellence in the delivery of patient-centered care and improving the health of the community locally, nationally and globally. With partner Jackson Health Systems (JHS), the division provides care to the most vulnerable patients in the area, including the indigent, and staffs two inpatient teaching teams and two outpatient clinics.

Research programs are aimed at developing and testing innovative models of team-based care to improve health outcomes among all populations.

POPULATION HEALTH PROGRAM HELPS MANAGE DISEASE OUTSIDE THE CLINIC Established in 2015, the division’s Population Health Program serves over 2,000 elders, of whom 65% are racial/ethnic minorities.

The program is a partnership with several Medicare managed care plans, whose goals are to maximize population health outcomes while simultaneously promoting efficient use of health care resources.

The program employs a multidisciplinary team, which ensures high quality care not only during clinical visits, but also in between visits. Offering a supportive infrastructure beyond the clinic, the program aims to improve

adherence to medication instructions, help with chronic disease management and ensure timely preventive care.

The program has significantly improved several important quality metrics for this population, most notably in care for diabetics, and in 2017 it achieved a five-star ranking.

“The success of the program is due to the patient-centered care structure that is provided to this population,” says Medical Director Yanisa Del Toro, MD. Among many innovations, the program introduced a telehealth collaboration with UM’s world-renowned Bascom Palmer Eye Institute to provide diabetic retina eye screening examinations on site, without having the patients make a separate visit to the eye clinic.

HIV SCREENING IN BLACK IMMIGRANT POPULATIONS Although the University of Miami has long been a national leader in HIV research, additional efforts are needed to address the crisis in the local community. Miami has the highest rates of new HIV infections in the U.S., and AIDSrelated illnesses are the 2nd leading cause of death among Blacks aged 25-44 in Florida.

With support from the Elton John AIDS Foundation, Sonjia Kenya, EdD, leads a

Right: Community Health Workers attend a Leadership Institute from the Office of Minority Heath, learning patient advocacy.

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U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

DIVISION FACULTY LIST

Left: Community Health Worker accompanying a patient at a visit to a doctor as part of a randomized clinical trial on diabetes management

Professors of Clinical Medicine Panagiota Caralis, MD, JD Laurence Gardner, MD Daniel Lichtstein, MD Alex Mechaber, MD Research Professor Kenneth Goodman, PhD Associate Professors of Clinical Medicine Keith Custer, MD Michael Federman, MD Mark Gelbard, MD Marco Gonzalez, MD Erin Marcus, MD, MPH Hilit Mechaber, MD Paul Mendez, MD Ross Scalese, MD Joan St. Onge, MD Frederick Williams, MD Judi Woolger, MD

comprehensive effort to support communitybased rapid HIV testing and linkage to care services. The program targets Miami’s diverse Black populations, including the one third of blacks in the county who are immigrants from countries including Haiti and Jamaica.

“Though cultural and linguistic norms among African Americans and black immigrants are often quite distinct, most HIV/ AIDS disparities research in the U.S. has targeted African Americans,” says Dr. Kenya.

In the three months since the program started, Dr. Kenya’s team tested over 300 participants in the Overtown, Liberty City, and Little Haiti neighborhoods. The approximately 5% who tested HIV positive also received support in accessing follow-up care.

HEALTH IN YOUR HANDS INITIATIVE EXPANDS This year the division began the second phase of the Health in Your Hands Initiative. This new NIH-sponsored project is a randomized study of 900 black or Hispanic women, most of whom lack health insurance. The study seeks to find innovative ways to deliver preventive services outside traditional clinics.

The study will use home-based testing to screen for cervical and colorectal cancer, as well as rapid testing for Hepatitis B and HIV. “When it comes to providing health care to our most vulnerable populations, it is all about providing the most cost-effective care,” says D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Division Chief Olveen Carrasquillo, “at the right time and in the right setting.”

Dr. Carrasquillo hopes findings from the study will help inform population health initiatives beyond so-called “safety net” institutions. As payment mechanisms increasingly reward health systems for quality and outcomes rather than volume, privately-insured populations also benefit from innovative and efficient approaches.

INNOVATION IN EDUCATION First-year residents now benefit from the Multispecialty Learning Community Program implemented by Joan St. Onge, MD, Senior Associate Dean for Graduate Medical Education and Yvonne Diaz, MD, Assistant Dean for Graduate Medical Education. Interns learn wellness techniques and various crossspecialty competencies in graduate medical education, including methods to address physician burnout.

Division faculty also work closely with the School of Medicine Office of Inclusion and Diversity’s “Safe Space” initiative. Dr. Kenya provides monthly LGBT sensitivity trainings to UM faculty, staff and students and most recently participated in the ongoing visual media project I am U, which highlights diversity leaders and allies on campus and the unique opportunities that culturally and ethnically distinct people can experience while learning and teaching here.

Research Associate Professor Chi Zhang, PhD Assistant Professors of Clinical Medicine Gauri Agarwal, MD Howard Anapol, MD Monica Broome, MD Stefanie Brown, MD Alexandra Calandriello, MD Gregory Coleman, MD Gloria Coronel-Couto, MD Yanisa Del Toro, MD Yvonne Diaz, MD Bruce Eisenberg, MD Antonia Eyssallenne, MD, PhD Alexis Federman, DO Robert Federman, MD Annette Fornos, MD Sherin Ghali, MD Lilliam Guzman, MD Brian Hagenlocker, MD Melanie Helfman, MD Margarita Llinas, MD Sudha Lolayekar, MD Meaghan McNulty, MD, MPH Michael Mueller, MD Elizabeth Parra-Garnica, MD Carla Rabassa, MD Hector Rivera, MD Hiram Rodriguez, MD Stacy Rubin, MD Andrea Sosa Melo, MD Maritza Suarez, MD James Trice, MD Jacobo Wajner, MD Alan Yesner, MD Amalinnette Zito, MD Research Assistant Professor Sonjia Kenya, PhD Assistant Professor Professional Practice Adrian Reynolds, PhD

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Division of Hematology CLINICAL CARE FOR POPULATIONS WITH BLOOD DISORDERS

Joseph D. Rosenblatt, MD Division Chief, Hematology Professor of Medicine, Microbiology & Immunology

DIVISION FACULTY LIST Professors Yeon Soong Ahn, MD John Byrnes, MD Krishna Komanduri, MD Izidore Lossos, MD Stephen Nimer, MD Associate Professors Donald Temple, MD Associate Professors of Clinical Medicine Amer Beitinjaneh, MD Mark Goodman, MD Juan Ramos, MD Jonathan Schatz, MD Assistant Professors Marzenna Blonska, PhD Ronan Swords, MD, PhD Justin Watts, MD Assistant Professors of Clinical Medicine Alvaro Alencar, MD Ney Alves, MD Sharhabil Ammus, MD Roberto Cano, MD Deborah Glick, MD Thomas Harrington, MD James Hoffman, MD Antonio Jimenez, MD Lazaros Lekakis, MD Denise Pereira, MD Alexandra Stefanovic, MD Research Professor Arthur Zelent, PhD Research Associate Professors Wenche Jy, PhD Seung-Uon Shin, PhD Ramiro Verdum, PhD Eric Wieder, PhD Research Assistant Professors Cara Benjamin, PhD Xiaoyu Jiang, PhD JonaYe Xu, PhD Yu Zhang, M.D.

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The Adult Sickle Cell Clinic at Jackson Memorial Hospital, directed by Thomas Harrington, MD, serves the large South Florida population with hemoglobinopathies. Dr. Harrington’s expertise in the area is widely recognized, with many patients referred to the clinic for management of high risk pregnancies and complicated sickle cell anemia-related emergencies. A transitional care program for adolescents with sickle cell disease has also been established in collaboration with UM Pediatrics.

The Division also works within the multidisciplinary Adult Program for the Federally Funded Hemophilia Treatment Center (HTC). The HTC serves as a major regional tertiary referral center, and offers free gene sequencing, genetic counseling, and perinatal care to patients.

65,000 Florida residents from 50 different countries since its U.S. inception, and Dr. Villa has voluntarily attended patients at La Liga since 1979.

INSIGHTS FOR LEUKEMIA, ESPECIALLY IN THE HISPANIC POPULATION

The Leukemia Program continues to thrive under the leadership of Ronan Swords, MD, PhD, ably assisted by Justin Watts, MD. Dr. Swords’ studies are supported by a recently awarded National Cancer Institute R21 grant.

Swords and colleagues have also focused efforts on application of Precision Medicine to treat hematologic malignancies, in an effort to identify targets in order to personalize leukemia treatment.

The Program’s studies of molecular genetic differences in acute myeloid leukemia (AML) patients by ethnicity found that in mutations conferring high risk for AML were more common in Hispanics, while mutations conferring low risk were less common in PARTNERING WITH Hispanics. These data, presented at the LA LIGA CONTRA EL CANCER American Society of Hematology, have led to a Luis Villa, MD, a recent addition to the large retrospective study of 300 AML patients faculty, serves as President of La Liga Contra in collaboration with Moffitt Cancer Center in el Cancer, an organization originally founded Tampa, Florida. in 1925 in Havana, Cuba for the purpose of The laboratory of Dr. Stephen Nimer, serving those who could not afford cancer care.

SCCC Director is studying the role of a a newly After its closure during the Cuban revolution recognized epigenetic regulator, PRMT5, in of 1959, the organization was reestablished in malignant hematopoeisis, and has identified Miami by Cuban emigrees in 1975. inhibitors of PRMT5 through high throughput Recognized as one of South Florida’s most screening which will be adapted to clinical well-regarded cancer treatment agencies, “La Liga” continues to provide free medical services use. Swords and colleagues have also focused efforts on application of Precision Medicine to to nearly 1,000 low-income and uninsured patients each year. The organization has helped treat hematologic malignancies, in an effort to identify targets in order to personalize leukemia treatment.

Alvaro Alencar, MD studies the molecular and clinical heterogeneity of acute lyphoblastic leukemia in Hispanic and non-Hispanic populations unique to South Florida, together with collaborators in Brazil, Colombia, New Mexico and New York City.

Right: Dr. Amer Beitinjaneh (second from the left) leads his Stem Cell Transplant multi-disciplinary team at the Sylvester Cancer Center

U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

BRIDGING THE GAP: Resources for the Transgender Population At the University of Miami, several efforts are underway to reduce health disparities among the transgender community we serve.

Several efforts to improve the LGBT cultural competency of UM healthcare providers and staff are also underway.

The transgender population experiences significant health disparities, including lack of access to trans-competent healthcare, lack of access to adequate health insurance, higher prevalence of HIV infection, and higher prevalence of psychological distress and suicide attempts. Negative experiences seeking healthcare underlie many of these disparities. The 2015 National Transgender Discrimination Survey indicated approximately 23% of transgender people living in the US reported avoiding healthcare due to discrimination. Moreover, 33% of transgender people reported having at least one negative experience related to being transgender with a healthcare provider within the past year.

UNIVERSITY OF MIAMI INITIATIVES FOR TRANSGENDER PATIENT CARE TRANSGENDER HORMONE REPLACEMENT PROGRAM:

LGBTQ CENTER FOR WELLNESS, GENDER AND SEXUAL

This program provides patients with gender identity-affirming care,

HEALTH: University of Miami Hospital recently opened this center,

using hormone replacement designed to induce physical changes to

which provides a broad array of services for transgender patients

match gender identity.

including gender affirmation surgery, primary care, OB/GYN and

The goal of treatment is to maintain hormone levels in the normal

Urology care, as well as mental health services.

physiological range for the target gender, and both transgender

SAFESPACE TRAINING: Led by Sonjia Kenya, EdD of the Division

women and men begin to see changes within the first few months

of General Internal Medicine, this training focuses on basic LGBT

of therapy. Before treatment is initiated, patients are counseled

cultural competency and is provided free of charge to UM clinicians,

about diagnosis, treatment plan, expectations, risk and benefits of

medical students, and staff.

treatment, and the possibility of infertility with treatment.

LGBT COMPETENCY TRAINING FOR ONCOLOGISTS: Along

Criteria for starting hormone replacement include persistent, well-

with investigators at the Moffitt and University of Florida Cancer

documented gender dysphoria/gender incongruence, the capacity

Centers, Julia Seay, PhD of the Division of Population Health and

to make a well-informed decision, and well controlled relevant

Matthew Schlumbrecht, MD of Gynecologic Oncology have recently

medical or mental health issues.

received a Florida Academic Cancer Center Alliance award to

The diagnosis of gender dysphoria is generally made by a mental

develop and pilot this training online.

health provider. Mental health providers are an important part of

FEASIBILITY FOR SELF CANCER SCREENING: Julia Seay, PhD

the transgender care team, and patients are required to continue

of the Division of Population Health, along with several UM and

follow up with a mental health provider throughout hormone

community collaborators, is investigating the feasibility and

replacement. These providers identify, address, and support patients

acceptability of HPV self-sampling for cervical cancer screening

throughout transition in personal, public, family, and work settings.

among transgender men, which may circumvent significant barriers to screening within this vulnerable population.

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Division of Medical Oncology

Albert Craig Lockhart, MD Division Chief, Medical Oncology Professor of Medicine

The University of Miami serves an area that can be broadly characterized by cancer disparity and lack of access to the formal healthcare systems, partly as a result of the remarkable diversity in race/ethnicity, ancestry, socioeconomic variables and culture.

The faculty within the Division of Medical Oncology has embraced the specific regional challenges and is leading efforts to identify and address disparity issues. The faculty spearhead studies including patient populations that are often underrepresented in most scientific endeavors, as well as key research efforts that engage the global community.

boards with colleagues in Latin America and Vietnam that support decision-making in cancer medicines. Physicians also have opportunities to complete preceptorship programs in Miami and to participate in visiting professorships abroad, including a recently launched Gynecologic Oncology fellowship in partnership with the University of the West Indies.

Physicians have generated publications in journals such as The Lancet, Journal of Clinical Oncology and Cancer on topics of policy, equity, and the World Health Organization essential medicines list for cancer.

GLOBAL ONCOLOGY PROGRAM CONNECTS PHYSICIANS IN UNDER-RESOURCED SETTINGS

INVESTIGATING HIGHER RISK FOR BREAST CANCER IN THE LOCAL COMMUNITY

In partnership with Sylvester Comprehensive Cancer Center, Dr. Gilberto Lopes, Medical Director for International Programs and Associate Director for Global Oncology, established and developed the Global Oncology program in September 2016. The program addresses disparities in education, research and care for patients with cancer in resourceconstrained settings, with a focus on Latin America and the Caribbean.

The program gives physicians abroad access to remote lectures, as well as tumor

Individuals in South Florida are at higher risk for obesity related health problems, including obesity-linked inflammatory factors that adversely affect breast cancer risk and treatment. To investigate the obesityinflammation relationship, Joyce Slingerland, MD, was recently awarded a National Institutes of Health R01 grant in collaboration with fellow Division faculty member Judith Hurley, MD, and Internal Medicine Resident Ryan Chapman, MD. Their study will evaluate how obesity affects the treatment outcome of neoadjuvant

Right: In Antigua, Guatemala the Global Oncology Program co-organized an event to teach participants from Central American governments and civic organizations how to create and execute national cancer control plans.

Other partners included the NCI Center for Global health and the Pan American Health Organization.

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Left: High occurrence of

DIVISION FACULTY LIST

gastrointestinal cancers in the South Florida community are a focus for the division. There is an increased incidence of hepatocellular cancers, which is correlated to both Hepatitis B and C infections.

Professors of Medicine Bach Ardalan, MD Pasquale Benedetto, MD Lynn Feun, MD Marc Lippman, MD Stephen Richman, MD Joyce Slingerland, MD Jonathan Trent, MD, PhD Professors of Clinical Medicine Judith Hurley, MD Mohammad Jahanzeb, MD Charles Vogel, MD Associate Professors Dorraya El-Ashry, PhD Jaime Merchan, MD Rakesh Singal, MD

therapy (the first therapy used prior to a main treatment such as surgery) in a cohort of patients with locally-advanced breast cancer.

The women in the study will be predominantly Latina (66%) and African American (27%).

Related to the effort, molecular investigations led by Marc Lippman, MD have identified that RAGE (receptor for advanced glycation endproducts) signaling within the inflammation signaling network may represent a novel therapeutic strategy to treat breast cancers. Investigations into this pathway are funded by the Florida Academic Cancer Center Alliance (FACCA).

NOVEL INVESTIGATIONS INTO A RARE SKIN CANCER Denizens of the Sunshine State are also more likely to be diagnosed with skin cancers such as melanoma. A rare subtype called uveal melanoma has limited therapeutic options, and Nicolas Acquavella, MD has initiated a study to address this unmet medical need. His research investigates the possibility of repurposing vorinostat, a histone deacetylase inhibitor approved by the FDA for the treatment of Cutaneous T-Cell Lymphoma.

The repurposing of previously-approved drugs for a new indication is an efficient way to deliver new therapies for patients. The clinical trials for new indiciations tend to be D epartmen t o f Medic in e C h air man ’s R e po r t 2017

more rapid to initiate, less costly to complete and safer for patients. Dr. Acquavella’s study will provide key proof-of-concept clinical data to determine whether a larger study of vorinostat is warranted for this rare cancer.

TACKLING SOUTH FLORIDA’S HIGH INCIDENCE OF GASTROINTESTINAL CANCERS Research endeavors to evaluate and treat gastrointestinal malignancies are a Division priority, as Hispanics in our local community experience excess colorectal cancer incidence and the high prevalence of Hepatitis B and C infections correlate with an increased incidence of hepatocellular cancers.

The Gastrointestinal Oncology program saw significant growth in 2016-2017 under new leader Peter Hosein, MD. Compared to the previous year, new patient visits for GI cancers increased by 74% and accruals to gastrointestinal cancer clinical trials are up by 85%.

A particular highlight was the high accrual of an investigator-initiated trial of pembrolizumab, a monoclonal antibody targeted against the PD-1 immune checkpoint, in advanced hepatocellular carcinoma. This study is led by Lynn Feun, MD and aims to exploit the finding that hepatocellular cancers often express pembrolizumab’s immune checkpoint target.

Associate Professors of Clinical Medicine Chukwuemeka Ikpeazu,MD Peter Hosein, MD Gilberto Lopes, MD, MBA, FAMS Alejandra Perez, MD Catherine Welsh, MD Assistant Professors Nicolas Acquavella, MD Breelyn Wilky, MD Assistant Professors of Clinical Medicine Timothy Aliff, MD Carmen Calfa, MD Gustavo Fernandez, MD Reshma Mahtani, DO Raja Mudad, MD Lawrence Negret, MD Agustin Pimentel, MD Maria Restrepo, MD Pearl Seo, MD Frances Valdes-Albini, MD Luis Villa, M.D. Steven Weiss, MD Israel Wiznitzer, MD Research Professors Niramol Savaraj, MD Research Associate Professor Priyamvada Rai, PhD

19

Division of Hospital Medicine

Erick Palma, MD Interim Division Chief Assitant Professor of Clinical Medicine

DIVISION FACULTY LIST Professors Steven Cohn, MD Associate Professor Joshua Lenchus, DO, RPH Associate Professor of Clinical Medicine Efren Manjarrez, MD Assistant Professors Tanya Clarke, MD Sadaf Farasat, MD Jorge Florindez, MD Alexander Garcia, DO Matthew Imm, MD Maria Antonietta Mosetti, MD Deepak Mummidavarapu, MD Aldo Pavon Canseco, MD Piotr Tabaczewski, MD Sara Taveras Alan, MD Wassim Samra, MD Jessica Zuleta, MD

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The Division of Hospital Medicine’s faculty serve as primary care physicians when patients are admitted to University of Miami Hospital (UMH), Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital (JMH) and Bascom Palmer Eye Institute/ Ann Bates Leach Eye Hospital.

Faculty communicate with the patient’s primary care physician to coordinate inpatient care with specialists and to prepare for the patient to have a safe discharge from the hospital. The Division also provides an inpatient consult service for the hospital’s non-medical wards and runs an innovative procedure team as part of the effort to decrease length of stay and complications.

The Division is heavily involved with resident education and focuses research efforts in quality improvement and patient safety, medical education and perioperative medicine.

Members of its faculty serve as the President of the Medical Staff at JMH and the Chairman of the Pharmacy and Therapeutics committee at UMH. Moving forward, Hospital Medicine plans to focus on strengthening the resident teaching experience, as well as encouraging significant growth in academic activity and professional development.

CARING FOR THE POPULATION MOST VULNERABLE TO READMISSION The Division of Hospital Medicine has taken action to combat the leading cause of both hospitalizations and hospital readmission in the country, congestive heart failure.

Nationally, one in five patients discharged with a diagnosis of heart failure will have to be readmitted to a hospital within 30 days.

Drs. Shreevinaya Menon, Jorge Florindez, and Efrén Manjarrez have taken on a project to evaluate the risk factors associated with hospital readmission at University of Miami Hospital. The physicians studied what factors distinguish patients with heart failure who are readmitted with those who are not readmitted.

Initial factors associated with increased risk for hospital readmission as identified by the study include physiological differences such as advanced age, poor kidney function and severely reduced left ventricular ejection fraction, as well as differences in care such as discharge to a skilled nursing home, prolonged initial hospital length of stay. Although not all readmissions are preventable, the project aims to help identify patients who would benefit from interventions that would reduce readmission and improve survival and health care outcomes.

U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

BRIDGING THE GAP: Certified Community Health Workers Department members Brendaly Rodriguez, MA, and

CERTIFIED CHWs IN FLORIDA

Olveen Carrasquillo, MD, MPH, have mobilized a statewide effort to develop a new healthcare worker certification – the Certified Community Health Worker. In collaboration with various federal and state educational and medical agencies, the effort has certified over 570 CCHWs since 2015, with the highest

Region

concentration in areas served by the University in the

Southeast Florida 264 Counties: Monroe, Miami Dade, Broward, Palm Beach, Martin, St Lucie, Indian River and Okeechobee

Southeast Florida region.

CCHWs are critical to addressing health disparities, acting as a liaison between health services and members of underserved communities. They provide education and screenings that help prevent disease and identify healthcare needs. To qualify, individuals must have a high school diploma or equivalency, over

Certified CHWs

Southwest Florida 123 Counties: Manatee, Sarasota, Charlotte, Lee, and Collier counties Northwest Florida County: Panhandle

16

East Central Florida

72

North Central Florida

23

Northeast Florida

63

500 hours of work or volunteer experience in a related field, complete a 30-hour training course and pass the state certification exam.

CCHWs are also helping increase access to research for underserved populations. A training module designed

by UM and funded by the Patient-Centered Outcome Research Institute (PCORI) will be used nationwide in PCORI-funded research projects. CCHWs will advance research that helps patients and caregivers make better-informed health decisions.

The Department hopes to build a national movement through which CCHWs can be further involved in patient-centered research, and plans to share best practices learned in this initial implementation with partners in other states.

Brendaly Rodriguez, MA, serves as the co-president of the Florida Community Health Worker Coalition, and Olveen Carrasquillo serves as the Chief of the General Internal Medicine and Geriatrics and Palliative Care divisions.

Above: Brendaly Rodriguez, MA and Olveen Carrasquillo, MD co-presenting a poster with CHWs Maria Azqueta and Valentine Cesar and a community partner representative, Dr. Saint Anthony Amofah from the Health Choice Network (HCN), a federally qualified health center network in Florida.

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Division of Infectious Diseases CONTINUED COMMITMENT TO SOUTH FLORIDA’S HIV/AIDS CRISIS

Mario Stevenson, PhD Division Chief Director, AIDS Institute Co-Director of CFAR Professor of Medicine

The Adult HIV Section within the Division of Infectious Diseases continues to be a strong partner to the South Florida community, which is at the epicenter of the HIV/AIDS epidemic and home to prevalent health disparities related to HIV. Division HIV clinics provide inpatient and outpatient care to a socioeconomically and demographically diverse population of patients, giving the faculty greater insight into the gaps in care that lead to poorer outcomes.

Drs. Michael Kolber and Mario Stevenson represented the University of Miami on the newly formed Miami-Dade County “Getting to Zero” Task Force, which aims to reduce reported AIDS and HIV cases, especially among residents ages 13-19, and to increase the percentage of patients linked to care within 90 days of diagnosis.

Numerous other faculty participated on task force committees as experts in the field, and Drs. Kolber and Rodriguez established a same-day linkage to care for patients testing positive on rapid HIV tests in Miami-Dade County Department of Health (DOH) clinics,

soon to be implemented at JMH emergency rooms as well.

The Rapid Response HIV Treatment Initiation Program is among the few programs in the country ensuring that patients diagnosed with HIV infection are evaluated by an HIV expert and receive antiretroviral medications within one week of diagnosis. This approach is crucial for both individual health outcomes and to prevent further HIV transmission in the community.

EXPANDING ACCESS TO HIV PREVENTION AND TESTING Dr. Susanne Doblecki-Lewis spearheads both the Division’s efforts to expand preexposure prophylaxis (PrEP) and the Expanded Testing Initiative (ETI) program in South Florida, in partnership with county and state health agencies.

Lower income individuals are often discouraged from seeking PrEP because of its perceived high cost, but a partnership with Miami-Dade DOH allows access for at-risk populations regardless of a patient’s ability to pay.

The ETI trains healthcare providers to

Right: Dr. Allan Rodriguez directs the Behavioral Social Sciences and Community Outreach Core for the Miami Center for AIDS Research, which has established ongoing relationships with multiple community based organizations in South Florida. From left to right: Valeria Botero, Marcia Vidal, Katie Klose, Gregory Tapia, Andrisael Lacoste, Lavarr Farmer and Allan Rodriguez (center)

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DIVISION FACULTY LIST Professors of Medicine Gio Baracco, MD Jose Castro, MD Gordon Dickinson, MD Luis Espinoza, MD Margaret Fischl, MD Michael Kolber, MD Michele Morris, MD Allan Rodriguez, MD Thomas Hooton, MD Dushyantha Jayaweera, MD Associate Professors Lilian Abbo, MD Maria Alcaide, MD Catherine Boulanger, MD Susanne Doblecki-Lewis, MD Paola Lichtenberger, MD Isabella Rosa-Cunha, MD Stephen Symes, MD Michael Bergman, MD

make HIV testing as routine as a cholesterol screening or a blood count in their facilities.

Treating HIV screening as another universally applied test reduces the stigma of HIV testing, increasing awareness of infection and linkage to the appropriate services.

Above: Dr. Maria Alcaide is an expert HIV clinician and infectious disease researcher. Over 95% of patients benefitting from the Rapid Response HIV Treatment Initiation Program are from ethnic minorities. One such patient was a young Cuban immigrant who received treatment from Dr. Alcaide on the same day of his diagnosis. He and his partner are now routinely followed in the HIV clinic, have restored immune systems, live a healthy lifestyle, and are research participants. From Left to Right: Dr. Christina Cloke (ID Fellow), Dr. Luis Espinosa, Dr. Maria Alcaide, Dr. Julia Bini

AT THE FRONT LINES OF THE FIGHT AGAINST ZIKA

(ID Fellow), and Sam Ayuk (Research Coordinator)

The explosive pandemic of Zika virus infection occurring throughout the Americas is the most recent of several unexpected arrivals of viral disease in the Western Hemisphere over the past 20 years. The Division took a leadership role in the community when Zika came to South Florida in the summer of 2016, collaborating with the Centers for Disease Control and Prevention as well as state and local authorities and participating as advocates and expert consultants to support funding at the local and national level for Zika clinical care and research.

Tropical Medicine Program Director Paola Lichtenberger, MD led clinical efforts, advising in the design of protocols for diagnosis and management of suspected Zika infections in non-pregnant adults in Miami-Dade. Dr. Lichtenberger also joined forces with Christine Curry, MD of the Department of Obstetrics

and Gynecology and Ivan Gonzales, MD of Pediatric Infectious Diseases to increase awareness among healthcare workers of Zika viral infection.

The group coordinated “train the trainer” sessions as well as Medical Grand Rounds presentations in Miami-Dade, Broward and Palm Beach counties, and participated in several local and regional symposiums on the disease.

Continuing the effort, Dr. Stevenson’s laboratory is now using a novel diagnostic test they developed last year to study how long the virus can persist in different body fluids.

Dr. Lichtenberger and Maria Alcaide, MD, are collaborating in State-funded research of diagnostic testing, as well as in studies with the Division of Cardiovascular Medicine and Department of Pathology to determine the cardiac implications of the virus.

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Assistant Professors Jose Camargo, MD Hector Bolivar, MD Alexis Powell, MD Antoine Salloum, MD Jacques Simkins-Cohen, MD Jose Gonzales Zamora, MD Research Assistant Professor Mark Sharkey, PhD

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The Katz Family Division of Nephrology and Hypertension

Alessia Fornoni, MD, PhD Division Chief Professor of Medicine

The generosity of the Peggy and Harold Katz Family helped establish the first named Division in the Department of Medicine, The Katz Family Division of Nephrology and Hypertension. Every day, our faculty contribute to groundbreaking research driven by the commitment to improve the lives of patients affected by kidney disease and its related complications.

The Division has initiated a strong clinical research program, closely collaborating with the Peggy and Harold Katz Family Drug Discovery Center (the Katz Center) and the Clinical and Translational Science Institute, and its increased presence in the community provides opportunities for all patients to enroll in the latest clinical trials and engage in global educational networks.

PRIORITIZING HEALTH DISPARITIES IN NEPHROLOGY TRAINING

Below: Fellows interacting with Dr. Marie Anne Sosa, Director of Quality Improvement for the Department of Medicine.

The Division emphasizes interdisciplinary connections across the School of Medicine and with outside organizations, and is especially invested in fostering an environment for those eager to learn the fundamentals of discovery science, translational medicine and clinical research. Nephrology fellows stood out this year, winning the award for best clinical

research poster at the 2017 Department of Medicine Eugene J. Sayfie, MD Research Day. Fellows also assisted Marie Anne Sosa, MD, Director of Quality Improvement for the Department of Medicine, in several quality improvement projects, some designed to facilitate access of medical care to underrepresented minorities. With the support of Nephcure Kidney International, and in collaboration with adult and pediatric nephrologists in the community, the Division has organized a well-attended educational symposium for patients and families affected by nephrotic syndrome, a clinical condition that primarily affects minorities and often leads to dialysis or kidney transplantation.

RESEARCH FOCUSED ON DISPROPORTIONATELY AFFECTED POPULATIONS Kidney disease primarily afflicts African Americans and Hispanics in the United States, and many Division faculty study the disproportionate effect on these populations.

Some example studies include: • Jair Munoz Mendoza, MD researches patients enrolled in the Chronic Renal Insufficiency Cohort (CRIC) and has demonstrated that elevated levels of IL6, CRP and FGF23 are independent risk factors for mortality in CKD (Kidney International, 2017) in these groups.

• Gabriel Contreras, MD joined other researchers in the Systolic Blood Pressure Intervention Trial (SPRINT), a study in which different predictors of cardiovascular disease were identified between mainland Hispanics and Hispanics from Puerto Rico.

• Leopoldo Raij, MD is the Co-Principal Investigator of the Hispanic Community Health Study (HCHS)/Study of Latinos (SOL), a multi-center epidemiological study to investigate the sociocultural factors that contribute to cardiovascular outcomes in these specific patient populations.

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DIVISION FACULTY LIST Professors of Medicine David Roth, MD Leopoldo Raij, MD Professors of Clinical Medicine Gabriel Contreras, MD, MPH Warren Kupin, MD Oliver Lenz, MD, MBA

• David Roth, MD was the lead author of a multicenter Phase-3 study published in Lancet in 2017. His work investigates the efficacy of disease modifying drugs in patients affected by Hepatitis C Virus, which primarily affects ethnic minorities. His work will offer opportunities for our transplant program to properly manage these individuals in a way that translates into good long-term outcomes.

Above: Peggy Katz and The Katz Family Division of Nephrology and Hypertension. Longtime donors, Peggy and Harold Katz, committed $10 million to ensure long-term progress in research, education, and clinical achievements in the The Katz Family Division of Nephrology and Hypertension.

The division has been named in their honor with approval by the Executive Committee of the University’ s Board of Trustees.

Her recently published study (Am J Physiol Heart Circ Physiol, 2016) demonstrated a novel regulatory role of oxygen concentration • Warren Kupin, MD has reported a strategy on proliferation, senescence, and migration to improve awareness for living transplant of cardiac stem cells. Ongoing studies are donation in the general population (Clin examining the role of sex-related differences on Kidney J 2016). In an effort to better understand the long-term medical outcomes of adult stem cell function in an effort to bridge African American and Hispanic/Latino kidney the gender gap in cardiovascular research and health disparities. donors.

In the Katz Center, Drs. Alessia Fornoni • Drs. Mariella Ortigosa-Goggins, Giselle and Sandra Merscher have described a Guerra and Alessia Fornoni have submitted key contribution of renal cholesterol in the an NIH UO1 Network Clinical Center grant progression of kidney disease (Journal of application to investigate how the presence Clinical Investigation, 2016). As a result, of apolipoprotein L1 (APOL1) risk alleles in Dr. Fornoni was awarded membership to the donors and recipients may affect long-term American Society of Clinical Investigation and kidney transplantation outcomes. intellectual property claims filed around this topic are now successfully translating into GROUNDBREAKING RESEARCH drug development opportunities for the cure of PARTNERSHIPS focal segmental glomerulosclerosis, a disease The Division also has strong affiliations with with high prevalence in Hispanic and African UM’s Interdisciplinary Stem Cell Institute Americans. through the outstanding NIH-funded research Moving forward, the vision of the Division of Ivonne H. Schulman, MD. Dr. Shulman is to bring patients, academia, industry, has been working toward the development of investors and not-for-profit organizations novel strategies to enhance the cardiovascular from different disciplines around the table regenerative capacity of adult stem cells to develop clinical, research and educational and their translation into clinical trials of strategies aimed at closing in on the health cardiovascular and renal cell-based therapy. disparity gap.

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Associate Professors of Clinical Medicine Giselle Guerra, MD Mariella Ortigosa-Goggins, MD Ivonne Schulman, MD Marie Anne Sosa, MD Assistant Professors of Clinical Medicine Adela Mattiazzi, MD Jair Munoz Mendoza, MD Fernando Pedraza, MD Marco Ladino Avellaneda, MD Research Associate Professor of Medicine Sandra Merscher, Ph.D.

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Division of Population Health and Computational Medicine

David M. Seo, MD Division Chief Associate Professor Associate VP and Chief Information Officer Chief Medical Informatics Officer Chief Research Information Officer

DIVISION FACULTY LIST Professor of Medicine Erin Kobetz, PhD, MPH Associate Professors of Clinical Medicine Ana Palacio, MD, MPH Leonardo Tamariz, MD, MPH Research Assistant Professors Julia Seay, PhD Natasha Solle, PhD

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The founding mission of the Division of Population Health and Computational Medicine is to develop and study approaches that combine electronic health records , “Big Data” and other healthcare technologies into integrated systems that improve health and wellness. With our partners in the University of Miami Health System Information Technology team (UHIT), this year we have advanced several initiatives that tackle the problem of health disparities.

Under the leadership of Ana Palacio, MD, last year we introduced the Social Determinants of Health patient questionnaire into UChart, our electronic health record system. These surveys help physicians learn more about non-clinical factors that may affect their patients, such as financial resources, food security, educational attainment, environmental quality, adequate housing, and community safety. This year the questionnaire was implemented into the clinical workflow of one of our primary care practices, and Dr. Palacio and others are now beginning to incorporate these data in their analyses.

To further the understanding of non-clinical factors that affect patient health, Leo Tamariz, MD, partnered with UHIT to complete geo-coding of the UHealth patient population, allowing UHealth to associate U.S. Census information with patients. Likewise, Erin Kobetz, PhD, aligned the Sylvester Comprehensive Cancer Center and UHIT to bring UHealth’s cancer analytics to the next level.

Scan360 simultaneously maps data such as cancer outcomes, socioeconomic variables and Environmental Protection Agency Superfund sites, providing a unique view of the impact of cancer within different communities and socioeconomic populations.

Insights gained from non-traditional patient characteristics not only allow for the investigation of health disparities, but are often an avenue for novel interventions to improve wellness. This data help drive program development and resource allocation, allowing the University to have a profound impact on the health and wellness of our community.

Below: Scan360, an analytic tool that characterizes our local cancer burden relative to rest of state and US. The image on the left shows the percentage of late stage breast cancer by county while the image on the right highlights the percentage of female Medicare enrollees (ages 67-69) that receive mammography screening.

U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

Division of Pulmonary, Allergy, Critical Care and Sleep Medicine The Division of Pulmonary, Critical Care, Allergy and Sleep Medicine has a unique opportunity to discover and address the main barriers that lead to health disparities in many conditions due to South Florida’s abundant cultural and socioeconomic diversity. The Division’s experiences in this population are especially contributing to what is known about a devastating chronic lung disease, Cystic Fibrosis (CF).

IDENTIFYING CYSTIC FIBROSIS IN UNDERSERVED POPULATIONS CF is a condition that affects about 1 in 3,000 live births, and is an autosomal recessive disease that was thought to afflict predominantly Caucasian individuals.

However, a majority of the patients enrolled in the University of Miami Cystic Fibrosis registry are Hispanic (45%) and African American/ Black (10%). These patients are also 44% female, a group well known to have poorer prognosis and faster lung decline than their male counterparts. Other known challenges for CF patients are related to ethnicity, age and geographic location.

In South Florida, the Division has observed an overwhelming need for treatment of patients that have never received the necessary comprehensive care, suggesting that a significant number of patients from these communities may be misdiagnosed or not receiving care for their CF. CF patients face dire outcomes when comprehensive care is substandard, including

early death resulting from improper treatment of the acute and/or frequent exacerbations of this chronic disease.

To help investigate these differing outcomes, CF researchers are participating in the nationwide Barriers study, which involves collecting pharmaceutical data and medication adherence habits that might provide some insights on this multifaceted issue. Additionally, the Adult Cystic Fibrosis Center (the Center) is coordinating with the Cystic Fibrosis Foundation to survey the Center’s Hispanic patients to learn about specific challenges for this group and to identify tools that can help address the needs of this population.

IMPLEMENTING NATIONALLY RECOGNIZED BEST PRACTICES The Center continuously works to find and close gaps in treatment both within the CF clinic and in the larger UHealth system and affiliated hospitals. In October 2017, the Center completed its participation in an 18-month Cystic Fibrosis Leadership and Learning Collaborative, which provides coaching and basic tools to improve patient care.

Maria G. Tupayachi-Ortiz, MD leads efforts to coordinate with University of Miami Hospital to identify a unit that can best serve the needs of inpatient CF patients.

Pulmonary Fellows receive specialized training in CF patient care, including educational meetings with the interdisciplinary members of the team.

Left: Cystic Fibrosis Team. From left to right: Sherri Kelly (Social Worker), Byron Florian (Respiratory Therapist), Christina Nicolais (Psychologist), Virginia Kondas (ARNP), Maria Tupayachi-Ortiz, MD; Matthias Salathe, MD; Johana

Matthias A. Salathe, MD Division Chief Professor of Medicine

DIVISION FACULTY LIST Professors Horst J. Baier, MD Marilyn K. Glassberg, MD Robert M. Jackson, MD Daniel H. Kett, MD Andrew Quartin, MD Roland M. Schein, MD Adam Wanner, MD Associate Professors Michael A. Campos, MD Alejandro D. Chediak, MD Elio Donna, MD Shirin Shafazand, MD, MS Assistant Professors Alexandre R. Abreu, MD Roger A. Alvarez, DO Sixto Alejandro Arias, MD Jonathan Auerbach, MD Hari V. Brundavanam, MD Jorge L. Cabrera, DO Rafael Calderon-Candelario, MD, MSc David J. De La Zerda, MD Lesley A. Farquharson, MD Tanira B. Ferreira, MD Lauren M. Fine, MD Gregory E. Holt, MD, PhD Mehdi Mirsaeidi, MD, MPH Erick A. Palma, MD Sheyla Paredes-Aller, MD Andreas Schmid, MD Waleed Sneij, MD Maria G. Tupayachi-Ortiz, MD Alejandro Vilasuso, MD Research Professor Philip L. Whitney, Ph.D.

Arana (Research Assistant), Nicole Eustis (Physical Therapist), Sheyla Paredes-Aller, MD; Carlos Munoz (Registered Medical Assistant)

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Research Assistant Professor Eliana P. Mendes

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Division of Rheumatology and Immunology

Eric L. Greidinger, MD Division Chief Associate Professor of Medicine

DIVISION FACULTY LIST Professor of Clinical Medicine Carlos J. Lozada, MD Associate Professors Dana P. Ascherman, MD Elaine C. Tozman, MD Assistant Professors Gustavo Carbone, MD Maria F. Carpintero, MD Schartess Culpepper-Pace, MD Elana Oberstein, MD Ozlem Pala, MD Christine Savage, MD Larry Young, MD

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To address disparities that exist in disease susceptibility and outcomes based on sex or ethnic background, the Division has established efforts that span its research, teaching, service and administrative functions. The Division recognizes that diversity in its own clinical and teaching faculty is essential to creating an environment of equitable and novel care for all of its patients. Over half of the faculty are from Black, Caribbean, or Hispanic backgrounds, over half of the faculty are women, and the Buddhist, Catholic, Hindu, Islamic, Jewish, Protestant, and Sikh faiths are represented.

Acceptance of differences helps bind the Division together as a cohesive group in which the individuals consistently seek to help one another and others in the UHealth system to benefit patients, and to discover the future of rheumatology.

STUDYING THE “HISPANIC PARADOX” Hispanics with rheumatoid arthritis often experience higher disease severity scores than other ethnic groups, but without an associated difference in mortality rates. This discrepancy, referred to as the “Hispanic Paradox,” is the research focus of Division newcomer Gustavo Carbone, MD. Using the multicenter RISE (Rheumatology Informatics System for Effectiveness) and Corrona registries, Dr. Carbone is searching for clues in collaboration with Division rheumatoid arthritis expert Ozlem Pala, MD.

Above: Bethly Aubourg, Director of the Clinical Research Core for Rheumatology and Immunology, enrolls a new study patient.

address this inflammation in more precisely targeted manners, potentially turning risk factors for disease development into new treatment opportunities.

ENSURING DIVERSE CLINICAL TRIALS A challenge in clinical research is to recruit diverse patient populations for studies. As Director of the Clinical Research Core for the Division, Bethly Aubourg has helped increase enrollment of research subjects from underrepresented backgrounds and has maintained the level of participation of more typical research participants at or above our baseline levels.

Ms. Aubourg trained and practiced as a physician in her native Haiti before immigrating to the US to begin her research career. Fluent in Spanish, English, Creole, and French, she is able to provide information and encouragement to a wide range of individuals who are contemplating being part of a research study.

CELLULAR BASES FOR INCREASED SUSCEPTIBILITY

SERVICE IN OUR COMMUNITY

Studies that identify the role of specific cell biology pathways in the pathogenesis of rheumatic diseases are beginning to usher in an era of personalized medicine. The pioneering studies of Dana Ascherman, MD on the immunopathogenesis of autoimmune muscle disease have been awarded new NIH R01 grant funding. Dr. Ascherman’s work identifies both genetic and environmental correlates of over-exuberant inflammation that can drive expression of autoimmune muscle disease. His work also is developing novel approaches to

The Division is particularly proud to provide free rheumatology care through the San Juan Bosco Clinic for indigent patients in Downtown Miami, with lead volunteer faculty support from Drs. Larry Young and Dana Ascherman. Additionally, the dedication of the Division’s faculty to providing accessible clinical rheumatology care has allowed the establishment of practices at a diverse and expanding number of locations, including our newest clinics at the Lennar Foundation Medical Center on the Coral Gables campus.

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Division of Geriatrics and Palliative Medicine The Division of Geriatrics and Palliative Medicine is dedicated to promoting the independence and well-being of elderly individuals. A stand-out project this year was the development of a Patient Aligned Care Team (PACT) with the Miami Veteran’s Affairs Medical Center. Led by Joel Danisi, MD, PACT promotes collaboration and ensures a safe and effective transition of geriatric patients as they move from various levels of care. The Geriatric PACT will expend to Key Largo, Homestead, Ft. Lauderdale, and Broward County VA Centers, where trained Geriatricians already practice the PACT primary care model.

EDUCATION IN COMMUNITY AND CLINIC-BASED PROGRAMS The Geriatrics and Palliative Care longitudinal curriculum for medical students spans all four years of training, and includes opportunities to assess patients in the community through the Active Older Adult Home Visit Program.

Students practice their interviewing skills and provide counseling and education on topics including advanced directives, home safety, emergency preparedness and preventive health services recommendations for older adults.

The division also implemented an interactive case-based session that gave students experience in applying a de-prescribing protocol, which addresses poly-

pharmacy and unneeded medication issues for older adults and is slated to be implemented in the clinical environment as well.

In recognition of the growing Palliative Medicine focus nationally, the division expanded clerkship training in this area by giving students the opportunity to participate in palliative care consults and clinics under the supervision of Khin Zaw, MD.

STANDOUT PROJECT CHRONICLES AGEISM IN POPULAR TELEVISION Under the mentorship of our education faculty, several medical students completed scholarly geriatrics projects this year that were presented at the annual scientific meeting of the American Geriatrics Society. Danielle Howard, MD, a recent graduate, received high acclaim for her project “’Back When They Lost What Made Them People’ – an Analysis of Ageism in Popular Medical Television.”

Studying popular medical shows such as Grey’s Anatomy, House, and Scrubs, Dr. Howard’s research found that the elderly are underrepresented in medical-themed media, and when shown are often portrayed as “enfeebled, burdensome and dehumanized.” This is especially relevant given prior research showing that older patients exposed to negative stereotypes both performed worse in testing and were more likely to refuse life-prolonging interventions.

“Back When They Lost What Made Them People”—an Analysis of Ageism in Popular Medical Television Danielle Howard, MS4 and Rose Maria van Zuilen, PhD

University of Miami Miller School of Medicine and Miami VAMC GRECC, Miami, FL The work reported was supported by the authors’ institutions. The investigators retained full independence in the conduct of this work.

Introduction  The term “Ageism” was first coined in 1968 by Dr. Robert Butler.  Exposure to stereotypes (positive or negative) has been shown to impact older people.

• Older patients exposed to negative age-related stereotypes performed worse in both cognitive and physical activities than those primed with positive stereotypes1.

• Elderly people who were primed with negative stereotypes about their age cohort were also less likely to accept life-prolonging interventions in hypothetical medical situations2.  Any ageism in popular medical TV has potential to have serious implications on elderly patient’s health • and on how doctors see their elderly patients.

Methods  The first seasons of three medical shows—Grey’s Anatomy, House, and Scrubs—were reviewed.  All patients who were interacted with physically or verbally by a main character were recorded, along with their given ages - If no age was given, it was estimated.  Additionally, quotes were recorded that demonstrated ageist qualities.

Results

Table. Number (%) of patients across different age groups TV Show (# of episodes) Grey’s Anatomy (N=9) Scrubs (N=24) House (N=22)

age 0-15

age 16-30

age 31-60

age >60

3 (8.8%)

4 (11.8%)

23 (41.1%)

4 (11.8%)

3 (3.8%)

11 (14.1%) 43 (55.1%) 21 (27.0%)

12 (16.0%) 17 (22.7%) 42 (56.0%)

4 (5.3%)

Total # of pts

Average # of pts per episode

34

3.78

78

3.25

75

3.41

Quotes that Exemplify Ageism “Maybe I should have gone into geriatrics.

No one minds when you kill an old person” “She’s old, she’s ancient. She’s lucky she’s still breathing. I’ve got a shot to scrub in downstairs on a patient who wasn’t alive during the civil war.”

“Why does this gomer got to try and die every day during my lunch?”

“The man’s 92 years old. He has full dementia. He doesn’t even know we’re here. He’s inches from Carla’s rack and he hasn’t even flinched.”

“This isn’t really what I expected. Most of my patients are…older and sort of checked out mentally.”

“Pumpkin…that’s modern medicine.

Advances that keep people alive who should have died a long time ago, back when they lost what made them people.”

“If I have to see one…one more gomer who is shuffled back and forth between some godforsaken home…”

“Well Mrs. Winston, it’s back to the home for you!”

“You have to grab my 3 gomers in 408.”

“Not bad for an 82 year old. She asked me to give that to her true love.”

“What can I say. Chicks with no teeth turn me on.”

“That’s…fairly disgusting.”

“And that’s ageism.”

“You better watch yourself around this ‘babe’.”

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Discussion  Three major themes noticed during project • The elderly are underrepresented in medical media.

• When represented, geriatric patients are portrayed as enfeebled, burdensome, dehumanized.

• Parallels can be drawn between how society treats the elderly and children, especially in regards to love/sex.  Possible hypotheses on why the elderly are so underrepresented in popular medical television • May stem from society’s view that youth = beauty.

• The shows target audience is younger.

• Showing older people in hospitals might hit too close to an uncomfortable topic for viewers (aging/death/dying).

• Older people with illnesses are not unusual and are therefore perceived as uninteresting.  What about the doctors on the show?

• In 2014 approximately 30% of doctors working in America were >60 years old3.

• 54% were 50 years old or older.

• No data recorded on this, but in general a majority of the doctor characters were in their residency.

• The few that were not in residency were mostly young attending physicians.  Future Steps • Repeat this study with all seasons of the shows.

• An unbiased team to verify estimated ages.

• Expand focus to include the ages of the doctor characters, not just the patients.

• Comparison with older medical TV shows to examine ageism over time.

References

"Ageism and stereotyping affect how older people are treated in society but also in the medical field. Danielle Howard’s work sheds light on how these age stereotypes are perpetuated by the medical media. Making people more aware of this problem is an

Olveen Carrasquillo, MD, MPH Interim Division Chief Division Chief, General Internal Medicine Professor of Medicine and Public Health Sciences

DIVISION FACULTY LIST Professors of Medicine Silvina Levis-Dusseau, MD Guy Howard, PhD Bernard Roos, MD (Emeritus) Bruce Troen, MD (Emeritus) Michael Mintzer, MD (Emeritus) Associate Professors Evan P. Cherniack, MD Stuti Dang, MD, MPH Jorge Ruiz, MD Carlos Perez-Stable, PhD Maria Rose van Zuilen, PhD Assistant Professors Enrique Aguilar, MD Joel Danisi, MD Jenny Drice, MD Itzel Fernandez, MD Juan Carlos Palacios, MD Osvaldo Rodriguez, MD Luis Samos-Gutierrez, MD Marcio Soares, MD Khin Zaw, MD Miriam Gutt, PhD Karin Zachow, MD

important early step in weeding it out. As a faculty member, it incredibly rewarding to be a mentor to a medical student who embraces Geriatrics and recognizes the need to raise awareness of the special challenges facing our growing older adult population."

—Rose Maria van Zuilen, PhD

1. Levy, B., & Leifheit-Limson, E. (2009). The Stereotype-Matching Effect: Greater influence on functions when age stereotypes correspond to outcomes. Journal of Psychology and Aging, 24(1), 230-233.

2. Langer, E. J. (2009). Counter clockwise: Mindful health and the power of possibility, Ballantine Books, New York.

3. Young, A., et. al. (2014). A census of actively licensed physicians in the United States, 2014. Journal of Medical Regulation. 101, 8-23.

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Education RESIDENCY & FELLOWSHIP PROGRAMS

BECOMING A TOP RESIDENCY IN THE NATION

EDUCATING LATIN AMERICA’S MOST PROMISING NEW PHYSICIANS

Internal Medicine Residency Stefanie Brown, MD Vice Chair for Education

The modern era of the Department of Medicine residency program commenced in 1970 with the recruitment of Jay Sanders, MD from his chief residency at the Massachusetts General Hospital. Dr. Sanders became the director of the first-in-the-nation Division of General Internal Medicine as well as residency program director. He held this position until 1973 when it was filled by Dr. Laurence Gardner, whose tenure in this position lasted until 1982.

Dr. Mark Gelbard then became residency director, and would hold this seat for twentytwo years. He was succeeded by Dr. Daniel Lichtstein for two years until Dr. Stephen Symes, who had been associate residency director, assumed the directorship in 2006. Dr. Symes turned over this position to its current leader, Dr. Stefanie Brown, in 2016.

The UM-JMH residency program has always attracted excellent students with enthusiastic attitudes, who were motivated and prepared to spend the additional time, devotion and effort in return for the opportunity to be truly involved in and responsible for patient care.

An important and unique feature of the UM-JMH residency is the Latin American Housestaff Training Program. It is an extension of the age-old tradition of providing stateof-the-art medical education to physicians from other nations with lesser resources and opportunities. Former Department of Medicine Chairman, Dr. William J. Harrington, founded the program, and it is now named in his honor.

It began with three resident physicians in 1967 and has grown substantially over the years.

The goal of the program is to train physicians in cutting edge medicine who, upon completion of their residency, will return to their native countries to apply their North American training in medicine and its subspecialties. Candidates are rigorously screened and selected from all over Latin America, and have traditionally developed into some of our most outstanding trainees.

Cardiovascular Carlos Alfonso, MD Cardiovascular- Advanced Heart Failure/Transplant Sandra Chaparro, M.D. Cardiovascular – Electrophysiology Raul Mitrani, MD Cardiovascular – Interventional Alexandre Ferreira, MD CardiovascularInterventional Structural HD Fellow Eduardo de Marchena, M.D. Critical Care Andrew Quartin, MD Endocrinology, Diabetes and Metabolism Atil Kargi, MD Gastroenterology David Kerman, MD Geriatrics Jorge Ruiz, MD Hematology-Oncology Judith De Leo Hurley, MD

Below: Dr. Weiss says a final goodbye to the outgoing Chief Medical Residents and gives a warm welcome to the incoming class.

Hepatology Cynthia Levy, MD Hospice and Palliative Khin Zaw, MD Infectious Diseases Paola Natalia Lichtenberger, MD Infectious Disease Transplant Michele Morris, MD Medicine-Pediatrics Antonia Eyssallenne, MD. Nephrology Oliver Lenz, MD Pulmonary-Critical Care Horst Baier, MD Rheumatology Carlos Lozada, MD Left: 2017-2018 Chief Medical Residents: Erik Kimble, Melissa Vitolo, Daniel Watford, Samantha Gonzalez, Jonatan Nunez, Nathalie Pena, Carlos Diaz, Not Pictured Praful Tewari

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Residents and Fellows

Above: 2016-2017 Chief Medical Residents: Andrew Calzadilla, Elizabeth Vilches, Rhaderson Nascimento, Ana Berbel, Rafael “Quique” Hernandez, Aymara Fernandez, Andrew Elden , Ann Vu.

DATA SUMMARY Internal Medicine Residents Number Total IM Residents................................................ 127 Med-Peds Residents............................................... 20 Residents with Advanced Degrees (MBA, MPH, PhD, MS).......................................... 15 Resident Education % Medical School in Florida.................................. 28 Medical School in U.S. outside of Florida........... 36 Medical School Outside the U.S......................... 35

35%

28%

36%

9% 11% 12% 34%

Resident Ethnicity % Hispanic or Latino ............................................. 35 White ................................................................ 34 Asian................................................................. 12 Black or African American................................. 11 Other .................................................................. 9 Resident Gender % Female............................................................... 39 Male.................................................................. 61 Resident Outcomes % Matches............................................................... 100 Job Placements....................................................... 95 Staying at UM/JMH................................................ 40 Staying in Miami.................................................... 52

61%

35%

39%

Internal Medicine Fellows Number Total Internal Medicine Fellows............................ 118 Cardiology.............................................................. 22 Cardiology - Interventional....................................... 3 Cardiology - Electrophysiology................................. 1 Cardiology - Heart Failure......................................... 1 Critical Care.............................................................. 4 Endocrinology.......................................................... 8 Gastroenterology................................................... 15 Geriatrics.................................................................. 9 Hematology/Oncology............................................ 16 Hepatology............................................................... 1 Infectious Diseases................................................. 10 Nephrology............................................................... 8 Pulmonary.............................................................. 16 Rheumatology.......................................................... 4 Fellow Ethnicity % Hispanic or Latino ............................................. 38 White ................................................................ 15 Asian................................................................. 13 Black or African American................................. 19 Other ................................................................ 15

15% 38% 19%

13%

53%

15%

47%

Fellow Gender % Female............................................................... 47 Male.................................................................. 53 D epartmen t o f Medic in e C h air man ’s R e po r t 2017

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By the Numbers CLINICAL ACTIVITY & CARE PROCEDURES

FY16 FY17*

FY16

UMH........................................................... 54,491........... 48,822 UMHC ........................................................ 18,579........... 22,690 Lennar ............................................................................... 6,401 ADMISSIONS

FY16

FY17*

FY17*

UMH .................................................................. 3281............. 3,350 UMHC/SCCC............................................................................ 1,051 Medical ICU............................................................................. 3,974

0

10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000

TRANSPLANTS FY16-17* Kidney................................................................................... 319 Liver...................................................................................... 132 Pancreas.................................................................................. 28 Intestine.................................................................................. 20 Heart....................................................................................... 26 Lung........................................................................................ 13

4,000 3,500 3,000

2% 4% 5% 5%

2,500 2,000 1,500

CLINICAL CARE

FY16

FY17*

25%

59%

Outpatient Visits............................................ 146,402......... 152,023 Inpatient Visits............................................... 125,955 ........ 136,099 New Patient Visits ............................................ 32355 .......... 33,614 Net Patient Revenue................................. $4,266,582 .. $4,695,178 Work RVUs ................................................... 803,490......... 828,986

1,000 500

UMH

UMHC/SCCC

Medical ICU

*FY17 figures to May, 2017

DOM PLAYS A BIG ROLE AT NEW LENNAR FOUNDATION MEDICAL CENTER Department of Medicine faculty practice on all four floors of the facility, which opened in December 2016 and is located on the University of Miami’s Coral Gables campus. On the first floor, our General and Internal Medicine faculty provide services at the primary care and student health clinics. Gastroenterology faculty perform procedures in the state of the art facilities on the second floor. The

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third floor houses our multispecialty clinic, which includes Cardiology, Gastroenterology, Hepatology, Nephrology, Sleep Medicine and the Comprehensive Diabetes Center. The Hematology and Medical Oncology faculty have a dedicated space on the fourth floor, which is also outfitted for patient infusions and is home to the Rheumatology, Endocrinology-Thyroid and Endocrinology-Bone specialists.

Lennar Outpatient Visits FY17* Division NPV Total Endo ................. 562........2,566 HemOnc ............ 774........2,997 Rheum .............. 271...........476 Cardio ............... 620........1,128 GI ...................... 238...........715 Hepa ................. 163...........374 Neph ................... 72...........154 Sleep ................... 81...........140 Total................ 2,781 8,550

U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

Philanthropy We extend our deepest thanks to the many loyal donors, who support our mission to advance medical science, develop new treatments and cures, train new generations of physicianscientists, and improve the health of those in Miami, South Florida and beyond. Your gifts support over 326 physicians whose appointments in the Department of Medicine are represented by the 15 Divisions in this report.

EXTRAORDINARY GIFT NAMES DIVISION OF NEPHROLOGY AND HYPERTENSION Longtime donors, Peggy and Harold Katz, committed $10 million to ensure long-term progress in research, education, and clinical achievements in the The Katz Family Division of Nephrology and Hypertension. The division has been named in their honor with approval by the Executive Committee of the University’s Board of Trustees.

“This gift will help us advance to the forefront of clinical and experimental innovation,” said Roy E. Weiss, M.D., Ph.D., chair of the Department of Medicine and the Kathleen and Stanley Glaser Distinguished Chair in Medicine.

Anticipated initiatives include the creation of an interdisciplinary Renal Disease Center to translate discovery research into patient care, research into rare diseases such as adult polycystic kidney diseases (ADPKD), further emphasis on drug discovery, and a push to expand interest in nephrology among undergraduate students and medical students.

The gift will also create two professorships and establish the “David Roth, M.D., Endowed Chair in Transplant Nephrology,” which creates a named legacy for the former chief of the division, who is a 33-year member of the UM faculty.

“It is a remarkable honor and I am very humbled by it,” said Roth, William Way Anderson Professor of Nephrology and director of clinical services. “I have dedicated my life to teaching and research in an academic setting.

To have this type of recognition from a grateful patient like Peggy Katz is a real honor because it exemplifies what I’ve tried to accomplish.”

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Over the past decade, the Katz family has made other generous contributions that have led to the growth of the division’s scientific program and investigators. They helped establish The Peggy and Harold Katz Family Drug Discovery Center, which conducts groundbreaking research to improve the lives of patients with kidney disease and is led

by Director Alessia Fornoni, M.D., Ph.D., a professor of medicine who is also the Peggy and Harold Katz Family Chair, and the newly named chief of The Katz Family Division of Nephrology and Hypertension

From left, Alessia Fornoni, M.D., Ph.D., Peggy Katz and David Roth, M.D.

GIFTS AT WORK Thanks to the generosity of our friends and grateful patients, alumni, and faculty, the department is able to offer six annually endowed lectures presented by distinguished scholars, who are researching some of the most challenging health care problems we face today. More about two such lectures below, and a recap of this year’s Dr. Robert J. Myerburg Endowed Lecture in the Cardiovascular Medicine section of this annual report.

THE CUNIO-RICHARDSON ENDOWED LECTURE IN

From left, William W. Anderson, M.D., former UM clinical faculty, who helped spearhead both the memorial lecture and community funding to support it, was on hand to greet Joseph Bonventre, M.D.

NEPHROLOGY, presented by Joseph V. Bonventre,

M.D., Ph.D., Samuel A. Levine Professor of Medicine, Harvard Medical School, focused on “Acute Kidney Injury: Adaptive and Maladaptive Repair.” The lecture is administered thru the longtime collaboration between the National Kidney Foundation of Florida and UM’s Katz Family Division of Nephrology and Hypertension. The NKFF’s donations have totaled nearly $550K in the last 56 years, and have supported both research and education.

THE SUZANNE R AND LAWRENCE M.

From left, Gary D. Hammer, M.D., Ph.D. (University of Michigan) and Lawrence M. Fishman, M.D.

FISHMAN ENDOWED ENDOCRINOLOGY VISITING PROFESSORSHIP, as supplemented by a generous

gift from Tisch and Stuart R. Weiss, M.D. ’71, made this year’s Fishman Lecture and Endocrine Conference possible. Gary D. Hammer, M.D., Ph.D., Millie Schembechler Professor of Adrenal Cancer and Director, Endocrine Oncology Program at the University of Michigan, addressed “Adrenocortical Carcinoma: Challenges & the Future of Integrated Care.”

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Research Data and Publication Summary The Department of Medicine continues its robust tradition of research with over 450 publications authored by its faculty in 2016 and 2017 (to date). In the pages that follow we present abstracts from this period’s publications in the top peer reviewed journals, and below we summarize the research activity of the department both in terms of publications and funding.

RESEARCH SPENDING

RESEARCH FUNDING SOURCES

Total Grants and Contracts Revenue in Millions of Dollars

FY17* Extramural Research Funding (Total Award Budgets)

35

30

2%

32

Federal.................. $27,840,117

2%

7% 25

27

6%

25 23

20

Pharmaceutical........... 21,416,001 Foundation.................. 18,662,842

2%

23

33%

Healthcare Providers..... 2,055,986 Industry......................... 5,362,778

15

22%

Other............................. 5,558,658

10

University...................... 1,870,520 25%

5

0

FY2013

FY2014

FY2015

FY2016

State........................ $1,982,771

*FY17 figures to May, 2017

FY2017*

PUBLICATION DATA Publication Activity

Top 10 Department Authors

Articles

Top 10 Research Collaborators

Articles

Articles.................................................................... 385

Alberto Pugliese, Endocrinology, Diabetes,

Harvard University..................................................... 34

Chapters...................................................................... 4

and Metabolism........................................................ 19

University of Pennsylvania......................................... 24

Editorials................................................................... 19

Joshua Hare, Cardiovascular Medicine...................... 19

National Institututes of Health.................................. 23

Letters....................................................................... 18

Mauricio Cohen, Cardiovascular Medicine................ 17

VA Medical Center.................................................... 20

Review articles.......................................................... 34

Mehdi Mirsaeidi, Pulmonary...................................... 16

University of Florida.................................................. 18

Total Publications............................................. 460

Lilian Abbo, Infectious Diseases................................. 14

Johns Hopkins University........................................... 18

Matthias Salathe, Pulmonary..................................... 13

University of Washington.......................................... 17

Articles

Jamie Barkin, Gastroenterology................................. 12

Yeshiva University..................................................... 17

Neoplasms................................................................ 52

Maria Abreu, Gastroenterology................................. 11

University of Pittsburgh............................................. 17

Infection.................................................................... 47

Armando Mendez, Endocrinology, Diabetes

Memorial Sloan-Kettering Cancer Center.................. 17

Proteins..................................................................... 40

and Metabolism........................................................ 11

Mortality................................................................... 39

Margaret Fishcl, Infectious Diseases.......................... 10

Transplants................................................................ 36

Stephen Nimer, Hematology...................................... 10

Kidney....................................................................... 35

Raul Mitrani, Cardiovascular Medicine...................... 10

Top 10 Research Topics

HIV............................................................................ 34 In Vitro Techniques.................................................... 34

See more about our research activity by using

Safety........................................................................ 31

the University of Miami Research Profiles Tool at

Biological Markers..................................................... 27

https://miami.pure.elsevier.com/en/

Incidence................................................................... 27

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U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

PRESTIGIOUS RESEARCH RECOGNITION DR. ALESSIA FORNONI INDUCTED INTO AMERICAN SOCIETY FOR CLINICAL INVESTIGATION

In recognition of her distinguished career and dedication to excellence in research, Alessia Fornoni, MD, PhD, Chief of the Katz Family Division of Nephrology and Hypertension, and Director of the Peggy and Harold Katz Family Drug Discovery Center, was inducted into the American Society for Clinical Investigation in April 2017.

The American Society for Clinical Investigation (ASCI), established in 1908, is one of the nation’s oldest and most respected medical honor societies. The association seeks to support the scientific efforts, educational needs, and clinical aspirations of physicianscientists to improve human health.

ASCI comprises more than 3,000 physician-scientists from all medical specialties elected to the Society for their outstanding records of scholarly achievement in biomedical research. The association

represents physician-scientists who are at the bedside, at the research bench, and at the blackboard. Many of its senior members are widely recognized leaders in academic medicine.

ASCI is dedicated to the advancement of research that extends our understanding and improves the treatment of human diseases, and its members are committed to mentoring future generations of physicianscientists. The association considers the nominations of several hundred physicianscientists submitted from among its members each year, up to 80 of whom are inducted as new members for their significant research accomplishments. Because members must be 50 years of age or younger at the time of their election, membership reflects accomplishments by its members relatively early in their careers.

Above: Alessia Fornoni, M.D., Ph.D., with with the 1985 Nobel laureates Michael Brown (left) and Joseph Goldstein (right)

HIGH IMPACT PUBLICATION FEATURES JAMA Internal Medicine

Journal of the American Medical Association

January 1, 2016

July 12, 2016

DOM Author: Susanne Doblecki-Lewis, M.D.| Division of Infectious Diseases

DOM Author: Allan E. Rodriguez, MD | Division of Infectious Diseases

Preexposure Prophylaxis for HIV Infection Integrated With Municipal- and Community-Based Sexual Health Services

Effect of Patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use a randomized clinical trial

American Journal of Respiratory and Critical Care Medicine

Nature Medicine

February 15, 2016

October 2016

DOM Author: Matthias Salathe M.D. & Eliana Mendes| Division of Pulmonary, Allergy, Critical Care and Sleep Medicine

DOM Author: Alberto Pugliese, MD | Division of Endocrinology, Diabetes and Metabolism

Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

Analysis of self-antigen specificity of isletinfiltrating T cells from human donors with type 1 diabetes

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Proceedings of the National Academy of Sciences of the United States of America

Lancet February 2017

December 20, 2016

DOM Author: Gilberto Lopes, MD| Division of Medical Oncology

DOM Author: Renzhi Ca, PhDi; Xianyang Zhang, PhD and Andrew V. Schally, Ph.D., MDhc (Multi), D.Sc| Division of Hematology and Oncology & Division of Endocrinology, Diabetes and Metabolism

Changing global policy to deliver safe, equitable, and affordable care for women’s cancers

Growth hormone-releasing hormone receptor antagonists inhibit human gastric cancer through downregulation of PAK1每STAT3/NF-百B signaling

JAMA Internal Medicine

Nature Medicine

DOM Author: Natasha Schaefer Solle, RN, PhD; Daniel A. Sussman, MD, MSPH; Julia Seay, PhD; Erin N. Kobetz, PhD, MPH | Multiple Divisions

March 2017

December 2016

Feasibility of Fecal Immunochemical Testing Among Hispanic and Haitian Immigrants Living in South Florida

DOM Author: Stephen D. Nimer, MD | Division of Hematology DNMT3A mutations promote anthracycline resistance in acute myeloid leukemia via impaired nucleosome remodeling

Blood April 2017

Journal of Experimental Medicine January 3, 2017

THE JOURNAL OF EXPERIMENTAL MEDICINE VOLUME 214 NUMBER 2 FEBRUARY 2017 www.jem.org

Downloaded from jem.rupress.org on August 3, 2017

DOM Author: Marzenna Blonska, PhD | Division of Hematology Dissection of SAP-dependent and SAP-independent SLAM family signaling in NKT cell development and humoral immunity

January 2017 DOM Author: Maria T. Abreu, MD| Division of Gastroenterology

Anti-CD20-interleukin-21 fusokine targets malignant B cells via direct apoptosis and NK-cell– dependent cytotoxicity

JAMA Internal Medicine PAR3 SUPPRESSES MELANOMA Meningeal ILC2s Identif ied The Long Life of Human Gut Plasma Cells

Gastroenterology

DOM Author: Joseph D. Rosenblatt, MD| Division of Hematology

May 1, 2017 DOM Author: Olveen Carrasquillo, M.D., M.P.H. |Division of General Internal Medicine Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes

Diet as a Trigger or Therapy for Inflammatory Bowel Diseases The New England Journal of Medicine Journal of Clinical Oncology February 2017 DOM Author: Jonathan Trent, MD | Division of Medical Oncology Surgical Management of Wild-Type Gastrointestinal Stromal Tumors: A Report From the National Institutes of Health Pediatric and Wildtype GIST Clinic

May 11, 2017 DOM Author: David A. Baidal, M.D.| Division of Endocrinology, Diabetes and Metabolism Bioengineering of an Intraabdominal Endocrine Pancreas

Nature June 2017 (Published online May 2017) DOM Author: Paola N. Lichtenberger, M.D.| Division of Infectious Diseases Genomic epidemiology reveals multiple introductions of Zika virus into the United States

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U H ea l t h | U n i v er s i t y o f M i a m i M i l l er Sc hool of Med i c i ne

Find Us Online!

Department of Medicine faculty member Hector Rivera, MD, of the Division of General Internal Medicine, developed a mobile application that empowers patients to recognize potentially dangerous symptoms. Red Light Warning Signals is available on both iTunes and the Google Play Store.

UNIVERSITY OF MIAMI LEADERSHIP President: Julio Frenk, MD, MPH, PhD CEO, UHealth and SVP of Health Affairs: Steven Altschuler, MD Dean and Chief Academic Officer - Edward Abraham, MD

DEPARTMENT LEADERSHIP

Hector Rivera, MD

Chair: Roy Weiss, MD, PhD Vice Chair for Administration: Anna Carol Herman-Giddens, RN, BSN Vice Chair for Appointments, Promotion and Tenure: Oliver Lenz, MD, MBA Vice Chair for Clinical Affairs: Michael Kolber, MD Vice Chair for Education: Stefanie Brown, MD Vice Chair for Innovation and Diversity: Marilyn Glassberg, MD Vice Chair for Research: Matthias Salathe, MD Associate Vice Chair for Quality: Maritza Suarez, MD Executive Director, Clinical Operations: Carlos Prieto Executive Director, Finance: Andres P. Macia Director, Business Operations: Laura J. Pinzon

DIVISION CHIEFS Cardiovascular: Jeffrey Goldberger, MD, MBA Clinical Pharmacology: Richard Preston, MD, MSPH, MBA Endocrinology, Diabetes and Metabolism: Ernesto Bernal-Mizrachi, MD Gastroenterology: Paul Martin, MD (Interim) General Internal Medicine: Olveen Carrasquillo, MD, MPH Geriatrics and Palliative Medicine: Olveen Carrasquillo, MD, MPH (Interim) Hematology: Joseph Rosenblatt, MD Hepatology: Paul Martin, MD Hospital Medicine Erick Palma, MD (Interim) Infectious Diseases: Mario Stevenson, PhD Medical Oncology: Craig Lockhart, MD Nephrology and Hypertension: Alessia Fornoni, MD, PhD Population Health and Computational Medicine: David Seo, MD Pulmonary, Allergy, Critical Care and Sleep Medicine: Matthias Salathe, MD Rheumatology and Immunology: Eric Greidinger, MD

DIVISION ADMINISTRATION

For the latest announcements, events and opportunities, follow us on social media:

HTTPS://WWW.FACEBOOK.COM/UMIAMIDEPARTMENTOFMEDICINE

Cardiovascular: Jennette Prieto Endocrinology, Diabetes and Metabolism: Cristina Calderon-Parra Gastroenterology: Carol Cottrell General Internal Medicine: Sarah Quadri Geriatrics and Palliative Medicine: Sarah Quadri Hematology: Stephanie Reinoso Hepatology: Carol Cottrell Hospital Medicine: Iliana Vera Infectious Diseases: Maria Piega Medical Oncology: Jennifer Kim Nephrology and Hypertension: Susan Martin Population Health and Computational Medicine: Michelle Hutarte Pulmonary, Allergy, Critical Care and Sleep Medicine: Rolando Briceno Rheumatology and Immunology: Anouk Gachelin

HTTPS://TWITTER.COM/UMIAMIHEALTH

HTTPS://WWW.INSTAGRAM.COM/UMIAMIHEALTH/

D epartmen t o f Medic in e C h air man ’s R e po r t 2017

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University of Miami Health System delivers leading-edge patient care by top-ranked physicians. Powered by the Miller School of Medicine’s groundbreaking research and medical education, UHealth provides life-saving care. UHealth is a comprehensive network of six hospitals, two dozen outpatient facilities, 1,200 doctors, and more than 8,000 associates. As the region’s only university health system, UHealth is a vital component of the South Florida community.

Department of Medicine, Chairman’s Office Don Soffer Clinical Research Center Leonard M. Miller School of Medicine University of Miami 1120 NW 14th Street, Suite 310 Miami, FL 33136 305.243.9120 medicine.med.miami.edu