Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 10 Issue 2 Apr. 2021
Vaccine Roll Out A significant challenge was not knowing when the vaccine would be approved, and, once approved, not knowing when and how much vaccine we would receive. UTMC was notified of the number of doses we would be receiving for the first round just 48 hours before they arrived. It took tremendous organization to get eligible team members vaccinated in a timely fashion without allowing any doses to be wasted. “We had a great deal of support from RNs who work in administrative positions who came out to help with the vaccination effort, giving shots, monitoring people for reactions, and helping with paperwork.” Dr. Rasnake said. Careful planning and flexibility have been key. “At first, neighborhood pharmacies were going to administer the vaccine,” Dr. Rasnake said. There were even plans to have drive-thru vaccinations. However, after the CDC and FDA received notification of a small number of suspected anaphylaxis cases following COVID-19 vaccination, the rollout changed significantly. CDC guidelines included monitoring people for 15 minutes after vaccination, which meant that distribution had to be done in places that had enough space for socially-distanced waiting for 15 minutes after administration of the vaccine, as well as having the ability to store the vaccine at the appropriate temperature. Dr. Rasnake and his team tried to anticipate problems early on, in order to be ready for anything. “We practiced everything,” he said. “And we practiced a lot.” As of mid-January, 9,000 doses had been administered without a single wasted dose. To commemorate the effort, Dr. Rasnake engaged another one of his skill sets: woodworking. He has built display cases for several of the vials that held the first doses. “The wood for them came from a downed limb from the ginkgo tree that stands in front of the old Preston library,” he said. One of these will be displayed in the new Preston Library/ Health Information Center, in recognition of their graciously lending their space for the vaccination effort.
The rollout of the vaccine for COVID-19 has been a very bright spot in a dark time. On December 17, 2020, the first doses of the Pfizer-BioNTech COVID-19 vaccine were administered to UTMC employees. Vaccine rollout began in the Preston Library/Health Information Center, then moved to the Heart Hospital conference room. By any measure, it has been a success. “It takes a huge team effort to make something of this magnitude go smoothly,” said Dr. Mark Rasnake. Teamwork from the state level down to individual institutions have made it possible to get shots into arms. “Two years ago, when there was a hepatitis A outbreak, we worked closely with the state to roll out that vaccine,” recalled Dr. Rasnake. “The connections and protocols we developed then have helped with this vaccine rollout.” Similarly, collaboration between the regional hospitals and the Knox County Health Department has helped facilitate vaccine distribution just as it has earlier in the pandemic with other measures like PPE acquisition and guidelines, visitor restrictions, and so on.
Points of View
on most weekdays. Fortunately, we had a new department manager, Cassandra Mosley, who is very tech savvy and had previous experience working with Zoom. With her guidance and Jenny Roark’s help we immediately switched to virtual conferences. Despite their hectic schedules, Drs. Norwood, Morris, Lubas, Pierce, Purkey, Williams and Rasnake stepped up to ensure that teaching conferences were not interrupted and arranged for them to be held remotely. Our residents and faculty had to go through a steep learning curve, with some hands on coaching, of course. With the help of our residents, fellows and attending physicians we kept the clinical services operational throughout this period. Unfortunately, we had to make the residents Graduation Party a low key affair last year because of the restrictions on social gatherings. We also had to prepare for the resident recruitment to be done virtually. This required that all the websites had to be updated before the interview season began. Coordinating all the interviews was a grand
Virtual Resident Conferences The devastating effects of the COVID-19 pandemic posed many unprecedented challenges. In the initial phases of the pandemic the predominant concern was to keep everyone safe and protect them from getting SARS-CoV-2 infection. In the Department, we adapted to the uncertainty and took several unique measures so that Rajiv Dhand, MD, Chair we could function in this “new reality”. For example, we had to continue our teaching conferences so that our trainees’ education did not suffer during the lockdown and to allow our staff to work from home. We have a very active teaching schedule with at least 2 conferences daily
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Mental Health Resources Available at UTMCK If “health is a state of body, wellness is a state of being”, our minds, bodies, and spirits require nourishment to flourish. Nowhere has this been truer than in hospitals like our own, which have been stressed due to the ongoing pandemic. Recognizing this need, the medical center has purchased a 1-year premium subscription to the mindfulness app Wise@Work to help staff relieve stress and focus on their mental well-being. Wise@Work was created by Wisdom Labs, a mindfulness-based software company. The app features numerous guided practices for all aspects of your day and offers solutions to questions which may be on your mind, such as how to inspire your creativity, deal with uncertainty, improve focus, and how to better wind down before bed. Session lengths can be stretched or shortened to fit your schedule, no matter how busy it may be. More importantly, the app really works: the guided meditations and mindfulness strategies utilized in the Wise@Work app have shown significant benefits surrounding emotional intelligence, resilience, stress levels, and communication among employees in many large companies within the US. We hope this app can help provide UT Medical Center employees with the tools and healthy habits needed to maintain a healthy level of mindfulness and improve overall well-being even beyond the 1-year mark!
Resident Spotlight: Chad Hughett One of the bright spots within our second year Internal Medicine Residency class is Dr. Chad Hughett. Dr. Hughett grew up in Scott County, TN where he met his high school sweetheart and began his path to becoming a physician. Initially aspiring to join the military or become a football lineman right out of high school, he was encouraged to pursue a degree at Tennessee Tech University in Cookeville, TN by his wife. It was there that he suffered an injury playing intramural football that first exposed him to the world of medicine. He was shadowing an orthopedic surgeon when he recognized his dream of becoming a physician. He applied and got into the Edward Via College of Osteopathic Medicine (VCOM-Carolina Campus) in 2016. He joined the Army National Guard at the same time, which allowed him the honor of serving his country. By the end of Dr. Hughett’s time at VCOM-Carolina, he and his wife had grown their family to the tune of three beautiful daughters. He landed his dream residency program here at UT-Knoxville in 2019, but not before completing Basic Officer Leader Course at Fort Sam Houston in San Antonio, TX. As part of his National Guard duties, Dr. Hughett continues to drill with the South Carolina Guard one weekend monthly in addition to two weeks of annual training each year. His responsibilities include working at the South Carolina Medical Command, where they perform health screening for soldiers eligible for deployment and for those about to be deployed. Following completion of his residency, he too will be eligible for deployment as he continues on his pursuit of becoming a much-needed and well-respected primary care physician within his local community.
Points of View
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undertaking and the chief residents – Kat Coombes, Nikhil Jain and Morgan Morelli, along with Sissy, Kristi and Cassandra played a huge role in making this successful. Many attending physicians and residents stepped in to help Drs. Rasnake, Norwood, Bresee, Dudney, and Overly and Pam to select applicants for their respective programs. They ended up interviewing on average 50% more applicants than they would normally do. The IT department and Kandi Hodges took on additional responsibilities and managed to get everything done in a timely and professional manner. Our Department displayed excellent team work that helped us get through these challenging times. I can think of no better shining example of how we can come together, one and all, for the common good and show that we truly care for each other. To each and every one who contributed in this magnificent effort, named and unnamed, my heartfelt thanks and everlasting gratitude. I know we are all hoping for a smoother ride in 2021!
CME OPPORTUNITIES—Mark Your Calendars! • 8th Annual Primary Care CME Conference, offering up to 6.75 hours of CME credit this year. The conference will be held virtually in real time livestream on April 9th, 2021. We hope you can join us for this informative event. View course information, agenda, and fees at: Primary Care CME Details • Cardiology Conferences, held weekly on Wednesdays for .75 hour CME credit. • Medicine Grand Rounds, held on the 2nd, 4th, & some 5th Tuesdays each month for 1.00 hour CME credit. • Ethics Case Rounds, held on the 4th Thursday of the month at noon in Wood Auditorium, are available for 1.00 hour CME credit. • Pulm/HTN Conferences, held on the 2nd Monday each month at noon in different locations and are available for 1.00 hour CME credit. 2
Faculty & Staff Announcements: New Faculty We are elated to welcome Dr. Isaac Biney for appointment to the rank of Clinical Assistant in the division of pulmonary disease and critical care. Dr. Issac Biney completed medical school at the University of Ghana Medical School in Accra, Ghana. He completed residency in categorical medicine at Howard University Hospital in Washington, D.C. and then completed a fellowship in pulmonary disease and critical care at the University of Tennessee Medical Center in Knoxville, TN. He has been awarded honors in scholarship for pulmonary disease and critical care. He was selected as Fellow of the Year for 2019-2020.
We are pleased to welcome Dr. Alexander Hartmann as Assistant Professor in the division of neurology. Dr. Hartmann completed medical school at Eastern Virginia Medical School in Norfolk, VA. He completed a residency in neurology at the University of Minnesota in Minneapolis, MN and then completed a fellowship in neuroophthalmology at Emory University Hospital in Atlanta, GA. Dr. Hartmann is among one of the first neurologists with neuro-ophthalmology subspecialty training in Knoxville.
Faculty and Departmental Awards: Congratulations are in order to our very own Department Chair and Associate Dean, Dr. Rajiv Dhand. He was selected as the inaugural Wahid T. Hanna, MD Endowed Chair for the Department of Medicine at the University of Tennessee Graduate School of Medicine. Through this endowment funding, the Department will be able to better enhance the training environment for residents, fellows, post-graduate trainees, students, faculty, and staff as well as enhance the quality and safety for people in the service region, and encourage innovation and research in medicine, specifically hematology/oncology. Dr. Hanna is an internationally known physician, faculty member and research specialist in hematology and oncology. Dr. Hanna was appointed to the UT Graduate School of Medicine faculty in 1980, was named a full professor in 2002, and served as the chief in the Divison of Hematology and Oncology within the Department of Medicine. He has served as director of the East Tennessee Comprehensive Hemophilia Center since 1983. Dr. Hanna said “I am grateful to all the donors and for this wonderful gift. It has been an honor for me to practice, teach and contribute to the acquisition of knowledge during my more than four decades at The University of Tennessee Medical Center. I am delighted to know that the Department of Medicine will now be better able to advance its research and educational missions.” He added, “I can think of no more a deserving candidate to hold the Chair than Dr. Dhand.” Before serving in his current position, Dr. Dhand was Professor of Medicine (with tenure) at the University of Missouri, Department of Internal Medicine, in Columbia, Missouri. There, he served as Director of the Division of Pulmonary, Critical Care, and Environmental Medicine and as Program Director for the Division of Pulmonary, Critical Care, and Environmental Medicine Fellowship. He also served as Medical Director of Landmark Hospital in Columbia, Missouri. Dr. Dhand joined University Pulmonary and Critical Care (UPCC) in 2012. He has over 30 years of clinical experience as a pulmonary physician with major interest in the treatment of airway disorders, including chronic obstructive pulmonary disease, asthma, and bronchiectasis. He has served as President of the American Association of Chest Physicians of Indian Origin and is currently Past President of International Society for Aerosols in Medicine. Dr. Dhand said, “It is a great honor for me to be named as the inaugural Hanna Endowed Chair, which honors Dr. Hanna and his decades of dedication to patients living with cancer or blood disorders. He has made important contributions to the field of hemophilia, in part through his role in teaching the next generation of physicians. This support will be of great benefit to the Department of Medicine as we seek to expand our academic footprint.” 4
ECMO, UTMCK, and Ethics Ethics Case Rounds are monthly, hospital-wide discussions of morally distressing cases. Cases are de-identified to protect patient confidentiality.
Years of hard work, vision, and expertise came to fruition in December of 2020, when UTMC accepted its first ECMO patient. Extra-corporeal membrane oxygenation, or ECMO, is a complex apparatus that maintains critically ill patients by oxygenating the blood outside the body. It supports the lungs, or the lungs and heart, allowing them to rest and heal while the patient is treated for the underlying illness or injury. “With ECMO support,” note Makdisi & Makdisi (2019) “the definition of human viability has changed and the complete arrest of the heart or the lung no longer means death.” Considered the most intensive of intensive care measures, the lifesaving promise of ECMO is accompanied by ethical challenges. The role of clinical ethics in ECMO delivery has two main sets of goals: 1. Facilitating patient and family understanding about ECMO, encouraging realistic expectations, and aligning their goals with the care team’s, and 2. Addressing the moral distress of providers involved in complex ECMO cases (Stevens and Bruce, 2018). Patients are considered for ECMO for one of two reasons: native organ recovery, or as a bridge to transplant or implant. ECMO patients must be maintained in the ICU and continuously monitored for complications such as infections, blood clots, bleeding, and limb ischemia. Patients may need this level of intensive support for only a few days, but many require ECMO for weeks or longer. Due to the level of care involved, it is an extremely expensive modality. ECMO requires careful interdisciplinary collaboration between a variety of specialists. The complexity of the teams needed to maintain patients on ECMO, the uncertainty around outcomes, the intricacy of the medical situation compared to the level of medical literacy of most patients and families, and the intense emotions that accompany this degree of critical illness creates fertile ground for miscommunication. Even with careful selection criteria and superb management, the mortality rate on ECMO is quite high – around 50%. The most common ethical issue arises when it appears that ECMO is no longer likely to accomplish the patient’s goals. As there is usually no “bright line” to definitively indicate that goals cannot be met, there may be divisions among the staff or between staff and families about whether to discontinue ECMO and transition the patient to comfort measures. As with less-intensive modalities, proactive discussions about what the patient would be willing to undergo and what quality of life would be acceptable are key to resolving uncertainty. At UTMC, patients who are thought to be candidates for ECMO are screened conscientiously for likelihood of survival before ECMO is offered. When a patient is placed on ECMO, Palliative Care and Clinical Ethics are included in the team. Goals of care are established with the family early. The ECMO team rounds daily and provides thorough updates to families, and family meetings are held periodically to ensure that the family’s and team’s expectations align. The East Tennessee community is extremely fortunate to have this lifesaving possibility available.
Comments may be sent to email@example.com References • Courtwright, et al. “Ethics Committee Consultation and Extracorporeal Membrane Oxygenation.” Annals of the American Thoracic Society 13(9): 2016 1553-1558 • Makdisi T, Makdisi G. Extra corporeal membrane oxygenation support: ethical dilemmas. Ann Transl Med. 2017;5(5):112. doi:10.21037/atm.2017.01.38 • Stephens, AL and Bruce, CR. “Setting Expectations for ECMO: Improving Communication between Clinical Teams and Decision Makers.” Methodist DeBakey Cardiovascular Journal 14(2) 2018 120-125
Presentations, Publications, Awards
Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.
Thank You For Your Support
For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or firstname.lastname@example.org. If you would like more information about any of the topics in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.
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Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you! 5
Vol. 10, Issue 2: April 2021 Publisher Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs Editor Annette Mendola, PhD Administrative Director Jenny Roark Contributors Jenny Roark Robin Underwood Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Cassandra Mosley Kristin O’Connor, MD Megan Sears-Smith, DO Design J Squared Graphics In Touch is produced by the University of Tennessee Graduate School of Medicine, Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities. Contact Us In Touch University of Tennessee Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920 Telephone: 865-305-9340 E-mail: InTouchNewsletter@utmck.edu Web: http://gsm.utmck.edu/ internalmed/main.cfm The University of Tennessee is an EEO/AA/Title VI/ Title IX/Section 504/ADA/ ADEA institution in the provision of its education and employment programs and services. Disclaimer: quotes/ interviews are edited for length and clarity