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Department of Medicine

Con necting Tec h n olog y, Educ a tion a n d D iscov e r y w i t h H u m a n i s m i n M e d i ci ne

Intrinsic Factors of Discovery

Vol. 3 Issue 1 January 2014

In 1928, when George Minot, MD, assumed his position as the second director of the Thorndike Memorial Laboratory at Boston City Hospital, he pledged to maintain an atmosphere that allowed “opportunities for freedom of thought and open discussion.” Because of its work, this lab is now considered to be the birthplace of modern hematology. Jonathan Wall, PhD, Professor in the Human Immunology and Cancer Program at the University of Tennessee Graduate Drs. Jonathan Wall and Steven Kennel School of Medicine, lead a successful team of investigators that Knoxville, TN, and has been researching better methods to image the director of basic and treat amyloidosis. science research for the Department of Medicine (DOM) runs that kind of lab. The walls along the laboratory hallway are lined with multicolored posters presented at meetings all over the world; each poster, every presentation, reams of journal articles and book chapters documenting incremental progress toward understanding the pathogenesis of primary (AL) amyloidosis. Building on this, Wall’s team was instrumental in performing the “firstin-human” clinical trial studying a radio-iodinated monoclonal antibody that detected light chain amyloidosis by PET scan. Their latest

imaging agent is a protein that seeks and binds to amyloid. In addition to creating better PET scan images, it has the potential to serve a therapeutic role for patients with amyloidosis, Alzheimer’s disease, and Type II diabetes. This expertise was recently acknowledged by an NIH grant that will help fund the program for the next four years. Steve Kennel, PhD, Associate Professor of Medicine and Radiology, transitioned from the Biology Division at Oak Ridge National Labs to the DOM basic sciences division nearly ten years ago, bringing with him a wealth of experience in creating radioisotope delivery systems for the treatment of cancer. The Thorndike atmosphere is especially apparent between Wall and Kennel. They oxygenate their ideas with each other, debating their plausibility while simultaneously designing an experiment to confirm or refute it. Kennel and Wall are quick to give credit to each other, but they both are proud of their committed team of co-investigators. Alan Stuckey, BA, CNMT; Tina Richey, MS; Emily Martin, BS; Angela Williams, MS; Sallie Macy, BS; and Craig Wooliver, MLT, are an unusually specialized group of talented people, each with unique and indispensable talents that are vitally important to the success of this research. Less than a century ago, B12 deficiency was a lethal illness.  William B. Castle, MD, another hematology icon, built on Dr. Minot’s work and reversed the bone marrow failure of pernicious anemia by feeding his patients beef steak that was partially digested in the stomachs of impoverished medical students. He concluded that the result was due to a then unknown “intrinsic factor” present in the students gastric juices that was absent in his patients. Now, this once deadly disease is little more than a nuisance. An atmosphere of freedom to think and opportunities for discussion is alive and well in the basic sciences division here in the DOM. It is a lot to imagine, but the work performed here in the shadows of the Smoky Mountains may someday render many fatal illnesses curable.

Points of View

boards, do night call, entertain friends, follow up on patients, practice patient safety, make the right clinical decisions, run a code, do projects, study, sleep, write a paper, attend courses, learn computer programs, work in a team, participate in committees, interact with patients’ families, answer pages, entertain friends, do something interesting, complete paperwork, sleep, be responsive, be respectful, be a role model, teach students, eat, make decisions, be a guide, be diplomatic, be with friends, provide emotional support, go on vacation, learn skills, practice skills, play with kids, apply for jobs, identify patients’ needs, sleep, explain management decisions, respond to emails, interpret tests, help with recruitment, provide preventive care, study, be friendly, learn technical skills, go for job interviews, teach procedures, be professional, communicate as a consultant, have fun. What are the roles and responsibilities of a resident? Are we asking too much of them?

Rajiv Dhand, M.D., Chair

See patients, review lab results, put in orders, present patients, attend conferences, read textbooks, log duty hours, sleep, review protocols, learn to put in central lines, intubate patients, dictate notes, review notes, present at conferences, go to clinic, do journal club, do procedures, be respectful of colleagues, look after family, check emails, attend meetings, review labs and x-rays, arrange day care, study, be responsible, make a poster, read journals, eat, exercise, be professional, lead a team, teach medical students, drop the children off at school, see more patients, help others, do a project, take written tests, prepare for 1


Clinical Research Division Annual Update One year ago, In Touch introduced Carol Ellis, MD, as the Director, and Lauren Davis as the Clinical Trials Coordinator, of the newly designated Clinical Research Division of the Department of Medicine. Their goal from the outset was to find and implement meaningful clinical research that could be done by our clinical investigators. To date, they have successfully obtained IRB approval and initiated three trials. The three studies that are in progress are: Bayer 13084 (INHALE) - A Prospective, Randomized, DoubleBlind, Placebo-Controlled, Multicenter Study to Evaluate the Safety and Efficacy of BAY 41-6551 as Adjunctive Therapy in Intubated and Mechanically-Ventilated Patients with Gram-negative Pneumonia Spiration EMPROVE - A Prospective, Randomized, Controlled, Multicenter Clinical Study to Evaluate the Safety and Effectiveness of the Research nurses, Rose Jensen and Jeanie Myers, discuss the Bayer INHALE IBV® Valve System for the Single Lobe Treatment of Severe Emphysema clinical trial with Lauren Davis, study coordinator. From left to right, Rose Muscle Study - Muscle Weakness in Hospital Patients with Medical Jensen, BSN, RN; Jeanie Myers, RN; Lauren Davis (Clinical Trials Coordinator). Illnesses:  Prevalence, Phenotypes, and Influence on Patient Outcomes (A Pilot Study) Dr. Ellis gives much of the credit for these successes to Ms. Davis for the detailed work she has done in shepherding protocols through the IRB, developing and negotiating budgets, and facilitating the processes involved in initiating the clinical trials. Ellis and Davis anticipate the availability of more research opportunities soon. If you are interested in learning more about these studies or have a patient to refer, please contact Lauren Davis at 305-7975. Likewise, please contact Lauren if you have a study concept to explore.

Clinical Trial – A Non-surgical Treatment Approach to Severe Emphysema When medical therapy is no longer effective for patients with advanced emphysema, doctors often have to consider interventions such as lung volume reduction surgery. This procedure removes the most severely damaged and over-inflated areas of the lung, allowing the healthier lung tissue to expand. This is major surgery and many of the people who need it are too frail to tolerate it. A new clinical study is testing a minimally invasive way to provide lung volume reduction for patients without undergoing surgery. Using a bronchoscope, a small, umbrella-shaped, one-way valve is placed in the airways leading to the damaged lung. The valves allow air and secretions to come out of the target lobe when the patient exhales but prevent air from reentering on inhalation. The damaged part of the lung deflates, allowing the healthier portion to expand. UTMC is one of fewer than 20 centers in the country and the only center in Tennessee participating in this trial. The trial is now open and recruiting patients with severe emphysema who have daily symptoms. Patients must have completed pulmonary rehabilitation and must have quit smoking for at least four months. Participants will be randomized to either valve treatment or to a control group. They will be closely monitored for six months, then at yearly intervals. To find out more, please contact Lauren Davis at 305-7975 or one of the physician investigators: Paul Branca, MD; James Shamiyeh, MD; or Michael McCormack, MD, at 524-7471.

Inquiring Mind Wants to Know

Dr. Max Rajan has an inquiring mind. He graduated from the University of Illinois College of Medicine with a James Scholar distinction for his research in functional imaging for sports concussions, a project he anticipates completing in the spring of 2014. Since coming to UT, he has performed a study on patients who abuse IV oxymorphone and were admitted to UTMCK with thrombotic thrombocytopenic purpura. He presented this at the Tennessee ACP meeting this fall. He also had a case report at the Southern Hospital Medicine Conference about porphyria cutanea tardae. Dr. Rajan’s other interests include playing Scrabble with his grandmother (she always wins), judo (he’s a black belt), karate (also a black belt), and lacrosse (he played during college at the Illinois Institute of Technology). After residency, he plans to apply to Doctors Without Borders for “deployment to a humanitarian crisis zone.” Ultimately, he hopes to complete an infectious diseases fellowship and then become a career academician. 2


Awards and Honors Faculty Announcements and Honors

Dr. Rajiv Dhand presented Dr. Wahid Hanna with the R. A. Obenour Distinguished Alumnus Award

Paul Branca, MD (right) received the R. A. Obenour, Jr., Award

Service award recipients pictured with Dr. Dhand from L to R . . . Dr. Christopher Scott, Dr. Karla Matteson, Dr. Carmen Lozzio, Dr. Rajiv Dhand, Dr. Rolland Regester, and Dr. Thomas Sullivan. (Not pictured are Drs. Thomas Young and Robert Levey).

Several distinguished faculty members received awards at the Department of Medicine’s Annual Faculty Recognition Dinner in December. Alan Solomon, MD, received the Beasley Pylon Award in recognition of his outstanding efforts in building our research department and for his stellar contributions to the field of amyloid research. The R.A. Obenour, MD, Distinguished Alumnus Award was presented to Wahid Hanna, MD, for his successful career in the field of hematology and oncology. The London Award for a faculty member who shares a dedication to excellence was presented to Jerry Crook II, MD. The recipient of this award is chosen by our internal medicine residents. The R.A. Obenour, Jr., Award for steadfast dedication to excellence in teaching was presented to Paul Branca, MD. We congratulate all of these faculty members on their well-deserved recognition.

Resident Awards

Service Awards At the American College of Physicians, Tennessee Chapter Scientific Meeting in October, Dr. Ryan Kerr won 2nd prize for his poster presentation, “Invasive Procedure Training Requirements of Internal Medicine Residencies--a Survey of Internal Medicine Program Directors.” Dr. Max Rajan won 2nd place in the narrative medicine competition for his short story, “Speaking Human.” 

Dr. Ryan Kerr

25+ Years

Robert E. Levey, PhD J. Christopher Scott, MD Thomas Young, MD Karla Matteson, PhD Thomas A. Sullivan, Jr., MD

40 Years

Rolland F. Regester, MD

45 Years

Carmen B. Lozzio, MD

Dr. Max Rajan

Continuing Education Opportunities:

The University of Tennessee Graduate School of Medicine, Department of Medicine, offers the following educational courses this winter and spring.

Department of Medicine Grand Rounds Morrison’s Conference Center University of Tennessee Medical Center, Knoxville Approved for AMA credit Visit www.tennessee.edu/cme for a complete schedule.

January 14: Anaphylaxis: An Update February 11: Atrial Fibrillation February 25: ID Cases from the Archives March 11: Pharmacogenetics March 25: Cardiovascular Implications of Sleep Apnea

Tenth Annual Hematology Conference: An Update of Selected ASH Topics

Second Annual Medicine Conference: Today’s Technology and Treatment Trends

University of Tennessee Conference Center, Knoxville, Tennessee Approved for 5 AMA, AAPA and ACPE credits and .5 CEUs www.tennessee.edu/cme/Hematology2014 The annual update occurs as soon as possible after the American Society of Hematology (ASH) international conference, while allowing time for the featured speakers to develop unique presentations combining their areas of expertise with new information garnered from the ASH presentations.

University of Tennessee Conference Center, Knoxville, Tennessee Approved for 11 AMA, AAPA, ACPE credits and 1.1 CEUs www.tennessee.edu/cme/Medicine2014 Faced with an aging population, new developments in technology and treatment options, it will be increasingly important for the health care provider to stay up-to-date on the newest developments and trends in the medical community. The Second Annual Medicine Conference will address new developments and trends in relevant areas, such as osteoporosis, celiac disease, hypertension, and lung cancer among others.

Saturday, January 11, 2014

February 28 – March 1, 2014

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Other Announcements: It is not too late to show your pride in the Department of Medicine by purchasing one of our “Tomorrow’s Leaders Today” polo shirts offered in grey long sleeve or green short sleeve. The long sleeve shirts are $27, and the short sleeve shirts are $22. The proceeds from the sale of these shirts will benefit the Department of Medicine. Please contact the department at (865) 305-9340 to place your order.

In Touch

Volume 3, Issue 1: January 2014

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Publishers James Neutens, PhD, Dean Rajiv Dhand, MD, Chair Editor Ronald Lands, MD Administrative Director Susan Burchfield, CAP-OM

Welcome to New Faculty Members We would like to welcome several new volunteer faculty members to our department: Janet Lubas, MD, Internal Medicine Drew Miller, MD, Dermatology Jeremy Mahlow, MD, Cardiology Jessica Ivey, MD, Internal Medicine Drs. Miller, Mahlow, and Ivey are well-known to us because of their previous training here at UTMCK. Dr. Ivey was an internal medicine resident here from 1998 to 2001. Dr. Miller was a transitional year resident from 2006 to 2007, and Dr. Mahlow was a cardiovascular disease fellow from July 2009 to June 2012. Dr. Lubas will be the preceptor for a new rotation in Jefferson City for our interns. The interns will gain experience in an ambulatory setting under her guidance. We are very fortunate to add these talented physicians to our faculty and look forward to their active participation in training our residents and fellows.

Guest Speakers

On Tuesday, October 29, 2013, Paul Pockros, MD, Director of Clinical Research, Scripps Translational Science Institute; Director of the Center for Liver Diseases, Scripps Clinic; and Director of the SC Liver Research Consortium in La Jolla, CA, presented the Department of Medicine Grand Rounds, “Chronic Hepatitis C Virus: Modifying Screening and Treatment Practices to Optimize Outcomes”.

Paul Pockros, MD

Contributors Susan Burchfield Rajiv Dhand, MD Christen Fleming, MD Kandi Hodges Ronald Lands, MD Jane Obenour 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 UT Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920

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 development@utmck.edu. If you would like more information about any of the information 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.

Stay In Touch! 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! 4

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.


In Touch - January 2014