InTouch Newsletter - January 2021

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D epartment

of

M edicine

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 1 Jan. 2021

New Year, Renewed Hope As we embark on a new year, we often reflect on the past and hope for the future. This past year brought about many uncertainties but also led to new research discoveries that will bring opportunities for the Graduate School of Medicine in 2021. Attralus (Biopharmaceutical Company founded by Dr. Emily Martin, Dr. Steve Kennel, Dr. Tina Richey, Dr. Alan Stuckey, and Dr. Jonathan Wall to develop amyloid imaging agents and therapeutics) recently secured $25 million to work on transformative medicines to improve the lives of patients with Amyloidosis. Dr. Emily Martin and Dr. Jonathan Wall are also currently working on a research project that will evaluate peptides that can inhibit the ApoE3 interaction with heparin in a dosedependent manner. This will open the door to a new method for delaying the onset of Alzheimer’s dementia in patients with a genetic predisposition. Dr. Rajiv Dhand, Dr. Paul Terry, and Jennifer Ferris are currently working on an investigator-initiated project to study the feasibility, safety, and efficacy of nebulized long-acting bronchodilators (Formoterol and Revefenacin) vs. short-acting bronchodilators (Albuterol and Ipratropium) in hospitalized patients with AECOPD. Dr. Jeffrey Bieber was recruited by Dr. Paul Blanc (Occupational and Environmental Health at the University of California) to work as a co-investigator on a research project that studies the effects of exposure from coal mining on the risk for and severity of rheumatoid arthritis. They are recruiting men with rheumatoid arthritis over the age of 50 and

physicians in coal mining regions of the country to assist with the study. Dr. Annette Mendola was recruited by Dr. Lisa Lindley (professor in the College of Nursing at UTK) to work as a co-investigator on a grant that studies the effectiveness of concurrent care on pediatric and family outcomes at end of life. The hypothesis is that children and adolescents with advanced illnesses will have unique life-prolonging care needs and that those care needs will vary by type of serious illness. Dr. Mendola was asked to join the team because of the bioethical dimensions of the issue, particularly in the realm of social justice. Dr. Paul Terry is working on a grant to study the Ovarian Cancer Survival in African- American woman. The goal is to look at the continued on page 2

Points of View

However, when a nation goes to war there emerge acts of heroism and incredible valor. That is true for the current pandemic as well. The response of frontline workers to this threat has been nothing short of magnificent. All over the world, health care professionals have sacrificed their lives and have shown the courage and determination of true warriors. The dedication of medical teams and their concern for the welfare of their patients is worthy of applause. On this note, I wish to recognize the heroic efforts of all team members at UT Medical Center, especially our residents and fellows, for their outstanding efforts in caring for patients with Covid-19. The scientific community quickly marshalled all their resources and focused their attention on controlling the spread of this hitherto unknown virus. In the short span of a few months, the virus had been identified, its modes of transmission elucidated, and determination of the genetic sequence laid the groundwork for development of highly sensitive diagnostic methods. In quick succession, the clinical

The world went to war with a virus in 2020! The novel SARS-CoV-2 coronavirus that first emerged in Wuhan, China sometime in December 2019 rapidly circumnavigated the globe and was officially declared a pandemic by The World Health Organization on March 11th, 2020. The virus has caused an unprecedented upheaval in our daily lives, produced a staggering loss of life, untold Rajiv Dhand, MD, Chair misery and an enormous disease burden. By the first week of December, in less than a year since its recognition, the virus had infected over 66 million individuals worldwide and caused more than 1.5 million deaths with the US accounting for over 14 million cases and more than 280,000 casualties.

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Resident Research At UT Medical Center, we are exposed to a wide variety of patients with many rare disease processes, which lends to numerous avenues for developing research projects. One of the most difficult parts of initiating any research project is finding an idea worth pursuing. Mr. David Petersen works in the Preston Medical Library located here on campus and is eager to help out residents and fellows alike with their research projects. He is able to perform a literature review and provide other resources to help explore all aspects of your initial idea. The next step involves obtaining data. This step is made easy by Ms. Laura Wolfe, who can quickly provide you with a patient data base with which to review and collect data if you provide her with basic information regarding admission dates and diagnoses. Once your idea is well established, you have performed appropriate literature review to direct your research, and data has been collected, the last step is analyzing the data. This can be a frightening step for those of us new to research as it involves many statistical formulations, however with the help of Dr. Eric Heidel, this entire process can be made simple. Prior to meeting with Dr. Heidel, he only asks that you have done appropriate work as far as establishing which statistical data you wish to pursue, including but not limited to number needed to treat, number needed to harm, positive predictive value, negative predictive value, etc. We are fortunate here at UT Medical Center to have a great group of individuals who can help us jump start our research here as residents.

Resident Spotlight: Dr. Sam Walker Happy memories of Knoxville contributed to PGY-3 Dr. Sam Walker’s decision to attend UTK for his undergraduate degree. “We used to come down to Knoxville for UT games when I was growing up” in Blacksburg Virginia, he says. He and his wife, Allison, also a UTK alum, were glad to be able to return here for residency. The Walker family includes son Henry, who was born in the summer of 2019. Dr. Walker likes the intensity of hospital medicine, and will join the UT Hospitalists later this year. “Hospital medicine gives you the opportunity to practice with every system without having to choose just one,” he said. “I enjoy being able to problem-solve with all the different specialists.” He also values being able to comfort people. “The relationships are briefer than in primary care, but you still have a big impact on patients’ lives.”

New Year, Renewed Hope

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continuation of the African-American Cancer Epidemiology Study (AACES) focused on the reasons (medical, environmental, genetic, and societal) for the relatively poor ovarian cancer survival in African-American women. Ovarian cancer is a dreaded disease with overall poor survival. There are racial disparities in survival that are still poorly understood. For example, according to cancer.gov: “Between 1975 and 2016, the 5-year relative survival rate for ovarian cancer increased from 33% to 48% among non-Hispanic White women but decreased from 44% to 41% in African-American women.” The hope is to better understand the complex reasons for poorer survival in African-American women. This study will continue until 2025. As we close on 2020, we are excited for new beginnings especially in research that will take place in 2021. It will further promote research activities within the Graduate School of Medicine, provide new data to clinicians, and bring hope to patients and the community at large.

Points of View

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features, prevention and treatment were determined and susceptible populations identified. Most striking has been the unprecedented momentum for development of vaccines. Two mRNA-based vaccines are now awaiting Emergency Use Authorization by the Food and Drug Administration and barring unforeseen circumstances should be available for use by the year-end. This process of vaccine development, which would normally take several years to complete, was achieved in a record time of a few months. Widespread adoption of these vaccines has the potential to save hundreds of thousands of lives. A search of the literature reveals over 80,000 papers in PubMed on Covid-19 with the first published papers published on January 30, 2020 and in Nature Medicine on March 17th, 2020. Likewise, there were 18,819 studies currently recruiting patients in the US on clinical trials.gov and almost 4100 of them relate to Covd-19 and SARS-CoV-2. These numbers reflect the immense interest and focus of the scientific community in finding solutions to control this deadly virus at the earliest. In our department, we are doing our part, in small measure, to contribute to the rich body of scientific literature on this subject. 2


Recent Publications The COVID-19 pandemic has negatively impacted many things, but it cannot keep our staff from continuing to contribute to medical education and literature! Here is a list of publications from October and November 2020 from our department: OUR CARDIOLOGY DEPARTMENT HAS HAD SEVERAL PUBLICATIONS AND A BOOK CHAPTER AUTHORS

TITLE

JOURNAL/BOOK

Mehmood M

Staring points in heart failure drug development: Future outlook The competitive advantage of adaptability in the approach to heart failure populations Low publication rates of heart failure clinical trials: Finding success in failure The proof is in the appendage: A case report of a fenestrated membrane overlying the left atrial appendage. The new kids on the block: Don't delay. Is ClinicalTrials.gov searchable for patients with heart failure?

JACC Heart Fail. 2020 Oct;8(10):872.

Mehmood M Mehmood M Holbert J, Shepple B, Rogers B, Hirsh J Hauptman PJ, Piña IL Goff ZD, Heidel RE, Hauptman PJ

Shepple BI

The prognostic value of the electrocardiogram in acute coronary syndromes

JACC Heart Fail. 2020 Oct;8(10):877. J Am Coll Cardiol. 2020 Oct 6;76(14):1715-1716. Echocardiography. 2020 Oct 18. [Epub ahead of print] J Card Fail. 2020 Oct;26(10):811-812. J Card Fail. 2020 Sep 26:S1071-9164(20)314378. Available in PubMed: Oct 2020. [Epub ahead of print] Electrocardiogram in Clinical Medicine

OUR ID DEPARTMENT AND RESIDENTS ARE ALSO PUBLISHING QUITE A FEW ARTICLES AUTHORS

TITLE

JOURNAL

Hennessy K, Shorman M

Verrucous plaques on the face, dysphagia, and limb weakness Candida spp. infective endocarditis: Characteristics and outcomes of twenty patients with a focus on injection drug use as a predisposing risk factor Comparison of dalbavancin to standard-of-care for outpatient treatment of invasive Grampositive infections.

Cleve Clin J Med. 2020 Oct 1;87(10):587-589

Morelli MK, Veve MP, Lorson W, Shorman MA

Veve MP, Patel N, Smith ZA, Yeager SD, Wright LR, Shorman MA

Mycoses. 2020 Oct 18

Int J Antimicrob Agents. 2020 Oct 23:106210. Available in PubMed: Nov 2020. [Epub ahead of print]

OUR PULMONARY SERVICE HAS CONTRIBUTED TO RECENT LITERATURE AS WELL AUTHORS

TITLE

JOURNAL

Biney I, Dudney T, Ferris J, Shamiyeh J, Peeke J, Dhand R Li J, Fink JB, Moran EM, Kiourkas RD, McLaughlin R, Vines DL, Jing G, Porszasz J, Dhand R.

CT findings in 30-day COPD readmissions

CHEST. 2020 Oct;158(4):A2491. Available in Scopus: Nov 2020. Chest. 2020 Nov 1:S0012-3692(20)35118-7. doi: 10.1016/j.chest.2020.10.064. Online ahead of print.

Airborne Particulate Concentrations During and After Pulmonary Function Testing

AND OUR HEME/ONC COLLEAGUES HAVE CONTRIBUTED AS WELL AUTHORS

TITLE

JOURNAL

Hart LL, Ferrarotto R, Andric ZG, Beck JT, Subramanian J, Radosavljevic DZ, Zaric B, Hanna WT, Aljumaily R, Owonikoko TK, Verhoeven D, Xiao J, Morris SR, Antal JM, Hussein MA

Myelopreservation with Trilaciclib in patients receiving Topotecan for small cell lung cancer: Results from a randomized, double-blind, placebo-controlled phase II study

Adv Ther. 2020 Oct 29. [Epub ahead of print]

We are so proud of all the hard work of this department and look forward to even more discoveries and productivity in the coming months as well!

CME OPPORTUNITIES—Mark Your Calendars!

***currently still virtual only via Zoom

• Cardiology Grand Rounds, held weekly on Wednesdays for 0.75 hour CME credit. • Medicine Grand Rounds, held on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit. • Ethics Case Rounds, held on the 4th Thursday of each month for 1.00 hour CME credit. 3


Faculty Announcements New Faculty We are delighted to welcome Dr. Renju Raj as Assistant Professor in the division of hematology and oncology. Dr. Raj completed medical school at Mahatma Gandhi University in Kottayam, India. Followed by residency in internal medicine at Presence Saint Francis Hospital in Evanston, IL and fellowship in hematology and oncology at Medical College of Wisconsin in Wauwatosa, WI. Since 2018, Dr. Raj was with the Avera McKennan Hospital and University Center in Hematology and Bone Marrow Transplant program in Sioux Falls, SD. Dr. Raj’s clinical acumen and skills in Stem Cell Transplantation and Cell Therapies was instrumental in building and developing the inpatient Hematologic Malignancies service.

We are pleased to welcome Dr. Kelly McCaul as Assistant Professor in the division of hematology and oncology. Dr. McCaul completed medical school at Queens University in Kingston, Ontario followed by residency in internal medicine and fellowship in hematology at Dalhousie Internal Medicine in Halifax, Nova Scotia. He completed his fellowship in leukemia and bone marrow transplant at the University of British Columbia in Vancouver. In 2000, Dr. McCaul founded and was the Medical Director of the Avera Medical Group Hematology and Bone Marrow Transplant in Sioux Falls, SD. It is the only leukemia and transplant program in South Dakota.

We are elated to welcome Dr. Jessica Sheah for appointment to the rank of Clinical Assistant Professor in the division of neurology. Dr. Sheah completed medical school at Florida State University College of Medicine in Tallahassee, FL. She completed a residency in pediatric neurology at Vanderbilt Medical Center in Nashville, TN. Dr. Sheah received her undergraduate training at Yale University in New Haven, CT. She is board-certified through the American Board of Psychiatry and Neurology with special qualifications in child neurology. Since 2018, Dr. Sheah has worked in Pediatric Neurology at East Tennessee Children’s Hospital and University of Tennessee Medical Center.

Guest Speaker We were honored to have Dr. Felix Yang, MD, FACC, FHRS, CCDS, give this special presentation titled, “Combined Endocardial / Epicardial Approaches in Managing Complex Arrhythmias & Left Atrial Appendage Management,” via Zoom on November 11th, 2020. Dr. Yang is the Associate Director of the Cardiac Electrophysiology and Pacing Program as well as the Director for the Lead Extraction Service at the Maimonides Medical Center in Brooklyn NY. Dr. Yang completed his medical school, internship and residency training at Cornell (NY Presbyterian Hospital). He subsequently completed his fellowship in Cardiovascular Medicine at Beth Israel Medical Center, where he served as Chief Fellow, and a second fellowship in Cardiac Electrophysiology at Montefiore Medical Center. Dr. Yang has published numerous articles in leading journals and presented his research at professional societies. He is a member of several professional organizations and is a Fellow of the American College of Cardiology and the Heart Rhythm Society. He is also a Certified Cardiac Device Specialist as designated by the International Board of Heart Rhythm Examiners.

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Making Difficult Decisions - Autonomy in Palliative Care Ethics Case Rounds are monthly, hospital-wide discussions of morally distressing cases. Cases are de-identified to protect patient confidentiality.

Mr. B is a 32-year-old gentleman who was admitted with urosepsis and a malfunctioning jejunostomy tube. His medical problems included C2 quadriplegia from a diving injury 15 years ago, chronic ventilator dependence, cirrhosis due to past total parental nutrition (TPN), and severe malnutrition. The site of his J-tube had eroded and required an ostomy device to control drainage. He had required multiple admissions over the years for recurrent medical issues. Mr. B’s family moved to East Tennessee when he was a child. Since the accident, he has lived with and been cared for by his family. He and his parents have consistently voiced satisfaction with his quality of life and desire for continued aggressive treatment. At this point, unfortunately, he had limited options for ongoing nutrition. His J-tube could not be replaced due to poor wound healing from his malnutrition. TPN would carry multiple risks, including further liver damage and infection. There was also concern that his family had undue influence on his decisions. Ethics and Palliative Care were consulted to help clarify goals. Autonomy is one of the four principles of bioethics. The traditional interpretation of autonomy characterizes people as free, independent, and rational. It characterizes relationships as freely-chosen and equitable (that is, both parties have roughly equal power within the relationship). This interpretation of autonomy has been criticized as failing to acknowledge that personal identity is formed within the context of social relationships and is shaped by intersecting social features such as race, class, gender, and ethnicity. This interpretation of autonomy can devalue emotion, worsen imbalances of power, and overvalue independence. It also focuses on the effect of a person’s choices on herself or himself, irrespective of how they affect others. In contrast, relational autonomy recognizes that everyone is embodied, interdependent, and potentially vulnerable. It emphasizes the values of interconnectedness, caring, and consideration rather than prioritizing self-sufficiency and independence. It also recognizes that emotions are as important as rationality. Clinicians foster relational autonomy when they support their patients’ family systems as well as their patients as individuals. They recognize that power imbalances are inevitable in relationships and are careful to provide a counterbalance when needed. Mr. B reported his quality of life to be excellent, having adjusted to quadriplegia over 15 years. He did not experience much pain per se, although he did have experiences of hunger, thirst, fatigue, anxiety, and depression. When asked what is important to him, he immediately mentioned his family. He loved listening to music and watching TV with them (especially his little cousins). He acknowledged that his choices reflect his consideration for them, and that he might make decisions differently if they were not so invested in caring for him. His goal was to prolong his life if possible. However, he was also concerned about how complicated his care was becoming for his parents. He was aware that he was nearing the end of his life, and wanted their quality of life to be part of his care planning. After much discussion with Palliative Care, Mr. B concluded that if he could no longer communicate with his parents, he would want to die in peace at home. For the time being, he opted for TPN. He and his parents expressed feeling a greater sense of peace and strengthened relationships at UT Medical Center.

Comments on this case may be sent to amendola@utmck.edu References • Killackey T, Peter E, Maciver J, Mohammed S. Advance care planning with chronically ill patients: A relational autonomy approach. Nurs Ethics. 2020;27(2):360-371. • Ould Brahim L. Reconsidering the ‘self’ in self-management of chronic illness: Lessons from relational autonomy. Nurs Inq. 2019;26(3): e12292.

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 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.

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! 5

In Touch Vol. 10, Issue 1: January 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 Kristin O'Connor, MD Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Cassandra Mosley 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