1

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

SPOTLIGHT ON:

Best Doctors

Spanning more than three dozen specialties, 148 doctors from SLUCare have been selected for St. Louis Magazine's 2009 "Best Doctors" list. The list is based on the annual "Best Doctors in America" database, which considers more than one million peer evaluations to create a directory of approximately 30,000 doctors. The Department of Internal Medicine SLUCare physicians are: Cardiology: Preben Bjerregaard, MD, Bernard R. Chaitman, MD, Paul J. Hauptman, MD, Denise L. Janosik, MD, Arthur J. Labovitz, MD, Michael J. Lim, MD, Alan R. Maniet, DO, Lisa Schiller, MD, Megumi Taniuchi, MD*. Endocrinology: George T. Griffing, MD, Alan B. Silverberg, MD*. Gastroenterology and Hepatology: Banke Agarwal, MD, Bruce R. Bacon, MD, Alex S. Befeler, MD*, Frank R. Burton, MD, Adrian M. Di Bisceglie, MD, M. Louay Omran, MD, Charlene Prather, MD, Brent A. Tetri, MD. General Internal Medicine: Erin L. Bakanas, MD, Bishnu Devkota, MD*, James R. Drake, MD, Robert M. Heaney, MD, Govind K. Nagaldinne, MD*, Thomas J. Olsen, MD, H. Douglas Walden, MD. General Internal Medicine/Pediatrics: Victoria E. Cornelius, MD, Marilyn Maxwell, MD, Nora L. Porter, MD, Timothy Rice, MD.

Geriatric Medicine: Joseph H. Flaherty, MD, Julie K. Gammack, MD, John E. Morley, MB, BCh, Miguel A. Paniagua, MD*, David R. Thomas, MD. Hematology and Oncology: Steven M. Pincus, MD, Paul J. Petruska, MD*. Infectious Diseases: Sharon E. Frey, M.D., Marcia L. Sokol-Anderson, M.D. Nephrology: Alejandro C. Alvarez, MD*, Bahar Bastani, MD, Kevin J. Martin, MB, BCh, Paul G. Schmitz, MD. Pulmonary, Critical Care and Medicine: George M. Matuschak, MD. Sleep

Rheumatology: Terry L. Moore, MD, Peri Hickman Pepmueller, MD. *(These physicians were named for the first time.) Saint Louis University SLUCare Sleep Disorders Center Receives Program Accreditation Saint Louis University SLUCare Sleep Disorders Center recently received program accreditation from the American Academy of Sleep Medicine (AASM). The American Academy of Sleep Medicine congratulates Saint Louis University SLUCare Sleep Disorders Center on fulfilling the high standards required for receiving accreditation as a sleep disorders center, said Dr. Clete Kushida, AASM president. The center is a significant resource to the local medical community and will provide academic and scientific value in addition to the highest quality care for patients suffering from sleep disorders. To receive a five-year accreditation, a sleep center must meet or exceed all

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

standards for professional health care as designated by the AASM. The accreditation process involves detailed inspection of a centers facility and staff, including an evaluation of testing procedures, patient contacts, and physician training. Additionally, the facilitys goals must be clearly stated and include plans for positively affecting the quality of medical care in the community it serves. The AASM currently accredits more than 1,600 sleep medicine centers and laboratories across the country. The AASM is a professional medical society for clinicians, researchers, and other health care providers in the field of sleep medicine. As the national accrediting body for sleep disorders centers and labs, the AASM is dedicated to setting standards and promoting excellence in sleep medicine heath care, education and research. Saint Louis University SLUCare Sleep Disorders Center is directed by Drs. Joseph Espiritu (left) and Raman Malhotra and is located at 3545 Lafayette Avenue. For more information or to refer a patient, call (314)977-5337. RECOGNITION Saint Louis University Hospital Recognized for Excellence by the American Heart Association Saint Louis University Hospitals cardiovascular services were recently recognized as a recognized as a 2009 Triple Achievement Hospital under the American Heart Associations Get With the Guidelines (GWTG) program for outstanding work in the

areas of coronary artery disease, heart failure and stroke. In order to receive this designation, SLU had to follow guidelines in all three areas of treatment at least 85 percent of the time and maintain the performance level for two or more consecutive years. SLU Hospital is the only hospital serving both Missouri and Illinois that received all three Gold Performance Awards and one of only 10 hospitals in the United States to receive Gold Performance Awards in all three areas of treatment, the highest recognition possible. GWTG is the American Heart Association and American Stroke Associations hospital-based quality program. There are more than 1,500 hospitals participating in the program. Saint Louis University Hospital began participating in the GWTG program in 2003. At that time, our treatment of patients with myocardial infarction or heart failure lacked consistency. Most obvious was the prolonged average time it took to open the offending occlusion of the coronary artery causing the MI (i.e. Door-toBalloon time). By looking at every step in the process of care for these patients, major improvements in this indicator have occurred over time, greatly benefiting the patients at SLU (see figure below). Average Door-to-Balloon Times at Saint Louis University Hospital

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

These achievements are a result of a very large team of people working in concert to provide patients with the highest level of cardiovascular care. Many hospital employees, including all of the nurses in the emergency department, cath lab, 9ICU, and 9 South, technicians in the cath lab and emergency department, registration clerks, and nurse managers throughout the facility should be given significant credit. Likewise, every internal medicine resident rotating on the cardiology services and the cardiology fellows are on the front lines of this success story and deserve a great deal of credit and thanks. Lastly, the faculty of the division of cardiology should be congratulated for this recognition of their commitment to excellence in patient care.
Michael J. Lim, MD Interim Director Division of Cardiology

was the honored guest. Listed below are the recipients of a plaque and $1,000 cash award. Ali Pakravan, MD, SLU Resident He is always very friendly, patient and willing to answer questions. He is always willing to explain things in a non-condescending way. (Nurse) Dr. Pakravan (left) is consistently professional and courteous in his interaction with patients and hospital staff. He remains calm and collected during an emergent situation. He is true mentor to his peers and subordinates. (Nurse) Dr. Pakravan is an extremely knowledgeable and dependable physician. His bedside manner is outstanding, as well as his ability to communicate with both patients and staff. He is truly one of the best residents I have seen come through the VA. (Nurse) Ali is delightful to work with. He takes his role as an educator to lower level residents and interns seriously. He is very proactive with the patients care. He actively involves all disciplines, including nursing and pharmacy. (Pharmacist) Dr. Pakravan is an outstanding human who happens to be a physician. He goes beyond the call of duty to provide the best patient care possible while taking the time to teach and communicate with not only staff, students but also patients families. His knowledge base is excellent and he never hesitates to go the extra step to serve VA patients and their families.

Marilyn Maxwell, MD, was recently recognized for her services as Co-Chair of the Presidents Advisory Council on HIV/AIDS, for the past 3 three years, by Kathleen Sebelius, Secretary of Health and Human Services. Ranjit Ray, PhD, has accepted an invitation to serve as a member of the Cancer Etiology Study Section, Center for Scientific Review, for a 3 year term. Outstanding Scholar Awards On Thursday, June 18, 2009 the St. Louis VAMC presented its second annual Outstanding Scholar Awards. Mr. James R. Floyd, FACHE, Dir. of VA Heartland Network,

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

He is the personification of excellence. (Fellow Resident) Cade Lawrence, SLU Medical Student, had an outstanding performance as a third year medical student. He was excellent with patients and developed a great rapport with them. He was able to present a case in a precise, concise and accurate manner-something that is often difficult for third year medical students. His fund of knowledge was excellent and he was a pleasure to work with. Mr. Lawrence has worked with Dr. Labovitz in Cardiology on research projects. Raj Chadaga, MD, Attending, Saint Louis University Internal Medicine Dr. Chadaga is a shining example of what an attending should be-someone who has breadth and depth of knowledge of medicine, a drive to learn and improve, unending curiosity and enthusiasm, and a kind and gentle bedside manner. Dr. Chadagas answer to why he works so hard and takes on so many projects is that he likes to stay busy. Truly, he demonstrates every day that he loves medicine and we are fortunate to have him here as a role model for trainees and staff alike.

He is one of the residents favorite attendings from both the VA and Saint Louis University. He is known for his eagerness and drive to learn along with his excellent teaching on rounds. He is always available for questions and always willing to give a helping hand. It is great to see an attending that knows as much about the patient and care about the outcome of the patient as he does. We should all strive to be more like him. (Resident) Michael Ombrello, M.D., 2009 graduate of SLU Rheumatology Sub-specialty Resident Program, has been selected to receive the 2009 American College of Rheumatology Distinguished Fellow Award which is given to a select few rheumatology fellows from across the country each year. Dr. Ombrello said After obtaining 16 years of excellent education and training at SLU, I credit my SLU training with this opportunity, and I will do anything that I can to sing its praises (nobody from Wash U received this award!) He recently started a 3-year postdoctoral research fellowship at the National Institutes of Health, National Institute of Arthritis, Musculoskeletal, and Skin Diseases, Genetics and Genomics Branch in Bethesda, Maryland. COMMITTEE APPOINTMENTS Robert B. Belshe, M.D., was re-appointed as a member of the Research Planning Committee of the School of Medicine for a 3 year term. Victoria Cornelius, M.D., was re-appointed as a member of the School of Medicine Curriculum Management Committee for a 3 year term. Daniel Hoft, M.D., was re-appointed as a member of the Academic/Sabbatical Leave Committee for a 3 year term.

Dr. Chadaga (center) shown with Carlos R. Escobar, Acting Director St. Louis VAMC (left) and James R. Floyd, VISN 15 Director (right)

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

Marilyn Maxwell, M.D., was re-appointed as a member of the Admissions Committee of the School of Medicine for a 6 year term. Nora L. Porter, M.D., was re-appointed as a member of the Admissions Committee for a 6 year term. Nina Tumosa, Ph.D., was re-appointed as a member of the Continuing Medical Education Committee (CME) of the School of Medicine for a 3 year term. H. Douglas Walden, M.D., was appointed as a member of the Student Dismissal Appeals Council of the School of Medicine for a 3 year term. SPEAKING ENGAGEMENTS Arthur J. Labovitz, M.D., participated as a speaker at the 20th Annual Scientific Sessions of the American Society of Echocardiography in Washington DC, which was held from June 6-9, 2009. His June 6th presentation for the Contrast Echo Symposia Session was Stress Myocardial Perfusion Imaging and his June 7th presentations for the Contrast Echo Primer Symposia was Myocardial perfusion imaging: Principles behind perfusion imaging; enhance detection of CAD with stress; ER applications for ACS and for the Stress Echo Updates Symposia was Assessment of myocardial viability. DIVISION OF GASTROENTEROLOGY & HEPATOLOGY NEWS Digestive Disease Week 2009 (5/30-6/3/09) The Division of Gastroenterology & Hepatology was well represented at the annual gastroenterology meetings. Fellows and faculty presented their research, moderated

sessions, participated in the educational activities at the meeting and served on committees. Session Chairs Banke Agarwal, Roy K. Wong, Clinically Relevant Advances in the Management Of Gastric Neoplasms. ASGE Topic Forum. Banke Agarwal, Julia J. Liu, Hemostasis In Endoscopy: How to Stop the Flood. ASGE Topic Forum. Mitchell L. Shiffman, Adrian M. Di Bisceglie, Management of Hepatitis C Non-Responders and Relapsers. DDW Combined Clinical Symposium Mack C. Mitchell, Fasiha Kanwal, Current Concepts In Cirrhosis Management: An Updated Evidence-Based Approach To Common Clinical Issues. AGA Institute Clinical Symposium. Oral Presentations: Postgraduate Course, State-of-the Art Lecture, Clinical Symposium Bruce R. Bacon, Hereditary Hemochromatosis: Diagnosis and Treatment of a Common Genetic Disorders, AGA Institute Postgraduate Course. Luncheon Breakout Session. Charlene M. Prather, Approach to Functional Constipation and Lookalikes: IBSC, Colonic Inertia and Pelvic Dysfunction, AGA Institute Postgraduate Course. General Session. Brent A. Tetri, NASH and Co-Morbidities, State-of-the-Art Lecture

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

Adrian M. Di Bisceglie, Is There Still a Role for Maintenance Therapy? DDW Combined Clinical Symposium. Oral Presentations Research Sessions Nezam H. Afdhal, Bruce R. Bacon, Keyur Patel, Eric J. Lawitz, Stuart C. Gordon, David R. Nelson, Tracy Challies, Imad Nasser, John McHutchison, United States Multicenter Study of Ultrasonic TRANSIENT ELASTOGRAPHY (Fibroscan) for the Diagnosis of Cirrhosis and Fibrosis in patients with hepatitis B & C. AASLD Topic Forum. Adrian M. Di Bisceglie, SVR Results of PROVE3, a Phase 2b Clinical Trial Assessing Safety and Efficacy of Telaprevir in Hepatitis C Genotype-1- Infected Patients with Prior Nonresponse, Viral Breakthrough or Relapse to Peginterferon-Alfa-2a/b and Ribavirin Therapy. AGA Institute Late-Breaking Abstract Session Hashem B. El-Serag, Christine Y. Hachem, Michael L. Johnson, Robert O. Morgan, Insulin Treatment and the Risk of Hepatocellular Carcinoma in Patients with Diabetes. AGA Institute Distinguished Abstract Plenary Fasiha Kanwal, Steven M. Asch, Jennifer R. Kramer, Steven A. Edmundowicz, Arun J. Sanyal, Hashem B. El-Serag, Jason A. Dominitz, Kenneth R. McQuaid, Paul Martin, Emmet B. Keeffe, Lawrence S. Friedman, Samuel B. Ho, Francisco A. Durazo, Bruce R. Bacon, Measuring Quality of Care in Patients with Cirrhosis: Development of an Explicit Quality Indicator Set. Scientific Session. Brennan M. Spiegel, Fasiha Kanwal, Use of Health Related Quality of Life Instruments. Scientific Session.

Poster Sessions Christopher D. Mehan, Naveen B. Krishna, Amith V. Reddy, Jeremy A. Hartman, Banke Agarwal, Small Focal Non-Cystic Pancreatic Lesions in Patients without Obstructive Jaundice: How Many of These Are Neoplastic? What Is the Role of EUS-FNA in These Patients? Amith V. Reddy, Naveen B. Krishna, Jeremy A. Hartman, Christopher D. Mehan, Banke Agarwal, Risk of Malignancy in Patients with Isolated Dilation of Common Bile Duct and Without CBD Stones On Abdominal Imaging. Marina Silveira, Kris V. Kowdley, Velimir A. Luketic, M. Edwyn Harrison, Timothy M. McCashland, Alex Befeler, Denise M. Harnois, Roberta A. Jorgensen, Jill C. Keach, Keith D. Lindor, The Changing Face of Primary Sclerosing Cholangitis. Ashish Chopra, Samer Alkaade, Frank R. Burton, Numan C. Balci, Prior Endoscopic Sphincterotomy Can Affect the Interpretation of Secretin-Stimulated Magnetic Resonance Cholangiopancreatography (S-MRCP) in Patients with Chronic Pancreatitis. Adrian M. Di Bisceglie, Robert G. Gish, Patty Peterson, Elaine Rudell, HBV Management Among US Clinicians: Gaps in Clinical Competence and Practice Performance Survey Findings. Ellen J. Scherl, Ron E. Pruitt, Glenn L. Gordon, Mark Lamet, Audrey L. Shaw, Shirley Huang, Shadreck M. Mareya, William P., Forbes Twice-Daily Dosing of Balsalazide Tablets 3.3 G Is Safe and Effective in the Treatment of Mild-to-Moderate Ulcerative Colitis.

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

Glenn L. Gordon, Salam Zakko, Uma K. Murthy, Shahriar Sedghi, Ron E. Pruitt, Kunal Merchant, Audrey L. Shaw, James Yuan, Enoch Bortey, William P. Forbes, Long-Term Safety of Once-Daily 1.5-G Mesalamine Granules in Patients in Remission from Ulcerative Colitis. Salam Zakko, Glenn L. Gordon, Uma K. Murthy, Shahriar Sedghi, Ron E. Pruitt, Kunal Merchant, Audrey L. Shaw, James Yuan, Enoch Bortey, William P. Forbes, Once-Daily Mesalamine Granules Effectively Maintain Remission from Ulcerative Colitis: Data from 2 Phase 3 Trials. Fasiha Kanwal, Hashem B. El-Serag, Mark Schnitzler, Paula Buchanan, Bruce R. Bacon, Completion of Hepatitis C Virus (HCV) Treatment in Community Based PracticeAn Insight Into the Effectiveness of Treatment. Received Poster of Distinction. Fasiha Kanwal, Jennifer R. Kramer, Tuyen Hoang, Hashem B. El- Serag, Seth Eisen, Steven M. Asch, Quality of Diagnosis and Evaluation-Related Care in Patients with Chronic Hepatitis C Virus Infection. Fasiha Kanwal, Ian M. Gralnek, Steven M. Asch, Alan N. Barkun, Ernst J. Kuipers, Marc Bardou, Joseph J. Sung, Robert A. Enns, Lars Agreus, David Armstrong, Brennan M. Spiegel. Measuring Quality of Care in Patients with Nonvariceal Upper GI Hemorrhage (NVUGIH): Development of An Explicit Quality Indicator Set. Temitope Foster, Fasiha Kanwal, Steven-Huy B. Han, Brennan M. Spiegel, Are High Risk Individuals Appropriately Screened for Hepatitis B Virus (HBV) Infection? A Survey of Physician Knowledge, Attitudes and Beliefs about CDC Guidelines.

Jennifer L. LaBundy, Krista Lentine, Huiling Xiao, Patrick M. Ercole, Mark Schnitzler, Charlene M. Prather, A Call to Screen Clinical Correlates and Consequences of Colorectal Cancer Among Kidney Transplant Candidates and Recipients: Should We Revisit Our Screening Practices? Barbara Ulmasov, Rosemary ONeill, Brent A. Neuschwander-Tetri, Angiotensin II Induces Production and Secretion of Thrombospondin 1 in Primary Rat Hepatic Stellate Cells. RESIDENCY PROGRAM UPDATE Residents Excellence Program June Winners (Sponsor Drs. H. Douglas Walden and Frank R. Burton) Top Intern: Fadi Hussein, MD Top Resident Chris Chan, MD Quiz Master: Bernadette Hiltner, MD The overall winner every month receives a monetary award of $100 donated by a faculty member. More faculty sponsors are needed and their contributions are greatly appreciated. Runners-up are awarded an extra day off in the following service month. CONGO 2009 NEWS For 2 weeks in June 2009 Dr. Timothy Rice took his fourth trip to The Democratic Republic of Congo in Africa. This trip continues the collaboration between churches caring for orphans in the capital city Kinshasa and supporters in America. Donated medical supplies from Cardinal Glennon Childrens Hospital and Saint Louis University Hospital were delivered to the small medical clinic that was opened in July 2008.

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

NEW RESEARCH GRANTS AWARDED Bernard Chaitman, Cardiology, $189,470 from the University of Washington / NIH for AIM-HIGH. Ravi Nayak, Pulmonary, Critical Care and Sleep Medicine, $22,950 from the Cystic Fibrosis Foundation for CF Adult Program. Marcia Sokol-Anderson, Infectious Diseases, $124,583 from the City of St. Louis for Case Management Services : Ryan White HIV/AIDS Treatment Modernization Act of 2006, Part B. John Morley, Geriatric Medicine, $389,557 from HRSA for Geriatric Education Centers. Terry Moore, Arthritis & Rheumatology, $40,000 from Arthritis Foundation for Comparison of ANA by ELISA vs. IRA. Terry Moore, Arthritis & Rheumatology, $25,000 from American College of Rheumatology for ACR REF / Amgen / Wyeth Rheumatology Fellowship Training Award. Ranjit Ray, Infectious Diseases, $199,125 from Washington University / NIAID for MRCE for Biodefense and Emerging Infectious Diseases (Project 13). Robert Belshe, Infectious Diseases, $3,776 from Washington University / NIAID for MRCE for Biodefense and Emerging Infectious Diseases (Career Development). Robert Belshe, Infectious Diseases, $24,075 from Washington University / NIAID for MRCE for Biodefense and Emerging Infectious Diseases (Project 15).

The Congolese nurse practitioners that staff the clinic received training as patients were seen together with Dr. Rice in the clinic. Funds that were donated by SLU faculty, staff and others were used to restock the clinic pharmacy. One particularly ill child seen in the clinic had both sickle cell anemia crisis and severe malaria was hospitalized at a nearby hospital for four days. The $90 hospital bill was paid out of the donated funds. Using $1500 of donated funds we are able rent a facility, proved teaching materials and hire an official Congolese trainer to hold a three day primary care nurse practitioner training seminar for 10 nurses in Kinshasa. While there in Congo, Dr. Rice worked with the Congolese board overseeing the medical work to review the clinic budget and visit volumes. The clinic is well on it way to being self-sustaining and further changes were recommended to help achieve that goal. In June of 2010 Dr. Rice hopes to travel with students and residents that have expressed interest in helping with the work in Congo.

DEPARTMENT OF INTERNAL MEDICINE NEWSLETTER

internalmed.slu.edu

July 2009

Robert Belshe, Infectious Diseases, $7,375 from Washington University / NIAID for MRCE for Biodefense and Emerging Infectious Diseases (Core A). CONDOLENCES To Dr. Stewart Albert and family on the loss of his wife, Ingrid Renee Albert, MD, on July 22, 2009. DATES OF NOTE October 22-24, 2009, Saint Louis University School of Medicine Alumni Reunion Weekend. CLINICAL TICKER
PRACTICE LOCATION FY 08 YTD BILLED AMB ENCs 9,202 743 2,774 51,215 280 316 491 14,454 6,891 10,463 6,714 103,543 FY 09 YTD BILLED AMB ENCs 9,865 805 3,965 52,680 0 246 1,508 13,435 7,313 10,587 8,042 108,446 104.7%

WEBSITE Access the Department of Internal Medicine website at http://internalmed.slu.edu.

INFORMATION FOR NEXT NEWSLETTER

If you have any news, grants, notices, achievements that you would like to be included in the next newsletter or if you think something important was missed, please let Camille Goff know at goffcj@slu.edu .

CANCER CENTER CARDINAL GLENNON DES PERES DOB MIDWEST ENDOSCOPY OP CATH LAB SLEEP DISORDERS CENTER SLUH SNF/NF/CC/HOSPICE UNIVERSITY CLUB TOWER OTHER GRAND TOTAL FY 09 / FY 08 YTD AMB ENCs

Editor Adrian M. Di Bisceglie, MD, FACP Professor of Internal Medicine Chairman