The University of Minnesota Department of MedicineA n nual Report 20052 Chairman’s Introduction6 Department of Medicine Organization7 EducationOverview10 Medicine and Medicine-Pediatric Residents (listing)11 Medicine Fellows (listing)12 UMPhysicians: Clinical Programs15 Research18 Administrative Summary20 Development Office Summary23 Affiliated Campus Reports24 Abbott Northwestern Hospital26 Hennepin County Medical Center30 Regions Hospital33 VA Medical Center1On the coverDr. Kristin L. Nichol isChief of Medicine and Directorof the Primary and SubspecialtyMedicine Service Line at theMinneapolis VA Medical Center.Her research addressing thesafety, efficacy, and cost effectivenessof influenza vaccinationin healthy adults and theelderly has influenced publichealth policy and practice bothnationally and internationally.37 Divisions, Department of Medicine38 Cardiology42 Endocrinology and Diabetes45 Gastroenterology, Hepatology, and Nutrition48 General Internal Medicine53 Genetics55 Hematology, Oncology, and Transplantation59 Infectious Diseases and International Medicine62 Pulmonary, Allergy, and Critical Care67 Renal Diseases and Hypertension70 Rheumatic and Autoimmune Disease75 Faculty Recognition: Fall 200576 Prestigious Society Memberships
Chairman’s Introductionpatient care: our first priorityJonathan I. Ravdin, M.D.Nesbitt Professor andChairmanDepartment of Medicinewww.dom.umn.eduProviding the highest quality patient care must be the numberone priority of our Department of Medicine, from which excellencein research and education naturally flow. Why begin aChairman’s Report with such a statement? In 2006, this philosophy must be thebedrock of any outstanding Department of Medicine. Fifteen years ago the primacyof managed care shook up academic medicine, causing change at a tumultuouspace. Following the Institute of Medicine’s report (“To Err is Human”), the currenttransparency and emphasis on clinical quality and patient satisfaction requirescomparable cultural and organizational changes (but changes that are much moremission oriented). What can be wrong about providing better patient care? Why nothave our clinical programs represent models to be aspired to by our students andresidents rather than be disparaged later on? There is no downside to having directaccountability to our patients. The challenge is to set our goals high, be honest inevaluating the changes needed, and move forward.After ten years of leadership at Minnesota, it is gratifying to see how much wehave grown and how many wonderful students and residents we have trained, yetit is humbling to recognize that our future plans are even more ambitious. In 1997,there were 72 faculty based at the University. Today, there are over 150 facultybased at the University and almost 400 Medicine faculty city-wide, yet much moreremains to be done. Our strategic goals are to double, yet again, our Universitybased,research-intensive faculty and NIH funding; to attain recognized levels ofoutstanding quality in clinical care, including patient satisfaction; to become theresidency and fellowship training programs of choice in the entire Midwest; tosignificantly globalize all aspects of our mission so as to strengthen our educational,research, and clinical programs while devoted to promoting global healthequity; and lastly, to build one cohesive Department of Medicine faculty across fiveaffiliated academic medical centers. The latter is essential to achieve new levels
of excellence and nationalprominence while enhancingthe career development andcultural life for our entirefaculty. We will make progressin 2005/2006 toward thesestrategic goals by advancingclinical research throughcollaboration with Jas Ahluwalia,Executive Director ofClinical Research in the AHC,Associate Dean for ClinicalResearch, and one of ournewest Professors. Togetherwith Jas, we are recruitinga number of new clinicalresearchers and have openeda national search for a newDepartment of MedicineDirector for InterdisciplinaryClinical Research. The searchfor a new Cardiology DivisionDirector and Director ofthe Lillehei Heart Instituteis off to a great start underAnne Taylor’s leadership; thisrecruitment should solidifyAbove: Members of the University of Minnesota and Abbott NorthwesternResidency Program Merger Taskforce (Back Row L to R): Robert Miner, M.D.;Kelly Frisch, M.D.; Brad Benson, M.D.; Ben Bornzstein, Ph.D.(Front Row L to R): Peter Duane, M.D.; Lisa Callies, M.D.; Michael Ornes, M.D.NOT PICTURED: Heather Thompson, M.D.To advance the University of MinnesotaInternal Medicine Residency Program,a planned merger with AbbottNorthwestern’s Program providesa new impetus to raise the bareducationally for the entire program.development of cardiovascularresearch at the Universityof Minnesota for years tocome. Other research-intensivefaculty recruitmentsin medical genetics, pulmonary/criticalcare, infectiousdiseases, autoimmunity,diabetes, and stem cell biologyare underway. To advancethe University of MinnesotaInternal Medicine ResidencyProgram, a planned mergerwith Abbott Northwestern’sProgram provides a new impetusto raise the bar educationallyfor the entire program.Recruitment of a new InternalMedicine Residency ProgramDirector, Bill Browne, was theresult of a national search tobring strong, experienced,and talented leadership forthe future. Greg Vercellottireceived the all UniversityAward for Excellence in Postbaccalaureate education(joining Wes Miller and KathyWatson as being so honored)and took over leadership ofthe fabled “Blood Course.”Implementation of the GlobalHealth Pathway Curriculumin 2006 will provide our residentswith a program that isnot available anywhere elsein the United States. There aremany initiatives to improveclinical quality that will bediscussed further.With regard to globalization,together with Roby Thompson(CEO, UMPhysicians), Patti
Chairman’s Introductionglobalization: bangalore, IndiaWe also are seeking to developpartnerships in cardiovascular medicinewith Narayana Hrudalaya Hospitalin Bangalore.FROM L to R: Drs. Devi Shetty (Managing Director, Narayana HrudayalayaInstitute of Medical Sciences, Bangalore, India), Jonathan Ravdin, KumarBelani (Cordinator, India Programs, UMP), Roby Thompson, K. Muralidhar(Director, Academic Programs NHIMS), Patti Arnold (CFO, UMP), Dr. TVChandrasekhar (Consultant, NHIMS), Lakshmi Mani (Manager, CharitableCell, NHIMS), Marcie Christensen (UOM, Medical School Executive) andDr. Ashley D’cruz (Director, Pediatric Hospital, Chief Pediatric SurgeonNHIMS) at a meeting in Bangalore at NHIMS to discuss program developmentin Cardiovascular Sciences.From L to R: Patti Arnold (CFO, UM Physicians), Dr. Nagendra Swamy(Director, Medical Services and Post Graduate Studies, Manipal hospital),Mr. T. Ramoji (CFO, Manipal Hospital), Drs. Kumar Belani (Coordinator, IndiaPrograms, UM Physicians) Jonathan Ravdin, and Roby Thompson andMr. R. Basil, CEO, Manipal Hospital and Health Systems). This leadershipmeeting at Manipal Specialty Hospital in Bangalore, India was to negotiatea contract for implementation of the UMPhysicians Bone MarrowTransplant Program in India in partnership with Manipal.Arnold (CFO, UMPhysicians),and Kumar Belani (Professorof Anesthesia and Medicine),we returned to Bangalore andcompleted an agreement tostart the UMPhysicians BoneMarrow Transplant Programat the Manipal SpecialtyHospital. We also are seekingto develop partnerships incardiovascular medicinewith Narayana HrudalayaHospital in Bangalore.Kristin Nichol, Vice Chairand Chief of Medicine at theV.A. Medical Center, surveyedthe entire faculty of thegreater academic Departmentof Medicine to provide a transparentbaseline to measurefuture successes in our “buildingone faculty” efforts. Inaddition, the new relationshipwith Abbott NorthwesternHospital will bring manynew faculty members intothe Department to contributeto our academic mission.Amid these efforts andgrowth, we will sustain anunbending focus on patientcare. Top research-intensivemedical schools and academicmedical centers are almostalways associated with excellencein patient care; Harvard(the Brigham and MassachusettsGeneral Hospitals),Johns Hopkins, UCSF, Vanderbilt,and now, the Universityof Pittsburgh are great examples.Studies of the organizationalbehaviors that promoteclinical excellence indicatethat a culture of accountability,transparency, and dedicatedleadership (from Chairto Division Head to ProgramDirector) are essential. TheInstitute of Medicine (IOM)has delineated key indicatorsof clinical quality:Institute of Medicine’s SixAims in Patient Care:n Safetyn Effectivenessn Patient – Centerednessn Timelinessn Efficiencyn Equity
The Division Heads haveagreed that each divisionwill undertake an IOM projectincluding all six measuresin one area of clinical care.We have developed a comprehensiveanalysis and plan tocompletely reorganize theInpatient General MedicineServices at University ofMinnesota Medical Center(UMMC), led by Karyn Baum.This effort will fundamentallychange how we deliverpatient- centered care. Thisstep represents only the tip ofthe iceberg in the necessarychanges for our inpatientunits, which will truly requirea team approach. John Regenfuss,Administrative CenterDirector, and Sue Prause,Clinical Analyst, will providevaluable data to DivisionHeads to assist faculty inmeeting goals of patientcenteredcare (access, timeliness),while improving productivitythrough use of teamcare, nurse practitioners, andmore efficient scheduling.Bobbi Daniels, Vice Chair forClinical Affairs and CMO ofUMPhysicians, is leading arenewed Medicine FacultyCSU Board to enhance clinicalpractice improvement andcommunication with faculty.All divisions have agreed toset up and implement plansfor immediate patient accessin every ambulatory clinicwithin the UMPhysicians.Wes Miller, Vice Chair ofEducation and Head ofGeneral Internal Medicine,is leading an initiative todevelop an Inpatient GeneralMedicine Hospitalist Programthat will serve all patientsthroughout the UMMC byJuly 2007. The implementationof a Managed ServicesAgreement (MSA) with UMMCfor Adult CardiovascularServices has provided tremendousresources and supportfor quality improvement,as will a new Solid OrganTransplant MSA. Given theseinitiatives and efforts, I amconfident that we will meetthe challenge of providing thevery best in state of the artcare to our patients withinUMPhysicians and at UMMC.Our colleagues at theMinnesota VA Medical Center,Hennepin County MedicalCenter, Regions Hospital, andAbbott Northwestern Hospitalare all engaged in similarquality improvement efforts,as together we keep the stateof Minnesota number one inthe nation in health outcomes,and our educational programssecond to none.Amid these efforts and growth,we will sustain an unbending focuson patient care.Dr. Karyn Baum (center) confers with the pharmacist and nursing staff regardinga patient’s care in the University of Minnesota Medical Center.Thank you for your continuedefforts and support of the Universityof Minnesota Departmentof Medicine. It will takeall of us working together toovercome the many challengesthat present themselves as westrive to move the Departmentforward. Best wishes for a successfuland healthy New Year.Sincerely,Jonathan I. Ravdin, M.D.Nesbitt Professor and ChairmanDepartment of MedicineUniversity of MinnesotaMedical School
Department of Medicine OrganizationNesbitt Professorand ChairmanJonathan I. Ravdin, M.D.Vice ChairsVice Chair for Clinical AffairsBobbi S. Daniels, M.D.Vice Chair for EducationWesley J. Miller, M.D.Vice Chair for ResearchRobert P. Hebbel, M.D.Associate Chair forClinical ResearchDaniel Weisdorf, M.D.Vice Chair,Abbott Northwestern HospitalTerry Rosborough, M.D.Vice Chair,Hennepin County Medical CenterScott Davies, M.D.Vice Chair, Regions HospitalElie Gertner, M.D.Vice Chair, VA Medical CenterKristin Nichol, M.D.Divisions of Medicine,DirectorsCardiologyLeslie W. Miller, M.D.Endocrinology and DiabetesCary N. Mariash, M.D.Gastroenterology,Hepatology and NutritionJohn R. Lake, M.D.General Internal MedicineWesley J. Miller, M.D.GeneticsRichard A. King, M.D., Ph.D.Hematology, Oncology andTransplantationPhilip B. McGlave, M.D.Infectious Diseases andInternational MedicinePhillip K. Peterson, M.D.Pulmonary, Allergy, andCritical CareDavid H. Ingbar, M.D.Renal Diseases and HypertensionMark E. Rosenberg, M.D.Rheumatic andAutoimmune DiseasesDaniel L. Mueller, M.D.Education LeadershipResidency Program Director(University of Minnesota)Peter Duane, M.D. (interim)Medicine-Pediatric ResidencyProgram DirectorBradley Benson, M.D.Associate Residency ProgramDirector (Regions)Kelly Frisch, M.D.Associate Residency ProgramDirector (University of Minnesota)Heather Thompson, M.D.Associate Residency ProgramDirector forGlobal Health PathwayPatricia Walker, M.D.Associate Residency ProgramDirector, Physician ScientistProgramPeter Bitterman, M.D.Residency Program Director(Hennepin County Medical Center)Anne Pereira, M.D.Residency Program Director(Abbott Northwestern Hospital)Robert Miner, M.D.Fellowship DirectorsSenior Fellowship Program DirectorCary L. Mariash, M.D.Allergy and Immunology FellowshipMalcolm Blumenthal, M.D.Cardiovascular Disease FellowshipLeslie W. Miller, M.D.Clinical Cardiac ElectrophysiologyFellowshipScott Sakaguchi, M.D.Interventional CardiologyFellowshipRobert Wilson, M.D.Endocrinology and DiabetesFellowshipCary N. Mariash, M.D.Gastroenterology FellowshipRoger Gebhard, M.D.Geriatric Medicine FellowshipMichael Spilane, M.D.Hematology/Medical OncologyFellowshipLinda Burns, M.D.Infectious Disease FellowshipJames R. Johnson, M.D.Nephrology FellowshipMark E. Rosenberg, M.D.Pulmonary Disease and CriticalCare FellowshipMelissa King-Biggs, M.D.Rheumatology FellowshipBarbara Segal, M.D.Medicine ClerkshipSite DirectorsUniversity of MinnesotaL. James Nixon, M.D.Abbott Northwestern HospitalTerry Rosborough, M.D.Hennepin County Medical CenterM. Thomas Stillman, M.D.RegionsTom Yacovella, M.D.VA Medical CenterStacey Mollis, M.D.Affiliated ResearchInstitutes and CenterDirectorsAdvanced Lung Disease CenterMarshall I. Hertz, M.D.Autoimmunity CenterTimothy Behrens, M.D.Stem Cell InstituteCatherine M. Verfaillie, M.D.Vascular Biology CenterRobert P. Hebbel, M.D.Lillehei Heart InstitutePeter Bitterman, M.D.(Research Director)AdministrationAdministrative DirectorJohn RegenfussFinance DirectorPatrice SchausHuman Resources DirectorCynthia Livon-ShraggProject ManagerLara GjerstadResearch DirectorLeslie Kennedy
Department of Medicine Educationflexibility of medical school trainingThis is an extremely exciting time to be an educator at theUniversity of Minnesota Medical School, as the Departmentof Medicine (DOM) has been involved in planning innovativechanges in both medical school and residency educationalactivities. The Medical School, fueled by Dean Powell’s vision of future medicaleducation, has undertaken Med 2010, a curriculum design for the future.Kathleen Watson, M.D. and Jonathan Ravdin, M.D. have taken on leadership of thisplanning and many DOM faculty are active participants. Our goals are to increasethe quality of care (decrease medical errors, increase interdisciplinary teamwork);decrease the cost of care; decrease health care disparities; and increase the flexibilityof medical school training. Two retreats involving outside participants ofmajor influence have generated many ideas and have resulted in national enthusiasmfor the curriculum reform underway at the University of Minnesota.A number of exciting innovations are in progress within our residency program.The initiation of the Global Health Pathway and the Physician Scientist Pathwayhave led to great excitement for residents and applicants. Restructuring residentwork hours has been very positive and plans are moving forward to more sharplylimit work hours with the goal of more focused patient-centered care by residentteams. The largest anticipated change in the residency is the potential to jointhe UMMC and the Abbott Northwestern residency programs. A number of trulyexciting and leading-edge changes are anticipated from this meeting of mindsfrom two great programs.James Nixon, M.D. has been a remarkable force in undergraduate medical educationin his role as Director of Medicine Clerkships and Director of the PediatricsClerkship. In a recent self study for the LCME Accreditation, these were the twohighest rated courses in the year three-four curriculum. Dr. Nixon is very innovativeand rigorous in his approach to education. His paper on the effect of workWesley J. Miller, M.D.Distinguished TeachingProfessor of MedicineVice Chair for Educationwww.dom.umn.edu/education
L. James Nixon, M.D.Medicine Clerkship DirectorPeter Duane, M.D.Interim Residency Program DirectorKelly Frisch, M.D.Associate ResidencyProgram DirectorHeather Thompson, M.D.Associate ResidencyProgram DirectorDepartment of Medicine Educationhours on student perceptionof resident teachingwas nominated for the bestresearch paper at the 2005Clerkship Directors of InternalMedicine (CDIM) meeting.In addition, he proposed andnow heads a national effort ofthe CDIM affiliates to developinteractive web-based casesto support medicine clerkshipcurriculum.Karyn Baum, M.D. is directorof the year two Physician andSociety Course, the contentof which centers around acommunity service projectdesigned to engage medicalstudents with regional organizationsfor improvement ofcare, especially those involvedin addressing health caredisparities. Her strong effortsin building a curriculumemphasizing interdisciplinaryteamwork are also reflected inher advisorship for CLARION,described below.Graduate medical educationcontinues to be the core ofthe department’s educationalactivity. Peter Duane, M.D.,Associate Program Directorfor the past eight years, hasserved as Interim ProgramDirector during our nationalsearch for a program director.Dr. Duane has been aremarkable leader and anoutstanding supporter andadvocate for residents, as wellas a superb recruiter. Peter isalso leading the task force tomake recommendations forthe structure to combine theUMMC and ANW residencyprograms. Kelly Frisch, M.D.and Heather Thompson, M.D.have been very involved inthese plans as well. Dr. Frischalso heads the curriculum andplanning for improvementsin resident ambulatory careeducation. Dr. Thompsonleads the Resident EducatorDevelopment (RED) programand, has generalized this curriculumto include trainees inother departments, and hasdelivered a faculty developmentworkshop at the Duluthcampus during the past year.Brad Benson, M.D., Medicine-Pediatrics Program Director,has done an outstanding jobbuilding the excellence andculture of Med-Peds. He is awonderful innovator and hasled the way for use of electronicportfolios for reflectionand evaluation of competencein Med-Peds residents. DavidLeach, M.D, director of theACGME (who accredit residencies),recently visited anddelivered Medicine GrandRounds. His topic was theuse of portfolios. He was veryimpressed with Dr. Benson’scutting-edge use of portfoliosin the Med-Peds Residencyand the ACGME ManagementGroup has invited Dr. Bensonto work with them in developingportfolios for national usein residency education. Thisyear, Dr. Benson founded theMinnesota Association ofMed-Peds, which held its firstmeeting in conjunction withthe Minnesota ACP meeting.Dr. Benson serves as secretary-treasurerof the nationalMed-Peds Program DirectorsAssociation and is in a fouryearterm on the executivecommittee of MPPDA.Drs. Watson and Baum (alongwith Powell) have continuedto be active in the Institutefor Healthcare Improvement(IHI). The University of Minnesotahosted the national meetingin 2004, a meeting whichresulted in a number of activities.Drs. Benson and Nixonwere invited to a number ofmeetings to present, “How toTeach Practice-Based Learningand Improvement,” and,in fact, they presented themost highly ranked workshopat AAIM this year. The interdisciplinarygroup, CLARION,presented their case analysiscompetition model in whichstudent groups suggest solutionsto patient care problems/errors.In April of thisyear, the University of Minnesota(with Dr. Baum as anadvisor to the group) hosteda national case competitionamong interdisciplinary studentgroups from seven medicalschools.
Bradley benson, M.D.Medicine-Pediatric ResidencyProgram DirectorPatricia Walker, M.D.Associate Residency ProgramDirector (International Medicine)Peter Bitterman, M.D.Associate Residency ProgramDirector (Physician Scientist Program)Cary L. Mariash, M.D.Senior Fellowship Program DirectorInternational medicine isa growing focus. PatriciaWalker, M.D. from RegionsHospital, has joined the leadershipranks as AssociateProgram Director for InternationalMedicine. We haveestablished internationalsites for resident rotationsin Thailand, India, Uganda,and Tanzania. Dr. Walker andBill Stauffer, M.D., (AssociateCourse Director) havecombined forces to develop acourse in tropical medicine,which, combined with ourresidency training in thispathway, is one of only 13 sitesworldwide which qualify participantsto sit for the Certificatein Tropical Medicine ofthe American Society for TropicalMedicine and Hygiene.Unique among such offerings,this course is offered withoutcharge to our residents.Peter Bitterman, M.D. isAssociate Residency ProgramDirector for the Physician ScientistPathway. This programhas placed residents (whohave shown strong commitmentto an academic career)into a two year residencyprogram followed by a fellowship,which adds an extra yearof research time to the usualclinical and academic fellowshiptraining. Residents inthis program qualify to sit forboards both in internal medicineand in their subspecialtyof choice while enhancingtheir research training.The department continuesto attract outstandingsubspecialty fellows. CaryMariash, M.D. Senior FellowshipDirector, and JonathanRavdin, M.D., DepartmentChair, mentor our residentson how to obtain fellowships.Two faculty deserve specialrecognition for their nationalcontributions to fellowshiptraining. Linda Burns, M.D.has developed national prominenceas a member of theAmerican Society of HematologyCommittee on TrainingPrograms for seven years andchair of that committee for thepast three years. In that role,she has worked with the RRCto revise hematology trainingrequirements; conducted asurvey of training programdirectors which was publishedin Blood; established a TrainingProgram for ProgramDirectors at the national ASHmeeting; and been instrumentalin implementing ERASfor the national oncologymatch process. She is also acouncilor of the Associationof Subspecialty Professors.Faculty development and CMEhave continued to be a majorfocus of our educational effort.Ron Messner, M.D. heads theCME effort in the department.The annual internal medicinereview continues to be highquality and well attended,especially by practitioners inMinnesota. Department ofMedicine faculty members arealso frequent participants inCutting-edge innovations are beingdesigned and delivered in both undergraduateand graduate medical education.Mark Rosenberg, M.D., formerDirector of the Renal FellowshipProgram, has been amember and then Chair of theTraining Program DirectorsExecutive Committee, AmericanSociety of Nephrology. Hehas also been elected to theCouncil of the Association ofSubspecialty Professors wherehis prime role is to develop asystem of in-training examsfor all fellowship programs.both local and regional facultydevelopment activities.The Department of Medicineis designing and deliveringcutting-edge innovations inboth undergraduate and graduatemedical education. Wehave enthusiastically enteredthe new millennium and areexcited by the national andinternational connections wehave established. It is an excitingtime to be an educator inthe Department of Medicine.
Medicine and Medicine-Pediatric Residents10UMMC Anne Blaes,Amy LarsenRegions Thom Dahle,Christopher BowronVAMC Suresh Koneswaran,Dimitri Drekonja (frontrow), Amy Muchow, MichaelAylward (back row)Chief ResidentsUMMCAnne BlaesAmy LarsenRegionsChristopher BowronThom DahleVAMCMichael AylwardDimitri DrekonjaSuresh KoneswaranAmy MuchowMedicine ResidentsPGY-3Ijaz AbidGhiyath Al-TabbalMustafa ArainDonnevan BlakeRachel BurtonGeorge ChenMaren EggertLinda FaulkDina GadBilal HameedViet HoangRajat JhanjeeChristine JohnsSujata KaushalKristopher KruegerPatti KunzeKyle LehenbauerAmyn MalikDanny MuskardinJeffrey NaceSumit RingwalaShauna RuncheyRafael Santana-DavilaTina SvatosJoleen TurjaKirk WilsonPGY-2James AbrahamSyed “Sohail” AliBasel AloulFeyza AsikuzunogluBrett BalounBrian BettsJayashri BhaskarAmy Candy HeinleinJaclyn ChaffeePaul DambowyM. Shakir EjazViorel FloreaPatrick FoyNaomi FujiokaDeka JamaMohammad JameelCybele JohnsonCourtney JordanJoEllen KohlmanHaresh KumarIsmail MualinJack MutnickSoichiro NagamatsuChad OlingerErin RaciKendall RicklefsMeghan RothenbergerPGY-1Yan BakmanJagroop BasraonZach BeresfordSyed BokhariAlison BormannKevin BroderMatthew BunteEndea CurryJurek HuszczoAlya JawaidGreg JohnsonTaimur KhanWei Yen KongJoel McCauleyBrian MillerElizabeth NelsonDaniel NoonanJoseph NovikMatthew OstranderMrinal PatnaikRizwan RomeeEmily RosePaul SufkaKhuong VuongJeannine WallnuttBenjamin WilliamsDylan ZyllaMed-Peds ResidentsMP-1Kimberly BorkeRachel DarlingRobyn KaiserHenry KeeneTaryn LambrechtTaj MustaphaJulie OttoMichael RhodesKaren StarkAnne ValaasCecily WaitTim WoodMP-2Woei EngKatherine MarienfeldMicah NiermannJeffrey NormanPatrick PedersonKeith PetersonKara SchneiderTula TopColin TurnerTheresa Wampler MuskardinMP-3Jesse HennumNicole NaceLaura MutterCatherine NguyenKreegan ReiersonDaniel RiesSonya Schober-JohnsonHeather Woller
UMPhysicians: Clinical Programsimproving quality of care12Bobbi S. Daniels, M.D.Vice Chair for Clinical AffairsOutstanding clinical care is integral to the identity andfunction of the Department of Medicine. Clinical care is the basisfor our educational programs, and inspires and informs our research— bothclinical and basic science. Continued focus on both clinical quality and service,coupled with increased emphasis on the visibility of clinicians, has been a priorityduring this year.Recognizing the variety of different types and locations of care, ranging fromprimary care in an ambulatory setting to the most highly complex care of criticallyill patients, the department has embarked on a multi-pronged approachto improving the clinical care that we deliver. While some efforts are broad andinvolve significant partnerships with the University of Minnesota Medical Center(UMMC), some efforts are unique to specific programs or even specific diseases.As an example, The Department is participating in the AAMC/IHI AmbulatoryCare Collaborative under the leadership of Brian Sick, M.D., Division of GeneralMedicine. We are implementing The Chronic Care Model, a patient-centric modeldesigned to provide patients with the information and tools they need to managetheir own chronic diseases. Our initial efforts are focused on diabetes in ourPrimary Care Center, and significant improvements in both outcomes for patientsas well as the ease with which our faculty can help patients with improving carehave been realized. Our ultimate goal is to provide all patients throughout theUniversity of Minnesota Medical Center with access to the necessary patientcenteredresources for all types of chronic disease management. For our mostcomplicated patients, who often have more than one chronic disease, empoweringthe patients and providing appropriate system-based infrastructure is recognizedas the most important step. Involvement of trainees in developing and practicingthis model is an important part of our educational mission as well.
Marshall Hertz, M.D.Lung Transplant Program DirectorJohn lake, M.D.Liver Transplant Program DirectorBert Kasiske, M.D. (HCMC)Kidney Transplant Program DirectorWes Miller, M.D.Primary Care Program DirectorInpatient care remains apredominant part of both ourtraining programs and theactivity of the faculty.To that end, there is significantenergy related toimprovement in outcomesin the hospital. University ofMinnesota Medical Centerhas been recognized by theUniversity Health Care Consortium,a group of nearly allacademic medical centers inthe country, for top decile performancein general medicine,oncology, cardiology andICU mortality. The involvementof our faculty has beencritical for achieving theseoutstanding outcomes.Individual services lines,which cut across traditionalacademic and discipline-specificboundaries are also afocus of improvement.For example, all aspects ofthe Cardiovascular ServiceLine, are being managedjointly by leaders in theDepartments of Medicineand Surgery through a managedservice agreement withUMMC. Overall performanceimprovement efforts havebeen focused on performingin the top decile amongst thehospitals participating in theCMS demonstration projectand significant improvementshave ensued. Financial performanceas well as servicequality are also a part of themanagement agreement.The success of this project,both from a faculty and ahospital perspective, haveled to plans for similar managementagreements for otherservice lines, such as organtransplantation.The interconnectivity betweenclinical care and our student,resident, and fellow educationis particularly prominent inour inpatient care delivery.The need for more reasonablework hours for traineeshas led to a re-evaluationof how we deliver inpatientcare. Our evaluation has ledto a department-wide initiativeto fundamentally redesignour inpatient clinicalservices and how we deliverTable 1: Department of Medicine Clinical ServiceUnit (CSU) Board MembersBobbi Daniels, M.D.Jonathan Ravdin, M.D.John RegenfussBoard MembersLynn Burmeister, M.D.Linda Burns, M.D.Gladwin Das, M.D.Jordan Dunitz, M.D.Edward Greeno, M.D.Marshall Hertz, M.D.Jack Lake, M.D.James Nixon, M.D.Carmelo Panetta, M.D.Barbara Segal, M.D.Richard Spong, M.D.Heather Thompson, M.D.Marcie Tomblyn, M.D.Jo-Anne van Burik, M.D.care. Eliminating clerical andadministrative work from theresidents’ responsibilitiesto focus predominantly onphysician activities, developinga system to assure gradedtrainee responsibility fromstudent through fellow, andimplementing geographicallydistinct teams that focus onChair, Ex OfficioEx OfficioEx OfficioEndocrinology and DiabetesHematology, Oncology, andTransplantionCardiologyPulmonary, Allergy, and Critical CareHematology, Oncology, andTransplantionPulmonary, Allergy, and Critical CareGastroenterology, Hepatology,and NutritionGeneral Internal MedicineCardiologyRheumatic and Autoimmune DiseasesRenal Diseases and HypertensionGeneral Internal MedicineHematology, Oncology, andTransplantionInfectious Diseases andInternational Medicinemeeting the patients’ careneeds are all steps to improveclinical care in the setting ofmandated residency changes.The Department annually recognizesoutstanding clinicalquality and service providedby faculty. Nominations aresought and objective data,such as information from13
Daniel Weisdorf, M.D.BMT Program DirectorPhilip McGlave, M.D.Oncology Program DirectorLeslie Miller, M.D.Cardiovascular Program DirectorHeart Transplant Program DirectorUMPhysicians: Clinical Programs14Table 2: Department of Medicine Clinical Activitying very attentive care with reformulated the governingapplication of the highest board for the clinical practiceClinical RevenueTotal RVUs % change (Patient and Contract) % changestandards of quality and service.from each division and pro-to provide representation2004 2005 2004 to 2005 2004 2005 2004 to 2005Cardiology 117,940 121,362 2.90% 6,228,472 6,730,612 8.06%gram, as well as representativesFaculty Diabetes/Endo/Metab. clinical leadership 16,388 16,388 3.22% 677,969 697,425 2.87%from the 46,217 division direc-28.02% 1,444,369 1,881,249 30.25%Gastroenterology 36,102development remains anGeneral Medicine 48,209 61,087 26.71% 2,087,035 2,757,058 32.10%tors (see Table 1). The group isimportant Genetics goal. During the 395 623 57.61% 16,969 26,827 58.09%Heme/Onc/Transplant. 77,129 responsible for 83,460 the oversight 8.21% 4,212,864 5,129,604 21.76%last Infectious year, the Diseases department 11,304 13,080 15.71% 609,393 667,894 9.60%Pulmonary 50,268 55,901 11.21% 2,329,078 2,620,344 12.51%Renal 22,847 30,465 33.34% 1,161,906 1,689,688 45.42%Rheumatology 11,267 12,200 8.28% 429,490 531,164 23.67%Total Department 391,338 440,782 12.63% 19,197,545 22,731,865 18.41%patient satisfaction data andfeedback from residents, areused to identify the mostdeserving faculty. This yearfour faculty, Linda Burns,M.D. (Bone marrow transplantation)),Connie Manske,M.D (Renal), Arek Dudek,M.D.(Oncology) and BarbaraSegal, M.D. (Rheumatology)were recognized as recipientsof the Department’s ClinicalExcellence Award. Theseindividuals truly performedbeyond expectations, provid-of the clinical practice, as wellas quality and service goals,and will serve as an importantmechanism for developingfuture clinical leaders withinthe Department and the medicalschool. In addition, theDepartment has implementeda clinical strategic plan, whichincludes increasing emphasison clinical quality metricsacross the entire range of ourpractice, reorganizing theinpatient general medicineteaching service to improvepatient-centered care, andrecruiting additional clinicalscholar faculty.The investments describedin clinical quality, clinicalservice, and faculty havetranslated to significantgrowth in the clinical activityprovided by the Department(see Table 2). Overall, theDepartment looks forwardto continued growth in care,building on an alreadystrong foundation of qualityand service.
Department of Medicine Administrative Summarysteady growthThe Department of Medicine continues to achieve steady18John M. Regenfuss,MBA, CMPEAdministrative Center DirectorDepartments of Medicine,Emergency Medicine,Neurology, and Dermatologygrowth and improved administrative and clinical efficiency.The department is poised to implement its five year strategic plan to increaseresearch funding. Total revenues, which include extramural research funds, clinicalactivity, educational support, and philanthropic gifts, have increased. Thenumber of faculty at all sites continues to increase, as does the department’sreserves for the fourth straight year. Continuous improvement in all administrativeprocesses and procedures so as to support our missions of excellence in education,research and patient care remain a primary goal of the department, whileinitiating administrative infrastructure plans to support our growth.The Department of Medicine experienced a nearly 8 percent increase over theprevious year in total revenues to nearly $68 million (see Figure 1). The asset base,created by the activities of sponsored research, clinical practice, and student, resident,and fellow education, grew proportionally. The department continues to havethe largest overall budget and largest number of faculty and support staff of anydepartment within the Medical School. Within the faculty practice plan (Universityof Minnesota Physicians), the department maintains its lead with the highest grosscharges, total revenue, and total assets. Philanthropy continues to be an importantsource of funding for the department. Gifts from donors provide over $3 millionannually, making a significant impact on our research, education, and patient care.Research program revenues continue to grow at a slower, but steady pace, with morefunding from State and Federal sources, as well as internal funding mechanisms forcollaborative research. The indirect cost recovery (ICR) received from the Universityof Minnesota provides support of research infrastructure at a department level.The faculty practice group, UMPhysicians, continues to demonstrate a strongfinancial performance. Initiatives undertaken over the past several years in the
Oncology Clinic, ImagingCenter, and Riverside EndoscopyCenter, continue toprovide additional financialresources for UMPhysiciansas well as for the department.The Department of Medicinehas increased its clinicalactivity by 12 percent overthe previous year resultingin additional net revenue ofover $2.5 million. Contractsincreased as well, whichincluded a new CardiovascularMedical Service Agreement.Faculty salaries were able tobe increased on the averageby 6.2 percent The amountreturned to faculty compensationfor their clinical effortcontinues at almost fifty percentof income generated.The Department of Medicine’sfinancial performance isexpected to remain strong,allowing for investment innew initiatives and ongoingsupport of existing programs.This will also ensure thatresources are available torecruit and retain outstandingphysician scientists and clinicalscholars, and to providethe necessary infrastructureto support their activities.The number of faculty positionscontinues to increase asit has over the past five years.During fiscal year 2005, thegrowth rate was 8.6 percent innet total positions on the Universityof Minnesota campus(see Table 1). At the affiliatesites, the rate of growth hasbeen more disparate. The distributionby academic rank(tenure and non-tenure trackcombined) is indicated inTable 1, which indicates thenumber of faculty increased atevery rank for fiscal year 2005.706050403020100figure 1: department of medicine funding ProfileIn Millions46.92001 200256.5200360.5Fiscal Year200462.9200567.9ResearchProgramRevenuesStateAppropriationICRClinicalRevenueOtherRevenueTotalRevenue19Table 1: Faculty AppointmentsSite Instructor Asst. Prof. Assoc. Prof. Professor TOTALANW - 2 3 - 5UMMC 6 79 24 42 151HCMC 7 53 12 14 86Regions 2 31 5 2 40VAMC 18 45 17 27 107Total: 33 208 58 85 389% Male 64% Male 67% Male 69% Male 86% Maleor Female 36% Female 33% Female 31% Female 14% FemaleTable 1 All Department of Medicine Faculty (Including Part Time Appointmentsat UMMC)
Development Office Summaryeach gift makes a difference20Jennifer SoderholmDirector of Developmentwww.mmf.umn.eduIn calendar year 2005, a record number of donors—786—reachedout for the good of all and supported health-related education,research, and service in the Department of Medicine and StemCell Institute. These generous individuals, organizations, corporations,and foundations together contributed the highest fund-raising total ever forthe department and institute: $14.6 million in new gifts and pledges.Each gift makes a difference. This record—setting philanthropy helps thedepartment reach new heights in:n Preventing diseasen Developing more effective, targeted therapiesn Improving patient caren Educating the next generation of health professionalsBelow you will read about a few of the gifts that have greatly impacted the work ofour dedicated faculty. These partnerships with faculty, programs, and divisions ofthe department help in educating the next generation of doctors, developing bettertreatments, and offering more hope to those in need.n David R. and Anne Amato and Friends contributed over $36,000 to the InterstitialLung Disease Research and Education Fund managed by Tim Whelan, M.D.,through the Center for Advanced Lung Disease.n Dennis W. and Audrey L. Anderson continue their annual support of ArekDudek, M.D., Ph.D., with a gift of $250,000. Over the past three years, theirgifts totaling $750,000 have supported research into novel treatments forlung cancer.n Earl E. Bakken (The Earl & Doris Bakken Foundation) contributed $100,000each in support of work by David Benditt, M.D., in the Cardiac ArrhythmiaCenter and Les Miller, M.D., in the Division of Cardiology.
n Blue Cross and Blue Shieldof Minnesota contributed$83,000 to the TobaccoCessation Guideline ImplementationAssessmentFund under the directionof Larry An, M.D.n Consolidated Anti-AgingFoundation contributed$57,000 to stem cellresearch for Parkinson’sDisease following a $40,000gift in 2004.n Rodney L. and Judith L.Cooperman continuedtheir annual support ofthe research of BrucePeterson, M.D., in hematologicalmalignancies with agift of more than $110,000.This is their eleventh yearof support to Dr. Peterson.n The Graf Family Foundationpledged $50,000 to the worked closely with MCCF,Dr. Philip McGlave hasHarold M. Wexler Professorshipin gratitude foryears. This tremendousInc. leadership for over tenDr. Wexler’s exceptional pledge is in addition to theircare, with a matching grant generous annual supportfrom Guidant Foundation. of $500,000 + for research,education, and servicen The Masonic Family ofconducted through theFraternities through theHematology, Oncology, andMasonic Cancer CenterTransplantation division.Fund, Inc. pledged $10 milliontoward the Masonic n The Alice M. O’Brien Foundationpledged $250,000Oncology Pavilion, whichwill be housed in the new to support the O’Brien Bioclinicalsciences building. Bank housed within theDepartment of Medicine (and SCI) Total Dollars RaisedMillions of Dollars151413Center for Advanced LungDisease. Tim Whelan, M.D.,Christine Wendt, M.D., andMarshall hertz, M.D., havebeen working closely withthe O’Briens.In addition to pledges, outrightgifts, and planned giftssupporting various researchand programmatic areas, anumber of significant tributesbenefitting the department orinstitute were received. A fewof these have been listed onthe following page.n James P. and Deb Deanovic1221donated $25,000 to theAndrea Deanovic Fundfor HSP Research underthe direction of HassanIbrahim, M.D.111098n Donald L. and Patricia A.Garofalo contributed$125,000 to the departmentbenefiting cardiologyand hematology research.Since 2000, the Garofaloshave generously given tothe Friends of CardiologyFund sponsoring a fellowshipin memory of their son,Anthony. For three years,they have supported theresearch of Dan Weisdorf,M.D., with gifts of $25,000.7654321020012002 2003 2004Calendar Year2005
Development Office Summary22We thank all the familiesfor involving us during theirtime of celebration andremembrance.40 gifts totaling close to$6,000 were given in memoryof Kathleen M. Curran. Thesegifts support the Kathleen M.Curran Leukemia ResearchFund directed by DanWeisdorf, M.D.49 gifts totaling over $2,000were given in honor of Dale R.Liesch’s wedding in support ofHuman Embryonic Stem CellResearch and Developmentunder the direction of DanKaufman, M.D., Ph.D.39 gifts totaling over $3,000were given in memory ofWilliam F. Martyn in supportof the Hematology, Oncology,and Transplantation Divisionunder the direction of PhilipMcGlave, M.D.127 gifts totaling closeto $18,000 were given inmemory of Judith H. Murphyin support of the Center forAdvanced Lung DiseaseFund under the directionof Marshall Hertz, M.D.106 gifts totaling close to$5,000 were given in memoryof Arthur B. Summerfield insupport of Cancer ImmunotherapyFund under the directionof Dan Weisdorf, M.D.Minnesota MedicalFoundationThe Department of Medicine’sdevelopment program is apart of the Minnesota MedicalFoundation, a 501(c) (3)nonprofit organization dedicatedto supporting the worldrenownedprograms at theUniversity of Minnesota MedicalSchools and the School ofPublic Health. The MinnesotaMedical Foundation raisesmillions of dollars annuallyfor health-related educationand research at the Universityof Minnesota.Office of DevelopmentDepartment of Medicine andStem Cell Institute612.625.6114Toll-free 800.922.1663Fax 612.625.9468Mailing Address:Minnesota Medical FoundationMedicine/SCI DevelopmentMcNamara Alumni Center200 Oak St. SE, Suite 300Minneapolis, MN 55455-2030www.mmf.umn.eduJennifer SoderholmDirector of Development612.firstname.lastname@example.orgThese generous individuals, organizations,corporations, and foundations togethercontributed the highest fund-raising totalever for the department and institute:$14.6 million in new gifts and pledges.
Affiliated Campus Reports23
Affiliated Campus ReportsAbbott Northwestern Hospital24Terry Rosborough, M.D.Director of Medical Education,Abbott Northwestern HospitalPatient CareAbbott Northwestern Hospital (ANW) continues to provide carefor the largest number of adult patients in the Twin Cities metroarea. In spring 2005, we opened a major new addition that created an integratedHeart Hospital, an Orthopedic/Spine center, and a Neurosciences center. Thisnew addition also allowed us to make almost every room in the institution a privateroom. The hospital continues to be ranked highly on multiple regional andnational best-hospital lists for care in multiple specialty areas.In summer 2005, ANW implemented Epic, a complete computerized medicalrecord system that integrates inpatient and outpatient records throughout theAllina multi-hospital and clinic system. The ANW Medical Education Departmentwas a leader in this project. Epic began in the resident/faculty clinics in December2004. Residents and faculty access all clinical information and perform all clinicaldocumentation and ordering through the computer system. The Allina computerizedmedical record project has been complicated, since it is the most extensivesuch project in the country to date, but the residents and faculty have been verysuccessful in this transition.
FacultyThe core faculty is growingrapidly with much of thegrowth due to increases inour hospitalist program. ANWcurrently has over 40 internalmedicine hospitalists who arethe primary attending physiciansor primary consultantsfor over 200 patients in thehospital. The computerizedmedical record is acceleratingthe movement towards havinga hospitalist as the attendingor main consultant for a highpercentage of the patients inthe hospital.The two Medical EducationDepartment outpatient clinicsfor faculty and residents arealso growing. The on-campusclinic, the site of the residentcontinuity clinic, serves theMinneapolis area and itsdiverse patient population.Our southwest metro clinic,opened in the fall of 2003, isalso growing because of theincreasing need for internistswho can care for agingpatients and patients withcomplex medical illness.EducationANW continues to be successfulin resident, fellow, andmedical student education inInternal Medicine. The hospitalexpanded supportfor the University fellowshipsin Cardiology and Gastroenterologyduring the pastyear. It was an importanteducational advance duringthe last year to make all ofour residency conference presentationsavailable onlineas part of our Web site. Ourhand-held computer projectusing Pocket PC technologyfor information accesscontinues to advance and bevery important for patientcare and learning.ResearchClinical research at ANWis focused in several areas.We have a very large researchprogram in Cardiology thatmade important contributionsduring the last year.We also have large HIV andGastroenterology outpatientresearch programs. The coregeneral Internal Medicinefaculty members also have avariety of research projectsthat include management ofpatients with thrombosis, controlof hyperglycemia in theintensive care unit, and strategiesto alter physician behaviorto improve patient care inthe outpatient setting.Research Highlight: Timothy D. henry, M.D.DDr. Tim Henry is the Director of Research for theMinneapolis Heart Institute Foundation and aninterventional cardiologist at the Minneapolis HeartInstitute at Abbott Northwestern Hospital. His major areaof research has been patients with refractory myocardial ischemia whoare not amenable to surgical or percutaneous revascularization. Thisinterest has led to development of the OPTions In Myocardial IschemicSyndrome Therapy (OPTIMIST) Program where nearly 1,200 patientswith refractory ischemia have been seen in the last seven years. Thegoals of the OPTIMIST Program are to define the natural history and toexplore cutting edge therapeutic options for this complex and growingpatient population. Current options include myocardial angiogenesiswith both gene therapy and stem cell clinical trials, enhanced externalcounterpulsation, spinal cord stimulation, and novel pharmacologicagents such as ranolazine. His other major area of research hasbeen the development of the Minneapolis Heart Institute Level 1MI Program for transfer of patients with acute myocardial infarctionfrom 30 community hospitals in Minnesota and Wisconsin to AbbottNorthwestern Hospital for direct percutaneous revascularization.This unique Program has become a model for acute MI treatment inthe United States. Both areas have provided an excellent opportunityto integrate clinical research at University of Minnesota with theMinneapolis Heart Institute at Abbott Northwestern Hospital. Patientsin the two Programs have participated in eight recently completedor ongoing clinical trials using stem cell therapy for patients withrefractory ischemia and acute myocardial infarction. These trials havelaid the groundwork for a joint University of Minnesota/MinneapolisHeart Institute NIH grant submission to be part of the NHLBICardiovascular Cell Therapy Research Network.25
Affiliated Campus ReportsScott F. Davies, M.D.Professor andChief of MedicineHennepin County Medical Center26 From preparing the community for biological, chemical, and otherdisasters, to providing Level 1 Trauma Care and Intensive CareDavid N. Williams, M.D.Professor and AssistantChief of MedicineOther HCMC Faculty*ProfessorsRichard Grimm, M.D.,Clinical EpidemiologyPaul Pentel, M.D.,Clinical PharmacologyAssistant ProfessorsMilt Bullock, M.D.,Addiction/Alternative MedicineMark LeSage, M.D.,Addiction/Alternative MedicineKathleen Wesa, M.D.,Addiction/Alternative Medicine*No equivalent Division at the U of MNUnits with outstanding patient outcomes, HCMC provides criticalcare in critical times. As a public teaching hospital, HCMC serves twokinds of vulnerable patients. The first group fits the stereotype of patients needingsafety net services, those who are poor, uninsured, of different culture andlanguage, and sometimes afflicted by chemical health and mental health issues.They are subject to more severe illness and the challenge - and privilege - is to seeeach patient as an individual and fight to give them the best possible outcome.But other patients are not vulnerable for any economic or social reason but simplybecause they have a severe acute surgical or medical illness necessitating a systemof care that includes transportation, resuscitation, stabilization, source control,and intensive support. Some of the first group of vulnerable patients and nearlythe entire second group require critical care at a critical time of their lives and itis an important component of our broader work. This competency to take care ofthe most ill also translates into the ability to care for more usual conditions forpatients across all socioeconomic and other categories.The Department of Medicine faculty and residents are actively involved in providingthis critical care to our patients. The Department is able to provide this criticalcare to its patients by retaining and attracting good faculty, recruiting topnotch
esidents and fulfilling itsbring in new business to themission of “delivering outstandingand compassionateclinical services to allhospital, by attracting physiciansback to HCMC who arecurrently doing procedures atDivision of Geriatric Medicineat Hennepin County Medical Centerpopulations, especially theother sites and by being moreunderserved, provide superiorresponsive to direct referraleducation for physicians intraining, and advance medicalchannels. HCMC will opennew beds to supportFacultyknowledge through research.”The accomplishments of ourfaculty and residents in 2005are summarized below.this program. This initiativewas approved and began inJuly 2005, with Dr. Glen Varnsas the Group Leader.Assistant ProfessorsLawrence J. Kerzner, M.D.Martha L. McCusker, M.D.Roberta M. Meyers, M.D., M.P.H.Anne M. Murray, M.D., M.ScinstructorClinical ActivityEducationMaria del Pilar Hoenack-Cadavid, M.D.For the eighth straight year,HCMC was ranked amongAmerica’s best hospitals.Congratulations to HCMCDivisions of Nephrology(ranked 31), Endocrinology(ranked 36), Gastroenterology(ranked 40) and Pulmonary/Critical Care (ranked 41) whowere four of the five HCMCThe Medical Education Programexperienced a coupleof leadership transitions in2004 and 2005. In July 2004,Dr. Kevin Larsen became theAssociate Medical Directorfor the Internal MedicineResidency Program, in placeof Dr. Steven Hillson whoshifted his responsibilities.The Geriatric Medicine Division leads in teaching, clinicalcare, management, and research in a wide range of geriatricmedicine and long-term community care areas. Underscoringthe division’s commitment to excellence is the ACGME ResidencyReview Committee commendation of the HCMC GeriatricMedicine Fellowship program. Weekly Geriatric MedicineGrand Rounds, organized by Anne Murray, M.D., M.Sc, servesas a University-wide educational resource. Significant newactivities of the division and its members include:27specialties ranked in the topIn December 2004, Dr. MorrisLawrence J. Kerzner, M.D.50 in their specialty from theDavidman retired from HCMCCouncilor to the Association of Sub-Specialty ProfessorsU.S. News and World Report2005 America’s Best Hospitalranking. Ranked hospitalsare judged on reputation,risk-adjusted mortality, and aafter 29 years of service, andDr. Anne Pereira took over asResidency Program Director.We wish to thank Dr. Davidmanfor his many years ofMartha L. McCusker, M.D.Chair-Elect, HCMC Biomedical Ethics CommitteeAnne M. Murray, M.D., M.ScPresident-Elect, Hennepin Medical Societygroup of factors such as nursingand technology.As part of the hospital’sgrowth initiative, Medicinespearheaded the creation ofa Hospitalist Program. Thisnew program will streamlinethe referral, care coordination,and discharge processfor both primary care andselected specialty patientswhile hospitalized. This willdedication, enthusiasm andpassionate service to theDepartment. We hope he continuesto stay involved withthe Medical Education Programas a master teacher. Welook forward to the continuedexcellence of the Medical EducationProgram under the newleadership of Drs. Pereira andLarsen, along with continuedmedical student leadershipMajor research fundingDemonstration of improved outcomes of Adult ProtectiveService interventions towards community-dwelling, selfneglecting,vulnerable adults associated with resident andfellow physician interdisciplinary team home visits.
Affiliated Campus Reports28from Drs. Thomas Stillmanand Peter Weissmann.On an international note,a delegation of Medicinestaff, Drs. Michelle Johnson,Kevin Larsen, Pilar Hoenack-Cavadid, Valerie Ulstad andKathleen Hall, visited Indiato explore research and clinicalopportunities for futureHCMC Internal Medicine residents.In addition, Dr. RebeccaZadroga, third-year resident,chose to do an internationalelective rotation at St. John’sMedical College in Bangalore,India, and focused her studieson “Leprosy, Malaria andTyphoid.” We are excitedabout these internationalconnections and educationalopportunities for our facultyand residents.Our educational programscontinue their history ofexcellence allowing us toattract bright young physician-traineescommittedto the mission of HCMC.In 2005, our residents werevery productive and presentedposters and/or workshopsat the American College ofPhysicians (ACP) MinnesotaChapter and national annualscientific meetings, Societyof General Internal Medicine(SGIM) meeting, the Universityof Minnesota Departmentof Medicine Research Day,Society of Hospital Medicinemeeting, American HeartAssociation meeting, AmericanSociety of Tropical Medicineand Hygiene meeting,Digestive Disease Week andInternational Conference ofthe Journal of Travel Medicineand Infectious Disease meeting.Our residents’ ability toprepare for and attend thesemeetings is made possibleby grants from the AlvinL. Schultz Education andResearch Fund.Our Department is alsoengaged in the advancedtraining of many subspecialtiesof internal medicine. Inmost cases, this training is avital component of the fellowshipprograms based at theUniversity of Minnesota.In Critical Care, Geriatrics,Sleep Medicine, and Alternativeand ComplementaryMedicine, fellowship programsare centered at HCMC.ResearchOur commitment to basicand applied research remainsstrong, particularly in areasof prevention and treatmentof conditions that are overrepresentedin our patientpopulation. These areasinclude: diabetes, chronicrenal failure, cardiovasculardisease, obesity, addiction,toxicology, tuberculosis, HIVinfection, hepatitis C, sleepapnea and critical aspectsof hemodynamic and organsupport for critically ill andinjured patients. Women’shealth, international health,and geriatric issues, includingdementia, are otherimportant areas of investigation.Work is proceeding todevelop a center for urbanhealth to focus on issuesrelated to quality of care andequality of care across thepatient groups we serve.The faculty brought in$15.5 million in directrevenues from grants andcontracts in 2004. In addition,our faculty and residents publisheda total of 108 journalarticles and editorialsin 2004. (2005 data wasnot available at time ofpublication).New FacultyWe recruited ten wonderfulnew colleagues in 2005. Dr.Natarajan Raman, formerlyfrom University of Nebraska,joined the Division of Hematologyand Medical Oncologyas the new RadiationOncologist. Drs. Jeff Connaire,formerly from MinneapolisVA, Keith Eidman, formerNephrology Fellow from theUniversity of Minnesota MedicalSchool, and Ajay Israni,formerly from University ofPennsylvania, were recruitedby the Division of Nephrologyto provide clinical andresearch support. Dr. GavinBart, most recently from theRockefeller University andformer HCMC resident, joinedthe Division of Addiction Medicineas the Division Director.Dr. Meghan Walsh, formerHCMC Chief Resident, joinedthe Division of General InternalMedicine as an attendinginternist on the CardiologyService and outpatient clinician.Drs. Glen Varns and JuliaGrigoriev, former HCMC ChiefResident and resident respectively,were hired to work onthe new Hospitalist Service.Dr. Ronald Johannsen, formerlyfrom Minneapolis VA,joined Dr. Fouad Bachour ona part-time basis in interven-Our commitment to basic and appliedresearch remains strong, particularlyin areas of prevention and treatment ofconditions that are over-represented inour patient population.
tional cardiology. Dr. CrispinSemakula, most recently fromSouthside Community Clinicand a former University ofMinnesota Internal MedicineResident and EndocrinologyFellow, joined the Division ofEndocrinology, Metabolismand Diabetes to add neededcapacity in the DiabetesClinic.Other HighlightsIn 2004, a governance taskforce was formed and madespecific recommendations tothe County Board about creatinga new public benefit corporationand a new subsidiaryboard for the hospital. TheHennepin County Board gavefinal approval on December 15,2004, to a resolution askingthe Legislature to create apublic benefit corporationfor HCMC. The Legislature,Governor and County Boardapproved this on 2005, andthe change will occur in January1, 2007. HCMC will remaina public teaching hospital anda major safety net contributorbut will have a new governanceboard focused entirelyon the hospital.SummaryWe look forward to continuedservice to our communitythrough our commitment toexcellence in clinical care,education, scholarly activityand leadership.Dr. Henry (left) discusses a potential candidate for a clinical researchstudy with Dr. Ron Schut, the Director of the HIV Clinic at HCMC.Research Highlight: Keith Henry, M.D. Program include efforts to decreaseDHIV transmission (in conjunctionDr. Keith Henry’s research with the University of Southernfocuses on a wide range of California and the CDC), treatmentissues directly impacting of HIV/hepatitis C co-infectedHIV-infected persons. The persons (Dr. Kay Schwebke) and 29umbrella term “HIV ClinicalHPV/HIV co-infected personsResearch” includes far-rangingtopics such as behaviorial studies(drug adherence and prevention),bone metabolism,fat metabolism, cardiac risks,anal cancer, hepatitis C, viral straindiversity, drug resistance, andassessment of new antiretroviraldrugs and treatment strategies.The centerpiece of his translationalresearch effort is the HIV Clinicat HCMC which is the largest inthe upper Midwest (now servingover 1200 patients). An exampleof a research project completedin 2005 was a study of the viralstrain diversity among African-bornHIV+ patients spearheaded by TracySides of the Minnesota Departmentof Health and Bosola Akinsete, MD,an ID fellow from the Universityof Minnesota (JID 2005; 192:37-45). That study demonstratedthe wide HIV strain variabilitywithin Minnesota and made a strongcase for monitoring HIV subtypesin the US (also discussed in theaccompanying editorial from theCDC- JID 2005; 192: 4-9). Newinitiatives within the HCMC HIV(Dr. Mark Sannes). Researchpartners for active studiesinclude the University of MinnesotaACTU, Abbott-Northwestern,Park Nicollet, and the Mayo Clinic.Due to the remarkable advancesin HIV therapeutics, Dr. Henrypredicts that geriatrics will beone of the next frontiers for HIVclinical research as life expectancycontinues to lengthen.
Affiliated Campus ReportsRegions Hospital30 Elie Gertner, M.D.The tradition of health care excellence at Regions Hospital beganProfessor and Headin 1873 with the establishment of the City and County Hospital.Internal MedicineBy 1913, the hospital was the largest in the country west of Chicago. It was renamedAncker Hospital in 1923, became St. Paul Ramsey Hospital in 1965, and RegionsHospital in 1997. Regions Hospital has one of the largest multi-specialty medicalstaffs in the region with more than 500 physicians and more than 35 specialties.It has been associated with, and dedicated to, medical education for more thana century.EducationThe wide range of academic activities at the institution and outpatient clinicsare directed by Elie Gertner, M.D. In the University of Minnesota training program,Dr. Kelly Frisch, M.D. coordinates post-graduate resident activities at the hospitaland outpatient ambulatory care rotations for all the post-graduate medicaltrainees. Thomas Yacovella, M.D. is the Clinical Clerkship Coordinator.Thom Dahle, M.D. and Chris Bowron, M.D. serve as chief residents in Medicineand provide leadership and stability to the house staff program.
ClinicalOur outpatient services havebeen expanding rapidly. Wehave seen continued markedgrowth in numerous subspecialties,including Rheumatology,Infectious Diseases, andPulmonary, as well as generalInternal Medicine and ourGeriatrics services. As a result,this year we opened a 130,000square foot Specialty Centerapproximately one mile fromRegions Hospital to housenumerous Internal Medicinesubspecialties, as well as a fulllaboratory; pharmacy; imagingcenter with CT, MRI, andPET scan facilities; physicaltherapy; and chemotherapyinfusion rooms, among otherservices. A second specialtycenter with 125,000 squarefeet is scheduled to open in2007, across the street fromthe first speciality center, tofurther accommodate ourpatients. Given the proximityto Regions Hospital, physicianscan easily transitionfrom one practice point to thenext, as we focus on people,their health care, and stewardshipof resources. These outpatientclinics will supplementour cardiovascular, gastrointestinal,and cancer centers,which remain located on theRegions campus.Our inpatient wards, staffedboth by general internists, aswell as hospitalists from ournationally recognized hospitalistprogram, have bothteaching and non-teachingservices. The hospitalist componentnumbers greater than20 individuals, with manyformer chief residents inour program.Formal teaching rounds areheld four times weekly. Dailynoon conferences, weeklygrand rounds, pathology conferences,code review conferences,and inter-departmentalconferences supplement thebedside teaching.ResearchPhysicians at Regions Hospitaland members of Health-Partners continue to be veryinvolved in internationallyrecognized basic, clinical,as well as health servicesoutcomes research. A fewexamples:Thomas Kottke, M.D. (Cardiology)has developed a webbaseddecision support toolfor heart disease that will letpublic planners and policymakers identify opportunitiesto significantly improveoutcomes by improving careprocesses. A version of thisdecision support tool is beingdeveloped for individuals sothat they can compare therelative impact of risk factorcontrol to interventions thatmight need to be appliedlater in the disease process.These tools have attractedworld-wide attention andIn the spotlight: Michael H. Kim, M.D.Prior to joining the Regions faculty last year, MichaelH. Kim, M.D. was the Director of the ElectrophysiologyLaboratory at Rush University Medical Center inChicago, Illinois. He has also been the Director of the Pacemakerand Defibrillator Program at Evanston (Northwestern University) andat Barnes (Washington University). Dr. Kim brings special expertise inelectrophysiology, for example, in advanced ablation techniques suchas curative atrial fibrillation ablation, as well as implantable devicebasedtherapies. He is very active in academic pursuits. In his firstyear at Regions, Dr. Kim published 13 abstracts and papers on topicssuch as cardiac pacing, atrial fibrillation management, biventricularpacing therapies, and defibrillator technologies. He is the author orco-author of 100 papers and abstracts in medical journals. Dr. Kimis also establishing a research program in electrophysiology atRegions Hospital.31
Affiliated Campus Reports32In the spotlight: jagdeep bijwadia, M.D.Jagdeep Bijwadia, M.D. joined our staff in late 2004 ascountries such as Lithuaniaand Slovenia are using themas they reform their healthcare system.Michael Kim, M.D. (Cardiology)has published 13 papers andabstracts in 2005 in the fieldof electrophysiology, particularlyin pacing and defibrillatortechnologies.Daniel Anderson, M.D., M.P.H.(Hematology/Oncology) isinvestigating if statin drugshelp prevent recurrence ofsurgically resected breast andcolon cancer.Charlene McEvoy, M.D. (Pulmonary)has numerous ongoingstudies on smoking cessation,COPD, and asthma.the Twin Cities, includingpartnerships with NorthMemorial Medical Center,Abbott Northwestern Hospital,and St. Mary’s Schoolof Anesthesia. One of theprograms that the Center isfocusing on includes the effectivetraining of rapid responseteams, in response to theIHI national 100,000 LivesCampaign challenge. A secondfocus program is our L.E.A.D.program in which medicalresidents are taught leadershipskills, particularly inemergency situations – a skillthat is not formally taughtelsewhere in our training program.(See section on GeneralInternal Medicine).Director of the Sleep Health Center and a staff memberof the Section of Pulmonary and Critical Care Medicine.He is a diplomate of the American Board of Internal Medicine and theAmerican Board of Sleep Medicine, and a fellow of the AmericanCollege of Chest Physicians. Prior to joining our group, he was in theMayo Health System and directed the Sleep Center at Luther MidelfortClinic in Eau Claire, Wisconsin.In the past year, our Sleep Center was accredited by the AmericanAcademy of Sleep Medicine, in great part due to Dr. Bijwadia’s efforts.He developed a rotation in sleep medicine for the Internal Medicineresidents in our training program. He was also recruited to co-directthe University of Minnesota Sleep Center at the Fairview campus andnow spends two days a week in the Cardiovascular Clinic providingconsultative services for patients with sleep disorders. Dr. Bijwadia hasjust been awarded a grant (together with Dr. Gertner) to study effectsof sleep deprivation on working memory capacity in InternalMedicine residents.Simulation Center forPatient SafetyThe Simulation Center forPatient Safety, an initiativebetween the HealthPartnersInstitute for Medical Educationand Metropolitan StateUniversity, continues to grow.It has received numerousgrants this year, includinggrants from the EdwardsMemorial Trust, St. Paul Foundation,F. R. Bigelow Foundation,Minnesota Job SkillsPartnership, and the RobertWoods Johnson Foundation.It has expanded remarkablywith utilization from acrossSummaryIn summary, after more than acentury, Regions Hospital andHealthPartners continue topursue their missions of excellencein clinical care, education,and research with innovationand farsightedness. Inpartnership with the trainingprograms in Internal Medicineat the University of Minnesota,we are also working toensure that the next generationof physicians is superblytrained and able to meet thedemands of the future.
VA Medical CenterThe Medicine Service/Primary and Subspecialty Medicine ServiceLine (PSM SL) at the Minneapolis VA Medical Center continuesto pursue its tripartite mission of clinical care, teaching, andresearch. Its affiliation with the University of Minnesota’s Department ofMedicine is critical for its success.The PSM SL is the single largest service at the VA Medical Center and withinthe integrated veterans’ health care network known as VISN 23 (including VAmedical centers in Minnesota, the Dakotas, Iowa, and Nebraska). The serviceincludes approximately 660 FTEs of which about 85 are full-time physicians.Other employees include nurses, clerical staff, technicians, and social workers.Top leadership of the service includes the PSM SL director/chief of medicine,the chief nurse, the assistant chief of medicine, the associate residency programdirector, and an administrative officer. Responsibilities of the PSM SL includecoordination and oversight of all aspects of ambulatory and inpatient care occurringin urgent care/ER, general medicine clinics, medical subspecialty clinics,the Women’s Clinic, and the medicine inpatient wards (including MICU). In addition,the service line is responsible for oversight of employee health, the community-basedoutpatient clinics, and the veterans’ compensation and pensionprogram. Reporting relationships within the Medical Center and VISN 23 haveresulted in a matrix organization. The PSM SL director reports to the VA MedicalKristin L. Nichol, M.D.,M.P.H., MBAChief of Medicine & DirectorPrimary and SubspecialtyMedicine Service LineMinneapolis VA MedicalCenterVice Chair and Professor ofMedicine,University of Minnesota33
Affiliated Campus Reports34Center chief of staff and CEOas well as the VISN 23 CEO forthe service line. As chief ofmedicine, the PSM SL directoralso reports to the chair of theDepartment of Medicine atthe University of Minnesota.Over the past few years,demand for clinical care at themedical center has resultedin substantial growth in thenumbers of patients. Enrollmentin primary care clinicsat the Minneapolis VA andassociated outpatient clinicshas grown from about 23,000at the end of FY 00 to nearly50,000 at the end of FY 05.Outpatient activity in medicalsubspecialty clinics continuesto grow as well, reflectingthe increase in primary carepatients. Virtually all of thisincrease in clinical activityhas been absorbed throughenhanced efficiencies andthe addition of more staff.Even while increasing clinicalactivity, the PSM SL has takenan active role in continuousimprovement activities withinthe medical center and hasan extensive performancemonitoring program in place.Measures of efficiency includeaverage cost-per-outpatientvisit in primary care, averagecost-per-inpatient stay, averagehospitalization cost perDRG, and primary care panelsizes. Minneapolis PSM SLmeets or exceeds regional ornational goals in most of theseareas. In addition, measuresof quality of care, includingthe delivery of preventivehealth care; adherence to clinicalguidelines for the care ofpatients with diabetes, heartdisease, and chronic lungdisease; and other measures,also suggest that the PSM SLproviders do an outstandingjob of providing high-qualitycare to veterans. The VA hasbeen recognized nationallyin an Institute of Medicinereport for its extensive qualityof care performance measurementinitiatives and itsextremely high marks in allquality of care domains.One of the special clinicalprograms housed in the PSMSL is the Women VeteransComprehensive Health Centerin which about 1,700 womenveterans receive primary careand 1,100 receive specialtycare. This multidisciplinaryprogram provides not onlyprimary care but also mentalhealth, gynecological, urological,and breast care. Internalmedicine residents andpsychology interns regularlysee patients in these clinics.The Women’s Clinic at theVA is also a major collaboratorwith the University ofOne of the special clinical programshoused in the PSM SL is the WomenVeterans Comprehensive Health Centerin which about 1,700 women veteransreceive primary care and 1,100 receivespecialty care.Minnesota’s Center of Excellencein women’s health.Medical education is centralto the mission of themedicine service/PSM SL.Faculty are heavily involvedin teaching medical students,residents, and fellows. CatherineNiewoehner, M.D., anendocrinologist at the VA,continues to lead the MedicalSchool’s program to develop aWeb-based educational tool,the virtual clinic, for medicalstudents. Maren Mahowald,M.D. (VAMC), a rheumatologist,is involved in a nationallyfunded project to developcomputerized teaching aidsrelated to the virtual humanproject, including virtual joint\exams and injections. TheWorkshop on Oral Presentationsand Computer Skillscontinues to evolve, as doesthe Workshop on Professionalism,both directed by VAfaculty. Stacy Mollis, M.D., ageneral internist, is developinga three-year teaching cur-riculum for resident continuityclinics, as well as a clinicalcare module for the residentsto improve the management ofnon-malignant chronic pain inthe primary care setting.Another recent innovation ineducation has included a seminarto supplement routineACLS training. This seminarprovides focused instructionin leadership skills and practicalaspects of properly resuscitatingarrested patients. In thecoming months, the VA will beimplementing an attending–sub intern inpatient teachingservice. Additional learningopportunities will includeopportunities for traineesto learn about the specificmedical problems and issuesrelating to care of militarypersonnel injured duringthe Iraq war engagements(e.g., traumatic brain injury,limb amputation, posttraumaticstress syndrome, certaininfectious diseases, etc.).
Research funding in medicineservice has increased substantiallyover the past fiveyears, with medicine serviceresearch funding representingmore than 50 percentof all research funding atthe VA. Not infrequently,students, residents, and fellowswill elect to spend sometime working with a researchmentor at the VA on one ormore research projects. TheVA is recognized not only forthe strength of its individualresearchers, but also for anumber of its interdisciplinaryresearch programs.The Center for ChronicDisease Outcomes Research(CCDOR), headed by HannaBloomfield, M.D., M.P.H. ingeneral medicine, was establishedin April 1998. It is anationally funded healthservices research unit with22 core investigators, 22 affiliateinvestigators, 18 core supportstaff, and 18 project staff.Among its areas of focus aretwo of ten nationally fundedquality enhancement researchinitiatives (QUERIs) withinthe VA—one in colorectalcancer and a newly fundedone in polytrauma. TheseQUERIs provide multi-yearOver the past few years, demand forclinical care at the medical center hasresulted in substantial growth in thenumbers of patients.funding to promote thetranslation of research intoimproved clinical care systemsand ultimately improvedclinical care.The Minneapolis Center forEpidemiological and ClinicalResearch (CECR) is a VAClinical Research Center ofExcellence headed by FrankLederle, M.D. in general medicineand established in October2004 to provide salarysupport and mentoring forfive clinical scholars who arepursuing advanced training(e.g., M.P.H.) and additionalexperience in clinicalresearch. The current scholarsinclude junior faculty fromcardiology, GI, renal, rheumatology,and psychiatry.The Hepatitis C ResourceCenter headed by Sam Ho,M.D. in GI is one of four VAbasedcenters in the UnitedStates dedicated to optimizingtreatment of veteranswith Hepatitis C. The centerscollaborate to improve screening,testing, clinical care,and education for HepatitisC patients. The MinneapolisHCRC team is developing,testing, and disseminatingbest-practices care modelsfor integrating medical,psychiatric, and addictiontreatment for patients withHCV. Clinical researchinvestigating HCV-relatedquestions, dissemination,translation of research intopractice, and patient educationissues are all potentialareas for investigation.The National Center forPatient Safety has receivedfunding from the VA CentralOffice under the direction ofAnna Schorer, M.D. (Heme-Onc) to analyze opportunitiesfor enhancing chemotherapysafety. The project hasinvolved evaluation of workprocesses, establishmentof core clinical content, anddevelopment and implementationof computer chemotherapyordering programs. Thisproject includes three VAs(Minneapolis, Cincinnati,and Iowa City).An integrated obesity treatmentprogram under thedirection of Charles Billington,M.D. (endocrine) combinesclinical treatment withbasic and clinical research inthe field of obesity. Endocrinefellows, residents, and studentsmay participate in theevaluation and treatment ofpatients with obesity includingthe center’s two-week residentialprogram, outpatientclinics, and group sessions.Research activities focus onclinical treatment and brainmechanisms for appetiteregulation.35
Affiliated Campus ReportsDennis Niewoehner, M.D. (pulmonary)is the principal investigatorfor the MinnesotaStudy Center for the NHLBI’sCOPD Clinical ResearchNetwork consisting of sevenstudy centers. Established in2003, the network’s goal is toimprove the management ofCOPD through multi-centerstudies and trials. The CoordinatingCenter for the networkis headed by John Connett,Ph.D. in the School of PublicHealth at the University ofMinnesota. Protocols are currentlyunder development andtrials will begin shortly.36education Highlight: craig Roth, m.d.The educational efforts of Craig Roth, M.D. in theGeneral Medicine Section highlight the VA’s commitmentto medical education. Roth’s educational activities haveincluded a focus on communication skills. He has developed a requiredcommunication skills seminar for interns across all of the Twin Citiesinternal medicine training programs that address “difficult” situations.To date, almost 250 interns have participated in this workshop.Roth also meets weekly with residents taking the Ambulatory Skillsrotation to provide more intensive coaching on dealing with challengingprovider-patient interactions. At a national level, he is involvedwith a project on teaching professionalism and humanism.The VA has been recognized nationallyin an Institute of Medicine report for itsextensive quality of care performancemeasurement initiatives and its extremelyhigh marks in all quality of care domains.
Divisions, Department of Medicine
Division of Cardiologynationally recognizedAccording to the American Heart Association, cardiovasculardisease accounts for more than one million deaths in the United38 Leslie W. Miller, M.D.Division Directorwww.dom.umn.edu/cardiologyStates each year, and enormously impacts patients and familiesand the health care system. The Cardiovascular Division at the Universityof Minnesota has substantial depth and expertise in all the major cardiovasculardiseases including coronary artery disease, heart failure, valvular heart disease,cardiac arrhythmia, as well as both primary and secondary heart disease prevention.Many of the division faculty are nationally recognized leaders in their fieldsand chair numerous scientific sessions at national meetings, give invited plenarytalks, and serve on editorial boards for all of the prominent journals in the fieldof cardiovascular medicine.The Hennepin County Medical Center and the VA Medical Center are importantcomponents of the cardiovascular program. Each full-time faculty member at thesefacilities has a primary appointment in the Department of Medicine at the Universityof Minnesota. Cardiology fellows rotate to these facilities on a regular basisand conferences that include faculty from all three sites are held monthly. Mostfaculty members at these sites are engaged in basic or clinical research, and severalfaculty have NIH-level funding for their research.The Lillehei Heart Institute has been created from a very generous gift from thefamily of C. Walton Lillehei, M.D., who played a pivotal role in the birth of cardiovascularsurgery here at the University 50 years ago. The Institute has a focuson education and research including heart failure, transplantation, and use ofmechanical assist devices, including the molecular basis of cardiac remodeling andthe role of stem cells in cardiac repair. One of the new areas of clinical research isheart disease prevention. Jay Cohn, M.D. has created the Rasmussen Heart DiseasePrevention Center. This program is providing non-invasive, cutting-edge assessmentof the risk of cardiovascular disease and is diagnosing cardiovascular disease
in its earliest stages, beforeconventional tests are positiveor symptoms are present.Additionally, blood samplesare collected for geneticscreening that may identifyindividuals at risk for atherosclerosis.This will leadto earlier intervention andreduction of complicationsover time.Educational ProgramsThe cardiology fellowship program,headed by Leslie Miller,M.D, is one of the most highlyregarded and competitivecardiology fellowship trainingprograms in the country. Fellowsrotate through the fourtraining sites including Universityof Minnesota MedicalCenter, HCMC, the VA MedicalCenter, and Abbott NorthwesternHospital, to gain exposureto different types of patientcare delivery systems anddiverse patient populations.All types of advanced trainingin subspecialty areas, suchas interventional catheterization,electrophysiology, heartfailure, and vascular diseaseand prevention are alsooffered within the program.In addition, medical studentsand residents from the Universityof Minnesota, as wellas from around the country,rotate on the inpatient andconsult services, helping tocare for patients with cardiovasculardisease.The fellowship programincludes approximately eighthours per week of conferencesdirected specifically for thefellows, including didacticlectures on core topics in cardiology,interactive sessionson topics such as EKG interpretation,as well as a seminarformat for review of researchin progress. Fellows may alsoelect to pursue the master’s inpublic health in clinical trialdesign and execution duringtheir third or fourth year,as well as clinical or basicresearch in one of the numerouslabs within the cardiovasculardivision or the LilleheiHeart Institute.Research ProgramsResearch in the CardiovascularDivision has been focusedon both clinical and basic scienceareas of cardiovasculardisease. Basic research isconducted by Jay Zhang, M.D.,Robert Bache, M.D., DorisTaylor, M.D., Yuqing Huo,M.D., Jennifer Hall, M.D.,and Yingjie Chen, M.D..The Cardiovascular Divisionis heavily involved in clinicaland translational research.The new Lillehei Clinical TrialCenter opened in June 2003and includes nine patientexam rooms, areas for phlebotomy,a core chemistry lab,and a procedural area fornon-invasive tests, such asechocardiography, exercisetesting, and carotid ultrasound.Research coordinatorshelp staff with over 45 clinicaltrials conducted by cardiologyfaculty, including both NIHand industry-sponsored trials.Anne Taylor, M.D. was thenational PI on the importantAfrican American HeartFailure Trial (A-HEFT) whichshowed the benefit of addingHydralazine and NitratesThis year, the center will be initiatinga number of clinical trials in stemcell therapy.to heart failure therapy inAfrican Americans. Thistherapy, which adds a nitricoxide donor and an anti-oxidant,demonstrates importantgenomic differences inresponse to drugs.Center for Cardiac Repairand RecoveryThe Medical School has createda new Center for CardiacRepair and Recovery. Thedirector of this center is DorisTaylor, Ph.D. The center willFacultyProfessorsInder Anand, M.D. (VAMC)Richard Asinger, M.D. (HCMC)Robert Bache, M.D.David Benditt, M.D.Henry Blackburn, M.D., M.S. (Emeritis)Jay N. Cohn, M.D.Daniel Duprez, M.D., Ph.D.Arthur From, M.D.Steven Goldsmith, M.D. (HCMC)Richard Grimm, M.D., Ph.D. (HCMC)Charles Herzog, M.D. (HCMC)Donald Hunninghake, M.D. (Emeritis)Russell Luepker, M.D.Keith Lurie, M.D.John McBride, M.D. (Regions)Edward McFalls, M.D. (VAMC)Leslie W. Miller, M.D. (Director)Murray J. Murray, M.D.Anne Taylor, M.D.Doris Taylor, M.D.Naip Tuna, M.D.Kamil Ugurbil, Ph.D.Kyuhyun Wang, M.D. (HCMC)Yang Wang, M.D. (Emeritis)E. Kenneth Weir, M.D. (VAMC)Carl White, M.D.Robert Wilson, M.D.Jianyi Zhang, M.D., Ph.D.Associate ProfessorsAlan Bank, M.D.Y.S. Chandrashekhar, M.D. (VAMC)James Daniel, M.D. (ANW)Gladwin Das, M.D.Charles Gornick, M.D. (ANW)Timothy Henry, M.D. (ANW)Alan Hirsch, M.D. (ANW)David Homans, M.D. (PNMC)John Lessor, M.D. (ANW)James Lillehei, M.D., M.S.Michael Mooney, M.D. (ANW)Gordon Pierpont, M.D. (VAMC)Scott Sakaguchi, M.D.Valerie Ulstad, M.D. (HCMC)Dennis Zhu, M.D. (Regions)Assistant ProfessorsSelcuk Adabag, M.D. (VAMC)Adrian Almquist, M.D. (ANW)Woubeshet Ayenew, M.D. (HCMC)Fouad Bachour, M.D. (HCMC)Bradley Bart, M.D. (HCMC)Alan Berger, M.D.Andrew Boyle, M.D.Toni Bransford, M.D.Yingjie Chen, M.D., Ph.D.Monica Colvin-Adams, M.D.Kevin Graham, M.D. (ANW)(Continued on page 41)39
Division of Cardiology40AResearch Highlight: Alan Berger, M.D.Alan Berger, M.D. has recently been awarded a KO8 awardby the NIH for his research on outcomes with AcuteMyocardial Infarction (MI) in the elderly. Berger is a graduateof Georgetown and Yale, and he has a joint appointment in the Schoolof Public Health, Department of Epidemiology. His primary mentor isRussell Luepker, M.D., M.S. His research interests include use of the largeMinnesota Heart Study to examine trends in outcomes with Acute MI inMinnesota. He is also involved in use of intravascular ultrasound to definethe presence and extent of coronary intimal thickening and atherosclerosisin patients with coronary artery disease, including patients who haveundergone heart transplantation. He lectures internationally on thesetopics. In addition, he will be involved with the interpretation of the new64-slice CT scanner, which will become an important method to screenpatients with chest pain or high risk of coronary disease.focus on the use of cell-basedtherapy, including differenttypes of stem cells (bonemarrow-derived as well asskeletal muscle) for cardiacand vascular repair. Thecenter will also be involved inthe development of gene therapywith the cells as the vectorfor gene delivery that mayallow substantial improvementin cardiovascular repairover cells alone.This year, the center willbe initiating a number ofclinical trials in stem celltherapy. The first will be withthe use of autologous bonemarrow mononuclear cells forpatients with acute MI, followedby trials with skeletalmyoblasts and pro-angiogenicendothelial progenitor cellsin patients with heart failurethat undergo elective cardiacsurgery, including insertion ofmechanical assist devices forrefractory heart failure. Use ofcell therapy in patients on theheart transplant list will allowexamination of the heart atexplant to determine percentengraftment and effects ofcell therapy.The center is also investigatinga novel Beta-2 AR agonist,Clenbuterol that induces skeletalmuscle hypertrophy andmay have a direct role in stemcell mobilization in patients
with heart failure and otherforms of vascular disease.Dr. Miller will be leading aninternational trial of thisagent in patients with nonischemicetiology of theirheart failure who are on aheart transplant waiting listand require a ventricularassist device to be placed forrefractory heart failure. Theend point of the trial will bethe ability to show sufficientventricular remodeling andrecovery to have the deviceremoved and not requiretransplantation. The Universitywill also be the coordinatingcenter for a national trialwith this novel drug for inducingventricular remodelingand recovery. The drug hasshown preliminary evidenceof possibly promoting stemcell mobilization as part of itsmechanism of action, whichwill be defined by this trial.Women’s CardiovascularHealth ProgramCardiovascular (CV) diseaseremains the leading causeof death in women, accountingfor more than eighttimes the rate of death due tobreast cancer. Women havean increased risk of deathwith cardiovascular diseasecompared to men, and to datehave been disproportionatelyless enrolled in clinical trials.Anne Taylor, M.D. led a multidisciplinaryeffort that successfullycompeted for anNIH grant to become one ofonly a few designated nationalCenters of Excellence in Women’sHealth. In addition,NIH awarded Dr. Taylor andSoma Sen, M.D. a separategrant to specifically studywomen’s CV disease. Thiscenter, which is housed inthe CV Clinic, includes fivehealth care providers, includingfour female faculty andone female nurse practitioner,making it the largest andmost complete program of itstype in the Midwest. It offersCV disease prevention screeningin conjunction with theRasmussen Prevention Centerand employs the latest in noninvasivetesting for cardiovascularrisk.New Joint Adult-PediatricHyperlipidemia ClinicDaniel Duprez, M.D. hasjoined Julia Steinberger, M.D.,M.S. of the Pediatric CardiologyDivision to initiate aclinic in which the children ofpatients with significant andpremature hyperlipidemia canhave their children tested andtreated by an expert pediatrician.This is one of the firstsuch clinics in the countryand already has over 200 familiesbeing followed by thesephysicians. These effortsreflect the intense focus onheart disease prevention nowtaking place at the University.Xinquiang Han, M.D., M.S.,Ph.D. joined the faculty ofthe Cardiovascular Divisionin July 2005, after finishinghis general cardiology andelectrophysiology training atthe University of Minnesota.Han has a Ph.D. degree andis an outstanding molecularbiologist, having spent fouryears at the Brigham Hospitalworking in this area. He willbecome the new Director ofMolecular Research for theEP program, and he will workwith Doris Taylor, Ph.D.. in theCenter for Cardiac Repair toinvestigate the mechanismsinvolved in the potential proarrhythmiceffects of stem celltransplantation. The LilleheiHeart Institute awarded Hana Lillehei Scholars Award forthis research.Marco Guerrero, M.D. hasbeen a member of the CardiovascularDivision facultyfor the past four years, butwill begin a 0.4 FTE appointmentin the Division at theUniversity hospital beginningin January 2006. His activitywill be entirely in the sectionof electrophysiology and willinclude both diagnostic proceduresfor arrhythmias, as wellas arrhythmia ablation anddevice implantation.Faculty(Continued from page 39)Assistant ProfessorsMarco Guerrero, M.D. (HCMC)Jennifer Hall, Ph.D.Xinqiang Han, M.D.Kevin Harris, M.D. (ANW)Yuqing Huo, M.D., Ph.D.David Hurrell, M.D. (ANW)Antoine Khoury, M.D. (Regions)Thomas Knicklebine, M.D. (ANW)Jian-Ming Li, M.D. (VAMC)Vuy Li, M.D. (VAMC)Linda Long, M.D. (Regions)Fei Lu, M.D., Ph.D.K.P. Madhu, M.D.Richard Madlon-Kay, M.D. (VAMC)Mackenzi Mbai, M.D. (VAMC)Emil Missov, M.D., Ph.D.James Morrison, M.D. (Regions)Mohammed Murad, M.D. (VAMC)Carmelo Panetta, M.D.Marc Pritzker, M.D. (ANW)Mohammad Rizvi, M.D. (Regions)Thomas Russell, M.D. (Regions)Soma Sen, M.D.Wendy Shear, M.D. (VAMC)Shailesh Shetty, M.D. (Regions)Ronald Sih, M.D.Richard Taylor, M.D. (HCMC)Venkatakrishna Tholakanahalli, M.D.(VAMC)Cynthia Toher, M.D. (PNMC)Jay Traverse, M.D. (ANW)Robert Van Tassel, M.D. (ANW)Anthony Varghese, Ph.D. (VAMC)Ping Zhang, M.D.Faculty Honors andAwards for 2005Cardiology Fellows2005 Distinguished Teacher AwardLeslie W. Miller, M.D. (UMMC)Ed McFalls, M.D. (VAMC)Fouad Bachour, M.D. (HCMC)Casey Lawler, M.D. (ANW)Cynthia Toher, M.D. (MethodistHospital)Jay Cohn, M.D.Distinguished Scientist Award(clinical domain) (2005)American College of CardiologyNaip Tuna, M.D.The Yang Wang Lifetime EducatorAward (2005) University of MinnesotaDivision of Cardiovascular MedicineHarold S Diehl Award (2004)University of MinnesotaMedical Alumni Society41
Division of Endocrinology and DiabetesThe other major focus of the division’s teaching activity is the fellowship program.The division is funded by the NIH to operate a research program in endocrinologyand metabolism for the training of academic physicians and scientists. Basicscience research training occurs under the direction of Dr. Mariash in a state-ofthe-artlaboratory in the newly constructed Microbiology and Cellular Biologybuilding. Research collaboration efforts are ongoing with members of the Departmentof Biochemistry and research efforts are also carried out at the VA MedicalCenter and at HCMC.The endocrinology faculty at University of Minnesota Medical Center, Fairview,HCMC, and at the VA Medical Center supervise the daily clinical activities offellows during their inpatient, outpatient, and research experiences. Each hosapassion for researchUnder the leadership of Director Cary N. Mariash, M.D. since 1999,the Division of Endocrinology and Diabetes has increased its42 Cary N. Mariash, M.D.Division Directorwww.dom.umn.edu/endofaculty with interests in diabetes mellitus and thyroid disease.Clinical activity continues to increase while faculty members manage all forms ofendocrine diseases. Other vital divisional activities include teaching students andresidents; providing educational seminars and CME programs; training endocrinologyfellows, and establishing research programs while developing new ones.Educational ProgramsThe Endocrinology and Diabetes Division maintains an active teaching programat both the undergraduate and graduate levels. Catherine Niewoehner, M.D.directs the year-two medical school pathophysiology course in endocrinology.Under her leadership, the course has achieved high ratings by the medicalstudents. In addition, she has edited a textbook for this course that is usedat the University of Minnesota and at other institutions.
pital is highly individual inits patient mix and areasof expertise. Special effortsare made to include activitiesrelating to pediatric andreproductive endocrinology.The training program utilizesthe University’s General ClinicalResearch Center (GCRC)for its clinical research.The GCRC has been fundedby the NIH for more than35 years. The CRC activelysupports studies of recipientsof pancreas and islet transplantation,metabolic effectsof dietary carbohydrates,and immunogenetics ofdiabetic families.Other Teaching Activitiesn A teaching conference inbasic clinical endocrinologyfor medical students, housestaff, and first-year fellowsn Divisional grand rounds andbers of the division participatein multiple NIH fundedmulti-center trials, many ofwhich are located at the Universityof Minnesota. Someexamples include the LookAHEAD trial, the ACCORDtrial, the EDIC trial, and theBARI 2D trial. In addition, thedivision director participatesas a core director in the MinnesotaObesity Center, whichis under the co-direction ofDr. Billington, a member ofthe Division of Endocrinology.Some of the basic scienceresearch programs includeinvestigation into the regulationof fatty acid synthesisby novel proteins; the role ofthyroid hormone in the regulationof brain development;the identification of brainpathways responsible fornormal and abnormal feedingbehavior; lipoprotein polymorphismsand cardiovasculardisease; immunobiology ofislet transplantation; and pancreaticislet precursors fromembryonic stem cells. Clinicallybased research studiesinclude the regulation of glucosetransport into the brainin diabetes; the role of obesityin the development of diabeticassociated renal disease; therole of diet in the regulationof blood sugar levels; the roleof renin-angiotensin systemin diabetic complications; andthe regulation of blood lipidsby oral hypoglycemic agents.FacultyProfessorsJohn Bantle, M.D.Jose Barbosa, M.D. (Emeritus)Charles Billington, M.D. (VAMC)Frederick Goetz, M.D.Angeliki Georgopoulos, M.D. (VAMC)John MacIndoe, II, M.D. (Regions)Cary Mariash, M.D. (Director)Catherine Niewoehner, M.D. (VAMC)Frank Nuttall, M.D., Ph.D. (VAMC)Jack Oppenheimer, M.D. (Emeritus)Elizabeth Seaquist, M.D.Associate ProfessorsLynn Burmeister, M.D.Mary Gannon, Ph.D. (VAMC)Alex Lange, M.D.J. Bruce Redmon, M.D.Assistant ProfessorsPuneet Arora, M.D. (Regions)Nacide Ercan-Fang, M.D. (VAMC)Meri Firpo, Ph.D.Kathleen Hall, M.D. (HCMC)Guilford Hartley, M.D. (HCMC, Adjunct)Bernhard Hering, M.D.Sidney Jones, M.D. (HCMC)Susan Raatz, Ph.D., R.D.Crispin Semakula, M.D. (HCMC)Shalamar Sibley, M.D.David Stuart, M.D. (HCMC)43research seminars given byfaculty members or guestsn Journal clubs and data conferenceswithin individuallaboratoriesn An introductory coursedesigned to teach first-yearfellows research methodologiesand technologiesResearch ActivitiesThe Endocrinology and DiabetesDivision continues to excelin its research efforts. Investigatorsat the University,HCMC, and VA Medical Centerare nationally funded. Mem-Basic science research training occursunder the direction of Dr. Mariash in astate-of-the-art laboratory in the newlyconstructed Microbiology and CellularBiology building.
Division of Endocrinology and DiabetesOver the past several years, our research group has taken a systematic,comprehensive approach to determining the effects on body function(hormonal and non-hormonal) of varying the amounts and types ofproteins, carbohydrates, and fats in the diet. We have been particularlyinterested in the dietary management of type 2 diabetes.Type II diabetes is characterized by an impaired ability to secrete insulin,even though insulin-secreting cells are still present. This results in dysfunctionalregulation of macronutrient metabolism and a rise in blood glucoseconcentration, which in turn results in the medical complications known tooccur in people with diabetes. Thus, the major goal in diabetes is to reducethe blood glucose to as close to normal as possible and to maintain theglucose at this level. Typically this is done by using drugs and/or insulininjections. One of our goals has been to develop a diet based upon soundbiological principles, which can stimulate insulin secretion and correctthe elevated blood glucose concentration in people with type 2 diabeteswithout the need for pills or insulin injections. This empowers patients tocontrol blood glucose on their own.Drs Nuttall and Gannon review research data.Research Highlight: frank Q. nuttall, M.D.DDietary fats, carbohydrates and proteins are referred toas macronutrients, in contrast to the micronutrients, i.e.vitamins and minerals. The macronutrients provide fuel for the bodyand provide building materials for growth and for replacement of worn outbody parts. They also are important for keeping the body in a high state ofhealth under differing environmental conditions. The latter is accomplishedby interacting with signaling systems that control and integrate the variousbody functions. Mechanistically, macronutrients stimulate secretionof hormones, have direct effects on regulatory pathways, or do so throughtheir digestion products in the intestines or from absorption of the digestionproducts into the blood stream. Overall, this is a very complex processthat is necessary for maintenance of life in a very uncertain world.In this regard, we have determined that dietary proteins strongly stimulateinsulin secretion and actually result in a decrease in blood glucose in shortterm studies. Some proteins are more potent than others. We also havedetermined that, in general, it is only glucose available in foods that raisesthe blood glucose.By modest changes in the diet incorporating these principles, we havedesigned diets that nearly completely correct the abnormal blood insulinand glucose values in people with type 2 diabetes within 5 weeks. Theseresults have been obtained without weight loss. Other potentially salutaryeffects of such diets have been identified. Longer term and more detailedstudies are now in progress.Confirmation of our preliminary results could significantly alter the managementof type 2 diabetes. Theoretically, dietary modification, even withoutweight loss, also could greatly delay or even prevent the appearanceof new diabetes in persons at risk for the disease.
Division of Gastroenterology, Hepatology, and Nutritionseminal contributionsThe Division of Gastroenterology, Hepatology, and Nutrition (GI)has played an important role in the Department of Medicine andthe Medical School for more than twenty-five years. The divisionhas made seminal contributions to the fields of Hepatology and Gastroenterology,including being arguably the birthplace of ERCP, and generating importantknowledge in our understanding of liver metabolism. More recently, members ofthe division have contributed to the understanding of the role of biliary endoscopyand endoscopic ultrasound in managing a number of clinical conditions, and havehelped develop the concept of gene repair as a potential therapy.In addition to the faculty members at the University campus, there are also facultymembers who participate in GI division education and research activities at theVA Hospital, HCMC, Abbott Northwestern Hospital, and Regions Hospital.The division currently boasts an extensive clinical service program, educationalprogram, and active clinical and basic science research activities. We have addedseveral new members to our faculty at all sites and we will continue to grow overthe next several years, both in terms of attracting new clinical scholars, as wellas basic research faculty.John Lake, M.D.Division Directorwww.dom.umn.edu/gi45Educational ProgramsHouse Staff and Student ProgramsThe division participates in all house-staff training programs and student educationprograms. The second-year GUT course is consistently highly rated. Not restingon our laurels, we are currently proceeding with a two-year revision of all of thedivisional educational programs.
Division of Gastroenterology, Hepatology, and Nutrition46FacultyProfessorsJohn Bond, M.D. (VAMC)William Duane, M.D. (VAMC)Martin Freeman, M.D. (HCMC)Roger Gebhard, M.D. (Regions)John Lake, M.D. (U of M)Michael Levitt, M.D. (VAMC)Douglas Nelson, M.D. (VAMC)Coleman Smith, M.D. (Adjunct ANW)Clifford Steer, M.D. (U of M)Jack Vennes, M.D. (U of M Emeritus)associate ProfessorsJeff Albrecht, M.D. (HCMC)Oliver Cass, M.D. (HCMC)Robert Ganz, M.D. (ANW)Samuel Ho, M.D. (VAMC)J. Shawn Mallery, M.D. (HCMC)Ronald Soltis, M.D. (U of M)Assistant ProfessorsBashar Aqel, M.D. (VAMC and U of M)Alexander Khoruts, M.D. (U of M)Mohamed Hassan, M.D. (U of M)Irshad Jafri, M.D. (Regions)Betsy Kren, Ph.D. (U of M)Rebecca Lai, M.D. (HCMC)Rob McCabe, M.D. (Adjunct ANW)Stephen McSorley, Ph.D. (U of M)Peter Meier, M.D. (VAMC)Craig Peine, M.D. (HCMC)David Perdue, M.D. (U of M)Paola Ricci, M.D. (Regions)Mandeep Sawhney, M.D. (VAMC)Christopher Shepela, M.D. (U of M)instructorDavid Weinberg (Adjunct ANW)Faculty Honors andAwards for 2005Martin Freeman, M.D.Editorial BoardsGastrointestinal EndoscopyReviews in Gastrointestinal DisordersRobert Ganz, M.D.Elected Councilor – Governing Boardof American Society of GastrointestinalEndoscopyRoger Gebhard, M.D.Physician of the Year -Minnesota-Dakota’s chapter ofthe Crohn’s and Colitis Associationof America(May 2005)Douglas Nelson, M.D.Distinguished Service Award,American Society for GastrointestinalEndoscopy, May 15, 2005Who’s Who in America 2006Editorial BoardsGastrointestinal Endoscopy2004-2006World Journal of Gastroenterology2004-2006GI Training ProgramThe University of Minnesotagastroenterology subspecialtytraining program (fellowshipprogram) is fully ACGMEaccredited through the nextfive years. The current programdirector is Roger L.Gebhard, M.D. The three-yeargastroenterology programconsists of five training sites(FUMC, VA Medical Center,HCMC, Regions Hospital,and Abbott-NorthwesternHospital), 30 faculty members,and a current complementof ten trainees. We also currentlyoffer a fourth-year ofadvanced endoscopic trainingin either ERCP or endoscopicultrasound. The programoffers excellent training in allaspects of gastroenterology,including standardGI procedures, biliary endoscopy,inflammatory boweldisease care, viral hepatitis,liver transplantation, andesophageal motility.The gastroenterology trainingprogram has been highlysuccessful and extremelycompetitive, with more than200 applicants for our traineepositions each year. The qualityof applicants is excellent,with candidates applying fromoutstanding teaching centersthroughout the United States.Our fellows have expresseda high level of satisfactionwith the training program.The graduates are in strongdemand, as faculty recognizethem as possessing superbclinical and endoscopic skillsupon completion of our program.All trainees undertakeresearch projects during theirsecond year of training, andevery trainee who has graduatedfrom the program in thepast 10 years has published orpresented a paper, abstract, ormade an oral presentation atone of the national GI or Livermeetings. The trainees whocomplete our program andtake ABIM boards havepassed with excellent scores.About half of our graduatesbecome academic facultymembers here or at otherinstitutions. We recognizethe current extraordinaryshortage of gastroenterologistslocally and nationally,and are proud of our programand its important missionto provide outstandinggraduates to meet currentdemands both in practiceand in academia.
From Left to Right: John R.Lake, MD, Professor of Medicine,Department of Medicine, WilliamD. Payne, MD, Professor of Surgery,Department of Surgery, Abinav(Abhi) Humar, MD, AssociateProfessor of Surgery, Departmentof SurgeryResearch Highlight: the liver transplant program at the university of minnesotaTThe Liver Transplantation Program at the University ofMinnesota has grown dramatically over the past eightyears, in terms of both clinical activity and academicproductivity. The program, which is led by John Lake, M.D, WilliamPayne, M.D, and Abhi Humar, M.D, has contributed seminal research tothe field of transplantation, which has had a major impact on transplantationof both children and adults. The research is focused on three mainareas: new sources of donor organs, new approaches to the managementof viral hepatitis in liver transplant recipients, and splitting of one liverto serve two recipients.First, while splitting of livers for two recipients has been used successfullyto serve one adult and one pediatric recipient, the real need is to be ableto develop ways to provide adequate liver to transplant to two adults. TheUniversity of Minnesota Liver Transplantation Program, and a study led byHumar, demonstrated that this can be done with good results. The majorfindings of this study were that both donor and recipient selections wereimportant, particularly recipient selection for the relatively smaller leftlobe liver graft. The University of Minnesota is now one of the most experiencedcenters for splitting livers for two adults.Second, in the early days of liver transplantation, the outlook for patientstransplanted for hepatitis B was poor, as recurrence of the infection wasalmost universal and half or more of the patients developed very aggressiveliver disease that led to death within a matter of several months.The uses of high doses of antibodies directed against the hepatitis B virusled to a marked improvement in the overall prognosis for patients transplantedfor hepatitis B and prevented re-infection of the new liver in themajority of patients. The problems with hepatitis B antibody preparationincluded extremely high-cost, significant side effects in the probabilitythat life-long administration of antibodies would be necessary.Over the past ten years, several new antivirals have been developed whichare affective against hepatitis B virus. The University of Minnesota LiverTransplantation Program has recently demonstrated that using combinationsof antiviral medication can obviate the need for high doses of antibodiesagainst the hepatitis B virus, thereby leading to much improved patientsatisfaction and substantially lower cost. It is anticipated that, in the nearfuture, this will become the standard method for preventing re-infectionof the transplanted livers with hepatitis B virus.Finally, the University of Minnesota, in general, has been a pioneer in theuse of live donors for all types of solid organ transplants including kidney,intestine, lung, as well as liver. The University of Minnesota Liver TransplantationProgram has contributed important knowledge of live donor livertransplantation in several ways. Perhaps the most significant has been inthe area of the use of live donors for transplantation for patients with hepatitisC. The University of Minnesota has published the best results obtainedto date regarding transplantation using live donors for patients with hepatitisC. The program has demonstrated that these patients have excellentsurvival and, most importantly, have significantly less severe recurrenceof hepatitis C. Like hepatitis B in the older days, the hepatitis C virus reinfectedthe new livers in almost 100 percent of cases.The significance of the University of Minnesota study is that if one canavoid post transplant complications and poor graft function, than onecan get excellent results using live donors for transplanting patients withhepatitis C. In fact, results using live donors for liver transplantation bythe University of Minnesota Liver Transplantation Program are among thevery best in the United States. The Liver Transplantation Program willcontinue its research in developing new and improved ways of providingliver transplantation to the many desperate people with both acute andchronic end-stage liver disease.47
Division of General Internal Medicinea passion for excellenceThe Divisions of General Internal Medicine at Abbott Northwestern,Hennepin County Medical Center, Regions Hospital, University ofMinnesota Medical Center, and the Minneapolis VA Medical Center48Wesley Miller, M.D.Division Directorwww.dom.umn.edu/gimhave developed an outstanding cohort of clinicians, educators,and investigators. The divisions share a passion for teaching students andresidents and for the delivery of evidence-based care. Each division has contributedin a major way to educational initiatives and has contributed significantly to theregional and national dialogue in teaching and research.Educational ProgramsDuring 2005, significant new educational activities and positions by generalinternal medicine faculty have included:Abbott Northwestern (ANW) SiteInternal Medicine Program Director: Robert Miner, M.D.Clerkship site coordinator: Laurel Drevelow, M.D.ANW continues to be successful in resident, fellow, and medical student educationin Internal Medicine. The hospital expanded support for the University fellowshipsin Cardiology and Gastroenterology during the past year. It was an important educationaladvance during the last year to make all of our residency conference presentationsavailable online as part of our Web site. Our hand-held computer projectusing Pocket PC technology for information access continues to advance and bevery important for patient care and learning.Hennepin County Medical Center (HCMC) SiteThe general medicine division has continued its excellent tradition of outstandingcare for patients and education of students and residents. This year, a hospitalistservice was initiated at HCMC led by former Chief Resident, Glen Varns, M.D.
FacultyProfessorsHanna E. Bloomfield, M.D.Division Director, VAMCThe division faculty havedeveloped outstanding educationalleadership roles,including:n Internal medicine programdirector: Anne Pereira, M.P.H.n Transitional residencyprogram director: PeterWeissmann,M.D.n Governor, Minnesota AmericanCollege of Physicians:David Williams, M.D.n General medicine inpatientservice director (HCMC):Heidi Coplin, M.D.n Chair, SGIM CME committee:Steve Hillson, M.D.Regions Hospital SiteOur General Internal Medicinedepartment has introduceda major education/research innovation this year.They have developed a newprogram to teach residentsSystem-Based Practice, oneof the ACGME core competencies.Paula Skarda, M.D. andKelly Frisch, M.D. first piloted,and then introduced, residentdrivenquality improvementprojects to guide residents inunderstanding the process ofquality improvement. GroupsTerry Rosborough, m.d.Director of Medical Education, ANWof residents rotating togetheron the three-month ambulatoryrotation are given thetime and oversight to reviewareas within the residencythat may need improvement,then develop programs andimplement these processesin the residency program.The first few projects havebeen outstanding, with majorinnovations resulting incurriculum and patient care.We are also developing aprogram to develop leadershipskills in our residents(L.E.A.D. = Leadership Educationand Development). In thefirst project, our residents areworking with code teams inmock code training sessionsat our Simulation Center toimprove leadership skills andto learn how to efficientlyand effectively oversee teams(over and above the actualresuscitation procedure).Three special programs led bygeneral medicine faculty fromRegions Hospital deservespecific recognition: MichaelSpilane, M.D. has successfullycraig garrett, m.d.Division Director, HCMCachieved ongoing accreditationand initiation of a fellowshipin Geriatric Medicine,admitting the first class oftrainees this year. BurkeKealy, M.D. leads the HospitalistFellowship at Regions,training physicians to deliveroutstanding and cost effectivecare and education inthe inpatient setting. Finally,Patricia Walker, M.D. is theAssociate Program Directorfor the Global Health Pathwayin the University of MinnesotaInternal Medicine ResidencyProgram and has establishedan outstanding program andrecent accreditation by theAmerican Society of TropicalMedicine and Hygiene fortrainees to qualify for a certificatein Tropical Medicine.University of MinnesotaMedical Center (UMMC) SiteThe UMMC site generalmedicine faculty have beendedicated to and have becomeleaders in the educationalactivities of the department,Medical School, and AcademicHealth Center. The facultyhave focused on all aspectsRichard Adair, MD (ANW)Jasjit S. Ahluwalia, M.D., M.P.H., MS.Hanna Bloomfield, MD, MPH (VAMC)Ronald Ellis, MD (Regions)Kristine Ensrud, MD, MPH (VAMC)Robert Howe, MD, FACPKjeld Husebye, MD, MS (Emeritus)Anne Joseph, MD, MPH (VAMC)Jeff Kahn, PhD, MPHFrank Lederle, MD (VAMC)Steven Miles, MDWesley Miller, MD (Director)Charles Moldow, MDKristin Nichol, MD (VAMC)Henry Smith, MD (HCMC)Harold Wexler, MDDavid Williams, MD (HCMC)Timothy Wilt, MD (VAMC)Susan Wolf, PhDAssociate ProfessorsLaurel Drevlow, MD (ANW)Kenneth Hepburn, PhDEarl Hill, MD, MBBS (Emeritus)Steven Hillson, MD, (HCMC)Alan Johns, MD (Adjunct)Maureen Murdoch-Nelson, MD, MPH(VAMC)Robert Petzel MD (VAMC)Richard Pfohl, MD (Emeritus)Gregory Plotnikoff, MDEdward Ratner, MDWilliam Robiner, PhDCraig Roth, MD (VAMC)Connie Sias, MD (VAMC)Kathleen Watson, MDAssistant ProfessorsLarry An, MDJoseph Arcuri, MDEbi Awosika, M.D. (VAMC)Kathleen Ayaz, MD (ANW)Nina Bacaner, MDBeth Baker, MD, MPH (Regions)Amy Barger, MD (Regions)Dianne M. Bartels, RN, MA, PhDKaryn Baum, MDBradley Benson, MDPaul Bloomberg, MD (Regions)Robert Bonello, MD (VAMC)Ben Bornsztein, PhD (HCMC)Diana Burgess, PhD (VAMC)Mark Burke, MD (VAMC)Lisa Callies, MD (ANW)John Cardle, MD(HCMC)Ellen Coffey, MD (HCMC)Heidi Coplin, MD (HCMC)(Continued on page 50)49
Division of General Internal Medicine50Faculty(Continued from page 49)Assistant ProfessorsRoger Cornetto, MD (Regions)Mike Cummings, MD (ANW)John Degelau, MD (Regions)Sarah D’Heilly, MD (VAMC)Susan Diem, MD, MPHAlisa Duran, MD (Regions)Kenneth Engberg, MD (Regions)Howard Epstein, MD (Regions)Susan Ferron, MDHenry Fink, MD (Regions)Howard Fink, MD, MPH (VAMC)Franklin Fleming, MD (Regions)Heather Forrester, MD (Regions)Dean Fox, MD (ANW)Elaine Francis, MD (Regions)Kelly Frisch, MD (Regions)Steven Fu, MD (VAMC)Craig Garrett, MD (HCMC)Raymond Gensinger, MD (HCMC)Laxmana Godishala, MBBS (HCMC)Richard Granger, MD (HCMC)David Griffin, MD (VAMC)Joan Griffin, PhD (VAMC)Frank Grund, MD (VAMC)Leslie Hahn, MD (Regions)Bruce Hanson, MD (VAMC)James Hart, MD (Regions)Rick Hilger, MD (Regions)Russell Holman, MD (Regions)Jeremy Holtzman, MD (HCMC)Joan Ireland, MD (Regions)Bruce Johnson, MD (Regions)Paul Johnson, MD (HCMC)Michael Kamp, MD (Regions)Burke Kealey, MD (Regions)Keiko Kimura, MD (Regions)Floyd Knight, MD (Regions)Laura Kochevar, PhD (VAMC)Kris Kopski, MD, PhDWilliam Korchik, MD (VAMC)Kevin Larsen, MD (HCMC)Gregory Lucas-Silvis, MD (HCMC)Terrence Maag, MD (Regions)David Macomber, MDSanne Magnan, MD, PhD (Regions)Mobin Malik, MD (HCMC)Donald Masler, MD (VAMC)M. Kathryn McCulloch, MD (HCMC)Angela Medina, MD (Regions)Tanya Melnik, MDRobert Miner, MD (ANW)(Continued on page 51)including medical student andresident and resident teaching,as well as faculty development.Specific activities/andaccomplishments include:n Resident education developmentprogram for residenciesof University of Minnesotaand Duluth Campus:Heather Thompson, M.D.n Treasurer, program directorof medicine-pediatrics:Brad Benson, M.D.n National meeting of Institutefor Healthcare Improvement(IHI) hosts: KarynBaum, M.D. and KathleenWatson, M.D.n Finalist for Award for BestResearch Paper at ClerkshipDirectors of InternalMedicine (CDIM) –James Nixon, M.D.n Teaching practice-basedlearning and improvementworkshop: Presented atAAIM by James Nixon, M.D.and Brad Benson, M.D.n National interdisciplinarycase competition (CLAR-ION): Karyn Baum, M.D.n President, MinnesotaGerontological Society:Ed Ratner, M.D.n Completion of Masters ofMedical Education,:Karyn Baum, M.D. (USC),James Nixon, M.D. (Universityof Illinois, Chicago)VA Medical Center(VAMC) Siten VA Department of MedicineJournal Club, geared towardsteaching critical assessmentof the literature to residentsand studentsn Primary care continuityclinics and women’s clinictraining for residents: Drs.Weinshenker and Mollistake on significant administrativeresponsibility for thecontinuity clinic experienceResearchAbbott NorthwesternHospitalThe core general internalmedicine faculty membersalso have a variety of researchprojects that include managementof patients with thrombosis,control of hyperglycemiain the intensivecare unit, and strategies toalter physician behavior toimprove patient care in theoutpatient setting.University of MinnesotaMedical CenterWe are proud to be joined bynew faculty member, JasjitSingh Ahluwalia, M.D., M.P.H,M.S. Dr. Ahluwalia is ExecutiveDirector of the Office ofClinical Research in the AcademicHealth Center, AssociateDean for Clinical Researchin the Medical School, andProfessor in the Departmentof Medicine. He has been anoutstanding researcher insmoking cessation and healthcare disparities, and his rolewill be to develop collaborativeinterdisciplinary researchprograms and new clinicalresearch initiatives across thesix health sciences schools atthe University of Minnesota.Dr. Ahluwalia has alreadyproven a wonderful force inmentoring faculty, creatingcollaborations, and recruitingclinical researchers to theUniversity of Minnesota.Educational scholarship hasbecome a strong focus in thedivision, with five papers presentedat the AAMC regionalCentral Group for EducationalAffairs in 2005. James Nixon,M.D. was a finalist for the bestresearch paper at this year’sClerkship Directors of InternalMedicine Meeting.Division of General Medicinefaculty member GregoryA. Plotnikoff, M.D., M.T.S.,F.A.C.P. is currently onextended leave in Tokyo and isnow a faculty member at KeioUniversity, exploring uses ofherbal medicines in Japanesemedicine. He is the principalinvestigator on a phase II
andomized, controlled trialof TU 025 Keishi Bukuryo Ganfor Menopausal Hot FlashManagement. This study isfunded by Tsumura and Company,and is conducted in theUniversity of Minnesota’sGeneral Clinical ResearchCenter (GCRC).John Song, M.D. and EdRatner, M.D. are collaboratorsin studies of end-of-lifecare decisions for homelesspatients in the Twin Cities.Susan Diem, M.D. has furtherdeveloped her fundedresearch in osteoporosis.Larry An, M.D. has continuedexcellent studies in smokingcessation and has had anumber of papers acceptedthis year, one of which (withAnne Joseph, M.D., M.P.H.)will be a featured article onthe cover of Archives ofInternal Medicine.VA Medical CenterThe research activities of theVA section of general internalmedicine take place withinthe Center for Chronic DiseaseOutcomes Research (CCDOR),a national VA health servicesresearch center of excellence,affiliated with the Universityof Minnesota Schools ofMedicine and Public Healthand directed by VictorBloomfield, Ph.D.The overarching theme of thecenter’s research is: Improvingthe Quality of ChronicDisease Care. Our primaryarea of research inquiry is:Understanding and improvingprovider, patient, and systemlevel factors and interactionsto enhance the quality of andaccess to care. The center’sresearch covers a broad rangeof content areas and employsa variety of research methodologies.Content areas includepreventive cardiology, smokingcessation, vaccine preventabledisease, cancer detectionand prevention (prostate andcolon cancer), abdominalaortic aneurysm, urologicaldisease, osteoporosis, effectsof trauma on health, patientself management, quality ofcare, effect of race/ethnicityon access to care, and systemsinterventions. Methodologiesinclude clinical trials,observational epidemiology,systematic reviews and metaanalysis,surveys, qualitativemethods, database, and economicanalyses.CCDOR currently comprises22 core investigators, 22 affili-ate investigators, 2 trainees,18 core support staff, and18 project staff. The coreinvestigators include 10 clinicallyactive physicians. Thenonphysician core investigatorsinclude two biostatisticians,one health economist,five behavioral scientists,three clinical psychologists,and one Pharmacist.During the past fiscal year,CCDOR investigators published80 papers, reports,and book chapters, includingarticles in high profile andprestigious journals suchas New England Journal ofMedicine, JAMA, MedicalCare, and Annals of InternalMedicine. Center investigatorspresented 90 abstracts,symposia, or workshops at avariety of scientific meetingsat the regional, national, andinternational level. Nationalmedia attention was directedto Lederle’s work on aneurysms(New York Times),and Wilt and Partin’s workon patient education forprostate cancer screening(Wall Street Journal).The divisions share a passion forteaching students and residents, andfor the delivery of evidence-based care.Faculty(Continued from page 50)Assistant ProfessorsKaren Moeller, MD (Regions)Stacey Mollis, MD (VAMC)Brian Neil, MD (VAMC)David Nelson, MD (VAMC)L. James Nixon, MDSiamak Noorbaloochi, PhD (VAMC)Stephanie Norris Sanchez, MDMelissa Partin, PhD (VAMC)Anne Pereira, MD, MPH (HCMC)Douglas Peterson, MD (VAMC)Paul Phillips, MD (ANW)Douglas Pryce, MD (HCMC)Steven Radosevich, MD (Regions)Hallie Richards, MD (ANW)Donna Rodel, MD (ANW)Terry Rosborough, MD (ANW)Peter Rothe, MD (Regions)Miguel Ruiz, MD (Regions)Nina Sayer, PhD (VAMC)Brian Sick, MDPaula Skarda, MD (Regions)Teresa Skiba, MD (ANW)John Song, MD, MPHMichael Spilane, MD (Regions)Norman Steinberg, MD (VAMC)Martin Stillman, MD (HCMC)Patricia Sullwold, MD (VAMC)Paul Sutter, MD (ANW)Paul Swan, MDHeather Thompson, MDTryg Velde, MD (Regions)Teresa Vrabel Sonier, M.D. (HCMC)Patricia Walker, MD (Regions)James Warren, MD (Regions)Donald Weinshenker, MD (VAMC)Peter Weissmann, MD (HCMC)Kathleen Wesa, MD (HCMC)Melissa West, MD (VAMC)Dawn Wheeler, MDBenjamin Whitten, MD (ANW)Lori Witter-Sargent, MD (ANW)Thomas Yacovella, MD (Regions)John Yozwiak, Ph.D.Zhong Zhao, MD, PhD (Regions)Debra Zimmer, MD (VAMC)instructorsMisghina Abraha, MD (VAMC)Arshad Ahsan, MD, (VAMC)Marie-Helene Almonor, MD (VAMC)Chaitanya Anand, M.D. (VAMC)Stephanie Anderson, MD (VAMC)Azber Ansar, MD (VAMC)Beth Averbeck, MD (Regions,Geriatrics)51(Continued on page 52)
Division of General Internal MedicineFaculty(Continued from page 51)52instructorsStacey Mollis, MD (VAMC)Nicholas Benson, M.D. (VAMC)Adam Bock, MD (VAMC)Louis Chen, M.D. (VAMC)Carmen Divertie, MD (HCMC)David Hilden, MD (HCMC)Douglas Hotvedt, MD (Regions)Michelle Johnson, MD (HCMC)Sander Johnson, MD (VAMC)David Klevan, MD (Regions)Robert Koch, MD (Regions)Thokozeni Lipato, M.D. (VAMC)Dale Meyer, MD (Regions)Salima Mithani, MD (VAMC)James Mohn, MD (HCMC)Jeffrey Niemasz, MD (VAMC)Andreas Ostenso, MD (VAMC)Tom Pandey, MD (VAMC)Glennon Park, MD (VAMC)Bernard Quebral, MD (Regions)Sonal Sidhwani, M.D. (VAMC)Jerome Siy, MD (Regions)Julie Topping, M.D. (HCMC)Meghan Walsh, M.D. (HCMC)Heba Wassif, MD (VAMC)Mark Wolters, MD (HCMC)lecturerJames Smith, MD (Regions)Faculty Honors andAwards for 2005Karyn Baum, M.D.Resident Teacher of the Year (UMMC)James Nixon, M.D.Outstanding Medical SchoolTeacher AwardKaryn Baum, M.D.MMF Alumni Early DistinguishedCareer AwardKristin Nichol, M.D.First recipient of the Dr. CharlesMerieux Award for Scientific Achievementfrom the National Foundationfor Infectious Diseases for her“outstanding contributions in the fightagainst infectious diseases in the publichealth arena.” Dr. Nichol also receivedthe Caregiver of the Year Award forher scholarship as author of dozensof medical journal articles on influenzaand other diseases.Timothy J. Wilt, M.D., M.P.H.Center for Chronic Disease OutcomesResearch, MinneapolisResearch Highlight: Screening andTreatment of Chronic ObstructivePulmonary DiseaseCChronic Obstructive Pulmonary Disease (COPD) is a leadingcause of death and disability. COPD is primarily caused by cigarettesmoking and has associated health care costs exceeding $15 billionannually. Much of these costs are due to widespread use of spirometrictesting to detect airflow obstruction in “at risk” individuals and use oflong-acting inhaled medications to try and improve respiratory relateddeath and disability. However, the effectiveness of these diagnostic testsand inhaled treatment options is not known.Under a contract from the Agency for Healthcare Research and Qualityto the Minnesota Evidence Based Practice Center that Wilt co-directs withRobert Kane, M.D. in the School of Public Health, Wilt and his colleaguescomprehensively evaluated published literature to determine: 1) whetherroutine testing and monitoring with spirometry to measure airflow obstructionin “at risk” patients was useful; 2) whether providing current smokerswith results of their spirometric testing improved smoking cessation;3) whether different types of inhaled therapies in patients with varyingseverity of disease proved effective.They found that: 1) Routine use of spirometry for diagnosis and monitoringasymptomatic “at risk” patients increases costs without benefit; 2) providingcurrent smokers with their spirometric test results does not improvesmoking cessation; 3) treatment with long-acting inhaled medicationsshould be targeted to individuals who have both respiratory symptomsand spirometric evidence of severe to very severe airflow obstruction;4) compared to treatment with a single long-acting inhaled medication,combination therapy with multiple long-acting inhalers resulted in highermedication costs without improving survival, COPD exacerbations, orrespiratory related quality of life.These findings are being used to develop treatment guidelines with theAmerican College of Physicians which are expected to appear, along witha background paper by Wilt, in the Annals of Internal Medicine next year.
Division of Geneticsactive collaborationsThe Division of Genetics in the Department of Medicine participatesin educational, clinical, and research activities with thebroad genetics community at the University of Minnesota thatincludes the Division of Genetics and Metabolism in the Department of Pediatrics,the Department of Genetics, Cell Biology and Genetics, and the Institute ofHuman Genetics.The division is committed to providing high quality care to patients and familieswith genetic susceptibility and disease in Genetic Clinic, Familial Oncology Clinic,Genetic Eye Clinic, and an International Pigment Clinic. Richard A. King, M.D.,Ph.D. directs the Familial Oncology Clinic for the Fairview system. Research activitiesfocus on single gene and complex genetic disorders, with active collaborationswith the Division of Pulmonary, Allergy and Critical Care in the Department ofMedicine, as well as the Departments of Surgery and Ophthalmology in the MedicalSchool, the pharmacogenomics program in the College of Pharmacy, and thePsychology Department in the College of Liberal Arts. The division is also the homefor the General Clinical Research Center Molecular Genetics Core Laboratory. Kingis the director of the division. Laboratories for the division are located in the newMolecular and Cellular Biology Building and the Institute of Human Genetics.Richard A. King, M.D., Ph.D.Division Directorwww.dom.umn.edu/genetics53Educational ProgramsThe division participates in educational activities for undergraduate students,graduate students, medical students, and residents. King is the course director forthe first year medical student Human Genetics course (GCD6110). He also directsthe graduate student Advanced Human Genetics course (GCD8073) through theDepartment of Genetics, Cell Biology and Development.William Oetting, Ph.D. teaches the undergraduate student Human Genetics course(GCD4143) through the Department of Genetics, Cell Biology and Development.
Division of Genetics54Both King and Oetting haveregularly scheduled lecturesas part of the medicine residenteducational program,as well as institutional anddepartmental seminars.ResearchOne emphasis of research inthe Division of Genetics forboth King and Oetting hasbeen the genetic regulation ofmelanin biosynthesis in themodel system of human oculocutaneousalbinism. Clinical,biochemical, and molecularstudies have provided informationfor accurate definitionand classification ofgenetic disorders of humanpigmentation. ImportantFacultyProfessorRichard A. King, M.D., Ph.D.Assistant ProfessorWilliam S. Oetting, Ph.D.Faculty Honors andAwards for 2005Richard A. King, M.D., Ph.D.Editor-in-Chief for Genetics inMedicine, the official journal of theAmerican College of Medical Genetics.William Oetting, Ph.D.Secretary/Treasurer,Human Genome Variation SocietyBoard Member, PanAmerican Societyfor Pigment Cell Research.genes involved in the synthesisand regulation of melaninsynthesis have been identified,cloned, and analyzed formutations responsible for lossof function. The molecularanalyses have led to the currentgene-based classificationof oculocutaneous albinism(in comparison to the impreciseclinical classificationbased on pigmentation patterns),and this has aided infamily counseling and planning.Current work includesgenomic studies to investigatethe role of melanin formationon the development of theretina and optic nerves.A second major area ofemphasis for the divisioninvolves gene mapping andlocalization for complexdiseases. A collaborativestudy between King, Oetting,and Malcolm Blumenthal,M.D. Division of Pulmonary,Allergy, and CriticalCare involves the mappingand identification of genesresponsible for componentsof the asthma phenotype.A major quantitative traitlocus (QTL) has been identifiedon chromosome 2 andgenetic and genomic studiesare underway to identify thegene and the associated singlegene polymorphism (SNP)in this region. A collaborativestudy between King andMarshall Hertz, M.D. Divisionof Pulmonary, Allergy, andCritical Care uses microarrayanalyses of peripheral bloodand bronchoalveolar lavagemacrophagesto identifygenes and genetic pathwaysinvolved in acute and chronicrejection. A gene expressionprofile has been identified inbronchioalveolar lavage cellsin patients undergoing acuterejection of the transplantedlung, and studies are underwayto correlate this expressionprofile with the standardbronchial biopsy approach topatient follow up.A collaborative projectbetween Dr. Oetting andArthur Matas, M.D. Departmentof Surgery, involves theanalysis of gene polymorphismsin kidney transplantoutcomes to determine ifspecific alleles in candidategenes of both recipients anddonors alter the outcome ofsolid organ transplantation.A collaborative projectbetween Oetting and HassanIbrahim, M.D. Departmentof Medicine, involves a proteomicapproach to studykidney transplant rejection.A major goal of this project isto identify biomarkers associatedwith different clinicalstates, but for predictive testingand to better understandthe biology of rejection.A collaborative study betweenKing and Russell Luepker,M.D., M.S. Epidemiology Division,School of Public Health,has identified mutations inLong QT syndrome genes inapproximately 11 percent ofindividuals who die suddenlyout-of-hospital with no obviousexplanation.Other collaborative projectsinclude a study betweenOetting and Matt McGue,Ph.D. in the Department ofPsychology in the Collegeof Liberal Arts to determinethe association of specificDNA variants with behaviorand studies with AngelaBirnbaum, Ph.D. and PamelaJacobson, Pharm.D. in theCollege of Pharmacy toprovide pharmacogeneticanalysis for anti-epilepticdrugs and immunosuppressantdrugs.The division is committed to providinghigh quality care to patients and familieswith genetic susceptibility and disease.
Division of Hematology, Oncology, and Transplantationimproving treatmentMembers of the Division of Hematology, Oncology, and Transplantation(HOT) provide care to patients with hematologic and oncologicdiseases, conduct research into the causes, improve treatment ofthese disorders, and provide training to medical students, houseofficers, fellows, and other health care professionals. PhilipMcGlave, M.D. has directed the HOT Division since 1997. Over 50 full-time facultyare based at the four HOT Division training sites, including the University ofMinnesota Medical Center (UMMC), the VA Medical Center (VAMC), HennepinCounty Medical Center (HCMC), and Regions Hospital. Cheri Ptacek, SeniorAdministrative Director, manages the administrative functions of the division.Philip B. McGlave, M.D.Division Directorwww.dom.umn.edu/hot55Educational ProgramsThe Fellowship Training Program in Hematology, Oncology, and Transplantationis directed by Linda Burns, M.D. and currently includes 15 fellows in years onethrough four of subspecialty training. The program is partially supported bya T32 Training Grant from the National Heart, Lung, and Blood Institute.Robert Hebbel, M.D. is the principal investigator of this long-standing, competitiveNIH Award. Fellowship training is conducted at VAMC, HCMC, Regions Hospital,and UMMC. Institutional representatives on the HOT Division Fellowship Committeeinclude Doug Rausch, M.D. (HCMC), Jeff Jaffe, M.D. (Regions Hospital), RobertPerri, M.D. (VAMC), as well as faculty from the University campus.HOT Division faculty members participate in training of medical students throughthe Clinical Medicine I-III courses, as well as a variety of medical school electivesincluding Fundamentals of Oncology and Medical Oncology Consultation(led by Bruce Peterson, M.D.) and the Blood Pathophysiology Course (led by GregVercellotti, M.D.). Faculty also lead clinical training efforts of medical studentsand house officers in the inpatient and outpatient setting, including regularly
Division of Hematology, Oncology, and Transplantation56FacultyProfessorsRobert P. Hebbel, M.D.Robert Howe, M.D.Harry Jacob, M.D. (Emeritus)Gerhard J. Johnson, M.D. (VAMC)Nigel Key, M.D., Ch.B., FRCPDavid Kiang, M.D. (Emeritus)Sharon Luikart, M.D. (VAMC)Philip B. McGlave, M.D.Jeffrey Miller, M.D.Bruce Peterson, M.D.Keith Skubitz, M.D.Gregory Vercellotti, M.D.Catherine Verfaillie, M.D.Daniel Weisdorf, M.D.Douglas Yee, M.D.Mimi Yu, Ph.D.Associate ProfessorsMichael Belzer, M.D. (HCMC)Linda Burns, M.D.Edward Greeno, M.D.Pankaj Gupta, MBBS (VAMC)Dale Hammerschmidt, M.D., FACPSagarika Kanjilal, Ph.D.Rudolph Keimowitz, M.D.Robert Kratzke, M.D.Carol Lange, Ph.D.Vicki Morrison, M.D. (VAMC)Robert Perri, M.D. (VAMC)Anna Schorer, M.D. (VAMC)Arne Slungaard, M.D.Assistant ProfessorsDaniel M. Anderson, M.D., M.P.H. (Regions)Mukta Arora, M.D.Aneel Ashrani, MBBSJuliet Barker, MBBS, FRACPClaudio Brunstein, M.D., Ph.D.Arkadiusz Dudek, M.D., Ph.D.Faris Farassati, Ph.D., Pharm.D.Patrick Gaffney, M.D.Jian-Guo Geng, M.D., Ph.D.Kalpna Gupta, Ph.D.Randolph Hurley, M.D. (Regions)Koho Iizuka, M.D.Jeffrry Jaffe, M.D. (Regions)Balkrishna Jahagirdar, MBBS (VAMC)Yuehua Jiang, M.D.Raj Kasthuri, M.D.Dan Kaufman, M.D., Ph.D.Susan Keirstead, Ph.D.Nobuaki Kikyo, M.D., Ph.D.Rachel Lerner, M.D. (HCMC)Colleen Morton, M.D. (Regions)Amy Harker-Murray, M.D. (Regions)(Continued on page 57)scheduled seminars held onthree mornings each week formedical students and houseofficers. Special courses forHematology, Oncology, andTransplantation fellows onthe University campus includeGrand Rounds and JournalClub (led by Arne Slungaard,M.D. and Nasfat Shehadeh,M.D.) and the GaribaldiResearch Conference (led byRobert Hebbel, M.D.). The HOTDivision also conducts a threeweeksummer workshop forfellows in fundamentals of laboratoryand clinical research(led by Kalpna Gupta, Ph.D.).Research ActivitiesThe HOT Division is heavilyengaged in funded laboratoryand clinical research. Researchis supported by the NIH andother national organizations,by pharmaceutical companies,by nonprofit philanthropicorganizations such as theMasonic Cancer ResearchFund, Inc., the Komen Foundation,the Children’s CancerResearch Fund, and by a varietyof generous individualdonations.University-based faculty serveas principal investigators onover 30 national grants withtotal annual direct funding ofover $12.5 million and a largenumber of industry-sponsoredprojects with total annualfunding of over $4 million.VAMC faculty conductadditional research projectsgenerating over $1 million inannual funding.Research interests includebreast cancer biology(K. Gupta, Lange, Yee);thoracic oncology (Kratzke);stem cell biology (Jahagirdar,Kaufman, Kikyo, Luikart,McGlave, Verfaillie);immunotherapy (Iizuka,Miller); vascular biology(Geng, K. Gupta, Hebbel,Vercellotti); hemostasis andthrombosis (Ashrani, Geng,Johnson, Kasthuri, Key,Morton, Reding, Slungaard);genetic polymorphisms(Gaffney); tumor suppressorgenes (Kratzke); genetransfer (Farassati); clinicalhematopoietic stem celltransplantation (Arora,Brunstein, Burns, Kaufman,McGlave, Slungaard, Tomblyn,Weisdorf); hematologicmalignancies (Anderson,P. Gupta, Howe, Morton,Peterson); innovative cancertherapy (Dudek, Greeno,Sahin, Shehadeh, Skubitz);cell sorting (Perri); infectionsin immunocompromisedpatients (Morrison); ethicalconduct of clinical trials(Hammerschmidt); medicaleducation (Schorer); andmolecular epidemiology ofcancer (Yu). Faculty serveas principal investigatorson four NIH programmaticgrants on topics of sicklecell anemia (Hebbel); naturalkiller cell biology (Miller);stem cell biology (Verfaillie);and hematopoietic stem cellbiology (McGlave). Severalfaculty have leadership rolesin national research consortiastudying oncology therapy(Peterson) and stem celltransplant (Weisdorf).Over the last several years,HOT Division faculty haveestablished and led severalinterdepartmental researchprograms including the StemCell Institute (Verfaillie); theHemostasis and Thrombosisprogram (Key); the VascularBiology program (Hebbel);the Breast Cancer Biologyprogram (Yee); and the AdultBlood and Marrow Transplantationprogram (Weisdorf).HOT Division faculty(McGlave, Miller, Yee, Yu) alsohold leadership positions inthe University of MinnesotaCancer Center.Masonic ClinicThe Masonic Clinic for cancerand blood disorders has beenestablished in renovatedspace on the first floor of theMasonic Hospital Building.
This UMPhysicians-ownedclinic houses interdisciplinarycare teams and clinicalresearch teams. The clinic hasexperienced rapid growth inboth number of patients seenand infusions administered.Ed Greeno, M.D. is the MedicalDirector of the MasonicCancer Clinic.Vascular Biology ProgramLaboratoriesRenovation has recently beencompleted on a new laboratoryfor the developing VascularBiology program led by RobertHebbel, M.D. The VascularBiology program occupies900 square feet, comprisingall current laboratory spaceon the 14 th floor of the Phillips-WangensteenBuilding.This space houses VascularBiology program investigators,including Ashrani,Dudek, Geng, K. Gupta,Hebbel, Key, Slungaard,Reding, and several scientistsfrom other divisions.Faculty TransitionOver the last year, severalfaculty have joined the HOTDivision. The Cancer Centerrecruited Mimi Yu, Ph.D., whohas a long-standing interestin molecular epidemiology ofcancer. Kathy Ogle, M.D. hasjoined the clinical teachingfaculty at Hennepin CountyMedical Center, and AmyHarker-Murray, M.D. hasjoined the clinical teachingfaculty at Regions Hospital.Raj Kasthuri, M.D. has joinedthe clinical faculty on theUniversity of Minnesotacampus. He has a laboratorybasedinterest in proteomicsunderlying mechanisms ofhemostasis and thrombosis.He also functions as a clinicalhematologist. The HOT divisionrecruited five additionalfaculty members who willjoin in 2006. Active facultyrecruitments are underwayin solid tumor oncology,vascular biology, stem cellbiology, and hematopoieticcell transplantation.Several faculty left the HOTDivision in 2005. David Kiang,M.D., Ph.D., a long-standingmember of the Oncology divisionand a pioneer in breastcancer research, announcedhis formal retirement. JulietBarker, M.D. has taken aleadership position in theAdult Blood and MarrowTransplantation Program atSloan Kettering MemorialCancer Center. Nigel Key,M.D. has accepted the prestigiousHarold Roberts Chair inHemostasis and Thrombosisat the University of NorthCarolina and will direct thehematology section.Catherine Verfaillie, M.D. hasagreed to establish a sisterStem Cell Institute at the Universityof Leuven in Belgium.She will continue as a facultymember and a member ofthe Stem Cell Institute at theUniversity of Minnesota whileassuming this major leadershipposition in Europe.Faculty(Continued from page 56)Assistant ProfessorsKathleen Ogle, M.D.Douglas Rausch, M.D. (HCMC)Mark Reding, M.D.M. Behnan Sahin, M.D.Nasfat Shehadeh, M.D.Wufan Tao, Ph.D.Marcie Tomblyn, M.D.Punit Wadhwa, M.D. (VAMC)Faculty Honors and Awards for 2005Faculty members have received a variety of local and national awards over thelast year.Linda Burns, M.D. has received three important institutional awards including theDepartment of Medicine Clinical Excellence Award, the Department of Medicine EducationalExcellence Award, and the HOT Division Fellowship Academic Mentor Award.Dale Hammerschmidt, M.D. received the Annual Special Service Award of the AppliedResearch Ethics National Association.Koho Iizuka, M.D. is a recipient of a prestigious American Society of HematologyScholars Award.Balkrishna Jahagirdar, M.D. received the HOT Fellowship Clinical Mentor Award.Raj Kasthuri, M.D. received the 2005 Robert Jenness Award for excellence in postdoctoralresearch in biochemistry. This is a combined award given by the Medical Schooland the College of Biological Sciences at the University of Minnesota.Dan Kaufman, M.D., Ph.D. received the McKnight Land-Grant Professorship from theUniversity of Minnesota.Nigel Key, M.D. was elected to membership in the American Clinical and ClimatologicalAssociation and is President-elect of the Hemophilia and Thrombosis Research Society.Philip McGlave, M.D. received a second competitive renewal (years 11-15) on a programproject grant in stem cell biology from the National Cancer Institute.Jeffrey Miller, M.D. received first-time funding for a highly competitive program projectgrant on natural killer cell biology from the National Cancer Institute.Gregory Vercellotti, M.D. has received the All University Award for Post Baccalaureate,Graduate, and Professional Education and was admitted to the Academy of DistinguishedTeachers at the University of Minnesota.57
Division of Hematology, Oncology and TransplantationAs a clinical investigator, Burnsof long-term transplant survivorsfocuses on developing novelgrow. Studies led by Burns includetherapies for patients with hema-clinical trials intended to preventtologic malignancies. She and herand treat osteoporosis and iron58faculty Highlight: Linda Burns, M.D.According to the U.S. Centersfor Disease Control and Fellowship Director for theAssociate Professor of Medicineand Prevention, the overallincidence of cancer ogy, and Transplantation. BurnsDivision of Hematology, Oncol-will increase over the annually supervises the careernext 20 years, as the “baby development of 18 fellows who areboom” generation starts in various stages of their training.to reach age 65 in 2010. On a national level, Burns has beenIn addition, 64 percent of all adult instrumental in establishing educational,research, and professionalcancer patients will survive for atleast five years. These individuals development opportunities forwill need ongoing care.both trainees and training programdirectors at institutions throughoutTraining the next generation ofthe United States and Canada indoctors to provide care and seekher role as Chair of the Americancures for patients with hematologicSociety of Hematology Committeeand oncologic disorders is a majoron Training Programs.emphasis of Linda Burns, M.D.,collaborators in the University ofMinnesota Cancer Center, includingDaniel Vallera, M.D; John Kersey,M.D.; Brenda Weigel, M.D.; JohnWagner, M.D.; Jerry Froelich, M.D.;and Russell Ritenour, M.D. are usingradiolabeled monoclonal antibodiesdeveloped at the Universityto target specific proteins on thesurface of leukemia and lymphomacells in patients with advanceddisease. The success of this therapydepends on the ability of the novelagents to recognize the tumorcells, and thus deliver radiationdirectly to the tumor withoutharming normal tissues.Burns also studies late effects ofblood and marrow transplantation,an increasingly important areaas more patients in the numberoverload.Burns’ contributions to the divisionand department in 2005 have beenrecognized by the HOT DivisionAcademic Mentor Award, theDepartment of Medicine ClinicalExcellence Award, and the Departmentof Medicine EducationalExcellence Award. Her researchhas been funded by peer-reviewedgrants as well as generous,ongoing support from theJanie Lymphoma Fund.
Division of Infectious Diseases and International Medicinegrowth and change2005 was a year of growth and change for the Division ofInfectious Diseases and International Medicine (IDIM). A numberof young clinical- or laboratory-based investigators and more senior clinicalcolleagues, as well as faculty given joint or adjunct appointments, joined thedivision to bring the total by the end of the year to 48 members. Notably, four colleaguesfrom Abbott Northwestern Hospital were added to the faculty, and sevenresearch faculty moved into the Center for Infectious Disease and MicrobiologyTranslational Research (CIDMTR), housed within the new McGuire TranslationalResearch Facility.In keeping with the Department of Medicine’s strategic plan, two IDIM faculty,Patricia Walker, M.D. and Bill Stauffer, M.D. assumed a leadership role in “globalizingresidency education in the department.” Their main focus has been ondeveloping a Global Health Pathway for residents. However, the curriculum willalso serve medical students and community physicians who are desirous of gainingexpertise in tropical medicine and immigrant health. This exciting course isscheduled to be launched in the summer of 2006. Other important developmentsin the international arena included the appointment of Kumar Belani M.D. ascoordinator of clinical, educational, and research initiatives in India, and theestablishment by Paul Bohjanen M.D. of a research collaboration with the InfectiousDiseases Institute at Makerere University (Kampala, Uganda) on immunereconstitution and inflammatory syndrome (IRIS).Providing outstanding patient care, within an environment energized by medicaleducation and research, is the top priority of our faculty. The infectious diseaseproblems at each of our teaching hospitals are extraordinarily diverse and challenging,including infections in HIV/AIDS patients, bone marrow and organ transplantrecipients, and new immigrants to Minnesota, as well as veterans returningfrom Iraq infected with highly resistant bacteria.PhilLip Peterson, M.D.Division Directorwww.idim.umn.edu59
Division of Infectious Diseases and International Medicine60FacultyProfessorsKumar Belani, M.D.Kent Crossley, M.D. (VAMC)Gregory Filice, M.D. (VAMC)Ashley Haase, M.D.W. Keith Henry, M.D. (HCMC)James Johnson, M.D. (VAMC)Anura Kurpad, M.D.Alan Lifson, M.D., M.P.H.Michael Osterholm, M.P.H., Ph.D.Marguerite Pappaioanou, D.V.M., Ph.D.Craig Packer, Ph.D.Phillip Peterson, M.D.Jonathan Ravdin, M.D.Frank Rhame, M.D. (ANW)Leon Sabath, M.D.David Williams, M.D. (HCMC)Associate ProfessorsPaul Bohjanen, M.D., Ph.D.James Lokensgard, Ph.D. (HCMC)Vicki Morrison, M.D. (VAMC)Ramaiah Muthyala, Ph.D.Timothy Schacker, M.D.Joseph Thurn, M.D. (VAMC)Dean Tsukayama, M.D. (HCMC)Jo-Anne van Burik, M.D.Assistant ProfessorsMohamed Abd-Alla, M.D., Ph.D.Omobosola Akinsete, M.D., MPH (Regions)Daniel Anderson, M.D. (ANW)Charles Cartwright, Ph.D. (HCMC)Winston Cavert, M.D.Maxim Cheeran, D.V.M., Ph.D.Sarah D’Heilly, M.D. (VAMC)Genya Gekker, M.D.Shuxian Hu, M.D.Mary Ann Kish, M.D. (Regions)Susan Kline, M.D., M.P.H.Jason Sanchez, M.D. (ANW)Mark Sannes, M.D. (HCMC)Ron Schut, M.D. (HCMC)Kay Schwebke, M.D. (HCMC)Jonathan Sellman, M.D. (Regions)Wen S. Sheng, Ph.D.Margaret Simpson, M.D. (HCMC)Steve Sonnesyn, M.D. (ANW)William Stauffer, M.D., M.P.H.David Strike, M.D. (Regions)Patricia Walker, M.D. (Regions)instructorsNoe Mateo, M.D. (Regions)R. Bryan Rock, M.D.Educational ProgramsThe education of fellows, residents,students, and associatedhealth care professionalsis a high priority of the division.The Infectious DiseasesFellowship, under the superbleadership of James JohnsonM.D. (see Faculty Highlight),graduated three traineeswho joined our faculty,each of whom has academicactivities at two institutions:Bosola Akinsete, M.D., M.P.H.(Regions Hospital/HCMC),Bryan Rock, M.D. (UMMC/HCMC), and William Stauffer,M.D. (UMMC/Regions Hospital).The NIH T32-supportedInfectious Disease Trainingin Clinical Investigation isa popular pathway for manyof the division’s six fellows.Those who select this routeto an academic career canchoose mentors with researchexpertise in an area of EmergingInfections, and they takecoursework that leads to anM.P.H. or MSc. degree fromthe School of Public Health.As mentioned above,Drs.Walker and Stauffer aredeveloping a Global HealthPathway. Although infectiousdiseases will be a prominentcomponent of this curriculum,the curriculum will includea wide range of medical andpublic health topics. In thearea of Continuing MedicalEducation, the 11 th AnnualConference on EmergingInfections in Clinical Practicewas held in November. As inyears past, this highly successfulcourse was co-sponsoredby the IDIM Division, theCenter for Infectious DiseasesResearch and Policy, and theMinnesota Department ofHealth. Reflecting new andvital collaborations, two cosponsorswere added this year:the Department of PediatricsDivision of Infectious Diseasesand Immunology, andthe Mayo Clinic Departmentof Infectious Diseases.Research ActivitiesIDIM faculty members havea variety of basic science,clinical, and public healthresearch interests. As in yearspast, HIV/AIDS continuesto capture major attention,with cutting-edge studies onpathogenesis carried out byTim Schacker, M.D. and PaulBohjanen, M.D., Ph.D. andon antiretroviral therapy byWinston Cavert, M.D.; KeithHenry, M.D.; Ron Schut, M.D.;and Mark Sannes, M.D. Opportunisticfungal and viral infectionsof immunocompromisedpatients are the focus of theclinical research programs ofJo-Anne van Burik, M.D. andVicki Morrison, M.D. and ofthe laboratory-based researchof Max Cheeran, Ph.D.; GenyaGekker, M.D.; Shuxian Hu,M.D.; Jim Lokensgard, Ph.D.;Phil Peterson, M.D.; BryanRock, M.D.; and Sunny Sheng,Ph.D. at the CIDMTR.James Johnson, M.D. continueshis pioneering work onthe potential link betweencolonization of poultry withEscherichia coli and devel-This was theinaugural yearof the Center forInfectious Diseaseand MicrobiologyTranslationalResearch(CIDMTR), housedwithin the newMcGuire TranslationalResearchFacility.
opment of invasive clinicalextraintestinal infections inhumans (see Division Highlight).Bryan Rock, M.D.;William Stauffer, M.D., M.P.H.;Dean Tsukayama, M.D.; PatriciaWalker, M.D.; and DavidWilliams, M.D have all doneclinical reports on the topicof infections of immigrants.And the laboratory- andclinical-based research ofMohamed Abd-Alla, M.D.,Ph.D. and Jonathan Ravdin,M.D. continues to hold greatpromise for development ofa vaccine against amebiasis,a disease that wreaks enormoushavoc in developingcountries. In this era ofincreased attention to Qualityof Care and Patient Safety,Greg Filice, M.D. and SusanKline, M.D., M.P.H. have beendeveloping computer-basedsystems to improve AntibioticDecision Support.As mentioned above, thiswas the inaugural year ofCIDMTR, which provides astate of the art, interdisciplinary(Microbiology/InfectiousDiseases, Immunology,Genomics, Neuroscience), andinterdepartmental (Medicine,Microbiology, Pediatrics)environment for investigatorsworking on global infectiousdisease problems, includingHIV infection of the brain,congenital CMV infection,malaria, tuberculosis, andtyphoid fever.faculty Highlight: james johnson, M.D.Jim Johnson, M.D. exemplifies the classic “triple threat”of academic medicine, by excelling in the arenas ofresearch, education, and patient care/clinical service.ResearchJohnson has established himself as an internationally recognized authorityon extraintestinal pathogenic Escherichia coli (ExPEC), a term he coinedfor this important group of pathogens, which is responsible for most ofthe 35,000 deaths annually in the U.S. due to severe E. coli sepsis. Areasof Johnson’s research into ExPEC include its reservoirs and transmissionpathways (including household pets and the food supply, particularlypoultry), evolution, pathogenesis, and antimicrobial resistance. He hasover 110 peer-reviewed research papers and was named the 2005 “VAResearcher of the Year” by the Minneapolis VA. He is funded by theNational Institutes of Health, the Centers for Disease Control andPrevention, and the Department of Veterans Affairs.Johnson consistently receives high praise for his teaching from medicalstudents, residents, and fellows. However, his most noteworthy recenteducational contribution has been as director of the ID fellowship program.Under Johnson’s leadership (since 2002), the ID fellowship program hasflourished. The program received a new NIH T32 training grant, whichallowed it to grow from one to six fellows, and up to eight fellows. It hasadded international research opportunities, an annual fellows’ researchretreat and the Midwest ID Fellows Forum (a joint effort involving the Mayoand University of Wisconsin fellowship programs), an extensive library ofcurrent reference and boards review materials, an online infection controlcourse, and pediatric and private hospital clinical experiences.Johnson also has distinguished himself as an outstanding clinician andclinical systems improver. Since 1996 at the VA Medical Center, Johnsoninstigated formation of an antimicrobial subcommittee (on which he nowserves), and convened and/or served on task forces for antimicrobialtherapy appropriateness, improved foley catheter use, Clostridium difficilesurveillance, optimized severe sepsis management, and computerizeddecision support for antibiotic ordering. Johnson’s regular patient careactivities at the VA include the ID consult service, ID clinic, MICU service,and Hepatitis C clinic. In 2002, Johnson was elected Clinician of the Yearby the North-Central chapter of the Infectious Diseases Society of Americaand was nominated for VA Clinician of the Year.61
Division of Pulmonary, Allergy, and Critical Carebroad expertiseThe Division of Pulmonary, Allergy, and Critical Care encompassesfull-time academic faculty at four hospital sites, providing broad62David Ingbar, M.D.Division Directorwww.pacc.umn.eduexpertise and a diverse clinical practice along with fellowshiptraining. The Division is privileged to work with bright, dedicated studentsand trainees from across the United States and around the world. With generoussupport from the NIH, VA Research Service, American Lung Association, CysticFibrosis Foundation, American Heart Association, Will Rogers Institute, and severalother private foundations, we are committed to providing our students thebest graduate and postgraduate education in lung science available today. TheDivision proudly features internationally recognized programs in critical caremedicine (ARDS), advanced lung disease and lung transplantation, COPD, physiologyof mechanical ventilation, genetics of asthma, adult cystic fibrosis, fungalinfections, and sleep-disordered breathing. We strive to find cures for acute lunginjury, pulmonary fibrosis, COPD, pulmonary hypertension, and other deadly lungdiseases as we continuously improve current preventive strategies and treatmentmodalities. The division has made major commitments to using techniques ofproteomics, genomics, and novel drug design and delivery methods to accomplishthese advances.Faculty members based at four hospital sites and our fellowship training utilize theunique strengths of each patient population and faculty. The University Programsite (University of Minnesota Medical Center, Fairview) offers in-depth experiencesin medical critical care and advanced lung disease, including cystic fibrosis, interstitiallung disease, pulmonary hypertension, and lung transplantation. The VAMedical Center offers a large base for outpatient consultative practice and commonlung diseases, including COPD and lung cancer. The HCMC provides training ininner-city critical care medicine (including a level I trauma center), TB care, and
sleep medicine. Regions Hospitalprovides a broad pulmonaryand critical care experience,including trauma centerand burn center experiences.Under the leadership of DavidIngbar, M.D., Professor ofMedicine, Pediatrics, andPhysiology, the division isbuilding on existing strengthsto further integrate researchacross the four sites and toaugment the existing strongrelationships with basic sciencedepartments, AHC centers,and other AHC schools,such as the School of PublicHealth and the School of Pharmacy.The AHC, the MedicalSchool, and the Departmentof Medicine recently havemade major investments tofurther advance the division’sresearch, educational, andclinical activities in importantstrategic areas. New recruitmentsare underway for benchscientists, patient-orientedresearchers, and clinicianscholars, focusing particularlyon COPD, sleep, asthma/allergy/lung immunology, andlung vascular biology.Critical Care MedicineFollowing ten years as aNHLBI Specialized Centerof Research in Acute LungInjury, our efforts are directedat understanding the basicbiology and bioengineeringaspects of lung healing so thatwe can develop new therapiesto speed the healing process.The Division has extensiveclinical expertise in caring forpatients with acute respiratoryfailure, including acuterespiratory distress syndrome(ARDS) and acute lung injury.Peter Bitterman, M.D.; VitalyPolunovsky, Ph.D.; CraigHenke, M.D.; and David Perlman,M.D. are developing newtherapies to treat the fibroproliferativephase of ARDS.David Ingbar, M.D. is testingways to accelerate the clearanceof pulmonary edemafluid and, with Hyun Kim,M.D., to speed the healing ofthe lung epithelium. Studiesled by Christine Wendt, M.D.are examining the molecularregulation of ion transportersinvolved in clearing edemaby steroid hormones. JohnMarini, M.D. and Alain Broccard,M.D. are developing lessinjurious methods of mechanicalventilation. They also areexploring advanced modelingmethods and the biophysicalaspects of ventilator-inducedlung injury. Craig Weinert,M.D. is using newly developedoutcome measurement toolsto study the course of ARDSand assess the impact of sedativedrugs and other ICU treatments.In addition to translationallaboratory research,the team has been involved inphase I, II, and III studies ofnew ARDS treatments, includinguse of artificial recombinanthuman surfactants. Thedivision is an integral partof the Center of Excellencein Critical Care program ofthe AHC, and participatesin the national Program ofExcellence in Critical Care.Clinically, the division worksclosely with the Departmentof Surgery’s Division of SurgicalCritical Care and Trauma,led by Greg Beilman, M.D.Shared training experiencesand conferences lead to collaborativeresearch projectsand breadth of education.Advanced Lung DiseaseCOPD, Interstitial Lung Disease,CF, Pulmonary Hypertension,and Lung TransplantThe Center for AdvancedLung Disease, led byMarshall Hertz, M.D., isThe Division is privileged to workwith bright, dedicated students andtrainees from across the United Statesand around the world.FacultyProfessorsPeter Bitterman, M.D.Malcolm Blumenthal, M.D.Scott Davies, M.D. (HCMC)Marshall Hertz, M.D.Conrad Iber, M.D. (HCMC)David Ingbar, M.D. (Director)John Marini, M.D. (Regions)Dennis Niewoehner, M.D. (VAMC)Vitaly Polunovsky, Ph.D.Jeffrey Rubins M.D. (VAMC)Associate ProfessorsAlain Broccard, M.D. (Regions)Peter Duane, M.D. (VAMC)Craig Henke, M.D.James Leatherman, M.D. (HCMC)William Marinelli, M.D. (HCMC)Avi Nahum, M.D. (Regions)Kathryn Rice, M.D. (VAMC)Christine Wendt, M.D.Assistant ProfessorsJagdeep Bijwadia, M.D.Joanne Billings, M.D.Jordan Dunitz, M.D.Krista Graven, M.D. (Regions)Jannica Groom, M.D. (Regions)Robert Kempainen, M.D.Hyun Joo Kim, M.D.Melissa King-Biggs, M.D. (Regions)Charlene McEvoy, M.D. (Regions)David Perlman, M.D.Robert Shapiro, M.D. (HCMC)Mark Sprenkle, M.D. (HCMC)Maryam Valapour, M.D.Craig Weinert, M.D.Timothy Whelan, M.D.instructorsManeesh Bhargava, M.D.Deanna Diebold, M.D.clinical facultyDavid Graff, M.D.Keith Harmon, M.D.Robert Kim, M.D.Susan Ravenscraft, M.D.Richard Sveum, M.D.63
Division of Pulmonary, Allergy, and Critical Care64bringing together multidisciplinaryclinical care, clinicalresearch, and translationalscience. It provides care forpatients with a variety ofchronic lung problems, includinginterstitial lung disease(pulmonary fibrosis), adultcystic fibrosis, pulmonaryvascular diseases (jointly withcardiology), and COPD. It alsois home for the internationallyrenowned Lung TransplantProgram.The interstitial lung diseasegroup already is active inall three major domains andFaculty Honors andAwards for 2005Marshall Hertz, M.D.Recipient of the Judith and JohnMurphy Professorship in AdvancedLung DiseaseDavid Ingbar, M.D.Vice President (Elected)American Thoracic SocietyChair, American Board of InternalMedicine, Pulmonary SubspecialtySEP CommitteeVoted one of the Best Doctors inthe U.S.includes Drs. Whelan, Kim,Henke, Perlman, and Bitterman.Under Whelan’s leadership,the center offers multipleclinical trials for pulmonaryfibrosis to our patients.Hertz is medical director ofthe Lung Transplant Programand the physician coordinatorof the national UNOS lungtransplant database. He alsois principal investigator ofan ongoing NIH PPG on thepathogenesis of obliterativebronchiolitis after lung transplantation.Generous philanthropyhas let us establish aBio-Bank of tissue, serum,and data about patients witha variety of lung diseases tofacilitate our existing andnew research.Wendt is using advanced proteomictechniques to identifyearly markers of complicationsafter lung transplantationand to understand theirbiology. Maryam Valapour,M.D., a joint faculty memberwith the Center for Bioethics,brings expertise in bioethicsand utilization of scarceresources, with a particularinterest in living donor lungtransplantation.COPD is a major focus ofthe research led by DennisNiewoehner, M.D. andKathryn Rice, M.D. at theVA Medical Center.Niewoehner is the lead investigatorin several VA multicentertrials and is the principalinvestigator of the NIHCOPD clinical trials networksite. Assisted by Wendt, JohnConnett, M.D., professor in theSchool of Public Health, leadsthe data-coordinating centerfor the NIH lung health studyand the COPD trials network.Rice is principal investigatorfor VA sponsored studies ofcase management in COPD.The adult CF program, led byJordan Dunitz, M.D. is oneof the most active adult CFprograms in the United Statesand has had outstandingclinical outcomes. Clinicalresearch in this area is fundedby grants to Joanne Billings,M.D. from NIH and the CFFoundation. Robert Kempainen,M.D. brings a focuson education for our fellows,residents, and students aswell as providing clinicaland training support to theCF program.Asthma and AllergyMalcolm Blumenthal, M.D.leads an active research programincluding an NIH-fundedinvestigation of the geneticsof asthma, the American LungAssociation’s Asthma ClinicalResearch Center (ALA-ACRC),and international collaborativeefforts involving Taiwan,Georgia, and India. His investigationsidentified somenovel genetic loci for asthmaand atopy susceptibility. Hisgroup also evaluated outcomesof various drug regimens forasthma, and assessed theepidemiology of asthma andatopy. He directs the accreditedallergy/clinical immunologytraining program and thedelivery of multidisciplinaryclinical allergy and asthmahealth care.Sleep MedicineThe division has growingactivities in sleep medicine,led by Conrad Iber, M.D., pastPresident of the AmericanAcademy of Sleep Medicineand section head of the divisionat HCMC. The HCMCbasedMinnesota RegionalSleep Disorders Center(MRSDC) is a nationally recognizedcenter of excellencefor sleep medicine, featuringoutstanding clinical care andresearch. Recently openedsleep centers at Regions Hospitaland the University ofMinnesota Medical Center,Fairview also serve as clinicaland educational sites. TheDivision works cooperativelywith the Neurology andENT Departments in theseactivities. We are expanding
the clinical services to newsubgroups of patients withcardiovascular, neuromuscular,and unusual pulmonarydiseases, while increasingour training and researchin sleep medicine.Collaborative ResearchProgramsNew research collaborationsin cancer cell biology havebeen led by Polunovsky, Bitterman,and Perlman. Workingwith faculty in medicinalchemistry, they are discoveringnew, small molecule-basedtherapies that target theprocess of protein translationand affect cell growth andsurvival. These discoveriesare being applied to cancermodels and pulmonary fibrosis.There are strong connectionswith the Institute ofHuman Genetics, involvingstudies on asthma, bronchiolitisobliterans, and acuterejection by Blumenthal,Wendt, and Hertz. Proteomicresearch in the division isled by Wendt.Educational ProgramsA major focus of the Division’sactivities is education forstudents at many levels. TheDivision’s active fellowshipprogram in pulmonary andcritical care incorporatesclinical activity at fourhospital sites: University ofMinnesota Medical Center,Clinically, the division works closely with the Department ofSurgery’s Division of Surgical Critical Care and Trauma.Hennepin County MedicalCenter, the VA Medical Center,and Regions Hospital. Theprogram includes extensivecritical care training anddedicated educational experiencesin sleep disorders andtuberculosis. The Pulmonaryand Critical Care fellowshiptraining director is MelissaKing-Biggs, M.D. Weinert,Billings, and Ingbar publisheda national assessment oftraining of pulmonary/criticalcare physician scientists.Bitterman is leading thephysician-scientist pathwaywithin the medicine residencyand also is associate directorof the University’s M.D.-Ph.D.program. Kempainen andRubins coordinate medicalstudent and resident educationin pulmonary and criticalcare medicine in both didacticand clinical settings.The Allergy Section provideseducation and training ofstudents, residents, fellows,and physicians in the communityabout asthma andallergy. They have a trainingprogram in allergy andclinical immunology, offeran annual CME course eachspring, and sponsor theannual Blumenthal Lectureship,which brings outstandingindividuals in the field ofallergy and immunology tothe University of Minnesota.Research training is providedto pre-doctoral students andpost-doctoral M.D. and Ph.D.fellows through an NHLBItraining grant directed byIngbar. The training has threemajor curricular domains:(1) cell and molecular biology;(2) bioengineering; and(3) clinical research leadingto a master’s degree in publichealth or clinical research.This effort includes University-widecollaboration withfaculty across many schoolsand departments. Traineesare strongly encouraged toobtained advanced degrees(Ph.D., M.P.H. or MSc. in clinicalresearch) through establishedjoint pathways.65
Division of Pulmonary, Allergy, and Critical Care66faculty Highlight: Timothy Whelan, M.D.Timothy Whelan, M.D. was recruited to join the divisionfaculty at the University of Minnesota in August of 2003after completing his Pulmonary and Critical Care fellowshipat the University of Washington. During the research componentof his training, he focused on learning about lung transplantation,pulmonary fibrosis, and clinical study design.Dr. Whelan has two main areas of interest: lung transplantation and pulmonaryfibrosis. He is an active member of the University of Minnesota’s LungTransplant Program. He cares for patients with advanced lung disease bothbefore and after lung transplantation. He also participates in ongoing clinicalresearch evaluating outcomes after lung transplantation. Dr. Whelan isdedicated to continuing the education of others interested in lung transplantationand is currently working as the editor of the latest edition ofthe University of Minnesota Lung Transplantation Manual.Dr. Whelan serves as the Director of the Interstitial Lung Disease clinicalprogram within the Center for Advanced Lung Disease and works to buildclinical – translational research in this area. Interstitial lung diseases (ILD),such as idiopathic pulmonary fibrosis (IPF), are increasingly recognized asa very difficult to treat problem with a high mortality. The division alreadyhad a small ILD clinic to accompany extensive laboratory and translationalbench research in this area by Drs. Bitterman and Henke. Dr. Whelan hassuccessfully built the ILD clinic into a state-of-the-art clinic that providesthe latest care to patients with IPF and all types of interstitial lungdiseases. As part of this mission, this clinic now provides patients withthe opportunity to participate in clinical trials investigating interventionsto improve their outcomes. Currently, Dr. Whelan is the principal investigatorfor the INSPIRE trial at the University of Minnesota. This trial isevaluating the safety and efficacy of gamma interferon-1b in patients withidiopathic pulmonary fibrosis. The University of Minnesota is in the top5 enrollers out of over 80 sites participating between North America andEurope. Based on this success, under Dr. Whelan’s leadership, the clinicis already planning to participate in two future protocols for patientswith idiopathic pulmonary fibrosis. Dr. Whelan also helped conceive andspearhead the development of a tissue and sample repository, the O’BrienFamily Foundation Lung Bio-Bank. These samples will be used for researchon interstitial and other lung diseases.Dr. Whelan’s interest in educating others is evident from the many outreachlectures he has given through the state. He hosted a patient and familyeducation day, attended by more than 200 individuals from more than20 states and Canada. He also has an active project in collaboration withthe Coalition of Pulmonary Fibrosis to develop a CME program to updateprimary care physicians on interstitial lung disease.In less than three years on the faculty, Dr. Whelan has markedly increasedthe University’s clinical and clinical research activities in interstitial lungdisease while educating local care-givers, patients, and families about thisproblem. He is rapidly developing a national reputation as a leader in thisarea. Based in part on his clinical efforts, the division is preparing a NIHprogram project grant led by Dr. Craig Henke to study basic mechanismsof lung fibrosis. This program will identify new targets for Dr. Whelan andothers to test in clinical trials interventions in the future.
Division of Renal Diseases and Hypertensionimproving long-term careThe Division of Renal Diseases and Hypertension has activeclinical, research, and educational programs spanning allaspects of nephrology and hypertension. Major clinical activitiesof the division include inpatient consult and transplant services and outpatientclinics that care for patients with a diverse array of kidney diseases. A majorongoing clinical initiative of the division has been continued expansion of transplantnephrology with a focus on long-term follow up and cardiovascular riskfactormanagement of kidney transplant recipients.There are active programs in both clinical and basic science research. Clinicalresearch programs in the division include outcomes research in chronic kidneydisease and transplantation. Hassan Ibrahim, M.D., M.S. is the principal investigatorof a large NIH sponsored research project investigating the role of angiotensinII receptor blockers in the primary prevention of chronic allograft nephropathy.Research into the epidemiology of kidney disease is being conducted by RobertFoley, M.D.; Allan Collins, M.D., FACP; Areef Ishani,M.D.; Bert Kasiske, M.D., FACP;and others taking advantage of many resources including the United StatesRenal Data System Coordinating and Cardiovascular Center based at HCMC.In basic science, Sandeep Gupta, M.D. and Mark Rosenberg, M.D. are investigatingthe role of kidney-derived stem cells in renal regeneration. Yoav Segal, M.D., Ph.D.is using a mouse model of Alports syndrome to study the pathophysiology ofglomerular filtration.Mark E. Rosenberg, M.D.Division Directorwww.dom.umn.edu/renal67Educational ProgramsEducational activities of the division range from medical student teaching toadvanced fellowship training in nephrology. The renal fellowship program utilizesthree teaching hospitals: University of Minnesota Medical Center, HennepinCounty Medical Center, and the VA Medical Center. There are currently 11 renal
Division of Renal Diseases and Hypertension68FacultyProfessorsAllan Collins, M.D., FACP (HCMC)Bobbi Daniels, M.D.Bert Kasiske, M.D., FACP (HCMC)Mark Paller, M.D., M.S.Mark Rosenberg, M.D. (Director)Associate ProfessorsPaul Abraham, M.D. (Regions)Robert Foley, M.D. (HCMC)Connie Manske, M.D.Charles Smith, M.D. (HCMC)Suzanne Swan, M.D. (HCMC)Assistant ProfessorsRobert Berkseth, M.D. (HCMC)Jeffrey Connaire, M.D. (HCMC)David Dahl, M.D. (HCMC)Keith Eidman, M.D. (HCMC)Kambiz Farbakhsh, M.D. (HCMC)Sandeep Gupta, M.D. (VAMC)Hassan Ibrahim, M.D., M.S.Areef Ishani, M.D. (VAMC)Ajay Israni, M.D. (HCMC)David Ma, M.D. (VAMC)Edward Muter, M.D. (Regions)Eileen O’Shaughnessy, M.D. (HCMC)Prasun Ray, M.D. (Regions)Meena Sahadevan, M.D. (HCMC)Yoav Segal, M.D., Ph.D.Richard Spong, M.D.Marc Weber, M.D.Jay Xue, Ph.D. (HCMC)instructorAnne Rinehart, M.D. (Regions)fellows. The program providesthree pathways: a clinicianpathway that is a two-yearcore program; a clinical investigatorpathway that involvescompleting the course workfor the clinical researchmaster’s program; and a basicresearch pathway. The goalof the fellowship program isto have 25 to 50 percent offellows go into the clinicianpathway and the rest into theacademic pathways. A comprehensivetraining program inall aspects of clinical nephrologyis provided, includingtreatment of end-stage renaldisease, transplantation, andICU nephrology. The programhas an NIH institutionaltraining grant to provide supportfor training in clinicalinvestigation in nephrology.We also offer a fellowshipin transplant nephrologythat follows the two years ofgeneral nephrology training.This program is directed byKasiske and is certified by theAmerican Society of Transplantationand the AmericanSociety of Nephrology. Thedivision participates in theeducational activities of theinternal medicine residencyprogram through consultrotations and formal didacticteaching programs. Medicalstudent teaching activitiesinclude the year-two renalpathophysiology courseand the clinical teaching ofthird- and fourth-year medicalstudents. All faculty membersparticipate in these teachingprograms. Connie Manske,M.D. leads the pathophysiologycourse and serves as sitedirector for the 5-501 course,which focuses on advancedclinical teaching of students.The division participates in anumber of continuing medicaleducation programs sponsoredby the Medical School,including the internal medicinereview course.Faculty RecruitmentMarc Weber, M.D. joined theUniversity renal divisionJuly 1, 2005, after completinga nephrology fellowship atthe University of Minnesota.Weber is establishing a basicscience research programwith a focus on opioids, thekidney and the pathophysiologyof sickle cell nephropathy.His clinical interests includeall aspects of consultativenephrology. Hennepin CountyMedical Center has recruitednew faculty that include AjayIsrani, M.D. who completedhis nephrology fellowship atthe University of Pennsylvaniaand works in the field ofmolecular epidemiology oftransplant outcomes. KeithEidman, M.D. completed hisnephrology fellowship at theUniversity of Minnesota andis involved in all aspects ofchronic kidney disease careand consultative nephrology.The goal of the fellowship program is tohave 25 to 50 percent of fellows go intothe clinician pathway and the rest intothe academic pathways.
Faculty Honors andAwards for 2005involved in a number of clinicalstudies in kidney transplantation.Allan J. Collins, M.D.President Elect, National KidneyFoundationDirector, Kidney Early EvaluationProgram (KEEP) Coordinating Center,National Kidney FoundationRobert Foley, M.B.Co-Editor, American Journal ofKidney DiseasesLinking data from the UnitedStates Renal Data System, theUnited Network for Organ Sharing,and Medicare Claims, Kasiskeand coworkers have carried out anumber of observational studies oftransplant outcomes. For example,Hassan Ibrahim, M.D.Editorial Board,Clinical Transplantationthey recently reported on the highincidence of new onset diabetesafter kidney transplantation in theAreef Ishani, M.D.Clinical Scholar Award,VA Medical CenterBertram L. Kasiske, M.D., FACPBoard of Directors, Kidney Disease:Improving Global Outcomes (KDIGO),National Kidney FoundationEditor-in-Chief, American Journal ofKidney DiseasesMark E. Rosenberg, M.D.Chair, Training Program DirectorsExecutive Committee, AmericanSociety of NephrologyCo-Editor, American Journal ofKidney DiseasesSuzanne K. Swan, M.D.Co-Editor, American Journal ofKidney Diseasesresearch Highlight: improving outcomeof kidney transplant recipientsBBert L. Kasiske, M.D., FACP isthe Director of Nephrologyat Hennepin County MedicalCenter (HCMC), the MedicalUnited States. The same team hasalso described the high incidenceand epidemiology of cancer afterkidney transplantation in theUnited States. At a local level,his group has carried out severalobservational studies defining riskfactors for cardiovascular diseaseafter kidney transplantation.In addition, Kasiske is a co-investigatorof a NIH sponsored, multicenterstudy to determine thenatural history of chronic kidneyallograft dysfunction in the United69Yoav Segal, M.D.Associate Editor, AmericanJournal of Kidney DiseasesDirector of Transplantationat HCMC, and the MedicalDirector of Kidney andStates and Canada. This prospectivestudy will collect data and kidneybiopsy material in a large, prospec-Pancreas Transplantationtive cohort of transplant recipientsat the University of Min-in order to determine the causes ofnesota. He has been involved inlate kidney allograft failure. Kasiskeimproving the long-term care andis also the principal investigatoroutcomes of kidney transplantof a NIH sponsored, multi-center,patients at both the University ofprospective cohort study of livingMinnesota Hospital and HCMC. Inkidney donors. This study will enrolladdition to providing clinical careliving kidney donors and siblingand medical direction, Kasiske andcontrols, and will follow them tohis team of investigators have beendetermine changes in kidney functionand cardiovascular disease risk.
Division of Rheumatic and Autoimmune Diseasesongoing researchThe Division of Rheumatic and Autoimmune Diseases seeks the curefor a diverse group of systemic diseases affecting a wide range70Daniel L. Mueller, M.D.Division Directorwww.dom.umn.edu/rheumatologyof organ systems, which usually includes the synovial joints andtheir surrounding connective tissues and bones. Although the causeof many of these illnesses is unknown, most share some form of immunopathologythat leads to uncontrolled inflammation, pain, disability, and often tissue destruction.Some of these illnesses that are better understood include the post-traumaticand crystalline arthropathies, osteoarthritis, and osteoporosis; however, ongoingbasic research in this division and elsewhere is leading to an even greater understandingof the autoimmunity that leads to systemic inflammatory diseases suchas rheumatoid arthritis, scleroderma, systemic lupus erythematosus (SLE),Sjogren’s syndrome (SS), anti-phospholipid antibody syndrome (APS), and polymyositis/dermatomyositis.The major academic effort of this division is biomedicalresearch in these areas.Clinical ServicesPhysicians in the division are available for both inpatient and outpatient consultationat the University of Minnesota Medical Center. Physicians currently staff16 outpatient clinics, as well as two rheumatology fellow outpatient continuityclinics. In these clinics, physicians have the opportunity to effectively and safelycontrol rheumatologic disease in most individuals using a combination of potentand selective anti-inflammatory agents, analgesics, anti-metabolite immunosuppressives,biological immune modulators, and/or bisphosphonates. Together with thesetherapeutic drug regimens, weight loss and exercise are reinforced through educationalprograms, and additional consultation with physical medicine and rehabilitation,the Pain Clinic, physiotherapy, or orthopedics is utilized when needed. Patientcare is also offered at the University of Minnesota Medical School’s affiliated sites.
Full-time rheumatology clinicalfaculty at Regions Hospital,the VA Medical Center, andHCMC continue their traditionof excellence in patient careand teaching.This year, Barbara Segal, M.D.and her collaborators openeda University of MinnesotaScleroderma Specialty Clinic,which has already evaluatedover 50 new patients. Her goalin starting the Sclerodermaprogram at the University ofMinnesota has been two-fold:(1) to bring the medicalspecialists caring for sclerodermapatients together toallow for comprehensiveservices and maximum conveniencefor the patients and(2) to make available stateof-the-artmanagement andaccess to the latest clinicalresearch. She has broughttogether a team of basic scientistsand clinical investigatorsto apply new insights into thegenetics of autoimmunity,pulmonary fibrosis, basicimmunology, and vascularbiology, with the aim ofimproving our understandingof the pathobiology of Sclerodermaand developing rationalinterventions. During thecoming year, they will beginenrolling patients in severalwell-designed randomizedprotocols for treatment ofscleroderma disease manifestations(lung, skin, anddigital ulcers).Educational ProgramsIn addition to clinical service,this division is committed tothe education of the next generationof rheumatology careproviders and investigators.Medical students, internalmedicine interns, and residentsrotate through ourclinics, gaining experiencein the diagnosis and treatmentof rheumatic diseases.The program, headed by AnneMinenko, M.D. at the University,includes (1) instructionin how to perform a detailedmusculoskeletal examinationusing patients from theMedical School’s standardizedpatient program, (2) instructionin how to perform jointaspirations and soft tissueinjections using simulatedlimb models, and (3) selfguidedCD-ROM tutorials tocomplement the clinic andhospital learning experience.At Regions Hospital, ElieGertner, M.D. and EllenShammash, M.D. supervisethe instruction of medicalresidents and students onrheumatology clinical services.David Rhude, M.D. andPeter Schlesinger, M.D. directthe fourth-year medical studentrheumatology trainingat the HCMC. Rhude providesspecialized clinical trainingin the areas of metabolicbone disease and APS, whileSchlesinger focuses on thediagnosis and treatment ofSLE and scleroderma. Theyboth participate in the clinicalcorrelations and physicalexamination skills componentsof the first-year medicalschool curriculum. At theVA Medical Center, MarenMahowald, M.D.; Hollis Krug,M.D.; and Jasvinder Singh,M.D. also provide importantmedical training opportunitiesto students and residents.In addition to training medicalstudents and residents,our ACGME-accredited twoyearrheumatology fellowshipprogram provides an intenseclinical training experiencefor physicians who desire acareer in specialized, stateof-the-artrheumatology care.Our fellowship program currentlytrains two rheumatologyfellows at any given timeat both the UMMC and VAMedical Center sites underSegal’s direction. Clinicalresearch training opportunitiesfor fellows are now alsoavailable at HCMC. Finally, apersonalized scientific educationunder the tutorship ofone of our research facultymentors provides M.D. andPh.D. post-doctoral fellows,as well as undergraduate andgraduate students, with anopportunity to contribute tothe search for a cure. Abundantfederal (NIH) fundingis available to support thisresearch training withinthe division.FacultyProfessorsTimothy Behrens, M.D.Maren Mahowald, M.D. (VAMC)Ronald Messner, M.D.Daniel Mueller, M.D. (Director)Thomas Stillman, M.D. (HCMC)Elie Gertner, M.D. (Regions)Associate ProfessorsHollis Krug, M.D. (VAMC)Barbara Segal, M.D.Assistant ProfessorsThomas Bloss, M.D. (HCMC)Anne Minenko, M.D.Kathy Moser, Ph.D.Erik Peterson, M.D.David Rhude, M.D. (HCMC)Peter Schlesinger, M.D. (HCMC)Ellen Shammash, M.D. (Regions)Jasvinder Singh, M.D. M.P.H. (VAMC)Patricia Tam, Ph.D.instructorKeli Hippen, Ph.D.Faculty Honors andAwards for 2005Anne Minenko, M.D.American College of Rheumatology71
Division of Rheumatic and Autoimmune Diseases72Research ActivitiesAutoimmunity develops asthe consequence of a loss oftolerance to self-antigens.Investigations carried out byDr. Daniel Mueller are leadingto a better understandingof the biological and biochemicalnature of immuneself-tolerance. Of particularinterest are those factors (e.g.growth factors and costimulatoryligands) that determinewhether antigen stimulationof a T-cell will lead to anincrease in the clone size andthe development of protective(or pathological) effector function,or lead to its functionalinactivation (clonal anergy)and T-cell tolerance.Patty Tam, Ph.D. and RonaldMessner, M.D. are interestedin how viruses and their interactionwith the host affectthe development of chronicrheumatic and autoimmunediseases. Molecular analysisof coxsackievirus strains hasidentified the genetic determinantsthat cause chronicautoimmune myositis followinginfection. In a secondproject, second harmonic generationimaging technologythat is used to detect changesin diseased muscle is beingadapted to perform non-invasiveimaging of the collagenfound in knee joints. Thisproject represents an interdisciplinaryeffort headed byTam that includes investigatorsin dermatology, chemicalengineering, and materialsscience; the Biomedical ImageProcessing Laboratory; andphysics. The ability to detectminor degenerative changesin collagen on the cartilagesurface will translate into earlierdiagnosis and improvedopportunities for therapeuticintervention in joint diseasessuch as osteoarthritis.The Timothy Behrens Laboratoryis broadly interested inunderstanding the molecularbasis of human autoimmunediseases by engaging in alarge gene-mapping project inhuman SLE. In the past year,they demonstrated a geneticassociation of a polymorphismof the protein tyrosine phosphatasePTPN22 with humanSLE. The Behrens Laboratory,together with laboratories atNew York University/NorthShore and the University ofCalifornia San Francisco,is working with familiesenriched for multiple differentautoimmune diseases.These families will be used toidentify genes that predisposeto autoimmunity in general.A second focus of the BehrensLaboratory is the use of mousemodels to better understandthe mechanism by which toleranceto self is maintained inthe immune system. Finally,the laboratory is using microarray technology to study bothpatients with autoimmunityand our various mouse modelsto identify novel moleculesand pathways that are dysregulatedin autoimmunity,so that improved therapies forpatients with autoimmune disorderscan be designed. Theirresults now suggest a criticalrole of interferon in the pathogenesisof human SLE.Erik Peterson, M.D. has developeda molecular immunologyresearch program thatis focused on the roles ofT-cell signaling proteins inleukocyte development andautoimmunity. He has identifieda novel role for the leukocyte-specificadapter protein,ADAP, in the suppression ofT-cell dependent autoimmunityin mice. His laboratoryis investigating the molecularand cellular bases for ADAPaction through studies of bothT-cells and of other ADAPexpressingleukocytes thatregulate T-cell activity in autoimmunedisease. Peterson hasalso discovered that anothernovel adapter protein, PRAM-1,is important for physiologicproduction of infection-fightingchemicals by neutrophils.Recent experiments suggestthat PRAM-1 interacts withprotein components of the cellular“trash disposal” system.Current studies are investigatingthe biologic significanceof those interactions.A second group of projects inPeterson’s laboratory utilizesgene “knockout” technologyin mice to better understandthe cellular function ofLyp (PTPN22), the proteinphos-phatase recentlydescribed as a novel regulatorof human SLE, rheumatoidarthritis, and autoimmunediabetes. Finally, in collaborationwith other faculty inthe Autoimmunity group atthe University and faculty atthe Mayo Clinic, Peterson islooking for clues to the pathogenesisof human psoriaticarthritis. He is using microarraytechnology to probe geneexpression profiles in peripheralblood of patients withthis disorder.Investigations by KathyMoser, Ph.D. are also focusingon the identification andcharacterization of genes thatlead to autoimmune processesin SLE, SS, and APS. Thesedisorders may overlap withinpatients, tend to cluster infamilies, and are thought toshare at least some aspects ofimmune dysfunction. Studies
in her lab rely on family-basedgene mapping strategies toidentify genetic polymorphismsinvolved in autoimmunedisease and microarraytechnologies to assess globalgene expression. Two majorgene mapping studies in SLEare underway: (1) the mappingof susceptibility gene(s) onchromosome 16q12 in SLE,and (2) the identification ofmultiple genomic regionsharboring genes that influenceautoantibody productionin SLE. Using microarraytechnology, dysregulatedinterferon-inducible genesare being investigated in SSpatients, particularly thosehaving anti-Ro/SSA and anti-La/SSB autoantibodies.Additional studies underwayinclude the identification ofpathways that are dysregulatedacross multiple autoimmunediseases versus pathwaysthat distinguish specificdiseases, collaborative studiesto assemble an internationalregistry and repository ofsamples and data in SS, andstudies using microarraytechnologies to examine geneexpression in women withrecurrent miscarriages inSLE and APS.Anne Minenko, M.D. is one offive recipients of the AmericanCollege of Rheumatology’sClinician Scholar EducatorAward for 2003 to 2006. Sheis concerned about the nationwideproblem of the decliningnumber of internal medicineresidents who pursue rheumatologytraining, particularlybecause the “graying ofthe population” predicts anever-growing prevalence ofrheumatic diseases. She hasendeavored to diagnose theculture of the rheumatologyeducational experience atthe University of MinnesotaMedical Center campus andis exploring the notion that anenhanced orientation towardsa CLAN culture of teamwork,facilitation, high trust, andhuman resource developmentwould generate a higherrate of entry into therheumatology subspecialtyby medical trainees.At the VA Medical Center,research by a team led byMaren Mahowald, M.D. isinvestigating the efficacy ofchronic joint pain managementusing opioids or theintra-articular injection ofBotulinum Toxin A. She isalso evaluating the effectivenessof teaching rheumatologyprinciples and practiceto community physicians wholack previous formal rheumatologytraining. Hollis Krug,M.D. at the VA Medical Centerinvestigates abnormal bonemetabolism and ankylosisusing Ank/Ank mutant mice.In particular, she is interestedin the role that TGF-ß playsin the fusion of the vertebraeSecond harmonic generation imagingtechnology that is used to detect changesin diseased muscle is being adapted toperform non-invasive imaging of thecollagen found in knee joints.in these mice. Data obtainedin this work will lead to abetter understanding of thebiochemical and biomechanicalfactors that are associatedwith stiffening of the spine.Jasvinder Singh, M.D. isactively involved in variousaspects of health serviceresearch, including assessmentof quality of care, healthcare utilization, and accuracyof administrative diagnoses inpatients with arthritis in theVA Medical Center. Singh isalso participating in clinicaltrials of novel local therapiesfor chronic joint pain, whichincludes the intra-articularinjection of Botulinum ToxinA for patients with chronicshoulder pain. Other interestsinclude development ofquality-of-life instrument forpatients with gout and systematicreview of available therapiesfor various arthritidies.At Regions Hospital, ElieGertner, M.D. has developededucational models and aCD-ROM for rheumatologicalprocedures which are currentlyin use by house staff inour programs and elsewhere.He also continues his researchin medical education.73
Division of Rheumatic and Autoimmune Diseasesresearch Highlight: Researchers Identify Gene Associated with Lupus74A team of researchers led by Timothy W. Behrens, M.D.,of the University of Minnesota, has identified a specificgenetic change, or gene variant, that is associated withan increased risk of lupus. The results of the study, which wassupported in part by a grant from the ALR to Behrens, are reported in theSeptember issue of the American Journal of Human Genetics.Research suggests that susceptibility to lupus is strongly influenced bygenetic factors, and that genes also play an important role in other autoimmunediseases. On the basis of recent studies showing that a tiny variationin a gene called PTPN22 is linked to an increased risk of rheumatoidarthritis and type I diabetes, and previous findings that mice lacking thisgene develop lupus-like disease, Behrens and his colleagues investigatedwhether the PTPN22 gene variant is also associated with an increased riskof lupus in humans.“The interesting answer was that a greater percentage of lupus patientsalso carry this genetic change in PTPN22 than do people in the normalpopulation. And that essentially is the definition of a gene that is involvedin predisposing people to disease,” explains Behrens. “What’s also excitingis that this is the first gene, outside of the HLA group of molecules, that’sbeen identified that predisposes people to multiple autoimmune diseases,including lupus.”Behrens and his collaborators – including Ann Begovich, Ph.D. and her colleaguesat Celera Diagnostics in Alameda, CA, and ALR Scientific AdvisoryBoard member Peter Gregersen, M.D., who were key players in the studyof the PTPN22 gene in rheumatoid arthritis – analyzed DNA samples from525 lupus patients and 1,961 healthy “control” individuals. They foundthat the PTPN22 gene variant was present in 22.9 percent of whiteNorth Americans with SLE and 16.7 percent of control individuals.Although the difference in frequency of the PTPNP22 gene variant inpeople with lupus versus control individuals may seem relatively small,it is highly significant in terms of increasing the risk of SLE, says Behrens.“Sometimes small differences make a big difference in terms of who’sgoing to get a disease and who isn’t, and I think this is one of those cases,”he says. “We think that lupus is going to be caused by many genes of rela-tively small effect. So it could bethat it’s the combination of thesegenes of small effect that conspireto put you at very high risk.”What it means for people withlupus: “We’re starting to be ableto put the genetic picture of lupustogether,” says Behrens, althoughmany more genes involved in thedisease remain to be identified.He and others who study thegenetics of lupus believe thatfinding these genes will helpdoctors diagnose SLE, enable themto predict how the disease willaffect individual patients, and allow them to tailor therapies in a moretargeted and rational way. The finding that the PTPN22 gene plays a rolein lupus and other autoimmune diseases should also lead to new insightson how the immune system goes awry in these diseases. Behrens saysthere is evidence that the PTPN22 gene variant associated with thesediseases may slightly impair the ability to shut down the activity ofimmune cells known as effector T-cells after they get “revved up” inresponse to an infection. This hypothesis fits with the idea that certainaspects of the immune response are overactive in people with lupus andother autoimmune diseases.Timothy W. Behrens, M.D.Portions of this article have been reprinted from Lupus Research Update, Winter 2004,with the permission of the Alliance for Lupus Research (ALR). The ALR is a nonprofitorganization dedicated to supporting medical research for the prevention, treatment,and cure of lupus. One-hundred percent of all donations received go to support thescience program of the ALR. For more information or to provide a donation, visit theALR Web site at www.lupusresearch.org.
Faculty Recognition: Fall 2005New Division Directors &Section HeadsHCMCDean TsukayamaDivision of Infectious Diseases andInternational MedicinePromotionsPresented by Jonathan Ravdin,Nesbitt Professor and ChairProfessorGregory FiliceSamuel HoConrad IberDouglas NelsonJeffrey RubinsAssociate ProfessorPaul BohjanenEdward GreenoCarol Ann LangeMaureen MurdochCraig PeineCharles SmithChris WendtLifetime Achievement Awardfor Faculty EmeritusNeal GaultResearch Excellence AwardsPresented by Robert Hebbel,Vice Chair for ResearchResearch DayUMMCPeter BittermanHCMCAllan CollinsRegionsJohn MariniVAMCJames JohnsonEducational Excellence AwardsPresented by Wesley Miller,Vice Chair for EducationMMF Medical AlumniDistinguished Early CareerKaryn BaumOutstanding Medical SchoolTeacher AwardJames NixonOutstanding Contributions toPostgraduate, Graduate andProfessional Education AwardGreg VercellottiLifetime DistingushedTeacher AwardM. Thomas StillmanValerie UlstadEducational Excellence AwardsLinda BurnsSteven MilesMark RosenbergDistinguished Alumni AwardVince IacopinoResidency Program Teacherof the Year AwardPresented by Wesley Miller,Vice Chair for EducationUMMCKaryn BaumRegionsBryan WarrenVAMCMackenzi MbaiHCMCCharles SmithNew Medical EducationProgram DirectorAnne PereiraUniversity of MinnesotaMedical Student EducationalExcellence Award forOutstanding Contributionto Medical EducationM. Thomas StillmanClinical Excellence AwardsPresented by Bobbi Daniels,Elie Gertner, Scott Davies andKristin NicholUMMCLinda BurnsArek DudekConnie ManskeBarbara SegalRegionsElie GertnerHCMCEllen CoffeyVAMCRobert BonelloRecognition for OutstandingAcademic Achievement,Election to National ResearchSocieties Leadership ofSubspecialty Societies:Presented by Jonathan RavdinAlain BroccardBest Swiss Publication,Critical Care 2004Swiss Society of Critical CareAlan CollinsPresident ElectNational Kidney Foundation,2005President (2006)Conrad IberPresidentAssociated Professional SleepSocieties, 2005David IngbarVice PresidentAmerican Thoracic SocietyPresident2007-2008Dan KaufmanMcKnight Land-GrantProfessorship AwardDouglas NelsonDistinguished ServiceAward, American Society forGastrointestinalCharles Merieux AwardKristin NicholHarold S. Diehl Award,University of MinnesotaAlumni SocietyM. Thomas StillmanLeonard Tow Humanismin Medicine Award(National Award)Morris DavidmanMPR Minnesotan of the YearSteven Miles75
Prestigious Society MembershipsAmerican Society of ClinicalInvestigation (23)Robert J. BacheTimothy W. BehrensDavid G. BendittPeter B. BittermanJay N. CohnWilliam C. DuaneAshley T. HaaseRobert P. HebbelHarry S. JacobMichael D. LevittCary N. MariashPhilip B. McGlaveRonald P. MessnerJeffrey S. MillerCharles F. MoldowDaniel L. MuellerJack H. OppenheimerJonathan I. RavdinLeon D. SabathClifford J. SteerLouis TobianGregory M. VercellottiCatherine M. Verfaillie76Association of AmericanPhysicians (9)Robert J. BachePeter B. BittermanJay N. CohnAshley T. HaaseRobert P. HebbelHarry S. JacobPhilip B. McGlaveJonathan I. RavdinCatherine M. VerfaillieFellows, American Associationfor the Advancement ofScience (4)Jay N. CohnHarry S. JacobJonathan I. RavdinClifford J. SteerInstitute of Medicine (1)Ashley T. Haase600420