Produced by the Office of Communications // November 13, 2008
Team effort results in positive margin
for practice plan
End-of-fiscal-year results and institutional compliance were the featured topics of the Oct. 20 Medical Service, Research and Development Plan board meeting.
Karen Parsons, director of institutional compliance, said that all faculty and staff are being held to the compliance policy found in HOOP 2.19 and on the Legal Affairs and Institutional Compliance Web site.
“Conflict of interest is fact based, but the perception of conflict of interest is just as problematic as the real thing,” she said.
One of the rules is no cash gifts to employees, and a new HOOP policy states that any outside work related to one’s job here must be approved by an administrative supervisor. All faculty and administrative and professional staff will be required to complete an annual disclosure related to conflicts of interest.
Parsons reminded the group that each situation is different and to please contact the office of Legal Affairs and Institutional Compliance for specific questions.
Kevin Dillon, executive vice president and chief operating and financial officer, reported that fiscal year 2008 marks the sixth consecutive year the practice plan has posted a positive margin.
The Medical School practice plan includes MSRDP and UT Physicians. MSRDP is the “trust fund” for the university’s clinical services, and its board members are the Medical School department chairs and at-large members, who are elected by the faculty. UT Physicians is the business arm of the practice plan.
Dillon said the past year had been a “rebuilding year” for the Medical School, as it filled vacant faculty positions. There also was a growth in charges of 9 percent. Unsponsored charity care was $178 million, with the practice plan posting actuals of $0.2 million.
“Early indications are that it will be a good year of charges in fiscal year 09,” Dillon added.
Dean Giuseppe Colasurdo said he is encouraged by last year’s performance and the start of fiscal year 2009. “This was the first time in seven years that we have seen an increase in outpatient growth,” he said.
A team effort has resulted in these successes, he said. “The DMOs are engaged like never before, the chairs are engaged and talking to each other – this is a true group practice,” Dean Colasurdo said.
Dr. Steve Brown, associate dean for Harris County programs, reported volumes are high at LBJ General Hospital, with a an increase of deliveries of babies over last year, a result of Hurricane Ike and improvements in service and marketing. “Despite a medical surgical utilization that is below the arithmetic length of stay, the hospital is 97 percent occupied, and $119 million in new buildings are planned by 2011,” he said.
The next MSRDP board meeting will be held at 4 p.m., Jan. 12, 2008 in MSB 2.103. All clinical faculty are encouraged to attend.
Researchers: Phototherapy can improve preemie neurodevelopment
Medical School researchers say the use of aggressive phototherapy reduces the odds that tiny premature infants will develop neurodevelopmental impairment such as cerebral palsy, blindness, deafness, or physical or mental challenges. The study, “Aggressive Versus Conservative Phototherapy for Infants with Extremely Low Birth Weight,” is published in the Oct. 30, 2008 issue of the New England Journal of Medicine.
The study was a multi-center clinical trial funded by the Neonatal Research Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the Medical School was the lead center in designing and conducting it.
“Before this study, we had very limited information from clinical research to indicate how phototherapy should be used in small premature babies. The only previous major clinical trial was performed more than 30 years ago and included only a few infants who weighed less than 1,000 grams, or 2.3 ounces. With all the advances in obstetric and neonatal care, these infants are much more likely to survive today, and we need large clinical trials like this to know how to achieve the best possible long-term outcomes,” said co-author Dr. Jon Tyson, professor of pediatrics and obstetrics and the Michelle Bain Distinguished Professor in Medicine and Public Health.
Neonatal jaundice is a yellowing of the skin and other tissues in a newborn due to high levels of bilirubin, an indication that red blood cells are being broken down too quickly for the liver to process. The condition is caused by the newborn’s overall physiologic immaturity, including immaturity of the liver. Phototherapy helps to reduce the bilirubin level and the risk of brain damage that can occur when bilirubin reaches high levels and crosses over from the blood into the brain.
The study involved nearly 2,000 infants who were born at 501 to 1,000 grams birth weight between September 2002 and April 2005 in hospitals of the Neonatal Research Network, including Children’s Memorial Hermann Hospital and the Harris County Hospital District’s Lyndon B. Johnson General Hospital.
Aggressive phototherapy reduced the infants’ chances of having severe neurodevelopmental impairments, said Dr. Brenda Morris, former associate professor of pediatrics and principal investigator of the Neonatal Research Network study. “There was a 14 percent reduction in neurodevelopment impairment with aggressive phototherapy. This relative risk reduction was statistically significant, and we did not see any evidence of harm in the study’s larger infants, those weighing 751 to 1,000 grams at birth,” she said. Phototherapy was deemed aggressive when started in the first 24 hours of life and used until the bilirubin remained at very low levels.
In the smaller babies, the ones weighing 501-750 grams, Tyson said, the results suggest that the reduction in profound impairment may be offset by a trend toward a somewhat higher mortality rate. However, this increase was not statistically significant and may have simply occurred by chance. Tyson added that the Neonatal Research Network is in the planning stages of a trial which would investigate another treatment option for jaundice.
A special feature of the phototherapy trial was the use of an innovative method of statistical analysis (Bayesian analysis) to evaluate the study results. These analyses were performed by Dr. Claudia Pedroza, of the School of Public Health. Other study personnel include: Dr. Kathleen Kennedy; Georgia McDavid, R.N., Dr. Patricia Evans; Dr. Pamela J. Bradt; Dr. Laura L. Whiteley; Patty A. Cluff, R.N.; Anna E. Lis, R.N.; Claudia Y. Franco, R.N.; Maegan Currence, R.N.; Nora I. Alaniz; Patti L. Tate; Sharon L. Wright; and Esther G. Akpa, R.N.
Buja named outstanding alumnus
Dr. L. Maximilian Buja, executive vice president for academic affairs, received the 2008 Outstanding Alumnus Award from the Tulane Medical Alumni Association Oct. 4.
Buja earned an M.D. degree with honors from Tulane University School of Medicine in 1967 and was awarded a master of science degree in anatomy from Tulane’s graduate school the following year.
The award recognizes his “outstanding career accomplishments and his excellence in the medical profession.”
“I am very pleased and grateful to be recognized as the Outstanding Alumnus of the Tulane University School of Medicine,” Buja said. “Tulane provided me with a great medical education as well as exposure to biomedical research, which led to a position at the NIH for postgraduate training and a subsequent career in academic medicine.
“I feel that my early experiences at Tulane and especially my interactions with my mentor, Victor Ferrans, were crucially important for my subsequent development as a physician-scientist. Tulane and my hometown of New Orleans remain very special to me. Therefore, I am particularly gratified to receive this recognition by my medical alma mater.”
A faculty member since 1989, Buja served as chair of the Department of Pathology from 1989-1996 and as dean of the Medical School from 1996-2003.
Internationally recognized for his research in cardiovascular pathology, he is the author of more than 240 research articles, 150 book chapters, and two books.
Researchers: U.S. “super bugs” invading South America
Two clones of highly antibiotic-resistant organism strains, which previously had only been identified in the United States, are now causing serious sickness and death in several Colombian cities including the capital Bogotá, say Medical School researchers. The study, done in collaboration with Universidad El Bosque in Bogotá, is presented in a research letter published in the Nov. 13 issue of the New England Journal of Medicine.
U.S. clones of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecalis (VREF) have emerged in communities across Colombia. The variation of the MRSA clone, referred to as the USA 300, has been previously reported to be the most important cause of severe skin and soft tissue infections in the United States. The VREF clone is genetically related to a strain that hit a Houston hospital in 1994.
In Colombia before 2005, there were no recorded cases of any community-associated MRSA infections, including USA 300 MRSA. In 2005, there were two: one in Bogotá and one in the city of Villavicencio. Now the number of MRSA infections is climbing across the country. The paper reports a total of 15 infections, some of which were documented in two additional cities between 2006 and 2007, said Dr. Cesar A. Arias, assistant professor of infectious diseases.
The first case of VREF was reported in Bogotá in 2001. Since then, 50 additional cases have been identified at seven hospitals.
“We are tracking and recording these cases to find the link between the U.S. and Colombia. The goal is to find out why and how these organisms got there. With this information, researchers hope to better understand the molecular epidemiology of these super bugs to understand how they spread and how to control them,” Arias said. “The UT Medical School will continue to work with Latin American academic institutions to learn more about these antibiotic-resistant organisms.”
All patients diagnosed with community-associated MRSA infections suffered severe skin and soft-tissue infections. Some patients also experienced death of tissue surrounding bones, bacteria in the bloodstream and meningitis, and 20 percent of the patients died. The MRSA infections were treatable with common antistaphylococcal antibiotics, although 40 percent were resistant to tetracycline.
Arias added that the USA 300 clone of MRSA has not only been found in Colombia. In a recent presentation at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and Infectious Disease Society of America in Washington, D.C., Arias shared the news that this clone has been recorded in multiple patients in Ecuador and Venezuela.
Other research personnel at the UT Medical School included: Shahreen Chowdhury, Dr. Sreedhar Nallapareddy, and Dr. Barbara Murray. The research was funded in part by the National Institute of Allergy and Infectious Diseases.
NIH issues new policy on amended grant applications
The National Institutes of Health (NIH) have announced a major change in policy on the submission of amended grant applications. For original new applications and competing renewal applications submitted for the Jan. 25, 2009 due dates and beyond, the NIH will accept only one single amendment to the original application. The agency believes this policy will lead to the funding of high quality applications earlier, with fewer resubmissions.
During the transition to this new policy, original new and competing renewal applications that were submitted for due dates prior to Jan. 25, 2009 will be permitted two amendments. This new policy applies to all grant applications.
Information: Go to http://grants.nih.gov/grants/guide/notice-files/NOT-OD-09-003.html
Applicants sought for NIH Pioneer and New Innovator awards
The National Institutes of Health (NIH) are seeking applicants for the 2009 NIH Director's Pioneer Awards and New Innovator Awards. Both programs support exceptionally creative scientists who take highly innovative, potentially high-impact approaches to major challenges in biomedical or behavioral research. Pioneer Awards provide up to $2.5 million in direct costs over five years and are open to scientists at any career stage. New Innovator Awards provide up to $1.5 million in direct costs over five years and are for early career investigators who have not received an NIH regular research (R01) or similar NIH grant. The agency expects to fund up to ten Pioneer Awards and up to 24 New Innovator Awards in September 2009. The Pioneer Award competition begins with a proposal submission period from Nov. 17 to Dec. 17, 2008. The New Innovator Award competition begins with a proposal submission period from Dec. 15, 2008 to Jan. 15, 2009.
Information: Go to http://nihroadmap.nih.gov/pioneer and http://nihroadmap.nih.gov/newinnovator
Poster Club prize
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Events to Know
Microbiology and Molecular Genetics Seminar Series: Dr. Deborah Hogan (Dartmouth Medical School) presents “Pseudomonas-Candida interactions: A model, a problem and a solution.” 4 p.m., MSB 2.103. Reception to follow in 1.180 MSB.
Neurology Grand Rounds: Dr. Oscar Benavente (UT Health Science Center at San Antonio) presents “Prevention of Lacunar Strokes.” Noon, MSB 2.135.
BCM/UT PM&R Alliance Grand rounds: Drs. Enrique Ginzburg (University of Miami) and Dr. Elena Napolitano (New Jersey – University Hospital) present “Current Status of Throboembolic Disease in Rehabilitation Patients.” Noon, MSB B.605.
Department of Psychiatry and Behavioral Sciences Grand Rounds: Dr. John Oldham (Baylor) presents “Borderline Personality Disorder: New Findings and New Treatments.” 11 a.m., MSI Auditorium.
Issues in Global Health blue book elective: Dr. Cathy Flaitz, dean of the Dental Branch,presents “Oral Disease in the Developing World.” Noon, MSB 2.006. Sponsored by the “Global Health Initiative” and the John P. McGovern, M.D. Center for Health, Humanities, and the Human Spirit.
The 20th Annual William S. Fields Lecture: Dr. Walter Bradley (University of Miami) presents “Recent Advances in the Diagnosis and Management of ALS.” Noon, MSB 2.135.
Issues in Global Health blue book elective: Dr. Philip Johnson, professor of internal medicine, presents “HIV/AIDS & Tuberculosis” Noon, MSB 2.006. Sponsored by the “Global Health Initiative” and the John P. McGovern, M.D. Center for Health, Humanities, and the Human Spirit.
NRC Poster Session. 10 a.m. – noon MSB Leather Lounge.
Microbiology and Molecular Genetics Seminar Series: Dr. Alison O’Brien (Uniformed Services University of Health Sciences) presents “Shiga toxins: Potent poisons and pathogenicity determinants.” 4 p.m., MSB 2.103. Reception to follow in MSB 1.180.
The Mobile Health Clinic received a best practices award from the Texas Association of Counties. The mobile clinic serves the population of the Lower Rio Grande Valley that would otherwise not have access to health professionals. It is led by Dr. L. Maximilian Buja, Dr. LaTanya Love, Dr. Margaret McNeese, Kelly Bolton, and Dr. Kathy Becan-McBride.
Sam Li, first-year medical student, was elected to the Asian Pacific Medical Student Association (APAMSA) national board as Hepatitis B Chair. He will represent the Medical School Nov. 1 in San Francisco at APAMSA's Hep B Conference as part of the American Association for the Study of Liver Disease meeting.
Dr. Vasanthi Jayaraman, associate professor of biochemistry and molecular biology, was elected to the Council of the Biophysical Society for a three-year term, beginning in March.
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