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Emergency Medicine

Quick thinking leads to miraculous recovery of a stroke patient at VCU Health – VCU Health

By Leigh Farmer

Imagine watching your close friend and EMS surround you. Your eyes and ears take it all in, but you cannot move or speak.

This type of paralysis is called locked-in syndrome. It can happen when someone experiences a stroke.

I will never forget the paramedic. I kept going out and I remember he kept saying Chwanda look at me!, Chwanda Johnson recalled. She remembers everything from start to finish.

Sitting down with Chwanda, youll notice how she always has a smile on her face. It takes mere moments from the start of a conversation to see why she calls herself a jokester, others just start laughing right along with her. She even smiles when telling you about the scariest day of her life. November 7, 2023.

It was just like any other normal morning. I didnt feel anything different, the 49-year-old said, describing her early morning routine.

Chwanda usually hits the road at 6:30 a.m. to head to her job as a medical technician at a local senior living facility, where she has worked for more than 22 years. Usually, shes enthusiastic about getting a jump start on her day. But on that November morning, Chwanda stumbled to the car.

I got closer to the car, and it got worse. And I was like oh my God what is going on? she recalled.

When she got to the car, Chwanda called her friend Calvin on the phone who was still inside the house. As soon as she pressed send, her body gave out. She couldnt talk and her hands curled up into fists.

I wasnt able to say 9-1-1. I just said ugh, ugh, ugh.

Calvin ran out of the house and immediately knew Chwanda was having a stroke, so he dialed 911.

According to doctors, Calvins quick thinking saved his friends life. EMS was there in minutes and knew exactly where to take Chwanda.

Once I saw the VCU sign I was at ease because I knew I was in the right place. I didnt want to go anywhere else, Chwanda said.

About two million brain cells could be lost every minute a stroke goes untreated, according to VCU Health stroke specialists. A stroke happens when something blocks the blood supply to part of the brain or when a blood vessel in the brain bursts, rapidly decreasing the flow of oxygen to the brain. The more time that elapses, the worse the brain damage. After experiencing a stroke, an individual can have lasting brain damage, long-term disability or die.

Being prepared to react swiftly and appropriately, as Calvin did, can save a life. That is why it is important to recognize the symptoms.

I think if he hadnt called 911 when he did, I wouldnt be here, Chwanda recalled, her face changing quickly from a smile to a somber gaze.

Because Chwanda Johnsons close friend Calvin knew the signs of stroke, he immediately called 911. (Contributed photo)

When Henrico Division of Fire answered the call, medical personnel knew exactly what to do get Chwanda to the most equipped stroke care team in the area. They alerted VCU Medical Center. Thanks to this communication, emergency medicine physicians, nurses and a vascular neurologist were waiting at the door for Chwanda to arrive.

Our personnel are accustomed to the immediate availability of a multi-disciplinary team of specialists in emergency medicine, radiology, and neurology to care for these patients as well as the Direct to CT pathway that minimizes patient time to diagnosis and treatment, said Jeff Ferguson, M.D., medical director of Henrico Fire. Ferguson is also an emergency medicine physician at VCU Medical Center and associate professor in VCU School of Medicines Department of Emergency Medicine.

VCU Healths Comprehensive Stroke Center is one of only three centers of its kind in the region. Upon arrival, a patient suspected of having a stroke receives CT scans, labs, neurology assessments in one place. If surgery is needed, no time is wasted. They are waiting in a dedicated operating room that allows for the complete care of a stroke patient.

A quick CT scan at the hospital revealed a blood clot at the base of Chwandas brain. John Reavy-Cantwell, M.D., Chwandas neurosurgeon, removed that clot through a procedure called a mechanical thrombectomy less than an hour after Chwanda tripped in her driveway. The minimally invasive procedure is one of a few highly effective treatment options available when a patient is brought to the hospital soon after suffering from a stroke. If it takes longer for them to been seen by a medical team, the patient may be ineligible for the surgery.

Thats why its so critical for stroke patients to get medical treatment as soon as possible more options are available to prevent long-term health problems.

Recovery from a stroke is different for every person. Sometimes recovery can take weeks, months or even years. While some people fully recover, others live with lifelong disabilities such as problems with memory, speech or mobility. Rehabilitation can involve a variety of different therapists and support groups that help stroke survivors live with their new normal.

For Chwanda, it was a matter of hours before she was sitting up and laughing, back to her old self.

I could hear voices saying, move your feet, lift your leg. And anything they told me to do I did. And I heard them say Oh, call the doctor! Call the doctor! They were so surprised, said Chwanda. She describes it like she was performing a magic trick.

Reavey-Cantwell couldnt believe his own eyes when he went to check up on Chwanda several hours after removing the blood clot from her brain.

I thought that I had walked into the wrong patient's room because she was awake and talking and moving everything, he said. I was turning around to leave and then said, oh, no, this is her. Oh my gosh!

Her daughter and two granddaughters were by her side. Reavey-Cantwell believes Chwandas remarkable recovery is part miracle and part perfect execution of emergency stroke protocol.

She was probably as close to death as one can really come and then came back and made an incredible recovery, in my opinion, Reavey-Cantwell said.

Since Chwanda Johnson had a stroke, her 9-year-old granddaughter keeps stroke educational information with her so she can help if theres an emergency. (Contributed photo)

While the month of May is Stroke Awareness Month, VCU Healths Comprehensive Stroke Center is dedicated to raising awareness all year long.

The center works with the academic health system, VCU, and the Richmond community to educate residents, students, faculty, and medical professionals alike on the signs, symptoms, and latest methods for treating stroke patients. This outreach includes an annual conference as well as the city-wide initiative Stroke Smart Richmond, which educates people on stroke symptoms to reduce treatment delays.

The co-leaders of the project, VCU Health stroke program manager Stacie Stevens, Ph.D., D.N.P., R.N., and emergency room physician Ramana Feeser, M.D., are driving home one important message: When you spot a stroke, call 911.

The majority of patients with a confirmed diagnosis of stroke do not arrive by EMS, Feeser said. On top of this, most stroke patients arrive too late to be eligible for effective medication for a stroke. There is hope, if you come to us fast. We need everyone possible to spot a stroke and stop a stroke by calling 911.

You never know who will take it to heart.

Chwandas littlest advocate, her 9-year-old granddaughter, carries stroke information everywhere she goes.

She keeps it in her purse just in case she is here with me and needs to know what to do, said Chwanda with tears running down her face and a heart bursting with gratitude.

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Quick thinking leads to miraculous recovery of a stroke patient at VCU Health - VCU Health

Emergency Medicine

CPR and AED save life of man at the gym with help from UAB physician – University of Alabama at Birmingham

Knowing the basics of CPR, even low-quality CPR from a bystander, can be a lifesaving action for a person in need.

Photography: Jennifer Alsabrook-TurnerFor Floyd Lawson, it started off as a normal weekend workout at his local YMCA branch. A veteran, husband, grandfather and gym regular, Lawson usually spends two hours or so at the gym doing cardio, stretching, lifting weights and then a visit to the steam room. To say he is active and in good health is an understatement.

However, on that Saturday in the spring of 2024, Lawson sat up after doing a round of crunches and felt the blood drain from his body.

I thought wow, let me compose myself, Lawson recalled. And that is the last thing I remember. That is until I saw my guardian angel, Dr. Andy.

On that same Saturday at the same YMCA by pure chance, Andrew Edwards, M.D., emergency medicine physician at the University of Alabama at Birmingham, was working out with his son. He saw a group of people gathered around a man on the floor and immediately ran over to help.

I realized what was happening a man had collapsed and was suffering from what appeared to be cardiac arrest so I jumped in to help a medical student and nurse who were already performing CPR on the man, Edwards said. We realized how dire the mans situation was and that it was imperative that early onset and effective CPR and defibrillation were needed.

After CPR was performed for nearly two minutes followed by advised shock via an AED, Lawsons pulse went out again and Edwards did another round of CPR and defibrillation. Once Lawson woke up after nearly 10 minutes, Edwards was immediately able to route EMS to UAB Hospital and give a heads up to the attending in UABs University Emergency Department that Lawson was on the way.

It felt like I was really put in the right place at the right time, Edwards said. Ive been doing this long enough that I went into automation mode; I can help restart someones heart this is my fastball. But outcomes can be variable if bystander CPR isnt administered quickly and effectively. Im really glad we were able to get him to UAB fast, too.

Edwards stresses that every person should know the basics of CPR, as even low-quality CPR from a bystander can be a lifesaving action for a person in need.

Cardiac arrest occurs when the heart stops beating unexpectedly and results in no blood flow to the entire body. Like Lawson, theindividualwill beunresponsive, witheither no signsof breathingor very abnormalbreathing, and no detectable pulse.

Ryan Coute, D.O., assistant professor in the UAB Department of Emergency Medicine, outlines what a person should do if they find themselves in a position to administer CPR to a person in need:

Photography: Jennifer Alsabrook-TurnerIt is OK to not provide rescue breaths if you are uncomfortable doing so. Instead, focus on providing chestcompressions until 9-1-1personnel arrive. If providingrescue breaths, givetwo breaths after every 30 chest compressions and repeat until 9-1-1personnel arrive.

If available, use an automated external defibrillator, or AED, and follow its instructions as soon as possible.

CPR is highly effective and can double thelikelihoodof survival for those in cardiac arrest, Coute said. It is very important to begin CPR as soon as possible because survival will decrease byaround10 percent for every minute without CPR.If in the moment you are uncertain of what to do, call 9-1-1 and the medical dispatcher can provide youinstructions over the telephone to helpidentifycardiac arrest and begin the steps for CPR.

At the YMCA that day, Edwards and others performed hundreds of chest compressions. Their quick action undoubtedly saved Lawsons life, and bystanders watching and seeing how quick and simple CPR can be undoubtedly will save others, Lawson thinks.

When I got to UAB, it was clear that I had had a heart attack, Lawson said. I was perfectly healthy, and for this to happen at the gym of all places I was just in the right place at the right time. I truly feel like Dr. Andy is my guardian angel and that God put him there to save my life that day. If I had collapsed anywhere else, I may not be here today.

Since Lawsons heart attack at the YMCA that day, he and Edwards have struck up a friendship. They have much in common, including their faith, and even plan to meet up at the YMCA one day soon for a joint workout when Lawson is back to full health.

I never thought in my life that I would be saved by a complete stranger performing CPR, which is why its so important that everyone knows the basics of CPR I cannot stress that enough, Lawson said. I dont know what I can ever say to Dr. Andy for saving me. Thank you for not giving up on me.

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CPR and AED save life of man at the gym with help from UAB physician - University of Alabama at Birmingham

Emergency Medicine

Visby Medical Sexual Health Test Results in More Appropriate Antibiotic Treatment and Shorter Emergency … – PR Newswire

Point-of-Care test significantly shortens time from ED arrival to test results, treatment and discharge significant improvements are seen in the use of antibiotics for the treatment of chlamydia and gonococcal infections in women

Nationwide increases in sexually transmitted diseases and antibiotic resistance create the need for a paradigm shift from traditional lab-based molecular testing

SAN JOSE, Calif., May 30, 2024 /PRNewswire/ -- Visby Medical and the Johns Hopkins Medicine Department of Emergency Medicine announced findings froma study evaluating a new approach to management of the three most common non-viral sexually transmitted infections (STI) in women. The study found that use of the Visby Medical Sexual Health Test, a point-of-care (POC) polymerase chain reaction (PCR) test, shortened time from specimen collection to STI result to only 47 minutes per patient, compared to an average of 25 hours for the standard of care (SOC) lab-processed molecular send-out tests. The Visby Medical test also resulted in significantly higher rates of appropriate treatment and lower rates of over-treatment with antibiotics for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections, compared to SOCi.Full data were presented on May 17 at the 2024 annual meeting of the Society for Academic Emergency Medicine (SAEM).

The Visby Medical Sexual Health Test is the only "instrument-free" POC test available in the U.S. that provides PCR results in under 30 minutes. In March 2023, the Visby Medical test received 510(k) clearance and was granted a CLIA waiver from the U.S. Food and Drug Administration for its second-generation POC test.

An STI surveillance report published in 2024 by the U.S. Centers for Disease Control (CDC) found more than 2.5 million cases in 2022ii. At the same time, the rate of inappropriate use of antibiotics to treat STIs has contributed to antimicrobial resistant strains of NG, prompting the World Health Organization (WHO) to release new guidance to improve diagnosis of STIs, including POC tests, with special emphasis on reducing antimicrobial resistanceiii.

"The rise in STIs has created a crisis for the nation's hospital emergency departments because the conventional send out tests do not provide results fast enough to inform treatment decisions during the patient visit. Rather than lose a potentially infected patient, clinicians must decide whether to treat before they have definitive results, which isn't ideal for anyone and contributes to antibiotic resistance," explained Gary Schoolnik, MD, an infectious disease expert, Chief Medical Officer at Visby Medical, and Professor of Medicine at Stanford University. "The dramatic improvements seen with the Visby Sexual Health test in testing time, ED visit duration, and in the use of antibiotics point the way toward a new best practice for STI testing. Implementation of a new rapid point-of-care testing standard of care would greatly benefit our hospitals, urgent care centers and, most importantly, women who seek treatment for this condition."

The study, Management of Sexually Transmitted Infections in the Emergency Department: Evaluation of a Point-of-care Test, compared two approaches to testing female patients presenting to the Johns Hopkins Emergency Department in Baltimore, MD with potential STIs during two separate four-month study periods in 2022 and 2023. The first approach, SOC central laboratory testing with batched nucleic acid amplification testing (NAAT) (n=517 patients), and the second approach, the POC PCR Visby Medical Sexual Health Test (n=304 patients), were compared for rates of STIs identified, median time-to-result intervals between the two phases, and rates of appropriate treatment (including over and under treatment) based on CDC recommended guidelines.

For patients testing positive (4.8% for CT, 2.7% for NG, 8.0% for trichomoniasis [TV], and 1.9% with co-infections), proportions of appropriate treatment were significantly higher among the POC group for CT (92.7% vs 75.1% p<0.001) and NG (87.1% vs 74.3% p<0.001). Proportions of over-treatment were significantly lower among the POC group for CT-negative (7.0% vs 25.2% p<0.001) and NG-negative (13.0% vs 25.5% p<0.001) patients. No significant differences between the two testing groups were seen for TV. Median time intervals were significantly lower for the POC group, including time from specimen collection to STI results (47.0 minutes vs 25 hours p<0.001), time from ED arrival to STI results (5.7 hours vs 33.9 hours p<0.001), and time from ED arrival to discharge (9.1 hours vs 11.9 hours p<0.001)iv.

The study was conducted by researchers at Johns Hopkins Universitywith support fromVisby Medical.

About Visby Medical Visby Medical is transforming the order of diagnosis and treatment for infectious diseases so clinicians can test, talk with, and treat the patient in a single visit. The Company developed a proprietary technology platform that is the world's first instrument-free, single-use PCR platform that fits in the palm of your hand and rapidly tests for serious infections.

The Visby Medical Sexual Health Test for women is the first step in a robust pipeline that is accelerating the delivery of fast and accurate, palm-sized PCR diagnostics to the point of care, and eventually for use at home. For more information, visitwww.visbymedical.com. Follow Visby Medical onLinkedIn.

Media Contact: Harry Wade [emailprotected] 917-482-9057

iKendall N. Maliszewski BS, Management of Sexually Transmitted Infections in the Emergency Department: Evaluation of a Point-of-care Test. Paper presented at the 2024 annual meeting of the Society for Academic Emergency Medicine, May 14-17 2024, Phoenix, AZ. iiCDC, CDC's 2022 STI Surveillance Report underscores that STIs must be a public health priority. Available here: https://www.cdc.gov/std/statistics/2022/default.htm. iii WHO Announcement: WHO releases new guidance to improve testing and diagnosis of sexually transmitted infections, 24 July 2023. Available here: https://www.who.int/news/item/24-07-2023-who-releases-new-guidance-to-improve-testing-and-diagnosis-of-sexually-transmitted-infections. ivKendall, Management of Sexually Transmitted Infections.

SOURCE Visby Medical

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Visby Medical Sexual Health Test Results in More Appropriate Antibiotic Treatment and Shorter Emergency ... - PR Newswire

Emergency Medicine

St. Luke’s EMS Physician Response Team Partners with Bethlehem Ambulance Crews – The Valley Ledger

The blue, gold and white Ford Expedition with the St. Lukes logo on its doors rushed along Schoenersville Road in Bethlehem on route to assist an ambulance crew caring for a patient with an unusual, life-threatening medical emergency.

This specialized vehicle is a key component of a new partnership between St. Lukes Emergency Medicine Department and Northampton County, aimed at saving more lives at on-scene accidents and incidents in Bethlehem.

Bryan Wilson, MD, St. Lukes EMS Fellowship Director and Director the EMS Response program, explained: This new collaboration with Northampton County and our first-responder partners puts our fellowship-trained emergency medical services faculty physicians and fellows in the field in a mobile manner to supplement and support the medically complex care provided by emergency medical technicians (EMT) and paramedics in the community.

St. Lukes mobile EMS Response Team is the first one of its kind in the Lehigh Valley area, currently serving ambulance units from the City of Bethlehem EMS, Suburban EMS and Bethlehem Township Volunteer Fire Company and expecting to add other units in the future.

The grant-funded $250,000 vehicle, like a mini-ER on wheels, is equipped with state-of-the-art heart monitor/defibrillator, integrated CPR and ventilation feedback devices, life-saving medications, advanced airway management supplies and a hand-held ultrasound machine. Plans are underway to carry emergency blood for on-scene transfusions when there is major blood loss.

Dr. Wilson was behind the wheel of the Ford that day, responding to a request for assistance from the EMS crew. Together, he and the EMS crew worked with staff from a cardiologists office to save the patients life after his pacemaker malfunctioned. The team was able to safely deliver the living patient to a nearby hospital for follow-up care.

Based at St. Lukes Anderson Campus, the EMS Response Team receives requests from an ambulance crew through Northampton Countys 911 Center. The Response Team also provides continuing hands-on emergency medicine education to first responders in the county. These services help show EMS clinicians how much we value their expertise and possibly address recruitment and retention issues faced by EMS services professionals across the region, added Dr. Wilson.

What the EMS Response Team brings to that on-scene setting are extra hands and an advanced understanding of the patients pathophysiology (disease processes), so we can better the direct the care of the patient, in partnership with the on-scene EMTs and paramedics, thinking outside of the box, when necessary, to save lives.

Photo caption: Bryan Wilson, MD, St. Lukes EMS Fellowship Director and Director the EMS Response program.

About St. Lukes

Founded in 1872,St. Lukes University Health Network(SLUHN) is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 350+ outpatient sites. With annual net revenue of $3.4 billion, the Networks service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Lukes hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Lukes Childrens Hospital.

Dedicated to advancing medical education, St. Lukes is the preeminent teaching hospital in central-eastern Pennsylvania. In partnership with Temple University, the Network established the Lehigh Valleys first and only four-year medical school campus. It also operates the nations oldest School of Nursing, established in 1884, and 52 fully accredited graduate medical educational programs with more than 500 residents and fellows. In 2022, St. Lukes, a member of the Childrens Hospital Association, opened the Lehigh Valleys first and only free-standing facility dedicated entirely to kids.

SLUHN is the only Lehigh Valley-based health care system to earn Medicaresfive-starratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and HealthgradesTop Hospitaland a Newsweek WorldsBest Hospital. The Networks flagship University Hospital has earned the100 Top Major Teaching Hospitaldesignation from Fortune/PINC AI 10 years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Lukes was identified as one of the15 Top Health Systemsnationally. Utilizing the Epic electronic medical record (EMR) system for both inpatient and outpatient services, the Network is a multi-year recipient of theMost Wiredaward recognizing the breadth of the SLUHNs information technology applications such as telehealth, online scheduling and online pricing information. The Network is also recognized as one of the states lowest-cost providers.

Information and image provided to TVL by: Sam Kennedy

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St. Luke's EMS Physician Response Team Partners with Bethlehem Ambulance Crews - The Valley Ledger

Emergency Medicine

Extreme Heat: What ER Doctors Want You to Know – The New York Times

The heat index hit 112 degrees in Miami this week. Monkeys have been dropping dead amid scorching heat in Mexico. India is experiencing its latest heat crisis.

With warmer temperatures comes a greater potential for heat-related illnesses. Rates of emergency room visits for conditions related to heat rose substantially in many parts of the United States last summer, according to the Centers for Disease Control and Prevention. And weather experts are again predicting above-normal temperatures in much of the country this summer.

We asked emergency room doctors around the country what the public should know about extreme heat.

Mild heat illnesses include heat rash; swelling in the hands and feet; muscle cramps; and heat syncope, or a fainting episode after standing too long or getting up suddenly. People with heat exhaustion have more severe symptoms, which could include headache, nausea, vomiting and dizziness.

Dr. Hany Atallah, an emergency medicine physician and the chief medical officer of Jackson Memorial Hospital in Miami, said heat exhaustion is the most common heat-related illness he sees in the E.R. Doctors can usually help patients cool down and hydrate properly and, within a few hours, discharge them, he said.

Heat stroke, which can be caused by exposure to extreme heat or strenuous exertion in high temperatures, is less common but much more dangerous. The hallmark signs are a core body temperature above 104 degrees; and confusion, seizures or other mental status changes in the context of extreme heat exposure.

The bodys ability to cool itself is impaired, Dr. Atallah said. The condition can lead to brain damage, muscle breakdown and kidney failure.

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Extreme Heat: What ER Doctors Want You to Know - The New York Times

Embryology

ESHRE Ferti Job Hub: A New Initiative for Employers and Job Seekers in Human Reproduction and Embryology – ESHRE

Written by Alberto Sola-Leyva & Mariana Sousa Leite

17 hours ago

2 min read

Bridging the Gap Between Talent and Opportunities in the Field of Reproductive Health

To streamline the process of connecting employers with qualified candidates within the human reproduction and embryology field, the ESHRE Young Talent Group (YTG) has launched an innovative initiative known as the Ferti Job Hub. This significant move underscores the commitment of the YTG and ESHRE to enhance the career prospects and support of professionals in reproductive health .

The Ferti Job Hub serves as a centralised digital resource within the ESHRE website that aims to simplify and facilitate recruitment and provide a much-needed and valuable resource for both potential employers and job seekers. This digital resource lists open job vacancies categorised according to different areas of expertise and job types. Job seekers can explore each vacancy at their own pace and share it with themselves or other colleagues via email. All ESHRE exhibitors and attendees are invited to submit their job vacancies and make them available for all to see in this ESHRE digital resource. In this way, we hope to promote and facilitate relationships between clinics, educational institutions, companies and qualified candidates, ensuring that the connections made are valuable, optimised and meaningful for all parties.

At the 40th ESHRE Annual Meeting in Amsterdam (7th-10th July 2024), the YTG will unveil the ESHRE Ferti Job Hub. Located in the ESHRE Village, the Ferti Job Hub is designed as a focal point for employment opportunities.

The Hub has a dual purpose. It provides a space for qualified professionals to actively explore employment opportunities and serves as an avenue for potential employers to advertise jobs.

The ESHRE Ferti Job Hub will have its own corner so visitors to the ESHRE Village can recognise it easily. It will feature touch screens where job seekers will find this centralised ESHRE digital resource and can identify and explore the advertised employment vacancies according to their areas of expertise and interests. All work openings will have a description that remains consistent across the job listing to ease the searching and application process.

The call to submit job vacancies will open next week via an online form submission. All ESHRE exhibitors and attendees are invited to submit their job vacancies. To ensure the quality and relevance of job postings, the initiative is supervised to guarantee that the offers are suitable for the ESHREsspecialised audience.

For employers: Prepare your proposals of the job vacancies you may currently have available and contact ESHREs communication manager at laura@eshre.eu to share your interest and learn how to submit them to the digital resource.

For job seekers: Make sure you CV, cover letters and research overviews are updated and ready to be shared with interesting opportunities. Dont miss out on potentially finding your next adventure and visit the Ferti Job Hub at the ESHRE Village in Amsterdam.

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ESHRE Ferti Job Hub: A New Initiative for Employers and Job Seekers in Human Reproduction and Embryology - ESHRE

Internal Medicine

Residents and Faculty Shine at Internal Medicine Annual Meeting – Washington State University

Residents and faculty from the WSU College of Medicine and Internal Medicine Residency Program in Everett were showcased via multiple posters, oral presentations, and workshops at the highly competitive Society of General Internal Medicine annual meeting in Boston. The conference was attended by approximately 2700 clinicians.

The list of presentations and leadership roles by WSU colleagues represents an incredible level of engagement and highlights WSU COMs growing national reputation.

Meeting proceedings will be published in a supplemental issue of the Journal of General Internal Medicine.

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Residents and Faculty Shine at Internal Medicine Annual Meeting - Washington State University

Internal Medicine

Opinion | Smoking Isn’t the Only Source of Nicotine Addiction in Town – Medpage Today

Benowitz is a professor of medicine, and a nicotine and tobacco researcher.

E-cigarettes were introduced in the early 2000s as a way for smokers to manage their nicotine addiction without exposing themselves to the well-documented harms associated with the toxins and carcinogens in combustible cigarette smoke. These harms include increased risks of cancer, cardiovascular disease, chronic lung disease, and a number of other debilitating or life-threatening diseases. While many people have used e-cigarettes to quit smoking, other non-smokers have taken up e-cigarette use, particularly young adults.

However, the use of e-cigarettes, commonly known as vaping, is not without harm. Based on a review of the published data available at the time, an expert committee of the National Academies of Sciences, Engineering, and Medicine issued a report in 2018 finding conclusive evidence that although substituting e-cigarettes for combustible cigarettes reduced exposure to numerous toxins and carcinogens, e-cigarette use is not risk-free.

What are some of the harms? People who vape continue to be exposed to nicotine, which is highly addictive, making quitting e-cigarettes difficult for some. In addition, vapers may be subject to social stigma, and they incur expenses for purchasing vaping devices and liquids. Many people who have taken up vaping, either to help themselves quit smoking or as a primary form of recreational drug use, would like to quit. Furthermore, some healthcare professionals are supportive of the use of e-cigarettes to quit smoking but would like their patients to stop use when they are confident they will not relapse to smoking, due to the possible risks of nicotine use.

A study recently published in JAMA Internal Medicine is the first randomized, placebo-controlled trial to report a successful e-cigarette cessation benefit with pharmacological treatment. As a member of the Data and Safety Monitoring Committee for this study and an author on the publication, I believe the findings are an important step in addressing a relatively new source of nicotine addiction. This publication provides an opportunity for clinicians and the public health community to revisit how we think and talk about the harms associated with smoking, vaping, and nicotine addiction, and to reconsider how we can best take action to help reduce these harms.

Help or Harm: How Do We Discuss Vaping With Patients?

The fact that vaping can be associated with a high degree of dependence and a possible risk to health creates a challenge in counseling patients about their use of e-cigarettes. Given the extreme dangers associated with cigarette smoking, I believe that vaping can be a useful tool for harm reduction. I also believe that overcoming nicotine addiction -- in any form -- provides health, social, and economic benefits to those who can quit.

Healthcare professionals are solutions-oriented, and we strive to help patients set and achieve goals that can improve their physical and mental health and their quality of life. The lack of effective vaping cessation medications is an important missing piece of the puzzle when discussing the relative risks and benefits of smoking, vaping, and overcoming nicotine dependence. Survey data show that more than half of adults vaping nicotine plan to quit using e-cigarettes, and approximately 15% had already tried to quit in the prior year. Some succeeded, but additional tools are likely needed to help others. Is it realistic to counsel patients to quit vaping without addressing the very real biochemical basis of their nicotine addiction?

Hope for an Effective Vaping Cessation Therapy

Our data in JAMA Internal Medicine suggest we may be moving closer to finding an important intervention for e-cigarette-related nicotine dependence. The Phase II randomized clinical trial ORCA-V1 found that e-cigarette cessation rates were significantly higher for participants receiving 12 weeks of cytisinicline plus behavioral support compared with those receiving behavioral support alone. Cytisinicline is a partial agonist at 42 nicotinic acetylcholine receptors that mediate nicotine dependence and has shown efficacy for cigarette smoking cessation.

In the study, 160 participants were randomized 2:1 to 3 mg cytisinicline taken three times daily or placebo for 12 weeks. All participants received weekly behavioral support. The primary endpoint was biochemically verified continuous abstinence from nicotine e-cigarette use, measured during the last 4 weeks of treatment. Participants receiving 12 weeks of cytisinicline treatment had 2.6 times higher odds of having quit vaping during the last 4 weeks of treatment compared with subjects who received placebo, with vaping cessation rates during weeks 9-12 of 31.8% and 15.1%, respectively. No treatment-related serious adverse events were reported, and rates of adverse events were similar between the cytisinicline (50.9%) and placebo (54.7%) arms.

Acting Today While Awaiting Tomorrow's Advances

Although additional studies are needed to confirm the efficacy and safety of cytisinicline as a vaping cessation therapy, the ORCA-V1 results show that pharmacological tools may help to address the complex role that vaping plays in the continuum of reducing harms from cigarette smoking while sustaining nicotine addiction. These findings are particularly encouraging given the increasing prevalence of e-cigarette use among adults -- especially young adults -- in the U.S. Moreover, as a plant-based alkaloid, cytisinicline may appeal to those who prefer natural products as well as those who have tried and failed to quit smoking or vaping using other pharmacologic agents.

As we await additional data supporting the use of cytisinicline as a vaping cessation therapy, those of us who counsel patients who smoke cigarettes or vape nicotine should not shy away from having candid discussions about smoking, vaping, and overcoming nicotine addiction. We should be able to explain the risks and benefits of vaping and our patients' ability to make decisions that meet their personal health and lifestyle goals. With additional research, I hope those discussions will one day soon include the availability of safe and effective vaping cessation therapy.

Neal L. Benowitz, MD, is professor emeritus in the Department of Medicine at the University of California San Francisco.

Disclosures

Benowitz reported personal fees from Achieve Life Sciences while the JAMA Internal Medicine study was being conducted, as well as personal fees as a tobacco litigation expert witness in litigation against tobacco companies.

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Internal Medicine

Benefis gets approval for Internal Medicine residency program – KRTV NEWS Great Falls

Benefis Health System recently earned approval for its new Internal Medicine Residency Program from the Accreditation Council for Graduate Medical Education, bringing more health care professionals to the central Montana area.

Physicians coming out of medical school become residents to further learn their specialty. It works like an apprenticeship with gradually escalating responsibilities and autonomy. Internal medicine providers for adult patients over time, treating chronic illness and monitoring wellness. Residents in the program will learn to take care of hospitalized patients and learn preventative medicine.

Internal Medicine Residency Program Director Michael Sheffield says, Statistics say that when you finish your training, wherever you are, 60 to 70% of those residents will remain in the area. So if we train them here, we have a good chance of keeping about two thirds of them in the area to provide care for the future patient, future generations in this area.

After the three year program, most residents will become internal medicine providers and later move on to a speciality like cardiology or critical care. Program leaders hope to gear residents towards relevant specialities like geriatrics and addiction medicine. With the new residency, patients will be interacting with students and residents which may take more time, but all care and decisions will be supervised by medical professionals.

Sheffield describes, as patients become accustomed to it, the nursing staff, respiratory therapy, all of the staff will begin to work with residents more directly and change the way they work, and so forth in the way patients receive their care.

Sheffield explains he is most excited for the residents energy, curiosity are things that are refreshing every day. And so looking forward to having them here to have those discussions, to remember back when and what it was like when I started and what it's like now, to make sure they get the same sort of joy and excitement that we all had when we were training.

The first graduates from Touro College of Osteopathic Medicine in Great Falls, as well as will be eligible to apply for the Internal Medicine Residency in Fall 2025, in the programs second year.

Benefis will be accepting applications this fall, with the first ten Internal Medicine Residents starting in July 2025.

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Benefis gets approval for Internal Medicine residency program - KRTV NEWS Great Falls

Internal Medicine

A Mother’s Encouragement and a Husband-Wife Doctor Team Set the Stage for a Career in Hematologic Oncology – The ASCO Post

Lymphoma expert Jane N. Winter, MD, grew up on the south shore of Long Island in New York. My dad sold cars in my great uncles dealership after a failed foray into business after World War II. My mom graduated high school at 16 to go to work to help support her family. When my younger brother went off to kindergarten, she went back to school to take college prerequisites, then to a community college, then to college, and ultimately to graduate school, where she completed a masters degree in learning disabilities. I think my mom was the driving force in my decision to become a physician; when I told her I wanted to be a nurse, having read the Cherry Ames book series, she said, No, youll be a doctor, which was pretty forward-thinking for a woman in the 1950s, she related. I have two brothers who have been amazing in terms of their successes, both executives at Fortune 500 companies, and have always been very supportive.

TITLE

Professor of Medicine, Division of Hematology/Oncology; a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University; and a hematologist at Northwestern Medicine

MEDICAL DEGREE

University of Pennsylvania School of Medicine, Philadelphia

ADVICE FOR YOUNG WOMEN CONSIDERING A CAREER IN ONCOLOGY

We have certainly made progress in closing the gender gap, but its definitely challenging for young women who want to balance a career and a family. Its never going to be easy, because there is never enough time for everything we want to do. However, being persistent and confident in yourself is key. In short, join societies such as ASH and ASCO, and when you have an opportunity, seize it.

Dr. Winter continued: I also had a very unusual set of pediatricians, a husband-wife team, who influenced my perception of medicine. Their office was on the first floor of their home, and their children would play in the yard while one of them saw patients, and the other made house calls. If I was sick, my mom would say, Dr. Bea is in the office, and Dr. Philip is making house calls. Who do you want to see? I didnt think twice that Dr. Beatrice was a physician.

On the Cusp of the Womens Movement

It was totally serendipitous that I wound up at a womens college, the same college Dr. Bea had attended. I was recruited to Bryn Mawr by friends of my parents who really wanted me to date their son, who was applying to nearby Haverford. As it happened, I was invited to a Bryn Mawr Alumnae Association reception where I met the most amazing group of professional women. That just sealed the deal for me as to which college I wanted to attend. Bryn Mawr was a very intellectually challenging place, which, in many ways, laid the foundation for my career path and my world view, she said. I majored in philosophy and spent a year at the London School of Economics studying Philosophy of Science, a field I keep hoping to revisit.

Valued Early Mentors

During her undergraduate years at Bryn Mawr, Dr. Winter spent free time in Philadelphia, which influenced her next step. I loved Philadelphia, so the University of Pennsylvania School of Medicine seemed like a natural transition. It was career-shaping in many ways. For example, I encountered Dr. John Glick, who later became Penns Cancer Center Director but also my housemates beloved hematologist-oncologist. I also spent an invaluable month rotating at Fox Chase, where I had amazing experiences caring for patients with all types of malignancies but particularly patients with leukemia and lymphoma, she explained.

Asked what sealed the deal for her decision to pursue blood malignancies, Dr. Winter replied: Its fairly common for important experiences during medical school to impact a students career choice. I had some very engaging rotations as a medical student, particularly with hematologists who impressed me. I also had a close childhood friend who developed Hodgkin lymphoma and underwent treatment with Dr. Glick while living with me during my second year of medical school. In retrospect, that experience in addition to the role models I encountered during medical school and residency likely determined my direction.

Dr. Winter added: I loved looking under the microscope at blood smears, bone marrow, and lymph node biopsies, and I especially enjoyed integrating the pathology with the clinical picture. Some of my best mentors were hematopathologists.

Brief Indecision

After attaining her medical degree in 1977 from the University of Pennsylvania School of Medicine, Dr. Winter decided on another big city experience for her internship and internal medicine residency at the University of Chicago, where her interest in the hematologic malignancies was further encouraged by rotations with Dr. John Ultmann and Dr. Harvey Golomb, both of whom played major roles at ASCO. But I also liked bedside cardiology and found myself being strong-armed by the Chief of Cardiology to stay on as a cardiology fellow. Did I really want to be an interventionalist, passing catheters all day and wearing a lead apron?

Dr. Winter continued: Luckily, I had a good friendthe other Jane from collegewho was an internal medicine resident at Columbia, where Dr. Rose Ruth Ellison was the new head of oncology and the attending on Janes General Medicine rotation. Jane told Dr. Ellison that she had a friend who might be interested in hematology/oncology and Rose Ruth said, Bring her tomorrow. So, I showed up and signed on. Truth be told, my goal in life at that time was a subscription to the New York City Ballet, a passion Jane and I share. So, thats how I wound up at Columbia, she related.

As it turned out, Dr. Winters fellowship at Columbia was cut short by unforeseen circumstances. Within the first weeks of my fellowship, the head of the cancer center, Dr. Paul Marks, left to become President of Memorial Sloan Kettering Cancer Center and took with him the Division Chief of Hematology, Dr. -Richard Rifkind. Soon thereafter, one of Columbias best -hematologists, Dr. Hymie Nossel, had a massive heart attack. The place seemed to be decimated.

At the same time, Dr. Winter had become increasingly committed to her soon-to-be husband, Dr. Richard Larson, a then budding leukemia expert. He had been a resident with me and had stayed at the University of Chicago for fellowship, Dr. Winter explained. Fortunately, a second-year position in the fellowship program at Northwestern became available unexpectedly and I had the opportunity to work in Dr. Alan Epsteins lab making monoclonal antibodiesthen very new and excitingto the diffuse large B-cell lymphoma cell lines that Alan had developed while a graduate student at Stanford.

An Opportunity to Grow

Dr. Winter took the faculty position at Northwestern University. Asked whether there were other reasons for her decision besides a serendipitous job opening, she commented: Actually, there was an opportunity at the University of Chicago, but I needed my own space, separate from my husband, which Northwestern offered. Moreover, I was attracted to Alans work in large cell lymphoma and the opportunity to focus on lymphoma clinically.

Dr. Winter shared how this opportunity started small but grew. When I came to Northwestern, the clinical trials office was the size of a closet. It was very much a private practice kind of place, with a very small, full-time, academic faculty. However, soon after arriving as a second-year fellow, I saw that I could be part of a team that was building something for the future. When offered the opportunity to stay on as a faculty member, I seized the opportunity and have been here ever since. Over the years, we have turned the institution into a real powerhouse, which has been immensely rewarding. I work with absolutely terrific scientists and clinicians, with a top-notch support system from the top down.

In addition to her many accomplishments, Dr. -Winter also served as President of the American Society of Hematology (ASH) for a year-long term (20212022). She has been a member of ASH for -nearly 40 years, and during that time, she has served in various leadership roles representing the Society.

A Busy Schedule

Asked to briefly describe the focus of her current work, Dr. Winter replied: My path has been anything but linear. My work making monoclonal antibodies to diffuse large B-cell lymphoma cell lines led me to bone marrow purging with my own antibodies to remove malignant lymphoma cells from bone marrow harvests for patients undergoing stem cell transplants. Early on, I had collaborations with faculty on Northwesterns Evanston campus expanding hematopoietic progenitors ex vivo for use in bone marrow transplant patients. And, similarly with another project here on the Chicago campus in megakaryocytopoiesis. We had funding from the Department of Defense to support these projects. I had a period where I was very involved in transplantation and even ran our fledgling bone marrow transplant program, but eventually focused on clinical and translational investigation in lymphoma.

Dr. Winter had a long career looking at prognostic markers in diffuse large B-cell lymphoma. That grew out of my initial laboratory experience in Alans lab. My goal from the start was to sort out the clinical and biologic heterogeneity of the diffuse large B-cell lymphomas. And 40 years later, it remains an elusive goal. Over time, that work became more molecularly based at a level I was not prepared to lead. So, Ive been fortunate to collaborate with folks who are much better equipped to address those kinds of questions at a genetic level. My clinical investigation has focused in recent years on Hodgkin lymphoma, more specifically on the use of checkpoint inhibition in both previously untreated and relapsed patients. We just launched a new clinical trial in patients with newly diagnosed Hodgkin lymphoma, building on our prior trials, further shifting from chemotherapy to immunotherapy. This trial will also compare circulating tumor DNA and imaging with FDG-PET. Like all my recent projects, Ive partnered with one of my fellows, Megan Melody. Its my greatest pleasure to see my mentees develop and succeed.

Challenges Ahead

Given that Dr. Winters career began contemporaneously with the womens rights movement, she reflected on the difference between now and then for a young woman entering the field. We have certainly made progress in closing the gender gap, she noted, but its definitely challenging for young women who want to balance a career and a family. Its never going to be easy, because there is never enough time in the day for everything we want to do. However, being persistent and confident in yourself is key. In short, join societies such as ASH and ASCO, and when you have an opportunity, seize it.

Dr. Winter shared some thoughts on mentorship relationships: I didnt have an easy time of it early on; mentorship wasnt what it is today. Today, young trainees are very aggressive about seeking out mentorship relationships. When I was coming up, I had a career development award where my mentor met with me only to put his signature on the grant but never sat down or communicated with me. Members of the current generation know what they need to get from a mentorship relationship. Choose wisely, I always say, in your collaborators, mentors, and spouses; be careful about how you invest your precious time and energy and who you look to for help

Decompression Time

What does a super-busy oncology leader do to decompress? I have a 19th-century house, so theres always a project underway, and I live in an amazing city, where theres so much to discover and experience. I have two wonderful sons and daughters-in-law and two beautiful grandchildren to spoil. I still go to the ballet, and Im actually making it a bigger priority recently. My husband and I walk and ride the lakefront, which is a great way to keep centered and relax. And I love my work. Ive had a long and rewarding career and still fully enjoy my patients, my colleagues, and my trainees, commented Dr. Winter.

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A Mother's Encouragement and a Husband-Wife Doctor Team Set the Stage for a Career in Hematologic Oncology - The ASCO Post