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Department of Internal Medicine

Department of Internal Medicine What WE have accomplished Where We are going Department of Internal Medicine Full time Faculty 11 Divisions 18 Clinical Faculty 80 Adjunct Faculty 5 Program Director Lisa Staton MD Associate Program Director Cathy Payne MD

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Department of Internal Medicine

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  1. Department of Internal Medicine What WE have accomplished Where We are going

  2. Department of Internal Medicine Full time Faculty 11 Divisions 18 Clinical Faculty 80 Adjunct Faculty 5

  3. Program Director Lisa Staton MD • Associate Program Director Cathy Payne MD • Program Coordinator Ms. Deborah Fuller • Clerkship Director Gary Malakoff MD • Research Director Victor Kolade MD • UMA Director Lisa Staton MD • Associate Director Victor Kolade MD • Chief Residents D Meadows MD/A BhushanMD M Tveite MD/N Gupta MD • Administrative Assistant Ms. Laura Nihiser • Transitional Year Program Ms. Joyce Poke Coordinator

  4. Department of Medicine Leadership

  5. Dr. BW Ruffner • President-elect of the TMA for 2009-2010

  6. Dr. Charles F. Longer • Chairman, Board of Trustees

  7. New Faculty • General IM • GI • Endocrine • Cardiology • Hospitalists • Neurohospitalist • Neurology

  8. Administrative Staff New Administrative Assistant - Ms. Laura Nihiser Electronic Completion of Evaluations via New Innovations by Faculty, Residents and Staff Monthly Staff Meetings Faculty Appointment System (Notification of Final Appointment Completion) Monthly UTCOMC sponsored New Innovation & Web Training Sessions

  9. Residency and Fellowship Program Dr Lisa Staton

  10. Palliative Care Fellowship • Successful accreditation • Successful completion of first year • Successful recruiting

  11. The Past Year • Medical Knowledge • Noon Conference Block • In-training Exam • Board Passage Rate • Patient Care • Home Visits • ACLS one-on-one • Practice Based Learning • Quality Data • Dedicated Case manager and Clinical documentation personnel • Interpersonal Skills and Communication • Ethics Quarterly • One on One mentoring

  12. The Past Year • Professionalism • Transition to Residency – Chief Residents • Pharmaceutical Company Interactions- Bhushan and Grubb • Ethics Conferences • Esprit de Corp Activities • RRRnR sessions • 3 Alper Humanism inductees, IM resident received award • DOM established the UT campus wide Gold Humanism Society Chapter • Systems Based Practice • Recruiting • Inpatient Teams (core faculty and hospitalists) • Rotation updates (Inpatient Medicine, Critical Care, Night float, Private Office, Neurology) • Competency committee enhanced • Accountability committee

  13. University Medical Associates Dr Lisa Staton Dr Victor Kolade Ms M Calloway

  14. OVERVIEW • Firm Assignments • Change in Continuity Clinic Hours • Changes in Cardiology Clinic • Staff Retreat

  15. WHY FIRM ASSIGNMENTS • To structure resident clinic as a group practice • To allow for shared responsibility for learning • To provide continuity of patient care • To promote an interdisciplinary approach to patient care • To encourage mutual support and collegiality • To help ensure mentoring and supervision during resident’s continuity experience

  16. CHANGE IN CONTINUITY CLINIC HOURS • Allow residents to be able to round on inpatients without interruption for clinic • Provides adequate time for conferences • Allows time for clinic staff to prepare for clinic • Allows time for clinic staff to handle calls and additional paper work

  17. CHANGES IN CARDIOLOGY CLINIC • Cardiology Clinic changed from two clinic a month to four clinics a month to allow for increase in patient volumes • Pacemaker Clinic implemented (1st Wednesday of each month) • Referral Form implemented to ensure that patient referred have specific test prior to appointment • New EKG machine purchased • Dedicated Medical Assistant for Cardiology Clinic • Proposal for onsite Chest X-Rays

  18. STAFF RETREAT JUNE 12, 2009 • Team building activities • To foster better communication between staff, residents and attending physicians • To improve staff morale • To improve patient flow

  19. Medical Students

  20. M3 Clerkship Accomplishments • Restructured orientation to include • How to write notes • How to present to an attending • Professionalism • Instituted shelf reviews with faculty/chief residents • Moved several core lectures to beginning of the clerkship to avoid interruptions in clinical rotations • Physical diagnosis teleconference across all 3 campuses • First class of GHHS inducted

  21. Medical Student Accomplishments • Pulmonary/critical care as separate entities • Initiated student evaluation of clerkship/rotations • Secured palliative care experience in the ambulatory and specialty rotations • GME office organizing special interest groups for medical students rotating here • Total of 7 students completed their patient safety QI clerkship through our department • 4 of our 10 new IM interns rotated in our department • 1 of 6 new TY interns rotated in our department

  22. Youth Health Forum • M3 and M4 students, IM and TY residents and Dr Malakoff and Panda participated • Mentoring of 4 UTC premed students

  23. Future of Medical Student Rotations • Possible neuro/psych rotations • Increased class size = more students in Chattanooga in 2 years • Actively involved in selection process for these students

  24. Quality Improvement Projects • Initiated chapter of IHI Open School • Improving inpatient glycemic Control • Evaluating the global trigger tool to identify adverse events in the hospital • Evaluating and improving inpatient VTE prophylaxis protocol • Evaluating successful implementation of the national patient safety goals in regards to anticoagulation medications • Review of internal medicine admissions daily to assure equitable distribution between hospitalists and teaching service

  25. Quality Improvement Projects • Ambulatory Geriatric Screen & chart audit • Consultation form • Code committee • Inpatient Medicine Scorecard • Transfer of Care • Pneumonia Core Measures • CHF core measures • AMI core measures • Antibiotic Stewardship • Hand Hygiene

  26. Quality Improvement Projects • VAP bundle • Sepsis protocol • Patient flow • Mortality reduction

  27. Department of MedicineScholarly Activity Update Publications, Lectures, Meetings, Research, QI, UMA, Education, Scholarships

  28. Peer-Reviewed Publications

  29. Patel V, Yalavarthy U, Desbiens NA. Does reporting estimated glomerular filtration rate affect ordering of timed urine collections? Am J Med Sci. Mar 2009;337(3):185-187 • Li HY, Grubb M, Panda M, Jones R. A Sore Throat-Potentially Life-Threatening? J Gen Intern Med. May 10 2009 • Gupta N, Patel C, Panda M. Hepatitis following famotidine: a case report. Cases J. Jan 27 2009;2(1):89 • Rahman AA, Panda M. Locked lung by looped hernia: a case report. Cases J. Jan 8 2009;2(1):29

  30. Pai S, Panda M. Limited Wegener's granulomatosis presenting as lung nodules in a patient with rheumatoid arthritis: a case report. Cases J. Dec 23 2008;1(1):417 • Estrada C, Panda M, Landry M. Why Should I Write a Case Report or Clinical Vignette? SGIM Forum December 2008; 31(12):5, 9 • Gray ER, DeVersa R. Hereditary Multiple Exostoses. Hospital Physician. November 2008;44(11):8 • Navaid M. Perception of hospice/palliative medicine: a fellow's narrative. J Palliative Med. Apr 2009; 12(4):385-6

  31. Tumlin JA. Lupus nephritis: histology, diagnosis, and treatment. Bull NYU Hosp Jt Dis. 2008;66(3):188-194 • Desbiens NA. A departmental experience in promoting oral and poster presentations. Teach Learn Med Jul-Sep 2008;20(3):254-260 • Heath GW. Recommended Levels of physical activity and health-related quality of life among overweight and obese adults in the US. Journal of Physical Activity & Health 2008;JPAH-2008-0028.R1

  32. Tindni A, Gaurav K, Panda M. Non-healing painful ulcers in a patient with chronic kidney disease and role of sodium thiosulfate: a case report. Cases J. 2008;1(1):178 • Ross MA, Amsterdam E, Peacock WF, et al. Chest pain center accreditation is associated with better performance of centers for Medicare and Medicaid services core measures for acute myocardial infarction. Am J Cardiol. Jul 15 2008;102(2):120-124. (F Fesmire) • Jones R, Panda M, Desbiens N. Internal medicine residents do not accurately assess their medical knowledge. Adv Health SciEduc Theory Pract. Nov 2008;13(4):463-468

  33. Roux L, Pratt M, Tengs TO, Yore MM, Yanagawa TL, Van Den Bos J, Rutt C, Brownson RC, Powell KE, Heath G, et al.  Cost effectiveness of community-based physical activity interventions.  Am J Prev Med. Dec 2008;35(6):578-588 • Bhattarai N, Panda M. Uremic Frost. Mayo Clin Proc. December 1, 2008;83(12):1309 • Dutta G, Panda M. An uncommon cause of lower gastrointestinal bleeding: a case report. Cases J. 2008;1(1):235 • Conner C, Paydar A. Intradural Extramedullary Arachnoid Cyst Presenting as Arteriovenous Malformation in the Thoracic Spinal Cord. Radiology Case Reports 2009;4:263

  34. Cecil WT, Kasteridis P, Barnes JW, Jr., Mathis RS, Patric K, Martin S. A meta-analysis update: percutaneous coronary interventions. Am J Manag Care. Aug 2008;14(8):521-528 • Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW, (Fesmire FM, et al), American College of Emergency Poisoning.  Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache.  Ann Emerg Med.  Oct 2008;52(4):407-436 • Cardiel MH, Tumlin JA, Furie RA, Wallace DJ, Joh T, Linnik MD. Abetimus sodium for renal flare in systemic lupus erythematosus: results of a randomized, controlled phase III trial. Arthritis Rheum. Aug 2008;58(8):2470-2480

  35. Scherer K, Gupta N, Caine W, Panda M Differential Diagnosis and Management of a Recurrent Hepatic Cyst:  A Case Report and Review of Literature JGIM • Navaid M Power of presence and compassion J Palliative Med • Makdsi F, Brit M A Case of SclerosingMesenteritis With Rheumatoid Arthritis South Med J • Makdsi M, Fall M Acute Renal Infarction J Hosp Med • Dutta G, Panda M Bands of cacophony Cases J • Scherer K, Panda M, Johnston J Dural Based Mass Journal of Radiology • Makdsi F Acute Pancreatitis with Eruptive XanthomasJ Hosp Med

  36. Book Review • Mathis R. Cause And Coincidence In Autism. Health Aff. May 1, 2009;28(3):916-917

  37. Submissions • Makdsi F Transient Thyrotoxicosis as an Initial Presentation of Rheumatoid Arthritis, accepted Cases J • Makdsi F Inflammation of Actinic Keratosis with Combination of Alkylating and Taxane Agents, Cases J • Staton L, Rybolt A, Panda M, Jones R Achieving the AAA's of Ambulatory Medicine - Aptitude, Appeal and Appreciation J GME, in review • Panda M, Desbiens N Life long learning after residency J GME, in review • Increased frequency and nocturia in a middle-aged male may not always be due to Benign Prostatic Hypertrophy (BPH): a case report Gaurav, Panda JCRin review

  38. Submissions Pending Decisions • LeucocytoclasticvasculitisJGIM • AVM Cases J • DKA and PneumomediastinumCases J • Subacute Combined Degeneration With Normal Vitamin B12, submitted to Cases J

  39. Manuscripts in Preparation • Catastrophic Antiphospholipid Antibody Syndrome Jacobson • Scrofula Kafle • Extragonadal Germ Cell Tumor Hadgu, Tindni, Panda • How much is too much Grubb, Gaurav, Panda • Clonidine overdose Tveite • A Rare Cause of Acute Seizure in a Young Man  Krummert, Scherer, Whitley, Dixon, Sirelkahtim, Panda • Diabetes Insipidus Chhakchhuak, Tumlin • Pulmonary LCNEC Kaako

  40. Local and Distant Conferences Posters and Oral Presentations

  41. Panel Discussions • Approaches to Interactions with Industry: A Multidisciplinary Panel Discussion to Educate Residents In Training • Dr Malakoff • Robin Grant, R.Ph. • Dr Mathis • Dr Fore • Sylvia Friedl • Physician Stress & Burnout” at the Departmental Residency RetreatCohen, Barker, Panda

  42. Research Week Research Abstracts • RAPID RESPONSE TEAMS: Their Impact on the Rate of Cardiac Arrests at the Baroness Erlanger Hospital (BEH) of the University of Tennessee at Chattanooga Jacobson, Tindni, Panda, Staton (2nd place poster) • The Frequency and Significance of Incidental Thyroid Nodules (ITNS) on Chest CT Scans,  a retrospective study:  Scherer, Means, Chijioke, Karmin, Panda (3rd place poster)   • Clinical Decision Making for Pulmonary Embolism: Are Physicians Using the Latest Evidence? Makdsi, Staton, Panda

  43. Research Week Case Reports • A Rare Cause of Acute Seizure in a Young Man  Krummert, Scherer, Whitley, Dixon, Sirelkhatim, Panda (3rd place poster) • Painful Ophthalmoplegia as the first Manifestation of Lung Carcinoma Mocanu, Obaid, Kolade • Late-Onset Asthma and Stridor; Think about Adenoid Cystic Carcinoma! Kaako, Stansell, Kolade • The Persistent Parasite, Patient, and Physician Scherer, Gupta, Caine, Panda (also presented at Internal Medicine 2009)

  44. SSGIM, 2/09 • 3 workshops • 9 oral presentations • 13 posters

  45. Presented at National SGIM • Numbness in a 39 Year-old Man Makdsi F, Kadrie H • Common shortness of breath for uncommon reason: Rahman A, Kolade V • When A Piece Of Heart Hurts The Brain. Kafle P, Dutta G, Yium J • Painful Ophthalmoplegia as the first Manifestation of Lung Carcinoma Mocanu B, Obaid B, Kolade V • Late-Onset Asthma and Stridor; Think about Adenoid Cystic Carcinoma! Kaako A, Stansell K, Kolade V • Oral: A Case of LeukocytoclasticVasculitis with Rare Complications Finch T, Brit M, Panda M • Workshop: Getting your vignette published, a step wise approach Panda et al

  46. International Humanities in Medicine (Posters) • Chijioke C, Scherer K, Panda M Relaxing, rejuvenating and rejoicing in residency: RRR in Residency • Kaako A, Panda M Taking care of the Muslim patient: How culturally aware are our health care providers?

  47. International Conference of the American Thoracic Society, May 15-20, 2009 • Food and Particulate Aspiration Pneumonia Gupta N, Enjeti S

  48. Abstracts • Dr YiumLead Toxicity: Lead and Moonshine Nephropathy • North American Society for Dialysis and Transplantation, • July 12-16, 2009; Kapalua-Maui, Hawaii • Dr Tumlin • Bilateral Symmetry in Chronic Uremic Pruritus: The Brain-Skin Connection • A Phase III, Randomized, Double-Blind, Placebo-Controlled Study of Tenecteplase for Improvement of Hemodialysis Catheter Function: TROPICS 3 • American Society of Nephrology Meeting • October 27 - November 1, 2009; San Diego

  49. Ongoing Research And QI

  50. Current projects • Kyle, Stansell, Rahman, Anower, Tumlin, Boldt, Gunter, Shome: PRESSURE Trial • Gupta, Strelnikova, Boldt, Panda: VIPP study • Kaako, Panda: Care of Muslim Patients • Todd, Payne: Vaccine history and pneumococcal sepsis in alcoholics • Hawkins, Malakoff, Chhakchhauk: C. difficile Colitis • Navaid: Quality of life in hemodialysis patients • Bhushan, Payne: Patient handoffs

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