Week 36: Looking Out for Our Junior Faculty
On August 31, we held our first research town hall. There was a robust discussion regarding many of the challenges and institutional barriers that our investigators face as they seek to advance their research agendas and for our junior faculty to launch their research careers. The feedback received following this event has been positive. Based on these discussions and subsequent conversations, there are a number of action items requiring follow up. Let me highlight two.
Early career faculty would like to have a forum focusing on matters of direct relevance and concern to their careers. We will plan a follow up town hall forum to begin those conversations. Stay tuned… Second, I received an excellent recommendation to consider convening a group, similar to our clinical operations group that will meet regularly to identify, discuss and work towards solutions for our research community. I agree that such a group should be convened. After we announce our senior vice chairs, the next leadership role to be filled will be a new vice chair for research. We will convene the research group under the leadership of this individual, with active participation of the senior vice chairs and me.
Finally, plans are progressing well for our first in-person research day since the pandemic. It is scheduled a little over two months from now on November 10. Details of the program will be announced soon. Please respond to requests for abstract submissions so that we can receive all of them by requested deadlines.
I will focus much of today’s post to highlighting examples of research achievements among our early-stage faculty, who as I have said many times, represent the future of our department’s academic mission.
Eight weeks ago, we welcomed Dr. Richard Leuchter as a new faculty member in the GIM-HSR division. I am pleased to share he was just awarded his first NIH grant to support a project “Using Machine Learning and Patient-Reported Outcomes to Identify Unnecessary Hospitalizations.” In the first phase of this two-year grant, Dr. Leuchter will use the Covid-19 pandemic as a natural experiment to evaluate how UCLA Health System’s shift from inpatient to outpatient care for conditions historically treated in the hospital impacted patient health outcomes. Based on these findings, he will then build machine learning models to identify in real-time which patients traditionally admitted to the hospital can instead safely receive closely monitored outpatient care. This project, which aims to avoid unnecessary hospitalizations, fits with Dr. Leuchter’s broader aim to build predictive models from large datasets to identify wasteful medical procedures and practices at-scale, and reduce low-value care and the resulting harm to patients.
Dr. Leuchter shared the following perspectives about his work:
“Low-value medical services, such as overly liberal use of diagnostic imaging or unnecessary admission for inpatient care, lead to patient harm in the form of care cascades, emotional stress, and financial burden. This work is deeply rooted in principles of health equity and efforts to reduce socioeconomic disparities. Both our research and that of others have found that patients from historically marginalized or disadvantaged backgrounds are more likely to disproportionately bear the burden of low-value care. Ultimately, my work aims to reduce the frequency and impact of low-value services through reducing barriers to accessing care, EHR-based interventions, and health system redesign.”
Dr. Leuchter will be working closely with several mentors and co-investigators, including department of medicine (DoM) GIM-HSR faculty members Drs. Catherine Sarkisian, Ron Hays, and Keith Norris, as well as David Elashoff from DOMStat and Alex Bui from the department of radiology. Upon completing the project, Dr. Leuchter looks to test the predictive models in a clinical trial. His goal is to develop the infrastructure at UCLA to enable real-time identification of patients with lower-acuity illnesses who are at greatest risk for unneeded inpatient care and provide them with additional outpatient resources and follow-up so that hospitalization can be avoided.
I will also add from my administrative perspective that this work has strong implications for adapting our health system to new models that will continue to emerge that will impact reimbursement and support for the clinical services that we provide.
The next grant to celebrate is a new RO1 NIH award to Dr. George Agak, who was recently appointed as an assistant professor in residence in the division of dermatology. Dr. Agak’s research focuses on the immunological mechanisms that lead to acne. His recently awarded $1.5 million NIH grant is entitled, "TH17 extracellular trap-mediated antimicrobial host defense in acne vulgaris."
Over the past 4 years the Agak Lab has focused on how phylotypes of the skin commensal and acne-associated bacterium Cutibacterium acnes (C. Acnes) interact with the host immune system to preserve homeostasis or sustain disease.
The Agak lab has made significant conceptual advances in human T cell biology by providing a new paradigm for human T cell responses including the first evidence that TH17 cells release T cell extracellular traps (TETs) that trap and kill C. acnes and other pathogens. To date, the mechanisms by which C. acnes phylotypes induce TETs and their biological impact in acne are unknown. The proposed research in the R01 grant aims to define the immune landscape of acne lesions, provide mechanistic insights into the biological impact of TH17-TET formation in acne, and identify novel immune pathways and potential biomarkers that can be targeted for acne therapy. This is important, as future strategies could be developed to modulate TH17 function. Additionally, maintaining the balance among the different phylotypes of C. acnes may represent a strategy for novel probiotic design and the treatment of other chronic inflammatory skin diseases caused by dysbiosis, which describes imbalances in the composition of bacteria that normally live on our skins.
The third NIH award I would like to highlight is Dr. René Packard's. René Packard is an assistant professor-in-residence of Medicine and Physiology at UCLA. He received his MD from the University of Geneva, Switzerland. His NIH award will explore novel protective pathways induced by cardiomyocytes in response to anthracycline chemotherapy-induced injury. Anthracyclines such as doxorubicin (Dox) are a cornerstone of chemotherapy in various cancers, however, their use is complicated by anthracycline-induced cardiotoxicity. Topoisomerase (Top)-2b has emerged as a key molecular mediator of Dox-induced DNA damage and cardiomyocyte death. The Packard Lab will study the regulation of Top-2b by protective pathways and the contribution thereof to the pathobiology of Dox-induced cardiotoxicity.
It has been a good year so far for publications by Dr. Russell Buhr, an assistant professor in the division of pulmonary and critical care medicine. Dr. Buhr, along with colleagues at UCLA and across the country, are members of a consortium participating in a study of risk factors for chronic obstructive pulmonary disease (COPD) in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) Cohort, which has monitored the lung function and development of COPD in adults since 2010.
He is the lead author in this publication in the American Journal of Respiratory and Critical Care Medicine, which reported new findings from the SPIROMICS. Currently, guidelines require that a COPD diagnosis include a spirometry test demonstrating airway obstruction before and after administering a bronchodilator. These guidelines can make it challenging to diagnose medically underserved populations who do not have easy access to pulmonary function testing. Dr. Buhr notes that only one-third of people carrying a diagnosis of COPD have ever had appropriate testing to confirm the diagnosis. The report revealed that study participants whose airway obstruction resolved after administering a bronchodilator still faced a significant risk of developing COPD within 2.5 years. Their findings present a compelling case to expand the spirometric criteria used to define COPD and use a simpler diagnostic test which considers the pre-bronchodilator airway obstruction as criteria met for the diagnosis. Changing these guidelines will allow patients to achieve a timely diagnosis, access proper treatment, counseling and care that could prevent or delay the exacerbation of COPD.
Russell has also co-authored papers this year in the following journals: New England Journal of Medicine, Critical Care Medicine, Annals of the American Thoracic Society, Chest, Chronic Obstructive Pulmonary Disease, Sleep, and even the Journal of Cannabis Research!
The success of our junior faculty reflects in part the oversight and support of mentors and department leaders whose work support the careers of early-stage investigators. It is gratifying when our senior faculty receive national recognition for their work.
Join me in congratulating Dr. Patricia Ganz, who was awarded the 2022 Ellen Stovall Award for Innovation in Patient-Centered Cancer Care. This honor recognizes her commitment to improving the care and lives of cancer survivors and their families. Her research interests include cancer survivorship and the late effects of cancer treatment, measurement of patient reported outcomes in clinical treatment trials, and quality of care for cancer patients.
The National Coalition for Cancer Survivorship (NCCS) describes Dr. Ganz as “a leader in the survivorship movement… [who] has been instrumental in developing in the field of cancer survivorship, advancing the science, advocating for guidelines and policy change, and mentoring investigators and clinicians who contribute to the research and care of cancer survivors.” We are fortunate to work alongside Dr. Ganz who has been a member of the school of medicine faculty since 1978. She serves as the associate director for population science at the Jonsson Comprehensive Cancer Center.
The VA represents an integral partner with the DoM in research and training that advances the careers of early-stage faculty. I was therefore pleased to note that Dr. Michael Ong has been appointed associate chief of staff for research and development (ACOS/R) at the VA Greater Los Angeles (GLA) Healthcare System. Dr. Ong has been at UCLA since 2005 and is a professor in residence of medicine, and health policy and management, at UCLA. He has been the VA GLA hospitalist chief since 2018. Many of our esteemed colleagues are based at the VA and play an integral role in providing research mentorship to our early career faculty. We look forward to working alongside Dr. Ong to expand our partnership under his leadership. Learn more about Dr. Ong’s research accomplishments HERE.
Last week, the DoM hosted over 80 internal medicine leaders from across the UCs at the 2022-2023 UC Internal Medicine Leadership Conference at the David Geffen School of Medicine. Over the course of two days, program faculty, chief residents, and administrators met to discuss and reflect on the successes and challenges commonly experienced while leading residency training programs. Several of our faculty members participated in leading discussion sessions where they addressed topics that included:
- Looking Back, Moving Forward: Pandemic Lessons and Opportunities
- How to Run a Great Morning Report
- How We Can Approach Societal Issues as a Medical Educator in a Public Institution
- Speed Mentoring for Chiefs with your APDs and PD
- Innovative Approaches to Teaching QI & Patient Safety
Successfully hosting a two-day conference required careful planning and execution. I would like to acknowledge the DoM leaders who ensured that conference participants had a great experience and went back to their programs inspired with new ideas. Congratulations to Director of the UCLA Internal Medicine Residency Primary Care Program Dr. Mina Ma and Primary Care Program Coordinator Nina Talverdian who worked tirelessly to produce a seamless event that supports collaboration across UC internal medicine programs. View pictures from the conference HERE.
After 2-months of setting up our lab, my four colleagues from Iowa (who joined our faculty in July) conducted the first experiment last week! My family had a chance to visit and catch up with old friends while boxes were being unpacked.
Pictured below are Dr. Yuan Zhang (foreground), Dr, Quanjiang (QJ) Zhang (hands in the air), to my left Dr. Young Do Koo and Dr. Rhonda Souvenir. Son, son-in-law and daughter to my right. Arm around me, Mom.