Week 37: Breadth and Depth of Clinical Programs
This week I will highlight a few clinical programs and initiatives that illustrate the breadth of our faculty’s commitment to provide high-quality patient care and investigate approaches that address diverse health needs across a range of specializations. Most importantly, a common thread throughout these projects is that our expertise promotes equity and access to all, including groups that could be marginalized.
Venice Family Clinic
The Venice Family Clinic (VFC) continues to grow and remains one of the largest federally qualified health center in the country. VFC now provides services to 45,000 patients and has 17 locations, most recently expanding to the South Bay region through a merger with South Bay Family Healthcare.
The department of medicine (DoM) internal medicine and med-peds residency programs have maintained long-term training sites at VFC's Simms/Mann Health & Wellness Center for nearly three decades. Over the past five years, our residency program leadership, in partnership with VFC, has strived to enhance the ability of our residents to follow the same patients in continuity.
In previous years this was challenged by sporadic resident presence in the clinic and limited administrative and EHR infrastructure. By addressing these issues in various ways, our residents are now regularly in the clinic and positioned to longitudinally build the rapport needed to meet their patient's health goals and improve their outcomes. Trainees participating in the continuity clinics are gaining valuable insight and experience providing high-quality care in communities that have been traditionally underserved, for a patient population that faces significant social determinants of health. The success and growth of the program is attributed to its leadership and the 32 preceptors who work closely with trainees.
"Much thanks and credit are due to our IM and Med-Peds faculty preceptors who continue to support our resident training in this under-resourced setting,"says Dr. Daniel Kozman, associate program director of UCLA's Medicine-Pediatrics and Preventive Medicine training programs.
Their precepting role is critical to ensuring that our trainees develop the knowledge and skills necessary to serve marginalized populations by fostering meaningful resident-patient connections and leveraging local resources to secure health holistically. The preceptors include:
Our Gender Health Program provides culturally competent care to our transgender and gender-diverse community. Dr. Amy K. Weimer is the program's medical director and oversees the medical home and comprehensive care environment for transgender and gender-diverse (TGD) people. Through the program, multidisciplinary teams work together to provide comprehensive and compassionate care in a safe and welcoming environment for TGD patients. The program offers comprehensive LGBTQ+ primary healthcare services and a range of gender-affirming care options, including all gender-affirming surgeries. There is also a variety of behavioral health services for TGD patients.
At the time the program was launched, Dr. Weimer was the only primary care doctor. Now the program has grown to include nine primary care doctors and over 40 providers across different departments and divisions.
"We have had many people come through the program who say it is the best care they have ever received. Many say it is the first time they feel seen and heard, which is the most meaningful experience to me. We also aim to continue educating other providers and learners across various disciplines,"says Dr. Weimer.
The Gender Health Program complements the LGBTQ Healthcare fellowship. This fellowship aims to train future primary care physicians to be sensitive, comfortable, clinically knowledgeable, and culturally competent in delivering healthcare to sexual and gender minority patients.
Yesterday, the Gender Health Program leaders attended the World Professional Association for Transgender Health Conference. Dr. Weimer presented the research findings from a study for which she was the principal investigator titled the “Goals of Treatment and Indicators of Treatment Success from a Community Survey of Trans and Gender-Diverse People Assigned Male at Birth.” She was joined by DOM colleagues that included Shira Grock, Stan Korenman, Reema Patel; VA colleagues Atara Geft, Jane Weinreb; DGSOM student Sarah Fadich; and urology project manager Kristen Williams.
Additionally, the group hosted a workshop on “Integrating Holistic and Affirming Transgender Health into Your Practice and Health System.” Co-presenters for this latter presentation included Dr. Jessica Bernacki, staff psychologist of DOM Dr. Emery Chang, Dr. Gifty Ntim from med-peds, and Dr. Rebecca Rada from family medicine.
On October 22nd, the UCLA Gender Health Program will host a conference on "Contemporary Considerations in Gender-Affirming Care," both in-person and virtual. This conference will be presented by members of the integrated, multidisciplinary UCLA Gender Health Program and will feature a panel of community members with diverse backgrounds and experiences.
Rates of obesity continue to increase worldwide and contributes to increasing risk of many disorders such as diabetes, cardiovascular disease, sleep apnea and some cancers. Managing patients with obesity in ways that do not amplify stigma or negative stereotyping is essential.
The Program for Reducing Obesity (PRO) was founded by one of our endocrinology faculty, Dr. Na Shen in 2019 in response to the growing obesity epidemic and the lack of a UCLA weight loss program outside of the main Westwood campus. PRO is an insurance-supported program consisting of individual visits and shared medical appointments with an obesity medicine board-certified endocrinologist and registered dietician. Services include personalized medical and nutritional weight management, comprehensive diagnosis and management of related hormonal and metabolic disorders, body fat assessment, and group nutrition classes on weight loss.
Since its inception, PRO has experienced impressive growth and popularity, having helped over 500 UCLA patients in the northwest valley community. Currently there are four obesity medicine certified endocrinologists (Dr. Na Shen, Dr. Susan Ahern, Dr. Deepashree Gupta, and Dr. Laura Sue), two dietitians (Pamela Lee and Lara Al-Danchi), three weekly PRO classes and one monthly maintenance class. Research published in Obesity Science and Practice Journal last year showed that out of 102 patients who attended PRO, the average weight loss achieved after one year was 7.8% and 52% of patients lost over 5% of their baseline weight.
“Currently, PRO is focused on the northwest valley, but we hope to expand the program to more UCLA community clinics where there is a huge need for an obesity program,”says Dr. Na Shen.
Our division of infectious diseases has been at the forefront of conducting COVID-19 research and now they are leading the charge in broadening our understanding about the treatment of monkeypox. An NIH sponsored phase 3 clinical trial designed by the AIDS Clinical Trials Group is evaluating the antiviral tecovirimat, also known as TPOXX, is now enrolling adults and children with monkeypox infection in the United States. UCLA is a clinical research site for this trial with Dr. Raphael Landovitz as the lead investigator. Dr. Judith Currier received a supplement to the AIDS Clinical Trials Group (ACTG) grant from NIH to support this important multisite trial and, the UCLA site enrolled its first participant last week.
“We appreciate the incredible teamwork at the CARE clinic and with our colleagues in research administration that led to the rapid development and start-up of this trial at UCLA; it seems that COVID taught us how to do things faster,”notes Currier.
Investigators will gather data to determine if participants receiving tecovirimat heal more quickly compared with those taking placebo. They also will examine tecovirimat’s impact on pain scores, rates of progression to severe disease, clearance of monkeypox virus from various samples, and its safety, among other data. The study will also evaluate whether resistance to tecovirimat occurs during treatment. This study also will provide critical data on the optimal dosing and safety of tecovirimat in children and people who are pregnant.
“We hope that this important study will provide regulatory agencies the necessary data to evaluate tecovirimat for emergency use authorization, which if granted, would allow greater access to this medication. Currently, we don’t have sufficient data on its efficacy or safety to endorse its universal use in MPX disease,”states Landovitz.
To read the announcement from the NIH, click HERE.
We are now in the third year of the pandemic, and have learned a lot about prevention and treatment, even as we have seen the course of the pandemic evolve.
I was pleased to learn about a recent publication from Dr. Joanna Schaenman who alongside DoM colleagues Drs. Ramin Salehi-Rad, Jennifer Fulcher, and Elaine Reed from the department of pathology published the study titled “Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study” in eBioMedicine. Amid all the uncertainty surrounding COVID in March 2020, Dr. Schaenman launched the IMPACC (Immunophenotyping Assessment in a COVID-19 Cohort) Study, a NIAID sponsored longitudinal, multicenter study of hospitalized patients with COVID. Their study introduced key findings which have made significant contributions to our understanding of severity of disease and outcomes. These insights include the identification of clinical “trajectory groups” representing specific longitudinal outcomes that has been used as a basis for multilevel immunologic analysis. Moreover, they observed that slope of quantitative SARS-CoV-2 viral load and ratio of viral load to levels of antibodies to the receptor-binding domain (RBD) of the coronavirus spike protein were significantly associated with clinical outcomes.
I applaud Dr. Schaenman and colleagues for this successful collaboration between departments that required a high level of coordination with the health system in order to to safely enroll patients and process COVID samples. As Dr. Schaenman looks towards her next steps through this project, she is working on a sub-analysis of the clinical and immunologic data gathered for transplant recipients versus non-transplant controls, allowing her to continue her focus in transplant infectious diseases.
The explosive growth of artificial intelligence in many aspects of our personal lives, already has and will continue to have significant impact on health care delivery, health equity and the way that we train future physicians. Last week, we learned that UCLA will oversee a $10M, NIH funded Bridge to Artificial Intelligence Program (Bridge2AI) Program, a new computable knowledge program that will innovate how biomedical research data is collected and prepared using artificial intelligence and machine learning (AI/ML).
Within this interdisciplinary initiative, DoM faculty Dr. Karol Watson and Dr. Pei Pei Ping will be leading the program’s Skills & Workforce Development Core which will unite experts in biomedical and behavioral research domains, AI/ML data science, and team science to develop an understanding of AI/ML use within the biomedical and behavioral research workforce. Recognizing the need to increase diversity and inclusion in AI/ML science, the core will identify and implement strategies that increase diversity in this area of research.
"Among the major challenges we currently face is the potential for bias using AI/ML with our biomedical and behavioral datasets, and the lack of diverse representation – both within the data and in its application. As directed by the NIH, our core will incorporate specific outreach, recruitment and retention plans to enhance diversity in both of these areas,"Dr. Watson stated.
We look forward to following the course of this innovative research initiative over the next four years which will include collaboration with faculty from the David Geffen School of Medicine at UCLA, Dr. David Bui from the department of informatics, and Dr. Paul Boutros, professor of human genetics and urology. To read the entire announcement, click HERE.
Reminder: DoM Research Day
We are looking forward to our first in-person DoM research day on November 10th. Note that we expect that all active research programs within the DoM should submit an abstract and present a poster at this meeting. This is a wonderful opportunity for our trainees and faculty to see the depth and breadth of research being undertaken within the DoM and a unique opportunity to build collaborations.
The instructions for abstract submission that you received could be clearer. Updated instructions are summarized below.
Abstract Submission Instructions
- Abstracts are expected to be submitted from junior faculty (assistant professors - all series, clinical instructors, and assistant researchers who are full-time employees) and trainee’s (graduate students who have a graduate advisor that has an appointment in the department of medicine, either primary or secondary, or a resident or fellow).
- Indicate your faculty rank or trainee status on the abstract.
- All abstracts will be presented as posters.
- Abstracts can represent:
- Unpublished work in progress
- Studies that might have been presented at another scientific meeting within the past year
- Studies that were published within the past year.
Abstract Submission Deadline: October 7, 2022.
Posters will be judged, and poster-awards provided as summarized below.
“A cash prize for up to five places will be awarded in each category (Basic Research, Health Services Research and Clinical Translational Research), along with an award letter and certificate. Winners may also be invited to present their work at Medical Grand Rounds."
- First Place $3,000
- Second Place $2,000
- Third Place $1,000
- Fourth Place $1,000
- Fifth Place $1,000
I look forward to a robust event.
Last week I took a brief detour to Austria to receive an award and give a lecture. I spent all of 36 hrs. there, so not enough time to get jet lag, although some sleep deprivation from which I am recovered.