Year 3. January 22. From Strategy to Impact.
This week I highlight members of our department representing trainees, junior faculty and senior faculty whose contributions and recognition exemplify the core values of our strategic plan – LEADERS.
Kush Fansiwala, MD, Leads Study Examining Optimal Route of Antibiotic Administration in Inflammatory Bowel Diseases
Internal Medicine third-year resident Kush Fansiwala, MD, recently published a study in “Inflammatory Bowel Diseases” examining the difference in outcomes of using oral versus intravenous (IV) discharge antibiotic regimens in the management of intra-abdominal abscesses in penetrating Crohn’s Disease. The premise of the paper, which he started while in medical school, is that the optimal route of antibiotic administration for intra-abdominal abscesses is poorly studied but may have important implications for clinical care and patient quality of life, given the potential inconvenience of prolonged indwelling catheters.
Having identified gaps in the literature, Dr. Fansiwala and his coauthors designed a retrospective cohort study to analyze how two outcomes – 1) need for surgery, and 2) hospital readmission within one year from discharge – differed between patients who received oral antibiotics compared to patients who received IV antibiotics. They found surgical outcomes to be similar across patients regardless of their antibiotic regimen, but did find that patients treated with IV antibiotics had a decreased risk for nonsurgical readmission within one-year post-discharge. There was a trend towards the increased nonsurgical readmissions being driven by need for readmission for conversion to IV antibiotics. Regardless of route of discharge antibiotics, the majority in both groups required surgery or had readmission within one year of discharge.
Their findings have implications for patient care, indicating that for patients hospitalized with intra-abdominal abscesses secondary to Crohn’s disease, an oral discharge antibiotic regimen may be a reasonable option depending on clinical context, with similar surgical outcomes to intravenous regimens, though there may be a risk for nonsurgical admission. This study is a strong example of department of medicine (DoM) trainees whose research may have far reaching clinical implications that will shape the future of medicine. Dr. Fansiwala continues to pursue his research interest in inflammatory bowel disease, which he says he appreciates the “complexity and cerebral and patient-facing nature of,” and is working on additional projects alongside Dr. Berkeley Limketkai at UCLA. You may read the study HERE.
Cardiologist Jeffrey Hsu, MD, PhD, Pushes the Boundaries of Sports Cardiology
Jeffrey Hsu, MD, PhD, spends time every day either running or cycling, and just completed his first triathlon last year. He says that doing so is only fair, considering that the crux of his clinical work involves encouraging patients to safely maintain their exercise regimens. This is because Dr. Hsu specializes in sports cardiology, a burgeoning field that focuses on managing heart health of athletes and active individuals. The area of study and clinical practice was born out of a growing recognition that the heart of an athlete can look different and perform differently than the heart of a non-athlete, therefore requiring specific research and care. Dr. Hsu, who is currently an assistant professor of cardiology in the DoM, is an emerging national leader in this field, and we are proud to share he was recently appointed as the vice chair for the American College of Cardiology’s (ACC) Meeting "Care of the Athletic Heart," and appointed to the team of technical editors for the preeminent journal Circulation.
These appointments stem from an impressive portfolio. As a physician scientist in his fourth year on faculty at UCLA following completion of the STAR Program and a fellowship in advanced heart failure and transplant cardiology at UCLA, Dr. Hsu helped to develop UCLA's Sports Cardiology Program alongside Ali Nsair, MD, and Ravi Dave, MD. The program is the first and only sports cardiology practice in Los Angeles and Southern California and treats a range of patients from players on the Dodgers to the marathoning parent. In addition to helping lead this program, Dr. Hsu holds a joint appointment at the VA, works on the VA and UCLA's heart transplant teams, and leads several research projects spanning topics such as the pathophysiology of vascular calcification, the effects of COVID-19 on cardiovascular inflammation, and the mechanisms of exercise intolerance in long covid. Needless to say, he’s staying busy, benefitting the field of sports cardiology and medicine in many ways.
When speaking to his goals in his ACC appointment, Dr. Hsu shared plans to build on the growing momentum in sports cardiology, and to use the conference as a means of improving education in the field and bringing new clinicians in.
"Navigating the return to sports during the pandemic and high-profile events such as Buffalo Bills player Damar Hamlin's cardiac arrest during a nationally televised game, really brought attention to how sports cardiology impacts society," Hsu stated. "My goal in this role is to continue this growth and keep developing interest in the field, especially through education."
These efforts in the ACC Care of the Athletic Heart conference are especially important given the limited number of fellowships and formal education programs in sports cardiology.
In his role as a technical editor for Circulation, he hopes to further enhance and ensure the high quality of the pioneering research published in the journal. Research is where "you can really make a significant change in our knowledge of the human body, of disease, and how to improve our treatments of these diseases," says Dr. Hsu. In doing so, he aims to add context and color to our understanding of heart health, so that we can guide patients with more nuance and pragmatism. Dr. Hsu expressed deep gratitude towards UCLA and his mentors:
"I'm just so grateful to have this opportunity," he reflected. "But now it's the time to really deliver."
We are confident you will deliver, Jeff, and are grateful for your leadership!
Connie Rhee, MD, MSc, Continues to Pave the Path for the Future of Nephrology with Compassion and Care
We are thrilled to share that Connie Rhee, MD, MSc, has been appointed editor in chief of the Clinical Journal of the American Society of Nephrology (CJASN), and has been recognized with receipt of the American Society of Nephrology's (ASN) Distinguished Mid-Career Mentor Award. These significant accomplishments are par for the course for Dr. Rhee, who was appointed last year as the section chief of nephrology at the VA Greater Los Angeles Health Care System and is pioneering research in the DoM spanning intersecting areas including kidney health, endocrinology, and renal nutrition and metabolism using a range of multi-disciplinary research methods. It's not just the topics she studies or the methods she utilizes, however, that make her a standout leader; it's her deep commitment to the perspectives of her patients, and the mentorship of her trainees.
This commitment is evident in the ambitious goals Dr. Rhee has set for her six-year tenure as editor in chief of CJASN (2024-2029) which include expanding the global reach of the journal, ensuring that voices from the most vulnerable populations in the kidney community are heard, and increasing content written for and by trainees. Efforts to meet these objectives are already underway. For instance, Dr. Rhee has already expanded the number of international CJASN associate editors based outside of the US to 50% of all associate editors, and has recruited three Patient Voice Editors who are focused on coaching patients to write pieces for the journal, as each monthly issue features commentary on an article from a patient using their own experience.
“Our patients have a critical voice in guiding the direction of research and innovation, policy, and clinical care,” says Dr. Rhee.
These developments are just the beginning for Dr. Rhee, who shares that for her, serving in this role for CJASN is a form of giving back to the journal and kidney community that have given so much to her over her professional career.
"When I was a trainee," Dr. Rhee explained, "I grew up reading and studying CJASN as a major source of my nephrology curriculum as I was evolving into a clinical nephrologist and physician-scientist, especially given that there were few clinically focused journals in nephrology at the time. The journal had a huge impact in shaping my career in clinical nephrology and in clinical and translational research, and I am truly grateful to be able to serve in this role to give back to the journal and field due to how significantly I've benefited."
It's poetic then, that the very organization that coached Dr. Rhee in her training is now recognizing her for the way she coaches current trainees.
"My trainees inspire me," Dr. Rhee says. "We have a lot of fun, and I learn as much from them as they learn from me. Their enthusiasm and passion motivate me to have longevity in my academic career."
There's no doubt, that feelings are mutual, as Dr. Rhee is as focused on building community within her research, clinical, administrative, and editorial teams as she is at obtaining NIH grants. This community-based and compassion-oriented approach isn't without a source. Dr. Rhee was the primary caregiver for her father who has navigated multiple cancer and cardiac diagnoses, beginning when she was a medical student.
"Being a family member of a patient and being a patient myself -- seeing and experiencing the positive impact of outstanding and compassionate clinical care and how it can heal not only the physical body, but also the heart and soul has deeply inspired my work and will continue to do so."
Please join us in celebrating Dr. Rhee for this deep commitment to compassionate care, and the recent accomplishments that recognize her unique leadership in this field.
Research Day Poster Abstracts Now Available Online
We're pleased to announce that poster submissions for the successful Research Day 2023 are now viewable online! The abstract and poster webpage catalogues the details of 167 abstracts total, which represents many of the over 300 posters submitted to the Research Day poster competition. Not all presenters opted to share their poster submissions due to a range of reasons including preliminary results and ongoing research; however, the work that is represented is rich and ranges across topics, methodologies, and presenter affiliations from faculty to residents to medical students. We encourage you to browse the posters to get a sense of what your fellow DoM community members are working on, and hopefully develop collaborations that could stem from this information!
"Autophagy certainly has a housekeeping role and if you increase it, you could probably have better housekeeping. But what we don't know is where the line gets crossed between good housekeeping and now starting to throw out all your best china,”says Dr. E. Dale Abel an endocrinologist, chair of the Department of Medicine at the David Geffen School of Medicine at UCLA, and executive medical director of the UCLA Health Department of Medicine.
Cancer deaths declining overall, but troubling increase for colon and breast cancer in younger adults: Report
"There are studies that even show that risk factors like whether or not you were breastfed, whether or not you had antibiotics at a high rate as a child -- that these factors might be predicting your chances of getting cancer when you're an adult."Dr. Folasade May, gastroenterologist, researcher and member of the UCLA Health Jonsson Comprehensive Cancer Center.
"Cortisol is produced in higher quantities in the morning, and it causes higher blood sugars," said Dr. Sarah Kim, an endocrinologist at UCLA Health. So, "you may not have as much of a drop in blood sugar."
On Thursday, January 25, I will be giving the State of the Department of Medicine address during Medicine Grand Rounds in the Tamkin Auditorium. I invite you to attend in person.
My mom is in town and met her great grandson!
The t-shirt says, “this is what the world’s greatest great grandmother looks like.”