Year 3. November 12. Veterans Day. Honoring Those Who Serve and Those Who Serve Them.
November 11 was Veterans Day. For the many Veterans who are members of the UCLA Department of Medicine (DoM), I salute you and thank you for your service. For many of you, this holiday provided a day off from usual duties, and I hope that you enjoyed it and got some rest. Veterans Day was once known as Armistice Day and was initially established to remember the end of the World War I. Since then, our military continues to play important roles in defending U.S. interests across the globe. Although there may be disagreement regarding some of these deployments, what is clear is that military service takes its toll on those who serve. Veterans Affairs (VA) represents the major health care provider for our Veterans in strong partnership with many academic medical centers. The West Los Angeles VA is no exception, representing an essential clinical and academic affiliate of the David Geffen School of Medicine, with the DoM playing an outsized role. This week, in addition to acknowledging, recognizing and celebrating the world-class care that our VA-based faculty provide to our Veterans and the exceptional teaching provided by many VA-base DoM faculty to our trainees, I want to highlight outstanding VA faculty, whose contributions are nationally recognized. They too are our DoM LEADERS.
Donna Washington, MD, MPH Elected to the National Academy of Medicine
When I think of examples of faculty who exemplify the DoM’s mission to advance health for all, one of the first names that comes to mind is Donna Washington, MD, MPH, a VA-based internist, professor of medicine and health disparities researcher who directs the Health Equity-Quality Enhancement Research Initiative National Partnered Evaluation Center. Dr. Washington has dedicated her career to improving access to high-quality healthcare among Veterans from marginalized backgrounds, including women and racial and ethnic minorities. Her trailblazing research sheds light on the challenges these vulnerable populations face and informs and assesses the impact of policies designed to improve their health outcomes. I am proud to share that Dr. Washington was recently elected to the National Academy of Medicine, one of the highest honors of our profession.
“I am honored to join such an esteemed group and thrilled about the recognition and elevation of the importance and impact of health equity research for Veterans,” Dr. Washington said.
Dr. Washington was inspired to pursue a career in medicine by an interest in science and problem-solving coupled with a desire to make a difference in the lives of others. She saw firsthand how race and class influence the trajectory of one’s life when, as a child, she went from living in a segregated, Black neighborhood to attending diverse schools with students from a wide range of socioeconomic, racial and ethnic backgrounds. These observations — along with a strong sense of social justice instilled by her parents — drove her passion for health equity. She became interested in applying this lens to diverse Veteran populations while working as a physician-scientist in a primary care practice at the VA, where she witnessed the intersectionality of Veteran experiences with social determinants of health.
Over the course of her career, Dr. Washington has quantified what she saw in the clinic in studies that have shown how health disparities shape pregnancy and postpartum outcomes among Veterans; demonstrated racial disparities in mortality across Veterans within the VA health system; warned of the potential outsized impact of COVID-19 on Veterans from marginalized racial backgrounds; and much more. One of the most visible impacts of her research was the creation of the Women Veterans Call Center, which helps women access the healthcare benefits they have earned through their military service. The center was established following a landmark national survey led by Dr. Washington that investigated obstacles to women Veterans’ access to health services.
Congratulations to Dr. Washington for her election to NAM!
Russell Buhr, MD, PhD Publishes New Research on SRAPs
Scarce resource allocation policies (SRAPs) are a difficult but necessary aspect of hospital medicine, as so many of us witnessed at the height of the COVID-19 pandemic. These guidelines help us determine how to distribute limited resources among patients during emergencies so that we can save as many lives as possible.
It may surprise you to learn that the University of California health system did not have SRAP in place prior to the COVID-19 pandemic. To take on the challenging task of designing one, the health care office of the UC Office of the President called upon VA Pulmonologist Russell Buhr, MD, PhD to serve as one of the project’s experts. In October, Dr. Buhr and his UCLA GIM-HSR colleague Lauren Wisk, PhD, an assistant professor based at the UCLA and Kaiser Permanente Center for Health Equity, published findings in JAMA from a randomized clinical trial that showed that a six-minute animated educational video could increase laypeople’s knowledge of the UC healthcare system’s SRAP without increasing their anxiety.
“Imagine having to tell 200 people in an emergency waiting room that if you end up in an ICU situation, you might not actually get to go to the ICU, and therefore you might die of an otherwise survivable illness,” Dr. Buhr said. “That’s a really crazy thing to have to educate people about.”
Their video, which you can view here, was written at a sixth grade reading level and translated into the top five non-English languages spoken in California. It introduces the SRAP and explains its use, ethical principles, logistics and patients’ rights. To assess the video’s effectiveness, the researchers recruited a pool of 2,000 people — most of whom worked outside of healthcare and were based primarily in California — and gave them all a quiz to assess their baseline knowledge of SRAP logistics. The Californians were then randomized into one of two groups: a group that watched the video before taking a follow-up test and an assessment about their trust and anxiety levels with regards to the SRAP, or a group that just took the trust and anxiety assessment after the initial knowledge test. The researchers also analyzed responses to the tests among non-Californian participants, who did not watch the video, and used them as a control.
Buhr and his team noted that the video improved knowledge on the SRAP and instilled trust in participants that the healthcare system could implement it effectively — and that their anxiety was no higher after watching the video than before it. He believes that the results have implications for communicating other types of health policies as well.
“There are lots of controversial health policies out there that people don’t necessarily agree on, or that people don’t understand because they are really complicated,” Buhr said. “This becomes a test case for developing other interventions for things like this in the future.”
Dr. Buhr and Dr. Wisk’s latest paper follows another that was published in JAMA this past spring. It is a valuable study on how healthcare workers and laypeople differ in their views regarding scarce resource allocation, and a good read for those of us who are interested in ethics and policymaking in critical care.
While I hope that our faculty and staff are never faced with the circumstances that would require us to put Dr. Buhr’s work into practice, I am proud that our faculty were invited to carry out such an immensely important and challenging undertaking. Please join me in thanking Dr. Buhr for his service to our healthcare system!
Michael Ong, MD, PhD Appointed Research Officer of VISN 22
Our VA faculty are also called to assume important roles at the regional and national levels within the VA healthcare system. I am pleased to share that Associate Chief of Staff for Research and Development Michael Ong, MD, PhD, a practicing general internist and prolific health services researcher, was recently appointed as research officer for the VA Desert Pacific Healthcare Network, also known as the VA Integrated Service Network (VISN) 22. With eight facilities total across the southwest, VISN 22 is one of the largest networks in the VA. It includes the VA Greater Los Angeles Healthcare System and the VA San Diego Healthcare System, two of the largest VA research programs nationally.
Dr. Ong’s role was newly created to help coordinate research issues across all eight of the VISN 22 facilities. He envisions building upon the VA’s pioneering work in clinical trials to develop a clinical trial network that will span a large Veteran population within three states. He added that VISN 22 is working on a network-specific career development award mechanism for scientists who want to work in the VA.
As the son of a Veteran, Dr. Ong believes deeply in the in the VA’s mission. He also views it as an incredible hub for innovation — as exemplified by the pioneering work of Dr. William Henry Oldendorf in building the conceptual framework that led to CT scanning and others who developed the nicotine patch, all at our own VA here in Los Angeles.
“The opportunity to leverage the collective resources across Southern California, Arizona, and New Mexico for clinical and translational team science opportunities is truly energizing,” Dr. Ong said.
Please join me in congratulating Dr. Ong on this exciting opportunity. I look forward to watching him elevate the VA’s immense research legacy to new heights in his role at VISN 22!
Matthew Goetz, MD Honored with VASPID 2024 Lifetime Achievement Award
For nearly three decades, the VA Division of Infectious Disease thrived under the leadership of Chief Matthew Goetz, MD. His initiatives at the VA have shaped national guidelines on tuberculosis, HIV care and antimicrobial stewardship, and his mentorship of early-career clinicians and investigators has influenced generations of infectious disease LEADERS. With so many accomplishments across basic science, clinical research and patient care, it is certainly fitting that Dr. Goetz was recently awarded the VA Society of Practitioners of Infectious Diseases 2024 Lifetime Achievement Award.
Dr. Goetz said he was “deeply appreciative and humbled” when he learned VASPID had chosen him for this recognition. “It led me to reflect on the longevity of my career and the reasons why I’ve been successful, which I attribute to the research support and opportunities that were provided to me for collaboration within the VA and the general UCLA infectious diseases community,” he said.
After completing a fellowship in infectious disease, Dr. Goetz launched his career in academic medicine at the lab bench, analyzing the oxidative metabolism in immune cells called neutrophils. As the HIV epidemic hit, he was called upon to serve as acting chief of the infectious disease section at the Sepulveda VA Medical Center and Olive View Medical Center under what was then known as the UCLA San Fernando Valley program. He guided the program in expanding its clinical care and educational programs in the area of HIV.
These developments led Dr. Goetz to transition from basic science to clinical research — and what he considers some of the most rewarding work of his career. Goetz considers some of the most meaningful work of his career, beginning with initiatives to improve quality of care for HIV patients. This evolved into projects focused on the roll-out of direct-acting agents against hepatitis C and later into CDC-supported multi-site initiatives to promote antibiotic stewardship across the VA.
“I’ve been able to marry my interests in the basic sciences with the larger scale population work,” Dr. Goetz said. “It’s been really remarkable that I’ve had that flexibility and opportunity.”
Dr. Goetz believes his career can serve as a lesson for early-career faculty about the importance of being fearless in the face of new challenges — especially those that require expanding one’s repertoire of skills.
“I started out as a basic science investigator working in a wet lab,” he said. “The concept of doing broad-scale, collaborative research and reaching out to multiple other stakeholders unknown to me seemed daunting, yet proved to be one of the best career decisions I made.”
Please join me in congratulating Matt for his lifetime achievement award, and in thanking him for his many years of service to our Veterans and his contributions more broadly to the field of infectious disease!
First TEER Procedures Performed on VA Patients
The cardiology divisions at the VA and UCLA have been close partners in education for decades, with a shared cardiology fellowship that sees fellows rotate through both institutions. Our clinical partnership is expanding as well, most recently in the form of the first two transcatheter edge-to-edge repair (TEER) procedures performed at Ronald Reagan on VA patients.
“This is part of a bigger, multidisciplinary system of care that offers VA patients cutting-edge and lifesaving therapies that we provide at UCLA,” Marcella Calfon Press, MD, PhD, an interventional cardiologist and associate clinical professor of cardiology, said. Dr. Press leads the team that performed TEER procedures on VA patients, both of whom are now at home recovering and doing well so far.
TEER is a non-invasive procedure that can treat mitral and tricuspid valve regurgitation, conditions in which blood leaks from the heart’s valves. It is currently FDA approved for use in patients who are at high or prohibitive surgical risk and remain symptomatic despite optimal medical therapy. While TEER for primary and secondary mitral valve regurgitation has been FDA approved since 2013 and 2018, respectively, TEER for tricuspid valve regurgitation was just approved in April 2024. Given that both mitral and tricuspid valve regurgitation are so prevalent in our aging population, TEER can help reduce symptoms, decrease hospitalization rates and in some cases provided mortality benefit for a population of patients who have otherwise run out of options.
TEER is one of several transcatheter procedures that are now available to VA patients at UCLA thanks to the advocacy of several of our faculty and support from hospital administration both at UCLA and the VA. Our LEADERS in the heart and liver transplant programs and the transcatheter aortic valve replacement (TAVR) programs at UCLA have already offered these life-saving procedures to VA patients. Expansion of care for all VA patients with structural heart disease at UCLA is now possible due to the prior success of these established collaborations.
Dr. Press herself trained at the VA and enjoys working with Veterans. She appreciates the close-knit relationship between the VA and UCLA’s cardiology divisions and views it as an opportunity to transform patient care.
“They’re a wonderful patient population, and I think that we can really make a difference in their care,” she said. “Therapies like TEER make people feel better and can prolong life, and there’s no reason that our VA patients shouldn’t have access to that care here at UCLA."
I would like to thank Dr. Press as well as the many other faculty who were involved in bringing TEER into our patients, including Jesse Currier, MD; Natalia Neverova, MD; Donald Chang, MD; Ravi Dave, MD; Olcay Aksoy, MD; Ali Nsair, MD; and Fady Kaldas, MD. I would also like to thank hospital administrators Laura Yost, executive director of clinical services at UCLA Health, and Richard Azar, chief operating officer at UCLA Health, along with our VA leadership.
It is personally gratifying to hear of VA patients benefitting from this remarkable procedure and the expertise of our UCLA faculty. I look forward to seeing additional growth of new clinical partnerships across the 405.
Opportunities to Support the VA Veterans’ Garden
The Veteran’s Garden at the West L.A. VA campus is a wonderful way for our Veteran population to access nutritious food and benefit the healing powers of gardening. Preventive medicine fellow Kaitlyn Fruin, MD is seeking donations to a fundraising campaign that will support its growth and is calling for volunteers to help with restoration projects at the garden’s next Volunteer Day, which will be held Saturday, December 7 from 9 AM to 12 PM. Anyone over the age of 14 are welcome to join. Please reach out to her by email if you would like to get involved.
I encourage those of you who have the time or means to do to so to support the Veteran’s Garden. We are fortunate to have this resource for our Veteran patients and are grateful to Dr. Fruin for spearheading this important and impactful work!
Below are some photos of volunteers enjoying the last VA Garden Volunteer Day.
Dale
P.S.
Go Dodgers!!
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