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Peds ID Fellow Jeff Donowitz helps pinpoint problems, find cures

Peds ID Fellow Jeff Donowitz

Peds ID Fellow Jeff Donowitz recently wrapped up a two-year study that took him half a world away in a search for answers to problems of malnutrition, stunted growth and oral vaccine failure seen in millions of children.

A two-year research effort took Jeff Donowitz, M.D., half a world away in a search for answers to problems of malnutrition, stunted growth and oral vaccine failure seen in millions of children.

Now, armed with fresh data from the study, he’s ready to move forward, continuing his research on how overgrowth of bacteria in the small intestine is damaging the guts of children in low- and middle-income countries.

In 2014, Donowitz, an infectious diseases fellow in VCU’s Department of Pediatrics, was one of just seven pediatricians in the U.S. chosen by the Association of Medical School Pediatric Department Chairs for the Pediatric Scientist Development Program. Over the past two years, he traveled frequently to Dhaka, Bangladesh, seeking to identify a viable cure.

Donowitz’s interest in international public health medicine was ignited by trips to Haiti when he was younger. Later, as he was looking for potential research topics, his interest was piqued by environmental enteropathy, a low-level chronic inflammation in the GI tract that’s found in a large number of children living in unsanitary conditions.

“The effects of environmental enteropathy are very, very broad,” he says. “We have limited understanding of exactly what about it is affecting growth stunting, cognitive delays or oral vaccine failures, so that is partially what we are trying to figure out.”

Peds ID Fellow Jeff Donowitz

A Bangladeshi child reminds Donowitz not to step in the open sewer. Environmental enteropathy is a low-level chronic inflammation in the GI tract that’s found in a large number of children living in unsanitary conditions.

His fellowship afforded him the opportunity to examine the issue under the mentorship of William Petri, M.D., Ph.D., the respected chief of Infectious Diseases and International Health at the University of Virginia. Bangladesh has world-class research facilities, including the International Centre for Diarrhoeal Disease Research, Bangladesh, notes Donowitz.

He hypothesized that small intestine bacterial overgrowth (SIBO) could, in part, explain those problems in poor communities. “When I started, there were only a few studies looking at SIBO in low-income countries, and most of them were just describing that it was there in large numbers. That’s where I got into the field.”

In his two-year fellowship, Donowitz says his hypothesis proved credible. Overgrowth, which was found in one in six children tested, was indeed associated with inflammation in the GI tract.

But other findings surprised him. “I had thought maybe SIBO was related to diarrheal disease but what we showed was that it’s really related to poor sanitation. So what is it about poor sanitation that leads to overgrowth in these children?”

Donowitz has a hypothesis about that, which he is exploring in a new, larger study of 275 Bangladeshi children who he is following from birth to age 2. “We’ll be measuring SIBO at multiple time points.” With that, he hopes to identify opportunities when treatment will be beneficial for the large numbers of children affected by SIBO.

Peds ID Fellow Jeff Donowitz

Armed with his study data, Donowitz is ready to move forward, continuing his research on how overgrowth of bacteria in the small intestine is damaging the guts of children in low- and middle-income countries.

“The nice thing about SIBO is that you can treat it with relatively low-cost antibiotics,” he notes. “But the downside to that is antimicrobial resistance. The idea of giving antibiotics on a large scale to a lot of people is not very attractive.”

Not only is Donowitz advancing knowledge about childhood disease, he’s proved to himself that he can secure funding. That’s important, as this fall he’ll be submitting grant requests to continue his work.

Donowitz has a message to prospective researchers. “I think a lot of times, young, smart people get put off of it because they hear that funding is hard to come by. Don’t be dissuaded by the first person who says there’s no money in it. It’s extremely rewarding.”

By Lisa Crutchfield


“The best year of my life:” Neurosurgery resident conducts brain tumor research in New Zealand

Lisa Feldman, M.D.

Supported by the most prestigious fellowship in neurosurgery, resident Lisa Feldman spent a year doing research in New Zealand.

As a sixth-year neurosurgery resident, Lisa Feldman, M.D., Ph.D., aches for her patients battling aggressive brain tumors.

Despite surgery, chemotherapy and radiation treatments, the average life expectancy for patients diagnosed with glioblastoma multiforme, the most aggressive type of brain tumor, is 15 months.

“We have to do better than that,” she said. “It’s so frustrating. I see so many patients suffering.”

Thanks to a prestigious fellowship and numerous collaboration efforts, Feldman is feeling optimistic about the future. The Chicago native was selected last year for the William P. Van Wagenen Fellowship, which awarded her a $120,000 stipend and $15,000 in research support. She used the funds to travel to New Zealand, where she studied perfluorocarbons as a new oxygen delivery therapy in hopes of reversing the death of healthy cells that results from radiation treatment of brain cancers.

“Our preliminary findings are very exciting,” said Feldman, who just returned to Richmond. “We are discovering that nanoparticles do improve tumor sensitivity to radiation.”

Feldman worked alongside physicians, scientists and researchers at the University of Auckland and the Malaghan Institute of Medical Research in Wellington. She is also collaborating with Washington University in St. Louis and her home Neurosurgery Department on the MCV Campus.

“The year I spent in New Zealand was extraordinary in that I had the opportunity to work with some of the brightest minds in the world,” she said. “It was the best year of my life.”

The teams have landed two more grants from the local government in New Zealand and the University of Otago to replicate their findings. Feldman is hopeful the next step will be clinical trials.

“Now that I’m back, we have weekly Skype calls,” she said. “Collaboration is absolutely crucial. There’s no way we could dream of accomplishing this without working together.”

Lisa Feldman, M.D.

In addition to studying how perfluorocarbons could help patients battling aggressive brain tumors, Feldman also spent time exploring New Zealand and says, “The country is absolutely breathtakingly gorgeous.”

Feldman is the Department of Neurosurgery’s first Van Wagenen Fellowship winner. The fellowship was established by the estate of Van Wagenen, one of the founders and first president of the Harvey Cushing Society, now the American Association of Neurological Surgeons.

“This is a big deal,” said R. Scott Graham, M’92, H’98, director of the Department of Neurosurgery’s residency program. “It’s the most prestigious fellowship to win in neurosurgery.

“Lisa has the perfect personality to get an award like this because she is so collaborative. She’s good at searching out people who have the skills that match her interests. She knows that you can accomplish so much more as a team than on your own.”

Feldman, 38, holds a bachelor’s degree in psychology from McGill University in Montreal. While conducting research for her Ph.D. in neuroscience at Montreal Neurological Institute, she regularly performed brain surgery on lab mice. It wasn’t long before she had an epiphany.

“I realized I really enjoyed operating,” she said. “I enjoyed the procedure. That’s what motivated me to go to medical school. I thought it would be much more fulfilling to help people.”

She earned her medical degree from Rush Medical College in Chicago in 2010 before coming to the MCV Campus for her residency. She is currently completely a three-month rotation at McGuire VA Medical Center, where she is mainly performing spine surgery. She will return to the MCV Campus in September to concentrate on brain surgery.

“That’s where my passion is – coming up with better ways to help my patients,” said Feldman, who will complete her residency in July 2018. “I am so grateful for all the opportunities I’ve had here. I’ve learned so much. It’s a dream come true.”

By Janet Showalter


Walk the Walk 2016

GME Match Map 2016From all over the country: 140 new interns begin training at VCU Health this summer, hailing from 25 different states and 53 different medical schools.

Each summer, academic medical centers around the country welcome a new class of interns into their teaching hospitals. These recent M.D. graduates are embarking on three to seven years of additional training in the specialty of their choice.

From Boston to Tucson to Seattle, 140 new interns have arrived at VCU Health from 25 states.

“We’re really proud of the caliber of this year’s recruits,” said Mary-Alice O’Donnell, Ph.D., associate dean for graduate medical education. “I’ve heard from many program directors who are enthusiastic about the interdisciplinary team spirit and patient focus this group will bring.”

Of the 140 interns, 43 completed their medical degrees at the VCU School of Medicine. But the remaining 97 interns hail from 53 different medical schools. They bring with them certain core competencies along with experiences and expectations that are based on what they’ve learned at more than four dozen medical centers.

GME Match Map 2016“Nationwide, communication failures are the leading cause of medical errors,” Ryan Vega, M.D., H’14, told the interns.

To be sure that they are on the same page in terms of what’s expected at VCU Health, the GME office organizes a three-day orientation called Walk the Walk. It differs from orientation programs at other medical centers where newly arrived interns are often trained in specialty specific programs. Instead, for seven years, O’Donnell has trained new arrivals in interdisciplinary teams.

Highlighting Handoffs
A session this year emphasized how to transfer care and responsibility of a patient to the next shift of caregivers, a process known as the handoff. The session was led by Ryan Vega, M.D., H’14, who completed residency training in internal medicine at VCU in 2014 and serving as the first chief resident for quality and safety at the McGuire VA Medical Center in 2014-15.

“Nationwide, communication failures are the leading cause of medical errors,” Vega told the interns.

Walk the Walk 2016This summer, 140 new interns participated in interdisciplinary orientation program so that everyone is on the same page. One of this year’s sessions tackled a leading cause of medical errors in hospitals across the country: handoffs.

To address the issue, VCU Health has adopted the I-PASS system developed by Boston Children’s Hospital. It’s a guideline for structured communication that uses a mnemonic to help health care providers move through the handoff process. (See chart below.) A 2014 study published in the New England Journal of Medicine reported the system can greatly increase patient safety without significantly burdening existing clinical workflows.

Vega estimates that VCU Health has applied the system more broadly at an institutional level than any other medical center in the country. Seven departments have completed a yearlong training, it’s built into patients’ electronic medical records and this is the second class of interns to train in the process.

“If we’re going to becoming the safest hospital in the nation,” Ryan emphasized, “structured communication is a route to eliminating medical errors.”

I Illness Severity Stable, “Watcher,” Unstable
P Patient Summary Summary statement; events leading up to admission; hospital course; ongoing assessment; plan
A Action List To do list; timeline and ownership
S Situation Awareness & Contingency Planning Know what’s going on; plan for what might happen
S Synthesis by Receiver Receiver summarizes what was heard; asks questions; restates key action/to do items

© 2016 I-PASS Study Group/Children’s Hospital Boston
All Rights Reserved. For Permissions contact ipass.study@childrens.harvard.edu

By Erin Lucero


Father Figure: Neurosurgery alumni pay homage to Harry Young

Harold F. Young, M.D.

This year, the usually low-key Resident Research Day Conference in Neurosurgery turned into a three day celebration of Harry Young, M.D. It drew more than 200 people, some of whom traveled across country to honor him.

Mike Chen, M.D., H’06, PhD’07 (ANAT), can’t recall a time when he worked harder or with more intensity than as a neurosurgery resident under Harold F. Young, M.D.

“The training was brutal,” he said. “As a resident at that time, you could work 120 hours a week. But there was no resentment. Dr. Young was preparing you to be the best under the most adverse circumstances. He was the most influential teacher of my life.”

Chen, who completed his residency in 2007 and now serves as associate professor at City of Hope in California, returned to Richmond in June. He traveled more than 2,000 miles to honor Young during the Resident Research Day Conference.

“I wasn’t going to miss it,” Chen said. “I owe him my career. He has the deepest passion for the profession, especially teaching it. He treated everyone with respect. He treated everyone like family.”

Usually a small, one-day event in which residents present their papers, organizers expanded it into three days this year to honor Young, who last year stepped down after 30 years as chairman of the Department of Neurosurgery. He remains on faculty as professor of neurosurgery.

“It can be hard to motivate people to come back for an event, but we had an amazing response,” said R. Scott Graham, M’92, H’98, director of the residency program. He has worked with Young since 1992. “He’s a father figure to so many of us. He instilled that sense of responsibility in everything you do.”

Harold F. Young, M.D.

Last year, Young stepped down after 30 years as chairman of the department. He remains on faculty as professor of neurosurgery.

About 225 people traveled from near and far to pay homage to their mentor. In year’s past, the conference has drawn about 50.

The alumni were eager to share stories and make a special presentation in Young’s honor. On day three of the conference, Young gave his presentation on preparing trainees for independent practice.

“I’m not sure we’ll ever see his like again,” said John Ward, M.D., neurosurgery professor. “He was able to create a bond with patients that was enviable.”

Ward was one of Young’s first residents, arriving on campus in 1970.

“He was always there to help, and over the years, that held,” he said. “He trained residents to be excellent clinicians, and he demanded that we treat everyone with dignity.”

After completing his residency in 1977, Ward worked alongside Young until 1990, then opened a private practice in South Carolina. He returned two years later.

“I looked at other hospitals, but felt this was the place to be,” he said. “Harry was here.”

By Janet Showalter

Harold F. Young, M.D., who began his career at VCU in 1972 and served as department chairman from 1985-2015, is famous for his Youngisms:

  • “Treat patients, not images.”
  • “Don’t cut the steak and butter to live a few more days.”
  • “I never go on vacation because people get sick on vacation.”
  • “Any organ you can transplant is basically worthless.”
  • “It is just a patch job. We can’t give you a new spine.”

Third-year surgery resident Krista Terracina pens first-place essay

She no longer stuffs her pockets full of supplies and reference materials like she did when she was an intern. “Yet I find that what I carry now is much heavier than it was then,” writes Krista Terracina, M.D., a third-year general surgery resident at VCU Health. “I no longer carry any books or pocket cards; instead, I carry the lessons I have learned.”

Krista Terracina, M.D.

In a first-person essay, The Things I Carry, Terracina recounts those lessons – encapsulated in life-changing experiences that taught her about diligence, about relationship between surgeons and patients and about how appearances can be deceiving.

Hers was chosen as the winner of an annual essay contest organized by the Resident and Associate Society of the American College of Surgeons (RAS-ACS) Communications Committee. The committee had invited residents to describe what they learned outside of the lectures, textbooks, ORs and patient wards that typify residency training.

“Dr. Terracina’s piece exemplifies heartfelt experiences that will forever change her career path as a surgeon,” wrote Raphael C. Sun, M.D., a general surgery resident at Washington University, St. Louis who announced Terracina’s first-place honor. “I anticipate that as you take the time to read her essay, you will empathize and gain further insight into what is not formally taught in surgical training.”

Terracina earned her medical degree at Louisiana State University. She will receive a $500 prize, and her essay will be published in the Bulletin of the American College of Surgeons.

By Erin Lucero


Trio of residents crowned state-wide Jeopardy champions at emergency medicine conference

Answer: This virus, originally isolated in 1947 from a rhesus monkey in Uganda, is a flavavirus transmitted by Aedes aegypti mosquitoes and causes a mild, self-limiting illness that is sometimes is mistaken for Dengue Fever.

Question: What is Zika virus?

Identifying the headline-making virus helped a trio of VCU residents secure the win at the Virginia College of Emergency Physicians’ annual CME conference in early February.

Loyd,Josh Moss,Mike Irby,Kyle from VCU EM FB page

Second-year resident Josh Loyd, M’14, along with chief residents Mike Moss, M.D., and Kyle Irby, M’13, took home the VACEP Jeopardy championship trophy for the second year in a row.

Chief residents Kyle Irby, M.D., and Mike Moss, M.D., along with second-year resident Josh Loyd, M.D., made up the Department of Emergency Medicine’s victorious team. The annual Jeopardy-style competition pitted the residents from VCU’s MCV Campus against physicians in training from the state’s four other emergency medicine residency programs: Eastern Virginia Medical School, the University of Virginia, the Naval Medical Center Portsmouth and Virginia Tech Carilion.

With Michelle Troendle, M.D., F’14, playing Alex Trebek’s role as host, the competition tested residents’ knowledge in a variety of categories like ultrasound, GI and eponyms. Troendle is assistant program director for VCU’s emergency medicine residency program.

Director of the residency program Joel Moll, M.D., FACEP, says, while there’s no specific way to prep for the competition, the questions cover topics residents need to know for both the practice of emergency medicine and to pass their boards.

“We sent all of our second-year residents to the conference, so they were a great source of encouragement,” says Moll, who organized a session during the weekend for residents from all five of the state’s programs. He covered the topic of career options, assistant program director Peter Moffett, M.D., spoke on test taking skills, and a presentation on the future of observation medicine was led by Pawan Suri, M.D., who is director for the emergency medicine-internal medicine program.

This is the second year in a row that VCU’s residents have won the competition. Irby and Loyd are graduates of VCU’s medical school and Moss earned his degree at Ohio State University. In addition to having their names inscribed on the foot-and-a-half high trophy that now sits in the VCU emergency medicine offices, the three competitors each received a $100 gift certificate.

By Erin Lucero