December 19, 2003

2003: Another successful year for VUMC

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Photo by Dana Johnson

The past year was again a prosperous one for Vanderbilt University Medical Center. The staff of the Reporter selected several top stories from this year, which are recapped in no particular order.

“U.S. News” ranks VUMC high

The Vanderbilt-Ingram Cancer Center was the 10th ranked cancer center in the country, and for the second year in a row, VUMC has been named to the U.S. News and World Report “honor roll” in the magazine’s “America’s Best Hospitals” special issue.

The cancer ranking of 10 is a 16-place leap from last year.

The magazine says the 17 honor roll hospitals demonstrate an “unusual breadth of excellence.” Vanderbilt is the only Tennessee hospital on the list, which includes Johns Hopkins, Duke University Medical Center, the Mayo Clinic, and UCLA Medical Center.

The honor roll is based on rankings in medical specialties; Vanderbilt was ranked in nine specialties out of the 17 that U.S. News tracks.

In addition to the 10th place ranking in cancer, VUMC also ranked in kidney disease, 11th; ear-nose-throat (otolaryngology), 12th; hormonal disorders, 18th; urology, 20th; respiratory disorders, 23rd; orthopaedics, 27th; gynecology, 28th; and rheumatology, 43rd.

Vanderbilt top five in research impact

A recent ranking looking at the scientific impact of the research conducted in biological science fields at the nation’s research universities ranked Vanderbilt in the top five in clinical medicine and pharmacology.

The Thomson Institute for Scientific Information rankings are based on how often research studies conducted between 1997 and 2001 are cited by peer researchers. Vanderbilt’s Pharmacology department ranked first in the nation for the second time in a row. Vanderbilt ranked fifth in Clinical Medicine, up from 10th in the previous ranking (1993-1997).

The ISI rankings look at the total number of scientific papers published by research institutions and the number of times those were cited by other researchers. The score is obtained by dividing the number of citations by the number of published papers, and then the institutions are ranked accordingly.

New Children’s Hospital dedicated

A new era in the care of children was launched Dec. 6 when almost 1,000 people cheered the ribbon cutting that officially opened the Monroe Carell Jr. Children’s Hospital at Vanderbilt.

The group listened to speeches and greetings from Vanderbilt leadership, local and national political figures including Nashville Mayor Bill Purcell, the mother of a Vanderbilt Children’s patient, and Monroe Carell Jr., the Nashville business executive who is the hospital’s lead donor and namesake.

Until now, Nashville was the only city among the top 25 in the nation that didn’t have a freestanding hospital dedicated to serving children and their families. The new hospital, which cost nearly a quarter of a billion dollars, is the biggest single construction project ever undertaken by Vanderbilt and the single biggest construction project ever built in the city of Nashville.

Reality TV lands at Vanderbilt

This fall, residents filled the small screen in a new series that’s the first of its kind, to enlighten the world about physician training.

Resident Life tells the stories of 26 Vanderbilt residents from 18 academic departments and their up-and-down worlds of professional and personal challenges and recreational diversions.

New York Times Television produced the show for TLC. For five and a half months in the winter and spring of this year, 13 videographers shadowed the subjects in surgery, on rounds and in clinic.

VUMC news director John Howser oversaw the project internally. This was his fourth TLC project; his veteran’s perspective helped Vanderbilt beat several competing academic medical centers for the show.

Buerhaus, Moses join Institute of Medicine

Two Vanderbilt University Medical Center faculty members have been elected into the Institute of Medicine of the National Academies. The elite group of scientists called upon for independent analysis and recommendations on issues related to human health has elected Dr. Harold L. Moses, director of the Vanderbilt-Ingram Cancer Center and Peter I. Buerhaus, Ph.D., senior associate dean for Research at the School of Nursing.

Buerhaus and Moses join 1,382 active members in the prestigious organization. Individuals are elected to the Institute on the basis of professional achievement and of demonstrated interest, concern and involvement with problems and critical issues that affect the health of the public.

Moses is internationally known for his research in growth factors, particularly transforming growth factor-beta, which Moses’ team discovered as the first growth factor to act as both a cell growth stimulator and suppressor under different circumstances.

Buerhaus is the leading expert on issues relating to the national nursing shortage.

Women exceed men for first time in Medical School’s history

This year, for the first time in the history of the School of Medicine, there are more women than men in the first year’s class, and the increase is substantial — 58 percent of the 104-member class, or 60, are women.

Other medical schools have also seen a steady increase in women, although the gap isn’t quite as large. The medical school class of 2007 at Johns Hopkins University has 57 men and 63 women. The first-year medical school class at Duke University has 51 women and 49 men.

The class of 2007 hails from 32 states with 16 from Tennessee. Seven are from Florida and North Carolina. They represent 56 colleges and universities with 14 coming from Vanderbilt and 19 from Ivy League schools. There were 35 applications for every student’s spot.

School of Nursing

celebrates record high enrollment

A total of 264 new students enrolled at VUSN for the 2003-2004 academic year, compared to 243 last year. Linda Norman, DSN, senior associate dean for academics, said the three-semester “bridge,” or pre-specialty program, where students with a non-nursing background enter the program, is the area that is seeing the most growth. The enrollment in the pre-specialty area has increased from last year’s 124 new students to 148 this year.

The nursing school hired four new, part-time, clinical faculty members to meet the demands of a larger class this year.

The new VUSN students range in age from 20 to 62 and make-up a diverse group, including Hispanic, African American, Asian, Native American, Caucasian, and other ethnicities. With the option of distance learning for many of the specialty programs, students have enrolled from as far away as South Dakota, Texas, Colorado and Louisiana.

‘Top Doctors’ recognize VUMC physicians

The third edition of America’s Top Doctors lists 46 VUMC physicians among its rankings, an increase over the 39 cited in the book’s second edition, published last year. The guide uses a peer recommendation methodology to choose the physicians included.

Sandler named Pendergrass Chair

The Carol D. and Henry P. Pendergrass Chair in Radiology and Radiological Sciences was bestowed upon Dr. Martin P. Sandler, professor and chair of department. The honor was created by the Pendergrass family in 1992 to pay tribute to the achievements of emeritus professor and former vice chairman of the radiology department, Dr. Henry P. Pendergrass and his late wife Carol. Sandler is the second faculty member to hold the title; Dr. C. Leon Partain, professor of Radiology and Radiological Sciences, was the first.

Limbird steps down, Balser to assume post

Lee E. Limbird, Ph.D., professor and former chair of Pharmacology, stepped down as associate vice chancellor for Research. Limbird will begin winding down her laboratory on the fourth floor of the Robinson Research Building. It will close next July. She will continue to serve on the faculty and guide the medical center’s fledgling research magazine, Lens, as a member of its editorial board. Dr. Jeffrey R. Balser, a respected physician-scientist and chair of the department of Anesthesiology, will assume the post Jan. 1, 2004.

Limbird’s role as associate vice chancellor for Research evolved from a faculty-driven strategic planning process, culminating in a 1997 report that recommended investments in people and programs to enhance the academic enterprise. Upon being named to the position in 1998, Limbird assembled a team committed to facilitating research and research training and letting faculty-initiated independent and team research flourish, from bench to bedside.

Part of the plan involved reorganization of the Office of Research, an enhanced infrastructure that helped increase the amount of extramural research funding at the medical center from $94 million in 1998 to a current level of $254 million.

Balser, 41, is also professor of Anesthesiology and Pharmacology and holder of the James Tayloe Gwathmey Physician-Scientist Chair.

Pinson to head

clinical affairs

Dr. C. Wright Pinson, H. William Scott professor of Surgery and chair of the department, director of the Vanderbilt Transplant Center and chief of staff of Vanderbilt University Hospital, has been named associate vice chancellor for Clinical Affairs and chief medical officer effective Jan. 1. Pinson succeeds Dr. John S. Sergent, who stepped down in July to become vice chairman for education in the department of Medicine.

One of his major priorities will be completion of the improvement projects that emerged in the clinical enterprise retreats hosted this summer by Vice Chancellor Jacobson, projects such as reducing unwanted variability of treatment and testing, managing discharge time, optimizing inpatient capacity, improving OR patient throughput, and enhancing outpatient productivity.

Other responsibilities of the associate vice chancellor for Clinical Affairs and chief medical officer include participation in strategic planning, oversight for clinic operations, and helping to represent physicians and the hospital in contracting efforts and other matters.

Sergent has new role

In July, Dr. John S. Sergent stepped down as chief medical officer of Vanderbilt Medical Group and senior associate dean for clinical affairs to become vice chairman for education and program director for the residency training program in the department of Medicine.

Sergent replaced Dr. John M. Leonard, who has decided to step down after 20 years as department vice chairman/residency program director. Leonard will continue his role as professor of Medicine.

VUMC doctors

perform first robotic surgery

Vanderbilt’s first robotic surgical procedure was performed in mid-May by Dr. Joseph A. Smith Jr., William L. Bray Professor and Chair of Urologic Surgery. Smith used VUMC’s new $1 million-plus Da Vinci Surgical System, built by Intuitive Surgical, to perform a radical prostatectomy.

Introducing a new degree of freedom and control for the surgeon, and eliminating the awkwardness of endoscopic technique, robotic systems help to extend the important benefits of minimally invasive surgery to new groups of patients.

Vanderbilt surgeons worked with experts in the School of Engineering to create new instrumentation and to integrate radiological images alongside the robot’s view into the operating field.

In addition to applications in urologic and neurologic surgery, the robot is expected to be used in general surgery, cardiac, thoracic, vascular, ob-gyn and surgical oncology procedures.

VUSN among top 15 receiving NIH funding

The National Institutes of Health released a ranking of schools of nursing awarded research funding by the medical research center, placing the Vanderbilt University School of Nursing at 14.

VUSN was given seven total awards from the NIH in 2002, totaling $2,673,374, five research grants for $1,303,979, one Fellowship at $43,193, and one other award for $1,326,202.

The figures place VUSN above the University of Missouri Columbia, University of Alabama at Birmingham, Case Western Reserve, and Indiana University-Purdue University at Indianapolis, among others. Ninety schools of nursing are ranked as having received NIH funding.

Clinics go paperless

This year, under an initiative called E3 (as in electronic by 2003), Vanderbilt Medical Group rid itself of a number of paper processes in favor of new electronic processes. This project’s eventual impact on patient care quality and safety can’t be overstated, as it sets the stage for better management of chronic disease, automated clinical decision support and outcomes tracking, and greater standardization of practice.

Major parts of the patient record, such as test results, clinical notes and inpatient orders, had been electronic for years. By early 2003 outpatient areas had begun daily scanning and indexing of the remaining paper documents — outside test results, referral letters, forms for collecting patient history and consent, and all other documents.

The immediate benefit of this massive work redesign project was that communication of patient information among members of the patient care team became much easier and quicker, as doctors and nurses no longer needed to request records and root through sheaves of paper. The project had already brought $1.7 million in labor savings by the end of the fiscal year in June 2003.

Nursing shortage

slowed, not over

Peter I. Buerhaus, Ph.D., Valere Potter Professor of Nursing and senior associate dean for Research at the School of Nursing, released new data about significant changes in the nationwide hospital nursing shortage in an article featured in the November/December issue of Health Affairs.

The article outlined how, in 2002, hospital registered nurse (RN) employment and earnings rose dramatically, as more than 104,000 nurses entered the workforce. The demand for hospital RNs pushed earnings up nearly 5 percent and two times the rate of RN wages in non-hospital settings. The research also shows older, married RNs over the age of 50, and foreign-born nurses, accounted for nearly all of the increase in employment.

This influx of older and foreign-born workers has temporarily slowed the growth of the shortage of hospital nurses that first started back in 1998. Buerhaus said efforts to increase the flow of RNs into the workforce, retaining older RNs and recognizing the role that foreign-born RNs play in providing nursing care in the United States are needed.

Liebler joins VUMC to expand Proteomics

Daniel Liebler, Ph.D., a co-recruit of the Vanderbilt Institute of Chemical Biology and the department of Biochemistry, has taken the reins of the Proteomics Laboratory and will expand the technologies and services offered to Vanderbilt investigators.

Vanderbilt’s Proteomics Laboratory offers the newest generation of mass spectrometers from Thermo Electron Inc. and Applied Biosystems. The laboratory also has established interactions with excellent biostatistics and bioinformatics/supercomputing groups, led by Yu Shyr, Ph.D. and Jason Moore, Ph.D., respectively. Any Vanderbilt investigator interested in pursuing a proteomics approach is encouraged to make use of the laboratory.

Liebler hopes to develop what he calls a “culture of proteomics” at Vanderbilt, a culture where investigators know how to design experiments that will make the best use of the available proteomics technologies. He plans to launch a proteomics journal club in the near future, and he will be teaching a graduate level course in proteomics starting next spring. The laboratory will also host workshops periodically on more specific applications.

VICC awarded third ‘SPORE’ grant

Vanderbilt-Ingram Cancer Center investigators were awarded a Specialized Program of Research Excellence (SPORE) in breast cancer, making VICC one of only seven centers in the country with three or more of these highly competitive grants from the National Cancer Institute.

The grant will provide $2.5 million in the first year, with total recommended funding over the five-year period of more than $13 million. The grant recognizes VICC’s researchers for their innovative leadership in the development of new ways to treat and prevent breast cancer.

New sleep lab opens

In a first for Nashville and Middle Tennessee, Vanderbilt has opened the first hotel-based sleep center in the Marriott at Vanderbilt University. The state-of-the-art sleep laboratory utilizes regular hotel rooms, slightly converted to monitor sleeping patterns.

The new lab area encompasses one end of the fifth floor of the Marriott (4,000 square feet), and has six rooms set aside for sleep studies, with additional rooms for monitoring and program support.

The location of the new sleep center, which was more then two years in planning stages, was the idea of Drs. Robert L. MacDonald, professor and chair of the Neurology Department, and Dr. James R. Sheller, associate professor of Medicine in the Allergy/Pulmonary and Critical Care Medical Division.

Such disorders as sleep apnea, narcolepsy, restless legs syndrome, sleep walking, possible nocturnal seizures or other sleep-related events, insomnia, and shift work disorders are evaluated and treated, as well as sleep difficulties associated with illnesses, such as Parkinson’s disease, stroke, epilepsy and lung or heart disease.

First southern swap


In November, Kay Morris, 53, of Paris, Tenn. and Tom Duncan, 40, of Jackson, Tenn. received new kidneys in what became Vanderbilt University Medical Center’s and Tennessee’s first paired exchange, or double swap kidney transplant. Morris was to receive a kidney from her daughter, Melissa Floyd, and Duncan, from his friend and neighbor, Patricia Dempsey.

Debbie Crowe, Ph.D., an astute Nashville immunologist who works for the laboratory that does Vanderbilt’s tissue typing, discovered that by swapping kidneys between the two pairs, the transplants would work.

Since there was a positive cross match with both couples, Morris successfully received a kidney from Dempsey and Duncan successfully received a kidney from Floyd.

Iraqi baby travels

to Vanderbilt

While the rest of the nation was celebrating Independence Day, a 4-month-old Iraqi-born boy underwent surgery at Vanderbilt Children’s Hospital for a debilitating birth defect called spina bifida.

Ahmed Mahmood was born just days before the launch of Operation Iraqi Freedom in March, was flown from Iraq to Nashville July 3 for the surgery, which closed the baby’s open lower spine and removed a large sac of spinal fluid called a meningocele.

The baby’s uncle, and Nashville resident, Abdul Koshnaw approached Vanderbilt Neonatologist Dr. Brian Carter, asking if there was something that could be done for his nephew in Iraq. Carter, realizing that Vanderbilt donates surgery to children in life-or-death situations, wasted no time in making arrangements. The surgery was done at Vanderbilt Children’s Hospital for free.

The baby traveled from Erbil, through Amman, Jordan to Chicago and eventually here to Nashville.

Vanderbilt, Meharry establish new Center for AIDS Research

AIDS research in Nashville has been given a big boost with the establishment of a new, federally funded center to be operated jointly by Vanderbilt University Medical Center and Meharry Medical College.

The Vanderbilt-Meharry Developmental Center for AIDS Research, supported by a three-year, $750,000-a-year grant from the National Institutes of Health (NIH), is one of 20 CFARs (centers for AIDS research) that have been established nationwide since 1988.

The goal of the grant is to encourage collaboration between Vanderbilt and Meharry, and train new investigators to advance AIDS treatment and prevention. At the end of the three-year grant period, the developmental center can apply for full center status and a larger continuation grant, he added.

Vanderbilt and Meharry have been collaborating for several years on research involving the human immunodeficiency virus (HIV), which causes AIDS, and which is spread primarily by sexual contact and intravenous drug use. Current AIDS-related funding by the NIH at both institutions exceeds $7 million.

VUMC No. 3 in heart transplant trials

Vanderbilt University Medical Center has been ranked No. 3 worldwide in enrollment for an international trial testing the efficacy of a new immunosuppressant drug for use in heart transplant patients.

Dr. Stacy F. Davis, assistant professor of Medicine, is the primary investigator for the Vanderbilt study.

The study, sponsored by Novartis, is a randomized, single blind trial testing a known immunosuppressant therapy called Mycophenolate Mofetil (MMF) against a newer more tolerant form called Mycophenolic Acid (ERL).

The standard therapy may cause significant nausea and gastrointestinal distress. The hope is that the newer drug, a broken-down formulation of the existing therapy, will be better tolerated. Investigators already have some evidence that it is just as effective.

New consortium to map cellular lipids

Vanderbilt University Medical Center will play a prominent role in a new $35 million collaboration supported by the National Institutes of Health.

The Lipid MAPS (metabolism and pathways strategy) Consortium will identify and measure all the lipids — fats and oils — within a cell and how they change during cellular signaling. This information is expected to shed light on a range of diseases including heart disease, cancer, arthritis and diabetes.

H. Alex Brown, Ph.D., Ingram Associate Professor of Cancer Research and Pharmacology, is leading one of six national “lipidomics” centers, the consortium sites that will sift through and identify all of the lipids in the cell.

School of Medicine changes curriculum

This year, Vanderbilt University School of Medicine announced two major changes in the way medical students are trained. VUSM replaced its current traditional letter grading system with a pass/fail system in July — a move the administration hopes will eliminate student pressure and promote content learning. The school also will begin to offer the new Emphasis Program, a two-year program of self-directed study.

Vanderbilt will join several other elite medical schools using the pass/fail system, including Johns Hopkins, Washington University and Stanford University in changing over to a pass/fail system.

The School of Medicine has established a series of learning objectives for its educational program that will be clustered into seven categories: knowledge, skills in assessing information, skills for the diagnosis and management of patient problems, clinical reasoning skills, skills in communication and interpersonal relations, professional development, and professional values.

As part of Emphasis, students will develop and pursue a project in one of eight areas related to medicine in order to gain skills and knowledge that will contribute to their medical careers.

A student’s area of interest will be matched with those of a growing group of faculty mentors. Each student will cultivate knowledge and skill through the mentor relationships as well as hands-on research and study in his or her desired focus area.

The eight focus options are: biomedical informatics, community health initiatives and health outreach, education, healthcare research and management, laboratory-based biomedical research, law, medical humanities and patient-oriented research.