CONSULT

A Newsletter for Medical Professionals FALL 2019 LUNG CANCER RESEARCHER CONDUCTS CLINICAL TRIAL FOR LIQUID BIOPSIES What will lung cancer diagnosis and treatment look the time of its removal. Back in the lab, Johann’s team like in the future? Look no further than the research at runs genetic sequencing on the tumor and re-grows it UAMS that is happening today. using different methods. Once the sample tumor is big “We’re coming into the long-promised ‘future’ of enough, the team tests individual existing drugs and cancer treatment,” said physician-scientist Donald J. novel combinations of existing drugs on the tumors to Johann Jr., M.D. “For the last 50 years, the holy grail find the most effective treatment. of cancer research has been being able to detect the The information is analyzed and stored so that if an presence of cancer with a simple blood test, known individual patient’s cancer comes back, the doctors will as a liquid biopsy, and treat cancer patients on an know the best therapies to use. The information is also individualized basis, which is precision medicine. compiled in large datasets so researchers can look for In pursuit of this quest, Johann was awarded $1.47 aggregate patterns and identify trends regarding which million from the Food and Drug Administration (FDA) treatments work best for different types of tumors. to continue a clinical trial to develop a liquid biopsy The goal is for scientists to be able method for diagnosing and monitoring lung cancer. to genetically test a tumor to identify “Recent advancements in genetic sequencing the best course of treatment for technology, computational science and the ability to that individual manage massive amounts of data have made this type patient. of research possible,” he said. “The vision is to combine the power of these approaches with clinical knowledge to improve outcomes. This is the future of cancer medicine, and it’s all doable.” Johann is an associate professor in the departments of Biomedical Informatics and Internal Medicine in the UAMS College of Medicine. Biomedical informatics is a key part of Johann’s work. Its powerful computational methods allow him to process information on a large scale, looking for previously unrecognized patterns. Lung cancer is the leading cause of cancer- related deaths in the United States and the world, and the incidence in Arkansas has been higher than the national average for the past 20 years. Early stage lung cancer is treatable with surgery and chemotherapy and/or radiation, but the cancer often returns after two to three years and is deadly. Researchers like Johann believe precision medicine is key to changing these statistics. As an integral part of Johann’s clinical trial, UAMS surgeons provide samples of the tumor at (Continued on page 2) September 2019 Message from

(Continued from page 1) Dr. Mette

development of Dear Colleagues, liquid biopsies I’m happy to for cancer share that U.S. treatment News & World guidance and Report ranked less invasive UAMS Medical clinical care,” Center the No. 1 Johann said. hospital in Arkansas on its 2019-20 “We want to list. catch disease UAMS ear, nose and throat early and services ranked among the top 50 operate on nationwide, coming in at No. 42. it for cure, Meanwhile, UAMS cancer monitor it services were singled out as “high Donald J. Johann Jr., M.D., consults with members of his lab, from left, performing” on a national level, Meei Liu and Ikjae Shin, Ph.D. effectively, develop model and several other services and systems procedures were designated as Liquid biopsies are important effectively and then look at “high performing” regionally: colon because the average diagnosis potential therapies to see what cancer surgery, heart failure, hip for lung cancer patients is about would be the best treatment for replacement, knee replacement and age 70. Patients are often in poor each patient, instead of just giving lung cancer surgery. health in addition to battling everyone the standard treatment. For the 2019-20 ratings, U.S. cancer, and traditional invasive “The practice of clinical oncology News evaluated more than 4,500 medical centers nationwide. biopsies can lead to complications is rapidly changing, and we need The Best Hospitals ranking or death. to be part of that and contribute. indicates quality complex care for Patients in Johann’s clinical trial When I came to UAMS, I believed challenging health conditions and give blood samples at multiple we should be able to do state- for common elective procedures. stages of treatment. The research of-the-art cancer research and “High performing” ratings designate team determines whether the treatment here. I’m proud to be specialty care that is significantly cellular material shed by tumors part of this science, the teamwork better than the national average, into blood can help doctors and potential for our patients.” as measured by factors such as detect cancer earlier and monitor Johann’s work on lung cancer patient outcomes, volume, quality patients during cancer treatments has been underway for three of nursing and other care-related to improve outcomes. Again, years. During previous phases, indicators. compiling big datasets plays a role. his team developed the advanced These rankings aim to offer The liquid biopsy part of bioinformatics and infrastructure at patients and physicians a resource Johann’s lung cancer work is also UAMS that are necessary to handle for making informed decisions supported by the Blood Profiling the large datasets involved in this about care. U.S. News found these Atlas in Cancer (BloodPAC), a research, and he brought firsthand programs to be special, and we nonprofit consortium for data knowledge of the latest molecular couldn’t agree more. sharing between stakeholders in technologies to UAMS. industry, academia and regulatory UAMS is working to achieve agencies with the goal of making National Cancer Institute (NCI) Best, liquid biopsies a reality. Designation for its Winthrop BloodPAC also supports liquid P. Rockefeller Cancer Institute, biopsy clinical trials at Memorial which would benefit Arkansans Stephen A. Mette, M.D. Sloan Kettering Cancer Center with improved access to clinical Interim Senior Vice Chancellor for for prostate cancer, University trials and expanded access to Clinical Programs of Southern California for federal research funding. Research Interim Chief Executive Officer breast cancer, and University of like Johann’s is both part of that Chief Clinical Officer Pennsylvania for pediatric cancers. effort to gain designation and an University of Arkansas for Medical “The collaborative element example of what will be possible Sciences Medical Center to this is very important. We – on an even larger scale – once work with three very prestigious, designation is achieved. NCI-Designated Comprehensive For more information, visit Cancer Centers to accelerate the Cancer.UAMS.edu. ■

2 Physician Relations News to Know: Updates from UAMS Physician Relations Pait reviews and discusses & Strategic Development Orthopaedics Sets Clinic for Michael Manley, RN, M.N.Sc. Upper Extremity Amputees the patient’s medical records, [email protected] Patients with amputations to radiological studies, imaging and their fingers, hands and arms can other information with the patient. Director receive care from a specialized To make a referral, call 501-686-5270 Melanie Meyer, M.Ed. physician, occupational therapist option 5. [email protected] and prosthetist all under one roof at the Orthopaedics Clinic on Guido J.K. Tricot, M.D., Ph.D., Manager Autumn Road. Returns to UAMS Carla Alexander, M.Ed. [email protected] Fellowship-trained upper Hematologist Guido J.K. Tricot, M.D., Ph.D., has returned extremity surgeons Mark Tait, Byron Jarrett to UAMS’ Myeloma Center. M.D., and John W. Bracey, M.D., [email protected] are part of the monthly clinic, When Tricot was first at UAMS along with from 1993-1997, Wendy Sheridan occupational he was intimately [email protected] therapist involved in Angela developing and pioneering the CONSULT Green and is produced by the UAMS Office Total Therapy an upper of Communications & Marketing extremity Approach and Physician Relations & prosthetist. to myeloma, Strategic Development. Together, they provide a level of consisting of upper extremity care unique in induction chemotherapy, stem Editor Arkansas. cell transplantation consolidation Amy Widner The clinic is for anyone with an and maintenance. This treatment upper limb amputation, including method was adopted worldwide Designer multiple fingers, partial hand, full and is responsible, together with Norma Edwards hand, below the elbow, above the introduction of novel drugs, the elbow and into the shoulder. for the greatly improved median Vice Chancellor for The amputation could be recent survival rate for myeloma, which Communications & Marketing or several years or decades in exceeds 10 years, with some Leslie Taylor the past. patients achieving cure. For more information, visit Go.UAMS. Tricot also served as director edu/AutumnRoad or call 501-526-1046. of clinical research for myeloma at UAMS from 2000-2007. UAMS Starts Digital Health To make a referral, call 501-686-7105. Program to Help Spine Patients Statewide Psychiatry Names New UAMS’ digital health spine Faculty, Medical Director clinic allows patients across Veronica Raney, M.D., has CONSULT Arkansas who have recently joined the Division of Child Quiz of the Month undergone spinal surgery or have Psychiatry’s Child Study Center spinal disorders or spinal cord as medical director, one of Question tumors to get treatment close to several new faculty positions Your patient is a 36-year-old female home without having to travel to within the Department of recreational tennis player with elbow pain Little Rock to see a specialist. Psychiatry. radiating down the posterior aspect of The clinics are held through a Srini Gokarakonda, M.D., her forearm that has increased over the live video and data connection has also joined past two days. She recently began playing tennis on a team that practices nightly. with spine surgeon the Child Study T. Glenn She is afebrile with normal vital signs. Pait, M.D., at Center. Victoria Examination reveals tenderness distal to UAMS regional Flynn, M.D., the lateral epicondyle, with pain increased campuses divides her with wrist extension against resistance. around the state. time between She has increased pain with resisted Pait has the Psychiatric supination. trained the local Research nursing staff Institute’s (PRI) Which of the following is most appropriate how to conduct Veronica Raney, M.D. Walker Family for this patient? neurological and Clinic and the UAMS Student A. Opioid analgesics B. Corticosteroid injection Wellness Program. spinal examinations under the Hannah C. Counterforce bracing direction of the physician and to Williams, M.D., and Amy Grooms, D. Extracorporeal shock wave therapy

assess the patient’s condition. M.D., see patients in the Walker E. Strength training E

A nswer (Continued on page 4) 3 News to Know: Updates from UAMS (Continued from page 3) Family Clinic, with Williams also UAMS Offers Free Exercise UAMS has named Jay Gandy, assigned to the Institute for Classes for People with Ph.D., as associate provost at Digital Health & Innovation OB Parkinson’s Disease the UAMS Northwest Regional Program and PRI’s Women’s UAMS has received two grants Campus. Mental Health Program. totaling almost $29,000 to Hunter Gibbs, M.D., who is launch a free exercise program an associate professor in the for people with Parkinson’s Department of Psychiatry, serves disease and Parkinsonism. as an attending in PRI’s adult The Parkinson’s Foundation inpatient unit. Molly Reeves, provided $13,924 to train, staff M.D., serves as the consult- and support the program, and liaison psychiatrist for child and the Philip R. Jonsson Foundation adolescent patients at Arkansas of Little Rock provided $15,000 Children’s Hospital and also sees for the equipment. Cindy Stowe, Pharm.D. Mark Williams, Ph.D. patients in the Child Study Center. Classes meet from 2:30-3:20 p.m. All are assistant professors in on Tuesdays and Thursdays in the department. the Ottenheimer Fitness Center Jessica Coker, M.D., has in the UAMS Donald W. Reynolds been promoted Institute on Aging, 629 Jack to medical Stephens Drive. director of the For more information, call 501-766-5045. Psychiatric Research Academic Appointments Institute’s Cindy Stowe, Pharm.D., has Brian E. Gittens, Shuk-Mei Ho, Ph.D. women’s been named dean of the UAMS Ed.D., M.P.A. inpatient College of Pharmacy. unit. Coker, Mark Williams, Ph.D., has Jessica Coker, M.D. an assistant been named dean of the UAMS professor in the Department of Fay W. Boozman College of Psychiatry and the Department Public Health. of Obstetrics and Gynecology, Brian E. Gittens, Ed.D., M.P.A., For a list of new will also continue her role as has been named vice chancellor co-director of the Women’s for diversity, equity and inclusion physicians, visit Mental Health Program with an at UAMS. Jay Gandy, Ph.D. UAMShealth.com/MD emphasis on inpatient services. Shuk-Mei Ho, Ph.D., has For more information about psychiatry joined UAMS as vice chancellor services at UAMS, call 501-526-8100. for research.

UAMS PHYSICIAN RECRUITMENT & PROVIDER PLACEMENT PROGRAM

The UAMS Physician Recruitment & Provider Placement Program has a team of placement specialists dedicated to serving the recruitment needs of our partner communities, UAMS Regional Campuses and UAMS faculty. Physician/provider opportunities are available in all specialties throughout Arkansas.

FEATURED JOBS

Family Medicine Residency Program Faculty — Geriatric Focus: UAMS has an opening for a geriatric physician or a family medicine physician with a CAQ/fellowship in geriatrics at the UAMS South Central Regional Campus, Pine Bluff. Family Medicine Residency Director: UAMS has an opening for a residency program director at the UAMS Northwest Regional Campus, Jonesboro. Pediatric Faculty Opportunity: UAMS is seeking a pediatric physician for a full-time faculty position at the UAMS Southwest Regional Campus, Texarkana.

Recruitment services contact: Carla Alexander: 501-686-7934 or [email protected]

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Neurosurgical Oncology Looks to MAURICIO GARCIA SAENZ DE SICILIA, M.D. Future with Tumor Tissue Banking Assistant Professor of Medicine Each day in Neurosurgical Oncology at UAMS blurs the line Liver Transplant Medical Director between the future of what is possible and the reality of what Division of Gastroenterology and Hepatology is already being done. Nowhere is this more dramatically illustrated than with the What inspired you to become tissue bank, overseen by Analiz Rodriguez, M.D., a doctor? Ph.D., director of neurosurgical oncology, and I was fortunate to know I J.D. Day, M.D., chairman of the Department of wanted to be a doctor early in . my career. I had several role Since mid-2018, the Neurosurgical models who inspired me. They Oncology team has collected brain tumor showed me that medicine samples for genetic analysis from all would enable me to apply consenting patients. science for the benefit of my patients, and I saw “We’re trying to tailor treatment the impact that physicians have on individuals specifically to the individual patient through and society. precision medicine, while also learning about the nature of these tumors for the benefit of What do you like the most about your future patients,” Rodriguez said. “Everyone specialty? has a slightly different tumor and responds Transplant hepatology includes a wide to therapy in a different way, which makes spectrum, from simple abnormalities on lab treatment challenging. However, technology chemistries to life-threatening illness. The field is changing that right now.” is challenging but gratifying. It is truly inspiring In some cases, genetic testing reveals a tumor type with to treat patients with the severe, disabling a known treatment. Sometimes patients are a match for an complications of end-stage liver disease, ongoing clinical trial. For others, the researchers use these guiding them through a life-changing liver samples to grow more cells in the lab and test different transplantation and witnessing their impressive compounds on recovery. It is humbling when you are able the unique tumor to offer them hope for a better life through types in the search proper evaluation for matching, right timing for new therapies. and an altruistic donation. Pharmacologists at UAMS assist What makes you unique among your peers? the researchers I have extensive training on transplant in developing the hepatology, allowing me to tackle complex specific compounds. liver diseases. My team is unique in Arkansas These results as the only program with this level of are being compiled training. I genuinely understand and care about the well-being of my patients. I pay Analiz Rodriguez, M.D., Ph.D., (pictured) is director and analyzed with of neurosurgical oncology and is leading UAMS’ the help of the special attention to details during the initial brain tumor tissue bank with J.D. Day, M.D., chair UAMS Department evaluation, treatment and follow up to ensure of the Department of Neurosurgery. of Biomedical the best possible outcome. Informatics. As trends emerge from the massive amounts of data, more patients will gain access to personalized treatment What are your clinical specialties? solutions based upon the specific characteristics and genetics Liver transplantation, hepatocellular of their tumor. The data analysis is also helping the researchers carcinoma, end-stage liver disease, portal understand how these tumors form in the first place, providing and its complications, an additional means of prevention in the future. management of ascites including paracentesis, Scientists have long had ideas of how personalized hepatic encephalopathy, alcoholic liver disease medicine might look in the neurosurgical oncology setting. and alcoholic hepatitis, viral hepatitis and The patient takes a genetic test, perhaps from a sample of autoimmune and metabolic liver diseases. I their tumor or maybe even a blood test, and those genetic also perform a diagnostic and therapeutic results determine the best treatment. Each patient can endoscopic procedures. benefit from their own unique blend of surgery, medicine and radiation/chemotherapy. How can doctors make referrals to you? Day said brain tumor tissue banking is helping these Referral for liver transplantation: 501-686-6644 theories become reality. Referral for hepatocellular carcinoma: 501-296-1200 “It’s not really that far off,” Day said. “A lot of it is Referral for liver diseases in general: 501-603-1900 happening now.” Email: [email protected] For new brain tumor referrals, call 501-686-5270. n MEDICAL CASE STUDY Awake Craniotomy with FaceTime

BACKGROUND surgery with Day, The UAMS Department of the patient and Neurosurgery has offered awake his family. craniotomies since 2014 for brain Chakraborty tumor surgeries close to areas of considers it the brain that control the senses, vital for there movement, language and memory. to be extensive The patient is awake for most of discussion with the surgery and is asked to complete the patient and neurological tasks while he or family before she is observed for changes that any awake indicate the potential for collateral craniotomy, so neurological damage. that they have Imaging shows the hole left behind by the tumor removal and the Indranil Chakraborty, M.D., the clear and realistic patient’s brain filling in the space over time. team’s neuroanesthesiologist, wrote expectations the awake craniotomy protocol along about the surgery with neurosurgeon J.D. Day, M.D., and know how it who is also chair of the department. may differ from Patient selection has been key to standard surgery. the 50-plus successful surgeries to In this case, date. The procedure can last four to Chakraborty six hours, and the patient’s head is expanded that secured in a fixed position for most discussion to of that time. Patients must be able include what to handle discomfort and high levels might happen of stress and understand in advance because of what the surgery will entail. the use of the In addition to selecting the right smartphone in the candidates, the team also strives to operating room. keep the patient calm during surgery. The family might

With this in mind, Chakraborty see something Indranil Chakraborty, M.D., is the neuroanesthesiologist who wrote the considered allowing a patient to distressing. awake craniotomy protocol used at UAMS with neurosurgeon J.D. Day, M.D. use FaceTime, a smartphone video Patient They have performed more than 50 awake craniotomies since 2014. messaging application, to talk to information family members at certain parts could be exposed. A neurological Chakraborty then applied a scalp of the surgery to keep the patient complication might occur on camera. block. Using seven injections on calm, allow the team to observe the During these discussions, each side of the head for a total of 14 patient’s neurological functions, and Chakraborty’s goals were to set injections, the procedure blocks the reassure the family, which would be expectations, establish rapport and nerves that supply the scalp, leaving an example of providing patient- and also evaluate where the patient and the whole head numb. family-centered care. family had the stress management The head was then fixed in a skills for communicating with and particular position by the surgeon, INITIAL CONTACT reassuring each other during the who began surgery. Chakraborty A 34-year-old male patient with a surgery. mildly sedated the patient to a the size of an orange in The brain tumor team, the patient drowsy state during this phase the left hemisphere of his brain was and the family agreed to proceed. because the patient’s feedback is scheduled for an awake craniotomy. not needed. The patient had support from PROCEDURES Day then performed a standard close family members and a fiancé, Chakraborty put in an arterial brain surgery, with the exception who would be in the waiting room line to monitor the patient’s blood being that the patient was awake during the surgery. pressure and vital signs. The urinary and communicating with a member catheter was inserted while the of the team. The patient was asked ASSESSMENT patient was awake, in contrast to to perform tasks. These tasks were Chakraborty discussed the idea of the standard practice of inserting it periodically repeated so the team the family using FaceTime during the under general anesthesia. could notice any changes.

6 (Continued on page 7) Indranil Chakraborty, M.D.

Associate Professor Director of the Division of Neuroanesthesiology Department of Anesthesiology UAMS College of Medicine

Education Medical degree, Maulana Azad Medical College, Delhi University, New Delhi, India

Residency Anesthesiology, Maulana Azad Medical The patient’s family prepares to talk to the patient using FaceTime during the awake craniotomy. College Anesthesiology, UAMS It was during these periods that recover more quickly than those the FaceTime chats occurred. They who undergo standard brain surgery were initiated only when the patient, under general anesthesia. J.D. Day, M.D. surgeon and team agreed they The patient was awake and alert, were ready. Each chat was about 30 he ate and drank quickly, and the Professor and Chair seconds to a minute long, and there nerve block kept him pain-free for up Department of were a total of three chats. to 24 hours. Neurosurgery They went well. The team was able Instead of going to the ICU, to watch as the patient talked and the patient was able to go to an UAMS College of Medicine recognized his family, which were observational step-down unit on the good neurological indicators. neurosurgery ward. He was also able After the tumor removal, to go home faster and required less Chakraborty again mildly sedated pain medication. Education the patient while Day closed the The family reported that they Medical degree, University of Washington incision. liked hearing from the patient School of Medicine during the surgery. They found this FOLLOW-UPS more reassuring than if the news Patients who undergo awake had come from a member of the Residency craniotomies with the scalp block medical team. ■ Neurological surgery, University of Southern California School of Medicine, Los Angeles

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A resource of the UAMS Institute for Digital OCT. 1 NOV. 5 DEC. 24 Health & Innovation, the LearnOnDemand. Living Donor Program To be determined Holiday Break org web portal offers health care Aparna Sharma, M.D. professionals the flexibility of earning Department of Internal NOV. 12 DEC. 31 continuing education (CE) on their own Medicine COPD and Inhalers Holiday Break schedule, through an expanded array of Kaci Thiessen, Pharm.D. teleconferences and online courses. OCT. 8 College of Pharmacy Neurodegenerative n Track all educational hours and Disorders of Aging NOV. 19 credits earned inside or outside Denise Compton, Ph.D. Endo Bariatrics the program Department of Geriatrics Benjamin Tharian, M.D. n Ensure compliance with the CE Department of Internal requirements for the national OCT. 15 Medicine accrediting organizations for Hydrocephalus physicians and nurses Alicia Cook, APRN NOV. 26 n Earn certificates of attendance for Department of Thanksgiving Break a variety of other disciplines Neurosurgery DEC. 3 OCT. 22 Culinary Medicine LearnOnDemand.org Traumatic Brain Injury in Gina Drobena, M.D. For information on LearnOnDemand, the Elderly Department of Pathology contact: [email protected] or Katie Kimbrough, M.D. 1-855-234-3348. Department of Surgery DEC. 10 Major Depressive Disorder To request speakers or topics or to learn OCT. 29 Jeffrey L. Clothier, M.D. more about how the UAMS Physician Tweet Others as You Wish Department of Psychiatry Relations & Strategic Development team to be Treated: Social can help you, visit UAMShealth.com/MD Media Problems in the DEC. 17 Health Care Arena Sickle Cell Update Mark Hagemeier Office of General Counsel