sUMMEr 2011

uclaMEDICINE

ASurgSeonescatoUnCLdA peHrforamnfirdst h,aand Straenscploannt indthCe Whestaernn Uc.Se.

Foreign Exchange Partnership with Chinese university opens the door to broader global reach

A New Paradigm UCLA puts patients front and center

Sisterhood Female philanthropists support research in women’s health

Conversation Dr. Mario C. Deng takes heart

Spring11_Cover.FINAL.indd 1 6/9/11 12:36 PM UCLa MEDiCINE inside THis Issue SPRing 2011 • Volume 31 Number 1 01 • Leadership A PublicaTion of the From the dean: Recommitting ourselves to basic research. David GefFen School of Medicine aT UclA by a. eugene washington, m.d., m.sc. ChancELLor Gene D. Block 02 • The Cutting Edge News and research: The pain of loneliness. VicE ChancELLor, UCLA HEALTh SciencES DeAn, DaVid GeFFEn School • of MeDicine aT UCLA 08 Conversation GeraLD S. LeVEy, M.D., EndowED Chair Dr. Mario C. Deng, medical director of the Advanced A. Eugene wAshingTon, M.D., M.Sc. Heart Failure, Mechanical Circulatory Support and Heart Transplant Program. DireCTor, MarkeTing PaTTie Cuen Features ManaGEr, MARkETInG COMMUNiCATIonS Judi GoodFRiend 12 • A Second Hand, a Second Chance The first hand transplant in the Western U.S. offers Editor a young mother renewed hope. by david greenwald David GreenwAld

DeSign DireCTor 18 • Foreign Exchange Susan landesmAnn UCLA’s partnership with a medical school in China opens the door to broader global reach. by justin bergman ContribuTing WritErs justin berGMAn • Mona Gable 22 A New Paradigm Dan GorDon UCLA moves toward a more integrated approach to o r

kim kowsky providing care. by dan gordon u k u

MaRk S. litWin, m.d., m.p.h. b a m Joseph A. Michelli, Ph.D. i • h

26 The Excellence Rx s

ginny king supPle e u

How UCLA Health System elevated the patient experience. z VAlerie Walker o k .

by joseph a. michelli, ph.d. r d f o y s e

Editorial Advisory CommitteE 28 • Sisterhood t r u

An innovative program draws female philanthropists o Alan G. Robinson, M.D. c ) y

J. ThomAs Rosenthal, M.d. t to support research in women’s health. by mona gable l u

co-chairs c a f ( ;

JaMes W. Davis, Jr., M.d. n

NEWS + NOtES e l l

BRuce H. Dobkin, m.d. o b s

PaTRick T. Dowling, m.d. e 34 • Faculty Notes m a j

Dieter R. EnzmAnn, m.d. ) Notables, honors and achievements: Going home to help. e g n

Joy S. FrAnk, ph.d. a h c x Judith C. Gasson, ph.d. 36 • Alumni Notes e n g GaRy Gitnick, M.d. i e

What’s happening from the MAA: Design for Sharing. r o f

E. CARMAck Holmes, m.d. ( : y h

BARTly J. Mondino, m.d. • p 38 Friends a r

Neil H. PaRker, m.d. g o

Donor roundup: A chair to offer comfort. t o

Michael E. Phelps, ph.d. h p . l

Janet P. Pregler, m.d. l 41 • Epilogue e w d

LeonaRD H. Rome, ph.d. l

A life passes, a ritual of birth begins. a c

Arnold B. Scheibel, m.d. k r

by mark s. litwin, m.d., m.p.h. i k )

Peter C. Whybrow, M.D. e g d Cover: A study of a woman’s hands, c.1490. Leonardo da e g n i t

© Copyright 2011 by The Regents of the University of Vinci. The Royal Collection © 2011, Her Majesty Queen t u c California. Permission to reprint may be granted by ( Elizabeth II. : n

contacting the editor, UclA Medicine, 10920 Wilshire o i t

Blvd., Suite 1850, Los Angeles, CA 90024. a r

Email: [email protected] t s u l l Dear reader: Share your thoughts with us. Submit i Printed on recycled paper. letters to: [email protected].

Spring11_TOC_FINAL.indd 2 6/9/11 12:37 PM leadership

OUR CORE COMMITMENT. Basic research is at the heart of

everything we do, from work at the bench to educating future healthcare

leaders to transforming patient care to promoting healthy communities.

magine living in a world where there is no need A group of researchers at the School of Medicine for organ transplants – because failing kidneys and has succeeded in using genetically modified human faltering hearts can be induced, through stem-cell stem cells to target melanoma, the least common but therapy, to heal themselves. The dedicated women and most deadly form of skin cancer. This cancer kills one men who conduct research at the David Geffen School American every hour, and the incidence of melanoma is of Medicine at UCLA and UCLA Health System rising faster than the rates for the seven most common have imagined such a world, and the work they are cancers – up 60 percent in the last 30 years. engaged in today is laying the solid scientific founda- The stem cells used in this experiment were tion for a future in which such miraculous self-repair genetically altered to recognize and kill melanoma is commonplace. cells in mice with human immune systems. Treatment Little more than half-a-century ago, routine trans- with these specialized cells led to a dramatic decrease plantation of organs seemed equally farfetched, but in the size of melanoma tumors in the mice. Obviously, that did not deter a group of researchers at UCLA this new approach to targeting solid-tumor cancers is Ifrom envisioning such a world – and preparing for it by still in its infancy, but we can imagine a world in which developing a method of tissue-matching that reduces many cancers will be treated in this way – with pinpoint the likelihood a donated organ will be rejected. Some effectiveness and without the onerous side effects of 4,300 successful transplants of organs taken from 2,190 standard chemotherapy. donors were performed in this country in the first two In pursuing our vision to “discover the basis for months of this year alone. All of those recipients were health and cures for disease,” we are recommitting indirect beneficiaries of basic research conducted at ourselves to basic research, building an efficient UCLA in the 1960s. infrastructure to facilitate that research, optimizing At a time when we are celebrating the expansion of the use of laboratory space, and recruiting outstanding translational science at UCLA, and nationally, these faculty members. Today’s medical reality is being aus- heartening statistics remind us of the value and vitality piciously altered through the efforts of our biomedical of the fundamental research being conducted in our scientists – men and women who keep UCLA in the laboratories. This research undergirds and guides every- vanguard of the basic science that will yield tomorrow’s thing we do here at UCLA. It not only feeds our trans- medical reality. lational pipeline, it also underpins our efforts to educate leaders in the health sciences, to transform patient care, and to promote healthy communities. Fortunately, we are building for the future on the bedrock of a rich history of biomedical discovery, aided by a faculty of basic scientists who are collectively com- i n a

i mitted to the School of Medicine’s new strategic plan d e i

n to “discover the basis for health and cures for disease.” h a p

e I could cite a dozen examples of basic research being t

s A. Eugene WashingTon, M.D., M.Sc. :

y conducted at UCLA that foster this plan, but I think h p a that one will suffice, both because of its novelty and

r Vice Chancellor, UCLA Health Sciences g o

t because of its potential application to a wide range of Dean, David Geffen School of Medicine at UCLA o h P human cancers. Gerald S. Levey, M.D., Endowed Chair

UCLA Medicine 1

FALL10_Leadership_v3.indd 1 6/9/11 12:37 PM the cutting edge news and research report

immune cells and found that genes originating from two particular cell types – plasmacytoid dendritic cells and monocytes – were over- expressed in chroni- cally lonely individuals, compared with the re- mainder of the sample. These cell types produce an inflammatory re- sponse to tissue dam- age and are part of the immune system’s first line of defense, which produces an immediate inflammatory response The Pain of Loneliness to tissue damage. It’s this same inflammatory response that, over the loneliness is no fun, and now it appears it’s long-term, can promote cardiovascular disease, cancer bad for you as well. UCLA researchers report that and neurodegeneration. Chronically lonely chronically lonely people may be at higher risk for The report provides further evidence of how lifestyle people may be at higher certain types of inflammatory disease, because their and social environments can effect human health. In feelings of social isolation trigger the activity of addition, the researchers suggest that evolutionarily risk for certain types of pro-inflammatory immune cells. ancient immune-system cells may have developed a inflammatory disease. In their analysis of 93 older adults, the researchers molecular sensitivity to our social environment in order screened for gene function among different types of to help defend us against socially transmitted pathogens.

Extreme Morning Sickness? It Could Be Your Genes

approximately 60,000 And for women and the University of more than 17-fold risk of pregnant women are with sisters, mothers Southern California. experiencing the debili- hospitalized each year and grandmothers Researchers traced tating condition, too. due to hyperemesis gravi- who have experienced the family histories of “Pregnant women darum (HG), an extreme extreme morning sick- women with HG and with a family history form of nausea and vom- ness during pregnancy, found not only that of extreme nausea in iting that endangers their the risk of HG may be the condition could be pregnancy should be lives and often forces heightened, according genetic, but also that aware that they may have them to reluctantly ter- to a new study led by women with sisters who it, too, and healthcare minate their pregnancies. researchers from UCLA had HG could have a providers should take a

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6/1 /1 1:3 AM the cutting edge news and research report

The brains of children carrying the risk version of CnTNAP2 (top row) show over-connectivity in the frontal lobe, with more connections to the right side of the brain (at left), compared with the brains (bottom row) of children whose DNA carries the non-risk version of the gene.

How Autism-Risk Gene Rewires the Brain

ucla scientists have illustrated how a gene influence brain activity, the researchers used functional variant tied to autism rewires the brain. Their discovery, magnetic resonance imaging (fMRI) to scan the brains which was published in the online edition of Science of 32 children as they performed learning-related tasks. and Translational Medicine, pinpoints the crucial Half of the children had autism and half did not. missing mechanism that links altered genes to Depending on which CNTNAP2 version the modified brain function and disrupted learning. child carried, the researchers observed a difference in “This is a key piece of the puzzle we’ve been search- connectivity between the left and right sides of the ing for,” says Professor of Neurology and Psychiatry brain. In children with the non-risk gene, communica- “Now we can begin to Daniel Geschwind, M.D., Ph.D., the Gordon and tion pathways in the frontal lobe linked more strongly unravel the mystery of Virginia MacDonald Distinguished Chair in Human to the left side of the brain, which processes functions how genes rearrange Genetics. “Now we can begin to unravel the mystery tied to language. In children with the risk variant, the brain’s circuitry, of how genes rearrange the brain’s circuitry, not only in communications pathways in the front lobe connected more broadly to both sides of the brain, suggesting that not only in autism but autism but also in many related neurological disorders.” The UCLA team scrutinized the differences in the gene variant rewires connections in the brain. also in many related brain connectivity and function that result from two The finding could lead to earlier detection for au- neurological disorders.” forms of the CNTNAP2 gene, one of which boosts tism and new interventions to strengthen connections the risk of autism. Suspecting that CNTNAP2 might between the frontal lobe and the left side of the brain.

Heart Programs Earn Recognitions

an agency of the u.s. department of health and to the efforts of our entire UCLA team,” says Abbas human services has recognized UCLA’s heart- Ardehali, M.D., surgical director of UCLA’s transplant program at Ronald Reagan UCLA heart-transplant program. “We are incredibly proud Medical Center as the nation’s best. The recognition of our program, which has served so many patients by the Health Resources and Services Administration with this life-saving procedure.” (HRSA) followed a survery designed to evaluate In addition, the American Heart Association and recognize the country’s highest-performing honored Ronald Reagan UCLA Medical Center with organ-transplant programs. the Get With the Guidelines (GWTG)-Heart Failure “We are incredibly proud The survey was developed as a way to measure Silver Plus Performance Achievement Award for its of our program, which performance by assessing transplant rates, post- success in implementing a higher standard of care for has served so many transplant survival rates and mortality rates for pa- heart-failure patients. The GWTG-Heart Failure patients with this life- tients after being placed on the organ-donation wait- initiative helps hospital staff to develop and implement ing list. “This remarkable achievement is a testament heart-failure-care processes. saving procedure.”

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illustrations: (autism) courtesy of dr. daniel geschwind; (tai chi): juliette borda A T 4 i W c c c g e d o or t m a a r t a a s s n p m B P M I v v UC UC i i i i f f h h s t s a n t n p h n h o a t e r o C a l s d s g l e f t a 0 m r e m r u e e a r e a i o o o c a n e e t o u e e d a g r r e p u o o n a a r h r n t i m d n i k t n e h s Th Th “ W s ie a t d H R up i r n e r w d b h n s o h r i C g g t n l l l mo L L i l e h r i o w c d t t t g t c i e h e c a d o o e e p Th n c i s r e i t t n t u e n s h h r r i s o A A a t i a s l c n r a h e m e mo e s y o n o h n , t i u w s o s i l e t d a t g h - - s y t m e rd e w t l i b o r w m e n t o e e e ’ ’ n w . L t i i i g e e p s mo s L i i h n J h e u a a a h id l I i p o n l e id h a g s i n g t t y a d d t a s

e b n k t r f c r . “ n b r c f t a h d m e n r e r u t s t h h i e s , a o m a n o h t u u i i S y t O a s e au e i c i y c t o s s t n u e r s d y f , g i e a n e m a t h m n h , a a t c c W r h s a c u a c s e c e h m o e h p t s y i n , M t m e j s g a a u i n s e mo i s i o i i c 2 n r i e n e o r n t i h s a e , w c t h e t o e p r i e UC o e r i p t t e p d mor n e e n t r e k - o - h g c a n o g e s h t n t f e lp e i i p e fi s d m u l a m h u l m n s a d L d 7 o o a h l . Th h n t n n l y m s u a n a i t UC r n e i o n a . s l d p h i n s l n c n c o t or t c i c e r o b i , i v i l w l D e t e y P t amo n j t h t i p n d g e r l t f t UC e o a a r i s o r or d d b i o v i d t n s a l h e s 3 p o

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t e i n p h t . B e . d o h o t A o o L mor a t e s o w r l e , n s t i ” D e t o o n t u k a . t d p i n e h “ “ j m t t d n h a v u e e D r a W e c h e h c i t c l i r r g t b i o c m r r c n n i o h t e a s r t b l o e . B s n a e id m or i e id t g t u ffi k a n p s u t s i c e s e o t e t h t s i e r e u k e n e e o - t c w i e - a e id h s o g n d f h mor b t y s b y i r e r a s o x t e c , d a a g g t o i t y x s e c y c f UC p - n i c i s f t a e u or t a i r h mo f o o n s . h . s a i y o o t r h t q n c s o s h e r s a n u i a e p i u e l id . “ n t i o i e n h - r b f a , L i e

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e l 5 6/1 /1 1:3 AM the cutting edge news and research report

Heart in a Box

since the advent of trans- that can be transplanted within plantation, the only method to six hours or less of recovery. preserve a donor heart has been to Using a new organ-preservation place it in a cold preservation system in which the heart is solution during transport to the revived to a beating state, recipient. But that may change protected within a sterile chamber with a new heart-preservation and continuously perfused with system designed to maintain the warm, oxygenated, nutrient-rich organ in a warm, beating and func- donor blood, the heart may tioning physiologic state outside potentially be kept outside of the of the body. body for longer periods of time. “Human hearts were never “If we’re able to safely transport meant to be put on ice in a donor hearts across longer cooler,” says Abbas Ardehali, distances, from the East Coast to M.D., surgical director of the West Coast for example, we may UCLA Heart and Lung Trans- be able to increase the pool of plant Program. He also is principal donor hearts available to patients,” immediate and long- investigator of the Organ Care Dr. Ardehali says. term heart function, reduce the risk System – also known as “heart in Another potential benefit of the of organ rejection and increase the a box” – trial in the U.S., which new system, Dr. Ardehali adds, number of hearts accepted “Human hearts were is being conducted at UCLA and is the ability to more comprehen- for transplant. never meant to be put four other leading heart-transplant sively assess the heart prior to The “heart in a box” may extend centers across the country. implantation using imaging, how long a donor heart can be on ice in a cooler.” Many major transplant centers functional and metabolic testing. kept outside the body, increasing only consider using donor hearts This may lead to improved the pool of available organs.

Stemming Infant HiV

when HiV is not diagnosed until a pregnant woman women in low- and middle-income countries having with the virus goes into labor, her infant is usually been tested during pregnancy. treated soon after birth with the anti-HIV drug Infants in the study born to women whose HIV zidovudine (ZDV) to prevent the baby from becoming was not diagnosed until they were in labor, and who infected. Now, a National Institutes of Health were treated after their birth with the routine six-week study has found that adding one or two drugs to the course of ZDV plus three doses of nevirapine (NVP) standard ZDV treatment can reduce the chances during the first week of life or with ZDV plus two by more than 50 percent that an infant will develop weeks of lamivudine and nelfinavir, were more than A National Institutes of an HIV infection. 50 percent less likely to be infected with HIV than Health study has found The study was conducted at 19 research hospitals in those infants who received ZDV alone. South America, Africa and the United States, under “Our results showed conclusively that the two- and that adding one or two contract to the National Institutes of Health’s Eunice three-drug regimens are superior to the standard drugs to the standard Kennedy Shriver National Institute of Child Health treatment with zidovudine,” says the study’s chair, ZDV treatment can re- and Human Development (NICHD). Karin Nielsen-Saines, M.D., clinical professor of duce the chances by more From 100 to 200 infants are born with HIV in the pediatrics in the division of infectious diseases at the than 50 percent that an U.S. each year, many to women who either were not David Geffen School of Medicine at UCLA and a infant will develop an tested in early pregnancy or who did not receive treat- member of the UCLA AIDS Institute. ment during pregnancy. Internationally, estimates of HIV infection. HIV testing vary, with only 21 percent of pregnant

6 suMMer 2011

UCLAMED_SPRING.indb 6 6/1/11 11:33 AM The Coffee-Diabetes Connection

coffee may give us an early jump-start, but numerous studies have shown that it also may be protective against type 2 diabetes. Yet no one has really understood why. Now, UCLA researchers have discovered a possible molecular mechanism behind coffee’s protective effect: a protein called sex hormone-binding globulin (SHBG). The protein regulates the biological activity of testosterone and estrogen, which have long been thought to play a role in the development of type 2 dia- betes. And coffee consumption, it turns out, increases plasma levels of SHBG. Reporting with colleagues in the journal Diabetes, Atsushi Goto, a doctoral student in epidemiology, and Simin Liu, M.D., professor of epide- miology, show that women in the study who drank at least four cups of coffee had significantly higher levels of SHBG and were less than half as likely to develop diabetes as non-coffee drinkers. A large body of clinical studies has implicated the important role of sex hormones in the development of type 2 diabetes, and it’s known that SHBG not only regulates the sex hormones that are biologically active, but may also bind to receptors in a variety of cells, directly mediating the signaling of sex hormones. “It seems that SHBG in the blood does reflect a genetic susceptibility to developing type 2 diabetes,” Dr. Liu says. “But we now further show that this protein can be influenced by dietary factors such as coffee intake in affecting diabetes risk – the lower the levels of SHBG, the greater the risk beyond any known diabetes risk factors.” Unfortunately, decaf doesn’t seem to convey the same benefit. Says Goto: “You probably have to go for the octane!”

Wake-up Call

k ucla scientists have discovered c i a way to “wake up” the immune research focused on using a patient’s white blood cells to create den- r r a system to fight cancer by delivering an immune-system-stimulating dritic cells – immune-system cells that process antigens which, when l w y

r protein directly into lung-cancer tumors. The new method harnesses presented to T cells, stimulate an immune response. e h : c

) the body’s natural defenses to fight disease growth. The vault nanoparticles containing the CCL21 have been engi- s e t

e The protein, CCL21, is delivered in a “vault,” barrel-shaped na- neered to slowly release the protein into the tumor over time, producing b a i

d noscale capsules found in the cytoplasm of all mammalian cells. Pre- an enduring immune response. Although the vaults protect the packed ; ( s c i clinical studies in mice with lung cancer showed that the protein stimu- CCL21, they act like a time-release capsule, Dr. Rome says. d e m

s lated the immune system to recognize and attack cancer cells, potently If proven successful, the vault-delivery method would add a des- n a

r inhibiting cancer growth, according to the study’s co-senior author perately needed weapon to the arsenal in the fight against lung cancer. f t Leonard Rome, Ph.D., a cell biologist at UCLA’s Jonsson Comprehen- “It’s crucial that we find new and more effective therapies to fight this y o s e t sive Cancer Center and associate director of the California NanoSys- deadly disease,” says Steven Dubinett, M.D., director of the Jonsson r u o tems Institute at UCLA. Comprehensive Cancer Center’s lung-cancer program. “Right now, we ) c x o The goal of the research, Dr. Rome explains, was to alert the im- don’t have adequate options for therapies for advanced lung cancer.”

n a b mune system, which has been suppressed in lung tumors, to the pres- The researchers plan to test the vault-delivery method in human t i r a

e ence of the tumor cells, “to have the cancer say to the immune system, studies within the next three years. The vault nanoparticle would re- h : (

s ‘Hey, I’m a tumor and I’m over here, come get me!’” quire only a single injection into the tumor because of the slow-release n o i

t The study was published in the journal PLoS One. design, and it eventually could be designed to be patient-specific by a r t

s The new vault-delivery system, which Dr. Rome characterized as adding the individual’s tumor antigens into the vault, Dr. Dubinett says. u l l i “just a dream” three years ago, is based on a 10-year research effort. The

UCLA Medicine 7

UCLAMED_SPRING.indb 7 6/1/11 11:33 AM conversation

Dr. MaRIO C. DeNG. The internationally recognized physician and

researcher takes the reins as medical director of UCLA’s Advanced Heart

Failure, Mechanical Circulatory Support and Heart Transplant Program.

hilE a mEDicAL sTUDEnt aT the UnivErsity of BErlin in 1977, Mario C. Deng, M.D., was working the nightshift in the resuscitation center, when his team sought to transfer a dying 45- year-old heart-failure patient more than 5,500 miles to Stanford University, one of only three centers in the world performing heart transplants at the time. The man died before he could receive a new heart, but the experience had a lasting impact on Dr. Deng, who went on to become an internationally recognized leader in the field. On April 1, 2011, Dr. Deng arrived at UCLA as medical director of the Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplant Program at Ronald Reagan UCLA Medical Center. Born and raised in Berlin and Hamburg, Germany, Dr. Deng spent his senior year of high school in Southern California as part of an international-student-exchange program. He returned to Germany for medical school and trained in internal medicine and cardiology. In 1992, he came back to California to complete a postdoctoral fellowship in heart transplantation/molecular Wcardiology at Stanford University. He then served as medical director of the Interdisciplinary Heart Failure and Heart Transplant Program at Muenster University in Germany before moving to Columbia University Medical Center in New York City in 2000, where he was director of cardiac-transplantation research for more than a decade prior to coming to UCLA. In Germany, and then at Columbia, Dr. Deng conceived of and pioneered one of the seminal recent advances in heart transplantation, in close collaboration with UCLA and other leading academic U.S. heart-transplant centers: the first FDA-cleared blood test to rule out cardiac rejection, known as the Allomap test. The genomics-based test has greatly reduced the number of invasive cardiac biopsies required by heart-transplant recipients. Dr. Deng spoke with UCLA Medicine contributor Dan Gordon about his career, his humanistic perspective on patient care and about his vision for UCLA’s Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplant Program.

How did the Allomap test come about, and what a biotech company, Expression Diagnostics in San has its development meant for heart-transplant Francisco, that we could determine the absence of “I grew up in Germany, patients? rejection by drawing the recipient’s white blood cells but at age 16, I was Dr. Deng: When I arrived at Columbia University, we and subjecting these cells to gene-expression profil- privileged to live in asked questions based on work we had done, both at ing with DNA microarray technology, which had the United States. ... Stanford and in Europe, on the interaction between become increasingly available during the years before I (associate) California the immune system and the cardiovascular system. For the Human Genome Project was completed in 2001. 30 years, every heart-transplant center had been using This finding led to Clinical Laboratory Improvement with the spirit of heart-muscle biopsy with an invasive heart catheter Amendments approval in 2005 and FDA clearance in novel concepts and to rule out heart-transplant rejection. We learned, 2008 of the Allomap test, which is now used in many testing boundaries.” through a large study involving collaboration among U.S. transplant centers to rule out rejection in stable 20 of the largest U.S. heart-transplant centers and heart-transplant patients coming in for their routine

8 SUMMer 2011

UCLAMED_SPRING.indb 8 6/1/11 11:33 AM UC LAME D_S PRIN G.ind b 9

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U C L A M e d i c i n e

9 6/1 /1 1:3 AM conversation

man being. These two meet, and within this encounter everything unfolds. I listen to you as the patient, clearly communicate different options for you based on my ex- pertise and experience, and empower you as the patient to make an appropriate decision, in consultation with your family and other second opinions. I would never say, “Either you have a heart transplant or you will die,” because eventually we all will die, and no matter how white our coat is, none of us can predict with certainty what is going to happen. Everything we do within the specialized field of advanced heart failure – including education, training, translational research and collabo- ration with other healthcare providers in the region – should take place within the framework of these humanistic, patient-centered values.

How does this patient-centered approach play out in the clinical landscape for advanced-heart-failure patients, in particular, given the shortage of organs available for transplant? perspective. Twenty years later, I came back to the Dr. Deng: Our goal is to recommend to our advanced- United States to train in the sub-specialization of heart-failure patients various options in answer to their heart failure, transplant and molecular cardiology at question: “Doc, which treatment concept gives me the Stanford University, where many of the heart-trans- best chance of growing old and living a good quality of plantation concepts had been developed. As a result, life?” I will be working closely with my colleagues in I associated California with the spirit of exploring the Ahmanson-UCLA Cardiomyopathy Center, the novel concepts and testing boundaries. Ahmanson/UCLA Adult Congenital Heart Disease I knew and had always admired the UCLA Center and the Division of Cardiothoracic Surgery organ-transplant and heart-failure program – both to meet the needs of patients along the continuum of its outcomes and its team-oriented approach. Most heart failure. In the Greater Los Angeles Area, there important, I felt that the vision of the hospital are roughly 100,000 to 200,000 people with heart CEO, Dr. David Feinberg, and the medical school failure, and of them, at least 10,000 have advanced dean, Dr. A. Eugene Washington, were well-aligned heart failure. The number of donor organs for heart with mine. transplantation is 100-200 a year, leaving at least 9,800 persons who have to be treated in other ways. Mechani- What is that vision? “The most rewarding cal circulatory support is a rapidly evolving therapy Dr. Deng: The core of my clinical convictions is that with which I have been intimately involved in Europe moments for me are high-tech modern medicine can be practiced in a long before coming to the United States. Currently, the those times when I am humanistically sound way only if we empower pa- number of patients with lifetime-assist heart pumps is interacting with my tients and their families to make decisions, and that already similar to the number of patients with a heart patients in a way that we physicians see ourselves not as gods or goddesses transplant. In 10 years, we will probably have a fourth- connects us as two in- – the sole possessors of knowledge and truth – but or fifth-generation device with completely implantable dividuals – not white as consultants in our patients’ decision-making pro- assist heart pumps that stay in the body 10-to-20 years, cess. I believe that at the center of anything we do in along with a transcutaneous belt energy transformer and coat and patient, but medicine is the encounter between a person who has a very low risk of infection. With that advance, similar two human beings.” an illness and seeks professional help and a health to the evolution of pacemakers over the last 50 years, professional who has a white coat on but is also a hu- another 1,000 to 2,000 of these persons may choose to

10 SUMMer 2011

UCLAMED_SPRING.indb 10 6/1/11 11:33 AM “The core of my clinical convic- have a mechanical-circulatory-support device for their lifetime. But many of these individuals may opt to live a tions is that high-tech modern life with less aggressive treatment options. For example, medicine can be practiced in a in 2008, my American father was 82 and in advanced humanistically sound way only heart failure, and he was asked if he wanted a lifetime- assist heart pump. After careful discussions and delib- if we empower patients and their erations, he opted to live with his own heart as long as families to make decisions, and it would carry him. He spent a beautiful holiday season with his family and passed away one week later. That that we physicians see ourselves kind of informed-patient preference has to be respected. ... as consultants in our patients’

How can the program best position itself to be able decision-making process.” to meet patient needs and preferences? Dr. Deng: Obviously, if someone opts to have a heart transplant, UCLA – with a tradition of more than 25 years and having recently been ranked by the U.S. government as the nation’s top-quality heart-transplant program – must continue to deliver world-class out- Reflecting back to when you were first starting in comes through its clinical teams, as well as continue to this field, what are the most striking advances that be a leader in discovery through its basic-science teams. have been made? We will also be rapidly expanding our lifetime- Dr. Deng: Starting with the development in medical mechanical-support program to offer more options for therapies, there has been a more complete understand- people who make that choice. Assist heart pumps are ing of what the dysfunction in heart failure is about moving rapidly from bulky, crisis-intervention treat- – not seeing it only on the isolated organ level, but also ments toward small, completely implantable devices taking the person as a complex, dynamic system and that allow patients to return to a fairly normal life. We treating him or her accordingly. The field of mechani- will take on the challenge to develop a network with cal circulatory support has been rapidly advancing over community cardiology providers who are an integral the last 20 years. We have moved to more evidence- part of a lifelong-care continuum for these patients after based, less-invasive types of assist heart pumps that are their devices are implanted. smaller, more durable and allow the patient much more And finally, if after being evaluated, patients opt to freedom to move about. And finally, in heart trans- have a less-aggressive treatment plan, as my American plantation, I think one of the most important advances father did, we need to provide what is usually termed is the introduction of non-invasive monitoring based palliation care. What it really means is a focus on qual- on molecular white blood cell gene-expression testing. ity of life not just at the end of life but during the entire Not only does this procedure expose patients to fewer of continuum of the illness, in conjunction with the family the invasive heart-muscle biopsies, but now we are also and community, as part of a broader vision. using this gene-expression profiling approach to safely We also have a responsibility to play a leadership down-titrate immunosuppression therapy, thereby re- role in creating what the current administration and ducing their side effects. healthcare discourse has termed accountable healthcare organizations. The outcome measure should not be how Where do you derive the most personal satisfaction many transplants we do or how many assist devices from your work in this field? we implant. Instead, it should be how these 10,000- Dr. Deng: To have had the underlying vision and to have to-20,000 patients in the region with advanced heart been intimately involved with the implementation of failure are treated in an evidence-based-medicine way the first-in-history genomic heart-transplantation test that respects their personal choices, their humanity is certainly very rewarding. But the most rewarding and their dignity. Part of this vision for our program moments for me are those times when I am interact- at UCLA is that we will be working very closely with ing with my patients in a way that connects us as two cardiologists, primary-practice offices and community individuals – not white coat and patient, but two human hospitals in the Greater Los Angeles Area and beyond, beings. This interaction is the spirit in which we must guaranteeing their indispensible active role and respon- conduct our high-tech modern medicine. sibility in the healthcare continuum. That’s a vision that should be owned not just by UCLA but by all of us who provide care in the region.

UCLA Medicine 11

UCLAMED_SPRING.indb 11 6/1/11 11:33 AM UCLAMED_SPRING.indb 12 6/1/11 11:33 AM by david greenwald photography by ann johansson

A Second Hand,

with the first a Second Chance operation of At 2:55 in the afternoon on March 5, 2011 – one of those lovely sun-washed days in Los Angeles – Emily its kind in the Fennell moves the index finger of her right hand. This wouldn’t be remarkable if not for the fact that just hours earlier Emily had no right hand at all. western united But now, 16 hours after she was wheeled into O.R. 12 on the second floor ofR onald Reagan UCLA Medical Center, Emily has a new right hand of flesh and bone, with five long, slender fingers, and the hope of recapturing a more states, surgeons normal life. And with that slight, almost imperceptible stirring of her finger,E mily Fennell, a 26-year-old mother from Yuba City, California, becomes a part of history as the first patient in theW estern United States to receive a hand trans- at UCLA give a plant. And UCLA makes history as the first hospital west of theR ockies to perform the landmark surgery. Gathered around Emily’s O.R. bed before she is brought back to her room in ICU for recovery, the surgical team that young mother began its labors in the darkness of a Friday night and has concluded them in the light of a Saturday afternoon appears to be in awe. Nick Feduska can’t peel his gaze from her right hand, which is sheathed in a thick wrap of white gauze a new hand and and bandage with just the fingers, slightly curled, exposed. “It’s beautiful,” says the organ preservationist for the fledgling UCLA Hand Transplant Program and a member of renewed hope. the recovery team that flew by helicopter toS an Diego to procure the donor limb. The match is uncanny; the size and shape of the hand, the taper of the fingers, the skin tone and even the hair pattern are so close to Emily’s own hand that the new limb already seems to wholly belong to her. “It looks great,” Feduska murmurs. “It just looks great.” His eyes, like those of many others now drawn together around Emily, are brimming with tears.

Kodi Azari, M.D., is a dedicated surgeon and scientist, but he becomes lyrical when he speaks of the hand – an organ of both delicacy and strength that is capable of painting a masterwork, playing a musical instrument, picking up a tiny pin or wielding a sledgehammer. “There is something magical about the hand,” he says. Not only do we use it to touch and feel, but also to see and to express ourselves and communicate with others. “I am not a religious man,” Dr. Azari continues, “but if there is an argument for creation, it is the hand. It makes no sense to me that something as exquisite as this could have been formed by just random chance.” The human hand is as complex as it is elegant. Wrapped tightly within that small package are 27 bones, 34 muscles to move the fingers and thumb, 48 named nerves, dozens of blood vessels and more than 100 ligaments and tendons. With all those moving parts, transplanting a hand is a highly intricate and technical procedure that requires a large team of specialized surgeons. For Emily’s operation, the O.R. team assembled by Dr. Azari, the surgical director of the UCLA Hand Transplant Program, numbers 19: nine surgeons with expertise in hand, orthopaedic and plastic

UCLA Medicine 13

UCLAMED_SPRING.indb 13 6/1/11 11:33 AM surgery; three anesthesiologists; four nurses; an O.R. forearm and hand, which are like cables to deliver technician, a preservationist and a transplant coordinator. movement, are attached to those embedded within All surgery carries risk, and this operation will be the patient’s existing arm, the capability for gross move- particularly lengthy. But the greater risk comes from the ment – wiggling the fingers or bending the wrist, for immunosuppressive medication that Emily must take for example – is almost instantaneous, though return of the rest of her life to prevent rejection of her new hand. strength and function to the small, intrinsic muscles Though rejection has not proven to be a significant that enable fine movement takes much longer. BEFORE AND AFTER Previous page left: As the problem in past cases, it remains a primary concern, Sensation returns more slowly. Reinnervation, the tattoo on her left arm attests, says Sue McDiarmid, M.D., a transplant specialist who restoration of nerve function, progresses at about 1 Emily must “Believe” she can was instrumental in conceiving the UCLA Hand Trans- millimeter a day, Dr. Azari says. At that rate, it can take get through this next trial plant Program and now is its medical director. When 12-to-18 months to reestablish a good level of sensation in her life as she prepares to Emily was first being considered for the program,D r. in the new hand. become the first hand-trans- plant recipient in the Western McDiarmid laid out all the potential consequences of United States. immunosuppression: the possibility of renal failure, hy- UCLA’s hand-transplant program is the fourth in pertension, liver damage, elevated cholesterol, ulcers. the country, and the first in the Western United States. Previous page right: One “I think I scared the living daylights out of her,” she The others are in Louisville, Kentucky; Atlanta, Georgia; month after her transplant, says. In truth, Emily appreciated Dr. McDiarmid’s frank- and Pittsburgh, Pennsylvania, where Dr. Azari partici- Emily shows off her new hand. The closeness of the ness. “She wasn’t just selling the program. She really pated in four of the previous 12 hand transplants that match is remarkable. cared about me as a patient and that I have all the in- had been done in the country. The first successful formation necessary to make my decision,” Emily says. hand transplant was performed in 1998 in France, and AT HOME Emily also benefits from the fact that she, unlike more than 40 have been done worldwide. This page: After losing her the majority of transplant patients, is young and very Limb transplantation is a still-experimental new fron- hand when she was 21, Emily had to relearn such tasks healthy. “She is an ideal candidate,” Dr. McDiarmid tier in medicine that involves composite tissues. Unlike as how to take care of her says. “She has a terrific support system. She is very a liver or a kidney, which has a more homogenous tis- daughter and do the dishes. together medically, emotionally, family-wise, support- sue composition, the hand is bone and nerve and ten- wise, and she seems to have the ability to achieve this don and muscle and skin and blood vessels, and each balance in her life in spite of what obviously was a has its own characteristics for healing and regeneration. horrendous event for her, the loss of her hand.” “Since UCLA is one of the premier transplant programs Once the operation is complete, the first post-surgi- in the country, it is natural for us to start doing com- cal measure of success posite-tissue transplantation,” says Ronald W. Busuttil, is whether or not the M.D., Ph.D., executive chair of the UCLA Department of graft survives. After Surgery and a groundbreaking liver-transplant surgeon. that, Dr. Azari says, When he and Dr. Azari brought the idea of estab- “we will be judged on lishing such a program to the UCLA Health System’s how much function leadership, it was immediately embraced. “I’m trained and sensation returns.” as a psychiatrist, so I wait until people finish their sen- Function – the ability tence before responding,” says David T. Feinberg, M.D., to move and use the M.B.A., CEO of UCLA Hospital System. “Had I not been hand – is the first to trained like that, I would have said ‘yes’ before they return. Because the finished their sentence. The answer was, ‘Of course!’” tendons in the new That decision was not without some cost; because

UCLAMED_SPRING.indb 14 6/1/11 11:33 AM the procedure is experimental, it is not covered by While Emily is in the ICU to be prepped for surgery, insurance, so funds were secured from both within the Dr. Azari, Drs. Scott Mitchell and Tristan Hartzell, health system and from outside sources to establish the Feduska and Core take an elevator to the hospital roof, program and to cover the first several participants. where a helicopter is waiting to fly them to San Diego IN THE O.R. In addition, embarking on such a program involves to recover the donor limb. Left: The surgical team preps both ethical and economic concerns. Is it okay, for A few hours later, the recovery team has completed Emily for the surgery to trans- example, to potentially turn a healthy and well-adapted its work. It is now time to bring Emily to the operating plant a new right hand. The amputee into a transplant patient at risk for serious ill- room. As she is rolled in her bed down the long corridor operation, which begins at ness from a lifetime of immunosuppressive medication? to the O.R. suites, Emily’s mother, Kim Herman, who one minute before midnight, will take more than 14 hours What about the issue of identity? Would the recipient arrived at the hospital shortly after her daughters, and to complete. of a transplanted hand identify the limb as “self,” or Andrea follow. The procession stops at the red line on would it create conflicts in identity? Is the cost of hand the floor, beyond which family cannot pass.I t is the mo- Right: Dr. Kodi Azari, surgical transplantation appropriate, given today’s constrained ment for Kim and Andrea to say good-bye. Each leans director of the UCLA Hand healthcare resources? After lengthy consideration and over to wrap Emily in a long, tight hug. The medical Transplant Program, com- pletes reattachment of the discussion with the principal physicians, members of team has assured Emily that even at this stage, she can tendons in Emily’s new hand. the UCLA Ethics Committee were satisfied that all such still change her mind about the surgery. “Are you sure?” The next step will be to concerns were being addressed. Kim asks very softly. “Yes,” Emily responds. “I’m sure. re-establish the blood flow. I’m scared, but I’m sure.” At around 9:30 Friday morning, Lifesharing, a As Emily is undergoing further preparation, Dr. Azari non-profit organ- and tissue-recovery organization for and the procurement team enter the O.R., trailing a blue San Diego and Imperial Counties, notifiesU CLA that plastic cooler on wheels that contains the donor limb. “It there is a potential donor. E-mails and telephone calls went super well,” Dr. Azari says. “It could not have been fly back and forth. Is it a good visual match? Will the better. The hand is, I think, perfect. We’re very excited.” donor’s family consent? How soon can Emily be in Los Shortly after, Emily is sedated. Dr. Azari opens the Angeles? By early Friday afternoon, an e-mail message cooler, digs his hands into the ice and lifts out the limb announces: “It’s a go!” that will become her new hand. It is wrapped in blue Emily is at work when she receives the call on her cloth and gauze. Once removed from its swaddling, the cell phone from Erin Core, the transplant coordinator, limb, which is small and delicate, with a yellowish cast, telling her there is a donor. Upon hearing the news, she is placed palm-up on a steel tray that has been covered bursts into tears. Emily calls one of her two sisters, in a layer of ice and a slate-blue towel saturated with Andrea, crying into the phone, “They have a hand!” After a flight from Sacramento to Los Angeles, Emily w To read more about Emily and her post-transplant recovery, and Andrea arrive at the front entrance to Ronald and to view a slideshow of images of Emily and her surgery, click on Reagan UCLA Medical Center at around 6:15 p.m. the link to this story at: www.magazine.uclahealth.org

UCLA Medicine 15

UCLAMED_SPRING.indb 15 6/1/11 11:33 AM frigid water. It is necessary to keep the hand as cold as w For more information about the UCLA Hand Transplant Program and to view videos about the program and UCLA’s first hand-transplant possible throughout the procedure to minimize degra- surgery, go to: www.handtransplant.ucla.edu dation of the tissues – an environment that leaves the surgeons’ fingers chilled and aching as they work. At one minute before midnight Friday, Dr. Azari makes the first long incision along the inner forearm of the donor limb. The surgery has begun. Two surgical teams work simultaneously, one to prepare the donor limb and the other to ready Emily’s arm to receive her The Team new hand. For both teams, the task is essentially the same: dissect the limbs to reveal, identify and preserve As Kodi Azari, M.D., surgical director of the UCLA Hand Transplant Program, the important internal structures – the bones, tendons, notes, “No single person can do this by himself. It requires an enormous group of blood vessels and nerves – that must be connected to people who are dedicated, willing and believe in the mission. Without everyone successfully accomplish the transplant. giving 100 percent, this would not be possible.” His team in the O.R. for the first Chatter in the O.R. is minimal. “How’s it looking, hand-transplant surgery performed at UCLA numbered 19. They were: Prosper?” Dr. Azari asks the team working on Emily’s forearm at 12:45 a.m. “Veins okay?” “We have two re- Surgeons ally nice ones,” responds Prosper Benhaim, M.D., the Kodi Azari, M.D. (hand surgery, orthopaedic surgery and plastic surgery) lead surgeon working on Emily. “I can’t tell you how Prosper Benhaim, M.D. (hand surgery, orthopaedic surgery and plastic surgery) happy that makes me,” Dr. Azari says. Christopher Crisera, M.D. (plastic surgery) It is a slow, laborious process. After each structure Jaco Festekjian, M.D. (plastic surgery) is revealed and carefully trimmed away from the Tristan Hartzell, M.D. (hand surgery, orthopaedic surgery and plastic surgery) surrounding tissue, a small piece of blue cloth marked Timothy Miller, M.D. (plastic surgery) in indelible ink with an identifying abbreviation is Scott Mitchell, M.D. (hand surgery, orthopaedic surgery) sutured on: FDPs (flexor digitorum profundus tendon Roee Rubinstein, M.D. (hand surgery, orthopaedic surgery and plastic surgery) to the small finger); BV (basilic vein); PL (palmaris Charles Tseng, M.D. (plastic surgery) longus tendon), and so on. These bits of cloth are essential; when it is time to join the donor hand with Anesthesiologists Transplant Coordinator Emily’s arm, they will ensure that the corresponding Neesa Patel, M.D. Erin Core structures can be correctly matched and sewn together. Randolph Steadman, M.D. The surgeons will tag 23 tendons, two arteries, four Bita Zadeh, M.D. Organ Preservationist veins and three nerves. Nick Feduska By 3 a.m., the dissections of both the donor limb Nurses and Emily’s arm are completed. The bones of the do- Kristine Alessandrini, R.N. O.R. Technician nor forearm are then cut, so the length of Emily’s two Andrew Aybar, R.N. Marco Rueda arms will match. A pair of teal-green titanium plates are Donna Russel-Larson, R.N. screwed onto the ulna and radius bones of the donor Anna Wang-Matheson, R.N. forearm and, after fluoroscopically confirming the positioning of the plates, the limb is carried across the O.R. to the table where Emily lies. The donor limb and Emily’s arm are aligned, and the surgeons screw the plates down onto Emily’s bones. At 4:30 a.m. – 4-½ hours after the operation began – Dr. Azari lifts Emily’s arm with the now-joined donor limb and announces, “Emily has a new hand.” There are still 10 hours to go before the surgery is finished.

Emily lost her hand on June 11, 2006, when a car she was riding in rolled over as the driver tried to avoid another vehicle that turned in front of them on a street in Inglewood, California. When the car started to tumble, Emily put her right arm up to brace herself, but her hand went out the open sunroof and was trapped be- tween the top of the car and the roadway as the vehicle slid upside down. It was, in Dr. Azari’s words, “a com- plete degloving injury.” Emily’s hand was so badly man- gled that surgeons at UCLA, where she was taken, had

16 spring 2011

UCLAMED_SPRING.indb 16 6/1/11 11:34 AM no choice but to amputate about 1-1/2 inches proximal to her wrist. Neither the driver nor another passenger in the back seat was seriously injured. On the underside of Emily’s left forearm is a tattoo that reads “Believe.” “After I had my accident, I just had to believe that I could get through it,” she says, scratching the ears of her white Lab, Duke, and talking on the back patio of the house in Yuba City that she and her 6-year-old daughter share with Emily’s father, Danny. She could have made another choice – “Woe is me, take drugs the rest of my life and be high and become the kind of person that nobody wants to be around,” she says – but instead, she recognized that “I was alive, I would still get to see my daughter grow up, I could still live my life.” Before her accident, Emily was right-handed. Though she was fitted with both a myoelectric pros- Connection of the first artery is a milestone; it is thetic hand and a traditional “hook,” she found them finished at 9:39 a.m., and the tourniquet that has been uncomfortable and awkward to use. With therapy, she restricting the circulation to Emily’s arm throughout the learned to do everything with her left hand: groom her- surgery is released and blood again flows through her AFT ER SURGERY self, dress and tie her shoes, cook, write, drive, type (45 vessels. As the blood courses through the newly con- In the ICU, Emily’s mother, Kim Herman, reaches out to words a minute, fast enough to hold a job as an office nected artery into the donor hand, which has been with- touch her daughter’s new assistant), and perform the basic skills necessary to out blood for more than 12 hours, it warms and slowly hand. “Now she has all her take care of her child. turns from a dull, lifeless pallor to pink and takes on the fingers and all her toes,” she But she can’t put her hair in a ponytail. She can’t appearance of a living hand. The surgeons then con- says. “I’m so grateful.” teach her daughter how to tie her shoes. She can’t ride nect the second artery. A Doppler is attached to Emily’s a jet ski or snowboard. She can’t cut her food. “It’s arm, and the whoosh-whoosh of blood flowing through been the little things that I think have been the hardest her arm and new hand can be heard throughout the to overcome,” Emily says. And she can’t improve her operating room. Finally, the nerves are connected. By typing enough to advance to the next level in her work 1:30 p.m., the skin flaps have been closed in an elon- to better support herself and her child. gated zig-zag incision line. Drain lines are inserted and So she must “Believe,” and she has faith that she sewn into place, and final closures are made. can overcome this next trial as well, first the surgery It is 2:30 p.m. More than 14 hours after Dr. Azari and then the long post-surgery therapy – six days a made the first cut, the surgery is over. week, three-to-six hours a day – and the years of ongo- As Emily slowly emerges from anesthesia, Erin Core, ing rehabilitation. “If you believe you can get through the transplant coordinator, stands at the head of her something that is difficult, then you can,” she says. bed. She asks Emily if she can see her new hand and then gently lifts Emily’s head so she can look. Though The first connections Dr. Azari makes are the she is sill very groggy, Emily casts her eyes down to tendons. “It is one of the hardest parts of the surgery,” her right arm. “Can you see it?” Core asks. Emily nods he says. The challenge is to establish the right tension slightly. “Thumb,” she says. A few moments later, in and balance. If the tendons are too tight, Emily will have response to Core’s encouragement, she moves her difficulty curling her fingers and closing her hand.I f finger for the first time. they are too loose, her fingers will be floppy. Getting it Upstairs in the ICU a short while later, Kim stands right “is an art,” Dr. Azari says. As he and Dr. Benhaim outside her daughter’s room as the nurses settle work, splicing and weaving the tendons together Emily back in following surgery. As Kim watches, she before suturing, they are assisted by Dr. Hartzell and struggles to stay calm. “When you are about to become Roee Rubinstein, M.D., and as they progress, they a mother,” she says, “one of the things that you hope periodically stop to curl and flex the fingers to evaluate for is that your baby will have all her fingers and all the quality of their connections. her toes.” Kim’s composure suddenly fractures. She By 8 a.m. Saturday, they are done with the tendons, presses her fingers to her lips and her eyes moisten. and it is time to connect the blood vessels – first the “Emily lost that. But now she has all her fingers and veins and then the arteries. Working with a magnifying all her toes,” Kim continues, her voice choking as scope, microsurgeons Christopher Crisera, M.D., Jaco she looks at her child lying in bed with her new right Festekjian, M.D., and Charles Tseng, M.D., skillfully hand resting beside her. “I’m so grateful. Now she has manipulate and stitch the small vessels together. Once that back.” connection of the veins is completed, it is time to estab- lish blood flow to Emily’s new hand. David Greenwald is editor of UCLA Medicine.

UCLA Medicine 17

UCLAMED_SPRING.indb 17 6/1/11 11:34 AM Foreign Exchange

by justin bergman x photography by james bollen R

18 suMMer 2011

UCLAMED_SPRING.indb 18 6/1/11 11:34 AM Foreign by partnering with an up-and-coming medical school in China, Exchange UCLA Health System elevates its international presence and boosts its competitiveness in today’s global healthcare market.

uShing down the haLL of the Second Affiliated Hospital of Zhejiang University School of Medicine wearing white lab coats and clutching computers, Qian Huan Rand Hu Wen look like the type of serious, hard-working medical students who are about to graduate and begin their careers as doctors. It’s only when they begin recounting their 10-week exchange program at Ronald Reagan Ucla Medical Center last year that they start to giggle like teenagers, even when describing the endless hunt for housing near campus. “Renting an apartment in L.A. can be a nightmare,” says Qian, a 25-year-old der- matology major, sounding as world-weary as someone who has lived in Los Angeles her whole life. “So we tried to walk every street around campus. That was tough.” On the day before they were to begin their rotations, Qian, Hu and their four classmates from Zhejiang University finally found a house. “It was quite near the hos- pital, so we can walk there in 10 minutes and we can stay up late,” says Qian, trailing off into more giggles. “All around us were fraternities, so that was quite new to us.” Of course, this wasn’t a typical foreign-exchange program that’s more about the partying than it is the classes. The visit by the Zhejiang University students, all of whom are fluent in English and at the top of their class, was part of a much broader and more involved collaboration between Ucla and Zhejiang (pronounced Jeh- jee-ahng) University in the eastern Chinese city of Hangzhou that could become the model for other universities seeking to bridge the educational and medical-research gap between the U.S. and China. Driven by the mutual desire to boost their competitiveness in a rapidly global- izing healthcare industry, the two schools formed a partnership several years ago that sought to connect not only the academic sides of their institutions, but also the clinical functions of their hospitals. For Zhejiang University, the goal was simple: to improve its curriculum and hospital standards so it could one-day join the elite club of the world’s best medical universities and healthcare systems. “We believe that through a collaboration with such a world-class university as Ucla, it can bring our level up and improve our hospital to be a world-recognized hospital,” says Wang Jian-an, M.D., Ph.D., president of the Second Affiliated Hospital. “Bit by bit, we can

UCLA Medicine 19

UCLAMED_SPRING.indb 19 6/1/11 11:34 AM PREVIOUS PAGE: Classroom in laboratory building. ABOVE (From left): Cardiovascular Intervention Center; elevator lobby; students in Pathology Department. OPPOSITE PAGE: Replica of Second AffiliatedH ospital’s original gate outside new entrance; the characters on the gate read: “Spreading benevolence, saving people.”

w To view a slide show of more images from Zhejiang University, click on the link to this article at: www.magazine.uclahealth.org

change our behavior and style of thinking and how to work and make a specific problem or case that they are tasked with solving, so they us synchronized with the world.” have to “go out (and) acquire the knowledge rather than the knowl- UCLA had a very different motivation; it felt that in order to edge being downloaded in the classroom to the student,” Dr. Sun remain relevant in the new global order, it would need to start look- says. “That is fundamentally different from the education philosophy ing outward in a significant way. T“ he great medical schools of the and the methodology in China.” The Chinese were also impressed 21st century are going to be international,” says Tom Rosenthal, M.D., by UCLA’s integrated curriculum, in which individual courses like chief medical officer forUC LA Health System. “In 20 years, we’re not anatomy and biochemistry have been replaced by three-to-12-week just going to be competing to be among the top five or top 10 in the “blocks” of related subjects, such as a grouping together of the United States, we’re going to be competing to be one of the top five respiratory, renal and cardiac systems. or top 10 in the world, and you’re not going to achieve that without Considering the magnitude of adopting UCLA’s entire curriculum, having international presence.” Zhejiang University devoted several years to the project, sending batches of professors to UCLA for two-month stints to participate FORMING THAT PRESENCE IN HANGZHOU had as much to do with in lectures and experiments and observe problem-based learning personal connections as with strategy on UCLA’s part. Zhejiang in action. University, located on a sprawling campus of tree-lined boulevards “They rented a few apartments in Westwood, and one group would and modern high-rises built on farmland outside the city, has one trade out for the next group,” says LuAnn Wilkerson, Ed.D,, senior of China’s top engineering programs, but it has not especially been associate dean for medical education in the David Geffen School of known for its medical school, which it only acquired 12 years ago. Medicine at UCLA. “Our courses occur one block at a time, so they Since the merging, the medical school has been evolving and could really concentrate on how everything in this course fits together. improving. UCLA’s engagement with the school began in the mid- So by the end of the year, they had site-visited the entire curriculum 2000s with one of UCLA’s professors of molecular and medical that they wished to adopt.” pharmacology, Ren Sun, Ph.D., who was born in Hangzhou. After When they returned to China, the professors began translating arranging a few student exchanges with Zhejiang University, Dr. Sun the curriculum and making necessary adjustments, moving certain met with the then-president of the university, Pan Yunhe, who had courses up in the schedule, for instance, to accommodate the differ- been an exchange student at UCLA himself in the 1980s, and they ent educational backgrounds of the Chinese students, says Xia Qiang, began discussing the possibility of Zhejiang University using UCLA’s M.D., Ph.D., chairman of the Department of Physiology at Zhejiang curriculum to train its students. Before settling on the partnership University and one of the professors who visited UCLA. Then, after with Zhejiang University, however, UCLA did reach out to the top training other faculty in the new approach, the system was imple- medical schools in China to gauge their interest in collaborating. mented in the fall of 2009. Dr. Xia says they are already seeing the The response was surprising. Other schools showed little interest, results: On exams in February, the students using the new curriculum perhaps because they were not inclined to change their systems, outperformed students learning in the traditional method by a size- but Zhejiang University had signaled its desire right away, Dr. able margin. “It is very encouraging,” he says. Rosenthal says. “There was a lot of enthusiasm of how a relation- “PBL is very effective in learning, especially in medical education, ship with UCLA could enhance what they were trying to accomplish because it can stimulate the students to learn by themselves,” he in their schools and hospitals and in their city,” he adds. adds. “It’s actually an intrinsic, driving force to promote students to Specifically,Z hejiang University wanted to revamp the entire way study. They just want to study more.” of learning at its medical school. The traditional educational model That’s an easy claim for an administrator to make, but the students in China is based on rote learning: Students memorize the lessons say as much themselves. “There’s teamwork – we solve problems in their books and their lecture notes and then regurgitate the together,” says Liang Luo, a 25-year-old in the sixth year of the medi- information on their exams. There is very little room for creativity cal-school program. “If we had to do this one by one, all by ourselves, or interaction with one another. it would be difficult.A nd we can learn from each other in the process. The UCLA system, by comparison, is centered on problem-based It’s a motivation for learning.” learning (PBL). In addition to attending lectures, students are given Her classmate, 25-year-old Zhou Yijiang, says that although the

20 summer 2011

UCLAMED_SPRING.indb 20 6/1/11 11:34 AM students still have a limited number of lectures each week, they are The system is remarkably fast, given the technological hurdles that always related to the PBL sessions, creating a better overall educa- needed to be overcome: After a doctor in Hangzhou digitizes the tional experience. “We are combining the new way and the old way,” patient’s specimen slide, it is sent electronically to UCLA, where a he explains. “The old way still exists, but with the adding of PBL, pathologist reviews the case and either makes a diagnosis or sets up we can learn in the big classes more efficiently and in a more goal- a teleconference with the Hangzhou doctor to ask further questions oriented way.” or request additional tests. The aim is to finish the job in three days. Zhejiang University officials realize, however, that there is only so “All the treatments, remedies, therapies start from the diagnosis. much that can be taught in the classroom, which is why the collabo- If you have a correct diagnosis, then you can have better treatment,” ration also includes on-the-job training in U.S. hospitals for the lucky says Dr. Chen. “For the Chinese doctors, they’ll have more opportuni- few chosen to participate in the 10-week UCLA exchange program. ties to learn U.S. ways, U.S. systems, and they can change their One of the elements of the UCLA educational system that’s been habits of working and improve their skills.” hardest to export to China is the focus on developing doctor-patient For UCLA, the hope is for a future collaboration with the Second relationships. “That’s a very important and critical reason why we Affiliated Hospital in clinical research and perhaps in the future, want to work with UCLA, to change the behavior and working style of even a joint venture, says Dr. Sun. The Chinese government recently our doctors,” says Dr. Wang. “However, this cannot be done in one relaxed its rules on foreign investment in government-run hospitals, day or one week, just by one visit or two visits. It’s a long-term thing, allowing overseas hospitals to invest more capital in joint ventures and and it needs to be changed gradually. That’s why we want to send our set up their own wholly owned private hospitals on a trial basis. “Once students there.” diagnosis (at Zhejiang University) is standardized according to Ameri- Hu Wen, one of the students who went to Los Angeles last year, can standards, then we can expand into clinical research. And then says she was struck by the level of interaction between doctors and we can expand into clinical service,” Dr. Sun says. patients in the U.S. “When we’re in the clinic in your country, first the “Someday we might build a hospital together with a partner, with patient is seen by the resident, then the resident goes to the attending Zhejiang University,” he continues. “That’s our goal. We’re moving and then they go back together to see the patient again,” she says. toward that direction.” “But here, we don’t have that much time. Our GI doctor sees almost Eventually, UCLA would also like to expand this type of partnership 100 patients in one day.” elsewhere in China and other Asian countries. “We’ve got a couple of “Patients in the U.S. know their diseases a lot better, too,” adds her other institutions that have expressed interest in having this kind of classmate, Qian Huan, the dermatology student. “They do research relationship,” says Dr. Rosenthal. “The next thing would probably be before they see the doctor, so they can tell him or her their symptoms to see if any of the things we are doing in Hangzhou are exportable to and the names of their drugs. But here, doctors have to spend a lot of other places, to see what part of what we are doing is franchisable.” time educating patients. Sometimes we don’t have so much time.” But that could be far down the road, Dr. Sun notes. The first priority is to develop a functioning model. “Once we work out the ins Chinese hospitals are indeed chaotic places. On a recent and outs with one university, we can expand it. But at this moment, Wednesday at the Second Affiliated Hospital of Zhejiang University, we’re concentrating on one place to make it work well. And then it will dozens of people jostled in line to pick up their medicine at the have a significant social impact for people on both sides.” pharmacy, while others waited in queues to register or pay for their visits. Some patients carried suitcases and were accompanied by Based in Shanghai, China, Justin Bergman is a correspondent for family members, a sign they’d traveled great distances to see a the British magazine Monocle and a regular contributor to TIME, doctor and would camp out in the hospital until they received treat- China Economic Review and The New York Times. ment. High-tech machines helped alleviate some of the confusion. In one corner, patients scanned the receipts from their doctor visits into machines that would instantly spit out the results of their exams. Another touch-screen monitor provided short bios on all of the specialists, directing patients where to find them. Chen Gongxiang, Ph.D., the director of the hospital’s Center for Clinical Laboratories, says the Chinese healthcare system faces two main challenges: the sheer number of people demanding better treatment in the country and a lack of resources and train- ing to provide that kind of quality care. After Zhejiang University’s medical school began working with UCLA to improve its curriculum, Dr. Chen says it was only natural for the Second Affiliated Hospital to form a partnership with Ronald Reagan UCLA Medical Center to try to address the latter problem and bring the level of its care up to U.S. standards, as well. Sensing an opportunity to someday forge a more symbiotic relationship with Zhejiang University, UCLA agreed to share its expertise, starting with the development of a joint diagnostic center. Operational since last October, the center has already helped Zhejiang University doctors diagnose some 100 cases.

UCLAMED_SPRING.indb 21 6/1/11 11:34 AM A New Paradigm

22 summer 2011

UCLAMED_SPRING.indb 22 6/1/11 11:34 AM o providing care. > ach t by d pro an ap gor ful do se n po > r pu il d lu an s tr ed a at t r io g n te b n y i s e a r n o d m r , a r e d d i a o o n i r s b i a d r a

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t experience, both at Ronald Reagan UCLA Medical Center and at our resources as efficiently and effectively as possible,” says Tom n

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post-discharge planning. Interdisciplinary rounds most doctors worked fairly independently,” says have dramatically improved communication Jan Tillisch, M.D., executive vice chair of across the healthcare teams and with patients. the Department of Medicine in the David The increased use of hospitalists – physi- Geffen School of Medicine at UCLA. cians who specialize in inpatient care But particularly in the last decade, – has improved coordination and Dr. Tillisch notes, there has communication, reduced been a growing recogni- fragmentation tion that the

UCLA Medicine 23

UCLAMED_SPRING.indb 23 6/1/11 11:34 AM

patient’s system-wide needs should be addressed, That imperative led to the building of a care- and that a multidisciplinary team of individuals coordination department to support the physician should implement their care. “a system means you and nurse teams around transitions of care both “When you come to UCLA, whatever your have a primary doctor who within the hospital and out of the hospital. illness, it should be addressed in a way understands the priorities for The department’s nurse case managers and that reduces duplication and competition that patient’s health but can also social workers work with the care team among alternative forms of therapy, and on each hospital service to establish and gives the patient the best access in the be educated by subspecialists as to coordinate the target date and plan for most efficient way,” Dr. Tillisch says. what the patient needs, with strong discharge, identify any barriers, and “A system means you have a primary communication and easily accessible help facilitate a plan of care to ensure doctor who understands the priorities information that everyone shares.” that proper steps are taken to meet the for that patient’s health but can also be goals. Social workers help families with educated by subspecialists as to what the decision-making and potential conflicts, patient needs, with strong communica- and link them to community services. tion and easily accessible information that Last year, a consulting group, Stock- everyone shares. We have begun to develop amp, was brought in to work with both the this type of integrated system, with more Westwood and Santa Monica hospitals on the people involved and responsibilities distributed issue of patient progression – how to appropriately more widely.” move patients through the system to avoid bottlenecks Under the banner of the UCLA Operating System, the and ensure their stay isn’t any longer than necessary. The ef- hospitals have empowered performance-excellence teams, as well fort touched key hospital services such as transportation and patient as outside consultants, to help implement process-improvement placement (assigning patients to the right bed on the right service at the initiatives modeled after Toyota Lean production methods. The wide- right time), as well as care coordination and the structure of patient- ranging efforts aim to better organize the delivery of services and care rounds. The consulting group also introduced a new database sys- bolster communications across the healthcare team, as well as with tem – metrics that the hospitals use to ensure proper patient progression. patients. “Lean is a culture – it’s about engaging staff in eliminating “We have become much better at communicating with one another, waste and improving performance, so that everyone is looking at identifying the status of any given patient and informing patients and new and better ways of doing things,” says Douglas Gunderson, families when we expect to discharge them, which is very important,” executive director of Operative Services and interim director of says Marcia Colone, Ph.D., director of care coordination for UCLA Performance Excellence. Health System. “With good communication we all have the same focus Initiatives implemented by the performance-excellence group and priorities, which has a direct effect on both quality and satisfaction.” have included a “time out” before every procedure during which the healthcare team members validate that they are undertaking the right procedure with the right patient and know their role, and any ques- > Major changes have also taken place in the structure of the tions or concerns can be raised and addressed. The group has analyzed rounds on which these discussions occur: They are more systematic how patients move from the emergency department to hospital beds than in the past, and they are now interdisciplinary. to discharge, finding ways to improve the flow and ensure smooth The challenges in the daily coordination of care have become transitions through better coordination. Closer scrutiny of supply increasingly intense in recent years for two major reasons, Dr. needs has led to $10 million a year in cost savings without compro- Rosenthal notes. First, given the growing number of health services mising care. A program called “C-I Care” trains all hospital staff that can be provided on an outpatient basis, patients who are in how to interact with patients in ways that show respect, ensure hospitalized are much sicker than in previous times. privacy and keep patients and their families informed of the care plan. The difficulties in managing these complex cases have been com- “We now have a comprehensive system that aligns our mission, vision pounded in recent years by the restrictions on residents’ work hours. and values to performance at the point of care,” says Gunderson. “We “It used to be you’d have a team of residents taking care of patients, with have metrics that allow us to track how we’re doing and see where we oversight from an attending physician,” Dr. Rosenthal explains. “They need to be more effective. Members of the staff are very open about were the glue – they coordinated all of the care, and there were no opportunities to address problems, and are working together to improve handoffs necessary because it was basically the same doctors 24/7. With performance. It’s been a very positive cultural change.” resident-work-hour restrictions, they began changing shifts more often and sometimes working only a week at a time, and that has increased the chances for daily care to become disorganized.” > Rarely are there many empty beds at Ronald Reagan UCLA One of the responses has been to formalize the way nurses and Medical Center – and, with the facility operating at nearly 100 physicians communicate with each other on a daily basis. “In healthcare, percent capacity, it is particularly important for processes to be in there has always been some kind of rounding by each service, but on place that ensure patients receive services they need, and are prepared the acute-care floors it tended to be haphazard,” says Cathy R. Ward, for discharge in a timely manner. “We want to optimize the number R.N., D.N.Sc., UCLA Health System’s director of nursing. “The of people who can have access,” says Dr. Rosenthal, “and it doesn’t doctors would come through and see the patient, and they might not serve patients if they’re in the hospital longer than they have to be even see the nurse to have a coordinated discussion about the care.” simply because the care wasn’t well organized.” As patients’ acuity has increased, Ward contends, so has the need for

24 summer 2011

UCLAMED_SPRING.indb 24 6/1/11 11:34 AM

good communication. “There is a lot of evidence that says the better Dr. Lazarus says, involve communication with the patient’s primary- communication and collaboration you have amongst the team, the care physician to ensure that information about the patient’s status better the outcomes will be,” she says. “There are so many things that and needs is clearly understood and appropriately acted on. have to get done during a patient’s stay, and often the nurses weren’t UCLA Health System is in the process of expanding its aware of the plan. When all team members are hearing the same hospitalist program significantly – from 26 to 40 full-time physicians. thing, they can act right away.” Traditionally confined to medicine units, the hospitalist role is also Now each service runs its own version of a program called Every expanding to surgical services – including orthopaedics, urology and, Patient Every Day in which the entire care team discusses each case within the next year, neurosurgery – as a way of freeing up surgical during rounds – ideally with the patient and family present – on a house staff to spend more time in the operating room. daily basis. The team – which, in addition to nurses and physicians, includes the care coordinator and other relevant disciplines such as social work, physical therapy and pharmacy – discusses the care > All of these developments are having a major impact on the plan and sets daily goals as well as the goals toward discharge. In training of new physicians, Dr. Tillisch notes. Now that residents some cases, a plan is written on a whiteboard in the patient’s room are less likely to manage patients throughout their hospital stay, a to ensure that all parties are aware of the direction being taken. greater emphasis is being placed on interpersonal matters. Residents “In the complex, fast-paced environment of a teaching hospital, it’s are being taught to make sure they introduce themselves to the easy for decisions to be made without pivotal members of the team patient every time they enter a room, explain what they’re about to being present or becoming aware of them in a timely fashion,” says do, and assure the patient that, despite being a new face, they are Mark Flitcraft, R.N., M.S.N., unit director of the medical intensive well versed in the intricacies of the case. A detailed computer sign- care unit at Ronald Reagan UCLA Medical Center. The interdisci- out system has been developed for house staff to ensure that no infor- plinary rounds enable key team members, each of whom offers a mation is lost in handoffs. different perspective, to participate in those decisions, Flitcraft notes. Other changes are related to a widening of the physician’s scope as It also ensures that the desires of the patient and patient’s UCLA moves toward a more integrated healthcare system. “Because family remain central to the discussion. of all these system needs, it’s important to train physicians much Ward’s team studied the effect of the interdisciplinary rounds and more broadly,” Dr. Tillisch explains. “We have to teach them not just found that across the board, nurses and physicians at the hospital how to treat disease but also how to help patients navigate through believe care has improved on their units as a result of the clearer and that system to get the support they need. Particularly for the physi- shared decision-making, and that patients are more likely to know cians who are most involved with a continuum of care, we’re teaching what to expect. The study also found that average length of stay and them how to participate in a more collaborative way. That’s a differ- hospital readmissions have been reduced. ent kind of teaching, going beyond understanding the fundamental mechanism of disease. So the content of medical education continues to expand, even as the training hours are reduced.” > The emergence of hospitalists in recent years has also helped For all of the challenges in teaching physicians in new ways, to address concerns about continuity of care at a time when residents though, Dr. Tillisch believes the move toward a more integrated, no longer work the long shifts that enabled them to manage patients systematic approach is to everyone’s benefit. Dr. Rosenthal agrees. through much of their stay – even as it raised concerns about levels of “Our goal is to deliver reliably excellent care, 100 percent of the time,” fatigue among residents. he says. “To do that, we need to look at all of the processes and Hospitalists are physicians devoted almost entirely to inpatient explicitly determine the best ways to operate. At the end of the day, care. As such, they are skilled in the management of the acute all of these changes are being made in the service of making the conditions that get patients admitted to the hospital patient experience better, and we have clear evidence and adept at navigating the often complex hospital that we are succeeding in doing that.” system. Moreover, their constant presence in the facility makes them highly accessible Dan Gordon is a regular contributor to to patients. UCLA Medicine. “We provide a continuous presence in the hospital,” says Michael Lazarus, “our goal is to deliver reliably M.D., medical director of the hospital- ist service for UCLA Health System. excellent care, 100 percent of the “It makes the handovers and transitions time. to do that, we need to look at all of care more seamless when you have the processes and explicitly determine someone who understands the intrica- the best ways to operate. at the end of cies of care in that part of the hospital the day, all of these changes are and is always there.” being made in the service of making Dr. Lazarus notes that there is greater recognition of the importance of transitions the patient experience better.” of care. “This is a critical time when you don’t want anything to slip through the cracks,” he explains. The keys to successful transitions,

UCLA Medicine 25

UCLAMED_SPRING.indb 25 6/1/11 11:34 AM by joseph a. michelli, ph.d. > illustration by sandra dionisi

> a new book details how ucla health system

The Excellence Rx elevated the patient experience and trans- > “ou r level of service can’t let this building down.” formed itself into an architect of the Those words rang through an otherwise quiet hallway prior to the opening of Ronald Reagan UCLA Medical Center in June 2008. David T. Feinberg, M.D., M.B.A., and CEO of UCLA Hospital customer-service revolution. System, not only made that proclamation but he and leaders through- out the system have been on an unrelenting mission ever since to elevate the satisfaction levels of patients. and getting feedback on what we are doing to make the patient While stories of revolutionary medical breakthroughs and experience better.” extraordinary clinical outcomes are common at UCLA, the health Informal processes of listening like those described by Speare have system’s leadership did not always hear that patients were impressed evolved at UCLA into systems that increase the consistency of service with their treatment journey. In fact, when Dr. Feinberg was delivery and ardently solicit the voice of the patient. “To turn our promoted to CEO, in 2007, he took the reins of an organization that patient-satisfaction numbers around, we had to go back to the basics,” was rich with strengths in medical education, research and health- Dr. Feinberg notes. “We took our mission statement, ‘Delivering care delivery but decidedly deficient in leaving its patients and their leading-edge patient care, research and education,’ and personalized families with a warm feeling about their experience. UCLA’s overall it for staff with a strong emphasis on care delivery. Specifically, we re- patient-satisfaction scores were in the 30th-to-40th-percentile range designed our vision statement to say ‘Healing humankind, one patient and in need of considerable improvement. at a time, by improving health, alleviating suffering and delivering Rather than looking at the miserly numbers and feeling discour- acts of kindness.’” By linking that vision to UCLA’s underlying values aged, Dr. Feinberg saw in this a significant opportunity. “To be hon- of integrity, compassion, respect, teamwork, excellence and discovery, est, being chosen for this job was rather daunting,” he says. “This is a “we built a framework to solicit staff’s commitment to caring.” place where miracles are performed every day, however, when I talked Providing excellent medical care was never the issue. “We knew to patients I heard some disconcerting things. I’d gone to business we delivered great clinical outcomes and that we are one of the finest school and they taught me that you should know your customer. But healthcare facilities in the world but we needed to be challenged to how much were we talking to our customers at UCLA, and why were be, first and foremost, known for our compassion and our relation- our satisfaction scores so low?” Even more disconcerting was the fact ships with patients and their families,” says Tony Padilla, director of that few patients indicated they would refer their family or friends to patient affairs and volunteer services. “We have faced and met that UCLA, in spite of the excellent medical care they had received. challenge by demonstrating unprecedented increases in our satisfac- “Some people [within the system] told me that our scores were in- tion levels from the 30s to greater-than-95th percentile systemwide.” evitable given the complexity of the cases we treated and the training Those systemwide improvements have led to UCLA being recognized nature of our facilities,” Dr. Feinberg says. “I just couldn’t accept that.” as one of the nation’s top-rated academic medical centers from a From that point forward, Dr. Feinberg’s overarching goal was to patient-satisfaction standpoint. More importantly, they have caused boost those scores by giving patients and their families the level of those receiving care, like Rachel Vollmer, to say, “Hospitals are not care, both medical and personal, that any member of his own leader- exactly the most fun place to be … but I actually look forward to go- ship team would expect for themselves or their families. To that end, ing to UCLA when we have post-operative appointments … and I Dr. Feinberg inserted the “face of the patient” into every business don’t want to think of a world without UCLA Health System.” discussion at UCLA by starting each meeting with a patient story. UCLA’s turnaround of the patient experience, elevating it to the He also asked leaders in the organization to get out of their offices forefront of the system’s thinking about how it delivers care, is just and go up to the floors to talk with patients. part of the story that I learned while researching my book about UCLA Health System. The lessons revealed have relevance beyond > “ Our senior-most leaders asked me if I saw patients, and I healthcare. For anyone interested in “serving well” – whether person- realized at that point that my contact with patients was merely ally or professionally – the experience of UCLA Health System offers incidental and not the focus of what I did as a leader,” recalls Mark an opportunity for insight, renewal and transformation. Speare, senior associate director for patient relations and human resources. “It was a significant ‘aha!’ moment for me. The first patient Author, public speaker and organizational consultant Joseph A. Michelli, visits were a little awkward and angst producing. Initially, the staff Ph.D., has written extensively about transformative corporate cultures, members were perplexed, if not suspicious, of hospital administrators including Starbucks, Ritz-Carlton Hotel Company and the online retailer when we visited the patient floors.” Zappos. His book about UCLA Health System, Prescription for Excel- But it soon became evident, Speare says, “that listening to the lence (McGraw-Hill, 320 pages), has just been released. Dr. Michelli is patients was the only way anyone could truly learn how to serve them, donating proceeds from the book to benefit UCLA’s Operation Mend. and patients wanted us to listen. Now, some years later, visits with patients and families come naturally. All of our directors and managers w To watch a video about Prescription for Excellence and UCLA Health participate in patient rounds, and our staff members enjoy seeing us System’s patient-first culture, go to: www.uclahealth.org/excellence

26 summer 2011

UCLAMED_SPRING.indb 26 6/1/11 11:34 AM by joseph a. michelli, ph.d. > illustration by sandra dionisi

a new book details how ucla health system elevated the patient experience and trans- formed itself into an architect of the customer-service revolution.

UCLA Medicine 27

UCLAMED_SPRING.indb 27 6/1/11 11:34 AM Seven yeaRs aGo, Janet Pregler, M.D., invited a obstetrics and gynecology, there wasn’t a single course small group of successful executives to break- devoted to women’s health? Were they aware that, his- fast. Over coffee and croissants, the affable torically, medical-research subjects were often exclu- director of the Iris Cantor-Ucla Women’s sively men, in part because women had this reproduc- Health Center proceeded to tell the high- tive issue that made it easier and cheaper for scientists powered bankers, lawyers and assorted to study males? Furthermore, did the audience realize professionals an improbable tale. that even the mice used in studies – the mice! – were Deploying a Power Point pre- usually male? sentation, she trotted out a series The guests at the breakfast, who happened to be of blunt facts. Did they know, for in- exclusively female, had heard enough. “All those things stance, that when she was in medical were new to me,” recalls Julia Gouw, one of the at- school in the 1980s, that apart from tendees, “Whether it’s research or medical treatment,

UCLAMED_SPRING.indb 28 6/1/11 11:34 AM An innovative program draws female philanthropists together

to support and advance research in women’s-health issues.

By Mona Gable ∞ Photography by Mark Berndt

women are the stepchild of the medical field.” tackled studies ranging from heart failure in women and sex differences Soon after, Gouw, president of East West Bank and a member of the in migraine to understanding menstrual irregularity and the effects of board of directors of The Ucla Foundation, placed a few strategic calls. female hormones on stress. She told her friends about the funding crisis in women’s health, and Each year, Dr. Pregler huddles with a group of handpicked scientists then she asked them a probing question: Would they be willing to kick who sift through proposals from campus researchers to winnow the re- in $10,000 a year to advance research solely on women? They, in turn, cipients to four. In many cases, the researchers have been able to lever- asked other prominent executives they knew. And with that, a unique age those initial small studies to obtain much larger grants. philanthropic effort was born called the Iris Cantor-Ucla Women’s The chemistry between the capitalists and the researchers has also Health Center Executive Advisory Board. led to another memorable meal. Now, every winter, Dr. Pregler and Gail “It has always made me angry that research was not done on women,” Greendale, M.D., research director of the Cantor Center, host a “Lunch says Jan R. Cloyde, co-founder and former president of Grandpoint with the Scientists.” There, over iced tea and grilled salmon, the female Bank, and one of the three original board members Gouw recruited. “So rainmakers hear presentations from the researchers who’ve benefited I was immediately interested in helping support and grow this group. from their feminist vision and largesse. “To sit in the lunch with those Originally, we thought if we could get 10 or 15 members, that would be scientists,” says Cloyde, “is beyond words.” great. We now have 27.” Here are stories of some of those researchers whose work has been Since then, “the capitalists,” as they jokingly call themselves, have supported by these forward-thinking women. provided Ucla scientists with more than $1 million to advance women’s health, including more than $600,000 in seed money for research relat- VisionARIes: (From left) Dr. Janet Pregler with ed to women’s health. With that funding, investigators across Ucla have philanthropists Jan R. Cloyde and Julia Gouw.

UCLA Medicine 29

UCLAMED_SPRING.indb 29 6/1/11 11:34 AM “Most people would right away think you were responsible for getting lung cancer because you smoked. Even patients them- selves feel that way. They don’t want people to know.”

Dr. Richard Pietras

Richard Pietras: Women & Lung Cancer

When Dana Reeve died in 2006 of lung cancer, at age 44, the a grim outcome and often elicits judgment and disdain as something beloved widow of actor Christopher Reeve had never smoked a ciga- that is self-inflicted. M“ ost people would right away think you were rette. Her shocking diagnosis led many to ask the same question: How responsible for getting lung cancer because you smoked,” Dr. Pietras could she have gotten such a toxic form of lung cancer and died at says. “Even patients themselves feel that way. They don’t want people such a young age? to know.” It was precisely because of her high profile that Reeve drew atten- As it happens, one of the under-reported findings of the 15-year, tion to a largely invisible medical crisis. Since 1987, lung cancer has National Institutes of Health’s Women’s Health Initiative study was surpassed breast cancer as the leading killer of women; more than that women who took hormone-replacement therapy were more likely twice as many women die of lung cancer as succumb to breast cancer. to die of lung cancer than women who had a placebo. Dr. Pietras And, like Reeve, an astonishing 80 percent of nonsmokers who get the was already studying the hormone-lung cancer connection, and he deadly disease are women. suspected that estrogen was fueling the disease. With a grant in 2008 Richard Pietras, M.D., Ph.D., is all too aware of these grim statis- from the Iris Cantor-UCLA Women’s Health Center Executive Advisory tics. For the past seven years, he’s been researching what he calls the Board, he and co-investigator Diana Marquez-Garban, M.D., made a “epidemic” of lung cancer in women. He will tell you that female lung- pivotal contribution to the field: Dr. Pietras confirmed the presence of cancer deaths have soared 600 percent since 1950. He will also tell estrogen-receptors in lung-cancer cells. That research has enabled Dr. you why there’s so little awareness of this fact. “It gets lost in the wave Pietras to pursue a new study, one that could lead to better treatments of publicity for all these other cancers, especially breast cancer,” says for the deadly disease. Along with Edward Garon, M.D., professor of Dr. Pietras, professor of medicine-hematology/oncology and director of hematology and oncology, he is now running a clinical trial to explore the Stiles Program in Integrative Oncology. the benefits of using anti-estrogen therapy in more than 100 female While there are advocacy groups to fight breast cancer and prostate lung-cancer patients. cancer, lung cancer is another story. There’s no real advocacy group for “We always knew the breast was a target,” says the scientist of estro- lung cancer because the survival rate of patients is so poor. “In the first gen’s role in breast cancer. “But most people never thought about the five years, most patients with advanced lung cancer will pass away,” he lung as a target organ. So having this seed funding is very critical to try says. “You don’t have these survivor groups for research funding.” to inspire people to move forward in areas where there’s not a proven Lung cancer also has an image problem; it is a grim disease with track record.”

30 summer 2011

UCLAMED_SPRING.indb 30 6/1/11 11:34 AM Kathrin Plath & Alissa Minkovsky: The X Factor

As eve ryone learned in high school biology, males carry one X-inactivation affects the outcome of mutations on the X chromosome. X and one Y chromosome while females have two X chromosomes. Rett syndrome, for instance, a rare brain disorder caused by a genetic Yet in females, this XX is toxic. So during embryonic development, a mutation on the X, occurs almost exclusively in girls. After six to 18 remarkable thing happens. One of the Xs in females is “silenced,” or months, girls with the disease suddenly develop severe learning, commu- inactivated. nication and language problems. Male cells only have one X, and if that X How does this process happen? Scientists don’t really have a clue, but has a mutation, embryos die. it is a puzzle that Alissa Minkovsky finds fascinating. I“ t’s a crazy thought “On average, every cell in a girl with Rett syndrome will have 50 per- you can silence an entire chromosome,” says the young researcher, a cent of cells expressing a mutant form of the protein and 50 percent fourth-year student in a joint M.D./Ph.D. program in the David Geffen of the normal one, due to X inactivation,” says Minkovsky. Therefore, School of Medicine at UCLA. females are born but carry the disease. In the lab, the two scientists And it’s a puzzle the enterprising medical student could eventually have been taking normal cells and manipulating them into stem-like cells help solve. Last year, Kathrin Plath, Ph.D., assistant professor of biologi- that express the normal protein. Potentially, these cells could be made cal chemistry, invited Minkovsky to join a pilot study she’s leading to into neurons and then reintroduced into patients to treat disease. “The unravel the mysteries of the double X. With a $30,000 grant from the Iris beauty of that is you’ve derived the cells from the patient to begin with,” Cantor-UCLA Women’s Health Center Executive Advisory Board, Dr. Plath Minkovsky says. and Minkovsy are trying to understand how X inactivation occurs. They’re Although it’s not yet clear, studies suggest that X inactivation could hoping to find the proteins involved. play a role in breast cancer and other diseases affecting women. “You’ve If they succeed, the researchers could provide insights into one of got this whole chromosome that’s been inactivated,” says Minkovsky. “It’s the most important mysteries surrounding female biology. As Minkovsky such an important process, and if it goes wrong, female cells don’t be- explains, “The larger part of women’s health focuses on studying the have correctly at all.” function of reproductive organs and hormonal axes. Yet X-chromosome For researchers to prove that intimate connection, she adds, inactivation is one of the most basic cellular differences between men “We must identify more molecular players involved in silencing the and women.” X chromosome.”

Maureen McMahon: Lupus & Heart Disease

In 1997, when Maureen McMahon, M.D., graduated from the Women’s Health Center Executive Advisory Board program, Dr. McMa- University of Chicago’s Pritzker School of Medicine, women’s health hon set out to test her theory – this time using women as her research was not a priority at the well-regarded institution. “It did strike me as a subjects. In the study, she examined more than 300 women with lupus little odd,” recalls Dr. McMahon, assistant clinical professor of rheuma- and more than 165 healthy women for atherosclerosis and the HDL tology at the David Geffen School of Medicine at UCLA. abnormality. At the time, Dr. McMahon was beginning to focus on lupus, a little- The results were staggering. “We found, lo and behold, that HDL understood disorder that afflicts some 1-million Americans with condi- does seem to strongly associate with the risk of heart disease in lupus tions that range from arthritis to severe fatigue. The disease can dam- patients,” says Dr. McMahon. Nearly 87 percent of the women with age the brain, the kidneys and other organs. “Lupus was interesting lupus and thickening of the arteries characterized by cardiac disease to me largely because it’s a disease that can affect women, and often had dysfunctional HDL. Even after accounting for traditional cardiac- young women,” she says. “It has a wide range of what it does.” risk factors, women with lupus and dysfunctional HDL were 10 times When she had the opportunity to launch her own study, Dr. Mc- as likely as women with normal-functioning HDL to develop athero- Mahon thought she’d approach it a little differently. The scientist knew sclerosis. Similar increases in risk were seen in non-lupus women with that women with lupus are at much greater risk of heart attacks and dysfunctional HDL. strokes, even when you consider normal cardiac-risk factors like high Although it wasn’t her primary goal, Dr. McMahon also set straight blood pressure. Yet, despite the high prevalence of heart disease in a widespread misconception about women and heart disease. “Our females in both the general and the lupus populations, Dr. McMahon mean age was about 45,” she says of the participants, “so it’s a young- was struck by one prevailing fact: “When you start to look through the er age than you’d think of as being the age for onset of heart disease. cardiovascular literature, a lot of the studies had been done on primar- Yet in women with lupus, we do see this increased risk.” ily male populations. The number of studies done in populations of She also proved the importance of doing gender-based studies on women with additional risk factors like lupus was even smaller.” women. Unlike men, women typically have “silent” heart attacks, where She also knew that some men with heart disease had an elevated their symptoms aren’t obvious. “Looking at men doesn’t give you the full level of dysfunctional, pro-inflammatory HDL – the so-called “good” picture of risk in women,” says Dr. McMahon. “There’s a lot we don’t cholesterol. Was this dysfunctional “good” cholesterol playing a similar understand about the most significant risk factors in women.B y studying role in women with lupus and their enhanced threat of heart disease? a population of women who have inflammation, it might give us some In 2007, with $20,000 in seed money from the Iris Cantor-UCLA insights into what’s going on with women in the general population.”

UCLA Medicine 31

UCLAMED_SPRING.indb 31 6/1/11 11:34 AM “When women complained of breast tenderness, doctors always patted them on the shoulder: ‘Oh, we’ll change brands, or maybe we’ll change the dose.’ Maybe that was the wrong answer.”

Dr. Carolyn Crandall

Carolyn Crandall: Tackling Breast Cancer

In 2009, CARolyn crAndAll, m.d., published a landmark study on Crandall was politely told it wasn’t of interest. breast cancer. The findings, which appeared in the Archives of Internal Shortly after, the frustrated researcher burst into her boss’s office. Medicine, showed that women who experienced breast tenderness “I can’t believe the editors of this journal didn’t think it was important!” after taking menopausal hormone therapy had nearly twice the risk of she fumed to Dr. Pregler. The women’s-health expert promptly gave developing breast cancer after a year than women who did not have achy her a reality check. “Pick up the phone,” she told Dr. Crandall, “call breasts. any woman age 50 and over in this country and ask, ‘Do you think it’s It was the first time such a link had been made. For women go- important that breast tenderness might indicate breast-cancer risk?’ ing through menopause and conflicted about menopausal hormone They’ll say, ‘Duh, of course I want to know this!’“ therapy, the implications were profound. “We never really understood if For the record, Dr. Crandall got a similarly tepid response when she there was any way to predict who gets breast cancer while they’re tak- approached government agencies. A pilot study on breast tenderness ing hormones,” says Dr. Crandall, professor of medicine, who examined linked to breast cancer risk? It was so hypothetical and out of the box. data from more than 16,000 women involved in the 15-year, National There weren’t any data. Besides, agency funders contended, meno- Institutes of Health’s Women’s Health Initiative study. pausal women weren’t even taking estrogen and progestin anymore. “Maybe breast tenderness is such a hint? It’s important because Wouldn’t you know it, it took a woman – or rather, three women – fear of breast cancer is one of the most marked fears women have,” Dr. to see the brilliance in the scientist’s idea. Banding together, interior Crandall says. “Women are afraid to take hormones.” designer Rose Tarlow, children’s-health philanthropist Jane Eisner and For physicians, the findings were a long-needed wake-up call. “When artist and philanthropist Ann Moss, owner of the racehorse Zenyatta, women complained of breast tenderness, doctors always patted them on created the Tarlow-Eisner-Moss Research Endowment of the Iris Can- the shoulder: ‘Oh, we’ll change brands, or maybe we’ll change the dose,’” tor-Ucla Women’s Health Center. It gave Dr. Crandall the funding she says Dr. Crandall. She pauses. “Maybe that was the wrong answer.” needed to take off. The Women’s Health Initiative study was the most ambitious ef- “Thank god there is an alternative source that exists for this type fort ever taken to understand the link between menopausal women of work,” she says. With backing from the Iris Cantor-Ucla Women’s on menopausal hormone therapy and breast cancer, among other Health Center Executive Advisory Board, Dr. Crandall recently com- issues. But in 2002, the study was halted, when researchers found pleted a follow-up study. While her original investigation examined that women who were taking the estrogen-plus-progestin treatment breast discomfort in women taking estrogen plus progestin, this one had a marked risk of breast cancer. Although Dr. Crandall’s discovery looked solely at a group of 8,000 women using estrogen. Will there be generated a frenzy of international media attention, the initial response a difference? from some in the medical establishment was more like a yawn. When Whatever she discovers, the need for such gender-focused research she sought to publish her research in a prestigious medical journal, Dr. is clear. “Women want to know,” she says.

32 suMMer 2011

UCLAMED_SPRING.indb 32 6/1/11 11:34 AM Thomas Drake: Gender Matters

Not that long ago, women were regarded in medicine as merely little “The sex-aspect differences between men and men. Obviously, their reproductive equipment was different, but as far as the rest of biology went, their bodies were assumed to behave the women are perennially of interest to people. same. After all, didn’t they share the same genetic code? That’s the one paper I’ve been involved with Then, in 2006, a group of UCLA researchers were looking at mice when we’ve had news people call; even TV – specifically at the liver, brain, muscle and adipose tissues of mice – when they noticed something extraordinary. There were striking differ- people come over and videotape us.” ences in the way genes were expressed in males and females. If this finding was true in mice, it almost certainly was the case in humans. “There are biological differences that almost certainly affect diagno- Gender, in fact, did matter. Maybe this discovery could help explain sis and treatment,” says Dr. Drake. “If you find a genetic mutation in a something that baffled physicians: why women and men sometimes man and the same genetic mutation in a woman, in one of them you respond differently to the same diseases and drugs. could have a very significant risk and in the other no risk. In general, This was heady stuff. So when the study was published in the Au- it’s probably not going to be all or nothing, but a modifier.” gust 2006 issue of Genome Research, the attention it attracted was The study was also significant in another way because it identified immense. “The sex-aspect differences between men and women are areas for developing gender-specific drugs.I n heart disease, for in- perennially of interest to people,” says Thomas Drake, M.D., professor stance, it has long been known that aspirin is more effective in prevent- of pathology. “That’s the one paper I’ve been involved with when we’ve ing heart attack in men than in women. Yet the drug has been routinely had news people call; even TV people come over and videotape us.” prescribed for women as well. Dr. Drake, working with colleagues Jake Lusis, Ph.D., professor of Dr. Drake and other scientists have been fascinated by gender differ- human genetics, and Xia Yang, Ph.D., then a postdoctoral fellow in ences for some time, and they are seeing the mouse-research commu- cardiology, discovered that even in the same organ, thousands of genes nity increasingly recognize their importance. “You need preliminary data varied according to sex. While the smallest gender gap turned up in the to publish something to show that it’s real,” Dr. Drake says. The $20,000 brain, the largest appeared in the liver. This finding wasn’t just academ- he received from the Cantor Center “helped us at an early stage.” ic. With those differences, researchers might be able to understand a variety of common disorders, from obesity to diabetes. Mona Gable is a freelance writer in Los Angeles.

Dr. Thomas Drake

UCLAMED_SPRING.indb 33 6/1/11 11:34 AM faculty notes

A Native Daughter Returns

Kozue ShimAbuKUro, M.D., hAD been “My government believed in me and gave me a pLANNinG to visit her fAMily in OKinAWA for tWo weekS in MarcH, but the day scholarship to go study in America. Now it was before she was scheduled to leave, Japan was my turn to believe in Japan.” hit by the largest earthquake in its recorded history. The tsunami that followed devastated parts of the country, killing more than 11,000 people and leaving tens of thousands more still missing and homeless. Instead of her intended family visit, Dr. On top of the destruction she witnessed, shelter to about 150 children. They also found Shimabukuro, a critical-care pediatrician at the temperature was freezing, adding to the several unofficial evacuation centers, usually a Mattel Children’s Hospital Ucla, switched her misery of the disaster victims. And in her large home containing 20 to 50 children who plans and, with her family’s blessing and spon- haste to leave, Dr. Shimabukuro packed only had no place else to stay. sorship from the hospital, volunteered to help flip-flops and summer clothes; she had to bor- “They were cut off from the world with no cell with medical relief. “My government believed row and buy warm clothing when she arrived. phone, no electricity, and no one even knowing in me and gave me a scholarship to go study Although a large team of physicians had where they were,” says Dr. Shimabukuro, who in America. Now it was my turn to believe in been assembled for relief work, Dr. Shima- returned to Los Angeles on April 1, after three Japan,” she says. bukuro and another doctor were the only weeks in Japan. “They were all helping each When she arrived in the disaster zone, pediatricians sent into the disaster zones, she other, living off boiled river water – just surviving she was unprepared for what she encoun- says. The devastation she saw in hard-hit Iwate on whatever was there at the house.” tered. “All the towns for 500 kilometers along and Miyagi prefectures left her speechless. “It The earthquake and tsunami was an “all the coast were destroyed,” Dr. Shimabukuro looked like the end of the world,” she says. “It or nothing” kind of disaster, Dr. Shimabukuro says. “It was a nightmare. You see a ship was so much worse than what you see on Tv.” says. “You either died or were wholly fine. If you on a four-story building, if there is a building Traveling by car and sometimes by foot, survived, you happened to be in the right place left. Trains thrown into mountains. Railroads she and her colleague visited up to five official at the right time.” pulled apart. No signs of civilization.” evacuation centers every day, each serving as Although she treated many children for

Awards/Honors Dr. Marie-Françoise Chesselet, chair of the surgery and his accomplishments throughout Dr. Michael Grunstein, professor of biological Department of Neurobiology, was selected his career. chemistry at the David Geffen School of as a Fellow by the American Association for Medicine at Ucla, received the 2011 Lewis S. the Advancement of Science. The goal of Dr. Janet C. Frank, assistant director for aca- Rosenstiel Award for Distinguished Work in Dr. Chesselet’s research is to develop new demic programs at the Ucla Multicampus Basic Medical Science. therapeutic treatments for neurodegenera- Program in Geriatric Medicine and Gerontol- tive diseases. ogy, has been named president-elect for the Dr. Oliver Hankinson, chair of the Ucla Association of Gerontology in Higher Educa- Molecular Toxicology Interdepartmental Dr. Jorge R. Barrio, professor of molecular tion (Aghe). Doctoral Program, received the Society of and medical pharmacology, was honored Toxicology’s 2011 Distinguished Toxicology by the World Molecular Imaging Congress Dr. Patricia Ganz, director of the Division of Scholar Award. with an award in his name, The Jorge R. Cancer Prevention and Control Research at Barrio Award for the Best Clinical Transla- the Jonsson Comprehensive Cancer Center, Dr. William McBride, director of the Division i n a tional Research Abstract. was awarded the American Cancer Society’s of Cellular and Molecular Oncology, has been i e d i

Medal of Honor. awarded the Gold Medal by the American n a h p

Dr. Eric Fonkalsrud, professor emeritus Society for Radiation Oncology. e t ) s

of pediatric surgery, will be recognized at Dr. Jennifer Grossman, associate clinical o r u the American College of Surgeons’ Clinical professor of medicine, and a team from Dr. Timothy Miller, chief of plastic and recon- k u b a

Conference, when the meeting and journal Ucla’s Division of Rheumatology were structive surgery, was named among s m People’ i h S (

publication of the presentations during recognized by the American College of 2010 “Heroes Among Us” for his work with : Y h p

the group’s Surgical Forum are given in Rheumatology for developing a set of treat- Operation Mend. a r g

his honor. The distinction recognizes Dr. ment guidelines for patients suffering from o t o h

Fonkalsrud’s contributions to the field of bone loss as a result of glucocorticoid use. Dr. Karin Nielsen, clinical professor of P

34 suMMer 2011

UCLAMED_SPRING.indb 34 6/1/11 11:34 AM PhotographY: (Shimabukuro) stephanie diani UCLAMED_SPRING.indb 35 pediatrics, helped forge an official agreement agreement an forge helped official pediatrics, A medical pharmacology, was selected as a pharmacology, selected medical was cal cal contributions incontributions neural science. in the chemistry cal sor in the sor F U M S between the between G O psychological trauma than from any physical health initiativehealth in 10 in the D D D of her young patients suffered more from or asking when mom would return.” or friends because family members were miss- one or two children under the care of neighbors further research collaborations and collaborations apublic- research further origami with children trying to cope with their asthma, pneumonia and skin infections, most and referred to her as “big sister” or “ she says. sobbing, missing their parents, calling for mom, and enjoy the so helpless. self-sufficient aspossible so they wouldn’t feel she found herself feeling guilty for being able young patients didn’t believe she is a doctor, S bukuro couldn’t shake what she had seen, and injuries, she says. having trouble sleeping or having nightmares, ing. loss and encouraged the older ones to be as then some showed no emotion at all,” to eat whatever she wanted, wear clean clothes el pe dv hi eri ut r. r. r. ni ed “ low by the low mabukuro says. “ S W B versity of of versity I standing ancement of H L C ncer ncer atrics atrics nv D icine at om ec aw ath he o r. D estigation estigation ng ng

ause of her slight physique, many of her e of the kids would cry and cry, and S n she got back to the rence Zipursky ep erine A hi E W D S wa artment of of artment mabukuro played games and made ve oc iv u U S D ry ry evacuation center had at least T , pr ision of rd for outstanding research research rd outstanding for A C iety. CLA ci or or S iv mer al ark entific entific ision of ofessor of molecular of and ofessor A S V ifornia sunshine. “ wa erg ci , ea isian ican ican ence. A D rd the from G ata in ata A P t av rned the2010rned eri A nighttime, kids were fr , professor of biologi- of , professor ed , associate profes- , associate I A c id id ican countries. ican nf atrics, received the received atrics, hievement for iatrics and the iatrics ss G ectious ectious R ociation for the for ociation ef U om fen . S e, ., A

S mer D D I I h ch ta r. is K W ad a hard

ly, to D eases eases ool of of ool S oz ican ican . r. hi C A ue,” ma- li ld ni- en Grants medical needs to functioning hospitals, ness about the scope of the devastation and cancer tissue banks to develop new and todevelop new novel banks tissue cancer breast- established from data with combined linecell and current animal three the of models raising money to help transport people with professor of cellular and molecular pathology; cellular of pathology; and molecular professor son she had given a distressed teenager who was non-cultured, autologous fat-derived stem cells. fat-derived stem autologous non-cultured, Acquisition Activity Acquisition D P C G G G G living in one of the evacuation centers. kids. human breast-cancer therapeutic subtypes subtypes therapeutic human breast-cancer treatment approaches. treatment tor of clinical/translational research, research, clinical/translational of tor S S to go back to normal.” things time,” she says. “ Regenerative Medicine Regenerative for Institute California agency: Funding Funding agency: U.S. Army Medical Research Research Medical Army U.S. agency: Funding um um ri o- ra ra ra ra r. “ ncipal investigator: T T nt duration: 3 years millionnt amount: $5.4 nt duration: 5years nt amount: $7.7 million C principal investigators: principal investigators: C mary: mary: mary: he ha h I om f ia ia I n a t’s when elt like c S prehensive prehensive an do from here,” like raising aware- oo T T UC o re o ut , associate professor of surgery of professor , associate LA I h generate bone with purified, purified, with bone generate ilize molecularly characterized ilize characterized molecularly I d c ad abandoned my people.” I k olleague told her: “ ecided C ept remembering all the an D I t r. cer cer was the same advice D I D ’m enn C r. ent going to focus on B is is ru er S no no la U mon, direc-mon, P CLA I ea t’ s okay ult, ult,

J ons - restore. “ she rendered, but also the hope she helped to D lowed to laugh.” teenage girl told her. “ to do while there – not just the medical aid disaster-recovery team to continue that work. that to continue team disaster-recovery inquake March. medical relief in her native Japan after the earth- the after inJapan relief her native medical Dr. r.

1967 he founded theclinical 1967 laboratories I & devise new methods for collecting and inter- collecting for methods new devise of allied health programs, died died programs, alliedof health and subcellular organelles. assistant dean for 11 for dean assistant years. at production of highly focused highly of focused production preting diffraction data from biological cells cells biological from data preting diffraction 2010. P P w G G D S the A Funding agency: W.M. Keck Foundation W.M. Keck agency: Funding S K n Memoriam um ri au nd ra ra hi as one of the first pathology residents at residents pathology as thefirst of one ozue ozue r. Joseph B U ncipal investigator: mabukuro says. nt duration: 3years nt amount: $900,000 io l U she holds on to the good she was able CLA mary: mary: D chemistry CLA T H . S ha h B e wa

imabukuro spent three weeks providing providing weeks three spent imabukuro oye M nk you for coming,

T S ed o exp R S ch s 89 years old. years s 89 r h ay ical ical P e returned there inwith a April there e returned ool of of ool – Kim Kowsky ro mond loit recent advances in the advances recent loit fessor of of fessor C I d en M idn’t think , former assistant dean dean assistant , former D ter. ed r. UCLA Medi UCLA D icine, and in H M av D e ser ol X r. K id id -r ecular N oz R ay beams to ay beams E ov I w aymond ue,” one is ved as ved c ember 26, 26, ember enberg, enberg, as al- in B e io logy logy

35 6/1/11 11:34 AM alumni notes

MAa Board News One-on-One with Dean Bok, Ph.D. ’68

The Maa Board of Directors passed a revised Dr. Dean Bok is the Dolly Green Pro- mission statement on January 31, 2011: “The fessor of Ophthalmology in the David mission of the Ucla Medical Alumni Association Geffen School of Medicine at UCLA. (Maa) is to facilitate support for and interaction among the alumni, medical students, David Geffen My researcH on tHe eye begAN School of Medicine at Ucla and the in 1965, while I was a graduate community at large.” student at Ucla. One objective of On April 11, 2011, the Maa Board of Directors my research is to understand interac- elected the slate of officers for 2011-12: President: tions that take place among three cell Wade Aubry, M.D. ’77, Vice President: Rosalind types in the retina – the retinal pig- (Roz) Warner, M.D. ’81. Secretary-Treasurer: Jean- ment epithelium (Rpe) and the rod nine Rahimian, M.D. ’00, M.B.A. ’00. and cone photoreceptors. Rods are Email addresses have been created for the follow- Left to right standing: Alberto Ruiz, M.S., Marcia responsible for dim-light vision, and ing executive board positions: President: maaboard- Lloyd, M.S., Dean Bok, Ph.D. Seated: Jane Hu, B.S. cones give us color vision. The Rpe [email protected]; Executive Vice Presi- provides the photoreceptors with nutrients necessary for their daily survival, includ- dent: [email protected]; Vice President: ing a derivative of vitamin A essential for light detection. The Rpe also removes waste [email protected]; 60th Anniversary products produced by the active rods and cones. Due to gene mutations, these criti- Chair: [email protected]. cal processes malfunction, and patients become partially sighted or blind.

Highlight of the project so far and its effect EArly in my cAreer aT UCLA, with Professor Richard Young and colleague Michael Dr. William Hastrup Hall, we discovered how healthy Rpe maintains photoreceptor cells in a healthy state New Board Member over the course of a human lifetime. It does so by tending to the needs of the photo- receptors, which includes taking out and disposing of the garbage that they produce r e

on a daily basis. Without this nurture, the photoreceptor cells die. A second, highly k l a

WilLiaM (BilL) satisfactory experience much later in my career involved the discovery, through gene W e i r e

HaSTruP, M.D. ’77, disruption in mice, that the absence of a single protein renders mice incapable of l a V was elected to the detecting light with their photoreceptor cells. We now know that this protein is the ) n o s Maa Board of Direc- enzyme that converts vitamin A into its light-sensitive form. A similar disease exists l u a p

tors at the spring in children who are born without the ability to see (Leber congenital amaurosis). This ; ( g b i e

meeting and will finding led to the development of a gene therapy for children who, born without vision, i L n

begin serving on July can now see. o D ) g

1, 2011. Dr. Hastrup n i r a

lives in Fresno and Immediate and future steps for the project h r s

is a diagnostic pe- My cUrrenT work is focUSed on uNDersTANDinG the causes and treatment of o n f g

diatric radiologist at age-related macular degeneration. By virtue of the discovery by others of important i s e Children’s Hospital disease-causing genes for this condition, we now have a rational avenue for future d ; ( r

Dr. Hastrup and Kristen. e

Central California and clarification and therapies. I collaborate with colleagues at Ucla, the University of k l a W

conducts women’s imaging at Wishon Radiology, Utah, Uc Santa Barbara, the University of Oklahoma, the University of Wisconsin and e i r e

where he has been president for the past 15 years. the University of Florida at Gainesville. l a V )

Dr. Hastrup has had a faculty appointment as assis- k o b

tant clinical professor of radiology at Uc San Fran- Sentiments on conducting research at Ucla ; ( g n i

cisco for 20 years. Prior to being elected as a board UCLA provides a very frienDLy aND sUPPortive environMenT for junior and D n i L -

member, he served on the Maa Outreach Commit- senior scientists. Its intellectual and material resources are vast, and, because of these n i L )

tee. Bill is married and has three children, including attributes, I have never seriously considered relocating to another university, in spite of p u r t

Kristen, who attends medical school at Ucla. multiple opportunities. s a H : ( y h p

Best way to reach me with follow-up questions: [email protected]. a r g o t o h p

362 FsAuLMLM 20e1r0 2011

UCLAMED_SPRING.indb 36 6/1/11 11:35 AM O n e - o n - O n e w i t h D e a n B o k , P h . D . ’ 6 8

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l PhotographY: Courtesy of Ucla medical sciences development; opposite (ride-along) photograph by adrienne walt Center Foundation to support women’s cancer Foundation, thanks to the generosity of he was awarded The Ucla Medal. research under the direction of Dr. John Lynda R. and Stewart A. Resnick, for the Glaspy. Nff uses educational and awareness Specialized Program of Research Excellence The Richard and Patricia Sinaiko family campaigns to raise funds for translational (Spore) in prostate cancer. Their generous recently made a gift to support the David H. cancer research aimed at developing new support will provide funding for young cancer Solomon Lectureship in Geriatrics Program. prevention methods, diagnostic tools and non- investigators as they explore innovative re- Dr. Solomon, professor emeritus, served as toxic therapies to treat women’s cancers. search projects with transformative potential, chairman of the Ucla Department of such as developing individualized treatments Medicine for nine years and is an internationally Dr. Richard Merkin, president and Ceo of for tumors and studying the effect of diet recognized pioneer in the field of geriatric Heritage Provider Network, and the Merkin on prostate-cancer cell growth. The Resnicks medicine. He played an integral role in the Family Foundation have directed $1.1 million also made a gift to the Department of development of the Ucla Multicampus Division to the Ucla Department of Neurology. The Neurology at year-end 2010. of Geriatric Medicine and founded the Ucla Richard Merkin Foundation for Neural Regen- Center on Aging in 1991. eration will support research in neural repair Maxine and Eugene Rosenfeld have made a and recovery being conducted by Dr. Bruce $4-million bequest to Ucla; $1.5 million was The Tchekmedyian Family Foundation made Dobkin, professor of clinical neurology. “This directed to the David Geffen School of Medi- a $100,000 gift to establish the Tchekmedyian research can hopefully play an integral part in cine at Ucla for medical scholarships. This Family Scholarship Fund. Clinical faculty the progress following tragic injuries involving commitment broadens their support of the member N. Simon Tchekmedyian, M.D., Facp, nerve response and recovery,” says Dr. Merkin. health sciences, having endowed a chair in and his wife, Seta Tchekmedyian, hope to help “Dr. Richard Merkin’s generous gift enables a computational genetics and underwritten the future Ucla medical students with the burden- collaboration of Ucla scientists to test novel work of the simulation center, as well as other some cost of a medical education. Four of the strategies that aim to help people with brain or areas across campus. Mrs. Rosenfeld sits on Tchekmedyians’ six children have Ucla roots. nerve damage from stroke, spinal cord injury, the medical school’s Board of Visitors, The Nishan graduated from medical school in 2010 multiple sclerosis, neuropathies and other neu- Ucla Foundation’s Board of Governors, and and is in residence at Beth Israel Deaconess rological diseases,” says Dr. Dobkin. Heritage the Women & Philanthropy Board of Directors. Medical Center; Vatche is a fourth-year medical Provider Network, Inc. is on the cutting edge Mr. Rosenfeld, who holds a bachelor of student and president of the Class of 2011; of the accountable-care model of healthcare science degree in business administration Alene was editor-in-chief of the Daily Bruin delivery: coordinated, patient-doctor centric, from Ucla, has served as chairman and trust- in 2010, her senior year; and Raffi is an integrated systems that represent the future of ee of The Ucla Foundation and is a member under-graduate and member of the Ucla healthcare in the United States. of the Ucla Chancellor’s Associates. In 2010, rowing team.

The Jean Perkins Foundation has been in- volved in many projects within the Department Ride-along of Urology, as well as other fields of medicine While in Al Asad, Iraq, on May 5, 2007, U.S. at Ucla. Recently, it provided $300,000 Marine Cpl. Tony Porta was in a Humvee that for a urologic-oncology fellowship, as well as hit a roadside Ied, killing two Marines instantly research support for the study of lower-urinary- and severely wounding him. His prognosis was tract reconstruction using stem cells and tissue devastating: third-, fourth-and fifth-degree engineering. James J. Carroll Iii, president of burns over 35 percent of his body, with several the foundation, participates on the Board of disfiguring injuries. As a patient at Ucla, Tony Advisors, which comprises a dedicated group mentioned his lifelong love of fast cars to a Tony Porta (left) with Anders Hainer. of donors and was created by Dr. Jean B. member of the Operation Mend team. When racecar driver Anders Hainer got wind deKernion, chairman of the department. Mr. of it, he offered to drive Tony along Pacific Coast Highway in his shiny black Ferrari Carroll and his business partner, Joe Kennedy, 430 Spider. have committed the foundation’s funds to proj- Anders and his wife, Julie, are generous donors to Operation Mend, Ucla Health ects that have been instrumental in the careers System’s unique partnership with Brooke Army Medical Center in Texas and the V.A.- of several young urologic faculty and trainees Greater Los Angeles Healthcare System to help treat U.S. military personnel injured in and have advanced the diagnosis and treat- Iraq and Afghanistan. Since 2009, Julie and Anders have provided unrestricted support ment of a broad range of urologic diseases. to the program as well as to research in skin and bone regeneration, since severe blasts can render wounded survivors’ own skin and bone unavailable for reconstruction. “That The Ucla Department of Urology received day was one of the most important in my life,” Anders says of his ride with Tony. “Tony a $250,000 gift from the Prostate Cancer was such a powerhouse of will and strength in the face of unimaginable adversity.”

UCLA Medicine 39

UCLAMED_SPRING.indb 39 6/1/11 11:35 AM fRIENDS

Events

The UCLA/Orthopaedic Hospital Department of Orthopaedic Surgery hosted approximately 60 guests on October 28, 2010, at Bone Health Across the Lifespan, a reception featuring Orthopaedic Hospital Re- search Center (OHRC) faculty members Dr. Deborah Kado, Dr. Deborah Krakow and Dr. Aurelia Nattiv. The presentations highlighted innovative research in stress fractures in female athletes, in-utero bone deformities and healthy aging.

The Fifth Annual Lunch with the Scientists took place on February 9, 2011. Members of the Executive Advisory Board of the Iris Cantor- UCLA Women’s Health Center gathered with friends of UCLA to hear the results of research funded by the board. Dr. Janet Pregler, the center’s director, organizes this event. The group has contributed $600,000 to university-wide pilot projects that investigate women’s-health topics ranging from new treatments for breast and lung cancer to the effects of yoga on stress, leading to more than $5 million in National Institutes of Health funding.

In March 2011, a ribbon-cutting event was held to celebrate the new partnership between The Chase Foundation and the Child Life/ Child Development Program at Mattel Children’s Hospital UCLA. Susan The annual Mattel Party on the Pier is and Robin Richards, through The Chase Foundation, gave more than $2 fun for all ages. million to name the Chase Child Life Program, housed on the fifth floor of Ronald Reagan UCLA Medical Center. Made in memory of their son, Chase Richards, this gift provides additional funding to expand and en- Women’s Cancer Research Program is the leading beneficiary of this an- hance the services provided to pediatric patients. The foundation also nual 5K event, which is the city’s largest fundraiser for women’s cancers. provided a generous gift to create the Chase Family Healing Garden, an area for play and educational therapy that will be located on the Tisch Today’s and Tomorrow’s Children Fund (TTCF) at Mattel Children’s Family Children’s Terrace. Hospital UCLA held its Sixth Annual Faculty and Award Presentation on May 16, 2011. TTCF members each commit a minimum of $5,000 In April 2011, Mattel Children’s Hospital UCLA board members J.R. annually to hear presentations from pediatric faculty members and DeLang and Mark Sear hosted the Sixth Annual No Limit Texas vote on how to distribute their collective funding. In addition, they hear Hold’em Poker Tournament at Fox Studios benefiting the hospital. from the previous year’s award winners on the progress of the research The event has raised more than $800,000 since its inception. projects and see their dollars in action. Kuk-Wha Lee, M.D., Ph.D., as- sistant professor of pediatric endocrinology, received the Grand Prize Proceeds from the Jonsson Cancer Center Foundation’s annual Taste for for her work on a potential therapy for Type 1 diabetes. a Cure signature event, held on April 15, 2011, at the Beverly Wilshire Hotel, benefited theJ onsson Comprehensive Cancer Center. The eve- Mr. and Mrs. Gerald Oppenheimer joined Dr. Gary Gitnick, Dr. Eric ning featured premier wines and local dishes from Oregon’s Willamette Esrailian and Dr. Emeran Mayer in celebrating the official opening of Valley. David Nevins, president of Entertainment, Showtime Networks, the Gail and Gerald Oppenheimer Family Center for Neurobiology of was honored with the 2011 Gil Nickel Humanitarian Award. Dinner com- Stress on June 14, 2011. The Oppenheimer Center is a program of the mittee co-chairs were Dana Walden, chairman of Twentieth Century Fox UCLA Division of Digestive Diseases. Television; Jon Holman, president of The Holman Group; Larry Maguire, president and CEO of Far Niente Winery; and Jay Sures, partner and The 12th Annual Mattel Party on the Pier is scheduled for October board member of United Talent Agency. 16, 2011, from 11 a.m. to 3 p.m. at Pacific Park on the Santa Monica a medical sciences development cl

Pier. The event underwrites the vital work of Mattel Children’s Hospital U w For more information, visit www.tasteforacure.com. UCLA, supporting physicians, programs, and research within the UCLA

Department of Pediatrics. rtesy of ou C

The 18th Annual Entertainment Industry Foundation Revlon Run/Walk : Y for Women Los Angeles took place on May 7, 2011. The Revlon/UCLA w For more information, visit www.partyonthepier.ucla.edu. hotograph P

40 Summer 2011

UCLAMED_SPRING.indb 40 6/1/11 11:35 AM UC LAME D_S PRIN G.ind b 41

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m e e U l ’ i e L e i h a . t b i d f n t h d G e y a s m t e n i r s h ab u A M e l , a o o s e h i a c g p o b e i ag l i n t a n i n w h t s n a m e w o s r n t r e a l l w e C s n e , y e e . e n c e y n r ef a e d g t v e e i q r er d i . l s o l L t a o W i s t d w e t y r l v l t d n u i u b . f S s a e A S r A t n i r e en a o h t h g l i e a e i i t t o i d h t h d c . l r m h f a o b e l i u o l e n t a . m u e a i e i t e n A e u e c a h n i n i o s r t e c n e t d g r o i d b ’ t s d f i i n c o r a i s d l a g p e r o n ho u n n s h e . . h t g t b t p t g

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