Los Angeles Medical Center Research Newsletter · Los Angeles Medical Center Research Newsletter Page 3 NEWS BOARD 2015 LAMC Research Week Debrief—House Staff Research Competition

Vol. 1, Issue 2 Summer 2015

Los Angeles Medical Center Research Newsletter

EDITOR’S INTRODUCTION: Welcome to the second edition of our research newsletter. After a successful Research Week, we hope to keep up the enthusiasm year round. With the end of the academic year now upon us, we say goodbye to our outgoing residents and fellows and welcome our new trainees. I hope this newsletter is a valuable resource to aid you in getting started on your research career here at LAMC.

Our first research newsletter was met with an overwhelmingly positive response. Thank you to those who sent feedback and contributed content. Your input is critical to the future of this newsletter. Please continue to submit your presentations, papers, open clinical trials, collaborator requests, and profile nominations to Deena Pourang, PGY-4, Allergy/Immunology Fellow.

—Angelina Crans Yoon, MD, PGY-5, Allergy/Immunology

RESEARCH PROFILE:

Joan Ryoo, Radiation Oncology, PGY-? (the ? is intentional)

Dr. Joan Ryoo, a fifth-year Radiation Oncology resident at LAMC, tries to downplay the impressive list of accomplishments I managed to coax from her: Harvard undergrad, followed by a year at Cambridge under the John Harvard Scholarship, then Harvard med where she was active in bench research under the Doris Duke fellowship. She also obtained a master’s degree in health services, then completed three years at a seven-year categorical general surgery residency at Brigham & Women’s Hospital, after which she was accepted to the Robert Wood Johnson Clinical Scholar fellowship at UCLA. There, her research included 1) readmissions for surgery and 2) quality of lung cancer care at the Veteran’s Administration. Ultimately, she pursued a Post-Doc position at UCLA’s Jonsson Comprehensive Cancer Center; followed by a switch mid-career to radiation oncology, where she has been for the past five years. “I’ve had a lot of time,” she explains in all seriousness. “I’m 900 years old but people say I don’t look a day over 850.”

Accomplishments aside, it was obvious from our brief conversation that she manifested an extraordinary, unadulterated drive for knowledge—a rather charismatic trait when juxtaposed against such an authentic, self-deprecating humility. “I think ignorance allows me to move forward in life,” she says. “I’m not sure I would have had the courage to do things if I knew what I was getting into.”

493Total Open

IRBs

61Total LAMC

publications in 2014

Outgoing Editor in Chief: Angelina Crans-Yoon • Incoming Editor in Chief: Deena Pourang • Co-editors: Joon Suk Park, Rebecca Ahdoot, • Advisory Committee: Davida Becker, John J. Sim, Bechien Wu • Produced by SCPMG & Stakeholder Communications

(continues on page 2)

Los Angeles Medical Center Research Newsletter

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And if such “ignorance” is the gravity pulling her down her path, it was also evident that she does not simply seek to be an indiscriminate connecting tube to some nondescript container of knowledge. She thrives on research that is practical and easily implemented—”sharp,” as she calls it. “I knew pretty early on that lab science was not for me. It’s quality research that floats my boat. I really have a bizarre fascination with standards—why we have the standards we do and whether we are upholding them.”

She points to her research experience at the VA, where on the surface, the medical staff had been doing a poor job of adhering to guidelines of care for lung cancer patients. “But that was just based on administrative data. If you biopsy the chart, you see that doctors were really having conversations with patients regarding chemo, radiation, etc., and after excluding those who had willfully opted out, adherence was closer to 80 percent,” she explains. “This has so many policy implications because so much hangs on these performance standards that are based on these guidelines.”

Her most recent research project, “Radiotherapy for Brain Metastases Near the End of Life: Palliation or Poor Quality Care?” claimed first prize for Outcome studies at the 2015 KP House Staff Research Day. This project challenged whether some of these guidelines led to over-treatment of lung cancer patients at the end of life, and found that a surprising number of patients were receiving brain radiotherapy within 30 days of death. “What does it mean to be aggressive?” she asks. “We are so bad at predicting life expectancy, and it’s tough because I think it’s a disservice to recommend treatments that may harm them [patients]. Research like this really has changed what treatment plans I recommend and how I recommend them to patients. I think as providers we really need to explore these issues with patients in a way that does not make them lose hope.”

Furthermore, she views the field of medicine itself as an ongoing quality improvement project. “The nice thing about medicine is that it constantly changes, and forces you to continually reevaluate treatments, your practice, and even yourself. You continue to train and you pick up nuances, and these nuances accumulate over time to create a clearer picture.”

Thus “...it’s always good to not let go of ideas,” she advises. “If you have an idea and some will, you can usually power through those moments of getting lost.”

—Profile by Joon Suk Park

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NEWS BOARD

2015 LAMC Research Week Debrief—House Staff Research Competition

We had an excellent showing for our 16th Annual House Staff Research Competition Grand Rounds. More than 200 people came to see the top five trainees give oral presentations of their research. Our panel judges selected the top three presentations, which were awarded plaques at the annual graduation ceremony. The presenters were:

Dr. Keith Thompson, Cardiology—1st Place• Mentor: Dr. Somjot Brar• Presentation title: Statin Use

Prior to Angiography for the Prevention of Contrast Induced-Acute Kidney Injury: A Meta-analysis of 19 Randomized Trials

Dr. Patrick Kilday, Urology—3rd Place• Mentor: Dr. Gary Chien• Presentation title: Long-

Term Effect of Neoadjuvant Leuprolide Injection on Quality of Life Following Radical Prostatectomy

Dr. Krystle Ziebell, Ob/Gyn • Mentor: Dr. Scott Lentz• Presentation title: A Pilot

Analysis of The Effect of Pre- and Post-Operative Metformin Use on Epithelial Ovarian Cancer Survival

Dr. Joan J. Ryoo, Radiation Oncology• Mentors: Dr. Winston W. Lien &

Dr. Michael K. Gould, Research & Evaluation

• Radiotherapy (RT) for Brain Metastases (BM) Near the End Of Life (EOL): Palliation or Poor Quality Care?

Dr. Aaron Lee, Gastroenterology—2nd Place• Mentor: Dr. Bechien Wu• Barriers to Patient Attendance

for Outpatient Endoscopic Gastroenterology Procedures in an Integrated Health Delivery System

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Research Week on the Road

The Research Week on the Road Poster session was a great success. There were a total of 41 posters that began their journey at the Rejuvenate Café at LAMC. They were then on display in our 2nd floor healing garden for our evening mixer on June 4, which more than 75 people attended. From there, the posters traveled to Baldwin Park and West LA. This year we awarded prizes for best poster in five categories.

Best Original Research• First Place: #18 Maya Remington, Michael Fassett,

Darios Getahun—Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy

• Second Place: #20 Lindsey Spragg, Jason Chen, Raffy Mirzayan, Rebecca Love, Gregory Maletis—Effect of Autologous Hamstring Graft Diameter on Likelihood for Revision of Anterior Cruciate Ligament Reconstruction

Best Quality Improvement Project • First Place: #6 Jack Der-Sarkissian, Christiane Wert

Rivard— Impact of a Clinical Quality Care Award on Weight Management Program Engagement among Obese Adult Southern California Kaiser Permanente Patients

• Second Place: # 40 Jeannie K. Huang, Nilesh J. Patel, and Robert M. Cooper—Increasing HPV Vaccination Rates among Pre-Adolescent Males and Females at Kaiser Permanente Los Angeles Medical Center

• Honorable Mention: #10 Theresa B. Sevilis, Navdeep S. Sangha, Zahra A. Ajani—The effect of ABCD2 score as a triage tool for TIA patients on 90-day hospital readmission.

Best Case Report • First Place: #14 Christopher Y. Way, Annette

Langer-Gould, Jim H. Nomura, Rene Patino—Severe Immune Reconstitution-like Inflammatory Syndrome from Cryptococcus gattii meningoencephalitis treated with Cyclophosphamide

• Second Place: #26 Laura Frisher, Angelica Zen, Michael Rotblatt—A 48-Year-Old Woman with Persistent Fevers and Cavitary Lung Lesions

Best Outcome Study • First Place: #12 Joan Ryoo—Radiotherapy for Brain

Metastases Near the End of Life: Palliation or Poor Quality of Care?

• Second Place: #25 Terrance Yu, Derenick Gharibian, Helen Chun, Giselle Willick—Evaluating the Clinical and Economic Outcomes of an Integrated Pharmacy Primary Care Service

Best Chart Review • First Place: #37 Lee Christianson, Becky Lim, Raoul

Burchette, Scott Lentz—Single Port Laparoscopic Hysterectomy Outperforms Conventional Multisite Laparoscopy in Properly Selected Individuals: A Retrospective Matched Cohort Study

• Second Place: #24 Monti Khatod, Guy Cafri, Maria Inacio, Elizabeth Paxton, Robert Namba—Risk Factors for Total Hip Arthroplasty Aseptic Revision

GME Research Program Update

The GME Research Mentorship Program is currently ongoing. You can follow along and participate in the didactic sessions remotely through the GME Research website at https://sites.google.com/site/kpscgmeresearchmentorship/home

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UPCOMING DEADLINES:

Openings for Research Consultations

Please contact John J. Sim, area research chair, if you are interested in having a team of LAMC Researchers give feedback on your research project at any stage. The following dates are available:

• August 18, 2015 12:30-1:30 p.m.• September 22, 2015 12:30-1:30 p.m.

Regional Research Committee Funding

• Attendings requesting less than $6,000 application due to Area Research Chair, RRC—August 3, 2015

• Residents and Fellows (Less than $6,000) application due to Area Research Chair, RRC—August 3, 2015 and October 19, 2015

• For assistance with the RRC application, please contact Usha G. Vaghasia 562-777-2650 (office) tie line 371 or 626-564-3128 (office) tie line 338

PUBLICATIONS:

Allergy/ImmunologyAngelina Crans-Yoon PGY-5• Crans Yoon, A., Crawford, W., Sheikh, J., Nakahiro, R., Gong, A., Schatz, M. J “The HEDIS Medication

Management for People With Asthma Measure is Not Related to Improved Asthma Outcomes” Allergy Clin Immunol Pract. 2015 Mar 7. pii: S2213-2198(15)00051-3. doi: 10.1016/j.jaip.2015.02.002. [Epub ahead of print].

• Crans Yoon A, Lin CK, Sheikh J “The mamey sapote fruit (Pouteria sapota) as a novel cause of IgE-mediated allergic reaction.” Ann Allergy Asthma Immunol. 2015 Feb 19. pii: S1081-1206(15)00042-3. doi: 10.1016/j.anai.2015.01.011. [Epub ahead of print]

DermatologyJashin J. Wu• Wu JJ, Choi YM. Time to consider psoriasis an autoimmune disorder? Journal of Drugs in Dermatology,

February 2015;14(2):112. PMID: 25689804.• Wu JJ, Rowan CG, Bebchuk JD, Anthony MS. No association between tumor necrosis factor inhibitor

therapy and hemoglobin A1C and fasting glucose among psoriasis, psoriatic arthritis, and rheumatoid arthritis patients. Journal of Drugs in Dermatology, February 2015;14(2):159-166. PMID: 25689811.

• Martires K, Aquino LL, Wu JJ. Factors affecting academic leadership in dermatology. Cutis, February 2015;95(2):98-102. PMID: 25750963.

• Wu JJ, Rowan CG, Bebchuk JD, Anthony MS. Association between tumor necrosis factor inhibitor therapy and blood pressure, C-reactive protein, and alanine aminotransferase among psoriasis, psoriatic arthritis, or rheumatoid arthritis patients. Journal of the American Academy of Dermatology. Published online March 4, 2015. PMID: 25748312.

• Manalo I, Gilbert K, Wu JJ. An updated survey for the 2007-2013 period of randomized controlled trials for psoriasis: treatment modalities, study designs, comparators, outcome measures, and sponsorship. Journal of the European Academy of Dermatology and Venereology. Published online March 12, 2015. PMID: 25763768.

• Raposo RA, Gupta R, Abdel-Mohsen M, Dimon M, Debbaneh M, Jiang W, York VA, Leadabrand KS, Brown G, Malakouti M, Arron S, Kuebler PJ, Wu JJ, Pillai SK, Nixon DF, Liao W. Antiviral gene expression in psoriasis. Journal of the European Academy of Dermatology and Venereology. Published online March 23, 2015. PMID: 25809693.

• Aquino LL, Wen G, Wu JJ. The association between dermatology residency program characteristics and graduates pursuing a career in academics. Cutis. In press, April 2015.

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Radiation OncologyMichael Hitchler, PhD • Back to the future: transgenerational transmission of xenobiotic-induced epigenetic remodeling.

Jiménez-Chillarón JC1, Nijland MJ, Ascensão AA, Sardão VA, Magalhães J, Hitchler MJ, Domann FE, Oliveira PJ. Epigenetics. 2015 Mar 16:1-15. PMID:25774863

Sharon M. Lu, PGY-3• Lu, Sharon M., Christine Chang-Halpenny, and Julie Hwang-Graziano. “Sequential versus “sandwich”

sequencing of adjuvant chemoradiation for the treatment of stage III uterine endometrioid adenocarcinoma.” Gynecologic oncology 137.1 (2015): 28-33. PI: Dr. Julie Hwang-Graziano, MD. http://www.sciencedirect.com/science/article/pii/S0090825815005892. 

• Lu, Sharon M., Yashar, Catheryn M. (2015). Chapter 2: Biologic and Physical Aspects of Radiation Oncology. In Levine, Douglas A., Dizon, Carlos, Yashar, Catheryn, et. al. (Eds.), Handbook for Principles and Practice of Gynecologic Oncology, 2nd edition (pp. 20-43). Philadephia, PA: Wolters Kluwer.

• Lu, Sharon M., Yashar, Catheryn M. (2015). Chapter 5: The Vulva. In Levine, Douglas A., Dizon, Carlos, Yashar, Catheryn, et. al. (Eds.), Handbook for Principles and Practice of Gynecologic Oncology, 2nd edition (pp. 72-95). Philadephia, PA: Wolters Kluwer.

• Lu, Sharon M., Yashar, Catheryn M. (2015). Chapter 6: The Vagina. In Levine, Douglas A., Dizon, Carlos, Yashar, Catheryn, et. al. (Eds.), Handbook for Principles and Practice of Gynecologic Oncology, 2nd edition (pp. 96-117). Philadephia, PA: Wolters Kluwer.

• Lu, Sharon M., Yashar, Catheryn M. (2015). Chapter 7: The Uterine Cervix. In Levine, Douglas A., Dizon, Carlos, Yashar, Catheryn, et. al. (Eds.), Handbook for Principles and Practice of Gynecologic Oncology, 2nd edition (pp. 118-152). Philadephia, PA: Wolters Kluwer.

Christine Chang-Halpenny, PGY 4• Chang-Halpenny CN, Yeh J, Lien W. Elderly Patients with Glioblastoma Multiforme Treated with

Concurrent Temozolomide and Standard versus Abbreviated Course Radiotherapy. The Permanente Journal. 2015 Winter, 19(1): 15-20.

• Chang-Halpenny CN, Natarajan S, Hwang-Graziano J. Early stage papillary serous or clear cell carcinoma confined to or involving an endometrial polyp: outcomes with and without adjuvant therapy. Gynecologic Oncol. 2013 Dec; 131 (3): 598-603.

• Lu SM, Chang-Halpenny CN, Hwang-Graziano J. Sequential versus “Sandwich” Sequencing of Adjuvant Chemoradiation for the Treatment of Stage III Uterine Endometrioid Adenocarcinoma. Gynecologic Oncol.. Accepted Jan 2015 for publication, in press.

Sports MedicineBrian D. Kurose, PGY 4 and Leena Patel, PGY 4• Vasquez, Marissa S.; Fong, Michael K.; Patel, Leena J.; Kurose, Brian; Tierney, John; Gardner, Imani;

Yazdani-Arazi, Arash; Su, John K “Medical Planning for Very Large Events: Special Olympics 2015 World Games.” American Medical Society Sports Medicine Clinical Journal May/June 2015 - Volume 14 - Issue 3 - p 161–164 doi: 10.1249/JSR.0000000000000160 http://journals.lww.com/acsm-csmr/Abstract/2015/05000/Medical_Planning_for_Very_Large_Events___Special.9.aspx

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PRESENTATIONS

Allergy/Immunology Angelina Crans-Yoon PGY 5• Crans Yoon, A., Shen, E., Kaplan, M., Goldberg, B., Sheikh, J. “The Pattern of Environmental Allergic

Sensitization and Association with Pollution in the Kaiser Permanente Southern California Population” Poster presentation at the AAAAI 2/2015 Annual Meeting

DermatologyJashin J. Wu• Wu JJ. Speaker, Current and future therapy for psoriasis, Annual dermatology business meeting of Kaiser

Permanente Southern California, Pasadena, CA, Pasadena, CA, February 24, 2015.• Wu JJ. Speaker, Symposium S017, Biologics: Promises or Peril? (Topic: Biologics and risk of malignancy,

infection, and major adverse cardiovascular events). 1015-1045am, March 21, 2015. 73rd Annual Meeting of the American Academy of Dermatology, San Francisco, CA, March 20-24, 2015.

• Wu JJ. Chair and Speaker, Forum F063- Psoriasis: Updates in Biologic Therapy and Comorbidities, 1-3pm, March 21, 2015. 73rd Annual Meeting of the American Academy of Dermatology, San Francisco, CA, March 20-24, 2015.

• Wu JJ. Speaker, The effect of biologics on cardiovascular disease. The Colin Ramsay Lectureship (for Rising Stars), 7-8am, June 9, 2015. 90th Canadian Dermatology Association and 23rd World Congress of Dermatology. Vancouver, Canada, June 8-13, 2015.

• Wu JJ. Speaker, Big data in psoriasis. National Psoriasis Foundation Research Symposium, San Francisco, CA, July 23-25, 2015.

• Wu JJ. Speaker, Psoriasis and comorbidities. Immunology summit, Tokyo, Japan, August 1-2, 2015.• Wu JJ. Speaker, Does treating psoriasis improve cardiovascular disease? 67th Annual meeting of the

Pacific Dermatologic Association, Park City, Utah, August 5-9, 2015.• Wu JJ. Speaker, Biologics and risk of malignancy and infection. 67th Annual meeting of the Pacific

Dermatologic Association, Park City, Utah, August 5-9, 2015.• Wu JJ. Speaker, Forum 008þ: Hot Topics in Nail Disorders (Topic: New developments in systemic nail

psoriasis treatment), 320-340pm, August 21, 2015. Summer Meeting of the American Academy of Dermatology, New York, NY, August 20-23, 2015.

• Wu JJ. Speaker, Forum F007- Pearls from Members (Topic: Psoriasis pearls), 424-436pm, August 21, 2015. Summer Meeting of the American Academy of Dermatology, New York, NY, August 20-23, 2015.

• Wu JJ. Speaker, Symposium S012- Psoriasis (Topic: The effect of biologics on cardiovascular disease), August 21, 2015. Summer Meeting of the American Academy of Dermatology, New York, NY, August 20-23, 2015.

Family MedicineNatalie Rose Mourra, MD, PGY-3• Immunize and Save Lives: The Kaiser Los Angeles Medical Center Hospital and Community-

Based Immunization Intervention AAFP Foundation, SENIOR IMMUNIZATION AWARDS POSTER PRESENTATION July 30-August 1, 2015.

GastroenterologyAaron Lee PGY-4 • Aaron Lee MD1, PGY-4, Marianne Fahmy MD1, Julie W Liu2, Matthew D Devine2, Robert M Cooper MD2.

Colon Cancer Surveillance: Identification of Individuals Lost-to-Follow-up and Development of a Colonic Adenoma Registry within an Integrated Healthcare Delivery System. KP Cancer symposium 3/27/15.

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Internal MedicineJoseph Thouin PGY-1• The Persistent Left-Sided Superior Vena Cava: You Inserted the Catheter Where?! Gabriel Gomez, MD-

Cedars Sinai Medical Center, Joseph Thouin, MD- Kaiser Permanente, Los Angeles Medical Center, Rene Patino, MD- Kaiser Permanente, Los Angeles Medical Center. American Thoracic Society, 2015 Annual Meeting, 5/15-5/20/15 Denver, CO.

Medical EducationHanna Garth, Davida Becker, and Rachel Hollander—GME office• D. Becker, H. Garth, R. Hollander, F. Klein, S. M. Gonzalez, M. Klau. A formative assessment of research and

quality improvement-related knowledge, attitudes and practices within Kaiser Permanente’s Graduate Medical Education (GME) programs to inform a new training program. Association of American Medical Colleges Integrating Quality Meeting Chicago, IL June 11-12, 2015.

Radiation OncologyMichael Hitchler, PhD • “Deciphering the role of epigenetic processes in cancer treatment” Michael J Hitchler. Oral Presentation

at Larry W. and Terry. Oberley Memorial Symposium, Iowa City, IA 6/2015.

Sharon M. Lu, PGY-3• Concurrent Radiotherapy with Cetuximab or Platinum-based Chemotherapy for Locally Advanced

Cutaneous Squamous Cell Carcinoma of the Head and Neck. • PI: Winston Lien, MD. 2015 ACRO Annual Conference. May 14-16, 2015 Arlington VA.

Christine Chang-Halpenny, PGY-4• Farol HK, Girvigian MR, Miller MJ, Chen JC, Rahimian J, Chang-Halpenny CN, Glousman BN, Alshak N,

Lodin K. Treatment Outcomes of WHO Grade III Malignant Meningioma with and without Postoperative Radiation Therapy. Poster presentation at 2015 American Radium Society (ARS) in Kauai, HI.

• CN Chang-Halpenny, S Natarajan, J Hwang-Graziano Early Stage Pure and Mixed Endometrial Clear Cell Carcinoma: Outcomes and Patterns of Recurrence. Oral presentation (update) at 2015 American College of Radiation Oncology (ACRO) in Arlington, VA. Poster presentation at 2014 ASTRO in San Francisco, CA.

• CN Chang-Halpenny, J Rahimian, M Girvigian, J Chen, M Miller, L Feng, A Arellano, K Lodin. Clinical Outcomes from Frameless Stereotactic Radiosurgery of Arteriovenous Malformations Using High Resolution 3-Dimensional Rotational Angiography. Poster presentations at 2014 American Radium Society (ARS) in St Thomas, US Virgin Islands, 2015 Los Angeles Radiological Society (LARS) in Pasadena, CA.

• CN Chang-Halpenny, S Natarajan, J Hwang-Graziano. Early stage papillary serous or clear cell carcinoma confined to or involving an endometrial polyp. Poster presentation at 2013 ASTRO in Atlanta, GA.

• CN Chang-Halpenny, J Yeh, J Kaptein, W Lien. Glioblastoma in elderly patients: A single institution retrospective study of conventional vs hypofractionated regimen with concurrent temodar. Poster presentation at 2013 ASTRO in Atlanta, GA.

Sports MedicineBrian D. Kurose, PGY 4• “Bilateral shoulder pain in a high school football player.” April 16, 2015: Poster Presented at American

Medical Society for Sports Medicine 24th National Conference; Hollywood, Florida. Abstract published American Medical Society Sports Medicine Clinical Journal.

• “The Influence of Prayer on Athletic Coping Skills in Sports” April 17, 2015: Poster Presentation at American Medical Society for Sports Medicine 24th National Conference; Hollywood, Florida. Abstract published American Medical Society Sports Medicine Clinical Journal.

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DEPARTMENT RESEARCH CHAIRSAllergy/Immunology Javed Sheikh, MDCardiology Yuh-Jer A. Shen, MDCommunity Medicine Moises I. Cruz, MDDermatology Jashin J. Wu, MDDiagnostic Imaging George Vatakencherry, MDFamily Medicine Bruno Lewin, MDGeriatrics Kuo-Wei Lee, MDPalliative Care Susan E. Wang, MDSports Medicine Marissa S. Vasquez, MDInternal Medicine Thomas Y. Tom, MDGastroenterology Bechien Wu, MDNephrology Dean A. Kujubu, MDNeurology Sonja Potrebic, MDOb/Gyn Elena Martinez, MDOrthopedic Surgery Michael Pearl, MDPediatrics Nilesh Patel, MDRadiation Oncology Jergin Chen, MDSurgery Kevin Patel, MDUrology Gary Chien, MD

CONTACTSArea Research Chair John J. Sim, MD House Staff Research Davida Becker, PhD, MS, Residency Research Manager

Nursing Research Jennifer K. Chai, MSN, RN

Library Services Thomas Shreves, MLIS, Manager, Library Services

KPSC IRB Marcela Sanchez, IRB Administrator

IRB website irb.kp-scalresearch.orgiRIS website iris.kp-scalresearch.orgPoster Printing Kirk Stevens