Download GrandRounds A GRAND COMMITMENT Winter 2015 Saint Louis University School of Medicine

GrandRounds
Winter 2015
Saint Louis University School of Medicine
A GRAND COMMITMENT
Saint Louis University Expands its Partnership with SSM Health
From the Dean | On September 1, 2015, the
ownership of Saint Louis University Hospital (SLUH) was
transferred to the Sisters of St. Mary St. Louis (SSMSL).
This major transaction is the cover story of this edition
of Grand Rounds. As you read the story, you’ll learn more
about the history of our university hospital from its original
construction as Firmin Desloge in the 1930’s, to its
sale to the Tenet Corporation in 1998 and the current
re-acquisition and transfer to SSMSL.
Saint Louis University is no longer simply an affiliate of
SSMSL but is a minority owner. This puts SLUH at the
tertiary-quaternary apex of an 8-hospital regional network
that also contains numerous SSMSL outpatient centers.
These new linkages already have begun to facilitate high
quality medical education and patient care and promise to
yield many more exciting developments. Over the next five
years, SSMSL will invest $500 million in new building and
renovation projects at the Grand Boulevard campus.
This includes the construction of a new mainframe adult
hospital and a new outpatient ambulatory care center.
SLU’s new partnership with SSM has drawn attention
well beyond our region. The national publication Becker’s
Hospital Review recently rated “SSM Health buys SLU
Hospital” as the most interesting healthcare transaction in
the nation for the calendar year 2015. We appreciate this
affirmation and are optimistic that our patients, students,
faculty and community will be the ultimate beneficiaries.
I want to close on a personal note. Within weeks of the
close of the SSM transaction, I notified Dr. Pestello of my
desire to begin the process of stepping down from the
deanship. While my nearly eight years to date as the dean
have been most rewarding, I believe this is the right time
to pass the torch of leadership to the next generation. I’ve
been truly blessed to work with outstanding professionals,
physicians, nurses, support staff, university colleagues,
Jesuits and students here at SLU and particularly in our
School of Medicine. I am honored by the trust that has been
placed in me and am grateful for my time here. Dr. Pestello
and I have agreed that I will stay in the deanship until a
suitable successor can be brought on board, and then will
continue part-time at SLU in fundraising and other duties.
For now, I say simply thank you and hope that you share our
optimism about the SSM partnership and the exciting years
ahead at the SLU medical center.
Grand Rounds is
published biannually by
Saint Louis University
Medical Center
Development.
Nicole Purcell, laboratory technician for the Vaccine Center.
From Topical
to Tropical
With strong NIH
support, researchers in
the Division of
Infectious Diseases,
Allergy and Immunology
are developing
vaccines to combat
the flu, dengue fever,
anthrax, cholera,
the plague and other
infectious threats.
Grand Rounds is mailed
to alumni and friends of the
School of Medicine.
Philip O. Alderson, M.D.
Dean|Saint Louis University
School of Medicine
Vice President|Medical Affairs
Schwitalla Hall M268
1402 S. Grand Blvd.
St. Louis, MO 63104-1028
GRAND ROUNDS EDITORIAL BOARD
Philip O. Alderson, M.D.
Edward J. O’Brien Jr., M.D. ’67
Jessica Card Pressler
page 14
MAGAZINE CONTRIBUTORS
Coordinator and Writer|Marie Dilg|SW ’94
Writer|Stephanie Stemmler
Graphic Designer|Jamie Klopmeyer
Laura Geiser|A&S ’90|Grad ’92
Nancy Solomon
Carrie Bebermeyer|Grad ’06
Maggie Rotermund
PHOTO AND ILLUSTRATION CREDITS
RE-I CHIN Photography|3
Steve Dolan|front cover, 1, 8, 20, 21, back cover
Bill Greenblatt/UPI|2
Kabance Photography|21
Kevin Lowder|10, 21
Charlotte Robinson|1, 14
© 2015, Saint Louis University
All rights reserved
GrandRounds
Saint Louis University School of Medicine
Vol. 13
No.2
Expanded Potential
Saint Louis University’s expanded partnership with SSM Health will enhance facilities, extend clinical
reach and broaden learning opportunities.|page 8
FALL 2015
Vital Signs page 2
Reunion Weekend page 21
Transitioning from Clinic to Classroom
The five medical students Grand Rounds has been following since Year 1 have entered clinical training
with equal amounts of anxiety and excitement.|page 16
Less Stress, More Learning
Curriculum changes are reducing student depression and anxiety rates.|page 18
Philip O. Alderson, M.D.
Dean | Saint Louis University School of Medicine
Vice President | Medical Affairs
20 GrandRounds
For more information about
the magazine or to submit story
suggestions, please contact
314 -977- 9302 or
[email protected].
Decades of Doing Good
An alumnus’ gift to the School of Medicine allows his mission in Malawi to continue.|page 19
Alumni Pulse page 19
Saint Louis University School of Medicine 1
VitalSigns
Emergency
Department Wait
Has No Impact
on Trauma
Patient Mortality
School of
Medicine
researchers
have found
that the
amount
of
time
DALAWARI
a trauma
patient stays in the
emergency department
(ED) makes no significant
difference in the patient’s
mortality.
The researchers examined
Level I and Level II activated
adult trauma patients at SSM
Health Saint Louis University
Hospital admitted from July
1, 2010, to June 30, 2011,
to assess the relationship
between a trauma patient’s
emergency department
length of stay (EDLOS)
on hospital length of stay
and mortality.
The data analysis showed
that while high ED volume
did increase a trauma
patient’s EDLOS, there
was no association between
staying in the ED more than
four hours and mortality in
trauma patients.
Author Preeti Dalawari,
M.D., M.S.P.H., associate
professor and a SLUCare
Physician Group emergency
department doctor, said
the study showed that the
ED’s systems were able to
accommodate a fluctuating
volume of patients without
posing a significant risk to
trauma patients.
“I suspect this is due
to the coordinated care
between the ED and trauma
2 GrandRounds
teams; however the demands
on resources and manpower
may add to the length of
stay or morbidity of other
patients,” Dalawari said.
“We are at an all time high
for patients in the ER. We
are extremely busy, and with
the Affordable Care Act,
we’ve only gotten busier.”
She noted that ED
overcrowding is a pressing
issue, and critically ill patients
boarding in the emergency
department use substantial
resources, especially the
time of emergency
physicians and nurses.
“Overcrowding may impact
overall patient satisfaction
and hospital staff stress, but
the primary outcome for
trauma care survival remained
favorable,” said co-author
Eric Armbrecht, Ph.D. of
the Center for Outcomes
Research at Saint Louis
University.
The emergency
department length of stay
was categorized as short if
the duration was less than
four hours. The study found
approximately two-thirds
of patients stayed in the
emergency department for
four hours or less.
The researchers found
severely injured patients have
a longer hospital length of
stay regardless of how long
they are in the emergency
room. The Level I and II
patients were evaluated as
they came into the hospital.
The review, “Does
emergency medicine
length of stay predict
trauma outcomes at a
Level I Trauma Center?”
was published online in
the Journal of Hospital
Administration in May.
Former Patient
Becomes Champion
for Center of
Innovative
Reconstruction
and Rehabilitation
Andrew Oberle fulfilled a
lifelong dream in August —
he threw out the first pitch
at a Cardinals baseball game.
While an exciting moment
for any baseball fan, the
evening was truly a moment
of triumph for Oberle.
Professor and chief
of plastic and reconstructive
surgery at the School
of Medicine.
Under Kraemer’s care,
Oberle received pioneering
treatment utilizing a new
product called Matristem.
The product, created by
a company named ACell,
functions as stem cells in
the human body, effectively
healing and regrowing tissue.
Kraemer, who has become
a global leader pioneering
Matristem to heal his
nurses, occupational
therapists, physical therapists,
athletic trainers and
dietitians — is typical of
the interdisciplinary, holistic
approach envisioned for
the center.
“My care providers at SLU
wanted me to not just survive,
but to thrive,” Oberle said.
“Each of them cared for
me physically, mentally and
emotionally, and made me
feel like more than just a
patient. I felt like part of
the family.”
Grant Reconnects
Medical School
Faculty to SLU’s
Jesuit Mission
Andrew Oberle poses with Fredbird and pitcher, Tyler Lyons, of the St. Louis Cardinals.
Oberle made global news
in 2012, after he was attacked
by two chimpanzees at an
animal sanctuary in South
Africa where he was working
as part of his graduate
studies in anthropology.
The attack resulted in severe
trauma all over his body,
and he spent several weeks
in a coma in a South African
hospital.
Through “Operation
Oberle,” a campaign led by
his friends and family back
home, he was flown back
to the United States to be
treated by the SLUCare
Physician Group, led by
Bruce Kraemer, M.D.,
Pandrangi Endowed
patients, was able to heal
Oberle’s tissue, connective
tissues, fingers, nose and
other areas of trauma, with
limited scarring. And he gave
Oberle back his ability to
throw a baseball.
After three years of
interdisciplinary treatment
and rehabilitation, which
Oberle describes as “treating
the whole person,” he
now works as the director
of development for the
Center for Innovative
Reconstruction and
Rehabilitation at Saint Louis
University.
The team of medical
providers that treated
Oberle — including doctors,
What does
it mean
to be a
medical
professional at a Jesuit
institution?
EVERARD
How does
the Jesuit mission fit with the
everyday rigors of practicing
and teaching medicine?
Kelly Everard, Ph.D.,
director of medical
student education and
an assistant professor in
family and community
medicine, recently received
a Lilly Fellows Program in
Humanities and the Arts
grant to explore such topics
and to fund a speakers series.
The program is aimed at
reconnecting medical school
faculty with SLU’s mission
of educating and treating the
whole person — mind, body,
heart and spirit.
“We want to connect with
why people became doctors
in the first place,” Everard
said. “It can be easy to forget
that physicians started out
wanting to help people. We
want to connect to that part
of being a physician that says
this is what I’m meant to do.”
The aim of the program,
“Stirring the Embers:
Reconnecting Medical
School Faculty to the
Jesuit Mission of Saint
Louis University,” is to
build discussion among
co-workers across different
specialties and fields,
allowing them to revive
their faith in order to create
a sense of vocation and
commitment to the broader
institutional life of the
University.
This is a pilot program
for the School of Medicine.
If it is successful, the model
could be rolled out to other
schools such as the law
school and business school,
Everard said.
Hospital Physicians
Miss Opportunities
to Identify Weight
Issues in Children
School of
Medicine
researchers
found that
physicians
and
physician
KING
trainees
fail to identify or address
overweight/obesity in
more than 90 percent of
hospitalized children.
Study author Marta
King, M.D., M.Ed., assistant
professor of pediatrics,
said this represents a missed
opportunity for both patient
care and physician trainee
education.
“Overweight/obesity is
the most common chronic
pediatric disease in the
United States,” said King, a
SLUCare Physician Group
pediatrician. “Physicians
who recognize overweight/
obesity can provide healthy
weight counseling, inpatient
consultations and outpatient
referrals and thereby have
CLASS OF 2019
181
8,519
CLASS SIZE
Number of applicants
3.85
AVERAGE GPA
AVERAGE
MCAT
32.75
EIGHT
32
States
represented
93 10
Undergraduate
colleges represented
EIGHTY-SIX
Women
Master’s
degrees
Countries
represented
NINETY-FIVE
Men
1
Ph.D. (psychology)
Saint Louis University School of Medicine 3
the opportunity to improve
outcomes for children with
this severe and potentially
life-threatening disease.”
King and her fellow
authors conducted the
study at Primary Children’s
Hospital, a pediatric
facility associated with the
University of Utah School
of Medicine.
Using an administrative
database, the Centers
for Disease Control and
Prevention’s Body Mass
Index (BMI) calculator and a
random sampling technique,
King and her co-authors
identified a population of
300 hospitalized children
ages 2-18 who were
overweight or obese. They
then reviewed admission,
progress and discharge notes
written by medical students,
interns, senior residents and
attending physicians for this
group of patients.
“The children were
hospitalized on the general
medical service for a
variety of reasons,” King
said. “Common diagnoses
included asthma, pneumonia
and cellulitis.”
The study found
physicians and physician
trainees identified
overweight/obesity in 8.3
percent of the overweight
patients and addressed it
in 4 percent. Attending
physicians were most likely
to document weight issues in
physical exam or assessment,
while medical students were
least likely to document
such issues.
Authors note that
previous studies have
reported that BMI
calculations are seldom
performed during
hospitalizations and that
weight issues are rarely
included among discharge
diagnoses.
Sixteen percent
of children ages 2-18
4 GrandRounds
hospitalized on the general
pediatric service at Primary
Children’s Hospital
during the time of the
study were overweight
or obese. Physicians and
physician trainees identified
overweight/obesity in only
25 children (8.3 percent) of
300 hospitalized children
with overweight/obesity.
They addressed overweight/
obesity for 12 (4 percent)
of the patients.
“At least a third of
parents do not acknowledge
their child is overweight or
obese, making recognition
by health providers
essential,” King said.
“Like most patients
admitted to a teaching
hospital, patients in our
study were cared for by
numerous physicians and
physician trainees,” King
said. “The fact that none
of them identified or
addressed weight as a
problem might easily
provide false reassurance
to patients and family.
‘Since none of a crowd of
doctors caring for my child
during the hospitalization
mentioned weight, it must
mean it is not a problem.’”
“Physicians and Physician
Trainees Rarely Identify or
Address Overweight/Obesity
in Hospitalized Children,”
was published in August
in the online version of
The Journal of Pediatrics.
New Surgical
Director of Liver
Transplantation
A familiar
face has
returned
to the
transplant
program at
the School
VARMA
of Medicine.
Chintalapati Varma, M.D.,
FRCS, FACS, rejoined the
department of surgery’s
division of abdominal
organ transplantation as
surgical director of the liver
transplant program in July.
Varma was director of the
live donor liver transplant
program at the School of
Medicine from 1997 to
2004 before leaving to join
the Methodist Specialty &
Transplant Hospital in San
Antonio, Texas. He then was
recruited to establish a new
liver transplant program
and direct the multi-organ
transplant program at
Geisinger Health System
in Philadelphia.
“My wife and I still had
a lot of community ties and
friends in St. Louis,” Varma
said. “When I came back
to speak at the division of
gastroenterology’s grand
rounds, we recognized that
we wanted to return to
this city and to Saint Louis
University.”
In his new role, Varma
performs liver transplants,
laparoscopic live donor
nephrectomies and
hepatobiliary surgery, and
has a particular interest in
pediatric liver transplantation
at SSM Health Cardinal
Glennon Children’s Hospital.
He would like to perform
live donor liver transplants
in children and adults in
the future in carefully
selected patients.
Varma earned his
medical degree in 1983
from the Armed Forces
Medical College in India. He
completed residency training
in general surgery in India
and the United Kingdom
before moving to become
a fellow in multi-organ
transplant and hepatobiliary
surgery at the Mount Sinai
Medical Center in New
York. During his previous
tenure here, Varma was the
recipient of the St. Luke’s
Day Award from Saint Louis
University Hospital for
being “the most caring and
compassionate physician.”
“The most gratifying and
amazing thing about my
return is that there have been
so many faculty and staff
who remembered me from
eleven years ago,” Varma
said. “It is that sense of
belonging, and those lasting
relationships that one builds
in this university, that makes
me glad to be back.”
Building on
Blood-Clotting
Research
Breakthrough
Molecular structure of prothrombin.
POZZI
On the heels of a
breakthrough discovery
about the way in which
blood clots, researchers
are racing to solve the
next puzzle.
Last summer, School
of Medicine researchers
used X-ray crystallography
to solve the molecular
structure of prothrombin,
an important blood-clotting
protein, revealing an
unexpected, flexible role for
a “linker” region that may be
the key to developing better
life-saving drugs.
With a $214,500 grant
from the American Heart
Association, Nicola Pozzi,
Ph.D., a research associate
in the department of
biochemistry and molecular
biology, is building upon
these findings.
“What I absolutely love
about my job is the domino
effect that a new discovery
brings,” Pozzi said. “When
we solved the three-
dimensional crystal structure
of prothrombin, we soon
realized that our discovery
would change the way we see
prothrombin.
“Since our results were
totally unexpected, they were
very challenging to interpret
but at the same time very
fascinating. It turned out
that solving the structure
was the beginning of a new
unexplored chapter for
prothrombin, which is full
of unanswered questions.
“One at a time, we hope
we will address all of them.
And, thanks to this award
from the American Heart
Association, we will be
able to continue our work,
test our hypothesis and
eventually figure out how the
transition from prothrombin
to thrombin occurs at the
molecular level.”
To really understand how
and when prothrombin is
activated, the investigators
need to observe how its
structure changes.
“When we were able
to trap prothrombin and
solve its structure, it was
like getting one good snap
shot that gave us a lot of
information,” Pozzi said.
“Now what we really need
are lots of stills that we can
piece together, like a movie.
This will show us the exact
way in which prothrombin
changes into thrombin.
“The key, we believe,
will be in the flexible
linker. Using both X-ray
crystallography and single
molecule spectroscopy, we
will begin to see how the
molecule moves.
“I believe that we are
close to reaching another
milestone in the field: the
true dynamic look of
prothrombin will soon
be revealed. Stay tuned.
We have such a great
environment here at
SLU that I am positive
we will succeed.”
New Drug May
Turn Off Cancer
In research published
in Cancer Cell, Thomas
Burris, Ph.D., chair
of pharmacology and
physiology, and Colin
Flaveny, Ph.D., assistant
professor, have found a way
to stop cancer cell growth
by targeting the Warburg
effect, a trait of cancer cell
metabolism that scientists
have been eager to exploit.
Unlike
recent
advances in
personalized
medicine
that focus
on specific
BURRIS
genetic
mutations associated with
different types of cancer,
this research targets a broad
principle that applies to
almost every kind of cancer:
its energy source.
The study, which was
conducted in animal models
and in human tumor cells
in the lab, showed that a
drug developed by Burris
and colleagues at Scripps
Research Institute can stop
cancer cells without causing
damage to healthy cells or
leading to other severe
side effects.
“Targeting cancer
metabolism has become
a hot area over the past few
years, though the idea is not
new,” Burris said.
Since the early 1900s,
scientists have known that
cancer cells prefer to use
glucose as fuel even if
they have plenty of other
resources available. This
preference for using glucose
as fuel is called the Warburg
effect.
In his paper, Burris
reports that the Warburg
effect is the metabolic
foundation of oncogenic
growth, tumor progression
and metastasis as well
as tumor resistance to
treatment.
Burris and his
colleagues created a class
of compounds that affect
a receptor that regulates
fat synthesis. The new
compound, SR9243, which
started as an anti-cholesterol
drug candidate, turns down
fat synthesis so that cells
can’t produce their own
fat. This also impacts the
Warburg pathway, turning
cancer cells into more
normal cells. SR9243
suppresses abnormal
glucose consumption
and cuts off cancer cells’
energy supply.
The drug also has a good
safety profile; it is effective
without causing weight loss,
liver toxicity
or inflammation.
So far, SR9243 has been
tested in cultured cancer
cells and in human tumor
cells grown in animal models.
Because the Warburg
pathway is a feature of
almost every kind of cancer,
researchers are testing it on a
number of different cancer
models. And, in even more
promising news, it appears
that when SR9243 is used in
combination with existing
chemotherapy drugs, it
increases their effectiveness,
in a mechanism apart
from SR9243’s own cancer
fighting ability.
Saint Louis University School of Medicine 5
Aging Successfully
Nutritional supplements may add weight but not longevity for many
seniors according to research at the School of Medicine. While taking
nutritional supplements helps older adults in the general population
gain weight, seniors don’t necessarily live longer or function better
than those who don’t take supplements.
Julie Gammack, M.D., professor of geriatrics
and lead author of a research review article
published in Current Opinion in Clinical Nutrition
and Metabolic Care, did find, however, that
supplements do improve the ability of those
who are malnourished or frail to function
better and help them live longer.
GAMMACK
Nutrition supplements such as Ensure
or Boost contain vitamins, minerals, proteins and calories and
frequently are taken between meals. Gammack noted that
malnutrition affects up to 15 percent of elderly residents in
long-term care facilities.
“Malnutrition and weight loss are common and have serious
consequences for older adults. It’s often under-recognized,
and its consequences can be devastating,” said Gammack,
a SLUCare Physician Group.
“People lose strength and their ability to function
independently, which puts them at risk of increased
hospitalizations, and their overall quality of life deteriorates.
Oral nutritional supplements have shown benefits for those
who are malnourished or frail.”
The School of Medicine is leading an ambitious initiative to improve
the health of older Missourians by training primary care health
providers in geriatrics. The endeavor is funded through a $2.5 million
grant from the U.S. Department of Health and Human Services.
SLU has recruited two other universities, a rural hospital, a
hospital system, two federally qualified community health
centers, a senior center and a health non-profit to join in a
plan that addresses the significant shortage in underserved
urban and rural areas of health care professionals who
know how to care for older adults. The project will involve
6 GrandRounds
professionals and students in geriatric medicine, geriatric
psychiatry, nursing, social work, physical therapy, occupational
therapy and interprofessional education.
Slightly more than a quarter of the institutions that
submitted applications for federal funding received it.
The project is one of 44 Geriatric Workforce Enhancement
Programs in the United States and one of two in Health
Resources and Services Administration Region VII, which
includes Missouri, Iowa, Kansas and Nebraska.
The initiative targets underserved areas: urban north
St. Louis city and county, rural Perry County and an eightcounty region in northeast Missouri, where the impact
of the shortage of health care providers who understand
the special needs of geriatric patients is amplified.
Patients 70 and older should have their memory and reasoning ability
evaluated annually according to a panel of international experts that
convened at the School of Medicine in September.
This is the first time routine brain health
screenings have been recommended for
patients, starting at age 70. Patients found
to have cognitive problems also should be
screened for physical frailty, and vice versa,
suggested the panel.
Published in the September issue of
MORLEY
JAMDA, the recommendation for brain
health comes in light of numerous studies that suggest 30
percent of those older than 70 have memory problems.
Approximately 16 percent of this group has mild cognitive
impairment, while 14 percent has dementia, which includes
Alzheimer’s disease.
“This is an important step toward enhancing brain health
for aging populations throughout the world,” said John Morley,
M.D., director of geriatric medicine and lead author of the
consensus paper. “The ability to learn, solve problems and
remember is a key to successful health and aging.”
Some causes of early cognitive disorder can be reversed
and treated when caught early. These include depression,
hypothyroidism, sleep apnea, problems with sight and hearing,
and treatments of multiple health conditions with medications.
“You can actually fix some of these issues, which is one
reason why it’s critical to identify a problem and try to find
a root cause,” said Morley, a SLUCare Physician Group
geriatrician.
The progression of cognitive impairment sometimes can
be slowed through a series of lifestyle changes, the panel said.
They endorsed changes suggested in FINGER, a Finnish
geriatric study published in The Lancet, which found those
who ate a healthy diet, exercised, trained their memories and
managed cardio-vascular risks were less likely to develop
cognitive decline and memory problems than older adults
who did not.
“Our recommendations are going to shape clinical
practice in a big way,” Morley said. “Physicians are hungry for
this information to help their patients, and as the message gets
out, patients will request screenings.”
BRIDGING CULTURAL DIVIDES
St. Louis Women
of Achievement
honored SLUCare
neurologist Ghazala
Hayat, M.D., for her
multicultural leadership
and extensive work
promoting religious
tolerance and
understanding.
After Sept. 11, 2001, Hayat has worked
tirelessly to dispel misconceptions about
Islam and the Muslim community. She
has served the Interfaith Community
for the last 13 years and has served on
the board of Interfaith Partnership/
Faith Beyond Walls (IP/FBW) for seven
A project spearheaded
by Dawn Hui, M.D.,
assistant professor
of surgery and a
SLUCare cardiac
surgeon at the Center
for Comprehensive
Cardiovascular Care,
aims to connect
members of the
Bosnian community
with health care
services in the
St. Louis region.
Hui received a grant from the
Greater Saint Louis Health Foundation
to educate and screen the local Bosnian
population for cardiovascular disease.
St. Louis is home to the largest Bosnian
years. She also writes
the “Civil Religion”
blog for the St. Louis
Post-Dispatch, which
addresses many of the
issues facing Muslims
and faith communities
HAYAT
at large.
She also helped establish JAM, a
Jewish and Muslim youth group that has
been active in interfaith dialogue and
service, as well as a Jewish and Muslim
dialogue group for adults. Hayat has
taken part in many interfaith service
projects and serves on the planning
committee of Arts & Faith, which
commemorates 9/11 with music and
arts from different faiths.
“I believe the vast majority of
people want to live productive lives;
they want peace. I believe, even with
our differences, we can work together
for peace and to make the world a
better place,” said Hayat, a member of
the neurology faculty since 1986 and
director of the Neuromuscular Service
and the Clinical Neurophysiology
Laboratory. Hayat also is director of the
clinical neurophysiology fellowship, and
she is director of the ALS clinic.
Hayat was one of only 10 women to
receive the annual award.
population outside of
Bosnia.
“There are a lot
of risk factors tied to
this population,” Hui
explained. “Smoking
is prevalent in their
HUI
culture, and the
Bosnian diet can be high in salt and fat.”
The screenings provide a heart health
checkup for patients, including a body
mass index (BMI) check, lipid and
glucose screenings and an EKG.
Hui said she was inspired to find
ways to connect this group with health
care after learning about a friend’s
father’s health issues and his difficulty
accessing care.
“There are a lot of barriers there,”
she said. “That can include the basic
language barrier, as well as cultural
norms which dictate a certain stoicism
and reluctance to seek help.”
Hui’s program involves bringing
health screenings to area Bosnian
businesses. Translators are on hand to
facilitate communication between the
patient and the screener. The screenings
are performed by nurses from SSM
Health Saint Louis University Hospital.
In addition to the health screenings,
SLU nutrition and dietetics students
provide tips to make heart-healthy
modifications to the Bosnian diet.
Both SLUCare and community
physicians counsel patients on their
screening results.
The screenings also serve as a way
to connect the community with health
care providers, including primary care
physicians and dentists, who speak
Bosnian.
Saint Louis University School of Medicine 7
SSM Health St. Joseph Hospital –
Wentzville
SSM Health St. Joseph Hospital - St. Charles
70
SSM Health St. Joseph Hospital Lake Saint Louis
SSM Health Urgent Care
A GRAND
COMMITMENT
TO IMPROVE THE
REGION’S HEALTH
270
70
SSM Health DePaul Hospital - St. Louis
SSM Health Outpatient Center
SSM Health Urgent Care
SSM Health Urgent Care
170
SSM Health St. Mary’s Hospital - St. Louis
64
40
SSM Health Cardinal Glennon Children’s Hospital
SSM Health Urgent Care SSM Health Saint Louis
University Hospital
Saint Louis University and SSM Health expand
their partnership and plan for a new $500 million
hospital and ambulatory care facility
270
55
44
SSM Health St. Clare Hospital - Fenton
255
SSM Health Urgent Care Locations
SSM Health Hospital/Outpatient Locations
SSM Health Saint Louis University Hospital
Saint Louis University SLUCare Locations
SSM Health Saint Louis University Hospital
8 GrandRounds
Saint Louis University School of Medicine 9
O
On September 1, 2015, members of the Saint Louis University
family, employees of SSM Health Saint Louis University
Hospital, civic and political officials and guests had no idea
they’d be attending a surprise party.
They crowded into the hospital lobby for a quick program
that marked two milestones: the official start of an expanded
partnership between SSM Health and Saint Louis University
aimed at improving the health of the St. Louis region, and the
first day the hospital operated under the new partnership. A row
of television cameras and reporters with notebooks hinted that
more was coming.
SSM Health CEO William P. Thompson was nearly at the
end of his brief remarks when he broke the news. SSM Health
would invest $500 million in a new hospital and outpatient care
center on Grand Boulevard. He said SSM also would make
immediate capital investments in the current hospital.
“While the current hospital has served the community well,
we have the opportunity to construct state-of-the-art academic
facilities that incorporate the best practices in patient-centered
design,” said Thompson, who was flanked by St. Louis Mayor
Francis Slay (Law ’80) and Saint Louis University President Fred
10 GrandRounds
P. Pestello, Ph.D. “This significant investment will enable us to
deliver an improved patient experience and even better care for
our community.”
The crowd erupted into cheers.
firm to design the new facilities based on these identified needs.
Approximately two years later, builders will break ground.
The first patients are expected to be admitted to the new SSM
Health Saint Louis University Hospital in September 2020.
WORK IN PROGRESS
FOLLOW THROUGH
Details about the new hospital and outpatient care facility
have yet to be decided. The original hospital, formerly named
Firmin Desloge Hospital, opened in 1933 and is used mostly
for medical offices. The hospital’s 365 patient rooms and other
operations were moved into a connecting facility in 1988.
The nearby Doctors Office Building was constructed as
a temporary facility in 1977. While it has been renovated
periodically throughout the years, it is not considered ideal for
handling its more than 100,000 outpatient visits each year.
In October, SSM Health St. Louis hired a programming
architect to meet with hospital faculty and staff to gather
information about what they, their patients, services and
students need. This information will include an eye to the future
of the dynamic and changing health care environment. Once
this future program is completed, SSM will hire an architectural
Although plans for new facilities are down the road, SSM
Health is demonstrating its commitment to making capital
investments in current facilities. Less than three weeks after the
September event, SSM Health issued a purchase order for a new
linear accelerator, a device commonly used for external beam
radiation treatments for cancer patients; and a 3T MRI, the gold
standard in neuro-imaging. Hospital administrators also met
with architects who will design a radiation-oncology suite to
house the new equipment. The total cost of the project is more
than $9 million.
“There is quite a bit of pent-up demand on this campus,”
said Kate Becker (A&S ’83, PH ’11), president of SSM Health
Saint Louis University Hospital. “Our number one goal is
exceptional patient care, and these investments will ensure
that we can support our physicians in providing that
exceptional care.”
AN INSPIRED MOVE
The shared mission of providing exceptional patient care
inspired the expanded partnership between two of the region’s
outstanding faith-based health care organizations. While the two
Catholic non-profits have committed to work together to define
the best practices to care for patients, they will retain their
individual identities, which complement each other.
As part of the expanded partnership, the University bought
back Saint Louis University Hospital from Dallas-based Tenet
Healthcare Corp. over the summer and contributed it to SSM
Health in exchange for a minority financial interest and two
seats on the board of SSM Health St. Louis. The deal became
official in September when the hospital was renamed SSM
Health Saint Louis University Hospital.
In addition to the hospital, SSM Health now owns what
had been the Anheuser-Busch Eye Institute, the AnheuserBusch Eye Institute Annex, the West Pavilion, the Saint Louis
University Hospital garage and the Auxiliary Hospitality House.
The Doctors Office Building on Vista remains part of Saint
Louis University, as does the University’s physician practice,
SLUCare Physician Group, which will collaborate closely with
SSM’s physician group.
Saint Louis University School of Medicine 11
Pestello and Heaney
THE PATH TOWARD PARTNERSHIP
facility that offered the specialized care
and equipment; access to rare procedures,
researchers and clinical trials; and an academic
hospital and physician practice. The hospital
is SSM Health’s first adult academic medical
center in its four-state (Illinois, Missouri, Ohio
and Wisconsin) 19-hospital network.
Becker
“Both SSM and SLU have a vision for the
future of health care, and it involves integration of the delivery
network,” said Becker, who was associate general counsel at
SLU for more than four years and SLUCare CEO for more
than two years before joining SSM Health in 2011 as president
of SSM Health St. Mary’s Health Center.
“What that means is that from the time patients enter
our health care system – whether it’s through the emergency
department, an urgent care or their primary care physician’s
office – all the way through their outpatient procedure
or inpatient stay and aftercare, we want to offer an entire
continuum of care. Through this continuum of care, we’re
able to provide better care at a reduced cost because we’re
not duplicating services and we’re sharing information.
We’re able to follow up and stay connected to our patients
in a meaningful way.
“Our goal is to provide this level of care to all patients,
including the underinsured and uninsured in our community.”
Both SSM Health and SLU are interested in maintaining ties
to federal health care centers, regional health commissions and
integrated health networks.
“The partnership will significantly strengthen our university
by advancing our ability to deliver high quality and compassionate
medical care, which the SLU community has identified as a key
initiative in our strategic plan,” said Philip O. Alderson, M.D.,
vice president of medical affairs and dean of the School of
Medicine. “The deal also reflects a major investment in the future
of SLUCare, which is vital to our mission and essential to the
University’s overall financial health.”
Robert Heaney, M.D., professor in the department of internal
medicine, assistant vice president of medical affairs and chief
executive officer for SLUCare, said the University began
exploring the idea of partnership about three years ago.
The University realized that in order for the School of
Medicine and SLUCare to thrive in an increasingly complicated
health care delivery system, it needed a strong network partner,
he said. With new payment models aimed at rewarding quality
and affordability, partnering with a larger system would
be critical. Health care organizations with limited patient
populations and inefficiencies in care delivery would be left out
of the game. In addition, a larger system could help with capital
needs, as well as with technology and infrastructure upgrades
that are needed in the hospital.
In light of these changes in the health care landscape, Heaney
said the University’s first step was to buy back the hospital from
Tenet Healthcare, which was changing it health care delivery
model. While SLU previously operated its own teaching hospital,
he said the University did not want
to return to that model.
“You don’t want to have a stand-alone tertiary, quaternary
teaching hospital especially when contracts are being set with
systems, not individual groups or hospitals,” said
A TE AM EFFORT
Heaney, who helped facilitate the buyback and
The partnership is a long-term, 50-year
structure the SSM Health partnership. “We
agreement. Alderson noted that many
also had about 400 clinicians in 40 different
A video about
university faculty and staff leaders made
locations spread across the St. Louis metro
the expanded
important contributions to the planning
area, and we needed a coherent, cohesive
partnership is available
of the partnership. In the later stages of
way forward with a network that had the
at www.slu.edu/
what was a complex three-way agreement
same vision and mission we had.”
slucare-home/ssminvolving Tenet, SLU and SSM, a small core
SSM Health quickly emerged as the
health-construction
group worked hard to bring the transaction
frontrunner. The two organizations have
-announcement
to a successful conclusion. Bill Kauffman,
a history that stretches back to 1903 (see
SLU vice president and general counsel,
timeline sidebar) and a proven track record in
led the overall transaction team and the core
working together. For the past several decades,
negotiation group. Alderson and Heaney, represented
the SLUCare Physician Group and SSM Health have
academic and clinical interests. Anne Garcia, SLU senior
partnered to provide pediatric care services to patients at SSM
associate general counsel, provided vital legal support, and
Health Cardinal Glennon Children’s Hospital and maternal-fetal
David Heimburger, vice president and chief financial officer,
medicine services at SSM Health St. Mary’s Hospital.
led SLU’s financial issues group. Critical contributions were
made by outside consultants from Hogan Lovells (legal issues)
A CONTINUUM OF CARE
and Raymond James (financial issues). Among many others
Becker said it made sense for SSM Health to partner with
who made important contributions were SLU trustees Frank
SLU. While SSM Health had a strong network of community
O’Donnell, M.D., and Al Litteken; Kathy Merlo, SLUCare
hospitals, the system lacked a tertiary, quaternary care
12 GrandRounds
chief operating officer; Marty Clay, SLUCare director of
administrative operations; and Gary Whitworth, School of
Medicine chief financial officer.
“SLU trustees, led by Chairman Joe Conran and University
President Fred Pestello, were unwavering in their belief of the
importance of completing the agreements,” said Alderson.
“Without all of this support and the efforts of countless others,
this transformative transaction could not have been completed.”
Thompson
of a much larger population of patients with a broader range
of specialties and subspecialties. For instance, Heaney said
the school will be able to consider offering programs in new
specialties, such as child psychiatry or rehabilitative medicine.
“We have a way forward to build out those experiences,
and SSM has expressed a willingness to build them with us,”
he said.
Alderson noted that students in SLU’s other health
Slay
NUTS AND BOLTS
Medical staff members are meeting monthly to determine
logistical details such as the operational configuration of the
expanded partnership and what care will be provided and
where. As a Level I trauma center, SSM Health Saint Louis
University Hospital will provide for the critical care needs of
patients. Heaney said SLUCare physicians also plan to maintain
their signature programs, such as solid organ and bone marrow
transplantation, and cardiovascular and spine surgery; and
expand in other quaternary programs.
“The good news is we appear to be on the same page, and
we’re excited about the opportunities,” Heaney said
Each entity brings strengths to the partnership. Saint Louis
University is a leader in medical education and research, as
well as in the advanced health care delivered to patients by
an academic medical practice. SSM has a superb network and
knowledge of where care needs to be provided and how to
deliver it. Heaney and Becker said SSM Health and Saint Louis
University want to build a system that provides care where
patients live and work.
“We have to think about what patients want, where physician
capacity exists and where the infrastructure and equipment are,”
Becker said. “This transition isn’t like flipping a switch. It’s a
process that will unfold as we plan for the new facilities on this
campus.”
GOOD STE WARDS
Saint Louis University anticipates the partnership will lead to
dramatic improvements in the educational experience for SLU’s
medical students, residents and fellows. Heaney said the new
facilities will match the high quality of their education and will
allow students to learn about best practices in medicine in an
environment where performance will be judged not only by the
quality of care physicians provide but by the degree to which
they provide just stewardship of the resources available to them.
“Our students, residents and fellows deserve to learn
about the best care in a great facility. Now we’ll offer that
opportunity,” he said.
More importantly, Heaney said expanded clinical services
will provide students with greater learning opportunities
(see map on page 9). He said they will be involved in the care
St. Louis Archbishop Robert J. Carlson
professions programs, including nursing and physical therapy,
also will benefit from the expanded opportunities. In addition,
Alderson said the partnership can lead to extended clinical
research trials of new medications and new technologies
area-wide in the SSM Health network.
SIMIL AR CULTURES
Becker and Heaney said the feedback from staff and faculty
within both organizations has been overwhelmingly positive.
And they hope to keep it that way by giving priority to one key
aspect of the partnership – cultural integration.
“Inability to find compatibility in culture means you will fail,
no matter what else you do,” Becker said.
She is confident that because SLU and SSM Health have
similar missions their partnership will succeed.
SSM Health’s mission: “Through our exceptional health care
services, we reveal the healing presence of God.”
SLU’s mission: “The pursuit of truth for the greater glory of
God and for the service of humanity.”
During her first two weeks as president of SSM Health
Saint Louis University Hospital, Becker held town hall meetings
at the hospital daily, sometimes twice daily, to explain SSM’s
mission and identify common ground. SSM Health established
a Mission Partnership Team comprised of staff from both
organizations and different disciplines (housekeeping to medical
staff) to find ways of fostering cultural integration. SSM Health
took members of SLU’s pastoral care department, which will
have a leadership role in the cultural transition, on a heritage
tour that celebrates the Franciscan Sisters of Mary and their
founding of SSM Health in St. Louis.
Becker said SSM and SLU employees are encouraged to
serve together not only in their health care settings but in their
communities as well. This fall, employees from SSM Health
Saint Louis University Hospital and SSM Health Cardinal
Glennon Children’s Hospital teamed up for a Habitat for
Humanity project.
“The Jesuit tradition of care for the person will remain at
our center,” Heaney said. “We’re collaborating with a partner
that not only understands our values but understands the
importance of care providers as people in their own right.
That gives me the greatest hope for the future.”
Saint Louis University School of Medicine 13
The Battle Against Infectious
Diseases Through Safer Vaccines
As winter approaches, think about this — is the flu vaccine physicians are giving to patients
effective against this season’s predicted influenza strains?
It’s a question that causes angst each
year as scientists and pharmaceutical
companies try to predict which
morphed version of the influenza virus
has the potential to trigger flu epidemics
worldwide. In recent years, a majority
of the educated guesses have been fairly
accurate. But, in some years, such as
2014, it’s a miss.
Frey with senior research assistant, Yinyi Yu
The Division of Infectious Diseases,
Allergy and Immunology at Saint
Louis University School of Medicine is
working to minimize the risk of future
misses. By early 2016, the Division’s
Center for Vaccine Development will
begin the first human clinical trials
of a universal vaccine that will target
influenza A viruses, the type most
responsible for global flu epidemics.
“The human clinical trial will last a
year, and then it will take a year or two
to analyze the results,” said Daniel Hoft,
M.D., Ph.D., director of the division
of infectious diseases and head of the
Vaccine and Treatment Evaluation Unit
(VTEU), one of only nine such units in
the country that works on NIH-funded
14 GrandRounds
vaccine projects. “We think an effective
vaccine could be developed within the
next five to 10 years.”
Hoft’s colleague, Sharon Frey,
M.D., clinical director of the Center
for Vaccine Development, serves as
principal investigator of this novel
influenza research project. Her team is
targeting a specific area on one protein
— the stem of the hemagglutinin (HA)
protein — because that is the most
stable part of the HA antigen, unlike the
HA head that continuously mutates and
evolves.
Hoft’s lab also has identified T cell
epitopes within internal viral proteins
that can trigger immune responses.
These epitopes exist in almost every
influenza A strain, leading researchers to
believe that vaccines targeting HA stem
and conserved T cell epitopes could
provide effective universal influenza A
vaccines within the next decade.
In the meantime, SLU researchers
continue to build upon the
groundbreaking work of Robert Belshe,
M.D., the founder of the SLU Center
for Vaccine Development, who was
instrumental in helping to develop
the intranasal FluMIST vaccine. His
colleague, Geoffrey Gorse, M.D., also
was a principal investigator of another
study that found that higher doses of a
particular type of influenza vaccine were
safe and resulted in significantly better
protection rates in the elderly population.
R AMPING UP PREPAREDNESS
The VTEU accounts for almost half of
the $6 to $7 million in funding awarded
to the Center for Vaccine Development
each year through NIH, nonprofit
foundations and industry research grants.
VTEU researchers have spent almost 25
years tackling some of the most virulent
infectious diseases, from influenza to
tuberculosis, herpes, yellow fever, dengue
fever and smallpox.
Vaccines Against the Following Diseases Have Been Evaluated at SLU in the Past Five Years:
Anthrax • Cholera • Dengue • Herpes • Influenza (seasonal, bird flu and swine flu) • Plague • Pneumococcus • Rotavirus • Smallpox • Tuberculosis •Tularemia
Total VTEU funding
awarded since 2007
= $30,073,249
36 active projects with total funding of
$20.3 million
NIH approved the VTEU to conduct
emergency vaccine clinical trials related to
national preparedness.
“Sharon Frey’s work after 9/11 on
the smallpox vaccine was instrumental
in showing our ability to ramp up for
emergency preparedness,” Hoft said.
“We also completed emergent work on
the new pandemic H1N1 influenza virus
in 2009 and the H7 bird flu studies in
2013, which were important for national
biodefense. Because of our experience
in these areas, we are extremely wellpositioned to participate in future
national preparedness types of trials.”
VACCINES FOR TROPICAL DISE ASES
Influenza virus.
“Our focus is on testing vaccines to
prevent disease,” Frey said. “In some
cases, however, we also are focused on
national preparedness and the prevention
of bioterrorism. An example of this is
the smallpox vaccine.”
Shortly after smallpox was eradicated
in 1980, a concern grew that countries
that previously were known to have
stockpiles of smallpox virus could
potentially use the virus as an agent of
bioterrorism. Frey, who has researched
the smallpox vaccine for more than 15
years, found that the nation’s limited
supply of the vaccine could be used
at 1/10th of its standard dose and
remain effective. Her discovery meant
that the vaccine could safely be diluted
and given to far more people than
previously thought. Because of SLU’s
track record in biodefense research, the
Now, in an
evolution of
the smallpox
vaccine
studies, Sarah
George,
M.D., is
working
on the
development of a safer vaccine for
yellow fever. The currently available
vaccine is a live attenuated version
that, while effective, does have rare,
sometimes fatal, side effects. In 2014, an
Oregon woman died after receiving the
vaccine prior to a planned trip to Africa.
According to the CDC, her death was
caused by an “adverse reaction resulting
from uncontrolled replication of the
vaccine virus.” George, who serves as
principal investigator for a multi-site
VTEU yellow fever vaccine study, is
working to develop a new vaccine that
does not contain the whole live virus.
“We are using an engineered version
of the live smallpox vaccine that is
weakened and can no longer replicate
in cells and we are inserting only a few
key proteins of the yellow fever virus
that have been found to induce good
immune responses in animal studies,”
George said. “This recombinant DNA
technology looks promising, and we’ll
be starting the first phase of clinical
trials in humans next year.”
In addition to yellow fever, George
studies other tropical diseases, including
chikungunya and dengue fever, both
mosquito-borne diseases originating
in Africa. Due to increased worldwide
travel and global interactions, cases of
both diseases have been diagnosed in
the United States in the past six years.
George and her colleagues led the
first human clinical trials of a promising
vaccine against the dengue virus and
have honed in on key aspects of the
virus that point toward a better immune
response and the development of a
more effective vaccine. Work on a
protective vaccine against chikungunya
is just getting under way.
A BET TER TUBERCULOSIS VACCINE
Hoft also has a particular interest in
the creation of a better tuberculosis
(TB) vaccine. He has conducted 15 TB
vaccine trials and has found that an
oral version of the current vaccine can
induce better lung mucosal immune
responses than an intradermal version.
In addition to large NIH grants over
the past 20 years, Hoft’s laboratory
was awarded almost $3 million this
year from the Bill and Melinda Gates
Foundation to accelerate TB research in
a multi-center project that includes Saint
Louis University, Stanford University,
University of Washington, Colorado
State University and the University of
Illinois-Chicago.
THE “OMIC” REVOLUTION
What enables the string of successes
for the infectious diseases division is
the strong, collaborative atmosphere
and a highly skilled research team that
is both inquisitive and persistent. It’s
been five years since the divisions of
10
active NIH
grants totaling
$8.4 million
immunobiology, allergy and infectious
diseases/immunology at SLU School
of Medicine were merged to create
the combined Division of Infectious
Diseases, Allergy and Immunology.
Since that time, the division has grown
to include 20 faculty members.
“I believe the combined division
offers an abundance of crossfertilization of ideas,” Hoft said.
“This has escalated our progress into
translational research and enabled us to
recruit some of the brightest researchers
in the country.”
Among heavy competition with the
other eight VTEUs, SLU was one of
only two centers named by the NIH to
be a VTEU “Omics” Core, potentially
bringing another $6 million into the
Center for Vaccine Development during
the next few years.
“We will be the core investigators
studying whole genome responses
to vaccines and infections using
transcriptomics, proteomics, lipidomics
and metabolomics,” Hoft explained.
“This puts us on the cutting edge of
the ‘omic’ revolution to study every
possible response in the human body
to infectious diseases or vaccines and
to look for host responses that cause
protection or are associated with adverse
events.”
Belshe added, “I’m most proud
of bringing online a whole series of
effective vaccines that are safer and
more reliable than anything we had
previously. We’ve driven public policy
related to vaccine recommendations,
and we have taken an active role in
informing policy-makers about the use
of vaccines to eliminate disease. I’m also
very proud of the fact that we’ve created
a wonderfully collaborative atmosphere
where innovative research can grow and
continue to produce outstanding results
that enhance health worldwide.”
Saint Louis University School of Medicine 15
WITH A MIX OF EXCITEMENT AND UNCERTAINTY, THIRD-YEAR MEDICAL STUDENTS EMILY AU, AMBROSE CAMPBELL,
MATTHEW GARRITY, COURTNEY KAAR AND JESSICA LIU PUT ON THEIR WHITE COATS, WALKED THROUGH THE DOORS
OF SAINT LOUIS UNIVERSITY HOSPITAL AND BEGAN A CRITICAL STAGE IN THEIR FORMATION. THE FIVE STUDENTS, WHOM
GRAND ROUNDS HAS BEEN FOLLOWING SINCE THEIR FIRST YEAR OF MEDICAL SCHOOL, STARTED CLINICAL ROTATIONS.
The Class of 2017 is the first to
begin rotations under significant
curriculum changes designed
to allow students more time
to explore specialties.
• The students had a one-week orientation in April,
rather than the previous half-day orientation.
• The students began rotations in May when residents
and interns are at their most seasoned, rather than in
July when residents and interns also are acclimating
to new responsibilities
• The students won’t go more than 16 weeks without
a break, rather than their predecessors who had to
wait six months for a break
• The students will have almost five months — twice
the time given to previous classes — to select
specialties and submit residency applications
To talk about their expectations
this year and reflections on last
year, Grand Rounds checked in
with the five students just as
they were getting their feet wet.
16 GrandRounds
Emily Au
Age: 29
Hometown: Palos Verdes, California
I really enjoyed my psychiatry rotation, and I love the neuro
ICU. I’m not sure I’m in love with neurology per se, but I
like the critical care setting. When I was a kid I said I wanted
to be a psychiatrist because I like picking people’s brains. It’s
fascinating the way the mind works. I like talking to people and
understanding where they’re coming from, what their reality is.
Psychiatry reminds me of what I love about medicine. It’s
not just about medication. You can apply behavior therapy and
psychotherapy. You get to spend time with your patients and
get to know them.
I still struggle with getting enough sleep, but I’m learning
to be really efficient and minimal with things in my daily life. I
can get ready in the morning faster than I ever realized I could.
I mass cook one day a week to save time and money, and to
eat healthier. I bring workout clothes wherever I go in case I
can squeeze in trip to the gym, but I don’t beat myself up if I
can’t make it at least five days a week like I used to. If I choose
studying over working out, I’m OK with that.
Ambrose Campbell
Age: 25
Hometown: Shreveport, Louisiana
I’m looking forward to experiencing the primary care rotations. I know I’ll learn a great deal, and I feel medicine finally is
starting to make sense. So far, I really like pediatrics. It’s a well
organized rotation — and who doesn’t love kids?
The civil unrest in Ferguson took place during my second
year. This affected me greatly. As a member of the Student National Medical Association I helped organize a panel discussion
for community leaders to keep students informed. I also helped
organize students to participate in some of the protests. Seeing
militarized vehicles and heavy artillery in the St. Louis area had
me living in a state of anxiety because I’ve experienced cases
of mistaken identity with law enforcement in the past.
Volunteering and managing the Health Resource Center
(HRC) prepared me for the array of patients I’ll see in my clinical years. I feel perfectly comfortable getting personal information from my patients. I think that will take me a long way this
year.
To take care of myself as a complete person I stretch, read
spiritual lessons and meditate every morning before I go to the
hospital. Also, I exercise frequently and cook my own meals
to monitor what foods I take in. In addition, I don’t watch
television, as I feel it’s a tool for complacency and gives false
expectations of reality. All of this helps me focus on my path
no matter what comes my way.
Courtney Kaar
Age: 27
Hometown: Chesterfield, Missouri
So far I’ve had my OB-GYN rotation and part of my pediatric
rotation. I’ve liked both, but at this point my mind is still wide
open when it comes to choosing a specialty.
Dr. Thomure (Michael F. Thomure, M.D., professor and
director of the division of gynecologic sub-specialties) was my
mentor during my OB-GYN rotation. In one of our meetings
he said something similar to, “You’re going to feel like you
don’t know anything. And it’s true, you don’t know anything.
But that’s why you’re here. You’re here to learn.” That sentiment will stick with me going forward. It was nice to have
someone acknowledge the very uncomfortable feeling of not
knowing anything.
I’m enjoying the clinical application of knowledge from
“the books” to real life treatment of patients. So much of
what I’ve learned has come without context; descriptions of
diseases, lists of symptoms, lists of drugs, etc. At this point,
I’ll finally be able to make connections to patients. Having a
patient with a face and a story I can associate with a disorder
will help me tremendously. I’ve always found rote memorizing
difficult.
The moment I finished the Step 1 exam was quite significant. I remember pushing my chair away from the table and
just sitting there with only one thought in my head: “I’m done.”
I don’t know how long I sat there without moving. And I don’t
know how long it took for that massive smile to fade from my
face either.
Matthew Garrity
Age: 30
Hometown: Boston, Massachusetts
may be my only chance to experience a variety of medical arenas. Every surgery that I get to scrub in on could be the only
time I ever get to see that procedure. The same goes for each
unique patient population.
Outside the classroom I’ve been volunteering some of my
time with St. Louis Effort for AIDS (STLEFA). The organization offers education on the prevention of HIV/AIDS
and comprehensive support services for those affected by the
disease. My experiences with STLEFA have been preparing me
for engaging with my community about issues of health and
medicine that go far beyond the boundaries of the clinic.
The community is always present around us, and it’s important
to remember that those in need won’t always know enough to
come to seek help and education.
I’m continuing to stay as physically active as time allows
outside of my studies. I relocated from the Central West End
to Tower Grove East this year, so my jogging routes have
changed a bit, but I still love getting outside for a run whenever
I can. Living farther from Forest Park won’t stop me from
getting back up there to run on the trails though!
Jessica Liu
Age: 24
Hometown: Omaha, Nebraska
The hospital is a completely different arena of learning now
that I’m in my third year. I definitely feel as though I’m thriving in this environment. I enjoy being able to work as a team
member, and it’s rewarding to know my efforts to care for my
patients are appreciated by my team.
It’s fun getting to know your residents and attending physicians. They’re amazing individuals who come from different
walks of life. I used to think I was busy when I was studying
for boards. I was putting in 10 to 12 hours of studying each
day, but now I work 10 to 12 hours almost six days a week —
and I study on top of that! It’s a huge adjustment.
The most challenging thing about second year was finding
a balance between preparing for class, preparing for the Step
1 exam and managing extracurricular activities. Though time
consuming, each experience was well worth it and will define
the physician I will become. Holding leadership positions with
the Mobile Health Initiative for the homeless and SLU Sight at
the HRC helped prepare me to serve a diverse patient population in my clinical years.
Dr. Porter (Thomas I. Porter, O.D., assistant professor of
ophthalmology) is a man of integrity and is an inspiration to
me. All physicians are busy, but Dr. Porter goes above and
beyond. He volunteers at the HRC and at homeless shelters
downtown. I hope to emulate his compassion when I have
patients of my own. It comes as no surprise that he won this
year’s SLU Caring Physician Award.
I’m looking forward to exploring every one of my clinical rotations fully. I’m still undecided about which area of medicine to
go into, so I look forward to throwing myself into each area.
My career eventually will lead me down a single path, so this
Saint Louis University School of Medicine 17
Less Stress, More Learning
DECADES OF DOING GOOD
ENDOWED PROFESSORSHIP ALLOWS ALUMNUS’ MISSION IN AFRICA TO CONTINUE
When Stuart Slavin, M.D. (’83), M.Ed., spoke at the White Coat
dinner this fall, he told students and their parents something he
never imagined he’d be able to say. The first year of medical
school actually improved the mental health profile of
SLU students.
Slavin, associate dean for curriculum, supported his
statement with data he’s been collecting on first- and
second-year students since the School of Medicine began
implementing curriculum changes six years ago. The changes,
which are evolving continually, are designed to combat the
well-documented depression and anxiety students experience
during their medical education. The changes include pass/fail
grades for pre-clinical courses; more opportunities for students
to explore their interests through expanded electives and
learning communities; and greater focus on student wellness,
mindfulness and stress reduction.
Slavin’s most recent statistics (see chart) measured
depression and anxiety levels of first- and second-year
students at the end of the academic year — before and after
implementation of the curriculum changes. More than 90
percent of students participated in the confidential mental
health surveys.
Slavin noted that while anxiety and depression ratings clearly
have declined, the decreases are less dramatic for second-year
students. Slavin attributes this to the intense pressure of the
U.S. Medical Licensing Examination (Step 1 exam). He pointed
out, however, that School of Medicine Step 1 exam scores have
gone up since the curriculum changes.
PERCENTAGE OF STUDENTS REPORTING MODERATE TOSEVERE DEPRESSION AT THE END OF THE ACADEMIC YEAR
PERCENTAGE OF STUDENTS REPORTING MODERATE-TOSEVERE ANXIETY LEVELS AT THE END OF THE ACADEMIC YEAR
Pre-change
First-Year Students
2008 27%
2009 27%
Pre-change
Second-Year Students
First-Year Students
28%
2008 56%
35%
2009 54%
Post-change
Second-Year Students
58%
61%
Post-change
2010 19%
17%
2010 44%
61%
2011 18%
18%
2011 30%
39%
2012 11%
16%
2012 31%
46%
2013 14%
17%
2013 43%
44%
2014 8%
21%
2014 23%
47%
2015 4%
2015 14%
The medical school curriculum changes and their impact are featured in Beyond Measure, a new book by Vicki Abeles about stress in high school students.
From Your Alumni Association President EDWARD J. O’BRIEN JR., M.D. (’67)
The past few
months have been
exciting! The Class
of 2019 arrived with
great credentials and
expectations. With 181
slots filled from an
O’BRIEN
applicant pool of 8,500,
it is clear that interest in medical careers
continues to increase.
Our entering class will matriculate
in a fairly new program. In addition to
the didactic curriculum, the curriculum
will have a clinical emphasis and offer
students clinical exposure within their
first two years. Follow Grand Rounds for
feedback from students and faculty on
this new structure.
18 GrandRounds
Also exciting is Saint Louis
University’s expanded partnership with
SSM Health. We’ve been affiliated with
SSM for many years, and we continue
with a stronger bond.
My class had fantastic exposure
to great clinical teaching and patient
interactions at SSM Health St. Mary’s
Health Center. Who can forget the busy
internal medicine, surgery and obstetric
departments? The early mornings and
late nights were worth every hour. Plus,
many of us were able to live in longsince demolished St. Francis Hall. If
we performed H&Ps on uncomplicated
patients, we could live in St. Francis Hall
for the year. It was a great deal. The best,
however, was the awesome cafeteria that
was open from early morning until nearly
midnight. We had four square meals a day
and burned off the extra calories on the
busy services.
And finally, please welcome Jessica
Card Pressler to the newly created
position of Director of Alumni and
Donor Engagement. Her department
will be your contact for alumni events,
programs and reunion information. You
will continue to receive this magazine and
emails, including updates and “Dialogue
with the Dean” messages. Keep us
updated on your contact information.
Volunteer as a class agent, caller or scribe.
Visit the ever-expanding medical campus.
Be involved!
Kemme and his trainees take a break between cases.
Orthopaedic surgeon Richard J. Kemme, M.D. (’56), usually
spends his Septembers in Malawi, where he’s been volunteering
with an orthopaedic surgery training program for the past 25
years. This September, however, Kemme and his wife Mary, a
1955 graduate of the SLU School of Nursing, spent their time
closer to home working on a project that will benefit Malawi
for many more years to come.
The Kemmes were attending a ceremony at Saint Louis
University celebrating establishment of the Dr. Richard J.
Kemme Endowed Professorship in Orthopaedic Surgery.
The endowed professorship was created through a gift
from the Kemme family and friends of the department of
orthopaedic surgery.
Along with the prestige and financial support an endowed
professorship confers, this honor also carries with it the
opportunity for its holder to travel to Malawi annually and
to serve one month with the same Rotary Club-funded
Orthopaedic Overseas Training Program Kemme has
volunteered with since 1988. Malawians who have trained
under the program provide 90 percent of the orthopaedic
care available in the country of 14 million people.
“I wish I could keep traveling to Africa, but at my age it’s
time to give it up,” said Kemme, who spent anywhere from a
month to five months in Africa during his visits. “I am forever
grateful that members of the department of orthopaedic
surgery at SLU will carry on the mission in Malawi.”
Kemme said he was pleased to learn the inaugural
holder of the endowed professorship is Howard M. Place,
M.D. (’83), professor and vice chair of the department of
orthopaedic surgery. He also is a physician who lives a life of
service. For more than a decade, Place has traveled to Haiti,
the Dominican Republic, Kenya and Honduras to bring
equipment and to perform orthopaedic surgeries. Last year he
accompanied Kemme and an orthopaedic surgery resident on
a trip to Malawi.
AlumniPulse
“The professorship recognizes the department’s
commitment to service to others both locally and
internationally,” Place said. “It was a particular honor
for me to travel with Dr. Kemme to a place he
considers home and to receive this gift from such an
outstanding individual.”
This is the second gift the Kemme family has given
to the department that encourages volunteerism in
Malawi. Three years ago the Kemme Family
Foundation established an elective for a senior
orthopaedic surgery resident that allows the resident
to spend a month with the Orthopaedic Overseas
program. Place oversees the elective. The department
of orthopaedic surgery is one of the few departments
in the country that allows residents to serve overseas
for more than a week.
“I didn’t start volunteering in Africa until after I
retired,” said Kemme, who also volunteered with
Habitat for Humanity and as an instructor with a
ski program for the handicapped in Greeley, Colorado.
“My hope is that young physicians won’t wait until they’re
retired to give back. I also hope they learn how much you can
do with so little. It’s a heck of an opportunity.”
Berton R. Moed, M.D., professor and chair of the
department of orthopaedic surgery, helped establish both
the orthopaedic elective and endowed professorship.
“I’m proud to have played a small role in supporting Saint
Louis University’s involvement in a volunteer experience in a
region where care is sorely needed,” Moed said. “It enriches the
lives of many — both the patients in Malawi and our resident
trainees. We are grateful for this gift.”
Kemme and his trainees outside the hospital in Malawi.
Kemme with best presentation awardees at the annual Orthopaedic Overseas
Training Program seminar
Saint Louis University School of Medicine 19
2015 Alumni
Merit Award
ALUMNI
MERIT
AWARD
2015
Ira M. Rutkow, M.D. (’75),
may be retired from clinical
surgery for 13 years, but his
mind — and his pen — are
still immersed in the intricacies
of the operating room.
Rutkow, the author of seven
books on medical and surgical
history, is the recipient of the
2015 Saint Louis University
School of Medicine Alumni
Rutkow and Pestello.
Merit Award.
“My interest in history can be traced back to my childhood
and a fascination with understanding the past,” Rutkow said.
“As I would later learn, there is no way to separate present-day
surgery from the experiences of all the surgeons and all the
years that have gone before.”
Rutkow’s book, Bleeding Blue and Gray, Civil War Surgery and
the Evolution of American Medicine, first published in 2005, is
being reissued this December. His last book, Seeking the Cure,
A History of Medicine in America, was published in 2010.
Rutkow, who is recognized as developing the PerFix mesh-plug
operation for groin hernia repair, also regularly writes articles
on surgery in 19th century America in the Annals of Surgery.
The surgeon-turned-historical-author has a profound
interest in public health. Following graduation from the School
of Medicine, Rutkow simultaneously completed surgical
residency training while pursuing a master’s degree and
doctorate in public health as a Robert Wood Johnson Clinical
Scholar at Johns Hopkins University.
“My interest in combining surgery and public health started
at SLU due to the depth of the surgical department and the
innovative curriculum of the community medicine department
under the leadership of Drs. Max Pepper and Rodney Coe,”
Rutkow said. “This cross-disciplinary approach allowed me to
easily move from one field to another, starting as a practicing
general surgeon, then focusing on the socioeconomics of hernia
surgery while building one of the country’s earliest ambulatory
surgical centers and then ending up as a historian of surgery.”
Rutkow and his wife, Beth, divide their time between a
home in New York City and a farm in Hudson Valley, New
York. Humbled by his selection as an Alumni Merit Award
recipient, he noted, “SLU was instrumental in my development
as a doctor. It is a privilege to have a lifelong association with
such an outstanding university and to be an example for all that
a SLU education has to offer.”
OTHER HONOREES
Herman J. Echsner, M.D. (’52), recipient
of the School of Medicine Community
Service Award. Echsner practiced medicine
in Columbus, Indiana, for more than 50
years, working in family medicine, emergency
medicine and anesthesiology. Throughout
his career, he delivered more than a thousand
ECHSNER
babies. He also made house calls and early
in his career accepted food and gifts as compensation for his
services. Echsner worked to construct the first full-service
nursing home in Columbus and remained its medical director
for more than 40 years. He was director of the Bartholomew
County Hospital Emergency Department for more than 20
years and educated EMTs. He was a generous supporter of
his church and Saint Louis University. Fourteen of Echsner’s
family members have attended SLU.
Edward Chen, M.D. (’05), recipient
of the School of Medicine Early
Achievement Award. After completing
his family medicine residency, Chen and
a colleague built a busy private practice in
Kirkwood, Mo. He serves on the Mercy
Health Clinic Quality/Safety/Value
CHEN
committees to ensure that Mercy physicians
provide consistent, evidence-based care to their patients. He
also helps educate future physicians by allowing students from
the School of Medicine and Washington University to rotate
through his private practice. He volunteers at the student-run
Health Resource Center and with the School of Medicine
Alumni Advisory Board. Chen paints and is interested in
photography. He wrote a children’s book, The Bad Alphabet,
and has helped other people publish their books. He also
manages a website (www.tedcoxen.com) that contains an
“authoritative index of humorous medical images.”
Joseph Ernst, M.D. (’51)
Robert Binkley, M.D. (’52)
Francis San Filippo, M.D. (’52)
Austin Dixon, M.D. (‘53)
Edwin Lytle, M.D. (’53)
Joseph Lauber, M.D. (’55)
Robert Farley, M.D. (’56)
Richard Applebaum, M.D. (’57)
John McMahon, M.D. (’57)
MED
reunion
Weekend 2015
MARK YOUR CALENDAR
SCHOOL OF MEDICINE EVENTS
Dec. 8
Samuel Hardy, M.D. (’58)
Frederick Jameson, M.D. (’58)
Leslie Shalan, M.D. (’58)
Robert Adams, M.D. (’59)
Aloysius Chen, M.D. (’59)
James Auckley, M.D. (’61)
Kenneth Rashid, M.D. (’61)
Lester Mann, M.D. (’62)
Henry Fuller, M.D. (’66)
Thomas Jaski, M.D. (’67)
Caroline Tharayil, M.D. (’69)
Philip Zeve, M.D. (’69)
Theodore Mehalic, M.D. (’70)
James Hamilton, M.D. (’71)
Frederick Cason, M.D. (’78)
Michael Resnik, M.D. (’81)
William Horn, M.D. (’95)
Andrew Huffman, M.D. (‘13)
St. Louis Symphony Concert to benefit the Cancer
Center Music Therapy Program - 7 p.m., free
Feb. 18-19 Frank R. Burton, M.D., Memorial Lecture
March 4
Alumni Reception in conjunction with the American
Academy of Orthopaedic Surgeons Annual Meeting
March 18
Alumni Reception at the Missouri State Medical Association 2016 Annual Convention
NOTE: Starting in
January, the School
of Medicine will send
emails to alumni
about the 2016
reunion weekend.
If you are not receiving
email updates from
the School of Medicine,
please send an email
to mdalumni@slu.
edu and share your
name, class year
and email address.
October 13 – 15
Medical Reunion Weekend
Celebrating the classes of 2011, 2006, 2001,
1996, 1991, 1986, 1981, 1976, 1971, 1966,
1961, 1956 and earlier.
314-977-8335
medschool.slu.edu/alumni/
FOR INFORMATION:
CONTINUING MEDICAL EDUCATION PROGRAMS
Jan. 4-8 Medicolegal Death Investigator Training Course
Jan. 22-23
Hip Skills Course: Hip Arthroscopy,
Preservation and Replacement Procedures
Jan. 29-30 Foot and Ankle Arthroscopy: St. Louis Skills Course
Feb. 5-7
Masters Workshop: Advanced Flaps and Aesthetic
Facial Reconstruction
Feb. 18-20 9th Annual Cervical Spine Research Society
April 9 Innovations in Glaucoma Surgery
April 18-22 Medicolegal Death Investigator Training Course
Advanced Retroperitoneal Anatomy of the Pelvis
with Focus on Pelvic Neuroanatomy and Complication
April 21-23
Prevention in Minimally Invasive Surgery in
Endometriosis, Urogynecology
April 28-30 Surgical Approaches to Skull Base
June 23-25
Advanced Surgical Management of Obstructive
Sleep Apnea
July 21-23
23rd Advanced Techniques in Cervical Spine
Decompression and Stabilization
July 29-31
Cosmetic Blepharoplasty and
Fundamentals of Facelift
Aug. 5-6
In Memoriam DECEASED ALUMNI
Guillermo Arbona, M.D. (’34)
S. Polito, M.D. (’46)
Paul Klingenberg, M.D. (’47)
Jack Hackney, M.D. (’48)
Robert Mack, M.D. (’48)
Lester Sauvage, M.D. (’48)
John Babich, M.D. (’49)
Robert Fontana, M.D. (’49)
Richard Dames, M.D. (’51)
saint louis university
Foot and Ankle Arthroscopy: St. Louis Skills Course
for Podiatric Surgeons
Aug. 22-26 Medicolegal Death Investigator Training Course
*denotes hands-on cadaver workshop
FOR INFORMATION:
314-977-7401 medschool.slu.edu/cme/
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Permit No. 134
1 N. Grand Blvd., Salus 609
St. Louis, MO 63103
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WE INVITE YOU
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ROBERT KISTNER, M.D. (’54)
VASCUL AR SURGEON
With benefits designed
exclusively for supporters
of the School of Medicine,
the White Coat Society
celebrates partnerships
between the medical
school and alumni.
Annual contributions
of $2,500 or more to
any School of Medicine
fund grant membership
in this prestigious circle,
with tiered membership
levels for graduates of
the past 15 years; giving
at the $2,500 level also
grants membership to the
President’s Circle Giving
Society, which honors
leadership donors across
the entire University.
For more information, visit giving.slu.edu/WhiteCoat or call 314 -977-9302.