UC San Diego Endocrinologists Team with Pharmacists to Offer Diabetes “Tune Up” Clinic

Dr. Steven Edelman

Dr. Steven Edelman

Department of Medicine endocrinologists Steven V. Edelman, MD, (left) and Robert R. Henry, MD (below right), collaborate with Candis Morello, Pharm D, and students in the Skaggs School of Pharmacy and Pharmaceutical Sciences to offer a six-month Diabetes Intensive Medical Management (DIMM) “tune up” clinic for patients with complex cases of diabetes at the VA San Diego Healthcare System.

Dr. Robert Henry

Dr. Robert Henry

At each visit, a patient receives an hour of personalized attention to medication management, diet, exercise, controlling blood sugar levels and other necessities that may be involved in a complex case of diabetes.

The aim is to achieve glycemic control within the six-month period of the “tune up” clinic..

In a preliminary study, Drs. Morello, Evans, Henry and coworkers have assessed the outcomes of the clinic, and the findings indicate that this pharmacist-endocrinologist collaborative approach is effective.  |  Read the Study Abstract in the January 2016 issue of Annals of Pharmacotherapy  |  Read the full story from the UC San Diego Newsroom

Steven V. Edelman, MD, Clinical Professor in the Department of Medicine, directs the Diabetes Care Clinic at VA San Diego Healthcare System (VASDHS) and is an investigator in the VA Center for Metabolic Research. He is founder and director of Taking Control of Your Diabetes, a non-profit diabetes education organization. He conducts research focusing on developing and evaluating new treatments for type 1 and type 2 diabetes.

Robert R. Henry, MD, Professor in the Department of Medicine, is Chief of the VA Center for Metabolic Research and Chief of the Section of Endocrinology, Metabolism and Diabetes at VASDHS. In his research, he investigates the etiology, treatment, and prevention of obesity and type 2 diabetes.

Dr. Morello is Professor of Clinical Pharmacy and Associate Dean for Student Affairs at Skaggs School of Pharmacy and Pharmaceutical Sciences.

The study report was published online in November, 2015, and in print in January, 2016.

Complex Health Issues of Aging Patients Not Solved in a Senior Moment

Program teaches medical professionals how to address obstacles to care, such as isolation and homelessness —

Reams of medical books and guidelines exist on how to manage a patient’s diabetes, but much of that goes out the window when your patient is a 70-year-old homeless man eating out of a trashcan.

“There’s no point in simply giving this patient insulin and telling him to get on a restricted diet,” said Dr. Diane Chau, associate professor of medicine at UC San Diego School of Medicine and a physician at Veteran Affairs San Diego Healthcare System. “We need to intervene in a broader, more comprehensive way.” … Read the full story from the UC San Diego Newsroom

New Division Chief and Vice Chief of Endocrinology and Metabolism

Announced July 28, 2014, by Wolfgang H. Dillmann, MD, Helen M. Ranney Distinguished Professor and Chair of the Department of Medicine

Dr. Nicholas Webster

Nicholas Webster, PhD

I am pleased to announce that an internal review committee has selected Dr. Nick Webster as the new chief of the Division of Endocrinology and Metabolism in the Department of Medicine. Dr. Nai-Wen Chi has been selected to serve as vice chief.

Wolfgang H. Dillmann, MD

Wolfgang H. Dillmann, MD

I would like to express my gratitude to Dr. Nick Webster, who accepted the role of interim division chief after I stepped down in 2010. In leading the Division of Endocrinology and Metabolism for the past four years, Dr. Webster has done an important service for the division and the department.

Nick Webster, PhD, professor of medicine, is Associate Director for Shared Resources at the Moores Cancer Center and holds a joint appointment as a Senior Research Career Scientist at the VA San Diego Healthcare System. He is a highly respected researcher and thought leader in the field of endocrinology and metabolism.

Dr. Webster earned his B.A. and M.A. from Cambridge University and his Ph.D. from Stanford University.  After a post-doctoral fellowship at the CNRS in Strasbourg, France, he joined the UCSD faculty in the Division of Endocrinology and Metabolism in 1989 and was promoted to Professor in 2006.

Dr. Webster has been very active in service to the University and the Veterans Affairs San Diego Healthcare System (VASDHS).  He has held a number of leadership positions at UCSD, including Associate Vice Chancellor for Research Facilities in the Office of Research Affairs, where his portfolio included oversight of the animal welfare program and university-wide shared resources.  Dr. Webster has served as chair of a number of university committees, including the Radiation Safety and Surveillance Committee, the Animal Program Oversight Committee, the Recruitment and Admission Committee for the Biomedical Sciences Graduate Program, the Shared Resources Oversight Committee, and the Research Space Committees at the VASDHS.

Over the past 25 years, Dr. Webster has maintained an active research program, which is broadly focused on the mechanisms of hormonal signal transduction and gene regulation in different developmental and disease contexts.  He actively participates in the Center for Reproductive Science and Medicine, the Diabetes Research Center, and the Center for Transdisciplinary Research in Energetics and Cancer.

Nai-Wen Chi, MD, PhD

Nai-Wen Chi, MD, PhD

The newly appointed vice chair of the Division of Endocrinology and Metabolism, Dr. Nai-Wen Chi, is a researcher and board-certified endocrinologist at the UCSD Medical Center and the VA. Dr. Chi earned his M.D. from National Taiwan University prior to receiving his Ph.D. from Harvard University, where he was mentored by Dr. Richard Kolodner in investigating the molecular machinery that maintains the yeast mitochondrial genome.  Dr. Chi then completed his medical residency and endocrine fellowship at the Massachusetts General Hospital.  During his postdoctoral fellowship at MIT, he was mentored by Dr. Harvey Lodish in identifying novel insulin-signaling molecules that regulate vesicular trafficking.

Dr. Chi joined the UCSD faculty in 2000 and has been the director of the Endocrine Fellowship since 2005.  His clinical interest focuses on dysnatremias while his research program takes biochemical and genetic approaches to investigate the pathophysiology of diabetes and obesity.

Please join me in giving your enthusiastic support to Drs. Nick Webster and Nai-Wen Chi in their new positions of leadership in the Department of Medicine.

Four Common Antipsychotic Drugs Found to Lack Safety and Effectiveness in Older Adults

In older adults, antipsychotic drugs are commonly prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications – schizophrenia and bipolar disorder. The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia, some of which carry FDA warnings on prescription information for these drugs.

In a new study – led by researchers at the University of California, San Diego School of Medicine, Stanford University and the University of Iowa, and funded by the National Institute of Mental Health – four of the antipsychotics most commonly prescribed off label for use in patients over 40 were found to lack both safety and effectiveness. … Read the full story from the UCSD Newsroom

Department of Medicine endocrinology and metabolism researchers Robert R. Henry, MD, and Sunder Mudaliar, MD, are coinvestigators in the study of the antipsychotic drugs.Dr. Robert R. Henry

Robert R. Henry, MD, is professor of medicine in the Division of Endocrinology & Metabolism at UC San Diego. At the Veterans Affairs San Diego Healthcare System (VASDHS), he is Chief of the Section of Endocrinology, Metabolism & Diabetes and Director of the Center for Metabolic Research.

Sunder Mudaliar, MD, is health sciences clinical professor in the Division of Endocrinology & Metabolism at UCSD. He is extensively involved in medical teaching and clinical care at the VASDHS. As an investigator in the Center for Metabolic Research, he performs clinical research focused on the prevention and treatment of diabetes.

More information:

Citation for the study report: Jin H, Shih PB,Golshan S, Mudaliar S, Henry R, Glorioso DK, Arndt S, Kraemer HC, Jeste DV. Comparison of Longer-Term Safety and Effectiveness of 4 Atypical Antipsychotics in Patients Over Age 40: A Trial Using Equipoise-Stratified Randomization. E-pub ahead of print, November 27, 2012, The Journal of Clinical Psychiatry.

Bringing Power of Prevention, Diagnosis to the People

“A Mercedes Benz isn’t designed to function in the Sahara Desert,” notes Dr. Eliah Aronoff-Spencer of the University of California, San Diego. “So why are we designing medical equipment for developing countries the same way we do for developed ones?”

It’s a question researchers at the new Distributed Health Laboratory in the California Institute for Telecommunications and Information Technology (Calit2) at UC San Diego aim to address, and eventually, to render moot. In collaboration with the UC San Diego School of Medicine and the Universidade Eduardo Mondlane (UEM) in Maputo, Mozambique, Calit2’s DH Lab is designing low-cost medical devices such as microscopes and wireless sensing devices that can be used by virtually anyone anywhere in the world to prevent and even diagnose illness. … Read the full story from the UCSD Newsroom

Co-directing the Distributed Health Laboratory is Eliah Aronoff-Spencer, MD, PhD, fellow in infectious diseases at UCSD and informatics coordinator for the Medical Education Partnership Initiative (MEPI) between UC San Diego and Universidade Eduardo Mondlane (UEM) in Maputo, Mozambique.

Eliah Aronoff-Spencer, MD, PhD with Dr. Manuel TomasThe photo at left shows Dr. Aronoff-Spencer with UEM physician Dr. Manuel Tomás (at right) on a patient ward at Maputo Central Hospital.

Dr. Aronoff-Spencer is also an organizer of the Biomedical Research Informatics for Global Health Training (BRIGHT) program, an international collaboration devoted to training the next generation of informatics researchers in partner countries.

The BRIGHT program, a Division of Biomedical Informatics project, is funded by grant D43TW007015 from the Fogarty International Center of the National Institutes of Health.

A graduate of the UCSD Internal Medicine Residency Program and Physician-Scientist Training Pathway, Dr. Aronoff-Spencer has completed a fellowship in clinical infectious disease and is now a fellow in research in infectious disease, global health informatics and decision making at UCSD. He is also a staff physician in infectious disease at the VA San Diego Healthcare System.

More information:

Progression of Lung Fibrosis Blocked in Mouse Model

Study points to a phosphorylation pathway that may contribute to the development of lung injury and fibrosis

A study by researchers at the University of California, San Diego School of Medicine may lead to a way to prevent the progression, or induce the regression, of lung injury that results from use of the anti-cancer chemotherapy drug Bleomycin… Read the full story from the UCSD Newsroom

The study investigators are Drs. Martina Buck and Mario Chojkier of the Division of Gastroenterology in the Department of Medicine and the Biomedical Sciences Program at UC San Diego and the VA San Diego Healthcare System. Martina Buck, PhD, is associate professor of medicine and Mario Chojkier, MD, is professor of medicine. | Read the report online in PLoS ONE

Dr. Gary Firestein Steps Down as Chief of Rheumatology, Allergy and Immunology; Dr. Robert Terkeltaub Named Interim Chief

Dr. Gary Firestein

Dr. Gary Firestein

Dr. Gary Firestein will step down as Chief of the Rheumatology, Allergy and Immunology division as of July 1, announced Dr. Ken Kaushansky, Helen M. Ranney Distinguished Professor and outgoing Chair of the Department of Medicine.

Dr. Firestein, who has been chief of the division since 1998, is making the move because of the increasing demands of his leadership responsibilities as Dean of Translational Medicine and Director of the Clinical and Translational Research Institute (CTRI) for UCSD Health Sciences.

“During the last 12 years, the division grew dramatically in both accomplishments and international visibility. This is due entirely to the incredibly creative faculty, our outstanding trainees, and the dedicated staff,” said Dr. Firestein.

“I want to express my thanks to Dr. Firestein for being such an outstanding division leader for the past 12 years,” said Dr. Kaushansky. “Under Gary’s leadership, the division has continued to grow and prosper in all three of its missions: research, education, and clinical care.

“The division has gone from unranked to a consistent top-20 ranking in the ‘America’s Best Hospitals’ list from U.S.News & World Report,” he said. “Its research portfolio has grown to be generally among the largest in the department.”

“Gary has also overseen the creation and expansion of the Center for Innovative Therapy as a model for translational medicine and helped bring in supporting program project grants,” Dr. Kaushansky said.

These include the NIH-funded Specialized Centers of Research program on rheumatoid arthritis, the Rheumatic Diseases Core Center grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and a new NIAMS Ruth L. Kirschstein T32 Training Grant to support research training in rheumatic diseases.

“Gary has also recruited a number of very successful research-oriented faculty into the Rheumatology and Allergy/Immunology sections,” Dr. Kaushansky said. “The division’s clinical mission has expanded to include a novel multidisciplinary clinic with the Department of Orthopaedics.

Dr. Robert Terkeltaub

Dr. Robert Terkeltaub

Dr. Robert A. Terkeltaub, Professor of Medicine, will serve as Interim Chief. For most of the last decade, Dr. Terkeltaub has served as Associate Director of the division and Director of the Rheumatology Training Program.

He has been Chief of the Rheumatology Section at the VA San Diego Healthcare System since 1985.

“I’m grateful to Dr. Robert Terkeltaub for agreeing to serve in the interim role,” said Dr. Kaushansky. “I know he will carry on the rich tradition of the division.”

“Dr. Terkeltaub is an outstanding physician-scientist who has played an integral role in the division’s success. We are truly grateful that he agreed to take on this new responsibility,” said Dr. Firestein.

“I look forward to helping the division through the transition period and into the future,” Dr. Terkeltaub said.

“We are very proud of our faculty and their accomplishments,” he said. “We want to ensure that the clinical programs remain strong and the clinical, translational, and basic research from our very accomplished faculty members grows in breadth, quality, and scope.”

Another goal, he said, is to increase the division’s interaction with other Department of Medicine divisions, including the three newest – Geriatrics, Global Public Health, and Biomedical Informatics.

About Dr. Terkeltaub

Dr. Terkeltaub received his M.D. degree and completed his internship, residency, and fellowship at McGill University in Montreal, Canada. From 1981 to 1984, he was a postdoctoral fellow in the laboratory of Dr. Mark Ginsberg at The Scripps Research Institute in La Jolla.

He spent the following year as a research associate at The Scripps Research Institute before he joined the UCSD faculty as Assistant Professor of Medicine in the Division of Rheumatology, Allergy and Immunology and Chief of the Rheumatology Section at the VA San Diego Healthcare System.

Dr. Terkeltaub has served on numerous study sections for the National Institutes of Health, the American Heart Association, the Arthritis National Research Foundation, and other organizations. He is currently Associate Editor of the journal Arthritis & Rheumatism.

As an investigator, Dr. Terkeltaub studies the interfaces of inflammation with skeletal and vascular biology, focusing on arthritis and vascular diseases, including infantile artery calcification, gout, and osteoarthritis. At the VA and UCSD, his lab discovered the molecular etiology of generalized artery calcification of infancy, and has done seminal research on innate immunity in gout, and on cartilage innate immunity and chondrocyte hypertrophy in osteoarthritis.

About Dr. Firestein

Dr. Gary Firestein first joined the UCSD Department of Medicine faculty in 1988 as Assistant Professor of Medicine in the Division of Rheumatology, Allergy and Immunology.

He spent 1992 through 1996 as Senior Director of Immunology for Gensia, Inc, and returned to UCSD as Associate Professor of Medicine in 1996. He was promoted to Professor of Medicine in 1998, when he was also appointed division chief.

On a personal note, Dr. Kaushansky said, “Gary was the only person I knew at UCSD when I started interviewing for the position here. We collaborated on a couple of papers back in our formative days.”

Those days were in the late 1980s, when Dr. Kaushansky was Assistant Professor in the Division of Hematology at the University of Washington and the younger Dr. Firestein was Assistant Professor in the Rheumatology, Allergy and Immunology division here at UCSD.

The two papers reported some of Dr. Firestein’s earliest work, with his mentor and then-division chief Dr. Nathan Zvaifler, on the presence of pro-inflammatory mediators in the synovial fluid of rheumatoid arthritis patients.

In the following years, Dr. Firestein’s basic science studies would open the way for the development of anti-cytokine agents as the first broadly effective treatments for rheumatoid arthritis.

Dr. Firestein was founding director of the UCSD Clinical Investigation Institute, a responsibility that has evolved into his current role as Director of the Clinical and Translational Research Institute.

He was appointed Dean of Translational Medicine for UCSD Health Sciences in 2008.

In the Media: Dr. Steven Edelman

Dr. Steven Edelman is featured in the La Jolla Light story, “Revamped show premieres with insights on diabetes.” Through his nonprofit organization Taking Control of Your Diabetes in partnership with UCSD-TV, Dr. Edelman has developed a video series by the same name to help patients take an active part in managing their diabetes.

The first broadcast in the updated video series is June 24 at 8:00 pm on UCSD-TV.

Steven V. Edelman, M.D., is Professor of Medicine in the Division of Endocrinology and Metabolism and director of the Diabetes Care Clinic at the VA San Diego Healthcare System.

ADA honors Dr. Steven Edelman as Outstanding Educator in Diabetes

For his longtime devotion to education and advocacy in diabetes, Dr. Steven Edelman will receive the American Diabetes Association’s Outstanding Educator in Diabetes Award at the ADA annual meeting in New Orleans in June.

Steven V. Edelman, M.D., is Professor of Medicine in the Division of Endocrinology and Metabolism and director of the Diabetes Care Clinic at the VA San Diego Healthcare System.Dr. Edelman is director of Taking Control of Your Diabetes, a nonprofit organization he founded in 1995.

Its mission is to educate and inspire diabetes patients and the medical professionals who care for them.

Read the press release from the UCSD Newsroom

More Information

Medical Students Use Video and Peer Feedback to Refine Their Communication Skills in the Clinic

In a UC San Diego clinic, a patient is describing his symptoms to a medical student. The student asks questions and listens closely to discover the patient’s chief concern.It’s a normal part of her fourth-year clinical training – except that another medical student is observing and filming the entire encounter.

When the visit is over, she’ll watch the video and listen to the other student’s comments about her communication skills.Then he’ll hand her the camera. He’ll interview the next patient, and she’ll do the filming and the feedback.They’re taking part in the Paired Observation and Video Editing (POVE) project at UC San Diego.

The project is testing a new method for teaching and learning the skills that make a doctor a good communicator.

Kristin Bell, MDUC San Diego is one of 10 centers participating in the 3-year POVE project. The project is conducted as a fourth-year elective, MED 472, in the School of Medicine curriculum.

Peer learning is powerful

Year 1 of POVE has just ended, with medical students Christine Lee and Ninad Athale completing the elective last December.“The feedback they gave one another was amazing,” says Dr. Kristin Bell, Associate Professor of Medicine in the Division of General Internal Medicine. “They taught each other.”

As Principal Investigator of the POVE Project site at UC San Diego, Dr. Bell is the course director.“It was really great to watch their progress, and it was a unique learning experience for me as well,” she says.“I think it’s very powerful to learn from your peers.”

The goal is to teach the skills that make a doctor a good communicator.

Students produce a “before and after” video

The POVE course is a four-week, full-time intensive in doctor-patient communication. The medical students work in pairs, taking turns at filming and critiquing.All of the filming is done with the patients’ consent.The students meet with Dr. Bell and Ellen Lavin, Ph.D., a clinical psychologist, in weekly video review sessions to talk about the interactions they find challenging.

The film footage records their progress.

At the end of the course, the students extract the best “before” and “after” clips and produce a video essay that highlights the interactions they found difficult and the ways they addressed them.

“You can learn a lot from your medical student peers.”

On December 7 of last year, POVE students Lee and Athale presented their video essays at an interactive seminar for fellow students, residents, and faculty.“They did an amazing job,” Dr. Bell says.The students’ videos will become resources for medical centers across the nation after the study is concluded.

UC San Diego part of “a nationwide learning community”

Seeing the videos and having the immediate peer feedback, which Dr. Bell says was delivered with great sensitivity, helped the medical students pinpoint the interactions they found challenging.The goal is to train the students to be their own observers. Once they are able to recognize precisely the communication skills they want to refine, they are better equipped to improve their interactions with patients.

Studies show that when a doctor communicates in an effective and caring way, patient satisfaction goes up and the average length of a clinic visit actually goes down. Both doctor and patient find the experience more positive.

A University of Washington therapist and educator is the POVE project leader.

A total of 4 students from UC San Diego will be part of the POVE study, but more may enroll in the course if they are interested. Dr. Bell is now recruiting two students for the Fall 2008 session.The POVE project is headed by the Department of Family Medicine at the University of Washington. Larry Mauksch, M.Ed., a University of Washington family therapist and the overseeing investigator, calls it “a nationwide learning community.”Funding for the POVE study comes from the Arthur Vining Davis Foundations, whose healthcare grants are devoted to advancing caring attitudes in medical professionals.

The participating centers include community-based clinics as well as academic Family Medicine and Internal Medicine departments.

Dr. Bell credits many individuals who have worked to make the POVE project possible here. Many School of Medicine colleagues have been greatly supportive, she says, including Jess Mandel, MD, Associate Dean of Undergraduate Medical Education (UGME), and the UGME Electives Committee.

Looking to the future

Dr. Bell considers how the POVE experience will influence the medical school curriculum in the future.

“Can you do more peer learning?” she says. “I think you can. You can learn a lot from your medical student peers. It’s instruction from someone you can relate to.”

“It’s powerful to see a video. As a teaching tool, it’s just limitless.”

She hopes that the POVE course concept will eventually be incorporated into the new curriculum in a different form.“As it is, the course is very time consuming,” she says. “When we design a course for the new curriculum, we need to set aside enough time to make it effective for student learning, and at the same time keep it sustainable with the faculty resources available.”“It’s powerful to see a video. As a teaching tool, it’s just limitless.”

More about Kristin Bell, M.D.

Dr. Kristin Bell has been a primary care physician and educator at UC San Diego since 2001. She is based at the VA San Diego Healthcare System’s Vista Clinic, where she is Physician Site Leader.Challenged to help veterans manage chronic pain conditions, she has trained as an acupuncturist and founded an acupuncture clinic at the VA.

A grateful patient nominated her for the American Medical Association’s Young Physician Award, which was granted to her last fall.An emphasis upon doctor-patient communication was built in to her own residency training, she says. She’s a graduate of the Primary Care track in the Medicine program at UC San Francisco.

“For me, the POVE project
is a great learning experience.”

She’s relatively new to video production, but she has a longtime passion for medical education.She chose to develop a new behavioral medicine curriculum in her project for her National Center of Leadership in Academic Medicine (NCLAM) course.It grew into an addition to the third-year Medicine Core Clerkship.

That course also uses video, among other teaching methods, to teach medical students behavioral change counseling and motivational interviewing. The goal is to help patients make healthy lifestyle changes.

It has been a required part of the curriculum here for the past three years.

Dr. Bell acknowledges and thanks her mentors Shawn Harrity, M.D., and Peggy Wallace, Ph.D., for encouraging her and helping her attain success in this area of education.

Dr. Harrity is Clinical Professor of Medicine in the Division of General Internal Medicine. Dr. Wallace is Associate Adjunct Professor of Medicine and Director of the Professional Development Center in the Office of Undergraduate Medical Education.

“For me,” Dr. Bell says, “the POVE project is a great learning experience. I learn from the other POVE faculty, and especially from our students.”

More Information