Category Archives: Internal Medicine

Should neonatal-perinatal medicine move to two-year fellowships? | Journal of Perinatology – Nature.com

Keller DM, Davis MM, Freed GL. Access to pediatric subspecialty care for children and youth: possible shortages and potential solutions. Pediatr Res. 2020;87:11512.

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Bethell CD, Read D, Blumberg SJ, Newacheck PW. What is the prevalence of children with special health care needs? Toward an understanding of variations in findings and methods across three national surveys. Matern Child Health J. 2008;12:114.

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Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. Jama. 2015;314:103951.

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National Academies of Science, Engineering, and Medicine. The Future of Pediatric Subspecialty Physician Workforce: Meeting the Needs of Infants, Children and Adolescents. Consensus Study Report 2023. https://nap.nationalacademies.org/read/27207/chapter/1.

Shah S, Cheng TL. Optimizing the childrens hospitals graduate medical education payment program at a time of pediatric workforce challenges and health need. J pediatrics. 2022;245:46.e2.

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Rimsza ME, Ruch-Ross HS, Clemens CJ, Moskowitz WB, Mulvey HJ. Workforce trends and analysis of selected pediatric subspecialties in the United States. Acad Pediatr. 2018;18:80512.

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Catenaccio E, Rochlin JM, Simon HK. Differences in lifetime earning potential for pediatric subspecialists. Pediatrics 2021;147:e2020027771.

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Rochlin JM, Simon HK. Does fellowship pay: what is the long-term financial impact of subspecialty training in pediatrics? Pediatrics 2011;127:25460.

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Catenaccio E, Rochlin JM, Simon HK. Association of lifetime earning potential and workforce distribution among pediatric subspecialists. JAMA Pediatr. 2021;175:10539.

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Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Pediatric Hospital Medicine 2022. https://www.acgme.org/globalassets/pfassets/programrequirements/334_pediatrichospitalmedicine_2022v2.pdf.

Cleveland WW, Brownlee RC. Future training of pediatricians: summary report of a series of conferences sponsored by the American Board of Pediatrics. Pediatrics. 1987;80:4517.

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Freed GL, Dunham KM, Switalski KE, Jones MD Jr, McGuinness GA. Pediatric fellows: perspectives on training and future scope of practice. Pediatrics. 2009;123:S317.

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Health Resources and Services Administration. Physician Workforce: Projections, 2020-2035; 2022. https://bhw.hrsa.gov/sites/default/files/bureau-healthworkforce/Physicians-Projections-Factsheet.pdf.

Keels EL, Goldsmith JP. Neonatal provider workforce. Pediatrics 2019;144:e20193147.

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American Board of Internal Medicine. Critical Care Medicine Policies 2023. https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/criticalcaremedicine/#:~:text=Candidates%20certified%20in%20internal%20medicine,the%20critical%20care%20medicine%20examination.

Cordero L, Hart BJ, Hardin R, Mahan JD, Giannone PJ, Nankervis CA. Pediatrics residents preparedness for neonatal resuscitation assessed using high-fidelity simulation. J graduate Med Educ. 2013;5:399404.

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Freed GL, Dunham KM, Loveland-Cherry C, Martyn KK, Moote MJ. Private practice rates among pediatric subspecialists. Pediatrics 2011;128:6736.

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Pineda R, Kati K, Breault CC, Rogers EE, Mack WJ, Fernandez-Fernandez A. NICUs in the US: levels of acuity, number of beds, and relationships to population factors. J Perinatol : Off J Calif Perinat Assoc. 2023;43:796805.

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The American Board of Pediatrics. Pediatric Subspecialists Ever Certified 2023. https://www.abp.org/dashboards/pediatric-subspecialists-ever-certified.

Gamber RA, Blonsky H, McDowell M, Lakshminrusimha S Declining birth rates, increasing maternal age and neonatal intensive care unit admissions. Journal of perinatology :official journal of the California Perinatal Association. (2023).

Orr CJ, Turner AL, Ritter VS, Gutierrez-Wu JC, Leslie LK. Educational debt and subspecialty fellowship type. Pediatrics 2023;152:e2023062318.

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Backes CH, Bonachea EM, Rivera BK, Reynolds MM, Kovalchin CE, Reber KM, et al. Preparedness of pediatric residents for fellowship: a survey of US neonatal-perinatal fellowship program directors. J Perinatol: Off J Calif Perinat Assoc. 2016;36:11327.

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NYU Grossman School of Medicine Accelerated Three-Year MD 2023. https://med.nyu.edu/education/md-degree/accelerated-three-year-md.

Campoamor D Idaho closes its maternity ward, citing the states political climate2023 Date Accessed: 12/12/23. https://www.today.com/parents/pregnancy/idahosbonner-general-hospital-closes-maternity-ward-rcna75776.

Machut KZ, Kushnir A, Oji-Mmuo CN, Kataria-Hale J, Lingappan K, Kwon S, et al. Effect of Coronavirus Disease-2019 on the workload of neonatologists.J Pediatr.2022;242:14551.e1.

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Should neonatal-perinatal medicine move to two-year fellowships? | Journal of Perinatology - Nature.com

Vigorous exercise may preserve cognition in high-risk patients with hypertension – EurekAlert

image:

Richard Kazibwe, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine

Credit: Wake Forest University School of Medicine

WINSTON-SALEM, N.C. June 6, 2024 People with high blood pressure have a higher risk of cognitive impairment, including dementia, but a new study from researchers at Wake Forest University School of Medicine suggests that engaging in vigorous physical activity more than once a week can lower that risk.

The findings appear online today in Alzheimers & Dementia: The Journal of the Alzheimers Association.

We know that physical exercise offers many benefits, including lowering blood pressure, improving heart health and potentially delaying cognitive decline, said Richard Kazibwe, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine and lead author of the study. However, the amount and the intensity of exercise needed to preserve cognition is unknown.

In 2015, published findings from the landmark Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure management reduced cardiovascular disease and lowered the risk of death.

SPRINT began in the fall of 2009 and included more than 9,300 participants with hypertension ages 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States. Participants were randomly assigned to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment) or less than 140 mm Hg (standard treatment). The National Institutes of Health (NIH) stopped the blood pressure intervention earlier than originally planned to quickly disseminate the significant preliminary results, resulting in a new set of guidelines for controlling blood pressure.

In 2019, results of the ancillary SPRINT MIND trial, led by Wake Forest University School of Medicine, showed that intensive control of blood pressure in older people significantly reduced the risk of developing mild cognitive impairment, a precursor of early dementia.

In a secondary analysis of the SPRINT MIND study, Kazibwe and team examined the effect of self-reported sessions of vigorous physical activity (at least once a week) on the risk of mild cognitive impairment and dementia.

People who engaged in one or more sessions of vigorous physical activity per week had lower rates of mild cognitive impairment and dementia.

Kazibwe said that nearly 60% of study participants reported vigorous physical activity at least once a week, even among those aged 75 and up.

It is welcome news that a higher number of older adults are engaging in physical exercise. This also suggests that older adults who recognize the importance of exercise may be more inclined to exercise at higher intensity, Kazibwe said.

However, the research team found the protective impact of vigorous exercise was more pronounced for those under 75.

While this study provides evidence that vigorous exercise may preserve cognitive function in high-risk patients with hypertension, more research is needed to include device-based physical activity measurements and more diverse participant populations, Kazibwe said.

Alzheimer s & Dementia

People

Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension

6-Jun-2024

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Vigorous exercise may preserve cognition in high-risk patients with hypertension - EurekAlert

Studying the effects of probiotics for idiopathic epilepsy – DVM 360

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Canine idiopathic epilepsy (IE) is one of the most commonly diagnosed and treated chronic neurological conditions, according to Zoe Bailey, DVM, neurology/neurosurgery resident at the University of Wisconsin-Madison.1 The cause of this epilepsy type is unknown, but a higher prevalence has been seen in purebred dogs vs mixed breed dogs, and male dogs are more commonly affected than females.2

To treat IE, starting an antiepileptic drug (AED) is the most common route and usually the first line therapy. However, this is not always the best option for every patient and client. Bailey explained in her lecture at the 2024 American College of Veterinary Internal Medicine Forum in Minneapolis, Minnesota, that adverse effects of this medication can negatively impact the clients perception of their dogs quality of life. Additionally, approximately 30% of dogs will be drug resistant to this specific treatment.1 Bailey noted some other therapies for this condition can include dietary changes, use of cannabidiol products, neurostimulation, and more.

Bailey participated in a study aimed at investigating the microbiota-gut-brain axis and its impact on epilepsy. In humans, probiotics have been found to decrease seizure frequency and severity,3 however, there has yet to be a large-scale study on dogs with IE. Bailey and other researchers used a probiotic (Visbiome Vet) with 42-client owned dogs previously diagnosed with IE and already taking a prescription AED. Dogs in this study were between the ages of 1 and 9 years and had a seizure history of at least 6 months, with a frequency of at least 1 every 3 months. Dogs were enrolled on a rolling basis from January 2022 through May of 2023. So we did a prospective, placebo controlled, masked, crossover clinical trial, both with a 9- or 12-month period, there was a total of 3 or 4 phases, each of which was 3 months in duration, Bailey explained during the ACVIM session.1

The first phase was used as an observational period, also to have some control data as a basis before moving forward in the study. The second phase administered a daily placebo capsule provided by Visbiome Vet to the enrolled dogs. A daily dose of the probiotic from Visbiome Vet was given during phase 3 and adjusted based on the dogs body weight. The study concluded with phase 4 in which dogs were observed again, now evaluating any changes in data with the introduction of a regular dose of probiotics.

By the end of the study, only 21 dogs had completed all 4 phases. The other 21 dogs were excluded at various time points throughout the study due to the development of new diseases, the need for additional non-AED medications, dietary modifications, owner compliance, and death due to other circumstances, said Bailey.

Seizure logs were maintained by owners and every seizure was documented. At the start of the study, 17 of the 21 completed dogs were on 2 or more AEDs and 12 of 21 dogs had their AED prescription adjusted by their veterinarian.

The study results revealed the following:

Bailey concluded that, although there was some improvement discovered, the measurement of seizure frequency was not statistically significant enough to prove the use of probiotics improves the outcomes of dogs with IE. Some of the limitations of this particular study was a small population size and reliance on owners for seizure detection and documentation. So really, the next steps that we're still in progress with are evaluating the microbiome of this population of dogs with refractory idiopathic epilepsy. And then [also] to determine if this biome alters their microbiome, Bailey said.

References

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Studying the effects of probiotics for idiopathic epilepsy - DVM 360

Pride Celebrated at UConn Health – UConn Today – University of Connecticut

UConn Health believes in health care for all and provides equitable and inclusive care to lesbian, gay, bisexual, transgender, and queer/questioning+ members of our community.

Students from Reach Out, a student organization at UConn Health dedicated to LGBTQIA+ awareness, education, and activism in the UConn medical and dental communities, proudly raised the flag. The UConn School of Medicine students were fourth-year medical students Cailyn Regan, Sarah Hartmann, and Ryan Hannon.

Reach Out aims to bring students of any gender or sexual identity together, make an impact through service in the greater Hartford community, and provide education amongst the next generation of clinicians who strive for excellence in well-rounded patient care.

The students were supported by the newly appointed UConn Health CEO Dr. Andy Agwunobi, Chief Diversity Officer Dr. Jeffrey Hines, and their Reach Out faculty advisor Zita Lazzarini, JD, MPH.

Also, in attendance were Internal Medicine Resident Dr. Nicholas Harriel, who will be entering his third year of graduate medical education training (GME) at UConn Health and Ian Shick, assistant director of the Rainbow Center at UConn.

A special thanks to UConn Fire Departments Captain Anthony Ruggiero and Deputy Chief Christopher Renshaw for their special assistance of the UConn Health students with the flag raising, along with UConn Police Officer Nolan Hurst.

This month UConn Healths campus is also being illuminated in rainbow.

Learn more about UConn Health and its LGBTQIA+ Services.

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Pride Celebrated at UConn Health - UConn Today - University of Connecticut

Residents and Faculty Shine at Internal Medicine Annual Meeting – Washington State University

Residents and faculty from the WSU College of Medicine and Internal Medicine Residency Program in Everett were showcased via multiple posters, oral presentations, and workshops at the highly competitive Society of General Internal Medicine annual meeting in Boston. The conference was attended by approximately 2700 clinicians.

The list of presentations and leadership roles by WSU colleagues represents an incredible level of engagement and highlights WSU COMs growing national reputation.

Meeting proceedings will be published in a supplemental issue of the Journal of General Internal Medicine.

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Residents and Faculty Shine at Internal Medicine Annual Meeting - Washington State University

Opinion | Smoking Isn’t the Only Source of Nicotine Addiction in Town – Medpage Today

Benowitz is a professor of medicine, and a nicotine and tobacco researcher.

E-cigarettes were introduced in the early 2000s as a way for smokers to manage their nicotine addiction without exposing themselves to the well-documented harms associated with the toxins and carcinogens in combustible cigarette smoke. These harms include increased risks of cancer, cardiovascular disease, chronic lung disease, and a number of other debilitating or life-threatening diseases. While many people have used e-cigarettes to quit smoking, other non-smokers have taken up e-cigarette use, particularly young adults.

However, the use of e-cigarettes, commonly known as vaping, is not without harm. Based on a review of the published data available at the time, an expert committee of the National Academies of Sciences, Engineering, and Medicine issued a report in 2018 finding conclusive evidence that although substituting e-cigarettes for combustible cigarettes reduced exposure to numerous toxins and carcinogens, e-cigarette use is not risk-free.

What are some of the harms? People who vape continue to be exposed to nicotine, which is highly addictive, making quitting e-cigarettes difficult for some. In addition, vapers may be subject to social stigma, and they incur expenses for purchasing vaping devices and liquids. Many people who have taken up vaping, either to help themselves quit smoking or as a primary form of recreational drug use, would like to quit. Furthermore, some healthcare professionals are supportive of the use of e-cigarettes to quit smoking but would like their patients to stop use when they are confident they will not relapse to smoking, due to the possible risks of nicotine use.

A study recently published in JAMA Internal Medicine is the first randomized, placebo-controlled trial to report a successful e-cigarette cessation benefit with pharmacological treatment. As a member of the Data and Safety Monitoring Committee for this study and an author on the publication, I believe the findings are an important step in addressing a relatively new source of nicotine addiction. This publication provides an opportunity for clinicians and the public health community to revisit how we think and talk about the harms associated with smoking, vaping, and nicotine addiction, and to reconsider how we can best take action to help reduce these harms.

Help or Harm: How Do We Discuss Vaping With Patients?

The fact that vaping can be associated with a high degree of dependence and a possible risk to health creates a challenge in counseling patients about their use of e-cigarettes. Given the extreme dangers associated with cigarette smoking, I believe that vaping can be a useful tool for harm reduction. I also believe that overcoming nicotine addiction -- in any form -- provides health, social, and economic benefits to those who can quit.

Healthcare professionals are solutions-oriented, and we strive to help patients set and achieve goals that can improve their physical and mental health and their quality of life. The lack of effective vaping cessation medications is an important missing piece of the puzzle when discussing the relative risks and benefits of smoking, vaping, and overcoming nicotine dependence. Survey data show that more than half of adults vaping nicotine plan to quit using e-cigarettes, and approximately 15% had already tried to quit in the prior year. Some succeeded, but additional tools are likely needed to help others. Is it realistic to counsel patients to quit vaping without addressing the very real biochemical basis of their nicotine addiction?

Hope for an Effective Vaping Cessation Therapy

Our data in JAMA Internal Medicine suggest we may be moving closer to finding an important intervention for e-cigarette-related nicotine dependence. The Phase II randomized clinical trial ORCA-V1 found that e-cigarette cessation rates were significantly higher for participants receiving 12 weeks of cytisinicline plus behavioral support compared with those receiving behavioral support alone. Cytisinicline is a partial agonist at 42 nicotinic acetylcholine receptors that mediate nicotine dependence and has shown efficacy for cigarette smoking cessation.

In the study, 160 participants were randomized 2:1 to 3 mg cytisinicline taken three times daily or placebo for 12 weeks. All participants received weekly behavioral support. The primary endpoint was biochemically verified continuous abstinence from nicotine e-cigarette use, measured during the last 4 weeks of treatment. Participants receiving 12 weeks of cytisinicline treatment had 2.6 times higher odds of having quit vaping during the last 4 weeks of treatment compared with subjects who received placebo, with vaping cessation rates during weeks 9-12 of 31.8% and 15.1%, respectively. No treatment-related serious adverse events were reported, and rates of adverse events were similar between the cytisinicline (50.9%) and placebo (54.7%) arms.

Acting Today While Awaiting Tomorrow's Advances

Although additional studies are needed to confirm the efficacy and safety of cytisinicline as a vaping cessation therapy, the ORCA-V1 results show that pharmacological tools may help to address the complex role that vaping plays in the continuum of reducing harms from cigarette smoking while sustaining nicotine addiction. These findings are particularly encouraging given the increasing prevalence of e-cigarette use among adults -- especially young adults -- in the U.S. Moreover, as a plant-based alkaloid, cytisinicline may appeal to those who prefer natural products as well as those who have tried and failed to quit smoking or vaping using other pharmacologic agents.

As we await additional data supporting the use of cytisinicline as a vaping cessation therapy, those of us who counsel patients who smoke cigarettes or vape nicotine should not shy away from having candid discussions about smoking, vaping, and overcoming nicotine addiction. We should be able to explain the risks and benefits of vaping and our patients' ability to make decisions that meet their personal health and lifestyle goals. With additional research, I hope those discussions will one day soon include the availability of safe and effective vaping cessation therapy.

Neal L. Benowitz, MD, is professor emeritus in the Department of Medicine at the University of California San Francisco.

Disclosures

Benowitz reported personal fees from Achieve Life Sciences while the JAMA Internal Medicine study was being conducted, as well as personal fees as a tobacco litigation expert witness in litigation against tobacco companies.

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Opinion | Smoking Isn't the Only Source of Nicotine Addiction in Town - Medpage Today

Benefis gets approval for Internal Medicine residency program – KRTV NEWS Great Falls

Benefis Health System recently earned approval for its new Internal Medicine Residency Program from the Accreditation Council for Graduate Medical Education, bringing more health care professionals to the central Montana area.

Physicians coming out of medical school become residents to further learn their specialty. It works like an apprenticeship with gradually escalating responsibilities and autonomy. Internal medicine providers for adult patients over time, treating chronic illness and monitoring wellness. Residents in the program will learn to take care of hospitalized patients and learn preventative medicine.

Internal Medicine Residency Program Director Michael Sheffield says, Statistics say that when you finish your training, wherever you are, 60 to 70% of those residents will remain in the area. So if we train them here, we have a good chance of keeping about two thirds of them in the area to provide care for the future patient, future generations in this area.

After the three year program, most residents will become internal medicine providers and later move on to a speciality like cardiology or critical care. Program leaders hope to gear residents towards relevant specialities like geriatrics and addiction medicine. With the new residency, patients will be interacting with students and residents which may take more time, but all care and decisions will be supervised by medical professionals.

Sheffield describes, as patients become accustomed to it, the nursing staff, respiratory therapy, all of the staff will begin to work with residents more directly and change the way they work, and so forth in the way patients receive their care.

Sheffield explains he is most excited for the residents energy, curiosity are things that are refreshing every day. And so looking forward to having them here to have those discussions, to remember back when and what it was like when I started and what it's like now, to make sure they get the same sort of joy and excitement that we all had when we were training.

The first graduates from Touro College of Osteopathic Medicine in Great Falls, as well as will be eligible to apply for the Internal Medicine Residency in Fall 2025, in the programs second year.

Benefis will be accepting applications this fall, with the first ten Internal Medicine Residents starting in July 2025.

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Benefis gets approval for Internal Medicine residency program - KRTV NEWS Great Falls

A Mother’s Encouragement and a Husband-Wife Doctor Team Set the Stage for a Career in Hematologic Oncology – The ASCO Post

Lymphoma expert Jane N. Winter, MD, grew up on the south shore of Long Island in New York. My dad sold cars in my great uncles dealership after a failed foray into business after World War II. My mom graduated high school at 16 to go to work to help support her family. When my younger brother went off to kindergarten, she went back to school to take college prerequisites, then to a community college, then to college, and ultimately to graduate school, where she completed a masters degree in learning disabilities. I think my mom was the driving force in my decision to become a physician; when I told her I wanted to be a nurse, having read the Cherry Ames book series, she said, No, youll be a doctor, which was pretty forward-thinking for a woman in the 1950s, she related. I have two brothers who have been amazing in terms of their successes, both executives at Fortune 500 companies, and have always been very supportive.

TITLE

Professor of Medicine, Division of Hematology/Oncology; a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University; and a hematologist at Northwestern Medicine

MEDICAL DEGREE

University of Pennsylvania School of Medicine, Philadelphia

ADVICE FOR YOUNG WOMEN CONSIDERING A CAREER IN ONCOLOGY

We have certainly made progress in closing the gender gap, but its definitely challenging for young women who want to balance a career and a family. Its never going to be easy, because there is never enough time for everything we want to do. However, being persistent and confident in yourself is key. In short, join societies such as ASH and ASCO, and when you have an opportunity, seize it.

Dr. Winter continued: I also had a very unusual set of pediatricians, a husband-wife team, who influenced my perception of medicine. Their office was on the first floor of their home, and their children would play in the yard while one of them saw patients, and the other made house calls. If I was sick, my mom would say, Dr. Bea is in the office, and Dr. Philip is making house calls. Who do you want to see? I didnt think twice that Dr. Beatrice was a physician.

On the Cusp of the Womens Movement

It was totally serendipitous that I wound up at a womens college, the same college Dr. Bea had attended. I was recruited to Bryn Mawr by friends of my parents who really wanted me to date their son, who was applying to nearby Haverford. As it happened, I was invited to a Bryn Mawr Alumnae Association reception where I met the most amazing group of professional women. That just sealed the deal for me as to which college I wanted to attend. Bryn Mawr was a very intellectually challenging place, which, in many ways, laid the foundation for my career path and my world view, she said. I majored in philosophy and spent a year at the London School of Economics studying Philosophy of Science, a field I keep hoping to revisit.

Valued Early Mentors

During her undergraduate years at Bryn Mawr, Dr. Winter spent free time in Philadelphia, which influenced her next step. I loved Philadelphia, so the University of Pennsylvania School of Medicine seemed like a natural transition. It was career-shaping in many ways. For example, I encountered Dr. John Glick, who later became Penns Cancer Center Director but also my housemates beloved hematologist-oncologist. I also spent an invaluable month rotating at Fox Chase, where I had amazing experiences caring for patients with all types of malignancies but particularly patients with leukemia and lymphoma, she explained.

Asked what sealed the deal for her decision to pursue blood malignancies, Dr. Winter replied: Its fairly common for important experiences during medical school to impact a students career choice. I had some very engaging rotations as a medical student, particularly with hematologists who impressed me. I also had a close childhood friend who developed Hodgkin lymphoma and underwent treatment with Dr. Glick while living with me during my second year of medical school. In retrospect, that experience in addition to the role models I encountered during medical school and residency likely determined my direction.

Dr. Winter added: I loved looking under the microscope at blood smears, bone marrow, and lymph node biopsies, and I especially enjoyed integrating the pathology with the clinical picture. Some of my best mentors were hematopathologists.

Brief Indecision

After attaining her medical degree in 1977 from the University of Pennsylvania School of Medicine, Dr. Winter decided on another big city experience for her internship and internal medicine residency at the University of Chicago, where her interest in the hematologic malignancies was further encouraged by rotations with Dr. John Ultmann and Dr. Harvey Golomb, both of whom played major roles at ASCO. But I also liked bedside cardiology and found myself being strong-armed by the Chief of Cardiology to stay on as a cardiology fellow. Did I really want to be an interventionalist, passing catheters all day and wearing a lead apron?

Dr. Winter continued: Luckily, I had a good friendthe other Jane from collegewho was an internal medicine resident at Columbia, where Dr. Rose Ruth Ellison was the new head of oncology and the attending on Janes General Medicine rotation. Jane told Dr. Ellison that she had a friend who might be interested in hematology/oncology and Rose Ruth said, Bring her tomorrow. So, I showed up and signed on. Truth be told, my goal in life at that time was a subscription to the New York City Ballet, a passion Jane and I share. So, thats how I wound up at Columbia, she related.

As it turned out, Dr. Winters fellowship at Columbia was cut short by unforeseen circumstances. Within the first weeks of my fellowship, the head of the cancer center, Dr. Paul Marks, left to become President of Memorial Sloan Kettering Cancer Center and took with him the Division Chief of Hematology, Dr. -Richard Rifkind. Soon thereafter, one of Columbias best -hematologists, Dr. Hymie Nossel, had a massive heart attack. The place seemed to be decimated.

At the same time, Dr. Winter had become increasingly committed to her soon-to-be husband, Dr. Richard Larson, a then budding leukemia expert. He had been a resident with me and had stayed at the University of Chicago for fellowship, Dr. Winter explained. Fortunately, a second-year position in the fellowship program at Northwestern became available unexpectedly and I had the opportunity to work in Dr. Alan Epsteins lab making monoclonal antibodiesthen very new and excitingto the diffuse large B-cell lymphoma cell lines that Alan had developed while a graduate student at Stanford.

An Opportunity to Grow

Dr. Winter took the faculty position at Northwestern University. Asked whether there were other reasons for her decision besides a serendipitous job opening, she commented: Actually, there was an opportunity at the University of Chicago, but I needed my own space, separate from my husband, which Northwestern offered. Moreover, I was attracted to Alans work in large cell lymphoma and the opportunity to focus on lymphoma clinically.

Dr. Winter shared how this opportunity started small but grew. When I came to Northwestern, the clinical trials office was the size of a closet. It was very much a private practice kind of place, with a very small, full-time, academic faculty. However, soon after arriving as a second-year fellow, I saw that I could be part of a team that was building something for the future. When offered the opportunity to stay on as a faculty member, I seized the opportunity and have been here ever since. Over the years, we have turned the institution into a real powerhouse, which has been immensely rewarding. I work with absolutely terrific scientists and clinicians, with a top-notch support system from the top down.

In addition to her many accomplishments, Dr. -Winter also served as President of the American Society of Hematology (ASH) for a year-long term (20212022). She has been a member of ASH for -nearly 40 years, and during that time, she has served in various leadership roles representing the Society.

A Busy Schedule

Asked to briefly describe the focus of her current work, Dr. Winter replied: My path has been anything but linear. My work making monoclonal antibodies to diffuse large B-cell lymphoma cell lines led me to bone marrow purging with my own antibodies to remove malignant lymphoma cells from bone marrow harvests for patients undergoing stem cell transplants. Early on, I had collaborations with faculty on Northwesterns Evanston campus expanding hematopoietic progenitors ex vivo for use in bone marrow transplant patients. And, similarly with another project here on the Chicago campus in megakaryocytopoiesis. We had funding from the Department of Defense to support these projects. I had a period where I was very involved in transplantation and even ran our fledgling bone marrow transplant program, but eventually focused on clinical and translational investigation in lymphoma.

Dr. Winter had a long career looking at prognostic markers in diffuse large B-cell lymphoma. That grew out of my initial laboratory experience in Alans lab. My goal from the start was to sort out the clinical and biologic heterogeneity of the diffuse large B-cell lymphomas. And 40 years later, it remains an elusive goal. Over time, that work became more molecularly based at a level I was not prepared to lead. So, Ive been fortunate to collaborate with folks who are much better equipped to address those kinds of questions at a genetic level. My clinical investigation has focused in recent years on Hodgkin lymphoma, more specifically on the use of checkpoint inhibition in both previously untreated and relapsed patients. We just launched a new clinical trial in patients with newly diagnosed Hodgkin lymphoma, building on our prior trials, further shifting from chemotherapy to immunotherapy. This trial will also compare circulating tumor DNA and imaging with FDG-PET. Like all my recent projects, Ive partnered with one of my fellows, Megan Melody. Its my greatest pleasure to see my mentees develop and succeed.

Challenges Ahead

Given that Dr. Winters career began contemporaneously with the womens rights movement, she reflected on the difference between now and then for a young woman entering the field. We have certainly made progress in closing the gender gap, she noted, but its definitely challenging for young women who want to balance a career and a family. Its never going to be easy, because there is never enough time in the day for everything we want to do. However, being persistent and confident in yourself is key. In short, join societies such as ASH and ASCO, and when you have an opportunity, seize it.

Dr. Winter shared some thoughts on mentorship relationships: I didnt have an easy time of it early on; mentorship wasnt what it is today. Today, young trainees are very aggressive about seeking out mentorship relationships. When I was coming up, I had a career development award where my mentor met with me only to put his signature on the grant but never sat down or communicated with me. Members of the current generation know what they need to get from a mentorship relationship. Choose wisely, I always say, in your collaborators, mentors, and spouses; be careful about how you invest your precious time and energy and who you look to for help

Decompression Time

What does a super-busy oncology leader do to decompress? I have a 19th-century house, so theres always a project underway, and I live in an amazing city, where theres so much to discover and experience. I have two wonderful sons and daughters-in-law and two beautiful grandchildren to spoil. I still go to the ballet, and Im actually making it a bigger priority recently. My husband and I walk and ride the lakefront, which is a great way to keep centered and relax. And I love my work. Ive had a long and rewarding career and still fully enjoy my patients, my colleagues, and my trainees, commented Dr. Winter.

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A Mother's Encouragement and a Husband-Wife Doctor Team Set the Stage for a Career in Hematologic Oncology - The ASCO Post

Local doctor to share new lifestyle health techniques with Longboaters – Your Observer

Dr. Coeurlida Ashby loved working as a doctor at her internal medicine practice until she realized how little time it gives for patients to heal.

There were a lot of patients that needed time and the system isn't really set up for giving them that kind of time, said Ashby. I realized very early on in my career that I was practicing medicine in a way that I knew wasn't sustainable for me as a healer.

Dr. Coeurlida Ashby

This led to an existential crisis. Ashby didnt know if traditional medicine was the best outlet for her healing art. So, she went to the only thing that made her feel better: health and fitness.

Ashby poured most of her free time into bodybuilding and learning about nutrition. She started teaching her health techniques to clients after hours and saw a significant difference in her mood. She also noticed that implementing a healthy lifestyle reversed chronic diseases for most of her clients.

In 2017, Ashby discovered the lifestyle medicine concept and immediately knew it was her calling.

The Paradise Center will host Ashby for an exclusive presentation on lifestyle medicine from 1:30 to 3:30 p.m. on June 3.

Lifestyle medicine focuses on implementing lifestyle changes that promote healthy fitness and nutrition to prevent chronic diseases. Ashby said that lifestyle medicine is based on six pillars from ancient Chinese tradition. The pillars include sleep, nutrition, fitness, social connections, mental health and toxins you put in your body.

Ashbys presentation will serve as an introduction to lifestyle medicine for Longboaters. It will provide an interactive discussion for participants to understand and see the benefits of incorporating these lifestyle changes.

She will cover how it improves overall health, boosts energy and vitality, manages stress and prevents and reverses chronic diseases. She will mainly focus on heart disease and metabolic health.

Ashby earned her medical degree in internal medicine from Yale University School of Medicine. She completed her residency training at Yale New Haven Hospital where she served as chief resident of the Yale Internal Medicine Primary Care Program.

Ashby got a lifestyle medicine certificate in 2020 and has become a leader in the field through her recognition in the American Board of Lifestyle Medicine. She now runs her own practice, Conscious Health, in Sarasota.

Ashby hopes the presentation will interest Longboaters to start thinking about their everyday habits and how their lifestyle affects their health. She is open to giving consultations at The Paradise Centers Medical Suite if people are interested.

I think lifestyle medicine is a missing resource right now on Longboat, said Ashby. It is incredible the potential impact it could have on reducing suffering and disease burden. I love the atmosphere of having a space for movement at The Paradise Center, having a physical therapist in the same building and having potential other providers. It is just the type of setting that lifestyle lends itself to. They're definitely on the right track and this would be adding right in the mix.

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Local doctor to share new lifestyle health techniques with Longboaters - Your Observer