2018 Featured Stories

Michael Flis, an Occupational Therapist and Certified Driver Rehabilitation Specialist at the MetroHealth Rehabilitation Institute and the Department of Physical Medicine and Rehabilitation, was awarded a $100,000 grant from the Craig H. Nielson Foundation to acquire and equip a high-tech driving evaluation and training van. 

As one of only 14 federally designated Spinal Cord Injury Model System Centers in the country, the MetroHealth Rehabilitation Institute has been a leader in providing rehabilitation care for patients with tetraplegia (previously known as quadriplegia). Currently, there is a significant need in Ohio for an evaluation and training van to enable individuals with tetraplegia to drive independently. 

Independent driving is associated with significant quality of life improvements of people with disabilities including improving self-esteem and increasing options for employment, education and independent living. This vehicle will allow the MetroHealth Rehabilitation Institute to enable many more people with tetraplegia to travel independently in their community.  

Jeffrey R. Schelling, MD, Director of the Division of Nephrology, was invited by the Director of the National Institutes of Health (NIH) to serve a two-year term on the Kidney, Urologic and Hematologic Diseases Subcommittee within the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The Committee serves in an advisory capacity to the Director of the NIH and Director of NIDDK and provides a primary review of grant applications and contract proposals for special research programs.

The NIDDK’s research programs include program projects, training grants, conference grants and special manpower developmental award programs relating to the research interest of the NIDDK. "The invitation is a reflection of Dr. Schelling’s scientific contributions and prominence at the national level in the field of renal diseases," said John Chae, MD, Vice President, Research and Sponsored Programs, MetroHealth.

Dr. Schelling is Professor of Medicine at Case Western Reserve University School of Medicine.

Kenneth Laurita, PhD, bioscientific staff in the Heart and Vascular Center and Lance Wilson, MD, attending physician in the Department of Emergency Medicine, were awarded a 1-year, $600,000 NIH grant to improve cardiac outcomes during resuscitation from sudden cardiac arrest.

Sudden cardiac arrest, due to an abnormal heart rhythm, is a major public health problem. Every year, over 300,000 people die from sudden cardiac arrest, which is particularly tragic because it is often the first manifestation of potentially treatable underlying heart disease. Despite significant efforts to improve resuscitation, patient survival remains poor. NIH has recently identified resuscitation as a high priority for emergency care research. 

In this project, Drs. Laurita and Wilson propose to investigate the causes of cardiac arrest and re-arrest during resuscitation and to develop better treatments for improved outcomes. 

Drs. Laurita and Wilson serve as Co- and Principal Investigators on this grant. Dr. Laurita is an Associate Professor of Medicine (Cardiology) and Biomedical Engineering and Dr. Wilson is an Associate Professor of Emergency Medicine, Case Western Reserve University. Co-Investigators include Joseph Piktel, MD, Associate Professor of Emergency Medicine and Ohad Ziv, MD, Assistant Professor of Medicine (Cardiology).

David Kaelber MD, PhD, MPH, Chief Medical Informatics Officer, has been appointed to the American Academy of Pediatrics’ Child Health Informatics Center Project Advisory Committee.

The AAP launched the Child Health Informatics Center to support and prepare pediatricians for the many changes that will be occurring over the next few years in health information technology. The center is governed by a seven-person Project Advisory Committee comprised of general pediatricians who are experts in medical informatics, epidemiology, research, and quality improvement in both rural and urban settings.

“I am very excited about the opportunity to serve on CHICPAC.  This appointment allows me to leverage some of the insights and experiences using health information technology within The MetroHealth System over the last decade to try to help children, adolescents and health care providers throughout the country.”

Dr. Kaelber will serve on the committee for four years.

Richard Wilson, MD, Director of the Division of Neurorehabilitation and Director of Stroke Rehabilitation, was awarded a 5-yr $3.3 million NIH grant to study the effectiveness of peripheral nerve stimulation (PNS) for the treatment of subacromial impingement syndrome (SIS), one of the most common causes of shoulder pain in the general population. 

This multisite, placebo-controlled trial will test the hypothesis that PNS of the axillary nerve with physical therapy (PT) is more effective than PT alone in the treatment of shoulder pain. The secondary objectives are to explore mechanisms of PNS for the treatment of SIS and to determine which characteristics can predict successful treatment outcomes. 

Outcome measures include pain, pain interference with activities of daily living, capacity for activities of daily living, quality of life, shoulder biomechanics and measures of central sensitization. Participants will be followed for 24 weeks after treatment has concluded. 

Trial sites include the MetroHealth Rehabilitation Institute, led by Richard Wilson, MD, and the Vanderbilt Health System, led by Nitin Jain, MD. Dr. Wilson is Associate Professor of PM&R at the Case Western Reserve University School of Medicine and Principal Investigator in the Cleveland Functional Electrical Stimulation (FES) Center. 

Shari Bolen, MD, MPH, a faculty member in the Center for Health Care Research and Policy and Associate Professor of Medicine at Case Western Reserve University, will serve on the National Clinical Care Commission for the Department of Health and Human Services (DHHS). Dr. Bolen will represent primary care clinicians on the committee, and will serve as one of 12 selected non-federal committee members.

The Secretary of the DHHS is required to establish this committee to evaluate and make recommendations regarding improving the coordination and leveraging of programs within DHHS and other federal agencies related to clinical care of adults on insulin. The Commission’s work will contribute to the development of federal programs to improve diabetes care within our patient populations. The Secretary and congress must have an operational plan made on the committee recommendations within 90 days of the first meeting.

Other federal committee members include the heads of Center for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, National Institutes of Health, Department of Veteran Affairs, Health Resources and Services Administration, Department of Defense, Department of Agriculture, and the Office of Minority Health. 

Jayme Knutson, PhD, Director of Research for the Department of Physical Medicine and Rehabilitation (PM&R) was awarded a $3.2 million grant from the NIH to evaluate the effectiveness of Contralaterally Controlled Functional Electrical Stimulation (CCFES) for hand recovery following stroke. The MetroHealth System is the lead site on this first multicenter clinical trial of CCFES, a technique developed by researchers at MetroHealth. 

CCFES applies electrical stimulation to weak finger and thumb extensor muscles through surface electrodes, and causes the weak hand to open, a function that is often lost in stroke survivors. The patient controls the intensity of stimulation to their weak hand by wearing a glove with sensors on their unaffected hand. When the patient opens their unaffected hand, a proportionate intensity of stimulation opens their weak hand. CCFES puts the patient back in control of their weak hand, and this may drive changes in the central nervous system that lead to better recovery of hand function. 

Other sites in the study include the Cleveland Clinic (Ela Plow, PT, PhD), the Kessler Institute for Rehabilitation (Anna Barrett, MD) and the Rusk Rehabilitation Institute of New York University (Preeti Raghavan, MD). Co-Investigators at The MetroHealth System include John Chae, MD and Doug Gunzler, PhD. 

Dr. Knutson is Associate Professor of PM&R at the Case Western Reserve University School of Medicine and Principal Investigator and Research Biomedical Engineer in the Cleveland FES Center of the Louis Stokes Cleveland VA Medical Center. 

Heather Olsen, a CWRU student and researcher in the Center’s “Patient Centered Media Lab”  presented findings of a recently completed study of plasma donation. The study was conducted with Dr. Perzynski, Associate Professor of Medicine, sociologist, and faculty member in the Center for Health Care Research and Policy and Dr. David Margolius, General Internist and Center faculty member. 

Mary Vargo, MD, Director of Cancer Rehabilitation and Electrodiagnostic Medicine in the Department of Physical Medicine and Rehabilitation (PM&R), has been promoted to Professor of PM&R at Case Western Reserve University (CWRU). She is the first woman faculty in the department of PM&R to achieve this academic rank, the highest possible at the university.

Dr. Vargo received her bachelor's degree from the University of Pennsylvania and her medical degree from the University of Rochester. She completed her residency in PM&R at the University of Pittsburgh. Dr. Vargo initially joined the PM&R faculty in 1989. After three years at the National Institutes of Health (NIH) Clinical Center, she rejoined the PM&R faculty in 1994. 

Dr. Vargo is nationally recognized for her expertise in cancer rehabilitation. She has served as the Director of the region’s only PM&R based cancer rehabilitation and lymphedema clinic since 2001. In 2007, Dr. Vargo and a team of therapists initiated the breast protocol, where all postsurgical breast cancer patients are referred for rehabilitation services. She also advocated for specialized lymphedema certification for several of our therapists, which has greatly enhanced the quality of clinical services at The MetroHealth System. With improvements in early surveillance and interventions, cancer survival has increased dramatically. This has led to the greater appreciation for the necessity to improve the overall function and quality of life of our cancer survivors, especially with respect to the physical and cognitive sequela of chemo and radiation therapy, surgical interventions, and immobility. 

Dr. Vargo serves on the Cancer Committee, Breast Program Leadership Committee, and Cancer Survivorship Committee at MetroHealth. She also is board certified in Brain Injury Medicine, an expertise she applies to the care of individuals with brain tumor and other neurologic sequelae of cancer, as well as, separate from her cancer rehabilitation focus, to a busy concussion care clinical practice and educational activities within MetroHealth’s brain injury program.

Dr. Vargo’s participation on the Institute of Medicine committee on cancer survivorship led to the publication of “Lost in Transition: From Cancer Patient to Cancer Survivors (2006).” This highly influential work emphasized the importance of physical activity and the need for additional research in cancer rehabilitation. She was the only physiatrist and rehabilitation clinician among invited panelists at the Breast Health Global Initiative in Vienna, Austria, in 2012. The goal of this population health effort was to establish supportive care guidelines for breast cancer patients worldwide. Recommendations were published in 2013. In 2016, Dr. Vargo was an invited participant on a NIH-National Cancer Institute panel on employment issues in cancer survivors.

Dr. Adam Perzynski was recently named a Fellow of the “Gerontological Society of America (GSA).”  Fellowship in GSA is an acknowledgment of outstanding and continuing work in the field of gerontology. Dr. Perzynski, Associate Professor of Medicine, sociologist, and faculty member in the Center for Health Care Research and Policy has been an active member of GSA since his first presentation at the annual meeting in 2002. Since being a graduate student at the University of Toledo under Dr. Cary Kart in 1997, he has been commitment to research and teaching that improves the lives of older adults.

Molly McNett, PhD, RN, has received fellowship designation (FNCS) from The Neurocritical Care Society. The honor recognizes exceptional service, academic excellence, leadership, and multidisciplinary practice in the field of neurocritical care. She is the first nurse at MetroHealth to hold this designation, and one of only a few in the country.

Fellowship designation is awarded based on significant contributions in program development, research, and leadership to advance the field of neurocritical care. In her role as Director of Nursing Research and Evidence Based Practice at MetroHealth, Dr. McNett oversees nurse-led research and integration of best evidence into practice, and continues to advance program development and research in neurocritical care. 

Dr. McNett was recognized for creating an innovative academic-clinical partnership with the Frances Payne Bolton School of Nursing at Case Western Reserve University involving the training of advanced practice providers (APPs) in neurocritical care.  The program was the first of its kind in the nation and addressed an unmet clinical need for educational preparation of APPs interested in neurocritical care specialty training. 

Dr. McNett also was recognized for her leadership as chair of the Guideline Development Committee for The Neurocritical Care Society.  She previously served as a member of the guidelines committee, and has authored over 70 publications in peer-reviewed journals. In her current role as chairperson, she directs and oversees international, multidisciplinary teams in development of clinical practice guidelines for the society. 

Monica Gerrek, PhD, was recently named Vice Chair of the American Burn Association's (ABA) Ethical Issues Committee. She is thought to be the first professional ethicist to serve in this capacity.

The ABA's Ethical Issues Committee Chair plans and moderates the ethics education sessions at the annual meeting. “What I hope to do over the next few years is to foster collaboration between ethicists and burn providers to increase the research being done in burn ethics, thereby improving care for patients,” says Dr. Gerrek, Co-director, Center of Biomedical Ethics and the Institute of Burn Ethics, and Assistant Professor, Department of Bioethics, Case Western Reserve University (CWRU).

In 2016, MetroHealth's Comprehensive Burn Care Center and its Center for Biomedical Ethics -- a collaboration between the CWRU School of Medicine’s Department of Bioethics and MetroHealth -- created the Institute of Burn Ethics. The goal is to be the leader in the ethics of burn care for patients by promoting research and education.

Ethicists and burn care providers at MetroHealth collaborate often, which is not always the case on a larger scale, Dr. Gerrek explains. “With the encouragement and support of Dr. Anjay Khandelwal, I joined the ABA and asked to be on the Ethical Issues Committee so that I could begin to bridge the gap between ethicists and burn providers outside of MetroHealth to improve burn care,” she explains.

Since joining the ABA, Dr. Gerrek has done several ethics presentations at the organization’s annual meeting, and is planning two sessions for next year's event. In addition, she has been in communication with several providers and researchers who are interested in furthering their work in ethics.

Dr. Gerrek’s term as Vice Chair for the ABA’s Ethical Issues Committee is for three years. After that, she will chair the committee.

Greg Nemunaitis, MD, Director of Spinal Cord Injury (SCI) Rehabilitation in the Department of Physical Medicine and Rehabilitation (PM&R), was awarded a $181,000 Craig H. Neilsen Foundation Grant to support two MetroHealth/Case Western Reserve University SCI Medicine Fellows for the 2018-2019 Academic Year. The grant award will be used to produce well-trained physicians with advanced knowledge and competencies capable of addressing the prevention, diagnosis, treatment and management of persons with spinal cord dysfunction in acute, chronic and lifelong phases. The Northeast Ohio Regional Spinal Cord Injury System (NORSCIS) at The MetroHealth System, one of only 14 federally designated SCI Model Systems in the nation, serves as the primary training site. Other training sites include The Cleveland Clinic Foundation and The Louis Stokes VAMC. Dr. Nemunaitis has received nearly $600,000 from the Craig H. Neilsen Foundation since 2011 in support of the SCI Fellowship. Dr. Nemunaitis is Professor of PM&R at Case Western Reserve University and Director of NORSCIS at The MetroHealth System. 

Tara Nagaraj, PharmD, is a recipient of the Toby Clark Resident Research Award, a recognition from Ohio Northern University’s (ONU) Raabe College of Pharmacy, in partnership with the Ohio Pharmacy Resident Conference. 

An annual recognition, the Toby Clark Award is presented to two recipients -- one in ambulatory care and the other in an institutional setting -- for demonstrating excellence in pharmacy practice research. More than 150 abstracts were considered for this award from pharmacy residency programs in Ohio, Michigan and neighboring states.  

Tara’s research project evaluated the cost effectiveness of pharmacist-led diabetes management in a primary care clinic. MetroHealth Pharmacists Cynthia King and Ben King provided guidance to Tara on the development of the project. 

The award is named in honor of Toby Clark, a 1967 graduate of ONU's pharmacy school. He was dedicated to pharmacy leadership, and the education of students and residents.

Peter C. Koch joined MetroHealth June 1 as the new Director of Research Administration. He has over 25 years of experience in the management of research grants and sponsored programs. Peter comes to us from the University of Cincinnati, College of Medicine, where he served as Associate Dean of Research Operations. Prior to this, he served as the Assistant Vice President for Sponsored Programs in the Office of Research Administration and Finance at the Cincinnati Children’s Hospital. Peter is an active member of the National Council of University Research Administrators, where he served as faculty for its Fundamentals of Sponsored Project Administration workshops. He presently serves in their Peer Reviewer Program providing comprehensive sponsored program operations review for research institutions across the country. Peter will establish the foundation for rebuilding the research enterprise at The MetroHealth System. He received his undergraduate degree in business administration from Xavier University and his MBA from Northern Kentucky University. 

An article co-authored by Eileen Seeholzer, MD, has been selected for the inaugural edition of “The Best of Health Promotion Practice.” The article focuses on a study conducted by Dr. Seeholzer and other medical professionals on how primary care residency programs are preparing physicians to counsel patients about obesity, nutrition and physical activity (ONPA). The study identified widespread expectations that primary care physicians should counsel their overweight and obese patients, but few residency programs provide the training to support such counseling. MetroHealth’s OB/GYN, Family Medicine and Internal Medicine residency program participated in the study. Read article.

Thomas E. Love, PhD, Director Biostatistics and Evaluation at the Center for Health Care Research and Policy, as well as Professor of Medicine, and Population & Quantitative Health Sciences at Case Western Reserve University, and Chief Data Scientist for Better Health Partnership, is a 2018 recipient of The John S. Diekhoff Award for teaching. This prestigious award is presented to full-time faculty making exemplary contributions to the education and development of graduate students at CWRU. Congratulations Dr. Love! 

Read more at the Case Daily article.

Thomas E. Love, PhD, Director Biostatistics and Evaluation at the Center for Health Care Research and Policy, as well as Professor of Medicine, and Population & Quantitative Health Sciences at Case Western Reserve University, and Chief Data Scientist for Better Health Partnership, is a 2018 recipient of The John S. Diekhoff Award for teaching. This prestigious award is presented to full-time faculty making exemplary contributions to the education and development of graduate students at CWRU. Congratulations Dr. Love! 

Read more at the Case Daily article.

A MetroHealth team won Best in Category for its poster presentation, “Variations and Indications for Inpatient Admission Following Evaluation in an Outpatient Burn Clinic,” at the American Burn Association’s 50th Annual Meeting.

The team looked at reasons for inpatient admissions following outpatient management of burn injuries. Their research was based on data from the Comprehensive Burn Care Center. 

While most burn centers admit about 30-40% of the new patients they see, Dr. Khandelwal says MetroHealth admits about 12-15%. “We found that we have a 99.5% success rate for the outpatient management of burns, and that even patients with lower extremity burns, moderate-sized burns and pediatrics can successfully be managed as outpatients,” he says.

The winning team was comprised of (pictured left to right):

• Tammy Coffee, APRN (supervising provider for project)
• Anjay Khandelwal, MD (Director of the Burn Center and supervising provider for project)
• Brian Young, MD (Resident, presenter)
• Husayn Ladhani, MD (Resident)
• Justin Smith (student, not pictured)

A study published on-line in the April 16, 2018 issue of JAMA Internal Medicine reports the effect of repeating an initially elevated blood pressure (BP) on final blood pressure control.  Funded by grants from the Centers for Disease Control and the Mount Sinai Foundation,  faculty member Douglas Einstadter was lead author on the investigation alongside other faculty and Senior Scholars of the Case Western Reserve University-MetroHealth System Center for Health Care Research and Policy, including Shari Bolen, James Misak, David Bar-Shain, and Randall Cebul. The study examined more than 38,000 patients with hypertension who made over 86,000 visits to the primary care clinics at MetroHealth during 2016. Across all visits, re-measuring an initially elevated BP was associated with a median 8 mm Hg drop in the systolic BP.  Among those with a repeat BP, the final BP readings were <140/90 mm Hg 36% of the time.  Overall, repeating an initially elevated BP increased the overall rate of good BP control from 61% to 73%.  While much of the change in systolic blood pressure may be attributed to regression to the mean, the observed decrease remains clinically important, comparable with that associated with addition of an antihypertensive medication. The full article is available here https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2678452 .

Ashwini Sehgal, MD, and Douglas Gunzler, PhD, were awarded a $3.3 million NIH R01 grant to study depression among patients receiving kidney dialysis. Many dialysis patients have depression that is difficult to diagnose and treat due in part to the overlap between depressive symptoms (e.g. appetite change, trouble sleeping, feeling tired) and symptoms related to kidney dialysis treatment (e.g. nausea, nocturnal cramps, feeling washed out after treatment). The goal of this project is to develop a screening instrument to improve diagnosis and to test the value of weekly directly observed antidepressant treatment in managing depression. Innovative features of the proposed project include the use of advanced statistical techniques to address overlap, administration of a long-acting weekly antidepressant, directly observed treatment, and a rigorous randomized controlled trial design. Dr. Sehgal is the Duncan Neuhauser Professor of Community Health Improvement and Professor of Medicine, Bioethics and Population and Quantitative Health Services. Dr. Gunzler is Assistant Professor of Medicine and Population and Quantitative Health Sciences.

Anthony DiMarco, MD, Professor of Physical Medicine and Rehabilitation, was awarded a 5-year, $2.8 million NIH grant entitled, “Spinal Cord Stimulation: A Novel Method to Restore Breathing in Spinal Cord Injury.” Many patients with spinal cord injuries are dependent on invasive mechanical ventilation to sustain life. These devices are uncomfortable, limit mobility, interfere with eating and sense of smell, and reduce quality of life. New methods are needed to restore breathing utilizing patient's own breathing muscles to address these limitations. Dr. DiMarco’s team will explore new electrical stimulation methods to restore more normal and natural breathing and improve the quality of life of patients with spinal cord injury.

John Chae, MD, Interim Vice President, Research and Chair of the Department of Physical Medicine and Rehabilitation, also serves as president of the Association of Academic Physiatrists (AAP). This nationwide organization is dedicated to advancing the field of physical medicine and rehabilitation (PM&R) through research and education.

The AAP recently honored Dr. Chae at its annual meeting. Attendees saw this video, which highlights his pioneering work and professional accomplishments, and received a copy of the MetroHealth Rehabilitation Institute’s current outcomes report.

Dr. Chae is Medical Director of Neuromusculoskeletal Service at MetroHealth; Director of the MetroHealth Rehabilitation Institute; and a professor of PM&R and biomedical engineering at Case Western Reserve University. He has been a member of the AAP since 1992.