The UCSF Housecalls program was featured on the front page of SFGate. The article highlights the great work that is being done in the Housecalls Program. This is one of the programs in the Division of Geriatrics that provides innovative care for seniors. Read article

A grant entitled: Neurodevelopment and Imaging among HIV-infected Children from the PREDICT study received a score of 19 (2nd percentile) by NIH study section on Monday, November 16.  This grant will examine brain vulnerability in the setting of HIV by determining if timing of antiretroviral therapy impacts brain development.  The findings may impact our understanding of HIV brain injury at all ages.

Louise Aronson, MD, MFA was one of the national leaders in the medical humanities who contributed to “Osler’s Bedside Library: Great Writers Who Inspired a Great Physician.” The book, a companion and guide for contemporary readers published by the ACP Press, features excerpts from the literary masterpieces Osler himself recommended to his students and colleagues plus commentaries by scholars in medical humanities who discuss why the work remains relevant to the physician's education and the practice of medicine.

Dr. Kaycee Sink, a graduate of the UCSF Geriatrics Fellowship Progam, and an Assistant Professor of Medicine at Wake Forest University received an award for educational product of the year at the 2009 annual meeting of Reynolds Foundation Grantees.  She received this award for her lesson in the Smart Prescribe Curriculum, Principles of Effective Prescribing. View the curriculum

Rebecca Sudore, MD received the award for best poster at the 2009 Bay Area Symposium on Clinical Research for her project titled: "Uncertainty About Advance Care Planning Treatment Preferences Among Diverse Older Adults." Co Authors were Dean Schillinger from San Francisco General Hospital and Terri Fried from Yale University. View Poster

Eric Widera, MD and Alexander Smith, MD were recognized for their work developing GeriPal in the weekly AGS email newsletter to the entire AGS membership.  GeriPal was noted to be an outstanding forum for discourse, recent news, research, and commentary.  Be sure to visit www.geripal.org each day to keep a pulse on what is happening in the worlds of Geriatrics and Palliative Care.

The Division of Geriatrics is pleased to welcome Dr. Chek Wong as a visiting Fulbright Scholar.  Dr. Wong is one of of Singapore's leading Geriatricians, and he has been a trailblazer in advocating for the development of Geriatric programs in Singapore.  Dr. Wong hopes to learn from us how we developed the UCSF academic program, and we look forward to expanding our understanding of Geriatric program development and leadership as we learn from Dr. Wong.

Geriatrics news items for the week of October 26, 2009

Jennifer Morris, MD and the UCSF Newsletter on Aging received special notice in Chris Langston’s recent post from the John A. Hartford Foundation.  Langston, Program Director at the Foundation, cites the Newsletter in telling how Dr. Morris “goes the extra mile in caring for challenging older veterans” and, in so doing, shows that “the heart of geriatrics is heart.”  Dr. Morris is Staff Physician, San Francisco VA Medical Center.  The Newsletter was conceived and co-edited by Ken Covinsky, MD, MPH and Joan Abrams. View Positng

The Amercian College of Physicians Journal Club identified Dr. Madhuri Reddy's article, "Treatment of pressure ulcers: a systematic review," as an original study that warrants immediate attention by physicians attempting to keep pace with important advances in internal medicine.  ACP Journal Club Review

On October 14, 2009 Kala Mehta D.Sc  and Gwen Yeo, PhD presented the first webinar in a series of nine on ‘Ethnicity and the Dementias’ for the Stanford Geriatrics Education Center. This webinar featured recent information on Alzheimer’s disease and dementia for various race/ethnic populations in the US. See Presentation Slides

Dr. Rebecca Sudore published an article in JAMA for the Piece of My Mind series entitled: “Can We Agree to Disagree”. This essay explores the complexities of surrogate decision making. It is a great story about how people often make decisions more for others than themselves, how this is relevant to health care at the most important times, and how we all keep learning. Read Article

A capacity audience filled the room for The Benjamin Lieberman Memorial Lecture and reception on Tuesday, October 13, 2009 at the Millberry Union Conference Center. Sharon Kaufman, Ph.D., Professor of Medical Anthropology in the UCSF Institute for Health and Aging, presented a fascinating talk entitled “Ordinary Medicine: How We Are Shaping Longevity in an Aging Society” in which she discussed how advances in medical care and technology impact the lives of elderly people.  The biennial lecture, sponsored by the UCSF-Mt. Zion Center on Aging, is supported by a generous gift from Dr. E. James Lieberman, Mrs. Marcia Popper and Mrs. Ediera Plotinsky, in honor of their father, Dr. Benjamin Lieberman.

Geriatrics news items for the week of October 19, 2009

Janice Schwartz, MD and Michael Steinman, MD were awarded a National Institutes of Health challenge grant funded through the American Recovery and Reinvestment Act – one of only 4% of all applications that were funded.  The grant will investigate patterns of multiple chronic diseases in older persons and the quality of drug prescribing in these patients.  Dr. Schwartz is PI and Research Director of the Jewish Home and Clinical Professor of Medicine and Pharmaceutical Sciences at UCSF.  Dr. Steinman is Assistant Professor of Medicine at UCSF and the San Francisco VA Medical Center.

Delia Lee, a medical student participating in the Medical Student Training in Aging Research (MSTAR) summer program, won the 2008 Gleitsman award for the best student researcher. Delia worked under the mentorship of faculty member Dr. Louise Walter on project entitled "Outcomes of Fecal Occult Blood Testing (FOBT) Among Elderly Veterans," which she presented in the scientific sessions of the 2009 annual meeting of the American Geriatrics Society.

Ken Covinsky, MD and Seth Landefeld, MD were co-authors on  the article "Functional Status of Elderly Adults before and after Initiation of Dialysis" in the current issue of The New England Journal of Medicine.  The first author was Manju Kurella, an Assistant Professor in the Nephrology Division at Stanford and a Paul Beeson Faculty Scholar.  Other co-authors included Glenn Chertow, Kristine Yaffe, and Chuck McCulloch. The article showed that the initiation of dialysis was associated with sharp, substantial, and sustained decline in functional status among 3702 nursing home residents. Read article

Dr. Christine Kistler is one of the co-chairs of the UCSF Residents’ and Fellows’ Council (RFC) which has worked closely with UCSF to pass a new policy prohibiting ‘daily lab’ orders (e.g. CBC qAM) at UCSF.  This was done to promote patient comfort, safety, efficient utilization of resources, and reduce iatrogenic anemia.  This policy was proposed by the RFC in recognition that UCSF utilizes more laboratory tests per inpatient that any other academic medical center.

Ron Walent, RN, PhD received the Judith V. Braun Award for Research Excellence Saturday at the Annual Meeting of the National Gerontological Nursing Association for his paper, “Autobiography, Environment and "Doing Well" in Older Nursing Home Residents.”  Dr. Walent is a NIA-funded postdoctoral fellow in the Division of Geriatrics and the UCSF Centers of Excellence in Geriatrics and Gerontologic Nursing, both funded by the John A. Hartford Foundation, Inc.

Louise Aronson, MD, MFA, launched an innovative two year Interprofessional Aging and Palliative Care curriculum this fall. Over 70 students from the Schools of Medicine, Nursing and Pharmacy have enrolled in the course which includes bimonthly seminars, clinical experiences in hospitals, clinics, nursing homes, hospices and patient homes, and independent study. Helen Kao, MD gave the opening lecture, “Approach to the Older Patient: Essential Skills for All Specialists”; Helen Chen, MD speaks on Oct. 14, “Cross Cultural Issues at End of Life”. More information

Thursday, the California HealthCare Foundation announced the selection of new fellows in the Health Care Leadership Program, including Sandra Moody, BSN, MD, Associate Professor of Medicine (Geriatrics) and Director, Home-Based Primary Care, San Francisco VAMC. 

The Benjamin Lieberman Memorial Lecture will be held on Tuesday, October 13, 2009 at the City Lights Room at Millberry Union. This year’s speaker is Dr. Sharon Kaufman from the UCSF Institute for Health and Aging. The lecture is a semi-annual event held by the UCSF Mount Zion Center on Aging in cooperation with Dr. E. James Lieberman, Mrs. Marcia Popper and Mrs. Ediera Plotinsky, in honor of their father, Benjamin Lieberman.
View Event Details

Nanjiang Hou, MS joined the Division of Geriatrics and Psychiatry as a Senior Statistician on September 28th.   Ms. Hou comes to us with over 7 years of experience in data management, statistical analysis and reporting for clinical trials data from the Department of Preventive Medicine at Northwestern University.  She will be primarily working with Kristine Yaffe, Louise Walter, and Ken Covinsky.

The Division was recently honored with a site visit from the Health Resources and Services Administration. As one of only a few institutions with three federal grants for geriatrics education - the Geriatric Academic Career Awards, a Geriatrics Education Center, and a multidisciplinary fellowship for internal or family medicine, dentistry and psychiatry, they were eager to learn about our collaborative infrastructure and interprofessional training opportunities.

Helen Kao, MD and Louise Walter, MD published "Improvement of Hospital Care of Elderly Patients: Thinking Outside the (Hospital) Box" in the Archives of Internal Medicine.  They write, "it may be possible to avoid hospitalization entirely by caring for elderly patients in their homes."  Read full article

Guy Micco, MD, Alexander Smith, MD and Patricia Villars, MD Authored an article in The Lancet titled “The Death of Ivan Ilyich and pain relief at the end of life”. This is a thought provoking article focused on the question of whether there is overuse of pharmaceuticals to treat various forms of suffering in hospice and palliative medicine. This article was also featured and discussed on GeriPal, a Geriatrics and Palliative care blog.

Sandra Moody, MD (Associate Professor and Medical Director, Home Based Primary Care (HBPC), SFVAMC) announced that the new HBPC practice in Eureka, CA has enrolled its first patient. The new program extends SFVAMC's and Geriatrics services to homebound veterans 250 miles north of San Francisco for the first time. More than 50 patients will be enrolled over the coming months.

Alexander Smith, MD and Eric Widera, MD recently published an article in Geriatrics and Aging titled "Pain Management in Moderate and Advanced Dementia".  The article highlights the complex challenges seen when managing pain in patients with moderate or advanced dementia, as well as ways to overcome these challenges.

On Sunday, September 27th, more than 50 Division of Geriatrics members and their families enjoyed a wonderful picnic in Tilden Park to celebrate graduating fellows Namita Kansal, MD and Veronica Steenpass, MD, and teacher of the year award recipient Eric Widera, MD.

Brie Williams, MD and Michael Steinman, MD have authored an article in the American Journal of Public Health, titled “Prescribing Practices for Older Prisoners in the Texas Prison System.” The paper provides important insights about appropriateness of medication prescribing for older prisoners in Texas and the similarities to older adults in the community. This study also provides an overview of system-level pharmacy interventions that can improve the quality of geriatric medication prescribing both in prison and in non-prison healthcare systems.

Sarah O'Brien joined the Division of Geriatrics as a Staff Research Associate. Ms. O'Brien's first day was on August 3rd and she is working with our research group at the SFVA. Sarah O'Brien has received a BS in Brain, Behavior, and Cognitive Science and in Spanish in 2005 from the University of Michigan in Ann Arbor. Ms. O'Brien brings with her three years of research assistant/coordinator experience at the University of Washington, Seattle, WA.

Wyeth Ghostwriting Documents Added to Drug Industry Document Archive. The Wyeth ghostwriting documents unsealed by a Federal judge last month at the request of PLoS, represented by Public Justice, and the New York Times. The documents illustrate how Wyeth Pharmaceuticals contracted with DesignWrite, a medical communications company, to write articles for top-tier medical journals with the intention of bolstering the sales of the Premarin family of hormone replacement products. After the articles were written, DesignWrite solicited prominent health professionals to appear as “authors.” The documents are full-text searchable and limited metadata, such as names of people and organizations mentioned, has been created for most documents to aid searching. The documents can be found by entering “ddu:2009*” without the quotation marks in the query box on DIDA’s home page.

The Drug Industry Document Archive (DIDA) was created by the UCSF Center for Knowledge Management in collaboration with Geriatrics faculty Seth Landefeld, MD and Michael Steinman, MD.

Carolyn Peterson joined the Division of Geriatrics as a Staff Research Associate. Ms. Peterson's first day was on September 8th and she is working with the research group at the SFVA primarily assisting Dr. Michael Steinman with his research. Ms. Peterson received a MA in Developmental Psychology from San Francisco State University in 2008 and a Bachelor of Science Degree in Psychology from Pacific Lutheran University in 2005.

On Thursday, September 17, Anna Chang, MD gave the keynote lecture in Foundations of Patient Care to UCSF's 150 new first-year medical students.  Dr. Chang serves as the course director for FPC, which is the only longitudinal and clinically relevant course in the first two years of medical school in the forefront of medical education innovations including competency-based assessments and portfolios.

Sandra Moody, MD has been selected to participate in a fellowship in the California Health Care Foundation's Health Care Leadership Program.  The program is a part-time, two-year fellowship that offers clinically trained health care professionals the experiences, competencies, and skills necessary for effective vision and leadership of our health care system.

Anna Chang, MD has been selected for membership in the Haile T. Debas Academy of Medical Educators. Dr. Chang will be formally inducted during a celebration on Monday September 21. Election to the Academy is one of the highest honors for educators at UCSF. Dr. Chang's selection recognizes her exceptional talents as a direct teacher, for which she receives among the highest evaluations in the Department, her leadership of major curricular programs in the medical school, and her award winning medical education scholarship.

Brie Williams, MD will receive a K23 Clinician-Investigator Award from the National Institute on Aging for her work on health care of older prisoners. Dr. Williams is one of the rare K-award applicants who will be funded on her first application in this very difficult funding environment. Dr. Williams will start work on her award in November.

Rebecca Sudore, MD continues her excellent research on the impact of health literacy on outcomes and quality of care. In the June issue of Patient Education and Counselling, Dr. Sudore published a paper that showed that limited health literacy and inability to speak English conspire together to damage the quality of communication between the patient and her doctor. Other division faculty authors included Seth Landefeld, MD and Brie Williams, MD. Other UCSF authors included Eliseo Perez-Stable, Kirsten Bibbins-Domingo, and Dean Schillinger.

Kala Mehta, DSc, MPH continues her work on understanding how race and ethnicity impacts dementia. In an article in Neurology, Dr. Mehta presents intriguing results showing higher rates of survival after a diagnosis of Alzheimer's disease in African-American and Latino patients, compared to white patients. Kristine Yaffe and Deborah Barnes were co-authors.

Michael Steinman, MD published an important paper on the quality of medication prescribing in the elderly in the August issue of the Archives of Internal Medicine. Dr. Steinman showed that current criteria for measuring prescribing quality, particularly "drugs to avoid criteria" are largely ineffective at distinguishing between elders who do or do not have a problematic medication as part of their regimen. This finding calls for better criteria for measuring prescribing quality in the elderly. Seth Landefeld, MD was a co-author on the paper.

Louise Aronson, MD is continuing to attract notice for her innovative work on reflective learning. Dr. Aronson has published a description of her reflective learning faculty development curriculum in Medical Education.

Eric Widera, MD continues to be recognized for his exceptional teaching as a recipient of one of the 2009 Academy of Medical Educators Excellence in Teaching Awards. Dr. Widera was recognized for his skills as a direct teacher and his leadership in Palliative Care and Geriatrics education at UCSF.

Rebecca Sudore, MD has been selected to participate in the American Academy of Hospice and Palliative Medicine Leadership Education and Academic Development Program (AAHPM LEAD). The AAHPM LEAD is an innovative 3-year leadership development program designed to promote collaboration among hospice and palliative medicine junior faculty as they prepare to assume leadership positions at academic institutions.

Dr. Carie Chin-Garcia, Dr. Angela Hsu and Dr. Carla Perissinotto joined the division as Clinical Geriatrics Fellows on July 1, 2009. Dr. Chin-Garcia completed her Internal Medicine residency at California Pacific Medical Center. Dr. Hsu completed her Internal Medicine residency at Columbia-Presbyterian Medical Center in New York, and is new to the Bay Area. Dr. Perissinotto completed her Internal Medicine residency right here at UCSF. They join Dr. Namita Kansal and Dr. Veronika Steenpass in the Clinical Geriatrics Fellowship. We are delighted to have them all here!

Alexander Smith, MD and Eric Widera, MD have launched a new blog regarding Palliative Care and Geriatrics – www.geripal.org.  A number of faculty have already contributed to the blog! Please feel free to comment on the site, and if you are interested in posting, contact Dr. Smith or Dr. Widera.

Brie Williams, MD was lead author in an article in JAGS titled, "Caregiving Behind Bars: Correctional Officer Reports of Disability in Geriatric Prisoners." Karla Lindquist was second author and Louise Walter was senior author. This paper continues Dr. William's landmark work on healthcare of older prisoners. It demonstrates the need for better approaches towards identifying disability in older prisoners.

Alexander Smith, MD was lead author on a publication in the Annals of Emergency Medicine that described the perspectives of Emergency Department (ED) providers on improving Palliative Care in the Emergency Department. The paper provides a number of important insights about how to how the quality of palliative care care be improved in the ED, particularly with respect to improving communication and synergy with outpatient providers.

Michael Harper, MD was senior author on the lead article in the July edition of Academic Medicine, which focused on training in the 4th year of Medical Students. The first author was Pamela Liss Lerman, a Psychiatry resident at UCSF. The conclusions are based on interviews with residency program directors. The paper demonstrates the importance of the 4th year in training students for residency and has important implications for curricular reform.

Helen Kao, MD was featured on the CBS, KPIX evening news in a story about proposed budget cuts to home health, IHSS, Medicaid. Dr. Kao is shown caring for one of her patients and commnents on how budget cuts will impact the services she provides for low-income and senior patients. *Please note Dr. Helen Kao was referred to as Nancy Kao in error.

View news clip

Deborah Barnes, Ph.D. was a lead author on an article co-authored with Drs. Covinsky, Whitmer, Kuller, Lopez, and Yaffe. The published a study titled, "Predicting risk of dementia in older adults. The late-life dementia risk index" was featured in on the CBS Evening News with Katie Couric, Time Magazine and US News & World Report.

Read article in Time Magazine article
View CBS Evening News report

Dr. Alex Smith is the recipient of a Junior Faculty Development Award from the National Palliative Care Research Center. This highly competitive award is given to early career faculty who are expected to become national leaders in Palliative Care research. His project will examine emergency department use at the end of life. This is one of many accomplishments for Dr. Smith in his very productive first year on our faculty.

Candice Crider, RN received the Secretary’s Award for Excellence in Nursing as part of the Nurse Week festivities at the San Francisco Veterans Affairs Medical Center (SFVAMC). Ms. Crider has been the first floor nurse manager at the SFVAMC Community Living Center (CLC) since February of 2006. This award recognizes her exceptional leadership and outstanding advocacy on behalf of the CLC veterans. 

Dr. Anna Chang was presented with AME Cooke Award for the Scholarship of Teaching and Learning at the 7th annual UCSF Education Day. The award honors the year’s most outstanding hypothesis-driven educational research project. Dr. Chang received the award for her study of early predictors to identify students who fail the required fourth year clinical skills exam.

UCSF Geriatrics was ranked 9th among all Geriatrics programs in the US by US News & World Report . UCSF joins Johns Hopkins, Harvard, Yale, UCLA, Duke, the Univ of Michigan, and Mt. Sinai in the top 10 rankings. The UCSF School of Medicine ranked fifth among all medical schools in the nation.

view ranking list- Best Geriatrics Programs
view ranking list -Best Medical Schools

Maxine Davis has been promoted to serve as Division Administrator. Maxine has worked and risen steadily in the Division over the last decade, and she has come to know the Division very well. In her new position, Maxine will be responsible for overall leadership of our administrative functions and staff, and for working with faculty in our strategic initiatives.

The Spring 2009 edition of UCSF Newsletter on Aging is now available. Click here to view a PDF version of the Newsletter

Rebecca Sudore, MD was quoted in a recent New York Times article titled, "Do you know what your doctor is talking about?" In this article, Dr. Sudore comments on the association of limited health literacy with mortality in the elderly.

Read New York Times Article

Leslie Kernisan, MD has authored an article in Journal of the American Medical Association titled, "Association Between Hospital-Reported Leapfrog Safe Practices Scores and Inpatient Mortality." This article comments on the relationship between hospitals’ safe practice scores and risk-adjusted inpatient mortality rates. Dr. Kernisan was also recently featured on a KSL Channel 5 Newscast regarding this topic.

View News Report
Read Published Article

Sei Lee, MD has published in article in the Journal of the American Geriatrics Society on functional status, SES, and all-cause mortality in older drinkers. In this novel article, Sei shows that older persons who are daily light consumers of alcohol have markedly better prognostic profiles than non drinkers, including much higher SES and much better functional status. This article was recently featured in the New York Times.

Read New York Times Article
Read Published Article

Seth Landefeld, MD is author of an editorial in the most recent issue of the Journal of the American Geriatrics Society on the promises and perils of quality indicators in Geriatrics. This editorial presents novel insights into the important discussion about how to best improve processes of care for older persons. Read Article

Alex Smith, MD has been awarded a KL2 award from the UCSF Clinical and Translational Science Institute, to start July 1, 2010. The award will support Alex's development as a clinician researcher in Palliative Care, and support his work to improve the provision of Palliative Care in the Emergency Department. The KL2 process was extremely competitive, and it is a testament to his great work that he was able to obtain this award in his first year at UCSF.

Louise Aronson, MD has been named part of the Deputy Editor Team at the Journal of General Internal Medicine. Louise will be in charge of redesigning and improving the Reflections section, starting a new section titled, "Passages." This be a great use for Louise's skills in writing and scholarly work in reflecting learning.

Dr. Alexander Smith was lead author in the most recent issue of JAMA, titled, "Palliative Care for Latino Patients and Their Families: Whenever We Prayed, She Wept." Geriatrics faculty member Rebecca Sudore, and Eliseo Perez-Stable were coauthors on the paper. This article is part of the JAMA series on Perspectives on Care at the Close of Life. The article provides a wonderful framework for thinking about the importance of cultural competence and sensitivity in end of life care.

Dr. Louise Walter has received the 2009 Outstanding Scientific Achievement in Clinical Investigation Award from the American Geriatrics Society. This is the AGS' highest award for research achievement, awarded annually to the Geriatrician whose work has had the greatest impact on care of older persons. Louise's award recognizes her groundbreaking work on cancer screening which has influenced numerous guidelines and had a major impact on the approach to cancer screening in older persons in the US.

Dr. Helen Kao will be the recipent of the 2009 Ida Cannon Award from Alta Bates Hospital.  Ida Cannon was a legendary social worker who is credited as the founder of medical social work.  This award is presented to a health professional who best exemplifies the spirit of Ida Cannon by advocating for patients and attending to all of their needs. 

Dr. Sei Lee has been awarded a Hellman Family Award for Early Career Faculty.  This award recognizes early career faculty at UCSF whose work shows originality and the promise of distinction.  Sei joins Brie Williams and Rebecca Sudore to become our 3rd faculty member to receive the Hellman Award. 

Dr. Anna Chang was asked to by the nursing staff at the VA to represent the SF VAMC physicians at the closing ceremonies of nursing week.  This recognizes Anna's extraordinary leadership of the CLC and her status as a role model for multidisciplinary collaboration. 

Dr. Alexander Smith received a pilot award from UCSF Clinical and Translational Science Institute's Strategic Opportunities Fund for his project titled, " Racial and Ethnic Differences in End of Life Care."  This award recognizes junior faculty with exceptional potential to succeed as independent investigators. 

Adam Schickedanz, an MSTAR (Medical Student Training in Aging Research) student mentored by Rebecca Sudore, MD published a paper in the January issue of JAGS titled, A Clinical Framework for Improving the Advance Care Planning Process: Start with Patients' Self-Identified Barriers. This paper describes patients views of barriers to advance directive completion. This was one of the few studies to examine this issue from the perspective of patients, and provides important insights that may guide improved completion of advance directives. read abstract

Alexander Smith, MD published an important study examining differences in end of life treatments for minority elders with cancer.  Dr. Smith demonstrated higher rates of hospitalization, higher rates of ICU care, and lower rates of hospice use in minority elders.  The findings have important implications for improving end of life care in minority elders. To read the abstract click here

Seth Landefeld, MD and Michael Steinman, MD have authored a commentary in the New England Journal of Medicine titled, "The Neurontin Legacy--Marketing Through Misinformation and Manipulation."  This paper comments on the deceptive and inappropriate industry practices to increase off label use of neurontin. 

The commentary is based on Dr. Steinman's landmark analysis of voluminous industry documents that showed how CME and research were manipulated to promote use of Gabapentin. To read this paper click here