Knox Named Phoenix Associate Dean of Faculty Affairs

Dr. Kenneth S. Knox

The University of Arizona College of Medicine-Phoenix has announced the appointment of nationally recognized physician-scientist Kenneth S. Knox, MD, as the associate dean of faculty affairs. Dr. Knox who has been at the University of Arizona-Tucson since 2008, will oversee the Faculty Affairs Office whose charge is to promote an engaged, diverse community of faculty and scholars that sustain a culture of engagement, professionalism and inclusion. He also will serve as director of research at the Banner Lung Institute.

Dr. Knox is a pulmonologist known for his research in sarcoidosis, fungal diagnostics and immunologic lung disease. His work includes developing treatments for HIV, AIDS and valley fever. The division chief of Pulmonary, Allergy, Critical Care and Sleep Medicine in Tucson, Knox was responsible for dramatic growth. His accomplishments include increasing the number of clinical and basic science faculty from five to 30 and fellowship trainings from six to 20, rekindling the sleep program, establishing a section of allergy and revamping the teaching model in the intensive care unit. He also served as vice chair for education in the Department of Medicine.

Dr. Knox is co-principal investigator on the Arizona portion of a $9.7 million National Institutes of Health-funded clinical trial to test the use of fluconazole as an early treatment for valley fever. Additional grants for more than $6 million have been submitted for efforts to develop a valley fever vaccine. He has received continuous funding since 2001 for his research on the use of bronchoalveolar lavage for immunodiagnostics and lung immunity. He is NIH-funded to perform longitudinal translational studies correlating immunological findings and the lung microbiome with clinical disease in HIV as his lab seeks to understand the role of pulmonary inflammation in the development of HIV-related lung diseases.

A native of Youngstown, Ohio, Dr. Knox graduated cum laude with a bachelor’s degree in microbiology from Miami University in Oxford, Ohio. He completed his medical degree and residency training in Internal Medicine at Ohio State University and a fellowship in Pulmonary/Critical Care/Sleep Medicine at Indiana University where he remained on faculty for eight years, serving as educational director and director of the immunologic lung disease program before coming to Tucson. Dr. Knox is an associate editor of the SWJPCC and has edited the highly successful “Medical Image of the Week” section since its inception.

Richard A. Robbins, MD
Editor, SWJPCC

Cite as: Robbins RA. Knox named Phoenix associate dean of faculty affairs. Southwest J Pulm Crit Care. 2016;13(6):311-2. doi: https://doi.org/10.13175/swjpcc141-16 PDF

Rating the VA Hospitals

USA Today is listing the star rating system for the Department of Veterans Affairs medical centers based on the quality of care. The website has a link that allows searches for individual medical centers. The ratings have been done for years but the VA has refused to release the ratings saying they are meant for internal use only.

The top-rated hospitals received a 5 and the lowest a 1. According to the star ratings the best hospitals are in the Northeast and upper Midwest.  In the Southwest the ratings are not so good with the top-rated hospital Palo Alto and the lowest a tie between Phoenix and Albuquerque (Table 1).

Table 1. Southwest VA medical center star compare VA hospitals ratings.

Quality can be difficult to measure and it is not clear what metrics were used in the VA ratings. For this reason, the VA star ratings were compared to another hospital rating service Compare VA Hospitals (2). This scale uses a 1-100 scale with 100 being the best. In this scale the Palo Alto turned out to be the best in the country with Phoenix and the VA being more in the middle of the pack. There was no correlation between the ratings (r=0.2386, p>0.05). This is consistent with a previous publication in the SWJPCC which showed no or little correlation between the various hospital ratings.

The lack of correlation between rankings and not knowing the metrics which determine the rankings suggest that the VA is right, the rankings should remain for an internal use rather than adding to the confusion already generated by the various hospital rankings.

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Slack D. Exclusive: Internal documents detail secret VA quality ratings. USA Today. December 7, 2016. Available at: http://www.usatoday.com/story/news/politics/2016/12/07/internal-report-details-secret-quality-ratings-veterans/94811922/ (accessed 12/14/16).
2. Health Grove by Graphiq. Compare VA hospitals. Available at: http://va-hospitals.healthgrove.com/ (accessed 12/14/16).
3. Robbins RA, Gerkin RD. A comparison between hospital rankings and outcomes data. Southwest J Pulm Crit Care. 2013;7(3):196-203. [CrossRef]

Cite as: Robbins RA. Rating the VA hospitals. Southwest J Pulm Crit Care. 2016;13(6):309-10. doi: https://doi.org/10.13175/swjpcc138-16 PDF 

Garcia Resigns as Arizona University VP

Dr. Joe G.N. "Skip" Garcia resigned his administrative duties as senior vice president for health sciences at the University of Arizona. Garcia said he would devote his full attention as a professor at the UA College of Medicine-Tucson according to the Arizona Republic (1). "After much thought and reflection, I have decided that the time is right for me to take a step back and focus on my continually growing research commitments," Garcia said. "Please know that this decision was an exceptionally difficult one and not reached lightly, and that I am humbled by all of your support during my time as senior vice president."

Garcia was hired in 2013 to oversee the university's medical schools in Phoenix and Tucson, as well as the schools of nursing, pharmacy and public health. Shortly after Garcia was hired, he reorganized UA health sciences, recruited a roster of academics and tightened oversight of the Phoenix medical school. However, after Dr. Stuart Flynn, the Phoenix medical school's longtime dean, and most of his leadership team resigned to join the staff of a newly created medical school in Fort Worth, Texas, Garcia faced increasing scrutiny and criticism. The departures prompted the Arizona Medical Association, a physicians' organization with 4,000 members, to ask the Arizona Board of Regents to interview the departed leaders as part of an investigation of the school's management.

In August, the regents' health affairs committee held public hearings in Tucson and Phoenix to gather input from medical-school stakeholders. The regents also hired an independent consultant to evaluate concerns about the two medical schools. The consultant delivered a report to the regents, who concluded in October following a closed-door meeting that no further action was needed. Even though the Board of Regents spent $179,653 in public funds on the report, the regents have refused to provide a copy of the report to the public, citing attorney-client privilege and work-product protections.

UA President Ann Weaver Hart who previously announced she would leave the president’s post in 2018 praised Garcia's track record. "The work accomplished by Dr. Skip Garcia in just three short years as the senior vice president for health sciences has had a profound impact on the future of the College of Medicine-Tucson, the College of Medicine-Phoenix, and the Colleges of Pharmacy, Nursing and Public Health at the University of Arizona," Hart said in a statement released by the university.

Garcia is a pulmonary physician whose research focused on the genetic basis of lung disease and the prevention and treatment of inflammatory lung injury (2). He had previously served in academic positions at the University of Texas Health Center at Tyler, Indiana University School of Medicine, Johns Hopkins University School of Medicine, the University of Chicago, and the University of Illinois at Chicago before coming to Arizona. He has been continuously funded by the NIH since 1988 and has authored or co-authored more than 400 peer-reviewed publications and over 35 book chapters. In 2016, Dr. Garcia received the Trudeau Medal from the American Thoracic Society in recognition of his lifelong major contributions to the prevention, diagnosis and treatment of lung disease through leadership in research, education and clinical care.

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Alltucker K. Joe 'Skip' Garcia, the embattled University of Arizona med-school chief, quits his VP post. Arizona Republic. December 8, 2016. Available at: http://www.azcentral.com/story/news/local/arizona/2016/12/08/embattled-ua-med-school-chief-quits-vp-post-to-return-to-teaching-and-research/95156932/ (accessed 12/9/16).
2. The University of Arizona Health Sciences. Joe G. N. “Skip” Garcia, MD biography. Available at: http://uahs.arizona.edu/senior-vice-president-health-sciences/joe-garcia-bio (accessed 12/9/16).

Cite as: Robbins RA. Garcia resigns as Arizona university VP. Southwest J Pulm Crit Care. 2016;13(6):305-6. doi: https://doi.org/10.13175/swjpcc137-16 PDF

Combination Influenza Therapy with Clarithromycin-Naproxen-Oseltamivir Superior to Oseltamivir Alone

As we enter the influenza season, Ivan et al. (1) are reporting in Chest that oseltamivir-clarithromycin-naproxen combination for treatment of serious influenza results in reduced mortality, less frequent ICU admission, and shorter hospital-stay compared to oseltamivir alone. From February to April 2015, the authors conducted a prospective open-label randomized-controlled trial. Adult patients hospitalized for A(H3N2) influenza were randomly assigned to a 2-day combination of clarithromycin 500mg, naproxen 200mg and oseltamivir 75mg twice daily, followed by 3 days of oseltamivir; or oseltamivir 75mg twice daily for 5 days as control (1:1). Among the 217 influenza A(H3N2) patients enrolled, 107 were randomly assigned to the combination treatment. Ten patients succumbed during the 30-day follow-up. The combination treatment was associated with lower 30-day mortality (p=0.01), less frequent ICU/HDU admission (p<0.001), and shorter hospital-stay (p<0.0001). Multivariate analysis showed that combination treatment was the only independent factor associated with lower 30-day mortality (p=0.04). The authors advised further study on the antiviral and immunomodulatory effects of this combination treatment, but those caring for severely ill patients with influenza might wish to consider combination therapy since all these drugs are available.

Richard A. Robbins, MD

Editor, SWJPCC

Reference

1. Hung IF, To KK, Chan JF, et al. Efficacy of clarithromycin-naproxen-oseltamivir combination in the treatment of patients hospitalized for influenza A(H3N2) infection: an open-label, randomized controlled, phase 2b/3 trial. Chest. 2016 Nov 21. [Epub ahead of print] [CrossRef] [PubMed]

Cite as: Robbins RA. Combination influenza therapy with clarithromycin-naproxen-oseltamivir superior to oseltamivir alone. Southwest J Pulm Crit Care. 2016;13(6):302. doi: https://doi.org/10.13175/swjpcc136-16 PDF

VAP Rates Unchanged

In a research letter to JAMA Metersky and colleagues (1) report that ventilator-associated pneumonia (VAP) rates have remained near 10% since 2005. The authors reviewed Medicare Patient Safety Monitoring System (MPSMS) data on a representative sample of more than 86,000 critically ill patients treated at 1330 US hospitals between 2005 and 2013. To meet a diagnosis of VAP patients were required to have at least 2 days' ventilation in intensive care units; a chest radiograph with a new finding suggesting pneumonia; a physician diagnosis of pneumonia; and an order for antibiotics. VAP incidence was 10.8% (95% confidence interval, 7.4% - 14.4%) during 2005 to 2006 and 9.7% (95% confidence interval, 5.1% - 14.9%) during 2012 to 2013.

In contrast, data from the CDC's National Healthcare Safety Network (NHSN) have shown declines in VAP rates of 71% and 62% in medical and surgical intensive care units, respectively, between 2006 and 2012 (2,3). "The most likely explanation for the discrepancy is thought to be bias in reporting to CDC by the hospitals," Dr. Metersky told Medscape Medical News (4). Dr. Charles S. Dela Cruz at Yale agrees. "Strict and varying VAP measure definitions and the hospital reporting mechanisms possibly contributed to the differences in rates," he said.

VAP has no standard definition and its diagnosis has considerable clinical variability. Other than removing the endotracheal tube as quickly as possible, VAP prevention guidelines are non- or weakly evidence-based (5). Furthermore, financial incentives from CMS for low VAP rates may have contributed to the bias in reporting (6).

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Metersky ML, Wang Y, Klompas M, Eckenrode S, Bakullari A, Eldridge N. Trend in ventilator-associated pneumonia rates between 2005 and 2013. JAMA. 2016 Nov 11. [Epub ahead of print] [CrossRef] [PubMed]
2. Edwards JR, Peterson KD, Andrus ML, et al; NHSN Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control. 2007;35(5):290-301. [CrossRef] [PubMed]
3. Dudeck MA, Weiner LM, Allen-Bridson K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control. 2013;41(12):1148-66. [CrossRef] [PubMed]
4. Swift D. No drop in VAP rates, study contends. Medscape Medical News. November 21, 2016. Available at: http://www.medscape.com/viewarticle/872157?nlid=110853_3464&src=WNL_mdplsfeat_161129_mscpedit_ccmd&uac=9273DT&spon=32&impID=1243721&faf=1 (accessed 12/2/16).
5. Padrnos L, Bui T, Pattee JJ, Whitmore EJ, Iqbal M, Lee S, Singarajah CU, Robbins RA. Analysis of overall level of evidence behind the Institute of Healthcare Improvement ventilator-associated pneumonia guidelines. Southwest J Pulm Crit Care 2011;3:40-8.
6. Cassidy A. Medicare's hospital-acquired condition reduction program. Health Affairs. August 6, 2015. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=142  (accessed 12/2/16).

Cite as: Robbins RA. VAP rates unchanged. Southwest J Pulm Crit Care. 2016;13(6):288-9. doi: https://doi.org/10.13175/swjpcc134-16 PDF