Academics at the Boise Academics at the Boise VAMC: Past, Present and VAMC: Past, Present and

FutureFuture

Dennis L. Stevens, Ph.D., M.D.Dennis L. Stevens, Ph.D., M.D.

Chief, Infectious Diseases Section andChief, Infectious Diseases Section andDirector of Research and DevelopmentDirector of Research and Development

VA Medical Center, Boise, IDVA Medical Center, Boise, ID

Questions for the Idaho State Legislature to ponder: Why should the State of Idaho Legislature Why should the State of Idaho Legislature

be involved in the federally funded VAMC?be involved in the federally funded VAMC? What are the relationships between the What are the relationships between the

VAMC and Institutions of higher learning VAMC and Institutions of higher learning in Idaho?in Idaho?

What can Idaho Legislaters do to enhance What can Idaho Legislaters do to enhance research activities throughout the state of research activities throughout the state of Idaho?Idaho?

Broad Academic Goals and Responsibilites at the Boise VAMC

Primary mission: Excellent patient care to Primary mission: Excellent patient care to veteransveterans

Secondary Goals:Secondary Goals: TeachingTeaching ResearchResearch

Patient Care at the Boise VAMC

19971997 9,000 patients 9,000 patients 20052005 19,000 patients19,000 patients 20052005 Outpatient visits 170,000Outpatient visits 170,000

University of Washington Affiliation (1975-2005)WAMI program: Boise VAMC site for 3WAMI program: Boise VAMC site for 3rdrd

and 4and 4thth year medical students (385) year medical students (385)Primary Care Internal Medicine ResidencyPrimary Care Internal Medicine Residency

(200).(200).Transitional year internship (60)Transitional year internship (60)Family Practice Residency Family Practice Residency

Teaching of WAMI Students and Primary Care Residents at the Boise VAMC Didactic lectures Didactic lectures Clinical conferencesClinical conferences

Daily noon conferences, Grand Rounds Daily noon conferences, Grand Rounds by VAMC Facultyby VAMC Faculty

Daily Attending Rounds ( VA faculty, Daily Attending Rounds ( VA faculty, WAMI students, U of Wash ResidentsWAMI students, U of Wash Residents

Subspecialty RoundsSubspecialty Rounds Clinic Rotations (Daily)Clinic Rotations (Daily)

Boise (51)Nampa (2)

Caldwell (5)

Rupert (1)

Sand Point (1)

Cottonwood (1)

McCall (1)Sun Valley (1)

GIM (27)Med/Peds (1)Cardiology (3)Renal (3)Pulmonary (9)GI (2)Geriatrics (4)Rheumatology (1)Anesthesia (1)

FACULTY AND TRAINEES FROM BOISE VAMC

PRACTICING IN IDAHO(2004)

Research and Teaching Activities involving ISU Faculty at the Boise VAMC Full time ISU Faculty Full time ISU Faculty

Sandra Jue, PharmDSandra Jue, PharmD Barbara Mason, PharmDBarbara Mason, PharmD Rex Lott, PharmDRex Lott, PharmD Karl-Madaras Kelly, PharmDKarl-Madaras Kelly, PharmD

BSU Clinical Teaching and Research at the Boise VAMC Respiratory Therapy StudentsRespiratory Therapy Students

Nursing StudentsNursing Students

Collaborations with BSU ResearchersCollaborations with BSU Researchers

University of Idaho Affiliation

Master’s degrees and Doctoral Degrees in Master’s degrees and Doctoral Degrees in Microbiology (5 and 1 current)Microbiology (5 and 1 current) Graduate committee made up of VAMC Graduate committee made up of VAMC

investigators, U of I faculty and BSU investigators, U of I faculty and BSU facultyfaculty

Collaborative research in Infectious Collaborative research in Infectious DiseasesDiseases

Basic Science Research(Currently active areas at Boise VAMC) Cellular mechanisms of shock and Cellular mechanisms of shock and

pathogenesis of Infectious Diseasespathogenesis of Infectious Diseases Mechanisms of vascular injuryMechanisms of vascular injury Cardiomyopathy of anthracyclinesCardiomyopathy of anthracyclines Pulmonary physiologyPulmonary physiology GeriatricsGeriatrics

Clinical Trial Research

Infectious DiseasesInfectious Diseases AntibioticsAntibiotics

IclaprimIclaprimTigecyclineTigecyclineLinezolidLinezolid

Hepatitis CHepatitis CPegylated INF and RibavirinPegylated INF and Ribavirin

Composition of Clinical Teams Infectious Diseases:Infectious Diseases:

D.L. Stevens, MD, PhDD.L. Stevens, MD, PhD Karl Madaras Kelly, PharmDKarl Madaras Kelly, PharmD Pam Lewis, R.N.Pam Lewis, R.N. Darlene Fowble, Clin MicroDarlene Fowble, Clin Micro Larry Meyer, PharmacistLarry Meyer, Pharmacist Tony Mebane, PA Tony Mebane, PA Patricia Michas, RN (Research Coordinator) Patricia Michas, RN (Research Coordinator)

Composition of Clinical Teams

PulmonaryPulmonary Dr. Nirmal Charan, MDDr. Nirmal Charan, MD Dr. Paula Carvalho, MDDr. Paula Carvalho, MD William Thompson, MDWilliam Thompson, MD Sandra Jue, Pharm DSandra Jue, Pharm D Barbara Mason, Pharm DBarbara Mason, Pharm D Pulmonary Fellows (2) MDsPulmonary Fellows (2) MDs

Composition of Clinical Teams

GeriatricsGeriatrics Barry Cusack, MDBarry Cusack, MD Desmond Amin-Appia, MDDesmond Amin-Appia, MD Sandra Jue, Pharm DSandra Jue, Pharm D Stan Hall, PAStan Hall, PA

Composition of Clinical Teams

CardiovascularCardiovascular David Lee, MDDavid Lee, MD Sandra Jue, Pharm DSandra Jue, Pharm D Barbara Mason, Pharm DBarbara Mason, Pharm D Gwen Lindberg, PAGwen Lindberg, PA Richard Olson, Ph.DRichard Olson, Ph.D Dr. Charles EirikssonDr. Charles Eiriksson

Composition of Clinical Teams

DiabetesDiabetes David Hindson, MDDavid Hindson, MD Barbara Mason, Pharm DBarbara Mason, Pharm D Sandra Jue, Pharm DSandra Jue, Pharm D Jennifer Ackerly, PAJennifer Ackerly, PA

Composition of Clinical Teams

NeuropsychiatryNeuropsychiatry Larry Dewey, M.D.Larry Dewey, M.D. Rex Lott, Pharm DRex Lott, Pharm D Need to recruit academically oriented Need to recruit academically oriented

psychiatrist!psychiatrist!

Potential for Enhancement of Clinical Research Team ApproachTeam Approach Computerized Patient records Boise VAMCComputerized Patient records Boise VAMC Access to VA National DatabaseAccess to VA National Database Recruitment of an Recruitment of an

Epidemiologist/statistician with expertise in Epidemiologist/statistician with expertise in design of clinical studies.design of clinical studies.

Evolution of a U of Washington IRB Evolution of a U of Washington IRB specifically for VA studies.specifically for VA studies.

Proposal to develop a translational research program at the Boise VAMC In vitro and ex vivo cellular studies: Mechanisms of In vitro and ex vivo cellular studies: Mechanisms of

action, toxicityaction, toxicity Signal transductionSignal transduction Gene expressionGene expression

Polymorphisms (TNF, Beta-agonists)Polymorphisms (TNF, Beta-agonists) ProteomicsProteomics

Expression of known proteins (arrays)Expression of known proteins (arrays) Identification of novel proteinsIdentification of novel proteins

• 2-D gel electrophoresis/Mass spectroscopy_2-D gel electrophoresis/Mass spectroscopy_

Bridging Basic Science and Outcomes Research Identification of novel mechanisms of Identification of novel mechanisms of

action, cellular toxicity, etc will provide action, cellular toxicity, etc will provide markers that can be pursued in patient based markers that can be pursued in patient based studies.studies. Boise VA patientsBoise VA patients National VA DatabaseNational VA Database Sub-projects of National/international Sub-projects of National/international

clinical trials.clinical trials.

Biomedical Research and Education Institute at the Boise VAMC

Expand Research Space and EquipmentExpand Research Space and Equipment Enhance Research Collaborations with Idaho Enhance Research Collaborations with Idaho

Universities and InvestigatorsUniversities and Investigators Expand Teaching Facilities, Classrooms and Expand Teaching Facilities, Classrooms and

Conferencing Capability Including Conferencing Capability Including Teleconferencing with Idaho Universities Teleconferencing with Idaho Universities and the University of Washingtonand the University of Washington

How can the Idaho Legislature Promote Research Activities Re-instate the small research grants administered through Re-instate the small research grants administered through

HERC.HERC. Increase the number of Center of Excellence Grants Increase the number of Center of Excellence Grants

through HERCthrough HERC Increase the number of graduate student stipends at the Increase the number of graduate student stipends at the

UniversitiesUniversities Utilize Tobacco Fund monies for Biomedical Research in Utilize Tobacco Fund monies for Biomedical Research in

IdahoIdaho Consider establishing joint graduate degree program Consider establishing joint graduate degree program

utilizing faculty at all the Universities and the Boise utilizing faculty at all the Universities and the Boise VAMCVAMC