KANSAS News from the University of Kansas Medical Center SPRING/SUMMER 2021
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KANSAS News from the University of Kansas Medical Center SPRING/SUMMER 2021
Access to ON THE COVER
Illustration by Matt Manley
nationally
EXECUTIVE EDITOR
Donna Peck
GRAPHIC DESIGN
Grace Reap
CONTRIBUTING WRITERS
ranked care
Kristi Birch
Anne Christiansen-Bullers
Kay Hawes
Leilana McKindra
Donna Peck
has never
PHOTOGRAPHERS
Selena Jabara
Elissa Monroe
ILLUSTRATION
Tim Bradford
Matt Manley
been more
Grace Reap
UNIVERSITY OF KANSAS
ADMINISTRATION
Douglas A. Girod, M.D.
Chancellor, University of Kansas
important.
Robert D. Simari, M.D.
FROM THE EXECUTIVE
Executive Vice Chancellor, KU Medical Center
Akinlolu O. Ojo, M.D., Ph.D., MBA
VICE CHANCELLOR Executive Dean, KU School of Medicine
Sally Maliski, Ph.D., RN
Dean, KU School of Nursing
Abiodun Akinwuntan, Ph.D.
Dean, KU School of Health Professions
Nationally ranked care has never been more important or more available than it
is right now, and you can find it here. We are honored to be the only hospital ever This past year has been a stressful one I think you will also be interested in read- Kansas Medicine + Science is published by
for all of us ― but none more so than our ing about the important work being done the Office of Communications at the
recognized by U.S. News & World Report as the best in Kansas and as the best in University of Kansas Medical Center. To view
Kansas City, in addition to having 6 medical and surgical specialties ranked this year. frontline health care providers. These by Judy Johnston, a research instructor Kansas Medicine + Science online, go to
heroes have been integral to the global for the Department of Public Health at kumc.edu/communications. The entire issue is
response to COVID-19. As you will read the KU School of Medicine in Wichita. copyrighted and no part may be reproduced
As the only academic medical center in Kansas, we challenge ourselves each day to in the cover story of this issue of Kansas Several years ago, she took on the chal- without prior permission. Patient photos are
used with permission.
consistently improve the quality, safety, efficiency and convenience of the care we Medicine +Science, many health care pro- lenge of surveying residents living in ru-
fessionals ― particularly those who work ral Kansas counties on what they think
offer. We are dedicated to providing exceptional care, when and where you need it – in the rewarding, but demanding, field they need to live healthy and fulfilling The University of Kansas prohibits discrimination
including primary, specialty, urgent and emergency care. of academic medicine ― were already lives. Her assessments are already result- on the basis of race, color, ethnicity, religion, sex,
national origin, age, ancestry, disability, status as a
under stress before the pandemic hit. ing in better resident services in many of veteran, sexual orientation, marital status, parental
The pressure of balancing teaching, con- the counties surveyed. status, gender identity, gender expression and
We’re focused on enhancing the lives of those we serve – not on earning awards.
ducting research and providing clinical genetic information in the university’s programs
But when we do, we hope they inspire your confidence and trust in us and the care care has taken its toll on many academic As always, we appreciate your feed- and activities. Retaliation is also prohibited by
university policy. The following persons have
we provide. medicine professionals. back, so please drop us an email at been designated to handle inquiries regarding
kmands@kumc.edu with your thoughts. the nondiscrimination policies and are the Title IX
While the pandemic has disrupted most We look forward to hearing from you! coordinators for their respective campuses:
of our lives in some way, I am pleased Director of the Office of Institutional
Opportunity & Access, IOA@ku.edu,
Schedule the care you need. Call 913-588-1227 or visit that our outstanding scientists have been Room 1082, Dole Human Development Center,
kansashealthsystem.com/appointments. able to continue their work in meeting 1000 Sunnyside Avenue, Lawrence, KS 66045,
KU Medical Center’s research mission. In 785-864-6414, 711 TTY (for the Lawrence, Edwards,
this issue, you can read about how some Parsons, Yoder, and Topeka campuses);
Director, Equal Opportunity Office, Mail Stop 7004,
of our researchers are incorporating arti- Robert D. Simari, M.D. 4330 Shawnee Mission Parkway, Fairway, KS 66205,
ficial intelligence into their quests to find Executive Vice Chancellor 913-588-8011, 711 TTY (for the Wichita, Salina, and
A D V A N C I N G T H E P O W E R O F M E D I C I N E ® cures and treatments for disease. University of Kansas Medical Center Kansas City, Kansas medical center campuses).
Spring/Summer 2021 3
© The University of Kansas Health System
WHAT’S INSIDE
14 HEALING THE
HEALERS
Burnout in medicine was an issue
long before a global health crisis
came along.
PULSE
NEWS FROM KU MEDICAL CENTER
FROM SCIENCE FICTION
TO SCIENCE
University of Kansas researchers are using
08
ARTICLES
artificial intelligence to bring futuristic NEW COVID-19 OUTPATIENT TREATMENTS PART OF NIH-FUNDED EFFORT SEEKS TO IMPROVE COVID-19
ideas to present day. CLINICAL TRIAL AT KU MEDICAL CENTER TESTING IN UNDERSERVED KANSAS COMMUNITIES
Three new outpatient treatments are being tested at the University The University of Kansas Medical Center was chosen as one of
of Kansas Medical Center in an effort to broaden options for 32 institutions nationwide to receive a grant from the National
COVID-19 patients. These new therapies may make it easier to re- Institutes of Health (NIH) through the RADx-UP program to sup-
NEW KIDNEY, 05 ceive COVID-19 treatment outside a hospital because they include port projects designed to rapidly implement COVID-19 testing
BETTER BRAIN HEALTH an oral pill, an injection and a medication inhaled through a home strategies in populations disproportionately affected by the pan-
A new study from KU Medical Center
PULSE nebulizer. This new trial is open to most adults who have a positive
COVID-19 test. There’s no need to have a pre-existing condition or
demic. KU Medical Center is partnering with community efforts
in 10 Kansas counties, six rural (Crawford, Finney, Lyon, Riley,
shows that kidney transplants may
reverse some brain abnormalities. 24 DEPARTMENTS The latest news from
KU Medical Center
meet a certain age limit. KU Medical Center is partnering with The
University of Kansas Health System to recruit participants through
its outpatient clinics and swab clinics as well. All of the drugs are
Saline and Seward) and four urban (Douglas, Johnson, Sedgwick,
Wyandotte). The goal is to establish community-led, health de-
partment-linked Local Health Equity Action Teams in 10 counties
being tested as part of a unique nationwide clinical trial known as in Kansas disproportionately affected by COVID-19 and provide
MYTHBUSTERS! 12 ACTIV-2 — Accelerating COVID-19 Therapeutic Interventions and
Vaccines — which allows multiple drugs to be tested under the same
trial protocol, saving time and effort. KU Medical Center is one of
them with the training and resources to identify and respond to
COVID-related inequities in their communities.
We look at the truth behind
some common health myths. 10 QUESTIONS at least 95 sites across the nation that will be participating in this
clinical trial, sponsored by the National Institute of Allergy and
JUNTOS DELIVERS COVID-19 INFORMATION TO
KANSAS CITY’S SPANISH-SPEAKING POPULATION
Nelda Godfrey, the
28
Infectious Diseases (NIAID), part of the NIH. When a language barrier prevents people from getting critical
associate dean of innovative information about the COVID-19 virus, including guidelines for
partnerships and practice at JAYSTART CLINIC SWITCHES TO VIRTUAL prevention, it puts them at a higher risk of infection. Many of
the KU School of Nursing, is PHYSICAL REHABILITATION these residents rely on community services, such as free school
exploring professional identity Physical therapy, occupational therapy and speech pathology stu- lunches for children. The JUNTOS Center for Advancing Latino
SURVEYING HEALTH of nurses. dents at the KU School of Health Professions have benefited from Health at the University of Kansas Medical Center, whose mis-
IN RURAL KANSAS the weekly JaySTART Clinic, which offered them a chance to prac-
tice what they’ had learned in the classroom and help patients from
sion is to eliminate health disparities in under-served Latino
communities in Kansas, is working to deliver COVID-19 informa-
42
Judy Johnston is surveying residents underserved communities who might otherwise not receive ther- tion to these communities in their native language. In addition to
apy. But when the COVID-19 pandemic closed the in-person clinic, creating and sharing materials about the coronavirus in Spanish
34
in Kansas’ rural counties on what they
need to lead healthy lives. faculty turned to telehealth to keep the therapy — and the learning through JUNTOS social media, JUNTOS worked with the Unified
ALUMNI opportunity — going. After restrictions related to the COVID-19
pandemic prohibited the traditional way of treating patients,
Government Public Health Department, which serves Wyandotte
County and Kansas City, Kansas, to create a Spanish version of
SPOTLIGHT JaySTART appointments were conducted using Zoom videoconfer- the COVID-19 section of its website. In the Kansas City area,
VIRTUAL SUPPORT Jennifer Bacani McKenney, M.D.,
encing. The virtual therapy program began in the spring of 2020
with four patients and has grown to students and faculty seeing
nearly 6% of the population speaks Spanish as their primary lan-
guage. In Wyandotte County, home to the Kansas City campus
Business is booming for is a family practice specialist the about 30 patients a week, which is close to the number of pa- of the University of Kansas Medical Center, the percentage is far
online therapy… in Fredonia, Kansas. tients served when the clinic was face-to-face. Dave Burnett, Ph.D., higher. Nearly one-quarter of residents are Spanish speakers —
but does it work? KU School of Health Professions associate dean for faculty practice and close to 15% report that they can speak English “less than very
38 and community partnership, said he believes some portion of tele-
health may remain a part of JaySTART even after the pandemic.
well,” according to data from the American Community Survey of
the U.S. Census.
Spring/Summer 2021 5
KU CANCER CENTER RESEARCHERS IDENTIFY BREAST WOMEN IN ACADEMIC MEDICINE REMAIN LESS LIKELY KU MEDICAL CENTER OPENS NEW CTSU UNIT KU MEDICAL CENTER OPENS THRIVE FOOD PANTRY
CANCER PREVENTION DRUG WITH FEWER SIDE EFFECTS TO BE PROMOTED A new research unit that will greatly expand the capacity for scien- FOR STUDENTS IN NEED
Women with a high risk for breast cancer can be prescribed drugs Female physicians are more likely to pursue careers in academic tists to conduct clinical trials has opened at the University of Kansas The KU Medical Center Office of Student Life has opened Thrive, a
to help reduce their risk of cancer, but many don’t take the drugs be- medicine than their male counterparts but are less likely to be pro- Medical Center. It is the first clinical and translational science unit food pantry for students who are experiencing food insecurity. A
cause of their problematic side effects. Researchers at The University moted to senior faculty and leadership positions, and that gender (CTSU) on the main KU Medical Center campus in Kansas City, fundraiser for the pantry raised more than $13,000 in the first month,
of Kansas Cancer Center have identified a drug that may keep the gap is no narrower than it was 20 years ago, according to a study pub- Kansas. CTSUs are central to the mission of Frontiers: University of and more than 1,300 individual food items were donated to stock
preventive punch but lessen the strong side effects. The result could lished by researchers at the University of Kansas Medical Center in Kansas Clinical and Translational Science Institute, which was estab- the pantry shelves. National studies indicate that anywhere from 30-
mean that more women will stay on the preventive therapy and see the New England Journal of Medicine (NEJM). The study, Women lished by the KU Medical Center in 2011 with a five-year, $20 million 45% of college students experience some type of food insecurity. The
better results. The drug is called Duavee, a medication containing Physicians and Promotion in Academic Medicine, is an expansion Clinical and Translational Science Award (CTSA) from the National Student Campaign Against Hunger and Homelessness reported that
estrogen and anti-estrogen bazedoxifene. Duavee is FDA-approved and update to a landmark study published in the NEJM in 2000 by Center for Advancing Translational Sciences, part of the National students experiencing food insecurity often have difficulty paying
for hot-flash relief and prevention of osteoporosis, but it is rarely a researcher at the Association of American Medical Colleges. The Institutes of Health. As part of a network of more than 50 such hubs the rent, mortgage or utility bills. The stress of dealing with food
used in women with a high risk of breast cancer because it contains earlier study demonstrated that female graduates of U.S. medical across the country, Frontiers accelerates research by connecting or housing can impact a student’s educational success. The study
estrogen (a higher lifetime exposure to estrogen has been linked to schools working at academic medical centers in the United States scientists to resources, providing training and facilitating collabo- found that 55% percent of students responding reported that these
increased breast-cancer risk). were advancing from assistant to associate professor, and from ration among researchers, institutions and communities. Frontiers problems caused them to not buy a required textbook and 53% per-
associate to full professor, at lower-than-expected rates. The new was awarded a second five-year CTSA grant, for $25 million, in 2017. cent reported missing a class.
Carol Fabian, M.D., founder of the KU Cancer Center’s Breast Cancer study shows that gender differences have not diminished since the The new CTSU has five exam rooms; six infusion bays for intrave-
Prevention and Survivorship Research Center, and her team con- 2000 study was done — the same era during which women have nous drug delivery; two phlebotomy bays for blood draws; a kitch- ATHLETIC TRAINING PROGRAM COMES TO
ducted a six-month pilot study of Duavee after studies of the drug’s closed the medical school admissions gender gap. The authors of en; a sample processing laboratory with refrigerators, freezers and KU MEDICAL CENTER
components in animal models suggested it may help prevent breast the study were: Kimber P. Richter, Ph.D., MPH; Lauren Clark, M.S.; centrifuges; a conference room; and workspace for coordinators. It KU’s athletic training program has a new home at the University
cancer. The results of the study, published in Cancer Prevention Jo A. Wick, Ph.D.; Erica Cruvinel, Ph.D.; Dianne Durham, Ph.D.; also has a pulmonary testing laboratory with equipment to test lung of Kansas Medical Center. The Master of Science in Athletic
Research, show that women who took Duavee had a reduction in Pamela Shaw, M.D.; Grace H. Shih, M.D.; Christie A. Befort, Ph.D.; function. A nurse trained in clinical research protocols, a medical Training (MSAT) program classes will begin in the summer of
risk biomarkers for breast cancer. These biomarkers — early warn- and Robert D. Simari, M.D. assistant and an administrative assistant will staff the unit. 2021. Founding program director LesLee Taylor, Ph.D., said ath-
ings that something is not right — can include breast density as seen letic training will benefit from a synergy with similar but long-es-
on a mammogram, for example. While taking Duavee, study par- DRUG AFFECTING HIGH CHOLESTEROL FROM GENES, KU CAMP GIVES KIDS WITH ADHD THE ATTENTION tablished programs such as physical therapy, occupational therapy
ticipants had decreased mammographic breast density. Moreover, NOT LIFESTYLE, SHINES IN CLINICAL TRIAL THEY NEED and dietetics and nutrition in the KU School of Health Professions.
participants reported an improvement in one key side effect: tem- Individuals who have an inherited condition that cause them to have Spurred by the initiative and expertise of faculty and staff from KU The program comes to KU Medical Center after University of
perature fluctuations, also known as hot flashes. They listed their high cholesterol regardless of diet or other lifestyle issues might School of Medicine-Wichita, a new summer camp aims to help young- Kansas leadership decided to close its undergraduate athletic
median hot flash score at a 15 at the start of the trial but zero at the one day benefit from a new drug recently tested at the University of sters with ADHD modify their behavior and thrive using a program training department in Lawrence and move the master’s degree
end of the trial. Most women had complete relief of their hot flashes Kansas Medical Center. Patrick M. Moriarty, M.D., director of clini- unavailable for hundreds of miles around. Jointly sponsored by the program to the medical center campus. MAST will take two years
by two weeks into the study. cal pharmacology at the Atherosclerosis/ Lipid-apheresis Center, is KU School of Medicine-Wichita’s Department of Psychiatry and and 68 credit hours to complete. Year one will be filled with class-
a professor of internal medicine for the University of Kansas School Behavioral Sciences and the Department of Pediatrics, the ADHD room learning and some clinical experiences. In the first semester
Hot flashes can develop or intensify with all of the standard drugs of Medicine. Moriarty co-authored a multisite clinical trial study Summer Treatment Program serves up to 28 children ages 6 to 10 of year two, students will increase their time in clinics, and by
currently used to reduce the risk of developing cancer for women published in The New England Journal of Medicine. The article with its 13 full-time staff. The camp is built on the belief ― and de- their last semester, they will be off campus in a practicum, practic-
considered at increased risk for breast cancer. Tamoxifen is one well- shares the results of a drug trial. This particular drug targets the veloping research ― that teaching kids how to adjust their behavior ing what they have learned.
known example. Less than 5% of women advised to take chemopre- creation of a protein that carries cholesterol. If eventually approved and cope is a powerful tool alongside medications that help but can’t
vention drugs actually do, however, because the side effects can ini- by the Food and Drug Administration, the drug could help lower a entirely do it alone. Each day at the camp consists of a brief morning JOURNAL PUBLISHES ANALYSIS OF KU MEDICAL ALUMNI
tiate or aggravate their menopausal symptoms. Fabian said women specific type of cholesterol found in the blood, which in turn lowers session where counselors go over the behavioral goals and plan for ASSOCIATION’S FUND FOR TEACHING EXCELLENCE
most likely to be interested in taking chemoprevention medicines the risk for life-threatening conditions. The new drug, referred to the day. Students have about two hours of classroom time, where A history and analysis of the KU Medical Alumni Association’s
are in their mid-40s to early 60s ― the peak time for menopause as APO(a)-I, affects a particular lipoprotein within the body called they’ll work on academic materials while learning appropriate class- Medical Alumni Innovative Teaching Fund (MAITF) program
transition, where 75% of women experience hot flashes and night lipoprotein(a), also known as Lp(a). Lp(a) is a close cousin to LDL, room behaviors. Several sports drills and games will take place each was published in the academic journal Medical Science Educator:
sweats. For many, menopause symptoms are severe enough to in- since it causes similar problems. But unlike LDL, this particular li- day, giving children additional opportunities to practice social skills The Journal of the International Association of Medical Science
terfere with their quality of life, and women are not likely to take a poprotein can’t be managed by lifestyle changes, such as quitting and behavioral goals. Educators. The fund provides grants to KU School of Medicine
medicine that might worsen them. smoking or starting and maintaining an exercise program. Since professors who need money to pursue a specific project that might
Lp(a) contains LDL, it can cause atherosclerosis, but it can also in- CLINICAL TRIALS HOPE TO INCREASE TREATMENT be difficult or impossible to fund through more traditional avenues.
EIGHTH COMMUNITY COLLEGE JOINS NURSING crease blood clots and inflammation. OPTIONS FOR STROKE PATIENTS Giulia A. Bonaminio, Ph.D., senior associate dean for medical edu-
PARTNERSHIP PROGRAM Researchers at the University of Kansas Medical Center are testing cation, co-authored the Medical Science Educator article with five
The University of Kansas School of Nursing welcomed Cloud County GRANT SUPPORTS ADVANCE PRACTICE NURSES IN the boundaries of stroke care with their participation in two inter- KU School of Medicine colleagues and investigated the prevalence
Community College to the school’s Community College Nursing RURAL AND UNDERSERVED AREAS national clinical research trials that could lead to more treatment of funding for medical education. Bonaminio said research showed
Partnership, the eighth community college in the state to join the in- Advance practice nurses will have an opportunity to gain addi- options for stroke patients and an expanded window of time to treat that nationally, 70% of medical education research projects went
novative program. The Community College Nursing Partnership al- tional training in rural and underserved areas with support from them effectively. KU Medical Center is one of 99 sites worldwide for unfunded, and the 30% that did receive funding were often un-
lows students to enroll in both community college and the KU School a nearly $2 million grant from the Health Resources and Services the TIMELESS study, funded by Genentech, looking at the effective- derfunded. In the 10-year history of MAITF, the program has dis-
of Nursing to receive both an associate degree in nursing (ADN) Administration (HRSA). The University of Kansas School of ness of treating patients with a clot-busting drug within 4.5 to 24 persed $1 million to fund 69 different projects. Funding for these
and a bachelor of science in nursing (BSN). Face-to-face courses are Nursing is using the four-year grant to fund a post-doctoral fel- hours of the onset of stroke symptoms. Meanwhile, in the SELECT 2 research projects came from the University of Kansas Medical
completed on Cloud County Community College’s main campus in lowship program for recent graduates of doctor of nursing practice study, KU Medical Center is one of 30 sites around the world testing Alumni Association.
Concordia, Kansas, a community 50 miles north of Salina, Kansas. (DNP). Cara Busenhart, Ph.D., CNM, APRN, FACNM, clinical assis- the effectiveness of performing thrombectomies, the surgical remov-
Classes from the KU School of Nursing are offered online, allow- tant professor in the KU School of Nursing and project director for al of blood clots, in stroke patients with ASPECT scores between 3 EIGHT KU MEDICAL CENTER PROGRAMS MAKE THE
ing students to remain in their home communities for the extent of the post-doctoral fellowship program, said the fellows might come and 5 and/or a core infarct size of greater than 50 cubic centimeters, TOP 50 IN U.S. NEWS AND WORLD REPORT
their enrollment and practice clinical skills in nearby medical centers. from various specialties, including nurse practitioners in family both of which are a greater amount of tissue damage than previous- The University of Kansas Medical Center had 8 graduate programs
KU faculty members have worked with the community colleges to de- practice, pediatrics and primary care, or other specialties such as ly thought treatable as shown on advanced perfusion imaging. Both ranked in the top 50 among public universities in the latest rank-
velop a curriculum that contains all the necessary elements required nurse-midwife or women’s health. For one year, the fellows will TIMELESS and SELECT 2 will be conducted in acute care settings. ings from U.S. News and World Report. The programs making the
to sit for nursing licensure. By taking advantage of resources that are balance didactic learning with clinical practice in primary care. Anyone who comes to the Emergency Department at The University top 50 included: Physical Therapy (#6); Speech-Language Pathology
already in place at the community colleges, the program is designed The first fellowships were awarded in the fall of 2020. The School of of Kansas Health System or who is transferred to the health system (#6); Occupational Therapy (#9); Audiology (#10); Nursing-Midwifery
to be completed in four years (including summers). Students pay tui- Nursing’s primary clinical partner in the grant is The University of with stroke symptoms may be eligible for participation in the stud- (#11); Family Medicine (#14); Medicine-Primary Care (#22); and
tion to the respective school through which a course is offered. Kansas Health System. ies with KU Medical Center if inclusion criteria are met. Medicine-Research (#31).
6 Kansas Medicine+Science Spring/Summer 2021 7
In the first episode of the television series
Star Trek: Voyager, the starship’s chief med-
ical officer is killed, and the crew is forced
to rely on an Emergency Medical Hologram
— an artificial intelligence programmed with
all known medical knowledge — for med-
ical care. That is how a software program
became a major character in the show.
Of course, Voyager flew missions to far-
flung galaxies in the 24th century. Here on
present-day Earth, health care professionals
are just beginning to tap into the full po-
tential of artificial intelligence (AI) in med-
icine. At the University of Kansas Medical
Center, researchers from the Department
of Otolaryngology, Head and Neck Surgery
are leading projects that incorporate AI into
clinical care and research.
In one project, a computer program may be
able to diagnose cancer just by “seeing” it in
a photo. In another, software may be able to
a predict a debilitating brain disease by ana-
lyzing someone’s sense of smell. The success
of these projects is dependent on partner-
ships with computer programmers, hours of
testing and a mountain of data.
CATCHING UP TO COMMERCE
Andrés M. Bur, M.D., assistant professor
in the KU Department of Otolaryngology-
Head and Neck Surgery, is a devoted dis-
ciple of both medicine and technology. He
graduated first in his class with a bachelor’s
degree in electrical engineering before en-
tering medical school.
“I have always been interested in finding
F ROM
ways to combine my technical interests
and my expertise in health care,” Bur said.
“With advances in computing in recent
years, we have seen an explosion in artifi-
SCIENCE FICTION
cial intelligence in making better predic-
tions and in helping us make better deci-
sions for the patient.”
A subcategory of AI called machine learn-
ing has been especially explosive. Machine
learning is dependent on massive amounts
UNIVERSITY OF KANSAS RESEARCHERS
TO
of data being fed into a computer algorithm
ARE USING ARTIFICIAL INTELLIGENCE that identifies patterns within the data
TO BRING FUTURISTIC IDEAS to make predictions when provided with
new data.
SCIENCE
TO PRESENT DAY
Machine learning is how social media apps
like Facebook and Instagram can identify
the names of individuals in posted photo-
BY ANNE CHRISTIANSEN-BULLERS graphs. By using on an algorithm that dis-
tinguishes facial characteristics and their
relation to each other, facial recognition
can also be implemented as a security fea-
ture, such as access to a cell phone or to a
secure facility.
Spring/Summer 2021 9
Machine learning is also behind the algo- division of the National Institutes of Health, A patient begins by smelling a middle con- Could the algorithm put the Alzheimer’s
rithms of online shopping. The more a com- to fund the project. They will need to figure centration of a scent and indicating wheth- patient’s results with the results from the
puter discovers about your previous shop- out how to overcome one big complication: er they can smell it, and if so, identifying it. other Alzheimer’s patients in the group?
ping habits, the more it can suggest items the fact that the larynx moves. By virtue of Answers are recorded, and the patient will Would the same happen for the other
you might buy in the future. its function, it opens for breathing and clos- be presented with either stronger or weaker two groups?
es to keep food out. It performs anatomic scent concentration in subsequent rounds,
Bur’s machine learning project involves magic that causes the vocal cords to vibrate. depending on if their responses were cor- In this initial stage, the machine learning
more than 50,000 images of the larynx, or rect or incorrect. program scored a B+, with an accuracy rate
voicebox, gathered from the clinical practic- Movement wasn’t a variable in the classifi- of 87%. With such a small sample, more re-
es of physicians in his department. cation of colorectal-polyps. But Wang said Villwock is interested in building the da- search will need to be done, but Villwock is
larynx images and colonoscopy images still tabase that will help us understand which excited about the potential of the AROMA
In partnership with Guanghui Wang, Ph.D., share common features. patterns of specific sense-of-smell problems system and a tweaked algorithm.
former associate professor for electrical signal a corresponding medical problem.
engineering and computer science at the “The results we achieved in the colonosco- Tests are already on the market to detect
University of Kansas in Lawrence, Bur is de- py project will greatly benefit our research “Let’s say I’m giving you a rose concentration, Alzheimer’s disease, Parkinson’s disease
veloping a machine-learning program that in the larynx-image analysis,” Wang said. and you say, ‘Yes, I smell it,’ but then you and diabetes, and Villwock doesn’t see the
can identify the presence of a lesion and, if “This is a very interesting topic to me since say, ‘I smell licorice.’ Well, that’s incorrect. AROMA test and algorithm replacing these
present, classify lesions into set categories. I am working on many machine-learning But what does that incorrect answer mean?” tests. Instead, she’s attempting to create a
projects with applications in object detec- test that could be given easily, even at home,
“Essentially, we are trying to have the ma- tion and classification.” What if the wrong answer ― or the inabili- as an early indication of trouble.
chine recognize if there is something abnor- ty to smell a certain scent at all ― could be
mal in the image, locate it within the image, USING AI TO DIAGNOSE mapped out so that it signals something to Imagine if such a kit had been available for
and then classify it. Is it cancerous? Benign? NEUROLOGICAL DISEASE your doctor? You smell licorice? That has purchase during the COVID-19 pandemic.
Or is it some other type of noncancerous dis- While Wang and Bur’s larynx project gets been proven to be a sign of fill-in-the-blank. One well-known symptom of the coronavi-
order?” Bur said. its dataset from visual images, Jennifer Villwock’s first job is to find what goes in rus is a loss of sense of smell, and Villwock
Villwock, M.D., is creating data based on that blank, but she will need enormous is currently working to quantify olfactory
The program builds on the algorithm Wang smell, not sight. Villwock, an associate amounts of patient data to do so. And that is dysfunction in subjects who have a high
created to detect and classify polyps from professor of rhinology and skull-base sur- where machine learning helps. likelihood of contracting COVID-19.
the inner lining of the colon and the rectum. gery at KU, is working towards a day when
These polyps can develop into colorectal a quick, noninvasive test of one’s sense of “There are all these different permutations If Villwock’s research had been farther
cancer, the third-most diagnosed cancer in smell could signal the presence of a chron- of possible answers. So maybe it’s not lic- along, and the data on the coronavirus
the United States. ic disease such as Alzheimer’s disease, orice, but another wrong answer. We want patients already known, sniffing a few
Parkinson’s disease or diabetes. to be able to track the answers and classi- lipstick-like vials could have been an ear-
Working with Ajay Bansal, M.D., KU associ- fy them and then decipher meaning from ly warning someone had contracted the
ate professor of gastroenterology, and Amit Villwock’s hypothesis is that as these them,” Villwock said. “That would be dif- disease. A definitive test would still be
Rastogi, M.D., KU professor of gastroenter- chronic diseases progress, patterns emerge ficult using traditional statistical methods, required, but AROMA and the algorithm
ology, Wang developed a machine-learning in olfactory decline, or the degree to which but machine learning is great for that type could confirm initial suspicions.
program using 157 video sequences from a person loses the sense of smell. It may of complex data.”
colonoscopies as the dataset. be in only a specific scent ― say, rose or “One of the reasons people lose their sense
citrus ― but the decline would be predict- So, how would one go about building that of smell with a viral illness is because the
According to their published paper, the able and could be compared to known pat- smell-problem database? The first step loss is your body’s own protective mech-
computer learned to successfully classi- terns of olfactory decline in people with a would be to test participants with known anism. Because your olfactory nerves
fy two types of polyps with an accuracy certain disease. medical concerns to see if the machine-learn- come down from your brain, they are a
comparable or better than reported among ing algorithm could classify them correctly. direct conduit from your sinonasal cavity
gastroenterologists. In other words, the ma- “If we had a reliable way of tracking smell, Villwock conducted a study of 81 clinical to your brain,” Villwock said. “So, one of
chine-learning “doctor” could classify two that could help us potentially make trial participants, with 24 participants with the thoughts is that your body shuts down
types of polyps as well as a flesh-and-blood, clinical decisions,” Villwock said. “We mild cognitive impairment, 24 participants those nerves. It’s saying, ‘Let’s head it off at
human specialist could. know that sense of smell is something that with Alzheimer’s disease and 33 partici- the pass.’”
can be objectively measured ― the litera- pants with no cognitive impairment.
Bur is hoping for similar successful result ture supports that — so we want to devel- So, how do other viruses affect the sense of
from their larynx project. He foresees a day op a way to measure that is cost-effective All participants gave feedback in response smell? And at what stage of the illness does
when the machine learning program they and accessible.” to smelling the AROMA vials, and a portion olfactory dysfunction happen? Again, there
develop could be the second opinion for of those responses ― about 80% ― were fed are more questions than answers right now,
rural doctors. To achieve that goal, Villwock worked with into a computer algorithm with its group but Villwock sees machine learning as a big
a team from KU Medical Center to create a information (Alzheimer’s, impairment or part of the process.
“There is a lot of potential to be able to help patent-pending “smell kit.” The Affordable control). This process essentially taught the
support clinicians, especially those living in Rapid Olfactory Measurement Array (with computer program what to look for when as- “When you have a methodology that is gen-
more rural communities where they may not the aptly named acronym of AROMA) in- signing a person’s AROMA results to a par- erating a ton of data, it becomes very cum-
have access to sub-specialty care,” Bur said. cludes small plastic vials that resemble lip- ticular group. The remaining 20% of AROMA bersome to analyze via traditional statis-
stick tubes. These tubes contain a medium responses were then input to test how well tical models,” she said. “And that’s where
Bur and Wang recently received a $150,000+ that holds different concentrations of es- the machine-learning program could classify the strength of machine learning comes
grant from the National Cancer Institute, a sential oils in different scent families. them into the proper group. into play.”
Andrés M. Bur, M.D. Jennifer Villwock, M.D.
10 Kansas Medicine+Science Spring/Summer 2021 11
What does it mean to be a nurse? That question is front and center in a national discussion on the professional
identity of nursing, and the University of Kansas School of Nursing is helping to lead that conversation. Nelda
Godfrey, Ph.D., RN, ACNS-BC, FAAN, associate dean of innovative partnerships and practice at the KU School
of Nursing, has been exploring what it means to be a nurse for much of her career, teaching professional identi-
ty courses at the KU School of Nursing and researching the concept of professional identity formation. We sat
down to talk to Godfrey about the importance of defining what nursing is.
WHY EXPLORE PROFESSIONAL IDENTITY FOR THE IT WOULD ALSO SEEM THAT PROFESSIONAL IDENTITY
NURSING PROFESSION? FOR NURSING COULD BE HARD TO DEFINE BECAUSE
NURSING IS SUCH A BROAD AND DIVERSE FIELD.
It’s something that has been discussed pretty much since Florence
Nightingale’s time. She understood from the beginning that nurses Without question. There are more than 100 different nursing spe-
needed to be more than those who perform tasks ― they also need- cialties and trying to find what’s common among all of them is
ed to contemplate what it means to be a nurse. The challenge is that a challenge. The good thing is that nurses in all of these various
nurses spend the majority of their time DOING rather than BEING. specialties are interested in exploring their professional identity.
They have tended to be invisible and silent, but that is changing. The three specific areas we are looking at are regulation, edu-
cation and practice, which all nurses have in common. And we
HAS NURSING BEEN BEHIND THE CURVE WHEN also consider the four pillars of nursing professional identity ―
IT COMES TO EXPLORING AND DEFINING PROFES- values and ethics, knowledge, leadership and comportment ― to
SIONAL IDENTITY? guide our discussions.
Definitely. If you ask a physician or a minister what it means to
WHAT ARE YOU HOPING TO DO WITH ALL THE DATA
work in one’s profession, they most likely will have a strong opin-
YOU GATHER?
ion. Nursing has been an academic field for quite a while, but we ha-
ven’t spent as much time exploring identity like many other fields. We are currently in the process of building a language and ter-
But now nursing education has evolved from training classes based minology around professional identity for nursing. And as we do
primarily in hospitals to a full-fledged bachelor’s degree, master’s that, our task force is working on building awareness about our
degrees and multiple doctorates. It’s time to have these discussions. efforts and encouraging nurses to think more deeply about what
they do. I am also interested in taking the data we have gath-
WAS THERE A PARTICULAR CATALYST THAT GOT YOU ered and using it to push for a professional identity component
INTERESTED IN THIS ISSUE? in nursing education curricula across the country.
I have a broad academic background in liberal arts, so I have spent
YOU RECEIVED A $5,000 INNOVATION GRANT TO
many hours discussing philosophical issues with college students
HELP WITH A PILOT PROJECT IN HOSPITALS IN
from all majors. I‘m very passionate about helping the nursing
KANSAS. CAN YOU EXPLAIN THAT PROJECT?
profession develop a philosophy and language to clearly com-
municate what we do. I have long felt that if nurses focus solely We’re very excited about it. It’s a demonstration project at up
on the tasks they are assigned and their patient outcomes, we are to 15 schools of nursing and hospitals in Kansas to present our
missing the broader picture of nurses and their contributions to ideas around professional identity to nurses, but also listening
their health care teams and to society at large. and recording what they think about the process. We hope to
eventually expand the project to Missouri and nationally at
HOW ARE YOU GOING ABOUT GATHERING INFORMA- some point.
TION ABOUT PROFESSIONAL IDENTITY?
I WOULD ASSUME THAT EDUCATING THE PUBLIC
In 2019, we invited more than 50 nurse leaders and nurse educa-
ABOUT WHO NURSES ARE AND WHAT THEY DO IS
tors from all over the United States and Canada to Kansas City to
PART OF THE PROCESS?
discuss professional identity in nursing. This group of leaders has
essentially become the think tank to advance concepts and ideas Absolutely. Public perception of the nursing profession is critical.
QUEST10NS
that will lift professional identity into conversations and ultimate- Once we figure come up with a consensus on professional iden-
ly, into nursing curricula, across the nation. In 2020, we hosted tity, we need to communicate that to not just our nurses, but also
an international virtual forum on professional identity in nursing, to patients and the public.
again with more than participants and an active work agenda to
advance professional identity in nursing. WHAT IS YOUR DREAM END RESULT FOR ALL YOUR
WORK AROUND PROFESSIONAL IDENTITY?
IS IT A CHALLENGE GETTING A CONSENSUS AROUND I would love for every health care institution in the country
SUCH A COMPLICATED ISSUE?
to create the space for its nursing staff to discuss what pro-
10 QUESTIONS WITH NELDA GODFREY It is very tough. When you ask 50 leaders from nursing organiza- fessional identity means, both generally and specifically for
tions across the United States and Canada what professional identi- their organization. And I hope that the key components of pro-
ty for nurses should be, you will most likely get 50 different answers. fessional identity will be used in evaluation, recognition and
But we are starting to come up with a shared terminology and build- communication about how one thinks, acts and feels as a pro-
BY DONNA PECK
ing the new knowledge and language that we can take forward. fessional nurse.
12 Kansas Medicine+Science Spring/Summer 2021 13
BURNOUT IN MEDICINE WAS AN ISSUE
LONG BEFORE A GLOBAL
HEALTH CRISIS CAME ALONG.
BY KRISTI BIRCH
ILLUSTRATION BY CHAD HAGEN
Spring/Summer 2021 15
All her life, Karen Little has been an achiever. After graduating as navirus reached the United States just one month later — and the
salutatorian of her high school class in Chicago, she was a student mainstream news media began to report on overworked and over-
athlete and an aspiring musician in college before deciding to pur- whelmed frontline health care workers — it underscored the impor-
sue her interest in science and go to medical school. When she com- tance of having a workforce not already at the breaking point.
pleted her residency and fellowship training and launched her ca-
reer as a physician at The University of Kansas Health System, she Burnout is not always the result of simple exhaustion or lack of per-
brought with her the same zeal and drive that had already helped sonal time caused by pandemics or chronic overwork. Sometimes
her accomplish so much. burnout is the product of moral injury: the distress experienced by
someone forced into working in a way that violates their values.
“I was always looking forward to what I was going to do and who I
was going to see that day,” she said. “I had a lot of energy.” Jessica Gay, MSN, a clinical assistant professor in the KU School of
Nursing, remembers how happy she was working at a hospital in
But a dozen years later, that energy left her. Little, who preferred Texas, until she was moved to a different department with horrific
that her real name not appear in this article, found herself dreading nurse staffing levels.
leaving home for work each morning.
“I lived in fear of losing my license and of harming patients all the
“I just felt overwhelmingly exhausted,” she said. “On more than one time,” she said. “And it was tragic, because I had been doing that job
occasion, I remember driving into the parking lot and sitting there for years and I loved it.”
crying in my car, thinking, ‘I can’t do this anymore.’ By the end of
the week, after seeing a lot of patients, I had nothing left.” “I have heard it said that burnout is not a crisis of time, it’s a crisis of
spirit,” noted Nelda Godfrey, Ph.D., FAAN, associate dean of inno-
Little was suffering from burnout, a state of chronic, employment-re- vative partnerships and practice at the KU School of Nursing. “And
lated stress that causes people to become so physically and emotion- I believe that.”
ally exhausted that they develop negative feelings, detachment or
even cynicism toward once meaningful work and sometimes also IT’S ALL ACADEMIC
lose their sense of personal accomplishment. Burnout is often com- At KU Medical Center, the problem of burnout is especially complex
pounded by obligations and responsibilities outside of work, espe- because academic medical centers have a diverse mission and em-
cially for women, who tend to do more work at home and have high- ploy and educate a variety of health care professionals. News and
er rates of burnout. research about burnout have focused largely on doctors and nurses,
but burnout is an issue for all the health care professionals who work
Little didn’t know what ailed her because at the time, burnout and train at KU, including physical, occupational and respiratory
wasn’t a problem many health care professionals talked about. therapists and laboratory scientists who conduct medical research.
But in recent years, even before the COVID-19 pandemic called
on health care workers to save the world, burnout among doctors, And those who choose careers in academic medicine do much
nurses and other health care workers had been making headlines more than provide care. In addition to taking care of patients at
as a public health crisis. The University of Kansas Health System or elsewhere, KU Medical
Center faculty teach courses, train interns and residents, conduct
Though not technically a disease or disorder, burnout is linked to medical research, serve on committees, take on leadership pub-
cardiovascular disease, substance abuse and depression. It can even lic health roles within the community or some combination of the
lead to suicide, usually in those who also have depression: nurses above. Many go into academic medicine because of that variety, but
and doctors, especially women, have substantially higher rates of juggling competing priorities can be a challenge.
suicide than the general population. Burnout can also increase the
risk for medical errors, decrease patient safety and lead to poorer Richard Korentager, M.D., a plastic surgeon and chair of the
health outcomes and patient dissatisfaction. Moreover, when burn- Department of Plastic Surgery at the KU School of Medicine, said
out drives practitioners to leave their professions, not only does the there are times when it can seem impossible to juggle all the de-
turnover compound the national shortage of providers, it also drives mands of academic medicine.
up health care costs because of the expenses incurred to recruit new
employees and the revenue lost during the gap. “You have all these multiple jobs, and the health system is telling you
to do one thing and the school tells you to do another, your faculty
In October 2019, the National Academy of Medicine (NAM) released is saying something else, your residents are saying another thing,
a 334-page report on clinician well-being stating that between one- and you’re desperately trying to get everybody the resources they
third and one-half of all U.S. nurses and physicians have symptoms need,” he said. “Meanwhile, you haven’t had a date night with your
of burnout. In January 2020, Medscape published a study in which wife in six months. When you get to the point where you’re starting
half of all doctors surveyed said they were willing to take a pay cut to feel like it all doesn’t matter, that’s when you realize you’re getting
in exchange for better work-life integration. When the novel coro- burned out.”
Richard Korentager, M.D.
16 Kansas Medicine+Science Spring/Summer 2021 17
At the same time, doctors and nurses especially are expected to Some of the trouble spots revealed were predictable: cli- Many contributors to burnout are the result of systemic changes to
be resilient, competent and wholly devoted to their professions. nicians cited the volume of patient care and dealing with health care. EMR systems, which replaced paper patient charts and
Even those who suspect they have a mental or emotional prob- electronic medical records (EMR) as top stressors, while are mandated by federal law, are often so large and cumbersome
lem often do not seek treatment for fear of having to report the researchers cited securing funding. As they are around the that they gave rise to the term “pajama time” to describe the hours
diagnosis on their licensure applications and potentially jeopar- country, burnout rates were higher for women, who shoul- providers spend feeding information into them at home after dinner.
dize their ability to practice. Burnout is for wimps. There might der more domestic responsibilities at home on top of their And then there’s the way physicians are paid now, not with a salary
be no better example of this mindset than a physician’s residency, careers. “In addition, women tend to spend more time with but according to a fee-for-service methodology created by Medicare
the period after medical school when a new doctor trains in a their patients, which is not always accommodated in clinical that rewards them for doing more procedures and seeing more pa-
particular specialty. scheduling, and frequently are dealing with issues of gender tients rather than the amount and quality of time that they spend
bias,” said Kim Templeton, M.D., professor of orthopedic sur- with patients.
Korentager remembers a three-month neurosurgery rotation gery at KU Medical Center and nationally known expert on
during his residency in Toronto in the late 1980s. gender differences in burnout. But in those early days, burnout was thought of largely as an indi-
vidual problem requiring individual solutions. People were encour-
“I was the only resident. I was on call every day for three months The biggest organizational culture problem the respondents aged to get more exercise, meditate, do yoga and attend workshops
and probably averaged three hours of sleep a night,” he said. “When identified was leadership, especially leadership that com- and webinars on stress management, all with the goal of improving
I got mono and splenomegaly diagnosed by the chief of medicine, I municated poorly or failed to recognize good work. Godfrey their own personal resilience.
got 24 hours off, and then I was right back in the call schedule.” noted that research shows that good leadership is especially
That kind of grind was far from uncommon in those days, but few
“Burnout is more than critical for nurses; strong nurse managers are associated with
healthy work environments as well as better health outcomes
These sorts of programs are offered to residents, as well as all
students at KU Medical Center, through the Counseling and
dared to complain. Terry Tsue, M.D., the Douglas A. Girod Endowed
Professor of Health and Neck Surgical Oncology at the KU School of
just a workload thing. for patients. Educational Support Services office. And they can be very helpful
coping mechanisms.
Medicine and vice president of physician services at The University
of Kansas Health System, did his residency in Washington State
It’s also about, am I Those surveyed also complained about not feeling like they had
enough autonomy to be able to change processes that needed fixing What they cannot do is address systemic root problems, such as high
around the same time. valued, and am I part or even to control to their own schedules. nurse-to-patient staffing ratios, cumbersome EMR systems, fierce
competition for research funding and a national model of compen-
“It was like the stigma of mental illness, which is wrong. You didn’t of a community where “People who work in academia are problem solvers, independent sating physicians that rewards quantity of services rather than qual-
talk about it because it would mean you were weak,” he said. “And thinkers,” said Jeff Radel, Ph.D., associate dean for academic and stu- ity of care.
it was something you did as an investment for your future. It was a my perspectives are dent affairs in the Department of Occupational Therapy Education
rite of passage.” at the KU School of Health Professions. “Burnout is more than just a Even the word burnout implies that the problem is the individual’s
considered?” workload thing. It’s also about, am I valued, and am I part of a com- failing, which is one reason that many, including Godfrey, prefer to
INSTITUTION, HEAL THYSELF munity where my perspectives are considered?” frame the issue more positively in terms of clinician well-being.
For the past several years, leaders at the University of Kansas Medical
Center have been working, in collaboration with The University of JEFF RADEL, PH.D. “There’s an awareness now about the problem. And we have a sense After all, people who go into medical fields are already a relative-
Kansas Health System and The University of Kansas Physicians, to of its various components, of pre-burnout and burnout,” said Tsue. ly tough bunch. Just getting into school and surviving the train-
help promote more work-life integration, a healthy work environ- Associate Dean for Academic and Student Affairs “But we’ve got a lot of work to do. Changing culture takes time.” ing takes more than a little resilience. The same is true for labo-
ment and, ultimately, wellness for the professionals who protect the Department of Occupational Therapy Education ratory scientists, employed at academic medical centers to conduct
health of the rest of us. KU School of Health Professions IT’S THE SYSTEM the basic research behind new drugs and treatments. Many of
A guest speaker at that 2017 faculty retreat was Tait Shanafelt, M.D., these scientists never treat patients, but they’re also at risk for
In 2017, Leland Graves, M.D., then president of the faculty council, Stanford’s chief wellness officer, the first such position at an academ- burnout, largely because of the intense pressures of getting their
presented the results of a wellness survey conducted among phy- ic medical center designed to improve clinician well-being. research funded.
sicians and non-physician faculty at the KU School of Medicine
faculty retreat. The survey was composed of an abbreviated Twenty years ago, when he a senior resident at the University of Consider the tenacity of a basic scientist such as Tomoo Iwakuma,
form of the Maslach Burnout Index, the standard instrument Washington, Shanafelt started questioning the culture of medicine M.D., Ph.D., a professor in the Department of Cancer Biology at
used to measure burnout, as well as the Expanded Well- when he noticed other residents becoming cynical. KU Medical Center.
Being Index for Physicians, to assess work-life integration
and meaning in work. “I remember observing the distress among the interns on the team, Before he became a researcher, Iwakuma was an orthopedic surgeon
their reaction to another admission and even some of the things they treating bone and soft tissue cancer patients in Japan. Too many times,
The survey indicated that the rate of burnout among all would say,” he said in a 2019 video interview. “The way they were he watched patients die when there were no more treatment options.
faculty at the KU School of Medicine is lower than it is reviewing their work or viewing patients was in some ways just in-
for physicians nationwide, and that 86% percent find congruent with what I knew they stood for as people and why they “I couldn’t stand it,” he said. “Doctors are supposed to help cure the pa-
their work meaningful. But there were also concerns. went into medicine.” tient. I wanted to be able to give hope to the patient. That’s my dream.”
Between 53% and 61% of faculty ages 35 to 55 were at
high risk for burnout. And nearly 40% of all faculty In the early 2000s, Shanafelt published the first study connect- Iwakuma gave up his relatively lucrative career, earned a doctorate
disagreed with the statement, “My work schedule ing clinician well-being and quality of care and became a major in molecular genetics and took a job at Louisiana State University so
leaves enough time for my personal/family life.” thought-leader on burnout. he could do the research necessary to create new treatments.
18 Kansas Medicine+Science Spring/Summer 2021 19You can also read
