This is an exciting yet demanding time for American health care. An aging population will put new strains on our capacity to meet future needs, and the rapid emergence of powerful new treatments challenges our ability to deploy them as they become available. To do its part to address these issues, the Health System unveiled the Decade Plan, the first joint strategic plan to cover all areas of the Health System. Titled "Models for All of U.S.," the plan has proven an effective guide to advancing medicine and delivering it at the bedside.

An essential part of this vision is the physical development of the Health System. Plans call for the construction of a new Clinical Cancer Center, a new multidisciplinary Children’s Outpatient Center as an integral part of the U. Va. Children’s Hospital, and a core clinical laboratory, among other projects. We are planning a new companion building to be constructed in proximity to McLeod Hall, home of the School of Nursing, and with a challenge grant from the Claude Moore Charitable Foundation, a new medical education building. Funding is largely in place for Medical Research Building 6, thanks to a combination of state and University resources and donor support, including a generous new commitment from the Harrison Family Foundation. This facility will address the growing need for laboratory space.

Construction is well under way on a hospital addition and other projects that will add up to 130,000 gross square feet to the Medical Center and will bring its total operating rooms to twenty-four. Thorough renovations of the first and second floors of the hospital will help to accommodate patients using heart and vascular, perioperative, and interventional radiology services. The expansion effort is expected to be completed in 2006.

The Medical Center remains strong financially, achieving a consistent operating margin of 5 percent. To continue to perform at this level over the long term, it will commit 9 percent of its budget over the decade to upgrading its equipment, facilities, and information technology, in addition to funds devoted to the expansion now under way. This steady infusion of resources is on a par with the best of the Medical Center’s peer group.

Dr. Richard Guerrant, director of the Center for Global Health, visits a home with nurse Sayonara Sadio Bezerra de Alancar in Fortaleza, Brazil.y

BUILDING ON A SOUND FOUNDATION
Consistently rated among the best hospitals in the nation, the University Medical Center was named a top-100 cardiovascular hospital by Solucient. U.S.News & World Report placed nine of the University’s medical specialties in the top forty. The School of Medicine entered the top twenty-five in the annual U.S. News & World Report survey, its highest ranking ever. The School of Nursing’s master’s program ranks twenty-sixth nationally. Another three specialty nursing graduate programs are in the top ten. In addition, the Nursing School has risen to number sixteen in National Institutes of Health funding for nursing research.

Jeanette Lancaster is president-elect of the American Association of Colleges of Nursing.

These rankings reflect the work of faculty and staff who are frequently singled out for their excellence as clinicians, researchers, educators, and leaders in their professions. In October 2003,Dr. Richard Guerrant, the Thomas Harrison Hunter Professor of International Medicine, was elected to the Institute of Medicine of the National Academies, the highest honor for a medical researcher. Dr. Guerrant directs the University’s Center for Global Health, which received a generous challenge grant from the Ellison Medical Foundation this past year to expand its efforts to combat disease in the developing world.

Dr. Michael Thorner, the Henry B. Mulholland Professor of Internal Medicine and a leading endocrinologist, was designated a master of the American College of Physicians, and Dr. John Jane, the David D.Weaver Professor of Neurosurgery, was given the Cushing Medal, the highest award of the American Association of Neurological Surgeons. Other faculty at the forefront in their professions include Dr. Edward Laws, the W. Gayle Crutchfield Professor of Neurological Surgery and president-elect of the American College of Surgeons; Jeanette Lancaster, the Sadie Heath Cabaniss Professor and dean of the School of Nursing, who is presidentelect of the American Association of Colleges of Nursing; and Dr. Paul Mintz, director of clinical pathology, and now president of the American Association of Blood Banks. Dr. Arthur Garson, Jr., vice president and dean of the School of Medicine, serves as chair of the National Advisory Council for Healthcare Research and Quality of the Agency for Healthcare Research and Quality, while R. Edward Howell, vice president and chief executive officer of the Medical Center, co-chairs the National Institutes of Health Advisory Board for Clinical Research.

Comfort with Quality The $1.25 million renovation of the Cancer Center’s Infusion Center captures our new vision of cancer care. In a soothing environment that promotes comfort and dignity, our patients receive the most advanced treatments available today. For example, the Medical Center is one of the first in the nation to use a new diagnostic technology, molecular cytogenetics, to map key areas of DNA in brain tumors. As a result, doctors can prescribe the chemotherapy regimen that is best for each patient. Dr. Peyton Taylor, clinical director of the Cancer Center, with benefactor Trudy Peyton at the Infusion Center dedication

Catherine Kane, associate professor of nursing, won the 2004 Education Award from the International Society of Psychiatric Nursing. Courtney Lyder, the University of Virginia Medical Center Professor of Nursing and professor of internal medicine and geriatrics, was the first nurse to give the Bernard Hornberg Memorial Lecture on Chronic Wound Care at the University of Pennsylvania School of Medicine. A geriatric specialist, he also was the Visiting Minority Scholar for 2004 at the University of North Carolina’s School of Nursing.

Bristol-Myers Squibb Medical Imaging, Inc., paid tribute to Dr. George A. Beller, the Ruth C. Heede Professor of Cardiology, by making a gift to the Division of Cardiovascular Medicine to create a professorship in his honor. A renowned expert in nuclear cardiology, he is stepping down as chief of the division to return to full-time teaching, research, and clinical practice.

AT THE FOREFRONT OF DISCOVERY
The Health System is moving forward on a number of fronts to gain knowledge that can save lives. Dr. Davis Parker, Jr., the Eugene P.Meyer Professor of the Neurosciences, continues to make progress in linking errors in mitochondrial DNA to the onset of Alzheimer’s disease, offering tremendous hope for slowing or even curing the neurodegenerative disorder. Todd Stukenberg, an assistant professor of biochemistry and molecular genetics, has discovered how cells receive the correct number of chromosomes during cell division, a process that can lead to cancer and other diseases when it goes awry.

The promise of our basic medical research is evident in the generous grants received recently from the National Institutes of Health and other sources. The following are just the most prominent examples:
• Dr. Jerry Nadler, the Kenneth R. Crispell Professor of Internal Medicine, was awarded a $1.3 million grant for research on a gene potentially involved in damaging the insulin-producing islet cells of the pancreas.
• Robin Felder, professor of pathology, received a $10 million grant to further studies of the genetic basis for high blood pressure and salt sensitivity.
• Dr. Joel Linden, professor of cardiology and molecular physiology and biological physics, received a $7.4 million grant to uncover the molecular and cellular mechanisms responsible for inflammation in the lung during pulmonary injury.
• John Bushweller, associate professor of molecular physiology and biological physics, and Dr. Milton Brown, associate professor of chemistry, will share a five-year, $5 million grant from the Leukemia and Lymphoma Society to develop new targeted drug treatments for leukemia.
• The School of Nursing was awarded a $1.4 million grant to establish a Rural Health Care Center, to be directed by Elizabeth Merwin, associate dean for research.
• Viktor Bovbjerg, assistant professor in health evaluation sciences, was selected for a $3.5 million grant to study the effects of exercise and diet on type 2 diabetes.

New Talent in Health Care Dr. Bankole Johnson, at right, one of the world’s leading experts on addictions, has joined the University as chair of the Department of Psychiatric Medicine and professor of neurology. Dr. Johnson’s research has linked certain types of alcoholism with molecular abnormalities in the brain. Elsewhere in the Health System, Dr. Geoffrey Weiss, an internationally renowned cancer researcher, has been appointed chief of the Division of Hematology-Oncology and deputy director of clinical affairs and clinical research for the Cancer Center. Known for his studies of how the immune system may be marshaled to fight cancer, Dr. Weiss participated in the development of interleukin-2 as a standard treatment for advanced kidney cancer and for malignant melanoma, a serious form of skin cancer. Both Dr. Johnson and Dr. Weiss were at the University of Texas Health Sciences Center at San Antonio before coming to the University.

Our physician- investigators are capitalizing on advances in basic research to develop new diagnostic tools and treatments. Dr. Dan Theodorescu, the Paul Mellon Professor of Urology and professor of molecular physiology and biological physics, identified a gene whose activity correlates with the prognosis for bladder cancer, while Debra Lyon, an assistant professor of nursing, is investigating whether cranial electrostimulation can relieve depression in women undergoing chemotherapy for breast cancer. Cardiologist Christopher Kramer proved for the first time that magnetic resonance imaging can be used to identify the characteristic warning signs of a potential aneurysm. He received a $3.7 million grant to study diagnostic tools and drug treatment for peripheral arterial disease.

Other investigators pursuing new therapies, cures, and diagnostic methods include Dr. Milagros Huerta, assistant professor of pediatrics and co-medical director of the Children’s Fitness Clinic, who was awarded a $700,000 grant from the National Institute of Diabetes and Digestive and Kidney Diseases to search for the best treatment to prevent obesityrelated diabetes in children.Dr. Michael Williams, the Byrd S. Leavell Professor of Internal Medicine and professor of pathology, received $450,000 from the Lymphoma Research Foundation to develop new, more effective treatments for mantle cell lymphoma.

Improving Digestive Health The Health System is at the national forefront of efforts to combat inflammatory bowel disease, gastrointestinal cancers, and gastrointestinal infections. Dr. Fabio Cominelli, the David D. Stone Professor of Internal Medicine, leads a team that received a $6 million, five-year grant from the National Institutes of Health for a new Digestive Health Research Center. Combining basic science and clinical research, the center is one of only sixteen facilities of its kind in the nation and the only one in Virginia.

ADVANCES IN CLINICAL CARE
The Health System is acting swiftly to adopt innovations that can improve the lives of patients and their families. In the area of children’s health, we have expanded the child neurology program and the pediatric neurological surgery program, and we have enhanced the Pediatric Intensive Care Unit. The successful launch of Virginia’s first islet cell transplant program, which offers great promise for diabetics, demonstrates the Health System’s commitment to adopting and further developing advanced therapies. The program also provides a model for how generous philanthropic support can improve the delivery of medical care in our region.

In addition to receiving gifts from donors committed to fighting diabetes, the islet transplant effort has benefited from the endowment recently created by a $52.6 million planned gift from the late Ward Buchanan. Income from the fund is supporting a new program for chronic obstructive pulmonary diseases like asthma and chronic bronchitis; it also financed the equipment needed to perform wholebody stereotactic radiosurgery, a technique used to treat extremely small brain tumors with minimal radiation. The Buchanan Fund supports our Atrial Fibrillation Center, another area of innovation this past year. The Medical Center was the first in the United States to use a pacemaker approved by the Food and Drug Administration for atrial fibrillation and heart failure. We also are treating atrial fibrillation with new catheter ablation techniques that our own physicians have helped to develop. In another area of cardiology, our hospital is one of only two in Virginia approved to use mechanical left ventricular assist devices as a final treatment for people with end-stage heart failure.

New Hope for Diabetics A surgical team transplanted the islet cells into the patient’s liver, where they began to produce insulin. On June 3, a Charlottesville diabetic received the first islet cell transplant in Virginia, performed by a team led by Dr. Kenneth Brayman, professor of surgery and director of the Health System’s Center for Cellular Transplantation and Therapeutics. In the first of two procedures, the pancreatic islet cells were injected into a vein in the liver, where they attached themselves and began producing insulin, greatly improving the patient’s ability to control blood sugar levels. Immunosuppressant drugs kept her body from rejecting the transplanted cells. The new transplant program won the University a place in the National Institutes of Health’s prestigious Islet Cell Research Consortium and has received generous support from the Ward Buchanan Fund and the Islet Replacement Research Foundation, created by Paul and Diane Manning of Gordonsville, Virginia. A research team led by Dr. Jerry Nadler, chief of the Division of Endocrinology, and comprising Dr. Brayman and Dr. Zandong Yang, recently obtained a five-year NIH grant to help advance the transplant program. In addition, the Diabetes and Hormone Center of Excellence, directed by Dr. Nadler, has received major support from a number of donors, including Dickey Meade (McIntire ’67) and Elizabeth Meade of Richmond, Buford Scott (College ’55) and Susan Scott of Richmond, and Dennis Casey and Pamela Ruth Casey of McLean.

THE OUTLOOK FOR MEDICAL EDUCATION
As we continue to teach the core skills of the health professions, we are preparing students for an age in which robotic surgery, telemedicine, and molecular-based treatments will be the norm. A new course that epitomizes this approach is "Cells to Society," a three-day introductory program for first-year medical students. "Cells to Society" concentrates on a common disease as a way to illustrate the complex scientific and social issues that intersect in the course of modern medical practice.

As we join medical schools across the country responding to the Outcome Project of the Accreditation Council for Graduate Medical Education, we are looking anew at the way we train medical residents. The Medical Center has established the $1 million GME Innovative Grant Program, again made possible by the Buchanan Fund. This program is spearheading some twenty initiatives in such areas as competency-based education, duty hours, and the quality of work life for medical residents, setting the stage for additional funding from outside sponsors. The Health System also is taking the lead in developing innovative programs for nontraditional students.With a grant from the Department of Health and Human Services, the School of Nursing has created two-year online versions of its master’s degree programs in Leadership in Community and Public Health and Health Systems Management. These have proven especially valuable for health-care professionals in rural settings.