Posts from the ‘education’ category

Mummies Scanned at the Brigham Reveal Clues About Heart Disease

What secrets lie in the hearts of our ancestors? Signs of cardiovascular disease, for one, as a Brigham team of cardiovascular imaging experts recently helped discover.

Through a collaboration with an international team of researchers and anthropologists, Brigham faculty and staff performed CT scans on five mummies from 16th-century Greenland in the Shapiro Cardiovascular Center early last year. The team was looking for evidence of plaque in the arteries—also known as atherosclerosis—to see if the leading cause of death in the U.S. today was also prevalent centuries ago.

Sure enough, high-resolution scans of the mummified remains—belonging to four young adults and one child from an Inuit community—revealed telltale signs of the disease: hardened calcium deposits in various blood vessels in the chest.

“It’s always fascinating to look at humans who lived hundreds of years ago and see if learning about the past could teach us more about the present and future,” said Ron Blankstein, MD, associate director of the Brigham’s Cardiovascular Imaging Program, director of Cardiac Computed Tomography and a preventive cardiology specialist.

Blankstein was among the experts who scanned the mummies and interpreted the images last January, an event featured on National Geographic’s “Explorer” series this month. Other faculty and staff who helped conduct the scans included Kristen Burke, CT technologist; Marcelo Di Carli, MD, director of the Cardiovascular Imaging Program and chief of the Division of Nuclear Medicine; Abe Haboub, RT(R)(CT), cardiac CT manager; and Michael Steigner, MD, director of Vascular Imaging.

The effort was part of a broader project, led by a group of external researchers, to scan mummies from hunter-gatherer and preindustrial civilizations worldwide to search for signs of heart disease. The Brigham is one of several institutions to have participated and was approached based on the prestige of its cardiovascular imaging program, Blankstein said. 

Searching the Past

From Egypt to Mongolia and now Greenland, mummies throughout the ages have shown evidence of atherosclerosis. The Greenland mummies were particularly of interest due to their diet, which would have primarily consisted of fish and sea mammals.

While increased fish consumption is commonly touted as a heart-healthy diet—which may make the findings of atherosclerosis seem surprising—Blankstein emphasized that scientists still have much to learn about its exact relationship to cardiovascular health. For example, although it is known that consuming fish rich in omega-3 fats has benefits, some types of fish can also be high in cholesterol and, in the current era, contain toxins such as mercury or polycholrinated biphenyls (PCBs) that may pose some risk, he said.  

There could also have been lifestyle factors, such as exposure to cooking smoke in their dwellings, that contributed to the mummified individuals developing cardiovascular disease during their lifetimes, Blankstein explained.

With all that in mind—and the small sample sizes of these mummy scans—he noted that the team’s findings shouldn’t be taken too much to heart, so to speak.

“The question of whether fish is good or bad for you is still open-ended, and it would be unrealistic to think that we could provide a definitive answer by scanning a small number of mummies for plaque,” Blankstein said. “Our team found it fascinating that there was evidence of atherosclerosis despite the mummies’ estimated young ages, but this also doesn’t mean cardiovascular disease is inevitable. In fact, the majority of cardiovascular disease events that we see in patients is preventable with appropriate diet, weight control and lifestyle changes, such as regular exercise; at times, medication can also be used to treat various risk factors.”

A Different Kind of Patient

Although the mummies needed to travel only a few miles from a museum in Cambridge to Longwood, bringing them to the Brigham was no small feat logistically. Working closely with the hospital’s Police and Security team, Brigham faculty and staff members spent countless hours coordinating with museum officials and the researchers on how to safely transport these extraordinarily rare, delicate remains.

Once inside Shapiro, scanning the mummies wasn’t too different from work the cardiovascular imaging team normally does. In fact, they were a little easier to scan than a living patient; normally, the CT scanner must account for the movement of a beating heart.

Interpreting the images required a different perspective, however, Blankstein explained.

“This is not the same as scanning a [living] human. All of the organs are decomposed—in fact, you don’t see much of the heart at all,” he said. “The major plaque we saw was not necessarily in the arteries of the heart but in some other blood vessels in the chest, such as the aorta or some arteries of the neck.”

In addition to satisfying the team’s intellectual curiosity, Blankstein hopes their findings will inspire people to learn more about atherosclerosis and how to reduce their risk.

“It was certainly an exciting and interesting experience, and I hope we can use it to promote awareness of this mostly preventable disease,” he said.

Exploring the Legacy and Future of Medical Education

s Stan Ashley, MD, of the Division of General and Gastrointestinal Surgery, and Marshall Wolf, MDCelebrated medical educators Stan Ashley, MD, of the Division of General and Gastrointestinal Surgery, and Marshall Wolf, MD, emeritus vice chair for Medical Education, reflected on their decades of experience training the next generation of physicians during an event at the Brigham Education Institute (BEI) Knowledge Center on Dec. 21. The fireside chat—complete with a digital display of a crackling fireplace—was moderated by BEI Executive Director Erik Alexander, MD, who asked Ashley and Wolf to share their thoughts on the evolution of medical education, their advice for today’s educators and more.

Special Delivery: Local Student Donates 600 Books to NICU

Aidan Chen

Aidan Chen displays one of the books donated to the NICU.

Ever since Aidan Chen was a young child, he’s had a love for reading. Wanting to share his passion for literature and the written word with others, he recently collected and delivered a large donation of children’s books—600, to be exact—to the Brigham’s Neonatal Intensive Care Unit (NICU) for our tiniest patients and their families to enjoy.

“Even very small babies need books,” said Chen, 16, a junior at Weston High School. “I love that through my donation I am able to help one baby at a time build their first library.”

His visit last month marked the second time Chen has contributed to the unit’s Brigham Baby Academy—a program introduced in 2016 that seeks to improve neurodevelopment of NICU babies and help families bond with their babies by reading, talking and singing to them every day. During their hospital stay and upon discharge from the hospital, NICU babies and their families are gifted new books for parents to continue reading with their infants at home.

Carmina Erdei, MD, medical director of the NICU’s Growth and Development Unit and neonatologist in the Department of Pediatric Newborn Medicine, who oversees the Brigham Baby Academy, explained that babies in the womb are listening to their mother’s voice and other family members for many hours a day. For most healthy, full-term newborns, that practice continues without interruption after birth and plays a notable role in the rapid brain development that occurs in infancy and early childhood.

On the other hand, babies who require acute care in the NICU—and need to remain hospitalized for several weeks or months—have significantly less exposure to that form of auditory stimulation. Through the Brigham Baby Academy, the NICU is creating the opportunity for some of these therapeutic experiences to occur for its littlest patients.

“We do think that reading and meaningful auditory exposure is medicine,” Erdei said.

For Chen, who hopes to be a doctor when he’s older, his latest donation to the program is just one chapter of a bigger story. As a research intern at the Brigham in 2017, he learned about the NICU and its commitment to ensuring each infant is read to at least once a day by staff or a family member.

To support the program, Chen created the GoFundMe fundraiser “Books for the Babies.” He continues to collect donations to purchase books for Boston-area NICUs and military families through events sponsored by the March of Dimes.

Sarah Wood and baby Hayden

Erdei said Chen’s latest donation couldn’t have come at a better time.

“Our shelves were getting quite bare, and we are incredibly grateful for Aidan’s efforts and donations,” Erdei said. “Because of him, we are able to spread the literacy message to so many families. He’s incredible.”

During his latest visit to the NICU, Erdei introduced him to two families and their babies who received books through the Brigham Baby Academy.

Sarah Wood was reading a book to her infant daughter, Hayden, a patient in the NICU, when Chen stopped by for a visit. An educator, Wood said she’s thrilled the Brigham created the reading program because not only does it help babies and their families bond, but it also sets infants up for success later in life. She began reading to her daughter before she was born. Some of Wood’s favorite books to read to Hayden are Corduroy, Polar Express and Goodnight Moon.

“As a teacher, I am always trying to instill the importance of reading to children,” Wood said. “The more language and the more words that your child hears in these formative years, the more effective communicators they will become. Having books available in the NICU is wonderful.”

Standing Room Only: Nursing Dreams Becoming a Reality

PCAs preparing to go to nursing schoolMany of you have already heard about the four amazing Brigham patient care assistants (PCAs) who received the inaugural Neskey Educational Opportunity Fund Scholarships, which provide full-tuition support to University of Massachusetts (UMass) Boston for PCAs who aspire to have a career in nursing. David and Sharon Neskey established the fund to honor the extraordinary care they received from a PCA here. As it turns out, the day we announced those four recipients was just one piece of what would become my One Shining Moment this year.

Weeks earlier, I had the pleasure of attending an information session about the scholarship. Considering that this was a new program, I set my expectations accordingly, thinking six to eight attendees would have been a good showing for our first year. Little did I know how incredible the response would really be. About 40 PCAs came to the session, brimming with enthusiasm about the next potential step in their careers. I was also amazed that attendees were at all stages of thinking about their future as nurses—some had completed all the academic prerequisites and were ready to start at UMass, while others who had never taken any formal steps for continued education viewed this potential scholarship as the push they needed.

Linda S. Thompson, DrPH, MPH, RN, FAAN, dean of UMass Boston’s College of Nursing and Health Sciences, was so inspired by the program that she attended the information session and spoke of how her own professional beginnings looked very similar to those in the room. The most moving part of the event, though, was that when I looked at that group of PCAs, I saw the future nurses of the Brigham, who will one day inspire the next generation that follows them. I can’t wait to see the amazing things they will do in the years to come.

Ron M. Walls, MD
Executive Vice President and Chief Operating Officer, Brigham Health

Celebrating the First of Many Future Successes

Bernard Jones headshot

Bernard Jones

“Great Friday news!!!” At first glance, it seemed that was the entirety of the email from Paula Squires, MBA, SHRM-SCP, SPHR, our senior vice president of Human Resources. But as I scrolled down to read what she had forwarded, I clearly saw why she was so excited. After a lot of hard work with a great team (Ron M. Walls, MD, executive vice president and chief operating officer; Shelita Bailey, director of Workforce Development; Carmen Santos, Workforce Development specialist; and Paula, among others), we had hired the first person through our Brigham Health SUCCESS Program.

SUCCESS is designed to increase employment opportunities at the Brigham for those members of our local communities whose life trajectories would be most transformed by them, whether due to incarceration for nonviolent offenses, past challenges with substance use disorder or simply the broad spectrum of life’s personal challenges that anyone can encounter. The program’s initial partnership is with STRIVE, a Dorchester-based organization that provides an intensive five-week training on workplace readiness, responsibility and professionalism, along with career-specific skills training. We work with STRIVE to identify graduates with career potential and an interest in health care and then help guide those graduates through our employment process.

It all sounded great in theory and it was a program we loved working on and describing to others, but it didn’t feel real until I got that Friday afternoon email. I quickly emailed back an excited response and walked over to Ron’s office. He had seen the news and we shook hands on a job well done, but we also agreed that this had to be the first of many. I’m hoping for many, many more “great news” emails and I doubt they will ever be any less exciting.

Bernard Jones
Chief of Staff to the Executive Vice President and Chief Operating Officer, Brigham Health

A Community of Lifelong Learners

Bruynell and staff

From left: Alyssa Schifano, Sue Warthman, Karen Bruynell, Anna DeCristofaro and Caitlyn DeCastro

Being a new employee at Brigham and Women’s Hospital, my personal shining moment has been the teamwork and camaraderie I’ve experienced here, and it is one of the many joys that make me proud to be part of the Brigham.

As a team in the Brigham Education Institute’s Knowledge Center, our shining moment is working with trainees, faculty, allied health professionals and staff who are creating a community of learning and inspiration. They are producing results, they influence and impact today’s rapidly changing medical education environment and they shape our teaching and learning culture.

Karen Bruynell, MM, C-TAGME
Administrative Director, Brigham Education Institute

Bulletin Bullets

Winter Food Drive Concludes Dec. 20
The Center for Community Health and Health Equity is hosting a winter food drive to benefit the Parker Hill/ABCD Emergency Food Pantry in Mission Hill, now–Dec. 20. Beans, rice, cereal, pasta, soups, peanut butter, jelly and canned goods are most needed. Donations can be placed in the food drive bins outside the Garden Cafe on Tower 2. For questions, or to make a cash or check donation, call 617-264-8750 or email cchhe@partners.org.

OHS Episodic Care Clinic for Employees
Occupational Health Services (OHS) offers conveniently located care for upper respiratory infections, sore throats, conjunctivitis, urinary tract infections and back pain. Staff who have a Brigham primary care provider and receive medical insurance through Partners HealthCare can visit the clinic Monday–Friday, 7 a.m.–3:30 p.m. Employees will not be charged a co-pay for their visit; labs, radiology exams and prescription medications are billed to insurance. The clinic is hosted at OHS’ mid-campus clinic on the Lower Pike. To schedule an appointment, call 617-732-8501.

Professional Development Series
The Professional Development Series (PDS) is available to help Brigham staff and teams gain new skills through self-led resources and classroom learning. PDS has a spring and fall semester, with spring courses beginning in February and fall courses starting in September. Class offerings include: Behavioral Interviewing; Communication Skills; Delegation; Presentation Skills; Time Management; Running Effective Meetings; Role of the Manager and more. To learn more, visit BWHPikeNotes.org.

BEI Yoga: Winter Series
The Brigham Education Institute (BEI) will host its winter series of 60-minute vinyasa yoga classes in the BEI Knowledge Center (located in the Thorn building, first floor, room 127D). The class is designed for all levels of experience, from beginners to more advanced yogis. Attendees should wear appropriate workout attire and bring their own yoga mat. Upcoming classes will be held 5:30-6:30 p.m. on Wednesday, Jan. 9, and Wednesday, Jan. 16. View a full schedule and register. 

Bulletin Bullets

Gift-Wrapping Fundraiser to Support the NICU

The Brigham Young Professionals group is hosting a gift-wrapping fundraiser outside of the Shop on the Pike throughout December. Bring your unwrapped holiday presents and a volunteer will wrap them for you. Donations will benefit the NICU Friends of BWH, a group that support the families of the Neonatal Intensive Care Unit (NICU). Hours of operation will be Tuesday, Dec. 11–Friday, Dec. 14 and Tuesday, Dec. 18–Thursday, Dec. 20, 11 a.m.–1 p.m.

Shop on the Pike Holiday Sale, Dec. 13-14

The Shop on the Pike will celebrate its 10th birthday by offering 20 percent off most items, including select Brigham apparel, during a holiday sale on Thursday, Dec. 13, and Friday, Dec. 14. The discount does not apply to flowers/plants, balloons, candy, food, magazines, greeting cards, website orders, phone cards, gift cards or paperback books. Call 617-732-7878 for more details.

‘Flooded: Lessons Learned from a Major Hospital Flood,’ Dec. 13

The Department of Quality and Safety hosts “Flooded: Lessons Learned from a Major Hospital Flood” as part of the Quality Rounds. Ronald Iverson Jr., MD, MPH, of Boston Medical Center will present. Attendees will learn about planning and practice for a large-scale flood, as well as the use of outside resources during a response to such an event. Thursday, Dec. 13, noon-1 p.m., in Bornstein Amphitheater. Learn more.

Holiday Reminder: Personal Package Policy

With the holidays fast approaching, the Receiving & Distribution and Office Services teams remind employees that personal package deliveries cannot be accommodated. The priority of these departments is delivering items directly related to patient care and hospital business. Due to the large volume of these deliveries alone, the added responsibility of processing personal packages delays the turnaround time on products that may directly affect patient care. Please make alternate arrangements for the delivery of personal packages. For questions, contact Jonathan Santiago at jmsantiago@bwh.harvard.edu.

From Falls to Fires, Staff Partner to Simulate Home-Hospital Scenarios

Nahall Rad (left) and Anish Mehta (right) simulate caring for a patient, played by Herrick “Cricket” Fisher, who has fallen in her kitchen.

Nahall Rad (left) and Anish Mehta (right) simulate caring for a patient, played by Herrick “Cricket” Fisher (center), who has fallen in her kitchen.

While home-based hospital care yields considerable benefits for patients, it also poses unique challenges for care teams as they monitor and treat patients outside the controlled environment of a hospital.

Members of the Brigham’s Home Hospital team recently collaborated with experts at the Neil and Elise Wallace STRATUS Center for Medical Simulation to transform the center’s space in Neville House to mimic a home setting. They practiced responding to events the clinical team might encounter in a patient’s house or apartment—running the gamut from emergency to end-of-life scenarios.

The Home Hospital program provides hospital-level care to select acutely ill adults in the comfort of their home. Eligible patients, who must live within five miles of the Brigham’s main campus or BWFH, are enrolled via the Emergency Department upon seeking care for issues such as infections and exacerbations of heart failure, asthma and chronic obstructive pulmonary disease. If inpatient care is needed, the Home Hospital team will discuss the opportunity with the patient to receive care at home instead of through a conventional hospital admission.

The recent exercise with the Home Hospital team was a first for the simulation experts at STRATUS, who usually set up their facilities to look like traditional hospital settings, such as an operating room or patient room. For this training, STRATUS staff created a mock foyer, kitchen, bedroom and living room.

Seeing the Team Come Together

During the exercise, the nine-person Home Hospital clinical team went through six scenarios, including caring for a patient who has fallen in his or her kitchen; what to do when a dementia patient has forgotten to turn off the toaster, leading to a small fire; and speaking with a cancer patient about end-of-life and goals of care. With assistance from STRATUS, they acted out each scenario and reviewed the appropriate protocols and procedures for handling each situation.

“Our team was phenomenal,” said David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care who oversees the Home Hospital program. “To see our clinical team come together to enhance their home-hospital skills and learn from each other was beautiful. I am very proud of our team and look forward to organizing more simulated training experiences with STRATUS in the future.”

Home Hospital nurse Nahall Rad, BSN, RN, said taking part in these types of simulations is critical because it prepares the team for the challenges of delivering care outside the hospital.

“The dynamic nature of patient care in the field requires you to be as best prepared as possible for managing unforeseen and emergency scenarios,” Rad said. “The training we received at STRATUS was crucial in allowing our clinicians to be exposed to these types of experiences in a controlled environment to receive feedback on what was done well and what could have been done better. This allows us to have the highest level of patient care and improves our patients’ outcomes that much more.”

Also participating in the training was Gregory Goodman, MD, a Home Hospital attending physician. He appreciated the opportunity to work through the different cases with the team and learn about ways to improve patient care in the home setting.

“This was a powerful opportunity to work with our Home Hospital colleagues to improve our approach to care in a real-life way,” Goodman said. “It was great to see our team work together to collaborate to deliver exceptional and innovative care.”

Preparation Is Key

Planning and organizing such a course takes a lot of preparation behind the scenes—one year to be exact, Levine said. From writing the curriculum to ordering the furniture and equipment for the simulation, both teams wanted to ensure the course was as authentic as possible.

Michael Sampson, CHSOS, senior medical simulation specialist at STRATUS, enjoyed working with Levine and the entire Home Hospital team to create the course and operate the computerized simulation manikins during the training. He said seeing their passion for continued learning was inspiring.

“It is truly a team effort to put on simulation programs at STRATUS,” Sampson said. “It requires extensive planning and dedication from our staff and faculty members.”

Jamie Robertson, PhD, director of Education at STRATUS, also worked closely with the team to create the curriculum for the course. She said it was an exciting opportunity to think creatively about how to simulate the most realistic experience possible for Home Hospital providers.

Charles Pozner, MD, executive director of the STRATUS Center, said the course is another example of how STRATUS continues to contribute to the transformation of care delivered by Brigham Health providers. “This unique interprofessional program not only enables the Home Hospital staff to stay current with procedural care, but it also provides an excellent opportunity to strengthen the team-based care that is crucial in making this program such an overwhelming success,” Pozner said. “STRATUS takes pride in ‘pushing the envelope’ in health care education and research.”

Family Day Fun in the ORs, PACU and Peri-op Areas

children participating in family day at the hospital by trying out simulation items.

PACU nurse Kaitlyn Fredrickson (third from left), RN, demonstrates for “Family Day” attendees Gianni and Kelis Wilkinson (first and second from left) how to place intravenous lines, while their mother, PACU nurse Teyarnna Straughter, RN, snaps a photo.

More than 500 children, parents and siblings of staff from the Brigham’s Operating Rooms (ORs), Post-Anesthesia Care Unit (PACU) and Perioperative Services received a glimpse of what their loved ones do each day during an inaugural “Family Day” event, held in partnership with the Neil and Elise Wallace STRATUS Center for Medical Simulation, on Nov. 17.

In addition to providing tours of the ORs, PACU and Peri-op areas, staff hosted family-friendly educational activities. Interactive stations around the three areas provided hands-on opportunities for young visitors to use simulation tools to try out laparoscopy, intubation, CPR, ultrasound and more. Using models of bones, children also learned surgical skills used in orthopaedic surgery and how joint replacements are performed.

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Investigators Present Cardiovascular Discoveries at AHA Scientific Sessions

On Nov. 10, the American Heart Association (AHA) held its annual Scientific Sessions meeting in Chicago, featuring the latest advances from major cardiovascular trials with the potential to transform clinical practice. Investigators from the Brigham led some of the most highly anticipated trials and presented their results at the conference.

Insights into Omega-3s, Vitamin D

The benefits of omega-3 fatty acids – a “good” fat largely found in fish, nuts, flax seeds and leafy greens – have been touted in recent years. But just how protective are they in cardiovascular health?

JoAnn Manson shares findings from the VITAL study.

JoAnn Manson shares findings from the VITAL study.

Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs in the Division of Cardiovascular Medicine, presented results and insights from the clinical trial REDUCE-IT, which tested whether icosapent ethyl (a medication derived from an omega-3 fatty acid found in fish oil) could reduce the risk of cardiovascular events in at-risk patients. Participants were defined as “at risk” if they fell into one of two categories. Either they had atherosclerosis – a disease in which plaque builds up in the arteries – or they had diabetes plus at least one other cardiovascular risk factor along with elevated triglyceride levels, despite taking statins.

Participants who took the medication saw a 25 percent risk reduction in cardiovascular events and a 20 percent reduction in death due to cardiovascular causes, a result Bhatt described as “remarkable.”

“This may be the biggest development in cardiovascular prevention since statins,” he said. “The REDUCE-IT trial sets a new standard of care for these patients.”

In another presentation, JoAnn Manson, MD, DrPH, chief of the Division of Preventive Medicine, unpacked results from the VITamin D and OmegA-3 TriaL (VITAL). VITAL also examined whether omega-3 fatty acids affected a person’s risk of experiencing cardiovascular events, but Manson and colleagues studied them among a general, racially diverse population and used a lower-dose supplement that contained both of the major forms of marine omega-3s. VITAL also examined effects on cancer occurrence.

The team found that omega-3s reduced the risk of heart attacks but did not reduce stroke, major cardiovascular events or cancer. VITAL also tested the effects of taking a vitamin D supplement, which did not reduce cardiovascular or cancer outcomes except for a signal that cancer deaths were lower over time.

Diabetes Drug Lowers Heart Failure Risk

A new class of diabetes drugs known as SGLT2 inhibitors can help lower blood glucose levels in patients with diabetes. Investigators are finding mounting evidence that the inhibitors may also lower cardiovascular risk.

Stephen Wiviott, MD, of Cardiovascular Medicine, shared findings from the DECLARE–TIMI 58 trial. The multinational trial tested an SGLT2 inhibitor known as dapagliflozin. Wiviott highlighted reductions in risk of adverse heart and kidney outcomes for patients.

Separately, Elisabetta Patorno, MD, DrPH, of the Division of Pharmacoepidemiology and Pharmacoeconomics, presented initial results from the real-world EMPRISE study, which found that another SGLT2 inhibitor reduced the risk of hospitalization for heart failure in routine care.

Inflammation and Heart Disease: A Roadmap for the Future

Brigham cardiologists have been at the forefront of basic, clinical and translational research linking inflammation and heart disease for decades and presented the next chapter in the ongoing story of the inflammatory hypothesis at this year’s meeting.

Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention, delivered results from the Cardiovascular Inflammation Reduction Trial (CIRT), a large-scale trial that tested whether low-dose methotrexate – an inexpensive, generic drug widely used to treat inflammatory diseases – was effective in reducing cardiovascular risk.

Last year, the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) showed that the high-cost drug canakinumab targeted a specific inflammatory pathway and consequently lowered rates of heart attack and cardiovascular death. By contrast, the findings from CIRT showed that low-dose methotrexate neither inhibited that same pathway nor did it reduce major adverse cardiovascular event rates.

“The results from CIRT and CANTOS, when considered together, tell us something critically important: Not all inflammation is the same, and not all drugs that target inflammation are the same,” said Ridker. “While it is disappointing that an inexpensive drug like methotrexate did not have the effects we previously saw in CANTOS, the results from CIRT shed crucial light on the underlying biology that connects inflammation with cardiovascular disease. The divergent trial results provide a clear roadmap to guide our efforts going forward.”

In a separate presentation, Brendan Everett, MD, MPH, director of General Cardiology Inpatient Service, reported that the interleukin-1β inhibitor canakinumab reduced hospitalization for heart failure and heart failure-related death. These data represent the first-large scale evidence that inflammation inhibition can improve outcomes in heart failure. The results suggest that the role of inflammation reduction in improving heart failure outcomes merits further exploration.

Celebrating Innovation at Discover Brigham

The Brigham was buzzing with excitement as Discover Brigham drew hundreds of attendees to the hospital’s main campus on Nov. 7.

Through digital poster sessions, hands-on demonstrations, panel discussions, award presentations and more, the event showcased the Brigham’s expertise in several areas of science, medicine and technology. This year’s event highlighted discoveries and insights around lung disorders, sleep medicine, genomics, cancer, women’s health and opioid use disorder.

The day-long event concluded with an awards ceremony that announced the winners of the BRIght Futures Prize and Brigham Research Institute Director’s Transformative Award.

Brigham Launches Global Health Track in Hospital Medicine

Bram Wispelwey trains community health workers in Palestine.

Thanks to a new Global Health track in Hospital Medicine, hospitalists have the support they need to practice at the Brigham and work to improve health around the world.

The first cohort of three Global Health track physicians began at the Brigham in July, with projects supporting communities in Ethiopia, Guatemala and Palestine. In 2017, Peter Rohloff, MD, PhD, an attending hospitalist, established the track to expand opportunities for his colleagues to be a part of both the Brigham and the global health community.

“The vision for this track is to help junior faculty with a strong interest in global health take the next steps in advancing their careers,” said Rohloff, who is also the founder of Maya Health Alliance, a nonprofit that addresses the health care needs of Guatemala’s most impoverished communities. 

He added that the track helps clinicians connect with mentorship and development opportunities at the Brigham and have a clinical home at the hospital – a goal shared by the Division of Global Health Equity. Since its founding in 2001, the division has provided an anchor for faculty who wanted to work globally but remain active clinically and academically in the U.S. 

Among those in the first cohort of physicians on the Global Health track is Bram Wispelwey, MD, MS, who completed the Brigham’s Doris and Howard Hiatt Residency Global Health Equity and Internal Medicine earlier this year. When not practicing at the Brigham, Wispelway is caring for Palestinians and helping mend fractured health care systems in Palestinian refugee camps. 

To address the complex issues facing refugees in these camps – which lack dedicated local clinics or consistent access to affordable primary care – Wispelway helped launch and monitor a Community Health Worker program. This work aims to improve relationships and rebuild trust between physicians and patients, strengthen the health care delivery system and improve the health of refugee families. He now divides his time between the Brigham and Palestine.

Jennifer Goldsmith, MS, MEd, administrative director of the Division of Global Health Equity, helped establish the partnership between Hospital Medicine and the division. She described the global health track as “highly customizable to meet the needs and interests of individuals and to offer opportunities for global health research and field work, didactics and career mentorship.” 

“We’re delighted to work together to build on the mentorship and global health opportunities at the Brigham by creating this new career step,” Goldsmith said. 

Q&A: Reflections on Interactive Teaching, Learning from Trainees

Raymond Mak

Raymond Mak, MD, of the Department of Radiation Oncology, was honored with the 2018 Bernard Lown Teaching Award, which celebrates physicians who are outstanding clinical teachers.

In this Q&A with BWH Bulletin, Mak shares his ideas on the field of radiation oncology, effective teaching and the Socratic method.

What drew you to the field of radiation oncology?

RM: I was always interested in cancer care and patients. One of my medical school mentors, Anthony D’Amico, MD, PhD, happened to be a radiation oncologist. He introduced me to the field of radiation oncology, serving as a mentor and teacher. The field combines procedural/interventional aspects of medicine, technology and imaging, with an academic, evidence-based and patient-centered focus, which was very appealing to me.

What is the key to being an effective instructor?

RM: From my perspective, it’s about trying to put yourself in trainees’ shoes. You need to understand where they are coming from, their level of knowledge and their experience. Using this information, you need to tailor your teaching style accordingly. I focus most of my efforts here when designing a lecture or lab for trainees.

Additionally, I try to make the material as interactive as possible. Using the Socratic method, I ask a lot of questions, both rhetorical and direct, to gauge the level of understanding in the classroom or clinic. As an instructor, this is the key to understanding the needs of the learner.

Whose teaching style has influenced your own?

RM: My dad was a college professor, so growing up, I often observed him teaching and tailoring material to the needs of different people, and much of my approach now comes from him.

In the past, I considered myself somewhat of an introvert and did not really think I would be a good teacher. It was in speaking to and learning from my mentors in medical school and throughout residency that I was able to hone my craft and come out of my shell.

At Harvard Medical School, the problem-based learning curriculum set the stage for my own teaching style. Going into residency, the teaching model was Socratic as well, with the emphasis on direct questioning and audience participation. This emphasis combined with the many great teaching role models in my department and at the Brigham greatly influenced my own teaching.

How has working with trainees influenced your work as a physician-scientist?

RM: Residents teach me a lot. They have great ideas, and they don’t follow the assumptions and orthodoxies that those who have been in the field for a long time do. Between the teacher and the trainee, it’s a two-way street. I ask them questions to help them learn, and in return, they ask me questions that challenge my own thinking and customs. I always tell my residents when they’re on service with me to make sure they continually ask why I’m doing a procedure or approaching a patient’s situation in a particular way. I encourage my trainees to challenge my conventions and methods as much as possible.

Our department is an environment with such an emphasis on teaching; everyone is pushed to improve, from residents to junior faculty. There was no doubt to me that one of the most important things that I could do as a physician was to be a great teacher for residents and medical students. This has always been a primary focus for me. When everyone you’re surrounded by is focused on effective teaching and trying to do their best, you have to bring your A-game.

Brigham Health’s Strategy in Action: Teaching and Training
Learn more about our strategic priorities at BWHPikeNotes.org.

iHub Celebrates 5 Years of Innovation at the Brigham

Interactive demonstrations at the ‘iHub Turns 5’ celebration showcase digital health innovation at the Brigham.

On Sept. 12, more than 200 clinicians, scientists, staff and entrepreneurs commemorated the fifth anniversary of the Brigham Digital Innovation Hub (iHub) during a celebration of innovation and digital advancement at BWH and beyond.

The half-day event, “iHub Turns 5,” featured panel discussions with BWH innovators, iHub alumni and senior leaders from the Brigham and Partners HealthCare in the Hale Building for Transformative Medicine.

Since 2013, iHub has helped innovators launch and advance projects focused on using technology to streamline hospital operations, improve care delivery and enhance the patient and employee experience. One example is the Brigham’s online wayfinding tool, which provides step-by-step directions for navigating the hospital. iHub members have also worked with Medumo, a startup co-founded by Internal Medicine and Dermatology resident Omar Badri, MD. The company’s flagship application – in use at the Brigham’s Endoscopy Center – delivers precisely timed reminders via email and text message to patients for various purposes, such as preparations for procedures.

“We are aspiring to drive the safest, most patient-centered and efficient care through the use, development, evaluation and commercialization of digital health solutions,” said Adam Landman, MD, chief information officer of Brigham Health.

Improving Lifesaving Care Through Innovation

During a panel highlighting current and former BWHers’ journeys from ideation to innovation, YiDing Yu, MD, shared her experience of working with iHub to grow a startup company from a single idea.

When she was a second-year Internal Medicine resident, Yu attended iHub’s inaugural hackathon five years ago wanting to solve a problem she had encountered firsthand, specifically the communication challenges care teams encounter when a patient is arriving via ambulance.

Due to privacy concerns, emergency medical service (EMS) responders can only transmit limited information about an incoming patient to hospital care teams over public radio channels. Yu wanted to develop a tool to bridge this gap – a technology that would provide emergency departments with timely information while protecting patient privacy.

Yu was determined to solve this problem, despite the fact that she had no experience starting a tech company. “All of us were first-time entrepreneurs. We had no idea what we were doing,” said Yu.

Yu’s application, Twiage, is now used by over 50 hospitals in 12 states. Its secure digital platform enables first responders and emergency departments to accelerate lifesaving care by sending real-time clinical data and location updates directly to hospital care teams. Yu said that while it was daunting to pivot her career path to focus on Twiage – she also practices medicine at Atrius Health a few hours a week – she believes in her startup.

Yu attributes part of her success to the support she has received from iHub and the larger Brigham community. “I came to the Brigham to train because of the culture here,” said Yu. “I think you have to be surrounded by people who support your passion – I have bosses and mentors who do that. They help ignite that fire in your belly.”

Yu was joined on the panel by Karen Fasciano, PsyD, a psychologist at BWH and Dana-Farber Cancer Institute, who discussed her work on banYAn, an app that helps young adults coping with cancer; Alexander Lin, PhD, director of the Center for Clinical Spectroscopy in the Department of Radiology, who launched a company called BrainSpec to make virtual biopsies a reality; and Scott Weiner, MD, MPH, of the Department of Emergency Medicine, who is working on several digital health projects related to the opioid crisis.

In addition to the speaking program, the celebration was a homecoming for many iHub alumni, including Lesley Solomon, MBA, who helped create iHub and was honored that evening with the inaugural Disrupting Medicine Award for her contributions and leadership.

Reflecting on iHub’s early days, Solomon said the Brigham had to chart new territory to get iHub off the ground: “You just have to go for it. You just have to start doing things.”

BWHer Pioneers First Neurology Fellowship in Haiti

From left: Aaron Berkowitz works with Roosevelt François, inaugural graduate of Haiti’s first neurology fellowship.

The Brigham has more than a hundred neurologists on faculty, each with their own subspecialties. Yet until recently, Haiti, a country of nearly 11 million people, had only one. Aaron Berkowitz, MD, PhD, hopes to change that.

Following the island’s devastating 2010 earthquake, Berkowitz, director of the Brigham’s Global Neurology Program, was deeply moved by what he learned from his colleagues who had traveled to Haiti to assist with medical relief efforts. The disaster magnified how the country, especially its rural areas, was in dire need of specialized care.

“Most doctors in Haiti are general practitioners because there are no specialty training programs,” said Berkowitz. “If you go to medical school in a country with few or no neurologists, you have very minimal training in neurology to help patients with neurologic conditions.”

Six years ago, Berkowitz and his colleagues, including Michelle Morse, MD, MPH, assistant program director of the Internal Medicine Residency Program and associate physician in the Division of Global Health Equity, resolved to remedy this shortage. They worked with global nonprofits Partners In Health and EqualHealth to teach neurology courses for internal and family medicine practitioners and trainees.

Following this, Berkowitz, Morse and their Haiti colleagues developed a four-week neurology rotation for five internal medicine residents at the Hôpital Universitaire de Mirebalais (HUM). Their subsequent success inspired Berkowitz and colleagues to start a new, more intensive program – thus, Haiti’s first neurology fellowship was born.

One applicant is chosen each year for the two-year fellowship, and the program is rigorous; the fellow cares for all neurology inpatients and outpatients at HUM and receives mentorship from about a dozen U.S.-based neurologists, each of whom spends one to 12 weeks teaching in Haiti annually.

Last year, the first fellow, Roosevelt François, MD, graduated from the program. He recently joined the hospital’s faculty and became director-in-training of the neurology clinical program and educational fellowship. With the second fellow set to graduate this fall and a third next year, the program is on track to reach its goal of a 500 percent increase in neurologists – from one to five – within five years.

The need for neurology care is especially critical in Haiti, Morse explained. The country has a disproportionately high rate of hypertension, which is a key risk factor for stroke, in addition to a high burden of epilepsy from neurologic infections.

Building a Pipeline

Berkowitz and Morse hope their latest milestone ignites a fast-growing, self-sustaining fellowship led by HUM faculty.

“This program is going to have an enormous impact on the next generation of health care professionals because it has this faculty pipeline built into it,” Morse said. “And, more importantly, it’s a step toward achieving what citizens of Haiti deserve: health care as a human right.”

Berkowitz expects the program will not only expand access to high-quality neurologic care in Haiti, but will also train a cohort of clinician-educators who will teach neurology to their peers and train more neurologists in Haiti. More broadly, he hopes it becomes a model that other health professionals in resource-poor settings can replicate to develop specialty training programs in partnership with visiting faculty.

“Haiti is just one country,” he said. “Around the world, patients who need specialized care often can only see their general practitioner, who has no one they can refer the patient to for specialized expertise. The need is endless, and we hope our program can inspire other clinician-educators to expand their teaching efforts beyond borders.”

Morse, who has worked on health equity initiatives in Haiti and beyond for more than a decade, said Berkowitz’s passion and dedication has positioned the project for long-term success.

“Aaron is one of my heroes for being so committed to this program,” she said. “No matter what challenge comes along, he never gives up.”

Brigham Health’s Strategy in Action: Teaching and Training
Learn more about our strategic priorities at BWHPikeNotes.org.

Residents Support Local Community with ‘Wednesday Wellness’

Rich Joseph leads a class about creating a personalized health plan at Brigham and Women’s Center for Community Wellness.

When Christina Meade, MD, was invited by a fellow resident to give a talk about kidney health – one of her clinical interests – to people in the local community, she jumped at the opportunity.

“I love medicine, specifically preventive medicine, and to educate people in our local communities about their health and wellness is what makes my job so wonderful and exciting,” said Meade, a second-year resident in the Department of Medicine. “After I participated in the talk, my passion for primary care was rejuvenated.”

Last year, Rich Joseph, MD, MBA, a third-year resident in Primary Care and Population Medicine, approached Paul Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention, about possibly launching an ongoing health and wellness series led by residents at Sportsmen’s Tennis and Enrichment Center in Dorchester. Ridker, who at the time was the board chair of Sportsmen’s, said he instantly loved the idea, knowing the series could benefit both Brigham residents and community members.

Ongoing since September 2017, the “Wednesday Wellness” series takes place twice a month at the Brigham and Women’s Center for Community Wellness, Dorchester, located within Sportsmen’s. Each course focuses on a different health- and wellness-related topic, with more than 20 sessions held to date. Courses have covered diabetes and hypertension, dementia and arthritis, among other topics.

Opened in 2015, the goal of the Brigham and Women’s Center for Community Wellness Center at Sportsmen’s is to advance health and chronic disease prevention in underserved communities of Dorchester, Mattapan and Roxbury. The facility includes both classroom space for educational activities and a full gym, free to anyone living in the area.

For Ridker, the center has been a “terrific way for the Brigham to have a positive impact on preventive health in underserved neighborhoods where so many of our patients live and work.”

Wanda McClain, MPA, vice president of Community Health and Health Equity, agreed, adding the “Wednesday Wellness” program shows the power of collaboration. “Bringing together health care providers, community residents and Sportsmen’s is a perfect trifecta for improving community health,” she said.

Toni Wiley, Sportsmen’s executive director, has seen firsthand how valuable the courses have been for attendees.

Attendees of a recent “Wednesday Wellness” course gather for a photo with Brigham resident Rich Joseph (back row, center).

“I’ve heard many success stories from our members who’ve attended the ‘Wednesday Wellness’ sessions,” Wiley said. “Some have lost a few pounds, and others have come to understand how their medications truly work. It has been truly gratifying to hear people talk about how attending these sessions has been life-changing for them.”

The series has a loyal following. William Mitchell, of Mattapan, has attended nearly every “Wednesday Wellness” session, even inviting friends to join him. A retired firefighter, Mitchell said he appreciates the residents’ thoughtful, insightful presentations.

“To me, it’s a great thing to bring health and wellness education into the local community,” he said. “I’m grateful that the Brigham and Sportsmen’s came together to bring this goodness to our community, which is helping many of us live a better life.”

The series has also benefited Brigham trainees by providing opportunities to “get outside one’s comfort zone” and talk about health and wellness in a setting other than the hospital, Joseph explained.

Since the series launched, Joseph has heard from many resident colleagues who are interested in getting involved.

“It feels good knowing our work is helping others,” said Joseph, noting the series is a collective effort and would not be possible without the support of his resident colleagues.

BWH Emergency Medicine residents and Boston Children’s Hospital pediatric residents are among those involved in the series. Since Sportsmen’s offers programs for all ages, Joseph said it has been valuable to have residents from different specialties share their expertise.

Joseph, along with a handful of other Brigham residents, including Joshua Lang, MD, MS, a third-year resident in Internal Medicine, are also teaming up with Sportsmen’s to launch related programs, including community health fairs and an educational series for children attending summer camp at Sportsmen’s. Lang said it has been wonderful to participate in this work. “I feel pretty lucky to have found out about it,” he said.

Joseph added: “Partnering with Sportsmen’s has been one of the best decisions I’ve made as a resident. For me, this is the type of work that keeps me going – it’s very motivating. I love showing people the process of discovering their own health and taking care of themselves.”

Brigham Health’s Strategy in Action: Improve Health
Learn more about our strategic priorities at BWHPikeNotes.org.

Combating the Opioid Crisis with Lifesaving Training Opportunities

Buprenorphine is widely considered one the most effective medications available to treat opioid use disorder. It blocks the effects of opioids and suppresses cravings and withdrawal symptoms – “tricking” the brain into believing an opioid like heroin or oxycodone has been ingested without producing a drug-induced high.

But there’s one big catch: It can be difficult for patients to access, primarily because clinicians must undergo a specialized, eight-hour training to prescribe it to patients with opioid use disorder.

The time commitment alone is a significant barrier for many providers. Additionally, access to the buprenorphine waiver training course is limited in many areas of the country.

Mia Lozada, MD, an internal medicine physician at Gallup Indian Medical Center in Gallup, N.M., and her colleagues are all too familiar with these challenges. Serving residents of the Navajo Nation, the U.S. Indian Health Services (IHS) hospital is about a two-hour drive from the nearest city, Albuquerque, where waiver training is occasionally offered.

“In addition to the time and distance, we typically don’t hear that these trainings are available until a month or two ahead of time. By then, our clinics are already scheduled, so the logistics are even more complicated,” she said.

That’s why Lozada and her colleagues jumped at the chance to remotely attend an online waiver training last month led by Joji Suzuki, MD, director of BWH’s Division of Addiction Psychiatry, organized in collaboration with the Brigham and Women’s Outreach Program. The course was scheduled several months in advance, enabling 38 Navajo-area IHS clinicians from multiple disciplines across five sites to attend without affecting patient care.

Since 2009, BWHers have collaborated with the IHS – the U.S. government agency responsible for delivering medical and public health services to members of federally recognized Native American tribes. Through the Outreach Program, BWH faculty, nurses, trainees and other providers volunteer their time and expertise to offer specialized care and training on the ground at IHS hospitals in rural New Mexico and Arizona and through remote teaching opportunities.

Providing waiver training remotely and offering it to IHS clinicians were firsts for Suzuki, who has led waiver training courses for prescribers across the Brigham, Greater Boston and New England for more than 10 years.

“The clinicians out there in Navajo Nation are doing amazing work with such limited resources, and I’m happy to do anything I can to help them,” Suzuki said. “Since we already had this relationship established through the Outreach Program and the technology to provide the training remotely, it was a great opportunity to lower some of the barriers they face in accessing waiver training.”

Joji Suzuki

Joji Suzuki provides buprenorphine waiver training to Indian Health Services clinicians based in New Mexico.

A Valuable Resource

Many patients with substance use disorder are reluctant to seek care from an addiction medicine specialist due to social stigma. They may be more open to discussing treatment options with a clinician with whom they have an existing relationship, such as a primary care provider or gynecologist, underscoring the importance of expanded waiver training.

But because those providers typically haven’t received more specialized training in treating substance use disorders, they often report not feeling confident prescribing medications such as buprenorphine. Lozada, who completed the waiver training in 2011 during her residency at the University of California, San Francisco, was thrilled to have an opportunity to retake the course with Suzuki for this exact reason.

“The training reviewed a lot of areas in which we sometimes feel a little uncertain and would otherwise push some of us away from prescribing buprenorphine,” she said. “Hearing from an expert such as Dr. Suzuki was really valuable and reassuring. It gave me a lot more confidence in how to care for patients with opioid use disorder.”

Lozada noted that not only did the recent training help IHS clinicians increase their roster of buprenorphine prescribers, but it also expanded the range of specialties where patients can now access the medication. In addition to internal medicine practitioners, Navajo-area IHS clinicians representing inpatient care, obstetrics/gynecology, pediatrics and pharmacy services attended, as well.

“Having that diversity in expertise is important because it gives us the opportunity to provide this treatment to more patients, regardless of age or condition,” Lozada said. “It’s also a chance to cross-collaborate between our departments in a way we haven’t been able to do before.”

Another benefit is that having so many colleagues take the same training together will result in more consistent practice across multiple sites and disciplines, Lozada added.

“It puts us all on the same page,” she said. “Rather than attending different waiver trainings across the country, we all have a common foundation as we prescribe medications to treat opioid use disorder.”

While the number of clinicians receiving waiver training across the country is increasing, Suzuki noted it is one piece of a far bigger, more complex puzzle in responding to the opioid crisis.

“There’s a huge educational gap that’s going to take an entire generation to close,” he said. “You have several generations of physicians and health care providers who never received any substantial training around addiction treatment. One eight-hour course is not going to solve that problem. But it’s part of the solution.”

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Celebrating Student Success Jobs Program Graduates

Seniors from SSJP’s class of 2018 celebrate with Center for Community Health and Health Equity staff.

Kaman Hau never thought she’d get hands-on experience in a research laboratory as a high school student.

After friends and family encouraged her to apply to the Student Success Jobs Program (SSJP), Hau was overjoyed to achieve exactly that. Upon her acceptance into the program, she was placed in the Division of Endocrinology, where she met her mentors, principal investigator Ann Marie Zavacki, PhD, and research technician Colleen Carmody, who supervised her.

“Never in a million years would I have imagined myself being this far in my career in high school,” Hau said, adding that many college students never even step foot inside a lab. “I grew as a student because Colleen and Ann Marie challenged me to leave my comfort zone – I created bonds with individuals who motivated me to strive toward my goals.”

A program of the BWH Center for Community Health and Health Equity (CCHHE), SSJP partners with select Boston-area high schools to match students with mentors and paid internships across the Brigham. The program is focused on fostering the next generation of talented, diverse health care workers.

Joined by their families, colleagues and SSJP underclassmen, this year’s seniors were honored during a graduation ceremony held at the Joseph B. Martin Conference Center on June 4.

Attendees heard from fellow students, keynote speaker Ricalder A. Valentine, MPH, MBA, director of Ambulatory Clinical Operations in the Department of Medicine, and SSJP alumna Angela Vu, RN.

In addition to her ongoing mentorship with Zavacki and Carmody and learning practical techniques, such as how to properly handle mice and genotype their DNA for research, Hau worked closely with SSJP on the college application process, including SAT preparation, essay writing and career planning. The Boston Latin Academy senior begins college at her dream school – Tufts University – this fall.

“It was this experience that pushed me to go into the medical field,” said Hau, who aspires to become a physician. “I can confidently say that SSJP is the best internship that any high school student could have.”

Overcoming Obstacles Together

More than 60 departments host SSJP interns. In a survey of SSJP alumni, more than 70 percent of program participants are first-generation college students, and more than 90 percent felt that the opportunity to work in a professional environment while in high school greatly assisted them in their college and career pursuits.

As part of her alumnus address at the recent graduation ceremony, Vu reflected on how the support network she found here helped her overcome personal challenges later in her college career.
During her junior year at the College of the Holy Cross, Vu unexpectedly needed to take a leave of absence for medical reasons. Shortly after she made this difficult decision, she received an email from SSJP asking alumni for an update on how they were doing.

“I didn’t want to reach out because I was embarrassed to tell them I was no longer in college,” Vu said. “A few days later, I found myself in the Longwood Medical Area speaking to SSJP staff about everything I was going through. After many tears and hugs, and a lot of encouragement, we came up with a plan.”

After taking the remainder of her junior year off to focus on her health, Vu and SSJP staff worked together on her application to University of Massachusetts Boston’s nursing program, to which she was accepted the following fall.

Today, she is a registered nurse at the Charles River Community Health Center and is applying to a family nurse practitioner program at Simmons College.

“The love from SSJP is enormous,” Vu said. “I can’t emphasize enough that the SSJP staff truly care about their students and support them in every way – they taught me resilience and to never give up on my dreams, no matter how impossible the situation may seem.”

Study Examines Best Way to Teach Bystanders How to ‘Stop the Bleed’

Training class for staff at Gillette Stadium

This tourniquet training class for staff at Gillette Stadium was one of many conducted by BWH researchers last year.

In the immediate aftermath of an accident or attack, can bystanders help save the life of someone who has experienced a traumatic injury? Brigham researchers recently sought to answer this question by studying how well different training methods prepared laypeople to apply tourniquets to stop uncontrolled bleeding, finding that those who underwent in-person training were most likely to successfully perform and retain this skill.

Traumatic injuries are the leading cause of death for Americans under 46, and uncontrolled bleeding is the most common cause of preventable death following a traumatic injury. Since the Boston Marathon bombings in 2013, several national initiatives, including the White House’s “Stop the Bleed” program, have emerged to empower laypeople to act as immediate responders until emergency personnel arrive on scene. These efforts have led to the development of different training methods, but it was previously unknown which type, frequency and format of training would competently prepare nonmedical personnel to conduct hemorrhage control.

To determine the best training method for tourniquet education, BWH researchers completed the PATTS Trial (Public Access and Tourniquet Training Study). The study was funded by The Gillian Reny Stepping Strong Center for Trauma Innovation and conducted in partnership with Gillette Stadium and the New England Patriots.

In total, 465 Gillette employees, who had no prior training in this area, participated in the study. The trial was designed to not only train staff in responding to uncontrolled bleeding, but also to test whether, and under what conditions, such training was effective. The results were published in JAMA Surgery this month.

Participants were randomly assigned to one of four groups. The first was provided instructional flashcards to learn about proper tourniquet application. The second group used flashcards and audio kits. The third received in-person training through the Bleeding Control Basic (B-Con) course, led by BWH instructors. The final cohort was asked to apply tourniquets with no training or instructions. Participants in the first, second and fourth groups later received in-person training.

Researchers found that in-person training, via the B-Con course, was the most effective instructional method and resulted in 88 percent of participants correctly applying a tourniquet. By comparison, participants who received no training applied a tourniquet correctly only 16 percent of the time, and participants who had access to instructional flashcards or an audio kit with flashcards experienced only small gains in effectiveness.

Looking at skill retention, researchers discovered that only about half of the participants could correctly apply a tourniquet three to nine months later, emphasizing the need for refresher training.

“Before the PATTS Trial, we didn’t know what was the best way to train the public in bleeding control,” said Adil Haider, MD, MPH, a trauma surgeon and Kessler director of the Center for Surgery and Public Health. “Now that we know, we can be more effective in creating training programs, public awareness campaigns and tools to empower people.”

Researchers stress that most external hemorrhages, or bleeds, can and should be controlled by direct pressure. While bystanders were critical first responders following the Boston Marathon bombings, subsequent research indicated that all 27 improvised tourniquets administered at the scene were applied incorrectly.

Looking ahead, Eric Goralnick, MD, MS, medical director of Emergency Preparedness and lead author of this study, said clinicians and public health investigators will convene to define a common research agenda for laypeople and bleeding control.

Meghan McDonald, MSN, RN, nurse director of the Trauma Program in the Division of Trauma, Burn and Surgical Critical Care and co-author of the study, said intervention from bystanders in any situation, not just mass-casualty events, can help save lives.

“Some people hesitate, especially when it comes to tourniquets, because they are afraid of causing more harm,” McDonald said. “Educating laypeople on hemorrhage control, be it direct pressure or tourniquet application, is not only the responsible thing to do as a trauma center – it is also the right thing to do.”

Brigham Health’s Strategy in Action: Scalable Innovation
Learn more about our strategic priorities at BWHPikeNotes.org.

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Helping Expand Access to Complex Care in Underserved Communities

Elizabeth Buzney demonstrates how phototherapy is performed at the BWH Phototherapy Center.

After topical treatments failed to heal a patient with a rare form of skin cancer, family physician John Mohs, MD, carefully evaluated the patient’s next steps.

Mohs practices at Northern Navajo Medical Center in Shiprock, N.M., a rural hospital operated by the U.S. Indian Health Services (IHS), which provides health care for American Indians living on or near their native homeland. Patients in this remote region of Navajo Nation are at higher risk for many diseases, yet specialty care is scarce. Northern Navajo Medical Center serves approximately 30 inpatients per day and approximately 600 outpatients per day, according to the IHS.

Diagnosed with cutaneous T-cell lymphoma – a form of lymphoma that affects the skin – Mohs’ patient was a good candidate for phototherapy, which exposes targeted areas of the body to ultraviolet light to reduce skin inflammation. Also known as light therapy, phototherapy has been proven to be safe, effective and affordable in treating a number of inflammatory skin conditions. 

For Mohs and his patient, the challenge was access. Until recently, Mohs had neither the training nor equipment to provide phototherapy at his small dermatology clinic in Shiprock. The nearest phototherapy center was about 200 miles away, and his patient would need to go there three days per week for several months. The combination of barriers made it infeasible for the patient to obtain the specialized care he needed. 

Ironically, the solution to their problem would be found more than 2,000 miles away – in the BWH Department of Dermatology. 

Thanks to a clinical collaboration between BWH faculty volunteers and IHS clinicians through the Brigham and Women’s Outreach Program, Mohs developed and launched a phototherapy service for his patients in Shiprock based on guidance he received from BWH experts in the field.  

He worked closely with Elizabeth Buzney, MD, director of the BWH Phototherapy Center, and Margaret Cavanaugh-Hussey, MD, MPH, director of Public Health and Community Outreach Programs in BWH Dermatology, who Mohs said both played a significant role in helping him get this new clinical service off the ground.

“I probably would not be using phototherapy without the guidance and assistance they provided. Dr. Buzney willingly shared many resources so that I wouldn’t have to reinvent the wheel,” Mohs said. “Thanks to all of this support, my patient was treated right at Northern Navajo Medical Center and is now in remission.” 

Buzney was delighted she could help to expand access to this treatment – a cause she says is close to her heart.

“I felt like I did something that was so small – I shared resources and knowledge I already had – and Dr. Mohs has since been able to care for so many people as a result,” Buzney said. “As physicians, we typically treat patients one-to-one. To play a part in assisting many patients who are so far away is immensely gratifying.” 

A Helping Hand

From left: Toby Crooks, Margaret Cavanaugh-Hussey and John Mohs

The project represents one of many collaborations established over the years between IHS clinicians and BWH faculty volunteers through the Outreach Program. Building on their latest momentum in phototherapy, Mohs and his physician assistant colleague, Toby Crooks, PA-C, visited the outpatient Dermatology clinic at 221 Longwood Ave. last month for a weeklong shadowing opportunity to observe and learn from BWH clinicians in action.

Mohs and Crooks were assigned to various specialty clinics, ranging from advanced wound care to cutaneous lymphoma – an experience that enabled them to broaden their dermatologic knowledge and strengthen relationships with experts in the field, said Cavanaugh-Hussey. In return, she added, BWH faculty had the chance to learn firsthand about the important work their IHS colleagues are doing in Shiprock. 

“The BWH Outreach Program is a model for how forming meaningful relationships with primary care providers in underserved communities can dramatically increase access to high-quality specialty care,” said Cavanaugh-Hussey. “This is particularly important in dermatology, where access to care is limited in many areas of the country.”

While the Outreach Program may be best known for sending BWH faculty volunteers to Shiprock to train IHS clinicians and help care for patients, providing shadowing and observation opportunities at the Brigham are equally important to its work and mission, said Thomas Sequist, MD, MPH, medical director of the Outreach Program, a primary care physician in the Phyllis Jen Center for Primary Care, and chief quality and safety officer at Partners HealthCare. Since 2009, the program has hosted training opportunities at the Brigham for 18 IHS clinicians.

“The delivery of highly specialized, complex care is crucially needed within the IHS. However, the number of patients that require such care on a day-to-day basis is relatively low, so if we send a BWH specialist to New Mexico, it is quite likely that there will be no training opportunity with actual patients the week they are there,” Sequist said.

Mohs agreed that observing the BWH Dermatology team in person was enormously beneficial. 

“We were able to see a large volume of more rare and complex conditions that we don’t see often enough to feel confident managing,” he said. “Being able to see these cases with BWH attendings and ask questions – and receive extensive answers from the experts – in real time was invaluable.”

Brigham Health’s Strategy in Action: Improve Health
Learn more about our strategic priorities at BWHPikeNotes.org.

BWH Welcomes Newest Residents on Match Day

Growing up in Zimbabwe, Tracy Makuvire witnessed the difficulties people faced in accessing health care and how those challenges affected many families, including her own.

Determined to become a doctor so that she could help heal others, Makuvire came to the United States seeking an education in medicine. She graduated from Stanford University in 2013 and is now just months away from receiving her medical degree from Harvard Medical School (HMS).

On March 16, Makuvire said her dream came true when she found out she was one of the 76 incoming interns selected for BWH’s Internal Medicine Residency Program on Match Day. She, along with several other newly matched interns, celebrated their acceptance into the program with current BWH residents, faculty and staff during a reception in the Zinner Breakout Room.

“This is the culmination of my studies since high school,” said Makuvire, who completed a rotation in the Department of Surgery as a fourth-year medical student. When she opened the envelope and saw it contained the words Brigham and Women’s Hospital, Makuvire was overjoyed to know she would soon begin her journey as a physician at this world-class medical institution.

“I immediately contacted my family in Zimbabwe and told them I had matched at the Brigham,” Makuvire said. “I’m counting down the days until I will put on my white coat and say to a patient for the first time, ‘Hello, I am Dr. Makuvire, and I’ll be taking care of you today.’ That is going to be a very special moment for me.”

Classmate and fellow incoming intern Enrico Giuseppe Ferro echoed Makuvire’s excitement. He was thrilled to video chat with his family back home in Italy as he opened his envelope earlier in the day. Ferro said he’s proud to continue the family tradition of caring for patients, just as his parents have done for so many years as physicians.

“Having the honor to enter patients’ lives and help them feel better – that is a privilege that will stay with us forever as doctors,” said Ferro, who completed an elective rotation in the BWH Division of Cardiovascular Medicine during medical school. “Matching at the Brigham is hard to beat. The community here is filled with such supportive people who want to help you succeed.”

Fellow HMS student David Wang enjoyed the Match Day festivities with his family, who was visiting from Texas. While he said they weren’t enthusiastic about the snowy weather, they were ecstatic about Wang’s match news. Recently having completed a rotation in the Department of Anesthesiology, Perioperative and Pain Medicine, Wang said he was very grateful to join an academic medical center so renowned for clinical training, constant support and a sense of family.

Thinking back to his Match Day experience a year ago, Zachary Hermes, MD, MPH, a resident in the Department of Medicine, attended this year’s celebration and congratulated his soon-to-be colleagues. He said it “feels like yesterday” when he found out he matched at the Brigham.

“The past year here has been more than I could have imagined,” Hermes said. “I hope the newly matched residents come to work with open minds and hearts and ready to learn. This is an experience unlike any other.”

Diana Bartenstein, of Tufts University School of Medicine, and Sally Tan, of HMS, gave each other a big hug when they arrived at BWH on Match Day. Bartenstein and Tan, who both plan to pursue a career in dermatology, recently met and became close friends after working as counselors at a camp for children with dermatologic conditions. They’re thrilled to spend this next chapter in their careers together at the Brigham.

During the Match Day celebration, Joel Katz, MD, director of the Internal Medicine Residency Program and vice chair for Medical Education in the Department of Medicine, welcomed the new interns into the Brigham family and congratulated them on finding their match.

“Today is a banner day for our hospital,” Katz said. “It’s wonderful to be able to welcome so many talented, hard-working and enthusiastic students to the Brigham. I hope our new residents enjoy the experience and focus on becoming the best doctors possible.”

‘An Unbreakable Bond’: BWHers Partner with Indian Health Service Providers

From left: Hanni Stoklosa, Mardi Chadwick, Annie Lewis-O’Connor, Jacqueline Savage Borne and Jessica Loftus

For several BWHers, including Srini Mukundan, MD, PhD, of the Department of Radiology, being able to work with care providers at Northern Navajo Medical Center in Shiprock, N.M., and Gallup Indian Medical Center in Gallup, N.M., through the Brigham and Women’s Outreach Program with Indian Health Service (IHS) has been an educational and transformative experience they will always cherish.

Mukundan, who has trained IHS staff on-site in Shiprock and remotely from BWH, said his experiences with the program provide an antidote to burnout and remind him why he chose this path in medicine.

“The Outreach Program opportunities have been one of the greatest rewards of being a BWHer,” Mukundan said. “After meeting the wonderful patients and witnessing firsthand the work of our remarkable colleagues at Shiprock, it is clear how important the essence of the physician-patient relationship is, especially in light of the limited resources available in Shiprock.”

Since 2009, BWHers have collaborated with the Navajo Area IHS – the federal agency responsible for delivering medical and public health services to members of federally recognized Native American tribes in the region. Through the Brigham and Women’s Outreach Program with IHS, BWH faculty, nurses, trainees and other providers volunteer their time and expertise to provide specialized care and training – on the ground at IHS hospitals and through remote teaching – in rural New Mexico and Arizona.

Advancing Care

Over the past year, BWHers across multiple disciplines have helped establish critically needed and sustainable services that would have otherwise been unavailable in these resource-poor areas.

Earlier this year, a BWH team traveled to Shiprock to teach IHS staff about human-trafficking in addition to screening and intervention strategies for domestic violence in the health care setting. Because of that visit, a BWH/IHS Trauma-Informed Care working group has been established with the goal to implement a trauma-informed care model in Shiprock by late 2018.

“During our time there, I learned new things from my Brigham colleagues as well as from the IHS staff. The whole experience challenged me to think more broadly about my interactions here with patients in the Emergency Department,” said Hanni Stoklosa, MD, MPH, an attending physician in the Department of Emergency Medicine and a member of the Division of Women’s Health, who trained IHS staff in human-trafficking awareness.

Annie Lewis-O’Connor PhD, MPH, NP, director of the C.A.R.E. Clinic and a member of the Division of Women’s Health, provided staff with techniques for incorportating trauma-informed care into practice, emphasizing the need for self-care, patient autonomy and meeting patients where they are at.

Also on the team was Jacqueline Savage Borne, LICSW, hospital program manager for the Passageway program in the Center for Community Health and Health Equity, who said working with the program was a professional dream fulfilled.

“The providers at Shiprock are so deeply committed to holistic, trauma-informed care for their patients,” Savage Borne said. “The resiliency in this community and its network of care providers is nothing short of inspiring.”

The collaboration between BWH and IHS providers results in dramatic, lasting improvements in care. Because of the radiology training provided by Mukundan, a neuroradiologist and medical director of Magnetic Resonance Imaging at BWH, along with other faculty members and house officers from the Department of Surgery, Shiprock providers are now able to screen patients for stroke based on head CT scans. Prior to this, they had no ability to provide this service.

Also in the works is a live, interactive remote video-training program to license IHS clinicians to be able to administer buprenorphine, a medication to treat opioid use disorder. Joji Suzuki, MD, director of the Division of Addiction Psychiatry, provides the same training in Boston and will lead the new remote course. Such support is needed to help IHS clinicians combat the opioid crisis in their remote and resource-poor communities.

“I have a lot of respect for the clinicians in IHS. I have visited and taught remotely, and I’ve seen firsthand how they work under very difficult conditions due to their limited resources,” Suzuki said. “I’m pleased we’ll be able to help them have access to training that would have otherwise not been readily available.”

Thomas Sequist, MD, MPH, a primary care physician in the Phyllis Jen Center for Primary Care and medical director of the Outreach Program with IHS, said he believes the Outreach Program is a vital resource for the region.

“Access to specialty care services is particularly challenging in more rural parts of the country, often limiting the treatment options for patients in these areas,” said Sequist, who also serves as chief quality and safety officer at Partners HealthCare. “We are extremely proud of the work of our BWH clinical community – physicians, nurses and other staff working together to fill important gaps in care. This work is built on the premise of establishing long-lasting relationships that represent a sustainable approach to delivering advanced and high-quality care in these native communities.”

Brigham Health’s Strategy in Action: Improve Health
Learn more about our strategic priorities at BWHPikeNotes.org.

Q&A: Caterson Reflects on Career Path, Clinical Teaching Goals

Stephanie Caterson (center) with her husband and “number one supporter,” E.J. Caterson (left), MD, PhD, and Dennis Orgill (right), MD, PhD, who presented her award.

Stephanie Caterson, MD, director of the Perforator Flap Breast Reconstruction Program in the Division of Plastic Surgery, received the 2017 Bernard Lown Teaching Award, which celebrates BWH physicians who are outstanding clinical teachers.

In this Q&A with BWH Bulletin, Caterson shares her thoughts on her career in plastic surgery and her education style.

What drew you to the field of plastic surgery?

SC: I was an aerospace engineer as an undergraduate, and when I went to medical school, I was not even considering surgery. I was seeking a higher-level degree so that I could apply for the astronaut program. I thought I would study emergency medicine because it would be applicable in space. But as I started my clinical rotations, I fell in love with the technical aspects and challenges of surgery.

Plastic surgery stood out to me due to the parallels to engineering. You have a set of “tools,” and you must solve the problem, which is different for each patient. During my formative years as a medical student, the most inspiring role models I came across were plastic surgeons. They loved what they did, and it was contagious.

As I completed my surgical residency, I began to question my path to the astronaut program because, as an astronaut, I wouldn’t practice any clinical medicine. In the end, the pull of plastic surgery won. I applied for a fellowship and I was lucky enough to match.

What is your education style when working with trainees?

SC: I try to teach using encouragement instead of intimidation. I gauge my audience for their level of training and prior clinical exposure, then go from there. For instance, the complexity will be different when teaching a first-year medical student versus teaching an instructional course at a plastic surgery conference. I enjoy the challenge of tempering my style for the audience, and I like to provide a comfortable but stimulating atmosphere in which to learn.

I would say the most intensive teaching takes place in the operating room, but there’s a lot that goes into the pre- and post-operative stages. I think you would be remiss in just teaching trainees how to do the operation, but not teaching them how you get the patient to the operation.

What nonclinical skills do you also reinforce in your teaching?

SC: The doctor-patient relationship is something that I try to emphasize. Dr. Bernard Lown is famous for teaching the doctor-patient relationship and its importance in healing and care. I place a special emphasis on practicing empathy. Every patient responds differently to their diagnosis, and it is our responsibility as caregivers to be respectful and supportive.

In addition to teaching medical trainees, I am also passionate about patient education. Recently, our deep inferior epigastric perforator (DIEP) flap program started a preoperative education class for patients who are preparing for DIEP flap surgery, as well as their families. We host the class in the hospital on the floor where the patients will be staying post-operatively. They get a tour of the facilities and a demonstration of the medical equipment we will be using during their care. Patients gain a better understanding of recovery and meet surgical team members who will be caring from them and other patients about to undergo the same procedure. At the same time, I am learning what concerns patients have pre-operatively, which allows me to improve my consultations. The response has been tremendously positive for patients and caregivers alike.

How do you think medical training could be improved?

SC: I think personalized mentorship is much more powerful than teaching in large group settings. The more we can do to center the instruction around the learner, the more effective we can be. Additionally, I think early exposure to specialties is important for students. Often these areas of medicine are competitive and difficult to pursue, so starting off on the right track is important.

Lastly, I am a strong believer in collaborative interactions improving the field of medicine. The DIEP flap program is an example of a multi-disciplinary team – including office staff, physician assistants, nurses and nurse practitioners, OR staff, anesthesiologists, plastic surgeons, physical therapists, staff from radiology, surgical oncology and medical oncology and the patient – all working together with the common mission of optimizing patient care.

Q&A: Brigham PA Shares Passion for Profession, Education

National Physician Assistant (PA) Week is held every October to honor physician assistants’ substantial role in improving health. PAs are involved in nearly every facet of care at BWH.

Chioma Tomlinson

Chioma Tomlinson, MMS, PA-C II, who practices Internal Medicine and Primary Care at Brigham Circle Medical Associates, is one PA making a difference in the lives of patients, colleagues and trainees.

“Having had the good fortune of watching Chioma practice and teach medical trainees, I’m struck by how effective she is at immediately establishing rapport,” said Charles Morris, MD, MPH, associate chief medical officer and an attending physician at Brigham Circle Medical Associates. “She was the first PA in our practice, so she often was introducing not only herself in the exam room but also her profession. Her ability to quickly forge a connection is a skill at which she excels and then leverages to provide a superlative level of care.”

In this Q&A, Tomlinson shares why she loves her job and her commitment to helping educate the next generation of PAs.

What’s your favorite part of your work?

CT: Our team-based approach. It’s a pleasure for me to get to know many of our patients almost as well as their physician does. This dynamic helps us provide better continuity of care. It’s a privilege to be there as someone who can step in and is as invested in the patient’s overall health as their physician when issues arise that need immediate attention or that require frequent visits.

Why did you choose primary care?

CT: I value the relationships we have with our patients in primary care. Our ability to consistently provide quality care for any number of medical and/or psychosocial issues is often tethered to our ability to establish caring and trusting relationships. One example is management for illnesses such as hypertension and diabetes. Staying healthy for these patients often requires not only regularly taking medication but also making significant lifestyle modifications. I try to find common ground and talk to patients about how we can help them live their best lives.

You’re also a preceptor. What do you enjoy about educating PA students?

CT: I love what I do and enjoy sharing that fulfillment with students. I’m fortunate in that I teach students from a few local programs. It’s a nice opportunity to give back to the community that has given me so much. It’s inspiring to remember how much we learn during those didactic years and how stressful – but exciting – that time can be. I also like challenging students to think through the many ethical and professional issues in medicine and how they impact our practice as PAs.

What’s your advice for new PAs and PA students?

CT: It’s important for all of us to make sure our profession stays strong by honoring those who came before us, supporting those around us and fostering those who come after us. I encourage PAs to find a meaningful way to stay active in our community. Teaching, publishing, advocacy or trailblazing new opportunities are just a few examples of ways to stay engaged. Lastly, take pride in the fact that we’re part of a larger medical community with the common goal of providing the best care for our patients.