Posts from the ‘strategic priorities’ category

Brigham Team Recognized for Role in Disaster Response

When a major flood caused by a burst pipe forced the closure of the labor and delivery and neonatal intensive care units at Boston Medical Center (BMC) temporarily last year, the Brigham and several other hospitals stepped up to ensure patient care remained the priority.

During a Quality Rounds presentation in Bornstein Amphitheater last month, BMC clinicians spoke about the flood and reflected on the disaster response and lessons learned. 

A critical piece to the emergency plan for BMC was the safe and timely transfer of patients out of the affected units to area hospitals, including the Brigham, for care. At the end of Quality Rounds, the Brigham was presented with an award from BMC in recognition of the assistance staff provided during the flood incident. 

Karen Fiumara, PharmD, BCPS, executive director of Patient Safety at Brigham Health, said the Brigham teams that responded to this challenging situation were “nothing short of remarkable.” 

“While continuing to safely care for their existing patients, they welcomed this group of BMC patients and their loved ones to the Brigham with open arms and provided them with exceptional care,” Fiumara said. “This was one of those amazing stories that makes you proud to be part of the Brigham community.” 

Katherine Gregory, PhD, RN, associate chief nursing officer for the Mary Horrigan Connors Center for Women and Newborns, echoed Fiumara’s thoughts.

“The Brigham comes together in a crisis like no other, and we care—not only about our patients but also those across the city and region,” she said. “It was our privilege to care for the women and newborns who were affected by the BMC flood last year, and we stand ready to serve if called upon by our obstetric and newborn colleagues again in the future.”

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.

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

The Power of Hand Hygiene

La’Lena Etheart BSN, RN, PCCN and staff

From left: Nina Jordan, La’Lena Etheart, Michelle Lafferty and Reba Dookie

I recently went back to school for my master’s degree in Nursing Administration. I had to design a brochure as part of an assignment, and I decided to make a brochure about hand hygiene and preventing the spread of infection. I thought of the idea to have real nursing staff in my visuals, and my amazing coworkers on Shapiro 9/10 were more than willing to help! This picture is the cover photo of my brochure, which was titled “The Power Is in YOUR Hands!”

La’Lena Etheart BSN, RN, PCCN
Nurse in Charge, Shapiro Cardiovascular Center 9/10

A Shared Commitment to Improving Diabetes Care

Hudson and colleages

From left: Lauren Godsoe, Margo Hudson and Maricruz Merino

I have been going annually to New Mexico with the Outreach Program with Indian Health Service since 2009, and each year gets better. I have primarily been involved with the diabetes program at Gallup Indian Medical Center in Gallup, N.M.

A former Brigham internal medicine resident, Maricruz Merino, MD, is now their chief of Medicine, and we have been working together closely over the years developing inpatient and outpatient glucose-management protocols. We are both close friends as well as colleagues, and we have shared the joys of the birth of children and grandchildren with each other in addition to seeing the growth of the diabetes program.

This past March, I had the pleasure of traveling with Brigham Health nurse practitioner Laura Godsoe, NP, for a week of lecturing and consulting on patients. I am so proud of the work we have done and thankful to Outreach Program for continuing to support this opportunity.

Margo Hudson, MD
Division of Endocrinology, Diabetes and Hypertension

The ‘Antidote to Burnout’: Helping Underserved Communities

Jason Frangos and team

From left: Zachary Holcomb, John Mohs, Jason Frangos, Margaret Cavanaugh-Hussey, Toby Crooks and Diana Woody

I made my second trip to Shiprock, N.M., in November 2018 as part of the Brigham and Women’s Outreach Program. Working alongside the dedicated doctors and staff at the Indian Health Service hospital in Shiprock has truly inspired and motivated me in my life and work. Contributing much-needed clinical care to the Navajo community has re-energized me with a sense of meaning and purpose as a physician. Volunteering at Shiprock has been my antidote to burnout and has revitalized my spirit.

Jason Frangos, MD
Director, Program for Infectious Diseases of the Skin
Department of Dermatology

The Heart of the Matter: Brigham Team Delivers Precious Outcome

Jasmine Taylor with her son, Jaydan

When doctors told Jasmine Taylor, 30, five years ago that pregnancy would be a life-threatening condition due to her poor health, including a complex heart defect she’s had since birth, it didn’t come as a surprise to her. It was something Taylor had heard from her care providers since adolescence. Still, as she and her husband, Damon, dreamed of starting a family, that didn’t make the news any less heart-wrenching.

Today, however, her heart overflows with love. Seemingly against all odds—and thanks to the support of Taylor’s passionate and collaborative multidisciplinary care team at the Brigham and Boston Children’s Hospital (BCH)—the Stoughton couple welcomed their son, Jaydan, to the world in July.

“When I heard him cry for the first time in the delivery room, I thought, ‘I want to protect and love him forever,’” Taylor said.

Getting to that point was a long and difficult road, one that Taylor said she doesn’t take for granted. She was born with a severe form of tetralogy of Fallot, a cardiovascular disorder that restricts the passage of blood to the lungs. By the time she was a teenager, Taylor had undergone three open-heart surgeries—the first one performed when she was just eight months old.

Upon reaching her 20s, her health continued to decline. She became overweight, diabetic and struggled with high cholesterol. On top of that, she wasn’t keeping up with the long list of medications she had been prescribed to treat these issues; at 23, she had a stroke. The frightening event was a wakeup call, Taylor said.

She began taking her medications dutifully. She adopted a healthier diet and intensive exercise regimen, leading her to drop 100 pounds in one year and safely come off most of her medications. Taylor said she did it all with one aspiration in mind: getting healthy enough to become a mother.

“There was a chance—a hope—that I could become a parent, so I was very determined to make it happen,” Taylor said.

‘We’re Going to Do This’

Even with the dramatic improvements to her health, Taylor’s weak heart would make pregnancy challenging. Among the many changes women undergo while pregnant is a significant increase in blood volume—sometimes almost doubling to nourish a fetus—which puts more stress on the heart to pump blood through the body.

“I told Jasmine, ‘It’s going to be hard work,’” recalled obstetrician Katherine Economy, MD, co-director of the Brigham’s Pregnancy and Cardiovascular Disease Program. “She just looked and me and said confidently, ‘None of this is a problem for me. My goal is to have a baby,’ and I said, ‘That is my goal now for you, too. We’re going to do this.’”

Economy is just one member of the large interdisciplinary care team that worked together over the past two years to achieve a safe pregnancy and childbirth for Taylor and baby Jaydan. But just as important as the advanced, comprehensive care they delivered was Taylor’s fierce commitment to staying healthy and starting a family, her providers emphasized.

“It takes more than a village of expert care, compulsiveness, outreach, detail, innovation, coordination and attention to quality outcomes at every step,” said cardiologist Michael Landzberg, MD, senior staff member, founder and immediate-past director of the Boston Adult Congenital Heart and Pulmonary (BACH) Program, a joint effort of the Brigham and BCH that cares for adults born with heart conditions. “That said, without identifying and utilizing her unique strengths, Jasmine could never have accomplished what she has near-miraculously done. She remains a hero to each and every one of us.”

Close Collaboration

After facing fertility challenges unrelated to her heart condition, Taylor was referred to the Brigham’s Center for Infertility and Reproductive Surgery, where she underwent two rounds of in-vitro fertilization (IVF) at the center’s Weymouth clinic. Even at this stage, her complex health needs influenced how her fertility care was planned, said reproductive endocrinologist Janis Fox, MD.

“There were definitely unique considerations in performing IVF on someone with her history,” Fox said. “I very much wanted to avoid rare but known complications such as ovarian hyperstimulation, and I absolutely wanted to avoid a multiple pregnancy, as we all felt that would be an unnecessary challenge for her heart.”

Throughout her pregnancy, Taylor’s providers were in near-constant communication and, via the Pregnancy and Cardiovascular Disease Program, met monthly to discuss her progress and anticipate possible complications. The team also involves experts from other disciplines—including anesthesiology, cardiac surgery, neonatology and nursing—to ensure they are fully prepared, said cardiologist Anne Marie Valente, MD, co-director of the program.

“We coordinated and developed a written care plan so that at any point, no matter who was on call, each of us would know exactly the potentials and treatment plan,” Valente said.

As a patient, Taylor said her providers’ extraordinary commitment, support and compassion have been remarkable: “These are priceless people in my life. They are like my extended family.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

Nature Themes and Seating Areas Come to the Pike

An artist’s rendering illustrates the Pike’s upcoming coastalthemed area, which will be located near Bornstein Amphitheater.

An artist’s rendering illustrates the Pike’s upcoming coastal-themed area, which will be located near Bornstein Amphitheater.

You may have noticed a few changes along the Pike recently, including the addition of seating alcoves and nature-themed designs. Kicked off two years ago by the Brigham’s Planning and Construction team, the project is part of a larger effort to make it easier for patients, visitors and staff to navigate the hospital and to create a more welcoming and soothing environment.

As part of the new design, six areas are designed to correspond to a scene in nature, such as a forest, pond or wheat field. Seating alcoves within these areas will provide places for patients and families to relax in a peaceful setting as they traverse the Pike.

“We wanted to brighten up the Pike by bringing a sense of nature into the building,” said Bea Gomez, senior project manager of Real Estate. “Giving patients, families and staff a connection to the outdoors while inside was extremely important to us, as research suggests that immersion in nature makes people feel more at ease.”

The improvements are not only exciting to the team executing the work, but also to Brigham patients, families and staff.

“We’ve received feedback from people that the Pike feels more welcoming and accommodating now,” said Steve Dempsey, executive director of Planning and Construction. “We’re excited to continue to look for new opportunities to incorporate nature themes throughout the hospital.”

The team has previously worked on improving design throughout the Brigham with the addition of area platforms overlooking gardens at the Garden Café, as well as the installation of a bright green roof below the windows of the Neonatal Intensive Care Unit (NICU).

Dempsey credits Brigham Health President Betsy Nabel, MD, with supporting the team’s work to spruce up areas across the main campus. Nabel challenged the group to combine both navigational and welcoming elements in their renovations, a task that Dempsey was eager to take on.
“We’ve been able to successfully put the two concepts together,” said Dempsey. “We’re excited to make it easier for patients to find their way around the Brigham in a more comfortable and peaceful environment.”

The project is scheduled to be completed in February 2019.

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

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Unraveling the Mysteries of Sex Differences and the Brain

Participants speak at the Interdisciplinary Neuroscience Inaugural Symposium: Sex Differences and the Brain - Implications for Research, Health and Disease.

From left: Ursula Kaiser listens as Cynthia Lemere asks a question during the first annual Women’s Brain Initiative Symposium.

In human disease biology, sex differences are as perplexing as they are pervasive. One crucial place where these differences manifest themselves is in the brain and in conditions affecting or affected by this critical organ.

There are more women than men with Alzheimer’s disease, multiple sclerosis, obesity, eating disorders, anxiety and depression, for example, while men have higher rates of Parkinson’s disease and schizophrenia. Yet the reasons for these differences remain understudied and unknown.

“Women’s health is often understood to mean reproductive health, but that’s a narrow definition for the health of half the human race,” said Charles Jennings, PhD, executive director of the Brigham’s Program for Interdisciplinary Neuroscience and Ann Romney Center for Neurologic Diseases. “We’re increasingly recognizing that many and perhaps most diseases show differences between men and women. In many cases, the effects are quite large, and if we want to understand the cause and eventual treatment of these diseases, we can’t ignore the sex differences.”

With the help of a generous philanthropic gift from Rick and Nancy Moskovitz, the Brigham-wide Women’s Brain Initiative (WBI) launched in 2017 to support research over four years into women’s brain health and the science of sex differences.

WBI-funded projects may span a range of questions from basic biology—how male and female brains became wired differently—to practical clinical questions about sex differences in disease risk and treatment responses, as well as how conditions specific to women (such as pregnancy and menopause) influence brain health. The WBI also supports community-building through an annual symposium and an ongoing Seminar Series starting Dec. 18.

“Surprisingly, there is nothing like the WBI anywhere else,” said Patti Stoll, MBA, director of the Women’s Brain Initiative. “Our goal is to attract not only investigators who are currently interested in the subject but also those who might not yet appreciate how this area could be important for their research.”

A Catalyst for Curiosity

Rosalind Lai, MD, WBI research fellow in the Department of Neurosurgery, is examining how hormones affect subarachnoid hemorrhages—which result from the rupture of an intracranial aneurysm, an abnormal dilation in a blood vessel of the brain—and why these events occur more often in women than men.

“We know that hormonal levels are altered after a head bleed, but we want to know if estrogen is a contributing factor to the rupture of an aneurysm,” said Lai. “Being a part of the WBI means being a part of a supportive community that fosters interest and curiosity about sex differences and the brain.”

Lai attended the inaugural WBI Symposium on Sept. 26 and enjoyed talks by visiting researchers. One lecture that stood out to her was given by Arthur Arnold, PhD, from the Brain Research Institute at the University of California, Los Angeles, who spoke about how chromosomal differences could affect disease risks that have previously been attributed to hormones.

“His talk made me think more about the different factors that may affect sex differences,” said Lai.

Meeting of the Minds

Another goal of the WBI is to connect researchers and clinicians at the Brigham and encourage these experts in different disease areas to think about the effects of sex differences.

Ursula Kaiser, MD, WBI-funded researcher and chief of the Division of Endocrinology, Diabetes and Hypertension, studies the effects of endocrine-disrupting chemicals, which can act similarly to estrogens, on increased risk of premature puberty in girls.

Needing guidance about how to examine the role of estrogen in Parkinson’s disease, Silke Nuber, PhD, WBI-funded researcher in the Ann Romney Center, came to Kaiser for her expertise. Kaiser invited Nuber to her lab to learn some of the techniques for examining the effects of ovarian function and estrogen levels in preclinical models.

“I think one of the wonderful things about WBI is that it brings so many multidisciplinary groups together who perhaps haven’t interacted as much in the past,” said Kaiser. “It makes all of us more aware of other research being conducted at the Brigham.”

Building on a Brigham Legacy

The WBI does not exist in isolation—it builds on and unites entities and areas of focus with a long legacy at the Brigham. One of those collaborating entities is the Mary Horrigan Connors Center for Women’s Health and Gender Biology.

Hadine Joffe, MD, MSc, executive director of the Connors Center and vice chair for psychiatry research, has encouraged researchers to join the WBI to increase funding opportunities and further advances pertaining to sex differences and the brain. One of those investigators is Katherine Burdick, PhD, of Psychiatry, whose research on predictors of cognitive impairment in postmenopausal women with major depressive disorder (MDD) has become part of the WBI’s portfolio.

“I became aware of the opportunity to apply for funding via the WBI thanks to Hadine Joffe, with whom I worked to develop the protocol for the funded study,” said Burdick. “With support from the WBI, we are trying to identify clinical and biological explanations for why some postmenopausal women with MDD develop cognitive and functional disability while others do not. This information will hopefully lead to a more personalized-medicine approach in the future.”

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

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.

From a Harrowing Past Emerges a Brighter Future for Brigham Researcher

Morteza Mahmoudi

Morteza Mahmoudi displays the latest prototype of a novel skin patch designed to heal chronic wounds.

Morteza Mahmoudi, PhD, vividly remembers the fear and heartache he felt as a child growing up in Iran during the Iran-Iraq War in the 1980s. The armed conflict played out in the streets of his hometown of Tehran, where he says it wasn’t unusual to encounter a friend, neighbor or loved one suffering from traumatic injuries following a missile attack.

But just as clearly, Mahmoudi recalls what the voice inside him often said those days: Help people. Help heal their pain.

Now a biomedical investigator at the Center for Nanomedicine and the Department of Anesthesiology, Perioperative and Pain Medicine, Mahmoudi has spent the last three decades following that calling. It has propelled him to fulfill his life mission to ease suffering, no matter the obstacle.

“The war was a very hard period, but when I think about those days, I realize that kind of experience puts fuel in your motivational tank for the rest of your life,” he said. “From the time I entered university, I made the decision to use my past as a driving force for the future.”

As the winner of the seventh annual BRIght Futures Prize, Mahmoudi is especially hopeful about what tomorrow holds for patients around the world. The competition’s $100,000 award will support his project, “Time to Heal Chronic Wounds.”

Sponsored by the Brigham Research Institute, the BRIght Futures competition invites the Brigham community and the public to vote for one of three finalists whose innovative research is poised to transform medicine. This year’s competition garnered its largest-ever number of votes: 16,530. Mahmoudi was announced as this year’s winner during an awards ceremony at Discover Brigham on Nov. 7.

For the past 10 years, Mahmoudi has been working to develop a skin patch to heal chronic wounds that the body is unable to repair on its own, such as bedsores and diabetic wounds. There is no effective treatment for these types of wounds, which can easily become infected and sometimes lead to amputation or even death.

Mahmoudi’s patch is made from multifunctional nanofibers – fibers that are 1,000th the diameter of a single human hair – that mimic most of the skin’s characteristics. They are engineered to deliver a cocktail of healing biomolecules and immunotherapeutic nanoparticles to a wound site. These unique properties can help cells reach the site of a wound and create new blood vessels. Meanwhile, the nanoparticles detect and help fight infections while also lessening inflammation. The BRIght Futures Prize funding will help advance the project from the lab bench to clinical trials so that it can be rigorously tested in humans.

A Long Road

Once he got the idea for the patch, Mahmoudi soon realized how ambitious an endeavor creating it would be. It demanded expertise in four highly complex, distinct scientific fields: materials science and engineering, biomedical engineering, nanomedicine and cell biology. Undeterred, Mahmoudi earned a degree in each one (a bachelor’s, master’s, doctorate and post-doctorate, respectively).

“The time in which I was working on bachelor’s and master’s was extremely hard, as in addition to my university courses and research, I had to work over 70 hours per week as a high school teacher to support my family at the time,” Mahmoudi recalled. “The motivational fuel and my old friend – my internal monologue – gave me the stamina to make it through those days and continue my scientific activities while also taking care of my immediate family.”

He kicked off his research career at universities in Ireland, Switzerland and the U.S., advancing his understanding of science and medicine as he chipped away at the project’s protocols and prototypes.

“I was like a scientific nomad,” he said. “Ten years ago, the crosstalk between different experts was not great – not like today – so that’s why I had to train in different medical and engineering fields.”

Each part of the patch – its precise structure and physical, chemical and mechanical properties – took years to perfect.

“I would say that this was one of the hardest projects I’ve ever done because it took a lot of time, and I could have easily given up many times, but I kept going,” he said. “My long-term collaborators and I made a huge number of prototypes. We haven’t yet published anything on this topic, as I believe that the scientific community and patients would benefit from the A-to-Z story, rather than progressive reports. We needed to make sure our final prototype was error-free, and we are now at that stage.”

Being part of the Brigham’s highly collaborative clinical and research community has been a tremendous gift in advancing this work, Mahmoudi said.

Today, he is excited to see the project move one step closer to changing outcomes for patients with chronic wounds, thanks to the BRIght Futures Prize.

“If I can reduce the pain of one patient, even for one minute, I have done my share. But if these patches can help many lives, that would be my ultimate dream,” Mahmoudi said. “This prize opens the way to that.”

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

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B-PREP Program Aims to Stop Breast Cancer in Its Tracks

Bprep

From left: Mil Pierce reviews information about a clinical trial with Shivam Dua at the Comprehensive Breast Health Center.

As far as she can tell, Mil Pierce, 55, of Belmont has done everything right in terms of leading a healthy lifestyle. She never smoked. She goes to the gym twice a week and walks her dog nearly every day. She doesn’t drink alcohol in excess. And she’s eliminated red meat from her diet.

Pierce has made these choices with the knowledge that she has a strong family history of breast cancer. The disease has affected her mother, maternal grandmother and a maternal great aunt, among many other relatives.

Yet after Pierce underwent genetic testing to see if she had an inherited mutation in the BRCA1 or BRCA2 genes – an alteration that greatly increases a woman’s risk of breast cancer – the lab results showed she didn’t have the harmful mutation.

That’s why Pierce was stunned to learn two years ago, following a biopsy, that there were precancerous cells in her breast tissue. If left untreated, the abnormal cells could develop into breast cancer.

“When I got that diagnosis, it hit me like a brick. I thought, wow, there’s something else going on,” she said. “Genetically speaking, there’s no explanation for it.”

Today, Pierce is hopeful not only for her own continued health but also that of her two teenage daughters, thanks to the care, resources and guidance she’s receiving through the Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).

Launched about two years ago and led by Tari King, MD, chief of Breast Surgery at DF/BWCC, the B-PREP Program develops a comprehensive, customized risk profile for every patient and a personalized plan aimed at reducing the likelihood of developing breast cancer. Upon entering the program, patients complete a survey that asks not only about their medical history but also a wide range of lifestyle factors that experts believe can contribute to breast cancer risk, including diet, physical activity, sleep, weight changes, whether they work a night shift and more.

“Assessing individual risk for breast cancer is complicated,” King said. “Breast cancer is not just one disease; it is a family of diseases, and the risk factors that can lead to the development of different types of breast cancer also vary.”

King emphasized that the program is open to all patients, including – and perhaps especially – those who don’t know their breast cancer risk.

“Many women think that if breast cancer is not in their family that they don’t have to worry about it, and that is not true. In fact, most women who come in with their first diagnosis of breast cancer don’t have a family history,” King said. “Our doors are open to anyone who wants to learn about their risk.”

Novel Trials

Another big misconception the B-PREP Program is working to dispel is that people at increased risk are at the mercy of their biology, King said. Based on what B-PREP’s multidisciplinary team learns from an assessment, each patient receives personalized recommendations and is connected to relevant resources, such as a referral to the Brigham’s Program for Weight Management or information about clinical trials currently enrolling patients.

One such novel trial is looking at how exercise affects breast cancer risk in women who have dense breast tissue and do not currently engage in regular exercise. Led by Jennifer Ligibel, MD, a medical oncologist specializing in breast cancer at DF/BWCC, the study pairs participants with a personal trainer for 12 weeks. Researchers will collect a breast tissue sample from participants before and after they complete the exercise program.

“We know that women who exercise more have a lower risk of developing breast cancer, but we don’t know why. We also know that denser breast tissue – that is, tissue containing more glandular elements to it and less fatty tissue – is linked to a higher risk, and, again, we don’t know why,” Ligibel said. “In a previous study we conducted looking at women who already had breast cancer, we saw that exercise actually changed the immune system within the cancer. Now, we’re looking at whether those same types of changes from exercise can be seen before a tumor has even emerged.”

Pierce learned about her eligibility for the study from her B-PREP providers and became one of the first patients to enroll. She appreciates how comprehensive the B-PREP Program is, including the opportunities to participate in clinical trials that explore wellness-based approaches to prevention.

“This breast density and exercise study was music to my ears,” she said. “I’m really excited about being on the cutting edge of research, especially since there’s a mystery here.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
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Extending Access to Psychiatric Care for Pregnant, Postpartum Patients

While pregnancy, childbirth and motherhood are joyful times for many women, for others these experiences can be emotionally challenging, isolating or even traumatic. An estimated one in seven women experiences depression during pregnancy or in the first year after giving birth – making depression during this time nearly twice as common as gestational diabetes. 

But unless a mother or mother-to-be already has an established relationship with a behavioral health provider, she faces multiple barriers in terms of accessing specialized care to prevent, identify and manage mental health and substance use concerns.

“Psychiatrists who are trained in and comfortable with treating pregnant and postpartum patients are an extremely limited resource. There are simply not enough,” said Leena Mittal, MD, director of the Division of Women’s Mental Health in the Department of Psychiatry. “Meanwhile, in low-resource areas like Central and Western Massachusetts, the wait time to see any psychiatrist – let alone a perinatal psychiatrist – could be three or four months. In Southeastern Mass., it could take more than six months.”

That usually leaves primary care providers and obstetricians on the front line, but they don’t typically receive the specialized training necessary to feel confident treating these patients either, Mittal said. 

Helping to bridge that gap is the Massachusetts Children Psychiatry Access Program (MCPAP) for Moms, which provides free, real-time perinatal psychiatric consultations and referrals for obstetric, pediatric, primary care and psychiatric providers across Massachusetts. The Brigham serves as the Boston hub for the program, which is based out of the University of Massachusetts Medical School in Worcester. 

Supporting Patients and Providers

From fluctuating hormones to sleep deprivation to a traumatic childbirth, there are a number of circumstances that can make pregnancy and motherhood a difficult time for patients. 

Leena Mittal

Launched four years ago, MCPAP for Moms maintains a consultation, resource and referral phone line that providers can call to receive guidance on diagnosing, treating and prescribing medications for pregnant and postpartum women with mental health or substance use concerns. For complex cases, perinatal psychiatrists in the program conduct in-person consults with patients. The service can also help frontline providers identify other relevant community resources or help facilitate referrals to group and individual therapy or other services.

For example, if an obstetrician suspects that a patient who’s come in for a prenatal care visit is showing signs of depression, the provider could call MCPAP for Moms and ask for input on a possible diagnosis and treatment plan, explained Mittal, one of two Brigham psychiatrists who provide consults through the program.

“There’s this misconception that pregnancy is a time when women are always ‘glowing’ and happy, but it can be a complicated time,” said Mittal, who also serves as associate medical director of MCPAP for Moms. “In addition, women – and sometimes their providers – assume they have to stop all medications, including antidepressants, during pregnancy. But that’s not the case. We give providers evidence-based guidelines, and they can ask questions as needed.”

Nicole Smith, MD, MPH, of the Department of Obstetrics and Gynecology, has used MCPAP for Moms’ services in her practice and recommended it to colleagues as a novel, vital resource for providers. 

“A lot of programs tend to focus on trying to increase the number of and access to therapists and psychiatrists, which is wonderful and very necessary, but that may not meet our patients’ needs,” said Smith, an unpaid obstetric consultant for the program. “Patients can receive great, timely care from their primary care doctor or obstetrician, who may just need confirmation that a treatment is appropriate or a best practice.” 

MCPAP for Moms supplements the Brigham’s robust in-house psychiatric resources, she added. For example, the program makes it easy to help patients who live outside Boston find support services closer to home. “Many patients don’t want to drive to the city with a newborn, and that can be an obstacle to accessing treatment,” she said.

Looking ahead, MCPAP for Moms is expanding its services to support providers caring for perinatal patients with substance use disorders, an effort that will be based out of the Brigham and led by Mittal. 

“Massachusetts is the first state in the country with a program like MCPAP for Moms, and getting to be part of something so innovative has been very exciting,” she said. “We’re moving the needle in the way that perinatal mental health is treated, and I’m thrilled to be part of that.” 

Learn more at mcpapformoms.org or contact MCPAP for Moms at 855-MOM-MCPAP (855-666-6272). Providers interested in training opportunities around perinatal mental health and substance use are also encouraged to contact the program.

Brigham Health’s Strategy in Action: Timely Access
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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
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AERD Center Aims to Clear the Air on an Underdiagnosed Disease

From left: Alice Maxfield speaks with David Doyle during a recent follow-up appointment.

For David Doyle, 54, taking in the flavors and aromas of food is more than his passion – as co-owner of several restaurants in Jamaica Plain, it’s also his livelihood. So when what seemed like unusually intense seasonal allergies caused his senses of smell and taste to diminish three years ago, Doyle grew concerned.

First experiencing severe nasal and chest congestion, he tried several over-the-counter allergy medications. Nothing worked – in fact, his symptoms worsened. Within a few months, Doyle not only felt miserable physically, but he was also devastated to find he could no longer smell or taste anything.

“I didn’t really want to eat because there was no joy in it,” Doyle said. “On a professional level, it was also really hard to work with these great chefs who would ask, ‘David, can you taste this?’ and all I could comment on was the texture.”

Hoping his symptoms would eventually subside, he continued taking allergy medications and pain relievers, even though their effects were minimal. It wasn’t until after suffering a frightening medical event that Doyle would learn the very medications he was taking to feel better were actually making him sick.

Doyle was on vacation with his family in Spain when he realized something was gravely wrong with his health. Suffering from a bad headache and congestion, he took some ibuprofen, a treatment he had used before without incident. This time, however, he began experiencing serious respiratory distress within a few hours and was rushed to a local hospital.

“My lungs were filled with fluid. I felt like I was suffocating,” Doyle said. “I had no idea what had prompted that reaction, but I was starting to suspect something had changed inside me.”

After returning home, he was referred by his primary care provider to Tanya Laidlaw, MD, director of Translational Research in Allergy in the Division of Rheumatology, Immunology and Allergy, who diagnosed him with aspirin-exacerbated respiratory disease (AERD). Triggered by a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, AERD is a chronic condition that includes severe asthma and recurrent, fast-growing nasal polyps.

Also known as Samter’s Triad, the disease often strikes otherwise healthy adults and progresses rapidly. Its cause is unknown, and effective treatments are elusive.

“This is a disease that is really not well-known and is underdiagnosed,” said Laidlaw, who also serves as director of the Brigham’s AERD Center. “It requires a multidisciplinary approach, particularly between ear, nose and throat surgeons and allergists – specialists who don’t ordinarily talk to each other about patients with these symptoms. Without that communication, an ENT surgeon is unlikely to ask about an aspirin allergy, and an allergist doesn’t typically look for nasal polyps.”

Founded five years ago, the Brigham’s AERD Center brings together allergists, ENT surgeons and researchers to explore new treatments and improve the lives of patients with AERD. The center’s clinicians diagnose and treat hundreds of patients per year, and its investigators manage an international research registry of more than 1,000 people with AERD. Combined with its robust clinical trials program, these efforts make the Brigham’s AERD Center the largest clinical and research center for the disease worldwide.

“We have an incredibly collaborative relationship between bench scientists and those of us who see this disease in patients,” Laidlaw said. “We are all in constant communication. Every patient with an aspirin allergy seen by an ENT surgeon is likely referred to us. That proves education can solve the diagnosis gap. However, there is still an enormous need for broader awareness and research funding.”

Tasting Success

Upon returning home and beginning treatment at the Brigham, Doyle enrolled in a clinical trial at the AERD Center to initiate high-dose aspirin treatment, which involves administering increasing doses of aspirin to patients and closely monitoring them for the next several hours.

After starting this daily therapy and seeing only marginal improvement, Doyle underwent two surgeries to remove nasal polyps under the care of Alice Maxfield, MD, an ENT surgeon in the Department of Otolaryngology. A third procedure adjusted the blood flow in his nose to reduce inflammation. Within days of the last surgery, Doyle said he felt dramatically better.

Today, Doyle estimates he’s recovered about 90 percent of his senses of taste and smell, and his respiratory symptoms are largely under control. Although it was a long road, Doyle said he is deeply grateful for the expert, compassionate care he has received at the Brigham.

“I feel like my experience mirrors many others with AERD. It’s really frightening to develop symptoms that don’t make sense to you, so it was a huge relief just to know what was happening,” he said. “My hope is more clinical trials will shed light on not only the causes of this disease but also treatments for it.”

Shortly after recovering from his final surgery, Doyle and his family returned to Europe to vacation in Italy. It was on this trip that he realized his senses started to return. The first food he remembers tasting? Truffles.

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‘An Amazing Gift’: Patient Receives Rare, Lifesaving Heart-Lung Transplant

Camille Frede (right), pictured with her mother, Nancy, is the first BWH patient to undergo a heart-lung transplant in more than 20 years.

When Camille Frede, 28, saw Antonio Coppolino III, MD, MSc, then a fellow in the Division of Thoracic Surgery, enter her patient room at the Shapiro Cardiovascular Center earlier this year, her heart skipped a beat as she recalled their last conversation several weeks prior.

“The next time I see you will be when we get ‘the call,’” Coppolino, now an associate surgeon in the division, had told Frede and her family at the time. “The call” would be the care team’s notification that a matched donor heart and lungs were available for transplantation. Frede received her transplant in March following two months of hospitalization at the Brigham. The 10-hour surgery was completed by a multidisciplinary team comprising nearly 60 staff members. 

The rare, complex surgery – which requires the donor heart and lungs to be transplanted simultaneously – was the first performed at the Brigham in more than two decades. 

For Frede, the transplant cured pulmonary hypertension, a life-threatening condition she had lived with since age 4. It causes high blood pressure in the arteries of the lungs and severe breathing problems. The condition worsens over time, progressively restricting the flow of oxygenated blood and potentially leading to heart failure. After trying numerous therapies over the years, Frede and her family grew worried as her health continued to decline.

“We would go on family bike rides, and I would be blue,” Frede said. “We were always waiting for another tragedy to happen.”

In February, she began receiving inpatient care at BWH. Within a month, she was treated with high-flow oxygen and extracorporeal membrane oxygenation (ECMO), a machine that pumps blood and oxygen for a patient when their own heart and lungs can no longer do so adequately. The therapy sustained Frede while she waited for suitable donor organs to become available. 

Patients whose pulmonary hypertension worsens to the point of requiring organ transplant normally undergo a lung transplant only, explained Hari Mallidi, MD, FRCSC, section chief of Transplant and Advanced Lung Diseases in the Division of Thoracic Surgery. 

But Frede also was born with an atrial septal defect, often referred to as “a hole in the heart,” which drove the need for both a donor heart and lungs, Mallidi said. 

“Even though her heart function was OK, we couldn’t technically make all the connections in the right places without changing everything,” he said. 

‘A Whole New Chapter’

Now six months post-transplant, Frede says every day she feels stronger and that a world of possibilities has opened up. She is hiking, biking, doing yoga and, for the first time in her life, running. 

“Every time I’m doing one of those things, I pray and think of my donor and their family. Without them, none of this would have been possible,” Frede said. “It’s been an amazing gift.” 

Aaron Waxman, MD, PhD, director of the Brigham’s Pulmonary Vascular Disease Program, who has treated Frede for the past 10 years, is thrilled to see her progress. 

“It’s a whole new chapter of her life,” Waxman said. “My expectation is she’s going to have a completely new, healthy life.”

Frede, who recently obtained her bachelor’s in nursing, is now evaluating advanced training programs to fulfill her dream of becoming a nurse practitioner to help others – a goal inspired by her mother, Nancy, who is also a nurse. In addition, Frede hopes to dedicate her time to raising awareness about pulmonary hypertension and the importance of organ donation.

While the past year was challenging for Frede and her family, they said the remarkable, compassionate care they received at BWH helped them weather the stress and uncertainty. In ways big and small, their Brigham care team lifted their spirits and provided a supportive environment for healing. 

Throughout her life, including during her hospitalization, Frede sought to remain as active as possible. While she was on ECMO, care team members helped her obtain a stationary bike for her hospital room and played YouTube videos of scenic routes while she pedaled. In the months following discharge, Frede completed several bike rides around New England with Waxman and her exercise physiologist, Julie Tracy, of the Division of Pulmonary and Critical Care Medicine. 

Nancy recalled the moment she and several Shapiro nurses shed tears of joy as they watched Frede listen to her own heartbeat with a stethoscope for the first time post-transplant. She said the experience marked the first of many wonderful moments to come.

Brigham Health’s Strategy in Action: Advanced, Expert Care
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NICU Milk Analyzer Study Aims to Personalize Pre-Term Infant Nutrition

From left: Mandy Brown Belfort and Valencia Koomson, with baby Justin

During a prenatal visit for their second child, Valencia and Jude Koomson were surprised to learn Valencia had pre-eclampsia, a form of high blood pressure that can occur during pregnancy. The diagnosis, just 28 weeks into her pregnancy, led to immediate hospitalization and, within days, the premature birth of their son.

That was the best option for the health of both Valencia and baby Justin, born 12 weeks before his due date and weighing just over 3 pounds. He would require intensive support to continue to grow and develop in the Brigham’s Neonatal Intensive Care Unit (NICU).

With breathing assistance for Justin’s developing lungs and a feeding tube to deliver human breast milk to his belly, he grew and thrived. He soon graduated from the Intensive Support area to the Growth and Development area, no longer needing oxygen support and becoming strong enough to feed on his own.

One novel technology available to him was a breast milk analyzer, a device that assesses nutritional composition of human breast milk. Justin was among the first babies enrolled in a new study at BWH to examine whether knowing the exact nutrition in individual feedings of human milk, and adding the right nutrients (also known as fortification), could aid the smallest babies.

“We know that more optimal nutrition is a predictor of better growth and neurodevelopment,” said Mandy Brown Belfort, MD, MPH, of the Department of Pediatric Newborn Medicine.

Special Nutritional Needs

Human breast milk is uniquely equipped to meet nutritional needs of full-term infants. But pre-term babies – especially those born before 35 to 36 weeks’ gestation – generally require that a fortifier containing calories, protein, calcium and micronutrients such as zinc and Vitamin A be added to a breast milk diet. This aims to replicate the nutrition the baby would receive from the mother’s placenta if still in the womb.

Typically, a premature infant’s growth is followed carefully, but the fortifier is only adjusted if the baby’s weight gain slows over several days. Belfort and her team are using the milk analyzer to avoid this lag, with the goal of delivering accurate, customized fortification with each feeding.

The milk analyzer was initially developed and used in the dairy industry. Recently adapted for human breast milk, it is approved for use in Europe and Canada. In the United States, it is currently available only for research purposes. BWH is one of a few NICUs engaged in that research.

Prior research by Belfort and others has shown surprising variations in the nutritional composition of a mother’s milk throughout a given day. Nutritional makeup also varies from one mother to the next, and it is not necessarily related to the mother’s diet. It’s also known that nutritional quality can degrade as expressed milk is handled and stored.

In Belfort’s current study, each feeding of milk is sampled and analyzed using the countertop device that sits in the NICU’s milk storage room. A tiny syringe, containing less than a teaspoon of milk, is inserted into the analyzer. A readout shows within seconds the milk’s nutritional elements. The results determine how much fortifier should be added on top of the standard fortifier to ensure that nutrient targets are met.

Study results won’t be known immediately as to whether this nutritional fine-tuning will improve growth and development in pre-term babies. The first patients began in the study in spring 2018. Belfort’s team is continuing to offer NICU families the opportunity to volunteer.

Valencia, a scientist herself, was glad to know that she was giving her baby every opportunity to grow, while contributing to newborn science.

“We are thrilled and blessed that he could participate to customize his feedings to his specific nutritional needs,” Valencia said. “Particularly for NICU mothers, there is so much anxiety and uncertainty about what your baby needs. It’s a great comfort to know he’s being fed well here. A baby needs to eat to grow.”

She also expressed her gratitude for the high-quality, compassionate care that she and her family received.

“All the people here are so consistently amazing,” Valencia said. “I want to say a big thank you to the staff at Brigham and Women’s Hospital and the NICU. At all levels of staff, there are such wonderful, caring and loving people here.”

Brigham Health’s Strategy in Action: Discovery and Innovation
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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.”

BWH Receives First NICU Installed MRI System in the U.S.

Work crews lower the NICU’s MRI into the Connors Center.

Arriving by crane through a roof hatch in the Mary Horrigan Connors Center for Women and Newborns on Sept. 8, a new MRI system specifically designed for safe imaging of newborns will provide high-quality scans directly in the Brigham’s Neonatal Intensive Care Unit (NICU). The system, approved by the U.S. Food and Drug Administration last year, is the first NICU-dedicated MRI in the country.

“The installation of the state-of-the-art, neonatal MRI system will greatly enhance the research capabilities of BWH and elevate and expand neurocritical care for our littlest patients,” said Terrie Inder, MBCHB, chair of the Department of Pediatric Newborn Medicine. “Locating this technology within the NICU will reduce time and patient risk associated with transporting newborns to a traditional MRI and allow MRI access from the first hours of life through the challenging, sometimes life-threatening, time within the NICU.”

Babies undergoing scans will be in a temperature-controlled, self-contained incubator bed that minimizes the patient’s movement while allowing for better control of the environment and continuous monitoring of vital signs. Information gained from the MRI can inform a care team and family as to whether brain injury has occurred and, in the future, guide which treatments may assist in preventing disability.

The self-shielded, permanently magnetic system has been specifically designed for the NICU, an area that would be typically size- and risk-prohibitive for an MRI. The system is also quieter than traditional whole-body scanners to ensure the safety and comfort of infants undergoing scans.

Manufactured by Aspect Imaging, the system, known as EMBRACE, initially will be used for research purposes.

“This new MRI system, designed with a single use – scanning of the newborn – will enhance the care we provide for our NICU patients. This empowering technology will complement our existing fleet of MRI scanners and improve efficiency by offering imaging to our tiniest patients within the controlled confines of the NICU,” said Srinivasan Mukundan Jr., PhD, MD, medical director of Magnetic Resonance Imaging in the Department of Radiology.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

‘Frailty Pathway’ Leads to Safer, Standardized Geriatric Trauma Care

From left: Ann Cook, a patient on the frailty pathway, speaks with Lynne O’Mara on Tower 8B.

Older patients face a unique set of health challenges – including chronic fatigue, low muscle mass, cognitive impairment, bone fractures and reduced mobility – that can raise their risk of illness or injury during hospitalization.

Launched in 2016, the BWH Frailty Identification and Care Pathway is a multidisciplinary program addressing these challenges by providing clinicians with standardized guidelines for identifying and accommodating frailty – a complex, often age-related syndrome characterized by physical decline and increased vulnerability to stressors.

“Frailty and cognitive impairment are often key contributing factors in falls and accidents that lead to fractures and other injuries among older patients presenting in our Emergency Department,” said Zara Cooper, MD, MSc, FACS, of the Division of Trauma, Burn and Surgical Critical Care. “We believe that focusing on these underlying conditions is essential to optimizing the care and outcomes of these patients.”

Physician assistant Lynne O’Mara, PA-C, of the Department of Surgery, was one of many BWHers who played a key role in implementing the pathway in the Emergency Department (ED) and the Surgical, Burn and Trauma Intermediate Care Unit on Tower 8ABCD. Part of a multidisciplinary team that sought to identify and remove barriers to care for older patients, O’Mara worked closely with Cooper and Samir Tulebaev, MD, of the Division of Aging and Center for Older Adult Health, to create order sets for the pathway.

The Frail Scale

At the heart of the initiative is an assessment tool known as the “frail scale,” which is used to screen for frailty in patients over the age of 65 when they arrive at the ED. In the frail scale, “frail” also functions as an acronym, with each letter representing the constellation of symptoms and conditions that may indicate frailty. Patients are considered frail if they meet three or more of these criteria:

  • Fatigue (“Are you fatigued?”)
  • Resistance (“Can you climb one flight of stairs?”)
  • Ambulation (“Can you walk one block?”)
  • Illnesses (“Do you have more than five illnesses?”)
  • Loss of weight (“Is your weight loss greater than five percent?”)

It’s important to recognize these risk factors early because frail patients are more likely to experience negative health outcomes, including increased rates of morbidity, obesity and trauma, O’Mara explained.

In addition to the normal effects of aging, a patient’s circumstances at home may contribute to or worsen their frailty, O’Mara said. For example, a patient might have poor muscle mass because they’re not eating, and they might not be eating because they’re on a fixed income and don’t have the financial means to purchase food. While such challenges are not unique to frail patients, understanding this context is key to helping these patients recover smoothly, avoid injury, discharge safely and reduce readmissions, O’Mara said.

During hospitalization, frail patients are also at greater risk of experiencing delirium, an acute state of confusion that is separate from dementia. Patients who experience delirium may try to pull out their IV lines or attempt to get out of bed when they cannot safely do so, leading to a secondary injury, O’Mara said.

The frailty pathway includes standardized ways to prevent, assess for and treat delirium. Since implementing these measures, the rate of delirium has decreased by a remarkable 50 percent among patients over 65 on Tower 8ABCD. The mortality rate for the same population has dropped by 30 percent, and complications have decreased by 47 percent.

“Our main goals when we first started the pathway were to prevent delirium and preserve function for these patients, which we have since been able to achieve,” O’Mara said.

Standardizing Care

Once a patient is screened and meets the criteria for frailty in the ED, providers enter a set of admission orders to standardize the care for each patient on the pathway. Within 72 hours, the patient receives a comprehensive geriatric assessment, which includes an evaluation of medical conditions, cognition, function, nutrition, emotional status and risk for delirium, with a geriatrician, and a nutritional assessment with a nutrition consultant. This information is detailed in the patient’s electronic medical record to ensure a safe transition of care.

On Tower 8ABCD, care teams work closely with patients on the pathway to ensure they eat, get out of bed, have bowel movements and perform other self-care tasks on a routine basis.
O’Mara said collaborating with her colleagues to develop and implement the pathway – and ultimately achieve better outcomes for patients and their families – has been extraordinarily fulfilling.

“I really enjoy the personal interaction with the patients,” she said. “I like having that one-on-one time to talk with them on the floor, meet their families, discuss their diagnoses and create a personal care plan. You really become part of the patient’s family for a couple of days.”

Reiterating the importance of the frailty pathway’s multidisciplinary model, O’Mara has engaged both staff and trainees in the program. To date, she has trained 70 residents on the pathway, and she continues to offer ongoing training for new residents and providers.

“The pathway has brought the entire trauma floor together and has gotten me really excited about geriatrics,” O’Mara said.

Brigham Health’s Strategy in Action: Highest-Quality, Safe Care
Learn more about our strategic priorities at BWHPikeNotes.org.

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.

Brigham Researchers Design Fast-Acting Cholera Vaccine

Waldor Lab members, from left: Brandon Sit, Alyson Warr, Gabriel Billings, Matthew Waldor and Troy Hubbard (not pictured: Carole Kuehl)

When an outbreak of cholera unfolds, a vaccine that offers rapid protection could mean the difference between life and death for tens of thousands of people.

In a preclinical study, investigators at the Brigham are developing a new class of vaccine that can combat cholera, a highly contagious, quickly fatal diarrheal disease with a long history of causing epidemics. The vaccine is designed to act in two ways – training the immune system to detect and destroy the bacteria in the long term and protecting a person immediately from cholera’s effects. Using mathematical modeling, the research team predicts that, if successful in humans, their highly innovative approach could change the trajectory of a cholera epidemic.

This novel therapeutic, which has been tested in a preclinical model, is made from a live strain of the disease and protects against cholera-like illness less than a day after it is administered. Traditional, oral cholera vaccines are made from strains that have been killed and take effect after about 10 days.

“Our work represents a whole new concept in vaccinology – this dual-acting agent elicits a long-term immune response and confers protection almost immediately,” said Matthew Waldor, MD, PhD, of the Division of Infectious Diseases and the study’s corresponding author. “What we’ve done is something very different than what others have done before.”

Waldor and colleagues engineered the live vaccine based on the strain of cholera that caused a large epidemic in Haiti beginning in 2010. The research team engineered the strain by removing the genetic code that gives cholera its deadly properties. They also encoded within it a system that keeps out any toxin-producing genes, preventing the strain from ever regaining toxin production abilities. The team performed additional engineering to prevent other side effects, including mild diarrhea.

Researchers tested the vaccine in a preclinical model of cholera.

The vaccine, known as HaitiV, did not elicit cholera-like symptoms and caused minimal or no fluid accumulation in the intestines after being administered, even though the vaccine colonized the small intestine. When the team exposed the preclinical experimental group to cholera 24 hours later, no signs of disease were present.

The team also performed mathematical modeling to predict the public health impact the vaccine might have compared to traditional vaccines. The researchers’ simulations showed that in a population of 100,000 people, a fast-acting vaccine could prevent 20,000 infections compared to vaccines that can take the typical 10 days to build up a host’s immunity.

“The speed with which you respond to an outbreak significantly helps your ability to control it and prevent people from getting cholera,” said lead author Troy Hubbard, PhD, a graduate student in the Waldor Laboratory at the Brigham. “We are very focused on feasibility – the idea of being able to come in with a single-dose intervention that works rapidly but confers immunity over a long period.”

The team notes that evaluating the immune response that HaitiV elicits in human volunteer studies is a critical next step.

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

BWH Ambulatory Services: Construction and Leadership Updates

An artist’s rendering of Brigham and Women’s Health Care Center – Westwood, which opens this fall

As Brigham Health advances its efforts to expand access to ambulatory care in communities around Greater Boston, BWH will open a new multispecialty outpatient clinic in Westwood this fall and is expanding the Outpatient Care Center at Brigham and Women’s/Mass General Health Care Center in Foxborough, which is slated for completion next year. To support these expansions, BWH has restructured and expanded the responsibilities of two roles in Ambulatory Services.

Ambulatory Regional Operations Expansion

Cindy Peterson

Brigham and Women’s Health Care Center – Westwood is scheduled to open this October at the University Station development. The center, which will add 30,000 square feet of outpatient care, will provide primary care through Partners Community Physicians Organization and embed Behavioral Health through the Brigham and Women’s Physicians Organization (BWPO) Department of Psychiatry. Additionally, Brigham Health providers will offer Dermatology, Obstetrics and Gynecology, Orthopaedics, Phlebotomy and Radiology services. A separate, multispecialty clinic within the center will offer Brigham Health Cardiology, Endocrinology, Gastroenterology, General Surgery, Neurology and Urology. Partners Urgent Care, an additional occupant of the Westwood site, will open later in 2019.

In Foxborough, a second, 60,000-square-foot building is being constructed across from the Outpatient Care Center at the Brigham and Women’s/Mass General Health Care Center. The additional space will double the size of its primary care practice in Foxborough, enabling further growth of the center’s nearly 30 medical and surgical specialties. Brigham Health is partnering with Dana-Farber Cancer Institute, which will occupy a floor in the new building to provide medical oncology and infusion services. The building is set to open in 2019.

New Roles and Responsibilities

Cindy Peterson, MBA, was named vice president of Regional Ambulatory Operations and Business Development. The new position will extend Peterson’s span to support and guide future ambulatory sites. She previously served as executive director at Brigham and Women’s/Mass General Health Care Center, Brigham and Women’s Health Care Center at 850 Boylston St. in Chestnut Hill and Brigham and Women’s Health Care Center – Westwood.

Julia Raymond

“Cindy has provided a regionally focused perspective, assuming ever-increasing responsibilities across the Brigham’s large off-site Ambulatory care centers in Foxborough, Chestnut Hill and soon, Westwood,” said William Johnston, MBA, chief operating officer and treasurer of the Brigham and Women’s Physicians Organization and senior vice president of Ambulatory Services. “She’s adept at utilizing external business development to grow the community’s awareness of our services in Foxborough, and her expertise will be integral to our efforts to expand regional access to ambulatory care.”

Peterson joined the Brigham in 2008 as administrative director for the Brigham and Women’s/Mass General Health Care Center in Foxborough. She received her MBA in health care management from Boston University and her bachelor’s degree from Amherst College.

In addition, Julia Raymond was promoted to director of Operations in Foxborough. She is responsible for all day-to-day operations at Brigham and Women’s/Mass General Health Care Center, and she will play a larger role in strategic planning, community outreach and supporting the Foxborough expansion efforts and new Westwood site. Raymond was previously senior operations manager in Foxborough.

“Julia has been an integral part of Foxborough operations from before our site opened in 2009,” Johnston said. “I’m excited to see how Julia will bring her unwavering commitment to continuous improvement, patient satisfaction and operational excellence to her new role.”

Raymond began her career at BWH in 2005 working with the Brigham and Women’s Physicians Organization as an application manager. Raymond received her bachelor’s degree in Health Management and Policy from the University of New Hampshire.

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