Posts from the ‘improve health’ category

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

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Investigators Present Cardiovascular Discoveries at AHA Scientific Sessions

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

Insights into Omega-3s, Vitamin D

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

JoAnn Manson shares findings from the VITAL study.

JoAnn Manson shares findings from the VITAL study.

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

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

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

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

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

Diabetes Drug Lowers Heart Failure Risk

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

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

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

Inflammation and Heart Disease: A Roadmap for the Future

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

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

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

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

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

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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. 

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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.

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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.

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Helping Expand Access to Complex Care in Underserved Communities

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

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

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

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

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

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

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

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

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

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

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

A Helping Hand

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

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

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

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

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

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

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

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

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

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Research Program Aims to Build a Healthier World for ‘All of Us’

From left: Elizabeth Karlson and Cheryl Clark

From genealogy to genetics, BWH patient Margo Blackwell-Moquin says she has long been curious about her roots. Recently, she has been keenly interested in what her unique makeup means for her health.

“I really believe knowledge is power, and not knowing is not healthy. You can’t do anything preventive if you don’t know,” said Blackwell-Moquin. “It’s really important that we all educate ourselves about our health.”

When she learned about the All of Us Research Program – which seeks to accelerate research and medical breakthroughs that will enable individualized prevention, treatment and care – Blackwell-Moquin was immediately interested and enrolled at the Brigham. The program, part of the National Institutes of Health’s Precision Medicine Initiative, has a goal of enrolling one million or more people across the country to share their health data and samples to build the largest health database of its kind.

Partners HealthCare was selected to take part with Boston Medical Center in All of Us, making it one of several participating organizations nationwide. The BWH program, led by Elizabeth Karlson, MD, and Scott Weiss, MD, and co-investigators Cheryl Clark, MD, ScD, and Robert Green, MD, MPH, is currently enrolling participants in its pilot phase prior to All of Us’ nationwide launch.

Data that researchers obtain from volunteers – including physical measurements, medical history, and blood and urine samples – will be used to conduct thousands of studies in multiple disease areas. In addition to having the opportunity to help fuel the next medical breakthrough, some participants receive research results.

“This project will help researchers learn how individual lifestyle, environmental and genetic factors work together to affect our health so that all of us can learn how to prevent and treat disease,” Karlson said.

A cornerstone of the program is its emphasis on enrolling participants who reflect the rich diversity of the U.S., especially those who have historically been underrepresented in research, Clark explained.

“Too often, as we think about medical breakthroughs and research, the information we rely on is not always tailored to the needs of diverse communities – that can include social factors such as race, ethnicity, sexual orientation or gender identity,” Clark said. “We want to make sure the treatments we develop really do reflect the needs of every person, which makes it so important that people from all walks of life participate.”

Blackwell-Moquin, who is African-American, said she was moved by the program’s mission to improve representation in medical research and care. By enrolling in All of Us, she hopes to learn more about her own health while also supporting an effort that could uncover important information that would benefit future generations.

“I don’t know a lot of my medical family history. Sometimes there’s information that isn’t discussed in families, or the person who does know has passed on,” Blackwell-Moquin said. “And just because it’s not in your family history doesn’t mean it can’t happen to you. Doctors can’t order every test under the sun. But if African-Americans can learn, for example, that some are prone to certain diseases or disproportionately affected by specific issues, that is so important.”

Learn more about the All of Us Research Program at joinallofus.org. To find out how you can enroll as a participant at the Brigham, call 617-768-8300 or email allofus@partners.org.

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

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

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

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

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

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

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

Advancing Care

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

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

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

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

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

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

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

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

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

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

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

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

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Through Cord Blood Donation, Some BWH Babies Help Save Lives

Justene and Ryan Spitz, with their daughter, Kinsley

Justene and Ryan Spitz of Dorchester know exactly how precious an umbilical cord blood donation can be.

Seven years ago, Justene’s brother-in-law was diagnosed with acute lymphocytic leukemia, an aggressive form of cancer that causes the bone marrow to produce an excess number of white blood cells called lymphocytes. A bone marrow or stem cell transplant offered the most promising outcome. To his family’s relief, he received the call that they had been waiting for: He had been matched for a stem cell transplant, thanks to an anonymous umbilical cord blood donation.

“My brother-in-law is in remission. His life was saved because of cord blood,” Justene said.

Umbilical cord blood, often referred to simply as cord blood, is rich in blood-forming stem cells, which can renew themselves and grow into mature blood cells. Stem cells are used in transplants for patients with leukemia, lymphoma and other life-threatening diseases. After a baby is born, these cord blood cells can be collected, preserved and later used to provide a lifesaving stem cell transplant for a patient in need. If a mother declines, does not qualify to donate or the donation cannot be completed for logistical reasons, the umbilical cord and stem cells it contains are discarded as medical waste.

Justene, 33, honored the gift of life her brother-in-law received years ago by donating her own cord blood at BWH earlier this month – coinciding with National Cord Blood Awareness Month – when the couple welcomed their third child at the Brigham.

The Cord Blood Donation Program, jointly operated by BWH and Dana-Farber Cancer Institute (DFCI), became Boston’s first public cord blood program when it launched in 2009. Since then, 6.6 percent of the units banked at BWH – a total of 75 units – have been used for stem cell transplants. That may sound like a small amount, but it’s actually more than twice the national average, said Deborah Liney, associate director of the Cord Blood Donation Program.

“Stem cells derived from cord blood are used in transplants at Dana-Farber, and our colleagues use them at Boston Children’s Hospital. We know firsthand how important a stem cell transplant is for these patients and the potential it has to save their lives,” Liney said.

Getting the Word Out

Nearly 5,000 patients have consented to donate cord blood since the Cord Blood Donation Program launched – an achievement Liney attributes to the support of clinical teams in the units who have proactively reached out to the program’s staff to identify eligible patients.

“Nursing plays an especially big role in the success of our program, from remembering to page us when a baby is being delivered to reminding the obstetrician that the patient is donating cord blood,” Liney said.

Although their offices are at DFCI, collection specialists often maintain a physical presence in BWH Labor and Delivery so that they’re immediately available when needed, said Yen Huynh, one of DFCI’s two cord blood donation specialists.

A number of circumstances affect whether a collection can ultimately be banked. A small umbilical cord may not contain enough blood to meet the minimum volume required by Duke University’s Carolinas Cord Blood Bank, which the BWH program partners with.

Even in those cases, however, the samples can often be used in research, Liney said. Over the past eight years, the program has distributed almost 850 units of cord blood to researchers at the Brigham and elsewhere.

Often, the barrier to collection is timing. Babies don’t always arrive during normal business hours, which is when the collection specialists work. To help capture some of those evening and weekend donations, some BWH physicians have been trained to perform a cord blood collection when specialists aren’t available.

One of those providers, Ashley Ackerman, MD, of the Department of Obstetrics and Gynecology, said most patients are receptive to donating after hearing how cord blood could be used. A strong advocate for the program, Ackerman was eager to get involved and support the collection specialists whenever she is on service.

“A cord blood donation is an amazing gift, and this program opened up a really nice opportunity for patients and staff to help make that possible,” Ackerman said.

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Taking the Next STEPS: Mentorship Program for Young Parents Launches

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Photo credit: Gretjen Helene Photography

When Laticia Goodman learned she was pregnant at 21 years old with her first child, her mind fired off a series of questions: Could she continue her education? What about her career plans? Was she really ready to be a parent?

Fortunately, Goodman didn’t have to answer those questions alone. Backed by her partner, family and friends – and with support from a BWH program for young parents like her – the Mission Hill mother celebrated the birth of her son Jonah, now 5, embarked on a career in the health care industry and plans to pursue an undergraduate degree.

Now, Goodman is part of a new cohort of young parents who will serve as peer mentors in a BWH program for other young parents confronting similar questions, challenges and triumphs. The initiative was announced during the seventh annual STEPS Young Parent Summit, a day-long event hosted by BWH’s Center for Community Health and Health Equity (CCHHE) on June 29.

“One of the things we know about young parents is that they’re often marginalized and isolated in their communities, so this mentorship program is a great way to break down those barriers,” said Maisha Douyon Cover, director of Health Equity Programs at CCHHE. “It’s someone who knows what you’re going through and all the complexities of not really being an adult, but not really being a kid, and now parenting.”

Both the summit and mentorship program are part of the CCHHE’s Stronger Generations, which supports a lifetime of good health through a focus on social, medical and economic needs before, during and after pregnancy.

The new group of mentors, whose roster is expected to grow in the coming months, are all alumni of the CCHHE’s Young Parent Ambassador Program. In addition to offering social support and services, the year-long program provides the ambassadors with leadership training and workforce development skills. Each mentor will be partnered with a parent or expectant parent under the age of 25.

Goodman, now 27, said that while she was fortunate to have such a supportive network of family and friends – including many who were also young parents – not everyone has the same experience. She added that interacting with other young parents through STEPS and the ambassador program was an invaluable opportunity – and one that has inspired her to give back as a mentor.

“I want to help people, especially someone who may not have that person to talk to – that big sister, aunt or friend who is going through or has gone through the same thing as you,” Goodman said.

When asked what advice she would give other young parents, Goodman offered a message of empowerment: “Life is not over. Your goals are not gone. It’s just a different pathway.”

‘I Have a Power in Me’

Each year, STEPS brings young families and community agencies together to provide a safe forum for young parents to expand their knowledge and access resources to help them succeed.

Hosted at Simmons College, this year’s summit opened with a panel discussion with several young parents, followed by workshop sessions covering a wide variety of topics. Included among them were candid discussions about early-childhood literacy, immigrant rights, sexuality, pursuing higher education, empowerment and, for the first time, a workshop for young parent allies on how to best support the young parent in their life.

In addition, a resource fair provided the young parent attendees with access to community-based agencies and organizations supporting pregnant and parenting young adults across the greater Boston area.

Among the event’s most moving moments are its annual Proud2Parent Young Parent Awards ceremony, which bestows five honors: the Courage Award, the Self-Sufficiency Award, the Resiliency Award, the Education Award and the Co-Parenting Award.

Wiping away tears as she accepted the Courage Award, Noime Alves shared how challenging it was to arrive in the United States six years ago when she was 18 years old, pregnant, unable to speak English and immigrating before her husband. Now a student at Endicott College, she expressed her gratitude for the programs and individuals who have supported her path to success.

“It was very difficult. When you don’t speak the language, you don’t even say your name and you can’t understand people,” Alves told the audience. “But now I will always say, ‘I’m the power.’ I have a power in me.”

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

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Q&A: Anesthesiologist Reflects on Global Health Work in Rwanda

From left: Goretti Hategekimana, Servent Izabayo, Jill Lanahan and Saidia Angelique

Last summer, Jill Lanahan, MD, of the BWH Department of Anesthesiology, Perioperative and Pain Medicine, departed for Rwanda to train residents at King Faisal Hospital in the country’s capital, Kigali, for one year. The outreach is part of the Human Resources for Health Program, a collaborative, seven-year project between the Rwandan government, BWH, Harvard Medical School and more than 20 other academic institutions in the U.S.

BWH Bulletin recently interviewed Lanahan to hear about her experiences abroad.

How would you describe your time in Rwanda so far?

JL: I could not have anticipated how well-received I would be in Rwanda’s medical community. We have formed a multidisciplinary team of medical students, resident physicians, surgeons and anesthesiologists, with the goals of improving pain control for women in labor and for patients undergoing orthopaedic procedures. Pain is often undertreated in these settings, and by maximizing what we can do preoperatively and intraoperatively, I believe we can have a significant impact on postoperative pain control and patient satisfaction.

What are some of the challenges around providing anesthesia care in a setting with limited resources?

JL: Now more than ever, I realize how much I take for granted back home. For example, I never have to worry about not having a medicine that I need to safely provide anesthesia.

Treatment of pain with intravenous opioids never occurs on the wards here due to safety concerns caused by the lack of sufficient monitoring equipment. The use of local anesthetics, especially one called bupivacaine, has been essential to our project. We have developed protocols for injection of this drug by surgeons and anesthesiologists for select procedures. Recently, however, we had a month-long bupivacaine shortage. During that time, we were unable to offer regional anesthesia because any small amount we had left had to be saved for mothers undergoing cesarean sections.

In addition, many patients do not have the proper nutrition to heal. In Rwanda, food is not part of medical care, and patients’ families are required to supply it. For various reasons, families are often unable to do so. A project at the Centre Hospitalier Universitaire de Butare called “Growing Health” is trying to tackle this problem by cultivating a small farm on hospital land to grow food for patients. The crops they grow provide patients with two nutritious meals a day. Unfortunately, though, the farm can only produce enough food for about a third of the patients.

What kind of training have you helped provide?

JL: Last month, the hospital had a visit from Team Heart, a multidisciplinary team from the U.S. that promotes sustainability and excellence in cardiac care. It was an amazing experience for two second-year anesthesia residents, Servent Izabayo, MD, and Gerald Kirenga, MD, and me. BWH anesthesiologists Danny Muehlschlegel, MD, MMSc, and Martin Zammert, MD, along with BWH residents Jeffrey McLaren, MD, and Matt Swisher, MD, welcomed Servent and Gerald to their team.

The week consisted of complex heart surgeries, mostly valve operations in children and adults with rheumatic heart disease, which is rare in the U.S. The team truly went above and beyond by teaching our residents skills and imparting knowledge that will be used to provide anesthesia for complex cases throughout their careers.

Is there a need for training in others areas?

JL: Patient safety and communication are two areas where significant improvement is needed. At least two, if not three, languages are spoken during every procedure: Kinyarwanda, French and English. Also, the culture tends to be hierarchical, and there is a reluctance to question anyone higher in the chain of command, even if there may be an error.

Specific to anesthesiology, the vast majority of anesthesia care in the country is provided by technicians whose highest degree is a high school diploma, with minimal or no physician oversight. This is quite a different model from BWH, where every case is closely supervised.

Another struggle in anesthesia has been physician recruitment and retention. In recent years, some of the most promising doctors have gone to work for nongovernmental organizations, which are able to offer higher salaries.

Although I am looking forward to rejoining my colleagues at the BWH in August, it will be hard to leave Rwanda. It has been a privilege to teach the residents and care for patients. Hopefully, I’ll have an opportunity to return soon.

 

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Q&A: Introducing Brigham Health

bh_bwh_pms_293Brigham Health was unveiled earlier this week as the new name for the parent organization that includes Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and the Brigham and Women’s Physicians Organization. All three entities will retain their individual names and identities. Brigham Health replaces Brigham and Women’s Health Care (BWHC). 

Brigham Health President Betsy Nabel, MD, discusses with BWH Bulletin what this change means for us. 

Why did we change from BWHC to Brigham Health?

Nabel: Those who know the Brigham think of it as a top-tier New England hospital – a place to go for care when needed, especially complex procedures. But according to market research, many outside of New England assume we are solely a women’s hospital. And while we are certainly a leader in women’s health care, we want to be sure it’s clear that our excellence and expertise extend to so many other areas. Brigham Health reinforces that we are not just one point on a map, or even a single point of discovery.

The new name eliminates some of the confusion we have found among those outside of New England. Talking about the services of BWH, BWFH and the BWPO as simply Brigham Health will enable us to more effectively reach people who are seeking health information, referrals and care.

How does this change fit into our strategy?

Nabel: This change is a vital component of our institutional strategy. For example, one of our strategic priorities is to improve health. In addition to providing highly specialized care in the hospital and ambulatory settings, we also must engage people around the world as we promote health and wellness and concentrate on preventing disease in populations.

Another example is twofold. By building national and international lines of business, we reinforce our financial strength and advance our work in business development – two areas essential to guaranteeing we continue delivering on our mission.

Why was the name Brigham Health selected?

Nabel: Brigham Health reflects our role as a leader in maintaining and restoring health around the world, encompassing all that we do in delivering care, advancing scientific discovery and educating the next generation of health care professionals. It broadly defines everything we do today and provides a new platform for amplifying our commitment to what everybody desires: health.

For more Brigham Health information and resources – including an FAQ, downloadable logos and presentation templates – visit BWHPikeNotes.org. 

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BWHers Team Up to Respond to Opioid Crisis

From left: Pharmacists Jayme Boutilier and Amrita Chabria review naxolone inventory in the Outpatient Pharmacy.

From left: Pharmacists Jayme Boutilier and Amrita Chabria review naxolone inventory in the Outpatient Pharmacy.

Scott Weiner, MD, MPH, began to notice two trends emerge over the past decade in emergency departments around Boston: The number of opioid prescriptions was increasing and, more troubling, so was the frequency of patients who had overdosed on prescribed or illegally obtained opioids.

“It got to the point that on nearly every shift I was working, someone would come in with an overdose. It started to just seem normal, which is unacceptable,” said Weiner, who joined BWH’s Department of Emergency Medicine in 2014.

The observation wasn’t merely anecdotal. Opioid addiction has escalated into a public health crisis across the state—and the country—with the Massachusetts Department of Public Health reporting an estimated 1,659 unintentional and undetermined opioid-related deaths in 2015, the highest-ever number recorded by the state.

At BWH, small projects began popping up in various departments in response to the crisis. But a comprehensive, hospital-wide approach was necessary, Weiner said. As a result, he worked with champions from various departments and disciplines across BWHC to form the Brigham Comprehensive Opioid Response and Education (B-CORE) program earlier this year.

bcore_group1

Members of BCORE’s Addiction Task Force, from left: Kristen Wendth, Elizabeth Harry, Scott Weiner, Lina Matta, Juan Jaime de Zengotita, Erika Pabo, Stuart Pollack and Joji Suzuki

The group is made up of pain specialists, surgeons, hospitalists, nurses, primary care providers, pharmacists, Partners eCare representatives and others. Supported by an executive steering committee consisting of BWHC leadership, B-CORE members work in task forces focused on issues around opioid prescribing and treating opioid addiction.

Their goal for this year is to develop BWHC-wide guidelines for opioid addiction prevention and management, opioid prescribing and chronic pain management. Technology, data, outreach, clinical support and training all play vital roles in achieving that.

“B-CORE is an umbrella,” Weiner said. “It belongs to the whole hospital—not just a handful of departments—as a way to support all opioid-related projects.”

Responding to the crisis requires not only the development of best practices—such as standardizing opioid dosage recommendations—but also a cultural shift in how addiction is treated, says Joji Suzuki, MD, director of the BWH Division of Addiction Psychiatry and the head of B-CORE’s addiction task force.

“The reality is that most hospital systems in this country have not incorporated addiction treatment into their programs,” he said. “The opioid crisis has forced us to rethink how we bring treatment for addiction into the mainstream.”

Taking the First Steps

Since its inception earlier this year, B-CORE has implemented several initiatives. Naloxone, a fast-acting treatment for opioid overdoses, is now available to at-risk patients in the Emergency Department at no cost and without a prescription. In addition, the Outpatient Pharmacy recently launched a drug take-back program, providing a secure bin to deposit leftover pills so they can be disposed of safely.

Looking ahead, B-CORE’s members also hope to launch a “bridge clinic,” a temporary care clinic for patients who need treatment for a substance use disorder after overdose or hospitalization but cannot immediately get into a long-term program.

Technology will be pivotal for other initiatives. BWH hospitalists Elizabeth Harry, MD, and Raj Patel, MD, are working with B-CORE to implement a framework developed by the Society of Hospital Medicine called RADEO (Reducing Adverse Drug Events Related to Opioids), which provides guidelines for safer opioid prescribing and symptom management.

As part of the project, they are collaborating with BWH’s Patient Safety Learning Labs to develop a dashboard within Epic that will automatically flag an opioid prescription if the dose is too high or if another medication is needed to manage its side effects. The system also recommends that non-opioid medications are prescribed first. Additionally, Harry and Patel are working on a mobile app that allows patients to notify their providers if they have concerns regarding their pain levels or treatment.

“The more barriers we can remove to getting clinicians what they need to make these decisions, the better care we’re going to provide,” Harry said.

Meanwhile, Pharmacy is collaborating with the PeC team to provide clinicians with a high-level view of their opioid prescribing habits. The teams are meeting with prescribers to learn what data would be most helpful, such as how many prescriptions they write each month and for what doses.

Providers sometimes struggle to find time to reflect on those trends amid daily demands of the job, said BWHC Chief Pharmacy Officer William Churchill, MS, RPh, FMSHP, a member of BCORE’s steering committee. Giving prescribers that data in an easy-to-digest format can help them make more informed care decisions, he said.

“There might have been three patients with the same condition, but three different quantities of medication were given,” Churchill said. “Seeing that may be an ‘ah-ha’ moment.”

The goal is not to eliminate the use of opioids but to prevent abuse, said Jessica Dudley, MD, BWPO chief medical officer, BWHC vice president of care redesign and part of BCORE’s steering committee.

“We now have the ability to treat pain so well, and you wouldn’t want to withhold that from patients where the treatment is clearly indicated,” she said. “These interventions should enable us to continue to prescribe those medications in a more sophisticated way so that we can reduce the amount of abuse seen now.”

Security Officers Carry Naloxone
Every second counts during an overdose, and fast access to naloxone can be the difference between life and death.

Since Aug. 15, select BWH Security officers began carrying the life-saving therapy after completing training to safely administer it to someone overdosing on opioids.

Security launched the initiative with help from the Emergency Response Committee and the STRATUS Center for Medical Simulation.

“Security is usually the first on the scene during a medical emergency and we call the code, so there can be a gap between when we find the person and when the code team arrives,” said Robert Chicarello, director of BWH Security and Parking. “It became clear that if our officers carry naloxone, they may be able to save a life.”

 

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