How can engaged patients improve health care? BUSM's Suzanne Mitchell, MD, and other...
By Lisa Brown
Boston University School of Medicine (BUSM) received major funding from the National Institute on Aging (NIA) as part of a national effort to identify rare genetic variants that may protect against and contribute to Alzheimer’s disease risk.
The four-year, $3 million grant, “Identifying Risk and Protective Variants for AD Exploring their Significance and Biology” is led by Sudha Seshadri, MD, professor of neurology at BUSM and a Senior Investigator at the Framingham Heart Study and for the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. This project is linked to CHARGE projects at two other universities which all together received grants totaling more than $10 million. Other BU investigators who are part of the CHARGE project are Anita DeStefano, PhD, Adrienne Cupples, PhD, and Josee Dupuis, PhD, who are professors of biostatistics, and Honghuang Lin, PhD, assistant professor of medicine.
“As a neurologist treating patients with Alzheimer’s disease, it is very exciting to see the increased recognition, at a national level, of the need to find more effective preventive and therapeutic measures,” said Seshadri.
Alzheimer’s disease, a progressive neurodegenerative disorder, has become an epidemic that currently affects 5.2 million people in the United States with economic costs that are higher than those of heart disease or cancer. Available drugs only marginally affect disease severity and progression. While there is no way to prevent this devastating disease, the discovery of genetic risk factors for Alzheimer’s is bringing researchers closer to learning how the genes work together and to identifying the most effective intervention for the disease.
Genetics is a cornerstone of identifying targets for Alzheimer’s disease therapies. This movement began in 2011, when President Barack Obama signed into law the National Alzheimer’s Project Act (NAPA), mandating support for Alzheimer’s research and health and long-term care services for affected individuals across all federal agencies. One of the first projects mandated by NAPA was the Alzheimer’s Disease Sequencing Project (ADSP). With this funding, CHARGE becomes a member of the National Institute of Aging-mandated Sequence Analysis Consortium, which also includes three National Human Genome Research Institute (NHGRI) Large-Scale Sequencing Centers.
CHARGE investigators will analyze whole exome and whole genome sequence data generated from 6,000 subjects with Alzheimer’s disease and 5,000 elderly individuals who do not have Alzheimer’s disease. They also will study data from approximately 100 large families, mostly of Caribbean and Hispanic descent, that include multiple individuals with Alzheimer’s disease to identify rare genetic variants that either protect against or cause Alzheimer’s disease. They will also be contributing additional CHARGE data from over 11,000 subjects with information on genetic sequence and AD-related traits.
“AD currently has no effective treatment thus prevention is the primary strategy to combat this disease,” said Boston University School of Medicine Dean Karen Antman, MD. “This is an exciting opportunity for our faculty to develop novel approaches that might ultimately delay or prevent AD.”
CHARGE is a collaboration of an international group of investigators. Eric Boerwinkle, PhD at the University of Texas, Houston and Baylor College of Medicine and Ellen Wijsman, PhD at the University of Washington will lead other funded CHARGE projects. Cornelia van Duijn, PhD who is a consultant on behalf of Erasmus University in the Netherlands.
This research at Boston University is supported by the National Institute on Aging grants U01-AG049505.
Robert Stern, PhD, professor of neurology, neurosurgery, and anatomy & neurobiology at BU School of Medicine as well as co-founder of BU’s Center for the Study of Traumatic Encephalopathy, testified before the U.S. Senate’s Special Committee on Aging at the June 25 hearing, “State of Play: Brain Injuries and Diseases of Aging.”
Stern, who is also Director of the Clinical Core of the BU Alzheimer’s Disease Center, gave an overview of the long-term consequences of repetitive brain trauma in athletes, in particular, chronic traumatic encephalopathy or CTE. CTE has been found in individuals, including youth, college, and professional contact sport athletes (including football, hockey, soccer, and rugby players), military service members exposed to blast trauma and other brain injuries, and others with a history of repetitive brain trauma.
He explained that although little is known about CTE what studies have shown thus far is that, in some individuals, early repetitive brain trauma triggers events in the brain leading to progressive destruction of the brain tissue including the build-up of an abnormal protein called tau, one of the abnormal proteins also seen in Alzheimer’s disease.
According to Stern, the ability to diagnose CTE during life is the next critical step in the study of CTE. He believes it will lead to the ability to answer important questions about this disease, such as: How common is CTE? What are the risk factors for CTE? Can it be prevented? How can we treat it? “At this point, we actually know very little about this disease, however one thing we do know about CTE is that every case of post-mortem diagnosed CTE has had one thing in common: a history of repetitive brain trauma,” Stern testified.
BU School of Medicine is participating in the American Association of Medical Colleges (AAMC) Faculty Forward Engagement Survey to benchmark our faculty members’ engagement levels with peer institutions, and to provide data for us to enhance our efforts to attract, retain, support and advance our faculty.
Who is eligible: All full time and part time faculty members at BUSM
When: June 24 launch
How: You will receive an email from the AAMC with a personalized link to the Survey
Confidentiality assured: The AAMC’s staff administers all aspects of the Survey
Please share your views candidly to help us understand how you view specific BUSM institutional policies and practices and prioritize key workplace issues that are important to our faculty.
For questions or concerns, contact Robina Bhasin.
Please participate in this important initiative!
Many patients require medication to thin blood, and some of these patients also have liver disease. Often warfarin is prescribed for this condition. This presents a challenge for physicians and patients, as the risk of bleeding in patients with liver disease taking warfarin is unknown and has not been studied.
BUSM Associate Professor of Medicine Adam Rose, MD, who is also affiliated with the VA of Bedford, Mass., Lydia Efird, MD, a former BMC resident (2013) in internal medicine and first author, and others have found that patients with liver disease taking warfarin have more bleeding events, and that certain lab values are most predictive of bleeds. Using these findings, they created a simple predictive scoring tool to assist clinicians. In a retrospective cohort study of more than 100,000 VA patients taking warfarin the researchers identified outcomes in more than 1700 patients with liver disease. Findings include:
- Patients with liver disease taking warfarin have poorer anticoagulation control and more major bleeds.
- Low albumin levels and poor renal function, as measured by creatinine, are most predictive of these poor outcomes.
The researchers created a 4-point clinical predictive tool to help identify and individualize the risks of treatment and direct future interventions. The system uses albumin and creatinine which help predict patients that are at risk of a major bleed while taking warfarin. “Prescribing blood thinners to patients with liver disease is challenging. This simple tool allows a quick calculation, in the office or bedside, to help clinicians predict which patients may safely receive warfarin and in which patients it is best avoided,” said Efird.
This article was published in Circulation Cardiovascular Quality Outcomes, May 20 2014. Epub May 13, 2014, 4 p.m. (Circ Cardiovasc Qual Outcomes. 2014;7:461-467) http://circoutcomes.ahajournals.org/
Lauren Sweetser, a first year student at the BU School of Medicine, was named an Albert Schweitzer Fellow for the 2014-15 class. She will join approximately 220 other 2014-15 Schweitzer Fellows spending the next year learning to effectively address the social factors that impact health, and developing lifelong leadership skills. In doing so, they will follow the example set by famed physician-humanitarian Albert Schweitzer, for whom their Fellowship is named.
Sweetser’s focus is addressing issues of pediatric homelessness in Roxbury, Mass. with a service-learning project “Resources and Education for Adolescents and their CHildren” (REACH). The mission of REACH is for medical students to work with and learn from homeless teenaged mothers and their young children by actively supporting them through educational workshops, constructive childcare and longitudinal multifaceted mentorship.Ultimately, the goal is for medical students to serve as healthcare liaisons for this often-neglected population while encouraging positive consistent relationships for both mother and infant.
Upon completion of the Fellowship year, the 2014-15 Boston Schweitzer Fellows will become Schweitzer Fellows for Life and join a vibrant network of nearly 3,000 Schweitzer alumni who are skilled in, and committed to, addressing the health needs of underserved people throughout their careers.
On Saturday, May 17, members of the BUSM Class of 2014 gathered to celebrate their graduation from medical school. Congratulations, Grads! View the pics on Facebook
Graduates Welcomed to Medical and Scientific Community
The 167th Boston University School of Medicine commencement opened with an academic procession of 300 members of the faculty lining up on either side of the Class of 2014 to welcome them into the community of scientists and physicians. The ceremony, held at the Agganis arena on May 17, was a celebration of achievement and commitment to medical research and caring for patients.
“We gather together today to publically recognize and celebrate the credentials that these degree candidates have earned, a major life transition,” said Dean Karen Antman, MD. “I speak for the faculty in saying that it has been a great privilege to work with you. You are smart and committed, resilient and adaptive.”
The degrees earned by the Class of 2014 included 52 PhDs, 157 MDs, 12 MD-PhDs, 10 MD-MPHs, and six graduates who received an MSc.
“It has been said that ‘life is what happens when you are otherwise making plans,’” said U.S. Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, who delivered the commencement address. “I have found this to be true time and again, and it expresses the need in life to expect the unexpected. Each of you should be prepared to negotiate around obstacles even as you keep your eye on the prize or the long range goals you have set for yourself. It is important to understand that deviations are the friction points in life when we learn the most about ourselves and we grow.
Woodson asked the parents of the graduates to stand to be recognized for their support and dedication that helped make their children’s accomplishments possible.
Speaking for her fellow doctoral students, Ariana Harris, PhD, noted, “To solve the mysteries of the world, we need each and everyone one of us to contribute. In a little while we will received our academic hoods and you will hear the titles of our individual projects, getting a sense of how different they are. This is what makes the scientific community amazing. There is so much to learn and so many of us are eager to figure it out. I am confident that whatever careers we pursue as individuals, our thirst for knowledge will continue. We use our scientific training every day. We search for logic, reason and evidence that support our thoughts and beliefs.”
Referring to the white coats he and his classmates received upon entering BUSM, Brian Curry, MD, speaking on behalf of the medical students, said, “We received these as a symbol of our induction to a calling. We didn’t realize it at the time, they also symbolized the granting of a very special kind of power. One that, just like our white coats themselves, we have spent the better part of four years clumsily trying to grow into and will likely continue to do for the rest of our careers. My message to you, BUSM class of 2014, is simply this: Earn this power. Earn it, but recognize we will never own it. We only can ever be responsible stewards of this power our patients have entrusted to us. Though today marks the retiring of these short white coats, we should never allow ourselves to get fat and happy with the notion that we have somehow grown into them. We must earn it anew every day, with every patient, always.”
Boston University’s Schools of Medicine, Public Health, Dental Medicine and the Division of Graduate Medical Sciences are proudly sponsoring the John McCahan Medical Campus Education Day on Thursday, May 22, 8:30 a.m.-3:30 p.m. in the BUSM Instructional Building, Hiebert Lounge 14th Floor.
“Education Day is a fantastic opportunity to meet and network with innovative educators from across the entire medical campus,” explains BUSM Gross Anatomy Course Director Ann Zumwalt, PhD, who also serves as chairman of the event planning committee. ”The event showcases creative educational initiatives and is consistently inspiring and invigorating for BUMC educators.”
The purpose of the event is to showcase and enhance educational innovations, scholarship and research across the Boston University Medical Campus. All faculty, students, residents, fellows and staff of BUMC are invited to attend.
Register online: http://www.bumc.bu.edu/jmedday/ Registration by May 22 is required for workshops and lunch.
Keynote Lecture: (8:45 a.m.)
The Art and Science of Giving Feedback
Carole Pfeiffer, PhD
University of Connecticut Health Center
Dr. Pfeiffer is a Professor of Medicine and a sociologist who has worked in medical education for three decades. She is the Director of the Clinical Skills Assessment Program at the University of Connecticut School of Medicine and was a founding member of the Association of Standardized Patient Educators. She has a particular interest in communication skills in the clinical encounter.
Poster Session: Posters focus on themes of educational innovations, research and technology. Oral presentations and awards will be given for outstanding student, fellow/resident and faculty abstracts
Luncheon: Pre-registered attendees will be provided lunch. Register
Faculty Workshops: Pre-Registration required. Participants will learn about educational strategies, innovations, research and scholarship by attending the interactive workshops. See workshop details and registration online.
Contact: For more information, contact Liza Young, 638-4799 or firstname.lastname@example.org
John McCahan Medical Campus Education Day
- Thursday, May 22
- 8:30 a.m.-3:30 p.m.
- BUSM Instructional Building, Hiebert Lounge 14th Floor.
Free Fitness Center-based Exercise Referral Program Among Women with Chronic Disease Risk Factors Not Well Utilized
Eliminating financial barriers to a fitness center as well as providing physician support, a pleasant environment and trained fitness staff did not result in widespread membership activation or consistent attendance among low income, multi-ethnic women with chronic disease risk factors or diagnoses according to a new study from Boston University School of Medicine. The findings, published in Journal of Community Health, is believed to be the first study of its kind to examine patient characteristics associated with utilization of community health center- based exercise referral program.
Currently, fewer than half (47.3 percent) of Americans meet expert recommendations of 150 minutes per week of moderate-intensity exercise or 75 minutes per week of vigorous-intensity exercise. Women are less likely than men to meet guidelines for physical activity. Certain subpopulations are at elevated risk for both inactivity and CMD, including Hispanics, African Americans and those below the poverty level.
Adult female patients of a community health center with an affiliated fitness center, were included in the study if they received a referral to the fitness center from their primary care provider. Demographic and medical information was abstracted from their medical chart and fitness records were abstracted to measure activation of a fitness center membership (creation of an account denoting at least an initial visit) and utilization over time.
The researchers found less than half of the women activated their memberships (40 percent), although Black/African Americans women and those with higher numbers of co-morbidities were more likely to activate. In addition, only a small subset–10 percent of women who activated their memberships (0.4 percent of the total referred sample)–achieved three-month participation levels consistent with cardiometabolic disease (CMD, including heart disease, hypertension, hyperlipidemia, Type 2 diabetes) risk reduction. Nonetheless, average visits per month declined from the beginning to the end of the free 3-month trial membership period.
“Despite providing free access to a fitness center and its staff, the number of women utilizing this service was highly variable,” explained corresponding author John Wiecha, MD, associate professor of family medicine at BUSM. “Our observations are consistent with findings from the United Kingdom, where a recent systematic review found that exercise referral “uptake” (attendance at an initial consultation) by participants varied from 28 to 100 percent and “adherence” (signifying participation in at least 75 percent of all sessions) from 12 to 93 percent,” he added.
According to Wiecha, these findings suggest that program design may benefit from developing activation, initial participation, and retention strategies that address population-specific barriers and integrate credible behavioral change strategies. “Significant public health gains could be realized by increasing physical activity among populations at high risk of chronic disease, and additional research is warranted to develop effective models in the U.S.,” said Wiecha.
The BUSM Historical Society is proud to announce publication of Volume II of Aceso: Journal of the Boston University School of Medicine Historical Society.
The BUSM Historical Society mission is to expose students and the BUSM community to the rich history of the School, Boston Medical Center, medicine in Boston, and the medical profession in general. By exploring how the landscape has changed and the profession has evolved, and introducing people and innovations that helped create modern medicine, the society offers perspective and inspiration for students to carry throughout their careers.
Aceso: Journal of Boston University School of Medicine Historical Society is named for the Greek goddess Aceso and comes from the Greek word akéomai meaning “to heal.” Aceso represented the healing process. Unlike other gods, she personified medicine from the patient’s perspective as a process involving both the ill person and the physician. Aceso was involved in overall care and the recognition that healthcare and well-being took time and was an active process.
“This aspect of healing is in striking accord with the BUSM mission and BU CARES educational philosophy,” says Michael Sherman, BUSM ’15, Aceso founder and editor-in- chief. “In our journal we hope to highlight medical history and all of its manifestations. With Aceso, it is our intent to awaken the reader to the common ground we all share. By exposing readers to the vast experience that the humanities offer, we will provide a better understanding of our place in medicine and society.”
“Trauma Informed Services: Implications for Healthcare Providers and Systems”
Carole Warshaw, MD
Director, National Center on Domestic Violence, Trauma and Mental Health
Executive Director, Domestic Violence Mental Health Policy Initiative
Tuesday, May 13
BUSM Instructional Building, L-110
This annual memorial lecture is in honor of Lynne Stevens, LICSW, BCD (1946-2009), the director of the Responding to Violence Against Women Program and an Assistant Professor in the Department of Family Medicine. She was a clinician, activist and researcher who worked locally, nationally, and internationally, specializing in evaluation of the quality of care offered to women who were victims of violence.
Attendees are cordially invited for lunch at 11:45 a.m. and a Q & A discussion from 1-2 p.m. with Dr. Warshaw following the lecture.