As a result of the limited transgender medical training offered at medical...
By Lisa Brown
Brian Jack redesigned hospital discharge procedures
The problem first came to Brian Jack’s attention 10 years ago. The School of Medicine professor and chair of family medicine noticed that patients at Boston Medical Center (BMC), like patients at most hospitals, were leaving without a good understanding of how to care for themselves in the short term. Jack started to track the amount of time that nurses and doctors spent with patients before sending them home. The average was five minutes.
“Patients in the hospital are not at the top of their cognitive game,” says Jack, explaining that sick, feverish, or sleep-deprived people are unlikely to comprehend first-time instructions about prescriptions or at-home care procedures.
Jack and his team found that nearly a third of patients experienced a medical setback after going home, and that one in five returned to the hospital within 30 days. That’s when the team started brainstorming solutions and identified 11 areas that must be covered during each discharge—steps like making appointments for follow-up care, identifying and creating a plan for prescriptions, and educating patients about their diagnoses. That list formed the foundation of Project RED (Reengineered Discharge), a practice that has been shown to lower the rate of returns to the hospital in the month after discharge by 30 percent.
It also led, this fall, to Jack earning the Peter F. Drucker Award for Nonprofit Innovation, a respected prize that has been given annually since 1991 to recognize existing programs that meet famous business guru Drucker’s definition of innovation—“change that creates a new dimension of performance.”
This year, 864 nonprofits applied for the award. Boston Medical Center officials nominated Jack’s Project RED, and it won the top prize of $100,000, which he will accept on behalf of BMC at in a November ceremony in Vienna, Austria.
“Project RED is an example of the innovative work we do here to provide safe, effective care to the whole patient,” says Kate Walsh, BMC president and CEO. “I am extremely proud of Dr. Jack, and the Project RED team, and pleased to see them honored with the Drucker Award for this creative approach to decreasing hospital readmissions.”
These days, before leaving BMC, patients are given a personalized package of information, with details about prescriptions and follow-up appointments, exams, or stress tests color-coded on a calendar. The plan, Jack says, reads like a comic book, with big font sizes, multiple colors, and plenty of icons.
Initially, nurses were responsible for going over each part of the plan with patients, but after they found it was too time-consuming, Jack and Timothy Bickmore, a Northeastern University associate professor of computer and information science, designed a computer program with a virtual patient advocate named Louise, who methodically explains the plan to patients at the end of their hospital stay.
Critics might scoff at Louise’s unpolished animation, but, Jack says, the point isn’t to entertain. “Every time she talks to a patient, it’s about their unique tailored information,” he says. “Louise is still four to five years ahead of her time. That really is the future of health care.”
And that future may have lower system-wide costs. A randomized trial performed in 2009 with 749 patients found a 30 percent lower rate of hospital use in the Project RED intervention group compared to those receiving the usual care one month after a patient’s discharge. One readmission or ER visit was prevented for every seven RED participants. According to Jack’s estimates, if readmission rates can be lowered from the current 20 percent to 15 percent over five years, that would save Medicare $17 billion and the private sector another $17 billion.
Project RED developed “at the right place, at the right time” in terms of federal public policy, Jack says. President Barack Obama’s Affordable Care Act, signed into law in 2010, emphasizes efficiency, reducing hospital readmission rates, and increasing the quality of care and patient safety. Federal agencies are now pushing Project RED as an example among the top 10 best practices for reducing cost while maintaining quality, and Jack estimates that at least 500 hospitals have adopted his team’s new discharge procedure so far.
“Many health care institutions are now studying and implementing Dr. Jack’s Project RED strategies,” says Karen Antman, MED dean and Medical Campus provost. “Clearly, reengineering discharge planning to keep patients safe is key to their recovery and to prevent unneeded readmissions.”
While Jack relishes the national attention and awards Project RED has received, he has other things on his mind—like learning how to waltz and finding something to wear to a formal ball in Vienna.
This BU Today story was written by Leslie Friday.
On the Senate floor on Monday, Sept.30, Senator Elizabeth Warren (D) made an impassioned plea against the long-term consequences of sequester budget cuts. She cited the Framingham Heart Study (FHS), which is set to lose 40 percent of funding from the National Heart, Lung, and Blood Institute (NHLBI). FHS, administered by Boston University and the nation’s longest running large-scale analysis of cardiovascular disease, has been credited with numerous breakthroughs connecting risk factors of smoking, obesity, and cholesterol to heart disease. “There are people across this country who are alive today in part because of the work that began with this study,” said Warren.
Watch an excerpt of her speech .
The 40 percent reduction in federal funding took effect Aug. 1 and will reduce the study’s clinical and administrative workforce. The biggest hit is the funding cut to conduct patient examinations, which FHS Principal Investigator Philip Wolf cites as “the lifeblood of the study.” The physical examination provides continuity with participants and allows more extensive data than telephone interviews. According to BU School of Medicine Dean Karen Antman, MD “If we let these people go because we don’t have an exam and because we have this cut and then, when we do get funding for the exams — and I’m sure we will — it will actually cost more to bring them back or retrain new staff.” The sequester cuts also affect another $28 million in research that depends on FHS data. Warren does not see the cuts as inevitable, but as a consequence of misguided priorities.
“Here we are,” says Warren, “bluntly hacking away at their funding … not because we have to, but because Washington has its priorities all wrong, and it is making some truly terrible decisions.”
Submitted by Thomas Peteet, MD
BU’s NEIDL moves closer to full operation
In an action that moves BU’s National Emerging Infectious Diseases Laboratories (NEIDL) closer to full operation, a federal court judge has ruled that a Final Supplementary Risk Assessment prepared by the National Institutes of Health (NIH) adequately analyzes the risks associated with research involving pathogens at BioSafety Level 3 (BSL-3) and BioSafety Level 4 (BSL-4) and that such research can be done safely at the BU Medical Campus site.
That risk assessment, which examined a series of scenarios and potential consequences of procedural failures, including containment system failures and malevolent acts, had been challenged in court by a number of Boston residents and the Conservation Law Foundation. The groups claimed that the risk assessment prepared by the NIH was not adequate and that the NIH decision to approve it was arbitrary and capricious.
In a 76-page opinion, US District Court Chief Judge Patti Saris found that “the NIH provides sufficient scientific support for its ultimate conclusions that the risks to the public are extremely low to not reasonably foreseeable, and the differences between the Boston location and the suburban and rural sites are not significant. In light of the benefits of placing the biolab in an urban area like Boston, which provides opportunity for expert medical research collaboration, and the low risk of harm to the public, NIH’s decision is rational.”
John R. Murphy, NEIDL director ad interim and a School of Medicine professor of medicine and microbiology, says he is pleased that the federal court “went through each and every objection of the plaintiffs in a methodical way and found that they were not warranted.”
“The court is saying that it’s reasonable for the NIH to determine that research using these types of pathogens can be done safely at the NEIDL,” says Murphy. “This is one more step to the opening of the lab.”
Murphy says that one additional judicial hurdle, a similar lawsuit filed in state court, will be heard later this year.
The University has also asked the Boston Public Health Commission for required permits to operate the facility as a BSL-3, and will soon submit documents required for permission to operate as a BSL-4 lab.
Once the lab is open, all research will be subject to at least three systems of supervisions and safeguards. Those include approvals from the Centers for Disease Control, the Institutional Biosafety Committee, and the Boston Public Health Commission.
Construction of the $200 million NEIDL facility was completed in September 2008, but controversy and litigation have kept much of the building’s 192,000 square feet of laboratory space closed. In March, BU researchers moved into the NEIDL, at 620 Albany St., to work on tuberculosis research that has been approved for Biosafety Level 2 (BSL-2) laboratories.
This BU Today story was written by Art Jahnke. He can be reached at firstname.lastname@example.org.
Kendra Kobrin, MD, PhD, candidate in pharmacology, received the Carl E. Rosow Award for Pharmacology Education at the Department of Pharmacology & Experimental Therapeutics reception held in September for new faculty and students.
Kobrin graduated summa cum laude from Boston University in 2008 with bachelor degrees in psychology and music. Following graduation, she spent a year as a research assistant in the Dermatology department at Roger Williams Medical Center before enrolling at Boston University School of Medicine (BUSM). As a second year student in the disease and therapy course, Kendra excelled in the neurology and psychology modules and joined the Department of Pharmacology & Experimental Therapeutics for her dissertation work. In 2011 Kendra joined Dr. Gary Kaplan’s laboratory at the VA Hospital in Jamaica Plain, where her research focuses on neuronal morphological changes associated with extinction of opioid use and relapse to drug-seeking behavior in models.
“Kendra has excelled in both her medical and graduate pharmacology courses, serves as tutor coordinator for the disease and therapy course, and contributes to Pharmacology Department orientation and recruitment events. As the 2013 recipient of the Carl E. Rosow Award for Pharmacology Education, Kendra exemplifies the leadership and academic qualities we seek to foster in all of our graduate students. We are proud of Kendra’s accomplishments and enthusiastic about her bright future in research and medicine,” said Dr. David H. Farb, Professor and Chair of Pharmacology.
Dr. Carl Rosow, for whom the award is named, is an MD, PhD, BUSM graduate and Professor of Anesthesiology at Harvard Medical School. Since 1985 Dr. Rosow has honored his doctoral mentor Dr. Joseph Cochin, an internationally recognized authority on opioids, by teaching this subject to medical students in the second-year curriculum and donating his honorarium to the school. The Carl E. Rosow Award for Pharmacology Education serves both to honor graduate students for their excellence in teaching pharmacology and Dr. Rosow for his continued service to his alma mater and its students.
Submitted by Christina Cherel.
A piano was delivered to the Talbot Green on the BU Medical Campus today as part of “Play Me, I’m Yours,” Street Pianos Boston Festival 2013. Students & faculty are invited to play the multicolored instrument. Tweet your photos to @BUMedicine and use hashtag #streetpianosboston.
The BUMC community is invited to a dedication and reception to celebrate recently restored historical pieces at the School of Medicine and Medical Campus. Recent improvements include the newly created picnic area on Talbot Green, a display of BUSM artifacts and artwork on the first floor of the Instructional Building, and the refurbished marble fountain in front of the School of Medicine.
“We are pleased to recognize the philanthropic support of BUSM faculty, staff, alumni and friends whose generous contributions made these restorations possible,” said BUSM Assistant Dean for Development Lawrence Crimmins. There will be a brief program followed by a reception with light food and beverages.
This event will be held Tuesday, Sept. 24, 4-5 p.m., in the BUSM Instructional Building, Conference Room L-107. RSVP to email@example.com or (617) 638-4570.
World renowned Vitamin D expert and BUSM professor Michael F. Holick, PhD, MD, recently returned from a trip to Brazil at the invitation of one of the country’s parliament members.
During his visit, Holick spoke at a seminar where several Brazilian Parliament members and the public attended and met with the country’s Minister of Health and the governor of Sao Paulo about the vitamin D deficiency problem in Brazil. Approximately 50 percent of the residents of Brazil are vitamin D deficient.
Through his years of research Holick has discovered that Vitamin D plays an integral role in modulating the immune system to help fight infections like the flu and reduces the risk of many common diseases including cancer, cardiovascular disease, depression and diabetes.
As part of his trip, Holick met with more than 100 multiple sclerosis (MS) patients who had come to Sao Paulo specifically to meet him. According to Holick, many of these MS patients had experienced improvement in their symptoms as a result of treatment with high doses of Vitamin D.
Karen H. Antman, MD, Dean, BUSM; David McAneny, MD, AOA Councilor, BUSM and Robert Lowe, MD, AOA Secretary-Treasurer, BUSM, have announced that the following students from the BUSM class of 2014 have been elected to membership in Alpha Omega Alpha (AOA), the national honor medical society organized exclusively for educational purposes.
|Joshua August||Kirsten Lyman|
|Melissa Baldwin||Steven Mills|
|Lauren Collins||Raed Moustafa|
|Brian Curry||Kaitlin Peace|
|Kaylyn Duerfeldt||Alec Peniche|
|Anthony Esposito||Baijing Qin|
|Chad Farris||David Robinson|
|Isaiah Giese||Marissa Schwartz|
|Daniel Gittings||Rima Sestokas|
|Michael Hwang||Evan Shalen|
|Allison Kimball||Jamie Sparling|
|Tejaswi Kompala||Lindsey Storer|
|Xiaoxin Li||Nilay Sutaria|
|Vincent Liao||Joyce Wang|
|Adam Luce||Lindsay Warner|
AOA aims to promote scholarship and research in medical schools, encourages high standards of character and conduct among medical students and graduates, and the recognizes high attainment in medical sciences, practice, and related fields. Its motto is: “Be worthy to serve the suffering.”
The students will have an opportunity to participate in an energetic Chapter that is a vital part of the BU Medical Campus. A formal induction ceremony will be held in the spring.
White coat ceremony highlights transformative process
The 2013 White Coat Ceremony held on Talbot Green August 5 marked a threshold for the 165 members of the BUSM Class of 2017; it is the beginning of a transformative process that will take them from their current life experience to the role of healer.
Keynote speaker Robert Lowe, MD, BUSM associate professor of medicine, noted to the class how the white coat is a symbol of intelligence, trust and responsibility, and explained it is a visible sign to others. “Right now, at the start of medical school, the coat is for you too because you’re just starting on this journey, so put it on, take some pictures, and wear it proudly when we have you see patients this year. But soon, it is just going to be a coat, with pockets full of books and tools, impossible to keep clean, with a space-age design that is boiling hot in the summer yet ice cold in the winter.
“That’s what’s supposed to happen – you are going to internalize the knowledge, the skills, and the values of medicine – they will be in you, not on you, and best of all, they will be there when you take off the coat and leave the hospital. And I say ‘best of all’ because this is goal of medical education – to transform you from the college graduate you are today into a physician. “
Drawn from a pool of 11,780 candidates through six entry pathways and 82 undergraduate institutions, the Class of 2017 comprises 52 percent women, 15 percent under-represented minorities and 20 percent with a graduate degree at the Master’s level or above, some with more than one. A highly accomplished class, most have participated in research and many have published scientific papers. Some have been volunteers with Americorps, Teach for America, and The Peace Corps, while others have worked in high tech, taught elementary school or started a business.
The class is diverse in many ways. Its members come from 27 different states in the U.S. and were born in 25 countries. One hundred forty-three speak more than one language and as a group speak a total of 25 different languages. “In cultural, social, economic, racial, ethnic, educational, and linguistic terms, and in your life experiences, you define the pluralism that we so value in our society,” noted Associate Dean for Admissions Robert Witzburg, MD ’77 in formally presenting the class.
In accepting the Class of 2017 to the School of Medicine, Dean Antman noted that there would be “bumps in the road” of their medical education, but reassured them that those who have gone before them have faced the same hurdles. She cited the example of one of her own classmates who fainted numerous times during anatomy class only to become a distinguished professor of psychiatry.
“You are about to embark on a great adventure, with a steep learning curve,” said Antman. “Students talk about the process of learning medicine as ‘drinking from a fire hose.’ Nevertheless, you will be supported by more than 2,000 faculty, upper class students, residents and dedicated staff.
She congratulated the parents of the class and explained, “Becoming a physician will change your daughter or son. Not all of the transition to being a physician is academic and having issues with adapting to being a physician is normal. In fact, we worry if students don’t have difficulty dealing with some of the injuries and illnesses they see during the course of their transition from student to physician.”
While Douglas Hughes, MD, associate dean for academic affairs read off their names, each class member climbed the stage where they received assistance donning their white coat from Associate Dean for Students Affairs Angela Jackson, MD; Assistant Deans of Student Affairs Kenneth Grundfast, MD, and John Polk, MD’74; Assistant Dean for Diversity and Multicultural Affairs Samantha Kaplan, MD; and Professor Emeritus of Surgery Robert Beazley, MD. Led by Associate Dean for Alumni Affairs Jean Ramsey, MD ’90, the class recited the Hippocratic Oath for the first time.
“Beneath that white coat, carry your uniqueness proudly, and with great self-awareness of the contributions each one of you can make in the open environment we have created for your education and professional development,” said Rafael Ortega, MD, Associate Dean for Diversity and Multicultural Affairs in his closing remarks. “Let these white coats collectively represent a large canvas on which you will, with great inspiration, paint the masterpieces of your careers.”
See more images on the Facebook album.
Patricia Resick, PhD, ABPP, professor of psychiatry and psychology at Boston University School of Medicine (BUSM), received the American Psychological Association’s (APA) Division of Trauma Psychology Award for Lifetime Achievement in the field of Trauma Psychology in Honolulu on Aug. 2.
This award recognizes a senior distinguished psychologist who has made outstanding contributions to science, practice, advocacy and education/training that has advanced the field of trauma psychology.
Resick is Director of the Women’s Health Sciences Division of the National Center for posttraumatic stress disorder (PTSD) at VA Boston Healthcare System. Throughout her career, she served on the faculties of the University of South Dakota, the Medical University of South Carolina and the University of Missouri-St. Louis, where she held an endowed professorship.
Having served as president of the Association for Advancement of Behavior Therapy (AABT) and president of the International Society for Traumatic Stress Studies (ISTSS), Resick has dedicated her career to research on the effects of traumatic events, particularly on women. She developed Cognitive Processing Therapy (CPT), considered to be one of the most effective treatments for PTSD and is used by clinicians worldwide.
“I am very honored to be recognized by my colleagues for my work on PTSD,” said Resick. “I have been working with trauma victims since the 1970s before there was a recognized disorder for the ongoing suffering of trauma victims. It has been very gratifying to be able to develop a treatment that is effective in improving PTSD symptoms in most patients whether they were raped, physically abused, combat veterans or victims of natural disasters. When patients or therapists tell me how helpful my therapy protocol has been, I am thrilled.”
She has published more than 200 papers and is the recipient of numerous awards including the Robert S. Laufer Memorial Award for Outstanding Scientific Achievement in the Field of PTSD from ISTSS, the 2009 Leadership Award by the Association for VA Psychologist Leaders and the 2012 Outstanding Contributions by an Individual for Educational/Training Activities Presented by the Association for Behavioral and Cognitive Therapies.