Category: Featured

Boston University Researchers Report NHL Player Derek Boogaard Had Evidence of Early Chronic Encephalopathy

December 6th, 2011 in Featured

Researchers at the Boston University Center for the Study of Traumatic Encephalopathy (BU CSTE), a collaboration with the Sports Legacy Institute (SLI) and the Bedford (MA) Veterans Administration (VA) Medical Center, announced today that National Hockey League (NHL) player Derek Boogaard had evidence of early stages of Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease linked to repeated brain trauma, when he died May 13, 2011, at the age of 28.

Boogaard played left wing for the Minnesota Wild from 2005-2010 before playing for the New York Rangers during the 2010-2011 season. He was considered by many to be the toughest fighter in the NHL. In 277 NHL games, Boogaard scored three goals, had 589 penalty minutes and reportedly participated in 61 regular season fights. He also reportedly participated in 174 career fights in professional hockey.

Boogaard had not played since Dec. 9, 2010, due to injuries sustained in a fight, including a reported concussion. His family reported he had “seen stars” in a game two weeks prior to his final game. Boogaard had been diagnosed with post-concussion syndrome twice, and his family believes he spoke of having his “bell rung” (a term athletes use for a mild concussion) at least 20 times, although he reported few of them to his team or medical staff. Boogaard dealt with drug addiction and exhibited abnormal behaviors, including emotional instability and problems with impulse control, along with short-term memory problems and disorientation, for two years prior to his death.

Boogaard was diagnosed with mild CTE by neuropathologist and CSTE co-director Ann McKee, MD, professor of neurology and pathology at BUSM and the director of the CTE brain bank located at the Bedford VA Medical Center. CTE can only be diagnosed by examining brain tissue post-mortem. Boogaard had evidence of early CTE in his cerebral cortex, although the severity of his brain changes was more advanced than most other athletes of similar age with CTE examined by Dr. McKee.

The association between Boogaard’s brain pathology and his clinical symptoms, specifically the behavioral changes and memory problems he experienced in his last two years, is unclear. For example, his clinical symptoms occurred during the same time period he was exhibiting narcotic abuse. CTE has been found in other deceased athletes who have died from overdoses or who had problems with substance abuse. It is unknown if the substance abuse is caused by the impulse control problems associated with CTE or if they are unrelated.

Dr. McKee found mild stages of CTE in former NHL players Rick Martin and Bob Probert. It is unclear if the degree of their pathology contributed to any clinical symptoms. More severe CTE was found in Reggie Fleming. Fleming, who died in 2009 at the age of 73 with dementia, displayed 30 years of worsening behavioral and cognitive difficulties and had advanced CTE.

“It is important not to over-interpret the finding of early CTE in Derek Boogaard,” said BU CSTE Co-Director and SLI Co-Founder Robert Cantu, MD. “However, based on the small sample of enforcers we have studied, it is possible that frequently engaging in fistfights as a hockey player may put one at increased risk for this degenerative brain disease.”

Added BU CSTE Co-Director and professor of neurology and neurosurgery at BUSM, Dr. Robert Stern, “Boogaard’s clinical history was complex, so it is unclear as to if or how much CTE contributed to his behavior, addiction or death. However, CTE appears to be a progressive disease in some individuals, so even if it was not directly affecting Boogaard’s quality of life and overall functioning before he died, it is possible it could have in the future.”

“Unfortunately this finding does not contribute to our knowledge of the risks of normal hockey play for most participants, as very few hockey players engage in as many fights as Boogaard,” said BU CSTE Co-Director and SLI Co-Founder Chris Nowinski. “Athletes and parents should know that anyone who experiences repetitive brain trauma may be at risk to develop CTE, but we are hopeful that risk is small in hockey.” Nowinski added that two other young non-NHL professional hockey players studied did not show signs of CTE at postmortem examination.

The VA CSTE Brain Bank contains more brains diagnosed with CTE than have ever been reported in the world combined. There are 99 specimens. McKee has completed the analysis of the brains of over 70 former athletes, and more than 50 have shown evidence of CTE, including 14 of 15 former NFL players, as well as college and high school football players, other hockey players, professional wrestlers and boxers. Early evidence of CTE has been found in individuals as young as 17. More than 500 living athletes have committed to donate their brain to the BU CSTE after death, including over a dozen former hockey players.

The Boogaard family requested that the diagnosis be made public at this time. A full report of Boogaard’s brain tissue analysis is embargoed pending publication in an academic medical journal.

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The CSTE (www.bu.edu/cste/) was founded in 2008 and is the leading center in the world studying the long-term effects of repetitive brain trauma in sports and the military. The CSTE was created as a collaboration between Boston University (BU), Sports Legacy Institute (SLI) and the Department of Veterans Affairs (VA). Co-directors of the BU CSTE include Robert Cantu, MD, clinical professor of neurosurgery at BUSM; Ann McKee, MD, professor of neurology and pathology at BUSM and director of the VA CSTE Brain Bank; Chris Nowinski; and Robert Stern, PhD, professor of neurology and neurosurgery at BUSM. The mission of the CSTE is to conduct state-of-the-art research of CTE, including its neuropathology and pathogenesis, clinical presentation, biomarkers, methods of diagnosing it during life, the genetics and other risk factors for CTE, and ways of preventing and treating this cause of dementia. The BU CSTE has received grants from the National Institutes of Health and the National Operating Committee on Standards in Athletic Equipment (NOCSAE), and has received an unrestricted gift from the NFL.

Sports Legacy Institute is a 501(c)(3) nonprofit corporation founded in 2007 to advance the study, treatment and prevention of the effects of brain trauma in athletes and other at-risk groups. SLI partnered with Boston University School of Medicine to form the Center for the Study of Traumatic Encephalopathy in 2008. (www.sportslegacy.org)

CSTE co-directors Cantu, McKee, Stern and Nowinski serve on the NFL Players Association Mackey/White Traumatic Brain Injury Committee. In addition, Cantu serves as a senior advisor to the NFL Head, Neck and Spine Committee.

Fight data from www.hockeyfights.com

BUSM Students Without Borders, Ecuador program gives first years a perspective on global health

October 19th, 2011 in Featured

BU medical students learn about global health by running health education camps for children, working in clinics and hospitals, and living with host families in Ecuador, see the the video. (View closed captions on YouTube.)

Owen Kendall (MED'14) inspects a student's infected cut during a health camp in rural Ecuador.

Owen Kendall (MED'14) inspects a student's infected cut during a health camp in rural Ecuador.

Thumbs were not supposed to look that way. That was Owen Kendall’s first thought when he spotted the green wrapping around the thumb of an elementary school student in Obraje. The first-year BU School of Medicine student led the boy from the dim cinderblock classroom into the Andean sunlight of rural Ecuador.

Kendall (MED’14) squatted down and peeled a leaf from the boy’s thumb, revealing a swollen, mud-encrusted gash. He grabbed some wet towels and dabbed at the wound, asking the impassive boy in halting Spanish how and when he got hurt.

Seconds later, Kendall was on his cell phone calling for assistance. Within half an hour, a driver arrived from the Cacha Medical Spanish Institute (Cachamsi), a nonprofit international medicine program less than 10 miles away in Riobamba, through which Kendall and five other BU first year medical students were volunteering last summer. The driver questioned the boy in Quichua, the local language, then whisked him away to the nearest clinic.

For two days, as part of their monthlong health education camps for kids in the indigenous Cacha region, Kendall’s group had been talking to children about the best way to care for nasty cuts. Apparently that lesson hadn’t sunk in. The Quichua remedy, cover with mud or cow liver and wrap with a leaf, clearly trumped the Americans’ advice.

“I just hope that some of the stuff that we teach sticks,” Kendall said. “I think we’re doing a good job, but we just need to keep trying.”

The students in the Cachamsi group worked primarily as camp counselors, but they also took medical Spanish classes, shadowed doctors at hospitals and clinics, and lived with families. For some, the trip was an adventurous way to learn Spanish (a useful skill at Boston Medical Center http://www.bmc.org/ , where it is the first language of many patients). For others, it was a trial run at a career in global health.

They were the third wave of BU medical students to conduct health camps through Cachamsi, a program that Suzanne Sarfaty—MED assistant dean for academic affairs and director of international health programs—discovered and hopes will continue.

Sarfaty knows the value of an experience like Cachamsi, which teaches a few things that aren’t ordinarily learned from textbooks or rotations at BMC. And most of it is about the limitations of health care in remote parts of the world. Talking to kids about hand-washing falls a bit short when even the schools lack running water. Encouraging people to brush their teeth is tricky when local water is laden with parasites. And preaching about protecting the skin from the high-altitude sun is useless when most families have no access to (and can’t afford) sunscreen.

Few people beyond hikers and backpackers drive the four hours south of Quito, Ecuador’s capital, to Riobamba, a bustling city of 150,000 encircled by volcanoes with Quichua names like Chimborazo, Carihuairazo, and Tungurahua. Even fewer people travel to the mountains of Cacha, an autonomous union of 23 Quichua communities.

But at 7:30 each weekday morning, that’s where the BU medical students went, hopping from one Cacha community to another to talk about hygiene and health.

Just minutes outside Riobamba, their two pickup trucks, carrying boxes of long-sleeved T-shirts, markers, and notebooks as well as the students, turned onto a newly paved switchback path and started the climb. The trucks passed ruddy-cheeked Quichua men and women walking to Riobamba to buy supplies and to sell their hand-woven goods. They wore fedoras, scarlet red ponchos, and fuchsia shawls, adding splashes of color to a backdrop of zinc and cinderblock homes sprinkled among cornfields.

Stephanie Feldman (MED'14) checks out a hand-woven sweater in a Riobamba market.

Stephanie Feldman (MED'14) checks out a hand-woven sweater in a Riobamba market.

In recent years, 70 percent of the Quichua from Cacha have moved to Riobamba or to bigger cities like Cuenca and Guayaquil, seeking jobs and better education. Those who remain are the elderly, women, and children. They grow most of their own food and sell some of their produce in the Riobamba markets. That includes quinoa, a grain rich in protein that brings a high price on the market. They use the profit to buy cheaper, less nutritious foods like pasta, an economic trade-off that ends up boosting rates of malnutrition, just one of many common health problems.

Many Cacha adults suffer from rheumatoid arthritis (made worse by the cold mountain climate), high blood pressure, tuberculosis, and lung disease from cooking over wood fires. It’s not uncommon to find a seizure-inducing disease called neurocysticercosis, caused by tapeworm cysts from undercooked pork. (Whole, roasted hogs are sold at roadside barbecue stands all along the Pan-American Highway from Quito to Riobamba.) Cacha water is also problematic. Unfiltered and unchlorinated, it infects many people—especially children—with intestinal parasites.

In Shilpala, 10 minutes along the main road, Kendall and fellow students Caroline Mullin (MED’14) and Adriane Levin (MED’14) spilled out the back of a pickup and carried the boxes to an elementary school classroom, observed by several raven-haired children in the school’s cement courtyard. Respectfully shy and apple-cheeked, they were dressed in ponchos, wrap skirts, and vibrantly hued shawls, miniature versions of their parents.

Caroline Mullin (MED'14) teaches a lesson on bones and muscles.

Caroline Mullin (MED'14) teaches a lesson on bones and muscles.

Mullin, wearing an easy smile and a llama-print jacket, led the lesson on bones and muscles, while Kendall and Levin wrote notes on the whiteboard. Wooden desks and benches crowded the middle of the classroom. A dust-covered computer sat on a shelf, useless without electricity. In nearby fields, sheep bleated their presence.

The BU group originally planned to meet with 120 students at 8 sites; they ended up with 320, an increase attributed to the drawing power of Americans and to the fact that it was summer vacation. And while all of the medical students took daily immersion classes in Spanish, they often struggled to understand the children.

“We’ve had to learn to improvise,” Mullin said. “Half of the puzzle is really having the dialogue with the kids.”

Midway through the lesson, Mullin ushered the younger children into another classroom and shooed away a stray dog. She handed each child a long-sleeved white shirt and had them draw arm bones with markers.

“The area where these children live is very high up in altitude, very close to the sun,” she explained. “Even though the long-sleeved shirts might have cost us a little bit more, we thought that might be an appropriate decision to make for the kids.”

Cacha children draw arm bones on long-sleeved shirts during a health camp activity.

Cacha children draw arm bones on long-sleeved shirts during a health camp activity.

After class, students lined up for a snack of cheese sandwiches and bananas (another possible reason for large class sizes). Because there was no running water, Levin and Mullin washed the children’s hands with antibacterial lotion before they ate.

Health care is free in Ecuador, yet few Cacha residents take advantage of it, preferring to visit a doctor only when traditional medicine has failed. It’s the job of local doctors like Patricia Reátegui to earn their confidence and change their habits. Reátegui, who works in a four-room clinic in Machangara, Cacha’s central province, was one of the local doctors shadowed by BU students. When a mother explained that her young son and daughter had pain in their ears, Kendall listened carefully.

“Saca la lengua. Diga, ‘Ah,’” he said. The boy stuck out his tongue and breathed a long sigh. His mother and younger sister encouraged him by doing the same. Eventually, Reátegui sent the children home with medication for their earaches and for intestinal parasites. Because Cacha’s water is infamously dirty, the doctor says, she often deworms younger patients as a precautionary measure.

Kendall (left) and local doctor Patricia Reátegui (center) examine a boy in a rural Cacha clinic.

Kendall (left) and local doctor Patricia Reátegui (center) examine a boy in a rural Cacha clinic.

At the monthlong program’s end, the students agreed that their journey took them to another world, one in which hospitals and clinics have few anesthetics, antibiotics, and painkillers, let alone staff. Levin witnessed skin grafts. Mullin took medical histories for a pediatrician. And Stephanie Feldman (MED’14) assisted on a laparoscopic surgery to remove a gall bladder.

Some of the things they learned were heartening, and some were not. On one home visit, Peters Otlans (MED’14) saw a Quichua woman who had spread liver on a weeks-old gash and was in severe pain from the infected wound. After cleaning the wound, the doctor Otlans was shadowing told the woman to go to Riobamba for treatment.

“It’s eye-opening to see the way people are out here,” Otlans said. “Until you actually see it, it doesn’t have the same impact. The woman still refused to go.”

This BU Today story was written by Leslie Friday. Video by Robin Berghaus.  Photos by Vernon Doucette.

Who Wants To Be a Doctor? And Why. New BUSM students reflect shifting medical landscape

October 5th, 2011 in Featured

Members of the School of Medicine Class of 2015 were welcomed at the traditional White Coat Ceremony and Welcoming Reception at the Medical Campus on August 8. Photo by Frank Curran

Members of the School of Medicine Class of 2015 were welcomed at the traditional White Coat Ceremony and Welcoming Reception at the Medical Campus on August 8. Photo by Frank Curran

Who wants to be a doctor?

The BU School of Medicine Class of 2015 is being groomed for a respected profession now in financial upheaval and plagued by what many believe is a worrying trend away from the traditional, often nearly lifelong doctor-patient relationships nurtured by primary care. But despite concerns about health care access and future loan debt, interviews with incoming MED students reveal optimism about a career that will enable them to serve not just their patients, but their communities.

Plucked from 11,400 applicants, the 173 members of the new class hail from 32 states and 19 nations. On August 8, at the storied White Coat welcoming ceremony, they recited the Hippocratic Oath, and then, lest the proceedings get too solemn, were reminded by Kitt Shaffer, a MED professor of radiology, that “being a doctor is the best job on the planet,” and that “if you’re not having fun, you don’t have the right attitude.”

And then the grind began. Already confounded by the demands of gross anatomy, many first-year medical students are eyeing specialty medicine right off the bat—it’s not uncommon for even premed students to be planning careers not just in, say, orthopedic surgery, but in hand surgery.

Heather Dehaan (MED’15): “Today’s doctors are seen as being more humanitarian, and more involved with public health.” Photo by Vernon Doucett

Heather Dehaan (MED’15): “Today’s doctors are seen as being more humanitarian, and more involved with public health.” Photo by Vernon Doucett

“I always worry about people having a fixed idea so early, making decisions based on a very incomplete understanding of themselves,” says Robert Witzburg (MED’77), a MED professor of medicine and associate dean for admissions. But in recent years, says Witzburg, MED and other medical schools that had routinely selected applicants most adept in the sciences are now choosing students based on a more holistic review.

“That changes everything about the admissions process,” Witzburg says. “It creates a structure in which every element of the application is considered in the context of every other element. The academic record is no longer looked at as a stand-alone item, but rather in the context of the applicant’s life experience, the adversities he or she has faced, the advantages he or she may have had.”

He says adopting the holistic approach is part of an effort to “educate more students interested in community health and primary care specialties.” But, he says, “in essence we just don’t know yet.”

While he acknowledges the need for specialists, Witzburg echoes a growing sentiment in his profession that primary care is slighted by the payment system, and accumulating medical school debt is pushing young doctors toward the more lucrative specialties. Because doctors are compensated more for procedures like diagnostic scopes, scans, and biopsies than for services such as counseling or dispensing prescriptions, core primary care services are difficult to quantify and reimburse. The income gap between primary care doctors and those in subspecialties has grown steadily in the last decade, with a difference in median income of as high as $250,000 between primary care physicians and those practicing diagnostic radiology and orthopedic surgery, according to a report by the Robert Graham Center , which surveyed doctors’ incomes between 1979 and 2004. The disparity is seen as the main cause for a drop, by nearly one half, in the odds medical students will choose primary care. And the report estimated a drop of 30 percent in the odds a student will end up working in a rural health center.

Javier Rios (MED’15): “I feel like, even during residency, you can have time for your family.” Photo by Vernon Doucette

Javier Rios (MED’15): “I feel like, even during residency, you can have time for your family.” Photo by Vernon Doucette

The dramatic decline in primary care is compounded by an aging U.S. population and the expansion of health care access under the 2010 Patient Protection and Affordable Care Act, often referred to as Obamacare. A report by the American Academy of Family Physicians predicts a shortfall of almost 40,000 primary care providers by 2020. At the same time, the American Association of Medical Colleges estimates that among 2010 medical school graduates, average debt was almost $160,000, almost double the $87,000 in debt for graduates in 2002.

“There’s no doubt that students and residents tend to gravitate toward highly lucrative careers that are respected by their colleagues,” says Witzburg, an internist who as a young man turned down a prestigious cardiology fellowship. “And it’s common for people to turn their noses up at primary care after looking at primary care doctors struggling with paperwork and being paid poorly, and seeing other people doing high-class procedures, making disease go away in 60 minutes and being very well compensated for it. It’s not lost on medical students that these specialists are sought after by hospitals, have big fancy offices and big fancy cars, and live a different life than primary care doctors.”

Lifestyle issues

But it’s not just concerns about income that is causing the shift in the medical landscape, he says. There are lifestyle issues—dermatology and ophthalmology, for example, have virtually no emergencies. Writing in the New York Times, surgeon Karen S. Silbert recently made waves by suggesting that women who want to work part-time—there’s an increasing trend for doctors to split jobs—should choose a profession other than medicine.

Heather Dehaan (MED’15), a University of Miami graduate from Nashua, N.H., thinks the attraction to lucrative specialized medicine has started to wane. “Today, doctors are seen as not being so selfish,” she says. “Doctors are seen as being more humanitarian and more involved with public health.” Dehaan hopes to be a pediatrician and is attending medical school on a U.S. Navy scholarship. Her lifelong resolve to be a doctor was strengthened as a college freshman, when her much younger sister became ill with cancer. “Caring for my sister reconfirmed what I already wanted to do,” she says. A biology major, she’s always wanted to work with children and believes that a career in pediatrics will afford her “the most influence and the most input” toward bettering kids’ lives. Under the terms of her scholarship, she’ll serve one year as a doctor in the Navy, beginning as a lieutenant, for each year of medical school. “I’m not going into this with the expectation of making a lot of money,” she says. The income question hasn’t come up in discussions with residents and fellow students, she says. Dehaan is engaged and would like to have children some day, but that will have to be put on hold until some point in the future. “And I’m okay with that,” she says.

Matthew McAdams (CAS’10, GRS’11, MED’15): “Access to health care is the biggest problem we’ll always face.” Photo by Vernon Doucette

Matthew McAdams (CAS’10, GRS’11, MED’15): “Access to health care is the biggest problem we’ll always face.” Photo by Vernon Doucette

Matthew McAdams (CAS’10, GRS’11, MED’15), of Vero Beach, Fla., believes that BU “actively selected our class for more humanism.” He and Luke Stevens (GRS’11, MED’15), of Winchester, Mass., completed BU’s master’s program in medical sciences, which they believe improved their medical school applications. They were thrilled to be accepted (it was McAdams’ second try), and they are allowing themselves to dream a bit, while coping with the much-dreaded anatomy lab. McAdams is interested in neurology; Stevens hopes to specialize in emergency medicine. Both expect to be well-compensated for their work, but as McAdams puts it, “if we wanted money, we’d go into business.” As for the prestige of being a doctor, “it’s not a bad thing,” says Stevens.

McAdams was drawn to medicine by his late grandfather, a general practitioner in rural Arkansas. He did house calls and sometimes took his grandson along. “I saw the magic in what he did,” says McAdams, who hopes to practice academic medicine, enabling him to have clinical hours, teach, and do research. He believes he probably “doesn’t have the wherewithal to perform surgery for 10 hours” and wants to work with people suffering from conditions like multiple sclerosis, neuropathy, and dementia—all of which have affected friends or family members.

Luke Stevens (GRS’11, MED’15): “Even Superman couldn’t know all disease symptoms and processes.” Photo by Vernon Doucette

Luke Stevens (GRS’11, MED’15): “Even Superman couldn’t know all disease symptoms and processes.” Photo by Vernon Doucette

“I’m committed to doing emergency medicine,” says Stevens, who completed EMT training as an undergraduate. “I have a short attention span.” And with an ER doctor acquaintance estimating he’d see 40,000 patients by the end of his four-year residency, Stevens decided the specialty would be a good fit for him. “They see about three patients an hour; they see everything,” he says, and they usher patients through initial diagnosis and treatment. With median salaries of nearly $247,000, ER doctors have an added lifestyle benefit. “It’s shift work,” he says. “You’re not committed to be on call for 100 hours a week or anything crazy like that. You work as hard as you can for the hours you work, and then you go home.” Most important to him is the notion that “in the ER you have a really big chance to make an impact on each and every patient—it’s an intersection between public health and medicine.”

Javier Rios (MED’15) and Deirdre Rodericks (MED’15) have their eyes on orthopedic surgery, which, along with radiology and invasive cardiology, is among the top-earning medical specialties, followed closely by cardiology. For Rios, from El Paso, Tex., and Rodericks, who grew up in Coles Neck, N.J., the specialty’s pull is less about income and more about results: both see orthopedists as doctors with great physical competence and as clinicians who fix people. Rodericks, the daughter of a Mexican-American mother and Egyptian-Indian father, was recently in India shadowing orthopedic surgeons. “I wanted to be a mechanic when I was really little, and it’s like being the mechanic of physicians—you use drills and saws, and can see an immediate effect,” she says. She wants a family and hopes that while she’ll restore flexibility in her patients, her profession will afford her some, too. “I’ll have to plan really meticulously,” says Rodericks. “Upperclassmen have been a really big help. Though the surgeons I spoke with are all men, BU’s residency program is now about half and half.”

A weight lifter and soccer and basketball player, Rios is drawn to orthopedics, specifically sports medicine. “It’s really fascinating to me,” he says. Rios envisions working with professional athletes, maybe being a team physician. But he also expects, as he puts it, to “have a life.” Marriage and family were not among the most urgent concerns of the male students interviewed, but they were discussed often by female medical students. “We have been talking a lot about what we’re going to do about having a husband and kids,” says Rodericks. “It’s a really big concern. We’ve joked about hiring surrogates. With so many women doing surgical residencies, you’re talking about nine more years of your life.”

Deirdre Rodericks (MED’15): “I’m really into preventive care and dealing with the obesity epidemic.” Photo by Vernon Doucette

Deirdre Rodericks (MED’15): “I’m really into preventive care and dealing with the obesity epidemic.” Photo by Vernon Doucette

Committed to doing medicine

When their conversation alights on issues beyond their new regimens and surroundings, the students share many concerns, and one that’s foremost in their minds is the lack of access to health care. “Access is a big deal for me,” says McAdams. “I have a brother who doesn’t have health insurance, and when he has an issue, he comes to his younger brother, who’s not a doctor yet, for advice. Access is the biggest problem we’ll always face.” Dehaan, too, worries about access, especially for children. “I didn’t have health insurance for a while when I was growing up,” she says. “My mom doesn’t have health insurance.”

Just moments after explaining their plans to enter specific fields, all the students interviewed conceded that everything could change. “I’m told every day that in four years I might be doing primary care,” says Rodericks. McAdams often hears that he “might come out on the other side wanting to do something completely different.”

But as Stevens puts it, what’s important is that “we’re all committed to doing medicine in some way.”

This BU Today story was written by Susan Seligson. She can be reached at sueselig@bu.edu.

ER Care for Sexual Assault Victims, BUSM prof’s NEJM article calls for sensitivity, thoroughness

September 28th, 2011 in Featured

Judith Linden says that in treating sexual assault victims, “it's most important to make sure that patients are believed, understood, and get the care they need and asked for.” Photo by Cydney Scott

Judith Linden says that in treating sexual assault victims, “it's most important to make sure that patients are believed, understood, and get the care they need and asked for.” Photo by Cydney Scott

Nearly a third of women are sexually assaulted at some point in their lives, but less than half will seek medical care for their injuries. For those who do, emergency care often fails to conform to established protocol.

For the past 15 years, Judith Linden has worked to improve and streamline evaluation and treatment of adult sexual assault victims seeking care at hospital emergency rooms. The School of Medicine associate professor of emergency medicine has written an overview, published in the September 1 issue of the New England Journal of Medicine, of the evolving state of that care, which increasingly involves the use of sexual assault nurse examiners (SANEs).  SANEs are quick-responding, specially trained, certified professionals who perform forensic medical-legal exams. When cases go to trial, the SANEs are available to testify. The program was pioneered at Boston Medical Center and there are now 650 nationally, according to Linden. Some—for example in San Diego—are at freestanding sites.

Linden’s review study points out that especially in the absence of physical injury (about half of all cases), victims “are often frightened, emotionally traumatized, and embarrassed. They often fear that they will not be believed, and they may also fear for their safety if they know the assailant or if the assailant has access to their personal information.” And she also reports that many rape victims doubt that their cases will be prosecuted successfully, a justified fear in light of the fact that in the United States fewer than half of rape cases end in convictions. Medical providers should understand, Linden stresses, that “it is not their responsibility to determine whether a sexual assault has occurred, since such a determination can rarely be made on the basis of examination alone.”

The U.S. Department of Justice , the World Health Organization, and the American College of Emergency Physicians have issued guidelines for the treatment of patients after sexual assault. Linden underlines the importance of following consistent procedures, from evaluation of traumatic physical injuries to emotional support to evidence collection. Although every sexual assault case is different, maintaining protocol is crucial, she says, noting that cases where SANE-trained nurses gather forensic evidence end in a 92 to 95 percent prosecution rate.

BU Today spoke recently with Linden about the demands of caring for sexual assault victims, how emergency medical staff is rising to that challenge, and what improvements can be made.

BU Today: Is the medical response to adult sexual assault close to being standardized or does it vary widely?

Linden: I don’t think it’s standardized at all. The beauty of having a SANE program or response team is that it establishes protocols. There are still a lot of community hospitals that don’t follow the same protocols.

What are some of the problems hospitals face in establishing sexual assault protocols?

I think staffing is a difficult issue. These cases can take a long time; it can take up to six hours for an exam, longer to make sure victims have proper treatment and the counseling they need. The ER is very unpredictable—traumas come in, and you have to prioritize patients. Sexual assault patients’ injuries may not be life-threatening. Each hospital, unless it’s SANE-certified, comes up with its own protocol. We’ve gotten to the point where EMS will often triage to SANE sites.

Are there common mistakes ER staff make in handling sexual assault cases?

The first common mistake is that some of the staff can be very judgmental. Often they may question the history given by the patient, who may be intoxicated. Some of the patients may be sex workers. As far as mistakes in treatment, people are often confused about the amount of time that can elapse before evidence degrades. In Massachusetts it’s 120 hours, a limit of five days for the vaginal exam; after that it’s less likely there will be evidence, and we don’t recommend doing a rape kit after that. For oral or anal assault it’s 20 hours.

Boston Medical Center has SANE examiners. What impact has the SANE program had?

That’s the million-dollar question if you want continued funding. Our SANE program funding is cut every year; last year it almost became unworkable, but it was restored in a supplemental budget. We’re hoping lawmakers will approve another supplemental budget. You want to show that these programs improve patient care and treatment, but you also want to prove that they’re cost-effective. Are they getting criminals out of the system, or are we saving the state money? Are they (the culprits) pleading out? Not that many studies have looked at this. There was one done in Massachusetts and several other states showing an increased prosecution rate. Anecdotally, in our SANE program there’s a 97 percent success rate when SANE is involved. Different districts don’t share information.

You write that it’s not the medical team’s responsibility to determine whether a sexual assault has occurred. Does that mean that every person arriving at an ER saying she or he is a sexual assault victim, regardless of degree of physical injury, gets the same response?

The response is the same for every woman or man who presents complaining of sexual assault. When practitioners perform a sexual assault exam they probably won’t be able to tell if there’s been an assault just from the exam. A practitioner isn’t asked to decide whether it did or did not happen. He or she is collecting evidence, and the whole thing gets passed on to the justice system. Sometimes people come in and say, “Can you tell me if I was assaulted? I passed out; I woke up with my clothes off.” My point is, it really doesn’t matter. When someone comes in with chest pain, it’s not alleged chest pain. You treat these people as sexual assault victims. It’s very rare that someone will go through this whole embarrassing, invasive questioning if nothing happened. One reason these cases are so scary to clinicians is they’re not familiar with them, and they’re scared of the justice system. They worry that they’ll have to testify. I try to bring it back to the care. We have to offer good medical care based on the latest protocol.

What happens first when a sexual assault victim comes to the ER? Is he or she afforded privacy? Do victims sometimes have to wait a long time for attention?

At least in our emergency department, they’re given top priority triage and get a room immediately. You don’t know if the attacker has followed them to the ED. Does this always happen? Maybe not. Best practice is they should not wait out in the waiting room. The other problem we have is, we take them back, close the door, and the practitioner will just leave them there. I don’t want that to happen either. What we can’t see, for example, is strangulation injuries. The victim may have bruising or difficulty breathing. I don’t want that person to sit in the waiting room.

After sexual assault victims are released, what kind of follow-up is there currently and what role does the hospital play in ensuring a victim’s safety once he or she leaves?

That’s where we ask for social worker colleagues. Safety planning is very complex. What we try to do, if the victim has identified the person (and most of the time they can’t identify the person), is we try to get creative, have them stay with friends or family. One of the more complex situations is if they live in a dorm—that’s where lawyers and crisis counselors are involved. Authorities can have a suspected attacker moved out of the dorm. Safety planning is not a cookie-cutter solution.

Which of your concluding recommendations is the most urgent?

First and foremost, to make sure that patients are believed, understood, and get the care they need and asked for. It’s important to treat them for STDs and possible pregnancy. In Massachusetts, it’s the law: we must offer all rape victims emergency contraception. And it’s important for them to know where to access services in the future.

How has your role evolved as clinician advocate for sexual assault victims?

I came to Boston Medical Center after my residency and never left. When I joined BMC 15 years ago it was right when the SANE program was being formed, and I loved the program because it was very nurse-driven. To me, it is incredibly important that we continue training our young doctors to offer accurate and compassionate treatment. I felt if I didn’t get myself trained as a SANE, my residents would be missing out. It’s important to train our future doctors, who may not have done a SANE exam by the time they graduate. It’s important that they go off to community hospitals with this knowledge. I keep up-to-date on all the latest protocols and treatments; I serve as a 24-hour resource to them and make sure that the medical community stays involved.

More information about support for sexual assault victims and reporting sexual assault can be found here.

This BU Today story was written by Susan Seligson.

William B. Kannel, MD, Pioneer in Cardiovascular Epidemiology, 1923-2011

August 22nd, 2011 in Featured

William B. Kannel, MD

William B. Kannel, MD

William B. Kannel, MD, died Saturday, Aug. 20, 2011. He made the courageous decision to refuse medical interventions for cancer and chose to die with dignity with the help of hospice, family and friends. He is survived by his wife, four children, 12 grandchildren and 23 great-grandchildren.

Dr. Kannel was born in 1923 in New York, where he attended high school, and then graduated from the Medical College of Georgia in Augusta in 1949. He was trained in internal medicine in the US Public Health Service at Staten Island, New York, and was a fellow of the American Heart Association, the American College of Cardiology, the American Epidemiology Society, the American College of Epidemiology and the American College of Preventive Medicine. Dr. Kannel was Emeritus Professor of Medicine and Public Health at the Boston University School of Medicine (BUSM). He was a past Chairman of the Council of Epidemiology of the American Heart Association and a past Chief of the Section of Preventive Medicine and Epidemiology in the Department of Medicine at BUSM. He was a recipient of numerous national and international awards and honorary degrees, notable among which were the AHA Distinguished scientist award (2006), the Lifetime Achievement award from the New York Academy of Medicine (2006), and the Joseph Stokes Award from the Board of the American Society for Preventive Cardiology (2011). Other important awards received by him include the Dana Award in Preventive Medicine (1972), the Dutch Einthoven Award (1973), the Canadian Gairdner Award (1976), the CIBA Award for Hypertension Research (1981), the James D. Bruce Memorial Award of the American College of Physicians (1982), and the Charles A. Dana Award for Pioneering Achievement in Health (1986). He served on the editorial board of numerous scientific journals, including Hypertension, the American Journal of Cardiology, and the American Heart Journal.

Dr. Kannel has been active in the field of cardiovascular epidemiology for more than 60 years and led the way for the world famous Framingham Heart Study to become the leader in cardiovascular epidemiologic research that it is today. He joined the Heart Study in 1950 and in 1966, he became the NIH Director of the Heart Study, replacing Dr. Thomas R. Dawber, the original architect of the study, serving in this capacity until 1979. Between 1979 and 1987, as Professor of Medicine at Boston University, he served as the Principal Investigator of the Framingham Study. Subsequently, he continued work as the senior-most investigator at the Heart Study until his recent illness curtailed those efforts.

The Framingham Study has been acknowledged among the top ten medical advances in the last century in several reports, in no small measure attributable to Dr. Kannel’s scientific contributions. He published over 600 medical articles, numerous editorials and book chapters in premier texts. His work at the Framingham Study established the utility of population-based research for seeking out correctable predisposing conditions for cardiovascular disease (CVD), putting prevention at the forefront of cardiology. Dr. Kannel coined the medical term ‘risk factor’ in 1961 in a landmark publication in the Annals of Internal Medicine, and promoted the concept that CVD is multifactorial in origin, that is, that there is no single cause that is essential or sufficient by itself for CVD occurrence. He promoted the notion of combining information about multiple risk factors mathematically to estimate risk of CVD (the Framingham risk score). His research established the importance of distinguishing between usual (average in the population) and optimal risk factor levels. He described the risk factors for both heart attacks and brain attacks (stroke), and identified the importance of irregular heart beat (atrial fibrillation) as a precursor of stroke and high blood sugar (diabetes) as a risk factor for CVD.

In several seminal papers he dispelled the concept of “benign essential hypertension” and showed the systolic component of the blood pressure to be no less important than the diastolic level. Pioneering work conducted by him also identified risk factors for the individual components of CVD, including sudden death, heart failure, and peripheral artery disease. Data collected by Dr. Kannel and his colleagues at the Heart Study in the late 1950s and early 1960s determined CVD population incidence at a time when only mortality statistics were available. In 1971 (approximately three decades before the completion of the human genome project), Dr. Kannel began the second generation study called the Framingham Offspring Study that quantified the hazard of a family history of CVD based on observations on parents and their offspring. His research on the two generations of Study participants provided path-breaking insights on mechanisms of atherogenesis (build up of cholesterol plaques in the blood vessels), including: LDL and HDL dyslipidemia, obesity-induced clustering of CVD risk factors, importance of physical activity in CVD prevention, and smoking as a trigger for heart and brain attacks. His research stimulated national campaigns against smoking, high cholesterol, high blood pressure, and obesity.

There are few areas in cardiovascular disease epidemiology Dr. Kannel did not explore. His research highlighted the lethal nature of congestive heart failure and a thick left ventricular wall, the frequent occurrence of clinically silent myocardial infarction and the factors predisposing to sudden death, which until then had been under-appreciated. His research warned in 1985 of the lack of efficacy and danger of estrogen replacement for preventing CVD. In 2008, along with his colleagues he formulated the ‘Framingham General CVD risk score’, a profile that enables primary care physicians to pull together risk factor information to assess the global risk of heart attacks, failure, strokes, and peripheral artery disease.

By his example, Dr. Kannel influenced several generations of cardiologists and physicians and was one of a handful of “founding fathers” of preventive cardiology utilizing prospective observations to draw conclusions usually readily applicable to clinical practice. He also trained scores of postdoctoral research fellows at the Heart Study who are following in his footsteps inspired by the depth and breadth of his research.

All are welcome at the funeral, which will be held at 11 a.m. Tuesday, Aug. 23, at Temple Beth Am, 300 Pleasant St., Framingham, MA. Burial will be private.

Contributions may be made in Dr. Kannel’s memory to the Friends of the Framingham Heart Study, 73 Mt. Wayte Ave., Suite 2, Framingham, MA 01702.

William B. Kannel, MD, Pioneer in Cardiovascular Epidemiology, 1923-2011

William B. Kannel, MD, died Saturday, Aug. 20, 2011. He made the courageous decision to refuse medical interventions for cancer and chose to die with dignity with the help of hospice, family and friends. He is survived by his wife, four children, 12 grandchildren and 23 great-grandchildren.

Dr. Kannel was born in 1923 in New York, where he attended high school, and then graduated from the Medical College of Georgia in Augusta in 1949. He was trained in internal medicine in the US Public Health Service at Staten Island, New York, and was a fellow of the American Heart Association, the American College of Cardiology, the American Epidemiology Society, the American College of Epidemiology and the American College of Preventive Medicine. Dr. Kannel was Emeritus Professor of Medicine and Public Health at the Boston University School of Medicine (BUSM). He was a past Chairman of the Council of Epidemiology of the American Heart Association and a past Chief of the Section of Preventive Medicine and Epidemiology in the Department of Medicine at BUSM. He was a recipient of numerous national and international awards and honorary degrees, notable among which were the AHA Distinguished scientist award (2006), the Lifetime Achievement award from the New York Academy of Medicine (2006), and the Joseph Stokes Award from the Board of the American Society for Preventive Cardiology (2011). Other important awards received by him include the Dana Award in Preventive Medicine (1972), the Dutch Einthoven Award (1973), the Canadian Gairdner Award (1976), the CIBA Award for Hypertension Research (1981), the James D. Bruce Memorial Award of the American College of Physicians (1982), and the Charles A. Dana Award for Pioneering Achievement in Health (1986). He served on the editorial board of numerous scientific journals, including Hypertension, the American Journal of Cardiology, and the American Heart Journal.

Dr. Kannel has been active in the field of cardiovascular epidemiology for more than 60 years and led the way for the world famous Framingham Heart Study to become the leader in cardiovascular epidemiologic research that it is today. He joined the Heart Study in 1950 and in 1966, he became the NIH Director of the Heart Study, replacing Dr. Thomas R. Dawber, the original architect of the study, serving in this capacity until 1979. Between 1979 and 1987, as Professor of Medicine at Boston University, he served as the Principal Investigator of the Framingham Study. Subsequently, he continued work as the senior-most investigator at the Heart Study until his recent illness curtailed those efforts.

The Framingham Study has been acknowledged among the top ten medical advances in the last century in several reports, in no small measure attributable to Dr. Kannel’s scientific contributions. He published over 600 medical articles, numerous editorials and book chapters in premier texts. His work at the Framingham Study established the utility of population-based research for seeking out correctable predisposing conditions for cardiovascular disease (CVD), putting prevention at the forefront of cardiology. Dr. Kannel coined the medical term ‘risk factor’ in 1961 in a landmark publication in the Annals of Internal Medicine, and promoted the concept that CVD is multifactorial in origin, that is, that there is no single cause that is essential or sufficient by itself for CVD occurrence. He promoted the notion of combining information about multiple risk factors mathematically to estimate risk of CVD (the Framingham risk score). His research established the importance of distinguishing between usual (average in the population) and optimal risk factor levels. He described the risk factors for both heart attacks and brain attacks (stroke), and identified the importance of irregular heart beat (atrial fibrillation) as a precursor of stroke and high blood sugar (diabetes) as a risk factor for CVD.

In several seminal papers he dispelled the concept of “benign essential hypertension” and showed the systolic component of the blood pressure to be no less important than the diastolic level. Pioneering work conducted by him also identified risk factors for the individual components of CVD, including sudden death, heart failure, and peripheral artery disease. Data collected by Dr. Kannel and his colleagues at the Heart Study in the late 1950s and early 1960s determined CVD population incidence at a time when only mortality statistics were available. In 1971 (approximately three decades before the completion of the human genome project), Dr. Kannel began the second generation study called the Framingham Offspring Study that quantified the hazard of a family history of CVD based on observations on parents and their offspring. His research on the two generations of Study participants provided path-breaking insights on mechanisms of atherogenesis (build up of cholesterol plaques in the blood vessels), including: LDL and HDL dyslipidemia, obesity-induced clustering of CVD risk factors, importance of physical activity in CVD prevention, and smoking as a trigger for heart and brain attacks. His research stimulated national campaigns against smoking, high cholesterol, high blood pressure, and obesity.

There are few areas in cardiovascular disease epidemiology Dr. Kannel did not explore. His research highlighted the lethal nature of congestive heart failure and a thick left ventricular wall, the frequent occurrence of clinically silent myocardial infarction and the factors predisposing to sudden death, which until then had been under-appreciated. His research warned in 1985 of the lack of efficacy and danger of estrogen replacement for preventing CVD. In 2008, along with his colleagues he formulated the ‘Framingham General CVD risk score’, a profile that enables primary care physicians to pull together risk factor information to assess the global risk of heart attacks, failure, strokes, and peripheral artery disease.

By his example, Dr. Kannel influenced several generations of cardiologists and physicians and was one of a handful of “founding fathers” of preventive cardiology utilizing prospective observations to draw conclusions usually readily applicable to clinical practice. He also trained scores of postdoctoral research fellows at the Heart Study who are following in his footsteps inspired by the depth and breadth of his research.

All are welcome at the funeral, which will be held at 11 a.m. Tuesday, Aug. 23, at Temple Beth Am, 300 Pleasant St., Framingham, MA. Burial will be private.

Contributions may be made in Dr. Kannel’s memory to the Friends of the Framingham Heart Study, 73 Mt. Wayte Ave., Suite 2, Framingham, MA 01702.

Study of Academic Productivity Among U.S. Neurology Faculty Ranks BUSM’s Department of Neurology in the Top 20 U.S. Programs

August 19th, 2011 in Featured

Carlos Kase, MD

Carlos Kase, MD

A study published in the August 2011 Archives of Neurology ranks BUSM medical education and neurology residency training programs among the top 20 of 120 U.S. programs examined by the researchers in producing academic neurologists. The analysis assessed the impact of the medical schools and residency training programs on the decision to pursue a career in academic neurology as well as an estimation of the most productive medical schools and residency programs based on the academic productivity of their respective graduates.

BUSM medical education and neurology residency programs ranked 15 and 13 respectively by number of graduates, their rank and h-index that measures an author’s most cited articles and the number of citations each of the articles receive. “I am proud to see that we came within the 15 top spots among 120 US institutions,” said Carlos Kase, MD, professor and chair of the Department of Neurology.

“I am delighted that we made both lists, clearly competing with the best medical schools and residency programs in the country,” said Dean Karen Antman, MD. “Dr. Kase and his department have done a great job to motivate our students and residents.”

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Addiction Expert Designated White House Champion of Change. BUSM’s Daniel Alford has a question for you: How often do you drink?

August 3rd, 2011 in Featured

The White House is honoring Daniel Alford for his work with addiction.

The White House is honoring Daniel Alford for his work with addiction.

President Obama’s father was an alcoholic whose drunken driving killed a friend and put the elder Obama in the hospital with two broken legs. 
That unfortunate bit of history may help explain the White House’s interest in addiction, which includes honoring BU addiction expert Daniel Alford with a visit there on August 5.

Alford (SPH’86, MED’92), a School of Medicine associate professor, is the medical director of MASBIRT (Massachusetts Screening, Brief Intervention, Referral and Treatment), a federally funded program at Boston Medical Center and seven other hospitals and community health centers in the state that screens for risky alcohol, tobacco, and drug use. “When you come to see your doctor for your diabetes management or hypertension or just for your annual visit, you’ll be asked questions about unhealthy substance use,” Alford says.

Alford will be in Washington Friday, courtesy of Obama’s Champions of Change program, which hosts weekly White House visits for innovators in various fields. He’ll participate in a roundtable with federal drug policy experts, write a short blog entry about his work, and film a short biographical piece for the White House website.

Through MASBIRT, BMC and participating organizations now have trained health promotion advocates, who work throughout the institutions, from primary care offices to emergency rooms, screening people for risky substance use and assessing what the next step should be to help those with problems. The goal is to identify people at risk of addiction before the addiction consumes them, an approach that Alford says has been overlooked by the medical establishment. “If we waited for patients with kidney disease to need dialysis, that would be malpractice,” he says. “That’s kind of what we’ve done with addiction. We basically ignore unhealthy substance use until the person’s coming in with alcoholism or drug addiction.”

Alford, who joined the BU faculty in 1996, also leads BMC’s program to train medical residents in a new (for nonpsychiatric doctors) subspecialty, addiction medicine. BMC recently appointed its first addiction resident, one of only 20 such residents nationwide. BU Today spoke with Alford about his work and Friday’s event.

BU Today: My doctor asks me, “Do you smoke? Do you drink?” Is that a result of MASBIRT?

Alford: Certainly some doctors were doing it before. But there are ways of asking it, and then there are ways of asking it. You can say, “You don’t drink or use drugs, right?” as opposed to asking it with questions that have been shown to be more reliable. When you phrase a question as, “How often do you do something?” it normalizes it, and patients feel more comfortable answering.

The state would like to expand this approach. The majority of our work this past year has been, how do we sustain these efforts? Is it trying to sustain this health promotion advocate model? Nurses, medical assistants, docs could probably ask those questions. It’s probably going to be different, depending on the treatment center.

Is training in addiction medicine feasible when there are so many addictions out there? Being addicted to drugs or alcohol is different from being addicted to gambling or the Internet or sex.

There’s a lot of commonality, no matter what the substance or behavior. Addiction starts to disrupt someone’s life, despite negative consequences. It turns out that a lot of the neurobiology—what’s happening in the brain—that reinforces those unhealthy behaviors is similar as well. And they respond to a lot of treatments in a similar way.

Have there been advances in treating addiction?

The answer’s definitely yes. A perfect example is methadone maintenance. Methadone was developed for pain, but was found to be effective in treating opiate addiction. There’s a lot of stigma around it and people who don’t believe in methadone for treatment, but there’s more evidence over the last 40 years showing efficacy around methadone than pretty much anything else that I do in primary care.

A lot of behavioral therapies can be effective in treating lots of addictions as well as behavioral addictions, like gambling. All of the medications work better when you include nonpharmacological therapy, like counseling. In order for treatment to work, it needs to be continued. Historically, people got treatment, they stopped using, they then got discharged, they relapsed, and we said, “Aha, the treatment doesn’t work because they relapsed,” as opposed to saying, “The treatment works; it just needs to be continued.” Some people are cured permanently and don’t require extensive treatment. But the large majority needs sustained treatment.

What got you interested in addiction?

When I finished my residency, there was an opportunity, part-time, to be the medical director of a methadone maintenance program at the Boston Public Health Commission. I loved it immediately. I realized there were a lot of success stories within that treatment model that we as physicians didn’t know about.

This BU Today story was written by Rich Barlow. He can be reached at barlowr@bu.edu.

School of Medicine Receives LCME Reaccreditation

June 28th, 2011 in Featured

BUSM faculty, staff and student members of the LCME self-study and site-visit team

BUSM faculty, staff and student members of the LCME self-study and site-visit team

BU President Robert Brown and School of Medicine Dean Karen Antman received notification from the Liaison Committee on Medical Education (LCME) that the School of Medicine has been reaccredited for the next eight years.

The LCME is the only nationally recognized accrediting body for all medical education programs in the U.S. leading to the medical education degree. Accreditation signifies that national standards for structure, function, and performance are met by a medical school’s education program.

“The School of Medicine is a leader in education, research and clinical training,” said Antman. “The LCME accreditation confirms the quality and the standards that we have developed and continually refine and enhance. My colleagues at the School have my sincerest congratulations on this recognition.”

The School received high marks from the accreditation survey committee for the strong support provided by central administration for the teaching mission; the robust series of faculty development activities that are well attended by MED faculty; the mission-based allocation model that allows all components of the School’s mission to be strongly supported by department chairs and faculty; and the dedicated leadership at the School’s affiliated hospitals that strongly support its educational mission.

“Receiving this accreditation is an endorsement of the quality of the education we provide, our pedagogical process, and the outcomes—our graduates who are highly prepared both clinically and scientifically to contribute to health care at the bedside and in the laboratory,” said Antman.

Students and graduates of LCME-accredited medical schools are eligible to take the United States Medical Licensing Examination (USMLE). These graduates are also eligible to enter residencies approved by the Accreditation Council for Graduate Medical Education (ACGME). Graduating from an LCME-accredited U.S. school and passing the national licensing examinations are accepted as prerequisites for medical licensure in most states. LCME accreditation establishes eligibility for select federal grants and programs, including Title VII funding administered by the Public Health Service. The accrediting body comprises medical educators and administrators, practicing physicians, public members and medical students.

Hundreds of faculty, staff and students participated in the three-year self-analysis that preceded the site visit by an LCME evaluation team in February, providing the platform for the LCME team to comprehensively examine our institutional setting, governance, academic and student support programs, as well faculty development and evaluation and educational resources. About 120 participated in the actual visit.

“I was very impressed by the dedication and hard work of the BUSM community,” Antman said. “The outstanding effort of the hundreds of faculty, students and staff involved in conducting the self-study illuminated our strengths as an academic institution. We have extensive and purposeful student involvement especially in service learning; a deep sense of collegiality among faculty, students, and staff; responsive institutional structures; mission-based budgeting that reinforces our emphasis on quality teaching; diverse clinical opportunities for our students; and a cutting-edge research program fully open to our students that enriches their educational experience.”

US News & World Report: DASH Diet Number One, BU-created plan tops magazine’s list

June 9th, 2011 in Featured

Want the inside scoop on dieting? Ask BU’s Thomas Moore. The Medical Campus associate provost helped create the best diet plan going, according to US News & World Report.

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The DASH diet was codeveloped by BU’s Thomas Moore. Image courtesy of US News & World Report.

DASH (Dietary Approaches to Stop Hypertension) topped 19 other diet plans in the magazine’s “Best Diets Overall”  category, beating out such popular plans as Atkins, Jenny Craig, and Slim-Fast. The accolade is eye-catching for two reasons: DASH hasn’t been commercially marketed like those other plans—you don’t “see it at halftime during the football game,” notes Moore, a School of Medicine professor. And it wasn’t even designed to shrink waistlines. Rather, it’s a doctor-devised regimen to help people lower high blood pressure.

Several studies have confirmed DASH’s calorie-cutting potential, including this  one by researchers who looked at adolescent girls using the diet. The plan was devised in the 1990s in a multi–medical center trial led by Moore, who was a Brigham and Women’s Hospital researcher at the time. Since then, it has anchored a BU-developed weight reduction regimen offered free to University employees. Moore says several companies, including CVS, offer DASH to workers.

The benefits of DASH, which is similar to the Mediterranean diet, won’t surprise followers of nutrition news. The diet stresses fruits, vegetables, whole grains, and avoiding high-fat dairy products and high-sugar foods. Cutting salt intake enhances the diet’s potency. DASH’s key insight is that a nutritional diet can reduce high blood pressure, just as losing weight and cutting your salt intake can. It also recommends exercise as a complement to the menu.

“DASH is really better known to the medical community,” says Moore. “To get it out in the lay press like this is always lots of fun,” not to mention great publicity: the day US News announced its rankings, traffic to the DASH website jumped 20-fold, he says.

“It’s OK to ease into DASH,” US News writes. “Try adding just one vegetable serving to a meal, and a fruit serving to another. Go (sort of) vegetarian by preparing two or more meat-free dishes each week. And start using the herbs and spices hiding in the back of the pantry—they’ll make you forget the salt’s not on the table.”

Thomas Moore

Thomas Moore

“Because DASH emphasizes so many healthful foods, it can easily support weight loss,” the magazine writes, adding that the diet also improves heart health: “Rigorous studies show DASH can lower blood pressure, which if too high can trigger heart disease, heart failure, and stroke.…It’s also been shown to increase ‘good’ HDL cholesterol and decrease ‘bad’ LDL cholesterol and triglycerides, a fatty substance that in excess has been linked to heart disease. Overall, DASH reflects the medical community’s widely accepted definition of a heart-healthy diet.”

The magazine includes some caveats: people seeking to lose weight above all else might prefer to choose plans from its “Best Weight-Loss Diets” category, since DASH’s primary goal is to reduce hypertension. (The magazine also graded the “Best Diabetes Diets.”) Moore’s plan can cost a bit more than some, it adds, since fresh produce is more costly than the processed foods beloved by Americans and larded with ingredients subsidized by the government.

“We worried about that from the time we did the research,” says Moore. “You can eat cheaper than this, but it’s not by any means off the charts.” He and his colleagues found that a week’s worth of groceries under the DASH plan fell in the middle-price range. Dieters can save some money, he says, by replacing fresh produce with frozen varieties.

This BU Today article was written by Rich Barlow.  He  can be reached at barlowr@bu.edu.

BUSM Instructional Building Lobby Renovations Start Monday, May 23

May 19th, 2011 in Featured

Renovations to the BUSM Instructional Building, also known as the L-Building, begin Monday, May 23. During this initial phase some items in the lobby will be removed.

Lobby Closed to Pedestrians May 27 – August 8

Image A

Image A- Exterior view temporary entrance

Image B

Image B - Interior view temporary exit

Beginning Friday, May 27, access to the lobby will be closed to all pedestrian traffic. This will be in effect until completion of the renovation, which is expected on or about August 8.


New Temporary Entrances
There will be a handicapped ramp at the entrance between the L and Evans buildings (see image A). This doorway also may be used as the temporary main entrance for the entire complex. Image B shows this door from the interior of the building.

A-building Access
A-building occupants may use the door closest to East Concord Street as shown in image C. There will be an ID-card reader installed to allow access as well as a vision panel so that people on either side of the door are visible. Picture D shows this door from inside the building. This entrance should be available by May 23.

Visitors to A-Building may enter the complex through the new temporary entrance between the L and Evans buildings. They may take the L-building elevators to the basement and follow the  hall past Chequers  to the staircase at the end of the hall on the right. Then visitors  may take these stairs to the first floor and follow the corridor past Bakst Auditorium to the A-building elevators.

Image C

Image C - A-Building occupants may use this entrance

Image D

Image D - Interior view of exit for A-Building

Lobby Statues
The statues that had been displayed in the lobby are being carefully packed by a company that specializes in moving delicate materials. They will be stored off-site and will be reinstalled at a later time.

If you have any questions about the renovation, please contact John Barton at 638-4211. For urgent issues, please call the Control Center at 638-4144.