Transgender Medical Research and Provider Education Lacking
As a result of the limited transgender medical training offered at medical...
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BUSM Forensic Anthropology Faculty Published in Journal of Forensic Identification
Faculty members in BUSM’s program in Forensic Anthropology recently wrote a technical paper “Relaxation of Clenched Digits in Cadaveric Hands to Facilitate the Recovery of Postmortem Friction Ridge Impressions” that will appear in the January/February 2014 issue of Journal of Forensic Identification that demonstrated a simple technique to more easily obtain finger or palm print impressions of deceased individuals. This technique is particularly useful when determining identities resulting from mass casualty incidents.
Donal Siwek
Assistant Professor Donald Siwek, PhD and Instructor Gary W. Reinecke, retired FBI, detail how an incision placed at the crease of the wrist to sever the flexor tendons allows for access to the palmar surface of the hands in order to record postmortem fingerprint or palm print impressions for identification purposes. This technique will be proven to be helpful to the Medical Examiner community as well as law enforcement in general. Learn more about the Program in Forensic Anthropology at http://www.bumc.bu.edu/gms/forensicanthro-masters-program/
BUSM/BMC Nephrologist Honored by American Society of Nephrology
David J. Salant, MD
David J. Salant, MD, professor of pathology and laboratory medicine at Boston University School of Medicine (BUSM) and chief, section of nephrology at Boston Medical Center (BMC), has been awarded the 2013 John P. Peters Award from the American Society of Nephrology (ASN). The award was presented at ASN Kidney Week in Atlanta earlier this month.
The John P. Peters Award recognizes individuals who have made substantial research contributions to the discipline of nephrology and have sustained achievements in one or more domains of academic medicine including clinical care, education and leadership. Established in 1983, this annual award is named for one of the fathers of the discipline of nephrology.
The American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
With over 130 contributions to scientific literature, Salant has written several clinical papers on diverse nephrological subjects and book chapters on glomerular diseases and vasculitis of the kidney. He served as chairman of the American Board of Internal Medicine Subspecialty Board of Examiners in Nephrology.
Salant earned his medical degree from the University of the Witwatersrand in Johannesburg, South Africa. He completed his residency at Johannesburg General Hospital, where he gained extensive experience in renal transplantation, dialysis and other aspects of clinical nephrology before coming to BMC and BUSM. He also is a faculty member of the renal training program at BUSM.
BUSM Faculty Edits Second Edition Clinical Manual of Addiction Psychopharmacology
BUSM’s Domenic A. Ciraulo, MD, co-edited the recently published Second Edition of the “Clinical Manual of Addiction Psychopharmacology.”
The Second Edition provides a thorough update on the pharmacology of drugs and abuse, as well as the medications used to treat dependence on those substances. This manual delves into the broad range of addictive substances and covers the areas where significant advances have been made since the publication of the first edition.
“This book is an invaluable reference for clinicians, including psychiatrists, psychiatric residents and fellows, as well as other mental health practitioners who encounter individuals with substance-related disorders in the course of their clinical work,” said Dr. Ciraulo. “The material is presented in an organized fashion with the most up-to-date information on psychopharmacology.”
Dr. Ciraulo is the chairman of psychiatry and a professor at BUSM and the chief of the Department of Psychiatry at BMC. He co-edited the manual with Henry R. Kranzler, MD and Leah R. Zindel, RPh, MALS.
Former Governor Dukakis Visits BUSM Advocacy Training Program
The BU Advocacy Training Program (BUATP) is a student-led, faculty-mentored program at BUSM that provides training in medical advocacy. Founded as a student-led elective class called “The Spectrum of Physician Advocacy” in 2005, the BUATP grew into a multi-year curriculum that currently trains approximately 15 percent of each incoming class.
Recognizing that the health of patients is often tied intimately to social, economic, and other non-biomedical circumstances, and that medical students and future physicians may in many cases have an opportunity to influence these circumstances, the BUATP trains medical students in the theory and practice of advocating for the health and well-being of patients and the communities that they serve.
Michael Dukakis, the former governor of Massachusetts and an expert on health care reform visited the Spectrum of Physician Advocacy second year elective class on Wednesday, Nov. 6. Governor Dukakis shared his experiences, spoke about the history of health care reform, answered questions about health care reform and the affordable care act and urged students to get involved in public policy.
Learn more about BUATP at http://blogs.bu.edu/buatp/about/
Study Shows Veterans Psychologically Impacted by Boston Marathon Bombing
According to a new study, many Boston-area military veterans diagnosed with post-traumatic stress disorder (PTSD) experienced flashbacks, unwanted memories and other psychological effects as a result of the Boston Marathon Bombing in April 2013. The study raises awareness of the effects that tragic events such as terror attacks and mass shootings have not only those directly affected but also on those with PTSD and other preexisting psychological conditions. The researchers urge healthcare systems to be prepared in the future to treat individuals who were either directly or indirectly affected by such tragedies.
Led by researchers at Boston University School of Medicine (BUSM) and the U.S. Department of Veteran’s Affairs National Center for PTSD in Boston, this study is published online in the Journal of Traumatic Stress.
PTSD is a psychiatric disorder defined by serious changes in cognitive, emotional, behavioral and psychological functioning that can occur in response to a psychologically traumatic event. Previous studies have estimated that approximately eight percent of the U.S. population will develop PTSD in their lifetime. That number is significantly greater among combat veterans where as many as one out of five suffer symptoms of the disorder.
Using data from an ongoing study of Boston area veterans diagnosed with PTSD, the researchers conducted 71 telephone interviews within one week of the bombing. Because the researchers had symptom data from participants approximately two months before the bombing, they were able to compare those levels with results from the interview one-week after the bombing.
Of those interviewed, 38 percent reported that they were emotionally distressed by the bombing and the subsequent lockdown of Boston and other communities. A majority of those participants said that the bombing caused them to experience flashbacks and the re-emergence of unwanted memories relating to their own past traumas.
Mark Miller
“The effects felt by the veterans were likely due to thematic similarities between the Marathon explosions and the veterans’ own traumatic combat experiences, especially for those deployed to recent conflicts characterized by attacks involving improvised explosive devices,” said Mark Miller, PhD, associate professor at BUSM and a clinical research psychologist in the National Center for PTSD at the VA Boston Healthcare System who served as the study’s principal investigator.
There was not a significant change of symptoms between the pre and post-event data across the sample as a whole. However, for those who reported being personally affected, there was a strong correlation between distress at the time of the bombing and change in the severity of PTSD symptoms. According to the researchers, this change was primarily attributable to increases in intrusion and avoidance symptoms.
“This study highlights the fact that tragic local and national events of this type can have a significant impact on the health and wellbeing of individuals already suffering with PTSD,” said Miller. “It is crucial that relevant healthcare organizations understand this phenomenon and be prepared in the wake of tragedy to care not only for those who are directly impacted, but also for those with preexisting psychological conditions, including our nation’s veterans with PTSD.”
This study was funded by the U.S. Department of Veterans Affairs.
Vitamin D Guru to Deliver University Lecture
MED’s Holick will discuss the sunshine nutrient and why we need it
MED Professor Michael Holick, a vitamin D expert, will deliver tonight's “D-Lightful” University Lecture. Photo by Vernon Doucette
“Vitamin D chose me,” says Michael Holick, who has been an outspoken advocate worldwide for awareness of the ravages of vitamin D deficiency. As tonight’s 2013 University Lecturer, the School of Medicine professor of medicine, physiology, and biophysics will speak about his long career studying what he dubs the “D-Lightful” nutrient and share the story of how he became consumed by a subject he once considered boring.
Director of Boston Medical Center’s Bone Health Care Clinic and of MED’s Vitamin D, Skin and Bone Research Laboratory, Holick is a winner of the Linus Pauling Institute’s Linus Pauling Prize for health research and the author of The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problem (Plume, 2011). He believes the world is in the throes of a vitamin D defiency pandemic, which is causing bone disease and osteoporosis in adults as well as increasing the risk of a range of diseases, including some cancers, tuberculosis, influenza, diabetes, stroke, heart disease, and schizophrenia. About a third of all Americans are at risk for vitamin D deficiency, he says, and that the risk is higher for young children. It’s estimated that vitamin D deficiency affects nearly two billion people worldwide, making it, he says, one of the world’s leading medical problems.
Vitamin D regulates insulin production in the pancreas as well as in genes that control cell growth, and it helps the immune system, says Holick, who has been studying how skin makes vitamin D for more than 30 years. “Every tissue and cell has a vitamin D receptor. We estimate that as many as 2,000 genes—up to one-sixth of the total human genome—are directly or indirectly regulated by vitamin D.”
Holick’s zeal for the “sunshine vitamin,” which has earned him some detractors, has its roots in his early research as a resident at Massachusetts General Hospital, which shed light, so to speak, on the elegant way that our bodies synthesize the vitamin in our skin during sun exposure. His research resulted in what he calls “the concept of sensible sun exposure” coexisting with protection from skin cancers and other damage. Recently he worked with a California-based software engineer to develop an app that he says “not only tells you how much Vitamin D you are producing anywhere at any time of the year, but also provides a warning when you’ve made enough Vitamin D and that further sun exposure can increase the risk of skin damage.”
“The major cause of the vitamin D deficiency epidemic is the lack of appreciation that sun exposure has been, and continues to be, the major source of the vitamin worldwide,” says Holick, who in his lecture will elaborate on his three-step strategy to treat and prevent vitamin D deficiency.
The University Lecture was established in 1950 to honor faculty engaged in outstanding research and to offer an opportunity to hear a distinguished scholar discuss a favorite topic. All faculty members are invited each spring to nominate the subsequent year’s lecturer. University Lecturers from the previous five years act as the selection committee.
Michael Holick will give the 2013 University Lecture, titled The D-Lightful Vitamin D for Health, tonight, Wednesday, November 6, at 7 p.m. at the Tsai Performance Center, 685 Commonwealth Ave. Admission is free and open to the public.
This BU Today story was written by Susan Seligson. She can be reached at sueselig@bu.edu.
Introducing: BUSM’s Finding Information Framework (FIF) – Conceptual Algorithm, Practical Web-based Tool
In this age of rapid information expansion, medical education no longer can be structured solely around information acquisition. Faculty need to teach the concepts and lifelong learning skills of information management and information mastery to be used both at the “point-of-learning” and later applied in the clinical setting at the point-of-care. Recognizing that these concepts can be difficult to teach, the Boston University School of Medicine (BUSM) Evidence-based Medicine (EBM) Vertical Integration Group developed the “BUSM Finding Information Framework” – a conceptual algorithm as well as a practical web-based tool – to structure how medical students ask and categorize their questions and link them directly to the most appropriate information resource to answer their question. This framework is the basis of its longitudinal EBM/Information Mastery curriculum, which is woven throughout the four years of medical school.
“This new approach emphasizes the principles of adult learning and highlights the continuously changing and growing nature of the body of medical information. BUSM is training our students to be lifelong learners who can perform accurate self-assessment of their own learning needs, and can use information resources both for their own education, and for application during patient care,” said BUSM’s Director of Medical Student Education, Department of Family Medicine Miriam Hoffman, MD.
How it works
The student-centered tool, the “Finding Information Framework” (FIF), starts with students generating a question (based in the concepts of adult learning).
The FIF takes learners through an algorithm, much like a mathematical factor tree, to define their question first by determining whether it is a foreground or a background question. Once they continue down the algorithm, background is split into basic science or clinical. Clinical background is further split into common and rare/academic interest. Foreground questions are defined as always being clinical, and are split into point of care, rare/academic interest, and resources/services. Once students are able to put their questions into one of these final categories, they are directed to the appropriate information resource group to answer them. Each information resource group has a list of recommended resources. The framework is housed on the BUSM library website, so students can use it with direct one-click links into the actual resources (e.g. e-textbooks, databases, point-of-care resources, websites, etc.).
This framework and its concepts are taught to students early in the first year, reinforced throughout the curriculum and builds on itself over the four years. It is used in multiple courses including the medical library curriculum, the EBM/biostats course, the problem-based learning course, and the Family Medicine clerkship. Feedback from students has been overwhelmingly positive, with an emphasis on how logical and relevant this to their learning needs.
“Traditional EBM curricula focus mainly on concepts of study design, evidence based medicine theory, and the primary literature, and less on effective application of evidence in real time at the point-of-care. This curriculum teaches these difficult concepts and skills to students throughout the four years of medical school in a way that builds on itself and is relevant to students. It can also be a powerful faculty development tool. It is simple, clear, and intuitive to both students and faculty alike and can serve to frame these concepts for both,” said Hoffman.
Learn more about BUSM’s Curricular Innovations at http://www.bumc.bu.edu/oaa/curricular-innovations/ including the Finding Information Framework http://medlib.bu.edu/busm/fif/.
ASN Recognizes BUSM’s Salant as Leader in Fight against Kidney Disease
David J. Salant, MD, a professor of medicine at Boston University School of Medicine, chief of nephrology at Boston Medical Center, will be recognized by the American Society of Nephrology (ASN) as a leader in the fight against kidney disease, the eighth leading cause of death in the U.S. He will be awarded the John P. Peters Award on Saturday, Nov. 9, during the ASN Kidney Week in Atlanta, for his work on the mechanisms of immune deposition and the role of complement in glomerular diseases as well as the structural biology of the podocyte.
The John P. Peters Award recognizes individuals who have made substantial research contributions to the discipline of nephrology and have sustained achievements in one or more domains of academic medicine including clinical care, education and leadership.
Supported by grants from the National Institutes of Health, Salant has conducted extensive research on immune disorders of the kidneys. He was one of the earliest proponents of the notion that podocyte injury forms the basis of most, if not all, proteinuric kidney diseases. He was among the first to identify the podocyte as the primary target of injury in antibody-mediated glomerular disease.
BUSM Professor, BMC Physician Appointed to National Health Information Technology Policy Committee
Devin Mann, MD
Devin Mann, MD, MS, assistant professor of medicine at Boston University School of Medicine (BUSM) and attending physician at Boston Medical Center (BMC), has been appointed to the Health Information Technology (HIT) Policy Committee by the U.S. Government Accountability Office (GAO).
Mann, who was one of three new appointments, will serve as a researcher on the committee and will complete a full, three-year term through October 2016.
“In developing policy for health information technology, it’s important to take into account expertise related to privacy and security, health care research, as well as the views of health care workers who are the users of HIT,” said Gene L. Dodaro, Comptroller General of the United States and head of the GAO. “A number of individuals with backgrounds in these areas responded to GAO’s request for nominations, and I am pleased to announce the addition of today’s new appointments.”
The American Recovery and Reinvestment Act of 2009 established the HIT Policy Committee and gave the Comptroller General responsibility for appointing 13 of its 20 members. The HIT Policy Committee makes recommendations to the National Coordinator for Health IT on the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information.
“I am honored to have been selected to serve on this prestigious committee and I look forward to representing BUSM and BMC over the next three years,” said Mann.
To this role, Mann brings years of experience in healthcare IT. His research has focused on the use of health information technology in improving clinical care, such as developing decision support systems with electronic health records to support advanced medical home care. He serves as the lead physician in ambulatory implementation of the Epic system at BMC and co-leads Epic optimization at East Boston Neighborhood Health Center.
Mann has served as the HIT lead on the Evidence-Based Medicine Task Force of the Society of General Internal Medicine. He received his medical degree from the New York University School of Medicine and his MS of Science in Clinical Epidemiology and Health Services Research from Weill Cornell Medical College.
For more information visit the GAO Health Care Advisory Committees web page at http://www.gao.gov/about/hcac/.
BUSM Researchers Study Epigenetic Mechanisms of Tumor Metastasis for Improved Cancer Therapy
A review article by researchers at Boston University School of Medicine (BUSM) suggests that epigenetics may be a useful target to stop the growth, spread and relapse of cancer. The findings are published online in Volume 14 of the International Journal of Molecular Sciences.
(L-R): Kimberly Moulton, Anuja Oza, Sibaji Sarkar, Shannon Byler, Garrick Horn and Mckenna Longacre
The term epigenetics refers to the external modifications to DNA that turn genes “on” or “off.” These modifications do not change the DNA sequence, but instead, they affect how cells read genes.
The researchers propose that epigenetic and other changes mediate the development of cancer progenitor cells. These cells represent the early stage of cancer cell development and can grow rapidly to become full-fledged cancer. According to the researchers, progression of different cancer stages and development of metastatic potential requires differentiation of these cancer progenitor cells.
“These findings are not only important in understanding how cancer progresses, but also help in understanding how cancer progenitor cells grow and differentiate via epigenetic regulators,” said Sibaji Sarkar, PhD, instructor of medicine at BUSM.
Mutated cells are more vulnerable to the environment. Some of these mutations may alter epigenetic regulation in addition to epigenetic changes occurring by external and internal influences, which impacts gene expression and regulates cell behavior, playing a profound role when normal cells develop into progenitor cancer cells.
Sarkar and his colleagues hypothesize that when the progenitor cancer cells metastasize, rapid growth halts. When differentiation is complete, the rapid growth resumes.
The researchers believe that epigenetic mechanisms are involved in this process. Once a degree of metastatic form of cancer is achieved, the genes, which cause the change, become inactive and the genes causing rapid growth are again turned on.
“The acknowledgement of epigenetic changes as key regulators of this switching is expected to generate better epigenetic drugs. It has been suggested that epigenetic drug treatment in combination with standard chemotherapeutic drugs may have better outcomes in preventing and treating drug-resistant cancers,” he added.
This study was funded in part by the American Cancer Society. Garrick Horn, Kimberly Moulton, Anuja Oza, Shannon Byler, Shannon Kokolus and Mckenna Longacre are co-authors of the review article.
