Areas of Clinical Excellence
The Endocrinology, Diabetes, Nutrition and Weight Management Clinic was established in September 2001. The facility houses spacious exam rooms, multiple thyroid ultrasound and biopsy rooms, bone densitometry, and space for patient education.
The Nutrition and Weight Management Center includes physicians, nurse practitioners, dietitians, and an exercise specialist. The center provides medical consultation (Drs. Apovian, Istfan, Kim, Rizo, and Srivastava) in the area of obesity and nutritional disorders, as well as weight loss surgery (Drs. Hess, Carmine, Carter, and Pernar).
The Section continues to provide outstanding clinical service in the diagnosis and management of bone disease and calcium disorders under the direction of Dr. Michael Holick. State-of-the-art bone density and body composition evaluations on normal and morbidly obese patients are now carried out in the clinic on demand, a service currently not available elsewhere in Greater Boston. Free bone density screenings are offered to anyone including staff, patients or visitors to BMC.
Drs. Braverman, Lee, Safer, and Pearce offer nationally and internationally recognized expertise in diseases of the thyroid in the Thyroid Diagnostic and Treatment Center. The Thyroid Center offers comprehensive medical evaluation and medical and surgical therapies of diseases of the thyroid. In our clinic, thyroid ultrasounds are available on site to further assess thyroid size and nodularity and adenopathy. The ultrasound is also utilized to assist in fine needle aspiration biopsies of thyroid nodules and cervical adenopathy. Drs. Braverman and Lee offer special expertise in radioactive iodine therapy of hyperthyroidism and thyroid cancer. Drs. Lee and Braverman are two of a few endocrinologists who directly administer radioactive iodine to patients. Together they have more than 70 years of experience with radioactive iodine therapies. Dr. Lee has developed a radioactive iodine dosimetry program for maximal dose I-131 therapy of advanced thyroid carcinoma. This is one of only a dozen programs in the country to provide extremely high dose radioactive iodine therapy for life threatening thyroid malignancies. Drs. Braverman and Lee’s expertise in thyroid disease has made our hospital a national and international referral center for patients with complicated thyroid disease. The endocrinologists and surgeons [Drs. David McAneny (General Surgery), Thurston Drake (General Surgery), Gregory Grillone (ENT), Pieter Noordzij (ENT), Scharukh Jalisi (ENT)] work closely to ensure excellent coordinated care of patients who require surgical treatment of their thyroid disease.
The diabetes clinical service has greatly expanded under the direction of Drs. Sara Alexanian and Devin Steenkamp. Under the leadership of our certified diabetes nurse educators, Ms. Barbara Jarvis and Ms. Joyce Lekarcyk, our ADA-accredited Clinical Diabetes Education Program successfully completed a re-evaluation and certification. In 2005, a comprehensive Inpatient Diabetes Management Service has been providing intensive management of diabetes in the the inpatient medical floors and intensive care units. The Adult Inpatient Diabetes Program is designed to meet current national standards for glycemic control in patients hospitalized at Boston Medical Center. The program recognizes that, with the rising prevalence of insulin resistance due to conditions such as obesity and the metabolic syndrome, the number of inpatients with known diabetes, as well as unknown diabetes, is expected to rise. Moreover, expert opinion and clinical research have identified hyperglycemia as a factor that increases length of stay, hospital complications, and even inpatient mortality. Dr. Alexanian directs the inpatient diabetes program and a second inpatient diabetes nurse practitioner service focuses primarily on patient education and transition from hospital discharge to the outpatient clinics. The central goals of the program include the following:
In all Critical Care Units:
- Support the safe and effective use of one insulin infusion protocol in all ICUs
- Directly assist with glycemic control in the CCU
- Develop a “transition off drip” protocol for use in the BMC electronic order entry system
- Develop insulin protocols for special populations: e.g. high dose steroids
- Develop a hospital-wide critical pathway for Hyperglycemic Crisis (DKA, HHS)
On all Medical, Surgical, Ob/Gyn Units:
- Promote patient-appropriate insulin prescribing in the hospital
- Improve glycemic control on the floors (fbg 80-110, pp < +180)
- Dedicated consultation service for education and management of patients with diabetes
- Advocation for patients with diabetes, especially those using special therapies (e.g. pump patients, new insulins)
- Improve inpatient transition to home & to their primary physician
- Develop “New Onset Diabetes Pathway” for use in BMC’s electronic order entry system
An essential element of the program is the education of nurses, physicians and patients. A major source of the necessary education comes from the members of the newly-formed Endocrine subcommittee of the Pharmacy and Therapeutics hospital committee. This is a multidisciplinary group of health care professionals led by Dr. Alexanian with members from the department of pharmacy, nursing, information technology, the Internal Medicine Residency and the Section of Endocrinology. The initial group was founded in the Fall of 2004 and made official in 2005 to reach the goal of safe and effective insulin therapy for all inpatients with hyperglycemia.
Lastly, in collaboration with BMC’s pharmacy and information technology, a plan is in place to continuously evaluate the diabetes-related clinical outcomes in our patient population. The data from this ongoing project will be invaluable for both internal and general knowledge about the management of patients with diabetes and hyperglycemia at Boston Medical Center.
This team will directly manage all patients with hyperglycemia in all intensive care units of the BMC (medical and surgical) and to transition to the floors to improve medical outcome. The diabetes service has been working with the high-risk prenatal obstetrics group at BMC to manage pregnant women with diabetes mellitus.
Our faculty has expanded its clinical activities to other sites. We are participating in endocrine clinics at the East Boston Health Center, the Brockton VA Hospital, the Bedford VA Hospital, and Atrius Health.