By Dave Steger

Dr. David McAneny, Vice Chair, Department of Surgery featured in Reuters Health discussing BMC’s ICOUGH Program

June 24th, 2014

A Risk-Stratified, Mandatory Prophylaxis Protocol Reduces Postop VTEs

By James E. Barone MD

June 12, 2014

NEW YORK (Reuters Health) – A protocol combining mandatory estimation of risk and prophylaxis orders significantly reduced the incidence of venous thromboembolic events (VTEs) at Boston University and Boston Medical Center, researchers there report.

They found an 84% decrease in the rate of deep venous thrombosis (DVT) – from 1.9% to 0.3% – while the incidence of pulmonary embolism (PE) dropped 55%, from 1.1% to 0.5% (p<0.01 for both).

Senior author Dr. David McAneny spoke with Reuters Health by phone and said, “We were gratified by the improved outcomes after the implementation of our programs.”

The before-and-after study was prompted by the authors’ recognition that their hospital had a high rate of VTE compared to other institutions participating in the National Surgical Quality Improvement Program (NSQIP).

Dr. Peter K. Henke, a professor of surgery and Associate Chair of Research at the University of Michigan, has studied VTE extensively. He said the paper is a “solid contribution to the literature, particularly addressing a high VTE rate at their institution and approaching this in a systematic manner with marked improvement.”

Prior to developing the VTE prevention strategy, no formal prophylaxis guidelines were in place.

The team adopted the Caprini VTE risk stratification method for all general and vascular surgery patients and developed standardized prophylaxis regimens-including drugs, mechanical devices, and ambulation orders-linked to the risk scores.

“The inter-rater reliability of Caprini scoring has been good,” said Dr. McAneny. “In addition to surgery residents, our physician assistants are an important part of maintaining consistent practices.”

Their electronic medical record was modified to require completion of both the risk score and the orders for prophylaxis.

Heparin and mechanical compression were optional for the lowest-risk patients, who were walked frequently. Low-risk patients were treated with either heparin (low dose unfractionated or low molecular weight) or compression boots, and those scored as moderate-risk got both heparin and boots.

High- and highest-risk patients were to receive extended prophylaxis of boots and heparin for seven to 10 days or 30 days, respectively, continuing if necessary after hospital discharge.

At the University of Michigan, “We use the Caprini scoring system and have mandatory risk assessment,” said Dr. Henke. His group typically administers 30-day prophylaxis only for oncology patients and those with inflammatory bowel disease.

The Boston paper, published online in the Journal of the American College of Surgeons, said the prophylaxis order mandate could be overridden by a physician, but the reason had to be documented in an automatic drop-down menu.

After the prophylaxis program began, recommended prophylaxis in the 749 low- and moderate risk-patients was given 100% of the time. Of the 99 high-risk patients, 89% received appropriate prophylaxis as did 10 (77%) of the 13 patients in the highest risk group. All protocol deviations were documented in the electronic record.

Dr. Henke, who was not an author of the study, wondered about patients who received prophylaxis but did not benefit. He said, “This is often a neglected part of aggressive VTE prophylaxis. Anticoagulants do have bleeding risks, and at the very least, a significant monetary cost.”

Dr. McAneny’s group is now analyzing failures of the protocol. He said, “We are investigating patients who developed VTEs despite the protocol, questioning if those events were a function of improper scoring, withholding recommended prophylaxis, or some other reason.”

Before the protocol was adopted, audits of nursing practice showed that only 19.6% of 250 patients were out of bed at the time of the visit vs. 69.1% after the intervention (p<0.001).

Other NSQIP hospitals of over 500 beds during the years studied had annual rates of 0.8% for DVT and 0.4% for PE.

Using a risk-adjusted NSQIP data for the authors’ hospital, the ratio of observed to expected VTE was 3.41 prior to instituting the program, and steadily decreased to an odds ratio of 0.94 (p<0.05).

“It will be difficult to get the rate of VTE to zero because the risks of bleeding from anticoagulation sometimes outweigh the risks of VTE so that prophylaxis cannot be administered,” said Dr. McAneny also noting that certain patients will develop VTEs despite appropriate prophylaxis.

He mentioned several important factors in the success of their program such as its standardization, buy-in by the surgeons-they are all competitive people and none wants to be on the wrong side of the outcomes curve, a user-friendly system with check-box format, mandated VTE hazard scoring and prophylaxis selection or declination, electronic reminders, and regular monitoring and feedback of data.

SOURCE: http://bit.ly/1j7DXOq

J Am Coll Surg 2014.

Nilton Medina, MD, Awarded George H. Kaye Alumni Award for Outstanding Service to Others

May 15th, 2014

Nilton-Medina-MDNilton Medina, MD, Attending Surgeon, Division of Plastic and Reconstructive Surgery, Boston Medical Center and Associate Professor of Surgery, Boston University School of Medicine,was awarded the very first George H. Kaye Alumni Award for Outstanding Service to Others from the Biomedical Science Careers Program (BSCP) at their annual Evening of Hope event.

The award was established in honor of George H. Kaye who was a founding member of BSCP and worked with others to create an organization that would provide students of every race, ethnic background, gender, and financial status with encouragement, support, and guidance needed for the successful pursuit of biomedical science and other science-related careers. 

Dr. Medina first met Mr. Kaye at a BSCP Conference in 1996 as a college student. He was a recipient of a Hope Scholarship in 1998, and has given back to BSCP as a Student Advisor for the last decade. 

About the Biomedical Science Careers Program (BSCP)
The Biomedical Science Careers Program (BSCP), founded in 1991, was incorporated as a not-for-profit organization in 1994. BSCP’s first student conference took place in March 1992 and was attended by 300 high school, college, medical and graduate minority students. Since its inception, more than 10,000 minority students and over 1,100 underrepresented postdoctoral trainees and junior faculty members have participated in BSCP programs. The founding sponsors of the Biomedical Science Careers Program are the Harvard Medical School Minority Faculty Development Program, the New England Board of Higher Education and the Massachusetts Medical Society.

Gerard Doherty, MD, Installed as President of American Association of Endocrine Surgeons (AAES)

April 28th, 2014

Doherty Headshot

Gerard Doherty, MD

Gerard Doherty, MD, chief of Surgery at Boston Medical Center (BMC) and chair of the Department of Surgery at Boston University School of Medicine (BUSM) has been installed as President of the American Association of Endocrine Surgeon (AAES). He will serve as President through 2015.

As president, Doherty will preside at council assemblies and the annual members’ assembly. He will appoint members to all committees, serve as an ex-officio member of each, appoint successors to open positions, and deliver the 2015 Presidential Address.

Endocrine surgery is the discipline of surgical management of endocrine disorders, including the understanding of the disease process, and comprehensive care of surgical endocrine disease of the neck and abdomen. The AAES is dedicated to the science and art of endocrine surgery, and maintenance of the highest standards in clinical practice.

“Being chosen by my colleagues to fulfill this role is a distinct honor. The AAES has been my professional home throughout my career, and I admire the many achievements that we have made as a group to improve the care of patients, to advance the field, and to train the next generation of practitioners.”

Doherty’s clinical focus is endocrine oncology and comprises surgical diseases of the thyroid, parathyroid, endocrine pancreas and adrenal glands, as well as the surgical management of multiple endocrine neoplasia (MEN) syndromes.

Prior to coming to Boston Medical Center and Boston University in 2012, Doherty spent a decade as chief of General Surgery at the University of Michigan Health System. He is the immediate past-president of the Michigan Chapter of the American College of Surgeons and has held multiple leadership positions in national and international professional groups, including the Board of Directors of the American Thyroid Association.

A graduate of Holy Cross and Yale School of Medicine, Doherty completed his residency at the UC-San Francisco, including Medical Staff Fellowship at the National Cancer Institute. He joined the faculty at Washington University School of Medicine in 1993 and became professor of Surgery there in 2001.

About the Association of Endocrine Surgeons

The American Association of Endocrine Surgeons (AAES) is dedicated to the advancement of the science and art of endocrine surgery. Our members have clinical expertise in and research interests that focus on endocrine surgical diseases. They are certified by either the American Board of Surgery of the United States, the Royal College of Surgeons of Canada or the equivalent governing boards in Mexico and South America. Our membership has recently expanded to include international leaders in endocrine surgery and allied specialists that have demonstrated a similar focus of practice. The AAES is committed to providing surgical expertise in diseases of the thyroid, parathyroid, adrenal glands as well as in neuroendocrine tumors of the pancreas and GI tract. Our goal is to discover and promote the best treatments for endocrine disease to help improve our patients’ lives.

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 496-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet – 14 community health centers

Gerard Doherty, MD and Peter Burke MD, featured in Boston Globe Opinion Piece

April 17th, 2014

 

Gerard Doherty, MD, James Utley Professor and Chairman, Department of Surgery, Boston University School of Medicine and Surgeon-in-Chief, Boston Medical Center and Peter Burke, MD, Professor of Surgery, Boston University School of Medicine and Cheif of Trauma Services at Boston Medical Center were published in The Podium Opinion section of The Boston Globe discussing Boston’s trauma centers and the preparation for the events surrounding the Boston Marathon bombings. 

Click here to read the article.

Globe Op-Ed

Dr. Alik Farber on Lessons From Boston’s Emergency Response One Year Ago

April 10th, 2014

Alik Farber, MD, Chief, Division of Vascular and Endovascular Surgery at Boston Medical Center and Associate Professor of Surgery at Boston University School of Medicine was a guest on WBUR discussing “Lessons From Boston’s Emergency Response One Year Ago“.

Click here to listen to the radio segment.

 

 

BU School of Medicine and Boston Medical Center Seeking Chair, Department of Orthopaedic Surgery

March 21st, 2014

Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) are jointly seeking a new Chief and Chair of Orthopaedic Surgery.

We are seeking an energetic and academically committed individual with strong clinical credentials and a research background who is prepared to lead a department and serve as a key leader at our academic medical center.  The Department of Orthopaedic Surgery has 11 faculty members; 28 residents; 7 nurse practitioners; 6 physician assistants and over 30 administrative staff.  The Department offers the usual complement of Orthopaedic services including hand and upper extremity, joint reconstruction, knee, Orthopaedic pediatrics, spine, sports medicine and trauma and fractures. In the most recent academic year, the Department had 31,000 office visits and over 3,000 surgical cases.

The Department has a thriving graduate medical education program with residents rotating between Boston Medical Center, Lahey Clinic Medical Center, Shriner’s Hospital for Children and Veterans Affairs (VA) Healthcare System. In addition, the Department has a Trauma Service/Program, an ACGME accredited Sports Medicine fellow/program and a Spine Fellow program.

BMC is a 496-bed academic medical center located in Boston’s historic South End. The hospital is the primary teaching affiliate for Boston University School of Medicine. BMC provides a full range of pediatric and adult care services, from primary to family medicine to advanced specialty care. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England.

BMC is the principal teaching affiliate of Boston University School of Medicine (BUSM). BUSM is highly ranked and committed to urban and international health and has recognized leader in groundbreaking medical research.

We ask that candidates who wish to be considered send a CV and cover letter describing the experiences that qualify them for our position and their vision of what an academic Department of Orthopaedic Surgery should aspire to be. Please send all materials directly to: Gerard Doherty, MD, Utley Professor and Chair of Surgery, Boston University School of Medicine and Surgeon-in-Chief, Boston Medical Center via email to gerard.doherty@bmc.org. Please include “Orthopaedic Chair” in the subject line.

Boston University and Boston Medical Center are equal opportunity employers, committed to their common mission of improving the health of Boston’s residents while adhering to the highest standards of academic medicine.

BMC and BUSM are affirmative action/equal employment employers.
Women and minorities are encourage to apply.

Boston Doctors Reveal Lessons Learned in Marathon Attack

March 21st, 2014

 

http://www.necn.com/03/20/14/Boston-doctors-reveal-lessons-learned-in/landing.html?blockID=864098&feedID=11110

Department of Surgery Welcomes Robert W. Schulze, MD, FACS, FCCM

February 7th, 2014

Robert W. Schulze, MD, FACS, FCCM

Robert W. Schulze, MD, FACS, FCCM

The Department of Surgery is pleased to announce that Robert W. Schulze, MD, FACS, FCCM, has joined the department. Dr. Schulze is an Attending Surgeon in the Section of Acute Care & Trauma Surgery at Boston Medical Center and Associate Professor of Surgery at Boston University School of Medicine. He was most recently Director of Surgical Nutrition and Surgical Critical Care at SUNY Downstate Medical Center in Brooklyn, NY and Attending Physician of Surgery at Kings County Hospital Center also in Brooklyn, NY.

Dr. Schulze is a graduate of Boston University (BA, MA, MD). He completed a residency in General Surgery at the University of Medicine and Dentistry of New Jersey in New Brunswick, NJ, and a Fellowship in Trauma and Critical Care at the University of Maryland in Baltimore, MD. In addition, Dr. Schulze completed a research fellowship at New England Deaconess Hospital. 

Dr. Schulze has authored and co-authored numerous chapters and scientific publications and is a Fellow of the American College of Surgeons (ACS) and the American College of Critical Care Medicine. His research and clinical interests include surgical education, ARDS, advanced ventilator management, sepsis, pre-hospital trauma care and violence prevention programs.

 

Local researchers Awarded Grant from the DeGregorio Family Foundation for Gastric and Esophageal Cancer Research & Education

January 17th, 2014

(Boston) –Tony Godfrey, PhD, associate chair of research in the department of surgery at Boston University School of Medicine (BUSM) and Boston Medical Center (BMC), was recently awarded a two-year, $225,000 grant from the DeGregorio Family Foundation for Gastric and Esophageal Cancer Research & Education. Godfrey, who is also an associate professor of surgery at BUSM, will use the funding to study Barrett’s Esophagus (BE). People with BE are at increased risk for a type of cancer called esophageal adenocarcinoma.

Esophageal adenocarcinoma is an aggressive tumor that is often diagnosed after it has already spread to other sites. Currently, the only way to detect esophageal adenocarcinoma is with an endoscopy, which is an invasive procedure that requires a hospital visit, sedation and a day off work.

The research team is developing a new approach for esophageal cancer detection that could be performed simply in a primary care physician’s office or even at home. The approach uses a sponge-containing capsule attached to a string. When swallowed, the sponge expands in the stomach and can then be pulled back through the esophagus and out of the mouth. Esophageal cells are rubbed off onto the sponge as it is pulled through the esophagus and can be examined to look for cancerous changes.

“Our project, clinically conducted in our Barrett’s Esophagus Program at Boston Medical Center, will attempt to find cancer cells using a sensitive method to detect mutations that are known to cause esophageal adenocarcinoma,” said Godfrey, who is also principal investigator of the study. “If successful, this project may lead to more wide-spread esophageal cancer screening, earlier detection of tumors and improved survival,” he added. “We are grateful for the funding provided by the DeGregorio Family Foundation which will allow us to perform vital experiments to determine if this approach is feasible.”

Lincoln Stein, MD, PhD, from the Ontario Institute for Cancer Research (OICR) and Virginia Litle MD, director, Barrett’s Esophageal Program at BMC, are collaborating with Godfrey on this project.

The DeGregorio Family Foundation seeks to promote and facilitate education and collaborative research on the pathogenesis, early diagnostic and treatment of upper gastrointestinal malignancies. It was founded in 2006 after a tenth member of the DeGregorio family succumbed to stomach cancer and was found to have possessed a rare gene that causes the disease and other common cancers. Her surviving siblings, who both tested negative for the gene, created the Foundation to raise funds for research on the hereditary and non-hereditary varieties of stomach and esophageal cancer. Since its inception, the Foundation has made tremendous progress in providing the private support needed to learn more about these cancers, which has had an enormous global impact.

Founder Lynn DeGregorio looks forward towards the advancement in early detection and treatment of these diseases.

Department of Surgery Welcomes New Associate Chair for Education

January 15th, 2014

The Department of Surgery is pleased to announce that Douglas F. Kauffman, PhD, is the new Associate Chair for Education.

Dr. Kaufman graduated Cum Laude from the University Of Minnesota Institute Of Child Development with a BA in Child Psychology. He obtained an MS in Educational Psychology from the University of Nebraska-Lincoln and a PhD in Psychological and Cultural Studies: Cognition, Learning, and Development also from the University of Nebraska-Lincoln.

Most recently, Dr. Kaufman was a tenured Associate Professor of Educational Psychology at the University of Nebraska-Lincoln. Prior to that, he was an Assistant Professor of Educational Psychology at the University of Nebraska-Lincoln; Assistant Professor of Education at Eastern Connecticut State University; and Assistant Professor of Measurement and Research Methods in the Department of Educational Psychology at the University of Oklahoma.

Dr. Kaufmann’s research interests include instructional innovations designed to improve students’ learning, cognition and self-regulation in complex learning environments. In his role as Associate Chair for Education, Dr. Kauffmann serves as a faculty member in the Department of Surgery, with specific responsibility for the development and administration of educational programs offered by and within the department to medical students, other professional students, surgery residents and department faculty and staff. His research agenda will include efforts to improve the efficiency and efficacy of our teaching and learning, thus advancing the field of Surgical Education.