Category: Faculty News

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.


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.

Boston Doctors Reveal Lessons Learned in Marathon Attack

March 21st, 2014

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.

Department of Surgery Faculty Recieve Collaborator of the Year Awards

November 1st, 2013

Donald Hess, MD : Collaborator of the Year Award: Clinical Collaborator for his work with members of the Department of Medicine in studying the physiology and biochemistry of obesity and weight loss. Generous and insightful collaboration of Dr. Hess with members of the Evans Center Affinity Research Collaborative (ARC) on METABOLIC DISEASES AND INSULIN RESISTANCE: STUDIES IN PATIENTS UNDERGOING BARIATRIC SURGERY has contributed to advancing cutting edge translational research.

Karl Karlson, MD: Collaborator of the Year Award: Clinical Collaborator for his co-leadership of the Evans Center Affinity Research Collaborative ARC on NANOTHERANOSTIC PLATFORMS FOR CANCER AND VASCULAR DISEASE, for most valuable insights on animal surgery in the context of drug delivery to the cardiovascular system, and for leading by example much sought after collaborations among basic and clinical researchers.

About the Award

The Department of Medicine Evans Center Collaborator of the Year Award: Clinical Collaborator is given yearly to investigators affiliated with Boston University (BU) or outside of BU, who have contributed to the research mission of the Evans Center for Interdisciplinary Biomedical Research (ECIBR) by creating and/or significantly enhancing webs of interdisciplinary collaborations within the Evans Center and BU.

Boston Globe Opinion – Lessons from the Marathon bombing – By BMC/BUSM Surgeon Jeffrey Kalish

October 16th, 2013

Working at Boston’s largest Level One Trauma Center, the staff at Boston Medical Center care for patients with complicated medical issues every day. But as we all have come to understand, April 15, 2013, was not like any other day, and the events that our nation observed have forever changed the way many of us approach medicine.

All of us at BMC who were involved with Marathon Monday and its aftermath think about that day while moving forward with our daily lives and work. We all had different reactions and adjustments to the violence that transpired six months ago. While many of us are still working through our personal challenges associated with the tragedy, many more have likely placed the incident in a mental storage compartment in order to facilitate forward progress. However, not a day goes by when we do not think about the Marathon and how we can take the lessons learned and apply them to our future trauma victims and patients.

To read the full opinion, please click here.

Department of Surgery Appoints New Vice Chair

September 4th, 2013

David-McAneny-MDDr. David McAneny, Associate Professor of Surgery, Boston University School of Medicine and Associate Chair for Clinical Quality and Safety, Boston Medical Center Department of Surgery is the new Vice Chair in the Department of Surgery. In this role, he will also serve as Division Chief of General Surgery and Section Chief of Surgical Oncology.

A graduate of Georgetown University School of Medicine, Dr. McAneny completed his residency at Boston University Medical Center and Boston City Hospital and a Fellowship in Gastrointestinal Surgery at Lahey Clinic Medical Center. He is a member of the Board of Governors of the American College of Surgeons, and an active member of the American Association of Endocrine Surgeons, the Society of Surgical Oncology, the New England Surgical Society and the Boston Surgical Society. He is also a Past-President of the Medical-Dental Staff of Boston Medical Center, a Past-President of the Massachusetts Chapter of the American College of Surgeons and former Massachusetts state chairman of the Commission on Cancer.

Dr. McAneny’s practice is devoted to endocrine surgery, surgical oncology, and general surgery, especially gastrointestinal surgery. His fellowship training was in upper GI surgery, with emphasis on the pancreas and the biliary tract. His surgical expertise is in tumors and other diseases of the endocrine organs, gastrointestinal tract, pancreas, hepatobiliary system and spleen.

In addition to his clinical practice, Dr. McAneny has received numerous teaching awards. He is the recipient of the 2005 Grant V. Rodkey Award, bestowed by the Massachusetts Medical Society for “outstanding contributions to medical education and medical students.” He is the 2008 Boston University faculty selection for Alpha Omega Alpha, the national honor medical society, and he is currently Councilor of the AOA chapter at BUSM. He received the 2008-2009 Erwin F. Hirsch, MD Teaching Award from the graduating Boston University Surgery chief residents, The Stanley L. Robbins Award for Excellence in Teaching, conferred at the 2010 graduation to the “outstanding educator at the Boston University School of Medicine,” and the Educator of the Year Award in Clinical Sciences, conferred at the 2013 BUSM graduation ceremony.

David McAneny, MD, named councilor of the BU School of Medicine Chapter of Alpha Omega Alpha Honor Medical Society

August 14th, 2013

David McAneny, MD, Associate Professor of Surgery, Boston University School of Medicine, has been named councilor  of the BU School of Medicine Chapter of Alpha Omega Alpha Honor Medical Society (AOA).
A national honor society, AOA recognizes excellence in scholarship and supports high standards and ethics in the profession of medicine. Being elected to AOA identifies the member as committed to scholarship, leadership, professionalism and service. Along with the student officers, faculty councilors organize chapter functions, projects, meetings, and most importantly the annual selection of nominees for election to membership in AOA.