Bidmc department of medicine annual report 2012 low res

D e pa r t m e n t o f M e d i c i n e 2 0 1 2 A n n ua l R e p ort

I NNO V A T I ON Past

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Present

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Future

The Department of Medicine wishes to thank the Division Chiefs, administrators, partners and affiliates who contributed to this report. We also thank Jane Hayward and Bruce Wahl in BIDMC Media Services, Gigi Korzenowski and Katie Pendlay of Korzenowski Design, and Jennie Greene and Buck Strewler in the Department of Medicine. Ray Dolin composed an eloquent

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Department of Medicine 2012 Annual Report

eulogy for Norm Letvin, which we greatly appreciate. We thank Pam Lesser for sharing her personal story with us and Margaret Pantridge of the CardioVascular Institute for documenting it for this report. Michael Keating of the BIDMC Communications Department kindly allowed us to adapt his Fall 2012 BIDMC Quarterly article on hospital readmissions; and, with the help

of Susan Pasternack, he also provided the archival images for this report, courtesy of The Ruth and David Freiman Archives at BIDMC. The majority of contemporary photos in this report were taken by Bruce Wahl, with additional photography by Shelly Harrison and Marilyn Humphries.

Contents 2

From the Chair

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Departmental Organization

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A History of Innovation

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Remembering Norman Letvin

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Evolving and Innovating, Primary Care Takes Center Stage

10 Quality Improvement: Building Careers that Save Lives 14 Unveiling the Basis of Cancer One Gene at a Time 16 Pamela Lesser’s Story: The Right Care at the Right Time in the Right Place 18 Teaching Better, Learning More: Innovations in Education 20 Teaching Honors and Awards 20 Medicine Housestaff 21 Clinical Fellows in Medicine 22 The Readmission Challenge: Helping Patients Stay Healthy and Out of the Hospital 24 Medicine Without Borders: Residents, Faculty and Global Citizens 28 From Bench to Bedside: Basic Science in Pursuit of Cutting-Edge Therapies 32 Enhancing Patient Health and Satisfaction through Effective Communication 34 Selected Publications 38 Building Bridges and Promoting Health through Innovative Community Partnerships 42 Honors and Awards 45 By the Numbers

Department of Medicine 2012 Annual Report

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From the Chair Dear Colleagues and Friends, In a time of tumultuous change in the health care environment, the Department of Medicine continues to perform its patient care, teaching and research missions in an exemplary manner. Continued success requires constant innovation and the relentless pursuit of improvement. This year, rather than create a report that summarizes the work of each of our divisions, we have chosen to highlight areas of innovation, starting with a timeline of key dates in the department’s rich history and continuing with features on exciting new innovations and explorations. The report closes with a statistical overview that serves as a dashboard of the department’s continued success.

In patient care we continue to expand our practices by supporting the medical center in building a strong network of care. With support from the hospital, Harvard Medical School and a generous gift from the Linde Family Foundation, we are redesigning primary care from the ground up in Healthcare Associates (the first academic primary care practice in the country). The new approach will offer comprehensive care of the highest quality to our patients while supporting our clinicians with reliable and effective systems to manage all aspects of patient health. We are also expanding OpenNotes — a program that gives patients access to notes written by their clinicians — throughout our practices to further involve and engage patients in their care. In the inpatient arena we are developing novel approaches to prevent readmissions as well as enhanced systems of care.

In education we have redesigned the primary care program, developed novel simulations for family meetings, started a new rheumatology fellowship and developed multiple sites overseas for training our residents in global health. We have also, over the past few years, created a career development incubator for physicians who devote their academic and research efforts to improving the quality of care at the medical center and beyond.

In a time of shrinking NIH support, we continue to perform important, groundbreaking research in a range of areas, including HIV vaccine development, cancer signaling, metabolism in diabetes, and basic and outcomes research in cardiovascular diseases.

I am privileged to be able to serve a superb faculty, inspiring trainees and a wonderful patient care, teaching and research institution. I hope that you find this report informative as well as entertaining and that it gives you a sense of the excitement generated by this terrific department every day.

Mark L. Zeidel, MD Chair, Department of Medicine 2

Department of Medicine 2012 Annual Report

Departmental Organization Administration Mark Zeidel, MD Chair, Department of Medicine Mark Aronson, MD Vice-Chair, Quality Barbara Kahn, MD Vice-Chair, Research Strategy Gordon Strewler, MD Vice-Chair, Education Peter Weller, MD Vice-Chair, Research Joanne Casella Chief Administrative Director Marian McDermott Financial Administrator

Clinical Divisions Allergy and Inflammation Peter Weller, MD, Division Chief Courtney Ives, Division Administrator Cardiovascular Medicine Mark Josephson, MD, Division Chief Lynn Dockser Cornell, Division Administrator Endocrinology, Diabetes and Metabolism Anthony Hollenberg, MD, Division Chief Nicholas Lord, Division Administrator Gastroenterology Simon Robson, MB, ChB, PhD, Division Chief Eileen Joyce, Division Administrator

General Medicine and Primary Care Russell Phillips, MD, Division Chief Mark Aronson, MD, Acting Division Chief Louise Mackisack, Division Administrator Gerontology Lewis Lipsitz, MD, Division Chief Karen Turnquist, Division Administrator Hematology-Oncology Lowell Schnipper, MD, Division Chief Simona Arcidiaco, Division Administrator Infectious Diseases Peter Weller, MD, Division Chief Ruth Colman, Division Administrator Nephrology Martin Pollak, MD, Division Chief Courtney Ives, Division Administrator

Genetics Pier Paolo Pandolfi, MD, PhD, Division Chief Hemostasis and Thrombosis Barbara Furie, PhD, and Bruce Furie, MD, Division Co-Chiefs Immunology Cox Terhorst, PhD, Division Chief IMBIO Vikas Sukhatme, MD, PhD, Division Chief Ary Goldberger, MD, Division Co-Chief Molecular and Vascular Medicine William Aird, MD, Division Chief J. Peter Oettgen, MD, Associate Chief Signal Transduction Lewis Cantley, PhD, Division Chief

Pulmonary, Critical Care and Sleep Medicine J. Woodrow Weiss, MD, Division Chief Courtney Ives, Division Administrator

Translational Research Steven Freedman, MD, PhD, Division Chief

Rheumatology George Tsokos, MD, Division Chief Patricia Harris, Division Administrator

Transplant Immunology Terry Strom, MD, and Laurence Turka, MD, Division Co-Chiefs

Research Divisions

Vaccine Research Dan Barouch, MD, PhD, Division Chief

Clinical Informatics Charles Safran, MD, Division Chief

Viral Pathogenesis Norman Letvin, MD, Division Chief

Clinical Nutrition Bruce Bistrian, MD, PhD, MPH, Division Chief Experimental Medicine Jerome Groopman, MD, Division Chief Department of Medicine 2012 Annual Report

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1922 – Insulin is administered for the first time in New England by Howard Root and Elliott Joslin (shown here) at the Deaconess. Joslin went on to develop one of the first comprehensive approaches to chronic disease management and preventive care for a disease, the Joslin diabetes care model.

1920s 1940s

1800s

1896 – The New England Deaconess Hospital is founded

by Methodist congregants and deaconesses of the church to provide care to the underserved.

1940 – Abraham Stone Freedberg, Chief of Cardiology at Beth Israel, describes the potential role of bacteria in peptic ulcer disease. These bacteria are rediscovered in the 1980s to be H. pylori, leading to improved ulcer care and the Nobel Prize in Medicine for the rediscoverers.

A H I STO R Y O F

I NNO V A T I ON

1890 — 1969

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1900s

1916 – Beth Israel Hospital opens as a community hospital to address the exclusion of Jewish professionals from other area hospitals and to provide care to Jewish patients.

1941 – Herrman Blumgart studies myocardial infarction in dogs induced by ligating coronary arteries and then releasing the blockage. He demonstrates that cardiac muscle can recover from ischemia and his work provides the research underpinnings for the use of angioplasty in acute myocardial ischemia and infarction.

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1930s

1933 – Herrman Blumgart introduces thyroid ablation by thyroidectomy for treatment of angina and congestive heart failure. ▲

1950s

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1954 – Paul Zoll, of Beth Israel, discovers that external electrical stimulation during cardiac arrest could produce an effective heartbeat, which led to the development of the defibrillator and the implanted cardiac pacemaker.

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Department of Medicine 2012 Annual Report

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2002 – BIDMC becomes one of the only clinical trials sites in Boston to test a new therapeutic AIDS vaccine on healthy adults.

1972 – Beth Israel Ambulatory Care, one of the first primary care teaching practices at an academic health center, opens as the forerunner to the present day Healthcare Associates.

2003 – Researchers at BIDMC identify the source of preeclampsia, a complication of pregnancy and one of the leading causes of maternal and infant mortality worldwide.

1970s

2003 – BIDMC implements the Multiple Urgent Sepsis Therapy (MUST) protocol to reduce sepsis-related mortality. The medical center goes on to become a national and international leader in sepsis treatment.

1976 – One of the first academic gerontology programs in the US is established at Beth Israel.

1990s

1996 – Beth Israel and the Deaconess hospitals merge to form Beth Israel Deaconess Medical Center (BIDMC).

2000s

1972 – The first Rights of Patients statement in the nation is implemented at Beth Israel.

1970 — 1999

2000 — Present

65%

2000s

1998 – The first adult live-donor liver transplant in New England is performed at BIDMC.

Unexpected Mortality

1990s

1996 – BIDMC researchers identify a new enzyme, Pin1, which leads to the discovery of new signal transduction mechanisms during cell growth control, tumor formation and onset of Alzheimer’s disease, along with potential diagnostic and therapeutic approaches to cancer and Alzheimer’s.

2005 – A BIDMC team launches the Triggers Program, a novel model for rapid response to reduce unexpected mortality among hospitalized patients.

1999 – Cancer researchers find that the tumor suppressor PTEN prevents tumors by restraining the PI3 kinase pathway, an important controller of cell growth which was previously identified by the same group.

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1983 – The first successful liver transplant in New England is performed at Deaconess Hospital.

2009 – The OpenNotes program is launched at BIDMC, generating research and innovation in patient-provider communication.

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1980s

1981 – A clinical informatics team at Beth Israel launches PaperChase, the first user-friendly search engine for biomedical literature, a precursor of PubMed. The team also develops an electronic medical record, which becomes an important template for electronic records used worldwide.

2010 – BIDMC researchers identify APO-L1 as a likely cause of increased risk of focal sclerosing glomerulonephritis and and chronic renal failure among young people of West African descent.

1989 – A Beth Israel team creates ClinQuery, enabling health care workers to search for patients in a clinical database without requiring them to write computer code.

Department of Medicine 2012 Annual Report

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Remembering Norman L. Letvin (1949-2012)

By Raphael Dolin, MD

N

orm Letvin, MD, Professor of Medicine and Chief of the Division of Viral Pathogenesis in the Department of Medicine, passed away on May 28, 2012, after a courageous struggle against pancreatic cancer for nearly five years. He bore this heavy burden with grace and determination and was at the peak of an extraordinary career, which he maintained up to the very last few days of his life.

Norman Letvin, MD Professor of Medicine and Chief of the Division of Viral Pathogenesis Department of Medicine

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Department of Medicine 2012 Annual Report

Norm was a world leader in research to develop a vaccine against HIV/AIDS. After graduating from Harvard College summa cum laude in 1971, Harvard Medical School in 1975 and training in internal medicine, he began his work in immunology in the laboratory of Nobel Laureate Baruj Benacerraf in 1978. From 1982 to 1994, he was the founding Chair of the Division of Immunology at the New England Primate Research Center. There he made one of the seminal discoveries in the field of AIDS pathogenesis; namely, Simian Immunodeficiency Virus (SIV) and the AIDS-like disease that it causes in rhesus macaques. Using this as an experimental model, Norm made major contributions to our understanding of the role of cellular immunology in SIV/HIV infection, and to the design of candidate vaccines against this infection.

DISCOVERIES IN AIDS PATHOGENESIS Letvin made one of the seminal discoveries in the AIDS field, identifying the Simian Immunodeficiency Virus (SIV). SIV causes an AIDS-like illness in

In 1994, Norm came to the Department of Medicine at Beth Israel Hospital as Chief of the Division of Viral Pathogenesis. Over the years, Norm stated that he considered taking this position to be one of the very best decisions that he ever made. He built the division into a center of enormous research strength and international prominence in HIV research. He led major collaborative research initiatives supported by the NIH and by the Bill and Melinda

Medical School in 2009, as recognition for his contributions as an outstanding mentor. Characteristically for him, he was determined not to let his illness interfere with the mentoring to which he was so devoted.

There was an additional hallmark to Norm’s activities in his division. He was totally devoted to teaching and mentoring undergraduates, graduate students, postdoctoral fellows and junior faculty. It was something that he enjoyed immensely and at which he excelled. He received the William Silen Lifetime Achievement in Mentoring Award from Harvard

Ricka, Rebecca, Adam and Elizabeth. The field of AIDS research will miss Norm as a leader, and those who knew him miss him as a friend and colleague.

Any discussion of Norm’s achievements must include his talent and accomplishments as a musician.

He was a world-class clarinetist who

“He was a world-class clarinetist who gave concerts with the Boston Symphony Orchestra and chamber music groups both locally and nationally.”

Gates Foundation. He was a member of virtually every major HIV research advisory committee throughout the world.

monkeys. Its discovery shed light on the immunology of the infection and provides a model for vaccine development.

gave concerts with the Boston Symphony Orchestra and chamber music groups both locally and nationally. He was invited to give concerts at scientific conferences at which he spoke, and these were memorable occasions for attendees.

Norm was a most devoted family man.

The love and companionship of his family was an enormous source of joy and pride to him. He is survived by his wife, Marion Stein Letvin, who is a neurologist at BIDMC, and his four children, Andrea

Dan Barouch, MD, PhD, has been named Director of the Center for Virology and Vaccine Research in the Department of Medicine. This newly created center represents the merger of the former Division of Viral Pathogenesis and Division of Vaccine Research. Barouch, a Professor of Medicine at Harvard Medical School, has led the Division of Vaccine Research since 2009. He has also recently served as Interim Chief of the Division of Viral Pathogenesis, assuming the role previously held

by HIV vaccine pioneer Norman Letvin, MD, who passed away in May. “In creating this combined center, Dr. Barouch will help enhance the synergies of these two critically important programs, with the goal of continuing BIDMC’s pioneering work in developing preventive strategies and treatments for HIV,” says Medicine Chair Mark Zeidel, MD.

Department of Medicine 2012 Annual Report

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Evolving and Innovating,

Primary Care Takes Center Stage

Healthcare Associates’ Francine Theberge, RN, with a patient.

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Department of Medicine 2012 Annual Report

Two patients with their care teams at Bowdoin Street Health Center. Left: Gai Nguyen with Manuela Silva, RN, Barbara Mendes, MD, and Sylma Prevost. Right: Luis Amado with Deborah Tatum, LPN, Kathleen King, RN, Jean Alves, MD, and Manuela Spinola.

Linde Family Foundation Award A $10 million gift from the Linde Family Foundation will support Healthcare Associates’ transformation to a “patient-centered

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n Massachusetts and throughout the country, health care reform is dramatically changing the medical landscape. At the forefront of this transformation is primary care — a field often overshadowed by flashier medical specialties. Indeed, BIDMC’s Division of General Medicine and Primary Care is increasingly in the spotlight. Its primary care practice, Healthcare Associates (HCA), is poised to become a “patientcentered medical home” (PCMH) for its 41,000 patients. The PCMH model joins clinicians and support staff — physicians, nurses, nutritionists, pharmacists, technicians, social workers, residents, fellows and others — to form interdisciplinary teams built around the needs of individual patients. This team approach focuses on enhancing access and the patient experience, improving population management of preventive services and chronic diseases, and engaging and empowering patients.

In its transformation to a PCMH, HCA is building from a position of strength that goes back to 1971, when doctors at Beth Israel Hospital launched a groundbreaking multidisciplinary approach to primary care that became HCA. Today, HCA places in the top 7% of practices statewide, according to Massachusetts Health Quality Partners’ patient experience data reported in the July 2012 issue of Consumer Reports.

The transformation of HCA will be bolstered by an extraordinarily

generous gift of $10 million from the Linde Family Foundation, which will enable the medical center to establish the Linde Family Institute for Primary Care at BIDMC and make substantive investments in primary care delivery, innovation and leadership training for residents and physicians. HCA’s transformation is also supported by hospital funds to match a generous grant from the new the new Harvard Medical School Center for Primary Care, now headed by Russell Phillips, MD, who stepped down this year as Chief of the Division of General Medicine and Primary Care. Mark Aronson, MD, the Interim Division Chief, is leading the HCA redesign together with Section Chief James Heffernan, MD, MPH, and Medical Director Kim Ariyabuddhiphongs, MD. In addition to HCA, the division includes sections in Hospital Medicine, Research and Palliative Care, headed by Joseph Li, MD, Edward Marcantonio, MD, SM, and Lachlan Forrow, MD, respectively.

The HCA redesign team will benefit from the leadership and experience of Bowdoin Street Health Center (BSHC).

A community health center licensed under Beth Israel Deaconess Medical Center, BSHC has been designated a Level III PCMH by the National Committee for Quality Assurance. “This is the highest recognition possible and the result of a four year transformation of our practice,” says Adela Margules, the Executive Director of BSHC. “We

medical home” and enable BIDMC to establish the Linde Family Institute for Primary Care.

are now a team-based, patient-centered, integrated and coordinated delivery system of the highest quality care for our adult and pediatric populations.”

BSHC is one of a few health centers in Massachusetts to reach Level III designation, a process that required it to meet nine rigorous standards of care.

Primary care training also evolved in new and exciting ways this year. Under the leadership of Howard Libman, MD, the Primary Care Track — part of the Internal Medicine Residency Program — has been redesigned and this year, for the first time, a separate match number has been established. Building on an existing primary care track that began in 1973 and has graduated more than 300 residents, the newly designed program offers several benefits. Primary Care Track residents have additional ambulatory time during their internship and will spend six consecutive months in ambulatory care in their PGY2 and PGY3 years, with opportunities for many electives and for practice at our affiliated community centers or our primary global health site in Botswana. Primary Care Track residents have additional curriculum focused on leadership skills, interviewing and communication techniques, and office procedure training. Furthermore, residents will be engaged and involved in the redesign of HCA during a particularly exciting and dynamic time in primary care at BIDMC.

Department of Medicine 2012 Annual Report

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Quality Improvement:

Building Careers That Save Lives

“ If any improvement in care, developed anywhere, can benefit our patients, it is a moral imperative that we adopt it as quickly, effectively and reliably as possible.”

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– Mark Zeidel, MD, Chair of Medicine

Department of Medicine 2012 Annual Report

Anjala Tess, MD, consulting with a colleague.

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s part of its commitment to fostering a culture of quality improvement (QI) at BIDMC, the Department of Medicine is dedicated to training and mentoring residents, fellows and faculty in QI work. The department is proud of the many talented young men and women who have been inspired to improve patient care by challenging the status quo, asking thoughtful questions, conducting rigorous research and implementing evidence-based solutions. Here are just a few examples of members of the department (all alumni of our residency program) who are building exciting careers and leading the way in the field of quality improvement.

Anjala V. Tess, MD, is a hospitalist in the Division of General Medicine and Primary Care, Associate Program Director for Curriculum and Patient Safety, Director of Patient Safety and Quality Education for GME and Codirector of the Quality and Safety Educators Academy. Tess has designed and implemented a novel curriculum to teach QI to residents in the Department of Medicine. The program, which includes a QI rotation and a retreat, has won national acclaim. Engaging residents in QI work creates a culture of quality at the medical center and prepares them for careers in QI, both of which serve to improve patient care at BIDMC and across the industry. novel curriculum Every year 48 medical residents complete a curriculum on the fundamentals of quality improvement and participate in hospital-wide QI activities.

Michael D. Howell, MD, MPH, Director of Critical Care Quality at BIDMC, is leading multiple efforts to improve care in Medicine and other ICUs. He oversees the Triggers program, a novel model of a rapid response. Unlike the usual rapid response approach, this program relies on the existing care team rather than adding additional clinical staff, and organizes the team’s response to diagnostic factors such as heart rate, blood pressure, respiratory rate and oxygen saturation. A trigger can also be called directly by concerned nurses, patients or family members.

Howell has also been instrumental in reducing ventilator-associated pneumonia (VAP), a potentially fatal infection. By implementing interventions to prevent VAP, BIDMC has been able to reduce morbidity, mortality and length of stay related to VAP cases and simultaneously increase ICU throughput without

Michael Howell, MD, MPH increasing bed capacity. Howell is also the Executive Director of the new BIDMC Center for Healthcare Delivery Science, aimed at improving the quality, safety and value of health care at the medical center. This year the Center awarded three grants for proposals to improve operating room scheduling, methods for moderate sedation and care for patients with chronic kidney disease.

TRIGGERS PROGRAM Howell oversees the Triggers program, which resulted in a 65% reduction in the odds of unexpected mortality among patients admitted to the hospital between 2004 and 2008.

Department of Medicine 2012 Annual Report

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Kenneth Sands, MD, MPH

Kenneth Sands, MD, MPH, Senior Vice President of Health Care Quality at BIDMC, introduced the concept of “preventable harm” into the medical lexicon and the culture of health care.

“Since there was nothing in the literature that defined preventability, we had to come up with our own definition,” explains Sands. The definition is twopart: when an event occurs (e.g., a patient falls) the hospital first determines if all of its existing protocols were followed; and second, if protocols were followed, the hospital determines if any reasonable change in the hospital’s protocol could have prevented the injury. Under Sands’s leadership, BIDMC is the first hospital in the US to define and implement the goal of reducing preventable harm, and the results have been dramatic. “preventable harm” While still working toward the ultimate goal of zero preventable events, under Sands’s leadership BIDMC has reduced preventable incidents from 169 in 2008 to 92 in 2011.

Melissa Mattison, MD, a hospitalist in the Division of General Medicine and Primary Care and a member of the Gerontology Division, developed the GRACE initiative (Global Risk Assessment and Careplan for Elders), a program designed to improve the care for older adults admitted to the hospital. Through a bedside checklist, customized computer software, and provider education and process improvement, the program standardizes care for all older adults admitted to the hospital. The goal of the program is to reduce functional and cognitive decline that can occur during hospitalization.

Mattison has also been instrumental in launching ECHO-AGE, a paradigmshifting videoconferencing program that brings geriatric expertise to providers and patients in skilled nursing facilities throughout New England. See p. 38 for more on ECHO-AGE.

As residents, Bradley Crotty, MD, and Arash Mostaghimi, MD, MPA, recognized that BIDMC housestaff routinely spent significant amounts of time trying to locate up-to-date information to manage their workflow.

In response, they created a user-editable wiki, which is now in its third generation of housestaff managers. With easy access to important phone numbers, schedules and other current information, housestaff report that the wiki has improved their experience (90%), efficiency (89%) and education (57%), respectively. Crotty and Mostaghimi also spearheaded the adoption of PatientSite, BIDMC’s patient portal, by residents in ambulatory

GRACE Initiative Since its launch in 2010, GRACE has resulted in significant improvements in appropriate medication ordering, reducing by 50% the chance an older patient will receive an inappropriate dose of morphine, and decreasing by 40% the chance of receiving an inappropriate dose of haloperidol. GRACE has also increased the percentage of patients discharged to home as opposed to a skilled nursing facility.

Melissa Mattison, MD 12

Department of Medicine 2012 Annual Report

practice. They were responding to a growing demand among patients interested in emailing their doctors directly, as well as to the inefficiencies of a system that places several intermediaries between patients and residents. Although many were skeptical about how this would impact their practice, a survey of residents who have begun using PatientSite suggests that the portal enhances communication between residents and patients and may improve patient care. user-editable wiki Crotty and Mostaghimi created a user-editable wiki that received over 40,500 visits in 2011.

The Department of Medicine is fortunate to have several other exceptional leaders in quality improvement on its faculty, including Mark Aronson, MD, who leads the Department’s QI work as Vice-Chair for Quality Improvement, and Julius Yang, MD, PhD, whose nationallyrecognized work on hospital readmissions is featured on p. 22.

Arash Mostaghimi, MD, MPA, and Bradley Crotty, MD

Selected Publications Crotty BH, Mostaghimi A, Reynolds EE. Adoption of a wiki within a large internal medicine residency program: a 3-year experience. J Am Med Inform Assoc 2012; 19:621-5.

Howell MD, Ngo L, Folcarelli P, Yang J, Mottley L, Marcantonio ER, Sands KE, Moorman D, Aronson MD. Sustained effectiveness of a primary-team-based rapid response system. Crit Care Med 2012; 40:2562-8.

Hunziker S, McHugh W, Sarnoff-Lee B, Cannistraro S, Ngo L, Marcantonio E, Howell MD. Predictors and correlates of dissatisfaction with intensive care.

Crit Care Med 2012; 40:1554-61.

Kim HS, Kriegel G, Aronson MD. Improving the preventive care of asplenic patients. Am J Med 2012; 125:454-6.

Neeman N, Sehgal NL, Davis RB, Aronson MD. Quality improvement and patient safety activities in academic departments of medicine. Am J Med 2012; 125:831-5.

O’Neill S, Calderon S, Casella J, Wood E, CarvelliSheehan J, Zeidel ML. Improving outpatient access and patient experiences in academic ambulatory care.

Acad Med 2012; 87:194-9.

Kheraj R, Tewani SK, Ketwaroo G, Leffler DA. Quality improvement in gastroenterology clinical practice.

Clin Gastroenterol Hepatol 2012; 10:1305-14.

Department of Medicine 2012 Annual Report

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Unveiling the Basis of Cancer One Gene at a Time

T

he Division of Genetics is a global team drawn from a dozen countries, all working under the guidance of the Division Chief, Pier Paolo Pandolfi, MD, PhD, who also serves as Scientific Director of the Cancer Center at BIDMC. The division aims to understand the genetic basis of cancer and cancer-associated conditions. Pandolfi is a world-renowned cancer geneticist and expert in the development of genetically engineered mouse models (GEMMs) that faithfully recapitulate features associated with the initiation and progression of human cancer. These GEMMs not only help us better understand the biology of cancer but are also accurate predictors of which treatments will most benefit cancer patients with particular types of genetic lesions. Finally, they are critical to the development of effective new treatments for those patients for whom current therapies are inadequate.

Pier Paolo Pandolfi, MD, PhD, reviews experimental data with John Clohessy, PhD.

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Department of Medicine 2012 Annual Report

The Preclinical Murine Pharmacogenetics Core Facility, which was established as part of the Division of Genetics in 2010, is a vibrant core facility for GEMMs. John Clohessy, PhD, recently assumed the directorship of the “Mouse Hospital,” as it is widely known. Since its inception, the Core Facility has pioneered “co-clinical” trials, which aim to utilize mouse models of human cancer to test novel therapeutics in parallel with ongoing human clinical trials. Such studies can greatly facilitate patient stratification and accelerate the drug

CODING-INDEPENDENT REGULATION OF PTEN Our DNA encompasses not only genes but many pseudogenes that do not encode an active protein, as well as small noncoding

approval process, enabling a more rapid transition from bench to bedside for novel therapeutics. Indeed, the Core Facility has been instrumental in the lab’s recent work on reducing resistance to therapy for prostate cancer patients. The principles behind this approach have been published in Cancer Discovery, and several coclinical studies have been completed this year and will soon be reported.

In addition to the co-clinical work being carried out within the division, the Pandolfi laboratory has also developed a powerful new focus on the cellular role of RNA and the role of the ribosome in cancer. Increasing evidence points to an important role for ribosomes in regulating critical biological processes; and it is becoming apparent that the deregulation of the ribosome is implicated in

RNAs (microRNAs) that regulate gene expression. The team proposed that RNAs from different protein-coding genes, pseudogenes

disease initiation and progression and could also serve as a potential target for therapeutic intervention.

Until recently the lack of high throughput ribosomal analysis has limited characterization of the ribosomal proteome. Pandolfi’s laboratory, however, has developed a SILAC-based mass spectrometry approach to probing these microscopic structures. Applying this novel high-throughput approach to the analysis of proteins associated with actively translating polysomes has enabled the team to compile a comprehensive survey of the prostate riboproteome — the first of its kind. This survey has already revealed a number of exciting and surprising findings, with important therapeutic implications.

and non-coding RNAs regulate each other through competition for microRNA binding. The concept was validated using the gene for PTEN,

a key tumor suppressor.

This study presents the first roadmap for the prediction and validation of RNA networks.

Moreover, this new analytic platform can be readily applied to other biological systems, and so will enable important insights into the make-up and regulation of the riboproteome for years to come. These techniques will also be fundamental to establishing the key factors related to the regulation of protein translation and enable scientists to highlight the functional roles of possible disease genes associated with the riboproteome.

Selected Publications Garcia-Cao I, Song MS, Hobbs RM, Laurent G, Giorgi C, de Boer VCJ, Anastasiou D, Ito K, Sasaki A, Rameh L, Carracedo A, Vander Heiden MG, Cantley LC, Pinton P, Haigis MC, Pandolfi PP. Systemic elevation of PTEN induces a tumor-suppressive metabolic state. Cell 2012; 149:49-62.

Ito K, Carracedo A, Weiss D, Arai, Ala U, Avigan DE, Schafer ZT, Evans RM, Suda T, Lee CH, Pandolfi PP. A PML-PPARä pathway for fatty acid oxidation regulates haematopoietic stem cell maintenance. Nature Medicine 2012; 18:1350-8.

Karreth, FA, Tay Y, Perna D, Ala U, Rust AG, Webster KA, Weiss D, Perez-Mancera PA, Krauthammer M, Halaban R, Provero P, Adams DJ, Tuveson DA, Pandolfi PP. In vivo identification of tumor suppressive PTEN ceRNAs in an oncogenic BRAF-induced mouse model of melanoma.

Cell 2011; 147: 382-95. Erratum: 147: 948.

Nardella C, Lunardi A, Patnaik A, Cantley LC, Pandolfi PP. The APL paradigm and the “co-clinical trial” project.

Cancer Discov 2011; 1:108-16.

Tay Y, Kats L, Salmena L, Weiss D, Tan SM, Ala U, Karreth F, Poliseno L, Provero P, Di Cunto F, Lieberman J, Rigoutsos I, Pandolfi PP. Coding-independent regulation of the tumor suppressor PTEN by competing endogenous mRNAs. Cell 2011; 147:344-57.

Pandolfi with members of his team.

Department of Medicine 2012 Annual Report

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Pamela Lesser’s Story:

The Right Care at the Right Time in the Right Place

“I’m grateful for the expertise of Dr. Josephson and the cardiology staff at BIDMC. I credit them with saving my life.”

Lesser with her husband and children.

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Department of Medicine 2012 Annual Report

Mark Josephson, MD, Chief of the Division of Cardiovascular Medicine and Lesser’s cardiologist.

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amela Lesser, a 47-year-old mother of three living near Boston, was slender, energetic and in good health. She frequently enjoyed power yoga classes and long-distance bike rides. Then one day, while doing a handstand during a fitness class, Lesser felt “something happen” inside her chest. Struggling to catch her breath, she left the class and drove home to rest, to no avail. “At first, I felt like I had a collapsed lung. My heart was pounding with rapid heartbeats that rocked my body and would not slow down,” remembered Lesser. Light-headed, she drove to her doctor’s office, where her heart beat was clocked at 230 beats a minute, far over the average of 60-80 beats per minute.

Lesser’s physician called 911, and during the ambulance trip, paramedics tried to slow her heartbeat. After IVs did little to help, they tried defibrillation, which finally jolted her heart into a slower rhythm. At the local emergency room, doctors recognized the seriousness of her condition. She was transferred to BIDMC’s CardioVascular Institute (CVI) where Mark E. Josephson, MD, Chief of the Division of Cardiovascular Medicine and internationally known cardiac electrophysiologist, diagnosed ventricular tachycardia (VT). A potentially lethal condition that originates in the lower chambers of the heart, VT is characterized by an abnormally fast heart rate. While

VT is sometimes asymptomatic, common symptoms include discomfort in the chest, fainting or loss of consciousness, pale skin, light-headedness or dizziness, a sensation of feeling heart beats and shortness of breath.

Josephson considered various treatment options for Lesser. Medications can sometimes be useful but can also have significant side effects and, in some cases, even cause an arrhythmia. Procedural options to treat VT include ablation of the arrhythmia circuit responsible for the VT, which can be curative and prevent the need for life-long drug therapy. And surgical therapies, used quite rarely, include resection (removal) of the scar responsible for the VT and/or modification of the nervous system that sends signals to the heart.

Josephson chose catheter ablation for Lesser. A non-surgical procedure, catheter ablation involves insertion of one or more catheters (long, thin tubes) through the groin and arteries and into the heart. Then an arrhythmia is induced, sometimes by administering an adrenaline injection, and when the areas that trigger it are identified, a high-frequency, lowvoltage current is delivered to burn or cauterize the area, preventing recurrence of an abnormal heart rhythm. While some patients only require one catheter

ablation procedure, VT has a high rate of recurrence and sometimes a repeat procedure is needed.

In Lesser’s case, Josephson has performed two ablations about a year apart. “Pam Lesser presented an unusual case,” explained Josephson. “Although she had an apparently normal heart, she had five different VT areas in the right ventricle, which were ablated in the first session. A year later, she experienced a new VT that was mapped to the left coronary cusp in the aorta, which was successfully ablated.

Since then, she has been prescribed a beta blocker to help prevent future episodes of VT and has been fine.”

Lesser considers the procedures successful.

“I did learn that heart troubles can happen to anyone,” she said. “The lesson here is to pay attention to your body and, when you know something’s off, address it and attend to it right away.

When a condition like this occurs, a delay can cost you your life.”

Since her last ablation in 2010, Lesser has been back to living a normal, active life, which still includes a healthy dose of exercise. She has made a few adjustments — avoiding running and other activities that make her short of breath and using caution on very hot days. “I feel really good and I’m very active,” said Lesser. “I’m grateful for the expertise of Dr. Josephson and the cardiology staff at BIDMC. I credit them with saving my life.”

Department of Medicine 2012 Annual Report

17

Teaching Better, Learning More: Innovations in Education

T

here’s a new spirit in the air. At Beth Israel Deaconess and across the Harvard hospitals, student-faculty collaboratives are designing new courses and clinical initiatives. The BIDMCCrimson Care Collaborative practice opened in January 2012, after a needs assessment and planning that began in 2010. It is part of a network of five student-faculty practices across Harvard — now the most popular extracurricular activity at HMS — but is unique in focusing on chronic disease management.

Working closely with BIDMC faculty, HMS students act primarily as clinic managers and patient educators in chronic management of hypertension, diabetes, COPD and (coming soon) obesity. Given the program’s success, tapping the talents of medical students as innovators and educators is here to stay.

Residents are building programs as well.

The new Primary Care Track, headed by Howard Libman, MD, and now recruiting its first class of residents, was planned with leadership by residents and chief residents. (See the feature on primary care on p. 8 for details.) The Stoneman Program in Quality Improvement (QI) places residents squarely in the middle of QI activities in the department and the hospital. One recent example: residents completed a Plan-Do-Study-Act (PDSA)

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Department of Medicine 2012 Annual Report

Members of the BIDMC Crimson Care Collaborative team.

Front row: Susan McGirr, Amy O’Brien, Connor Johnson. Back row: Kara Johnson, Michael Simoni, Amy Weinstein, MD, Kristin Remus, DO, Daniel Killeen, Nida Nashaud, Arshed Al-Obeidi.

cycle in Healthcare Associates. The problem they identified was that patients had a low rate of scheduling follow-up appointments for specialty care — in contrast to primary care appointments, which were scheduled by staff. The resident team developed a new checkout sheet and introduced a new checkout desk where help with specialty appointment scheduling was provided. Problem solved.

The outcome was heartening, as was the development of a process by which several groups of residents collaborated to lead the full PDSA cycle over the course of a year, managing all the handoffs that were required.

One of the hardest forms of communication for residents is the family meeting in the ICU. The patient is acutely ill, the family is distraught and challenging issues including end-of-life planning are on the table. Responding to input that residents were not comfortable running family meetings in the “see one, do one, teach one” approach, the Division of Pulmonary, Critical Care and Sleep

Medicine has initiated a new teaching program on the family meeting. Residents are learning the communication skills that they need through a combination of didactics, a simple checklist and simulated family meetings. A unique feature of the program is that the family members in the simulations are, in fact, real family members of ICU patients who have volunteered their time.

There’s a new fellowship program as well.

In 2011, the Division of Rheumatology has started an ACGME-accredited rheumatology fellowship after many years of joint participation in a combined training program with Brigham and Women’s Hospital. Funded in part by a training grant, the fellowship offers comprehensive clinical training in rheumatic diseases as well as outstanding research opportunities.

The flagship continuing medical education (CME) course for the department is Update in Internal Medicine, held each December. Attended by more than 500

Attending physician Michael Curry, MD, with intern Liana Schweiger, MD, and resident Shanthini Kasturi, MD.

individuals from 46 US states and 30 countries, the course newly includes a blank page after each talk in the syllabus entitled “Commitment to Improve.”

If an attendee feels that the talk is relevant to her work, she is asked to jot down two or three things that she plans to incorporate into her clinical practice as a result of having heard the talk.

According to research recently published

by CME Co-Director Sanjiv Chopra, MD, and colleagues, integrating the “Commitment to Improve” page is an effective method of reinforcing learning and measuring outcomes.

Harvard medical students Hailu Tilahun and Aswin Sekar with Crimson Care Collaborative faculty Kristin Remus, DO, and patient Marrian MacDonald.

Selected Publications Faculty Domino FJ, Chopra S, Seligman M, Sullivan K, Quirk ME. The impact on medical practice of commitments to change following CME lectures: a randomized control trial. Med Teach 2011; 33:e495-500.

Huang G, Almeida J, Roberts D. Reaching the limits of mandated self-reporting: clinical logbooks do not predict clerkship performance. Med Teach 2012; 34:3185-e188.

Newman LR, Brodsky D, Roberts DH, Atkins KM, Pelletier SR, Vollmer CA, Johansson AB, Schwartzstein RM. Developing expert-derived rating standards for the peer assessment of lectures. Acad Med 2012; 87:356-63.

Roberts DH, Newman LR, Schwartzstein RM. Twelve tips for facilitating millennials’ learning.

Med Teach 2012; 34:274-8.

“Given the program’s success, tapping the talents of medical students as innovators and educators is here to stay.”

Resident Gonzalo J, Herzig S, Reynolds E, Yang J. Factors Associated with Non-Compliance During 16-Hour Long Call Shifts. J Gen Intern Med 2012; 27:1424-31.

Rostholder E, Ahmed A, Cheifetz AS, Moss AC. Outcomes after escalation of infliximab therapy in ambulatory patients with moderately active ulcerative colitis. Aliment Pharmacol Ther 2012; 35:562-7.

Tapper EB, Cohen EB, Patel K, Bacon B, Gordon S, Lawitz E, Nelson D, Nasser IA, Challies T, Afdhal N. Levels of alanine aminotransferase confound use of transient elastography to diagnose fibrosis in patients with chronic hepatitis C virus infection.

Clin Gastroenterol Hepatol 2012; 10:932-7.

Videlock EJ, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2012; 35:1355-69.

Yurgelun MB, Goel A, Hornick JL, Sen A, Turgeon DK, Ruffin Iv MT, Marcon NE, Baron JA, Bresalier RS, Syngal S, Brenner DE, Boland CR, Stoffel E. Microsatellite instability and DNA mismatch repair protein deficiency in Lynch syndrome colorectal polyps. Cancer Prev Res (Phila) 2012; 5:574-82.

Department of Medicine 2012 Annual Report

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Teaching Honors and Awards

John Mafi, MD – Earned the Resident as Teacher Award.

Resident Awards Ginger Allister, MD, Bevin Hearn, MD, and Jason Choi, MD – Won the Principal Clinical Experience (PCE) Outstanding Resident Teaching Award.

Adam Meyer, MD – Earned the Steven E. Weinberger Award for his contributions to the residency program and for exemplifying the collegial spirit of BIDMC through membership, advocacy and leadership.

Kristin Beaver, MD, and Ken Ralto, MD – Received the James Tullis Award, junior and intern recipient, respectively, in recognition of intellectual growth and enthusiasm for learning.

Amber Moore, MD – Received the Katherine Swan Ginsburg Resident Award, given to a senior resident who best embodies Katherine’s qualities of intelligence, courage, dignity and compassion.

Kristin Burke, MD – Earned the Housestaff Award from the Nursing Department.

Elliot Tapper, MD – Received the Medicine Quality Council Stoneman Award and the Resident as Teacher Award, which goes to the resident considered by medical students to be an outstanding teacher.

Joseph Feuerstein, MD – Earned the Fellow Teaching Award.

Elizabeth Housman, MD, and Daniel Ricotta, MD – Earned the Elmer Hinton Award, junior and intern recipient, respectively, in recognition of outstanding physician-patient relationships.

Frank Volpicelli, MD – Received the Harvard Medical School Class of 2012 Resident and Fellow Teaching Award as well as the Lowell McGee Award, which is given to the senior residents who contributed the most to educating his/her fellow houseofficers.

Faculty Awards Tony Breu, MD – Received the Hospital Medicine Teaching Award.

Susan Burgin, MD – Received the Teaching Award for Non-medical Specialties.

Mary Buss, MD, MPH, Jonathan Crocker, MD, Jeremy Richards, MD, MA, and Anita Vanka, MD – Named Rabkin Fellows in Medical Education for 2011-2012.

David Roberts, MD, Paul Bailey, MD, Samuel Edwards, MD, Jared Grochowsky, MD, Anasuya Gunturi, MD, and Richard Schwartzstein, MD. Paul Bailey, MD, Samuel Edwards, MD, Jared Grochowsky, MD, Anasuya Gunturi, MD, Joseph Ladapo, MD, Jonathan Lu, MD, and Manish Maski, MD – Received the Harvard Medical School Class of 2012 Resident and Fellow Teaching Award.

Alexander Carbo, MD – Named Best Clinical Instructor at BIDMC by the Harvard Medical School Class of 2012.

Jayson Carr, MD – Received the Department of Medicine Excellence in Ambulatory Student Teaching in Primary Care Award.

James Chang, MD – Received the Department of Medicine Excellence in Ambulatory Student Teaching in Subspecialty Medicine Award.

Richard Schwartzstein, MD, Grace Huang, MD, and David Roberts, MD. Peter Clardy, MD – Received the Katherine Swan Ginsburg Faculty Award for Humanism in Medicine.

Grace Huang, MD – Received the BIDMC Academy of Medical Educators Award.

Ciaran Kelly, MD – Earned the Mentorship of Resident Research Award.

Murray Mittleman, MD – Received a Mentoring Award from the Harvard School of Public Health.

Ellen McCarthy, PhD, MPH and Ken Mukamal, MD, MPH – Received the A. Clifford Barger Excellence in Mentoring Award.

Kenneth Mukamal, MD, MPH – Received the A. Clifford Barger Excellence in Mentoring Award.

Cassie Smith, RN – Earned the Nursing Excellence Award.

C. Christopher Smith, MD – Received the Herrman Blumgart Award.

Anjala Tess, MD – Earned the Robert C. Moellering Teaching Award.

Michael Thane, MD – Won the Preceptor of the Year Award.

Edward Weiss, MD – Received the Affiliated Physicians Group Excellence in Teaching Award.

Medicine Housestaff Interns Robin Allister, MD Bracken Babula, MD Philip Brondon, MD James Brush, MD Kristin Burke, MD Jonah Cohen, MD Ali Damavandy, MD Lucas Donovan, MD Margarita Ebril, MD

20

Marleys Fassett, MD, PhD Matthew Frank, MD, PhD Jason Freed, MD Karuna Ganesh, MA, MB, BCHIR, PhD Laurie Gashin, MD Robert Gaudet, MD Brian Gaudino, MD Rebecca Glassman, MD Mark Gromski, MD

Department of Medicine 2012 Annual Report

Douglas Grunwald, MD Brian Halbert, MD Andrew Hale, MD Glenn Hanna, MD Zhenghui Jiang, MD, PhD Jennifer Kleinman, MD Lisa Knopf, MD Isabel Lamour, MD Alison Lennox, MD Yi Li, MD

Kathryn Lowry, MD David Lucier, MD, MBA Kelly Ma, MD Shannon McGinty, MD Alexandra Migdal, MD Ari Moskowitz, MD Joo Yeon Nam, MD Asa Oxner, MD Patricia Peter, MD Mary Linton Peters, MD

Colin Phillips, MD Evan Piette, MD Jullia Pleet, MD Kenneth Ralto, MD Eveleen Randall, MD Sheela Reddy, MD Erin Reigh, MD Jennifer Reske-Nielsen, MD Christopher Richards, MD Daniel Ricotta, MD

Brent Rose, MD Philip Song, MD Roy Sriwattanakomen, MD David Suskin, MD Ara Tachjian, MD Xiao Tan, MD, PhD Alexis Tumolo, MD Nidhi Sukul MD Haider Warraich, MD Nicole White, MD

Medicine Housestaff continued Anna Wolfson, MD Xiaoyu Yang, MD

Junior Residents Joshua Allen-Dicker, MD, MPH April Atiba, MD Mariam Ayub, MD Tomer Barak, MD Daniel Barker, MD Kristin Beaver, MD Adam Binder, MD Elizabeth Brem, MD Marie Brubacher, MD Kathleen Buchheit, MD Meghan Campo, MD, MA Pei Chen, MD Michael Coronado, MD, MA Ramsey Daher, MD Joshua Davis, MD Colleen Ford, MD

Haven Garber, MD Katharine Germansky, MD Jonathan Goldman, MD Sujeet Govindan, MD Jared Grochowsky, MD Brianne Hackman, MD Zena Hassan, MD James Heckman, MD Jennifer Higa, MD Elizabeth Housman, MD Nancy Kang, MD Shanthini Kasturi, MD Dmitriy Kedrin, MD, PhD Andrew Korson, MD Darshan Kothari, MD Jason Lake, MD, MPH Sean Levy, MD, MS Kristin MacArthur, MD Joshua Obuch, MD Shalin Patel, MD

Bryan Piccirillo, MD David Rahni, MD Kenneth Roach, MD, PhD Michael Roberts, MD, MA Matthew Ronan, MD Elana Rosenthal, MD Robert Salazar, MD Nishan Tchekmedyian, MD Luke Strnad, MD Jeffrey William, MD Katherine Wrenn, MD

Senior Residents Mona Akbari, MD, MPH Paul Bailey, MD Eric Bonno, MD Steven Brauer, MD Apoorva Chawla, MD George Cheng, MD, PhD Jason Choi, MD

Samuel Edwards, MD Jason Ferreira, MD Sarah Flores, MD Louise Francois, MD, MPH Stephen Gordon, MD Anasuya, Gunturi, MD, PhD Evan Gwyn, MD Bevin Hearn, MD Anita Hegde, MD Tammy Hshieh, MD Sushrut Jangi, MD Rebecca Karp, MD Varun Khanna, MD Hyon Lee, MD Bobby Liaw, MD Jonathan Lu, MD John Mafi, MD Ian McCormick, MD Adam Meyer, MD

Carrie Morgenstein, MD Amber Moore, MD, MPH Ryan Nall, MD Laura Nasrallah, MD Matthew Niemi, MD Rachel Putman, MD Tracy Rose, MD, MPH Hans Rutzen Lopez, MD Coralynn Sack, MD Kevin Selby, MD Ami Shah, MD Sveta Shah, MD Juliana Simonetti, MD Elliot Tapper, MD Jesse Theisen-Toupal, MD Elizabeth Videlock, MD Frank Volpicelli, MD Jessica Wong, MD Melinda Yushak, MD

Megumi Maguchi Aldrete, MD Oliver Marasigan, MD Young-Ki Paik, MD Nicky Quinlan, MD Rotem Tellem, MD

Westyn Branch Elliman, MD Yehuda Cohen, MD Claudia Denkinger, MD, PhD Charlene Flash, MD, MPH Douglas Krakower, MD Keren Landman, MD John Love, MD, PhD Sarah Moore, MD Simi Padival, MD Gowri Satyanarayana, MD Graham Snyder, MD Rebecca Zash, MD

Jessica Zerillo, MD

MedicineDermatology Residents Steven Chen, MD, MPH Kudakwashe Maloney, MD Arash Mostaghimi, MD, MPA

Chief Medical Residents Alicia Clark, MD Bradley Crotty, MD Richard Kalman, MD Mary LaSalvia, MD Elizabeth O’Donnell, MD Elizabeth Sandman, MD

Clinical Fellows in Medicine Cardiovascular Medicine Anjan Chakrabarti, MD Ethan Ellis, MD Ricardo Esquitin, MD Adam Fein, MD Lisa Fleming, MD Michael Gavin, MD Katie Hawthorne, MD Yehoshua Levine, MD Christopher Meduri, MD Yonathan Melman, MD, PhD Rupal Parekh, MD Pablo Quintero Pinzon, MD Erin Rafferty, MD Satya Rao, MD Jason Roh, MD Jonathan Waks, MD Maryann Williamson, MD

Cardiac Non-Invasive Natalie Bello, MD Cardiology Interventional Anne-Marie Anagnostopoulos, MD David Burke, MD, MSc Debanik Chaudhuri, MD Perwaiz Meraj, MD Eric Osborn, MD, PhD Yuri Pride, MD, MA

Adam Zucker, MD

Cardiac Electrophysiology Maheer Gandhavadi, MD Daniel Kramer, MD Emerson Liu, MD Michael Rosenberg, MD Joshua Silverstein, MD Alex Tan, MD Andrew Zohlman, MD

Endocrinology, Diabetes and Metabolism Iratxe Escurza, MD, PhD Heather Ferris, MD, PhD Eleanna De Filippis, MD, PhD Tahereh Ghorbani Rodriguez, MD Zhiheng He, MD, PhD Brian O’Neill, MD, PhD Elena Toschi, MD Qin Yang, MD, PhD

Gastroenterology Ahmad Alharbi, MD Alan Bonder, MD Joseph Feuerstein, MD Tahereh Ghaziani, MD Maggie Ham, MD Toufic Kabbani, MD Gyanprakash Ketwaroo, MD

Rakhi Kheraj, MD Sandeep Krishnan MBBS, PhD Suma Magge, MD Rupa Mukherjee, MD Xi Na, MD, PhD Kavinderjit Nanda, MD Kumar Pallav, MBBS Parham Safaie, MD Paul Sepe, MD Saurabh Sethi, MD, MPH Harjot Sidhu, MD Zhighang Song, MD, PhD Lindsey Surace, MD Sumeet Tewani, MD Byron Vaughn, MD Talia Zenlea, MD Cheng Zhang, MD, PhD

General Medicine and Primary Care Bradley Crotty, MD Michelle Dossett, MD, PhD Kelly Graham, MD John Mafi, MD

Gerontology Andrea Berg, MD Jesse Foote, MD Laura Frain, MD Tran Cassandra Huynh, MD Jinesh Kochar, MD, MPH Pei Chang Liu, MD

Hematology/ Oncology Allison Ackerman, MD, PhD Alexandra Bailey, MD Chiara Battelli, MD, PhD Kelly Bodio, MD Eddy Chen, MD Alexandra Drakaki, MD Renee Funches, MD Elizabeth Gaughan, MD Samuel Klempner, MD Jamie Potosek, MD Kathleen Mahoney, MD, PhD Lourdes Mendez, MD, PhD Adam Rojan, MD Benjamin Schlechter, MD, MA Anish Sharda, MD Sarah Slater, MD Jeremy Warner, MD Peter Yang, MD Matthew Yurgelun, MD

Infectious Diseases Roger Araujo Castillo, MD Catharina Armstrong, MD

Nephrology Varun Chawla, MD Peter Czarnecki, MD Ranil DeSilva, MD Arvind Goel, MD Prachi Jog, MD Eli Khankin, MD Katherine Lynch, MD Manish Maski, MD Mihran Naljayan, MD Ali Poyan Mehr, MD Rupam Ruchi, MD Wen Shen, MD, PhD

Renal Transplant Ajay Kher, MD

Pulmonary, Critical Care and Sleep Medicine Neil Ahluwalia, MD

Raja Andulnour, MD Jeremy Beitler, MD Katherine Berg, MD Patrick Burkett, MD, PhD Kate Dudley, MD Joshua Englert, MD Ekaterina Gldaysheva, MD Jason Griffith, MD, PhD Kathryn Hibbert, MD Brian Hobbs, MD Douglas Hsu, MD Emer Kelly, MD Edy Kim, MD, PhD Charles Kinsey, MD Rachel Knipe, MD Puja Kohli, MD Barbara LeVarge, MD Jakob McSparron, MD Sydney Montesi, MD Andrew Mihalek, MD Peter Moschovis, MD Debby Ngo, MD William Oldham, MD, PhD Farbod Rahaghi, MD, PhD Mary Rice, MD Elisabeth Riviello, MD, MPH Tanya Weinstock, MD Hilary Womble, MD

Sleep Medicine Omer Ahmed, MD Eric Heckman, MD

Department of Medicine 2012 Annual Report

21

The Readmission Challenge:

Helping Patients Stay Healthy and Out of the Hospital

Lorraine Britting, MSN, NP, Cardiology, discussing post-discharge treatment concerns with patient Barbara Sardzinski.

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Department of Medicine 2012 Annual Report

PACT PROGRAM Julius Yang, MD, PhD, heads the BIDMC team that was recently awarded a $4.9 million Innovation Grant from

W

hat to do about “preventable” hospital readmissions is a topic of much discussion among clinicians, agency and government officials, and patient advocates these days. The US Department of Health and Human Services has made reducing 30-day hospital readmissions a top priority, even imposing a heavy financial penalty on hospitals with high readmission rates, beginning in 2012.

That presents a challenge for Beth Israel Deaconess because the medical center has a high readmission rate for some types of illnesses and procedures. But BIDMC also has a low mortality rate (among the lowest in the nation) for the same conditions.

Some say over-emphasis on readmissions is misguided. Isn’t saving lives the best indicator of excellent patient care?

Could hospitals that are best at lowering mortality have higher 30-day readmission rates because they are better at treating the sickest people — those who are more likely to require readmission? “Our goal is to offer the highest quality care in whatever setting is most beneficial to the patient,” says Kenneth Sands, MD, MPH, Senior Vice President, Silverman Institute for Health Care Quality and Safety.

“Preventing readmissions requires reliable coordination of care for our patients, both in and out of the hospital,” notes Julius Yang, MD, PhD, Faculty in the Department of Medicine and Medical Director of Inpatient Quality.

Yang and Sarah Moravick, MBA, Quality Improvement Project Manager, Inpatient Quality, lead the BIDMC team recently awarded a $4.9 million Innovation Grant from the federal Centers for Medicare and Medicaid Services (CMS) for a PostAcute Care Transitions (PACT) program to reduce avoidable readmissions during the high-risk 30-day period following acute care hospitalization. “We hope to improve how our health system as a whole supports our patients after discharge because so much happens during the 30-day period outside the hospital,” says Yang. “The CMS grant will help us focus our efforts and bolster collaborations with providers across the care continuum.”

Recognizing that there are also opportunities for improvement prior to hospital discharge, a readmission within three days of discharge is reviewed as a case of potentially preventable harm.

“Reviewing unexpected readmissions within three days of discharge often reveals opportunities to improve our assessment of and planning for patient needs at discharge,” says Yang. In general, problems occur when patients leave the hospital and continuity of the care plan falls apart. To address that issue, PACT deploys nurses and clinical pharmacists who facilitate smooth transitions between hospital and home to help reduce readmission risk for Medicare patients at six affiliated sites: BIDMC’s own Healthcare Associates and Bowdoin

the federal Centers for Medicare and Medicaid Services for a Post-Acute Care Transitions (PACT) program to reduce

avoidable hospital readmissions.

Street Health Center, plus Beth Israel Deaconess Healthcare offices in Jamaica Plain, Brookline-Washington Square, Brookline-Pastor Medical and Chelsea. “A transitional nurse calls patients the day after discharge to verify they have picked up their medications, have transportation to follow-up appointments and that other aspects of the care plan are in place,” says Moravick. “Nurses call at least once a week for 30 days to check and make sure patients are doing well. Often, patients only call their doctor when there is a major issue. If we can identify trends earlier, then our nurses can manage them proactively. If a patient isn’t doing well, our nurses increase the frequency of calls and collaborate closely with primary care providers (PCPs), specialists, visiting nurses, community organizations and others to plan next steps.”

The PACT program is anticipated to reduce the number of 30-day rehospitalizations by 30% over three years, and to save over $12 million in Medicare expenses. Making these postdischarge activities standard across the system is under way, says Moravick, thanks to recommendations made by a collaborative group of visiting nurses, home care providers, extended care facilities, community organizations, PCPs, specialists, patients, families and many other hospital representatives.

This was adapted from Michael Keating’s article in the Fall 2012 BIDMC Quarterly.

Department of Medicine 2012 Annual Report

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UNITED STATES

Medicine Without Borders:

Residents, Faculty and Global Citizens

GABON

Dagan Coppock, MD, with Koketso Tau, RN, at Scottish Livingstone Hospital in Botswana.

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Department of Medicine 2012 Annual Report

KUWAIT ISRAEL

T KENYA

VIETNAM

he physicians profiled in the following pages, along with many other Department of Medicine residents, fellows and faculty, have worked across the globe this year — often in places where their skills and resources are most needed. They have gained unparalleled experience that will serve them throughout their careers. The Internal Medicine Global Health Program also enables residents to gain experience at sites closer to home through rotations at Native American reservations and community health centers.

SINGAPORE

BOTSWANA

Department of Medicine 2012 Annual Report

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Todd Pollack, MD, providing mentoring at an HIV clinic in Hanoi, Vietnam.

BOTSWANA Like many BIDMC physicians, Dagan Coppock, MD, wakes up early each morning and commutes 45 minutes to work. When he arrives at the hospital, he greets fellow physicians, nurses and residents and inquires about patients on the floor. But, unlike most BIDMC doctors, Coppock works thousands of miles from Boston in a district hospital in Botswana. For the last year, Coppock has served as an attending physician and preceptor to BIDMC residents visiting the Scottish Livingstone Hospital. “My goal is to help people get the best medical care they can while simultaneously giving the residents the best education they can get in this unique setting,” Coppock says. “If I have done both, I am happy.”

VIETNAM Todd Pollack, MD, lives in Hanoi and serves as Country Medical Director of the Harvard Medical School AIDS Initiative in Vietnam (HAIVN). He spends most days mentoring Vietnamese doctors and nurses on HIV/AIDS care and treatment at any one of over 50 partnering sites throughout the country. Working closely with HAIVN’s US-based Director, Howard Libman, MD, Pollack also runs the day-to-day operations of HAIVN, including a staff of over 25 people.

In addition to the field work, Pollack particularly appreciates the collaborative nature of his role: “It is so wonderful to have the opportunity to work closely with so many talented people from the Vietnam Administration of HIV/AIDS Control and from other international partners such as the CDC, WHO and UNAIDS.”

GABON Third-year internal medicine resident Kevin Selby, MD, spent five weeks this year at the Albert Schweitzer Hospital in the West African country of Gabon.

He spent mornings attending rounds and helping with the management of inpatients. In the afternoon, he assisted in the “polyclinique,” seeing outpatients with a range of conditions from osteoarthritis to undiagnosed tuberculosis. Selby was inspired, he says, by the legacy of Albert Schweitzer, MD, who first built a makeshift clinic here 100 years ago. The Schweitzer Fellowship, headed by Lachlan Forrow, MD, continues to honor Schweitzer’s philosophy of “reverence for life” through fellowship programs in Gabon and across the US.

Resident Kevin Selby, MD, at the Albert Schweitzer Hospital in Gabon.

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Department of Medicine 2012 Annual Report

Eli Gelfand, MD, with a patient and fellow clinicians at Kenyatta Hospital in Kenya.

KUWAIT Charles Safran, MD, and Antoine Kaldany, MD, Chief of the Division of Clinical Informatics and Executive Director of International Initiatives at Harvard Medical Faculty Physicians, respectively, have been working closely with the Dasman Diabetes Institute in Kuwait this year. Members of their multidisciplinary team are on the ground there one week per month collaborating on the development of a cutting-edge electronic health records system. An exciting model for the next generation of electronically-supported, patientcentered diabetes treatment and prevention, the system is designed to help curb the epidemic in Kuwait and across the region, where diabetes rates are among the highest in the world.

Charles Safran, MD, Antoine Kaldany, MD, and Judith Goodwin in Kuwait.

KENYA Eli Gelfand, MD, member of the Division of Cardiovascular Medicine and Director of the CardioVascular Institute’s Russian Cardiovascular Clinic, recently completed his latest medical mission to Nairobi, Kenya. Under the aegis of the organization Hearts Around the World, Gelfand led a team of six specialists, including cardiologists, cardiac nurses and a heart surgeon to Kenyatta National Hospital. During their third such visit, the team trained Kenyan specialists in diagnostic and interventional cardiac techniques, intensive care of postoperative patients and clinical cardiology.

Increasingly recognized as a global leader in quality improvement (QI), the Department of Medicine provides QI consultation to several international and US -based partners. In Botswana, for instance, the BIDMC Triggers Program is being implemented as a novel approach to rapid response. And, this year, the department consulted on QI curricula for the National University Hospital in Singapore, Rambam Medical Center in Haifa, Israel and Hadassah Medical Center in Jerusalem. The department is also forging QI-related partnerships with several US medical schools and hospitals, including Yale University, Brown University, Mayo Clinic and Cincinnati Children’s Hospital.

“My goal is to help people get the best medical care they can while simultaneously giving the residents the best education they can get in this unique setting.”

– Dagan Coppock, MD

Department of Medicine 2012 Annual Report

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From Bench to Bedside:

Basic Science in Pursuit of Cutting-Edge Therapies

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Department of Medicine 2012 Annual Report

Peripartum Cardiomyopathy Zoltan Arany, MD, PHD, and colleagues in the Division of Cardiovascular Medicine found that loss of a specific

I

n each of the department’s 24 divisions investigators are pushing the limits of biomedical science and paving the way for innovative approaches to disease prevention and treatment, the following are just a few examples of this exciting work.

Obesity and Diabetes Over the last few decades, the twin epidemics of obesity and diabetes have emerged as among the most significant public health issues of our day. As a result of intensive investigation into the causes of these pandemics, it has been recognized that the fat cell plays a central role in controlling healthy blood sugar levels and the levels of the key metabolic hormone insulin which regulates blood sugar levels. The laboratory of Barbara Kahn, MD, in the Division of Endocrinology, Diabetes

and Metabolism first identified a defect in the transport of sugar into fat cells as an early feature in the development of diabetes and obesity-related diseases.

Using a series of genetically modified mice, the Kahn laboratory demonstrated that the defect in sugar transport into fat cells caused insulin resistance in the whole body. Recently, Mark Herman, MD, an instructor in the Kahn laboratory, determined that a critical nutrient sensing transcription factor — Carbohydrate Responsive-Element Binding Protein, or ChREBP — is essential for mediating the effects of altered sugar transport into fat cells on whole body glucose metabolism.

Moreover, Herman identified a previously unknown form of ChREBP that is far more potent than the previously known form. Herman and Kahn have shown that levels of the novel form of ChREBP in adipose tissue predict insulin sensitivity

The canonical ChREBP-alpha isoform is predominantly localized in the cytoplasm in low and high glucose conditions. In contrast, the novel, potent ChREBP-beta isoform is localized in the nucleus in low and high glucose conditions.

nuclear factor in heart cells leads to a perfect replica of peripartum cardiomyopathy.

in people. Herman’s ongoing investigation into the function and regulation of this novel form of ChREBP may provide new strategies for the treatment and prevention of obesity and diabetes.

Heart Disease During Pregnancy In another scientific breakthrough, investigators in the laboratory of Zoltan Arany, MD, PhD, noticed that genetically engineered mice lacking a specific transcription factor, PGC-1α, in their hearts were dying unexpectedly during pregnancy. On closer inspection, the hearts of these mice were dilated, weakened, and scarred in ways reminiscent of a condition affecting 1 in 3,000 pregnant women called peripartum cardiomyopathy (PPCM).

In a series of elegant studies of both the animal models and women with PPCM, Arany and colleagues in the Division of Cardiovascular Medicine found that although this disease is manifest as weakening of heart muscle, it is actually due to a failure of blood vessel development in the heart (angiogenesis).

Working in collaboration with Ananth Karumanchi, MD, a Howard Hughes Medical Institute investigator in the Center for Vascular Biology Research at BIDMC, the Arany laboratory determined that the combination of loss of PGC-1αdependent pathways and anti-angiogenic factors circulating during pregnancy culminates in PPCM. These insights may lead to studies that would enable clinicians to identify women at risk for Department of Medicine 2012 Annual Report

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The “kissing bug,” or triatomine bug, transmits T cruzi, the parasite responsible for Chagas disease, a potentially fatal infection.

this condition and even suggest possible strategies for prevention or treatment of PPCM through restoration of angiogenic signals, an approach that has shown some positive results in animal models.

Chagas Disease, a Parasitic Infection Chagas disease, also known as American trypanosomiasis, is a potentially lifethreatening illness caused by the protozoan parasite, Trypanosoma cruzi (T cruzi). It is found mainly in Latin America, where it is mostly transmitted to humans through the feces of triatomine bugs, often called “kissing bugs.” An estimated 10 million people are infected worldwide, and many succumb to myocarditis (heart damage). Investigators in the Division of Immunology have demonstrated that parasite replication in macrophages plays a far greater role in the development of myocarditis than replication in other cells, even though macrophages ordinarily ingest and destroy parasites. Moreover, a costimulatory molecule on the surface of macrophages, SLAMF1, is required for replication there. When infected with T cruzi, mice without SLAMF1 had reduced numbers of parasites in their hearts compared to normal mice. This explains why T cruzi-infected SLAMF1 deficient mice, in contrast to normal mice, do not succumb to myocarditis induced by a lethal challenge with T cruzi. Those results were corroborated using an alternative approach, blocking SLAMF1 function in vivo by treating mice with 30

Department of Medicine 2012 Annual Report

anti-SLAMF1 antibodies. Consequently, this research suggests that SLAMF1 is an attractive novel therapeutic target for modulating T cruzi infection.

Prostate Cancer Prostate cancer responds initially to deprivation of male hormones (androgens), but unfortunately, tumors invariably become refractory to androgen deprivation and relapse later in the course of the disease. Steven Balk, MD, PhD, and colleagues in the Division of Hematology-Oncology recently found a mechanism for this type of relapse.

They showed that the androgen receptor (AR) feeds back to repress the expression of its own gene and also of multiple genes that drive proliferation, so that an unintended consequence of standard androgen deprivation therapy for prostate cancer is activation of these AR-repressed genes. The mechanisms by which the AR represses gene expression differ from its positive actions; this may make it possible to target AR selectively and prevent or delay the emergence of resistant prostate cancer in men treated with androgen deprivation.

Myocardial Infarction, Venous Thromboembolic Disease and Stroke Thrombosis, or blood clot formation, is designed to stop bleeding, but when clotting gets out of control it can lead to coronary artery disease, pulmonary emboli, venous thrombosis and stroke.

Existing antithrombotic drugs block

either one limb of the clotting mechanism — formation of fibrin — or the other, aggregation of platelets. Published work from the Furie Lab in the Division of Hemostasis and Thrombosis has established that protein disulfide isomerase (PDI) is an enzyme that is required for formation of a thrombus, but that it acts early in the thrombosis cascade, in both of its limbs. With Rob Flaumenhaft, MD, PhD, their present aim is to develop a new antithrombotic agent that will inhibit PDI. In animal experiments, a PDI inhibitor — quercetin 3-rutinoside — has proven to be antithrombotic. Second generation PDI inhibitors can now be identified by highthroughput screening of large chemical libraries. With Jeffrey Zwicker, MD, the role of PDI inhibitors is being examined in clinical trials in humans to prevent clotting in patients with cancer-associated thrombosis or anti-phospholipid syndrome.

Selected Publications Endocrinology, Diabetes and Metabolism Fisher FM, Kleiner S, Douris N, Fox EC, Mepani RJ, Verdeguer F, Wu J, Kharitonenkov A, Flier JS, Spiegelman BM,* Maratos-Flier E*. FGF21 regulates PGC-1α and browning of white adipose tissues in adaptive thermogenesis. Genes Dev 2012; 26:271-81. *Co-senior authors.

Herman MA, Peroni OD, Villoria J, Schön MR, Abumrad NA, Blüher M, Klein S, Kahn BB. A novel ChREBP isoform in adipose tissue regulates systemic glucose metabolism. Nature 2012; 484:333-8.

BIRTH OF THROMBUS Using cutting-edge intravital microscopy, investigators in the Furie Lab are able to visualize thrombus formation in a live mouse in real time. A laser is used to damage the blood vessel of an anesthetized mouse and fluorescent antibodies are used to visualize the growing thrombus. The laser damages the vessel wall such that the endothelial cell layer is exposed to the blood stream. The endothelial cell layer expresses Tissue Factor (green) which, upon exposure to plasma, begins the necessary steps to recruit platelets (red) to the site of injury. Activated platelets release the necessary components to further recruit more platelets, as well as begin to form a fibrin clot (blue) which acts as a patch to repair the injury.

Bright Field

Tissue Factor

Platelets

Fibrin

Merge

Liu T*, Kong K*, Shah BP*, Ye C*, Koda S, Saunders A, Ding JB, Yang Z, Sabatini BL, Lowell BB. Fasting activation of AgRP neurons requires NMDA receptors and involves spinogenesis and increased excitatory tone.

Neuron 2012; 73:511-22. *Equal first authors.

infarction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase. Circulation 2011; 124:2512-21.

Vella KR, Ramadoss P, Lam FS, Harris JC, Ye FD, Same PD, O’Neill NF, Maratos-Flier E, Hollenberg AN. NPY and MC4R signaling regulate thyroid hormone levels during fasting through both central and peripheral pathways.

Cell Metab 2011; 14:780-90.

Immunology Calderón J, Maganto-Garcia E, Punzón C, Carrión J, Terhorst C, Fresno M. The receptor SLAMF1 on the surface of myeloid lineage cells controls susceptibility to infection by trypanosoma cruzi. PLoS Pathog 2012; 8:e1002799.

Wrann CD, Eguchi J, Bozec A, Xu Z, Mikkelsen T, Gimble J, Nave H, Wagner EF, Ong S-E, Rosen ED. FOSL2 promotes adipocyte-specific leptin gene expression in humans and mice. J Clin Invest 2012; 122:1010-21.

Cardiovascular Medicine Ashida N, Senbanerjee S, Kodama S, Foo SY, Coggins M, Spencer JA, Zamiri P, Shen D, Li L, Sciuto T, Dvorak A, Gerszten RE, Lin CP, Karin M, Rosenzweig A. IKKa regulates essential functions of the vascular endothelium through kinase-dependent and -independent pathways. Nat Commun 2011; 2:318.

Cutlip DE. Five-year outcomes of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: are they equally good (or bad)? Circulation 2011; 123:2779-81.

Kramer DB, Buxton AE, Zimetbaum PJ. Time for a change — a new approach to ICD replacement. N Engl J Med 2012; 366:291-3.

Patten IS, Rana S, Shahul S, Rowe GC, Jang C, Liu L, Hacker MR, Rhee JS, Mitchell J, Mahmood F, Hess P, Farrell C, Koulisis N, Khankin EV, Burke SD, Tudorache I, Bauersachs J, del Monte F, Hilfiker-Kleiner D, Karumanchi SA, Arany Z. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 2012; 485:333-8.

Pinto DS, Frederick PD, Chakrabarti AK, Kirtane AJ, Ullman E, Dejam A, Miller DP, Henry TD, Gibson CM. National Registry of Myocardial Infarction Investigators.

Benefit of transferring ST-segment-elevation myocardial

Keszei M, Detre C, Rietdijk ST, Muñoz P, Romero X, Berger SB, Calpe S, Liao G, Castro W, Julien A, Wu YY, Shin DM, Sancho J, Zubiaur M, Morse HC 3rd, Morel L, Engel P, Wang N, Terhorst C. A novel isoform of the Ly108 gene ameliorates murine lupus. J Exp Med 2011; 208:811-22.

Liao G, Detre C, Berger SB, Engel P, de Waal Malefyt R, Herzog RW, Bhan AK,Terhorst C. Glucocorticoidinduced tumor necrosis factor receptor family-related protein regulates CD4(+)T cell-mediated colitis in mice.

Gastroenterology 2012; 142:582-91.

Ma C, Wang N, Detre C, Wang G, O’Keeffe M, Terhorst C. Receptor signaling lymphocyte-activation molecule family 1 (Slamf1) regulates membrane fusion and NADPH oxidase 2 (NOX2) activity by recruiting a Beclin-1/Vps34/ultraviolet radiation resistanceassociated gene (UVRAG) complex. J Biol Chem 2012; 287:18359-65.

Wang G, Abadía-Molina AC, Berger SB, Romero X, O’Keeffe MS, Rojas-Barros DI, Aleman M, Liao G, Maganto-García E, Fresno M, Wang N, Detre C, Terhorst C. Cutting edge: Slamf8 is a negative regulator of Nox2 activity in macrophages. J Immunol 2012; 188:5829-32.

Hematology/Oncology Avigan D, Rosenblatt J, Kufe D. Dendritic/tumor fusion cells as cancer vaccines. Semin Oncol 2012; 39:287-95.

Cai C, He HH, Chen S, Coleman I, Wang H, Fang Z, Chen S, Nelson PS, Liu XS, Brown M, Balk SP. Androgen

receptor gene expression in prostate cancer is directly suppressed by the androgen receptor through recruitment of lysine specific demethylase 1. Cancer Cell 2011; 20:457-71.

Konstantinopoulos PA, Awtrey CS. Management of epithelial ovarian cancer. JAMA 2012; 307:1420-9.

Tung N, Silver DP. CHEK2 DNA damage response pathway and inherited breast cancer risk. J Clin Oncol 2011; 29:3813-5.

Van der Vorst JR, Schaafsma BE, Verbeek FPR, Hutteman M, Mieog JSD, Lowik CWGM, Liefers G-J, Frangioni JV, van de Velde CJH, Vahrmeijer AL. Randomized comparison of near-infrared flouresence imaging using indocyanine green and 99m technetium with or without patent blue for the sentinel lymph node procedure in breast cancer patients. Ann Surg Oncol 2012; 19:4104-11.

Hemostasis and Thrombosis Cho J, Kennedy D, Merrill-Skoloff G, Furie BC, Furie B. Protein disulfide isomerase capture during thrombus formation in vivo depends on the presence of ß3 integrins. Blood 2012; 120:647-55.

Dockendorff C, Aisiku O, Verplank L, Dilks JR, Smith DA, Gunnink SF, Dowal L, Negri J, Palmer M, Macpherson L, Schreiber SL, Flaumenhaft R. Discovery of 1,3-diaminobenzenes as selective inhibitors of platelet activation at the PAR1 receptor. ACS Med Chem Lett 2012; 3:232-7.

Jasuja R, Passam FH, Kennedy DR, Kim S, Van Hessem L, Lin L, Joshi SS, Dilks J, Furie B, Furie BC, Flaumenhaft R. Protein disulfide isomerase inhibitors: a new class of antithrombotic agents. J Clin Invest 2012; 122:2104-13.

Peters CG, Michelson AD, Flaumenhaft R. Granule exocytosis is required for platelet spreading: differential sorting of α-granules expressing VAMP-7. Blood 2012; 120:199-206.

Xu X, Gårdsvoll H, Yuan C, Lin L, Ploug M, Huang M. Crystal structure of the urokinase receptor in a ligandfree form. Blood 2012; 416:629-41.

Department of Medicine 2012 Annual Report

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Enhancing Patient Health and Satisfaction Through Effective Communication

T

he Department of Medicine strives to provide every patient with the kind of care that we would want for our own family members. The goal is to offer patients exceptional clinical care, which requires clear and compassionate communication.

This year, several projects within the department have focused on communication strategies — ranging from high-tech internet tools to good, old-fashioned mailings — to help ensure both patient satisfaction and positive health outcomes.

Many patients first experience BIDMC when they go online or call the medical center. To ensure quality at these initial points of contact, the BIDMC website is being updated and enhanced to provide more current, helpful and engaging information. The department has also continued to ensure that frontline phone staff members are providing effective and friendly service through a Mystery Shopping program whereby trained “shoppers” pose as patients seeking information and appointments.

Pamela Vohra-Khullar, MD, reviewing notes with a patient.

Inset: Sonia Figueroa checking in a patient.

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Department of Medicine 2012 Annual Report

This year, one of the department’s largest physician networks, Beth Israel Deaconess HealthCare (BIDHC), also known as Affiliated Physicians Group, expanded its Service Excellence Program and implemented several new initiatives, including customer service trainings for all practice staff, Mystery Shopping and standardization of new patient phone call

Kidney Tracker Using the latest in information technology, Nephrology fellow Ali Poyan Mehr, MD, has

protocols. BIDHC has also augmented its use of patient satisfaction surveys to better serve its patients.

For some patients, communication comes in the form of a letter. This year, through the Division of Gastroenterology’s Colonoscopy Recall Project, patients who might otherwise have missed their recommended colonoscopy received a reminder in the mail. The division estimates that this recall project resulted in approximately 1,000 additional colonoscopies performed, thus potentially saving lives through cancer prevention and early diagnosis.

Other initiatives have focused on using electronic health records to engage patients in their medical care. OpenNotes, a project originally launched in 2009

by Tom Delbanco, MD, and Jan Walker, RN, MBA, in the Division of General Medicine and Primary Care, has explored the impact of giving patients access to online notes written by their doctors. Published in the Annals of Internal Medicine this year, the team’s

findings suggest that patients with access to doctors’ notes feel more in control of their care. They also report a better understanding of their medical issues, improved recall of their care plan and being more likely to take their medications as prescribed.

Steven Freedman, MD, PhD, and Camilia Martin, MD, MS, of the Division of Translational Research are also using information technology to enhance communication and patient outcomes.

This year, the team received a $1.1 million grant from NexJ Systems for the development of Passport to TRUST. The online tool provides greater structure to the doctor-patient interaction by creating a blueprint for comprehensive care that is unique to each patient. The program aims to foster two-way communication between patients and physicians, thus empowering and enabling the patient to make informed decisions. According to research published this year in the International Journal of Quality Health Care, 77% of patients were extremely satisfied and another 21% were somewhat satisfied for an overall satisfaction rate of 98%.

The Division of Nephrology is exploring ways to use information technology to improve care for patients with chronic kidney disease. Headed by nephrology fellow Ali Poyan Mehr, MD, a newly developed tool, Kidney Tracker, uses

developed Kidney Tracker, a new tool to improve care for patients with chronic kidney disease.

predefined algorithms to generate a health summary in BIDMC’s Online Medical Record (OMR) system. The summary helps patients and their providers identify areas requiring further attention, areas of strength and milestones to be achieved.

The department is also engaged in several efforts to improve communication, patient satisfaction and outcomes among hospitalized patients. A team in the Division of Clinical Informatics has applied social network analysis within the OMR system to develop a novel algorithm for nursing assignments in inpatient units. Staff Lynx uses data, such as who looks at the patient records or signs a note, combined with information about patient location, to develop a care network for each patient. This has led to better nursing assignments with improved staff and family satisfaction. Staff Lynx has been deployed in the neonatal intensive care unit and is being piloted on two medical units.

To improve communication between caregivers and patients and families in the Medical Intensive Care Units, the Division of Pulmonary, Critical Care and Sleep Medicine initiated a new training program this year. Medical residents and fellows receive training on holding family meetings and providing effective and compassionate communication with critically ill patients and their loved ones.

(See p. 18 for more information.)

Department of Medicine 2012 Annual Report

33

SELECTED PUBLICATIONS Allergy and Inflammation Akuthota P, Spencer LA, Melo RC, Weller PF. MHC Class II and CD9 in human eosinophils localize to detergent-resistant membrane microdomains. Am J Respir Cell Mol Biol 2011; 46:188-95.

Allergy and Inflammation Akuthota P, Xenakis JJ, Weller PF. Eosinophils: offenders or general bystanders in allergic airway disease and pulmonary immunity? J Innate Immun 2011; 3:113-9.

Eosinophils are blood cells associated with allergic diseases. Findings of this study reveal novel roles of eosinophils as antigen-presenting cells that can activate T lymphocyte responses. Notably, this research is the effort of Praveen Akuthota, MD, a former BIDMC resident, Chief Medical Resident and Pulmonary and Critical Care Fellow.

Bandeira-Melo C, Weller PF, Bozza PT. Identifying intracellular sites of eicosanoid lipid mediator synthesis with EicosaCell assays. Methods Mol Biol 2011; 717:277-89.

Luna-Gomes T, Magalhaes KG, Mesquita-Santos FP, Bakker-Abreu I, Samico RF, Diaz BL, Bozza PT, Weller PF, Bandeira-Melo C. Eosinophils as a novel cell source of prostaglandin D2: autocrine role in allergic inflammation. J Immunol 2011; 187:6518-26.

Shamri R, Melo RC, Young KM, BivasBenita M, Xenakis JJ, Spencer LA, Weller PF. CCL11 elicits secretion of RNases from mouse eosinophils and their cell-free granules. FASEB J 2012; 26:2084-93.

Cardiovascular: See p. 31 Clinical Informatics Davis RB, Eamranond PP, Phillips RS, Wee CC. Patient-physician language concordance and primary care screening among Spanish-speaking patients. Med Care 2011; 49:668-72.

Geva A, Wright SB, Baldini LM, Smallcomb JA, Safran C, Gray JE. Spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: network analysis. Pediatrics 2011; 128:e1173-80.

Gray JE, Feldman H, Reti S, Markson L, Lu X, Davis RB, Safran CA. Using digital crumbs from an electronic health record to identify, study and improve health care teams. AMIA Annu Symp Proc 2011; 491-500.

Reti SR, Feldman HJ, Safran C. Online access and literacy in Maori New Zealanders with diabetes. J Prim Health Care 2011; 3:190-1.

34 34

Praveen Akuthota, MD

Slack WV, Kowaloff HB, Davis RB, Delbanco T, Locke SE, Safran C, Bleich HL. Evaluation of computer-based medical histories taken by patients at home. J Am Med Inform Assoc 2012; 19:545-8.

Clinical Nutrition Bistrian BR, Askew W, Erdman JW Jr, Oria MP. Nutrition and traumatic brain injury: a perspective from the Institute of Medicine report. JPEN J Parenter Enteral Nutr 2011; 35:556-9.

Le HD, de Meijer VE, Robinson EM, Zurakowski D, Potemkin AK, Arsenault DA, Fallon EM, Malkan A, Bistrian BR, Gura KM, Puder M. Parenteral fish-oilbased lipid emulsion improves fatty acid profiles and lipids in parenteral nutrition-dependent children. Am J Clin Nutr 2011; 94:749-58.

Ling PR, Malkan A, Le HD, Puder M, Bistrian BR. Arachidonic acid and docosahexaenoic acid supplemented to an essential fatty acid-deficient diet alters the response to endotoxin in rats.

Metabolism 2012; 61:395-406.

Martin CR, Dasilva DA, Cluette-Brown JE, Dimonda C, Hamill A, Bhutta AQ, Coronel E, Wilschanski M, Stephens AJ, Driscoll DF, Bistrian BR, Ware JH, Zaman MM, Freedman SD. Decreased postnatal docosahexaenoic and arachidonic acid blood levels in premature infants are associated with neonatal morbidities. J Pediatr 2011; 159:743-9.

Department Department of of Medicine Medicine 2012 2012 Annual Annual Report Report

Endocrinology, Diabetes and Metabolism See p. 30 Experimental Medicine Kocher O, Birrane G, Yesilaltay A, Shechter S, Pal R, Daniels K, Krieger M. Identification of the PDZ3 domain of the adaptor protein PDZK1 as a second, physiologically functional binding site for the C terminus of the high density lipoprotein receptor scavenger receptor class B type I. J Biol Chem 2011; 286:25171-86.

Jiang S, Fu Y, Avraham HK. Regulation of hematopoietic stem cell trafficking and mobilization by the endocannabinoid system. Transfusion 2011; 51: 65S-71S. Olnes MJ, Shenoy A, Weinstein B, Pfannes L, Loeliger K, Tucker Z, Tian X, Kwak M, Wilhelm F, Yong ASM, Maric I, Maniar M, Scheinberg P, Groopman J, Young NS, Sloand EM. Directed therapy for patients with meylodysplastic syndromes (MDS) by suppression of cyclin D1 with ON 01910. Na Leuk Res 2012; 36:982-9.

Shrivastava A, Kuzontkoski PM, Groopman JE, Prasad A. Cannabidiol induces programmed cell death in breast cancer cells by coordinating the crosstalk between apoptosis and autophagy.

Mol Cancer Ther 2011; 10:1161-72.

Zhang X, Yu Y, Kuzontkoski PM, Zhu W, Li DY, Groopman JE. Slit2/Robo4 signaling modulates HIV-1 gp120induced lymphatic hyperpermeability.

PLoS Pathog 2012; 8:e1002461.

Gastroenterology Chalmin F, Mignot G, Bruchard M, Chevriaux A, Végran F, Hichami A, Ladoire S, Derangère V, Vincent J, Masson D, Robson SC, Eberl G, Pallandre JR, Borg C, Ryffel B, Apetoh L, Rébé C, Ghiringhelli F. Stat3 and Gfi-1 transcription factors control Th17 cell immunosuppressive activity via the regulation of ectonucleotidase expression. Immunity 2012; 36:362-73.

Kabbani TA, Goldberg A, Kelly CP, Pallav K, Tariq S, Peer A, Hansen J, Dennis M, Leffler DA. Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment Pharmacol Ther 2012; 35:723-9.

Lembo AJ, Schneier HA, Shiff SJ, Kurtz CB, MacDougall JE, Jia XD, Shao JZ, Lavins BJ, Currie MG, Fitch DA, Jeglinski BI, Eng P, Fox SM, Johnston JM. Two randomized trials of linaclotide for chronic constipation. N Engl J Med 2011; 365:527-36.

Longhi MS, Liberal R, Holder B, Robson SC, Ma Y, Mieli-Vergani G, Vergani D. Inhibition of interleukin-17 promotes differentiation of CD25- cells into stable T regulatory cells in patients with autoimmune hepatitis. Gastroenterology 2012; 142:1526-35.

Rostholder E, Ahmed A, Cheifetz AS, Moss AC. Outcomes after escalation of infliximab therapy in ambulatory patients with moderately active ulcerative colitis. Aliment Pharmacol Ther 2012; 35:562-7.

General Medicine and Primary Care Loo TS, Davis RB, Lipsitz LA, Irish J, Bates CK, Agarwal K, Markson L, Hamel MB. Electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Intern Med 2011; 171:1552-8.

Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older. J Am Geriatr Soc 2011; 59:1444-51.

Smetana GW, Umscheid CA, Chang S, Matchar DB. Methods guide for authors of systematic reviews of medical tests: a collaboration between the Agency for Healthcare Research and Quality (AHRQ) and the Journal of General Internal Medicine. J Gen Intern Med 2012; 27:S1-3.

Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, Kirsch I, Israel E, Kaptchuk TJ. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med 2011; 365:119-26.

Walker J, Leveille SG, Ngo L, Vodicka E, Darer JD, Dhanireddy S, Elmore JG, Feldman HJ, Lichtenfeld MJ, Oster N, Ralston JD, Ross SE, Delbanco T. Inviting patients to read their doctors’ notes: patients and doctors look ahead: patient and physician surveys. Ann Intern Med 2011; 155:811-9.

Genetics See p.14

Hematology/Oncology See p. 31

The role of TNF-α in mice with type 1- and 2- diabetes. PLoS One 2012; 7:e33254.

Gerontology Berry SD, Zhang Y,Lipsitz LA, Mittleman MA, Solomon DH, Kiel DP. Antidepressant Prescriptions: an acute window for falls in the nursing home.

J Gerontol A Biol Sci Med Sci 2011; 66:1124-30.

Hemostasis and Thrombosis See p. 31

Sukhatme VP, Chan B. Glycolytic cancer cells lacking 6-phosphogluconate dehydrogenase metabolize glucose to induce senescence. FEBS Lett 2012; 586:2389-95.

Hayden KM, Reed BR, Manly JJ, Tommet D, Pietrzak RH, Chelune GJ, Yang FM, Revell AJ, Bennett DA, Jones RN. Cognitive decline in the elderly: an analysis of population heterogeneity.

Age Ageing 2011; 40:684-9.

Manor B, Hao Y, Liu J, Zhang K, Chai Y, Lipsitz L, Peng CK, Novak V, Wang X, Zhang J, Fang J. Novel MRI-compatible tactile stimulator for cortical mapping of foot sole pressure stimuli with fMRI. Magn Reson Med 2012; doi: 10.1002/ mrm 24330.

Saczynski JS,* Marcantonio ER,* Quach L, Fong TG, Gross A, Inouye SK,* Jones RN.* Cognitive trajectories after postoperative delirium. N Engl J Med 2012; 367:30-9. *Co-first and -senior authors.

Samelson EJ, Christiansen BA, Demissie S, Broe KE, Louie-Gao Q, Cupples LA, Roberts BJ, Manoharam R, D’Agostino J, Lang T, Kiel DP, Bouxsein ML. QCT measures of bone strength at the thoracic and lumbar spine: the Framingham Study. J Bone Miner Res 2012; 27:654-63.

Immunology See p. 31 IMBIO Balachandran JS, Bakker JP, Rahangdale S, Yim-Yeh S, Mietus JE, Goldberger AL, Malhotra A. Effect of mild, asymptomatic obstructive sleep apnea on daytime heart rate variability and impedance cardiography measurements. Am J Cardiol 2012; 109:140-5.

Hanai J, Doro N, Sasaki AT, Kobayashi S, Cantley LC, Seth P, Sukhatme VP. Inhibition of lung cancer growth: ATP citrate lyase knockdown and statin treatment leads to dual blockade of mitogen-activated protein kinase (MAPK) and phosphatidylinositol-3kinase (PI3K)/AKT pathways. J Cell Physiol 2012; 227:1709-20.

Kohane IS, McMurry A, Weber G, Macfadden D, Rappaport L, Kunkel L, Bickel J, Wattanasin N, Spence S, Murphy S, Churchill S. The co-morbidity burden of children and young adults with autism spectrum disorders. PLoS One 2012; 7:e33224.

Koulmanda M, Bhasin M, Awdeh Z, Qipo A, Fan Z, Hanidziar D, Putheti P, Shi H, Csizuadia E, Libermann TA, Strom TB.

Clinical Nutrition Le HD, Meisel JA, de Meijer VE, Fallon EM, Gura KM, Nose V, Bistrian BR, Puder M. Docosahexaenoic acid and arachidonic acid prevent essential fatty acid deficiency and hepatic steatosis. JPEN J Parenter Enteral Nutr 2012; 36:431-41.

Humans are unable to synthesize certain essential fats and develop liver disease if they are not present in the diet. This paper shows that liver disease can also be prevented by two metabolically active fatty acids that are downstream of those classically considered to be essential. Inclusion of the metabolically active fatty acids in solutions for intravenous feeding may benefit patients.

Infectious Diseases Branch-Elliman W, Golen TH, Gold HS, Yassa DS, Baldini LM, Wright SB. Risk factors for Staphylococcus aureus postpartum breast abscess. Clin Infect Dis 2012; 54:71-7.

Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto J, Godbole SV, Mehendale S, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshlerman SH, Piwowar-Manning E, Wang L, Makherma J, Mills LA, de Bruyn G, Sanne I, Eron J, Gallant J, Havlir D, Swindells S, Ribaudo H, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano D, Essex M, Fleming TR. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365:493505.

Geva A, Wright SB, Baldini LM, Smallcomb JA, Safran C, Gray JE. Spread of MRSA in a large tertiary NICU: A network analysis. Pediatrics 2011; 128:1173-80.

Guerrant RL, Walker DH, Weller PF (editors). Tropical infectious diseases: principles, pathogens and practice. Third edition. Philadelphia: Elsevier, 2011.

Fessler DA, Mitty J, Mayer KH, Makadon HJ. The 2010 Health Care Act and barriers to effective health promotion among men who have sex with men.

Sex Transm Dis 2012; 39:449-52.

Bruce Bistrian, MD, PhD, MPH, and Pei-Ra Ling, PhD Department of Medicine 2012 Annual Report

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Molecular and Vascular Medicine Vijayaraj P, Le Bras A, Mitchell N, Kondo M, Juliao S, Wasserman M, Beeler D, Spokes K, Aird WC, Baldwin HS, Oettgen P. Erg is a crucial regulator of endocardial-mesenchymal transformation during cardiac valve morphogenesis. Development 2012; 139:3973-85.

Molecular and Vascular Medicine Regan ER, Aird WC. Dynamical systems approach to endothelial heterogeneity.

Circ Res 2012; 111:110-30.

The Ets family of transcription factors is diverse, but several members regulate development.

This work shows that Erg, an Ets-family member, regulates the formation of blood vessels and heart valves by controlling a fascinating process by which epithelial cells lining blood vessels are transformed to motile mesenchymal cells that crawl into place to form the heart valves.

Sage PT, Varghese L, Martinelli R, Sciuto T, Kamei M, Dvorak A, Springer TA, Sharpe A, Carman CV. Antigen recognition is facilitated by invadosomelike protrusions formed by memory/ effector T cells. J Immunol 2012; 188:3686-99.

Yuan L, Le Bras A, Sacharidou A, Itagaki K, Zhan Y, Kondo M, Carman CV, Davis GE, Aird WC, Oettgen P. ETS-related gene (ERG) controls endothelial cell permeability via transcriptional regulation of claudin-5 (CLDN5). J Biol Chem 2012; 287:6582-91.

Zhao D, Qin L, Bourbon PM, James L, Dvorak HF, Zeng H. Orphan nuclear transcription factor TR3/Nur77 regulates microvessel permeability by targeting endothelial nitric oxide synthase and destabilizing endothelial junctions. Proc Natl Acad Sci U S A 2011; 108:12066-71.

Nephrology Boucher I, Yu W, Beaudry S, Negoro H, Tran M, Pollak MR, Henderson JM, Denker BM. Gα12 activation in podocytes leads to cumulative changes in glomerular collagen expression, proteinuria and glomerulosclerosis.

Lab Invest 2012; 92:662-75.

Friedman DJ, Bhatt N, Hayman NS, Nichols BJ, Herman M, Nikolaev N, Danziger J. Impact of activated vitamin D on insulin resistance in nondiabetic chronic kidney disease patients. Clin Endocrinol (Oxf) 2012; 77:56-61.

Rodrigue JR, Ladin K, Pavlakis M, Mandelbrot DA. Disclosing recipient information to potential living donors: preferences of donors and recipients, before and after surgery. Am J Transplant 2011; 11:1270-8.

Stewart AK, Shmukler BE, Vandorpe DH, Reimold F, Heneghan JF, Nakakuki M, Akhavein A, Ko S, Ishiguro H, Alper SL. SLC26 anion exchangers of guinea pig pancreatic duct: molecular cloning and functional characterization. Am J Physiol Cell Physiol 2011; 301:C289-303.

36

Tran M, Tam D, Bardia A, Bhasin M, Rowe GC, Kher A, Zsengeller ZK, Akhavan-Sharif MR, Khankin EV, Saintgeniez M, David S, Burstein D, Karumanchi SA, Stillman IE, Arany Z, Parikh SM. PGC-1 promotes recovery after acute kidney injury during systemic inflammation in mice. J Clin Invest 2011; 121:4003-14.

Pulmonary, Critical Care and Sleep Medicine Banzett RB, Adams L, O’Donnell CR, Gilman SA, Lansing RW, Schwartzstein RM. Using laboratory models to test treatment: morphine reduces dyspnea and hypercapnic ventilatory response.

Am J Respir Crit Care Med 2011; 184:920-7.

Bera MM, Lu B, Martin TR, Cui S, Rhein LM, Gerard C, Gerard NP. Th17 cytokines are critical for respiratory syncytial virusassociated airway hyperreponsiveness through regulation by complement C3a and tachykinins. J Immunol 2011; 187:4245-55.

Dauber A, Yu Y, Turchin MC, Chiang CW, Meng YA, Demerath EW, Patel SR, Rich SS, Rotter JI, Schreiner PJ, Wilson JG, Shen Y, Wu BL, Hirschhorn J. Genomewide association of copy-number variation reveals an association between short stature and the presence of lowfrequency genomic deletions. Am J Hum Genet 2011; 89:751-9.

Department DepartmentofofMedicine Medicine2012 2012Annual AnnualReport Report

Han X, Li X, Yue SC, Anandaiah A, Hashem F, Reinach PS, Koziel H, Tachado SD. Epigenetic regulation of tumor necrosis factor α (TNα) release in human macrophages by HIV-1 single-stranded RNA (ssRNA) is dependent on TLR8 signaling. J Biol Chem 2012; 287:13778-86.

Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012; 185:435-52.

Rheumatology Crispin JC, Apostolidis SA, Rosetti F, Keszei M, Rauen T, Thai TH, Wang N, Terhorst C, Mayadas T N, Tsokos GC. Protein phosphatase 2A confers susceptibility to autoimmune disease by increasing accessibility to the Il17 locus.

J Immunol 2012; 188:3567-71.

Ghosh D, Tsokos GC, Kyttaris VC. c-Jun and Ets2 regulate the expression of spleen tyrosine kinase in T cells. J Biol Chem 2012; 287:11833-41.

Lapchak PH, Ioannou A, Rani P, Liberman LA, Yoshiya K, Kannan L, Dalle Lucca JJ, Kowalska AM, Tsokos GC. Platelet Factor 4(PF4; CXCL4) promotes lung injury after mesenteric ischemia and reperfusion. PLOS One 2012; 7:e39934.

Rauen T, Hedrich CM, Juang YT, Tenbrock K, Tsokos GC. cAMP responsive element modulator (CREM)α induces IL-17A expression and mediates epigenetic alterations at the IL17A locus in patients with systemic lupus erythematosus. J Biol Chem 2011; 286:43437-46.

Tsokos, GC. Systemic lupus erythematosus. N Engl J Med 2011; 365:2110-21.

Signal Transduction Anastasiou D, Poulogiannis G, Asara JM, Boxer MB, Jiang J-K, Shen M, Bellinger G, Sasaki AT, Locasale JW, Auld DS, Thomas CJ, Vander Heiden MG, Cantley LC. Inhibition of PKM2 by reactive oxygen species contributes to cellular antioxidant responses. Science 2011; 334:1278-83 Benes CH, Poulogiannis G, Cantley LC, Soltoff SP. The SRC-associated protein CUB Domain-Containing Protein-1 regulates adhesion and motility.

Oncogene 2011; 31:653-63..

Locasale JW, Grassian AR, Melman T, Lyssiotis CA, Mattaini KR, Bass AJ, Heffron G, Metallo CM, Muranen T, Sharfi H, Sasaki AT, Anastasiou D, Mullarky E, Vokes NI, Sasaki M, Beroukhim R, Stephanopoulos G, Ligon AH, Meyerson M, Richardson AL, Chin L, Wagner G, Asara JM, Brugge JS, Cantley LC, Vander Heiden MG. Phosphoglycerate dehydrogenase diverts glycolytic flux and contributes to oncogenesis. Nat Genet 2011; 43:869-74.

Yang X, Turke AB, Qi J, Song Y, Rexer BN, Miller TW, Janne PA, Arteaga CL, Cantley LC, Engelman JA, Asara JM. Using tandem mass spectrometry in targeted mode to identify activators of class IA PI3K in cancer. Cancer Res 2011; 71:5965-75.

Ying H, Kimmelman AC, Lyssiotis CA, Hua S, Chu GC, Fletcher-Sananikone E, Locasale JE, Son J, Zhang H, Coloff JL, Yan H, Wang W, Chen S, Viale A, Zheng H, Paik J-H, Lim C, Guimaraes AR, Martin ES, Chang J, Hezel AF, Perry SR, Hu J, Gan B, Xiao Y, Asara JM, Weissleder R, Wang YA, Chin L, Cantley LC, DePinho RA. Kras is required for pancreatic tumor maintenance through regulation of hexosamine biosynthesis and the nonoxidative pentose phosphate pathway.

Cell 2012; 149:656-70.

Translational Research Martin CR, Blanco PG, Keach JC, Petz JL, Zaman MM, Bhaskar KR, CluetteBrown JE, Gautam S, Sheth S, Afdhal NH, Lindor KD, Freedman SD. The safety and efficacy of oral docosahexaenoic acid supplementation for the treatment of primary sclerosing cholangitis — a pilot study. Aliment Pharmacol Ther 2012; 35:255-65.

Martin CR, Zaman MM, Ketwaroo GA, Bhutta AQ, Coronel E, Popov Y, Schuppan D, Freedman SD. CFTR dysfunction predisposes to fibrotic liver disease in a murine model. Am J Physiol Gastrointest Liver Physiol 2012; 303:G474-81.

Neeman N, Isaac T, Leveille S, DiMonda C, Shin JY, Aronson MD, Freedman SD. Improving doctor-patient communication in the outpatient setting using a facilitation tool: A preliminary study. Int J Qual Health Care 2012; 24:357-64.

Ooi CY, Nightingale S, Durie PR, Freedman SD. Ursodeoxycholic acid in cystic fibrosis-associated liver disease. J Cyst Fibros 2012; 11:72-5.

Stahl D, Groeben H, Kroepfel D, Gautam S, Eikermann M. Development and validation of a novel tool to estimate perioperative blood loss. Anesthesia 2012; 67:479-86.

Transplant Immunology Chalmin F, Mignot G, Bruchard M, Chevriaux A, Végran F, Hichami A, Ladoire S, Derangère V, Vincent J, Masson D, Robson SC, Eberl G, Pallandre JR, Borg C, Ryffel B, Apetoh L, Rébé C, Ghiringhelli F. Stat3 and Gfi-1 transcription factors control Th17 cell immunosuppressive activity via the regulation of ectonucleotidase expression. Immunity 2012; 36:362-73.

Feng S, Edong UD, Lobritto SJ, Demetris AJ, Roberts JP, Rosenthal P, Alonso EM, Philogene MC, Idle D, Poole KM, Bridges ND, Turka LA, Tchao NK. Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants. JAMA 2012; 307:283-93.

Yamada Y, Boskovic S, Aoyama A, Murakami T, Putheti P, Smith RN, Ochiai T, Nadazdin O, Koyama I, Boenisch O, Najafian N, Bhasin MK, Colvin RB, Madsen JC, Strom TB, Sachs DH, Benichou G, Cosimi AB, Kawai T. Overcoming memory T-cell responses for induction of delayed tolerance in nonhuman primates. Am J Transplant 2012; 12:330-40.

Vaccine Research Barouch DH, Klasse PJ, Dufour J, Veazey RS, Moore JP. Macaque studies of vaccine and microbicide combinations for preventing HIV-1 sexual transmission. Proc Natl Acad Sci U S A 2012; 109:8694-8.

Barouch DH, Liu J, Li H, Maxfield LF, Abbink P, Lynch DM, Iampietro MJ, SanMiguel A, Seaman MS, Ferrari G, Forthal DN, Ourmanov I, Hirsch VM, Carville A, Mansfield KG, Stablein D, Pau MG, Schuitemaker H, Sadoff JC, Billings EA, Rao M, Robb ML, Kim JH, Marovich MA, Goudsmit J, Michael NL. Vaccine protection against acquisition of neutralization-resistant SIV challenges in rhesus monkeys. Nature 2012; 482:89-93.

Kovacs JM, Nkolola JP, Peng H, Cheung A, Perry J, Miller CA, Seaman MS, Barouch DH, Chen B. HIV-1 envelope trimer elicits more potent neutralizing antibody responses than monomeric gp120. Proc Natl Acad Sci U S A 2012; 109:12111-6.

Stephenson KE, Li H, Walker BD, Michael NL, Barouch DH. Gag-specific cellular immunity determines in vitro viral inhibition and in vivo virologic control following simian immunodeficiency virus challenges of vaccinated rhesus monkeys. J Virol 2012; 86:9583-9.

Stephenson KE, Sanmiguel A, Simmons NL, Smith K, Lewis MG, Szinger JJ, Korber B, Barouch DH. Full-Length HIV-1 Immunogens Induce Greater Magnitude and Comparable Breadth

of T Lymphocyte Responses to Conserved HIV-1 Regions Compared With Conserved-Region-Only HIV-1 Immunogens in Rhesus Monkeys. J Virol 2012; 86:11434-40.

Viral Pathogenesis Bolton DL,* Santra S,* Swett C, Custers J, Song K, Balachandran H, Kozlowski PA, Letvin NL, Roederer M, Radosevic K. Priming T-cell responses with recombinant measles vaccine vector in a heterologous prime-boost setting in non-human primates. Vaccine 2012; 30:5991-8. *Co-first authors.

Dang X, Wüthrich C, Gordon J, Sawa H, Koralnik IJ. JC virus encephalopathy is caused by a novel agnoprotein-deletion JCV variant. PLOS One 2012; 7:e35793.

Santra S, Muldoon M, Watson S, Buzby A, Balachandran H, Carlson KR, Mach L, Kong WP, McKee K, Yang ZY, Rao SS, Mascola JR, Nabel GJ, Korber BT, Letvin NL. Breadth of cellular and humoral immune responses elicited in rhesus monkeys by multi-valent mosaic and consensus immunogens. Virology 2012; 428:121-7.

Wüthrich C, Koralnik IJ. Frequent infection of cortical neurons by JC virus in patients with progressive multifocal leukoencephalopathy. J Neuropath Exp Neurol 2012; 71:54-65.

Transplant Immunology Gupta S, Thornley TB, Gao W, Larocca R, Turka LA, Kuchroo VK, Strom TB. Allograft rejection is restrained by short-lived TIM-3+PD-1+Foxp3+ Tregs. J Clin Invest 2012; 122:2395-404.

Regulatory T cells (T regs) that counteract rejection infiltrate transplants. With each wave of proliferation, T regs are more able to produce locally active immunosuppressive agents. Data suggest that these cells may be propagated ex vivo and used as a therapy to protect transplants from injury. But after proliferation, T regs are programmed for death, so their effective use will require great care and delicacy.

Laurence Turka, MD, and Terry Strom, MD Department of Medicine 2012 Annual Report

37

Building Bridges

and Promoting Health through Innovative Community Partnerships

Left to right: Susanne Hartmann, MD, MPH, Daniel Press, MD, and Melissa Mattison, MD, during an ECHO-AGE session.

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Department of Medicine 2012 Annual Report

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very two weeks, a group gathers in a conference room on BIDMC’s East Campus.

The team consists of two geriatricians, a neurologist, a geriatric psychiatrist and a social worker. They sit facing a large video screen divided into several windows, each representing an extended care facility in New England.

The “clinic” starts with one facility presenting the case of a patient suffering from delirium and/or dementia and often debilitating symptoms. During the two-hour session, made possible with support from the Rx Foundation, the BIDMC team listens to a number of such cases — some new and some follow-up — and offers guidance to the partnering facilities’ health care teams, and occasionally to patients’ family members.

A similar “clinic” was launched this year on the medical center’s West Campus, but this videoconference-enabled discussion focuses on the treatment of patients with hepatitis C, a potentially fatal liver disease that can be managed, but only with a complex, sophisticated and sometimes toxic combination of medications. This team, led by members of the Divisions of Infectious Diseases, Hepatology and Pharmacology, is partially supported by an innovations grant from Vertex Pharmaceuticals and holds bi-weekly videoconferences with four facilities: three that are part of Outer Cape Health Services and the Greater Lawrence Family Health Center.

Both of these initiatives — ECHO-AGE and ECHO-HCV, respectively — are part of BIDMC-ECHO, an innovative program bringing specialty care to a wide range of community partners. Modeled after Project ECHO (Extending Community Health Outcomes), a program started at the University of New Mexico by Sanjeev Arora, MD, BIDMC-ECHO builds partnerships between academic health centers and community colleagues.

For patients, this collaboration means they receive state-of-the-art health care from professionals they know and trust in their own communities. For primary care providers, the partnership enables them to provide specialty care while overcoming geographic and/or clinical support obstacles. The end result is better quality and greater access to health care for patients throughout New England.

Embracing the concept of patient-centered care and “medical homes,” the ECHO model has been shown to improve patient outcomes.

These BIDMC-ECHO programs reflect the department’s growth and adaptation in the face of a changing health care landscape, which will increasingly require academic medical centers to foster and strengthen partnerships with patients and providers in communities near and far.

But they are not the only Department of Medicine programs expanding access, regardless of geography. In February 2012, Julie Moran, DO, of the Division of Gerontology and the Massachusetts

Stephen Tobierre, MD, with patient at Joseph M. Smith Community Health Center.

Department of Developmental Services, entered into a formal partnership to expand clinical and educational services statewide for aging adults with intellectual and developmental disabilities. Moran, an expert in this field, now provides consultative services to the Central and Western regions of the state at Glavin Regional Center in Shrewsbury, MA, modeled after the unique specialty clinic she created at BIDMC SeniorHealth. The Division of Endocrinology has similarly expanded its Department of Medicine 2012 Annual Report

39

13

Department of Medicine Partnering Throughout New England

reach this year by providing services at newly-created satellite clinics at Lawrence General Hospital. There, Jill Paulson, MD, has started successful thyroid nodule and general endocrine clinics.

The BIDMC Community Benefits Department continues to work closely with seven affiliated community health centers, supporting the Community Care Alliance and the Mystery Shopping Program, an anonymous means of gauging and improving access and customer service. Additionally, this year there has been major expansion — or planning for expansion — at several of the health centers, with South Cove Community Health Center opening a new site in Quincy, Fenway Health completing the build-out of its final two and a half floors, The Dimock Center planning renovations and an expansion of it clinical capacity, Outer Cape Health Services completing renovation and expansion at its Provincetown site, and Joseph M. Smith Community Health Center developing plans for a new site on Soldier’s Field Road and opening a new pharmacy in Waltham.

With support from the Health Resources Service Administration, Outer Cape Health Services and Fenway Health will both be implementing breast cancer screening programs as part of these expansions.

Bowdoin Street Health Center also received Level III Designation as a Patient-Centered Medical Home, as featured on p. 9.

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Department of Medicine 2012 Annual Report

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8 10

5

4

3

9

6

2 7

1

14 6

11

Barbara Mendes, MD, with patient Gai Nguyen at Bowdoin Street Health Center.

Alex Gonzalez, MD, with a patient at Fenway Health.

1 Bowdoin Street Health Center — Dorchester

8 Chelsea Jewish Nursing Home — Chelsea

2 The Dimock Center — Roxbury

9 Coolidge House —Brookline

3 Fenway Health — Boston 4 Joseph M. Smith Community Health Center — Allston/ Brighton and Waltham 5 Sidney Borum Jr. Health Center — Boston 6 South Cove Community Health Center — Boston and Quincy 7 Leonard Florence Center for Living — Jamaica Plain, Boston

10 Newton Health Care Center — Newton 11 Life Care Center Raynham — Raynham 12 Outer Cape Health Services — Provincetown, Wellfleet and Harwich 13 Greater Lawrence Family Health Center — Lawrence

Kathy Kates, NP, of Joseph M. Smith Community Health Center, with Julianna and Gillian Kibirige.

12

Lawrence General Hospital — Lawrence 14 Glavin Regional Center — Shrewsbury

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Department of Medicine 12 2012 Annual Report

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Honors and Awards highlights Griffin Weber, MD, PhD, of the Division of Interdisciplinary Medicine and Biotechnology (IMBIO) launched Clinical Query 2, a web-based tool that enables investigators at BIDMC to query 2.2 million patients and 200 million data elements. It can be used to test research hypotheses and determine the feasibility of clinical trials. InformationWeek named BIDMC the “#1 technology innovator in the United States” and identifies Clinical Query 2 as a “centerpiece of BIDMC’s ITbased innovation.” The Boston Globe magazine also featured the tool as one of the “5 biggest medical breakthroughs of the year: The most notable medical advances of 2012.”

Alexander Carbo, MD, a member of the Division of General Medicine and Primary Care, was named a Top 10 hospitalist in the US by the American College of Physicians (ACP) for 2012. This is the fifth year that ACP has offered this honor, and the department has had four previous recipients: Julius Yang, MD, PhD (2011); Anjala Tess, MD (2010); and Melissa Mattison, MD, and Joseph Li, MD, the current Director of the department’s Hospital Medicine Program (2008).

Jerome Groopman, MD, and Pamela Hartzband, MD, Chief of the Division of Experimental Medicine and Medical Director of the Thyroid Nodule Center in the Endocrinology Division, respectively, received the Humanism in Medicine Award from The Arnold P. Gold Foundation for their example and leadership in advancing professional standards of compassionate, patient-centered care and service to the community. In addition to being exceptional physicians, educators and researchers, Groopman and Hartzband are prolific co-authors, their latest work being Your Medical Mind, a fascinating look at medical decision making.

Groopman is also well-known for his articles in the New Yorker magazine, where he is a staff writer.

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Department of Medicine 2012 Annual Report

John Frangioni, MD, PhD, of the Division of Hematology-Oncology and the BIDMC Center for Molecular Imaging, was named “one of the top three innovators in the field of medicine,” by The Boston Globe, part of its Top 100 Massachusetts Innovators list.

Dr. Frangioni was recognized for his work on “FLARE” (Fluorescence-Assisted Resection and Exploration), a novel technology that enables surgeons to identify sentinel lymph nodes during breast cancer surgery.

Cardiovascular Medicine Saumya Das, MD, PhD – Received the Klarman Scholar Award for translational studies of cardiac resynchronization therapy.

Mark Josephson, MD – Delivered the American College of Cardiology 49th Annual Carl J. Wiggers Memorial Lecture and was honored by colleagues and almost 200 electrophysiologists who trained under him at the “The Josephson Scholars – Four Decades of Clinical EP” program, held in conjunction with the 33rd Annual Heart Rhythm Society Scientific Sessions.

Clinical Informatics Meghan Dierks, MD – Inducted Fellow of the American College of Surgeons.

Justin Hubbard, MD, and Yonas Tamrat, MD – Won the New England Journal of Medicine’s 200th Anniversary Essay Contest for their essay, “From data to action: how passive data streams will drive patient wellness.”

Warner Slack, MD – Received the Medical Alumni Citation Award from the Wisconsin School of Medicine and Public Health.

Clinical Nutrition Bruce Bistrian, MD, PhD, MPH – Named a Fellow of the American Society of Parenteral and Enteral Nutrition at the Annual Clinical Congress of the Society.

Endocrinology, Diabetes and Metabolism Christos Mantzoros, MD, DSc – Received the Distinguished Physician Scientist Award from the Greek Society of Obesity for his distinguished lifetime research and clinical contributions to obesity and metabolism.

Johanna Pallotta, MD – Recognized by Best Doctors in America.

Gastroenterology Maggie Ham, MD – Received the Inflammatory Bowel Disease Working Group’s Research Award in Inflammatory Bowel Disease.

Alan Moss, MD – Named Associate Editor, Frontiers in Gastroenterology (BMJ Group); appointed to the Nominating Committee, Immunology and Inflammatory Bowel Diseases Section, AGA Institute Council; first recipient of the Irving W. and Charlotte F. Rabb Endowed Fund for Gastroenterology Research; and delivered Goldwitz-Allen Memorial Lecture at the State University of New York.

Douglas Pleskow, MD – Appointed 2012 Honorary Director of Endoscopy at Changhai Hospital in Shanghai, China, and received the Compassionate Doctor Award.

Simon Robson, MB, ChB, PhD – Named Chief of the Division of Gastroenterology.

General Medicine and Primary Care Ken Mukamal, MD, MPH, and Christina C. Wee, MD, MPH – Elected to the American Society of Clinical Investigation.

Genetics Pier Paulo Pandolfi, MD, PhD – Received the Scanno International Medical Award and a special recognition from Giorgio Napolitano, the President of Italy.

Gerontology Sharon Inouye, MD, MPH – Elected Member of the Institute of Medicine of the National Academies.

Susan Mitchell, MD, MPH – Elected to the Association of American Physicians.

Hemostasis and Thrombosis Kenneth Bauer, MD, David Roth, MD, and Bruce Furie, MD – Named Best Doctors by Best Doctors, Inc. Barbara Furie, PhD – Elected Chairman of the Board of the North American Society on Thrombosis and Hemostasis.

Bruce Furie, MD – Received the Distinguished Career Award from the International Society on Thrombosis and Haemostasis; was the Sol Sherry Distinguished Lecturer in Thrombosis at the American Heart Association Annual Meeting; and delivered the inaugural Simon Karpatkin Lecture at New York University School of Medicine.

Department of Medicine 2012 Annual Report

43

IMBIO Ary Goldberger, MD – Delivered the keynote address at the national meeting of the Society of Industrial and Applied Mathematics; was the co-organizer and speaker at the Wyss Institute Symposium; and was the invited speaker at the DARPA Fundamental Laws of Biology conference.

Vikas Sukhatme, MD, PhD – Delivered the keynote addresses for five PriMed conferences.

Infectious Diseases Sigall Bell, MD – Received the Arnold P. Gold Foundation Professorship.

Kenneth Mayer, MD – Received the 2012 Founders Award at the “Us Helping Us” Annual Celebration for his leadership in support of HIV prevention in the African-American community.

Michael Wong, MD – Honored as a Hero in Action by the AIDS Action Committee and the Department of Public Health.

Nephrology Peter Czarnecki, MD – Earned the American Society of Nephrology Research Fellowship Award.

Katherine Lynch, MD – Received the American Kidney Fund Amgen Clinical Scientist in Nephrology Fellowship Award.

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Department of Medicine 2012 Annual Report

Ali Poyan Mehr, MD – Earned the BIDMC Silverman Institute Innovation Quality Grant Award.

Theodore Steinman, MD, FASN – Received the 2012 Medal of Excellence Award from American Association of Kidney Patients.

Pulmonary, Critical Care and Sleep Medicine Sanjay Patel, MD – Selected to Chair the Program Committee for the Sleep and Respiratory Neurobiology Assembly of the American Thoracic Society, and named Vice Chair of the Research Committee of the American Academy of Sleep Medicine and Deputy Editor of the journal Sleep.

Richard Schwartzstein, MD – Received the 2012 Harvard Medical School Donald O’Hara Faculty Prize for Excellence in Teaching.

Robert Thomas, MD – Elected to the Sleep Medicine Fellowship Directors Council steering committee.

Rheumatology Gwen Kane-Wanger, MD – Elected Vice President of New England Rheumatism Society.

George Tsokos, MD – Appointed to the Scientific Advisory Board of the Alliance for Lupus Research, to the Medical/Scientific Advisory Board of the Lupus Foundation of America and to the Nominations Committee of the American College of Rheumatology.

Transplant Immunology Maria Serena Longhi, MD, PhD – Received a Medical Research Council Clinician Scientist Fellowship.

Moritz Schmelzle, MD – Received the Translational Centre for Regenerative Medicine Excellence Award, the German Ministry of Education and Research Young Investigator Award, the European Society for the Study of the Liver Young Investigator Award and the American Liver Foundation Research Fellowship Award.

Vaccine Research Dan Barouch, MD, PhD – Received the Oswald Avery Award from the Infectious Diseases Society of America; served as Conference Chair of AIDS Vaccine 2012; was appointed Chair of the NIH VACC Study Section, HIV Vaccines, NIH/ NIAID; joined the Scientific Governance Committee of the HIV Vaccine Trials Network; and was named Director of the Center for Virology and Vaccine Research at BIDMC.

BY THE NUMBERS Research Funding AY 2012 Division

Funding Source

Direct Award July 2011 through June 2012

Indirect Award July 2011 through June 2012

Allergy and Inflammation

Federal Total Non-Federal Total

1,039,888.52 205,386.49

735,716.78 18,264.01

Cardiovascular Medicine

Federal Total Non-Federal Total

9,205,109.69 4,325,073.44

3,173,273.64 701,269.85

Clinical Informatics

Federal Total Non-Federal Total

107,142.24 17,391.30

18,211.76 2,608.70

Endocrinology

Federal Total Non-Federal Total

5,898,828.48 3,470,471.86

3,567,853.13 410,009.79

Experimental Medicine

Federal Total Non-Federal Total

1,251,427.00 791,982.93

833,088.00 8,500.00

Gastroenterology

Federal Total Non-Federal Total

2,579,305.92 3,013,014.81

1,313,209.18 771,479.09

General Medicine

Federal Total Non-Federal Total

7,675,364.55 3,982,085.73

1,207,878.17 362,153.56

Genetics

Federal Total Non-Federal Total

2,425,008.11 1,340,163.11

1,339,741.48 17,825.90

Gerontology

Federal Total Non-Federal Total

1,273,049.77 517,520.59

172,662.91 126,692.81

Hebrew Senior Life

Federal Total Non-Federal Total

7,955,271.00 1,010,335.00

2,351,886.00 163,911.00

Hematology-Oncology

Federal Total Non-Federal Total

13,391,597.99 9,211,436.75

6,406,137.34 1,268,681.75

Hemostasis and Thrombosis

Federal Total Non-Federal Total

2,674,757.62 374,143.78

1,329,973.63 34,656.22

Immunology

Federal Total Non-Federal Total

4,067,112.43 426,632.47

1,195,866.99 172,507.00

Infectious Diseases

Federal Total Non-Federal Total

1,276,432.84 743,982.25

579,021.03 68,440.35

Department of Medicine 2012 Annual Report

45

Department/Division

Funding Source

Direct Award July 2011 to June 2012

Indirect Award July 2011 to June 2012

Interdisciplinary Medicine/Bio

Federal Total Non-Federal Total

1,683,773.61 1,901,512.46

776,129.40 68,187.49

Molecular and Vascular Medicine

Federal Total Non-Federal Total

3,125,183.42 1,672,761.92

1,837,876.35 18,366.30

Nephrology

Federal Total Non-Federal Total

2,801,416.79 2,499,718.65

1,391,116.64 281,321.09

Nutrition Medicine

Federal Total Non-Federal Total

17,727.27 44,334.52

13,090.80 –

Pulmonary and Critical Care

Federal Total Non-Federal Total

857,602.46 316,723.57

528,309.78 56,399.63

Rheumatology

Federal Total Non-Federal Total

3,459,645.63 337,275.55

1,973,843.47 34,916.45

Signal Transduction

Federal Total Non-Federal Total

3,721,584.40 11,162,639.38

1,052,809.76 150,301.29

Translational Research

Federal Total

3,518,972.24

–

Transplant Immunology

Federal Total Non-Federal Total

3,908,970.54 835,458.21

843,811.47 89,711.56

Vaccine Research

Federal Total Non-Federal Total

12,877,917.62 3,913,947.58

1,061,100.70 441,170.47

Viral Pathogenesis

Federal Total Non-Federal Total

11,477,648.94 4,195,960.93

4,511,231.64 480,995.57

164,593,528.16

43,962,209.93

Grand Total

46

Department of Medicine 2012 Annual Report

Statistical Snapshot Clinical (FY 2012)

Research (AY 2012)

823,227

$108,281,536.08

Work RVU

$58,618,901 Payments

14,555 Discharges

Federal Direct

$56,311,992.08 Non-Federal Direct

$164,593,528.16

268,560

Total Direct

3,606

$38,213,840.05

25,701

$5,748,369.88

Outpatient Visits

Cardiac Catheterizations

Endoscopic Procedures

Federal Indirect

Non-Federal Indirect

$43,962,209.93 Total Indirect

Department of Medicine 2012 Annual Report

47

Department of Medicine at Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215 617-667-7000 www.bidmc.org/medicine

Beth Israel Deaconess Medical Center (BIDMC) is a patient care, teaching and research affiliate of Harvard Medical School and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. The medical center is clinically affiliated with the Joslin Diabetes Center and is a founding member of the Dana-Farber/ Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox.