October 7, 2022

DOM CONNECT:

Your Department, Your Colleagues, Your Stories

We are pleased to introduce DOM CONNECT: Your Department, Your Colleagues, Your Stories, our new monthly newsletter where we will bring you in-depth stories and features about our remarkable faculty, staff, and teams in the Department of Medicine.

We hope you enjoy!

Spotlight: The Bone Health Service

The Bone Health and Osteoporosis Foundation has estimated that 1 in 2 women and up to 1 in 4 men over the age of 50 will have an osteoporotic fracture. For those that suffer a hip fracture, the one-year mortality is 25% and at six months, only 15% of individuals are able to walk across a room unaided. While effective and safe methods exist for osteoporosis screening and treatment, worldwide these modalities are chronically underutilized. Through a variety of collaborative efforts within the Department of Medicine and the broader institution, those interested in osteoporosis and bone health have been working to address these challenges.


Here, we highlight some of their recent initiatives. 

 

Improving screening methods for identifying individuals at risk of fracture  

The US Preventative Services Task Force (USPSTF) recommends that women aged 65 and over should be screened for osteoporosis. Effective screening methods, such as dual-energy x-ray absorptiometry (DXA) scans are well established across UMMH sites, but in 2021, in partnership with the Office of Clinical Integration (OCI), it was determined that only 50% of non-white, and 64% of white women in the Wellness Registry met this recommendation. Thus, improving screening rates, specifically in non-white women, became a priority. Interventions that began with identifying care gaps among primary care practices whose populations were eligible for screening were initiated in partnership with the OCI. As of September 2022, screening in all groups has increased, with white women at 69% and non-white women at 62%. Megan Brochu, PA-C conducted much of this work, in conjunction with her role as a provider at Hahnemann Family Health Center. She was co-awarded this year’s Advanced Practice Council Paulette Seymour-Route Exemplar Award. 

 

DXA Service Improvements 

Work has focused on the attempt to standardize equipment and processes at all locations through better access, a simplified and expanded list of indications in the Epic order (with help from Elise Pyun, MD, clinical chief and associate professor of medicine in the Division of Rheumatology, Gabriela Szabo, MD, assistant professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism, and Steve Erban, MD, section chief of Clinical Informatics and associate professor of medicine in the Division of Health Systems Science), a new standard operating procedure (led by Dr. Gabriela Szabo), and a capital upgrade to DXA software and hardware which will bring all machines up to current standards and offer Trabecular Bone Score in addition to bone mineral density screening.  

 

Study of Incidental Vertebral Fractures 

Vertebral compression fractures (VCFs) are a common example of an osteoporotic fracture and their presence indicates a clinical diagnosis of osteoporosis. However, up to 50% of all VCFs are asymptomatic, and therefore are only discovered if imaging of the spine is performed for another reason (e.g., a CT chest for low dose cancer screening).  A study of CT and MRI scans in individuals over the age of 50 with note of a VCF at the Benedict Internal Medicine practice led by Internal Medicine residents Jason Yang and Alexia Hwang and APPs Meridith Malysz, Krista Sabina and Megan Brochu, with assistance from colleagues in the Department of Radiology identified that approximately 40% of those individuals did not have a pre-existing diagnosis of osteoporosis and that there was room for improvement to ensure further bone health assessment in the time after an index scan. Discussions are presently underway to see how to leverage internal and external Natural Language Processing solutions to better bring these incidental findings to attention. 

 

Post-Fracture Care Service 

The Fracture liaison service (FLS) aims to identify individuals with an osteoporotic fracture in real time. The original FLS was initiated by Eyad Hamoudeh, MD, assistant professor of medicine in the  Division of Endocrinology, Diabetes and Metabolism, and after a hiatus due to the COVID-19 pandemic, efforts have been renewed in restarting this service. Under Dr. Hamoudeh’s guidance and with support from Hospital Medicine leadership (Richard Forster, MD and Gregory Leslie, MD) and the Department of Orthopedics, there are now formal weekday Orthopedic Trauma multi-disciplinary rounds (MDRs), where an outpatient referral to Endocrinology is placed as required, but also incorporates the health-system initiative around MDRs with initial feedback suggesting enhancements in overall patient care. 

 

Education 

Providers and leadership of the Bone Health Service are involved in educational initiatives at the local, regional, and national level. Locally, webinars and written materials such as the OCI Population Health Webinar have been created and disseminated to PCPs at UMMH. At the regional level, a joint UMass and BU monthly online bone club has been established by Dr. Gabriela Szabo which serves as a venue for case presentations, discussions of clinical questions, and review of guidelines related to metabolic bone disease. Additionally, outreach education on osteoporosis has taken place at local communities of practice including Central MA Association of Physicians and Sturdy Memorial Hospital. At the national level, members from the osteoporosis initiative are contributing to the American College of Rheumatology’s redesign of their Rheum2Learn initiative, which provides online learning opportunities to Internal Medicine and Family Medicine trainees. In conjunction with colleagues from Geisinger Health System, the Osteoporosis module, co-authored by Jonathan Cheah, MD, assistant professor of medicine in the Division of Rheumatology, will be available in early 2023. Additionally, UMass will be represented in the soon to be released 2022 update to the American College of Rheumatology’s Clinical Practice Guideline relating to Glucocorticoid-Induced Osteoporosis, with Dr. Cheah contributing to the updated literature review on which the guidelines are constructed. 

 

A number of additional initiatives are also presently focusing on ensuring those with osteoporosis at risk of future fracture are linked to therapies proven to reduce the risk of fracture and embraces colleagues from the Departments of Medicine, Radiology, Family Medicine and beyond. 

Spotlight: Hematology-Oncology and Hospital Medicine Collaboration

Left to Right: Drs. Forster, Eisenstock, and Gerber

Since the summer of 2020, the Divisions of Hematology-Oncology and Hospital Medicine have engaged in an innovative collaboration which benefits patients, faculty, and residents at UMass Chan. Richard Forster, MD, executive vice chair, chief of the Division of Hospital Medicine and associate professor of medicine; Kimberly Eisenstock, MD, clinical chief of the Division of Hospital Medicine and assistant professor of medicine; and Jonathan Gerber, MD, the Eleanor Eustis Farrington Chair in Cancer Research, chief of the Division of Hematology-Oncology (Hem-Onc) and professor of medicine, collaborated to create a care model where hospitalists work alongside specialists in Hem-Onc. This initiative was conceptualized when Hem-Onc was struggling to maintain the balance of inpatient and outpatient services.   

 

As a result, hospitalists, supervising medical residents, oversee the general medical needs of oncology patients and the oncologists collaborate in a consultative role. This arrangement frees up oncologists to see patients in their ambulatory clinics. The transition to a collaborative model has been successful and well-received, especially from a resident and faculty standpoint. “I [have] enjoyed being on [the] service,” remarked Dr. Forster. “I liked learning more about advancing cancer care and enjoyed my interactions with the Oncology faculty and fellows."   

 

The COVID-19 pandemic presented some challenges when, during the surges, Hospitalists assigned to the Hem-Onc service had to re-deploy back to general Hospital Medicine services. This required the Hem-Onc faculty to reassume the total care of the oncology inpatients. During such challenging times, the flexible nature of this collaboration made it an overall success and a positive experience for both Hem-Onc and Hospital Medicine.   

 

Collaborations like these strengthen our clinical care services. This creative solution where resources were redistributed and utilized in new ways, was ultimately beneficial to all involved. With that in mind, collaborative efforts with other divisions are continuing to emerge within our department. In addition to their work with Hem-Onc, our hospitalists have also started working with Gastroenterology residents to help manage patients and free up time for GI physicians.   

Excellence in Research

Honghuang Lin and Davos Alzheimer's Collaborative: Digital Technology Aims to Reduce Health Disparity 


On September 27, 2022, the Today Show featured a story out of Rio Grande City, in Starr County Texas, whose population has one of the highest incidences of Alzheimer’s disease (AD) in the nation. According to the report, in Starr County (whose population is 98% Hispanic), 1 out of 4 people ages 65 or older are suffering from AD or dementia. By contrast, the overall national AD rate reported by the Alzheimer’s Association for the same age group is 1 out of 9. However, most studies up to this point have not been inclusive, even though Hispanics are one and half times more likely than whites to have dementia.  

 

In the report, Dr. Rhoda Au, Global Cohort Program Director of Davos Alzheimer’s Collaborative explained how researchers want to understand why there is such a high incidence of the disease in this region and population, and are studying how factors including diet, sleep, activity, and alcohol consumption, as well as family history, may contribute.  

 

Honghuang Lin, PhD, professor of medicine in the Division of Health Systems Science and the Program in Digital Medicine, is closely collaborating with Dr. Au on this work. Together, the team is leveraging technological advances to build a global cohort of AD patients that is representative of the world population. The project would enable global collaboration to accelerate AD research and allow investigators from low-resourced environments, like Rio Grande City, to participate on the same playing field as those from high-resourced environments. “This is one of many examples to demonstrate how digital technology might help to reduce health disparity and improve global health through international collaboration,” said Dr. Lin of these collaborative efforts. 

Today Show Feature

Excellence in Clinical Care

Gisela Banauch and the EMCO Team Deliver Exceptional Care


The Department of Medicine would like to recognize Gisela Banauch, MD, assistant professor of medicine in the Division of Pulmonary, Allergy, and Critical Care, and the ECMO (extracorporeal membrane oxygenation) Team for excellence in patient care. Dr. Banauch, who served as the eICU attending for the team, recommended that a patient undergo an ECMO consult, a form of life support that can replace the lung temporarily and be used as temporary support for cardiac failure. She and her team worked tirelessly to transfer several ICU patients to ensure the patient had an open bed while they began cannulation. Along with physician assistant Christina Carbone, Dr. Banauch also initiated a conversation with various medical centers that perform VV-ECMO procedures to arrange for the patient to be transferred. The team was ultimately able to locate a bed for the patient at another medical center in the region, where they could undergo their procedure. 


“This effort across multiple disciplines and multiple medical centers resulted in saving [the]…life [of] a person who [was] sick, due to a condition which intermittently endanger[ed] their otherwise normal life,” stated Dr. Banauch. “The [other facility’s] team communicated to me that the patient’s family was extremely nice and grateful for this course of events.” We applaud the exceptional teamwork of Dr. Banauch and her colleagues! 

Excellence in Education

Fantastic Start to 2022-2023 Medical Grand Rounds 


The 2022-2023 Medical Grand Rounds series kicked off in early September with a talk by Terence Flotte, MD, dean of the T.H. Chan School of Medicine, titled, “Clinical Gene Therapy for Tay-Sachs and Sandhoff Diseases”. “[Dr. Flotte] embodies excellence in clinical medicine, leadership, medical education, and, as we saw in his wonderful talk, translational research. His work to use gene therapy to treat genetic disorders in children is inspiring and incredibly impressive,” said Read Pukkila-Worley, MD, associate professor of medicine in the Division of Infectious Diseases and Immunology and interim director of the Department of Medicine Medical Grand Rounds series, of his talk. 


September Grand Rounds also featured a presentation by Kate Fitzgerald, PhD, professor of medicine, vice chair for research, and chief of the Division of Innate Immunity, on “The Offensive Side of Immune Defenses; How the Innate Immune System Protects and Harms.” “Dr. Fitzgerald is a shining star of our department…her talk was inspirational,” said Dr. Pukkila-Worley. 


Our first October Grand Rounds was presented by Jerry Gurwitz, MD, chief and professor of medicine in Geriatric Medicine, titled “We Have Met the Aging and They Are Us-Confessions of an Aging Geriatrician,” which was also very well received by the UMass community.


We look forward to welcoming the rest of our fantastic line-up of speakers from our department and around the globe to campus. Please join us in person for these presentations if you are able. Light refreshments will be available. 


Interested in watching our Grand Rounds presentations? Click on the links below.


September 8 - Grand Rounds: Clinical Gene Therapy for Tay-Sachs and Sandhoff Diseases

September 15 - Grand Rounds: Rapid COVID-19 Development and the Future of Vaccinology

September 22 - Grand Rounds: Computational Medicine for the Heart

September 29 - Grand Rounds: Immune Defenses and Offenses

October 6 - Grand Rounds: We Have Met the Aging and They Are Us-Confessions of an Aging Geriatrician

Convocation Honors

Department of Medicine Faculty Honored, Invested at 2022 Convocation


At the UMass Chan Convocation Ceremony on September 16th, Drs. Deborah DeMarco, Ira Ockene, and Melissa Fischer were honored with Chancellor’s Awards and Drs. Roberto Caricchio and Alan Mullen received invested professorships. Click here to read our September 19th DOMCOMM: Special Issue to learn more. 

Promotions and Recruitment

Promotions


Congratulations to the following faculty on their recent promotions:


Kevin C. Floyd, MD, MS

Cardiovascular Medicine

Associate Professor


Afroz S. Saquib, MBBS

General Internal Medicine

Assistant Professor


Randall J. Morse, MD, FACP, CMD

Geriatric Medicine

Associate Professor

Recruitment


Please join us in welcoming our recent new hires:


Cardiovascular Medicine

Kevin O'Day, MD


Gastroenterology

Lauren Feld, MD


Hematology and Oncology

Alice Caffrey, MD


Hospital Medicine

Jonathan Fogel, MD

Matthew Greenwood, MD

Omar Hadzipasic, MD

Michael Kalfopoulos, MD

Robert Le, MD

William White, MD