BIDMC Obstetrics and Gynecology 2013 Annual Report

Transcription

BIDMC Obstetrics and Gynecolog y 2013 Annual Report
Table of Contents
4
Chair’s Message
48 Female Pelvic Medicine and
6
Who We Are
8
A Medical History of BIDMC
51 Urogynecology at
52 Neonatology
13 Clinical
14 Obstetrics and Gynecology
25 Maternal-Fetal Medicine/High-Risk Obstetrics and Clinical Genetics
31 Gynecologic Oncology
35 Colposcopy and Laser Surgery Unit
36 Family Planning
38 Reproductive Endocrinology and Infertility
43 Minimally Invasive Gynecologic Surgery
Mount Auburn Hospital
57 Quality, Safety, and Performance
Improvement
65 Nursing
68 Social Work
70 Education
71 Maternal-Fetal Medicine Fellowship
72 Reproductive Endocrinology
and Infertility Fellowship
BIDMC OB/GYN Annual Report 2013
11 Honors and Awards
Reconstructive Surgery
2.
Previous Section • Next Section
Table of Contents
73 Female Pelvic Medicine and
95 Social Mission
96 Community Health Consortium
74 Obstetrics and Gynecology
Residency Program
77 Administrative Chief Resident
79 Medical Student Education
97 Global and Community Health Program
100The Parent Connection
101 Service-Based Learning and
Reconstructive Surgery Fellowship
Research Projects
82 Research
104Living in Boston
83 Research
106Publications
87 Preeclampsia and Hypertensive Disorders of Pregnancy
88 Reproductive Endocrinology Research
90 Optical Diagnosis of Disease
93 Medical Education Research
3.
BIDMC OB/GYN • Chair ’s Message
Chair’s Message
Beth Israel Deaconess Medical Center (BIDMC), a major teaching hospital of Harvard Medical School, is known for its quality
research, and outstanding educational programs. Our distinctive
blend of academic rigor, combined with empathic family-centered care, makes us unique. As a flagship teaching hospital of
Harvard Medical School, the faculty in the Department of Obstetrics and Gynecology at BIDMC teaches obstetrics and gynecology to a third of all Harvard Medical students. The department
offers a residency program in obstetrics and gynecology to 20
residents, with 5 residents per year. Our intimate program gives
residents a feeling of individuality that is partnered with an emphasis on evidence-based medicine and research. We offer felHope Ricciotti, MD
Acting Chair of Obstetrics and Gynecology
–> Table of Contents
lowship programs in Maternal–Fetal Medicine and in Reproductive Endocrinology and Infertility. An accredited fellowship in
and value in patient care, leading-edge clinical and basic science
4.
BIDMC OB/GYN • Chair ’s Message
Female Pelvic Medicine and Reconstructive Surgery is offered
is a leader in educational research in women’s health. We believe
in partnership with the Mount Auburn Hospital in Cambridge,
that it takes a team effort to deliver quality health care. Our ex-
Massachusetts. An Ob/Gyn Clinical Informatics Fellowship is
traordinary group of attending physicians, fellows, residents, and
offered in collaboration with the BIDMC Division of Informat-
medical students work in partnership with our world-renowned
ics. Through close collaborations with other departments at the
nurses and staff to care for patients. A tradition of service to com-
medical center and at Harvard Medical School, the department
munity is at the core of our founding hospitals and remains an im-
has a varied research portfolio. Our programs reflect the diversity
portant part of our mission. Our diverse patient population hails
that is valued in our department, and include clinical, basic sci-
from various racial, ethnic, and socioeconomic backgrounds, and
ence, public health, health care quality, and educational projects.
we are committed to eliminating health disparities. We take great
Our collaborations on the pathogenesis of preeclampsia have
pride in providing innovative care with a personal touch.
led to exciting basic research findings and potential new clinical therapies. The department also places special emphasis on
Hope Ricciotti, MD
epidemiology and public health policy as it relates to women’s
Acting Chair of Obstetrics and Gynecology
health both in the United States and globally. The department is
a leader in the effort to improve patient safety and in outcomesbased research. Our simulation and team training curricula, which
include teambased training exercises, are nationally renowned.
Finally, in concert with Harvard Medical School, the department
Chair’s Message continued
5.
BIDMC OB/GYN • Who We Are
Who We Are
Beth Israel Deaconess Medical Center
rael Deaconess Medical Center is an affiliate of Harvard Medical School, offering patient care as well as teaching and research
programs. Three-quarters of a million patients are served each
year, with 649 licensed beds, including 440 for medical/surgical
patients, 77 for critical care, and 60 for Ob/Gyn. Our Level III Neonatal Care Unit has 47 licensed beds. BIDMC consistently ranks
among the top three recipients of biomedical research funding
from the National Institutes of Health. Research funding totals
$229.8 million annually, and BIDMC researchers run more than
850 active, sponsored projects and 500 funded and nonfunded
clinical trials.
Located in the heart of Boston’s medical community, Beth Is-
6.
BIDMC OB/GYN • Who We Are
Who We Are continued
Department of Obstetrics and Gynecology
Preventative women’s health care and complex, state-of-the-art services to the most critical of patients are all within the realm of the
women receive our unique brand of patient- and family-centered care. While we are proud to be one of the most sought-after teaching
hospitals in the country, we focus our attention on each and every one of the nearly 5,000 babies we deliver each year.
Harvard Medical School
Harvard Medical School opened its doors in 1782 to a handful of students and just three faculty members. Today, with over 11,000
faculty on board, more than 5,000 students apply for the 165 openings at the school each year. Under the leadership of Dean Dr. Jeffrey Flier, the Caroline Shields Walker Professor of Medicine at Harvard Medical School and former Chief Academic Officer for BIDMC,
Harvard Medical School lives out its mission “to create and nurture a community of the best people committed to leadership in alleviating human suffering caused by disease.” The school attracts some of the best and brightest students from around the country, and every
class exhibits its own brand of creativity and interests, making its members the medical leaders of tomorrow.
compassionate, highly personalized treatment provided in BIDMC’s Department of Obstetrics and Gynecology. A diverse community of
7.
A Medical Histor y of BIDMC
BIDMC OB/GYN • Medical Histor y
196 0
19 70
1986
BIH delivers first
baby conceived
through in vitro
fertilization in
Massachusetts.
198 0
19 90
1995
Deaconess Hospital
performs New England’s
first minimally invasive
coronary bypass surgery
and implants first deep
brain stimulator for
treatment of Parkinson’s.
1998
BIDMC performs
first adult live donor
liver transplant in
New England.
19 95
1991
BIH researchers first
to discover evidence that
abnormalities in visual
system of brain help
explain dyslexia
symptoms.
1983
Deaconess Hospital
performs first successful liver
transplant in
New England.
1998
BIDMC cardiothoracic surgeon
William Cohn issued patent for
Cohn Cardiac Stabilizer,
allowing coronary artery
bypass surgery without a
heart-lung machine.
1972
BIH implements
nation’s first
Rights of
Patients
statement.
1960
Beth Israel Hospital (BIH)
develops first implantable
cardiac pacemaker.
8.
20 0 0
2003
BIDMC researchers
discover probable cause of
preeclampsia and publish
results in New England
Journal of Medicine and
Journal of Clinical
Investigation.
20 02
20 03
20 0 4
20 0 5
2007
BIDMC’s Department of
Ob/Gyn receives Joint
Commission award for
excellence in patient
safety and innovation.
2006
US News & World Report
places BIDMC among
nation’s Best Hospitals in
6 clinical specialties.
20 0 6
20 0 7
2008
BIDMC reports in Nature
that COMT gene, known
for its role in schizophrenia, also plays a role in
preeclampsia.
20 0 8
20 0 9
2005
BIDMC reports the
involvement of s-Flt1
factor in preeclampsia
in New England Journal
of Medicine.
2006
BIDMC reports a team
training method for
patient safety in
obstetrics in JAMA.
2007
BIDMC’s Department
of Ob/Gyn first
recipient of BCBS of
Massachusetts Health Care
Excellence Award in patient
safety programs.
2009
BIDMC among 3 hospitals
recognized for leadership/
innovation in quality, safety,
and commitment to patient
care as American Hospital
Association–McKesson
Quest for Quality Prize®
finalist.
2009
ranks BIDMC in Top 50
for care and treatment of
heart and heart surgery;
cancer; digestive disorders;
kidney diseases; geriatrics;
gynecology; ears, nose,
and throat; diabetes
(in conjunction with
Joslin Clinic).
20 0 1
9.
20 10
2011
names BIDMC Top Hospital,
plus Honorable Mention for
the Gynecology Division.
2011
BIDMC first nationally
to meet federal electronic
health record requirements
with its own software
technology supporting
ARRA’s quality, safety, and
efficiency goals.
20 1 1
2012
ranks BIDMC among top 3%
of all hospitals nationally.
20 12
2013
again ranks BIDMC as in
the top 3% of hospitals
nationally.
2012
Becker’s Hospital Review
places BIDMC on its list of
year’s 100 Great Hospitals.
2012
International Board of
Lactation Consultant
Examiners and International
Lactation Consultant
Association recognize
BIDMC for excellence in
lactation care.
10.
20 13
2011
BIDMC named nation’s
top-ranked healthcare
information company
and 12th overall on
InformationWeek 500, a
list of top US technology
innovators.
2010
BIDMC awarded $38.2
million from NIH as part
of American Recovery and
Reinvestment Act (ARRA).
BIDMC scientists receive
69 grants across all
departments.
BIDMC OB/GYN • Honors and Awards
Honors and Awards
The BIDMC family includes a large staff of dedicated employees,
working both behind the scenes and upfront with direct patient
care. Here’s just a small sampling of special awards and honors
•For the 3rd consecutive year, BIDMC distinguished by the
•For the 11th time, Truven Health Analytics names BIDMC one Human Rights Campaign’s Healthcare Equality Index as a of the Top 100 US Hospitals—and the only Boston hospital leader in LGBT healthcare equality. The award recognizes cited this year.
efforts in delivering equitable care, guaranteeing equal visita-
•For the 6th time in 7 years, the national Leapfrog Group ranks tion for same-sex partners/parents, and providing LGBT health BIDMC as a Top Hospital.
education for key staff members.
•In the Leapfrog Group’s latest update to the Hospital Safety •BIDMC one of 10 medical centers across the country and the Score, BIDMC receives an A rating.
only hospital in Massachusetts chosen to pilot a resident •BIDMC one of 11 hospitals nationally included in the
chapter of the Gold Humanism Honor Society. Drs. Katherine Hitachi Foundation’s Pioneer Employee Hospitals Initiative
Johnson and Zoe McKee represent the Department of Ob/Gyn for its commitment to addressing key personnel shortages by in the inaugural chapter.
training existing employees to advance professionally.
received so far this year:
11.
BIDMC OB/GYN • Honors and Awards
Honors and Awards continued
•BIDMC honored by the US Environmental Protection Agency with an Environmental Merit Award for making significant
contributions toward protecting and preserving the nation’s BIDMC OB/GYN Annual Report 2013
natural resources.
•BIDMC honored as Partner for Change, with Distinction at the Practice Greenhealth Environmental Excellence Awards for aggressive goals for recycling, regulating medical waste, and progress in environmentally preferred purchasing.
•BIDMC becomes first hospital in the nation to join and be recognized by the EPA’s Food Recovery Challenge.
•Dr. Yvonne Gomez-Carrion received Harvard Medical School’s 2013 Dean’s Community Service Faculty Award for her work with Concerned Black Men of Massachusetts, a group that promotes young men’s personal development.
12.
Clinical
13.
BIDMC OB/GYN • Clinical
Obstetrics and Gynecology
Hope Ricciotti, MD
Division Director
Sandra Mason, MD
Clinical Director Shapiro Practices
Renee Goldberg, MD
Clinical Director Community Practices
Renee Goldberg, MD
Sandra Mason, MD
14.
Faculty Ambulatory Practices
Community Faculty Practices
Community Health Centers
Shapiro 8 Faculty Practice
One Brookline Place
Bowdoin Street Health Center
(hospital-based practice)
Cindy Kobelin, MD
Sarah Averbach, MD
K. Meredith Atkins, MD
Chestnut Hill
Celeste Royce, MD
Diane Kaufman, MD
Dimock Street Health Center
Chelsea
Anjelica Garza, MD
Laura Bookman, MD (Gyn only)
Toni Golen, MD
Yvonne Gomez-Carrion, MD
Ronald Marcus, MD (Gyn only)
Monica Mendiola, MD
Hope Ricciotti, MD
Jennifer Scott, MD, MPH, MBA
Sandra Mason, MD
Needham
Neel Shah, MD, MPP
Renee Goldberg, MD
Jacqueline Stephen, MD (Gyn only)
Susan Lincoln, MD (Gyn only)
(Chinatown and Quincy)
Isabel Morais, MD
Kristin Bixel, MD
Lexington
Allegra Deucher, MD
Marc Kobelin, MD
Milton
Alice Shin, MD
South Cove Community Health Center
Ira Chan, MD, MPH
Lucy Chie, MD, MPH
Janet Chollet, MD
Fenway Community Health Center
Sandra Mason, MD
Obstetrics and Gynecology continued
15.
16.
Obstetrics and Gynecology:
Education
Patient care is the foundation for resident and medical student
training in BIDMC’s Department of Obstetrics and Gynecology.
Residents spend all 4 years of their training working with faculty
in both ambulatory and in-patient settings. Upon graduation, they
are well prepared to work as independent practitioners in general
practice. Ambulatory settings include hospital-based practices,
suburban settings, and affiliated community health centers, all
of which provide diverse patient care experiences, exposure to
faculty with a variety of interests and expertise, and a lifetime of
options for contributing to the education of patients and service
to community.
17.
different needs at different times
Obstetrics and Gynecology:
Clinical Care
of their lives. The generalists
Well-woman care, obstetrical care, and gynecologic and meno-
provide gynecologic and prenatal health services offered through the department. Our deep, abid-
care throughout all the transitions
ethnic, racial, and sexual backgrounds is unyielding. Working in
a woman may go through, from a
pause management are among the comprehensive women’s
ing commitment to provide care for women of all socioeconomic,
concert with our maternal-fetal and gynecologic specialists, the
obstetrician/gynecologist oversees and coordinates exceptional
young adult through menopause
care for each patient. Physicians are available at many locations
and beyond.”
ess Medical Center, Brookline, Chelsea, Chestnut Hill, Lexington,
Renee Goldberg, MD
in the greater Boston community, including Beth Israel DeaconMilton, and Needham, as well as the community health centers
Bowdoin Street Health Center, Dimock Center, South Cove Community Health Center, and Fenway Health.
“We understand that women have
18.
Nulliparas as a Proportion of Total Deliveries
Total Deliveries
Nulliparas
Nulliparas Percentage
Nulliparas
Percentage
Cases
40%
5000
41%
4823
4670
42%
4763
42%
42%
41%
4601
4571
4507
45%
44%
4000
30%
3864
3000
2000
1986
1848
2018
1879
1913
2010
1594
15%
1000
0%
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
*October 2012 to July 2013, 10 Months
6000
19.
Total Cesareans
Total Deliveries
Total Cesareans
Cesarean Percentage
Total Cesareans
Percentage
Cases
7000
45%
39%
6000
5000
4823
4670
37%
4763
37%
36%
31%
4601
4571
4507
34%
30%
3864
4000
3000
2000
1882
1868
1759
1651
1624
15%
1546
1181
1000
0
0%
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
40%
20.
Nulliparous Term Singleton Vertex (NTSV)
NTSV Deliveries
NTSV Cesareans
NTSV Cesarean Percentage
NTSV Cesarean
Percentage
Cases
37%
40%
36%
33%
34%
31%
29%
2000
1986
1958
1824
1889
1853
30%
25%
1913
1601
20%
1000
698
680
651
626
591
10%
559
404
0
0%
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
3000
21.
VBAC Success Rate
All VBACs
All VBACs + Failed TOL
VBACs Success Rate
Linear (All VBACs)
VBAC Success
Rate Percentage
Cases
200
80%
76%
69%
69%
67%
63%
150
60%
100
92
82
78
77
75
40%
86
113
20%
50
71
118
71
112
76
117
78
130
88
134
108
149
80
124
0%
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
69%
64%
22.
OB Episiotomy
Total Vaginal Deliveries
Episiotomy Cases
Episiotomy Percentage
Cases
4823
4670
4763
16%
4601
4571
4507
3864
4000
3000
12%
9%
8%
8%
7%
8%
7%
7%
2000
5%
4%
1000
421
355
364
370
340
323
175
0%
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
5000
Episiotomy
23.
OB Induction 37—39 Weeks
Total Deliveries
Induction of Labor Cases
Induction of Labor Percentage
Induction of
Labor Percentage
Cases
15%
13%
14%
15%
14%
13%
12%
4000
10%
3000
8%
2825
2684
2660
2669
2515
9%
2597
2000
6%
1736
3%
1000
394
376
374
345
354
219
172
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
0%
FY2013*
5000
24.
Maternal-Fetal Medicine/
High-Risk Obstetrics and
Clinical Genetics
Steven J. Ralston, MD, MPH, Division Director
Faculty
Achilles Athanassiou, MD
Karen O’Brien, MD
Sarosh Rana, MD
Jami Alynn Star, MD
Brett C. Young, MD
Affiliated Faculty
Ananth Karumanchi, MD, PhD, Nephrology
Catherine Bearce Nowak, MD,
Medical Director Clinical Genetics
Clinical Faculty
Deborah Platek, MD (Harvard Vanguard)
Mary Vadnais, MD, MPH (Harvard Vanguard)
Steven J. Ralston, MD, MPH
25.
7,500
Clinical Genetics: Education
Fellows, residents, medical students, and attending staff all benefit from the compre-
The Division of Maternal-Fetal
hensive educational environment found in the Division of Maternal-Fetal Medicine and
Medicine provided consulta-
Clinical Genetics. Second- and third-year residents team up with the Maternal-Fetal
tions to over 7,500 women and
Medicine Fellow and High-Risk Obstetrical Chief Resident on all academic and patient
families experiencing a high-
care matters. Frequent clinical exchanges with anesthesiology, neonatology, genetics,
risk pregnancy in the last year.
radiology, nephrology, endocrinology, and hematology are all part of the experience. Faculty and fellows staff morning sign-out on Labor and Delivery, and the division sponsors
a weekly multidisciplinary Perinatal Conference of faculty to optimally treat women with
challenging obstetrical issues. Teaching in the clinical setting is supplemented by bimonthly resident didactic series presentations.
26.
Clinical Genetics: Clinical Care
Maternal-fetal medicine faculty offer targeted and specialized ultrasound examinations,
prenatal diagnosis, and genetic counseling at BIDMC as well as at a variety of healthcare
facilities throughout Massachusetts. We foster a close and productive relationship with
177
community-based Ob/Gyns, family practitioners, and midwives, providing outstanding
care while enhancing patient convenience and satisfaction.
Last year, 177 women were transported by helicopter, plane, or ambulance to BIDMC’s Labor and Delivery unit for acute care. Our maternal transport program supports hospitals
Last year, 177 women were transported by helicopter, plane, or
throughout New England and has transported patients from as far away as Bermuda. The
ambulance to BIDMC’s Labor and
majority of cases require Maternal-Fetal Medicine services or Level III neonatal intensive
Delivery unit for acute care.
care. Faculty also collaborate with programs such as the Advanced Fetal Care Center
at Boston Children’s Hospital, an association that allows diverse diagnostic and treatment options, including invasive antenatal and peripartum procedures. These clinical
advances help fetuses affected by congenital abnormalities and offer hope and guidance
to families.
Patients from all over New England are referred to BIDMC for high-risk obstetrical care.
27.
Clinical Genetics: Clinical Care
The Clinical Genetics faculty works alongside the Maternal-Fetal
Medicine faculty to provide counseling and support for women
and families at risk for pregnancies complicated by genetic disease, birth defects, or intellectual disability. Counseling is also
available for individuals or couples experiencing infertility or
recurrent pregnancy loss. Program staff meets with families to
discuss individual concerns, provide risk assessments, and aid in
decision making regarding additional testing—complex genetic
counseling information is summarized in a letter for additional
understanding.
28.
a high level of technical skill and clinical acumen; but we
also need a high degree of empathy to compassionately
guide pregnant women to healthy outcomes for
themselves and their babies.”
Steven J. Ralston, MD, MPH
“Maternal-Fetal Medicine is a subspecialty that demands 29.
28,000
Clinical Genetics: Prenatal Diagnosis
The Division of Maternal-Fetal Medicine provides obstetrical ultrasound and consulta-
The Division of Maternal-Fetal
tive services for pregnancies at risk for fetal abnormalities and adverse pregnancy out-
Medicine provided over 16,000
comes. Patients receive state-of-the art diagnostic care with 2D, 3D, and 4D capabilities.
ultrasound examinations last year,
Diagnostic procedures include chorionic villus sampling and amniocentesis, as well as
and
examinations
a variety of therapeutic procedures such as fetal blood transfusions and shunting. The
this year are projected to exceed
Center for Maternal-Fetal Medicine at BIDMC also includes an antenatal testing unit for
28,000.
all pregnancies. The Division of Maternal-Fetal Medicine provided consultations to over
ultrasound
7,500 women and families experiencing a high-risk pregnancy in the last year. We also
provided over 16,000 ultrasound examinations last year, and ultrasound examinations
this year are projected to exceed 28,000.
30.
Gynecologic Oncology
Christopher Awtrey, MD, Division Director
Leslie Garrett, MD
Christopher McCann, DO
Affiliated Faculty
Stephen Cannistra, MD,
Director, Gynecologic Medical Oncology
Jonathan Hecht, MD, PhD,
Christopher Awtrey, MD
Pathology, Perinatal, Placental, Gynecology
31.
Gynecologic Oncology: Education
“Our goal in the
Each year, residents rotate in the Division of Gynecologic Oncology, along with third-
Division of Gynecologic year medical students and fourth-year subinterns. This unique academic environment
includes a weekly Gynecologic Oncology Tumor Board—a multidisciplinary conference
attended by division members as well as pathologists, radiologists, medical oncologists,
and radiation therapists to discuss each patient’s clinical course and treatment options.
A gynecologic oncology journal club and monthly research meetings are also among
sponsored activities.
Daily rounds, assisting in surgical procedures, and presenting at Tumor Board are among
resident responsibilities. Residents experience the full breadth of cancer care and risk reduction by participating in cancer genetic counseling sessions and medical chemotherapy ambulatory management. Clinical education also includes simulated surgical practice
and participation in the colposcopy/laser ambulatory clinics, where they are taught the
principles of colposcopy and the place of laser surgery in gynecology, and they graduate
with certification in laser surgery. Almost every graduating class over the past decade has
had one graduate continue training in a Gynecologic Oncology Fellowship—a testament
Oncology is to provide compassionate,
individualized care of
the highest quality, to
all patients with a
suspected or diagnosed gynecologic cancer.”
Christopher Awtrey, MD
to the division’s educational program.
32.
Gynecologic Oncology:
Clinical Care
Medical oncologists, radiation oncologists, and pathologists work
with the division’s physicians on patient-centered, multidisciplinary teams to provide optimal treatment for women with cancer of the reproductive tract. Therapeutic options include open
surgery (encompassing radical and ultra-radical procedures),
minimally invasive surgery, robotic surgery, radiation, chemotherapy, and biological therapies. Clinical outreach programs are
in operation at Mount Auburn Hospital, Lawrence General Hospital, Anna Jacques Hospital, and Brockton Hospital.
Clinical trials are open to patient accrual through the Dana-Farber/Harvard Cancer Center. We are also a participating institution of the national Gynecologic Oncology Group clinical trials,
whose mission is entwined with our own: to promote excellence
in the quality and integrity of clinical and basic scientific research
in the field of gynecologic malignancies. We work in close collaboration with Dr. Stephen Cannistra, a nationally recognized
medical oncologist with particular expertise in ovarian cancer.
33.
GYN Cancer Surgical Approach**
GYN Cancer Total Open Cases
GYN Cancer Total LSC/HSC Cases
LSC/HSC Cases Percentage
LSC/HSC
Cases Percentage
Cases
50%
45%
46%
39%
36%
150
100
86
78
50
40%
135
135
127
109
28%
41%
38%
30%
83
20%
35
31
42
48
56
62
10%
23
0%
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
**BIDMC Cases Only, Coded as Malignancy
LSC/HSC - Laparoscopy and Hysteroscopy
200
34.
Elizabeth Buechler, MD, Director
The Colposcopy Clinic is a referral-based clinic for patients with benign and pre-invasive
disease involving the vulva, vagina, and cervix. Most patients are referred for the evaluation of abnormal Pap tests, persistent high-risk HPV tests, and DES exposure. Women
with abnormal Pap tests during pregnancy are followed for evidence of developing invasive disease. Patients who have condyloma or other vulvar lesions, and have not responded to the usual modes of therapy, are also referred for evaluation and treatment.
When indicated, treatment with LEEP (loop electrosurgical excision procedure) or lAser
is performed either in the Gyn Minors Clinic or operating room. Second-year residents
initiate their training in colposcopy in this unit, and by graduation will have the skills and
opportunity to obtain laser certification.
Colposcopy and Laser Surgery Unit
35.
Family Planning: Education
Maureen Paul, MD, MPH
Maureen Paul, MD, MPH, Section Head
The 5-week Family Planning rotation, which takes place during a BIDMC resident’s sec-
Faculty
ond year, provides exposure to family planning counseling and skills as part of the Ryan
Siripanth Nippita, MD
Program. Residents rotate through the Contraceptive Consult Clinic and perform ambu-
Phillip Stubblefield, MD
latory procedures including manual vacuum aspiration, medical abortion, and D&E cas-
Clinical Faculty
es. We are committed to training residents in abortion and contraception, as well as cultivating interests in public health, global and community health, research, and healthcare
Shiao-Yu Lee, MD
Boris Orkin, MD
policy as integral components of family planning. All contraceptive options—hormonal,
barrier, implant, and intrauterine methods—are provided by residents. A Family Planning–
sponsored lecture series covers a wide range of topics, emphasizing the epidemiological
evidence underlying current practice and new technologies in fertility regulation.
36.
Family Planning: Clinical Care
and confidential reproductive health care, providing women with
pregnancy options counseling, first- and second-trimester abortion services (medical abortion, vacuum aspiration, and D&E),
and comprehensive contraception counseling and provision.
The BIDMC Contraceptive Consult Clinic caters to women with
complex medical conditions or psychosocial situations. In addition, the BIDMC Family Planning Ambulatory Procedure Clinics
provide management of early miscarriage, first-trimester surgical
abortion, and early medical abortion. Offsite family planning experiences include Women’s Health Services and the Dimock Center, which expose residents to the variety of ways family planning
Siripanth Nippita, MD
services are delivered to heterogeneous populations.
Family Planning clinical care focuses on comprehensive, safe,
37.
Reproductive Endocrinology
and Infertility: Education
Kim Thornton, MD, Division Director
Alan Penzias, MD, Fellowship Director
Kim Thornton, MD
Reproductive Endocrinology and Infertility (REI) offers a robust educational program.
Clinical Faculty
IVF, the program’s principal clinical site. New patient and follow-up consultations; minor
Michael Alper, MD
office procedures such as ultrasound, sonohysterography, and hysterosalpingograms;
Steven Bayer, MD
ambulatory surgery; and advanced reproductive technology procedures are among the
Brian Berger, MD
experiences provided. Residents are also responsible for REI patient care at BIDMC, in-
Merle Berger, MD
cluding medical management of inpatients, gynecologic surgery, and ambulatory pa-
Alice Domar, PhD
tient care for the fellow-led Reproductive Endocrinology Ambulatory Clinic. Monthly
Benjamin Lannon, MD
conferences at BIDMC, in addition to monthly Boston IVF Grand Rounds, a lecture se-
Selwyn Oskowitz, MD
ries held at Boston IVF, and a monthly Boston IVF journal club provide ample learn-
David Ryley, MD
ing opportunities for understanding the latest topics in reproductive endocrinology and
Rita Sneeringer, MD
infertility. Residents and fellows are encouraged to become involved in clinical and/or
Alison Zimon, MD
basic research projects, and they may have opportunities to attend national meetings
and present their research.
During a 5-week rotation, second-year residents participate in clinical services at Boston
38.
Age of women
‹ 35
35 — 37
38 — 40
41 — 42
Number of cycles
908
536
572
311
Average number of
embryos transferred
1.9
2.1
2.6
3.4
Percentage of transfers
resulting in live births
35.6
27.5
19.5
17.6
Percentage of live births
with twins
26.6
18.7
20
17.4
Percentage of live births
with triplets or more
1.0
0.8
3.2
0
*Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2010 Assisted
Reproductive Technology Fertility Clinic Success Rates Report. Atlanta: U.S. Department of Health and Human Services; 2012.
Boston IVF
IVF Success Rate and Live Births—Fresh Embryos from Non-Donor Eggs*
39.
Age of women
‹ 35
35 — 37
38 — 40
41 — 42
Number of transfers
192
112
89
31
22.4
24.1
20.2
12.9
Boston IVF
IVF Success Rate and Live Births—Donor Eggs*
Fresh Embryos
Thawed Embryos
Number of transfers
145
86
46.9
21.4
*Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2010 Assisted
Reproductive Technology Fertility Clinic Success Rates Report. Atlanta: U.S. Department of Health and Human Services; 2012.
Boston IVF
IVF Success Rate and Live Births—Thawed Embryos from Non-Donor Eggs*
40.
our community for the reproductive rights and options available for all patients impacted by infertility.”
Kim Thornton, MD
“Endocrinology and Infertility works to advocate within 41.
Reproductive Endocrinology and Infertility: Clinical Care
Eleven board-certified reproductive endocrinologists staff the full-service, state-of-the-art clinical reproductive endocrine and infertility unit at Boston IVF. The clinic is one of the largest assisted reproductive technology programs in the United States, with faculty having assisted in over 30,000 births. Ovulation induction, intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection,
Boston IVF has a robust third-party reproduction program that, in addition to offering traditional egg donation (fresh), was one of the
first centers in the Northeast to offer patients frozen donor eggs. The clinic continues to offer a gestational carrier program, and its fertility preservation (oocyte and sperm cryopreservation) program is designed for patients with malignancies or who are concerned about
reproductive aging and desire to preserve their reproductive options. Diagnostic and operative endoscopy (laparoscopy/hysteroscopy)
for developmental and acquired abnormalities of the reproductive tract, and procedures to correct developmental uterine anomalies,
uterine fibroids, and severe endometriosis, are among the surgical procedures performed.
In addition to the main facility in Waltham, Massachusetts, Boston IVF has sites in Boston, Quincy, Maine, Rhode Island, and satellite
clinics throughout New England. Recognizing the impact that stress has on fertility, REI offers care complementary to conventional
medicine through the Domar Center for Complementary Medicine. Among the center’s offerings are specific mind/body techniques
designed to elicit the relaxation response, acupuncture, yoga, and nutritional counseling, as well as a full range of mental health counseling services.
blastocyst culture and embryo freezing, and preimplantation genetic diagnosis and screening programs are among the services offered.
42.
Minimally Invasive
Gynecologic Surgery: Education
Hye-Chun Hur, MD, Division Director
Hye-Chun Hur, MD
Third-year BIDMC residents rotate with the Minimally Invasive Gynecologic Surgery
settings for comprehensive training. Principles and surgical skills in pelvic/abdominal,
vaginal, and minimally invasive procedures are taught progressively, an approach that
Faculty
allows residents to develop the competencies expected of well-trained gynecologists by
Louise P. King, MD, JD
the end of the 4-year curriculum.
Training is enhanced by outside rotations at Mount Auburn Hospital, Needham, and Milton Hospital, as well as by ambulatory hysteroscopy and surgery in the Shapiro Clinical
Center and in private offices. In addition to daily inpatient management and teaching
rounds with the Gynecology Attending of the Week, teaching at the bedside and in the
operating theater occurs with all cases. Weekly staff and resident conferences enhance
evidence-based care, and monthly educational surgical meetings with a gynecologic
surgical committee are used to discuss surgical planning for resident patients.
Division’s physicians in the inpatient operating room as well as in ambulatory surgical
43.
Minimally Invasive
Gynecologic Surgery: Education
Other learning opportunities include monthly skills sessions in
biannual intensive simulation workshops. Residents also participate in a structured Fundamentals of Laparoscopic Surgery
Program that includes didactic and skills training in laparoscopic
techniques—passing the cognitive and skills examination is a requirement during the third year of the residency program and offers the opportunity to be accredited in this area prior to completing their Ob/Gyn training.
Residents interact with a tremendous number of minimally invasive surgical patients, resulting in our graduates consistently
ranking in the 80th to 90th percentile of procedure numbers
nationally.
the simulation laboratory, bimonthly resident didactic series, and
44.
Minimally Invasive Gynecologic
Surgery: Clinical Care
Our priority is to establish a plan of care for patients that is specifically tailored to the individual’s needs—incorporating the mediBIDMC OB/GYN Annual Report 2013
cal issues at hand in the context of the patient’s clinical profile
and well-being. Although a variety of treatment options exist for
different gynecologic conditions, our role is to guide the patient
to the right decision and treatment plan for her specific condition and life stage. Our minimally invasive gynecologic surgery
specialists are fellowship-trained to perform advanced gynecologic surgeries using the latest techniques and equipment. We
provide evidence-based care for women who require surgical
management, including both traditional laparoscopic and robotic
approaches, with procedures including hysterectomies, removal
of ovaries and ovarian cysts, myomectomies, surgical treatment
of endometriosis, and hysteroscopic sterilizations.
45.
GYN Department Surgical Approach
GYN Total Surgical Cases
GYN LSC/HSC Surgical Cases
GYN LSC/HSC Percentage
LSC/HSC
Cases Percentage
Cases
50%
4000
2750
40%
40%
2894
2689
2711
43%
40%
2384
2397
2312
30%
2000
20%
1000
974
966
924
960
1076
1169
998
10%
0%
0
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
LSC/HSC - Laparoscopy and Hysteroscopy
36%
35%
3000
40%
39%
46.
GYN Department
Hysterectomy Approach
Robotic Laparoscopy
Abdominal Hysterectomy
Laparoscopy
Vaginal Hysterectomy
LSC/Robotic Percentage
LSC/Robotic Cases
Percentage
Cases
250
82%
80 %
76%
197
64%
166
198
62%
57%
142
150
46%
100
94
115
110
41%
105
103
35 %
104
64
50
65
58
51
94
87
81
63
21%
42
23
39
33
25
12
0
0%
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
Minimally Invasive Percentage = Laparoscopy + Robotic
All Hysterectomies
200
74%
202
47.
Female Pelvic Medicine and
Reconstructive Surgery: Education
Janet Li, MD, Section Chief
Affiliated Mount Auburn Faculty
Roger Lefevre, MD, Faculty
Peter Rosenblatt, MD, Division Chief
The Female Pelvic Medicine and Reconstructive Surgery section provides clinical train-
Eman Elkadry, MD
ing to medical students, residents, and fellows, as well as faculty development. A rela-
Katharine Hanaway, MD
tionship between BIDMC and Mount Auburn Hospital allows collaboration on research
Lekha Hota, MD
projects related to urogynecology and pelvic reconstructive surgery. Residents from
BIDMC participate in urogynecologic procedures as part of their 4-year gynecology experience, and each third-year resident rotates at Mount Auburn in urogynecology for
a 10-week immersive experience. Curricula emphasize minimally invasive and robotic
urogynecologic surgery, as well as ambulatory care that includes office evaluations and
treatment for pelvic floor disorders.
Janet Li, MD
48.
“Pelvic floor disorders can often
Urinary incontinence, overactive bladder, interstitial cystitis,
genitourinary fistulae, recurrent urinary tract infections, pelvic
organ prolapse, fecal incontinence, and urethral disorders are
among the pelvic floor disorders treated in women of all ages. The
comprehensive evaluation and management offered includes inoffice testing (urodynamics and cystourethroscopy) and in-office
treatments (tibial nerve stimulation, bladder instillations, and
periurethral injections). The broad range of surgical treatments
for pelvic floor disorders include abdominal, vaginal, laparoscopic, and robotic approaches. Surgeries include minimally invasive
mid-urethral sling, hysterectomy, paravaginal cystocele repair,
anterior/posterior colporrhaphy, uterosacral/sacrospinous ligament vaginal vault suspension, sacrocolpopexy, graft-augmented
be devastating for women who suffer from symptoms. Our
sensitive, team-based approach
is designed to help patients
navigate through the range of treatment options, thereby
empowering women to regain
active lifestyles on their own terms. We strive to provide
exceptional, personalized, high-quality care.”
Janet Li, MD
repairs, and InterStim.
Reconstructive Surgery:
Clinical Care
49.
FPMRS Surgical Approach**
FPMRS Total Cases
FPMRS LSC/HSC/Robotic Cases
FPMRS LSC/HSC/Robotic Percentage
LSC/HSC/Robotic
Cases Percentage
Cases
244
250
204
23 %
192
156
150
147
20%
19 %
18 %
15 %
100
10%
73
50
46
5%
4%
10
6
0
3%
2
13
45
26
2
0%
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
FY2013*
**Coded as Incontinence, Prolapse, and Fistula
200
30%
50.
Division of Urogynecology
at Mount Auburn Hospital
Cambridge, Massachusetts
The Division of Urogynecology in the Department of Obstetrics and Gynecology at
Mount Auburn Hospital in Cambridge, Massachusetts, is a large urogynecology and reconstructive pelvic surgery center that serves all of New England as a referral center for
basic and complex evaluation and management of pelvic floor disorders such as uri-
Faculty
Anthony DiSciullo, MD
nary and fecal incontinence, overactive bladder, and pelvic organ prolapse. The division
Eman Elkadry, MD
consists of four fellowship-trained urogynecologists, a minimally invasive gynecologic
Katherine Hanaway, MD
surgeon, three fellows in female pelvic medicine and reconstructive surgery, and a nurse
Leka Hota, MD
practitioner and two nurses who specialize in urodynamic and anorectal testing. The
clinical investigation team has a full-time research coordinator. The division’s philosophy emphasizes nonsurgical as well as minimally invasive surgical procedures, including
robotic and laparoscopic reconstructive surgery.
Peter L. Rosenblatt, MD, Division Director
51.
Neonatology: Education
DeWayne Pursley, MD, MPH, Chair
The neonatal training program at BIDMC is one of four clinical/research training sites
program of its kind in the United States. Fellows rotate through BIDMC, providing care to
newborns and their families, and honing their patient management and team leadership
skills in the Neonatal Intensive Care Unit (NICU), nurseries, delivery room, and for the
high-risk antepartum consultation service.
Each year, the Department of Neonatology offers an American Academy of Pediatrics–
approved training course in neonatal resuscitation to all Ob/Gyn and anesthesia residents—first-year residents receive initial training, while all others receive annual refresher courses. Formal clinical training for Harvard Medical School students is also offered.
During the core pediatrics rotation at Boston Children’s Hospital, third-year medical
students focus on newborn medicine in a 1-week rotation through the BIDMC newborn
nursery, and fourth-year students are offered a month-long subinternship in the NICU.
for the Harvard Neonatal-Perinatal Medicine Fellowship program, the largest training
52.
Neonatology: Clinical Care
The 48-bed NICU at BIDMC provides care to over 1,200 newborns each year—900 require admission, while the remainder
are triaged to the newborn nursery. The multidisciplinary team
of physicians, nurse practitioners, nurses, neonatal respiratory
therapists, social workers, neonatal dieticians, occupational and
physical therapists, and pharmacists are extensively trained in
the care of high-risk newborns and provide a full range of services for neonatal patients and comprehensive support for their
families.
Through a tightly integrated consultation system with the maternal-fetal medicine staff, genetic counselors, and Boston Children’s Hospital pediatric subspecialists, the NICU team provides
clinical input and tracks all maternal admissions likely to result
in the delivery of a newborn requiring intensive care. The unit
provides cutting-edge therapy, including therapeutic hypothermia and inhaled nitric oxide, as well as makes potentially groundbreaking clinical research protocols available to eligible patients.
53.
Neonatology: Clinical Care
Together with attending neonatologists and neonatal-perinatal
An additional component of our clinical care is the Cochran New-
fellows, nurse practitioners and physician assistants provide
born Service in the newborn nursery, where we provide compre-
around-the-clock coverage in the NICU and participate in the
hensive care to those infants whose primary pediatric providers
teaching of Harvard Medical School students as well as nurse
are not members of the BIDMC staff. The department’s pediatri-
practitioner and other preprofessional students. Neonatal-peri-
cians, neonatologists, and pediatric nurse practitioners provide
natal fellows play an important clinical role in the NICU, provid-
care of the highest quality. All nursery babies undergo hearing
ing triage, consultative, and admission support, as well as ongoing
screening under a program that was among the first universal
care. During monthly rotations, they continue to bring new knowl-
newborn screening programs developed in the state. Car seat po-
edge and clinical innovations to the department that support the
sition and fit testing is also performed for indicated infants prior
unit’s goal of providing care at the leading edge of medicine.
to discharge.
54.
55.
The mission of the Department of Neonatology research program
Recent research themes within the Department:
is to advance neonatal health and health care through excellence
•Determining the impact of nutrition on health and disease in the
and innovation across the spectrum of clinical research. The pro-
preterm infant
gram is broadly aimed at improving the care provided to new-
•Improving NICU patient safety through team training
borns and their families through epidemiologic, health services,
•Applying cost-effectiveness analysis to optimize NICU
and translational research in these areas: improving outcomes of
resource utilization
NICU patients, graduates, and families; understanding the eco-
•Understanding the role of racial and social disparities in
nomic implications of neonatal care; improving care delivery; un-
infant outcomes
derstanding the mechanisms of prematurity complications; and
•Determining whether dietary factors and epigenetic
optimizing education in newborn care.
modifications account for disparities in preterm birth
The program has pioneered comparative quality assessment in
•Advancing the integration of evolving information technologies
neonatology through the development of the Score for Neona-
into the delivery and evaluation of newborn care
tal Acute Physiology (SNAP), a key illness severity normalization
•Identifying barriers to early intervention enrollment for
tool, to establish inter-institutional variations in care amenable to
NICU graduates
quality improvement efforts. Early work has fostered collabora-
•Assessing the effectiveness of perinatal and neonatal
tion among all Massachusetts NICUs and led to an active, state-
health services on the health of very premature infants
wide quality improvement collaboration, established and headed
• Understanding the emotional burden of families with preterm by a BIDMC neonatologist.
infants during and after discharge from the NICU
Neonatology: Research
56.
Quality, Safety, and Performance
Improvement: Clinical Services/Organization
Toni Golen, MD, Vice Chair, Quality, Safety, and Performance Improvement
Faculty
Medical Director, Labor and Delivery and Postpartum
Marc Kobelin, MD,
Improving the safety of childbirth and women’s health care is the primary goal in the Di-
Co-Chairperson, QA Committee
vision of Quality, Safety, and Performance Improvement. This area became a formal divi-
Susan Mann, MD,
sion in 2011 with the naming of Dr. Toni Golen as vice chair, and the work of the division is
Director of Team Training
achieved through careful analysis of cases, identification of opportunities for systematic
Neel Shah, MD, MPP
process improvement, compliance with regulatory guidelines, and an environment of just
culture. BIDMC’s institutional goal of eliminating preventable harm is embedded in quality improvement projects. Through teamwork, simulation, and transparency surrounding
adverse events, we look critically at ourselves and identify opportunities to prevent adverse outcomes and improve patient satisfaction.
Toni Golen, MD
57.
Quality, Safety, and Performance Improvement:
Quality Assurance
Quality Improvement
Traditional case review, project-based quality improvement,
While the Quality Assurance Committee assesses individual
and sentinel event analysis make up the structure of our patient
cases, leadership committees (Quality Improvement) develop
safety program. The Ob/Gyn Quality Assurance Committee—in-
systems to implement process improvement on a broader scale.
cluding attending physicians, residents, and nurses, represent-
Many ideas for quality improvement projects are generated by
ing all specialties—chooses cases based on indicators defined by
the case reviews performed by the Quality Assurance Commit-
the Joint Commission, ACOG, and the Harvard Risk Management
tee. Gaps in systems-based practice are identified. Examples of
Foundation. Additionally, staff members submit specific concerns
recent process improvements put into action include postpartum
regarding a patient’s care to the committee. Committee members
vaccination to prevent the spread of pertussis, standardized pro-
serve as volunteers and commit to the goals of monitoring and
cesses to prevent retained surgical items, integrating LEAN mo-
enhancing quality patient care.
dalities for improving patient safety during cesarean delivery, and
introducing blunt needles to decrease accidental needle sticks.
58.
59.
BIDMC’s Department of Obstetrics and Gynecology helps lead
The ability to measure quality is an essential element of quality
the national movement to systematically improve patient safety
improvement and patient safety. Our goal is to identify opportu-
and health care quality. In 2007, we received the John M. Eisen-
nities for improvement, measure our current state, set goals, and
berg Award for Patient Safety and Quality from the Joint Com-
then achieve them.
mission, an award that recognizes leadership and dedication in
To that end, one of our latest advances organizationally is a Joint
innovations to improve patient care and safety. Also in 2007,
Informatics Fellowship. The use of bioinformatics is essential to
Blue Cross Blue Shield of Massachusetts awarded us its very first
creating a safer environment for patients. Our first fellow is Dr.
Health Care Excellence Award, created to recognize exceptional
Neel Shah, MPP, an Ob/Gyn who recently completed his resi-
achievement in improving the safety and efficacy of health care
dency and has a strong interest in the analysis and measurement
in Massachusetts. Today, BIDMC has among the lowest Adverse
of value in health care. We see value as part of the definition of
Outcome Index ratings of any comparable tertiary hospital re-
quality and seek to meld his interests and talents with our rich
porting to the National Perinatal Information Center, a national,
history and clinical activity. Dr. Shah has already garnered nation-
nonprofit organization that collects data. As a direct result of our
al attention with the nonprofit organization he founded, Costs
work, there are now statewide initiatives in Massachusetts, Mary-
of Care, and the textbook Understanding High Value Care. We
land, and the District of Columbia to introduce obstetrical team
anticipate that his work here will have national and international
training. The model is replicable and widely adaptable for other
impact. Dr. Shah is also working as part of Atul Gwande’s Ariadne
healthcare organizations.
Labs Health Systems Innovation.
Quality and Volume
Growth of Services
60.
Almost any department will have adverse outcome reviews. What
on performance, will make decision making during crisis situa-
differentiates us is the complexity of our quality improvement
tions easier and more accurate. We also participate in the nation-
process and our attention to a just culture—a nonpunitive en-
al ACOG Simulation Consortium, where we are able to contribute
vironment. When an unexpected outcome occurs, we focus on
our knowledge about simulation and learn from others.
a thorough analysis of events with an emphasis on uncovering
We have also had great success with local improvements.
systematic flaws that might make another patient vulnerable to a
•We were early adopters of having a hard stop when it comes to
similar event in the future. We then set about making sustained
elective delivery. Over the last 4 years, we have continually dem-
and meaningful systemic changes.
onstrated an extremely low rate (reported nationally through
As part of our emphasis on systematic improvement, we utilize
LeapFrog) of elective deliveries prior to 39 weeks.
simulation and drills to teach protocols and guidelines to the
•We have seen a steady decrease in the rate of cesarean deliver-
frontline worker. We apply what we learn to the next drill in a
ies at BIDMC. As a quality metric we measure nulliparous, term,
continuous loop of improvement. A recent improvement involved
singleton, and vertex (NTSV) cesarean delivery rates.
emergency cesarean delivery. Through standardized work, we
•We have focused on surgical site infection prevention by creat-
have demonstrated the ease of prioritizing the initial count to
ing “bundles,” or steps in patient care. Examples include the
prevent retained surgical items.
timely and appropriate use of perioperative antibiotics, preoper-
While drills typically take place on our clinical units, events are
ative chlorhexidine soap, and judicious hair removal. We moni-
held regularly at the BIDMC state-of-the-art Simulation Center.
tor compliance with our bundles and provide feedback to pro-
We believe that mimicking high-acuity events in a safe environ-
viders who do not complete the required steps.
ment, in a structured clinical scenario with immediate feedback
Growth of Services continued
61.
Simulation training for staff and faculty is a key aspect of our
Since 2007, the BIDMC Obstetrics Simulation has grown from
culture of safety and participation, and training is mandatory. We
a simple exercise involving shoulder dystocia to a comprehen-
are a national leader in our simulation programs, which are based
sive, multidisciplinary program that includes complex clinical
on the belief that teamwork and communication come first, with
scenarios; a rich collection of high-acuity, low-frequency events;
clinical and technical skills superimposed upon that foundation.
immediate standardized feedback; structured debriefing; and a
Our programs incorporate feedback and debriefings. Our obste-
combination of high- and low-fidelity models. Learners are asked
tricians and trainees undergo annual obstetrical simulation train-
to demonstrate knowledge, technical skill, and teamwork behav-
ing, and our trainees perform semi-annual gynecologic surgical
ior appropriate for these obstetrical events. Objectives of the pro-
skills simulation. We host other institutions as part of our active
gram are:
membership in the ACOG Simulation Consortium. Obstetrics staff
•To provide a safe environment to demonstrate and improve
members must complete simulations once yearly. The Depart-
teamwork communication and care with a particular focus on
ment of Obstetrics and Gynecology has signed an agreement with
high-acuity, low-frequency events.
CRICO Harvard Risk Management that participation be linked to
•To provide individual feedback in a structured, nonpunitive
credentialing.
environment by using an objective assessment tool.
•To provide related didactic education to physicians and nurses regarding high-risk, low-frequency obstetrical emergencies.
Simulation Training
Obstetrics
62.
63.
Obstetrics continued
•To provide an open forum for exchange among obstetrical attending
physicians, residents, nurses, anesthesiologists, and ancillary staff.
•To allow learners to demonstrate and exercise knowledge of
local guidelines and protocols to bring about safe and
expeditious care during obstetrical emergencies
(e.g., the massive transfusion protocol).
Improvement: Gynecology
Twice yearly, all residents participate in an intensive 3-hour simulation experience to learn surgical techniques and participate in intensive electrosurgical skills hands-on training. The structured Fundamentals of Laparoscopic Surgery (FLS) Program includes didactic and
skills training in laparoscopic techniques. Our residents are mandated
to achieve accreditation via the FLS Cognitive and Skills Examination
as a graduation requirement, and BIDMC requires FLS certification for
advanced laparoscopy and robotic privileging.
64.
Phyllis West, RN, MSN
Nursing
Phyllis West, RN, MSN, Associate Chief Nurse
Jane Smallcomb, RN, MS, Clinical Director
BIDMC’s Ob/Gyn Nursing staff is committed to caring for the health of women over their full life cycle. Obstetrical nurses provide childbirth education
and expert care to patients in the Labor and Delivery Unit, Newborn Nurseries, High-Risk Antepartum and Post-Partum Units, and Neonatal Intensive
Care Unit. New mothers receive one-on-one teaching as well as certified
lactation support. Our gynecologic nurses provide expert postoperative
care, including management of complex gynecologic surgical and oncology
patients while addressing patients’ emotional and physical well-being.
Jane Smallcomb, RN, MS
65.
family-centered and our goal is to maintain a balance
of expertise and innovation with an environment that is
welcoming and nurturing for you and your family.”
Phyllis West, RN, MSN
“Our nursing philosophy is anchored in care that is
66.
67.
Social Work
68.
Social Work
Barbara Sarnoff Lee, LICSW,
Ob/Gyn social workers have expertise in women’s health issues across the developmen-
Director of Social Work and
tal life cycle, with specialized knowledge in high-risk pregnancies, perinatal bereave-
Patient/Family Engagement
ment, pregnancy termination, HIV/AIDS in women, gynecological cancers, child welfare
Ob/Gyn Social Workers
issues, substance abuse, domestic violence, and menopause. Staff from the Department
Betsy Barnet, LICSW
of Social Work provide counseling, consultation, and education to BIDMC patients, fami-
Nina Douglas, LICSW
lies, and staff, as well as assist patients in locating and accessing community programs
Susan Remy, LICSW
and services.
Sheleagh Somers-Alsop, LICSW
The department sponsors the Center for Violence Prevention and Recovery, which pro-
Gail Wolfsdorf, LICSW
vides counseling and advocacy services for those whose lives have been touched by vio-
Community Resource Specialist
lence. The program includes SafeTransitions, a domestic violence intervention program,
Glady Thomas
the Rape Crisis Intervention Program, and a community violence intervention program.
Social Work
69.
Education
70.
BIDMC OB/GYN • Education
Maternal-Fetal Medicine Fellowship
Steven J. Ralston, MD, MPH, Fellowship Director
Sarosh Rana, MD, Associate Fellowship Director
Current Fellows
The Maternal-Fetal Medicine Fellowship is a 3-year American Board of Ob-
Academic Year 2013−2014
stetrics
Melissa March, MD
and
Gynecology
(ABOG)−approved
clinical
and
research
training
program. Fellows spend 12 months on clinical rotations, 18 months on research,
Kedak Baltajian, MD
and 6 months of additional clinical time on electives and subspecialty exploration.
Scott Shainker, DO
A mentoring team guides each fellow according to individual goals and interests.
Excellent basic and clinical research opportunities are offered, as well as extensive
Program Graduate 2013
clinical experience in high-risk obstetrics, prenatal genetics, sonography, and ultra-
Where Are They Now?
sound-guided procedures. Fellows complete all of the ABOG requirements to obtain
William Schnettler, MD,
subspecialty board certification.
Faculty member at TriHealth in Ohio
Sarosh Rana, MD
71.
Current Fellows
Kathryn Humm, MD
Werner Neuhausser, MD, PhD
Kristi Maas, MD
Where Are They Now?
Kara Nguyen, MD,
RMA Philadelphia in
Mechanicsburg, PA; affiliate of
Pinnacle Health System
Reproductive Endocrinology
and Infertility Fellowship
Alan Penzias, MD, Fellowship Director
In the Reproductive Endocrinology and Infertility Fellowship, participants learn skills to
embark on academic career paths in which they can lead both basic and clinical research
programs. In addition, in this 3-year, ABOG-approved training program, fellows use their
reproductive endocrinology and infertility skills in a clinical setting. Faculty expertise in
reproductive medicine, surgery, and genetics, as well as pediatric and adolescent reproductive medicine, assists fellows in developing a solid foundation of clinical skill while
achieving a specific area of expertise.
Alan Penzias, MD
72.
Reconstructive Surgery Fellowship
Training physicians to provide expert care in improving the quality of life for women with
pelvic floor dysfunction is the chief educational objective of the Female Pelvic Medicine
Current Fellows
and Reconstructive Surgery Fellowship. The 3-year program, located at Mount Auburn
Hospital/BIDMC, is approved by the Accreditation Council for Graduate Medical Educa-
Amos Adelowo, MD, MPH
tion (ACGME). The program covers outpatient urogynecologic assessment and treatment,
Sybil Dessie, MD
office-based procedures, and appropriate surgical candidate selection, with an emphasis
Emily Von Bargen, DO
on various treatment options and patient counseling. Additionally, a comprehensive ap-
proach to surgical management, including preoperative and postoperative management,
is emphasized. Surgical training in both clinical and surgical settings includes laparo-
Where Are They Now?
Sonia Adams, MD
scopic, vaginal, and abdominal procedures, as well as robotic surgery. Research is an
St. Elizabeth Medical Center,
important and well-integrated portion of the curriculum with the availability of research
Brighton, MA
mentorship and support.
Eman Elkadry, MD
Eman Elkadry, MD, Fellowship Director
73.
Obstetrics and Gynecology
Residency Program
Hope Ricciotti, MD, Program Director
Monica Mendiola, MD, Assistant Program Director
Yvonne Gomez-Carrion, MD, Director of the Resident Surgical Practice
Ronald Marcus, MD, Co-Director of the Resident Ambulatory Practice
Celeste Royce, MD, Co-Director of the Resident Ambulatory Practice
Anastasia Koniaris, MD, Associate Director of the Resident Ambulatory Practice
Susan Kilbride, Manager, Graduate Medical Education
Yvonne Gomez-Carrion, MD
Martina DiNapoli, Program Coordinator
Monica Mendiola, MD
74.
Residency Program
Each year BIDMC’s Residency Program provides world-class training in
Ob/Gyn for a select group of 5 residents. The principal training hospital,
Beth Israel Deaconess Medical Center, is located adjacent to the Harvard
working closely with our dedicated faculty and staff, see patients in ambulatory clinics, learn state-of-the-art surgical techniques including
minimally invasive and robotic surgery, and provide obstetric care to just
under 5,000 patients every year. In a level of training uniquely focused
on the residents, they work one on one with faculty members in all subspecialty areas—maternal-fetal medicine, gynecologic oncology, female
pelvic medicine and reconstructive surgery/urogynecology, reproductive endocrinology and infertility, family planning, and minimally invasive gynecologic surgery. Residents also have the opportunity to work in
community health centers in Boston neighborhoods, or to explore global
health issues through the Global and Community Health track.
Medical School campus in the Longwood Medical Area. Here residents,
75.
Residency Program continued
Teaching innovations such as simulation
exercises for team training, obstetrical
emergencies and laparoscopic surgery,
and the Resident-as-Teacher Program
all help to train the next generation of
medical educators. The program’s reBIDMC OB/GYN Annual Report 2013
quired academic research component
includes faculty consultation and support
throughout a research project’s design,
institutional review board approval, and
statistical analysis. Additionally, residents
have 2 months of elective time, with funding for project expenses.
We take great pride in training our
residents to pursue excellence in their
endeavors, always with respect for diversity and empathy for the individual patient
and family experience.
76.
Administrative Chief Resident
Lisa Hofler, MD, MPH, Administrative Chief Resident
Each year faculty and residents elect one Administrative Chief Resident, an honor given
to the resident who demonstrates leadership, professionalism, and clinical excellence,
to the faculty, and help develop innovative teaching programs. Dr. Kristin Bixel served
in the 2012–2013 academic year, and Dr. Lisa Hofler is serving in the current 2013–2014
academic year.
“BIDMC provides excellent clinical and surgical training, with a focus
on patient-centered care. The teamwork within the hospital and the
supportive learning environment of the department create an
exceptional residency experience.”
Lisa Hofler, MD, MPH
as well as the interpersonal skills needed to lead the residency program, serve as liaison
77.
Current Residents
PGY 1: Class of 2017
Maria Fradinho, MD
Academic Year 2013–2014
Erin Brooks, MD, MPH
Faculty Physician at
Chief Residents: Class of 2014
Olivia Chang, MD, MPH
Harvard Vanguard
Katharine Barnes, MD
Jessica Kuperstock, MD
Medical Associates,
Lara Harvey, MD, MPH
Kari Plewniak, MD
Copley Practice
Lisa Hofler, MD, MPH
Elizabeth Roberts, MD
Boston, MA
Kristin Hung, MD
Where are They Now?
Julia Head, MD
Class of 2013
Faculty Physician at
Brigham & Women's
Sarah Averbach, MD
Margaret Chory, MD
Working a year at Bowdoin
Hospital/Harvard
Emily Holden, MD
Street Health Center
Vanguard Medical
Yetunde Ibrahim, MD
Entering Fellowship in Family Planning
Associates, Kenmore Practice
Annie Liu, MD
University of California–San Francisco
Boston, MA
Nandini Raghuraman, MD
Kristin Bixel, MD
Working a year at South Cove
Faculty Physician at South Shore
Community Health Center
Women's Health
pursuing Fellowship in
Weymouth, MA
Katie Armstrong, MD
Katie Johnson, MD
Zoe McKee, MD
Bri Anne McKeon, MD
Stephanie-Marie Jones, MD
Boston, MA
Sara Won, MD
Lily Wu, MD
78.
Medical Student Education
Katharyn Meredith Atkins, MD, Clerkship Director
Malcolm Mackenzie, MD, Associate Clerkship Director
L. Renata Vicari, Clerkship Coordinator
BIDMC exposes third-year students to the depth and breadth of
experiences that occur in women’s reproductive healthcare delivery. Our goals are to provide wide-ranging opportunities to
develop and refine clinical reasoning and procedural skills and
to promote awareness and understanding of cultural differences
in women’s health and reproductive care. We want students to
understand their role within a healthcare team and the value of
systems of care, and encourage them to be active, self-directed
learners. Reading patient histories before providing care and developing a reflective attitude toward their work are just two of the
important skills that help students understand our responsibility
Katharyn Meredith Atkins, MD
as caregivers through the range of women’s life experiences.
The Harvard Medical School Ob/Gyn Core Clerkship Program at
79.
Martina DiNapoli, Residency Coordinator
L. Renata Vicari, Clerkship Coordinator
80.
Medical Student Education continued
Students rotate on teams caring for patients in labor and delivery, in the postpartum units, and in gynecology inpatient service. Ob/Gyn
generalists volunteer to be the Teaching Attending of the Day and guide students in learning about the care of women during labor and
delivery. Each student is paired with an Ob/Gyn generalist core preceptor and attends weekly ambulatory sessions designed to promote
both continuity in patient care and in student learning.
In addition to grand rounds and resident-run didactic sessions on each service, there are also 2 to 3 hours of weekly didactic sessions,
led by faculty and senior residents/fellows, on topics agreed upon by the Clerkship Committee, which comprises the clerkship directors
integration of these specialties into student learning. Additional sessions on physical examinations, suturing, teamwork, and knot tying
promote skill acquisition. Fourth-year Harvard Medical School students and selected students from outside institutions may take these
advanced electives:
•Obstetrics Subinternship
•Women’s Health in Urban
•Female Pelvic Medicine and
Toni Golen, MD, Vice Chair,
Community Settings
Reconstructive Surgery
Lucy Chie, MD, Director,
Roger Lefevre, MD,
Improvement
Community Health Consortium
Course Director, FPMRS
•Gynecology Oncology
•Reproductive Endocrinology
Chris Awtrey, MD,
and Infertility
Division Director,
Kim Thornton, MD,
Division Director, REI
at all of the Harvard Medical School teaching sites. Multidisciplinary conferences with Psychiatry and Radiology help to promote the
81.
Research
82.
BIDMC OB/GYN • Research
Research
Michele Hacker, ScD, MSPH, Director, Program in Epidemiologic Research
Laura Dodge, MPH, Research Assistant
Miriam Haviland, MSPH, Research Assistant
Basic science as well as translational, clinical, public health, and medical education research projects that support the interests and expertise so valued by the department are
all supported by the Program in Epidemiologic Research. Mentorship and assistance with
Michele Hacker, ScD, MSPH
study design, protocol development, institutional review board approval, study implementation, data collection and management, data analysis, manuscript preparation, and
grant writing are all provided, with an emphasis on the research endeavors of residents,
fellows, and junior faculty.
Residents and fellows routinely present at national and international meetings and
publish in peer-reviewed journals. Projects include prospective and retrospective observational studies, randomized controlled trials, mixed-methods surveys, and experimental
animal models.
Anna Merport Modest, MPH, Research Assistant
83.
Research continued
Recent topics have evaluated:
the cervix with transvaginal ultrasonography
•botulinum toxin injections for chronic pelvic pain
•in vitro fertilization outcomes in young women
•simulation training for minimally invasive surgery and
the pathogenesis of preeclampsia has led to exciting new findings
and potential clinical therapies, and an ongoing study of gene
expression in pregnancies complicated by intrauterine growth
restriction holds similar promise.
obstetric complications
Epidemiology and public health policy as it relates to women’s
•a structured curriculum to teach accurate assessment
health among the vulnerable and underserved, locally and
of the cervix with transvaginal ultrasound
internationally, have special emphasis in the department.
Each academic year concludes with the department’s Resident
Research Day, where our residents have been honored for their
outstanding projects.
Resident-initiated projects include:
• investigation of patient-collected samples for HPV testing among women with limited access to medical care in Boston
• multidisciplinary team approach to reducing the incidence of Collaborative efforts with other departments and institutions
cesarean delivery in China
have also advanced research and increased our understanding of
• evaluation of postpartum IUD placement in Uganda
disease and the delivery of health care. For example, a project on
•the timing of voiding on the ability to accurately assess
84.
Research Faculty
Lev Perelman, PhD,
Director of The Center for
Advanced Biomedical
Imaging and Photonics
Sarosh Rana, MD,
Director of Perinatal Research
Research continued
Research Coordinator
Faculty also collaborate with academic,
Research Nurse
governmental,
and
nongovernmental
partners to broaden our understanding
of women's health needs in humanitarian crises. Understanding sexual violence
Saira Salahuddin, PhD, MBBS,
Dawn McCullough, RN,
Affiliated Research Scientists
S. Ananth Karumanchi, MD, PhD,
Department of Medicine
in the eastern Democratic Republic of
Yunping Li, MD,
Congo, gender inequitable practices in
Department of Anesthesia
South Sudan, and postelection violence in
Jonathan Hecht, MD, PhD,
Kenya are among current collaborations.
Department of Pathology
85.
86.
Research collaboration between the Departments of Obstetrics
going, and although drug-based therapies for preeclampsia may
and Gynecology and Medicine at BIDMC has led to discoveries
still be a few years away, researchers are optimistic.
to help diagnose and eventually treat preeclampsia—a disease
Other preeclampsia research includes an evaluation of the patho-
that complicates 5% of pregnancies worldwide and is a cause of
genesis of the excess cardiovascular disease noted in women
maternal and fetal mortality. Researchers first found that sFlt-1,
with a history of preeclampsia. Investigators are also working on
a molecule that occurs naturally in the placenta, may cause pre-
noninvasive techniques to evaluate pregnancy in an animal model
eclampsia when it is overabundant. Further research, stemming
of preeclampsia. And, a BIDMC Ob/Gyn researcher is co-leading
from collaboration with the Hospital for Sick Children in Toronto,
a multicenter randomized controlled clinical trial across several
discovered that a second protein, soluble endoglin, when com-
hospitals in the United States and Canada to evaluate the role of
bined with sFlt-1, escalates preeclampsia to a life-threatening
optimal blood pressure management for patients with gestational
state. The work has led to BIDMC patent filings on methods of
hypertension. This research program is directed by renal special-
diagnosing and treating preeclampsia. BIDMC researchers are
ist Dr. S. Ananth Karumanchi, Howard Hughes Medical Institute
testing the hypothesis that these two molecules can be used as
Investigator, who collaborates with Maternal-Fetal Medicine
biomarkers in various clinical settings to help clinicians make a
Specialist Dr. Sarosh Rana.
more prompt and accurate diagnosis. Prospective studies are on-
Preeclampsia and
Hypertensive Disorders
of Pregnancy
87.
Reproductive
Endocrinology Research
The Division of Reproductive Endocrinology and Infertility
the NIH, are published, and researchers are participating in the
conducts a robust array of both basic science and clinical
NIH-funded FORTT trial to determine the best course of fertility
research projects. Goals in the laboratory at Boston IVF include
treatment for women of advanced reproductive age.
understanding the fundamental aspects of oocyte maturation
Stem Cell Research
tion genetic diagnosis techniques holds promise for strategies
to improve IVF outcomes and reduce the burden of multiple
pregnancies.
The division collaborates with the Harvard Stem Cell Institute
and the Department of Stem Cell and Regenerative Biology. Dr.
Kevin Eggan’s lab focuses on how developmental/environmental
cues induce heritable variation in chromatin structure and how
Clinical research focuses on outcomes related to assisted repro-
variation regulates developmental potency, cell fate, and gene
ductive technology. Drs. Michele Hacker and Alan Penzias have
expression. The lab uses nuclear transfer and other approaches
led efforts to perform rigorous analysis of the Boston IVF patient
to develop human embryonic and induced pluripotent stem
database, which contains records on 52,000+ in vitro fertilization
cell lines that carry the genes responsible for human neurode-
cycles. Other recent projects include estimating the cumulative
generative disease. Dr. Eggan’s publication in Science, “Induced
pregnancy rate of live born multiples following IVF and evaluat-
pluripotent stem cells generated from patients with ALS can be
ing the influence of endometrial thickness and progesterone level
differentiated into motor neurons,” was cited by Time as the Top
on outcomes of assisted reproductive technology. Results of the
Medical Breakthrough of 2008.
FASTT trial, the largest single-center fertility study funded by
and preservation through vitrification. The study of preimplanta-
88.
Reproductive
Endocrinology
Research
Ovarian Aging
Division researchers bridge basic science
with clinical research through the use of a
discarded blood sample bank established
in early 2008. The samples, paired with
clinical outcomes of the patients, provide
a powerful asset for establishing biomarkers of reproductive health. The study
dovetails with our basic science research
efforts on ovarian aging and the impact of
disease states, including polycystic ovary
syndrome, on reproductive success.
89.
The Center for Advanced Biomedical Imaging and Photonics
Studying Subcellular Morphology with CLASS Microscopy
in the Department of Obstetrics and Gynecology is directed by
Confocal light absorption and scattering spectroscopic (CLASS)
Professor Lev T. Perelman. Through its three main research pro-
microscopy is a novel way to use optical imaging techniques for
grams, the center develops and uses a variety of tools and plat-
noninvasive monitoring of embryonic cells on the submicron
forms for in vivo optical biomedical imaging.
scale with no exogenous labels. The human embryo’s develop-
In Vivo Optical Detection of Preinvasive Cancer
ment and response to environmental factors could be monitored
Developing an optical system to perform rapid optical scanning
progressively at all critical stages using CLASS microscopy. For
and multispectral imaging of the entire epithelial surface of vari-
example, when cells are in metaphase, CLASS could provide in-
ous organs in the reproductive and gastrointestinal tracts, and
formation concerning the number and shape of chromosomes.
presenting a diagnosis in near real time, is the purpose of this
Since measurement is nondestructive and requires no exogenous
program. This approach, vastly superior to the present strategy of
chemicals, a given embryo in vitro could be monitored over time
performing random biopsies, provides a powerful tool for screen-
before implantation. Such progression studies are not possible
ing large populations of patients for early precancerous changes.
with currently available techniques.
The instrument was pilot tested in the esophagus at BIDMC,
where for the first time in the world, it successfully guided biopsy—detecting and mapping sites of invisible dysplasia missed
by the current standard of care.
Optical Diagnosis of Disease
90.
91.
Optical Diagnosis of Disease
Optical Spectroscopic Technique for
Noninvasive Prenatal Diagnosis
Noninvasive prenatal diagnosis utilizing fetal cells circulating in
maternal peripheral blood has received much attention, since it
poses no risk to the fetus. Although several fetal cell types have
been targeted, the search has focused on fetal nucleated red
blood cells (fNRBC). Because of the low concentration of fNRBC
in maternal blood, and interference by adult nucleated red blood
cells (aNRBC), along with the failure to find broadly applicable
identifiers that can differentiate fNRBC from aNRBC, reliable use
of viable fNRBC in amounts sufficient for clinical use remains a
challenge. We have demonstrated that fNRBC optical properties
provide a unique optical biomarker that is based on the lightscattering spectroscopic signatures of fNRBC and may enable
isolation of these cells from maternal peripheral blood samples,
with the goal of developing a minimally invasive prenatal genetic
testing technique.
92.
The department conducts educational research projects utilizing
but critical obstetrical events to determine the optimal training
simulation, virtual patients, standardized patients, and innovative
frequency and the perceived effect of the program to
techniques in medical education.
perform clinical care.
Improving Handoff of Patients
Obstetrical Virtual Patient Project
Dr. Mimi Fradinho, then a chief resident, and Dr. Toni Golen de-
Dr. Hope Ricciotti developed a normal pregnancy virtual patient,
signed and implemented a quality assurance program to improve
funded by the Macy Foundation as part of a series produced by
communication during resident hand off, resulting in a more ef-
the Shapiro Institute for Education and Research. The education-
ficient and structured process.
al effect of the OB Virtual Patient as a teaching tool was evaluated
Communicating Bad News Simulation Training Module
in a randomized controlled study of Harvard medical students.
Dr. Jo Marie Janco, then a third-year resident, Dr. Hope Ricciotti,
Resident as Teacher Program
and faculty from the Division of Medical Oncology collaborated
Drs. Hope Ricciotti and K. Meredith Atkins lead a program using
to implement and evaluate simulated training modules for deliv-
videotaped, simulated medical student teaching encounters to
ering bad news to patients.
train residents, with immediate faculty feedback and self-reflec-
Obstetrical Emergencies Simulation Training
tion. The project has led to a similar Resident as Teacher in the
Dr. Toni Golen, vice chair of Quality, Safety, and Performance Im-
O.R. Project, still in its initial phase, under the direction of Dr. Ric-
provement, and Dr. Mary Vadnais, then a Maternal-Fetal Medicine
ciotti and recent resident graduate Dr. Lauren Cadish.
Fellow, evaluated a simulation training program for uncommon
Medical Education Research
93.
Simulated Surgical Skills Training
Teaching Scripts in Ob/Gyn
Dr. Hye-Chun Hur, division director of Minimally Invasive Gy-
Dr. K. Meredith Atkins is leading a project to investigate the use of
necologic Surgery, is involved in several educational studies
teaching scripts to improve medical student instruction.
evaluating the role of simulation teaching and assessment for
Robotic Surgery Curriculum
gynecologic surgical training. Areas of study include traditional
Dr. Janet Li, section head of Female Pelvic Medicine and
laparoscopic suturing, electrosurgery, and robotic surgery.
Reconstructive Surgery, is developing a curriculum to teach ro-
Simulator Development
botic surgery to residents. The project will evaluate residents’
Dr. Christopher Awtrey, division director of Gynecologic Oncol-
attitudes and opinions regarding robotic surgery before and after
ogy, developed and evaluated a novel laparoscopic simulator to
the training.
train residents in pelvic surgery suturing skills. The Pelv-sim is a
modified box trainer that can be used to hone suturing skill before seeing patients in the operating room. Currently, Dr. Awtrey is
developing and testing a laparoscopic sacrocolpopexy box trainer
that simulates one of the most advanced procedures for the treatment of women with pelvic organ prolapse.
Medical Education Research
94.
Social Mission
95.
BIDMC OB/GYN • Social Mission
Community Health Consortium
Lucy Chie, MD, MPH, Director
The Community Health Consortium leads and develops projects in obstetrics and
gynecology for the Boston area’s culturally diverse population of urban and suburban
women. A network of community health centers staffed by our core teaching faculty and
serving women from a wide range of ethnic backgrounds, as well as the LGBT community, function as ambulatory sites for the resident practice and medical student programs.
programs, public health research projects, educational endeavors, and public service.
A Harvard Medical School student elective entitled “Ob/Gyn and Women’s Health in
Urban Community Settings” is also offered as a fourth-year elective option.
“Everyone deserves to receive the health care they need to live life
to the fullest. We are committed to providing the highest quality
of care and access to all women.”
Lucy Chie, MD, MPH
Healthcare leaders from each center come together quarterly at BIDMC to plan clinical
96.
Global and Community
Health Program
Jennifer Scott, MD, MBA, MPH, Director
Whether in Roxbury, Massachusetts, or Sub-Saharan Africa,
much of women's health is shaped by social, economic, and political inequities. The goal of the Global and Community Health
Program is to help faculty, staff, and students develop a global
understanding of women's health and to foster culturally competent care practices that meet the needs of the communities we
serve. We are committed to advancing reproductive health care in
an equitable, ethical, and dynamic manner, both locally and globally. To that end, we support innovative approaches and models to
global health delivery that engage community partners and build
capacity. We encourage faculty, staff, and students to participate
in service-based projects and research initiatives in collaboration with local and international partners. Residents may also
97.
Global and Community
Health Program continued
choose to conduct their longitudinal clinics in Boston’s medically
underserved communities at health centers such as the Dimock
Center and South Cove Community Health Center. We encourage residents to contribute their second- and third-year elective
time toward global and community health initiatives. Numerous opportunities exist with the department, the BIDMC Global
Health curriculum, and the broader community at Harvard Medical School and Harvard School of Public Health. Mentorship programs for faculty, staff, and students allow meaningful contributions to women’s health as providers, researchers, and advocates.
98.
99.
The Parent Connection
Christine Sweeney, LICSW, Program Manager
Since 1999 the Parent Connection, an award-winning, complimentary postpartum
service, has helped families anticipate and adjust to life after birth.
parents weekly throughout the first 12 weeks postdelivery to offer encouragement and
support and to help connect families to appropriate resources. Mentors are sometimes
“As the only hospital-based
The Parent Connection provides families a continuum of care after their delivery.
program of its kind in Boston,
Mentoring Moms is a perfect
example of a ‘human first’
approach that gives me such
a sense of personal and
professional pride. That most
of our mentor volunteers are
program graduates—I couldn’t
ask for a better evaluation.”
Through personal outreach and support, it exemplifies our values of patient- and family-
Christine Sweeney, LICSW
the first to help a new mom recognize she is experiencing symptoms consistent with a
postpartum mood disorder, and they help new moms to feel they are not alone in their
struggles. New Moms groups at several community locations provide moms an opportunity to share experiences, ask questions, and reduce isolation. One group specifically for
working moms meets during evening hours.
The program offers a monthly workshop called “Becoming Parents” to help expectant
couples anticipate and plan for the initial weeks at home with their newborn.
centered care.
In the program’s Mentoring Mom service, trained and supervised volunteers call new
100.
Service-Based Learning
and Research Projects
Recent Global Health Initiatives
Ongoing Global Health Initiatives, 2012−2013
•Clinical resident elective in Botswana at Scottish
•Clinical resident elective in Nepal with Nyaya Health
•BIDMC interdepartmental collaboration and consultation on Livingstone Hospital
global women’s health initiatives in India, Zimbabwe, Gabon, •Clinical support of the urogynecologic surgical program at Botswana, and China
Panzi Hospital in the Democratic Republic of Congo in collabo-
•Collaboration with the Human Resources for Health Program ration with the Harvard Humanitarian Initiative
in Rwanda to support Ob/Gyn graduate medical education
•Obstetric ultrasound training and research collaboration on a and training
Gates Foundation−funded program in Ghana
•Obstetric anesthesia clinical and research collaboration in •Family planning research at Mulago Hospital in
China
Kampala, Uganda
•Maternal-fetal medicine research collaboration in Haiti
•Collaboration with WHO working groups to inform maternal •Gender-based violence, human rights violations, and gender
and child health policies and reproductive endocrine and
equality research in the Democratic Republic of Congo, infertility policies
Kenya, and South Sudan in collaboration with academic,
•Academic medical education collaborations with partners in governmental, and nongovernmental international partners
China and Vietnam
International
101.
Service-Based Learning
and Research Projects
Community Health Initiatives
• Mentoring, clinical preceptorships, and research supervision serving immigrants from East Asia; recent projects include health literacy and hepatitis B infection in pregnancy
•Mentoring, clinical preceptorships, and research supervision for residents at the Dimock Center, which serves African American and Latina populations in Roxbury; recent projects include HPV vaccination, teen pregnancy, and IUD utilization
•HPV detection study and health education curriculum for an urban shelter population
•Health education and outreach for women in correctional facilities and transitional programs
•Collaboration with community-based organizations to improve access to women’s health care for minority patient populations
for residents at South Cove Community Health Center,
102.
Global Women’s Health Program Areas of Activity
Ukraine
Geneva,
Switzerland
Boston
China
Korea
Japan
Nicaragua
India
Haiti
Ghana
South Sudan
Uganda
DR Congo
Rwanda
Gabon
Philippines
Kenya
Zambia
Botswana
South Africa
Nepal
Mexico
103.
Living in
Boston
104.
BIDMC OB/GYN • Living in Boston
Living in Boston
BIDMC is located in one of the most vibrant, livable cities in the United States. Boston is
institutions but offers so much more in terms of history and culture. Puritan colonists
from England founded the town in 1630, and since that time the city has played a central
role in the political, commercial, financial, religious, and educational development of the
New England region. Today, you’ll see the city’s full history reflected in its diverse neighborhoods, well-preserved architecture, and major historical sites. The city is also modern
and stylish, rich in culture, and beautifully situated near mountains and the ocean. Theater, dance, art, music, and sports are all within walking or biking distance—or a quick ride
on our public transportation system. An evening at Boston Symphony Hall is just a “T”
stop away or you can stroll down the street to catch a game at Fenway Park, home of the
world champion Boston Red Sox. Boston is a clean and safe city that mirrors the quality
and distinction you’ll find at BIDMC. Whether you are new to Boston or a long-time resident, we think you’ll find living in “the hub” an exciting experience.
known worldwide for its state-of-the-art medical facilities and world-class educational
105.
BIDMC OB/GYN • Publications
Publications
Adams SR, Durfee S, Katz D, Pettigrew C, Jennings R, Ecker J, House M, Benson
C, Wolfberg A. Accuracy of ultrasound to predict estimated weight in fetuses
with gastroschisis. Journal of Ultrasound in Medicine. 2012;31(11):1753-8.
Berger BM, Phillips JA. Pregnancy outcomes in oocyte donation recipients:
vaginal gel versus intramuscular injection progesterone replacement. Journal
of Assisted Reproduction and Genetics. 2012;29(3):237-42.
Adams SR, Hacker MR, Merport Modest A, Rosenblatt PL, Elkadry EA. Informed consent for sacrocolpopexy: is counseling effective in achieving patient comprehension? Female Pelvic Medicine and Reconstructive Surgery.
2012;18(6):352-6. NIHMSID #480644.
Bhan I, Powe CE, Berg AH, Ankers E, Wenger JB, Karumanchi SA, Thadhani
RI. Bioavailable vitamin D is more tightly linked to mineral metabolism than
total vitamin D in incident hemodialysis patients. Kidney International.
2012;82(1):84-9.
Adelowo AO, Hacker MR, Merport Modest A, Elkadry EA. Do symptoms of
voiding dysfunction predict urinary retention? Female Pelvic Medicine and
Reconstructive Surgery. 2012;18(6):344-7. PMCID: PMC3512564.
Boivin J, Domar AD, Shapiro DB, Wischmann TH, Fauser BC, Verhaak C. Tackling burden in ART: an integrated approach for medical staff. Human Reproduction. 2012;27(4):941-50.
Awtrey CS. Nomograms for predicting endometrial cancer recurrence. Gynecologic Oncology. 2012;125(3):513-4.
Branch-Elliman W, Golen TH, Gold HS, Yassa DS, Baldini LM, Wright SB. Risk
factors for Staphylococcus aureus postpartum breast abscess. Clinical Infectious Diseases. 2012;54(1):71-7.
Bartels S, Kelly J, Scott J, Leaning J, Mukwege D, Joyce N, Vanrooyen M. Militarized sexual violence in South Kivu, Democratic Republic of Congo. Journal of
Interpersonal Violence. 2013;28(2):340-58.
Bartels SA, Scott JA, Leaning J, Kelly JT, Joyce NR, Mukwege D, Vanrooyen
MJ. Demographics and careseeking behaviors of sexual violence survivors in
South Kivu province, Democratic Republic of Congo. Disaster Medicine and
Public Health Preparedness. 2012;6(4):393-401.
David S, Mukherjee A, Ghosh CC, Yano M, Khankin EV, Wenger JB, Karumanchi
SA, Shapiro NI, Parikh SM. Angiopoietin-2 may contribute to multiple organ
dysfunction and death in sepsis. Critical Care Medicine. 2012;40(11):3034-41.
Dodge LE, Haider S, Hacker MR. Knowledge of state-level abortion laws and
regulations among front-line staff at facilities providing abortion services.
Women’s Health Issues. 2012;22(5):e415-20.
Peer-Reviewed Manuscripts of Original Research
106.
Previous Section
Domar AD, Conboy L, Denardo-Roney J, Rooney KL. Lifestyle behaviors in
women undergoing in vitro fertilization: a prospective study. Fertility and Sterility. 2012;97(3):697-701.
Fadare O, Parkash V, Dupont WD, Acs G, Atkins KA, Irving JA, Priog EC, Quade
BJ, Quddus MR, Rabban JT III,Vang R, Hecht JL. The diagnosis of endometrial
carcinomas with clear cells by gynecologic pathologists: an assessment of
interobserver variability and associated morphologic features. The American
Journal of Surgical Pathology. 2012;36(8):1107-18.
Faupel-Badger JM, Wang Y, Staff AC, Karumanchi SA, Stanczyk FZ, Pollak M,
Hoover RN, Troisi R. Maternal and cord steroid sex hormones, angiogenic factors, and insulin-like growth factor axis in African American preeclamptic and
uncomplicated pregnancies. Cancer Causes and Control. 2012;23(5):779-84.
Haggerty CL, Seifert ME, Tang G, Olsen J, Bass DC, Karumanchi SA, Ness RB.
Second trimester antiangiogenic proteins and preeclampsia. Pregnancy Hypertension. 2012;2(2):158-63.
Helderman JB, O'Shea TM, Kuban KC, Allred EN, Hecht JL, Dammann O, Paneth N, McElrath TF, Onderdonk A, Leviton A; ELGAN Study Investigators.
Antenatal antecedents of cognitive impairment at 24 months in extremely low
gestational age newborns. Pediatrics. 2012;129(3):494-502.
Hota LS, Hanaway K, Hacker MR, Disciullo A, Elkadry E, Dramitinos P, Shapiro
A, Ferzandi T, Rosenblatt PL. TVT-Secur (Hammock) versus TVT-Obturator:
a randomized trial of suburethral sling operative procedures. Female Pelvic
Medicine and Reconstructive Surgery. 2012;18:41-45. NIHMSID #480627.
Hung KJ, Scott J, Ricciotti HA, Johnson TR, Tsai AC. Community-level and
individual-level influences of intimate partner violence on birth spacing in
Sub-Saharan Africa. Obstetrics and Gynecology. 2012;119(5):975-82.
Kane SE, Hecht JL. Endometrial intraepithelial neoplasia terminology in practice: 4-year experience at a single institution. International Journal of Gynecologic Pathology. 2012;31(2):160-5.
Kapur NK, Wilson S, Yunis AA, Qiao X, Mackey E, Paruchuri V, Baker C, Aronovitz MJ, Karumanchi SA, Letarte M, Kass DA, Mendelsohn ME, Karas RH. Reduced endoglin activity limits cardiac fibrosis and improves survival in heart
failure. Circulation. 2012;125(22):2728-38.
Karipcin FS, Moragianni VA, Milette B, Kinzer DR, Thornton KL, Barrett B,
Penzias AS. Effect of steroid and antibiotic treatment during assisted hatching on IVF outcomes. Human Fertility (Camb). 2012;15(4):205-9.
Dodge LE, Haider S, Hacker MR. Using a simulated patient to assess referral
for abortion services in the United States. Journal of Family Planning and Reproductive Health Care. 2012;38(4):246-51.
107.
Previous Section
Khankin EV, Mandala M, Colton I, Karumanchi SA, Osol G. Hemodynamic, vascular, and reproductive impact of FMS-like tyrosine kinase 1 (FLT1) blockade
on the uteroplacental circulation during normal mouse pregnancy. Biology of
Reproduction. 2012;86(2):57.
Lannon B*, Choi B*, Hacker MR, Dodge LE, Malizia BA, Barrett CB, Wong WH,
Yao MWM, Penzias A. Predicting the risk of multiple birth after in vitro fertilization—double embryo transfer. Fertility and Sterility. 2012;98:69-76.
Li F, Hagaman JR, Kim HS, Maeda N, Jennette JC, Faber JE, Karumanchi SA,
Smithies O, Takahashi N. eNOS deficiency acts through endothelin to aggravate sFlt-1-induced pre-eclampsia-like phenotype. Journal of the American
Society of Nephrology. 2012;23(4):652-60.
Lu J, Lian G, Zhou H, Esposito G, Steardo L, Delli-Bovi LC, Hecht JL, Lu QR,
Sheen V. OLIG-2 overexpression impairs proliferation of human Down syndrome neural progenitors. Human Molecular Genetics. 2012;21(10):2330-40.
Mijal RS, Holzman CB, Rana S, Karumanchi SA, Wang J, Sikorskii A. Mid-pregnancy levels of angiogenic markers as indicators of pathways to preterm delivery. Journal of Maternal-Fetal and Neonatal Medicine. 2012;25(7):1135-41.
Moragianni VA, Hacker MR, Craparo FJ. The impact of length of second stage
of labor on shoulder dystocia outcomes: a retrospective cohort study. Journal
of Perinatal Medicine. 2012;40:97-100.
Moragianni VA, Jones SML, Ryley DA. The effect of body mass index on the
outcomes of first assisted reproductive technology cycles. Fertility and Sterility. 2012;98(1):102-8.
Newman LR, Brodsky DD, Roberts DH, Pelletier SR, Johansson A, Voller CM
Jr, Atkins KM, Schwartzstein RM. Developing expert-derived rating standards
for the peer assessment of lectures. Academic Medicine. 2012;87(3):356-63.
Ogbechie OA, Hacker MR, Dodge LE, Patil MM, Ricciotti HA. Confusion regarding cervical cancer screening and chlamydia screening among sexually
active young women. Sexually Transmitted Infections. 2012:88(1):35-37. NIHMSID 480621.
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, Monte F, Hilfiker-Kleiner D, Karumanchi SA, Arany Z.
Cardiac angiogenic imbalance leads to peri-partum cardiomyopathy. Nature.
2012;485:333-9. PMCID: PMC3356917.
*Contributed equally to the work.
Khankin EV, Hacker MR, Zelop CM, Karumanchi SA, Rana S. Intravital highfrequency ultrasonography to evaluate cardiovascular and uteroplacental
blood flow in mouse pregnancy. Pregnancy Hypertension. 2012;2(2):84-92
PMCID: PMC3337759.
108.
Previous Section
Qiu L, Turzhitsky V, Chuttani R, Pleskow DK, Goldsmith JD, Guo LY, Vitkin E,
Itzkan I, Hanlon EB, Perelman LT. Spectral imaging with scattered light: from
early cancer detection to cell biology. IEEE Journal of Selected Topics in
Quantum Electronics. 2012;18:1073-83.
Rajakumar A, Cerdeira AS, Rana S, Zsengeller Z, Edmunds L, Jeyabalan A, Hubel
CA, Stillman IE, Parikh SM, Karumanchi SA. Transcriptionally active syncytial
aggregates in the maternal circulation may contribute to circulating soluble
fms-like tyrosine kinase 1 in preeclampsia. Hypertension. 2012;59(2):256-64.
Rana S, Cerdeira AS, Wenger J, Salahuddin S, Lim KH, Ralston SJ, Thadhani RI, Karumanchi SA. Plasma concentrations of soluble endoglin versus
standard evaluation in patients with suspected preeclampsia. PLoS One.
2012;7(10):e48259.
Rana S, Hacker MR, Modest AM, Salahuddin S, Lim KH, Verlohren S, Perschel
FH, Karumanchi SA. Circulating angiogenic factors and risk of adverse maternal and perinatal outcomes in twin pregnancies with suspected preeclampsia.
Hypertension. 2012;60(2):451-8. PMCID: PMC3432569.
Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, Lim KH,
Wenger JB, Thadhani R, Karumanchi SA. Angiogenic factors and the risk of
adverse outcomes in women with suspected preeclampsia. Circulation.
2012;125(7):911-9.
Ricciotti HA, Dodge LE, Head J, Atkins KM, Hacker MR. A novel resident-asteacher training program to improve and evaluate obstetrics and gynecology
resident teaching skills. Medical Teacher. 2012;34(1):e52-7.
Rosenblatt PL, Apostolis CA, Hacker MR, Disciullo A. Laparoscopic supracervical hysterectomy with transcervical morcellation and sacrocervicopexy:
initial experience with a novel surgical approach to uterovaginal prolapse.
Journal of Minimally Invasive Gynecology. 2012;19(6):749-755. NIHMSID
#480636.
Schnettler WT, Hacker MR, Barber RE, Rana S. Management of abnormal
serum markers in the absence of aneuploidy or neural tube defects. Journal of Maternal-Fetal and Neonatal Medicine. 2012;25(10):1895-8. NIHMSID
#480635.
Scott J, Polak S, Kisielewski M, McGraw-Gross M, Johnson K, Hendrickson M,
Lawry L. A mixed-methods assessment of sexual and gender-based violence
in eastern Democratic Republic of Congo to inform national and international
strategy implementation. International Journal of Health Planning and Management. 2012 May 20 [Epub ahead of print].
Petruzziello-Pellegrini TN, Yuen DA, Page AV, Patel S, Soltyk AM, Matouk CC,
Wong DK, Turgeon PJ, Fish JE, Ho JJ, Steer BM, Khajoee V, Tigdi J, Lee WL,
Motto DG, Advani A, Gilbert RE, Karumanchi SA, Robinson LA, Tarr PI, Liles
WC, Brunton JL, Marsden PA. The CXCR4/CXCR7/SDF-1 pathway contributes
to the pathogenesis of Shiga toxin-associated hemolytic uremic syndrome in
humans and mice. Journal of Clinical Investigation. 2012;122(2):759-76.
109.
Previous Section
Skiadas CC, Duan S, Correll M, Rubio R, Karaca N, Ginsburg ES, Quackenbush
J, Racowsky C. Ovarian reserve status in young women is associated with altered gene expression in membrana granulosa cells. Molecular Human Reproduction. 2012;18(7):362-71.
Stern J, Hickman RN, Kinzer D, Penzias A, Ball D, Gibbons WE. Can the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System
(SART CORS) be used to accurately report clinic total reproductive potential
(TRP)? Fertility and Sterility. 2012;97(4):886-9.
Tang JR, Karumanchi SA, Seedorf G, Markham N, Abman SH. Excess soluble
vascular endothelial growth factor receptor-1 in amniotic fluid impairs lung
growth in rats: linking preeclampsia with bronchopulmonary dysplasia.
American Journal of Physiology—Lung Cellular and Molecular Physiology.
2012;302(1):L36-46.
Vadnais MA, Dodge LE, Awtrey CS, Ricciotti HA, Golen TH, Hacker MR. Assessment of long-term knowledge retention following single-day simulation
training for uncommon but critical obstetrical events. Journal of MaternalFetal and Neonatal Medicine. 2012;25(9):1640-5. NIHMSID #480631.
Vadnais MA, Rana S, Quant HS, Salahuddin S, Dodge LE, Lim KH, Karumanchi SA, Hacker MR. The impact of magnesium sulfate therapy on angiogenic
factors in preeclampsia. Pregnancy Hypertension. 2012;2(1):16-21. PMCID:
PMC32541114.
Vikse BE, Irgens LM, Karumanchi SA, Thadhani R, Reisæter AV, Skjærven R.
Familial factors in the association between preeclampsia and later ESRD.
Clinical Journal of the American Society of Nephrology. 2012;7(11):1819-26.
Vinokurov VA, Muradov AV, Getmanskiy M, Qiu L, Vitkin E, Itzkan I, Perelman LT. Nonspherical gold nanoparticles as bright light scattering labels with
narrow plasmon lines. Advanced Sciences and Technologies. 2012;86:51-58.
Wang A, Holston AM, Yu KF, Zhang J, Toporsian M, Karumanchi SA, Levine
RJ. Circulating antiangiogenic factors during hypertensive pregnancy and increased risk of respiratory distress syndrome in preterm neonates. Journal of
Maternal-Fetal and Neonatal Medicine. 2012;25(8):1447-52.
Young BC, Hacker MR, Dodge LE, Golen TH. Timing of antibiotic administration and infectious morbidity following cesarean delivery: incorporating policy change into workflow. Archives of Gynecology and Obstetrics.
2012;285:1219-24.
Young B, Hacker MR, Rana S. Physicians' knowledge of future vascular disease in women with preeclampsia. Hypertension in Pregnancy. 2012;31(1):508. PMCID: PMC3227747.
Shahul S, Rhee J, Hacker MR, Gulati G, Mitchell JD, Hess P, Mahmood F, Arany
Z, Rana S, Talmor D. Subclinical left ventricular dysfunction in preeclamptic
women with preserved left ventricular ejection fraction: a 2D speckle tracking
imaging study. Circulation: Cardiovascular Imaging. 2012;5:734-739. NIHMSID# 480638.
110.
Previous Section
Zsengellér ZK, Ellezian L, Brown D, Horváth B, Mukhopadhyay P, Kalyanaraman B, Parikh SM, Karumanchi SA, Stillman IE, Pacher P. Cisplatin nephrotoxicity involves mitochondrial injury with impaired tubular mitochondrial enzyme activity. Journal of Histochemistry and Cytochemistry. 2012;60(7):521-9.
Adelowo A, Hacker MR, Merport A, Elkadry E. Do symptoms of voiding dysfunction predict urinary retention? 2012. Presented at the 38th Annual Scientific Meeting of the Society of Gynecologic Surgeons.
Adelowo A, Hacker MR, O’Neal E, Hota L. Underlying factors contributing to
the delay in patients seeking care for pelvic floor dysfunction. 2012. Poster
Presentation, AUGS 33rd Annual Scientific Meeting.
Adams SR, Dodge LE, Dramitinos P, Elkadry E. Do patient goals vary with stage
of prolapse? A follow up study of goal achievement. 2012. Presented as a poster at the annual meeting of the American Urogynecologic Society.
Averbach S, Lester F, Fortin J, Byamugisha J, Goldberg A, Kakaire O. Acceptability of the IUD among women who opted out of a randomized controlled
trial of intracesarean insertion of the Copper-T 380A in Kampala, Uganda.
2012. Presented as a poster at the 20th World Congress of Gynecology and
Obstetrics.
Adams SR, Hacker MR, Rosenblatt P, Merport A, Elkadry E. Informed consent
for sacrocolpopexy: is counseling effective in achieving patient comprehension? 2012. Presented as an oral presentation at the 38th Annual Scientific
Meeting of the Society of Gynecologic Surgeons.
Bixel K, Hur HC, Merport Modest A, Kiang M, Singer S. Impact of perceptions
of patient safety on planning and implementation of surgical safety checklists. 2012. Presented at the 41st AAGL Global Congress on Minimally Invasive
Gynecology.
Adams SR, McKinney JL, Rosenblatt, PL. Musculoskeletal pain and disorders
among gynecologic surgeons. 2012. Presented as an oral presentation at the
annual meeting of the American Association of Gynecologic Laparoscopists.
Bixel K, Merport Modest A, McCann A. Treatment and outcomes of patients
diagnosed with carcinoma confined to the abdomen. 2012. Presented as an
oral presentation at the annual meeting of the New England Association of
Gynecologic Oncologists.
Conference Abstracts
Yu XD, Branch DW, Karumanchi SA, Zhang J. Preeclampsia and retinopathy of
prematurity in preterm births. Pediatrics. 2012;130(1):e101-7.
111.
Previous Section
Harvey LF, Barnes K, Hofler L, Hung K, Wu L, Hur HC. Analysis of patient characteristics and subsequent surgical intervention among a cohort of women
trialing levonorgestrel intrauterine devices (IUDs) for medical indications.
Journal of Minimally Invasive Gynecology. 2012;19(6S):S103-4. Presented as
an oral presentation at the 41st AAGL Global Congress on Minimally Invasive
Gynecology.
Hawkins L, Schnettler W, Hacker M, Merport Modest A, Rodriguez D. Association of third trimester abdominal circumference with timing of delivery. 2012.
Presented as an oral presentation at the American Institute of Ultrasound in
Medicine, Annual Convention.
Hawkins L, Schnettler W, Hacker M, Merport Modest A, Rodriquez D. Association of third trimester abdominal circumference with timing of delivery. 2012.
Presented as an oral presentation at the 22nd World Congress on Ultrasound
in Obstetrics.
Hofler L, Merport Modest A, Dodge LE, Owen L, Hacker MR, Haider S. Patient satisfaction and procedure characteristics of uterine evacuation using
a vacuum aspiration with and without sharp curettage. 2012. Presented as a
poster at the annual meeting of the Central Association of Obstetricians and
Gynecologists.
Hofler L, Owen L, Dodge LE, Hacker MR, Haider S. Patient satisfaction and
procedure wait times for uterine evacuation with manual and electric vacuum
aspiration. 2012. Presented as a poster at the annual meeting of the Society
for Family Planning.
Lely TA, Salahuddin S, Holwerda KM, Karumanchi SA, Rana S. Circulating
lymphangiogenic factors in preeclampsia. 2012. Presented as a poster at the
28th International Society for the Study of Hypertension in Pregnancy World
Congress.
Malizia BA, Dodge LE, Sisti JS, Penzias AS, Hacker MR. Increased body mass
index (BMI) is a risk factor for poor fertilization among women undergoing in
vitro fertilization (IVF). 2012. Presented as a poster at the annual meeting of
the American Society of Reproductive Medicine.
Moragianni VA, Alper MM. Recurrent pregnancy loss in a patient with sex
chromosome mosaicism: a case report and review of the literature. 2012.
Presented as a poster at the annual meeting of the Society of Gynecologic
Investigation.
Moragianni VA, Mullen A, Penzias AS, Berger BM. Antral follicle count measurement in oocyte donors is not associated with recipient IVF outcomes.
2012. Presented as a poster at the annual meeting of the Society for Gynecologic Investigation.
Dessie S, Adams SR, Hacker MR, Merport Modest A, Elkadry EA. Bladder habits and attitudes in an ethnically diverse population. 2012. Presented as a
poster at the annual meeting of the American Urogynecologic Society.
112.
Previous Section
Rana S, Hacker MR, Salahuddin S, Karumanchi SA. Angiogenic factors and the
risk of adverse outcomes in twin gestation. 2012. Presented as a poster at the
annual meeting of the Society for Gynecologic Investigation.
Shapiro A, Dessie S, Hacker M, Awtrey C. Validation of a novel, camera-based,
procedure specific, laparoscopic box-trainer. 2012. Presented as a poster at
the annual meeting of the Society of Gynecologic Surgeons.
Wu LH, Humm KC, Dodge LE, Sakkas D, Hacker MR, Penzias AS. IVF outcomes
are paradoxically poorer under age 25. 2012. Presented as a poster at the annual meeting of the American Society of Reproductive Medicine.
Yiu T, Averbach S, Hacker MR, Merport A, Walker H, Dimitrakoff J, Ricciotti H.
The association between Mycoplasma genitalium and preterm delivery at an
urban community health center. 2012. Presented as a poster at the Women’s
Health Congress.
Schaarschmidt W, Rana S, Stepan H. The course of sFlt1 and PlGF reflects
different progression pattern in early- versus late-onset preeclampsia and
HELLP syndrome. 2012. Presented as a poster at the 28th annual meeting of
the International Society for the Study of Hypertension in Pregnancy World
Congress.
Other Publications
Scott J, Averbach S, Merport Modest A, Hacker MR, Murphy M, Cornish S,
Spencer D, VanRooyen M. An assessment of gender equitable norms in South
Sudan. 2012. Presented as a poster at the annual Women’s Health Congress.
Awtrey CS. Nomograms for predicting endometrial cancer recurrence. Comment on: Nomograms to predict isolated loco-regional or distant recurrence
among women with uterine cancer. Gynecologic Oncology. 2012;125(3):513-4.
Shahul S, Rhee JS, Rana S, Hacker MR, Mitchell J, Hess P, Mahmood F, Talmor
D. Subclinical left ventricular dysfunction in preeclamptic women with preserved left ventricular ejection fraction: a 2D speckled tracking imaging study.
2012. Presented as a poster at the 28th International Society for the Study of
Hypertension in Pregnancy World Congress.
Bixel K, Silasi M, Zelop CM, Lim KH, Zsengeller Z, Stillman I, Rana S. Placental
origins of angiogenic dysfunction in mirror syndrome. Hypertension Pregnancy. 2012;31(2):211-7.
Cerdeira AS, Karumanchi SA. Angiogenic factors in preeclampsia and related
disorders. Cold Spring Harbor Perspectives in Medicine. 2012;2(11).
Rana S, Hacker M, Merport A, Salahuddin S, Verlohren S, Perschel F, Karumanchi A. Angiogenic factors and risk of preeclampsia related adverse outcomes
in twin pregnancies. 2012. Presented as a poster at the 28th International Society for the Study of Hypertension in Pregnancy World Congress.
113.
Previous Section
Other Publications
Fallat ME, Hertweck P, Ralston SJ. Surgical and ethical challenges in disorders
of sexual development. Advanced Pediatrics. 2012;59(1):283-302.
Garrett LA, Boruta DM II. Laparoscopic single-site radical hysterectomy: the
first report of LESS type III hysterectomy involves a woman with cervical cancer. American Journal of Obstetrics and Gynecology. 2012;207(6)518.e1-2.
Hagmann H, Thadhani R, Benzing T, Karumanchi SA, Stepan H. The promise
of angiogenic markers for the early diagnosis and prediction of preeclampsia.
Clinical Chemistry. 2012;58(5):837-45.
Hur HC. Incidence and patient characteristics of vaginal cuff dehiscence complications after hysterectomy. Up To Date. 2009–present (revised annually).
Mackenzie M. Laparoscopic intracorporeal cinch knots: changing the square
knot paradigm. Journal of Minimally Invasive Gynecology. 2012;19(2):225-35.
March MI, Warsof SL, Chauhan SP. Fetal biometry: relevance in obstetrical
practice. Clinical Obstetrics and Gynecology. 2012;55(1):281-7.
Moragianni VA. Can we finally move away from the surgical diagnosis of endometriosis? Fertility and Sterility. 2012;98(3):609.
Moragianni VA, Hamar BD, McArdle C, Ryley DA. Management of a cervical
heterotopic pregnancy presenting with first-trimester bleeding: case report
and review of the literature. Fertility and Sterility. 2012;98(1):89-94.
Penzias AS. Recurrent IVF failure: other factors. Fertility and Sterility.
2012;97(5):1033-8.
Quant H, Arden D, Takoudes T, Rana S. Angiogenic factors and pregnant woman with new onset seizures. Hypertension in Pregnancy. 2012;31(2):207-10.
Konstantinopoulos PA, Awtrey CS. Management of ovarian cancer: a 75-yearold woman who has completed treatment. Journal of the American Medical
Association. 2012;307(13):1420-9.
Ralston SJ. Ethics of multifetal pregnancy reduction. Lahey Clinic Journal of
Medical Ethics. 2011;18(3).
Lowenstein L, Rosenblatt PL, Dietz HP, Bitzer J, Kenton K. New advances in
urogynecology. Obstetrics and Gynecology International. 2012;2012:453059.
Scott J, Averbach S, Merport Modest A, Hacker M, Cornish S, Spencer D, Murphy M, Parmar P. A gender lens on South Sudan: an assessment of gender
inequitable norms and gender-based violence in South Sudan 2009–2011.
Harvard Humanitarian Initiative and American Refugee Committee. July 2012.
Cerdeira AS, Kopcow HD, Karumanchi SA. Regulatory T cells in preeclampsia: some answers, more questions? American Journal of Pathology.
2012;181(6):1900-2.
114.
Previous Section
Other Publications
Scott J, Kelly J. Gender-based violence and reproductive health in humanitarian crises and conflict. In: Oxford Handbooks. Oxford University Press. Submitted September 2012.
Stillman IE, Karumanchi SA. Vasculitis is an antiangiogenic state. Journal of
the American Society of Nephrology. 2012;23(1):8-10.
Wang A, Karumanchi SA. Relaxin' with endothelial progenitor cells. Blood.
2012;119(2):326-7.
Wellons MF, Fujimoto VY, Baker VL, Barrington DS, Broomfield D, Catherino
WH, Richard-Davis G, Ryan M, Thornton K, Armstrong AY. Race matters: a
systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes. Fertility and Sterility. 2012;98(2):406-9.
115.
Previous Section
w w w.bidmc.org/obg yn

BIDMC Obstetrics and Gynecology 2013 Annual Report

Transcription

Similar documents

SucceSS on the Brain - Beth Israel Deaconess Medical Center

ACOOG 2015-2016 Board of Trustees

Family Physician

Mikko Hypponen Chief Research Officer, F-Secure Mikko

New Frontiers in Women`s Healthcare

FINAL PROGRAM

Pic need - Family Planning Association Trinidad and Tobago

August 2014 - Health Policy Project

The PowerPoint

Biosecurity protocols for the prevention of spread of porcine

2013-2014 GEMMA Annual Report - Rollins School of Public Health