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Contributions to Cardiac Electrophysiology: Dr. Mark Josephson, Chief of Cardiology – CardioVascular Institute at Beth Israel Deaconess Medical Center

Posted in Electrophysiology, tagged American Heart Association, Beth Israel Deaconess Medical Center, Josephson, Paul Dudley White, Tufts Medical Center, United States on June 11, 2013| Leave a Comment »

Dr. Mark Josephson, Chief of Cardiology – CardioVascular Institute at Beth Israel Deaconess Medical Center – Recipient of 2013 American Heart Association‘s Paul Dudley White Award for Contributions to Cardiac Electrophysiology

Reporter: Aviva Lev-Ari, PhD, RN

VIEW VIDEO – Outstanding !!

http://bidmc.org/Centers-and-Departments/Departments/Cardiovascular-Institute/About-the-CVI/CVI-In-the-News/2013/April/Josephson.aspx

Dr. Josephson Recognized for Contributions to Cardiac Electrophysiology

Date: 5/1/2013

The American Heart Association presented its prestigious Paul Dudley White Award to Mark E. Josephson, MD, Chief of Cardiovascular Medicine at the CardioVascular Institute at Beth Israel Deaconess Medical Center, at its annual gala in April.

The award is given annually to a Massachusetts medical professional physician who has made a distinguished contribution to the American Heart Association’s mission of building healthier lives, free of cardiovascular disease and stroke.

“The AHA is pleased to honor Dr. Josephson,” said N. A. Mark Estes III, MD, director of the New England Cardiac Arrhythmia Center at Tufts Medical Center, chair of the selection committee. The award “is a fitting tribute for his professional accomplishments, personal attributes, and contributions to the AHA.”

Transformed His Field

Dr. Josephson is credited with transforming the field of cardiac electrophysiology from an intriguing scientific idea to a robust diagnostic and therapeutic tool for the management of arrhythmias, or abnormal heart rhythms. His research into the physiologic basis of these conditions has led to revolutionary achievements in their diagnosis and treatment.

A passionate educator, Dr. Josephson in the late 1970s wrote the definitive textbook on the practice of electrophysiology. It is now in its fourth edition and one of the rare single-author textbooks in any field. Since 1982, he has co-taught a seminal bi-yearly seminar on the interpretation of complex arrhythmias. The course has been attended by nearly 6,000 physicians, including 85 percent of electrophysiologists in the United States, for whom it is considered a rite of passage. He is also one of the busiest clinicians in BIDMC’s Division of Cardiovascular Medicine.

Having trained more physicians in his specialty than anyone else in the world, Dr. Josephson is fond of saying that his greatest legacy is the successes of his “academic children and grandchildren” and the subsequent generations of clinicians and researchers they have gone on to teach.

Dr. Josephson is the author of 444 original articles in peer-reviewed scientific publications, such as the New England Journal of Medicine and Circulation, a journal of the AHA. He is the author of more than 200 chapters, reviews and editorials.

Unfailing Dedication

“The selection of Mark Josephson as the 2013 recipient of the Paul Dudley White Award is a fitting recognition of the impact he has had on cardiology in Boston for the last 20 years,” says cardiologist Peter Zimetbaum, MD, a BIDMC colleague and member of the AHA selection committee. “He, like Paul Dudley White, inspires us through his unparalleled clinical and research insights and his unfailing dedication to the practice of medicine.”

Dr. Josephson shares a number of attributes with Dr. White, who was one of Boston’s most revered cardiologists and a founding father of the AHA. Their shared experiences include an association with Harvard, a sustained tenure at his medical institution, and early military experience that helped launch his career.

Perhaps most significantly, they share an unbridled passion for saving and enhancing the lives of patients with cardiovascular disease.

Pamela Lesser, one of Dr. Josephson’s patients who endorsed his nomination, said, “I don’t know how old he is, but he has an enthusiasm and love for what he does that is like he’s in his 20s, just out of medical school and ready to conquer the world. He’s on the edge of discovery. He has a passion for his work that spreads to the patient and that feeds into that whole feeling of ‘I’m in the best hands possible.’”

http://bidmc.org/Centers-and-Departments/Departments/Cardiovascular-Institute/About-the-CVI/CVI-In-the-News/2013/April/Josephson.aspx

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A Radiologist Reflects on the Boston Marathon Bombings: NEMC – 22 Radiologists, 22 Residents with 16 Staff Members Onsite

Posted in Interviews with Scientific Leaders, tagged Boston Marathon, Patriots' Day, Radiology, Trauma center, Tufts, Tufts Medical Center, Tufts University on May 16, 2013| Leave a Comment »

Reporter: Aviva Lev-Ari, PhD, RN

A radiologist reflects on the Boston Marathon bombings

By Wayne Forrest, AuntMinnie.com staff writer

May 16, 2013 — Monday, April 15 — Patriots’ Day in Boston — started much like any other day for radiologist Dr. Robert Ward of Tufts Medical Center. But it turned out to be anything but normal after two bombs exploded at the end of the Boston Marathon, sending dozens of injured people to Tufts with battlefield-like injuries.

Ward is chief of musculoskeletal imaging and has been on the job at Tufts for more than five years. He’d finished his administrative duties for the day and was reading routine imaging studies when he received a text from his wife shortly before 3 p.m. A friend, who is a gastroenterology fellow at Boston University and was running in the marathon, told Mrs. Ward there had been explosions heard near the race’s finish line.

Dr. Robert Ward from Tufts Medical Center.

“My first inclination was that there was some sort of minor mischief; maybe someone dropped some firecrackers or something like that into a garbage can,” Ward said. “Then a colleague poked his head into the reading room and said there were explosions, limbs were lost, and there were several people dead. At that point, it became an entirely different matter.”

Marathon bombings

Soon thereafter, Ward, the city, the nation, and the rest of world would come to learn that two homemade bombs had been detonated within seconds of each other about 200 yards apart along the path to the finish line. In the end, three people died and more than 260 bystanders and runners were injured, some hurt so severely that they lost limbs.

On a normal Boston Marathon day, most patients at Tufts present with dehydration, or a couple of days after the race, people arrive with extremity abnormalities. There are 22 radiologists and 22 residents at the medical center, with 16 or 17 staff members onsite at any given time.

Word spread quickly that bombing victims were on their way to the level I trauma center.

“I elected to go down to the ER,” Ward recalled. “Patients were starting to come in, probably five times the normal number of people who are in the emergency department [at that time of day]. That place was really in a chaotic manner.”

He estimated there were 13 marathon patients in the emergency room, most of whom were young and probably runners. Most injuries were isolated to the lower extremities; a fair number of patients had skin ripped away from their bodies. What’s more, the limbs of many patients were embedded with the “strangest foreign bodies [and] shrapnel like we have never seen before.”

Some patients had BBs lodged in their extremities, as well as what Ward described as twisted, metallic items that must have been 2 to 4 inches in size. “Generally, those [objects] don’t make it deep into tissue unless there is a substantial explosion, which was obviously the case,” he said.

Onsite care

For the marathon, medical personnel and physicians often take the day off and donate their time to treat race-related injuries and other ailments at a makeshift facility near the finish line. On this day, having that kind of medical expertise so close to the bombings “made for an extraordinary rapid response,” Ward said. “It was almost like battlefield medicine in a sense.”

Under normal circumstances, Tufts’ protocol is to acquire two right-angle x-rays of leg and ankle injuries to determine their extent and location.

“Because of the emergent nature of the injuries, we would get one x-ray and [patients] would go straight to the operating room,” Ward explained. “It is purely a time issue. With some of the bizarre shrapnel fragments that we were seeing, it was hard to believe they were actually inside people.”

Patients with injuries above the waist received a CT scan of the chest, abdomen, and pelvis.

Ward stayed in the emergency department for about 30 minutes, collaborating with a fellow radiologist in the reading room. He later joined the rest of his colleagues, all of whom stayed late into the evening to process all the image interpretations that needed to be done.

Radiology was one of several departments at Tufts that rallied additional personnel to respond to the emergency conditions. The orthopedic department, for example, called in its entire staff to assist in the operating room.

Ward described the coordination between the radiologists and the surgeons as “seamless,” adding that communication between caregivers functioned the same as during any other day at the medical center.

“We have a very well-patterned response, and we were doing our job the same way we do every day, except with a little bit more intensity, given the experience,” he added. “When consultations were necessary, the lines of communication were open.”

Lessons learned

In the wake of the Boston Marathon bombings, Tufts will likely review its emergency response to the event and modify its disaster protocol, if needed, just as it regularly assesses its preparedness through periodic drills.

Within the past 18 months, Tufts was upgraded from a level II to a level I trauma center, which included the implementation of protocols for trauma and potential disaster scenarios.

“In the global sense, we are in the business of helping people, and every day you wake up and have to be aware that you never know what’s going to come your way,” Ward reflected. “You have to be ready, and vigilance is key in every aspect, whether it’s homeland security or taking care of patients who are victims of dramatic, unforeseen events. It brings an urgency to the importance of quality care and making sure that everyone in the department is ready to go at any moment.”

A few days after the tragedy, Ward and a colleague dined at a Boston restaurant while still wearing scrubs, as they had come straight from work. At the end of their dinner, the server insisted that they allow the restaurant to pay for their meal in gratitude for their service. The server told them his friend was treated in the neuro intensive care unit at Tufts during that week and had recently been discharged.

“We were both speechless,” Ward recalled. “That’s just us doing our jobs. The real tragedy is the people who wanted to go see a race, were running in the marathon, and were victims of this tragic incident. We are in the business of helping people. Whatever we can do to help is why we went into this endeavor to begin with.”

Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin C

Posted in Bio Instrumentation in Experimental Life Sciences Research, Biomarkers & Medical Diagnostics, Chemical Biology and its relations to Metabolic Disease, Health Economics and Outcomes Research, tagged Chronic kidney disease, Creatinine, kidney disease, Renal function, Tufts Medical Center, University of Minnesota on August 16, 2012| 2 Comments »

Reporter: Aviva Lev-Ari, PhD, RN

The combined creatinine–cystatin C equation performed better than equations based on either of these markers alone and may be useful as a confirmatory test for chronic kidney disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)

Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin C

Lesley A. Inker, M.D., Christopher H. Schmid, Ph.D., Hocine Tighiouart, M.S., John H. Eckfeldt, M.D., Ph.D., Harold I. Feldman, M.D., Tom Greene, Ph.D., John W. Kusek, Ph.D., Jane Manzi, Ph.D., Frederick Van Lente, Ph.D., Yaping Lucy Zhang, M.S., Josef Coresh, M.D., Ph.D., and Andrew S. Levey, M.D. for the CKD-EPI Investigators

N Engl J Med 2012; 367:20-29 July 5, 2012

BACKGROUND

Estimates of glomerular filtration rate (GFR) that are based on serum creatinine are routinely used; however, they are imprecise, potentially leading to the overdiagnosis of chronic kidney disease. Cystatin C is an alternative filtration marker for estimating GFR.

METHODS

Using cross-sectional analyses, we developed estimating equations based on cystatin C alone and in combination with creatinine in diverse populations totaling 5352 participants from 13 studies. These equations were then validated in 1119 participants from 5 different studies in which GFR had been measured. Cystatin and creatinine assays were traceable to primary reference materials.

RESULTS

Mean measured GFRs were 68 and 70 ml per minute per 1.73 m² of body-surface area in the development and validation data sets, respectively. In the validation data set, the creatinine–cystatin C equation performed better than equations that used creatinine or cystatin C alone. Bias was similar among the three equations, with a median difference between measured and estimated GFR of 3.9 ml per minute per 1.73 m² with the combined equation, as compared with 3.7 and 3.4 ml per minute per 1.73 m² with the creatinine equation and the cystatin C equation (P=0.07 and P=0.05), respectively. Precision was improved with the combined equation (interquartile range of the difference, 13.4 vs. 15.4 and 16.4 ml per minute per 1.73 m², respectively [P=0.001 and P<0.001]), and the results were more accurate (percentage of estimates that were >30% of measured GFR, 8.5 vs. 12.8 and 14.1, respectively [P<0.001 for both comparisons]). In participants whose estimated GFR based on creatinine was 45 to 74 ml per minute per 1.73 m², the combined equation improved the classification of measured GFR as either less than 60 ml per minute per 1.73 m² or greater than or equal to 60 ml per minute per 1.73 m² (net reclassification index, 19.4% [P<0.001]) and correctly reclassified 16.9% of those with an estimated GFR of 45 to 59 ml per minute per 1.73 m² as having a GFR of 60 ml or higher per minute per 1.73 m².

CONCLUSIONS

Supported by grants (UO1 DK 053869, UO1 DK 067651, and UO1 DK 35073) from the National Institute of Diabetes and Digestive and Kidney Diseases.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

This article was updated on July 5, 2012, at NEJM.org.

We thank Dr. Aghogho Okparavero for providing assistance with communications and manuscript preparation. (Additional acknowledgments are provided in the Supplementary Appendix.)

SOURCE INFORMATION

From Tufts Medical Center, Boston (L.A.I., C.H.S., H.T., Y.L.Z., A.S.L.); the University of Minnesota, Minneapolis (J.H.E.); the University of Pennsylvania School of Medicine, Philadelphia (H.I.F.); the University of Utah, Salt Lake City (T.G.); National Institutes of Health, Bethesda, MD (J.W.K.); Johns Hopkins University, Baltimore (J.M., J.C.); and Cleveland Clinic Foundation, Cleveland (F.V.L.).

Address reprint requests to Dr. Inker at the Division of Nephrology, Tufts Medical Center, 800 Washington St., Box 391, Boston, MA 02111, or at linker@tuftsmedicalcenter.org.

Additional investigators in the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) are listed in the Supplementary Appendix, available at NEJM.org.

N Engl J Med 2012; 367:20-29