INSIDE

3 PROGRESS ON DIVERSITY Daylong summit boosts institutionwide efforts toward a more diverse and inclusive student body and workforce. 5 PEOPLE PERSON Meet Bonnie Windsor, senior vice president of human resources for Medicine and the Johns Hopkins Health System. 7 A FASTER WAY TO DETECT TRAUMATIC BRAIN INJURY A new blood test helps doctors quickly diagnose TBI, hastening treatment.

INSIGHT New App from Johns Hopkins Medicine The app for Apple Watch helps neurologists A publication for the Johns Hopkins Medicine family Volume 66 • Number 11 • December 2015 collect data about epileptic seizures. Dome

DAWID RYSKI

peaking through an interpreter, Joseph Carrese told the middle-aged, Ethics somewhat overweight man that he had . It was 1988. Carrese, in the fresh from completing his internal Smedicine at Johns Hopkins Bayview Balance Medical Center, had recently arrived at the Nava- jo reservation to practice medicine through the The Berman Institute of Bioethics Indian Health Service. As he discussed a regimen teaches medical students how to weigh the moral dilemmas they will of medication and the risks of not taking it, the face as clinicians. patient sat in silence. Then, the man walked out of the office and never returned.

Carrese couldn’t understand why this patient and others refused treatment after he warned them of the potentially dire consequences. He later learned that many traditional Navajos believe language shapes reality—so talking about the risks of not treating a condition may make those outcomes happen. He was in an ethical bind. He couldn’t help patients without their understanding and cooperation, but his words were driving patients away. Learn more about the strategic priority To find a better approach, Carrese interviewed Navajo patients, for education online at traditional Navajo healers and other health care providers on the hopkinsmedicine.org/strategic_plan . Arizona reservation. His recommendations: Frame medical information

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Published by Johns Hopkins Medicine Marketing and Communications CHIEF PERSPECTIVES Patient- and family-centered care

The Case for Innovative Patient Safety and Bioethics Training Quality Collaboration Ronald R. Peterson Agreement between Johns Hopkins and Microsoft aims to develop President, The Johns Hopkins a technology solution that will eliminate preventable harms. and Health System Executive Vice President, he Medicine and director of the Armstrong Johns Hopkins Medicine School of Medicine and Micro- Institute. “We are excited to collaborate with soft will work together to rede- Microsoft to bring interoperability to these sign the way that medical devices medical devices, to fully realize the benefits of iven the in an intensive care unit (ICU) technology, and to provide better care to our advances Ttalk to each other. patients and their families.” in medical The two organizations plan to develop a Four million patients are admitted to ICUs technology health IT solution that collects data from dif- in the each year. Although it is ferent monitoring equipment and identifies key not known how many of these patients experi- Gand knowledge over trends aimed at preventing injuries and com- ence potentially preventable complications, be- the past 20 years, plications that can result from medical care. tween 210,000 and 400,000 hospital patients training to become a Pilot projects are expected to begin next year. die annually from such harms. Medical errors physician has become The idea stems from the Johns Hopkins are the third leading cause of death, behind more complicated than Armstrong Institute for Patient Safety and heart disease and cancer. ever. Yet the focus of Quality’s research on checklists to reduce In collaboration with Microsoft, Johns Hop- those advances and that infections and its pilot program called Project kins plans to revamp Project Emerge to better training remains the Emerge. First piloted in The Johns Hopkins serve patients in intensive care environments. same as it was millennia Hospital’s surgical intensive care unit in June Johns Hopkins will supply the clinical exper- ago: the patient. 2014, and now replicated at the University tise for the build, while Microsoft will provide of California, San Francisco, the program advanced technologies, including Azure cloud With everything physicians can do now, a key question uses technology to restructure a hospital’s platform and services, as well as software de- becomes whether they should or can do everything that’s workflow in an effort to eliminate the most velopment expertise. The final product will possible today—or how best they can fulfill the Hippocratic common causes of preventable harm and to allow physicians to see trends in patients’ care Oath’s most famous instruction: “First, do no harm.” promote better patient outcomes. While most in one centralized location, allowing them to Personally, I have had to deal with family issues that efforts to improve safety focus on one harm, access critical information from any hospital- required end-of-life decisions to be made. However, such as preventing central line-associated approved Windows device. quality-of-life issues can weigh upon anyone who oversees bloodstream infections, Project Emerge seeks This initiative is one of several collaborations a loved one’s care at any stage of life. In Johns Hopkins’ to eliminate all physical harms, including between the two organizations designed to exceptional neonatal intensive care unit, for example, such medical complications, such as blood clots foster innovative, health-based technologies. and pneumonia, as well as such emotional Earlier this year, Microsoft became a sponsor issues can arise shortly after birth. harm as lack of respect and loss of dignity. of FastForward, Johns Hopkins’ new busi- Our physicians face many other difficult situations. “Today’s intensive care patient room ness incubator designed to accelerate product With pharmaceutical companies demanding increasingly contains anywhere from 50 to 100 pieces of development for health IT startup companies. outrageous prices for some drugs, occasionally we have to medical equipment developed by different Johns Hopkins also recently joined Microsoft’s ask clinicians and physicians-in-training to seek alternative manufacturers that rarely talk to one another,” Partner Network, which provides enhanced medications. We also may face times when our resources says , senior vice president of services to the university. will not allow us to apply every treatment possible to every patient safety and quality for Johns Hopkins —Lisa Broadhead individual case. As president of The and Health System, I have thought about this a lot. That is why I was so pleased when Ruth Faden and Jeremy Sugarman of the Johns Hopkins Berman Institute of Bioethics contacted me seven years ago and proposed offering ethics education for PEOPLE Johns Hopkins Hospital house staff. Every year since, I have budgeted funds for the Berman Institute to train interns and residents in the departments of Medicine, and on ethical questions they will face while here and as practicing physicians later. In fiscal year 2015, internists Joseph Carrese and Mark Hughes joined pediatrician Margaret Moon in teaching Ethics in Clinical Practice to approximately 370 residents at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. (See cover story.) This initiative’s importance is recognized in other departments as well. Gifts from foundations now support ethics education in , , , gynecology and obstetrics, and child and adolescent . Since its founding in 1995, the Berman Institute has become one of the largest centers in the world for training future leaders in bioethics, health and science. I am glad that with the support that The Johns Hopkins Hospital and others have given, the institute’s faculty members can also train young physicians on the “everyday ethics” they will have to practice throughout their careers. n

FIFTY IS NIFTY: Pat Kastal, left, and James Boles were recently honored for 50 years of employment with Johns Hopkins Medicine during the 2015 Service Awards Celebration in Turner Auditorium. Kastal was lead medical technician in the Department of Pathology’s Hematopoietic and Therapeutic Support Service division before her recent retirement. Boles is a clinical technician in Nelson 6 nursing. Also honored for serving 50 years was Vivian Outing, discharge retrieval supervisor.

2 • DOME • DECEmBER 2015 PEOPLE Summit Highlights Diversity and Inclusion Johns Hopkins leaders are working toward a more diverse workforce, student body.

he newly established Johns Hopkins Office of Diversity and Inclusion gath- ered nearly 80 leaders from across Johns Hopkins Medicine in early November for a daylong summit devoted to discussing Tways to achieve health care equity and a deeper cultural understanding of the needs of patients and employees. Hospital executives, physicians, postdoctoral students and other professionals from The Johns Hopkins Hospital gathered at the Mt. Washington Conference Center with colleagues from Sibley Memorial and Suburban , as well as Howard County General Hospital, Johns Hopkins Bayview Medical Center and All Children’s Hospital in St. Petersburg, Florida. Also present were nearly 20 human resources managers. “Johns Hopkins Medicine has a firm commitment Diversity leaders at to equity,” Paul B. Rothman, dean of the medical the recent summit faculty and CEO of Johns Hopkins Medicine, told the inspired discussion group. “We’re not yet where we want to be, but we’re on race, gender committed to getting there.” and equity. From left, James Page, Recruiting and retaining diverse workers, students Lisa Cooper, Eloiza and trainees is a key part of Johns Hopkins Medicine’s Domingo-Snyder strategic plan. Rothman and Ronald R. Peterson, and Ty Crowe. president of The Johns Hopkins Hospital and Health System and EVP, Johns Hopkins Medicine, established the Office of Diversity and Inclusion to address race, gender and other inequities in the hospital system. According to Johns Hopkins data, Medicine. “What we do has to discussed how to improve the institution’s policies and since 2009, the number of under- Although make Johns Hopkins better.” practices, including the cultural, linguistic and spiritual represented minorities on the school Hispanic and The summit was organized by training of clinical and nonclinical employees. of medicine faculty has been slightly Page and diversity director Eloiza “Having James and Eloiza lead us toward a more di- below the national academic medical African-American Domingo-Snyder. verse and inclusive community is like coming upon a center average of 8 percent. hires more than Summit sessions were led spring in the desert,” says Barbara Cook, medical direc- Although Hispanic and African- by Domingo-Snyder; Thomas tor of The Access Partnership. This program provides American hires more than doubled doubled since “Ty” Crowe, director of care to uninsured and underinsured patients who live in since 2000, the fastest growing group 2000, the fastest spiritual care and chaplaincy; neighborhoods surrounding The Johns Hopkins Hospi- of newly hired faculty is Asian- and Lisa Cooper, director of tal and Johns Hopkins Bayview Medical Center. Americans. The school of medicine’s growing group the Johns Hopkins Center to Hopkins Bayview pediatrician Lisa DeCamp works classes of 2016–2018 comprised 44 of newly Eliminate Cardiovascular Health with Centro SOL, which is dedicated to providing care percent white students and 37 percent Disparities. Individual breakout for ’s Latino community. She attended the Asian and Asian-American students, hired faculty sessions presented vignettes of summit and saw it as a step to bring coordination to while Latino and black or African- is Asian- negative situations encountered disparate efforts. American students stood at about 9 by patients, employees and “There’s a lot of work around diversity and inclusion percent each. Americans. community members, where going on at Johns Hopkins,” she says. “Lots of people “This can’t be just diversity for its participants considered ways don’t know each other. This is a great way for us to own sake,” said James Page, chief to better approach health care begin coordinating.” diversity officer for Johns Hopkins equity issues. Participants also —Patrick Smith

INTEGRATION Building the Scaffolding for Epic Go-Live Leaders share lessons from launching the electronic medical record system. arrie Stein and Patricia Zeller What they learned: have been working together on clini- 1. involve as many people as possible. Before cal and operational readiness for Epic the first go-lives, about 50 people took part in rollouts starting with ambulatory users, twice-monthly conference calls to work through Howard County General Hospital and details. Now, the number is close to 200. “Over CSibley Memorial Hospital in 2013. Their collaboration the years, we’ve found ways to involve people continues through the current go-live at Johns Hop- much more,” says Stein. kins Bayview Medical Center and the July 1, 2016, 2. Get buy-in early. In October, Stein was asked go-lives at The Johns Hopkins Hospital and Kennedy if it was too soon to include Johns Hopkins Bay- Krieger Institute. view’s human resources people in her Epic work Stein leads the work group representing the clinical group for the Dec. 1 launch. Her answer: It’s and operational users who will use the new electronic never too early. medical record system; Zeller coordinates readiness 3. never stop moving forward. requirements with the team of Epic builders who are “The timeline creating the system for Johns Hopkins. Working as will not change,” says Zeller. She and Stein come to the conference calls prepared to make liaisons between their groups, they calmly shepherd decisions. these massive projects toward their set-in-stone dead- lines, while navigating myriad logistical hurdles to 4. Be clear about expectations. “We have got- make sure the correct systems are in place and people ten better about communicating project mile- are trained to use them. stones,” says Stein. For the first rollouts, Stein and Zeller created de- 5. communicate early and often with higher- tailed checklists and timelines. They eased fears and ups. Keep the process moving by taking ques- answered questions. Over time, they developed a tions or concerns to people with more decision- sturdy system that serves as the scaffolding for one making power. Epic leaders Carrie Stein and Patricia Zeller successful launch after another. —Karen Nitkin oversee clinical and operational readiness.

DOME • DECemBER 2015 • 3 EDUCATION

Ethics in the Balance (continued from page 1) in positive terms, involve traditional When Clinicians and healers and family members in health Patients Disagree discussions, and prepare patients for Ethical questions are routine for Delivering the News potentially upsetting news. clinicians. Under what circum- As technology advances, new ethical questions “I came back to Baltimore with a stances can parents refuse vac- emerge. For example, large-scale genetic tests much different frame of mind about cinations for their children? How that now cost less than $1,000 can reveal unan- being open to differences and avoiding can a care team help a terminally ticipated and devastating information. A test to the trap of making assumptions,” he says. ill patient live out his last days in help a patient learn her risk for breast cancer could uncover heightened odds for dementia. comfort when family members Do clinicians have a moral obligation to share Educating the Next insist on continued interventions? all the results of a genetic test with patients? Generation What can be done when a patient To gain insight on this question, Debra of Ethical Clinicians with early dementia insists on Mathews, assistant director of science pro- going home, without fully under- grams for the Berman Institute of Bioethics, is Carrese, now an internist at Johns Hop- standing the dangers? interviewing people who underwent genetic kins Bayview, is still wrestling with the Berman professors teach stu- testing for Huntington’s disease more than two ethical issues raised when a physician’s dents how to identify and frame decades ago. do-no-harm mandate clashes with a Joseph Carrese ethical issues, weigh opposing No treatment or cure exists for Hunting- patient’s right to choose or refuse treat- imperatives, persuade with respect ton’s disease, which is hereditary and fatal. The ment. As a faculty member in the Ber- and evaluate patients for decision- first symptoms usually appear in a person’s 40s and include irritability, loss of coordination and man Institute of Bioethics, he’s helping making competence. Students involuntary movements. In the next few years, Johns Hopkins medical students, in- are also trained to recognize their as nerve cells break down, victims lose the abil- terns, residents and clinicians navigate own moral considerations, such ity to walk, speak and swallow. Most die within this complex and changing territory. as a bias against people who are 15 years of symptom onset. The 20-year-old institute traces its obese. Nearly 30 years ago, Huntington’s became start to the mid-1980s, when Ruth “We consider ethics knowledge, the first disease detectible by genetic testing. Faden, a professor in the Bloomberg attitudes and skills as essential,” For the School of Public Health, began host- says Carrese. “It has to be in- first time, ing universitywide brown-bag lunches cluded in the earliest stages of people with to discuss ethical issues of the day. The medical education and all the way the disease institute now has more than 30 faculty through. You have to think of it in their families members from across the university. To- as a central part of your identity could learn gether, they research, teach, define and as a health care professional.” their fate shape bioethics—the study of the moral Recently, Carrese was invited before and ethical quandaries facing health to give Grand Rounds in the becoming Margaret Moon care providers and scientists. Department of Gynecology and ill. Not “We are committed to first-rate schol- Obstetrics and address the case everybody arship in the service of making policies of a woman who had refused to wanted to and practices better than they were be- undergo a cesarean section, even know, but those who did agreed to extensive fore,” says Faden, who has been director after learning of the dangers to counseling before taking the test. of Berman since its start and will step herself and her fetus. As a result, Mathews and her team are now asking those aside in 2016. both mother and baby required people how the counseling and test results influenced their lives. One person who learned Medical schools must provide eth- additional treatment. she wouldn’t get the disease felt liberated to ics education, and residency programs Carrese had no simple answer marry and start a business. Another felt guilty require training in professionalism, for his audience of about 60 peo- that her brother would become ill but she which has an ethics component. How- ple but gave this advice: “It is OK would not, and vowed that she would care for ever, programs vary widely because to educate and persuade, not OK him. A third, who had rushed toward success the specifics are up to each institution. to disengage or coerce.” at a young age, felt adrift when she learned her At Johns Hopkins, Berman faculty Ethics standards and laws life would not be cut short. members infuse the school of medicine evolve. In the 1950s, for example, Mathews is still gathering information from curriculum with robust clinical ethics physicians rarely burdened pa- people who took the test, gaining insights that instruction. And for the past decade, tients with bad news, such as could one day shape how clinicians counsel they have been extending this teaching a cancer diagnosis, or asked patients and share test results. —KN to residency training programs. Gail Geller pregnant women about their Learn more about Huntington’s disease The ethics program for medical childbirth choices. Today, respect and research: students, co-directed by urologist for patient preferences is a corner- Jacek Mostwin and Berman faculty “It’s really stone of ethical care, says Mar- bit.ly/balthuntingtonsdiseasecenterjhm member Gail Geller, begins with the garet Moon, a Berman faculty bit.ly/balthuntingtonsdiseaseresearch Foundations of Public Health, Epide- getting students member and pediatrician. miology and Ethics course in the first to recognize an But she notes that it’s impor- year and continues with student-led ethical dilemma tant to balance respect for patient workshops, topic-specific seminars choices with a duty to promote and ethics discussions based on real and learn the patient’s well-being. “Physi- holding information. “We teach a framework of analysis cases. In addition, students conduct strategies cians can sometimes be a little that helps us identify the ethics issues and then figure independent projects in an ethics- intellectually lazy when they yield out what we know and what we need to know,” Moon oriented concentration for first- and for how to automatically to the patient’s says. “Students start out saying, ‘This is a problem of the second-year medical students, co- address it.” wishes,” she says. “We used to be public’s health, and the patient’s wishes don’t have to be directed by Carrese and Geller. too paternalistic, and now we’re respected. We can’t have someone going out and infect- Residents at Johns Hopkins Bay- —Gail Geller, swinging in the other direction.” ing people.’ But when we talk about the specifics, they view rotate through the ethics con- Berman Institute faculty member A particularly interesting prob- often change their minds.” sultation service, working alongside lem arises when the patient is an Students learn that the care team had worked for years Carrese, who provides guidance on adolescent with definite but ill- to gain the boy’s trust and guide him through a complex ethical dilemmas encountered in the considered opinions about treat- treatment regimen. “Their concern is that if we force course of real patient care. A master’s ment, says Moon. She asks medi- him to do something he doesn’t want to do, he’ll alien- degree in bioethics, new this year, is cal students in her ethics classes to ate himself from care and die,” Moon says. Students also offered through a collaboration between Berman and consider the case of an adolescent who doesn’t want his find out that good ethics start with good facts, she says. the Bloomberg School of Public Health, providing “a HIV status discussed with a young woman who visits Case law, the facts of HIV transmission risk and the historical and contextual understanding of the problems him daily while he is hospitalized for a related illness. partner’s responsibility to engage in safe sex are all part in bioethics, as well as training in analyzing and evalu- The team is worried that the visitor is a sexual partner of the discussion. “This is a great case for showing how ating moral arguments,” says Travis Rieder, the Berman who may not be aware of the HIV risk. The patient says complicated these things get.” Institute’s assistant director for education initiatives. the woman is not his partner; the team doesn’t believe —Karen Nitkin him but could be wrong. The choice: Harming the patient by overriding his Learn more about the Berman Institute: wishes and breaking confidentiality based on a duty bit.ly/bermaninstbioethicsvideo to warn, or harming the presumptive partner by with-

4 • DOME • DECEmBER 2015 PEOPLE People Person How the senior vice president of human resources for Johns Hopkins Medicine and the Johns Hopkins Health System manages myriad employees and initiatives. ighteen Johns Hopkins human resources leaders, “Wh at’s important is gathered for their quarterly that employees feel leadership meeting, are wait- ing for updates on the institu- comfortable sharing Etion’s electronic performance evaluations, their experiences and wellness efforts and retirement benefits. feel that people are All eyes fix on Bonnie Windsor, senior vice president of human resources for listening to their Johns Hopkins Medicine and the Johns concerns.” Hopkins Health System. The self-assured —Bonnie Windsor woman in her classic blazer and under- stated jewelry flashes an easy smile. “Did everyone have time to read the minutes from the last meeting?” she asks. Beers, nurse manager of The Johns Hop- “Everybody good?” kins Hospital’s PICU, worked alongside For the next two hours, lively discus- Windsor in the 1970s. “Bonnie has always sion follows on such topics as how to been a consensus builder, a wonderful persuade employees to get flu shots, listener who wants the best for whomever understanding new benefit changes, and she’s interacting with,” says Beers. “She’s why every staff member must complete competent, attentive and always profes- mandatory discrimination and harass- sional—the kind of person you’d want ment training. taking care of your child.” Windsor’s 33rd Street office in the old Windsor makes a point of going deep Eastern High School building hosts into departments regularly to see the many high-level human resources man- workforce in action. She affectionately agement briefings. The senior HR execu- calls these jaunts across the enterprise her tive also visits Johns Hopkins member “rounds.” She says she wants people to organizations—from Howard County be more willing to speak out about prob- to the United Arab Emirates— to build lems, like patient safety or ways to work relationships, educate and troubleshoot more efficiently. “What’s important,” she whenever complicated HR issues arise. says, “is that employees feel comfortable As an accountable leader of the Johns sharing their experiences and feel that Hopkins Medicine Strategic Plan’s people people are listening to their concerns.” priority—“to attract, engage, develop Currently, Windsor is focused on and retain the world’s best people”—the rewarding employees with healthy life- 30-year Johns Hopkins veteran appears to styles. She’s working with Johns Hopkins have embraced her new role. Bonnie Windsor, a former pediatric nurse, says she HealthCare’s medical director, Richard draws from a “deep understanding of clinical care” “I enjoy spending time with employ- and recognizes the important role every person Safeer to assess whether Johns Hopkins ees,” says Windsor, a northern Virginia plays in upholding the institution’s values. Medicine entities are using evidence- native who started her career as a Johns based strategies and interventions to Hopkins Hospital pediatric intensive care prevent chronic diseases in employees, nurse. “We need to make sure HR is sup- ate director in pediatrics. Concurrently, proachable,” “thoughtful” and “unflap- as well as working toward tobacco-free porting a culture that champions diver- Windsor earned a master’s degree in pable.” Those qualities, they say, have campuses. sity, inclusion and civility.” management from The Johns Hopkins gone a long way to ease the inevitable She champions a more centralized, Her job requires ensuring that more University. After moving out of state for tensions that crop up whenever a policy, unified approach to retention and re- than 41,000 employees in every posi- several years, she was recruited back to such as overtime compensation, needs to cruitment, “moving beyond the silo tion across the Johns Hopkins enterprise create and oversee Intrastaff, Johns Hop- be changed. mentality,” while paying closer attention understand the intricacies of the institu- kins’ temporary staffing agency. She be- “First and foremost, Bonnie loves to diversity and making compensation/ tion’s initiatives and benefits. She says her came Intrastaff’s director in 1990, eventu- people and knows what it’s like to be an benefit packages more competitive. She approach boils down to “engaging, re- ally also leading career services in human employee on the front lines of a hospital,” says human resources is partnering with taining, recruiting and developing people resources. In 2004, she was named senior says her predecessor, Pamela Paulk, now nursing to find solutions in support for a who provide—directly or indirectly— director of human resources for Johns president of Johns Hopkins Medicine potential nursing shortage as more R.N.s the highest quality of care for patients.” Hopkins Medicine and was promoted to International. Along the way, adds Paulk, near retirement. Windsor has built an unusual career her current position two years ago. she’s built strong relationships with em- “What I love about my job,” she says, in health care. She became a nurse in Human resources leaders across the ployees and leaders. “is that every day, I have the opportunity 1976 and was hired in 1977 as a pediatric enterprise say Windsor’s success derives Several colleagues note Windsor’s calm, to work with employees who are hard- intensive care unit (PICU) nurse. She from an evenhanded management style. even voice, perhaps honed from years of working, loyal and very caring.” steadily advanced, becoming an associ- They use phrases like “always fair,” “ap- working in clinical crisis mode. Claire —Judy F. Minkove

In BRIEF

New Specialty Pharmacy at Johns Hopkins MLK Jr. Commemoration Home Care Group Johns Hopkins’ 34th Martin Luther King Jr. medical pioneer Levi Watkins Jr. The program A pharmacy that provides specialty outpatient rooms for staff members to educate patients Commemoration will take place on Friday, will feature world-renowned opera singer and infusion services opens this month at the and caregivers about infusion treatments and Jan. 8, 2016, from noon to 1:30 p.m. in Denyce Graves, as well as Watkins’ nephew, headquarters of Johns Hopkins Home Care about how to operate medical equipment, Turner Audito- Levi Garraway, director of the Joint Center Group. The new facility, located at the divi- including the masks and devices used to treat rium on the East for Cancer Precision Medicine at Dana-Farber sion’s Holabird Avenue office in Baltimore, is sleep apnea. Pharmacists will instruct patients Baltimore campus. Institute, Brigham and Women’s Hospital and the ninth such pharmacy in the Johns Hopkins how to take medications and why medication The theme is the Broad Institute. As always, Unified Voices, Health System. compliance is important. “The Beloved a choir of local residents and Johns Hopkins In addition to filling prescriptions, the phar- A new call center at the facility will take all Community: A employees, will sing spirituals, and recipients of macy offers medication management services inbound calls requesting prescription refills at Force for Social the 2015 MLK Jr. Community Service Awards for high-cost, specialty drugs that include oral, the specialty pharmacies at The Johns Hopkins Change.” This will be recognized. There also will be a video injectables and infusions used to treat infertil- Hospital, Medical Pavilion at Howard County commemoration tribute to Watkins. ity, hepatitis C, inflammatory diseases, cancer, and Johns Hopkins Bayview Medical Center. marks the first HIV and rheumatoid arthritis, and to help This service will help to centralize operations since the death of Learn moreabout the event at control pain. and give medical equipment trainers and phar- its founder, civil insidehopkinsmedicine.org/mlk. The Home Care expansion also includes macists more time to serve patients. Denyce Graves rights activist and

DOME • DECemBER 2015 • 5 patient- and family-centered care

Quincy Samus, left, reviews a patient’s care plan with memory care coordinator Kelly Marshall outside a client’s home. Making the Most of Dementia Care at Home Program addresses needs of elders with memory disorders and eases caregiver burden.

rom the moment the care team they could spiral out of control. stepped into the private home, they saw At least once a month, MIND at Home signs of dementia. “There were so many coordinators contacted households, checking on piles of papers,” says Quincy Samus, a home safety, medical and mental health care, Johns Hopkins behavioral gerontologist, nutrition, and food availability, as well as whether F“that the team, [which includes a dementia care patients were participating in meaningful activities, psychologist, nurse and occupational therapist], had like exercise or regular interaction with a friendly “Th is program has the difficulty finding a path into the living room.” visitor. Based on needs, the program provided potential to reshape dementia A team member had received a call from a referrals to day programs, education, informal care by linking medical and distraught woman whose father, a retired lawyer counseling and problem-solving. recently diagnosed with dementia, refused to discard At 18 months, study participants who received community-based services.” —Constantine Lyketsos any papers, official or otherwise. Concerned about these interventions were likely to remain at home— director, The Johns Hopkins Memory and his escalating paranoia, the daughter, who lives out of nearly two months longer than participants who Alzheimer’s Treatment Center town, called the Johns Hopkins program. received usual care. This gain extended to an average Called MIND (for maximizing independence) of about nine months when follow-up continued for at Home, the comprehensive program assesses the up to 41 months. In other words, says Samus, “we leaders were able to obtain $9.8 million in additional needs of people with memory disorders living at were able to help people age in place, and without government funding to find a better and less costly home—and those of the family caregivers. It aims sacrificing their quality of life.” way to keep dementia patients at home. Now he to keep patients at home longer, a preference for “We don’t pretend we can keep people with and his colleagues are working to package MIND most of them, and to reduce unmet care needs, dementia in their homes forever,” says Lyketsos, “but at Home as an affordable commercial product such as evaluation of home and personal safety, and for much longer than expected—all because we can tailored to diverse clinical, socioeconomic and racial management of neuropsychiatric issues. link those in need of care to appropriate resources populations. Currently, about 35 million people worldwide and services.” Most contacts were phone-based, he In the former lawyer’s case, the team met with have dementia, says Constantine Lyketsos, director notes, addressing problems like nutrition, which the family and enlisted the help of a professional of the Johns Hopkins Memory and Alzheimer’s implies that benefits can be achieved in a cost- organizer. “Over time,” says Samus, “we saw Treatment Center, and that number, doubling efficient way. major changes.” every 20 years, is projected to reach 115 million by Though the study hasn’t calculated cost savings, Whether it’s regulating the temperature at home, 2050. To help address what he calls “this staggering Lyketsos says delaying admission to a nursing home making sure the patient is groomed or sending reality,” Lyketsos and Baltimore philanthropist or a rehab facility likely saves families thousands a nurse to investigate a potential urinary tract Roy Hoffberger conceived MIND at Home, which of dollars. infection, “there’s always something we can do to debuted in 2012 as a $2.5 million privately funded But the most satisfying outcomes, says Lyketsos, improve enjoyment of life” says Samus. “It’s been pilot study. have been patients’ improved self-rated quality of life extremely rewarding.” Led by Samus and Lyketsos, the 18-month clinical and the benefits to caregivers. The pilot study showed —Judy F. Minkove trial included 303 participants ages 70-plus with that the program over time freed up as much as 16 dementia and mild cognitive impairment, plus 290 hours of caregiving time per week compared with Learn more about the program at caregivers. A dementia care coordinator came into control caregivers. mindathome.org. Watch a video: bit.ly/ each home to address living and care issues before So successful was the trial, says Lyketsos, that its MINDatHomeoverview.

6 • DOME • DECEmBER 2015 PEOPLE

A ‘Ray’ of Bright Light Longtime Baltimore nonprofit leader Selwyn Ray joins Johns Hopkins. biomedical discovery hen Selwyn Ray became director of community relations for the Johns Hopkins Health System, he began the job by reading the last will and testament of the founder of the system’s flagship hospital. Before his death in 1873, Baltimore philanthropist Johns HopkinsW stipulated that the hospital that would bear his name would care for all who needed it, regardless of race, gender or age. The requirement resonates deeply with Ray. “That tells me that our institution was founded to serve the people who live in the neighborhoods near our hospitals. Not just because of last April 27,” says Ray, referring to the unrest in Baltimore following the death of Freddie Gray. “But because of the man who said it 126 years ago! He said, ‘I want you to take care of the people who live here.’” Ray, a lifelong Baltimore resident, was hired in August to serve as an ambassador to the many neighborhoods of Baltimore’s east side. He is based at Johns Hopkins Bayview Medical Center, where he leads the Community Advisory Board and oversees programs that benefit people who live near the medical center. He also will steer Hopkins Bayview’s community health needs assessment and will serve on the Johns Hopkins Bayview Executive Council. Within the school of medicine, Ray will design programs to help other hospitals and departments in “Community the Johns Hopkins family to improve A Better Way relations is the health of their communities. Ray has spent nearly 35 years in to Determine everyone’s job.” service of others. A graduate of the —Selwyn Ray University of School of Brain Cell Damage Law, Ray was a policy advisor to the Baltimore City health commissioner and community relations director for Blood test developed at Johns Hopkins the city’s Safe and Sound Campaign, which aims to improve the health, safety and helps diagnose and assess traumatic well-being of Baltimore’s children. He is a former executive director of the Maryland Mentoring Partnership and acted brain injuries. as interim CEO of Big Brothers Big Sisters of the Greater Chesapeake. He was the executive director of the Maryland Mentoring Resource Center until accepting the fter a hit to the head or rapid whiplash, millions of job at Johns Hopkins. Americans develop traumatic brain injuries (TBIs) each year. TBIs can range from mild concussions, causing only a A Family Tradition of Health Care headache or temporary blurred vision, to much more severe A commitment for delivering top-quality health care runs in the family. Ray’s late injuries—causing seizures or even coma. These symptoms, mother, Lelia, was a nurse at both The Johns Hopkins Hospital and the Rosewood Awhether mild or more severe, are generally caused by damaged brain cells. Center. His late father, Uthman, was a civic activist and family physician in West Until now, most physicians have relied on CT scans and patients’ symp- Baltimore. toms to determine whether to take extra precautions. However, CT scans “That was old-school community health!” the 58-year-old director says. “My father can only detect bleeding in the brain, not damage to brain cells, which taught me very early not to judge others, and that’s something I’ve always tried to can happen without bleeding. adhere to.” “A typical situation is that someone comes to the emergency depart- He says the task of building and maintaining community relations belongs to all ment with a suspected TBI, we get a CT scan and, if the scan shows no Johns Hopkins employees. “It’s everyone’s job. Whether we’re in a hospital or out in bleeding, we send the patient home,” says emergency medicine physician the neighborhood, we’re all community relations. Every one of us represents Johns Frederick Korley. “However, these patients go home and continue having Hopkins, and that’s something to take seriously.” headaches, difficulty concentrating and memory problems, and they can’t As he works with leaders in grass-roots organizations, nonprofits and local figure out why they are having these symptoms after doctors told them government, Ray is already helping to improve East Baltimore’s health. He points to a everything was fine.” Hopkins Bayview food pantry program that fed more than 802 disadvantaged adults Now, Korley and his team have developed a new blood test that could and children this fall. help emergency deparatment doctors quickly diagnose a TBI and deter- “The way I look at it, we’re not just a hospital,” Ray says. “We’re a neighbor—a mine its severity. The blood test, taken within 24 hours of a head injury, good neighbor.” measures levels of brain-derived neurotrophic factor (BDNF). —Patrick Smith “Compared to other proteins that have been measured in traumatic brain injury, BDNF does a much better job of predicting outcomes,” says Korley, first author on the study that appeared in the July 10 Journal of Neurotrauma. The scientists followed 300 patients with TBI over six months, finding that those with the highest levels of BDNF, as measured soon after their injury, had the best recovery. The results suggest that a test for BDNF lev- els, administered in the emergency room, could help stratify patients. “The advantage of being able to predict prognosis early on is that you can advise patients on what to do, recommend whether they need to take time off work or school, and decide whether they need to follow up with a rehab doctor or neurologist,” Korley says. In addition, it could help doctors decide which patients to enroll in clinical trials for new drugs or therapies targeting severe TBIs. —Shawna Williams

Johns Hopkins Health System Director of Community Relations Selwyn Ray visits with Katrina Foster, principal of Henderson-Hopkins.

DOME • DECemBER 2015 • 7 who / what Picture THIS

New Medical Director assistant director of nursing since and VP of Academic 2013, began her career at The Affairs Johns Hopkins Hospital as a clinical nursing intern in the Charles Wiener, Department of Medicine before M.D., professor of transferring to the medical medicine and intensive care unit, ultimately physiology, has been becoming its nurse manager. She named medical has been integral to clinical director and vice nursing and leadership at The president of academic Johns Hopkins Hospital affairs for Johns Hopkins and overseas, teaching in the Medicine International (JHI). He, critical care core curriculum at along with John Ulatowski, JHI’s the hospital and the Nursing vice president and executive Leadership Academy through medical director, will lead the Institute of Johns Hopkins multiple global projects, including Nursing. strategic planning, educational infrastructure planning and Kenneth Cohen, medical training. Wiener, who is M.D., M.B.A., board certified in internal clinical director of medicine, pulmonary medicine pediatric and critical care medicine, will and director of focus on more closely integrating pediatric neuro- OPPORTUNITY SEIZED: Kenyan medical founded in 2000 by her late mother, Barbara JHI and school of medicine oncology, has been student Gloria Kotente Mumeita, a member Lee Shaw. programs, and on coordinating named associate director of of the Maasai tribe, is shadowing doctors at Only about 10 percent of Maasai girls get a physician involvement in Johns integration and strategic and the National Institutes high school education. MGEF is changing their relationships for the the Johns of Health through mid-December. Mumeita’s fate, by currently paying school fees for 106 Hopkins Medicine’s growing trip to the United States was organized and Maasai girls, including Mumeita, who is on track international collaborations. The Hopkins Kimmel Cancer Center. In his new role, Cohen will lead funded by Tracey Pyles right, an emergency to become the third Maasai woman doctor ever. 24-year Johns Hopkins veteran physician at Suburban. Pyles is president of the efforts to develop metrics; will retain his current nonprofit Maasai Girls Education Fund (MGEF), Learn more: johnshopkinsmedicine.org/dome. appointment at the school of evaluate relationships, strategies medicine and his post as director and negotiations with outside of undergraduate studies for the entities; and sustain existing relationships in supporting the medicine, science and the Heidi Krantz, R.N. Cancer Center. Innovation in MS Research, along , has been humanities major at the Krieger with two Johns Hopkins-trained appointed director of value School of Arts and Sciences. Rafael Llinas, M.D., physicians. Calabresi; Laura analysis for Hopkins Bayview’s has been promoted to Balcer, M.D. support services division. She will Leadership , a 1991 graduate of director of the the school of medicine, who now oversee the value analysis and Appointments Department of is professor of neurology, clinical product/supply analysis Dome Jacqueline Schultz, Neurology at Johns population health and programs at the medical center Hopkins Bayview and will work with the Johns Published 10 times a year for members of B.S.N., M.S.N., ophthalmology at New York the Johns Hopkins Medicine family by R.N., executive vice Medical Center. University; and Elliot Frohman, Hopkins Health System’s supply Marketing and Communications. president and chief Currently an associate professor of M.D., Ph.D., a member of the chain group. neurology, Llinas was director of The Johns Hopkins University nursing officer, has house staff and a fellow from 1991 The Johns Hopkins Bayview School of Medicine cerebrovascular neurology and the to 1995, who now is professor of The Johns Hopkins Hospital been named interim Diversity Council has received a Intracerebral Hemorrhage Center neurology and neurotherapeutics Johns Hopkins Bayview Medical Center president of Subur- 2015 Employee Resource Groups Howard County General Hospital at Hopkins Bayview, as well as and ophthalmology at the ban Hospital. Schultz has more and Diversity Councils’ ERG & Johns Hopkins HealthCare vice chair of clinical services and University of Texas in Dallas, Johns Hopkins Home Care Group than 30 years’ experience in the Council Honors Award, having Johns Hopkins Community Physicians quality for the neurology were cited for their decade of health care industry. A valued been ranked one of the top 25 department at The Johns Hopkins groundbreaking research into the Suburban Hospital member of the Suburban team diversity councils in the country Hospital. He was instrumental in anatomy and biology of the retina All Children’s Hospital since 2005, she oversees nursing, for the fifth consecutive year. The establishing the Stroke Center at and other eye structures in Editor all clinical services, quality and national award recognizes groups Hopkins Bayview; co-edited the patients with MS. Linell Smith patient safety, utilization out- that lead organizational diversity book Stroke, published by the Contributing Writers comes, security, planning, and Duke Cameron, processes and demonstrate results Lisa Broadhead, Neil A. Grauer, community health and wellness American College of Physicians; and is recognized nationally for M.D., chief of the in their workforce, workplace and Judy F. Minkove, Karen Nitkin, programs. marketplace. Linell Smith, Patrick Smith, teaching excellence. Division of Cardiac Shawna Williams Jessica Bienstock, Surgery and cardiac Suburban Hospital Copy Editors M.D., M.P.H., National Academy of surgeon-in-charge, Abbey Becker professor of Medicine Honor has been inducted John Grinkley, Judy F. Minkove gynecology and into the Royal M.B.A., has been Designers obstetrics, has been Kenneth Kinzler, College of Surgeons of England Max Boam Ph.D. named senior Kristen Caudill named associate dean , professor of and was also elected president of director of finance. for graduate medical oncology and co- the American Association for Photographer Most recently, he Keith Weller education. A Johns Hopkins director of the Thoracic Surgery, beginning in served as director of faculty member since 1993, Ludwig Cancer 2017. finance for Inova Dalal Haldeman, Ph.D., M.B.A. Research Center, has Senior Vice President, Bienstock has directed the Timothy Pawlik, Alexandria Hospital in Virginia. Johns Hopkins Medicine been elected a residency program in gynecology M.D., Ph.D., Marketing and Communications member of the National Academy and obstetrics for 15 years and has M.P.H. Marketing and Send letters, news and story ideas to: of Medicine. Kinzler was , chief of the served as vice chair of the Division of Surgical Communications Editor, Dome Graduate Medical Education recognized for his role in finding Johns Hopkins Medicine the genetic alterations linked to Oncology, has been Suburban Hospital Sibley Marketing and Communications Committee since 2004. named an honorary and 901 S. Bond St., Suite 550 Previously, she directed the colon cancer, developing novel Memorial Hospital each have Baltimore, MD 21231 member of the Phone: 410-502-9602 medical student clerkship in Gyn/ molecular analyses of cancer and received top awards from the deciphering the genetic blueprints Brazilian Society of Surgical Email: [email protected] Ob, was director of the Oncology. Association of Marketing and of many cancers. Communication Professionals Read Dome online at department’s division of education hopkinsmedicine.org/news/publications/ and was named vice chair for Johns Hopkins Bayview for publications and promotional dome East Baltimore materials. Among the awards, education in the department. She Medical Center © 2015 The Johns Hopkins University and has received national recognition Peter Calabresi, Sibley received a MarCom The Johns Hopkins Health System Corporation. for her teaching skills. M.D., professor of Elaine Clayton, M.S., R.N., has Platinum Award for an eye- neurology and head been named assistant director catching graphic “wrap” on its Kelly Caslin, R.N., of nursing for specialty hospital shuttle bus, while Suburban Follow Johns Hopkins Medicine B.S.N., M.H.S.M., of the Multiple Sclerosis Center, has programs. She has more than 15 received a Platinum Award for Facebook: has been appointed years of leadership experience its patient handbook, My Get f facebook.com/JohnsHopkinsMedicine director of nursing been named co- recipient of the at Hopkins Bayview, serving as Well Kit. Twitter: for neurosciences and the patient care manager for the t psychiatry. Caslin, National Multiple Sclerosis twitter.com/HopkinsMedicine Society’s 2015 Barancik Prize for progressive care unit since 1999. yt YouTube: youtube.com/user/ JohnsHopkinsMedicine Recognizing the Best in Clinical Excellence State of Johns Hopkins Medicine Address Winners have been announced for the inaugural year of the Johns Hopkins Mark your calendars for the 2015 State of Johns Hopkins Medicine Clinical Awards for Physicians and Care Teams. The Office of Johns Medicine address, which takes place on Thursday, Dec. 10, from Hopkins Physicians launched the annual awards program this year to honor the noon to 1 p.m. in Turner Auditorium on the East Baltimore physicians and care teams who embody the best in clinical excellence. More than campus. Dean/CEO Paul Rothman will update employees on 300 nominations were submitted from colleagues at The Johns Hopkins Hospital, the progress of the institution’s strategic priorities: people, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Sibley biomedical discovery, patient- and family-centered care, Memorial Hospital, Suburban Hospital and Johns Hopkins Community Physicians. education, integration and performance—and discuss ways in To learn more, visit johnshopkinsmedicine.org/clinical-awards. which Johns Hopkins Medicine’s work is making an impact. The event will be streamed live to all locations.

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