Increasing Our Capacity to Care

We can use this sidebar for the deep captions

SIDEBAR OR LONG PULL QUOTE HEADLINE

Sit ex es nossinv eraerere perum as exces sunt qui odipic te cum ullaut velendebis et ipicatio ipsum et resequisci accum fugit que dem quia quos dit moloriandiam aperis dolupidus dias aut rehendandem verepta dia ernamen denihitatur, od quias vollo et imi, sumque pa ipsam etur, que exerfer natur? Menimag nihillorem ut fugia deribustrum, cum volorerum invelis audicat atemporum rerorat in accus. Terri Lewinson

SIDEBAR OR LONG PULL QUOTE HEADLINE

Sit ex es nossinv eraerere perum as exces sunt qui odipic te cum ullaut velendebis et ipicatio ipsum et resequisci accum fugit que dem quia quos dit moloriandiam aperis dolupidus dias aut rehendandem verepta dia ernamen denihitatur, od quias vollo et imi, sumque pa ipsam etur, que exerfer natur? Menimag nihillorem ut fugia deribustrum, cum volorerum invelis audicat atemporum rerorat in accus. Christine Marie Gunn

face precarious housing and homelessness; unemployment or low-wage jobs; distrust of the care system; difficulty in finding transportation to clinics or hospitals; the inability to take time off work; and lack of practical support from people around them during a health crisis. Dev joined The Dartmouth Institute last year after four years as a maternal and newborn health researcher within Dartmouth-Hitchcock Health. She previously earned a master in health science at the Bloomberg School of Public Health at Johns Hopkins University and a doctorate at The Graduate and University Center of City University New York Much of Dev’s recent research has focused on Haiti—including the effects of gang violence on women’s decision-making during pregnancy, the quality of prenatal and neonatal nursing care, and women’s choices about whether to give birth in a hospital or at home. Dev is always looking for ways to make care more patient-centered. “I’m really interested in redesigning maternal care from the perspective of the women who are using the system for several months during one of the most important times in their lives,” she says. In addition to conducting research, Dev teaches two health equity courses and helped rethink the on-campus MPH program to implement a social justice thread across the curriculum. Frustrated by what she sees as the failure of many health care systems to consider how factors outside the clinic affect patients’ health, Dev wants her students to do more than recognize inequities in health and health care. “Ultimately, rather than simply studying inequities, it’s important that we generate the necessary evidence on how to reduce them,” she says. Health Systems for All Identities “Ultimately, health care has been designed and delivered by heterosexual white men, studied by heterosexual white men, and, historically, those studied have been heterosexual white men,” says Ellesse-Roselee L. Akré, MA, PhD. As a result, health care systems often don’t work well for diverse individuals. No group is a monolith, she says. Within any group—even heterosexual white men— there are wide variations in social class, education, and circumstances. “That same thing applies to the LGBT community,” says Akré, whose research focuses on the health and health care of lesbian, gay, bisexual, and transgender (LGBT) people, and of people who identify as Black, indigenous, and people of color (BIPOC). She examines how health care policy and health care itself have ignored the multiplicity of human experiences, identities, and bodies. As a postdoctoral researcher at Vanderbilt University, Akré looked at how macrolevel systems contribute to health inequities including racism, sexism, ageism, and heterosexism. For her doctoral research in health services at the University of Maryland School of Public Health, she had studied differences in health care access in California among four groups: gay and lesbian people in cities and in rural areas, and bisexual people in cities and in rural areas. She found different problems with access in each of these groups; a study that grouped these identities together would likely have missed these important variations. Through her research, Akré wants to give diverse individuals “information and tools they need to empower their communities, so they can advocate for themselves for better care and better policy.” At The Dartmouth Institute, Akré will bring her expertise in LGBT and BIPOC health not just to the Institute’s research community but also into classrooms, from the undergraduate to the graduate level. “We’re forming the minds of our future leaders, educators, practitioners,” says Akré. And those individuals will be the ones creating the more equitable health systems of the future.

REACHING NEW HEIGHTS Progress on the Patient Pavilion

pull quote

Dartmouth-Hitchcock Health (D-HH) achieved a significant milestone in the construction of its 212,000-square-foot, five-story Patient Pavilion at DartmouthHitchcock Medical Center (DHMC) on Friday, June 18, 2021, when one of the final beams in the building’s steel structure was installed. The occasion was marked with a traditional “topping off” ceremony, which is a long-standing tradition in the construction industry to mark the completion of a building’s structure— specifically the placement of the final steel beam. This beam was particularly special: It had spent two weeks in DHMC and was signed by patients, volunteers, employees, and donors. Construction on the Patient Pavilion began in July 2020, with an anticipated completion date in early 2023. It will include spacious, state-of-the-art private rooms to meet the needs of the most seriously ill patients in the region, as well as unfinished space to allow for future expansion. More than an entire floor will be occupied by the Heart & Vascular Center, with 16 beds dedicated to cardiac special care. Philanthropy is key to the success of this project. To help support the Patient Pavilion, please contact Elizabeth Dollhopf-Brown, Associate Vice President, Office of Development, at elizabeth.brown@hitchcock.org or 603646-5131.

placeholder

CARES Hits the Road for Heart Health

If knowledge is power, then the Dartmouth-Hitchcock Heart & Vascular Center (HVC) brings power to the people throughout rural Northern New England. Using a dedicated Dodge Transit minivan and a red-and-white pop-up tent, the Community Awareness Research and Education (CARES) program brings free, no-hassle blood pressure, blood sugar, and cholesterol screening to people across New Hampshire and Vermont who might not be aware of their risk for heart disease.

The program launched two years ago, but paused during 2020 because of the pandemic. In August 2021, HVC CARES resumed and held events at a home game of the Upper Valley Nighthawks collegiate baseball team in Hartford, VT, and at Dan & Whit’s General Store in Norwich, VT. Clad in HVC polo shirts and hats, the team of nurses who staff the CARES van set up their tent, tables, and chairs wherever the people are—at county fairs, farmers markets, food pantries, sporting events—and screen anyone over the age of 18 for the risk factors for heart attack and stroke. They know that for many rural residents, the logistics of time off from work, travel, childcare, and insurance can put basic health care out of reach and raise the risk of a catastrophic heart event down the road. The CARES team sees screening as just the first step in spinning a web of community connections to support heart-healthy living for the residents of rural New England, no matter how far they live from Dartmouth-Hitchcock Medical Center in Lebanon, NH. The CARES nurses welcome whole families under their tent—even kids too young for screening can squeeze a free HVC stress ball and chat about the benefits of fresh fruits and veggies while a relative gets their blood pressure checked. Folks with more risk factors—a history of smoking, for example, or family members who have suffered heart attack or stroke—receive referrals to local providers, while those interested in smoking cessation, healthy eating, and new fitness routines can take home pamphlets, as well as information about local resources to support lifestyle change.

“The purpose of HVC CARES is to raise awareness about heart and vascular health in our communities, and identify those at risk for heart disease by screening high blood pressure, high cholesterol, and diabetes. We particularly wish to connect with those living in underserved rural areas,” says Heart & Vascular Center Director Mark Creager, MD, the Anna Gundlach Huber Professor in Medicine at the Geisel School of Medicine.

Full image with caption??

From Plant Virus to Cancer Vaccine

A team of researchers at Dartmouth’s and Dartmouth-Hitchcock’s Norris Cotton Cancer Center, led by Steven N. Fiering, PhD, has identified pathways through which cowpea mosaic virus (CPMV), a plant virus that does not infect mammals, is recognized by the immune system. This discovery opens the door for a new biological drug for the treatment of cancer. CPMV is recognized by the immune system as a potential pathogen—any infectious agent that can cause disease. When tumors are injected with CPMV, molecules in the immune system send a warning signal of the invasion, which is heard by the “ears” of the immune system called toll-like receptors. The toll-like receptors then mobilize immune cells to attack the pathogen—and along with it, the tumor. Commercial development of CPMV as a cancer treatment is in progress by Mosaic ImmunoEngineering Inc., a biotech company co-founded by Fiering and Nicole Steinmetz, PhD, of University of California San Diego, with a team of scientists and entrepreneurs. Early-phase trials of CPMV in humans are planned to start in early 2022. Steven Fiering, PhD, is a member of the Immunology and Cancer Immunotherapy Research Program at Norris Cotton Canceer Center and a professor of microbiology and immunology at the Geisel School of Medicine.

New Ways to Understand Post-Traumatic Stress Disorder

A study of brain tissue from patients afflicted with post-traumatic stress disorder (PTSD) has uncovered new information about the disorder, and is poised to change how PTSD is understood and guide future treatment development. In research spanning several years, Matthew J. Friedman, MD, PhD, and his colleagues found that the brains of people with PTSD had “extensive remodeling” of the normal operations by which genetic information is coded, impacting everything from neural transmission to metabolism to inflammation. “This study is the first of many to come that are going to change the field of PTSD research,” Friedman said. “Unfortunately, our emerging understanding of the psychobiology of PTSD has not led to the development of effective medications for the disorder. We haven’t even seen a new drug developed for the treatment of PTSD in 20 years. Our team’s findings offer new clues about the causes of PTSD, the possibility of improved treatment, and most importantly, hope for people who live with this terrible disorder.” Matthew J. Friedman, MD, PhD, is a psychiatrist at Dartmouth-Hitchcock, a professor of psychiatry at the Geisel School of Medicine, and director of the U.S. Department of Veterans Affairs National Center for PTSD Brain Bank.