Pilot Projects Program

Round 4 Pilot Project Awardees

Dr. Chris Holmes, MD
Chris Holmes, MD

"Rural Patients Benefit from a National Map for Blood Clot Prevention"

Improving VTE Risk Assessment: Education and Prophylaxis in Rural Cancer Clinics

In 2015, the University of Vermont Medical Center launched a program to help follow national guidelines around reducing the risk of blood clots in patients who just started cancer therapy. This program increased risk assessments and patient education from 5% up to 95%, and the rates of blood clots in high risk patients was reduced by 40%. The question, however, was can this same program be implemented in rural community practices and offer the same benefits to rural patients? To address this, Dr. Chris Holmes received her pilot award to expand this same program to community oncology practices in rural Vermont and Maine. The goal was to create the first national roadmap for VTE guideline implementation and show that these programs can be effective in academic and community settings alike. The project team first aimed to identify barriers to implementation in rural practices and then develop a toolkit to help oncologists implement this program in their particular setting. While they are still finalizing the toolkit and analyzing data, Dr. Holmes and her team have found that just like at UVMMC, rates of risk assessment and education were around 5% or less prior to program implementation in rural practices. After program implementation, they were up to 30-50%. Through both this pilot project and a separate project led by Dr. Holmes, they found that rural practices with different levels of resources could attain the same positive results when implementing this program. Using their roadmap, they will continue improving patient outcomes across the region. Now, they hope to build on their work and strengthen this program by expanding it to new areas, as well as develop a new risk assessment that is simple and accessible so patients can calculate their own risk scores and become their own advocates.

“Moving national guidelines to clinical practice in rural communities is critical in preventing blood clots in patients with cancer.  This program is focused on meeting that goal through a multidisciplinary approach to individualized care."
Self-Reported Cognitive Decline in Rural vs Urban-Suburban Older Adults: Differentiating the Worried Well from True Cases

The northern New England region has one of the highest proportions of older adults in the country, and Dr. Thomas Meuser of University of New England received his pilot award to determine whether a self-screening tool could accurately identify older adults who were at risk of cognitive dysfunction. Leveraging a network of over 600 “Legacy Scholars,” Dr. Meuser and his team routinely receive surveys and self-reports from a diverse set of older adults across Maine. One of these self-reports is the AD8, a form that is typically used in clinical settings to screen for dementias. Dr. Meuser noticed that a higher-than-expected percent of respondents were screening positive on the AD8, which means that 20% were noticing cognitive changes in their lives. But does this mean they have a dementing disorder? Dr. Meuser says not necessarily. This higher proportion of older adults screening positive could be a result of the ‘worried well,’ or individuals worried about potential cognitive decline and thus monitoring their own health more closely. The challenge, then, is to tease apart who in that 20% are ‘worried well’ and who are actually experiencing or are at risk of experiencing a true case of dementia. To explore this, Dr. Meuser and his team conducted more in-depth assessments of this specific group of respondents over virtual visits, and they have just completed a one-year follow-up assessment in the same group. They found that the majority of adults who screened positive on their AD8 were indeed ‘worried well,’ or were not experiencing a dementing disorder. Now, they are continuing their analysis to identify any other factors that may coincide with cognitive decline that, when combined with the AD8, can be a predictive tool. The hope is to identify the most effective ways the AD8 and other screening tools can be used in community settings to identify those at risk of dementias as early as possible.

“They’re acknowledging changes in these two areas of cognition, but it could be that they’re just noticing it and saying yes on the form even though it’s not yet really a big deal. The question was what’s going on? Do 20% of these adults really have a dementing disorder, or are they just worried about it? Because a lot of older adults are worried."

Thomas Meuser, PhD
Thomas Meuser, PhD

"Sometimes You Have to Forget the Forgetfulness"


Michaela Reagan, PhDMichaela Reagan, PhD

"HIJACKED! The True Story of How Tumor Cells Alter Bone Marrow Fat Cells"

“Multiple myeloma cells are a blood cancer cells that grow predominantly in the bone marrow. We know that they depend on the bone marrow for their growth and survival, so we wanted to better understand how they change, or hijack, the bone marrow microenvironment, specifically those adipocytes inside the bone marrow, to further their own growth."
Myeloma-modified adipocytes exhibit a senescent-associated secretory phenotype

Multiple myeloma is a cancer that grows in the bone marrow, and this specific cancer is a large concern in our region where many individuals exhibit some of its risk factors, such as aging and obesity. Dr. Michaela Reagan of MaineHealth received her pilot award to more closely examine the microenvironments of these tumors in the bone marrow and better understand how these tumors might grow or spread. Her lab specifically wanted to look at the connection between cells that are increased in obesity, which are fat cells, and the tumor cells in multiple myeloma, but this came with a challenge. Primary adipocytes, or the fat cells in bone marrow, are extremely difficult to isolate or keep alive in a culture, which makes them difficult to study. The first step for Dr. Reagan’s team was to develop a protocol that would allow researchers to collect these hard-to-access fat cells directly from the bone marrow, and they managed to do just that. Their new methods and technological advances fill a large gap in the field of bone marrow adiposity and are under review as a methods paper in Frontiers in Oncology. With that hurdle expertly cleared, they then explored how these fat cells change when they have tumor cells as their neighbor. They found that the presence of the tumor cells changed these healthy fat cells, and that creates a cancerous microenvironment where these fat cells begin to produce proteins that could support the tumor cells. Dr. Reagan and her team want to understand more about how these fat cells are changing in the bone marrow of myeloma patients and how these cells may be helping the tumor cells, so that new ways to block or reverse this process can be uncovered.

Implementation and Validation of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) in a Rural EMS Region

To meet a new opportunity for better emergency stroke care, Dr. Daniel Wolfson, MD, of the University of Vermont received his pilot award to test whether an app could help rural EMTs effectively calculate the FAST-ED score, a score that measures the stroke’s severity right there in the field. The JoinTriage app, developed by ALLM, Inc., takes information supplied by the responding EMT and calculates the FAST-ED stroke severity score, identifies the nearest medical center offering the treatment best suited for that individual patient, and provides the route from their location to that center. Dan and his team set out to educate every EMS agency in the state of Vermont in the use of the app and collect data on whether the app’s calculated score in the field matched the score calculated at the hospital. The hope was that through training rural EMS personnel in the use of this tool, they could provide more equitable stroke care even in our remote areas that experience geographical barriers to accessing treatment. But they didn’t stop there. Leveraging the resources provided by the NNE-CTR, Dan helped cultivate a team across Vermont, Maine, and New Hampshire that included all three State EMS Medical Directors, emergency physicians and neurologists at each thrombectomy-providing hospital, research technicians, and project managers. Together, they were able to add FAST-ED training to the official protocols for EMS education and procedures, and now all three states calculate the FAST-ED score in the field. Now, this large team is creating the first research consortium focused on a rural region, collecting data on the scores, response times, patient outcomes, and so much more to analyze exactly how they can provide the best care for stroke patients in all of our rural and urban communities. Read the whole story here.

“Northern New England, we're a pretty unique place. We're largely rural and widespread. This was an amazing opportunity for us to collaborate with our other northern New England partners and do something like this. What we've set up, we hope will lead to research on other rural EMS questions. So. That's a pretty good story."

Daniel Wolfson, MD

Daniel Wolfson, MD

"Rural Stroke Care: How EMS Changed Overnight"

Read this project's news story.




Increasing the Efficacy of Breast Cancer Therapeutics; Activation of a Non-Steroidal Hormone Receptor

Frances Carr, PhD (University of Vermont)


Identifying mechanisms of noxious electrical stimulation to treat pain

Scott Stackhouse, PT, PhD (University of New England)