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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Boston Globe Health and Science staff:
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
Short White Coat blogger Ishani Ganguli
Short White Coat blogger Jennifer Srygley
Wednesday, October 24, 2007
Boston group to share genetic data on autism
A Boston group is sharing genetic information from families affected by autism with other researchers to promote understanding of the developmental disorder.
The Autism Consortium, whose members include hospitals, medical schools and universities in the Boston area, will transfer profiles of 500,000 genetic variations found across the genomes of 700 families with two or more children who have autism. The data will be held by the Autism Genetic Resource Exchange, a program of the advocacy organization Autism Speaks. Scientists can apply to the exchange, which gathered DNA from the families. The samples have been scanned for sequences where there are deletions or extra copies of DNA segments. The consortium is sharing the genetic variations it found.
"We returned all of the raw data to AGRE so they can distribute it to any other investigtors who want to begin exploring what may be the genetic underpinnings of autism," Mark Daly, a consortium member from Massachusetts General Hospital and the Broad Institute of MIT and Harvard, said in an interview. "Understanding the genetics underlying a complex disease is not an easy problem to solve. So there's no excuse for hoarding your data when much more can be learned by sharing."
Only a small percentage of autism arises from a recognizable genetic cause, such as Fragile X syndrome, Daly said. Recent research suggests that some families with autism might have higher rates of genomic abnormalities, but very few of these abnormalities have been conclusively identified.
"There's very strong heritability to autism but very little of the heritability has been explained by specific mutations of specific genes," he said. "What we hope is that this data is a starting point. We need to perform collaborative research in the spirit of the Human Genome Project to deliver on the trust the public has placed in us."
Members of the Autism Consortium are Beth Israel Deaconess Medical Center, Boston Medical Center, Boston University, Boston University School of Medicine, the Broad Institute of MIT and Harvard, Cambridge Health Alliance, Childrenís Hospital Boston, Harvard University, Harvard Medical School, Massachusetts General Hospital, Massachusetts Institute of Technology, McLean Hospital and Tufts-New England Medical Center.
Tuesday, October 2, 2007
Residents stand up for SCHIP
By Elizabeth Cooney, Globe Correspondent
Pediatric residents in Massachusetts and around the country gathered at noon today to push for expansion of a children's insurance plan that President Bush has threatened to veto.
At Boston Medical Center, about 50 residents, pediatricians, nurses and social workers paused in the hospital's main lobby as part of "Stand Up for SCHIP," the insurance program that covers children who don't qualify for Medicaid. There would have been one more, but that resident stayed behind in the intensive care unit with a child in respiratory distress, chief resident Marie Clark told the group. The child's father couldn't afford the asthma medication prescribed during an office visit on Friday, Dr. Suzanne Steinbach added, as an example of how lack of insurance hurts children.
"All of us here have had the same story," Dr. Barry Zuckerman, chief of pediatrics, said. "All of us are asking the president to do the right thing for children."
The State Children's Health Insurance Program is a federal program that covers 6.6 million children. It was set to expire after 10 years but Congress and the Bush administration are at odds over its funding and expansion. It is temporarily funded through mid-November.
Congress passed a bill that would expand the program by $35 billion over five years, to be paid for with new tobacco taxes.The number of uninsured children who could participate nationwide would grow to 10 million. Bush, who wants to increase funding by $5 billion over five years, has promised to veto the bill.
"Congressional leaders have put forward an irresponsible plan that would dramatically expand this program beyond its original intent," the president said in his radio address Saturday. "And they know I will veto it."
In Massachusetts, families earning three times the federal poverty level can obtain insurance through SCHIP for their children. The plan covers 90,500 children in the state.
Last week residents at Stanford's Lucile Packard Children's Hosptial in California planned a demonstration for today that spread to more than 30 hospitals around the country.
At Children's Hospital Boston, about 40 residents stood outside on Longwood Avenue to hear chief resident Carl Eriksson and second-year resident Michelle Niescierenko .
"We need to come together in solidarity with pediatric residents around the country to make a stand for children's health," Eriksson said.
At UMass Medical School in Worcester, about 40 medical students, interns, residents, staffers and administrators stood outside to voice their support for an expanded SCHIP program.
"It's not socialized medicine," UMass professor Dr. David Keller said in a statement. "It is good for our children."
Residents to take a stand on SCHIP
At noon today, pediatric residents across the country will join a 15-minute Stand up for SCHIP to urge President Bush not to veto an expansion of coverage for uninsured children who don't qualify for Medicaid.
The action started at Stanford's Lucile Packard Children's Hosptial in California but soon spread to dozens of hospitals, including Boston Medical Center, Children's Hospital Boston and UMass Memorial Medical Center in Massachusetts. The House and Senate have voted to reauthorize and expand the State Children's Health Insurance Plan, but the president has said he would veto it.
"It means children who could be covered won't be and the possibility that some children already covered may lose their insurance," Dr. Barry Zuckerman of Boston Medical Center said in an interview yesterday. "We see the consequences when patients don't get care when they don't have insurance."
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Tuesday, September 11, 2007
Questionnaire intended to help doctors treat older adults
Older adults have different concerns than younger people when they come to their doctors' offices, so a Boston coalition has created a free tool to help primary care physicians recognize and meet their needs.
The Boston Partnership for Older Adults, funded by the Robert Wood Johnson Foundation, has designed a two-page questionnaire to guide primary care physicians, who give most older people their care. The group is made up of 200 organizations and individuals concerned about the needs of older people in the city.
The focus is function, said Clare Wohlgemuth, nursing director of the Boston University Geriatric Services at Boston Medical Center and chair of the partnership's health committee.
"Those of us who work in geriatrics know that for older folks, their function is totally equivalent to how they perceive their health," she said in an interview. "What we set about doing was to develop a geriatrician cheat sheet for other primary care providers to think in a functional way."
Function for older people means how well they are managing a household, what their quality of life is and whether they have a support network. Common geriatric problems a patient might not raise in an office visit are falls, urinary incontinence, sexual activity, or the burden of care they might be providing for someone else, Wohlgemth said. A companion questionnaire, without the code numbers for billing purposes that appear on the physician version, is meant to help patients raise these issues with their doctors.
The tool also refers physicians and patients to Boston ElderInfo for information on other services.
The tool is not a substitute for seeing a geriatrician, Wohlgemuth said, but that might not always be neccessary.
"Not everyone needs a geriatrician or geriatric trained nurse, but every good primary care provider needs to have sensitivity to what the special needs of older people are," she said.
« BU, Children's win grant to develop minimally invasive heart surgery | Main | Today's Globe: bioterror drill, Blue Cross chairman, suicide rate for girls, Vioxx case, toy safety, Dr. Ann E. Kelley »
Thursday, September 6, 2007
BU and BMC tighten conflict-of-interest rules
By Liz Kowalczyk, Globe Staff
Boston University School of Medicine and Boston Medical Center today announced a strict new conflict-of-interest policy that will place hard limits on interactions between doctors and representatives from medical device makers and pharmaceutical companies.
Robert Restuccia, executive director of the Prescription Project, a Boston-based non-profit that promotes stricter conflict-of-interest policies nationally, said the university and hospital have adopted a model policy that goes further than many other institutions.
Boston Medical Center and the medical school, for example, now ban all clinicians from accepting personal gifts from industry, and meals funded by companies -- often a staple at teaching hospitals -- are no longer allowed on campus. Also, doctors who serve on committees that pick which drugs the hospital will use, are not allowed to have any financial relationship, including consulting agreements, with companies that might benefit from those decisions.
"This policy promotes the independence of our clinicians and establishes the highest professional standard of rigor and integrity in the care of our patients," BMC president Elaine Ullian said in a statement.
Restuccia added, "We see the pharmaceutical industry's marketing practices to physicians as undermining the practice of medicine."
Tuesday, July 24, 2007
Reach Out and Read honored by UNESCO
Boston-based Reach Out and Read, which promotes reading among low-income children, was awarded a literacy prize from the United Nations Educational, Scientific and Cultural Organization (UNESCO) -- one of only five awarded worldwide.
The group, which hands out free books to children when they visit the doctor, was founded in 1989 by Dr. Barry Zuckerman and Dr. Robert Needleman at what was then Boston City Hospital (now Boston Medical Center). The goal is to encourage parents to read to their children and prepare low-income children for school.
Monday, July 23, 2007
On the blogs: Joint Commission visit, euphemisms, privacy for immigrants
Surprise: On Running a Hospital, Paul Levy, president of Beth Israel Deaconess Medical Center, says the Joint Commission, which accredits hospitals, showed up this morning for an unannounced visit. Until last year, these periodic reviews of safety and quality were scheduled in advance, but now hospitals get no warning. The accrediting body, which used to be called the Joint Commission on Accreditation of Healthcare Organizations, will spend a week at the hospital.
"And, yes, we will publish our results once they go through the process of review at the Joint Commission headquarters," Levy writes.
Sugarcoating: On Healthy Children, Boston Medical Center pediatrician Dr. Steven Parker explores how doctors use euphemisms. Their intentions may be good, but they can end up creating confusion, he says.
"I know why this happens so often. Nice guys and compassionate to a fault, we pediatric providers hate to give bad news and avoid it when we can," he writes. "We think we are doing the family a favor: doesn't 'developmentally delayed' sound so much more hopeful, so much nicer, than 'mentally retarded?' "
HIPAA help: On WBUR's CommonHealth, Lori Abrams Berry of the Lynn Community Health Center worries that undocumented immigrants are being told that community health centers must report them to immigration officials if they seek health care.
"We need to find as many ways as we can to put the word out that community health centers are NOT obligated to report undocumented patients to immigration authorities," she writes. "On the contrary, HIPAA regulations actually prohibit us from giving information about our patients to anyone without their permission. (Who knew how handy this would turn out to be?)"
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Friday, July 13, 2007
MGH, Brigham make US News honor roll
Massachusetts General Hospital and Brigham and Women's Hospital held on to their honor roll positions in the annual rankings by U.S. News & World Report called "America's Best Hospitals." Nine Boston hospitals are featured in the guide.
Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth and the Cleveland Clinic slipped to fourth from third.
The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.
Other hospitals were ranked in the specialty areas, but not in a cumulative score. Beth Israel Deaconess Medical Center was in the top 50 for 10 categories: diabetes (in conjunction with the Joslin Clinic); digestive disorders; respiratory care; heart and heart surgery; cancer care; kidney diseases; geriatrics; gynecology, urology; and ear, nose and throat care.
Boston-area hospitals known for their specialties also made the top 50. Dana-Farber Cancer Institute placed fifth in the list for cancer care. Joslin Clinic, with its partner Beth Israel Deaconess, was ranked 12th for endocrinology. New England Baptist Hospital was 17th for orthopedics and Spaulding Rehabilitation Hospital ranked eighth for rehabilitation. Massachusetts Eye and Ear Infirmary placed fourth in ophthalmology and in the ear, nose and throat specialty.
Boston Medical Center was ranked 41st in geriatrics.
Mass. General's winning specialty areas were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; heart and heart surgery; gynecology; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; psychiatry; and rheumatology.
The Brigham's top specialties were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; and rheumatology.
Thursday, June 28, 2007
Cambridge Health Alliance will accept an award today from the National Association of Public Hospitals and Health Systems for its role in medical school curriculum change.
CHA developed a program for third-year Harvard Medical School students to follow patients for a year at one hospital instead of traditional rotations in different settings. The hospital was chosen for the 2007 Chair Award from 64 submissions, NAPH said in a statement.
Dr. Samantha L. Rosman, a third-year resident in pediatrics in Boston, has been re-elected to the American Medical Association's board of trustees. She is a 2004 graduate of Columbia University College of Physicians and Surgeons. After completing her residency, she will begin a fellowship in pediatric emergency medicine at Boston Medical Center.
Dr. Karen Shedlack (left), medical adviser for the mental retardation division of Vinfen, has won a 2007 Distinguished Fellowship from the American Psychiatric Association.
Before joining Vinfen, a private, nonprofit human services organization based in Cambridge, Shedlack was medical director for the adult developmental disabilities program at McLean Hospital and worked in the department of psychology and brain science at the Massachusetts Institute of Technology.
Virgin Life Care has named three Boston academics to its science advisory board.
A subsidiary of the Virgin group headed by Sir Richard Branson, the Boston company develops activity-based health rewards programs.
The board members are Dr. I-Min Lee of Harvard Medical School and the Harvard School of Public Health, Kyle McInnis of UMass-Boston and Jessica Whitely of UMass-Boston and Brown Medical School.
They are Dr. Anthony Compagnone of Hyde Park Pediatrics, Dr. Debra Ann Gfeller of Holliston Pediatrics, Dr. David Holder of the Martha Eliot Health Center, Dr. Richard Marshall of Harvard Vanguard Associates at Copley and Dr. Robert Michaels of Longwood Pediatrics.
Tuesday, May 22, 2007
Smoke causes evacuation of Boston Medical lab
By Stephen Smith, Globe Staff
A plastic container in a laboratory at Boston Medical Center caught fire late this morning, resulting in smoke but no injuries or damage, according to a hospital spokeswoman.
The container, carrying a salt solution, was being used by researchers in an endocrinology lab on the second floor of the building at 670 Albany St., said Maria Pantages, a Boston Medical spokeswoman. The researchers said they believed they had put the container into a machine that would spin its contents, Pantages said. Instead, the device was both a spinner and a hot plate, and about 11:45 a.m., researchers smelled smoke.
The building was evacuated as a precaution and emergency units summoned. Within 45 minutes, she said, the building's occupants were allowed to return.
In March, smoldering medical waste caught fire in a sterilizing machine in a lab at the Boston University School of Medicine. The BU medical school and Boston Medical Center are affiliated institutions.
Children's hires Jamaica Plain health center head
Childrenís Hospital Boston has named James Cote (left) executive director of the Martha Eliot Health Center, a community health center in Jamaica Plain that is licensed and operated by Childrenís.
Cote, who had been the health center's interim leader for the past year, has also worked at Childrenís and Boston Medical Center. He holds an MBA with a specialty in health care administration and marketing from UMass-Boston and a bachelor's degree in biology from Saint Josephís College in North Windam, Maine.
Friday, May 11, 2007
BMC nurses protest scheduled today
By Chris Reidy, Globe Staff
Nurses at Boston Medical Center have scheduled a demonstration for today to protest "management's unfair labor practices," a nurses union said.
The Massachusetts Nurses Association of Canton said management actions "threaten BMC's ability to retain the staff needed to provide the care patients deserve."
Boston Medical Center said patient care and patient safety are its highest priority and added that management will "continue to work with nurses to provide benefits that are important."
"Boston Medical Center values our nurses and is committed to ensuring an exceptional workplace for its staff while providing high quality and safe care for our patients," the hospital said in a statement.
Monday, May 7, 2007
CIMIT awards $5m to medical device researchers
Proposals to build new devices to help premature infants, to inject medicine without breaking the skin and to guide surgeons operating on the brain were among projects to win $5 million in grants from the Center for Integration of Medicine and Innovative Technology, the consortium announced today.
CIMIT, composed of Boston-area teaching hospitals and engineering schools, made 37 grants that range from $40,000 to $100,000. Twenty-two have military applications, acording to CIMIT, which receives support from the US Department of Defense as well as its members.
Dr. Riccardo Barbieri of Massachusetts General Hospital won a grant to develop a computational tool based on a premature infant's heartbeat to predict episodes when they stop breathing.
Mark Horenstein of Boston University will demonstate a way to inject medications through the skin using nanoparticles, leaving no wound behind.
Dr. Nobuyuki Nakajima of Brigham and Women's Hospital will work to improve how instruments can be navigated to diagnose and treat brain injury or disease.
"Our goal ... is to bring life-changing technology to patients as quickly as possible," Dr. John Parrish, CIMIT founder and director and Vietnam War battlefield surgeon, said in a statement. "We are especially aware of the needs of soldiers wounded on the battlefield."
Friday, April 6, 2007
On the blogs: painkillers (Oxy-what?), pain-free pediatrics
On Nurse at small, Betsy Baumgartner, who works at a Boston teaching hospital, relates how patients react when she suggests they take Oxycodone (left) for pain.
"I'm still amazed at how many people are afraid to take this painkiller because of the media hype" about Oxycontin, she writes. "The funny part is that if you offer them Percocet they will gobble it right up without any questions!"
On Healthy Children, Dr. Stephen Parker of Boston Medical Center talks about methods for pain-free pediatrics - from skin-to-skin contact for newborns during procedures, to pet therapy for older hospitalized children, as well as anesthesia.
"Using some well-established (and some not-so-well-established) techniques to diminish the experience of pain, the screaming of kids in our emergency room and offices has markedly decreased," he writes.
Monday, March 12, 2007
Children of long-lived parents have fewer heart risks
If you could pick your parents, you'd be wise to choose ones who live long and have few risk factors for heart disease. But don't lose hope if your parents died young -- you still can lower those risks yourself, researchers from the Framingham Heart Study say.
Results published in tomorrow's Archives of Internal Medicine show that middle-aged children who had at least one parent who lived to age 85 were less likely to develop high blood pressure, high cholesterol and other risk factors for cardiovascular disease than people whose parents died younger.
Other research has connected longevity to heredity, but this multigenerational study showed that having fewer risk factors for cardiovascular disease, the leading cause of death in Americans, was an advantage that lasted. The Framingham Heart Study has followed generations of residents since 1948 to study cardiovascular and other chronic diseases. This latest analysis included 5,124 people who were examined every 4 to 8 years from 1971 to the present.
"If you weren't lucky enough to choose your parents, this study shows how some of destiny is determined by risk factors we already know about and know to be modifiable," study co-author Dr. Daniel Levy, director of the Framingham Heart Study and a member of the National Heart, Lung and Blood Institute, said in an interview. "We know that if we eliminate high blood pressure, eliminate high cholesterol and then cigarette smoking, we would eradicate the overwhelming majority of cardiovascular disease in the United States."
People in mid-life shouldn't wait for signs of trouble to take steps to lower their blood pressure and cholesterol, said study co-author Dr. Emelia J. Benjamin, a professor of medicine at Boston University School of Medicine and a cardiologist at Boston Medical Center.
"Clearly there is a genetic basis to longevity but what this says is, some of the basis has to do with risk factors," she said in an interview. "You don't have to say, 'My parents died young so I can't do anything about it.' What this suggests to me is, 'Why don't you change the risk factors?' "
In an editorial about the article, Dr. Clyde B. Schecter of Albert Einstein College of Medicine asks whether cardiovascular disease is just postponed in long-lived people or if longevity might be a factor in whether people survive cardiovascular disease.
"Heart disease accounts for a large enough proportion of all deaths that any factor that promotes exceptional longevity almost inevitably must lead to decreased risk of cardiac death," he wrote.
The Framingham researchers, funded by NHLBI and NIH, are pursuing answers in the genes. A genome-wide scan of participants across the generations in the study began last fall with genotyping that Levy expects to be completed by the end of the summer.
"Longevity may be related to risk factors we don't yet know," he said. "We intend to look at the genetic variations that may differentiate children whose parents live to an old age from children whose parents died at a young age."
Friday, March 9, 2007
On the blogs: philanthropy and science, hospital quality measures, health care law, paying doctors more to teach
Corie Lok connects the $100 million windfall for the Broad Institute's new psychiatric research center with other grants to the Harvard-MIT venture, suggesting they account for the dominance of the Broad in papers published in Nature journals. But the effect of philanthropy doesn't stop there.
"To me, this is more evidence that Boston research is greatly benefiting from philanthropic sources of funding," she writes. "I find it interesting that people who became millionaires through businesses that have nothing to do with science are quickly becoming the benefactors of science."
Paul Levy, president and CEO of Beth Israel Deaconess Medical Center, repeats his call for hospitals to make public their rates of central line infections, which can occur after tubes are inserted into patients. An anonymous poster asked about another safety issue:
"What about the NY Times story just the other day on how rapidly the various hospitals react when someone enters the emergency room with what looks like a heart attack?" the writer says. "Boston Medical Center (is) way ahead of the BID (and all others in the Boston area). Are we working on this (and other things we are low on on the HHS measures)?"
John McDonough of Health Care For All reports on yesterday's Commonwealth Health Insurance Connector board meeting that celebrated meeting milestones, having enrolled more than 52,000 people and approving seven health plans to sell Commonwealth Choice coverage to people who don't qualify for subsidized plans.
"Working nurse" sounds a note of caution, however, saying 48,000 of those people were automatically given insurance paid for through the state budget, and the other 4,000 had state subsidies for their coverage.
"More folks having true affordable quality coverage is a very good thing," the post says. "It should be pointed out that in the big picture whatís been accomplished thus far has been the easy part."
On WBUR's CommonHealth, Jonathan Gruber, professor of economics at MIT and member of the Connector Board, asks whether health insurance can be compared with food.
"Most Americans think of health insurance as medical prepayment: you buy an up-front premium and in return all of your medical expenses are covered," he writes. "But such a system has an inherent flaw: any time something is free, it will be overused. This should not be a controversial statement to anyone who has ever gone to an all-you-can-eat buffet. Having paid at the door, you always end up eating more than if you were paying for each item your ordered."
Based on research of how insurance is used, he argues that individuals should pay for some of their health care costs, according to their income.
"Coming back to the buffet analogy, it is clearly harmful to not allow individuals to eat Ė- but less critical that you allow them to eat as much as they want."
"Great, so now my tuition goes up $10,000."
Tuesday, January 30, 2007
More than half Boston hospital workers got flu shots
More Boston hospital workers may be getting flu shots this season than the national average, but beyond that itís hard to figure out how they measure up.
Public health officials have been pushing for virtually all hospital workers to get flu shots because they can easily be exposed and infect vulnerable patients. But each of six hospitals that answered a White Coat Notes query today counts health care workers involved in direct patient care in its own way. And they donít necessarily know who might have gotten a flu shot outside their hospitals' programs.
Here are the results:
Boston Medical Center: 71 percent
"The national average is 38 percent," said Dr. Robert Goldszer, associate chief medical officer at Brigham and Womenís. "We feel weíre doing better than average, but we know we donít have an accurate rate."
Beth Israel has a broad definition of who comes into direct contact with patients. Itís not just the people who have day-to-day hands-on contact, but it also includes people who see patients face-to-face, such as ward secretaries, people who sit at the front desk in clinics, and workers who clean floors in patientsí rooms, said Dr. Sharon Wright, director of the infection control and hospital epidemiology program.
Beth Israel tries to track who gets a flu shot elsewhere, she said, asking employees to use an internal web site to state explicitly why they are declining to get a flu shot.
The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to at least offer flu shots. The Infectious Diseases Society of America recommends that hospitals and other health care facilities mandate flu shots for employees, except for religious or medical reasons.
"JCAHO told us to immunize 100 percent of health care workers who donít have a contraindication," Beth Israel's Wright said. "Weíre trying to get to that 100 percent in three to five years. The goal this year was 60 percent and we did it."
"Obviously we think everybody should get vaccinated against the flu, but itís especially important for health care workers," he said.