The Gutenberg press disseminated ideas to a wider society. But in the clinical world, much information is still on "lockdown." (Wikimedia Commons)
The best things in life are free: friends, sunny days, beautiful vistas. Wouldn’t it be nice if knowledge were also free? Historically, libraries promulgated knowledge sharing because it was for the public good. We see this spirit increasingly embraced on the Internet – take the recent announcement of a collaboration between Harvard and MIT to make their courses freely available to users around the world via the edX platform.
But have we made all useful knowledge available in a way that allows for the greatest societal advancement? Not really. According to Ken Mandl, MD, MPH, director of the Intelligent Health Laboratory at the Children’s Hospital Informatics Program (CHIP), one important source of information still on lockdown is clinical trial data. In an article called, “Learning from Hackers: Open-Source Clinical Trials” published this month in Science Translational Medicine (not currently available in full text), Mandl and his coauthors call for making raw, de-identified clinical trial data free to the public. Full story »
Surgeons and dentists often use Gelfoam sponges to mop up blood and help stop bleeding. Could they act as drug-eluting devices to grow new heart tissue?
While current heart-attack treatments mainly try to preserve healthy heart tissue, scientists have been finding ways to stimulate growth of new tissue to replace the tissue that’s damaged. They’ve done this either by getting heart muscle cells (cardiomyocytes) to make more copies of themselves, or by stimulating other cells to become cardiomyocytes (one recently reported study, for example, used genetic regulators called microRNAs).
The next challenge lies in getting these regenerative factors into a living patient’s damaged heart tissue — without affecting healthy tissue – and getting the factors to stay in place long enough to work their magic.
A new approach developed at Boston Children’s Hospital, which could be used relatively soon, takes advantage of Gelfoam, a gelatin-based sponge that’s already FDA-approved and has been used by surgeons and dentists for decades. Full story »
Small interfering RNAs, or siRNAs, could be great targeted treatment tools for breast and other cancers. The problem is making sure they get packaged and delivered to where they need to go. (pscf11/Flickr)
Breast cancers whose cells carry the HER2 protein are pretty tough customers. They only account for about 20 percent of all breast cancers, but they are some of the most aggressive. While targeted drugs like trastuzumab (Herceptin) and lapatinib (Tykerb) have made these tumors easier to treat, those that resist these drugs, relapse or don’t have HER2 on their cells’ surfaces can still stymie oncologists.
A molecular phenomenon called RNA interference (RNAi)—in which small pieces of RNA silence the expression of individual genes—could provide an alternative solution for breast and other cancers.
Though it was first discovered in plants, researchers have known for about a decade that small interfering RNAs (siRNAs) are active in mammals like us, and are already working on ways to harness them for shutting down genes promoting cancer and other diseases.
The problem with siRNAs for treatment, however, is making sure they get exactly where they need to go. That’s a problem that Judy Lieberman, MD, PhD, has taken a big step toward solving. Full story »
What time is the right time to give a transfusion? Doctors at Boston Children's are turning a fresh eye on transfusion guidelines for children. (@alviseni/Flickr)
Cancer. Trauma. Sickle cell disease. Surgery. There are many reasons why a child might need a blood transfusion, but they all share a common theme: the need to replace blood or blood products (e.g., red blood cells, platelets) that have been lost or consumed, or make up for defects that keep the body from producing them in adequate amounts.
And though transfusions can be life saving, they come with risks, such as iron overload, inflammation or disease (a very low risk, thanks to improved screening tests). And blood products are expensive and scarce—another reason to be prudent about transfusions.
“There’s little science behind physicians’ current practices when deciding when to transfuse a patient,” says Jenifer Lightdale, MD, MPH, of Boston Children’s Hospital’s Division of Gastroenterology and Nutrition. “Many doctors use criteria their mentors passed down to them, which their mentors passed down to them, and so on. But ideally, the decision should be based on evidence, not tradition.” Full story »
Early seizures may disrupt circuit formation in babies' brains, leading to autism. But new research suggests that an existing drug can reverse this.
This is the third post in a series about new approaches for seizures and epilepsy. Read the first and second posts.
We already know that there’s some kind of connection between epilepsy and autism: Children who have seizures as newborns not uncommonly develop autism, and studies indicate that about 40 percent of patients with autism also have epilepsy. New research at Boston Children’s Hospital finds a reason for the link, and suggests a way to break it — using an existing drug that’s already been given safely to children.
In the online journal PLoS ONE, Frances Jensen, MD, in the Department of Neurology and the F.M. Kirby Neurobiology Center at Boston Children’s, and lab members Delia Talos, PhD, Hongyu Sun, MD, PhD, and Xiangping Zhou, MD, PhD, showed in a rat model that early-life seizures not only lead to epilepsy later in life, but also produce autistic-like behaviors.
Drilling deeper, they showed that early seizures hyper-activate a group of signaling molecules collectively known as the mTOR pathway. Full story »
Excess brain electrical activity at night can disrupt development -- but if found, may be treatable.
This is the second post in a series about new approaches for seizures and epilepsy. Read the first post here.
When a 2- or 3-year-old child begins losing milestones like language, walking skills and fine motor abilities, or is slow to achieve them, it’s devastating for families. The good news, at least for some children, is that it might be treatable.
Tobias Loddenkemper, MD, a neurologist in the Epilepsy Center at Boston Children’s Hospital, suspected that some children with developmental delay have seizure-like activity in the brain at night. These spikes of electrical activity, referred to medically as sleep-potentiated epileptiform activity, can be readily and inexpensively detected by electroencephalography, or EEG, and readily treated with nighttime anti-seizure drugs.
But likely, no one’s thought of it. “Very few physicians have been looking to see what’s happening at night,” Loddenkemper says.
He and research fellow Iván Sánchez Fernández, MD, with other colleagues, decided to look themselves. Full story »
This comfy wristband can sound an alarm when a child is having a seizure, and can help doctors better time medication dosing.
This is the first post in a series about new approaches for seizures and epilepsy.
Seizures are often hard to track in children with epilepsy, making it difficult for doctors to optimize their treatment. For parents, the greatest worry is that their child will have a life-threatening seizure in the middle of the night or away from home, unable to get help. And what about when that child goes off to college?
“Every parent asks, ‘What can I do to prevent my child from harm?’” says Tobias Loddenkemper, MD, a neurologist in the Epilepsy Program at Boston Children’s Hospital.
Loddenkemper also wanted to better understand his patients’ seizure patterns so he could better time the dosing of their medications. He’s been testing a wristband sensor system, developed by Rosalind Picard, ScD, and colleagues at the MIT Media Lab (Epilepsia, March 20), and thinks it could be part of the solution. Full story »
(Kenny Louie/Flickr)
National data suggest that up to 70 percent of sentinel events—the most serious errors in hospitals—stem at least in part from miscommunications. Communication problems are especially apt to occur during hospital shift changes, when a patient’s care is transferred to incoming doctors and nurses—known in health care as the “handoff.”
More than a year ago, a team led by Amy Starmer, MD, MPH, of the Division of General Pediatrics at Boston Children’s Hospital, developed and began testing a bundle of interventions to ensure that the hospital’s residents were thoroughly and accurately briefed on each patient’s medical history, status and treatment plan in a standardized way.
Through measures such as communications training, a mnemonic to help residents remember key information to pass on and a computerized handoff tool that integrated with the patient’s electronic medical record, they managed to move the needle: Medical errors fell by 40 percent—from 32 percent of admissions at baseline to 19 percent of admissions three months after the program started.
But that wasn’t all. Full story »
Naomi Fried, PhD, is Boston Children’s Hospital’s chief innovation officer. This post is adapted from her opening keynote address this week at the Institute for Health Technology Transformation (iHT2) annual conference in Atlanta.
Fried giving the opening keynote at iHT2
CLICK HERE TO WATCH THE KEYNOTE
Innovation is one of the most talked-about subjects in business and now health care. It is also one of the most misunderstood subjects. People confuse innovation with creativity, brainstorming and invention.
Simply put: Innovation is a process for testing and developing new ideas. Innovation in health care organizations does not happen by chance, and in fact follows a predictable course.
Several years ago I developed the idea of an innovation “lifecycle,” comprised of six predictable stages with a gap in the middle (more on that gap below). It’s a powerful paradigm for understanding and organizing innovation in a health care organization (or any organization, for that matter).
Stage 1: Initiate
An innovation’s lifecycle begins with the identification of a problem or opportunity. Full story »
Margaret Coughlin is a Senior Vice President and the Chief Marketing and Communications Officer at Boston Children’s Hospital.
Here at the TEDMED conference, it’s all about horizontal or lateral thinking – coming at problems from new directions, without regard to conventional boundaries. I like the thoughts of Edward DeBono (not a TEDMED speaker), who coined the term “lateral thinking” in 1967:
Some people are unhappy about lateral thinking because they feel it threatens the validity of vertical thinking. This is not so at all. The two processes are complementary, not antagonistic. Lateral thinking enhances the effectiveness of vertical thinking by offering it more to select from. Vertical thinking multiplies the effectiveness of lateral thinking by making good use of the ideas generated.
Lateral thinking is, in a way, an antidote to the way we’re all taught—vertically and specifically. Our education systems seem to be getting more vertical – more concerned with meeting prescribed benchmarks, and, in so doing, discarding the creativity and imagination of learning that is critical to real innovation and real forward movement. As for medical education, radiation oncologist and TEDMED speaker Jacob Scott said it has replaced creativity in the brain with a warehouse. Full story »
