Is universal cardiovascular screening supported by the data, and are clinicians ready?
In 2011, the National Heart, Lung, and Blood Institute (NHLBI) guidelines for cardiovascular risk reduction in pediatrics reinforced the recommendation that primary care pediatricians (PCPs) should screen children and adolescents for cholesterol and blood pressure elevations. However, as PCPs try to incorporate it into their well childcare routine, questions are being raised about the practical implications of implementing that recommendation.
Last month, the U.S. Preventive Services Task Force (USPSTF) published its finding that there is not enough evidence to recommend for or against routine screening for primary hypertension in asymptomatic children and teens, repeating its suggestions from 2003. It has issued similar statements about lipid screening.
At this week’s 2013 American Academy of Pediatrics (AAP) conference, Sarah de Ferranti, MD, MPH, director of the Preventive Cardiology Clinic at Boston Children’s Hospital, gave a presentation titled “Universal Lipid Screening: Are Pediatricians Doing It and How Is It Working?” She spoke with Vector about screening both for cholesterol and blood pressure in children. Full story »
Hackathons are quickly growing beyond Red Bull- and Dorito-fueled code-fests into fertile grounds for new technologies and products that potentially could improve medicine and health care.
But beyond individual events, could hackathons signal the beginnings of a new ecosystem for medical innovation?
That’s what groups like MIT’s H@cking Medicine, Brigham and Women’s Hospital (BWH)’s new iHub and the New Media Medicine group at the MIT Media Lab are betting on. By tapping the same creative entrepreneurial energy that hackathon culture has brought to the technology industry, they believe they can fundamentally reimagine health care, one device, app and system at a time.
“The Boston area is the most fertile ground for medical innovation you could ever imagine,” says Michael Docktor, MD, a gastroenterologist at Boston Children’s and one of the organizers, with the H@cking Medicine team, of this weekend’s Hacking Pediatrics hackathon. “We need to make the case with the local medical and technology community that hackathons are a viable way of innovating in this day and age, that this is the way we ought to be innovating.” Full story »
The Human Genome Project’s push to completely sequence the human genome ran a tab of roughly $2.7 billion and required the efforts of 20 research centers around the world using rooms full of equipment.
But that was using technology from the 1990s to early-2000s. As by a panel of genomics experts from industry and academia pointed out at last week’s National Pediatric Innovation Summit + Awards, a scientist in a single laboratory today can sequence a genome for as little as $1,000, making sequencing almost a medical commodity.
Now what? How do we go about making clinical genomics an everyday thing? The discussion left the answer to that question—and the other questions it raises—unclear. While the panelists expressed excitement about what’s possible, they cited great uncertainty among doctors, scientists, patients, payers, companies and regulators about how to make clinical genomics work. Full story »
In Part 1 last week, Vector took a look at digital health apps, telemedicine, genomics, phenomics and new behavioral diagnostics as transformative trends in pediatrics. This week, we complete our list. These posts will also appear as an article in the fall issue of Children’s Hospitals Today magazine.
6. New pharma research and development (R&D) models
Academic medical centers have always worked with the pharmaceutical industry but never so closely as now. In the old model, industry drove therapeutic development. A company might fund an academic project or supply reagents, but the relationship generally ended with the project (and publication of a paper).
Now, with drug pipelines drying up and R&D costs rising, Big Pharma is under pressure to change. New industry-academia collaborations are forging creative partnerships, altering how both parties do business. The new models are allowing hospital researchers to do what they’ve never done before: take the lead in R&D. Full story »
Since our “trends” posts at the top of the year are among our most viewed, Vector took time out this summer to take an interim snapshot of pediatric medicine’s cutting edge. Here we present, in no particular order, our first five picks. Check back next Friday for Part 2. If you want more, there’s still time to register for our National Pediatric Innovation Summit + Awards (September 26-27). The posts will also appear as an article in the fall issue of Children’s Hospitals Today magazine.
1. Digital health apps 2.0
The electronic revolution in health care continues. According to recent surveys, more than 90 percent of physicians have smartphones and more than 60 percent are using tablet devices like iPads for professional purposes. Dr. Eric Topol and others think these digital tools are the future of medicine.
Mobile apps keep proliferating, adding more and more features: high-quality image capture, voice-to-text capabilities and gaming techniques to motivate adherence, as well as sensors that gather physiologic data, like glucose levels and heart rate. Consumers are tracking and sharing data themselves, saving time in the clinic and helping physicians monitor their symptoms. Through the much-hyped Google Glass, it won’t be long before doctors can seamlessly call up patient data, look up a drug dosage and get decision support during a clinical visit without using a hand-held device.
One limiting factor in this “Wild West” scenario is the FDA’s ability to keep up with digital advances from a regulatory standpoint. Full story »
Michael Docktor, MD, is director of Clinical Mobile Solutions at Boston Children’s Hospital and a pediatric gastroenterologist with a research and clinical interest in inflammatory bowel disease. (See a recent interview with him on MedTech Boston.)
How do the most disruptive companies of our day like Facebook and Pinterest get started? In the warm glow of Silicon Valley, in the shadows of technology titans such as Apple and Google, bright, enthusiastic young entrepreneurs, programmers and designers get together to “hack” ideas for the next big thing. The concept is simple and has worked in tackling challenges from creating the next great social network to developing an innovative green-energy technology.
However, applying this model of collaborative, rapid problem-solving to pain points in health care is still a relatively novel concept. Hacking Medicine, a community of passionate “hackers” at the Massachusetts Institute of Technology (MIT), has brought this practice to medicine and successfully organized events from Uganda to Boston. Graduates of one recent event with AthenaHealth—which develops and sells cloud-based services for electronic health records, practice management and care coordination—are on their way to developing successful businesses, including PillPack (helping patients manage their medications), the BeTH Project (inexpensive adjustable prostheses) and Podimetrics (a data-transmitting shoe insole for diabetics). Full story »
Asperger’s syndrome vs. autism spectrum disorders:
This histogram separates children with Asperger’s (in red) from those with autism spectrum disorders (green) based on EEG coherence variables. Although there is overlap with high-functioning autism, the Asperger’s children clearly form a distinct group. (Courtesy BMC Medicine)
Is it Asperger’s syndrome or is it autism? Since there are no objective diagnostic measures, the diagnosis is often rather squishy, based on how individual clinicians interpret a child’s behavior. According to the Diagnostic and Statistical Manual, fourth edition (DSM-IV)
, early problems with language development are an indicator of autism; if there are behavioral symptoms but no early language problems, the child has Asperger’s. However, if the diagnosis is made late, parents’ recall of early language development may be fuzzy.
Under the new DSM-V, published in May, Asperger’s is included under the general “autism spectrum disorders (ASD)” umbrella. This has raised concerns among families who feel their children with Asperger’s have unique needs that won’t be met in classroom programs designed for autism.
Frank Duffy, MD, a neurologist at Boston Children’s Hospital, believes it’s possible to objectively differentiate Asperger’s from ASDs using a new wrinkle on an old technology. Originally trained as an engineer, Duffy is expert at interpreting electroencephalography (EEG) signals—the wiggly lines that represent electrical activity in the brain. Full story »
Researcher Anna Young of MIT's Little Devices Lab works on a solar-powered autoclave for sterilizing medical instruments
(Image: Jose Gomez-Marquez)
“It’s a robot…it brings the remote.”
A kid in a striped shirt who looks to be going into the second or third grade reluctantly explains his cardboard and foam creation, a boxy figure with four wheels and a grabbing arm. He’s taken his invention from paper design through model through an imagined cover of TIME magazine, joined by countless other children who have designed everything from rockets to surprisingly detailed wind turbines.
I’m at the MIT Museum, and today it is overrun with inventors. Upstairs, younger visitors are invited to invent and model their own creations—like the remote-getting robot—and downstairs people gather to see presentations and prototypes by students working in MIT labs. This event is Insight into Innovation, the mad invention of the museum’s summer interns, and it’s a natural fit for MIT’s Little Devices Lab, a medical research group with a do-it-yourself twist whose offices are right above the museum. Three groups from that lab are exhibiting.
Full story »
Lee's team is using proteomics and glycomics to establish normal urine profiles, as well as biomarkers of kidney damage. (Harald/Flickr)
Part 1 of a two-part series on kidney disease. Part 2 is here.
In up to 5 percent of all pregnancies, children are born with some degree of kidney dilation or swelling, known as hydronephrosis. Unfortunately, says urologist Richard Lee, MD, of Boston Children’s Hospital, “many of these kids go through a lot of testing after birth and are followed for a long period of time—sometimes unnecessarily.”
Hoping to reduce such testing, Lee and his colleagues are turning to urine. They’ve been collecting comprehensive data on the urinary proteome—all the proteins urine normally contains. With this baseline information, they hope to establish biomarkers that identify kidney damage.
In a recently published study, Lee and his coauthors compared the urinary proteomes of healthy infant boys versus men to find out what happens naturally with age. Through their work, they identified nearly 1,600 protein groups and determined that the healthy male urinary proteome changes over time. Full story »