Good things, including therapeutics, can come in small packages—and increasingly this means nano-sized packages. For a sense of the scale of these diminutive tools, a strand of human DNA is 2.5 nanometers in diameter.
Nanomedicine offers the promise of drugs that are activated by physiologic stimuli in the body (like the shear stress of blood flow that’s partially blocked by a clot), that can home to very specific targets in the body (like pancreatic islets that are being attacked by the immune system in diabetes) and that carry their own imaging agents—a built-in “metric” to show that they’re working. Biomaterials are being crafted to enhance their properties—like adding gold “nanowires” to heart patches to increase their electrical conductivity.
Vector’s new sister publication, Innovation Insider, looks at the promise and challenges of nanomedicine—both technical and regulatory. Read more about nanoscissors, theranostics, quantum dots and how the future is nano.
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The people who deliver care are starting to think in terms of population health.
A growing number of health care professionals are looking at their patients not just as individuals with unique concerns but also as members of larger groups with common problems and needs. This broader, population-based framework could lead to better health outcomes for more people, according to Jonathan Finkelstein, MD, MPH
of Boston Children’s Hospital.
“The health care system is changing from one that’s more reactive to illness—you come see the doctor when you’re not well—to one that’s more responsible for the promotion of health for defined groups of people,” he explains. While individual patients will always be treated as, well, individuals, the concept of population health can help providers “figure out the most appropriate services within a set of limited resources for specific groups.” Full story »
With appendicitis readmissions rates at some hospitals as high as 30 percent for children with severe disease, a group of children’s hospitals has started handing out comparative performance report cards to grade the way they diagnose and treat the condition. The quarterly reports are tools for hospitals to examine their performance across the entire scope of appendicitis care, prioritize quality improvement efforts and establish best practices.
According to Shawn Rangel, MD, a surgeon at Boston Children’s Hospital, the report cards grew out an effort to “understand high rates of preventable readmissions for complicated appendicitis.” A few years ago, Rangel and his colleagues began comparing appendicitis readmission rates at hospitals in the Children’s Hospital Association. The researchers found that the rate of kids readmitted within 30 days ranged from a low of 5 percent to a high of 30 percent for children with severe (ruptured) appendicitis. Full story »
On the minds of everyone involved in the care of sick children is the pressing need for more pediatric research funding. Last November, Congress finally passed the National Pediatric Research Act. It authorizes the National Institutes of Health to support a nationwide network of up to 20 pediatric research consortia, but it falls short of actually increasing NIH spending. Indeed, the next step in implementing the Act is to secure a specific funding commitment from the NIH or Congress.
Currently, only about 5 percent of NIH’s budget goes to pediatric research. Rather than wait for the government, an editorial in Vector’s new sister publication, Innovation Insider, proposes that foundations and companies become active participants in the consortia.
The prospects for such alliances are good. Patient advocacy foundations are increasingly active in research, and academic-industry partnerships are on the rise. At Boston Children’s Hospital alone, sponsored research and collaborations with foundations and industry have tripled from nine in 2009 to 29 in 2013. Alan Crane, MBA, a partner at Polaris Partners and an advisor to Boston Children’s Technology and Innovation Development Office, points out that drug discovery is much harder and more complex today than it used to be—just as many products are coming off patent.
Read more on what makes these partnerships work.
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Ed. note: This is the second in a two-part series on making clinical trial data more transparent. Click here for part 1.
To grossly oversimplify, there are two kinds of people in the world: those who want to see data from clinical trials made widely and freely available, and those who would rather have the data restricted for privacy or business reasons. And as we noted in our last post, there are valid arguments to be made on both sides.
But is there a way to balance the benefits of openness and the safety of confidentiality? Full story »
Ed. note: This is the first in a two- part series on making clinical trial data more transparent. Click here for part 2.
2013 was the year when big data became, well, big. Everyone from investment companies to public utilities to security agencies—including medical researchers—are now clamoring for as much data on as many subjects and topics as they can get their digital hands on.
But while data in other fields are becoming ever more open, clinical trial data—especially from corporate-sponsored trials—are relatively hard for medical researchers to obtain. Full story »
Israel Green-Hopkins, MD, is a second-year fellow in Pediatric Emergency Medicine at Boston Children’s Hospital and a fierce advocate for innovation in health information technology, with a passion for design, mobile health, remote monitoring and more. Follow him on Twitter @israel_md.
A few months ago, I spent 15 minutes filling out a detailed health data form at the doctor’s office. The paper form contained multiple questions about my health, family history, medications and basic demographic information. I assumed that an administrative specialist would code it into the practice’s electronic medical record (EMR) to be put to use. So it came as a surprise when I spent another 5 minutes reviewing the form with my physician, who then proceeded to type this information into the EMR herself. I’m confident neither my physician nor I felt enabled by the experience.
Countless people have had a similar experience—or worse, filled out a form with no sign that any clinician ever saw the information. Though the industry has made outstanding progress in adopting EMRs, the practice of data acquisition from patients remains cloudy. Patient-generated health data (PGHD), a term encompassing all forms of data that patients provide on their own, is a relatively new concept in health care. It falls into two broad groups: historical data and biometric data. Full story »
Alexandra Pelletier is the Digital Health Program Manager in the Innovation Acceleration Program at Boston Children’s Hospital. She manages the FastTrack Innovation in Technology Award, an initiative to accelerate, rapidly develop and deliver innovative clinical software solutions to improve patient experience and operational efficiency.
When the largest and most innovative technology companies in the world invest, radical disruption follows. Google and Apple, multibillion-dollar companies operating across the globe, are already deeply embedded into most of our lives. They now want to bring their network and reach to health care.
Their new investments could completely transform how patient data are captured and how information is shared. Through their big data capabilities, they’re well placed to rapidly evolve health care delivery processes. In the very near future, I expect we will see connected sensors or “smart” devices of all kinds begin to integrate into our lives, weaving a web of quantified data into actionable health information and changing how patient and care providers engage together.
Consider some recent events. First, there was Google’s buzz-generating meeting with the FDA. Full story »
Shawn Farrell, MBA, is Telemedicine and Telehealth Program Manager at Boston Children’s Hospital.
The TeleDactyl, as depicted on the cover of Science and Invention magazine in 1925.
Back in the 1920s, when medicine was more an art than a science and doctors made home visits, a publishing and radio pioneer named Hugo Gernsback predicted the future of telehealth. As described on Smithsonian.com, he wrote of a device called the TeleDactyl: “a future instrument by which it will be possible for us to ‘feel at a distance’”—dactyl, from the Greek, meaning finger.
Since that time, the practice of medicine has changed dramatically. Our understanding of the human body has advanced beyond our wildest dreams, producing drugs, devices and procedures that have made hospitals a place for healing and curing. At the same time, home visits were abandoned in favor of the office visit, making doctors more efficient. Almost 100 years later, several converging forces are making the home visit popular again, increasing the likelihood of seeing Gernsback’s vision become a reality.
The rollout of the Affordable Care Act, which will add millions of new patients to the health care system, comes at the same time that we have a shortage of primary care doctors, specialists and other care providers. Full story »
One of the hot trends in drug discovery could be called drug re-discovery: finding new uses for drugs that have already received FDA approval for a different indication.
It’s an approach that allows researchers and clinicians to rapidly test potential treatments for rare or difficult-to-treat conditions. Because the drug’s safety profile is already known, much of the preclinical and early clinical work that goes into developing a drug can be bypassed.
It was this kind of strategy that Alejandro Gutierrez, MD, and A. Thomas Look, MD, of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, and Jon Aster, MD, PhD, of Dana-Farber Cancer Institute and Brigham and Women’s Hospital, had in mind when they started screening a library of nearly 5,000 FDA-approved compounds, off-patent drugs and natural products using a zebrafish model of T-cell acute lymphoblastic leukemia (T-ALL).
And with that strategy, they may have struck gold. Just not in the way they had expected. Full story »