Alal Eran, PhD, studies the molecular basis of autism at Boston Children’s Hospital and Harvard Medical School.
An 'Information Commons' could better delineate the different faces of ASD by combining objective molecular, biochemical and neurological measures.
Yet another redefinition of autism spectrum disorder (ASD) has stirred up debate. The new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now collapses four previously distinct conditions—autistic disorder, Asperger syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified—under one umbrella label of ASD. It also collapses the traditional autistic triad (social deficits, communication impairments and restricted interests/behaviors) into two domains: social/communication deficits and restricted interests/behaviors.
While intended to increase accuracy and utility, the new diagnostic criteria for autism—the fifth revision since 1980—have attracted an unprecedented level of criticism by clinicians, researchers and families. The criteria for membership in DSM categories are much less robust than those for other clinical classification schemes—as evidenced by the rapid change in the DSM over the last 50 years. But more importantly, they are based only on behavioral symptoms. Full story »
This array of sensors surrounding a baby's head will give researchers and eventually clinicians a high-resolution image of neural activity.
Imagine you’re a clinician or researcher and you want to find the source of a newborn’s seizures. Imagine being able to record, in real time, the neural activity in his brain and to overlay that information directly onto an MRI scan of his brain. When an abnormal electrical discharge triggered a seizure, you’d be able to see exactly where in the brain it originated.
For years, that kind of thinking has been the domain of dreams. Little is known about infant brains, largely because sophisticated neuroimaging technology simply hasn’t been designed with infants in mind. Boston Children’s Hospital’s Ellen Grant, MD, and Yoshio Okada, PhD, are preparing to launch a new magnetoencephalography (MEG) system that will soon turn those dreams into reality. Full story »
Last month, we told you about cTAKES, which can read notes from clinical records and turn them into structured data that can be used for research on drug interactions, risk factors, clinical phenotyping and much more.
One of the key challenges with cTAKES, though, is getting access to the data in the first place. Electronic medical records (EMRs) generally run on proprietary platforms built for record keeping, and it can be difficult to extract data for research purposes. In addition, hospitals’ processes and controls around patient privacy usually don’t readily lend themselves to data mining.
Now mind you, when we talk about EMR data, we’re not just talking about notes, but also about the structured data gathered with every clinical visit and inpatient procedure, such as diagnosis, lab values and prescriptions. Those data could open up the taps for all kinds of clinical innovation—if researchers could get to them.
So what’s the solution? How do we make clinical data locked in EMRs work for research while keeping confidential information confidential?
Vector sat down with Jonathan Bickel, MD, Boston Children’s Hospital’s senior director of Clinical Research Information Technology (CRIT) and director of Business Intelligence, to learn what he thinks should be done. Full story »
Vector is taking some time off for the holidays, but we wanted to leave you with some good news. After nearly 10 years of lobbying and debate, Congress finally passed the National Pediatric Research Network Act (NPRNA). President Barack Obama signed the act into law on Nov. 27.
As David Williams, MD, of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, and Amy DeLong of Boston Children’s Office of Government Relations wrote on Vector back in September, NPRNA provides legislative authorization for a nationwide network of up to 20 National Institutes of Health (NIH)-funded pediatric research consortia.
Those consortia—each of which would be created through a competitive grant process modeled after the National Cancer Institute’s highly successful Comprehensive Cancer Centers initiative—would bring together the resources and expertise of multiple academic and health care institutions to make new headway against pediatric diseases.
In this way, the bill—sponsored by U.S. Representatives Lois Capps (D–CA) and Cathy McMorris Rogers (R–WA) and U.S. Senators Sherrod Brown (D–OH) and Roger Wicker (R–MS)—sought to address the severe shortfall in NIH funding for pediatric medical science. Only about 5 percent of the NIH’s current $30 billion budget goes to pediatric research. Full story »
Food insecurity is a major problem for diabetic patients at the Kay Mackensen clinic in Haiti where Julia Von Oettingen, MD (top center) serves as medical director.
In parts of the developing world, especially remote, rural areas, it’s not unusual for people with diabetes to ignore their symptoms until they’ve collapsed and need immediate care. By the time they see a doctor, their blood sugar levels might be so high as to cause diabetic ketoacidosis (DKA), where the body starts breaking down fats and proteins, turning their blood acidic and leaving them extremely dehydrated.
For many, it won’t be the first such episode. But for some, it can be the last.
Stories like this are increasingly common across large swaths of the developing world—as Diane Stafford, MD, an endocrinologist from Boston Children’s Hospital, discovered when she traveled to Kigali, Rwanda, through the Human Resources for Health program. Full story »
Michael Docktor, MD, is a pediatric gastroenterologist, director of clinical mobile solutions at Boston Children’s Hospital and a co-founder of Hacking Pediatrics. Above: The Hacking Pediatrics executive team: Judy Wang, MS; Michael Docktor, MD; Alex Pelletier, MBA; Margaret McCabe, PhD, RN, PNP; Kate Donovan, PhDc, MBA, BS, from Boston Children’s Hospital. (Photos: K.C. Cohen)
A hackathon is most easily explained by relating it to the crowd-sourced, time-crunched challenges that we see every day in pop culture. From “Top Chef” to “The Apprentice” to “Extreme Makeover,” television is teeming with passionate individuals trying to solve a difficult task with incredibly constrained resources and time. What results is often remarkable by any standard and speaks to the power of concentrated, collaborative problem solving.
When the challenge involves children and their health, the results can be magical, as witnessed by the weekend-long Hacking Pediatrics in late October, the first event of its kind. More than 150 “hackers,” including engineers, designers, software developers, entrepreneurs and roughly 40 clinicians gathered to create ground-breaking solutions for children and their families. Full story »
Charles Dumoulin, PhD, is the director of the Imaging Research Center at Cincinnati Children’s Hospital Medical Center (CCHMC) and a professor of pediatric radiology at University of Cincinnati College of Medicine. He led the team of scientists and engineers from CCHMC’s Imaging Research Center who won the Clinical Innovation Award at Boston Children’s Hospital’s National Innovation Pediatric Summit + Awards in September.
A 4.2-lb baby girl in the new 1.5 Tesla MRI magnet, designed for use in the NICU. (Images courtesy of Cincinnati Children’s Hospital Medical Center)
Experience suggests that magnetic resonance imaging (MRI) and advanced MR techniques such as spectroscopy and diffusion imaging offer substantial benefits when diagnosing problems in premature babies. However, today’s MR systems poses significant logistical barriers to imaging these infants. We have been working to change that.
MRI provides an unparalleled ability to visualize anatomy without the hazards of ionizing radiation. Yet premature and sick babies in neonatal intensive care units (NICUs) are usually too delicate to leave the unit. The few babies who receive MRI today must be accompanied by NICU staff during transport to and from the Radiology Department. This process is often a multi-hour ordeal and reduces the staff available to care for other babies in the NICU. Moreover, infants must be imaged in an adult-sized MRI scanner Full story »
Alisa Khan, MD, is a pediatric hospitalist and health services research fellow at Boston Children’s Hospital. She and Christopher Landrigan, MD, MPH, research director of the Boston Children’s Hospital Inpatient Pediatrics Service, recently received a Community/Patient Empowerment Award at the National Pediatric Innovation Summit sponsored by the hospital.
A nightly family signout not only helps families of hospitalized children sleep better, but also empowers them to play an active role in patient safety.
Miscommunications are a root cause of more than 70 percent of sentinel events, the most serious preventable adverse events in hospitals, according to data from the Joint Commission and the Department of Defense. As Vector reported yesterday, a bundle of interventions focused on improving patient “handoffs” during clinician shift changes, piloted at Boston Children’s Hospital, resulted in a 46 percent reduction in medical errors and a 54 percent reduction in preventable adverse events. What’s now known as I-PASS is now being implemented at 10 children’s hospitals across the U.S.
While I-PASS has greatly improved patient safety and communication between medical providers, it does not currently involve the family. Yet families play a pivotal safety role, advocating for their children and monitoring their progress through acute illness. Full story »
Medical errors are a leading cause of death and injury in America, and an estimated 80 percent of serious medical errors involve some form of miscommunication, particularly during the transfer of care from one provider to the next. However, a study published this week in the Journal of the American Medical Association demonstrates that standardizing written and verbal communication during these patient “handoffs” can substantially reduce medical errors without burdening existing workflows.
The study followed 1,255 patient admissions to two separate inpatient units at Boston Children’s Hospital—half occurring before a new verbal and written handoff program was introduced (July to September 2009) and half after (from November 2009 to January 2010).
After implementation, providers spent more time communicating face-to-face in quiet areas conducive to conversation. There were fewer omissions or miscommunications about patient data during handoffs. And medical errors decreased 45.8 percent. Full story »
The Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.
According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals. Full story »