Spending on children with medical complexityJay Berry, MD, MPH, is a pediatrician and hospitalist in the Complex Care Service at Boston Children’s Hospital.

Growing up, my parents repeatedly reminded me that “money doesn’t grow on trees.” They pleaded with me to spend it wisely. I’ve recently been thinking a lot about my parents and how their advice might apply to health care spending for my patients.

As a general pediatrician with the Complex Care Service at Boston Children’s Hospital, I care for “medically complex” children. These children—numbering an estimated 500,000 in the U.S.— have serious chronic health problems such as severe cerebral palsy and Pompe disease. Many of them rely on medical technology, like feeding and breathing tubes, to help maintain their health.

These children are expensive to take care of. They make frequent health care visits and tend be high utilizers of medications and equipment. Some use the emergency department and the hospital so often that they’ve been dubbed frequent flyers. Full story »

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catheter hub cleaning

Sarah Goldberg and Ali Ataollahi pitching their device, which cleans central-line hubs with the push of a button, at Boston Children's Hospital's Innovation Tank.

Thousands of hospital patients die every year from infections that start in a central line, a catheter used to inject life-saving medications directly into the bloodstream. One infection can add two to three weeks and a whopping $55,000 to a patient’s hospital stay. Even worse, up to 25 percent of patients who come down with a central line infection die from it—a staggering number considering that 41,000 such infections are recorded in the U.S. each year.

“Central line infections are life-threatening, costly and completely preventable,” says Sarah Goldberg, MD, a fellow in Boston Children’s Hospital’s Cardiac Intensive Care Unit (CICU).

The problem is that the catheter’s hub—the port where it enters the body—is exposed to bacteria in the world around it. If clinicians don’t thoroughly clean the hub before each use, they risk pushing bacteria straight into a patient’s blood. But that brings up a second problem.

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From a series on researchers and innovators at Boston Children’s Hospital.

David Hunter, MD, PhD

Happy to fix things, Hunter realigns a strike plate on a balcony door. (Photo: Constance West, MD)

David G. Hunter, MD, PhD, dreamed of a career as a rock star. Instead, he became Boston Children’s Hospital’s ophthalmologist-in-chief and invented the Pediatric Vision Scanner. The device, designed for use by pediatricians, detects amblyopia or “lazy eye,” the leading cause of vision loss in children, as early as preschool age when the condition is highly correctable. Full story »

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Naomi Fried, PhD, is Chief Innovation Officer at Boston Children’s Hospital.

Return on innovation ROI

When people hear about ROI, they often think of financial returns and “return on investment.” But, in my world, ROI is actually “return on innovation.” While the return on innovation can be financial, it can also take many other forms. Here are my top five. Full story »

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Judy Wang, MS, is a program manager in the Telehealth Program at Boston Children’s Hospital.

hackathons

Hackathons create ideas and excitement, but then reality sets in.

Much has been written about the successes that result from medical hackathons, in which people from across the health care ecosystem converge to solve challenges. For example, PillPack, which formed out of MIT Hacking Medicine, recently closed an $8.75 million funding round. But is this a realistic snapshot of what happens after a hackathon? We took a look at two of the 16 teams that competed at Boston Children’s Hospital’s Hacking Pediatrics last year. Full story »

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Boston Globe CRISPR gene editing research

You have an immune system. Your cat has an immune system. And bacteria have an immune system, too—one that we’ve tapped to make one of the most powerful tools ever for editing genes.

The tool is called CRISPR (for “clustered regularly interspaced short palindromic repeats”), and it makes use of enzymes that “remember” viral genes and cut them out of bacterial genomes. Applied to bioengineering, CRISPR is launching a revolution. And the Boston Globe reported over the weekend that while researchers at the University of California at Berkeley first developed CRISPR, the technique is booming in labs around Boston. Full story »

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proteins and peptides from noncoding DNA

Probing the genome's 'dark side' could change our view of biology.

Vast chunks of our DNA—fully 98 percent of our genome—are considered “non-coding,” meaning that they’re not thought to carry instructions to make proteins. Yet we already know that this “junk DNA” isn’t completely filler. For example, some sequences are known to code for bits of RNA that act as switches, turning genes on and off.

New research led by Judith Steen, PhD, and Gabriel Kreiman PhD, of Boston Children’s Hospital’s Proteomics Center and Neurobiology program, goes much further in mapping this “dark side” of the genome.

In a report published last month in Nature Communications, they describe a variety of proteins and peptides (smaller chains of amino acids) arising from presumed non-coding DNA sequences. Since they looked in just one type of cell—neurons—these molecules may only be the tip of a large, unexplored iceberg and could change our understanding of biology and disease. Full story »

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As Epilepsy Awareness month closes out and we embark upon the holiday season, we’re pleased to see an innovation initiated here at Boston Children’s Hospital move toward commercial development. This wearable device for patients with epilepsy, called Embrace, is like a “smoke alarm” for unwitnessed seizures that may potentially prevent tragic cases of sudden, unexpected death from epilepsy (SUDEP) in the future.

The Bluetooth-enabled, sensor-loaded wristband, using technology developed and tested in collaboration with the MIT Media Lab, can detect the onset of a convulsive seizure based on the wearer’s movements and autonomic nervous system activity. Full story »

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Gomez's team at work on a platform for vaccine tracking and ordering

Gómez's team at work on an app for vaccine tracking and ordering

Eva Gómez, RN-BC, MSN, CPN, is a staff development specialist in Clinical Education and Informatics 
at Boston Children’s Hospital. She and Tami Chase, RN, nurse manager at Martha Eliot Health Center, received the Springboard Prize from Boston Children’s Innovation Acceleration Program at last month’s Hacking Pediatrics.

For months, my colleague Tami Chase and I had been experiencing a big pain point in our patient-care process: the complicated and time-consuming task of ordering vaccines—a task that requires providers and nurses to memorize or figure out complex algorithms based on variables like patient age, ethnicity and medical/family history. There are many vaccines and formulations, and if vaccine supplies are used incorrectly, we are less able to order free vaccines from federal and state sources. We’re then forced to purchase vaccines privately—tapping hospital funds that could be used for many other worthy projects. Full story »

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This post is first in a series of profiles of researchers and innovators at Boston Children’s Hospital.

Martha Murray, Braden Fleming and their children in San Francisco.

Martha Murray, Braden Fleming and their children in San Francisco.

“I’d like to meet the innovator who made the tricorder that Bones used on Star Trek,” says orthopedic surgeon Martha Murray, MD. “A push of the button and things healed, no muss, no fuss. I’d like to know how he or she made that work because I could really use one.”

Murray has been on a 30-year quest to devise a better way to treat anterior cruciate ligament (ACL) tears. She recently crossed a major milestone: The Food and Drug Administration approved a first-in-human safety trial of a bio-enhanced ACL repair that encourages the ligament to heal itself. Murray expects the first patients to enroll in the 20-patient trial by early 2015. We had a few questions for her.

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