boston.com Your Life your connection to The Boston Globe
White Coat Notes: News from the Boston-area medical community
Comments
Send your comments and tips to whitecoat@globe.com
Categories


Blogger
Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Contributors
Boston Globe Health and Science staff:
Scott Allen
Alice Dembner
Carey Goldberg
Liz Kowalczyk
Stephen Smith
Colin Nickerson
Beth Daley
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
 Short White Coat blogger Ishani Ganguli
 Short White Coat blogger Jennifer Srygley
Week of: November 4
Week of: October 28
Week of: October 21
Week of: October 14
Week of: October 7

« We're number 9, health survey says | Main | Today's Globe: 'Robin Hood' Medicare case, $4m malpractice award, TB in Chelmsford, painkillers and Parkinson's, antibleeding drug, FDA power, art in hospitals »

Monday, November 5, 2007

Screening shows 1 in 7 teens might have substance abuse problem

About 1 in 7 teenagers in Massachusetts and Vermont might have a substance abuse problem, according to screening questionnaires filled out during routine doctors’ visits, a study has found. The adolescents' answers were more likely to indicate a problem during an appointment when they were sick or injured than when they were having a checkup.

“Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only,” wrote Dr. John R. Knight of Children’s Hospital Boston, lead author of the study in this month’s Archives of Pediatrics & Adolescent Medicine.

Researchers from Children’s, Tufts-New England Medical Center, Cambridge Health Alliance, the University of Vermont and Fallon Clinic in Worcester asked more than 2,000 12- to 18-year-old patients to answer six questions: five about using alcohol or other drugs and one about engaging in risky behaviors, such as riding in a car with someone who was impaired. Two 'yes' answers meant the teen screened positive for substance abuse.

Overall, 14.8 percent of patients said yes to at least two of the six questions. The most positive responses to the questions came in school-based health centers, at just under 30 percent of patients, followed by rural family practices, at about 25 percent. At sick visits, 23.2 percent of the screenings were positive, compared with 11.4 percent of well visits.

Positive screenings do not establish a diagnosis, the authors write, but they do require follow-up. Noting that sick visits are generally allotted less time than well visits, they suggest healthcare providers be trained in how to help patients who test positive by either offering brief advice or referring them for counseling or treatment.

Posted by Elizabeth Cooney at 05:41 PM

« MGH to study fish oil compounds as treatment for depression | Main | Short White Coat: Brain at rest »

Wednesday, October 24, 2007

Boston group to share genetic data on autism

A Boston group is sharing genetic information from families affected by autism with other researchers to promote understanding of the developmental disorder.

The Autism Consortium, whose members include hospitals, medical schools and universities in the Boston area, will transfer profiles of 500,000 genetic variations found across the genomes of 700 families with two or more children who have autism. The data will be held by the Autism Genetic Resource Exchange, a program of the advocacy organization Autism Speaks. Scientists can apply to the exchange, which gathered DNA from the families. The samples have been scanned for sequences where there are deletions or extra copies of DNA segments. The consortium is sharing the genetic variations it found.

"We returned all of the raw data to AGRE so they can distribute it to any other investigtors who want to begin exploring what may be the genetic underpinnings of autism," Mark Daly, a consortium member from Massachusetts General Hospital and the Broad Institute of MIT and Harvard, said in an interview. "Understanding the genetics underlying a complex disease is not an easy problem to solve. So there's no excuse for hoarding your data when much more can be learned by sharing."

Only a small percentage of autism arises from a recognizable genetic cause, such as Fragile X syndrome, Daly said. Recent research suggests that some families with autism might have higher rates of genomic abnormalities, but very few of these abnormalities have been conclusively identified.

"There's very strong heritability to autism but very little of the heritability has been explained by specific mutations of specific genes," he said. "What we hope is that this data is a starting point. We need to perform collaborative research in the spirit of the Human Genome Project to deliver on the trust the public has placed in us."

Members of the Autism Consortium are Beth Israel Deaconess Medical Center, Boston Medical Center, Boston University, Boston University School of Medicine, the Broad Institute of MIT and Harvard, Cambridge Health Alliance, Children’s Hospital Boston, Harvard University, Harvard Medical School, Massachusetts General Hospital, Massachusetts Institute of Technology, McLean Hospital and Tufts-New England Medical Center.

Posted by Elizabeth Cooney at 11:37 AM

« Today's Globe: hospital infections, in-store clinics, healthcare disparities, Bush's Lyme disease, Brenda Finn-Cochran | Main | On the blogs: hospital infections, healthcare quality and cost »

Thursday, August 9, 2007

Beth Israel Deaconess takes over cardiothoracic surgery at St. Vincent

Beth Israel Deaconess Medical Center has taken over the cardiothoracic surgery program at St. Vincent Hospital previously run by Tufts-New England Medical Center and is starting a transplant referral program at the Worcester hospital, the hospitals said.

BIDMC physicians already staff the 348-bed medical center's emergency and radiation oncology departments. The change in cardiothoracic surgery took place July 1, when Dr. Robert M. Bojar, a surgeon based at St. Vincent, switched from Tufts-NEMC to BIDMC. Bojar and Dr. David C. Liu, another BIDMC surgeon, now operate in Worcester.

Tufts-NEMC spokeswoman Brooke Tyson Hynes said yesterday the cardiothoracic surgery change came about because of BIDMC's new surgical residency program at St. Vincent. On July 1, seven surgical residents began the first BIDMC rotations at the Worcester hospital, a year after University of Massachusetts Medical School and its clinical partner, UMass Memorial Medical Center, ended their surgical residency programs at St. Vincent.

Under the new arrangement for transplant patients, St. Vincent specialists will refer patients to BIDMC for kidney, liver or pancreas transplants, Dr. Douglas W. Hanto, chief of transplantation at BIDMC, said yesterday. Most St. Vincent patients had previously been referred to UMass Memorial, which provides kidney, liver and pancreas transplants through a joint program with the Lahey Clinic.

Posted by Elizabeth Cooney at 08:16 AM

« Today's Globe: free care, Blue Cross change, surgeon general hopeful, bad memories, SARS doctor, diabetes drug, John Hogness, Anne McLaren, Donald Michie | Main | Harvard doctors will blog on Gather.com »

Friday, July 13, 2007

MGH, Brigham make US News honor roll

Massachusetts General Hospital and Brigham and Women's Hospital held on to their honor roll positions in the annual rankings by U.S. News & World Report called "America's Best Hospitals." Nine Boston hospitals are featured in the guide.

Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth and the Cleveland Clinic slipped to fourth from third.

The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.

Other hospitals were ranked in the specialty areas, but not in a cumulative score. Beth Israel Deaconess Medical Center was in the top 50 for 10 categories: diabetes (in conjunction with the Joslin Clinic); digestive disorders; respiratory care; heart and heart surgery; cancer care; kidney diseases; geriatrics; gynecology, urology; and ear, nose and throat care.

Boston-area hospitals known for their specialties also made the top 50. Dana-Farber Cancer Institute placed fifth in the list for cancer care. Joslin Clinic, with its partner Beth Israel Deaconess, was ranked 12th for endocrinology. New England Baptist Hospital was 17th for orthopedics and Spaulding Rehabilitation Hospital ranked eighth for rehabilitation. Massachusetts Eye and Ear Infirmary placed fourth in ophthalmology and in the ear, nose and throat specialty.

Boston Medical Center was ranked 41st in geriatrics.

Mass. General's winning specialty areas were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; heart and heart surgery; gynecology; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; psychiatry; and rheumatology.

The Brigham's top specialties were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; and rheumatology.

Posted by Elizabeth Cooney at 06:27 AM

« Provider groups object to MinuteClinics in CVS stores | Main | Short White Coat: Take a number »

Thursday, June 14, 2007

Hospital Association chairman takes gavel

Robert G. Norton, president and CEO of North Shore Medical Center in Salem, became chairman of the Massachusetts Hospital Association's board of trustees today, the group said.

Norton came to the Partners HealthCare hospital from Shands Jacksonville Medical Center in Florida after being executive vice president at Beth Israel Deaconess Medical Center.

Other MHA officers are Winchester Hospital president and CEO Dale M. Lodge, chairman elect; Tufts-New England Medical Center president and CEO Ellen M. Zane, treasurer; and Cambridge Health Alliance president and CEO Dennis Keefe, secretary.

Posted by Elizabeth Cooney at 04:07 PM

« Harvard names acting medical school dean | Main | On the blogs: lab waste, hospital competition »

Monday, June 11, 2007

Journal Watch makes financial ties more visible

By Carey Goldberg, Globe Staff

Late last month, Dr. Adam Urato filed a complaint with the editors of Journal Watch, which summarizes research highlights for doctors, about an article on antidepressant use during pregnancy.

Urato, an assistant professor and obstetrician at Tufts-New England Medical Center, complained that the piece failed to disclose prominently enough that its author had received payments from several antidepressant makers, and that it painted antidepressant use in a more positive light than warranted by current data.

Now, Urato pointed out to the Globe today, the online journal has changed the piece to display the author’s financial ties right at the bottom of the main body of the article, instead of a few clicks away.

"It's a step in the right direction," he said in an e-mail.

Journal Watch is published by the Massachusetts Medical Society, which also publishes the New England Journal of Medicine.

« Today's Globe: alternative therapies, spiritual needs, culture change, Alzheimer's test, biologics standards | Main | Harvard names acting medical school dean »

The cost of health

People do put a price tag on their existence, a story in a special section on the business of health says in today's New York Times.

Studies of real-world situations produce relatively consistent results, suggesting that average Americans value a year of life at $100,000 to $300,000, Peter J. Neumann, director of a program at Tufts-New England Medical Center that measures the cost-effectiveness of new treatments, told the Times.

The story also quotes David Cutler, a professor of economics at Harvard and author of "Your Money or Your Life: Strong Medicine for America’s Health-Care System." He says such estimates have value, at least as guides to the diseases and conditions that people will spend the most to avoid.

kingsdale150.bmpAlso in the Times section, Jon Kingsdale (left) of the Commonwealth Health Care Connector and John McDonough of Health Care For All describe the challenges of implementing Massachusetts' new healthcare law.

"We’ll try to be the test laboratory for the rest of the country," Kingsdale said.

Posted by Elizabeth Cooney at 08:25 AM

« Children's hires Jamaica Plain health center head | Main | Sen. Barrios to head BCBS of Mass. Foundation »

Tuesday, May 22, 2007

Doctor raises conflict of interest questions on pregnancy study

By Carey Goldberg, Globe Staff

Late last month, Journal Watch, a publication for doctors seeking quick highlights of recent research, published an overview of an important question: whether pregnant women should take antidepressants.

Headlined "Antidepressants during Pregnancy: Treating the
Condition While Acknowledging the Risks
," it was written by Dr. Claudio N. Soares.

Today, Dr. Adam Urato, a Tufts assistant professor and obstetrician at New England Medical Center, sent The Globe a copy of a complaint he has just filed with the journal's editors, saying that the piece downplayed the potential dangers of antidepressants during pregnancy, and failed to adequately disclose that Soares had received payments from at least six drugmakers.

Journal Watch is published by the Massachusetts Medical Society, which also publishes the New England Journal of Medicine.

In an e-mail to the Globe, Urato said that Journal Watch "shouldn't be running one-sided editorials on antidepressants in pregnancy without notifying readers that the author is paid by the antidepressant manufacturers."

Dr. Sandra Ann Carson, Editor-in-Chief of Journal Watch, Women's Health, responded to a Globe query:

"Dr. Urato has mistakenly overlooked the disclosures by Dr. Soares at
http://womens-health.jwatch.org/misc/board_disclosures.dtl#dSoares.
Journal Watch's conflict-of-interest policy is publicly available at
http://www.jwatch.org/misc/conflict.dtl."

Sandra Jacobs, spokeswoman for the publishing division of the Massachusetts Medical Society, said that the site is in the process of being restructured to make financial disclosures more obvious.


Posted by Karen Weintraub at 03:34 PM

« Angina drug helps with symptoms but doesn't reduce risk of further heart problems, study says | Main | Today's Globe: stem cell ban, DMR chief, tainted food, vaccine gaps, VA care, Caritas lawyer »

Tuesday, April 24, 2007

Gene variants tied to progression of eye disease

Age-related macular degeneration is the most common cause of vision loss in people over 60, but only some of the people who have the early or intermediate stages of the eye disease develop its more serious form, losing so much of their central vision that they can no longer drive or read.

Researchers led by Dr. Johanna M. Seddon of Tufts-New England Medical Center report in tomorrow’s Journal of the American Medical Association that people with variations in two common genes have a two- to four-times higher risk of developing advanced AMD. When combined with smoking and obesity, already known risk factors for advanced AMD, the gene variations pushed the risk of advanced AMD 19 times higher.

"We have shown how genetic variations do add to progression," Seddon said in an interview about the clinical trial, which followed 1,466 people for about six years. "Genetic factors, smoking and obesity are all independent factors related to progression of AMD and they seem to be additive."

But Seddon and her co-authors, who include Sarah George and Bernard Rosner of Harvard, say it's too early to call for genetic screening. Many, but not all, people with the gene variations progress to advanced AMD, but so do some people without the gene variation.

"The story is unfolding and we have a lot more to learn," Seddon said. "Genetic screening is premature at this point."

They do recommend that people exercise, eat a healthy diet and not smoke, based on previous work implicating the same risk factors for cardiovascular disease in AMD. Seddon showed in 1994 that diet is linked to AMD, and in 1996 that smoking is related.

Dr. Bruce P. Rosenthal of Lighthouse International, a non-profit organization established to help people with vision loss, said the study will be valuable as researchers continue to seek the root causes of the disease.

"While we have known for many years that smoking and being overweight contributes to the risk of macular degeneration, the findings of a genetic link for the progression of macular degeneration from early or intermediate stages to advanced disease are indeed significant and will have a major impact on future study and possible treatment of AMD," he said in a statement.

Rosenthal was not involved in the study, which was funded by the National Eye Institute and other grants.

Posted by Elizabeth Cooney at 05:27 PM

« Dana-Farber Cancer Institute gets second largest gift ever | Main | Computers don't increase mammogram accuracy and may hurt, study says »

Wednesday, April 4, 2007

Pregnancy history overlooked in stem cell studies, Tufts researcher says

Stem cell researchers should consider whether a woman has been pregnant when they interpret results of stem cell transplantation trials, Dr. Diana Bianchi writes in a commentary in today's Journal of the American Medical Association.

Bianchi, who is chair of research in the department of pediatrics at the Floating Hospital for Children at Tufts-New England Medical Center, showed in 1996 that fetal cells persist in the blood of women who have been pregnant. In 2004 she reported that these cells appear to act like stem cells, traveling to injured organs in the mother and repairing them.

Fetal cells are "betwixt and between" adult and embryonic cells, she said in an interview. Embryonic stem cells are prized for their ability to become any kind of cell in the body. Adult stem cells are less capable of this kind of differentiation.

"It's not all adult versus embryonic stem cells," she said. "Fetal cells may have qualties that are intermediate between embryonic and adult cells. We are still testing the hypothesis that they have capabilities that may be closer to embryonic stem cells than adult stem cells."

Recent discoveries of stem cells in amniotic fluid-- another "bewtixt and between" situation -- fit in with her findings, she said.

Bianchi and her co-author, Nicholas M. Fisk of Imperial College London, reviewed 58 articles on the long-term fate of stem cells transplanted into sex-mismatched recipients. None of them reported whether the women who donated or received these bone marrow transplants had been pregnant, they write in their commentary.

Without knowing the pregnancy history of women involved in trials using bone marrow stem cells to treat disease, researchers cannot know whether fetal cells or adult cells are responsible for the results they are seeing, Bianchi said.

"It's important because it's a mixed population of the woman's bone marrow stem cells as well as cells from all the pregnancies she has had, including ones she might have terminated," she said. "It's just remarkable to me that this is not part of the paradigm."

Posted by Elizabeth Cooney at 02:01 PM

« UMass Medical School picks dean from Florida | Main | HSPH takes anti-smoking campaign to Hollywood »

Tuesday, April 3, 2007

Feldman leaving as leader of Worcester health center

Zoila Torres Feldman, an ardent advocate for expanding access to high-quality health care, is leaving as chief executive officer of Great Brook Valley Health Center in Worcester after 26 years.

zoila.jpg
Zoila Torres Feldman

Feldman, 62, said her Oct. 1 departure is "absolutely not" a retirement. She has accepted no specific position but said she is passionate about addressing the ethnic and racial disparities that persist in health care.

"There are too many challenges in health care I’d like to participate in," she said in an interview. "I’d like to do some new things."

Her influence has been felt beyond Worcester, where the health center grew from an apartment in a housing complex to a free-standing clinic with an annual budget of $23 million and 140,000 patients a year. Another health center opened in Framingham last year, despite anti-immigrant opposition.

Feldman, who lives in Newton, is a native of Ecuador and a graduate of Boston University and the Harvard School of Public Health. She worked as a nurse for 12 years at Tufts-New England Medical Center.

"I think there is no more talented and respected community health leader in the commonwealth than Zoila," Andrew Dreyfus, executive vice president of health care services at Blue Cross Blue Shield of Massachusetts, said in an interview. "Her center was a kind of magnet for innovation in community health delivery. She was always a thought leader in the kind of public policy issues that surround the community health movement."

Posted by Elizabeth Cooney at 01:37 PM

« On the blogs: patient safety, candy | Main | Beth Israel Deaconess hires new COO »

Thursday, March 8, 2007

Heart Association to honor Tufts-NEMC physician

Dr. Deeb Salem, physician-in-chief at Tufts-New England Medical Center, will receive the American Heart Association’s Paul Dudley White award at the Boston Heart Ball on May 12, the AHA said today. The event is a major fund-raiser for the organization.

Salem, who is also the chairman of the department of medicine at Tufts University School of Medicine, is being honored for his work as a cardiologist.

Posted by Elizabeth Cooney at 02:42 PM

« Stomach bug continues to take a toll | Main | Managing chronic disease at community health centers »

Wednesday, February 28, 2007

How medical students learn the pelvic exam

How do you teach a pelvic exam?

In the past medical students performed exams on anesthetized patients waiting for surgery, sometimes without their knowledge or consent, a practice now condemned. But the backlash from that controversy resulted in today's medical students doing many fewer exams during training than before, Dr. Adam J. Wolfberg, a fellow in maternal-fetal medicine at Tufts-New England Medical Center, writes in a Pespective in tomorrow's New England Journal of Medicine.

"We have an absolute obligation to provide our patients with outstanding compassionate care and it requires that we respect their privacy and their wishes regarding whether they want to participate in the process," he said in an interview. "But we also have a responsibility to make sure that medical school graduates are competent at doing a pelvic exam."

Medical schools now hire volunteers who are typically paid about $200 a session to allow students to examine the cervix, ovaries and uterus. The women also teach, guiding the students as they proceed with the exam.

"They tell them if something hurts and also explain to the medical students how to communicate during an exam that can be embarrassing for the patients and for the medical students, " Wolfberg said.

The next step is for medical students to perform the exams on patients who have agreed to be part of the teaching process.

Dr. Steven Ralston, associate professor of obstetrics and gynecology at Tufts, said in an interview that the pelvic exam is different from other diagnostic procedures and that it requires sensitivity when asking a patient's consent.

"There is a much greater degree of intimacy involved," he said. "The vulnerability is much greater than any other thing we do in medicine."

Third-year student Eva Christensen said learning first with a paid volunteer helped remove some of the awkwardness of first attempts. With patients she always identifies herself as a medical student and works with a physician at her side.

"The most important thing to me is to communicate to the patient, to tell them what they will feel," she said. "It is critical for patients to be informed and to be comfortable."

Wolfberg comes to the same conclusion.

"Communication is the key," he said.


Posted by Elizabeth Cooney at 05:00 PM

« Paul Farmer wins $100,000 Austin College award | Main | Stomach bug continues to take a toll »

Floating Hospital hires pediatrician-in-chief

Dr. John Schreiber has been named pediatrician-in-chief and chief administrative officer of Floating Hospital for Children at Tufts-New England Medical Center, as well as chairman of the department of pediatrics at Tufts University School of Medicine.

schreiber-blog.jpg
Dr. John Schreiber

Schreiber, who will step into his new role in July, is coming from the University of Minnesota Medical School, where he was pediatrician-in-chief of the University of Minnesota’s Children’s Hospital.

Schreiber received a masters degree in public health and a medical degree from Tulane University. He completed pediatric residency and clinical and research fellowships in infectious diseases at Children’s Hospital Boston and Harvard Medical School. He was in the United States Air Force Reserves for 11 years, serving during Desert Storm as a flight surgeon with the 757 Airlift Squadron at Scott Air Force Base.

Posted by Elizabeth Cooney at 10:48 AM

« QMass leader wins LGBT award | Main | Mass. General president swings back »

Friday, February 23, 2007

Tufts-NEMC workers suspended for fake pipe bomb

Two workers at Tufts-New England Medical Center allegedly planted a fake pipe bomb in an office the same day that Boston was panicked by a Cartoon Network marketing ploy.

The stunt sparked a 45-minute evacuation of the first floor of one building and other offices nearby, including an on-site day-care center but no patient-care areas, Brooke Tyson Hynes, vice president of public affairs and communications at Tufts-NEMC, said today.

The Boston Police Department bomb squad, called by Tufts-NEMC security, determined the device was not active. No charges against the two employees have been filed. The prank was first reported in this morning's Boston Herald.

The employees have been suspended without pay for two weeks, Hynes said.

"The fake device found here was part of an inappropriate, but not malicious, prank between friendly coworkers," Hynes said. "This type of behavior is not acceptable here."

Posted by Elizabeth Cooney at 12:01 PM

« Children's creates database on media violence research | Main | Joslin doctor joins state's new Asian American Commission »

Wednesday, February 21, 2007

Project seeks to limit ties between doctors, drug companies

A new campaign called The Prescription Project seeks to end conflicts of interest that may arise from pharmaceutical company marketing aimed at physicians. It calls for academic medical centers to tighten their policies governing ties with industry.

"We are looking to see that payers, consumers and physicians work together to promote evidence-based medicine and to counter the bias of drug marketing," said Robert Restuccia, the project's Boston-based executive director.

The Prescription Project points to Stanford University Medical School, University of Pennsylvania Health System and Yale University School of Medicine as leaders. While their models vary, the institutions restrict gifts to doctors, drug samples and visits by industry sales representatives.

Boston hospitals surveyed by the Globe during the past week say they require drug company employees and other vendors to register with them before visiting, but other policies vary.

Tufts-New England Medical Center does not allow pharmaceutical sales representatives in clinical areas. Caritas St. Elizabeth's Medical Center says its doctors cannot give patients free samples of medications, but Partners' hospitals, Brigham and Women's and Massachusetts General, do let doctors give free samples to patients at certain approved sites, such as a practice serving a significant number of uninsured patients unable to pay on their own.

Beth Israel Deaconess Medical Center and St. Elizabeth's prohibit on-site meals paid for by drug companies and restrict gifts to under $100. Partners' hospitals have a similar cap on what doctors can accept. Gifts may include nominal-value items related to education or patient care, the Partners' rules say.

A speaker or panelist at a professional meeting may accept payment for expenses if the meeting's purpose is "promoting objective scientific and educational activities," the Beth Israel Deaconess policy states.

"We take this issue very seriously and continue to update our policies," said St. Elizabeth's spokeswomen Melanie Franco. "We will look at what the Prescription Project is saying."

The Prescription Project, funded by $6 million from the Pew Charitable Trusts, is a joint effort of Community Catalyst in Boston and the Institute on Medicine as a Profession at Columbia University. Its impetus was a January 2006 article in the Journal of the American Medical Association that said the $12 billion spent annually on drug marketing influences how doctors prescribe medications, whether they receive free lunches, free samples or free trips from companies.

Posted by Elizabeth Cooney at 01:28 PM

« Autism-like disorder reversed in mice | Main | Baxter warns of medication mix-up »

Friday, February 9, 2007

Also in today's Globe: hospital switch, DSS support, autism rates, birth defects and fertility aids

Beth Israel Deaconess Medical Center and New England Baptist Hospital will work together on a suburban expansion. Tufts-New England Medical Center had planned to build a $300 million suburban hospital with New England Baptist but will now proceed alone.

Harry Spence, commissioner of the Department of Social Services, defended how his agency handled the case of 4-year-old poisoning victim Rebecca Riley but said his department needs more medical expertise to help social workers review the diagnoses and drugs prescribed by doctors treating children overseen by the agency. JudyAnn Bigby, secretary of Health and Human Services, said she would appoint an independent physician in the next few days to be on call to help DSS, until the agency develops a medical review system.

About 1 in 150 American children has autism, an urgent public health concern, said US health officials yesterday who reported on the largest study done so far on the disorder. The new numbers, based on 2002 data from 14 states, are higher than previously reported.

Babies conceived through fertility treatments have higher rates of birth defects, but the overall risk is so small that it should not keep couples from having children this way, doctors are reporting.

Posted by Elizabeth Cooney at 06:23 AM

« Brockton Hospital nurses ratify contract | Main | Nonprofit hospitals under fire, report says »

Wednesday, February 7, 2007

Psychiatrist takes paid leave after death of girl

Dr. Kayoko Kifuji, the psychiatrist who treated Rebecca Riley, a 4-year-old Hull girl whose parents have been charged with giving her a fatal overdose of prescription drugs, agreed today to immediately stop seeing patients while the state investigates her role in the case.

The Board of Registration in Medicine accepted the voluntary agreement from Kifuji, who works at Tufts-New England Medical Center. Such agreements "are one tool available to the Board to ensure the safety of the public during the pendency of an investigation," the board said in a statement. "Voluntary agreements are appreciated by the Board as a sign of cooperation on the part of a physician."

Nancy Achin Audesse, the board's executive director, said after the board's meeting: "Clearly this case and the attention it has garnered is very frightening to patients and to the public, and it raises a lot of questions. A voluntary agreement gives us time to gather information and decide what we need to do next."

Tufts-NEMC issued a statement saying that Kifuji is on a paid leave of absence.

The voluntary agreement does not detail any specific allegations against Kifuji. It states that it "is considered to be a disciplinary action" but that Kifuji does not waive her right to contest any allegations that may be brought against her by the board. "Nothing contained in this Agreement shall be construed as an admission or acknowledgement by me as to wrongdoing of any kind," Kifuji states in the document.

Kifuji began treating Riley in August 2004 and diagnosed her with attention deficit hyperactivity disorder and bipolar disorder. She prescribed the medications, including clonidine, a blood pressure drug for adults that is also sometimes given to children to reduce aggressiveness and help them sleep. Prosecutors allege that Riley's parents, Michael and Carolyn Riley, intentionally killed their daughter in December by giving her a clonidine overdose.

In an interview today, Kifuji's attorney, J.W. Carney Jr., said, "Dr. Kifuji's diagnosis of Rebecca, her prescribing of medication and the care provided was 100 percent appropriate under the circumstances."

Kifuji has been licensed to practice in Massachusetts since 1999. She is a 1981 graduate of Tokyo Women's Medical College and is board certified in pediatrics and psychiatry, including a subspecialty certification in child & adolescent psychiatry, acccording to the board of registration.

« Boston stroke expertise exported to Seattle | Main | Funding concerns hit some cancer trials »

Today's Globe: overdose questions, Caritas debate, breast cancer relapse test, bleeding drug concerns

A doctor's role is questioned in a girl's fatal overdose from powerful prescription drugs fed to her by her parents. Prosecutors would not say whether Dr. Kayoko Kifuji of Tufts-New England Medical Center is a target of a criminal investigation, but have forwarded details from the case to state medical licensing regulators.

News that Ascension Health plans to absorb six Caritas Christi hospitals operated by the Archdiocese of Boston triggered a debate yesterday about the future of Catholic healthcare in the region. Mayor Thomas M. Menino expressed trepidation about the fate of two Boston hospitals in the chain, Caritas St. Elizabeth's Medical Center in Brighton and Caritas Carney in Dorchester.

The Food and Drug Administration yesterday approved a genetic test that, when conducted soon after a woman learns she has breast cancer, can predict the odds of the disease returning and worsening. The test, called MammaPrint, analyzes tissue from a breast tumor to gauge the activity of 70 key genes and determines the likelihood of the cancer's recurrence.

A drug widely used to prevent excessive bleeding during heart surgery appears to raise the risk of dying in the five years afterward by nearly 50 percent, an international study found. The researchers said replacing the drug -- aprotinin, sold by Bayer AG under the brand name Trasylol -- with other, less expensive medications for a year would prevent 10,000 deaths worldwide over the next five years.

Posted by Elizabeth Cooney at 06:15 AM

« Stem cell guidelines drafted by Children's doctor | Main | State spent $234M on care for uninsured workers »

Thursday, February 1, 2007

Nurses ratify contract

About 1,100 unionized nurses at Tufts-New England Medical Center have ratified a new contract that includes wage increases of between 11 and 16 percent over two years, depending on experience. The highest hourly wage for nurses will rise to $58.23, from $52.23.

The contract, made public today by the Massachusetts Nurses Association, will be in effect through Oct. 31, 2008. It also establishes a retiree health insurance savings account, which will be funded through contributions from employees and the hospital.

- Christopher Rowland

Posted by Karen Weintraub at 02:43 PM

« After loss of heart docs, Brigham recruits replacements | Main | Today's Globe: Dana-Farber sets $1B campaign, Tufts HMO cuts jobs, FDA pilots drug report cards »

Tuesday, January 30, 2007

More than half Boston hospital workers got flu shots

More Boston hospital workers may be getting flu shots this season than the national average, but beyond that it’s hard to figure out how they measure up.

Public health officials have been pushing for virtually all hospital workers to get flu shots because they can easily be exposed and infect vulnerable patients. But each of six hospitals that answered a White Coat Notes query today counts health care workers involved in direct patient care in its own way. And they don’t necessarily know who might have gotten a flu shot outside their hospitals' programs.

Here are the results:

Boston Medical Center: 71 percent
Dana-Farber Cancer Institute: 63 percent
Beth Israel Deaconess Medical Center: 60 percent
Massachusetts General Hospital: 59 percent
Brigham and Women’s Hospital: about 48 percent
Tufts-New England Medical Center: more than 50 percent, according to a preliminary count

"The national average is 38 percent," said Dr. Robert Goldszer, associate chief medical officer at Brigham and Women’s. "We feel we’re doing better than average, but we know we don’t have an accurate rate."

Beth Israel has a broad definition of who comes into direct contact with patients. It’s not just the people who have day-to-day hands-on contact, but it also includes people who see patients face-to-face, such as ward secretaries, people who sit at the front desk in clinics, and workers who clean floors in patients’ rooms, said Dr. Sharon Wright, director of the infection control and hospital epidemiology program.

Beth Israel tries to track who gets a flu shot elsewhere, she said, asking employees to use an internal web site to state explicitly why they are declining to get a flu shot.

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to at least offer flu shots. The Infectious Diseases Society of America recommends that hospitals and other health care facilities mandate flu shots for employees, except for religious or medical reasons.

"JCAHO told us to immunize 100 percent of health care workers who don’t have a contraindication," Beth Israel's Wright said. "We’re trying to get to that 100 percent in three to five years. The goal this year was 60 percent and we did it."

Dr. Al DeMaria, assistant commissioner of the state Department of Public Health, said health care workers are exposed to the flu more often, they are difficult to replace if they get sick, and they put their patients at risk if they have the flu.

"Obviously we think everybody should get vaccinated against the flu, but it’s especially important for health care workers," he said.

Posted by Elizabeth Cooney at 08:32 PM
Sponsored Links