Author: Tom Ulrich

Clinicians and social media: Finding the right relationship

doctor_social_media_shutterstock_264246836_260x260I remember the day about 15 years ago when my doctor tentatively gave me his email address, telling me he trusted that I wouldn’t abuse it. (For the record, I’ve used that address maybe five times.)

Fast forward to today, where doctors and nurses are frequently on social media the same as the rest of us, usually behaving well, sometimes not.

What place do social media have in a physician or nurse’s career? And where do the boundaries lie?

Read the full story on Boston Children’s Hospital’s new blog for healthcare providers, Notes.

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Is that fever a problem? Ask Thermia

Thermia fever calculator HealthMap

Your child’s forehead is warm, and you just took her temperature. The next question is, what to do about it? We all know that an average normal temp is 98.6°F, but is 100° a problem? Should 102° be a concern?

This is where Thermia comes in. It’s an online fever calculator developed by the HealthMap team at Boston Children’s Hospital. Essentially, it’s an educational tool aimed at helping concerned parents interpret a child’s temperature and understand which steps they should consider taking.

“I’m a father of two, and I still wonder sometimes what a temperature actually means,” says HealthMap co-founder John Brownstein, PhD. “We realized that there really aren’t any fever calculators out there to help parents answer that question.

“Our idea with Thermia,” he adds, “was to arm families with information so they don’t panic when their child has a temperature.”

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The design world’s eyes are on organs-on-chips

Organs-on-chips Museum of Modern Art MoMA London Design Museum exhibit Wyss Institute Vascular Biology
Organs-on-chips on display in New York City’s Museum of Modern Art. (Photo: Wyss Institute at Harvard University)

[Update 5/18/15: According to a Wyss Institute press release, the Design Museum in London has selected the organs-on-chips as the winner of their 2015 Designs of the Year exhibition’s Product category.]

If you’re in New York City in the next few months, pop into the Museum of Modern Art (MoMA) and stop by the “This Is For Everyone: Design For The Common Good” exhibit. There—alongside displays dedicated to the “@” symbol, the pin icon from Google Maps and bricks made from living mushroom roots—you’ll find three small silicone blocks mounted on a wall panel.

Those blocks are actually three of the organs-on-chips developed in the lab of Donald Ingber, MD, PhD, founding director of the Wyss Institute for Biologically Inspired Engineering and a scientist in Boston Children’s Hospital’s Vascular Biology Program.

Earlier this month, MoMA announced its plans to include the chips as part of their exploration of contemporary design in the digital age. In the museum’s eyes, organs-on-chips are more than a way to model disease in a complex, living system—they’re also art.

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Targeting leukemia with a clinical trial of CAR T-cell therapy

relapsed leukemia targeted therapy CAR T-cell immunotherapy

One of the immune system’s basic jobs is to tell “self” from “non-self.” Our cells carry markers that the immune system uses to recognize them as being part of us. Cells that don’t carry those markers—like bacteria and other pathogens—therefore don’t belong.

Cancer cells, however, fall into a gray area. They’re non-self, yet they also bear markers that connote self-ness—one of the reasons the immune system has a hard time “seeing” and reacting to cancer.

Can we focus the immune system’s spotlight on cancer cells? The provisional answer is yes. Research on cancer immunotherapy—treatments that spur an immune response against cancer cells—has boomed in recent years. (The journal Science recognized cancer immunotherapy as its Breakthrough of the Year in 2013.)

And one of the more recent methods—called chimeric antigen receptor (CAR) T-cell therapy—is now in a clinical trial for relapsed or treatment-resistant B-cell acute lymphoblastic leukemia (ALL) at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.

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Looking beyond allergies: Does IgE keep a wary eye out for cancer?

watchdog IgE allergies cancer

Allergies of all kinds—to food, pollen, pets, etc.—can be blamed on a kind of antibody called IgE. Cousins of the more common IgG, IgE antibodies work with immune cells called mast cells to trigger the symptoms we associate with an allergic reaction (itchy skin, runny nose, closing throat, etc.).

Edda Fiebiger, PhD, has been studying IgE and allergies for years, and has noticed a curious association in several epidemiologic studies: people with high levels of IgE in their blood (as in people with allergies) have a lower risk of certain cancers. This—and the discovery of human IgE antibodies that bind to tumor antigens—suggests that IgE may help protect the body from cancer, and has given rise to a whole new field dubbed AllergoOncology.

But how does it work? In a recent paper in Cell Reports, Fiebiger and her colleagues reveal a pathway by which IgE may keep watch for tumor cells, one that’s totally separate from its allergic role.

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What we’ve been reading: Week of April 20, 2015

(Stougard/Wikimedia Commons)
(Stougard/Wikimedia Commons)

Chinese team reports gene-editing human embryos (MIT Technology Review)
Using the CRISPR technique, the researchers attempted to correct the gene for thalassemia in fertilized eggs. The experiment showed that the technique is far from ready from clinical use, and added new fuel to the already-fiery debate over editing genes in human embryos.

How Apple is building an ecosystem for your body (Fast Company)
The company’s HealthKit and ResearchKit together may form the core of a new “digital ecosystem” for health data and digital medicine, just as iTunes did for music and movies. But a lot of unanswered questions remain that could affect Apple’s chances for success in the health arena.

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What we’ve been reading: Week of March 16, 2015

 

(government_press_office/Flickr)
(government_press_office/Flickr)

Scientists Call for a Summit on Gene-Edited Babies (MIT Technology Review)

Tools like CRISPR could give us the power to alter humanity’s genetic future. A group of senior American scientists and ethicists have called for a moratorium any attempts to create genetically engineered children using these technologies until there can be a robust debate.

Meet the healthcare company that won Mark Cuban’s heart at SXSW (MedCity News)

CareaLine, founded by the parents of a young girl who died of cancer, won over audience members’ hearts and investors’ wallets during SXSW 2015’s Impact Pediatrics competition.

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Yes, poor vaccination rates are fueling the 2015 measles outbreak

CDC measles outbreak map vaccination Disneyland
(CDC)

There’s been a lot of speculation about whether low vaccination rates are feeding the 2015 U.S. measles outbreak, which as I write this stands at 145 cases across seven states. Well, we can stop speculating, because the numbers are in, and measles is taking advantage of pockets of inadequately vaccinated people.

That’s the stark, unequivocal message from a study by epidemiologists at Boston Children’s Hospital, published this week in the journal JAMA Pediatrics.

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The emerging genetic mosaic of lymphatic and vascular malformations

somatic mosaic mutations vascular anomalies vascular malformations CLOVES Klippel-Trenaunay KTS fibroadipose FAVA lymphatic malformation

Our genes can mutate at any point in our lives. In rare cases, a mutation randomly occurs in a single cell of an embryo and gets carried forward only in the descendants of that particular cell, leaving its mark in some tissues, but not in others. This pattern of mutation, called somatic mosaicsm, can have complicated consequences down the road.

Take CLOVES, a rare syndrome combining vascular, skin, spinal and bone or joint abnormalities described by Ahmad Alomari, MD, co-director of Boston Children’s Hospital Vascular Anomalies Center (VAC). Four years ago, a research team including Alomari and Matthew Warman, MD, discovered that the growths in CLOVES patients had mutations in a growth-regulating gene called PIK3CA. Those mutations, they found, were spread through the affected tissues in a somatic mosaic pattern.

Now it turns out that CLOVES is not alone. In a recent paper in the Journal of Pediatrics, VAC researchers led by Warman proved that three other rare lymphatic and vascular anomalies and overgrowth syndromes often share the same somatic mosaic PIK3CA mutations: Klippel-Trenaunay syndrome (KTS), fibroadipose vascular anomaly (FAVA) and isolated lymphatic malformations.

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Web offerings talk up the promise of genetic testing, but skip the limitations

Using a computer personalized cancer medicine direct to consumer genetic testing

We all remember how the genetic testing firm 23andMe roused the FDA’s ire in 2013, earning itself a warning letter to stop marketing its direct-to-consumer Personal Genome Service. The kerfuffle, though partially resolved, remains at the center of an ongoing debate in diagnostic and regulatory circles over laboratory-developed tests (LDTs) offered directly to the public, and the agency’s role in regulating those tests.

But like nature, business abhors a vacuum, and longs to fill it. Many companies and institutions have already jumped into the LDT ring, offering up genomic or pharmacologic services that they say would help guide patients’ and doctors’ treatment decisions and improve outcomes. Especially for patients with cancer.

How solid is the science behind these claims? And do vendors do a good job disclosing the strengths and weaknesses of personalized medicine? Those questions form the core of a study published this week in the Journal of the National Cancer Institute.

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