Press Release - Nov 18, 2009

Boston, MA - Researchers at Brigham and Women’s Hospital (BWH) have found that there is a significant risk of seizure for individuals who currently smoke cigarettes but long-term, moderate intake of caffeine or alcohol does not increase the chance of having a seizure or developing epilepsy. This is the first prospective study to examine the potential risks associated with cigarette smoking, caffeine intake, and alcohol consumption as they independently relate to epilepsy. These findings appear online on November 18 in Epilepsia.

Epilepsy is a neurological condition characterized by repeated unprovoked seizures where electrical disturbances in the brain cause sudden, involuntary changes in body movements (convulsions and muscle spasms) and sensory awareness.  Approximately 2.5 million Americans are affected by epilepsy with 150,000 new cases diagnosed this year alone, according to the Centers for Disease Control and Prevention (CDC).  The CDC further estimates that epilepsy accounts for $15.5 billion in medical costs and lost earnings.  Single seizures or those provoked by alcohol withdrawal or other cause are even more common, occurring in up to 10% of the population.

The researchers used data obtained from the Nurses’ Health Study II, a group of 116,608 female registered nurses, aged 25-42 years old who returned mailed questionnaires on their lifestyle and medical history including epilepsy and seizure activity.  In the analysis for cigarette smoking, researchers accrued 246 cases among 116,363 participants.  For the analyses of caffeine intake, there were 201 cases among 105,941 participants, and for the alcohol consumption analyses, 198 cases among 104,934 participants.  The data used in this study were obtained from 1989 through May 31, 2005.

After adjusting for stroke, brain tumor, hypertension and other potential confounding factors, researchers observed a significant association between current cigarette smoking and risk of seizure. “Our analysis showed risk of seizure was significantly higher for current smokers, but not related to the amount of cigarettes smoked daily,” said Barbara Dworetzky, MD, Department of Neurology Department at BWH.  “It does appear, however, that the number of years of smoking does increase seizure risk.”  Risk of epilepsy was modestly elevated with both past and current smoking, but not statistically significant. 

The analysis of caffeine consumption showed that a long-term average intake of greater than 400 mg of caffeine/day (two or more cups of coffee) compared with less than 200 mg/day was not associated with greater risk of seizures or epilepsy. Researchers also found no trend of increasing seizure or epilepsy risk with increasing caffeine consumption.

Further results indicate that risk of seizures or epilepsy was not significantly different between moderate alcohol drinkers and alcohol abstainers.  Study authors did not find that heavy alcohol consumption was associated with risk of seizure or epilepsy. 

The participants for this study were comprised primarily of Caucasian women who had better health knowledge and access to healthcare than women in the general population.  “Given the composition of the study group, our findings may not apply to men, younger or older populations, groups with lower socioeconomic status or lower attained education, or populations with higher percentages of minorities,” advised Dr. Dworetzky.  The authors suggest that further studies are needed to increase knowledge of modifiable risk factors to prevent seizures and epilepsy.

Press Release - Nov 18, 2009

Boston, MA – Contrary to previous studies which suggest that asthma patients with a specific genetic mutation might respond less favorably to certain treatments than those with a different mutation, researchers at Brigham and Women’s Hospital (BWH) found that patients with either mutation respond to combination treatment, and this treatment should be continued for these patients. These findings appear in the November 19 issue of The Lancet.
Some studies suggest that patients with the an amino-acid variation at a certain position in the ß2-adrenergic receptor benefit less from treatment with long-acting ß2 agonists than do those with a different mutation at the ß2-adrenergic receptor. The authors investigated whether there is a genotype-specific response to treatment with a longacting ß2 agonist in combination with an inhaled corticosteroid.

Adult patients with moderate asthma were enrolled in pairs of similar lung capacity and ethnic origin, according to which genetic mutation they had. Individuals in a matched pair were assigned to receive inhaled longacting ß2 agonist or a placebo. An inhaled corticosteroid was given to all participants during the treatment periods. Researchers measured lung function with standard measure of lung function with morning peak expiratory flow (PEF).

The team found that lung function did not differ between groups, but participants with the genetic mutation arginine-arginine did not benefit from the addition of longacting ß2 agonist in regards to airway hyperresponsiveness.
“Interestingly, we also found that African-Americans with one of the genetic variations did not improve with respect to lung function with the addition of the long-acting beta-agonist to the inhaled corticosteroid the way African-Americans with the other mutation did,” said Michael Wechsler, MD, of the Pulmonary Division at BWH. This may modify the risk benefit ratio of longacting beta agonists in this population.

Press Release - Nov 13, 2009

 

Researchers find that characteristics of blood vessels in a prostate cancer tumor may be an indicator of risk for metastasized cancer.

Boston, MA - The growth of a tumor requires a vascular network that carries blood to the developing cells and in new research published online in the Journal of Clinical Oncology, researchers at Brigham and Women's Hospital (BWH) have found that the characteristics of the blood vessels within prostate tumor cells may indicate the aggressiveness of the cancer. 

Researchers examined the blood vessels in prostate tumors from 572 mostly Caucasian men who underwent prostatectomy between 1986 and 2000.  Researchers studied three qualities of the blood vessels within the prostate tumor cells: the diameter of the blood vessels, the vessel density - or how much of the area of the tissue sample was comprised by vessels, and the vessel lumen - or the roundness of the cross section of a vessel.  Men whose tumors had either vessels that were smaller in diameter or abnormal lumens were more likely to have metastasized cancer. Vessel lumen was the strongest predictor of how the cancer would develop after treatment.  Men with abnormal vessel lumen were 17 times more likely to develop lethal disease compared to men with circular, or regular shaped vessels.  Men with the smallest vessel diameter were six times more likely to develop lethal prostate cancer.  The density of the vessels was not associated with an increase in lethal cancer after adjusting for other clinical factors such as Gleason grade and prostate-specific antigen (PSA).

These findings are in line with research on other cancers, where the smaller size of blood vessels may also be a prognostic indicator for cancers such as melanoma and pancreatic cancer, giving these findings biological significance as well.  "The morphologic characteristics of tumor vessels may better reflect the pattern and maturity of the growing vascular network. These smaller and more poorly formed vessels may be leakier and thus influencing cancer aggressiveness and metastatic potential," said Lorelei Mucci, ScD, MPH, lead researcher and an epidemiologist at BWH.

"The next step is to confirm these findings in prostate cancer biopsies," said Mucci.  "If we can show that this is true in biopsies, then we may one day be able to tell a man at diagnosis what his prognosis may be 15 years later."

"More research is needed to verify our findings.  If other groups are able to verify our findings, then a more standardized and automated way of classifying information about these vessels could be created to eventually aid clinical diagnosis and prognosis," Mucci said.

Press Release - Nov 9, 2009

The failure to order tests, report results to patients, or follow-up with abnormal test findings, are leading types of diagnostic errors,  according to a survey of primary care and specialist physicians in the United States sponsored by HHS' Agency for Healthcare Research and Quality.

Tests were overlooked because clinicians often failed to consider the diagnosis, leading to delays in ordering the tests or making the correct diagnosis. The most common missed or delayed diagnoses include pulmonary embolism, drug reactions or overdose, lung cancer, colorectal cancer, acute coronary syndrome, including heart attack, breast cancer and stroke, according to the survey which is published in the November 9, 2009 issue of the Archives of Internal Medicine.

The anonymous questionnaire was completed by nearly 300 surveyed physicians who reported 583 cases of diagnosis error -- the largest-ever report of published diagnosis errors. While the exact prevalence of diagnostic errors in unknown, and cannot be estimated from the voluntary reporting methodology used in this type of study, data from autopsies estimate that diagnostic errors occurring 10 to 15 percent of cases.  

The study, which was led by Gordon Schiff, M.D., associate director of Brigham and Women's Hospital Center for Patient Safety Research and Practice in Boston, which is part of the Cook County Hospital/Rush University AHRQ-supported Developmental Center for Research in Patient Satiety.  According to Dr. Schiff, the survey found that other major categories of errors involved failure to consider a diagnosis or overweighing a competing diagnosis, failures in history taking, physical examination, and referral or consultation delays.

Results further showed that adverse outcomes in 28 percent of the 583 reported cases were major, meaning that they resulted in death, permanent disability, or a near-life-threatening event. Another 41 percent were moderate, causing the patient short-term illness, a prolonged hospital stay, an invasive procedure or more intense care, and 31 percent of the cases were minor or insignificant. 

Physicians participating in grand round presentations on diagnostic errors at 20 hospitals across the country were surveyed along with others at two collaborating academic medical centers. The researchers concluded that physicians readily recalled multiple cases of diagnostic errors and were willing to share their experiences, suggesting that soliciting such reports and experiences could be used to enhance knowledge, understanding and awareness of diagnostic errors.

Details are in "Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors," in the November 9, 2009 issue of the Archives of Internal Medicine. 

SOURCE:  Agency for Healthcare Research and Quality

Press Release - Nov 4, 2009

Boston, MA – Chronic kidney disease has reached epidemic proportions in the US, affecting as many as 16 million sufferers. A common underlying characteristic in many diseases, progressive fibrosis can lead to organ failure and death in progressive kidney disease. New research from Brigham and Women’s Hospital (BWH) is the first to identify a therapeutic protein with potential to prevent fibrosis. These findings appear online in Science Translational Medicine. 

Fibrosis can occur when the body is repairing damaged tissue or organs. Once damaged tissue is replaced, the process may continue uninhibited, leading normal tissue to be replaced by fibrous scars, which can result in organ failure and death. Fibrosis is a common feature not only in kidney disease, but also in diseases such as cardiac failure, liver cirrhosis, stroke and lung disease.

The researchers found that a therapeutic protein, Serum Amyloid P (SAP), or Pentraxin-2, prevented fibrosis in models of kidney disease. SAP functions only at sites of tissue injury and reprograms inflammatory macrophages, driving the inflammatory and fibrogenic process to become anti-inflammatory, preventing the formation of fibrous scars.

The researchers also determined that kidney fibrosis depends on inflammatory monocytes and macrophages, unlike the heart and lung, which depend on fibrocytes.   “This breakthrough in the study of chronic inflammation not only provides a potential new therapy for treatment of chronic diseases,” said Jeremy Duffield, MD, PhD, of the Renal Division at BWH. “It also highlights a key molecular pathway that may be accessible to novel therapeutics in the near future.”

The study was funded by the National Institutes of Health (NIDDK), the American Society of Nephrology, Promedior Inc. and National Taiwan Science Council.

Press Release - Oct 30, 2009

Researchers from Brigham and Women's Hospital (BWH) and international collaborators have conducted a major clinical trial of anemia treatment with darbepoetin alfa (Aranesp) in patients with diabetes and chronic kidney disease (not requiring dialysis) and found no significant differences in deaths, heart attacks, heart failure, or need for dialysis compared to placebo. However, researchers found an increased risk of stroke among those assigned to darbepoetin alfa compared to placebo.

The findings will be presented as a Late Breaking Clinical Trial at The Annual Scientific Meeting of The American Society of Nephrology in San Diego, California Friday, October 30, 2009 and will appear concurrently online in The New England Journal of Medicine.

TREAT, (Trial to Reduce cardiovascular Events with Aranesp Therapy) launched in 2004, was a randomized, double-blind placebo-controlled trial of 4038 patients with type 2 diabetes, chronic kidney disease and anemia. It is the largest trial to date to examine the use of erythropoiesis stimulating agents (ESAs), a class of drugs approved to raise hemoglobin levels, and the only study to compare morbidity and mortality outcomes against placebo.

"Chronic kidney disease can be associated with anemia and both of these factors greatly increase the risk of a patient with diabetes having premature adverse cardiovascular events and progressing to dialysis. We tested whether the treatment of anemia with Aranesp would reduce the dreaded complications of diabetes- heart failure, myocardial infarction, stroke, end-stage renal disease (dialysis) and death. Previous trials presumed benefits of ESAs without conducting the most fundamental test against placebo," said Marc A. Pfeffer M.D., PhD lead investigator of TREAT and Senior Physician in cardiovascular medicine at BWH.

TREAT supplies new data from the most reliable assessment of the risks and benefits of ESA therapy and provides physicians and patients with more accurate information on which to base individual patient care decisions.

Pfeffer, who is also the Dzau Professor of Medicine at Harvard Medical School added,
"Although darbepoetin had some benefits in the patients we studied, it also had important risks. Raising hemoglobin did reduce the need for red cell transfusions and led to a statistically significant but rather modest improvement in a measure of fatigue in our patients with chronic kidney disease (not on dialysis) with moderate anemia. However, in my view, for many patients the increased risk of stroke that was uncovered and possibly deaths in those with prior malignancy outweigh the potential benefits of ESA use. The highest goal of a clinical trial is to provide data that improves clinical practice. TREAT meets this objective."

The research was supported by and conducted in collaboration with Amgen.

Press Release - Oct 29, 2009

Boston, MA - Despite recent advances in anti-inflammatory therapy, many rheumatoid arthritis (RA) patients continue to suffer from pain. This pain is likely due to both inflammatory and non-inflammatory causes. Researchers at Brigham and Women’s Hospital (BWH) investigated the association between disease activity, sleep, psychiatric distress and pain sensitivity in RA and showed that inflammation is associated with heightened pain sensitivity at joint sites, whereas increased sleep problems are associated with heightened pain sensitivity at both joint and non-joint sites. These findings appear online in BioMed Central’s open access journal, Arthritis Research & Therapy on October 29, 2009.

Researchers from the Division of Rheumatology and Pain Management Center of BWH, and the Chronic Pain and Fatigue Center of the University of Michigan Medical School, assessed experimental pain sensitivity, disease activity, sleep problems and psychiatric distress in 59 women with RA. The researchers used questionnaires to assess the women’s sleep problems and psychiatric distress and measured the levels of C-reactive protein as an indicator of disease activity. Pain sensitivity was measured with pressure pain threshold testing at joint and non-joint sites, with lower pain thresholds indicative of higher pain sensitivity.  

The researchers found that sleep problems lowered the pain threshold at all sites, suggesting a defect in central pain processing. This finding emphasises the need for research into the mechanisms underlying sleep disorders and pain in RA patients, particularly given the common occurrence of sleeping problems among RA patients. This autoimmune disease, causing chronic inflammation, affects nearly 1% of the population and sufferers often report ongoing pain in spite of successful anti-inflammatory treatment.

“Since differences in pain sensitivity may shape the course of pain complaints and influence treatment decisions, it is important to understand the factors associated with enhanced pain sensitivity”, lead author Yvonne Lee says, adding, “Physicians and researchers should consider both inflammatory and non-inflammatory factors when evaluating pain in research settings and in the clinic.”

Press Release - Oct 28, 2009

 

Boston, MA – Fish oils are known to be beneficial to health, but how and why they produce anti-inflammatory effects remains to be fully determined. New research from Brigham and Women’s Hospital (BWH) and Queen Mary, University of London recently revealed that the body converts an ingredient found in fish oils into a chemical mediator called Resolvin D2 (RvD2). The researchers discovered the complete chemical structure of RvD2, which could have major clinical implications for the treatment of a number of diseases related to inflammation. In contrast to other anti-inflammatory drugs, this chemical signal does not appear to suppress the immune system. These findings are published in the October 29 issue of Nature.

“These results uncover new anti-inflammatory and pro-resolving mechanisms in host defence that protect from uncontrolled inflammation, as in sepsis,” said Prof. Charles Serhan, director of the Experimental Therapeutics and Reperfusion Injury Center at BWH. 

The researchers found that the body converts an ingredient in fish oils, docosahexaenoic acid (DHA) into RvD2. DHA, an omega-3 fatty acid, is an essential nutrient that humans do not produce and thus is obtained through one’s diet. Earlier results showed that omega-3 fatty acids are converted to novel anti-inflammatory mediators, coined resolvins. In this study, researchers determined a number of ways RvD2 relieves inflammation and that it does so powerfully with very small amounts.

In nearly all cases, the fundamental cause of tissue damage from inflammation is the excessive accumulation of white blood cells (leukocytes), which migrate from the bloodstream to the site of infection or injury by sticking to the inner lining of the blood vessels, called the endothelium. In this study, the research team looked at how RvD2 stopped inflammation, by assessing its actions on the activity of the body’s leukocytes and how they interact with the endothelium. They found that RvD2 causes endothelial cells to produce small amounts of nitric oxide, which act as a chemical signal discouraging the leukocytes from sticking to the endothelial cells and preventing inflammation.

“These direct vascular actions of RvD2 also have implications for cardiovascular diseases such as atherosclerosis, where deficiencies in nitric oxide production and excessive leukocyte adhesion are a prominent disease components” said Dr. Matthew Spite, the lead author on this study.  Importantly, in addition to preventing excessive leukocyte infiltration, “We also discovered that RvD2 helped leukocytes ‘clear-up’ bacteria, preventing overwhelming infection, thus RvD2 may potentially show beneficial outcomes in treating other diseases of bacterial origin” said Dr. Lucy Norling, a co-author on this study.

These results showed us how omega-3 fatty acids in fish oils can be used by the body to produce very powerful local chemical signals that control the inflammatory response. Potentially, RvD2 could be used as an agonist to stimulate resolution of acute inflammation and clear invading bacteria. This may be important not only to treat uncontrolled acute inflammatory diseases, but possibly many other more complex diseases associated with inflammation, like sepsis or even periodontal diseases, without causing immune-suppression. 

This study was funded by the National Institutes of Health, Arthritis Research Campaign UK and the Wellcome Trust.

Press Release - Oct 27, 2009

Boston, MA – The most common site of prostate cancer metastasis is in bone. Researchers in the Dimitroff Laboratory at Brigham and Women’s Hospital (BWH) have found that fucosylations, structures on the surface of prostate cancer cells, trigger prostate cancer cell adhesion inside a blood vessel wall in bone tissue, greatly increasing the prospect of prostate cancer cells metastasizing to bone. These findings appear online in the Proceedings of the National Academy of Science. 

Fucosylations are created by the action of alpha1,3 fucosyltransferases, which are proteins found at high levels in native prostate cancer cells that have metastasized to bone. Alpha 1,3 fucosyltransferases have been studied for more than a decade in other disease settings, such as inflammation and they are more commonly known for making fucosylations on white blood cells that help white blood cells stop in blood vessels and migrate into inflamed tissues. Understanding the previously well-characterized mechanism of these proteins allows researchers to consider these mechanisms, a process now referred to as "Hematopoietic Mimicry", as a means to identify factors in prostate cancer metastasis. This mechanism may also be applied to understanding metastasis of cancers of the breast, colon, pancreas and lung.

What are the next steps in this research and what may be the long-term clinical implications?

Now that the Dimitroff laboratory has elucidated a molecular mechanism for prostate cancer cell adhesion inside blood vessels, their subsequent studies will focus on how these bound prostate cancer cells exit a blood vessel and enter bone tissue.  Better understanding of this process will provide a new perspective on how cancer cells metastasize as well as provide new targets for cancer therapy development.

The study was funded by investigator-initiated grants from the American Cancer Society and the National Institutes of Health.

Press Release - Oct 26, 2009

 

In a novel approach to the study of embryonic stem cells, researchers at Brigham and Women’s Hospital (BWH) have discovered a potential means of controlling differentiation into desired cell types, by demonstrating that sugars play a major role in modulating stem cell differentiation into tissues. These findings appear online on October 26, 2009 in Circulation.  

The potential for enabling the differentiation of stem cells holds tremendous implications in organ growth and regeneration. “Repairing or replacing damaged organs requires proper direction of vessel growth to support organ function and we now know that sugars play a key role determining this direction,” said Dirk Hentschel, MD, of the Renal Division at BWH.

Differing from previous studies that focused on the role of growth factors in controlling differentiation, BWH researchers investigated the role sugars play. “Finding a way to control differentiation with sugars has the crucial advantage of reducing oncogenic risks associated with growth factor therapy in clinical settings,” said Rania Harfouche, PhD, research fellow in the Renal Division at BWH.

Using sugar sequencing techniques, researchers discovered that as embryonic stem cells differentiate into endothelial cells, the sugars on the cell surface change in composition to become more sulfated. Inhibiting this process prevents the formation of blood vessels. By knocking down the enzyme responsible for sulfation of sugars in a developing zebrafish embryo, the researchers observed abnormal vascular development that could be recovered using defined sulfated sugars. “This is a simpler solution to differentiation, compared to determining the exact combination of growth factors that a cell requires,” explains Shiladitya Sengupta, PhD of the Department of Medicine at BWH.

“The next step in this research is to determine specific sugar sequences that can promote efficient differentiation of stem cells into endothelium,” said Stephanie Piecewicz, a graduate student at MIT. The researchers believe that by providing the appropriate extracellular ‘net,’ the cell can capture the appropriate combination of physiological molecules that it needs to proceed through differentiation.

The Department of Defense and the American Heart Association funded this research.

Press Release - Oct 26, 2009

Boston, MA – For more than 20 million people infected with the human immunodeficiency virus (HIV) in Africa, treatment with antiretroviral therapy (ART) can suppress the virus and stop progression of the disease, leading to substantial reduction in suffering and rates of death. However, the effectiveness of ART is undermined by the large number of individuals who initiate treatment but do not continue regular clinic visits and taking medication. Strategies to improve retention in care may improve long-term outcomes, but concerns of prohibitive costs serve as barriers to implementing such programs.  In an article published in the October 26, 2009 issue of PLoS Medicine, researchers from the US, France and Côte-d’Ivoire, West Africa collaborated using a validated computer simulation model of HIV disease (CEPAC-International) to evaluate the cost-effectiveness of potential strategies designed to prevent loss from HIV care.

Major international efforts have increased ART availability, but it is critical to ensure that HIV-infected patients in African countries, like Côte d’Ivoire, who initiate ART, receive regular follow-up and continue taking these life-saving medicines. “Starting ART without appropriate long-term care is not enough to ensure the full benefit of treatment.  Survival losses from stopping care within one year since starting ART range from 74 to 81 months,” explains Elena Losina, PhD, a researcher at Brigham and Women’s Hospital (BWH), and lead author of the study.  Loss to follow-up creates a challenge for the success of expanding ART programs.

To address the issue of preventing loss-to-follow-up, the researchers used a model to assess the cost-effectiveness of interventions addressing this issue.  The interventions considered included reducing costs to patients by eliminating medication co-payments, paying for transportation, increasing services to patients by improving staff training, and providing meals. The researchers found that at a per person cost of $22 to $77 per year, if these strategies were even modestly effective, they would be highly cost-effective by World Health Organization (WHO) standards.

“These results demonstrate that in resource-limited settings, loss to follow-up prevention strategies would improve survival, be cost-effective, and should be incorporated into HIV treatment programs to improve patient outcomes,” said Dr. Xavier Anglaret, director of the PAC-CI HIV program in Abidjan, Côte d’Ivoire, and co-investigator on the study. “The next step is to test these different interventions, and determine which are the most effective.”

The study was conducted within collaboration of ART-LINC Collaboration of International Epidemiological Databases to Evaluate AIDS (IeDEA) and the CEPAC International Research Team.  Co-authors include Hapsa Toure, Xavier Anglaret, Eric Baleste, Francois Dabis from INSERM U897, Institut de Sante´ Publique d’Epide´miologie et de De´veloppement (ISPED), Universite Victor Segalen, Bordeaux,  Lauren Uhler, Rochelle P. Walensky, Kenneth A. Freedberg from Massachusetts General Hospital, A. David Paltiel from Yale University, Eugene Messou from CePReF, Abidjan, Cote d’Ivoire, Milton C. Weinstein, PhD from Harvard School of Public Health.

The study was funded by the National Institute of Allergy and Infectious Diseases and the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS). 

Press Release - Oct 23, 2009

 

Boston, MA - Over the past decade, treatment with antiretroviral therapy (ART) has produced striking survival gains for those infected with the human immunodeficiency virus (HIV) in the United States. Yet the benefits in survival appear to differ by both gender and ethnicity, according to researchers from Brigham and Women’s Hospital (BWH), Massachusetts General Hospital (MGH) and their colleagues. The study is based on a comprehensive computer simulation model of HIV developed by the “Cost-effectiveness of Preventing AIDS Complications (“CEPAC”) team, and was led by Elena Losina, PhD, researcher at BWH. These findings appear online in Clinical Infectious Diseases and in the November 15, 2009 print issue.

Having identified an effective therapy for HIV, many of the current challenges for treatment now focus on HIV testing and linking people to care, as well as helping them to remain in care after beginning therapy. The goal of the study was to assess survival with effective HIV therapy, compared to survival in people without HIV.

The researchers used the CEPAC model, which employs the most up-to-date data on HIV disease and therapy to forecast disease progression and survival. They found that for people in the United States living without HIV, life expectancy beginning at age 33 is an additional 43 years.  High risk behavior, such as substance abuse, on average, accounts for an 8 year reduction in life expectancy.  HIV infection itself reduces life expectancy by an additional 12 years and a late start or premature discontinuation of HIV treatment further reduces life expectancy by 23 years.

Researchers also found that reduction in life expectancy in HIV-infected individuals differ between race and sex, with an overall higher risk for HIV contraction in women. Such differences are mostly due to differential risk profiles as well as different time of ART initiation and prematurely stopping treatment. Furthermore, the impact of risk behaviors appeared greater in Hispanic and Black women with HIV, with these women experiencing greater survival losses than White women with HIV. “These disparities highlight the need to focus more attention on those in the higher at-risk groups for contracting HIV, and emphasizing care for those with HIV and are part of the populations that are not receiving immediate and long-term care,” said Dr. Losina.

“There is a critical need for people with HIV to begin care in a timely way and to remain in care,” adds Kenneth A. Freedberg, MD, MSc, director of the HIV Clinical Research Program at MGH, and senior study author of the report. . “HIV testing for all adults in the United States, as currently recommended, with effective linkage to care, will have important survival benefits.”

Study co-authors include Bruce Schackman, PhD from Weill-Cornell Medical College, Sara Sadownick, MPH, Rochelle P. Walensky, MD, MPH, John Chiosi, Wendy Aaronson, MPH, from Massachusetts General Hospital, Kelly A. Gebo, MD, MPH, Perrin L. Hicks and Richard D. Moore, MD, MPH from Johns Hopkins University School of Medicine, Milton C. Weinstein, PhD from Harvard School of Public Health, and A. David Paltiel, PhD from Yale University School of Medicine.

The study was funded by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute on Drug Abuse, the Agency for Healthcare Research and Quality, the Doris Duke Charitable Foundation, and Johns Hopkins University.

Press Release - Oct 22, 2009

Elizabeth G. Nabel, MD

Brigham and Women's/Faulkner Hospitals (BW/F) named Elizabeth G. Nabel, MD, the Director of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, its next president after a unanimous vote last evening by the Board of Trustees. Dr. Nabel, who will assume her position January 1, 2010, will succeed Gary Gottlieb, MD, MBA, who becomes CEO and president of Partners HealthCare when James Mongan, MD, retires at the beginning of the new year.

"We are extremely pleased that Dr. Nabel, an extraordinarily talented and accomplished physician, scientist and educator, is joining the Brigham and Women's/Faulkner community," said Gottlieb. "Her vision to build on the hospitals' legacy of excellence in care, research and teaching will strengthen further a steadfast commitment to our patients, their families and all the communities that we serve."

For Dr. Nabel this is a homecoming.  She completed her internship and residency in internal medicine and a clinical and research fellowship in cardiovascular medicine at BWH and Harvard University.  Prior to this, she graduated from the Cornell University Medical College.

"The opening of this door is a tremendous opportunity to share a personal passion with world-class clinicians and scientists to link excellent patient care to internationally-respected research and then carry our collective wisdom forward to our students, the future leaders of medicine," according to Dr. Nabel.  "All of this will be done with a keen focus on how we can make a difference in the lives of those who depend on us whether they live half way around the world or across the street from our front doors."

During her distinguished career, she has served on the faculty at the University of Michigan, joining in 1987 as an Assistant Professor of Medicine.  She went on to become Director of the Cardiovascular Research Center, Professor of Internal Medicine and Physiology, and then Chief of the Division of Cardiology.  She is a board-certified cardiologist.

While at the University of Michigan, Dr. Nabel became known for her research in the fields of vascular biology and molecular cardiology and with her gene transfer studies of the cardiovascular system.  In 1999, she joined the NHLBI as Scientific Director for Clinical Research and in 2005 became Director, where she oversees an extensive national research portfolio and an annual budget of approximately $3 billion. 

At the NHLBI, she is active in community outreach programs, believing strongly in the need to bring attention to important research findings that can touch and improve lives, with a particular focus on women and heart disease, such as the Red Dress campaign and through the childhood obesity program known as WE CAN.

Dr. Nabel is a nationally recognized scholar; working with her NIH Vascular Biology Lab, she is the author of 250 publications. Her numerous honors and awards affirm the depth and breadth of her dedication to medicine, including her commitment to mentoring the next generation.  Her colleagues have recognized her leadership by selecting her to the American Academy of Arts and Sciences, the Association of American Physicians (Council), the Institute of Medicine of the National Academy of Sciences (Council), and as a Fellow of the American Association for the Advancement of Science.  Dr. Nabel currently serves on the Editorial Boards of the New England Journal of Medicine and Science Translational Medicine.

Dr. Nabel is a native of St. Paul, Minnesota, but her ties to Boston run deep.  Not only did she train at Brigham and Women's, but she and her husband Gary J. Nabel, MD, PhD, met during their residencies at the hospital.  They have three children, Christopher, 23, Elisa, 21, and Katherine, 17.

 "The Board members of Brigham and Women's/Faulkner Hospitals enthusiastically welcome Dr. Nabel and her family to the BW/F community and to the Partners HealthCare system," said George Marshall Moriarty, Esq, Chairman of the BW/F Board of Trustees.  "Her leadership, her passion and her collaborative spirit will allow our clinicians, our scientists and our next generation of providers to continue to grow and build on the foundation of excellence that is a hallmark of the BW/F hospitals."

Press Release - Oct 21, 2009

MetLife Foundation and the Afterschool Alliance today honored the Brigham and Women's Hospital's Student Success Jobs Program (SSJP) with an Afterschool Innovator Award in recognition of the program's success in opening the path to careers in health care, science and medicine for high school students, through paid internships at the hospital.  MetLife Managing Director David Murphy presented the Award at a Lights On Afterschool event, held at Brigham and Women's Hospital.  The organization received $5,000 to sustain its work.

"Despite the many benefits of afterschool programs, far too many youth  in middle and high school do not have access to high quality programs during these critical hours," said Dennis White, president of MetLife Foundation.  "We are pleased to join the Afterschool Alliance in recognizing the Student Success Jobs Program's exemplary model of addressing the needs and interests of older youth, which helps put them on the path to success."

The Student Success Jobs Program is one of only six afterschool programs nationwide to be named an Afterschool Innovator.  It was highlighted in an Issue Brief on afterschool programs, part of a series developed by the Afterschool Alliance with funding from MetLife Foundation, that examines critical issues facing older youth, schools and communities, and the role that afterschool programs play in addressing these issues. The brief focused on several critical areas, including opening doors to work and careers, where SSJP was highlighted.

"These students are talented, enthusiastic and serious about making a distinctive contribution to the field of healthcare and science" said Michelle Keenan, director of Community Programs at Brigham and Women's Hospital. "Brigham and Women's is committed to them and to the patient care and research contributions these young people will make in the future.  With workforce development programs like this, everyone wins."

The Lights On Afterschool event coincided with the beginning of orientation and training for a new class of students in the program.  Speakers from Brigham and Women's Hospital described the impact of the program on youth, families, and the community.  Gladys Fashote, an SSJP alumnus, reflected on her experience and her hopes for the future, and alumnus Nasha Lee Bailey performed. Other alumni also talked about the life and job skills they acquired through the program and the significance of SSJP in their lives.  

Organized by the Afterschool Alliance, Lights On Afterschool is the only nationwide rally for afterschool programs.  The event in Boston is one of more than 7,500 being held across the country, during which children, parents, community leaders, educators and others meet with leaders show support for the afterschool programs that children and families need.  The events also give youth a chance to showcase the skills they learn and talents they develop at their afterschool programs, and to send the message that millions more kids need quality afterschool programs. 

"Afterschool programs provide children with unique opportunities to get the exposure, experiences and support they need to achieve success," said Afterschool Alliance Executive Director Jodi Grant.  "The Afterschool Innovator Awards honor programs that have developed and are using promising practices to help children and youth excel."

Related Links:

50 Graduate from SSJP, BWH Bulletin

Press Release - Oct 15, 2009

Foxborough, MA –Brigham and Women’s/Mass General Health Care Center in Foxborough will sponsor a free screening and lectures on women’s health issues during the “Women’s Health Fall Program at Patriot Place,” October 20 – November 3. Events will include free varicose vein screening, and health lectures will be held on breast cancer, headache, uterine fibroids, orthopedic injuries, and chronic pain management.

Prevention of Home Injuries will be held on Tuesday, October 20, from 6:30 - 8 p.m. Brigham and Women’s Hospital primary care physician Stuart Pollack, MD, and Kristina Dunlea, PT, DPT, from Mass General Hospital, will discuss home safety, added risks with osteoporosis, and the important role exercise and healthy diet plays in the prevention of injury. Presented in collaboration with the Neponset Valley Chamber of Commerce and HESSCO Elder Services.

Breast Cancer: A panel discussion on wellness, diagnosis, and treatment will be held on Thursday, October 22, from 6:30 - 8:30 p.m.  Plastic surgeon Paul Liu, MD, primary care physician Jennifer Parent, MD, and radiologist Robyn Birdwell, MD, all of Brigham and Women’s Hospital, along with a local breast cancer survivor will join together for a panel discussion on breast cancer. From risk and prevention to treatment and survivor experience, learn about the disease, latest treatments including choices regarding reconstruction, and one woman’s courageous story. This discussion is being presented in collaboration with the American Cancer Society.

Feet First: Care for common conditions will be held on Monday, October 26, from 7 - 8:30 p.m. Brigham and Women’s Hospital orthopedic surgeon and Foot and Ankle Division Chief Christopher Chiodo, MD, and Massachusetts General Hospital orthopedic surgeon Anne Johnson, MD, will discuss the prevention and treatment of common foot and ankle disorders. Topics to be covered will include arthritis, bunions, heel pain, toe deformities, and nerve disorders.

Uterine Fibroids: Medical and surgical treatments will be held on Tuesday, October 27, from 7 - 8:30 p.m. Fertility experts Serene Srouji, MD, and Elizabeth Ginsburg, MD, will discuss the impact of fibroids on fertility and treatment options – including the latest minimally invasive procedures – for women to consider.

Managing Chronic Pain will be held on Tuesday, October 27, from 7:30 - 9 p.m. Brigham and Women’s Hospital anesthesiologist Sanjeet Narang, MD, will discuss chronic pain, what it is, common causes, and management, including medications, physical therapy, psychological therapy, and surgical therapy. This program will take place at New Pond Village, in the Auditorium at 180 Main Street, Walpole.

Elbow Injuries: Diagnosis and treatments will be held on Wednesday, October 28, from 7 - 8:30 p.m. Join Massachusetts General Hospital orthopedic surgeon Luke Oh, MD, and physiatrist Jennifer Kurz, MD, for this discussion that will cover the basic anatomy of the elbow, common elbow problems – including bursitis, tendonitis, sprain, dislocation, and fracture – and learn more about non-surgical and surgical options for treatment.

Women and Headache will be held on Thursday, October 29, from 7 - 8:30 p.m. Brigham and Women’s Hospital neurologist Autumn Klein, MD, Director, Women’s Neurology Program, will discuss types of headaches – particularly headaches and migraines that vary with hormonal fluctuations, advances in treatment, and when you should speak with your doctor.

Treatment for Hip Problems will be held on Monday, November 2, from 7 - 8:30 p.m. Brigham and Women’s Hospital orthopedic surgeon Scott D. Martin, MD, and physiatrist Kelly McInnis, DO, will discuss common hip problems in active females – such as muscle and tendon injuries, impingement problems, labral tears, and stress fracture – as well as overuse injuries. They also will cover the latest treatments available.

Arthritis and Joint Replacement will be held on Tuesday, November 3, 7 - 8:30 p.m. Presented by Brigham and Women’s Hospital rheumatologist I-Cheng Ho, MD, PhD, and orthopedic surgeon Wolfgang Fitz, MD, and Massachusetts General Hospital surgeon Eric Berkson, MD, this discussion will cover state-of-the-art advances in surgical and non-surgical treatments of knee disorders, including joint replacement and ACL repair, biologic treatment options, and considerations that help to determine the best treatment for a patient.

Varicose Vein Screening will be held on Thursday, October 29, from 5 - 8 p.m. This screening evaluates you for a new one-hour laser treatment that can return you back to your normal everyday activities. Vein screenings will be held in the Specialty Clinic, located on the 1st floor of the Brigham and Women’s/Mass General Health Care Center.

All classes will be held in the Community Room on the 2nd floor of the Health Care Center unless otherwise noted.  Please visit www.brighamandwomens.org/foxborough for directions.

For more information and to reserve your space, call 866-378-9164, or visit, www.brighamandwomens.org/foxboroughevents

Press Release - Oct 14, 2009

Improved Adherence Could Positively Impact Patient Health and Save Consumers and Health Plans Billions

WOONSOCKET, R.I., Oct. 14 /PRNewswire/ -- CVS Caremark (NYSE: CVS) is sponsoring research to investigate patient adherence to prescription drug therapies and identify ways to increase adherence. Working with researchers from Harvard and Brigham and Women's Hospital, the company expects knowledge gained from the research will help health professionals better understand patient behavior and lead to developing programs that health care providers and pharmacies can use to improve medication adherence and ultimately help improve patient care and medical outcomes by avoiding costly hospital treatment.

Non-adherence to essential chronic medications has been widely recognized as a major public health problem, according to prior research cited in numerous medical journals. One quarter of original prescriptions for essential medications are never filled, and patients with important chronic diseases such as diabetes and coronary artery disease adhere to their medication only about half of the time. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. health care system estimated at over $200 billion annually. A better understanding of the predictors of non-adherence and strategies to improve medication use has the potential to meaningfully impact the public health.

"As the nation looks for ways to reduce health care spending, we need to improve patient compliance with prescribed drug therapies," said Troyen A. Brennan, M.D., Executive Vice President and Chief Medical Officer, CVS Caremark. "Many reasons have been discussed for patient non-adherence, including cost, forgetfulness, confusion when taking multiple medications, and problems with renewing a prescription. This research, which will be available not only to CVS affiliates but to all pharmacies, will help doctors, pharmacies, hospitals and health plans design programs to help patients stay on their prescribed medication treatments."

Dr. Brennan says non-compliance with a prescribed drug reduces or eliminates the positive effects of a medication. Patients who fail to take prescriptions properly can face unnecessary and costly treatments, such as hospital admissions, re-admissions, and surgeries. Patients are considered to be non-compliant if they do not fill a new prescription or do not refill an existing one, take appropriate medication incorrectly (e.g., on the wrong schedule) or take the wrong medication dose (e.g., dose is too low).

To address this significant public health problem, CVS Caremark, through a research agreement, is working with faculty from Brigham and Women's Hospital, Harvard Medical School and Harvard Faculty of Arts and Sciences to develop an interdisciplinary initiative to improve medication use. The interdisciplinary approach allows experts in disciplines like psychology, sociology and political studies to bring their expertise about patient behavior and health care policy to bear on a complex public health problem.

This research collaboration has four key components:

• Determine causes and scope of abandoned prescriptions -- Researchers know little about how often and why prescriptions are filled but not picked up at the pharmacy. A better understanding of the types of essential medication abandoned and the predictors of abandonment can be used to create better approaches to medication delivery. Specifically, the team will study the effect of different insurance structures to help design plans to support medication adherence. The study also seeks to determine the impact of the current economic downturn on insurance coverage and prescription abandonment to provide guidance on how best to support patient health in such economic conditions.
• Drive adherence through simplification and consolidation -- In a fragmented health care system, there are numerous sources of complexity that may interfere with medication adherence. Patients see multiple physicians, are charged multiple copayments for different medications, may use multiple pharmacies and may have to make many trips to the pharmacy to manage their medications. The research team will seek to assess how actions such as simplifying drug regimens and consolidating pharmacy management services within a "pharmacy home" can improve adherence. This research will provide the basic knowledge needed to help pharmacies, insurers and doctors simplify medication use and encourage adherence.
• Evaluate the clinical and financial value of adherence incentives -- Scientific literature has discussed the notion that rewarding desired behavior is a powerful tool to stimulate that behavior. The team is developing a randomized controlled trial of the effects of providing rewards for optimal medication adherence with the goal of better engaging patients in their medical care in order to improve their health. The results can provide a rigorous evaluation of the clinical and financial value of implementing novel insurance designs on patient behavior.
• Determine how electronic prescribing impacts costs, compliance and safety -- Many health care experts are looking to improved health information technology to reduce health care costs and improve safety. The researchers will examine the role that ePrescribing can play in adherence in helping companies better understand and evaluate how electronic prescriptions and processing impact medication costs, adherence and safety. This is especially important as Medicare has launched an initiative to drive electronic prescriptions.
  

"This research will help us understand the reasons why patients do not take their medications as prescribed. We will use this information to develop effective, evidence-based approaches to improve prescription adherence," said William Shrank, M.D., MSHS of Brigham and Women's Hospital and Assistant Professor of Medicine at Harvard Medical School, and principal investigator of the program. "We'll strive to better understand barriers to adherence that range from patient characteristics (e.g. income or marital status); patients' attitudes about their condition and the importance of medicine; understanding how to take medications appropriately; the impact of complex therapy; and, the trust and communication between the patient, the physician and the pharmacist. We hope this research will help us create strategies to promote wellness in our patients. "

Press Release - Oct 14, 2009

Olivia Okereke, MD, MS, and colleagues at Brigham and Women’s Hospital (BWH), have demonstrated that a high ratio of amyloid ß peptides (Aß) 40 and 42 (Aß 40:42 ratio)  may be a predictor of future decline in cognitive function, such as Alzheimer’s disease. These findings appear in the October 12, 2009, issue of Archives of Neurology.  

Researchers measured the level of Aß in the blood of 481 healthy middle-aged Nurses’ Health Study participants. Beginning 10 years after the initial blood draw, women had cognitive testing three times, spaced out about every two years. Researchers found that higher plasma Aß 40:42 ratios in late midlife and increases in Aß 40:42 ratios 10 years later were significantly associated with greater decline in cognitive function later in life.

Previous studies have looked at Aß levels in more elderly populations. “By showing that there are earlier measurable risk markers of future cognitive decline, we have hope in the possibility of someday using blood biomarkers to find people at risk years before cognitive decline becomes apparent,” said Dr. Okereke, of the Division of Aging at BWH. “This is an important step in the effort to prevent and to provide early intervention against dementia.”

The National Institutes of Health funded this research.

Press Release - Oct 13, 2009

Boston, MA - Frequently, attending physicians who perform emergency procedures or deliveries during the overnight often schedule deliveries or elective procedures for the following day. New research from Brigham and Women's Hospital (BWH) finds that procedures performed the day after attending physicians worked overnight were not more likely to have an increased risk for complications if the physician had an opportunity to sleep for six or more hours. If a physicians' only opportunity for sleep was less than six hours, the risk for complications in a procedure following an overnight procedure rose significantly. The findings appear in the October 14, 2009 issue of JAMA.

The researchers compared 919 surgical procedures and 957 obstetrical procedures performed following an overnight emergency procedure with 3,552 similar surgical procedures and 3,945 similar obstetrical procedures performed by the same physicians on days without having performed overnight emergency procedures. The procedures in this study were performed between January 1999 and June 2008.

Overall, the researchers found that procedures performed the day after attending surgeons and obstetrician/gynecologists worked during the overnight did not increase the risk for complications in procedures the following day when compared with similar procedures performed that were not preceded by overnight work. However, the researchers found that among surgeons, a nearly 3-fold increase for risk of complications in procedures following an overnight procedure when the surgeon had less than a six hour opportunity for sleep (62 complications, 8.5 percent of procedures) compared to when the surgeon had a greater than six hour opportunity for sleep (6 complications, 3.1 percent of procedures).

Because performing an overnight procedure followed by additional procedures during the next day extends a doctors work hours, the researchers looked at complication rates among procedures done by physicians who worked less than 12 hour shifts and those who worked greater than 12 hour shifts. They found there were higher complication rates compared to the case done during the less than 12 hour work shift but the difference was not significant.

"Our findings suggest that attending physicians, like resident physicians and nurses, may be at an increased of making errors when sleep deprived or working extended shifts," said Dr. Jeffrey Rothschild, lead author of the study and a physician in the Department of General Medicine and Primary Care at Brigham and Women's Hospital. He added, "We are adding to the limited literature on the effects of attending physician sleep deprivation and extended work shifts on clinical outcomes for patients."

He concluded, "It is important to note that the complication rates for the attending physicians who participated in our study who performed procedures the previous night was not higher than those who did not. But it was also clear that surgeons with limited opportunity for sleep had substantially higher complication rates compared to those with a longer opportunity to sleep."

Dr. Jeffrey Rothschild will present the findings from this study at a JAMA press conference on Tuesday, October 13 at 10 a.m. Central time.

The study was funded by a grant from the Rx Foundation.

Press Release - Oct 13, 2009

Rates of minimally invasive radical prostatectomy (MIRP) for men with prostate cancer have increased nearly five-fold in the years from 2001 to 2006 despite the lack of scientific evidence that MIRP is superior to the traditional, open retropubic radical prostatectomy approach (RRP). New research from Brigham and Women's Hospital (BWH) shows that while MIRP results in shorter hospital stays, it does not result in fewer complications overall. These findings are published in the October 14, 2009 issue of the Journal of the American Medical Association.

"There are advantages to each type of surgery," said Jim Hu, MD, a surgeon in the Urology Division at BWH and lead author of the paper. "Any man who is making the decision to undergo RRP or MIRP should talk with his surgeon about their level of experience performing each type of surgery and what the outcomes are."

Researchers compared tumor registry and Medicare linked data from nearly 9,000 men with prostate cancer who underwent either MIRP or RRP from 2003-2007 for various outcomes. They found that men who underwent MIRP experienced shorter hospital stays, were less likely to need a blood transfusion, had less post-operative respiratory complications and less anastomic stricture. However, these men also had more genitourinary complications, were more likely to be diagnosed with incontinence and erectile dysfunction. The need for additional cancer therapy did not differ by surgical approach.

Researchers note that surgeons have been performing RRP for approximately 30 years whereas MIRP has only been an option for the past 8 years and that the differences in outcomes may be related to the technical skill of the surgeon.

"As with any new procedure, there is a learning curve," said Hu. "This finding is based on an average of the outcomes of many surgeries performed by many different surgeons with different skill levels throughout the country."

This research was funded by a Department of Defense Prostate Cancer Physician Training Award.

Press Release - Oct 6, 2009

Boston, MA - Brigham and Women’s Hospital (BWH) has added the IMRISNV and IMRIScardio to the Advanced Multimodality Image Guided Operating (AMIGO) suite, combining the most advanced and complete image guidance capabilities in a single suite with the goal of delivering the best possible therapy to patients across a range of applications including neurological, neurovascular, oncological and cardiovascular disorders.

IMRISNV and IMRIScardio, which were recently cleared by the FDA, include an MR diagnostic center and interventional theatre, incorporating a Siemens wide bore 3T MRI and single plane angiography system. The system will permit rapid and seamless transitions between MR imaging and intervention without transporting the patient between modalities. MR images can be taken before and during procedures to assess tissue health, and can also be used in conjunction with the fluoroscopic images during interventional procedures.

The IMRIS system is the first in the world to allow the capabilities of both MRI and x-ray angiography in a single suite eliminating the need to transport the patient between modalities. In addition, no other system offers the same degree of safety for both the patient and the surgical environment. Ferenc Jolesz, MD, director of the Division of MRI and Image Guided Therapy Program at BWH, believes IMRIS’s capabilities best meet the hospital’s requirements for achieving the vision of AMIGO.

IMRIS and BWH have also entered into a five-year research initiative. The goals of the collaboration between IMRIS and BWH include the development of new applications, establishment of workflows and the validation of the benefits associated with new applications.

“We are extremely pleased to establish this important relationship with BWH and to have our system selected as the platform for AMIGO,” said David Graves, President & CEO, IMRIS. Internationally recognized as a pioneer in intra-operative MRI, BWH leads the U.S. National Center for Image Guided Therapy (NCIGT), under the leadership of Jolesz, MD, and Clare Tempany, MD, of the Radiology Department at BWH. “Partnering with BWH is a part of our overall vision to develop the next generation of applications, in support of further helping clinicians improve patient outcomes.”

Press Release - Sep 30, 2009

Karen Hoffmeister, of the Hematology Division at BWH, and colleagues have identified a possible means of storing platelets in cold temperatures to improve usability. These findings appeared online on September 27, 2009, in Nature Medicine.  
 
At sites of injury, platelets, tiny disc-shaped cells devoid of a nucleus that are produced by the bone marrow, become activated and interact with plasma proteins such as fibrin to form clots. For more than 50 years, platelet transfusions have prevented life-threatening blood loss in trauma, surgery, and bone marrow transplant patients. However, unlike red blood cells, refrigeration of platelets leads to their rapid clearance from circulation after transfusion. Platelets are therefore stored at room temperature, which limits their shelf life to five days and seriously compromises their use for transfusion.

Researchers dissected two platelet clearance pathways by which sugar residues on platelets are recognized by liver immune cells (macrophages) and, unexpectedly, by hepatocytes, which differentially control the clearance of refrigerated platelets dependent of their time in the cold. Inhibition of chilled platelet clearance by both immune cells and hepatocytes may potentially present a strategy to attain the goal of storing platelets in the cold.

The National Institutes of Health and the Pew Scholars Award funded this research.

Press Release - Sep 29, 2009

Joins the Division of Endocrinology, Diabetes and Hypertension and the Dept. of Neurosurgery

Boston, MA - Whitney W. Woodmansee, MD, has been named the Director of the Clinical Neuroendocrine Program in the Division of Endocrinology, Diabetes and Hypertension and the Department of Neurosurgery at Brigham and Women's Hospital (BWH). 

"We are pleased to welcome Dr. Woodmansee as a new integral member of our Pituitary/Neuroendocrine Center.  Her experience, skills and enthusiasm make her a wonderful complement to our current faculty," said Edward R. Laws, MD, Director of the Pituitary and Neuroendocrine Center at BWH.

Dr. Woodmansee joins Drs. Ursula B. Kaiser and Edward R. Laws and their support staff in a multidisciplinary setting designed to diagnose and treat patients with pituitary and allied disorders.  Her research contributions have focused on somatostatin receptor biology and physiology, metabolic derangements in thyroid disease, regulation of thyrotrope function, and hypopituitarism.

Woodmansee received her Bachelor's degree in Molecular Biology and Master's degree in Behavioral Neurosciences from the University of Colorado, Boulder.  Her M.D., postgraduate training in Internal Medicine and Fellowship in Endocrinology were obtained at the University of Colorado School of Medicine in Denver, the latter under the leadership of Dr. E. C. "Chip" Ridgway.  She is Board Certified in Endocrinology, Diabetes and Metabolism.

Prior academic positions include Instructor, Assistant Professor, and Associate Professor of Medicine at the University of Colorado Denver, School of Medicine.  Woodmansee was a founding member of the Pituitary Center there, highly regarded as a clinician, researcher, and teacher.  She is a member of the American College of Physicians, Endocrine Society, American Thyroid Association, and Pituitary Society, among others.

Press Release - Sep 24, 2009

Boston, MA - The National Institutes of Health (NIH) is awarding $348 million to encourage investigators to explore bold ideas that have the potential to catapult fields forward and speed the translation of research into improved health. Researchers at Brigham and Women’s Hospital (BWH) are recipients of two of the 115 awards, presented from three innovative research programs supported by the NIH Common Fund’s Roadmap for Medical Research: the NIH Director’s Transformative R01 (T-R01) Awards, Pioneer Awards, and New Innovator Awards.

"The appeal of the Pioneer, New Innovator, and now the T-R01 programs, is that investigators are encouraged to challenge the status quo with innovative ideas, while being given the necessary resources to test them," said NIH Director Francis S. Collins, M.D., Ph.D. "The fact that we continue to receive such strong proposals for funding through the programs reflects the wealth of creative ideas in science today."

Receiving one of the 42 T-R01 grants, Charles Serhan, PhD, of the Reperfusion Center at BWH, and Ru-Rong Ji, PhD, of the Pain Research Center at BWH, are of the first group of researchers to receive support from this newly created program. Supporting highly innovative research is an ongoing effort at the NIH, but the T-R01 Program provides a new opportunity for scientists that is unmatched by any other NIH program. Since no budget cap is imposed and preliminary results are not required, scientists are free to propose new, bold ideas that may require significant resources to pursue. They are also given the flexibility to work in large, complex teams if the complexity of the research problem demands it.

The five year $1,885,525 grant awarded to Drs. Serhan and Ji will support their research titled, Resolvins, protectins, and chronic pain resolution. “This multiple PI grant is a perfect example of inter-department collaboration between a pain research group and an inflammation research group. We believe a deficit in the resolution of inflammation will lead to chronic pain, and this deficit can be treated by novel lipid mediators developed in Dr. Serhan’s laboratory,” said Dr. Ji.

For his work titled, Prevalence, Risk Factors and Consequences of Complex M. tuberculosis Infections, Ted Cohen, MD, MPH, DrPH, of the Division of Global Health Equity at BWH, is one of 55 to receive the New Innovators award, totaling $1,500,000 over five years. Intended to stimulate highly innovative research and support promising new investigators, the award goes to new researchers with exceptionally innovative research ideas that may not yet have the preliminary data required to fare well in the traditional NIH peer review system.

“This is an incredible and unique opportunity that the NIH New Innovator mechanism will provide. This support will allow me to test new ideas and to take on higher-risk questions than is typically possible for an investigator at my career stage,” said Dr. Cohen.

Press Release - Sep 21, 2009

Boston, MA — The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has recognized Brigham and Women’s Hospital (BWH) as one of  25 ACS NSQIP participating hospitals in the United States that have achieved exemplary outcomes for surgical patient care.  As a participant in ACS NSQIP, BWH is required to track the outcomes of inpatient and outpatient surgical procedures and collect data that directs patient safety and the quality of surgical care improvements.  

BWH is commended as part of the select group of hospitals that achieved exemplary outcome performances related to patient management in two or more of five clinical areas:  DVT (deep vein thrombosis, thrombophlebitis and pulmonary embolism); cardiac incidents (cardiac arrest and myocardial infarction); Pneumonia; SSI (surgical site infections-superficial and deep incisional and organ-space SSIs); or urinary tract infection. Risk-adjusted data from the June 2009 ACS NSQIP Semiannual Report were used to determine which hospitals demonstrated exemplary outcomes.   

ACS NSQIP is the only nationally validated quality improvement program that measures and enhances the care of surgical patients. This program measures the actual surgical results 30 days postoperatively as well as risk adjusts patient characteristics to compensate for differences among patient populations and acuity levels.  The goal of ACS NSQIP is to reduce surgical morbidity (infection or illness related to a surgical procedure) and surgical mortality (death related to a surgical procedure) and to provide a firm foundation for surgeons to apply what is known as the “best scientific evidence” to the practice of surgery.  Furthermore, when adverse effects from surgical procedures are reduced and/or eliminated, a reduction in health care costs follows.  ACS NSQIP is a major program of the American College of Surgeons and is currently used in over 250 hospitals.

Press Release - Sep 18, 2009

A team of researchers led by Massachusetts General Hospital (MGH) radiologists has developed a computed-tomography-based protocol that identifies both narrowing of coronary arteries and areas of myocardial ischemia – restricted blood flow to heart muscle tissue – giving a better indication of clinically significant coronary artery disease. Their report appears in the September 15 issue of the Journal of the American College of Cardiology.

"This is among the first demonstrations of the use of cardiac CT [computed tomography] to detect both coronary artery stenosis and resulting myocardial ischemia simultaneously in a single examination," says Ricardo C. Cury, MD, a cardiac imaging specialist at the MGH Heart Center and the study's principal investigator.

CT scanning uses conventional X-rays to produce cross-sectional images of anatomic structures and can detect plaques in coronary arteries. But the appearance of plaques on CT images may not indicate whether or not they actually compromise the heart muscle's blood supply. More detailed angiographic images obtained via invasive cardiac catheterization give a better picture of how obstructive a plaque may be, and perfusion studies utilizing technologies such as MRI scans or the nuclear medicine technologies SPECT and PET reveal areas where limited blood flow has damaged the heart muscle, information that can determine whether a patient can be treated with drugs or requires surgical intervention.

Earlier studies showed that CT can identify areas of restricted coronary blood supply in resting individuals. The MGH-led study was designed to see whether a comprehensive cardiac CT examination could incorporate myocardial perfusion studies in both resting and stress situations along with the anatomic data provided by CT angiography. The study enrolled 34 cardiac patients who recently had SPECT stress tests and were likely to also require angiography via cardiac catheterization.

Participants first had a cardiac CT taken while receiving an infusion of adenosine, which produces physiologic stress symptoms such as elevated heart rate and blood pressure. When vital signs returned to normal several minutes after the adenosine infusion, a resting cardiac CT was taken. Both of those scans involved the use of contrast material, and to detect areas with little or no contrast agent – indicating restrictions to the myocardial vasculature – a third CT scan was taken 7 minutes later.

The accuracy of CT-based perfusion imaging in diagnosing coronary artery narrowing that significantly affected myocardial perfusion was virtually the same as SPECT stress imaging, and the results of coronary CT angiography also compared favorably to those of cardiac catheterization. Because the investigators used new radiation-dose-reduction techniques, the radiation dose of the three CT scans did not exceed the dosage involved in the SPECT stress perfusion study.

"While nuclear perfusion imaging provides information that can help guide patient treatment, it has limitations that can lead to either false negative or false positive findings," Cury explains. "The ability to acquire anatomical visualization of coronary artery stenosis together with physiological assessment of myocardial perfusion in a single study could improve diagnostic accuracy while potentially reducing costs and radiation exposure. Since our study was relatively small, we need to test this approach in a larger multicenter trial and further investigate the additional value of CT perfusion studies over CT angiography." A consulting radiologist at MGH, Cury recently joined the Baptist Cardiac and Vascular Institute in Miami.

Source: Massachusetts General Hospital

Press Release - Sep 18, 2009

Researchers find that reproductive differences are not responsible for the lower risk of breast cancer in blind women

Boston, MA - Researchers at Brigham and Women's Hospital (BWH) have found that totally blind women have more than a 50 percent reduction in breast cancer compared to visually impaired women and that this same group of totally blind women have an earlier menarche, or first menstrual period, when compared to blind girls with some light perception.  These findings are published online in two separate papers appearing in Cancer Causes and Control and Ophthalmic Epidemiology.

The role of light on human reproductive development is unclear and much of the research has been focused on the differences between blind women with varying levels of vision compared to women with no visual impairment.  Researchers in these studies evaluated the differences in nearly 1,400 blind women who either had no light perception or were blind but retained some light perception. 

In the first study, researchers report that of the 66 cases of breast cancer, there was a significant difference in the number of cases in each group even when controlling for known reproductive risk factors for breast cancer, with 11 cases of breast cacner in blind women with no light perception compared to 55 cases in blind women who retained some light perception.

In their second study, researchers looked at the age of the first menstrual period in these blind women and found that blind women with no light perception have their first period at an earlier age when compared to blind women with light perception.  Researchers also found that the earlier the loss of light perception in blind girls, the earlier the age of the first period.   

"These reproductive differences are opposite of what you would expect for a group with decreased cancer rates," said Erin Evans, the lead author on both papers and a doctoral candidate in the Division of Sleep Medicine at BWH. "An earlier menarche is associated with an increased risk of breast cancer in sighted women, so taken together; these two recent findings suggest that it is not reproductive differences that account for the lower risk of breast cancer among blind women.  More research is needed to examine how production of the hormone, melatonin, and the internal circadian coordination may be responsible for this observed lower risk of breast cancer," she added.

"Although these findings are not entirely new discoveries, they are more detailed than previous research and provide additional insight into the role that light plays in cancer risk as it relates not only to blind women with no light perception, but also to shift workers and to those who sleep for short durations throughout the night," said Steven Lockley, PhD, senior author of the papers and a researcher in the Division of Sleep Medicine at BWH.

Press Release - Sep 15, 2009

Stress that occurs during pregnancy is known to affect a mother’s physiology, which can in turn affect the fetus’ developing biological systems. In a novel study looking at stressors that have occurred throughout the mother’s lifetime, rather than only during pregnancy, researchers at Brigham and Women’s Hospital (BWH) and the Harvard School of Public Health found that interpersonal trauma experienced throughout the mother’s life may have an effect on her baby’s immune development during gestation. These findings are published online in the Journal of Allergy & Clinical Immunology.

“A previous link has been established between psychological stress and allergies and asthma,” said senior study author Rosalind J. Wright, MD, MPH, of the Channing Laboratory and the Department of Medicine at BWH. In this ongoing study researchers are looking at how stress occurring at various stages of a woman’s life influences gestational development and ultimately the development of allergies and asthma in her child.

A group of 478 inner-city pregnant women aged 18 years or older were recruited from hospitals in the Boston area to participate in the study. Women were asked to answer whether they experienced interpersonal trauma at various stages of their life, including childhood or teenage years, adulthood or pregnancy, or chronically during both periods. Interpersonal trauma was defined as being pushed, grabbed, shoved, kicked, bit, punched, hit with something that hurt their body, choked, burned, forced to have sexual activities or physically attacked in some other way.

Venous placental cord blood collected from the children of the study participants at birth was analyzed for immunoglobulin E (IgE) levels. IgE, a class of antibody that plays an important role in allergy, is typically found in low levels in blood serum, but when found in high levels can be an early indicator of immune system shift toward allergic sensitization. Researchers found high levels of IgE in the cord blood of children whose mothers experienced intrapersonal trauma early in life and especially in those children whose mother experienced chronic interpersonal trauma over multiple life stages.

“This study has shown that, when examining prenatal stress and childhood risk for allergic sensitization or asthma, researchers should also consider certain stressors experienced by mothers before the pregnancy, even remote childhood stress, which may have lasting impact” said Michelle J. Sternthal, PhD, lead author and postdoctoral fellow at the Harvard School of Public Health. “Linking interpersonal violence in women’s lives to not only her own health and wellbeing but to the health of the next generation further underscores the need to prevent such trauma,” emphasized Dr. Wright.

Press Release - Sep 15, 2009

 Boston, MA – In patients with recent onset type-2 diabetes, treatment with insulin or the diabetes drug metformin did not reduce inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP), although the treatment did improve glucose control, according to a study in the September 16 issue of JAMA.

As diabetes is in part an inflammatory condition, a possible therapeutic target for patients is subclinical inflammation, a modifiable risk factor. Evidence is limited on whether improvement in glycemic control, insulin resistance, or both with antidiabetic agents such as insulin and metformin may beneficially change inflammation.

Aruna D. Pradhan, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine whether insulin alone or combined with metformin lowers levels of hsCRP, and other biomarkers for inflammation in patients with recent-onset type 2 diabetes. The study included 500 adults with suboptimal glycemic control and elevated hsCRP levels. Participants were randomized to 1 of 4 treatments: placebo metformin only; placebo metformin and insulin; active metformin only; or active metformin and insulin. The researchers noted the change in the measurement of the inflammatory biomarkers from the beginning of the trial to 14 weeks.

The authors write that “no consistent association was found between glucose reduction and improvement in inflammatory status ascertained by change in levels of hsCRP and other biomarkers. Despite substantially improving glucose control, neither insulin nor metformin reduced inflammatory biomarker levels for the main effects evaluated or in comparisons between the individual treatment groups. An interaction between interventions was observed such that, compared with no pharmacologic intervention, those allocated to insulin alone had a significant attenuation of inflammation reduction, an effect not observed among those allocated to metformin and insulin or to metformin alone.”

Pradhan added, “From a clinical perspective, until other similar trial data become available, these findings underscore the need to improve adherence with actions that do reduce cardiovascular events among diabetic patients, including exercise; weight management; smoking cessation; blood pressure control; and, in appropriate patients, antiplatelet and statin therapy,” the authors conclude.

The research received funding from Sanofi-Aventis.
Source: JAMA

Press Release - Sep 10, 2009

Boston, MA - New England Journal of Medicine (NEJM), in partnership with Brigham & Women’s Hospital, is now offering a unique online learning tool called Interactive Medical Cases on NEJM.org. The series of cases simulate clinical encounters to enable doctors to learn best practice strategies and improve outcomes for their patients. 

Each Interactive Medical Case is based on a real patient’s experience of illness, and follows that patient all the way from presentation through outcome.  Learners are presented with an evolving patient history, and their knowledge is tested incrementally through multiple choice questions, matching, and/or identification tasks.  Users can choose to examine the patient, and listen to their hearts or lungs, and then make some initial choices on how they want to proceed. They can order tests, receive the results, and act on those decisions. 

Through peer reviewed commentary, learners receive immediate feedback on their choices and use online video and interactive materials to reinforce the learning themes and learning objectives.  Physicians are able to view their performance in comparison to their peers at the end and receive contextual feedback on their choices throughout the case.  Once completed, users will be awarded up to 2 AMA PRA Category 1 CME Credits.

“The pace of change in medical knowledge makes it essential for clinicians to find effective ways to develop their problem-solving skills,” said Graham McMahon, M.D., M.M.Sc., Editor for Medical Education at the New England Journal of Medicine.  “This unique educational resource answers that need. The Interactive Medical Cases will help clinicians enhance retention, and will allow physicians with limited time to learn by managing a real case online from present through outcome.” 

The new Interactive Medical Cases will help residents, IMs, office-based primary care clinicians, hospitalists, and rural MDs, learn optimal decision making for patient care; prioritize appropriate use of diagnostic tests; understand pathophysiology of medical problems; and recognize areas for improving their clinical practice.

The interactive cases were developed by Dr. Joseph Loscalzo, chair of the Department of Medicine at Brigham and Women’s Hospital (BWH) and Dr. John J. Ross, one of the authors of the Interactive Medical Cases and a BWH hospitalist. “By simulating a real-world patient encounter, the Interactive Medical Cases provide clinicians with a novel and entertaining way to hone their problem-solving skills," said Dr. Ross.

The first four cases will be published consecutively September through December 2009, followed by a Clinical Problem Solving (CPS) article that will appear in the print issue of NEJM a few weeks later. 

The New England Journal of Medicine (NEJM.org) is the world’s leading medical journal and website. Owned by the Massachusetts Medical Society, NEJM publishes peer-reviewed research and interactive clinical content for physicians, educators and the global medical community. For more information, please visit www.nejm.org.

Press Release - Sep 4, 2009

Researchers share lessons learned from the experience of implementing an HIV testing program in a busy academic teaching hospital

Boston, MA - In 2006, the Centers for Disease Control and Prevention (CDC) recommended that HIV testing be offered to adults aged 13-64 in all healthcare settings, including the emergency department (ED).  Since then, EDs throughout the United States have begun to implement rapid testing programs as a public health screening service.  In the absence of guidelines on how to implement these recommendations into clinical practice, researchers from Brigham and Women's Hospital (BWH) have outlined a framework of lessons learned during the establishment of a rapid HIV testing program in an academic teaching hospital.  These findings are published online in the International Journal of Emergency Medicine.

"Although at times challenging, we believe that routine HIV screening in the ED is feasible with appropriate infrastructure and with longitudinal and financial support.  We offer this framework so that others both domestically and internationally who are poised to embark on HIV testing programs may benefit from our experiences," said Christian Arbelaez, MD, MPH, of the BWH Department of Emergency Medicine, Assistant Professor of Medicine at Harvard Medical School and lead author of the paper.

Researchers implemented this program over the course of a year which included time for advanced planning, piloting, and continuous refinement of programmatic details.  Highlights of the framework identified in creating a successful HIV testing program in the emergency department included: identifying a champion, performing a needs assessment, engaging a comprehensive team, selecting an appropriate HIV test, establishing proper protocols and quality assurance measures, and providing education and training for the providers.

"While we have found that it is entirely possible to develop an HIV screening program in an emergency department, we have also experienced the challenges that arise along the road to implementation.  Developing an interdisciplinary team of supportive clinical and administrative staff is a critical step in the success of this public health service," said Rochelle P. Walensky, MD, MPH, of the BWH and Massachusetts General Hospital (MGH) Divisions of Infectious Disease, Associate Professor of Medicine at Harvard Medical School, senior author of the study.

"We hope that components of this program will serve as a model and preliminary guidance for EDs throughout the United States. In international settings, many of the recommendations may also be applied, with careful attention to country- and setting-specific details." said Arbelaez.

Additional co-authors of the International Journal of Emergency Medicine report are Brian Block, Elena Losina, Elizabeth A. Wright, William M. Reichmann, Regina Mikulinsky, Jessica D. Solomon, and Matthew M. Dooley. Experiences leading to this review and efforts to write it were funded by the National Institute of Mental Health and the Doris Duke Charitable Foundation Clinical Scientist Development Award. ClinicalTrials.Gov: #NCT00502944

Press Release - Sep 1, 2009

Since the discovery of community-associated methicillin-resistant staphylococcus aureus, more commonly called MRSA, the emergency department visits for skin and soft-tissue infections (SSTI) increased from 1993-2005.  In a new study, researchers from Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH) sought to determine if the number of SSTI visits also increased in the larger setting of physicians' offices.  They found that SSTI visits to physicians' offices have not become more common since the discovery of community-associated MRSA.  These findings are published online and will appear in the September 15 print edition of Clinical Infectious Disease.

Community-associated MRSA is a type of staph infection that is resistant to certain antibiotics.  Previous research indicated an increase in SSTI visits associated with community-associated MRSA in the emergency department setting, and also suggested an increase across all ambulatory medical settings. 

"In contrast with previous research, our study finds that SSTI visits to physicians' offices have not increased since the discovery of this ‘drug-resistant superbug' - community-associated MRSA," said Daniel Pallin, MD, MPH, lead author of the paper and Director of Research in the Department of Emergency Medicine at BWH.

Because dermatitis, a disease of the skin, is also thought to increase the risk of SSTI, the researchers analyzed office visits at which patients were diagnosed with dermatitis or an SSTI to determine if the two conditions were linked, and if the link became stronger since the discovery of community-associated MRSA.  Using the National Ambulatory Medical Care Survey, data from 361,697 physicians' office visits were collected and the researchers calculated national estimates.   

Pallin and colleagues found that dermatitis was diagnosed at 13 million office visits per year, and SSTI were diagnosed at 6.3 million visits per year, with the frequency of both diagnoses remaining unchanged over the study period of 13 years (1993-2005).  They also found that dermatitis was associated with SSTI, but that the association did not strengthen over time, while community-associated MRSA became prevalent.  The researchers also found that dermatitis is most commonly diagnosed in infants and small children, but that SSTI affect all age groups similarly.

"It appears that we are in the midst of an epidemic of skin and soft-tissue infections, likely due to community-associated MRSA.  But we now know that the epidemic seems only to be affecting emergency department visit rates, not office visit rates. The reason for the disproportionate effect upon the emergency department is unknown. Though community-associated MRSA can rarely cause serious infections like pneumonia and septicemia, the importance of the epidemic should not be overblown, as most cases involve only mild superficial infections," Pallin said. He also emphasized that there is no evidence that skin infections require different treatment today than they did before the advent of community-associated MRSA, stating that "Abscesses are treated surgically, and usually do not require antibiotics, and cellulitis has not been shown to require antibiotics effective against community-associated MRSA."  Cellulitis is a form of skin infection that is different from abscess, and is the subject of a clinical trial being conducted at BWH, MGH, and Children's Hospital Boston, by Dr. Pallin and co-authors.

Press Release - Aug 31, 2009

An analysis of a large clinical trial has shown that proton pump inhibitors (a commonly prescribed antacid medication) do not interfere with the clinical benefit of the anticlotting drugs clopidogrel or prasugrel in patients after an acute coronary syndrome (heart attack or unstable angina). These findings are in contrast to other recent studies that have shown potential harm when these two classes of drugs are combined.  The results are published in an Article Online First and in an upcoming edition of the Lancet, written by Dr Michelle O’Donoghue, Brigham and Women’s Hospital, and colleagues.

Proton pump inhibitors are often administered with clopidogrel and prasugrel, to help reduce the risk of gastrointestinal bleeding, a strategy that is endorsed by existing guidelines. But several studies have raised concerns that proton pump inhibitors could negate the clinical benefit of clopidogrel.  The authors studied the effects of proton pump inhibitors in the TRITON-TIMI 38 trial. The trial enrolled 13608 patients after a heart attack or unstable angina and randomly assigned them to clopidogrel or prasugrel. Use of a proton pump inhibitor in combination with these drugs did not increase the risk of cardiovascular events, including death, heart attack, or stroke.

The authors conclude: “The current findings do not support the need to avoid concomitant use of proton pump inhibitors, when clinically indicated, in patients receiving clopidogrel or prasugrel.”

In an accompanying Comment, Dr Dirk Sibbing and Dr Adnan Kastrati, Technische Universität München, Munich, Germany, agree that patients with a risk profile similar to those patients in the TRITON-TIMI 38 study can be safely treated with a proton pump inhibitor on top of clopidogrel or prasugrel. They say: “Caution is however required when prescribing proton pump inhibitors in selected high risk patients with intrinsic reduced response to thienopyridines,” adding that, if absolutely needed, PPIs less likely to interfere with the anticlotting effect of thienopyridines may be given to such patients.

Press Release - Aug 30, 2009

Boston, MA - Results from a phase II trial of an investigational intravenous drug designed to block the formation of blood clots, shows potential to reduce the risk of death, a second heart attack, or other coronary complications compared with the current standard of care in patients with acute coronary syndromes (heart attacks or unstable angina). The findings will be presented at the European Society of Cardiology meeting in Barcelona, Sunday, August 30, 2009 and appear simultaneously on line in the journal the Lancet.

Otamixaban inhibits the activity of Factor Xa, a key enzyme involved in the process of blood coagulation.  It has already shown promising results when tested in low-risk patients undergoing elective angioplasty.  In this trial, otamixaban was studied in high-risk patients with acute coronary syndromes undergoing urgent coronary angiography.  Otamixaban was compared with heparin, a very commonly used blood thinner, and eptifibatide, an intravenous GP IIb/IIIa platelet inhibitor, the combination of which represents current standard of care for acute coronary syndromes.  Heparin, however, has many limitations, including thinning the blood to an unpredictable degree and therefore requires frequent monitoring.  “There is intense interest in finding a more effective, reliable, and safe replacement for heparin,” said study’s lead author, Marc S. Sabatine, MD, MPH, an Investigator in the TIMI Study Group and a cardiologist at Brigham and Women’s Hospital, who presented the findings at the European Society of Cardiology meeting in Barcelona.

Sabatine, along with Professor Eugene Braunwald, Chairman of the TIMI Study Group, and colleagues studied the use of otamixaban in 3241 patients from 36 countries around the world who presented with an acute coronary syndrome.  Study medications were started within 24 hours of presentation.  Patients received state-of-the-art care with 98 percent getting aspirin, 98 percent getting clopidogrel, and 99 percent undergoing early coronary angiography.  Otamixaban or heparin was given for approximately 5 hours (typically until the end of the angioplasty).

The study (called SEPIA-ACS1 TIMI 42) was designed to identify the optimal dose of otamixaban.  Patients were randomized to one of 5 doses of otamixaban (an initial loading dose of 0.080 mg/kg followed by an infusion of 0.035, 0.070, 0.105, 0.140, or 0.175 mg/kg/hr) or to heparin plus the intravenous platelet inhibitor eptifibatide. The researchers tracked study participants for the incidence of death, a second heart attack, additional coronary complications, and bleeding through 7 days  as well as over the following 6 months. The lowest dose group of otamixaban was stopped early at the recommendation of the Data Safety Monitoring Committee due to inadequate anticoagulation; the remaining dose groups enrolled in the study to scheduled completion.

At the end of the study, Dr. Sabatine and colleagues found that in all of the otamixaban dosage groups, except the lowest one, the rate of death, second heart attack, or additional coronary complications tended to be  lower with otamixaban than with heparin plus eptifibatide.  Specifically, patients receiving an intermediate dose of otamixaban (0.105 or 0.140 mg/kg/hr) had a 40 percent lower rate of death, second heart attack, or additional coronary complications than those treated with the current standard of care - heparin plus eptifibatide.  Moreover, these patients had a 46 percent reduction in death or a second heart attack.  These benefits persisted through 180 days.  There was a significant increase in bleeding across the 5 otamixaban dosage groups, but the rate in intermediate doses of otamixaban (0.105 or 0.140 mg/kg/hr) was similar to the rate in patients treated with heparin plus eptifibatide.
“The data show that intermediate doses of otamixaban may offer a substantial reduction in major coronary complications in patients presenting with an acute coronary syndrome, with bleeding rates comparable to current therapy,” says Sabatine.  “These findings will need to be tested in a large phase III trial to establish the definitive role of otamixaban in the treatment of acute coronary syndromes.”
 
Otamixaban is under development at Sanofi-Aventis, and sponsored the study. Dr. Sabatine has received research support, honoraria for educational presentations, and consulting fees from Sanofi-Aventis.

Press Release - Aug 25, 2009

Researchers have now identified the specific underlying health conditions that increase the risk of death in men treated with hormonal therapy for prostate cancer  

Researchers at Brigham and Women's Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) have found that hormonal therapy is associated with an increased risk of death when used to treat prostate cancer in men who have a history of coronary artery disease leading to heart failure or a heart attack. These results are published in the August 26 issue of the Journal of the American Medical Association.  

"Although the addition of hormonal therapy to radiation therapy has been shown to increase survival in men with unfavorable-risk prostate cancer whose health is in otherwise relatively good condition, evidence now suggests that this may not be the case in men with more significant underlying health issues," said lead author Akash Nanda, MD, PhD, a radiation oncology resident at BWH in the Harvard Radiation Oncology Program. "The goal of the current study was to identify specific health conditions that may be responsible for this observation. Until now, we were unsure which additional health risks might limit this well-established survival benefit."  

Previous research has shown that hormonal therapy when used in combination with radiation therapy in the treatment of localized, unfavorable-risk prostate cancer increases survival rates in men with no or minimal comorbidity but not in men with moderate to severe comorbidity. Researchers therefore sought to determine which health conditions might be directly responsible for eliminating this survival benefit from combination therapy.  

Nanda and colleagues followed more than 5,000 men who were treated either with a combination of hormonal and radiation therapy or radiation therapy alone for about five years. They found overall that there was no increased risk of mortality with the addition of hormonal therapy when analyzing the entire cohort of patients, which confirms what has been previously reported from multiple randomized studies. However, hormonal therapy was associated with an increased risk of death in the subset of men with a history of coronary artery disease resulting in either congestive heart failure or a heart attack, representing approximately 5% of patients in the study. The researchers also found that hormonal therapy appeared to be safe in men who had only a single coronary artery disease risk factor including diabetes, high blood pressure, or high cholesterol.   

"This study highlights the potential harm of hormonal therapy in men with a history of coronary artery disease-induced heart attack or heart failure," said Anthony D'Amico, MD, PhD, chief of genitourinary radiation oncology at Dana-Farber/Brigham and Women's Cancer Center and senior author of the study. "For these men a careful discussion of the potential risk versus benefit of administering hormonal therapy should be performed and consideration be given to optimizing cardiovascular health with the help of a primary care physician prior to initiating hormonal therapy."

Press Release - Aug 17, 2009

Researchers identify a coronary vascular progenitor cell capable of growing new coronary arteries

Boston, MA – Most of the clinical displays of coronary artery disease can be treated by new formations of coronary arteries that replace the constricted or occluded coronary vessels, restoring blood flow to the heart. Unfortunately, this has been so far an impossible task. In this study, Dr. Piero Anversa MD, from Brigham and Women’s Hospital (BWH) and colleagues, have demonstrated that the human heart contains a population of stem cells which has the unique property to form large vessels similar to those commonly affected by atherosclerosis, a disease which can lead to heart attack. These findings are published in the online Early Edition of the Proceedings of the National Academy of Sciences during the week of August 17, 2009.

"We have defined this novel class of primitive cells and named them coronary vascular progenitor cells (CVPCs).  These cells possess all the fundamental properties of stem cells and are distributed within niches located in the vessel wall of the entire human coronary circulation system," said Anversa, who is director of the Center for Regenerative Medicine and a physician in the Department of Anesthesiology, Perioperative, and Pain Medicine Research Laboratories at BWH.

To establish the functional importance of CVPCs, a critical blockage was created in immunosuppressed dogs and human CVPCs were injected in proximity of the constricted artery. One month later, there was an increase in coronary blood flow in the affected myocardium resulting in functional improvement of the heart. Regenerated large, intermediate and small human coronary arteries were found, suggesting that the human heart contains a pool of CVPCs that can be implemented clinically to form a biological bypass in patients with chronic coronary artery disease and ischemic cardiomyopathy.

"This therapeutic strategy could dramatically change the goal of cell therapy for the ischemic heart; prevention of myocardial injury would become the goal of cell therapy rather than the partial restoration of established damage,” said Anversa.

Press Release - Jul 31, 2009

NEW YORK - The Doris Duke Charitable Foundation's African Health Initiative has awarded an eight million dollar research grant to Brigham and Women's Hospital's program to strengthen and study community-based, integrated primary health care systems in rural Rwanda. In partnership with Harvard University and Partners In Health, BWH is working with the Rwandan Ministry of Health to implement and study an innovative model of comprehensive, community-based health care in two rural districts in Rwanda.

The DDCF grant will help the partners expand their community-based model to additional health centers and strengthen the medical and social services they provide beyond HIV and tuberculosis to address the full spectrum of primary health care needs and chronic diseases. An electronic medical record developed initially for HIV/AIDS and TB patients will be expanded to use for all health services. Research will evaluate improvements in health outcomes at the district and local levels, as well as the costs and cost-effectiveness of the model.      

The grant awarded to BWH is one of four research grants totaling 44 million dollars. "We are proud to support this challenging but critical work," said Ed Henry, President of the Doris Duke Charitable Foundation. "We hope the foundation's grants will provide the funding and flexibility the four partnerships need to address some of the delivery gaps that will improve the healthcare systems in the regions where they are working."     

BWH was selected by members of the African Health Initiative's Advisory Council and other experts in epidemiology, health economics and statistics. After reviewing the submitted planning grant proposal, the selection committee considered the proposed program's  potential to significantly strengthen the local health system and improve health, the strength and quality of the team, the presence of local leadership, the alignment with local and national activities, the ability to build on existing programs, and the innovation and potential for replication.       

The DDCF African Health Initiative was launched in 2007 to fund partnerships between teams of researchers, practitioners and local governments that will strengthen fragile health systems and address inefficiencies that prevent health agencies from providing higher quality integrated healthcare.  The close collaboration between the research teams and government health systems is a unique feature of these partnerships. The researchers will both ensure
the delivery of health services and rigorously measure the impact of these services on people's lives. Importantly, government involvement will ensure that the programs are aligned with national plans and policies, which should improve their sustainability when DDCF funding ends.        

In the fall of 2009, the research team will begin by analyzing health system performance and establishing baseline measures to determine the impact
of the interventions on health outcomes. 

Brigham and Women's is one of four organizations to receive a multimillion-dollar grant from the Doris Duke Charitable Foundation’s African Health Initiative, out of more than 100 initial applicants. The DDCF African Health Initiative seeks to strengthen health systems by supporting partnerships that link implementation research and workforce training directly to the large-scale delivery of integrated primary healthcare in sub-Saharan Africa.
 

Press Release - Jul 29, 2009

New research has uncovered an early disruption in the process of memory formation in older humans who exhibit some early brain changes associated with Alzheimer's disease (AD) but show little or no memory impairment. The work, published by Cell Press in the July 30th issue of the journal Neuron, sheds light on the role of amyloid protein in memory impairment and may lead to development of strategies for predicting and treating cognitive decline in individuals who are at-risk for AD.

Amyloid b-protein plays a major pathogenic role in AD, a devastating neurodegenerative disorder characterized by progressive cognitive impairment and memory loss. In fact, one of the primary characteristics of AD is the accumulation and deposition of neuron-damaging clumps of amyloid protein. Previous studies have led to the suggestion that amyloid deposition begins many years prior to the onset of clinical symptoms. However, the exact link between amyloid deposition and memory impairment has not been clearly demonstrated in humans.

"Two recent advances in neuroimaging now allow us to explore the early, asymptomatic phase of AD, the ability to measure amyloid pathology in living humans and the identification of sensitive markers of brain dysfunction in AD," explains lead study author, Dr. Reisa Sperling from the Center for Alzheimer's Research and Treatment at Brigham and Women's Hospital in Boston. In addition to amyloid accumulation, AD has been associated with functional alterations in a specific network of brain regions that are intimately linked with memory formation.

Dr. Sperling and colleagues combined amyloid imaging with an associative memory functional brain imaging paradigm to study older humans who did not exhibit significant memory impairment. Importantly, the researchers found that a significant number of non-demented older individuals exhibited amyloid deposition and abnormal neural activity in key areas of the brain network thought to be involved in successful memory function. These results demonstrate for the first time that amyloid pathology in asymptomatic older humans is linked with aberrant neural responses during the process of memory formation.

"Longitudinal studies are certainly needed, but our findings are consistent with the premise that cognitively intact older individuals with amyloid pathology may already be in the early stages of AD," explains Dr. Sperling. "The combination of molecular and functional imaging techniques may prove useful in monitoring disease progression prior to significant clinical symptoms, as well as the response to amyloid-modifying therapeutic agents in subjects at-risk for developing AD."

Press Release - Jul 27, 2009

Press Release - Jul 26, 2009

 

BOSTON, MA – Researchers at Brigham and Women’s Hospital (BWH) have found that two common over-the-counter allergy medications may reduce both obesity and type 2 diabetes in mice. The medications, called Zaditor and cromolyn, stabilize a population of inflammatory immune cells called mast cells. This research appears in the July issue of Nature.

Guo-Ping Shi, a biochemist from the Department of Medicine at BWH, began to suspect such a connection when, in a previous study, he found mast cells present in a variety of inflammatory vascular diseases.

Mast cells are immune cells that facilitate healing in wounded tissue, primarily by increasing blood flow to the site. However, in certain conditions mast cells build up to levels far beyond what the body needs. As a result these cells become unstable and eventually, like punctured trash bags, leak molecular “garbage” into the tissue. This can result in chronic inflammation that causes asthma and certain allergies.

As Shi and colleagues discovered, mast cells were far more abundant in fat tissue from obese and diabetic humans and mice than they were in normal weight fat tissue. This led to an obvious question: by regulating mast cells, could we then control the symptoms?

To find out, Shi and colleagues took a group of obese and diabetic mice and, for a period of two months, treated them with either ketotifen fumarate (also called Zaditor) or cromolyn, both over-the-counter allergy drugs.

“We knew from published research that both cromolyn and Zaditor help stabilize mast cells in people suffering from allergy or asthma,” said Shi. “It’s almost as if the drugs place an extra layer of plastic on the ripped trash bag. So it seemed like a logical place to begin.”

The mice were divided into four groups. The first was the control group; the second group was simply switched to a healthy diet; the third was given cromolyn or ketotifen fumarate; and the fourth was both given the drug and switched to a healthy diet.

While symptoms of the second group improved moderately, the third group demonstrated dramatic improvements in both body weight and diabetes. The fourth group exhibited nearly 100 percent recovery in all areas.

To bolster these findings, Shi and colleagues then took a group of mice whose ability to produce mast cells was genetically impaired. Despite three months of a diet rich in sugar and fat, these mice neither became obese nor developed diabetes.

“The best thing about these drugs is that we know it’s safe for people,” says Shi. “The remaining question now is: Will this also work for people?”

Shi now intends to test cromolyn and ketotifen fumarate on obese and diabetic non-human primates.

The research was funded by grants from the National Institutes of Health.

Press Release - Jul 24, 2009

WASHINGTON - The American Hospital Association (AHA) today announced the winners of the AHA NOVA Award.  These five collaborative hospital-led programs work to improve community health by improving health habits and other social and educational factors leading to better health status and improving access to care.  Each program will be honored at a July 25 ceremony held during the association’s annual Health Forum Leadership Summit in San Francisco.

“We know that hospitals improve the health of a community by caring for the sick, but hospitals can also inspire and work with those around them, so that together they can extend their reach,” said AHA president and CEO Rich Umbdenstock.  “The AHA NOVA Award recognizes those hospitals that through collaboration provide for the community through education, outreach and so much more.”

Established in 1993, the AHA NOVA Award recognizes hospitals and health systems for their collaborative efforts toward improving community health.

The AHA NOVA AWARD winners are:

Student Success Jobs Program
Brigham and Women’s Hospital, Boston, Mass.
The Student Success Jobs Program (SSJP) is an intensive year-round employment and mentoring internship program for students of Boston public high schools.  The program introduces students from the city’s lowest-income communities to careers in health care, science and medicine by offering paid internships within the hospital.  Now in its eighth year, the program creates pathways into science, health or medicine careers for those who have traditionally been underrepresented in the field.   

SSJP is distinctive in that works on three levels to improve community health - by contributing to educational achievement for young people, enabling employment opportunity in communities of greatest need as well as increasing the diversity of the healthcare workforce as SSJP students proceed forward in their career.  SSJP is comprised of multiple components that support the educational and social growth of participants.  Aside from internships and mentoring from health care professionals, SSJP students attend monthly seminars, participate in academic tutoring, receive financial college scholarships and assistance with the college application process and have the opportunity to shadow physicians, nurses and other health care professionals in the emergency department, operating room and during patient rounds. 

The outcomes have been impressive, with 98 percent of SSJP high school seniors pursuing a college education after graduating and 94 percent of these students majoring in science, medical or health related fields of study.

Lighten Up 4 Life
Mission Health System, Asheville, N.C.
As part of an effort to educate the public on the importance of being aware of key health measurements, Mission partnered with its local Chamber of Commerce, newspaper and radio station to create a community-wide weight loss program called Lighten Up 4 Life (LU4L).  The program was designed as a five-month weight loss challenge, focusing on creating teams of employees at area businesses who encourage and support each other to lose weight and become healthier. 

Embraced by the entire community, over 3,000 individuals and 200 businesses participated in LU4L and over 20,000 pounds (or 5.2 percent overall) have been lost by participants.  The success of LU4L has created its own momentum with a second year already in progress and participating businesses working to stay involved.   

Project BRIEF
Jacobi Medical Center and North Central Bronx Hospital, Bronx, N.Y.
The goal of Project BRIEF is to increase access to HIV screening, provide risk reduction education and offer seamless linkage to care for those testing positive.  The Bronx has a death rate from AIDS that is nearly ten times higher than the national average, while many patients most at risk lack coverage or access to health care providers.  Because these patients primarily use the hospital emergency department for their care options, Project BRIEF offers HIV testing and education in the ED /Urgent Care area during all shifts, coupled with immediate linkage to clinical care.

Using specially designed educational videos and software, more patients can be efficiently seen and offered appropriate medical care.  From 2005 to July 2008, 14,690 patients agreed to be HIV tested and 98 were newly diagnosed or confirmed as HIV patients. 
 

Really Awesome Health (RAH) and Wholesome Routines
Duke Raleigh Hospital, Raleigh, N.C.
Established in 2000, RAH served as a model program for the larger initiative Wholesome Routines.  The goal of RAH is to provide health education to kindergarten through 2nd graders with the hopes of preventing illness, increasing preventive health screenings and developing life-long healthy habits.  Wholesome Routines evolved and took health education one-step further.  The school-based comprehensive nutrition and physical activity program is designed for 3rd and 5th graders in local counties.

Wholesome Routines provides assistance to approximately 700 students.  Some successes include a decreasing prevalence of overweight children from 43 percent to 34 percent; 28 percent of participants reporting having fewer servings of fried snacks; and 39 percent of students reporting an increase in their weekly physical activity by an hour.

Taos First Steps Program
Holy Cross Hospital, Taos, N.M.
The First Steps program provides new parents with information, support and access to resources in the community that promote early childhood development and a positive family foundation.  The program provides weekly home visiting services from the prenatal period until the child’s third birthday.  Parents learn about nutrition, preventive health care and pre-school readiness, which helps promote physically and mentally healthy children in a safe and nurturing family relationship.

In 2001, Taos established a formal collaboration to change the health and education status of its children.  First Steps eventually come about from this community collaboration that continues today.  During its first funded year beginning in July of 2007, First Steps provided 1,878 visits that served a total of 93 families. 

The 2009 AHA NOVA Award winners were selected from 58 applications, recommended by the AHA NOVA Award Committee and approved by the AHA Board of Trustees.  The award is co-sponsored by Hospitals & Health Networks magazine.

AHA NOVA Award winning programs share a common goal with the Association for Community Health Improvement (ACHI) – to improve community health.  ACHI is the premier national association for community health, healthy communities and community benefit and is an educational affiliate of the AHA NOVA award.

Press Release - Jul 21, 2009

Boston, MA – Heart failure occurs in an average 550,000 people each year in the United States. The lifetime risk of heart failure - the risk of ever developing heart failure during one’s remaining lifetime before dying from other causes - at 40 years of age is approximately one in five. Researchers at Brigham and Women’s Hospital found that men who followed a number of healthy lifestyle factors may reduce their risk of heart failure to one in ten. This research appears in the July 22, 2009 issue of the Journal of the American Medical Association.

“Previous relationships between various lifestyle factors and predictors of heart failure have been established,” said Luc Djoussé, MD, ScD, MPH, of the Department of Medicine at BWH, and lead study author. “But little was known about the joint contribution of these factors on the reduction of lifetime risk of heart failure.”

In a study of 20,900 healthy men from the Physicians’ Health Study I, researchers found that healthy men who had normal body weight, never smoked, got regular exercise, drank alcohol in moderation, and consumed breakfast cereal and fruits and vegetables lowered their lifetime risk of heart failure. A greater number of healthy lifestyle factors was associated with an increasingly dimished lifetime risk of heart failure, compared to men adhering to none of the six measured factors at highest lifetime risk, and those adhering to four or more at lowest lifetime risk.

During the follow-up more than 22 years after the study began, 1200 men had developed heart failure, and the overall risk of heart failure for the entire group was about one in seven for ages 40 years through age 70 years, with the risk dropping once men reached aged 80. Lifetime risk of heart failure was also found to be higher in men with hypertension than in those without hypertension.

“We know that hypertension is a contributing risk factor for heart failure,” said Dr. Djoussé. “However, we found that adhering to the specific lifestyle factors such as healthy body weight, not smoking, and regular exercise was associated with a lower lifetime risk of heart failure in the overall population and in men with hypertension, as well as those without hypertension.”

“By identifying a number of modifiable lifestyle factors, we can arm patients and physicians with targeted habits to help reduce the occurence of heart disease,” said Dr. Djoussé, noting the need for additional investigation into the effects of these factors on other populations.

The Physicians’ Health Study is supported by grants from the National Cancer Institute and the National Heart, Lung and Blood Institute.

Press Release - Jul 21, 2009

Boston, MA – As a  risk factors for stroke, heart attack, heart failure, chronic kidney disease and shortened life expectancy, high blood pressure (hypertension) contributes to more excess deaths in women than any other preventable factor. In a novel study that looked at a combination of healthy lifestyle choices in regards to hypertension, researchers at Brigham and Women’s Hospital (BWH) found that simultaneously addressing six modifiable risk factors drastically reduced the risk of developing hypertension. This research appears in the July 22, 2009 issue of the Journal of the American Medical Association.

Researchers investigated previously established factors that are independently associated with high blood pressure and found that, when combined, maintaining a normal weight, eating a healthy diet, exercising an average of 30 minutes per day, drinking alcohol in moderation, avoiding over the counter pain relievers and taking at least 400 micrograms of folic acid per day, resulted in a nearly 80 percent reduction in the risk of developing high blood pressure.

“If all of the women in the study followed these six low risk factors, then 78 percent of all new cases of high blood pressure may conceivably have been avoided,” said John Forman, MD, of the Renal Division at BWH and lead study author. Researchers studied nearly 84,000 women 27 to 44 years of age in the second Nurses’ Health Study (NHS II) who had normal blood pressure at the beginning of the study. After following the women’s diet and lifestyle over 14 years and determining whether or not they developed high blood pressure, researchers found that for each adopted healthy lifestyle change, the risk of developing hypertension decreased.

“Adopting these low-risk lifestyle factors could prevent the majority of new-onset hypertension in young women, including those with a family history of hypertension,” said Dr. Forman. “Previously, women may have believed that they had no control over their development of hypertension if their parents had hypertension, but this study demonstrates that they can reduce their risk,”.

Researchers also found that all but one of the low-risk factors could be adopted in any combination to decrease risk of development. Women who were obese, however, did not benefit from the other low-risk factors in any combination, indicating the added importance of maintaining a healthy weight.

This study was supported by grants from the American Heart Association and the National Institutes of Health.

Press Release - Jul 16, 2009

Boston, MA – Brigham and Women’s Hospital (BWH) has again earned high marks on the U.S. News & World Report annual Honor Roll of America’s Best Hospitals, ranking tenth among the 21 hospitals on the list. 2009 marks the 17th consecutive year that Brigham and Women's Hospital has appeared on the Honor Roll.

“The Brigham’s presence on the U.S. News & World Report Honor Roll stands as symbol of our employee’s dedication to our mission,” said Gary L. Gottlieb, MD, MBA, president of Brigham and Women’s Hospital. “This recognition is also a reflection of the talent and devotion of our entire community who embrace a commitment of delivering the best care possible to our patients and their families.” 

BWH ranked first in kidney disease for the third consecutive year, while also earning the top ranking in gynecology for the second year in a row. Three other specialties also received top-ten rankings, cardiology (#6), rheumatology (#7) and endocrinology (#7).  The hospital ranked among the top 20 in the nation for Cancer, Gastrointestinal Disorders, Respiratory Disorders, Orthopedics, and Urology and placed on the list for Geriatric Care, Neurology and Neurosurgery, and Otolarynology (Ear, Nose and Throat).

U.S. News ranked hospitals in 16 specialties and analyzed data on 4,861 medical centers to produce this year’s rankings.  Only 174 hospitals were ranked in one or more specialties and, of those, just 21 were of Honor Roll caliber.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Jul 15, 2009

Boston, MA – Melatonin supplementation can be a viable therapy for some of the 60 million Americans battling sleep problems, including those performing shift work and those suffering from jet lag. Researchers at Brigham and Women’s Hospital (BWH) and Biotek Inc. found that transdermal delivery of melatonin, through a skin patch, is successful in maintaining sleep for several hours during daytime. Thus, a patch may have advantages over oral melatonin, whose effect is often short-lasting. This research appears in the July 15, 2009 issue of Clinical Pharmacology & Therapeutics.
Melatonin, a hormone naturally produced in the pineal gland and secreted at night time, plays an important role in regulating sleep. “Melatonin supplements can be used to treat jet lag and some sleep problems by inducing sleep, particularly during hours of daylight when natural melatonin production does not normally occur,” said Daniel Aeschbach, PhD, of the Division of Sleep Medicine at BWH. “A limitation of this treatment has often been an inability to maintain sleep though, because melatonin taken orally often wears off quickly, as it is rapidly removed from the body.”

Researchers studied eight participants who received either a patch containing 2.1 mg melatonin or no drug. The controlled inpatient setting simulated a change from a traditional nighttime sleep schedule to a sleep schedule typical for shift workers, where participants were asked to sleep during the morning and into the early evening. By measuring melatonin levels in the blood, the researchers found that participants receiving the active patch showed elevated melatonin levels for an extended duration, differing greatly from a typical melatonin profile after oral administration.

“The melatonin levels in the blood observed with the active patch resembled natural nighttime melatonin levels more closely than did those previously observed after oral administration of melatonin.” said Dr. Aeschbach. “And importantly, melatonin levels rose gradually, such that the peak concentration occurred in the early evening, during the latter part of the bed rest.  We know – and shift workers know - that this is a time during which it is particularly difficult to remain asleep.”  The researchers found that when the study participants wore the active patch, they were indeed able to maintain sleep better, and their sleep was more comparable to natural nighttime sleep. 

Transdermal melatonin delivery may have promise not only for shift workers and individuals with jet lag, but also as a remedy against early-morning awakenings, a sleep problem frequently associated with older age.  Dr. Aeschbach notes that future research needs to be aimed at testing transdermal melatonin delivery in different populations with specific sleep problems. 

This study was supported by grants from the National Institutes of Health.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Jul 13, 2009

In the first and only study designed to compare a single prostate cancer treatment, brachytherapy, to a combination of treatment methods for differences in mortality rates in men with high-risk prostate cancer, researchers at Brigham and Women's Hospital (BWH) have found that a single treatment method of brachytherapy, also called seed therapy, alone is associated with higher death rates from prostate cancer. This research is published online and in an upcoming print edition of the Journal of Clinical Oncology.

"Despite the increasing numbers of men worldwide who choose to undergo brachytherapy alone for their high-risk, prostate cancer, the evidence supporting this treatment method alone based on survival data from randomized trials is lacking" said Anthony D'Amico, MD, PhD, lead researcher and chief of genitourinary radiation oncology at BWH."In order to get the highest cure rate for men with high risk prostate cancer, it appears that five weeks of external beam radiation and at least four months of hormonal therapy should be added to brachytherapy."

To address the difference in mortality rates, researchers evaluated the difference in the risk of death from prostate cancer in 1,342 men with high-risk cancer and at least a 10-year life expectancy. Participants were treated at one of 21 community- based medical centers in the United States using brachytherapy alone or in conjunction with hormone therapy (androgen suppression therapy), external beam radiation therapy or both. High-risk cancer was defined as having cancer felt beyond the prostate capsule on exam or having a prostate-specific antigen level over 20 or Gleason score between eight and 10 inclusive.
 
The study disclosed that despite a higher baseline risk of death from prostate cancer, men who underwent a combination therapy of brachytherapy, hormone therapy and external beam radiation had a lower risk of death from prostate cancer after treatment when compared to men who brachytherapy alone or the combination of external beam radiation and had brachytheapy or hormonal therapy and brachytherapy. 

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Related Links:
Center of Excellence: Cancer

Press Release - Jul 13, 2009

Press Release source: American Heart Association

Women who drink moderately may have a lower risk of cardiovascular disease (CVD) and death from CVD in part because of how alcohol affects the body's processing of fats and sugar in the blood, researchers report in Circulation: Journal of the American Heart Association. 

In an analysis of data from the Women's Health Study, researchers compared non-drinkers to moderate drinkers and found that an intake of one-half to one drink a day was associated with:

• 26 percent lower risk of CVD;
• 35 percent decrease in total mortality; and
• 51 percent decrease in CVD mortality.

CVD is a term that encompasses all diseases of the heart and blood vessels, including stroke and was defined in this study as a presence of heart attack, coronary bypass or angioplasty, stroke, or death from any of these conditions.

Moderate drinking was defined as 5 to 14.9 grams of alcohol a day - one-half to one drink.  However, the risk of CVD among women consuming 15 to 30 grams of alcohol a day (more than one but no more than two drinks a day) was not significantly different from the risk of CVD among non-drinkers. 

"Our data show that beyond one drink a day there isn't any benefit," said Luc Djoussé, M.D., D.Sc., lead author of the study, assistant professor of medicine at Harvard University and associate epidemiologist at Brigham and Women's Hospital and Veterans Affairs Healthcare System in Boston, Mass.

The effects of alcohol on blood fat was the most significant contributor to lowering the risk of CVD.  It explained almost 29 percent of the lowered risk.  Alcohol's effects on glucose metabolism accounted for about 25 percent of the lowered risk. 

The effects of moderate drinking on inflammatory/hemostatic factors and blood pressure had a neglible contribution to the reduction in CVD risk, accounting for 5 percent and 4.6 percent respectively.  These mediating factors explained 86.3 percent of the lower risk of CVD, but only about 19 percent of total mortality and 22 percent of CVD mortality. 

"The findings add to a large body of evidence showing that moderate drinking favorably affects lipids and glucose metabolism, and thus contributes to a lower risk of cardiovascular disease in women," Djoussé said. 

"The American Heart Association suggests a limit of one drink per day for women who already drink alcohol," said Jennifer H. Mieres, M.D., spokesperson for the association's Go Red For Women campaign and director of Nuclear Cardiology at New York University.  "However, those who do not currently drink alcohol don't need to start drinking to prevent cardiovascular disease.  As the study's authors point out, alcohol can raise the risk of breast cancer, high blood pressure and alcohol abuse.  There are many ways women can lower their risk of cardiovascular disease." 

In the study, researchers analyzed alcohol consumption in the past 12 months of 26,399 women, average age 55 years.  The researchers assumed that 12 ounces of beer contains 13.2 grams of alcohol, 12 ounces of light beer contains 11.3 grams, four ounces of wine contains 10.8 grams and 1.5 ounces of liquor contains 15.1 grams of alcohol.  Total alcohol intake was computed as the sum of alcohol content in beer, wine and spirits.  Infrequent drinkers, moderate drinkers who drank one-half to one drink a day  (5 - 14.9 grams per day), and heavy drinkers were compared to non-drinkers.

Alcohol intake was strongly related to higher levels of high-density lipoproteins (HDL), the good cholesterol, as seen in previous studies, Djoussé said.  "It may be that moderate drinking improves fat and muscle cells' ability to absorb glucose and may improve the levels of adiponectin, a hormone known to lower the risk of diabetes."

The effects of moderate drinking on inflammatory and hemostatic factors as well as blood pressure were minimal in explaining the lower risk of CVD in moderate drinkers, he said. "Drinking alcohol can be a double-edged sword, as alcohol can raise blood pressure."

During follow-up of more than 12 years, 1,039 CVD events, 785 confirmed total deaths and 153 CVD deaths occurred.  The lowest CVD risk was in women who consumed 5 to 14.9 grams - or about one-half to one drink of alcohol a day.

Similarly, researchers found a relationship between alcohol consumption and total and CVD mortality, with the largest effect observed in women consuming half to one drink a day.  However, no single factor explained most of the reduction in mortality.

"Even when putting all the factors together, only about 20 percent of the reduction in mortality was explained by the effects of moderate drinking on lipids, glucose metabolism, blood pressure and inflammation/hemostatic factors," Djoussé said.

Besides limiting alcohol to no more than one drink a day - due to the potential increased risk of breast cancer - "women should also stop smoking, eat a healthy diet, maintain a normal weight and exercise," he said.

Co-authors are I-Min Lee, M.B.B.S., Sc.D.; Julie E. Buring, Sc.D.; and J. Michael Gaziano, M.D.  Individual author disclosures can be found on the manuscript.

The National Institutes of Health funded the study.

Related Links:

• Center of Excellence: Cardiovascular
• AHA alcohol recommendations
• AHA scientific statement

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Jun 30, 2009

Boston, MA – In the U.S. back pain continues to be a leading cause of disability and one of the most common reasons to see a physician for evaluation. Among various treatment options is spinal fusion surgery, which may use a biological agent known as bone-morphogenetic protein (BMP). Researchers at Brigham and Women’s Hospital (BWH) found that BMP is used in 25 percent of spinal fusion surgeries and is associated with a higher rate of complications in certain types of fusions as well as greater hospital charges, compared to fusions that do not use BMP. This research appears in the June 30, 2009 issue of the Journal of the American Medical Association.
Researchers looked at the outcomes of more than 300,000 patients who underwent spinal fusion surgery. “The use of BMP in these surgeries jumped from less than one percent in 2002 to 25 percent in 2006,” said Kevin Cahill, MD PhD, of the Neurosurgery Department at BWH and  lead author of the study. “With the use of BMP on the rise, this study illustrates the need to determine the cost-effectiveness of the product in different procedures.”

The researchers found that immediate postoperative, in-hospital rates of complications among patients undergoing spinal fusion by BMP use status were no higher for lumbar, thoracic, or posterior cervical procedures. However, the use of BMP in anterior cervical fusion procedures was associated with a higher rate of complication occurrence, with the primary increases seen in wound-related complications and dysphagia or hoarseness. BMP use was associated with a longer length of stay in the hospital and greater inpatient hospital charges across all categories of fusion, with an 11 to 41 percent increase in total hospital charges.

“This study has highlighted the need to continue to develop refined guidelines for BMP usage and to further study its long-term risks and benefits,” concluded Dr. Cahill. Other investigators on the study include John H. Chi, MD, PhD, Arthur Day, MD, and Elizabeth B. Claus, MD, PhD, all of the Neurosurgery Department at BWH.

This study was funded by the Brain Science Foundation.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Jun 29, 2009

Boston, MA - Researchers at Brigham and Women’s Hospital (BWH) found that diabetics hospitalized for non-critical illnesses who develop hypoglycemia during hospitalization have an increased likelihood of remaining hospitalized longer and a greater risk of mortality both during and after hospitalization. This research appears in the July 2009 issue of Diabetes Care.

Previous research showed an increased risk of mortality, seizures and coma in patients who, while admitted to the intensive care unit (ICU), developed hypoglycemia. “Ours is the first study to examine mortality risks for hospitalized diabetes patients outside of a critical care setting,” said Alexander Turchin, MD, of the Endocrinology Department at BWH. “This is crucial because a majority of hospitalized diabetics are treated on the general ward rather than the ICU.”

Researchers examined the medical records of more than 2,500 diabetics admitted to the general ward of a teaching hospital. They studied the association between the number and severity of hypoglycemic episodes with inpatient mortality, length of hospital stay and mortality within one year of discharge.

This study found that for each hospital day with at least one hypoglycemic episode, there was an 85.3 percent increased risk of dying as an inpatient and a 65.8 percent increased risk of dying within one year of discharge. The odds of inpatient death also tripled for every 10 mg/dl decrease in the lowest blood glucose during hospitalization. Additionally, a patient’s length of stay increased by 2.5 days for each day spent in the hospital with a hypoglycemic episode.

“Hypoglycemia is common among diabetics admitted to the general ward,” said Dr. Turchin. “These findings provide support for considering increased monitoring, more aggressive treatment of infections, and transitioning to a more intensive care setting for diabetic patients who have developed hypoglycemia in the general ward.”

The study was funded by grants from the Diabetes Action Research and Education Foundation and the National Library of Medicine.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Jun 26, 2009

BOSTON -- June 26, 2009 -- In collaboration with Boston's disability community and the Boston Center for Independent Living (BCIL), Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH) have begun a comprehensive and landmark effort to improve access and care for people with disabilities. The initiative was announced this morning at MGH where the presidents of both institutions -- the founding hospitals of Partners HealthCare - joined individuals with disabilities to present the new collaboration. 

The initiative is comprehensive in scope. It includes an ongoing assessment by the MGH and BWH and the BCIL of the degree to which the hospitals are addressing the needs of people with disabilities, and what steps need to be taken to further improve care. These are likely to include:

• removing architectural barriers in hospitals, off hospital campus physicians' offices and health centers (including exam rooms, patient rooms, treatment rooms, waiting areas, gift shops and parking areas);
• purchasing additional medical equipment and devices that are accessible for people with disabilities (including wheelchair scales, power adjustable exam tables, power door openers, mammography);
• modifying hospital policies and procedures that address issues related to the care of people with disabilities;
• developing a training program for all staff including physicians, nurses and support staff who interact with patients and visitors.

In announcing the collaboration, Brigham and Women's Hospital President Gary L. Gottlieb, MD, MBA said "This initiative is intended to go well beyond providing ramps and eliminating architectural barriers. It is designed to build a stronger partnership between health care providers and patients with disabilities, and help to fundamentally change the culture of access and care for people with disabilities." 

MGH President Peter L. Slavin, MD, commended members of the disability community for their "courage, tenacity and willingness" to work with the hospitals to address this challenging problem. "This collaboration is about developing a deeper understanding of the needs of people with disabilities and reaffirming our commitment to provide the best care to all of our patients," said Dr. Slavin.

"We hope this process can be a catalyst for improving access and health care for people with disabilities in Massachusetts and throughout the country," said Bill Henning, director of BCIL.  Greater Boston Legal Services (GBLS), which worked collaboratively with BCIL, BWH, and MGH to develop the wide-ranging plan to better address the needs of patients with disabilities at the hospitals, called the initiative a "model for hospitals in Massachusetts and nationwide."

In April 2008, the BCIL and GBLS made BWH and MGH aware that patients with disabilities felt they were not consistently getting the care and services they needed. Patients with disabilities cited a number of concerns including: not being weighed because they use a wheelchair, but being worried because certain medicines are dosed by weight; being examined in a wheelchair instead of on an adjustable exam table; a lack of sensitivity to their disability by some caregivers.

The patients' statements were taken very seriously by the hospitals, and during the past year, representatives from the hospitals, Partners HealthCare, BCIL and GBLS met frequently to develop a comprehensive plan to address the problems. In the meantime, the hospitals continued implementing a number of previously planned patient improvements.

Both BWH and MGH have large disability awareness councils composed of representatives from a full range of hospital departments, including patient care and nursing, human resources, facilities, support services and senior management. The goal of the councils is to support the hospitals' efforts to be first-rate providers of choice for people with disabilities.

Some of the issues identified by the BCIL had already been raised by the disability awareness councils in the hospitals. The councils have used the discussions with the BCIL to reassess their priorities.  The hospital disability awareness councils understand, and it is clear in the initiative, that the definition of disabilities goes beyond mobility issues and patients who are deaf and blind, to include the elderly and other patients with partial hearing loss and/or other visual impairments, the frail, and those with non-visible disabilities.

SOURCE: Partners HealthCare

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org. 

Press Release - Jun 23, 2009

The potential health benefits of vitamin D and marine omega-3 fatty acids are receiving increasing attention in both the media and medical field; however, definitive evidence on the health benefits and risks of these supplements is not yet available.  Researchers at Brigham and Women's Hospital (BWH) will soon launch the largest randomized trial of vitamin D and omega-3s in the primary prevention of chronic disease. 

Adding to the recent Associated Press report on the VITamin D and OmegA-3 TriaL (VITAL), the study's co-leader, JoAnn E. Manson, MD, said, "Vitamin D and omega-3's are two of the most promising nutrients we know of for the prevention of cancer, heart disease, stroke, and many other chronic diseases, but we need large-scale randomized trials to clarify the benefits and risks."   Manson, who is also chief of Preventive Medicine at BWH added, "What is most exciting is that these low-cost supplements have the potential of tremendously reducing the burden of chronic disease in this country and throughout the world if they are shown to be effective." She and Julie Buring, ScD, an epidemiologist in the Division of Preventive Medicine at BWH, will co-direct the study.

Researchers are also excited about the possibility of reducing many of the health disparities seen by race and ethnicity.  For example, African-Americans have a higher risk of vitamin D deficiency as well as a greater frequency of diabetes, hypertension, and certain types of cancer.  "We are excited about the potential of vitamin D to reduce this health gap, but it is important to get answers from clinical trials before recommending mega-doses of this supplement," said Manson.

There is epidemiological evidence that vitamin D and omega-3 may play a role in the prevention of disease, but larger primary prevention trials have not been conducted until now.  For vitamin D, previous trials have generally tested low doses and, for omega-3s, trials have been done in high-risk populations. This randomized, double-blind, placebo-controlled clinical trial will enroll 20,000 participants throughout the entire U.S. to determine whether moderate-to-high doses of these supplements can prevent colorectal, breast, prostate, and other cancers, as well as heart disease and stroke.  Those eligible for the five-year trial, including women older than 65 and men older than 60 without a prior history of cancer, heart disease, or stroke, will be randomly assigned to take either one or both of the supplements or placebo. 

Additional studies will look at whether these nutrients have a role in preventing a wide range of other health conditions. "The trial will be a rich resource for answering questions about the effects of vitamin D and fish oil on myriad health conditions besides cancer and heart disease - from cognitive function to vision disorders to diabetes to bone fractures," said Buring.

Mechanism-wise, both vitamin D and omega-3s have powerful anti-inflammatory effects and also work through multiple other pathways that may have a role in preventing chronic disease.  "We are hopeful that this study will provide definitive proof of the effect of these nutrients on several health outcomes," added Buring. 

Researchers note that while the potential for vitamin D and omega-3s for reducing chronic diseases is great, it is important to be cautiously optimistic.  "We tend to forget the lessons of other nutrients -- many had high hopes for vitamin E, vitamin C, beta-carotene, folic acid, selenium, and other supplements as preventive tools for many diseases, but large-scale trials didn't confirm the hoped-for benefits and even found some risks when consumed at higher levels.  Let's not jump on the bandwagon to take mega-doses of these supplements before clinical trials help to clarify their role," Manson said.

The study is funded by the National Institutes of Health through the National Cancer Institute and the National Heart Lung and Blood Institute, as well as through other institutes and agencies that are co-funding the trial.

To learn more about the study, visit www.vitalstudy.org.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org. 

Press Release - Jun 22, 2009

Boston, MA – Each year nearly 500,000 total knee replacements (TKR) are performed in the US at a cost exceeding $11 billion. Due to the aging population, projections indicate dramatic increases in TKRs over the next two decades. Researchers at Brigham and Women's Hospital (BWH) have found that TKR in US Medicare-aged population is very cost-effective, across various patient risk levels for post-surgical complications. Further results note that TKR performed at a high-volume health center yields better value compared to those performed at lower volume centers. This research appears in the June 22, 2009 issue of Archives of Internal Medicine.

The researchers examined whether cost-effectiveness of TKR is affected by patients’ surgical risk and the volume of TKRs performed at the procedure site. The study showed that TKR shows consistent success and cost-effectiveness across all surgical risk groups and that TKR was more costly and less effective in low-volume than high-volume centers.

“Because health care expenditures related to TKR are substantial, it is critical to understand the value obtained for the money spent on TKR,” said Elena Losina, PhD, co-director of Orthopedics and Arthritis Center for Outcomes Research in the Department of Orthopedic Surgery at BWH, associate professor of orthopedics, Harvard Medical School, and lead author of the study. Dr. Losina and colleagues developed a mathematical model to simulate the outcomes of end stage knee osteoarthritis in a Medicare population with and without TKR. In addition to pain relief, the model considered adverse events including surgical complications and prosthesis failure.

Researchers found that TKR added  on average 1.1 quality adjusted years (QALYs) per patient receiving the procedure and increased costs by about $20,000, yielding a cost-effectiveness ratio of $18,300/QALY gained.  According to US thresholds, TKR appears to be very cost-effective.  In other words, for every $18,300 in costs associated with total knee replacement, one individual would gain one additional quality adjusted year of life because of the TKR. “Importantly, results do not necessarily suggest  that a person will live longer but rather that they will experience improvement in the quality of each year lived," said Dr. Losina, who is also an adjunct associate professor of Biostatistics at Boston University School of Public Health.

“This work is a natural continuation of our previous research where we found that mortality rates, and risk for postoperative complications, and failure of the knee replacement generally decrease for those who have the procedure at a high-volume center,” said Jeffrey N. Katz, MD, director of the Orthopedic and Arthritis Center for Outcomes Research at BWH, and senior study author .

"Medicare patients and their referring physicians should consider these findings when discussing TKR options for knee osteoarthritis. Higher volume centers lead to better outcomes and confer a better value” said Dr. Losina. “Having a TKR in low-volume hospital is, however, preferable to not having TKR at all, as TKR at a low-volume hospital still provides tangible improvement in quality of life and confers a good value for cost."

This study was funded by grants from National Institute of Arthritis, Musculoskeletal and Skin Disease and the Arthritis Foundation. Contributing authors include Rochelle P. Walensky, MD, MPH, Courtenay L. Kessler, MS, Parastu S. Emrani, William M. Reichmann, MA, Elizabeth A. Wright, PhD, Holly L. Holt, Daniel H. Solomon, MD, MPH, Edward Yelin, PhD, A. David Paltiel, PhD and Jeffrey N. Katz, MD, MS.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

BWH Orthopedics and Arthritis Center

Press Release - Jun 19, 2009

Researchers at Brigham and Women's Hospital and the University of Michigan have developed a software program that prescribes a regimen for avoiding jet lag using timed light exposure. The method is described in an article published June 19 in the open-access journal PLoS Computational Biology.

Traveling across several times zones can cause an individual to experience jet lag, which includes trouble sleeping at night and difficulty remaining awake during the day. These effects largely reflect de-synchronization between the body's internal time clock and local environmental cues.

The program, which seeks to re-synchronize the body with its new environment, considers inputs like background light level and the number of time zones traveled. Then, based on a mathematical model, the program gives users exact times of the day when they should apply countermeasures such as bright light to intervene and reduce the effects of jet lag.

Timed light exposure is a well known synchronization method, and when used properly, this intervention can reset an individual's internal clock to align with local time. The result is more efficient sleep, a decrease in fatigue, and an increase in cognitive performance. Poorly timed light exposure can prolong the re-synchronization process. Using their computational method,  researchers simulated shifting sleep-wake schedules and the subsequent light interventions for

realigning internal clocks with local time. They found that the mathematical computation resulted in quicker design of schedules and also predictions of substantial performance improvements. They were able to show that the computation provided the optimal result for timing light exposure to reduce jet lag symptoms.

"Using this computation in a prototyped software application allows a user to set a background light level and the number of time zones traveled to obtain a recommendation of when to expose a subject to bright light, such as the bright lights sometimes used to treat Seasonal Affective Disorder" said lead-author Dennis Dean. "Although this method is not yet available to the public, it has direct implications for designing schedules for jet lag, shift-work, and extreme environments, such as in space, undersea or in polar regions."

"This work shows how interventions can cut the number of days needed to adjust to a new time zone by half," said co-author Daniel Forger.

The next phase of this research includes the addition of interventions such as naps, caffeine and melatonin to help the process of realigning the internal body clock while reducing decreased performance experienced during travel across time zones.

To learn more about why sleep matters, the science behind it and how to improve your sleep, visit http://healthysleep.med.harvard.edu/.

FINANCIAL DISCLOSURE: The work described in this article was supported by US AFOSR F49620-95-1-0388 and F49620-95-1-0388, NASA Cooperative Agreement NCC 9-58 with NSBRI HPF-00405, NIH M01-RR02635 and NIH R01-NS36590. EBK is also supported by NIH K02-HD045459. DBF is an AFOSR Young investigator. DAD is also supported by T32 HL07901-10. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org. 

Press Release - Jun 8, 2009

Dry eye disease is common among American men older than 50 and increases with age, high blood pressure, benign prostate disease and the use of antidepressants, according to researchers at Brigham and Women's Hospital (BWH) in a report in the June issue of Archives of Ophthalmology.

Dry eye is one of the most common eye diseases and reason that older adults seek eye care, according to background information in the article. "It is an important public health problem, causing increased risk of ocular infections and bothersome symptoms of ocular discomfort, fatigue and visual disturbance that interfere with crucial activities such as reading, working on a computer and driving a car," the authors write.

Debra A. Schaumberg, Sc.D., O.D., M.P.H., of BWH, and colleagues estimated the prevalence of and examined risk factors for dry eye disease among 25,444 U.S. men who participated in the Physicians' Health Study I and II. The men were asked if they had ever been diagnosed with dry eye disease and also whether they had symptoms, including dry or irritated eyes.

Overall, 765 men (3 percent) reported being diagnosed with dry eye, 6.8 percent experienced at least one symptom (dryness or irritation) constantly or often and 2.2 percent reported both symptoms constantly or often. The total age-standardized prevalence of dry eye disease among men 50 and older was estimated to be 4.34 percent. Men 75 years and older were more likely to have the condition-prevalence increased from 3.9 percent among men age 50 to 54 to 7.7 percent among men age 80 and older. High blood pressure, benign prostatic hyperplasia (a non-cancerous enlargement of the prostate) and the use of medications to treat depression, hypertension or hyperplasia were also associated with an increased risk of dry eye disease.

"The present study estimates that approximately 1.68 million men 50 years and older are affected with dry eye disease in the United States," the authors write. "These data, derived from studying more than 25,000 men, show a significantly lower prevalence of dry eye disease than was found in a similar study using the same methods in U.S. women, among whom the prevalence was estimated at 3.23 million women. Nonetheless, there is a significant increase in the prevalence of dry eye disease with age among men, as is the case among women, and there is a predicted growth to 2.79 million U.S. men affected by dry eye disease in 2030."

"Given the increasing recognition of the adverse visual impact of dry eye disease, and the high level of bother patients report because of its irritative symptoms, we hope that these data from a large and well-characterized group of U.S. men will provide further motivation for clinicians and researchers to understand this disease and develop more effective and targeted interventions for patients," they conclude.

This research was supported by National Institutes of Health grants and the Joint Clinical Research Center, Massachusetts Eye and Ear Infirmary and Schepens Eye Research Institute, Boston.  

Source: Archives of Ophthalmology, one of the JAMA/Archives journals.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org. 

Press Release - Jun 4, 2009

Researchers at Brigham and Women's Hospital (BWH), have found that older men, who are otherwise healthy, benefit from aggressive treatment for unfavorable-risk prostate cancer, a finding that draws contrasts with a recent US Preventive Task Force recommendation stating that older men should not be screened for prostate cancer. These findings are published online and in an upcoming print issue of the International Journal of Radiation Oncology, Biology Physics.  

"When the US Preventive Services Task Force recommended against PSA screening for any man over 75 years old, it gave some people the impression that it isn't worthwhile to either find or treat prostate cancer in older men. However, our study found that if an older man is diagnosed with unfavorable-risk prostate cancer, aggressive treatment can improve his chances of surviving, just as it does for younger men, provided that he is otherwise relatively healthy, said Paul L. Nguyen, MD, a radiation oncologist at the Dana-Farber/Brigham and Women's Cancer Center. "This tells us that it's not just age alone, but also overall health status that must be considered when deciding whether or not to aggressively treat men with prostate cancer,"

In this study, researchers reanalyzed a randomized trial comparing radiation therapy plus hormone therapy versus radiation therapy alone for men with clinically localized unfavorable-risk prostate cancer (such as Gleason score 7 or higher, or PSA >10).  The original trial had shown that patients who were randomized to a combination of radiation and hormones lived longer than those randomized to radiation alone. In this reanalysis, researchers focused on the subgroup of  78 men who were older than the median age of 72.4 yrs and found that those over the median age also obtained a significant survival benefit with more aggressive treatment as long as they were otherwise healthy, or had little to no other health issues (comorbidities), aside from their prostate cancer. They also found that older men who had some or many additional health issues, did not benefit from the more aggressive treatment.  

"As clinicians, we must not use strict age cutoffs when deciding which patients should be treated aggressively. We must evaluate the entire patient including his age, additional health issues and longevity," said Nguyen.    

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org. 

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Center of Excellence: Cancer

Press Release - May 27, 2009

Researchers at Brigham and Women’s Hospital (BWH) found that elderly adults who live below the poverty line and perceive their neighborhoods to be dangerous are more likely to have a mobility disability. These findings appear in an online publication of the journal BMC Public Health on May 28, 2009.

The team of researchers studied 1,884 people aged 65 and older, measuring both the individuals’ perceptions of danger and the levels of violent crime actually reported in the areas where they lived. Although these measures correlated quite well, it was the elder’s sense that the neighborhood was unsafe that was most strongly associated with the development of a disability.

“Our results suggest that dangerous neighborhoods get from the mind into the body and engender mobility disability through psychosocial or psychological processes,” said Cheryl Clark, MD, ScD, of the Department of Medicine at BWH.

The researchers suggest that lower income elderly who live in unsafe neighborhoods may have fewer resources to cope with neighborhood stresses. Moreover, neighborhoods with high crime rates or a reputation for being dangerous may have more difficulty attracting businesses that provide material resources and services. In addition, the correlation between perceived danger and actual danger also suggests that elders may have been reacting to actual crime events in their neighborhoods. 

“Our findings underscore the importance of neighborhood safety to healthy aging. Specifically intervening to improve perceptions of neighborhood safety at retirement age may be an important step to reduce the risk of mobility disability among elders,” concluded Clark.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - May 22, 2009

Boston, MA - Dr. Gary L. Gottlieb, President of Brigham and Women's Hospital, will be the keynote speaker at Bunker Hill Community College's 35^th commencement exercises, on Saturday, May 30, at 11:00 a.m. Dr. Gottlieb, a strong proponent of alleviating health care disparities, will receive the President's Distinguished Service Award  in recognition of his outstanding commitment and service to the College.

"Dr. Gottlieb is a visionary  leader  with a lifelong commitment to healthcare based on equity and affordability," said Mary L. Fifield, Ph.D., President of the College. "His  dedication to our College has been shown time and again. He was instrumental in the design of our College's strategic goals. Further, he has spearheaded partnerships between BHCC and Brigham and Women's Hospital to help hospital employees upgrade job skills and to enable our students to obtain clinical experience."

Gottlieb became president of Brigham and Women's Hospital in 2002.  In January of 2010, he will become president of Partners HealthCare, the largest healthcare provider in Massachusetts.

In 2005, Boston's Mayor Thomas Menino appointed Dr. Gottlieb chair of the Private Industry Council, the city's workforce development board.  The Council works with education, labor, government and the community to oversee public and private workforce development programs. 

From 1998-2002, Dr. Gottlieb served as Chairman of Partners Psychiatry and Mental Health System in Boston. Prior to his arrival in Boston, he served as Director and Chief Executive Officer of Friends Hospital in Philadelphia, the nation's oldest, independent, psychiatric hospital. He was appointed to that position in 1994.

Gottlieb received his M.D. from Albany Medical College of Union University, in New York State. He received a master's degree in Business Administration at the University of  Pennsylvania, and a B.S. cum laude from Rensselaer Polytechnic Institute in New York State.

Bunker Hill Community College is the largest community college in Massachusetts. The College enrolls almost 9,800 students on two campuses and at five satellite locations each semester. Some 2,000 students take classes online. BHCC is one of the most diverse institutions of higher education in the Commonwealth. Six in ten students are people of color and more than half of BHCC's students are women. The College also enrolls more than 690 international students who come from more than 103 countries and speak 75 different languages.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - May 13, 2009

Boston, MA - Guillermo García-Cardeña, director of the Laboratory for Systems Biology of the Center for Excellence in Vascular Biology at Brigham and Women's Hospital (BWH) and George Q. Daley, MD, PhD, director of the Stem Cell Transplantation Program at Children’s Hospital Boston (CHB), along with scientists from the Indiana University School of Medicine, intrigued by the appearance of blood progenitors in the wall of the developing aorta soon after the heart starts beating,  investigated the effects of mechanical stimulation on blood formation in cultured mouse embryonic stem cells. Their findings appear in the May 13, 2009 issue of Nature.

They showed that shear stress - the frictional force of fluid flow on the surface of cells lining the embryonic aorta - increases the expression of master regulators of blood formation, including Runx1, and of genetic markers found in blood stem cells. Shear stress also increased formation of colonies of progenitor cells that give rise to specific lineages of blood cells (red cells, lymphocytes, etc.). These findings demonstrate that biomechanical forces promote blood formation.

García-Cardeña, Daley and colleagues also studied mouse embryos with a mutation that prevented initiation of the heartbeat. These embryos had a sharp reduction in progenitor blood cell colonies, along with reduced expression of genetic markers of blood stem cells. When specific cells from the mutant embryos were exposed in vitro to shear stress, markers of blood stem cells and numbers of blood cell colonies were restored.

Finally, the team showed that when nitric oxide production was inhibited, in both cell cultures and live mouse embryos, the effects of shear stress on blood progenitor colony formation were reduced.

“In learning how the heartbeat stimulates blood formation in embryos, we’ve taken a leap forward in understanding how to direct blood formation from embryonic stem cells in the petri dish,” says Daley, who is also affiliated with the HSCI.

“These observations reveal an unexpected role for biomechanical forces in embryonic development,” adds García-Cardeña. “Our work highlights a critical link between the formation of the cardiovascular and hematopoietic systems.”

The authors speculate that drugs that mimic the effects of embryonic blood flow on blood precursor cells, or molecules involved in nitric oxide signaling, might be therapeutically beneficial for patients with blood diseases. For example, nitric oxide could be used to grow and expand blood stem cells either in the culture dish or in patients after transplantation.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - May 12, 2009

BW/F's Leadership in Equal Treatment of LGBT Patients Highlighted in Human Rights Campaign Foundation & Gay & Lesbian Medical Association's Index

Boston, MA - Brigham and Women's/Faulkner Hospitals (BW/F) proudly announce that they have been named top performers in the Healthcare Equality Index 2009. The HEI is an annual survey administered by the Human Rights Campaign Foundation and Gay and Lesbian Medical Association. BW/F earned top marks for their treatment of lesbian, gay, bisexual, and transgender patients and employees. BW/F are two of only ten hospitals to earn a complete score on all survey dimensions among the 166 participating hospitals and clinics.

"We at Brigham and Women's and Faulkner Hospitals in Boston are thrilled to have participated in the HEI survey in 2009, and we vigorously embrace the commitment to inclusion and diversity in healthcare that it embodies," said Dr. Michael Gustafson, Brigham and Women's Hospital's senior vice president for Clinical Excellence.  "And while we are proud of our perfect HEI score, we are equally gratified that the process of self-assessment has stimulated significant new quality improvement activity to further bolster our care policies and practices for both LGBT patients and our LGBT staff."

The HEI focuses on key policies and practices that ensure culturally competent healthcare for the lesbian, gay, bisexual and transgender patients and families. These policies address patient non-discrimination, visitation rights, decision-making practices, and employee benefits and non-discrimination. BW/F's efforts in ensuring healthcare equality for the LGBT community earned it the distinction of being among the 10 participants to answer "yes" to each of the survey's main criterion which applied to them.

For more information on the Healthcare Equality Index 2009, or to download a free copy of the report, visit www.hrc.org/hei.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Faulkner Hospital, founded in 1900, is a 150 bed non-profit, community teaching hospital located in Jamaica Plain, MA.  In 1998, Faulkner Hospital, highly regarded as one of the region's most respected community teaching hospitals, joined with Brigham and Women's Hospital, one of the country's leading academic medical centers, to form a common parent company.  Faulkner has a long history of meeting the health care needs of the residents of southwest Boston and surrounding suburbs and offers comprehensive medical, surgical and psychiatric care as well as complete emergency, ambulatory and diagnostic services.  The hospital also serves as a site for training several hundred health care professionals, annually, in the areas of nursing, nutrition, pharmacy, social work, psychiatry, rehabilitation therapies, addiction recovery and more.  Faulkner is dedicated to improving the health and well being of residents of the community and serves over 60,000 men, women, children and elderly each year through a wide variety of preventive health education, free health screenings, school partnerships and community outreach. More information at www.faulknerhospital.org

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Press Release - May 11, 2009

Men with 4+3 score are at three fold greater risk

Boston, MA - The Gleason scoring system is an important method of classifying prostate cancers based on the appearance of the prostate cancer cells under a microscope.  Gleason patterns range from one to five, with higher Gleason patterns being associated with more aggressive disease. The Gleason score, which ranges from two to ten and is calculated by adding the primary (most prevalent) and secondary Gleason patterns, is an important prognostic tool for clinicians. Studies showing that short-term outcomes for prostate cancer differ according to Gleason scores have helped to guide clinical practice.  Now, researchers at Brigham and Women's Hospital (BWH) have shown that Gleason score is a strong predictor of prostate cancer mortality and that mortality rates differ among patients with a Gleason score of seven depending on whether Gleason pattern four is primary or secondary.  This research was published online in the Journal of Clinical Oncology.

Researchers collected tissue samples from prostatectomies and biopsies from men who were diagnosed with prostate cancer between 1984 and 2004 and were enrolled in the Physicians' Health Study and Health Professionals Follow-up Study. The samples were assigned primary and secondary Gleason patterns by study pathologists.  Researchers found that within the group of men with Gleason scores of seven, men with primary and secondary patterns of 4 and 3 respectively had worse long-term outcomes compared to men with a primary pattern of 3 and secondary pattern of 4.

"Four plus three cancers were associated with a three-fold increase in lethal prostate cancer compared to three plus four cancers," said Jennifer Rider Stark, Post-doctoral research fellow at BWH and the Harvard School of Public Health.  "If we are lumping these cancers into one category of Gleason score 7, then we are missing important prognostic information." 

Lethal prostate cancer was defined by the development of bony metastases or prostate cancer death.  Current clinical practice evaluates and treats men with three plus four cancer differently than a man with four plus three cancer, but until now there was no long-term mortality data to support this practice.  Clinicians were making these decisions based primarily on surrogate outcomes such as prostate-specific antigen relapse.

"This study provides clinicians with further evidence that men who have Gleason scores of seven should be evaluated based on the predominant Gleason pattern," Stark said.

This research was funded by grants from the National Cancer Institute.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

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            BWH Center of Excellence: Cancer

Press Release - Apr 28, 2009

Boston, MA - Intramuscular injections of vascular endothelial growth factor (VEGF) gene show promise for improving neuropathic symptoms in individuals with diabetic polyneuropathy, a condition most commonly affecting diabetics who have had the disease for many years. These findings were presented in April at the American Academy of Neurology Annual Meeting in Seattle.

Symptoms associated with diabetic polyneuropathy include loss of sensation and pain in the legs and feet, weakness, and imbalance. Due to loss of sensation, the development of ulcerations on the feet often go undetected, potentially resulting in amputation, a procedure 15 times more prevalent in diabetics.

Study participants who received the VEGF gene injection had improvement in sensory symptoms and pain, though not in many other characteristics such as nerve conduction tests. “Most patients had fairly severe neuropathy and the expectation for improvement was therefore not high” said Allan Ropper, MD, executive vice chair of the Department of Neurology at Brigham and Women’s Hospital (BWH).

Preclinical studies using animal models have shown that injecting VEGF into the muscle adjacent to nerve trunks can improve clinical function, blood flow in the nerves, and electrophysiological function.

Thirty nine patients were randomly chosen to receive three sets of intramuscular injections of plasmid VEGF in one leg while 11 patients received a placebo in one leg. The injections were given at eight standardized sites adjacent to the sciatic, tibial, and peroneal nerves. Six months after treatment, participants receiving the VEGF injection had greater improvement in symptoms in the injected leg than those receiving the placebo.

In this study, the investigators used a form of the gene that is active without packaging it in a virus, offering a major advantage in safety. “The study shows that this form of gene transfer therapy can be performed relatively safely but further investigation using a larger study group is needed before it can be introduced as a mainstream therapy,” said Dr. Ropper, noting that this study was limited by its small size and rigid participation criteria.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Apr 27, 2009

Researchers implemented an enhancement in the electronic health record to improve rates of smoking cessation.
 
Boston, MA – Although the dangers of smoking are well known, tobacco still remains the number one cause of preventable death in the United States. The US Public Health Service recommends that physicians ask all patients about their tobacco use and connect them to cessation services, but there are still many patients who are never asked about their smoking habits. Researchers at Brigham and Women’s Hospital (BWH) have found that by enhancing the electronic health record, physicians were more likely to document a patient’s smoking habit and that access to cessation counseling was improved. This research is published April 27, 2009 in the Archives of Internal Medicine.
 
“As the use of the electronic health record expands, so does the opportunity to use it to improve patient care and delivery. In our study, we found that an enhancement in the electronic health record is a successful tool to remind clinicians to ask patients about smoking status and refer smokers for cessation counseling” said Jeffrey Linder, MD, MPH, a physician and researcher at BWH and lead author of the study.
 
Linder and colleagues developed an electronic health record enhancement to increase documentation of smoking status, the prescription of tobacco treatment medications and referral of patients to tobacco treatment counseling. This study was performed in 26 primary care practices which were randomized to be intervention practices and have the enhancement implemented in their electronic health record system or be a control practice without the enhanced electronic medical record. Over a period of nine months, more than 315,000 patient visits were made to the participating practices.
 
Researchers found that documentation of a patients smoking status in the health record was improved in all participating practices, but intervention practices had a higher increase, a 17 percent increase compared to 11 percent in control practices. They also found that in practices with the intervention, patients who were documented smokers at the start of the study were more likely to be non-smokers at the end of the study (a 3.4 percent increase in documented non-smokers) when compared to practices without the enhancement in the medical record. Researchers note that this finding may be due to improved overall documentation. They also found the enhancement did not change the number of patients who were prescribed cessation medication, but did find that documented smokers at the intervention practices were over 10 times more likely to make contact with a smoking cessation counselor. Making contact with cessation counseling roughly doubles a smoker’s odds of successfully quitting.
 
 “Tobacco use is the leading preventable cause of death in the United States and more research is needed to maximize the utilization of health information technology to streamline tobacco treatment efforts by clinicians,” said Linder.
 
This research was funded by a grant from the National Cancer Institute and the Agency for Healthcare Research and Quality.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network.  BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals.  In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Apr 27, 2009

Boston, MA - Researchers at Brigham and Women’s and Massachusetts General Hospitals report that using a computerized application to record and track patients’ medications could decrease the occurrence of potentially harmful medication discrepancies. These findings appear in the April 27 issue of Archives of Internal Medicine.

Medication discrepancies describe the unexplained differences in medication regimens that occur as patients move through the health care system, which have the potential to lead to adverse drug events. To address this issue, hospitals use medication reconciliation, the process of correctly identifying all the medications a patient was taking before the hospitalization and using the list to correctly order medications during their hospital stay and at discharge.  

“Improving medication reconciliation is an important patient safety goal across the medical field,” said Jeffrey Schnipper, MD, MPH, senior author and hospitalist at BWH. “We found that in the hospital setting, with the use of an electronic application and a revision to the reconciliation process, there is a 28 percent reduction in the number of potentially harmful medication discrepancies that can happen at admission or discharge.”

Participants in the study were randomly assigned based on the medical team and floor to which they were admitted at one of the two participating hospitals. One half of the participants received traditional procedures for medication reconciliation. The second group of participants- those in the intervention group, were assigned to a medical team that used a new Web-based computer application that pooled medication information from several electronic sources, making it easier to take the medication history and track medication lists until discharge.

The intervention also included reassigning roles, including greater involvement of pharmacists to confirm that medications taken before the hospitalization were appropriately ordered in the hospital and greater use of nurses to confirm the accuracy of the medication history. “The redesign streamlined the process and eliminated redundant history-taking what was being performed in silos and replacing it with collaboration between doctors, nurses, and pharmacists,” said Dr. Schnipper.

Patients in the intervention group still averaged one potentially harmful medication discrepancy after the reduction in risk, compared with 1.4 errors in the control group. “We have found a way to address a number of problems with medication reconciliation, but there is still a need to improve the process further, especially concerning issues of patient and caregiver inaccuracy when reporting medication histories, the lack of compliance with the process from medical staff, and software usability issues,” said Dr. Schnipper.

The research was funded by Brigham and Women’s Hospital, Massachusetts General Hospital, Partners Healthcare and Harvard Risk Management Foundation.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Apr 20, 2009

Boston, MA - An interdisciplinary team of researchers at Brigham and Women's Hospital (BWH) and the Harvard-MIT Division of Health Sciences and Technology has demonstrated a better way to deliver cancer drugs directly to tumors by using specially engineered nanoparticles that can inhibit a signaling pathway and deliver a higher concentration of medication to the specific area. Details of their work appear on April 20, in an early online edition of the Proceedings of the National Academy of Science.

The team constructed the nanoparticles from a biodegradable, biocompatable, Food and Drug Administration-approved polymer which they chemically engineered to deliver a MAPK inhibitor. By inhibiting the MAPK signaling pathway, which is involved in a majority of human tumors, the nanoparticles hinder the multiplication of cancerous cells and predispose those cells to the cytotoxic effects of chemotherapeutic drugs. The team also modified the polymer to increase drug loading 20 fold, which overcomes a current drawback in nanomedicine, low efficiency of drug loading.

"Current chemotherapeutic drugs must be administered in high concentration throughout the body in order to destroy tumor cells, translating to high toxicity and discomfort for the patient, mainly due to the effects on normal cells," said Rania Harfouche, one lead author of the study, and fellow in the Health Sciences and Technology (HST) Division at BWH. These newly engineered nanoparticles would, however, selectively target the tumor cells and predispose them to chemotherapeutic drugs. "This will allow for lower drug concentration to be used, and provide opportunity for more potent treatments with lesser side-effects for the patient."

The combination of nanoparticles and the cancer drug cisplatin proved successful in preventing the growth of cancerous skin and lung cells and also induced cell death. When researchers gave the same combination to mice with melanoma, it inhibited tumor growth and enhanced the efficacy of the cancer drug. The entire tumors regressed in fifty percent of mice, compared with none in the group receiving cisplatin and the inhibitor without nanoparticles.

In previous work, the group demonstrated that a combination of two drugs delivered with a nanoparticle could exert superior anti-cancer effects. However, most cancers converge into a few pathways for survival and uncontrolled division. “We thought a better strategy might be to target these pathways using nanoparticles, almost like shutting the escape route before exposing the cancer to the drugs,” said lead author Sudipta Basu, fellow in the HST Division at BWH.

 “The nanoparticles target pathways involved in multiple cancer types and can be applied to a diverse set of cancers, including hard-to-treat cancers, such as breast, pancreatic and liver cancer,” noted senior study author Shiladitya Sengupta, PhD, of the Department of Medicine at BWH. “The potential to add homing beacons on the surface of the nanoparticles can increase the efficiency of selectively targeting specific tumors and abolish off target side-effects”.
The team also included BWH research fellows Dr. Shivani Soni, Dr. Geetanjali Chimote, and Dr. Raghunath Mashelkar, a polymer chemist and visiting professor at HST from the National Chemical Laboratories in India. This research was funded by grants from the Coulter Foundation, the Mary Kay Ash Charitable Foundation and the Department of Defense BCRP.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Apr 13, 2009

Brigham and Women's Hospital (BWH),  along with other national, state and community organizations, are participating in an effort to highlight the importance of advance healthcare decision-making-an effort that has culminated in the formal designation of April 16 as National Healthcare Decisions Day (NHDD). As a participating organization, BWH is providing information and tools for the public to talk about their wishes with family, friends and healthcare providers, and execute written advance directives, such as healthcare power of attorney and living will, in accordance with MA state laws.

BWH will join the NHDD effort April 16 by hosting an information table for patients, families and employees at the second floor of 75 Francis St and at the 45 Francis St. lower level lobby.  Free information about advance care planning and advance directive forms will be available at the information table and by visiting www.nationalhealthcaredecisionsday.org.

As a result of National Healthcare Decisions Day, organizers expect that many more people in the community will have thoughtful conversations about their healthcare decisions and take steps to complete reliable advance directives to make their wishes known. This will enable healthcare providers and facilities to be better equipped to address advance healthcare planning issues before a crisis and honor patient wishes when the time comes to do so.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Apr 10, 2009

Boston, MA - A Brigham and Women's Hospital (BWH) plastic surgery team, led by Dr. Bohdan Pomahac, performed a partial face transplant April 9, 2009, the second such procedure to be performed in the U.S.

The team of seven plastic surgeons and one ear, nose and throat (ENT) surgeon, nurses, anesthesiologists and residents worked for 17 hours in replacing the mid-face area of the patient including the nose, hard palate, upper lip, facial skin, muscles of facial animation and the nerves that power them and provide sensation.

"Advances in transplantation only happen when there are individuals and families who can see past their own tragic circumstances and agree to donation.  A gift such as this holds the promise of health and hope for a patient in need and it was New England Organ Bank's honor to work with such a remarkable donor family," said Kevin O'Connor, Senior Vice President, New England Organ Bank.

To protect privacy, the patient wishes to remain anonymous and will not attend the news conference and will not be available for interviews.

Consent for the donation of the tissue graft from the face was obtained by New England Organ Bank staff after conversations with the donor family. Signing up as an organ and tissue donor on a driver's license is not accepted as consent for face donation; family consent is required.

Transplant History at BWH

Today, BWH is recognized as one of the world's leaders in transplantation. In 1954, a BWH team led by Dr. Joseph Murray performed the first successful human organ donor transplant, a kidney, from one brother to another.  In recognition of this achievement, Dr. Murray received the Nobel Prize for Medicine in 1990.

In 2006, BWH performed for the first time in its history 100 kidney transplants in one year and in 2008, more than 30 lung transplants were performed, putting BWH among the top hospitals in the country for volume. Since 1984, BWH has performed more than 560 heart transplants.

^{Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org}

Press Release - Mar 31, 2009

Boston, MA – Using data from the Nurses’ Health Study, researchers from Brigham and Women’s Hospital (BWH) and colleagues found that exposure to traffic pollution may increase the risk of developing rheumatoid arthritis (RA). These findings appear in an advanced online publication of Environmental Health Perspectives.

Researchers looked at the records of 90,000 female participants in the Nurses’ Health Study and used Geographical Information Software to measure the distance between each individual’s home in 2000 and the nearest major roadways. Women who lived within 50 meters of interstates or primary, multi-lane roads had a 31 percent increased risk of developing rheumatoid arthritis compared with women who lived more than 200 meters away from major roadways.

“Even after accounting for the effects of age, race, sex, socioeconomic status and cigarette smoking, the increased risk for women located nearer major roads remained substantially higher,” said Jaime Hart, ScD, research fellow in the Channing Laboratory at BWH. And while looking more closely at nurses who lived within 50 meters of the very largest roadways, the risk jumped from 31 to 63 percent.

Genetic factors are thought to account for less than 50 percent of RA risk, and previous research has indicated that environmental factors, such as cigarette smoke, may increase the risk of development, noted Hart. “This coupled with prior research that suggests air pollution from traffic can cause systemic inflammation prompted us to study whether there was a direct relationship between air pollution and risk of RA.”

Hart explains that this research will prompt further investigation to determine to which degree specific, measured pollution levels increase risk of development of RA.

The research was supported by grants from the National Institutes of Health.

View full text of the study here.  

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Mar 30, 2009

Orlando, FL – Apparently healthy men and women who achieved low levels of both Low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein (hsCRP) after starting statin therapy dramatically lowered their risk of a future heart attack, stroke, need for bypass surgery, angioplasty, or cardiovascular death—up to 80 percent among patients who achieved more aggressive reductions in on-treatment LDL and hs-CRP levels, according to new data presented at the American College of Cardiology’s 58th Annual Scientific Session. The findings will also appear in the online version of the journal The Lancet.

This study—the first to prospectively examine clinical benefits of “dual targets” after initiating statin therapy— raises the possibility that clinicians should consider screening for hsCRP, a marker of underlying inflammation, in addition to LDL cholesterol when identifying patients at high risk for heart disease or monitoring the success of treatment among patients starting statin therapy.

In this analysis of 15,548 initially healthy men and women participating in the JUPITER trial, researchers prospectively evaluated the effects of rosuvastatin (20 mg) versus placebo on rates of heart attack, stroke, hospitalization for unstable angina, arterial revascularization, or cardiovascular death according to achieved levels of LDL and hsCRP.

“Our data confirm that statins reduce vascular risk by lowering both inflammation and cholesterol, and we found that achieving low levels of both matters for heart health,” said Paul Ridker, MD, Brigham & Women’s Hospital, Boston and the study’s lead investigator. “Reducing cholesterol is clearly very important, but a reduction in hsCRP with statin therapy also appears important, and patients who lower both simply do better than those who lower only cholesterol or only hsCRP.”

“When assessing cardiovascular risk, a measure of hsCRP is valuable” said Dr Antonio Gotto, Dean and Medical Provost at the Weill Cornell Medical College in New York. “JUPITER confirms prior data that the best clinical outcomes following statin therapy occur for those who not only reduce LDLC below 70 mg/dL, but who also reduce hsCRP below 1 mg/L”.

Compared to those given placebo in the JUPITER trial, those taking rosuvastatin who achieved  target levels of LDL <70mg/L (1.8 mmol/L) and hsCRP<2 mg/L experienced a  65 percent reduction in CV risk compared to only a 36 percent reduction among those treated with rosuvastatin who did not achieve one or both of these target levels. Event-free survival was even greater among patients achieving more aggressive LDL and hsCRP levels (LDL <70mg/dL and hsCRP <1mg/L); these patients had an 80 percent reduction in cardiovascular risk. These effects remained after adjustment for all available baseline characteristics that varied between groups, including pre-randomization levels of both LDLC and hsCRP.

JUPITER was a randomized, double-blind, placebo controlled trial. Study participants were followed for a maximum of 5 years (median 1.9 years). Enrolled patients had an LDL of less than 130 mg/dL, which meant they did not qualify for statin therapy under current guidelines.

“JUPITER previously showed that statin therapy is highly effective among patients with low cholesterol who are at risk due to increased levels of inflammation as picked up by elevated hsCRP. We now know that the benefit gained is due not only to reduction in cholesterol, but to reduction in hsCRP as well,” said Dr Ridker. “A patient can be at risk for heart attack or stroke even when cholesterol levels are low. Inflammation is a major determinant of CV risk. The statin drugs seem to be ‘two-fers’ that lower both inflammation and cholesterol.”
It is critical to identify new strategies to detect patients at high risk, and then link those strategies to treatment approaches that work and are cost-effective, he added. 
“For any patient with high cholesterol or a high hsCRP level, the first steps remain diet, exercise, and smoking cessation,” said Dr Ridker. “However, for those electing to start drug therapy, both reductions in LDL and hsCRP appear to be indicators of the success of statin therapy.”

JUPITER was conducted by investigators in 26 countries and was overseen by an academic statistician and an independent Data and Safety Monitoring Board. The study was funded by AstraZeneca, US, which had no access to unblinded trial data and played no role in the analysis or interpretation of the study data, nor in manuscript preparation. Dr. Ridker is listed as a co-inventor on patents held by BWH that relate to the use of inflammatory biomarkers in cardiovascular disease that have been licensed to Seimens and AstraZeneca.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Mar 29, 2009

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH) have found that participants in the landmark JUPITER trial who were taking a daily statin, cut the risk of blood clots in the veins, or venous thromboembolism (VTE), overall by more than 40 percent compared to those who took a placebo. Previous JUPITER findings showed that statin therapy lowered cholesterol as well as a biomarker for inflammation, high sensitivity C-reactive protein (hsCRP). The new findings show that a daily regimen of rosuvastatin also significantly reduces the risk of dangerous, life threatening blood clots in the veins. The findings were reported at the American College of Cardiology’s 58th Annual Scientific Session, and will appear in the online issue of the New England Journal of Medicine.

“VTE is a serious sometimes fatal event that is costly and inconvenient to treat,” said Robert J. Glynn, PhD, ScD, a biostatistician at Brigham and Women’s Hospital. “When patients and their doctors discuss initiation of statin therapy, prevention of VTE is an important additional consideration beyond proven benefits in the prevention of heart attack and stroke.”

VTE is a very common illness with risk of development increasing with age. Other risk factors include obesity, use of hormone replacement therapy, certain genetic defects and long periods of inactivity and injury to the blood vessels. Deep vein thrombosis, which can cause pain in the legs, is an early form of VTE, while pulmonary embolism is a frequently fatal, advanced form of the condition that involves a blood clot traveling dangerously to the lungs. Nearly 100,000 people die each year as a result of DVT with nearly 600,000 cases diagnosed each year. It has been called America’s number one preventable illness.

 JUPITER is the first randomized trial to prospectively examine whether statin therapy can prevent VTE. The trial was made up of 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg/dL and high-sensitivity C-reactive protein (hsCRP) levels of 2.0 mg/L, or higher, randomly assigning them to rosuvastatin, 20 mg/day, or placebo. The average age of the study participants was 66 years, and 38 percent were obese.

During follow-up, 34 participants in the rosuvastatin group and 60 in the placebo group developed symptomatic VTE, a 43 percent reduction. Similar reductions in risk were found among people who had cancer or had recently been hospitalized, undergone surgery, or suffered a trauma (so-called provoked VTE), as well as among those who did not have any of these triggers for VTE (so-called unprovoked events). Risk reductions were seen for both deep vein thrombosis and for pulmonary embolism.

“Our findings require confirmation, but they have the potential to broaden our perspective on the treatment targets for statin therapy,” Glynn said. “Including consideration of VTE in addition to conditions caused by arterial thrombosis, such as heart attack and stroke, increases the estimated benefits associated with statin use.”

“The clinical bottom line here is simple” said Paul Ridker, MD, also of the Brigham and Women’s Hospital and Trial Chairman of the JUPITER study. “In addition to reducing risks of heart attack and stroke, we now have hard evidence that statin therapy reduces life-threatening blood clots in the veins as well. In contrast to drugs like warfarin and heparin, we got this benefit with no bleeding hazard at all, so the new data are an exciting advance for our patients”.

JUPITER was conducted by investigators in 26 countries and was overseen by an academic statistician and an independent Data and Safety Monitoring Board. The study was funded by AstraZeneca, US, which had no access to unblinded trial data and played no role in the analysis or interpretation of the study data, nor in manuscript preparation. Dr. Ridker is listed as a co-inventor on patents held by BWH that relate to the use of inflammatory biomarkers in cardiovascular disease that have been licensed to Seimens and AstraZeneca.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Mar 23, 2009

Boston, MA - Multidisciplinary research out of Brigham and Women’s Hospital (BWH) and the Massachusetts Institute of Technology (MIT) and Massachusetts General Hospital (MGH) has produced a mechanical clutch-based needle-insertion device that automatically stops once the needle tip enters a cavity or lower-density tissue. Borrowing concepts from a drill model from the oil industry, Omid Farokhzad and Jeffrey Karp from BWH, and Alex Slocum and Erik Bassett from MIT, developed an s-shaped needle that could offer a solution to the hundreds of thousands of complications due to improperly inserted and positioned needles, and injuries from overshooting. These findings appear in the March issue of the Proceedings of the National Academy of Science.

“Current needle systems depend on the clinician to physically sense when the needle has passed through the tissue into the desired area,” explained Jeffrey Karp, PhD, director for the Laboratory for Advanced Biomaterials and Stem Cell based Therapeutics at BWH. “This sensory skill requires substantial experience and even with the most practiced clinicians there is still a sizable complication rate.”

The mechanical clutch-based needle consists of a flexible filament inside a rigid s-shaped tube, which together act like a clutch. Due to the shape of the tube, the filament coils and “locks” inside the tube when the tip of the needle encounters resistance- dense tissue. Since the filament is locked in the tube, it pushes the tube forward through the tissue until resistance subsides- when it reaches a cavity or tissue or lower density. The decreased resistance causes the filament to slack and move forward through the tube into the tissue, while the needle remains in place.

Using a laparoscopic video camera, Dr. Peter Masiakos and Dr. Howard Pryor from MGH, demonstrated the needle’s effectiveness in a deceased pig by inserting the needle into the abdomen and observing a 100 percent success rate for stopping when reaching the peritoneal cavity.

The device could prove useful in placing a needle into a specific site to draw blood, remove fluid, or to administer medicine to a specific site. In addition, there is potential for application when administering epidural anesthesia, placing chest tubes, arterial line catheters, catheters and central venous lines, accessing fistulas for dialysis patients, and potential in accessing the brain.

“By eliminating the reliance on tactile feedback, this device could help reduce the number of injuries due to overshooting in the numerous procedures that require accessing a specific tissue or tissue compartment,” said Dr. Karp. “It also provides the ability to decrease the amount of steps necessary to insert guide wires or catheters, which, in the case of an emergency, is crucial.” added Dr. Farokhzad.

Funding for this study was provided by the Deshpande Center for Technological Innovation and the Center for Integration of Medicine and Innovative Technology.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Mar 19, 2009

Boston, MA – Recently, Massachusetts joined the growing number of states in publicly reporting mortality and risks associated with treatment for interventional cardiac care, such as being treated for a heart attack with a stent, coronary artery by-pass surgery (CABG) and other procedures. The public’s right to know about the quality of care they can receive and the creation of transparency between health care providers and patients is a positive initiative. In states where public reporting is in place, such as Massachusetts and New York, significant declines in mortality rates have been reported. Brigham and Women’s Hospital (BWH) interventional cardiologists Dr. Frederic Resnic and Dr. Frederick Welt analyzed current reporting criteria and found that potential risks of public reporting of clinical outcomes may lead some care givers to be more conservative in treating, or not, the sickest patients who stand to gain the most. The study appeared in the Journal of the American College of Cardiology.

In an analysis of interventional coronary procedures at BWH between 2003 and 2005 (the first year of public reporting), Drs. Resnic and Welt found that nearly 45 percent of patients who died prior to being discharged from the hospital had at least one severe, acute medical condition before treatment that was not accounted for in the data collection methods used by the state mandated initiative. Examples of acute severe conditions included stroke, active infection, post-operative heart attack following major non-cardiac surgery among others. By further analyzing and classifying the deaths and adding pre-procedural information, such as presenting with a neurologic compromise following a heart attack, history of malignancy, in-hospital acute coronary syndrome following non-cardiac surgery and admittance to the hospital with an existing infection, the doctors were able to do a “before and after” comparison of the reporting and found modest improvement. This finding suggests that expanding the existing risk prediction methods would provide a more accurate picture for outcomes among patients with a co-existing medical condition who need interventional cardiac care.

Comparing the results that Resnic and Welt found at BWH to data from New York shows that deaths following interventional coronary procedures had decreased by 36 percent between 1996 and 2003 in New York State. However, the doctors found a trend toward the avoidance of performing cardiac procedures on higher risk patients in NY, with a 30 percent decline over a six year period in patients presenting with cardiogenic shock, a severely decreased ability of the heart to pump blood throughout the body, sending a patient into shock. Similar declines were also found in Massachusetts.

“Public reporting of risk-adjustment outcomes for patients being treated for emergency heart attacks, who also may have a co-existing and serious medical condition, is an important tool to ensure quality improvement and transparency,” said Dr. Frederick Resnic, director of the Cardiac Catheterization Lab at BWH. “The risk currently is that it could lead to changes in patient selection by physicians who do not trust that the risk- adjustment is accurate for the highest risk patients. This leads to a gradual erosion in the willingness of doctors to treat the sickest and most complex patients; despite the fact that these patients have the most to gain from a heart procedure.”

Drs. Resnic and Welt recommend a four point strategy to help improve public reporting outcomes.

• Address the underlying incentives for “case-selection creep” by improving risk adjustment methods for the highest risk patients and by highlighting centers and physicians who undertake high-risk procedures in appropriate patients.
• Provide adequate resources for assuring high quality data collection and analysis efforts as part of any mandated outcomes reporting effort.
• Develop national standards for public reporting of risk adjusted clinical outcomes
• Develop and report measures of appropriateness to complement risk adjusted outcomes in public reporting programs.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Mar 16, 2009

Boston, MA - Defibrillators are commonly recommended to patients with heart failure to prevent sudden cardiac death, but there is a lack of criteria to identify the appropriate patients for this therapy beyond having heart failure due to systolic dysfunction. Researchers at Brigham and Women’s Hospital (BWH) found that older people with comorbidities and those with multiple hospital admissions related to heart failure are unlikely to receive a meaningful survival benefit from implanted defibrillators. These findings appear in the March 17 issue of the Canadian Medical Association Journal.

Even if all out-of-hospital cardiac deaths were prevented by implanted defibrillators, the researchers found that survival was significantly lower in patients who were repeatedly hospitalized for heart failure. Similarly, survival was poor for older patients with comorbidities, such as cancer, dementia, and kidney disease. However, patients under 65 years of age and older patients without kidney disease, cancer or dementia would be most likely to benefit from defibrillators to prevent sudden death.

“Previous trials show significant benefits of defibrillators in patients with heart failure, but the study populations typically exclude elderly patients and those with comorbidities,” said Soko Setoguchi, MD, of the Department of Medicine at Brigham and Women’s Hospital (BWH). However, information from the US National Cardiovascular Data Registry from 2006 through 2007 indicates that defibrillators are frequently implanted in patients with comorbidities, and 61 percent of implanted defibrillators go to people aged 65 or older.

Dr. Setoguchi and study co-author Lynne Warner Stevenson looked at more than 14,000 patients admitted to a hospital for heart failure from an administrative database. The average age of the group was 77 years, and patients had a high prevalence of comorbidities such as other cardiovascular disease, diabetes, chronic pulmonary disease and kidney disease. Researchers tracked the patients, recording number of hospital admission due to heart failure, development of comorbidities, and cause of death when appropriate.

“Patients at extremely high risk of death, including patients with prior heart failure hospitalizations and chronic disease, have such a high risk of all-cause death that even if the potentially treatable sudden cardiac deaths were prevented, the overall risk of death would remain prohibitively high,” notes Dr. Setoguchi. 

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Mar 2, 2009

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has recognized Brigham and Women’s Hospital (BWH) as one of  26 ACS NSQIP participating hospitals in the United States that have achieved exemplary outcomes for surgical patient care.  As a participant in ACS NSQIP, BWH is required to track the outcomes of inpatient and outpatient surgical procedures and collect data that directs patient safety and the quality of surgical care improvements.   

The ACS NSQIP recognition program commends a select group of hospitals for achieving exemplary outcome performances related to patient management in five clinical areas:  DVT (deep vein thrombosis, thrombophlebitis and pulmonary embolism); cardiac incidents (cardiac arrest and myocardial infarction); respiratory incidents (unplanned intubation, ventilator dependence for more than 48 hours and pneumonia); SSI (surgical site infections-superficial and deep incisional and organ-space SSIs); or urinary tract infection.  The 26 hospitals commended achieved the distinction of attaining exemplary results in two or more of the five areas listed above.  Risk-adjusted data from the June 2008 ACS NSQIP Semiannual Report were used to determine which hospitals demonstrated exemplary outcomes.             

ACS NSQIP is the only nationally validated quality improvement program that measures and enhances the care of surgical patients. This program measures the actual surgical results 30 days postoperatively as well as risk adjusts patient characteristics to compensate for differences among patient populations and acuity levels.  The goal of ACS NSQIP is to reduce surgical morbidity (infection or illness related to a surgical procedure) and surgical mortality (death related to a surgical procedure) and to provide a firm foundation for surgeons to apply what is known as the “best scientific evidence” to the practice of surgery.  Furthermore, when adverse effects from surgical procedures are reduced and/or eliminated, a reduction in health care costs follows.  ACS NSQIP is a major program of the American College of Surgeons and is currently used in over 225 hospitals.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient.  The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients.  The College has more than 74,000 members and it is the largest organization of surgeons in the world.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Mar 2, 2009

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH) and Beth Israel Deaconess Medical Center (BIDMC) have identified the potential cause of the increased risk for cardiovascular and metabolic disease in shift workers. The researchers found that misalignment between the internal biological clock and the sleep/wake and fasting/feeding cycles, known as circadian misalignment, resulted in hormonal and metabolic changes that, if chronically maintained, could explain the increased risk for obesity, high blood pressure, diabetes and cardiovascular disease frequently found among shift workers. These findings appear in the online Early Edition of Proceedings of the National Academy of Sciences during the week of March 2, 2009.

“There is convincing evidence for an increased risk of cardiovascular and metabolic complications associated with shift work, but the underlying mechanisms were largely unknown,” said Frank Scheer, PhD, a neuroscientist in BWH’s Division of Sleep Medicine, Associate Director of the Medical Chronobiology Program at BWH and lead author of the paper.” We studied the influence of circadian misalignment, typical of shift work, on physiological pathways involved in glucose metabolism, the regulation of body weight and cardiovascular function as a possible mechanism.”

Ten healthy volunteer subjects underwent a ten-day laboratory stay where they slept and ate at all hours of the day and night, achieved by living on recurring 28-hour ‘days’. Their daily activities and meals were carefully controlled. Alterations in blood pressure, blood glucose, sleep quality and hormones like leptin, insulin, and cortisol were analyzed throughout the ten days.

"Knowing that the hormone leptin–which helps control appetite and satiety–rises and falls based on circadian rhythms, we wanted to find out if leptin levels were low in individuals who had shifted their behavioral rhythms, such as being awake at night,” explained Christos Mantzoros, MD, clinical research overseer of the Department of Endocrinology, Diabetes and Metabolism at BIDMC. The researchers did find reduced leptin levels during circadian misalignment, which can increase appetite and may decrease activity levels, potentially contributing to obesity and cardiovascular problems.

“Study participants showed the largest deviations from normal hormone levels when their sleep/wake cycles were shifted by approximately 12 hours, while they were sleeping during standard daylight hours and waking at night,” said Steven Shea, PhD, director of the Sleep Disorders Research Program at BWH.  “Abnormal levels of these hormones may lead to increased health risks common in shift workers.”

Dr. Scheer also noted that circadian misalignment caused three patients with no history of diabetes to show post-meal glucose levels typical of those with pre-diabetes. “This suggests that in some otherwise healthy people, irregular sleep patterns could increase the risk for the development of diabetes.”

 “These findings do not apply only to those performing shift work, but may also have implications for people suffering from circadian rhythm sleep disorders, including advanced and delayed sleep phase syndrome and many blind people experiencing circadian misaligned due to the absence of resetting their body clock by light,” explained Dr. Scheer “In addition, because these changes were observed within just a few days of misalignment, circadian misalignment may even temporarily affect millions of international travelers each year.”

The research was supported by grants from National Heart, Lung and Blood Institute, National Center for Complimentary and Alternative Medicine, National Institute for Diabetes and Digestive and Kidney diseases, and BIDMC.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Feb 25, 2009

Boston, MA - Information on drugs and treatment for specific diseases is abundant in medical education, but a need for guiding principles for ways to effectively prescribe is drawing attention. In a Commentary published in the February 25 issue of the Journal of the American Medical Association, a physician from Brigham and Women’s Hospital (BWH) and his colleague suggest 25 principles to help prescribers improve their effectiveness.

Recent reports from the Association of American Medical Colleges (AAMC) expressed major concern with the current state of pharmacology teaching, specifically, the influence that the pharmaceutical industry has at all stages of medical education. “While addressing these concerns, we also need to think about providing prescribers with a set of comprehensive guiding principles,” said Gordon Schiff, MD, of the Department of Medicine at BWH. “Educational reform alone is not sufficient to ensure the most efficient and successful prescribing practice.”

The Commentary suggests 25 principles to help trainees become more careful, cautious, evidence-based prescribers. The guidelines cover a range of focuses, including strengthening the patient-prescriber relationship, practicing caution and skepticism when prescribing drugs that are new to the market, considering therapeutic options other than drugs when appropriate, and reducing adverse drug events.

“Taken separately, none of the principles are novel, but when combined, they represent a significant shift in current prescribing patterns,” said Dr. Schiff. The authors address the two dueling philosophies of pharmacology by finding a balance between the current thinking pattern that newer and more is better, and the previous idea that fewer and more time-tested drugs are best.

The research was funded by grants from the Agency for Healthcare Research and Quality and the Attorney General Consumer and Prescriber Education Grant Program (the Neurontin settlement).

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Feb 23, 2009

Age-related macular degeneration (AMD) is a leading cause of vision loss in older Americans and the only previously known prevention method is not smoking.  New research from Brigham and Women’s Hospital finds that taking a combination of vitamins B₆ and B₁₂ and folic acid appears to decrease the risk of age-related macular degeneration in women.  This research is published in the February 23 issue of Archives of Internal Medicine.

“Women taking the supplements had a 34 percent lower risk of any AMD and a 41 percent lower risk of visually significant AMD. The beneficial effects began approximately two years after the start of treatment and lasted throughout the trial,” said William G. Christen, Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston,

Christen and colleagues conducted a randomized, double-blind clinical trial involving 5,442 women age 40 and older who already had heart disease or at least three risk factors. Of these, 5,205 did not have AMD at the beginning of the study. In April 1998, these women were randomly assigned to take a placebo or a combination of folic acid, vitamin B₆, and vitamin B₁₂. Participants continued the therapy through July 2005 and were tracked for the development of AMD through November 2005.

Over an average of 7.3 years of treatment and follow-up, 137 new cases of AMD were documented, including 70 cases that significantly affected vision. Of these, 55 AMD cases, 26 visually significant, occurred in the 2,607 women in the active treatment group, whereas 82 of the 2,598 women in the placebo group developed AMD, 44 cases of which were visually significant.

“These findings apply to the early stages of disease development and may be the first identified way—other than not smoking—to reduce the risk of AMD in individuals at an average risk.” Christen said.  “From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, which is the leading cause of severe, irreversible vision loss in older Americans.”

This study was supported by grants from the National Heart, Lung and Blood Institute and from the National Eye Institute.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

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Center of Excellence: Women's Health

Press Release - Feb 19, 2009

hsCRP Important for Stroke Detection and Treatment

In the landmark JUPITER trial of 17,802 patients, researchers from Brigham and Women’s Hospital (BWH) report that rosuvastatin reduces by nearly 50 percent the risk of stroke among individuals who had low levels of cholesterol but were nonetheless at high risk for stroke due to increased levels of a simple blood test for the inflammatory biomarker hsCRP (high sensitivity C-reactive protein). These findings will be presented February 19, at the 2009 Scientific Sessions of the American Stroke Association in San Diego.
 
The JUPITER trial focused on low cholesterol/high hsCRP patients who were given a daily regimen of rosuvastatin. Compared to study participants who were given a placebo the researchers found a 48 percent reduction in stroke. During a follow-up period of up to 5 years, there were 33 stroke events among those randomly given 20mg of rosuvastatin daily, compared to 64 strokes among those given a placebo This reduction in risk was almost entirely due to strokes caused by blood clots or reduced blood flow to the brain. No increase or decrease in risk of rare hemorrhagic strokes due to bleeding were observed during the trial.
 
“The JUPITER data clearly demonstrate that statin therapy reduces stroke risk among individuals with elevated levels of hsCRP” said Dr. Robert Glynn from the Division of Preventive Medicine at Brigham and Women’s Hospital who presented the data. “Prior prevention studies that relied on cholesterol to identify high risk patients have not found similar benefits. These findings also underscore the important role that inflammation plays in stroke.”
 
 “Our results are relevant for patient care and the prevention of stroke,” said Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital and Principal Investigator of the JUPITER trial. “Physicians can no longer assume that patients are at low risk for stroke simply because they have low cholesterol. We have confirmed that patients with increased hsCRP are at increased stroke risk even if cholesterol levels are low, and we now have evidence that a simple and safe therapy cuts that risk and saves lives.”
 
Started in 2003, JUPITER (the Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) was designed to test whether rosuvastatin, taken at 20mg daily compared to placebo, could reduce the risk of cardiovascular events among apparently healthy men and women who had LDL cholesterol levels below 130mg/dL who were nonetheless at silent risk due to increased levels of inflammation as measured by a simple blood test known as high sensitivity C-reactive protein (hsCRP).
 
Prior work had established that patients with increased hsCRP were at high risk for heart disease and stroke despite lacking other conventional risk factors, and that statins lower hsCRP levels, indicating anti-inflammatory as well as cholesterol lowering effects. Until JUPITER, whether or not statin treatment would be effective in reducing cardiac events among these patients had been uncertain.
 
Participants in JUPITER had cholesterol levels widely considered optimal by most physicians; the average LDL cholesterol was just above 100mg/dL and the average HDL cholesterol was nearly 50mg/dL. Nonetheless, event rates in the trial were high because all participants had elevated levels of hsCRP.
 
“JUPITER should change prevention guidelines” said Dr. James Willerson, Director of the Texas Heart Institute in Houston. “The bottom line here is simple – if your hsCRP is high, you should be on statin therapy regardless of your cholesterol level. This is an approach we can start using tomorrow”.
 
JUPITER was a randomized, double-blind, placebo-controlled trial conducted by investigators in 26 countries and overseen by an academic statistician (Robert Glynn, PhD, Harvard University, USA) and an independent Data and Safety Monitoring Board (chaired by Professor Rory Collins, Oxford University, UK). The study was funded by AstraZeneca, US who had no access to unblinded trial data and played no role in analysis or interpretation of the study data nor in manuscript preparation. Dr. Ridker, the JUPITER Principal Investigator, is listed as a co-inventor on patents held by BWH that relate to the use of inflammatory biomarkers in cardiovascular disease that have been licensed to AstraZeneca.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Feb 18, 2009

Boston, MA - In 2004, the Hospital Quality Alliance (HQA) began publicly reporting hospitals’ performance on 10 quality measures. One measure, the percentage of patients admitted to a hospital with pneumonia who are given antibiotics within four hours of arriving, was considered controversial because of concerns that patients would suffer unintended consequences as hospitals tried to improve their scores. Now, researchers at Brigham and Women’s Hospital (BWH), have studied the nationwide effects of this measure on patient care for the first time. Their results are published online in the American Journal of Managed Care.

Researchers, led by Dr. Mark Friedberg at Brigham and Women’s Hospital, found no evidence that publicly reporting hospital performance on this quality measure resulted in adverse effects for patients seeking care in hospital emergency departments (ED). “Public reporting of the antibiotic timing measure did not appear to lead to over diagnosis of pneumonia, excessive antibiotic use, or inappropriate prioritization for patients coming to hospital emergency departments with respiratory symptoms,” said Friedberg.

In 2007, due to concerns about the potential for diagnostic errors, antibiotic resistance, and other adverse side effects of unnecessary antibiotic use, the HQA’s window for giving antibiotics to patients with pneumonia was lengthened from four hours to six hours. 

“It can be difficult to diagnose a patient with pneumonia within four hours, especially in a busy ED,” said Friedberg. “Some policy makers were worried that if emergency physicians were focused too closely on pneumonia, other respiratory conditions might be missed. Additionally, there were concerns that patients who were more likely to have pneumonia would be fast tracked through the ED, resulting in longer wait times for other patients.”

Friedberg and colleagues set out to detect evidence of these unintended consequences in a nationally representative sample of more than 13,000 patient visits to approximately 400 hospital EDs.  The researchers evaluated data from before and after the start of public reporting on the antibiotic timing measure. They asked three questions:

1. Did the rate of pneumonia diagnosis for patients with cough, shortness of breath and difficulty breathing increase? 
2. Were patients with cough, shortness of breath and difficulty breathing more likely to receive antibiotics after reporting began? 
3. Did waiting times for patients with respiratory symptoms decrease, relative to patients less likely to have pneumonia?  

They found that:

1. Rates of pneumonia diagnosis did not increase after reporting. 
2. Rates of patients who received antibiotics with pneumonia symptoms did not increase.
3. Waiting times in the ED increased by similar amounts for patients with and without respiratory symptoms.

When looking for differences between ED visits to hospitals with higher and lower scores on the antibiotic timing measure, researchers found that the major difference was the length of time patients waited to see a doctor.  On average, patients waited 38 minutes at the highest-scoring hospitals, compared with 66 minutes at the lowest-scoring hospitals.

“It was interesting to find that by comparing two hospitals’ publicly reported scores on pneumonia antibiotic timing, you could potentially make a good guess about whether one ED will have a longer waiting time than the other,” said Friedberg. “This information is not publicly reported anywhere else.”

This research was funded by the Brigham and Women’s Hospital Primary Care Teaching and Education Fund.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Feb 3, 2009

Boston, MA – For patients with end-stage renal disease (ESRD) receiving dialysis, the altitude at which they reside could influence their lifespan. Researchers from Brigham and Women’s Hospital (BWH) found that patients residing at higher altitudes experience up to a 15 percent longer survival rate, compared to those residing at lower attitudes. These findings appear in the February 3 issue of the Journal of the American Medical Association.

Recent research reported that dialysis patients living at higher altitudes achieved greater response to therapeutic treatment with erythropoietin, a protein that controls red blood cell production. Patients with ESRD are treated with erythropoietin to increase red blood cell production. Researchers believe that hypoxia, or oxygen deficiency in blood, which occurs at higher elevations, may cause the greater effectiveness of erythropoietin as well as other hypoxia-induced factors that could prolong life for dialysis patients.

“The results of our new study imply the possibility of numerous benefits of mild hypoxia for patients undergoing dialysis, in addition to making erythropoietin more effective,” said Wolfgang Winkelmayer, MD, ScD, of the Pharmacoepidemiology and Renal Divisions at BWH and lead study author. “Since patients at higher elevations experience lower rates of death from all causes, it’s possible that hypoxia has a positive effect on various co morbidities associated with ESRD.”

Researchers referenced 804,812 records of patients in the US with ESRD who initiated dialysis between 1995 and 2004, obtained from the US dialysis registry. They examined the differences in mortality rates across different residential altitudes by noting the patients’ zip code and comparing the rates of death from various elevation groups.
Compared with patients living at lower altitudes (less than 250 ft.), the rate of death was reduced for patients living at an elevation of 250 to 1,999 ft by 3 percent; 2,000 to 3,999 ft. by 7 percent; 4,000 to 5,999 ft by 12 percent; and higher than 6,000 ft. by 15 percent.

“Further investigation of the hypoxia-induced factors that may prolong lifespan would help to better understand the exact benefits of residing at a higher altitude,” said Dr. Winkelmayer. “And with more research, additional treatment options could be developed once the details of this relationship are uncovered.”

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Jan 27, 2009

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH) and colleagues have identified a genetic variant which indicates a predisposition for the development of uterine leiomyomata, better known as uterine fibroids. The HMGA2 gene has recently been associated with variation in human stature, and this new research links an increased transmission of the TC227 allele, within HMGA2, with a predisposition for fibroids in white women with shorter stature. The findings appear in an advance on-line publication of Human Genetics.

“This genetic indicator could prove after further investigations to be valuable information for women making decisions about medical management of fibroids,” said Cynthia Morton, PhD, senior study author and Director of Cytogenetics at BWH. “A woman with symptomatic fibroids might one day undergo diagnostic testing for the TC227 allele to determine whether she’s genetically predisposed to develop additional fibroids.”

Dr. Morton explains that with this information, a woman who has the TC227 allele might decide to opt for a hysterectomy, rather than removal of only the fibroids, to avoid likely having to return to have additional fibroids removed in the future. “On the other hand, a woman with fibroids who does not have the TC227 allele might decide to just remove the fibroid rather than have a hysterectomy.”

The researchers analyzed DNA from 248 pairs of sisters affected by fibroids and their family members, and found that women who are TC227-positive were predisposed to the development of fibroids, compared to women who did not have the TC277 allele. A link between the TC227 allele and decreased height was also established, leading to the researchers’ hypothesis that decreased height would be consistent with early menarche, and its known risk for developing fibroids.

The research looked specifically at white women because of a low frequency of the TC227 allele in African American women. “We believe that there are multiple genetic indicators for fibroids, in addition to the TC227 allele in white women, including genetic risk alleles for predisposition specific in black women who suffer an earlier age of onset and more severe fibroid symptoms,” said Dr. Morton.

The research was supported by grants from the National Institutes of Health.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Jan 20, 2009

Boston, MA – In November of 2008, Brigham and Women’s Hospital (BWH) became the second hospital in the country to be recognized as having a Comprehensive Academic Sleep Program of Distinction by the American Academy of Sleep Medicine (AASM), which sets standards and promotes excellence in sleep medicine health care, education and research.

AASM endorses the concept of academic sleep centers becoming independent interdisciplinary units. In 2001, BWH was one of the first hospitals in the nation to establish an independent Division of Sleep Medicine within the Department of Medicine. In recognizing the BWH Division of Sleep Medicine as a Comprehensive Academic Sleep Program of Distinction, the AASM is providing nationwide recognition for the success of this academic program in fostering cutting-edge sleep research, training the next generation of physicians specializing in sleep disorders medicine, and providing outstanding clinical care for patients with sleep disorders.  

The academic sleep program at BWH is led by co-directors, Charles A. Czeisler, PhD, MD, Chief of the Division of Sleep Medicine, and Atul Malhotra, MD, Medical Director of the BWH Sleep Disorders Research Program. Dr. Czeisler said, “By creating an independent academic unit to house sleep medicine at BWH, the leadership of the Department of Medicine here enabled us to attain this achievement.”

The BWH Division of Sleep Medicine now has 31 faculty and 20 post-doctoral fellows. Its clinical sleep medicine fellowship program was one of the first in the nation to be accredited by the Accreditation Council of Graduate Medical Education. 

This year, the BWH Division was awarded three post-doctoral fellowship research grants from the AASM, more than any other hospital in the United States has ever received in one year. BWH Division of Sleep Medicine faculty physicians care for their patients in an outpatient clinic and a 6-bed clinical sleep laboratory that are managed by Sleep Health Centers® at their Brighton location, 1505 Commonwealth Avenue. Division faculty have also performed extensive research on sleep and circadian rhythms, successfully competing for NIH research grants and publishing landmark studies in top-tier medical and scientific journals. 

 
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network.  BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals.  In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Jan 14, 2009

Boston, MA – A pilot program conducted at hospitals in eight cities around the world has shown that the use of a simple surgical checklist during major operations can lower the incidence of deaths and complications by more than one third. The results were published online on January 14 and appear in the January 29, 2009 print issue of the New England Journal of Medicine.

The year-long study was led by Atul Gawande, a surgeon at Brigham and Women's Hospital and Associate Professor of Health Policy and Management at the Harvard School of Public Health, and conducted in collaboration with the World Health Organization. 

The one-page checklist requires only a few minutes to complete at three critical junctures of operative care: before anesthesia is administered, before skin incision, and before the patient is removed from the operating room. Items on the checklist are intended to ensure safe delivery of anesthesia, appropriate preventive measures against infection, effective teamwork and other essential practices in operative care.

"The checklist had a visible impact in every site in the study," added Alex Haynes, MD, a research fellow at HSPH and the Massachusetts General Hospital, and the article's lead author. "Even many clinicians who were initially skeptical of the idea became advocates once they saw the benefits to safety and consistency of care."

Gawande and colleagues collected data from 7,688 patients: 3,733 before implementation of the checklist and 3,955 after the checklist was implemented.  All patients were treated at one of the pilot hospitals listed here: http://www.who.int/patientsafety/safesurgery/pilot_sites/en/index.html.  Researchers found that by using this checklist, the rate of major complications in the study operating rooms fell from 11% in the baseline period to 7%, a reduction of more than one third.  Additionally, inpatient deaths following major operations fell by more than 40 percent (from 1.5% to 0.8%) with implementation of the checklist.  The reductions were of equal magnitude in high income and lower income sites in the study.

"The results are startling," said Gawande, senior author of the NEJM article. "They indicate that gaps in teamwork and safety practices in surgery are substantial in countries both rich and poor. With the annual global volume of surgery now exceeding even the volume of childbirth, the use of the WHO checklist could reduce deaths and disabilities by millions. There should be no time wasted in introducing these checklists to help surgical teams do their best work to save lives."

Four countries, the UK, Ireland, Jordan and the Philippines, have already established nationwide programs to implement the checklist in all operating rooms.  The Institute for Healthcare Improvement (IHI) in the U.S. recently announced a "sprint" to introduce the checklist in all 4,000 hospitals that took part in its recent 5 Million Lives Campaign, a national effort to improve quality and safety. These hospitals represent two-thirds of American hospitals. Gawande's research team has also estimated that if the WHO Surgical Safety Checklist were implemented in all operating rooms across the U.S., the annual cost-savings from the prevention of major complications would be $15 billion to $25 billion per year.

"Modern medicine is complex. Our findings have implications beyond surgery, indicating that checklists could increase the safety and reliability of care in numerous medical fields. The checklists must be short, extremely simple, and carefully tested in the real world. But in specialties ranging from cardiac care to pediatric care, they could become as essential in daily medicine as the stethoscope," said Gawande.

Funding for the study was provided by the World Health Organization.

The checklist and other supporting materials are freely available on the WHO Safe Surgery Saves Lives site: http://www.who.int/patientsafety/safesurgery/en/

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network.  BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals.  In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Jan 12, 2009

Boston, MA – According to a new study from researchers at Brigham and Women’s Hospital (BWH), small and independent primary care practices may find it challenging to qualify for higher payments under the Patient-Centered Medical Home (PCMH), a new initiative designed to revitalize the nation’s primary care system. This could undermine access to primary care for communities that rely on these small practices. Detailed study findings, recently released on-line, will be published in the February issue of the Journal of General Internal Medicine.

To address the crisis in primary care, physician professional societies have proposed increasing payments to practices certified as PCMHs. Qualifying practices must develop capabilities such as electronic health records (EHRs) and specially-trained staff who assist patients in managing chronic disease, like diabetes. 

In a new statewide survey of Massachusetts primary care practices, researchers found that the largest practices were more than twice as likely as two-physician practices to have EHRs with advanced features (48% versus 19%) and staff to assist patients with chronic diseases (83% versus 39%). Overall, larger practices were more likely to have eight of the thirteen capabilities commonly included in PCMH proposals.

The study authors also found that practices affiliated with large physician networks, such as Partners, Harvard Vanguard, Fallon, and others, were more likely to have multi-functional EHRs than independent practices (40% versus 18%). 

PCMH pilot projects are underway in many states, and Medicare will be announcing sites for its own medical home demonstration in 2009. Though the PCMH model is designed to apply to practices of any size, researchers say the discrepancy in readiness for the PCMH may lead to unintended consequences for some primary care practices.

“In the U.S., most primary care practices are small and independent, with only one or two doctors. These small practices may have to invest the most to be eligible for medical home payments,” said Mark Friedberg, MD, a fellow in the Department of Medicine at BWH and lead study author. “Larger practices and those affiliated with provider networks will have an advantage in qualifying as medical homes. If small practices cannot make the necessary investments, they may be driven out of business, threatening primary care access for the communities they serve.”

The research was funded by the Commonwealth Fund.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Dec 30, 2008

The many Americans who take high-dose supplements of antioxidant vitamins may be doing so in vain.  Numerous research studies in 2008 showed that many vitamins that were thought to offer some protection from chronic diseases, such as cardiovascular disease and cancer, failed to do so.  In a new study adding to this growing body of evidence, researchers at Brigham and Women’s Hospital show that supplemental vitamins C, E and beta-carotene also fail to provide protection against cancer for middle aged women. In this study, women who took beta-carotene or vitamin C or E or a combination of the supplements had a similar risk of cancer as women who did not take the supplements.  This research is published online on December 30 in the Journal of the National Cancer Institute.

“Our finding is what is called a null result, meaning that no benefit was found from supplementation,” said Jennifer Lin, PhD, a researcher at Brigham and Women’s Hospital and lead author of the study.  “However, this finding and other similar ones are still important not only because many Americans take vitamin supplements with belief that they are obtaining some benefit, but also because these findings help to shed light on both the causes of cancer and the prevention of it.”

Previous research suggests that people whose diets are high in fruits and vegetables, and thus antioxidants, may have a lower risk of cancer, however; results from previous randomized trials that address the issue, rarely supported that observation. “Our study is another case where vitamin supplements failed to prevent against cancer,” said Lin.

Lin and colleagues tested the impact of antioxidant supplements on the development of cancer in 8,171 women who were at high risk of cardiovascular disease.  The women were randomly assigned to take vitamin C, vitamin E, or beta-carotene.  After following the women for an average of 9.4 years, there was no benefit from taking the supplements compared with placebo in terms of the development of cancer or death from cancer

“Supplementation with vitamin C, vitamin E, or beta carotene does not appear to lower cancer incidence or deaths from cancer,” said JoAnn Manson, chief of Preventive Medicine at Brigham and Women’s Hospital and senior author on the paper.  “Although a healthful dietary pattern rich in fruits and vegetables may lower cancer risk, such benefits cannot be mimicked by simply popping a few vitamin supplements.” 

This study was supported by a grant from the National Heart, Lung, and Blood Institute.

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Center of Excellence: Women's Health

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network.  BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals.  In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Dec 22, 2008

Boston, MA – Researchers from Brigham and Women’s Thrombolysis in Myocardial Infarction (TIMI) Study group have found that approximately one third of the population has variations in a specific gene that renders them unable to metabolize properly clopidogrel, one of the most commonly prescribed anti-platelet medications.   Compared to people who did not have the variants in the cytochrome P-450 2C19 (CYP2C19) gene, those who possessed the variants had lower levels of the active metabolite of clopidogrel, less inhibition of platelets, and a significantly higher risk for major adverse cardiovascular events such as death, heart attack, stroke, and stent thrombosis (a serious blood clot formation following a stenting procedure).  The findings appear today as an advance on-line publication for the New England Journal of Medicine.

“We found that patients with particular gene variants do not optimally respond to clopidogrel and therefore face a significantly higher risk of having a major cardiac event,” said Dr. Jessica Mega, lead author of the study and an Investigator at the TIMI Study Group as well as an Instructor of Medicine at Harvard Medical School.  Dr. Mega explained that “the identification of this link could be an important part of targeting medicine to individual patients rather than treating everyone with one-size-fits-all therapies.  In the future, doctors armed with this type of genetic information may be better positioned to care for patients suffering from heart attacks and other cardiovascular illnesses.”

The researchers found that in 162 healthy volunteers given clopidogrel, CYP2C19 genetic variant carriers had 32 percent lower levels of the active metabolite of clopidogrel and 25 percent less platelet inhibition as compared with those who did not have the variants.  The CYP2C19 gene encodes an enzyme in the liver that is responsible for converting clopidogrel from an inactive prodrug into its active metabolite.  Variation in the CYP2C19 gene is common in the general population, affecting 30 percent of Caucasians.
 
Building on those findings, the researchers examined outcomes in 1477 patients with acute coronary syndromes (heart attacks or unstable angina) who were treated with clopidogrel in the multinational TRITON-TIMI 38 study.  They found that CYP2C19 genetic variant carriers had a 53 percent increase in risk for death, heart attacks, or strokes as compared with those who did not have the variants.  They also found that those with the variants had a threefold increased risk of stent thrombosis, a life-threatening complication that can occur after coronary stenting.

Dr. Marc Sabatine, an Assistant Professor of Medicine at Brigham and Women’s Hospital and Harvard Medical School and senior author of the study, commented, “These data show that genes determine not only what diseases we have, but how we respond to medications.  Patients who harbor one of these genetic variants are not getting the benefit from clopidogrel that their doctors think they will.  Our results support the concept that genetics may be useful to tailor the pharmacotherapies we prescribe to our patients.”  

The research was supported by grants from Daiichi Sankyo and Eli Lilly.

The TIMI Study Group receives research funding from Brigham and Women’s Hospital and additional sources.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Dec 17, 2008

Imagine a computer chip so fast, it is capable of doing calculations it would take current computers a billion years to replicate. 

Imagine the ability to kill a cancer tumor by taking some of its cells and destroying them outside the body and, in turn, cells from that tumor still inside the body would die. 

  Is either example plausible?

In the case of the computer chip, researchers suggest that by 2025, the chip’s ability to perform more functions at a faster rate will come to an end.  A research team in the Department of Orthopedics at Brigham and Women’s Hospital in Boston, MA and Harvard Medical School, under the leadership of Mark Brezinski, MD, PhD, using principles related to quantum teleportation, has made an important step which not only opens the way for computer chips to increase the processing rate indefinitely, but information processing and telecommunication in general. These findings appear in the December 2008 issue of Physical Review.

The quantum computer chip is an excellent example of where the advances of this study could affect everyday lives.  Our society has reached a point where almost every device around us is controlled by a conventional computer chip or integrated circuit.  The chip, as well as telecommunication in general, transmits information with an alphabet of two (also known as bits), 0 and 1.  The computer age has seen the transmitting speed of 0's and 1's increase, but there is a limit.  Enter the quantum computer, which is not limited to transmitting 0’s and 1’s separately; it works with qubits which include 0 and 1 and also fall between the spectrum of 0 and 1.  The basis of the quantum computer comes from well established laws of the universe, non-locality and macroscopic superposition. The quantum computer can send information where the 0 and 1 are superimposed to various degrees, allowing an enormous amount of information to be transmitted over very small time scales. This will dramatically change the way and the degree to which information can be processed. Dr. Brezinski’s research work has developed an approach to make this far more feasible.

Factoring a number with 4000 digits - a numerical feat needed to break some security codes - would take even the fastest supercomputer in existence billions of years. But a quantum computer could achieve the task in under a year, thereby defeating many of the most sophisticated encryption schemes in use.

To understand superposition, one must accept the important, but somewhat inconceivable based on everyday life, principle of quantum mechanics that two particles can be spread over the same region of space.  In other words, they both exist in the same space simultaneously.  This has been achieved in the small atomic world with individual atoms and molecules, using complex systems typically cooled to temperatures near that of deep space.  Most scientists acknowledge that there is no known law of physics which says that superposition cannot occur even with objects on a larger scale - macroscopic superposition.  In the work at Brigham and Women’s Hospital, Dr. Brezinski’s team discovered that they can achieve macroscopic superposition, but at room temperature and with a light source similar to that of a laser pointer.  Explained below, this superposition was produced by manipulations that took place at a different location with no communication in between – non-locality.  This opens the door for applying these laws once limited to the world of the atom to objects on a larger scale. 

To understand further this work, non-locality must be addressed.  When two quantum objects are connected and then are separated even galaxies apart, as long as the 'connection' is not broken, what happens to one affects the other even though no communication is occurring in between.  Albert Einstein originally proposed this with two other scientists and referred to this action at a distance as 'spooky'.  For purposes of illustration, if two people become 'linked' (a non-local connection) and then are sent to different sides of the country, when the skin of one is burned by a match, the other feels the burn.  In the work done at Brigham and Women’s Hospital, Dr. Brezinski’s group split connected light, one toward a reflector and medium (target), the other to a special reflector called a grating.  By manipulating light at the grating, a macroscopic superposition was produced in the target, a true non-local effect.  A critical point, the target could be changed through events that were taking place at a different location, with no signal in between because the light maintained its connection or non-locality.

This is fascinating but what does it mean practically?  Let’s return to the quantum computer, which depends on superpositions.  Superpositions and non-locality can deteriorate rapidly (a trillionth of a second) in a process known as decoherence, rendering the quantum computer ineffective.  Conventional wisdom is the larger the object, the shorter the time superposition can be maintained or more rapidly it will undergo decoherence.  Furthermore, any attempt at measuring or directly manipulating the superposition will lead to its breakdown.  Here, Dr. Brezinski and his team were able to maintain the macroscopic superposition indefinitely but manipulate it non-locally at the grating because the split light remained connected.  This ability to perform manipulations at a distance is critical to countering the problem of decoherence.

A critical advance was not trying to cool the target down to extremely low temperatures.  Many investigators in the past have used this approach because at these temperatures – similar to outer space - all the molecules essentially are in one energy state or coherent.  In the approach used by Dr. Brezinski, the target was left at room temperature, but the entire system operated as one coherent state even though the target by itself was not.  In other words, the system was only connected when you looked at it as a whole, not just by looking at its individual parts.  Dr. Brezinski notes, “It’s hard to describe this in a few sentences, but think of two violinists trying to play the same piece.  It is extremely hard for them to sound nearly identical.  Now consider a more complex piece played by two orchestras with a large number of different musicians.  The piece will sound very similar, but if we only compared two violinists in the two orchestras, they could sound very different.  The whole, and not the parts, are behaving most closely as one unit.”

The question now arises, beyond the world of faster computers and communication, can this work be extended to the field of medicine.  Can cells for example exhibit these same quantum properties?  This is precisely the focus of Dr. Brezinski's current work.  "I am unaware of any physical laws which would prevent cells from exhibiting non-locality and macroscopic superposition.  The key obstacle, as was addressed in the current paper with light and reflectors, is overcoming decoherence.  It's not an easy problem, but to date I have seen no evidence that it is not potentially achievable through physical principles of the universe known for almost 80 years."  While the concept of killing cancer cells removed from the body and having those in the body die as well seems 'spooky,' the bizarre laws of quantum mechanics, non-locality and macroscopic superposition, move these concepts from the realm of science fiction to areas which, Dr. Brezinski adds, should be actively investigated.

This research was funded by NIAMS (National Institute of  Arthrtitis and Musculoskeletal Disease), NIBIB (National Institute of Biomedical Imaging and Bioengineering) and NHLBI (National Heart Lung and Blood Institute).

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network.  BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals.  In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Dec 16, 2008

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Related Links:

Center of Excellence: Women's Health

Press Release - Dec 9, 2008

Boston, MA - In a major cancer prevention study, researchers at Brigham and Women’s Hospital (BWH) found that long-term supplementation with vitamin E or C did not reduce the risk of prostate or other cancers for nearly 15,000 middle-aged and older male physicians. This study will be published online on December 9, and in the January 7 issue of the Journal of the American Medical Association.

In some observational studies, intake or blood levels of vitamins E and C have been associated with reduced risk of certain cancers. However, “Definitive proof that vitamins E and C can reduce the risk of overall or site-specific cancers must rely on large-scale randomized trials,” said J. Michael Gaziano, MD, MPH, Chief of the Division of Aging at BWH. “A number of trials have addressed the potential role of vitamins in the prevention of cancer; however, the results from these trials have not been consistent.”
 
The researchers conducted the Physicians’ Health Study II, a randomized, placebo-controlled trial to examine the effects of vitamin E and vitamin C on prostate cancer and total cancer. The study included 14,641 male physicians in the United States, age 50 years or older at the time of entering the trial, of whom 1,307 had a prior history of cancer. Participants were randomized to receive individual supplements of 400 IU of vitamin E every other day and 500 mg of vitamin C daily.
 
During an average follow-up of 8 years, there were 1,943 confirmed total cancer cases and 1,008 prostate cancer cases. Compared with placebo, vitamin E had no effect on the incidence of prostate cancer or total cancer. The researchers also found no significant effect of vitamin C on total cancer or prostate cancer. Neither vitamin E nor vitamin C had a significant effect on site-specific cancers, including colorectal, lung, bladder and pancreatic. Stratification by various cancer risk factors demonstrated no significant modification of the effect of vitamin E on prostate cancer risk or either agent on total cancer risk.
 
Despite uncertainty about the long-term health effects or benefits, more than half of US adults take vitamin supplements, and vitamins E and C are among the most popular individual supplements. “These data provide no support for the use of vitamin E and C supplements in the prevention of cancer in middle-aged and older men,” the authors conclude.

The research was funded by grants from the National Institutes of Health and an investigator-initiated grant from BASF Corporation.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Dec 8, 2008

Boston, MA - Researchers at Brigham and Women’s Hospital and Massachusetts General Hospital found that electronic prescribing systems that allow doctors to select lower cost or generic medications can save $845,000 per 100,000 patients per year, and possibly more. These findings appear in the December 8, 2008 issue of the Archives of Internal Medicine.
 
With insurers, policymakers and patients seeking ways to control fast-rising drug costs, researchers wanted to test the cost-savings potential of an electronic prescribing system that includes data on insurers’ formularies. Formularies are the lists of approved prescription drugs and corresponding patient co-payments for each insurance plan.
 
Using formularies, patients are charged the lowest cost and co-payment for generic medications (tier 1), a higher sum for preferred brand-name drugs (tier 2) and the highest amount for non-preferred brand-name drugs (tier 3). However, a major challenge to the effectiveness of tiered systems is the lack of current data on insurers’ prescription drug formularies at the moment of prescribing.
 
This new research demonstrates that “an electronic prescribing system showing doctors up-to-date formulary information can provide the opportunity to select more cost-effective medications,” according to Michael A. Fischer, MD, of the Department of Medicine at BWH. “This change in the way medication is prescribed can save money for insurers and patients alike.”
 
To test the cost-savings potential of an electronic prescribing system that includes data on insurers’ formularies, researchers compared the change in prescriptions written in three formulary tiers before and after an electronic prescribing system with formulary decision support was launched. The study examined data collected over 18 months from two major Massachusetts health insurers covering 1.5 million patients.
 
Doctors using electronic prescribing with formulary decision support, which accounted for over 200,000 filled prescriptions in the study, increased their use of tier 1 prescriptions by 3.3 percent, study authors found. Prescriptions written for tier 2 and tier 3 drugs decreased by 1.9 percent and 1.5 percent, respectively. These changes were above and beyond increasing use of generics that is occurring among all doctors and the already high rate of generic drug use in Massachusetts. 
 
Dr. Fischer noted that even doctors who had access to e-prescribing only used it about 20 percent of the time: “Our results likely represent a conservative estimate of the potential savings – as doctors begin to e-prescribe more frequently, the amount saved could increase dramatically.” 
 
The research was funded by grants from the Agency for Healthcare Research and Quality and the National Institutes of Health.

Brigham and Women's Hospital (BWH) is a 757-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine.  MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system.

Press Release - Dec 2, 2008

Boston, MA – In a study of trials comparing generic and brand-name drugs used to treat cardiovascular diseases, researchers at Brigham and Women’s Hospital (BWH) found that brand-name drugs are not clinically superior to their generic counterparts. After also looking at editorials written on the topic, they were surprised to find that a substantial number cautioned against widespread substitution of generic drugs for brand-name drugs in the treatment of cardiovascular disease. The findings will be published in the December 3 issue of the Journal of the American Medical Association.

“Generic prescription drugs can help improve patient adherence to treatment plans by reducing spending on needed drugs. And though generics must be approved by the FDA, there is still widespread concern among physicians and patients that generic drugs are somehow inferior to brand-name drugs,” said Aaron S. Kesselheim, MD, JD, of the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH and lead author of the study. “We found that head-to-head trials do not support this notion.”

The authors performed a systematic search of studies published in health care-related journals between 1984 and 2008 that compared clinical outcomes of generic and brand-name drugs used to treat cardiovascular disease. They identified 47 such studies, and a meta-analysis combining the results of clinical trials demonstrated no evidence for the superiority of brand-name drugs.

In addition, the authors reviewed all relevant editorials and commentaries from the same time period and found that about half expressed a negative view of the use of generic drugs to treat cardiovascular diseases, while only about a quarter supported the practice of substituting low-cost generics for brand-name drugs.

“We were surprised that so many editorials expressed a negative view of the interchangeability of generic and brand-name drugs, contradicting the available evidence on this point,” said Dr. William H. Shrank, MD, MSHS, of the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH, and one of the co-authors of the study.

“It is possible that the disconnect between the data and opinions expressed stems from physicians’ personal experiences, anecdotal reports, and even popular media coverage of cases in the community,” said Dr. Kesselheim.  He also commented that another possible explanation could be undisclosed financial relationships held by the editorialists, noting that nearly half of the trials and almost all of the editorials did not disclose funding sources or conflicts of interest.

The research was funded by a grant from the Attorney General Prescriber Education Program and investigator-initiated grants from the National Heart, Lung and Blood Institute, the National Institute on Aging, and the Agency for Healthcare Research and Quality.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 28, 2008

Brigham and Women’s Hospital (BWH) recently received the American Stroke Association’s Get With The Guidelines^SM–Stroke (GWTG–­Stroke) Gold Performance Achievement Award. The award recognizes BWH’s commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment for at least 24 months according to nationally accepted standards and recommendations.

“During a stroke, time is of the utmost importance because time loss translates into brain loss.  In achieving this award, we have addressed the important element of time,” said Steven Feske, MD, director of the Stroke Division.

BWH’s Stroke Division has developed a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department. This includes always being equipped to provide brain imaging scans, having neurologists available to conduct patient evaluations and using clot-busting medications when appropriate.

To receive the GWTG-Stroke Gold Performance Achievement Award, BWH demonstrated 85% adherence in the GWTG–Stroke key measures for 24 or more consecutive months. These include aggressive use of medications like tPA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol-reducing drugs, and smoking cessation.

“The American Stroke Association commends Brigham and Women’s Hospital for its success in implementing standards of care and protocols,” said Lee H. Schwamm, M.D., national Get With The Guidelines Steering Committee Member and director of the acute stroke services at Massachusetts General Hospital in Boston. “The full implementation of acute care and secondary prevention recommendations and guidelines is a critical step in saving the lives and improving outcomes of stroke patients.”

GWTG–­Stroke uses the “teachable moment,” the time soon after a patient has had a stroke, when they are most likely to listen to and follow their healthcare professionals’ guidance. Studies demonstrate that patients who are taught how to manage their risk factors while still in the hospital reduce their risk of a second heart attack or stroke. Through GWTG–­Stroke, customized patient education materials are made available at the point of discharge, based on patients’ individual risk profiles. The take-away materials are written in an easy-to-understand format and are available in English and Spanish. In addition, the GWTG Patient Management Tool provides access to up-to-date cardiovascular and stroke science at the point of care.

“We are proud to receive this award at a time when focusing on this issue is of growing importance.  The number of acute ischemic stroke patients eligible for treatment is expected to grow over the next decade due to increasing stroke incidence and a large aging population,” said Feske.

According to the American Stroke Association, each year approximately 700,000 people suffer a stroke — 500,000 are first attacks and 200,000 are recurrent. Of stroke survivors, 21 percent of men and 24 percent of women die within a year, and for those aged 65 and older, the percentage is even higher. 

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Nov 25, 2008

Boston, MA – In a study of U.S. railroad workers, researchers from Brigham and Women’s Hospital’s (BWH) Channing Laboratory and the Harvard School of Public Health (HSPH) found that individuals who were regularly exposed to diesel exhaust at work may have had an increased risk of dying from chronic obstructive pulmonary disease (COPD). These findings appear in the September 2008 issue of the British Medical Journal.  

COPD is a lung disease characterized by obstructed airways, difficulty breathing and is the fourth leading cause of death in the U.S. “There has been minimal research on the relationship between exposure to diesel exhaust and non-malignant pulmonary disease,” said Jaime E. Hart, ScD, Project Coordinator at BWH’s Channing Laboratory. “These findings can help provide researchers with direction regarding future research on the effects of diesel exhaust in today’s workplace.”

The researchers compared the death certificates of male railroad workers with and without diesel exhaust exposure, aged 40 to 64 years in 1959, with10 to 20 years of prior railroad work experience. After calculating the likely smoking history for the workers, a major contributing factor to COPD, and noting whether COPD was listed as a primary or secondary cause of death, researchers derived what the effects of exposure to diesel exhaust had on the likelihood of dying from COPD. With each additional year of exposure to diesel exhaust at work, an individual’s risk of dying from COPD increased by 2.1 percent.

Hart also explains,”Since the time period that the study investigated, the mid-twentieth century, technology and regulation have advanced. This study establishes a relationship between COPD mortality and diesel exhaust exposure in the workplace and encourages investigation of current trends in the locomotive and other industries where employees are regularly exposed to diesel exhaust.”

The research was funded by grants provided by the National Institute for Occupational Safety and Health, the National Institutes of Health and the National Cancer Institute.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Nov 24, 2008

Boston, MA – For patients with diabetes, thiazolidinediones (TDZs) are an oral treatment option for those who would otherwise have to resort to insulin shots to control their blood sugar levels. Researchers at Brigham and Women’s Hospital (BWH) compared the outcomes of the two TDZs available on the market today and found that in the group of patients using rosiglitazone, there was a higher occurrence of death and a greater risk of congestive heart failure (CHF) in elderly patients, when compared with those using the other TDZ, pioglitazone. The findings appear in the November 24, 2008 issue of Archives of Internal Medicine.

Shortly after rosiglitazone and pioglitazone entered the market, it became apparent that both had important adverse effects, most importantly CHF. Previous study of the drugs yielded results suggesting an increased risk of CHF for both, and an increased risk of myocardial infarction (MI) for those using rosiglitazone,. In studies of pioglitazone, however, it was suggested that patients had a lower risk of MI or stroke as compared to those in the study that did not receive the drug.

“Because there was limited data that directly compared the two drugs, we wanted to look specifically at the comparative risks of each,” said Wolfgang Winkelmayer, of the Pharmacoepidemiology and Renal Divisions at BWH and lead author of the study. “We wanted to determine whether older patients should consider certain risks when deciding whether to take one drug over the other.”

To examine the relative effects of rosiglitazone and pioglitazone, researchers looked at the medical information available for 28,361 Medicare beneficiaries aged 65 years and older who had diabetes and initiated treatment with one of the two TDZs.

After looking at the number of patients who died while on one of the drugs, researchers found that patients taking rosiglitazone were at a higher risk of death, with 15 percent greater mortality among patients using rosiglitazone. In addition, the occurrences of MI, stroke and CHF in patients were examined, and the group taking rosiglitazone exhibited a 13 percent greater risk of CHF. However, the study did not establish any differences in the risk of MI or stroke between the groups of patients taking the two drugs.

“This could be valuable information for elderly diabetic patients who are considering a TDZ, as well as for physicians prescribing these drugs to patients,” said Dr. Winkelmayer.

The research was funded by the American Heart Association.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 17, 2008

Boston, MA – Controversy about prostate-specific antigen (PSA) screening remains in the absence of large, randomized clinical trials that compare the benefits of screening vs. not screening. Patients and health care providers alike are confused about the current role of PSA screening and how to screen patients while waiting on definitive results of those trials.  New research at Brigham and Women’s Hospital finds that serial PSA screening may play a role in improving outcomes for patients who are diagnosed with prostate cancer.  These findings are published online and will appear in an upcoming print issue of CANCER.

“Men who were serially screened were diagnosed at an earlier stage and with more favorable PSA levels than men who had not had serial screening prior to diagnosis,” said Paul Nguyen, MD, lead author of the study and a chief resident in the Harvard Radiation Oncology Program at the Dana-Farber Brigham and Women’s Cancer Center.  “This supports the notion that serial PSA screening could lead to the diagnosis of prostate cancers at more curable stages, which could potentially result in lower death rates from prostate cancer.”   

Researchers evaluated nearly 2000 men with prostate cancer who had surgery, radical prostatectomy, to treat their prostate cancer.  Patients were separated into two groups, those who had a history of regular, repeated PSA screenings before being diagnosed with prostate cancer and those who were diagnosed with prostate cancer as a result of their first PSA screening.  Nguyen and colleagues found that men who had had PSA screening at regular intervals prior to their diagnosis had a substantially lower risk of recurrence than men who had not had prior serial screenings.  This effect remained significant even when the analysis was controlled for stage, PSA level, and gleason score, which are the factors doctors typically use to predict a patient’s risk of recurrence.
 
 “This research adds to the growing body of evidence showing the success of PSA screening, said Anthony D'Amico, MD, PhD, chief of Genitourinary Radiation Oncology at BWH and senior author of the paper. "Without serial PSA screening, recurrence rates of prostate cancer after surgery are 80 percent higher.”

“Patients who are diagnosed with prostate cancer the first time their PSA is checked may harbor more aggressive disease than their Gleason grade, PSA level, and stage would suggest, and may therefore need to be considered for more aggressive therapy than patients who have been screened serially” Nguyen said.

Researchers emphasize that more research is needed and that the most conclusive evidence will come in the form of results from randomized trials, which are expected in a few years.  This research was conducted as a collaboration with Dr. William J. Catalona of the Northwestern University Fineberg School of Medicine Department of Urology.,

 Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 9, 2008

Boston, MA – Until now, there has been no proven method to detect and prevent the many heart attacks and strokes that  occur in patients with normal or low cholesterol levels.  In the landmark JUPITER trial of 17,802 patients, researchers from Brigham and Women’s Hospital (BWH) report that rosuvastatin reduces by nearly fifty percent the risk of heart attack, stroke, and cardiovascular death among apparently healthy men and women participating in the trial who had low levels of cholesterol but were nonetheless at high risk for vascular disease due to increased levels of a simple blood test for the inflammatory biomarker hsCRP (high sensitivity C-reactive protein). These findings appear in the November 20, 2008 issue of the New England Journal of Medicine and will be presented November 9th at the 2008 Scientific Sessions of the American Heart Association. The New England Journal of Medicine will also publish the findings online November 9, 2008.

In the JUPITER trial which focused on low cholesterol/high hsCRP patients, a daily regimen of rosuvastatin was associated with a 54 percent reduction in heart attack, a 48 percent reduction in stroke, a 46 percent reduction in need for angioplasty or bypass surgery, and a 20 percent reduction in all-cause mortality compared to participants who were given a placebo. These effects are nearly twice as large as what doctors expect when using statin therapy among patients with high cholesterol, demonstrating the importance of elevated hsCRP as a major risk factor for cardiovascular disease. Among trial participants with elevated hsCRP but no other risk factors, rosuvastatin reduced cardiovascular events by 37 percent.  There was no difference between treatment groups for major adverse events, including cancer or myopathy. As in almost all prior statin trials, there was a small increase in reported diabetes.

Dr Robert Glynn, the academic study statistician, estimated that approximately 250,000 heart attacks, strokes, revascularization procedures, or cardiac deaths could be avoided in the US alone if the strategy tested in JUPITER was applied over a five year period.
 
“Our results are relevant for patient care and the prevention of heart attack and stroke,” said Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital and lead author of the study. “Physicians can no longer assume that patients are at low risk for heart disease simply because they have low cholesterol. We have confirmed that patients with increased hsCRP are at high risk even if cholesterol levels are low, and we now have evidence that a simple and safe therapy cuts that risk and saves lives.”

The JUPITER trial results also demonstrate for the first time that statin therapy is highly effective in the prevention of heart disease among women and minority patients, groups that typically have been excluded or understudied in prior trials. For example, rosuvastatin reduced the risk of cardiovascular events by 46 percent in women compared to 42 percent in men.

Started in 2003, JUPITER (the Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) was designed to test whether rosuvastatin, taken at 20mg daily compared to placebo, could reduce the risk of cardiovascular events among apparently healthy men and women who had LDL cholesterol levels below 130mg/dL who were nonetheless at silent risk due to increased levels of inflammation as measured by a simple blood test known as high sensitivity C-reactive protein (hsCRP).

Prior work had established that patients with increased hsCRP were at high risk for heart disease despite lacking other conventional risk factors, and that statins lower hsCRP levels, indicating anti-inflammatory as well as cholesterol lowering effects. Until JUPITER, whether or not statin treatment would be effective in reducing cardiac events among these patients had been uncertain.

“The JUPITER trial data are paradigm shifting and a win-win for patients and for health care providers” said Dr. Antonio Gotto, Dean of the Weill-Cornell Medical College in New York. “We should regularly measure hsCRP along with lipids when we determine cardiovascular risk.”

“For the cardiology world, discovering a major new risk factor as well as an effective treatment is like hitting a walk-off home run to win the World Series,” said Dr. Eugene Braunwald, a renowned cardiologist also at Brigham and Women’s Hospital.

The strategy of screening for hsCRP and treating those at high risk is likely to be cost-saving since rates of hospital admission and the need for expensive angioplasty and coronary artery bypass surgery were also reduced by nearly 50 percent among trial participants receiving rosuvastatin.

Participants in JUPITER had cholesterol levels widely considered optimal by most physicians; the average LDL or “bad” cholesterol was just above 100 mg/dL and the average HDL or “good” cholesterol was nearly 50 mg/dL. Nonetheless, event rates in the trial were high because all participants had elevated levels of hsCRP.

“JUPITER should dramatically change prevention guidelines” said Dr. James Willerson, Director of the Texas Heart Institute in Houston. “The bottom line here is simple – if your hsCRP is high, you should be on statin therapy regardless of your cholesterol level. This is an approach we can start using tomorrow”.

Led by Dr. Ridker of BWH, JUPITER was a randomized, double-blind, placebo-controlled trial conducted by investigators in 26 countries and overseen by an academic statistician (Robert Glynn, PhD, Harvard University, USA) and an independent Data and Safety Monitoring Board (chaired by Professor Rory Collins, Oxford University, UK). The study was funded by AstraZeneca, US who had no access to unblinded trial data and played no role in analysis or interpretation of the study data nor in manuscript preparation. Dr. Ridker is listed as a co-inventor on patents held by BWH that relate to the use of inflammatory biomarkers in cardiovascular disease that have been licensed to AstraZeneca and Siemens Healthcare Diagnostics in the therapeutic and diagnostics field respectively.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 9, 2008

Web-based application shows patients and doctors how risk can be dramatically reduced

Boston, MA – Using data collected from nearly 11,000 initially healthy American men, researchers from Brigham and Women’s Hospital (BWH) have devised a Web-based formula that uses information on C-reactive protein and family history to more accurately predict risk of heart attack, stroke, or cardiovascular death among men.  In addition to usual risk factors like age, cholesterol, blood pressure, and smoking, the new assessment tool known as the Reynolds Risk Score for Men adds information on two additional factors, parental  history of heart attack prior to age 60 and blood level of high sensitivity C-reactive protein (hsCRP), a measure of artery inflammation. Using the new risk assessment tool, the researchers found that nearly 20 percent of men in the study could be reclassified into higher or lower-risk categories with greatly improved accuracy. The findings appear in the journal Circulation in an advanced online version November 9, 2008. The Reynolds Risk Score for Men parallels the Reynolds Risk Score for Women that was released in 2007 and rapidly adopted by the preventive cardiology community.

For the millions of American men currently classified at “intermediate risk,” use of the Reynolds Risk Score provides doctors and their patients a much clearer picture of expected risk and therefore is an important step towards “personalized medicine” to ensure that the right preventive therapies are given to the right patients. Application of the new Reynolds Risk Score for men should help physicians decide where the greatest impact of diet and exercise can be made, and will help to better target therapies including aspirin and statins.

 “Beyond providing an opportunity for improved risk classification for men similar to that currently available for women, we believe these findings have potential importance for more accurately targeting preventive therapies,” said cardiologist Paul Ridker, director of the Center for Cardiovascular Disease Prevention at BWH and lead author of the study.  “The findings further demonstrate the important role that inflammation and parental history can have in risk prediction, even in the setting of optimized access to preventive care.”

The Reynolds Risk Score for men derived from an evaluation  of 10,407 initially healthy men enrolled in the Physician’s Health Study II in 1995 who were followed prospectively for more than a decade for the occurrence of first heart attack, stroke, and other major cardiovascular events. The researchers first evaluated traditional approaches to risk prediction in these men using a model based on cholesterol level, history of smoking, blood pressure and age.  They then added family history of heart attack prior to age 60 and hsCRP level, and directly compared the new prediction tool to the traditional approach. The two new risk factors proved crucial to better understanding cardiovascular risk in these men, each representing an important advance in the biology of heart disease.

“Using the Reynolds Risk Score, we found that about 20 percent of all men had either higher or lower cardiac risk than we would have presumed based on more traditional approaches” Ridker explained. “Correctly classifying risk is crucial for those of us trying to get the right preventive drug to the right patient and to do so as cost-effectively as possible”. The new risk prediction algorithm comes on the heals of the large-scale JUPITER trial demonstrating that individuals with elevated hsCRP levels markedly benefit from statin therapy.

Both the Reynolds Risk Score for Men and the Reynolds Risk Score for Women are  freely available at www.ReynoldsRiskScore.org. In addition to providing men and woman with an improved estimate of their risk of suffering a future heart attack, stroke, or other major cardiovascular event over the next 10 years, the Reynolds Risk Score website simultaneously shows each person what his or her  risk would be if they improved each of their individual risk factors to optimal levels. For some young people, risk may appear low over the next 10-years, yet can be very high over a lifetime. The Reynolds Risk Score also allows people to calculate risk as they age, demonstrating the impact that risk reduction early in life can have on future events. The Reynolds Risk Score website provides useful links to prevention programs from the National Heart Lung and Blood Institute, the American Heart Association, and the American College of Cardiology.

Development and validation of the Reynolds Risk Score was supported by investigator-initiated grants from the Donald W. Reynolds Foundation, Las Vegas, Nevada and by funds from the National Heart Lung and Blood Institute, Bethesda, Maryland. Dr Ridker is listed as a co-inventor on patents held by the Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers including CRP in the detection and treatment of cardiovascular disease.  Other BWH investigators involved in the project include Nina Paynter, Michael Gaziano, Nader Rifai, and Nancy Cook.

Related Links
JUPITER trial resutls
Cardiovascular Center of Excellence

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 9, 2008

Both vitamin E and vitamin C are antioxidant supplements that are taken by many American adults with the belief that they offer protection against chronic conditions such as cardiovascular disease.  However, new research from Brigham and Women’s Hospital (BWH) finds that neither vitamin E nor vitamin C supplements protect against cardiovascular disease in middle-aged and older men.  This research was presented at the American Heart Association’s (AHA) Scientific Sessions 2008 and published simultaneously online in the Journal of the American Medical Association (JAMA).  

“There has been great interest in antioxidants in the prevention of disease.  Our study shows that vitamin E and vitamin C supplements are not effective in the prevention of cardiovascular disease for middle-aged and older men.  People should continue to focus on eating a healthy diet, exercising regularly and controlling known risk factors such as high cholesterol and high blood pressure to reduce the risk of cardiovascular disease,” said Howard D. Sesso, Sc.D., M.P.H., Project Director of Physicians Health Study II at Brigham and Women’s Hospital and lead author of the paper published in JAMA.

Researchers studied more than 14,000 male physicians who took either a vitamin E or C supplement or its placebo, depending upon the group to which each physician had been randomly assigned. Over an average of eight years follow-up, participants provided annual updates on their pill-taking, potential side effects, risk factors for disease, medication use, and new disease diagnoses.  Researchers were able to access participant’s medical records when necessary to confirm participant reports of cardiovascular events or cause of death.  After analyzing participant data, researchers found that neither vitamin reduced the risk of cardiovascular disease in men. 

“Unlike most previous studies in which vitamins E and C were given in combination with other antioxidants, this study investigated the two vitamins individually.  Our findings add to the growing consensus about vitamin E and C’s lack of cardiovascular protection,” said J. Michael Gaziano, M.D., M.P.H., Principal Investigator of the study and a cardiologist at Brigham and Women’s Hospital and VA Boston, Boston, Mass.  Dr. Gaziano presented these results as a late breaking clinical trial at the AHA Scientific Sessions.

This research was funded by the National Institutes of Health and BASF Corp. (Florham Park, N.J.).  Supplements and packaging was provided by BASF, Wyeth Pharmaceuticals (Madison, N.J.), and DSM Nutritional Products, Inc. (Parsippany, N.J.).

Related Links
Physicians' Health Study
Division of Preventive Medicine
Cardiovascular Center of Excellence 

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 6, 2008

BOSTON, MA - Researchers from Brigham and Women's Hospital (BWH) and City College of New York have developed a new self- assembling hydrogel drug delivery system that is biocompatible, efficient at drug release, and easy to tailor. The findings, which are now available online at Science Direct, will be published in the November 25  issue of Biomaterials.

These new structures can deliver clinically approved drugs in high concentrations without requiring carriers for the drug or generating toxic components, a problem with hydrogel systems until now.

"This strategy could serve as the platform technology for developing drug-based delivery gels that can release drugs such as anti-inflammatory agents on demand in response to inflammation, for example," said Jeffrey Karp, PhD, a researcher in the Department of Medicine at BWH.

"Converting known, clinically-practiced drugs into amphiphilic molecules which can undergo self-assembly is the key development in our present research; this may eliminate the need for an external carrier for delivering drugs" says Praveen Kumar Vemula, PhD, research fellow in the Department of Medicine at BWH.

The self-assembling nano-fiber gel is developed from drug-based hydrogels and can release drugs on demand, through enzyme triggered gel degradation.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 5, 2008

Gray Matter Imaging May Lead to More Accurate Identification of Those At-risk

Researchers at Brigham and Women’s Hospital (BWH) have shown that MRI scans used on multiple sclerosis (MS) patients to determine if the disease has affected gray matter in the brain can identify those at-risk for progression of disability.  This research is published in the current issue of the Journal of Neuroimaging. 

MS affects approximately 400,000 people in the United States and as many as 2.5 million worldwide. It is the most common cause of progressive disability in young adults. While the cause of the disease remains unknown, it is characterized by damage to the covering over the nerve fibers in the brain and spinal cord, or to the nerve fiber itself.

In an attempt to understand the causes of disease progression, Dr. Rohit Bakshi, director of the Laboratory for Neuroimaging Research at Brigham and Women’s Hospital, and his team have developed new ways to detect gray matter damage.  Researchers led a four year follow-up study, which found that patients with unnatural darkness of gray matter structures as seen on MRI pictures carried a higher risk for progression of physical disability.  In addition, the researchers found that the new marker of gray matter damage showed closer correlations with patients’ clinical status than other established MRI markers of disease severity, including lesions, called plaques, and shrinkage of the brain, or atrophy.

“MRI scans obtained from patients with MS are being used to develop measures and techniques that can accurately measure the visible and hidden damage to the brain, especially in gray matter areas and can more accurately predict the course of the disease,” says Bakshi.  “MRI-based measurement of gray matter damage may be used as a surrogate marker of disease progression so that physicians may be able to more accurately identify patients at risk for developing progressive disease,” he added.

MS has been traditionally viewed as a disease affecting the white matter of the brain, where messages are transferred between the brains gray matter sections, which control the processing of information. While prior research has shown that the brain’s gray matter is also affected, studies detailing its effects have been limited. In addition, current therapies for MS are incomplete, raising the need to better understand disease mechanisms and the biomarkers of disease progression. If excessive iron in gray matter contributes to damage, this would open a new avenue for developing better therapies.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 4, 2008

 BOSTON, MA – Previous studies have shown a connection between folate, B6 and B12 vitamin intake and cancer prevention.  Approximately one-third of adults in the United States take a daily multi-vitamin containing these supplements.  Now, researchers from Brigham and Women’s Hospital (BWH) have found no association between folic acid, vitamin B6 and B12  intake and overall cancer risk in middle aged women.  This research is published in the November 5, 2008 issue of the Journal of the American Medical Association.

“Women have been under represented when it comes to clinical trials with B vitamins.  This study shows that combined treatment of folic acid, vitamin B6 and B12 provided neither beneficial nor harmful effects on overall risk of cancer for women aged 42 years or older with underlying cardiovascular disease or risk factors,” said Shumin Zhang, MD, ScD, lead author of the study and a researcher in the Division of Preventive Medicine at BWH.

Researchers assigned 5,442 female health professionals aged 42 years or older to receive either a daily combination of folic acid, vitamin B6 and B12 or placebo starting April 1998 through July 2005, when the US food supply began to be fortified with folic acid.  The women either had preexisting cardiovascular disease or carried three or more risk factors for coronary disease.  Of the participants, 187 who received the daily supplement developed invasive cancer compared to 192 who received the placebo.  Researchers found that treatment with combined folic acid, vitamin B6 and B12  has no effect on total invasive cancer, breast cancer or deaths from cancer.  Researchers note that there was a reduced risk for total invasive cancer and breast cancer observed in women who were 65 or older when enrolled in the study and were randomized to receive the combination folic acid, vitamin B6 and B12,  but they cautioned that these subgroup findings may have been due to chance.

“Despite the apparent lack of benefit from these supplements for cancer prevention, several studies suggest that dietary sources of folate, such as dark green leafy vegetables, may lower cancer risk.  Also, previous studies have shown conclusively that folic acid lowers the risk of certain birth defects, such as spina bifida, and adequate intake is important throughout pregnancy,” said JoAnn Manson, MD, DrPH, senior author of the paper and chief of Preventive Medicine at BWH.

This research was funded by the National Heart Lung and Blood Institute of the National Institutes of Health.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Nov 1, 2008

BOSTON, MA - Adult stem cells resemble couch potatoes if they sit and divide in a dish for too long. They get fat and lose key surface proteins, which interferes with their movement and reduces their therapeutic potential. Now, via a simple chemical procedure, researchers at Brigham and Women’s Hospital (BWH) have found a way to get these cells off the couch and over to their therapeutic target. These findings were published online in Bioconjugate Chemistry on October 31.

To do this, researchers simply added a molecule called SLeX to the surface of the cells. The procedure took just 45 minutes and restored an important biological function.

"Delivery remains one of the biggest hurdles in stem cell therapy," explains Jeffrey Karp, PhD, a researcher in the Department of Medicine at BWH. "The blood stream offers a natural delivery vehicle, but stem cells don't move through blood vessels normally after being expanded in culture. Our procedure promises to overcome this obstacle."

In order for cells injected into the blood stream to be therapeutically useful, they need to take initiative to reach target tissues. But instead, cultured stem cells move with the natural blood flow. They travel through the body quickly, carried by the current, which means they seldom contact the sides of blood vessels. Thus, they have fewer opportunities to escape into the surrounding tissue. Adult stem cells must escape before they can colonize surrounding tissue and rebuild damaged structures.

Previously, BWH researcher Robert Sackstein showed that this problem could be corrected by adding a particular molecule to the surface of adult stem cells. This molecule - a cousin of SLeX - formed temporary connections with proteins on the blood vessel wall, serving as a kind of weak tape. However, Dr. Sackstein's method involved enzymes, which limits the potential modifications. Dr. Karp's team achieved the same result without enzymes.

Debanjan Sarkar, a fellow in the Renal Division at BWH, flooded a dish of cells with three molecules - biotin, streptavidin, and SLeX - one after the other. The biotin and streptavidin anchored SLeX to the cell surface. Sarkar tweaked the concentrations of each molecule to maximize the cell's ability to roll along the interior of the blood vessel, rather than getting lost in the flow. He also confirmed that the altered cells were still viable.

"The method is very simple," says Sarkar. "Plus, biotin and streptavidin work with many molecules, so labs can use this universal anchor we discovered to tackle other problems. They're not limited to sticking SLeX on cells."

The team worked with human cells extracted from the bone marrow. The cultures included mesenchymal stem cells (MSCs), which can form fat cells, cartilage, bone, tendon and ligaments, muscle cells, and even nerve cells. When injected into the bloodstream of patients, MSCs can home to the site of an injury and replace damaged tissue. Currently, only a fraction of cultured MSCs currently reach their target in clinical trials.  Karp's procedure might improve their homing abilities.

The discovery must be validated in animals, before doctors can apply it in the clinic, notes Karp, who is collaborating with another lab to test the homing ability of the SLeX-dotted cells in mice.

"We need to confirm that this rolling behavior translates into increased homing and tissue repair," explains Karp. "We may need to tweak the cells a little further."

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Oct 13, 2008

BOSTON, MA – Researchers at Brigham and Women’s Hospital (BWH) have dispelled a past belief that caffeine consumption may increase breast cancer risk.  Their findings, published in the October 13 issue of Archives of Internal Medicine, show that caffeine consumption does not appear to be linked with overall breast cancer risk.

Caffeine, one of the most commonly consumed drugs worldwide, was previously thought to increase the risk of breast cancer after a study showed that women with non-cancerous breast disease experienced relief from their symptoms after removing caffeine from their diet.  In this study, Ken Ishitani, MD, Ph.D, of BWH, and colleagues studied 38,432 women 45 years or older who provided dietary information in 1992-1995. Over an average of 10 years of follow-up, 1,188 of the women developed invasive breast cancer.

Although caffeine was not statistically significantly associated with overall risk of breast cancer, researchers note that there is a possibility of increased risk for women with benign breast disease or for tumors that are hormone-receptor negative or larger than 2 centimeters.  This potential risk was observed in women with the highest consumption; four or more cups of coffee daily.  Researchers also note that consuming caffeine was associated with a 68 percent increased risk of estrogen receptor–negative and progesterone receptor–negative breast cancer, or tumors to which the hormones estrogen and progesterone do not bind, and a 79 percent increased risk for breast tumors larger than 2 centimeters.

“The mechanisms by which caffeine may affect the development of breast cancer are complex and remain unclear.  Our findings indicate that caffeine consumption may affect breast cancer progression, and such an effect may be independent of the estrogen pathway,” said Shumin Zhang, MD,ScD,MSC.  “Further study is required to better understand caffeine’s role.”

This research was funded by the National Institutes of Health.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Oct 8, 2008

WASHINGTON, D.C. — For the first time, five leading healthcare organizations have come together to publish practical science-based strategies to help prevent the six most important healthcare-associated infections (HAIs). Titled the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, the strategies were authored by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA), with input from the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission.

HAIs are one of the nation’s most serious public health and patient safety issues. The Centers for Disease Control and Prevention (CDC) estimate that 2 million Americans contract an infection while receiving treatment and over 90,000 Americans will die as a result of complications from an infection each year. Hospital infections cost Americans between $4.5 billion and $6.5 billion in extra healthcare costs each year.

“The goal of all of us as healthcare providers is to offer the best and safest patient care possible.  Not all HAIs are preventable, but we can make use of practices that we know are effective to prevent as many of these infections as possible,” said lead author of the strategies, Deborah S. Yokoe, MD, associate physician at the BWH Channing Laboratories and SHEA spokesperson. “We know that relying on the best science available will help get us to that goal.”

With the support or endorsement of an additional 21 healthcare organizations, the Compendium is expected to be a good starting point for addressing this critical public health crisis before it worsens. Infection control experts at SHEA and IDSA will assume responsibility for updating these strategies as science evolves.  

 “People should expect healthcare that is safe and free from additional complications, “said P.J. Brennan, MD, head of the federal Healthcare Infection Control Practices Advisory Committee and President of SHEA.  “This effort will benefit healthcare providers, patients and their families and, just about everyone who walks in the hospital door because the strategies announced today identify what hospitals should be doing based on the latest scientific evidence and also provide  performance measures to ensure accountability."   

The urgency is heightened for acute care facilities to work toward eliminating HAIs. Beginning Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for costs related to treating certain HAIs.

“These strategies clearly identify basic things all hospitals should be doing and how they can measure their progress through internal performance measures,” said Rich Umbdenstock, CEO of AHA. “Regardless of where a hospital falls on the spectrum of controlling HAIs, this compendium offers practical advice on specific steps they can take today to improve patient safety. These strategies work in a real life setting.”

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Oct 5, 2008

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH) and colleagues found that excess bodyweight and high plasma concentrations of C-peptide (a protein that reflects the amount of insulin secretion) in men who are subsequently diagnosed with prostate cancer are reliable indicators that they are more likely to die from their disease than those with lower levels. This substudy of the Physician’s Health Study is found in an article published online on October 5, and in the November edition of The Lancet Oncology.

 Jing Ma, MD, MPH, PhD, of the Department of Epidimiology at BWH, and colleagues assessed data from 2546 men diagnosed with prostate cancer during 24 years of follow-up in the Physician’s Health Study. The association between baseline BMI, baseline plasma C-peptide concentrations, and BMI measured at 8-years of follow-up and subsequent prostate cancer-related death was examined.

Several past studies have suggested that men who are overweight, as measured by body-mass index (BMI), have an increased risk of prostate-cancer progression and disease-related death. However, long-term, prospective data on prostate cancer-specific mortality have been scarce. Furthermore, although the high insulin concentrations associated with obesity could potentially explain the adverse effect of obesity on prostate cancer mortality, no studies had assessed the association between pre-diagnostic plasma concentrations of C-peptide and prostate cancer-specific mortality.

 Using the Physician’s Health Study, researchers found that men who were overweight (BMI =25–29·9 kg/m2) or obese (BMI =30 kg/m2) before diagnosis were significantly more likely to die from their prostate cancer than men of normal weight (BMI <25 kg/m2).="kg/m2)." This="This" trend="trend" remained="remained" significant="significant" after="after" controlling="controlling" stage="stage" Gleason="Gleason" grade.="grade." Baseline="Baseline" were="were" available="available" for="for" 827="827" those="those" highest="highest" plasma="plasma" concentrations="concentrations" also="also" prostate-cancer="prostate-cancer" mortality="mortality" compared="compared" the="the" lowest="lowest" concentrations.="concentrations." Men="Men" with="with" both="both" C-peptide="C-peptide" concentration="concentration" and="and" high="high" BMI="BMI" prior="prior" to="to" diagnosis="diagnosis" prostate="prostate" cancer="cancer" had="had" a="a" four="four" times="times" higher="higher" risk="risk" disease-specific="disease-specific" mortality,="mortality," independent="independent" of="of" other="other" clinical="clinical" predictors.

 The findings provide “further impetus for men to avoid becoming overweight and to decrease their risk of metabolic syndrome by physical activity and diet; and also adds to the rationale for investigation of new therapeutics and prevention strategies, such as use of insulin-lowering or anti-diabetic drugs,” says Dr Ma.

 Researchers also note that measurement of a blood hormone level, even prior to the diagnosis of a cancer, allows one to predict the behavior of cancer that might arise many years in the future.

 Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Sep 25, 2008

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH) and Harvard Medical School (HMS), studying the long-term effectiveness of drug-eluting stents compared to bare-metal stents among patients who had an acute heart attack, found that patients who received drug-eluting stents had significantly lower mortality rates after two-years compared to patients who received bare-metal stents. This study used the largest cohort and longest follow-up time to date for stent comparison research in the US. The findings appear in the September 25, 2008 issue of the New England Journal of Medicine.

The researchers followed 7,217 patients from Massachusetts who were treated with a stent for a heart attack between April 1, 2003 and September 20, 2004 (4016 with drug-eluting stents and 3201 with bare-metal stents). Each drug-eluting stent patient was matched with a similar bare-metal stent patient and followed for two years. Overall, death rates were two percent lower during this time for patients with drug-eluting stents. The death rate was further lowered (3.1 percent) for patients who had an acute heart attack and received a drug-eluting stent compared to those receiving a bare-metal stent for the same type of heart attack and again in cases of less acute heart attacks (2.9 percent). Additionally, rates of repeated stenting were significantly reduced during the two year span for all of those in the study who received a drug-eluting stent.

"Heart attacks are a life threatening condition where physicians need to decide quickly what the best way is to open the blocked artery. We conducted this study to understand whether drug-eluting stents are safe in this situation. It is very reassuring that drug-eluting stents were actually associated with better survival and fewer repeat procedures," said lead author Laura Mauri MD, an interventional cardiologist at Brigham and Women’s Hospital and an assistant professor at Harvard Medical School. Dr Mauri also cautioned, "Safe treatment with stents requires that patients are also able to take important medications like aspirin and other medicines that prevent clotting such as clopipdogrel, and so the choice of treatment still requires careful consideration of each individual patient’s condition.

Principle investigator of the study and professor of Health Care Policy at HMS, Sharon-Lise Normand added, "Through an effort headed by the Division of Health Care Quality at the Massachusetts Department of Public Health we were able to use clinical data collected from every hospital in the state that treats patients with stents to assess safety of the drug-eluting stents."

The research was part of a program that the Massachusetts Department of Public Health established in 2002 to examine the quality of cardiac care in Massachusetts hospitals.  Dr. Paul Dreyer, Director of the Department's Bureau of Health Care Safety and Quality which oversees the program, said "The potential impact of this research on public health is an excellent example of the benefits of collaboration between government and academic institutions."  Harvard Medical School serves as the cardiac data and research coordinating center for the Department's program.

The research was funded by the Massachusetts Department of Public Health.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Harvard Medical School http://hms.harvard.edu has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Press Release - Sep 21, 2008

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH) and colleagues have uncovered specific locations on chromosomes (loci) linked to rheumatoid arthritis (RA), a progressive autoimmune disease that attacks the joints and other organs. Variations in the genetic sequence at these locations imply a risk of developing RA. These findings appear in the September 14, 2008, advance on-line issue of Nature Genetics.

A painful and sometimes disabling disease, RA afflicts up to one percent of the global population and an average of two million people in the U.S. “Learning of new loci linked to RA can help researchers determine how variations there effect the immune system, as well as fuel research for new treatments,” said Robert Plenge, MD, of the Division of Rheumatology, Immunology and Allergy at BWH.

The discovery of a particular location, CD40- a gene linked to mediating immune and inflammatory responses- is important because CD40 has been a target for therapy in the past. By confirming that genetic variations at this location implies risk of developing RA, researchers have provided a basis for continuing investigation of CD40 to help determine therapy for the disease.

In addition to the six loci researchers found, seven other loci have previously been shown to imply risk for RA if variations occur. Plenge said, “This study supports the idea that there are many more locations on chromosomes that are linked with determining risk of developing this disease.”  He emphasizes, “Each discovery of a new locus is like finding another puzzle piece that helps us put together a better understanding of RA."

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Sep 18, 2008

Robert M. Friedlander, MD, vice chairman of the Department of Neurosurgery at Brigham and Women's Hospital (BWH) and associate professor in neurosurgery at Harvard Medical School, has been appointed to the National Advisory Neurological Disorders and Stroke Council, the major advisory panel for the National Institute of Neurological Disorders and Stroke (NINDS).

The NINDS, a component of the National Institutes of Health (NIH), is the nation’s primary supporter of basic, translational, and clinical research on the brain and nervous system. The council meets three times each year to review applications from scientists seeking financial support for biomedical research and research training on disorders of the brain and nervous system.  Members also advise the institute on research program planning and priorities.

Dr. Friedlander’s clinical specialties include aneurysms and vascular malformations, brain tumors, carotid disease, cerebrovascular disease, Chiari malformation, microvascular decompression, and radiosurgery. His research focuses on mechanisms of apoptosis, or programmed cell death.  He and his team are investigating ways to stop or slow the progression of cell death in Huntington’s disease, ALS, and stroke.  He was the first to demonstrate the functional role of apoptotic pathways in a number of neurologic diseases. He and his team have reported success with using pharmacological interventions to reduce apoptosis in mouse models of neurological disease.  He is a member of numerous professional societies and is widely published in his field.  Dr. Friedlander is also an associate neurosurgeon at Children’s Hospital Boston and on the consulting staff at Dana Farber Cancer Institute.

Dr. Friedlander formally joined the 18-member council, composed of physicians, scientists, and representatives of the public, at the council’s September 18 meeting, and will serve through July 2012.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Sep 4, 2008

Future therapeutics can target specific risk factors for Crohn’s disease and ulcerative colitis

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH), Harvard’s School of Public Health and Medical School and colleagues in Europe have found a new genetic pathway for the development of both of the major forms of inflammatory bowel disease (IBD); Crohn’s disease and ulcerative colitis.  Alterations in the gene XBP1, (X box binding protein 1) which is involved in regulating cellular stress pathways, has been identified as a major risk factor for the development of these two IBDs and the researchers point to the epithelial cell as the cell type responsible for initiating IBD as a result of the genetic alterations. The findings appear in the September 5, 2008 issue of the Journal Cell.

 It has long been suspected that the epithelium may play a critical role in the development of ulcerative colitis and Crohn’s disease. The epithelium that lines the inside surfaces of the intestine is the first set of cells to contact the environment and serves as the primary functional barrier to the outside world. This epithelium is strategically placed between the two major ingredients involved in the development of IBD, the largest concentrations of bacteria and immune cells in the human body.

 To determine the role of XBP1 in the intestinal epithelium, the researchers developed mice in which that gene was deleted. The mice developed an IBD-like intestinal inflammation through a mechanism that involved an inability to regulate intestinal bacteria, together with a hypersensitivity of the epithelium to the products of the bacteria, culminating in spontaneous intestinal inflammation. To determine if XBP1 might be a genetic risk factor in the development of the human conditions, the researchers performed genetic analysis on nearly 5,000 IBD patients and controls which involved genetic sequencing through the XBP1 gene of 1,200 patients and controls and found that there was an association with both forms of IBD. They also found unique genetic alterations that were likely to be functional risk factors.

 “The findings are very exciting and paint the first coherent picture of how a genetic encoded risk factor can emerge as inflammatory bowel disease,” said Richard Blumberg MD, senior author of the study and Chief of the Division of Gastroenterology, Hepatology and Endoscopy at BWH. He continued, “The therapeutic implications are huge because the findings allow us, for the first time, to rationally target a factor that we know is a risk factor for developing IBD.”  Co-senior author Laurie Glimcher the Irene Heinz Given Professor of Immunology at Harvard School of Public Health comments, “We had no idea when we first discovered XBP1 that it would turn out to be such a key factor in a human disease.”

 The research was funded by the Crohn’s and Colitis Foundation of America, the National Institutes of Health, the Ellison Medical Foundation, the DFG/German Ministry of Science Excellence Cluster, the Austrian Science Fund and the Max Kade Foundation.

The research team was comprised of: Arthur Kaser, Brigham and Women’s Hospital; Ann-Hwee Lee, Harvard School of Public Health; Andre Franke, Christian-Albrechts University, Kiel, Germany; Jonathan Glickman, Brigham and Women’s Hospital; Sebastian Zeissig, Brigham and Women’s/Harvard Medical School; Herbert Tilg, Innsbruck Medical University, Austria; Edward Nieuwenhuis, Sophia Children’s Hospital, Rotterdam, The Netherlands; Darren Higgins, Harvard Medical School; Stefan Schreiber, Christian-Albrechts University, Kiel, Germany; Laurie Glimcher, Harvard’s School of Public Health and Medical School and Brigham and Women’s Hospital; Richard Blumberg, Brigham and Women’s Hospital and Harvard Medical School.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.

Press Release - Sep 3, 2008

Researchers analyzed outcomes and characteristics of federal cases exposed by whistleblowers between 1996 and 2005

BOSTON, MA – Health care fraud is widely thought to be pervasive, and now, for the first time, researchers at Brigham and Women’s Hospital (BWH) have chronicled the characteristics and financial impact of recent health care fraud cases.   Their work, published in the September 2, 2008 issue of the Annals of Internal Medicine, provides important insights into where health care fraud is found most frequently and the whistleblowers who enact most of the legal action.

“With health care costs continuously rising and straining government budgets, the efforts of prosecutors to identify and address health care fraud where it exists are becoming increasingly important,” said Aaron S. Kesselheim, MD, JD, MPH, an Instructor in Medicine in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH and lead author of the study.  “This study provides the results from a systematic evaluation of fraud cases.”

Kesselheim and his co-author, David M. Studdert, LLB, ScD, of the University of Melbourne, Victoria, Australia, analyzed all 379 federal health care fraud cases resolved between 1996 and 2005 that were initiated by whistleblowers who have inside knowledge of the alleged fraud—so-called qui tam actions.  Whistleblowers, who were most commonly executives or physicians and were more likely to be internal employees, now account for nearly all health care fraud legal actions and can share in the proceeds. Researchers found that the 379 cases led to $9.3 billion in financial recoveries, with $7.2 billion returned to the federal government and $861 million to state governments.  On average, whistleblowers recovered $3.6 million per case, with approximately $1 billion returned to whistleblowers overall.

“Fraud prosecutions have been successful in bringing back an extremely large amount of health care dollars to the government, and whistleblowers are integral in that process.  The concern is that there is still more unrecognized fraud ongoing in the system.  It is important to understand features and trends in health care fraud prosecution so that we may identify effective enforcement strategies and other policy interventions to bring fraud under control,” Kesselheim said.

Researchers also note that although there has been a decline in the frequency of cases since 2002, there has been a steady increase in the average value of the sum recovered, which is attributable to a number of recent high-value cases against pharmaceutical manufacturer defendants.  Although pharmaceutical manufacturers accounted for only 4 percent of the defendants, they led to nearly 40 percent of the money recovered.  The profile of defendants has also changed over time.  At the beginning of the study, laboratory service providers, hospitals, medical equipment companies, and physician groups were the most common defendants.  But while these types of defendants decreased over time, by the end of the study, billing organizations and pharmaceutical manufacturers accounted for 25 percent of the cases.  Among the 85 percent of cases that were classified, Kesselheim and Studdert also discovered that billing fraud was the most common type of fraud, specifically billing for unnecessary services, falsifying documents, and billing for services not provided.

“Future research will focus on the trends in the types of defendants and the types of cases as well as the whistleblowers themselves,” said Kesselheim.  “We are interested in exploring how the qui tam approach for targeting health care fraud may be best utilized to play a role in controlling inefficient health care spending.”

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery.  The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org

Press Release - Sep 2, 2008