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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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

Related Links:
Center for Clinical Excellence

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.

Related Links
            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.

Related Links:
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.

Related Links:
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

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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

Daily ibuprofen use may increase cardiovascular risk for arthritis patients

Boston, MA - In 2004, rofecoxib, better known by its brand name, Vioxx, was withdrawn from the market due to concerns about possible increased risk of heart attack and stroke.  Not long after, valdecoxib, marketed as Bextra, was removed for the same reason.  Since then, anxieties surrounding the cardiovascular safety of nonselective NSAIDs (nonsteroidal antiinflammatory drugs), as well as other selective coxibs (Cox 2 inhibitors), have escalated among arthritis patients and the doctors who treat them. Now, researchers from Brigham and Women's Hospital (BWH) have performed one of a few randomized controlled trials to measure the cardiovascular risks for the millions of daily users of all Cox 2s and NASIDs, including over-the-counter pain relievers.

How dangerous are Cox 2s and NSAIDs?  Do all users face a dramatically increased risk of suffering a crippling or fatal cardiovascular event?  For answers, Daniel H. Solomon, MD, a researcher in the Rheumatology, Immunology & Allergy Department at BWH and lead author of the study and his colleagues examined cardiovascular events in specific subgroups of patients prescribed Cox 2s or NSAIDs.  Featured in the August issue of Arthritis Care & Research, their findings support the cardiovascular safety of taking most NSAIDs and Cox 2s for most arthritis patients.  Certain patients, however, may be at an increased risk when using some medications.  This study also raises a red flag for all patients who routinely take ibuprofen.  Ibuprofen, the analgesic agent in Advil and Motrin, and the now-banned rofecoxib were the only drugs consistently associated with an increased risk for cardiovascular events across patient subgroups.                                           

The patient subgroups were drawn from two databases of Medicare recipients enrolled in drug benefit programs.  Patients covered by Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) were the primary subjects, with participants in New Jersey’s Pharmaceutical Assistance for the Aged and Disabled (PAAD) designated as a secondary cohort.  Researchers chose 1999 to 2004, prior to the restrictions on coxib use, for their study period.   

In the primary group, researchers identified 76,082 new users of Cox 2s, either rofecoxib, valdecoxib, or celecoxib, also known as Celebrex, and 53, 014 new users of nonselective NSAIDs, including prescription diclofenac, naproxen, ibuprofen, and a composite of all other available oral NSAIDs, excluding aspirin.  For comparison, 46, 558 patients receiving medication for thyroid problems or glaucoma were identified as nonusers.  The only major difference between Cox 2s and NSAID users and nonusers was that nonusers were less likely to have been diagnosed with arthritis.  The mean age of the study population was 80 and nearly 85 percent were white women.  Defined by patient characteristics, subgroups included age and sex; prior myocardial infarction (MI), congestive heart failure (CHF), stroke, or any cardiovascular (CVD) event; hypertension, diabetes, or any CVD risk factor; chronic renal disease; rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD); and use of a statin or angiotensin.

For each subgroup, researchers assessed the increased cardiovascular risk associated with using specific Cox 2s and/or nonselective NSAIDs.  They calculated not only the relative risk (RR) for MI, CHF, stroke, or cardiovascular death, but also the attributable proportion (AP) of risk due to the biological interaction between the specific patient characteristic and the individual drug.  As a whole, the group experienced 7,262 CVD events during the 64,136 person-years of followup.  The incidence rates varied substantially across the exposure groups, with rofecoxib users experiencing the highest rates, naproxen users experiencing the lowest rates, and nonusers midway between the two.  When calculating the AP, researchers found 7 characteristics linked to an increased risk of CVD events among Cox 2s and NSAID users:  age 80 years and older, hypertension, prior MI, prior CVD, RA, chronic renal disease, and COPD.  When comparing the incidence rates by agent, rofecoxib and ibuprofen users experienced more CVD events in every subgroup.  For example, among patients with a prior MI, rofecoxib users suffered 9.4 more CVD events and ibuprofen users 11.4 more events per 100 person-years compared with nonusers.

Solomon acknowledges the study's limitations.  For one, the subjects were overwhelmingly frail, elderly patients.  For another, researchers had no information on aspirin use, smoking history, body mass index, or other potential confounders.  For still another, possible effects of drug dosage differences were not considered.  Despite these limitations, the results have potential clinical relevance.  “Our findings suggest that rofecoxib and ibuprofen are the only agents consistently associated with an increased risk for CVD events among specific patient subgroups,” Dr. Solomon notes.  “The fact that we did not observe a similar concentration in risk among subgroups of patients using many of the other agents may be of even greater relevance.  These results should bolster physicians’ and patients’ confidence that most Cox 2s and nonselective NSAIDs are not associated with an elevated risk of CVD events in many patient subgroups using typical doses.”

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 - Aug 25, 2008

Research documents successful outcomes for patients with extensively drug resistant tuberculosis

Boston, MA – Rates of extensively drug-resistant tuberculosis (XDR-TB) are growing rapidly throughout the world, and curtailing the disease is a major World Health Organization (WHO) priority. Now, researchers from Brigham and Women’s Hospital (BWH) have shown successful treatment outcomes for patients with XDR-TB in Tomsk, Russia. These findings are published in the August 25, 2008 online issue of The Lancet.

"While early studies suggested that XDR-TB is untreatable, our report indicates that while it may be difficult, it is possible to treat these patients through the use of aggressive regimens," said Salmaan Keshavjee, MD, a researcher in the Division of Global Health Equity at BWH and lead author of the report. "A cure rate of 48.3 percent is promising in a disease that has been touted as untreatable."

Researchers report on the treatment approaches and outcomes of 608 patients with multi-drug resistant tuberculosis who were treated between September 2000 and November 2004 to determine the frequency of favorable outcomes and document clinical characteristics. Patients were categorized into two groups, those with XDR-TB and those with non-extensively drug-resistant (non-XDR) TB. Of the 608 patients, four percent or 29 patients were diagnosed with XDR-TB.

Researchers report:

* Drug resistant strains of TB are treatable. Of the 608 patients, 48.3 percent of patients with XDR-TB and 66.7 percent of patients with non-XDR-TB had treatment cure or completion.

* Prior, inadequate treatment of non-XDR-TB increases the chance for a patient to develop XDR-TB. Inadequate treatment includes an incorrect combination of medicines or inadequate duration of treatment.

* The frequency of adverse events did not differ in patients with XDR-TB as compared to patients with non-XDR-TB. This is the first report to provide information about the frequency of adverse events during a treatment course for XDR-TB specifically.

"Through aggressive management of XDR-TB cases, including by ensuring that patients are correctly diagnosed as early as possible and put on appropriate treatment for the correct length of time, it may be possible to slow the rise of XDR-TB deaths around the world and reduce further transmission of the most drug resistant strains of TB," said Keshavjee.

This research was funded by Bill & Melinda Gates Foundation, Eli Lilly Foundation, The Open Society Institute, Frank Hatch Fellowships in Global Health Equity at BWH, Infectious Disease Society of America, the Heiser Foundation, the United States National Institutes of Health, and the John D and Catherine T MacArthur 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 - Aug 14, 2008

Boston, MA – The Joint Commission made inpatient medication reconciliation a National Patient Safety Goal in 2005, focusing nationwide attention on the issue of errors in inpatient medication records as they move in and out of the hospital. According to a new study from researchers at Brigham and Women's Hospital (BWH) and Massachusetts General Hospital, inpatients experience an average of nearly one and a half potentially harmful errors in their medication record during a hospital stay. Unique from previous research, the study goes on to uncover the frequency of different kinds of errors, at what point during the process they most often occur, and factors that place a patient at risk for having these errors occur. These findings appear in the September 2008 issue of the Journal of General Internal Medicine.

 Inpatient medication reconciliation is the process of identifying the most accurate list of all medications a patient is taking and using the list to provide correct medications for the patient.  Until now, the attention has been on meeting this requirement without understanding where efforts should be focused. This study exposes the specific times during an inpatient visit when medication reconciliation errors most often occur. Seventy two percent of potentially harmful discrepancies are due to errors in taking patients’ medication history, while only twenty six percent occur while reconciling medication history with discharge orders. Also, the majority of discrepancies are due to the omission of medications, which account for more errors than incorrect reports of dosage, frequency, substitutions, and the addition of medications combined.

 “This information can help guide hospitals in determining where to focus their efforts for addressing this problem,” said Jeffrey Schnipper, MD, MPH senior author and Hospitalist at BWH, who also notes that some hospitals are now assigning pharmacists to take inpatients’ medication histories at admission.

 Though the majority of errors occur at the time of admission, the potential to cause harm generally occurs at discharge. At discharge patients can be sent home without necessary medications, with additional unnecessary medications, or on the wrong doses.  “Medication discrepancies at discharge are especially dangerous because patients are no longer being monitored consistently and may not recognize signs of medication problems on their own,” Schnipper said.

 Researchers also uncovered several predictors that can help professionals identify inpatients that are at higher risk for discrepancies in their medication records. Indicators of a higher risk inpatient include those with six or more medication changes during hospitalization; minimal understanding of preadmission medications; a caregiver providing medication information; thirteen or more outpatient visits during the previous year; an admission history taken by an intern; or four or more high-risk medications prescribed prior to admission.

 “With patients today on more medications than in days past, the stakes are higher than ever before,” Schnipper says of reconciling medication. “Knowing when and where to look for discrepancies will help hospitals prevent errors that could cause harm to patients.”

 The research was funded by internal support from Brigham and Women’s Hospital, Massachusetts General Hospital, and Partners Healthcare, and by an investigator-initiated grant from the 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 - Aug 12, 2008

Men who had regular PSA tests were less likely to have adverse features to their prostate cancer at time of diagnosis

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 - Aug 4, 2008

Rapid HIV tests lead to false positive results when HIV prevalence rates are low

Boston, MA – In 2006, the Centers for Disease Control and Prevention (CDC) recommended that all adults be offered an HIV screening test in healthcare settings throughout the United States.  Since then, more than 150 emergency departments across the country have been expanding HIV screening efforts.  Such public health interventions are possible because new technologies allow rapid HIV tests to be conducted on either blood or oral fluid samples and provide patients with results within 20 minutes. 

In a new study, researchers at Brigham and Women’s Hospital (BWH) have found that one of the most commonly used rapid HIV tests, when conducted on oral fluid in a low prevalence emergency department population, may lead to a high rate of false positive results.  In this study, researchers report that out of 849 adults tested with the oral rapid HIV test, 31 persons had reactive results. Five patients were truly HIV-infected upon confirmation.  84 percent of positive rapid screening tests turned out to be false when further testing documented that the patient did not have HIV infection.  These findings are published in the August 5, 2008 issue of the Annals of Internal Medicine.

“The rapid test is still useful to screen to patients for HIV infection.  Patients with a reactive test had up to 32-fold increased odds of having HIV infection compared to their pre-test odds.  We have learned that a reactive test does not mean that the patient is HIV-infected but rather that confirmation is required,” said Rochelle Walensky, MD, MPH lead author on the paper and an Infectious Disease physician at BWH.

The researchers found that in every 100 patients tested in the emergency department, 95 leave knowing that they are HIV-negative, and five patients leave with confirmation pending.  One in these five is typically identified as actually having HIV.

Christian Arbelaez, MD, MPH, a BWH emergency physician and study co-author, noted “We continue to use this test in our study at the BWH Em

ergency Department because we recognize that every screening test has trade-offs. The advantages of the oral, rapid test are that it is easy to use, acceptable to patients and has correctly identified cases of HIV infection that we would have otherwise missed.”

With HIV screening efforts growing throughout the United States, the timing of these results is critical.  This study underscores the importance of proper management of results from HIV screening tests conducted in emergency departments and elsewhere.  Patients should understand before testing that reactive (positive) results are only preliminary.  Furthermore, providers should be readily equipped to handle reactive results, which often occur in the absence of true disease, and there must be a well-defined mechanism for confirmatory studies and follow-up. 

“It is critical to provide a balanced interpretation of the results of our study,” commented Elena Losina, PhD, senior author of the report. “We cannot simply blame the test; we need to recognize that even tests with excellent performance characteristics will lead to false positive results in low prevalence settings.  The most important message from our study should focus on proper management of patients with reactive rapid HIV test results given increased number of persons being tested for HIV in the US.”  

“We must consider the performance of this test in the context of other large-scale screening programs, such as mammogram screening for breast cancer.  When we screen for disease, false positive results are expected, especially if the disease is uncommon. ‘Positive’ results of any screening test require definitive confirmation.  At a new HIV-case identification rate of 0.6%, I am satisfied that we have successfully used the OraQuick® test to identify patients who might have been overlooked,” said Walensky. 

This research was funded by the National Institute of Mental Health and the Doris Duke Charitable Foundation.   Contributing authors include Christian Arbelaez, MD, MPH, William M. Reichmann, MA, Ron M. Walls, MD, Jeffrey N. Katz, MD, MSc, Brian L. Block, Matthew Dooley, Adam Hetland, Simeon Kimmel, Jessica D. Solomon, and Elena Losina, PhD.

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 - Aug 4, 2008

Boston, MA – New research from the Division of Sleep Medicine at Brigham and Women’s Hospital (BWH) and Harvard Medical School finds that sleep inertia, the grogginess and impaired cognitive performance experienced upon awakening from sleep, is much stronger when awakening during the biological night as compared to during the biological day. The findings have implications for people who need to be alert upon awakening including on-call physicians, emergency personnel, pilots and even parents. Conversely, the study shows that waking up from a daytime nap may not be so detrimental to cognitive ability. The research appears in the August issue of the Journal of Biological Rhythms.

The researchers sought to determine whether the magnitude of sleep inertia at the time of awakening varied according to the phase of the internal circadian pacemaker, or "biological clock." Over the course of 11 days spent in the sleep lab, 12 participants were scheduled to live on seven recurring artificial ‘days’ each of 28-hour duration under dim light conditions, while the biological clock ticked along at its inherent rate under these conditions, with a cycle length very close to 24 hours. This technique (called Forced Desynchrony protocol) results in each individual’s sleep/wake cycles being distributed evenly across all phases of the circadian cycle, so that any effect of the circadian cycle on sleep inertia can be assessed.

Each sleep episode included three evenly spaced awakenings to the sound of an alarm clock. Immediately upon awakening, participants completed a series of two-number addition tests (e.g., 51 + 38 = ?). The magnitude of sleep inertia was measured as the increase in the number of correct additions across the first 20 minutes of wakefulness.

Sleep inertia was nearly four times stronger when participants were awoken during the biological night compared to the biological day. Furthermore, subjects showed the least cognitive impairment following awakening during the middle of the biological day. The findings were confirmed when comparing awakening from the same sleep stage.

"Our findings show that sleep inertia has the strongest effect on cognitive function during the biological night, when the core body temperature is at its minimum, and is minimal when awakening during the middle of the biological day. This can have serious implications for people who need to make important decisions upon awakening at different times during day or night, such as emergency personnel, on-call physicians, military personnel and even parents being awoken by a crying baby," said Frank A.J.L. Scheer, a neuroscientist in BWH’s Division of Sleep Medicine and lead author of the paper. He added, "The cognitive impairment during the biological night was twice as large as during the normal time of awakening—the biological morning. This is especially important, considering that already following awakening during the morning the cognitive impairment can be more detrimental than staying awake all night and has been shown to be comparable to the effects of alcohol intoxication."

The other authors are Thomas J. Shea, Michael F. Hilton and Steven A. Shea.

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 - Jul 29, 2008

Brigham and Women’s Hospital Welcomes Two New Cardiac Electrophysicists

Brigham and Women’s Hospital (BWH) welcomes two new doctors, Roy John, MD, PhD and Gregory Michaud, MD, both of Concord, MA, to the cardiac electrophysiology team in the Cardiovascular Division. 

Dr. John joins Brigham and Women’s as the Director of Experimental Arrhythmia Research and Associate Director of the Electrophysiology Laboratory. He will bring his years of clinical and research experience in ablation for cardiac arrhythmias and device implantations. He comes to BWH from Lahey Clinic Medical Center in Burlington, MA where he served as Director of the Cardiac Electophysiology Laboratory.  

Dr. Michaud has been named the Director of the BWH Center for the Advanced Treatment of Atrial Fibrillation, where he will be responsible for the Center’s clinical research development, and will also work as a clinical cardiac electrophysiologist. He too comes to BWH from Lahey Clinic Medical Center, where he was an attending cardiac electrophysiologist and Director of Atrial Fibrillation Center.

“Together, Dr. John and Dr. Michaud bring nearly 60 years of medical experience to the cardiac electrophysiology team.  They are outstanding clinicians and researchers and we are happy to welcome them to the Cardiovascular Division.” said Laurence M. Epstein, MD, chief of the Cardiac Arrhythmia Service at BWH.

Both Dr. John and Dr. Michaud have earned numerous grants and awards and have also published work in some of the world’s most illustrious medical journals. With his work at BWH, Dr. John hopes to advance the therapy of all arrhythmias and device based management of heart failure through clinical and research activities. While Dr. Michaud aspires to further BWH’s reputation as one of the premier centers in the world for advanced treatment of atrial fibrillation.

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 25, 2008

Boston, MA – It has long been known that aging is associated with a reduced capacity for sleep.  Now, researchers at Brigham and Women’s Hospital (BWH) have shown that when older people are asked to stay in bed during 16 hours of darkness, they sleep only about 7.5 hours compared to the 9 hours that younger people sleep when in the same situation.  This research is published online in Current Biology, a Cell Press publication, on July 24, 2008. 

“These results have two possible interpretations,” said Elizabeth Klerman, MD, PhD, a physician and researcher in the Division of Sleep Medicine at BWH.  “Older people may need less sleep or they may sleep less because of age-related changes in the ability to fall asleep and remain asleep.”

Klerman and her colleague, Dr. Derk-Jan Dijk, of the University of Surrey in the UK, evaluated the capacity for sleep in young people, between the ages of 18 and 32, compared to older people, aged 60 to 72, by monitoring healthy individuals taking no medication and having no medical conditions or sleep disorders.  Researchers controlled for circadian rhythms (the body’s natural sleep/wake cycle) by allowing the chance to sleep both during the night and day and by also controlling sleep opportunities.  Researchers found:

• If they previously spent the same amount of time in bed, older people took a longer period of time to fall asleep than younger people.
• After spending several days during which they were required to stay in bed for 16 hrs/day, older people slept, on average, 1.5 hours less than younger people.
• The difference in sleep time was split evenly between rapid eye movement (REM), or sleep associated with dreaming, and non-REM sleep.
• Most younger subjects slept longer than their usual self-selected sleep times.

Klerman also notes that, “Younger people frequently do not get as much sleep as they need, and there are many health and safety problems associated with too little sleep.” 

These findings may influence clinical treatment in older people, as insomnia – being awake when wanting to be asleep – is a frequent complaint in older age groups. 

“If older people believe that they need more sleep than they can achieve even when they spend extra time in bed, then they may complain of insomnia and could start taking medications needlessly,” Klerman said.  “Older people may need to be evaluated for a sleep disorder if they are tired during the day.”

The researchers encourage more investigation into this area of age-related changes in sleep and the problems associated with insufficient sleep.  

Visit www.understandingsleep.org for more information about the importance of sleep in a healthy lifestyle.

This research was funded by 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

Press Release - Jul 21, 2008

Researchers show direct pathway which could be targeted for drug therapy

A new genetic finding from a group of researchers at Brigham and Women’s Hospital (BWH), the University of Wisconsin School of Medicine and Public Health (SMPH), and the University of Ottawa, may help pave the way for the discovery of therapies that could effectively treat Parkinson’s disease (PD).  Clemens Scherzer, MD, a neurologist and researcher at BWH, along with collaborators, showed that the build up of a certain protein is responsible for controlling the production of the gene, alpha-synuclein, which is a cause of PD.  These findings appear online in the Proceedings of the National Academy of Science during the week of July 21, 2008 and will appear in a later print edition of the journal.

“This discovery is exciting because it allows for a paradigm shift in how researchers can search for a cure for Parkinson’s disease.  So far research has focused on ways to get rid of excess alpha-synuclein that is built up in the brain of patients with Parkinson’s. Now, we can look for ways to lower the production of alpha-synuclein upfront,” Scherzer said. 

Patients with PD have clumps of alpha-synuclein in their brains and high levels of this protein kill off dopamine neurons and cause tremors and other symptoms of PD.  While looking at blood tests for Parkinson’s disease, the researchers noticed high levels of alpha-synuclein in the blood.  Because alpha-synuclein was thought previously to be a gene found in the brain, its presence in the blood was surprising.  Seeking to uncover the reason for the presence of this gene in blood, they used gene chips to look at whether or not any of the thousands of other genes active in blood was linked to alpha-synuclein. They discovered that there are actually three genes, called heme genes, which are responsible for carrying oxygen and transporting electrons through the blood, whose activity was in lock step with the activity of the alpha-synuclein gene. 

“In the middle of this noisy picture of gene expression in blood, we were able to uncover a very clear pattern of activity with these four genes,” said Scherzer. “By recognizing that pattern, we then deduced that there must be a switch, or mechanism that was responsible for controlling the activity of these genes.” 

The next step for researchers was to discover what was controlling the activity of these genes in the blood.  For this, Dr. Scherzer and Dr. Schlossmacher, who leads the University of Ottawa research team, turned to Emery Bresnick, an SMPH professor of pharmacology, and an expert in GATA transcription factors.  A transcription factor is a dial that turns the activity of genes up or down.  Through this collaboration, researchers discovered that the transcription factor, GATA-1, was responsible for controlling the functions of these four genes in the blood and that a relative of GATA-1, the transcription factor GATA-2 – which is highly present in the brain regions affected by PD – may be responsible for the activity of alpha-synuclein in the brain.

“We were able to show that the GATA-2 transcription factor directly sticks to the alpha-synuclein gene and when GATA-2 was knocked down in dopamine cells, the levels of alpha-synuclein went down as well,” said Dr. Schlossmacher. 

This discovery illustrates the direct regulation of the gene by GATA factors, but researchers emphasize that further research is needed to understand if this pathway can be used for the development of drug therapies to tailor treatment strategies.

This research was funded by Paul B. Beeson K08AG024816 from the NIA & the American Federation for Aging Research, the American Parkinson Disease Association, Michael J. Fox Foundation, the M.E.M.O. Hoffman Foundation and numerous NIH grants.

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

Press Release - Jul 17, 2008

BWH Researchers compared Mediterranean and Low-carb to Low-fat diets

 Boston, MA – Research on the safety and effectiveness of different diets has been previously limited due to the high number of participants who drop out of studies and because the length of time that the participants are followed is often too short. Researchers at Ben-Gurion University of the Negev in Beer Sheva, Israel, and at Brigham and Women’s Hospital’s (BWH) Channing Laboratory have effectively evaluated three different weight-loss diets over two years and found that both Mediterranean and Low-carbohydrate diets are as effective in achieving weight-loss as low-fat diets.

“The findings suggest that because Mediterranean and low-carbohydrate diets are effective alternatives to low-fat diets, individual preferences could be taken into consideration when tailoring dietary interventions for weight loss,” said Meir Stampfer, MD, DrPH, associate director of the Channing Laboratory at BWH and senior author of the study.  The lead author, Dr. Iris Shai of Ben Gurion University, planned the study when she was a Fulbright fellow at Harvard School of Public Health and Channing Laboratory.

Researchers followed 322 obese patients who were randomized to either a low-fat, Mediterranean or low-carbohydrate diet for two years.  Patients on the low-fat and Mediterranean diets were restricted in the number of calories that they could eat, but patients on the low-carbohydrate diet were not.  Researchers report that after one year, 95 percent of patients had stuck to the diet and after two years, 85 percent had. 

After two years, patients in the low-fat diet group lost 2.9 kg; patients in the Mediterranean diet group lost 4.4 kg; and patients in the low-carbohydrate diet group lost 4.7 kg. The Mediterranean diet-group consumed the highest dietary fiber and monounsaturated to saturated fat ratio.  The low-carbohydrate diet-group consumed the fewest carbohydrates and the highest fat, protein and cholesterol.  Among all three diet groups, the number of calories consumed was similar.  Improvements in other health measures such as liver function and levels of cardiovascular disease were also similar among groups.

In an effort to encourage retention and to enable participants to stick to the diet, the trial was conducted in an isolated workplace at the Nuclear Research Center Negev, Israel, with an on site clinic. Daily diet-group-specific colored food labels were displayed in the cafeteria at the workplace. 

The findings suggest that Mediterranean and low-carbohydrate diets are effective alternatives to low-fat diets. The more favorable effects on lipids (low-carbohydrate) and on glycemic control (Mediterranean) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.

This study was supported by the Nuclear Research Center Negev (NRCN), Dimona, Israel, The Dr. Robert C. and Veronica Atkins Research Foundation and the S. Daniel Abraham International Center for Health and Nutrition.

Brigham and Women's Hospital (BWH) is a 747-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. 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 14, 2008

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 eighth among the 19 hospitals on the list. This ranking is two spots higher than 2007’s number 10 ranking.

"This honor is a testament to the talents and passions of every one of our 13,000 people, who each day show their commitment to providing the best patient care, training the next generation of health care providers and advancing research to improve care," said BWH President Gary Gottlieb. "Our consistent ranking on the list of America’s Best hospitals truly is because of our dedication to making a difference for those who depend on us."

BWH ranked first in kidney disease for the second consecutive year, while also earning the top ranking in gynecology. Three other specialties also received top-ten rankings, cardiology (#5), rheumatology (#7) and endocrinology (#8). The hospital ranked among the top 20 in the nation for Orthopedics, Respiratory Disorders, Urology and Gastrointestinal Disorders and placed on the list for Neurology and Neurosurgery, Cancer, Ear, Nose and Throat and Geriatric Care.

U.S. News analyzed data on 5,453 medical centers to produce this year’s rankings. Only 170 hospitals were ranked in one or more specialties and, of those, just 19 were of Honor Roll caliber.

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

Press Release - Jul 11, 2008

Brigham and Women’s Hospital (BWH) welcomes two new doctors, Roy John, MD, PhD and Gregory Michaud, MD, both of Concord, MA, to the cardiac electrophysiology team in the Cardiovascular Division. 

Dr. John will join Brigham and Women’s as the Director of Experimental Arrhythmia Research and Associate Director of the Electrophysiology Laboratory. He will bring his years of clinical and research experience in ablation for cardiac arrhythmias and device implantations. He comes to BWH from Lahey Clinic Medical Center in Burlington, MA where he served as Director of the Cardiac Electophysiology Laboratory.  

Dr. Michaud will become the Director of the BWH Center for the Advanced Treatment of Atrial Fibrillation, where he will be responsible for the Center’s clinical research development, and will also work as a clinical cardiac electrophysiologist. He too comes to BWH from Lahey Clinic Medical Center, where he was an attending cardiac electrophysiologist and Director of Atrial Fibrillation Center.

"Together, Dr. John and Dr. Michaud bring nearly 60 years of medical experience to the cardiac electrophysiology team.  They are outstanding clinicians and researchers and we are happy to welcome them to the Cardiovascular Division.” said Laurence M. Epstein, MD, chief of the Cardiac Arrhythmia Service at BWH.

Both Dr. John and Dr. Michaud have earned numerous grants and awards and have also published work in some of the world’s most illustrious medical journals. With his work at BWH, Dr. John hopes to advance the therapy of all arrhythmias and device based management of heart failure through clinical and research activities. While Dr. Michaud aspires to further BWH’s reputation as  one of the premier centers in the world for advanced treatment of atrial fibrillation.

Brigham and Women's Hospital is a 747-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, 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, dedication to educating and training health care professionals, and strength in biomedical research. With $370M in funding and more than 500 research scientists, BWH is an acclaimed leader in clinical, basic and epidemiological investigation - including the landmark Nurses Health Study, Physicians Health Studies, and the Women's Health Initiative.  For more information about BWH, please visit: www.brighamandwomens.org.

Press Release - Jul 10, 2008

Boston, MA – Basic physical examination skills among medical students, residents and practicing physicians have been on the decline. Simple procedures that were routinely done by health care providers, such as careful inspection, are now often replaced by expensive laboratory tests and radiological exams. In an effort to change this trend, researchers from Brigham and Women’s Hospital (BWH) designed a pre-clinical course for Harvard Medical School students to enhance their diagnostic abilities and improve their visual acumen through close observation and guided discussion of fine art and artistic concepts and application of these new skills to clinical patient assessments. The researchers found that the students who took the course had a 38 percent increase in overall accurate visual observations of patients and art work compared to otherwise similarly-trained control students in the study. The findings appear in the July, 2008 issue of the Journal of General Internal Medicine.

The course, Training the Eye: Improving the Art of Physical Diagnosis is a nine week pre-clinical course that meets weekly for two-and-a-half-hour sessions, and features observation exercises at Boston’s Museum of Fine Art (MFA) and lectures linking visual arts concepts with physical diagnosis. An optional ninth class is offered where students have the opportunity to draw the human body from a live model with professional art instruction available. Both the students in the class and the control group took pre-course and post-course visual skill examinations.

As an example, in one session the students practiced inspecting, verbally describing, interpreting and building on the analyses of how form was used in works by ancient Chinese and aboriginal artists exhibited at the MFA, and then explored how careful examination of form in patients can reveal the causes of various breathing disorders. Other artistic topics studied by the students in the matched museum and didactic sessions included luminance (patient color), texture and pattern (dermatology), symmetry (neurology), and line contour (radiology). The works of art included paintings by Pablo Picasso, Claude Monet, John Singer Sargent, Jackson Pollack, Jan Steen and others.

The researchers, led by Joel Katz and Shahram Khoshbin, from the Departments of Medicine and Neurology at BWH, found that students completing the course made more accurate observations on the visual skills exam compared to the control group. There was an average increase of 5.41 observations per image, after the taking the course. The control group showed no improvement in the average number of observations. Overall, students in the class showed a 38 percent improvement in accurate observations compared to the control students. In addition, class participants described images with a higher level of sophistication and complexity.

"Our findings suggest that through the structured study of works of art and medical imagery, visual inspection skills, including those directly relevant to clinical medicine, can be improved," said Katz. He added, "At a time when physical examination skills are waning, I am encouraged that an interdisciplinary course designed to help develop better visual literacy can expand medical students’ diagnostic capabilities. An unintended benefit of the course was to inspire busy medical students with the wonders of the extraordinary MFA collection just down the street."

The research received support from the Creative Center, New York, N.Y

Press Release - Jul 9, 2008

Boston, MA – David Silbersweig, MD, has been named chair of the Brigham and Women’s/Faulkner Department of Psychiatry effective July 1, 2008.  Dr. Silbersweig’s distinguished career as a clinician, scientist, innovator and mentor, as well as his expertise in the development and use of neuroimaging techniques will distinguish further the hospital’s nationally recognized reputation.

“I am excited about the opportunity for collaboration with my colleagues at BWH and Faulkner and I am eager to bring together the researchers in the departments of Psychiatry, Neurology, Neurosurgery and Radiology to achieve transformative advances in patient care for those suffering with brain illnesses,” said Silbersweig.

Dr. Silbersweig is nationally recognized as a clinician researcher who is at the forefront of the rapidly advancing field of neuropsychiatry at the interface of brain and mind.  He is a pioneer of neuroimaging techniques used to identify brain circuit abnormalities associated with psychiatric disorders.  His work is transforming the understanding of psychiatric disorders and opening up new possibilities for medically-based diagnostic and therapeutic strategies in the context of personalized medicine.  Dr. Silbersweig has received numerous national awards and played an active role in shaping the field of neuropsychiatric biomedicine through both his publications and his work with international organizations and the National Institutes of Health.

Dr. Silbersweig plans to further strengthen the clinical and educational profile of the Department of Psychiatry by expanding programs in neuropsychiatry, as well as in other areas, and to enhance the depth and breadth of interdisciplinary scientific research. 

“Dr. Silbersweig is an outstanding clinician and researcher and we are very pleased to have him lead our combined Psychiatry Department at Brigham and Women’s and Faulkner Hospitals.  Under his leadership, the Department of Psychiatry will continue to deliver nationally recognized clinical care to patients and their families,” said BWH President, Dr. Gary Gottleib.

Dr. Silbersweig comes to BWH from Weill Cornell Medical College where he served as the Stephen Tobin and Arnold Cooper, MD, Professor of Psychiatry and Professor of Neurology and Neurosciences.  Dr. Silbersweig also served as Vice Chairman for Research in the Department of Psychiatry at The New York Presbyterian Hospital-Cornell Medical Center. 

Brigham and Women's Hospital is a 747-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.  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.

Press Release - Jul 1, 2008

Boston, MA – New research from Brigham and Women’s Hospital (BWH) finds that women who are diagnosed with a heart attack stand to benefit as much as men from routine cardiac catheterization.  This is contrary to prior reports that women might not benefit from the procedure.  However, for women diagnosed with a “near” heart attack, also known as unstable angina, the risks of routine cardiac catheterization may well outweigh the benefits.  The findings appear in the July 2, 2008 issue of the Journal of the American Medical Association.

Cardiac catheterization is an invasive procedure that allows doctors to find and open potential blockages in the coronary arteries in order to help prevent heart attacks and even death.  The procedure is commonly performed on patients in the hospital with unstable heart disease.  However, results from some earlier trials did not show any benefit with routine cardiac catheterization in women.  In the current study, the researchers combined data from across eight clinical trials, comparing invasive versus conservative treatment strategies in more than 10,000 men and women patients with unstable heart disease.

"There’s a tremendous need to better understand gender differences in cardiac care.  Heart disease continues to be the number one killer in women and yet women remain underrepresented in clinical trials”, said Michelle O’Donoghue MD, a researcher with the TIMI Study Group at BWH and a Physician in the Cardiology Division at Massachusetts General Hospital. “Our results now confirm that men and women who have had a heart attack appear to have a similar benefit from an early invasive strategy that involves cardiac catheterization.”

She continued, “However a more conservative approach should be used in lower risk women who have not had a heart attack.  In these cases we would recommend a more conservative approach that involves maximal medical therapy and performing a catheterization only for those women with ongoing symptoms or a positive stress test.”

These new findings support the recently updated guidelines from the American College of Cardiology and the American Heart Association that now recommend a more conservative treatment strategy in lower-risk women with heart attacks and unstable angina.

Brigham and Women's Hospital (BWH) is a 747-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. 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 25, 2008

Definition of “Normal” May Need Revising

Healthy individuals with higher levels of albumin excretion, even levels considered normal, are at increased risk of developing hypertension (high blood pressure), according to a study appearing online on June 25, 2008 and in print in the October 2008 issue of the Journal of the American Society Nephrology (JASN). The study suggests that to prevent cardiovascular disease, the definition of “normal” urinary albumin excretion should be reconsidered.

Because kidneys normally prevent large molecules such as albumin from being excreted in the urine, high levels of urinary albumin excretion— called albuminuria—can be an indicator of kidney damage. Albuminuria may also reflect dysfunction of endothelial cells throughout the body, which in turn may be a precursor to hypertension.

A variety of studies have shown that higher levels of urinary albumin excretion, even within the normal range, are associated with cardiovascular disease in individuals with diabetes or hypertension. However, less research has been done in low-risk populations. Therefore, it is unclear whether higher, although normal, levels of albumin in the urine might indicate that generally healthy individuals are at risk of developing cardiovascular disease, a condition that claims more than 800,000 lives each year.

Dr. John Forman and his colleagues at the Brigham and Women’s Hospital in Boston looked at the new development of hypertension among 2,179 women without baseline hypertension or diabetes, and with normal levels of urine albumin, who were enrolled in the Nurses’ Health Studies, which are among the largest and longest running investigations of factors that influence women’s health. The researchers discovered that higher levels of urinary albumin excretion, even within the range considered normal, increased an individual’s risk of developing hypertension. Among older women (median age of 65 years), those with the highest levels of albumin excretion were 76% more likely to develop hypertension than those with the lowest levels. Among younger women (median age of 44 years), the risk was 35% higher. These elevated risks held true when factors such body mass index, blood pressure, smoking, and family history of hypertension were taken into account.

The authors conclude that their results, in conjunction with the findings of various other studies, suggest that “it is time to re-evaluate our current concept of ‘normal’ albumin excretion.” Hypertension monitoring and treatment of individuals with higher urine albumin levels, even that are within the currently defined normal range, may be warranted.

Brigham and Women's Hospital (BWH) is a 747-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. 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 24, 2008

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH), studying the potential role of omega-3 fatty acids in preventing asthma attacks and allergic reactions, have identified a molecule produced by the body that helps alleviate respiratory attacks in lab mice. The study was led by Bruce Levy from BWH’s Division of Pulmonary and Critical Care Medicine and appears in the June 22, 2008, advance on-line issue of Nature Immunology.

Resolvin E1, the molecule generated by the body, is a product of an omega-3 fatty acid. Fresh water fish such as salmon, anchovies and mackerel are good sources of omega-3 fatty acids. Previous studies have shown that people who consume high levels of omega-3 rich fish are less likely to be asthmatic, however, why this is so has not been clear. In this study, the researchers were able to show the key role resolvin E1 plays in reducing inflammation in the airway and helping to quickly clear respiratory attacks.

"The findings are exciting," said Levy. "They shed light onto the natural processes that resolve asthma attacks and on resolvin E1’s potential therapeutic actions for asthma and other inflammatory diseases."

The research was supported by a grant from the National Institute of Allergy and Infectious Diseases, a component of the National Institutes of Health.

Brigham and Women's Hospital (BWH) is a 747-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. 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, 2008

Soluble Beta-Amyloid Protein Fragments May Damage Brain Cells, Study Finds

Scientists have long questioned whether the abundant amounts of amyloid plaques found in the brains of patients with Alzheimer's actually caused the neurological disease or were a by-product of its progress. Now, using new research techniques, scientists have shown that a two-molecule aggregate (or dimer) of beta-amyloid protein fragments may play a role in initiating the disease. The study, supported by the National Institutes of Health, suggests a possible new target for developing drug therapies to combat the irreversible and progressive disorder.

Ganesh M. Shankar, Ph.D., and Dennis J. Selkoe, M.D., of the Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, conducted the study in collaboration with other researchers in Ireland at University College Dublin, Beaumont Hospital and Royal College of Surgeons Ireland, and Trinity College Dublin. The National Institute on Aging (NIA), part of NIH, funded the study which appears online in the June 22, 2008, Nature Medicine.

Alzheimer's disease is marked by the build-up of plaques consisting of beta-amyloid protein fragments, as well as abnormal tangles of tau protein found inside brain cells. Early in the disease, Alzheimer's pathology is first observed in the hippocampus, the part of the brain important to memory, and gradually spreads to the cerebral cortex, the outer layer of the brain. In this study, researchers tested cerebral cortex extracts from brains donated for autopsy by people aged 65 and older with Alzheimer's and other dementias, as well as those without dementia. The extracts contained soluble one-molecule (monomer), two-molecule (dimer), three-molecule (trimer) or larger aggregates of beta-amyloid, as well as insoluble plaque cores. The researchers then injected the extracts into normal rats or added the extracts to slices of normal mouse hippocampus.

Shankar, Selkoe and colleagues discovered that both the soluble monomers and the insoluble plaque cores had no detectable effect on the hyppocampal slices. However, the soluble dimers induced certain key characteristics of Alzheimer's in the rats. The dimers impaired memory function, specifically the memories of newly learned behaviors. In the mouse hippocampal slices, the dimers also reduced by 47 percent the density of the dendrite spines that receive messages sent by other brain cells. The dimers seemed to be directly acting on synapses, the connections between neurons that are essential for communication between them.

To confirm this effect, the researchers then injected certain antibodies against beta-amyloid protein fragments. These latched onto and inactivated the dimers, preventing their toxic effects in the animal models. However, much work remains to be done before inactivation of dimers could move into the clinic.

"Scientists have theorized for many years that soluble beta-amyloid may be critical to the development and progression of this devastating disease. Now these researchers have isolated a candidate causative agent from brains of people with typical Alzheimer's and directly tested it in an animal model," said NIA Director Richard J. Hodes, M.D. "While more research is needed to replicate and extend these findings, this study has put yet one more piece into place in the puzzle that is Alzheimer's."

The animal findings were consistent with what the researchers found when they examined the brain tissues of people who had been clinically diagnosed with Alzheimer's and those without dementia. They detected soluble dimers and some trimers of amyloid in the brains of patients with Alzheimer's, but none or very low levels in those free of the disorder. Some people free of the disorder, however, did have insoluble amyloid plaques in their brains.

"These findings may help explain why people with normal cognitive function are sometimes found to have large amounts of amyloid plaques in their brains, which has been a puzzle for some time," said Marcelle Morrison-Bogorad, Ph.D., director of the NIA Division of Neuroscience. "Their findings noted that the brain of an individual who was never clinically diagnosed with dementia was found with abundant insoluble Alzheimer's plaques, but no soluble beta-amyloid."

Selkoe and Shankar noted that further insights into the early stages of this disease process may answer questions not only about Alzheimer's, but also about age-related memory impairments. "The approaches we used to isolate dimers and the widespread availability of tissues from brain banks, open new avenues of investigation into how these aggregates induce Alzheimer's disease," said Selkoe. "We still need to find out why dimers in particular are so destructive to neurons."

Brigham and Women's Hospital (BWH) is a 747-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. 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

NIA leads the federal government effort conducting and supporting research on the biomedical and social and behavioral aspects of aging and the problems of older people. For more information on aging-related research and the NIA, please visit http://www.nia.nih.gov/. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer's Disease Education and Referral (ADEAR) Center site at www.nia.nih.gov/Alzheimers.

Press Release - Jun 19, 2008

Laws will also serve as Interim Director of Neurooncology

Edward R.  Laws, MD, FACS, one of the world's experts in the treatment of neuroendocrine disorders, has joined the Department of Neurosurgery at Brigham and Women’s Hospital (BWH).  Dr. Laws will serve as director of the Neuro-Endocrine/Pituitary Program and interim director of Neurooncology at BWH.  His vast experience in the management of pituitary tumors and related diseases and the use of intraoperative endoscopy to safely and effectively excise these tumors is a welcome addition to the Department of Neurosurgery.

“There are few neurosurgeons with an interest in the history of our field who could resist an opportunity to work where it all began, and to join the group of outstanding Clinical and Basic Neuroscientists at BWH,” said Laws about his decision to come to BWH.

The Pituitary Center is dedicated to providing efficient and comprehensive care for patients who travel from across the country and the world.  In one appointment, patients will receive focused Pituitary Endocrine and Neurosurgical evaluations, laboratory tests, imaging studies (MRI) and appropriate consultations are arranged.  Treatment as indicated can then be promptly recommended and offered.  The clinical group at the Pituitary Center has unequalled experience, superb outcomes for patients, and a therapeutic environment.

Dr. Laws’ arrival to BWH from Stanford University Medical Center adds to the already outstanding leadership team in Neurosurgery.  Physicians in the department have successfully led, or are currently leading, not only their respective departments or programs, but also the world’s largest neurosurgical professional organizations.  Dr. Laws is the past president of the American Association of Neurological Surgeons, the World Federation of Neurosurgical Societies and the American College of Surgeons. He is an Honorary Fellow of the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Surgeons of Edinburgh, and an honored guest and speaker of organizations throughout the world. Dr. Laws received his MD from Johns Hopkins and completed his residency training in neurological surgery at Johns Hopkins.

Just after arriving at BWH, Laws performed his 5,000th transsphenoidal operation for pituitary disease.  Laws has dedicated much of his career to the treatment and research of pituitary tumors, which are fairly common and are almost always benign lesions.  There are no known precipitating or environmental factors involved in the growth of pituitary tumors, and with the exception of a small minority of genetically determined cases, most pituitary tumors develop by chance.  These tumors grow from cells that are working hard to produce hormones and therefore may be more likely to have “hits” in their metabolic processes that lead to tumor formation.

“Early detection and expert treatment are the keys to success in pituitary diseases,” said Laws.  “Encouragement of basic and clinical research will shed light on the origin of these tumors and may tell us why they usually remain benign, an important clue for cancer management in general.”

Press Release - Jun 16, 2008

Researchers at Brigham and Women’s Hospital (BWH) have shown for the first time that a strong association exists between insulin resistance and peripheral arterial disease (PAD), a risk factor for heart attacks and stroke.  These findings are published in the June 17, 2008 issue of Circulation.

“PAD becomes more common as one gets older, and by age 65, about 12 to 20 percent of the population has it.  Diagnosis is critical, as people with PAD have four-to-five times higher risk of heart attack or stroke,” said Reena L. Pande, M.D., lead author of the study and a physician and researcher in the Cardiovascular Division of BWH.

PAD occurs when arteries in the legs become narrowed or clogged with fatty deposits, reducing blood flow to the legs.  PAD affects about 8 million Americans and is associated with significant disease and death, according to the American Heart Association.  Insulin resistance contributes significantly to the development of diabetes, a known risk factor for PAD, and has been implicated in the development of atherosclerosis; however, the role of insulin resistance in PAD is not well established, according to the researchers.

Pande and colleagues analyzed data from 3,242 adults enrolled in the National Health and Nutrition Examination Survey 1999–2004.  The nationally representative sample population study included data on arterial pressure in each person’s ankle.  Comparing the ankle and arm pressures (the ankle brachial index) can indicate restricted blood flow or PAD.  Blood levels of c-reactive protein (CRP) and fasting insulin and glucose were also measured.  Researchers compared PAD incidence and insulin sensitivity using a model of insulin resistance (HOMA-IR), a simple test derived from fasting glucose and insulin values.

The researchers found that people with the highest levels of insulin resistance had twice as much PAD, regardless of other cardiovascular risk factors, including diabetes.  Patients with the highest insulin resistance had nearly twice as much PAD.   The association was still seen after adjusting for age, gender, race/ethnicity, hypertension, hyperlipidemia, smoking, body mass index, chronic kidney disease and CRP.

“For doctors and patients, our study highlights the role of insulin resistance in PAD and gives us a snapshot of the association between the two diseases,” Pande said.  “For this to play out, however, we still need prospective studies that follow over time insulin-resistant patients to determine their risk of developing PAD.”

Brigham and Women's Hospital is a 747-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. 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.

Press Release - Jun 11, 2008

Researchers from Brigham and Women’s Hospital have shown in a new study that low melatonin levels are associated with an increased risk of breast cancer in postmenopausal women.  This research is published in the June 11, 2008 issue of the Journal of the National Cancer Institute.
Melatonin is primarily secreted during the dark hours of a light-dark cycle and has been shown to be low in some night workers. Previous research has found that low melatonin levels in premenopausal women are associated with an increased risk of breast cancer.

Schernhammer and colleagues compared melatonin levels in 178 postmenopausal women and 710 matched controls. All of the women were enrolled in the Hormones and Diet in the Etiology of Breast Cancer Risk study.  Researchers report that women with the lowest levels of melatonin had a significantly higher incidence of breast cancer than those with the highest levels.

“Further studies are needed to confirm these data and investigate the mechanisms that underlie the association between melatonin levels and breast cancer risk,” concluded Schernhammer.

This research was funded through a grant from the Department of Defense.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - May 10, 2008

Leads to Lower Surgical Complication Rates Though Long-Term Outcomes Dependant on Surgeon Experience

Boston, MA – Many patients perceive minimally invasive surgery as the better choice over open surgical procedures; however, up to this point, little data was available about utilization and outcomes of minimally invasive radial prostatectomy (MIRP) to treat prostate cancer compared with the older open radical prostatectomy approach. 

Jim Hu, MD, MPH, and colleagues at Brigham and Women’s Hospital (BWH) assessed surgical utilization and complications, lengths of hospital stay and cancer outcomes in over 2,700 men who underwent prostate cancer surgery and found that MIRP usage almost tripled between 2003 and 2005 – a striking finding since the procedure was introduced in the US in 2000. Additionally, the researcher found although MIRP patients had less surgical complications and shorter hospital stays by almost three days, they were more likely to require additional cancer treatments after surgery compared to men undergoing open surgery. These findings appear in the May 10, 2008, issue of the Journal of Clinical Oncology.

“In short time, MIRP has taken over as one of the most popular treatments for prostate cancer, but one cannot help but think this procedure was adopted by surgeons too quickly because cancer outcomes for MIRP patients overall were not as favorable as those who underwent open radical prostatectomy,” said lead author Hu. “However, the results of our national study differ from outcomes at high volume centers where cancer control for the open and minimally invasive approaches are very similar.”

The researchers found that experienced or high volume MIRP surgeons were more likely to have favorable cancer outcomes compared to low-volume MIRP surgeons, suggesting that the rapid adoption of the procedure by eager surgeons, not the procedure itself, is a possible cause for worse long-term outcomes compared with open radical prostatectomy.

“There is a steep learning curve for MIRP and based on our research, I would tell patients deciding on a prostate cancer treatment to pay attention to the experience of their doctor and not be seduced by the smaller incisions and newer technologies offered by minimally invasive surgery,” Hu added.

This research was supported by a Lance Armstrong Young Investigator Award, a Dana-Farber/Harvard Cancer Center Career Development Award and by a grant from the Brigham and Women’s Center for Surgery and Public Health.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - May 8, 2008

The Brigham and Women’s Hospital Asthma Research Center (ARC) has received a $2 million Genetics Enters Medicine (GEM) grant from Partners to study the influence of one’s genetic profile on response to asthma therapies and involves examining whether patients with different versions of a receptor for commonly used asthma drugs have a better response to one drug versus another.

"More than one out of six patients have a different version of the receptor we’re focusing on," said Elliot Israel, principal investigator of the project. The specific drug being examined is a long-acting beta-agonist which is a component of the commonly used drugs Advair® and Symbicort. Studies have found that these drugs improve asthma control in some patients, yet others may not benefit.

Patients will be provided with the equivalent of the drug they are receiving or an alternative, and the study will examine how patients with different versions of the receptor will respond to one treatment versus the other. "Since this is a Partners’ study, we are trying to get the widest participation possible across the Partners’ network" said Elliot Israel, director of the Asthma Research Center. Dr. Israel and Dr. Michael Wechsler, associate director of the Asthma Research Center, plan to contact almost all physicians using the Longitudinal Medical Record (LMR) to obtain permission to contact their patients.

There are approximately 14,000 patients throughout the Partners’ network who are potentially eligible to participate in the Genotype stratified treatment with Anticholinergic vs. Beta-agonist (Long Acting) and Exacerbations (GABLE) study. Potential participants will be screened to determine the genetic makeup of their beta-adrenergic receptor and will be prescribed one of the treatment plans. "We’re asking all Partners’ physicians to help us in identifying patients of theirs who might be good candidates for this important research," said Dr. Israel.

Dr. Wechsler added, "Prescription of current therapies for asthma, including long-acting beta-agonists, is on the rise but may not benefit everyone equally. Our goal is to find an additional therapy that helps those who aren’t helped by the current standard of care."

To learn more about GABLE and how potential participants can enroll please visit, www.asthmabwh.org or call 617-732-8201.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - Apr 24, 2008

First results from the Women’s Genome Health Study

Boston, MA – Researchers at Brigham and Women’s Hospital (BWH) have found that  variation in several genes that are associated with metabolic and inflammatory regulation – in diseases such as diabetes and heart disease – also have significant effects on C-reactive protein (CRP) levels.  These results, to be published online in the American Journal of Human Genetics on April 24, 2008, suggest that CRP, or regulating CRP levels, may have a role in controlling metabolic, cardiovascular and inflammatory diseases. 

CRP is a marker of inflammation in the bloodstream, measured by a simple blood test that has been shown to predict heart attack, stroke, and cardiovascular death, even among individuals with low levels of cholesterol. Lifestyle modifications, such as weight loss and regular exercise, has been shown to lower CRP levels, but there has also been concern  that genetics might impact CRP  because high CRP often runs in families, specifically families with high cardiovascular risk and diabetes.

These results come on the heels of an announcement that the JUPITER trial, designed to test whether cholesterol-lowering statins can prevent heart disease in people with normal cholesterol but increased CRP levels, was terminated early by its Independent Data and Safety Monitoring Board.  

“Half of all heart attacks and strokes occur among apparently healthy individuals with normal or even low levels of cholesterol” said Paul Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention at BWH and lead author of the paper and the Principle Investigator of the JUPITER trial.  “Defining the core genetic determinants of CRP is an important step toward understanding what it is about CRP that is driving cardiovascular risk.”

Researchers evaluated genetic variations in segments of DNA from 6,345 healthy women to determine which genes, or variations in gene sequences, play a role in regulating levels of CRP.  The women are participants in The Women’s Genome Health Study, a unique collaboration between the National Heart, Lung and Blood Institute, Amgen and BWH.  The project brings together government, academic researchers and industry in a model partnership designed to answer genetic questions in an effort to realize the goal of personalized medicine that would allow for patient-specific preventive programs in advance of symptoms. 

Ridker and colleagues found that much of the common genetic variation that contributes to CRP levels is closely related to genes responsible for insulin resistance, weight gain, metabolism, and the early development of plaque build up in heart arteries.  These results provide insight into the relationship that CRP has with metabolic syndrome, diabetes, and vascular events such as heart attack or stroke and coincide with the fact that interventions such as diet, exercise, and statin medications lower both cardiovascular risk and levels of CRP.

“The exciting finding is that some of the genes we identified are directly involved in metabolic syndrome pathways which could eventually be targeted for clinical therapies” said Dr. Daniel Chasman, director of Computational Biology in the Center for Cardiovascular Disease Prevention at BWH and a coauthor on the paper.  “We also found for the first time that a part of the genome lacking known genes, often called a ‘gene desert,’ influences CRP levels. This is exciting because such areas have no known function, yet we now have evidence that this gene region influences inflammation in a direct way.”

This research was funded by the National Heart Lung and Blood Institute, the National Cancer Institute, the Donald W. Reynolds Foundation, the Doris Duke Charitable Foundation and the Foundation Leducq.  Major collaborative scientific and genotyping support was provided by Amgen. Other BWH investigators involved in the study include Drs Robert Zee, Guillaume Pare, Jacqueline Suk-Danik, Julie Buring, Nancy Cook, and David Kwiatkowki.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - Apr 13, 2008

Boston, MA - Charles Lee, PhD, an assistant professor at Brigham and Women’s Hospital (BWH) and Harvard Medical School (HMS) and an associate member at the Broad Institute of MIT and Harvard, has been awarded the 2008 Ho-Am Prize in Medicine.  At 38, Lee will be the youngest recipient of the award when the clinical cytogeneticist receives the “Nobel Prize” of Korea in Seoul on June 3.

“I am truly honored and indebted to my hard working lab, wonderfully supportive colleagues here in my Department and BWH and, most of all, my valued collaborators from whom I have learned so much over the years,” said Lee.

Lee’s 2004 discovery of widespread structural genomic variation in humans has revolutionized human genetics. Because of his work, scientists have already associated some of these genetic variations with increased susceptibility to AIDS, autoimmune diseases and cancer.

"Dr. Lee is an excellent example of a new breed of genetic scientist – a translational molecular pathologist,” said Michael Gimbrone, MD, chairman of Pathology at BWH. “His basic discovery is not only paradigm-shifting but may well be translated into new strategies for the diagnosis and treatment of diseases, strengthening the promise of personalized medicine.”

Lee, who came to BWH in 1998 for his clinical cytogenetic training, is now an assistant professor of Pathology at BWH and HMS. He was born in South Korea in 1969 and immigrated to Canada when he was 1 year old.

The Ho-Am Prize was established in 1990 in the memory of the late Byung-chull Lee, founder of the Samsung group of companies, and is awarded annually in five disciplines including arts, community service, engineering, medicine and science. It honors scholars who have made outstanding contributions to their field of study to the better welfare of mankind.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital is a 747-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. 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, visit www.brighamandwomens.org.

Press Release - Apr 7, 2008

Boston, MA – Researchers at Brigham and Women’s Hospital have successfully treated a chronic blood cancer in mice using a novel designer drug to attack a mutant protein that triggers malignant blood cell growth. They say it shows promise as a definitive treatment for myeloproliferative diseases (MPD), which affect some 80,000 to 100,000 people in the United States.

The drug shut down or reduced abnormal production of blood cells in the bone marrow and spleens of mice with polycythemia vera, one of three MPD cancers, according to a report in the April 7 issue of Cancer Cell  by a group led by Gary Gilliland, MD, PhD, at Brigham and Women’s. He is also affiliated with Dana-Farber Cancer Institute and Harvard Medical School, and is an Investigator of the Howard Hughes Medical Institute.

The positive results in animal testing have already prompted the launching of phase I clinical trials in patients at Dana-Farber and other centers to study the safety in humans of trials of the drug, TG101348, which caused no toxicities in mice.

“A betting person would be excited about this,” said Richard Stone, MD, an oncologist who is leading the clinical study at Dana-Farber.

Scientists at TargeGen Inc., a biopharmaceutical company in San Diego, designed the compound to selectively block a mutant protein growth signal, JAK2, that drives the majority of cases of polycythemia vera, essential thrombocytosis, and primary myelofibrosis.

There currently are few good treatments for the myeloproliferative diseases, and although patients may live with them for a number of years, they can cause serious complications and morph into a lethal form of leukemia.

In the mice, TG101348 decreased the amount of cancer and dramatically increased the survival rate. The first rationally designed targeted drug for a cancer, Gleevec, has vastly improved the outlook for patients with chronic myelogenous leukemia (CML), which is related to the MPD, and Stone and Gilliland said they are optimistic that TG101348 or a related drug might have a similar impact on the myeloproliferative disorders, which are five times as prevalent as CML.

Gilliland and colleagues at Brigham and Women’s and Dana-Farber reported in Cancer Cell in 2005 that most cases of MPD are triggered by a mutation in the tyrosine kinase JAK2, an enzyme that promotes the growth of blood cells. The mutation in JAK2 is like a broken switch that leads to runaway growth of red and white blood cells. The team had used the Internet to request and obtain blood samples from patients with MPD, and used robots to sequence their DNA in the hunt for the mutation.

“In less than three years since the discovery of the mutation, we have worked in a collaboration between academia and industry to carry out preclinical development of the drug, and it is now in phase I trials,” said Gilliland. “It is truly remarkable, given that drug development often takes a decade or longer.”

The precise cause of MPD, as with many cancers, is unknown. Patient experiences differ widely, but the overproduction of blood cells and the damage to normal bone marrow cells can lead to painful spleen enlargement, clots, bleeding, and infections. Some patients eventually develop acute myelogenous leukemia (AML), which, especially in older patients, is often fatal.

Led by Gilliland and Gerlinde Wernig, MD, lead author of the Cancer Cell report, the researchers created a mouse model of polycythemia vera by transplanting bone marrow cells containing the mutant JAK2 enzyme into mice.

Mice were treated with TG101348, a small-molecule kinase inhibitor administered orally, or a placebo. All the animals in the treated group survived, whereas a significant proportion of mice in the placebo group died. Importantly, the drug had no effect on normal blood cell production or immune function.

The drug shrunk the enlarged spleens, reduced abnormal blood cell production and reversed myelofibrosis in some drug-treated animals – scarring of the bone marrow tissue in severe cases of MPD. In the early clinical trials, patients with myelofibrosis will be the first to receive the experimental drug, said Ann Mullally, a research fellow at Dana-Farber and co-investigator on the clinical trial there.

“Our overall plan,” said Gilliland, “is to determine if the drug is safe and effective, and ultimately to determine if other types of cancers may be amenable to treatment with JAK2 inhibitors.”

Support for the research was provided by the National Institutes of Health, the Howard Hughes Medical Institute, the MPD Foundation, Leukemia and Lymphoma Society.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - Apr 7, 2008

Bar-coding surgical sponges may reduce the risk of leaving them in patients

Boston, MA – Improving patient safety is an initiative at nearly every hospital across the country.  Now, researchers at Brigham and Women’s Hospital (BWH) have shown that using bar-code technology to augment the counting of surgical sponges during an operative procedure increases the detection rate of miscounted and/or misplaced sponges.  This research is published in the April issue of the Annals of Surgery.

“Bar-code technology offers an easy way to help track sponges during an operation.  This has the potential to improve patient safety by reducing the chance that the sponges will be miscounted and possibly left in a patient,” said Caprice Greenberg, MD, MPH, a surgeon at the BWH Center for Surgery and Public Health and Dana-Farber Cancer Institute Center for Outcomes and Policy Research.

Previous studies have shown that counts are falsely reported as correct in the majority of cases of retained sponges and instruments, resulting in the surgical team believing that all the sponges are accounted for.  In this study, researchers compared the traditional counting protocol with or without augmentation by the bar-code technology in 300 general surgery operations.

Greenberg and colleagues found that the bar-code system detected more counting errors than traditional counting methods both in cases where sponges were misplaced and counted incorrectly.  Researchers also report that although the technology introduced new difficulties in the operating room, clinicians felt confident that the technology was effective and easy to use.

“The inadvertent leaving of sponges inside surgery patients is a rare but embarrassingly persistent error. It happens in at least 3,000 patients a year. Surgical teams have been seeking a solution to this problem for decades. And with this trial of computer-assisted method of counting surgical sponges, we have proof that we have likely found one," said Atul Gawande, MD, MPH, surgeon at BWH and a co-author on the study.

This research was funded through a grant by SurgiCount Medical.  

Brigham and Women's Hospital is a 747-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.  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.

Press Release - Apr 3, 2008

Paper Resulted from Identification of Childhood Obesity Gene and Carries Implications for Fundamental Study Design and Analysis

Boston, MA – A team of researchers from Harvard School of Public Health (HSPH), Brigham and Women’s Hospital (BWH), and elsewhere have described a possible reason why some studies have been unable to replicate associations between genes and traits — namely that the strength of a gene/trait association might vary with age and that current study designs typically fail to take that into account. The paper was selected for early publication online on the American Journal of Human Genetics (AJHG) web site on April 3, 2008, and will appear in the April 11 print issue of the journal.

Said Christoph Lange, HSPH Associate Professor of Biostatistics and senior author: “In reexamining a vast amount of original data from an earlier study, we have illustrated clearly that genetic effects for complex traits can vary by age and that such an interaction can prevent independent replications of the work if this variable is not taken into account in planning and analyzing the study. This insight has implications for all fellow researchers in genetic association studies.”

In 2006, Lange was a co-author of a paper in Science that found a common genetic variant, or SNP, that is associated with adult and childhood obesity. The association was confirmed in some, but not all, cohorts.

When more data became available, Lange and collaborators reanalyzed the original data, plus genetic information from 399 additional individuals. Subjects participated in the Framingham Heart Study offspring cohort. More than 116,200 SNPs were initially genotyped, of which 86,604 were used in the association analyses. Measurements of body mass index (BMI) were taken six times over an average of 23 1/2 years. BMI is weight in kilograms divided by the square of height in meters.

The researchers found a second common genetic variant called rs1455832 in the ROBO1 gene that affects obesity. More to the point, the variant’s influence on obesity appears to be strongest during childhood and diminishes after age 45.

“This is important because it demonstrates that genetic effects can vary over time,” said Jessica Lasky-Su, Instructor at Harvard Medical School and Brigham and Women’s Hospital. “In this example, the marker may increase obesity in early life and then as time goes on, other effects become stronger, and the influence of this marker diminishes. It is likely that many other genetic variants also act in this fashion.” Lasky-Su is co-lead author of the study with Helen Lyon of Children’s Hospital Boston.

To test rs1455832 further, the researchers examined its association with obesity and with age in eight other study populations comprising 13,584 individuals. Five international centers participated, including studies from Costa Rica, Greece, Poland, Iceland, and Germany. The interaction was observed in five of the eight replicate samples with statistically significant results. The authors note that this interaction would have been missed in all but one of the replication samples if they had failed to incorporate the age-dependent effect in the association analysis.

Said Lange, “We are now in an era where scanning entire genomes for associations with diseases is rapid. In assessing the resulting data, it will be important for scientists to keep in mind the significance of age, otherwise findings may not be replicated or may be overlooked entirely.”

The importance of age-dependent genetic effects for BMI was suggested in a 2003 paper published by researchers at the University of Texas MD Anderson Cancer Center in the European Journal of Human Genetics that described a genome-wide scan for genes related to BMI. However, the incorporation of age-dependent genetic effects for BMI into genetic analyses remains uncommon.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - Apr 2, 2008

Suppression of the immune system’s surveillance response could prevent transplant rejection and fetal cells may be an easier source of stem cells than banking

Boston, MA - For the first time, researchers have observed that fetal cells remain in the blood of mothers who had pregnancies with donor eggs for years after delivery, without being destroyed by her immune system. This mechanism could prevent transplant rejection and these cells may be an easier source of stem cells. These findings were presented by lead author Zev Williams, MD, PhD, of Brigham and Women’s Hospital (BWH) at the Society of Gynecological Investigators conference in San Diego on March 26, 2008, and will be published this week on-line in Fertility and Sterility, the journal of the American Society for Reproductive Medicine.

"These findings may impact how we think about using stem cells in regenerative medicine because the 'foreign' fetal cells are not rejected by the mother's immune system, even in donor egg pregnancies," said Williams, a chief resident in the Department of Obstetrics and Gynecology at BWH. "Not only do we want to understand the novel mechanism that suppresses the immune system's surveillance response, but we want to know if these fetal cells can be a source of stem cells later in life for the mother and even for unmatched patients, which could eliminate the need for stem cell banking."

Williams and colleagues studied the blood of 11 healthy women 18 to 60 years of age who had delivered a male infant using a donor egg, and were able to detect male cells in the blood of these women up to nine years after delivery. The unmatched and foreign fetal cells’ ability to evade detection and destruction by the mother's immune system's surveillance response may also be beneficial in transplant medicine, where powerful immunosuppressant medications are required to prevent rejection, even of matched organs.

"It is also interesting to note, that after a donor egg pregnancy the mother and child do, in fact, share DNA, albeit at a very low level and therefore do have a biological connection,” added Williams.

An internal grant from the Department of Obstetrics and Gynecology at BWH funded this research.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital is a 747-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. 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.

Press Release - Apr 2, 2008

Study finds socioeconomic status affects odds patients requiring a mastectomy for breast cancer treatment will learn about breast reconstruction

 CHICAGO – In a new study examining disparities in postmastectomy breast reconstruction, researchers at Brigham and Women’s Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) concluded that lack of patient-provider discussion may contribute to socioeconomic, age and race-related inconsistencies in the use of breast reconstruction after mastectomy. However, the study also found that reconstruction was more likely to occur after the surgeon discussed options with the patient, suggesting that efforts are required to increase and improve these conversations. The full study appears in the April issue of the Journal of the American College of Surgeons.

Breast reconstructive surgery is an expensive elective procedure, but for many women it is a vital component of surgical care for breast cancer. The choice to have breast reconstruction is a complex decision that is influenced by access to care, patient preference and the provider’s interaction with the patient. 

“Patient preferences should be respected, but an informative discussion of reconstruction is required to help patients understand and weigh the risks and benefits of this procedure,” said Caprice C. Greenberg, MD, instructor of Surgery in the Center for Surgery and Public Health at BWH and the Center for Outcomes and Policy Research at DFCI. “We learned that physicians need to improve communications with patients and whenever possible, universally address the issue of reconstruction with all women undergoing a mastectomy, regardless of age, race or socioeconomic status.” 

Using the National Initiative on Cancer Care Quality database, researchers evaluated 626 patients who underwent mastectomy for breast cancer. The data had been collected in a study commissioned by the American Society of Clinical Oncology (ASCO) and undertaken by researchers at the Rand Corporation and the Harvard School of Public Health. Researchers reviewed data collected via survey and chart review approximately four years after diagnosis of breast cancer. Of these patients, 253 (40.4 percent) received breast reconstruction, and 249 (39.8 percent) had medical records documenting the occurrence of a discussion about this option.

“The data from the NICCQ study are continuing to reveal important opportunities to improve cancer care,” said ASCO President Nancy Davidson, MD, professor of oncology and breast cancer research chair at the Sidney Kimmel Cancer Center at Johns Hopkins University in Baltimore. “As oncologists, we need to be sure that we are thoroughly communicating with patients about all of their options for care.”

Approximately 70 percent of patients who had a documented discussion about breast reconstruction with their provider underwent the procedure. However, researchers found that increasing age and lower levels of education were associated with lower rates of a documented discussion. Hispanic patients, patients born outside the United States and those whose primary language was not English were less likely to actually receive reconstruction once the procedure was discussed

Based on these results, the study authors suggest that physicians should systematically address the issue of reconstruction with all patients undergoing mastectomy, including why she is or is not a candidate. They also recommend optimizing physician-patient discussions by using interpreters and appropriate educational materials to ensure an informative conversation regardless of primary language, ethnicity, or education level.

For more information, please contact Media Relations at (617) 534-1600 or BWHMediaRelations@partners.org.

 Brigham and Women's Hospital (BWH) is a 747-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.  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.

Press Release - Mar 28, 2008

New size of up to 18,000 subjects will ensure timely completion to evaluate the effect of ezetimibe on clinical events

Boston MA and Durham NC: The academic leadership of the IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial) announced today that the number of subjects enrolled into the trial now exceeds 11,000 and will be increased to up to 18,000 subjects. Trial chairman Dr. Eugene Braunwald of the Thrombolysis in Myocardial Infarction (TIMI) Study group at Brigham and Women’s Hospital and co-chairman Dr. Robert Califf of the Duke Clinical Research Institute (DCRI) noted that the sample size reassessment was based on ongoing evaluation of blinded, aggregate cardiovascular event rates in the trial, in conjunction with review of data on the relationship between the lowering of low-density lipoprotein cholesterol (LDL-C) and clinical benefit that has emerged since the original protocol was prepared. "This expansion will allow the trial to test definitively whether the additional lowering of LDL cholesterol with ezetimibe, when added to a statin, will translate into further clinical benefit", noted Dr. Braunwald.

The IMPROVE IT trial, sponsored by the Merck/Schering Plough joint venture, is a multicenter, international, randomized, controlled trial which compares the combination of ezetimibe/simvastatin versus simvastatin alone on cardiovascular outcomes in patients recovering from an acute coronary syndrome. The original protocol called for enrollment of 10,000 subjects and was designed to detect a reduction in the primary endpoint of cardiovascular death, non-fatal myocardial infarction, rehospitalization for unstable angina, coronary revascularization (occurring at least 30 days following randomization) or stroke. A total of 2955 primary endpoints were initially projected to meet this goal.

The publication of the Cholesterol Treatment Trialists (CTT) meta-analysis (Baigent C, et al. Lancet 2005;366:1267-1278) and a meta-analysis of the four intensive vs. standard-dose statin trials (Cannon CP, et al. J Am Coll Cardiol. 2006;48:438-445) prompted further review of the statistical assumptions surrounding the relationship between LDL-C lowering and the expected reduction in clinical events. After this review, it was determined that a total of approximately 5,250 primary endpoint events would be required to have appropriate power to detect a significant reduction in risk. This led to a

protocol amendment in September, 2007 in which the targeted number of events was increased to 5,250 and the study sample size to 12,500 subjects. It was anticipated that the sample size would be updated as the trial progressed.

More recently, the availability of better estimates of aggregate, blinded event rates in IMPROVE-IT has led to the decision to increase the sample size further (up to 18,000 subjects) in order to ensure the accrual of the needed number of clinical events in the most timely manner. The protocol is being discussed with regulatory authorities and is being amended accordingly. At the present time, over 11,000 patients have been enrolled in the trial.

The first patient was enrolled into IMPROVE IT in October, 2005. At that time, with a projected enrollment of 10,000 subjects, with a minimum of 2 ½ year follow-up, the trial was projected to end in 2011. IMPROVE IT is an "event driven" trial, and therefore the end of the study is declared when the target number of events is reached and the last subject enrolled will have been followed for a minimum of 2 1/2 years. With the increase in enrollment, the current estimate for the completion of the trial is 2012. However, the actual date of completion is highly dependent on the observed event rates during the follow-up phase of the trial and the rate of enrollment. Therefore, it is not possible to determine with precision an exact date that the trial will end. It is planned to adjust both the trial timeline and the number of subjects needed to be enrolled based on review of the aggregate, blinded event rate at six month intervals.

All trial participants and leaders are blinded to which treatment the patients are receiving. An independent Data Monitoring Committee is evaluating the trial results periodically in an unblinded fashion and could recommend earlier cessation if a definitive excess of benefit or harm were found. At their last evaluation, held on February 18, 2008, the Data Monitoring Committee advised that it found no indication in the data of adverse safety signals that would warrant a change in the protocol, and recommended that the study be continued.

Dr. Califf noted, "We are pleased that this large randomized trial will have adequate sample size and statistical power to determine the clinical effects of the combination of ezetimibe and simvastatin vs. simvastatin alone. This will answer an important question that many patients and doctors are asking about the secondary prevention of coronary artery disease and to the balance between benefit and risk of reducing LDL-cholesterol to very low levels in high-risk patients."

For more information please contact BWH Media Relations at BWHMediaRelations@partners.org or (617) 534-1600.

Brigham and Women's Hospital is a 747-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.  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.

Press Release - Mar 25, 2008

New Director comes from Cleveland Clinic

Boston, MA – Deepak L. Bhatt, MD, has been named the new director of the Integrated Interventional Cardiovascular Program at Brigham and Women’s Hospital (BWH) and the VA Boston Healthcare System (VA) effective July 1, 2008.  In addition, Dr. Bhatt will also serve as the Chief of the Cardiology Section at

the VA Boston Healthcare System and as Senior Investigator at the Thrombolysis in Myocardial Infarction (TIMI) Study Group, directed by Dr. Eugene Braunwald.

“As Director of the Integrated Cardiovascular Intervention Program at BWH and the VA, I am excited to be working with a very talented group of interventional cardiologists who are highly skilled at both patient care and research, and very happy that my arrival will coincide with the opening of the Carl J. and Ruth Shapiro Cardiovascular Center at BWH in May 2008,” said Bhatt.

Dr. Bhatt comes from the Cleveland Clinic, where he has worked on staff in the Department of Cardiovascular Medicine since 2001 and more recently as associate director of the Cleveland Clinic Cardiovascular Coordinating Center since 2006. 

“I had a wonderful time at the Cleveland Clinic, a fantastic place from which I would have been happy to retire; however the chance to work with this very talented group of academic interventionalists at Brigham and Women’s and the VA and the honor of being the Chief of Cardiology of the VA Boston Healthcare System is too great an opportunity to pass up,” said Bhatt.

Dr. Bhatt’s research interests include preventive cardiology, as well as the optimal management of patients with heart attacks. He also has research interests in advanced techniques in cardiac, cerebral, and peripheral intervention. He has authored or co-authored more than 200 articles in prestigious, peer-reviewed journals.  He has been listed in Best Doctors in America for the past several years.

“Dr. Bhatt is an outstanding interventional cardiologist and dedicated researcher.  We are very pleased to have him join the cardiovascular team at BWH. His leadership and talent will complement the existing strengths of our Cardiovascular Division,” said Peter Libby, MD, chief of Cardiovascular Medicine at BWH.

Brigham and Women's Hospital is a 747-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.  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.

Press Release - Mar 14, 2008

Findings beneficial to developing countries

Boston, MA – In a new study from Brigham and Women’s Hospital (BWH), researchers show that methods using non-laboratory-based risk factors predict cardiovascular events as accurately as more costly laboratory-based tests. These results are published in the March 14, 2008 issue of Lancet.

“Using non-laboratory tests could simplify risk assessment in countries where laboratory testing is inconvenient or unavailable,” said Thomas Gaziano, MD of the Division of Cardiovascular Medicine at BWH and lead author of the study.

Using a previous cohort  developed in the early 1970’s and comprised of 14407 US participants between the ages of 25 -74, Gaziano and colleagues re-analysed the NHANES I study. The follow-up study population included 6186 participants who did not report a history of cardiovascular disease (heart attack, heart failure, stroke, angina), or cancer. The lab-based method, which required blood-tests, looked at age, systolic blood pressure, smoking status, total cholesterol, reported diabetes status, and current treatment for high blood pressure. The non-lab method substituted body-mass index for cholesterol.

Researchers found that in the 6186 people initially not reporting a history of CVD, there were 1529 first-time cardiovascular events and 578 deaths due to cardiovascular disease over a 21 year period. Both lab and non-lab methods calculated a number called the c-statistic to assess cardiovascular risk prediction, and for both men and women, lab and non-lab methods gave similar c-statistics. Furthermore, the non-lab method correctly classified patients at the same rate as the lab method across four commonly used levels of risk used in guidelines around the world, suggesting good calibration.

Study authors add that the cost for developing nations to perform cholesterol tests on patients who were at risk for the development of cardiovascular disease could use more than 10 percent of the nation’s health care budget, which adds little benefit to non-lab tests.  Non-lab test are effective at collecting the appropriate information to determine risk quickly and in a non-invasive way.

“Approximately 80 percent of cardiovascular deaths occur in developing countries where assessment of patients at high risk is an important strategy for prevention. Since developing countries have limited resources for laboratory testing, cheap, simple and effective, non-lab methods of testing would help immensely,” said Gaziano.

For more information, please contact Media Relations at (617) 534-1600 or BWHMediaRelations@partners.org.

 Brigham and Women's Hospital (BWH) is a 747-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.  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.

Press Release - Mar 13, 2008

Researchers explore how an injured kidney may be able to repair itself using a mouse model

Boston, MA – With the population aging and rates of hypertension and diabetes higher than ever, there is a growing importance to understand how the kidney works to repair itself in order to guide the development of much needed future therapies.  Researchers at Brigham and Women’s Hospital (BWH) examined cells in the kidney to determine which cells are responsible for generating repair.  Their results are published in the March issue of Cell Stem Cell.

 “There has not been a new therapy developed to treat kidney failure since dialysis was introduced in the 1950's,” said Benjamin Humphreys, MD, PhD, in the Renal Division at BWH and lead author of the study.  “We have known for some time that the kidney can often repair itself after acute injury, and our goal is to understand this kidney repair process in hopes that it will lead us to pathways that can be used to guide the development of much needed clinical therapies.”

In recent years there have been reports that an adult kidney stem cell may exist in the kidney and be responsible for repair.  If an adult stem cell does exist though, researchers have yet to define its location.  Humphreys and colleagues genetically marked tubular epithelial cells in adult mice kidneys, but not other cells present between the tubules, where studies have suggested the kidney stem cell might reside.   Researchers then caused injury to the kidney, allowed the kidney to repair and tested whether the repaired epithelial cells still carried the genetic marker, or if they had been replaced by the non-marked cells adjacent to the tubules.  They found that repaired tubules retained the genetic marker, indicating that epithelial cells have the full capacity to repair themselves without any contribution from other adult kidney cell types.  The research was performed in the Humphreys' Lab at BWH and Harvard University.

Researchers conclude that if an adult stem cell does exist in the kidney, it is located within the tubular epithelial population, not outside of them, and emphasize that further research is needed to determine whether all tubular cells have the same ability to generate growth, or if an adult stem cell with the capacity to repair is responsible for generating the growth.

 “Defining the specific cell type responsible for repair after kidney injury is the first step toward designing regenerative therapies that ultimately will accelerate repair or slow chronic damage to the kidney,” said Humphreys.

This research was funded through the National Institutes of Health and an award from the Genzyme Renal Innovations Program.

For more information, contact BWH Media Relations at (617) 534-1604 or bwhmediarelations@partners.org.

 Brigham and Women's Hospital (BWH) is a 747-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.  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.

Press Release - Mar 12, 2008

Boston, MA – A relationship has been observed between deep sleep and the ability of the brain to learn specific tasks. Researchers at Brigham and Women’s Hospital (BWH) have now shown that the processes that regulate deep sleep may affect visual learning.  These results are published in the March 12, 2008 issue of the Journal of Neuroscience.

“These findings show that deep sleep is important for visual learning and possibly the ability of the brain to learn new tasks,” said Daniel Aeschbach, researcher in the Division of Sleep Medicine at BWH and lead author of the study.

Deep sleep, also called slow wave sleep, is a period of non-rapid-eye-movement sleep when very large brain waves, called slow waves, can be observed in the EEG, which is a recording of the brain waves.  Slow waves are thought to reflect the need for sleep, but their exact function is unknown.  Researchers sought to determine the function of these waves in visual learning.

Aeschbach and colleagues trained healthy subjects on a visual learning task in which they were required to determine on a computer screen the orientation of a few dashes that were embedded in a field of horizontal dashes.  Subjects were tested on their accuracy of performing this task before and after they had slept for a period of four hours.  One group of subjects slept normally, with no interruptions, and their visual skill in performing the task improved after sleep.  In another group, researchers suppressed the occurrence of slow waves by playing targeted acoustic tones while subjects were asleep.  The tones did not wake the subjects, but prevented them from slipping into deep sleep as monitored on the EEG.  This group was also tested in the visual task after sleep and their skill did not improve.

Researchers suggest that these findings could have clinical implications for conditions like depression and insomnia, as well as aging, which are associated with learning deficits and also a reduction of deep sleep.

This research was funded by awards from the National Alliance for Research on Schizophrenia and Depression, the Milton Fund of Harvard University, and the National Institutes of Health.

For more information, please contact Media Relations at (617) 534-1600 or BWHMediaRelations@partners.org.

Brigham and Women's Hospital (BWH) is a 747-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.  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.

Press Release - Feb 26, 2008

Washington, DC - Eli Lilly and Company and Partners In Health (PIH) announced a series of multidrug-resistant tuberculosis (MDR-TB) trainings for health officials and physicians treating drug-resistant patients in 10 former Soviet Republics. The trainings will be conducted by experts from Brigham and Women's Hospital (BWH), which is closely affiliated with PIH, and are funded as part of a $4 million grant made to PIH and BWH through The Lilly MDR-TB Partnership.

The announcement was made in conjunction with the release here today by the World Health Organization of the largest survey ever conducted on the global spread of MDR-TB. The report covers data on both MDR-TB and XDR-TB (extensively drug resistant TB) collected in more than 80 countries. The report, "Anti-Tuberculosis Drug Resistance In The World," calls for "urgent measures" to address the HIV-MDR-TB co-epidemic and prevent the more rapid spread of the highly contagious and deadly disease.

"When I visit patients in these clinics and see that they are getting better, I'm thankful for the contribution of everyone working to end this disease," said Paul Farmer, MD, PhD, co-founder of PIH and associate chief of the Division of Social Medicine and Health Inequalities at BWH. "Our work must continue because it is making a significant impact on MDR-TB."

"This training program successfully addresses the WHO call for urgent measures that can serve as a model for other areas of the world where MDR-TB is reaching epidemic proportions," said Jim Yong Kim, MD, PhD, co-founder of PIH and chief of the Division of Social Medicine and Health Inequalities at BWH.

The PIH trainings will bring together public health officials and leaders responsible for overseeing MDR-TB programs in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Ukraine and Uzbekistan.

A second session in June, also funded by the Lilly grant to PIH/BWH, will bring TB physicians from these same 10 countries to the TB Research Institute at Novosibirsk in Siberia, one of five Russian TB Centers where PIH and BWH faculty have provided education programs to physicians over the last two years.  The Institute, recently designated by the World Health Organization as a Center of Excellence, will provide a two-week clinical education program in MDR-TB.

June also marks a milestone in an international partnership between Lilly, PIH, BWH, the Moscow Medical Academy and the Harvard School of Public Health, which for several years has brought Russian physicians to Boston for a 7-week program in quantitative research methods and evidence-based medicine, with some of the physicians ultimately earning a Master's in Public Health. This newly trained cadre of experienced Russian faculty now will be joined by Harvard faculty to begin teaching advanced methods of biostatistics and epidemiology in Moscow to medical students and practicing physicians. The program promises not only to improve TB research and treatment, but also to more generally improve medical care in Russia and the Former Soviet Republics.

In addition to the doctors being trained this year, PIH-led sessions have provided education to 375 physicians, representing all 88 territories of the Russian Federation.

In conjunction with the Research Center in Novosibirsk, Tomsk Oblast TB Service has enrolled more than 1,300 MDR-TB patients in treatment provided by hospitals, day hospitals and ambulatory facilities in a continuum of care.  Patients come from the general population, as well as from the regional prison system, and benefit from the additional physician education and programs offered by PIH and their BWH colleagues.

"Lilly is working to ensure that our corporate responsibility efforts drive measurable results for the communities and patients we serve," said Robert L. Smith, president of the Lilly Foundation.  "We do not have a better example of this than The Lilly MDR-TB Partnership, a collaboration with 14 partners including PIH and BWH, which has achieved impressive results.  We're honored to be part of this effort." 

The $4 million in funding to PIH/BWH for this program and others is part of a $50 million commitment the company announced on World TB Day 2007.

PIH and BWH also have used Lilly funds for a pilot study to implement and assess a simple screening tool (AUDIT) to identify alcohol use disorders among Russian TB patients.  This work has led to a randomized controlled trial funded by the U.S. National Institutes of Health to assess the effectiveness of pharmacologic and behavioral treatment of patients who are at risk of dropping out of TB treatment due to excessive alcohol use. Working with their Russian colleagues, PIH/BWH faculty also have implemented a community-based intervention program for treating and supporting MDR-TB patients at high risk of treatment default due to social factors such as unemployment, homelessness and alcohol addiction.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital (BWH) is a 747-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.  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.

The Division of Social Medicine and Health Inequalities (DSMHI) in the Department of Medicine at BWH fosters the support and coordination of training, research, and service to reduce disparities in disease burden and to improve treatment outcomes both at home and abroad. The Division focuses on infectious diseases (e.g., HIV and tuberculosis) as well as non-infectious diseases (e.g., coronary artery disease, diabetes, addiction) and other health problems of major importance to society.

Partners In Health (PIH) is a non-profit organization based in Boston that works with partner organizations based in some of the world's poorest communities to improve the health and well-being of those most in need. Responding to an epidemic in the shantytowns of Lima, Peru, in 1996, PIH pioneered successful, community-based treatment of MDR-TB in poor countries. The success of that program contributed to a change in WHO policies and to creation of the Green Light Committee to make effective MDR-TB treatment available to the poor. The organization currently has programs in Haiti, Peru, Russia, Rwanda, Lesotho, Malawi, Mexico, Guatemala, and Boston.

Press Release - Feb 25, 2008

Tumor’s unique "fingerprint" will help future cancer patients receive personalized, targeted treatments

Boston, MA – Researchers from Brigham and Women’s Hospital (BWH), for the first time, using new DNA sequencing technology, can identify the unique genetic mutations of a cancerous tumor of an individual patient. This new, more rapid and efficient approach may dramatically improve therapeutic decisions for cancer patients.

The researchers obtained the genetic sequences of all of the expressed genes in tumors from four patients with mesothelioma, an asbestos caused cancer of the lung. Three to four novel genetic mutations were found in each tumor, none of which had been implicated in cancer in previous studies. Each tumor had a unique mutation profile, similar to having a unique fingerprint. The research results are published in the February 25, 2008 issue of the Proceedings of the National Academy of Sciences.

The findings confirmed the accuracy of advanced new sequencing technology to identify the patient-specific genetic mutations in surgically removed tumor tissue and suggest that this approach could become a new standard for discovery of tumor mutations that underlie cancer. This approach points the way to individualized analysis of patient tumors thereby encouraging discoveries that have tremendous potential to highly refine individual patient care and guide therapy.

The BWH group developed new methods to preserve and select the optimal tissue from newly harvested tumors, and software tools to manage the billions of DNA sequence data points and discovered the important cancer causing genetic changes. This newly developed pipeline could be used to identify the genetic mutations in a given patient within a relatively short time frame, from a several weeks to just a few months.

BWH surgeons analyzed tissue from four malignant pleural mesothelioma tumors, one lung cancer specimen and from normal lung tissue. Approximately 266 megabases of cDNA were sequenced per patient using technology in collaboration with 454 Life Science Inc. All expressed genes were sequenced without any preconceived notion as to which may be more or less important. Analysis of the billions of DNA sequence data points was enabled by software developed in collaboration with the National Center for Genome Resources in Santa Fe, NM. The computer programs were designed to assemble the data and compare it among the patients and with public DNA and RNA databases to determine candidate mutations, which were validated by independent methods. In the four mesothelioma tumors 15 novel mutations of multiple types were discovered and each mesothelioma tumor had a unique mutation profile. None of the mutated genes has ever been implicated in mesothelioma.

"We found that each tumor had its own unique genetic mutation, sort of like its own fingerprint," said David Sugarbaker, chief, Division of Thoracic Surgery at BWH, lead author of the study and a pioneer in mesothelioma research. "One truly encouraging aspect of our findings is after spending a year and a half to develop the methodology and software for the pipeline, new tumors can be analyzed over the course of about a month. Knowing which genes are mutated opens the door to better understanding and the discovery of more targeted and effective patient-specific treatments in real time."

He added, "Technical advances are rapidly changing the way we can do mesothelioma research and advance personalized medicine at the clinical level. This step forward is akin to mainframe computers giving way to the desk top PC revolution. Ultimately, every patient’s tumor will be directly sequenced to determine its mutations and optimal treatment just as we now identify the cause of an infection before selecting the best antibiotic to treat it."

The research was supported by the International Mesothelioma Program at BWH (www.impmeso.org). All the data will be made publicly available at the time of publication and can be accessed here.

For more information, please contact the Media Relations Department at BWHMediaRelations@partners.org or at (617) 534-1600.

Brigham and Women's Hospital is a 747-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.  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.

Press Release - Feb 19, 2008

Once again demonstrating their commitment to improve health care and the fight against cancer, Carl J. and Ruth G. Shapiro have pledged $27 million to Dana-Farber/Brigham and Women’s Cancer Center in Boston to substantially upgrade and expand its facilities for cancer care services.

Dana-Farber Cancer Institute and Brigham and Women’s Hospital jointly operate the Dana-Farber/Brigham and Women’s Cancer Center, a national leader in cancer care. The Shapiro gift will make possible the renovation of several patient floors into a state of the art facility for cancer care and surgical services offering “comfort to our patients as well as resources and support to their families.”  One floor of the patient tower will feature a new cancer-care pavilion bearing the Shapiro name.  A portion of the gift also will underwrite a floor in the new Yawkey Center for Cancer Care and establish a new Shapiro Center for Patients and Families, both at Dana-Farber.

 “Carl and Ruth Shapiro’s foresight and generosity will help us meet the challenges of cancer in the 21^st century,” said Gary Gottlieb, MD, MBA, president of Brigham and Women’s Hospital.  “As the Baby Boom generation ages, cancer will become more prevalent.  And people are living longer with cancer now, which also increases the demand for sophisticated cancer treatment and services.  This gift will help us meet this growing responsibility.”    

Supported by the Shapiro gift, the eighth floor of the 275,000 square foot Yawkey Center for Cancer Care at Dana-Farber, which is slated to open in 2011, will house chemotherapy infusion, medical examination and other essential medical services.  In addition, the Shapiro Center for Patient and Family Services will serve as a gateway to a wide range of specialized resources available at Dana-Farber, some of which will be located or delivered throughout the Institute.  

“This is a crucial commitment that will help enable us to provide our patients the most advanced cancer care possible in the most comfortable, modern facilities possible,” said Edward J. Benz, Jr., MD, president of Dana-Farber.  “It will have a very significant impact on the lives of thousands of people with cancer in the coming decades.”

Carl J. Shapiro is the founder and former chairman of Kay Windsor Inc., a New Bedford, MA-based manufacturer and importer of women's apparel. He founded Kay Windsor in 1939 and built it into one of the largest companies of its kind in the country before it was acquired by VF Corporation in 1971.  The Shapiros, who live in Palm Beach and Boston, are widely known for their extensive support of the regions’ major medical, cultural and educational institutions.  Along with their longstanding support of Brigham and Women’s Hospital and Dana-Farber Cancer Center, they have given to Brandeis University, Beth Israel Deaconess, Wellesley College, the Boston Symphony Orchestra, the Museum of Fine Arts and several other Boston-area organizations. The Shapiro Family Foundation also supports a wide range of community based non-profits focused on improving the lives of the disabled, disadvantaged and disenfranchised.  In Florida, they are active with the Norton Art Museum in West Palm Beach, the Kravis Center for Performing Arts and the Palm Beach Opera.  In 2005, they made a gift of $25 million to establish the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital, scheduled to open this spring. 

Brigham and Women's Hospital is a 747-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.  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.

Dana-Farber Cancer Institute is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

Press Release - Feb 18, 2008

Boston, MA -  Researchers at MIT and Brigham and Women's Hospital (BWH) have created a waterproof adhesive bandage inspired by gecko lizards that may soon join sutures and staples as a basic operating room tool for patching up surgical wounds or internal injuries. The work is described in the February 11, 2008, online issue of the Proceedings of the National Academy of Sciences.

Drawing on some of the principles that make gecko feet unique, the surface of the bandage has the same kind of nanoscale hills and valleys that allow the lizards to cling to walls and ceilings. Layered over this landscape is a thin coating of glue that helps the bandage stick in wet environments, such as to heart, bladder or lung tissue. And because the bandage is biodegradable, it dissolves over time and does not have to be removed.

The team is led by Dr. Jeff Karp, an instructor of medicine at BWH and Harvard Medical School (HMS), and MIT Institute Professor Robert Langer. Both are also faculty members at the Harvard-MIT Division of Health Sciences and Technology (HST).

"There is a big need for a tape-based medical adhesive," said Karp. For instance, a surgical adhesive tape made from this new material could wrap around and reseal the intestine after the removal of a diseased segment or after a gastric bypass procedure. It could also patch a hole caused by an ulcer. Because it can be folded and unfolded, it has a potential application in minimally invasive surgical procedures that are particularly difficult to suture because they are performed through a very small incision.

Gecko-like dry adhesives have been around since about 2001 but there have been significant challenges to adapt this technology for medical applications given the strict design criteria required. For use in the body, they must be adapted to stick in a wet environment and be constructed from materials customized for medical applications. Such materials must be biocompatible, meaning they do not cause inflammation; biodegradable, meaning they dissolve over time without producing toxins; and elastic, so that they can conform to and stretch with the body's tissues.

The researchers met these requirements by building their medical adhesive with a "biorubber" invented by Karp, Langer and others. Using micropatterning technology--the same technology used to create computer chips--the researchers shaped the biorubber into different hill and valley profiles at nanoscale dimensions. After testing them on intestinal tissue taken from pigs, they selected the stickiest profile, one with pillars spaced just wide enough to grip and interlock with the underlying tissue.

Karp then added a very thin layer of a sugar-based glue, to create a strong bond even to a wet surface. The resulting bandage "is something we never expect to remove," said Karp. Because of that difference, he continued, "we're not mimicking the gecko"--which has sticky feet but can still lift them up to walk--"we are inspired by the gecko to create a patterned interface to enhance the surface area of contact and thus the overall strength of adhesion."

When tested against the intestinal tissue samples from pigs, the nanopatterned adhesive bonds were twice as strong as unpatterned adhesives. In tests of the new adhesive in living rats, the glue-coated nanopatterned adhesive showed over a 100 percent increase in adhesive strength compared to the same material without the glue. Moreover, the rats showed only a mild inflammatory response to the adhesive, a minor reaction that does not need to be overcome for clinical use.

Among other advantages, the adhesive could be infused with drugs designed to release as the biorubber degrades. Further, the elasticity and degradation rate of the biorubber are tunable, as is the pillared landscape. This means that the new adhesives can be customized to have the right elasticity, resilience and grip for different medical applications.

"This is an exciting example of how nanostructures can be controlled, and in so doing, used to create a new family of adhesives," said Langer.

The work was funded by the National Institutes of Health, the Materials Research Science and Engineering Center (MRSEC) program of the National Science Foundation, and the MIT-Portugal program.

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital (BWH) is a 747-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. 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.

Press Release - Feb 18, 2008

Full prescription coverage of heart drugs could help heart attack survivors live longer, better lives and lower the nation’s healthcare costs, according to a new analysis reported in Circulation: Journal of the American Heart Association.

Researchers who conducted the analysis said as many as 50 percent of patients significantly underused highly effective medications to prevent recurrence of heart attacks.  Cost is a major factor in why patients don’t take these medications.

Researchers examined Medicare beneficiaries over age 65 who received usual prescription drug coverage under the Part D program, with substantial cost-sharing, co-payments and out-of-pocket costs compared to full prescription drug coverage.

American College of Cardiology/American Heart Association guidelines recommend heart attack patients receive treatment with a beta-blocker, a statin cholesterol-lowering drug, an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), and aspirin.  A combination of the drugs has reduced coronary heart disease death by 80 percent compared to placebo.  This study examined the cost effectiveness of providing full Medicare coverage for these drugs. 

At present, patients under the Part D program take some combination of beta blockers, ACE inhibitors or ARBs, statins and aspirin.  Some patients take only one of these drugs; others use several, but on average patients are 50 percent adherent, researchers said.

“By reducing financial barriers to highly effective medications, we have the opportunity to not only increase adherence, but also decrease overall healthcare costs,” said Niteesh Choudhry, M.D., Ph.D., lead author of the study and an assistant professor at Harvard Medical School and in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston, Mass.

Researchers used a sophisticated mathematical model to assess the post-heart attack patients, and determine costs, healthcare savings and length and quality of life.

They found that an average cost reduction of $2,500 per Medicare beneficiary would save society $1 billion for the approximately 400,000 Medicare beneficiaries who have a heart attack each year.  The average cost of the drugs is more than $400 per year.

“Patients who adhere to these prescription medications are less likely to have adverse events, such as recurrent heart attacks, strokes, heart failure admissions and death, which cost a lot more than the drugs themselves,” Choudhry said.

In the study, Medicare beneficiaries who received prescription drug coverage under Part D lived an average eight years and two months of Quality Adjusted Life Years (QALYs) after their initial heart attack.  (Quality adjusted life years means that the length of life after a heart attack is adjusted by the quality of life.)  Related medical costs were $114,000. 

Those who received prescription drug coverage without deductibles or co-payments lived an average eight years and five months (QALY) with related medical costs of $111,600.  Thus, full coverage results in greater life expectancy and less use of resources. 

Compared to coverage under Part D, full coverage for preventive therapies would result in greater functional life expectancy of about four months and less resource use of about $2,500.

“The important point is that full prescription drug coverage may saves lives, improve quality of life and cost less money overall,” Choudhry said.

He said that prescription drug costs increase under the full-coverage strategy because more people are using the medications.  But in exchange, healthcare costs, including hospitalizations, procedures and death, decrease.

Choudhry said this model may provide a viable strategy for policy makers to consider and evidence for Medicare to rethink how they structure prescription drug benefits.

“Cost-sharing for prescription drugs may be counter-productive,” he said.  “Sometimes, it does not lead us to reduce the over-utilization of ineffective medications but rather it leads us to under-utilize highly effective medications.”

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital (BWH) is a 747-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. 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.

Press Release - Feb 11, 2008

Chicago, IL – A healthy lifestyle during the early elderly years—including weight management, exercising regularly and not smoking—may be associated with a greater probability of living to age 90 in men, as well as good health and physical function, according to a report in the February 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Studies of twins have found that about one-fourth of the variation in human life span can be attributed to genetics, according to background information in the article. That leaves about 75 percent that could be attributed to modifiable risk factors.

Laurel B. Yates, MD, MPH, of Brigham and Women’s Hospital and colleagues studied a group of 2,357 men who were participants in the Physician’s Health Study. At the beginning of the study, in 1981 to 1984, the men (average age 72) provided information about demographic and health variables, including height, weight, blood pressure and cholesterol levels and how often they exercised. Twice during the first year and then once each following year through 2006, they completed a questionnaire asking about changes in habits, health status or ability to do daily tasks.

A total of 970 men (41 percent) lived to age 90 or older. Several modifiable biological and behavioral factors were associated with survival to this exceptional age. “Smoking, diabetes, obesity and hypertension significantly reduced the likelihood of a 90-year life span, while regular vigorous exercise substantially improved it,” the authors write. “Furthermore, men with a life span of 90 or more years also had better physical function, mental well-being, and self-perceived health in late life compared with men who died at a younger age. Adverse factors associated with reduced longevity—smoking, obesity and sedentary lifestyle—also were significantly associated with poorer functional status in elderly years.”

The researchers estimate that a 70-year-old man who did not smoke and had normal blood pressure and weight, no diabetes and exercised two to four times per week had a 54 percent probability of living to age 90. However, if he had adverse factors, his probability of living to age 90 was reduced to the following amount:

• Sedentary lifestyle, 44 percent
• Hypertension (high blood pressure), 36 percent
• Obesity, 26 percent
• Smoking, 22 percent
• Three factors, such as sedentary lifestyle, obesity and diabetes, 14 percent
• Five factors, 4 percent

For more information, contact BWH Media Relations at (617) 534-1600 or bwhmediarelations@partners.org.

Brigham and Women's Hospital (BWH) is a 747-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. 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.

Press Release - Feb 7, 2008

Dallas, TX - Women face unique risks for developing hypertension and special challenges in keeping their high blood pressure under control, according to new research published in a special themed issue of Hypertension: Journal of the American Heart Association.

The themed issue features more than 45 studies and editorials -  including research by Lu Wang, MD, PhD, of Brigham and Women's Hospital (BWH) - related to women and hypertension.  The publication commemorates the fifth anniversary of the launch of the American Heart Association's Go Red For Women movement, which raises awareness of heart disease risks for women.

"Our goals were to help convey the importance of prevention and treatment of hypertension and cardiovascular disease in women, to emphasize that hypertension is a critical cardiovascular risk factor in women, and to publish the newest and best research related to hypertension in women," said John E. Hall, Ph.D., Hypertension Editor-in-Chief, and Arthur C. Guyton Professor and Chair and Associate Vice Chancellor of Research, University of Mississippi Medical Center, Jackson, Miss. 

Data from the American Heart Association Heart Disease and Stroke Statistics - 2008 Update shows that high blood pressure kills significantly more women than men and is two to three times more common in women who take oral contraceptives than in women who don't.

In his preface to the journal, Hall cited previous studies that show only about 60 percent of hypertensive women are treated, and among those treated, only about a third had their blood pressure controlled at optimum levels.  "Thus, inadequate control of high blood pressure continues to be the most important, and potentially treatable, cause of cardiovascular disease and stroke in women," he said.

"Through Go Red For Women the American Heart Association provides education and resources to help women live heart-healthy lives.  More importantly, our movement puts a face on heart disease - the No. 1 killer of women," said Nieca Goldberg, MD, Go Red For Women spokesperson, author and medical director of the New York University Women's Heart Program.  "Our cause is based on science, such as the studies and perspectives we have gathered in this issue of Hypertension and the ongoing scientific research supported by the American Heart Association.  This research is the foundation for the medical care doctors deliver in their offices.  What we learn from this important body of science could one day save the life of someone's mother, wife, sister or daughter."

 Here are highlights from the themed issue:

Dietary calcium, not supplements, may have a role in preventing hypertension
In a study of 28,886 non-hypertensive American women, age 45 or older, researchers found that the risk of hypertension decreased with a higher intake of low-fat dairy products, dietary calcium and dietary vitamin D; did not change with calcium or vitamin D supplements; and did not change with high-fat dairy product intake. Researchers tracked the intake of dairy products, calcium and vitamin D based on a 131-item food frequency questionnaire and conducted annual follow-up over a 10-year period.  (Nine possible responses ranging from "never or less than once per month" to "6+ per day" were recorded.)  During that time, 8,710 cases of hypertension were identified. 

Contact: Lu Wang, MD, PhD, Brigham and Women's Hospital, Boston, Mass.; (617) 278-0802 or luwang@rics.bwh.harvard.edu.

Hypertension poses numerous risks for pregnancy
In a brief review accompanying several pregnancy-related studies in this issue, researchers note that hypertension is the most common medical disorder of pregnancy, complicating one in 10 pregnancies.  They emphasize the importance of diagnosis in differentiating between pre-existing (chronic) hypertension from pregnancy-induced (gestational) hypertension and preeclampsia.  They also support that pregnant women and those planning to become pregnant should avoid ACE inhibitors and angiotensin receptor blockers. Acceptable alternatives may include methyldopa, labetalol and nifedipine, in standard doses to manage hypertension in pregnancy.

Contact: Tiina Podymow, MD, McGill University Health Center, Montreal, Quebec, Canada; (514) 934-1934 or tiina.podymow@muhc.mcgill.ca.

In a prospective study of 822 women with chronic hypertension, researchers in London identified 180 cases of preeclampsia (22 percent), with early onset preeclampsia accounting for nearly half of those.  Of those women with preeclampsia, nearly half (48 percent) delivered small birthweight babies, while 51 percent of them delivered preterm, compared to 21 percent of women without preeclampsia having smaller babies and 15 percent of those women delivering preterm.  According to the researchers, women with chronic hypertension should take special precautions before getting pregnant, in