Children’s news
June 2006
Happy birthday, Waltham!
Adam Ravenelle
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Robotic surgery steps up to the plate
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hirteen-year-old Adam Ravenelle isn’t one to sit on the couch. The Sudbury, Mass. teen is an athlete,
playing competitive baseball, basketball and soccer, a musician, playing trumpet for his school’s band, and an accomplished student. So, when an undetected UPJ (ureteropelvic junction) obstruction inflated his kidney pelvis to three times its normal size and doubled him over in pain last August, his parents quickly researched the best way to keep him healthy and active. Their research brought them to Children’s Hospital Boston, where urologist Hiep Nguyen, MD, introduced them to the da Vinci Surgical System, also known as “the robot.” By using the robot to reconstruct Adam’s obstructed ureter, Nguyen offered the best of two surgical worlds—the precision of traditional surgery and the quick recovery from a minimally invasive procedure. On November 9, Nguyen sat at the da Vinci console, a few feet away from Adam, where the surgeon viewed a three-dimensional internal image of his patient and maneuvered the system’s three robotic arms. The entire procedure took approximately six hours, comparable to traditional surgery. The continued on page 6
hildren’s Hospital Boston at Waltham celebrates its first birthday this month, and like many babies, it’s grown quite a bit. The ambulatory center at 9 Hope Avenue opened last June with a single clinical floor encompassing 21 subspecialties, including Cardiology, which Julie Kinney and her son, Grant, were happy to take advantage of last September. At Grant’s three-month checkup, his pediatrician heard a slight heart murmur. While he didn’t think it was anything to worry about, he suggested Grant see a cardiologist to get things checked out. He referred Julie to Children’s cardiologist Jonathan Rhodes, MD. When Julie called to make her son’s appointment, she was offered the opportunity to see Rhodes in Waltham and jumped at the chance. “It’s hard enough to travel with a newborn, without having to factor in finding parking, walking on city streets, and so forth,” says Julie. “Waltham was the easier option. It’s right off the Mass Pike and has great signage. We made it in just under an hour from our home in Plainville.” Grant underwent an echocardiogram, which Rhodes found to be normal. He suggested a return visit in six months. After the second visit this February, Grant was determined to be in the clear. And while Julie hopes she won’t be returning to Children’s at Waltham anytime soon, she would absolutely go back should Grant or her other son, Will, experience any additional health concerns. “It’s a beautiful place,” she says. “I just couldn’t get over how nice it was.” Since last June, Children’s at Waltham has grown significantly, adding Genetics and Communication Disorders services to the main building, and Physical and Occupational Therapy to nearby 20 Hope Avenue. A second clinical floor, scheduled to open this July, will have two ORs and a 10-chair infusion therapy center. Two more ORs will be added in the fall, and an 11-bed inpatient unit is scheduled to open in March 2007. So here’s wishing Children’s at Waltham a very happy first birthday! Stay tuned for additional updates as it continues to grow.
For more information, visit: www.childrenshospital.org/waltham.
Inside
Research briefs • Ask me! • New playground • Scout comic strip • Mass. health care reform
Neuroscience Testing herbal remedies Pediatric Academic Societies meeting Children’s presentations
CHAMPS: Phase 2 kicks off
Research briefs
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his year’s Pediatric Academic Societies meeting included nearly 100 presentations from Children’s Hospital Boston. Below are
just a few of the studies presented. For more, visit: www.childrenshospital.org/newsroom.
Injury prevention by zip code
When it comes to childhood injury, not all zip codes are equal, finds a study led by Eric Fleegler, MD, MPH, in Children’s Division of Emergency Medicine. Using 2002 data, Fleegler and colleagues mapped the nearly 200,000 Massachusetts hospital visits for pediatric injury to their zip code of origin. Of 503 zip-code areas, 39 zip codes accounted for 30 percent of all hospital charges for pediatric injury. Fleegler believes the map will help target scant injury-prevention dollars.
Pictured here is a popular Chinese herbal prescription for so-called “wind-related conditions,” including stroke. Patients boil each ingredient for specified amounts of time to make a tea. Sucher estimates that this single prescription contains 250 or more chemical compounds.
ADHD drugs can stunt children’s growth
Stimulants like Ritalin and Adderall have been the mainstay of treatment for attention-deficit hyperactivity disorder (ADHD) for the last 40 years. Now, an analysis of 22 selected trials finds that children on these drugs have slightly restricted growth, averaging about three-quarters of an inch in height for a 10-year-old boy. The researchers, including Children’s Omar Khwaja, MD, and Dean Sarco, MD, in Neurology, suggest close growth monitoring for children taking ADHD drugs.
Stroke and epilepsy: East meets West
hase 2 of CHAMPS (Children’s Hospital Applications Maximizing Patient Safety) is now underway. This next phase will include Nursing Documentation (fall 2006) and Provider Order Entry/ EMAR/Meds Process (winter 2007). All nurses and clinical assistants will be required to attend an instructor-led training session tailored to the specific needs and workflows of their areas. Other users, who will not be documenting in PowerChart (administrative assistants and other clinicians), will have the option of learning about the new features on their own through Web-based training or by attending instructor-led classes, which are now available for sign-up through NetLearning in the CHAMPS curriculum. Introductory PowerChart classes and Web-based training modules (previously known as CHAMPS Results Viewing Training) will continue to be offered through NetLearning. Please continue to check the CHAMPS site, web2.tch.harvard.edu/champs, for project updates and training information.
One year of Ask me!
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sk me!, Children’s Hospital Boston’s family and visitor greeting program, celebrated its one-year anniversary in May with an appreciation event in the Patient Entertainment Center for all participants. Vice President for
Ambulatory and Network Services Mark Marcantano offered words of thanks to the assembled crowd, singling out program creators Greg Fredo, program manager for Adolescent Medicine, Carol Sayles, director of the International Center, and Todd Katzman, administrator for the Department of Surgery, for their hard work in pulling the whole effort together. Attendees enjoyed a delicious spread of sushi, sandwiches and desserts.
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raditional Chinese herbal medicine has been practiced for millennia, yet has rarely been rigorously tested like Western medicine. Nikolaus Sucher, MD, PhD, in Children’s Hospital Boston’s Division of Neuroscience, is one of a handful of U.S. scientists who are probing Chinese herbal medicines at the molecular level, with the hope of someday developing better Western-style treatments for stroke and epilepsy. Focusing on 58 traditional Chinese medicines used to treat stroke, Sucher used a variety of techniques to determine what ingredients they contain—a complicated task, since ingredients can vary and aren’t always detectable by usual laboratory methods. Sucher showed that many herbal formulations are active at molecular targets known to be important in both stroke and epilepsy. Whole formulations often showed more activity than single compounds within them. “My major insight was that you can’t just isolate active compounds into a drug,” Sucher says. “Rather, you have to go with a combination approach.” Chinese herbal formulations contain, on average, six to seven different drugs: a socalled “ruler,” or principal ingredient, directed at a disease’s main cause and symptoms, “minister” drugs directed at underlying causes and their symptoms, “assistants” to target secondary symptoms and counteract side effects of the other drugs and “enablers” to direct the drugs’ action into the right “channels.” But in the United States, combination therapies are uncommon, and the FDA forbids clinical trials of drug combinations except for conditions like cancer and HIV. Sucher’s studies, summarized in the March issue of Epilepsy & Behavior, also found that many compounds act on multiple targets, and bind to those targets only weakly. Qualities like these are typically shunned by U.S. pharmaceutical companies, which favor “magic bullets”—single drugs with single targets to which they bind tightly. But with the drug pipeline running dry, the industry is starting to take a second look at natural products—the source of drugs like aspirin, digitalis and penicillin—in hopes of finding novel compounds. Expanded treatment options, whether single drugs or combinations, would greatly benefit children and adults with epilepsy and stroke.
Gratitudes
Keeping Children’s afloat
Initiated in 2001, Children’s Hospital Boston’s Float Pool is an administrative resource for Ambulatory areas. Extensively trained in clinic flow, operations and customer service, floats work at front desks and administrative offices, assisting when areas are short-staffed, such as when employees are out sick, on vacation, on maternity leave, or at training. Floats can cover a position for half a day or several months. The Float Pool recently began working to accommodate Children’s satellite locations, including Children’s Hospital Boston at Waltham and the Martha Eliot Health Center, when possible.
Martha Eliot Health Center ring the registration desk at Thank you very much for cove onal Service Training. I attend the Ritz Carlton Excepti yesterday so the staff could n the process in the mornthe entire day so you could lear understand that you worked this exceptional teamwork, in the afternoon. Not only is ing, and then cover the desk of providing excellent service. but reinforced the Ritz message appreciated this effort more bers of the MEHC team who I have spoken to many mem than you probably realize. llent collaboration. Thank you again. It was exce Sincerely, Jim Cote ons Director of Ambulatory Operati
Validating an obesity gene
Genes that cause obesity are extremely hard to pin down: obesity likely involves many different genes and numerous outside factors, but a recent study linked obesity with a common variant of a gene called INSIG2. Now, Children’s researchers Helen Lyon, MD, MS, in Genomics and Genetics, and Joel Hirschhorn, MD, PhD, in Genomics, Genetics and Endocrinology, have helped to replicate the finding in five of six large, demographically diverse populations. A surprising 10 percent of the world’s population carries two copies of the INSIG2 variant, making it a good possible starting point for developing obesity treatments.
This letter was sent to (l-r) Izar Garcia, Patricia Timmons and Julianne Castiello, all part of Children’s Hospital Boston’s Ambulatory Services Float Pool.
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Children’s News | June 2006
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90 years of experience
Each spring, Children’s Hospital Boston honors employees and staff who have worked at the hospital for a multiple of five years. The Service Awards recognize the dedicated employees who, each day, contribute to Children’s tradition of excellence in pediatric care, research, training and service to the community. New this year, Children’s News sat down with a few of the 2005 Service Award recipients to find out a little bit about their time at Children’s.
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Paul Williams
Director of Engineering
aul began his 35-year stint at Children’s in the plumbing shop. A pipe fitter by trade, he focused on the heating and cooling aspects of the facility, eventually becoming night shift supervisor, then project manager and today, director of Engineering.
35 years
Through the years, Paul has worked closely with the entire Facility Operations team on
many infrastructure and capital improvement projects, including the Main building, the Enders building expansion, the Karp building and most recently, Main South. “I work with incredible people every day,” says Paul. “They’re all highly energized, and in most cases, the best at what they do. It’s truly wonderful.” But what really keeps Paul going from year to year is the mission of the hospital. “There’s a wonderful culture here that everything we do is ‘for the kids,’” he says. “It’s the energy that fuels this place and reminds us all why it’s such a blessing to work here.” “It’s the little things we do, like jumping in the car at 3 a.m. to shovel snow so families can access the hospital, that make this place so special,” he adds. “It’s very inspiring.”
gram ication Pro tello ohn Cos Augmentative Commun J f the Director o
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5 years
Marguerite David, RN
10 Northwest
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arge has been taking care of Children’s patients and their families for the past 30 years. A level-three nurse, she began her career on the Infant/Toddler and Surgical Intensive Care Unit, then known as Division
24, in the Farley building. The ICU eventually separated with the advent of the Main building, and Marge continued on with her infant/toddler patients. “It’s amazing to think how different things were back then,” she says. “The main entrance to the hospital has even changed three times since I’ve been here.” Through her years at Children’s, Marge co-founded and continues to run a patient and family support group with Rosemary Grant, RN, in Urology. She was also one of the first champions for creating the Center for Families. Today, Marge is piloting a new position on the Surgical Service, which includes 10
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South, 10 Northwest and 8 ennifer spent her first few years at Children’s as the Program Funds coordinator in what was then known as the Community Benefits office. She worked closely with community health programs and the West, acting as a patient/family liaison. “I sit down with families who are being discharged on a given day and ask them questions about their experience
30 years
Children’s Hospital Trust, writing proposals and fundraising. Dedicated to community health but ready for a new challenge, Jennifer transitioned into her current role as Communications manager in 2004,
at Children’s,” she says. “I’m learning volumes about the various issues families have while they’re here. But overall, the feedback has been more positive then negative.” “My heart has always been with the patients and their families,” adds Marge. “So, this role is a perfect fit for me. Not a day goes by that I don’t learn something new here, even though it’s been 30 years. I really feel valued as part of the care team here. There’s great camaraderie and collaboration.”
20 years
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Jennifer Fine
Communications Manager for the Office of Child Advocacy
overseeing the Office of Child Advocacy’s overall communications efforts. From talking to the local press to editing brochure copy, Jennifer does it all with a keen eye toward promoting Children’s community health mission. “I’ve really enjoyed watching our community health efforts grow over the years,” she says. “I’m so proud of how far we’ve come. And it’s been personally very rewarding to go out into the community and see the kids we’re helping with all that we do.”
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Robot continued from page 1
biggest difference was that by 6 p.m. the following day Adam was heading home where he recovered quickly and only missed one day of school. Three weeks later, he was back shooting hoops for the Curtis Cougars. Had he undergone the same procedure using traditional surgery, his recovery would have been three to four times longer. “Making the decision to have major surgery wasn’t easy because Adam had been Hiep Nguyen, MD, practices with the robot. almost completely asymptomatic,” says Adam’s mother, Edie Ravenelle. “In researching our options, we ultimately chose to proceed with the robotically-assisted pyeloplasty so Adam wouldn’t risk future kidney damage or episodes of pain. Adam’s age, the surgery’s success rate and quicker recovery time made robotic surgery a good fit.” “Surgeons are using robots to perform more difficult surgeries than traditional minimally invasive technologies have allowed,” says Nguyen, who was recently named co-director of Robotic Surgery and director of Robotic Research at Children’s. In Urology alone, such procedures include complete and partial kidney removal, uretral reconstruction and correction of undescended testes. A team led by Nguyen and urologist Joseph Borer, MD, the other codirector of Robotic Surgery, are also looking forward to the publication of several papers presented at the annual meeting of the American Urological Association in May, reporting data such as robotic surgery success, narcotic use as it relates to robotic surgery, as well as patients’ return to school, and parents’ return to work following robotic procedures. The first institution in the country to introduce this technology for use in pediatric patients, Children’s specialists have used the robot for procedures in Urology, Cardiology, Otolaryngology and General Surgery, and are developing applications for Neurosurgery and Fetal Surgery. In 2005, Children’s surgeons trained in this technique performed 45 robotic surgeries. Thirty-six procedures have already been performed this year, and Nguyen expects the trend of growth to continue.
Playground gives kids a chance to be kids again
In his own words Joshua Greenberg, Office of Child Advocacy
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hospital stay can be a frightening experience. But a new handicapped-accessible playground— made possible by a $150,000 grant from BJ’s Charitable Foundation, with additional funding from the Louise Crane Foundation—may make stays a bit easier for kids like Isabelle Labbe. Four-year-old Isabelle and her mother, Wendy, recently joined Children’s Hospital Boston and BJ’s leadership at the playground From left , Steven Karp, Isabel le dedication ceremony. Labbe and Michael We dge at the An inpatient for three playground opening. months, Isabelle was transferred to Children’s in January when doctors near her hometown couldn’t diagnose her condition. At Children’s, tests revealed Isabelle had a rare form of vasculitis called Polyarteritis Nodosa, an autoimmune disease that affects the blood vessels that carry oxygenated blood to organs and tissues. For Isabelle, it meant an emergency operation to remove two-thirds of her small intestine. “Children’s has done everything possible to make this an enjoyable experience for our family—from providing emotional support to engaging our daughter in activities that allow her to feel like a kid and take her mind off her medical condition,” Wendy says. A playground can do just that. The colorful new addition of ladders, stairs, climbers, monkey bars and slides also can be used to evaluate patients’ balance and coordination. It can also aid in play therapy, a hallmark of psychiatric services. “The new playground is a welcome tool to advance Children’s healing mission,” says Cynthia Levin, director of the Center for Families. “Play is the way kids experience the world. Deciding where and what to play gives children a sense of power—which is all the more critical when kids are confined to both long and short hospital stays.”
Massachusetts health reform law
What is the new health care law?
It’s landmark legislation reforming the Massachusetts health care system that seeks to provide insurance coverage to nearly all of the 600,000 uninsured residents of the Commonwealth over the next three years. In addition, there are significant pieces of the new law focused on improving quality and controlling costs. Children and young adults make up a significant percentage of the uninsured in Massachusetts. As many of us know first hand, lack of insurance can often lead to delays in accessing care, allow chronic conditions to go untreated, and make follow up care more difficult.
A lot has been written about the law, but the stories have tended to focus on adults. How does it help children?
The new law means that Massachusetts will continue to be a national leader in child health coverage for years to come. The legislature has done a lot to make coverage for children more affordable. The state’s MassHealth [Medicaid] program, for example, provides a safety net for many low income children, but not all Massachusetts children are eligible, as the state law limits how much income a family can have and still qualify for the Medicaid program. The new law, which will take effect in July, expands financial eligibility for the MassHealth program to 300 percent of the federal poverty line—for a family of four, that’s a yearly income of about $60,000. At Children’s Hospital Boston, nearly 30 percent of our patients are covered by Medicaid, and we expect that about 27,000 children will gain coverage and will have access to a comprehensive benefits package. Some of the children will be transitioned directly from the Children’s Medical Security Plan, which is a state-funded program that provides basic preventive care. These recipients will have access to a much more comprehensive package of benefits, including sub-specialist services, diagnostic and ancillary services, prescription drugs and dental coverage. The legislature also recognized the special problem of children “aging out” of coverage when they become young adults. The new law allows parents to keep their children on their family plans until age 25, and creates special insurance products specifically designed for young adults. Finally, the law ultimately requires individuals to purchase “affordable” insurance, although it’s still unclear what “affordable” means or how this requirement applies to family coverage.
How will the new law impact Children’s and our providers?
Joshua Greenberg is the director of State and Federal Relations for Children’s Hospital Boston’s Office of Child Advocacy.
How did Children’s participate in the development and passage of the legislation?
Computer safety tips for the technologically impaired
http://ehelp.tch.harvard.edu
Hopefully, we’ll see fewer uninsured children because more children and young adults will have coverage through Medicaid or their parent’s insurance. The law specifically funds a substantial outreach effort to get eligible people enrolled in available public programs. We’ll need to be ready to answer patient questions and assist with the enrollment process. We do expect to see new forms of health plans emerge that have higher deductibles and increased cost-sharing, but are awaiting the details from the private payors. As the law takes effect, we expect to see additional emphasis on quality reporting and efforts to address disparities in health care. There is also a significant increase in hospital and physician rates budgeted for the MassHealth program over the next three years. However, the law is very comprehensive, very complicated, and is likely to be tweaked, embellished and modified as we go along.
Children’s has been involved since spring 2003, when we proposed the MassHealth coverage expansion that was ultimately adopted, and by the fall were actively engaged in discussions about this phase of health reform with other hospitals, the Massachusetts Medical Society, and community, religious and business groups. We were primarily focused on a number of issues. In addition to financial coverage for children, we wanted to make sure that we didn’t trade comprehensive benefits for expanded coverage. For example, a number of the early conversations on low-cost plans proposed dropping the requirement that they provide mental health coverage, which we vehemently opposed. We also wanted to see some aspect of the legislation address public health or child health issues that don’t fit neatly into an insurance model. In this area, we were thrilled to see funding for diabetes care management, anti-smoking programs and a new pediatric palliative care center included in the bill. We also worked really hard on educating legislators by knocking on doors at the State House. We participated in a broad coalition over many months that pushed for a comprehensive bill. Dr. Mandell [Children’s Caption president and CEO] has spent a lot of time with Massachusetts State House leaders and staff emphasizing our commitment to expanded child health coverage. In the Office of Child Advocacy, we have used our grassroots network, the CAN [Children’s Advocacy Network], to engage our own internal community in direct advocacy on key child health concerns. It has been a long haul, but we are thrilled with the outcome.
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National Cancer Survivor Week
June 12 to 16
It happened in May
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hildren’s Hospital Boston’s employees were excited to hear about the newly increased MBTA pass subsidy. The hospital will fund 50 percent beginning this July. Children’s also offers free shuttle
Join Children’s Hospital Boston and Dana-Farber Cancer Institute for this week-long celebration of childhood cancer survivorship. Call (800) 883-6012 for a schedule of events.
services for North Shore and Back Bay commuter railers, as well as Longwood Express shuttles to Ruggles and JFK at no cost to Children’s employees. Call ext. 5-6251 or stop by the Parking and Commuter Services Office for more information. In fiscal year 2005, 740 volunteers contributed 64,873 hours of service to Children’s Hospital Boston, many of whom were honored at the Annual Volunteer Recognition Dinner (left) on May 11 at the Inn at Longwood. One hundred twenty-five volunteers, staff and guests celebrated as 26 volunteers, who have served at Children’s for a multiple of five years, received awards. Chris Pappas and Fred Feldmesser were also honored for 25 years of service, and Scott Freedland and Jack Stuart for 20 years of service. The 8th Annual Bob Groden Distinguished Service Award was presented to Stephen Griffin. And seven Customer Service Awards were also presented to volunteers in the Surgical Liaison Program. On May 22, Children’s partnered with the Martha Eliot Health Center, ABCD Head Start, BuckleUpBoston!, Boston Police Department, Massachusetts Minority State Police Officers’ Association and HOPE Talent Search Program to hold a car seat safety clinic in Jamaica Plain (right). Technicians spent four hours checking and properly fitting over 60 seats. In celebration of World Asthma Day (left), Children’s hosted a Community Health Fair on May 10 in the PEC. The afternoon combined activities that informed and entertained kids with asthma and their families. Children’s nurses, the American Lung Association, the Environmental Protection Agency and the Allergy Foundation provided information and interactive demonstrations on relevant medications and delivery devices. Community Asthma Programs Manager Amy Burack, RN, MA, AE-C, and Pamela Kelly, PNP, from Children’s Healthy Link Asthma Program, co-chaired the event.
Lace up your sneakers for miracles
It’s not too late to participate in Miles for Miracles, the 7- and 2-mile pledge walks for Children’s Hospital Boston. The event is Sunday, June 11, at the Charles River Hatch Shell, and walk-up participants are welcome. The 7-mile walk begins at 10 a.m., the 2-mile at 11 a.m. All walkers are asked to raise $100 to benefit the hospital. For more information, visit: www.childrenshospital.org/walk.
Employee appreciation ice cream event
This year’s celebration is a birthday bash, celebrating 137 years of Children’s Hospital Boston. Wednesday, July 19, Main Lobby Day event: 12:30 to 2:30 p.m. Night event: 10:30 p.m. to midnight Everybody’s celebrating— all Children’s locations will host ice cream parties within a few days of our main campus event. Watch Children’s intranet homepage for the exact dates.
Join the Band(it) Wagon to help kids
Become a Mix 98-5 Change Bandit— pledge to raise money for Children’s Hospital Boston by “robbing” family and friends of spare change. The bandit with the biggest take wins a 7-day stay for two in Aruba. Sign up by emailing your name, address and phone to changebandits@chtrust.org or call Jocelyn Fary at (617) 355-1997. For more information, visit: www. childrenshospital.org/changebandits. Tune in to the Mix 98-5 Radiothon, July 12 and 14, to hear how your donations benefit Children’s.
Editor: Anna Gonski Designers: Patrick Bibbins, Javier Amador-Peña Contributors: Nancy Fliesler, Julie Kinney, Nicole Palovich, Rachel Pugh
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More News online at www.childrenshospital.org/chnews © 2006, Children’s Hospital Boston. All rights reserved.
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Email: news@childrens.harvard. edu or call (617) 355-6420.