Children’s news
October 2006
ome of Jacky Cortes’s most poignant childhood memories growing up in Mission Hill include frantic trips to Children’s Hospital Boston. All too frequently, her mother, Maria, would come home from work and rush Cortes, coughing and wheezing from an asthma flare-up, to Children’s Emergency Department. Cortes remembers how the crying children and the sights and sounds of medical equipment frightened her. “The nebulizer treatments were scary,” Cortes says of the medical device that emits a fine mist that a child inhales to help open the airways. “But the nurses always stood out. I remember their smiles and how hen he steps onto the they talked me through my breathing.” baseball field, Red Sox It was then that Cortes first had the dream captain Jason Varitek of becoming a pediatric nurse to help children becomes a hero to countless and their families manage asthma and other children throughout New England. pulmonary diseases. Her dream came true in But for many patients at Children’s 1994, when she graduated from Boston ColHospital Boston, he’s even more of lege with a degree in Nursing and soon after a hero when he steps into their hosjoined Children’s as one of the hospital’s few pital rooms. As part of Tek’s 33s, the Latina RNs. charity he started in 2004 with his Cortes has worked as a nurse here ever wife, Karen, Varitek visits Children’s since, first on the school-age medical floor several times a year, taking pictures and today in the Pulmonary Clinic, where with patients and signing autoshe cares for patients suffering from asthma, graphs. And a few lucky kids even tuberculosis, cystic fibrosis, pneumonia and get to go to a Sox game with tickets other pulmonary diseases. “Now, I see myself Varitek sets aside just for Children’s when I see my patients, because I was one of patients and their families. them. I remember how it felt to have trouble One such patient is William Johnbreathing, and I say to myself, ‘I’m going son, a 7-year-old from Medfield, to get these children better.’” Mass., who is treated here for While Cortes can put smiles on Spinal Muscular Atrophy (SMA). children’s faces with ease, her road SMA, which affects one in 6,000 to Children’s was anything but easy. children, causes the muscles to Growing up in the housing degenerate and means William projects of Mission Hill during the has to use a specially designed crime-ridden 1980s, Cortes and wheelchair. Thanks to Tek’s her family were exposed to gangs, 33s, William attended the violence and illegal drugs on a daily September 9 Red Sox game. basis. She attributes the fact that she Along with a group of other didn’t get involved in those things patients, William watched to her parents, Ramon and Maria, batting practice and asked both of whom are of Puerto Rican the big-league catcher descent. “Their discipline and dedica-
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Jacky Cortes’s journey from patient to RN
Teaming up for SMA
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tion brought us to where we are today,” Cortes says of herself and her siblings. “They taught us to make the right choices and showed us what could happen if we headed in the wrong direction.” Despite how tired her parents were when they got home from work, their children’s academics and health always came first. Ramon and Maria always made time to help them with their homework and, of course, to take young Cortes to Children’s whenever necessary. Since her asthma made playing sports difficult, Cortes spent long hours reading books at the library instead, and she remembers being frequently teased by the neighborhood kids for her studious habits. “There was a lot of negativity. People looked at my family and would say, ‘Those kids will be lucky if they make it out of high school, let alone college,’” she recalls. “The more I heard it, the harder I pushed myself—not to prove it to them, but to prove it to myself,” she says. “I didn’t want to be a statistic.” Instead of becoming a statistic, Cortes has become a role model—to her 2-year-old daughter, Jayline, to patients with asthma and their families, and to the local Latino community. “Never give up on what you want in life,” she says. “If there’s something nobody can take away from you, it’s your faith in yourself. Hold onto that, and you’ll be amazed how far you’ll go.”
some questions.
continued on page 7
Jacky Cortes examines a patient with asthma and cystic fibrosis.
Inside
CHAMPS’ new technology • Benefits get even better • Latino heritage celebrations
Informatics September 11, airplanes and the flu Neurobiology Nitric oxide gas makes us sleepy
It takes a team
Flu control: a public health lesson
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An all-nighter drug?
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Benefits get a boost
he staff of Children’s Hospital Boston’s Neonatal Intensive Care Unit (NICU) celebrated the success of a new departmental plan designed to reduce the
ir travel restrictions after the attacks of September 11, 2001, may have had an unexpected healthful effect: They slowed the spread of flu, delaying the 20012002 U.S. flu season by nearly two weeks. An analysis by John Brownstein, PhD, and Ken Mandl MD, MPH, of the Children’s Hospital Informatics Program, suggests that limiting air travel could buy critical time during a flu pandemic. “For the first time, we’ve been able to show that airlines help spread the flu, and that you can impact its spread by slowing down air travel,” Brownstein says. While other researchers have used simulation to study air travel’s effect on flu, Brownstein and Mandl used real data from the Centers for Disease Control and Prevention. Analyzing nine consecutive flu seasons beginning with 1996–1997, they found that flu consistently peaked on or around February 17 during the first five seasons. But in 2001–2002, it didn’t peak until March 2. In the following years, the peaks occurred in the usual February time frame. “At first we thought there was a problem with the data,” says Mandl. “But then we realized we were seeing the shadow of September 11 cast upon the influenza season.” During the 2001–2002 flu season, it took 53 days for flu to spread across the United States, compared with the usual 33-day average, the researchers found. In contrast, in France, where flight restrictions were not imposed, there was no post-September 11 delay in flu activity. Brownstein and Mandl also showed that domestic airline volume during November is an especially strong predictor of how flu spreads, confirming suspicions that Thanksgiving travel helps spread new flu strains across the country. For international flights, passenger volume in September was the strongest predictor of flu spread, suggesting that September is when foreign flu strains are introduced to the United States. Given fears about bird flu, both the U.S. government and the World Health Organization are now considering flight restrictions should we have a flu pandemic. The researchers hope their findings, published September 12 in the online journal PLoS Medicine, will influence their decisions.
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number of catheter-related bloodstream infections among NICU babies. The plan was a joint effort by the Cardiovascular and Critical Care Programs, and their teamwork paid off: Before the plan was put into action, the average length of time between catheter-related blood stream infections in the NICU was seven days. After implementing various practice changes, they reached an unprecedented 171 days. Kudos to the team!
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Air travel and the flu
eople who need to stay awake—soldiers, pilots, truckers, students, doctors, parents of newborns—might someday benefit from drugs that prevent nitric oxide gas from building up in the brain. Research conducted jointly at Children’s Hospital Boston and the University of Helsinki in Finland finds that accumulation of nitric oxide, which is produced naturally in the basal forebrain, is both necessary and sufficient to produce sleep. “This new understanding might provide a basis for completely new drugs to prevent excessive sleepiness or to promote sleep,” says Paul Rosenberg, MD, PhD, a researcher in the Neurobiology Program at Children’s who also sees patients at the hospital’s Center for Pediatric Sleep Disorders. Rosenberg and his Finnish collaborators found that nitric oxide production in the basal forebrain increased by 50 to 150 percent in rats that were mildly sleepdeprived. When agents inhibiting nitric oxide production were injected into their basal forebrains, the rats were able to stay awake. The same was true when the researchers injected a compound that removed nitric oxide from their brains. On the flip side, when rats on a normal sleep-wake cycle received an agent that boosts nitric oxide levels, the rats fell into a sleep much like the “recovery” sleep that occurs after prolonged wakefulness. The results tie in with previous research showing that adenosine accumulation in the brain triggers sleep. In 2000, Rosenberg showed that nitric oxide stimulates adenosine’s release. The new studies revealed that nitric oxide inhibitors also prevent adenosine accumulation, while agents boosting nitric oxide production also boost adenosine levels. The findings appeared in the August 18 issue of the Journal of Neurochemistry and the September 5 issue of the European Journal of Neuroscience.
uman Resources has announced an array of employee benefits improvements, effective in 2007. Eligible employees will see an increase in the percentage the hospital subsidizes for medical, dental and short-term disability, as well as the addition of three new voluntary insurances: Whole Life, Critical Illness and Accident. Learn all the details at the Employee Benefits Fair on October 11 at the Longwood Galleria, and make your benefits changes during open enrollment—October 23 to November 10.
Latino heritage celebrations
In celebration of Latino Heritage month, which runs through October 15, Children’s Hosptial Boston employees, patients and families can experience the sounds, tastes and traditions of Latino culture. Each day of the week of October 3, dining services will prepare cuisine from a different Latin country. On October 4, cafeteria patrons will be treated to the sounds of Inca Son, a Peruvian-Andean group that specializes in the centuries-old music of the Andes. The celebration culminates October 9 with a performance by the youth dance troupe Fuerza Internacional in the Patient Entertainment Center at 2 p.m.
Inca Son will perform as part of Children’s celebrations.
ic Affairs The following letter was sent to Publ family, whose son, William, from the King James underwent a surgical procedure by of Children’s Mandell, MD, president and CEO Hospital Boston, on August 24. how much My husband and I want to say William King was given we appreciate the care that overnight to our son, William, during his or I think the most heartfelt, caring doct stay. Dr. James Mandell is ner. And the a wonderful bedside man I have ever met, and he has iam. took such special care of Will nursing staff on 10 South what really touched our hearts was One thing in particular that e a call to the iam’s stay. He mad happened on the night of Will hopes of getting aunt works, around 2 a.m., in cafeteria, where his to apologized, saying on William spoke a blueberry muffin. The pers could have one for any muffins, but that William that there weren’t intment in William’s heard the disappo breakfast. I guess the person freshly baked bluehour later, they delivered 40 voice, because an ch truly made my son happy. berry muffins to his room, whi took care of my son. Thanks again to everyone who Sincerely, Lisa and Paul King
Gratitudes
Looking for the Good (muffin) Samaritan!
The identity of the staff person who brought the blueberry muffins remains a mystery. William can’t remember the details about the muffin delivery because of the medication he was taking, and the Food Services staff is baffled. Shawn Goldrick, director of Food Services, says, “Nobody works in the cafeteria at 2 a.m., so we just don’t know who it was. But we’d love to find this person and celebrate this act of kindness.”
Have research news you would like to share?
In recent years, flu has tended to peak around February 17 (blue line). But international flight volume (in red) plummeted after the 9/11 attacks, delaying the peak until March 2.
Email nancy.fliesler@childrens.harvard.edu or call ext. 5-2426.
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Children’s News | October 2006
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Medicine in the digital age
New technologies help take patient care to the next level at Children’s
Handheld devices
These devices will be used to scan the new barcoded wristbands that will identify each patient and contain all medical information. The hand-held lets the nurse know which medications the patient is scheduled to receive. The nurse then scans the barcoded medication, verifying that it matches the order for that child. At the same time, the device checks the patient’s records for possible drug interactions and allergies. Finally, the hand-held records the fact that the patient has taken the medication and sends that information into the patient’s online records, thereby significantly reducing the risk of double-dosing.
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or the past several months, the people rolling out Children’s Hospital Applications Maximizing Patient Safety (CHAMPS) have been busy implementing new computer systems to improve and enhance the safety of patient care. The initiative incorporates a host of new technologies that
clinicians use to access and update patients’ electronic records. Early next year, clinicians will be able to place orders for all medications and tests electronically. In addition, electronic documentation of medication administration will happen right at the patient’s bedside. Daniel Nigrin, MD, MPH, chief information officer and co-executive sponsor of the project, explains, “It makes access to important data more reliable and less prone to errors of handwriting interpretation. It also allows more than one clinician to review the data at a time and to access it remotely. These steps in particular will make patient care safer at Children’s.” Below is a round-up of the new devices that are helping Children’s Hospital Boston caregivers improve the quality and safety of a child’s stay.
Clinical workstations
Nurses and clinical assistants can now use one of more than 200 new clinical workstations, many of which are mounted on mobile carts. They’re totally wireless so the nurse can wheel the computer right up to the patient’s bed, bring up her records and enter her vital signs, sending them to the patient’s electronic records. This process completely replaces the paper flowsheets that were in use. At right, Clinical Assistant Dorine Brown demonstrates how to use the new tablet.
Tablets
The new tablets, which will primarily be used for entering vitals and weights and documenting other patient information into the medical record, are lightweight, wireless computers that can function either as a handheld laptop or, with a flip and a twist, a clipboard-shaped device. In clipboard mode (above), the clinician can write directly onto the screen with a special pen, and the tablet recognizes its user’s handwriting.
Bedside monitors
Electronically linking bedside monitors already in use to the new online medical records is a big part of this effort. These monitors will automatically keep track of the patient’s vital signs, which are then downloaded into the electronic medical record. In this way, caregivers can quickly access each patient’s most accurate, up-to-the-minute medical information.
“CHAMPS will make it much easier to achieve the continuity of care that we’ve always tried to achieve for our patients who may see many clinicians in several settings over a long period of time.” —Beth Berkowitz, RN, and a member of the CHAMPS Clinical Leader Group
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Children’s News | October 2006
www.childrenshospital.org
Finding his niche in nursing
In her own words Mary Place
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hen Patrick Galette, a recent graduate of Brighton High School, started working at Children’s Hospital Boston in July, it was supposed to be just a job—a way to make some summertime spending money. It turned out to be a lifechanging experience. “Before the internship, I had wanted to go to school to become a computer engineer,” Patrick says. “But working at the hospital opened my eyes to nursing.” Patrick, who is from Mattapan, Mass., was one of 36 teens who came to Children’s as part of the Summer Jobs Program for Local Youth, which was created to help Boston youth spend the summer months productively while exploring health-related careers. For seven weeks, the participants, aged 15 to 19, worked side-byside with Children’s employees at what was, for many, their first jobs. Coordinator Brian Hughes from Human Resources and Heather Marban, an intern in HR, put together a series of seminars for the teens on topics, such as How to Create a Resume and Professional Etiquette. “It gave them a broader perspective on how to conduct themselves in a professional atmosphere,” says Hughes. Patrick, in particular, got a lot out of the seminars. “My favorite one was when a nurse explained how she gets to interact with all the patients that come into her part of the hospital,” says Patrick. “I hadn’t known there were male nurses at all.” In his role in the Public Affairs office, Patrick made himself indispensable. Christine Powers-Perry, executive assistant to Vice President of Public Affairs and Marketing, got him involved in every area of the department, from
A grateful mom tells her son’s story
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Patrick Galette at work in Children’s Department of Public Affairs and Marketing.
the Web team to graphic design. “I also worked with the media team, going to the hospital with news crews to interview patients—and I even met Jason Varitek,” Patrick says. Public Affairs appreciated him so much they threw an 18th birthday party for him in August. Powers-Perry spoke at an end-of-summer ice cream party for the interns, saying, “The program is an exciting addition to the hospital, and I think I learned as much as Patrick did. I grew up in Boston, and the fact that the hospital is putting this much effort into helping the city’s neighborhoods is so meaningful.” Plans are already underway for next summer’s program. “It’s a much bigger initiative next year,” Hughes says, estimating
that the hospital will be accepting 100 or more interns. If Patrick’s experience is any indication, the program will continue to have a huge impact on the teens. He plans to continue working with the hospital through the Student Career Opportunity Outreach Program (SCOOP), which lets students speak with nurses, tour the hospital and even watch a live surgery. Patrick also decided to head back to school to study nursing at Bunker Hill Community College in the spring, and he plans to transfer to Northeastern University to finish his nursing degree. He says, “This internship changed everything that I had planned for my future—I was surprised!”
ello. My name is Mary Place, and I wanted to share my 10-year-old son Jeffrey’s story. Last January, my husband and I received the shocking news that Jeffrey had a brain tumor. We never expected that our child, who had seemed perfectly healthy his whole life, would ever face such a challenge. It started during the holidays when Jeffery had flu-like symptoms, including fatigue, headache, upset stomach and vomiting. Our pediatrician in Connecticut ran multiple tests, and we learned that there was fluid on Jeffrey’s brain—a condition called “morbid hydrocephalus.” At that moment, our whole world just seemed to fall apart. Jeffrey needed immediate surgery to get rid of this fluid, and since transporting him was dangerous—he was at risk of having a seizure or stroke—he had the operation at our local hospital. The surgery revealed that Jeffrey had a benign brain tumor that was blocking the drainage of spinal fluid through his spinal column. After they removed the tumor, several complications arose and another surgery was required to implant a shunt that would drain the fluid properly. Then he had another operation because the drain wasn’t working. That’s when we learned that Jeffrey would need yet another surgery to address his hematoma—a dangerous gathering of blood on the brain. In March, we transferred Jeffrey’s care to Liliana Goumnerova, MD, a neurosurgeon at Children’s Hospital Boston, who specializes in the management of pediatric brain tumors. Dr. Goumnerova met with us and thoroughly evaluated Jeffrey. She was extremely kind, and involved Jeffrey in our discussions about his condition. She carefully explained the challenges of his case but was confident she could correct
Jeffrey’s many complications. We were admitted the following morning and stayed for 19 days. The Neurosurgery Department’s staff immediately put us at ease and became a strong support system for us. After Jeffrey’s first procedure on the shunt, Dr. Goumnerova performed a surgery to create an actual drain in the center of Jeffrey’s brain. This was a huge success because it meant that Jeffrey wouldn’t need a permanent artificial shunt, which would have been prone to infections. We were amazed how she performed this intricate surgery, in such a critical area, without any complications. After this success, Dr. Goumnerova corrected Jeffrey’s hemtatoma with one last OR visit. My husband and I are overjoyed by the outcome and have tears in our eyes every time we see Dr. Goumnerova. We were so blessed to have our child in her care. And the care we received didn’t end there, as we met many other caregivers through the multidisciplinary neuro-oncology team offered through Children’s and the Dana-Farber Cancer Institute (DFCI). In particular, our oncologist, Christopher Turner, MD, regularly met with us, guiding us through our fear, while educating us on our future. We felt like we’d gained a strong advocate for our son. We were pleased to learn that Dr. Turner is affiliated with the Jimmy Fund Clinic at DFCI, where Jeffrey’s recuperation and health will be monitored closely in the months and years to come. The nurses on the Neurosurgery Unit were fantastic, as everyone took a special interest in each child. When Jeffrey was finally up and about after operation, there was a wave or smile for him at every turn. There were clearly very difficult patient cases on our floor and I was impressed by the nurses’ ability to successfully manage their many challenges with ease.
Photo: Randy H. Goodman
The Place family, with Jeffrey in the middle, and Dr. Goumnerova
We eventually returned to Connecticut with a much more optimistic outlook about our son’s future. Although 5 percent of his tumor remains, Jeffrey’s team doesn’t recommend radiation or chemotherapy at this point. We have regular MRIs at Children’s to monitor the tumor, as well as a small spot on his spine. If that tissue grows, we’re confident we have the right team to deal with it. Jeffery is doing great. He’s back in fifth grade and has resumed an aggressive schedule of physical, occupational and speech therapy sessions. He’s regained his strength and weight—13 pounds since leaving the hospital. And although we’re avoiding contact sports for the time being, Jeffery’s back to playing baseball.
Computer safety tips for the technologically impaired
http://ehelp.tch.harvard.edu/security
Teaming up continued from page 1
William is a huge fan of the Sox—and, as it turns out, the Sox are fans of his, too. A year ago, the Johnsons’ home wasn’t equipped for William’s wheelchair, so in stepped the Sox—and ABC’s show Extreme Home Makeover, which helps build homes for families facing unique challenges. Last October, Varitek, along with Curt Schilling, Kevin Millar and Doug Mirabelli, pitched in to make the Johnsons’ home completely wheelchair-accessible. Most of the players weren’t able to attend the home unveiling ceremony, and William has always wanted to thank Varitek for the work he put into his house—and for the set of catcher’s gear that adorns the Johnsons’ living room wall. October is National Cyber Security Month. Scout says bone up on cyber safety at www.staysafeonline.info. On September 9, William finally got his chance. When Varitek saw William before the game, he said, “Hi! I remember you!” And William, beaming, presented Varitek with a hand-made, construction paper thank-you note. William says, “Mr. Varitek signed a ball and glove for me. He’s a really nice guy—and he’s tall.” Varitek is a big supporter of Children’s. On September 7, he hosted the Jason Varitek Celebrity Putt-Putt, a miniature golf tournament that raises money for charities. As a result of the tournament, the Children’s Hospital Trust will get a check for $25,000.
Children’s News | October 2006
www.childrenshospital.org
This month’s
It all happened at Children’s Hospital Boston!
Hot off the presses… Three publications have just hit the stands at Children’s Hospital Boston. The Fall edition of Dream magazine features a cover story on Richard Ferber, M.D., Children’s resident sleep expert. Dream is available in the magazine racks throughout Children’s and at www.childrenshospital.org/dream. Making its debut this month is the new nursing newsletter, Children’s Hospital Boston Nurses: Dedicated to Excellence. The bi-monthly publication, produced by the Nursing and Public Affairs departments, is available in nursing units and on the internal Web site. Finally, the Office of Child Advocacy released Children’s first community brochure—Healthy Children. Healthy Communities—to promote the hospital’s efforts to make the city a safer, healthier place. The brochure is Children’s first publication available in English, Spanish and Haitian Creole. Copies are available at www.childrenshospital.org/communitybrochure. Calling MEHC employees… On October 2, the Martha Eliot Health Center (MEHC) phone system was integrated into the Children’s Hospital Boston’s system. You can now reach MEHC employees by dialing a five-digit, direct-dial extension. To call MEHC from Boston, dial 721-xxxx. To call Boston from MEHC, dial 705-xxxx. All MEHC employees will be listed in Children’s phone directory. Costco supports Children’s… As part of its commitment to Children’s Miracle Network hospitals, Costco recently raised money to support Children’s. During a month-long campaign, Costco employees at six local branches raised more than $97,000. The Everett branch raised nearly $40,000, becoming one of the leading fundraising stores nationally. On September 19, Costco representatives came to Children’s to present a check to Sandra Fenwick, COO. Children’s champ… The August 11 edition of The Boston Business Journal featured a supplement, Champions in Health Care, celebrating the top medical minds throughout Greater Boston. Children’s COO, Sandra Fenwick, was chosen as an administrator champion for the work she’s done in bringing the hospital back from tough financial times.
Upcoming events
Open meetings
The next round of hospital-wide open meetings will be held on Tuesday, Oct. 24, at noon and again at 3:30 p.m. in the Enders Auditorium. James Mandell, MD, president and CEO, and Sandra Fenwick, COO, will both speak, as will Charles Weinstein, vice president of Real Estate Planning and Development, who will give building and real estate updates. The meetings will also be available via Breeze Webcast for staff and employees at satellite locations.
Say “Thanks!”
When you go to the cafeteria the first week of October, be sure to thank the person serving you. It’s national Food Service Workers week, and the hospital’s food service team will celebrate with all sorts of internal contests, including an Iron Chef competition and new, blue uniforms for Food Service employees.
What a week
October 15 to 21 is national HealthCare Quality Week as well as Infection Control Week. Check the intranet for updates on hospital-wide events that will take place for both staff and patients. Free flu vaccinations will be offered to employees this week, too.
Asthma campaign kick-off
Children’s is about to launch its Kids with Asthma Can campaign, bringing positive messages about asthma to children in neighborhoods with the highest asthma rates. The campaign launches October 4 with a kick-off event at the Orchard Gardens School in Jamaica Plain. See the intranet and the next issue of Children’s News for more information on the campaign.
Kisses and hugs… The Hershey’s Kissmobile team is a determined lot. Bad directions and an unexpected detour (the giant Kissmobile couldn’t clear a tunnel) couldn’t keep Hershey’s Chocolate Ambassadors from making it to Children’s September 6. Kissy the human Hershey’s Kiss met dozens of patients and posed for Polaroids with the children before continuing his tour of North American hospitals.
Editor: Erin Graham Designers: Javier Amador-Peña, Patrick Bibbins Contributors: Jackie Biederman, Andrea Duggan, Nancy Fliesler, James Newton, April Roneau and Nikki Shimshock
Department of Public Affairs and Marketing Children’s Hospital Boston 21 Autumn St., 2nd Floor Boston, MA 02115 (617) 355-6420
VP of Public Affairs and Marketing: Michelle Davis Director of Public Affairs: Bess Andrews Manager of Public Affairs: Matthew Cyr
More News online at www.childrenshospital.org/chnews © 2006, Children’s Hospital Boston. All rights reserved.
Do you have news?
Email: news@childrens.harvard.edu or call (617) 355-6420.
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