Tufts Medical Center News August 2007

Tufts Medical Center News Headlines

August 2007

The following headline stories are re-printed from the Tufts Medical Center News, Tufts Medical Center's weekly publication.

Floating Hospital Celebrates the Arrival of New Pediatrician-in-Chief

Floating Hospital for Children celebrated the arrival of John Schreiber, MD, MPH, new Pediatrician-in-Chief and Chief Administrative Officer at an all-employee welcome party on Tuesday, July 24. During the celebration Kevin Petit, MD, was honored for his work as Interim Pediatrician-in-Chief. Petit served in this role beginning October 2005; he will continue to work as Vice Chair for Clinical Affairs in the Department of Pediatrics.

Michael H. Entrup, MD, Named Tufts Medical Center’s Anesthesiologist-in-Chief

Michael H. Entrup, MD, has been named Tufts Medical Center’s Anesthesiologist-in-Chief and Chair of Tufts University School of Medicine’s Department of Anesthesia.   Entrup will also play a lead role in managing surgical services.  He joins the Medical Center from the Lahey Clinic where he served as Chair of the Department of Anesthesiology, Perioperative Medicine and Pain Management.  He will succeed W. Heinrich Wurm, MD, who is leaving his position after more than 16 years of dedicated service as Anesthesiologist-in-Chief.

Entrup is a graduate of the University of Medicine and Dentistry at New Jersey Medical School and completed his postgraduate training in anesthesia and pediatric anesthesia here at the Medical Center. He also completed a fellowship in cardiovascular anesthesia at Baylor College of Medicine in Houston, Texas.  Nationally known in the field of anesthesiology, Entrup is a member of numerous professional societies, including past President of the Massachusetts Society of Anesthesiologists and a member of the Board of Directors of the American Society of Anesthesiologists (ASA), where he also serves as Chair of the Committee on Communications.  Board certified in anesthesiology, his clinical specialties include cardiac anesthesia, liver transplant anesthesia, operating room management and transfusion medicine. 

“I am very excited to be returning to the Medical Center. I completed my residency at Tufts Medical Center and have always considered it home,” said Entrup. “I look forward to working closely with the wonderful staff members from the Department of Anesthesia as well as my colleagues throughout the Medical Center and Tufts University School of Medicine.”

“Please join us in congratulating Dr. Entrup on his new position and extend to him the support he will need as he undertakes this important role in our Medical Center and Medical School communities,” said Ellen Zane, President and Chief Executive Officer of Tufts Medical Center and Floating Hospital for Children. “We are fortunate that Dr. Wurm will continue his work at Tufts Medical Center as a skilled clinician and teacher. We extend our heartfelt and deep appreciation for his many contributions and years of dedicated service to the Medical Center.”

Tufts Medical Center Researchers Find Link Between Low Cholesterol Levels and Cancer

Millions of Americans take statins to lower their cholesterol, but how low is considered too low?  Many scientific studies support the benefits of lowering low density lipoprotein (LDL) cholesterol and believe achieving low LDL cholesterol levels is one of the most important steps in preventing heart disease.  New research, however, provides evidence for an association between low LDL levels and cancer risk. 

A Tufts Medical Center study, published in the July 31st issue of the Journal of the American College of Cardiology (JACC), investigated how and why statins cause side effects, particularly damage to the liver and muscle cells. The key message of the study supports taking multiple medications rather than high-dose statins to minimize those side effects.  The researchers did not expect to find the increased cancer risk (one additional incident per 1,000 patients) from low LDL levels, and additional studies have already begun to investigate this potential risk further.  Future studies will aim to confirm the risk and to identify whether the risk may be a side effect of statins or just low LDL.

 “This analysis doesn’t implicate the statin in increasing the risk of cancer,” said Richard H. Karas, MD, PhD, FACC, lead author and Director of Tufts Medical Center’s Preventive Cardiology Center.  “The demonstrated benefits of statins in lowering the risk of heart disease remain clear; however, certain aspects of lowering LDL with statins remain controversial and merit further research.”  Dr. Karas emphasized that patients are advised to continue their statin treatments and, as always, consult their doctor before discontinuing use of any medication.

The researchers evaluated randomized controlled statin trials published before November 2005. They looked at 13 treatment arms consisting of 41,173 patients and assessed absolute change and percentage of change in LDL reduction and the resulting achieved LDL levels in relation to rates of newly diagnosed cancer in each treatment arm. They also looked at the relationship between low, intermediate and high doses of statins and rates of newly diagnosed cancer. They did not find a relationship between percent of change and absolute change in LDL levels, but they observed higher rates of newly diagnosed cancer among patients with lower achieved LDL levels.  In addition, the new cancers were not of any specific type or location.

Recent data from large-scale statin trials have shown that more intensive LDL lowering can provide significant cardiovascular benefits to higher-risk patients. In response to these findings, recent national guidelines have advocated for lower LDL goals and higher doses of statins to reach them. However, informal observations linking intensive LDL lowering and higher incidence of reported health problems (including liver and muscle toxicity and cancer) has introduced some concern over the safety of such treatments.  These concerns, in part, prompted the current study. 

The current findings are not definitive, as limitations of the study show. Researchers performed their analysis from summary data taken directly from published manuscripts of each trial. An analysis based on data for each individual patient would have yielded more specific and potentially more compelling results, said Dr. Karas. 

For this portion of the study, researchers analyzed 23 statin treatment arms that included 75,317 patients with a combined 309,506 years of follow up. A link between LDL lowering and liver or muscle irritation was not found. However, liver toxicity levels increased with higher statin dosage. Based on their findings, Tufts Medical Center researchers concluded that moderate-dose therapy with multiple medications including statins may prove to be preferable to high-dose therapy with statins alone.

“As we’ve seen in treating high blood pressure, using combinations of multiple medications at moderate doses may also prove to be the best approach to lowering bad cholesterol,” said Dr. Karas.  “Our study focused on better understanding the risks associated with statin treatment so that we can better weigh them against the benefits to give our patients the best care possible. As such, the current findings do not diminish the importance of taking statins to lower heart attack risk.” 

Teenagers need their parents to provide “unconditional positive regard,” coupled with negotiated limits and a requirement that teens face consequences for their decisions. This was the message that John Kulig, MD, director of Floating Hospital for Children’s Adolescent Medicine Clinic, gave a standing-room only crowd of more than 35 employees at a  “Lunch and Learn” brown bag lecture on Thursday, July 19th.

In Surviving Adolescence: How to Talk to Your Teen, How to Get Them to Listen, Kulig advised parents that “appropriate limit setting and appropriate expectations are important all along the way,” but are especially important for teens.

“Puberty lasts about four years, starting anywhere from age 9 to age 14,” Kulig said. “Adolescence, on the other hand, begins with puberty but may last into the early 20s.” “Early adolescence is associated with breaking away from one’s family and beginning to focus on one’s own independence. In mid-adolescence, the peer group is the most important thing, and this is where you’ll see a lot of testing behavior. Late adolescence is when the transition to adulthood occurs.”

Kulig discussed issues ranging from driving, drug and alcohol use and friendships, to sexual behavior and parental responses to poor teen choices.

First and foremost, parents should relay their attitudes and values, use teachable moments such as stories in the news, and whenever possible avoid over-reacting, Kulig said. “Choose your battles carefully,” he said.

Educational materials were also provided, including a “Contract for Life” from the Students Against Drunk Driving (SADD) web site, and a recommendation for “The Teenage Body Book” as a reference for both parents and teens.

For more information about the series or services provided by General Pediatrics and Adolescent Medicine, please call 617-636-5241.   

Tufts Medical Center Researchers Find Drug Company Evidence Submitted to Health Plans of Inconsistent Quality

An opportunity for drug companies to voluntarily provide detailed evidence of their products’ cost-effectiveness compared to existing alternatives is showing promise, but still far from successful. That’s one conclusion researchers at Tufts Medical Center and colleagues found in a study that looks at how closely information submitted to formulary committees at managed health care systems and pharmacy    benefit management companies (PBMs) complies with national guidelines from the Academy of Managed Care Pharmacy (AMCP).

The findings of the joint study by researchers at Tufts Medical Center, the University of Washington, and Washington-based Premera Blue Cross are published in the July issue of The American Journal of Managed Care.

“We reviewed the quality of economic analysis in dossiers submitted to Premera Blue Cross, a large health insurer serving 1.7 million people, between 2002 and 2005,” said Peter J. Neumann, ScD, senior author of the study and Director of Tufts Medical Center’s Center for the Evaluation of Value and Risk in Health (CEVR). “We also examined the clinical studies included in the submissions made to Premera in 2003. What we found was that the quality of information that drug companies submitted was of relatively poor quality, including sub-standard economic analyses.”

The FDA does not consider cost-effectiveness a condition of approval. But health insurers and pharmacy benefit management companies can ask for such information. Premera routinely requests the information to design benefits that reward consumers for purchasing the most cost-effective and high-quality drugs.

The study of 115 submissions by drug makers found that drug companies voluntarily provided economic or cost-effectiveness analyses about 46 percent of the time. When economic analyses were submitted, they had relatively low levels of compliance with industry standards. In analyzing cost-effectiveness, only 17 percent of the 115 submissions by drug makers compared their new drugs to the most relevant or cost-effective treatment alternatives.

The researchers did find that economic analyses of high-value or innovative products had higher compliance with recommended practices. The study team also found substantial amounts of evidence submitted by drug makers in support of various off-label uses, but the information was less extensive and of poorer quality than for labeled indications.

 “The take away message here is that the guidelines contained in AMCP’s Format for Formulary Submissions provide an opportunity for health plans to evaluate various drugs’ clinical and economic information.  But concerns persist about the quality of the information submitted, and continued vigilance and caution is warranted,” Neumann said.

Co-authors of the study included Sean Sullivan, PhD, of the University of Washington, John Watkins of Premera Blue Cross, and Jennifer A. Palmer, MS, and Kathleen Bungay, both of Tufts Medical Center’s Institute of Clinical Health Policy and Research Studies.  The study’s lead author, Harvard doctoral student Fernando Colmenero, MD, passed away in April 2006.  The study was funded by the AHRQ in an award to the Harvard School of Public Health.

A review of previous studies indicates that use of a class of medications known as “incretin-based therapy,” which act via certain pathways that affect glucose metabolism may provide modest effectiveness and favorable weight change outcomes for the treatment of type 2 diabetes and may represent an alternative to other hypoglycemic therapies, according to an article in the July 11 issue of JAMA.  Tufts Medical Center researchers conducted a meta-analysis of 29 studies to assess the effectiveness and safety of incretin-based therapy (GLP-1 analogues and DPP4 inhibitors) in nonpregnant adults with type 2 diabetes.

Current therapies for type 2 diabetes are often limited by adverse effects such as weight gain or hypoglycemia (low blood sugar). A more recent class of treatment to address these issues is incretin therapy, which involves glucose-stimulated insulin secretion by intestinally derived peptides, which are released in the presence of glucose or nutrients in the gut, according to background information in the article. In October 2006, the Food and Drug Administration approved the first oral incretin enhancer, sitagliptin, a selective DPP4 inhibitor (a class of oral hypoglycemics), for use as monotherapy or in combination with other medications. The effectiveness of this class of medications in managing type 2 diabetes is not well understood.

“Incretin therapy offers an alternative option to currently available hypoglycemic agents for non-pregnant adults with type 2 diabetes with modest efficacy and a favorable weight change profile,” according to the authors of the study, which includes Tufts Medical Center endocrinologist Anastassios G. Pittas, MD. “Individuals with mild diabetes, suggesting an adequate pancreatic beta cell reserve, who are at risk of hypoglycemic sequelae and in need of weight loss may benefit from this new class. However, these new classes of hypoglycemic agents will need continued evaluation both in long-term efficacy and safety controlled trials and in clinical practice to assess their effectiveness and safety profile to determine their role among the many available and well-established therapies for type 2 diabetes.” 

John “Dana” Pyburn of Tufts Medical Center Environmental Services Department is this month’s recipient of the William Saltonstall Employee Excellence Award. Pyburn has worked at ESD for more than two years.

 “I believe Dana embodies the spirit of true customer service in approaching his duties with an unwavering sense of diligence and positive energy,” said Robin Morris, Vice President of Clinical Services.  “I have worked with the housekeeping staff and Dana in particular and have been consistently impressed with his work ethic in approaching tasks that some might not notice in the flurry of delivering direct patient care.”

William Pryor, Director of Service Response Center, said, “All our dispatchers are constantly telling me what a pleasure it is to interact with Dana because of his sense of humor and speed in completing requests.”

“Dana truly focuses on the customer, which for housekeeping our customers are all the employees, visitors, and patients in our Medical Center,” said Nora Blake, Director of Hospitality Services. “Dana always has a smile no matter what is asked, and he is asked to do some very tough things!”

The Saltonstall Award honors employees who exhibit the highest standards of service and performance in their work and their interactions with staff members, patients and visitors.  To nominate an employee for this award, contact Yolanda Rosero at ext. 5669 for more information.

11th Annual Cycle for Life To Be Held on September 8

The 11th Annual Cycle for Life to benefit the Floating Children’s Cancer Center will take place on Saturday, September 8. The Cycle for Life offers riders two route choices—a scenic 25-mile or 50-mile New England ride. The bike ride starts at Devereux Beach in Marblehead, runs through several North Shore towns, and finishes back at Devereux Beach for a festive post-ride BBQ.

Cyclists check in at 8 a.m. and the ride begins at 9 a.m.  Each cyclist who chooses to, will be matched with a young patient from the Floating Children’s Cancer Center and will wear a picture of that child on a button during the ride. Proceeds from the event directly benefit the Pediatric Cancer Center and its renowned Child Life program.

Water and snack stops at the half way points and a “sag wagon will also be available for those who need support along the route. This year, participants who bring in new riders (riders who have not ridden in the Cycle for Life for the past two years) or raise more than $500 will be entered into a drawing for a pair of tickets to see the Boston Red Sox play the Minnesota Twins on Sunday, September 30th at Fenway Park.

The Cycle for Life is actively recruiting riders and volunteers. Registration is $50 before September 1; $75 after September 1. To register, volunteer or obtain more information, visit http://cycleforlife.kintera.org or call Becca Romish at ext. 9846.

Floating Hospital for Children has opened two new Pediatric Specialty Centers at 20 Research Place at Drum Hill in North Chelmsford and 7 Alfred Street in Woburn.

The specialty centers, staffed by expert physicians from Floating Hospital for Children, provide a range of services, including pediatric cardiology, pulmonology, gastroenterology, nephrology, ENT and neurology with future plans to include pediatric rheumatology, developmental and behavioral pediatrics, and genetics.

Specialists seeing patients include; William Yee, MD, Pediatric Pulmonology; Anirban Banerjee, MD, Pediatric Cardiology; Pamela Follett, MD, Pediatric Neurology; Deborah Shipman, MD, Developmental Behavioral Pediatrics; Peter Ngo, MD, Pediatric Gastroenterology; Alex Flores, MD, Pediatric Gastroenterology; Lawrence Milner, MD, Pediatric Nephrology; and Clark Elliot, MD, Pediatric Otolaryngology.

Additional specialties will be added to the clinics at a later date.

For more information about the North Chelmsford location, contact Kristine D’Amour at 978-937-NEMC (6362), and for information about the Woburn clinic, contact 781-897-0240.

Tufts Medical Center’s Rapid Response Team (RRT), a rapid bedside response program that aims to improve patient outcomes, marked its first anniversary this August.

"The rapid response team is called upon as soon as any registered nurse or clinician notes a ‘trigger sign’ indicating that a patient’s condition is deteriorating," said Greg Schumaker, MD. "The team’s mission is to improve the quality of care for the patient, decrease the number of code instances and reduce intensive care admissions."

In less than 5 minutes, the RRT, a group of expert clinicians trained in specific rapid intervention procedures, is deployed to provide critical care expertise at the bedside of a patient. The team empowers nurses and hospital staff to get immediate help assessing and managing a patient’s care before their condition becomes an emergency. The Rapid Response Team usually consists of a critical care nurse/CRN, a respiratory therapist, in addition to a medical resident and a surgical resident. Each month there are between 14 to 20 calls that bring this team to the bedside of patients in need.

"North 7 piloted the Rapid Response Team Program here at Tufts Medical Center," said Amy Lund, RN. "The system was designed to expedite patient care and provide expertise and a high level of care that potentially prevents a patient from going to the ICU. Over the past year, we have seen many positive outcomes using this system."

The model for Tufts Medical Center’s Rapid Response Team was developed as part of a collaborative project with the Association of American Medical Colleges to provide better resources to patients and is now accessible for all inpatient medical surgical units and intensive care areas at Tufts Medical Center.

"Rapid response is a way to recognize earlier when a patient may be in trouble," said Jason Rhee, MD, surgical resident. "What better way to offer patient care than to be at the bedside when they are in need."

Initiatives from the Institute for Healthcare Improvement (IHI), the American Medical Association (AMA), the Joint Council on Accreditation of Healthcare Organizations (JCAHO) and the Robert Wood Johnson

Foundation continue to encourage the development of rapid response teams nationwide.

"The team works with the primary nurse, who understands the patient’s history and knows the protocol for care," said Terry-Hudson Jinks, RN, MSN, Clinical Director of Adult Nursing. "The collaborative nature of the program offers an opportunity for nurses and clinicians to better identify which signs require immediate attention. It empowers them to act on their assessment and intuition and call for help when a patient first begins to show signs of decline."

Ellen Meyers, CRT, a respiratory therapist at Tufts Medical Center for more than 20 years, notes that the team operates efficiently because its activated when the patient isn’t at code level and there’s time to better access the situation.

Employees of U.S. Bank visited Floating Hospital for Children in late July to deliver more than 200 teddy bears and a message of friendship and comfort to the Floating Hospital’s young patients.  U.S. Bank sponsored a teddy bear drive for the hospital during the late spring, collecting 200 teddy bears from generous U.S. Bank employees.

“The U.S. Bank team is very happy to donate the teddy bears to Floating Hospital for Children. We hope that the children who are patients will be comforted and encouraged by them,” said Bryan Calder, President of U.S. Bank Corporate Trust Services. “Our teddy bear drive was organized by U.S. Bank’s New England Chapter of our  Employee Development Network.  These chapters are employee-driven and are active in communities across the country where our employees live and work.”

Representatives from U.S. Bank, including Calder, were on hand at Ace’s Place, the playroom at Floating Hospital, to greet some of the young patients and present the teddy bears.

 “U.S. Bank’s gift to Floating Hospital for Children will touch the lives of many patients and their families and is a reflection of the bank’s strong leadership within the community,” said Ellen Zane, President and Chief Executive Officer of Floating Hospital for Children and Tufts Medical Center.  “We are truly grateful for their generosity.”

Tufts Medical Center Credit Union Announces New “Express Line”

The Medical Center’s Credit Union has opened a new “Express Line” telephone banking option. The new feature allows credit union members to access account information, including account balance inquiries, savings to checking transfers and loan payment transfers. Users will also be able to review their transaction history using the new line. The “Express Line” operates 24 hours a day, seven days a week. Members will need their “Member Number” ending in “00” when they dial in to access the service. The Credit Union “Express Line” can be reached at 781-419-1283.