A rendering of the Brigham Building for the Future, which will open this fall

The Brigham Building for the Future (BBF), opening this fall, will be home to research labs and ambulatory clinics dedicated to the neurosciences, orthopaedics, immunology, rheumatology and musculoskeletal health. Clinical and research teams from across BWH’s campus will come together in the 12-story building to collaborate and accelerate the translation of laboratory discoveries into novel treatments for patients.

BWH Bulletin asked for your questions about the new state-of-the-art building and talked with Lani Kuzia, project manager for Real Estate, to find the answers. Here they are below:

What is the address of BBF?
BBF is located at 60 Fenwood Road.

When will various teams be moving in?
With the first patients scheduled to be seen on Oct. 3, the first move is set for Sept. 30. There will be staggered move-ins through March 2017, but all clinical teams will be moved in before the end of October 2016.

What are the plans for patient parking?
Patients able to do so may self-park in the BBF’s underground garage, which contains 150 spaces for patients. They may also leave their car with BWH’s valet service on the second level of the BBF underground garage or at 75 Francis St. for valet parking.

Will people be able to access BBF directly from the Mission Park Garage without having to go outside?
No, there will not be indoor access from the Mission Park Garage to the BBF; however, BBF is just a few steps away from the garage.

Will there be any inpatient beds in the new building?
No. The building will consist of eight floors of research laboratory space and three floors for outpatient clinical visits.

Will there be any food options in the new building?
There will be a cafe in the BBF operated by BWH and Sodexo, a hospitality company.

Are there any public spaces that employees will be able to reserve?
There will be public conference space that employees will be able to reserve as meeting space through the Audio/Visual Resource Scheduler (at BWHPikeNotes.org).

Are there any “green” features in the new building?
The building will incorporate a number of innovative, environmentally friendly features, including a roof garden to reduce storm water runoff and a co-generation power plant that will enable BWH to make enough electricity to power about 80 percent of the BBF’s and Shapiro Center’s electrical needs. The power plant, which was built in Germany, is a natural gas-fired engine that will supply the building with electricity and steam. The BBF has been designed to achieve the environmentally friendly Leadership in Energy and Environmental Design (LEED) Gold certification.

What other innovative features will be part of BBF?
Six highly-sophisticated MRI and CT machines will comprise the BBF’s state-of-the-art underground imaging facility. One of the MRI machines, the 7-Tesla, is the most powerful MRI machine in the world and one of only a few of its kind available to clinicians and researchers. The MRI provides extremely detailed images of metabolic pathways in the brain.

Were any patients or family members of patients involved in the design of the building?
Martie Carnie, BWH’s senior patient advisor, was involved in the planning and design of the building from the beginning, sharing insights from the patient and family perspective with BWH Real Estate and Facilities staff and building architects.
“We talked about what kinds of resources and information would be helpful to patients at the front desk in patient waiting areas and how the front desk should be set up for an easy approach for patients,” said Carnie. “We also discussed clear signage for patients, traffic flow, the use of media in waiting areas and colors for building finishes. It’s important for people to know that the patient and family voice was incorporated.”

Will there be employee tours of the new building?
Employee tours will be available in September for day, evening, night and weekend staff. Dates and more details about tours and celebrations will be forthcoming.

Do you have a question about the BBF? Share it with bwhbulletin@partners.org. Stay tuned for additional stories about the BBF in the coming months in the print and online Bulletin, and view BWH Clinical & Research News’s BBF series.

Giorgio Giatsidis

Researcher Giorgio Giatsidis, MD, of the Department of Surgery, is running this year’s Boston Marathon as a member of the BWH Stepping Strong Marathon Team. His motivation: honoring patients affected by traumatic wounds.

“My patients are my life,” said Giatsidis. “I wanted to run the Boston Marathon to pay tribute to anyone who has ever suffered from a traumatic wound and to raise awareness of innovative research and clinical programs at BWH that are helping to advance trauma healing.”

Giatsidis, a native of Milan, Italy, is a plastic surgeon who specializes in reconstructive and aesthetic surgery. He’s also a researcher, who is currently focused on trauma-related issues and, in particular, methods to reconstruct damaged soft tissues and improve the chance of tissue survival.

After hearing Boston Marathon bombing survivor Gillian Reny’s story of hope and perseverance, Giatsidis was inspired to raise funds to advance trauma research and clinical care. Giatsidis says he has enjoyed the challenge of training for his first marathon and getting to know his teammates. Come race day, he’s excited to run along the historic route and witness the energetic crowds cheering runners on.

“Throughout my career, I’ve had the opportunity to assist a large number of patients affected by trauma,” said Giatsidis. “It has meant so much to me to be able to support them and help them get back to their lives. When I’m running on Marathon Monday, I’ll be thinking about Gillian and all of the other patients who have experienced trauma. These stories are what drive me to be a better physician, researcher and person.”

To learn more about the BWH Marathon Program, visit BWHMarathonProgram.org.

From left: Histology supervisor Donna Skinner and Teresa Bowman, with the team’s staining technology

On March 10, BWH labs recognized National Histotechnology Day and the role histotechnologists play in patient care and research.

Using tissue samples from patients, plants or preclinical models, histotechnologists process, slice and stain samples for pathologists. In a clinical setting, these stains can help to diagnose cancers and other disorders in patients, while other tissue samples help with research.

“We are proud that our work contributes directly to patient care,” said Teresa Bowman, manager of the Specialized Histopathology Lab, which is directed by Jon Aster, MD, PhD.

The National Society of Histotechnology started celebrating the work of histotechnologists four years ago, as there was no existing day or event drawing attention to their work. For Pathology labs, where dedicated technicians sometimes work seven days per week and through holidays, the day of national recognition serves as a positive way to highlight the role they play in patient care.

Each day, the Specialized Histopathology Lab can process and stain anywhere from 20 to 150 tissue samples, depending on demand, and the team typically processes more than 4,000 cases each year. While most of the samples are research-related, the lab also tests preclinical samples for drug efficacy and assesses different types of treatment.

There are five primary steps to histotechnolgy. First, technicians must examine and trim tissue samples to fit on the slides and then place them in chemical solutions to prevent decomposition. Next, the water is removed from the tissue and substituted with wax to provide support, after which the sample is embedded into a larger block of wax. The block of wax and tissue are then placed on an instrument called a microtome, where small sections are cut to form a thin ribbon. These sections of ribbon are placed on slides for observation. Finally, the slides are stained with different dyes to identify cell structures, antibodies or other structures that will help a pathologist or researcher make a diagnosis.

“A lot of people will tell you it’s an art form and that not everyone can do it,” says Bowman. “The tissue can be dry and tissues with disease can be more difficult to section, so you have to have some patience and take the time and finesse to get a good section.”

Although the role histotechnologists play may fly under the radar of most patients, Bowman is proud of the work the lab completes day in and day out.

“The clinical diagnosis and the satisfaction of getting a tough stain to work are the most rewarding parts of the job,” Bowman said. “Although some people don’t know we are here, we are an important part of the diagnostic process.”

Mehra Golshan

The use of contralateral prophylactic mastectomy (CPM)—the surgical removal of a breast unaffected by cancer as part of the course of treatment for breast cancer—more than tripled from 2002 to 2012. However, according to a new BWH study, there has been no evidence of a survival benefit for patients who receive CPM compared to patients who receive breast-conserving surgery, which removes part of the breast tissue but not the entire breast.

Researchers note that while CPM may have a survival benefit for patients who are at high risk of developing breast cancer, such as those with a genetic mutation, the majority of women undergoing CPM are at low risk for developing breast cancer in the unaffected breast. Data show that women who are diagnosed with cancer in one breast are increasingly unlikely to be diagnosed with cancer in the other breast.

“Our analysis highlights the sustained, sharp rise in popularity of CPM and the mounting evidence that this more extensive surgery offers no significant survival benefit to women with a first diagnosis of breast cancer,” said senior author Mehra Golshan, MD, distinguished chair in Surgical Oncology at BWH. “Patients and caregivers should weigh the expected benefits with the potential risks of CPM, including prolonged recovery time, increased risk of complications, cost, the possible need for repeat surgery and effects on self-image.”

Researchers analyzed data from a group of nearly 500,000 women with a stage-one to stage-three breast cancer diagnosis in one breast and followed them from 1998 to 2012. Patients undergoing breast-conserving surgery, unilateral mastectomy—the removal of one breast—and CPM were compared. Nearly 60 percent underwent breast-conserving surgery, 33.4 percent underwent unilateral mastectomy and 7 percent underwent CPM. Overall, the proportion of women undergoing CPM increased from 3.9 percent in 2002 to 12.7 percent in 2012. When compared with breast-conserving therapy, no significant improvement in survival was found for women undergoing CPM.

Importantly, CPM may be indicated for women with BRCA1/2 mutations, a strong family history of breast or ovarian cancer or a personal history of mantle field radiation during childhood. A significant number of younger women are actively choosing CPM over conservative surgery, but only about a third of women who opt for CPM have one or more of these risk factors. Surveys of women suggest that a desire to minimize breast asymmetry and improve overall appearance through increasingly available and expanding reconstructive techniques may influence a decision to undergo CPM. Specifically, research shows that rates of reconstruction in CPM patients increased from 35.3 percent to 55.4 percent during the study period.

“Women with unilateral breast cancer undergoing CPM continue to report a desire to extend life as one of the most important factors leading to their surgical decision,” said Golshan, who is also the medical director of International Oncology Programs at Dana-Farber/Brigham and Women’s Cancer Center. “Understanding why women choose to undergo CPM may create an opportunity for health care providers to counsel women about surgical options, address anxieties, discuss individual preferences and ensure peace of mind related to a patient’s surgical choice.”

Sarbattama Sen

Inflammation is part of the immune response, allowing the body to heal from injury, but uncontrolled inflammation can stress or damage the body. Diet is known to play a role in inflammation in adults, but exactly how a woman’s diet during pregnancy may affect inflammation and, in turn, her health and the health of her baby, is not well understood.

A new study led by BWH researchers uses the Dietary Inflammatory Index (DII) to score a woman’s diet during pregnancy and measure the influence of diet on both inflammation during pregnancy and on maternal and infant outcomes before and after childbirth. The team found that more pro-inflammatory diets are associated with lower rates of breastfeeding and lower-than-expected birth weight in certain groups.

“As health care providers for pregnant and post-partum women, we often think about and advise women on diet in the conventional sense of calorie and macronutrient intake, but we haven’t paid much attention to dietary inflammation,” said Sarbattama Sen, MD, a neonatologist in BWH’s Department of Pediatric Newborn Medicine. “By focusing on the elements of diet that may be linked to inflammation, we’ve been able to tease out certain outcomes associated with a more pro- or anti-inflammatory diet.”

The DII focuses on the nutrients that are found in different food items and uses evidence from previous studies to assign an inflammatory score to each food component. Previous studies in non-pregnant adults have found that some food components—such as caffeine, as well as trans, saturated and monounsaturated fats—have a pro-inflammatory effect, while others—such as vitamin A, beta carotene, fiber and magnesium—have an anti-inflammatory effect. Using these data, past researchers were able to assign foods an inflammatory score.

In the current study, 1,808 participants in Project Viva, a study of expectant mothers in Massachusetts that began enrollment in 1999, completed food questionnaires in the first and second trimesters of pregnancy, which were used to create individualized DII scores for the women. Higher scores indicated a more pro-inflammatory diet and lower scores indicated a more anti-inflammatory diet. A blood sample was drawn from each participant in the second trimester, and two markers of inflammation—C Reactive Protein (CRP) and white blood cell count—were measured. The team also collected information on women’s pre-pregnancy body mass index (BMI).

Participants who had higher DII scores also had higher CRP levels. Women who had higher BMIs before pregnancy tended to have higher DII scores and also higher CRP levels.

Researchers also looked at a number of pregnancy outcomes. Among women who reported that they initiated breastfeeding, women who had a more pro-inflammatory diet had a lower likelihood of successfully breastfeeding their child past one month of age. Obese women who had a more pro-inflammatory diet were also more likely to deliver a baby who weighed less than would be expected at a given gestational age. Researchers did not observe an association between dietary inflammation and other maternal or infant outcomes such as gestational diabetes, preeclampsia, maternal weight gain during pregnancy or cesarean-section delivery.

“We have known for some time that excessive inflammation is associated with adverse health outcomes in adults,” said Sen. “But there have been few studies investigating the role of inflammation in pregnancy, when both the health of the mother and the fetus are at stake. We hope that this work opens the door for more investigation of the role of inflammation in important pregnancy outcomes such as fetal growth and breastfeeding.”

Marcelo DaSilva

Marcelo DaSilva, MD, an associate surgeon in the Division of Thoracic Surgery, is running his first Boston Marathon as a member of the Brigham and Women’s Hospital Marathon Program to pay tribute to his friend and colleague, the late Michael J. Davidson, MD.

“I’m honored to have the opportunity to run for BWH and for Mike,” DaSilva said. “To me, running in the name of a loved one is extremely powerful. I know that’s what motivates me every time I lace up my sneakers and head out on a course.”

DaSilva is running in this year’s Boston Marathon as a member of the “Running to Remember Dr. Michael J. Davidson” team, which is part of the Brigham and Women’s Hospital Life.Giving.Breakthroughs. Marathon Team. The team is raising funds to establish the Michael J. Davidson, MD, Endovascular Fellowship, which will offer support for cardiothoracic surgeons who have completed their formal residency training and are seeking to enhance their surgical skills in transcatheter valve techniques. The fellowship will provide direct experience using novel and less invasive solutions for complex cardiac patients.

DaSilva, who joined BWH in 2008, described Davidson as a talented surgeon and educator. He said by establishing this fellowship, BWH and health care institutions around the country will be able to continue training the best physicians.

“That’s what Mike would have wanted,” he said. “He was a visionary who was ahead of his time in how he thought about cardiovascular surgery. Like so many of us, Mike wanted to make a difference in people’s lives, and I am pleased that this fellowship will help us do just that.”

DaSilva isn’t new to the racing scene; he’s previously run nine other marathons, including Chicago and New York City. He’s looking forward to passing the cheering crowds, running up Heartbreak Hill and crossing the finish line. Meditation is what gets him through some of the hardest parts of races, he says.

“Running a marathon can be compared to performing surgery, meaning that it takes a lot of determination, training and physical and mental endurance to cross the finish line or complete a case,” DaSilva said. “It’s an amazing feeling to run among thousands of other participants knowing that they all have a reason for running. I know Mike will be with the Brigham team in spirit on race day.”

To learn more about the BWH Marathon Program, visit BWHMarathonProgram.org.

From left: Kathryn Rexrode, YiDing Yu, Ritu Gill, Lesley Solomon and Esther Rhei

At a recent panel discussion featuring female physician innovators, Esther Rhei, MD, a breast surgical oncologist at BWH and the Dana-Farber Cancer Institute, said she considers herself a newcomer to innovation. As medical director of the BWH Breast Center, one of Rhei’s greatest challenges has involved discussions with patients about what their breasts will look like after certain types of surgeries since it’s impossible for patients to truly envision how they would look post-surgery. Rhei wanted her patients to have this knowledge in making such an important decision.

Rhei pitched the problem to provide a way for patients to envision their bodies post-surgery at a Brigham Innovation Hub (Brigham iHub) Surgery Innovation Series event in 2014. The Brigham iHub team is now working with Rhei to create a database solution.

“You don’t have to be a longtime innovator or know everything about putting an idea into practice to get the ball rolling,” Rhei said. “Lesley Solomon and her team supported this idea every step of the way.”

During a panel discussion on Feb. 26, female physician entrepreneurs Rhei, radiologist Ritu Gill, MD, MPH, and YiDing Yu, MD, a graduate of BWH’s Internal Medicine Residency program who is now chief innovation engineer at Atrius Health, talked about their paths to innovation at BWH.

As part of its seminar series, the Center for Faculty Development & Diversity’s Office for Women’s Careers (OWC) hosted the discussion, which was moderated by Kathryn Rexrode, MD, MPH, faculty director of the OWC.

Solomon, executive director of Brigham iHub, offered tips for success in entrepreneurship and spoke about the benefits of working with Brigham iHub. 

Solomon said that in a 2013 Brigham iHub survey, 72 percent of clinicians stated that they had health care improvement ideas but didn’t take steps to move those ideas forward due to funding, time and lack of clarity on next steps.

“In developing Brigham iHub, we realized that we needed to create a support structure so that people knew where to go when they had an idea,” Solomon said. “Our vision is to disrupt traditional medicine, reinvent health care and unleash your knowledge and expertise so that we can foster innovation at all stages.”

During the panel, Gill, who is currently working on developing a tool to identify and characterize actionable lung nodules—small masses of tissue in the lung that are sometimes cancerous—told attendees to think big and never underestimate themselves.

“The word ‘impossible’ is not in my dictionary,” she said. “If a problem comes up, I figure out a way to tackle it. I encourage all of you to think outside of the box and believe that anything is possible.”

Phil De Jager

A team of investigators at BWH and the National Institute of Neurological Disorders and Stroke (NINDS) has launched a study of individuals at risk for multiple sclerosis (MS), called the Genes and Environment in Multiple Sclerosis (GEMS) project. By focusing on first-degree family members of MS patients, researchers seek to better understand the sequence of events that leads some people to develop the disease. Their work also sets the stage for developing and testing interventions that may block the onset of MS.

“Early detection of MS means the possibility of earlier treatment, which could delay the accumulation of disability,” said co-senior author Phil De Jager, MD, PhD, who directs the Program in Translational NeuroPsychiatric Genomics at the Ann Romney Center for Neurologic Diseases at BWH. “Our long-term goal is to map out the sequence of events from health to disease in order to identify and intervene early in individuals at high risk for MS.”

The GEMS study leverages the outreach efforts of patient advocacy groups such as the National Multiple Sclerosis Society, social media such as Facebook and electronic communication to recruit first-degree relatives (parent, sibling or child) of people who have been diagnosed with MS. More than 2,600 family members have been recruited from across the U.S. Family members can interact with the study through its Facebook page, where updates on the project and MS-related news are shared. The study, which will ultimately enroll 5,000 first-degree relatives, will continue for the next 20 years.

“This first report from the GEMS study is important because it shows that we can recruit the large number of family members that is necessary to perform a well-powered study of MS risk factors,” said lead author Zongqi Xia, MD, PhD, of the Department of Neurology.

Upon enrollment in the study, participants completed a web-based questionnaire about their medical and family histories, environmental exposures and more. Participants also submitted a saliva sample for DNA extraction.

Although first-degree relatives are 20 to 40 times more likely to develop MS than the general population, their risk is still low; researchers estimate that of 10,000 first-degree relatives, only about 62 will be diagnosed with MS over five years. Having a means to predict who is most at risk for developing MS not only provides an opportunity for early intervention, but also makes clinical trials for new treatments more feasible since the incidence of MS is low in the general population.

In their preliminary analysis, researchers tested a method to calculate an individual’s risk of MS and identified a subset of family members that may have a higher risk of developing MS than the average family member. This risk score could help design long-term studies of higher-risk individuals.

“This report is an important first step,” said De Jager. “We do not yet have a tool that we can use clinically to predict MS. To develop such tools and a platform for testing strategies to prevent the disease altogether, we are expanding GEMS into a larger collaborative study that will accelerate the progress of discovery and bring together a community of investigators to overcome this important challenge.

“Overall, the risk of MS remains very small for most family members,” said De Jager. “The most effective therapies for MS will ultimately be those that prevent its onset, as halting inflammation and disease progression is much more difficult once the disease has become established.”

Jessica Whited with an axolotl salamander

Jessica Whited, PhD, has fond memories of exploring the outdoors when she was younger—catching crayfish with her sister and studying butterflies and moths with her mother. Now a researcher in BWH’s Regenerative Medicine Center, Whited devotes her days to understanding limb regeneration in a species of salamanders and how research on these creatures might one day help humans suffering from limb loss.

Could you tell us about your work and how it could help patients one day?

My work is devoted to understanding limb regeneration in axolotl (Mexican) salamanders. The salamanders I study have legs that look and function very much like human limbs. They can completely regenerate these limbs, even as adults.

Millions of Americans are currently living with the consequences of having a major limb amputation, some of which are due to injuries and a rising number of which are due to diseases, including diabetes and peripheral artery disease—a condition in which plaque builds up in the arteries and reduces blood flow to the limbs. I believe that if we want limb regeneration in humans to become reality, we’ll only get there if we first understand how nature has solved this problem, which is why we’re studying salamanders.

How did you get interested in this field?

From an early age, my mother taught me how to identify, catch and display butterflies. I remember making my big score of a perfect tiger swallowtail on the ashes of our previous night’s campfire at the age of five. I also vividly remember going with my sister to a nearby creek to catch crayfish with our hands and coffee cans. I attribute my love of nature, which eventually gave rise to my interest in science, to these early experiences outdoors.

My grandfather, who was afflicted with peripheral artery disease, underwent a series of amputations starting with a few toes and culminating in his foot before he eventually died of the condition. This was my first encounter with the disease. I hope that someday our work will help people with this condition.

Tell us more about what it’s like working with salamanders.

Working with axolotls is a ton of fun and also a lot of work. They are permanently aquatic, which means we devote a great deal of time to keeping them clean and their water in good shape. We have hundreds of axolotls at all life stages.

Many species of salamanders can regenerate limbs. We work on axolotls specifically, though, because they have a generation time—the time between birth and when they can have babies—of nine months, which is shorter than many other salamanders.

What types of genetic tools are you working on developing?

In collaboration with the Broad Institute of MIT and Harvard, we are making a map of all of the genes that get turned on or off during regeneration and which are specific to the regenerating part of the leg. We’re also mapping how this changes over time, with respect to specific kinds of cells.

In your opinion, why is BWH a good fit for your research?

BWH is a premier medical center. In orthopedic surgery, people are getting joints replaced and fractures fixed every day. It’s exciting to be a part of extending that outlook into the research domain, because doing research is how we make progress so that conditions that have no great treatment now might become treatable someday. Additionally, in a hospital, there’s the feeling that what you’re doing in the lab could have a double benefit—besides just pushing the boundaries of human understanding and satisfying curiosity, what you’re doing might actually help people someday.

3-D Printing in Healthcare Fair attendees take a look at 3-D printed models after the event.

From the auto and fashion industries to snack foods and retail, 3-D printing has sparked innovation in a variety of industries, especially health care. 3-D printing—the process of making a three-dimensional object from a digital model—is no stranger to BWH labs and clinics, as attendees learned at the 3-D Printing in Healthcare Fair, held earlier this month.

Co-sponsored by the Center for Surgical Innovation (CSI) and the Brigham Innovation Hub (Brigham iHub), the event featured brief presentations from seven Brigham and guest speakers who incorporate 3-D printing technology into their clinical care and research. More than 80 attendees sat in on the presentations, which were held outside of the Brigham iHub’s space in the Shapiro Center, and later met with speakers and examined 3-D printed models on display in the Brigham iHub’s space.

“With an expanding role in health care and research, 3-D printing is helping to create new innovations in patient care,” said Yolonda Colson, MD, PhD, executive director of the CSI and thoracic surgeon. “Having surgeons, physicians, scientists and engineers all working in a hospital setting helps to fuel this innovation.”

Radiologist Ritu Gill, MD, MPH, associate director of Surgical Imaging in the CSI, organized the event with the help of Radiology resident Tatiana Kelil, MD. Gill shared how her team is using 3-D printed models for thoracic surgery planning and how she and her team have designed customized implants and plates to treat rib fractures more efficiently.

Donald Annino, MD, DMD, of the divisions of Otolaryngology and Head and Neck Surgery, highlighted 3-D printing’s usefulness in jaw surgeries, for which traditional approaches can be limited. Surgeons can print custom reconstruction plates to precisely fit the particular curvature of a patient’s jaw, which reduces operating time and promotes better healing.

BWH is home to several 3-D printing resources, including the 3-D Slicer, a free desktop application built for medical image computing. Steve Pieper, PhD, of the Surgical Planning Lab, explained that this software facilitates the use of 3-D printing in areas such as image-guided surgery and quantitative imaging.

Seung-Schik Yoo, PhD, of the Department of Radiology, and E.J. Caterson, MD, PhD, of Plastic and Reconstructive Surgery, also presented at the event.

Tell us how you’re using 3-D printing technology in your area in the comments below.

Partners institutions are leaders in hospital-based federally funded medical research, with nearly $730 million from the National Institutes of Health (NIH) alone in 2015. Research is a key element of the overall Partners mission, in addition to patient care, education and community health.

“Having research as a part of our mission offers important societal and patient benefits,” said Partners President and CEO David Torchiana, MD. “Offering our patients access to the latest advances in medical treatment is dependent on allowing our researchers to better understand and fully appreciate the clinical applications of new developments.”

Integrating research and clinical care. At Partners, there’s a perfect storm brewing that could bring to reality the vision of personalized or precision medicine. Its elements include Partners eCare, the Partners Biobank and the Partners Big Data Commons—a data platform anchored by the Partners Research Patient Data Registry.

Partners Chief Academic Officer Anne Klibanski, MD, said the key to pulling these elements together is the robust electronic health record (EHR) that Partners eCare offers. “We have been able to integrate a number of initiatives and research tools through the Partners Big Data Commons. For example, patients who have enrolled in the Partners Biobank are linked to their health care data from the EHR and other research data—things like information on lifestyle, environment and family history. We’re getting ready to include imaging information in the Big Data Commons as well.”

An added bonus comes in the form of genomic data that further links research with patient care. Last year, investigators across Partners institutions, in collaboration with the Broad Institute, received two four-year grants totaling $12.3 million from the NIH as part of the Electronic Medical Records and Genomics (eMERGE) network; grantees will study approaches to combining genomics and EHRs such as Partners eCare. Researchers will analyze genetic data from the 25,000-plus samples in the Partners Biobank, looking for variants that could impact clinical diagnostics and care. The study will also evaluate how this information can be provided to patients and their physicians so it can be used to support diagnosis, treatment and even prevention.

“This could include anything from identifying when a patient might be a candidate for a specific therapy to identifying when a genetic variation might result in adverse effects from a proposed therapy,” said Klibanski.

Direct patient engagement: The new research frontier. In the past, patients were contacted by their primary care physician (PCP) if they were eligible to participate in a research study. (Even before this step, the researcher had to contact the PCP, explain the study being conducted and ask if any of his or her patients might be eligible.) Occasionally, highly motivated patients might search the internet to find out about clinical trials for which they might be eligible.

All that will change with Partners eCare. When the new system is fully implemented across Partners, patients will have access to a research portal where they can enroll to be contacted by investigators working in areas that relate specifically to them. In addition, patients may be able to help define what some of the endpoints of a research project might be.

“Having patients’ perspective—knowing what would be meaningful to them as an outcome of a research project—is new and exciting territory,” said Klibanski. “Our capabilities in so many areas, including bioinformatics, genomics, data analytics and IT, are escalating rapidly and converging.”

NICU nurse Sandra Borgerson, with baby Noah and mother Toni Johnson-Lewis, on the day of Noah’s discharge

For 158 days last year, Toni Johnson-Lewis and her husband, Ron Lewis, made the NICU their home. Most of their days and nights were spent watching over their son, Noah, who was born prematurely at 22 weeks gestation, weighing less than a pound. Now, more than a month after Noah and his family headed home together, Johnson-Lewis said her son is making great strides. 

“Noah had a 10-percent chance of survival,” said Johnson-Lewis, who works in Research Management for Partners HealthCare. “But he was a fighter and wanted to be here. We relied on our faith and never gave up hope that our miracle would make it through this. We’re excited he’s on the road to good health.”

Weighing more than 15 pounds now, Noah is being weaned off of supplemental oxygen, achieving milestones and “growing like a weed,” Johnson-Lewis said. He receives frequent visits from visiting nurses and specialists and sees doctors at Children’s Hospital Boston for weekly check-ups.

Baby Noah on the day of his discharge from BWH

While coming home and taking care of Noah on their own was a major adjustment, Johnson-Lewis and Lewis say they are grateful to the BWH NICU staff who educated them about caring for their medically fragile baby.

“We’ve received so much support from the NICU team since the first day Noah was there,” Johnson-Lewis said. “Many of Noah’s primary nurses have checked in on us since discharge to see how he’s doing and to make sure we know how to take care of him in every way. It’s a good feeling knowing they still care about him.”

Noah at home, celebrating his half-birthday

Sandra Borgerson, RN, took care of Noah for the duration of his stay in the NICU and updated his parents about his progress as often as possible. She said it’s rewarding caring for babies during their most critical time in the NICU up through their discharge.

“It was a pleasure taking care of Noah and his family,” Borgerson said. “I look forward to seeing more photos and hearing updates on his progress.”

Earlier this month, the new parents celebrated Noah’s 6-month birthday with family and friends. Johnson-Lewis said it was wonderful to be able to mark this major milestone.

One exciting part of the family’s new routine at home is reading books to Noah each night before bed, a practice that started in the NICU, where staff encourage families to read to their babies daily through a new program called the Brigham Baby Academy. The goal of the reading program is to expose babies to a rich word environment to promote language acquisition and expression. Studies have shown that frequent exposure to meaningful auditory experiences reduces some of the stress of being in the NICU and aids in a child’s brain development.

Baby Noah at home

Carmina Erdei, MD, a neonatologist in the Department of Pediatric Newborn Medicine, said she feels fortunate to have had the opportunity to care for Noah and his family. During his stay in the NICU, Erdei often talked with Noah’s parents about the benefits of reading to their infant.

“It was a rollercoaster ride, with many ups and downs during the 158 days Noah spent with us, during which I had many opportunities to share happy moments, provide care and offer guidance during challenging times,” Erdei said. “I am delighted to hear that Noah is thriving and making great progress at home. Noah’s story is one of perseverance, dedication and faith, and I am grateful to him and his family for allowing me to be part of it.”

Jessica Allegretti speaks with BBC reporter Giles Yeo about FMT.

When Jessica Allegretti, MD, MPH, was a resident, she cared for a patient with inflammatory bowel disease (IBD) whose words ended up shaping the path of Allegretti’s career.

The patient told Allegretti that she would not consider surgery to treat her IBD—which is defined by chronic inflammation of the digestive tract—unless she could get a fecal microbiota transplant (FMT) as part of her treatment. FMT is currently being tested in more than 90 research trials as a potential treatment for a variety of diseases and conditions, including IBD.

Presently, the only clinical application of FMT is to treat patients who have experienced three or more episodes of C. difficile (C. diff) or for patients who do not respond to antibiotics. C. diff is an infection that causes symptoms ranging from diarrhea to life-threatening inflammation of the colon. During FMT, fecal matter from a healthy stool donor is instilled into the colon of a patient through a colonoscopy to displace disease-causing bacteria and fight the infection.

As a medical resident, Allegretti didn’t know about the procedure, but after she researched it, she became immediately interested in the potential of FMT as a possible therapy for IBD.

“At the time, it was viewed as almost science fiction,” said Allegretti, who treats patients and performs clinical trials as part of BWH’s Division of Gastroenterology, Hepatology and Endoscopy. “In 2013, the first controlled trial came out in the New England Journal of Medicine showing that FMT was extremely effective at treating C. diff, and it took off from there.”

As a first year fellow at BWH, Allegretti helped to found the hospital’s FMT program, with support from her mentor and Crohn’s and Colitis Center Director Joshua Korzenik, MD, as well as Endoscopy Center leadership and the Division of Infectious Diseases. She is currently the only clinician at BWH who performs FMTs and does three to five of these procedures each week, a rate that has been increasing exponentially in the past four years. At the Brigham, one FMT yields a 95-percent success rate of curing C. diff (compared to the reported success rate in scientific literature, which is about 90 percent). Many other major academic medical centers also offer FMT.

Each patient who is a candidate for FMT goes through a detailed consent process, during which Allegretti discusses what to expect. From there, OpenBiome—a nonprofit stool bank—sends the frozen stool sample, which Allegretti instills into a patient via colonoscopy. Patients go home right after the procedure, similar to a routine colonoscopy.

“We know if it’s worked within 72 hours; the response is quite quick,” she said. “The symptoms of loose bowel movements or diarrhea go away and remain away. We provide counseling for patients to avoid unnecessary antibiotics, which are a big part of what’s driving C. diff infections.”

In addition to time in the clinic, Allegretti is involved in several clinical trials, including one that is testing the effectiveness of a single FMT in improving liver inflammation among patients with primary sclerosis cholangitis—a chronic disease that slowly damages the bile ducts. She also recently worked on a dose-finding study of fecal capsules, learning that lower doses are just as effective as higher doses when it comes to curing C. diff. She is beginning work on a study that will look at the use of FMT to treat obesity, which will include an initial transplant via colonoscopy and oral capsule maintenance therapy.

Though fecal capsules are not appropriate for all FMT candidates, Allegretti believes they are the future of FMT.

“Capsules allow us to not only offer FMT to a broader patient population in a more timely and cost-effective manner, but they let us do better research,” she said. “For example, for chronic disease, one FMT is not going to be enough, but with capsules, we can provide the maintenance therapy that is needed.”

Allegretti says the most rewarding aspect of this work are the results.

“Some patients with C. diff suffer for years and are ostracized by family and friends or they feel they can’t leave their houses,” she said. “They have an FMT and feel better almost immediately. There is nothing more rewarding than seeing these patients break the cycle of recurrent C. diff. FMT is not going to be a cure-all for all diseases, but it allows clinicians and researchers to better understand the role bacteria play in many gastrointestinal diseases and to make more sophisticated, targeted therapies. It’s an exciting therapy to be able to offer and study.”

Mark Andersen

Mark Andersen, MHA, MS, has been appointed interim chief information officer (CIO) for BWHC, as of Jan. 4. The appointment will ensure continued progress of Partners eCare implementation while the search for a permanent CIO continues.

Andersen joins BWHC from the University of Virginia (UVA) Health System in Charlottesville, where he served as interim chief technology and health information officer. A skilled and collaborative leader, he has a proven track record in health care information technology consultation and management, and brings extensive experience in integrating IT and innovation to support clinical operations. He joined UVA as interim chief technology and health information officer shortly after the launch of Epic at UVA’s 700-bed hospital, where he led the organization through a successful stabilization effort, effectively resolving issues related to resource management, training and data mining.

As senior vice president and chief information officer at Yale New Haven Health System, Andersen led the selection, contract and implementation process for the transition to Epic from multiple legacy systems. Prior to that, he was vice president of Management Systems and Technology at New York Presbyterian/Columbia University Medical Center and was director of Revenue Management for the Dallas-based Epic Healthcare Group.

Andersen earned his MHA at The Ohio State University and his MS in industrial engineering/health systems engineering from the University of Missouri. He began his health care career as an occupational therapist, and his commitment to patients and the highest-quality patient care has been a driving force throughout his career.