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Grand Roundup

Grand Roundup: Top posts for the week of Sept. 14

The five most-read stories this week on Scope were:

So my life will be shorter than I’d hoped – what should I do differently?: In the latest installment of our Inspire patient series, a patient with “stage 4” Pancreatic Neuroendocrine Tumor discusses how his diagnosis has changed how he’s living his life.

Lloyd B. Minor, Stanford medical school’s dean, shares five principles of leadership: One of the highlights of the recent Medicine X conference was a course – “Navigating Complexity and Change: Principles of Leadership” – taught by our own leader, Lloyd B. Minor, MD.

Should we worry? Stanford’s global health chief weighs in on Ebola: In this piece, Michele Barry, MD, professor of medicine and director of Stanford’s Center for Innovation in Global Health, discusses the possibility of the Ebola epidemic spreading to the United States.

Stanford bioengineer develops a 50-cent paper microscopeManu Prakash, PhD, assistant professor of bioengineering, has developed an ultra-low-cost paper microscope to aid disease diagnosis in developing regions. The device is further described in a technical paper.

In a human brain, knowing a face and naming it are separate worries: Josef Parvizi, MD, PhD, associate professor of neurology, and Kalanit Grill-Spector, PhD, associate professor of psychology, have published new research on how our brains process face perception.

And still going strong – the most popular post from the past:

The mystery surrounding lung-transplant survival rates: A 2012 article in the San Francisco Chronicle offered a look at the challenges facing lung transplant patients and explored why a significant number don’t live beyond the five-year mark, despite improvements in survival rates.

Aging, Health and Fitness, Public Health, Research

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

free_weightsPast research has shown that strength training can benefit older adults’ health in numerous ways including arthritis relief, alleviating back pain, increasing bone density, improving sleep and boosting mental health. But despite these findings, a new study from Centers for Disease Control and Prevention (CDC) has found that few U.S. adults age 45 and older adhere to the Department of Health and Human Services’ muscle-strengthening recommendations.

The guidelines advise middle-aged and older adults to do moderate or high intensity muscle-strengthening activities that involve all major muscle group two or more days a week. Training can involve hand weights or weight machines, basic exercises such as sit-ups and push-ups or yoga and similar fitness practices.

In the latest study, researchers examined data from a telephone health survey conducted in 2011 by the CDC known as the U.S. Behavioral Risk Factor Surveillance System. For the survey, respondents provided information about the types of physical activities they engage in and frequency, as well as answered questions about if they specifically did exercises to strengthen their muscles. HealthDay reports:

Of all those who answered the questions on muscle strengthening, about 24 percent said they met the government’s recommendations.

Among those less likely than others to meet these guidelines were women, widows, those age 85 or older, people who were obese, and Hispanics. Participants who didn’t graduate from high school were also less likely to meet U.S. strength-training recommendations.

Jesse Vezina, of Arizona State University, and his fellow researchers concluded that interventions designed to encourage people to participate in strength training should target these high-risk groups.

Previously: Moderate exercise program for older adults reduces mobility disability, study shows, Help from a virtual friend goes a long way in boosting older adults’ physical activity and Do muscles retain memory of their former fitness?
Photo by Positively Fit

Medical Education, Medical Schools, Mental Health, Stanford News, Surgery

New surgeons take time out for mental health

New surgeons take time out for mental health

rope webI spent a recent morning watching about 30 Stanford surgical residents take time off from their operating rooms to participate in a series of team-building games out on the alumni lawn on campus. These are busy, dedicated professionals who are passionate about their work, so getting them to take time off is hard. “I can tell you a surgical resident would rather be in the operating room than anywhere else on earth,” Ralph Greco, MD, a professor of surgery, told me as he sat on a nearby bench watching the residents play games.

In a story I wrote about the games, I describe how the Balance in Life program, which sponsored the day’s event, was founded following the suicide of a former surgical resident, Greg Feldman, MD. Greco, who helped build the program, was committed to doing whatever he could to prevent any future tragedies like Feldman’s, as I explain in the piece:

“The residency program was just rocked to its knees,” he said, remembering back to the death in 2010 of the much-loved mentor and role model for  many of the surgical residents and medical students at the time. Feldman died after completing his surgical residency at Stanford and just four months into his vascular surgery fellowship at another medical center. “It was a very frightening time,” Greco said. “Residents were questioning whether they’d made the right choices.”

Today, the Balance in Life program includes, among other thing, a mentorship program between junior and senior residents, group therapy time with a psychologist and a well-stocked refrigerator with free healthy snacks. Residents themselves, like Arghavan Salles, MD, who participated in the ropes course, plan and coordinate activities:

“Some people think this is kind of hokie,” said Salles, who was one of a group of residents who helped found the program along with Greco following Feldman’s death. “Surgery is a super critical field,” Salles said. She paused to instruct a blind-folded colleague: “Step left! Step left!” “You face constant judgment in everything you do and say,” she added. “Everyone is working at the fringes of their abilities. They’re stressed.”

While writing this story, my co-workers suggested I read a September editorial in the New York Times that brought the issue into sharp focus. Spurred by the suicides two weeks prior of two second-year medical residents who jumped to their deaths in separate incidents in New York City, Pranay Sinha, MD, a medical resident at Yale-New Haven Hospital wrote about the unique stresses of new physicians:

As medical students, while we felt compelled to work hard and excel, our shortfalls were met with reassurances: ‘It will all come in time.’ But as soon as that MD is appended to our names in May, our self-expectations skyrocket, as if the conferral of the degree were an enchantment of infallibility. The internal pressure to excel is tremendous. After all, we are real doctors now.

Pranay’s message was similar to the one promoted by Stanford residents during the games: The key to battling new physician stress is realizing that you are not alone, that your colleagues are there to support you. “It sounds touchy feely to say that we care,” Salles told me. “But at the end of the day, if we want to have better patient care, we need to take care of each other too.”

Previously: Using mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Norbert von der Groeben

Cancer, Stanford News

Stanford Cancer Institute offers latest in cancer news, 140 characters at a time

Stanford Cancer Institute offers latest in cancer news, 140 characters at a time

Untitled-3 copyThe American Cancer Society’s 2014 annual report states that more than 1.6 million people in the U.S. will be diagnosed with cancer in the coming year. In response to this reality, many people try to arm themselves with as much information as possible about how to prevent, detect and/or treat the disease.

The Stanford Cancer Institute is committed to making cancer news and information more accessible and recently launched a new Twitter feed – @StanfordCancer – that delivers the latest developments in cancer research and clinical care from Stanford and around the world.

Combined with the Campaign for Stanford Medicine’s Transforming Cancer Care initiative, the Stanford Cancer Institute’s foray into social media is just one of Stanford Medicine’s many efforts to raise awareness about all the innovation scientists and physicians are pouring into disease detection, prevention and treatment.

Kylie Gordon works on the digital media team at Stanford University Communications. She received her undergraduate degree from Stanford in Modern Thought and Literature and has a graduate degree in Creative Writing from Northwestern University.

Health Costs, Health Policy, In the News, NIH, Public Health, Science Policy

Research investment needed now, say top scientists

Top scientists made the case for continued investment in basic science and engineering earlier this week by unveiling a new report, “Restoring the Foundation: The Vital Role of Research in Preserving the American Dream” by the American Academy of Arts and Sciences.

Here’s why this is important: Federal investment is needed to power innovation engines like Stanford’s School of Medicine, and if that money gets funneled to roads, the military, Medicare, or any of a variety of other uses, fewer jobs, and fewer discoveries, could result. From the report:

Unless basic research becomes a higher government priority than it has been in recent decades, the potential for fundamental scientific breakthroughs and future technological advances will be severely constrained.

Compounding this problem, few mechanisms currently exist at the federal level to enable policy-makers and the research community to set long-term priorities in science and engi­neering research, bring about necessary reforms of policies that impede progress, or facilitate stronger cooperation among the many funders and performers of research…

Stanford President John Hennessy, PhD; biochemist Peter S. Kim, PhD; and physicist (and former U.S. Secretary of Energy) Steven Chu, PhD, are among the scientific rock-stars who co-authored the report.

For an excellent piece on the political debate surrounding the report’s release, check out the coverage in Science here. NPR also recently aired a series that colorfully illustrates the effects of research cutbacks, including a piece on a patient suffering from ALS, and a profile of several underemployed scientists.

Becky Bach is a former park ranger who now spends her time writing or practicing yoga. She’s a science writing intern in the Office of Communications and Public Affairs. 

Previously: More attention, funding needed for headache care, “Bold and game-changing” federal report calls for $4.5 billion in brain-research funding, Federal investments in research and higher education key to U.S. maintaining innovation edge

Neuroscience, Research, Stanford News

The life of a brain, captured by Stanford scientists

The life of a brain, captured by Stanford scientists

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At last, Stanford psychologists have come up with an explanation for our 20s. Or at least my 20s. That period of time when I was in so many ways an adult and yet some higher processing – inpulse control, for example – did not yet seem fully formed.

A group led by psychologist Brian Wandell, PhD, measured the brain composition of 102 people spanning ages 7 to 85 in 24 regions of the brain. The were specifically measuring what’s known as white matter – the fatty protective covering on our nerves that helps them fire more efficiently and, as the name implies, makes up the white part of our brains. People have long known that the white matter increases as the brain matures and white matter abnormalities have been associated with schizophrenia and other conditions. As I wrote in a Stanford News piece:

What [the researchers] found is that the normal curve for brain composition is rainbow-shaped. It starts and ends with roughly the same amount of white matter and peaks between ages 30 and 50. But each of the 24 regions changes a different amount. Some parts of the brain, like those that control movement, are long, flat arcs, staying relatively stable throughout life.

Others, like the areas involved in thinking and learning, are steep arches, maturing dramatically and then falling off quickly. (The group did point out that their samples started at age 7 and a lot of brain development had already occurred.)

That’s right. Thinking, learning, emotional control – none of those are firing at full capacity until around age 40. Beyond providing an excuse for a few bad decisions, the work could also become useful for doctors. In this study, the group examined the brains of people with multiple sclerosis, and they were able to detect more subtle decreases in white matter than doctors can when monitoring the disease. The researchers also say the work could help monitor effects of drugs, or diagnose kids who appear to have learning delays.

Previously: Learning how we learn to read and Teaching an old dog new tricks: New faster and more accurate MRI technique quantifies brain matter

Chronic Disease, Pediatrics, Public Health, Stanford News

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes_coaches_classThe prevalence of Type 2 diabetes among Americans ages 12 to 19 has grown from nine percent to 23 percent in less than a decade. In an effort to reduce U.S. adolescents’ diabetes risk, researchers at Stanford developed a school-based program where medical residents train healthy at-risk teens to be self-management coaches for family members diagnosed with Type 2 diabetes.

Researchers tested the initiative, called the Stanford Youth Diabetes Coaches Program, over the course of a year at three Bay Area high-schools serving primarily ethnic minority youth of low socioeconomic status. The study involved 97 adolescents – 49 student coaches and 48 non-participant students. Student coaches participated in an eight-week training course that was taught by family medicine residents and modeled after the Stanford University Diabetes Self-Management Program for adults. All participants completed pre- and post-study questionnaires and a select group of student coaches and family members gave in-depth interviews.

The program emphasized communication skills, problem solving and setting achievable goals using action plans. Beyond providing basic diabetes knowledge, the program also included guidance on nutrition, healthy meal planning, physical activity, weight management and stress management and on developing relationships with health-care providers. Student-coaches engaged with their family members during weekly 30-minute sessions where they shared information about topics they learned in class, discussed their relatives’ experiences and goals and helped them make an action plan for the week. In discussing their findings, study authors’ wrote:

The results of the study indicate that the Stanford Youth Diabetes Coaches Program increases knowledge and psychosocial assets of participant youth … Youth participants also reported positive changes in their own lives as the coached family members, and family members emphasized the importance of student coaches’ role in encouraging healthy behaviors. Additionally youth participants reported high program satisfaction.

These results substantiate current work suggesting that school-based programs benefit adolescents and that children have potential to support the self-management of family members with diabetes. Evidence strongly suggests that school-based programs hold promise to improve the health of at-risk adolescents.

“This study really speaks to the question of: How do you engage teens about their health?,” said first author Liana Gefter, MD, a research associate in Stanford’s Center for Research and Education in Family and Community Medicine. “The effectiveness of the program is rooted in the idea of empowering students to be a leader in a setting where they are traditionally only told what to do. A lot of the students really had a transformation during the eight-week course. Our findings demonstrated that after only eight weeks, compared to non-participants, students had significant increases in self-worth and belonging – assets that have been shown to be necessary precursors for adopting healthy behaviors. In this way, we believe the program could lay the foundation for sustainable health improvement.”

During interviews with researchers, student coaches and diabetes patients said the program inspired them to improve their diet and increase their regular physical activity. Additionally, they noted that the program strengthened their relationships with each other, and students reported their appreciation for having a physician come into their classroom.

In light of the program’s success, Gefter and colleagues Nancy Morioka-Douglas MD, MPH; Eunice Rodriguez, MPH, DrPH, and Lisa Rosas, MPH, PhD, are working to expand the program to underserved schools at other sites in California and around the country. Pilots are currently underway, or will begin, at campuses in Delaware, Georgia, Washington, Ohio and Michigan.

Previously: Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert, Have you voted in the Healthy Living Innovation Awards?, Diabetes prevention program trains youth in chronic disease self-management and Stanford Diabetes Coaches Class selected as 2011 Healthy Living Innovation Awards finalist
Photo by Stanford Youth Diabetes Coaches Program

Big data, Chronic Disease, Clinical Trials, Health and Fitness, Public Health

Stanford to launch Wellness Living Laboratory

Stanford to launch Wellness Living Laboratory

1200px-Female_joggers_on_foggy_Morro_Strand_State_BeachIf you’re the kind of person who wears a heart monitor while jogging, tracks your sleep with an app or meditates to lengthen your lifespan, then a new Stanford project, called WELL, just might be for you.

WELL, which stands for the Wellness Living Laboratory hasn’t started quite yet — it will launch in 2015 — but when it does, it will unleash a variety of cutting-edge tools in an effort to define health.

Health seems like a no-brainer, but it is more than the absence of disease, says John Ioannidis , MD, DSc, the head of the Stanford Prevention Research Center. Ioannidis wants to find out how people can be “more healthy than healthy.”

To do that, he secured $10 million and laid out plans for the project. WELL plans to enroll thousands of volunteers — who Ioannidis calls “citizen scientists” — in two initial locations: Santa Clara County, Calif., and China, with plans to expand to other sites in the future.

Participants may be able to select which health factors to track and to report much of their information remotely and digitally, although some in-person visits may be required. Participants will also have the opportunity to enroll in a variety of clinical trials to test various interventions, such as nutrition counseling or smoking cessation programs.

The program will focus on wellness, rather than diseases, with the hypothesis that promoting wellness thwarts diseases, Ioannidis said.

Volunteers who would rather not provide health information will also have the opportunity to benefit from access to a program-wide social networking effort that will spread news of successful practices, he said. “This outer sphere could reach out to tens of millions of people,” Ioannidis told me.  Stay tuned to learn how to sign up.

The $10 million came as an unrestricted gift to Stanford University from Amway’s Nutrilite Health Institute Wellness Fund.

Previously: Medicine X explores the relationship between mental and physical health, Stanford partnering with Google [x] and Duke to better understand the human body, New Stanford center aims to promote research excellence and Teens these days smoking less but engaging in other risky behaviors
Photo by: Mike Baird

Aging, Health Policy, In the News, Medicine and Society

No one wants to talk about dying, but we all need to

No one wants to talk about dying, but we all need to

“Dying in America is harder than it has to be.”

That’s the headline of one of the stories published following the release of the Institute of Medicine’s 500-page report titled “Dying in America.” The report tackles head-on the difficult topic of how to provide individualized, appropriate care for patients with advanced serious illness in a country that is grappling with out-of-control health care costs.

Patients should, and can, take control of the quality of their life through their entire life, choosing how they live and how they die

Its conclusion: The system needs a major overhaul.

“Our current system is broken,” said David M. Walker, co-chair of the 21-member committee that authored the report and former U.S. Comptroller General from Bridgeport, Conn. “It does not result in the type of quality of care that people deserve and desire and it’s much more costly. Systematic changes are needed for more compassionate, affordable care.”

No easy solutions exist, the authors said at an hour-long press conference announcing the release of the report yesterday. Instead, they plan to spend the next year getting their message out to the public with far ranging goals for change: from more comprehensive coverage of palliative care by medical insurance, to more hours of palliative care education in medical and nursing schools, to improved communication between health care providers and their patients about their end-of-life care choices – along with a payer-system that reimburses for those conversations.

It’s a controversial topic that broke out into the public debate five years ago during the passage of the Affordable Care Act, when opponents of the bill claimed that a proposal for Medicare to reimburse doctors for counseling patients about living wills and advance directives would lead to bureaucrats setting up “death panels” to determine who deserved care.

But it’s also a topic that can no longer be ignored, authors of the report said. Too many Americans are suffering unnecessarily and as the elderly population continues to grow with the aging of the baby boom generation, these problems will continue to multiply.

“For most people, death does not come suddenly,” said Philip Pizzo, MD, co-author of the report and former dean of Stanford’s medical school, in an email to me discussing the conclusions of the report. “Instead, dying is a result of one or more diseases that must be managed carefully and compassionately over weeks, months, or even years, through many ups and downs.”

Physicians and other health care professionals can provide well-rounded care at the end of life to relieve patient pain, maximize functioning, alleviating emotional stress, and ease the burden of loved ones – all in a manner that is consistent with individual choices, he said.

“Patients should, and can, take control of the quality of their life through their entire life, choosing how they live and how they die,” Pizzo said.

But it’s not happening today.

“Studies show that doctors want to die in comfort at home at the end of life, but subject patients to high-intensity ineffective treatments,” he said. “Why?”

Previously: Study: Doctors would choose less aggressive end-of-life care for themselves, Former School of Medicine dean named to expert panel to reform end-of-life care in America, Communicating with terminally ill patients: A physician’s perspective and On a mission to transform end-of-life care

Biomed Bites, Cancer, Research

Discover the rhythms of life with a Stanford biologist

Discover the rhythms of life with a Stanford biologist

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This the second installment of our Biomed Bites series, a weekly feature that highlights some of Stanford’s most compelling research and introduces readers to innovative scientists from a variety of disciplines. 

What do giant bamboo plants — which flower once every 64 years — and cancer cells have in common? Both are governed by a biological cycle that Stanford professor James Ferrell, MD, PhD, is working to decipher. “We’re trying to figure out how these clocks work,” Ferrell says in the video above.

Ferrell says he has to use many tools familiar to physicists who work commonly with oscillations, although he studies living organisms as part of the burgeoning field of chronobiology.

Humans are governed by a network of closely rhythms, Ferrell explains:

We are intrinsically rhythmic organisms. We are a different person in the morning from the person we are in the evening. This might have profound consequences in terms of the proper way to treat disease.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving forward biomedical innovation here.

Becky Bach is a former park ranger who now spends her time writing or on her yoga mat. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Studying the drivers of metastasis to combat cancer, Why sleeping in on the weekends may not be beneficial to your health, The key to speed? Inside the cell, it’s trigger waves 
Photo in featured entry box by Breezy Baldwin

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