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Patient Care, Pediatrics, Research, Stanford News, Surgery

Spanish-speaking families prefer surgical care in their native language, study finds

Spanish-speaking families prefer surgical care in their native language, study finds

Bruzoni-scrubsFive years ago, when Matias Bruzoni, MD, was a new pediatric surgical fellow at Lucile Packard Children’s Hospital Stanford, his fluency in Spanish meant that he often accompanied other surgeons to consult with Hispanic families who spoke little English.

“I went with the attending surgeon, and would help explain the operation in Spanish, and then the family would say to me ‘Great, would you mind being our surgeon?'” he recalled recently. “And I’d say, ‘But I’m a fellow’ and they would say ‘We’d rather stay with you.'”

The families greatly valued their linguistic and cultural connection to Bruzoni. As he had more of these interactions, Bruzoni realized the hospital’s entire pediatric general surgery team held a mostly untapped linguistic resource. Many of its members – including receptionists, nurse practitioners and triage staff – spoke fluent Spanish.

After Bruzoni finished his training, he organized this group of caregivers into the hospital’s Hispanic Center for Pediatric Surgery, which offers patients and families the ability to receive all of their pre- and post-surgical care in Spanish. Every interaction, from registering the patient to giving post-surgical instructions, happens in the families’ first language. Bruzoni wondered how this approach would compare to using trained medical interpreters, whose services are offered to all non-English-speaking families at the hospital.

A new study, published in the most recent issue of the Journal of Pediatric Surgery, shows what his research found. From our press release:

Spanish-speaking families that discussed their children’s care in Spanish reported a higher level of satisfaction and higher ratings of the quality of information they received compared with the families in the control group and those that worked through an interpreter. Spanish-speaking families rated the importance of discussing care in their native language more highly than English-speaking families, the study found.

Although socioeconomic status was not assessed in this study, Bruzoni noted that Hispanic families of low socioeconomic status may have an even greater need than others to receive care in their native language. “There is a big cultural barrier,” Bruzoni said. “Because of these patients’ circumstances, it is even more important to work with them using their own language.”

Bruzoni plans to continue studying how to deliver better surgical care to California’s growing population of Hispanic children.

Previously: Stanford student earns national recognition for research on medical communication, An app to break through language barriers with patients and Advice for parents whose kids need surgery
Photo courtesy of Lucile Packard Children’s Hospital Stanford

Big data, Pediatrics, Research, Stanford News

Rare gene variants help explain preemies’ lung disease, Stanford study shows

Rare gene variants help explain preemies' lung disease, Stanford study shows

double-helixBecause they’re born before their lungs are fully mature, premature babies are at risk for a serious lung disease. Over the last several decades, this disease, bronchopulmonary dysplasia, has evolved into both a great medical success story and a persistent mystery. But a new Stanford study, published this week, is helping clarify the mysterious part.

First, the success story: Today, doctors can prevent BPD in many babies who would have died of it in the past. Artificial surfactant, which helps keep the air sacs of the lungs open, and extensive research on when it’s appropriate and safe to put preemies on a respirator have both greatly reduced the risk of lung injuries after birth, which can contribute to BPD. The improvement has been especially remarkable for babies born on the later end of the premature spectrum.

However, BPD is still a big problem for infants who arrive more than 12 weeks early. Doctors still have trouble figuring out which of these early preemies are at risk, and why. An editorial accompanying the new Stanford study, which appears in the American Journal of Respiratory and Critical Care Medicine, explains how scientists’ understanding of BPD has evolved:

It is now widely appreciated that the persistence of BPD is strongly linked with factors far beyond postnatal lung injury alone. Importantly, the BPD and related respiratory outcomes clearly have antenatal origins… Growing data support the concept that BPD is at least partly a “fetal disease.”

The editorial names several factors in the prenatal environment that weigh into BPD risk, including certain pregnancy complications and also maternal smoking or drug use. It’s not just the environment that plays into risk, though; twin studies also hint that genes also factor in, and knowing which genes are involved would provide enormous clues to how the disease occurs.

A prior Stanford study that attempted to connect common human gene variants to BPD risk didn’t turn up any good candidates. So, in the new study, the Stanford team focused instead on rare genetic variants. Using data from California’s extensive repository of newborn blood spots (small blood samples collected as part of the state’s program to screen newborns for genetic diseases), they turned up 258 rare gene variants for further investigation, all of which are linked to cell processes that could plausibly be involved in BPD.

“We hope these results will guide future research that can determine the most important pathophysiologic pathways leading to BPD,” said Hugh O’Brodovich, MD, the study’s senior author. The idea isn’t to target the genes themselves for treatment, but rather to help researchers figure out what goes wrong at a molecular level in the lungs of babies who get BPD.

“We also hope this work will be used to discover how clinicians can minimize the chance that an extremely premature baby will develop the disease,” he added.

Previously: Study of outcomes for early preemies highlights complex choices for families and doctors, Stanford-led study suggests changes to brain scanning guidelines for preemies and Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges
Photo by James Gaither

Chronic Disease, Events, Pain, Stanford News

Stanford expert on back pain: “The important thing for people to know is that it’s treatable”

BackPainSeptember is Pain Awareness Month and later this month, Stanford will host a Free Back Pain Education Day. The event, sponsored by the Division of Pain Medicine, offers community members the opportunity to come to campus and hear about current back pain management strategies and the latest research. The event will also be live-streamed via YouTube for people unable to make it in person.

In anticipation of the Sept. 13 event, I sat down with Beth Darnall, PhD, a pain psychologist at Stanford’s Pain Management Center, and one of the day’s speakers. I was interested to understand why back pain is such a critical health problem worldwide and what people living with back pain can do to manage their pain.

Back pain is a leading cause of disability in the U.S. and other countries. Why is chronic back pain so common?

I think there are many different reasons why back pain is the number one pain condition. The back seems to be the place that’s really most related to the development of chronic pain and debility from chronic pain. Pregnancy can either trigger or flare back pain, but there are a multitude of reasons: aging (there is degeneration of the spine), obesity (when people gain weight, it puts additional load on the spine), activity levels, and influence of posture. Dr. Sean Mackey will be talking about some of the reasons why back pain is the most prevalent pain condition in the world at the event.

[Back pain] is something that almost everyone will experience at some point in their lifetimes, so it’s really relevant to all of us, whether we have pain now or not.

Why have a community event about back pain now?

There has been increasing global and national attention to chronic pain in terms of its impacts and costs to society. In the United States alone, 100 million suffer from pain on a regular basis, and that is associated with costs of $635 billion dollars annually. That includes treatment costs and loss of productivity.

What we also know is that the incidence and prevalence of chronic pain has been increasing, despite the fact that theoretically, we have better treatments. So then the question is why. While we have a multitude of treatments available, we haven’t been focusing on back pain as comprehensively as we really should. We need a broader approach to the treatment of pain. This was recently outlined in the National Institute of Health’s National Pain Strategy (Note: Mackey co-chaired the oversight committee).

Some people may be under the misconception that the best way to treat back pain is simply with a pill… While medication can be one helpful component, the best way to treat back pain is with a comprehensive approach that involves self-management strategies.

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Cancer, Genetics, Imaging, Precision health, Research, Science, Stanford News

You know it when you see it: A precision health approach to diagnosing brain cancer

You know it when you see it: A precision health approach to diagnosing brain cancer

BurlIf you know which virus has made a person ill, as well as whether your patient responds better to drug A or drug B, you’re in a much better position to treat them. In the world of oncology, it’s often the genetic personality of the tumor itself that determines the best treatment protocol. A tumor with one set of gene variants may be susceptible to only one of several treatments. To decide which drug to prescribe, you’ve got to know your tumor.

In some cancers, such as skin cancer, it’s easy to physically examine the tumor and easy to take a biopsy to root out the tumor’s genetic secrets. But for cancers deep in the brain, a biopsy is problematic. And without knowing more about a brain tumor, it’s harder to guess the right treatment.

Now a team of researchers, led by Stanford’s Haruka Itakura, MD, and Olivier Gevaert, PhD, have distinguished three types of brain tumors. Each type is identifiable by their appearance in MRIs and predictably associated with specific molecular characteristics. Itakura and Gevaert report their work in today’s Science Translational Medicine.

Magnetic resonance imaging revealed three distinct kinds of glioblastoma brain tumors, each of which could be associated with a different probability of patient survival and a unique set of molecular signaling pathways. The work paves the way for more precise diagnosis, better targeted therapies and personalized treatment of GBM brain tumors.

Previously: Brain imaging, and the “image management” cells that make it possibleA century of brain imaging and When it comes to brain imaging, there’s nothing simple about it
Photo by Travis

Medicine and Literature, Podcasts, Public Health, Science

Jonas Salk: A life

Jonas Salk: A life

Salk book coverIn 1954, Charlotte DeCroes stood in line with her fellow second graders in Kingsport, Tennessee and received the polio vaccine. Her Tennessee hometown was one of the test sites for what was then the largest and most significant clinical trial in the history of medicine. By the end of 1953, there were 35,968 reported polio cases, and the United States was desperate to solve this devastating illness. A survey at the time ranked fear of polio second only to fear of atomic warfare.

Fast forward to 2015. Charlotte Jacobs, MD, professor of medicine, emerita at Stanford, has written a highly acclaimed biography of the famed researcher/physician Jonas Salk, MD, who developed the polio vaccine. In this 1:2:1 podcast, she told me that her ten-year journey into Salk’s life was instigated partly because she couldn’t find a thorough autobiography on him, something she considered a historical lapse.

Jacobs has written a finely honed and balanced portrait – saluting Salk’s great accomplishment while not flinching from describing a man who was enigmatic, complex and all too human. She conducted more than a hundred personal interviews and spoke to two of his three sons along with his longtime private secretary. The dichotomies of his life are fascinating. While he was loved and lauded by the public and the media, he was a pariah in the scientific community – never appreciated, accepted or awarded. (His scientific colleagues thought he was a press hound, an impression that was fueled by the media’s adoring gaze – covers and feature articles in the most popular media of the time, including Life, Time, Colliers, Consumer Reports, Popular Mechanics and U.S. News and World Report.)

Today, with vaccine wars sweeping certain areas of the country, Jacobs reminds us of a time when a major public-health crisis engulfed the nation and of a hero who made a difference and changed the landscape of medical history. It’s worth remembering.

Previously: Charlotte Jacobs on finding “snippets during every day” to balance careers in medicine and literatureStanford doctor-author brings historic figure Jonas Salk to life and Prescribing a story? Medicine meets literature in “narrative medicine”

Infectious Disease, Public Health, Research, Stanford News

Hikers beware: New tick-borne disease discovered in Northern California parks

Hikers beware: New tick-borne disease discovered in Northern California parks

dan with wood rat 3Meet Dan Salkeld, PhD, a disease ecologist and friend, shown here looking for ticks on a wood rat from the San Francisco Bay Area. According to Popular Science, he has one of the worst jobs in science: tick collecting.

But thanks to the nitpicky diligence of Salkeld and co-author Eric Lambin, PhD, a senior fellow at the Stanford Woods Institute for the Environment, Bay Area residents now know that getting sick from a tick bite is a real and present danger — in a recent study published in PLoS One, the researchers found that 10.6 percent of young nymph ticks and 8.1 percent of adult ticks harbored the disease-causing bacteria Borrelia miyamotoi and/or Borrelia burgdorferi, the causative agent of Lyme disease. (See map below for tick collection areas.)

“We continue to be surprised by the number of ticks carrying Borrelia burgdorferi and Borrelia miyamotoi throughout the Bay Area, and we believe more research into the connections between human disease and strains and species of bacteria is critical,” said Salkeld. “It was astonishing that we could see such variety in tick ecology, ranging from low tick infection risk on one trail to high tick infection risk on another trail in the same park.”

First discovered in the United States in 2013, the most extensive analysis of Borrelia miyamotoi infections in U.S. residents was published in the July issue of Annals of Internal Medicine. In this study, 51 patients from the Northeast were found to be “frequently very ill” with fever, headache (often severe), muscle pain, fatigue and joint pain. Almost one quarter of the patients required hospitalization. The researchers also found that the miyamotoi infections were not reliably detected by the standard two-tiered Lyme blood test and these patients didn’t develop the hallmark sign of Lyme disease, the bullseye rash.

“This research offers some insights into the complexity of diagnosing patients with tick-borne diseases, and the need for medical professionals to be alert to the different symptoms of this newly discovered infection,” said Linda Giampa, executive director, of the Bay Area Lyme Foundation, which funded this study.

The Bay Area Lyme Foundation also funds a number of projects at Stanford’s Lyme Disease Working Group, which is exploring ways to improve diagnostic tests, evaluate the effectiveness of innovative therapies, expand clinical services and build greater public awareness of tick-borne diseases.

SFBay_Parks_PLoS-One

Previously: Stanford study finds Lyme disease among ticks in California parksAdd a tick check to your vacation checklistPiecing together the clues: Diagnosing and treating autonomic disorders
Photo courtesy of Bay Area Lyme Foundation; map from PLoS One

Chronic Disease, Neuroscience, Pain, Research, Stanford News

Study: Effects of chronic pain on relationships can lead to emotional distress

Study: Effects of chronic pain on relationships can lead to emotional distress

sad womanIt’s not surprising that people living with chronic pain often have high levels of emotional distress. The question that Stanford researcher Drew Sturgeon, MD, a postdoctoral pain psychology fellow in the Stanford Pain Management Center, recently aimed to determine was why. Is a patient’s depression or anger caused by his or her inability to do physical things or is it perhaps because pain can limit social relationships?

“What I hear from patients is that it’s not just that it hurts, but that the pain takes you away from things that matter to you – the things that are meaningful to you,” Sturgeon recently said.

To explore this further, Sturgeon and colleagues analyzed data from 675 patients who came into the Stanford pain clinic and filled out data sets for the national open source Collaborative Health Outcomes Information Registry, referred to as CHOIR. CHOIR is a registry that originated at the Stanford pain center to help improve the collection and reporting of data on pain.

The researchers examined both physical functioning and social satisfaction reported by chronic pain patients, since both have been shown to play a role in causing anger and depression. Their results — published online recently in the journal Pain — show that the effects of chronic pain on a patient’s social relationships can be a key trigger of depression and anger, even more so than the limits that pain can place on physical activity.

“My suspicion was that there was going to be a stronger frustration when [the pain] affects social relations,” Sturgeon told me. “Relationships are one of the strongest predictors of mood. If you’re an avid bicyclist and can no longer cycle, that’s frustrating. But if cycling is the primary source of your social relationships, that’s even more frustrating.”

“The conversation when you have a patient with chronic pain who is very depressed tends to [focus on] how we treat the pain,” he continued. “Perhaps considering how the pain is affecting the people around the patient is also important… This is something that as a field we haven’t been paying very good attention to.”

Previously: National survey reveals extent of Americans living with pain, Chronic pain: getting your head around it and Advances in pain research and treatment
Photo by rochelle hartman

Patient Care, Pediatrics, Public Health, Stanford News, Surgery

Story highlights teens’ life-changing weight loss

Story highlights teens' life-changing weight loss

Over on the Healthy, Happier Lives blog today: A look at how bariatric surgery, combined with a strict diet plan and exercise regime, benefited two San Jose, Calif. teens. The siblings lost a combined total of more than 200 pounds and in the process have reduced their risk of obesity-related medical complications and improved their quality of life. “It’s been a life-changing transformation,” Sophia Yen, MD, an adolescent medicine specialist with Lucile Packard Children’s Hospital, commented.

Previously: The challenges of dieting and the promises of bariatric surgery and Bariatric surgery may help protect teen patients’ hearts

Mental Health, Pediatrics, Public Health, Stanford News

Stanford psychiatrist: It’s my “mission to help people develop to their full potential”

Carrion talking to patientHow can a person fully develop his or her potential, regardless of life circumstances? This is the question that brought Stanford child and adolescent psychiatrist Victor Carrion, MD, to his work on child anxiety and mood disorders. Carrion, who also directs the Stanford Early Life Stress and Pediatric Anxiety Research Program at Lucile Packard Children’s Hospital, just won the Silicon Valley Business Journal‘s Excellence in Healthcare award for his dedication to this question.

In an article describing this honor, Carrion says he’s always wanted to go into medicine and explore human behavior. While he’s very proud of the advances his lab has made in understanding the impact of early life stress on behavior, he also notes that there remain significant barriers to mental health in the region, including stigma and accessibility of treatment.

One of the innovative programs Carrion has been involved in is a study on the effectiveness of a health and wellness program in the Ravenswood City School District in East Palo Alto. The program teaches kids about mindfulness and positive habits that encourage calm, focused attitudes; Carrion and his colleagues will follow student participants over the next four years, tracking cognitive function, academic strengths and weaknesses, behavior, and stress-related hormone levels.

Previously: Stanford researchers use yoga to help underserve youth manage stress and gain focusProlonged fatigue and mood disorders among teensYoga classes may boost high school students’ mental well-beingLucile Packard Children’s Hospital partners with high schools on student mental health programs and More evidence that chronic stress may increase children’s risk of obesity
Photo courtesy of Stanford Medicine News

Genetics, Research, Science, Stanford News

Annoying anemones shed light on coral reef biology

Annoying anemones shed light on coral reef biology

Bleached CoralI stopped by John Pringle’s office last week to hear about what he’s been up to. A lot! As we mentioned here a few months ago, Pringle, PhD, a professor of genetics who spent the first decades of his career studying yeast genetics and cell biology, has switched gears and is looking for ways to help corals — while continuing a lifetime of basic research.

Corals and the incredibly species-rich ecosystems they support are disappearing fast in nearly every part of the world’s oceans. Coral reefs protect coastlines, sustain rich fisheries and support some of the most species-rich habitats in the world. Yet, around the world, a third of all coral has died.

The first sign of stress is a fading, or “bleaching,” of the coral that reflects the loss of photosynthetic algae that live inside the coral. In a quest to understand the molecular underpinnings of bleaching in corals, Pringle and two colleagues at Stanford helped sequence the genome of a small sea anemone that serves as a model for corals. They report their work this week in PNAS.

I asked Pringle what they’d found. But first, he wanted to tell me about his colleagues Christian Voolstra, PhD, Sebastian Baumgarten, and others at the Red Sea Research Center, in Thuwal, Saudi Arabia, where much of the experimental work and analysis took place. Pringle said the center is part of the King Abdullah University of Science and Technology, or KAUST, a six-year-old university with top researchers from around the world and a $20 billion endowment.

Although it’s easy to mistake coral for some kind of weird rock, corals are animals. But lab animals they are not. They grow slowly, in large colonies of tiny individuals, die easily and retreat inside their hard coral quarters when they aren’t happy.

A better option, Pringle learned, was a sea anemone called Aiptasia. Aiptasia is a pest that drives aquarium hobbyists to distraction. It thrives in captivity, takes over aquaria, and is seemingly impossible to eradicate — in short, the perfect lab animal.

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