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Emergency Medicine, Global Health, Stanford News

Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims

Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims

Paul Auerbach is in Nepal to aid victims of the recent earthquake and has been sending periodic reports.

The earthquake in Nepal caused immense damage to people and property not only in Kathmandu, but in a widespread area extending to Mt. Everest and in many other directions. Victims on Mt. Everest and in Kathmandu proper appropriately received a great deal of attention, but equally important has been the plight of persons trapped in villages remote from the big city. These communities are located in steep and isolated terrain, so that it is difficult to reach them by road, and sometimes even by helicopter. Part of the mission of International Medical Corps (IMC) and the other responding organizations has been to identify these areas of need and attempt to locate and treat the victims.

We continue to see improvement each day, and the number of volunteers from around the world is impressive

After a discussion with three health officials – the senior district health officer for Dhading, a pediatrician assigned to lead the district medical response to the earthquake, and the medical supervisor for the Dharding District Hospital, we were asked to consider finding a way to approach one of several villages that were reported to have urgent medical needs, but which had not yet been visited by rescuers and medical professionals. We selected Kumpur, a rugged 90-minute approach requiring a 4-wheel drive vehicle. We excluded others that required helicopter access, because these aircraft have been in short supply.

At the Dhading District Hospital, we witnessed arrival of a dozen earthquake victims choppered in from Darkha, which is at a high elevation in this region. They were suffering from trauma, with broken limbs and wounds in various stages of infection. The Nepalese doctors who volunteered their time by leaving Bangladesh to respond at the request of IMC, alongside a (literally) busload of surgeons and other medical professionals volunteering from India were skilled and swift in delivering treatment despite the limited resources and surge of patients.

The next day, we took a team into Kumpur and witnessed widespread destruction amid the beautiful surroundings. Many dwellings composed of mud and stone had collapsed, and the residents are now living in tents. With the monsoon season approaching, they will need assistance to rapidly create more suitable structures. They were busy clearing the remains of their homes and other structures, but always gave us a smile and a greeting. Their resilience and work ethic are amazing.

The health outpost has been rendered largely unusable, with large cracks in its side, holes in the wall, and instability in every direction. So, we worked mostly in the single safe room remaining and on the porch leading to the entryway. With a stellar support team, including two recently graduated doctors from Nepal, we were able to interview and examine many of the villagers, dealing with complaints both related to injuries sustained in the earthquake and medical conditions for which they sought advice.

As the days pass, fewer patients will present with acute earthquake-related injuries, and the medical care will shift to resumption of adequate primary care, surgeries related to orthopedic and soft tissue injuries, and aggressive detection and management of infectious diseases that might cause an epidemic. Public-health experts are on-scene, as are epidemiologists and other experts in sanitation systems, water disinfection, and so forth. Given the large geographic area affected by the earthquake and difficulty reaching many locations, the logistics are extremely important.

We continue to see improvement each day, and the number of volunteers from around the world is impressive. We hope for the best and appreciate all the support we’ve received from family and friends.

Paul Auerbach, MD, is a professor and chief of emergency medicine. 

Click here for a statement on Nepal from Michele Barry, MD, senior associate dean of global health and director of the Center for Innovation in Global Health (CIGH). Additional updates related to the Stanford relief efforts will be shared on the CIGH website in the coming days and weeks.

Previously: Day 2: “We have heard tales of miraculous survival” following Nepal earthquake and Day 1: Arriving in Nepal to aid earthquake victims

In the News, Sleep, Sports, Stanford News

Sleep = one of the keys to Golden State Warriors’ success

Sleep = one of the keys to Golden State Warriors' success

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All-Star shooting guard Klay Thompson loves to take three pointers, and he’s good at it – he’s second in the league in made threes this season. (His teammate and fellow “Splash Brother” Stephen Curry holds the number one spot.) Thompson also loves to sleep, and perhaps the two aren’t unrelated. The Associated Press was there when Stanford sleep researcher Cheri Mah paid a visit to the Golden State Warriors’ locker room last week, sharing some tips with the team.

Much of Mah’s work focuses on sleep and athletic performance, and she says sleep is something that’s often put on the back burner, especially with elite teams who have grueling  schedules. From the piece:

“It’s one of the first things we sacrifice but one of the most important,” Mah said Thursday. “Changing time zones frequently, that can affect circadian rhythms. Really, it was addressing improving and optimizing sleep and recovery.”

Getting more sleep is something Thompson has no problems with. “I know how important recovery is,” he said in the article. “We play such a long season. And I love to sleep, so it was good hearing that if you want to be at optimal peak performance you’ve got to get your eight hours, or at least try to. You can’t be hanging out long hours at night.”

Previously: Superathletes sleep more, says Stanford researcherAsk Stanford Med: Cheri Mah responds to questions on sleep and athletic performance, Expert argues that for athletes, “sleep could mean the difference between winning and losing,” Why your sleeping habits may be preventing you from sticking to a fitness routine and A slam dunk for sleep: Study shows benefits of slumber on athletic performance
Photo by Chilli Head

In the News, Patient Care, Pediatrics, Stanford News

Fifty-plus years of Sunshine: Long-time Stanford neonatologist discusses his career

Fifty-plus years of Sunshine: Long-time Stanford neonatologist discusses his career

sunshineWith a name like Dr. Sunshine, parents should know their premature babies are in good hands. On yesterday’s Forum, neonatologist Philip Sunshine, MD, discussed the fifty-plus years he’s been caring for preemies. At 84, he’s still at it, working 30 hours in a step-down nursery at Lucile Packard Children’s Hospital Stanford. (He jokingly told host Michael Krasny, “I do all the stuff the young people don’t want to do.”)

During the hour, Sunshine, a 2015 “Legends of Neonatology” honoree, talked about the changing field of neonatology, including his views on the ever-growing popularity of home births (“Home deliveries are for pizzas only,” he quipped, referencing a pin his former classmate always wore). He also read e-mails and took calls from listeners – many of whom thanked him for saving their children’s lives (30,000 and counting).

Previously: Eightysomething “neonatology superhero” still at itA pioneer of modern-day neonatology and Neonatologist celebrates 50 years of preemie care
Photo courtesy of Lucile Packard Children’s Hospital Stanford

Research, Sleep, Stanford News

William Dement: Stanford Medicine's "Sandman"

William Dement: Stanford Medicine's "Sandman"

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Sixty years before he would be referred to as the “Father of Sleep Medicine,” William Dement, MD, PhD, got kicked out of a class for dozing off.  One of the world’s foremost sleep experts, Dement is profiled in the current issue of STANFORD magazine, with writer Nicholas Weiler describing how Dement blazed a trail for the field of sleep research and medicine.

From the piece:

When he arrived at Stanford, he set aside most of his research on dreams and shifted his focus to pathologies that affect sleep quality—and to the importance of optimal sleep in our daily lives. “It wasn’t until we realized there were sleep disorders,” he says, that people started paying attention to sleep research. In 1970, he founded the Stanford Sleep Disorders Clinic, a center dedicated to the diagnosis and treatment of these maladies. The clinic was soon inundated by patients complaining of extreme daytime sleepiness due not to narcolepsy or insomnia, but to a recently discovered disorder, sleep apnea, in which the patient’s airway would collapse during sleep, causing him to wake gasping for air hundreds of times each night.

Galvanized by the unexpected prevalence of undiagnosed sleep disorders, Dement spent the next decade working feverishly to raise the profile of sleep medicine as a clinical field. Before long, similar clinics were springing up all over the country, “and they were finding the same thing,” Dement says. Still, it wasn’t until 1993 that the first long-term epidemiological study found that 24 percent of men and 9 percent of women suffer from sleep apnea. Research at the Stanford Sleep Disorders Clinic and elsewhere has found strong correlations between sleep apnea and obesity, high blood pressure and heart disease, America’s leading cause of death.

Thanks to his work and the popular sleep class that he has taught since 1971 (more than 20,000 students have taken it!), Dement is well-respected and loved among his peers and students – something captured by this 2008 video.

Previously: Stanford docs discuss all things sleepCatching some Zzzs at the Stanford Sleep Medicine CenterThanks, Jerry: Honoring pioneering Stanford sleep research and Catching up on sleep science
Related: Stalking the netherworld of sleep and Dement keeps last class wide awake
Illustration, which originally appeared in STANFORD, by Gabriel Moreno

In the News, Public Health, Sleep

Stanford docs discuss all things sleep

Stanford docs discuss all things sleep

“Drowsiness is red alert!” is a phrase coined by Stanford’s William Dement, MD, PhD, who is often referred to as the “Father of Sleep Medicine.” It’s also a phrase he wrote on the wall of KQED’s green room this morning as a guest on Forum. Dement, along with Stanford sleep expert Rafael Pelayo, MD, and UC  Berkeley’s Matthew Walker, PhD, discussed sleep, or lack thereof, in the United States.

KQED ForumDuring the hour-long segment, the panel weighed in on the detrimental effects that poor sleep has on people’s physical and mental health, and took numerous calls from listeners. The experts also emphasized that quality, not just quantity, of sleep is important. “You should wake up feeling refreshed,” Pelayo told listeners. “You don’t leave restaurants feeling hungry, [so] you should not wake up in the morning feeling tired.”

Previously: Stanford researcher examines link between sleep troubles and suicide in older adults, Catching some Zzzs at the Stanford Sleep Medicine Center, Exploring the effect of sleep loss on healthCatching up on sleep science and Thanks, Jerry: Honoring pioneering Stanford sleep research
Related: Sleep legend Dement keeps last class wide awake
Photo by Margarita Gallardo

Ethics, Events, Health Policy, Medicine and Society, Public Health, Transplants

Stanford Health Policy forum on organ-donation crisis now available online

Stanford Health Policy forum on organ-donation crisis now available online

The latest Stanford Health Policy Forum, which focused on ways to end our country’s organ-donor shortage, is now available online. More than 100,000 Americans currently need organ transplants, and the panelists discussed a variety of solutions for solving the problem. Among the ideas brought to the table was a compensation system for donors – an option that was also the focus of an article in today’s San Francisco Chronicle.

Previously: At Stanford Health Policy Forum, panelists dig into the issue of organ donationHow can we end the donor organ shortage?, Stanford visiting professor and founder of kidney-exchange program wins Nobel economics prize and One gift saves three young lives 

In the News, Parenting, Pediatrics, Sleep

Study: Baby sound machines may be too loud for little ears

Study: Baby sound machines may be too loud for little ears

DSC_0293Sound machines that help babies sleep more soundly are a staple on many new parents’  baby registries (I had a little sheep that mimicked the sounds of rainfall and ocean waves). Well, as you may have read about elsewhere today, a new study published in the journal Pediatrics finds those soothing sounds may actually do more harm than good. Researchers from the Hospital for Sick Children in Toronto have found that infant sleep machines can reach sound levels that are hazardous to infant hearing and development. Writer Michelle Healy outlines their findings in an article in USA Today:

When set to their maximum volume:

— All 14 sleep machines [studied] exceeded 50 decibels at 30 cm and 100 cm, the current recommended noise limit for infants in hospital nurseries.

— All but one machine exceeded that recommended noise limit even when placed across the room, 200 centimeters away.

–Three machines produced outputs greater than 85 decibels when placed 30 cm away. If played continuously, as recommended on several parenting websites, infants would be exposed to sound pressure levels that exceed the occupational noise limits for an 8-hour period endorsed by the National Institute for Occupational Safety and Health and the Canadian Centre for Occupational Health and Safety.

It’s important to note that the researchers only tested the maximum output levels produced by the sound machines, and not their direct effect on infants. But Nanci Yuan, MD, tells Healy that the study does raise some important concerns:

​Parents “can feel desperate and want to try anything” when a baby has difficulty sleeping, says Nanci Yuan, pulmonologist and sleep medicine specialist at Lucile Packard Children’s Hospital Stanford.

But this research highlights the potential for a previously “unknown harm that can occur,” Yuan says. “We’re getting more and more concerned about issues related to sound and noise and hearing-loss in children because it’s progressive.”

Photo by Margarita Gallardo

Behavioral Science, Mental Health, Stanford News

Study: Bulimics may have difficulty perceiving their own heartbeat

Study: Bulimics may have difficulty perceiving their own heartbeat

3408225331_ce15c66c6b_zNew research published in the December issue of Eating Behaviors shows a possible link between bulimia and the ability to detect one’s own heartbeat. The study found that women who suffered from the eating disorder were less likely to accurately detect their own heartbeat, and thus, may have difficulty detecting other internal cues such as hunger or fullness. From an Inside Stanford Medicine story:

A growing body of literature shows that heightened or suppressed interoception [which is the ability to sense internal body cues] is either a contributor to or a product of many psychiatric disorders. For example, anxiety patients tend to be particularly sensitive to their own heartbeat. They are more likely to accurately detect their own heartbeat than those without anxiety.

This is the first study to use the heartbeat detection task to assess interoception in recovered bulimia nervosa patients, [Megan Klabunde, PhD, a postdoctoral scholar at the Stanford Center for Interdisciplinary Brain Sciences Research], said. Previous studies have asked participants to rate their own ability to detect hunger and satiety.

Klabunde said it is unclear whether diminished interoception is a contributing factor to the development of the bulimia, or a consequence of repeated binging and purging.

However, she feels that bulimia and other eating disorders are not purely driven by a vain desire for thinness. “I come from a philosophy that, in terms of psychiatric disorders, symptoms are there for a reason. And if we don’t understand the symptom, it means we need to research it better,” Klabunde said.

Klabunde plans to continue to study interoception in the context of eating disorders and says this work could lead to potential new therapies for eating disorders. “The body is clearly involved in emotional processing,” Klabunde said. “We might have to be more creative in terms of how we address the body in treating psychiatric disorders.”

Previously: Possible predictors of longer-term recovery from eating disorders and Exploring the connection between food and brain function
Photo by sunshinecity

Aging, Health and Fitness, Stanford News

Exercise is valuable in preventing sedentary death

Exercise is valuable in preventing sedentary death

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There’s nothing positive about a sedentary lifestyle. Little or no physical activity can lead to worrisome health conditions, such as heart disease and Type 2 diabetes, and to premature death. With more people living longer than before, the value of exercise is a message that needs to be reinforced, especially among the aging population.

In a Q&A for the current issue of Stanford Medicine Newsletter, Carol Wingard, MD, former clinical director of the Geriatric Research Education Clinical Center at Stanford, discusses why it’s important for older adults to stay active and prevent age-related decline. She also explains:

We all start adult life with a certain amount of muscle, though men start out with more than women because of testosterone.

So over time there is a gradual loss of muscle that begins in the 20s. Men and women lose muscle at the same rate, but women start at a lower level. Because women start with less muscle mass, they tend to arrive at the disability threshold—the point at which it becomes difficult to carry groceries or go up the stairs—much earlier than men. That is part of why so many women are frail.

There also is a certain amount of age-related decline. A 60-year-old super-elite trained athlete may be able to run as fast as a 20-year-old, but that crossover happens physiologically between 60 and 70. However, all of us can reverse the degree of decline through exercise. Cardiovascular, strength, balance and flexibility exercises also can help prevent falls.

Wingard recommends to start slowly, especially for older patients who haven’t exercised for a while. “For someone who is able to walk, I suggest walking five minutes three times a day for a week or two. Then add one minute every week. That’s a very cheap, readily available way of doing it.”

Previously: Is standing healthier than sitting?How sedentary behavior affects your healthStudy shows frequent breaks from sitting may improve heart health, weight lossSeries looks at the physiology of sedentary behavior and Stanford hosts conference on the science of sedentary behavior
Photo by .v1ctor Casale

Medical Education, Stanford News

Free, online Stanford course on science writing opens this week

Free, online Stanford course on science writing opens this week

The School of Medicine has launched its fourth free MOOC (massive open online course), this one called SciWrite: Writing in the Sciences. The eight-week course is being taught by Stanford’s Kristin Sainani, PhD, and aims to turn scientists into more effective writers. Topics range from issues in publication and peer review to communicating science for lay audiences, and this week’s focus is on “principles of effective writing (cutting unnecessary clutter).”

You can join the class through its webpage.

Previously: Can massive open online courses change health care?, A call to fix the “crisis of communication” in science, Challenging scientists to better communicate their ideas to the
public
, Want to become a better science communicator? Try explaining science to a child and A conversation about the importance of conveying complex scientific concepts to broad audiences

Stanford Medicine Resources: