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Biomed Bites, Research, Science, Stanford News, Videos

Studying the drivers of metastasis to combat cancer

Studying the drivers of metastasis to combat cancer

Today we’re launching Biomed Bites, a weekly series created to highlight some of Stanford Medicine’s most compelling research and introduce readers to promising scientists from across the basic and clinical sciences.

One might not think there’s much of a connection between grapes and cancer cells, but Amato Giaccia, PhD, has found some similarities. “The tumor microenvironment is very analogous to the microenvironment you would have in Napa Valley, where different types of grapes grow in different areas depending on the richness of the soil and the different climate and weather that exist,” explains the Stanford radiation oncologist and cancer biologist in the video above. “In a similar matter, tumors require different environments for them to be able to grow and… metastasize.”

Giaccia and his colleagues study the genetic and epigenetic regulators of metastasis, and their work could lead to the development of therapeutics that inhibit or eradicate the process, which contributes to 90 percent of cancer-related deaths. “Understanding the drivers of metastasis and how to best target them is going to have a major impact on cancer survival and mortality in the future,” Giaccia says.

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

Previously: Cellular culprit identified for invasive bladder cancer, according to Stanford study, Potential anti-cancer therapy starves cancer cells of glucose and Nomadic cells may hold clues to cancer’s spread
Photo in featured entry box by Lee Coursey/Flickr

Mental Health, Research, Stanford News

Study shows benefits of breathing meditation among veterans with PTSD

Study shows benefits of breathing meditation among veterans with PTSD

man meditating - smallEarlier this year, Emma Seppala, PhD, associate director of Stanford’s Center for Compassion and Altruism Research and Education and a research psychologist at the the medical school, wrote on Scope about her work using breathing meditation to help veterans with PTSD. One of her studies, involving 21 male veterans of the Afghanistan and Iraq wars who were taught a set of breathing techniques from the Sudarshan Kriya Yoga practice, has now been published.

A recent Stanford Report article provides more details on the research, which found that the breathing techniques “resulted in reduced PTSD symptoms, anxiety and respiration rate” among study participants. The piece also highlights Seppala’s surprise that the meditation appeared to have a lasting effect:

“It is unusual to find the benefits of a very short intervention – one-week, 21 hours total – lasting one year later,” she said. One year after the study, the participants’ PTSD scores still remained low, suggesting that there had been long-lasting improvement.

When the scientists asked the veterans whether they had continued practicing at home, a few had but most had not. The data showed that whether or not they had practiced at home, it did not hinder meditation’s long-term benefits.

One reason, Seppala suggested, is that Sudarshan Kriya yoga retrained the veterans’ memories.

Before the breathing meditation training, participants reported re-experiencing traumatic memories frequently and intensely, Seppala said. Afterward, they reported that the traumatic memories no longer affected them as strongly or frequently.

The study appears in the in the Journal of Traumatic Stress.

Previously: The remarkable impact of yoga breathing for trauma, The promise of yoga-based treatments to help veterans with PTSD, Using mindfulness therapies to treat veterans’ PTSD, As soldiers return home, demand for psychologists with military experience grows, Stanford and other medical schools to increase training and research for PTSD, combat injuries and Can training soldiers to meditate combat PTSD?
Photo by Sebastien Wiertz

Medical Education, Medical Schools, Medicine X, Technology

At Medicine X, four innovators talk teaching digital literacy and professionalism in medical school

At Medicine X, four innovators talk teaching digital literacy and professionalism in medical school

med ed panelOne of my favorite talks yesterday at Stanford’s Medicine X was “Fostering Digital Citizenship in Medical School,” where four esteemed panelists talked about the innovative programs they’ve put in place at their institutions.

The physicians joked several times that a good panel often involves controversy or conflict among speakers – but the four of them weren’t in disagreement about much. They all believe that things like understanding social media and knowing how to build one’s digital footprint are crucial skills for doctors-to-be, even if those aren’t an obvious focus for the students themselves. “We can’t expect students to understand” this, said Warren Wiechmann, MD, an associate dean at UC Irvine School of Medicine. “They’re focused on learning core forms of medicine.” (Wiechmann started in 2010 a program to provide each incoming medical student with an iPad and has since added to the school’s curriculum courses on topics such as social media, wearables, and new digital trends in medicine.)

Kyra Bobinet, MD, PhD, who worked alongside Stanford anesthesiologist (and Medicine X executive director) Larry Chu, MD, to develop and teach Engage and Empower Me, an online course that focuses on patient-engagement design, noted that it’s academic leaders’ job to be “forward-thinking” for the students “so they’re so they’re not behind” when they become physicians. And Bryan Vartabedian, MD, who created at Baylor College of Medicine Digital Smarts, a four-year curriculum that focuses on “professionalism, safety, and mindfulness with social media,” agreed. “We’re asking big questions here,” he told the audience. “What does a doctor need to know 20 years from now? Will he (or she) know how to send a tweet? Do we have to be platform-specific [when teaching]?”

A portion of the 45-minute talk was devoted to the difficulty of incorporating new things in a medical school’s curriculum, which is, panelist Amin Azzam, MD, said, already “chock full.” Said Wiechmann: “The big dilemma is what do we take out to put in in?” In turn, many of the schools’ instructions on digital professionalism and literacy come in the form of elective courses.

When discussing other challenges, Wiechmann said the “line ups not very deep” when it comes to leaders in medical school who know about digital media. These topics aren’t “even on the radar” of many faculty-instructors, he said. The panelists also mentioned that the students – most of whom barely remember a time before e-mail, and many of whom consider themselves tech-savvy – don’t always think they need training on digital issues. “In one way they know a lot about technology, but they don’t get how to be doctors,” pointed out Azzam, who developed a University of California elective course that allows 4th year medical students to edit Wikipedia for academic credit. (“We want them to be digital contributors, not merely digital consumers,” he explained.)

Vartabedian said the information that Baylor provides to their students is contextual. Teaching medical students about smartphone use or social media in general wouldn’t be terribly helpful, he pointed out – but it becomes valuable “if you talk about it in the wards.” What should you do, for example, if a patient engages you via Twitter?

The end of the discussion shifted to patient engagement and the need to educate students about just the thing Vartabedian mentioned (i.e. how to interact with patients on social media) and how the e-patient movement works. “I have a responsibility as an educator to put this content [about patient engagement] – more than, say, biochemistry – in front of students,” said Wiechmann.

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Medicine X aims to “fill the gaps” in medical education, More reasons for doctors and researchers to take the social-media plunge, A reminder to young physicians that when it comes to social media, “it’s no longer about you”, A conversation about digital literacy in medical education, Advice for physicians when interacting with patients online and How can physicians manage their online persona? KevinMD offers guidance
Photo by Stanford Medicine X

Medicine and Society, Medicine X, Patient Care, Technology

What makes a good doctor – and can data help us find one?

What makes a good doctor - and can data help us find one?

Ornstein panelWhile much conversation at Medicine X focused around the doctor-patient relationship, ProPublica reporter Charles Ornstein posed to conference attendees this morning a more fundamental question: How do you find a doctor? “This is trickier than you think,” he said and proceeded to discuss how data can yield helpful information for those looking for (or assessing their current) physician. He outlined some of the information – mostly involving doctor-industry relationships and physician-prescribing practices – that ProPublica has gleaned from federal databases, and he outlined questions that patients might want to ask their doctors about such things. (“So my doctor has a relationship with a company. But how is that affecting my care?” he said.)

Ornstein spent a good amount of time discussing the importance of making information – presumably not just information on negative things, such as whether a doctor appears to over-prescribe a certain medication or has ever been disciplined, but also about thoughts on physicians’ care from patients – more widely available.“We all want doctors who are good at what they’re doing clinically, and it’s time for us to stop making that a secret,” he said, before making his closing statement that “Data should be freed so we can make better health-care decisions.”

In the panel session – moderated by our own Paul Costello – that followed, several important points were made. First, Vivian Lee, MD, PhD, MBA, dean of the University of Utah School of Medicine and CEO of University of Utah Health Care, reminded the audience that the “majority of doctors are not bad apples” and can improve on things if given the chance. University of Utah makes patient-survey information publicly available, and she described the six-month period before this service was launched as a time where doctors worked to boost their level of care. Almost every doctor received at least 4 out of 5 stars by the time the rankings went online, she said.

Panelist Carly Medosch, a patient advocate who has had Crohn’s disease for 20 years, expressed support for access to physician data but pointed out that she doesn’t have time to dig through “tons and tons of research” – she not only has a regular job but a second job managing her disease. And “If I’m taken to the ER for a ruptured intestine I don’t have time to ask questions” about, for example, a doctor’s industry relationships, she pointed out. It was an important reminder that access to data alone might not greatly benefit the average chronically ill patient.

Towards the end of the session, the panelists shared their own ideas of what makes a good doctor, with Ornstein listing good clinical outcomes and empathy as two must-haves. Numerous attendees took to Twitter to express their own thoughts, including patient advocate Liza Bernstein, who offered at least 10 criteria. (My personal favorite: “What kind of PERSON are you? Yes, always, top of your field, but are you a #mensch?) Given the complexity of the issue, as outlined during the panel, I think this attendee hit the nail on the head by tweeting:

What makes a good doctor? Medicine is not a monolith. There is no simple, single answer, regardless of data availability.

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Medicine X aims to “fill the gaps” in medical education, Relationships the theme of the day at Stanford’s Medicine X, Stanford Medicine X 2014 kicks off today and Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient
Photo of Ornstein (far right) and panelists by Stanford Medicine X

Medical Education, Medicine X, Stanford News, Uncategorized

Medicine X aims to “fill the gaps” in medical education

Medicine X aims to "fill the gaps" in medical education

Larry Chu  - intro remarks - smallWhen conference director Larry Chu, MD, took the stage this morning to welcome attendees to Day Two of Medicine X, few people knew he had big news to share. But moments after summarizing yesterday’s “great discussions,” which show, he said, what can be accomplished when “we pay attention to all voices,” he announced the launch of Medicine X Academy. It’s an umbrella, he explained, for a variety of  initiatives that will take MedX beyond conference walls and “quicken the pace of changing the culture of health care.” With the academy, he and his group will continue building a community and work on filling important gaps in education – with a focus on, among other things:

  • the importance of participatory medicine and the use of social media in patient engagement
  • the use of technology to meet the needs of millenials
  • the development of ways to best serve underserved or aging individuals
  • the inclusion of end-of-life issues in health-care discussions

The academy will offer massive open online courses and patient education programs and will host a new conference – MedX Ed – to occur just before next year’s regular Medicine X event. Noting that MedX has morphed from an annual meeting to a “global movement,” conference speaker Bryan Vartabedian, MD, noted that it’s “very well prepared” to address issues in medical education. “We have a global community of innovators and, most importantly, we have the proper mindset” to enact change, he told the audience.

The news got those in the audience (many of whom had barely had their first sip of coffee) buzzing. “Very cool – New #MedX ED conference will translate ideas into actionable parts of medical education,” wrote one attendee on Twitter, adding this was a necessary thing. “This is bigger than just ‘walking the talk’,” agreed another. “We’re going to change the future of health care.”

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Relationships the theme of the day at Stanford’s Medicine X, Stanford Medicine X 2014 kicks off today and Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient
Photo by Stanford Medicine X

Grand Roundup

Grand Roundup: Top posts for the week of Aug. 31

Grand Roundup: Top posts for the week of Aug. 31

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

Breast cancer patients are getting more bilateral mastectomies – but not any survival benefit: The first-ever direct comparison of breast-cancer surgeries shows no survival benefit for women who had both breasts removed compared with women who underwent lumpectomy followed by radiation therapy. In this post, Christina Clarke, PhD, a research scientist and scientific communications advisor for the Cancer Prevention Institute of California, and a member of the Stanford Cancer Institute, discusses the findings and their implications for women.

Can Alzheimer’s damage to the brain be repaired?: Neuroscientist Frank Longo, MD, PhD, director of the Stanford Center for Memory Disorders, has pioneered the development of small-molecule drugs that might be able to restore nerve cells frayed by conditions such as Alzheimer’s disease.

When it comes to weight loss, maintaining a diet is more important than diet type: A meta-analysis of 48 studies on popular weight-loss programs found that if people stick to their diets (no matter the type) they lost weight, but ultimately the “weight-loss differences between individual diets were minimal and largely unimportant.”

Examining the effects of family time, screen time and parenting styles on child behavior: Results of The Learning Habit Study have shown that limiting screen time, increasing family time, and choosing parenting styles that rely on positive reinforcement are among the things that can help children perform better in school.

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.

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

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Cancer, Men's Health, Stanford News, Videos

Stanford experts talk new diagnostic technology for prostate cancer

Stanford experts talk new diagnostic technology for prostate cancer

This month is National Prostate Cancer Awareness Month, and Stanford urologic oncologists are sharing their knowledge about prostate cancer diagnosis and treatment, both online and in person. This Saturday, at a free community talk hosted by the Stanford Cancer Center, several experts will be on hand to answer questions and discuss prostate cancer screening, “watchful waiting,” diagnostic advances, and treatment options. In an online Q&A and the video above, Eila Skinner, MD, chair of urology, and James Brooks, MD, chief of the urologic oncology division, and others provide more insight on the disease. And during the month of September, more information about prostate cancer, including the benefits of targeted prostate biopsy, will be offered on Twitter via @StanfordHosp.

Previously: Managing a prostate cancer diagnosis: From leader to follower, and back again, New technology enabling men to make more confident decisions about prostate cancer treatment, Six questions about prostate cancer screening, Ask Stanford Med: Answers to your questions on prostate cancer and the latest research and Making difficult choices about prostate cancer

Medicine and Society, Medicine X, Technology

A call to make digital-health technologies available to everyone

A call to make digital-health technologies available to everyone

In light of my conversation last month about the “no-smartphone patient,” I found this recent Forbes piece on the need to develop culturally sensitive digital-health technologies of interest. Contributor Rob Szczerba writes:

In recent years, technologies involving smart phones and data analytics have become an essential component of how healthcare is delivered throughout the world.  Moreover, some believe these tools hold special promise for people from poor communities, seniors, and ethnic and racial minorities.  In some cases, people from these groups are more likely to have chronic conditions that can be expensive to treat in the short- and long-term.  Unfortunately, many of the innovators developing health technologies are not well-equipped to understand the special needs of these groups.

Rohit Bhargava and Fard Johnmar, co-authors of ePatient 2015, describe this problem as “multicultural misalignment.”  They warn that digital health technologies, such as mobile and wearable devices, will be much less effective if they are not optimized to account for differences in age, gender, culture, ethnicity, knowledge, and literacy.  They believe that preventing multicultural misalignment is vital, suggesting that we must work hard to ensure “health innovations benefit all segments of society.”

As a reminder, Stanford’s Medicine X conference – where this topic will be discussed – begins tomorrow.

Previously: Countdown to Medicine X: How to engage with the “no smartphone” patient

Addiction, In the News, Pain, Public Health

Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse

Here are some frightening facts you might not know: Drug overdose death rates in the United States have more than tripled since 1990, with the majority of drug-related deaths caused by prescription drugs. And as of 2010, about 18 women in the U.S. die every day of a prescription painkiller overdose. Prescription-drug abuse, which we’ve written about extensively here on Scope, is a very real and pressing issue – and it was the focus of a recent Forum on KQED-FM.

Among the panelists on Friday’s show was Stanford addiction psychiatrist Anna Lembke, MD, who made the important point that most people who end up addicted to prescription painkillers didn’t start out “looking for a buzz” and that most doctors who prescribe the drugs are merely trying to help their patients. As she explained to listeners:

The problem with… prescription opioids is that they actually do work for pain initially… But for most people, after you take them every day for let’s say a month or more, [you] build up tolerance where they stop working so then you need more of the same drug to get the same effect and it escalates on like that. I really think the process is insidious, both for the patients who become addicted and the doctors who prescribe them. It happens in a subtle journey – when all of the sudden [patients are] using them not just for pain but also maybe to relax themselves, to lift their mood, to be able to go out to a party if they’re feeling anxious, and the doctors continue to prescribe them because they started out working, the patients were happy [and] their function improved. The dose is escalating, but they want to keep the patient happy for all kinds of reasons.

The entire conversation is worth a listen.

Previously: Why doctors prescribe opioids to patients they know are abusing them, Patients’ genetics may play a role in determining side effects of commonly prescribed painkillers, Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds and Study shows prescribing higher doses of pain meds may increase risk of overdose and Prescription drug addiction: How the epidemic is shaking up the policy world

Parenting, Pediatrics, Sleep

With school bells ringing, parents should ensure their children are doing enough sleeping

With school bells ringing, parents should ensure their children are doing enough sleeping

With so many schools starting today – or having recently started – it’s a good time for a reminder of the importance of sleep among children. In a recent blog post and the video above, Seattle Mama Doc (a.k.a. Wendy Sue Swanson, MD), offers guidance on how much sleep a child needs and offers five ways that parents can support good sleep:

    • Keep to an 8pm bedtime for young children. Move bedtime back slowly (move it by 30 minutes every 3-5 days) to prime your child for success and avoid battles!
    • 10pm bedtime for children age 12 & up is age-appropriate. More info here.
    • Habits: No screens 1-2 hours prior to bed, no caffeine after school, no food right before bed.
    • Exercise or move 30-60 minutes a day to help kids sleep easier
    • No sleeping with cell phones (create a docking station in the kitchen)
    • Don’t use OTC medications (cough & cold, for example) to knock your kids out and get them to sleep. Using medications that have a side effect of drowsiness can cause sleepiness to extend into daytime which can negatively affect school and sports performance.

Previously: Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”Stanford expert: Students shouldn’t sacrifice sleep, TV in a child’s bedroom? “No way,” says expert and Districts pushing back bells for the sake of teens’ sleep

Stanford Medicine Resources: