Published by
Stanford Medicine

Author

Medical Education, Medical Schools, Stanford News

It’s Match Day: Good luck, medical students!

It's Match Day: Good luck, medical students!

MatchDay14-

Updated 2 PM: A sampling of photos from today’s event can be found here.

***

7:30 AM: Today, small envelopes containing big news will be handed out to medical students at Stanford, and those at 155 medical schools across the country, as they gather to learn where they’ll spend the next three to seven years during their hospital residencies. We wish students at Stanford and around the country the best of luck!

The annual rite of passage for doctors-to-be is known as Match Day and is the culmination of the endless hours of hard work, countless nights of studying, years of college and grueling interviews. Residency assignments are determined by the National Resident Matching Program, a nonprofit organization that was created in 1952 at the encouragement of medical students to establish an orderly and fair mechanism for matching the preferences of applicants for residency positions in the United States with the preferences of program directors. The organization uses a computer algorithm to align the choices of students with those of the residency programs.

My colleague Becky Bach will be joining students this morning on the Stanford campus to capture the ceremony and excitement. Watch for photos and details from the festivities here, and on @StanfordMed and the medical school’s Facebook page.

Previously: At Match Day 2014, Stanford med students take first steps as residents, Image of the Week: Match Day 2013 and Match Day 2012 decides medical students’ next steps
Photo by Norbert von der Groeben

Big data, Public Health, Research, Technology

Harnessing mobile health technologies to transform human health

Harnessing mobile health technologies to transform human health

McConnell-YeungAn estimated seven in ten U.S. adults say they track at least one health indicator, and 21 percent of this group use some form of technology to track their health data, according to data from the Pew Research Center. But these figures are likely to skyrocket thanks to health platforms such as Google Fit, Apple’s HealthKit and AT&T ForHealth, which use sensors built into smartphones and wireless fitness devices to record physical activity.

This data deluge is a goldmine for biomedical research and drug development, particularly with the introduction of Apple’s ResearchKit. The software, which powers the Stanford-developed MyHeart Counts app, allows users to better understand their health data while providing researchers the opportunity to access it for future studies.

In a recent Huffington Post article, Ida Sim, MD, PhD, professor of medicine at University of California, San Francisco, noted that such technologies hold the potential to encourage the general public to participate in medical studies and make the research community more collaborative and open. “There’s a new movement in academic research called participatory research, where patients are part of the groups that should be asking: ‘What questions are interesting? What should we test?’” Sim said in the piece. “The public could start seeing research as something that isn’t imposed on [them], but as an activity that we all do together so that we can learn together.”

This May, Sim, who co-directs of Biomedical Informatics at UCSF’s Clinical and Translational Sciences Institute, will speak at Stanford’s Big Data in Biomedicine Conference on how health information collected on mobile devices holds the potential to inform clinical decisions and transform health care. As a co-founder of non-profit Open mHealth, she and colleagues are leading the charge to build open source software that facilitates sharing and integration of digital health data.

Below she outlines how leveraging mobile health data can improve how physicians diagnose, treat and prevent disease and the challenges in facilitating the sharing and integration of this vast treasure trove of data.

What are the large-scale opportunities to harness the rapidly growing reservoir of information to improve biomedical research and human health?

We can use this data to do a variety of things like combining genomic information and behavior data from wearables to discover new insights into health and disease.

We can also move from what works on average to more tailored programs focused on the idea of what works for me. For example, if we employ A/B-like testing with digital health, genomics, and other data combined, we can understand which interventions work for an individual and under what contexts, allowing for more tailored healthcare.

Finally, we can learn about a person beyond their clinical visit – which is only a small slice of their “health pie.” By getting multiple health snapshots, doctors will be able to provide patients with better medical support and preventative strategies that support overall physical and mental well-being.

What are the major challenges in unlocking the potential of digital health data?

When we write a sentence, we construct the sentence with grammar. We use vocabulary to fill in the blanks to give meaning to the sentence. Meaning is lost when either the grammar or the vocabulary is ambiguous or not shared between parties. In a similar way, making sense of data from various digital health devices is challenging when the devices don’t represent data the same way.

Currently, wearable devices and other healthcare tools describe the data they collect using their own languages that are not shared or integrated with other devices. For example, a Wi-Fi enabled weight scale might represent data as “weight: 88” but we have no clue if that means 88 kg, femptograms, lbs, or stones. A calorie counter might represent calories as “calories: 400” but we have no clue if this was calories expended or calories consumed. For clinicians, these kinds of ambiguities are show stoppers that lock up the potential of digital health data.

In addition, data from the devices themselves are stored in silos, meaning that it is not easy for patients or clinicians to combine and view multiple data streams together. Blood pressure from one device isn’t syncing with weight data from another, which can lead to an incomplete picture of a patient’s health over time.

If we strive for greater interoperability with a common language and structure for both understanding and integrating digital health data, we can help to bring clinical and patient needs together for better health-care outcomes.

Continue Reading »

Cancer, Stanford News, Stem Cells, Videos

A look at stem cells and “chemobrain”

A look at stem cells and "chemobrain"

As many as 75 percent of cancer patients experience memory and attention problems during or after their treatment, and up to 3.9 million are afflicted by long-term cognitive dysfunction. This foggy mental state, often referred to as “chemobrain,” can also affect cancer survivors’ fine motor skills, information processing speed, concentration and ability to calculate.

In this recently posted California Institute for Regenerative Medicine video, Stanford physician-scientist Michelle Monje, MD, PhD, explains the role that damage to stem cells in the brain plays in the condition, outlines some of the interventions that can mitigate patients’ symptoms, and highlights efforts to develop effective regenerative therapies.

Previously: Stanford brain tumor research featured on “Bay Area Proud”, Emmy nod for film about Stanford brain tumor research – and the little boy who made it possible and Stanford study shows effects of chemotherapy and breast cancer on brain function

Ask Stanford Med, Cardiovascular Medicine, Events, Genetics

A conversation about using genetics to advance cardiovascular medicine

A conversation about using genetics to advance cardiovascular medicine

2260347375_3eb4af95c9_z

In recognition of American Heart Month, Stanford Health Care is hosting a heart fair on Saturday. The free community event includes a number of talks ranging in topic from the latest developments in treating atrial fibrillation to specific issues related to women’s heart health.

During the session on heart-disease prevention, Joshua Knowles, MD, PhD, will deliver a talk titled “How We Can (and Will) Use Genetics to Improve Cardiac Health.” Knowles’ research focuses on familial hypercholesterolemia, a genetic disease that causes a deadly buildup of cholesterol in the arteries. He and colleagues recently launched a project that uses a big-data approach to search electronic medical records and identify patients who may have the potentially fatal heart condition.

To kick off the conversation about preventing heart disease, I contacted Knowles to learn more about how the genomics revolution is changing the cardiovascular medicine landscape and what you can do to determine if you have a genetic heart disorder. Below he explains why heart disease is a “complex interplay between genetics and environment” and what the future may hold with respect to personalized treatments and pharmacogenetics.

Let’s start by talking about your work on familial hypercholesterolemia (FH). How has the understanding of the genetic basis of FH evolved over the last few years, and what key questions remain unanswered?

For FH, there has been a revolution in our understanding. FH causes very elevated cholesterol levels and risk of early onset heart disease. We used to think that it affected 1 in 500 individuals, but recent studies have pointed out that this is probably an underestimate and it may affect as many as 1 in 200 people. This means that there may be as many as 1 million people in the United States who are affected. We have also identified new genes that cause FH, and the identification of some of these genes has directly translated into the development of a new class of drugs (so called PCSK9 inhibitors) to treat this condition.

What steps can patients take to determine if they are at risk of, or may have, a genetic cardiovascular disorder like FH?

The easiest way is to know about your family history of medical conditions- to know what illnesses affected parents, grandparents, uncles, aunts and other relatives. Of course, genes aren’t the only things that are passed in families. Good and bad habits, such as exercise patterns, smoking and diet, are also passed down through the generations. But a family history of heart disease or certain forms of cancer is certainly a risk factor.

Past research suggests that patients with a genetic predisposition to heart disease can significantly reduce their chances of having a heart attack or stroke by making changes to their lifestyle, such as eating a diet rich in fruits and vegetables. Can lifestyle changes overcome genetics?

Heart disease is a result of the complex interplay between genetics and environment – lifestyle, for instance. For some people with specific genetic conditions, such as familial hypercholesterolemia or hypertrophic cardiomyopathy, the effect of genetics tends to dominate the effect of environment because the genetic effect is so large.

For the vast majority of people without these “Mendelian” forms of heart disease, which follow the laws of inheritance were derived by nineteenth-century Austrian monk Gregor Mendel, it’s difficult to determine at an individual level how much of the risk is due to genes and how much is due to environment (this is for things like high blood pressure, high cholesterol, coronary disease). One clue is certainly family history. However, for most of these diseases the genes are not “deterministic” – that is, people are not destined to have these diseases. Some are more at risk than others, but there are certainly ways to mitigate genetic risk through lifestyle choices. Choosing not to smoke and exercising regularly are two examples of ways you can help to greatly minimize genetic risk.

Continue Reading »

Ask Stanford Med, Events, Nutrition, Obesity, Stanford News

Sticky situation: How sugar affects our health

Sticky situation: How sugar affects our health

132244825_dbf0e21d9f_zHere’s a shocking statistic: On average, Americans consume three pounds of sugar each week, or 3,550 pounds in an entire lifetime. This leads some to blame the sweet stuff for the increase of chronic disease in modern society. But simply reducing our sugar intake is easier said than done, in part because identifying foods with added sugars can be tricky.

This Thursday, Alison Ryan, a clinical dietician with Stanford Health Care, will deliver an in-depth talk on sugar and our health as part of a Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In the following Q&A, Ryan discusses the controversies surrounding sugar and the role of sugar in our diet, and she offers tips for making sure your consumption doesn’t exceed daily guidelines.

Why does our body need sugar?

Sugar, in the form of dextrose or glucose, is the main fuel or energy source for the cells of the human body. Without glucose, our body has to get creative and rely on other metabolic pathways, like ketosis, to keep our brain and other organs running. There is an optimal range for our blood sugar levels, and our bodies are making constant efforts to keep blood sugar within this range.

Our body can make glucose from any carbohydrate that is consumed, so consuming monosaccharide (glucose and the like) is not biologically required. This is one of the reasons it’s difficult to determine the right amount of sugar that is required for the human body. Do we think of the optimal amount as the amount needed to function at peak level? Or an amount not to go over in order to avoid detrimental effects on our health?

Sugar intake has been on the rise in human diets. Why do you think that is?

At one time, sugar used to be a seldom available food item. It is now ubiquitous and more of a hallmark for highly processed, low nutritional value foods. Now, consider the food industry and the politics of sugar. Soda companies, makers of desserts, cakes, sugary snack foods, the sugar and corn syrup refiners all lobby to keep their products “part of a balanced diet.” The food industry is deeply involved (or at least vocal about) the food and nutrition guidelines in the U.S. Then there’s the reality that sugar tastes good! Most people enjoy the taste of sweet foods and are drawn to consuming them.

What are some of the health risks of consuming too much sugar?

Sugar has been implicated as playing a role in some obvious ways, like obesity, diabetes, and tooth decay; but also in less direct appearing ways such as heart disease, chronic inflammatory conditions, cancer, etc. Often, when we’re consuming foods high in sugar, we’re not consuming foods that are rich in nutrients. These calorie-dense foods displace the nutrient-dense foods. The net effect is higher intake of calories, with concurrent lower intake of vitamins, minerals, phytonutrients, protein, etc.

Continue Reading »

Patient Care, Stanford News, Technology

Medical student-turned-entrepreneur harnesses Google Glass to improve doctor-patient relationship

Medical student-turned-entrepreneur harnesses Google Glass to improve doctor-patient relationship

Pelu - 560

When third-year Stanford medical student Pelu Tran began clinical rotations and started caring for patients in the summer of 2012, he experienced firsthand how paperwork, documentation and billing coding can leave “little time for the patient-physician relationship.” He shared his frustrations with Biodesign classmate and Stanford MBA graduate Ian Shakil and, after the pair tested out an early version of Google Glass, the solution became clear: develop a platform based on the wearable technology that automates the record-keeping process for doctors.

Tran, who was recently named to Forbes’ “30-Under-30: Healthcare,” and Shakil founded Augmedix and have raised a total of $23 million in venture capital funding. A story published today in Inside Stanford Medicine explains how the company has dramatically cut the number of hours doctors spend on record keeping:

Contracting with Google Glass, Augmedix provides the much-publicized internet-connected headgear, which looks and feels like a pair of eye glasses, to doctors on a monthly subscription basis. Physicians wear the headgear during appointments with patients and use verbal cues to instantly access a patient’s electronic medical records and transcribe the doctor-patient conversation. A thumbnail-sized screen appears in the corner of the right eye of the device, which also has a camera and a microphone. The visit gets live streamed directly to Augmedix, which then uses a combination of software and human support to type notes into the patient’s electronic medical records. When the doctor’s visit is complete, so is the record-keeping.

According to Tran, physicians who use the service have been able to reduce the number of hours spent record keeping from an average of 17 a week down to just two — or even fewer. “It literally changes the lives of the doctors we work with,” he said. “They’re getting back 15-hours a week to spend with family, with friends, with patients, to provide care. That is the whole point.”

The service is currently available for use in 35 clinics across 11 states and growing. Although Google recently announced that it will stop selling Glass to consumers, the company will continue to contract with companies such as Augmedix that have a specialized use for the technology.

Previously: Using Google Glass to help individuals with autism better understand social cues, Using Google Glass to improve quality of life for Parkinson’s patients and Abraham Verghese uses Google Glass to demonstrate how to begin a patient exam
Photo courtesy of Augmedix

Big data, NIH, Research, Videos

Fly through the inside of a mouse lung

Fly through the inside of a mouse lung

Take a 50-second ride through the inside of an adult mouse lung in this video created by Rex Moats, PhD, scientific director at Children’s Hospital Los Angeles. A post published today on the NIH Director’s Blog describes the animation and points out that the video is a prime example of how scientists are using big data to make biomedical research more accessible to the public:

We begin at the top in the main pipeline, called the bronchus, just below the trachea and wind through a system of increasingly narrow tubes. As you zoom through the airways, take note of the cilia (seen as goldish streaks); these tiny, hair-like structures move dust, germs, and mucus from smaller air passages to larger ones. Our quick trip concludes with a look into the alveoli — the air sacs where oxygen is delivered to red blood cells and carbon dioxide is removed and exhaled.

… [Moats] created this virtual bronchoscopy from micro-computed tomography scans, which use X-rays to create a 3D image. The work demonstrates the power of converting Big Data (in this case, several billion data points) into an animation that makes the complex anatomy of a mammalian lung accessible to everyone.

Speaking of the power of big data, the Big Data in Biomedicine conference returns to Stanford May 20-22. For more information about the program or to register visit the conference website.

Previously: Big data = big finds: Clinical trial for deadly lung cancer launched by Stanford study and Peering deeply – and quite literally – into the intact brain: A video fly-through

Aging, In the News, Neuroscience, Research

The distinctly different brains of “SuperAgers”

The distinctly different brains of “SuperAgers”

6824680659_cdbe83a387_z

Scientists are gaining insights into the cognitive abilities of “SuperAgers” and why their memories are more resilient against the ravages of time than are other older people’s. ABC News reports today on new research:

The SuperAgers were picked to be studied because all were over age 80 and had the memory capability of a person 20 to 30 years their junior according to the study recently published in the Journal of Neurology.

To understand how SuperAgers managed to keep their mental ability intact, researchers performed a battery of tests on them, including MRI scans on 12 SuperAgers and post-mortem studies on five other SuperAgers to understand the make-up of their brains.

“The brains of the SuperAgers are either wired differently or have structural differences when compared to normal individuals of the same age,” Changiz Geula, a study senior author and a research professor at the Cognitive Neurology and Alzheimer’s Disease Center, said in a prepared statement. “It may be one factor, such as expression of a specific gene, or a combination of factors that offers protection.”

The article goes on to explain that participants’ unusual brain signature had three common components in comparison to normal people of similar ages: notably fewer tangles (a primary marker of Alzheimer’s disease), a thicker region of the cortex and a significant supply of a neuron called von Economo, which is linked to higher social intelligence.

Previously: What brain scans reveal about “super agers”, The secret to living longer? It’s all in the ‘tude and Healthy aging the focus of Stanford study
Photo by Fiona Shields

Genetics, Neuroscience, Stanford News

“The uncertainty was killing me”: A student’s tale of genetic testing for Huntington’s disease

"The uncertainty was killing me": A student's tale of genetic testing for Huntington’s disease

happyImagine you had a 50 percent chance of being diagnosed with a disease that progressively breaks down the nerve cells of your brain, and that as early as your 30s or 40s you could begin exhibiting a range of symptoms of including involuntary movements, emotional problems and cognitive impairment. Such was the fate of Stanford student Kristen Powers.

Powers was three years old when her mother began experiencing symptoms of an incurable neurodegenerative disorder called Huntington’s disease, which claimed her mother’s life in 2011 at the age of 45. By the time she was 11, Powers became fully aware that she and her brother, Nate, had a 50/50 chance of someday developing the disease. Not long after, she learned that a genetic test could tell her if she carried the gene mutation that causes Huntington’s. The only problem was, she had to be 18 in order to take the test.

“The uncertainty was killing me,” said Powers, who was recently named one of the “15 incredibly impressive students at Stanford” by Business Insider. “I was constantly thinking about this ‘What if?’ scenario and it was very consuming in terms of my thoughts and conversations with my best friend. It was getting very tiresome.”

But rather than letting frustration and anxiety dominate her life, Powers channeled her energy into producing a documentary film, titled Twitch, about her experience growing up with her mother’s illness and the potential of carrying the Huntington’s gene.

“My film helped prepare me a lot because it gave me a sense of control in a process that was, very much, out of my control,” she said. “I could distract myself constructively and positively. My film was also a very important process for preparing for the results.”

Distraction came in the form of learning the documentary film business before she was barely old enough to drive a car. Powers had to pitch the idea of potential investors, raise money, hire a film crew, learn about film rights and copyright laws, work with attorneys to draft contracts, and make sure the production didn’t go broke.

To fund the film, she launched a crowdfunding campaign on Indiegogo. “I had decided that if the fundraising campaign was a failure I would take it as sign that I shouldn’t make the film,” she said.

But in the end she raised $18,025, 80 percent more than the goal amount. “I was so surprised. I had never raised more than $300. Within the first night we hit $1,000 and we hit our goal amount on the one-year anniversary of my mom’s passing,” said Powers.

On May 18, 2012, the long-awaited day finally arrived. Accompanied by her family and best friend, Powers took the test that, in her mind, would dictate major life decisions such as if she would have children. When the test results came back two weeks later, she learned the good news: She tested negative.

Continue Reading »

Health and Fitness, Nutrition, Public Health

Why establishing a health baseline is a “critical starting point for achieving future health goals”

Why establishing a health baseline is a "critical starting point for achieving future health goals"

5737718870_752045cbb1_z

Raise your hand if you want to be more successful at achieving health goals, such as losing weight or lowering your cholesterol levels, and maintaining a healthy lifestyle. Perhaps it’s time to consider creating a health baseline. “A health-care baseline is essentially where you are “at” on the broad, complex spectrum of physical, mental and emotional health,” explains Mary James, MD, an internal medicine physician at Stanford. “This can be a critical starting point for achieving future health goals.”

On Thursday, James will deliver an in-depth talk on the benefits of partnering with your primary care provider to establish a health baseline as part of the Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In anticipation of the event, I contacted James to learn more about why its important to have a basis for comparison, beyond the ever-fluctuating number on your bathroom scale or if you’re able to fit into your skinny jeans, to use in measuring progress in meeting your health goals. Below she discusses how assessing the state of your health now can pay off in a longer, more active life in the future.

What is a health baseline?

Your baseline has two basic components: existing illness and potential future illness. Your current baseline has been shaped by your medical, social and family history and is constantly being influenced by common factors in everyday life. Although some components of your healthcare baseline are more modifiable than others, it is important to have an accurate understanding of your current health status.

Why is it important to determine your personal health baseline?

You may be thinking, “I’m healthy – I take no medications and never go to the doctor. Why should I start now?” There are two fundamental components to good health. They are: appropriate treatment for current illness and appropriate preventative care to reduce health decline in the future. While most people actively seek care for the former, we often forget about the latter. Although the data is mixed on whether “routine check ups” are beneficial, there is strong evidence behind many of the preventative maneuvers that are typically discussed and ordered at these visits. Taking appropriate preventative health-care steps can help you avoid the need for prescription medications, hospitalizations and procedures and can help ensure a longer, healthier life.

How can establishing a health baseline help you be more successful in reaching personal wellness goals?

Many wellness goals start with changes in diet and exercise. Your primary care provider can help determine how to start making these changes in a safe, effective manner. Are there exercises you should avoid due to chronic back pain? Is it okay to start running if you have high blood pressure? Is it safe for you to start a vegan diet? What is a safe amount of weight to lose?

Wellness also includes mental and emotional health. Your primary provider can help determine what treatment is most appropriate for common conditions such as depression and anxiety. Maybe you’ve been feeling “down” lately – is this true depression that warrants medical treatment, or is it safe try a new yoga or meditation class first? These are just a few of the many things that can be assessed and addressed as part of your health baseline. Together, you and your primary care provider can prioritize health problems and determine effective interventions.

Continue Reading »

Stanford Medicine Resources: