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Aging, Medical Apps, Stanford News, Technology

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford_LetterFor many of us, the topic of how we want to spend our final days rarely comes up in discussions with our family members or doctors. And a big reason why is that we think of reflecting on how we want to die as highly emotional and unpleasant.

But there are some compelling reasons to take the time to clarify what matters to you most in your waning days of life: It can reduce stress on your loved ones and help your physician provide a better quality of care.

Earlier this year, VJ Periyakoil, MD, director of palliative care education and training at Stanford, launched the Stanford Letter Project, a campaign to empower all adults to take the initiative to talk to their doctor about what matters most to them at life’s end.

Recently, Periyakoil released mobile app versions of the Stanford Letter Project for both the iPhone and Android. The apps, which offer templates comprised of simple questions aimed at getting the end-of-life conversation rolling, are free and can be downloaded from the iTunes and Google Play stores. Templates are available in Spanish, English, Italian, Taglog, Russian and Hindi.

As Periyakoil explained in a recent 1:2:1 podcast, “2.6 million Americans die every year, and very few of them get to talk to their doctor about their end of life wishes.” She urges every adult to tell their doctors about how they want to spend their last days; she suggests engaging in end-of-life discussions each time you reach a milestone in your life such as getting married, having a baby or being diagnosed with a chronic illness.

Previously: How would you like to die? Tell your doctor in a letter, Stanford doctor on a mission to empower patients to talk about end-of-life issues, Medicare to pay for end-of-life conversations with patients and “Everybody dies – just discuss it and agree on what you want

Health and Fitness, Public Health, Research

Study shows taking short walks may offset negative health impact of prolonged sitting

Study shows taking short walks may offset negative health impact of prolonged sitting

3046594832_cc702e6266_zWhile most of us know that sitting for prolonged periods of time can be detrimental to our health, sometimes, despite our best intentions, we’re locked into our seats by other circumstances. Perhaps you’re on a long flight with lots of turbulence and, even though our activity tracker is buzzing us to stand up, the fasten seatbelt sign forces you to ignore the alerts. Or maybe you’re at a daylong workshop or training and the opportunities to stretch your legs are few and far between. But recent research suggests that you may be able to counteract such periods of prolonged sitting with a short walk.

In the small study published in Experimental Physiology, researchers at the University of Missouri and University of Texas at Arlington compared the vascular function of a group of healthy men at the beginning of the project, after sitting for six hours and again once they completed a short walk. Results confirmed that when you sit for the majority of an eight-hour work day, blood flow to your legs is significantly reduced. The findings also showed “that just 10 minutes of walking after sitting for an extended time reversed the detrimental consequences,” lead author Jaume Padilla, PhD, said in a release.

In addition to keeping your vascular system in good working order, walking can boost your creative inspiration. A past Stanford study showed a person’s creative output increased by an average of 60 percent when he or she was walking.

Previously: Does TV watching, or prolonged sitting, contribute to child obesity rates?, More evidence that prolonged inactivity may shorten life span, increase risk of chronic disease, Study shows frequent breaks from sitting may improve heart health, weight loss and How sedentary behavior affects your health
Photo by Laura Billings

Chronic Disease, Events, Medicine X, Sexual Health

A discussion of intimacy and illness at Medicine X: “Embrace yourself and embrace your normal”

A discussion of intimacy and illness at Medicine X: "Embrace yourself and embrace your normal"

21735972186_ef347da42d_zMedicine X is well known for shining a light on dark feelings and difficult-to-talk about topics, as well as being a safe place to hold such conversations within the health-care community. Last year, a key theme of the conference was addressing the relationship of mental and physical health. The discussion of treating the whole person, not just their disease or symptoms, was expanded this year to include sexual health.

In a Sunday session exploring intimacy and illness, Medicine X executive board member and well-known patient advocate Sarah Kucharski bravely spoke about her own relationship experiences as she led the discussion. “Illness completely changes one’s relationship with one’s body. It’s the idea of feeling broken. Of feeling you’re a burden. Of feeling not sexy,” she said.

Diagnosed at the age of 31 with intimal fibromuscular dysplasia, Kucharski has undergone multiple surgeries, resulting in permanent scarring of her body. She shared with the audience her anxiety over romantic partners seeing the scars for the first time during intimate moments and suddenly having to answer their questions. She said, “To expose that visual reminder of my health, maybe it’s too much. Maybe it’s forcing me to be who I really am instead of enjoying a certain escapism,” she said. “It takes away my opportunity to talk about my health.”

Many patients and caregivers can relate to Kucharski’s struggle with intimacy and illness. She conducted an informal online survey in preparation for the conversation. The biggest finding? There is no normal. But this reality often isn’t conveyed in doctor-patient conversations. For patients who undergo a medical procedure or women who give childbirth, physician advice is usually to wait for a certain period of time until they are physically healed and then resume sexual activity “when they feel ready.”

Matthew Dudley, MD, a hospitalist who works in Alaska, said one of the factors driving the lack of doctor-patient communication about sexual health is that “health care in this country is reactionary.” He added, “We end up dealing with this emergent actions, and so you don’t get time to sit down and talk about these issues.”

In addition, pointed out panelist Alexandra Drane, the medical education curriculum at many institutions doesn’t dedicate enough time to sexual health issues. Beyond expanding the training of future doctors, she advocated for “normalizing the conversation” about intimacy. “This is a topic that most people really, really want to talk about. There needs to be training [for doctors] on how to have these conversations and how to make someone feel safe and normal,” said Drane, co-founder of the Eliza Corporation.

But more training for medical students may not to be the silver bullet that resolves the problem, say some panelists. Dudely said he received a full two weeks of training on sexual health issues during medical school. “I thought at my school we did a good job,” he said, “But in the day to day it gets lost. We need patients to go to their doctors and say, ‘I want to know more about this.’ As our culture becomes more open about these issues, I think it will come to the forefront.”

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Media, Medical Education, Medical Schools, Medicine X, Technology

Integrating digital literacy into medical education

Integrating digital literacy into medical education

21474271319_dc2d63f449_zBertalan Mesko, MD, PhD, has cracked the code on convincing medical students that digital literacy skills are equally as important as clinical knowledge. Seats in his Social MEDia course fill up within 45 seconds of registration opening. Former students report a 100 percent satisfaction rate with the class, and 80 percent of those enrolling in the course heard about it from a classmate. How does Mesko do it? As it turns out: daily educational challenges promoted on Facebook, an arsenal of high-tech gadgets and lots of chocolate.

On Thursday at Stanford Medicine X|ED, Mesko shared his secrets with medical educators on how to develop a digital literacy curriculum that will engage millennial learners and keep pace with the ever-changing landscape.

A self-describe medical futurist, Mesko launched his class on social media in medicine in 2008 when Facebook and Twitter were still in their infancy. “I wanted to design the curriculum for students to prepare them for the future that is coming toward us,” he said. “My goal was to help them understand how to use these tools to be more productive and stay up to-date.”

Early on, the curriculum centered on his experience with social media tools, such as blogging, Twitter and Facebook. But as the field of digital media and medical devices has evolved, so has the class. These days, he’s constantly updating the coursework to the point where he never gives the same lecture twice. “Platforms come and go, but it’s the concepts and practices that really matter,” said Mesko, who teaches at Semmelweis University in Hungary. “Whenever I talk about these topics, I do everything live.”

Most students have been active on Facebook, Twitter, Instagram, Snapchat and other social media accounts, long before they enroll in Mesko’s class. However, he still believes it’s important to provide an introduction to social media; discuss search engines and the Google story; and provide instruction on medical blogging, crowdsourcing and mobile health.

“Students need some fundamental digital knowledge before diving into the topics of e-patients and how to empower patients,” said Mesko, author of the recently released book My Health: Upgraded . “Additionally, many students don’t fully understand the privacy polices of these services. I tell them to remember that there is no difference between offline or online conduct.”

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Events, Medical Education, Medicine X, Research, Stanford News, Technology

Medicine X 2015 kicks off this week with a focus on the theme “Great eXpectations”

Medicine X 2015 kicks off this week with a focus on the theme “Great eXpectations”

15146055376_5600a69df1_zThought-leaders and innovative thinkers will gather on campus this week for Medicine X. Stanford’s premier conference on emerging health-care technology and patient-centered medicine, the three-day event will be held at the Li Ka Shing Center for Learning and Knowledge and focus on the theme “Great eXpectations.”

Eric Topol, MD, chief academic officer at Scripps Research Institute, will kick off the conference on Friday with a keynote on democratizing medicine. Additional keynote speakers include Robert Pearl, MD, executive director and CEO of The Permanente Medical Group; and Peter Bach, MD, director of Memorial Sloan Kettering’s Center for Health Policy and Outcome. The program will also feature panels and presentations exploring the topics of precision medicine, aging, health and community and misconceptions and misperceptions in health care.

This year, Medicine X will be preceded by the first-ever Medicine X|ED conference. The two-day event, which begins on Wednesday, will examine the role of technology and networked intelligence in shaping the future of medical education. Digital media pioneer Howard Rheingold; Abraham Verghese, MD, vice chair for the theory and practice of medicine for Stanford’s Department of Medicine; and Sarah Stein Greenberg, executive director of the Stanford, will deliver keynote speeches at the conference. Medicine X|ED will focus on five core themes: Engaging millennial learners, opportunities and challenges for innovation in medical education, interdisciplinary learning, and how digital media and massive open online courses are redefining the educational landscape. Participants will also have the option to participate in a range of interactive and educational opportunities.

Those unable to attend the conferences in person can participate in the plenary sessions virtually through a high-quality streaming webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference. You can follow our tweets on the @StanfordMed feed or follow the hashtag #MedX.

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

Previously: Medicine X conference to focus on the theme of “Great eXpectations”, Registration now open for the inaugural Stanford Medicine X|ED conference and Stanford Medicine X: From an “annual meeting to a global movement”
Photo by Medicine X

Medical Education, Medical Schools, Sports, Surgery

Applying athletic and musical coaching techniques to surgical training

Applying athletic and musical coaching techniques to surgical training

5866567170_aa28901818_zPerforming in a harmonious group is a key characteristic in the success of athletes, musicians and surgeons. With this in mind, physicians at the University of Texas Medical Branch at Galveston worked with members of the Choral Arts Society of Washington D.C. and the U.S. National Rowing Team to develop a new coaching model for training surgeons that draws on strategies from the musical and sports world.

Findings (subscription required) from the study were recently published in a special edition of the journal Surgical Clinics of North America. A release offers more details about the training approach:

It has been shown that deliberate practice is crucial to expert performance. Deliberate practice, which entails setting a well-defined goal, being motivated to improve and having ample opportunities for practice and refinement of performance through structured feedback, is a hallmark of this model.

The model also employs a coaching team that is well rehearsed in the day’s training procedure and is in constant communication so that trainees receive immediate correction when needed.

“Coaching teams not only are more efficient at communicating but also have been shown to make fewer mistakes in high-risk and high-intensity work environments, compared with individuals,” said [Kimberly Brown, MD, associate professor of surgery at the University of Texas Medical Branch at Galveston.] “This fact is of greater relevance when performance requires multiple skills, judgments and experiences.”

Brown said that when all of the coaches and learners are actively engaged throughout the training session, the other team members also contribute more to their highest capacity. This leads to a multiplying effect on the team as a whole, resulting in a team’s best possible performance.

Previously: Spanish-speaking families prefer surgical care in their native language, study finds, Clementines help surgeons-in-training to practice and Surgical checklists and teamwork can save lives
Photo by Army Medicine

Mental Health, Parenting, Pediatrics, Pregnancy, Public Health, Research, Women's Health

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

2473235415_0584b78298_zSmoking can make it more difficult to get pregnant and it can contribute to complications after conception and endanger the health of babies as they grow. For these reasons, many women quit smoking when they are trying to conceive and during pregnancy. But an estimated 40 percent of women in the United States who kick the nicotine habit for the health of their unborn child relapse within six months after delivery.

New research published in the journal Addiction suggests that the stress of becoming a parent could be a significant factor in why some moms resume smoking after childbirth. In the study, British researchers interviewed 1,000 mothers about factors that influenced their relapse or contributed to them staying smoke-free. Lead researcher Caitlin Notley, PhD, discussed the findings in a PsychCentral article:

One of the most striking things that we found is that women’s beliefs about smoking are a major barrier to remaining smoke-free. Many felt that smoking after the birth of their child was acceptable provided they protected their babies from secondhand smoke.

Their focus is, admirably, on the health of the baby, but they often do not think about the long-term health consequences for themselves as mothers.

We also found that women who saw smoking as a way of coping with stress were more likely to relapse. And that feeling low, lonely, tired, and coping with things like persistent crying were also triggers. Women reported that cravings for nicotine, which had lessened or stopped during pregnancy, returned.

The majority of women who had successfully remained smoke free said that the support of their partner was a strong factor. Partners who gave up smoking, or altered their own smoking behaviors, were a particularly good influence. And those who helped ease the stress of childcare were also praised by women who had resisted the urge to light up

In addition to receiving help from their partners, moms said support from health professionals was another positive contributor to them being able to resist urges to smoke and manage stress.

Previously: Study shows mothers receiving fertility treatments may have an elevated risk of depression, Examining how fathers’ postpartum depression affects toddlers, A telephone lifeline for moms with postpartum depression, What other cultures can teach us about managing postpartum sleep deprivation and Is postpartum depression more of an urban problem?
Photo by Samantha Webber

Mental Health, Research, Science

Optimizing work breaks for health, job satisfaction and productivity

5187630414_6102463a6c_zThink about the breaks you take during the day. Perhaps you hit pause midday to grab lunch and to run errands. Or maybe you step away from your desk frequently to briefly socialize with co-workers, get coffee or satisfy a sugar craving. Have you ever wondered what might be the optimal length and type of break?

Researchers at Baylor University asked themselves that question and discovered new insights into what constitutes a “better break.” In a study involving employees ages 22 to 67, researchers asked participants to document their breaks from work and analyzed their responses. Psych Central reports that study results suggest not all breaks are created equal, and that the type of breaks we take could potentially affect our health and job satisfaction.

Findings showed a mid-morning break can help boost your concentration, motivation and energy and that doing things you either choose or like to do during a break can help aid in recovery from stress or fatigue. According to the story:

People who take “better breaks” experience better health and increased job satisfaction.

The employee surveys showed that recovery of resources — energy, concentration, and motivation — following a “better break” (earlier in the day, doing things they preferred) led workers to experience less somatic symptoms, including headache, eyestrain, and lower back pain after the break.

These employees also experienced increased job satisfaction and organizational citizenship behavior as well as a decrease in emotional exhaustion (burnout), the study shows.

Longer breaks are good, but it’s beneficial to take frequent short breaks.

While the study was unable to pinpoint an exact length of time for a better workday break (15 minutes, 30 minutes, etc.), the research found that more short breaks were associated with higher resources, suggesting that employees should be encouraged to take more frequent short breaks to facilitate recovery.

Researchers believe breaks are an essential intervention to help a person stay sharp and energized.

“Unlike your cellphone, which popular wisdom tells us should be depleted to zero percent before you charge it fully to 100 percent, people instead need to charge more frequently throughout the day,” [said Emily Hunter, PhD, associate professor of management in Baylor University’s Hankamer School of Business.]

Previously: No time for a vacation? Take a break without leaving the officeHow Stanford and Silicon Valley companies are fostering “work-life integration”, Workplace stress and how it influences health and Stanford class teaches students how to live a happier, healthier life,
Photo by Daniil Kalinin

In the News, Medical Education, Mental Health, Stanford News

An Rx for physician burnout

An Rx for physician burnout

artsy stethoscope - 250Burnout, which is characterized by emotional exhaustion, a sense of depersonalization and a lack of a sense of personal accomplishment, is on the rise among physicians and medical residents and students in the United States. A lengthy article (subscription required) published Friday in Time examines the growing problem and the movement to save physicians’ mental health:

Experts warn that the mental health of doctors is reaching the point of crisis—and the consequences of their unhappiness go far beyond their personal lives. Studies have linked burnout to an increase in unprofessional behavior and lower patient satisfaction. When patients are under the care of physicians with reduced empathy—which often comes with burnout—they have worse outcomes and adhere less to their doctors’ orders. It even takes people longer to recover when their doctor is down.

Many factors contribute to physician burnout, including long-hours, a high-pressure work environment, the stigma against weakness and mistreatment from higher-ranking physicians. Efforts are underway to change the culture of medicine and alleviate these sources of stress, and much of the story focuses on what’s happening here at Stanford:

In 2011, [Ralph Greco, MD, professor of surgery a Stanford,] Chaplain [Bruce Feldstein, MD,] and a few other colleagues, including [Arghavan Salles, MD, former chief resident of general surgery at Stanford], got together to discuss how to change things. “When people go somewhere new, they lose everything that was around them that supported them, and it’s very natural to doubt them- selves,” says Salles. “I had this idea that we could have sessions where people talk to each other, and then it wouldn’t be so lonely.”

They put together a program at Stanford to promote psychological well-being, physical health and mentoring. Every week, one of the six groups of surgery residents has a mandatory psychotherapy session with a psychologist. Each senior resident mentors a junior resident, and residents are given time for team bonding. Young doctors rarely have time to go see a doctor of their own, so the wellness team issues lists of doctors and dentists it recommends. And there’s now a refrigerator in the surgery residents’ lounge, stocked with healthy foods. They call the program Balance in Life.

“We knew we couldn’t necessarily prevent suicide—too complicated for us to solve it,” Greco says. “But we needed to feel we did everything we could do to prevent it, if we could.”

Previously: Stanford’s “time banking” program helps emergency room physicians avoid burnoutKeeping an even keel: Stanford surgery residents learn to balance work and lifeA call to action to improve balance and reduce stress in the lives of resident physicians and Program for residents reflects “massive change” in surgeon mentality
Photo by Lidor

Health and Fitness, Obesity, Pediatrics, Public Health

Taking breaks for physical activity may benefit children’s long-term health

Taking breaks for physical activity may benefit children’s long-term health

109320999_8b61257d14_zHere’s an eye-opening statistic: Children in the United States spend on average 6 hours per day sitting or reclining. As we head into the fall and winter months, it’s likely that the shorter, darker days and chilly weather will only add to our kids being more sedentary.

National exercise standards advocate for children getting at least 30 minutes of exercise daily to curb the risk of obesity, diabetes and other conditions. But for those days when achieving this goal isn’t possible, new research shows that short activity breaks can help offset a lack of exercise.

In the study (subscription required), researchers invited 28 healthy, normal-weight children to visit the National Institutes of Health on two separate occasions. During the first visit, participants were randomly assigned to two groups. One group watched TV, read or engaged in other sedentary activities for three hours; the other group alternated sitting with three minutes of moderate-intensity walking on a treadmill every 30 minutes for the three-hour period. On the return visit, the children switched groups. Each one took an oral glucose tolerance test at both visits. According to an NIH release:

On the days they walked, the children had blood glucose levels that were, on average, 7 percent lower than on the day they spent all 3 hours sitting. Their insulin levels were 32 percent lower.   Similarly, blood levels of free fatty acids — high levels of which are linked to type 2 diabetes — were also lower, as were levels of C-peptide, an indicator of how hard the pancreas is working to control blood sugar.

After the sessions, the children were allowed to choose their lunch from food items on a buffet table. Based on the nutrient content of each item, the researchers were able to calculate the calorie and nutrient content of what each child ate. The short, moderate-intensity walking sessions did not appear to stimulate the children to eat more than they ordinarily would, as the children consumed roughly the same amounts and kinds of foods after each of the sessions.

The study authors concluded that, if larger studies confirm their findings, interrupting periods of prolonged sitting with regular intervals of moderate-intensity walking might be an effective strategy for reducing children’s risk of diabetes and heart disease.

While regular walking breaks may not excite the average child, three-minute dance parties or stomping on bubbles are other options for getting kids out of their seat and moving.

Previously: Pediatrics group issues new recommendations for building strong bones in kids, Understanding the impact of sedentary behavior on children’s health and British government urging toddlers to ‘get physical’
Photo by Miika Silfverberg

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