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Big data, In the News, Patient Care, Pediatrics, Stanford News

Examining the potential of big data to transform health care

Examining the potential of big data to transform health care

Back in 2011, rheumatologist Jennifer Frankovich, MD, and colleagues at Lucile Packard Children’s Hospital Stanford used aggregate patient data from electronic medical records in making a difficult and quick decision in the care of a 13-year-old girl with a rare disease.

Today on San Francisco’s KQED, Frankovich discusses the unusual case and the potential of big data to transform the practice of medicine. Stanford systems-medicine chief Atul Butte, MD, PhD, also weighed in on the topic in the segment by saying, “The idea here is [that] the scientific method itself is growing obsolete.” More from the piece:

Big data is more than medical records and environmental data, Butte says. It could (or already does) include the results of every clinical trial that’s ever been done, every lab test, Google search, tweet. The data from your fitBit.

Eventually, the challenge won’t be finding the data, it’ll be figuring out how to organize it all. “I think the computational side of this is, let’s try to connect everything to everything,” Butte says.

Frankovich agrees with Butte, noting that developing systems to accurately interpret genetic, medical or other health metrics is key if such practices are going to become the standard model of care.

Previously: How efforts to mine electronic health records influence clinical care, NIH Director: “Big Data should inspire us”, Chief technology officer of the United States to speak at Big Data in Biomedicine conference and A new view of patient data: Using electronic medical records to guide treatment

Medical Education, Medical Schools, Stanford News

Free online Stanford course examines medical education in the new millennium

Free online Stanford course examines medical education in the new millennium

Prober_092314At this year’s Stanford Medicine X, executive director Larry Chu, MD, announced the launch of a new group of initiatives that would expand the conference and “quicken the pace of changing the culture of health care.” In addition to continuing to build community, the Medicine X Academy will aim to use technology, the principles of design thinking, and a model of inclusivity to redefine medical education.

“We’re moving from talking to doing,” said Chu. “We want to move the conversation earlier into the education system so students begin to think differently about health care and [so we can] improve medical education with the input of all stakeholders.”

As part of the academy, Chu, Kyle Harrison, MD, clinical assistant professor at the Palo Alto Veterans Affairs Hospital, and Nikita Joshi, MD, an academic fellow at Stanford, will begin teaching a massive open online course (MOOC) course titled “Medical Education in the New Millennium” this Thursday. Anyone can enroll in the class through Stanford OpenEdX. Additionally, it will be webcasted on the Medicine X website and live tweeted on the @StanfordMedX feed.

The eleven-week course will ask the fundamental question: What is the definition of medical education? Participants will explore a variety of topics including how to improve the educational experiences of today’s Millennial medical students and residents; how patients and caregivers can be active participants in their care teams; how MOOCs, social media, simulation and virtual reality change the face of medical education; and how to make learning continuous, engaging, and scalable in an age of increasing clinical demands and limited work hours.

Among the class guest lectures are Charles Prober, MD, senior associate dean for medical education at Stanford; Kirsten Ostherr, PhD, an English professor at Rice University and co-founder of the Medical Futures Lab; ePatient Britt Johnson; and medical and nursing students from Duke, Stanford and other universities.

As noted on the course website, the course is targeted not only towards medical students and educators but also patients, caregivers, and anyone who wants “to join a conversation about how to improve medical education.”

Previously: Medicine X aims to “fill the gaps” in medical educationRethinking the traditional four-year medical curriculum and A closer look at using the “flipped classroom” model at the School of Medicine
Photo of Charles Prober by EdTech Stanford University

Bioengineering, Imaging, Research, Stanford News, Videos

How CLARITY offers an unprecedented 3-D view of the brain’s neural structure

How CLARITY offers an unprecedented 3-D view of the brain's neural structure

Last year, Stanford bioengineer Karl Deisseroth, MD, PhD, and colleagues in his lab announced their development of CLARITY, a process that renders tissue transparent, sparking excitement among the scientific community. As explained in the above video, released yesterday by the National Science Foundation, researchers had been unable to directly study the human brain’s circuitry because much of the organ is covered in an opaque tissue. But using CLARITY researchers can “chemically dissolve the opaque tissue in a post-mortem brain, and in place of that tissue, they insert a transparent hydrogel that keeps the brain intact and provides a window into the brain’s neural structure and circuitry.” For this reason, the technique is “hailed as an important advance in whole-brain imaging.”

Previously: Process that creates transparent brain named one of year’s top scientific discoveries, An in-depth look at the career of Stanford’s Karl Deisseroth, “a major name in science”, Peering deeply – and quite literally – into the intact brain: A video fly-through and Lightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact

Cancer, Health and Fitness, Research

Exercise may boost effectiveness of chemotherapy

Exercise may boost effectiveness of chemotherapy

running_092214Staying physically active during chemotherapy treatment can benefit patients’ physical and mental health. But findings from an animal study show that exercising may also help reduce the size of tumors.

As reported by Futurity, University of Pennsylvania researcher Joseph Libonati, PhD, and colleagues originally set out to test whether adding a fitness regimen to chemotherapy would offset cardiac damage related to the drug doxorubicin. While the team failed to find any significant evidence that exercise provided protection against negative cardiac side-effects, they did find that mice that exercised while receiving chemotherapy had notably smaller tumors than those that had chemotherapy alone. From the article:

Further studies will investigate exactly how exercise enhances the effect of doxorubicin, but the researchers believe it could be in part because exercise increases blood flow to the tumor, bringing with it more of the drug in the bloodstream.

“If exercise helps in this way, you could potentially use a smaller dose of the drug and get fewer side effects,” Libonati says. Gaining a clearer understanding of the many ways that exercise affects various systems of the body could also pave the way for developing drugs that mimic the effects of exercise.

“People don’t take a drug and then sit down all day,” he says. “Something as simple as moving affects how drugs are metabolized. We’re only just beginning to understand the complexities.”

Previously: Stanford preventive-medicine expert: Lay off the meat, get out the sneaks, From leukemia survivor to top junior golfer, Examining exercise and cancer survivorship and Study shows benefits of exercise for patients with chronic health conditions
Photo by MilitaryHealth

Aging, Health and Fitness, Public Health, Research

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

free_weightsPast research has shown that strength training can benefit older adults’ health in numerous ways including arthritis relief, alleviating back pain, increasing bone density, improving sleep and boosting mental health. But despite these findings, a new study from Centers for Disease Control and Prevention (CDC) has found that few U.S. adults age 45 and older adhere to the Department of Health and Human Services’ muscle-strengthening recommendations.

The guidelines advise middle-aged and older adults to do moderate or high intensity muscle-strengthening activities that involve all major muscle group two or more days a week. Training can involve hand weights or weight machines, basic exercises such as sit-ups and push-ups or yoga and similar fitness practices.

In the latest study, researchers examined data from a telephone health survey conducted in 2011 by the CDC known as the U.S. Behavioral Risk Factor Surveillance System. For the survey, respondents provided information about the types of physical activities they engage in and frequency, as well as answered questions about if they specifically did exercises to strengthen their muscles. HealthDay reports:

Of all those who answered the questions on muscle strengthening, about 24 percent said they met the government’s recommendations.

Among those less likely than others to meet these guidelines were women, widows, those age 85 or older, people who were obese, and Hispanics. Participants who didn’t graduate from high school were also less likely to meet U.S. strength-training recommendations.

Jesse Vezina, of Arizona State University, and his fellow researchers concluded that interventions designed to encourage people to participate in strength training should target these high-risk groups.

Previously: Moderate exercise program for older adults reduces mobility disability, study shows, Help from a virtual friend goes a long way in boosting older adults’ physical activity and Do muscles retain memory of their former fitness?
Photo by Positively Fit

Chronic Disease, Pediatrics, Public Health, Stanford News

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes_coaches_classThe prevalence of Type 2 diabetes among Americans ages 12 to 19 has grown from nine percent to 23 percent in less than a decade. In an effort to reduce U.S. adolescents’ diabetes risk, researchers at Stanford developed a school-based program where medical residents train healthy at-risk teens to be self-management coaches for family members diagnosed with Type 2 diabetes.

Researchers tested the initiative, called the Stanford Youth Diabetes Coaches Program, over the course of a year at three Bay Area high-schools serving primarily ethnic minority youth of low socioeconomic status. The study involved 97 adolescents – 49 student coaches and 48 non-participant students. Student coaches participated in an eight-week training course that was taught by family medicine residents and modeled after the Stanford University Diabetes Self-Management Program for adults. All participants completed pre- and post-study questionnaires and a select group of student coaches and family members gave in-depth interviews.

The program emphasized communication skills, problem solving and setting achievable goals using action plans. Beyond providing basic diabetes knowledge, the program also included guidance on nutrition, healthy meal planning, physical activity, weight management and stress management and on developing relationships with health-care providers. Student-coaches engaged with their family members during weekly 30-minute sessions where they shared information about topics they learned in class, discussed their relatives’ experiences and goals and helped them make an action plan for the week. In discussing their findings, study authors’ wrote:

The results of the study indicate that the Stanford Youth Diabetes Coaches Program increases knowledge and psychosocial assets of participant youth … Youth participants also reported positive changes in their own lives as the coached family members, and family members emphasized the importance of student coaches’ role in encouraging healthy behaviors. Additionally youth participants reported high program satisfaction.

These results substantiate current work suggesting that school-based programs benefit adolescents and that children have potential to support the self-management of family members with diabetes. Evidence strongly suggests that school-based programs hold promise to improve the health of at-risk adolescents.

“This study really speaks to the question of: How do you engage teens about their health?,” said first author Liana Gefter, MD, a research associate in Stanford’s Center for Research and Education in Family and Community Medicine. “The effectiveness of the program is rooted in the idea of empowering students to be a leader in a setting where they are traditionally only told what to do. A lot of the students really had a transformation during the eight-week course. Our findings demonstrated that after only eight weeks, compared to non-participants, students had significant increases in self-worth and belonging – assets that have been shown to be necessary precursors for adopting healthy behaviors. In this way, we believe the program could lay the foundation for sustainable health improvement.”

During interviews with researchers, student coaches and diabetes patients said the program inspired them to improve their diet and increase their regular physical activity. Additionally, they noted that the program strengthened their relationships with each other, and students reported their appreciation for having a physician come into their classroom.

In light of the program’s success, Gefter and colleagues Nancy Morioka-Douglas MD, MPH; Eunice Rodriguez, MPH, DrPH, and Lisa Rosas, MPH, PhD, are working to expand the program to underserved schools at other sites in California and around the country. Pilots are currently underway, or will begin, at campuses in Delaware, Georgia, Washington, Ohio and Michigan.

Previously: Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert, Have you voted in the Healthy Living Innovation Awards?, Diabetes prevention program trains youth in chronic disease self-management and Stanford Diabetes Coaches Class selected as 2011 Healthy Living Innovation Awards finalist
Photo by Stanford Youth Diabetes Coaches Program

Immunology, Microbiology, Public Health, Research

Gut bacteria may influence effectiveness of flu vaccine

Gut bacteria may influence effectiveness of flu vaccine

flu_shotPast research has shown that the microbes living in your gut can dictate how body fat is stored, hormone response and glucose levels in the blood, which can ultimate set the stage for obesity and diabetes. Now new research suggests that the colonies of bacteria in our intestine play an important role in your body’s response to the flu vaccine.

In the study, Emory University immunologist Bali Pulendran, PhD, and colleagues followed up on a unexpected finding in a 2011 paper: the gene that codes for a protein called toll-like receptor 5 (TLR5) was associated with strong vaccine response. Science News reports that in the latest experiment:

[Researchers] gave the flu vaccine to three different groups: mice genetically engineered to lack the gene for TLR5, germ-free mice with no microorganisms in their bodies, and mice that had spent 4 weeks drinking water laced with antibiotics to obliterate most of their microbiome.

Seven days after vaccination, all three groups showed significantly reduced concentrations of vaccine-specific antibodies in their blood—up to an eightfold reduction compared with vaccinated control mice, the group reports online … in Immunity. The reduction was less marked by day 28, as blood antibody levels appeared to rebound. But when the researchers observed the mice lacking Tlr5 on the 85th day after vaccination, their antibodies seemed to have dipped again, suggesting that without this bacterial signaling, the effects of the flu vaccine wane more quickly.

Previously: The earlier the better: Study makes vaccination recommendations for next flu pandemic, Working to create a universal flu vaccine and Tiny hitchhikers, big health impact: Studying the microbiome to learn about disease
Photo by Queen’s University

Patient Care, Research, Technology

How can health-care providers better leverage social media to improve patient care?

How can health-care providers better leverage social media to improve patient care?

A growing number of Americans are turning to the Internet for health information and many are using social media tools to engage with patients like themselves or health-care providers. But findings recently published in the Journal of Medical Internet Research suggests that a significant portion of the health-related content on social networking sites is irrelevant or devoted to marketing or promotion of products, events and institutions. Study authors also warned that social media can quickly spread misinformation to a broad audience.

In the study, Stanford medical student Akhilesh Pathipati and colleagues analyzed Facebook search results for common medical conditions. Pathipati explains in a Sacramento Bee opinion piece how health-care providers can adopt social media strategies to address the  concerns mentioned above. He writes:

Providers should build online support systems that reach all patients. A PricewaterhouseCoopers poll found that 40 percent of respondents would use social media to cope with chronic medical conditions. If patients are embarrassed by having a stigmatized illness though, they may lack that coping mechanism.

In the short term, providers may want to set up private groups on social networking sites in which patients can interact with other affected individuals. Setting up an anonymous network may prove to be even more useful, as anonymity has been shown to help people share more about their health. The long-term goal should be to find ways to reduce the stigma associated with certain illnesses.

Previously: Lack of adoption of social media among health-policy researchers = missed opportunity, More reasons for doctors and researchers to take the social-media plunge and A reminder to young physicians that when it comes to social media, “it’s no longer about you”

Events, Medicine and Literature, Medicine and Society, Patient Care, Stanford News

Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED

Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED

Abraham Verghese TEMED

Few of us pay close attention to metaphors used in the language of medicine. Instead, our focus is typically on words relating to symptoms, test results and diagnoses. But as Stanford physician and author Abraham Verghese, MD, explained last week at TEDMED in San Francisco (which was co-sponsored by Stanford Medicine), metaphors, particularly as they relate to medicine, are significant because “they explain our past… [and] share our present and, perhaps most importantly, the metaphors we pick predicate our future.”

Verghese took conference attendees through a “grand romp through medicine and metaphor” during a session titled “Stealing Smart,” which featured seven speakers and their stories on how stealing something from another field, such as the principles of video game design, could improve medicine. As a child with “no head for math,” Verghese was drawn to the written word and developed a love for metaphors. His physical and metaphorical journey into medicine originated with his childhood reading and, as he sheepishly admitted, his reading list “had a certain prurient bias.” In fact, he selected the novel that set the course of his life, Of Human Bondage by W. Somerset Maugham, because the title “had great promise.” Despite it’s lack of salacious content, the book made a lasting impression on Verghese.

He recalled reading about how the protagonist, a boy named Philip who was born with a clubfoot, overcame great adversity to become a physician. The character was intrigued at the variety of patients he meets in the wards of the hospital and marvels at their willingness to open up about their personal lives at a time of distress. In describing the doctor-patient relationship, the author writes, “There was humanity there in the rough.” Those words spoke deeply to young Verghese and “implied to [him] that not everyone could be a brilliant engineer, could be a brilliant artist, but anybody with a curiosity about the human condition, with a willingness to work hard, with an empathy for their fellow human being could become a great physician.” He added, “I came into [the profession] with the sense that medicine was a romantic passionate pursuit. I haven’t stopped feeling that way, and for someone who loved words anatomy was such fun.”

Verghese reveled in the abundance of medical metaphors throughout his training. The prevailing metaphor in anatomy was that of a house, while the overarching metaphor of physiology was that of a machine. When it came to describing symptoms, there was no shortage of metaphors: the “strawberry tongue” associated with scarlet fever, the “peau d’orange” appearance of the breast in breast cancer and the “apple-core” lesion of colon cancer. “That’s just the fruits – don’t get me started on the non-vegetarian stuff,” he joked.

But all of the metaphors noted in his talk are 60-100 years old, and when it came to naming one from more recent times Verghese was at a loss. He said:

In my lifetime, and I suspect in yours, we’ve seen so many new diseases – AIDS, SARS, Ebola, Lyme… We have so many new ways at looking inside the body and scanning the body, such as PET and MRI, and yet, strangely, not one new metaphor, that I can think of… It’s a strange paucity because we are so imaginative. The amount of science that has been done in the last 10 years eclipses anything that was done in the last 100 years. We’re not lacking in imagination, but we may be lacking in metaphorical imagination.

This dearth of metaphor has two consequences, he said. The first is that Congress isn’t funding biomedical research to the level that is necessary to advance new discoveries and treatments. The second is that patients are “not as enamored with our medicine and our science as we might think they should be,” he said. Verghese implored the audience to “create metaphors befitting our wonderful era discovery.” He encouraged those in the crowd and watching the livestream online to accept this challenge, saying, “I want to invite you to name things after yourself. Go ahead! Why not?”

As he closed the talk, Verghese shared the metaphor that has guided his life by saying:

It’s the metaphor of a calling. It’s the metaphor of a ministry of healing. It’s the metaphor of the great privilege we’re allowed, all of us with anything to do with health care, the privilege of being allowed into people’s lives when they are at their most vulnerable. It’s very much about the art of medicine. And we have to bring all the great science, all the big data, all the wonderful things that we’re going to be talking about [at this conference] to bear one human being to another… We have to love the sick. Each and everyone of them as if they were our own. And you know what? They are our own, because we are all humanity there in the rough.

Previously: Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine, Inside Abraham Verghese’s bag, a collection of stories and Stanford’s Abraham Verghese honored as both author and healer

Medical Education, Medicine X, Stanford News

Lloyd B. Minor, Stanford medical school’s dean, shares five principles of leadership

Lloyd B. Minor, Stanford medical school's dean, shares five principles of leadership

Dean_MinorOne of the highlights of this past weekend’s Medicine X was a course – “Navigating Complexity and Change: Principles of Leadership” – taught by our own leader, Lloyd B. Minor, MD. I sat in on the thoughtful and robust discussion, which focused on five principles that Minor developed throughout his career as a scientist, surgeon and academic leader. Students in the class were a mix of ePatients, researchers, entrepreneurs, and physicians, including a neuroanesthesiologist at Yale School of Medicine.

The first principle that Minor introduced was listening and learning, which, he said “underlie success in everything.” He went on to say, “I think a lot of leadership problems and failures come about when leaders are not, first and foremost, good listeners.”

Listening to others in the organization articulate their core values and vision provides a cultural context and helps leaders avoid the pitfall of their viewpoint being seen as counter to the organization’s. It also allows leaders to better understand those who disagree with them, he said. Drawing on his recent experience transitioning from provost and senior vice president of academic affairs of Johns Hopkins University to dean of Stanford’s School of Medicine, Minor explained that holding town hall meetings with Stanford faculty, students and staff were crucial in order to engage the community in charting a vision. “Vision is a derivative from listening and learning,” he told the class.

The next principle Minor discussed was building diverse teams. “Successful organizations thrive on diversity, and building diverse teams is one of the most important responsibilities of a leader,” said Minor. He emphasized that racial, gender and socioeconomic diversity, and diversity of viewpoint, are equally essential. Master Class students were advised to identify their weaknesses and surround themselves with individuals who have different backgrounds and cultural contexts and who possess strengths that can compensate for those weaknesses. In addition, if leaders listen and learn from a diverse team that provides constant feedback then they’ll create more opportunities for collaboration.

Once leaders have built diverse teams, the third principle comes into play: empowering teams. “You need to demonstrate the type of team behavior that you want individuals to exemplify to the rest of the organization,” he said. “That will determine how effective those teams are and enable you to be a better leader.” Among Minor’s tenets for empowering teams are: establishing a system of equitable accountability, allowing people to realize and correct their mistakes, establishing incentives, recognizing individuals or teams’ successes, and developing skill sets.

Minor went on to discuss the principle of managing and leading, stressing the point that while management and leadership have different areas of focus, being an effective leader requires one to be capable in management. “There is nothing that will derail leadership faster than poor management,” he explained. Leaders must not only articulate an organization’s vision and core values and build diverse teams to carry out those actions, but respond in a timely fashion, communicate, organize and coordinate.

Minor closed out his talk by touching on transitions. “This is a principle that is often missed and one that often leads to bad consequences for the individual, as well as the organization,” he explained. Leaders need to take time to reflect on both their transition to subsequent roles and the future of the organization. He warned that failing to carve out time to do so could result the erosion of leaders’ physical and mental health and damage the organization. A common mistake that he spoke to students about is when leaders refuse to let go of their former role and try to do the same job in a new position. To make sure Minor himself remembered to abide by this principle during his transition to Stanford, his wife gave him a business card holder for his desk with a quote from Lord Chesterfield that reminds us that in order to “discover new oceans, you must have the courage to lose sight of the shore.”

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

Previously: Stanford Medicine X 2014 kicks off todayCountdown to Medicine X: 3D printing takes shapeCountdown to Medicine X: Specially designed apps to enhance attendees’ conference experience and Countdown to Medicine X: How to engage with the “no smartphone” patient
Photo by Stanford Medicine X

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