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Addiction, Events, Health Policy, Stanford News

Stanford Health Policy Forum to focus on balancing benefits and costs of prescription opioids

Stanford Health Policy Forum to focus on balancing benefits and costs of prescription opioids

6284740462_c1d824cbb7_zNationwide deaths from drug overdose have been steadily increasing since 1990 and are a leading cause of injury death. More than half of drug overdose deaths in the United States are related to pharmaceuticals and 71 percent of these involve prescription painkillers, according to the latest figures from the Centers for Disease Control and Prevention.

In California, the number of deaths involving opioid prescription medications has risen almost 17 percent in the past nine years. As a result, policymakers are struggling to develop methods to reduce the risk of such medications while making sure patients that rely on them for pain management have access.

On April 9, the School of Medicine will host a forum examining the challenges of balancing the benefits and costs of prescription opioids and discussing potential solutions. The event is part of the Stanford Health Policy Forum series and will be moderated by Paul Costello, the medical school’s chief communications officer. Stanford addiction medicine expert Anna Lembke, MD, and pain medicine expert Sean Mackey, MD, PhD, will participate in the forum.

For our local readers: The event, which is free and open to the public, will run from 12:30-2 p.m. in Berg Hall at the Li Ka Shing Center for Learning and Knowledge.

Previously: Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse, Why doctors prescribe opioids to patients they know are abusing them, Do opium and opioids increase mortality risk? and How to combat prescription-drug abuse
Photo by Erin DeMay

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

Registration now open for the inaugural Stanford Medicine X|ED conference

Registration now open for the inaugural Stanford Medicine X|ED conference

15168705662_f658f6aa3a_zSome exciting news for those who have followed our Medicine X coverage in the past or who have attended the popular event in person: The first-ever Stanford Medicine X|ED conference will be held on campus this fall. The two-day event, scheduled for Sept. 23-24, will bring together innovative thinkers to explore the role of technology and networked intelligence in shaping the future of medical education.

Lawrence Chu, MD, associate professor of anesthesia at the School of Medicine and executive director of Medicine X, explained in a release that he launched the conference because “changing the culture of health care starts with redefining medical education.” He hopes the gathering will “address gaps in medical education to drive innovation and make health care more participatory, patient centered and responsive.”

Digital media pioneer Howard Rheingold will kick off the conference with a keynote address, with the rest of the first day of the conference focusing on five core themes, including 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. Abraham Verghese, MD, vice chair for the theory and practice of medicine for Stanford’s Department of Medicine, will deliver the closing keynote.

Day two of the program will include a range of interactive and educational opportunities, as I describe in our release:

The conference will offer tutorial-style classes called “learning labs” on topics such as incorporating instructional technologies into curricula, and using social media to promote patient safety. Additionally, attendees can participate in 90-minute workshops on using 3D printing in medical education, interprofessional care models and methods for bringing real patients’ stories into medical education.

Conference-goers can also enroll in master classes where experts in specific disciplines will conduct small-venue seminars. Confirmed master-class speakers include [Lloyd B. Minor, MD, dean of the School of Medicine]; Bryan Vartabedian, MD, assistant professor of pediatrics and director of digital literacy at the Baylor College of Medicine; Bertalan Meskó, MD, founder of Webicina; and Kirsten Ostherr, PhD, professor of English at Rice University and director of the Medical Futures Lab.

“Health care has changed dramatically in recent years, but the way we teach the next generation of doctors has largely remained the same,” Minor commented. “Stanford Medicine X|ED brings together some of the most innovative minds in medicine, technology and education to re-imagine medical education for the new millennium.”

Registration details can be found on the conference website. Medicine X, Stanford’s premier conference on emerging health-care technology and patient-centered medicine, will kick off the day after Medicine X|ED.

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

Previously: Stanford Medicine X: From an “annual meeting to a global movement” and Medicine X aims to “fill the gaps” in medical education
Photo of Chu by Stanford Medicine X

Chronic Disease, In the News, Patient Care, Public Health

Physicians advocate for “more educated and deliberative decision making” about dialysis

Physicians advocate for "more educated and deliberative decision making" about dialysis

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More than 20 million Americans, one in 10 adults, have some form of chronic kidney disease. For those suffering from chronic kidney disease or end-stage renal disease, dialysis is a commonly recommended treatment. But a story published today in the New York Times reports that for older patients the treatment is increasingly being seen as an choice, not an imperative, and “a growing number of nephrologists and researchers are pushing for more educated and deliberative decision making when seniors contemplate dialysis.”

Paula Span writes:

Unquestionably, dialysis has helped save lives. The mortality rate for patients with chronic kidney disease decreased 42 percent from 1995 to 2012, according to the most recent report from the United States Renal Data System.

The picture for older patients, in particular, is less rosy. About 40 percent of patients over age 75 with end-stage renal disease, or advanced kidney failure, die within a year, and only 19 percent survive beyond four years, the renal data system has reported.

In a Canadian survey, 61 percent of patients said they regretted starting dialysis, a decision they attributed to physicians’ and families’ wishes more than their own. In an Australian study, 105 patients approaching end-stage kidney disease said they would willingly forgo seven months of life expectancy to reduce their number of dialysis visits. They would swap 15 months for greater freedom to travel.

In real-world hospitals and nephrologists’ offices, of course, patients aren’t offered such trade-offs. “People drift into these decisions because they’re presented as the only recourse,” said Dr. V. J. Periyakoil, a geriatrician and palliative care physician at Stanford University School of Medicine.

The moving video above, which was produced by Periyakoil, tells the story of one older man’s decision to stop dialysis after 12 years. (“It takes a lot out of you – it’s a long drawn-process,” Christopher Whitney explained in the piece. “If I would get a kidney now, it would be a waste… I’m not the person I used to be.”) About the difficult decision-making process that faces patients like Whitney, Periyakoil said in an email this morning:

Persons with kidney failure often struggle with making decisions related to dialysis. These decisions impact not only the patient but also their family members. For some, these decisions have ethical and moral implications as well. You may have questions like “Should I start dialysis right away or can I wait? Is it okay to refuse dialysis? I have been on dialysis and feel tired all the time and have poor quality of life – is it okay to stop dialysis? If I stop dialysis how long will live?”

Periyakoil urges patients to “think about what your life goals are as well as what matters most to you at life’s end. Be sure to discuss these important issues with your doctor so you can make your wishes known and make decisions that are right for you and your family.”

Previously: How best to treat dialysis patients with heart disease, Keeping kidney failure patients out of the hospital, Study shows higher Medicaid coverage leads to lower kidney failure rates and Benefits of dialysis for frail elderly debated

Medical Education, Medical Schools, Stanford News

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

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

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

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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

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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

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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

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