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Patient Care, Public Health, Stanford News

Stanford physician provides insight on use of aspirin to help keep heart attacks and cancer away

Stanford physician provides insight on use of aspirin to help keep heart attacks and cancer away


Douglas Owens, MD, is on the panel of medical experts that just recommended a daily dose of aspiring to ward off heart attacks and cancer. But he doesn’t want people running off to the drugstore just yet.

“It is nuanced,” said Owens, director of the Center for Health Policy/Center for Primary Care and Outcomes Research, in an online story. “Our recommendation applies to people who are at increased risk of heart disease and who do not have increased risk of bleeding complications.”

The U.S. Preventive Services Task Force, an independent panel of medical experts from around the nation, said yesterday that taking aspirin can help 50- to 59-year-olds who are at increased risk of cardiovascular disease prevent heart attacks and strokes.

The panel also said that taking aspirin for at least five to 10 years could help prevent colorectal cancer. Individuals 60 to 69 may also benefit from aspirin, but the benefit is smaller than in people 50 to 59.

But Owens cautioned the new recommendations come with a caveat: A daily dose of aspirin can cause stomach and brain bleeds. People with stomach and liver problems, bleeding disorders or who are taking blood thinners, are at greater risk of experiencing the side effects of aspirin.

And, he emphasized, the new recommendations are for older adults and those with substantially elevated risk of cardiovascular disease.

“Each person has only one decision to make — whether or not to take aspirin for prevention,” said Owens. “To help individuals and their clinicians make this decision, the task force integrated the evidence about the use of aspirin to prevent cardiovascular disease and colorectal cancer into one recommendation on the use of aspirin.”

But the task force also concluded that it doesn’t have enough to current evidence to assess the balance of benefits and harms of aspirin use in adults younger than age 50 and those older than 70.

The draft guidelines, which are open for public comment at the task force website, have provoked criticism by some cardiologists and physicians who are concerned that healthy Americans who start taking aspirin on a daily basis could expose themselves to the drug’s negative side effects, such as stomach bleeding and hemorrhagic strokes.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research.

Previously: Study shows daily aspirin could lower women’s risk of ovarian cancerCan repackaging aspirin get more people to take it daily for prevention? and New research shows aspirin may cut melanoma risk
Photo courtesy of CHP/PCOR

Patient Care, Pediatrics, Research, Stanford News, Surgery

Spanish-speaking families prefer surgical care in their native language, study finds

Spanish-speaking families prefer surgical care in their native language, study finds

Bruzoni-scrubsFive years ago, when Matias Bruzoni, MD, was a new pediatric surgical fellow at Lucile Packard Children’s Hospital Stanford, his fluency in Spanish meant that he often accompanied other surgeons to consult with Hispanic families who spoke little English.

“I went with the attending surgeon, and would help explain the operation in Spanish, and then the family would say to me ‘Great, would you mind being our surgeon?'” he recalled recently. “And I’d say, ‘But I’m a fellow’ and they would say ‘We’d rather stay with you.'”

The families greatly valued their linguistic and cultural connection to Bruzoni. As he had more of these interactions, Bruzoni realized the hospital’s entire pediatric general surgery team held a mostly untapped linguistic resource. Many of its members – including receptionists, nurse practitioners and triage staff – spoke fluent Spanish.

After Bruzoni finished his training, he organized this group of caregivers into the hospital’s Hispanic Center for Pediatric Surgery, which offers patients and families the ability to receive all of their pre- and post-surgical care in Spanish. Every interaction, from registering the patient to giving post-surgical instructions, happens in the families’ first language. Bruzoni wondered how this approach would compare to using trained medical interpreters, whose services are offered to all non-English-speaking families at the hospital.

A new study, published in the most recent issue of the Journal of Pediatric Surgery, shows what his research found. From our press release:

Spanish-speaking families that discussed their children’s care in Spanish reported a higher level of satisfaction and higher ratings of the quality of information they received compared with the families in the control group and those that worked through an interpreter. Spanish-speaking families rated the importance of discussing care in their native language more highly than English-speaking families, the study found.

Although socioeconomic status was not assessed in this study, Bruzoni noted that Hispanic families of low socioeconomic status may have an even greater need than others to receive care in their native language. “There is a big cultural barrier,” Bruzoni said. “Because of these patients’ circumstances, it is even more important to work with them using their own language.”

Bruzoni plans to continue studying how to deliver better surgical care to California’s growing population of Hispanic children.

Previously: Stanford student earns national recognition for research on medical communication, An app to break through language barriers with patients and Advice for parents whose kids need surgery
Photo courtesy of Lucile Packard Children’s Hospital Stanford

Patient Care, Pediatrics, Public Health, Stanford News, Surgery

Story highlights teens’ life-changing weight loss

Story highlights teens' life-changing weight loss

Over on the Healthy, Happier Lives blog today: A look at how bariatric surgery, combined with a strict diet plan and exercise regime, benefited two San Jose, Calif. teens. The siblings lost a combined total of more than 200 pounds and in the process have reduced their risk of obesity-related medical complications and improved their quality of life. “It’s been a life-changing transformation,” Sophia Yen, MD, an adolescent medicine specialist with Lucile Packard Children’s Hospital, commented.

Previously: The challenges of dieting and the promises of bariatric surgery and Bariatric surgery may help protect teen patients’ hearts

In the News, Parenting, Patient Care, Pregnancy, Public Health, Women's Health

Low-tech yet essential: Why parents are vital members of care teams for premature babies

Low-tech yet essential: Why parents are vital members of care teams for premature babies

3297657033_081d4f3630_zThanks to recent advances in medicine, technology and research, most premature babies born in the United States face better odds of surviving than ever before. Yet, the number of premature births in the U.S. remains relatively high, with a rate that’s on par with that of Somalia, Thailand and Turkey.

For the parents of a premature baby, an early birth can transform what was supposed to be a happy event into a stressful one, says Henry Lee, MD, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford. In a recent U.S. News & World Report article penned by Lee, he discusses why it’s important for parents, and beneficial for the baby, when parents are active members of the child’s medical team:

Giving birth to a preemie, especially when it’s unexpected, leaves many parents feeling unprepared and helpless. But we make it clear very early. “You, the parent, are a critical part of our medical team.” That’s right. Even in the heart of Silicon Valley where we’re located, two of our biggest assets are decidedly low-tech workers: the baby’s mom and dad.

Including parents in the care of preemies is a standard that was unheard of in the early days of neonatology, but is now used in leading NICUs for one critical reason: It works.

Here’s an example of how parents contribute. Studies have shown that skin-to-skin care, also known as kangaroo care, can have beneficial effects on preterm neonates, including improved temperature and heart rate stability. In many NICUs, you will see babies – clad only in a diaper and covered by a blanket – placed prone position on the chest of either the mother or the father. This intimate method of care provides a preterm baby a natural environment for rest, growth and healing.

No matter when a baby is born, term or preterm, families know their children best. A parent’s contribution is critical to treating these most vulnerable of newborns.

Previously: How Stanford researchers are working to understand the complexities of preterm birthNew research center aims to understand premature birth and A look at the world’s smallest preterm babies
Photo by Sarah Hopkins

Cancer, Patient Care, Stanford News, Transplants, Videos

Immunosuppression brings higher risk for skin cancer – and need for specialized care

Immunosuppression brings higher risk for skin cancer – and need for specialized care

An estimated 50 million Americans must take immunosuppressants to treat more than 80 autoimmune disorders, according to the National Institutes of Health. These medications are particularly vital to the survival of people who have undergone organ transplants to prevent their bodies from rejecting their donor organ.

While immunosuppressants can be life-saving, their very action of reducing the body’s innate defense systems can have negative side-effects. One particularly dangerous concern is an increased risk for skin cancer, particularly for those individuals with fair skin or an inherited tendency to develop skin cancers. (My colleague Tracie White told the story of one transplant patient’s struggle here earlier this summer.)

To address the specialized needs of patients taking immunosuppressants or with compromised immune function, Stanford dermatologists recently launched the High-Risk Skin Cancer Clinic.

In this Stanford Health Care video, the clinic’s Carolyn Lee, MD, PhD, explains the particular vulnerabilities of transplant patients to aggressive skin cancer and the importance of a dedicated clinic to meet their needs. “What we hate to see — and it’s easily preventable — is someone who’s been waiting for a transplant to finally get it, only to be felled by skin cancer,” she says.


Previously: Rebuilding Cassie’s smile: A lung transplant patient’s struggle with skin cancer and This summer’s Stanford Medicine magazine shows some skin

Global Health, Medical Education, Medicine and Society, Patient Care, Public Health

Exploring the benefits of pursuing anthropology and medicine

Exploring the benefits of pursuing anthropology and medicine

3470650293_60b27d6539_zAs a PhD student in medical anthropology, and having come from a very “medical family,” pursuing an MD has been a kind of shadow-dream of mine. For a year or two in high school, I was convinced that neonatology was the path for me; now I’m a doula and research the culture of childbirth.

Some people do live the double dream, and I recently interviewed two of them: Jenny Miao Hua at the University of Chicago and Rosalind Franklin University’s Chicago Medical School, and Stanford’s Amrapali Maitra, both of whom are medical anthropologists pursuing PhD/MD degrees. (Amrapali has brought an anthropological perspective to Scope through our SMS Unplugged series.)

The two came to their joint degree from different sides: Hua was an anthropology student interested in Chinese medicine and the body, while Maitra was enrolled in medical school and became serious about understanding the social context of illness. Each intends to pursue internal medicine, and each, incidentally, has family connections in the site she chose to research. We talked shop for quite a while, and what I found most interesting was their thoughts on what anthropology brings to clinical practice:

Maitra: On the broadest level, anthropology gives you an immense empathy for your patients and allows you to see them as people. It sounds cliché, but with the focus on efficiency and evidence-based medicine that has taken over American biomedical practice, even the most kind and caring individual can lose [his or her] empathy. And the kind of empathy you get from anthropology is not just sympathizing with the person, but really understanding where they’re coming from, historically and because of their life position: why they live in a certain neighborhood or have a certain diet. It allows you to think creatively about what they’re able to do or not do in pursuing their own health.

Hua: With anthropological training, students understand the various ways pathologies are dependent on larger socioeconomic forces. As a practicing physician, the person who comes through the door is never a textbook patient, so within a very short amount of time you have to pick up on this deep history, and when you’re not careful you end up stereotyping and profiling. Anthropology brings a more nuanced way of thinking about patients: they’re not just uniform biological entities, but hybrids of biology, society, and culture.

Maitra: I’ve seen so many clinic visits where I can tell, as the anthropologist in the room, that the attending physician and patient just have completely different agendas. There are simple questions like those Arthur Kleinman has laid out, asking what about the pain bothers her, why she thinks she’s having it, what she hopes to get out of the encounter. I see some doctors use these, and their visits go so much better. They’re able to build an alliance with their patient that’s very therapeutic.

That’s anthropology on the individual level, but on another level it allows you to recognize that certain things are trends. It allows you to think systematically about different kinds of structural violence. For example, why is it that so many people whose occupation is picking strawberries come in with knee and back pain issues? Treating pain is not going to solve the problem. It’s about getting to the root of the occupational hazards of being a farm worker.

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Addiction, In the News, Myths, Patient Care, Public Health, Public Safety

“24/7 Sobriety” program may offer a simple fix for drunken driving

"24/7 Sobriety" program may offer a simple fix for drunken driving

8684229367_2826035583_zEvery now and then I read a story that takes what I think I know about a certain topic and turns it upside down. Today, my understanding of programs to reduce drunk driving were upended by an article written by Keith Humphreys, PhD, professor of psychiatry and behavioral science at Stanford.

As Humphreys explains, many people mistakenly believe that no one can overcome a drinking problem without treatment involving a professional’s help. This, he says, is a myth, and the success of the “24/7 Sobriety” program highlights the importance of exploring and adopting new ways to combat drunken driving. From the Wall Street Journal article:

Offenders in 24/7 Sobriety can drive all they want to, but they are under a court order not to drink. Every morning and evening, for an average of five months, they visit a police facility to take a breathalyzer test. Unlike most consequences imposed by the criminal justice system, the penalties for noncompliance are swift, certain and modest. Drinking results in mandatory arrest, with a night or two in jail as the typical penalty.

The results have been stunning. Since 2005, the program has administered more than 7 million breathalyzer tests to over 30,000 participants. Offenders have both showed up and passed the test at a rate of over 99%.

Counties that used the 24/7 Sobriety program also had a 12% decrease in repeat drunken-driving arrests and a 9% drop in domestic-violence arrests, according to a 2013 study.

A possible reason why this program works — when attempts to help people with drinking problems often fail — is that the twice daily breathalyzer tests have immediate consequences, Humphreys explains. “It turns out that people with drug and alcohol problems are just like the rest of us. Their behavior is affected much more by what is definitely going to happen today than by what might or might not happen far in the future, even if the potential future consequences are more serious.”

Previously: Can the “24/7 sobriety” model reduce drunken disorderly conduct and violence in London?Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by: KOMUnews

Behavioral Science, Emergency Medicine, Health Disparities, Pain, Patient Care, Pediatrics, Research

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

crying-613389_1280When a child arrives in the emergency room complaining of a stomach pain, appendicitis is the last thing you want to miss, says KT Park, MD, assistant professor of pediatrics.

“The question is, ‘Does this patient have appendicitis – yes or no?,” he said. It is the most common immediate emergency that could bring a child into the emergency room with abdominal pain. If not treated in a timely manner, the appendix can burst, leading to infection or a host of other serious complications.

But kids arrive in the emergency room complaining of stomach aches all the time; most with perfectly healthy appendices. And what if you’re a doctor who has seen seven kids with more minor stomach problems one day? It might be tricky to spot that first case of appendicitis.

Unfortunately, misdiagnosis happens more often when the pediatric patient is black, Hispanic or low-income, according to a study published today in PLOS ONE led by Park and Stanford medical student Louise Wang.

“Our goal in this study is getting the word out about abdominal pain and appendicitis and the importance of the decisions made in the emergency room,” Wang said.

The researchers analyzed national data from 2 million pediatric visits to emergency rooms between 2004 and 2011 complaining primarily of abdominal pain. They found that blacks, Hispanics and low-income children were less likely to receive imaging that could help their physicians diagnose serious conditions like appendicitis. These patients were also less likely to be admitted to the hospital, but more likely to suffer perforated appendicitis, a clue that perhaps they didn’t receive adequate treatment in time, Park said. For example, low-income blacks were 65 percent more likely to have a perforated appendix compared to other children.

The study was not able to precisely determine why these disparities exist, Wang said. “What is the driving influence of these outcomes? Are these kids being mismanaged in the emergency department, or are they presenting at a later time in a more serious condition?,” she asked.

She and Park have a few ideas, based on other findings and their personal experience. Minorities and low-income families are more likely to use the emergency room as a first-stop for more minor conditions, rather than visiting their primary care doctor or pediatrician.

“This is a very delicate topic,” Park said. “Physicians are humans and there is potentially some intuitive thinking that goes on about the probabilities of various diagnoses more common in certain patient groups, potentially leading to differences in how clinicians perceive the acuity of a patient’s status.”

Appendicitis can be tricky to diagnose, a task made even harder when patients are young and unable to clearly describe their pain, Park said.

“The psychology of physicians is an area needing further evaluation,” Park said. “We have internal biases that we often are not even aware of. We want to be objective, but it’s never a black-and-white decision making tree.”

Previously: A young child, a falling cabinet, and a Life Flight rescue, New test could lead to increase of women diagnosed with heart attack and Exploring how the Affordable Care Act has affected number of young adults visiting the ER
Photo by amandacatherine

Cancer, Events, Patient Care, Pediatrics

Girls’ Day Out event helps unite — and nurture — teens battling cancer

Untitled designThere are many treatments, therapies and drugs for cancer, but sometimes a day of pampering with friends is just what the doctor ordered.

That’s why nine teenage girls being treated for cancer at Lucile Packard Children’s Hospital Stanford  were lavished with a bit of tender loving care — and some quality bonding time — at the seventh annual Girls’ Day Out.

The festivities began at 8:30 on Wednesday night with a limo ride from the hospital to TOVA Day Spa in the Fairmont Hotel in downtown San Jose. At TOVA, teens that had attended Girls’ Day Out events from years before had the opportunity to reconnect, chat and welcome newcomers as they received massages, pedicures, manicures, hairstyling and a gourmet lunch. This story in the San Jose Mercury News explains:

“It’s really fun and a great getaway; it’s really nice to be with people who won’t keep asking ‘what happened to your arm,’ ” said incoming Saratoga High School freshman Simran Mallik, 14. She was left with a scar on her arm after undergoing treatment for Ewing Sarcoma, a type of bone cancer. “I feel like I connect with them more; it’s just easier to communicate.”

Tova Yaron, the owner of TOVA Day Spa, has sponsored this event for the past seven years with support from the Children Having Exceptional Educational and Recreational Support (CHEERS) program that’s a part of the 19 for Life Foundation. At the event, Yaron and her staff donate their time and expertise to create a day of fun, and free spa treatments, for the girls.

TOVA’s spa treatments are a refreshing break from the kind of treatments and therapies the teens are used to receiving as cancer patients, but perhaps the most important gift the girls receive is the opportunity to relax and be themselves among friends who understand what it’s like to be a teenager battling cancer.

“It’s interesting to see how other people are after they’ve gone through (cancer treatment),” said Vivian Lou 15, a student at James Logan High School in Union City who was diagnosed with Wilms Tumor, a type of kidney cancer, five years ago. “It’s nice because I don’t have to feel weird about it because they’ve also been through it.”

“I wish I could do more,” said Yaron. “I am honored, they are lovely girls, they have amazing attitudes, they are brave beyond belief, they are amazing. They are inspiring us with their bravery.”

Previously: Not just for kids: A discussion of play and why we all need to do itHow social connection can improve physical and mental health and The scientific importance of social connections for your health
Photo by Lucile Packard Children’s Hospital Stanford

Medical Education, Medical Schools, Palliative Care, Patient Care, Stanford Medicine Unplugged

When Mr. Bailey passed away: A student’s story

When Mr. Bailey passed away: A student's story

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged categoryCertain details in this entry have been omitted or changed, and all names have been altered to protect the identity of those involved.

387521264_d1cd33d574_zBrief life update, since it’s been more than 3 months since I’ve last posted on SMS Unplugged:

  • I disappeared for most of April through the end of May to study for and take Step 1, which – for anyone who hasn’t heard of this test – is a pretty brutal, not to mention expensive (~$590!! One of many reasons why med students are poor), 8-hour exam that tests broad concepts of medicine (biochem, immunology, organ systems, etc.) and is widely heralded one of the most important tests for residency admission.
  • I started clerkships at the end of June, with my first clerkship being in internal medicine. The rest of this entry describes one of the most poignant experiences from my first month and a half on rotations.

It was just another call day, when all of a sudden, an overhead announcement rang through the ward: “Code Blue, respond to Room 281. Repeat – Code Blue, respond to Room 281.” Instantly, the atmosphere in our team room turned serious: We knew it was one of our patients, Mr. Bailey, there. As a group, we sprinted towards Room 281. Disorganized, panicked thoughts were running through my head – oh-my-god-what-happened-to-our-patient, thank-goodness-I’m-wearing-sneakers-and-scrubs-today-there’s-no-way-I-could-run-like-this-in-flats, oh-my-god-what-happened-to-our-patient, oh-my-god.

When we got to the room, there were at least 8 people there already, with more trickling in. Our patient was covered in wires, IV lines, a face mask for oxygen. My resident stepped up to the bed and began telling everyone else about our patient’s past medical history, what we were treating him for, how his clinical course had been. I stood in the back, with the single-minded goal of keeping out of everyone’s way. For the next several minutes, at least a dozen people worked to bring Mr. Bailey back to life – and when I left the room, they had succeeded.

I walked back to the team room in a bit of a haze, the relief beginning to course through me, mixed in with remaining vestiges of adrenaline. I had only met Mr. Bailey once before, as he was primarily being followed by another member of my team. From our daily morning rounds, however, I knew he was incredibly sick. We estimated that he only had a few months left. When I met him that one time, it was so clear to see that he was struggling, to breathe, to keep his state of mind. Still, I thought it would be months, not days before he passed away.

The morning after the code, I came into the hospital at the usual time, pre-rounded on my own patients, and headed back to the team room to prep my presentation and notes for rounds. As I walked back to the team room, I ran into another team member, who asked me, “Did you hear about Mr. Bailey?” “No,” I said. “He died last night.”

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