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Events, Medical Education, Medical Schools, Pediatrics, SMS Unplugged

A Match made at Stanford: From medical student to resident

A Match made at Stanford: From medical student to resident

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 category.

IMG_1127On March 20, in synchrony with thousands of senior medical students across the country, I received an envelope that determined where I would be spending the next three years of my life for residency training.

My academic advisor, Oscar Salvatierra, MD, had come out of retirement to share this day with his students. He had supported us over the years, from studying for our first-year exams to choosing a specialty and applying to residency. He supported my husband and me in the additional challenges of tackling medical school as a married couple, guided us through my husband’s decision to pursue a combined MD/PhD degree, and even weighed in on our decision to have a child during medical school. Now, on Match Day, I was so grateful that he was the one to call my name and hand me my letter.

“Open. Open. Open,” my daughter demanded, grasping for the bright red envelope with the same steady persistence that she normally uses to ask for raisins. My husband took her from my arms so that my shaking fingers were free to open the envelope and unfold the letter. It was real, right there in black and white: I’ll be staying at Stanford for a pediatrics residency.

I grinned, then I cried, then I started soaking in the hugs and congratulations of my family, friends, and mentors who all knew how desperately I had hoped for this outcome. But the fun part about Match Day is that there is more than just your own news to celebrate. Within minutes, I was fighting through the crowds to track down my friends and classmates to find out where they had matched. I was incredibly impressed, but not at all surprised, to hear about the excellent programs they will be attending across the country.

As I stepped back into my apartment later that morning, clutching my residency Match letter, it felt a lot like bringing a newborn baby home from the hospital: it was odd and unsettling to walk back through familiar doors into my familiar home when our family’s life was all at once so deeply changed. In residency (like becoming a parent), I am going to have to work harder than I’ve ever worked before, and be challenged in ways I haven’t even imagined. But at the same time, I have no doubt that it will be worth it, and that this was exactly what I want for my life.

I hope that my classmates are feeling the same excitement to start the next phase of the journey. Congratulations to the Stanford Medicine Class of 2015 on an incredible Match!

Jennifer DeCoste-Lopez is a final-year Stanford medical student who will soon start a residency in pediatrics at Stanford. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Global Health, Immunology, Infectious Disease, Pediatrics, Stanford News

Researchers tackle unusual challenge in polio eradication

Researchers tackle unusual challenge in polio eradication

poliovaccinationPolio is a tricky foe. One of the biggest hurdles in the World Health Organization’s polio eradication campaign is that the virus causes no symptoms in 90 percent of people who contract it. But these silently infected individuals can still spread the virus to others by coughing, sneezing or shedding it in their feces. And those they infect may become permanently paralyzed by or die.

Polio’s evasiveness has also led to a big speed bump on the road to eliminate the disease. As I report in the current issue of Inside Stanford Medicine, scientists are trying to figure out how to stop a form of poliovirus that is derived from one type of  polio vaccine. Oral vaccines, which consist of live poliovirus that has been inactivated, can occasionally mutate in someone’s intestines to regain infectiousness. And, in rare instances, these viruses escape to the environment in feces, spreading to other people via sewage-contaminated water.

These “circulating vaccine-derived viruses” are threatening to overtake naturally occurring, “wild” poliovirus as the main source of paralysis in the communities where polio persists. The CDC’s most recent report on polio infections in Nigeria says that during the first nine months of 2014, the vaccine-derived viruses caused 22 cases of paralyzing poliomyletis, whereas wild virus caused six cases, for instance.

To tackle the problem, researchers are investigating how the injected polio vaccine, which is made with killed virus, might be substituted for the oral vaccine. The injected vaccine has some potential disadvantages for use in developing countries, so it’s not necessarily an easy substitution. In my story, Stanford’s Yvonne Maldonado, MD, who is studying the problem with a grant from the Bill & Melinda Gates Foundation, explains:

“We don’t really understand how well the killed vaccine is going to work in kids in developing countries, where there is lots of exposure to sewage, and malnutrition leaves children with weakened immune systems,” Maldonado said.

Her Gates Foundation grant examines semi-rural communities in Mexico where children now receive routine doses of the killed vaccine, followed by twice-a-year doses of the live vaccine.

“It’s an opportunity for us to study a natural experiment,” Maldonado said. Her team wants to know if the primary immune response to the killed vaccine will reduce shedding and transmission of later doses of live vaccine. They hope that starting with one or more doses of the injected vaccine will give kids the best of both worlds: from the shot, protection against circulating vaccine-derived viruses; from the oral vaccine, intestinal immunity.

Previously: TED talk discusses the movement to eradicate polio and New dollar-a-dose vaccine cuts life-threatening rotavirus complications by half
Photo of children in South Sudan receiving oral polio vaccine by United Nations Photo

Events, Genetics, Patient Care, Pediatrics, Research, Stanford News, Stem Cells

“It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy

“It’s not just science fiction anymore": Childx speakers talk stem cell and gene therapy

childx PorteusAt the Childx conference last week there was a great deal of optimism that stem cell and genetic therapies are about to have a huge impact on many childhood diseases. “It’s not just science fiction anymore,” Matthew Porteus, MD, PhD, told the audience. “We can correct mutations that cause childhood disease.”

The session was hosted by Stanford professor Maria Grazia Roncarolo, MD, who until recently was head of the Italy’s Telethon Institute for Cell and Gene Therapy at the San Raffaele Scientific Institute in Milan. Roncarolo pointed out that there are more than 10,000 human diseases that are caused by a single gene defect. “Stem cell and gene therapies can be used to treat cancer and other diseases,” Roncarolo said.

Two such diseases are sickle cell disease and severe combined immune deficiency. In both cases, a single nucleotide change in DNA becomes a deadly defect for children with the bad luck to have them. Porteus is working on very new genome editing technologies that allow clinicians to go in and fix those DNA typos and cure diseases.

Stanford dermatology researcher Anthony Oro, MD, PhD is working to do something similar with skin cells for a painful blistering disease called epidermolysis bullosa. Children with EB lack a functional gene for one of the proteins that anchors the layers of skin together. Oro and Stanford Institute for Stem Cell Biology and Regenerative Medicine scientist Marius Wernig, MD, PhD, are taking defective skin cells from patients, transforming them into embryonic-like stem cells, fixing the gene defect, and then growing them back into skin stem cells and then layers of skin ready for transplantation. Oro says that they have shown that they can do this in a scalable way in mice, and they hope to start a clinical trial in humans soon.

One of the challenges to genetic therapy is that it often requires putting the gene into blood stem cells to deliver it to the body, but the high dose chemotherapy or radiation that is necessary to remove the bodies own blood stem cells and make way for the transplanted cells is very dangerous in itself. Researchers like Stanford researcher Hiromitsu Nakuchi, MD, PhD, are exploring gentler ways to make space in the body for the transplanted cells. He has discovered that simply by feeding mice a diet deficient in a particular amino acid, blood stem cells begin to die. Other cells in the body don’t seem to be as strongly affected. A dietary solution may eventually allow clinicians to avoid using the highly toxic treatments that have traditionally been used for blood stem cell transplant.

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Pediatrics, Research, Technology, Videos

Monitoring patients’ vital signs using a touch-free video system

Monitoring patients’ vital signs using a touch-free video system

When Rice University graduate student Mayank Kumar and colleagues visited Texas Children’s Hospital in 2013 they took note of the tangle of wires attached to premature infants to monitor their vitals. The wires frequently had to be removed or adjusted, which can potentially damage the preemies’ delicate skin, whenever mothers fed or cared for the babies.

So Kumar and Rice University professors Ashok Veeraraghavan, PhD, and Ashutosh Sabharwal, PhD, developed a video camera-based system that measures patients’ pulse and breathing by analyzing the changes in their skin color over time.

The system, called DistancePPG, corrects for challenges that have caused similar technology to be unreliable such as low-light conditions, dark skin tones and movement. According to a university release:

The Rice team solved these challenges by adding a method to average skin-color change signals from different areas of the face and an algorithm to track a subject’s nose, eyes, mouth and whole face.

“Our key finding was that the strength of the skin-color change signal is different in different regions of the face, so we developed a weighted-averaging algorithm,” Kumar said. “It improved the accuracy of derived vital signs, rapidly expanding the scope, viability, reach and utility of camera-based vital-sign monitoring.”

By incorporating tracking to compensate for movement — even a smile — DistancePPG perceived a pulse rate to within one beat per minute, even for diverse skin tones under varied lighting conditions.

Kumar said he expects the software to find its way to mobile phones, tablets and computers so people can reliably measure their own vital signs whenever and wherever they choose.

There’s more about how the system works in the above video.

Previously: Ultra-thin flexible device offers non-invasive method of monitoring heart health, blood pressure and Researchers develop mirror that reflects your vital signs

Ebola, Events, Genetics, Global Health, Patient Care, Pediatrics, Stanford News

Global health and precision medicine: Highlights from day two of Stanford’s Childx conference

Global health and precision medicine: Highlights from day two of Stanford's Childx conference

Childx Shah“I do think it’s possible to end preventable child death.” Those were the powerful words spoken by Rajiv Shah, MD, the former administrator of USAID, during his keynote address at the start of the second day of Stanford’s recent Childx conference. More than 6 million children die each year before age 5, mostly of easily preventible diseases, Shah told the audience.

Shah went on to describe some of the more daunting health and humanitarian crises he faced during his 5-year tenure at the helm of United States Agency for International Development, including the recent Ebola outbreak in West Africa, and the Somali famine that he helped to address with the U.S. government’s Feed the Future program. Speaking about visiting a severely overcrowded Somali refugee camp, he said, “If you looked closely, you saw signs of hope and innovation.” For instance, children were receiving the pentavalent vaccine that protects against five serious childhood diseases and that was, until quite recently, considered too expensive to distribute in this type of setting.

Shah also described how a rapid redesign of protective gear for health-care workers fighting Ebola was essential to helping get the highly contagious illness under control: The old gear was much too hot and cumbersome, as well as being difficult to remove safely, and may have been a factor in the high rates of infection among health care workers early in the Ebola outbreak. Several partners, including NASA, the Department of Defense, Kimberly-Clark and Motorola, worked together to make new protective equipment that was easier to use and better suited to intense heat.

Our capacity to innovate is essential for solving global health problems, Shah concluded. “…Saving children’s lives in resource-poor settings is not just… great and morally important,” he said. “It actually creates more stability in communities.” Families have fewer children and invest more in the education of those kids, including the girls, and the surrounding society begins to look more stable and prosperous, he said. Innovation and technology in the arena of child health are important “not just for health purposes but for shaping the kind of world that keeps us safe, secure and prosperous over many decades.”

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Chronic Disease, Clinical Trials, Genetics, Patient Care, Pediatrics, Stanford News

Cystic fibrosis patient on her 20+ years of care

Cystic fibrosis patient on her 20+ years of care

lauren-catron-dr-conrad-stanford-childrens560

When Lauren Catron was first diagnosed with a severe form cystic fibrosis, an inherited disease that makes mucous and sweat glands go haywire, her doctors were unsure that she’d live to be a teenager. That was nearly 23 years ago. Now, 26-year-old Catron is a full-time college student at Mission College in Santa Clara, Calif. with enough energy to work a job in her spare time.

Catron credits her sustained health to the more than two decades of care she’s received at the Pulmonary and Cystic Fibrosis Center at Lucile Packard Children’s Hospital. Catron shares her story on the Happier, Healthier Lives Blog:

“When I was first diagnosed in 1992, the doctors told my parents that I may not make it to my teens,” said Catron, who has the genotype associated with a shorter lifespan and the most severe symptoms of cystic fibrosis, including a constant buildup of mucus in her lungs that interferes with breathing. “But a whole team of people at Stanford has dedicated themselves to keeping me healthy. They have given me absolute unconditional support, amazing treatment and care, and have become my second family.”

Carol Conrad, MD, director of the pediatric pulmonary function lab, explains that the center’s expert care stems from the many clinical trials and studies they do to advance the treatment of cystic fibrosis. “No other CF center in California is doing these kinds of clinical trials,” Conrad said.

This research, which ranges from dietary-supplement studies by Conrad to gene therapy work done by Richard Moss, MD, shows promise. Moss and his colleagues were the first to discover that gene therapy could improve pulmonary function in cystic fibrosis patients – an important finding that may lead to a treatment for the disease in the future. “As depressing as the disease can be, there’s a lot of hope. That’s what keeps us motivated,” said Conrad.

Previously: New Stanford-developed sweat test may aid in development of cystic fibrosis treatmentsFilm about twin sisters’ double lung transplants and battle against cystic fibrosis available onlineDiverse microbes discovered in healthy lungs shed new light on cystic fibrosis and Living – and thriving – with cystic fibrosis
Photo of Conrad (left) and Catron courtesy of Lucile Packard Children’s Hospital

Events, Health Policy, Pediatrics, Stanford News

Innovating for kids’ health: More from first day of Stanford’s Childx

Innovating for kids' health: More from first day of Stanford's Childx

Childx table“We are at the precipice of massive change in health care.”

That was the message from pediatrician Alan Greene, MD, speaking during a Thursday afternoon session on accelerating innovation in child and maternal health at Stanford’s inaugural Childx conference. (The conference continues today and will be live tweeted from @StanfordMed.)

Greene, a practicing pediatrician who in 1995 launched one of the very first websites to provide patients with health information, knows a thing or two about innovating in health care. “Patients are the biggest underused resource in medicine, and moms and their kids are the biggest underused resource in pediatrics,” he said, noting that the idea for his website came from the parents of his patients.

The kind of innovation he anticipates in medicine is happening elsewhere in society first, Greene said. Car service Uber and accommodation website Airbnb have rapidly become global leaders not because they own fleets of cars or chains of hotels but because “they have used people, existing resources, data and software to create this magic that just sprung out of nowhere, seemingly,” he said. Now, we’re on the verge of parallel changes in crowd-sourced medicine, for instance with patients now able to contribute their data to research through the quantified-self movement and with user-oriented collaborative medicine, which will allow patients not just to participate in research but also to help shape the research questions.

After Greene’s presentation, three Stanford scientists spoke about their approaches to innovation. Daria Mochly-Rosen, PhD, described Stanford’s SPARK program, now in its ninth year, that she launched to help scientists take their medical innovations past the “valley of death” – the gap between research and clinical use that kills many good ideas before they help patients. To date, the program has moved an impressive 57 percent of its projects to companies for clinical trials or pre-clinical trial work, or to clinical trials that are being conducted at Stanford itself.

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Events, Health Policy, Pediatrics, Public Health, Research, Stanford News

“What we’re really talking about is changing the arc of children’s lives”: Stanford’s Childx kicks off

"What we're really talking about is changing the arc of children's lives": Stanford's Childx kicks off

Childx Guttmacher

Stanford’s Childx conference got off to a great start today. Shortly after Lloyd Minor, dean of the medical school, welcomed the attendees, keynote speaker Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute of Child Health and Development, took the stage to talk about how scientific research needs to evolve to continue to advance children’s health.

Pediatric research has reached an inflection point, Guttmacher said. “I really believe the fundamental questions we need to ask are different,” he said. “This isn’t about health in a narrowly defined way. What we’re really talking about is changing the arc of children’s lives, and the medical model is useful but not sufficient.”

He mentioned several successes from the history of pediatric medicine, including large reductions in infectious disease, better care for preterm babies, and the “Back to Sleep” public health campaign that cut newborn deaths from SIDS by more than half. But he also highlighted several areas where children’s health now needs research that goes beyond a strictly medical approach to integrate social and environmental factors, such as learning how to prevent preterm birth, help children with autism and intellectual and developmental disabilities participate more fully in society, understand how children’s lives are changed by cyberbullying, and make medical and ethical decisions about the possible use of newborns’ genomic data.

He anticipates that this type of research will bring new strength to pediatricians’ interactions with patients and their families. “I would hope that the pediatric practice of the future, in terms of anticipatory guidance, won’t be about the next six weeks, six months or even six years of [the child’s] life; it’ll be about the next six decades,” he said.

“We need to be a society that values children,” Guttmacher concluded, adding that we should view children as a shared societal responsibility and also a shared societal investment. He challenged the audience of pediatric researchers to ask themselves, “What do we need to do to … change the nature of research that would make real change, not just small blips, in the lives, especially of kids in the United States and globally?”

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Events, Pediatrics, Pregnancy, Research, Stanford News

Join us for two days of live tweeting from Childx

Join us for two days of live tweeting from Childx

Group of five happy children jumping on meadow.

Today and tomorrow, we’ll be live tweeting Stanford’s inaugural Childx conference, which brings together some of the top voices in pediatric and maternal health. We’ll be using @StanfordMed and the #StanfordChildx hashtag.

The action kicks off early today, with an 8 a.m. welcome by Lloyd Minor, MD, dean of the School of Medicine. Keynote speaker Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute on Child Health and Human Development, who talked with Scope last week, speaks at 8:15 a.m.

Check back throughout the day to learn about fetal, developmental and adult health at 9 a.m. and stem cell and gene therapy at 11:10 a.m. After lunch, the conference reconvenes to discuss child and maternal health at 2:20 p.m. with Alan Greene, MD, who leads the popular Dr.Greene.com. The speaking presentations wrap up at 5 p.m.

On Friday, Stanford’s Dennis Wall, PhD, will kick the conversation off at 8 a.m., followed at 8:10 a.m. by Rajiv Shah, MD, former head of the United States Agency for International Development. At 8:35 a.m., Stanford’s Euan Ashley, MD, DPhil, will lead a discussion on precision medicine for rare childhood diseases. Tune in to learn more about the health ecosystem at 10:30 a.m. and for a special presentation by Stanford’s Mary Leonard, MD at 11:55 a.m.

The complete schedule is available here.

Previously: Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survivalCountdown to Childx: Q&A with pediatric health expert Alan Guttmacher, Countdown to Childx: Stanford expert highlights future of stem cell and gene therapies and Stanford hosts inaugural Childx conference this spring
Photo by Lighttruth

Cardiovascular Medicine, Patient Care, Pediatrics, Stanford News, Surgery

Complex procedure helps teen with rare congenital heart defect

Complex procedure helps teen with rare congenital heart defect

broken heartPeople don’t usually associate teenagers with heart problems, but congenital heart defects are more common than you might think.

A recent Healthier, Happy Lives Blog post tells the story of Ray Santa Cruz, a high-school senior from Salinas, Calif. who began to suffer from a mysterious and severe chest pain when he exerted himself. It had gotten so bad he had trouble breathing and sleeping.

It turns out that Cruz had an anomalous aortic origin of a coronary artery, meaning that his arteries didn’t attach in the right places. Until very recently, most people with this condition went undiagnosed until a post-heart-attack autopsy. Even with a more timely diagnosis, many surgeons would try to operate in the same way they would on a 70-year old, which is “absolutely the wrong thing to do,” according to Frank Hanley, MD, the surgeon who ultimately fixed Cruz’s heart. A standard bypass operation is “what you do for Grandpa” but not young patients like Cruz.

Stanford physicians developed surgical techniques to fix the defect fifteen years ago, and since then, Lucile Packard Children’s Hospital has treated about 90 young patients, more than any other institution. Cruz had a very specific variation of the condition, for which neither of the standard procedures would have worked; Hanley tried something entirely new, and so far the complex procedure has been a success.

Check out the story to read more.

Previously: Baby with rare heart defect saved by innovative surgery, A nurse puts heart into her work at Adult Congenital Heart Program, Patient is “living to live instead of living to survive,” thanks to heart repair surgery and Should high school and college athletes be routinely screened for heart conditions?
Photo by Nicolas Raymond

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