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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

Big data, Pediatrics, Research, Stanford News

Rare gene variants help explain preemies’ lung disease, Stanford study shows

Rare gene variants help explain preemies' lung disease, Stanford study shows

double-helixBecause they’re born before their lungs are fully mature, premature babies are at risk for a serious lung disease. Over the last several decades, this disease, bronchopulmonary dysplasia, has evolved into both a great medical success story and a persistent mystery. But a new Stanford study, published this week, is helping clarify the mysterious part.

First, the success story: Today, doctors can prevent BPD in many babies who would have died of it in the past. Artificial surfactant, which helps keep the air sacs of the lungs open, and extensive research on when it’s appropriate and safe to put preemies on a respirator have both greatly reduced the risk of lung injuries after birth, which can contribute to BPD. The improvement has been especially remarkable for babies born on the later end of the premature spectrum.

However, BPD is still a big problem for infants who arrive more than 12 weeks early. Doctors still have trouble figuring out which of these early preemies are at risk, and why. An editorial accompanying the new Stanford study, which appears in the American Journal of Respiratory and Critical Care Medicine, explains how scientists’ understanding of BPD has evolved:

It is now widely appreciated that the persistence of BPD is strongly linked with factors far beyond postnatal lung injury alone. Importantly, the BPD and related respiratory outcomes clearly have antenatal origins… Growing data support the concept that BPD is at least partly a “fetal disease.”

The editorial names several factors in the prenatal environment that weigh into BPD risk, including certain pregnancy complications and also maternal smoking or drug use. It’s not just the environment that plays into risk, though; twin studies also hint that genes also factor in, and knowing which genes are involved would provide enormous clues to how the disease occurs.

A prior Stanford study that attempted to connect common human gene variants to BPD risk didn’t turn up any good candidates. So, in the new study, the Stanford team focused instead on rare genetic variants. Using data from California’s extensive repository of newborn blood spots (small blood samples collected as part of the state’s program to screen newborns for genetic diseases), they turned up 258 rare gene variants for further investigation, all of which are linked to cell processes that could plausibly be involved in BPD.

“We hope these results will guide future research that can determine the most important pathophysiologic pathways leading to BPD,” said Hugh O’Brodovich, MD, the study’s senior author. The idea isn’t to target the genes themselves for treatment, but rather to help researchers figure out what goes wrong at a molecular level in the lungs of babies who get BPD.

“We also hope this work will be used to discover how clinicians can minimize the chance that an extremely premature baby will develop the disease,” he added.

Previously: Study of outcomes for early preemies highlights complex choices for families and doctors, Stanford-led study suggests changes to brain scanning guidelines for preemies and Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges
Photo by James Gaither

Cancer, Genetics, Imaging, Precision health, Research, Science, Stanford News

You know it when you see it: A precision health approach to diagnosing brain cancer

You know it when you see it: A precision health approach to diagnosing brain cancer

BurlIf you know which virus has made a person ill, as well as whether your patient responds better to drug A or drug B, you’re in a much better position to treat them. In the world of oncology, it’s often the genetic personality of the tumor itself that determines the best treatment protocol. A tumor with one set of gene variants may be susceptible to only one of several treatments. To decide which drug to prescribe, you’ve got to know your tumor.

In some cancers, such as skin cancer, it’s easy to physically examine the tumor and easy to take a biopsy to root out the tumor’s genetic secrets. But for cancers deep in the brain, a biopsy is problematic. And without knowing more about a brain tumor, it’s harder to guess the right treatment.

Now a team of researchers, led by Stanford’s Haruka Itakura, MD, and Olivier Gevaert, PhD, have distinguished three types of brain tumors. Each type is identifiable by their appearance in MRIs and predictably associated with specific molecular characteristics. Itakura and Gevaert report their work in today’s Science Translational Medicine.

Magnetic resonance imaging revealed three distinct kinds of glioblastoma brain tumors, each of which could be associated with a different probability of patient survival and a unique set of molecular signaling pathways. The work paves the way for more precise diagnosis, better targeted therapies and personalized treatment of GBM brain tumors.

Previously: Brain imaging, and the “image management” cells that make it possibleA century of brain imaging and When it comes to brain imaging, there’s nothing simple about it
Photo by Travis

Infectious Disease, Public Health, Research, Stanford News

Hikers beware: New tick-borne disease discovered in Northern California parks

Hikers beware: New tick-borne disease discovered in Northern California parks

dan with wood rat 3Meet Dan Salkeld, PhD, a disease ecologist and friend, shown here looking for ticks on a wood rat from the San Francisco Bay Area. According to Popular Science, he has one of the worst jobs in science: tick collecting.

But thanks to the nitpicky diligence of Salkeld and co-author Eric Lambin, PhD, a senior fellow at the Stanford Woods Institute for the Environment, Bay Area residents now know that getting sick from a tick bite is a real and present danger — in a recent study published in PLoS One, the researchers found that 10.6 percent of young nymph ticks and 8.1 percent of adult ticks harbored the disease-causing bacteria Borrelia miyamotoi and/or Borrelia burgdorferi, the causative agent of Lyme disease. (See map below for tick collection areas.)

“We continue to be surprised by the number of ticks carrying Borrelia burgdorferi and Borrelia miyamotoi throughout the Bay Area, and we believe more research into the connections between human disease and strains and species of bacteria is critical,” said Salkeld. “It was astonishing that we could see such variety in tick ecology, ranging from low tick infection risk on one trail to high tick infection risk on another trail in the same park.”

First discovered in the United States in 2013, the most extensive analysis of Borrelia miyamotoi infections in U.S. residents was published in the July issue of Annals of Internal Medicine. In this study, 51 patients from the Northeast were found to be “frequently very ill” with fever, headache (often severe), muscle pain, fatigue and joint pain. Almost one quarter of the patients required hospitalization. The researchers also found that the miyamotoi infections were not reliably detected by the standard two-tiered Lyme blood test and these patients didn’t develop the hallmark sign of Lyme disease, the bullseye rash.

“This research offers some insights into the complexity of diagnosing patients with tick-borne diseases, and the need for medical professionals to be alert to the different symptoms of this newly discovered infection,” said Linda Giampa, executive director, of the Bay Area Lyme Foundation, which funded this study.

The Bay Area Lyme Foundation also funds a number of projects at Stanford’s Lyme Disease Working Group, which is exploring ways to improve diagnostic tests, evaluate the effectiveness of innovative therapies, expand clinical services and build greater public awareness of tick-borne diseases.

SFBay_Parks_PLoS-One

Previously: Stanford study finds Lyme disease among ticks in California parksAdd a tick check to your vacation checklistPiecing together the clues: Diagnosing and treating autonomic disorders
Photo courtesy of Bay Area Lyme Foundation; map from PLoS One

Chronic Disease, Neuroscience, Pain, Research, Stanford News

Study: Effects of chronic pain on relationships can lead to emotional distress

Study: Effects of chronic pain on relationships can lead to emotional distress

sad womanIt’s not surprising that people living with chronic pain often have high levels of emotional distress. The question that Stanford researcher Drew Sturgeon, MD, a postdoctoral pain psychology fellow in the Stanford Pain Management Center, recently aimed to determine was why. Is a patient’s depression or anger caused by his or her inability to do physical things or is it perhaps because pain can limit social relationships?

“What I hear from patients is that it’s not just that it hurts, but that the pain takes you away from things that matter to you – the things that are meaningful to you,” Sturgeon recently said.

To explore this further, Sturgeon and colleagues analyzed data from 675 patients who came into the Stanford pain clinic and filled out data sets for the national open source Collaborative Health Outcomes Information Registry, referred to as CHOIR. CHOIR is a registry that originated at the Stanford pain center to help improve the collection and reporting of data on pain.

The researchers examined both physical functioning and social satisfaction reported by chronic pain patients, since both have been shown to play a role in causing anger and depression. Their results — published online recently in the journal Pain — show that the effects of chronic pain on a patient’s social relationships can be a key trigger of depression and anger, even more so than the limits that pain can place on physical activity.

“My suspicion was that there was going to be a stronger frustration when [the pain] affects social relations,” Sturgeon told me. “Relationships are one of the strongest predictors of mood. If you’re an avid bicyclist and can no longer cycle, that’s frustrating. But if cycling is the primary source of your social relationships, that’s even more frustrating.”

“The conversation when you have a patient with chronic pain who is very depressed tends to [focus on] how we treat the pain,” he continued. “Perhaps considering how the pain is affecting the people around the patient is also important… This is something that as a field we haven’t been paying very good attention to.”

Previously: National survey reveals extent of Americans living with pain, Chronic pain: getting your head around it and Advances in pain research and treatment
Photo by rochelle hartman

Genetics, Research, Science, Stanford News

Annoying anemones shed light on coral reef biology

Annoying anemones shed light on coral reef biology

Bleached CoralI stopped by John Pringle’s office last week to hear about what he’s been up to. A lot! As we mentioned here a few months ago, Pringle, PhD, a professor of genetics who spent the first decades of his career studying yeast genetics and cell biology, has switched gears and is looking for ways to help corals — while continuing a lifetime of basic research.

Corals and the incredibly species-rich ecosystems they support are disappearing fast in nearly every part of the world’s oceans. Coral reefs protect coastlines, sustain rich fisheries and support some of the most species-rich habitats in the world. Yet, around the world, a third of all coral has died.

The first sign of stress is a fading, or “bleaching,” of the coral that reflects the loss of photosynthetic algae that live inside the coral. In a quest to understand the molecular underpinnings of bleaching in corals, Pringle and two colleagues at Stanford helped sequence the genome of a small sea anemone that serves as a model for corals. They report their work this week in PNAS.

I asked Pringle what they’d found. But first, he wanted to tell me about his colleagues Christian Voolstra, PhD, Sebastian Baumgarten, and others at the Red Sea Research Center, in Thuwal, Saudi Arabia, where much of the experimental work and analysis took place. Pringle said the center is part of the King Abdullah University of Science and Technology, or KAUST, a six-year-old university with top researchers from around the world and a $20 billion endowment.

Although it’s easy to mistake coral for some kind of weird rock, corals are animals. But lab animals they are not. They grow slowly, in large colonies of tiny individuals, die easily and retreat inside their hard coral quarters when they aren’t happy.

A better option, Pringle learned, was a sea anemone called Aiptasia. Aiptasia is a pest that drives aquarium hobbyists to distraction. It thrives in captivity, takes over aquaria, and is seemingly impossible to eradicate — in short, the perfect lab animal.

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Nutrition, Obesity, Research

A call to focus on the nutritional value of foods, rather than calorie counts

A call to focus on the nutritional value of foods, rather than calorie counts

10331709463_60f2188a69_zTo reduce obesity rates, cardiovascular risk and chronic diseases, ditch calorie counting and instead emphasize the nutritional content of foods. That’s the message from a group of British researchers in an editorial recently published in Open Heart.

Drawing on past scientific evidence, the authors argue that physicians, patients and society’s focus on low-calorie foods and diets has resulted in a sacrifice of good nutrition and failed to improve overall public health. According to a press release:

Daily consumption of a sugary drink (150 calories) is associated with a significantly increased risk of type 2 diabetes whereas daily consumption of a handful of nuts (30 g of walnuts, 15 g of almonds and 15 g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) is associated with a significantly reduced risk of heart attack and stroke.

It has been estimated that increasing nut consumption by two servings a week could stave off 90,000 deaths from cardiovascular disease in the US alone.

And the Action for Health in Diabetes trial shows that a low calorie diet on top of increased physical activity in patients with type 2 diabetes was not associated with a reduced risk of cardiovascular death despite significant weight loss and a monitoring period of 13.5 years, [the authors] point out.

“It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that ‘food can be the most powerful form of medicine or the slowest form of poison’,” they write.

Previously: The trouble with the current calorie-counting system, Homemade: Community-based project teaches how to cook for health and Cooked food, calorie counts and food labels
Photo by Mariya Chorna

Aging, Global Health, In the News, Public Health, Research

As life expectancy rises worldwide, many are living longer with illness and disability

10812180384_18496a55f3_zGood news: Average life expectancy has continued to climb over the past two decades. The downside is that those extra years are often marked by chronic disease or disability, according to a new analysis published in the Lancet.

In the study, an international team of researchers examined fatal and nonfatal health loss across countries in an effort to help direct global-health policies to improve longevity and quality of life regardless of where a person lives.

HealthDay reports:

The analysis of data from 188 countries found that life expectancy for both sexes increased from just over 65 years in 1990 to 71.5 years in 2013, while healthy life expectancy rose from almost 57 years to slightly more than 62 years.

“The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability,” study author Theo Vos, a professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, said in a journal news release.

The rise in overall life expectancy is due to significant declines in illness and death caused by HIV/AIDS and malaria, the researchers said, along with major advances in combating infectious diseases, nutritional deficiencies, and mother and baby health problems.

Earlier this year, Laura Carstensen, PhD, director of the Stanford Center on Longevity, spoke at the Big Data in Biomedicine conference about modern society’s gains in life expectancy and called it an “unprecedented” time in history. During her presentation, she presented data on the current aging population and what aging might look like in the future.

Previously: A look at aging and longevity in this “unprecedented” time in history, “Are we there yet?” Exploring the promise, and the hype, of longevity research and Living loooooooonger: A conversation on longevity
Photo by jennie-o

Cancer, Research, Science, Stanford News, Stem Cells

A stem cell “kill switch” may make therapies safer, say Stanford researchers

A stem cell "kill switch" may make therapies safer, say Stanford researchers

3225255407_596aa5bdff_zStem cell biologist Hiromitsu Nakauchi, MD, PhD, and his colleagues published an interesting article today about how to use stem cell technology to boost our body’s own immune cells to fight cancer or chronic viral infections like HIV or Epstein Barr virus. Because there’s a possible cancer risk with the use of induced pluripotent stem cells, or iPS cells, in humans, he and his colleagues have devised an innovative way to specifically eliminate these cells within the body if they start to cause problems. Their research appears today in Stem Cell Reports.

As Nakauchi explained to me in an email:

The discovery of induced pluripotent stem cells created promising new avenues for therapies. However, the tumorigenic potential of undifferentiated iPSCs is a major safety concern that must be addressed before iPS cell-based therapies can be routinely used in the clinic.

The researchers studied a type of immune cell called a cytotoxic T cell. These cells recognize specific sequences, or antigens, on the surface of other cells. Some antigens indicate that the cell is infected with a virus; others are found on cells that have become cancerous. When a cytotoxic T cells sees these antigens, it moves in to kill the cell and remove the threat.

In order to ensure that our immune systems recognize the widest variety of antigens, developing T cells randomly shuffle their genes to create unique antigen receptors. Researchers have found that it’s possible to identify, and isolate, T cell populations that specifically recognize cancer cells. By growing those cells in the laboratory, and then injecting them back into a patient, clinicians can give a boost to the immune response that can help kill tumor cells. The technique is known as adoptive immunotherapy, and it’s shown promise in treating melanoma. However, these cytotoxic T cells can become exhausted as they fight the cancer and become less effective over time.

Recently researchers in Nakauchi’s lab showed that it’s possible to create induced pluripotent stem cells from cytotoxic T cells. These iPS cells are then induced to again become cytotoxic T cells. These rejuvenated T cells, or rejT cells, recognize the same antigen they did before their brief dip in the pluripotency pool, but they are far more sprightly than the cells from which they were derived – they can divide many more times and have longer telomeres (an indicator of youthfulness).

So far, so good. But, as Nakauchi mentioned above, iPS cells carry their own set of risks. Because they are by definition pluripotent (they can become any cell in the body), they can easily grow out of control. In fact, one way of proving a cell’s pluripotency is to inject it into an animal and see if it forms a type of tumor called a teratoma, which is made up of multiple cell types.

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Research, Science

Short and sweet: Research papers with succinct titles cited more often

Short and sweet: Research papers with succinct titles cited more often

As a burgeoning journalist, I was often coached to cut unnecessary words. College professors mandated that story ledes be short and snappy and never exceed 35 words in length. When I began working at a daily newspaper, my editors were constantly condensing paragraphs and reminding me that “it takes more skill to write short than it does to write long.”

So I was interested to read a Nature article about new research showing that scientific studies with shorter titles receive more citations. Boer Deng writes:

Adrian Letchford and his colleagues at the University of Warwick in Coventry, UK, analysed the titles of 140,000 of the most highly cited peer-reviewed papers published between 2007 and 2013 as listed on Scopus, a research-paper database. They compared the lengths of the papers’ titles with the number of times each paper was cited by other peer-reviewed papers— a statistic sometimes used as a crude measure of importance.

As they report in Royal Society Open Science, “journals which publish papers with shorter titles receive more citations per paper”.

The impetus for the current study came from a desire to pen better papers, says Letchford, and to see whether good writing is rewarded in research. “As scientists, we’re all cursed,” when it comes to writing, Letchford says, as researchers hone their specialised knowledge but often cannot explain themselves to readers outside their own field.

While some quoted in the article agreed that concise titles can offer advantages, including increasing appeal to outside audiences, John Ioannidis, MD, DSc, director of the Meta-Research Innovation Center at Stanford, questioned whether the findings were conclusive. He said, “I will continue to struggle finding appropriate titles for my papers without worrying about whether the title length may affect their citations.”

Previously: A conversation with John Ioannidis, “the superhero poised to save” medical research, Shake up research rewards to improve accuracy, says Stanford’s John Ioannidis and John Ioannidis discusses the popularity of his paper examining the reliability of scientific research

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