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Big data, Cardiovascular Medicine, Chronic Disease, Research, Stanford News

Big data used to help identify patients at risk of deadly high-cholesterol disorder

Big data used to help identify patients at risk of deadly high-cholesterol disorder

Familial hypercholesterolemia is not exactly a catchy name. But Stanford cardiologist Josh Knowles, MD, is determined to make it easier to remember. This little known, high-cholesterol disease is a silent killer. If you don’t know you have it, it can strike suddenly – and years before most people ever start worrying about heart attacks.

Knowles and fellow researchers at Stanford have launched a new research project aimed at identifying people at-risk of having FH. Using “big data” research methods and software that “teaches” a computer how to recognize patterns, researchers plan to comb through electronic medical records at Stanford hospitals and, if successful, pinpoint those who might have the disease and not know it.

In a story I wrote on the new project, Knowles described how this innovative technology could potentially be used to transform health care:

Machine learning, in which computer algorithms learn to recognize patterns within data, is widely used by Internet businesses such as Amazon and Netflix to improve customer experience, get information about trends, identify likes and dislikes and target advertisements. These techniques have not been widely applied in medicine, but we believe that they offer the potential to transform health care, particularly with the increased reliance on electronic health records.

Using these methods to help identify patients with FH is a good place to start, Knowles said, since there are currently few systematic approaches to finding people with FH, and many doctors are unfamiliar with the disease. As he told me:

This disorder certainly leads to premature death in thousands of Americans each year … Less than 10 percent of cases are diagnosed, leaving an estimated 600,000 to 1 million people undiagnosed. If found early enough and treated aggressively with statin-based regimens, people can live longer, healthier lives.

The project is part of a larger initiative called FIND FH (Flag, Identify, Network, Deliver), a collaborative effort involving Stanford Medicine, Amgen Inc., and the nonprofit Familial Hypercholesterolemia Foundation to use innovative technologies to identify individuals with the disorder who are undiagnosed, untreated, or undertreated.

Previously: Registration for Big Data in Biomedicine conference now open, Hope for patients with familial hypercholesterolemia and Born with high cholesterol
Photo by Dwight Eschliman

Cancer, Health Costs, In the News, Stanford News, Videos

An initiative to deliver more compassionate and affordable advanced cancer care






This 9-minute video report from Al Jazzera America’s “America Tonight” offers an intimate glimpse into the lives of veterans suffering from advanced cancer, as they discuss end-of-life issues with their care providers at the Veterans Affairs Palo Alto Health Care System.

More than 200 late-stage cancer patients are participating in this Stanford-designed pilot study. Its goal is to improve the quality of life of these patients, while simultaneously reducing the costs of 11th-hour treatments that might not offer life-extending or life-enhancing benefits.

The driving force behind this study is Manali Patel, MD, a young Stanford oncologist who designed the plan with three others during her fellowship year at the Stanford Clinical Excellence Research Center, called CERC. The Center’s mission includes tests of its innovative care concepts at diverse U.S. health-care sites, in order evaluate and refine them prior to advocating widespread adoption.

The video focuses on one of three major components of the new CERC-designed approach to cancer care. The first is earlier patient counseling and shared decision-making about treatment options, well before a patient is on the brink of death, when emotions overwhelm the decision-making skills of patients, families and clinicians.

These difficult discussions don’t happen as often as they should, as I wrote in a 2012 Stanford Medicine magazine article on topic:

According to a recent study, end-of-life discussions typically take place only 33 days before death. With Patel’s proposed cancer care model, patients would be thoroughly briefed on the survival odds and side effects before being rushed off to surgery or chemotherapy. Many months before the family is gathered around a loved one’s deathbed, a person’s final wishes – resuscitation, feeding tubes, assisted breathing and whether a person wants to die at home – would be well-informed and documented.

Other pilot sites tests are in the process of implementing various components of the new approach. Last week Patel provided an update on these new cancer-care pilots:

And finally, an update on the cancer patients featured in the video: former Army police officer Rafael Arias, who chose to skip a final round of chemotherapy, recently passed away peacefully at his home. Timothy Blumberg is still in remission.

Previously: Uncommon hero: A young oncologist fights for more humane cancer careTV spot features a more humane approach to late-stage cancer care, “Stop skipping dessert:” A Stanford neurosurgeon and cancer patient discusses facing terminal illness
Video courtesy of Al Jazzera America

Global Health, Immunology, Research, Stanford News

With a Gates Foundation grant, Stanford launches major effort to expedite vaccine discovery

With a Gates Foundation grant, Stanford launches major effort to expedite vaccine discovery

Mark DavisThe vaccine field got a major boost today with the announcement that the Bill & Melinda Gates Foundation will invest $50 million in a new collaboration with Stanford’s School of Medicine to speed the development of vaccines for some of the world’s major scourges. The funds will support the new Stanford Human Systems Immunology Center, a multidisciplinary effort led by immunologist Mark Davis, PhD.

In recent decades, efforts to develop vaccines for major killers such as HIV and malaria have been stymied in part by the expense and time involved in conducting large-scale trials, which have often proved disappointing. Through the new initiative, scientists will use advanced immunological tools to better understand how vaccines provide protection and identify the most promising candidates to pursue in clinical trials.

What we need is a new generation of vaccines and new approaches to vaccination

“What we need is a new generation of vaccines and new approaches to vaccination,” said Davis, director of the Stanford Institute for Immunity, Transplantation and Infection. “This will require a better understanding of the human immune response and clearer predictions about vaccine efficacy for particular diseases.”

The 10-year initiative will involve multiple faculty from diverse fields, including medicine, engineering and computer science. It will capitalize on a range of technologies, some of which have been pioneered at Stanford, which can rapidly analyze individual cells and provide a detailed profile of the human immune response, with all of its various components.

“This grant will provide crucial support to Stanford’s world-class scientists as they collaborate with investigators around the globe to assess vaccines against some of the most formidable diseases of our time,” said Lloyd B. Minor, dean of Stanford’s medical school. “The Stanford Human Systems Immunology Center will help the most promising vaccine candidates to move quickly and efficiently from the lab to the front lines of treatment, impacting countless lives.”

Previously: Knight in lab: In days of yore, postdoc armed with quaint research tools found immunology’s Holy Grail
Photo of Mark Davis by Steve Fisch

Cardiovascular Medicine, Patient Care, Stanford News

“This reinforced why I went into nursing”: The story of two nurses who resuscitated plane passenger

"This reinforced why I went into nursing": The story of two nurses who resuscitated plane passenger

Woo and BinghamStanford Health Care cardiac nurse coordinators Angela Bingham, RN, MSN, CNL, and Sophia Loo, RN, MSHCA, have cared for hundreds of patients with serious heart disease. And they’ve had access to sophisticated technology and colleagues who are skilled at teamwork. Then came the one time that none of that was at hand – and a life was at stake.

Last December, Loo and Bingham had just boarded a plane back home to San Jose from a national health-care conference when they heard a call for help. Both rushed forward and found a male passenger in obvious cardiac distress. They recognized instantly that he was near death, and what followed was a classic case of making the best of what they had.

In a story in yesterday’s Inside Stanford Medicine, Bingham and Loo share their experience and how much it meant to be able to do something they knew made a difference. “This reinforced why I went into nursing,” Loo told me for the story. “I was so humbled and grateful that I could do something; that Angela and I knew what to do.”

Photo by Norbert von der Groeben

Mental Health, Neuroscience, Stanford News, Videos

Hope for the globby thing inside our skulls

Hope for the globby thing inside our skulls

While at the World Economic Forum annual meeting in Davos, neuroscientists Tony Wyss-Coray, PhD, and Amit Etkin, MD, PhD, had a webcast conversation with NPR correspondent Joe Palca as part of his series of conversations on brain science. During their conversation, Palca asked about the current state of treatment for mental health and neurodegenerative diseases (bad) and prospects for the future (better).

When asked the single most important thing people could do for their mental health, Etkin answered, “awareness”. He said people need to be aware of their mental health and know that help exists if they seek it out. Current treatments aren’t perfect, but they are better than no treatment at all.

They also discussed molecular tools for diagnosing degenerative diseases, and the goals of the Stanford Neurosciences Institute‘s Big Ideas in Neuroscience teams that the two co-lead to develop new diagnostics and treatments for mental health (Etkin) and neurodegenerative diseases (Wyss-Coray).

At the end, Palca summarized the wide-ranging conversation saying, “I think it’s a time of actually some hope. I feel quite positive that this globby thing that sits inside our skulls is being understood in enough detail to make some precise changes that can be helpful.”

Previously: Neurosciences get the limelight at DavosNeuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more

Cancer, Health Disparities, Patient Care, Research, Stanford News

Study shows evidence-based care eliminates racial disparity in colon-cancer survival rates

Study shows evidence-based care eliminates racial disparity in colon-cancer survival rates

For the past two decades, the National Cancer Institute has documented that African-American patients have consistently had lower survival rates in colon cancer when compared with white patients. In a study published today in the Journal of Clinical Oncology, lead author Kim Rhoads, MD, PhD, and colleagues from Stanford show that receiving high quality, evidence-based treatment can eliminate this racial disparity. As Rhoads explains in our press release:

Historically, we’ve taken less than a critical eye on our own health-care system in terms of how we can take the lead in addressing disparities. The big take away in this paper is that it’s treatment, not necessarily patient factors, but following evidence-based guidelines that gives all patients the best chance for survival. Our work also suggests a real opportunity to equalize these racial differences.

The evidence-based guidelines were created by the National Comprehension Cancer Network, which used clinical trials and medical research to create step-by-step, evidence-based treatments for most cancers. However, adherence to those guidelines depends on the facility and research shows that minority patients tend to receive care from hospitals that have low adherence rates.

The study found that integrated health-care organizations, which provide all of a patient’s health-care services, hospital care and insurance, delivered evidence-based care for colon cancer at a higher rate than non-integrated health-care organizations. In these facilities, all patients had higher survival rates and racial disparity for colon cancer survival disappeared.

“In integrated systems, there’s already a big push to thinking about following evidence-based guidelines, so everyone within that system is in the same mindset,” said co-author Manali Patel, MD, MPH. “It’s easier to do the right thing when you have the system-level support to do so.”

Integrated health-care systems are well suited for coordinating care among several specialists, which is another advantage for colon-cancer patients, because the treatment of colon cancer requires different types of treatments and different types of specialists, the study pointed out.

The results support the development of integrated health care models as envisioned by Affordable Care Act.

“With health-care reform, millions more patients are coming into the system, and we’re going to need to become more integrated in order to meet the demand. We’re going to need to work more closely together, decrease variations in care and standardize what we do,” Rhoads told me. “In this paper, we have a model that shows that when you do this, you get better colon cancer outcomes for everyone.”

Previously: Stanford researchers examine disparities in use of quality cancer centers, Uncommon hero: A young oncologist fights for more humane cancer care and Report shows continuing health disparities for racial and ethnic minorities

Applied Biotechnology, Bioengineering, Ophthalmology, Stanford News, Videos

A medical invention that brings tears to your eyes

A medical invention that brings tears to your eyes

dry-eye-implantMore than 20 million Americans suffer from dry eye, a painful condition where a personal’s lacrimal glands don’t create enough tears to lubricate the surface of the eye.

But relief is around the corner for these sufferers – a tiny implantable device that stimulates natural tear production on a long-term basis is currently in clinical trials. The device increases tear volume by delivering micro-electrical pulses to the lacrimal gland. It’s inserted into the mucus lining of the sinus cavity or under the skin beneath the eyebrow. Tear delivery rates can be adjusted manually with a wireless controller. (You can watch a video of this device producing tears, below.)

This clever invention is the brainchild of bioengineer and former Stanford Biodesign fellow Michael Ackermann, PhD, who says he spent a good part of his boyhood in Louisville, Kentucky, taking apart things like VCRs, radios and weed-whackers.

“My parents wanted me to be a doctor, but it was very clear from a young age that I was going to be an engineer,” said Ackermann.

He’s now at the helm of Oculeve, a 20-person startup dedicated to helping people with dry-eye. Ackermann’s tale of how he took one crazy idea and turned it into a product that has the potential to help millions of people is featured in the latest issue of Inside Stanford Medicine.

More than one person’s story, it’s another example of the efficacy of the Stanford Biodesign training program, whose fellows have started 36 medtech companies and filed more than 200 patents, all of which have reached 250,000-plus patients.

Previously: Crying without tears unlocks the mystery of a new genetic disease, Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing and Stanford-developed eye implant could work with smartphone to improve glaucoma treatments
Photo and video by Michael Ackermann

Events, Medical Education, Medical Schools, Stanford News, Videos

What’s it like to be an internal medicine resident at Stanford?

What's it like to be an internal medicine resident at Stanford?

“I remember being in your shoes,” Ronald Witteles, MD, said to prospective residents during a recent Google+ Hangout sponsored by the Stanford Internal Medicine Residency program. “I really felt that Stanford was the best fit for me, so I crossed my fingers and came out here. It’s been everything I hoped it could be and more.”

Witteles is the resident program director, and he joined a panel of faculty, residents, and physicians to share stories and answer questions from prospective residents and the interested public about life at Stanford.

During the Hangout, department chair Robert Harrington, MD, spent time discussing Stanford’s tradition of innovation – highlighting the Biodesign program, a collaboration between the School of Medicine and the School of Engineering, and the Department of Medicine’s Clinical Excellence Research Center, which organizes research teams to discover and design new methods of health-care delivery. When asked to comment on the school’s innovative reputation, he replied: “There is a spirit of innovation across the residency, across the department, and across the university that I think is unique, and is one of our defining characteristics.”

Several programmatic changes were also addressed during the hour-long conversation. Witteles talked about a new initiative called Pathways of Distinction, or POD, which will allow residents to select one of seven individualized pathways that align with their academic and professional interests. Each POD, he explained, will provide residents with a unique opportunity for mentorship and development outside of their primary education in internal medicine.

Additional audience questions ranged from the level of autonomy afforded to residents (the answer: a significant amount, but you’re never left by yourself), to favorite things about Palo Alto, which garnered enthusiastic group consensus about the vibrant food scene and the close proximity to nature. Watch the full conversation above.

Previously: Stanford Internal Medicine Residency program to host Google+ Hangout

Complementary Medicine, In the News, Mental Health, Pediatrics, Research, Stanford News

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

kids_yogaManaging stress and making healthy choices is a daily struggle for many of us. But what if way back in elementary school we had learned resiliency skills and mind-body practices to cope with anxiety, reduce incidents of bulling and violence, and boost our cognitive ability? Would this training have helped us keep our flight-or-fight response in check and live healthier lives?

A four-year study conducted by researchers at Stanford aims to answer these questions. The project will evaluate a yoga-based health and wellness program involving 3,400 students at the Ravenswood City School District. The program, which has been funded for three years by the Sonima Foundation, includes exercise-based on yoga, basic fitness regimes, relaxation techniques, mindfulness practices and nutrition. As the San Jose Mercury News reports:

The plan is to employ a multi-method approach that involves biology, physiology and psychology — a complete bio-psychosocial assessment — to measure [students’] emotions and behavior, academic and cognitive strengths and weaknesses, brain activity and structure, stress-related hormone levels, and sleep patterns.

“We’re really looking forward to a year from now — when I tell you this is effective — for you not to only take it on my word, but for you to also have data,” said Dr. Victor Carrion, a professor of psychiatry and behavioral sciences at [Stanford].

Carrion is also the director of the Stanford Early Life Stress and Pediatric Anxiety Program at Lucile Packard Children’s Hospital.

In 2012, he launched a mindfulness program in the Ravenswood City School District to treat post-traumatic stress disorder in teens that was featured on a PBS NewsHour segment. Jones and his wife happened to catch the broadcast, and because Carrion has done pro bono work with students and parents in the community for years, the partnership between the district, Stanford and the Sonima Foundation was forged.

The four-year study is also in partnership with the Center for Education Policy and Law at the University of San Diego.

“This is something that for years has been a gap in our educational system,” Carrion said. “There’s nothing… that teaches children to socialize and to be in touch with their emotions and to take care of their inner health.”

Previously: Stanford researchers use yoga to help underserved youth manage stress and gain focus, Yoga classes may boost high-school students’ mental well-being and Study shows meditation may lower teens’ risk of developing heart disease
Photo by Nicole Mark

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

Study finds gaps in referring California’s tiniest babies to follow-up care

Study finds gaps in referring California's tiniest babies to follow-up care

preemie feet2When very fragile babies go home from the hospital after birth, they often require special follow-up care. But a new Stanford study has found that some high-risk infants aren’t receiving referrals to the follow-up care they need.

The study, which appears in the February issue of The Journal of Pediatrics, analyzed statewide data on more than 10,000 California babies born in 2010 and 2011 who were considered high risk because they had very low birth weights. Of those who survived to hospital discharge, 20 percent did not receive referrals to the state’s high-risk follow-up program.

From our press release on the research:

Babies who weigh less than 3.3 pounds at birth, nearly all of whom are born prematurely, are at risk for a variety of neurologic and developmental problems in childhood. In California, all babies with a very low birth weight who received care in a California Children’s Services-approved neonatal intensive care unit qualify for a state-supported, follow-up program that provides diagnostic assessments and services until they turn 3.

“If we cannot succeed in that first step of getting these babies referred to follow-up, we’re at a critical disconnect for what we can offer them as they grow and develop,” said Susan Hintz, MD, professor of neonatal and developmental medicine and lead author of the study.

The study analyzed which very-low-birth-weight babies were receiving referrals. Neonatal intensive care units that treated more of these babies referred a higher proportion of such patients to follow-up care, and babies with several types of medical problems were more likely than others to receive referrals. Babies whose birth weights were on the higher end of the low-weight category were less likely to get referrals, as were those of African-American and Hispanic descent.

The good news, however, is that the data was collected just after California revamped its high-risk follow-up program. Hospitals with low referral rates are already receiving feedback to help them improve, and those with high referral rates are being studied to see how their successes can be transferred to other settings. More from our release:

“We’ve already made substantial improvements in site-specific online tools and resources available to hospitals for nearly real-time feedback, and referral rates now appear to be higher than they were during 2010 and 2011,” Hintz said.

California is ahead of other states in having a comprehensive, statewide program to help high-risk infants, [she] added. “The expectation that all our high-risk infants will be referred is enormously innovative in this country,” she said.

Previously: Preemies face increased risk of death in early adulthood, Stanford study finds, NICU trauma intervention shown to benefit mothers of preemies and How Stanford researchers are working to understand the complexities of preterm birth
Photo by Jenny

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