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

Using technology and more to reimagine medical education

Using technology and more to reimagine medical education

Over on The Health Care Blog, Michael Painter, MD, JD, shares his thoughts from a recent meeting at Stanford’s medical school inviting medical education leaders to debate big questions in their field. Painter, a senior program officer at the Robert Wood Johnson Foundation, explained that meeting participants discussed ways that educators can use technology and other tools “to help create a durable culture of health for all.”

From the post:

In 2013 we extended a $312,000 grant to Stanford Medical School that will support work by five medical schools, Stanford, Duke, University of Washington, UCSF and University of Michigan, as they create a consensus knowledge map of the critical things medical students should learn.

Why a knowledge map? The simple answer: because there isn’t one, and we need one if we’re going to build massive core online medical education content.

Why change now? There’s building pressure on fortress academia: pressure to push health care toward high value, pressure for health care to center itself on the patient rather than the professional, and pressure from technology, specifically the ability to move previously closely held knowledge of the expert more efficiently to the learner.

Here’s where this mapping effort also starts to get interesting. It wouldn’t be that surprising if these education leaders ticked through all the reasons why change is too hard—why it can’t or won’t happen. Instead something marvelous is happening: they’re challenging each other to examine the time they spend with their students—asking if they ignite the kind of passion in their learners that others ignited in them.

An even more hopeful sign—these leaders want to connect the teaching of new healers—from the beginning—with the key partner: the patient. Their early reimagining is fixed on patient and story.

Previously: A closer look at using the “flipped classroom” model at the School of MedicineCombining online learning and the Socratic method to reinvent medical school courses, Using the “flipped classroom” model to re-imagine medical education and Stanford professors propose re-imagining medical education with “lecture-less” classes

Events, Genetics, Stanford News, Technology

Euan Ashley discusses harnessing big data to drive innovation for a healthier world

Euan Ashley discusses harnessing big data to drive innovation for a healthier world

Euan_AshleyElectronic patient records, clinical trials, DNA sequencing, and medical imaging and disease registries are a sampling of the sources contributing to the exponential growth of public databases housing biomedical information. Researchers hope mining this vast reservoir of data will accelerate the process of understanding disease while driving down the costs of developing new therapies.

But the challenge of harnessing big data to transform scientific research and improve human health is one that is so complex that it can’t be solved alone by a single person, institution or company; collaboration among government, academia and industry is imperative. To foster such partnerships, Stanford and Oxford University are sponsoring the Big Data in Biomedicine conference from May 21-23.

The conference is part of a big data initiative launched by Stanford and Oxford to solve large-number problems at a global scale to improve health worldwide. Euan Ashley, MD, who directs the effort at Stanford, has been involved in several major projects over the past few years to link an individual’s genome sequence to possible increases in disease risk. In the following Q&A, he shares insights about the upcoming conference program, provides an update on the initiative, and discusses how big data can drive innovation for a healthier world.

A collaborative effort between Oxford and Stanford aims to accelerate discovery from large-number data sets to provide new insight into disease and to apply targeted therapies on an unprecedented scale. In what ways are the universities currently working together to achieve this goal?

The Global Institute for Human Health Initiative is a very exciting new venture between these two universities. Catalyzed by the Li Ka Shing Foundation, the initiative draws on the complementary strengths of each institution. Stanford excels in innovation, technology and data management and analysis. Oxford has global reach through its School of Public Health. So it makes sense to work together.

One of our primary goals will be to build “bridges” between the largest databanks of health information in the world. These individual large-scale efforts are remarkable in their own way, but each one has by definition to focus primarily on its own data. This means that limited bandwidth is available to develop mechanisms of secure sharing and analysis. That bandwidth and expertise are things we hope to provide through the initiative. The seed grants awarded through our program in Data Science for Human Health are another way we have started to collaborate. Each one has an Oxford-Stanford collaboration at its heart.

Tell us more about those seed grants. How many have you awarded, and for what kinds of projects?

We received 60 applications and were able to award 12 grants totaling $807,171.48. Among the projects receiving funding were new methods for analyzing accelerometer data in smartphones, approaches to imaging data, and ideas for large scale data analysis, point of care testing for infectious disease and mobile application development. It was an amazing group of applications and I wish we could have funded more projects. At the conference, there will be a brief satellite meeting for the recipients to interact.

Let’s talk more about the upcoming conference. What else can attendees expect from it?

We have an exciting program with a number of high-profile speakers. I’m particularly pleased this year with the broad representation of presenters across sectors. There will be speakers across government, industry and academia, including representatives from the National Institutes of Health, Google, Intel, Mount Sinai and Duke.

We’ve also expanded our international reach, and one of the keynote speeches will be delivered by Ewan Birney, director of the European Bioinformatics Institute. Additionally, this year’s program includes two new topic areas: computing and architecture, which will be chaired by Hector Garcia Molina, PhD, and infectious disease genomics, a particular strength at Oxford. Another addition is the Big Data Corporate Showcase, where companies ranging from industry giants to start-ups will share their achievements and innovations related to big data. So, lots to look forward to!

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Health and Fitness, Mental Health, Technology

A bike helmet that doubles as a stress-o-meter

A bike helmet that doubles as a stress-o-meter

bike_riderMany of those who ride their bike to work do so because of the health, financial and psychological benefits. While it’s clear that commuting on two wheels can help you stay fit and save money, a new high-tech helmet that measures brain activity shows bicycling may not be as stress-free as you believe.

The helmet, developed by the MIT MediaLab, is equipped with an LED display that lights up  green when you are calm, yellow when you are slightly irritated, and red when you are sleepy or anxious. If your stress level turns to panic, the lights flash red. The display is powered by built-in sensors and an electrode that translates electroencephalogram (EEG) feedback.

Dubbed MindRider, the latest version of the helmet maps your stress level to your route. Fast Company reports:

The first prototypes of the helmet just had colored lights, but the GPS adds new potential. “Now that it is a connected device, we definitely see its power in yielding insights over time,” [Arlene Ducao, a master's candidate at MIT's MediaLab] explains. “Urban and transportation planners can look at the data of many people and use that for transportation planning–things like bike lanes or bike-share programs.”

As a large group of people start to use the device, it can also be used for navigation. “You can access the data of others to help navigate you in a way that’s potentially less stressful, potentially more relaxing and more safe,” she says.

Previously: Now that’s using your head: Bike-helmet monitor alerts emergency contacts after a crash, University leaders raise awareness about the importance of bike helmets and Modest increases in bike ridership could yield major economic, health benefits
Photo by Roland Tanglao

Imaging, Ophthalmology, Research, Stanford News, Technology

Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing

Instagram for eyes: Stanford ophthalmologists develop low-cost device to ease image sharing

eye-phoneThis probably won’t grab as many headlines as the news of a smartphone that wakes you up with the sizzle and smell of bacon, but it should!

A team of Stanford scientists is using 3D printing to create inexpensive adapters that make it easy to use a smartphone and an ordinary examination lens to capture high-quality images of the front and back of the eye. And – what seems to me as just as important – providing a nearly effortless way to share those images.

“Think Instagram for the eyes,” said one of the developers, assistant professor of ophthalmology Robert Chang, MD.

This is a big deal because most primary-care doctors have no good way to see into patients’ eyes, and no easy way to share the images. The usual eye-imaging instruments are expensive and hard to use, and even ophthalmologists who have the equipment and know-how find capturing and sharing the images slow going.

As one of Chang’s fellow developers, Stanford ophthalmology resident Dave Myung, MD, PhD, told me when I interviewed him for an article in Inside Stanford Medicine:

“A picture is truly worth a thousand words… Imagine a car accident victim arriving in the emergency department with an eye injury resulting in a hyphema – blood inside the front of her eye. Normally the physician would have to describe this finding in her electronic record with words alone. Smartphones today not only have the camera resolution to supplement those words with a high-resolution photo, but also the data-transfer capability to upload that photo securely to the medical record in a matter of seconds.”

The scientists describe the adapters, currently dubbed the EyeGo, in two articles in the new issue (volume 3, issue 1) of Journal of Mobile Technology in Medicine. And you can read my story to learn more about the development process, including how Myung pieced together the first prototype (with plastic bits he ordered from the Internet and a few Legos), how mechanical engineering graduate student Alex Jais created the first printed model on his own 3D printer, and how residents Lisa He, MD, and Brian Toy, MD, are leading studies to test them out.

Those interested in using an EyeGo adapter for research or beta-testing can e-mail the team at eyegotech@gmail.com.

Previously: Image of the Week: Sigmoid volvulus and Treating common forms of blindness using tissue generated with ink-jet printing technology
Photograph by Dave Myung

In the News, Sleep, Technology

Exploring the benefit of sleep apps

Exploring the benefit of sleep apps

man sleeping in bedCan sleep-related apps be of benefit to the bleary-eyed masses? That’s the question explored today by the New York Times’ Molly Young, who sought the advice of one of our sleep experts for her story:

Browse the iTunes store or Google Play and you’ll find them by the dozen: offerings with names like SleepBot and eSleep, represented by icons of placid sheep or glowing moons. The offerings fall into two basic categories. One tracks sleep patterns through the smartphone’s accelerometer (the doodad that recognizes when your phone is upside-down), giving users a blueprint of their time in bed. The second promises to lull users to sleep with music, hypnosis or guided meditation.

If you’re the data-driven type, a sleep-tracking app surely appeals. By placing the phone next to you in bed and tapping a button, you record your movements and a sleep chart is created. But according to Dr. Clete Kushida, the medical director of the Stanford Sleep Medicine Center, these apps are hardly precise.

“Without EEG — brain wave activity — it’s very hard to tell different stages of sleep apart,” Dr. Kushida said. “People can stay still and the device will think the person’s asleep.” Still, “the advantage of these devices is that they can help individuals become more aware of a potential sleep problem,” Dr. Kushida said.

Previously: Why physicians should consider patients’ privacy before recommending health, fitness apps, A look at the “Wild West” of medical apps, Designing the next generation of sleep devices, Exploring the effect of sleep loss on health, Turning to an app to help your health and Stanford sleep expert offers evaluation of science behind one sleep device
Photo by dearoot

Events, Medical Education, Medicine and Society, Stanford News, Technology

Stanford-hosted AMA Medical Student regional conference focuses on health-care technology

Stanford-hosted AMA Medical Student regional conference focuses on health-care technology

AMA photoStanford med students Nuriel Moghavem and Trishna Narula co-chaired an AMA Medical Student Section Regional 1 conference last weekend at the Li Ka Shing Center for Learning and Knowledge. Ninety students, including 40 from Stanford, participated in the two-day event, which involved meetings, breakout sessions with industry leaders and social outings, plus an optional trip to a local winery the following day. Moghavem shared his thoughts on the weekend’s proceedings in the Q&A that follows.

How did you decide to focus on healthcare technology innovation?

When we were putting together the proposal, we thought a lot about what makes Stanford different from other schools that might host this conference, and how we could add educational and inspirational value to the trips of students coming from other states. Stanford obviously has many things that set it apart, but we thought that the energy of the health tech field would really capture the imaginations of our attendees.

What were some key takeaways from the sessions?

Our keynote speaker was Atul Butte, MD, PhD, a giant in the field of big data analytics and [someone who is] incredibly knowledgeable about the process of bringing a medical discovery to the market. Everyone in that room was rapt and half probably left wondering why we all weren’t millionaires already. We then had some breakout sessions from telemedicine and technology startups that again pushed our attendees’ understanding about the future of medicine. I think the main takeaways were that technology is changing health care, and the “visibility” – if you think about it like driving a car in the fog – probably isn’t more than two to three years ahead. Technology has the promise to entirely overturn our idea of how health is fundamentally defined and approached in ways that we simply can’t anticipate at this time. It’s big stuff.

What took place at the AMA Leadership School Workshop?

The Leadership School is a national initiative to put tools in the hands of emerging leaders to empower them to expand their efforts. The workshop they led during our conference was an excellent morning icebreaker – asking attendees to share media related to their own personal “brand” (a favorite image, a Google search of themselves, etc.). Through the exercise, we all shared interesting personal details about our lives, interests, passions and hobbies, and we learned a valuable lesson in controlling one’s brand and online presence.

You are a busy medical student. Why do you feel it’s important to participate in leadership opportunities in your field?

As medicine becomes increasingly driven by public policy, it’s important that we cultivate a generation of leaders in medicine with the tools to engage in policy. This conference was, for us, an opportunity to get 70 of the brightest future physicians in our region (which spans from Hawaii to South Dakota!) in one room to discuss that very issue and to develop those skills. We don’t just think it’s important for emerging physician leaders to participate in policy matters, we think it’s critical for the future well-being of our community and perhaps our country for them to do so.

Co-organizer Trishna Narula later shared with me, “while this was a great opportunity for the AMA to benefit from the health technology hub at Stanford, it was also another large step for Stanford Med to push to the forefront of health policy and advocacy.”

Previously: Top 10 reasons I’m glad to be in medical schoolFuture doctors have a lot at stake, even if they don’t know it: A student’s take on the Affordable Care Act and Stanford Medicine X seeking students for leadership program
Photo by James Pan

Applied Biotechnology, Bioengineering, Cardiovascular Medicine, Stanford News, Technology

Heart devices get a mobile makeover

Heart devices get a mobile makeover

AUM-close-up-chest560

Emerging diagnostic heart devices are going mobile. And by leveraging advances in smartphones and sensors, they’re able to perform their functions better, faster and cheaper than traditional heart monitoring equipment.

For example, the CADence, shown above, detects blocked arteries from the surface of the chest by identifying the noisy signals of blood turbulence associated with blockages.

The Zio Patch, on the right, is a sensor that can be worn on the chest for up to 14 days to detect intermittent, irregular heartbeats, called arrhythmias. ZIO-150-90

Both of these amazing devices reveal the mysteries of the heart non invasively, and they provide more potentially life-saving heart data to physicians than conventional equipment.

Yet despite these advantages, adoption into the medical system has been slow.

In the new issue of Stanford Medicine magazine on cardiovascular health, I interview the entrepreneurs behind these inventions — the heart gadgeteers — and let them describe the hurdles that add years to the process of launching new medical devices into the marketplace.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, New Johnson & Johnson CEO discusses medical device futures at Stanford eventStanford physician-entrepreneur discusses need to change FDA approval process and Is the United States losing ground as a leader of medical innovation?
Photos courtesy of AUM Cardiovascular, iRhythm Technologies

Behavioral Science, Events, Medicine and Society, Stanford News, Technology

The Dalai Lama talks business, compassion and happiness

The Dalai Lama talks business, compassion and happiness

One Christmas, my dad gave me and my siblings copies of the Dalai Lama‘s book The Art of Happiness – a quick read with a valuable missive. (“Be content with this book – you didn’t need other presents” was my takeaway.) I was reminded of this when reading about a recent visit – focused in large part on happiness – by His Holiness to Silicon Valley.

During his visit, which was co-sponsored by Stanford’s Center for Compassion and Altruism Research and Education (CCARE), the Dalai Lama gave a talk at Santa Clara University on business, ethics and compassion. As Stanford News reports from the event:

In his opening remarks, [James Doty, MD,] noted that stress, anxiety and depression are the greatest health care costs to businesses – he referred to an “epidemic of depression.” Companies do not pay enough attention to the well-being of its employees, he suggested.

“Is there a different approach?” asked Doty, referencing the effects of meditation and compassion on the brain. This type of research, he said, has stimulated a revolution in science. Being compassionate increases one’s health, well-being and longevity, he said.

The Dalai Lama talked about how to become a “happy person” and build a “happy community” where people spread love and compassion.

“Everyone has the right to be a happy person, but generally we have too much of an emphasis on material values,” he said.

Doty is director of CCARE, which studies the science of compassion. (The Dalai Lama is a founding benefactor of CCARE.) More from the article:

Doty said that researchers are especially interested in ways to integrate technology and well-being.

“We’re studying the development of interventions, including web-based or smartphone-based apps that support health and well-being by decreasing stress and anxiety in the workplace,” Doty said in an interview before the Dalai Lama spoke.

Previously: Are women more compassionate than men? What the science tells usHow practicing compassion could ease or eliminate chronic stress and How being compassionate can influence your health

Patient Care, Research, Stanford News, Technology

Automated safety checklists prevent hospital-acquired infections, Stanford team finds

Automated safety checklists prevent hospital-acquired infections, Stanford team finds

inserting central line - smallPilots, astronauts and workers in other high-risk industries follow rigorous safety checklists to help them avoid hazards. Checklists have shown potential to reduce risk in health care, too, but the challenge is figuring out how to incorporate them into physicians’ and nurses’ work flow.

A Stanford team has built a solution: an automated checklist that pulls data directly from patients’ electronic medical records and pushes alerts to caregivers. The checklist, and a dashboard-style interface they used to interact with it, caused a three-fold drop in the rates of a serious type of hospital-acquired infection, the team found. The work has just been published in Pediatrics.

From our press release about the study:

“Electronic medical records are data-rich and information-poor,” said Natalie Pageler, MD, the study’s lead author. Often, the data in electronic medical records is cumbersome for caregivers to use in real time, but the study showed a way to change that, said Pageler, who is a critical care medicine specialist at the hospital and a clinical associate professor of pediatrics. “Our new tool lets physicians focus on taking care of the patient while automating some of the background safety checks.”

Working in the pediatric intensive care unit at Lucile Packard Children’s Hospital Stanford, the researchers focused on bloodstream infections that occur via central lines, which are catheters inserted in major veins. The automated alerts were designed to help physicians and nurses follow an established set of best practices for caring for central lines. For example, alerts were generated when the dressing on a patient’s central line was due to be changed.

The drop in the rate of central line infections – from 2.6 to 0.7 infections per 1,000 days of central line use – not only protected patients from harm; it also saved money. The team estimated that the savings in the pediatric intensive care unit were about $260,000 per year.

Next, the researchers hope to adapt the automated checklists to other uses, such as helping to guide the recovery of patients who have received organ transplants.

Previously: More than a manual: Stanford’s crisis checklist helps those working in the OR, What health-care providers can learn from the nuclear industry and Sully Sullenberger talks about patient safety
Photo by Jocelyn Augustino/FEMA Photo Library

Cardiovascular Medicine, Research, Stanford News, Technology, Transplants

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

spring14_magazine-coverThe heart is a paradoxical organ. It declares its presence with that distinctive thump thump, yet its moment-to-moment condition is really hard to decipher. But as I learned while editing the just-published Stanford Medicine magazine special report “Mysteries of the heart,” new technologies and research are making it easier to assess heart health and diagnose disease. With heart disease the No. 1 cause of death worldwide, that’s good news.

The issue, published during American Heart Month, was supported in part by the Stanford Cardiovascular Institute. Among its contents:

  • A change of heart“: An interview with former vice president Dick Cheney on having “virtually everything done to me that you could do to a heart patient,” culminating with a transplant.
  • Fresh starts for hearts“: A feature on using stem cells to revolutionize cardiac care, and a family for which new treatments can’t come soon enough.
  • The ultramarathoner’s heart“: Visionary computer designer Mike Nuttall’s exploits as an ultramarathoner, despite having severe heart disease (online only).
  • Hiding in plain sight“: The story of a man born with high cholesterol — a surprisingly common but hidden and deadly condition.
  • Switching course“: A piece detailing the untangling of a heart surgery that saves babies, but threatens their lives in adulthood.
  • The heart gadgeteers“: A report on the new wave of heart- and fitness-monitoring devices, and why it’s hard to integrate them into the medical system.
  • Easy does it“: An article on an alternative to open-heart surgery to replace aortic valves.
  • Dear Dr. Shumway”: Catching up with a kid who in 1968 wrote to transplant pioneer Norman Shumway, MD, for advice — on his frog heart transplant.

The issue also includes articles on the use of big data in medicine, which will be the focus of the Big Data in Biomedicine conference May 21-23 at Stanford.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a babyFactoring in the environment: A report from Stanford Medicine magazine and New issue of Stanford Medicine magazine asks, What do we know about blood?
Illustration by Jason Holley

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