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Stanford medicine Volume 6, No. 14 August 4, 2014 Published by the Office of Communication & Public Affairs inside High school students increasingly look to the labs and departments at Stanford to find
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Stanford medicine Volume 6, No. 14 August 4, 2014 Published by the Office of Communication & Public Affairs inside High school students increasingly look to the labs and departments at Stanford to find internships. Page 4 Stanford Life Flight: 30 years of saving lives By Sara Wykes I n May 1984, Stanford Life Flight made its inaugural mission, heading to Santa Cruz County to help a 70-year-old woman critically injured in a car accident. With that incident, Life Flight was established as the first helicopter emergency services program in the Bay Area, and Stanford Hospital & Clinics became the first medical center in the region to have its own helicopter and air medical transport team. Thirty years and many thousands of flights later, Life Flight has a proud history to celebrate. Its flight crew has years of experience, and its helicopter carries some of the most advanced airborne health-care technology available. Stanford has always been regarded as one of the premier programs in the state, if not the country, said Michael Baulch, RN, JD, Life Flight s program manager. Life Flight may launch its helicopter and crew up to three times a day and averages about 700 flights annually, ranging as far south as Santa Barbara and as far north as the Oregon border. Between 30 and 40 percent of those flights carry children to the neonatal intensive care unit of Lucile Packard Children s Hospital Stanford. Adult patients are most often transported to Stanford for stroke, cardiac or trauma care. In-flight experts A number of the flight nurses have been on board for years, even decades. To be considered for the crew requires years of experience, as well as extensive clinical qualifications and exceptional interpersonal skills. People say, I bet your staff is a bunch of Type A personalities, Baulch said. I want the Type D personality whose heart rate never goes up. When you land on a highway where there are badly injured people, you want someone to step in and infuse a sense of calm into the situation. Most Life Flight nurses have advanced certifications in flight nursing and critical care specialties, and several have graduate degrees. The nurses maintain their expertise through ongoing training, continuing education courses and hours of practice with simulation mannequins for procedures they may not perform fre- norbert von der groeben Flight nurse and emergency medical specialist Michael Baulch is the program manager of Stanford Life Flight, which this year marks its 30th year of operation. The program s inaugural mission was in Universal molecular flag highlights key genes, study finds By Becky Bach After probing more than 200 genetic data sets, researchers at the School of Medicine have identified a molecular flag that labels genes critical to a cell s function. The flag appears to exist universally in cells ranging from worms to humans and can be used to help decipher the function of unfamiliar cells, said Anne Brunet, PhD, associate professor of genetics and senior author of the study. For example, by examining a cell s collection of flagged genes, researchers can classify a cell as a muscle, skin or other type of cell. This is the new era of using available data to make really quently but must manage well in a crisis. new hypotheses and new Specialized technology discoveries, Flight nurses also assist with trauma Brunet said. alerts in the Emergency Department and This paper help in the intensive care units with advanced procedures. Our job has evolved why it s nice exemplifies greatly over the years, said Geralyn Martinez, RN, a Life Flight nurse since ford where Anne Brunet to be at Stan- When I started, a doctor was giving the we re embracing big data. orders. Now we have protocols and expanded responsibilities. It s a very collaborative, team-centered approach. July 31 issue of Cell. The study was published in the Evolving tech- See life flight, page 6 See genes, page 7 After patient s heart recovers, ventricular pump deactivated using a minimally invasive approach By Sara Wykes Donna Jackson s heart, on the verge of failing two years earlier, had made a strong recovery. By spring 2013, she no longer needed the left ventricular assist device, or LVAD, that had been implanted in her chest almost three years earlier. It got in the way of things she wanted to do, like swim with her grandchildren. But her doctors at Stanford Hospital & Clinics believed the 70-year-old resident of the Central Valley would have courtesy of donna jackson Donna Jackson swims with a granddaughter after undergoing a minimally invasive deactivation of her mechanical heart pump. trouble surviving the surgery to remove the mechanical heart pump. So they decided to find another way. Their solution a minimally invasive, catheterbased procedure unlike any previously reported that allows Jackson to live free of the LVAD s batteries, controller and external driveline is described in a paper that is published in this month s issue of the Annals of Thoracic Surgery. Other minimally invasive techniques to deactivate the LVAD already existed, but they would require small incisions in the chest and the abdomen more than the Stanford team wanted. We decided the best thing to do was to use a catheter-based approach because it would involve only a small incision in her groin and the smallest amount of anesthesia possible, said the study s senior author, Richard Ha, MD, clinical assistant professor of cardiothoracic surgery at the Stanford School of Medicine and surgical director of the hospital s Mechanical Circulatory Support Program. The lead author of the paper is Sanford Zeigler, MD, a cardiothoracic surgery resident. Jackson s doctors threaded a slim plastic tube through a small incision to her femoral artery in the groin and up to her aorta, allowed them to plug the flow of blood to the LVAD. Then, they cut, cleaned and capped the wiring powering the LVAD so it no longer emerged from an opening in her abdomen. (The LVAD remains inside Jackson s chest.) Jackson returned See heart, page 6 Changes in brain may explain why chronic pain saps motivation By Bruce Goldman Chronic pain is among the most abundant of all medical afflictions in the developed world. It differs from a short-term episode of pain not only in its duration, but also in triggering in its sufferers a psychic exhaustion best described by the question, Why bother? A new study in mice, conducted by investigators at the School of Medicine, has identified a set of changes in key parts of the brain that may explain chronic pain s capacity to stifle motivation. The discovery could lead to entirely new classes of treatment for this damaging psychological consequence of chronic pain. Many tens of millions of people in the United States suffer persistent pain due to diverse problems including migraines, arthritis, lower back pain, sports injuries, irritable bowel syndrome and shingles. For many of these conditions, there are no good treatments, and a crippling loss of motivation can result. With chronic pain, your whole life changes in a way that doesn t happen with acute pain, said Robert Malenka, MD, PhD, the Nancy Friend Pritzker Professor in Psychiatry and Behavioral Sciences and the study s senior author. See pain, page 7 Stanford Medicine X conference will take place Sept. 5-7 By Lia Steakley Medicine X, Stanford University s premier conference on emerging health-care technology and patientcentered medicine, will return to campus Sept The conference, which will be held at the Li Ka Shing Center for Learning and Knowledge, brings together innovative thinkers to exchange ideas about how social media and mobile computing are advancing the practice of medicine, inspiring new health-care delivery models and empowering patients to be proactive in their own care. Medicine X has distinguished itself through a singular commitment to inclusivity and by finding new ways to bring every voice and perspective into important conversations about health care, said Lawrence Chu, MD, associate professor of anesthesia at the School of Medicine and executive director of the conference. We have expanded this inclusive spirit this year by exploring the themes of mental health, underserved populations and pharma. To register, visit Last year s conference sold out, and space is limited for this year s event. Stanford s Medicine X has become one of the most important forums for health-care stakeholders to identify and explore ways in which information technologies and social media can be used to improve human health, said Lloyd Minor, MD, dean of the School of Medicine. Dr. Chu has made this the go-to event for e-patients, physicians and innovators who want to get together to map out the future of health care. This year s program will spotlight the relationship between physical and mental well-being with three breakout panels. Psychologist Ann Becker-Shutte, PhD, will moderate a session on how mental health affects overall health. A conversation about emerging technologies in mental health will be led by Malay Gandhi, managing director of Rock Health, a business accelerator for health-care technology startup companies. Additionally, patient advocate Sarah Kucharski will direct a discussion about depression caused by chronic disease and about coping through online communities. Mental health is imperative to address in the overall conversation about the future of health care, said Chu. We need to be thinking about the health of the whole person, not just a patient s individual symptoms or disease. The three-day event will also feature panels on what the medical team of the future may look like; how patients with chronic diseases can use self-tracking tools to improve their health and support one another; ways for the pharmaceutical industry to partner with patients in the drug discovery and clinical trial process; and opportunities to connect with no-smartphone patients those who don t have the access or resources to fully We need to be thinking about the health of the whole person, not just a patient s individual symptoms or disease. engage with health-enhancing technologies. Keynote speakers at Medicine X will be Daniel Siegel, MD, clinical professor of psychiatry at the University of California-Los Angeles; Barron Lerner, MD, PhD, professor of medicine and population health at New York University School of Medicine; and Charles Ornstein, a Pulitzer Prize-winning journalist and senior reporter at ProPublica. On Sept. 5, Siegel, author of The New York Times bestseller Brainstorm: The Power and Purpose of the Teenage Brain, will deliver the opening keynote address, Interpersonal Connection, Self-Awareness and Well- Being: The Art and Science of Integration in the Promotion of Health. During the talk, he will discuss his approach to developing a healthy mind, an integrated brain and empathetic relationships. Also on Sept. 5, Lerner will share his perspective on medicine, bioethics and the doctor-patient relationship an ethical framework shaped by choices his own father made during a long and storied medical career in a keynote address titled Days of a Giant: Advice from My Father s Medical Career. In the Sept. 6 keynote, Harnessing Data to Better Involve Patients, Ornstein will examine data as a force multiplier for patient engagement and empowerment. Too often the media approach stories about healthcare quality, patient safety and health costs by focusing on a few individual examples, said Ornstein. To get patients to engage, we need to change the paradigm. The way we do that is to arm them with information that they can relate to. A new addition to this year s conference is the Medicine X mobile app, which was developed using Apple s ibeacon technology. Participants who use the app will be able to provide feedback about the conference and rate speakers in real time. They can also use the system to communicate directly with Medicine X staff members and request items, such as a blanket or water. The app also will facilitate networking among attendees by providing notifications about other users locations. Conference-goers will have the option to forgo this feature of the app altogether. The conference lineup also includes the Medicine X master class program, a series of small-venue seminars taught by experts in specific disciplines. Confirmed master-class speakers are: Minor; Ornstein; Wendy Sue Swanson, MD, pediatrician and author of the Seattle Mama Doc blog; Bryan Vartabedian, MD, assistant professor of pediatrics and director of digital literacy at the Baylor College of Medicine; and Roni Zeiger, MD, CEO of Smart Patients. As a pediatrician trying to change how we deliver health care, Medicine X is a lens to the future for me, Swanson said. Innovators, developers, nurses, patients and staff come together to improve the architecture of seeking and delivering health care. It s a place where the hallway is as exciting as the stage the networking, the stories and the solutions and partnerships that come out of Medicine X have been transformational for me. Pre-conference design challenge, workshops The IDEO Design Challenge and three pre-conference workshops will be held on Sept. 4. The workshops are on patient-engagement design, entrepreneurship in digital health and how patients can become active partners in clinical trial development. The pre-conference workshops will be held in Paul Brest Hall at the Munger Conference Center. courtesy of medicine x Lawrence Chu, executive director of Medicine X, speaks at the 2013 conference at the Li Ka Shing Center for Learning and Knowledge. The IDEO Design Challenge will be held at IDEO s headquarters in Palo Alto and offer patients the opportunity to collaborate with designers, technologists, researchers and health-care providers to develop solutions to enhance patient care. Patient involvement is a hallmark of Medicine X. Ten percent of the conference seats are reserved for e- patients, health consumers who use digital tools to get information about and help manage their medical conditions. This year, Medicine X awarded 37 scholarships to e-patients to offset registration and travel costs. Medicine X is all about people working together toward changing health care for the better, and everyone is welcome, said e-patient Hugo Campos. Patients are on an equal footing with all other participants, and that s fundamental for fostering true partnership toward change. To learn more about Medicine X, visit or follow the conference on Twitter or #MedX. Medicine X is a project of the Stanford University School of Medicine Anesthesia Informatics and Media Lab, and is sponsored in part by the school s Department of Anesthesiology, Perioperative and Pain Medicine. Other sponsors are Stanford Health Care, the Agency for Healthcare Research Quality, Stanford Hospital Corporate Partners Program, Eli Lilly COI and Boehringer Ingelheim. ISM By Aug. 27, physicians should review company gifts, payments By Kris Newby Physicians who received payments or gifts from pharmaceutical or medicaldevice companies in 2013 should give themselves several days before the Aug. inside Stanford medicine is produced by Office of Communication & Public Affairs Stanford University School of Medicine 3172 Porter Drive Palo Alto, CA Mail code 5471 (650) Send letters, comments and story ideas to John Sanford at or at Please also contact him to receive an version of Inside Stanford Medicine. Inside Stanford Medicine is published monthly in July and December and semi-monthly the rest of the year. Paul Costello Chief communications officer Susan Ipaktchian Director of print & Web communications John Sanford Editor Robin Weiss Graphic designer 27 deadline to register and dispute any errors on the government s open payments database. This data will be published online Sept. 30. (The first reporting cycle includes only five months of payments from 2013, but future reports will include a full calendar year.) The open payments database was initiated through the Physician Payments Sunshine Act, which requires manufacturers of drugs, medical devices and biological substances to report certain payments and items to physicians and teaching hospitals every year. This includes any item valued over $10, including consulting fees; honoraria; gifts; compensation for food, travel, education and conferences; research funding; stock or stock options; investment income; and royalty and licenses payments. The database will also list research payments made to Stanford under the principal investigator s name. The program, which is administered by the Centers for Medicare & Medicaid Services, or CMS, is intended to create more transparency in industry-provider relations, helping consumers make informed decisions on physicians potential conflicts of interest. Physicians have the right to review reports about them and challenge items they believe are false, inaccurate or misleading. If a physician disputes data reported by a company, and it isn t resolved by the deadline, CMS will publish the amounts in the database with a disputed notation. Because there isn t much time to correct errors before the data goes public and because the program s identity verification of physicians can take several days, it s recommended that physicians start this process well before the Aug. 27 deadline. Following are three useful web pages for learning about the database and how to get access to it: https://portal.cms.gov https://www.ama-assn.org/ama/pub/ advocacy/topics/sunshine-act-and-physician-financial-transparency-reports. page. ISM Kris Newby is the communications manager for Spectrum, the Stanford Center for Clinical and Translational Research and Education. 2 August 4, 2014 Inside Stanford Medicine Nation s first accredited clinical informatics fellowship launched A clinical informatics fellowship program at Stanford Medicine is the first in the country to be accredited by the Accreditation Council for Graduate Medical Education. Physicians who complete the fellowship program can be certified in the subspeciality, which became a recognized subspecialty in 2011 and granted its first board certifications in Beginning in 2018, the American Board of Medical Specialties will require physicians to complete a council-accredited fellowship to be eligible for certification in clinical informatics. The council is a nonprofit, private council that evaluates and accredits medical residency and fellowship programs. This accreditation recognizes that our program meets the new national standards in the field of clinical informatics, said pediatrician Christopher Longhurst, MD, MS, fellowship director, chief medical information officer for Stanford Children s Health and clinical associate professor of pediatrics and of medicine at the Stanford School of Medicine. We are the first because of our long history of biomedical informatics, our breadth of experience and our program s high level of collaboration among physicians and researchers in numerous specialties. Clinical informatics is the application of information technology and knowledge-management protocols to prevent disease, deliver more efficient patient care, streamline applications in translational research and improve access to biomedical data. The specialty promotes the understanding, integration and application of information technology to ensure clinical objectives and industry best practices. Four positions are available in the two-year fellowship program, which received accreditation on July 15. The first two fellows for are Lance Downing, MD, an internal medicine specialist, and pediatrician Veena Goel, MD. Downing is helping Christopher Sharp, MD, chief medical information officer and fellowship site director for Stanford Health Care and clinical associate professor of medicine at the Stanford School of Medicine, and others to develop a program to identify early signs of severe sepsis; Goel is helping Paul
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