“Live Because:” Living a fuller life with chronic illness: In this first-person piece, Michael Bihovsky, a musical theater composer and performer, talks about his experience with Ehlers-Danlos Syndrome and shares his philosophy of “Live Because.” The idea is that in many cases, patients with chronic illness can live a more fulfilling life with their disease than they would have without it.

Food stamp use shows scope of child poverty: Findings published in 2009 in the Archives of Pediatric & Adolescent Medicine suggest child poverty in the United States is even more widespread than previously suspected. Stanford’s Paul Wise, MD, comments on the findings and how the current economic downturn is making the situation worse.

The promise of yoga-based treatments to help veterans with PTSD: In a study from Stanford scholar Emma Seppala, PhD, yoga-based breathing exercises dramatically decreased post-traumatic stress disorder in veterans. Traditional PTSD is not effective for a large chunk of veterans, Seppala said, and this study provides numbers to back up anecdotal evidence that yogic breathing techniques can be helpful.

How meditation can influence gene activity: Findings recently published in PLoS One suggest that mindful-based therapies, such as meditation, may change practitioners’ gene activity and boost their overall health.

Big Data in Biomedicine conference opens this week: The Big Data in Biomedicine conference kicked off at Stanford on Wednesday. The event brought together leading figures from academia, industry, government and philanthropic foundations to discuss the burgeoning opportunities for mining the vast amounts of biomedical data housed in public databases.

Last month, a group of area high-schoolers came to Stanford for a taste of medical school. We shared photos of Med School 101 earlier in the week; this video provides a closer look at the program.

Previously: Highlights from Med School 2013, Image of the Week: Studying brains at Stanford’s Med School 101, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school

Did you know that May is Healthy Vision Month? To be honest, I didn’t really know about this until recently, and I’m a full-time eye doctor who thinks about vision and eyeballs all day long. Perhaps I overlooked the national eye health observance because, from my perspective, protecting your vision is a year-round personal health priority.

Many people don’t realize that they can improve their vision with glasses or contacts or that common eye diseases, including glaucoma and age-related macular degeneration, often have no warning signs. So in recognition of Healthy Vision Month, pause for a moment to consider the importance of eyes on your overall health and then adopt daily habits to help maintain good eyesight well into your golden years. Here’s are a few tips to get you started:

Eye Protection

One of the best things you can do to keep your eyes healthy is protect them from injury. Every day, about 2,000 U.S. workers have a job-related eye injury that requires medical treatment. Most of these injuries result from small objects that strike, abrade or splash the eye. When I used to work in an eye emergency room, I saw several patients a day who had been grinding metal or hammering something that got into their eye. Chemical burns from cleaning products or other industrial chemicals were also very common. Most of these injuries could have been prevented by wearing proper eye protection, such as safety glasses or using a splash guard.

While many injuries happen at work, eye injuries also occur at home. If you’re hanging pictures, mowing the lawn or working in your home workshop, make sure you wear proper eye protection. If you think you may have gotten something in your eye, contact a medical provider - ideally an optometrist or ophthalmologist – who can perform an assessment for any sight-threatening injury. If you splash any chemicals into your eyes, time is of the essence. The longer the irritant is in your eye, the higher the risk of permanent damage or scarring. Rinse out your eyes with clean water (tap water is great) for at least 10 minutes, then go to the emergency room or call 911.

Healthy body, healthy eyes

Aside from preventing injury, the best way to keep your eyes healthy is by keeping yourself healthy. If you maintain a healthy body weight, there is less of a chance of developing diabetes, high blood pressure or high cholesterol. These conditions can all lead to vision loss, with diabetes being the number one cause of vision loss in the working-age population in the United States. If you have already been diagnosed with one of these conditions, make sure you regularly follow up with your primary care doctor and take your prescribed medications. According to the published guidelines, if you keep your diabetes controlled, then you can reduce your risk of developing retinopathy (bleeding in the eye) by up to 76 percent and keep your kidneys healthy at the same time.

Prevention

A few last things you can do to keep your eyes healthy:

• Don’t smoke.
• Wear sunglasses to slow cataract formation and macular degeneration.
• Eat a well-balanced diet including green-leafy vegetables, like kale and spinach, and consider supplementing with anti-oxidant vitamins.
• Lastly, have your eyes examined regularly. Adults between the ages of 40 to 65 should have an eye exam every two to four years. Adults over the age of 65 should have an eye exam every one to two years.

Retina specialist Theodore Leng, MD, is a clinical assistant professor of ophthalmology at Stanford. He recently launched a clinical trial at Stanford to evaluate the safety of stem cell transplantation in advanced dry macular degeneration. Read more about eye health on his blog, VisionMD.org.

Photo by Chris Schrier

In some California counties, the local rates of elective procedures are dramatically higher than neighboring areas. For example, a man newly diagnosed with prostate cancer who lives in Tracy, Calif., is 479 percent more likely to undergo internal radiation, i.e., brachytherapy, than the state average. (Click on the map above for rates in other counties.)

To make this data more useful to medical consumers, the study authors published an online interactive map that allows Californians to quickly determine if their region performs elective procedures at disproportionately higher rates than the rest of the state.

“We’re hoping these maps can push along conversations about how to improve health-care delivery,” said Laurence Baker, PhD, a consultant on this study and a professor of health research and policy at Stanford. “One thing that is often important is better communication between patients and doctors, particularly in cases where patients can have different preferences. Getting this information out there might help some conversations happen that could lead to better treatment decisions and health outcomes.”

This new version of the procedure map adds breast cancer, prostate cancer, and spine procedure rates and expanded data to include Medicare patients and younger populations enrolled in commercial plans, Medicaid patients, and the uninsured.

Previously: Heart bypass or angioplasty? There’s an app for that, New breast cancer finding suggests limiting surgery and Ask Stanford Med: Answers to your questions on prostate cancer and the latest research

In the past, researchers who really wanted the data have combed through individual records - which can be hundreds of pages - manually. When I worked as an epidemiologist at the California Department of Public Health, for example, I worked on a large study that looked at prenatal hospital records for infectious disease lab testing – and our team of a dozen researchers took months to go through a few hundred records. It’s not an efficient approach for most diseases medical researchers might want to study. Recently launched national efforts also recognize this limitation and call for turning data from regular doctor visits into data points to figure out what is best for patients.

So when I learned that Nigam Shah, MBBS, PhD, a biomedical informatics professor at Stanford, has been looking at ways to pull out information electronically from clinical notes, my ears perked up.

In a paper published today in the journal PLOS ONE, Shah and co-authors Nicholas Leeper, MD, a Stanford cardiologist and vascular medicine specialist, and Anna Bauer-Mehren, PhD, an informaticist who recently moved from Stanford to Roche Germany, used a new methodology to answer a nagging question about the safety of Cilostazol, the only drug with the American Heart Association’s highest effectiveness rating – Class 1A - for treating the symptoms of peripheral arterial disease, a condition that affects millions of Americans. Regulators fear the drug might have side effects on the cardiovascular system that could lead to death, so the drug has historically carried a “black-box warning.” As a result, the use of this drug has been limited.

Looking at a specialized system that includes health-research data from millions of patients seen at Stanford Hospital over 18 years, the researchers found no evidence that patients with peripheral arterial disease who took Cilostazol suffered the side effects about which doctors were worried, compared with patients who didn’t receive the drug. By querying these records, the researchers identified a subset of patients they felt were at highest risk – a group which is often excluded from company-sponsored trials – and found no evidence of the side effects.

In April, Shah published a related paper describing his method. As he said then, the challenging part is developing an accurate list of key terms related to the condition researchers want to study, and then using that keyword list to fish the relevant patients from the thousands that come to the hospital:

“If you ask any audience related to health care how much of the clinical knowledge is bundled up in text, you won’t get an answer below 70 percent,” said Shah. “If 70 to 80 percent of the data is locked up in text notes, we asked ourselves, ‘What would be a good way to unlock it?’”

Today’s paper is one example of how data “unlocked” from previous patients’ records can aid doctors making decisions for future patients. Shah’s method simplifies that process immensely and makes it possible to ask many more interesting research questions that can open up intriguing areas of inquiry.

Shah and Leeper both say that further research about Cilostazol’s safety is needed, but this study is a good building block because it suggests further clinical studies are likely to be safe for the patients who participate. Finding that out any other way would have been expensive and labor-intensive.

The paper has been published, fittingly, on the second day of the Big Data in Biomedicine conference on the Stanford campus, which Shah is participating in. He says he’s eager to see how such methods can be used to derive practice-based evidence from large clinical data warehouses – a key aspect of the vision for a national learning health system.

Rina Shaikh-Lesko is a science-writing intern for the medical school’s Office of Communication & Public Affairs. She is a student in the Science Communication Program at University of California-Santa Cruz.

Previously: A call to use the “tsunami of biomedical data” to preserve life and enhance health, Atul Butte discusses why big data is a big deal in biomedicine, Mining data from patients’ charts to identify harmful drug reactions, Thousands of previously unknown drug side effects and interactions identified by Stanford study and Unexpected drug interactions identified by Stanford data mining

A close friend recently told me about the post-traumatic stress disorder research of Stanford’s Emma Seppala, PhD, whom she knows from the yoga community in Madison, Wisc. (Seppela did her postdoctoral work there.) It was amazing stuff, I was told (and what a small world, I thought.)

And so, I was eager to hear yesterday about one of Seppala’s studies, which found that yoga-based breathing exercises dramatically decreased PTSD in veterans – and that the effect lasted a full one year after the study period.

As Brooke Donald reports:

Twenty-one male veterans of the Iraq and Afghanistan wars participated. Half took part in the intervention, a seven-day workshop that emphasized a set of breathing techniques from the Sudarshan Kriya Yoga practice. The rhythmic breathing patterns exercised during this practice are meant to relax participants physically and mentally, and reduce symptoms of anxiety, depression and stress.

“Some people think of it as yoga, but it’s really more breathing – an active breathing intervention,” Seppala explained.

Before and after the workshop, which lasted three hours a day, the veterans completed questionnaires about how they were feeling. They also underwent cognitive and physiological tests to measure how they responded to loud noises and other startling stimuli.

The questionnaires were given and the tests were taken again a month after the workshop, then a year after.

Seppala called the results “extraordinary.”

Traditional PTSD is not effective for a large chunk of veterans, Seppala said, and this study provides numbers to back up anecdotal evidence that yogic breathing techniques can be helpful. She hopes that “having the data will help move this kind of treatment forward in a more substantial way” and will garner the attention of policymakers.

Seppala, the associate director of the Center for Compassion and Altruism Research and Education here, is now preparing the study for publication. Her work and that of University of Wisconsin’s Richard Davidson, PhD, was recently featured in the documentary “Free the Mind.”

Previously: Using mindfulness therapies to treat veterans’ PTSD, As soldiers return home, demand for psychologists with military experience grows, Stanford and other medical schools to increase training and research for PTSD, combat injuries and Can training soldiers to meditate combat PTSD?
Photo of veteran Adam Burn practicing yogic breathing techniques by Linda Cicero

Early in his career, Goosby treated AIDS patients at San Francisco General Hospital, back in the days when there were limited options for treatment (I remember crossing paths with him then, as I was a writer with University of California-San Francisco and based at the hospital).

Goosby has since gone on to major positions within the Clinton and now, the Obama, administrations. As the U.S. Global AIDS Coordinator, he directs the President’s Emergency Fund for AIDS Relief (PEPFAR), the nation’s premier international AIDS program begun in 2003 under the Bush administration. In recent years, he has come under fire from activists who believe the Obama administration has fallen back on its commitment to the program, whose budget has remained constant after years of substantial increases.

But at the International AIDS Conference in Vienna in 2008, former President Bill Clinton defended Goosby before an audience of thousands, saying he’s a good man with the best of intentions.

In addition to his work with PEPFAR, Goosby is the U.S. liaison with the Global Fund to Fight AIDS, Tuberculosis and Malaria, the international public/private partnership that provides antiretroviral medication to patients in developing countries. Goosby also leads the new Office of Global Health Diplomacy at the State Department.

I’ve heard Goosby speak on several occasions and found him to be an engaging and inspiring speaker with a deep understanding of global health needs.

The Stanford program will be held at 5:45 p.m. at the Li Ka Shing Center for Learning and Knowledge on the medical school campus. It’s free and open to the public, though registration is required.

Previously: Video: Kaiser Family Foundation town hall with U.S. Global AIDS Coordinator and New AIDS czar a good fit

Outlining the “tsunami of data crashing into us” (including electronic patient records; DNA sequencing; and comprehensive biological data on the mechanisms of disease, treatment monitoring, clinical trials, pharmaceutical records, medical imaging and disease registries), Minor said we must now take the information we have to improve health care. And for this, he said, collaboration is key:

[Big data presents a] challenge that is so big and so complex that single individuals, or companies, or institutions – no matter how accomplished or illustrious – cannot solve it alone.

Explaining that the conference was arranged to encourage such collaboration among academic researchers and their partners in industry, he went on to describe big data’s four “grand challenges:”

Extending big data studies to a global scale. Much of the biological data that has been collected so far does not include global studies of multi-ethnic populations, or studies about both men and women. We need to expand our field of study.

Faster interpretation of data. We need to increase the speed and effectiveness of analysis through the use of existing and emerging technologies.

A better grasp of the interactions. We need an understanding not just of genes and proteins in isolation, but of the complex, multi-factorial networks in which they operate.

Training the next generation. We need to prepare scientists who will follow us in the fields of medicine, statistics, informatics, and engineering to continue to seek transformative change.

Ultimately, he said, it’s up to those people who “see this time as a unique opportunity,” and who want to convert the massive amounts of biomedical data into “practical, usable tools that relieve suffering, preserve health, and enhance life.”

As a reminder, the conference, which is being supported by the Li Ka Shing Foundation, will be webcasted today and tomorrow via the Big Data in Biomedicine website. We’re also live tweeting event proceedings on the @SUMedicine Twitter feed.

Previously: Big Data in Biomedicine conference opens this week, Atul Butte discusses why big data is a big deal in biomedicine, Strength in numbers: Harnessing public gene data to answer a diverse range of research questions, Mining medical discoveries from a mountain of ones and zeroes and The data deluge: A report from Stanford Medicine magazine
Photo of Dean Minor at conference by Saul Bromberger

Last month, a group of 150 Bay Area high-school students visited Stanford to attend a series of hands-on, interactive sessions and lectures on a diverse range of subjects including biodesign, virtual anatomy, neuroscience and cancer. Their visit was part of our annual Med School 101 event, a day-long medical education program designed to expose teens to ongoing research at the School of Medicine and get them excited about potential careers in medicine and science.

This gallery illustrates some of the students’ exciting experiences, from performing procedures on simulated patients to examining animal brain tissue samples. To see more images from the day, visit our full photo set on Flickr.

Previously: Bay Area students get a front-row seat to practicing medicine, scientific research, Image of the Week: Studying brains at Stanford’s Med School 101, Live tweeting sessions at Stanford’s Med School 101, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school

The Walking Impairment Questionnaire, also known as the WIQ, is currently used to predict risks of peripheral artery disease, a narrowing of the arteries that causes limited circulation to the limbs. The authors of this new study wanted to see if the WIQ, which can be filled out by patients while waiting for their doctor appointments, might be helpful in predicting other health risks.

“A 70-year-old patient’s ability to walk six minutes is a great predictor of cardiovascular risks,” said Kevin Nead, a Stanford medical student and the first author of the study. “But most people are seen in 15-minute doctor visits. They’re not going to be doing a walking test.” Perhaps, he reasoned, a subjective test like this 17-question survey could be used instead.

Nead and his colleagues, who examined questionnaire results from more than 1,700 patients, found that the use of the WIQ alone successfully predicted cardiovascular outcomes. In addition, when the survey was used in conjunction with other common clinical tests such as blood pressure measurements and blood tests, it significantly improved the ability to predict mortality not just from cardiovascular disease but from any cause.

“In an era of increasing expense for medical costs, this work suggests that the WIQ, an extremely simple and economical tool, may significantly improve our ability to prognosticate risk,” Nead told me.

Photo by timparkinson