Identifying hidden hurdles for mothers in medicine

Jessica Gold, MD, is a clinical assistant professor and pediatrician at Stanford. After her second child, Gold began looking into workplace challenges that mothers face in the medical field. In a recent paper in the Journal of Hospital Medicine, she identified a policy that made career advancement more difficult for hospital-based pediatricians who have taken maternity leave. Her work ultimately led to a change.

Stanford researchers program cancer-fighting cells to resist exhaustion, attack solid tumors in mice

A new approach to programming cancer-fighting immune cells called CAR-T cells can prolong their activity and increase their effectiveness against human cancer cells grown in the laboratory and in mice, according to a study by researchers at the Stanford University School of Medicine.

 “We know that T cells are powerful enough to eradicate cancer,” said Crystal Mackall, MD, professor of pediatrics and of medicine at Stanford and the Ernest and Amelia Gallo Family Professor. “But these same T cells have evolved to have natural brakes that tamp down the potency of their response after a period of prolonged activity. We’ve developed a way to mitigate this exhaustion response and improve the activity of CAR-T cells against blood and solid cancers.”

A Stanford-led pilot study has provided early evidence that an antibody is a safe, effective and rapid food allergy treatment

The study provides early evidence that the antibody is a safe, effective and rapid food allergy treatment. A paper describing the findings was published online Nov. 14 in JCI Insight.

Such a treatment is badly needed. About 32 million Americans suffer from food allergies, which can develop at any point in life. The only existing treatment, oral immunotherapy, requires patients to eat tiny, gradually escalating doses of their food-allergy triggers under medical supervision. Desensitizing someone to their allergens with oral immunotherapy takes six months to a year, and can cause allergic reactions along the way.

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Choices, trade-offs and accomplishments at the Women in Medicine and Science Event

The path was rarely straight. The steps were neither easy nor obvious. Nonetheless Persis Drell, PhD, navigated the mostly male landscape of academic sciences to become Stanford's thirteenth provost. As the chief academic and chief budgetary officer, she holds a key position in setting university priorities and allocating funds to support them.

At the Stanford Medical Alumni Association's Women in Medicine and Science 2019 event on November 2, Drell, along with Stanford Medicine leaders, talked about her path to leadership -- a winding one that began as an undergraduate at Wellesley College.

Study finds that normal weight can hide eating disorder

The study, publishing online Nov. 5 in Pediatrics, shows that large, rapid weight loss is the best predictor of medical and psychological problems in patients with atypical anorexia, not their body weight at diagnosis. Dangerously low heart rate and blood pressure, as well as serious electrolyte imbalances and psychological problems, are common in patients with atypical anorexia whose weight is within a normal range, the study found.

“This group of patients is underrecognized and undertreated,” said the study’s senior author, Neville Golden, MD, professor of pediatrics at the Stanford School of Medicine. “Our study showed that they can be just as sick medically and psychologically as anorexia nervosa patients who are underweight.”

From the NY Times: California Tells Schools to Start Later, Giving Teenagers More Sleep

A new law pushed back start times at most public middle and high schools, citing research that says attendance and performance will improve if teenagers get more sleep.

Sleep experts also hailed the move. Dr. Sumit Bhargava, a clinical associate professor of pediatrics at Stanford University and specialist in pediatric sleep medicine at Stanford Children’s Health, called the law a “triumph,” noting that adolescents’ brains are still developing and that chronic sleep deprivation increases the risk of diseases later in life.

Although it might not seem like much, he said, “the effects of that one hour is something they will be feeling as 40-year-old adults,” adding that students would feel less anxious and less depressed and perform better academically. “When you give them the gift of increased sleep time, it is the biggest bang for buck that you can think about,” he said.

Burnout and care quality are connected

Stanford pediatrics instructor  Daniel Tawfik, MD and his research colleagues conducted a meta-analysis where they evaluated 123 studies on burnout and care quality.

The researchers found some reporting bias, but they also found a connection. As they write in an article in the Annals of Internal Medicine, when providers are feeling burned out, the quality of care patients receive is likely to be reduced.

Tawfik cautions against presuming a cause: "The more intuitive way of thinking is that burnout leads to poor care," he said. "But it can go in the other direction."

Watching for eating disorders in transgender teens

More than half of transgender teenagers intentionally gain or lose weight to align their bodies with their gender identity, a Stanford study found.

The study, published recently in the Journal of Adolescent Health, began because caregivers at the pediatric and adolescent gender clinic at Stanford Children's Health saw worrisome patterns of weight manipulation among their patients.

"We had a sense when we met our patients that they were perhaps manipulating their weight to get the body image they wanted," said the study's senior author, Tandy Aye, MD, a pediatric endocrinologist who directs the clinic. "But no one had looked into it or asked 'How often does this happen?'"

Full Circle: Forner Packard Children's Patient Ryan Lion returns as a resident

When Ryan Lion, MD, began his pediatrics residency at Lucile Packard Children’s Hospital Stanford in July, he already knew some of the doctors and nurses he would be working with. Ten years before, they had saved his life.

In 2009, during the final semester of Lion’s senior year at Saint Francis High School in Mountain View, California, he suddenly fell very ill.

“I had felt totally normal, and then in one specific moment everything changed,” Lion recalled. “I felt feverish, had chills. The next morning, I woke up with a rash on my arm and had weakness and pain in my joints. I could barely walk.”

Ryan’s local emergency department completed a series of blood tests that were sent to Packard Children’s for further evaluation.

Delivery of Crucial Protein to Brain Could Help Treat Rare Genetic Disorders

Children with the neurological diseases known as lysosomal storage disorders seem normal at birth. But their bodies are missing key components of the machinery that helps cells "empty the trash." Over time, wastes build up in their cells, causing severe cognitive and neurological degeneration.

Stanford scientists have come up with a new strategy to help: "We can use the blood to treat the brain," said Stanford clinical genetics expert Natalia Gomez-Ospina, MD, PhD.

In a paper published in Nature Communications, Gomez-Ospina and her colleagues describe how they genetically engineered blood stem cells to perform a helper role in the brain. The paper, describing proof-of-concept experiments in mice, could lead to a new way to help a very vulnerable group of children.

Math Makes Room for More Patients

Patients who undergo a surgical procedure may move from a surgical prep area, to an operating room, to a post-anesthesia care unit and possibly an ICU bed, before settling into a regular hospital bed. Ideally, hospitals would schedule surgeries and other procedures in a way that serves as many patients as possible—i.e., keeps all of these beds full—without bottlenecks that lead to delays and long wait times. That’s where math is helping at Lucile Packard Children’s Hospital Stanford.

In 2015, Packard Children’s hired David Scheinker, who has a PhD in mathematics and directs Systems Utilization Research For Stanford (SURF). He and his team use advanced mathematical approaches to improve internal operations – including optimizing surgical scheduling.