Bio

Clinical Focus


  • Pediatric Hospital Medicine
  • Pediatrics

Academic Appointments


Administrative Appointments


  • Faculty Advisor, Asian Pacific American Medical Student Association (APAMSA), Stanford School of Medicine (2017 - Present)
  • Director, Inpatient General Pediatrics Resident Rotation, Stanford School of Medicine, Department of Pediatrics (2017 - Present)
  • Faculty, Educators-4-CARE (Compassion, Advocacy, Responsibility, Empathy), Stanford School of Medicine, Department of Pediatrics (2013 - Present)
  • Faculty Coach, Stanford Pediatrics Residency Program, Stanford School of Medicine, Department of Pediatrics (2013 - Present)
  • Co-Director, Inpatient General Pediatrics Resident Rotation, Stanford School of Medicine, Department of Pediatrics (2010 - 2017)

Honors & Awards


  • Certificate of Honor in Medical Education, Clinical Teaching Seminar Series Program, Stanford School of Medicine Teaching and Mentoring Academy (2018)
  • Simulation Based Medical Education Special Interest Group Faculty Abstract Award, Academic Pediatric Association (2018)
  • Division of Pediatric Hospital Medicine Door of Fame Recognition Award, Stanford School of Medicine, Department of Pediatrics (2018)
  • Mid/Senior Career Clinical Excellence Award, Stanford School of Medicine, Department of Pediatrics (2018)
  • Division of Pediatric Hospital Medicine Certificate of Excellence in Patient Care, Stanford School of Medicine, Department of Pediatrics (2017)
  • Resident Feedback Award of Excellence in Recognition of Contribution to Education, Stanford School of Medicine, Department of Pediatrics (2017)
  • Division of Pediatric Hospital Medicine Certificate of Excellence in Citizenship, Stanford School of Medicine, Department of Pediatrics (2016, 2017)
  • Division of Pediatric Hospital Medicine Certificate of Excellence in Leadership, Stanford School of Medicine, Department of Pediatrics (2016)
  • Ray E. Helfer Award for Innovations in Medical Education, awarded to our research group, Academic Pediatric Association (2016)
  • Code Committee Acknowledgement Award, Lucile Packard Children's Hospital (2015, 2017)
  • Recognition of Colleague (R.O.C.) Award, Lucile Packard Children's Hospital (2014-2016)
  • Special Recognition Award for Supporting Pediatric Resuscitation, Lucile Packard Children's Hospital (2014)
  • Starfish Award for Palliative Care, Lucile Packard Children's Hospital (2014)
  • Rotation of the Year Award for Inpatient General Pediatrics, Stanford School of Medicine, Department of Pediatrics (2013, 2017)
  • Recognition of Service Excellence (R.O.S.E) Award, Lucile Packard Children's Hospital (2012)
  • Faculty Honor Roll for Teaching, Stanford School of Medicine (2010, 2012-2013, 2015)
  • Letter of Distinction for Teaching, Stanford School of Medicine (2010, 2012-2013)
  • Alpha Omega Alpha, Albert Einstein College of Medicine (2001)
  • American Medical Women's Association Janet M. Glasgow Memorial Achievement Citation, Albert Einstein College of Medicine (2001)
  • Edward Weinstein Award for Outstanding Scholarship and Human Commitment, Albert Einstein College of Medicine (2001)

Boards, Advisory Committees, Professional Organizations


  • Member, Acute Care Excellence Committee, Lucile Packard Children's Hospital (2012 - 2017)
  • Teaching Attending, Stanford Medical Students, Stanford School of Medicine (2010 - 2012)
  • Faculty Advisor, Pediatrics Residency, Stanford School of Medicine, Department of Pediatrics (2010 - Present)
  • Faculty Small Group Leader, Pediatrics Residency Humanism and Professionalism Course, Stanford School of Medicine, Department of Pediatrics (2011 - Present)
  • Chair, Family Centered Rounds Operations Subcommittee, Lucile Packard Children's Hospital (2012 - 2017)
  • Member, Pediatric Code Committee, Lucile Packard Children's Hospital (2009 - Present)
  • Member, Professional Practice Evaluation Committee, Lucile Packard Children's Hospital (2009 - Present)

Professional Education


  • Medical Education:Albert Einstein College of Medicine Office of the Registrar (2001) NY
  • Fellowship:Univ of California San Francisco (2009) CA
  • Residency:Univ of California San Francisco (2004) CA
  • Board Certification: Pediatrics, American Board of Pediatrics (2004)
  • Board Certification: Pediatric Hematology-Oncology, American Board of Pediatrics (2009)

Research & Scholarship

Current Research and Scholarly Interests


Medical education, shared decision making, resuscitation.

Teaching

Stanford Advisees


Publications

All Publications


  • Shared Decision-Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication. Journal of hospital medicine Blankenburg, R., Hilton, J. F., Yuan, P., Rennke, S., Monash, B., Harman, S. M., Sakai, D. S., Hosamani, P., Khan, A., Chua, I., Huynh, E., Shieh, L., Xie, L. 2018

    Abstract

    BACKGROUND: Shared decision-making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM.OBJECTIVE: To assess overall quality, provider behaviors, and contextual predictors of SDM during inpatient rounds on medicine and pediatrics hospitalist services.DESIGN: A 12-week, cross-sectional, single-blinded observational study of team SDM behaviors during rounds, followed by semistructured patient interviews.SETTING: Two large quaternary care academic medical centers.PARTICIPANTS: Thirty-five inpatient teams (18 medicine, 17 pediatrics) and 254 unique patient encounters (117 medicine, 137 pediatrics).INTERVENTION: Observational study.MEASUREMENTS: We used a 9-item Rochester Participatory Decision-Making Scale (RPAD) measured team-level SDM behaviors. Same-day interviews using a modified RPAD assessed patient perceptions of SDM.RESULTS: Characteristics associated with increased SDM in the multivariate analysis included the following: service, patient gender, timing of rounds during patient's hospital stay, and amount of time rounding per patient (P < .05). The most frequently observed behaviors across all services included explaining the clinical issue and matching medical language to the patient's level of understanding. The least frequently observed behaviors included checking understanding of the patient's point of view, examining barriers to follow-through, and asking if the patient has any questions. Patients and guardians had substantially higher ratings for SDM quality compared to peer observers (7.2 vs 4.4 out of 9).CONCLUSIONS: Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.

    View details for DOI 10.12788/jhm.2909

    View details for PubMedID 29401211

  • The SDM 3 Circle Model: A Literature Synthesis and Adaptation for Shared Decision Making in the Hospital. Journal of hospital medicine Rennke, S., Yuan, P., Monash, B., Blankenburg, R., Chua, I., Harman, S., Sakai, D. S., Khan, A., Hilton, J. F., Shieh, L., Satterfield, J. 2017; 12 (12): 1001–8

    Abstract

    Patient engagement through shared decision-making (SDM) is increasingly seen as a key component for patient safety, patient satisfaction, and quality of care. Current SDM models do not adequately account for medical and environmental contexts, which may influence medical decisions in the hospital. We identified leading SDM models and reviews to inductively construct a novel SDM model appropriate for the inpatient setting. A team of medicine and pediatric hospitalists reviewed the literature to integrate core SDM concepts and processes and iteratively constructed a synthesized draft model. We then solicited broad SDM expert feedback on the draft model for validation and further refinement. The SDM 3 Circle Model identifies 3 core categories of variables that dynamically interact within an "environmental frame." The resulting Venn diagram includes overlapping circles for (1) patient/family, (2) provider/team, and (3) medical context. The environmental frame includes all external, contextual factors that may influence any of the 3 circles. Existing multistep SDM process models were then rearticulated and contextualized to illustrate how a shared decision might be made. The SDM 3 Circle Model accounts for important environmental and contextual characteristics that vary across settings. The visual emphasis generated by each "circle" and by the environmental frame direct attention to often overlooked interactive forces and has the potential to more precisely define, promote, and improve SDM. This model provides a framework to develop interventions to improve quality and patient safety through SDM and patient engagement for hospitalists.

    View details for DOI 10.12788/jhm.2865

    View details for PubMedID 29073314

    View details for PubMedCentralID PMC5709161

  • Germline CBL mutations cause developmental abnormalities and predispose to juvenile myelomonocytic leukemia NATURE GENETICS Niemeyer, C. M., Kang, M. W., Shin, D. H., Furlan, I., Erlacher, M., Bunin, N. J., Bunda, S., Finklestein, J. Z., Sakamoto, K. M., Gorr, T. A., Mehta, P., Schmid, I., Kropshofer, G., Corbacioglu, S., Lang, P. J., Klein, C., Schlegel, P., Heinzmann, A., Schneider, M., Stary, J., van den Heuvel-Eibrink, M. M., Hasle, H., Locatelli, F., Sakai, D., Archambeault, S., Chen, L., Russell, R. C., Sybingco, S. S., Ohh, M., Braun, B. S., Flotho, C., Loh, M. L. 2010; 42 (9): 794-U93

    Abstract

    CBL encodes a member of the Cbl family of proteins, which functions as an E3 ubiquitin ligase. We describe a dominant developmental disorder resulting from germline missense CBL mutations, which is characterized by impaired growth, developmental delay, cryptorchidism and a predisposition to juvenile myelomonocytic leukemia (JMML). Some individuals experienced spontaneous regression of their JMML but developed vasculitis later in life. Importantly, JMML specimens from affected children show loss of the normal CBL allele through acquired isodisomy. Consistent with these genetic data, the common p.371Y>H altered Cbl protein induces cytokine-independent growth and constitutive phosphorylation of ERK, AKT and S6 only in hematopoietic cells in which normal Cbl expression is reduced by RNA interference. We conclude that germline CBL mutations have developmental, tumorigenic and functional consequences that resemble disorders that are caused by hyperactive Ras/Raf/MEK/ERK signaling and include neurofibromatosis type 1, Noonan syndrome, Costello syndrome, cardiofaciocutaneous syndrome and Legius syndrome.

    View details for DOI 10.1038/ng.641

    View details for Web of Science ID 000281388400018

    View details for PubMedID 20694012

  • Mutations in CBL occur frequently in juvenile myelomonocytic leukemia BLOOD Loh, M. L., Sakai, D. S., Flotho, C., Kang, M., Fliegauf, M., Archambeault, S., Mullighan, C. G., Chen, L., Bergstraesser, E., Bueso-Ramos, C. E., Emanuel, P. D., Hasle, H., Issa, J., van den Heuvel-Eibrink, M. M., Locatelli, F., Stary, J., Trebo, M., Wlodarski, M., Zecca, M., Shannon, K. M., Niemeyer, C. M. 2009; 114 (9): 1859-1863

    Abstract

    Juvenile myelomonocytic leukemia is an aggressive myeloproliferative disorder characterized by malignant transformation in the hematopoietic stem cell compartment with proliferation of differentiated progeny. Seventy-five percent of patients harbor mutations in the NF1, NRAS, KRAS, or PTPN11 genes, which encode components of Ras signaling networks. Using single nucleotide polymorphism arrays, we identified a region of 11q isodisomy that contains the CBL gene in several JMML samples, and subsequently identified CBL mutations in 27 of 159 JMML samples. Thirteen of these mutations alter codon Y371. In this report, we also demonstrate that CBL and RAS/PTPN11 mutations were mutually exclusive in these patients. Moreover, the exclusivity of CBL mutations with respect to other Ras pathway-associated mutations indicates that CBL may have a role in deregulating this key pathway in JMML.

    View details for DOI 10.1182/blood-2009-01-198416

    View details for Web of Science ID 000269380600022

    View details for PubMedID 19571318

  • Single-cell profiling identifies aberrant STAT5 activation in myeloid malignancies with specific clinical and biologic correlates CANCER CELL Kotecha, N., Floress, N. J., Irish, J. M., Simonds, E. F., Sakai, D. S., Archambeault, S., Diaz-Flores, E., Coram, M., Shannon, K. M., Nolan, G. P., Loh, M. L. 2008; 14 (4): 335-343

    Abstract

    Progress in understanding the molecular pathogenesis of human myeloproliferative disorders (MPDs) has led to guidelines incorporating genetic assays with histopathology during diagnosis. Advances in flow cytometry have made it possible to simultaneously measure cell type and signaling abnormalities arising as a consequence of genetic pathologies. Using flow cytometry, we observed a specific evoked STAT5 signaling signature in a subset of samples from patients suspected of having juvenile myelomonocytic leukemia (JMML), an aggressive MPD with a challenging clinical presentation during active disease. This signature was a specific feature involving JAK-STAT signaling, suggesting a critical role of this pathway in the biological mechanism of this disorder and indicating potential targets for future therapies.

    View details for DOI 10.1016/j.ccr.2008.08.014

    View details for Web of Science ID 000259896500008

    View details for PubMedID 18835035

    View details for PubMedCentralID PMC2647559