News Article | October 28, 2016
Providing financial rewards correlates with more weight lost in studies of weight loss motivation, but what about financial punishment? New findings from the Palo Alto Medical Foundation Research Institute show that people who signed up to lose money for failing to meet specific dieting goals lost more weight. In addition, the greatest weight loss success was among people who signed up to have the money they lost donated to a cause they passionately disagreed with. “Depending on your views, having to make a donation to the National Rifle Association, Planned Parenthood or a political party or candidate you do not support may provide motivation to keep exercising and eating healthier over a longer term,” explains Harold Luft, Ph.D., director of the Palo Alto Medical Foundation Research Institute and one of the study’s authors. The study examined 3,857 weight-loss commitment contracts from stickK.com, a site that allows the public to create voluntary personal contracts, with or without a monetary penalty, as a motivation to achieve a specific goal. Anonymity of the participants was protected by having all names removed from the data before the researchers examined it. The contracts were either penalty or no penalty contracts. In the penalty group, participants had the option of money deducted from a credit card stored on the site either sent to a friend, donated to an organization they agreed with or donated to an organization they disagreed with. Participants whose contracts included penalties were more likely to meet their weight loss goals and more diligent about reporting their weight each week. (Failure to report your weight every seven days resulted in an automatic penalty that week.) The participants whose penalties went to a group they disagreed with had the best results. In total, 37.1 percent of these participants met their final weight goal compared to 24.1 percent of those whose penalty was set to go to a group or charity they agreed with and 21.1 percent of those whose penalty went to a friend. The no penalty group had the lowest success rate. Only 5.1 percent of these participants met their final weight goal. The lead author of the study, Lenard Lesser, M.D., MSHS, Clinical Research Lead at One Medical Group, who conducted the research while at Palo Alto Medical Foundation Research Institute, became interested in "commitment contracts" to lose weight when his sister Lori Lesser started using stickK.com. “As a family doctor, I’ve seen many patients who do not need any more education on eating habits, but need a nudge to avoid all of the food that our society constantly puts in front of people,” explained Lesser. In addition to being more likely to meet weight loss goals at the end of the contract, Lesser found that those in the penalty group also lost more weight. Weight change per week was -0.33 percent for those whose penalty went to an organization they disagreed with, -0.28 percent for those whose penalty went to an organization they agreed with and -0.25 percent for those whose penalty went to a friend. Larger financial penalties also correlated slightly with more weight lost. Each $10 per week increase in deposit was associated with a -0.1 percent weight change per week. “On average, for all contracts there was about a -0.39 percent weight loss per week,” Dr. Lesser said. “For a 200-pound male with a contract of 16 weeks, this would be about a 10.5-pound weight loss." Is it the money or the watcher? Dr. Lesser cautions that the differences between the groups were significant, but small. He says, “Since there was no control group, the most important component of this intervention may be just setting up a contract where someone watches over you.” The study found that people who had a person serving as a “referee” or a wireless scale objectively documenting and watching over their progress reported slightly less weight loss. “It is likely that the ‘watcher’ was keeping these people more honest,” Dr. Lesser said. He was the referee for his sister when she signed up to use StickK.com and advises that people serious about adopting healthy habits should set up a system where they have someone observing their progress. Indeed, this worked for his sister. “I didn’t put any money down on my contract,” said Lori Lesser. “Just knowing that my brother, a nutrition expert, was watching, helped me keep away from unhealthy foods.” The study "Association Between Monetary Deposits and Weight Loss in Online Commitment Contracts" by Dr. Lesser, Caroline A. Thompson, Ph.D. and Dr. Luft appears in the American Journal of Health Promotion. About the Palo Alto Medical Foundation and Sutter Health The Palo Alto Medical Foundation (PAMF) for Health Care, Research and Education is a not-for-profit health care organization that is a pioneer in the multispecialty group practice of medicine. Founded in 1930, PAMF is part of the Bay Area Region of Sutter Health, one of the nation's leading not-for-profit networks of community-based health care providers. PAMF's nearly 1,500 affiliated physicians and 5,000 employees serve nearly one million patients at 49 medical centers and clinics in Alameda, San Mateo, Santa Clara, Santa Cruz and Contra Costa counties.
News Article | October 28, 2016
Summit Health Management (“SHM”), LLC, is pleased to announce Cecilia Montalvo has been appointed Chief Strategy and Business Development Officer and President of Summit Select, LLC, effective November 1, 2016. In this role, she will also serve as Chief of Strategy and Business Development for Summit Medical Group, P.A. ("SMG"), one of the largest physician-owned medical practices in the nation. This newly-created role is strategically and operationally aligned with SMG's and SHM's commitment to promoting major change in health care. Ms. Montalvo will play a key role in the development and implementation of corporate strategies and plans that ensure the success of SMG's and SHM’s value-based care, population health and risk-based products and initiatives. Approved by the New Jersey Department of Banking and Insurance for licensure as an organized delivery system (ODS), Summit Select will include New Jersey physicians and physician groups, including Summit Medical Group, who choose to align with Summit Select and benefit from a best-in-class medical practice model. “Ms. Montalvo’s leadership in market entry and expansion will help us achieve SMG's and SHM's commitment to best-in-class population health management,” said Jeffrey Le Benger, MD, chairman and chief executive officer of Summit Health Management. “As we continue to focus on managing costs, increasing patient satisfaction, and improving quality, her knowledge and experience will be of great value in the changing health care landscape. We are pleased to welcome Ms. Montalvo to our organization.” Most recently, Ms. Montalvo served as (Corporate) Vice President, Business Development for Kaiser Permanente. In this role she was responsible for developing and implementing strategies for the national geographic expansion of Kaiser. She led Kaiser's successful acquisition of Group Health Cooperative in Seattle, and Maui Memorial Medical Center, Wailuku, Hawaii. Prior to assuming her role at Kaiser, Ms. Montalvo was Chief Strategy Officer for the Palo Alto Medical Foundation ("PAMF") and Vice President, Strategy and Business Development for Sutter Health’s Peninsula Coastal Region. PAMF has $4 billion in revenues and includes over 1,300 physicians and three hospitals in San Mateo, Santa Clara, Santa Cruz and Alameda counties in California. At PAMF and Sutter Health, she was responsible for leading growth strategies for PAMF in the San Francisco Bay Area – the organization grew from 400,000 to 1 million patient lives during her tenure. Prior to joining Sutter Health in 2003, Ms. Montalvo was an Investment Banker in the San Francisco office of Shattuck Hammond Partners LLC, focusing her client work in the areas of healthcare mergers and acquisitions. While working in the investment banking industry, Ms. Montalvo and her colleague Mark Harrison published several major pieces of research on the financial health of California’s hospital and skilled nursing industry, made possible by over $1.5 in grant funding from the California Healthcare Foundation. Ms. Montalvo has served on the executive management teams of Brown & Toland Physician Services Organization, Hospital Corporation of America (HCA), Sequoia Hospital, Stanford Medical Center; and Bay Pacific Health Plan (a regional health plan owned by local physicians and hospitals that was subsequently sold to Aetna). Ms. Montalvo started her career in Washington and worked within the Center of Medicare and Medicaid Services (previously known as the Health Care Financing Administration) and was on the staff of the Health Subcommittee of the Ways and Means Committee in the U.S. House of Representatives. She earned her bachelor’s degree in psychology and sociology from Rollins College, Winter Park, Florida, and her master’s in public policy and healthcare administration with honors from the University of Chicago in Chicago. She was honored in the Who’s Who in California Healthcare, recognized as the “Whiz Kid” for accomplishments in the healthcare industry for professionals under the age of 40, and in 2013 by the Silicon Valley YMCA as a TWIN award winner recognizing outstanding women in leadership. She has served on numerous Boards of Directors, including the Corporate Board of the Dual Degree (MBA/MPH) program of the Haas School of Business and the UC-Berkeley School of Public Health, both in Berkeley, California; Sutter Maternity and Surgery Hospital in Santa Cruz, California; Pathways Home Care and Hospice (previously Mid-Peninsula Home Care and Hospice) in San Francisco, and Woodside Priory School in Portola Valley, California. Emerging from the success of Summit Medical Group, Summit Health Management (SHM) provides innovative management services for Summit Medical Group and mid-to-large size physician practices. SHM’s practice management services are focused in five discrete, but inter-related categories essential to running a successful, enterprise-scale medical group. For more information, visit http://www.summithealthmanagement.com. Summit Medical Group (SMG) is among the largest physician owned multispecialty medical practices in the nation. SMG maintains a 42-acre healthcare campus in Berkeley Heights and more than 65 additional practice locations in central and northern New Jersey. As an East Coast premier multispecialty group, SMG has provided exceptional primary and specialty care since 1929. For more, visit http://www.summitmedicalgroup.com.
News Article | December 9, 2016
Patient health records revealed two drug combinations that may reduce mortality rates in breast cancer patients, according to a study led by researchers at the Stanford University School of Medicine. The drugs involved were commonly used drugs that turned out to be associated with a longer average survival rate in breast cancer patients. The study will be published online Dec. 9 in the Journal of the American Medical Informatics Association. The lead author is Stanford postdoctoral scholar Yen Low, PhD. The senior author is Nigam Shah, MBBS, PhD, associate professor of medicine and of biomedical data science. Often, when different drugs are taken together, they can have unexpected side effects. For example, some antibiotics and antifungal drugs can interfere with the effectiveness of birth control pills. It occurred to Shah and his team that the opposite could also be true -- that some drug interactions might help patients. "What if we looked for combinations of drugs that have an accidental beneficial effect?" Shah said. The researchers decided to comb through a breast cancer database built at Stanford called Oncoshare, which takes de-identified patient information -- including tumor and treatment information for each patient -- from Stanford Health Care and from the Palo Alto Medical Foundation and links it to patient outcomes in the California Cancer Registry. The team searched for drugs that patients just happened to be taking and that were statistically associated with better outcomes. "By integrating different kinds of data, we can ask questions we couldn't ask before. Usually, you don't find both survivorship data and all the different kinds of drugs and other treatments patients get all in the same place," said Allison Kurian, MD, associate professor of medicine and of health research and policy. "We looked at all the noncancer drugs that breast cancer patients were on," said Shah. "People have other things going on in life. They might have hypertension, they might have high cholesterol or diabetes. They would be taking drugs for those as well. So the question we were asking was, do any of the drugs they are taking associate with better outcomes for breast cancer?" The team looked at data from nearly 10,000 adult women diagnosed with breast cancer between 2000 and 2013, of whom about 12 percent died within five years of the diagnosis. The team examined 294 drugs in more than 43,000 pairwise combinations. Specifically, they looked for combinations of drugs in which the beneficial effect on survival was greater than the effect of either drug by itself. "So we ran the analysis, and we found a few drug combinations that seemed to associate with better survival," said Shah. Specifically, there were three pairs of drug types: anti-inflammatory drugs, such as aspirin or naproxen, and blood-lipid modifiers, such as statins; lipid modifiers and drugs such as fluticasone used to treat asthmalike conditions; and anti-inflammatories and hormone antagonists -- typically, drugs that suppress the synthesis of estrogen. "But how do we know it's true, and not just an association?" said Shah. The researchers needed to look for confirmation in a data set they had not yet examined. To do so, they turned to Shah's former student Andrew Radin, a co-author of the paper and co-founder of a company called twoXAR that searches for drug interactions using gene-expression data. Radin's company looks for common molecular pathways that might account for drug pairs with apparent synergistic effects, searching for drug-protein interactions in the company's database. Said Shah, "So I asked Andrew, 'If I give you two drugs and a disease, can you tell me if there is any molecular-level evidence that would lead you to believe that, yes, these drugs might have a beneficial effect in treating this disease?' So we gave them our list of three drug pairs, and they looked at the protein targets for all the drugs." Two of the three drug pairs showed a likely molecular mechanism that a reasonable person might think had to do with survival in breast cancer, the study said. These were anti-inflammatories and lipid modifiers, and anti-inflammatories and anti-cancer hormone antagonists. "This study is a nice example of an analysis spanning multiple data modalities. It's the kind of thing that can only happen at Stanford," said Shah, pointing out how his lab worked with Oncoshare, twoXAR, oncologists and statisticians to bring the study off. The work is an example of Stanford Medicine's focus on precision health, the goal of which is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill. "It's a proof of principle that this kind of data mining has strong practical clinical applications," said Kurian. With electronic health records, she said, the challenge has been getting the data organized in a way that allows fruitful explorations like this one. The key, said Shah, is to ask why these drugs and their protein targets have something to do with breast cancer and to leverage that information for better treatment. "This is a holistic look at the data -- EHR, gene expression, protein targets of drugs -- all in one analysis," he said. Other Stanford co-authors are former research assistant William Chen; senior clinical data engineer Tina Seto; Susan Weber, PhD, director of informatics systems and software development for the Stanford Center for Clinical Informatics; former graduate student Michael Lim, PhD; Trevor Hastie, PhD, professor of statistics and of biomedical data science; biostatistician Maya Mathur; Manisha Desai, PhD, associate professor of medicine and of biomedical data science; research scientist Scarlett Gomez, PhD, MPH; and George Sledge, MD, professor of medicine. Researchers at twoXAR Inc., the Palo Alto Medical Foundation Research Institute and the Cancer Prevention Institute of California were also co-authors of the study. This research was supported by the National Institutes of Health (grants R01LM011369, GM101430RO1, EB00198815 and UL1RR025744), the National Science Foundation, the Susan and Richard Levy Give Fund, the Breast Cancer Research Foundation, the Regents of the University of California's Breast Cancer Research Program and the Stanford University Developmental Research Fund. Stanford's Department of Medicine also supported the work. The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://med. . The medical school is part of Stanford Medicine, which includes Stanford Health Care and Lucile Packard Children's Hospital Stanford. For information about all three, please visit http://med. .
Kassebaum N.J.,University of Washington |
Kassebaum N.J.,Seattle Childrens Hospital |
Jasrasaria R.,Stanford University |
Naghavi M.,University of Washington |
And 11 more authors.
Blood | Year: 2014
Previous studies of anemia epidemiology have been geographically limited with little detail about severity or etiology. Using publicly available data, we estimated mild, moderate, and severe anemia from 1990 to 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2010 Study. Global anemia prevalence in 2010 was 32.9%, causing 68.36 (95% uncertainty interval [UI], 40.98 to 107.54) million years lived with disability (8.8% of total for all conditions [95% UI, 6.3% to 11.7%]). Prevalence dropped for both sexes from 1990 to 2010, although more for males. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub-Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions. Iron-deficiency anemia was the top cause globally, although 10 different conditions were among the top 3 in regional rankings. Malaria, schistosomiasis, and chronic kidney disease-related anemia were the only conditions to increase in prevalence. Hemoglobinopathies made significant contributions in most populations. Burden was highest in children under age 5, the only age groups with negative trends from 1990 to 2010. (Blood. 2014;123(5):615-624).© 2014 by The American Society of Hematology.
Saxena A.,Foundation Medicine |
Granot A.,Palo Alto Medical Foundation
Journal of Foot and Ankle Surgery | Year: 2011
Achilles surgical patients were evaluated using an "anti-gravity" Alter-G (AG) treadmill that allows for reduction of weightbearing pressure on the lower extremity. We studied our hypothesis, which was based on our prior clinical findings, that being able to run on the AG treadmill at 85% of body weight is sufficient to clear patients to run with full body weight outside. Patients undergoing Achilles tendon rupture or insertional repair surgery were prospectively studied. They were compared with a control group that had similar surgeries and a similar rehabilitation program during the same time period: the variable was not using the AG treadmill. The criteria for the study group to be allowed to run outside was being able to run for at least 10 minutes on the AG at 85% of body weight. Each group had 8 patients who underwent surgery for 2 complete tendon ruptures and 6 insertional repairs. There was no significant difference between the AG and control group as to age and postoperative follow-up. AG patients began their initial run on the treadmill at 70% of their body weight at 13.9 ± 3.4 weeks, 85% at 17.6 ± 3.9 weeks, and outside running at 18.1 ± 3.9 weeks. The control group's return to running outside time was 20.4 ± 4.1 weeks. This was not significantly different (p = .27). We confirmed our hypothesis that being able to run at 85% of body weight after Achilles surgery was sufficient to clear patients to run outside. © 2011 American College of Foot and Ankle Surgeons.
Hussey P.S.,RAND Corporation |
Luft H.S.,Palo Alto Medical Foundation |
McNamara P.,Agency for Healthcare Research and Quality
Medical Care Research and Review | Year: 2014
Twenty-seven years after the first public release by the U.S. government of data on the quality of hospital care, public reporting for consumers has expanded substantially. Despite the growth in public reporting activities, there is limited evidence of their use by consumers in ways that significantly affect health care delivery. Support for public reporting continues, in part, because of the face value of transparency. The limited impact of reporting efforts is plausibly due to flaws in the content, design, and implementation of existing public reports rather than inherent limitations of reporting. Substantial work is still needed for public reports to achieve their potential for engaging and informing consumers. We present a vision statement and 10 recommendations to achieve this potential. © The Author(s) 2014.
Yu P.P.,Palo Alto Medical Foundation
Journal of Oncology Practice | Year: 2015
One of the most important benefits of health information technology is to assist the cognitive process of the human mind in the face of vast amounts of health data, limited time for decision making, and the complexity of the patient with cancer. Clinical decision support tools are frequently cited as a technologic solution to this problem, but to date useful clinical decision support systems (CDSS) have been limited in utility and implementation. This article describes three unique sources of health data that underlie fundamentally different types of knowledge bases which feed into CDSS. CDSS themselves comprise a variety of models which are discussed. The relationship of knowledge bases and CDSS to rapid learning health systems design is critical as CDSS are essential drivers of rapid learning in clinical care. Copyright © 2015 by American Society of Clinical Oncology.
Parikh R.D.,NuVasive |
Ryu S.I.,Palo Alto Medical Foundation |
Ryu S.I.,Stanford University |
Journal of Neurosurgery: Spine | Year: 2014
Object. Lumbar interbody fusion is indicated in the treatment of degenerative conditions. Laterally inserted interbody cages significantly decrease range of motion (ROM) compared with other cages. Supplemental fixation options such as lateral plates or spinous process plates have been shown to provide stability and to reduce morbidity. The authors of the current study investigate the in vitro stability of the interbody cage with a combination of lateral and spinous process plate fixation and compare this method to the established bilateral pedicle screw fixation technique. Methods. Ten L1-5 specimens were evaluated using multidirectional nondestructive moments (± 7.5 N·m), with a custom 6 degrees-of-freedom spine simulator. Intervertebral motions (ROM) were measured optoelectronically. Each spine was evaluated under the following conditions at the L3-4 level: intact; interbody cage alone (stand-alone); cage supplemented with lateral plate; cage supplemented with ipsilateral pedicle screws; cage supplemented with bilateral pedicle screws; cage supplemented with spinous process plate; and cage supplemented with a combination of lateral plate and spinous process plate. Intervertebral rotations were calculated, and ROM data were normalized to the intact ROM data. Results. The stand-alone laterally inserted interbody cage significantly reduced ROM with respect to the intact state in flexion-extension (31.6% intact ROM, p < 0.001), lateral bending (32.5%, p < 0.001), and axial rotation (69.4%, p = 0.002). Compared with the stand-alone condition, addition of a lateral plate to the interbody cage did not significantly alter the ROM in flexion-extension (p = 0.904); however, it was significantly decreased in lateral bending and axial rotation (p < 0.001). The cage supplemented with a lateral plate was not statistically different from bilateral pedicle screws in lateral bending (p = 0.579). Supplemental fixation using a spinous process plate was not significantly different from bilateral pedicle screws in flexion-extension (p = 0.476). The combination of lateral plate and spinous process plate was not statistically different from the cage supplemented with bilateral pedicle screws in all the loading modes (p ≥ 0.365). Conclusions. A combination of lateral and spinous process plate fixation to supplement a laterally inserted interbody cage helps achieve rigidity in all motion planes similar to that achieved with bilateral pedicle screws. ©AANS, 2014.
Huffman L.C.,Stanford University |
Sutcliffe T.L.,Palo Alto Medical Foundation |
Tanner I.S.D.,University of Wisconsin - Madison |
Feldman H.M.,Stanford University
Journal of Developmental and Behavioral Pediatrics | Year: 2011
In the care of children with autism spectrum disorders (ASD), medical treatment is typically considered an adjunct to educational and behavioral interventions. Nonetheless, large proportions of children with ASD are managed medically and receive both pharmacologic and complementary-alternative medicine (CAM) treatments. Although many medical treatments have been studied in children with ASD, studies vary widely in terms of the sample, sample size, research design, purposes of treatment, and measurements of change. Surprisingly, comprehensive reviews of the options for medical management in ASD are lacking, particularly reviews that address both pharmacologic and CAM treatments. Furthermore, reviews to date tend to emphasize general effects of medication; this perspective contradicts medical practice, which targets particular symptoms during treatment selection and monitoring. This review of 115 studies adds to the ASD treatment literature by (1) including studies of individuals 0 to 22 years of age; (2) aggregating studies of pharmacologic treatments and CAM treatments; and importantly, (3) organizing treatment response by ASD symptoms, differentiating core and associated symptoms. Copyright © 2011 Lippincott Williams & Wilkins.
Time to onset of clinically meaningful improvement with tadalafil 5 mg once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: Analysis of data pooled from 4 pivotal, double-blind, placebo controlled studies
Oelke M.,Hannover Medical School |
Shinghal R.,Palo Alto Medical Foundation |
Sontag A.,Eli Lilly and Company |
Baygani S.K.,Eli Lilly and Company |
Donatucci C.F.,Eli Lilly and Company
Journal of Urology | Year: 2015
Purpose Tadalafil once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia consistently shows statistically significant I-PSS improvements. However, physicians and patients wish to know whether tadalafil provides rapid, clinically meaningful improvement in lower urinary tract symptoms. In this post hoc analysis we integrated results from 4 placebo controlled studies to determine the duration of tadalafil once daily required to achieve clinically meaningful improvement. Materials and Methods We performed post hoc analysis of data integrated from 4 double-blind studies of tadalafil 5 mg and placebo once daily in 742 and 735 men, respectively, 45 years old or older with total I-PSS 13 or greater. Two clinically meaningful improvement categories were assessed, including 1) 3-point or greater baseline to end point total I-PSS improvement and 2) 25% or greater baseline to end point total I-PSS improvement. I-PSS was assessed at weeks 4, 8 and 12 in all studies, week 1 in 2 and week 2 in 1. Results in men treated with tadalafil who showed clinically meaningful improvement (responders) were further examined to determine the earliest time to clinically meaningful improvement. Results Of 742 tadalafil treated patients 513 (69.1%) and 444 (59.8%) demonstrated category 1 and 2 clinically meaningful improvement, respectively, at the study end point. Of 234 category 1 responders with week 1 assessments 140 (59.8%) achieved clinically meaningful improvement by week 1 and 407 of the total of 513 category 1 responders (79.3%) showed it by week 4. Of the 205 category 2 responders with week 1 assessments 103 (50.2%) achieved clinically meaningful improvement by week 1 while 322 of the 444 category 2 responders (72.5%) did so by week 4. Conclusions Tadalafil 5 mg once daily led to clinically meaningful improvement in approximately two-thirds of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. More than half of this group of tadalafil treated responders achieved clinically meaningful improvement after 1 week of therapy and more than 70% did so within 4 weeks. © 2015 American Urological Association Education and Research, Inc.