How to Secure Competitive R01 Research Grants? Check Out This Program!

by | Feb 27, 2024 | 2023, Education 2023

Michaela Kiernan, PhD

Michaela Kiernan, PhD

How to Secure Competitive R01 Research Grants? Check Out This Program!

Michaela Kiernan, PhD

Michaela Kiernan, PhD

How to Secure Competitive R01 Research Grants? Check Out This Program!

One of the hardest parts about being a scientist is obtaining research grants — particularly the very competitive ones from the National Institutes of Health (NIH).

Michaela Kiernan, PhD, a senior research scholar at the Stanford Prevention Research Center, has received a number of NIH grants throughout her career. She and the Stanford Medicine Office of Faculty Development and Diversity (OFDD) wanted to find an effective way to mentor junior faculty through the daunting application process. For the past decade, Kiernan has directed OFDD’s annual R01 Countdown Program — a 15-week intensive grant writing boot camp that teaches junior faculty how to produce clear, organized, and impactful R01 grant applications.

R01 grants are awarded by the NIH to support a project for up to five years, and they are the oldest, most prestigious grants awarded to independent investigators conducting biomedical research. The program also helps researchers who are applying for an R21 grant, which encourages exploratory research by supporting early and conceptual stages of project development.

Kiernan’s efforts have been widely successful; over the years, the R01 Countdown Program has generated over $152 million in NIH grants across 14 different NIH institutes, as well as other government and foundation grant funding.

“Scientists often struggle to write in a concise and approachable manner. As researchers, we had many research methods and stats courses, but not a lot of graduate programs include formal scientific writing courses,” says Kiernan.

The program’s intimate format makes it compelling for Stanford faculty members, says Magali Fassiotto, PhD, associate dean of OFDD. “This psychosocial support, in addition to the multiple proven techniques and specific skills-building provided by the program, makes for an empowering and safe environment for faculty who are submitting NIH R-series grants as a principal investigator.”

One of the hardest parts about being a scientist is obtaining research grants — particularly the very competitive ones from the National Institutes of Health (NIH).

Michaela Kiernan, PhD, a senior research scholar at the Stanford Prevention Research Center, has received a number of NIH grants throughout her career. She and the Stanford Medicine Office of Faculty Development and Diversity (OFDD) wanted to find an effective way to mentor junior faculty through the daunting application process. For the past decade, Kiernan has directed OFDD’s annual R01 Countdown Program — a 15-week intensive grant writing boot camp that teaches junior faculty how to produce clear, organized, and impactful R01 grant applications.

R01 grants are awarded by the NIH to support a project for up to five years, and it is the oldest, most prestigious grant awarded to independent investigators conducting biomedical research. The program also helps researchers who are applying for an R21 grant, which encourages exploratory research by supporting early and conceptual stages of project development.

Kiernan’s efforts have been widely successful; over the years, the R01 Countdown Program has generated over $152 million in NIH grants across 14 different NIH institutes, as well as other government and foundation grant funding.

“Scientists often struggle to write in a concise and approachable manner. As researchers, we had many research methods and stats courses, but not a lot of graduate programs include formal scientific writing courses,” says Kiernan.

The program’s intimate format makes it compelling for Stanford faculty members, says Magali Fassiotto, PhD, associate dean of OFDD. “This psychosocial support, in addition to the multiple proven techniques and specific skills-building provided by the program, makes for an empowering and safe environment for faculty who are submitting NIH R-series grants as a principal investigator.”

Rather than focus on their own grant, faculty first learn how to look at stellar, already funded grants at a 30,000-foot view to see how they are put together.

— Michaela Kiernan, PhD, senior research scholar at the Stanford Prevention Research Center 

Mastering Science Writing Techniques

Each October to February, nine or 10 junior faculty members are selected to participate in the program. Those who have submitted an R01 in the past but have not yet been awarded a grant are prioritized.

Faculty start by learning basic scientific writing techniques. “Rather than focus on their own grant, faculty first learn how to look at stellar, already funded grants at a 30,000-foot view to see how they are put together,” says Kiernan.

The work includes walking through each of eight elements recommended for writing a concise and compelling “specific aims” page — the most vital part of an NIH grant application designed to hook reviewers’ attention and convince them that the work is worth funding. OFDD has made these eight elements available online to investigators at Stanford and beyond, which has garnered strong interest, with over 5,900 page views in the past two years.

Editing and Presenting Your Grant

Next, each faculty member edits their own specific aims page. “One unique part of this program is we spend a lot of time on innovation,” says Kiernan. This involves distinguishing what is new about your scientific methods by juxtaposing them with the limitations of existing methods in the field. “The fact that something has never been done before doesn’t automatically make it innovative,” Kiernan says. Junior faculty also seek out new collaborations to further push their science.

Once a draft is completed, faculty read peers’ specific aims and provide detailed, constructive feedback in a quick round-robin manner. “We don’t want people dragging on in an oral presentation. It’s about trying to mimic how fast grant reviewers move when they work through a stack of grants,” says Kiernan.

For that reason, writing in a concise way that avoids scientific jargon and niche acronyms is key. “Everyone is from different departments and applying to different NIH institutes, so it’s important to make the writing super accessible,” Kiernan says.

A Collaborative Environment

One of the most exciting aspects of this program is that it creates a collaborative environment for a range of Stanford researchers who would otherwise not have the opportunity to dive into cross-disciplinary science.

“There is wonderful camaraderie in the cohorts. For two hours each week, faculty work with colleagues from other disciplines and talk about really cool science,” says Kiernan. “It is extremely intellectually stimulating and collaborative.”

Along with the joy that comes from teaching others valuable grant writing skills, one of Kiernan’s favorite parts about the R01 Countdown Program is hearing from faculty when they cross the finish line and are awarded their NIH R01.

“Faculty come in with different strengths and areas for growth, and it’s just so wonderful to see them expand on their strengths and succeed,” she says.

Fassiotto emphatically agrees. “Michaela and this incredible course, which she has developed and led, are true gems not only of our Office of Faculty Development and Diversity, but of Stanford Medicine as a whole.”

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From Oncology Staff to Oncology Patient

by | Feb 27, 2024 | 2023, Clinical Care 2023

Being done with treatment allows Kristy Kerivan to focus on the things that really matter.

Being done with treatment allows Kristy Kerivan to focus on the things that really matter.

From Oncology Staff to Oncology Patient

Being done with treatment allows Kristy Kerivan to focus on the things that really matter.

From Oncology Staff to Oncology Patient

Kristy Kerivan thought her fatigue was from a cardiac issue and was not expecting her diagnosis: breast cancer that was HER2+, one of the more aggressive types. As senior administrative division director in the Department of Medicine’s division of oncology, she fortunately had immediate access to resources.

“I was panicked,” Kerivan says about her diagnosis. “The first person I went to was Heather Wakelee, MD, chief of oncology and also one of my bosses, and we talked through what I was facing. After that, it was a whirlwind.”

While Kerivan’s mom had previously been treated for ductal carcinoma in situ (DCIS), a noninvasive early form of breast cancer, Kerivan’s cancer had spread into breast tissue, making treatment lengthier and more complex.

And that treatment lasted a full year, starting with chemotherapy followed by lumpectomy surgery, radiation, and Herceptin, an IV medication that targets HER2+ receptors to stop cancer cell growth. Says Kerivan, “I feel fortunate that the cancer was caught early and that I had access to this medication because without it my prognosis would have been very different.”

Cancer Care at Stanford

Kerivan likes to tell people that if you’re going to get cancer, you might as well get it while working in the division of oncology at a major academic institution like Stanford. “The care I received at Stanford was exceptional,” she says, referring to her 100-plus visits to Stanford during her yearlong course of treatment.

Kerivan has been in her current position since August 2020 and had worked as administrative director for Stanford’s Vera Moulton Wall Center for Pulmonary Vascular Disease for 17 years. Extremely familiar with the administrative side of health care, Kerivan found being a patient to be an eye-opening experience. “I was surprised about the things I didn’t know,” she explains. “While I understood how specialized cancer treatment is, I didn’t know just how complex cancer care is or how treatment impacts every area of your body.”

As a patient, she found it reassuring to visit areas she knew in passing as a staff person. “Because I was familiar with the hospital, it didn’t feel like a big, intimidating medical facility,” she says. 

“And from the people who checked me in, to the radiation therapists and the nurses who administered chemo — all of my personal interactions made me feel like people cared.”

As a comprehensive care center, Stanford offers an extensive array of cancer specialists. Allison Kurian, MD, professor of oncology and of epidemiology and population health at the Stanford School of Medicine, served as Kerivan’s breast oncologist and treatment physician, and her care team included a breast surgeon, a dermatology oncologist, a radiation oncologist, and a neuro-oncologist. Kerivan received periodic calls from a social worker and outreach specialist who helped her manage the emotional and nonmedical aspects of treatment.

“I felt lucky to have access to a wealth of specialists and support services that might not have been available to me at other institutions. I also felt a deeper appreciation for all the work conducted by Stanford researchers to find cures for cancer and other diseases. I like to think that, in some small way, I supported that progress,” she says.

From the people who checked me in, to the radiation therapists and the nurses who administered chemo — all of my personal interactions made me feel like people cared.

Going the Extra Mile

An example of the exceptional care and support Kerivan received occurred one Easter Sunday while she was experiencing side effects from chemotherapy. Wanting to avoid going to the emergency room and possibly exposing herself to COVID-19 and other germs when her resistance was weakened, she was relieved to learn that the Infusion Center was open every day of the year. A nurse practitioner was able to see her that day and helped address her symptoms.

Kerivan took a medical leave at the beginning of her treatment, then worked a reduced 10-hours-per-week schedule from April to October 2022. This allowed her return to full-time work to be less of a shock, and it gave her ongoing support from colleagues, especially from her administrative and finance team. “I’ll never forget the many offers of help and messages of support from staff and faculty throughout this process,” she notes. Among the small acts of kindness were the groceries that Bhuvana Ramachandran, administrative division director in the division of hematology, bought and delivered to her. Kerivan’s bosses, Wakelee and Cathy Garzio, director of finance and administration for the Department of Medicine, were also extremely supportive while she returned to full health. “Cathy checked on me frequently to see how I was doing and sent me flowers and food via DoorDash,” recalls Kerivan. “Heather was a great medical resource for questions, and she made sure I was taking care of myself and not working too much. A big part of their support was what they didn’t do — they never made me feel pressured about work, and they let me do what I felt capable of.”

During chemotherapy, Kerivan had cold capping treatment, a scalp cooling therapy that protects hair follicles to help reduce hair loss.

A New Lease on Life

Kerivan felt very lucky to be treated at Stanford and is confident in her prognosis. “People suggested I plan a big vacation after my treatment ended or do something on my bucket list, but I don’t feel the need to do that,” she adds. “Being done with treatment is a weight off my shoulders, and now I have time to focus on the things that really matter: my family, my friends, and a job that I love.”

And Kerivan found a way to help others with HER2+ breast cancer: she’s participating in a clinical trial testing the safety of a vaccine aimed at preventing cancer recurrence by targeting the HER2 protein. Fauzia Riaz, MD, clinical assistant professor of medicine, is the principal investigator of the trial.

Kerivan enjoys walking her dog at the beach in San Francisco.

Kristy Kerivan thought her fatigue was from a cardiac issue and was not expecting her diagnosis: breast cancer that was HER2+, one of the more aggressive types. As senior administrative division director in the Department of Medicine’s division of oncology, she fortunately had immediate access to resources.

“I was panicked,” Kerivan says about her diagnosis. “The first person I went to was Heather Wakelee, MD, chief of oncology and also one of my bosses, and we talked through what I was facing. After that, it was a whirlwind.”

While Kerivan’s mom had previously been treated for ductal carcinoma in situ (DCIS), a noninvasive early form of breast cancer, Kerivan’s cancer had spread into breast tissue, making treatment lengthier and more complex.

And that treatment lasted a full year, starting with chemotherapy followed by lumpectomy surgery, radiation, and Herceptin, an IV medication that targets HER2+ receptors to stop cancer cell growth. Says Kerivan, “I feel fortunate that the cancer was caught early and that I had access to this medication because without it my prognosis would have been very different.”

During chemotherapy, Kerivan had cold capping treatment, a scalp cooling therapy that protects hair follicles to help reduce hair loss.

Cancer Care at Stanford

Kerivan likes to tell people that if you’re going to get cancer, you might as well get it while working in the division of oncology at a major academic institution like Stanford. “The care I received at Stanford was exceptional,” she says, referring to her 100-plus visits to Stanford during her yearlong course of treatment.

Kerivan has been in her current position since August 2020 and had worked as administrative director for Stanford’s Vera Moulton Wall Center for Pulmonary Vascular Disease for 17 years. Extremely familiar with the administrative side of health care, Kerivan found being a patient to be an eye-opening experience. “I was surprised about the things I didn’t know,” she explains. “While I understood how specialized cancer treatment is, I didn’t know just how complex cancer care is or how treatment impacts every area of your body.”

As a patient, she found it reassuring to visit areas she knew in passing as a staff person. “Because I was familiar with the hospital, it didn’t feel like a big, intimidating medical facility,” she says. “And from the people who checked me in, to the radiation therapists and the nurses who administered chemo — all of my personal interactions made me feel like people cared.”

As a comprehensive care center, Stanford offers an extensive array of cancer specialists. Allison Kurian, MD, professor of oncology and of epidemiology and population health at the Stanford School of Medicine, served as Kerivan’s breast oncologist and treatment physician, and her care team included a breast surgeon, a dermatology oncologist, a radiation oncologist, and a neuro-oncologist. Kerivan received periodic calls from a social worker and outreach specialist who helped her manage the emotional and nonmedical aspects of treatment.

“I felt lucky to have access to a wealth of specialists and support services that might not have been available to me at other institutions. I also felt a deeper appreciation for all the work conducted by Stanford researchers to find cures for cancer and other diseases. I like to think that, in some small way, I supported that progress,” she says.

From the people who checked me in, to the radiation therapists and the nurses who administered chemo — all of my personal interactions made me feel like people cared.

Kerivan enjoys walking her dog at the beach in San Francisco

Going the Extra Mile

An example of the exceptional care and support Kerivan received occurred one Easter Sunday while she was experiencing side effects from chemotherapy. Wanting to avoid going to the emergency room and possibly exposing herself to COVID-19 and other germs when her resistance was weakened, she was relieved to learn that the Infusion Center was open every day of the year. A nurse practitioner was able to see her that day and helped address her symptoms.

Kerivan took a medical leave at the beginning of her treatment, then worked a reduced 10-hours-per-week schedule from April to October 2022. This allowed her return to full-time work to be less of a shock, and it gave her ongoing support from colleagues, especially from her administrative and finance team. “I’ll never forget the many offers of help and messages of support from staff and faculty throughout this process,” she notes. Among the small acts of kindness were the groceries that Bhuvana Ramachandran, administrative division director in the division of hematology, bought and delivered to her. Kerivan’s bosses, Wakelee and Cathy Garzio, director of finance and administration for the Department of Medicine, were also extremely supportive while she returned to full health. “Cathy checked on me frequently to see how I was doing and sent me flowers and food via DoorDash,” recalls Kerivan. “Heather was a great medical resource for questions, and she made sure I was taking care of myself and not working too much. A big part of their support was what they didn’t do — they never made me feel pressured about work, and they let me do what I felt capable of.”

A New Lease on Life

Kerivan felt very lucky to be treated at Stanford and is confident in her prognosis. “People suggested I plan a big vacation after my treatment ended or do something on my bucket list, but I don’t feel the need to do that,” she adds. “Being done with treatment is a weight off my shoulders, and now I have time to focus on the things that really matter: my family, my friends, and a job that I love.”

And Kerivan found a way to help others with HER2+ breast cancer: she’s participating in a clinical trial testing the safety of a vaccine aimed at preventing cancer recurrence by targeting the HER2 protein. Fauzia Riaz, MD, clinical assistant professor of medicine, is the principal investigator of the trial.

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CHIP: Where Artificial Intelligence and Cardiology Come Together

by | Feb 27, 2024 | 2023, Education 2023

From left: Desiree Steinberg, NP; Prasanth Ganesan, PhD; and Sanjiv M. Narayan, MD, PhD

From left: Desiree Steinberg, NP; Prasanth Ganesan, PhD; and Sanjiv M. Narayan, MD, PhD

CHIP: Where Artificial Intelligence and Cardiology Come Together

From left: Desiree Steinberg, NP; Prasanth Ganesan, PhD; and Sanjiv M. Narayan, MD, PhD

From left: Desiree Steinberg, NP; Prasanth Ganesan, PhD; and Sanjiv M. Narayan, MD, PhD

CHIP: Where Artificial Intelligence and Cardiology Come Together

“Computer tools are everywhere. They’re in your phone. They’re in your TV remote. They’re in your car gearbox,” says Sanjiv M. Narayan, MD, PhD, professor of cardiovascular medicine. As the benefits of artificial intelligence (AI) and machine learning in the medical setting become increasingly clear, it is imperative that physicians understand them, so they can be safely and thoughtfully leveraged to improve research and patient care. That is why he and his co-director Alison Marsden, PhD, have founded the first-of-its-kind Computational Medicine in the Heart: Integrated Training Program (CHIP). Marsden is Douglass M. and Nola Leishman Professor of Cardiovascular Diseases in the departments of Pediatrics, Bioengineering, and, by courtesy, Mechanical Engineering.

“If we don’t understand [machine learning and AI], we are ceding our responsibility to tech companies, who may have priorities other than patient care or science,” Narayan says. “If we understand these things better, we are better prepared. … It just makes the scientific mission better.”

At the same time, computer scientists and engineers, the professionals who typically develop the computer-based technologies that are used in medicine, may do a better job if they understand the nuanced medical and biological contexts in which they are used.

Learning How to Speak the Same Language

Welcoming its very first students during the summer of 2023, CHIP operates under the aegis of the Stanford Cardiovascular Institute (CVI) and the Institute for Computational and Mathematical Engineering (ICME). It is a truly multidisciplinary program, accepting students with diverse backgrounds to develop the novel specialty of computational medicine. CHIP cross-trains biologists and medical specialists on the one hand and engineers, mathematicians, and computer scientists on the other. “The idea is to have enough [mutual] understanding so we can talk the same language,” says Narayan, who in addition to being director of CHIP is also a professor of medicine and co-director of another multidisciplinary program — the Stanford Center for Arrhythmia Research.

While many are already working in the space that CHIP straddles, most are formally educated in one field and self-taught in the other. CHIP provides education that spans both while at the same time offering opportunities to make practical use of this multidisciplinary training in clinical and research settings.

Made possible via a prestigious and highly sought-after National Institutes of Health (NIH) T32 grant, the two-year research program offers on-the-job practical training to those with an MD or PhD in the fields of medicine, biology, computer science, or engineering. Students engage with Stanford faculty across the entire campus, including the schools of Medicine, Engineering, and Humanities and Sciences. “We want people who are committed to this intersection,” says Narayan. “They have proven to us that they are not just doing it to work with a certain faculty. They believe in the mission. To me, it’s a mindset.”

Harnessing a Powerful Tool in Medicine

“Medical AI, when it is used to complement the physician, is incredibly powerful,” continues Narayan. Examples include the Apple Watch, which can detect atrial fibrillation, or AI and machine learning algorithms to aid in the interpretation of findings on imaging. Unlike people, AI doesn’t get tired. It doesn’t get hungry. It doesn’t have good and bad days. But computers should never replace a physician. They simply provide new pieces of information with which to make decisions. In fact, a recent Stanford study revealed that using machine learning can help identify evidence of cardiovascular disease on imaging that was missed by clinicians. One of Narayan’s own specialties is in digital phenotyping to predict cardiovascular outcomes. The use of AI and machine learning allows for the number of factors included in an individual digital phenotype to be virtually limitless.

CHIP program participants from left: Prasanth Ganesan, PhD, cardiovascular medicine postdoctoral fellow; Desiree Steinberg, NP; and Sanjiv M. Narayan, MD, PhD

“Computer tools are everywhere. They’re in your phone. They’re in your TV remote. They’re in your car gearbox,” says Sanjiv M. Narayan, MD, PhD, professor of cardiovascular medicine. As the benefits of artificial intelligence (AI) and machine learning in the medical setting become increasingly clear, it is imperative that physicians understand them, so they can be safely and thoughtfully leveraged to improve research and patient care. That is why he and his co-director Alison Marsden, PhD, have founded the first-of-its-kind Computational Medicine in the Heart: Integrated Training Program (CHIP). Marsden is Douglass M. and Nola Leishman Professor of Cardiovascular Diseases in the departments of Pediatrics, Bioengineering, and, by courtesy, Mechanical Engineering.

“If we don’t understand [machine learning and AI], we are ceding our responsibility to tech companies, who may have priorities other than patient care or science,” Narayan says. “If we understand these things better, we are better prepared. … It just makes the scientific mission better.” At the same time, computer scientists and engineers, the professionals who typically develop the computer-based technologies that are used in medicine, may do a better job if they understand the nuanced medical and biological contexts in which they are used.

Learning How to Speak the Same Language

Welcoming its very first students during the summer of 2023, CHIP operates under the aegis of the Stanford Cardiovascular Institute (CVI) and the Institute for Computational and Mathematical Engineering (ICME). It is a truly multidisciplinary program, accepting students with diverse backgrounds to develop the novel specialty of computational medicine. CHIP cross-trains biologists and medical specialists on the one hand and engineers, mathematicians, and computer scientists on the other. “The idea is to have enough [mutual] understanding so we can talk the same language,” says Narayan, who in addition to being director of CHIP is also a professor of medicine and co-director of another multidisciplinary program — the Stanford Center for Arrhythmia Research. While many are already working in the space that CHIP straddles, most are formally educated in one field and self-taught in the other. CHIP provides education that spans both while at the same time offering opportunities to make practical use of this multidisciplinary training in clinical and research settings.

Made possible via a prestigious and highly sought-after National Institutes of Health (NIH) T32 grant, the two-year research program offers on-the-job practical training to those with an MD or PhD in the fields of medicine, biology, computer science, or engineering. Students engage with Stanford faculty across the entire campus, including the schools of Medicine, Engineering, and Humanities and Sciences. “We want people who are committed to this intersection,” says Narayan. “They have proven to us that they are not just doing it to work with a certain faculty. They believe in the mission. To me, it’s a mindset.”

Harnessing a Powerful Tool in Medicine

“Medical AI, when it is used to complement the physician, is incredibly powerful,” continues Narayan. Examples include the Apple Watch, which can detect atrial fibrillation, or AI and machine learning algorithms to aid in the interpretation of findings on imaging. Unlike people, AI doesn’t get tired. It doesn’t get hungry. It doesn’t have good and bad days. But computers should never replace a physician. They simply provide new pieces of information with which to make decisions. In fact, a recent Stanford study revealed that using machine learning can help identify evidence of cardiovascular disease on imaging that was missed by clinicians. One of Narayan’s own specialties is in digital phenotyping to predict cardiovascular outcomes. The use of AI and machine learning allows for the number of factors included in an individual digital phenotype to be virtually limitless.

CHIP program participants from left: Prasanth Ganesan, PhD, cardiovascular medicine postdoctoral fellow; Desiree Steinberg, NP; and Sanjiv M. Narayan, MD, PhD

We are at the cutting edge of next-generation computational engineering and medicine, to deliver solutions to improve the lives of patients.
— Sanjiv Narayan, MD

Integrating New Technology by Improving Competence Across Disciplines

Narayan uses the analogy of the increasing importance of statistics in medicine to explain the importance of programs like CHIP. “There was a time when physicians were not taught statistics. Now it’s such a major part of what we [as physicians] do,” he says. Computer science is becoming integral to how medicine is practiced, just as statistics has become integral to weighing evidence and ultimately making clinical decisions.

Narayan expects that by the end of their training, students will have worked and published across disciplines. Upon graduation, they will continue to leverage their understanding of computational medicine in their careers in academia, government, or industry. “The quality of our graduates will make this a signature for Stanford,” he says. “We are at the cutting edge of next-generation computational engineering and medicine, to deliver solutions to improve the lives of patients.” Ultimately, he says, he would like CHIP to be the catalyst behind the birth of the field of computational medicine, with one day perhaps a Center for Computational Medicine within the Stanford School of Medicine. “If we have done that,” he says, “we have moved the needle. The science will be more robust, outcomes should be better. Patients should get better treatment.”

How to Secure Competitive R01 Research Grants? Check Out This Program!
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Stanford Is Going South

by | Feb 27, 2024 | 2023, Rebuilding Community Connections 2023

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Stanford Is Going South

New Cardiovascular Clinic Brings Stanford Care to South Bay Communities

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Stanford Is Going South

New Cardiovascular Clinic Brings Stanford Care to South Bay Communities

The Department of Medicine’s growth mindset has taken shape in the form of a brand-new Cardiovascular Medicine (CVM) clinic, which opened its doors in spring 2023 at Stanford Health Care in San José, California. The driving force behind the clinic is an interest in expanding not only Stanford’s geographic footprint but also the diversity of its patients.

Expanding to Diversify the Patient Population

According to its champion, Eldrin Lewis, MD, “In California, patients don’t like to travel much for health care, especially routine health care. So, meeting the patient where they live is a rallying cry that I have been seeing during the time that I have been [working at Stanford].” Combined with similar endeavors, the new CVM clinic provides the opportunity for Stanford to expand beyond its traditional role as a “boutique” health care facility that people must travel to in order to receive high-quality tertiary and quaternary care to a system that cares for patients across the spectrum of disease severity and type, right in their own California communities.

Expansion of cardiology services first focused on the East Bay, but when the opportunity arose for a CVM clinic to provide ambulatory care in the South Bay, Lewis and his team jumped on it. Since opening, the clinic facility has had space to see 16 patients at once. 

“This is an opportunity to increase the diversity of the patients that we see in terms of race and ethnicity, with a larger Hispanic and Vietnamese population in the South Bay,” he says. “It allows us to see patients who may not have made the drive up to Palo Alto.” Lewis is Simon H. Stertzer, MD, Professor of Cardiovascular Medicine and chief of the division of cardiovascular medicine in the Department of Medicine.

Growing to Bring Specialty Care to the Doorsteps of New Communities

While several general cardiologists and a few electrophysiologists and interventional cardiologists were already working in the South Bay, the breadth of expertise that Stanford can offer was lacking. 

In addition to standard cardiovascular care, the new CVM clinic provides access to specialists in preventive cardiology as well as experts in heart failure, transplant, and adult congenital heart disease. It currently offers echocardiography and stress echocardiography, and Lewis hopes to eventually add nuclear medicine, cardiac magnetic resonance imaging, and CT angiography. It makes a welcome companion to the Santa Clara location of the Stanford South Asian Translational Heart Initiative (SSATHI) clinic, which is home to cardiologists who specialize in the needs of the South Asian population.

“A lot of patients can [now] stay in San José,” says Lewis. “Those who need more complex procedures or surgeries can come into Palo Alto to Stanford Health Care, then continue to be managed [closer to home]. … I would love to be a resource to the greater South Bay community. … I would also like to see the opportunity for educating the community with health fairs and a variety of other things for people who are not necessarily being seen by one of our providers.”

Renewal Through New Relationships

Lewis has made several forays into the South Bay to talk up the clinic to local cardiologists, regional hospitals, and the community at large, describing what the new clinic has to offer while also emphasizing that the goal is to work in partnership with local physicians to provide excellent patient care. “We want to provide the right care at the right time to the right patient,” he says. “My philosophy is that it should be a bidirectional process.” Patients can remain with their current cardiologists, only venturing to the South Bay clinic when they require specialized care.

An official ribbon cutting ceremony marked the opening of the Department of Medicine’s cardiovascular medicine clinic at Stanford Health Care in San José, California

The Department of Medicine’s growth mindset has taken shape in the form of a brand-new Cardiovascular Medicine (CVM) clinic, which opened its doors in spring 2023 at Stanford Health Care in San José, California. The driving force behind the clinic is an interest in expanding not only Stanford’s geographic footprint but also the diversity of its patients.

Expanding to Diversify the Patient Population

According to its champion, Eldrin Lewis, MD, “In California, patients don’t like to travel much for health care, especially routine health care. So, meeting the patient where they live is a rallying cry that I have been seeing during the time that I have been [working at Stanford].” Combined with similar endeavors, the new CVM clinic provides the opportunity for Stanford to expand beyond its traditional role as a “boutique” health care facility that people must travel to in order to receive high-quality tertiary and quaternary care to a system that cares for patients across the spectrum of disease severity and type, right in their own California communities.

Expansion of cardiology services first focused on the East Bay, but when the opportunity arose for a CVM clinic to provide ambulatory care in the South Bay, Lewis and his team jumped on it. Since opening, the clinic facility has had space to see 16 patients at once. 

“This is an opportunity to increase the diversity of the patients that we see in terms of race and ethnicity, with a larger Hispanic and Vietnamese population in the South Bay,” he says. “It allows us to see patients who may not have made the drive up to Palo Alto.” Lewis is Simon H. Stertzer, MD, Professor of Cardiovascular Medicine and chief of the division of cardiovascular medicine in the Department of Medicine.

Growing to Bring Specialty Care to the Doorsteps of New Communities

While several general cardiologists and a few electrophysiologists and interventional cardiologists were already working in the South Bay, the breadth of expertise that Stanford can offer was lacking. In addition to standard cardiovascular care, the new CVM clinic provides access to specialists in preventive cardiology as well as experts in heart failure, transplant, and adult congenital heart disease. It currently offers echocardiography and stress echocardiography, and Lewis hopes to eventually add nuclear medicine, cardiac magnetic resonance imaging, and CT angiography. It makes a welcome companion to the Santa Clara location of the Stanford South Asian Translational Heart Initiative (SSATHI) clinic, which is home to cardiologists who specialize in the needs of the South Asian population.

“A lot of patients can [now] stay in San José,” says Lewis. “Those who need more complex procedures or surgeries can come into Palo Alto to Stanford Health Care, then continue to be managed [closer to home]. … I would love to be a resource to the greater South Bay community. … I would also like to see the opportunity for educating the community with health fairs and a variety of other things for people who are not necessarily being seen by one of our providers.”

Renewal Through New Relationships

Lewis has made several forays into the South Bay to talk up the clinic to local cardiologists, regional hospitals, and the community at large, describing what the new clinic has to offer while also emphasizing that the goal is to work in partnership with local physicians to provide excellent patient care. “We want to provide the right care at the right time to the right patient,” he says. “My philosophy is that it should be a bidirectional process.” Patients can remain with their current cardiologists, only venturing to the South Bay clinic when they require specialized care.

The new clinic will partner with South Bay primary care physicians who are part of the Stanford Medical Foundation, acting as a local resource for the cardiology care their patients need. “On average, if you have a single general cardiologist paired to five to 10 primary care doctors, you can create ecosystems where you really get to know those primary care doctors,” says Lewis. “That is something I would like to see develop a little bit more.”

This is just one part of a bigger strategy to expand the network. What I would love to see in five years is Stanford reaching out beyond the East and South Bay, where we are now, to go farther east into the Central Valley.

Looking Forward

“This is just one part of a bigger strategy to expand the network,” he continues. “What I would love to see in five years is Stanford reaching out beyond the East and South Bay, where we are now, to go farther east into the Central Valley.” This is an area of California with limited access to specialized care, and patients experiencing acute cardiac events or with conditions that require special expertise to manage may opt not to drive several hours to obtain the care they need. “The majority of Americans live outside of urban areas, and those are the forgotten people, sometimes.”

Where Health Care Is a Luxury
Pause, Reflect, and Begin Again

Tying Together Pelvic Health and the Microbiome

by | Feb 27, 2024 | 2023, Clinical Care 2023

Leila Neshatian, MD

Leila Neshatian, MD

Tying Together Pelvic Health and the Microbiome

Pelvic Health Program Provides Relief From Pain and Shame

Leila Neshatian, MD

Leila Neshatian, MD

Tying Together Pelvic Health and the Microbiome

Pelvic Health Program Provides Relief From Pain and Shame

You laugh, you pee. This is the reality for many middle-aged women, especially if they gave birth vaginally. If it’s just a few drops, it’s usually no big deal. But sometimes it’s not just a few drops. Then there is the flip side of the coin — fecal incontinence. Now we are getting into territory so taboo and embarrassing that people do not even want to bring it up with their physicians.

Pelvic Health Problems — Embarrassing and Undertreated, Patients Suffer in Silence

Pelvic health is fundamental to good quality of life. Nevertheless, comprehensive multidisciplinary care in this area can be hard to come by. That’s why patients travel from all over the country to receive the kind of specialized care given by Leila Neshatian, MD, in collaboration with a team of dedicated clinicians who work alongside her at the Stanford Pelvic Health Center. 

While the Pelvic Health Center serves all genders, the majority of patients are women of middle or older age suffering from a wide array of pelvic floor disorders.

These conditions negatively impact quality of life with symptoms such as urinary and/or fecal incontinence, constipation, and pain or pressure in the pelvic area. It is not unusual for the center’s patients to have a long history of being dismissed or undertreated elsewhere. The unfortunate reality is that anorectal and pelvic health is not covered adequately in many medical training programs, so physicians simply aren’t equipped to handle the problem. They may recommend Kegel exercises or, in more severe cases, refer patients for surgery, but that is about the limit of their options.

Finally, a Comprehensive, Multidisciplinary Solution

The Stanford Pelvic Health Center, on the other hand, provides coordinated, multidisciplinary care that includes the specialties of gastroenterology, colorectal surgery, urogynecology, urology, pain anesthesiology, and physiotherapy. Neshatian, clinical associate professor of gastroenterology and hepatology, specializes in neurogastroenterology and benign anorectal disorders.  

Her patients receive a comprehensive evaluation, including assessment of anorectal function, coordination, and sensory function via high-resolution anorectal manometry, as well as three-dimensional dynamic ultrasound to evaluate the anal sphincter and surrounding muscles, and magnetic resonance imaging defecography to dynamically visualize overall pelvic organ structure and function.

Following this assessment, the multidisciplinary team works together to determine the best multipronged treatment course. “We offer comprehensive medical management, physical therapy, and combined surgeries,” says Neshatian. By “combined surgeries,” she means that two surgeons, one colorectal and the other specialized in urogynecology, may operate on a single patient during the same surgery to ensure that all the pelvic issues are addressed at once by the most experienced hands.

Innovative Research in Pelvic Health

In addition to seeing patients, the Pelvic Health Center conducts innovative research into an aspect of health that remains poorly understood, so that physicians all over the world can better treat their patients. For instance, Neshatian and her team are working to identify specific targets for measures of pelvic health, such as the size and quality of the skeletal muscles, that must be achieved in order to treat or prevent pelvic symptoms in aging women.

One important learning from her research is the importance of muscle size and quality, not just in the pelvic area but overall. “In order to have better pelvic health, you need better muscles,” says Neshatian. “If the person is deconditioned, the muscle is replaced by fat, and the likelihood of having these problems is certainly higher. We proposed that if we put women through physical activities, such as resistance training, to improve overall physical conditioning, symptoms related to pelvic floor dysfunction such as fecal and urinary incontinence will improve as well.” Research is currently ongoing to evaluate this hypothesis.

Leila Neshatian, MD

You laugh, you pee. This is the reality for many middle-aged women, especially if they gave birth vaginally. If it’s just a few drops, it’s usually no big deal. But sometimes it’s not just a few drops. Then there is the flip side of the coin — fecal incontinence. Now we are getting into territory so taboo and embarrassing that people do not even want to bring it up with their physicians.

Pelvic Health Problems — Embarrassing and Undertreated, Patients Suffer in Silence

Pelvic health is fundamental to good quality of life. Nevertheless, comprehensive multidisciplinary care in this area can be hard to come by. That’s why patients travel from all over the country to receive the kind of specialized care given by Leila Neshatian, MD, in collaboration with a team of dedicated clinicians who work alongside her at the Stanford Pelvic Health Center.

While the Pelvic Health Center serves all genders, the majority of patients are women of middle or older age suffering from a wide array of pelvic floor disorders. These conditions negatively impact quality of life with symptoms such as urinary and/or fecal incontinence, constipation, and pain or pressure in the pelvic area. It is not unusual for the center’s patients to have a long history of being dismissed or undertreated elsewhere. The unfortunate reality is that anorectal and pelvic health is not covered adequately in many medical training programs, so physicians simply aren’t equipped to handle the problem. They may recommend Kegel exercises or, in more severe cases, refer patients for surgery, but that is about the limit of their options.

Finally, a Comprehensive, Multidisciplinary Solution

The Stanford Pelvic Health Center, on the other hand, provides coordinated, multidisciplinary care that includes the specialties of gastroenterology, colorectal surgery, urogynecology, urology, pain anesthesiology, and physiotherapy. Neshatian, clinical associate professor of gastroenterology and hepatology, specializes in neurogastroenterology and benign anorectal disorders. Her patients receive a comprehensive evaluation, including assessment of anorectal function, coordination, and sensory function via high-resolution anorectal manometry, as well as three-dimensional dynamic ultrasound to evaluate the anal sphincter and surrounding muscles, and magnetic resonance imaging defecography to dynamically visualize overall pelvic organ structure and function.

Following this assessment, the multidisciplinary team works together to determine the best multipronged treatment course. “We offer comprehensive medical management, physical therapy, and combined surgeries,” says Neshatian. By “combined surgeries,” she means that two surgeons, one colorectal and the other specialized in urogynecology, may operate on a single patient during the same surgery to ensure that all the pelvic issues are addressed at once by the most experienced hands.

Leila Neshatian, MD

Innovative Research in Pelvic Health

In addition to seeing patients, the Pelvic Health Center conducts innovative research into an aspect of health that remains poorly understood, so that physicians all over the world can better treat their patients. For instance, Neshatian and her team are working to identify specific targets for measures of pelvic health, such as the size and quality of the skeletal muscles, that must be achieved in order to treat or prevent pelvic symptoms in aging women.

One important learning from her research is the importance of muscle size and quality, not just in the pelvic area but overall. “In order to have better pelvic health, you need better muscles,” says Neshatian. “If the person is deconditioned, the muscle is replaced by fat, and the likelihood of having these problems is certainly higher. We proposed that if we put women through physical activities, such as resistance training, to improve overall physical conditioning, symptoms related to pelvic floor dysfunction such as fecal and urinary incontinence will improve as well.” Research is currently ongoing to evaluate this hypothesis.

This is a unique educational opportunity because, to be honest, anorectal and pelvic training is missing from many programs.

— Leila Nehastian, MD, clinical associate professor of gastroenterology and hepatology

 

In a particularly innovative project, Neshatian and her team will be examining the relationship between pelvic health and the microbiome. “We know that the microbiome changes in patients who are frail,” she explains. “This becomes a vicious cycle in terms of the microbiome causing frailty and frailty changing the microbiome. We think that because frailty can lead to pelvic pathologies, by changing the microbiome, you can prevent frailty and therefore improve pelvic health.”

They would also like to determine how the physical therapy that they offer at the center improves symptoms, looking specifically at how it produces changes in overall muscle strength and whether it affects the microbiome. Findings of this research should be available in the next few years, which will give treating physicians around the world new information and tools to use with their patients.

Training a New Generation

Given the unique nature of the services provided and the research taking place at the Pelvic Health Center, training is an important component of the program. A clinician educator, Neshatian is GI program director of the Neuro-Gastroenterology Fellowship, which includes training at the Pelvic Health Center. Others who receive training at the center are medical residents as well as fellows in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and Gastroenterology. “This is a unique educational opportunity because, to be honest, anorectal and pelvic training is missing from many programs,” she says.

The need for and interest in a comprehensive approach to pelvic health is so great that there are plans to expand the Pelvic Health Center, with a move to a larger space in Pavilion E anticipated in the near future. This will provide the space they need to increase their clinical staff and ultimately help more patients.

From Oncology Staff to Oncology Patient
Renewing the Field