Larry Chu

• Doctor of Medicine
• Professor at Stanford Medicine

Purpose of review This review explores the potential of big data analytics and machine learning (ML) in transforming geriatric anesthesia to address the challenges posed by the growing elderly population. Recent findings ML algorithms have shown promise in enhancing preoperative risk stratification, optimizing intraoperative anesthesia management,...

Purpose of Review This review explores the potential of artificial intelligence (AI) and machine learning (ML) in enhancing geriatric anesthesia education, highlighting the need for a paradigm shift in training and supporting anesthesiologists in the era of digital transformation. Recent Findings AI and ML offer promising solutions for personalize...

A bstract Prior work has shown that large language models (LLMs) have the ability to answer expert-level multiple choice questions in medicine, but are limited by both their tendency to hallucinate knowledge and their inherent inadequacy in performing basic mathematical operations. Unsurprisingly, early evidence suggests that LLMs perform poorly wh...

Background Face shields were widely used in 2020-2021 as facial personal protective equipment (PPE). Laboratory evidence about how protective face shields might be and whether real world user priorities and usage habits conflicted with best practice for maximum possible protection was lacking – especially in limited resource settings. Methods Rela...

Background: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are self-reporting tools that can measure important information about patients, such as health priorities, experience, and perception of outcome. The use of traditional objective measures such as vital signs and lab values can be supplemented wit...

A practice-based guide to applying the principles of human-centered design to real-world health challenges; updated and expanded with post–COVID-19 innovations. This book offers a practice-based guide to applying the principles of human-centered design to real-world health challenges that range from drug packaging to breast cancer detection. Writte...

UNSTRUCTURED Introduction The design of Personal Protective Equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by health workers (HW) and reduce occupational-acquired diseases. As integrated PPE, a lightweight battery-powered air-purifying respirator (L-PAPR) could be used...

Background The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (...

BACKGROUND Objective measures such as vital signs and lab values only provide a partial view of a patient’s condition. Patient reported outcome measures (PROMs)1 and Patient reported experience measures (PREMs)1 are subjective reports shared by patients that can help complete this view by filling in gaps that other methods are incapable of assessin...

Purpose of review: The recent global pandemic has dramatically altered the anaesthesiology educational landscape in unexpected ways. It is important that we pause to learn from this crisis. Recent findings: Most resident trainees actively caring for COVID-19 patients present with probable or subclinical finding of post-traumatic stress disorder....

Both patients and providers in the United States (US) suffer from burnout, which can impact the clinical relationship and quality of care. Among providers, burnout is a state of exhaustion including heightened depersonalization; among patients, burnout can negatively affect clinical outcomes. More than half of clinical providers in the United State...

BACKGROUND Expressing empathy builds trust with patients, increases patient satisfaction and is associated with better health outcomes. Research shows expressing empathy and compassion to patients improves patient adherence to medications, decreases patient anxiety and decreases the number of malpractice lawsuits. Yet, there is a dearth of research...

Background Expressing empathy builds trust with patients, increases patient satisfaction, and is associated with better health outcomes. Research shows that expressing empathy to patients improves patient adherence to medications and decreases patient anxiety and the number of malpractice lawsuits. However, there is a dearth of research on teaching...

BACKGROUND Medical education, research, and healthcare practice continue to grow with minimal co-production guidance. We suggest the Commons approach to medical education as modeled by Ostrom and Williamson where we share how adapting these models to multiple settings can enhance empathy, increase psychological safety and provide robust just-in-tim...

Medical education, research, and health care practice continue to grow with minimal coproduction guidance. We suggest the Commons Principle approach to medical education as modeled by Ostrom and Williamson, where we share how adapting these models to multiple settings can enhance empathy, increase psychological safety, and provide robust just-in-ti...

The public and patients can be powerful sensors for shaping and powering healthcare research. They are joining research teams as investigators and collaborators to co-produce evidence for the practical use of interventions in clinical practice. While clinicians and researchers are encouraged by funders and policymakers to involve the public and pat...

Objective The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE) underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate SARS-CoV-2-exposed masks and respirators. We hypothesized that methylene blue (MB) photochemical treatment, which has various clinica...

The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological co...

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe shortages of personal protective equipment (PPE) necessary to protect front-line healthcare personnel. These shortages underscore the urgent need for simple, efficient, and inexpensive methods to decontaminate SARS-CoV-2-exposed PPE enabling safe reuse of masks and r...

The science around the use of masks by the general public to impede COVID-19 transmission is advancing rapidly. Policymakers need guidance on how masks should be used by the general population to combat the COVID-19 pandemic. In this narrative review, we develop an analytical framework to examine mask usage, considering and synthesizing the relevan...

Patient-centered organisations Healthcare organisations now integrate patient feedback into value-based compensation formulas. This research considered Stanford Healthcare’s same-day feedback, a programme designed to evaluate the patient experience. Specifically, how did patients with cancer interviewed in the programme assess their physicians? Fur...

The science around the use of masks by the general public to impede COVID-19 transmission is advancing rapidly. Policymakers need guidance on how masks should be used by the general population to combat the COVID-19 pandemic. In this narrative review, we develop an analytical framework to examine mask usage, considering and synthesizing the relevan...

Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management...

The COVID-19 pandemic is currently causing a severe disruption and shortage in the global supply chain of necessary personal protective equipment (e.g., N95 respirators). The U.S. CDC recommended use of household cloth by the general public to make cloth face coverings as a method of source control. We evaluated the filtration properties of natural...

The science around the use of masks by the general public to impede COVID-19 transmission is advancing rapidly. Policymakers need guidance on how masks should be used by the general population to combat the COVID-19 pandemic. Here,we develop an analytical framework to examine an overlooked aspect of mask usage: masks as source-control targeting egr...

Objective In this study, we investigated if chronic opioid exposure leads to changes in immune signaling pathways. Method We used phospho-flow cytometry to study intracellular signaling in immune cells of patients with chronic opioid exposure. PBMCs were stimulated with cytokines (IFN-α, IFN-γ, IL-2, IL-6, IL-7, IL-10, IL-21), then stained to anal...

The current COVID-19 pandemic has highlighted global supply chain shortcomings in the US hospital delivery system, most notably personal protective equipment (PPE) and COVID-19 is found on these masks ∼7 days. Recent work from our group has shown two promising disinfection methods for N95 facial masks, dry heat (hot air (75 °C, 30 min) and UVGI whi...

The science around the use of masks by the general public to impede COVID-19 transmission is advancing rapidly. Policymakers need guidance on how masks should be used by the general population to combat the COVID-19 pandemic. Here, we synthesize the relevant literature to inform multiple areas: 1) transmission characteristics of COVID-19, 2) filter...

Background: Twitter in anesthesiology conferences promotes rapid science dissemination, global audience participation, and real-time updates of simultaneous sessions. We designed this study to determine if an association exists between conference attendance/registration and 4 defined Twitter metrics. Methods: Using publicly available data throug...

Although PPI and co-production is an emergent practice, self-management and self-care initiatives in healthcare have reduced costs and increased quality of life. For example, patients remotely manage complex conditions such as diabetes, anti-coagulation therapies, home kidney dialysis, tube feeding, pain pumps, thyroid care and asthma. These inte...

This video shows viewers how to administer a peripheral nerve block. Its primary use, demonstrated here, is to aid the treatment of hand lacerations. This procedure can also be used for other conditions, including dislocations, paronychia, and felon drainage.

Background: For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic. Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcom...

Background: Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients. Objec...

It is important to consider that the goal of digital health is to improve the experience of the patient as they traverse the health care system and to ultimately improve their health outcomes. In today’s fully connected and digitally integrated world, patients, not providers are the rising stars in digital health innovation. Working from their own...

Background: Health care conferences present a unique opportunity to network, spark innovation, and disseminate novel information to a large audience, but the dissemination of information typically stays within very specific networks. Social network analysis can be adopted to understand the flow of information between virtual social communities and...

Objectives In this study, we investigated the co-administration of ondansetron with morphine, and whether it could prevent the development of physical dependence in patients taking opioids for the treatment of chronic pain. Methods A total of 48 chronic back pain patients (N = 48) participated in this double-blinded, placebo-controlled, randomized...

Purpose of review: This review summarizes the current applications of social media in regional anesthesiology, describes ways that specific platforms may promote growth, and briefly discusses limitations and future directions. Recent findings: Although Facebook users outnumber Twitter users, the latter has been better studied in regional anesthe...

Objectives: Individuals taking opioids for an extended period of time may become physically dependent, and will therefore experience opioid withdrawal should they stop taking the medication. Previous work in animal and human models has shown that the serotonin (5-HT3) receptor may be implicated in opioid withdrawal. In this study, we investigated...

Using their experience at Medicine X, Larry Chu and colleagues discuss the benefits of involving patients as partners at medical meetings The expression “nothing about us without us” was first coined by disability rights activists to convey the idea that no policy should be reached without full participation of representatives of all stakeholders....

Background: Treatments for reducing opioid withdrawal are limited and prone to problematic side effects. Laboratory studies, clinical observations, and limited human trial data suggest 5-HT3-receptor antagonists and antihistamines may be effective. Objectives: This double-blind, crossover, placebo-controlled study employing an acute physical dep...

Objective: . Prolonged exposure to opioids is known to produce neuroplastic changes in animals; however, few studies have investigated the effects of short-term prescription opioid use in humans. A previous study from our laboratory demonstrated a dosage-correlated volumetric decrease in the right amygdala of participants administered oral morphin...

Opioid analgesics are frequently prescribed for chronic pain. One expected consequence of long-term opioid use is the development of physical dependence. Although previous resting state functional magnetic resonance imaging (fMRI) studies have demonstrated signal changes in reward-associated areas following morphine administration, the effects of a...

Complex, perilous domains like surgery and aviation require accurate responses under extreme time constraints. Checklists improve important outcomes in these domains. However, current designs are based largely on intuition; there is little theory or empirical work about designing effective procedure aids. Furthermore, discretionary checklist use is...

Checklist usage can increase performance in complex, high-risk domains. While paper checklists are valuable, they are static, slow to access, and show both too much and too little information. We introduce Dynamic Procedure Aids to address four key problems in checklist usage: ready access to aids, rapid assimilation of content, professional accept...

One goal for massive open online courses is that the educational benefits they provide scale as a function of the number and diversity of learners interacting with the platforms, since an increasing amount of data is available about what interactions and content increase engagement and learning, as well as which educational interactions are effecti...

Dr. Frederic A. 'Fritz' Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitatio...

This video demonstrates the placement of a laryngeal mask airway, an alternative airway device that is both efficacious and easy to place. The laryngeal mask airway is routinely used for patients receiving general anesthesia and, increasingly, in patient resuscitation.

Cognitive aids such as checklists have been shown to benefit medical teams working in routine and crisis environments. This video presents a team of physicians reacting to a simulated operating room emergency, demonstrating potential benefits of interactive cognitive aids in medicine.

The transition from internship to residency training may be a stressful time for interns, particularly if it involves a change among programs or institutions after completing a preliminary year. We explored whether an e-learning curriculum would increase interns' preparedness for the transition to the first year of clinical anesthesiology training...

Emergency medical teams collaborate to solve problems and take care of patients under time pressure and high cognitive load, in noisy and complex environments. This paper presents preliminary work in the design and evaluation of head-mounted and multi-surface displays in supporting teams with interactive checklists and more generally dynamic cognit...

Purpose of review: There is an increasing importance of incorporating mobile computing into the academic medical environment. A growing majority of physicians, residents and medical students currently use mobile devices for education, access to clinical information and to facilitate bedside care. Therefore, it is important to assess the current op...

Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief. Analgesic tolerance, and more recently opioid-induced hyperalgesia, have been invoked to explai...

Today's educators are faced with substantial challenges in the use of information technology for anaesthesia training and continuing medical education. Millennial learners have uniquely different learning styles than previous generations of students. These preferences distinctly incorporate the use of digital information technologies and social tec...

Acute and chronic exposure to opioids has been associated with hyperalgesia in both animals and humans. A genetic analysis of opioid-induced hyperalgesia in mice linked the β(2)-adrenergic receptor to mechanical sensitization after opioid exposure. In humans, expansion of the area of mechanical hyperalgesia surrounding an experimentally induced les...

Many online physician-rating sites provide patients with information about physicians and allow patients to rate physicians. Understanding what information is available is important given that patients may use this information to choose a physician. The goals of this study were to (1) determine the most frequently visited physician-rating websites...

In an effort to reduce medical errors, doctors are beginning to embrace cognitive aids, such as paper-based checklists. We describe the early stage design process of an interactive cognitive aid for crisis care teams. This process included collaboration with anesthesia professors in the school of medicine and observation of medical students practic...

Chronic opioid exposure is known to produce neuroplastic changes in animals; however, it is not known if opioids used over short periods of time and at analgesic dosages can similarly change brain structure in humans. In this longitudinal, magnetic resonance imaging study, 10 individuals with chronic low back pain were administered oral morphine da...

Opioids such as morphine are the cornerstone of pain treatment. The challenge of measuring the concentrations of morphine and its active metabolites in order to assess human pharmacokinetics and monitor therapeutic drugs in children requires assays with high sensitivity in small blood volumes. We developed and validated a semi-automated LC-MS/MS as...

Unlabelled: Some recent studies suggested a role of the endogenous opioid system in modulating opioid-induced hyperalgesia (OIH). In order to test this hypothesis, we conducted a prospective randomized, placebo-controlled, 2-way crossover study in healthy human volunteers. We utilized a well-established model of inducing OIH after a brief exposure...

Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs). We us...

As residents work disparate schedules at multiple locations and because of workweek hour limits mandated by the ACGME, residents may be unable to attend lectures, seminars, or other activities that would enhance their skills. Further, the ACGME requires that residency programs document resident learning in six stated core competencies and provide p...

Informatics is a broad field encompassing artificial intelligence, cognitive science, computer science, information science, and social science. The goal of this review is to illustrate how Web 2.0 information technologies could be used to improve anesthesia education. Educators in all specialties of medicine are increasingly studying Web 2.0 techn...

Total subcutaneous implantable subcutaneous defibrillators are in development, but optimal electrode configurations are not known. We used image-based finite element models (FEM) to predict the myocardial electric field generated during defibrillation shocks (pseudo-DFT) in a wide variety of reported and innovative subcutaneous electrode positions...

Purpose While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized gene...

To test the hypothesis that regional anesthesia (RA) employing a block room reduces anesthesia-controlled time for ambulatory upper extremity surgery compared with general anesthesia (GA). Retrospective cohort study. Outpatient surgery center of a university hospital. 229 adult patients who underwent ambulatory upper extremity surgery over one year...

Addiction to opioid narcotics represents a major public health challenge. Animal models of one component of addiction, physical dependence, show this trait to be highly heritable. The analysis of opioid dependence using contemporary in-silico techniques offers an approach to discover novel treatments for dependence and addiction. In these experimen...

It is widely accepted that chronic opioid therapy is associated with the development of pharmacological tolerance. More controversial is the question as to whether acute opioid administration can result in "acute tolerance." The aim of this double-blind, placebo-controlled study in thirty-six healthy human volunteers was to examine whether a 3-h in...

Opioids were first cultivated around 3400 BC by the Sumerians in the Tigris-Euphrates river systems of lower Mesopotamia. Named from the ideograms hul and gil, the word for poppy translates to the “joy plant.” Ancient Sumerian writings found on clay tablets from Nippur show that opioid medications were used to treat pain and to “ease the harshness...

Background and Objectives: Efficacy of perivascular axillary block (AXB) and double-stimulation infraclavicular block (ICB) techniques in providing brachial plexus anesthesia have not been previously compared. Methods: After IRB approval, we reviewed a regional anesthesia database to compare supplementation rates for 141 axillary and 157 infraclavi...

Opioid-induced hyperalgesia (OIH) is most broadly defined as a state of nociceptive sensitization caused by exposure to opioids. The state is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain may actually become more sensitive to certain painful stimuli. The type of pain experienced may or may not...

One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. Twelve...

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Opioid analgesics are the most commonly prescribed class of medications in the United States. Given evidence that long-term opioid use may lead to hyperalgesic states, the reliance on these medications for chronic pain treatment is concerning. Limited evidence suggests that these hyperalgesic states may be reversed by simple withdrawal of opioids....

To assess the relative efficacy of three compression adjuncts -- D-Stat Dry (D-Stat), QR Powder (QR), and XS Powder (XS) -- for reducing time to hemostasis in patients who underwent diagnostic and interventional percutaneous procedures. D-Stat, QR, or XS was applied in 176 percutaneous diagnostic arterial, therapeutic arterial, venous, and arteriov...

The use of ketamine in children with increased pulmonary vascular resistance is controversial. In this prospective, open label study, we evaluated the hemodynamic responses to ketamine in children with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg). Children aged 3 mo to 18 yr with pulmonary hypertension, who were scheduled for c...

A single-dose of neuraxial morphine sulfate provides good post-Cesarean analgesia; however, its efficacy is limited to the first postoperative day. In a recent phase III study, extended-release epidural morphine (EREM) formulation provided more effective, prolonged analgesia after Cesarean delivery, compared to conventional epidural morphine. Howev...

This prospective study compared clinical outcomes after heart surgery between three groups of infants with congenital heart disease. One group received dilutional conventional ultrafiltration (group D), another received modified ultrafiltration (group M), and a third group received both dilutional conventional and modified ultrafiltration (group B)...

Daily variability in volume of elective pediatric procedures that require anesthesia may lead to an imbalance between available operating room resources and case load. Longer intervals between scheduling and the surgical date generally result in higher operating room utilization. In this study, we sought to determine which factors influence when pa...

Although nonsteroidal antiinflammatory drugs (NSAIDs) improve postoperative pain relief after cesarean delivery, they carry potential side effects (e.g., bleeding). Perioperative cyclooxygenase (COX)-2 inhibitors show similar analgesic efficacy to nonsteroidal antiinflammatory drugs in many surgical models but have not been studied after cesarean d...

Most hospital policies prohibiting the use of wireless devices cite reports of disruption of medical equipment by cellular telephones. There have been no studies to determine whether mobile telephones may have a beneficial impact on safety. At the 2003 meeting of the American Society of Anesthesiologists 7878 surveys were distributed to attendees....

Unlabelled: There is accumulating evidence that opioid therapy might not only be associated with the development of tolerance but also with an increased sensitivity to pain, a condition referred to as opioid-induced hyperalgesia (OIH). However, there are no prospective studies documenting the development of opioid tolerance or OIH in patients with...