- Internal Medicine
- Perioperative medicine/Surgical Co-Management
- Perioperative Hypnosis for Symptom Management
- Quality Improvement
Clinical Associate Professor, Medicine
Clinical Associate Professor (By courtesy), Psychiatry and Behavioral Sciences
Member, Wu Tsai Neurosciences Institute
Lactation Council Representative, Stanford Department of Medicine (2022 - Present)
Boards, Advisory Committees, Professional Organizations
Subject Matter Expert for Opioid Prescribing in Orthopedic Surgery, Vizient (2019 - 2019)
Member, Research Council, Department of Medicine (2018 - Present)
Center for Innovation and Global Health (CIGH), Faculty Fellow (2016 - Present)
Member, Venous Thromboembolism Committee - Stanford Healthcare (2016 - Present)
Residency: Stanford University Internal Medicine Residency (2016) CA
Medical Education: Tulane University School of Medicine Registrar (2013) LA
Board Certification: American Board of Internal Medicine, Internal Medicine (2016)
Community and International Work
Yale/Stanford Johnson & Johnson Global Health Scholars Program, Sukadana, W. Kalimantan, Indonesia
Internal, family, emergency medicine.
Alam Sehat Lestari (ASRI)/Health in Harmony
Adults and Children
Opportunities for Student Involvement
Current Research and Scholarly Interests
Hypnosis for perioperative symptom management in elective orthopedic surgery.
Hypnosis for Symptom Management in Elective Orthopedic Surgery
The purpose of the study is to determine if teaching self-hypnosis techniques to patients prior to knee replacement surgery will decrease their pain medication requirements, pain medication side-effects, length of stay in the hospital, readmission rates, pain, anxiety, physical function, satisfaction scores, and cost of admission.
Stanford is currently not accepting patients for this trial. For more information, please contact Jessie Kittle, MD, 831-840-0599.
Validating the New Remote Hypnotic Induction Profile (rHIP)
The purpose of the study is to determine if hypnotizability can be reliably tested over the phone, without having to see or touch a patient. The scores from a new test for hypnotizability by phone will be compared to the scores from a standard in-person test, to make sure the results are similar.
Stanford is currently not accepting patients for this trial. For more information, please contact Jessie Kittle, MD, 650-723-4000.
COMT Activity and Hypnotizability
Hypnosis is an effective pain management tool for surgery that can reduce opioid use up to 40%. COMT single nucleotide polymorphisms (SNPs) can predict pain sensitivity and opioid use perioperatively, and may also be associated with hypnotizability or response to hypnotic analgesia. Analyzing COMT haplotypes from DNA extracted from saliva or blood using a giant magnetoresistive (GMR) nanotechnology platform may be faster, less expensive, and at least as accurate as pyrosequencing. This study aims to validate a multi-SNP point-of-care (POC) GMR assay for the rapid genotyping of SNPs predictive of COMT activity, and test the feasibility of using COMT activity as a biomarker for hypnotizability and/or response to hypnotic analgesia.
Stanford is currently not accepting patients for this trial. For more information, please contact Jessie Kittle, MD, 800-000-0000.
Point of care testing of enzyme polymorphisms for predicting hypnotizability and postoperative pain.
The Journal of molecular diagnostics : JMD
Hypnotizability is a stable trait that moderates the benefit of hypnosis for treating pain, but limited availability of hypnotizability testing deters widespread use of hypnosis. Inexpensive genotyping of 4 single nucleotide polymorphisms in the catechol-o-methyltransferase (COMT) gene was performed using giant magnetoresistive biosensors to determine if hypnotizable individuals can be identified for targeted hypnosis referrals. For individuals with the proposed 'optimal' COMT diplotypes, 89.5% score highly on the Hypnotic Induction Profile (OR = 6.12, 95%CI = 1.26-28.75), which identified 40.5% of the treatable population. Mean hypnotizability scores of the optimal group were significantly higher than the total population (p = 0.015 effect size = 0.60), an effect that was present in females (p = 0.0015, effect size = 0.83), but not in males (p = 0.28). In an exploratory cohort, optimal individuals also reported significantly higher postoperative pain scores (p = 0.00030, effect size = 1.93), indicating a greater need for treatment.
View details for DOI 10.1016/j.jmoldx.2023.01.002
View details for PubMedID 36702396
- Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomised clinical trial-an infographic. Regional anesthesia and pain medicine 2022
Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomized clinical trial.
Regional anesthesia and pain medicine
BACKGROUND: Hypnosis decreases perioperative pain and has opioid-sparing potential but has not been rigorously studied in knee arthroplasty. This trial investigates the impact of perioperative hypnosis on inpatient opioid use following total knee arthroplasty.METHODS: This prospective randomized controlled trial was conducted at a single academic medical center. The hypnosis arm underwent a scripted 10min hypnosis session prior to surgery and had access to the recorded script. The control arm received hypnosis education only. The primary outcome was opioid use in milligram oral morphine equivalents per 24 hours during hospital admission. A secondary analysis was performed for patients taking opioids preoperatively.RESULTS: 64 primary knee arthroplasty patients were randomized 1:1 to hypnosis (n=31) versus control (n=33) and included in the intent-to-treat analysis. The mean (SD) postoperative opioid use in oral morphine equivalents per 24 hours was 70.5 (48.4) in the hypnosis versus 90.7 (74.4) in the control arm, a difference that was not statistically significant (difference -20.1; 95% CI -51.8 to 11.4; p=0.20). In the subgroup analysis of the opioid-experienced patients, there was a 54% daily reduction in opioid use in the hypnosis group (82.4 (56.2) vs 179.1 (74.5) difference of -96.7; 95% CI -164.4 to -29.0; p=<0.01), equivalent to sparing 65mg of oxycodone per day.CONCLUSION: Perioperative hypnosis significantly reduced inpatient opioid use among opioid-experienced patients only. A larger study examining these findings is warranted.TRIAL REGISTRATION NUMBER: NCT03308071.
View details for DOI 10.1136/rapm-2022-103493
View details for PubMedID 35715013
Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
2021; 5 (3)
Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are dedicated year-round to the orthopaedic surgery service. We examine whether this SCM model was associated with a decrease in medical complications, length of stay, and inpatient mortality in patients with hip fracture admitted at our institution, compared with the previous model.We included 2,252 admissions to the orthopaedic surgery service with a hip fracture between 2009 and 2018 (757 pre-SCM and 1495 post-SCM). We adjusted for age, Charlson comorbidity score, and operating time in all regression analyses.Mean Charlson comorbidity score (1.6 versus 1.2) and median case mix index (2.1 versus 1.9) were higher in the post-SCM group. A 32% decrease was observed in the odds of having ≥1 medical complication(s) (odds ratio, 0.68 [95% confidence interval, 0.50 to 0.91], P = 0.009) post-SCM. No change was observed in length of stay or inpatient mortality despite an increase in medical complexity post-SCM.Having dedicated orthopaedic hospitalists may contribute to fewer medical complications in patients with hip fracture.
View details for DOI 10.5435/JAAOSGlobal-D-20-00231
View details for PubMedID 33720101
The Hypnotic Induction Profile (HIP) in Clinical Practice and Research.
The International journal of clinical and experimental hypnosis
2021; 69 (1): 72–82
The Hypnotic Induction Profile (HIP) was developed as a brief, yet thorough, assessment of a person's level of trait hypnotizability and their potential to experience a hypnotic state. The HIP quantitatively and qualitatively measures hynotizability by evaluating biological and sensorimotor experiences designed to assess 3 fundamental observable and measurable components of hypnosis: absorption, dissociation, and suggestibility through a guided assessment that takes 5 to 10minutes. From conception, the HIP has been utilized in clinical settings to assess appropriateness for the use of hypnosis in treatment planning and research protocols to stratify research participants. The brevity, accessibility, and reliability of the HIP have allowed it to adapt, not only across settings but through media platforms as technology and remote delivery become increasingly incorporated in the field of hypnosis.
View details for DOI 10.1080/00207144.2021.1836646
View details for PubMedID 33513067
Testing Hypnotizability by Phone: Development and Validation of the Remote Hypnotic Induction Profile (rHIP).
The International journal of clinical and experimental hypnosis
2021; 69 (1): 94–111
Standard hypnotizability scales require physical contact or direct observation by tester and participant. The authors addressed this limitation by developing and testing the remote Hypnotic Induction Profile (rHIP), a hypnotizability test derived from the Hypnotic Induction Profile that is completed by telephone. To assess the validity of the rHIP, 56 volunteers naive to hypnotizability testing completed both the HIP and the rHIP, with order of testing randomized. Results indicate a strong correlation between HIP and rHIP scores, r s=.71(0.53-0.84), p <.0001, and good concordance, difference=.03(-0.53, 0.59), p =.91, independent of testing order. The rHIP had few complications. Possible advantages of using the rHIP include improving patient expectancy prior to scheduling a hypnosis session, increasing access to hypnotizability testing for remote interventions, and obviating resource-intensive in-person hypnotizability screening for trials that exclude subjects with certain scores.
View details for DOI 10.1080/00207144.2021.1827937
View details for PubMedID 33513064
- Hypnosis: The Most Effective Treatment You Have Yet to Prescribe. The American journal of medicine 2020
- A Patient with Sjogren's Syndrome and Subsequent Diagnosis of Inclusion Body Myositis and Light-Chain Amyloidosis JOURNAL OF GENERAL INTERNAL MEDICINE 2019; 34 (6): 1058–62
Cardiovascular adverse events in the drug-development program of bupropion for smoking cessation: A systematic retrospective adjudication effort.
2017; 40 (10): 899-906
In 2011, the US Food and Drug Administration requested that GlaxoSmithKline perform retrospective adjudication of cardiovascular (CV) events reported in the bupropion drug-development trials for smoking cessation.Retrospective adjudication of clinical trial data will not increase the identification of adverse events.We performed a comprehensive retrospective analysis of adverse events in 19 previously completed controlled US clinical trials of bupropion marketed for the treatment of smoking cessation, yielding 9479 subjects (5290 bupropion, 2927 placebo, 1018 active control [ACT], and 244 treated concurrently with bupropion and ACT). All adverse events were sent to the Duke Clinical Research Institute for adjudication by Clinical Events Classification (CEC) physician reviewers. The primary endpoint was a composite of major adverse CV events: CV death, nonfatal myocardial infarction (MI), and nonfatal stroke.Overall, 416 nonfatal CV events in 366 subjects, and 22 deaths, were identified and processed for adjudication. Of these, 7 nonfatal MIs (4 bupropion, 3 placebo, 0 ACT), 5 nonfatal strokes (1 bupropion, 3 placebo, 1 ACT), and 9 CV deaths (4 bupropion, 4 placebo, 1 ACT) were confirmed by the CEC Committee. The primary endpoint occurred in 3/4297 (0.07%) subjects in the bupropion group and in 4/2927 (0.14%) subjects in the placebo group (log-rank P value: 0.613).CV events in bupropion clinical trials for smoking cessation were uncommon, with no observed increase among subjects assigned to bupropion vs placebo. However, this effort was limited by a paucity of quality data.
View details for DOI 10.1002/clc.22744
View details for PubMedID 28605035
Regenerative Medicine: Potential Mechanisms of Cardiac Recovery in Takotsubo Cardiomyopathy.
Current treatment options in cardiovascular medicine
2016; 18 (3): 20-?
Takotsubo cardiomyopathy is an increasingly reported cause of acute chest pain and acute heart failure and is often associated with significant hemodynamic compromise. The illness is remarkable for the reversibility in systolic dysfunction seen in the disease course. While the pathophysiology of takotsubo syndrome is not completely elucidated, research suggests the presence of a cytoprotective process that allows the myocardium to recover following the inciting insult. Here, we summarize molecular and histologic studies exploring the response to injury in takotsubo disease and provide some discussion on how they may contribute to further investigations in cardiac recovery and regeneration.
View details for DOI 10.1007/s11936-016-0443-0
View details for PubMedID 26874708
- The Artist of Medicine JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 2011; 306 (22): 2429-2430