Bio


I am a medical doctor from Rio de Janeiro, Brazil, and currently a postdoctoral scholar at the Stanford Center for Clinical Research. I have experience in primary and emergency medicine, having worked with underserved populations in South America. I am also interested in bioethics, in the particularities of physician-patient relationships, and in the science of effective communication. I speak 4 languages, and I believe that communication and cultural learning are some of the keys to reduce health disparities and increase the quality of medical assistance. In 2021 I received the Stanford Champion of Justice, Equity, and Diversity Award for my work in clinical trial diversity. I will soon start my psychiatry residency at Yale University and ultimately, hope to continue finding ways to increase equity, diversity, and inclusion within health care.

Honors & Awards


  • Postdoctoral Champion of Justice, Equity, Diversity, and Inclusion, Stanford Office of Postdoctoral Affairs (2021)

Boards, Advisory Committees, Professional Organizations


  • Scholar, Stanford Leadership in Equity and Advancing Diversity (LEAD) (2021 - Present)
  • Scholar, American Heart Association - Strategically Focused Research Network (2021 - Present)
  • Member, Stanford Center for Clinical Research Committee of Equity, Diversity, and Inclusion (2021 - Present)
  • Member, American Psychiatric Association (2018 - Present)

Professional Education


  • Medical Licensing, Educational Commission for Foreign Medical Graduates (ECFMG) (2021)
  • Medical Education, Federal University of the State of Rio de Janeiro (UNIRIO) (2020)

Stanford Advisors


Research Interests


  • Diversity and Identity
  • Literacy and Language
  • Race and Ethnicity

Projects


  • Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AFib Stroke Prevention, Stanford University.

    A multi-center, randomized controlled 2-arm trial comparing the effectiveness of an innovative shared decision-making pathway and usual care for Atrial Fibrillation Stroke Prevention. The decision making tool is available in both English and Spanish. This project is funded by the American Heart Association. Our partners: East Carolina University, Ochsner Health System, The Cleveland Clinic, The Cooper Health System

    Location

    Stanford University, Palo Alto, CA

    Collaborators

    For More Information:

  • Project Baseline Health Study, Baseline Study LLC

    This study is the first initiative of Project Baseline, a broader effort designed to develop a well-defined reference, or "baseline," of good health as well as a rich data platform that may be used to better understand the transition from health to disease and identify additional risk factors for disease. Project Baseline endeavors to test and develop new tools and technologies to collect, organize, and activate health information. Our collaborators are: Stanford University, Verily Life Sciences LLC, Duke University, and Google LLC

    Location

    Stanford University, Palo Alto, CA

    Collaborators

    For More Information:

Lab Affiliations


All Publications


  • "Crimes against the Nervous System": Neurological References During the Nuremberg Doctors' Trials WORLD NEUROSURGERY Nunes, J. C., Perret, C., Ordookhanian, C., Kaloostian, P., Abdulrauf, S. I., Mattei, T. A. 2019; 122: 63–70

    Abstract

    The Nuremberg Trials were a sequence of tribunal sessions held by the Allied Forces between November 1945 and October 1946 with the intent of prosecuting prominent representatives of the Nazi Party for crimes committed before and during the war. Because medical experiments in human prisoners were among the most heinous offenses, a specific series of court cases, known as the Doctor's Trials (the USA vs. Karl Brandt et al), was carried out. A considerable part of the official documents of the Nuremberg Trials has been recently made publicly available through the Nuremberg Trials Project, an initiative of the Harvard Law School Library. We performed a comprehensive analysis of the Doctors' Trials original documents (NMT 1: Medical Case) as well as other available academic and historical sources focusing on references to the nervous system, neurosurgical, and neurologic diseases. Besides providing a brief glance of a unique source of original historical documents, this historical vignette also attempts to fulfill, at least in some limited sense, the moral duty toward the Holocaust victims laid on our generation by remembering their fate.

    View details for DOI 10.1016/j.wneu.2018.10.092

    View details for Web of Science ID 000457328100213

    View details for PubMedID 30368013

  • The ENHANCE-AF Clinical Trial to Evaluate an Atrial Fibrillation Shared Decision-Making Pathway: Rationale and Study Design. American heart journal Baykaner, T., Pundi, K., Lin, B., Lu, Y., DeSutter, K., Lhamo, K., Garay, G., Nunes, J. C., Morin, D. P., Sears, S. F., Chung, M. K., Paasche-Orlow, M. K., Sanders, L. M., Bunch, T. J., Hills, M. T., Mahaffey, K. W., Stafford, R. S., Wang, P. J. 2022

    Abstract

    Shared decision making (SDM) may result in treatment plans that best reflect the goals and wishes of patients, increasing patient satisfaction with the decision-making process.  There is a knowledge gap to support the use of decision aids in SDM for anticoagulation therapy in patients with atrial fibrillation (AF). We describe the development and testing of a new decision aid, including a multicenter, randomized, controlled, 2-arm, open-label ENHANCE-AF clinical trial (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention) to evaluate its effectiveness in 1,200 participants.Participants will be randomized to either usual care or to a shared decision-making pathway incorporating a digital tool designed to simplify the complex concepts surrounding AF in conjunction with a clinician tool and a non-clinician navigator to guide the participants through each step of the tool. The participant-determined primary outcome for this study is the Decisional Conflict Scale, measured at 1 month after the index visit during which a decision was made regarding anticoagulation use. Secondary outcomes at both 1 and 6 months will include other decision making related scales as well as participant and clinician satisfaction, oral anticoagulation adherence, and a composite rate of major bleeding, death, stroke, or transient ischemic attack. The study will be conducted at four sites selected for their ability to enroll participants of varying racial and ethnic backgrounds, health literacy, and language skills. Participants will be followed in the study for 6 months.The results of the ENHANCE-AF trial will determine whether a decision aid facilitates high quality shared decision making in anticoagulation discussions for stroke reduction in AF. An improved shared decision-making experience may allow patients to make decisions better aligned with their personal values and preferences, while improving overall AF care.

    View details for DOI 10.1016/j.ahj.2022.01.013

    View details for PubMedID 35092723

  • Preventing Uterine Cervix Cancer: The Clinical Meaning of Atypical Glandular Cells Brazilian Journal of Gynecology and Obstetrics Almeida, G., Sainz, J. E., Fonseca, R., Chaves, N., Silva, K. S., Nunes, J. C., Furtado, Y. 2022; PMID: 35139566 (Epub ahead of print)

    Abstract

     To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.

    View details for DOI 10.1055/s-0042-1742318

  • Case Report: Catatonic Stupor in Behavioral Variant Frontotemporal Dementia. Frontiers in neurology de França, G. C., Barreto, H. e., Paranhos, T., Nunes, J. C., de Oliveira-Souza, R. 2021; 12: 798264

    Abstract

    Catatonia is a psychomotor syndrome common to several medical and neuropsychiatric disorders. Here, we report on the case of a 95-year-old woman who underwent a radical change in personality characterized by sexual disinhibition, and physical and verbal aggressiveness. Over several months, she developed verbal stereotypies, gait deterioration, and double incontinence. She eventually developed mutism and an active opposition to all attempts to be fed or cared for. Benzodiazepines, olanzapine and electroconvulsive therapy were of no benefit. Magnetic resonance imaging revealed asymmetric (more severe on the right) frontotemporal, parietal, and upper brainstem atrophy. She died from sepsis without recovering from stupor seven years after the onset of symptoms. We believe that the initial behavioral disinhibition was related to the frontotemporal injury, whereas catatonic stupor reflected the progression of the degenerative process to the parietal cortices. Our case adds to the small number of cases of catatonia as a symptom of degenerative dementia. It also supports the idea that damage to the parietal cortex gives rise to pathological avoidance of which catatonic stupor represents an extreme form.

    View details for DOI 10.3389/fneur.2021.798264

    View details for PubMedID 35115996

    View details for PubMedCentralID PMC8805594

  • Underrepresentation of Ethnic and Racial Minorities in Atrial Fibrillation Clinical Trials. Circulation. Arrhythmia and electrophysiology Nunes, J. C., Rice, E. N., Stafford, R. S., Lewis, E. F., Wang, P. J. 2021: CIRCEP121010452

    View details for DOI 10.1161/CIRCEP.121.010452

    View details for PubMedID 34789014

  • Development of a New Coupled Cobb-Suction Instrument for Posterior Spinal Approaches: Technical Note WORLD NEUROSURGERY Mattei, T. A., Perret, C. M., Nunes, J. C. 2019; 125: 333–37

    Abstract

    During dissection of paraspinal muscles in posterior surgical approaches, the spine surgeon usually holds a subperiosteal (Cobb) elevator in 1 hand and a monopolar cautery in the other hand. In such a scenario, both the surgical smoke generated by the monopolar and eventual bleeding constitute a significant hindrance to simultaneous bilateral dissection of the paraspinal muscles by 2 surgeons.To address the identified shortcomings in the currently available instrumentation, we initially analyzed the most common surgical techniques employed by residents and fellows at our institution for paraspinal muscle dissection during posterior spinal approaches. Additionally, we collected trainees' feedback regarding the efficacy of available strategies for dealing with surgical smoke.A new coupled Cobb elevator-suction instrument was designed, manufactured, and tested by residents, fellows, and experienced spine surgeons, and small additional design modifications were performed.We present what we believe is the first description of a new coupled Cobb-suction instrument that has been developed to enable simultaneous retraction and suction with 1 hand, while allowing the spine surgeon to use the monopolar cautery with the other hand. In our preliminary institutional experience, this new tool has been proven to be especially useful in long posterior spinal approaches in the thoracolumbar region.

    View details for DOI 10.1016/j.wneu.2019.01.240

    View details for Web of Science ID 000466491700214

    View details for PubMedID 30776516