Dr. Meera Sheffrin is a clinician educator in geriatrics, and the the Medical Director of the Stanford Home-Based Senior Care Clinic. She cares for patients as a primary care physician for older adults at the Stanford Senior Care Clinic and Home-Based Senior Care Clinic. Her academic interests include treatment of dementia, geriatric education, and home care medicine. She has a special interest in improving the care of older adults with cognitive impairment.
- Internal Medicine
Clinical Assistant Professor, Medicine - Primary Care and Population Health
Honors & Awards
Alpha Omega Alpha, University of Pittsburgh School of Medicine (2009)
Gold Humanism Honor Society, Charles G. Watson Chapter (2009)
Morris H. and Gertrude M. Harris Foundation Merit Scholarship, University of Pittsburgh School of Medicine (2007- 2009)
UCSF Geriatrics Scholarship Award, University of California, San Francisco (2011)
Julian Wolfshon Award for Outstanding Performance in Internal Medicine and Neurology, Stanford University School of Medicine (2012)
Charles Dorsey Armstrong Award for Clinical Excellence in Caring for Patients by a Senior Resident, Stanford University School of Medicine (2013)
SGIM Annual Meeting Best Geriatrics Poster Award, Society of General Internal Medicine (2014)
Residency:Stanford University Internal Medicine Residency (2013) CA
Board Certification: Geriatric Medicine, American Board of Internal Medicine (2016)
Board Certification, American Board of Internal Medicine, Geriatric Medicine (2016)
Fellowship, University of California, San Francisco, Geriatric Medicine (2016)
Masters, University of California, San Francisco, Masters of Advanced Studies in Clinical Research (2015)
Board Certification, American Board of Internal Medicine, Internal Medicine (2013)
Residency, Stanford Medicine Internal Medicine Residency, Internal Medicine (2013)
Medical Education, University of Pittsburgh School of Medicine (2010)
Current Research and Scholarly Interests
Stanford Geriatric Trauma Initiative
Improving care for older adults with dementia
Graduate and Fellowship Programs
Geriatric Medicine (Fellowship Program)
Identifying and categorizing spurious weight data in electronic medical records.
The American journal of clinical nutrition
2018; 107 (3): 420–26
Spurious weights compromise the validity of summary measures, such as averages and trends. Even rare errors in weight records can undermine the utility of electronic medical record (EMR) data.We sought to estimate the prevalence of spurious weight values in a large EMR, to ascertain the likely causes, and to develop and test straightforward algorithms for identifying spurious weight data.Using EMR data from 10,000 randomly selected patients aged ≥65 y in the VA system, we examined the percentage of weight change across various time intervals, from 1 to 3000 d. We examined descriptive results and developed 3 algorithms to categorize degree of weight change over time. On the basis of distributions, we identified cases that were most likely spurious. We manually reviewed these and categorized the type of error.The data followed the expected distributions. The algorithms reliably identified spurious weight. Approximately 0.8% of all weights in the record appeared to be spurious and ∼1 in 5 patient charts included ≥1 spurious weight value. The most common type of error involved the misentry of a single digit (e.g., 148 for 178).Spurious weights are common in EMRs. Straightforward algorithms can identify and remove them, and thus enhance the reliability of EMR data.
View details for PubMedID 29566188
Methods Employed to Assess Weight Loss in Older Adults by Means of Electronic Medical Records: A Systematic Review.
Journal of nutrition in gerontology and geriatrics
2017; 36 (1): 18-30
Electronic medical records (EMRs) can be used to identify and categorize weight loss in older adults, but research has not scrutinized methods for doing so. Through a modified PRISMA protocol, we systematically reviewed published methods for quantifying weight change from EMRs. Articles (all available through July 2016) were identified through PubMed and SCOPUS searches, screened, and evaluated. We abstracted relevant data and tabulated the methods to assess weight change. The 13 selected articles showed little consistency in the approach to key methodological issues: 1) time ranges assessed; 2) removal of spurious values; 3) metrics to quantify weight change; 4) number of measures needed to estimate change; 5) threshold for significant weight change; and 6) relation to ideal weight. There was essentially no consensus around how to identify and categorize weight loss. Further investigation is needed to establish scientifically validated and clinically useful algorithms, accounting for the six issues above.
View details for DOI 10.1080/21551197.2017.1282390
View details for PubMedID 28207372
- Desire for predictive testing for Alzheimer's disease and impact on advance care planning: a cross-sectional study ALZHEIMERS RESEARCH & THERAPY 2016; 8
Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
2015; 63 (8): 1512-1518
To determine whether initiation of cholinesterase inhibitors is associated with significant weight loss in a real-word clinical setting.Retrospective cohort study from 2007 to 2010 comparing weight loss in individuals with dementia newly prescribed cholinesterase inhibitors and those newly prescribed other chronic medications.National Veterans Affairs data.Individuals aged 65 and older with a diagnosis of dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication.The primary outcome was time to 10-pound weight loss over 12 months. Propensity score matching was used to control for the likelihood of receiving a cholinesterase inhibitor based on baseline characteristics. Data were analyzed in a priori defined subgroups according to age, comorbid burden, and initial weight.Of 6,504 individuals that met study criteria, 1,188 started on cholinesterase inhibitors were matched to 2,189 started on other medications. The propensity-matched cohorts were well balanced on baseline covariates. Participants initiated on cholinesterase inhibitors had a higher risk of weight loss than matched controls at 12 months (hazard ratio = 1.23, 95% confidence interval (CI) = 1.07-1.41). At 12 months, 29.3% of participants taking cholinesterase inhibitors had experienced weight loss, compared with 22.8% of nonusers, corresponding to a number needed to harm of 21.2 (95% CI = 12.5-71.4) over 1 year. There were no significant differences in the risk of weight loss within subgroups.These results are consistent with the available data from randomized controlled trials. Clinicians should consider the risk of weight loss when prescribing cholinesterase inhibitors.
View details for DOI 10.1111/jgs.13511
View details for Web of Science ID 000360207000003
View details for PubMedID 26234945
Pilot Study of Augmentation With Aripiprazole for Incomplete Response in Late-Life Depression: Getting to Remission
JOURNAL OF CLINICAL PSYCHIATRY
2009; 70 (2): 208-213
To determine the feasibility and safety of aripiprazole augmentation for incomplete response to sequential selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) pharmacotherapy in late-life depression.This study was a 12-week, open-label pilot study of 24 patients (recruited from June 1, 2006, to June 1, 2007) aged 65 years and above (mean, 73.9 years) diagnosed with major depressive disorder (MDD) (according to DSM-IV) who responded partially (17-item Hamilton Rating Scale for Depression [HAM-D-17] score of 11 to 15) or not at all (HAM-D score > 15) to a 16-week trial of escitalopram (up to 20 mg/day), followed by either duloxetine (up to 120 mg/day) or venlafaxine (up to 225 mg/day) for 12 weeks. Subjects received 2.5 to 15 mg per day of adjunctive aripiprazole (mean dose, 9.0 mg/day) for 12 weeks. The criterion for remission during treatment with aripiprazole was a HAM-D score < or = 10 for 2 consecutive weeks.Of 24 subjects in the intent-to-treat study group, 19 completed 12 weeks of augmentation with aripiprazole, 12 of 24 (50%) met criteria for remission, and 2 of 24 discontinued due to side effects (sedation, akathisia). The mean (SD) HAM-D score decreased significantly by 6.4 (5.8) points (paired t test for means, p < .01, df = 16). There were no relapses among the 12 subjects who participated in continuation treatment over a median period of 27.6 weeks.In older adults with MDD with incomplete response to SSRI and SNRI pharmacotherapy, aripiprazole was well tolerated, and symptoms of depression improved significantly during treatment with aripiprazole. A randomized, double-blind, placebo-controlled trial of adjunctive aripiprazole for incomplete response in late-life depression is warranted to further evaluate benefit and risk.clinicaltrials.gov Identifier: NCT00177671.
View details for Web of Science ID 000263627300008
View details for PubMedID 19210951
Incomplete response in late-life depression: getting to remission.
Dialogues in clinical neuroscience
2008; 10 (4): 419-430
Incomplete response in the treatment of late-life depression is a large public health challenge: at least 50% of older people fail to respond adequately to first-line antidepressant pharmacotherapy, even under optimal treatment conditions. Treatment-resistant late-life depression (TRLLD) increases risk for early relapse, undermines adherence to treatment for coexisting medical disorders, amplifies disability and cognitive impairment, imposes greater burden on family caregivers, and increases the risk for early mortality, including suicide. Getting to and sustaining remission is the primary goal of treatment, yet there is a paucity of empirical data on how best to manage TRLLD. A pilot study by our group on aripiprazole augmentation in 24 incomplete responders to sequential SSRI and SRNI pharmacotherapy found that 50% remitted over 12 weeks with the addition of aripiprazole, and that remission was sustained in all participants during 6 months of continuation treatment. In addition to controlled assessment, evidence is needed to support personalized treatment by testing the moderating role of clinical (e.g., comorbid anxiety, medical burden, and executive impairment) and genetic (eg, selected polymorphisms in serotonin, norepinephrine, and dopamine genes) variables, while also controlling for variability in drug exposure. Such studies may advance us toward the goal of personalized treatment in late-life depression.
View details for PubMedID 19170399
- Di-mu-bromo-bis[(methyl isocyanide-kappa C)-(triphenylphosphine-kappa P)silver(I)] ACTA CRYSTALLOGRAPHICA SECTION E-STRUCTURE REPORTS ONLINE 2004; 60: M1142-M1143