Medical students abortion training is stifled in a post-Dobbs nation: Hannah Ahrendt and Eija Kent  cleveland.com

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Medical students abortion training is stifled in a post-Dobbs nation: Hannah Ahrendt and Eija Kent - cleveland.com

Gov. David Ige with state lawmakers, UH and JABSOM leadership, and leadership from affiliated health partners.

Gov. David Ige signed two bills to help combat the states increasing physician shortage and support the University of Hawaii at Mnoa John A. Burns School of Medicines (JABSOM) mission to retain more of its graduates to practice medicine in Hawaii. Ige signed Senate Bill 2657 and Senate Bill 2597 into law on July 7 at JABSOM.

The Hawaii Physician Workforce Assessment Project Report indicates that Hawaii is in need of at least 750 doctors, with the greatest statewide shortage being in primary care specialties. The proportional need is greatest on the neighbor islands, with both Maui and Hawaii County experiencing a physician shortage of 40%.

In addition to the bills introduced by the legislature, Ige identified the physician shortage as a priority at the start of the 2022 legislative session by including funding to expand JABSOMs residency program in his proposed budget.

My administration is committed to supporting the development and expansion of high-quality educational and training sites, especially on the neighbor islands where we face the greatest challenge, said Gov. Ige. Mahalo to our lawmakers for also making this a priority and to JABSOM and our local medical partners for their dedication to ensure our local residents can access the healthcare they need now and in the future.

Senate Bill 2657 funds JABSOMs expansion of medical residency and medical student training opportunities on the neighbor islands, and with the U.S. Veteran Affairs (VA) Pacific Islands Healthcare System sites across the statespecifically in areas where healthcare is most needed. The VA is a valuable partner in JABSOMs academic programs. Internal medicine, family medicine, psychiatry, geriatrics and addiction medicine residents or fellows have part of their curriculum based at VA sites.

Currently, some medical students complete pre-clinical rotations for up to three months on the neighbor islands of Hawaii Island, Lanai, and starting this academic year, Kauai. Third-year students participate in a longitudinal clerkship program where groups of students train in the same location for a five-month long rotation in rural communities. Third year students presently train at several locations on Hawaii Island, Maui and Kauai.

Data show that more than 80% of physicians who graduate from both JABSOM and its residency programs tend to stay in Hawaii to practicethat is one of the highest retention rates in the country, said JABSOM Dean Jerris Hedges.We know that physicians who train in rural areas on our neighbor islands are also more likely to put down roots and nurture the communities that theyre in. We look forward to expanding our medical training opportunities to these underserved areas and to stay true to JABSOMs vision of ALOHA: Attain Lasting Optimal Health for All.

More than 80% of physicians who graduate from both JABSOM and its residency programs tend to stay in Hawaii to practiceJerris Hedges, JABSOM Dean

To alleviate the shortage of physicians in the state, more than 225 physicians participate in JABSOMs Accreditation Council of Graduate Medical Education (ACGME)-accredited residency and fellowship programs. Kaiser Permanente Hawaii also has a primary care internal medicine residency program and the Hilo Medical Center is the sponsor of the Hawaii Island Family Medicine Residency Program. With the exception of the Hilo-based program, the remainder of these civilian residency programs are on Oahu, with some having clinical rotations on the neighbor islands. The neighbor island rotationsthrough the VA clinics or in partnership with other neighbor island physicians and health systemsgives residents and fellows the opportunity to train and eventually practice in rural areas.

Residency Programs, as the employer of the JABSOM residents and most fellows, is committed to our rural and at-risk communities by training our future physician workforce, said Natalie Talamoa, executive director of Hawaii Residency Programs. We are excited that the State of Hawaii shares our goal and look forward to working together on this initiative to invest in our neighbor island communities that have been hardest hit by the physician shortage. This funding will increase access to training opportunities for our residents and fellows, and provide them exposure and understanding of our most vulnerable populations so that they want to return to serve these communities.

The VAs ability to expand Graduate Medical Education can help reduce the effects of a forecasted physician shortage here in the Pacific Islands, especially in Hawaii, thanks to the partnership we have with the John A. Burns School of Medicine, said Adam Robinson, Jr., director of the Veteran Affairs Pacific Islands Health Care System. We take pride in providing the largest education and training enterprise for health professionals in the nation, but we cant do it without the relationships we share with our valued academic affiliate residency sponsors.

Senate Bill 2597 allows for more loans to be given in the Hawaii State Loan Repayment Program, which helps graduates of JABSOM and other health professions reduce their educational debt in exchange for remaining in Hawaii to practice. Loan repayment programs are a critical part of addressing the health professional workforce shortage, and Hawaiis program has proven to be highly successful.

According to JABSOMs Hawaii and Pacific Basin Area Health Education Center Director Kelley Withy, 83& of loan repayers have remained in Hawaii to practice, and 70% have remained at the site where they performed their service. Currently, there are 25 active providers in the program with another seven waiting for funding. We are very thankful to the legislature for the matching funds so that we can provide more opportunities to those interested in caring for communities where there is a dire shortage of healthcare providers.

Health care professionals who have benefited from the loan repayment program serve on all islands and in the communities of Waimea, Kihei, Waianae, Hilo and Wailuku; at Federally Qualified Health Centers in Kalihi-Palama and Kokua Kalihi Valley; and in public institutional settings at the federal detention center in Honolulu, the Halawa correctional facility and the Maui County correctional center. Health care professionals who are eligible to participate in the program include physicians, nurse practitioners, psychologists, social workers and many others.

Those present at the bill signing ceremony included state lawmakers Rep. Gregg Takayama, Rep. Ryan Yamane, Sen. Jarrett Keohokalole, UH President David Lassner, JABSOM Hedges, JABSOM Associate Dean for Academic Affairs Lee Buenconsejo-Lum, JABSOM Associate Dean for Administration and Finance Nancy Foster, as well as leadership from affiliated hospitals, the Hawaii Residency Programs, Inc., the VA Pacific Islands Health Care System, and leaders from several of JABSOMs clinical departments and the Office of Medical Education that oversees the MD Program curriculum.

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Bills address the physician workforce shortage, especially on the neighbor islands | University of Hawaii System News - University of Hawaii

Gerry Escovitz, 85, of Ardmore, retired vice dean and professor of medicine at the Medical College of Pennsylvania, expert and international consultant on medical education, and former chair of the board of directors at Freire Charter School, died Sunday, May 29, of a cardiac event at his home.

Celebrated by his colleagues at Freire in 2020 for his consultation, strength, counsel, insight, and curiosity, Dr. Escovitz, they said, challenged students everywhere to become critical thinkers, doers, knowers, visionaries, inventors, and leaders ready to build the future.

Dedicated to education and inspired by young people, he served on the board of directors at the Philadelphia high school beginning in 2001, was vice chair, treasurer, chair of the education committee, and then, from 2014 to 2020, chair of the board. He had such passion for the school, said his wife, Francyn. He believed in the youth of tomorrow and today.

Dr. Escovitz helped Freire establish a permanent school on Chestnut Street, earn national attention for accelerating student growth, and add a middle school on Market Street, a tech school on Broad Street, and a second high school in Wilmington. He was inquisitive, involved, thoughtful, and very funny, Kelly Davenport, chief executive officer and network founder at Freire Schools, said in a tribute. But, most of all, he really loved our kids.

Dr. Escovitz helped 2,500 students graduate during his two decades of leadership at Freire. At their June board meeting, the directors said he always believed in the right for every student to have the best, top-notch college prep education regardless of race, background, zip code, or experience. Gerry, you will guide us, and our commitment is to honor you now after you have honored students all these years.

Before his time at Freire, Dr. Escovitz championed medical education and research for nearly three decades as a doctor, professor, and administrator at the Medical College of Pennsylvania, now the Drexel University College of Medicine, and as senior vice president and chief operating officer for the Allegheny Health Education and Research Foundation.

He published papers on continuing medical education, health-care accountability systems, and other medical topics, and directed domestic and international medical education projects with the American College of Physicians, the Association of American Medical Colleges, and the Society of Medical College Directors of Continuing Medical Education.

Certified in internal medicine and gastroenterology, he began his career in Philadelphia in 1969 as assistant professor and deputy director of the regional medical program at Jefferson Medical College, now the Sidney Kimmel Medical College at Thomas Jefferson University. He earned grants, served on medical committees, commissions, councils, and boards across the country and in Israel, and was a Rockefeller Foundation scholar in residence in Bellagio, Italy, in 1991.

Born June 26, 1936, in Boston, Dr. Escovitz graduated from Boston Latin School, still the oldest existing school in the United States. He earned a bachelors degree at Harvard College in 1958 and a medical degree from the State University of New York Downstate in Brooklyn in 1962. He worked for the U.S. Public Health Service in the 1960s and went on to serve with several organizations, including as president in 1983 of the Society of Medical College Directors of Continuing Medical Education.

He married Ellen Strober, and they had daughters Karen and Lisa. After a divorce, he married Francyn Elion Sacks in 1998 and welcomed her two sons and two grandchildren into the family. I always said I hit the jackpot, his wife said.

Dr. Escovitz was a lifelong Red Sox fan, played tennis and golf, liked classical music, and became a choral singer in his 60s. He was witty, humorous, and optimistic, maintained many long-term friendships, and was interested in history and politics.

He was a Renaissance man, his wife said. He would help anyone. He cared about others. He was a special person.

In addition to his wife, former wife, and daughters, Dr. Escovitz is survived by three grandchildren, a brother, and other relatives.

Services were June 1.

Donations in his name may be made to the Dr. Gerald Escovitz memorial fund at Freire Charter School, Freire Foundation, PO Box 59028, Philadelphia, Pa. 19102.

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Gerry Escovitz, retired vice dean and professor at the Medical College of Pennsylvania and charter school board member, has died at 85 - The...

This years Doximity Residency Navigator results are in and an impressive 13 of the University of Michigan Medical Schools residency programs secured spots in the top 10. In addition, six residency programs came in strong with a ranking in the indexs top 20.

Nationwide, surgery ranks No. 1 out of 345 residency programs, while Otolaryngology and Urology rank No. 2 out of 128 and 146 residency programs, respectively. Plastic Surgery ranks No. 3 out of 86 residency programs.

The other top-10 residency programs at the U-M Medical School include Anesthesiology (7), Dermatology (10), Internal Medicine (7), Med-Peds (7), Neurology (9), Obstetrics and Gynecology (9), Ophthalmology (6), Pathology (Clinical) (4) and Radiology-Oncology (8).

Child Neurology (20), Emergency Medicine (12), Neurosurgery (14), Pediatrics (17), Psychiatry (19) and Radiology (12) were all listed in the top 20.

Doximitys Residency Navigator results highlight that the excellence of Michigan Medicines graduate medical education programs are broadly recognized, said Debra F. Weinstein, M.D., executive vice dean for academic affairs at the U-M Medical School and chief academic officer for Michigan Medicine.We are proud that so many of our programs are recognized as being among the very best, and we will continue to work to optimize the experience of everyone who trains here.

Doximity is the largest online professional network for physicians in the United States. Its comprehensive physician database includes every U.S. physician as identified by their National Provider Identifier number.

Doximitys Residency Navigator is a tool designed to assist medical students with making informed residency-related decisions. It also aims to provide transparency to applicants throughout the residency match process. According to their website, the Residency Navigator is comprised of three major parts: current resident and recent alumni satisfaction data, reputation data and objective data.

While satisfaction data is derived from satisfaction survey responses fromeach residencys current residents and recent graduates, reputation data is derived from nomination survey responses. This portion is limited to board-certified physicians in that specialty and is alumni weighted. Lastly, objective data is compiled from a variety of public sources, including the Doximity database, which coversall U.S. physicians.

These results reflect the high degree of expertise and commitment of our residency program directors, as well as our exceptional teaching faculty, said J. Sybil Biermann, M.D., associate dean for graduate medical education at the U-M Medical School. We are so honored to be recognized in this way.

For more information about the residency programs at U-M Medical School, visit medicine.umich.edu/medschool/education/residency-fellowship.

To learn more about Doximitys Residency Navigator results, visit doximity.com/residency/.

About Michigan Medicine: At Michigan Medicine, we advance health to serve Michigan and the world. We pursue excellence every day in our five hospitals, 125 clinics and home care operations that handle more than 2.3 million outpatient visits a year, as well as educate the next generation of physicians, health professionals and scientists in our U-M Medical School.

Michigan Medicine includes the top ranked U-M Medical School and University of Michigan Health, which includes the C.S. Mott Childrens Hospital, Von Voigtlander Womens Hospital, University Hospital, the Frankel Cardiovascular Center, Kellogg Eye Center, University of Michigan Health West and the Rogel Cancer Center. The U-M Medical School is one of the nation's biomedical research powerhouses, with total research funding of more than $500 million.

More information is available at http://www.med.umich.edu/.

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Doximity Residency Navigator Results: 13 U-M Medical School programs ranked in the top 10 nationwide - Michigan Medicine

I first met Wes Ely in 2016, when I wrote about ICU delirium and Elys attempts, as a critical-care physician at Vanderbilt University Medical Center, to urge fellow health care workers to rethink the use of heavy sedation in ICUs. His research was an attempt to limit the crippling cognitive and physical impairments he saw develop in many critical-care patients long after they left the hospital, something he came to call post intensive care syndrome, or PICS.

Well, a lots happened since 2016. I thought of Elys work often as ICU care became a mainstay of the Covid-19 pandemic and wondered about the long-term prognosis of people who were so sickened by the virus theyd been heavily sedated and placed on ventilators to survive. Then long Covid showed up, and became something Ely grappled with as well.

Through a new book, op-eds, and a steady stream of TikToks, Ely has become a leading voice on the recovery that can take place after trauma or grueling illness and on the importance of preventing new Covid infections. As the pandemic marches on, hes increasingly concerned about the resulting epidemic of chronic disease society may face. I spoke with Ely about his concerns, what he initially got wrong about long Covid, what he finds humbling about medicine, and, why, despite all the suffering he sees and treats, he still holds hope. The conversation has been lightly edited for length and clarity.

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In your book Every Deep-Drawn Breath, you describe how you came to understand that ICU treatment may harm patients even as it allows them to survive. Can you describe this awakening you had and how it started you on your research trajectory?

I had the opportunity to care for a woman in her 20s named Tracy Martin. She had made a mistake and found herself, after an overdose, in the ICU. I was the primary doctor helping to take care of her. We worked so hard, with all the technology that we had, to try to get her through. At the end of the day, I thought, What a great doctor I am, I helped you survive this. When she came back to clinic weeks later, I was expecting a high-five, but I saw a woman who couldnt walk, who couldnt go to the bathroom, who couldnt shower. Her mother said, Wheres my daughter? What happened to her? She looks like an old woman now.

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As a physician, I had to face the fact that none of that stuff she was suffering was what she came into the ICU with and that I was complicit. I felt guilty about it. I knew that something that Id done had injured her but I didnt even know what. I started grappling with that and became kind of obsessed with figuring out how to get people off the ventilator sooner so they didnt get so much injury in the ICU. And thats what started me on a 25-year journey in this area.

Can you describe these issues you work on: post-intensive care syndrome and ICU delirium?

What happens with people who get critically ill and live in an ICU is they come in with one problem and under our noses, in the ICU, under our care [and due to sedation, ventilation and immobilization], they accrue problems in their brain, such as acquired dementia, PTSD, and depression. And then they accrue profound problems neck down in their muscles and nerves which leave them unable to walk, climb stairs, and live a normal life physically. So they become very disabled, cognitively, mentally, and physically. Thats what PICS is. ICU delirium is one of the strongest predictors of the development of post-ICU syndrome.

Like so many ICU physicians and other staff, you were on the front lines of the first Covid waves. What were your first impressions, and how did those evolve during the pandemic?

Taking care of the most critically ill patients who were on ventilators, dialysis, and other forms of life support was just an immensely profound experience. And I knew that those patients were going to leave the hospital, those who survived, with an immense amount of acquired disease, that this was going to be PICS to the extreme. So when people started talking about being long haulers and having long Covid, I just thought, those are the ICU survivors who have PICS. Through our CIBS (Critical Illness, Brain Dysfunction, and Survivorship) center, we started offering Covid survivor support groups we didnt even call it long Covid in the beginning. We started finding people who got out of the ICU and had PICS. And we had patients, and this was shocking to me, who got out of the ICU, their PICS was in a strong state of recovery, then 100 days later they would fall off a cliff. And I thought, What is that? That is not PICS.

Then there was a third group that never came to the ICU at all, went through a mild case of Covid but then came to our support group and said, I didnt have a problem until three months after Covid and now my life is ruined. I cant think well anymore, and I cant work. I have all these heart-racing problems and GI disturbances. I had originally thought, this is PICS and all these people dont know about PICS yet, but then I realized that long Covid was something completely different.

That must have been startling because your research focuses on people post-ICU?

Yes, I had to admit I was wrong. And I was so sure I was right. It was super humbling. But thats what I love about medicine: The second we think we know what we are doing, we fall flat on our face.

Youve spent two decades trying to get people to realize that being released from the ICU may not necessarily be the end of their medical or mental health issues. Do you see an analogy with Covid that just because you test negative after an infection, your problems are not necessarily over?

Absolutely. The rapid antigen test tells you when you have that virus active in your body, and when it starts going negative, you think, this has passed. But now we know that the virus can persist as a viral ghost in your GI tract, brain, and cardiovascular system, and that it can also alter your immune reactions. What happens is that over ensuing weeks and months, your body takes on a new set of diseases that you did not have at the end of acute Covid. Thats what we call long Covid.

Unfortunately way too many people with this are not being believed about their illness. And this has happened before, with long Lyme, and CFS, and fibromyalgia. And I will tell you, as a medical insider, that I used to think that those werent real. I was taught in medical school that they werent real. I was just with some medical students last week, and I talked to them about a patient of mine who had long Lyme. And they said we were taught that thats not real and these are current med students. This is something the ivory tower medical profession needs to realize long Covid is going to push us to get outside of our comfort zone with illnesses that we cant define. Because we dont like it when we cant understand something, but we have to get over that.

In your book, you describe saying to patients, I will not leave you. Its not something you typically hear doctors saying to patients, even in movies. Can you talk about how you communicate with patients, especially those with PICS and long Covid?

If a person is suffering pain, fear, illness with uncertainty about where theyre going to be going with this illness and they are seeking somebody who can help, they want to be cuddled and lifted up and have things explained on their level. And by cuddled, I dont mean physically holding because some people wouldnt want that. What I mean is paid attention to at an intimate level. You know, if somebody was in the streets and they were broken, Im not going to stand 20 feet away from that person and minister to them at a distance. And yet, when patients come into the ICU and theyre super, super sick, that distance caring is exactly what our culture evolved into, where instead of being at the bedside and holding their hands, looking in their eyes, oftentimes were caring for them from the door. Were looking at their monitors. Were adjusting their life support machines at a distance. And throughout Covid, we literally were outside their room with the glass door shut, a worst-case scenario. Thats why Ill whisper in their ear and say, Im present. Im your doctor. Im not leaving you.

Whats your message to doctors, not just in critical care but in any speciality, who are seeing patients with these complicated symptoms that are difficult to understand, let alone treat?

The first thing I say to my fellow physicians and nurses and health care providers is were busy. We dont have a lot of extra time, I get that. But it does not take that much time to be at eye level with a patient, look them in the eyes, hold their hands, and give them this compassionate message of your presence and the fact that you will not abandon them during this illness. And also to say, I dont have all the answers for you. For example, for long Covid, theres no treatment yet, but you can say to them, Ill stick with you as we learn more in the months and years ahead and well figure this out together.

Why did you decide to write your book?

As a physician who is also a scientist, I have an intense amount of discomfort at the bedside when I see that we do things that dont have evidence to back them up. As a scientist, Ive conducted 25, 30 years of research and I realized there was a story evolving that no matter how many papers I published was never going to reach the lay public or other health care professionals who dont really keep up with the literature. Growing up in Louisiana with my mom, we read poetry, she edited my essays, she taught me to love words. So I love writing and reading and literature and thats why I thought, Why dont I use the stories of my patients, with their permission, to leverage the power of literature to show people how we can be caring for people in the most humanistic way.

I asked each patient for permission to use their story. And one patient said, OK, but I dont want you to make any money off my story. After she said that to me, we decided that every penny in proceeds from Each Deep-Drawn Breath would go into an endowment to help people with long Covid. Weve hired social workers and are helping people find disability services all over the country and the world.

On a very different end of the communication spectrum, theres your TikTok account. Why did you start that?

So, Im 58 years old. You know, an old doctor. And if you had told me two years ago that I was going on social media and Twitter, I would have said, Youre crazy. Theres no way. But two things happened. One was that at the beginning of the pandemic, a lot of doctors around the world were writing me and saying, theres so much ICU delirium, weve got to study this. And they said if you get on Twitter, we can find the patients faster. I said fine. Ill open a Twitter account and we will advertise for the study on Covid delirium. We enrolled 2,100 patients in two weeks. And so I decided to stay on Twitter to share and validate peoples stories and spread good science about long Covid and brain dysfunction and PICS and such.

And then about six months ago, people in the office said you need to get on TikTok and I said, No, Im drawing the line. But theres this crazy set of misinformation being spread on TikTok, misinformation so egregious that I thought, You know what, Im just going to try five videos and see what happens. So all I do is I sit in my office, flip my phone around, and give a two to three minute message on some topic, and I post it. I dont spend any time on it, theres no production. Its super old school. But if its helping people, then Ill keep doing it.

Entering the third year of the pandemic, there is so much anguish and strife right now, and possibly a wave of chronic disease that patients, health workers, and society at large will be facing. Yet you remain hopeful. Can you explain why people with long Covid should hold similar hope?

They can absolutely heal. The brains capacity to heal is so much greater than what people give it credit for. We have trillions and trillions of neurons and connections, and these things can regrow. So, if a patient gets this brain fog and they think, Oh, my gosh, Im never going to get back again, I always tell them, do not lose hope because you will find recovery. And whether its mitochondrial disease or glial cells that have died, or vascular clotting that develops into long Covid, your body has this capacity to recover, and you must remain hopeful that you can get through this. And we are working hard as scientists to do the right trials to find answers. I just want people to hang on and know were going to stick with them and not abandon them during the process.

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'Long Covid is going to push us to get outside of our comfort zone' - STAT - STAT

This week: A chance to network with health care marketing professionals, bike riders hit the streets to benefit cancer research and a medical student turned author pens a book for young adults.

Hull College of Business will host a business showcase and lecture featuring Dentsu Health from 4-6:30 p.m. Tuesday, Oct. 11 in the Dr. Roscoe Williams Ballroom in the Jaguar Student Activities Center. Dentsu Health specializes in health, wellness and pharmaceutical marketing and will network with students during the event.

Weve lost sight of care: care of ourselves, care of our loved ones and friends, the care that we received and the real care that we need, said Ken Groves, the firms global head of strategy. Two years since the pandemic outbreak, we keep hearing about the acceleration of tech adoption in health care. However, our new outlook on care cannot be limited to a broader set of services and devices.

The opening ceremonies for PaceDay 2022 will be from 4-9 p.m. Saturday, Oct. 15 to benefit the Georgia Cancer Center. The event will take place at SRP Park in North Augusta with food, fun, live music and cancer stories being told. Those participating in Sundays ride can also drop off their bikes. The 25-, 50- and 70-mile rides will start at 8 a.m. Sunday, Oct. 16 with the finish line at the Augusta Common. Since 2019, over $700,000 has been raised and invested in cancer research thanks to Paceline.

Cancer research is very competitive. Less than 10 percent of grants submitted get funded. A lot of people will be eventually impacted by cancer during their lifetime or have family members suffer from the disease, so its a fight that needs everyones involvement, said Huidong Shi, PhD, a cancer researcher at the Georgia Cancer Center.

Tyler Beauchamp, a fourth-year medical student at the Medical College of Georgia, has published his first book, Freeze Frame. Beauchamp has been working on the book since the beginning of the pandemic and would unwind from his studies by writing.

The story follows high school junior Will Horner, an introverted, avid filmmaker trying to move on from the horrors of his past.

I dont think I could do medicine without letting my creative side out every now and then. It just makes me feel human, Beauchamp said. There is something about creativity I really find beautiful, thats exciting.

Interview opportunities are available for these story ideas. Call 706-522-3023 to schedule an interview. Check out the Augusta University Expert Center to view our list of experts who can help with story ideas.

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What's happening at Augusta University? Week of Oct. 10-16 - Jagwire Augusta

What: Recent Advances in Phototherapy for PainWhen: Thursday, Sept. 15, 5:30 p.m.Where: Health Sciences Innovation Building, Forum, 1670 E. Drachman St., TucsonRegister for event

The University of Arizona Health Sciences Tomorrow is Here Lecture Series presents Recent Advances in Phototherapy for Pain, with Mohab Ibrahim, MD, PhD, medical director of the Comprehensive Pain and Addiction Center, on Thursday, Sept. 15, at 5:30 p.m. Registration is required for the free, in-person event.

People with migraine, fibromyalgia and other types of pain have benefited from the effects of light therapy using different colors. Dr. Ibrahim, professor of anesthesiology in the UArizona College of Medicine Tucson and director of the Chronic Pain Management Clinic, will discuss the scientific evidence behind phototherapy, as well as research discoveries related to pain and possible mechanisms of action.

Light therapy requires a minimum investment in technology and development and can be applied in different settings, said Dr. Ibrahim, an internationally known expert in chronic pain.

Dr. Ibrahim graduated from the University of Arizona with a medical degree after earning a bachelors degree in biochemistry, and master's and doctoral degrees in pharmacology and toxicology. He completed a general surgery internship at the College of Medicine Tucson, then spent five years at Harvard Medical School for an anesthesia residency at Brigham and Womens Hospital and a fellowship in clinical pain medicine at Massachusetts General Hospital. A board-certified anesthesiologist, he joined the UArizona College of Medicine Tucson and Banner University Medical Center in 2014.

TheTomorrow is Here Lecture Series offers engaging and inspiring presentations focusing on the research being done by UArizona Health Sciences faculty and staff. Registration is required and can be completed online. Complimentary parking and refreshments will be provided. Lectures are recorded and will be available on the UArizona Health Sciences YouTube channel after the event.

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Recent Advances in Phototherapy for Pain | UArizona Health Sciences - University of Arizona

Many college students enter their freshman year unsure of what they want to major in, let alone what theyll do after they graduate. Then there are students like Hussna Yasini, who entered her first year of college at the University of Colorado Denver knowing she could earn a reserved spot at the CU School of Medicine after she completed her undergraduate studies.

Now a second-year medical student, Yasini came to CU as part of the BA/BS-MD degree program, a partnership between the CU Denver and CU Anschutz Medical campuses that aims to increase the diversity of professionals practicing medicine in Colorado. The pipeline program identifies promising high school students with an interest in medicine many from backgrounds underrepresented in medicine then enrolls them in a premedical curriculum at CU Denver, providing an academic learning community and comprehensive premedical counseling and resources along the way. Students can earn a reserved spot at the CU School of Medicine after graduation, provided they meet academic requirements and pass the Medical College Admission Test (MCAT).

The program does not guarantee admission to medical school at the time of starting undergraduate studies, but this is a rigorous pathway that gets them to a position where their chances of going to medical school are really good, says Matthew Taylor, MD, PhD, professor of medicine and co-director of the BA/BS-MD degree program. We recruit students who are academically performing very well and have an interest in health care, and we help them identify and cultivate the skills and qualities that are necessary to make them be successful.

Through the pipeline program, students have access to boot camps, special lectures, journal clubs, research and leadership training, CU Anschutz campus visits, MCAT preparation courses, and more throughout their undergraduate career.

The goal is to set students in the program up for success once they start medical school and initiate a relationship with the Anschutz Medical Campus during their undergraduate years.

We even were able to sit in on a couple of medical school lectures while we were still undergraduates, Yasini says. A lot of medical students are from out of state, and their interview process was during COVID, so they had never even seen the campus. But I knew where everything was on my first day. It was really great to get that early exposure to the campus and to medical school.

The BA/BS-MD program has its roots in a Colorado Health Foundation initiative aimed at training more primary care physicians who would remain in Colorado after their training. After that the program was founded with that initial funding, its focus expanded to include recruiting students from underrepresented and diverse backgrounds including rural students, those with limited economic and educational resources, LGBTQ students, and racial and ethnic minorities into careers in medicine.

There's a clear recognition that the population of individuals who go to medical school nationally does not necessarily mirror the population of patients we aim to serve, Taylor says. If one or both of a students parents are professionals, if they are well off economically, if they live in a neighborhood that has lots of resources, if they go to an outstanding high school if they want to go to medical school, they can go to medical school. We're looking for some students who have a variety of different stories and paths, including students who haven't considered a career in health care until high school.

The program enrolls up to 10 new first-year college students each year, putting them through a rigorous application and interview process. Applicants must beColorado residentsandhave an interest in servingthe health care needs of Colorado when they become primary care physicians.

Students from the programs first cohort are just now finishing their residencies, Taylor says, and hes excited to see where their careers will go from here.

For Yasini, who just started a year of clinical training at Salud Family Health Center in Aurora, the BA/BS-MD program was an invaluable resource when it came to preparing for medical school, as well as her planned future medical career providing care for immigrants and refugees.

The program focuses a lot on the things that I care about, and it set us up with a lot of opportunities to be exposed to those things and work with those patient populations, she says. A lot of the things theyre teaching us in medical school about diversity and inclusion, immigrant health and global health you don't learn that in undergrad, unless you're in a structured program like this. It's been it's been very helpful in helping us become well-rounded physicians.

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BA/BS-MD Program Aimed at Increasing Diversity of Health Care Professionals in Colorado - University of Colorado Anschutz Medical Campus

On a Monday morning, a group of obstetrics and gynecology residents, dressed in blue scrubs and white coats, gathered in an auditorium at Indiana University School of Medicine. After the usual updates and announcements, Dr. Nicole Scott, the residency program director, addressed the elephant in the room. "Any more abortion care questions?" she asked the trainees.

After a few moments of silence, one resident asked: "How's Dr. Bernard doing?"

"Bernard is actually in really good spirits I mean, relatively," Scott answered. "She has 24/7 security, has her own lawyer."

They were talking about Dr. Caitlin Bernard, an Indiana OB-GYN who provides abortions and trains residents at the university hospital. Bernard was recently caught in a political whirlwind after she spoke about an abortion she provided to a 10-year-old rape victim from Ohio. Bernard was the target of false accusations made on national television by pundits and political leaders, including Indiana's attorney general.

The doctors interviewed for this article said that they are not speaking on behalf of their school of medicine but rather about their personal experiences during a tumultuous moment that they worry will affect the way they care for their patients.

The vitriol directed at Bernard hit home for this group of residents. She has mentored most of them for years. Many of the young doctors were certain they wanted to practice in Indiana after their training. But lately, some have been ambivalent about that prospect.

Dr. Beatrice Soderholm, a fourth-year OB-GYN resident, said watching what Bernard went through was "scary." "I think that was part of the point for those who were putting her through that," Soderholm said. They were trying "to scare other people out of doing the work that she does."

In early August, Gov. Eric Holcomb, a Republican, signed a near-total abortion ban into law, making Indiana the first state to adopt new restrictions on abortion access since the Supreme Court struck down Roe v. Wade in June. When the ban takes effect Sept. 15, medical providers who violate the law risk losing their licenses or serving up to six years in prison.

These days, Scott, the residency program director, uses some meeting time with residents to fill them in on political updates and available mental health services. She also reminds them that legal counsel is on call round-the-clock to help if they're ever unsure about the care they should provide a patient.

"Our residents are devastated," Scott said, holding back tears. "They signed up to provide comprehensive health care to women, and they are being told that they can't do that."

She expects this will "deeply impact" how Indiana hospitals recruit and retain medical professionals.

A 2018 report from the March of Dimes found that 27% of Indiana counties are considered maternity care deserts, with no or limited access to maternal care. The state has one of the nation's highest maternal mortality rates.

Scott said new laws restricting abortion will only worsen those statistics.

Scott shared results from a recent survey of nearly 1,400 residents and fellows across all specialties at the IU School of Medicine, nearly 80% of the trainees said they were less likely to stay and practice in Indiana after the abortion ban.

Dr. Wendy Tian, a third-year resident, said she is worried about her safety. Tian grew up and went to medical school in Chicago and chose to do her residency in Indiana because the program has a strong family-planning focus. She was open to practicing in Indiana when she completed her training.

But that's changed.

"I, for sure, don't know if I would be able to stay in Indiana postgraduation with what's going on," Tian said.

Still, she feels guilty for "giving up" on Indiana's most vulnerable patients.

Even before Roe fell, Tian said, the climate in Indiana could be hostile and frustrating for OB-GYNs. Indiana, like other states with abortion restrictions, allows nearly all health care providers to opt out of providing care to patients having an abortion.

"We encounter other people who we work with on a daily basis who are opposed to what we do," Tian said. Tian said she and her colleagues have had to cancel scheduled procedures because the nurses on call were not comfortable assisting during an abortion.

Scott said the OB-GYN program at the IU School of Medicine has provided residents with comprehensive training, including on abortion care and family planning. Since miscarriages are managed the same way as first-trimester abortions, she said, the training gives residents lots of hands-on experience. "What termination procedures allow you to do is that kind of repetition and that understanding of the female anatomy and how to manage complications that may happen with miscarriages," she said.

The ban on abortions dramatically reduces the hands-on opportunities for OB-GYN residents, and that's a huge concern, she said.

The program is exploring ways to offer training. One option is to send residents to learn in states without abortion restrictions, but Scott said that would be a logistical nightmare. "This is not as simple as just showing up to an office and saying, 'Can I observe?' This includes getting a medical license for out-of-state trainees. This includes funding for travel and lodging," Scott said. "It adds a lot to what we already do to educate future OB-GYNs."

Four in 10 of all OB-GYN residents in the U.S. are in states where abortion is banned or likely to be banned, so there could be a surge of residents looking to go out of state to make up for lost training opportunities. The Accreditation Council for Graduate Medical Education, the body that accredits residency programs, proposed modifications to the graduation requirements for OB-GYN residents to account for the changing landscape.

For some of the Indiana OB-GYN residents including Dr. Veronica Santana, a first-year resident these political hurdles are a challenge they're more than willing to take on. Santana is Latina, grew up in Seattle, and has been involved in community organizing since she was a teenager. One reason she chose obstetrics and gynecology was because of how the field intersects with social justice. "It's political. It always has been, and it continues to be," she said, "And, obviously, especially now."

After Roe was overturned, Santana, alongside other residents and mentors, took to the streets of Indianapolis to participate in rallies in support of abortion rights.

Indiana could be the perfect battleground for Santana's advocacy and social activism. But lately, she said, she is "very unsure" whether staying in Indiana to practice after residency makes sense, since she wants to provide the entire range of OB-GYN services.

Soderholm, who grew up in Minnesota, has felt a strong connection to patients at the county hospital in Indianapolis. She had been certain she wanted to practice in Indiana. But her family in Minnesota where abortion remains largely protected has recently questioned why she would stay in a state with such a hostile climate for OB-GYNs. "There's been a lot of hesitation," she said. But the patients make leaving difficult. "Sorry," she said, starting to cry.

It's for those patients that Soderholm decided she'll likely stay. Other young doctors may make a different decision.

This story is part of a partnership that includesSide Effects Public Media,NPR,and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

This story can be republished for free (details).

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Indiana's new abortion ban may drive some young OB-GYNs to leave a state where they're needed - Salon

KALAMAZOO, MI -- In 2006, Susan Brown lost a close friend to suicide. Another friend died the same way in 2011.

The two incidents left her reeling. Both men were highly accomplished, with plenty of resources at their disposal. If even people in that position could succumb to mental illness, what did that say about the status of mental-health care?

It was such a shock to all of us to have a contemporary die that way, said Brown, a longtime Kalamazoo resident and wife of Bob Brown, founder of the Treystar commercial real estate firm. How did this happen?

For the past decade, Brown -- who is now 80 -- has channeled her grief into action, rallying friends to raise money and researching how to improve access to mental-health services.

Her efforts led to the formation of the Kalamazoo Collaborative Care Program, which provides social workers and other mental-health expertise to help primary-care physicians treat patients with behavioral health issues.

Now Brown wants to take her efforts to the next level. The vision: Creating a Kalamazoo psychiatric clinic modeled after the University of Michigan Depression Center, a place that would combine high-quality care with cutting-edge research and education on mental health.

The tentative proposal calls for a clinic that would hire a dozen or more psychiatrists and include outpatient services for children, adolescents, adults and geriatric patients. Doctors would treat a wide variety of behavioral health disorders, including depression and anxiety, autism and autism spectrum issues, attention deficit disorder, bipolar and schizophrenia, psychosis, PTSD and Alzheimers and other memory issues.

Under this proposal, the clinic would be affiliated with the Western Michigan University School of Medicines psychiatric department. Brown is looking to raise about $25 million to finance a facility.

Such a project would achieve multiple objectives, say Brown and others. One would be the ability to recruit and retain psychiatrists based in Kalamazoo, addressing a critical shortage.

Treatment for mental-health disorders typically involve both medication and talk therapy. While a psychologist or other therapist can provide the latter, patients need a psychiatrist or other medical doctor to prescribe medications and oversee treatment regimes, especially for people with other medical issues.

A psychiatric clinic also would be a way to pull together the communitys fragmented mental-health system, improve coordination and create more consistency in regards to quality, said Dr. Rajiv Tandon, who recently retired as chairman of the WMU medical schools psychiatry department.

Absolutely, such a clinic would benefit the Kalamazoo community, especially people with private insurance, said Jeff Patton, CEO of Integrated Services of Kalamazoo, the countys community mental health agency.

His agency provides very comprehensive mental-health services for clients, but the vast majority are Medicaid patients, he said. By comparison, people with private insurance lack the same kind of comprehensive system.

Kalamazoo psychologist Larry Beer said having a comprehensive psychiatric clinic would be great.

My practice has really tried to recruit psychiatrists, even psychiatric nurse practitioners, but its been really, really hard to do that, Beer said. Services provided by such a clinic would go a long way toward filling a void.

The idea of creating a psychiatric clinic to get more psychiatrists to base here is a model used in other domains, and its been very successful, said Troy Zukowski, a clinical social worker in Kalamazoo. We dont want a situation where people are graduating from the WMU medical school and taking jobs in New York or Chicago. We want them to stay in Michigan and hopefully the Kalamazoo area, because theres definitely a shortage of psychiatrists here.

Patton added such a project would be an excellent way to leverage the assets of the WMU medical school, which was established in 2012 and is based in downtown Kalamazoo.

I think we need to promote our med school much more, and support their abilities to recruit and retain both students and (medical) residents, Patton said. Its quite a gem for a community the size of Kalamazoo to have a med school;. Its quite extraordinary to have that infusion of knowledge and science coming into our community. We need to talk that up.

Is WMU medical school on board?

While people in Kalamazoos mental-health community are enthused about the idea, institutions that would be key players -- the WMU medical school, Ascension Borgess Medical Center and Bronson Healthcare -- are much more cautious.

Borgess and Bronson did not respond to requests for comment for this story. As for the WMU medical school, Tandon -- who drafted the vision that Brown would like to bring to fruition -- recently retired and no long speaks for the college.

The WMU medical school has not yet hired Tandons permanent successor, and the new psychiatry chair undoubtedly will have their own vision of the departments direction, said Dr. Michael Redinger, the interim psychiatry chair of the WMU School of Medicine.

Were looking for somebody who can take a lot of the work that started with Rajiv and Susans conversations, look at the resources from U-M, the lessons we can take from them and build that out, Redinger said.

What form that takes, I cant really tell you right now, because the new chair is going to be the one who has the prerogative in terms of modifying and building that vision. he said.

All that said, the shortage of psychiatrists is a very real issue, Redinger said, and is a nationwide problem attributed to a number of factors.

One is a so-called retirement drain: A common scenario these days is that when a psychiatrist retires, theres no one to take over their caseload. And its a problem thats getting worse.

In Michigan, more than half of practicing psychiatrists are over the age of 55, one of the highest proportions among all physicians. Meanwhile, it can be hard to convince young doctors to specialize in psychiatry, especially when many have enormous medical school debt and psychiatry pays less than many other medical specialties.

The shortage of psychiatrists is definitely a bottleneck, no doubt about that, Redinger said. And the more the sub-specialty, the more acute the bottleneck, especially for people needing to see specialist in children and adolescents, or geriatric, or substance-use disorder. That doesnt mean we have an abundance of adult psychiatrists, but the waiting lists are just that much longer for the sub-specialties.

Addressing that shortage requires a multi-prong strategy, Redinger said. Already, the Kalamazoo Collaborative Care Program is arranging for consultants between psychiatrists and primary-care physicians, which is a way to extend the expertise of local psychiatrists.

One thing thats clear is that the mental health needs in the community are significant, they are not going away, and its going to take a multifaceted multifaceted approach to tackling all of that, Redinger said.

Institutional barriers

Tandon, the former psychiatry chair of the WMU medical school, agrees more than one approach is necessary. But hes also convinced that a standalone psychiatric clinic would be an immense boost for the public, the local mental-health system and the medical school.

For the public, such a clinic would provide much-needed high-quality specialized mental-health care. For the local mental-health system, the clinic would be a huge resource, particularly in providing access to research and professional training and support.

For WMU, it would be a way to hone the reputation of the medical school and help put Kalamazoos name on the map.

In terms of creating a nationally recognized program, psychiatry is an easy win because theres not many high-quality, go-to psychiatry places in the country, Tandon said.

Secondly, from a cost perspective, investing in psychiatry makes sense, he said. You dont make money in psychiatry, but you make money off it by significantly improving the quality of outcomes for people across the board -- surgical patients, cardiac patients, orthopedic patients.

Such a clinic also would provide WMU medical students with a better education, help with faculty recruitment, and expand the opportunities for research, as well as help recruit and retain psychiatrists to base in Kalamazoo, Tandon said.

Bu there are institutional challenges sin creating such a clinic, related to the particular setup of the WMU medical school.

Unlike most medical schools, WMU does not have its own hospital. Rather, its affiliated with Bronson and Borgess. Each hospital has three seats on the medical schools 11-member board, which means the hospitals together control the med school.

Thats a challenge in creating any new clinical programs because Bronson and Borgess are in competition, with legendary turf wars that extend back decades.

To complicate matters, of the two hospitals, Borgess is the one that operates an inpatient psychiatric unit. But Borgess is no longer locally operated; its now part of the Ascension healthcare system based in St. Louis. That means Borgess is now a very small fish is a very large pond.

And its unclear whether Ascension would back plans for a standalone Kalamazoo psychiatric clinic that would might require their investment -- or at least their approval -- especially if that clinic is perceived as creating competition to Borgess operations.

Its very frustrating, Brown said. We know the local people (at Borgess), who are fabulous and they get it, but they dont have control in making major decisions.

Its also unclear whether Bronson would want to expand its investment in psychiatry, and if or how that aligns with the hospitals future plans.

But Brown doesnt want to let the vision die.

I think Kalamazoo could do this, she said. WMU has a really good medical school. We need this. If people would just step up and get the word out, we could get this going.

This story is part of the Mental Wellness Project, a solutions-oriented journalism initiative covering mental health issues in southwest Michigan, created by the Southwest Michigan Journalism Collaborative. SWMJC is a group of 12 regional organizations dedicated to strengthening local journalism. For more info visit swmichjournalism.com.

Read more on MLive:

Mental health counseling can be highly effective. But finding the right therapist is key.

Saying these words could help someone who is contemplating suicide

Finding affordable mental-health care getting easier with reforms, new programs

Behavioral health urgent care planned for downtown Kalamazoo

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How Kalamazoo can address the shortage of psychiatrists -- and make a name for itself in the process - MLive.com

Are accountable care organizations (ACOs) potentially creating financial savings by neglecting or limiting care for serious mental illness (SMI)? A team of researchers has examined the issue for an article in Health Affairs. Based on their analysis, it appears that such is not the case; but there is complexity, which the researchers explore in their article.

In the article published in the August issue of Health Affairs and entitled ACO Participation Associated With Decreased Spending For Medicare Beneficiaries With Serious Mental Illness, Jos F. Figueroa, Jessica Phelan, Helen Newton, E. John Orav, and Ellen R. Meara look at the complexities around care for serious mental illness for Medicare patients enrolled in Medicare Shared Savings Program (MSSP) ACOs. What they find is complex and somewhat nuanced.

The authors state in their abstract at the outset of the article that Serious mental illness (SMI) is a major source of suffering among Medicare beneficiaries. To date, limited evidence exists evaluating whether Medicare accountable care organizations (ACOs) are associated with decreased spending among people with SMI. Using national Medicare data from the period 200917, we performed difference-in-differences analyses evaluating changes in spending and use associated with enrollment in the Medicare Shared Savings Program (MSSP) among beneficiaries with SMI. After five years, participation in MSSP ACOs was associated with small savings for beneficiaries with SMI ($233 per person per year) in total health care spending, primarily related to savings from chronic medical conditions (excluding mental health; $227 per person per year) and not from savings related to mental health services ($6 per person per year). Savings were driven by reductions in acute and post-acute care for medical conditions. Further work is needed to ensure that Medicare ACOs invest in strategies to reduce potentially unnecessary care related to mental health disorders and to improve health outcomes.

Jos F. Figueroa, M.D., M.P.H., is an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health (HSPH) and an assistant professor of medicine at Harvard Medical School (HMS). He is also a practicing Internist and associate physician at the Brigham and Women's Hospital, where he serves as the Faculty Director of the BWH Medicine Residency Management & Leadership Pathway. Jessica Phelan is a statistical analyst programmer at the Harvard Global Health Institute. Helen Newton, Ph.D., M.P.H., is a postdoctoral associate in the Department of Health Policy & Management at the Yale University School of Public Health. E. John Orav, Ph.D., is an associate professor in the Department of Biostatistics at the Harvard T.H.Chan School of Public Health. Ellen R. Meara, Ph.D., is a professor of health economics and policy at the T.H. Chan School of Public Health.

But what is behind that small savings on mental health services? It turns out, things are a bit complicated. For one thing, while more than one in five U.S. adults suffers from a mental health disorder, and 14.2 million U.S. adults suffer from a serious form of mental illness such as bipolar disorder, schizophrenia, or major depressive disorder, In the Medicare population, the burden of serious mental illness (SMI) is a concerning amount higher than in the general population, with a recent study suggesting that the prevalence of SMI in this population was nearly 23 percent, the articles authors note. This may be because Medicare beneficiaries have a higher number of chronic physical conditions than the general population, which may then lead to a higher prevalence of major depressive disorder, and given the bidirectional relationship, depression may also lead to worsening of underlying chronic conditions. High rates of schizophrenia and bipolar disorder may also result in disability, which then qualifies these patients for the Medicare program. In addition, Medicare beneficiaries with SMI were also found to spend substantially more on the treatment of other chronic medical conditions, such as heart failure and diabetes, than those without, even after clinical risk adjustment. This is likely because the presence of SMI impairs the ability of patients and clinicians to effectively treat other chronic conditions, they note.

In theory, the ACO model of care should be helpful in this regard, as, under the MSSP program, a group of clinicians and patient care organizations accepts responsibility for attributed patients across time. Still, the researchers note, To date, there are few long-term empirical data about how patients with SMI and comorbid chronic medical conditions are faring in ACOs. Early evidence suggests that ACOs have achieved modest savings and improved quality for the general Medicare population, likely because of the financial incentives to care for patients across the entire care continuum, they write. Still, they note, Although some studies have examined rates of outpatient visits to mental health providers and use of psychotropic medications among people with depression, it is unclear whether ACOs yield meaningful savings among people with SMI over a longer period of time as experience caring for these patients in ACOs increases.

The researchers write that they wanted to answer the question, Was the implementation of Medicare ACOs, specifically the Medicare Shared Savings Program (MSSP), associated with savings among beneficiaries with SMI? If so, were these savings achieved from reductions in spending related to mental health services or related to treatment of chronic medical conditions? Finally, did enrollment in ACOs lead to reductions in health care use among those with SMI, including rates of hospitalizations, emergency department visits, and post-acute rehabilitative care use, relative to beneficiaries not in ACOs?

So, the researchers used a 20 percent sample of Medicare administrative claims from the period 200917 that included Parts A and B spending and use. Our sample was limited to Medicare fee-for-service beneficiaries continuously enrolled during the study period or until death. Demographic data were obtained from the Master Beneficiary Summary File. Claims from the Inpatient, Outpatient, Carrier, Skilled Nursing Facility, Home Health Agency, and Hospice files were used. And the patients whose records looked at were cohorts of patients who were attributed to MSSP ACOs that started contracts in 2012, 2013, 2014, or 2015.

In that regard, the researchers write, In a national study of Medicare beneficiaries, we found that participation in the Medicare Shared Savings Program between 2013 and 2017 was associated with small savings among those with SMI, including schizophrenia and related psychotic disorders, bipolar disorder, and major depressive disorder. These savings were primarily related to reductions in spending related to medical conditions and not reductions in the treatment of mental health disorders.

And, they state, Our findings suggest that ACO savings are primarily related to the treatment and management of medical conditions and not due to changes in spending related to mental health disorders. These findings raise important questions. On the one hand, it is possible that the observed savings may signal more efficient care under ACOs for the treatment of medical conditions. Prior work has suggested that poorly controlled medical conditions among people with mental illness are an important driver of morbidity and mortality.47 It is possible that ACOs are mitigating some of the effects of mental illness on chronic medical conditions and preventing potentially unnecessary care, as evidenced by greater reductions in ED visits, hospitalizations, and subsequent post-acute care use. Our findings are consistent with other work that has shown that ACO incentives likely motivate physician practices to lower use by investing in specific strategies, including care transitions and care coordination programs, risk-stratification interventions, and chronic disease management programs. The magnitude of the savings among people with SMI, however, is about half the savings previously reported among the general ACO population in the MSSP.

Significantly, they write, [W]e found no evidence to suggest meaningful reductions in spending related to mental health disorders. This may be because other work has suggested that there has been little integration of behavioral health treatment in traditional primary care health systems. More recent data suggest that only 17 percent of ACOs reported implementing all components of the collaborative care model, which is a cost-effective model to treat mental illness that combines primary care and consulting behavioral health specialists with the support of mental health registries.

This is obviously complex, since, as the authors write, There has been little focus on specific quality measures that concentrate on the treatment of mental health disorders. This is a missed opportunity, given that Helen Newton and colleagues found that mental healthspecific quality measures are associated with ACO reports of behavioral health integration activity and with better follow-up after mental health hospitalizations.

Ultimately, they conclude, We found that after five years of participation in the MSSP, beneficiaries with SMI who are treated by ACO practices were achieving some small savings, primarily related to reductions in acute and post-acute care use and spending related to chronic medical conditions and not from reductions in mental health services. Although these findings may reflect potential reductions in unnecessary care related to chronic medical conditions, further work is needed to understand the impact of ACOs on health outcomes. In addition, our work suggests that ACOs may still need to implement more strategies to reduce potentially unnecessary care related to mental health disorders.

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Researchers Explore ACOs' Cost Savings Around Patients with Mental Illness - Healthcare Innovation

For Preet Khimasia, a third-year student in finance and business analytics, co-op was a major reason for choosing UC. Born in India, Khimasia knew he wanted to study abroad, but it was important to have a recognized leader in his chosen field.

UC had one of the best programs for what I wanted to do, he says. What really attracted me is I am a very hands-on learner and a very experiential learner. I cant just sit in a classroom and expect to study everything. I need to actually get out and do in order to be successful.

Cooperative education began at UC in 1906 and its program has remained a leader in experience-based learning ever since. The university ranks No. 4 in the nation for co-op, with Cincinnatis hands-on classroom extending to nearly every corner of the globe, from Fortune 500 companies to trailblazing experiences in places like China, Tanzania and South America.

UC students earn a collective $75 million annually working for thousands of employers including General Electric Aviation, Disney, Toyota, Kroger, Procter & Gamble and many more. UC has nearly 2,000 global partners for the co-op program with students participating in over 7,500 co-op opportunities each year.

Forbes recently noted the universitys leading position and longevity in cooperative education.

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Back to School 2022 | University Of Cincinnati - University of Cincinnati

When fat accumulates in the liver, the immune system may assault the organ. A new study from Weill Cornell Medicine researchers identifies the molecule that trips these defenses, a discovery that helps to explain the dynamics underlying liver damage that can accompany type 2 diabetes and obesity.

In a study published Aug. 19 in Science Immunology, researchers mimicked these human metabolic diseases by genetically altering mice or feeding them a high-fat, high-sugar diet. They then examined changes within the arm of the rodents immune system that mounts defenses tailored to specific threats. When misdirected back on the body, this immune response, which involves B and T cells, damages the organs and tissues it is meant to protect.

For the longest time, people have been wondering how T and B cells learn to attack liver cells, which are under increased metabolic stress due to a high fat high sugar diet, said lead investigator Dr. Laura Santambrogio, who is a professor of radiation oncology and of physiology and biophysics, and associate director for precision immunology at the Englander Institute for Precision Medicine at Weill Cornell Medicine. We have identified one protein probably the first of many that is produced by stressed liver cells and then recognized by both B and T cells as a target.

Back row from left to right: Madhur Shetty; Marcus DaSilva Goncalves; Laura Santambrogio; Lorenzo Galluzzi; Aitziber Buqu. Front row from left to right: Jaspreet Osan; Shakti Ramsamooj; Cristina Clement; Takahiro Yamazaki

The activation of the immune system further aggravates the damage already occurring within this organ in people who have these metabolic conditions, she said.

In type 2 diabetes or obesity, the liver stores an excessive amount of fat, which can stress cells, leading to a condition known as nonalcoholic steatohepatitis, commonly called fatty liver disease. The stress leads to inflammation, a nonspecific immune response that, while meant to protect, can harm tissue over time. Researchers now also have evidence that B and T cells activity contributes, too.

B cells produce proteins called antibodies that neutralize an invader by latching onto a specific part of it. Likewise, T cells destroy infected cells after recognizing partial sequences of a target protein. Sometimes, as happens in autoimmune diseases, these cells turn on the body by recognizing self proteins.

Dr. Santambrogio and her colleagues, including Dr. Lorenzo Galluzzi, assistant professor of cell biology in radiation oncology at Weill Cornell Medicine and Dr. Marcus Goncalves, assistant professor of medicine at Weill Cornell Medicine and an endocrinologist at NewYork-Presbyterian/Weill Cornell Medical Center, as well as researchers from Dr. Lawrence Sterns group at the University of Massachusetts Medical School, wanted to know what molecule within liver cells became their target.

Examining the activity of another type of immune cell, called dendritic cells, led them to a protein, called PDIA3, that they found activates both B and T cells. When under stress, cells make more PDIA3, which travels to their surfaces, where it becomes easier for the immune system to attack.

While these experiments were done in mice, a similar dynamic appears to be at play in humans. The researchers found elevated levels of antibodies for PDIA3 antibodies in blood samples from people with type 2 diabetes, as well as in autoimmune conditions affecting the liver and its bile ducts.

Unlike in autoimmune conditions, however, improving ones diet and losing weight can reverse this liver condition. The connection with diet and a decrease in fatty liver disease was already well established, Dr. Santambrogio said.

We have added a new piece to the puzzle, she said, by showing how the immune system starts to attack the liver.

Many Weill Cornell Medicine physicians and scientists maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosurespublic to ensure transparency. For this information, see profiles for Dr. Lorenzo Galluzzi and Dr. Marcus Goncalves.

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Researchers Identify the Target of Immune Attacks on Liver Cells in Metabolic Disorders - Weill Cornell Medicine Newsroom

UM School of Medicine Professor of Trauma Surgery Dr. Thomas Scalea Featured on National Network News Highlighting State of the Art Care Provided atUniversity of Maryland Medical Center's R Adams Cowley Shock Trauma Center

BALTIMORE, July 25, 2022 /PRNewswire/ -- A University of Maryland School of Medicine (UMSOM) faculty member was featured in a prestigious national news program over the weekend highlighting the lifesaving critical care medicine practiced at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (UMMC). In an extended segment called "One Night in America" that comprised half of the evening newscast for NBC Nightly News and additional coverage on MSNBC, a reporter was embedded at Shock Trauma for more than nine hours from Saturday evening, July 16, into Sunday morning to document emergency trauma cases caused by gun violence. Reporters were also embedded in three other major cities showing different perspectives including police response to shootings and community support from a local street pastor.

The special report aired on Sunday evening and prominently featured Thomas Scalea, MD, The Honorable Francis X. Kelly Distinguished Professor of Trauma Surgery at UMSOM and Physician-in-Chief of the R Adams Cowley Shock Trauma Center at UMMC. He also serves as Chief of Critical Care Services for the University of Maryland Medical System (UMMS).

Reflecting on the death of one of his patients, Dr. Scalea said in the segment, that gunshot deaths are an unnecessary injury in a civilized society. "This is one night in one city in the richest country in the world. How can this make any sense?"

For more than 50 years, the R Adams Cowley Shock Trauma Center has been a worldwide leader in trauma care and innovation, training some of the leading trauma physicians in the U.S. and around the globe. SOM physician-scientists have pioneered major advances in trauma care through research. Shock Trauma is the nation's first and only integrated trauma hospital and is considered a national model of excellence with a 96 percent survival rate. It is Maryland's Primary Adult Resource Center (PARC) designated to treat the most severely injured and critically ill patients. The Program in Trauma at UMSOM is the only multidisciplinary dedicated physician group practice that cares for injury in the United States.

Earlier this year, Dr. Scalea celebrated his 25thanniversary with the Shock Trauma Center. Among his many accomplishments, he cared for tens of thousands of Marylanders critically injured in motor vehicle collisions, falls and violent attacks, traveled to China and Haiti to render assistance to earthquake victims, helped train thousands of U.S. Air Force personnel and worked alongside military physicians in war-torn Afghanistan. He has steered Maryland's highest-level trauma center through two years of the COVID-19 pandemic.

Footage from Dr. Scalea's interviews and patient care in the Shock Trauma Center can be found in the links below.

About theUniversity of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System ("University of Maryland Medicine") has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent(#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

About the R Adams Cowley Shock Trauma Center

The R Adams Cowley Shock Trauma Center, University of Maryland was the first fully integrated trauma center in the world and remains at the epicenter for trauma research, patient care and teaching, both nationally and internationally today. Shock Trauma is where the "golden hour" concept of trauma was born and where many lifesaving practices in modern trauma medicine were pioneered. Shock Trauma is also at the heart of the Maryland's unparalleled Emergency Medical Service System. Learn more about Shock Trauma.

About theUniversity of Maryland Medical Center

The University of Maryland Medical Center (UMMC) is comprised of two hospital campuses in Baltimore: the 800-bed flagship institution of the 13-hospital University of Maryland Medical System (UMMS) -- and the 200-bed UMMC Midtown Campus, both academic medical centers training physicians and health professionals and pursuing research and innovation to improve health. UMMC's downtown campus is a national and regional referral center for trauma, cancer care, neurosciences, advanced cardiovascular care, women's and children's health, and has one of the largest solid organ transplant programs in the country. All physicians on staff at the downtown campus are clinical faculty physicians of the University of Maryland School of Medicine. The UMMC Midtown Campus medical staff is predominately faculty physicians specializing in diabetes, chronic diseases, behavioral health, long-term acute care and an array of outpatient primary care and specially services. UMMC Midtown has been a teaching hospital for 140 years and is located one mile away from the downtown campus. For more information, visit http://www.umm.edu.

This news release was issued on behalf of Newswise. For more information, visit http://www.newswise.com.

SOURCE University of Maryland School of Medicine

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UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE FACULTY MEMBER FEATURED ON NBC NIGHTLY NEWS SPECIAL REPORT ON GUN VIOLENCE IN AMERICA - PR Newswire

By Brian Tibbs

UIC Vice Chancellor for Health Affairs Dr. Robert Barish has been appointed to the 2022-2023 Board of Directors for the Association of American Medical Colleges, a nonprofit association dedicated to improving the health of people everywhere through medical education, health care, medical research, and community collaborations, a mission that is congruent with that of UI Health.

Association members comprise all 155 accredited U.S. and 16 accredited Canadian medical schools; approximately 400 teaching hospitals and health systems, including Department of Veterans Affairs medical centers; and more than 70 academic societies. Through these institutions and organizations, the Association of American Medical Colleges leads and serves medical schools and teaching hospitals and the millions of individuals employed across academic medicine, including more than 191,000 full-time faculty members, 95,000 medical students, 149,000 resident physicians and 60,000 graduate students and postdoctoral researchers in the biomedical sciences.

It is indeed an honor to join the board of directors of this esteemed and important organization, and I am looking forward to contributing my experience and background to its mission of advancing excellence in healthcare, Barish said. UI Health is already a leader among academic health enterprises. By collaborating with other health care leaders from across the nation, we can continue to advance education, care delivery and health equity.

Prior to joining UIC as vice chancellor of health affairs, Barish served as chancellor of the LSU Health Sciences Center at Shreveport from 2009 to 2015, where he provided leadership for the schools of medicine, allied health and graduate programs; a major academic medical center; and two affiliated hospitals.

Barish spent 24 years at the University of Maryland School of Medicine. He served as chief of emergency medicine from 1985 to 1996 and built a nationally recognized program. He was named associate dean for clinical affairs in 1998 and vice dean for clinical affairs in 2005.

That same year, following the devastation of Hurricane Katrina on the Gulf Coast, Barish helped lead a medical regiment dispatched by the state of Maryland to deliver emergency care to more than 6,000 hurricane victims in Jefferson Parish.

In addition to his medical duties at Maryland, Barish earned an MBA from Loyola College in 1995. From 1996 to 1998, he served as the chief executive officer of UniversityCARE, a University of Maryland physician-hospital network of family-oriented health centers located in neighborhoods throughout the Baltimore metropolitan area.

Barishs board appointment begins Nov. 15and will end at the conclusion of Learn Serve Lead: The AAMC Annual Meetingin November 2023.

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Vice Chancellor Barish appointed to Association of American Medical Colleges board - UIC Today

While the program has existed since 2008, Penn this year announced an expanded, formal partnership with five historically Black colleges Howard, Spelman and Morehouse in Atlanta, Xavier University of Louisiana, and Oakwood in Alabama.

We are talking about identifying students who show great potential and then we provide further enrichment, said Horace DeLisser, associate dean for diversity and inclusion and a 1981 Penn medical school graduate and pulmonary medicine specialist who has spent his entire career there.

For years, medical schools have struggled to diversify their pools. In 2020-21, only 8% or 7,710 of medical school students nationally identified as Black, according to the Association of American Medical Colleges. About 6.7% were Hispanic. Another 10.3% identified as multiple race/ethnicity.

While we have seen some increases over the years, the numbers in particular when we look at those who identify as Black or African American have been relatively flat, said Geoffrey H. Young, the associations senior director for transforming the health-care workforce. That doesnt mean that our schools havent been working diligently to increase diversity. They have.

Financial challenges, as well as structural racism, including disparities in K-12 education and access to housing, are among barriers, he said. Also complicating efforts to diversify student bodies is the high demand for students of color, said Annette C. Reboli, dean of Cooper Medical School of Rowan University. Smaller schools can lose admitted students to larger medical schools able to offer more generous scholarships.

Thats been a challenge that weve faced, that were also trying to raise money for scholarships so were not disadvantaged, said Reboli.

Nearly all medical schools that responded to a 2021 survey have pathway programs to attract more students of color, though they vary widely in structure and capacity, Young said. Locally, Cooper Medical School, Thomas Jefferson University, Philadelphia College of Osteopathic Medicine, Robert Wood Johnson Medical School at Rutgers, and Rutgers New Jersey Medical School all offer some form of preparatory programs or pipelines for college students from underrepresented or disadvantaged backgrounds to aid acceptance to medical school. Some of the programs require a student to have already taken the MCATs.

PCOM and Cooper also conduct outreach to students as young as elementary school age to encourage them to see a viable future in a medical profession.

Its not unusual for underrepresented students to not aspire to becoming a physician, said Reboli. They dont see many physicians who look like them.

Guaranteeing admission if students meet certain requirements and waiving the MCAT, as Penn does, is more rare, Young said.

Admitted students to Penn typically score in the top 1% on MCATs, DeLisser said.

If we had that as a filter, we would potentially lose the opportunity to really go after some talented diverse students, he said.

The program, he said, allows Penn to assess the students potential without MCATs in a way that is rigorous.

Jonathan Gaither, 20, who proudly wore a sweatshirt from Howard where he is a rising senior, wants to become a physician scientist and get both a doctorate and medical degree. The Colorado Springs resident said he views the Penn opportunity as a mandate to work doubly hard, not just for myself but for my peers.

I wont just be with [Penn Access Summer Scholars] students in medical school, said Gaither, the first in his family to pursue medicine. So I cant see myself as other.

Bryson Houston, 22, a 2021 graduate of Morehouse who completed Penns summer program, started medical school at Perelman last fall. His experience there helped him tremendously, he said.

I began to be more comfortable around these high-name professors and doctors and researchers and started to see myself in these spaces, he said.

Still, the strong support he got once in medical school made the difference.

It was insane to feel the love of the professors and my advisers, when I was going through tough times in the classroom, he said.

A native of the Dallas area and the son of a high school principal and X-ray technician, Houston hadnt considered Penn until his adviser called him one day when he was a sophomore.

He said, Hey can you put on a suit and meet me in my office in 15 minutes? Houston recalled.

Thats when he met DeLisser, who told him about the research opportunity and MCAT waiver. Though he thought it was pretty cool, he didnt apply immediately. Two weeks before the deadline, DeLisser reached out again, and Houston applied.

Penns medical school receives more than 7,000 applications annually, accepting about 250 or 3%-4%.

Thirty-nine of 150 students in the 2021 medical class at Penn 26% come from underrepresented groups. Penn ranks 28th in the country in medical school student diversity, according to U.S. News and World Report. Temple by comparison is sixth, while Drexel ranks 81st.

The summer scholars program started with promising undergraduates from Penn, Princeton and Haverford and eventually Bryn Mawr. Eighty-six students have participated since its inception, including 21 who are currently enrolled. Nearly all have gone on to medical school, and of those who went to Penn, all either graduated or are still enrolled.

The expansion to historically Black colleges began informally several years ago with DeLisser visiting and meeting with promising students. He coached them on medical school applications and offered advice.

Now we are getting students from Xavier who grew up in Arkansas, he said.

Much of the students summer research focuses on medical issues facing people of color, which appealed to Gabrielle Scales, 21, a rising senior at Spelman. Her research involves breast density of Black women as it relates to cancer.

She looks forward to advocating for patients from underrepresented groups.

There are not a lot of doctors who look like me and there could be a lot more, she said.

DeLisser eventually hopes to add Hispanic-serving colleges, once he can find donor support for tuition.

Growing the effort is important, especially considering that those from underrepresented backgrounds are more likely to serve those communities, the AAMCs Young said.

Thats what Johnson plans to do.

A lot of people from underrepresented communities, they benefit more from having physicians who look like them, she said, and understand the things they are going through.

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Penn med school partners with Spelman, Morehouse, other HBCUs to increase diversity - The Atlanta Journal Constitution

The National Football League is launching a program to invite medical students from historically Black colleges and universities to work with NFL teams medical staffs this season. The goal is to help diversify the pipeline of Black doctors who are interested in careers in sports medicine.

As part of their coursework, third- and fourth-year medical students do one-month clinical rotations focused on different specialties, often within the teaching hospitals affiliated with each medical school. The NFL Diversity in Sports Medicine Pipeline Initiative will allow students interested in sports medicine to do a rotation at an NFL club, working alongside physicians caring for professional athletes.

What we're really looking to do is to have the students understand all of the elements to go into the care of the NFL athlete, and also connect with mentors and advisors who they can stay in touch with as their careers develop, said Dr. Allen Sills, a neurosurgeon and the NFLs chief medical officer.

The program will accept 16 medical students interested in either primary care sports medicine or orthopedic surgery from four HBCUs: Charles R. Drew University of Medicine and Science, Howard University College of Medicine, Morehouse School of Medicine and Meharry Medical College.

Students will be placed with one of eight participating NFL clubs: Atlanta Falcons, Cincinnati Bengals, Los Angeles Chargers, Los Angeles Rams, New York Giants, San Francisco 49ers, Tennessee Titans and Washington Commanders.

Participants will learn how to provide care to players "both in practice situations, game day situations, in the training room, possibly in physicians offices, and even in surgery as well, Sills said. So it's a comprehensive overview of the sports medicine team of a professional team.

Nearly 86 percent of the members of the National Football League Physicians Society identify as White, and only 5 percent identify as Black, according to an NFL press release citing internal surveys.

Sills said the NFL has a long way to go to increase diversity among its medical staff. But the problem of lack of diversity in U.S. medicine is even broader.

According to a study in the New England Journal of Medicine, less than 12 percent of U.S. physicians identify as either Hispanic or Black, but census data shows these groups make up 18 percent and 13 percent of the U.S. population, respectively. Parts of sports medicine fall under orthopedic surgery, which is among the least diverse specialties in medicine, with only 3.4 percent of medical school faculty identifying as Black, according to one study.

We need to be very intentional about that. And we need to work on this pipeline of people who are choosing these careers, and making sure that we assist them, Sills said.

According to a statement from the NFL, the program will recruit medical students from additional academic institutions in future years, and expand to include placements at more NFL clubs across the U.S. in 2023.

The program will also work toward widening the sports medicine pipeline for other people of color and women in the seasons ahead [and] broaden to disciplines beyond primary care sports medicine and orthopedic surgery.

Disciplines that may be added in future years include: physicians assistants, certified athletic trainers, physical therapists, occupational therapists, nutritionists and behavioral health clinicians.

This story comes from a reporting collaboration that includes the Indianapolis Recorder and Side Effects Public Media, a public health news initiative based at WFYI. Contact Farah at fyousry@wfyi.org. Follow on Twitter: @Farah_Yousrym.

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To spur diversity in sports medicine, NFL teams will host med students from HBCUs - WFYI

Fourth-year medical student Mackenzie Bennett was on a conference call when news broke that Roe v Wade had been overturned. The topic was telehealth and medication abortion.

We stopped the meeting, we just had to log off and sit in those feelings for a minute. It was honestly really devastating, says Bennett, who is pursuing dual medical and public health degrees specializing in OB-GYN at Emory School of Medicine in Atlanta.

In coming weeks, Georgia will probably ban most abortions after six weeks. For students like Bennett pursuing their medical education in states poised to ban abortion services, the ruling impacts not just the training they will receive, it leaves them grappling with the personal, moral and practical challenges of a common (and sometimes, life-saving) healthcare procedure becoming criminalized. Clinical training opportunities for providing abortions are already limited in the US typically, students who want that training have to seek it out. In the wake of Roes overturning, those opportunities will become even more limited, forcing some students to travel out of state to seek out full-spectrum training, potentially prompting an exodus of medical students from the states banning abortion services.

The medical institutions they attend are left wondering how their OB-GYN programs will be able to give students the required clinical training to maintain their accreditation. That clinical experience involves observation of, and hands-on training in, uterine evacuation procedures, including medication abortion, first-trimester aspiration abortion, and dilation and evacuation (D&E) procedures used not just for induced abortions, but also for miscarriage management and other aspects of reproductive healthcare.

If we cant show that were providing enough of an experience for them to gain competency in that area, then that threatens the accreditation of any program thats meeting that challenge, says Dr Carrie Cwiak, an Emory professor of obstetrics and gynecology, and director of the medical schools family planning division. Thats what were potentially concerned about.

Some of Bennetts classmates have raised concerns about the what-ifs: what happens if an ectopic pregnancy rolls into the emergency department? What does this mean for cancer treatment? It has implications for everyones practice and everyones personal life, says Bennett, who is a member of Medical Students for Choice. I think people are realizing that this impacts them no matter what specialty theyre pursuing. Its incredibly far-reaching.

Medical students are weighing implications of Roes reversal on both professional and personal levels. As someone who has a uterus and can get pregnant, this will affect me personally, says Laura Rush, a second-year student at a different medical school in Georgia (the school did not want students giving its name). But also as future physicians, potentially OBs, who want to treat our patients with empathy and using evidence-based medicine, it feels like its disregarding a lot of that.

Sachi Shastri, a second-year student at the same school, is considering a career in either OB-GYN or psychiatry. She says that the news, while not a surprise, was still shocking as is the sense that her future career could be in jeopardy. I dont think I let myself believe that this future was so close and so present.

She says peers at her school who previously never expressed opinions about abortions are now speaking up. Rush adds that in the wake of the supreme court ruling, there was an increase in signups for her campuss chapter of Medical Students for Choice.

There is only one accrediting body for OB-GYN residency training in the US, The Accreditation Council for Graduate Medical Education (ACGME). In response to the supreme court decision, ACGME is proposing possible changes to its rules for OB-GYN programs: in states where laws prevent students from receiving clinical experience, programs will have to provide students access to training in a state that does. (Students with religious or moral objections can opt out.) While some medical students OB-track or otherwise seek out elective travel rotations already as a way to broaden their experience, Cwiak points out that abortion bans could make these travel rotations mandatory a financial and logistical burden for some students.

Cwiak says when it comes to abortion education lectures wont change, and educators might increasingly incorporate simulations with models. In medical education, we need to ensure that people have direct observation of the care we provide, and participation in that care, under supervision, says Cwiak. Especially when youre talking about procedures: you have to develop a skill, and confidence in that skill, and make sure youve done enough cases to learn that skill adequately.

To learn those skills, some students are limiting their residency options to states where abortion is legally protected. I think thats a large undertone of the conversations Im having with other medical students, especially ones that are in their last year like me, as were applying for residency, Bennett says. This has a major impact on where you can get trained, and what kind of training you can get. And, by extension, where medical trainees choose to eventually practice.

Others are concerned that the training they have already lined up in restricted states will no longer be available to them. Ive got a rotation lined up in reproductive health [in Georgia] where I would get that training on doing medical abortions, and Im worried that I wont be able to get the training I want, says Ben Haseen, a medical student at Atlantas Morehouse School of Medicine. Haseen adds that, as a transgender man, access to reproductive care is a personal issue, not just a professional one. Its a big deal for me, because medical access is my biggest passion, he says.

With the restrictive laws, you likely will see a behavioral change, that people will make decisions about where they choose to train, where they choose to practice, depending on the legislative landscape [in that state], explains Cwiak. If states and their legislations are interfering with your ability to practice safe, effective, ethical healthcare, like abortion care, you could understand that people would be reticent about training and practicing there.

Its an ethical dilemma for some trainees: leave their state to seek out the training they want, or stay and try to train and practice within the legislative confines of their state. Im very conflicted because I do not want to leave the south, says Haseen. I love being in the south because I love the patients here. Im at this crossroads where I could get training up north and then come back, but I also dont want to leave my patients here and abandon them.

With over half the countrys states likely to ban or severely restrict abortion, students and educators alike are also concerned that an exodus of providers from these states, will further compound healthcare disparities and worsen existing public health crises. (Data show that states with abortion restrictions have higher maternal mortality rates. In Georgia, half of the states counties lack a single OB-GYN provider, and maternal mortality rates are among the worst in the country.)

The people who live in these states still deserve an excellent quality of care and excellent doctors with world-class training, just like everywhere else in the country, says Bennett. But if people feel like they cant get a full education here, theyre not going to want to come here, and that just makes everything worse down the line.

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Its incredibly far-reaching: medical students on the Roe reversal - The Guardian US

BALTIMORE In the stuffy fourth-floor attic of a historic Baltimore academic building, amid discarded furniture and dusty filing cabinets, Larry Pitrof discovered treasure.

The trove isnt worth millions. But its a fascinating relic and a historic bridge between fact, lore and baseball.

Archibald Moonlight Graham played two innings of right field in a major league baseball game in 1905 and had zero at-bats. That was the extent of his big league career, a forgettable footnote in baseball history.

Then, years after his death, author W.P. Kinsella included Graham in his 1982 novel Shoeless Joe, which became the inspiration for the 1989 film Field of Dreams. The film that immortalized the phrase, If you build it, he will come, and which is beloved by American fathers and sons, launched Graham into folk hero status.

But Graham is no tall tale. He spent most of his life as a doctor and attended the University of Maryland School of Medicine in Baltimore in the early 1900s.

Pitrof is the medical school alumni associations executive director. Hes also a baseball fanatic whos long been intrigued by Graham.

Every few months, for one reason or another, hes visited the fourth floor of the schools Gray Hall, a 182-year-old building less than three blocks from Oriole Park at Camden Yards. Each time, hed pass a few cabinets, and each time, for 28 years, hed half-pause and half-wonder if anything from Grahams past was inside.

After Major League Baseball played its first Field of Dreams game on Aug. 12 next to the filming location in Iowa, Pitrof on a hunch there might be some trace of Graham decided to peek in the cabinets. There, within a stack of documents dating from 1812 to 1916, he found a dozen letters between the schools dean and one Archie Graham, one of baseball historys most unassuming legends.

There was that tingling feeling, Pitrof said.

The Graham documents span 1903 to 1905, the years Graham attended medical school in Baltimore while continuing his baseball career in the summers. They include Grahams matriculation cards and correspondence with the school.

Writing from Scranton, Pennsylvania where he played in the minor leagues after his MLB appearance with the New York Giants Graham noted he was enclosing $30, which he owed to the institution. In one letter, he sought a recommendation. In another, he asked whether there was any chance for me to get into Bay View in a training position, likely referencing the current Johns Hopkins Bayview Medical Center east of the city.

Before this discovery, there were only a handful as few as five or six known Graham signatures. In the letters, Pitrof found four more.

Graham went on to become an adored doctor, as depicted in the movie. He also made essential contributions to medical research. It was his 1945 study that prompted pediatricians to begin regularly monitoring blood pressure in children.

Theres a bounce in Pitrofs step and a thrill in his voice when he discusses Graham, who some categorize as a cult figure.

No, Pitrof protests. He was a role model.

Everybody had that chance that got away

Jonathan Algard created an eBay account in 2000 in pursuit of a historic needle in a haystack.

A baseball autograph collector who works in a foundry in Pennsylvania, Algard had the remote goal of landing a Graham signature. He took a meticulous approach, purchasing yearbooks from a high school in Chisholm, Minnesota, where Graham lived as an adult. He hoped Graham, a school physician, might have signed one for a student.

Dozens of yearbooks and 17 years into his search, Algard found it: a 1943 yearbook Graham signed for a graduate before the young man headed to World War II.

Algard, 52, has been collecting autographs since he was 5 years old, and his collection numbers in the thousands. He estimates he has six Hank Aaron autographs. But hes never gone to the lengths he did for a Graham autograph.

The character itself in the movie, I dont know, I think everybody can relate to, in a way, he said, trying to explain his and others fascination with Graham. Everybody had that chance that got away.

Its unknown why Grahams moniker was Moonlight. His medical school yearbook notes he enjoyed midnight walks and its also been suggested its because he moonlighted as a doctor. But articles at the time dubbed him Deerfoot for his supreme speed and Dr. Graham, because of his medical background. He was an exceptional minor league player and a fan favorite.

And yet, he had only the solitary MLB appearance 117 years ago last week stepping into the on-deck circle once, but never batting. He later served as a doctor for more than half a century, until his death at 88.

Field of Dreams, a reflection on the relationship between a father and son, stars Kevin Costner as an Iowa farmer who plows over his corn to build a diamond for ghosts of baseballs past. Graham is depicted both as a young ballplayer and, later in life, as a cherished pediatrician. When Costners character calls it a tragedy that Graham never realized his dream of batting in the big leagues, the fictionalized Graham replied: Son, if Id only gotten to be a doctor for five minutes, now that would have been a tragedy.

The movie takes artistic liberties, such as portraying Graham as living his whole life in Chisholm, making no mention of his origins in North Carolina nor of him attending medical school in Baltimore.

But, as in the movie, Grahams legacy is celebrated in real life. The high school in Chisholm awarded a scholarship in his honor for 20 years after the films release. The baseball field in the town is named for him, as is a festival held each August.

Grahams pioneering research into blood pressure in children was seminal, Pitrof says. And after the doctor died in 1965, a U.S. representative from Minnesota inserted his obituary which called Graham a champion of the oppressed for his generosity to children into the Congressional Record.

They did not embellish this mans character, Pitrof said of the movie.

Four signatures with a niche value

Letters between Graham and the University of Maryland School of Medicines dean sat in the cabinet, likely for decades. Despite not being preserved until recently, they remain in good condition. They are easy to read and detail practical matters: Graham sending a certification from a former school (the University of North Carolina), Graham requesting an academic catalog for a friend, and the dean writing that he is very glad to see that you have done so well academically.

Its a real glimpse into his life, said Tara Wink, the schools historical collections librarian and archivist.

One letter is signed, Your friend, Archie W. Graham, while another has a squeezed-in A.W. Graham. Two matriculation cards are signed Archibald Wright Graham.

A 1963 check signed by Graham sold for $3,000 in 2008, but signatures from the most germane period in a historical figures life are more valuable, making it possible the recently discovered letters are worth more. Still, their value is, like Grahams story itself, niche.

You could credibly make the argument that the signatures are a few thousands of dollars, and you could certainly make the argument that theyre tens of thousands of dollars, said David Hunt, president of Hunt Auctions in Exton, Pennsylvania, which specializes in vintage sports memorabilia.

A modern-day Moonlight

Mark Hamilton reacts to news of the discovery the way many others do: Thats so cool.

Like Graham, Hamilton had a brief major league career, and like Graham, he became a doctor. Hamilton is a Baltimore native who attended Friends School before moving away at age 12. He played for the St. Louis Cardinals in 2011 and hoped to return to the big leagues, but an injury sidelined him in 2013.

When major league opportunities dwindled, he heeded some advice from his father: Baseball is a young mans game. You can be a doctor forever. Around the age of 30, he, like Graham, retired from baseball and pursued medicine full time. He graduated from medical school in 2020 and is an interventional radiology resident at Northwell Health in New York City.

During his brief MLB career, he notched 12 hits.

I definitely didnt expect my final major league bat to be my final major league bat, he said last week. I thought Id probably get called back up.

In the film, Graham retires from baseball after his major league appearance. In reality, he played three more years in the minors, likely hoping for another shot at the big leagues.

His movie self expresses a sentiment similar to that of Hamilton: Back then, I thought, Well, there will be other days. I didnt realize that was the only day.

This is history

Pitrof said the letters will likely stay in an archive at the schools Historical Collections Department; the storied system boasts one of the oldest medical schools in the country, as well as the worlds first dental school.

But he said if other organizations the Baseball Hall of Fame or the Smithsonian Institution, for example sought to display the correspondence, the alumni association would consider such a request.

This is history, Pitrof said. This is a big deal that this was uncovered, and its bigger than us.

If the correspondence is exhibited, its likely to attract visitors. People will come.

If they ever put them on display, said Algard, who still flips through his Graham-signed yearbook on occasion. I will probably go see them.

2022 Baltimore Sun. Visit baltimoresun.com. Distributed by Tribune Content Agency, LLC.

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Autographs of Moonlight Graham of 'Field of Dreams' fame are discovered at Baltimore medical school he attended - The Killeen Daily Herald

BOSTON High dose inhaled nitric oxide gas (iNO) is a safe and effective respiratory therapy for pregnant women hospitalized with severe COVID-19 pneumonia, resulting in a more rapid weaning from supplemental oxygen and reduced length of hospital stay, according to a research team led by Massachusetts General Hospital (MGH). In a study published in Obstetrics & Gynecology, researchers from four Boston hospitals reported that the addition of twice-daily nitric oxide to standard of care oxygen therapy decreased the respiratory rate of pregnant women with low oxygenation levels of the blood without causing any side effects.

To date, very few respiratory treatments to complement supplemental oxygenation in COVID-19 pregnant patients have been tested, says senior author Lorenzo Berra, MD, with the Department of Anesthesia, Critical Care and Pain Medicine, MGH. Investigators from all four medical centers that participated in our study agreed that administration of high dose nitric oxide through a snug-fitting mask has enormous potential as a new therapeutic strategy for pregnant patients with COVID-19.

Pneumonia triggered by COVID-19 is particularly threatening to pregnant women since it may quickly progress to oxygen insufficiency in the blood and bodily tissues, a condition known as hypoxemia, requiring hospitalization and cardiopulmonary support. Compared to non-pregnant female patients with COVID-19, pregnant women are three times more likely to need intensive care unit admission, mechanical ventilation, or advanced life support, and four times more likely to die, notes Carlo Valsecchi, MD, lead author in the Department of Anesthesia, Critical Care and Pain Medicine, MGH. They also face a greater risk of obstetric complications such as preeclampsia, preterm delivery, and stillbirth.

Nitric oxide is a therapeutic gas that was initially approved by the U.S. Food and Drug Administration in 1999 for inhalation treatment of intubated and mechanically ventilated newborns with hypoxic respiratory failure. With MGH driving many early studies, iNO in high concentrations was also shown to be effective as an antimicrobial in reducing viral replication of SARS-CoV-1 and, more recently, SARS Co-V-2, the virus that causes COVID-19. During the first wave of COVID-19, MGH treated six non-intubated pregnant patients with iNO at high doses of up to 200 parts per million (ppm). Findings of a more favorable outcome with iNO led MGH clinicians to offer this treatment to other pregnant patients, and to design the current study to determine the safety and efficacy of iNO200 for COVID-19 pneumonia in pregnancy.

To that end, a collaborative network of four medical centers in the Boston area was formed. In addition to MGH, it included Tufts Medical Center, Beth Israel Deaconess Medical Center, and Boston Medical Center. Researchers and clinicians from multiple departments -- including critical care medicine, respiratory care, and maternal fetal medicine -- studied 71 pregnant patients with severe COVID-19 pneumonia admitted to these hospitals, 20 of whom received iNO200 twice daily. The study found that iNO therapy at this dosage, when compared to standard of care alone, resulted in reductions in the need for supplemental oxygen and in hospital and ICU lengths of stay. No adverse events related to the intervention were reported in either mothers or their babies.

Being able to wean patients from respiratory support quicker could have other profound implications, including reducing stress on women and their families, lowering the risk of hospital-acquired infections, and relieving the burden on the health care system, notes Berra. Above all, our study supports the safety of high dose nitric oxide in the pregnant population, and we hope more physicians will consider incorporating it into carefully monitored treatment regimens.

Berra is an associate professor of Anesthesia, Harvard Medical School (HMS), and medical director of Respiratory Care, MGH. Valsecchi is a post-doctoral fellow and investigator in the Department of Anesthesia, MGH. Co-authors include William Barth, Jr., MD, vice chair of Obstetrics, MGH, and an associate professor of Obstetrics, Gynecology, and Reproductive Biology, HMS; Ai-ris Collier, MD, investigator and instructor in Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center; Ala Nozari, professor of Anesthesiology at Boston Medical Center; Jamel Ortoleva, MD, assistant professor of Anesthesiology at Tufts Medical School, and cardiothoracic anesthesiologist and critical care physician at Tufts Medical Center; and Anjail Kaimal, MD, chief of the Division of Maternal-Fetal Medicine, MGH, and an associate professor of Obstetrics, Gynecology, and Reproductive Biology, HMS.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. TheMass General Research Instituteconducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in theU.S. News & World Reportlist of "Americas Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.

Obstetrics and Gynecology

High-Dose Inhaled Nitric Oxide for the Treatment of Spontaneously Breathing Pregnant Patients With Severe Coronavirus Disease 2019 (COVID-19) Pneumonia

7-Jul-2022

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Inhaled nitric oxide reduces hospital stay and improves oxygenation in pregnant patients with COVID-19 pneumonia - EurekAlert