Jersey Medical School Research Articles

Broken Promises to the People of Newark: A Historical Review of the Newark Uprising, the Newark Agreements, and Rutgers New Jersey Medical School's Commitments to Newark.

Many have referred to the coronavirus disease 2019 crisis and intertwined issues of structural racism as “twin pandemics”. As healthcare workers in Newark, New Jersey, a city heavily affected by the twin pandemics, we recognize that health workforce changes must be grounded in our community’s recent history. The objective of this essay is to briefly describe the relationship between organized medicine, state and local leaders, and the people of Newark. We begin with a discussion of Newark in the 1950s and 1960s: its people experienced poor socioeconomic conditions, terrible medical care, and the many sequelae of abhorrent racism. Plans to establish a New Jersey Medical School in Newark’s Central Ward also threatened to displace many residents from their homes. We then describe the Newark Agreements of 1968, which formalized a social contract between the state, business leaders, and people of Newark. In part, the Medical School committed to indefinitely promoting public health in Newark. We share progress towards this goal. Finally, we document key healthcare administrative decisions facing our community today. Stakeholder opinions are shared. We conclude that the Newark Agreements set an important standard for communities across the country. Creative solutions to healthcare policy may be realized through extensive community collaboration.

Fever and Seizure in an 11-month old Girl.

1. Avani Ganta, MBBS* 2. Adin Nelson, MD* 3. Carol Singer-Granick, MD* 4. Aditi Khokhar, MBBS* 1. *Rutgers New Jersey Medical School, Newark, NJ An 11-month-old Black girl, born at term, with no significant medical history presents to the emergency department (ED) after becoming unresponsive at home. She had 2 days of nasal congestion, rhinorrhea, and tactile fever. She had an episode of upward eye rolling and stiffening of the upper extremities, followed by unresponsiveness at home. The whole episode lasted for approximately 2 minutes. Her parents started cardiopulmonary resuscitation on her and called emergency medical services (EMS). On EMS arrival, the patient was responsive but weak. In the ED she is febrile to 103°F (39.4°C), tachycardic with a heart rate of 161 beats/min, alert, and active. Her blood pressure is initially high at 116/76 mm Hg, but it normalizes to 91/67 mm Hg on admission. Her physical examination findings are normal except for nasal discharge. Auscultation yields normal S1 and S2 heart sounds with no murmurs, and lung fields are clear. Abdominal examination findings are normal, with no distention or organomegaly. Neurologic examination findings are normal for her age: the patient is smiling and playful. Her pupils are equal and reactive bilaterally. No facial asymmetry is noted. She has good strength in all extremities, is sitting without support, and can pull to stand. She has symmetrical normal reflexes and a negative Chvostek sign, and no fasciculations or spasms are noted. She had no frontal bossing, widening of wrist joints, or long bone deformities. Laboratory studies are obtained, including complete blood cell count, complete metabolic panel, urinalysis, blood culture, and urine culture (Table). Initial laboratory evaluation shows a hemoglobin level of 12.9 g/dL (129 g/L); hematocrit value, 38.2%; white blood cell count, …

The Immutable Burden of Racial Disparities in Breast Cancer

The Immutable Burden of Racial Disparities in Breast Cancer

984. HIV Pre-Exposure Prophylaxis (PrEP) Prescription Rates Among Adolescents and Young adults (AYAs) at an Urban Academic Medical Center in Newark, NJ from 2017-2019: A Quality Assessment of HIV Prevention for High Risk Youth within the Epicenter of the NJ HIV Epidemic

BackgroundIn 2017, 21% of new HIV diagnoses occurred in AYAs (ages 13-24), disproportionately among black and Hispanic men who have sex with men (MSM). However, only 0.1-1.5% and 9.5-15.4% of national PrEP prescriptions have been provided to AYAs under 18 and 24, respectively, with a white male majority. In 2018, PrEP was approved for use in adolescents weighing more than 35kg. However, limited studies on attitudes of AYA providers suggest lack of familiarity of PrEP and concerns about adherence, safety, confidentiality, and cost have led to a slow uptake among AYAs. Here we describe the AYA PrEP prescription rates at Rutgers New Jersey Medical School (NJMS) in two unique practices, the Infectious Disease Practice (IDP) and Division of Adolescent and Young Adult Medicine (DAYAM).MethodsMedical records were queried for patients prescribed Truvada for PrEP at NJMS from 2017-2019 to assess the specialty-specific prescription rates and demographics of AYAs on PrEP.ResultsOf the 273 patients who were prescribed PrEP from 2017-2019, 2.2% (n=6) and 20.5% (n=56) were under 18 and 24, respectively. IDP and DAYAM respectively prescribed PrEP to 62.5% (n=35) and 33.9% (n=19) of AYAs. Among all AYAs on PrEP, 71.4% were black, 21.4% Hispanic, 19.6% transgender women (TGW), and 85.7% MSM or TGW who have sex with men. Most (73.7%) AYAs at DAYAM received PrEP from their primary care providers (PCP) compared to only 5.7% at IDP.Table 1. Department-specific characteristics of (A) patients of all ages and (B) AYAs prescribed PrEP at NJMS between 2017-2019, n (%). Fig. 1-3. Annual percentage of (1) patients receiving PrEP at NJMS by age group and (2) AYAs receiving PrEP by department, and (3) percentage of AYAs prescribed PrEP by their PCP, 2017-2019. Fig. 4. Percentage of AYAs prescribed PrEP at NJMS between 2017-2019 by (A) race, (B) gender identity, and (C) HIV transmission risk factor, % (n). ConclusionAYA PrEP prescription rates at NJMS were higher than national estimates, primarily driven by IDP and DAYAM, in contrast to national data identifying emergency, family and internal medicine providers as common AYA PrEP prescribers. Compared to national data, our AYAs on PrEP better reflected the national PrEP indications by race and HIV risk factor (although intravenous drug use was not identified as a PrEP indication in our study presumably due to a lack of forthcomingness). IDP and DAYAM routinely identify high risk AYAs, screen for PrEP eligibility using detailed, nonjudgmental sexual histories, and prescribe PrEP to AYAs. It is thus important to integrate primary care into subspecialty clinics with an emphasis on including PrEP in routine sexual/reproductive health services. PCPs in other fields should expand AYA PrEP prescriptions to further engage high risk youth in HIV prevention.Disclosures All Authors: No reported disclosures

MiR-708-5p enhances erlotinib/paclitaxel efficacy and overcomes chemoresistance in lung cancer cells.

Lung cancer is a collection of aggressive tumors generally not diagnosed until late-stage, resulting in high mortality rates. The vast majority of non-small cell lung cancer (NSCLC) patients undergo combinatory chemotherapeutic treatment, which initially reduces tumor growth, but frequently becomes ineffective due to toxicity and resistance. Researchers have identified multiple signaling pathways involved in lung cancer chemoresistance, including cyclooxygenase-2 (COX-2)/microsomal prostaglandin E synthase-1 (mPGES-1) derived prostaglandin E2 (PGE2). While COX-2 inhibitors have shown promise in the clinic, their use is limited due to severe side effects. One novel approach to effectively suppress COX-2 signaling is through microRNA (miRNA). MiRNAs are small-noncoding RNAs commonly misexpressed in cancer. One tumor suppressive miRNA, miR-708-5p, has been shown to repress pro-resistant signaling pathways, including COX-2 and mPGES-1. Here, we demonstrate that chemotherapies reduce COX-2 expression, possibly through induction of miR-708-5p. Moreover, combination treatment of erlotinib (ERL) or paclitaxel (PAC) with miR-708-5p enhances COX-2 and mPGES-1 protein suppression. We also show that combination chemotherapeutic and miR-708-5p treatment intensifies the anti-proliferative and pro-apoptotic effects of ERL and PAC. We also created ERL and PAC resistant lung cancer cell lines, which have increased COX-2 expression and diminished miR-708-5p levels compared to naïve lung cancer cells. While ERL and PAC treatments do not alter resistant cell phenotype alone, combination treatment with miR-708-5p partially restores the chemotherapies’ anti-proliferative effects and fully restores their pro-apoptotic qualities. These data suggest miR-708-5p may have potential combinatory therapeutic value to more efficaciously treat lung tumors while overcoming chemoresistance.

Medical Student Experience in the Wake of COVID-19 Pandemic and Next Steps

Back to table of contents Previous article ViewpointsFull AccessMedical Student Experience in the Wake of COVID-19 Pandemic and Next StepsGrace AnGrace AnSearch for more papers by this authorPublished Online:16 Nov 2020https://doi.org/10.1176/appi.pn.2020.11b30AbstractThe year 2020 has brought much stunning news. From deadly wildfires and giant hornets to racial injustice and a heated presidential election, there has been no shortage of events to challenge our mental well-being. But at the top of the list is COVID-19, which has universally affected people so much that nowadays conversations often start with “before COVID” and “after COVID.” When quarantine For COVID-19 was implemented and medical student clinical rotations were canceled in March, medical students at Rutgers New Jersey Medical School (NJMS) jumped into action to support the community and front-line workers. We volunteered for childcare, delivery of fresh groceries, collection and production of personal protective equipment, clinical research, and the creation of “wellness spaces” in the hospital.I volunteered at the New Jersey COVID-19 Hotline. Most callers requested information on testing locations and hours. Others asked which emergency rooms were safe for getting care for their grandparents for emergencies unrelated to COVID-19. Many people avoided the hospital altogether. Back on the floors, I encountered patients who had been severely affected by COVID-19. I distinctly remember the patient with diabetes who needed a below-the-knee amputation due to a worsening ulcer that progressed to osteomyelitis. He delayed care because he was afraid of contracting coronavirus in the hospital.In June, I was on the consultation-liaison service, and we consulted on a number of cases for anxiety and depression. Many patients had lost their jobs due to the pandemic, and one patient had lost her husband to COVID-19, home, and dog while she was recovering from the virus at the hospital. Psychiatry patients experienced interruptions to their care.Aside from losing friends and loved ones to COVID-19, we must recognize how the pandemic has impacted people in broader ways. Those who have recovered continue to have lingering symptoms. Others have been affected through socioeconomic impacts or delayed care. Therefore, medical students should approach patients with more humanism and compassion than ever, seeking to learn about their social history and determine how the pandemic has impacted their lives. Because medical students have more time to spend with patients, we should be trained to screen all patients for depression, trauma, domestic violence, life events, and stressors. Also, we should pay particular attention to patients with preexisting mental disorders to prevent progression of their illness.NJMS students get strong didactics on health equity and social justice. The curriculum and clinical opportunities should be expanded on breaking bad news, palliative care, and bereavement support for patients’ families. Through collaboration with the University Hospital Chaplaincy team, eight senior medical students provided spiritual care and virtual family support to those affected by the pandemic. With the changing public health environment and needs of our community, such learning and experiences should start during the preclinical years for all students.We know that the pandemic is far from over. The number of COVID-19 cases continues to rise, not only in the United States, but in other countries as well. Eager to return to campus life, many college students have fallen ill with the virus. Rather than becoming lax about following public health guidelines, people need to learn more about the consequences of COVID-19, even if they have already had the virus.Looking forward, medical students should receive early training on how to critically read research articles in order to be up to date with the latest scientific findings, as we expect that patients will seek care for long-term COVID-related neurological and psychiatric symptoms. Clinical students should be more vigilant about mental health, physical and sexual abuse, and substance abuse. Therefore, we should be equipped with the PHQ-9, Trauma Screening Questionnaire, and Stressful Life Events Screening Questionnaire, and the communication skills necessary for hard conversations. We should also gain experience in other aspects of mental health care such as social work services, community resources, and group or family therapy, whether it is during mandatory clerkships or electives.We medical students have learned much this past year beyond the usual curriculum. Perhaps the most important skill we have learned is the ability to be flexible and adaptable to an extent that we had never imagined. We stand ready to respond to our patients’ needs, whatever they may be. ■Grace An is a fourth-year medical student at the Rutgers New Jersey Medical School. She is applying for residencies in psychiatry and combined psychiatry/family medicine. ISSUES NewArchived

In Reply to the Letter to the Editor Regarding “Emerging Trends in the Neurosurgical Workforce Density of Low-and Middle-Income Countries: A Cross-Sectional Study”

Medical students report growing interest in health inequity and global surgery, subjects not currently integrated to their core curriculum. Currently, fundamental tenets of global surgical inequity are only available to students on an elective basis or in special interest groups. Therefore, an hour-long course with emphasis on global surgery was developed for third-year medical students. The aim of this study was to examine student response to this pilot course and to establish whether course content was applicable to clinical rotations.A 1-hour structured curriculum was delivered to third-year medical students (MS3s) during the 2-day orientation phase of each rotation of an 8-week surgery clerkship from August 2018 to May 2019. The course targeted approximately 30 students per session in the preclinical orientation at Rutgers—New Jersey Medical School. Upon completion of the 8-week clerkship rotation, a paper survey was administered to evaluate student's exposure to previous content, attitudes toward global health, interest and engagement in course materials, and applicability of learned course content to local environments.Rutgers—New Jersey Medical School, an urban medical school located in Newark, New Jersey.A total of 191 students attended the global surgery and health equity course; 146 participants participated in the postcourse survey.When asked about baseline interest in global or public health, the majority (51%) were extremely interested or very interested. Nearly all participants found the course to be valuable (94%). When asked which educational modality was preferred, 23% of participants favored the traditional lecture component and 29% favored case-based discussions. Nearly half (48%) the respondents found both modalities to be valuable. Fifty students (34% of respondents) reported encounters with patients affected by barriers in access to surgical care during their clerkships.Medical students responded favorably to this health inequity and global surgery pilot course and requested supplemental lectures. Additionally, course content was applicable to local clinical experiences. Therefore, 1 modality of integrating global surgery to the established curriculum is under the framework of health inequity and social determinants of health during surgical clerkships. This study demonstrates that meaningful inclusion of global surgery and health inequity can be implemented within the existing curricular structure.

Medical Students Envision Mental Health in Post-COVID World

Medical Students Envision Mental Health in Post-COVID World

Rutgers New Jersey Medical School.

Rutgers New Jersey Medical School.

Creating Disability-Competent Medical Students Via Community Outreach

IntroductionMedical students often have limited exposure to providing care to physically and cognitively disabled patients. To address this gap, Involvement with Disability Education and Advancement (IDEA) was started in 2015 at Rutgers New Jersey Medical School (NJMS). The organization provides NJMS students the opportunity to visit a school dedicated to disabled students and lead educational sessions on health topics. Materials and methodsWe conducted a survey study in 2018 to compare comfort levels between IDEA members and non-members in eliciting information from and providing medical attention to nonverbal, cognitively impaired, and physically disabled patients. The survey-based study utilized yes/no questions, and a Likert scale questionnaire to determine IDEA member and non-member comfort levels in working with various disabilities. Statistical analysis was performed using SAS Enterprise Guide 7.1; p value < 0.05 was considered statistically significant. Results and discussionA total of 56 responses (19 members, 37 non-members) were analyzed. Regardless of IDEA membership, medical students of all years perceived themselves to have more comfort caring for physically disabled than cognitively impaired or nonverbal patients. IDEA members also recorded higher comfort levels with eliciting information from cognitively impaired patients and lower comfort levels with providing medical attention to physically disabled patients. ImplicationsIDEA members may have increased comfort interacting with cognitively impaired individuals due to their regular experience and lower levels of comfort providing medical attention to physically disabled patients due to awareness of complex problems specific to the population. The current results warrant continued data collection and further evaluation.

Integrating a Novel Global Surgery and Health Inequity Course to the Surgical Clerkship

Medical students report growing interest in health inequity and global surgery, subjects not currently integrated to their core curriculum. Currently, fundamental tenets of global surgical inequity are only available to students on an elective basis or in special interest groups. Therefore, an hour-long course with emphasis on global surgery was developed for third-year medical students. The aim of this study was to examine student response to this pilot course and to establish whether course content was applicable to clinical rotations. A 1-hour structured curriculum was delivered to third-year medical students (MS3s) during the 2-day orientation phase of each rotation of an 8-week surgery clerkship from August 2018 to May 2019. The course targeted approximately 30 students per session in the preclinical orientation at Rutgers-New Jersey Medical School. Upon completion of the 8-week clerkship rotation, a paper survey was administered to evaluate student's exposure to previous content, attitudes toward global health, interest and engagement in course materials, and applicability of learned course content to local environments. Rutgers-New Jersey Medical School, an urban medical school located in Newark, New Jersey. A total of 191 students attended the global surgery and health equity course; 146 participants participated in the postcourse survey. When asked about baseline interest in global or public health, the majority (51%) were extremely interested or very interested. Nearly all participants found the course to be valuable (94%). When asked which educational modality was preferred, 23% of participants favored the traditional lecture component and 29% favored case-based discussions. Nearly half (48%) the respondents found both modalities to be valuable. Fifty students (34% of respondents) reported encounters with patients affected by barriers in access to surgical care during their clerkships. Medical students responded favorably to this health inequity and global surgery pilot course and requested supplemental lectures. Additionally, course content was applicable to local clinical experiences. Therefore, 1 modality of integrating global surgery to the established curriculum is under the framework of health inequity and social determinants of health during surgical clerkships. This study demonstrates that meaningful inclusion of global surgery and health inequity can be implemented within the existing curricular structure.

No Association Found Between Benzodiazepines, ‘Z-Drugs,’ Dementia

No Association Found Between Benzodiazepines, ‘Z-Drugs,’ Dementia

Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis.

The epicenter of the COVID-19 crisis since March 17, 2020—the New York metropolitan area—is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It is challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information is seldom disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19–relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professional, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.

A Post-donation Survey to Assess the Appropriateness of Medical Supply Donations to Freetown, Sierra Leone Following the Ebola Crisis.

The Recovery of Equipment for Capacity building OVERseas (RECOVER) initiative at Rutgers New Jersey Medical School involves collection and donation of clean and unused medical supplies that would otherwise be discarded to those desperately in need of those supplies abroad. RECOVER has recently responded to the aftermath of the Ebola crisis and the even more recent mudslide natural disaster in Freetown, Sierra Leone, which had resulted in a considerable diminishing of the local medical supplies. The goal of this study was to assess the match between donated supplies and local needs by using a post-donation survey. In December 2016, we conducted a pre-donation survey inquiring which of the supplies available from RECOVER were needed by four hospitals in Freetown. The survey also asked about specific barriers to keeping such supplies in stock. After each hospital received a shipment of supplies, we administered an online Qualtrics (Qualtrics, Provo, UT) follow-up survey intending to assess the appropriateness of the donated supplies. The survey asked about which wards used what supplies, most useful items, ability to sterilize, and whether the donation provided supplies that would otherwise need to be bought. Recipient hospitals reported the use of 90% of donated supplies. The most useful supplies were gowns, scalpels, gloves, and drapes; All recipients reported the ability to sterilize donated goods. Supplies were used in operating rooms, emergency rooms, and medical wards. Donated supplies provided hospitals with supplies that would typically need to be bought or that were unavailable in the region. No adverse events were reported related to the use of donated supplies. At first glance, our donations appear usable and appropriate for the recipients. We hope to provide a framework for an objective measure of need for hospitals in other low-income countries, using the Freetown post-Ebola crisis as a pilot for the assessment of medical supply donations and the longitudinal impact it can have on global health and surgery overseas. More studies are required to further explore the possible implications of our program including those relating to medical waste management and environmental considerations when donating and shipping disposable supplies to a developing country.

Sequential third-year medical student quality assurance (QA) clerkship projects appear to introduce a culture of continuous quality improvement across New Jersey family medicine practices

BackgroundIn recent years, Rutgers New Jersey Medical School Department of Family Medicine has integrated a quality assurance (QA) project as a required component of their 5-week medical student clerkship. This...

Therapy/treatment concepts from the Fourth Indochina Conference of Dermatology, December 19-21, 2019 Vientiane, Lao People's Democratic Republic.

Dermatologic TherapyVolume 33, Issue 2 e13252 Congress Reports Therapy/treatment concepts from the Fourth Indochina Conference of Dermatology, December 19–21, 2019 Vientiane, Lao People's Democratic Republic Robert A. Schwartz MD, MPH, DSc (Hon), FRCP (Edin), FAADV (Hon), Corresponding Author Robert A. Schwartz MD, MPH, DSc (Hon), FRCP (Edin), FAADV (Hon) roschwar@cal.berkeley.edu orcid.org/0000-0003-3036-3825 Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA Correspondence Robert A. Schwartz MD, MPH, DSc (Hon), FRCP (Edin), FAADV (Hon), Professor & Head, Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Email: roschwar@cal.berkeley.eduSearch for more papers by this author Robert A. Schwartz MD, MPH, DSc (Hon), FRCP (Edin), FAADV (Hon), Corresponding Author Robert A. Schwartz MD, MPH, DSc (Hon), FRCP (Edin), FAADV (Hon) roschwar@cal.berkeley.edu orcid.org/0000-0003-3036-3825 Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA Correspondence Robert A. Schwartz MD, MPH, DSc (Hon), FRCP (Edin), FAADV (Hon), Professor & Head, Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Email: roschwar@cal.berkeley.eduSearch for more papers by this author First published: 07 February 2020 https://doi.org/10.1111/dth.13252Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume33, Issue2March/April 2020e13252 RelatedInformation

Building Partnerships and Stakeholder Relationships for HIV Prevention: Longitudinal Cohort Study Focuses on Community Engagement

Building Partnerships and Stakeholder Relationships for HIV Prevention:Longitudinal Cohort Study Focuses on Community Engagement Rondalya D. DeShields, MSN, RN, Jonathan Paul Lucas, MPH, Melissa Turner, MSW, LICSW, Kemi Amola, PhD, Valarie Hunter, Stephanie Lykes, MPH, Anne M. Rompalo, MD, ScM, Sten H. Vermund, MD, Suzanne Fischer, MA, and Danielle F. Haley, MPH, PhD What Is the Purpose of This Study? • HIV Prevention Trials Network 064 assessed HIV incidence among 2,099 women living in 10 communities with high prevalence of HIV and poverty. • Women were recruited from community locations using venue-based sampling and followed in the study for 6 to 12 months. • Community engagement activities were designed to build rapport and establish mutual respect between researchers and community stakeholders. • The recruitment and engagement approach aligned with the National Institutes of Health (NIH) Director's Council of Public Representatives Community Engagement Framework's five core principles: meaningful community involvement, mutual respect, authentic community-academic partnerships, community stakeholder capacity building, and effective results dissemination. • The purpose of the manuscript is to describe the strategies used to engage community partners by the HPTN 064, a large NIH-funded, multisite trial, to successfully recruit and retain women at increased risk of HIV acquisition in the United States. • We describe the methods used throughout all phases of the research process to engage and sustain community partnerships and stakeholder relationships. What Is the Problem? • African American women bear a disproportionate burden of HIV in the United States, yet are under-represented in clinical research. • For African American women, the HIV incidence rate is 20 times higher than that of White women, and nearly five times higher than that of Hispanic/Latina women, yet African American women are under-represented in clinical research. • African American communities in the United States may mistrust research. • One effective strategy to decrease public mistrust and increase participation of African American communities in HIV prevention clinical research is community engagement. • Although there is a growing body of literature which supports the role of community engagement in HIV prevention research and potential frameworks for doing so, few studies describe detailed methods applied by research teams in field settings. [End Page 3] What Are the Findings? • We enrolled 2,099 women (88% African American) in only 14 months; final retention was 94%. • Community engagement activities spanned all phases of the research process and were designed to build community rapport and establish mutual respect between researchers and community stakeholders. • Study success, as evidenced by rapid recruitment and high retention, was grounded in the strong emphasis on meaningful community engagement throughout the research process. • HPTN 064 found that our pre-implementation work was pivotal to the success and laid the foundation for community engagement. • Applying the core principles of the Council of Public Representatives' model ensured inclusiveness and participation of African American women impacted by HIV from study inception to results dissemination, and supported recruitment and retention efforts. [End Page 4] Rondalya D. DeShields Department of Medicine, Rutgers University New Jersey Medical School Jonathan Paul Lucas Science Facilitation Department, FHI 360 Melissa Turner Infectious Disease Practice, Veteran's Administration Kemi Amola School of Medicine, University of North Carolina at Chapel Hill Valarie Hunter Hubert Department of Global Health, Emory University Stephanie Lykes Harlem Prevention Center, Columbia University Anne M. Rompalo Department of Medicine, Johns Hopkins University School of Medicine Sten H. Vermund Vanderbilt Institute for Global Health, Vanderbilt University Medical Center Suzanne Fischer Research Utilization, FHI 360 Danielle F. Haley Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill Copyright © 2020 Johns Hopkins University Press

Could Treatments for SUD Help Patients With Behavioral Addictions?

Back to table of contents Previous article Next article ProfessionalFull AccessCould Treatments for SUD Help Patients With Behavioral Addictions?Nick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:12 Aug 2019https://doi.org/10.1176/appi.pn.2019.7b7AbstractThere are key similarities and differences between patients with substance use disorder (SUD) and behavioral addictions including sex, gaming, eating, shopping, and internet addiction.Gambling disorder is the first non-substance-related addictive disorder to be included in DSM, but many practicing psychiatrists recognize that gambling is far from the only behavior that can become compulsive.At APA’s 2019 Annual Meeting in May, a panel of psychiatrists who specialize in addictions discussed four other potentially addictive behaviors: internet use, sex, shopping, and videogaming. None is listed in DSM-5, though the condition of “internet gaming disorder” is in the appendix under “conditions for further study.” (Gaming disorder was added in the International Classification of Diseases, 11th Revision.)Addiction specialist Timothy Fong, M.D., explains that while behavioral addictions share features of various psychiatric problems, neurobiological and pharmacological data point to their connection with substance use disorders.David HathcoxThe goal of the session was to help nonspecialists understand the biology of these problem behaviors, said session chair Timothy Fong, M.D., a professor of psychiatry at the University of California, Los Angeles (UCLA), and co-director of the UCLA Gambling Studies Program. This understanding can in turn lead to more effective diagnosis and treatment.A key question about behavioral addictions is whether they are a type of substance use disorder or whether they fit better in another DSM category. For example, addictive shopping is similar in appearance to hoarding disorder—a type of obsessive-compulsive disorder, while an eating addiction bears striking similarity to binge-eating disorder. In the case of sex disorder, Shram Shulka, M.D., a psychiatrist at Walter Reed National Military Medical Center in Bethesda, Md., noted that many patients with sex-control problems had attachment problems in childhood. This has led to a theory that sex disorder might be a type of attachment disorder.However, imaging studies indicate that people with sex and other behavioral addictions tend to have cue-related activity increases in regions of the brain known to be involved with motivation and reward, Shulka said. These activity changes are similar to what happens when someone with alcohol use disorder sees photos of drinks, supporting the idea that these behavioral addictions fit into the substance use disorder category.Fong also highlighted the importance of reward in driving addictive shopping behavior. “This compulsive need to buy and collect could be confused with hoarding disorder, but there is a key difference,” he said. “People with hoarding disorder know they have a bad compulsion, whereas people with shopping disorder have this urge or thrill to buy stuff.”Likewise, people who engage in addictive eating show more control over the foods they compulsively eat than do people who binge eat, said Robert Rymowicz, D.O., a psychiatry resident at the Rutgers New Jersey Medical School. For example, people with an eating addiction crave specific hedonic foods high in sugar and fat, whereas people who binge eat may be less discerning, he said. “This tendency to focus on foods like chocolate suggests that eating addiction might be better termed as ‘food addiction,’ ” Rymowicz added.While much of the session noted the similarities between these five behavioral addictions and traditional substance use disorders, the panelists did offer one important difference: the goals of treatment.“Unlike alcohol or drug treatment, abstinence is not a realistic goal,” said Meghan Quinn, M.D., a resident at the Uniformed Services University of the Health Sciences in Bethesda, Md. Therapists can’t ask someone to give up the internet, as an example. “We do need these behaviors in life,” she said. Rather, the panelists suggested that treatments focus on patient recovery and treating comorbidities (depression, insomnia, and other substance use are common) while promoting better self-awareness and self-care.As with substance use disorders, psychotherapy such as cognitive-behavioral therapy or acceptance commitment therapy is an important component of behavioral addiction treatment, and peer support groups can be useful as well.Medications are also an option. Fong cautioned that currently there is no consensus on pharmacotherapy for behavioral addictions, but there is some evidence for certain medications. Notably, naltrexone and bupropion—commonly used to treat alcohol use disorder, cigarette smoking, and obesity—are also effective for many of these behavioral addictions (further validating these disorders as substance use problems).Other panelists noted data suggesting that selective serotonin reuptake inhibitors (SSRIs) might work in some cases (especially for sex disorder since SSRIs have libido-lowering effects), as may mood stabilizers or stimulants. ■ ISSUES NewArchived

A Retrospective Case Series of a Novel Spinal Cord Stimulator Trial Technique with Less Displacement and Migration of the Trial Leads.

Background Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications. Objective This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success. Study Design Retrospective case series. Setting New Jersey Medical School, Department of Anesthesiology, Pain Management Division. Methods A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010–2012). Results Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications. Limitations Small sample size, retrospective case series, and no control group for comparison. Conclusion This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.

Physician and Gay: Am I Safe at Work?

To the Editor: It was just another day in the clinic. While I was examining a young child, her mother said she was glad she got a “usual straight” doctor for her child, rather than the other (aka homosexual) kind about whose competence she was not sure. And just like that, it was no longer just another day. One wayward statement, inconsequential to the speaker, left me in internal turmoil. As a gay physician, I was torn between my duty toward my patient and my desire for personal integrity. Homophobia in the workplace can seem almost too strong a label to address what may be perceived as a trivial incident. Often perceived as too insignificant to address, these incidents persist in the psyche of those of us who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Such incidents are a nagging reminder of how LGBTQ people continue to be perceived as different, as somehow diminished, on account of their sexuality. Often lacking an avenue to express these feelings, an LGBTQ physician may suppress these feelings, leading to a sense of exclusion and disenfranchisement at work. Many LGBTQ physicians still report social ostracization in the workplace, as well as harassment by colleagues and patients/the community.1 Workplace safety for the LGBTQ physician remains a moving target; much work is yet to be done.1–3 The Accreditation Council for Graduate Medical Education recently published guidelines emphasizing the need for diversity in the workplace.4 These guidelines, which should help broaden horizons and foster mutual respect, necessitate that all residency programs take concrete steps to ensure that a diverse workplace is also inclusive and safe for all. One action we medical professionals can take—beginning in medical school and continuing through residency and beyond—is sensitizing others to what working in an all-inclusive environment means. Simulation is a useful tool for adult learning that is used in medical training. Simulated encounters may be especially helpful in illustrating cases of “casual” homophobia which can be difficult to address or even to explain. A resident-driven committee focused on diversity and inclusion can help empower trainees to voice their concerns in a safe and nonhierarchical space. With support from leaders, such resident-led committees can be harbingers of change by identifying problems at the grassroots level, by finding feasible solutions developed by stakeholders, and by engaging colleagues who may feel marginalized because of their gender or sexual orientation. The journey to a truly inclusive workplace for LGBTQ physicians will be arduous, but is certainly worth making. Acknowledgments: The authors would like to thank John P. Sanchez, MD, MPH, for his valuable input and guidance on this letter. Aayush Gabrani, MDResident, Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey; [email protected]; ORCID: http://orcid.org/0000-0002-9660-1059.Suman Pal, MDResident, Department of Internal Medicine, Westchester Medical Center, Valhalla, New York.