School of Medicine

Multiple theories about the association between Post Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) have been proposed, but there is yet to be a common consensus on their exact relationship. Regardless of the etiology of their association, it is reasonable to suggest that the interaction between SUD and comorbid PTSD is complex. The intention of this project was not to dive deeper into the suggested theoretical models, but rather to focus on understanding how these conditions affect patients and on a pragmatic approach to treatment. This was based largely in principle on two observations from prior studies. One of which was the fact that patients with the SUD/PTSD are more likley to struggle with treatment for substance use disorder in regards to retention and periods of abstinence. Second was the realization that patients with comorbid disease have higher rates of homelessness, physical health problems, psychiatric cormorbities, and psychosocial impairment when compared to individuals with a single disorder. As such, the goal of this project was to gain a better understanding of the challenges associated with treating these patients and to also develop a greater understanding of the "best" practice approach to treatment.

The practice of vaccine delay and refusal has recently held the attention of the medical community, most notably due to outbreaks of vaccine preventable diseases. It is a loaded subject both for parents/guardians and pediatricians; to the point of pediatricians being more likely to dismiss families who refuse vaccinations for their children. Within the field of pediatrics, this is a topic that poses a threat to the physician-patient relationshp. Studies have shown an increase in vaccine refusals in the last decade; therefore, further examination of the reasons behind this decision remains key in better understanding what drives this decision when made by some parents and guardians. This survey will attempt to cite the most common reasons for this decision directly from parents/guardians, as well as to examine if there is any significant difference between the degree of trust in pediatricians amonst parents/guardians who refuse or delay vaccines when compared to non-refusing parents/guardians. The ultimate goal of such a survey will be to better understand the "why" behind parental vaccine delay and refusal. Ultimately it is unquestioned that both sides want the best for the child and patient; the hope of this survey is to better understand the gap between the two sides.

Undergraduate medical education is constantly evolving to develop new, effective, engaging teaching methods. An integrated medical school curriculum correlates the basic and clinical sciences beginning in the first year in order to engage students, develop clinical reasoning skills, and prepare them for their clinical experiences. Contextualization, in which clinical case examples are used to illustrate basic science principles, is one strategy used to achieve this goal. In addition to changes in the structure of medical school curricula, the platforms by which educational material is delivered are also rapidly changing. Web-based applications, including podcasts and virtual interactive cases, provide endless opportunities to present information in efficient and interesting formats and encourage self-directed learning by students. Pharmacology is an area of preclerkship education that is particularly challenging to medical students. One reason for this is the fact that students begin learning clinical pharmacology in the first year, prior to learning detailed pathophysiology of the diseases being treated; without clinical context, learning pharmacology can feel little more than memorization of names and mechanisms. The UCSD School of Medicine Integrated Scientific Curriculum addresses these challenges by through a two-pass curriculum, whereby pharmacology is introduced with physiology and basic pathophysiology in Year 1, and reiterated with pathophysiology as the focus in Year 2; however, pharmacology still remains a difficult subject for many medical students. Cardiovascular System 1 (CS1) and Renal System 1 (RS1) have been identified as courses in the first-year curriculum that would benefit from additional supplemental pharmacology resources.

We sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass, and hypothesized off-pump would be comparable to on-pump. Our primary outcome of interest was survival, and secondary outcomes included need for reintervention with new coronary stent, or new diagnosis of myocardial infarction (MI) occurring any time after surgery during the 8-12 year follow up period.

The Brain Trauma Foundation recommends intracranial pressure (ICP) monitor placement for patients with severe traumatic brain injury (TBI). Adherence with these guidelines in elderly patients is unknown. We hypothesized that disparities in ICP monitor placement would exist based on patient age.

Enrichment activities are known to enhance youth development, and are especially beneficial for at-risk youth who have not consistently had the social capital to receive such enrichment throughout the critical periods of their development. The National Institute of Justice has published many studies demonstrating the benefit of enrichment activities for disadvantaged youth. Enrichment activities promote self-esteem and sense of discipline and well-being, which impacts mental health and risk taking behaviors such as substance abuse. With the goal of achieving the aforementioned impact, juvenile detention centers offer enrichment programs as part of the rehabilitation process. My goal for this project was to further investigate the availability, equity and impact of such programs on mental health outcomes for at risk youth, I completed a needs assessment. The following needs assessment report summarizes my findings.

Background: opioid overdose and abuse have reaches epidemic rates in the United States. Legitimate prescriptions are a large source of opioid misuse in adults and adolescents. The goal of this quality improvement project was to reduce opioid exposure from our pediatric emergency department (ED).

Background: prescription opioid related deaths have increased dramatically over the past 17 years. Although emergency physicians (EPs) have not been the primary force behind this rise, previous literature has suggested that EPs could improve their opioid prescribing practices. We designed this study to evaluate the trend in emergency department (ED) opioid prescriptions over time during the US opioid epidemic. Methods: we conducted a retrospective cohort study from July 1, 2012 to June 30, 2018, evaluating all adult patients who presented to two study EDs for a pain-related complaint and received an analgesic prescription upon ED discharge. We compared these data to trends in lay media and medical literature regarding the opioid epidemic. We also evaluated the incidence of repeat ED visits based on the type of analgesic prescriptions provided. Results: opioid prescriptions decreased from 37.76% to 13.29% over the six year study period. This coupled with an increase in non-opioid medications from 6.12% to 11.33% and an incrase in "no prescription" from 56.12% to 75.37%. This corresponded with an increase in the number of publications on the opioid epidemic within the lay-public and medical literature. Additionally, those patients that received no opiates were less likely to require a repeat ED visit. Conclusions: ED physicians are prescribing less opiates, while increasing the amount of non-narcotic analgesic prescriptions. This may be in response to the literature suggesting that prescription opioids play a large role in the opioids crisis. This decrease in opioid prescriptions did not increase the need for repeat ED visits.

Post-laminectomy pain syndrome refers to persistent leg and/or lumbar back pain after a surgical procedure. The pathophysiology of this syndrome is complex, as often the operation was technically successful. Evaluation with MRI plays a crucial role in the assessment of post- laminectomy pain syndrome, as it provides soft tissue resolution for evaluation for common post- surgical pain generators, including recurrent posterior disc disease and associated narrowing of the spinal canal, lateral recess or neural foramina.

Fertility is important to young breast cancer survivors (YBCS). Treatment for breast cancer increases the risk of infertility. Fertility preservation prior to breast cancer treatment aims to improve options for fertility post-treatment. Fertility preservation decisions are challenging for YBCS. In retrospective cohort studies, YBCS that underwent fertility preservation experienced less decisional regret after primary cancer treatment. Objectives and hypotheses: to assess longitudinal changes in decisional regret on fertility preservation following breast cancer diagnosis; to determine if fertility concerns and fertility preservation treatment decisions are related to decisional regret.