School of Medicine

Health literacy, generally defined as an individual's skill in obtaining and understanding information related to their health, has been shown to have significant impact on patient outcomes. Low health literacy is associated with higher rates of hospitalization and health care resource utilization, higher prevalence and severity of chronic disease, and worsened global measures of health including mortality. Poor health literacy is prevalent in the United States; as many as 36 percent of the population demonstrates limited health literacy. Rates are higher in certain subgroups such as the elderly, minorities, and those of low education or socioeconomic status. Given the wide prevalence and far-ranging effects on long-term health outcomes, efforts to improve health literacy nationally clearly offer significant benefits across the population. This study surveyed ambulatory patients at four clinic sites within the UCSD health care system. Patients were offered participation in the survey based on availability while waiting for clinical appointments; no compensation or other reward for participation was offered. The survey included ten different platforms or categories of online source; for each source patients were asked to rate how often they used it, their level of trust in the source, and degree to which that source ultimately impacted their health care decisions. The order that sources were listed within survey questions was varied between copies of the survey. Responses were analyzed using repeated measures ANVOA to establish the significance of variation in responses for each measure.

Massage therapy in the NICU appears to be safe, feasible, and improves patient pain self-assessment without vital sign instability.

Military members are required to carry heavy loads frequently during training and active duty combat. We investigated if operationally relevant axial loads affect lumbar disc kinematics in forty-one male active duty Marines with no previous clinically diagnosed pathology. Marines were imaged standing upright with and without load. From T2-weighted magnetic resonance images, IVD health and kinematic changes between loading conditions and across lumbar levels were evaluated using two-way repeated measures analysis of variance tests. IVD kinematics with loading were compared between individuals with and without signs of degeneration on imaging. Linear regression analyses were performed to determine associations between IVD position and kinematic changes with loading. Fifty-eight percent (118/205) of IVDs showed evidence of degeneration and 3% (7/205) demonstrated a disc bulge. IVD degeneration was not related to posterior annular position (p>0.205). Changes in sagittal intervertebral angle were not associated with changes in posterior annular position between baseline and loaded conditions at any lumbar level (r<0.267; p=.091-0.746). Intervertebral angles were significantly larger in the lower regions of the spine (p<0.001), indicating increased local lordosis when moving in the caudal direction Disc height at the L5/S1 level was significantly smaller (6.3mm, mean difference =1.20) than all other levels (p<0.001) and baseline posterior disc heights tended to be larger at baseline (7.43mm ± 1.46) than after loading (7.18 ±1.57, p=0.071). Individuals with a larger baseline posterior annular position demonstrated greater reduction with load at all levels (p<0.002), with the largest reductions at L5/S1 level. Overall, while this population demonstrated some signs of disc degeneration, operationally relevant loading did not significantly affect disc kinematics.

Clinical notes, consults, vital signs, labs, and more are expected to be a part of a patient’s electronic file, so that they can be easily and quickly looked up to provide better patient care. The UCSD Student‐Run Free Clinic Project (SRFCP) implemented Electronic Health Records (Epic) in 2013. However, the laboratory used by the free clinics had not been integrated electronically. Therefore, the free clinics had been entering lab results into EPIC via manual data entry for four years. In 2017, the UCSD Epic Information Technology team, including the Ambulatory Offices’ Chief Medical Information Officer, decided that it was a UCSD Health Sciences priority to integrate Quest labs into Epic. This required a significant amount of retraining, writing new workflows, improving processes, re‐thinking the role of the free clinic lab manager, optimizing education, and ensuring the correct provider receives results in a timely fashion in the UCSD SRFCP setting. This ISP assessed the laboratory workflow and allowed the student to serve as Project Manager for the laboratory systems change within the Free Clinic setting. This required seeking input from all stakeholders before, during, and after the changes to optimize the process in this setting. New protocols, documentation, and training processes were created as part of this ISP. In addition, an analysis of recent lab test costs was performed, and an overview of lab test expenditures was produced.

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).

After 18 years of service in the same location, the UCSD Free Clinic Project (Free Clinic) had to close one its four clinic sites. Several hundred patients were faced with the challenge of commuting long distances to another clinic, and even losing access to car. Although unfortunate, this became an opportunity for the Free Clinic to examine where its patients live, the distances they travel to clinic, and determine new locations for a clinic. To complete this examination, the Free Clinic performed a spatial analysis--mapping patients and clinic locations--using specialized Geographic Information Systems (GIS) software.

Bone metastases of prostate cancer continue to elude effective clinical management world-wide. A newly developed xenograft model, PCSD1, is a pre-clinical therapeutic development and testing platform to understand the mechanisms of resistance to androgen deprivation therapy of bone metastatic prostate cancer. Prostate cancer is a heterogeneous disease for which it is especially important to study models that represent the range of different patients. However, of the patient samples investigated by Christina Jamieson’s lab at UCSD, only 5 out of 20 (25%) were able to successfully create xenografts. The hypothesis I tested is that metastatic cells that have failed to xenograft into a patient-derived tumor xenograft mouse model will be able to successfully survive in vitro in an organoid culture system. The goals of my research were twofold: to successfully develop organoid cultures for both cells that have successfully and unsuccessfully xenografted into the mouse model and to perform imaging and genetic analysis on these organoids.

At UC San Diego medical school, third year medical students’ exposure to Anesthesia is often as part of a two-week selective during their surgery rotation. Students are told to read up on Miller or Bareish (not for the faint of heart) to understand the foundational knowledge for the rotation. Fourth year medical students often feel like there should be a concise introductory document to help students before the rotation. This document is to provide a brief introduction to the field of anesthesia and ensure students feel more prepared prior to the rotation. This document is intended to be modified and altered as other students find the information outdated or irrelevant to the Anesthesia rotation.

As information technology continues to improve, patients are given access to increasing amounts of their health data. Health applications such as Epic MyChart provide an easily accessible archive of information for both patients and, in the case of pediatrics, parents. With increasing amounts of available information there is a concurrent need to provide education about interpretation. This study aimed to create a short, parent-focused, educational video to convey high-yield information regarding growth chart data. A pre- and post-survey were administered in conjunction with the educational video using QR codes at pediatric offices in La Jolla. We found, in general, parents felt well-equipped to be active participants in their child’s health, but identified some areas for improvement regarding perceptions of health.