School of Medicine

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.

1. Compare characteristics of patients in which a BHP was involved in any manner in apatient’s visit to those who did not have any BHP involvement in their visit.

2. Compare follow-through rates after referral to psychotherapy for patients who didversus did not have a warm handoff (i.e., face-to-face interaction with a BHP) at the timeof the patient’s visit to a PCP

Past studies suggest that patients who leave without being seen by a physician (LWBS) from a hospital’s emergency department (ED) represent a quality and safety concern, and thus LWBS rates have often been used as an ED performance metric. There are few recent studies, however, that have examined the characteristics of the LWBS population at hospitals in the United States.

Ischemia reperfusion injury is a major cause of morbidity and mortality worldwide. A better understanding of the cardioprotective effects of anesthetics is needed to open up opportunities for research in a variety of medical fields such as internal medicine, geriatrics, cardiology, surgery and anesthesiology. Furthermore, a better understanding of the mechanism of pre- and post- conditioning of anesthetics may lead to the development of novel cardioprotective therapeutics for older patients who are in need of cardiac surgery. This project takes a novel approach towards the study of cardiac tissue in vivo. Previously, human samples were obtained from patient surgeries. This approach presented the scientific community with several problems. First, the samples were scarce and difficult to obtain. Second, the experiments and the time available was very limited due to the viability of the tissue. New approaches include the culturing of cardiac myocytes. However, the lack of the microenvironment present in isolated cardiac cells makes it difficult to compare experimental results with those performed on adult heart tissue. Our approach involves using a vibratome to create slices of cardiac tissue with a preserved microenvironment to establish baseline parameters for mouse heart, with the hopes of replicating these experiments in human tissue. The ability to culture and study in vitro slices of human heart tissue will increase research output from difficult to obtain and limited human tissue samples.

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.

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.

To explore the topic of gender micro‐inequities, both on a personal level and on a professional level. To evaluate literature on the topic. This includes evaluating the different ways to study this topic (survey, focus group, longitudinal interviews, etc), as well as the specific populations studied and critically consider the positives and negatives of the different methods. To plan and give a professional lecture/webinar, including seeking feedback and evaluation.

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).

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.