School of Medicine

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.

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.

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

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.

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.

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.

Simulation has become an integral part of learning new procedures and staying adept at skills already learned. Ultrasound (US) guided peripheral IV (PIV) needle insertion is a skill necessary for EM, Anesthesia, and general practice nurses and physicians. Medical schools, teaching hospitals, and community hospitals universally use simulation amongst their practitioners. Ultrasound POC use is increasing in Emergency Department (ED) and other hospital areas. Most institutions have formalized training to teach residents and nurses proper techniques for POC US use. Training models can vary from commercially available ones costing thousands of dollars to home-made ones that have a short life-span and suboptimal viewing characteristics. 1 Patient safety has been a driving force in changing medical training. "To Err is Human", a landmark study published in 1999 estimated 3% of injuries to hospital patients are caused by medical errors, resulting in between 44,000-98,000 deaths per year. The traditional teaching mantra of "See one, Do one, Teach one" apprenticeship model has been replaced with proficiency-based teaching methods to improve physician training and patient safety.

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.

Danon disease is a congenital X-linked hypertrophic cardiomyopathy that results from mutations in LAMP2, a transmembrane lysosomal protein necessary for autophagy. The disease presents in childhood or adolescence, and life expectancy is 19 for men and 34 for women. Although Danon disease is rare, no specific therapy based on its biology is currently known. Recent in vitro studies using mouse by the Cherqui Lab have shown evidence supporting hematopoetic stem cell transplant as a novel treatment option for cystinosis. Cystinosis is a metabolic disease that arises from mutations in a transmembrane lysosomal protein - cystinosin (CTNS gene). Detailed in vitro and in vivo studies have shown that rescue of the phenotype occurs because wildtype macrophages derived from the transplanted wildtype hematopoietic stem cells can transfer lysosomes containing wildtype cystinosin directly to Ctns-deficient cells in multiple organs of the host Ctns -/- mice. Because Danon disease also arises from mutations in a transmembrane lysosomal protein, LAMP2, a similar approach could be effective in rescuing the phenotype of LAMP2 mutant mice. The Adler Lab has recently developed an in vitro cell model for Danon disease using skin fibroblasts expanded from skin biopsies from two identified patients diagnosed with Danon disease, confirmed by RT-PCR. These in vitro and in vivo models can be used show efficacy of hematopoietic stem cell transplant for Danon disease.

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.