5 ways the pandemic may transform medical education – American Medical Association

As the response to the COVID-19 pandemic restricted in-person activity, medical schools had to invent new ways to educate out of necessity. Some of those innovative methods may have staying power that go well beyond the pandemic, reshaping how tomorrows doctors are trained.

When you face a disruption on the order of this magnitude, it forces you to think about the principles by which we preserve the very essence of our work. We quickly learn that some strategies we assumed were the only way to do things can be changed without damaging the quality of our educational programs, said Catherine Lucey, MD. She is vice dean for education at the University of California, San Francisco, School of Medicine, one of the 37 member schools ofAMAs Accelerating Change in Medical Education Consortium.

A lot of changes were put in place to deal with COVID-19 disruption, but its also given us a new freedom to experiment with new models of education that may end up being better, Dr. Lucey said in an interview with the AMA.

Dr. Lucey and co-author S. Claiborne Johnston, MD, PhD, highlighted five potential COVID-19-related changes to medical education that may have staying power in a JAMA Viewpoint essay, The Transformational Effects of COVID-19 on Medical Education.

In response to the COVID-19 pandemic, medical schools have created electives giving medical students the chance to engage with the public health response. Learners also served as evidence-based ambassadors for the population at large.

The pandemic strengthened the partnership between health care delivery systems and public health professionals, Dr. Lucey said. The outbreak of the COVID-19 pandemic was acute and dramatic, but it made people reset their idea of what it means to alleviate suffering in our patients and improve the health of our communities.

Its not just doctors operating alone, and its not just a cardiologist and a basic science investigator working alone, she added. It requires everyonethat means doctors, nurses, public health experts, policy experts, all of those people are required to solve problems.

Dr. Lucey added that this type of approach could be applied to other public health crises such as the opioid epidemic and the ongoing pandemic of health care disparities.

Find out how medical schools innovated to engage medical students during the pandemic.

The pandemics onset was a teachable moment for any health professional. In her JAMA Viewpoint essay, Dr. Lucey outlined what that meant for medical students and how it could be adapted going forward.

The pandemic helped cement the shift to a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens, Dr. Lucey said. Thats a really important philosophic difference. The first approach really creates physician problem-solvers who are capable of addressing both enduring and emerging threats to health.

Learn how med schools used 3 learning models to keep students on track during COVID-19.

When the physician workforce proved to be overwhelmed in certain hot spots, states called on medical schools to graduate their fourth-year students months early to help bolster the response. The measures required navigating somewhat cumbersome red tape but demonstrated that move could be an option in the future.

The pandemic showed us an example of why we need to think about early graduation for our students, and it showed us all the hurdles we will need to jump over to do it, Dr. Lucey said. Its a shock to the system that asks the question: if we are willing to attest that our students are competent to graduate early in the pandemic, could we not also do so as a matter of usual practice?

Find out how a med school in a COVID-19 hot spot deployed early graduates.

The pandemic caused the cancellation of most away or visiting rotations. That could create a more level playing field going forward, since not all students can access such experiences.

The opportunity to go around the country and do audition rotations is a clear legacy practice, Dr. Lucey said. When you talk with people about it, its not clear who it benefits the most. Does it benefit the students or the programs?

In spite of the absence of away rotations, I dont believe that programs will see a big difference in the quality of that they recruit and match into their programs, Dr. Lucey said. As such, it is possible that we will be rethinking whether these rotations should be restarted next season.

Get four expert tips on how 2021 residency applicants can succeed with video interviews.

Medical schools were proactive in communicating expectations and restrictions with students. Going forward, Dr. Lucey envisions a more dedicated approach to student outreach during turbulence. She pointed to the civil unrest surrounding police brutality that took place on the heels of the pandemic as a potential example of a time in which that new approach had paid off in medical education.

It created another really existential disruption to the way many of our learners were approaching their education, Lucey said. Our faculty of color and students of color, and the allies that work with them, were really shaken to the bone by this vivid reminder of the elements of structural racism that exist within our communities. In situations like this, leaders of educational programs need to be facile with crisis communication strategies that support all stakeholders during these crises.

Consider how to support diverse learners during disruption.

The AMA has curateda selection of resourcesto assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.


5 ways the pandemic may transform medical education - American Medical Association

Trump doctor Conley degree from Philadelphia College of Osteopathic Medicine: What it means – On top of Philly news – Billy Penn

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The doctor whos been treating President Donald Trump for the coronavirus has roots in Philadelphia. Its where he trained in medicine.

Dr. Sean Conley, the 40-year-old whos been at the forefront of national health updates lately, has been the presidents physician for two years. He grew up in Doylestown, and graduated from Central Bucks High School East in 1998. His medical degree comes from the Philadelphia College of Osteopathic Medicine.

The Philly higher ed institution is not your average medical school. Turns out Conley doesnt actually have an MD degree.

Instead, hes a DO a doctor of osteopathic medicine. With that certification, Conley can do everything a regular doctor can do, like prescribe medicine and perform surgery in all 50 states.

The training is different in that it takes a more holistic look at the body than traditional medicine. It emphasizes primary care, and practices that encourage the body to heal itself rather than the immediate prescription of medicine or use of surgery to correct problems.

At first, the practice was highly controversial. During the first decade of PCOMs existence, it wasnt even legal in Pennsylvania. Over the next two centuries, debates over osteopathy continued, with traditional physicians critiquing its more controversial practices like the in the late 1800s idea to shake a child to cure scarlet fever.

In recent years, the stigma has mostly dissolved as the training and practice have themselves become more legit. Now, earning a DO degree requires the same training as an MD, plus extra coursework.

Conleys Philly alma mater is considered a pioneer in the field, and helped see it through to the modern day.

The first person to bring osteopathic medicine to Philadelphia was a woman named Clara Martin. In 1899, the city directory listed her as an osteopath, working from an office on 67th Street near the Cobbs Creek Parkway, just south of Mount Moriah Cemetery.

That same year, two physicians named Snyder and Pressly founded what would become PCOM, then called the Philadelphia College and Infirmary of Osteopathy.

Philly was experiencing a general boom in medical institutions right then, notes a published history of the school called To Secure Merit, by Carol Benenson Perloff. Episcopal Hospital, German Hospital (now Lankenau), Jewish Hospital (now Einstein Medical Center) and Presbyterian Hospital were all founded between 1849 and 1882.

PCOM first opened at 12th and Market, filling two rooms inside a 13-story office tower. Within a year, it outgrew that space and relocated to the Witherspoon building at Juniper and Walnut.

Enrollment kept growing. Many students were people inspired by seeing osteopathic doctors step in after traditional medicine had failed.

Alum Arthur Flack, who graduated in 1906, said he got interested when he saw osteopathic medicine helped cure cases of typhoid fever amid an epidemic in his hometown of Butler, Pa.

When I first became a studentmy marvel was as to the intense devotion manifested by the small group of physicians headed by you, Flack said in 1925, according to Perloffs book. Without such sincere devotion, Osteopathy today would be only a memory in Pennsylvania.

Thing is, osteopathy wasnt even legally recognized when PCOM first opened its doors.

The first attempt to legalize it in Pennsylvania passed through the state legislature in 1905, but was vetoed by then-Governor Pennypacker. It wasnt until 1909 that a Governor Stuart signed the bill to allow osteopathic doctors to apply for state licensure, 10 years after the Philadelphia college was first founded.

Licensing made the practice more popular, and PCOM continued to outgrow its facilities. The school moved to Spring Garden Street, then to 33rd and Arch, and eventually to North Broad Street.

Some drama: Before the legalization of osteopathy, the college had raised about $3,000. But the founders continued not to pay faculty with actual money for their teaching they compensated them only with stock in the school.

In 1904, faculty started demanding payment. The founders refused, and there was a theatrical back-and-forth in which the schools deans threatened to resign unless the two founders resigned. Shockingly, both founders did resign, and a board of trustees was established that still exists today.

By 1910, PCOM was considered a pioneer when it became one of the first to adapt to new statewide legalization requirements, and create a four-year program, which it maintains to this day.

After those gazillion relocations and expansions, PCOM landed at its current campus on City Avenue at the Bala Cynwyd border.

The school currently has almost 2,000 students, across areas of study like clinical psychology, biomedical sciences and forensic medicine. Like osteopathic medicine schools nationwide, its really tough to get in. In 2019, nearly 7k students applied for just 441 spots in the program.

Dr. Conley, Trumps doctor, has a degree that takes four years to complete. The first two are spent learning basic and clinical sciences, and the second two doing hands-on work in teaching hospitals.

While enrolled, the Bucks County native likely got plenty of Philly experience, since students spend four months working in city neighborhoods at PCOMs Community Healthcare Centers.

After their four years, some students declare a specialty and spend more time in school. PCOM reports that a majority of its grads end up in family medicine, general internal medicine, OB/GYN or pediatrics.

In general, osteopathic medicine has grown in popularity in recent years seen as a more hands-on version of health care. DOs work to understand how all parts of the body are connected, and take a major focus on preventative and primary care.

An osteopathic medicine student in New York told the New York Times in 2014 she became interested in the practice after a standard MD said shed need surgery to correct her chronic ear infections but then she went to a DO, who corrected the problem by stretching her neck, she said.

The infection happened because of fluid in the ear, said the student, Gabrielle Rozenberg, and the manipulations opened up the ear canal.

The practice has become widespread enough that PCOM has opened two more campuses, both in Georgia. According to the American Association of Colleges of Osteopathic Medicine, about 25% of all medical students today are training at an osteopathic school.

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Trump doctor Conley degree from Philadelphia College of Osteopathic Medicine: What it means - On top of Philly news - Billy Penn

Students Share Medical School Details You Won’t Find Anywhere Else | University of Michigan – Michigan Medicine

Applying to medical school is an extremely stressful experience, and Michigan medical students know that firsthand. Thats why five students took time to share their insights with hundreds of prospective students during a recent video livestream Q&A.

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Topics ranged from curriculum and mentorship to application advice and much more. Below, read through a few highlights from the session or watch the full video above to get all the topics covered.

One thing I wish I knew was that all I needed to do to get into medical school was to be myself and not try to be anything other than that.

I think when you're preparing for a process where everything that you've done and who you are is going to be heavily judged, you try to be the best version of yourself, and sometimes that's not the most honest or truthful version of yourself. Now, being on the other side of this, I've realized that they don't want that perfect applicant. They really just want you. So I wish I knew that prior to applying. It would have saved me a lot of stress and trouble in the process.

I've been very pleasantly surprised by how much of a work-life balance I feel I have. Everyone was telling me, Med school is hard, you're not going to have a life, all you're going to do is study, which is sort of true. But on the other hand, I feel like I really do have time to go have dinner with friends during the week or go Up North for a weekend. The pass-fail curriculum is really important and really crucial to allow work-life balance, and I've really tried to embrace that.

For me it was about seeing that everyone was really enthusiastic about their place in medicine, but also just enthusiastic human beings in general. It's really nice to be in an environment where everyone else is as high energy as you are. That's what I felt on my interview day and pretty consistently throughout my first year and now in this Transition to Clerkship period. Everybody that I've worked with here just has that energy and passion and drive that is medically related, but they also just have that human, fun, personal life-related energy and passion as well, which was really important for me.

SEE ALSO: DOCUMENTARY - Reality Checks: Michigan Medical School Students Open Up

My partner moved to Michigan with me and started a master's program. Something I've really appreciated is, for students with significant others or families locally, there are a lot of activities relating to the med school where you can bring your people. That's been really helpful for me in trying to integrate those parts of my life. So, for many things, you can come alone or come be a part of those activities with your significant other so they can join that broader group.

After taking the Step 1 exam, you return early in your third year and do two month-long sequences of transitioning to Branches. You have to do an intensive care unit rotation, an emergency medicine rotation and a sub-internship rotation in a field that you're interested in. But there's a lot of flexibility. You can choose quite a few electives and even create your own. This past year one of my friends created an elective in veterinary medicine and had a fun time exploring that. You can really branch out in your interests and work closely with faculty members. And there's a good amount of time to do research or to do a dual degree.

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Students Share Medical School Details You Won't Find Anywhere Else | University of Michigan - Michigan Medicine

In a First, New England Journal of Medicine Joins Never-Trumpers – The New York Times

Throughout its 208-year history, The New England Journal of Medicine has remained staunchly nonpartisan. The worlds most prestigious medical journal has never supported or condemned a political candidate.

Until now.

In an editorial signed by 34 editors who are United States citizens (one editor is not) and published on Wednesday, the journal said the Trump administration had responded so poorly to the coronavirus pandemic that they have taken a crisis and turned it into a tragedy.

The journal did not explicitly endorse Joseph R. Biden Jr., the Democratic nominee, but that was the only possible inference, other scientists noted.

The editor in chief, Dr. Eric Rubin, said the scathing editorial was one of only four in the journals history that were signed by all of the editors. The N.E.J.M.s editors join those of another influential journal, Scientific American, who last month endorsed Mr. Biden, the former vice president.

The political leadership has failed Americans in many ways that contrast vividly with responses from leaders in other countries, the N.E.J.M. said.

In the United States, the journal said, there was too little testing for the virus, especially early on. There was too little protective equipment, and a lack of national leadership on important measures like mask wearing, social distancing, quarantine and isolation.

There were attempts to politicize and undermine the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, the journal noted.

As a result, the United States has had tens of thousands of excess deaths those caused both directly and indirectly by the pandemic as well as immense economic pain and an increase in social inequality as the virus hit disadvantaged communities hardest.

The editorial castigated the Trump administrations rejection of science, writing, Instead of relying on expertise, the administration has turned to uninformed opinion leaders and charlatans who obscure the truth and facilitate the promulgation of outright lies.

The uncharacteristically pungent editorial called for change: When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.

Scientific American, too, had never before endorsed a political candidate. The pandemic would strain any nation and system, but Trumps rejection of evidence and public health measures have been catastrophic, the journals editors said.

The N.E.J.M., like all medical journals these days, is deluged with papers on the coronavirus and the illness it causes, Covid-19. Editors have struggled to reconcile efforts to insist on quality with a constant barrage of misinformation and misleading statements from the administration, said Dr. Clifford Rosen, associate editor of the journal and an endocrinologist at Tufts University in Medford, Mass.

Our mission is to promote the best science and also to educate, Dr. Rosen said. We were seeing anti-science and poor leadership.

Mounting public health failures and misinformation had eventually taken a toll, said Dr. Rubin, the editor in chief of The New England Journal of Medicine.

It should be clear that we are not a political organization, he said. But pretty much every week in our editorial meeting there would be some new outrage.

How can you not speak out at a time like this? he added.

Dr. Thomas H. Lee, a professor of medicine at Harvard Medical School and a member of the journals editorial board, did not participate in writing or voting on the editorial.

But to say nothing definitive at this point in history would be a cause for shame, he said.

Medical specialists not associated with the N.E.J.M. applauded the decision.

Wow, said Dr. Matthew K. Wynia, an infectious disease specialist and director of the Center for Bioethics and Humanities at the University of Colorado. He noted that the editorial did not explicitly mention Mr. Biden, but said it was clearly an obvious call to replace the president.

There is a risk that such a departure could taint the N.E.J.M.s reputation for impartiality. While other medical journals, including JAMA, the Lancet and The British Medical Journal, have taken political positions, the N.E.J.M. has dealt with political issues in a measured way, as it did in a forum published in October 2000 in which Al Gore and George W. Bush answered questions on health care.

But it is hard to imagine such a deliberative debate in todays acrimonious atmosphere, said Dr. Jeremy Greene, a professor of medicine and historian of medicine at Johns Hopkins University.

The Trump administration, he said, had demonstrated a continuous, reckless disregard of truth.

If we want a forum based on matters of fact, it strikes me that no form of engagement could work, Dr. Greene added.

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In a First, New England Journal of Medicine Joins Never-Trumpers - The New York Times

Brown University Medical School Dean to Lead Second Session of Five-Part Virtual Future of Medicine Summit : SF STAT! – South Florida Hospital News

October 5 2020 - Allan R Tunkel, Senior Associate Dean for Medical Education and Chief of Medical Education at the Brown University Alpert Medical School, will be presenting, The Impact of COVID-19 on Medical Education on Thursday, October 8, 6-7:30 p.m.nPresented by the Palm Beach County Medical Society (PBCMS) as part of the annual Future of Medicine Summit, the event is free to participants, who may register at:

Started in 2007 by Jose Arrascue, MD, the Future of Medicine Initiative brings together community leaders to define issues, establish partnerships and implement strategies for change. At the annual Summit, national and community health care leaders gather to explore the "hot topic" issues facing healthcare.

He received a Ph.D in experimental pathology before earning a medical degree at the College of Medicine and Dentistry of New Jersey in Newark. He completed a Residency in internal medicine at the Hospital of the Medical College of Pennsylvania in Philadelphia and an Fellowship in infectious diseases from the University of Virginia Health Sciences Center in Charlottesville. He has been at Brown since 2013 and previously taught at the Drexel University College of Medicine for a decade.

For more information and the Future of Medicine, Contact Katherine Zuber at KatherineZ@pbcms.org or 561-433-3940.

Originally posted here:

Brown University Medical School Dean to Lead Second Session of Five-Part Virtual Future of Medicine Summit : SF STAT! - South Florida Hospital News

Human brain dissected live in front of medical school students – The Argus

A MEDICAL school has become the first in the UK to live-stream a human dissection as part of a new virtual teaching technique.

Year two and medical neuroscience students at Brighton and Sussex Medical School (BSMS) witnessed a brain being removed.

They also had an introduction session where they explored the muscles and bones of the chest.

Social distancing restrictions as a result of the pandemic have forced universities online, blending curriculum with a mix of face-to-face and virtual teaching.

Staff at BSMS have implemented a blended medical curriculum to ensure students still receive face-to-face teaching in key clinical area and also benefit from digital innovations to support their learning.

One of these innovations has been to bring the dissecting room, a highly regulated space, to students via streaming.

The procedure had been carefully planned, considering the Human Tissue Authority regulations, and only involved donors who had consented to the activity.

Professor Claire Smith, head of anatomy, said: In responding to the current restrictions, it remains imperative that medical and surgical teaching continues.

In anatomy teaching, Covid-related restrictions have been compounded by the medical school only receiving half the number of donated cadavers for teaching. We are so fortunate to have donors and my thoughts are always with those who have suffered loss at such a difficult time.

This new innovation has meant the donors wish to educate and inform future generations can still occur, albeit in a slightly different way.

It is not only medical students who are benefiting.

Last month, a week-long course was arranged by Dr Jag Dhanda, using the live stream to demonstrate surgical procedures on cadavers with virtual reality (VR).

Multiple camera angle perspectives in the virtual reality view were live-streamed to 350 surgeons from 26 countries around the world.

Surgeons were able to view the surgical techniques on cadavers through virtual reality headsets that allowed them to choose the camera angle perspective they wanted by moving their heads.

One student who attended the brain dissection said they gained a lot from the experience.

He said: Its definitely a learning curve with all the new tech tools, but I really felt that I gained incredibly valuable experience by being present during the session.

I know that I speak on behalf of all the medical neuroscience students when I say that we are very grateful for the opportunity to be included in something like this.

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Human brain dissected live in front of medical school students - The Argus

After 40 years in medicine, here’s what a Maine addiction expert has learned about alcohol, opioids and public health – Bangor Daily News

When The New York Times, the Washington Post and news agencies across Maine have needed to understand the opioid epidemic and the policies emerging in response to it, they have often turned to a specialist in addiction medicine working in Portland, Dr. Mark Publicker. Unafraid to criticize redundant task forces and barriers to treatment, his advocacy led to better policy and saved lives, said those who learned of his impending retirement online.

As the pandemic complicates the more hidden challenge of addiction, Publicker, 70, will retire from his private practice at the end of the year, after 40 years in medicine. He recently spoke about his career and the changing upheavals of the opioid crisis. Today, synthetic opioids, including fentanyl, are the most common drugs involved in drug overdose deaths in the United States.

While people in Maine may have heard of drug dealers mixing deadly fentanyl with heroin, the public may not know that dealers are also increasingly mixing fentanyl with cocaine and fentanyl with methamphetamine and that methamphetamine use is rising, said Publicker, who is the past president of the Northern New England Society of Addiction Medicine. Given fentanyls potency, the drug combinations may be contributing to Maines increasing number of overdoses.

Indeed, deaths involving cocaine and methamphetamine have increased in the past few years, according to state figures. The vast majority of those deaths have also involved opioids such as fentanyl.

It complicates the crisis, Publicker said. It also makes expanding access to treatment and educating medical providers about addiction as important as its ever been, said Publicker, who is also a fellow of the American Society of Addiction Medicine and a diplomate of the American Board of Addiction Medicine.

The following is a transcript of a telephone interview with Publicker, of Gorham, on Monday, Oct. 5, which has been edited for length and clarity.

Erin Rhoda, BDN: I remember being in a community meeting several years ago. Someone had a question relating to addiction treatment, and someone else spoke up and said, Well, Maine has a top expert in that. Talk to Dr. Mark Publicker. How did you come to be an expert in addiction medicine?

Mark Publicker: I started my career as a family physician in a nonprofit HMO in Pittsburgh. It was in a community of steelworkers, and they had a whole range of medical signs and symptoms. They had evidence of liver disease. They had blood pressure that was hard to control, gout. And my thinking was it was evidence of industrial poisoning that nobody else had identified. I was quite excited by this. And somebody loaned me a book about alcoholism in doctors. I woke up after reading it, slapped my forehead and said, Oh my God, half my patients are alcoholic. Now what do I do? It just so happened the doctor who wrote the book was one of the countrys first addiction psychiatrists, and he was practicing in Pittsburgh. So I went to see him.

He told me I should go to [Alcoholics Anonymous] meetings, which was hard for me being a non-alcoholic doctor. I went, and I started to recognize and understand more about alcoholism. I started to talk with my patients about my concerns and encourage them to go to meetings themselves, and initially I would go to meetings with them, which is something I wouldnt recommend doctors to do now. About six months later I started to get God bless you letters from patients and their families. I went, Wow, diabetics never sent you God bless you letters.

That was that. I began to study, got involved in the countrys foremost addiction medicine society, developed an addiction treatment program for this HMO, got certified in addiction medicine and was recruited from Pittsburgh to Washington, D.C., to develop Kaiser Permanentes addiction treatment program. I was there for 10 years. Mercy Hospital recruited me here.

Even though Im in Portland, the vast majority of my patients are from midcoast or Down East, and I can name every single little town on the midcoast where I have a patient coming from. I have got some people coming as far away as Machias. Theyre lobstermen, and theyre oystermen, and theyre blood wormers, clammers. And then land-based patients, roof and carpentry.

My patients recovery just belies with what peoples beliefs are about people with addictive histories. These guys go out in the middle of the Gulf in January to fish. If the lobsters arent there, theyre roofing. And if theyre not roofing, theyre doing carpentry. If theyre not doing carpentry, theyre doing hardscaping.

Weve [my wife and I] lived in a lot of places we figure 10 places in our marriage. Ive never seen a work ethic like this. I have these frankly wonderful patients, and its hard now for me to be starting this process of saying goodbye to them.

ER: As a doctor at a family medicine practice in Pittsburgh in the 1980s, how did addiction manifest itself then compared with today?

MP: What happened in Pittsburgh is instructive because the steel industry collapsed, and, along with that, communities collapsed, and drugs came in. When communities and cultures are wounded, drugs are more likely to come in.

What weve seen is a trend from primarily alcohol dependence in the country, to cocaine and prescription opiates, followed by intravenous heroin, supplanted by intravenous fentanyl.

Now the scary thing that were facing is increases in combinations of fentanyl with cocaine, and fentanyl with methamphetamine. What the cartels are doing is combining fentanyl with cocaine. People may not be aware that theyre using fentanyl, which may be one of the reasons that can account for the increase in overdose death rate over the last year or so.

In this state weve been largely spared methamphetamine. But no longer. Over the last year and a half its flooded into the state. The drug problem is quite severe and not showing any signs of slowing. In the midst of all of this, hidden, is high rates of alcohol dependence. Attention to it has been orphaned by the prescription opiate epidemic. It definitely kills more people per year than opiates do.

ER: I hadnt heard about the increased mix of fentanyl and methamphetamine.

MP: Its interesting because at noontime today we just had a presentation that was given by Millennium labs, which is one of these reference labs. The September 18 issue of JAMA [the Journal of the American Medical Association] published the results of their surveys of their lab results, from not only Maine but across the country. What theyre showing are like 300 percent increases and 400 percent increases in drug screens positive for fentanyl plus methamphetamine or fentanyl plus cocaine.

The study that was done compared pre-COVID and post-COVID. So post COVID is when these rates of co-occurring drug use have exploded. Its likely stress, unemployment, the circumstances that tend to increase drug use.

ER: When you first started treating people for their alcohol use disorder, it sounds like you werent formally taught how to talk to and treat people with alcoholism, and later sought out training yourself.

MP: To this day there is little to no formal education of medical personnel on addiction. Its rare to find any real coursework in medical school. Residencies have very little, and medical schools have been resistant to introducing significant curriculum to address the deficits. If you think about what are the major causes of preventable morbidity and mortality, theyre addictions. Its anything from nicotine to alcohol to opiates and benzos.

The most interesting thing Im doing these days is participating in this project with the Lunder-Dineen foundation. [It] is an alliance to teach Maine health professionals on a variety of topics, everything from dental health to care for the elderly. Theyd approached me about six years ago, asking me for a suggestion for a project for addiction. My proposal was to help teach medical professionals how to initiate and have conversations with their patients about their concerns about their drinking.

Its not simply a matter of writing a prescription. How do we talk with people? If you have a concern about your patients alcohol, how do you approach that? This is a major project with project managers from Mass General. Its a five-year project. Its being piloted now in seven health centers, federally qualified centers around the state. This is all in Maine.

ER: Tell me more about how you learned to respond to people and how your initial experiences affected how you later developed addiction treatment programs.

MP: The first thing I learned is that treating people with care and respect allows patients to not respond defensively but at least to allow you to have a conversation to express your concerns. Contrary to my fear initially that if I spoke with patients about my concerns they would become angry, instead [what I found is] they might not agree, but I was able to continue expressing my concerns and, over time, get people to change.

There are a number of behavioral tools that are extremely effective in helping people become motivated to change. Not just change addictions, but it could change almost any behavior. I wish I had thought about using it with my teenagers when they were in school. Its called motivational interviewing. The principles are expressing empathy, not arguing, avoiding confrontation, emphasizing self-efficacy.

This was contrary to the old concept of treating addictions by confronting people and causing them to feel debased in order to build up their new selves. This was a revolutionary concept. It was one of the things that I did training and ultimately taught, was the use of this technique called motivational interviewing, which is now I think regarded as central to treatment.

ER: Mercy Hospital in Portland recruited you to be the medical director of the hospitals recovery center in 2003, and you helped develop a maternal addiction program there. Youve called it perhaps the most rewarding thing in your career. What was the work like?

MP: We recognized that we were seeing a lot of pregnant women coming into our detox unit. This is opiates. We kind of asked ourselves, Well, what are we doing? We have all these pregnant women. We need to come up with some formal way to treat them. So a number of us got together. Twenty-four hours a day, if a woman came into the recovery center, we would admit them to our inpatient unit, assess them, give them treatment options, generally begin them on buprenorphine [a medication used to treat opioid use disorder].

[Then wed] discharge, transition them into our partial hospital program, which was six hours a day, five days a week; then move them into our intensive outpatient treatment program, which was three hours a day, five days a week; then ultimately into a group we called the Moms Group that met for an hour-and-a-half every week with a counselor and a nurse, with participation of one of the three addiction doctors at the recovery center.

We would encourage women to continue in the group after they gave birth, so we had mothers breastfeeding, and we had babies crawling on the floor. We had peer support through that. It was wonderful.

My wife first started out by knitting baby outfits and then developed her own diaper bags that women still cherish. I still hear from them. Its very gratifying. I dont think I ever did anything that gave me as much professional satisfaction and pride as working at the moms program.

ER: Mercys recovery center closed in 2015 because it was losing money. How did you feel?

MP: Everyone who was working there was, I think, heartbroken. We were sad because we had a tremendous program. We understood why Mercy did it. Nonetheless it was a major loss. I would have worked there for the rest of my career. But along with it, our mothers program ended. I think we all wished that had continued.

At that point I was 65 and had always worked for nonprofit organizations, and suddenly I didnt have a job. I made the decision that I was going to go into private practice, which has been successful, but its not as gratifying as working with a group of people and a program.

ER: When you opened your own private practice in Portland, what did you learn about the needs of the state of Maine from your patients?

MP: Maybe 75 percent or more of my patients are uninsured. So even though MaineCare was expanded, Ive got a population of working people who dont have health insurance who make too little to qualify for the ACA [Affordable Care Act] and too much to qualify for MaineCare. Ive got a lot of patients who are uninsured, which severely limits their access to treatment.

Much of the treatment in the state is based on participation in outpatient treatment programs. There are patients who have been sober for years who dont need to be in group. For certain populations who are working people, a requirement that people participate in a group is a real impediment to access to care. If youre a lobsterman, and in order to get your prescription you have to show up at a group on a Thursday afternoon, for example, but your captains going out, youre not going to that group, and youre not going to get your prescription. That serves as a barrier.

ER: I was looking back through some of my emails. In 2016 you wrote to me, virtually everything that is being proposed or done is wrong in Maine when it came to combating the opioid epidemic. One thing that youve fought for is the recognition of the science that medication helps people with addiction. Have you seen progress on this front?

MP: This is a significant issue. Weve got this action plan for the state. If you read it, what youll see is its based on buprenorphine. That to me is a major error.

[Asked about it, Gordon Smith, the states director of opioid response, said the administration supports all types of medications. The state has increased the MaineCare reimbursement rate for methadone, for instance, he said, and is pursuing additional methadone clinics.]

ER: How do the other Food and Drug Administration-approved medications, methadone and Vivitrol, fill a gap that buprenorphine, commonly known by its brand name Suboxone, cant?

MP: Not everybody can manage a prescription medicine. Some people do better with greater structure. Adherence rates may be better for somebody on methadone.

What can happen and what often happens is, somebody continues to use opiates or is unable to stop while on buprenorphine, and theyre discharged. Theres no understanding that there are alternatives that you can offer to people other than simply to discharge them.

We know that methadone has been proven to be effective since the 60s. It should be part of our armamentarium. It also allows us to expand access to care. Vivitrol, which is an injectable form of the drug naltrexone, has also been shown to be very effective. All of the medications that are FDA approved should be part of our opiate response.

ER: As you know, the number of drug deaths rose in Maine as the pandemic shut everything down. What are your words of advice for what the state should do to slow the rate of death?

MP: It would be wonderful if I had the solution to this problem, which I dont. Let me start with that earned humility. No, I dont have an answer to this other than to recognize that our treatment programs may be so focused on opiates that we are forgetting that there are other drugs that may need to be addressed. Ill say this in regards to alcohol as a co-factor in deaths treatment isnt really available.

When I say to you, Gee, we have this tremendous increase in co-occurrence of fentanyl and methamphetamine, your answer is, I didnt know that. The knowledge that we have this problem isnt known yet, and that knowledge needs to be expanded. The fact that we have a methamphetamine epidemic is probably still not widely known. But we do. Cocaine is still prevalent.

The problem is more difficult, more complex and more resistant to solutions. I think we ought to try to solve what we can. Effective medication management is one such way, but that needs to be expanded to all medications.

If you look at the states action plan, education isnt part of it. In general, broader education of Maine health practitioners on addiction would improve our response to the epidemic. It should be included in our action plan.

[While we have not prioritized the education of future medical professionals on addiction, both medical schools have adopted new curriculum doing just that, said Smith, with the state. Plus, several family medicine residency programs are requiring all of their residents to get the needed approval to provide medication-assisted treatment, he said.]

ER: Maybe you could talk about why you decided to retire, and how you feel about it.

MP: Ive been debating this now for a year and a half. While there are a lot of rewards from private practice, it also has limited my ability to do things that I enjoy such as teaching and volunteering in the community.

Its time for me to figure out something else in addition to only practicing medicine for 40 years. Im not giving up medicine, but Im definitely moving to another stage in my life.

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After 40 years in medicine, here's what a Maine addiction expert has learned about alcohol, opioids and public health - Bangor Daily News

Trumps Lying Personal Physician And Dr. Umar Johnson Went To The Same Med School – News One

As if the situation surrounding Donald Trumps case of the coronavirus couldnt get any less predictable, it turns out that the presidents personal physician whos been under fire for telling apparent lies (go figure) graduated from the same medical school from which Dr. Umar Johnson earned his much-maligned doctorate.

That fact was an interesting twist to an already convoluted story centered onDr. Sean Conley, who has given the media conflicting reports about Trumps treatment (in other words, he lied) and has been accused of following the White Houses script to paint an optimistic picture of the presidents health that admittedly wasnt completely accurate.

While the fact that Conley and Umar Johnson both graduated from the Philadelphia College of Osteopathic Medicine is one tie that binds the two, the doctor of osteopathic medicine (D.O.) and his weekend of lying bore similarities to his doctor of clinical psychology counterpart, who has also been accused of telling lies albeit their lies having different degrees of urgency. (Yes, thats right, the presidents physician is not an M.D., or medical doctor.)

Conley admitted Sunday to lying a day before when he downplayed Trumps health prognosis to reflect the upbeat attitude that the team, the president, that his course of illness has had. Conley explained to reporters that he lied because he didnt want to give any information that might steer the course of illness in another direction.

Johnson, for is part, never really lied, per se, as much as just flat-out misrepresented himself as a doctor for years before earning his PhD in 2012. However, hes been accused of lying about raising money to purportedly build a school for Black boys. Hes reportedly helped raise hundreds of thousands of dollars (other rumors say as much as $1 million) in donations forthe construction of a schoolthat he seemingly never intended to build. For the record, he has insisted otherwise, as shown during the epic episode of NewsOne Now with Roland Martin from two summers ago.

Black Enterprise reported in 2014that Johnson launched an initiative to fund an all-Black boys school. At the time, Johnson said he was gaming to raise $5 million to buy St. Pauls College, an HBCU in Lawrenceville, Virginia, and convert it into a boarding school for young African American boys.

Five years later, Johnson announced in a video that he had finally raised the funds to buy property in Wilmington, Delaware, to house the Frederick Douglas Marcus Garvey Academy (FDMG).

However, Johnson said in a Labor Day video that he still needed money for the renovation of FDMG Academy. He said he already has the architectural plan but still needs money to pay for the electrician and HVAC and the fire alarm and the sprinkler company.

Conley, for his part, came under scrutiny in May for treating Trump with the drug hydroxychloroquine purportedly as a preventive measure against contracting the coronavirus despite medical studies suggesting the anti-malaria medication could be fatal and futile against Covid-19.

Still, Conley said at the time, he and Trump concluded the potential benefit from treatment outweighed the relative risks.

Five months later Trump is battling the coronavirus without any true indication of how severe it is both are no thanks to Conley and Johnsons school for Black boys remains unbuilt.


Trump Has The Coronavirus: What His Pre-Existing Health Conditions Mean In The Long, Or Short, Run

Trump Planned To Use Black Woman As A Prop During Debate Before Racist Meltdown


Trumps Lying Personal Physician And Dr. Umar Johnson Went To The Same Med School - News One

Study Finds Older Adults Using Cannabis to Treat Common Health Conditions – UC San Diego Health

With growing interest in its potential health benefits and new legislation favoring legalization in more states, cannabis use is becoming more common among older adults.

University of California San Diego School of Medicine researchers report that older adults use cannabis primarily for medical purposes to treat a variety of common health conditions, including pain, sleep disturbances and psychiatric conditions like anxiety and depression.

The study, published online October 7, 2020 in the Journal of the American Geriatrics Society, found that of 568 patients surveyed, 15 percent had used cannabis within the past three years, with half of users reporting using it regularly and mostly for medical purposes.

Pain, insomnia and anxiety were the most common reasons for cannabis use and, for the most part, patients reported that cannabis was helping to address these issues, especially with insomnia and pain, said Christopher Kaufmann, PhD, co-first author of the study and assistant professor in the Division of Geriatrics and Gerontology in the Department of Medicine at UC San Diego.

Patients surveyed in the study were seen at the Medicine for Seniors Clinic at UC San Diego Health over a period of 10 weeks.

The researchers also found that 61 percent of the patients who used cannabis had initiated use after age 60.

Surprisingly, we found that nearly three-fifths of cannabis users reported using cannabis for the first time as older adults. These individuals were a unique group compared to those who used cannabis in the past, said Kevin Yang, co-first author and third-year medical student at UC San Diego.

New users were more likely to use cannabis for medical reasons than for recreation. The route of cannabis use also differed with new users more likely to use it topically as a lotion rather than by smoking or ingesting as edibles. Also, they were more likely to inform their doctor about their cannabis use, which reflects that cannabis use is no longer as stigmatized as it was previously.

Given the rise in availability of CBD-only products, which is a non-psychoactive cannabinoid in contrast to THC-containing products, the researchers said it is likely that future surveys will continue to document a larger proportion of older adults using cannabis or cannabis-based products for the first time.

Alison Moore, MD, chief of the Division of Geriatrics in the Department of Medicine at UC San Diego School of Medicine.

The findings demonstrate the need for the clinical workforce to become aware of cannabis use by seniors and to gain awareness of both the benefits and risks of cannabis use in their patient population, said Alison Moore, MD, senior author and chief of the Division of Geriatrics in the Department of Medicine at UC San Diego School of Medicine. Given the prevalence of use, it may be important to incorporate evidence-backed information about cannabis use into medical school and use screening questions about cannabis as a regular part of clinic visits.

The researchers said future studies are imperative to better understanding the efficacy and safety of different formulations of cannabis in treating common conditions in older adults, both to maximize benefit and minimize harm.

There seems to be potential with cannabis, but we need more evidence-based research. We want to find out how cannabis compares to current medications available. Could cannabis be a safer alternative to treatments, such as opioids and benzodiazepines? Could cannabis help reduce the simultaneous use of multiple medications in older persons? We want to find out which conditions cannabis is most effective in treating. Only then can we better counsel older adults on cannabis use, said Kaufmann.

Geriatrics at UC San Diego Health was recently ranked thirteenth in the nation in the 2020-2021 U.S. News & World Report survey. The geriatrics and gerontology team at UC San Diego Health is committed to providing top quality, evidence-based care to older adults.

Co-authors of the study include: Reva Nafsu, Ella Lifset, Khai Nguyen and Michelle Sexton, all at UC San Diego; and Benjamin Han and Arum Kim, New York University School of Medicine.

Funding for this study came, in part, from the National Institutes of Health (T35AG26757, K01AG061239, P30AG059299, K23DA043651), the Stein Institute for Research on Aging, the Center for Healthy Aging and the Division of Geriatrics and Gerontology at UC San Diego.

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Study Finds Older Adults Using Cannabis to Treat Common Health Conditions - UC San Diego Health

My Body, Whose Choice? – The Regulatory Review

States should require doctors to seek informed consent before performing pelvic exams on anesthetized women.

More than three quarters of U.S. states do not require a womans consent before a doctor conducts an invasive procedure on her genitalia. State action is needed to curb the widespread practice of doctors performing pelvic exams on non-consenting women who are under anesthesia for other, non-gynecologic medical care.

Although medical codes of ethics emphasize the importance of obtaining consent before providing patient care, testimony from both patients and medical professionals shows that the troubling practice of unconsented gynecological examinations has existed for at least several decades.

A 2003 study of five Philadelphia area hospitals indicated that medical students completing fellowships on womens reproductive care were less concerned than other doctors with seeking consent for medical procedures. The study also revealed that 90 percent of students surveyed in these fellowships had apparently performed a pelvic exam on an unconscious, anesthetized woman without securing her consent.

One of the studys coauthors, Ari Silver-Isenstadt, became wary of this practice during his time as a medical student at the University of Pennsylvania. According to Silver-Isenstadt, an individual reported him to the medical schools dean for his efforts to avoid performing pelvic exams on women under anesthesia. Silver-Isenstadt had to make a personal arrangement with the dean to ensure he could avoid the practice and not flunk his course.

A pair of 2018 articles by biomedical ethicist Phoebe Friesenone scholarly article in the journal Bioethics, and an article for general audiences in Slatedrew an additional round of attention to the doctors performing pelvic exams on unconscious female patients without their consent. These articles inspired the hashtag #MeTooPelvic and have sparked a spate of investigative journalism reports published in early 2020.

Before 2019, only six states legally required that doctors seek informed consent to perform a pelvic exam. Five additional states passed bills in 2019 to require consent for the procedure, bringing the current total to just 11 states as of this spring.

To ensure that medical professionals conduct pelvic exams on explicitly consenting individuals, states have passed laws regulating the procedure. For example, California passed such a law in 2003. It requires that physicians, surgeons, and medical students obtain informed consent to perform a pelvic exam on an anesthetized or unconscious female patient. Otherwise, the patients pelvic exam must fall within the scope of care for treatment, or be necessary for an unconscious patients diagnosis. California also made breaking this law a crime.

Laws passed in other states contain similar language on pelvic exams, but do not always make violating the law a crime. For example, Marylands 2019 legislation requires that medical workers obtain informed consent before performing a pelvic exam on patients while they are under anesthesia or unconscious. The only consequences for breaking Marylands law, however, will be those meted out by a professional board housed in the Maryland Department of Health. The board can only punish violators through formal reprimands, probation, or the suspension or revocation of professional licenses.

Protecting female patients requires legislative action because women hoping to prevent the practice on their own face backlash. After a doctor performed a pelvic exam on a Wisconsin woman while she was under anesthesia for a 2009 abdominal surgery, the woman sought to prevent the same incident from happening during a 2018 procedure. She reportedly asked to draft a consent contract to prevent a pelvic exam, but hospital administrators told her to seek medical care somewhere else.

The reality is that pelvic exams on unconscious, non-consenting patients are not necessary. Doctors and medical students already have an existing system of knowledgeable, consenting, and conscious people on which they can practice pelvic exams. Female Genitourinary Teaching Associates (GUTA) are trained to guide health care trainees through sex-specific physical exams, and they use their own bodies as a demonstration and practice model.

Thirty-nine state legislatures are woefully late in recognizing that womens rights are not protected when they go into surgery. These states need to pass legislation to protect female patients from a practice and system that seems unconcerned with invading the most intimate parts of a persons body.

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My Body, Whose Choice? - The Regulatory Review

U of M Medical School Researchers Found Traces Of COVID-19 On Beaches – FOX 21 Online

DULUTH, Minn. Researchers at the University of Minnesota Medical School Duluth are reporting they have found traces of the COVID-19 virus in water from four area beaches.

The group has been taking samples from eight local beaches since July.

Researchers have found evidence of the genetic makeup of the COVID-19 virus at Leif Erikson, Park Point, Brighton, and 42nd Avenue beaches between the weekend of September 11th and 18th.

It is still unclear where the source or sources are coming from, but experts say testing samples might help answers some unresolved questions about COVID-19 in the area.

By watching for its presence may be able to show how long it stays or if it goes away. It will help understanding lake processes and levels of infection, said Dr. Richard Melvin, assistant professor of Biomedical Sciences. All of those things will help us find out how the virus ends up in the water.

U of M Medical School researchers will be continuing to monitor and take samples from all beaches for the next four to eight weeks.

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U of M Medical School Researchers Found Traces Of COVID-19 On Beaches - FOX 21 Online

Experimental COVID-19 Treatment Given To President Trump Part of Study At U of M Medical School – FOX 21 Online

This study is also being conduction nationally, which will enroll about 2,000 people.

DULUTH, Minn. The experimental treatment recently given to President Donald Trump for his diagnosis with COVID-19 will soon be part of a study being conducted at the University of Minnesota Medical School.

The particular drug treatment is made up of two identical antibodies, which are created in a lab.

The antibodies are expected to bind to the virus to help prevent it from attacking other cells in the body.

The U of M Medical School study will test the cocktail on people who have no symptoms, but have come in contact with people who were positive for COVID-19.

These are people we know have been exposed and are at higher risk of getting sick, but arent sick yet. What we are hoping to find out in my study is whether we can prevent them from becoming ill, said Anne-Marie Leuck, an assistant professor of infectious diseases and international medicine at the U of M Medical School.

The study is in partnership with a New York-based pharmaceutical company, which created the treatment.

The U of M Medical School has yet to start the trial, but plans to enroll about 100 people.


Experimental COVID-19 Treatment Given To President Trump Part of Study At U of M Medical School - FOX 21 Online

American Sign Language and the Power of Communication – Pager Publications, Inc.

I began my journey with the Deaf community before coming to medical school starting with a basic American Sign Language class just to learn a few routine signs. I continued with the American Sign Language Club at Geisinger Commonwealth School of Medicine, hoping to learn more medical signs for any future interactions with Deaf patients. Through the club, I recently met an incredible four-year-old boy named Kase at a local community event to meet Peppa Pig.

Kase is small for his age, has short, curly brown hair and wears bright blue glasses that accentuate his brown eyes. Meeting Peppa Pig was extremely overwhelming for Kase, who has a complicated medical profile, including polymicrogyria, cortical visual impairment, absence seizures, in-utero drug exposure, expressive language disorder, global developmental delays and Autism. No, Kase is neither your average four-year-old nor an average four-year-old who is hard of hearing. However, Kase is extraordinary, and through him I found the truest joy.

When I sat with Kase and asked him if he was excited to meet Peppa Pig, Kase responded with a script from his favorite YouTube video about coloring: Today I colored with orange. I colored a pair of cozy orange socks and an orange bouncy basketball. He didnt answer my question, but he was able to repeat word for word that video he watched one week prior. I then asked him if orange was his favorite color. He responded with the exact same script about the color orange. It was easy to pick up on this behavior, but difficult to fully engage and connect with him.

After the twentieth time I heard Kases story about the color orange, I decided to try connecting a different way; this time using American Sign Language. With the help of his family, his teacher, and his school counselor, we tried to pause Kases script as I used American Sign Language to spell a word and have Kase voice each letter. When he talked about the orange bouncy basketball, I would fingerspell B-A-S-K-E-T-B-A-L-L. He would stop, concentrate and spell basketball with me and then continue scripting. The best way to describe the change I saw in Kase was relief. When he was able to pause his mind and concentrate on my hands as they formed each letter, it looked and felt like Kase had temporary relief from the busyness surrounding him. American Sign Language was the key to not only communicate with Kase but also to connect with him.

Communication plays an extremely important role in all aspects of medicine, including patient interviews, shared-decision making, and working with other healthcare professionals. Through meeting Kase, I found that communication serves a greater purpose in that proper communication can be inherently therapeutic.

Kases reality is much different from my reality. For Kase, he is constantly stimulated by his environment, and due to his medical condition, he is unable to process that environment and then verbally communicate his feelings or desires. However, he does have the incredible ability to remember every little detail from every video he watches, and this scripting is how he copes with sensory stimulation. Instituting sign language into Kases experience clearly helps coordinate his processing, turning an overstimulating situation, into a more manageable experience. American Sign Language helps Kase become less overwhelmed and more in control of his environment, serving its therapeutic purpose. Now, I recognize that American Sign Language is not just a means to communicate, but an emotional, human experience that allows for genuine connection with some of the most complex, vulnerable individuals like Kase.

The art of American Sign Language transcends the dysfunctional neurological pathways to create genuine human connection. Therefore, it is important for healthcare professionals to identify individuals with hearing impairments and help get them and their families to receive the proper services they need. There is growing evidence that intervention at no later than 6 months of age for infants who are deaf or hard of hearing greatly helps language development, social-emotional skills and other school-related measures. One of these interventions could be introducing sign language at an early age, giving these infants a form of communication that can transcend their impairments. With this language, greater connection and engagement can be achieved. The simple task of fingerspelling the word basketball was truly transformative for Kase and could be for any child who is Deaf or hard of hearing.

Every time I see Kase and interact with him, I know how to aid his vulnerability and act compassionately towards him through language. When I think about Kase and the impact sign language has on his everyday experience, I wonder how his development could have improved if sign language was introduced to him at an earlier age. For those who are diagnosed with a hearing impairment, who are nonverbal, who are hard to connect with and engage with, American Sign Language could serve as an extremely powerful tool that we can continue to support in healthcare. American Sign Language epitomizes the idea of humanism in medicine for an extremely vulnerable population, and my experience with Kase, the young four-year-old boy who fights every day, helped me come to this realization.

Image Credit: Learning sign language(CC BY 2.0)bydaveynin

Contributing Writer

Geisinger Commonwealth School of Medicine

Matthew Busch is a third year medical student at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania class of 2021. In 2017 he graduated from The University of Scranton with a Bachelor in Science in neuroscience and biomathematics, with minors in philosophy and biochemistry. He enjoys playing soccer, listening to audiobooks, and completing puzzles in his free time. After graduating medical school, Matthew would like to pursue a career in Pediatrics.

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American Sign Language and the Power of Communication - Pager Publications, Inc.

Trump Returns Home After Downplaying Disease, but Doctor Says He Isnt Out of the Woods – The New York Times

Heres what you need to know:Video



[camera shutters] [from off-camera] Mr. President, how many staff are sick? How many of your staff are sick? [President Trump] Thank you very much. Thank you. [from off-camera] Do you think you might be a superspreader, Mr. President? [camera shutters]

After spending three nights at the Walter Reed medical center, President Trump returned on Monday evening to the White House, where he will continue to receive treatment for Covid-19. His physician, Dr. Sean P. Conley, had said earlier in the day that the president was not out of the woods yet.

Mr. Trump, wearing a mask and a suit, passed through the hospitals large golden doors, paused atop a flight of steps and pumped his fist a few times at chest level. He did not respond to shouted questions from the news media as he walked past, unaccompanied. Thank you very much, everybody, he said with a wave.

Mr. Trump then boarded a black S.U.V. that drove him to his presidential helicopter, Marine One, for the short flight to the White House. He offered a thumbs-up just before stepping onto his helicopter, which departed just after 6:45 p.m. for the 10-minute flight.

After landing on the South Lawn, Mr. Trump ascended a flight of stairs and then turned to face his helicopter and the live television cameras and removed his mask before giving the departing Marine One a long salute.



[no speech]

He then turned and walked into the White House residence without donning his mask. Several masked people, including what appeared to be an official photographer capturing the moment, were inside.

The three major network newscasts on ABC, CBS and NBC carried it all live, the kind of blanket television coverage that Mr. Trump relishes. But after climbing the stairs, Mr. Trump appeared to be short of breath.

At a briefing earlier in the day, Dr. Conley said, Over the past 24 hours, the president has continued to improve, adding, Hes met or exceeded all standard hospital discharge criteria.

The presidents doctors evaded some key questions about the presidents condition, including his lung function and the date of his last negative coronavirus test before he tested positive. They said that he had received a third dose of the antiviral drug remdesivir, and that he has continued to take dexamethasone, a steroid drug that has been shown to be beneficial to patients who are very sick with Covid-19.

Were looking to this weekend, Dr. Conley said. If we can get through to Monday, with him remaining the same or improving better yet, then we will all take that final deep sigh of relief.

Dr. Conley did not give a firm answer about whether Mr. Trump would be confined to his residence. The West Wing is experiencing a growing outbreak, with Mr. Trumps press secretary, Kayleigh McEnany, joining the list on Monday of his close aides who have tested positive.

The doctors remarks came after Mr. Trump tweeted that he would be returning to the White House, which is equipped with a medical suite. In doing so, as he has throughout the pandemic, he downplayed the seriousness of a virus that has killed more than 210,000 people in the United States, writing in his post, Dont be afraid of Covid. Dont let it dominate your life.

After returning home, the president later posted a video on Twitter, where he again downplayed the virus, saying, One thing thats for certain: dont let it dominate you; dont be afraid of it. Youre going to beat it.

That exhortation quickly resonated, with some Democrats, scientists and relatives of victims denouncing the president as cavalier and dismissive about a disease that has killed so many, sickened more than 7.4 million and upended daily life across the country.

It was not the first time Mr. Trump has drawn criticism for being cavalier about the pandemic. On Sunday, when he left his quarters at Walter Reed to wave to supporters from an S.U.V., some doctors and others noted the irresponsibility of being in a sealed vehicle and potentially exposing Secret Service agents for an unnecessary stunt.

Critics also noted the president is receiving care that isnt available to most people, including an experimental antibody treatment that is still being tested in clinical trials and has been given to only a few hundred people.

The manufacturer, Regeneron, has said that most of those who have gotten the cocktail have done so as participants in the trials, although in a handful of cases they have received it outside of the studies, as Mr. Trump did.

Dr. Conley would not discuss the findings of a scan of Mr. Trumps lungs, which can be affected by the respiratory virus. His doctors had earlier said that his blood oxygen levels had dropped at least twice, and that he had received supplemental oxygen, which would indicate that his lungs were not functioning properly.

There are HIPAA rules and regulations that restrict me in sharing certain things for his safety and his own health and reasons, Dr. Conley said, referring to a federal law that restricts what type of patient information health professionals can share. On Sunday, Dr. Conley was also evasive, avoiding questions about whether any lung damage or pneumonia was revealed by the presidents X-rays.

Mr. Trumps return home was a dramatic turn of events given that just a day earlier, his medical team had presented mixed messages about his condition, saying that the president was feeling well but also revealing that he had been prescribed the steroid dexamethasone, which is typically not used unless someone needs mechanical ventilation or supplemental oxygen.

Some medical experts said on Monday that given Mr. Trumps risk factors he is 74, male and overweight he should be closely watched for at least the first week of his infection because some patients quickly deteriorate several days into their illness.

I think it would be disastrous to be in a situation where he gets really sick at the White House, and youre having to emergency transfer him, said Dr. Cline Gounder of N.Y.U. Grossman School of Medicine, who has been caring for Covid-19 patients. To me, its not safe.

Dr. Mangala Narasimhan, the director of critical care services for Northwell Health, the largest health care provider in New York State, said that if the president does not need oxygen, it may be reasonable for him to go home, given that he can receive medical treatment at the White House.

But she said the information about his condition was too limited to allow outside experts to assess his condition. Were all guessing, she said.

She, too, warned that Mr. Trump was heading into a critical period. There could be a very rapid decline in these patients, she said, adding that some develop blood clots in their lungs and other pulmonary problems, and need to be quickly put on ventilators.

Public health experts had hoped that President Trump, chastened by his own infection with the coronavirus and the cases that have erupted among his staff members, would act decisively to persuade his supporters that wearing masks and social distancing were essential to protecting themselves and their loved ones.

But instead, tweeting on Monday from the military hospital where he had been receiving state-of-the-art treatment for Covid-19, the president yet again downplayed the deadly threat of the virus.

Dont be afraid of Covid, he wrote. Dont let it dominate your life.

The presidents comments drew outrage from scientists, ethicists and doctors, as well as some people whose relatives and friends were among the more than 210,000 people who have died in the United States.

I am struggling for words this is crazy, said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania. It is just utterly irresponsible.

Fiana Garza Tulip, 40, who lives in Brooklyn and lost her mother to the virus, wrote in a text message that she was reeling after reading Mr. Trumps tweet, which she described as a slap in the face and a painful reminder that our president is unfit for office and that he does not care about human life.

My mom, a respiratory therapist, couldnt get tested at her hospital where she worked, she had to look for two days for a testing site while feeling the effects of Covid, she didnt want to go to a hospital because she said it was worse there and she didnt want to call an ambulance because it was too expensive. So she stayed home for a week and lost her pulse as soon as the medics put her on a gurney.

Shane Peoples, 41, whose parents, Darlene and Johnny Peoples, died of the coronavirus on the same day in September, said the presidents comments were frustrating.

Is he actually trying to put more lives at risk? Mr. Peoples said. He needs to be held accountable for the deaths that could have been prevented if he never downplayed it.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical School in Tennessee, called the presidents message dangerous because it encouraged his followers to ignore basic recommendations to keep themselves safe.

It will lead to more casual behavior, which will lead to more transmission of the virus, which will lead to more illness, and more illness will lead to more deaths, Dr. Schaffner said.

Mr. Trump has often ignored the recommendations of public health experts, repeatedly mocking people for wearing masks, for example.

I dont wear masks like him, he said of the Democratic presidential candidate, Joseph R. Biden Jr., at a debate last week. Every time you see him, hes got a mask. He could be speaking 200 feet away from them, and he shows up with the biggest mask Ive ever seen.

Upon Mr. Trumps return on Monday evening from the Walter Reed medical center, he climbed the steps of the White House, turned to face the TV cameras that were carrying the news live, and removed his mask.

Top White House officials are blocking strict new federal guidelines for the emergency release of a coronavirus vaccine, objecting to a provision that would almost certainly guarantee that no vaccine could be authorized before the election on Nov. 3, according to people familiar with the approval process.

Facing a White House blockade, the Food and Drug Administration is seeking other avenues to ensure that vaccines meet the guidelines. That includes sharing the standards with an outside advisory committee of experts perhaps as soon as this week that is supposed to meet publicly before any vaccine is authorized for emergency use. The hope is that the committee will enforce the guidelines, regardless of the White Houses reaction.

The struggle over the guidelines is part of a monthslong tug of war between the White House and federal agencies on the front lines of the pandemic response. White House officials have repeatedly intervened to shape decisions and public announcements in ways that paint the administrations response to the pandemic in a positive light.

That pattern has dismayed a growing number of career officials and political appointees involved in the administrations fight against a virus that has killed more than 210,000 people in the United States.

The vaccine guidelines carry special significance: By refusing to allow the F.D.A. to release them, the White House is undercutting the governments effort to reassure the public that any vaccine will be safe and effective, health experts fear.

The public must have full faith in the scientific process and the rigor of F.D.A.s regulatory oversight if we are to end the pandemic, the biotech industrys trade association pleaded on Thursday, in a letter to President Trumps health secretary, Alex M. Azar II, asking for release of the guidelines.

The coronavirus outbreak in the West Wing continued to spread on Monday, as the White House press secretary and two of her deputies joined the list of aides close to President Trump who have tested positive for the virus, heightening fears that more cases are still to come.

The press secretary, Kayleigh McEnany, announced on Twitter that she had tested positive and would be quarantining. Ms. McEnany said she had previously tested negative several times, including every day since Thursday, but health experts said she may have been infectious for days including when she spoke briefly to reporters without a mask outside the White House on Sunday.

Two other members of the press team, Karoline Leavitt and Chad Gilmartin, who is Ms. McEnanys relative, also tested positive but learned about their status before Ms. McEnany, according to two people familiar with the diagnoses.

The revelations came amid many unanswered questions about whether Mr. Trump could relocate to the White House without endangering himself and others and suggested that the White House does not have control of the virus.

Vice President Mike Pence, who tested negative on Sunday, was scheduled to travel to Utah ahead of Wednesday nights vice-presidential debate. Mr. Pence also plans to attend campaign events in Arizona and Florida this week before stopping in his home state of Indiana to vote early.

His doctor said in a statement on Friday that Mr. Pence was not quarantining because, as of that time, he had not been close enough to any individuals known to have the coronavirus for long enough to qualify as a close contact at high risk of infection.

Despite almost daily disclosures of new coronavirus infections among President Trumps close associates, the White House is making little effort to investigate the scope and source of its outbreak.

According to a White House official familiar with the plans, the administration has decided not to trace the contacts of guests and staff members at the Sept. 26 Rose Garden celebration for Judge Amy Coney Barrett, Mr. Trumps Supreme Court nominee. At least 11 people who attended the event, including the president and the first lady, have since tested positive.

Instead, it has limited its efforts to notifying people who came in close contact with Mr. Trump in the two days before his Covid diagnosis on Thursday evening. The White House official, who declined to be identified because he was not authorized to speak about the matter, said that the administration was following guidelines from the C.D.C.

The contact tracing efforts have consisted mostly of emails notifying people of potential exposure, rather than the detailed phone conversations necessary to trace all contacts of people who have been exposed. These efforts, typically conducted by the C.D.C., are being run by the White House Medical Unit, a group of about 30 doctors, nurses and physician assistants, headed by Dr. Sean Conley, the White House physician.

This is a total abdication of responsibility by the Trump administration, said Dr. Joshua Barocas, a public health expert at Boston University, who has advised the city of Boston on contact tracing. The idea that were not involving the C.D.C. to do contact tracing at this point seems like a massive public health threat.

Two weeks after the Centers for Disease Control and Prevention removed online guidance about airborne transmission of the coronavirus, the agency has replaced it with language citing new evidence that the virus can spread beyond six feet indoors, adrift in the air.

These transmissions occurred within enclosed spaces that had inadequate ventilation, the new guidance said. Sometimes the infected person was breathing heavily, for example while singing or exercising.

Notably, the C.D.C.s new guidance softens a previous statement referring to the coronavirus as an airborne virus, a term that may have required hospitals to treat infected patients in specialized rooms and health care workers to wear N95 masks anywhere in a hospital.

The new version says the virus can be spread by both larger droplets and smaller aerosols released when people cough, sneeze, sing, talk, or breathe. But while the virus can be airborne under some circumstances, this is not the primary way the virus spreads.

The C.D.C.s revisions come as the Trump administration is contending with a rising number of such infections among the presidents inner circle. Kayleigh McEnany, the White House press secretary, announced on Monday morning that she was positive for the coronavirus, the latest in a string of political figures heading into isolation following what may have been a so-called super-spreader event at the White House last month.

Despite the time that former Vice President Joseph R. Biden spent with President Trump during the presidential debate in Cleveland last week, Mr. Biden is continuing to campaign because he did not meet the C.D.C. requirement for close contact less than six feet of distance from an infected person.

But in a statement accompanying the new guidance, the C.D.C. said, People are more likely to become infected the longer and closer they are to a person with Covid-19.

Mr. Trump talked loudly and at length during the debate, which experts said could have released 10 times as much virus as breathing alone.



On the schools in these areas not all of them have been tested. So we dont have data on all of the schools in these hotspot clusters that troubles me. They have sampled some schools in the clusters, but not all the schools. And these are the hotspot clusters, right? So you have to prioritize testing. You want to go to these schools first because you know they are in hotspot clusters. So some schools in those clusters we have not yet done testing on. Better safe than sorry. I would not send my child to a school in a hotspot cluster that has not been tested, where I did not have proof that the infection rate was low in that school. I would not send my child. I am not going to recommend or allow any New York City family to send their child to a school that I wouldnt send my child. Were going to close the schools in those areas tomorrow.

Gov. Andrew M. Cuomo of New York refused on Monday to allow New York City to close nonessential businesses in nine hot spots in Brooklyn and Queens where the coronavirus has spiked, pre-empting a plan announced the day before by Mayor Bill de Blasio.

The governor suggested that the ZIP codes that were being used to identify hot spots were too imprecise to guide shutdowns. The more pressing problem, he said, lay in schools and houses of worship, including many that cater to Orthodox Jews, rather than businesses that are not large spreaders.

The dissonance in messages from the states two most prominent politicians created confusion for residents, business owners and parents in the affected areas and drew scrutiny to the conflict between city and state over how to tackle early signs of a second wave of the virus in its onetime epicenter.

The governors announcement also seemed to be yet another manifestation of his long feud with Mr. de Blasio. Mr. Cuomo has frequently second-guessed or overruled the mayor, who is also a Democrat, during their tenures. Those clashes were cast in sharp relief during the early days of the pandemic, with the city and state at odds over the timing of shutting down the citys businesses and its schools, among other issues.

On Monday, that disconnect continued, as Mr. Cuomo accelerated the mayors plan to close schools in newly hard-hit areas, moving the closure date up a day to Tuesday, and forcing parents in those areas to again rejigger their schedules to accommodate changes in their childrens routines. Mr. Cuomo said he spoke with Mr. de Blasio and Michael Mulgrew, the president of the citys teachers union, among other local officials, on Monday morning and added that all were in agreement on the need for additional data on cases at specific schools.

Mr. Cuomo did not rule out closing nonessential businesses or public spaces in the near future, and top aides suggested a state plan could be unveiled as soon as Tuesday. Mr. Cuomo said his administration was reviewing how best to do it without relying on geographic delineations from ZIP codes, which he said were arbitrary and might not accurately capture the areas where new cases are going up.

A ZIP code is not the best definition of the applicable zone, he said. If you have to circumscribe an area, make sure you have the right boundaries.

Cuomo administration officials later suggested that the boundaries for business closures could even exceed the ZIP codes where the increases are now occurring.

On Monday afternoon, not long after the governors news conference, Mr. de Blasio said at a news conference of his own that he still planned to close nonessential businesses in the nine ZIP codes. He added later that we obviously will follow state law, and if the state does not authorize restrictions were not going to act. But I find that very unlikely at this point.

Mr. Cuomo had also announced that the state would take over supervision of enforcement of mask and social-distancing rules in the hot spot clusters, presumably putting the State Police in charge of New York City Police Department officers. He added that local governments would need to provide personnel.

The mayor said that he did not believe that the state could seize control of enforcement from local governments but that he agreed with Mr. Cuomo on the need for aggressive enforcement and stronger restrictions that will allow us to turn the tide.

President Trumps declaration that he would leave Walter Reed National Military Medical Center, where he was being treated for the coronavirus, left health professionals stunned. But even if he were not the president, his doctors would have to take extraordinary measures to keep him in the hospital against his will.

Under ordinary circumstances, a patient who wanted to leave the hospital against the recommendation of his or her doctor might be asked to sign a discharge form acknowledging that he or she was declining further treatment. At times, psychiatrists are called in to determine if the patient is capable of making such a decision.

In the medical lexicon, this is called leaving A.M.A. against medical advice. Roughly 2 percent of all patients do so, for varying reasons, often because they need to juggle work and home obligations. If the patient leaving against medical advice had a contagious disease, he or she would be asked to pledge to follow public health guidelines to keep those around him or her safe.

Having an infectious illness itself is not a reason to keep someone in the hospital, said Dr. Leana Wen, a former commissioner of health for the city of Baltimore. But if there is a suspicion that a patient will knowingly and purposefully endanger others, there would need to be a discussion had about keeping that patient in the hospital against his will.

That discussion would be a complicated legal one, governed by state and local public health laws and the Constitution. Both Dr. Wen and Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, raised tuberculosis a highly infectious disease as an applicable analogy.

In Baltimore, Dr. Wen said, the public health department routinely stepped in to ensure that patients in the hospital for tuberculosis treatment were kept there if they gave us reason to believe that if they were to leave that they would not take the medications that were prescribed and then they would be at high risk for infecting others. She said law enforcement often became involved.

In Tennessee, Dr. Schaffner said, doctors would be required to seek permission from a judge. The burden of proof is on the health care system, he said, to document that the person is a substantial hazard to others and then they can be confined until they complete their therapy.

The federal Centers for Disease Control and Prevention has published a handbook on tuberculosis control laws as a guide for medical professionals. Courts have struggled to determine when government authority to promote the populations health justifies encroaching upon established individual rights, the handbook says.

The White House physician, Dr. Sean P. Conley, told reporters on Monday that Mr. Trump had not pushed his doctors to do anything that was beyond safe and reasonable practice. And he noted that at the White House, Mr. Trump would have 24-7 world-class medical care surrounding him.

Even so, Dr. Conley acknowledged that Mr. Trump is not yet in the clear, and said he would not take that final deep sigh of relief until at least next Monday, because the next few days will be critical. Other experts have raised blunt questions about why Mr. Trump would go home even to the White House so soon after diagnosis, especially given the unpredictable course of Covid-19, the disease caused by the coronavirus.

Im worried about in two days he might suddenly crash and then on an emergency basis he would have to be rushed back, Dr. Schaffner said.

He also raised questions about the presidents decision to leave Walter Reed for an impromptu ride in a motorcade through surrounding Bethesda, Md., on Sunday afternoon. Ordinarily doctors want patients to self-isolate until they are 10 days from the onset of symptoms, and three days without symptoms.

Id be surprised if it were with medical concurrence, Dr. Schaffner said.

Dr. Sean P. Conley runs the White House Medical Unit and holds the title of physician to the president. He is also a commander in the Navy, which means his patient is also his commander in chief. The arrangement turns the traditional power dynamic between doctor and patient on its head, with Dr. Conley ultimately forced to choose between compliance and disobedience should President Trump disagree with his recommendations.

The president has been a phenomenal patient during his stay here, and hes been working hand in glove with us and the team, Dr. Conley said at a news conference at Walter Reed National Military Medical Center in Bethesda, Md., hours before the presidents departure from the hospital Monday afternoon. Dr. Conley refused to answer some of the questions asked by reporters, citing medical privacy laws.

That right to privacy under the 1996 Health Insurance Portability and Accountability Act can be waived by patients if they so choose, allowing doctors to share otherwise protected information with the public. It appears that Mr. Trump has waived only information that supports the idea that he is rapidly returning to good health.

Excerpt from:

Trump Returns Home After Downplaying Disease, but Doctor Says He Isnt Out of the Woods - The New York Times

Texas doctor, 28, dies of Covid: ‘She wore the same mask for weeks, if not months’ – The Guardian

It took Carrie Wanamaker several days to connect the face she saw on GoFundMe with the young woman she had met a few years before.

According to the fundraising site, Adeline Fagan, a 28-year-old resident OB-GYN, had developed a debilitating case of Covid-19 and was on a ventilator in Houston.

Scrolling through her phone, Wanamaker found the picture she took of Fagan in 2018, showing the fourth-year medical student at her side in the delivery room, beaming at Wanamakers pink, crying, minutes-old daughter. Fagan supported Wanamakers leg through the birth because the epidural paralyzed her below the waist, and they joked and laughed since Wanamaker felt loopy from the anesthesia.

I didnt expect my delivery to go that way, Wanamaker, a pediatric dentist in upstate New York, said. You always hear about it being the woman screaming and cursing at her husband, but it wasnt like that at all. We just had a really great time. She made it a really special experience for me.

Fagans funeral took place on Saturday.

The physician tested positive for the virus in early July and died on 19 September after spending over two months in hospital. She had worked in a Houston emergency department, and a family member says she reused personal protective equipment (PPE) day after day due to shortages.

Fagan is one of over 250 medical staff who died in southern and western hotspot states as the virus surged there over the summer, according to reporting by the Guardian and Kaiser Health News as part of Lost on the Frontline, a project to track every US healthcare worker death. In Texas, nine medical deaths in April soared to 33 in July, after Governor Greg Abbott hastily pushed to reopen the state for business and then reversed course.

Among the deceased healthcare workers who have so far been profiled in depth by the Lost on the Frontline team, about a dozen nationwide, including Fagan, were under the age of 30. The median age of death from Covid for medical staff is 57, compared with 78 in the general population. About one-third of the deaths involved concerns over inadequate PPE. Protective equipment shortages are devastating for healthcare workers because they are at least three times more likely to become infected than the general population.

It kicked me in the gut, said Wanamaker. This is not what was supposed to happen. She was supposed to go out there and live her dreams and finally be able to enjoy her life after all these years of studying.

Fagan worked at a hospital called HCA Houston Healthcare West, and had moved to Texas in 2019 after completing medical school in Buffalo, New York, a few hours from her hometown of LaFayette.

She was the second of four sisters, all pursuing or considering careers in the medical field. Her younger sibling, Maureen, 23, said she dealt with patients in uncomfortable or embarrassing situations with grace, as she had observed when she accompanied her on two medical mission trips to Haiti. Addie was very much, Do you understand? Do you have other questions? I will go over this with you a million times if need be.

Maureen also mentioned Fagans comic side she was voted by her colleagues most likely to be found skipping and singing down the hall to a delivery and prone to rolling out hammy Scottish and English accents.

Fagan loved delivering babies, loved being part of the happy moment when a baby comes into the world, loved working with mothers, said Dori Marshall, associate dean at the University at Buffalo medical school. But she found living by herself in Houston lonely, and in February Maureen moved down to keep her company; she could just as easily prepare for her own medical school entrance exam in Texas.

It is unclear how Fagan contracted coronavirus, but to Maureen it seemed linked to her July rotation in the ER. HCA West is part of HCA Healthcare the countrys largest hospital chain and in recent months a national nurses union has complained of its willful violation of workplace safety protocols, including pushing infected staff to continue clocking in.

Amid national shortages, Maureen said her sister faced a particular challenge with PPE. Adeline had an N95 mask and had her name written on it, she said. Adeline wore the same N95 for weeks and weeks, if not months and months.

The CDC recommends that an N95 mask should be reused at most five times, unless a manufacturer says otherwise. HCA West said it would not comment specifically on Maureens allegations, but the facilitys chief medical officer, Dr Emily Sedgwick, said the hospitals policies did not involve individuals constantly reusing the same mask.

Our protocol, based on CDC guidance, includes colleagues turning in their N95 masks at the conclusion of each shift, and receiving another mask at the beginning of their next shift. A spokeswoman for HCA West, Selena Mejia, also said that hospital staff were heartbroken by Fagans death.

On 8 July, Fagan arrived home with body aches, a headache and a fever, and a Covid test came back positive. For a week the sisters quarantined, and Fagan, who had asthma, used her nebulizer. But her breathing difficulties persisted, and one afternoon Maureen noticed that her sisters lips were blue, and insisted they go to hospital.

For two weeks the hospital attempted to supplement Fagans failing lungs with oxygen. She grew so weak she wasnt able to hold her phone up or even keep her head upright. She was transferred to another hospital where she agreed to be put on a ventilator.

Less than a day later, she was hooked up to an ECMO device for a highly invasive treatment of last resort, in which blood is removed from the body via surgically implanted intravenous tubes, artificially oxygenated and then returned.

She lingered in this state through August, an experience documented on a blog by her software engineer father, Brant, who arrived in Houston with her mother, Mary Jane, a retired special education teacher, even though they were not allowed to visit Fagan.

The medical team tried to wean her off the machines and the nine sedatives she was at one point receiving, but as she emerged from unconsciousness she became anxious, and was put back under to stop her from pulling out the tubes snaking into her body. She was able to respond to instructions to wiggle her toes. A nurse told Brant she might be suffering from ICU psychosis, a delirium caused by a prolonged stay in intensive care.

The family tried to speak with her daily. The nurse told us that they have seen Adelines eyes tear up after we have been talking to her on the phone, Brant wrote. So it must be having some impact.

On 15 September, her parents were at last permitted to visit. I do not think we were prepared for what we saw, in person, when we entered her room, he wrote. Occasionally, Adeline would try to respond, shake her head or mouth a word or two. But her stare was glassy and you were not sure if she was in there.

It was too much for him. Being the softy that cannot stand it when one of my girls is hurting, [I] commenced to get light-headed and pass out.

Finally, on 17 September, it seemed Fagan was turning a corner. Still partly sedated, she was nevertheless able to sit up without support. She mouthed the words to a song, being unable to sing because a tracheostomy prevented air passing over her vocal cords.

The next day, the ECMO tubes were removed. The day after that, Brant made his last post.

His daughter had suffered a massive brain haemorrhage, possibly because her vascular system had been weakened by the virus. Patients on ECMO also take high doses of blood thinners to prevent clots.

A neurosurgeon said that even on the remote chance Fagan survived surgery, she would be profoundly brain damaged.

We spent the remaining minutes hugging, comforting and talking to Adeline, Brant wrote.

And then the world stopped

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Texas doctor, 28, dies of Covid: 'She wore the same mask for weeks, if not months' - The Guardian

Warrior M.D. Chat: What to Expect – School of Medicine – Wayne State University – The South End

Preparing for medical school, possibly in a new city, has a lot of unknowns and can cause a lot of stress. The Warrior M.D. Ambassadors walk you through what to expect as you enter your first year of medical school.

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Wayne State University (WSU) is a public research university located in Detroit, Michigan.

Wayne State University, in alliance with Michigan State University and the University of Michigan, is part of Michigans University Research Corridor, responsible for $2.15 billion in research and development spending in fiscal year 2015. The URC is one of the nations top research clusters and the engine for innovation in Michigan and the Great Lakes region, increasing economic prosperity and connecting Michigan to the world.

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Nobel awarded to Charles Rice for hepatitis C discoveries at Washington University School of Medicine Washington University School of Medicine -…

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Research fueled advances that have saved millions of lives

The 2020 Nobel Prize in Physiology or Medicine was awarded Monday, Oct. 5, to three scientists for the discovery of hepatitis C virus, an insidious and deadly blood-borne virus. One of those scientists virologist Charles M. Rice, PhD conducted his seminal work while on the faculty of Washington University School of Medicine in St. Louis from 1986 to 2000. Rice, now at Rockefeller University in New York City, was awarded the prize along with Harvey J. Alter, MD, of the National Institutes of Health (NIH) and Michael Houghton, PhD, of the University of Alberta in Canada.

In announcing the prize, the Nobel Assembly said the hepatitis C discovery had made possible blood tests and new medicines that have saved millions of lives.

Rice remains an adjunct professor in the Department of Molecular Microbiology at the School of Medicine.

He described his surprise in getting a phone call at 4:30 a.m. notifying him of the award. When the phone rang, Rice assumed it was a prank call and let it go. But when the phone rang a second time, he answered. [T]here was a voice with a Swedish accent on the phoneWhen he mentioned that my friends and colleagues Harvey Alter and Mike Houghton were also being recognized with this prize, it started to sink in that it might actually be real, said Rice during a press conference at Rockefeller University.

An estimated 71 million people have chronic hepatitis C virus infection, according to the World Health Organization. A significant number of those who are chronically infected will develop liver cancer or cirrhosis, scarring of the liver caused by long-term liver damage.

Charlie is an absolutely brilliant scientist and a wonderful human being who has made a deep impression on all those who have worked with him, said David H. Perlmutter, MD, executive vice chancellor for medical affairs and the George and Carol Bauer Dean of Washington University School of Medicine. His work on hepatitis C has improved the lives of so many people, and he represents the best of what Washington University stands for.

Before the discovery of hepatitis C virus, physicians and researchers were concerned by unexplained cases of chronic hepatitis that developed years or decades after blood transfusions. At the time, only two viruses were known to cause hepatitis, and both had been ruled out. Hepatitis A virus does not spread through the blood, and while hepatitis B virus does, a blood test and vaccine had been developed to prevent infection.

According to the Nobel Assembly, Alter demonstrated that an unknown virus was a common cause of unexplained blood-borne chronic hepatitis, and Houghton isolated the genome of the new virus, which was named hepatitis C virus. Rice provided the critical final evidence showing that infection with hepatitis C virus alone could cause hepatitis.

The Nobel Laureates discovery of hepatitis C virus is a landmark achievement in the ongoing battle against viral diseases, the Nobel Assembly said in a statement. Thanks to their discovery, highly sensitive blood tests for the virus are now available, and these have essentially eliminated post-transfusion hepatitis in many parts of the world, greatly improving global health. Their discovery also allowed the rapid development of antiviral drugs directed at hepatitis C. For the first time in history, the disease can now be cured, raising hopes of eradicating hepatitis C virus from the world population. To achieve this goal, international efforts facilitating blood testing and making antiviral drugs available across the globe will be required.

Added Rice: Winning a prize is one thing, but the prize for all of us working in this fieldis just to have been a part of going from, basically, a mystery virus to having cocktails of drugs that can eliminate the virus without any side effects in more than 95% of people. At least in my case, anything we can contribute to this comes from an intrinsic curiosity about viruses and the chance opportunity of having an important human pathogen land in your family of viruses that you happen to be studying and go from, basically, the beginning to where it can be successfully treated. Its a rare treat for a basic scientist.

Hepatitis C virus caught Rices eye soon after the viral genetic sequence was published in 1989. From the sequence, it was clear that the virus was related to yellow fever virus, which he was already studying. But hepatitis C virus proved tricky. It wouldnt grow in a dish in the lab, and it wouldnt infect animals. One of Rices most important contributions was his recognition that the published viral sequence was incomplete. This breakthrough made it possible to engineer a version of hepatitis C virus capable of infecting animals and causing hepatitis. This work provided the final evidence that hepatitis C virus alone could cause the unexplained cases of transfusion-mediated hepatitis.

At Washington University, Charlie Rice recognized that one problem in developing genetic tools to study hepatitis C virus was that we lacked the correct sequence of the viral genome, said Sean Whelan, PhD, the Marvin A. Brennecke Distinguished Professor and head of theDepartment of Molecular Microbiology. Extending on his studies from a related virus, yellow fever virus, he identified a highly conserved sequence element at one end of the viral genome. This allowed Dr. Rice to engineer a correct copy of the viral genome which turned out to be infectious in primates. This paved the way for fundamental studies of how the virus replicates, which led, ultimately, to drugs that interfere with its replication. His visionary research helped pave the way for development of a cure for HCV. He has inspired a generation of virologists.

Rice and others went on to identify the genetic and molecular machinery the virus employs to infect cells, multiply and cause disease all potential targets of antiviral drugs. Rice developed a system to screen drugs that block key steps in the viral life cycle, eventually leading to the development of curative drugs for hepatitis C virus infection.

Rice is the 19th scientist associated with Washington University School of Medicine to be honored with a Nobel Prize. Across Washington University, 25 current or former faculty members or trainees have received a Nobel.

Charlie Rice is an amazing person, a spectacular scientist, and a wonderful colleague, said Scott J. Hultgren, PhD, the Helen L. Stoever Professor of Molecular Microbiology. He did work that led to the Nobel Prize here in the Department of Molecular Microbiology, creating the first infectious viral genome for in vitro replication. He was a phenomenal leader and colleague here at Washington University.

Added Washington University collaborator Michael S. Diamond, MD, PhD, the Herbert S. Gasser Professor of Medicine: For many decades, Dr. Rice has been a pioneer in the field of molecular biology and genetics of many emerging RNA viruses including flaviviruses, alphaviruses, and hepaciviruses. His seminal studies on hepatitis C virus directly led to the screening and identification of direct-acting antiviral drugs that have resulted in a cure for so many people around the world. His creative research on cellular host-defense responses to viruses have triggered the development of new classes of host-directed antiviral agents. Moreover, he has mentored and trained a generation of virologists who are now at the vanguard of the field. This is truly a deserving honor for a visionary scientist.

Born in Sacramento, Calif., in 1952, Rice received his PhD in biochemistry in 1981 from the California Institute of Technology, where he was a postdoctoral research fellow from 1981 to 1985. After his 14 years at the School of Medicine, Rice moved to Rockefeller, where he now is the scientific and executive director of the Center for the Study of Hepatitis C, an interdisciplinary center established jointly by The Rockefeller University, NewYork-Presbyterian Hospital, and Weill Cornell Medicine.

He is a member of the National Academy of Sciences, and a fellow of the American Association for the Advancement of Science. His previous awards include the 2007 M.W. Beijerinck Virology Prize, the 2015 Robert Koch Award, the 2016 InBev-Baillet Latour Health Prize, and the 2016 Lasker-DeBakey Clinical Medical Research Award. In 2019, he received an honorary degree from Washington University during Commencement.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Nobel awarded to Charles Rice for hepatitis C discoveries at Washington University School of Medicine Washington University School of Medicine -...

Hershey Medical Center: Celebrating 50 years of people helping people – Penn State News

Long before the credential of physician assistant appeared behind her name, Cynthia Thomasson remembers the pickup volleyball games behind the cafeteria at Penn State Health Milton S. Hershey Medical Center as a picture of what makes her second home great.

It didnt matter if you were in housekeeping or a cardiothoracic surgeon any and all would join the games, said Thomasson, who was a teenage short-order cook in the kitchen 40 years ago. We used to pull our cars up with the headlights shining and music playing when it got dark, and afterward, wed go out for pizza and stromboli.

Now, as then, a sense of teamwork, both on the job and in relationship, drives the mission and success that the Milton S. Hershey Medical Center celebrates this month on the 50th anniversary of its opening.

In the end, it all comes down to people, Thomasson said. Were all united in a mission to give our patients the best care possible, and no one is more important than the next in doing that.

View a gallery of photos from Hershey Medical Center's 50-year history

When Hershey Chocolate Corporation President Sam Hinkle, a board member of the Hershey Trust Co., made the oft-referenced $50 million phone call offering seed money to Penn State University President Eric Walker, the stakes were high: Could a world-class medical school and teaching hospital rise out of the cornfields of rural Derry Township?

In a grainy, black-and-white film of the 1963 meeting that brought together educators from other prestigious institutions such as Harvard and Temple universities, Hinkle casts a vision straight from the heart of Milton S. Hershey.

With the accumulation of money he didnt need for his orphans (at Milton Hershey School), I began to wonder, if he were living, What would Mr. Hershey do? Hinkle said. He was primarily concerned with alleviating human suffering, and thats where the medical school idea came into play.

With another $21.3 million in funding from the U.S. Public Health Service which would have to be repaid in full if the medical center failed ground was broken in 1966.

The water system was inadequate, the sewer system was inadequate the whole infrastructure of the community had to be upgraded, said Dr. C. Max Long, founding chair, comparative medicine.

Founding Dean Dr. George T. Harrell, the only person ever to found two medical centers, shepherded the project, literally laying out his design idea with wooden blocks in a video legacy.

Education embodied in the health campus library that bears his name was the underpinning of the bricks-and-mortar structure with its unique crescent-shaped facade.

The purpose in the establishment of any medical center is training practitioners in a local community, Harrell said, bringing together knowledge, research, education and patient care.

When Penn State College of Medicine opened its doors to students in 1967, Dr. Larien Bieber was among them.

It was a leap of faith to come to a medical school that consisted of a hole in the ground and three doctors, said Bieber, who is now an internal medicine physician at Penn State Health Lime Spring Outpatient Center.

To recruit clinical faculty when there was no hospital was always a question mark, said Dr. Graham Jeffries, founding chair of the Department of Medicine. The farmhouse, now the Cocoa Beanery, was pressed into service, with the kitchen serving as a laboratory for the first several months.

The day the hospital opened, there was a front-page story in the Philadelphia paper saying it would close, said Dr. Cheston Berlin, a pediatrician and professor of pediatrics and pharmacology. They didnt think we could make it financially.

Nancy Nightwine, the first in-patient admitted to the Medical Center in October 1970 for diagnostic testing, is still proud of her picture with Harrell that hangs at the entrance.

It was a very nice honor, she says of the experience 50 years ago. Little did she know then that the Medical Center would save her life some 20 years later when she was rushed there for emergency care after a bee stung that sent her into anaphylactic shock.

In 1977, a $90,000 project expanded capacity of the Neonatal Intensive Care Unit from 17 to 27 infants.

Since 1970, the campus has grown from 318 acres to 550 acres.

The milestones of the College of Medicine and Medical Center are intertwined in a long list of firsts these past 50 years. The College of Medicine was thefirst in the nationto have a dedicated Department of Family and Community Medicine and a Department of Humanities producing, in Harrells words, doctors with handbags and hearts.

Hematologist Dr. Elaine Eyster joined the medical staff in 1970 as one of the first female faculty members, leading the Division of Hematology for 22 years and serving as director of the colleges Hemophilia Program since 1973. Her research revolutionized the worlds understanding of HIV infection in individuals with hemophilia, improving their prognosis dramatically.

The Medical Center produced the worlds first mechanical blood pump for patients awaiting heart transplants and, in 1985, implanted its first total artificial heart. In 2006, groundbreaking research into how to grow the human papillomavirus in the lab led to the first vaccine for cervical cancer.

The Medical Center the only Level 1 Trauma Center in Pennsylvania accredited for both adult and pediatric patients continues its vision of bringing the highest level of care closer to home, with the opening of community Medical Groups and Penn State Health Hampden Medical Center, scheduled to welcome patients in 2021.

In many areas of our country, if you need a heart transplant or advanced cancer care or want to participate in a clinical trial that could save your life, you have to go to a big city hospital to access that care. Hershey Medical Center offers all that and more, close to where our patients live, said Steve Massini, Penn State Health CEO. I think that was the intent of the Hershey Trust and MS Hershey Foundation when they made that $50 million gift to start our College of Medicine and teaching hospital, and I think they would be really proud of how we care for our community.

Medical Center leaders say they find themselves, in some ways, at the same place their predecessors were 50 years ago, innovating and growing amidst uncertainty but with Hersheys same vision to alleviate human suffering.

His legacy is evident in the service to patients, education of future health care providers and ongoing transformative research, said Deborah Berini, Medical Center president.

If Milton S. Hershey were here, I would share with him the impact that this gift has made on the lives of our patients, our community and the world through service of our patients, education of future health care providers and transformative research, she said. Most of all,I would want him to meet our outstanding faculty and staff who do extraordinary things each and every day in the service of our mission.

Learn more about the history of Hershey Medical Center in clips from the documentary Memories & Milestones.

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Hershey Medical Center: Celebrating 50 years of people helping people - Penn State News

Medical school class writes own Hippocratic Oath acknowledging racism, Covid-19 deaths and the killing of Breonna Taylor – CNN

The symbolic white coat ceremony marks the beginning of an academic journey for students in medical programs across the country -- it's a time when students accept their white medical coats and recite an oath vowing to be fair and ethical as they begin their medical education.

As part of their orientation, first-year medical students were challenged by Chenits Pettigrew, the medical school's associate dean for Diversity, Equity, and Inclusion and assistant dean for Student Affairs, to create a new class oath that acknowledged "their ever-evolving responsibilities as physicians," Patrick McMahon, executive director of Communications at Pitt told CNN.

The oath continues to highlight health care disparities and racial injustice, but it doesn't just focus on current events alone.

"We recognize the fundamental failings of our health care and political systems in serving vulnerable communities," the oath says. "This oath is the first step in our enduring commitment to repairing the injustices against those historically ignored and abused in medicine: Black patients, Indigenous patients, Patients of Color and all marginalized populations who have received substandard care as a result of their identity and limited resources."

Tito Onyekweli, one of twelve students on the oath writing committee, told CNN he and his peers ultimately hope to create a safe space for exploration and to continue to push the boundaries of medicine.

"We saw our oath as an opportunity to specifically call out certain groups of individuals and say, hey we know you've been left out; we know that it is because of us and our health care system and we want to remedy that," he said.

"You have doctors who don't really prioritize communities of color. A lot of that isn't on doctors, it's on the health care system at large, but doctors have a very important role to play. How are we going to shape our education so that we're better prepared to serve the communities in need?"

And the University of Pittsburgh School of Medicine's Class of 2024 isn't the only program that allows its students to revise the oath.

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Medical school class writes own Hippocratic Oath acknowledging racism, Covid-19 deaths and the killing of Breonna Taylor - CNN

UMass Medical School-affiliated study finds federal rule will negatively impact immigrant health care – Worcester Business Journal

A study from an institute in which the UMass Medical School is a member has raised concerns about a federal rule regarding how non-residents receive coronavirus and other care.

A revised federal public charge admissibility rule could prompt thousands of Massachusetts residents to forgo health care or disenroll from their coverage plans, according to a report released Tuesday in a collaboration between the Blue Cross Blue Shield of Massachusetts Foundations Massachusetts Medicaid Policy Institute and UMass Medical Schools Commonwealth Medicine.

The public charge rule, which covers whether a non-citizen can receive health benefits, was suspended during the pandemic. It was reimposed when the U.S. Court of Appeals ruled on Sept. 11 that the Department of Homeland Security could do so.

The U.S. Department of Citizenship and Immigration Services says self-sufficiency has long been a basic principle of the country's immigration law.

The rule, according to the Blue Cross and UMass Medical School report, makes it harder for some immigrants to obtain green cards or visas if they've applied for or enrolled in public health benefits such as MassHealth, the state program that covers Medicaid and the Children's Health Insurance Program, or for the Supplemental Nutritional Assistance Program.

The report estimates that 55,000 to 129,000 Massachusetts residents will likely avoid enrolling in, or disenroll from, MassHealth. Another 27,000 to 63,000 residents will avoid enrolling in, or disenroll from, SNAP, it said.

Lower enrollment numbers in such programs could also mean less revenue for the state. Massachusetts gets an estimated $36 million to $85 million in SNAP retailer redemptions annually, as well as federal matching dollars for Masshealth, the report said.

"The public charge rule could impact the Commonwealths most pressing health policy priorities," the report said. "Over the past few decades, Massachusetts has invested heavily in achieving near-universal health care coverage, culminating in the lowest uninsured rate in the nation. By causing an estimated 55,000129,000 Massachusetts residents to forgo or disenroll from MassHealth coverage, the public charge rule could chip away at this progress."

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UMass Medical School-affiliated study finds federal rule will negatively impact immigrant health care - Worcester Business Journal