The Relationship of Adulthood Chronic Disease and Adverse Childhood Experiences (ACEs): Implications Regarding Prevention and Promotion in International Health

Several studies, including the innovative 1998 ACE Study by CDC-Kaiser Permanente, have assessed the association among adulthood chronic disease and the prevalence of maladaptive, health-harming behaviors including: excessive alcohol use, tobacco use, physical inactivity, psychiatric illness including suicidal ideation or attempts, promiscuous sexual behavior (>50 sex partners), history of STI/STD and severe obesity (obesity (BMI > 35 kg/m2)), subsequent to an individual’s exposure to adverse childhood experiences (ACEs). Individuals that have encountered numerous instances of ACEs are almost twice as likely to die before the age of 75, demonstrating a dose-dependent relationship between the instances of ACEs and an increased morbidity/mortality in regard to chronic disease. This excerpt examines the contribution of ACEs to chronic disease and the consequential maladaptive behavior to said adversity, the consequential physiologic and biomolecular changes explained by the Biological Embedding of Childhood Adversity Model in addition to the implications of recounted ACEs on international health security in regard to concepts like conflict, displacement and food insecurity. The apparent association among adulthood chronic disease and ACEs demand changes that promote preventative processes as a means to address the implications these interconnections have on international health

Patient Self-Harm in the Emergency Department: An Evidence- Based Approach

Violence, deliberate self harm, and suicide in emergency departments and hospitals is likely to remain a significant problem for health care systems well into the future. Understanding how to confront, intervene, and manage episodes of patient deliberate self harm is extremely important, and can be life-saving. Here, through a clinical vignette, and a discussion of deliberate self harm we will highlight the importance of the direct observation of such patients, containment procedures (seclusion and physical restraints), and the use of pharmacological adjuncts. We hope that this concise, practically-oriented review will provide our readers with foundational understanding of the topic, including the most important theoretical and clinical considerations

The Impact of Coronavirus Disease 2019 (COVID-19) on Graduate Medical Education (GME): An Exploration of Behavioral Health Aspects

The Coronavirus Disease 2019, regularly referred to as “COVID-19”, has had an unprecedented impact on not only the state of graduate medical education (GME) for post-doctoral trainees, but also their well-being and welfare. Trainees comprise approximately 14% of physicians in the United States. This crucial portion of personnel in healthcare has irrefutably represented the resilience that personifies the medical community. The prevalence of physical and emotional exertion by these trainees, necessitated by the pandemic, has precipitated behavioral health ailments like mood disorders including depression and anxiety, diminished satisfaction in their corresponding specialties and impaired their ability to achieve balance between professional and personal responsibilities. This excerpt examines the pervasiveness of the adverse psychosocial implications the COVID-19 pandemic has had on this susceptible practitioner population in addition to the examination of physical and emotional exhaustion that exacerbate physician burnout including the implementation of policies and procedures to address the emergent problem of physician burnout throughout the COVID-19 pandemic by the GME. Also, this excerpt examines the adaptation of GME, including the reformation and implementation of innovative policies and procedures that has incontestably created an imprint on medical education for descendants of ACGME residency and fellowship programs in the United States

Starting New Accreditation Council for Graduate Medical Education (ACGME) Residency Programs in a Teaching Hospital

Starting a new ACGME approved residency program can positively impact patient care, medical education, hospital operations, and the community as whole. This requires a significant amount of commitment, time, and preparation. The initial application and accreditation process should start early and requires a thorough understanding on the ACGME requirements. Building a new residency program involves collaboration among various stakeholders, starting with the teaching hospital, ACGME, and the Center of Medicare and Medicaid services (CMS). It is prudent to also consider the operational and logistical issues such as budget, faculty and administrative staff hire, faculty time for administrative duties, and educational space for faculty and residents. It is vital to recognize how the institution’s strengths and weaknesses match up to these requirements. A robust educational and clinical curriculum in line with ACGME’s core competencies and useful educational collaboration among various programs is critical for effective program. Recruiting and developing the appropriate faculty members is another important aspect for a successful program. The final challenge is recruiting residents that will fit well into the new residency program. Lastly, we discuss the challenges and tips to mitigate the risks of disappointment in the process of starting and creating a flagship residency program

Anesthetic Concerns in Psychiatric Disease

As the prevalence of mental health illnesses rises worldwide, the use of psychotropic medications follows. Undoubtedly, many patients using psychotropic medications will undergo procedures requiring anesthesia both in the operating room and outside of it. This chapter focuses on psychotropic medications that may complicate the surgical and postoperative course of patients undergoing anesthesia. Toward this aim, we performed a literature review using targeted key terms. Relevant articles were cited, and findings are summarized in this narrative review. We begin with discussing psychotropic medication pharmacology, drug-drug interactions, and side effects, emphasizing their interaction with anesthetic agents. We summarize the current recommendations for managing these medications in the perioperative period. In the discussion section, we focus on highlighting future directions for the intersection between psychotropic medications and anesthesia. Overall, we provide insight into the perioperative management of patients taking psychotropic medications, the point of intersection between the fields of psychiatry and anesthesia