Chapter 12 - Allogeneic versus Autologous Source: Comparative Effects

Mesenchymal stem cells (MSCs) are a safe and promising biologic therapeutic for promoting tissue repair in ischemic and non-ischemic heart disease. The mechanisms underlying the salutary effects of MSCs include multilineage differentiation potential, immunomodulatory effect, anti-fibrotic effect, and stimulation of neovascularization and endogenous progenitor cell proliferation and differentiation. The immune-evasive properties of MSCs permit their use in allogeneic therapy, which offers the benefit of immediate availability and the appropriate number of cells. A growing number of clinical trials support the notion that both autologous and allogeneic MSC therapy is safe and has the capacity for repair of the myocardium. Studies are underway to determine the best tissue source of MSCs and the optimal number of cells, route(s) of delivery, and timing of the intervention. In addition, combination stem cell therapy is emerging as a strategy to improve the therapeutic potential of MSCs

Socioeconomic Disparities in Knowledge and Behaviors of Zika virus in Pregnant Women [6J]

INTRODUCTION:Gaps in knowledge and prevention of Zika have been established in pregnant women, though it is unclear whether these gaps are further pronounced in disadvantaged populations. In this study, we aim to identify disparities in knowledge and behaviors of Zika during pregnancy. METHODS:A cross-sectional design was utilized. Surveys were distributed to pregnant women in the antenatal clinics of University of Miami Hospital and Jackson Health Systems. Women were divided into two groups based on socioeconomic status(SES):low(income less than $25,000 or education less than high school) and middle/high(income greater than$25,001 or education greater than high school). Data was then recorded onto REDcap and analyzed using SAS studio. Categorical variables were compared using Pearson’s chi-square or Fisher’s exact test. RESULTS:The study was carried out between January 17th,2017-May 3rd,2017, and a total of 224 women were surveyed. Low SES group consisted of 107 women, and middle/high SES group consisted of 117 women. Both groups were similar in trimester and parity and differed in age, race, ethnicity, employment status, and number of children. Women in middle/high SES group answered more questions correctly about Zika symptomology and prevention compared to the lower SES group. Women in lower SES group were more likely to answer that they feel doctors should talk to their patients about risks and protection from Zika at every visit compared to women in middle/higher SES group. CONCLUSION:There are disparities in knowledge and behaviors regarding Zika in women of lower SES compared to women of middle/higher SES. Interventions to further educate disadvantaged women on Zika

Group-Based Differences in Anti-Aging Bias Among Medical Students

Medical students (MS) may develop ageist attitudes early in their training that may predict their future avoidance of caring for the elderly. This study sought to determine MS' patterns of explicit and implicit anti-aging bias, intent to practice with older people and using the quad model, the role of gender, race, and motivation-based differences. One hundred and three MS completed an online survey that included explicit and implicit measures. Explicit measures revealed a moderately positive perception of older people. Female medical students and those high in internal motivation showed lower anti-aging bias, and both were more likely to intend to practice with older people. Although the implicit measure revealed more negativity toward the elderly than the explicit measures, there were no group differences. However, using the quad model the authors identified gender, race, and motivation-based differences in controlled and automatic processes involved in anti-aging bias

Endogenous Endophthalmitis Heralding Central Nervous System Involvement by Nocardia Farcinica

Nocardiosis is an uncommon opportunistic infection caused by aerobic, gram-positive, weakly acid-fast, filamentous bacteria of the genus Nocardia that presents as a suppurative disease in immunocompromised hosts. Herein the authors describe the case of an elderly male with granulomatosis with polyangiitis (GPA) on chronic immunosuppressive therapy that presented initially with visual symptoms and developed focal neurological deficits. Nocardia should be considered as a potential pathogen in any immunosuppressed patient presenting with endogenous endophthalmitis and new-onset focal neurological deficits. Early recognition and treatment may prevent irrevocable neurological compromise stemming from misdiagnosis

How Did the Zika Virus Outbreak Impact Residency and Fellowship Recruitment in Miami, FL?

Abstract Background In July 2016 South Florida experienced a Zika Virus (ZIKV) outbreak as part of the introduction of the flavivirus in the Americas. At the same time, the National Residency recruiting season was held. The affected area was a mile away from the residency/fellowship training programs of Jackson Memorial Hospital (JMH) and University of Miami Miller School of Medicine (UM). The population at risk for severe ZIKV complications include pregnant women. Many of the applicants were women at reproductive age. The factors influencing residency applicants’ choice of training program have been reported. However, no study has analyzed how a local outbreak with proximity to the area of training affects applicants’ choice of programs. Methods Following the Match 2017, an electronic survey was sent to 2,256 applicants to 19 JMH/UM graduate medical education (GME) programs (15 residency, 4 fellowship programs). We used quantitative and qualitative analyses to explore factors influencing candidates’ decisions, including the ZIKV outbreak. Results Survey response rate was 15% (331/2256). The quantitative analysis identified factors that were Òvery important to applicantsÓ rated 4–5/5 (current resident satisfaction; relationship between faculty and residents; collegiality of current residents; location; quantity and quality of faculty content/mentoring; faculty teaching expertise; diversity of patients; diversity of types of procedures), consistent with prior research In contrast, the presence of ZIKV in MDC was Ònot importantÓ; average score of 1.46/5. 10 respondents said that the presence of ZIKV was ÒVery ImportantÓ; 4 were female, 6 were male; 3/10 said ZIKV made the applicant less likely to accept the interview offer; all ultimately accepted the interview. 100% of respondents were aware that ZIKV was in Miami-Dade county. However, only 6 % (19) of respondents were provided information about ZIKV by their interviewed Program. Conclusion ZIKV outbreak was not a significant independent variable affecting likelihood to match at JMH/UM in Miami-Dade County. These results have important implications for the role of local disease outbreaks in affecting recruitment of medical trainees for residency and fellowship programs. Disclosures All authors: No reported disclosures

Opioid Use Disorder Curriculum: Medicine Clerkship Standardized Patient Case, Small-Group Activity, and Patient Panel

INTRODUCTION: The overdose crisis remains a critical public health problem, creating an urgent need to train physicians in the treatment and management of opioid use disorder (OUD). Our medicine clerkship module aimed to close this gap by training and assessing students’ motivational interviewing skills, harm reduction knowledge, and use of nonstigmatizing language in the treatment of patients with OUD. METHODS: We evaluated the impact of a small-group, case-based activity and patient panel on the clinical documentation skills of students in a medicine clerkship. Clinical documentation was based on an observed structured clinical examination of a standardized patient with OUD and was evaluated using a grading rubric that followed the module learning objectives. Students also submitted reflections on the curriculum. RESULTS: Qualitative responses (n = 40) from students evaluating the small-group activity and patient panel exercise revealed overall student satisfaction with the patient panel and exposure to patients living with OUD. Three themes emerged from student reflections: (1) humanity, (2) different paths to recovery, and (3) using nonstigmatizing language. For the quantitative test, students’ (n = 39) mean clinical documentation scores before and after the small-group activity and patient panel increased from 10.1 to 11.3 out of 13.5 possible points. There was a significant difference between mean pretest and posttest scores (p < .001). DISCUSSION: The medicine clerkship provided an acceptable and feasible opportunity for implementing a multifaceted educational experience for students with significant immediate impact on their evaluation of patients with OUD

Opioid Use Disorder Curriculum: Preclerkship Pharmacology Case-Based Learning Session

During the first year of the COVID-19 pandemic, over 93,000 Americans lost their lives to a preventable overdose. Medications for opioid use disorder (OUD) have been shown to decrease mortality in OUD but are underutilized. Through this case-based learning exercise, first-year medical students applied physiologic and pharmacologic principles to the diagnosis and treatment of OUD. Faculty facilitated a case discussion over a 1-hour large-group case-based learning (CBL) session. Facilitators utilized PowerPoint slides to illustrate graphs and figures while discussing the case. To evaluate students on the CBL learning objectives, three pharmacology exam questions were administered; students also evaluated the CBL's effectiveness in meeting educational objectives on three Likert-scale questions and via open-ended feedback. First-year medical students ( = 200) completed the CBL. The mean score on the exam questions was 91%. Students agreed or strongly agreed that the CBL was an effective way to learn pharmacology principles (69%), that it reinforced pharmacologic fundamentals (70%), and that it showed how pharmacology fundamentals were important in the real world of clinical medicine (86%). Qualitative feedback on the CBL was generally positive, including satisfaction with the small-group setting and practical applications of pharmacology to clinical practice. This CBL exercise contains content critical for preparing students to combat the modern opioid epidemic. The exercise provides an opportunity for learners to review fundamental pharmacodynamic and pharmacokinetic principles so as to ready them for clinical clerkships and beyond