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M.D./M.P.H. and Nursing Students Prepare for the Unthinkable


Special to UM News

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Nursing and M.D./M.P.H. students assumed the roles of first responders and patients during disaster drills at the Gordon Center for Research in Medical Education.

MIAMI, Fla. (December 12, 2016) — The Gordon Center for Research in Medical Education doesn’t usually take care of patients, but on one recent Saturday it served as a makeshift hospital for M.D./M.P.H. and nursing students working together on a complicated, frightening possibility: How would they respond to a terrorist attack at Marlins Park?

Triage for the disaster drill was in the lobby, a large emergency department was set up downstairs, and other areas included a medical/surgical floor, pediatrics, an intensive care unit, and OB/GYN.

“We ran two scenarios so that each student had the opportunity to play both a provider and a victim role,” said Ivette Motola, M.D., M.P.H., director of the Division of Prehospital and Emergency Healthcare and assistant director of the Gordon Center at the University of Miami Miller School of Medicine. “In the first scenario — a bombing and active shooter at the stadium — every area in the hospital had to figure out how to get the patients in, how to treat them, whether to send them home — the same thing that happened at the Boston Marathon bombing. The students who weren’t health care providers in the first scenario were the victims or family members, and then in between we flipped them.”

In the second scenario, the active shooter came to the hospital, Motola said. “The students had to manage sheltering in place, and some were given the role of incident commander and public information officer. We were a little concerned about the level of the challenge and having them all have active roles, but it came together beautifully.”

Casey McGillicuddy, a second-year M.D./M.P.H. student who wants to pursue a career in disaster medicine, shared Motola’s enthusiasm for the experience. “This was a great opportunity to take away the silos between medical and nursing students,” she said. “Nurses will be such a huge part of the rest of my career – it was great to learn from each other.”

Directing the exercise from the School of Nursing and Health Studies was Susana Barroso-Fernandez, Ph.D., R.N., director of simulation operations for the school’s International Academy for Clinical Simulation and Research.

“Nurses are the largest body of first responders in any disaster,” Barroso-Fernandez said. “When you look at a situation of this magnitude, you can pick up a nursing journal or read an article or watch the news, but unless we give them the experience of the front line and put them in that situation, they graduate not knowing what it feels like.

“In this day and age, unfortunately, it’s not a matter of if something happens, it’s when.”

The exercise was McGillicuddy’s capstone project, so she was involved in planning from the beginning. “After the Orlando massacre and the Boston Marathon, we were interested in doing an active-shooter exercise,” she said. “The roles had to be very carefully planned — for example, ‘You are a gunshot victim, right lower leg, and are experiencing shock.’ ”

Thinking about the unthinkable is critical for medical and nursing students, Motola said. “Because disasters don’t happen very often it’s hard to get people to focus on preparing for it, but the idea is to have health care providers who have thought about it and are prepared for it.”

Emergency management professionals who participated in the exercise stressed that message, McGillicuddy said. “They said some of our decisions weren’t necessarily right or wrong, but should it occur in real life we’ll be ready, and we won’t be panicking. It’s always better to have action than inaction.”

“Nursing school is an amazing experience,” Barroso-Fernandez said. “This exercise gives you an opportunity to step back. Because even if you’re working at a hospital during a disaster, it’s a different experience than coming in for your regular shift.”

Many of the nursing students will qualify to join the Medical Reserve Corps after graduation and be available for assignment during a disaster. Building relationships with the M.D./M.P.H. students was valuable preparation for those and other experiences, Barroso-Fernandez said. “At the end of the day what we all want is to enhance patient care and improve patient safety, whatever the scenario.”

 

 

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Behavioral Medicine Pioneers Honored

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Behavioral Medicine Pioneers Honored


By Alex Bassil
UM News

weiss-gellman

Stephen M. Weiss, and Marc D. Gellman

CORAL GABLES, Fla. (December 8, 2016)—Stephen M. Weiss, Ph.D., M.P.H., professor of psychiatry and behavioral sciences at the Miller School of Medicine, and Marc D. Gellman, Ph.D., research associate professor of psychology in the College of Arts and Sciences, were honored last week by the International Congress of Behavioral Medicine for their contributions to the interdisciplinary field that combines medicine and psychology.

Weiss, who is widely considered one of the founders of the field, received the ICBM’s Lifetime Achievement Award on December 7 at the ICBM’s 14th Congress in Melbourne, Australia. He has served as president of both the international society and the Society of Behavioral Medicine (USA).

“I’m not old enough for such an honor,” he joked when asked about the award, adding, “Well, perhaps approaching 80 means if you will ever receive such an honor from your colleagues, maybe sooner is better than later.”

Gellman, was honored with the Distinguished Career Contribution Award for his widely acknowledged contributions to the development of behavioral medicine, which is particularly relevant today, given that many illnesses, like diabetes and lung cancer, are often caused by behavior. He is editor-in-chief of the Encyclopedia of Behavioral Medicine and a former board member of both the USA and international societies.

In expressing his gratitude for the award, Gellman said, “It means so much to me to be acknowledged by my international colleagues. This award would not be possible without the exceptional contribution of so many members of the International Society of Behavioral Medicine.”

The international congress attracts global experts in behavioral medicine and related disciplines to foster research collaborations that contribute to the science and practice of behavioral medicine.

 

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The Lennar Foundation Medical Center Opens to First Patients


Special to UM News

CORAL GABLES, Fla. (December 5, 2016)—The first patients — nearly 150 of them — walked through the front door of The Lennar Foundation Medical Center last week, entering a spectacular new facility and a spectacular new world of health care.

The many months of preparation and the extraordinary support of The Lennar Foundation began paying off as the University of Miami Health System opened this model for future health care delivery — a conveniently located facility where patients are treated as individuals with a superior patient experience and transformational medical care.

Coral Gables campus faculty and staff, students, and residents from throughout south Miami-Dade County will find a wide range of the most advanced services — from Sylvester Comprehensive Cancer Center, Bascom Palmer Eye Institute, the University of Miami Health System Sports Medicine Institute, and many other academic medical specialties — under one roof.

“Today in Coral Gables, we show the world what the most convenient, compassionate, comprehensive care looks like — and will look like across the region, as we extend our vision in the coming months and years,” said Steven M. Altschuler, M.D., senior vice president for health affairs and chief executive officer of the University of Miami Health System.

“Physicians and staff will enjoy an unmatched work experience, in an unmatched setting, as they treat patients and advance translational research in ways only an academic medical center can,” said Ben Riestra, chief administrative officer at The Lennar Foundation Medical Center.

Hundreds of community leaders, University of Miami trustees and administrators, donors and other dignitaries helped dedicate The Lennar Foundation Medical Center on the Coral Gables campus on November 18, ushering in a new world of health care imagined and realized by the University of Miami Health System.

“This is a monumental day for the University of Miami,” Altschuler told those who had gathered for the event. “It is truly a transformational moment in the history of the University of Miami Health System, and it’s also the start of a new vision for health care in South Florida. This is a facility, this is a concept, that really thinks about the patient first.”

In this new vision for health care, the patient experience is transformed into a journey of being well.

“We will know you personally, care for you individually, and guide you uniquely,” Riestra says in a video Altschuler showed guests at the event. “This is not just about a new building. More important, it’s a new destination, a new experience, a new way of being well.”

The building was made possible by a $50 million gift from The Lennar Foundation. More information about the Lennar Center can be found here.

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UM Launches State’s First Needle Exchange Program

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UM Launches State’s First Needle Exchange Program


syringesFor years, while a student at the University of Miami Miller School of Medicine, Hansel Tookes fought the Florida legislature to pass the first law in the state that would allow drug users to exchange used needles for clean ones in an effort to combat HIV transmission among at-risk groups.

On Thursday, after four years of fighting and on a day that coincides with World AIDS Day, the pilot needle exchange program begins in Miami-Dade.

“Syringe exchange is one of the most evidence-based interventions we have to prevent HIV,” said Tookes, M.D., M.P.H. “As the heroin epidemic in South Florida flourishes, we now have the proper tools to keep this population healthy. Harm reduction works and now Miami will join other progressive U.S. cities to better service our citizens.”

The pilot program, the IDEA Exchange named after the Infectious Disease Elimination Act, is just one area where University of Miami health officials have been working to find a cure and stop the spread of HIV/AIDS.

“The HIV statistics in Miami are sobering and now it’s become a personal mission to stay working on HIV until it’s vanquished,” said Mario Stevenson, Ph.D., the Miller School of Medicine’s chief of infectious diseases and Director of the AIDS Institute.

As Stevenson notes, the HIV epidemic in Miami-Dade – which has the nation’s highest rate of incidence – extends beyond basic science.

“Much of the challenge is really dealing with societal issues in terms of how HIV thrives on substance abuse and lifestyles,” he said. “Those are the effects that we have to deal with to fight this epidemic.”

Miami has been a battleground for the HIV and AIDS epidemic since the early 1980s when the then-mysterious, immune-attacking virus first surfaced. The emergence of HIV and AIDS quickly propelled University of Miami physicians to the front lines of one of the deadliest and complex epidemics in modern times.

Seeing a swell of symptomatic women and dying infants, doctors at the School of Medicine were among the first to sound the alarm about the disease. Miami’s close proximity to endemic countries in Latin America and the Caribbean, rising substance abuse, homelessness and mental health are just some of the unique factors that have made Miami-Dade County the HIV epicenter, having both the highest rate and incidence of HIV and the largest and most diverse infected population. Broward County also consistently ranks among the nation’s top HIV-plagued counties.

Over the past three and a half decades, University of Miami Health System infectious disease physicians along with public health experts, psychologists and a team of world-renowned scientists have implemented a unique comprehensive care model and devised tailored population outreach strategies that range from rapid testing, strong community alliances and aggressive adolescent outreach, among other innovative initiatives. The pioneering work of UM pediatricians has nearly erased mother-to-child transmission in Miami. UM’s wide-ranging research has led to groundbreaking HIV drug discoveries and has served to inform top U.S. research institutes on what approaches are effective, especially among minority women. Across the University, scientists in high-tech infectious disease labs busily work toward a cure, vaccine and new therapies.

Stevenson, a renowned scientist, is one of three top infectious disease scientists who relocated their labs to Miami in recent years for greater access to Miami’s diverse patient population. UM’s HIV research arm has allowed thousands of patients to be enrolled in clinical trials that give them access to new therapies and help improve their overall health.

Stopping the Spread

Adding to its arsenal of outreach strategies is UM’s pilot needle exchange program, along with ramped up efforts to reach at-risk communities with the highly-critical pre-exposure prophylaxis (PrEP) drug that blocks the transmission so effectively that it has been likened to a vaccine. These measures may represent a turning point for Miami, as they were key to reducing HIV in other U.S. cities such as San Francisco.

The University of Miami Health System is collaborating with the Miami-Dade County Health Department to start a PrEP clinic that will allow enhanced access to PrEP for Miami-Dade County residents. “New strategies such as PrEP have revolutionized the way we think about HIV prevention,” said Susanne Doblecki-Lewis, M.D., associate professor of clinical medicine, and a PrEP expert leading the effort. “Our work now is to make these very effective interventions available to everyone in Miami who could benefit from them.”

In another innovative research project involving PrEP, renowned UM infectious disease physician Margaret Fischl, M.D., professor of medicine, Director of the Miami AIDS Clinical Research Unit and Co-Director of the Miami Center for AIDS Research, will be targeting transgender women with longer term inter-muscular injections of the drug. Transgender women, she said, tend to have higher rates of drug use and risky sexual behaviors.

“As part of our work, we continue to identify vulnerable populations and employ different modalities to prevent transmission, improve adherence and in turn stop the disease from replicating in those who are infected,” said Fischl, whose early pioneering research was instrumental in gaining FDA approval of AZT, the world’s first antiretroviral drug treatment for AIDS that would later be widely used to prevent transmission of HIV. “Longer term injections of PREP will greatly boost adherence, which has been one of the greatest obstacles in stemming HIV.”

Needle exchange is another new promising initiative. Florida was one of just 15 states that lacked a needle exchange program despite Miami-Dade having the highest rate of HIV and skyrocketing heroin use. Hansel Tookes, M.D., M.P.H., a Miller School-trained resident with a background in public health fought four years for passage of the state needle exchange bill, which was passed in April 2016 and authorized the Miller School of Medicine to conduct a five-year exchange program on a pilot basis within Miami-Dade County.

In addition to receiving clean needles, participants will be educated on safe injection techniques and offered immunizations, as well as viral hepatitis and HIV testing. The program will also link drug users into treatment programs and link those who test positive for HIV or hepatitis to health care – with the goal of reducing the spread of these diseases.

Changing Behavior, Changing Outcomes

Given the psychological burdens and barriers associated with HIV, behavioral health has long been a crucial component to UM’s role in connecting people to care and stemming transmission.  Since the 1990s, psychologists and behavioral health specialists in the Department of Psychology on UM’s main Coral Gables campus and the Department of Psychiatry and Behavioral Health Sciences on the Miller School campus have rigorously studied risky sexual behaviors, mental health patterns and barriers that contribute to HIV. Addressing the epidemic from a behavioral and mental health perspective allowed UM psychologists to create effective interventions and group therapy sessions that have helped HIV-infected minority women overcome the stigma and obstacles to care. The behavioral research also found that most infected women continue to be sexually active (often times unprotected) and go on to have children, which prompted UM behavioral health experts to collaborate with physicians to devise and implement interventions that provide pre-conception counseling. The project educates young HIV-positive women and teens on safe sex practices, including adherence and the role of PREP, preventing mother-to-child-transmission and overcoming barriers to disclosing their HIV status to their partners.

UM professor of psychology Steven Safren, Ph.D., and other UM collaborators, recently published a study in The Lancet HIV journal that linked depression to lower HIV drug adherence and also showed that integrating cognitive behavioral therapy with specialized counseling helps boost adherence.

“While HIV medications and drug prevention mechanisms have greatly improved, it can still be difficult for some to benefit from those drugs due to mental health issues that worsen adherence,” said Safren. “Evidence-based mental health interventions help patients overcome the psychological burdens of the disease which in turn helps boost their adherence and their overall health outcomes.”

UM has also made significant strides in HIV research, testing, outreach and care in the following areas

Street Testing

A project led by Sonjia Kenya, Ed.D., M.S., M.A., Director of Community Health Programs at Sylvester Comprehensive Cancer Center’s Jay Weiss Institute for Health Equity, conducts rapid street testing in African-American and black Caribbean neighborhoods. Funded by the Elton John AIDS Foundation, the project aims to increase knowledge of HIV transmission and treatment among African-American and Caribbean black adults in Miami, and reduce risky behaviors among program participants. The program builds on Kenya’s previous studythat showed the use of community-based health workers along with rapid, home-based HIV testing is an effective strategy for getting more high-risk African American residents tested and connected to health services and treatment.

Innovative Lab Research

Adding to existing clinical research and lab studies, the University became an HIV research hub with the addition of Stevenson and two other world-renowned infectious disease scientists, David Watkins, Ph.D., professor and Vice Chair for Research in the Department of Pathology, and Ronald Desrosiers, Ph.D., professor of pathology. In 2015, Desrosiers and his Harvard University collaborators identified an antibody-like molecule that provides long-term protection against HIV/AIDS infection. Researchers engineered molecules which blocked two key receptors that the HIV virus uses to gain entry to the body’s CD4 white blood cells. The study showed that 100 percent of HIV-1 strains were neutralized by this new molecule inhibitor, which is the first time that this level of protection has been accomplished.

Women’s Interagency HIV Study

As minority women are disproportionately affected and represent the majority of new HIV cases, the University became a site for the national Women’s Interagency HIV Study. Funded by an $8.5 million National Institutes of Health grant, the five-year study has a broad focus including epidemiology, social and behavioral issues, substance abuse, long-term impact of HIV medication, prevalence of co-infection with other opportunistic diseases, such as hepatitis B and C, early onset of menopause, vaginal health and other scientific insight. In a recent and significant finding, Fischl and her collaborators found that vaginal douching increases the risk for women to contract HIV and transmit it to their partners. Douching, researchers found, breaks down the vaginal cell structure and causes bacterial vaginosis, which leaves women more vulnerable. For HIV-positive women, it causes increased amounts of the virus to form in the vagina, particularly around the cervix, which increases chances for transmitting the virus to their partners.

Comprehensive Care

Partnering with Jackson Memorial Hospital, University of Miami Health System doctors created a comprehensive HIV clinic designed to be a one-stop-shop clinic for all the patients’ needs, especially those of low socioeconomic status. The unique center provides a range of medical and advocacy services and, partnered with the UM School of Law, provides a legal clinic at the site.

Adolescent Outreach

The teen and adolescent population (13-24) has become a primary target for UM’s local outreach efforts. Many are unaware of their status, or if positive, are unable to disclose to family members. Miller School outreach workers in the Division of Adolescent Medicine have become the foot soldiers of outreach and have mounted creative tactics to reach youngsters—from setting up mobile testing clinics to staffing health fairs outside of alternative night clubs and high school sporting events. The clinic itself and the group sessions for those newly diagnosed have become a safe haven for youth who can get comprehensive care, interact and confide in others like themselves.

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Researchers to Study Cancer Stress

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Researchers to Study Cancer Stress


UM research examines biological and psychological health mechanisms in cancer patients and their caregiving partners. 

By Deserae E. del Campo
Special to UM News

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Youngmee Kim, associate professor in the College of Arts and Sciences’ Psychology Department, is leading the study.

Cancer affects not only individuals suffering from the disease but their family members as well.

With the assistance of a five-year, $2.5 million grant from the National Institutes of Health, University of Miami researchers hope to gain an understanding of the connection between cancer patients and their caregiver’s health in relation to mutual stress regulatory patterns.

“The research will study and find answers to why cancer patients and their family members’ health deteriorates both psychologically and biologically,” said Youngmee Kim, associate professor in the College of Arts and Sciences’ Psychology Department and lead researcher of the study. “Currently, research is fragmented focusing on how the patient handles stress and how it affects their recovery. Yet, cancer caregivers also report high levels of anxiety and depression, sometimes at higher levels than the cancer patient, and their health is compromised by their elevated stress.”

UM researchers will study the stress regulation patterns between cancer patients and their caregivers, including coregulation (regulating the stress to mutually calm each other’s stress reactions and reduce negative affect and physiological arousal) and coagitation (mutual regulation increasing such reactions).

The coregulation and coagitation will be quantified by evaluating cardiovascular (heart rate variability), neuroendocrine (saliva), and self-reported affective reactivity and regulation in response to a stress situation that is relevant both to health and to close relationships; testing also includes how daily health, such as sleep and mood, as well as longer-term health, such as depression and cardiovascular health of both the cancer patient and caregiver, are affected.

“Findings of this project will help develop novel interventions pertaining to effective and mutual management of stress in daily life and dyadic influences on health promotion,” added Kim.

During a three-year period, UM researchers plan to gather data from 172 heterosexual colorectal cancer patients (86 female, 86 male) and their caregiving partners. Kim hopes to recruit patients living in South Florida.

“Colorectal cancer affects both genders, so we hope to investigate the role of gender in mutual stress regulatory patterns and their health outcomes by studying colorectal cancer patients and their heterosexual partners,” said Kim.

With the results, researchers hope to develop interventions to help cancer patients and caregivers find ways to curb adverse effects of stress and promote better health by using positive coregulation mechanisms. The interdisciplinary study will bring together Charles Carver and Barry Hurwitz, professors from the psychology department; Armando Mendez and Laurence Sands, from the University of Miami Leonard M. Miller School of Medicine; and David Spiegel and Jamie Zeitzer, from Stanford University School of Medicine.

 

 

 

 

 

 

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