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Division of General Internal Medicine & Health Services Research
Monthly Newsletter
June 2020
UCLA Division of GIM-HSR Monthly Newsletter
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Welcome to our June Newsletter 

Carol Mangione MDI am inspired by how our faculty, staff, residents, and fellows continue to work tirelessly during the pandemic in both clinical and research settings to insure that we provide the best possible care to our patients, take care of each other, and continue to make important contributions to the public discourse, while at the same time publishing important research findings.  Remarkably, many division members have been doing their work while also  caring for older adults in their lives and/or their children.  We are proving to be a very resilient group! 

But, much as the burden of the Covid-19 pandemic has disproportionately harmed African American, Latinx and Native American communities, the horrific murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and so many others who died because of brutality from police or others has caused great suffering and pain for many in our division who experience the day-to-day impact of racism in their lives.  Although we may feel powerless to influence the larger forces over the centuries that have created the deeply ingrained structural racism in our nation, we do have great power to bring respect, compassion, humility, and a willingness to learn from each other every day at work.  As I think back to our beautiful “Seat at the Table” holiday display, I am reminded of our incredible diversity and the love that we can all share with each other as we try to thrive during this most unprecedented and sad time.  It is these thoughts and the privilege of having all of you as colleagues that give me hope.  

Thank you for all that you do, and be safe,  

Carol

Introducing Department of Medicine Office of
Equity, Diversity, and Inclusion (DOM EDI) 

The Department of Medicine Office of Equity, Diversity, and Inclusion (DOM EDI) supports the Department in advancing diversity, equity and inclusion for students, residents, fellows and faculty in the context of scientific excellence, outstanding scholarship and innovation and the highest level of compassionate, high-quality care for our patients. To do this, we focus our efforts on open conversation, sharing ideas, data, and knowledge to build a thriving and inclusive community that fosters the success of us all. 

We recognize and support our amazing staff that support our divisional and departmental efforts, while they are not under our direct purview. Keith Norris, MD, PhD serves as the Vice Chair for EDI and leads the EDI team, which includes Associate Vice Chairs, Teresa Seeman, PhD and Christina Harris, MD as well as Program Manager, Cristina Punzalan, MPH and Program Coordinator, LeeAnn Nerpio

The Team is currently conducting the Listening Tour to connect with each Division Chief, Program Directors and Faculty Leaders to understand their unit issues, values, and goals related to EDI.  We also take the opportunity to brainstorm strategies to improve and enhance EDI in their division.  The Team has also conducted events related to the current issues of our communities.  Shining the Light was held on April 23 for residents, fellows and some faculty to discuss disparities in COVID-19 mortality and community narratives.  On June 1, the team conducted a virtual Healing Circle for our DOM community to come together to process, connect, and heal.  120 residents, fellows, and some faculty attended.  Tanishia Wright, Director of Community Healing and Trauma Prevention Center at Martin Luther King, Jr Community Hospital facilitated the session. 

We are also working on a recruitment tool kit for resident/fellow recruitment days as well as a training module that provides an EDI orientation for incoming clinical faculty. We have been active in writing op-eds, commentaries and more with housestaff and faculty and are active with many departmental and institutional EDI peers, as well as the UCLA-Drew Chapter of the Student National Medical Association in many events to support the Black Lives Matter efforts for justice and equity. We are also addressing COVID-19 hatred against Asians and COVID-19 health disparities as well as the underlying health inequities that lead to them.

At this link, please see our official departmental statement but much more is coming soon.

Please stay tuned for more to come from DOM EDI in our monthly newsletter and website launching this month!  Contact us at domedi@mednet.ucla.edu.

 

Reduce SARS-CoV-2 Spread During Civil Protesting: Recommendations 
A multi-campus group led by GIM's Dr. David Eisenman has authored a timely recommendations bulletin which was circulated to media and stakeholders:

Civil unrest over George Floyd’s murder during this SARS-CoV-2 pandemic will increase community transmission of this highly contagious virus and contribute to increased incidence of morbidity and mortality associated with COVID-19. Any large gathering creates risk for transmission. This risk impacts all participants in protests, including protestors, law enforcement officers, journalists, and bystanders. While many have urged protestors to wear facemasks to reduce virus spread, no specific, written safety recommendations for these activities have been developed to mitigate risk or to plan for an outbreak among anyone who attends, as well as their household members...

Read the full bulletin at: https://www.uclahealth.org/internal-medicine/police-tactics-covid-public-health
Join UCLA Health Care Workers in
Support of Black Lives Matter

Note: There will be no GIM Friday Noon Seminar tomorrow, June 5.

Health Care Workers for BLMPlease join CDU/DGSOM medical students, residents, and fellows on Friday, June 5th at 12pm, as we stand in solidarity with those protesting, and together commit to change.

We will hold 8 minutes 46 seconds of silence in honor of George Floyd and other victims of police violence and systemic racism. We encourage you to wear symbols of your profession (ex: white coats, stethoscopes) and bring signs in support of Black Lives Matter. Due to the COVID-19 pandemic, we ask you to bring your own face covering and stand six feet apart.

Locations:

Ronald Reagan - cafeteria courtyard
Santa Monica - cafeteria courtyard
VA - field near west entrance
Olive View - sidewalk between ED and 2nd floor entrance
Harbor-UCLA - outside doctor's dining
LAC+USC - Marengo St steps

For those who cannot join in person, please join us on Zoom where will we livestream from the Reagan, Olive View, and Harbor UCLA campuses. Please register for the event to access the Zoom links.

GIM in the Media
Joe LadapoDr. Joseph Ladapo published an Op-Ed, "The Crucial Reopening Question," in the Wall Street Journal on May 21st. 

In the piece, he argues that the priority for organizations must be to have a plan for when a customer or employee tests positive for Covid-19.

 

Emily MartinDr. Emily Martin was interviewed by Reuters Health regarding a new JAMA Oncology letter, "Trends in Provision of Palliative Radiotherapy and Chemotherapy Among Hospices in the United States, 2011-2018," for an article, "US Hospices Offering Less Palliative Chemotherapy and Radiation" She commented, "The study does highlight the need for improved tracking of palliative cancer therapies in U.S. hospices and further investigation into the drivers of treatment utilization."
New COVID-19 Articles of Interest
Sood N, Simon P, Ebner P, Eichner D, Reynolds J, Bendavid E, Bhattacharya J. JAMA. 2020 May 18:e208279. Online ahead of print. PMID: 32421144
 
Serological testing for SARS-CoV-2 antibodies. AMA.
Delivering Care: Public Health online post. May 14, 2020.
New GIM Publications

Aronin RG, Park KW, Hoque A. Necrotizing lung infections: Case report and review of the literature. Int J Case Rep Images 2020;11:101120Z01RA2020.

Nwadiuko J, Shah S. Latest Public Health Threats to Migrants at the US Southern Border. Am J Public Health. 2020 Jun;110(6):798-800. doi: 10.2105/AJPH.2020.305639.

The Role of Behavioral Health Diagnoses in Adverse Selection. Keller MS, Xu H, Azocar F, Ettner SL. Psychiatr Serv. 2020 May 22:appips201900354. PMID: 32438887

Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination Rates: A Randomized Clinical Trial. Szilagyi PG, Albertin C, Casillas A, Valderrama R, Duru OK, Ong MK, Vangala S, Tseng CH, Rand CM, Humiston SG, Evans S, Sloyan M, Lerner C. JAMA Intern Med. 2020 May 18.  PMID: 32421168

Considerations for prognosis, goals of care, and specialty palliative care for hospitalized patients with acute-on-chronic liver failure. Hernaez R, Patel A, Jackson LK, Braun UK, Walling AM, Rosen HR. Hepatology. 2020 May 16. PMID: 32416642

Dietary Protein, Fiber and Coffee Are Associated with Small Intestine Microbiome Composition and Diversity in Patients with Liver Cirrhosis. Hussain SK, Dong TS, Agopian V, Pisegna JR, Durazo FA, Enayati P, Sundaram V, Benhammou JN, Noureddin M, Choi G, Ayoub WS, Lagishetty V, Elashoff D, Goodman MT, Jacobs JP. Nutrients. 2020 May 13;12(5). pii: E1395. PMID: 32414035

Trends in Costs of Care and Utilization for Medicaid Patients With Diabetes in Accountable Care Communities. Moin T, Harwood JM, Mangione CM, Jackson N, Ho S, Ettner SL, Duru OK. Med Care. 2020 Jun;58 Suppl 6 Suppl 1:S40-S45. PMID: 32412952

Evaluation of a National Care Coordination Program to Reduce Utilization Among High-cost, High-need Medicaid Beneficiaries With Diabetes. Duru OK, Harwood J, Moin T, Jackson NJ, Ettner SL, Vasilyev A, Mosley DG, O'Shea DL, Ho S, Mangione CM. Med Care. 2020 Jun;58 Suppl 6 Suppl 1:S14-S21. doi: 10.1097/MLR.0000000000001315. PMID: 32412949

Filling the Public Health Science Gaps for Diabetes With Natural Experiments. Gregg EW, Duru OK, Shi L, Mangione CM, Siegel KR, Ramsay A, Thornton PL, Clauser S, Ali MK. Med Care. 2020 Jun;58 Suppl 6 Suppl 1:S1-S3. doi: 10.1097/MLR.0000000000001330. No abstract available. PMID: 32412947

Shortlist of Quality Indicators for End-of-Life Cancer Care. O'Hanlon CE, Walling AM, Lindvall C. JAMA Oncol. 2020 May 14. doi: 10.1001/jamaoncol.2020.1159. [Epub ahead of print] No abstract available. PMID: 32407454

Understanding the Experiences of First-Generation Medical Students: Implications for a Diverse Physician Workforce. Romero R, Miotto K, Casillas A, Sanford J. Acad Psychiatry. 2020 May 12. doi: 10.1007/s40596-020-01235-8. [Epub ahead of print] No abstract available. PMID: 32399837

The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring. Haynes SC, Tancredi DJ, Tong K, Hoch JS, Ong MK, Ganiats TG, Evangelista LS, Black JT, Auerbach A, Romano PS; Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group. J Cardiovasc Nurs. 2020 May 8. doi: 10.1097/JCN.0000000000000689. [Epub ahead of print] PMID: 32398500

2020 American College of Rheumatology Guideline for the Management of Gout. FitzGerald JD, Dalbeth N, Mikuls T, ... , Wenger NS, et al. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-760. PMID: 32391934

Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness Giannitrapani KF, Walling AM, Garcia A, Foglia M, Lowery JS, Lo N, Bekelman D, Brown-Johnson C, Haverfield M, Festa N, Shreve ST, Gale RC, Lehmann LS, Lorenz KA Am J Hosp Palliat Care. 2020 May 8:1049909120923595.  PMID: 32383388 

Palliative Radiotherapy Versus Esophageal Stent Placement in the Management of Patients With Metastatic Esophageal Cancer. Martin EJ, Bruggeman AR, Nalawade VV, Sarkar RR, Qiao EM, Rose BS, Murphy JD. J Natl Compr Canc Netw. 2020 May;18(5):569-574. PMID: 32380466

The Community Perspective on Potentially Inappropriate Treatment. Neville TH, Tarn DM, Pavlish CL, Wenger NS. Ann Am Thorac Soc. 2020 Apr 29. [Epub ahead of print] PMID: 32348687

Writing Accountability Groups Are a Tool for Academic Success: The Obesity Health Disparities PRIDE Program. Thorpe RJ Jr, Beech BM, Norris KC, Heitman E, Bruce MA. Ethn Dis. 2020 Apr 23;30(2):295-304. eCollection 2020 Spring. PMID: 32346275

Religious Service Attendance and Despair Among Health Professionals-A Catalyst for New Avenues of Inquiry. Bruce MA, Norris KC, Thorpe RJ Jr. JAMA Psychiatry. 2020 May 6.  [Epub ahead of print] No abstract available. PMID: 32374354

Opioid prescription patterns among radiation oncologists in the United States. Huang TQ, Chang EM, Grogan TR, Martin EJ, Raldow AC. Cancer Med. 2020 May;9(10):3297-3304.  PMID: 32167661

Clinical Effectiveness and Resource Utilization of Surgery vs Endovascular Therapy for Chronic Limb Threatening Ischemia. Lamaina M, Childers CP, Liu C, Mak SS, Booth MS, Conte MS, Maggard-Gibbons M, Shekelle PG. Ann Vasc Surg. 2020 May 18. pii: S0890-5096(20)30380-0. doi: 10.1016/j.avsg.2020.04.043. [Epub ahead of print] Review. PMID: 32439522

Engaging Community Networks to Improve Depression Services: A Cluster-Randomized Trial of a Community Engagement and Planning Intervention. Mendel P, O'Hora J, Zhang L, Stockdale S, Dixon EL, Gilmore J, Jones F, Jones A, Williams P, Sharif MZ, Masongsong Z, Kadkhoda F, Pulido E, Chung B, Wells KB. Community Ment Health J. 2020 May 19. doi: 10.1007/s10597-020-00632-5. [Epub ahead of print] PMID: 32430557

Patient experience of health care system hassles: Dual-system vs single-system users. Noël PH, Barnard JM, Barry FM, Simon A, Lee ML, Olmos-Ochoa TT, Chawla N, Rose DE, Stockdale SE, Finley EP, Penney LS, Ganz DA. Health Serv Res. 2020 May 7. doi: 10.1111/1475-6773.13291. [Epub ahead of print] PMID: 32380578

Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis. Gaut D, Jones J, Chen C, Ghafouri S, Leng M, Quinn R. Ann Hematol. 2020 Jun;99(6):1217-1223. doi: 10.1007/s00277-020-04050-1. Epub 2020 May 4. PMID: 32367178

Prospective randomized trial evaluating blood and prostate tissue concentrations of green tea polyphenols and quercetin in men with prostate cancer. Henning SM, Wang P, Lee RP, Trang A, Husari G, Yang J, Grojean EM, Ly A, Hsu M, Heber D, Grogan T, Li Z, Aronson WJ. Food Funct. 2020 May 1;11(5):4114-4122. doi: 10.1039/d0fo00565g. Epub 2020 Apr 29. PMID: 32347270

GIM in the Community
Iris Cantor WHERCThe Iris Cantor-UCLA Women’s Health Education & Research Center assisted the Federal Reserve Bank of San Francisco in gathering information from community development stakeholders in Los Angeles to help the Fed better understand how COVID-19 is impacting LMI communities, women and minorities.

The information collected by the Center was compiled with data throughout the state to directly inform the Fed’s community development efforts and how they might be able to best leverage their role in support of partners in responding to the needs of vulnerable communities.    The Center surveyed fourteen of our community partners about the issues faced by their clients and how our community partners responded to the needs. 

Some of the challenges identified included clients that did not want to use public transportation to get to facilities for services that are offered for fear of coronavirus exposure.  Clients only had emergency funds for three months.  Domestic violence calls increased.  Breastfeeding mothers no longer had access to in-person lactation specialists or support groups.  The impact of eligibility for health coverage from a reduction in wages and hours was of great concern.  Housing and food insecurity were ongoing challenges.  Anxiety and mental health concerns increased.  Services provided by outside professionals for inmates at the Century Regional Detention Facility, Women's Jail in Lynwood were suspended.  

Examples of responses to the needs included assistance with rent, food, and utilities.  Staff hours for crisis counseling increased and more supportive services were offered.  A tenants rights hotline extended its hours of operation.   Phone calls to clients to check on their well-being and connect them to resources was initiated.   Remote 24 hour crisis counseling was made available with online chat lines for domestic violence victims.  Helping families and children with online school resources was also provided.

 
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