Trauma-Informed Undergraduate Medical Education: A Pathway to Flourishing with Adversity by Enhancing Psychological Safety.

We describe the Life Experiences Curriculum (LEC), which attempts to integrate medical student well-being with trauma-informed medical education. The long-term goal of LEC is to help medical students flourish with adversity and trauma, where flourishing refers to having a sense of purpose that arises from awareness of one's strengths and limitations, shaped by life experiences. The short-term goal of LEC is to develop students' relational capacities, such as acceptance and awareness of self and others, while building and maintaining students' psychological safety. We describe the conceptual rationale for these goals and the curriculum's development, implementation, evaluation, and limitations. The curriculum extends over four years and involves a preclinical seminar and students' individual and group reflection sessions with LEC faculty. The seminar addresses the coexistence of trauma and flourishing across life experiences, as well as how safety in relationships is impaired by traumatic experiences and must be restored for healing and growth. The physician faculty have no role in student evaluation and co-lead all LEC activities. LEC is intended to provide students with new language for understanding the process of trauma and flourishing in both individuals and systems and to build and sustain students' relational capacities. There are ongoing efforts to re-imagine self-care as communal-care in which care and support are given and received in a community of students and faculty. Such a model may help build the relational capacities needed to deliver trauma-informed care and also promote flourishing with adversity in healers and in those seeking to be healed.

Opioid Knowledge and Prescribing Habits at a Large Tertiary Care Academic Center.

BACKGROUND: Opioids are commonly prescribed medications for pain management with high risks associated with chronic use. The inherent risk associated with opioids is worsened by variable prescribing practices used by prescribers. In the midst of the "opioid epidemic," perceptions of opioid prescription among healthcare practitioners have not been widely investigated. OBJECTIVE: This study aimed to explore the opinions, experiences, and habits of prescribers as well as other healthcare personnel involved in the administration of opioids at an academic medical center. METHODS: Questions were shared through an online survey format, answerable in Likert scale scores from 1 to 5, and categorized into three domains; prescribing habits/management, education, and risk stratification. RESULTS: A total of 638 survey responses were collected comprising 130 physicians (21%), 44 residents and fellows (6.9%), 53 physician assistants and nurse practitioners (8.31%), 18 pharmacists (2.82%), 85 medical students (13.32%), and 308 nurses (48.28%). Collected responses revealed a weak consensus on prescribing practices and a lack of evidence-based opioid management such as low utilization of multidisciplinary clinics and unfamiliarity with the WHO analgesic ladder across all specialties. The survey also indicated a lack of education regarding the prescribing of opioids across all specialties although pharmacists reported obtaining the most. Lastly, the use of risk stratification tools such as prescription drug monitoring programs and urine drug testing were underutilized amongst practitioners. CONCLUSION: Strengthening practitioners' opioid management abilities with evidence-based interventions for each aforementioned domain may aid in the fight against the opioid epidemic.

Palladium-catalyzed regio- and enantioselective allylic alkylation of bis allylic carbonates derived from Morita-Baylis-Hillman adducts.

Morita-Baylis-Hillman diene adducts are used as substrates in the palladium-catalyzed asymmetric allylic alkylation reaction with oxygen and carbon nucleophiles in good regio- and enantioselectivity.

Palladium asymmetric allylic alkylation of prochiral nucleophiles: horsfiline.

[reaction; see text] The asymmetric synthesis of the oxindole alkaloid horsfiline is described. A palladium-catalyzed asymmetric allylic alkylation (AAA) is used to set the spiro(pyrrolidine-oxindole) stereogenic center.

Neonatal hearing loss in the indigent.

OBJECTIVE: To compare the risk factor profile for neonatal hearing loss (HL), and the follow-up rate of those identified with HL in an indigent population with those in an insured population. STUDY DESIGN: Retrospective review. METHODS: We studied 4526 neonates from the high-risk nursery or neonatal intensive care unit from two adjacent hospitals in Houston, Texas. Ben Taub General Hospital (BTGH) is a county public hospital that serves mainly the indigent. Texas Children's Hospital (TCH) is a private tertiary care center that serves patients with private insurance and Medicaid. RESULTS: Overall, 133 infants failed the screening test. Follow-up diagnostic testing identified 48 patients with definite HL. Although nearly twice as many patients at BTGH failed screening compared with TCH (88 vs. 45), four times as many patients at BTGH did not return for diagnostic testing (43 vs. 10). When a hearing aid was needed, there was a delay in getting one at BTGH (P <.05). There was a higher prevalence of dysmorphic facial features and central nervous system disease and a lower prevalence of long-term ventilatory support at BTGH (P <.05). There were no differences between BTGH and TCH in the prevalence of low birth weight, neonatal asphyxia, syndromic stigmata, neonatal infection, family history of HL, or neonatal transfusion (P >.1). CONCLUSIONS: Significant differences in the risk factor profile for neonatal HL exist between the indigent and the general population. A worrisome problem exists with the timely intervention in hearing-impaired indigent neonates.