A new minimally invasive treatment to get you ready for the holidays

minimally invasive procedures to get you ready for the holidays

Now that the holidays are quickly upon us, how do we look great at the holiday party on very short notice? Luckily, there are several new aesthetic options that don’t require surgery or significant downtime.

PDO threads are synthetic absorbable surgical sutures that are used to enhance the appearance of the area treated. Although most commonly used in the face, PDO threads have also been successfully used in the extremities and the abdomen. PDO stands for polydioxanone, a material that induces collagen production around the thread. The thread can increase collagen production by up to 100% in the area treated.

How do PDO threads work?

When barbed threads are used in the face, they can lift the skin in the cheeks, jowls and marionette lines. The contour of the face is improved while, at the same time, stimulating long-term collagen production. In addition, PDO threads can be used to give lip fullness as well as reduce wrinkles in the perioral area.

The procedure takes less than one hour and is done under local anesthesia. Bruising and swelling can occur, but usually, patients can apply makeup and return to work the next day. If desired, thread lifts can be added to enhance surgical procedures such as a neck lift or facelift. They can also be combined with dermal fillers or neurotoxin treatments.

What results can you expect PDO threads?

For those patients do not want to undergo surgery, PDO threads offer an excellent alternative. The results last 12-24 months, but they are instantaneous and require minimal downtime. The best candidates for thread lifts are those who have early signs of aging. Patients with heavy tissues and advanced aging signs are probably better off with more traditional facial plastic surgery.

As with any aesthetic procedure, proper patient selection is key. If the patient is well informed and has appropriate expectations, PDO threads can yield a quick, natural-appearing rejuvenation. For the plastic surgeon, PDO threads represent another arrow in the ever-expanding quiver of choices that we can offer our patients.

So add a little Botox, some filler and a PDO lift and you can be at the company holiday party with no sign of surgery and without having missed a single day of work!

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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What’s so special about Retin-A?

what's so special about retin-A

Retin-A, or Tretinoin, is a form of vitamin A that was developed at the University of Pennsylvania in the 1960s. One of the most successful patents of all time, it revolutionized topical skin care and still has great utility today.

To understand how Retin-A works, it helps to understand the effects of aging on the skin. The most superficial cells—the keratinocytes of the epidermis—tend to become more adhesive and hang around longer. This leaves the skin looking dryer and rougher. The epidermal cells at the base also do not replicate as quickly, so the lifespan of these cells in the outer layer is much longer—and it shows. The pigmentation can become irregular and mottled because of this.

The deeper layer of cells, called the dermis, and the collagen bundles become thinner and disordered, allowing for creases and fine wrinkles to more easily show the muscular activity from below.

How does Retin-A work?

Retin-A is a topical medicine available by prescription only that is applied sparingly to the facial skin, sparing the eyelids and the corners of the nose and lips. It works at the cellular level and takes several months to see the full effect. In many ways, Retin-A can be thought of as reversing the outwards signs of aging on the skin.

The earliest effect of Retin-A is that the outer layer of keratinocytes start shedding off, leaving the skin fresher, smoother and more evenly pigmented. The next effect seen is that the epidermal cells start to replicate faster causing the skin to look and feel softer, more robust and healthier. Finally, the collagen bundles in the dermis will thicken and organize, causing the appearance of fine lines and wrinkles to lessen with time.

Retin-A improves the cosmetic appearance of the skin, but it also helps treat some functional problems of the skin such as acne and precancerous conditions, such as actinic keratoses.

How is Retin-A used for beauty treatments?

Typical treatment regimens include a period of tapering up. The topical product is applied sparingly 2-3 nights per week for several weeks and then the frequency is gradually increased until a nightly regimen is attained. A cream or gel delivery system is chosen based on the skin’s underlying dry or oily predisposition and the concentration can be increased over time.

Common side effects are raw itchy burning skin, generally from more aggressive application in the early phase of exposure. Often taking a break for a few days before continuing the medication at a slower ramp-up will remedy this. Sensitive areas like the corners of the nose, eyelids, lips and corners of the lips should not be treated. Patients should avoid exposure to the sun following Retin-A treatments. The use during pregnancy should also be avoided.

Pretreatment with Retin-A is extremely helpful prior to moderate to deep chemical peel, laser treatments, dermabrasion or facelifting to hasten healing and help prevent scarring or dyspigmentation. Retin-A is certainly a useful addition to any beauty regimen.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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How long does Botox last?

how long does Botox last?

Let’s start with what Botox is. Botox is the brand name for Onobotulinumtoxin A, a neurotoxin derived from Clostridium botulinum. There are currently four different types that are FDA-approved for cosmetic facial wrinkles. These include Botox, Xeomin, Dysport and now Jeuveau.

They all work by blocking a signal from the nerve to the targeted muscle that prevents it from contracting. By preventing the contraction of these specific muscles, there is less action or pull on the skin and a decrease in the formation of wrinkles. While all of these products have the same end result, they differ slightly in their onset, duration of action and discomfort.

When to use each product is dependent on several things. Sometimes, it is the surgeon’s or injector’s preference. In other instances, a patient may have had experience with different products and have found that one works better than the other in them personally. In either case, all of these products are safe and effective in the right hands.

What to expect during your procedure

Finally, the real question. Oftentimes, at the time of your injection, your injector will discuss with you your goals and, after an examination, will be able to assess if those goals can be achieved with the use of neurotoxin. If it can, it’s your lucky day!

Your face will be cleansed and the areas that are to be injected, possibly marked with a removable eyeliner/marker. You might have a numbing cream applied or be given ice packs to help with any discomfort. Once you are ready, the injections will be performed in various areas to target the desired muscles.

You might have a few small bumps in the skin at the actual injection site but these will be gone by the time you leave the office. You might also have some mild bruising which will resolve in 24-48 hours. Finally, you will be given instructions on what to do and what not to do in the next 24 hours. This is can vary from injector to injector.

Onset

Neurotoxins generally take effect in 3-5 days but it is common to not see your full and final results for 7-10 days. I, personally, always tell my patients to wait a full 2 weeks after their Botox injection and, at that point if they need a touch-up, we will take care of it. It takes this long because it takes time for the toxin to block off those nerve impulses to the muscles. It is not immediate.

Duration

Well, don’t we wish Botox lasted forever? Unfortunately, it doesn’t. Eventually, the action of the neurotoxin will wear off and the nerves will again be able to send those signals to the muscles to start working or contracting. In general, Botox lasts 3-4 months.

There will certainly be patients in which in lasts longer, in that 4-6 month range, or shorter, in that 2-month range. It is also common for first-timers to notice that it may not last as long initially but may last longer after the second treatment. Everyone has a unique experience and results may vary.

Hopefully, this helps answer any questions you have about Botox or other neurotoxins. For any further questions, consult with your local board-certified plastic surgeon or use the ASPS Ask A Surgeon tool.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Five common questions everyone has about getting a facelift

five common facelift questions

With so many facial products and nonsurgical treatment options available that address signs of aging, is a facelift still something people consider? The answer is that a surgical facelift remains an excellent option for many women and men who want better facial definition, smoother skin and an overall younger appearance. While numerous other options exist, facelifts are still the most effective way to lift sagging facial tissue and eliminate sagging neck skin.

To help you better understand the procedure and decide if it is right for you, here are some answers to a few of the top questions people have.

How do I know if I need a facelift?

When your daily regimen of creams and serums, or even nonsurgical treatment options, don’t seem to make a difference anymore, it may be time to consider a facelift procedure. If you have sagging skin that easily pulls away from the face and neck or hangs loosely, a facelift is the only treatment option that can help. The facelift procedure removes this extra skin, creating a firm, youthful appearance.

What happens during the surgery?

Several different techniques may be used during a facelift procedure, depending on the cosmetic concern your surgeon is correcting. After anesthesia is administered, incisions for a facelift are usually placed in the hairline around the temple and work down to the lower scalp. During this procedure, the surgeon will sculpt or remove fat, reposition underlying tissue and lift facial muscles. A small incision under the chin may be needed to treat an aging neck. Once complete, the incisions are closed with sutures or skin adhesives.

What about recovery and scarring?

After your facelift procedure, you can expect your lower face and neck to feel sore and tight for the first few days. Pain medications are usually prescribed and can help ease discomfort. Taking a couple weeks off from work is advised to allow yourself time to heal. You may be advised to avoid strenuous exercise for at least three weeks. While individual healing times vary, within about 10 days, the swelling and bruising should be minimal. Makeup is usually enough to cover any signs of surgery until your face heals completely.

Because the incisions follow your hairline, facelift scars typically aren’t noticeable. Even when a chin incision is necessary, it should be placed to follow the natural creases in your chin, hiding the scar.

When will I see real results?

You may see changes to your facial appearance immediately after the procedure, though you will experience bruising and swelling for the first 2 weeks. After that, any additional bruising can be covered with makeup. Your face may not yet feel normal and can take anywhere from 2 to 3 months to completely heal. Your face should appear much more youthful and toned and many patients are often able to take as much as 10 years off their appearance.

How much is the procedure?

The cost for a facelift procedure varies based on a variety of factors including the amount of correction needed, the surgeon’s experience and the area where you live. According to the American Society of Plastic Surgeons, the average cost of a facelift nationwide is $7,655. Keep in mind that this estimated cost does not include anesthesia or operating room expenses.

Next steps on your facelift journey

If you think facelift surgery is right for you and you’re ready to meet with a board-certified plastic surgeon for a consultation, be sure to use the ASPS Plastic Surgeon Match referral service to find an ASPS member surgeon in your area.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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UC Davis Health researchers join the search for chlamydia vaccines

UC Davis Health biostatistician Laurel Beckett and immunopathologist Alexander “Sandy” Borowsky are part of a new research center to develop vaccines for chlamydia, a common sexually transmitted disease caused by the bacterium Chlamydia trachomatis

Alexander Alexander “Sandy” Borowsky and Laurel Beckett will be testing the safety and efficacy of new chlamydia vaccines.

The center, called the Cooperative Research Center for NanoScaffold-Based Chlamydia trachomatis Vaccines, launched Oct. 1 at Lawrence Livermore National Laboratory (LLNL). It includes experts at LLNL, UC Irvine and UC Davis. Their work is funded by a five-year, $10.1 million grant from the National Institute of Allergy and Infectious Diseases. 

“LLNL is extremely pleased to be named an NIH Cooperative Research Center focused on developing new vaccines to prevent diseases that potentially touch so many lives,” said Kris Kulp, the acting leader of LLNL’s Biosciences and Biotechnology Division

“This project capitalizes on a wealth of expertise that our scientists have worked hard to build over the last decade and will help develop LLNL capabilities to create novel treatments for other diseases of national security interest,” Kulp added.           

The scientists will build on a nanotechnology ― called nanolipoprotein particles (NLPs) ― developed at LLNL for delivering vaccines and drugs inside the human body. NLPs are water-soluble molecules that are 6 to 30 billionths of a meter in size. They resemble HDL particles, which are associated with regulating good cholesterol.

They will use NLPs to find surface-exposed proteins within the outer membrane of Chlamydia trachomatis. They believe those proteins could serve as vaccine targets.

The UC Irvine team will develop models that mimic chlamydia infections in people. That process will enable LLNL researchers to refine their nanoparticle designs. The UC Davis team will focus on testing the safety and efficacy of the vaccines. 

The U.S. Centers for Disease Control and Prevention (CDC) estimates that at least 1.7 million cases of chlamydia were diagnosed in the U.S. in 2017. Nearly half of reported cases were in women aged 15 to 24 years. Most infections are asymptomatic. Untreated infections in women can lead to pelvic inflammatory disease or infertility. The disease also has been linked to ovarian cancer. 

More information about chlamydia is available from the CDC.

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Investing in your safety when choosing to have plastic surgery

investing in your safety when having plastic surgery

Before embarking on elective plastic surgery, you have choices to make. Who will perform your surgery? Where will your surgeon operate? How much will you pay?

The choices you make will depend on your priorities, but if your top priority is low cost, you might not be making the best decision. Why? Believe it or not, safety costs money.

Who will perform your surgery?

Lots of surgeons may do the procedure you want, and some may be temptingly less than others, but there may be an important difference. Their training and ongoing education. If you need bladder surgery, you would want to go to a board-certified urologist. Seems obvious, doesn’t it? If you have plastic surgery, you should look for a surgeon certified by the American Board of Plastic Surgery.

Here’s why board certification in plastic surgery is so important: It takes years of training and rigorous examinations to become a board-certified plastic surgeon, but that’s not all. To maintain their ASPS membership and hospital privileges, plastic surgeons must complete a minimum of 150 Continuing Medical Education (CME) hours every three years, with 20 hours devoted to Patient Safety.

That training and continuing education can impact you and your safety. Just as the best-trained pilots not only know how to fly a plane, they are better able to prevent problems and handle them if they do arise. The same is true in surgery. The surgeon who has invested in the most comprehensive training is more likely to assess your risk for complications and use protective measures to prevent them. For example, they may use special leg massagers (“sequential compression devices”) to prevent blood clots from forming.

To take advantage of potential discounts for multiple procedures, it makes sense, doesn’t it, to have as many procedures at once as you can afford? It would if we were talking about having your house cleaned. But humans are different. The longer surgery lasts, the greater the risks, some of them potentially fatal, so the well-trained surgeon is less likely to offer you that multiple-procedure “deal.”

If you have a surgical complication, you’ll want someone responsive who will take care of you. If your surgeon says they don’t have complications, look for someone who will tell you the truth.

Where will your surgeon operate?

The walls don’t do the surgery, it’s true, but your safety is dependent on more than your surgeon’s hands. An accredited facility has all equipment essential for an unexpected emergency, and it must have current safety and emergency protocols in place. And there is no slacking since it must be re-accredited every three years. These costs are an investment in your safety.

In the United States and Canada, you can look for facilities accredited by agencies, like AAAASF, AAAHC, IMQ, JHACO and Medicare. But if you are going abroad, the rules vary.

It is tempting to fly elsewhere to have surgery performed for a fraction of what it costs in the States, but what you don’t know can hurt you. Even the best surgeon’s skills won’t make up for a facility that doesn’t adhere to sterility standards or that uses old equipment that isn’t regularly maintained.

Would you fly on an airline whose pilots didn’t receive the training to operate the plane in which you’re seated? As in the airline industry, developing countries have limited resources for rigorous training, updated equipment and regular facility inspections. Even if you know friends who have a great experience, the thing to look at is what happens if something goes wrong. Who will be handling the emergency and how? Recent reports of unusual infections and deaths in the Dominican Republic emphasize that your life may depend on the answer.

How much will you pay?

Now you can see why choosing the cheapest surgery can end up being very costly. If you can’t afford to have plastic surgery by the best-trained surgeon in the safest facility, then do yourself a favor and save up, borrow the funds or don’t have surgery at all.

You deserve the best!

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Medical imaging rates continue to rise despite push to reduce them

Despite a broad campaign among physician groups to reduce the amount of imaging in medicine, the rates of use of CT, MRI and other scans have continued to increase in both the U.S. and Ontario, Canada, according to a new study of more than 135 million imaging exams conducted by researchers at UC Davis, UC San Francisco and Kaiser Permanente. A recent reacceleration in the growth of imaging concerns researchers because it is widely believed to be overused.

Imaging rates in the U.S. in adults and children. Imaging rates in the U.S. in adults and children.

The study, published Sept. 3, 2019 in the Journal of the American Medical Association, is the first of its size to determine imaging rates across different populations. It found that although the growth in imaging slowed in the early 2000s, it ticked back up in recent years for computerized tomography (CT) and magnetic resonance imaging (MRI) in most patient age groups. A notable exception was a decline in CT use in children in recent years.

CT scans use ionizing radiation to create images of the inside of the body, and they deliver a radiation dose far higher than a conventional X-ray, while MRIs use magnetic fields and radio waves to create images and do not expose patients to ionizing radiation. The authors noted that the study does not discuss whether the documented imaging use was appropriate or associated with better patient outcomes.

The benefits and harms of medical imaging

“Medical imaging is an important part of health care and contributes to accurate disease diagnosis and treatment, but it also can lead to patient harms such as incidental findings, overdiagnosis, anxiety and radiation exposure that is associated with an increased risk of cancer,” said lead author Rebecca Smith-Bindman, a UCSF professor of radiology, epidemiology and biostatistics, and obstetrics and reproductive medicine and a member of the Philip R. Lee Institute of Health Policy Studies.

Although it is widely believed that imaging rates are declining due to payment and educational efforts that have targeted unnecessary imaging, the authors found a reacceleration in imaging use, with ongoing growth in the use of CT and MRI in adults.

“Like all aspects of medicine, it’s important to make sure imaging is justified, and that the potential benefits are balanced against the potential harms,” said Smith-Bindman. “These potential harms of false positive diagnoses and overdiagnoses can impact everyone who undergoes a test and thus need to be considered when imaging is used.”

Good news on CT scan use in children

Diana Miglioretti, biostatistics professor at UC Davis Department of Public Health Sciences, senior investigator with Kaiser Permanente Washington Health Research Institute and senior author on the study, said there were some hopeful signs among the findings.

Expert studies EEG

“The good news is that rates of CT imaging are starting to come down in children,” Miglioretti said. “However, they’re still far lower in Ontario than in the U.S., suggesting there is additional room for improvement. It’s also important to reduce unnecessary imaging in adults given they are also at risk of radiation-induced cancers.”

The researchers analyzed patterns of medical imaging between 2000 and 2016 among a diverse group of 16-21 million adult and pediatric patients enrolled in seven U.S. health care systems and in the universal, publicly funded health care system in Ontario, Canada. For the U.S. data, they included people receiving care in both fully integrated health care systems such as Kaiser Permanente, and systems with mixed insurance including HMOs and PPOs with fee-for-service plans.

“Our capture of medical imaging utilization across seven U.S. health care systems and Ontario, Canada, over a 16-year period provides one of the most comprehensive assessments to date of imaging in children to older adults in North America,” said Marilyn Kwan, co-author and senior research scientist in the Kaiser Permanente Northern California Division of Research.

Among the findings:

  • Annual growth in CT, MRI and ultrasound were highest in earlier years (2000-2006), but utilization has continued to rise year over year; between 2012 and 2016 there has been 1%-5% annual growth for most age groups and most tests in both the U.S. and Ontario.
  • The one exception was CT use in children, which declined in the U.S. from 2009 -2013 and remained stable since 2013 and declined in Ontario since 2006.
  • Rates of imaging with CT and MRI are higher in the U.S. than in Ontario,  but that gap is closing. For example, among older adults in 2016, there were 51 MRIs per 1,000 patients in the U.S. and 32 per 1000 patients in Ontario.
  • Rates of imaging accelerated after initially dropping in many cases. For example, the rate of growth in CT scans among the elderly was 9.5 percent in 2000-2005, dropped to 0.9 percent in 2006-2011, but then increased to 3 percent annual growth over the last five years.
  • Imaging rates for both adults and children were higher in the mixed model versus fully integrated healthcare systems, but the differences were modest.

National efforts to reduce scanning use not entirely effective

Diana Miglioretti
Diana Miglioretti

The authors note that potential overuse of diagnostic testing has been addressed with the “Choosing Wisely” campaign launched in 2012 by the American Board of Internal Medicine Foundation and endorsed by 85 professional medical societies. The effort urges physicians to talk with their patients about whether an imaging study is necessary, free from harm and supported by evidence. Other initiatives, including by the federal Centers for Medicaid and Medicare Services, have created incentives to discourage overuse of imaging by reducing reimbursement rates for certain scans.

The study authors say their findings suggest that neither the financial incentives nor the campaign to reduce use of medical imaging have been entirely effective.

“Although most physicians are aware that imaging tests are frequently overused, there are not enough evidenced-based guidelines that rely on a careful consideration of the evidence, including information on benefits and harms that can inform their testing decisions,” Smith-Bindman said. “In the absence of balanced evidence, the default decision is to image.”

Co-authors: LH Kushi, MK Theis, EJA Bowles and S. Weinmann of Kaiser Permanente; EC Marlow of UC Davis; SY Cheng of ICES in Toronto, Canada, JR Duncan of Washington University at St. Louis, RT Greenlee of Marshfield Clinic Research Institute, JD Pole of the Pediatric Oncology Group of Ontario, AK Rahm of the Center for Health Research at Geisinger, and NK Stout of the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.

Funding: National Cancer Institute grants (R01CA185687 and R50CA2111150) and ICES, funded by an annual grant from the Ontario Ministry of Health, Long-Term Care.

UC Davis Health is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. For more information, visit health.ucdavis.edu.

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Prestigious scholarship recognizes medical student’s activism, UC Davis’ leadership in reducing health inequities

When medical student Pauline Nguyen was recently awarded one of the most prestigious medical education scholarships in America – the Herbert W. Nickens Medical Student Scholarship – it confirmed that both Nguyen and UC Davis are national leaders in addressing health inequities.

Pauline Nguyen Pauline Nguyen

Nguyen, selected for her leadership role as a social justice activist, is the seventh Nickens scholarship winner at the UC Davis School of Medicine. Among the 154 accredited medical schools across the country, UC Davis now sits at the top of the Nickens recipient list, tied with the medical schools at Stanford University and UCLA.

The Nickens Scholarship is awarded by the Association of American Medical Colleges to just five outstanding medical school students entering their third year. The scholarship, which was established nearly 20 years ago and comes with a $5,000 award, recognizes students for their efforts to eliminate inequities in medical education and health care, as well as their strong desire to address the educational, societal and health care needs of racial and ethnic minorities.

Each medical school can submit one student for consideration for the highly competitive award.

“Pauline personifies the missions of the UC Davis School of Medicine – to end health disparities, spread diversity across health care and make the world a healthier, better place,” said School of Medicine Dean Allison Brashear. “She is making a difference today and I have no doubt she will make even a bigger difference in the communities she will serve during her career as a primary care physician.

“We are enormously proud of Pauline and the hard work she has performed inside and outside the lecture halls to earn this well-deserved scholarship,” Brashear said.

Nguyen aspires to be a primary care physician

Nguyen is in her final year of the school’s three-year medical degree program, Accelerated Competency-based Education in Primary Care (ACE-PC).

She describes herself as “deeply humbled” to be a part of “the amazing group of students and activists who have received this award.”

When she’s not studying or seeing patients at Kaiser Permanente under the guidance of family medicine physician Mark Babo, Nguyen can be found raising awareness for and improving the health of people of color, including victims of police violence.

Nguyen, who proudly says she lacks a “political filter,” has taken active roles with several student run organizations at UC Davis School of Medicine, including White Coats for Black Lives, Code Blue and Southeast Asians in Medicine.

She helped organize the 2018 “die in” on the Sacramento medical school campus, where dozens of students in white coats demanded police accountability and trauma-informed care in under-resourced communities. Their demonstration was in response to the Sacramento Police Department’s fatal shooting of Stephon Clark, a 22-year-old unarmed black man.

She was also instrumental in encouraging 700 students at other medical schools to sign a petition demanding action from elected officials and healthcare institutions.

Nguyen, the daughter of Vietnamese refugees who work in nail salons, was born in Anaheim and aspires to be a primary care provider in Orange County in either family medicine or pediatrics, she says, because of her desire to improve the health of immigrant and refugee communities.

“As a physician, I don’t just want to serve the community,” she said. “I want to be part of the community.”

Influenced to advocate for Vietnamese-Americans

Nguyen studied public health and education during her undergraduate years at UC Berkeley thinking she would become a teacher.

But a job at Asian Health Services, a Federally Qualified Health Center in Oakland’s Chinatown, set her on a course toward medicine.

While working at the clinic, she was inspired by a Vietnamese-American physician who launched an initiative to educate nail salon workers about the health problems associated with their profession. The program, called Healthy Nail Salon Collaborative, alerted workers to the cancer risk from certain chemicals and provided tips on how to reduce back pain, arthritis and respiratory problems.

“I just remember thinking that was so amazing because it really resonated with me,” Nguyen said. “I didn’t know doctors could be activists in politics, current events and social issues.”

She also said she would not be where she is in her education and career without the sacrifices her parents made.

Nguyen’s father graduated second in his high school class in Vietnam and wanted to be a doctor, but he couldn’t afford college. Instead, he got drafted to fight for the South Vietnamese forces supported by the U.S.

When Saigon fell in 1975, the communist government sent her father to a reeducation camp for seven years. After his release, he married and started a family. In 1992, a U.S. program for war refugees allowed the family to immigrate to the United States.

“I always tell people,” Nguyen said, “I’m the product of very resilient and strong survivors.”

A “champion for health equity”

Nguyen was nominated for the Nickens Scholarship by a team of faculty and staff members led by Internal Medicine Professor Jorge Garcia.

“From the humblest of beginnings as the daughter of hardworking Vietnamese immigrants and the first member of her family to attend college in the U.S., Pauline now unassumingly stands as a powerful health care leader,” Garcia said. “She is a burgeoning family physician and champion for health equity, social justice, and diversity and inclusion excellence in medicine and medical education.”

Herbert W. Nickens, whom the scholarship is named after, was the founding vice president of the AAMC’s Division of Community and Minority Programs. He is credited with influencing medical schools across the nation to focus attention on supporting and increasing the numbers of underrepresented and ethnic minorities in medicine.

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Central Valley workplaces can be hostile for minority doctors

Despite the dire need for primary health care providers in California’s Central Valley, workplace discrimination and harassment can cause minority providers to change practices or leave the region entirely. They report experiences with colleagues, staff and administrators ranging from negative comments to vandalism of personal property to loss of professional privileges.

Michelle Ko Michelle Ko

These insights are included in a pilot study published Oct. 23 in JAMA Network Open. The study was led by UC Davis health policy expert Michelle Ko, who now recommends a larger assessment of U.S. workplaces for female, non-white and LGBTQ+ primary care providers in rural and agricultural areas. 

“Workplace discrimination, bias and harassment can happen in any health care setting,” said Ko, a physician and researcher with the UC Davis Department of Public Health Sciences. “But they are an even bigger problem in areas where there are shortages of primary care providers. The providers I talked with believed very strongly in serving their patients, but some felt forced out because they could no longer work in abusive environments.” 

The U.S. overall is facing a shortage of primary care providers, with the greatest shortages in rural and agricultural areas. UC Davis School of Medicine is bridging that gap by recruiting diverse students who are passionate about reducing health inequities and working in medically underserved communities. Based on her research, Ko believes medical educators also must help those students become aware of circumstances they could face once they begin their careers. 

A rare snapshot of diverse physicians’ work experiences 

Ko’s research is unique because of the racial, ethnic, gender and sexual orientation diversity of the participants. Most prior studies focused on the medical practice perspectives of white, male physicians. 

We are hoping to start a conversation throughout the health professions and medical schools about what constitutes acceptable interactions.
— Researcher Michelle Ko

The study included 26 physicians, nurse practitioners and clinic directors working in family medicine, internal medicine or pediatrics in a variety of settings ― from small community practices to large health systems. All were currently working, or had recent experience working, in the Central Valley. 

She conducted in-person and telephone interviews to learn more about their work-related experiences, challenges and coping strategies. The interviews were recorded, transcribed, coded and analyzed for major themes, which included: 

  • Bias, harassment and hostility based on gender, race/ethnicity, sexual orientation or gender identity. One female participant said, “I have kids and a family, so I was always on a blacklist.” 
  • Community and professional isolation due to minority status. LGBTQ+ providers, for instance, were reluctant to disclose their status due to stigma. One participant said, “Primary care providers are terrified about what it would do to their practice.” One Black participant expressed fear that overall discrimination and isolation were negatively impacting his/her children. 
  • Hostile environments and institutional discrimination that could lead to burnout, job change or leaving the region altogether. Two LGBTQ+ participants reported that staff filed formal complaints and hospitals retracted admitting privileges after they came out about their status. One said, “They made it super clear they didn’t want us there.” 

Non-minorities reported no career impact 

Another theme related to study participants who did not identify with a particular minority group. Generally, their personal identities had no impact on their practice experiences. They also were not likely to recognize how minority status impacted the work lives of their colleagues. 

Ko hopes to expand this research to encompass more health care providers and rural and agricultural regions. Her goal is to tell a complete story of provider experiences and see if the initial themes persist. While the current study is small, she says it raises important questions about the experiences of minority providers in underserved communities. 

“We are hoping to start a conversation throughout the health professions and medical schools about what constitutes acceptable interactions,” Ko said. 

Ko’s co-author was former UC Davis student Armin Dorri, now a Ph.D. student at the University of Texas, Austin. The study was funded by the National Institute for Occupational Health and Safety and UC Davis. 

“Primary Care Clinician and Clinic Director Experiences of Professional Bias, Harassment and Discrimination in an Underserved Agricultural Region of California” is available online.

More information about UC Davis Health, including its Department of Public Health Sciences and medical school, is available at health.ucdavis.edu.

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Dean Allison Brashear praises clinical trials program, wants to include more patients

The UC Davis School of Medicine Office of Research held its second Annual Research Expo at Betty Irene Moore School of Nursing on Wednesday, highlighting the facilities and programs available to support researchers’ work.

Allison Brashear, Dean of UC Davis School of Medicine Allison Brashear, Dean of UC Davis School of Medicine

Ted Wun, the Associate Dean for Research at UC Davis Health, presented a summary of the research achievements of the School of Medicine and introduced Allison Brashear, the Dean of the School of Medicine.

“What you do is incredibly important and matters to our patients, their families and our community,” she said. Brashear, who joined UC Davis in July, addressed the dozens of researchers and more than 30 exhibitors. She expressed her amazement with all the exciting research happening at the School of Medicine.

In 2019, she said, the School of Medicine was granted $315 million in funding, a little bit more than a third of all the total UC Davis grant funding.

“That is an incredible amount of funding. Nationally, we are at the top 20% of medical schools in terms of research funding,” she commented.

Brashear, who is a neurologist, praised the stem cell program, the Alzheimer’s Disease Center and the Autism Center of Excellence – calling it the number one center in the country.

“We bring to Northern California innovative health services unique to our region,” she added.

Stem cell research and clinical trials

Dean Brashear spoke of UC Davis’ efforts to find cures to diseases through clinical trials.

“We are strong not just in basic sciences, but we are strong in clinical trials,” she said. “By the end of 2019, there will be 50 stem cell clinical trials at the Alpha Clinic. We are also bringing gene therapy, which translates basic science discoveries into cures for patients.”

Currently, there are more than 5,200 patients enrolled in clinical trials at UC Davis, with more than 200 principal investigators working in over 2,000 active clinical studies.

Brashear-wun-haczku-mohapatra
Ted Wun, Allison Brashear, Angela Haczku and Prasant Mohapatra

“At UC Davis, we put patients first and we strive to bring cures to them,” Brashear said. “My belief is that every single patient should have the opportunity to be involved in clinical trials. We need to be able to offer clinical trials to all patients.”

She also spoke of her memorable experience in visiting the first patient in California who was being infused with the new drug UC Davis helped develop for post-partum depression called Zulresso. “That is taking basic science all the way to the bedside,” she said. “That is what UC Davis is all about.”

Aggie Square

The School of Medicine has substantial research presence on both the Davis and Sacramento campuses. The expo was an opportunity to bring together representatives from both campuses.

Brashear reminded the audience about Aggie Square, the new campus that will be built in Sacramento as an innovation hub that will create educational and economic opportunities in partnership with businesses and community programs. Aggie Square will include state-of-the-art research facilities.

“One message I want you to take back is that Aggie Square is real, and it is going to happen just next door,” she said. “At Aggie Square, researchers will work to find the next cure for the next disease.”

Prasant Mohapatra, Vice Chancellor for Research at UC Davis, highlighted the promising role of Aggie Square.

“There are lots of activities that will be going on in Aggie Square with lots of potential for collaborations,” Mohapatra said.

More than 100 participants, including faculty, students and staff attended the event. They had the opportunity to learn about the various centers and programs through more than 30 exhibitors from Davis and Sacramento.

The Expo included presentations by the Cardiovascular Research Institute (Nipavan Chiamvimonvat), the Center for Precision Medicine (Fred Meyers), the Center for Reducing Health Disparities (Sergio Aguilar-Gaxiola), Clinical and Translational Science Center (Ted Wun), the Eye Center (Paul Fitzgerald) and the Betty Irene Moore School of Nursing (Sheryl Catz). Angela Haczku, Associate Dean for Translational Research for the School of Medicine, moderated the presentations.

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