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Aluri J, Mojtabai R, Strain EC. Examining NSDUH's Assessment of Fentanyl Use: A Comparison of Trends in Fentanyl Use and Fentanyl Overdose Deaths from 2015-2020. J Stud Alcohol Drugs 2024. [PMID: 38563278 DOI: 10.15288/jsad.23-00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The National Survey on Drug Use and Health (NSDUH), as the primary source of epidemiological substance use data in the US, could illuminate trends in fentanyl use behaviors contributing to the opioid overdose crisis. We hypothesized that the trend in NSDUH prevalence of lifetime fentanyl injection would match the direction and magnitude of the trend in synthetic opioid overdose deaths. METHOD Using logistic regression, we modeled the 2015-2020 trend in synthetic opioid overdose deaths as a proportion of all deaths. We modeled contemporary trends from cross-sectional NSDUH data for (1) lifetime fentanyl injection, (2) past year prescription fentanyl (PF) misuse, (3) prescription tramadol misuse (the other synthetic opioid counted alongside fentanyl in the overdose deaths category), and (4) combined prescription fentanyl or tramadol misuse. Average annual NSDUH weighted sample size was 272,519,038 (51.5% female, 48.5% male). RESULTS Synthetic opioid overdose deaths increased from 2015-2020 (OR 3.39, meaning the odds of a death being from synthetic opioid overdose in 2020 were 3.39 times the odds of death from that cause in 2015, 95% CI: 3.34, 3.44). None of the substance use trends significantly increased. CONCLUSION Per NSDUH data, the prevalence of fentanyl misuse did not significantly increase in tandem with synthetic opioid overdose deaths from 2015 to 2020. Scrutiny of NSDUH's approach to assessing fentanyl misuse casts doubt on the utility of NSDUH fentanyl data collection. We acknowledge recent changes to the survey and recommend two further changes to optimize a vital source of data on behaviors related to the opioid overdose crisis.
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Affiliation(s)
- James Aluri
- Postdoctoral Fellow, Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St., Meyer 3-181c, Baltimore, MD 21287
| | - Ramin Mojtabai
- Professor, Johns Hopkins School of Public Health, 624 N. Broadway, Room 797, Baltimore, MD 21205
| | - Eric C Strain
- The George E. Bigelow Professor, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Aluri J, Ker J, Marr B, Kagan H, Stouffer K, Yenawine P, Kelly-Hedrick M, Chisolm MS. The role of arts-based curricula in professional identity formation: results of a qualitative analysis of learner's written reflections. Med Educ Online 2023; 28:2145105. [PMID: 36373894 PMCID: PMC9668275 DOI: 10.1080/10872981.2022.2145105] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Professional identity formation is an important aspect of medical education that can be difficult to translate into formal curricula. The role of arts and humanities programs in fostering professional identity formation remains understudied. Analyzing learners' written reflections, we explore the relationship between an arts-based course and themes of professional identity formation. MATERIALS AND METHODS Two cohorts of learners participated in a 5-day online course featuring visual arts-based group activities. Both cohorts responded to a prompt with written reflections at the beginning and end of the course. Using a thematic analysis method, we qualitatively analyzed one set of reflections from each cohort. RESULTS Themes included the nature of the good life; fulfilling, purposeful work; entering the physician role; exploration of emotional experience; and personal growth. Reflections written at the end of the course engaged significantly with art - including literature, poetry, lyrics, and film. One student disclosed a mental illness in their reflection. CONCLUSIONS Our qualitative analysis of reflections written during a visual arts-based course found several themes related to professional identity formation. Such arts-based courses can also enrich learners' reflections and provide a space for learners to be vulnerable. PRACTICE POINTS (five short bullets conveying the main points) Arts-based courses can support learners' professional identity formationReflection themes related to professional identity formation included entering the physician role, fulfilling clinical work, and personal growthAt the end of the course, learners' reflections included significant engagement with artReflective writing in small, arts-based learning communities can provide space for learners to be vulnerableThe Role of Arts-Based Curricula in Professional Identity Formation: Results of A Qualitative Analysis of Learner's Written Reflections.
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Affiliation(s)
- James Aluri
- Department of Psychiatry and Behavioral Sciences University School of Medicine, University Mental Health, Baltimore, Maryland, USA
| | - Joyce Ker
- Department of Medicine, Science, Humanities at Johns Hopkins University in Baltimore, Baltimore, Maryland, USA
| | - Bonnie Marr
- Section of Palliative Medicine Division of General Internal Medicine Johns Hopkins University in Baltimore, Baltimore, Maryland, USA
| | - Heather Kagan
- Department of Medicine at Memorial Sloan Kettering Cancer Center with a Secondary Appointment as an Instructor at Weill Cornell College of Medicine Maryland, USA
| | | | - Philip Yenawine
- Visual Thinking Strategies and an Independent Writer and Educator, Baltimore, Maryland, USA
| | | | - Margaret S. Chisolm
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Johns Hopkins University in Baltimore, Baltimore, Maryland, USA
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3
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Aluri J, Goodman D, Antshel K, Mojtabai R. Variation in ADHD Treatment by Mental Health Care Setting Among US College Students from 2019 to 2022. J Atten Disord 2023; 27:1411-1419. [PMID: 37309136 DOI: 10.1177/10870547231178310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess whether prevalence of treatment for ADHD varies by location of mental healthcare among US college students aged 18 to 25 with professionally diagnosed ADHD. METHOD Our analysis uses cross-sectional data from the National College Health Assessment (NCHA) and evaluated the relationship between types of care received and location of mental health services received in the past year (dichotomized into "use of any on-campus services" and "use of off-campus services only"). We generated unadjusted and adjusted logistic regression models of each type of treatment. RESULTS Students who reported receiving mental healthcare on campus were less likely to receive any medication (aOR 0.66, 95% CI [0.60, 0.72]), any therapy (aOR 0.82, 95% CI [0.75, 0.89]), and any medication or therapy for ADHD (aOR 0.63, 95% CI [0.57, 0.70]). CONCLUSION Future research should evaluate the causes of lower prevalence of ADHD treatment among students receiving mental healthcare from campus-based clinics.
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Affiliation(s)
- James Aluri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Goodman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- State University of New York, USA
| | | | - Ramin Mojtabai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Public Health, Baltimore, MD, USA
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Aluri J, Haddad JM, Parke S, Schwartz V, Joshi SV, Menon M, Conrad RC. Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies. Curr Psychiatry Rep 2023; 25:345-356. [PMID: 37470928 DOI: 10.1007/s11920-023-01431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures. RECENT FINDINGS Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.
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Affiliation(s)
- James Aluri
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 600 N. Wolfe St., Meyer 3-181c, 21287, Baltimore, MD, USA.
| | - Jessi M Haddad
- Child and Adolescent Psychiatry, New York-Presbyterian Hospital Columbia and Cornell, New York City, NY, USA
| | - Susan Parke
- Div. of Law & Psychiatry, Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA
- Medical Director, Community Forensic Services, Connecticut Mental Health Center, New Haven, USA
| | - Victor Schwartz
- Wellness and Student Life, CUNY School of Medicine, New York, USA
| | - Shashank V Joshi
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, Stanford, USA
| | - Meera Menon
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, USA
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Aluri J, Lewis S, Torres M, Wilcox HC. A suicide prevention initiative across a multi-campus university before and during the COVID-19 pandemic. J Am Coll Health 2022:1-5. [PMID: 35623055 DOI: 10.1080/07448481.2022.2076563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Increasing rates of depression, anxiety, substance use, and suicidal thoughts and behaviors among college students were exacerbated by the COVID-19 pandemic. This report describes how components of the Johns Hopkins Suicide Prevention Awareness, Response and Coordination (JH-SPARC) Project aligned with a multi-faceted strategy for suicide prevention. Key programs included suicide screening, gatekeeper trainings, and the use of third-party mental health services. Regarding suicide screening outcomes, staff sent 36,148 individual emails inviting students and trainees to participate in stress and depression screening. This approach garnered 2,634 responses and connected 130 students to care, 66 of whom (50.8%) indicated suicidal thoughts, plans, or behaviors. We estimate this screening cost $2.97 per student. Important lessons included the reliance on virtual platforms and the need to coordinate efforts across multiple campuses. Our manuscript provides an example of a transferable strategy for suicide prevention on college campuses in the pandemic era.
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Affiliation(s)
- James Aluri
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susanna Lewis
- Johns Hopkins University Counseling Center, Baltimore, Maryland, USA
| | - Matthew Torres
- Executive Director of the Counseling Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Aluri J, Moran D, Kironji AG, Carroll B, Cox J, Chen CCG, DeCamp M. The ethical experiences of trainees on short-term international trips: a systematic qualitative synthesis. BMC Med Educ 2018; 18:324. [PMID: 30594168 PMCID: PMC6310968 DOI: 10.1186/s12909-018-1424-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/05/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical student and resident participation in short-term international trips for trainees (STINTTs) has increased in the past few decades. However, there has been no systematic review of trainees' actual ethical experiences. The authors sought to identify what ethical issues medical trainees encounter during STINTTs, as elicited by and reported in peer-reviewed, quantitative and qualitative research papers. METHODS The authors systematically searched five academic databases finding 659 unique titles and abstracts. The authors applied inclusion and exclusion criteria to these titles and abstracts resulting in fourteen papers, which were analyzed using qualitative thematic synthesis. RESULTS The qualitative analysis of the papers generated four themes: (1) Trainees' Concerns Over Perpetuating Medical Tourism; (2) Struggling to Identify and Balance the Benefits and Harms of STINTTs; (3) The Complicated Trainee Mens (mind); and (4) Ethical Situations Encountered by Trainees. The fourth theme, which was the largest, was further divided into (a) Navigating social and cultural dynamics, (b) Trainees' experiences related to the learner role, and (c) Ethical situations not qualifying for other catagories. Some of these issues reported in the empirical research papers are well represented in the broader literature on STINTTs, while others were less so-such as mistreatment of trainees. All included papers were published after 2010, and comprised a total of less than 170 medical trainees. CONCLUSIONS Medical trainees report experiencing a wide range of ethical challenges during short-term international trips in which they engage in clinical or research activities. The authors call educators' attention to specific challenges that trainees face. The relevant literature covering US and Canadian STINTTs is relatively young and largely qualitative. The authors briefly sketch a program for expanding the research on this increasingly common educational experience.
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Affiliation(s)
- James Aluri
- Department of Psychiatry, Johns Hopkins Hospital, Meyer 4-181, 600 N. Wolfe Street, Baltimore, MD 21287-7381 USA
| | - Dane Moran
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas USA
| | - Antony G. Kironji
- Department of Emergency Medicine, Boston University Medical Campus, Boston, Massachusetts USA
| | - Bryn Carroll
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Jacob Cox
- Department of Medicine, Newton-Wellesley Hospital, Boston, MA USA
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA USA
| | | | - Matthew DeCamp
- Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Kironji AG, Cox JT, Edwardson J, Moran D, Aluri J, Carroll B, Chen CCG. Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness. Ann Glob Health 2018. [PMID: 30779518 PMCID: PMC6748281 DOI: 10.29024/aogh.2378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. Objectives: The primary aim was to identify characteristics of pre-departure training associated with participants’ reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students’ preferred subjects of study and teaching modalities for pre-departure training. Methods: A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students’ preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). Conclusions: Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students’ preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible “buy-in” effect.
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Affiliation(s)
| | - Jacob T Cox
- Johns Hopkins School of Medicine, Baltimore, MD, US
| | - Jill Edwardson
- Department of Gynecology and Obstetrics, John Hopkins School of Medicine, Baltimore, MD, US
| | - Dane Moran
- John Hopkins School of Medicine, Baltimore, MD, US
| | - James Aluri
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Bryn Carroll
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, US
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Kironji AG, Cox JT, Edwardson J, Moran D, Aluri J, Carroll B, Chen CCG. Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness. Ann Glob Health 2018; 84:683-691. [PMID: 30779518 DOI: 10.9204/aogh.2378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. OBJECTIVES The primary aim was to identify characteristics of pre-departure training associated with participants' reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students' preferred subjects of study and teaching modalities for pre-departure training. METHODS A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students' preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). CONCLUSIONS Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students' preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible "buy-in" effect.
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Affiliation(s)
| | - Jacob T Cox
- Johns Hopkins School of Medicine, Baltimore, MD, US
| | - Jill Edwardson
- Department of Gynecology and Obstetrics, John Hopkins School of Medicine, Baltimore, MD, US
| | - Dane Moran
- John Hopkins School of Medicine, Baltimore, MD, US
| | - James Aluri
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Bryn Carroll
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, US
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Aluri J. How was hidden-curriculum teaching enhanced? A question to Zhang et al. Med Teach 2018; 40:107. [PMID: 28990849 DOI: 10.1080/0142159x.2017.1385752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- James Aluri
- a School of Medicine , Johns Hopkins University , Baltimore , MD , USA
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Cox JT, Kironji AG, Edwardson J, Moran D, Aluri J, Carroll B, Warren N, Chen CCG. Global Health Career Interest among Medical and Nursing Students: Survey and Analysis. Ann Glob Health 2017; 83:588-595. [PMID: 29221533 DOI: 10.1016/j.aogh.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Global health experiences undertaken in international settings (GHEs) are becoming an increasingly prevalent aspect of health professions education and, as such, merit comprehensive analysis of the impact they have on students and host communities. OBJECTIVE To assess the associations between demographic/experiential factors and the interest of health professions students in careers involving global health. METHODS A cross-sectional survey was administered online to a convenience sample of medical and nursing students at Johns Hopkins University. Questions addressed level of interest in a global health career, prior GHEs, and demographic information. Items were either Likert scale or multiple choice. Various regression analyses were performed. FINDINGS Of 510 respondents, 312 (61.2%) expressed interest in a global health career and 285 (55.9%) had prior GHEs. Multivariate logistic regression found female sex, age ≥27 years, household income <$100,000/y, and a prior research-related GHE independently associated with higher interest in global health careers. On subset analysis of participants with one or more prior GHEs: age ≥27 years, household income <$100,000/y, a prior research-related GHE, and having multiple GHEs were each independently associated with increased interest in a global health career. CONCLUSIONS Simply participating in a global health experience abroad is not significantly associated with interest in a global health career. However, sex, age, household income, and research-related GHEs are significantly associated with global health career interest. These findings may inform the development of global health programs at medical and nursing schools and can guide efforts to increase the number of health care professionals entering global health careers.
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Affiliation(s)
- Jacob T Cox
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jill Edwardson
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD
| | - Dane Moran
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - James Aluri
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryn Carroll
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Baltimore, MD
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Aluri J. The Strong But Incomplete Relationship Between Medical Virtue and Healing/Relieving of Suffering. Fam Med 2017; 49:69. [PMID: 28166588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Molloy M, McGuire M, Aluri J, Mu W, Bodurtha J. Teaching the “Family History” Through Group Reflection. MedEdPublish 2016. [DOI: 10.15694/mep.2016.000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. Background: Family health history (FH) is a useful tool for assessing health risk and improving communication among family members, but remains underutilized in primary care practice. The goals of this study were to assess the utility of a content-driven group reflection on family history on student learning, and to equip them with tools to improve their skills in FH assessment. Methods: A 90-minute pilot Family History and Communication Reflection module was developed and made available to first and second-year medical students completing a longitudinal ambulatory clerkship; a group reflection model was used. 16 students (13% of the first year class) participated and 8 students completed the evaluation form. Results: The majority of students were satisfied with the module, would recommend the module to another student, and felt prepared or very prepared to incorporate FH assessment tools into their clinical practice. Conclusions: The pilot FH module was well-received by first-year medical students as a strategy for emphasizing the importance of assessing FH in a busy primary care setting and providing practical tools for FH. The reflective learning approach was cited as helpful for using and building upon prior clerkship experience.
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Aluri J, Carroll B, Kironji A, Edwardson J, Chen C. The ethic experiences and preparation of medical trainees participating
in short-term, international educational programs: a systematic review of
the literature. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cox J, Kironji A, Edwardson J, Moran D, Aluri J, Carroll B, Warren N, Chen C. Factors that increase medical and nursing students’ interest in global
health. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kironji AG, Cox JT, Edwardson J, Aluri J, Carroll B, Moran D, Warren N, Grace Chen CC. Factors related to preparedness of participants engaging in global health
experiences. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Edwardson J, Owens L, Moran D, Aluri J, Kironji A, Chen CCG. Pre-departure preparation for international clinical work: a handbook. Int Urogynecol J 2015; 26:1111-3. [PMID: 25994626 DOI: 10.1007/s00192-015-2682-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/08/2015] [Indexed: 11/24/2022]
Abstract
International clinical experiences are increasingly popular among medical students, residents, fellows, and practitioners. Adequate pre-departure training is an integral part of a meaningful, productive, and safe international experience. At Johns Hopkins University School of Medicine, we have developed a pre-departure handbook to assist practitioners in preparing for global health work. The handbook draws from current global health education literature, existing handbooks, and expert experiences, and includes information about logistical and cultural preparations. While a pre-departure handbook cannot serve as a substitute for a comprehensive pre-departure training program, it can be a useful introduction to the pre-departure process.
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Moran D, Edwardson J, Cuneo CN, Tackett S, Aluri J, Kironji A, Cox J, Carroll B, Lie E, Fofana M, Bollinger RC, Ziegelstein RC, Chen CCG. Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative. Med Educ Online 2015; 20:28632. [PMID: 26220909 PMCID: PMC4518163 DOI: 10.3402/meo.v20.28632] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 07/02/2015] [Indexed: 05/21/2023]
Abstract
Global health is increasingly present in the formal educational curricula of medical schools across North America. In 2008, students at Johns Hopkins University School of Medicine (JHUSOM) perceived a lack of structured global health education in the existing curriculum and began working with the administration to enhance global health learning opportunities, particularly in resource-poor settings. Key events in the development of global health education have included the introduction of a global health intersession mandatory for all first-year students; required pre-departure ethics training for students before all international electives; and the development of a clinical global health elective (Global Health Leadership Program, GHLP). The main challenges to improving global health education for medical students have included securing funding, obtaining institutional support, and developing an interprofessional program that benefits from the resources of the Schools of Medicine, Public Health, and Nursing. Strategies used included objectively demonstrating the need for and barriers to more structured global health experiences; obtaining guidance and modifying existing resources from other institutions and relevant educational websites; and harnessing institution-specific strengths including the large Johns Hopkins global research footprint and existing interprofessional collaborations across the three schools. The Johns Hopkins experience demonstrates that with a supportive administration, students can play an important and effective role in improving global health educational opportunities. The strategies we used may be informative for other students and educators looking to implement global health programs at their own institutions.
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Affiliation(s)
- Dane Moran
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill Edwardson
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Nicholas Cuneo
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean Tackett
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Aluri
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antony Kironji
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacob Cox
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bryn Carroll
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erina Lie
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariam Fofana
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert C Bollinger
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roy C Ziegelstein
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi C G Chen
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;
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Kironji A, Aluri J, Decamp M, Carroll B, Cox J, Fofana M, Lie E, Moran D, Tackett S, Chen C. Gaps in predeparture training and postexperience debriefing in global
health experiences: A survey of health professions students. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Shumaker R, Aluri J, Fan J, Martinez G, Thompson G, Ren M. 119 Effect of Ketoconazole Coadministration On Lenvatinib (E7080) Exposure in Healthy Volunteers. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71917-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ryan DP, Eder JP, Appleman L, Fidias P, Johnson B, Lucca J, Aluri J, Owa T, Renshaw FG, Shapiro G. A phase I study of E7070, a chloroindolyl-sulfonamide, in combination with irinotecan in gastrointestinal and thoracic carcinomas. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. P. Ryan
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - J. P. Eder
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - L. Appleman
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - P. Fidias
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - B. Johnson
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - J. Lucca
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - J. Aluri
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - T. Owa
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - F. G. Renshaw
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
| | - G. Shapiro
- Dana-Farber Cancer Inst, Boston, MA; Eisai Medcl Research, Ridgefield Park, NJ; Eisai Tsukabu, Tokoyo, Japan
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Cox D, Aluri J, Minthorn E, Holdbrook F, Parchman L, Fossler M. Pharmacokinetics (PK) and Pharmacodynamics (PD) of Argatroban in Combination With A GP IIB/IIIA Antagonist in Patients Undergoing Percutaneous Coronary Intervention (PCI). Clin Pharmacol Ther 2003. [DOI: 10.1016/s0009-9236(03)90474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mould D, Chapelsky M, Aluri J, Swagzdis J, Samuels R, Granett J. A population pharmacokinetic-pharmacodynamic and logistic regression analysis of lotrafiban in patients. Clin Pharmacol Ther 2001; 69:210-22. [PMID: 11309549 DOI: 10.1067/mcp.2001.114925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our objective was to assess the safety, tolerability, pharmacokinetics, and pharmacodynamics of lotrafiban, an oral glycoprotein IIb/IIIa inhibitor, in patients with a recent myocardial infarction, unstable angina, transient ischemic attack, or stroke. METHODS A 12-week, double-blind, multi-center, placebo-controlled, parallel-group, phase II study of lotrafiban (the Anti-platelet Useful Dose Study) was conducted in patients. Lotrafiban or placebo was administered as a twice daily oral dose at four dose levels (5-100 mg) for 12 weeks with daily doses of aspirin (300-325 mg). The pharmacokinetics of lotrafiban were characterized with the use of a population approach and were described by a two-compartment model with first order absorption and first order elimination. The pharmacodynamic data, ex vivo platelet aggregation, were described with the use of a direct effect inhibitory sigmoidal model with a baseline. The relationship between the severity of bleeding episodes and predicted steady-state lotrafiban exposure was characterized by logistic regression. RESULTS Pharmacokinetic analysis showed that increasing age and decreasing creatinine clearance resulted in increased exposure to lotrafiban. The concentration-effect relationship was steep, with near complete inhibition of platelet aggregation at lotrafiban concentrations in excess of 20 ng/mL. Logistic regression showed that at exposures that exceeded approximately 835 ng. h/mL, the severity of adverse bleeding events increased considerably; this suggested that dosing recommendations should be generated to minimize the likelihood of patients having an area under the plasma concentration-time curve from 0 to 24 hours in excess of this value. CONCLUSIONS Patients whose age exceeded 65 years or whose creatinine clearance was less than 60 mL/min should be given a lower dose of lotrafiban than younger patients with good renal function.
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Affiliation(s)
- D Mould
- Center for Drug Development Science, Department of Pharmacology, Georgetown University Medical Center, Washington DC 20007, USA
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Pade V, Aluri J, Manning L, Stavchansky S. Bioavailability of pseudoephedrine from controlled release formulations in the presence of guaifenesin in human volunteers. Biopharm Drug Dispos 1995; 16:381-91. [PMID: 8527687 DOI: 10.1002/bdd.2510160503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A multiple-dose bioequivalence study with six healthy human volunteers was conducted. The bioavailability of an experimental controlled release tablet containing pseudoephedrine was compared with a marketed controlled release pseudoephedrine capsule in a three-way crossover study. Plasma samples, collected serially after oral drug administration, were analyzed for pseudoephedrine content using a specific HPLC method with UV detection. The bioavailability parameters, area under the concentration-time curve (AUC), maximum plasma concentration Cmax, and time to peak (Tmax) were obtained from the plasma concentration-time data. Additionally, model independent pharmacokinetic parameters were estimated. Analysis of variance of the data revealed no statistically significant differences between the test and the reference formulation. The presence of guaifenesin in the sustained release tablet did not influence pseudoephedrine bioavailability. The relative bioavailability of the tablet dosage form with respect to the capsule was found to be 100.8%. Classical and Westlake 95% confidence limits as well as the two one-sided t test, proposed by Schuirmann, and the Anderson-Hauck power analysis supported the inference that the two formulations demonstrated comparable bioavailabilty, even in the presence of guaifenesin. Using a non-linear regression program, it was found that the pharmacokinetics of pseudoephedrine followed a simple one-compartment disposition model with no lag time. Additionally, an in vitro-in vivo correlation, based on the estimation of cumulative relative fraction absorbed, was developed between the absorption of pseudoephedrine in humans and the in vitro dissolution time.
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Affiliation(s)
- V Pade
- University of Texas at Austin, College of Pharmacy 78712, USA
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