Ruhdja Lindhorst  

Home Institution
Charité Universitätsmedizin Berlin

Host Institution(s)
New York University Medical School, New York
Department of Pain Research
Mentor: Michel Y. Dubois, M.D.

E-Mail: ruhdja@gmx.de
Research Topic
see Abstract
Personal Reactions to the U.S. Experience
New York is an amazing city: crowds of people from all over the world. Going to different parts of the city is like traveling to Russia, China, etc. Everybody likes it; me, too!
Sometimes you ask yourself why ethnic groups stick together and why there is no mixture of them in some areas. Somebody told me the U.S. is a tough environment to live in when you first arrive, not having much cash or good connections. Therefore, you need the support of your ethnic community. That might be part of it. It is astonishing. I can not imagine Germans staying that calm, having something like a Chinatown in the middle of a German city.
Handling the stress of dozens of new inputs almost every day made me very tired in the beginning. Not having a routine way of living is exciting and exhausting at the same time.
NYC is a very expensive place to be, and, although I like this city, the social gap takes away some of the beauty of NYC. Many people have to work two jobs, and I ask myself, "When do they have time for living?" Not nice.
The President: Almost no one here seems to like him. There have been a couple of demonstrations against him in NYC. Everybody knows that you have to pay for university in the U.S. I met 3 students who have loans over $200.000. That means that they are under enormous economic pressure, starting their young careers with this load upon their shoulders. One advantage of the private universities is that they have a lot of money for good scholarships to pay for tuition.
I was impressed that Columbia University had invited Slavoj Zizek (psychoanalyst and philosopher from Eastern Europe) for a year to teach there. There was a movie about him in the cinemas here. It was a very good one.
Greatest Difficulties Encountered
Is there a country even more bureaucratic than Germany? I found one: the U.S. Whatever you want to do, there is a form for a form to be filled in, and tons of letters of proof have to be added.
I thought I would know how it feels to be abroad from my last U.S. experience, when I was in school, but being abroad as a grown-up is completely different. In the past experience, everything was set for me, but this time I had to organize all the requirements of a modern life at once (bank account, renting a room, cell-phone contract, Social Security number, immigration clearance, E-Tutorials.)
My work environment has been very supportive and nice, with rare exceptions.
I was finally able to get an NYU-housing sublet, and I lived across the street from the hospital. This is very convenient, after moving 3 times.
After the first couple months, I realized that my clinical trial would not work well, and it took great effort to get together all of the professors involved in the project, to think about improvements, and finally to do the paperwork to submit the changes to the IRB. Waiting for the approval was hard, too. Concerning my PJ: Although my Professor said: "Don't worry," he was not aware of the meaning of it. I had to apply for it officially, and the process involved NY-State, and many forms had to be filled out and time was running out.
Most humorous incident
Friends just arrived from Germany were surprised that everybody would say "You are welcome", to them, and wondered how these people would know that they are new in the city. The answer was that saying "You are welcome", as a reply to "Thank you", doesn't mean welcoming you as a stranger, as my friends thought.
Helpful Hints for Future Students
  • Make friends with the administrative people in your environment. You may need their help.
  • Keep in mind what is important for you and what the requirements are, to enable you to go for it. Don't rely on others setting up everything for you. They may not know exactly what you need. Use gentle (!) pressure to make things work.
  • There is free admission at the Guggenheim Museum and the Museum of Modern Art on Friday afternoons.
  • ENJOY YOUR STAY!
  • www.tagesschau.de to be updated about the news in Germany!

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Abstract on Research Topic
The use of biofeedback in the management of acute post-operative pain
Purpose:
While opioid therapy in the post-operative period is considered to be the standard of care, it continues to have many drawbacks, including: nausea, vomiting, respiratory depression, constipation, itching, and in some circumstances, insufficient pain relief. Empirically based psycho-physiologic pain management interventions are needed. One of the most promising interventions is biofeedback. Biofeedback may reduce anxiety and overall pain scores, while decreasing opioid consumption.

Study Design:
The study design is prospective and randomized. The study population is 60 adults scheduled for abdominal procedures that require post-operative pain control.
After appropriate screening, the patients will be allocated into two groups, according to a predetermined random sequence.
Half of the patients will have a biofeedback tool brought to their bedside the morning of the day after surgery. There will be a demonstration of how to use the program, which has game participants use deep breathing and relaxation techniques as an integral part of the game. The patient will then be instructed to play through the different scenarios (the biofeedback device is set-up as a game with different tasks to complete by measuring heart rate, heart rate variability and skin conductance levels (SCL) for as long as they desire. While they can practice the biofeedback as long as they want, they are encouraged to complete at least 1 hour of biofeedback during the 24 hours observation while they are in the hospital. The biofeedback sessions will start the next morning after surgery and end 24 hours later. The sessions are directed by the device itself and need not be supervised by a proctor. At the completion of each biofeedback session the patients are requested to log the amount of time they played the game.
The other half will not receive the biofeedback device but will receive standard post-operative care, as determined by the surgical service.
For both groups, investigators will record the amount of analgesia required in the postoperative period during each day the patient is in the hospital, patients’ pain scores, as well as information such as patient demographics (age, gender, race, level of education) and hospital length of stay. A Spielberg-anxiety questionnaire will be implemented at the beginning and the end of the observation period. If applicable, total amount of time spent participating in biofeedback will recorded.
Patients in both groups will be instructed to ask the nurses for the pain medication that was prescribed to them as needed, as they normally would, after a surgery of this nature. During the first day until the morning of the second day after surgery, all patients will be assessed four times in terms of their overall pain score (0-10), as well as pain medication consumption and side effects of pain medications by a member of our research staff. At the end of the study, each patient will also complete a questionnaire assessing their overall satisfaction with their pain control during the post-operative period and, if applicable, questions regarding their experience with the biofeedback device.